Author: WorkCompAcademy

In California, where overdose deaths have been rising for years, addiction experts say administering a month’s worth of anti-addiction medication in a single injection holds great potential, particularly for people without housing or who struggle with other forms of instability. Yet despite its promise, the use of injectable buprenorphine remains fairly limited, especially compared with other forms of addiction medication. Researchers have yet to publish studies comparing different ways to administer buprenorphine.

Buprenorphine, one of three medications approved in the U.S. to treat opioid use disorder, works by binding to opioid receptors in the brain and reducing cravings and withdrawal symptoms. And because it occupies those receptor sites, buprenorphine keeps other opioids from binding and ensures that if a patient takes a high dose of a drug like heroin or fentanyl, they are less likely to overdose. Patients often stay on buprenorphine for years.

If Dr. Andrew Herring, who practices at an addiction clinic at Highland Hospital in the heart of Oakland, prescribes a supply of buprenorphine as a tablet or film that is placed under the tongue, the patient must commit to taking the medication at least once a day, and many fall out of treatment. He said this is especially true for his patients experiencing homelessness and those who also use methamphetamine.

Oral forms of buprenorphine have been available to treat addiction since 2002 and can be purchased as a generic for less than $100 a month. Injectable buprenorphine, sold under the brand name Sublocade, received FDA approval in 2017. It has a hefty list price of $1,829.05 for a monthly injection.

Still, addiction experts say, Sublocade use remains limited because of the regulatory hurdles required to dispense it.

Providers must register with the U.S. Drug Enforcement Administration and obtain a waiver to prescribe buprenorphine because it’s considered a controlled substance. In addition, clinics must complete an FDA safety certification program to dispense the medication. And Sublocade can be ordered only by a specialty pharmacy, which must also pass the FDA program.

“At many hospitals, that will mean either a delay in getting this medication on our shelves or just opting out,” said Dr. Rais Vohra, regional director for the California Bridge Network, a state-funded program that supports hospitals in offering treatment for substance use disorders, including Herring’s clinic.

Vohra said Community Regional Medical Center in Fresno, where he works as an emergency physician, is still looking through the documentation requirements to see if the hospital’s pharmacy can distribute the medication — which would make it one of the few Central Valley providers to do so.

Oral buprenorphine, by contrast, is a simple prescription that most local drugstores keep in stock.

“All the hoops that clinicians and patients have to jump through to get this medication is crazy. We don’t do that for any other disease,” said Dr. Hannah Snyder, who runs the addiction clinic at Zuckerberg San Francisco General Hospital across the bay.

“The most important question isn’t whether long-acting injectable bupenorphine is a better solution than sublingual buprenorphine for opioid use disorder,” said Dr. Michael Ostacher, a professor at Stanford University School of Medicine, who is comparing injectable and oral versions of buprenorphine through Veterans Affairs. “The bigger question is how we increase access to treatment for all people who need [the medication].”

California’s Medicaid program does not require prior authorization but providing Sublocade is still a challenge. At the Placerville clinic supported by the California Bridge Network, Dr. Juliet La Mers, the director, said a quarter of her buprenorphine patients get injections. Still, they often wait two weeks before Sublocade arrives from the specialty pharmacy.

In states where Medicaid plans may still require prior authorization, waits for Sublocade can stretch into months. Across the border at the Northern Nevada Hopes clinic in Reno, Nevada, for example, Dr. Taylor Tomlinson said she tells patients that between battles for coverage and pharmacy delays, they might have to wait two months for an injection.

Bijon Hill appeared in ten photo shoots organized by Walmart in San Francisco between July 2016 and August 2017 for a total of fifteen days, in non-consecutive periods of one or two days. Hill claims that this amounted to ten separate instances of employment and that she was “discharged” at the end of each photo shoot.

During this time, Hill was represented by Scout Talent Management Agency. Walmart had a contract with Scout and agreed to pay Scout a daily flat rate for each day of modeling services, which was to be passed along to Hill plus a commission. Walmart and Scout’s contract specified that Scout and its “personnel” were independent contractors.

Hill sued Walmart for its failure to pay her immediately after each photo shoot ended and sought more than $540,000 in penalties pursuant to California Labor Code § 203. Walmart removed the case to federal court based on diversity of citizenship. It also filed a third-party complaint against Scout.

The district court denied summary judgment on Walmart’s defense that plaintiff was an independent contractor outside the protection of the relevant Labor Code provisions due to disputes of material fact. However, it granted summary judgment on Walmart’s good-faith defense. The district court concluded that there was a good-faith dispute about whether plaintiff was an independent contractor that made it objectively reasonable for Walmart to believe plaintiff was not an employee.

