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Palomar Hospital Pays $250,000 for Diverting Fentanyl

Palomar Health, a California public health care district located in San Diego County, has paid $250,000 to resolve allegations of diversion of fentanyl from one of its facilities and failure to keep accurate records for fentanyl.

Palomar Health is California’s largest health care district, with campuses in Escondido and Poway. This settlement arises from a self-disclosure Palomar Health made to the U.S. Drug Enforcement Administration (DEA) that one of its employees may have diverted controlled substances.

The government investigated Palomar Health and concluded that vials of fentanyl were diverted from Pyxis machines – automated medication dispensing machines often used in hospital settings – located at Palomar Health’s Cardiac Catheterization Lab in Escondido. Specifically, the government concluded that over a five – month period, numerous vials of fentanyl were diverted from the Pyxis machines and unused fentanyl was not properly disposed of.

In addition to paying $250,000 to resolve the government’s claims, Palomar Health entered into a Memorandum of Agreement with the DEA requiring Palomar Health to undertake additional measures to increase security, implement specialized training, and to handle controlled substances properly and safely.

“We value our relationships with our registrant population and encourage all of them to be diligent in preventing and catching diversion,” said Diversion Program Manager Rostant Farfan. “Keeping medications, like fentanyl, off of the street is the responsibility of all who work with controlled substances.”

This settlement was the result of a coordinated effort by the U.S. Attorney’s Office for the Southern District of California and the Drug Enforcement Administration.

To report a tip directly to a DEA representative regarding medical personnel writing suspicious opioid prescriptions and pharmacies dispensing large amounts of opioids, call (571) 324-6499 or visit the DEA’s website (https://www.deadiversion.usdoj.gov/tips-online.html) and click on “Rx Abuse Online Reporting.”

This case was prosecuted by Assistant U.S. Attorney Dylan M. Aste.

The claims resolved by the settlement are allegations only, and there has been no determination of liability.

WCAB Rescinds WCJ Order to Compel Answers to Interrogatories

Jennifer Reveles filed an Application for Adjudication of her claim of injury while employed by the State of California Sierra Conservation Center.

On May 8, 2023, defendant filed a petition seeking an order compelling applicant to complete, sign and return medical releases, and that should applicant fail to do so, that the Workers’ Compensation Appeals Board (WCAB) suspend applicant’s entitlement to benefits.

On June 29, 2023, the parties proceeded to trial, framing for decision defendant’s May 8, 2023 Petition to Compel, and “whether defendant has to depose Applicant if further information is required [that is] not contained in the medical release.”

A Findings of Fact and Orders (F&O) issued by the Workers’ Compensation Administrative Law Judge on August 1, 2023, which ordered Reveles to list the medical treatment received during the last 10 years to the neck, bilateral upper extremities, and bilateral wrists. The WCJ further ordered that any additional information sought by defendant would need to be obtained by deposition.

The WCJ’s Opinion on Decision notes that the order complies with section 4663(d), and that section 5708 allows depositions to be admitted into evidence as part of proceedings before the WCAB.

Applicant filed a Petition for Removal which was granted, and the the decision of August 1, 2023 was rescinded in the panel decision of Reveles v State of California Sierra Conservation Center – ADJ16783231 (April 2025)

In her Petition for Removal applicant contends that the order to disclose medical treatment is not authorized under Labor Code section 4663(d), and that the WCJ’s order is premised on defendant’s demand for information, which is functionally equivalent to written interrogatories.

Applicant further asserts that scope of the compelled disclosure will require applicant to list medical treatment she has received during the last 10 years, including doctors, medical facilities, addresses, locations, parts of body treated, types of treatment, and the approximate date(s) of treatment.

Applicant cites Lubin v. Berkley East Convalescent Hop. & Mission Ins. Co.3 (1976) 41 Cal.Comp.Cases 283 [1976 Cal. Wrk. Comp. LEXIS 2480], wherein a panel of the Appeals Board noted that “in most cases the specific provisions of the Labor Code and of our rules relating to discovery will provide adequate tools to the practitioner,” and that only “in very rare instances, submission of written interrogatories to an opposing party may be the only practical and feasible way of obtaining adequate discovery.

