Cal/OSHA has cited two employers for serious accident-related health and safety violations after workers were poisoned by carbon monoxide while in a confined space at San Francisco International Airport.

Two plumbers from Gladiator Rooter & Plumbing were working in a crawl space replacing underground sewer pipes for airline caterer Gate Gourmet, Inc. on December 22, 2018. The plumbers were using a gasoline-powered saw to cut through concrete when they were overcome by carbon monoxide gas emitted from the equipment, causing one of the workers to lose consciousness. Emergency crews assisted the workers, one of whom was hospitalized for two days.

“These workers were fortunate because performing work in confined spaces can be deadly, especially when oxygen levels are reduced or when deadly gases are present,” said Cal/OSHA Deputy Chief of Enforcement Debra Lee. “Employers must identify and evaluate potential hazards before workers enter confined spaces so they can ensure workers are trained and a rescue plan is in place in case of emergency.”

Cal/OSHA’s investigation found that Gate Gourmet, Inc. did not inform Gladiator Rooter & Plumbing that the crawl space was a permit-required confined space, and did not provide information on the potential hazards posed by entering the space. Cal/OSHA also found that Gladiator Rooter & Plumbing did not have a safety and health program and did not train workers. In addition, the employer did not develop a confined space program, take steps to mitigate the hazards and did not have a rescue plan.

Cal/OSHA cited Gladiator Rooter & Plumbing $50,850 for eight violations, including two serious accident-related, two serious, and four general in nature.

The serious accident-related violations were cited for the company’s failure to implement a permit-required confined space program and its failure to train its employees on working safely in confined spaces. The serious violations were cited for the company’s failure to develop and implement a written permit space program and failure to obtain information about permit space hazard and provide that information to the workers entering the space.

Cal/OSHA cited Gate Gourmet $18,000 in proposed penalties for one serious accident-related violation for failing to communicate with Gladiator Rooter & Plumbing about confined space hazards and precautions.

Construction industry employers should review and follow confined space guidance detailed on pages 26-29 of the updated Cal/OSHA Pocket Guide for the Construction Industry. Cal/OSHA has other confined space resources available for employers in the general industry. All employers in California are required to have an effective written injury and illness prevention program, a safety program to identify, assess and control hazards in the workplace. Cal/OSHA has online tools and publications to guide employers on how to establish an effective safety program.

The Trump administration will no longer move forward on a proposed rule to eliminate the arcane rebates that flow from drugmakers to middleman pharmacy benefit managers, a significant reversal on one of the White House’s most sweeping actions to-date to curb rising treatment costs.

“Based on careful analysis and thorough consideration, the president has decided to withdraw the rebate rule,” spokesperson Judd Deere said in a statement. “The Trump administration is encouraged by continuing bipartisan conversations about legislation to reduce outrageous drug costs imposed on the American people, and President Trump will consider using any and all tools to ensure that prescription drug costs will continue to decline.”

In recent weeks, Politico and other publications reported that the White House and Health and Human Services Secretary Alex Azar disagreed over the rule.

And the proposal had faced resistance from domestic policy chief Joe Grogan and other fiscal hawks on grounds that it was too expensive – costing the government nearly $180 billion over a decade.

Some lawmakers also worried the rule would raise seniors’ Medicare Part D premiums.

The death of the proposal is also bad news for drug companies in that it is a sign that other Trump administration efforts could move forward, some of which the companies fiercely oppose.

Most prominently, the administration has proposed tying some Medicare drug prices to lower prices in other countries, a proposal currently under review at the White House.

Democrats, including Speaker Nancy Pelosi (D-Calif.), also opposed the rebate rule, favoring more direct actions against drug companies. White House staff has been in talks with Pelosi’s office for months on Medicare negotiating drug prices.

A new study conducted at the University of Liverpool has raised eyebrows by concluding that psychiatric diagnoses are “scientifically meaningless,” and worthless as tools to accurately identify and address mental distress at an individual level.

Researchers performed a detailed analysis on five of the most important chapters in the Diagnostic and Statistical Manual of Mental Heath Disorders (DSM). The DSM is considered the definitive guide for mental health professionals, and provides descriptions for all mental health problems and their symptoms. The five chapters analyzed were: bipolar disorder, schizophrenia, depressive disorders, anxiety disorders, and trauma-related disorders.

Researchers came to a number of troubling conclusions.

First, the study’s authors assert that there is a significant amount of overlap in symptoms between disorder diagnoses, despite the fact that each diagnosis utilizes different decision rules. Additionally, these diagnoses completely ignore the role of trauma or other unique adverse events a person may encounter in their life.

Perhaps most concerning of all, researchers say that these diagnoses tell us little to nothing about the individual patient and what type of treatments they will need.

The authors ultimately conclude that this diagnostic labeling approach is “a disingenuous categorical system.”

“Although diagnostic labels create the illusion of an explanation they are scientifically meaningless and can create stigma and prejudice. I hope these findings will encourage mental health professionals to think beyond diagnoses and consider other explanations of mental distress, such as trauma and other adverse life experiences.” Lead researcher Dr. Kate Allsopp explains in a release.

According to the study’s authors, the traditional diagnostic system being used today wrongly assumes that any and all mental distress is caused by a disorder, and relies far too heavily on subjective ideas about what is considered “normal.”

“Perhaps it is time we stopped pretending that medical-sounding labels contribute anything to our understanding of the complex causes of human distress or of what kind of help we need when distressed.” Professor John Read comments.

