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WCAB Proposes Repeal of Rules of the Court Administrator

The Workers’ Compensation Appeals Board has issued a notice of public hearing regarding proposed amendments to its Rules of Practice and Procedure. The primary purpose of this rulemaking is to repeal the Rules of the Court Administrator and to move the non-duplicative ones into the WCAB’s Rules, with some largely non-substantive changes. These changes are authorized by Assembly Bill 1426 (Stats. 2011, ch. 639 [AB 1426]), which eliminated the position of Court Administrator and deemed the Court Administrator’s regulations to be regulations of the WCAB. The rulemaking also proposes to make largely non-substantive changes to a limited number of existing WCAB Rules.

The public hearing will start at 10 a.m. on Wednesday, September 17 in the Santa Barbara Room, Basement Level, of the Hiram Johnson State Office Building at 455 Golden Gate Avenue, San Francisco, CA 94102. Members of the public may also submit written comment on the proposed Rules amendments until 5 p.m. that day.

The WCAB’s notice of the proposed rulemaking, the text of the proposed regulations, and the initial statement of reasons can be found at the board’s website.

Although equal weight will be accorded to oral and written comments, the WCAB prefers written comments to oral testimony and prefers written comments submitted by e-mail. If written comments are timely submitted, it is not necessary to present oral testimony at the public hearing.

Comments may be submitted by e-mail to or they may be mailed to: Workers’ Compensation Appeals Board, Attention: Annette Gabrielli, Regulations Coordinator, P.O. Box 429459, San Francisco CA 94142-9459.

The WCAB will consider all timely public comments and it encourages all interested members of the workers’ compensation community to participate in this important process.

WCIRB Report Shows Improving But Still Difficult California Work Comp Economics

The Workers’ Compensation system in California is more than 100 years old. It covers more than a half million employers and provides benefits to 800,000 injured workers annually. The WCIRB has released the new WCIRB Report on the State of the California Workers’ Compensation Insurance System. The Report, which the WCIRB plans to update annually, summarizes the cost of workers’ compensation insurance based on premiums paid by insured employers, shows how premium dollars are distributed among various system components, and identifies key cost drivers such as frequency and the average cost of claims. The Report also contains a brief summary of how post-Senate Bill No. 863 (2012) costs are emerging compared to initial projections.

Insurer rates have been slowly increasing over the past five years but are not significantly different from the rates charged in the 1970s. A steady long term decline in the frequency of claims has to some extent offset increasing medical and other costs. Yet rates charged in California have been markedly higher than rates charged in other states. The largest component of claims cost is the medical treatment benefit.

Claim frequency was 49.5 claims per 1000 employees per year back in 1991. There has been a steady decrease to 14.2 claims per 1000 employees per year in 2009. This has increased slightly to 16.6 claims per 1000 employees per year estimated for 2014. Note that this slight increase coincided with the onset of the great recession. Geographically, the largest percentage increase during that period was in Los Angeles County where claim frequency increased by 19% between 2009 and 2012 compared to the bay area which showed a 3 percent decrease over the same time frame. California also lead the nation in increase claim frequency during this period. Simply stated, Los Angeles County led the state that led the nation in workers’ compensation claim frequency increases after the commencement of the great recession of 2008. A number of explanations can come to mind as an explanation for this notable phenomena.

California reported medical costs per claim are among the highest in the country with an average cost more than 70% above the median level. This is the result of three factors. The high proportion of indemnity claims involving permanent disability, the longer duration of medical treatment in California, and higher level of medical-legal costs.

Loss adjustment expenses include the costs of the administration of claims, attorney and other legal expenses, the cost of medical cost containment programs, and other court and claims-related expenses. These costs have increased steadily since 2005. Instead of declining after the 2013 enactment of SB 863, these expenses increased by 7% per claim. Loss adjustment ratios are generally higher in California than for the average of other states. One reason is high litigation rates especially in the Los Angeles area and a large number of active liens. The unexpected high frequency of IMRs conducted pursuant to SB 863 is also impacting loss adjustment expenses.