Applicant asserts that the record does not support the necessity of interrogatories in lieu of other discovery vehicles available to defendant.

Hardesty v. McCord & Holdren, Inc. (1976) 41 Cal.Comp.Cases 111 Section 4663(d) requires that, “[a]n employee who claims an industrial injury shall, upon request, disclose all previous permanent disabilities or physical impairments.” (Lab. Code, § 4663(d).) Thus, while the section contemplates disclosure of specified disability or impairment, it does not require the employee to disclose all prior medical treatment.”

The WCAB panel therefore agreed with applicant that the order that she disclose prior medical treatment to specified body parts does not comport with the disclosure required by section 4663(d).

Defendant’s Petition to Compel “fails to explain how compelling applicant’s authorization to disclose an unlimited medical treatment history comports with the requirement for disclosure of disability or impairment pursuant to section 4663(d).”

However, the WCAB Panel went on to say “Irrespective of the requirements of section 4663(d), however, the WCJ retains significant discretion in resolving discovery disputes arising under the provisions of the Labor Code and our rules regarding pre-trial discovery.

In Hardesty v. McCord & Holdren, Inc. (1976) 41 Cal.Comp.Cases 111 [1976 Cal. Wrk. Comp. LEXIS 2406] “we explained that ‘in most cases the specific provisions of the Labor Code and of our rules relating to discovery will provide adequate tools to the practitioner, and that he should not be encouraged to go beyond them in search of other remedies. In those cases where the Labor Code and our rules do not provide a sufficient remedy, ‘the trial judge has, and should exercise[,] the authority conferred on him by § [10330] of our rules to issue such interlocutory orders relating to discovery as he determines are necessary to insure the full and fair adjudication of the matter before him, to expedite litigation and to safeguard against unfair surprise.’ “

“Thus, and insofar as the defendant seeks to compel discovery in the form of written disclosure of prior medical treatment, defendant must establish why the specific provisions of the Labor Code and our rules relating to discovery are otherwise inadequate. Here, defendant offers no argument for the need to resort to written discovery, nor does it aver previously unsuccessful discovery efforts. Because defendant does not assert that less burdensome vehicles for discovery are unavailable to defendant, and because the record reflects no such requests, we are persuaded that defendant’s requests for written disclosures are unduly burdensome.”

FDA Approves Traumatic Brain Injury Rapid Test Using One Drop of Blood

A new rapid test that checks for traumatic brain injuries (TBI) using a single drop of blood is expected to make its debut in the military in the coming months.

The product marks one of the most significant steps forward for TBI patients’ care in the past 20 years, Lt. Col. Bradley Dengler, an Army neuroscientist who directs the Military Traumatic Brain Initiative at the Uniformed Services University in Bethesda, Maryland, said in a recent release announcing the product’s approval by the Food and Drug Administration.

U.S. Army officials, in partnership with medical device manufacturer Abbott, jointly announced April 1, 2024, that the company’s i-STAT® TBI whole blood cartridge had received FDA marketing clearance. Abbott developed the blood test in collaboration with USAMMDA.

Previous tests to help diagnose concussion or more severe TBI were cleared by FDA in early 2021 only for use with blood plasma or serum. This required samples to be sent to a laboratory for processing and results.

The new test, which takes only 15 minutes for results and is run on a portable device, also can be used to evaluate patients up to 24 hours after injury, a significant improvement from previously available tests. The device therefore could aid in decisions on priority evacuations from forward deployments in a future conflict where rapid evacuation (the “golden hour”) is not possible.

“Given the large numbers of expected casualties with all severities of traumatic brain injury in future large-scale combat operations, this test can help maintain combat power far forward by helping to eliminate unnecessary evacuations,” Dengler said.

“Additionally, and just as important, given the limited number of neurosurgeons available in-theater, ongoing research demonstrates that a future version of this test could be used to triage more severely injured patients, as the blood biomarker elevations correlate with the severity of their intracranial injuries,” Dengler commented. “This can help get the most severely injured service members to neurosurgeons faster and ultimately save lives.”

The U.S. Army Medical Research and Development Command, headquartered at Fort Detrick in Frederick, Maryland, has been dedicated to developing a solution for detecting and evaluating TBIs for more than two decades.

