Kyle Pike was employed by the County of San Diego as a Deputy Sheriff Detention on July 31, 2010. He sustained an industrial injury to his right shoulder and received a combination of Labor Code section 4850 salary continuation benefits and permanent disability benefits between October 27, 2010 and November 15, 2011 and April 30, 2015 through June 19, 2015.

Pike received a Stipulated Award of 12% permanent disability on May 31, 2011, and filed a timely Petition to Reopen on May 26, 2015 as he claimed an entitlement to Labor Code section 4850 benefits for the period September 15, 12 2015 through March 28, 2016, and temporary total disability benefits from March 29, 2016 through August 18,2016 which was beyond the five year time limit from the date of his injury.

The County paid all temporary disability and 4850 benefits through the period ending five years from the date of injury. The issue to be determined was whether applicant could receive additional benefits for periods of temporary disability that extended more than five years from his July 31, 2010 date of injury. The parties submitted the issue on the record without testimony.

The WCJ concluded that when acting upon a timely petition to reopen, the Appeals Board may award temporary disability benefits more than five years from the date of injury, provided that applicant is limited to an aggregate of 104 weeks of benefits. A split panel decision denied reconsideration in the case of Pike v County of San Diego.

Labor Code section 4656( c )(2) provides that "Aggregate disability payments for a single injury occurring on or after January 1, 2008, causing temporary disability shall not extend for more than 104 compensable weeks within a period of five years from the date of injury."

The majority held that because "the statutory language does not provide that no temporary disability benefits may be paid more than five years from the date of injury, the WCJ concluded that the legislature did not intend to prohibit otherwise temporarily disabled injured workers from receiving the full 104 weeks of benefits where such temporary disability occurs within five years from the date of injury." The majority cited some panel decisions that have agreed with this view.

Commissioner Razo dissented. "I believe our ability to award temporary disability indemnity is constrained by the statutory language in Labor Code section 4656( c )(2), which expressly limits such an award to five years from the date of injury for injuries on or after January 1, 2008." He cited several panel decisions that agreed with his view and against the majority.

In August the County filed a Petition for Writ of Review with the Court of Appeal. At the end of September the Court issued a writ and agreed to hear the case. On October 23 the CWCI was grated permission to file an amicus brief in the case, and it is expected that the CAAA, and other stakeholders will soon weigh in as well.

Among the several theories presented by the County and CWCI, they claim "the decision below relies upon an improper use of Labor Code Section 3202. As noted by our Supreme Court in Nickelsberg v. Workers' Comp. Appeals Bd. (1991) 54 Cal.3d 288, 298 the rule of liberal construction stated in section 3202 should not be used to defeat the overall statutory framework and fundamental rules of statutory construction ...

Numerous lien claimants by and through their sole representative Maximum Medical filed over 1,200 Petitions for Reconsideration,challenging an administrative action which prevented them from filing in their cases because they had allegedly failed to timely file required declarations.

Thereafter, to secure uniformity of decision in the future, the Chair of the Appeals Board, upon unanimous vote of its members, assigned these cases to the Appeals Board as a whole for an en banc decision. The cases at issue are defined as: "The Cases Involving a Labor Code section 4903.05(c) Declaration filed after 5:00 p.m. on Friday, June 30, 2017 through 5:00 p.m. on Monday, July 3, 2017 where a Petition for Reconsideration was filed on the issue of timeliness of the filing" and are designated as The Lien Cases.

The Lien Cases were consolidated on motion of the Appeals Board for the limited purpose of making the orders herein, including designating Rodriguez v. Garden Plating Co. (ADJ8588344) as the master case and designating service of this decision to lien claimants’ representative, Maximum Medical.

The providers in the Lien Cases contend that since July 1, 2017 fell on a Saturday, the required declarations were timely filed because the declarations were filed no later than the close of business on Monday, July 3, 2017 so that the notation placed in EAMS by DWC was improper.

However, on October 3, 2017, DWC issued a Newsline stating in pertinent part that: [DWC] will lift the notation in its Electronic Adjudication Management System (EAMS) that indicates all liens with Labor Code section 4903.05(c) declarations filed on July 2 and July 3 were dismissed.

The DWC has now removed the notation as to dismissal. Accordingly, lien claimants are not aggrieved (Lab. Code, §§ 5900, 5903) and their Petitions for Reconsideration are moot. Thus, the WCAB ruled that the Petitions must be dismissed. As set forth above in the Newsline and as discussed below, the issue of timeliness must be adjudicated in each case in the first instance at the trial level. Accordingly, the WCAB made no opinion on the merits of the issue of whether the declarations were timely filed.

Given that the Petitions for Reconsideration are nearly identical and given the limited resources of the Appeals Board, consolidation of the cases for the narrow purpose of addressing the Petitions for Reconsideration was appropriate. The en banc decision shall apply to any case in which a Labor Code section 4903.05(c) Declaration was filed by a lien claimant after the close of business at 5:00 p.m. on Friday, June 30, 2017 through the close of business at 5:00 p.m. on Monday, July 3, 2017, whether or not the case number is identified in this decision.

Whether declarations filed after the close of business at 5:00 p.m. on Friday, June 30, 2017 through the close of business at 5:00 p.m. on Monday July 3, 2017 were timely filed is not presently at issue, and we make no determination as to the timeliness of filing of such declarations. Once such a determination has been made, any aggrieved person may seek review of such determination. (Lab. Code, §§ 5900, 5903.) ...

Purdue Pharma confirmed on Wednesday that it has become the subject of a U.S. criminal investigation related to its painkiller OxyContin as the drugmaker battles a series lawsuits seeking to hold it responsible for its role in the nation’s opioid epidemic.

U.S. Attorney Deirdre Daly is gathering documents about Purdue’s claim that OxyContin provides 12 hours of pain relief. A Los Angeles Times investigation, published last year, found that Purdue ignored evidence showing the drug’s effects failed to last that long in some patients, increasing the risk of withdrawal, abuse and addiction.

"Purdue is committed to being part of the solution to our nation’s opioid crisis and has been cooperating with the U.S. Attorney’s investigation," company spokesman Robert Josephson said in an email. "We will continue to do so until this matter is resolved."

Purdue is cast as the main villain in a wave of government lawsuits seeking to hold opioid makers and distributors responsible for an epidemic now killing thousands of people and costing the U.S. economy billions of dollars annually. Ten states and dozens of cities and counties have sued companies including Purdue, Endo International Plc, and Johnson & Johnson’s Janssen Pharmaceuticals, alleging that they triggered the epidemic by minimizing the addiction and overdose risks of painkillers such as OxyContin and Percocet.

