Rene Thomas Folse, JD, Ph.D. is the host for this edition which reports on the following news stories: Roundup Maker Prevails Again – in SoCal Jury Verdict. Federal Court Ends California Generic Drug Price Law. Retired WCJ Correro Clarifies Limits on Developing the Record. Price Gouging Drugmaker Resolves Antitrust Case for $40M. Owner of Multiple Bay Area Clinics Admits Fraud Charges. LAUSD Fires Hundreds of Employees Over Vaccine Mandate. Vaccine Mandate Forces 113 L.A. City Firefighters Off Duty. DWC Updates QME Educational Offerings. FDA Reports 111 Critical Drug Shortages. MEMIC Selects ClaimsPay Platform to Reduce Frictional Costs.
The U.S. Supreme Court will hear a case involving a San Fernando Valley business that could impact the Private Attorney General Act, a law that went into effect in 2004 and which allows employees of a business to sue over labor law violations even if they were not impacted by the violations. At issue in the case is the validity in California of employer-employee arbitration agreements.
In the underlying case of Moriana v Viking River Cruises Inc. a company in Woodland Hills, Angie Moriana sued her former employer Viking River Cruises, Inc. seeking recovery of civil penalties under the Labor Code Private Attorneys General Act of 2004 (PAGA) (Lab. Code, § 2698 et seq.).
Viking moved to compel Moriana’s claims into arbitration. The trial court denied Viking’s motion and the 2nd district Court of Appeal affirmed in the unpublished opinion which will now be reviewed by the U.S. Supreme Court.
Viking argued that the United States Supreme Court’s decision in Epic Systems Corp. v. Lewis (2018) overruled the California Supreme Court’s decision in Iskanian v. CLS Transportation Los Angeles, LLC (2014) 59 Cal.4th 348, in which the California Supreme Court held “that an employee’s right to bring a PAGA action is unwaivable,” and that “where . . . an employment agreement compels the waiver of representative claims under the PAGA, it is contrary to public policy and unenforceable as a matter of state law.”
Epic Systems Corp. v. Lewis was one of three cases consolidated by the United States Supreme Court in 2017 that raised the issue of the Federal Arbitration Act’s preemptive effect over private employment arbitration agreements prohibiting class and collective actions.
Numerous California Courts of Appeal have rejected the contention that Iskanian is no longer good law in the wake of Epic. On federal questions, intermediate appellate courts in California must follow the decisions of the California Supreme Court, unless the United States Supreme Court has decided the same question differently. Thus the 2nd District Court of Appeal rejected Viking’s arguments on forcing the case to arbitration, and followed Iskanian instead of Epic Systems.
The cruise line argued in its petition to the U.S. Supreme Court “whether the Federal Arbitration Act requires enforcement of a bilateral arbitration agreement providing that an employee cannot raise representative claims, including under PAGA.” And that the California Supreme Court was wrong in the 2014 Iskanian case.
In an email to the members of the California Business and Industrial Alliance, the group’s founder and president, Tom Manzo, said that the implications of a Supreme Court decision in Viking’s favor cannot be understated.
“If PAGA cases are subject to arbitration, it offers a clear pathway for employers to obtain relief from frivolous PAGA lawsuits,” wrote Manzo, who started the group, based in Sunland, in 2017 to specifically oppose the state law.
“In advance of the Supreme Court’s oral arguments next spring, we plan to submit a comprehensive amicus brief marshaling all of the data, stories and arguments that you – our members – have helped support these past few years,” Manzo wrote in the email.
According to its website “The California Business and Industrial Alliance (CABIA) is the only trade group exclusively focused on fixing the Private Attorneys General Act (PAGA).” Now that the U.S. Supreme Court has agreed to resolve the dispute between state and federal law, it is likely that CIABA will indeed achieve its mission.
The California Department of Industrial Relations maintains an online database on PAGA notices filed.
Nearly six years after a violent van crash killed four young Fresno-area members of the California Conservation Corps, the agency has been found responsible for “serious and willful misconduct” by failing to heed its own safety protocols leading up to the collision.
The Fresno Bee reported on a ruling by workers’ compensation judge in Fresno, that stems from the fatal wreck on Feb. 2, 2016, when a van carrying corps members to a job site rolled through a stop sign near Reedley and into the path of an 80,000-pound tractor-trailer going at least 50 mph.