The new diagnostic method will prevent unnecessary medical evacuations and improve TBI case management in the field since not all patients will require head CT scans, said U.S. Army Col. Andy Nuce, commander of the U.S. Army Medical Materiel Development Activity part of USAMRDC.

In July 2023, the technology was tested in simulated battle conditions during a soldier “touchpoint” as part of the Global Medic combat support training exercise at the U.S. Army’s Fort Hunter Liggett, California, which is known as the military’s premier total force training center.

“TBIs are a major concern for warfighter health, readiness, and resiliency,” said U.S. Army Brig. Gen. (Dr.) Edward H. Bailey, commanding general of USAMRDC. “This milestone demonstrates how Army medical developers can partner with industry to deliver solutions for frontline medical personnel caring for our injured service members.”

New Trial Ordered in Employers’ Class Action Against Sutter Health

Djeneba Sidibe, Jerry Jankowski, Susan Hansen, David Herman, Optimum Graphics, Inc., and Johnson Pool & Spa (“Plaintiffs”) represent a certified class of individuals and businesses in Northern California who paid health insurance premiums to certain health plans run by Aetna, Anthem Blue Cross, Blue Shield of California, Health Net, and United Healthcare.

Plaintiffs are or were insured by health plans that contract with Sutter, a healthcare system that spans 24 hospitals, five medical foundations, and 40 ambulatory surgery centers.

Plaintiffs allege that Sutter charged supracompetitive rates to these health plans, which the health plans in turn passed on to Plaintiffs by charging higher premiums. Plaintiffs are therefore “indirect purchasers” of Sutter’s services, and their “theory of antitrust impact depends on two separate overcharges”: an overcharge by Sutter to the health plans, and an overcharge by the health plans to Plaintiffs.

Aetna Health of California Inc., Aetna Live Insurance Company, Anthem Blue Cross, Blue Shield of California, United Healthcare Services Inc., and Kaiser Foundation Health Plan Inc., are Intervenors in this action.

This litigation was filed in 2012 and has proceeded for over a decade. The lawsuit was certified as a class action in 2020, allowing it to proceed on behalf of millions of Californians with health plans from specific insurers.

The district court initially set a damages period beginning on September 28, 2008. This was four years before Plaintiffs sued in September 2012, reflecting the statute of limitations for all three statutes. Second, the district court granted summary judgment to Sutter on Plaintiffs’ monopolization claims (section 2 of the Sherman Act) and for all claims between 2008 and 2010. Thus, the damages period began on January 1, 2011. Third, the district court granted several of Sutter’s motions in limine to exclude evidence..

The case proceeded to trial in February 2022 at a San Francisco Federal District Court on Plaintiffs’ claims under the Cartwright Act only. Following a four week trial a jury returned a verdict in favor of Sutter. Plaintiffs appealed the entry of final judgment in favor of Sutter.

The 9th Circuit Court of Appeals reversed the district court’s entry of final judgment and remand for a new trial in the published case of Sidibe et. al. v Sutter Health -22-15634 (June 2024)

On appeal Plaintiffs contended that the district court impermissibly excluded relevant evidence, failed to instruct the jury to consider Sutter’s anticompetitive purpose, failed to instruct the jury that the relevant purchasers are the health plans, and wrongly denied Plaintiffs’ motion for sanctions against Sutter for the destruction of evidence.

In the 98 page Opinion, the Court of Appeals first addressed Plaintiffs’ contention that the district court contravened California law when it omitted the word “purpose” from the jury instructions on Plaintiffs’ unreasonable course of conduct claim and that the legal error was not harmless.

The panel held that the district court contravened California law by removing the word “purpose” from the Judicial Council of California Civil Jury Instructions and thus failing to instruct the jury to consider Sutter’s anticompetitive purpose as to the unreasonable course of conduct claim, and that the legal error was not harmless.

Plaintiffs’ second contention is that the district court abused its discretion in excluding pre-2006 evidence and that the error was prejudicial.

The panel held that the district court abused its discretion under Fed. R. Evid. 403 in excluding as minimally relevant all evidence of Sutter’s conduct before 2006, which was five years before the specific contracts that Plaintiffs alleged caused them harm were negotiated and took effect.