Stamford, Connecticut-based Purdue invented many of the aggressive marketing techniques that made OxyContin a blockbuster drug and which government lawsuits now seek to frame as unlawful.

Purdue resolved a federal criminal prosecution in 2007. The company and three of its top executives pleaded guilty to "misbranding" OxyContin and collectively agreed to pay more than $630 million in civil and criminal penalties in one of the largest pharmaceutical settlements in U.S. history. The company specifically acknowledged that it trained its sales representatives to mislead physicians about opioid risks.

Purdue promoted the synthetic morphine substitute as a low-risk painkiller, according to court papers, although the drug is a habit-forming narcotic derived from the opium poppy.

The executives, former CEO Michael Friedman, General Counsel Howard Udell and Chief Medical Officer Paul Goldenheim, served no prison time and were sentenced to community service in drug rehabilitation centers.

Purdue has faced a wave of lawsuits by Louisiana, Washington, New Mexico, Oklahoma, Mississippi, Ohio, Missouri, New Hampshire and South Carolina, as well as several cities and counties. Many of those cases target other drugmakers as well.

The lawsuits have generally accused Stamford, Connecticut Purdue of deceptive marketing of OxyContin and convincing doctors and the public that its drugs had a low-risk of addiction and were effective for treating chronic pain.

Purdue is closely held and doesn’t release financial information, but the brokerage Sanford C. Bernstein & Co. estimates OxyContin alone generated sales of $1.3 billion in 2016. Purdue is also the focus of a Congressional investigation led by Senator Claire McCaskill, a Missouri Democrat, who’s demanding documents and information related to the sales, marketing and education strategies that opioid manufacturers used to promote their painkillers.
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Unused or expired prescription medications are a public safety issue, leading to potential accidental poisoning, misuse, and overdose. Proper disposal of unused drugs saves lives and protects the environment.

The Drug Enforcement Administration first launched its "Take-Back" day more than six years ago and since then has collected more than 8.1 million pounds of prescription drugs from the public.

After collecting and destroying 900,000 pounds - 450 tons - of unused prescription drugs last April, the U.S. Drug Enforcement Administration is continuing its efforts to take back unused, unwanted and expired prescription medications.

The DEA invites the public to bring their potentially dangerous, unwanted medicines to one of nearly 5,000 collection sites around the country that are manned by more than 4,000 of DEA’s tribal and local law enforcement partners.

The public can find a nearby collection site by visiting www.DEATakeBack.com or by calling 800-882-9539. This service is free of charge, with no questions asked.

"The abuse of opioids and prescription drugs is at an all-time high in our country, and the effect is devastating, not only on the users, but on their families, friends, and communities," U.S. Attorney Talbert stated. "Young people are particularly at risk, as they can gain easy access to unused and addictive prescription drugs inside the home. I strongly encourage everyone to take advantage of this safe and easy way to dispose of unused prescription drugs."

"America is in the midst of a prescription drug crisis and the home medicine cabinet is a major source. Let’s work together to help put an end to this epidemic by cleaning out that cabinet and disposing of unwanted medication at a take back location," stated DEA Special Agent in Charge John J. Martin.

Overdoses from prescription opioids are the driving factor in the 15-year increase in opioid overdose deaths. The removal from homes of unwanted prescription pills that can be abused, stolen or resold is an easy way to help fight the epidemic of substance abuse and addiction.
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Orange County rejected workers’ compensation claims from four sheriff’s deputies injured in the shooting, paving the way for a court battle that could force appellate judges to eventually decide an untested issue touching several counties and cities in Southern California.

Los Angeles County is considering whether to grant claims from two of its deputies shot Oct. 1 at the Route 91 Harvest festival. Officials acknowledged they have no policy on how to handle such requests and said they expect the issue will result in litigation.

Several other officers from Southern California law enforcement departments also plan to file claims in the near future, according to police unions, potentially forcing as many seven other municipalities - including San Bernardino and Riverside counties -to soon consider similar questions.

If the claims are approved, it could put taxpayers on the hook for years of medical expenses, allow officers to retire early on disability and guarantee injured officers paid time off in the short term. If officers begin to claim injuries related to PTSD suffered during the shooting - as two deputies in Orange County did - it also could open the door for scores of additional filings.

In San Bernardino County, which employs 11 deputies who attended the festival, including Sgt. Brad Powers, who was shot in the leg in Las Vegas, the deputies’ union has initiated talks with the sheriff’s department to advocate that Powers be treated as an on-duty injury.

Steve Nyblom, a manager in Los Angeles County’s risk management branch, which is weighing claims from local two deputies shot in Las Vegas, said legislative intervention may be needed to clarify the labor code in light of the looming disputes. "There is that vague issue, subject to interpretation, and issues relating to legislative intent should be clarified by the legislature," Nyblom said.

Had all those officers been shot and injured while responding to a mass-killing in California, they likely would be taken care of without dispute. But because they were shot in Nevada instead, their life-saving efforts could cost them dearly.

California’s labor code states that public agencies are required to pay benefits to off-duty police officers injured while engaging in "protection or preservation of life or property, or the preservation of the peace anywhere in this state," even if the officer "is not at the time acting under the immediate direction of his employer." Out-of-state events are not mentioned, spurring multiple interpretations of the law.

"The statute does not allow counties to cover off-duty conduct outside of states," Orange County Supervisor Todd Spitzer said, expressing a view shared by county lawyers. "These police officers went into their instinctive training mode - and I don’t think they should be punished because they trusted their instincts. But it requires a legislative fix to the statute to extend workers’ benefits for out-of-state conduct."

However, local workers’ compensation attorneys disagree with Orange County’s interpretation of state law. And the union representing Orange County’s sheriff’s deputies has said that if the county denied its members’ claims, the agency would be abandoning officers who were acting in accordance with their department’s training.

"The sheriff’s department has an expectation of its sworn members to take whatever actions are necessary to preserve life wherever they’re at," said Tom Dominguez, president of the Association of Orange County Deputy Sheriffs. "If they deny the claims, then the message that they’re sending to their peace officers is not to take action when it is certainly warranted." "Everybody’s watching what happens with these cases," Dominguez added ...

The U.S. Food and Drug Administration plans to encourage opioid addicts to use less harmful opioid drugs such as methadone and buprenorphine, a radical shift in policy that could agitate those in the addiction field who believe abstinence is the only effective treatment.

Speaking before the House Committee on Energy and Commerce on Wednesday, Reuters reports that FDA Commissioner Scott Gottlieb outlined a proposal under which every addict who suffers a non-fatal overdose would be treated with an opioid substitute, for long periods if necessary, or even for life.

"I know this may make some people uncomfortable," Gottlieb said of his proposal. Even so, he added, "FDA will join efforts to break the stigma associated with medications used for addiction treatment."