The Court of Appeals for the Ninth Circuit affirmed the summary judgment in the published case of Hill v Walmart – 21-15180 (April 26, 2022).

8 C.C.R. § 13520 provides that “A willful failure to pay wages within the meaning of Labor Code Section 203 occurs when an employer intentionally fails to pay wages to an employee when those wages are due. However, a good faith dispute that any wages are due will preclude imposition of waiting time penalties under Section 203.“

Moreover, 8 C.C.R. § 13520 explains that “[a] ‘good faith dispute’ that any wages are due occurs when an employer presents a defense, based in law or fact which, if successful, would preclude any recovery on the part of the employee.“

It is undisputed that if Hill were an independent contractor, then she would not be an “employee” entitled to an immediate payment of wages upon discharge pursuant to Labor Code § 201(a) or to recover penalties from Walmart pursuant to § 203.

Consequently, Walmart’s argument that Hill was an independent contractor is a “good faith dispute that any wages are due.” See also Amaral v. Cintas Corp. No. 2, 163 Cal. App. 4th 1157, 1202 (2008) (employer had good-faith defense because its “legal obligations” were “unclear,” and the arguments it made for its ultimately incorrect legal position were not “unreasonable or frivolous”); Barnhill v. Robert Saunders & Co., 125 Cal. App. 3d 1, 8 (1981) (legal ambiguity is a valid basis for a good-faith defense).

The Travelers Companies, the country’s largest workers compensation insurer, just released its 2022 Injury Impact Report. The study analyzed more than 1.5 million workers compensation claims over a five-year period (2015-2019) and revealed that 35% of injuries occur during employees’ first year on the job, regardless of age or industry experience.

Travelers analyzed more than 1.5 million workers compensation claims it received between 2015 and 2019 from a variety of industries and business sizes. Findings were based solely on indemnity claims, where the injured employees could not immediately return to work and incurred medical costs. This is the second analysis of its kind conducted by the company. The first was in 2016 and included data between 2010 and 2014.

The study provided insights in a number of areas related to first-year injury claims.

The most common causes of first-year injuries were overexertion (27% of claims); slips, trips and falls (22%); being struck by an object (14%); cuts and punctures (6%); being caught in or between objects (6%); and motor vehicle accidents (6%).

The most expensive claims, accounting for just 8% of total claims but 26% of total claim costs, were amputations, multiple traumas, electric shock and dislocations.

The restaurant industry experienced the most claims from first-year employees, with 53% of the claims involving the newest workers and representing 47% of total claim costs. The construction industry was a close second, with nearly half of all claims coming from those who were new to the job, driving 52% of the industry’s claim costs.

First-year injuries led to more than 6 million lost workdays over the five-year period studied, representing 37% of all lost days. Among all worker injuries over the same period, construction workers on average missed the most workdays (98) due to an injury, followed by employees in transportation (88) and those in services (69), which includes businesses such as legal, engineering and accounting firms.

Dislocation and inflammation injuries resulted in the most time away from work on average, at 132 and 82 workdays, respectively. Strains and falls both caused workers to miss an average of 69 workdays, followed by motor vehicle accidents (61) and being struck by an object (59).

“Our data underscores the importance of comprehensive onboarding and training programs for employees, particularly as we continue to navigate the challenges of COVID-19 and see many workers starting new jobs,” said Chris Hayes, Assistant Vice President, Travelers Risk Control – Workers Compensation and Transportation. “While new employees are among the most vulnerable, many injuries sustained by employees of any tenure can often be prevented if the proper safety measures are in place.”

The Federal Arbitration Act or FAA, enacted February 12, 1925, is federal law that provides for private dispute resolution through arbitration. The FAA recognizes benefits to society as a result of resolution of disputes in expeditious systems. It is most often implemented by use of an arbitration clause in the contract between the parties.  

An arbitration clause is a clause in a contract that requires the parties to resolve their disputes through an arbitration process. Mandatory arbitration clauses are widespread in the United States. For example, 15 of the largest 20 U.S. credit card issuers, and 7 of the 8 largest cell phone companies have arbitration clauses for resolution of disputes with customers.

In employment law, many employers have mandatory arbitration clauses in contracts with their employees, for the purpose of limiting the possibility of extreme jury verdicts in favor of former employees, as well as the risk of costly class action litigation.

Section 2 of the FAA declares that arbitration provisions will be subject to invalidation only for the same grounds applicable to contractual provisions generally, such as unconscionability or duress. Consequently, most state law that attempts to disfavors or limit the enforcement of mandatory arbitration agreements are preempted by the FAA.

Substantial federal and state litigation has evolved over the years on the issue of federal preemption precluding the ability of any state’s attempt to restrict an employer’s rights to force mandatory arbitration of disputes with employees. Generally speaking, individual states have not been successful in litigation efforts to limit the preemption provisions of the FAA.