The excluded evidence concerned the inception, Sutter’s stated purpose, and effects of the conduct challenged during the trial. The panel held that Sutter failed to rebut the presumption that the error prejudiced Plaintiffs because, among other things, the excluded evidence would have rebutted Sutter’s testimony and arguments at trial.

For the foregoing reasons, the district court erred in failing to instruct the jury to consider Sutter’s anticompetitive purpose and in excluding highly relevant pre-2006 evidence. Accordingly, the Court of Appeals reversed the district court’s entry of final judgment and remand for a new trial.

Dissenting, Judge Bumatay would affirm the jury verdict.

Growing Number of Female Minority Doctors in California Report Burnout

Physicians for a Healthy California (PHC), formerly known as the CMA Foundation, started in 1963 as a charitable arm of the California Medical Association (CMA), disbursing over $1 million dollars in grants and loans to medical students to support future physicians. It is dedicated to improving community health, growing a diverse physician workforce and promoting health equity.

A recent study, “A Prescription for Change,” by the nonprofit reveals a growing number of minority female doctors are feeling burned out and leaving their field of work.

Prior research has demonstrated that women physicians are more likely than their male counterparts to report feelings of “burnout.” Our prior research funded by The Physicians Foundation found that “burnout” among women physicians of color was uniquely associated with workplace harassment and low perceived value at work. Burnout and disengagement were also higher in women physicians whose competency was questioned by peers.

This follow-up study was undertaken to determine if there were changes in the rates of burnout among different races or the factors that contribute to career dissatisfaction since the beginning of the COVID-19 pandemic, and to collect data to inform health care organizations on effective strategies to improve the recruitment and retention of women physicians of color.

Reported burnout of respondents increased by 4.8 percentage points with 45.8% reporting high levels of overall burnout in the current study. Women physicians of color, whether represented or underrepresented in medicine, reported slightly lower overall burnout. When probed in focus groups, women physicians of color reported several protective factors that interviewees credited with their resilience.

Physician retention has been a growing problem for decades, exacerbated partly due to the COVID- 19 pandemic. California already suffers from severe physician shortages, creating vast underserved areas and under-resourced populations. Women physicians of color are more likely to serve these more vulnerable communities; therefore, to promote access to care and advance health equity, it is critical for health care organizations to implement effective strategies focused on the retention of this important group of clinicians.

Both the qualitative and quantitative research undertaken in this current study have led PHC researcher to develop eight recommendations for health care organizations to help address the retention of women physicians of color.

Summary of Recommendation to Improve Retention.

– – Commit to understanding, acknowledging and addressing the ways in which health care organizations influence attrition among women physicians of color.
– – Consider and accommodate for the effects of health care system changes on physicians, especially women physicians. Identify high-yield metrics to help determine success with diversity, equity and inclusion (DEI) programs and retention efforts.
– – Develop trusted mechanisms for employees to provide anonymous feedback to leadership.
– – Establish transparency into DEI measures and employee feedback, and develop an accountability framework that tracks plans to address inequities and outcomes.
– – Evaluate compensation, benefits, opportunities, and resources to ensure equity among genders and races.
– – Compensate for the diversity tax.
– – Revitalize employees’ sense of meaning and community at work.

This qualitative research also aligns with growing body of research that moral injury, rather than personal characteristics, is an important driver of physicians’ decisions to leave the workforce. In addition to the COVID-19 pandemic, interviewees reported several systemic issues leading them to feel stress and burnout including institutional racism, individual acts of discrimination committed by patients and colleagues, increased focus on revenue generation, decreased boundaries between work and personal life due to technology, and pressures to take on uncompensated diversity and equity work.

WCAB Affirms WCJ’s Apportionment in Psyche Case

The industrial claim of Ayana Spencer stems from a 2019 incident at an Oakland Unified School District elementary school, when the mother of a third-grader (and, also, a former student) confronted her over her treatment of those children.

This parent was reportedly “known to be using drugs (crack and marijuana and alcohol)” and was familiar to Ms. Spencer from the time the older child began at the school in 2005.

