(c) 2018 Jon L Gelman, All Rights Reserved.

Thursday, January 31, 2013

9/11 Fund Starts Making Payment to Victims

The Zadroga 9/11 Victims Claim Fund has started to make payments to victims of the World Trade Center attack. First Responders andthose who lived or worked in the immediate geographical site near "ground zero" may be entitled to the payment of benenfits for illness and injuries that they suffer as a result of the terrorist attack.

Those eligible include, individuals present at  a 9/11 crash site at the time of or in the immediate aftermath, who suffer physical harm as a result of the crashes or debris removal. Also the personal representatives of individuals who were present at a 9/11 crash site, who died as a result of the crashes or debris removal, are eligible to file claims.

I Told My Supervisor - Why Do I Need To File An Accident Report In Writing?

Today's post comes from Matthew Funk of the NY Bar.

Joe was working a construction job when Mike accidentally beaned Joe on the head with a 2X4. After seeing a couple of Tweety Birds and a whole bunch of stars, Joe went down to his supervisor’s station and told him he had just had an accident. Then he went off to the ER to make sure he was not seriously injured, relieved he had taken care of business at the job site. All he had to do now was get better.
No, Joe! No! Yes, Joe satisfied the notice requirement. However, Joe was NOT good to go.
Supervisors sometimes have a funny habit of forgetting conversations or oral notices of an accident. Even if Joe’s supervisor were his best friend, when push came to shove there could be no telling what the supervisor might say in Court front of a Judge. Furthermore,

Asbestos Disease Remains a Problem Despite Lower Consumption in the US

Recently release statistics from the US Geological Survey brings some hope to reducing asbestos disease in the US.  Historically, as the production of asbestos fiber lowers, so does the incidence of asbestos related disease, which is a latent medical condition that takes 10 to 30 years to manifest itself.

Asbestos this has been used for decades in the United States in militray and civilian environments in various forms including construction material and insulation. It appears in commercial and military buildings and equipment, as well as residential and consumer appliances. 

Asbestos has been causally connected to a rare and fatal cancer,  mesothelioma. Asbestos has also been linked to various other cancers including: lung cancer, a well as a pulmonary condition, asbestosis.

Wednesday, January 30, 2013

How to Protect Public Employees and Communities From Asbestos Exposure

It is unconscionable in this day and age for a worker who is exposed to asbestos fiber in the workplace. Ironically, in the 1950's, in Paterson, NJ, the city where the world renown asbestos researcher, Irving J. Selikoff MD, had conducted the initial the sentinel studies linking asbestos exposure with a fatal cancer, mesothelioma, public employees are still being exposed.
Despite the courts and public opinion frowning on such terrible events, it is imperative that the legislatures of the nation take the appropriate measures to ban asbestos in use, and to require a registry all sites where asbestos is known to be present. Additionally, the sites should be publicly listed in a registry by the US EPA and those site declared to be areas where a potential health emergency exists.

Tuesday, January 29, 2013

Siemens Recalls Temperature and Humidity Sensors for Schools, Hospitals and Other Buildings Due to Fire Hazard

Siemens Sensor - Biege Display Screen
Consumers should stop using this product unless otherwise instructed. It is illegal to resell or attempt to resell a recalled consumer product.

This recall involves wall-mounted Q-series sensors that control heat, air conditioning and humidity inside commercial buildings, hospitals and schools. 

The sensors come in three designs: a blank cover, a cover with a digital display screen or a cover with a digital display screen and door.

Monday, January 28, 2013

Social Security Disability: Get the evidence you need

Today's post comes from Roger Moore of the Nebraska Bar.

Social Security Disability applicants sometimes have trouble getting the evidence needed to demonstrate that they have a disability.

  PROBLEM 1: You haven't had regular medical care because you don't have health insurance. Without regular medical care, it's difficult to develop a relationship with a doctor that is strong enough that the doctor can complete a report on your health. Even if your disability is very real, proving it in Court can still be a hard thing to do. However, without medical insurance, most doctors won't see a patient.

 SOLUTION: In Nebraska there are some free clinics where you can be seen by a doctor even if you cannot afford to pay. To find a free clinic near you, contact your local health department. Anyone planning on applying for Social Security Disability should try to develop a relationship with a doctor by seeking regular medical care as often as possible.

PROBLEM 2: Many applicants don't have the right kinds of conversations with their doctors about their disabilities. Doctors are mainly concerned with your symptoms and how they can help you get well. They aren't necessarily focused on the kinds of things they'll need to know to help you with your Social Security Disability claim. To fill out a report for your claim, they'll need to know exactly how much you can and cannot do.

