Today's post is shared from cidrap.umn.edu US health care workers remain at growing jeopardy over Ebola virus. An American doctor who was exposed to the Ebola virus while working in Sierra Leone has been airlifted back to the United States and was admitted to the National Institutes of Health (NIH) Clinical Center in Bethesda, Md., for observation. No details were available about the patient. The Associated Press (AP) today published a photograph of a person in head-to-toe white protective gear descending the stairs of a private jet at Frederick (Md.) Municipal Airport, led by an individual who wasn't wearing any protective gear. |
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Tuesday, September 30, 2014
American doctor exposed to Ebola hospitalized at NIH facility
New Study Shows Earnings Losses Persist Much Longer After Work-Related Injury, Even for Minor Injuries
Income benefits paid to workers through the workers’ compensation system replace a smaller fraction of lost income benefits than previously believed Thomas A. Robinson, J.D., the Feature National Columnist for the LexisNexis Workers’ Compensation eNewsletter, is a leading commentator and expert on the law of workers’ compensation. Filling in gaps from earlier studies conducted by others, a group of researchers has released the findings of a significant new study showing persistent earnings losses for workers up to 10 years following a work-related injury, even for comparatively minor injuries. Moreover, the study reveals that income benefits paid to workers through the workers’ compensation system replace a smaller fraction of the lost income benefits than previously believed. [See Seabury, SA et al., “Using Linked Federal and State Data to Study the Adequacy of Workers’ Compensation Benefits,” American Journal of Industrial Medicine vol. 57, pp. 1165–1173, Oct. 2014]. Limitations of Prior Studies Past studies from U.S. jurisdictions have generally found that injured workers experience significant losses from work-related injuries and that on average the replacement of lost earnings is low. Those past studies faced data limitations, however. For example, most of the studies relied on earnings information from state unemployment insurance (UI) records. While UI data provide rich information on wage and salary income within a given... |
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A Healthy Diet In The Workplace Reduces Workers' Compensation Claims
A healthier diet in the workplace results in healthier workers and a reduction of chronic and costly medical conditions. At a conference, Mediterranean Diet and Workplace Health 2014, last week at The Harvard School of Public Health, physicians, chefs, nutritionists, and leaders in the food service industry presented overwhelming evidence that a "Healthy Plate" leads to healthier workers.
While the Federal government has modified its antiquated health food pyramid somewhat, The Harvard School of Public Health has take a step forward in advocating an even healthier menu. Based on extra virgin olive oil (EVOO) and a greater proportion of vegetables and fruit, the healthy plate recognizes the dangers of sugar in the diet of workers.
This poster is displayed at the cafeteria entrance at The Harvard School of Public Health |
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Why so many injury claims from L.A. public safety workers?
Los Angeles' police and firefighters take paid injury leave at significantly higher rates than public safety employees elsewhere in California. Why? Is it more strenuous or stressful to work in the city of Los Angeles, compared with L.A. County or Long Beach? Does the city have an older workforce more prone to injury? Or is it just so easy to game the system in L.A. that filing an injury claim has become a routine matter in the police and fire departments? A Times investigation on Sunday revealed that 1 in 5 Los Angeles police officers and firefighters took paid injury leave at least once last year, and that not only are the number of leaves going up, but they are getting longer too. While on leave for a work-related injury, a police officer or firefighter earns 100% of his or her salary — but is exempt from federal or state taxes for a year. So it is actually more lucrative not to work than it is to work. Meanwhile, the fire department has had to spend more money on overtime to ensure that fire stations are fully staffed, and the LAPD, which cut paid overtime, has had fewer cops on the streets. Taxpayers spent $328 million over the last five years on salary, medical care and related expenses for employees on injury leave. Oh, and the state Legislature has repeatedly expanded the kinds of work-related "injuries" covered by the policy. They include Lyme Disease and HIV and stress. Certainly, paid... |
