Author: WorkCompAcademy

Minimally invasive surgeons at UC San Diego Health are the first in the nation to evaluate the potential use of spatial computing apps on Apple Vision Pro in the operating room. This feasibility study was initiated after two months of testing in the Center for the Future of Surgery at the University of California San Diego School of Medicine.

“As surgeons, we are always looking for technologies that can help us deliver more safe and precise surgeries for our patients,” said Santiago Horgan, MD, chief of minimally invasive surgery at UC San Diego Health and director of the Center for the Future of Surgery. “The experience of the surgeon in the operating room, while interacting with imaging, is critical to patient outcomes.”

“This study is investigating whether spatial computing technology can enhance the surgical experience. Using an app that can stream a video feed from other devices, Apple Vision Pro can display the patient’s medical imaging, vital signs and the surgical camera view in real-time to guide decision making while the surgeon operates in a more ergonomic position,” said Horgan. “We are exploring whether this technology could revolutionize the operating room environment to benefit patients and doctors.”

Patients consented to the use of the technology prior to the procedure. All surgeries were performed under the guidance of the Institutional Review Board, which ensures the safe treatment of research volunteers.

The current trial is evaluating this use for ergonomic and clinical capabilities. During the study, surgeons using Apple Vision Pro also have access to a simultaneous set-up of traditional operating room monitors and displays.

Surgeons may stand in a surgery for anywhere from 30 minutes to more than 12 hours, depending on the complexity of the procedure. The length of the surgery and concurrent use of multiple technologies mounted from floor and ceiling can take a negative toll on the surgeon’s body, especially the neck and shoulders.

“Published studies show that minimally invasive surgeons experience musculoskeletal pain at higher rates due to continuous use of multiple imaging systems,” said Ryan Broderick, MD, principal investigator and minimally invasive surgeon at UC San Diego Health. “More technology platforms in surgery often means that the physical space in the operating room is crowded. A spatial computing platform, however, allows for infinite digital space to display imaging and potentially an overall streamlined workflow.”

“With the successful completion of the first surgery using an app on Apple Vision Pro, we may identify new applications in health care technology,” said Christopher Longhurst, MD, executive director, executive director, Joan and Irwin Jacobs Center for Health Innovation, and chief clinical and innovation officer, UC San Diego Health. “The knowledge learned will potentially enhance the surgical experience and pave the way for transformative advancements in medical practice.”

Launched in 2021, the Jacobs Center for Health Innovation is dedicated to advancing digital health solutions, including wearables, apps, and leading-edge AI-driven health service models. The center’s mission is to enhance access to data, facilitate better communication between patients and health care providers, and empower individuals to make informed decisions about their health.

A federal jury has found a Hollywood Hills man guilty of nearly a dozen felonies for paying illegal kickbacks for patient referrals to his addiction treatment facilities located in Orange County. Casey Mahoney, 48, was found guilty earlier this month of one count of conspiracy to solicit, receive, pay, or offer illegal remunerations for patient referrals, seven counts of illegal remunerations for patient referrals, and three counts of money laundering.

According to evidence presented at a nine-day trial, from at least October 2018 to December 2020, paid nearly $2.9 million in illegal kickbacks to so-called “body brokers” who referred patients to Mahoney’s addiction treatment facilities, the Huntington Beach-based Healing Path Detox LLC, and the San Juan Capistrano-based Get Real Recovery Inc.

Those body brokers in turn paid thousands of dollars in cash to patients, which some patients used to purchase drugs, to induce those patients to attend treatment at Mahoney’s facilities. Mahoney concealed the illegal kickbacks by entering into sham contracts with the body brokers which purportedly required fixed payments and prohibited payments based off of the volume or value of the patient referrals.

In reality, Mahoney and the brokers negotiated payments based on the patients’ insurance reimbursements and the number of days Mahoney was able to bill for treatment. Mahoney also laundered the proceeds of the conspiracy through payments to the mother of one of the body brokers, which Mahoney falsely characterized as consulting fees.

The jury also found Mahoney not guilty of one count of aiding and assisting the preparation of a false tax document.

