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Court Affirms Cal/OSHA Citation for Freeway Construction Injury

In June 2014, while Atkinson Construction LP’s employees were erecting “falsework” near the I-405/I-605 interchange in Seal Beach for a new freeway bridge, an accident occurred, which seriously injured one of it’s employees.

Specifically, a forklift attempting to position a long steel beam atop two vertical falsework structures, known as “bents,” accidentally hit another beam, causing that beam and another to overturn and fall off the bents. Each of the steel beams weighed approximately 60,000 pounds.

As the beams collapsed Ramon Torres, an employee standing on one of the bents fell nearly 30 feet to the ground. Torres suffered serious physical injuries from the fall.

After an investigation, the Division cited Atkinson for violating a construction safety order – section 1709, subdivision (b)(1) – that requires beams to be “braced laterally and progressively” to prevent overturning.

Atkinson appealed the citation, but the Occupational Safety and Health Appeals Board denied the appeal. It then filed a petition for a writ of administrative mandate in the superior court which also was denied.

Atkinson appealed the denial of its writ petition, arguing that (1) the cited safety order does not apply because another, more specific, safety order governs falsework operations; and that (2) it complied with the more specific safety order. The Court of Appeal was not persuaded by these arguments, and affirmed the citation in the unpublished case of Atkinson Construction LP v. DIR Division of Occupational Safety and Health.

Atkinson requested the court of appeal to review the regulatory history of section 1709, subdivision (b)(1). However the court found no basis for doing so. The language clearly states that “[t]russes and beams shall be braced laterally and progressively during construction to prevent buckling or overturning.” (§ 1709, subd. (b)(1).) There is no ambiguity in the text to justify an inquiry into its regulatory history.

Despite the safety order’s plain language, Atkinson argues that section 1709 does not apply to falsework operations. It contends that falsework is a “separate and distinct” type of construction, with its own specific safety order (section 1717), and therefore the absence of any reference to falsework in section 1709 necessarily implies that it applies only to nonfalsework construction.

Prior Board decisions establish that more than one safety order may apply to a particular set of facts, even when the construction involves falsework. Here, section 1709 is part of the specific industry safety orders promulgated for the construction industry. Such construction safety orders establish minimum safety standards that apply to any employment “in connection with the construction, alteration, painting, repairing, construction maintenance, renovation, removal, or wrecking of any fixed structure or its parts.”

Thus, Atkinson’s falsework operations were covered by the construction safety orders, including section 1709.

Omicron Surge Forces Closure of Northern California Courts

The Santa Clara County Superior Court announced Wednesday that it is closing public counters and restricting courthouse entry through the end of the month because of staffing absences driven by the rapidly spreading omicron variant of COVID-19, joining other Bay Area courts that have also been limiting public access.

The decision to decrease the public’s access to South Bay court facilities is effective through Jan. 31, by which point officials plan to reevaluate whether to rescind or modify the restrictions.

This marks at least the third large-scale order in Santa Clara County to restrict court availability. Courthouses across the state were largely shuttered in the first few months of the pandemic and began widely installing teleconference and videoconference lines to maintain some level of court access.

Mercury News reports that the order echoes past restriction orders, limiting courthouse access to people directly involved in a court hearing; those submitting an in-person pleading; family-court petitioners seeking protective orders regarding domestic violence, gun violence, civil harassment, workplace and school violence, elder abuse, and juvenile dependency; and those seeking emergency orders for eviction and child-safety matters.

Our court is experiencing a significant number of employee absences, creating staffing shortages across all departments of the court,”  Presiding Judge Theodore Zayner said in a statement. “We are hopeful that these circumstances are transitory and will frequently reexamine conditions as we continue to serve the public through the pandemic and the current omicron variant surge.”

In San Mateo County, court officials have shifted many non-criminal hearings from in-person to Zoom, and have consolidated preliminary hearings to court facilities in Redwood City. Both San Mateo and Contra Costa counties have obtained emergency authorization from the state’s Judicial Council – which governs Superior Court operations in California – to postpone jury selection panels and trials that were set to start in January by as many as 30 days.

In Alameda County, the court has temporarily decreased telephone and in-person access to clerk’s offices to “allow the court to mitigate the ongoing surge in COVID cases brought about as a result of the rapid spread of the Omicron variant,” according to a court statement. The court will continue to monitor the situation and make additional changes as circumstances warrant.

