Author: WorkCompAcademy

The Sacramento Bee reports that the four largest hospital groups in the Sacramento area are all beginning new construction projects to rebuild old facilities, meet state earthquake safety requirements and add new hospital beds to accommodate a projected population increase.

UC-Davis Health System, Sutter Health, Catholic Healthcare West (Now Dignity Health) and Kaiser Permanente are undergoing construction projects that will add a combined 3.5 million square feet to their facilities and cost about $2.6 billion. The projects are expected to add as many as 2,000 health care jobs by 2013 and already have created a boom in construction employment..

UC Davis Health is planning a new medical outpost in Folsom Ranch, a new tower at UC Davis Medical Center in Sacramento, and just south of that, is part of the Aggie Square research/education project coming out of the ground.

UC Davis Health has purchased a 34.5-acre parcel, at the intersection of East Bidwell Street and Highway 50, in Folsom Ranch. This property expands UC Davis Health’s care in Folsom and offers a prime location for the region to deliver wellness, community, convenience and excellent care for patients. Initial plans call for an outpatient medical office building and, in the future, a micro-hospital, an ambulatory surgery center and a hotel.

The California Tower will be added to the eastern side of the existing UC Davis Medical Center. It will feature a 14-story hospital tower and five-story pavilion, adding to a hospital complex that has been expanding eastward and serving the neighborhoods at this location for over 150 years.

The project is envisioned to comprise a minimum of 332 inpatient beds including ICU and medical/surgical, Acuity Adaptable (ICU capable rooms), complex procedure rooms, and imaging and support services. The building option under consideration is approximately 909,000 gross square feet of new space.

Located on the UC Davis Sacramento campus, Aggie Square will house business partners and community-based programs together with UC Davis innovation and research.The first phase of Aggie Square features state-of-the-art research facilities, modern office and mixed-use space and world-class amenities. The result will be a unique live/learn/work/play environment that values inclusion, advances human health, enriches lifelong learning, develops emerging technologies, and sets the stage for creative collaborations.

An 85,000-square-foot building to house the new residency program at Sutter Roseville Medical Center is expected to open in 2024. It features a new three-story building located right outside the current emergency department.

Dignity Health announced its plans to build a new Medical Office Building south of Highway 50 in the new development known as Folsom Ranch. The new MOB will house a host of specialty services as well as an outpatient surgery center. The new facility is at Mercy and McCarthy Way, in the heart of the new Folsom Ranch neighborhood.

The Folsom announcement comes on the heels of Dignity Health’s unveiling of plans to build a new full service hospital in neighboring Elk Grove. City entitlements and environmental approvals are already complete for the future medical campus, and work continues in advance of the groundbreaking and construction at Wymark Road and Elk Grove Boulevard.

Kaiser Permanente’s Railyards project is part of the health care construction boom. It will include an 18-acre Kaiser Permanente Hospital and Medical campus; a Historic Central Shops District; a Major League Soccer Stadium; 5-million square feet of modern innovative office space, half a million square feet of retail space; thousands of urban high-density residential units; cultural and entertainment amenities like a museum and hotels; 30-acres of green open space and parks; and a multi-modal transportation hub.

Scott Seamons, regional vice president for the Northern California Hospital Council, said none of the projects is excessive, needlessly duplicative or unsustainable over the long term.

However, Maribeth Shannon of the California HealthCare Foundation added that large cuts in reimbursement rates from federal and state health insurance programs could make it hard for the hospitals to justify these new investments.

McLaren Macomb operates a hospital in Mt. Clemens, Michigan, where it employs approximately 2300 employees. After an election on August 28, 2019, the Board certified Local 40 RN Staff Council, Office of Professional Employees International Union (OPEIU), AFL-CIO (Union) as the exclusive collective-bargaining representative of a unit of approximately 350 of its service employees.

Following the onset of the Coronavirus Disease 2019 (Covid-19) pandemic in March 2020,the government issued regulations prohibiting McLaren Macomb from performing elective and out-patient procedures and from allowing nonessential employees to work inside the hospital.

