Tag: 2013 News

Only about a third of patients surveyed at one U.S. medical center said their doctors told them about the possible risks of a CT scan, such as radiation exposure, a new study finds.According to the summary in Reuters Health, researchers, who published their findings in JAMA Internal Medicine on Monday, also found that most patients thought their doctors made the final decision to have the scans.

“I think that sounds pretty consistent of what my experience would be as a patient, physician and with family members,” said Dr. Howard Forman, professor of diagnostic radiology and public health at the Yale School of Public Health in New Haven, Connecticut, who was not involved with the new study.The new study jibes with previous research that found people are unaware of the radiation risks posed by CT scans.

CT scans are high-powered X-rays that provide clearer images but expose patients to between ten and 100 times as much radiation as a normal head or chest X-ray.

For the new study, Dr. Tanner Caverly, from the University of Colorado Anschutz Medical Campus in Aurora, and colleagues surveyed 286 patients getting a CT scan at the Denver Veterans Affairs Medical Center from November through December 2011. Of the 271 patients that returned their surveys, 35 percent said they discussed the risks of a CT scan with their doctors and 62 percent believed the final decision to have the scan was made by the doctors. Only 17 percent of the patients said they were involved in the decision-making process and discussed risks and benefits with their doctors. But even when doctors were discussing the potential risks, their patients ended up being no more informed than people who didn’t talk with their healthcare providers.

“It’s likely that many physicians also do not know the risks, and so it’s not surprising that even when there are discussions with patients about risks and benefits of the procedure, patients clearly still do not understand the true risk of radiation exposure,” wrote Dr. Patrick O’Malley, a deputy editor of the journal, in an note accompanying the new study.

One study from the National Cancer Institute estimated there would be about 29,000 future cancers related to scans done in 2007 alone. That year, Americans had about 72 million total CT scans, which can cost from a few hundred dollars to several thousand dollars.

Forman told Reuters Health there are a few ways to address the problem of patients not being told about the risks of CT scans, including educating doctors and empowering patients to ask questions. “I think we need to empower healthcare consumers/patients much more to have complete understanding and control of their care and its delivery. I think physicians are sometimes offended by patients who ask too many question and I think that’s something we need to change,” Forman said.

In an article published by the editorial board of the Sacramento Bee, the newspaper stated that “professional athletes claiming cumulative injuries incurred during the course of their careers have been abusing the California workers’ compensation system.” That is a notable statement by a typically liberal newspaper which may signal the political appetite in the Sacramento legislature for the elimination of these claims by passage of A.B. 1309.

In an article last week, Los Angeles Times reporter Marc Lifsher described how retired athletes tap into California’s generous workers’ compensation system to collect six-figure settlements for cumulative trauma, even though they played only a fraction of their games in California, or may never have played here. Many of them are big-name players who earned huge dollars. Others attained neither fame nor fortune.

The Bee article also notes that the California Insurance Guarantee Association is the entity that pays workers’ compensation claims when workers’ comp insurance companies become insolvent. California employers – not just professional sports teams – pay into the California Insurance Guarantee Association. In a letter to Assemblyman Henry T. Perea, D-Fresno, the association in December said that California residents account for only 373 of its 1,873 claims from professional athletes. The number of claims from retired athletes is growing at an alarming rate – 34 per month, as of December. The association had to add four claims adjusters to handle the influx of athletes’ claims.

The CIGA letter cited several issues that should alarm lawmakers, employers and workers. Athletes who played only one day in California, or suited up but sat on the bench, can receive compensation from California’s workers’ comp system. Athletes can file claims whether or not they were injured on a California field or court. The letter notes that players file claims in their home states and receive compensation. Because of the laxity of California’s law, California judges can award full benefits to out-of-state players. Adding to the complexity, the letter noted, “an athlete who last played 20 or 30 years ago is not barred from filing a claim today.”

The Bee article goes on to say that “California cannot afford to be the bank for out-of-state athletes and their lawyers. The guarantee association’s deficit hovers at $2 billion. California employers – not just sports teams – paid $78 million toward reducing that deficit last year. Since 2002, CIGA has paid $42 million in claims to professional athletes. The cost of processing the claims was $1 million a year. The largest number of claims come from Texas and Florida, states favored by wealthy athletes because, unlike California, they impose no state income tax.”

Assembly member Perea has proposed Assembly Bill 1309, which would deny California benefits to pro baseball, basketball, football, hockey and soccer players whose teams are not based in California and who came here only occasionally for games.

The Bee says that “The fix seems simple – though in the Capitol, nothing ever is easy. California’s system should take care of injured athletes who played the bulk of their time California, quickly and fairly. But if they played for teams in Texas, Florida, or any other state, those states need to take responsibility.”

Larry Centers and Troy Vincent were among more than 60 former National Football League players suing the organization’s management council to overturn an arbitration decision that bars them from seeking workers compensation in California.

According to the story in Bloomberg News, the players were required under a December arbitration award to withdraw claims in the state and banned from claiming they are entitled to the benefits, according to a complaint filed in federal court in San Francisco. The players contractually waived their rights to file workers’ compensation benefits in California, an NFL arbitrator decided, according to the lawsuit.