Gottlieb’s plan mirrors his recent proposal to reduce nicotine in cigarettes while expanding access to potentially less harmful nicotine delivery devices such as e-cigarettes. Both proposals embrace an approach to substance abuse that aims to reduce harm rather than insist on complete abstinence.

The stigma around opioid alternatives, Gottlieb said, "reflects a view some have, that a patient is still suffering from addiction even when they’re in full recovery, just because they require medication to treat their illness."

Drugs such as methadone and buprenorphine reduce pain in the same way that opioids do, but without delivering the "high" that leads to addiction. They are used to help addicts taper off opioids, but insurers are not always willing to pay for the treatment.

Gottlieb cited data from the Commonwealth of Massachusetts which found a greater than 50 percent reduction in the risk of death from overdose among those treated with methadone or buprenorphine after an overdose.

This kind of data "has immense implications for insurers and policymakers in deciding how to adopt these treatments," he said. The FDA also plans to examine expanding the labels for existing medication-assisted treatment for everyone who presents with an overdose, based on data showing a reduction in deaths.

"Such an effort would be a first for FDA," Gottlieb said. "We believe that granting such an indication in labeling can help promote more widespread use of, and coverage for, these treatments." The FDA, he said, will issue guidance for drugmakers to promote the development of new addiction treatments and lay out the agency’s interest in "novel, non-abstinence-based" products ...

Frank Neuhauser from the University of California, Berkeley published a new study on Qualified Medical Evaluators discussing trends in evaluations, availability to meet panel requests, and other issues. He used extensive electronic administrative data made available by the DWC Medical Unit and Disability Evaluation Unit (DEU), supplemented with summary data from several sources.

The study covers the period from 2007 through 2017. This period covers much of the evolution after the 2004 reforms which introduced utilization and treatment guidelines, a new permanent disability rating schedule based on the AMA Guides, and changes to the manner parties in represented cases can select QMEs. The key findings in this study included the following general observations:

- The number of providers registered as QMEs continues to decline (17% since 2007), but less rapidly than it did prior to 2007.
- The number of requests for QME panels has increased rapidly, 87% since 2007.
- The decline in QMEs and increase in panel requests means that the number of requests per QME has doubled (+101%).
- Coupled with a continuing increase in the average paid amount for QME reports, the average QME earns 240% more from panel reports now than in 2007.
- All the increase in panel requests is from represented track cases, up 400% despite the elimination of panels for most medical treatment issues (replaced by the IMR process). This increase was equally driven by requests from both parties, applicant and defense.
- Panel requests for unrepresented cases declined 55%, entirely driven by a decline in requests from injured workers. The number of requests by claims administrators in unrepresented cases changed little.
- The DWC began collecting the reasons for panel requests on represented cases in 2015. Those data show that the primary reasons for panels are: (1) Compensability (42.5%), Permanent disability (21.4%), and Permanent & Stationary (P&S) status (11.4%).

In response to the earlier study, SB 863 placed limits on the number of locations (10) at which QMEs can be registered. This has had the effect of distributing QME panels more evenly and widely among registered providers.

- Very-high-volume QMEs (with 11-100+ registered locations) have been eliminated.
- However, a high proportion of panel assignments (55%-60%) are still assigned to the busiest 10% of QMEs, nearly all of whom have exactly 10 offices and are in orthopedic specialties.
- Unlike the very-high-volume QMEs studied earlier, the top 10% and 5% of QMEs by number of panels in the current system produce reports that show less bias. Even the top 5% of QMEs by volume rate only slightly more conservatively than average.

Access to QMEs does not appear to be an important current problem, but there are signs that delays in getting an evaluation may be developing.

The DWC has made an effort to eliminate from the workers’ compensation system providers who are accused or convicted of fraudulent activity or violations of professional standards. This study examined the activity of these doctors in the QME process and how their suspension may impact QME evaluations. The study found:

- Of providers suspended or restricted under Labor Code sections 139.21 & 4615, 41 were registered as QMEs at least one year between 2007 and 2016.
- They represented a small minority of all QMEs (1.6%) and were assigned to a minority of all 3-doctor panels (4.6%).
- While these percentages are small overall, there were some areas where problem providers appear to be concentrated and represent a special issue. The "Pain" specialties (PAP, MAA, & MPP), stood out, with 40% -50% of QME panels including at least one restricted or suspended provider.
- The more general "pain" category (MPA) that is more commonly used now, as well as the Physical Medicine and Rehabilitation (MPR) and Internal Medicine--Hematology (MMH) had 15% - 17% of panels include a restricted or suspended provider.
- Overall, the restricted and suspended doctors gave much more generous evaluations to injured workers than the average QME: higher ratings, less frequent use of apportionment and more frequent "Almaraz" ratings ...

The Hartford said Monday it has agreed to purchase Aetna’s life and disability insurance business. The deal, valued at $1.45 billion, is expected to close early next month. The move will make The Hartford the second largest U.S. carrier of group life and disability insurance after MetLife.

"The transaction provides a unique and accretive opportunity for The Hartford to become the second largest group life and disability insurer, an important business for The Hartford with a stable risk profile, attractive returns and strong long-term growth prospects," said The Hartford’s Chairman and CEO Christopher Swift. "The combination of these two businesses strengthens our position as a leader in the large employer market and increases our presence among midsize employer clients."

Swift says the acquisition will be positive because of the complimentary nature between Aetna and The Hartford models, noting that the synergies around its claim systems as well as Aetna’s digital capabilities making the integration "natural."

"Our claims organization continues to use data and advanced analytics across workers’ compensation and disability to drive better outcomes for customers in both business lines," added Doug Elliot, The Hartford’s president. "As the nation’s second largest workers’ compensation insurer, and now, the second largest group disability insurer, this transaction increases our competitive differentiation and potential for future product offerings for absence management."

With the expanded data and advanced analytical capabilities, The Hartford’s claims organization will also be able to drive better recovery outcomes for customers in both workers’ compensation and group disability businesses.

The Hartford says it will integrate the absences and disability administration platforms with robust web portal and mobile capabilities with text message integration.

The Hartford will also acquire a majority of Aetna’s approximately 1,800 Group Insurance employees as part of the deal, as well as its digital assets and integrated absence-management platform. In addition, the deal includes an exclusive collaboration under which Aetna will offer The Hartford’s group life and disability products through Aetna’s sales team.

Earlier this year, Aetna abandoned its attempt to acquire fellow insurer Humana after a federal judge blocked the transaction on antitrust grounds.
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The federal courtroom battle over the survival of the new automatic stay law governing liens filed by indicted medical providers reached a milestone last week as Judge Wu issued his decision, one that is unlikely to provide the plaintiffs any substantial benefit for their efforts.

