The Travelers Companies, Inc. reported an almost 40 percent reduction in the use of opioids among the injured construction workers it has helped, thanks to a combination of its Early Severity Predictor® model and its comprehensive pharmacy management program.

The Early Severity Predictor is the company’s proprietary predictive model that helps forecast which injured employees are at higher risk of developing chronic pain, while the pharmacy management program monitors drug interactions, excessive dosing and abuse patterns to reduce the risk of opioid dependency.

Construction sites contain many health and safety risks for workers, with strains, sprains, broken bones and head traumas among the most common employee injuries. All of these can lead to chronic pain, a condition that is often treated with highly addictive opioids. In fact, roughly half of all workers compensation claims related to the construction industry that are submitted to Travelers involve opioid prescriptions.

“The opioid epidemic is having a profound effect on our society, and the crisis is especially concerning for the construction industry, where the work can be physically demanding,” said Rick Keegan, President of Construction at Travelers. “Identifying safe and effective alternatives to treat injuries and prevent chronic pain will help injured employees avoid the risks associated with opioids while helping our customers better manage the related medical costs.”

Travelers’ nurses and Claim professionals work closely with at-risk injured employees identified by the Early Severity Predictor model, and their physicians, to develop an aggressive, sports-medicine-like treatment regimen, which often includes physical therapy and other interventions to prevent acute pain from becoming chronic. This approach is particularly significant for the construction industry, where Travelers claim data show that injured workers who suffer from chronic pain can be out of work for as much as 50 percent longer than those in other industries.

“We are committed to using our deep domain expertise, and our industry-leading data and analytics, to help address the causes of chronic pain,” said Rich Ives, Vice President of Workers Compensation Claim at Travelers. “We’re finding new ways to curb prescription opioid abuse while getting injured workers the care they need to return to work as soon as is medically appropriate.”

Purdue Pharma L.P. is a privately held pharmaceutical company owned principally by descendants of Mortimer and Raymond Sackler. The company is the target of the Opioid litigation stampede.

In 2007 it paid out one of the largest fines ever levied against a pharmaceutical firm for mislabeling its product OxyContin, and three executives were found guilty of criminal charges. Purdue continues to market and sell opioids

Purdue Pharma was founded in 1892. In 1952, the company was sold to two other medical doctors, Raymond and Mortimer Sackler. OxyContin, was introduced by the company in 1995. Under a marketing strategy that Arthur Sackler had pioneered decades earlier, the company aggressively pressed doctors to prescribe the drug, wooing them with free trips to pain-management seminars and paid speaking engagements. Sales soared.

OxyContin became a blockbuster drug. Purdue had increased its earnings from a few billion in 2007 to US$31 billion by 2016. That had increased to US$35 billion by 2017. According to a 2017 article in The New Yorker, Purdue Pharma is “owned by one of America’s richest families, with a collective net worth of thirteen billion dollars”.

Perhaps in response to rumors that Purdue is considering filing for bankruptcy protection as a strategy to limit its damages, the Massachusetts Attorney General Maura Healey’s lawsuit filed against the company in June in Suffolk County Superior Court, was revised earlier this year to include new allegations. The suit is now the first by a state to try to attempt to hold Sackler family members personally responsible for contributing to the opioid epidemic.

Healey’s complaint cites records to argue that family members, including Purdue’s former President Richard Sackler, personally directed deceptive opioid marketing while making $4.2 billion from Purdue from 2008 to 2016.

They did so even after Purdue and three executives in 2007 pleaded guilty to federal charges related to the misbranding of OxyContin and agreed to pay a total of $634.5 million in penalties, the lawsuit said.

But in their motion, the Sacklers said nothing in the complaint supports allegations they personally took part in efforts to mislead doctors and the public about the benefits and addictive risks of opioids.

They said their role was limited to that of typical corporate board members who participated in “routine” votes to ratify the management’s staffing and budget proposals.

“Not a single document shows an individual director engaging in any unlawful conduct regarding the sale of prescription opioids or ordering anyone else to do so,” the Sacklers’ lawyers wrote.