Saturday, January 26, 2013

The Vanishing Concept of a Job

While reviewing some historical cases today, I realized that what is missing from the workplace is the concept of "a job." America's economy has dramatically changed, and so have jobs that were once available in the workforce.

Even clearer is the fact that the concept of a job has disappeared. The idea of getting up in the morning and going regularly to a job has even vanished. The evolution changed slowly with the younger generation claiming that a job cycle transformed from a lifetime position to one lasting two years. Then the next stage in the evolution occurred, where the employee became a transient worker, and daily the job changed, No stable employer really exists.

This evolution has eroded the underlining framework of a functional workers' compensation program and the delivery of benefits. The injured worker becomes lost to the system, and a safe and secure workplace has become an illusion. Lost in the complexity is the adequate reporting of accidents and occupational disease, and the ability to accurately follow the evolution of latent diseases and medical conditions.
"A new trend in the U.S. labor market is reshaping how management and workers think  about employment, while at the same time reshaping the field of occupational safety  and health. More and more workers are being employed through “contingent work”  relationships. Day laborers hired on a street corner for construction or farming work,  warehouse laborers hired through staffing agencies, and hotel housekeepers supplied by  temp firms are common examples, because their employment is contingent upon shortterm fluctuations in demand for workers. Their shared experience is one of little job  security, low wages, minimal opportunities for advancement, and, all too often, hazardous working conditions. When hazards lead to work-related injuries, the contingent nature of the employment relationship can exacerbate the negative consequences for the injured worker and society. The worker might quickly find herself out of a job and, depending on the severity of the injury, the prospects of new employment might be slim. Employerbased health insurance is a rarity for contingent workers, so the costs of treating injuries are  typically shifted to the worker or the public at large. Because employers who hire workers on  a contingent basis do not directly pay for workers’ compensation and health insurance, they are likely to be insulated from premium adjustments based on the cost of workers’ injuries. As a result, employers of contingent labor may escape the financial incentives that are a main driver of business decisions to eliminate hazards for other workers."
Click here to read "At the Company’s Mercy: Protecting Contingent Workers from Unsafe Working Conditions"

Thursday, January 24, 2013

Temporary Employees Cannot Be Excluded From Workers’ Compensation

Today's post comes from Paul J. McAndrew, Jr. of the Iowa bar. Paul 's expertise in workers' compensation issues is nationally known and he has bee an zealous advocate for workers' rights.

According to a recent decision by the Texas Supreme Court, a temporary employee cannot be excluded from an employers’ workers’ compensation policy. In 2005, Rafael Casados was killed on his third day at work at a grain storage facility owned by Port Elevator-Brownsville L.L.C.

Because Casados was a temporary employee of Port Elevator at the time of his death, he was initially awarded a liability ruling of $2.7 million directly from Port Elevator.

However, according to the latest Supreme Court ruling, Casados’s family should receive remedy under Port Elevator’s workers’ compensation policy instead. Port Elevator’s insurance provider is liable for Casados’s death benefits, despite the fact that Port Elevator never paid workers’ compensation insurance for any of their temporary employees.

According to the decision: “If Port Elevator’s policy had set out certain premiums solely for temporary workers and Port Elevator had not paid those premiums, Casados would still have been covered under the policy and the failure to pay premiums would be an issue between Port Elevator (their insurance provider).”    

 Photo Credit:sixninepixels /

Tuesday, January 22, 2013

US Supreme Court Upholds Equitable Tolling In Reimbursement Matter

US Supreme Court Upholds Equitable Tolling In Reimbursement Matter
Sebelius v. Auburn Regional Medical Center, Decided Jan. 22, 2013

"But this Court has explained that giving intermediaries more time to discover overpayments than providers have to discover underpayments may be justified by the “administrative realities” of the system: a few dozen  fiscal intermediaries are charged with issuing tens of thousands of NPRs, while each provider can concentrate on a single NPR, its own.  Your Home Visiting Nurse Services, Inc. v. Shalala, 525 U. S. 449, 455, 456.  Pp. 11–14. "
See full analysis on Scotus Blog.

Read more about equitable tolling:

Nov 13, 2012
ERISA health reimbursement claims asserted in Workers' Compensation claims may be subject to equitable relief depending on the upcoming decision in a case pending before the US Supreme Court. Oral argument is ...
Nov 22, 2011
The Doctrine of Equitable Allocation Not Applicable in a Medicare Secondary Payment Reimbursement Claim. The 6th Circuit Court of Appeals has ruled that The Center for Medicare and Medicaid Services (CMS) is entitle to ...
Nov 29, 2012
The US Court of Appeals for the Third Circuit, in defiance of several other circuits held [opinion] that "appropriate equitable relief" did not include revoking the payment to McCutchen. Interestingly enough at oral argument ...
Dec 05, 2011
US Supreme Court Maybe Asked to Rule on CMS Issue: "The Doctrine of Equitable Allocation". The 6th ... The Doctrine of Equitable Allocation Not Applicable in a Medicare Secondary Payment Reimbursement Claim A recent ...