The lien claimants argued that the new law violated due process requirements among other complaints. The DIR sought to demonstrate ample opportunities for due process mostly articulated by a declaration by Chief Judge Paige Levy. Her declaration did not completely convince the federal court.

Judge Wu commented that "nothing in Judge Levy’s declaration demonstrates that WCALJs are uniformly adjudicating challenges to Section 4615 in the manner she endorses, or that any Court precedent requires them to do so. Nonetheless, Defendants argue that Judge Levy’s testimony proves the merit of Defendants’ initial legal argument in opposition to Plaintiffs’ procedural due process claim: pre-existing regulations afford claimants sufficient due process."

"That being said, Judge Levy’s testimony still informs the Court’s interpretation of Section 4615 as well as the constitutionality of its current implementation. This is because established principles of interpretation permit the Court to look to extrinsic evidence to further discern the meaning of the statute if the statute is ambiguous on its face, including the statute’s legislative history, and its administrative implementation."

Judge Wu then concluded "this Court finds that Section 4615, as currently implemented, does not provide the sufficient procedural due process before or after it deprives certain lien claimants of a protectable interest. Because the 14th Amendment requires basic notice and hearing rights that Defendants are currently denying certain Plaintiffs, the Court would GRANT Plaintiffs’ Motion for a Preliminary Injunction, but only to a limited extent."

"After reviewing both parties’ second and third round of supplemental briefing, considering the relevant portions of AB 1422, and for the reasons stated below, the Court finds that Section 4615, even as amended, does not provide all affected lien claimants with a meaningful opportunity to be heard to challenge an erroneous application of Section 4615. See T.R. at 25-26. As such, the Court would find that Section 4615 as currently implemented fails to provide a specific group of affected claimants, namely those not listed on the DWC website, with the fair process the Constitution requires. The Court would also find that this deficiency is not solved even if it assumes what Defendants claim AB 1422 confirms, that the text of Section 4615 implicitly provides those lien holders the opportunity to utilize pre-existing procedures."

But, Judge Wu also said the "relief granted would be narrow and targeted to solve the specific procedural due process defects identified above."

"As to notice, the Court would require Defendants to include the name of any lien holder affected by Section 4615 on the "division’s [public] Internet Web site" as directed by statute. The Court would also prohibit Defendants from staying the processing of any lien pursuant to Section 4615 unless the lien holder is provided notice via the DWC Site, and given the opportunity to be heard as to whether that lienholder falls within the statute at a lien conference and/or lien trial. As stated above, the sole purpose of such hearing is to prevent the erroneous application of Section 4615, by its own terms, not the propriety of the underlying criminal charges, or whether or not a given lien arises from fraud."

The Court has asked Plaintiffs to submit a proposed order that comports with the scope of relief the Court has described. It would seem that the plaintiffs, Vanguard Medical Management Billing, Inc., and Eduardo Anguizola M.D. would not ultimately be removed from the automatic stay requirements as they had hoped. The DIR need only provide them proper notice on its website, if they have not already, and once this is accomplished there are no other limits to the new law imposed by this ruling. One might say their effort was more or less like trying to eat soup with a fork.

Transcripts of the public hearings in this case have been requested, signalling that this case is headed to the 9th Circuit Court of Appeals. One can assume we have not heard the last of the arguments in this case ...

The DWC has posted a draft amendment to the Benefit Notice regulations regarding required notices for denied claims to the DWC online forum for public comment.

Labor Code section 138.4 requires the Administrative Director, in consultation with the Commission on Health and Safety and Workers’ Compensation (CHSWC), to prescribe reasonable rules and regulations for service on the employee (or employee's dependents, in the case of death) notices dealing with the payment, nonpayment or delay in payment of temporary disability, permanent disability and death benefits; notices of any change in the amount or type of benefits being provided, the termination of benefits, the rejection of any liability for compensation; and an accounting of benefits paid.

Labor Code section 138.4 was amended, effective January 1, 2017, by section 1 of SB 1160 to require the AD to adopt regulations, on or before January 1, 2018, "to provide employees with notice that they may access medical treatment outside of the workers’ compensation system following the denial of their claim."

Section 9812 of the regulations prescribes the required timeframes for sending benefit notices and the content for notices dealing with each type of benefit to which an injured worker might be entitled. The proposed amendment to section 9812(i) will require the Notice Denying Liability for All Compensation Benefits to contain the following statement:

- Although your claim has been denied, if you believe that you still need medical treatment for your injury or illness, you have the right to obtain treatment outside the workers’ compensation system.
- If you have your own health insurance, or are eligible to be treated by someone else’s health insurance, you can use that insurance to get medical care. You should advise your physician that you believe that your injury or illness is work related, so the health insurer can seek reimbursement from the claims administrator.
- If you do not have health insurance available, there are doctors, clinics, or hospitals that will treat you without immediate payment. You should advise any doctor, clinic, or hospital that agrees to treat you that you believe that your injury or illness is work related so they can seek payment from the claims administrator through the workers’ compensation system.”

The "safe harbor" provision of Title 8, California Code of Regulations, section 9810(f) provides that: "Benefit notices using the sample notices devised by the Administrative Director and available on the Division’s website are presumed to be adequate notice to the employee and, unless modified, shall not be subject to audit penalties."

DWC welcomes suggestions from the workers’ compensation community to improve the quality and clarity of the proposed amendment. The division will accept comments on the proposed amendment to section 9812 until close of business on October 31, 2017. Please note that this comment period does not concern any other provision of the benefit notice regulations.

The proposed amendment to the existing regulation is shown in underlined format. In addition, due to the length of section 9812, the proposed amendment is highlighted in yellow.
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The California Workers’ Compensation Institute this week released a report on a list of bills that will affect the workers’ comp system.

The bills were recently signed into law at the end of the Legislative session by Gov. Jerry Brown. Here is the CWCI’s recap of those bills as reported by the Insurance Journal:

Physician Access to CURES (AB 40, Santiago): Enables medical providers to use third-party software to access information about a patient’s prescription drug history from the state’s prescription drug monitoring program (CURES). Currently, providers can only access this information through the CURES website, but AB 40 will simplify the process by allowing them to link their systems directly to CURES, eliminating the need to log on to the website and perform a manual search.

Advocacy Services for Workers Injured by Terrorist Acts (AB 44, Reyes): Requires employers to provide immediately available advocacy services for workers injured by acts of domestic terrorism. Advocates (nurse case managers) will be responsible for helping these injured workers obtain medical treatment and helping their medical providers obtain treatment authorizations and payments. The bill was introduced in response to medical treatment issues that arose on claims filed by workers following the December 2015 terrorist attack at the Inland Regional Center in San Bernardino.

