Tag: 2017 News

With the changing landscape of health care, outpatient spine surgery is being more commonly performed to reduce cost and to improve efficiency. Anterior cervical discectomy and fusion (ACDF) is one of the most common spine surgeries performed and demand is expected to increase with an aging population.

But a new study published in The Spine Journal claims that patients who get spinal surgery at outpatient centers may be more likely to have serious complications or require repeat operations than their counterparts who get these procedures in a hospital.

Researchers focused on an operation known as anterior cervical discectomy and fusion (ACDF), which involves removing a damaged disc in the neck to reduce pressure on the spinal cord or nerve root that can cause pain, numbness and weakness. Most of these surgeries are done in hospitals with a one or two night stay, but a growing number of people are going instead to outpatient centers that may have lower costs in part because they don’t keep patients overnight.

The study looked at outcomes for 1,215 patients who had outpatient ACDF and 10,964 people who had these operations in a hospital between 2011 and 2016. All of the patients in the study had insurance through Humana. In both the inpatient and outpatient groups, half of the patients were at least 65 to 69 years old. Overall, there were few complications, researchers report in The Spine Journal.

One year after surgery, 5.5 percent of the people who had outpatient surgery needed repeat operations, as did 4.1 percent in the inpatient group.

After accounting for individual patient characteristics like age, gender and other health problems, the researchers found that people who had outpatient ACDF were 79 percent more likely to require repeat operations within one year than patients who had operations in a hospital. Outpatients were also 25 percent more likely to experience postoperative kidney failure.

“We were surprised that the outpatient cohort had greater rates of postoperative renal failure since these patients are typically younger and healthier to undergo surgery in the outpatient setting,” said senior study author Dr. Don Young Park of the David Geffen School of Medicine at the University of California, Los Angeles.

“Our study is the first to show that outpatient ACDF is associated with some increased risk, even in ideal surgical candidates,” Park said by email reported as reported by Reuters Health.

But the study was not a controlled experiment designed to prove whether or how the location of surgery might influence the outcomes. Another limitation of the study is that it relied on insurance claims data and lacked detailed medical information on individual patients, the authors note. Researchers also didn’t have data on early complications such as emergency room visits or hospitalizations.

Individual patient factors missing from the insurance claims data might explain the slight differences in outcomes between inpatient and outpatient operations, said Dr. Matthew McGirt of Carolina Neurosurgery & Spine Associates in Charlotte, North Carolina, who wasn’t involved in the study.

Still, the findings add to the evidence that these operations can be done safely, but should be considered only after other treatments such as physical therapy, pain medication or steroid injections fail, doctors say.

“Surgery should be reserved for patients with severe pain despite an appropriate course of non-operative treatment or for those with neurologic deficits,” said Dr. Frank Phillips, a researcher at Rush University Medical Center in Chicago who wasn’t involved in the study.

“In appropriately selected patients, the success rate for ACDF procedure in terms of improving symptoms is generally above 90 percent,” Phillips said by email.

Mahmoud Alzayat, on behalf of the People of the State of California, filed a qui tam action against his employer, Sunline Transit Agency, and his supervisor, Gerald Hebb, alleging a violation of the Insurance Frauds Prevention Act (IFPA or the Act). (Ins. Code, § 1871 et seq.)

Sunline is a public entity that provides regional transportation services and oversight of other transportation entities such as taxi companies. Alzayat was employed by Sunline as a stops and zones technician, and in that capacity he maintained bus stop infrastructure. Hebb was Alzayat’s supervisor.

On the day of the injury, Alzayat was working on a bus stop. The only available bags of concrete mix weighed 90 pounds. Alzayat asked Hebb for permission to either break down a 90-pound bag into lighter ones or to have another employee help him. Hebb refused Alzayat’s requests, and the two argued for about two minutes. Hebb ultimately ordered Alzayat to lift the 90-pound bag by himself without breaking it down first. Alzayat complied and, immediately upon lifting the bag, felt intense pain in his lumbar spine, and he partially collapsed. Alzayat dropped the bag and its contents spilled out. When Hebb asked Alzayat why he had dropped the bag, Alzayat complained he had injured his back when lifting the bag.

In the report, Hebb wrote he did not witness Alzayat’s injury. Alzayat alleged Hebb made false statements in the incident report submitted in response to Alzayat’s claim for workers’ compensation, and Hebb repeated those false statements in a deposition taken during the investigation into Alzayat’s claim for compensation.

Hebb testified under oath that he had no conversation with Alzayat about the request to either break down the bag of concrete mix or to obtain help in lifting the bag. Hebb also denied having witnessed Alzayat injure himself when he lifted and then dropped the bag. Hebb’s false statements resulted in Alzayat’s claim being initially denied.

Alzayat filed a lawsuit alleging Hebb’s false statements in relation to Alzayat’s claim for workers’ compensation benefits constituted violations of Penal Code section 550, and formed predicate offenses for liability under the Insurance Frauds Prevention Act (IFPA). Alzayat prayed for a civil penalty against Hebb and Sunline of no less than $5,000 and no more than $10,000, an assessment of no more than three times the amount of his workers’ compensation claim, attorney fees, and costs.