McLaren Macomb then terminated its outpatient services, admitted only trauma, emergency, and Covid-19 patients, and temporarily furloughed 11 bargaining unit employees because they were deemed nonessential employees.

In June, McLaren Macomb permanently furloughed those 11 employees and contemporaneously presented each of them with a “Severance Agreement, Waiver and Release” that offered to pay differing severance amounts to each furloughed employee if they signed the agreement. All 11 employees signed the agreement.

The agreement required the subject employee to release McLaren Macomb from any claims arising out of their employment or termination of employment. The agreement further contained provisions broadly prohibiting disparagement of McLaren Macomb and requiring confidentiality about the terms of the agreement.

And Administrative Law Judge found that McLaren Macomb violated Section 8(a)(5) and (1) of the National Labor Relations Act (NLRA) by permanently furloughing the 11 employees without first notifying the Union and giving it an opportunity to bargain about the furlough decision and its effects, and by directly dealing with the 11 employees while entirely bypassing and excluding the Union.

However, he found no violation of the Act as a result of the nondisparagement and confidentiality provisions of the severance agreement relying on Baylor University Medical Center 369 NLRB No. 43 (2020). and IGT d/b/a International Game Technology 370 NLRB No. 50 (2020) which reversed a long-settled precedent that provisions in a severance agreement proffered to employees have a reasonable tendency to interfere with, restrain, or coerce the exercise of employee rights under Section 7 of the Act and are thus unlawful..

The National Labor Relations Board issued a decision in McLaren Macomb, 372 NLRB No. 58, returning to longstanding precedent by holding that employers may not offer employees severance agreements that require employees to broadly waive their rights under the National Labor Relations Act.

The decision reverses the previous Board’s decisions in Baylor University Medical Center and IGT d/b/a International Game Technology, issued in 2020, which abandoned prior precedent in finding that offering similar severance agreements to employees was not unlawful, by itself.

The new February 2023 decision, in contrast, explains that simply offering employees a severance agreement that requires them to broadly give up their rights under Section 7 of the Act violates Section 8(a)(1) of the Act. The Board observed that the employer’s offer is itself an attempt to deter employees from exercising their statutory rights, at a time when employees may feel they must give up their rights in order to get the benefits provided in the agreement.

Thus, such clauses must be carefully drafted and narrowly tailored to mitigate the issues addressed by the Board in this case.

“It’s long been understood by the Board and the courts that employers cannot ask individual employees to choose between receiving benefits and exercising their rights under the National Labor Relations Act. Today’s decision upholds this important principle and restores longstanding precedent,” said Chairman Lauren McFerran.

Members Wilcox and Prouty joined Chairman McFerran in issuing the decision. Member Kaplan dissented stating “extent law is sufficient to resolve this matter, my colleagues take this opportunity, not raised by the General Counsel until her Brief in Support of Exceptions to the Board, to address circumstances not present in this case and overrule the sound law of Baylor and IGT. On this aspect of their decision, I dissent.”

The Workers’ Compensation Insurance Rating Bureau of California (WCIRB) has released the next report in its Industry Profile series. This series examines an industry sector in California’s workers’ compensation system and provides insights into key characteristics and cost drivers in the industry. The latest report gives a comprehensive overview of the healthcare industry in California.

The healthcare industry is a significant and growing part of California’s economy and one of the largest sectors in the workers’ compensation system. Its workers’ compensation exposure covers a wide variety of occupations, ranging from physicians to nurses to home health aides with disparate average wages and levels of workers’ compensation risks.

In California’s Standard Classification System, there are a number of classifications that encompass healthcare operations. In this report, the healthcare industry is categorized into five segments that provide medical care: Physician Practices, Dental Offices, Hospitals, Nursing Facilities and Home Health Care. These segments are defined based on the locations of the services provided.

The Physician Practices and Dental Offices segments provide outpatient medical services and comprise the majority of workers’ compensation policies for the industry. The Hospitals segment includes both inpatient and outpatient services. The Nursing Facilities and Home Health Care segments may provide less medical care but more physical assistance in short-term and long-term patient care than other segments.

