Tag: 2013 News

Existing law specifies the time period within which various proceedings may be commenced under provisions of law relating to workers’ compensation. With certain exceptions, a proceeding to collect death benefits is required to be commenced within one year from the date of death or, in some cases, from the last furnishing of benefits. However, no proceedings for death benefits may be commenced more than 240 weeks from the date of injury.

AB 1373 would have provided that certain proceedings related to the collection of death benefits of firefighters and peace officers may be commenced within, but no later than, 480 weeks from the date of injury and in no event more than one year after the date of death if all of the specified criteria are met, including, but not limited to, that the employee’s death is the result of a specified injury.

According to the author, and the sponsor the California Professional Firefighters, there are cases where current law they say “unfairly harms” the dependents of fallen public safety officers. In circumstances where a safety officer dies more than 240 weeks after a diagnosis of the condition that causes death, current law does not provide benefits for surviving dependents. However, there are conditions where survival for more than 240 weeks after diagnosis is not uncommon, notably a cancer that goes temporarily into remission, or a blood-borne disease that results in a debilitating but long, slow decline.

A number of public agencies opposed the bill primarily on the basis of increased costs as well as the uncertainty of the as-yet unspecified time period. These agencies believe that the workers’ compensation benefits available to public safety officers are already sufficiently generous, and local governments are simply not in the position to incur new financial obligations.

Last year the legislature passed AB 2451 which also proposed to extend the statute of limitations in presumption cases. AB 2451 was significantly broader in at least 2 respects: it also applied to death resulting from heart conditions, and it did not limit the cases where the extended limitations period applied to those where the date of injury was during active employment. Rather, AB 2451 would have applied regardless of when the condition arose, resulting in significantly more uncertainty, and significantly more cases, than AB 1373 will apply to. Governor Brown vetoed AB 2451 last year.

And he also vetoed AB 1373 passed by the legislature this year. His veto message said “This measure is identical to the one I vetoed last year. At that time, I outlined the information needed to properly evaluate the implications of this bill. I have not yet received that information.”

A former Livingston police officer pleaded no contest Friday to insurance fraud and was ordered to repay the state more than $14,000. The Merced Sun-Star reports that Sammy Galindo, 31, pleaded to a single felony count of workers’ compensation fraud in Merced Superior Court before Judge Ronald W. Hansen. The judge ordered Galindo to serve two years of probation and pay $14,200 in restitution.

This sends the message that nobody is immune from the law and if you engage in fraud, you’ll be prosecuted,” said Walter Wall, the deputy district attorney who prosecuted the case.

After Friday’s hearing, Galindo made his first restitution payment of $4,500, Wall said. Galindo’s attorney, Marshall Hogkins, could not be reached for comment Friday.

According to the complaint, Galindo claimed he injured his right shoulder while making an arrest May18, 2011. He was placed on disability leave. It was at least the third disability claim Galindo had made since he was hired in September 2006. Livingston Police officials found it suspicious..Galindo claimed he was unable to move his shoulder without pain, but video surveillance taken by private investigators on June30, 2011, shows him performing heavy manual labor, including unloading a large tree from the bed of a pickup, digging holes in his yard and mowing his lawn.

Subsequent medical examinations showed no damage to Galindo’s shoulder, according to court documents.

When investigators confronted Galindo, he initially denied performing any yardwork. As part of his plea, he acknowledged making false statements to detectives, prosecutors said.

According to court records, the Livingston Police Department fired Galindo in September 2012 for dishonesty and violating the Police Officer’s Code of Ethics. He lost his appeal during a mediation hearing that same year.

Police Chief Ruben Chavez declined to comment directly on the case Friday, citing personnel confidentiality laws. Speaking in general terms, Chavez acknowledged that cases involving lying police officers do more than harm the image of law enforcement, they can undermine any investigations or convictions that involved those individuals. “As officers, we’re held to a very high standard of integrity and professionalism,” Chavez said. “Anytime an issue of credibility comes up, it causes great concern. You cannot risk losing the trust of the community.”