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L.A. pays millions as police and firefighter injury claims rise
Los Angeles Fire Capt. Daniel Costa liked to go all out on the racquetball court at the LAX fire station. A fellow firefighter described him as a "very competitive" player who "likes to win." Costa seemed in fine form after five spirited games in the fall of 2011. So his supervisor was skeptical when Costa, then 53, said he'd hurt his knee on the court and needed time off, according to a report by investigators for the city attorney's office. Costa was out on injury leave for a year, collecting his full salary, tax-free. In 2009, he took a nearly year-long paid leave after a run-in at the fire station with subordinates he described as "bullies." He complained of chest pain, high blood pressure and other symptoms, state records show. Costa has been one of the biggest beneficiaries of an injury-leave program for Los Angeles police and firefighters that has cost taxpayers $328 million over the last five years, a Times investigation found. Total salaries paid to city public safety employees on leave increased more than 30% — to $42 million a year – from 2009 through 2013, the five-year period studied by The Times. The number who took leaves grew 8%, and they were out of work an average of nearly 9 weeks — a 23% increase compared with 2009. The increased frequency and cost of leaves has forced the Fire Department to spend millions of dollars a year in overtime and reduced the number of police officers on the... |
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Working Long Hours Tied to Diabetes Risk
Working long hours may increase the risk for Type 2 diabetes, a new review has found, but the risk is apparent only in workers of lower socioeconomic status.
Long working hours are associated with diabetes risk factors — work stress, sleep disturbances, depression and unhealthy lifestyle, and some studies have found long hours associated with increased risk for cardiovascular disease.
Researchers combined data from 19 published and unpublished studies on more than 222,000 men and women in several countries.
The analysis, published in The Lancet Diabetes & Endocrinology, found no effect of working hours in higher socioeconomic groups. But in workers of lower socioeconomic status, working more than 55 hours a week increased the risk for Type 2 diabetes by almost 30 percent. The association persisted after excluding shift workers and adjusting for age, sex, obesity and physical activity.
The study is observational, and the lead author, Mika Kivimäki, a professor of epidemiology at University College London, said there were no intervention studies that could establish cause and effect.
“My recommendation for people who wish to decrease the risk of Type 2 diabetes,” he said, “applies both to individuals who work long hours and those who work standard hours: Eat and drink healthfully, exercise, avoid overweight, keep blood glucose and lipid levels within the normal range, and do not smoke.”
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Judge agrees not to sanction RI workers’ compensation lawyer
A Workers Compensation Court judge agreed Wednesday not to cite lawyer Stephen J. Dennis with criminal contempt for interrupting her on Sept. 3. Dennis spent an hour in a courthouse cell that day, after Associate Judge Janette A. Bertness had him handcuffed and removed from her courtroom. Saying that Dennis was in contempt, Bertness ordered him to sit in the cell for an hour “to figure out what it means to respect the court,” according to a court transcript. Amato A. DeLuca, Dennis’s lawyer, appealed to Bertness, saying that a criminal contempt citation would likely harm Dennis’s reputation and potentially affect his ability to practice. DeLuca said Dennis “was very anxious” as he tried to explain to Bertness why he had failed to appear as scheduled at 10 a.m. that day to represent a client. Bertness said she would vacate the criminal contempt citation, but noted that she had had “some problems” with Dennis’s explanation of why he was late to court, and that his failure to appear and show up on time “is awful – that’s just terrible” for the client. She also noted that Dennis “had interrupted eight times.” Dennis also apologized. “I did not intent to challenge your authority. I did not mean to …” Dennis said. “I did make a mistake but that was unintentional.” He added, “I think that what we do is good, and honorable... |
