Author: WorkCompAcademy

A new study from the Workers Compensation Research Institute (WCRI) analyzes recent changes in the composition of the medical workforce. These changes, including medical provider shortages and an increase in the demand for health care, may affect care for injured workers.

“Timely access to care is important for workers recovering from injuries,” said Sebastian Negrusa, vice president of research at WCRI. “Provider shortages can cause delays in treatment, longer recovery times, and higher workers’ compensation costs. These challenges were particularly noticeable during the pandemic and continue to be a concern.”

The study, Changes in the Medical Workforce and Impact on Claims, reviewed workers’ compensation data from 2013 to 2022 and addressed questions such as the following:

– – How has workers’ access to primary care physicians, as opposed to nurse practitioners or physician assistants, changed since 2013, including during the pandemic?
– – Did the use of advanced practitioners (nurse practitioners and physician assistants) instead of physicians vary across states and between urban and rural areas?
– – How did the increases in the number of advanced practitioners impact claim costs, disability duration, and types of care provided?

The study uses data from the WCRI Detailed Benchmark/Evaluation (DBE) database, which includes information on workers’ compensation claims, medical care payments, income benefits, and detailed billing data from insurers, state funds, and self-insured employers.

For more information or to purchase the study, visit www.wcrinet.org. The report was authored by Drs. Bogdan Savych and Olesya Fomenko.

The Workers Compensation Research Institute (WCRI) is an independent, non-profit research organization based in Waltham, MA. Established in 1983, WCRI remains neutral on the issues it investigates, providing objective information from studies and data collection efforts that adhere to recognized scientific methods. Rigorous, impartial peer review procedures further ensure objectivity. WCRI’s diverse membership includes employers, insurers, government entities, managed care organizations, health care providers, insurance regulators, state labor groups, and state administrative agencies across the U.S., Canada, Australia, and New Zealand.

Founded in 1898, the National Community Pharmacists Association is the voice for the community pharmacist, representing over 18,900 pharmacies that employ more than 205,000 individuals nationwide. Community pharmacies are rooted in the communities where they are located and are among America’s most accessible health care providers.

The Association recently submitted comments to the Centers for Medicare & Medicaid Services with a stern warning that more than 90 percent of independent pharmacies may decide, or have already decided, to not stock drugs in the Medicare Drug Price Negotiation Program because they will cause massive financial losses and potentially put them out of business.

“Pharmacies will have to float thousands of dollars every month waiting for refunds from the manufacturers. That will cause a massive cash flow problem in an environment where thousands of pharmacies have already closed,” said NCPA CEO B. Douglas Hoey.

In its comments, NCPA cited a recent national survey of independent pharmacists that found a jaw-dropping 93.2 percent of respondents have already decided to not stock the drugs in the program, or they are considering not stocking them.

“That will be devastating to the program,” said Hoey. “Patients who need these prescriptions will be unable to get them, because their pharmacies cannot participate in the program. It’s great the government removed big insurance’s PBMs from the negotiations and the result was lower prices for these prescription medications. That’s an important outcome for patients and taxpayers. But if almost no pharmacies can stock the drugs because they will sustain huge financial losses, the program will collapse before it even starts.”

According to the survey independent pharmacists:

– – 60.4 percent are considering not stocking one or more of the first 10 drugs listed in the Medicare Drug Price Negotiation Program.
– – 32.8 percent have already decided not to stock one or more of the drugs listed in the Medicare Drug Price Negotiation Program.
– – 96.5 percent said PBM and plan reimbursement for Medicare Part D threatened the viability of their business.
– – 40.8 percent said they were paid below what they pay to buy the drug, approximated by the National Average Drug Acquisition Cost (NADAC), on more than 40 percent of the prescriptions they filled for Medicare Part D patients.
– – 29.2 percent said they were paid below NADAC on 50 percent or more of the prescriptions they filled for Medicare Part D patients.
– – 80.3 percent said the financial health of their business declined in 2024.
– – 48.6 percent said the financial health of their business declined significantly in 2024.
– – 30.3 percent said they are considering closing their business in Calendar Year 2025.

If CMS and the new administration want to save the program, and if they want to prevent the disappearance of many more pharmacies, they will make a number of changes, said NCPA.