Monday, January 21, 2013

Boston Globe: Teen Work Related Injuries a “Major Problem”

Today's post comes from Deborah Kohl from Deborah G. Kohl Law Offices of Massachusetts. 

A recent article published in the Boston Globe cites injuries to teenagers are, “A major problem,” according to the Massachusetts Department of Public Health. The article can be found here. The article further goes on to state that rules are often “flouted” for minors. The majority of injuries to teenagers take place in retail jobs or those in the the food preparation and service industry.

The article reports that the injuries are often serious ones such as cuts from deli/meat slicers and back/neck pain as a result heavy lifting in service and landscaping jobs. The article also reported, “One local teen, who asked not to be identified fearing retaliation from his boss, described going onto a highway to retrieve supermarket carts.” Everyone, regardless of age, has the right to expect nothing less than a safe working environment.

If you are injured at work, do not hesitate to immediately report the injury to your employer. If you feel that your rights have been violated with respect to an injury you sustained on the job, please contact us to discuss your situation.

Read more abut child labor.

Dec 14, 2012
The U.S. Department of Labor's Bureau of International Labor Affairs today introduced Reducing Child Labor and Forced Labor: A Toolkit for Responsible Businesses, the first guide developed by the U.S. government to help ...
Sep 14, 2012
The US Library of Congress has just posted digital images o child labor that are in it s collection. Workers' Compensation benefits are but one instance that enforce penalties when child labor laws are not followed.
Jan 03, 2013
Other reforms included workplace safety regulations, child labor laws, and enhanced fire inspections, among others. There is a growing effort by worker groups to demand safety reforms in Bangladesh where factory fires have ...
Nov 22, 2011
He has announced that he will offer radical proposals including the elimination of child labor laws. For decades child labor laws and penalties have been integrated into state workers' compensation acts acting as a safety ...

UN Announces Treaty to Restrict Use of Mercury

Over 140 governments meeting at a United Nations forum in Geneva have agreed to a global, legally-binding treaty to address mercury, a notorious heavy metal with significant health and environmental effects.

The Minamata Convention on Mercury – named after a city in Japan where serious health damage occurred as a result of mercury pollution in the mid-20th Century – provides controls and reductions across a range of products, processes and industries where mercury is used, released or emitted.

These range from medical equipment such as thermometers and energy-saving light bulbs to the mining, cement and coal-fired power sectors, according to a news release issued today by the UN Environment Programme (UNEP), which convened the negotiations.

“After complex and often all-night sessions here in Geneva, nations have today laid the foundations for a global response to a pollutant whose notoriety has been recognized for well over a century,” said UNEP Executive Director Achim Steiner.

“Everyone in the world stands to benefit from the decisions taken this week in Geneva, in particular the workers and families of small-scale gold miners, the peoples of the Arctic and this generation of mothers and babies and the generations to come. I look forward to swift ratification of the Minamata Convention so that it comes into force as soon as possible,” he added.

The treaty, which has been four years in negotiation and which will be open for signature at a special meeting in Japan in October, also addresses the direct mining of mercury, export and import of the metal and safe storage of waste mercury.

Pinpointing populations at risk, boosting medical care and better training of health care professionals in identifying and treating mercury-related effects will also form part of the new agreement.

UNEP noted that mercury and its various compounds have a range of serious health impacts, including brain and neurological damage especially among the young. Others include kidney damage and damage to the digestive system. Victims can suffer memory loss and language impairment alongside many other well documented problems.

Among the provisions of the treaty, governments have agreed on a range of mercury-containing products whose production, export and import will be banned by 2020. These include batteries, except for 'button cell' batteries used in implantable medical devices; switches and relays; certain types of compact fluorescent lamps (CFLs); mercury in cold cathode fluorescent lamps and external electrode fluorescent lamps; and soaps and cosmetics.

Certain kinds of non-electronic medical devices such as thermometers and blood pressure devices are also included for phase-out by 2020.

Governments also approved exceptions for some large measuring devices where currently there are no mercury-free alternatives. In addition, vaccines where mercury is used as a preservative have been excluded from the treaty as have products used in religious or traditional activities.