With respect to SB 863, lien savings are emerging at a greater than expected level. However indemnity claim frequency is emerging at a higher rate than projected. The overall long term cost effects of SB 863 have yet to be fully determined.

California combined loss ratios are improving, but remain over 100%. In 2011 the loss ratio peaked at 119% and has now declined to 107%. Insurers can generate a profit with a combined ratio above 100% provided there be a favorable investment climate. However, long term ratios above 110% are not sustainable.

Supreme Court Limits Recovery of Caregiver Injured by Alzheimer’s Patient to Workers’ Comp

Bernard Cott contracted with a home health care agency to assist with his 85-year-old wife and codefendant Lorraine Cott, who had long suffered from Alzheimer’s disease. The agency assigned plaintiff Carolyn Gregory to work in the Cotts’ home.

Gregory was trained to care for Alzheimer’s patients, and had done so in other assignments. She knew they could be violent. Bernard told her Lorraine was combative and would bite, kick, scratch, and flail. Gregory’s duties included supervising, bathing, dressing, and transporting Lorraine, as well as some housekeeping. In September 2008, Gregory was washing dishes while Lorraine sat at the kitchen table. Bernard was not at home. As Gregory was washing a large knife, Lorraine approached her from behind, bumped into her, and reached toward the sink. When Gregory attempted to restrain Lorraine, she dropped the knife, which struck her wrist. As a result, Gregory lost feeling in several fingers and experienced recurring pain.

Gregory has received workers’ compensation for this injury. She also sued the Cotts for negligence and premises liability, with a claim against Lorraine for battery. The trial court granted a defense motion for summary judgment. A divided Court of Appeal affirmed, holding that Gregory’s claims were barred by the primary assumption of risk doctrine. The California Supreme Court affirmed the judgment in the case of Gregory v. Cott.

The question in this case is whether patients suffering from Alzheimer’s disease are liable for injuries they inflict on health care workers hired to care for them at home. Because agitation and physical aggression are common late-stage symptoms of the disease, injuries to caregivers are not unusual, California and other jurisdictions have established the rule that Alzheimer’s patients are not liable for injuries to caregivers in institutional settings. The California Supreme Court concluded that the same rule applies to in-home caregivers who, like their institutional counterparts, are employed specifically to assist these disabled persons. It is a settled principle that those hired to manage a hazardous condition may not sue their clients for injuries caused by the very risks they were retained to confront. “This conclusion is consistent with the strong public policy against confining the disabled in institutions. If liability were imposed for caregiver injuries in private homes, but not in hospitals or nursing homes, the incentive for families to institutionalize Alzheimer’s sufferers would increase. Our holding does not preclude liability in situations where caregivers are not warned of a known risk, where defendants otherwise increase the level of risk beyond that inherent in providing care, or where the cause of injury is unrelated to the symptoms of the disease.”

“As a general matter, Alzheimer’s patients and their families are liable under Civil Code section 41 for the injuries they inflict. Our holding bars recovery by only one class of plaintiffs: those employed to care for the patient. We also note that institutionalization is not an effective solution to the problem of injury to caregivers in general; as we have seen, it is not uncommon for Alzheimer’s patients to injure employees in institutions.”

“After weighing the public policies involved, we agree with those sister-state jurisdictions which have concluded that workers’ compensation, rather than tort recovery, is the appropriate means of compensating hired caregivers for injuries caused by Alzheimer’s patients.”

The dissenting opinion noted that “This is a hard case involving sad facts.” The dissent went on to point out several situations in which a caregiver will not be covered by workers’ compensation, and primary assumption of risk will bar any recovery for injuries of the type Gregory suffered, thus denying the caregiver any remedy for those injuries. Workers’ Compensation may not be available when there is no workers’ compensation insurance, or when the injured person is an independent contractor. “Under today’s ruling, the agency-provided home caregiver who is an independent contractor is barred from suing for injuries under the primary assumption of risk, and pursuant to long established principles he or she is denied workers’ compensation benefits as well.”