Among the changes the organization proposed, CMS should bar PBMs from requiring pharmacies to participate in the program in order to serve Medicare Part D patients, and it must also give pharmacies the ability to cancel PBM contracts without cause. NCPA made many additional recommendations.

In 1996, Todd Hearn began working for PG&E as a meter reader. A few years later, he began training as a lineman and completed his apprenticeship in 2004. During the relevant time period, Hearn worked out of PG&E’s facility in Napa. PG&E became aware of performance issues at the Napa yard around 2016, including delays in maintenance and repair projects and rising overtime claims. Roy Surges, PG&E’s Electric Superintendent, began working with Tanya Moniz-Witten, a senior director at PG&E, to help address the situation.

In early 2018, Surges noted “excessive meal costs, suspicions of misconduct, a high number of rest periods, poor attendance, schedule performance, multiple retaliatory compliance and ethics complaints, poor moral and bad attitude” among “the bulk” of the senior crew and foreman in the Napa yard. Surges was working with the supervisors to provide “added oversight measures” and brought in corporate security to assist. PG&E began gathering data, including timecards and vehicle GPS records, in order to “deal with” some “bad apples.” Moniz-Witten also brought in ”HR/Labor” for “advisement and help” in addressing the situation.

The investigation was subsequently narrowed down to five and Hearn was identified as one of the five based on “potentially false time cards.” In late June 2018, Hearn and four other linemen were suspended. Hearn was informed he was being placed on “crisis leave” due to an “alarming amount of discrepancies” in Hearn’s timecards.The investigation was transferred to Kevin Cashman, a senior investigator in PG&E’s Corporate Security Department (CSD). In August 2018, Cashman interviewed Hearn.

PG&E then hired Tony Mar, a retired PG&E Director of Electric Operations, to conduct a separate investigation into the Napa yard. While Mar claimed he was not asked to investigate any specific employees, Mar acknowledged he only wrote reports on the five suspended linemen. In early December 2018, Mar informed PG&E he provided Internal Auditing “what we have identified related to Hearn,” including that he took multiple trips to his house, claimed overtime when he was not on site, requested unearned meals, and delayed his arrival to work locations.

Hearn presented evidence that beginning in 2017, he repeatedly expressed safety concerns to PG&E management about a device called a “Tripsaver” that PG&E began installing on its electrical lines in 2016. PG&E Superintendent Roy Surges responded negatively to Hearn and others who raised these safety concerns. As a result, PG&E retained a lawyer named Kelly Applegate to conduct an external investigation of retaliation claims made by employees against PG&E management, including the report Hearn made.

After additional investigations transpired, in a January 18, 2019 letter, PG&E informed Hearn his employment was terminated based on findings of an investigation into his conduct. Hearn filed a lawsuit against PG&E, alleging four causes of action: (1) retaliation for disclosing the company’s safety violations (Lab. Code, § 1102.5); (2) retaliation for lodging a bona fide complaint about unsafe working conditions (Lab. Code, § 6310); (3) wrongful termination in violation of public policy; and (4) defamation.

The jury found PG&E liable for defamation but rejected Hearn’s retaliation claim. The jury awarded damages totaling $2,160,417, comprised of separate awards as to past and future economic and non-economic damages. The verdict form did not ask the jury to consider or award any assumed reputational harm damages. The jury declined to award punitive damages.

On appeal, PG&E contends the trial court erred by denying its motion for judgment notwithstanding the verdict (JNOV) because Hearn’s defamation claim was not separately actionable – i.e., the defamation claim was premised on the same conduct that gave rise to his termination and the damages sought were solely related to his loss of employment. In his cross-appeal, Hearn alleges the verdict rejecting his retaliation claim is not supported by sufficient evidence and contends the trial court erroneously excluded relevant evidence.

The Court of Appeal reversed the judgment entered in Hearn’s favor on his defamation cause of action. The costs award premised on Hearn prevailing consequently was likewise reversed in the partially published case of Hearn v. Pacific Gas & Electric Co. -A167742 (January 2025).

The question PG&E asked to be resolved on appeal was “In a wrongful termination case, can a plaintiff recover in tort based on the same underlying harm as caused by the discharge?”