Liens Filed by Suspended Providers (AB 1422, Daly): Extends the automatic stay on liens filed by medical providers charged with criminal fraud so that it runs from the time the criminal charges are filed all the way through the suspension hearing. The bill closes a loophole in existing law that gave providers an opportunity to pursue liens for payment between the time they were convicted of fraud and the point at which they were suspended. AB 1422 further clarifies that these rules also apply to entities controlled by individuals charged with criminal fraud.

Drug Transparency (SB 17, Hernandez): Requires pharmaceutical companies to notify health insurers and government health plans at least 60 days before scheduled prescription dnrg price hikes that would exceed 16 percent over a two-year period and to explain the reasons behind those increases.

Limits on Assistance to Immigration Enforcement Agents (SB 54, DeLeon): Requires the state attorney general to draft model policies for state agencies, including the Department of Workers’ Compensation, "limiting assistance with immigration enforcement to the fullest extent possible consistent with federal and state law." The model policies are to cover state buildings, including those used by the DIR, the DWC, and the WCAB. The bill requires the attorney general to adopt the model policies by Oct. 1, 2018.

Workers’ Comp Exemptions for Officers and Directors (SB 189, Bradford): Allows corporate officers and directors who own at least 10 percent of a business to opt out of workers’ comp coverage for themselves if they sign a waiver stating that they are covered by a health insurance plan. The 10 percent threshold is a reduction from the 15 percent threshold established by AB 2883 in 2016. This bill also includes a conclusive presumption that a person who executes a waiver is not covered by workers’ compensation.

New State Compensation Insurance Fund Executive Positions (SB 272, Mendoza): Enables the State Compensation Insurance Fund Board to appoint a chief underwriter, chief information security officer, senior vice president of insurance services, executive vice president of corporate claims, executive vice president of strategic planning, and a pricing actuary. Each of these are executive positions, exempt from civil service protections.

Retaliation Complaint Investigations and Awards (SB 306, Hertzberg): Expands the Labor Commissioner’s ability to investigate complaints by employees that their employer retaliated or discriminated against them in response to protected conduct (which may include filing or testifying on behalf of a coworker in a workers’ compensation claim, repealing safety violations, etc.). SB 306 allows the commissioner to initiate investigations of such claims without having to go to court to obtain an enforcement order, and to obtain an award for attorney’s fees and costs when it successfully prosecutes a retaliation claim through the courts.

CIGA Reinsurance (SB 430, Senate Committee on Insurance): Enables the California Insurance Guarantee Association (CIGA), upon the approval Of the Insurance Commissioner, to purchase reinsurance for its workers’ compensation fund from any reinsurer licensed in California. This removes the current restriction that has only allowed CIGA to purchase reinsurance from its member companies even though most re-insurers in the state are not CIGA members.

Emergency Room Physician Bills (SB 489, Bradford): Extends the deadline for emergency room physicians to submit their bills to workers’ compensation claims administrators from 30 days to 180 days, for treatment provided under SB 1160’s pass-through provisions for certain treatment provided during the first 30 days following injury ...

Dozens of cities are working frantically to land Amazon’s second headquarters, raising a weighty question with no easy answer: Is it worth it? An article in Mercury News answers this question with a big "yes."

"Most economists say the answer is a qualified yes." Amazon is promising $5 billion of investment and 50,000 jobs over the next decade and a half. "For the right city, winning Amazon’s second headquarters could help it attain the rarefied status of 'tech hub,' with the prospect of highly skilled, well-paid workers by the thousands spending freely, upgrading a city’s urban core and fueling job growth beyond Amazon itself."

It’s that hope that has triggered excitement, from such metropolises as New York, Boston and Chicago to tiny Maumee, Ohio (population 14,000). The deadline for submissions was October 19.

The Los Angeles Times reports that Southern California region has several willing candidates that are expected to submit bids, including Irvine, Santa Ana and San Diego.

Other known contenders will be communities in Los Angeles County, where a regional effort includes locations in Los Angeles and Pomona, where Cal Poly Pomona and the Fairplex have offered up land.

According to the Los Angeles County Economic Development Corp., which is helping coordinate the regional effort, the L.A. County bid contains nine separate sites that would each fulfill Amazon’s requirements. Some of the locations are outside Los Angeles and Pomona, but a spokesman declined to name them or the individual sites.

"This is a highly competitive process and we do not want to give our competitors around the country any information that could be used to strengthen their hands," Lawren Markle said.

The city of Irvine and the Irvine Co. are expected to submit a combined bid. They, too, have been largely mum since the developer issued a news release a day after Amazon announced its competition.

A possible location for Amazon could be land the Irvine Co. owns around the Irvine Spectrum. A company spokesman didn’t return emails seeking comment.

Gov. Jerry Brown has been supportive of the effort to lure Amazon, writing a cover letter for communities to include in their proposals. Addressed directly to the Amazon CEO, the letter cites the state’s strong university system and talented workforce as reasons the company should give "careful consideration to the many California cities interested in becoming the next home for Amazon’s newest headquarters."

Brown’s office also supplied communities with a list of possible state tax credits available to Amazon - something the tech company asked for in its request for proposals. Among the subsidies available under current law are up to $200 million as part of the California Competes Tax Credit program and up to $100 million in workforce training funds. Brown has also pledged to establish a multi-agency "strike team" that can help expedite permits and approvals.

Some cities are considering packages of their own. In Chula Vista, the City Council was expected to debate a $400-million incentive deal Tuesday evening.

Good luck with all that! The Chief Executive Magazine 2017 ranking of the 50 Best and Worst States for Business "California anchored the bottom of the list at No. 50 for the sixth consecutive year, New York wallowed at No. 49 and Illinois listed at No. 48." ...

This year, AB 570 was the only substantial workers' compensation related proposed law on the horizon.

AB 570 in the broad analysis was an attempted rollback of permanent disability apportionment rules. The purpose of the bill was to eliminate elements of what the author believes is gender bias in the workers' compensation system.

According to the author, women can receive disproportionately low compensation amounts for work-related permanent disability because of the gender-specific conditions of pregnancy and childbirth. The author points to specific examples where the evaluating physician has pointed to pre-existing conditions that have involved pregnancy or childbirth in apportioning the causation of subsequent industrial injuries, and argues that this constitutes an inappropriate discrimination, since male injured workers can never have their disability apportioned in this manner.

This bill would have prohibited apportionment in the case of a physical injury occurring on or after January 1, 2018, based on pregnancy, childbirth, or other medical conditions related to pregnancy or childbirth. It is similar to AB 1643 (Gonzalez) of 2016 which would have prohibited apportionment in cases of physical injury based on pregnancy, menopause, osteoporosis, and carpal tunnel syndrome. AB 1643 passed the legislature last year but was vetoed by the Governor.