WCAB Clarifies UR Time Limits and That UR Not Required For Denied Body Parts

Shalisa Chamberlain was employed as a veterinary technician by Humphrey and Giacopuzzi Veterinary Hospital when she sustained injury to her low back, soft tissue, neck, buttocks, right hip, and feet due to weight gain.  She further alleged to have sustained injury to her psyche, vision, balance, urology, weight gain, brain, and internal organs.

Applicant’s PTP, Dr. Moelleken, issued a report on March 5, 2013 (signed March 16, 2013) and requested authorization for the following: (I) One year extension of gym membership; (2) Follow-ups with a psychiatrist; (3) Pain management follow-ups with Dr. Kenly; (4) Urology consultation to evaluate urinary retention and incontinence; (5) Neurology consultation to address headaches; (6) Follow-up in four weeks (not addressed in the WCJ’s Findings and Award); (7) 16 hours of home health assistance every week; and 8. Eight visits of additional chiropractic treatment for neck and back.

After receiving Dr. Moelleken’s report, State Fund submitted the following issues to UR: (I) the prospective request for a one-year gym membership extension; (2) the prospective request for “unknown home health assistant for 16 hours per week for unknown number of weeks”; and (3) the prospective request for eight sessions of chiropractic manipulation. State Fund did not request a UR with respect to the other treatment recommendations by Dr. Moelleken. The April 2, 2013 UR determination did not certify the request for gym membership, 16 hours of home health assistance per week, and eight sessions of chiropractic treatment.

The WCJ found that applicant sustained industrial injury “to her low back, soft tissue, neck, buttocks, right hip, and feet due to weight gain; and claims lo have sustained injury to her psyche, vision, balance, urology, weight gain, brain, and internal organs.” Thus there was no finding of injury to the disputed body parts. The WCJ also found that defendant’s utilization review (UR) determination was untimely and concluded that applicant was entitled to the following medical treatment: (a) a one-year gym membership extension; (b) a follow-up with a psychologist; (c) a follow-up with a psychiatrist; (d) pain management follow-ups with Dr. Kenly; (e) a urology consultation; (f) a neurology consultation; (g) 16 hours of home health assistance every week; and (h) eight visits of additional chiropractic treatment for the neck and back.

In its petition for reconsideration, State Fund contends: (I) its UR determination was timely and, therefore, the WCJ’s Order of medical treatment that was denied through UR was improper; and (2) the WCJ’s Order of medical treatment for body parts that have not been determined as industrial was also improper. The WCAB reversed in part in the panel decision of Chamberlain v Humphrey and Giacopuzzi.

Labor Code section 4610 provides that prospective or concurrent UR decisions “shall be made in a timely fashion that is appropriate for the nature of the employee’s condition, not to exceed five working days from receipt of the information reasonably necessary to make the determination, but in no event more than 14 days from the date of the medical treatment recommendation by the physician.” Although section 4610(g)(l) states that these time limits run “from the date of the medical treatment recommendation,” Administrative Director Rule 9792.9(b)(2) clarifies the 14 days run “from the claims administrator’s receipt” of the treatment recommendation. (Cal. Code Regs., tit. 8, § 9792.9(b)(2).) Dr. Moelleken’s report is dated March 5, 2013, but signed March 16, 2013. State Fund received it on March 22, 2013. The UR denial itself memorializes the efforts State Fund made to obtain additional information about the treatment request from Dr. Moelleken. The UR company faxed Dr. Moelleken on March 27, 2013 and March 29, 2013, requesting additional information regarding the chiropractic treatment request; however, this additional information was never received.

Where a treating physician fails to respond to requests for additional information, the WCAB concluded that a defendant’s UR denial is timely if it is issued within five days of the last request for additional information (provided, of course, the 14-day absolute limit is met). State Fund’s April 2, 2013 UR denial issued 12 days after it received Dr. Moelleken’s report, within the 14 day time limit for receipt of additional information to make a determination of the treatment recommendation. Therefore, the UR denial issued “in no event more than 14 days” from receipt of the report, and the denial was therefore timely as to the industrially-related treatment addressed by State Fund’s UR denial.