The California Supreme Court ruled that employees may generally assert tort claims against their employer, even in the context of their termination in three key cases, Foley v. Interactive Data Corp. (1988) 47 Cal.3d 654 (Foley), Hunter v. Up-Right, Inc. (1993) 6 Cal.4th 1174 (Hunter), and Lazar v. Superior Court (1996) 12 Cal.4th 631 (Lazar).

Specifically, the California Supreme Court has specified two hurdles employees must overcome: (1) such tort claims must be based on conduct other than that giving rise to the employee’s termination and (2) the damages sought cannot exclusively “result from [the] termination itself.”

“Based on these principles, the trial court erred in denying PG&E’s JNOV because Hearn may not recover for defamation when it arose from the same conduct giving rise to his termination and the only result is the loss of his employment. In other words, Hearn cannot recover damages for wrongful termination by recasting his claim as one for defamation.”

TUCHER, P.J., Dissented in part with the majority opinion.

The Kerlan-Jobe Orthopaedic Clinic, Medical Group, Inc. (Kerlan-Jobe), known for its pioneering Tommy John surgery and commitment to athletes and first responders, filed a $150 million lawsuit against Cedars-Sinai Medical Care Foundation, Santa Monica Orthopaedic and Sports Medicine Group (SMOG), and several top executives.

The lawsuit, filed in Los Angeles County Superior Court (Case number: 25STCV01015), alleges that Cedars engaged in a decades-long effort all designed to appropriate Kerlan-Jobe’s reputation, intellectual property, assets, and patient base without compensation.

“Cedars-Sinai, hiding behind its non-profit status, has orchestrated an underhanded scheme to crush Kerlan-Jobe, steal its assets, and prioritize profits over patient care,” said a spokesperson for Kerlan-Jobe. “We’re fighting not just for our practice, but for the Los Angeles community, including first responders who depend on us.”

Kerlan-Jobe alleges Cedars and members of its executive leadership conspired with SMOG, at times in violation of state and federal law, to:

– – Prevent patients from scheduling appointments with Kerlan-Jobe doctors, all while holding itself as Kerlan-Jobe and misleading the public.
– – Unlawfully reap a financial windfall for Cedars, ostensibly a “non-profit” healthcare institution, by seizing control of Kerlan-Jobe’s key assets, brand and intellectual property rights, while paying nothing to Kerlan-Jobe in return.
– – Drain Kerlan-Jobe of many of its key physicians and coerce them into accepting employment with SMOG in violation of non-compete and fiduciary duties owed to Kerlan-Jobe.
– – Retaliate against the remaining Kerlan-Jobe physicians who stood in the way and attempt to starve their medical practices until they will have no choice but to dissolve and fold Kerlan-Jobe into SMOG.

According to the complaint, Cedars and Kerlan-Jobe entered into a decades-long contract which expired on October 1, 2024 and provides for an 18-month wind down period. Upon execution of the contract, Cedars allegedly demanded that Kerlan-Jobe’s physicians “row the boat” to bring all patient services, referrals, surgeries and treatments through facilities that Cedars controls.

The complaint states that some former Kerlan-Jobe physicians cooperated and colluded with the Cedars Enterprise and received benefits such as directorship roles, multimillion-dollar bonuses and large lump sum payoffs.

In contrast, those at Kerlan-Jobe who exercised their contractual rights and independent professional judgment as to the care of their patients were allegedly punished for their oppositions.

The complaint alleges that as of November 1, 2024, Kerlan-Jobe has no ability to bill for patient services, no control over its phone lines or websites and only has three non-disqualified physicians left to rebuild a nationally-recognized sports orthopaedic practice that Cedars allegedly sought to systematically destroy.

The complaint further states that this misconduct is reprehensible to public health policy and violates the law. Cedars has allegedly become solely focused on increasing its rankings and national renown so that it could better attract and serve the rich and famous and enrich its senior executives through lucrative multimillion-dollar salaries. This puts Kerlan-Jobe’s commitment to serve the entire Los Angeles community, particularly at this critical time, in jeopardy.

“For 45 years, we’ve set the standard for sports medicine and community care. Cedars’ actions threaten not just our legacy but the well-being of thousands of patients,” the spokesperson added.