Spencer called the police, who came and escorted the mother from the school. Ms. Spencer left work early, called Kaiser’s mental health facility and, thereafter, her own therapist, who took her off work. Defendant paid temporary disability benefits beginning May 4, 2019, through January 6, 2020, when Spencer returned to a modified position with the school district.

She had an earlier 2008 incident in which a custodian, disguised with wig and sunglasses and reportedly armed with a semi-automatic weapon, attacked her from behind and pistol-whipped her, causing lacerations and lasting psychological trauma diagnosed as post-traumatic stress disorder or PTSD.

Spencer missed relatively little time from work from this earlier incident, however, though she did continue in therapy and took prescription medications for a time. The parties engaged an agreed medical evaluator (AME), Dr. Richard Lieberman, who reported on November 10, 2009, that applicant’s injury had stabilized, with a GAF3 score of 60 or 15% permanent impairment, of which he apportioned 10% to non-industrial causes. The first workers’ compensation case resolved by a stipulated award of 27% permanent disability with a need for further medical treatment.

Dr. Lieberman reëxamined Ms. Spencer in 2016, concluding in his report of June 16, 2016, that she no longer showed signs of PTSD. The AME at this point did find a GAF score of 64 and recommended limiting further treatment.

In the current 2019 case, the parties have engaged a qualified medical evaluator (QME), Dr. Robbins. March 4, 2020, the QME found her maximally improved, with a GAF score of 65, plus additional impairment for sleep difficulties, amounting to 11% whole-person impairment, of which 75% stems from the 2019 injury and the rest from that in 2008.

The WCJ found that the impairment found by this QME did overlap the impairment in the 2008 injury, and thus did not affect different abilities to compete and earn. (Sanchez v. County of Los Angeles (2005) 70 Cal.Comp.Cases 1440 (appeals board en banc). The result was a finding of injury and need for treatment, but no permanent disability as the entirety of permanent disability was apportioned under Labor Code section 4664..

The apportionment was affirmed in the panel decision of Spencer v Oakland Unified School District –ADJ13057141 (May 2024).

The essence of applicant’s argument on reconsideration is that applicant’s disability to the psyche in 2008 does not overlap with the current disability to psyche in 2019, and thus defendant failed to prove apportionment.

The injury to psyche in both cases was post-traumatic stress disorder. Applicant’s disability was rated the exact same way, using the Global Assessment of Functioning (GAF). The diminished future earnings capacity modifier for both cases was 1.4. It is the same body part, same diagnosis, and same rating method in both cases. On these facts the two disabilities clearly overlap. (See, Kopping v. Workers’ Comp. Appeals Bd., (2006), 142 Cal. App. 4th 1099.)

“The WCJ was correct to apply apportionment under section 4664. … There may be cases where separate and independent disabilities occur to the same body part and the analysis of overlap is more intricate. The record here does not support such a finding.”

No Discovery of Attorney Work Product in Carrier’s Subrogation Case

The Creek Fire ignited on December 5, 2017 in Los Angeles County, and damaged multiple properties before being extinguished. On December 11 and 12, 2017, counsel for several of the plaintiffs insurance companies sent evidence preservation letters to Southern California Edison asserting that they believed SCE’s equipment likely contributed to the ignition and spread of the fire.

Plaintiffs 21st Century Insurance Company et.al, filed their initial subrogation complaint against SCE on May 14, 2021. A master subrogation complaint filed on April 18, 2022, which plaintiffs joined, alleged that an electrical arc on SCE’s Lopez Circuit “ignite[d] nearby trees, brush, and vegetation giving rise to the Creek Fire.”

During discovery in the subrogation case, SCE withheld certain documents that it asserted were generated during an attorney initiated and directed internal investigation into the cause of the Creek Fire.

Plaintiffs moved to compel, arguing the attorney-client privilege and attorney work product doctrine did not exempt these documents from production. Among other things, plaintiffs argued that SCE could not assert privilege and withhold documents because the primary reason SCE conducted the investigation was to comply with state law requiring it to publicly report any involvement it had in causing the fire.

The trial court agreed the dominant purpose of the investigation was to comply with public reporting requirements, and held the documents thus were not privileged, and compelled production. SCE petitioned the Court of Appeal for a preemptory writ against the order compelling production of these documents.  

