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Legislature Passes Limits on Professional Athlete Claims

Months of heavy lobbying by the National Football League and other professional sports team owners paid off when lawmakers gave final passage to a bill to limit most workers’ compensation claims by out-of-state professional athletes.

The bill, AB 1309 by Assemblyman Henry T. Perea (D-Fresno), cleared the Assembly on a 66-3 vote and was sent to Gov. Jerry Brown. The governor is expected to sign the bill into law, Perea’s office said.

The Los Angeles Times says that last week, the measure received an overwhelming endorsement in the state Senate with a 34-2 vote. Perea’s proposal, which was opposed by the NFL Players’ Assn. and the AFL-CIO, would close a provision in California law that allowed players from out of state to file workers’ compensation claims for so-called cumulative trauma, including head injuries that manifested themselves years after their careers had ended.

Many of those players may have participated in just a handful of games in California over the course of their careers.

During the bill’s eight-month transit through the Legislature, team owners argued that California had become a de facto forum for claims filed against football, baseball, basketball, hockey and soccer franchises and their insurance companies.

Players unions countered that the employers don’t want to be responsible for their former workers’ head injuries and other ailments.

Former athletes have filed more than 4,400 claims involving head and brain injuries since 2006. This bill would not affect pending claims. Provisions that initially would have had a retroactive effect were removed by a September 5 amendment to the bill. The bill now contains language in paragraph 3600.5 (h) tat says “the amendments made to this section by the act adding this subdivision apply to all claims for benefits pursuant to this division filed on or after September 15 2013.” The previous version of the bill had provisions that would have applied retroactively to all pending claims not yet adjudicated. Thus thousands of these claims already in the system will continue to move forward.

Pundits say that Governor Brown will sign this bill into law. The governor has until Oct. 13 to sign or veto the bill.

Wife Arrested for Cashing Comp Benefits After Injured Husband Dies

Huntington Park resident Rosa Maria Barajas, the wife of injured worker Jesus Barajas, was arrested for allegedly continuing to cash workers’ compensation structured settlement benefits after her injured husband died. She was receiving approximately $18,000 per month, each month after his death in May 2010.

Jesus Barajas suffered an industrial accident in October of 1997 when he fell from a scaffold while working for Aramark Uniform Services. As a result of his accident and serious injuries, Jesus was comatose and declared legally brain dead. Due to his condition, Rosa was appointed his legal guardian in April of 1998 by the Workers’ Compensation Appeals Board and placed in charge of all his financial dealings and pending workers’ compensation suit.

New York Life contacted the California Department of Insurance in January of 2013 to report that Barajas was continuing to collect on her deceased husband’s workers’ compensation structured settlement. Barajas had been receiving monthly payments of over $18,000 that would continue only while Jesus Barajas was alive according to the September 2000 Workers’ Compensation Appeals Board Order. As part of the agreement Rosa Barajas was directed to notify New York Life in the event of the demise of her husband, but according to the investigators she failed to do so when Jesus Barajas died in May of 2010.

Bail has been set at $505,341. If convicted, Barajas faces up to five years in state prison and a fine in excess of $500,000.

Panel Decision Allows Use of AMA Guides 6th Edition to Support Lower WPI

Edward Frazier, a peace officer with the Department of Corrections, had a presumptive (L.C. 3212.1 0) industrial heart trouble with diagnosed hypertensive heart disease accompanied by mild left ventricular hypertrophy.

The AME, Dr. Ng, provided an analysis that in his opinion that under the American Medical Association Guides to the Evaluation of Permanent Impairment, Fifth Edition,Table 4-2, (Criteria for Rating Permanent Impairment Due To Hypertensive Cardiovascular Disease AMA 5lh edition) would require a finding that he has a 30% Whole Person Impairment. l

However, the AME was of the opinion that this WPI while appropriate is not an accurate representation of the injured worker’s impairment. Doctor Ng referred to the new AMA Guides 6th Edition as a “standard text or recent research data” to support his conclusion that 30%WPI was too high. He concluded the writers of this recent publication decided that the 30% WPI was too high for asymptomatic mild ventricular hypertrophy. The 6th edition he states shows that for a gentleman with the same mild left ventricular hypertrophy an impairment of 23% WPI is recommended. He concludes that the authors of the AMA guides sixth edition have recognized the accuracy problem (in the 5th edition) and reduced the whole person impairment to a rating of 24% for left ventricular hypertrophy. By inference it is his clinical judgment this lower WPI is more accurate.