It was the worst day in the 45-year history of the conservation corps, which puts young adults to work on environmental projects throughout the state. Dead at the scene were Rhonda Shackelford, 20, and Justin Van Meter, 21, of Clovis; and Serena Guadarrama, 18, of Fresno. Ronnie Cruz, 19, of Fresno, suffered catastrophic brain and spinal injuries but lingered more than three years in a near-vegetative state before dying in July 2019. All were recent recruits, two of them so new to the corps that they had yet to receive their first paycheck.
The tragedy spawned a flurry of lawsuits and workers’ compensation claims that have plodded on for years, some still unresolved. The “serious and willful” ruling by Judge Geoffrey H. Sims of the Workers’ Compensation Appeals Board in Fresno followed two days of hearings this year.
The van driver, Nathan Finnell, who escaped with moderate injuries, was 20 at the time of the crash and had recently been promoted to a supervisory position. As detailed in an investigative report by the news organization FairWarning, corps members had complained about Finnell driving recklessly and clowning around behind the wheel, including on the morning of the wreck, when a member told supervisors that Finnell, the day before, drove off while he was closing the van door, causing injury to his shoulder.
An accident investigation by the California Highway Patrol found that 11 of 15 safety belts in the van were inoperative or unavailable because the belts and clasps had slipped through cracks in the seats and were behind them on the floor.
In his ruling, Judge Sims cited Finnell’s unsafe driving, and the agency’s failure to enforce its own safety rules, which require that vehicles pass a visual inspection of tires, lights, seatbelts and other components before being driven. The policy states that if deficiencies are found, the vehicle is to be placed out of service until repairs are made. “Clearly, had Employer followed its own protocols,” it “would have triggered the substitution of another vehicle,” the WCJ wrote. “Sadly, it did not.”
The case before Judge Sims highlighted an oddity, some would say an injustice, in California workers’ compensation law. When a worker killed on the job has no dependents, death benefits that would otherwise go to family members instead are claimed by the state. The Death Without Dependents Unit, a sub-agency within the California Department of Industrial Relations, puts the money in a trust fund for workers with preexisting disabilities who are later injured on the job.
As a result, prior to Sims’ ruling, $150,000 in death benefits for Guadarrama and Van Meter were claimed by the state. Rhonda Shackelford’s parents received $45,000 in benefits based on evidence they were partly dependent on their daughter’s help with rent and other bills.
Additional death benefits triggered by a ‘’serious and willful’’ ruling do go to families, even if they weren’t dependents of the deceased workers. Following Sims’ ruling last month the CCC agreed not to file an appeal in return for a 10% discount on the additional benefit owed the families. As a result, survivors of Guadarrama and VanMeter families will get $67,500 apiece, and the Shackelfords $22,050.
Ronnie Cruz received more than $2.8 million in workers’ compensation, nearly all of it to reimburse medical providers during the three-plus years he remained alive. As a result, with the ‘’serious and willful’’ finding $1,280,174 in additional benefits will go to his estate, less attorney’s fees.
Voice of OC is a 501(c)(3) nonprofit news source that has a focus on life in Orange County. One of its current projects is requesting information from the county regarding the worker’s compensation claim costs for COVID claims filed by county employees. They just published an update summarizing current workers’ compensation COVID claims frequency and costs.
Orange County sheriff staff are getting hit with COVID-19 illnesses at a much higher rate than other large county departments, and are by far the largest share of pandemic-related worker’s compensation costs the county has paid so far, according to county data obtained through a records request by Voice of OC.
Sheriff staff, who had the lowest self-reported vaccination rate – at 16% – among county employees as of the latest available data from August, are around 20% of the county government workforce. Yet they account for nearly half of the county worker’s compensation claims for COVID illnesses – $1.4 million of the $3 million total, and about 950 of the roughly 2,000 claims so far – according to county data provided this week.
Voice of OC followed up two weeks ago to request updated vaccination rate data, but the county has not provided it yet.
The next biggest department for COVID worker’s comp costs is the Social Services Agency, which has more employees than the Sheriff’s Department, but half as many Covid-related claims and costs. Many Social Services Agency employees work directly with the public and some visit houses to conduct wellness checks on children and seniors.
The high sheriff’s figures, which have privately drawn concern from county leaders, have prompted questions about what’s driving the department’s higher COVID rates and what can be done to better protect workers.
Sheriff officials didn’t have answers to questions Wednesday about whether it’s related to lower vaccination rates, the indoor work environment at jails – or both – and whether managers have analyzed the data to better protect workers’ health. Department spokeswoman Carrie Braun said she’d have a response after getting further clarification from county officials about the worker’s compensation data.