In the published case of Southern California Edison v Superior Court –B333798.PDF (May 2024), the Court of Appeal concluded that the trial court’s order improperly invaded the protection afforded by the attorney work product doctrine. A preemptory writ of mandate issue directing the trial court to vacate the November 17, 2023 order directing SCE to produce records in Los Angeles Superior Court case.

California law shields the “work product” of an attorney from disclosure in litigation. The legislative policy for affording this protection is to “[p]reserve the rights of attorneys to prepare cases for trial with that degree of privacy necessary to encourage them to prepare their cases thoroughly and to investigate not only the favorable but the unfavorable aspects of those cases” (Code Civ. Proc., § 2018.020, subd. (a)) and “[p]revent attorneys from taking undue advantage of their adversary’s industry and efforts” (id., subd. (b)).

To that end, subdivision (a) of section 2018.030 describes what is known as “absolute” work product protection, while subdivision (b) describes “qualified” protection.

“A writing that reflects an attorney’s impressions, conclusions, opinions, or legal research or theories is not discoverable under any circumstances.” (Id., subd. (a).) Any attorney work product that does not reflect counsel’s impressions, conclusions, opinions, or legal research or theories “is not discoverable unless the court determines that denial of discovery will unfairly prejudice the party seeking discovery in preparing that party’s claim or defense or will result in an injustice.” (Id., subd. (b).)

“[T]he Legislature in enacting section 2018.030 did not define ‘work product’ and instead left the term open to judicial interpretation.” (Coito v. Superior Court (2012) 54 Cal.4th 480, 494 (Coito).) Courts have defined attorney work product as “the product of the attorney’s effort, research, and thought in the preparation of his client’s case. It includes the results of his own work, and the work of those employed by him or for him by his client, in investigating both the favorable and unfavorable aspects of the case, the information thus assembled, and the legal theories and plan of strategy developed by the attorney-all as reflected in interviews, statements, memoranda, correspondence, briefs, and any other writings reflecting the attorney’s ‘impressions, conclusions, opinions, or legal research or theories’ and in countless other tangible and intangible ways.

“The documents at issue, which SCE provided substantial evidence were prepared as part of an attorney led internal investigation, are the type of materials typically entitled to work product protection. Our Supreme Court’s decision in Coito is instructive.”

New DOL Protections for Workers in Temporary Agricultural Employment

The U.S. Department of Labor has published the final rule, “Federal Register – Improving Protections for Workers in Temporary Agricultural Employment in the United States” effective on June 28, 2024.

The final rule strengthens protections for temporary agricultural workers by making several changes to H-2A program regulations to bolster the Department’s efforts to prevent adverse effect on workers in the U.S. and ensure that H-2A workers are employed only when there are not sufficient able, willing, and qualified U.S. workers available to perform the work.

These changes include empowering workers to advocate on behalf of themselves and their coworkers regarding working conditions; improving accountability for employers using the H-2A program; improving transparency and accountability in the foreign labor recruitment process; requiring seat belts in most vehicles used to transport workers; enhancing existing enforcement provisions; improving transparency into the nature of the job opportunity by collecting additional information about owners, operators, managers, and supervisors to better enforce program requirements; clarifying when a termination is “for cause” to protect essential worker rights; and revising provisions and codifying protections that are outdated, unclear, or subject to misinterpretation in the current regulations.

The final rule also strengthens protections for temporary agricultural workers when employers fail to properly notify workers that the start date of work is delayed, and clarifies and streamlines procedures to prevent noncompliant employers from using the Employment Service.

The Department of Labor will host a public webinar on Thursday, June 6, 2024, to educate employers, agricultural associations, farm labor contractors, farmworkers, advocates, and other interested members of the public on the changes to the H-2A and Wagner-Peyser Employment Service programs made by the 2024 Farmworker Protection Final Rule.

Participants of this webinar will learn from the Office of Foreign Labor Certification, the Office of Workforce Investment, and the Wage and Hour Division about the key aspects of this rule.

The Final Rule will become effective June 28, 2024, and OFLC will begin accepting applications subject to the provisions of this rule on August 29, 2024.