In conclusion the AME chose 24% as the most accurate description of this injured workers impairment. This percentage was a combination of his consideration of the analysis of the writers of the AMA 6th edition, his clinical judgment as well as his analogizing with the Coumadin paragraph 9.6C of the AMA 5th edition which has a lower impairment for asymptomatic conditions with serious health risks.

The 24% impairment after the formal rating resulted in a permanent partial disability of 44% which was awarded by the WCJ.

The WCAB denied reconsideration in the panel decision of Edward Frazier v State of California, CDCR – Correctional Training Facility.

Study Says Steroid Injections Offer Only Short Term Relief for CTS

Steroid shots for carpal tunnel syndrome may help some sufferers in the short term, but most people end up having surgery whether or not they get the shots, according to a small new study reported by Reuters Health.

Researchers in Sweden found that one year after diagnosis, three quarters of carpal tunnel patients who tried steroid shots and other treatments first had opted for surgery while more than 90 percent of those who did not get the shots had the surgery. “We did not know how effective steroid injections are so we were not expecting any particular result,” said lead author Dr. Isam Atroshi of Hässleholm Hospital.

According to this study, steroids usually don’t help enough to avoid surgery, which is “somewhat surprising” since many doctors routinely order the shots, Atroshi told Reuters Health. It’s estimated that one in 20 adults in the U.S. will experience carpal tunnel syndrome, as a result of pressure on the median nerve that runs from the arm into the hand, through the so-called carpal tunnel formed by bones and ligaments of the wrist. If ligaments forming the tunnel, or tendons that also run through the tunnel, become swollen, pressure on the nerve can cause tingling, weakness or pain in the wrist and hand. The condition, which can affect one or both hands, is initially treated with wrist splints, then if rest doesn’t bring improvement, with steroid shots. When neither splints nor steroids seem to help, the next step is surgery, an effective but costly remedy.

Atroshi and his coauthors gave injections of 80 milligrams methylprednisolone, or 40 milligrams of the steroid or a dummy shot to 111 carpal tunnel syndrome patients between 18 and 70 years old who had already tried wrist braces with no luck. Ten weeks later, patients who had received the steroids were less likely to report pain, numbness or tingling than those who got a placebo. At the one-year mark, however, 73 percent of the patients who got the 80 mg steroid shots had the surgery, as did 81 percent of patients who got the lower steroid dose and 92 percent of those who had a placebo shot. Though patients who got the highest dose of steroids were less likely to have surgery by one year, there were no differences between the three groups in reported pain at that point, according to the results published in the Annals of Internal Medicine.

Complications are unlikely with either treatment, Atroshi said. “Surgery is effective because, by dividing the ligament that forms the roof of the tunnel, or ‘opening’ the carpal tunnel, there will be a rapid dramatic decrease in the pressure and symptom relief, and the effect is usually durable,” he said.

The cause of carpal tunnel syndrome is not completely known, but it’s not surprising that surgery is more effective than shots, according to Dr. Charles Leinberry, a hand surgeon at the Rothman Institute in Philadelphia. Steroids temporarily reduce local swelling and relieve pressure in the tunnel, but surgery actually makes the tunnel bigger and is a permanent solution, said Leinberry, who was not involved in the study. “Surgery adds approximately 25 percent to the volume of the carpal tunnel area and provides more room for the tendons and nerves present in the tunnel,” he said.

Experts didn’t think the new study’s results would change the way carpal tunnel syndrome is treated. Most doctors first recommend splints, which can be very effective when used early, and take a medical image of the wrists to determine how severe the diseases is, Leinberry said. Steroids can help control pain for a short while if the disease is not severe, but can probably be skipped if the carpal tunnel syndrome is severe and requires surgery, he said.

JPIA Warns City About Interference With Work Comp Claims

The Imperial Valley Press claims that past behavior of City Council members of the city of Calexico has put the city in some hot water with the California Joint Powers Insurance Authority, which issued the city a warning letter earlier this year.

The California Joint Powers Insurance Authority is an organization that provides members with coverage such as liability protection, a workers’ compensation program, property insurance program and more.

In a letter to City Manager Oscar Rodriquez, California JPIA Assistant Executive Officer Norman A. Lefmann wrote, “It has come to our attention that members of the City Council may be inserting themselves into the interactive process for workers’ compensation claims which is inconsistent with good governance.”

The California JPIA periodically reviews members’ risk management practices as part of the authority’s Loss Control Action Plan program. The city was evaluated in June 2009 and the action plan was presented in March 2010. However, “the city has made very little effort in reducing the number of action items,” Lefmann wrote in the letter.