Key findings in the WCIRB Industry Profile: Healthcare report include:

– – The healthcare industry is one of the largest in California, with over 48,000 workers’ compensation policies, and has operations in five distinct healthcare segments that provide medical care (Physician Practices, Dental Offices, Hospitals, Nursing Facilities and Home Health Care). These segments generate 6% of all California workers’ compensation insurance premiums.
– – The advisory pure premium rates approved by the Insurance Commissioner for the healthcare industry are on average about 20% below the statewide average, driven by Physician Practices and Hospitals.
– – Within the healthcare industry, the pure premium rates for Physician Practices and Dental Offices are relatively low, while those for Home Health Care and Nursing Facilities are higher. The differences in pure premium rates by segments are mainly driven by differences in average wage levels (Chart 8) and claim frequency – potentially related to higher risk exposure from hands-on physical assistance provided to patients.
– – Hospitals experienced the largest reduction in payroll and the highest increase in indemnity claim frequency of all healthcare segments during the pandemic.
– – Dental Offices have a much higher share of Cumulative Trauma claims than other healthcare segments, potentially driven by repetitive movements and long duration of dental procedures.
– – Dental Offices have the highest share of claims involving cut, puncture and scrape injuries,likely resulting from the use of dental instruments.
– – Nursing Facilities and Home Health Care have higher shares of claims involving strain, struck and fall injuries than Physician Practices, likely due to the higher level of physical assistance provided in those segments.
– – Home Health Care has the largest share of claims involving motor vehicle injuries as care providers often drive patients to doctor appointments and perform other driving duties for their patients.
– – Overall, the healthcare industry has a lower-than-average claim severity, driven by the higher share of medical-only claims and the lower share of permanent disability claims.

The full report is available in the Research section of the WCIRB website.  

The Department of Industrial Relations’ Occupational Safety and Health Appeals Board (OSHAB) has issued a precedential decision regarding the provision of water at outdoor worksites, affirming that it must be as close as practicable to the areas where employees are working to encourage frequent consumption.

“This decision provides clarity and should serve as a reminder that employers must take adequate steps to ensure that potable drinking water is as close as practicable to workers,” said Cal/OSHA Chief Jeff Killip. “Staying adequately hydrated is essential to preventing heat illness, particularly during the hot summer months.”

The case clarified the definition of what “as close as practicable” means with water placement at the workplace.

Cal/OSHA opened a complaint-initiated safety inspection at the Rios Farming Co. vineyard in St. Helena on August 6, 2018. Inspectors found some workers had to climb through multiple grape trellises to access drinking water. On January 7,

California Code of Regulations, title 8, § 3395(c) (2019) provides that employees shall have access to potable drinking water, including but not limited to the requirements that it be fresh, pure, suitably cool, and provided to employees free of charge. The water shall be located as close as practicable to the areas where employees are working.

In 2019, Cal/OSHA cited Rios Farming Co. for a repeat-serious violation for not having water as close as practicable for their employees.

Rios Farming Co. appealed the citation and an administrative law judge affirmed the citation on October 12, 2022, with a modified penalty of $27,000.

OSHAB issued its decision (RIOS FARMING COMPANY, LLC. Vol: 50 | No: 6 | Published on: February 17, 2023 ) which clarifies that the term “as close as practicable” in terms of providing water to prevent heat illness means that the water must be as close as reasonably can be accomplished in order to encourage frequent water consumption.

In this case, the ALJ found, and the OSHAB affirmed, that the trellises were an obstacle that discouraged employees from frequently drinking water. The ALJ and Board further found that other reasonable options were available to the employer, such as providing a jug of water in each row where the employees were working or providing individual water bottles that employees could carry with them and refill from the jugs.

The California Division of Occupational Safety and Health, or Cal/OSHA is a division with the Department of Industrial Relations that helps protect workers from health and safety hazards on the job in almost every workplace in California. Employers who have questions or want assistance with workplace health and safety programs can call Cal/OSHA’s Consultation Services Branch at 800-963-9424.