Additional Information

– – Final Rule: Improving Protections for Workers in Temporary Agricultural Employment in the United States
– – Frequently Asked Questions
– – H-2A Employer’s Guide to the Final Rule “Improving Protections for Workers in Temporary Agricultural Employment in the United States”
– – Flyer: Protections for Workers Employed Under the H-2A Program (English and Spanish)
– – Flyer: Protections for U.S. Workers Under the H-2A Program (English and Spanish)
– – Proposed rule

OSHA Announces Changes to the Structure of Regional Operations

The Department of Labor just announced strategic changes to the structure of its Occupational Safety and Health Administration’s regional operations designed to direct its resources effectively and make the agency more resilient.

The changes include the creation of a new OSHA regional office in Birmingham, Alabama, overseeing agency operations in the state, and those in Arkansas, Kentucky, Louisiana, Mississippi and Tennessee as well as the Florida Panhandle. The Birmingham Region will address the area’s growing worker population and the hazardous work done by people employed in food processing, construction, heavy manufacturing and chemical processing.

OSHA is also planning to merge Regions 9 and 10 (view the new regional map) into a new San Francisco Region to improve operations and reduce operating costs.

As part of the changes, the agency will also rename its regions to associate them by geography, rather than its current practice of assigning numbers to regions. As such, the area OSHA calls Region 4 will be renamed the Atlanta Region with jurisdiction over Florida, excluding the Panhandle; Georgia, North Carolina and South Carolina. The current Region 6 will be renamed the Dallas Region and have jurisdiction over workplace safety issues in New Mexico, Oklahoma and Texas.

The composition of OSHA’s other regions will remain the same.

The changes reflect the nation’s demographic and industrial changes since the passage of the OSH Act and will allow our professionals to better respond to the needs of all workers, including those historically underserved,” explained Assistant Secretary for Occupational Safety and Health Doug Parker.

“With a stronger enforcement presence in the South and more consolidated state oversight and whistleblower presence in the West – an area dominated by states that operate their OSHA programs – we can direct our resources where they’re needed most.”

OSHA plans to fully transition to its new regional structure later in fiscal year 2024. Once implemented, the agency’s regional maps and contact information online will be updated publicly.

Cal/STERS/PERS & WC Carriers Subrogation Rights in MedMal Cases

Arasely Soto was injured during a routine medical procedure and had to retire from her job as a public school teacher. She sued her medical providers for medical malpractice and also sought disability retirement benefits from the California State Teachers’ Retirement System (CalSTRS).

The Sotos attended a CalSTRS benefits planning session in January 2018. CalSTRS gave them information and documents about applying for disability benefits. The documents explained CalSTRS’s “[r]ight of subrogation” as follows: “[I]f you pursue a claim against a third party for the same impairment that entitles you to a disability benefit from CalSTRS, you must notify us. This is true even if the claim has not yet resulted in a court action. [¶] CalSTRS has the right to participate in the claim by filing our own action against the responsible party, intervening in your claim, or filing a lien against any judgment you may recover. [¶] If you don’t notify CalSTRS and you recover – or have already recovered – a monetary sum from the third party, you may be required to reimburse CalSTRS for part of the costs of your disability benefit.”

One day after the Sotos’ benefits planning session with CalSTRS, they released their claims against Dr. Borna in exchange for a six-figure settlement. Ten days later, Arasely filled out an application for disability benefits. Her application stated that her injuries were caused by employees of the hospital, including Dr. Borna.CalSTRS acknowledged receipt of Arasely’s application for disability benefits in February 2018. That same day, the court in the malpractice action granted the Sotos’ request to dismiss Dr. Borna from the lawsuit.

In May 2018, the Sotos released their claims against the hospital in exchange for a seven-figure settlement. Eight days later, the Sotos dismissed the malpractice action with prejudice.

CalSTRS brought suit against the Sotos, seeking to enforce its right to subrogation or reimbursement. The complaint alleges that CalSTRS is entitled to be reimbursed for Arasely’s disability benefits from her settlement with the malpractice defendants.

CalSTRS moved for summary adjudication on its declaratory relief cause of action, and the Sotos moved for summary judgment. In connection with both motions, the Sotos argued that Civil Code section 3333.1 bars any subrogation claim that CalSTRS would have asserted against the malpractice defendants.