“We believe that good governance is about the City Council largely being policy setting in terms of their actions and concerns and to leave it to the city administration to manage the affairs of the operations, including hiring and firing employees, reviews of workers compensation injuries, how they respond to claims, etc,” Lefmann explained. He did not cite any particular City Council member or specific action but said “when we see that the City Council is interfering with best practices and recruiting a police chief and creating potential divisiveness on who might replace the police chief,” there’s “another concern as potential claims may arise.”

The hiring of Police Chief Pompeyo Tabarez earlier this year was the end of a controversial hiring process that in many ways further divided the council.

Lefmann did say that the city has generally made a good effort to respond to the issues brought up and the city and the California JPIA is moving ahead to work more closely to address these kinds of concerns. Mayor Bill Hodge said Rodriquez has informed the council of the situation and “it has happened because of a series of incidents.”

He specifically cited “a lot of workman’s compensation claims” and the sexual harassment claims filed by council member Maritza Hurtado against councilmen Luis Castro, Joong Kim and Hodge. He said he was “surprised” by the reference to the police chief selection process. “It was an option for us as council people to participate in selection of a new chief which we did but they’re citing that also,” he said.

California JPIA representatives will be meeting with City Council members individually, he said, but added that he’s “not exactly sure what plans are to be carried out.”

DWC Lien Fee Collection System Earns Technology Award

The California Department of Industrial Relations (DIR) announced that the Division of Workers’ Compensation’s Lien Fee Collection System for the Electronic Adjudication Management System (EAMS) has won a 2013 Digital Government Achievement Award.

“This award recognizes our dedicated staff’s use of innovative technology to create efficiencies in California’s workers’ compensation system while implementing the reforms of SB 863,” said DIR Director Christine Baker.

“Allowing the public to access critical services without inconvenience continues to be one of our main goals,” said DWC Acting Director Destie Overpeck. “This award is well deserved. Special thanks to OIS for helping to get this developed and implemented without a hitch.”

The award was presented by the Center for Digital Government, a national research and advisory institute on information technology policies and best practices in state and local government. DIR was honored in the “Driving Digital Government” State Government category for its outstanding implementation of one of the directives in Senate Bill 863.

Among the changes SB 863 made to California’s workers’ compensation system was regarding the filing of liens. SB 863 mandated a fee for certain liens filed after January 1, 2013, and specified that these must be paid electronically. DWC and DIR’s Office of Information Services (OIS) added functionality to the EAMS public information search tool allowing lien filers to file liens and pay fees in one integrated process.

EAMS was developed in 2008 as a seamless case management process for different, but interrelated units of the workers’ compensation system. EAMS also allows external users to file documents over the Web and compiles information that helps move cases through the workers’ compensation court system without delay.

DWC Issues Warning About Interpreter Rules

The California Division of Workers’ Compensation (DWC) issued a notice reminding claims administrators that failure to provide a necessary interpreter at a medical treatment appointment may constitute a failure to provide medical treatment. Examples of a failure to provide medical treatment include a situation where the lack of an interpreter’s services prevents the exam from going forward or inhibits the injured worker’s ability to communicate with the primary treating physician. Such conduct could also result in penalties and/or sanctions against the claims administrator.

The notice goes on to say “It has come to DWC’s attention that some claims administrators are not responding timely to requests for provisional certification of interpreters, and not arranging for other interpreters to attend medical treatment appointments. As a result, some appointments are not going forward as scheduled.”

Labor Code Section 4600(g) provides that injured workers who cannot communicate effectively in English with their primary treating physician are entitled to the services of a qualified interpreter at all medical treatment appointments.

“Qualified interpreters” for purposes of medical treatment appointments may be, but are not required to be, formally certified. They can be provisionally certified by agreement of the employer prior to providing interpreting services. Employers are not required to pay for the services of interpreters who are not formally or provisionally certified.

Interpreters certified for medical treatment appointments or medical legal exams qualify through successfully passing the Certification Commission for Healthcare Interpreters (CCHI) exam or by passing the National Board of Certification for Medical Interpreters (National Board). Interpreter services FAQs and information on recently approved interpreter services regulations are posted on DWC’s website.

Juliann Sum New Acting Chief of Cal/OSHA

Christine Baker, Director of the Department of Industrial Relations (DIR), today announced that Juliann Sum will serve as the Acting Chief of Cal/OSHA. Sum will head the Division of Occupational Safety and Health following the resignation of Ellen Widess. Cal/OSHA is a division of DIR.

Widess expressed her appreciation of the men and women of the Division and their commitment to ensuring workplace safety. She will continue as Special Advisor to Director Baker.