United States District Judge Josephine L. Staton scheduled a January 17, 2025, sentencing hearing, at which time Mahoney will face a maximum penalty of five years in prison on the conspiracy charge, up to 10 years in prison on each illegal remuneration count, and up to 20 years in prison on each money laundering count.

The FBI and IRS Criminal Investigation investigated this matter. The California Department of Insurance provided valuable assistance.

Assistant United States Attorney Nandor Kiss of the Santa Ana Branch Office and Justice Department Trial Attorney Siobhan M. Namazi of the Criminal Division’s Fraud Section are prosecuting this case.

Mahoney’s conviction arose out of violations of the Eliminating Kickbacks in Recovery Act (EKRA). EKRA was enacted in October 2018 as part of comprehensive legislation designed to address the opioid crisis in order to target the rise in body brokering and substance abuse facility profiteering.

Congress passed the Ryan Haight Online Pharmacy Consumer Protection Act in 2008, which requires the DEA, in conjunction with HHS, to promulgate permanent rules to allow practitioners to prescribe certain controlled medications via telehealth through a special registration pathway.

As of today, the agency still had not done so. In the advent of the Public Health Emergency, the DEA allowed DEA-registered practitioners to issue prescriptions for certain controlled substances to patients via telemedicine without requiring an in-person medical evaluation. The DEA authorization was temporary and is set to expire at year-end.

The American Telemedicine Association reports that these flexibilities have been a lifeline for countless individuals across the country, ensuring uninterrupted access to essential mental health care, substance use treatment, end-of-life care, and many other crucial treatments during a time when in-person visits were impossible or unsafe.

The ongoing challenges in accessing mental health and substance use treatment services, particularly in rural and underserved areas, underscore the importance of maintaining these flexibilities. More than half of U.S. counties do not have a psychiatrist. The shortage is even more prominent in rural areas, with nearly three quarters of rural counties lacking a psychiatrist. Telemedicine has proven to be an effective tool in bridging the gap between patients and providers, reducing barriers to care, and supporting those most in need. At its pandemic peak, telehealth represented 40% of mental health and substance use outpatient visits, and still remains strong, representing 36% of outpatient visits currently.

Given the widespread provider shortage across medical professions and specialties, this flexibility has been essential in ensuring that patients receive timely and necessary care. Continuing these practices is vital to sustaining access to treatment and addressing the ongoing healthcare challenges in underserved areas.

For these reasons, this week, more than 330 stakeholder organizations asked Congress and the White House to intervene to ensure ongoing access to remote prescribing of controlled substances. The letters were co-led by the American Telemedicine Association (ATA) and ATA Action alongside other like-minded partners and organizations. Stakeholders anticipate, based on current reporting, that the Drug Enforcement Administration (DEA) will dramatically limit virtual prescribing, either through new regulations or by allowing the existing flexibilities to expire at year-end.

“This is a predictable and preventable crisis that is looming come January 1 and we are quickly running out of time to save countless patients from being abandoned, left without lifesaving clinically appropriate care,” said Kyle Zebley, the ATA’s senior vice president, public policy, and executive director, ATA Action. “With each day, we are losing precious time the DEA needs to properly develop a rule that appropriately permits and regulates the prescribing of controlled substances through telehealth without jeopardizing the health and safety of Americans, especially those in underserved communities.”

Specifically, the letters to House and Senate leaders urge Congress to include a two-year extension of pandemic-era remote prescribing flexibilities for controlled substances in an end-of-year legislative package.

The letter to the White House recommends that the Biden Administration work with the DEA and other relevant agencies to use existing authorities to extend these flexibilities for two years, providing the DEA with additional time to fulfill its congressional mandate to establish a special registration pathway that balances access to medically necessary care with appropriate enforcement.

“President Biden has already pledged to do all he can to protect all Americans, especially those who are vulnerable, from losing access to vital healthcare services, and we are grateful for the Administration’s longstanding commitment to establishing telehealth as a permanent part of care delivery,”

Zebley added. “It’s in the hands of our policy champions in the Administration and Congress to safeguard the American people, create predictability for our providers, and modernize our healthcare system to make sure patients receive timely and necessary care. We continue to stand ready to work with policymakers to make telehealth a permanent option in a modernized healthcare system.”