In a statement, she noted that both sworn and non-sworn sheriff staff have been serving in-person throughout the COVID-19 pandemic. “They have worked tirelessly to provide for the safety of Orange County residents both in the jail and on the streets. Unlike other types of jobs, law enforcement is not a public service that can be provided remotely,” Braun wrote.
“The Department has implemented COVID-19 safety measures consistent with guidelines provided by public health officials for the health and safety of our 3,800 employees.”
The sheriff’s deputies’ union’s president didn’t respond to a phone message for comment. The union previously pushed back against a state mandate requiring jailhouse deputies to be vaccinated.
No OC sheriff staff are reported to have died from COVID-19, though law enforcement officers in neighboring counties have died from the virus.
Among the County of Orange workplaces with active COVID outbreaks this summer were the Sheriff’s Department central jail and headquarters complex in Santa Ana, according to county data.
The latest-available vaccination data showed the Sheriff’s Department had the lowest self-reported vaccination rate among county departments, as outbreaks continued hitting county workplaces in August. At the time, just 16% of sheriff staff self-attested to being vaccinated, compared with 75% of Board of Supervisors staff and about 68% percent of the general population who were eligible for shots at the time, according to county data.
Since June, county data shows sheriff staff have filed an additional 264 Covid-related worker’s comp claims, totaling $367,000. In contrast, staff at the county Health Care Agency – which has about 80% as many employees as the Sheriff’s Department – filed just 15 new claims during the same period, totaling about $500 altogether, according to the county data.
The California Employment Development Department (EDD) detected and is quickly taking action to halt a recent move by organized criminal elements to file false disability insurance claims.
The new disability insurance identity theft scam involved suspected organized criminal elements filing false disability insurance claims by attempting to use stolen credentials of individuals and medical or health providers.
Medical and health providers certify the existence of a disability that an applicant reports when seeking disability insurance benefits from EDD.
Evidence of the scam included a recent increase in new online medical or health provider account EDD registrations and a rise in disability insurance claims.
“The Department saw a recent rise in new online medical and health provider account registrations and strongly suspects most of those registrations were fraudulent,” said Ronald Washington, EDD’s Disability Insurance Deputy Director.
“We deployed additional safeguards that further protect providers and claimants from these scams.”
The Department has suspended payments on certain claims until it can further verify information on that claim. EDD is also boosting its medical and health provider vetting process and halting payment on many new claims. These efforts help protect legitimate providers and claimants from further fraud. The filters will slow the process of registering new providers and may impact the time it takes for legitimate claimants to receive benefits. EDD will be contacting providers as soon as possible to complete the additional verification processes.
There is currently no evidence that California medical or health providers were knowingly involved in this latest scam attempt. EDD is expanding its fraud information sharing across state and federal agencies as well as impacted medical groups. California will continue to closely monitor claim activity and take actions to protect the integrity of state disability insurance funds.
EDD continues to urge the public to remain vigilant about protecting personal information when engaging in any online activities. Communication from EDD seeking further information to verify a claim are examples of anti-fraud efforts at work and to stop payment on suspicious claims.
Those who receive communications from EDD and suspect fraud, such as someone filing a claim or creating an account, may want to file a fraud report by visiting Ask EDD and selecting the “Report Fraud” category to complete the Fraud Reporting Form. Victims may also want to file an identity theft report with the Federal Trade Commission (FTC). Information about how to combat fraud and guard against identity theft is available on the EDD’s Help Fight Fraud webpage.
EDD has posted Frequently Asked Questions about the new identity theft scam on the Help Fight Fraud page, along with helpful information and resources to help assist those who may be victims of identity theft.
Rene Thomas Folse, JD, Ph.D. is the host for this edition which reports on the following news stories: Supreme Court Denies Review of $86.7M Roundup Award. FOIA Lawsuit Seeks Expedited FDA Release of Vaccine Documents. Healthcare Vaccine Mandate Now Blocked Nationwide. Jury Verdict – Pharmacies Held Liable for Opioid Distribution. O.C. Sheriff’s Captain Charged with $17M Premium Fraud. East Bay Doctor Found Guilty of Illegally Prescribing Opioids. S.F. Disbarred Attorney Faces Insurance Fraud Charges. DWC Updates Low Back Treatment Guideline. Advocacy Group Claims PBMs Increase Healthcare System Costs. WCIRB Reviews Frictional Claim Cost Trends.