The additional information requested by State Fund related only to the 4 chiropractic treatment. However the WCAB concluded that State Fund was not required to issue separate partial denials with respect to the gym membership and the home health assistance within five days of its 6 March 22, 2013 receipt of Dr. Moelleken’s report. Neither section 4610 nor AD Rule 9792.9 (as it read in early 2013) requires separate partial denials. To “read any such requirement into section 4610 or Rule 9792.9 because to do so would create a procedural morass, not only for defendants issuing UR determinations, but also for injured employees who now face a statutory deadline for requesting Independent Medical Review (!MR) with respect to any UR determination.”

UR determinations for non-industrial body parts are not relevant, since non-industrial treatment recommendations are not subject to UR. (Simmons v. State of California, Dept. of Mental Health (2005) 70 Cal.Comp.Cases 866 (Appeals Board en banc).) The dispute over authorization of these treatment requests are, therefore, returned to the trial level for further development of the record and determination whether the disputed body parts are industrially-related.

Excellence in Workers’ Compensation Risk Management Awards Announced

Each year, National Underwriter’s Excellence in Workers’ Compensation Risk Management Award recognizes three organizations with exemplary loss control, safety and return-to-work programs. They are the leaders in this arena, all featuring success stories showing proven results. This year’s winners are AmQuip, Danos and Iron Mountain. All three companies are being profiled in its special cover feature in NU’s August issue, and also will be honored on Aug. 18 during the 69th annual Workers’ Compensation Educational Conference (WCEC), set for Aug. 17-20 at the Orlando World Center Marriott in Florida.

AmQuip knows the secret to a successful workers’ compensation program: zero injuries. A tall order, to be sure – especially when your company rents out and operates nearly 700 cranes in 47 states to refineries, power plants, and industrial and building construction sites. Eliminating injuries, however, was far from impossible, according to Jeffrey C. Hammons, vice president of risk management for the Philadelphia-based crane rental provider. The right training and participation among employees, the company and its carriers greatly payed off – and a shared passion for the company and its values doesn’t hurt, either.”We’re one of the three largest employers of union [crane] operators in the country,” Hammons says, and while he’s quick to point out that AmQuip’s partnerships with a lengthy list of local unions attract many eager candidates to work for the company, he acknowledges that when you source 300 to 500 seasonal employees, they come with varied levels of training and professional development. And therein lies Hammons’ No. 1 challenge to his workers’ compensation program. AmQuip has averaged $46,000 a year in workers’ compensation costs since 2009. Its workers’ compensation budgets are reduced by 15% each year that the company comes in below its previous budget.

Danos’ culture of safety yields a record number of incident reduction in often treacherous conditions. Headquartered in Larose, La., Danos provides contract labor services, construction and fabrication, sandblasting and painting services and consultants to the oil and gas industry worldwide. Founded in 1947 and currently boasting a workforce of more than 1,600 employees, Danos operates in the U.S. Gulf of Mexico and gulf coast region, Texas, Wyoming, Pennsylvania, Ohio and in several foreign countries, supplying personnel for various on-site oil and gas industry projects and work sites, including pipelines. “We provide people,” says Mayet. “They are our product.” The work, as one would surmise, is inherently dangerous – particularly on work sites set over water, such as oil rigs. Even traveling to the work sites can be treacherous: Boats and helicopters are used for transportation of personnel and supplies. Swing ropes and cranes are used to transfer personnel and supplies from vessels to platform. Platforms include machinery, high-pressure wells, boat landings, steel decks, stairways and handrails, all of which need continuous maintenance and upkeep to control the effects of a salt water environment on steel surfaces and electrical machinery. Yet through its dedication in recent years to achieving operational excellence, Danos has reached all-time lows in its total recordable incident rates at a time when the company’s personnel, man-hours and exposures have increased tremendously. As its time on-site and total number of personnel have grown in recent years, incidents are on an inverse track.