Healey, in a statement, called the motion “an attempt to avoid accountability.”

Jocelyn Bowen injured her neck and right shoulder while working for the County of San Bernardino. Since at least March 9, 2015, she was prescribed, and she used, Norco to control her symptoms of pain.

On November 23, 2015, IMR issued a final determination letter finding, that the prescribed Norco was medically necessary and appropriate. The rationale was that she “rates the pain 8-9 out of 10 on pain scale without medications and 4-5 out of 10 on the pain scale with medications . .. . The injured worker reports functional improvement and improvement in pain with medications. She notes improvement in activities of daily living (ADL) as well as increased ability to reach, lift, grab and hold as a result of her medication usage.”

The following month, the PTP again prescribed Norco based upon the same clinical observations. UR rejected the December RFA which was again appealed to IMR.The second IMR reviewer was a family practice physician, and upheld the UR denial.

The first November 23, 2015 IMR final determination letter was not included, in the information given to the second IMR reviewer, and there is no indication that the second IMR reviewer considered it. The second reviewer noted that “Although the physician noted an improvement in the level of function with medication use, there was no documentation of any specific objective functional improvements with the use of Norco.”

Applicant timely appealed the second IMR determination pursuant to L.C. section 4610.6(h). The WCJ granted the appeal, and found that the IMR determination contained plainly erroneous findings and was without or in excess of the powers of the AD, and rescinded the IMR determination, and ordered the dispute to a new IMR reviewer in the specialty of orthopedic surgery, pain management, and/or physical medicine and rehabilitation. The WCJ also indicated that the new IMR reviewer should review the previous IMR determination.

The former acting Administrative Director objected to the WCJ’s instruction that the new IMR reviewer should review a previous IMR determination approving the prescription for Norco, arguing that review of a prior IMR final determination may detract from the independence of the new review. The AD agreed that the IMR reviewer should be in a specialty more appropriately matched to applicant’s diagnosis, and submitted the matter for a new IMR determination.

The WCAB rejected the limits placed by the Administrative Director and affirmed the WCJ in the panel decision of Bowen v the County of San Bernardino.

The Court of Appeal held that IMR determinations are subject to meaningful review, even if the Appeals Board cannot change medical necessity determinations, noting that “[t]he Board’s authority to review an IMR determination includes the authority to determine whether it was adopted without authority or based on a plainly erroneous fact that is not a matter of expert opinion.” (Stevens v. Workers’ Comp. Appeals Bd. (2015) 241 Cal.App.4th 1074, 1100.)

The record reflects that the IMR reviewer did not review all the documents submitted. The record does not reflect the reason these documents were not included in the IMR review or what information was contained in them. It is unknown whether the IMR organization failed to provide these records to the reviewer, or whether the physician reviewer ignored or overlooked them.

As part of the new IMR, applicant may re-submit the November 23, 2015 IMR final determination and all of the PTP reports to the IMR reviewer.

Fresenius Medical Care operates more than 40 production sites on all continents. Its largest plants in terms of production output are in the U.S. (Ogden, Utah, and Concord, California), Germany (Schweinfurt and St. Wendel), and Japan (Buzen).

A division of Fresenius Medical Care North America (FMCNA), Fresenius Kidney Care is the worldwide leader in the treatment of renal disease and an innovative leader in kidney disease research. It claims to serve over 190,000 patients in over 2,400 facilities nationwide.

In 2012, Fresenius acquired Liberty Dialysis Holdings, in a deal which entailed the sale of its outpatient dialysis clinics in 43 local markets within the U.S.

In 2013, Fresenius Medical Care NA acquired Shiel Medical Laboratory Inc, expanding services to New York City metro area. In September 2017 the company announced the divestment of the business of Shiel Medical Laboratory, Inc. to Quest Diagnostics, Inc.

Fresenius Medical Care has just agreed to pay approximately $231 million to resolve investigations by the DOJ and the SEC into violations of the Foreign Corrupt Practices Act (FCPA) in connection with Fresenius’s participation in various corrupt schemes to obtain business in multiple foreign countries.