The study is published in the scientific journal Psychiatry Research.

Sedgwick has signed an agreement to acquire York Risk Services Group. Following the close of the transaction, Sedgwick will gain more than 60 offices across the US and nearly 5,000 employees, taking its total workforce up to nearly 27,000.

Once approved, the deal would mark Sedgwick’s third acquisition of a TPA in five years. The Memphis, Tennessee-based company purchased Cunningham Lindsey in 2018 and T&H Global Holdings, owner of VeriClaim, in 2014.

Sedgwick Group President Michael Arbour said during an interview that the purchase of York will enhance the company’s scope of services and improve its access to talent in the claims industry. He said York is active in some market segments where Sedgwick has little presence, such as with Longshore and Harbor Workers’ Compensation and Defense Base Act claims and the administration of group risk pools.

He noted that York also is in a strong position as a service provider for public agencies and provides managed care services for other claims administrators. Sedgwick also provides managed care services, but only to clients for whom it adjusts claims, he said.

“We’ve admired them as a friendly competitor for years,” Arbour said. “They do a lot of things that we do and they do a lot things that we don’t do.”

“Joining forces with Sedgwick will provide enhanced capabilities for York’s clients and new opportunities for our associates,” said Thomas Warsop, chairman and CEO of York. “It’s great news for all.”

“At Sedgwick, taking care of people is at the heart of everything we do,” North said. “Bringing together the expertise and capabilities of Sedgwick and York will allow us to serve more customers in more places and show an unprecedented number of people how caring counts.”

BofA Merrill Lynch and Morgan Stanley & Co. LLC served as financial advisors to Sedgwick, and Simpson Thacher & Bartlett LLP and Clifford Chance US LLP served as legal advisors. Jefferies LLC and J.P. Morgan Securities LLC served as financial advisors to York, and Fried, Frank, Harris, Shriver & Jacobson LLP served as its legal advisor. BofA Merrill Lynch and Morgan Stanley Senior Funding, Inc. have provided committed debt financing for the transaction.

The closing of the transaction is subject to customary conditions and regulatory approvals. The terms of the agreement were not disclosed.

Sedgwick isn’t the only third-party administrator on a buying spree. Also on Monday, Fairfax Financial Holdings’ Riverstone subsidiary announced that it has acquired Rockville Risk Management Associates and its sister company, ER Quinn Co.

Joe Paduda, owner of the employer consulting firm Health Strategy Associates, said the merger of the two TPAs – both of which adjust workers’ compensation claims – is not surprising.  “There’s no question there will be more consolidation in the industry,” he said in an email. “Worker’s comp is a shrinking business and consolidation is a foregone conclusion.”

Congress is cranking up the pressure on the Food and Drug Administration (FDA) to draft rules to regulate cannabis-based products.  Lawmakers legalized the use of hemp-based cannabidiol (CBD) products late last year in the farm bill, sending the agency scrambling to figure out new rules around regulating a unique product that is both a drug and a dietary supplement.

But Congress is signaling that it is growing impatient as the FDA looks for a solution and may not wait on the sidelines for much longer.

“In Congress, some are itchy [for action],” said Jonathan Miller, general counsel for the industry advocacy group U.S. Hemp Roundtable.  Miller said some lawmakers have been privately circulating potential legislation, but he doesn’t expect any formal push from Congress until at least later this fall. “If their patience ends [and FDA doesn’t act], there will be an effort for legislation,” Miller said.

The FDA held a public hearing at the end of May, and experts and industry representatives said it was a good start but did not advance the ball much in terms of giving clarity from a federal level. People who attended the meeting said they left without any new sense of the agency’s timing on creating new regulations.

During the 10-hour hearing, acting FDA Commissioner Ned Sharpless made no promises about timing, but FDA officials were clear that they wanted more data from the public. Sharpless said the agency was essentially operating in uncharted waters.

In particular, FDA wants more information about dosing levels, including how much CBD is safe to consume, and any long-term exposure risks. The agency is also focused on the effects CBD has on children, elderly and pregnant women.

Public comments concerning FDA’s role are due July 16, after the agency extended the deadline for an additional two weeks.

CBD is derived from the marijuana plant but doesn’t give users a high. Ever since the farm bill passed, CBD products have been appearing online and on the shelves of convenience stores, coffee shops and nutrition stores in select states.

In the meantime, lawmakers from both parties are trying to nudge FDA to act. A provision in the House appropriations package that passed last month sets aside funding for FDA to study and set specific levels of CBD to put in food and drinks.

Senate Majority Leader Mitch McConnell (R-Ky.) met with Sharpless last week, and urged the agency to speed up the timing on CBD regulation. “Congress’s intent was clear with the passage of the Farm Bill that these products should be legal, and our farmers, producers and manufacturers need clarity as well as a workable pathway forward regarding the agency’s enforcement,” McConnell said in a statement. “Like my constituents, I am anxious to know the FDA’s plans to ensure public access to safe CBD products,” he added.

Sen. Ron Wyden (R-Ore.) did not meet with Sharpless personally, but last week sent a letter to the agency urging FDA to set an interim policy by Aug. 1 that would allow products containing hemp-derived CBD to be manufactured and sold as food and dietary supplements. Wyden said it was “fully unacceptable” for FDA to suggest it may take up to five years to issue rules. “The regulatory confusion and uncertainty surrounding CBD cannot continue for that length of time,” Wyden wrote.