Subdivision (a) of section 3333.1 authorizes a defendant in a medical malpractice action to introduce evidence of a variety of ‘collateral source’ benefits – including health insurance, disability insurance or worker’s compensation benefits.” Subdivision (b) of the statute provides, in turn, that ‘[n]o source of collateral benefits introduced pursuant to subdivision (a) shall recover any amount against the plaintiff nor shall it be subrogated to the rights of a plaintiff against a defendant.”

In opposition, CalSTRS argues that (1) CalSTRS was not a source of collateral benefits for purposes of section 3333.1; (2) Arasely’s disability retirement benefits were never introduced as evidence in the malpractice action; and (3) the statutes governing CalSTRS’s right of subrogation were enacted after section 3333.1, and the later-enacted statutes prevailed.

The trial court ruled in favor of Cal/STERS. The Court of Appeal affirmed the trial court in the published case of Soto v. Super. Ct. -E081902 (May 2024). It expressed no opinion on the parties’ legal arguments concerning the applicability of section 3333.1 in general.

The Legislature enacted section 3333.1 in 1975 as part of the Medical Injury Compensation Reform Act (MICRA), a wide-ranging statutory scheme designed to reduce the cost of medical malpractice insurance ‘by limiting the amount and timing of recovery in cases of professional negligence. MICRA addressed the problem in numerous ways, including by revising certain legal rules applicable to medical malpractice litigation. (

Education Code section 24500 grants CalSTRS “a right of subrogation” for the amounts CalSTRS “paid and became obligated to pay as disability retirement allowances, disability allowances, family allowances, or survivor benefit allowances.” (Ed. Code, § 24500; see Ed. Code, § 22174.)

The Legislature enacted the statutes giving CalSTRS a right of subrogation in 1988. (Ed. Code, former §§ 23300-23305, added by Stats. 1988, ch. 380, § 1, pp. 1699-1700, repealed and reenacted as Ed. Code, §§ 24500-24505 by Stats. 1993, ch. 893, §§ 1-2, pp. 4867, 4973-4974.) According to the legislative history, the CalSTRS subrogation provisions were “patterned” on the subrogation provisions governing the California Public Employees’ Retirement System (CalPERS).

“The CalPERS provisions also incorporate the workers’ compensation statutes, and the pertinent language of the CalSTRS and CalPERS subrogation provisions is nearly identical.”

The workers’ compensation subrogation provisions bar double recovery by an employee who claims workers’ compensation benefits “and also seek[s] damages for the employee’s injury or death from negligent third parties.”

Section 3333.1, subdivision (a), does not specify how jurors should use the collateral source evidence, but “the Legislature apparently assumed that in most cases the jury would set plaintiff’s damages at a lower level because of its awareness of plaintiff’s ‘net’ collateral source benefits.

But the employer’s consent is not required if the settlement includes only the employee’s claim for damages that will not be paid by workers’ compensation benefits. (Lab. Code, § 3859, subd. (b); Marrujo, at p. 978.) That is, the employee may segregate their claim from that of the employer and settle it without the employer’s consent. (Board of Administration v. Glover (1983) 34 Cal.3d 906, 913 (Glover); Marrujo, at p. 978.)

If the employee segregates and settles their claim in that manner, then the settlement is not subject to the employer’s claim for reimbursement of workers’ compensation benefits, while the employer retains its subrogation right “against the alleged tortfeasor to recover payments it had made to its employee.” (Glover, at p. 914; Marrujo, at p. 978; Lab. Code, § 3860, subd. (b).) But if the employee settles an unsegregated claim (i.e., a claim that includes both the employer’s claim for reimbursement of benefits and the employee’s claim for damages not compensated by benefits), then the employer may seek reimbursement out of the settlement proceeds.

The Sotos did not offer any evidence that the malpractice defendants sought to introduce evidence of Arasely’s disability retirement benefits in the underlying action, so section 3333.1 was never triggered. In addition, if the Sotos had offered such evidence, then section 3333.1 would be irrelevant. The same evidence would tend to show that CalSTRS has no reimbursement claim against the Sotos for reasons independent of section 3333.1.