AB 570 was passed by the legislature by the end of session this year, but was vetoed by the Governor as he has done in the past. His signing message said the following.

"I am returning Assembly Bill 570 without my signature."

"This bill would prohibit apportionment of permanent disability, in the case of a physical injury occurring on or after January 1, 2018, from being based on pregnancy, childbirth, or other medical conditions related to pregnancy or childbirth. I am vetoing this bill for the same reasons that I vetoed similar measures Assembly Bill 1643 in 2016 and Assembly Bill 305 in 2015."

"The California Constitution provides that the Legislature shall create a complete system of Workers' Compensation so that employers compensate employees for injuries sustained in the course of their employment. To that end, Labor Code Section 4663 provides that the employer shall only be liable for the percentage of permanent disability directly caused by the injury. AB 570 is in direct contradiction to this Constitutional mandate and legislative scheme because it requires employers to be liable for non-work related injuries. This measure would extend the scope of the workers' compensation system well beyond what it is meant to do: compensate injured workers who suffer a work related injury."

"I agree with the Author that there is no place for gender discrimination in the workers' compensation system. However, it is not discrimination to have a gender-neutral system in which only permanent disability that results directly from work injuries is compensable. The creation of a broad exception to the apportionment statutes for medical conditions that affect only women would create a gender-based classification and would not be likely to withstand constitutional challenge."

"I am committed to ensuring that California's workers' compensation policy treats all injured workers fairly and that every worker, regardless of gender, is adequately compensated for their injury. I encourage proponents of this bill to support continuing efforts to educate medical evaluators on current laws prohibiting gender bias."

The California Applicant Attorneys Association (CAAA) responded to the Governor's letter with a brutal spoof "Father Knows Best" on its website. This issue will likely be raised again next year ...

A one-time sales representative for AFLAC was sentenced to 10 years in federal prison after being convicted of federal fraud charges related to a scheme that used bogus disability claims to bilk the insurance company out of more than $4 million.

Patricia Diane Smith Sledge, 61, of Redlands, was sentenced by United States District Judge James V. Selna. In addition to the prison term, Judge Selna ordered Sledge to pay $4,166,063 in restitution.

Following a two-week jury trial late last year, Sledge was found guilty of six counts of mail fraud, as well as two counts of witness tampering.

The fraud scheme involved fictitious employers and bogus employees who falsely claimed to have suffered injuries that prevented them from working.

The evidence presented at trial showed that Sledge - who was residing in Irvine while working for the company formally known as American Family Life Assurance Company - sold disability insurance policies to bogus companies and people who supposedly worked for those companies. Sledge then orchestrated the filing of fraudulent disability claims and directed the purported employees to doctors that would sign off on the fake injury claims.

Sledge made money both from the commissions related to the sale of the fraudulent insurance policies and from kickbacks she received from the supposedly injured "employees."

Sledge exploited her knowledge of AFLAC’s internal policies and underwriting procedures to further the scheme. For example, Sledge and others involved in the scheme listed artificially inflated incomes on the applications for insurance because the amount AFLAC paid on disability claims was based on the policyholder’s income.

Sledge was also found guilty of witness tampering for encouraging potential witnesses to lie to federal investigators and discouraging them from cooperating in the investigation. One of these crimes was committed while she was on bond in this case.

Three others have been prosecuted for acting as fake employers and fake employees in this scheme.

The case against Sledge and the others involved in the scheme is the result of an investigation by United States Department of Labor - Office of Inspector General, the Federal Bureau of Investigation, and California’s Department of Insurance.

This case is being prosecuted by Assistant United States Attorney Vibhav Mittal of the Santa Ana Branch Office and Assistant United States Attorney Joshua O. Mausner of the Violent and Organized Crime Section ...

The Orange County Register reports that four Orange County sheriff’s deputies have filed workers compensation claims against the county for physical and psychological injuries they say they suffered when they attended a country music festival in Las Vegas where a gunman killed 58 people.

Several Orange County deputies at the Route 91 Harvest festival quickly assumed life-saving roles - protecting the perimeter of the area with a shotgun in one case and administering medical care in other instances. Though the deputies were in Las Vegas on their personal time, their workers’ compensation claims will make the case that they acted as on-duty law enforcement officers when they sprang into action to help others.

The Orange County Board of Supervisors is set to meet Tuesday, Oct. 17, in closed session to discuss the claims.

The deputies filed their claims only a few days after the Oct. 1 shooting in which 64-year-old retiree Stephen Paddock fired into the festival crowd, killing 58 people and wounding more than 500.

Tom Dominguez, president of the Association of Orange County Deputy Sheriffs, said he traveled to Las Vegas the day after the shooting and, while there, encouraged his deputies who had helped others the night before to file claims. Those claims, if approved, could require the county to pay medical bills connected to the episode. The deputies also wouldn’t have to use vacation or sick days to take time off for their injuries.

"The sheriff’s department has an expectation that its deputy sheriffs, that when they are faced with circumstances where the public is in grave danger - they should take action," Dominguez said.

"The county has to be very cautious in these cases," Dominguez added. "If they deny the claims, then the message that they’re sending to their peace officers is not to take action when it is certainly warranted."

The county did not name the deputies who submitted claims. But following the shooting, the Southern California News Group reported the experiences of several Orange County deputies on the scene.

Deputy Joe Owen, sustained non-life-threatening injuries after he was shot in the abdomen and thigh. Deputy Melanie Cooper administered CPR on six of seven people, later saying the event was the "most traumatic thing I’ve ever been through." Deputies Mark Seamans and Brandon Mundy helped people escape and applied medical care to others. And Deputy Garrett Eggert, using a shotgun given to him by local law enforcement, helped to protect the perimeter.

Supervisor Todd Spitzer said he asked the board to consider the claims in closed session after he learned the county likely would have rejected them administratively. Spitzer said under a strict interpretation of California law, workers’ compensation might only extend to law enforcement officers responding to an emergency within the state. But he said he didn’t want the claims to be rejected summarily because he didn’t want to dissuade deputies from helping in emergencies in the future.

"These police officers went into their instinctive training mode, and I’m not going to send a message that Orange County is going to abandon any of its peace officers who are trying to save lives," said Spitzer, who is running for district attorney.

Dominguez disagreed with Spitzer’s interpretation of California workers’ compensation law but acknowledged that it is an extremely rare occurrence for police officers to file claims stemming from incidents that occurred out of state. He could not recall another time that had happened in Orange County ...