On March 8, 2018, Tatyana Litvinova filed a putative collective-action complaint against the City and County of San Francisco alleging that the City violated the Fair Labor Standards Act by not paying staff nurses time-and-a-half for overtime work, including per diem shifts. Litvinova v. City and County of San Francisco, No. 3:18-cv-1494-RS (N.D. Cal.). She moved to certify a collective action under 29 U.S.C. § 216(b), and the district court granted the motion.

On October 22, 2020, Kristen Silloway, Christa Duran, and Brigitta van Ewijk filed a similar complaint on behalf of themselves and “similarly situated dual-status registered nurses.” Silloway v. City and County of San Francisco, No. 3:20-cv-7400-RS (N.D. Cal.). Given the factual similarity between the two cases, the district court issued an order treating them as related. Between the two separate collective actions, a total of about 353 plaintiffs opted in.

On cross-motions for summary judgment, the district court granted summary judgment in favor of the City, concluding that the staff nurses were paid on a “salary basis” and therefore exempt from the FLSA overtime requirements. Litvinova v. City and County of San Francisco, 615 F. Supp. 3d 1061, 1069 (N.D. Cal. 2022). The district court treated the published salary ordinance, which referred to staff nurses as salaried employees, as “dispositive evidence” that the nurses were compensated on a salary basis. The district court found the nurses’ hourly pay rates to be a mere “accounting fiction” used for administrative purposes, and it rejected plaintiffs’ allegations of improper pay deductions by finding that the City’s expert report provided adequate explanations for those discrepancies.

Silloway timely appealed the district court’s decision. Litvinova filed a Motion for Reconsideration under Federal Rules of Civil Procedure 59 and 60 and then, after it was denied, timely appealed as well.

The United States Court of Appeals for the 9th Circuit consolidated the two appeals for argument and decision. It reversed the grant of the summary judgment motion in favor of the City in the published case of Kristen Silloway, et.al. v City and County of San Francisco  22-16079 (September 2024).

The City of San Francisco employs staff nurses in its hospitals, jails, and clinics. Many work more than 40 hours in a week. The Fair Labor Standards Act provides that employees should generally receive time-and-a-half pay for working overtime, but one of the Act’s exemptions from that requirement applies to employees working in a bona fide professional capacity. The City claims that staff nurses fall into that exemption. The plaintiffs disagree.

The 9th Circuit concluded that the district court erred in granting summary judgment to the City. The salary ordinance, which the district court found to be dispositive evidence that the staff nurses were paid on a salary basis, is neither the starting point nor the ending point for that inquiry. Rather, the salary basis test asks whether an employee actually receives a predetermined amount of compensation on a weekly or less frequent basis as a matter of practice. In this case, the parties dispute several factual issues that are material to answering that question.

The most significant is whether staff nurses are guaranteed the opportunity to work the hours corresponding to their full-time equivalency every week. According to an expert report submitted by the City itself, the City recorded staff nurses as working or being credited for fewer hours than their full-time equivalencies in at least 72 employee pay periods out of more than 2,200 reviewed.

Because staff nurses are paid according to the number of hours they are recorded as working or otherwise credited, it is uncertain whether staff nurses received their predetermined amounts of compensation during these irregular pay periods.

Additionally, the FLSA’s “actual practice” and “window of correction” provisions offer the City no refuge, at least on summary judgment. Assuming that the 72 abnormal pay periods represent improper deductions – as must be done in reviewing a grant of summary judgment against the plaintiffs – the City made improper deductions much more frequently than in cases where courts have found that no “actual practice” existed.

Questions about the propriety of these 72 deductions leave material factual issues in dispute as to whether the City maintained an “actual practice” of making improper deductions. As for the “window of correction” defense, the City has not provided evidence showing that the staff nurses were reimbursed for any of these possibly improper deductions, so summary judgment cannot be granted or affirmed on that ground, either.

The panel reversed the district court’s summary judgment for the City and County of San Francisco, and remanded, in both cases.