Read more about toxicity of mercury:
Dec 20, 2012
The US EPA has announce that mercury, a hazardous substance, that was dischardged by EI DuPont in the Pompton River in NJ will be removed. For decades it has been known that mercury exposure causes illness and ...
Nov 26, 2012
Irving J. Selikoff Center for Occupational & Environmental Medicine at Mount Sinai School of Medicine has released a guide to treatment for elemental mercury ((the pure form of the metal, when it is not combined with other ...
Mar 05, 2010
For example, nearly 70 years ago, on December 1, 1941, the U.S. Public Health Service ended mercury's use by hat manufacturers in 26 states through mutual agreements. The kinds of conditions that put hat-makers and ...
May 09, 2012
The U.S. Environmental Protection Agency will discuss plans to address high levels of contaminants, including PCBs, mercury and dioxin, which are present in Passaic River mud adjacent to Riverside Park in Lyndhurst, New ...

Sunday, January 20, 2013

Paper or Plastic: A Reusable Workplace Hazard From The Grocery Store

Most people have been driven by guilt or cost into thinking about using a reusable shopping bag from the grocery store. A recent report indicates that sometimes the bags, because they are not sanitized by regular cleaning, become killer bacteria farms that may be transported into the workplace in a casual fashion.

Brought home from the grocery store, reusable and contaminated shopping bags then become storage and transport containers left baking in the car and carried everywhere for convenience from gyms, to libraries, and then into the workplace for lunch.

A recent report reflects that the reusable grocery bags often become contaminated by bacteria, since they are not cleaned properly nor  regularly, and that deadly bacteria colonize in the bags resulting human illness and increased emergency room visits.

"Recent studies, however, suggest that reusable grocery bags harbor harmful bacteria, the most important of which is E. coli. If individuals fail to clean their reusable bags, these bacteria may lead to contamination of the food transported in the bags. Such contamination has the potential to lead to health problems and even death."
Jon L.Gelman of Wayne NJ, helping victims of workplace injuries and their families for over 4 decades, is the author NJ Workers’ Compensation Law (West-Thompson) and co-author of the national treatise, Modern Workers’ Compensation Law (West-Thompson).  

Other article of current interest

Saturday, January 19, 2013

The Obama Agenda: The Road to Workplace Wellness

As workers compensation programs are being diluted by soaring medical costs, The Obama Administration's policy makers are taking a bold new step to focus on promoting wellness and disease-prevention efforts in the workplace. 

Immediately following the presidential elction last November, the Department of Labor, Internatl Revenue Service and the Department of Health and Human Services proposed regulations to enforce workplace wellness programs under thre Affordable Care Act. The proposed regulations will stimulated employer programs to invite healthier workers and may go as far as penalizing those who maintian poor diets and inadequate exercise regiems. 
"... regulations would increase the maximum permissible reward under a
health-contingent wellness program offered in connection with a group
health plan (and any related health insurance coverage) from 20 percent
to 30 percent of the cost of coverage. The proposed regulations would
further increase the maximum permissible reward to 50 percent for
wellness programs designed to prevent or reduce tobacco use. These
regulations also include other proposed clarifications regarding the
reasonable design of health-contingent wellness programs and the
reasonable alternatives they must offer in order to avoid prohibited
One analysis of the proposal concludes......
"We are cautiously optimistic about the potential of workplace-wellness programs to help contain healthcare costs and to improve the health and well-being of millions of California’s workers. Preventing illness and injury through workplace-based strategies potentially benefits employees and their families, employers, and public and private insurance providers. There is emerging evidence about the effectiveness of WWPs in improving chronic disease outcomes, and a long history of occupational health and safety practices reducing workplace injury and death. Incentives in the ACA have the potential to serve as a catalyst for expanding WWP’s broadly in California. However, policy solutions need to respond to potential unintended consequences and account for the state’s incredibly diverse communities and businesses in order to make wellness programs work for all Californians."

Read The Greenlining Institute's report "Helth, Equity and the Bottom line: Workplace Wellness and California Business

Comments are due on or before January 25, 2013.

Read more about health care and workplace injuries and illnesses.

Jan 10, 2013
Curing the Profit Motive in Health Care. Soaring medical costs have afflicted the workers' compensation industry with economic distress and have severely impacted the efficient and effective delivery of medical care to injured ...
Nov 20, 2012
The National Institute For Occupational Safety And Health (NIOSH) has revised and republished informational material concerning the health hazards to healthcare workers were exposed to hazardous drugs. The publication ...
Nov 05, 2012
Access to health insurance is under attack. President's Obama's comprehensive health care reform law, intended to increase health care coverage for millions of Americans, faced extreme scrutiny by the U.S. Supreme Court ...
Sep 12, 2012
Throughout the nation Workers' Compensation systems have been impacted by health care costs that now take a large piece of the premium dollar. Traditional health care offered by employers mirrors the same problem of ...