The decision must be thrown out because it’s unconstitutional and against public policy and federal labor law, attorneys for the ex-players say in the complaint. The players suing were all injured in California, or claim that injuries they had were aggravated while playing in games or practices in California, according to the complaint.

Greg Aiello, an NFL spokesman, said there are other federal lawsuits involving athletes who played for football teams from outside California, weren’t injured in California and breached contracts they signed promising to file claims in their team’s home state.

“In all those cases, the federal courts threw out the lawsuits and confirmed the award,” Aiello said in an e-mail. “In addition to all signing contracts promising to file elsewhere, none of the players listed as plaintiffs in this lawsuit had any specific injury in California and they all played for non-California” teams.

Two similar lawsuits were filed in federal court in San Francisco in December. The case is Centers v. National Football League, 13-882, U.S. District Court, Northern District of California (San Francisco).

The Audit Unit of the Division of Workers’ Compensation has received an increasing number of complaints from individuals and entities providing services on a lien basis in workers’ compensation claims. The complainants report that some payors have adopted a policy of refusing to discuss negotiating the provider’s liens until the provider of the services demonstrates it has filed a lien with the WCAB and paid the applicable lien filing or activation fee required by the enactment of SB 863. As a result, the DWC published the following admonishment.

“Such a policy is both unsupported by the plain language of Labor Code sections 4903.05 or 4903.06, and directly contrary to the legislative intent of those sections and existing law.”

“If a claims administrator has reasonable grounds to contend that nothing is owed, then good faith negotiation does not necessarily require an offer of compromise. In the absence of a good faith contention that nothing is owed, however, a refusal to negotiate prior to payment of the filing fee would not be in good faith”.

Additionally, Title 8, California Code of Regulations, section 10109(e) mandates that “[a]ll Insurers, self-insured employers and third-party administrators shall deal fairly and in good faith with all claimants, including lien claimants”.

“Title 8 California Code of Regulations, section 10250(b) requires a moving party state under penalty of perjury that the moving party has made a genuine good faith effort to resolve the dispute before filing the Declaration of Readiness (DOR). Forcing a provider to file a lien and pay the filing or activation fee before the payor will discuss informal resolution of their billing amount prevents the provider from complying with this mandate. Such conduct could expose the payor to the imposition of sanctions, attorney’s fees and costs under Labor Code section 5813. This practice also exposes the payor to audit penalties for violation of Title 8, California Code of Regulations, section 10109(e). As is the Audit Unit’s existing practice, the Audit Unit will review all complaints received about this practice during the next random or targeted audit of any payor about whom such a complaint has been received.”

A.B. 1301 was introduced this week in the California Assembly by Assembly Insurance Committee Chairman Henry Perea (D-Fresno). If passed into law, it would limit the avalanche of workers compensation claims filed by out of state professional athletes,

This bill would provide that an employee hired outside of this state, his or her dependents, and his or her employer shall be exempt from this state’s workers’ compensation laws if the employee is a professional athlete, defined, for purposes of these provisions, to include an athlete who is employed at the minor or major league level in the sport of baseball, basketball, football, hockey, or soccer, and that professional athlete is temporarily within this state doing work for his or her employer. Perea’s bill would not apply to members of other professions whose work takes them from state to state, such as horse racing jockeys, truck drivers and salesmen.

This bill would deem a professional athlete to be temporarily within the state doing work for his or her employer if, during the 365 days immediately preceding either the professional athlete’s date of injury, or, in the case of an occupational disease or cumulative injury claim, the professional athlete’s last date of injurious exposure while employed anywhere as a professional athlete, the professional athlete performs less than 90 total days of required services within the state under the direction and control of the employer.

The bill would provide that if the employee is a professional athlete, the date of injury in cases of occupational diseases or cumulative injuries is the date of the employee’s last injurious exposure while employed anywhere as a professional athlete, or the date of diagnosis, as defined, by a licensed physician, whichever occurs later.

The bill would also provide that an employer of a professional athlete that is subject to California’s workers’ compensation laws is not liable for occupational disease or cumulative injury if at the time application for benefits is made the professional athlete performed his or her last year of work in an occupation that exposed him or her to the occupational disease or cumulative injury as an employee of one or more other employers that are exempt from California’s workers’ compensation laws or pursuant to the above provisions or any other law. The bill would provide that these changes apply to all pending claims for benefits, as specified.

The language of A.B. 1301 does not indicate if these provision are retroactive to claims that have already been filed. California is the only state that makes it relatively easy for long-retired players to claim cumulative trauma injuries. About 4,500 out-of-state players have won judgments or settlements since the early 1980s, according to a study commissioned by the professional sports leagues.

The filing of this bill will commence the arduous process of hearings, debates and amendments to the bill language before there will be any new law on this topic. The proposal is expected to be one of the most hotly debated issues of the legislative session, with team owners lining up against the players’ unions and their labor allies. It is likely that there will be a bitter debate in the weeks and months that follow.

Regardless of whether they play for out-of-state teams, said Angie Wei, legislative director of the California Labor Federation, “these players are workers and they deserve to have access to their benefits. They work for short durations of time at an intense level and get injured.”