The Alameda County court has also obtained authorization to postpone jury trials set to start in January and also to treat most of January as a holiday when it comes to many court filing deadlines. But it has also revived an emergency order, which was highly criticized as a due process violation when it was implemented in the first few months of the pandemic, to extend the allowable arraignment deadline for someone arrested and in jail custody from 48 hours to as many as seven days.

UC San Diego Health Resolves Medicare Billing Suit for $3 M

UC San Diego Health, the academic health system of the University of California, San Diego, has paid $2.98 million to resolve allegations that it violated the False Claims Act by ordering medically unnecessary genetic testing reimbursed by Medicare, the Justice Department announced today.

The settlement resolves allegations that, from December 2015 to October 2019, UC San Diego Health ordered and submitted referrals for medically unnecessary genetic testing performed by CQuentia Arkansas Labs, CQuentia NGS, and Total Diagnostic II (collectively “the CQuentia labs”). The government alleged that this conduct led to the submission of false claims for payment to Medicare for unnecessary genetic testing.

UC San Diego Health did not admit any liability as part of the settlement, which allowed the provider to continue to focus on patient care, said UC San Diego Health spokesperson Jacqueline Carr.

“Working at the forefront of patient care sometimes involves the use of new technologies from emerging companies. When UC San Diego Health learned that the Department of Justice had concerns about one of our technology providers, we fully cooperated and promptly resolved the matter,” Carr said in a statement. “The DOJ’s settlement announcement alleges that our doctors ordered tests from a company that then allegedly made false claims about those orders.”

“UC San Diego Health remains committed to integrating the leading best practices and technology into our research, teaching and patient care missions, in accordance with the highest standards of ethical conduct and all applicable laws and regulations,” Carr added.

Tennessee-based C Quentia has since apparently gone out of business.as it’s Website simply states “C Quentia has been closed” and tells previous customers how to obtain medical records.

The resolution obtained in this matter was the result of a coordinated effort between the Civil Division’s Commercial Litigation Branch, Fraud Section, and the U.S. Attorney’s Office for the Southern District of California, with assistance from the U.S. Department of Health & Human Services Office of Inspector General and the FBI.

“Ordering unnecessary genetic tests creates a drain on vital government-funded health care programs like Medicare,” said U.S. Attorney Randy Grossman. “This settlement is another example of this office’s commitment to work with our law enforcement partners to hold medical providers accountable when their conduct leads to taxpayers bearing the cost of improper billing practices.” Grossman thanked the prosecution team and investigators for their excellent work on this case.

Hospitals are the gatekeepers for medical care and are expected to ensure that all services performed at their direction, including genetic tests, are medically appropriate,” said Acting Assistant Attorney General Brian M. Boynton for the Justice Department’s Civil Division. “The department will continue to pursue those who undermine the integrity of federal health care programs and waste taxpayer dollars.”

This matter was handled by Nicholas C. Perros of the Civil Division’s Commercial Litigation Branch, Fraud Section, and Assistant U.S. Attorneys Joseph Price and Joseph Purcell of the U.S. Attorney’s Office for the Southern District of California.

The claims resolved by the settlement are allegations only, and there has been no determination of liability.

COVID Outbreak Returns WCAB to Telephonic Hearings

The Division of Workers’ Compensation announced that as of January 12, 2022, all hearings will be heard virtually.

Until further notice, DWC will telephonically hear all trials, lien trials, expedited hearings, and special adjudication unit (SAU) trials.

In addition, mandatory settlement conferences, priority conferences, status conferences, SAU conferences, and lien conferences will continue to be held on the individually assigned judges’ conference lines as announced in Newslines issued on April 3, April 28, May 28, August 12, September 9, 2020, and Sept. 1, 2021.

The division acknowledges that due to the recent surge in COVID-19 cases, a pause of in-person hearings is necessary at this time.

The pause will continue through the end of the month and will be reevaluated at that time.

DWC hearing notices will not change but parties should be aware that as of January 12, 2022, if a trial, expedited hearing, lien trial or SAU trial is set at a district office, all parties should call the judges’ assigned conference line and not appear in person.

The judges’ assigned conference lines may be found on the DWC webpage. All division offices will remain open during this time.

If a party to a DWC hearing has a question on a specific case, they may contact the DWC call center at (909) 383-4522.

Budget Proposes $4.9 B to Overhaul California Courts

California’s courts would see a sizable funding boost as part of Governor Gavin Newsom’s $4.9 billion judicial branch budget package that reflects a commitment to cybersecurity and other tech investments.

According to the report by Courthouse News, the proposal includes $34.7 million for electronic filing, digitizing records and updating case management software in fiscal year 2022-23, with plans to increase that amount to $40.3 million in fiscal year 2025-26.