USA Today reports that hospitals are starting to cut thousands of jobs amid falling insurance payments and inpatient visits.The payroll cuts are surprising because the Affordable Care Act (ACA), whose implementation took a big step forward this month, is eventually expected to provide health coverage to as many as 30 million additional Americans. “While the rest of the U.S. economy is stabilizing or improving, health care is entering into a recession,” says John Howser, assistant vice chancellor of Vanderbilt University Medical Center.

Health care providers announced more layoffs than any other industry last month – 8,128 – largely because of reductions by hospitals, according to outplacement firm Challenger Gray and Christmas. So far this year, the health care sector has announced 41,085 layoffs, the third-most behind financial and industrial companies.Total private hospital employment is still up by 36,000 in the past 12 months, but it’s down by 8,000 since April, and more staff reductions are expected into next year.

This month, Indiana University Health laid off about 900 workers as part of a move to trim its budget by $1 billion over five years. Vanderbilt plans to eliminate 1,000 jobs by the end of the year to help shave operating costs 8% a year. The Cleveland Clinic is offering buyouts to 3,000 employees as it shaves its annual operating costs by $330 million. “This is a challenging time for the health care industry,” says Jim Terwilliger, president of two of Indiana health’s hospitals. “The pace of change is far greater than any time in recent history.”

There are myriad reasons for the cuts, which are affecting administrative staff as well as nurses and doctors. Medicare, Medicaid and private insurance companies are all reducing reimbursement to hospitals. The federal budget cuts known as sequestration have cut Medicare reimbursement by 2%, the American Hospital Association says. The health care law has further reduced the Medicare payments to hospitals that provide lower-quality service or have high readmission rates.The National Institutes of Health reduced funding to hospitals by 5% as part of sequestration, forcing hospitals to trim research staff. The number of inpatient hospital days fell 4% from 2007 to 2011, in part because of the economic downturn, the hospital association says. As more Baby Boomers turn 65, their services will be reimbursed at Medicare rates that are lower than those of private payers, putting further pressure on hospital revenue.

The new health care law was supposed to ease the burden on hospitals by expanding Medicaid coverage to more low-income Americans, who often use hospital services in emergencies, then don’t pay their bills. But 26 states rejected the ACA’s offer of federal funding to expand Medicaid. That decision led to about a third of the job cuts by Nashville-based Vanderbilt, Howser says.

Knowing what is, or is not a good subrogation case takes time and experience. The negligence “reasonable man” standard has clear extremes, and a grey area in the center that makes a determination of what conduct is below the standard sometimes difficult. A new case from the California court of appeal shows what ended up to be not such a good case for the injured worker.

Plaintiff James C. Keith filed an action against the City of Pleasant Hill, and Kelli M. Geis, a police officer employed by the City, seeking damages for injuries he suffered at his job when he was struck by a water pump attached to a hose that became entangled with the underside of Geis’s squad car.

Keith was working for the Contra Costa Water District at the time, performing repairs in the street on Golf Club Road in Pleasant Hill. The construction area was set up with orange traffic cones directing eastbound traffic on Golf Club Road into the right hand, or “number two” lane. Keith was working in the number one lane, where a hole had been dug to fix a leaking pipe. As part of the construction work, the District workers placed a flexible hose attached to a water pump across the active lane of traffic, the number two lane.

Kelli Geis, a Pleasant Hill police officer, was driving a patrol car eastbound on Golf Club Road on a nonemergency assignment to back up a fellow officer. The posted speed limit was 25 miles per hour. Geis slowed as she entered the construction area, and passed over the hose at under 25 miles per hour. Traffic had been passing over this hose for several hours earlier that day, with some vehicles traveling faster than Geis and some traveling slower. When Geis passed over the hose, it became entangled in the undercarriage of her vehicle. As she continued driving, the hose pulled the water pump out of the excavation hole. The pump struck Keith’s leg, causing multiple serious fractures. The force of the impact also sent him into the air, causing him to fall on and injure his head and shoulder. Geis was not aware of the accident at the time it occurred. As she traveled further down the road, another driver indicated to her that some material was trailing from her patrol vehicle. She stopped the car and retrieved a section of yellow hose.