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American Heart Association: Pay More Attention to Radiation in Imaging Procedures
The American Heart Association is urging physicians to better understand the risks of radiation in cardiac imaging procedures. When ordering these procedures physicians should understand the appropriate use of each procedure, the radiation dose associated with the procedure, and the risks associated with that dose. Both the risks and benefits should be fully explained and discussed with patients prior to the imaging procedure. The full importance of radiation from cardiac procedures is not always appreciated, write the authors of the newly published scientific statement, “Approaches to Enhancing Radiation Safety in Cardiovascular Imaging.” But, according to Reza Fazel, the chair of the writing committee, “heart imaging procedures account for almost 40 percent of the radiation exposure from medical imaging.” The role of radiation is particularly important when considering cardiovascular imaging in younger patients for whom the lifetime risk is likely higher, said Fazel. The statement urges physicians to discuss several important questions with their patients, including how the procedure will be used to diagnose and treat the patient’s heart problem, whether there are other available techniques that don’t use radiation, how much radiation the patient will receive, and what is known about the risk of cancer associated with the radiation dose. Fazel offered some overall reassurance: “In general, the radiation-related... |
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Federal Appeals Court Rules State Apportionment Order Not A Bar to Medicare Recovery
The Court of Appeals, Hardiman, Circuit Judge, held that:
(1) recipient's liability settlement from third-party tortfeasor qualified as a “primary plan” within the meaning of the Medicare as a Secondary Payer Act;
(2) recipient's $90,000 settlement with tortfeasor included her medical expenses, and thus recipient had obligation to reimburse Medicare for $10,121.15 in medical
(3) the New Jersey Collateral Source Statute (NJCSS) did not prevent Medicare from recovering medical expenses as part of her damages in tort suit;
(4) state court's order apportioning settlement proceeds did not bar government from seeking reimbursement for medical expenses;
(5) District Court lacked jurisdiction to adjudicate recipient's unexhausted claim pursuant to “equity and good conscience” exception under Act; and
(6) District Court lacked federal question jurisdiction over due process claim.
"As the ALJ correctly found, the Superior Court's apportionment order was not “on the merits,” and need not be recognized by the agency. A court order is “on the merits” when it is “delivered after the court has heard and evaluated the evidence and the parties' substantive arguments.” Black's Law Dictionary 1199 (9th ed.2009); cf. Greene v. Palakovich, 606 F.3d 85, 98 (3d Cir.2010) (finding, in a criminal case, that “on the merits” means the state court “acted on the substance of [the] claim”), aff'd sub nom. Greene v. Fisher, ––– U.S. ––––, 132 S.Ct. 38, 181 L.Ed.2d 336 (2011); Thomas v. Horn, 570 F.3d 105, 115 (3d Cir.2009) (holding that state proceedings occur “on the merits” “when a state court has made a decision that 1) finally resolves the claim, and 2) resolves the claim on the basis of its substance”). Here, the state court did not adjudicate any substantive issue in the primary negligence suit. Indeed, in her motion for the order, Taransky clarified that she sought an apportionment not to resolve any outstanding issue in her suit, but “only to the extent necessary to obtain specified documentation relevant to anticipated administrative proceedings with the federal Centers for Medicare and Medicaid Services.” JA at 267. The state court, in effect, rubber stamped her request. Taransky's motion was uncontested, issued pursuant to a stipulation between Taransky and Larchmont, and prepared and submitted by Taransky's counsel for the judge's signature. This order is the antithesis of one made on the merits."