When Geoffrey Smith joined the risk management team at Iron Mountain in 2008, it was clear that the company required a sea change when it came to its workers’ compensation program. As the largest records-management company in the U.S. with operations in 35 countries, Iron Mountain’s employees face a number of on-the-job exposures. “We pick up and store boxes of customer paper records, computer tapes and media, and then return these records to our customers upon request,” explains Smith – boxes that can easily weigh up to 80 pounds. As a result, back and shoulder injuries are common. He set and achieved the goal of reducing their costs by half within five years.

On Aug. 18 during the conference, NU Executive Managing Editor Shawn Moynihan will lead a special roundtable at 1 p.m. during which attendees can learn some of the secrets behind these award-winning programs. The award is sponsored by Helmsman Management Services, a third-party administrator that offers claims management, managed care and risk-control solutions for businesses with 1,000 employees or more. Presented by the Workers’ Compensation Institute, WCEC is the largest gathering of its kind in the nation and offers discipline-specific programs and breakout sessions from hundreds of national speakers.

WCIRB Publishes Aggregate Medical Payment Trends Report

The WCIRB released the California Workers’ Compensation Aggregate Medical Payment Trends report comparing medical payment transaction data from the fourth quarter of 2013 to the fourth quarter of 2012. WCIRB researchers used reported medical payment data representing more than 90% of the California insurance market and accounting for approximately $1.3 billion in payments annually.

Among the findings of the report:

1) On a type of provider basis, specialist physicians, surgeons and services for hospital and ambulatory surgical centers services dropped from 53.6% of total medical paid in Q4 2012 to 49.5% in Q4 2013. During that same period, payments to general practitioners and occupational health providers increased from 13.1% to 16.2% of total paid medical.

2) On a place of service basis, payments to hospitals and ambulatory surgical centers dropped from 31.3% of total medical paid in Q4 2012 to 28.0% in Q4 2013. During that same period, office-based services increased from 47.5% of paid in Q4 2012 to 51.4% of paid in Q4 2013.

3) On a procedure basis, pharmacy spending increased from 12.8% of paid medical in Q4 2012 to 13.7% of paid medical in Q4 2013. Payments for opiates slightly declined from 3.8% of total paid medical in Q4 2012 to 3.7% in Q4 2013.

4) Pharmaceutical payments for 2013 and 2012 averaged approximately 13% of total paid medical as reflected in the WCIRB’s medical transaction data, while payments to pharmacists and pharmacies averaged about 9.7% for both years. These findings suggest that 3% to 4% of paid medical may be generated from physician dispensing in offices.

5) The fastest growing procedure between Q4 2012 and Q4 2013 was Level 4 office visits for existing patients, which is defined by the Official Medical Fee Schedule (OMFS) as involving a detailed history and examination for moderately complex medical decision-making. This code also grew the fastest between Q3 2013 and Q4 2013.

The report is available in the Research and Analysis section of the WCIRB website

UnitedHealth and Insurance Commissioner Battle Over $10 Billion Fines

Setting up a major legal fight, UnitedHealth Group Inc. has sued California’s insurance commissioner to block his attempt to fine the insurer $173.6 million for violations during a botched 2005 acquisition. The Los Angeles Times reports that the lawsuit, filed in Orange County Superior Court, is the latest twist in a long-running political drama. Four years ago, California sought a jaw-dropping fine of nearly $10 billion against UnitedHealth, the nation’s largest insurer. The penalty related to problems handling medical claims and policyholder applications after the insurer bought Cypress-based PacifiCare.

But that record penalty didn’t stand. Last year, an administrative law judge rejected much of the state’s case and said UnitedHealth should be fined no more than $11.5 million. California Insurance Commissioner Dave Jones rejected that ruling in a 220-page decision and imposed the $173.6-million penalty. He ordered UnitedHealth to pay it by July 22. That drew the lawsuit and a fiery response from UnitedHealth executives. The insurer, based in Minnetonka, Minn., said Jones was abusing his power and setting a dangerous precedent by seeking such stiff punishment for relatively minor violations. “This ruling threatens to paralyze the healthcare system in the state, resulting in more costs and bureaucracy for Californians,” said Stephen Scheneman, president of UnitedHealth’s PacifiCare unit. “We are taking this action to protect the interests of our customers, who depend on the availability of affordable health insurance.”