The DOJ announced that federal grand juries in the Southern District of Mississippi and the District of North Dakota returned indictments against two Chinese nationals and their North American based traffickers and distributors for conspiracies to distribute large quantities of fentanyl and fentanyl analogues and other opiate substances in the United States.

The Chinese nationals are the first manufacturers and distributors of fentanyl and other opiate substances to be designated as Consolidated Priority Organization Targets (CPOTs). CPOT designations are those who have "command and control" elements of the most prolific international drug trafficking and money laundering organizations.

Xiaobing Yan, 40, of China, was indicted in the Southern District of Mississippi on two counts of conspiracy to manufacture and distribute multiple controlled substances, including fentanyl and fentanyl analogues, and seven counts of manufacturing and distributing the drugs in specific instances. Yan allegedly operated websites selling acetyl fentanyl and other deadly fentanyl analogues directly to U.S. customers in multiple cities across the country.

Yan also operated at least two chemical plants in China that were capable of producing ton quantities of fentanyl and fentanyl analogues. Yan monitored legislation and law enforcement activities in the United States and China, modifying the chemical structure of the fentanyl analogues he produced to evade prosecution in the United States.

Over the course of the investigation, federal agents identified more than 100 distributors of synthetic opioids involved with Yan’s manufacturing and distribution networks. Federal investigations of the distributors are ongoing in 10 judicial districts.

Jian Zhang, 38, of China, five Canadian citizens, two residents of Florida, and a resident of New Jersey were indicted in the District of North Dakota for conspiracy to distribute fentanyl and fentanyl analogues in the United States. Zhang allegedly ran an organization that manufactured fentanyl in at least four known labs in China and advertised and sold fentanyl to U.S. customers over the Internet.

Elizabeth Ton, 26, and Anthony Gomes, 33, both of Davie, Florida were arrested. On Oct. 12, Darius Ghahary, 48, of Ramsey, New Jersey was arrested. Ton, Gomes, and Ghahary are charged with drug trafficking conspiracy in the Zhang indictment.

The investigations revealed a new and disturbing facet of the opioid crisis in America: fentanyl and fentanyl analogues are coming into the United States in numerous ways, including highly pure shipments of fentanyl from factories in China directly to U.S. customers who purchase it on the Internet.

"Zhang and Yan are the first Chinese nationals designated as Consolidated Priority Organization Targets (CPOTs)," said Deputy Attorney General Rosenstein. "CPOTs are among the most significant drug trafficking threats in the world." Twenty-one individuals in total have been indicted on federal drug charges in both North Dakota and Oregon as part of the investigation ...

On March 18, 2015, Margaret Nadey submitted a Workers' Compensation Form DWC-1 to her employer Pleasant Valley State Prison, claiming injury to her right shoulder. She later filed an application for adjudication, claiming she suffered a specific injury to her shoulders and lower extremities on November 11, 2014 while employed by defendant as a nurse.

Defendant sent Nadey a letter stating: "Pursuant to Labor Code section 4663(d), we hereby request disclosure of ALL permanent disabilities or physical impairments that existed prior to the injury."

Labor Code section 4663(d) states: "An employee who claims an industrial injury shall, upon request, disclose all previous permanent disabilities or physical impairments."

After Nadey and her attorney failed to respond, defendant filed a Motion to Compel, seeking to compel applicant to respond to the letters it had sent. The WCJ issued a ruling denying the Motion to Compel and the defendant filed a Petition for Removal. A panel reversed and remanded the issue in the case of Nadey v Pleasant Valley State Prison.

The Report of the WCJ in opposition to removal appeared to suggest that defendant should be required to depose applicant if defendant wishes to obtain information about applicant's prior disabilities. The WCAB panel found "no support for this contention in the language of the statute, which states clearly and unequivocally that applicant "shall" disclose such information 'upon request.' "

The panel went on to note that "If the Legislature intended such information to be only discoverable at a deposition, it would not have worded the statute in the manner it did. Moreover, we see little sense in mandating that such a basic disclosure be accomplished via the costly and time-consuming method of taking a deposition."

"We note that the Petition to Compel Disclosure does not include a timeframe for response, or mandate any particular method of response. We will therefore return the matter to the trial level for further proceedings. We suggest the parties confer among themselves and resolve the details amicably in a mutually satisfactory manner; if the parties cannot do so, they make seek a hearing before the WCJ, who can then determine the details of how applicant shall make the required Labor Code section 4663(d) disclosures." ...

Over the weekend, "60 Minutes" broadcast a story describing how a change in federal law last year curbed the ability of the Drug Enforcement Administration to freeze suspicious narcotic shipments from those companies.

Joe Rannazzisi, former head of the Office of Diversion Control for the DEA, was interviewed. He said members of Congress and the drug industry ultimately overcame earlier objections from law enforcement and won the day.

And it turned out that Trump’s nominee to head the Office of National Drug Control Policy championed the industry-friendly legislation that vexed lawman Rannazzisi. Rep. Tom Marino (R-Pa.), the nominee, helped steer the drive to go easier on the drug companies.

And there was substantial fallout from the story. President Donald Trump tweeted Tuesday that Rep. Tom Marino, a Pennsylvania Republican, has withdrawn his name from consideration to become the nation's next drug czar. A replacement candidate will have to be picked.

Sen. Joe Manchin (D-W.Va.) was among those calling for the withdrawal on Monday. Before Trump's announcement Tuesday, Manchin, who represents one of the hardest-hit states in the epidemic, told CNN's Chris Cuomo on "New Day" that Marino's bill "allowed hundreds and hundreds of thousands of people get killed."

"Over my dead body will he be the drug czar," he said.

"There’s no way that in having the title of the drug czar that you’ll be taken seriously or effectively by anyone in West Virginia and the communities that have been affected by this knowing that you were involved in something that had this type of effect," Manchin said.

The congressman's withdrawal comes after a joint CBS "60 Minutes" and Washington Post report revealed that Marino took nearly $100,000 from the pharmaceutical lobby while sponsoring a bill that made it easier for drug companies to distribute opioids across American communities and thwart the Drug Enforcement Agency.

Trump spoke with radio host Brian Kilmeade following Marino's decision. "He told me, look, if there is even a perception that he has a conflict of interest with insurance companies, essentially, but if there is even a perception of a conflict of interest, he doesn't want anything to do with it," Trump said.

It was not immediately clear what Trump meant when he referred to insurance companies. "There was a couple of articles having to do with him and drug companies and I will tell you, he felt compelled, he feels very strong about the opioid problem," the President added. "Tom Marino said, 'Look, I'll take a pass, I have no choice, I really will take a pass, I want to do it.'"
...