Gilead Sciences, Bristol-Myers Squibb, Janssen Pharmaceuticals and a group of consumers who accused the companies of conspiring to keep certain HIV therapy drugs off the market and at high prices have reached a $10 million class action settlement.
Lead plaintiff Peter Staley filed the class action lawsuit against Gilead in August 2019. He claimed the company’s inflated drug costs priced more than 400,000 people in the US out of their necessary HIV medications.
Gilead allegedly held a monopoly on HIV drug patents, the company has been able to charge high premiums for these medications. The class action also claimed that Gilead has violated state and federal laws by allegedly scheming with other drug manufacturers to prevent them from creating generic versions of these drugs, even after the patents on them expired.
And the federal court approved the $10 million settlement between the companies and end-payor plaintiffs, which claimed the pharmaceutical companies engaged in anti-competitive practices that kept less expensive generic HIV drugs from being available to the class members.
The Gilead HIV Drug Class Action Settlement is Staley, et al. v. Gilead Sciences Inc., et al., Case No. 3:19-cv-02573-EMC, in the US District Court for the Northern District of California.
Of that $10 million, $1.25 million will go to consumer members of the proposed Class of Evotaz purchasers. Plaintiffs will also receive up to $200,000 for providing notice to potential other class members, a sum of which Bristol-Myers has agreed to pay half.
The deal also includes “significant injunctive relief” which will prevent Bristol-Myers from continuing its alleged practice, along with Gilead Sciences, of withholding the generic product Evotaz from the market. Without this injunction, Bristol-Meyers’ agreement with Gilead Sciences would have kept the drug inaccessible until at least September 2029.
The settlement was negotiated in “good faith” and at “arm’s length,” as is required, and “secures an excellent result for the Class.” However, the document maintains Bristol-Myers’ displeasure with the complaints’ characterizations of Bristol-Myers’ conduct and its collaboration with Gilead Sciences.
In the midst of the pandemic, the total number of job injury claims reported by California public self-insured employers edged down slightly last year, but a growing number of lost-time claims and rising claim severity (average loss per claim) fueled by higher indemnity costs drove up total workers’ compensation paid and incurred losses for cities, counties and other public agencies in the state according to a California Workers’ Compensation Institute analysis of data from the state’s Office of Self-Insurance Plans (OSIP).
OSIP’s summary of public self-insured data for fiscal year (FY) 2020/21, issued late last week, provides an initial glimpse at the volume of claims, total loss payments and total incurred (paid losses plus reserves) for the 12 months ending June 30, 2021.
The state compiles the data annually from workers’ compensation reports submitted by hundreds of public self-insured entities, including cities and counties, local fire, school, transit, utility and special districts, and joint powers authorities. The latest summary shows that in FY 2020/21 these employers provided workers’ compensation coverage to nearly 2 million California public workers whose wages and salaries totaled more than $139 billion.
CWCI’s review of the data found that the number of employees covered by public self-insured employers last year declined 4.4% from the total noted in the FY 2019/20 initial report, though the total number of reported claims fell less than 1% to 107,161 cases.
Despite having fewer workers and slightly fewer claims, public self-insureds’ total claim payments at the first report increased by more than $30 million to $445 million, 7.3% more than the comparable figure for FY 2019/20, and $130.7 million (41.6%) more than the $314.3 million noted in the first report for FY 2013/14, which was the low point for the past decade and the first year following enactment of SB 863, the 2012 workers’ comp reform bill signed by Governor Brown.
Though overall public self-insured claim volume was down compared to a year earlier, CWCI noted that decline was completely due to a 19.7% drop in medical-only claims, which are relatively inexpensive, while the number of more costly lost-time claims increased by 8,957 claims (15.5%).
The average indemnity paid per FY 2020/21 lost-time claim at the first report was $4,256, so the addition of the 8,967 lost-time cases was the key factor fueling the increase in public self-insured payments last year.
According to CWCI, the recent increase in the number of indemnity claims in the public sector last year is likely due, at least in part, to the addition of COVID-19 claims to the claim mix, as the public self-insured work force includes many essential workers such as police, firefighters, prison guards, and state hospital workers who have a presumption of compensability if they contract the virus, and who were particularly hard hit by COVID last year.
The introduction of COVID claims into workers’ comp also coincided with a spike in public self-insured death claims, which according to the OSIP data more than doubled from 104 claims in FY 2019/20 to 220 claims in FY 2020/21.
The incurred data (paid losses + reserves for future payments) on public self-insured claims tell a similar story.