It also devotes $33.2 million for better access to remote proceedings each year for two years, with $1.6 million in ongoing funding thereafter. “These resources will be used to provide a publicly accessible audio stream for every courthouse in the state,” Newsom said.

Cybersecurity and remote technology have taken center stage as courts moved proceedings online during the Covid-19 pandemic, a change made all the more permanent with the passage of Assembly Bill 716 last year. AB 716 requires courts to provide streaming audio or a public call-in line when courthouses close for public health reasons.

Discussing budget priorities with reporters in December, Judicial Council administrative director Martin Hoshino said “There’s a big year coming up for the trial courts. In this window in time we see the courts are still dealing with pandemic impacts, trying to safety operate and having some limited operational capacities. At the same time they have to groove and balance two modes of operation, which are in-person and remote stuff that people have pivoted to during the pandemic. We’re pushing hard for funds to be able to support so we can find our way through that in this particular year,”

The budget proposal also provides funding for other online services, like $2.6 million in 2022-23 and $1.7 million ongoing for electronic filing systems for domestic and gun violence restraining orders.

Newsom also assigned $15 million in general fund dollars to “timely and accurate data collection” from trial and appellate courts, saying, “This investment will enhance the ability of all three branches of government to assess court programs and resource needs.”

Criminal fines and accompanying administrative fees have historically been a leading source of court funding for the courts – adding $1 billion in revenue in 2020-21. But with the support of Chief Justice Tani Cantil-Sakauye, Newsom and his predecessor Jerry Brown have sought to eliminate what they see as undue burdens on the poor.

Other funds include $42.6 million in 2022-23 and $42.3 million ongoing to hire 23 state court judges, funding for new courthouses in Fresno, Santa Clarita, Fairfield, Quincy, and San Luis Obispo, as well as three projects already approved by the council — a new courthouse in Mendocino County and renovations to juvenile facilities in San Bernardino and Butte counties.

Newsom’s proposal drew an initial positive reaction from the chief justice on Monday. “I welcome the governor’s continuing commitment to sustainable funding in his budget proposal for the judicial branch. He clearly recognizes how important equal access to justice is for all Californians,” she said in a statement. “We look forward to working on this landmark budget proposal with his administration and the Legislature in the next few months as the budget becomes finalized.”

HHS Mandates Insurers Cover At-Home COVID Tests

On January 10, 2022, the Departments of Health and Human Services (HHS), Labor, and Treasury announced new guidance outlining how insurers and group health plans will be required to cover and reimburse enrollees for up to eight at-home tests for COVID-19 per enrollee per 30-day period. This policy applies to tests purchased beginning on January 15, 2022 through the end of the declared public health emergency.

Healthaffaris.org reports that under the new guidance, insurers are incentivized to use their bargaining power with in-network pharmacies and other retailers to ensure that enrollees can obtain at-home COVID-19 tests without cost sharing (i.e., for free) at the pharmacy or retail counter.

The January 10 guidance clarifies that insurers and plans must cover and reimburse members for up to eight OTC COVID-19 diagnostic tests per enrollee per 30-day period.

In general, insurers and plans cannot limit coverage or reimbursement to only tests purchased at in-network pharmacies and other retailers. Put another way, a member can seek reimbursement no matter where they purchased their test from – whether at an in-network pharmacy or through Amazon.

But HHS strongly encourages insurers and plans to pay manufacturers or sellers directly for OTC COVID-19 tests. To that end, the guidance creates a safe harbor from enforcement for those that set up a “direct coverage” option. Under this option, the insurer or plan will arrange for OTC COVID-19 tests to be free (i.e., with no cost sharing) for enrollees through its in-network pharmacies and other retailers. Insurers and plans cannot impose prior authorization or medical management requirements – and must ensure that members truly have access to COVID-19 tests through an adequate number of retail locations.

Those that offer direct coverage will be allowed to limit reimbursement to $12 per test or the actual price of the test (whichever is lower) when a member purchases a test from a non-network pharmacy or retailer. This $12 limit helps mitigate the risk of price gouging by manufacturers and sellers. If payer reimbursement was uncapped, manufacturers and sellers might be tempted to raise the price of tests significantly, putting COVID-19 tests further out of reach for millions of people.

Insurers and plans can, of course, take reasonable steps to prevent, detect, and address suspected fraud and abuse, and the guidance identifies some examples of permissible activities for doing so.

For instance, an insurer or plan can require an attestation, signature, or proof of purchase to confirm that an OTC COVID-19 test was purchased for the enrollee’s use (as opposed to someone else’s use), has not been reimbursed by another source, and is not for resale.