Workers who have questions about their rights or have questions about workplace protections can call Cal/OSHA’s Bilingual Call Center at 833-579-0927 to speak with a Cal/OSHA representative. Complaints about workplace safety and health hazards can be filed confidentially with Cal/OSHA district offices. Information on heat illness prevention and other resources can be found on Cal/OSHA’s website.

The Occupational Safety and Health Appeals Board is a three-member, judicial body appointed by the Governor and confirmed by the Senate to handle appeals from private and public-sector employers regarding citations issued by the Division of Occupational Safety and Health for alleged violation of workplace safety and health laws and regulations. The mission of the Appeals Board is to fairly, timely and efficiently resolve appeals and to provide clear, consistent guidance to the public, thereby promoting workplace safety and health.

The Drug Enforcement Administration announced proposed permanent rules for the prescribing of controlled medications via telemedicine, expanding patient access to critical therapies beyond the scheduled end of the COVID-19 public health emergency. The public will be able to comment for 30 days on the proposed rules.

The proposal would reverse a policy enacted during the coronavirus pandemic that allowed doctors to prescribe these medications through telehealth appointments. The move will make it more difficult for Americans to access some drugs used for treating pain and mental health disorders.

The rules aim to maintain expanded access to telehealth, which has been crucial for millions of patients, particularly those living in rural areas, while also balancing safety.

The proposed rules – developed with the U.S. Department of Health and Human Services and in close coordination with the U.S. Department of Veterans Affairs – propose to extend many of the flexibilities adopted during the public health emergency with appropriate safeguards.

The proposed rules do not affect:

– – Telemedicine consultations that do not involve the prescribing of controlled medications.
– – Telemedicine consultations by a medical practitioner that has previously conducted an in-person medical examination of a patient.

The proposed rules also would not affect:

– – Telemedicine consultations and prescriptions by a medical practitioner to whom a patient has been referred, as long as the referring medical practitioner has previously conducted an in-person medical examination of the patient.

The proposed rules would provide safeguards for a narrow subset of telemedicine consultations – those telemedicine consultations by a medical practitioner that has: never conducted an in-person evaluation of a patient; AND that result in the prescribing of a controlled medication. For these types of consultations, the proposed telemedicine rules would allow medical practitioners to prescribe:

– – a 30-day supply of Schedule III-V non-narcotic controlled medications;
– – a 30-day supply of buprenorphine for the treatment of opioid use disorder

without an in-person evaluation or referral from a medical practitioner that has conducted an in-person evaluation, as long as the prescription is otherwise consistent with any applicable Federal and State laws. The proposed rules are explained in further detail for patients and medical practitioners on DEA.gov.

“DEA is committed to ensuring that all Americans can access needed medications,” said DEA Administrator Anne Milgram. “The permanent expansion of telemedicine flexibilities would continue greater access to care for patients across the country, while ensuring the safety of patients. DEA is committed to the expansion of telemedicine with guardrails that prevent the online overprescribing of controlled medications that can cause harm.”

“Improved access to mental health and substance use disorder services through expanded telemedicine flexibilities will save lives,” said HHS Secretary Xavier Becerra. “We still have millions of Americans, particularly those living in rural communities, who face difficulties accessing a doctor or health care provider in-person. At HHS, we are committed to working with our federal partners and stakeholders to advance proven technologies and lifesaving care for the benefit of all Americans.”

The proposed telemedicine rules also further DEA’s goal of expanding access to medication for opioid use disorder to anyone in the country who needs it. “Medication for opioid use disorder helps those who are fighting to overcome substance use disorder by helping people achieve and sustain recovery, and also prevent drug poisonings,” said DEA Administrator Milgram. “The telemedicine regulations would continue to expand access to buprenorphine for patients with opioid use disorder.”

The full text of the proposals may be found here and here. The public has 30 days to review and comment on the proposals, which DEA will then consider before drafting final regulations. DEA is appreciative of the public’s feedback.

Additional resources for practitioners can be found here:

– – Proposed Rules Summary Telemedicine Rules Summary.pdf (dea.gov)
– – Proposed Rules Highlights for Medical Practitioners Telehealth Highlights Medical Practitioners.pdf (dea.gov)