Byron Tucker, a spokesman for the insurance department, said the agency hadn’t had time to fully review UnitedHealth’s lawsuit. But he said, “Commissioner Jones carefully applied the law, and the department is confident the penalty will withstand the lawsuit.”

In its June 9 decision, the insurance department said its proposed fine “appropriately reflects the gravity of PacifiCare’s offenses and provides the necessary deterrent effect going forward.” The handling of the case by Jones, a Democrat running for reelection, could become a point of contention in this fall’s campaign over health insurance rate regulation. An initiative on the November ballot would give the insurance commissioner the authority to reject health insurance rate increases that he deems unreasonable. Health insurers, business groups and other opponents say the ballot measure gives the insurance commissioner too much power and subjects the rate-setting process to politics. Jones has said rate regulation is crucial to protect consumers and small businesses from excessive rate hikes. He also says the rate regulation authority is essential to fulfill the goals of the Affordable Care Act.

UnitedHealth has long acknowledged that the takeover of PacifiCare didn’t go as planned. The company admits numerous mistakes in processing medical claims and customer applications. California initially took action against UnitedHealth in 2008 under then-Insurance Commissioner Steve Poizner, a Republican. At first, he said a fine of $1.3 billion was warranted. Two years later – while Poizner was seeking the Republican nomination for governor – he upped the ante and sought as much as $10 billion in penalties. To justify the enormous fine, insurance regulators said UnitedHealth committed more than 900,000 violations after taking over PacifiCare. Poizner stood by his aggressive pursuit of the case while he was in office. He declined to comment directly on the latest developments. “When companies come to California and acquire healthcare organizations, and do not keep promises made to the California Department of Insurance and the people of California, there should be stiff fines,” Poizner said. “In my opinion, that’s what happened when UnitedHealth Group bought California-based PacifiCare.” Poizner is now chief executive of EmpoweredU, an education technology company in Campbell, Calif.

UnitedHealth had challenged Poizner’s proposed fines with an administrative law judge. The case dragged on from December 2009 to June 2013, and the state judge heard testimony and arguments for more than 230 days.In her August 2013 decision, Administrative Law Judge Ruth S. Astle found that “there were numerous problems related to the integration” of UnitedHealth and PacifiCare. She noted significant problems receiving, tracking and retrieving paper documents submitted to PacifiCare. PacifiCare identified 1,799 claims that it had denied in 2006 because of its failure to verify existence of previous coverage, court records show. “This is a serious violation in that it left some claimants with no coverage,” the judge wrote. “It is difficult to assess the full impact since some claimants may have given up and just waited out the six-month exclusion.” The administrative law judge, in setting her $11.5-million fine, noted that the insurer failed to pay claims correctly or on time.

The judge’s ruling was more in line with other penalties assessed against health insurers. The state’s other insurance regulator, the Department of Managed Health Care, cited many of the same problems and reached a settlement with UnitedHealth for a $2-million fine.

“Disabled” Berkeley Psychologist Convicted of $1 Million Income Tax Fraud

Hugh Leslie Baras, was sentenced to thirty months in prison today, and ordered to pay restitution of $593,513 to the Internal Revenue Service and the Social Security Administration for tax evasion and theft of government property, United States Attorney Melinda Haag, and Internal Revenue Service, Criminal Investigation Special Agent in Charge José M. Martinez announced.

On Feb. 3, 2014, Baras, 70, a Berkeley psychologist, was convicted by a jury of five counts of tax evasion, in violation of Title 26, U.S.C. § 7201, and one count of theft of government property, in violation of Title 18, U.S.C. § 641. The evidence presented during the seven-day trial, showed that Baras, who formerly worked as a psychologist at Kaiser Permanente, and as an Adjunct Clinical Assistant Professor in the Department of Psychiatry and Behavioral Sciences at Stanford University School of Medicine, started a solo, private practice in Palo Alto, Calif., in late 2002. At his private practice, Baras provided clinical psychotherapy services to clients. During the years 2005 through 2009, Baras’s private practice generated over $1,000,000 of income. Although he filed timely federal income tax returns for each of these years, Baras omitted all of the income produced by his private practice from those returns.