According to a joint explosive investigative report by "60 Minutes" that aired this Sunday and the concurrent story published the same day by the Washington Post, at the height of the deadliest drug epidemic in U.S. history, Congress effectively stripped the Drug Enforcement Administration in April 2016 of its potent weapon against large drug companies suspected of spilling prescription narcotics onto the nation’s streets.

The law was the crowning achievement of a multifaceted campaign by the drug industry to weaken aggressive DEA enforcement efforts against drug distribution companies that were supplying corrupt doctors and pharmacists who peddled narcotics to the black market. The industry worked behind the scenes with lobbyists and key members of Congress, pouring more than a million dollars into their election campaigns.

The chief advocate of the law that hobbled the DEA was Rep. Tom Marino, a Pennsylvania Republican who is now President Trump’s nominee to become the nation’s next drug czar. Marino spent years trying to move the law through Congress. It passed after Sen. Orrin G. Hatch (R-Utah) negotiated a final version with the DEA.

Marino declined repeated requests for comment. Marino’s staff called the U.S. Capitol Police when The Post and "60 Minutes" tried to interview the congressman at his office on Sept. 12. In the past, the congressman has said the DEA was too aggressive and needed to work more collaboratively with drug companies.

For years, some drug distributors were fined for repeatedly ignoring warnings from the DEA to shut down suspicious sales of hundreds of millions of pills, while they racked up billions of dollars in sales.The new law makes it virtually impossible for the DEA to freeze suspicious narcotic shipments from the companies.

Political action committees representing the industry contributed at least $1.5 million to the 23 lawmakers who sponsored or co-sponsored four versions of the bill, including nearly $100,000 to Marino and $177,000 to Hatch. Overall, the drug industry spent $106 million lobbying Congress on the bill and other legislation between 2014 and 2016, according to lobbying reports.

"The drug industry, the manufacturers, wholesalers, distributors and chain drugstores, have an influence over Congress that has never been seen before," said Joseph T. Rannazzisi, who ran the DEA’s division responsible for regulating the drug industry and led a decade-long campaign of aggressive enforcement until he was forced out of the agency in 2015. "I mean, to get Congress to pass a bill to protect their interests in the height of an opioid epidemic just shows me how much influence they have."

Besides the sponsors and co-sponsors of the bill, few lawmakers knew the true impact the law would have. It sailed through Congress and was passed by unanimous consent, a parliamentary procedure reserved for bills considered to be noncontroversial. The White House was equally unaware of the bill’s import when President Barack Obama signed it into law, according to interviews with former senior administration officials.

Top officials at the White House and the Justice Department have declined to discuss how the bill came to pass. Loretta E. Lynch, who was attorney general at the time, declined a recent interview request. Obama also declined to discuss the law.

A senior DEA official said the agency fought the bill for years in the face of growing pressure from key members of Congress and industry lobbyists. But the DEA lost the battle and eventually was forced to accept a deal it did not want.

The DEA and Justice Department have denied or delayed more than a dozen requests filed by The Post and "60 Minutes" under the Freedom of Information Act for public records that might shed additional light on the matter. Some of those requests have been pending for nearly 18 months. The Post is now suing the Justice Department in federal court for some of those records.

The successful effort of the opiate drug industry was also related to inside information on the DEA strategies obtained by the drug industry as a result of the "revolving door" of former DEA attorneys and investigators hired by the drug industry. At least 46 investigators, attorneys and supervisors from the DEA, including 32 directly from the division that regulates the drug industry, have been hired by the pharmaceutical industry since the scrutiny on distributors began.

Among them, Linden Barber, former associate chief council at the DEA. He's now a senior vice president at Cardinal Health, one of the nation's top drug distributors. Mike Gill, chief of staff for the former acting DEA administrator, was hired by one of the country's largest healthcare law firms. And most recently, Jason Hadges, a senior DEA attorney overseeing enforcement, joined the pharmaceutical division of a high-powered D.C. law firm.

Soon after the report aired on "60 Minutes" Sen. Claire McCaskill announced she will push to repeal the 2016 law. The ranking member on the Senate Homeland Security and Governmental Affairs Committee, said her legislation is being introduced in response to the joint Washington Post and "60 Minutes" investigation ...

Gov. Jerry Brown declared a state of emergency over the deadly hepatitis A outbreak in California. An increase in the incidence of infectious diseases related to geographic risk may give rise to industrial injury claims under several theories of California law on AOE-COE.

The emergency proclamation, which was issued by Brown on Friday, allows the state to increase its supply of hepatitis A vaccines in order to control the current outbreak.

The Los Angeles County Department of Public Health declared a local outbreak of hepatitis A in September. San Diego and Santa Cruz have also declared local outbreaks.

According to the CDPH, there have been a total of 18 deaths so far - all in the San Diego area, which has reported 490 cases of hepatitis A and 342 hospitalizations. The CDPH said the Santa Cruz area has 71 reported cases and 33 hospitalizations; Los Angeles has 8 reported cases and 6 hospitalizations; and other regions in California have 7 reported cases and 5 hospitalizations. This brings the total number of cases in the state to 576 with 386 hospitalizations.

California is experiencing the largest hepatitis A outbreak in the United States transmitted from person to person - instead of by contaminated food - since the vaccine became available in 1996. According to the CDPH, the hepatitis A virus is spread when the virus is ingested by mouth from contact with hands, objects, food or drinks that are contaminated by the feces of an infected person.

The Department of Industrial Relations has a webpage dedicated to the topic of "Protecting Workers from Hepatitis A." As part of their duty to correct unsafe or unhealthy conditions in the workplace (title 8 section 3203), The DIR says "employers should ask their local health departments whether hepatitis A vaccinations should be offered to employees who are at increased risk and if so, whether the local health department is available to assist."

Employers must ensure that workplace restrooms are kept clean and sanitary (title 8 section 1526 in construction and section 3364 for other workplaces). Additional cleaning may be needed if persons outside of the workplace who are at greatest risk for hepatitis A infection (i.e., homeless persons or persons using illicit drugs) have used or have had access to workplace restrooms. The County of San Diego Department of Environmental Health has posted Hepatitis A Disinfection Guidelines.

Cal/OSHA is encouraging employers and workers at risk of exposure to the hepatitis A virus to review preventive measures posted online.In outbreak locations, workers who have direct contact with persons who are homeless or use illicit drugs have an increased risk of hepatitis A exposure in settings that include the following:

- Health care and laboratory
- Public safety and emergency medical services
- Sanitation and janitorial
- Homeless services and substance use treatment facilities

A person can be exposed to the hepatitis A virus after coming into contact with objects, food or drinks contaminated by an infected person. Employers should maintain a clean and sanitary workplace and provide proper handwashing facilities and protective equipment ...