Beneficiary Not Permitted Injunctive Relief From EIRSA Plan Invoking MSP Terms

A Federal Court held that a beneficiary was unable to seek injunctive relief against an EIRSA plan, where the beneficiary sought to have the ERISA Plan action to declare Medicare the primary plan and subject to the Medicare Secondary Payer Act (MSP). The ERISA plan was held to have the right to changes the terms of the plan in order to align the UNICare Benefits of Choice Program with federal law.

The court declared the MSP action alleged in the complaint moot as it granted the motion to dismiss on the injunctive relief issue. The plaintiff/beneficiary sought to allege a private cause of action for double damages against "those of any entity contractually obliged to pay for an individual’s primary health care" The Court held, "....the plaintiff is not attempting to collect damages for medical bills improperly paid by Medicare on his behalf, but instead seeks an injunction requiring Unilever to pay for future medical expenses. No court has allowed a claim for injunctive relief under § 1395y(b)(3)(A) and I am persuaded that such a claim is not authorized by the statute." Im a footnote the indicated, "The government may be authorized to seek declaratory and injunctive relief under § 1395y (b)(2)(B)(iii)See United States v. Baxter Int'l, Inc., 345 F.3d 866, 909 (11th Cir.2003)."


"Opt-Out" -- TSA To Remove All Controversial Rapiscan Backscatter AIT Machines

The US Transportation Safety Administration (TSA) is following the lead on many other countries, including the European Community, and is removing all Backscatter machines from service. While not admitting to the radiation hazards of the equitment, TSA announced that it is just removing them from service at airports. They will be placed into storage and possibly redeployed for other government use.

"All Rapiscan AIT units currently operational at checkpoints around the country, as well as those stored at the TSA Logistics Center, will be removed by Rapiscan at their expense and stored until they can be redeployed to other mission priorities within the government. Most of the backscatter units being removed will be replaced with millimeter wave units. The millimeter units will be moved from the inventory currently deployed at other airports and from an upcoming purchase of additional millimeter wave units. "

TSA Blog, 1/18/13

Read more about "airport scanners" and worker safety

Mar 22, 2011
David Brenner, Phd,DSr, a researcher at The Center for Radiological Research at Columbia University in New York, reports that TSA's use of the machines will create an increase risk to passenger by causing an additional ...
Jan 04, 2012
How much radiation is just too much and an additional risk for cancer is the question now posed by scientists concerned about TSA scanners. The scanners emit radiation in one form or another that is where the issues gets ...
Aug 08, 2012
Whole Body Imaging (WBI) at US airports by The Transportation Safety Administration (TSA) has raised urgent health concerns over causing increased rates of cancer among airport workers and passengers. Parties have ...
Nov 16, 2012
At a US Senate hearing last week, Senator Susan Collins (R-Maine) revealed that TSA had made reporting errors in the statistics it has compiled in defense of the use of body scanners. "That is completely unacceptable when ...

Thursday, January 17, 2013

Metal-on-Metal Hip Implants: FDA Issues a Alert on Potential Risks

The US FDA has issued an alert concerning Metal-on-metal hip implants consist of a ball, stem and shell, all made from cobalt-chromium-molybdenum alloys. 
There are two types of metal-on-metal hip implants:
  • Traditional total hip replacement systems
  • Resurfacing hip systems
Purpose: In February 2011, the FDA launched a metal-on-metal hip implant webpage. The FDA is providing updated safety information and recommendations to patients and health care providers.  This new information is based on the FDA’s current assessment of metal-on-metal hip implants, including the benefits and risks, the evaluation of the published literature, and the results of the June 2012 Orthopaedic and Rehabilitation Devices Advisory Panel meeting.