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Monday, September 29, 2014
Private Military Companies And The Ever-Changing Army
Immigrants, mercenaries and the new military service The rise of the private military - who is fighting our wars? © TwitterThe rise of the private military – who is fighting our wars? Troops deployed by the thousands, adorned with camouflaged combat wear, tough boots ready to tread the ground of conflict territories and hands at one with a military-grade rifle – This is the image we often see when nations instigate , but do we ever really think about exactly who is fighting it? It seems this vision has become more blurred in recent decades as reports have surfaced recently highlighting that immigrants, some illegal, are recruited to the service by mercenaries – what are now referred to as Private Military Companies or contractors (PMC). Fear of the companies have once again been affirmed by the newest installment of the Call of Duty franchise, Advanced Warfare, which follows mercenaries who have turned against the US Government. But are these fears and events simply fabricated fictional narratives, or is there a dark reality lurking behind the plot? The Military Times reports that the Department of Defence (DoD) have unveiled a new policy which will allow undocumented immigrants to join the military, and is deemed a new path for gaining citizenship in the US. Estimates have shown that between... |
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Study: Cancer costs 'skyrocketed' despite drug cuts
Today's post is shared from thehill.com The cost of treating cancer has "skyrocketed" despite a 2003 law that sought to control Medicare drug costs, including the cost of chemotherapy, according to a new study. Research published Monday in the Journal of Clinical Oncology found that oncologists did not stop prescribing expensive cancer drugs even after Medicare cut the drugs' reimbursements in 2005. In fact, the aggregate cost of cancer care rose by as much as 60 percent between the passage of the law in 2003 and 2013, the study noted. "Economists expected a sharp decline in use of the most expensive drugs targeted by the [2003] law, because reimbursement to oncologists for these drugs was reduced, but that did not happen," said Mark C. Hornbrook of Kaiser Permanente Northwest, the study’s lead author. Cutting drug reimbursements is one way federal health officials seek to influence doctors' prescribing habits. Profit on Medicare reimbursements for chemotherapy drugs is one way cancer clinics generate profit, making the payments ripe for scrutiny by Medicare. The study looked at 5,831 chemotherapy regimens for 3,613 patients and found the the law lowered prescriptions for affected cancer drugs "slightly" in fee-for-service cancer clinics. The 2003 law — the Medicare Prescription Drug, Improvement and Modernization Act — is best known for creating Medicare Part D. |
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Group Health Patients Win 61% of Medical Care Denial Appeals; WC Patients Lose 84% of Appeals
Insurers have Stacked the Deck Against Californians Hurt at Work
Sacramento, CA – The California Applicants’ Attorneys Association (CAAA), whose members represent Californians injured on the job, today continued its series comparing quality health care measures in workers’ compensation insurance to group health insurance. The third release compares the frequency of Independent Medical Review (IMR) upholding Utilization Review (UR) denials of doctors’ recommended medical care. Workers’ compensation IMR denied84% of patients’ appeals of denied medical treatments in one year, while group health IMR reviewers approved 61% of patients’ appeals. Group health patients win appeals of denied medical care nearly four times as often as California’s injured workers.
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American doctor exposed to Ebola hospitalized at NIH facility
An American doctor who was exposed to the Ebola virus while working in Sierra Leone has been airlifted back to the United States and was admitted to the National Institutes of Health (NIH) Clinical Center in Bethesda, Md., for observation.
No details were available about the patient. The Associated Press (AP) today published a photograph of a person in head-to-toe white protective gear descending the stairs of a private jet at Frederick (Md.) Municipal Airport, led by an individual who wasn't wearing any protective gear.