The employer filed motions for judgment on the pleadings contending: (1) this lawsuit is based on allegedly false and fraudulent statements Hebb made in connection with a workers’ compensation proceeding and is, therefore, barred by the litigation privilege under Civil Code section 47, subdivision (b) and (2) Alzayat’s claim is barred by the workers’ compensation exclusivity rule.

The superior court concluded the workers’ compensation exclusivity rule is inapplicable, but ruled the litigation privilege bars Alzayat’s claim. Therefore, the court granted the motions without leave to amend and entered judgment dismissing the lawsuit.

Alzayat appealed from the judgment, contending the litigation privilege only applies to tort claims and not to statutory claims such as an action under the IFPA, and the IFPA is a specific statute that prevails over the general litigation privilege. The employer cross-appealed, arguing that, even if Alzayat’s lawsuit is not barred by the litigation privilege, the superior court erred by not granting judgment on the pleadings on the ground that Alzayat’s claim is barred by the workers’ compensation exclusivity rule.

The Court of Appeal agreed with Alzayat that his lawsuit is not barred by the litigation privilege nor by the workers’ compensation exclusivity rule in the published case of The People ex. rel. Mahmoud Alzayat v Gerald Hebb et. al.

The IFPA was in large measure designed to prevent workers’ compensation insurance fraud, and the Act includes a number of legislative findings and declarations that are relevant here. “Workers’ compensation fraud harms employers by contributing to the increasingly high cost of workers’ compensation insurance and self-insurance and harms employees by undermining the perceived legitimacy of all workers’ compensation claims.”

The IFPA provides for civil liability for various forms of workers’ compensation insurance fraud. “Every person who violates any provision of this section or Section 549, 550, or 551 of the Penal Code shall be subject, in addition to any other penalties that may be prescribed by law, to a civil penalty of not less than five thousand dollars ($5,000) nor more than ten thousand dollars ($10,000), plus an assessment of not more than three times the amount of each claim for compensation, as defined in Section 3207 of the Labor Code…”

The litigation privilege, codified at Civil Code section 47, subdivision (b), provides that a ‘publication or broadcast’ made as part of a ‘judicial proceeding’ is privileged. This privilege is absolute in nature, applying “to all publications, irrespective of their maliciousness.” The litigation privilege is broad, but it has its limits. Like any statute, Civil Code section 47(b) is subject to the rule of statutory construction that a particular provision prevails over a general one.

California’s top court on Thursday opened the door for consumers to sue Novartis AG and other makers of brand-name pharmaceutical products over injuries blamed on generic versions of the drugs manufactured by other companies.

The case is T.H. v. Novartis Pharmaceuticals Corporation, California Supreme Court, No. S233898.

The California Supreme Court’s ruling broke with decisions nationally to the contrary and created exposure for brand-name drugmakers who could be sued in the state for failing to warn users about the risks of cheaper, generic versions of their drugs.

Reuters Health reports that Leslie Brueckner, the plaintiffs’ lawyer, said the decision was the only one currently by a state’s top court to favor consumers of generic drugs, who legally cannot sue generic drugmakers for not warning about their products’ risks. “This is just a huge victory for public health and safety, and this victory will be felt nationwide,” she said.

Novartis, whose appeal had the support of industry groups including the U.S. Chamber of Commerce, said it disagrees with the court’s decision to potentially hold it responsible for an injury caused by a different company’s product.

The decision came in a lawsuit centered on two twin children who were diagnosed with developmental delays and autism after their mother while pregnant took a generic version of Brethine to suppress premature labor.

Under a 2011 ruling by the U.S. Supreme Court, generic drug companies cannot be sued for failing to provide adequate label warnings about potential side effects because federal law requires them to use the brand-name versions’ labels.

The father of the children, referred to in court papers as T.H. and C.H., instead sued Novartis, which made Brethine until 2001, and aaiPharma Inc, which bought the rights to it in 2007 while their mother was taking the generic version.

Novartis argued its duty to warn consumers did not cover those taking generics and that a contrary ruling would effectively make it the market’s insurer.

The court disagreed. Justice Mariano-Florentino Cuéllar wrote that brand-name manufacturers are the only entities with the ability to strengthen a warning label.

“So a duty of care on behalf of all those who consume the brand-name drug or its bioequivalent ensures that the brandname manufacturer has sufficient incentive to prevent a known or reasonably knowable harm,” Cuéllar wrote.

The court also held 4-3 that Novartis could be sued despite divesting itself of Brethine because its failure to update the warning label before the sale could foreseeably cause the children harm.

Though employers and workers’ compensation insurers have been utilizing telemedicine for quite some time, the Insurance Journal reports that there has been a recent uptick in interest surrounding virtual physical therapy, also known as telerehab.

Telerehab provides virtual access to physical therapy and is intended to be a replacement for an in-person visit to an outpatient facility. According to a recent white paper released by MedRisk, while not all treatment is translatable to telerehab, “online exercise demos, virtual workout supervision, and secure communication tools make it possible to supplement in-clinic physical therapy with valuable remote services including patient follow-ups, home treatment plans, questions and answers, and consultations with specialists.”