Insurers and plans can adopt these types of fraud prevention measures so long as they do not create significant barriers for obtaining tests (such as requiring enrollees to submit documents or delaying reimbursement).

No Quarantine Requirement for California Healthcare Workers

The California Department of Public Health issued guidance that allows health care networks to enable COVID-19-positive employees to keep working if they don’t show any symptoms.

“The department is providing temporary flexibility to help hospitals and emergency services providers respond to an unprecedented surge and staffing shortages. Hospitals have to exhaust all other options before resorting to this temporary tool. Facilities and providers using this tool, should have asymptomatic COVID-19 positive workers interact only with COVID-19 positive patients to the extent possible,” the Department of Public Health said in a statement to news outlets over the weekend.

The Epoch Times contacted the agency for comment.

Health care workers in the state now don’t have to isolate or show a negative COVID-19 test, the guidance said, before coming back to work if they are asymptomatic. The guidance, which remains in effect until Feb. 1, stipulates that staff wear N95 respirator masks while on the job.

After the guidance was handed down, several unions that represent nurses and other hospital staff expressed alarm.

“Healthcare workers and patients need the protection of clear rules guided by strong science. Allowing employers to bring back workers who may still be infectious is one of the worst ideas I have heard during this pandemic, and that’s really saying something,” Bob Schoonover, the head of union SEIU California, told CBS Sacramento.

Schoonover added that while his union supports “supplemental paid sick leave,” the latest guidance imperils a “critical piece of the protection that workers and the public need.”

The president of the California Nurses Association, Sandy Reding, told local media that the California health department’s guidance will put patients at risk.

“We are very concerned,” she told KNTV news. “If you have health care workers who are COVID positive care for vulnerable populations, we can spread the COVID virus inside the hospital as well.”

Union officials did not mention the rampant staffing issues that have plagued hospitals across the United States and California in recent days.

Health giant Kaiser Permanente suspended more than 2,000 employees who were not vaccinated in October. Other California systems such as Santa Clara Valley Medical Center and Sutter Health also terminated or suspended their employees who weren’t vaccinated in the fall of 2021.

Meanwhile, Dr. George Rutherford, professor of Epidemiology at the University of California San Francisco, told KNTV that the guidance revision isn’t anything new.  “This is about having infected people taking care of infected people. We did this with Ebola in South Africa. We’ve done it before. It’s not the first play option in our playbook. I think staffing issues are such that it led the state to put this guidance out,” he told the outlet.

It comes days after the Newsom administration mandated that booster shots be given to certain health care staffers by Feb.

Study Says Common Cold T-Cells Provide COVID-19 Protection

Is there any good news in the horizon about the COVID Pandemic.

A new study just published today in Nature Communications by Imperial College London found that High levels of t-cells from common cold coronaviruses can provide protection against COVID-19. T-cells are also believed to play a vital role in providing protection, however, evidence of whether these T cells could provide such a protective effect has been lacking.

The study, one of the first designed to find such scientific evidence, began in September 2020, looked at levels of cross-reactive T-cells generated by previous common colds in 52 household contacts of positive COVID-19 cases shortly after exposure, to see if they went on to develop infection.

It found that the 26 who did not develop infection had significantly higher levels of those T-cells than people who did get infected. Imperial did not say how long protection from the T-cells would last.

We found that high levels of pre-existing T cells, created by the body when infected with other human coronaviruses like the common cold, can protect against COVID-19 infection,” study author Dr Rhia Kundu said.

Current COVID-19 vaccines target the spike protein, which mutates regularly, creating variants such as Omicron which lessen the efficacy of vaccines against symptomatic infection.

“In contrast, the internal proteins targeted by the protective T-cells we identified mutate much less,” Professor Ajit Lalvani, co-author of the study, said.

“Consequently, they are highly conserved between the various SARS-CoV-2 variants, including Omicron. New vaccines that include these conserved, internal proteins would therefore induce broadly protective T cell responses that should protect against current and future SARS-CoV-2 variants.

Cal/OSHA Updates COVID FAQs on Isolation and Quarantines

Cal/OSHA just updated its FAQs on COVID-19 Prevention Emergency Temporary Standards (ETS) to incorporate new guidance from the California Department of Public Health (CDPH) on isolation and quarantine periods.

In December 2020, Governor Newsom issued Executive Order N-84-20, which states that the recommended isolation and quarantine periods in the ETS will be overridden by any CDPH applicable isolation or quarantine recommendation if the ETS periods are longer than those recommended by CDPH.