One of the Capitol’s most enduring conflicts pits personal injury attorneys and their allies in consumer advocacy groups against corporate interests and their insurers. The two factions clash incessantly over what events are deemed wrongful acts (torts), who can sue over those acts and what monetary damages can be awarded.
Dubbed “tort wars,” the conflict has raged for decades in the Legislature, in the courts and occasionally via ballot measures, each side depicting itself as the good guys and the other as rapaciously evil. Millions of dollars are spent each year on lobbyists, media strategists, political campaign advisors and other tools of the political trade.
CalMatters Reports that the intensity of the war varies from year to year, and 2022 is shaping up as one its hotter periods as the factions propose dueling ballot measures. One would effectively undo a 1975 law that limits damages for “pain and suffering” in medical malpractice cases, while another would place a new limit on the fees that personal injury attorneys can claim.
The controversial 1975 law, entitled the Medical Injury Compensation Reform Act (MICRA) and signed by Jerry Brown during his first year as governor, limits non-economic damages for medical malpractice to $250,000. Its passage was not only a big win for medical providers and their insurers but the opening salvo of the war.
MIRCA also ended workers’ compensation subrogation recoveries in California medical malpractice cases.
The attorneys not only have tried – very unsuccessfully so far – to repeal or modify MICRA while business groups and insurers have not only attempted to blunt the attorneys’ expansive ambition but to carry the MICRA model of damage limits into other potential injury cases.
According to the CalMatters article, in 1987, 12 years after MICRA was enacted, the speaker of the state Assembly, Willie Brown, mediated extensive negotiations between the warring factions on a truce, culminating in the infamous “napkin deal” worked out in Frank Fat’s restaurant near the Capitol with Brown hopping from table to table.
Quickly ratified by the Legislature, it gave lobbyists for every interest involved something to take back to their clients, including a slight modification of MICRA and new protections for the tobacco industry from lawsuits by smokers for cancer and other illnesses.
The napkin deal truce lasted for a few years, but tort wars resumed in the 1990s and have been waged ever since on specific issues, including several unsuccessful efforts to change MICRA. One subset of the conflict, involving roughly the same interests, has been perennial jousting over workers’ compensation, the employer-financed, multi-billion-dollar system that covers job-related injuries and illnesses.
A ballot measure that would indirectly but effectively repeal MICRA is already qualified for the 2022 ballot even though the anti-MICRA coalition has failed repeatedly in the past to undo what the Legislature and Jerry Brown wrought 46 years ago.
Meanwhile, the Civil Justice Association of California, an umbrella organization of business and insurance interests, has unveiled its own initiative measure that would limit lawyers’ contingency fees in personal injury cases to 20% of monetary judgments, sharply lower than the traditional one-third or more. The goal, obviously, is to make attorneys less willing to take on cases.
The U.S. Supreme Court on Monday declined to issue an injunction against New York’s COVID-19 vaccine mandate for health care workers, which doesn’t allow them to seek a religious exemption.
New York state imposed the vaccine mandate for doctors and nurses in August, which allows only for medical exemptions, not religious ones. The religious exemption policy expired in November.
The latest decision suggests the high court lacks the appetite to wade into the matter of mandates. The Supreme Court has previously rejected other challenges, including one that focused on Maine’s lack of a religious exemption to vaccine mandates for health care workers.
Petitioners, which included Christian doctors, said New York’s vaccine mandate violates the U.S. Constitution’s First Amendment prohibition on religious discrimination on behalf of the government. They also argued that it violates federal civil rights law that requires businesses to accommodate employees’ religious beliefs.
Justices Clarence Thomas, Samuel Alito, and Neil Gorsuch wrote they would have supported temporarily halting enforcement of New York’s mandate.
“Sometimes dissenting religious beliefs can seem strange and bewildering. In times of crisis, this puzzlement can evolve into fear and anger,” Gorsuch wrote in his dissent.
“One can only hope today’s ruling will not be the final chapter in this grim story,” Gorsuch continued. “Cases like this one may serve as cautionary tales for those who follow.”
In October, when the Supreme Court didn’t take up the Maine vaccine case, Gorsuch wrote that “healthcare workers who have served on the front line of a pandemic for the last 18 months are now being fired and their practices shuttered,” adding that they have been terminated “for adhering to their constitutionally protected religious beliefs.”
“Their plight is worthy of our attention,” he argued.
Other than Maine and New York, Rhode Island is the only other state that doesn’t allow religious exemptions to the vaccine for health care workers.