In addition, although he was self-employed and earning substantial income, Baras continued to collect Disability Insurance Benefits from the Social Security Administration. Between 2006 and 2009, Baras received Disability Insurance Benefits payments to which he was not entitled totaling $80,615. Also during this period, Baras sold nearly $600,000 worth of gold and silver coins to a coin-broker in Oakland. These sales created capital gains which Baras also failed to report on his tax returns.

The sentence was handed down by the Honorable Yvonne Gonzalez Rogers, United States District Court Judge, in Oakland. Judge Gonzalez Rogers also sentenced Baras to a three-year period of supervised release, ordered him to forfeit $80,615, and to pay a fine of $7,500. Baras was ordered to self-surrender for service of his sentence on Sept. 29, 2014.

WCJ Jane Madsen Moves to Eureka Office

The Division of Workers’ Compensation announced that Judge Jane Madsen will permanently transfer to the Eureka office effective August 1. Judge Madsen has been presiding over the calendar since former Presiding Judge Robert W. Kutz retired in 2013.

Judge Madsen will transfer from her former post as a judge in the Redding district office, where she has been since 2007. She joined DWC in 2005 as a workers’ compensation judge in the Long Beach office.

With only a single workers’ compensation judge, the Eureka office will become a satellite under the supervision of Santa Rosa Presiding Judge James Johnson. The transition will have no effect on access to the office by practitioners and injured workers in the Eureka area. Information and Assistance and Disability Evaluation services will be provided through coordination with the Santa Rosa and Redding offices, as they have been for some time.

The Eureka office will remain at its current location at 100 H Street, Room 202, although a move is possible in the future.

Activity Level May Predict Orthopaedic Outcomes

According to a literature review in the July issue of the Journal of the American Academy of Orthopaedic Surgeons (JAAOS), patients’ activity level is a strong predictor for how well they will do with certain treatments and how well they recover from injuries after treatment. Patients are encouraged to ask their orthopaedic surgeon if activity level is an important factor in their treatment decision. For example, more active patients are at a higher risk of re-injury after an anterior cruciate ligament (ACL) reconstruction, and activity level should be considered when deciding which graft to use in the ACL repair.

Easily administered, standardized scales for the shoulder, hip, knee and ankle are commonly used in orthopaedics to quantify a patient’s activity level. But, the measures of how often, rather than how well, a task is performed do not account for symptoms, functional disabilities, age, weight, overall health and other factors which also may impact prognostic and outcome variables.

“In orthopaedics, we want to restore function to take away pain and to help patients return to activity,” said orthopaedic surgeon and lead study author Robert H. Brophy, MD. “We’re still learning about how to best use, quantify and measure activity levels to optimize prognostics and outcomes.”

Shoulder: The strongest predictors for failure in rotator cuff tears were patient expectations on the efficacy of physical therapy and baseline activity level. After a rotator cuff tear, patients who were active were less likely to respond to nonsurgical treatment.

Hip: Preoperative activity levels, age, male gender and lower body mass index (BMI) were predictors of higher activity level at one and five years following total hip replacement surgery.Physical activity — including occupational lifting and standing — may accelerate the development and increased risk of osteoarthritis (OA).

Knee: Higher baseline activity, lower baseline BMI and higher level of athletic competition were associated with higher activity levels two years after ACL reconstruction.Female gender, smoking in the 6-month period before surgery, and revision ACL reconstruction were associated with lower activity level. Following ACL reconstruction, patients were significantly less satisfied if they had a lower post-surgical activity level. Increased incidents of knee injury and trauma in the athletic population, rather than participation in physical activity, may cause an increased risk of knee OA.

“There’s not just one activity level variable” in these measurements, said Dr. Brophy. “It depends on the population, the injury you’re studying, etc. We’re making progress, and the progress varies depending on what you’re looking at.”