The CDPH Updates as of January 6, 2022 clarified quarantine for workplace settings for fully-vaccinated persons who are booster-eligible, but have not yet received their booster dose. And removed Appendix to determine when a person is “booster-eligible” and instead provided direct link to CDC recommendation.

With only one exception noted in the FAQ, the new isolation and quarantine recommendations from CDPH replace the exclusion periods and return to work criteria in sections 3205(c)(9) and 3205(c)(10) of the ETS.

Persons Who are Exposed to Someone with COVID-19 (Quarantine) – Unvaccinated; OR Vaccinated and booster-eligible but have not yet received their booster dose (Refer to CDC COVID-19 Booster Shots to determine who is booster eligible):

– – Stay home (PDF) for at least 5 days, after your last contact with a person who has COVID-19.
– – Test on day 5.
– – Quarantine can end after day 5 if symptoms are not present and a diagnostic specimen collected on day 5 or later tests negative.
– – If unable to test or choosing not to test, and symptoms are not present, quarantine can end after day 10.
– – Wear a well-fitting mask around others for a total of 10 days, especially in indoor settings (see Section below on masking for additional information).
– – Strongly encouraged to get vaccinated or boosted.
– – If testing positive, follow isolation recommendations in another section of the guidance.
– – If symptoms develop, test and stay home.

In a workplace setting, asymptomatic employees in this category are not required to stay home from work if:

– – A negative diagnostic test is obtained within 3-5 days after last exposure to a case
– – Employee wears a well-fitting mask around others for a total of 10 days
– – Employee continues to have no symptoms.

Persons Who are Exposed to Someone with COVID-19 (No Quarantine) – Boosted; OR Vaccinated, but not yet booster-eligible.

– – Test on day 5.
– – Wear a well-fitting mask around others for 10 days, especially in indoor settings (see Section below on masking for additional information)
– – If testing positive, follow isolation recommendations above.
– – If symptoms develop, test and stay home.

Workers who have questions about COVID-19 hazards at work can call 833-579-0927 to speak with a Cal/OSHA representative during normal business hours.

NCCI Evaluates Various Drug Formulary Implementations

As more and more states look for opportunities to manage prescription drug utilization in their Workers Compensation systems, closed drug formularies continue to receive increased attention as a tool for managing the utilization of prescription drugs.

One of the key components is to provide evidence-based guidance to physicians when prescribing drug treatments for injured workers. One such formulary, which has been implemented in several states, is the Official Disability Guidelines Workers’ Compensation Drug Formulary.

Using data from NCCI’s Medical Data Call, this new report examines changes in price and utilization trends in WC prescription drug experience following implementation of the ODG Formulary for two different sets of states:

– – States which recently adopted mandatory use of the ODG : Indiana, Kentucky, and Montana. For these states, we look at pharmacy utilization trends before and after the
– – States where the initial impacts of formulary implementation were first studied by NCCI in 2019: Arizona and Tennessee. For these states, we focus only on post-implementation trends to observe longer-term impacts of the drug formulary.

To the extent possible, post-reform experience in each state is compared against a control group of nonformulary states in an attempt to isolate any effects specific to the formulary.

KEY FINDINGS – INITIAL IMPLEMENTATION EFFECTS (IN, KY, MT)

– – Decreased utilization of drugs contributed to overall cost declines in each of the three states in the period immediately after formulary implementation.
– – Post-reform decreases in drug costs for each state were comparable to decreases in overall drug costs observed in nonformulary states for the same periods.

KEY FINDINGS – CONTINUED IMPLEMENTATION EFFECTS (AZ, TN)

– – Overall drug costs decreased in each of the subsequent post-reform periods for both states. Overall cost declines were driven by decreased utilization of drugs, with a more significant decline in the utilization of drugs requiring prior authorization (N-drugs) relative to those that do not require prior authorization (Y-drugs).
– – ​Opioid utilization declined by more than 20% in each post-reform period for both states; however, similar declines in opioid utilization were observed in nonformulary states for the same periods. – – Utilization of topicals continued to decrease in Tennessee in the post-formulary periods while the share of topicals increased in Arizona.

Payors (i.e., insurers) in nonformulary states may use some prescription drug management practices when authorizing certain drugs despite the lack of a state-mandated drug formulary. The utilization of a formulary is a behavioral phenomenon and thus the resulting experience depends on the extent to which such formulary is used to make prescribing decisions by the physician, the insurer, and the injured worker.

Please note that the findings in this report are largely observational, rather than inferential.