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What We’re Learning About Drug Company Payments to Doctors
On Tuesday, the federal government is expected to release details of payments to doctors by every pharmaceutical and medical device manufacturer in the country. The information is being made public under a provision of the 2010 Affordable Care Act. The law mandates disclosure of payments to doctors, dentists, chiropractors, podiatrists and optometrists for things like promotional speaking, consulting, meals, educational items and research. It’s not quite clear what the data will show — in part because the first batch will be incomplete, covering spending for only a few months at the end of 2013 — but we at ProPublica have some good guesses. That’s because we have been detailing relationships between doctors and the pharmaceutical industry for the past four years as part of our Dollars for Docs project. We’ve aggregated information from the websites of some large drug companies, which publish their payments as a condition of settling federal whistle-blower lawsuits alleging improper marketing or kickbacks. Today, in cooperation with the website Pharmashine, we’ve added data for 2013, which now covers 17 drug companies accounting for half of United States drug sales that year. (You can look up your doctor using our easy search tool.) Here are some facts we’ve learned from the data: Many, many health professionals have relationships with industry. Dollars for Docs now includes 3.4 million payments since 2009, totaling more than $4 billion,... |
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At Goldman Sachs, Even the Legal Fees Are Different
Goldman Sachs has the reputation of being a breed apart on Wall Street. Its employees are smarter, hungrier and quicker to the draw than those at rival firms. Thanks to these differences, Goldman sits at the apex of the nation’s investment banking hierarchy. Whether or not you buy into that narrative, there is one way in which Goldman clearly does set itself apart from its competitors: It has more leeway to pick and choose which executives’ legal bills it will pay if they become entangled in an investigation or legal proceeding. While the corporate bylaws of other banks definitively state which employees will have legal fees covered in the course of their duties, Goldman’s bylaws are ambiguous on the matter of one group of people — its so-called officers — whose legal bills it is supposed to cover. This has the effect of letting the firm decide whose bills among this group it will pay and whose it won’t. The vagueness in Goldman’s bylaws surfaced last week in a dissenting opinion written by Judge Julio M. Fuentes of the United States Court of Appeals for the Third Circuit in Philadelphia. A member of a three-person panel hearing a case involving Goldman’s refusal to pay a former vice president’s fees, Judge Fuentes contended that the effect of the firm’s policy was inconsistent with the law in Delaware, the state in which Goldman is incorporated. Judge Fuentes also noted that the ambiguity in Goldman’s bylaws... |
World Heart Day — September 29, 2014
World Heart Day will be observed September 29, 2014. The focus of World Heart Day this year is creating heart-healthy environments in which persons are able to make heart-healthy choices wherever they live, learn, work, and play. Heart disease and stroke are the world's leading causes of death, claiming an estimated 17.3 million lives in 2008, and representing 30% of all deaths worldwide (1). A heart-healthy environment can help persons make healthy choices to reduce their risk for heart disease. World Heart Day 2014 encourages persons to reduce their risk for cardiovascular disease by promoting smoke-free environments, environments that encourage physical activity, access to healthy food choices, and a heart-healthy planet for all.
CDC is working to help create heart-healthy environments in multiple ways, including community-based approaches, such as the Sodium Reduction in Communities Program (SRCP), and community-clinical linkages, such as the Million Hearts Initiative. SRCP aims to increase access to and accessibility of lower-sodium food options while building the evidence base on population approaches to reduce sodium consumption at the community level. Million Hearts aims to prevent 1 million heart attacks and strokes by 2017 by bringing together communities, health systems, nonprofit organizations, federal agencies, and private-sector partners from across the country to fight heart disease and stroke and their risk factors.
Additional information about World Heart Day is available at http://www.world-heart-federation.org/?id=123. Additional information about Million Hearts, SRCP, and CDC's Healthy Community Programs is available at http://millionhearts.hhs.gov andhttp://www.cdc.gov/nccdphp/dch/programs/healthycommunitiesprogram/index.htm.