Fresenius admitted it paid bribes to publicly employed health and/or government officials to obtain or retain business in Angola and Saudi Arabia. as well as in Morocco, Spain, Turkey and countries in West Africa,

“Fresenius doled out millions of dollars in bribes across the globe to gain a competitive advantage in the medical services industry, profiting to the tune of over $140 million,” said Assistant Attorney General Benczkowski.

In total, Fresenius admitted to earning more than $140 million in profits from the corrupt schemes.

To resolve the case, Fresenius entered into a nonprosecution agreement (NPA) with the Department and agreed to pay a total criminal penalty of $84,715,273. As part of the NPA, Fresenius also agreed to continue to cooperate with the Department’s investigation, enhance its compliance program, implement rigorous internal controls and retain an independent corporate compliance monitor for at least two years.

Fresenius settled a related FCPA matter with the U.S. Securities and Exchange Commission (SEC), and will pay $147 million in disgorgement and prejudgment interest to the SEC, which the Department credited in its resolution, bringing the total amount paid by Fresenius to over $231 million.

This case is being investigated by the FBI’s International Corruption Squad in New York and the FBI’s Boston Field Office. Trial Attorneys Paul A. Hayden and Sonali D. Patel of the Criminal Division’s Fraud Section and Assistant U.S. Attorney Jordi de Llano of the District of Massachusetts are prosecuting the case.

Cal/OSHA has issued serious health and safety citations to Underground Construction Co., Inc. of Benicia after two of its employees contracted Valley Fever. The workers were exposed to the fungal disease while using hand tools to dig trenches in Kings, Fresno and Merced counties—areas where the soil is known to contain harmful spores that cause the infection.

Cal/OSHA was notified in September 2018 that the employees were hospitalized after being diagnosed with Valley Fever, also known as Coccidioidomycosis. Symptoms of the disease are similar to the flu and include fatigue, shortness of breath and fever. Severe cases can cause serious lung problems.

The workers were tasked with digging trenches up to 5½ feet deep to allow access to gas pipelines for maintenance. Dust was not controlled, and the workers did not wear any respiratory protection. Exposure to the disease could have occurred in any one of the three counties where the fungal spores are known to be endemic.

Cal/OSHA’s investigation found that Underground Construction Co., Inc. did not evaluate the hazard of performing digging work in areas known to contain the coccidioides fungal spores. The employer did not suppress or control harmful dusts and failed to provide employees with respiratory protection. Cal/OSHA issued three citations to the employer with $27,000 in proposed penalties.

Since 2017, Cal/OSHA has cited 12 businesses for work-related Valley Fever.

Valley Fever is caused by a microscopic fungus known as Coccidioides immitis, which lives in the top two to 12 inches of soil in many parts of the state. When soil is disturbed by digging, driving or high winds, fungal spores can become airborne and may be inhaled by workers who are not protected. While the fungal spores are most likely to be present in the soils of the Central Valley, they may also be present in other areas of California. Cal/OSHA’s Valley Fever informational page provides detailed information including resources for workers and employers.

Tips for reducing the risk of Valley Fever exposure include:
— Determine if a worksite is in an area where fungal spores are likely to be present.
— Adopt site plans and work practices that minimize the disturbance of soil and maximize ground cover.
— Use water, appropriate soil stabilizers, and/or re-vegetation to reduce airborne dust.
— Limit workers’ exposure to outdoor dust in disease-endemic areas by (1) providing air-conditioned cabs for vehicles that generate dust and making sure workers keep windows and vents closed, (2) suspending work during heavy winds, and (3) providing sleeping quarters, if applicable, away from sources of dust.
— When exposure to dust is unavoidable, provide approved respiratory protection to filter particles.
– Train supervisors and workers in how to recognize symptoms of Valley Fever and minimize exposure. Cal/OSHA helps protect workers from health and safety hazards on the job in almost every workplace in

California. Cal/OSHA’s Consultation Services Branch provides free and voluntary assistance to employers to improve their health and safety programs. Employers should call (800) 963-9424 for assistance from Cal/OSHA Consultation Services