Sean Sullivan, chief operating officer and vice president of Business Development for the national rehab and wellness provider Go2Care, said telerehab can include the whole spectrum of what is called “musculoskeletal care management.”

According to Michelle Despres, vice president and national product leader at workers’ compensation firm One Call, telerehab is convenient because it can be done via a cell phone, tablet or a computer. The process can work via live or pre-recorded videos and mobile apps, said Despres. Remote patient monitoring can be achieved by using health and fitness trackers or through patient self-reporting.

“They would have access to one on one live treatment with a physical therapist (PT), the idea being that there’s a convenience factor. If someone would like to be treated, we offer hours between 6:00 AM and 10:00 PM. There’s a lot of flexibility. Most outpatient clinics are not open to those hours,” added Despres. “There may be a possibility that someone could say at lunchtime, ‘I’m going to do my PT. I’m not going to leave my office. I’m going to do it right here.'” She added that injured workers could do it anywhere they have the privacy and the availability to perform their visit.

Highly adaptable, telerehab can begin with online videoconferencing and move toward live, face to face interaction, according to Sullivan of Go2Care.

“We’re also looking at telerehab being defined as a home exercise program support application. This is an apps based concept,” said Despres. “It allows the treating therapist in the brick and mortar facility to offer their individual patients and injured workers the ability to log into an app, much like a fitness app, that many people use on their phones or their tablets and have the opportunity to have their home program delivered electronically.”

While there’s been traction in both the group health and Medicare markets, there has been a slow adoption rate by the workers’ compensation industry, despite the fact the concept has been around for quite a while, said Sullivan.

“In workers’ compensation, to my knowledge no one yet has any deliverable data or outcomes information to be able to say that it’s being adopted at X rate in the work comp space,” said Despres.

“There was a push, not from the carriers but from – the employers,” said Sullivan. “I’m having a lot of carriers come to me saying, ‘We want to do it,’ but they don’t know where to start. When the carriers right now are talking to me, they’re saying, ‘Do we do the prevention? Do we do the treatment, or do we do the monitoring?'” He expects carriers will pilot one or all three aspects to determine the best fit.

Not much is needed for telerehab to work, said Sullivan and Despres. “They don’t require anything except the injured worker has to have their own Wi-Fi or their own device a cell phone, a smartphone or a tablet, or a computer,” said Despres. The employer doesn’t have to set up anything, though they might choose to offer a private room that employees could use at lunchtime or at their own discretion.

“It can be done from anywhere. We’re servicing a manufacturing site in rural America. There’s not a whole lot around it, but there are 600 employees,” Sullivan said. “We just set up a kiosk at the location. The employee has the freedom to elect to conduct that visit in the comfort of their home, should they choose. But they’re not choosing that, at least, to date.”

The number of U.S. deaths at work from unintentional drug and alcohol overdoses jumped more than 30% in 2016, according to new government data, showing that the nation’s struggle with a deadly opioid epidemic is migrating to the workplace.

The Bureau of Labor Statistics’ National Census of Fatal Occupational Injuries said that 217 workers died on the job last year as a result of an unintentional overdose from the nonmedical use of drugs or alcohol, up from 165 in 2015. The number of accidental overdose deaths at work has nearly tripled since the BLS began compiling the data in 2011.

And an article in the Wall Street Journal reports that the statistic is part of a bigger problem.

“The surge in deaths, the abuse and the way in which this has turned into a crisis which encompasses so many elements, it’s not at all surprising this crisis has migrated” into the workplace, said John Deskins, an economist at West Virginia University.

The Department of Labor will respond by working “with public and private stakeholders to help eradicate the opioid crisis as a deadly and growing workplace issue,” said Loren Sweatt, the Occupational Safety and Health Administration’s deputy assistant secretary.

Earlier this year, OSHA limited its reporting of fatalities in the U.S., as part of a series of moves by the agency cutting back the amount of information about workplace accidents made available to the public.

Other causes of workplace death still dominated in 2016, a year during which the economy added 2.24 million new jobs.

Total fatal work injuries rose 7% to 5,190 in 2016, according to the report. Deaths due to workplace violence increased 23% last year from the year before, making that the second most common cause of death on the job in 2016 after transportation incidents. The number of workplace suicides rose 27% in 2016 from the year before, to 291, the highest number since the census began recording the number of suicides at work in 1992.

Drug abuse is taking a toll on the U.S. economy. The burden of prescription opioid abuse from crime, lost work productivity through absenteeism or poor job performance and health care costs is an estimated $78.5 billion a year, according to a 2013 study by the CDC.

The Federal Reserve’s Beige Book – a survey based on anecdotes collected from the central bank’s 12 regional banks – reported in July that manufacturers in the St. Louis region cited candidates’ inability to pass drug tests or to consistently report to work as a difficulty in hiring workers.

In a 2015 paper, Princeton University economists Anne Case and Angus Deaton termed the rise in mortality from suicide, drugs and alcohol since the late 1990s among middle-aged white Americans “deaths of despair.”