Reference
World Health Organization. Global status report on noncommunicable diseases 2010. Geneva, Switzerland: World Health Organization; 2011. Available at http://www.who.int/nmh/publications/ncd_report2010
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Sunday, September 28, 2014
Federal research seeks alternatives to addictive opioids for veterans in pain
The National Institutes of Health and the Department of Veterans Affairs this week announced that they will launch a five-year, $21.7 million initiative to study the effectiveness of alternative therapies to opioids through a series of 13 research projects. Nearly half of all troops returning home from Afghanistan and Iraq are suffering from chronic pain, more than double the civilian population, according to the Journal of the American Medical Association. Many of those veterans have been prescribed opioids. The drugs often have disabling side effects, and some studies show they are often addictive and may exacerbate pain conditions in some patients. The joint research program includes studies on the use of morning light to treat lower-back pain and post-traumatic stress disorder, and the use of chiropractors, self-hypnosis and meditation to reduce pain, said Josephine P. Briggs, director of the National Center of Complementary and Alternative Medicine at NIH. Funding for the initiative comes from the NCCAM, the National Institute on Drug Abuse and the VA’s Health Services Research and Development Division. The research projects will be done at academic institutions and VA medical centers across the United States. “This is a very urgent issue for the soldiers returning home – the magnitude of the problem is huge,” Briggs... |
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Debate Grows Over Employer Plans With No Hospital Benefits
Lance Shnider is confident Obamacare regulators knew exactly what they were doing when they created an online calculator that gives a green light to new employer coverage without hospital benefits. “There’s not a glitch in this system,” said Shnider, president of Voluntary Benefits Agency, an Ohio firm working with some 100 employers to implement such plans. “This is the way the calculator was designed.” Timothy Jost is pretty sure the whole thing was a mistake. “There’s got to be a problem with the calculator,” said Jost, a law professor at Washington and Lee University and health-benefits authority. Letting employers avoid health-law penalties by offering plans without hospital benefits “is certainly not what Congress intended,” he said. As companies prepare to offer medical coverage for 2015, debate has grown over government software that critics say can trap workers in inadequate plans while barring them from subsidies to buy fuller coverage on their own. At the center of contention is the calculator — an online spreadsheet to certify whether plans meet the Affordable Care Act’s toughest standard for large employers, the “minimum value” test for adequate benefits. The software is used by large, self-insured employers that pay their own medical claims but often outsource the plan design and administration. Offering a... |
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DEA: Vicodin, Some Other Pain Meds Will Be Harder to Get
Patients who use drugs containing hydrocodone as a pain reliever or cough suppressant are going to have to jump through more hoops to get them starting next month. The Drug Enforcement Administration is reclassifying so-called “hydrocodone combination products” from Schedule III to Schedule II under the Controlled Substances Act, which will more tightly restrict access. Vicodin, for example, is an HCP because it has hydrocodone and acetaminophen. The final regulation, which takes effect Oct. 6, will mean that patients generally must present a written prescription to receive the drug, and doctors will no longer be able to call in a prescription to the pharmacy in most instances. The regulation is a response to the widespread misuse of prescription pain killers. In an emergency, doctors will still be able to call in a prescription, according to the new rule. And although prescription refills are prohibited, a doctor can, at his discretion, issue multiple prescriptions that would provide up to a 90-day supply. These measures don’t satisfy consumer advocates or pharmacists who are opposed to the new rule. While acknowledging that there has been an uptick in abuse and adverse events related to opioid painkillers, one patient advocate says the new rule restricts access indiscriminately. “We certainly want steps taken to reduce... |
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New lab incidents fuel fear, safety concerns in Congress
Symbol for biohazard.(Photo: CDC) Scientists wearing space-suitlike protective gear searched for hours in May for a mouse — infected with a virus similar to Ebola — that had escaped inside Rocky Mountain Laboratories in Montana, one of the federal government's highest-security research facilities, according to newly obtained incident reports that provide a window into the secretive world of bioterror lab accidents. During the same month at St. Jude Children's Research Hospital in Memphis, a lab worker suffered a cut while trying to round up escaped ferrets that had been infected with a deadly strain of avian influenza, records show. Four days later at Colorado State University's bioterrorism lab, a worker failed to ensure dangerous bacteria had been killed before shipping specimens — some of them still able to grow — to another lab where a worker unwittingly handled them without key protective gear. Nobody was sickened in the incidents and the mouse was caught the next day. Yet in the wake of serious lab mishaps with anthrax and bird flu at the Centers for Disease Control and Prevention that prompted an uproar and a Congressional hearing this summer, these additional incidents are further fueling bipartisan concern about lab safety. "As long as we keep having an ad hoc system of oversight in this country, we're going to keep seeing more and more incidents," said U.S. Rep. Diana DeGette of Colorado, the ranking... |
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