However, President Biden has just signed into law the Ending Forced Arbitration of Sexual Assault and Sexual Harassment Act of 2021. This Act was introduced in 2017.

The Act amends the Federal Arbitration Act to give employees who are parties to arbitration agreements with their employers the option of bringing claims of sexual assault or sexual harassment either in arbitration or in court.

The Act amends the FAA to include a new section, which states, in part: “[A]t the election of the person alleging conduct constituting a sexual harassment dispute or a sexual assault dispute, or the named representative of a class or in a collective action alleging such conduct, no predispute arbitration agreement or predispute joint-action waiver shall be valid or enforceable with respect to a case which is filed under Federal, Tribal, or State law and relates to the sexual assault dispute or the sexual harassment dispute.”

Thus this new Act is an employment law game changer. It gives employees the option to circumvent arbitration agreements and class or collective action waivers with respect to sexual assault and sexual harassment claims.

The Act applies to all claims that arise or accrue after March 3, 2022, regardless of the date of the agreement at issue. The Act, however, does not affect claims that arose or accrued before March 3, 2022.

The Act does not affect otherwise valid arbitration agreements for claims that are not related sexual assault and sexual harassment. What is unanswered in the new law, is how it will apply when sexual assault and sexual harassment claims are intermixed with other employment law claims in a single litigation filing.

At the Interdisciplinary Conference on Orthopedic Value-Based Care, According to an article in Helio, Randy Fagin, MD, chief medical officer – national group of HCA Healthcare, said among the 183 hospitals in the HCA Healthcare system, about 88,000 hip and knee replacements are performed annually, not including those performed at the system’s 125 ASCs.

And according to Dr. Fagin, “Physicians who use robotics are growing faster, 36% year-over-year case growth vs. 7% for those who are not using robotics.”

However, a factor that may be disruptive to robotics is augmented reality (AR), Fagin said. “Augmented reality is, I believe, going to be disruptive to robotics, massively disruptive. It is going to come on slow.”

However, because AR is a disruptive innovation, “it’s going to hit a dynamic growth curve” followed by a logarithm rise in utilization, until such time that the utilization levels out and become commoditized, Fagin said.

“We’re going to hit a logarithmic rise in utilization of augmented reality in hip and knee replacement and it will disrupt the robotic marketplace,” he said.

An article published by Stanford University helps explain how this new technology might be used by surgeons.

Surgeons make their way down to the Neurosurgical Simulation Lab to practice an upcoming operation. Because they’re practicing on images from the actual patient, rather than a generic brain, they can map out the surgery ahead of time. “It’s a window into the brain – and a window into the brain of the particular patient we’re going to operate on,” said Anand Veeravagu, MD, an assistant professor of neurosurgery and the head of the Stanford Neurosurgical Simulation Lab.

The three-dimensional aspect of the imagery eases surgeons’ planning and improves the accuracy of the surgery, with the aim of producing safer procedures. “We can plan out how we can approach a tumor and avoid critical areas like the motor cortex or the sensory areas,” said Steinberg, professor and chair of neurosurgery. “Before, we didn’t have the ability to reconstruct it in three dimensions; we’d have to do it in our minds. This way it’s a three-dimensional rendering.”

Stanford Medicine doctors are using the VR technology for the brain and spinal cord because these organs are stable and lend themselves to imagery – unlike other body parts, which move with blood flow and breathing. But Malie Collins, MS, senior program lead for the VR program said the technology may soon be available for the rest of the body.

Surgeons typically use video feeds while they are operating, but the new VR technology adds a three-dimensional view which they can superimpose on the real-time video. “It has much, much more detail,” said Steinberg.

And Johns Hopkins neurosurgeons have performed the institution’s first augmented reality surgeries in living patients. During the first procedure on June 8, 2020, the physicians placed six screws in a patient’s spine for spinal fusion surgery to fuse three vertebrae in order to relieve the patient’s chronic, debilitating back pain. For the second surgery on June 10, surgeons removed a cancerous tumor known as a chordoma from the spine of a patient.

The technology used by the physicians for the augmented reality surgeries consisted of a headset with a see-through eye display that projects images of the patient’s internal anatomy such as bones and other tissue based on CT scans – essentially giving the surgeons X-ray vision.

“When using augmented reality in the operating room, it’s like having a GPS navigator in front of your eyes in a natural way so you don’t have to look at a separate screen to see your patient’s CT scan,” says Timothy Witham, M.D., director of the Johns Hopkins Neurosurgery Spinal Fusion Laboratory and professor of neurosurgery at the Johns Hopkins University School of Medicine.