Defendants filed a motion for summary judgment. Defendants argued that Geis did not breach any duty to Keith. In opposition, Keith offered the opinion of an expert in accident reconstruction and analysis who concluded that Geis’s speed had “caused the pressurized hose to ‘jump’ higher than other motorists who had traveled at slower speeds over the hose, which allowed the hose to catch or entangle on the undercarriage of [her] vehicle.”

The trial court granted summary judgment in favor of the City and police officer. The judgment was affirmed in favor of the defendants in the unpublished case of Keith v. City of Pleasant Hill.

The Court concluded that it “is not reasonable to require a driver of a vehicle to foresee that driving at or below the posted speed limit over a hose that has been deliberately extended over the road, and which the driver has no choice but to drive over, will become entangled in the undercarriage of his or her vehicle. If such were the case, any vehicle driven over such a hose would potentially subject its driver to liability. Indeed, it is difficult to perceive how a driver could avoid potential liability in this case, given that hundreds of vehicles of all sizes had driven over the hose prior to Geis, some at different speeds and all without incident.”

The outcome of this case is not surprising. The opinion is based on simple common sense. Often it is just common sense that helps a claim administrator determine what is or is not a good case for subrogation. Keith’s claim is a good example of a case that would not justify a subrogation effort.

The Orange County Register reports that a Santa Fe Springs-based healthcare management company has acquired Pacific Hospital of Long Beach. The move by College Health Enterprises Inc. to purchase Pacific Hospital comes as Pacific Hospital faces state and federal investigations into alleged fraudulent spinal surgeries for workers’ compensation cases.

The deal was confirmed Tuesday evening by John Molina, CFO of Molina Healthcare Inc., and whose Long Beach-based company will be involved in managing the community hospital at 2776 Pacific Ave., a first in its portfolio of businesses. Molina said he expects the hospital to expand with the rollout of Obamacare, which is designed to give medical service to low-income people. “The focus of Pacific Hospital is to create access to what before had been barriers,” he said.

Financial terms of the acquisition by College Health, which was founded in 1986 and operates hospitals in Cerritos and Costa Mesa, were not disclosed. The deal became effective at midnight Tuesday, said Molina. As of late Tuesday, Barry J. Weiss, president of College Health, hadn’t returned a phone call seeking comment.

Molina Healthcare, a managed care insurer specializing in Medicaid-eligible families and individuals, said it will form a separate business unit to manage College Health’s acute-care services at Pacific Hospital. The new Molina Healthcare unit is to be called American Family Care Hospital Management, Molina said.

Molina said the newly created business unit will retain more than 300 of Pacific Hospital’s 700 workers. He was uncertain how many of the employees College Health will keep.

As part of the deal, College Health is to run two of Pacific Hospital’s psychiatric units. One is located at the main campus, with a smaller one located at Pacific Avenue and Pacific Coast Highway.

In June, the State Compensation Insurance Fund filed a complaint in federal court in Santa Ana claiming Pacific Hospital of Long Beach and other entities affiliated with it have been running scams for years to illegally boost payments for medical services provided to injured workers. SCIF wants to recoup some of the $160 million it has paid over the past dozen years under civil statutes used to prosecute organized crime syndicates. The Fund filed the federal lawsuit under the Racketeer Influenced and Corrupt Organizations Act against Pacific Hospital owners Michael D. Drobot Sr. and his son Michael R. Drobot Jr., the principals of HealthSmart Pacific, and several companies they operate, alleging five different schemes to illegally boost payments by the insurance fund.

The fund uncovered the alleged schemes after it launched an investigation into Pacific Hospital’s bills. It had learned of reports that the Federal Bureau of Investigation had served search warrants at the hospital and an affiliated entity, Industrial Pharmacy Management.