Summary of Problem and Scope:
Metal-on-metal hip implants have unique risks in addition to the general risks of all hip implants.
In metal-on-metal hip implants, the metal ball and the metal cup slide against each other during walking or running. Metal can also be released from other parts of the implant where two implant components connect.  Metal release will cause some tiny metal particles to wear off of the device around the implant, which may cause damage to bone and/or soft tissue surrounding the implant and joint. This is sometimes referred to as an “adverse local tissue reaction (ALTR)” or an “adverse reaction to metal debris (ARMD).”
Soft tissue damage may lead to pain, implant loosening, device failure and the need for revision surgery (a surgical procedure where the implant is removed and another is put in its place). Some of the metal ions released will enter the bloodstream and travel to other parts of the body, where they may cause symptoms or illnesses elsewhere in the body (systemic reactions).
Presently, the FDA does not have enough scientific data to specify the concentration of metal ions in a patient’s body or blood necessary to produce adverse systemic effects.  In addition, the reaction seems to be specific to individual patients, with different patients having different reactions to the metal wear particles.
Recommendations for Orthopaedic Surgeons:
Before Surgery
  • Select a metal-on-metal hip implant for your patient only after determining that the benefit-risk profile of using a metal-on-metal hip implant outweighs that of using an alternative hip system (metal-on-polyethylene, ceramic-on-polyethylene, ceramic-on-ceramic or ceramic-on-metal).  Factors to consider include the patient’s age, sex, weight, diagnosis, and activity level.
    • Note that a 2012 FDA advisory panel of experts identified young males with larger femoral heads as the best candidates for hip resurfacing systems. 
  • Inform patients about the benefits and risks of metal-on-metal hip implants, including the risk that the hip implant may need to be replaced. Also discuss the patient’s expectations and review the potential complications of surgery with a metal-on-metal hip implant.
  • Pay close attention to patient populations for which metal-on-metal hip systems are contraindicated.  Be aware of the risk factors that may predispose a device to excess wear and early failure. 
Additional information on the FDA’s recommendations for orthopaedic surgeons before, during and immediately following metal-on-metal hip replacement surgery can be found in Information for Orthopaedic Surgeons.
Patient Follow-Up
  • Follow-up of asymptomatic patients with metal-on-metal hip implants, including physical examinations and routine radiographs, should occur periodically (typically every 1 to 2 years).  If the hip is functioning properly, the FDA does not believe there is a clear need to routinely perform additional soft tissue imaging or assess metal ion levels in the blood.
  • Be aware that there are certain patients who are at risk for increased device wear and/or adverse local tissue reactions (ALTR) and should be followed more closely. They may include:
    • Patients with bilateral implants
    • Patients with resurfacing systems with small femoral heads (44mm or smaller)
    • Female patients
    • Patients receiving high doses of corticosteroids
    • Patients with evidence of renal insufficiency
    • Patients with suppressed immune systems
    • Patients with suboptimal alignment of device components
    • Patients with suspected metal sensitivity (e.g. cobalt, chromium, nickel)
    • Patients who are severely overweight
    • Patients with high levels of physical activity.
  • Pay close attention to signs and symptoms that may be associated with metal-on-metal hip implants. Please see the website for a list of common ALTRs and systemic symptoms/complications.
  • Conduct a thorough evaluation if a patient with a metal-on-metal hip experiences local symptoms such as pain or swelling at or near the hip, a change in walking ability or a noise from the hip joint more than three months after metal-on-metal hip implant surgery. 
  • Follow symptomatic patients with metal-on-metal hip implants at least every 6 months.
Additional information on the FDA’s recommendations for patient follow-up can be found in Information for Orthopaedic Surgeons.
For additional information regarding soft tissue imaging or assessing metal ion levels, please review the FDA’s recommendations below.
For some symptomatic patients with metal-on-metal hip implants, additional diagnostic imaging is required to assess and diagnose soft tissue findings surrounding the implant.  Please be aware of the FDA’s recommendations:
  • Consider the benefits and risks of using different types of diagnostic imaging procedures (e.g. MRI with metal artifact reduction, CT, or ultrasound) as well as the availability of specialized radiology expertise when determining the most appropriate imaging modality for each patient.
If you determine that an MRI of a metal-on-metal hip implant patient is appropriate, the FDA recommends the following:
  • Consult with the radiologist to evaluate the benefits and risks of utilizing MRI with metal artifact reduction;
  • Review the available device-specific labeling from manufacturers for MRI Conditions; and
  • Inform the MRI site that the patient has a metal-on-metal hip implant.
For additional information on the FDA’s recommendations about imaging a patient with a metal-on-metal hip implant, please see Imaging Evaluation.
Assessing Metal Ion Levels
Some patients with a metal-on-metal hip implant may have elevated metal ion levels (e.g. cobalt and/or chromium) in their bloodstream.  Several factors can impact the accuracy, reproducibility, and clinical interpretation of metal ion test results.  Please be aware of the FDA’s recommendations:
  • The FDA does not believe there is a clear need to routinely check metal ion levels in the blood if the orthopaedic surgeon feels the hip is functioning properly and the patient is asymptomatic.
  • Patients with metal-on-metal hip implants who develop any symptoms or physical findings that indicate their device may not be functioning properly, should be considered for metal ion testing.  
  • If measuring metal ions, consider obtaining and following serial measurements (using the same sample type, the same measurement method, and preferably the same laboratory) in determining metal ion levels in symptomatic patients.
  • At this time, the FDA is not recommending a specific metal ion level as a trigger for revision or other medical intervention.  The metal ion concentration values, including increases in metal ion levels over time, should be considered in addition to the overall clinical scenario including symptoms, physical findings, and other diagnostic results when determining further actions.
For additional information on the FDA’s recommendations on metal ion test methods, selecting a test lab and interpreting test results, please see Metal Ion Testing.
Device Revision
The decision to revise a metal-on-metal hip implant should be made in response to the overall clinical scenario. In case of adverse local tissue reactions (ALTR), revision of a metal-on-metal hip implant may have a worse prognosis than revision of other types of bearing surfaces.
In selecting components for revision:
  • Consider the benefits and risks of all bearing surfaces for each patient.
  • Check the specific device labeling for compatibility of device components.
  • If a patient is suspected to have developed metal sensitivity, carefully select the materials of the revision components (potentially avoiding materials with nickel or chromium). 
For additional information, please review the FDA’s considerations on device revisions, which includes our recommendation for a retrieval analysis of every failed metal-on-metal hip implant.
Summary of FDA Recommendations for Orthopaedic Surgeons
Symptomatic PatientsAsymptomatic Patients
Regular Clinical Evaluation At least every six months Typically at least once every 1 to 2 years
Soft Tissue Imaging Consider the benefits and risks of MRI, CT and ultrasound for each patient. Not necessary if you feel the hip is functioning properly.
Metal Ion Testing Consider monitoring serial metal ion levels.  Currently, the most reliable test results are available for cobalt in EDTA-anticoagulated blood*.  In repeat tests, use same sample type, measurement method and preferably the same laboratory. Not necessary if you feel the hip is functioning properly.
*For chromium testing, a validated method that resolves potential interferences must be used.  Please reviewFDA’s recommendations for chromium testing.
Recommendations for Health Care Providers:
Metal-on-metal implant patients with systemic symptoms are more likely to visit their primary care practitioner than their orthopaedic surgeon, which makes it important for all health care providers to be aware of metal ion adverse events that may occur in metal-on-metal hip implant patients. Based on case reports, these events may include:
  • General hypersensitivity reaction (skin rash)
  • Cardiomyopathy
  • Neurological changes including sensory changes (auditory, or visual impairments)
  • Psychological status change (including depression)
  • Renal function impairment
  • Thyroid dysfunction (including neck discomfort, fatigue, weight gain or feeling cold.
Patients with systemic findings that are thought to be related to a metal-on-metal hip implant should be advised to follow-up with his or her orthopaedic surgeon to determine the appropriate course of action.
For additional information, please review the FDA’s considerations to Health Care Professionals.
Recommendations for Patients Considering Hip Implants:
  • Be aware that every hip implant has benefits and risks.
  • Discuss your options for hip surgery with your surgeon. 
A list of some questions to ask your orthopaedic surgeon can be found in Patients Considering a Metal-on-Metal Hip Implant.
Recommendations for Patients with Metal-on-Metal Hip Implants:
  • If you are not having any symptoms and your orthopaedic surgeon believes your implant is functioning appropriately, you should continue to routinely follow-up with the surgeon every 1 to 2 years.
  • If you develop new or worsening problems such as pain, swelling, numbness, noise (popping, grinding, clicking or squeaking of your hip), and/or change in your ability to walk, contact your orthopaedic surgeon right away. 
  • If you experience changes in your general health, including new or worsening symptoms outside your hip, let your physician know you have a metal-on-metal hip implant.
Additional information for patients with a metal-on-metal hip can be found in Patients who have a Metal-on-Metal Hip Implant.
FDA Activities:
The FDA is committed to providing reliable safety recommendations to patients and health care providers about the utilization of these devices.  Recent activities include:
  1. On May 6, 2011, the FDA instructed manufacturers of metal-on-metal total hip replacement (THR) systems to conduct postmarket surveillance study of these devices.  Five manufacturers currently market metal-on-metal hip implants in the U.S. and all five have approved postmarket surveillance study plans.  Data from these studies will provide patients and health care providers with additional information about the safety profiles of the implants, including the effect of metal ion concentrations in the bloodstream.
  2. On June 27-28, 2012, the FDA convened the Orthopaedic and Rehabilitation Devices Panel of the Medical Devices Advisory Committee to seek expert scientific and clinical opinion on the benefits and risks of metal-on-metal hip systems. Information from this panel meeting has helped form these recommendations.
  3. On January 17, 2013 the FDA issued a proposed order requiring manufacturers of metal-on-metal total hip replacement systems to submit premarket approval (PMA) applications.  Metal-on-metal total hip replacement systems were evaluated under the 510(k) premarket notification program. Metal-on-metal total hip replacement systems were marketed in the U.S. prior to 1976 legislation that gave the agency premarket authority over medical devices. As “preamendment devices,” they were designated as Class III (higher risk) devices but were regulated under the 510(k) premarket notification program.
Additional information on FDA ongoing activities are provided in FDA’s Role and Activities.
Other Resources:
For additional resources, see Metal-on-Metal Hip Implants: Other Resources.
Reporting Problems to the FDA:
Prompt reporting of adverse events can help the FDA identify and better understand the risks associated with medical devices. If you suspect a problem with a metal-on-metal device, we encourage you to file a voluntary report through MedWatch, the FDA Safety Information and Adverse Event Reporting program. Health care personnel employed by facilities that are subject to the FDA's user facility reporting requirements should follow the reporting procedures established by their facilities. Device manufacturers must comply with the Medical Device Reporting (MDR) regulations.