Juliann Sum has worked for over 26 years to help workers understand and exercise their legal rights through numerous educational materials, training workshops, and consultation with legal aid groups that assist low-wage and immigrant workers. She joined DIR in May 2012 as a Special Advisor to Director Baker. Sum served at UC Berkeley from 1994 to 2012 as Project Director with the Institute for Research on Labor and Employment, and Consulting Attorney and Industrial Hygienist with the Labor Occupational Health Program. Her extensive experience includes work as an Associate Attorney with the Environmental Law Foundation and Industrial Hygienist and Business Representative with the International Brotherhood of Electrical Workers Local 1245.

Sum earned a law degree (with honors) from UC Hastings College of the Law, a Master of Science degree in environmental health sciences from the Harvard School of Public Health, and a Bachelor of Science degree in biophysics from Brown University.

“Juliann’s focus will be on prevention – strong enforcement, compliance, outreach and education,” said DIR Director Christine Baker. “I thank Ellen for her dedicated service and look forward to her knowledgeable advice in her new role. I am confident that Juliann’s extensive background and experience will further the Administration’s commitment to a comprehensive Cal/OSHA program.”

Five Thousand Dollar Surgery Costs Quarter Million – In Monterey Park!

When it comes to reducing one’s hospital bills, a key factor is location, location, location. A patient who undergoes joint-replacement surgery in Ada, Oklahoma, might receive a $5,300 hospital invoice for services rendered. But, according to an article in The Atlantic Cities, somebody who gets the same operation in Monterey Park, California, could be staring down the barrel of a much huger bill – $223,000, to be exact.

These were the average lowest and highest prices in 2011 for one particular joint-swapping procedure in the United States, according to federal data. They show in stark light how hospitals charge vastly different amounts for almost identical services, a peculiarity of the American healthcare system that Steven Brill wrote about this year in a Time cover story. Brill spent months investigating how hospitals calculate the bills they stick to patients; here’s Time describing one of his findings:

“Hospitals arbitrarily set prices based on a mysterious internal list known as the “chargemaster.” These prices vary from hospital to hospital and are often ten times the actual cost of an item. Insurance companies and Medicare pay discounted prices, but don’t have enough leverage to bring fees down anywhere close to actual costs. While other countries restrain drug prices, in the United States federal law actually restricts the single biggest buyer – Medicare – from even trying to negotiate the price of drugs.”

While some people have taken issue with Brill’s facts, the basic point that hospital pricing is opaque and often unfair is on target. The Centers for Medicare and Medicaid Services seem to be on board with this assessment. After Brill’s article appeared, the centers disgorged a trove of information dealing with what hospitals charged and what Medicare actually paid for 100 common procedures in 2011. The data revealed not just major differences among the states, but local variations as well. Reports Health 2.0: “For example, average inpatient hospital charges for services that may be provided to treat heart failure range from a low of $21,000 to a high of $46,000 in Denver, Colo., and from a low of $9,000 to a high of $51,000 in Jackson, Miss.”

The higher-value hospitals are clumped in the center of the United States. Two of the best-ranked ones hail from Arkansas – the Surgical Hospital in Little Rock and the Physicians’ Specialty Hospital in Fayetteville – followed by medical centers in Villa Rica, Georgia; Grinnell, Iowa; Paola, Kansas; Boise, Idaho; and Wichita.

Some of the lowest-ranked hospitals can be found in California locales like Porterville, Hemet, and Fresno, and in Floridian burgs like Dade City, Fort Myers, and Saint Petersburg, with others in Illinois, Oklahoma, Tennessee, New Mexico and elsewhere:

Lawmakers Back Off Of Medical Board Overhaul

Legislation once seeking major reform of the Medical Board of California was gutted and passed by a key Assembly committee last week

The state agency that regulates doctors is facing sunset review this year, meaning it will cease to exist if lawmakers and the governor don’t reauthorize it.

Senate Bill 304 is a vehicle to make changes and unwind or reauthorize the agency. Initially authored by Sen. Curren Price, it is now carried by Sen. Ted Lieu. Price left office to take a seat on the Los Angeles City Council on July 1. This bill includes numerous provisions related to the Medical Board of California (MBC) that emerged during sunset review of the Board in 2012; The bill as it is now written, extends the Medical Board’s sunset date until January 1, 2018 and makes MBC subject to review by the appropriate policy committees of the Legislature.

Amendments approved Tuesday eliminated a key enforcement reform that would have moved all staff investigating dangerous doctors to the California Department of Justice. The bill now moves investigative staff to Division of Investigation in the California Department of Consumer Affairs, keeping enforcement split between that department and the medical board staff.

The bill was also amended to extend Medical Board operations for four years. Price had threatened to pull the plug on the agency if serious changes were not made.