Reports to the FDA about adverse events related to metal-on-metal hip systems include, but are not limited to: pain, malposition, adverse local tissue reaction, metallosis, hypersensitivity (allergy), loosening, and dislocation.
To help he FDA learn as much as possible about the adverse events associated with metal-on-metal hip implants, please include the following information in your reports, if available:
  • Date of implantation
  • Date of implant removal (if applicable)
  • Clinical cause for revision (if available)
  • System components affected by the adverse event.
Read more about Hip Implants and Workers' Compensation
May 16, 2011
"The FDA is continuing to gather and review all available information about currently marketed metal-on-metal hip systems, including information related to adverse events that may be associated with increase levels of cobalt ...
Aug 27, 2010
Johnson and Johnson has recalled 2 Hip Implants because of failure. The two implants were made by the DePuy Orthopaedics unit of Johnson and Johnson. The decision to withdrawn the products was based upon the fact ...
Jul 10, 2012
Under Administrative Code section 80.32(3), a “total hip prosthesis” carries a minimum 40% PPD. Based on previous Wisconsin Court and LIRC decisions, generally any subsequent invasive surgery resulting from the same ...
Dec 17, 2010
The workers' compensation insurance system is about to be the initial payor for joint replacement surgery and for the complications of defective artificial hip joint damage that were said to be inadequately tested because of a ...

EPA Acts To Lower Toxic Old Diesel Engines in NY & NJ

The U.S. Environmental Protection Agency has provided a total of $2.7 million to help two organizations reduce air pollution in the New York metropolitan area by replacing old, dirty diesel engines on a tug boat and two trains with less polluting models. The projects will cut emissions of harmful nitrogen oxides by 70 tons per year and particulate matter by three tons per year. These pollutants are linked to health problems, including asthma, lung and heart disease and even premature death.

Diesel engines are durable and often remain in use a long time. Older diesels that predate current and stricter air pollution standards emit large amounts of air pollutants. EPA grants such as those announced today are helping to reduce air pollution from some of the more than 11 million older diesel engines that continue to emit higher levels of pollution.

“EPA grants to replace dirty diesel engines with cleaner models protect people’s health, create jobs and cut fuel costs,” said EPA Regional Administrator, Judith A. Enck. “Older diesel engines generate significant amounts of air pollution that can make people sick. Replacing old polluting diesel engines reduces asthma attacks and other respiratory ailments, lost work days and many other health impacts every year.”

Conservation Law Foundation Ventures, a not-for-profit organization, will use a $1.3 million EPA grant to replace an old engine on the Coral Coast, a 120-foot marine tug boat that operates out of New York harbor, with a new and cleaner EPA-certified engine. The new engine is estimated to emit 70% less nitrogen oxides and 83% less particulate matter than the current engine. The project is expected to reduce emissions of nitrogen oxides by 57.7 tons per year and particulate matter by 2.7 tons per year in addition to conserving 42,558 gallons of fuel annually.

The Northeast States for Coordinated Air Use Management will use a $1.4 million EPA grant to replace two old engines on locomotives operating in northern New Jersey with new and cleaner engines. The trains will also be equipped with either an automatic engine stop/start system or an auxiliary power unit, which will reduce idling. The new engines are estimated to reduce nitrogen oxides by as much as 12.8 tons per year and particulate matter by as much as 0.3 tons in addition to conserving 14,000 gallons of fuel per year.

The EPA grants to groups in New York and New Jersey announced today are part of nearly $30 million in grant funds awarded by the agency nationwide in 2012 for clean diesel projects.

For information about EPA’s clean diesel initiatives, visit: and the Northeast Diesel Collaborative

Read more about "diesel" and workers' compensation
Workers' Compensation: Diesel Exhaust Linked to Cancer
Jun 13, 2012
After a week-long meeting of international experts, the International Agency for Research on Cancer (IARC), which is part of the World Health Organization (WHO), today classified diesel engine exhaust as carcinogenic to ...
Apr 30, 2009
Diesel exhaust continues to be a major health hazard for certain workers. The American Lung Association has reported that, "Truck drivers, dockworkers and railroad workers may face higher risk of death from lung cancer and ...
Mar 14, 2012
Metro-North also must post an OSHA notice for employees in the Harmon Diesel Shop and on its internal website, and provide all diesel shop employees with information on employee protections for reporting work-related ...