The Health Reform Act Charts a New Course for Occupational Health Care

The occupational healthcare program embodied in the recently enacted legislation has the potential for being the most extensive, effective and innovated system ever enacted for delivering medical care to injured workers. The “Libby Care” provisions, and its envisioned prodigies, will embrace more exposed workers, diseases and geographical locations, than any other program of the past. Potential pilot programs  will now be available to injured workers and their families who have become victims of the failed workers’ compensation occupational disease medical care system.

The legislation initially establishes a program for the identification, monitoring and treatment of those who were exposed to asbestos in Libby Montana where W.R. Grace formerly operated an asbestos (vermiculite) mine producing, among other things, attic insulation. The plant belched thousands of pounds of asbestos fiber into the air of the geographical area daily. Libby Montana has been declared a Federal Superfund Site and the asbestos disease that remains as its legacy has been declared a National Public Health Emergency.

The newly enacted national health care law will have profound effect upon the treatment of occupational disease.  Placed deep within the text of the bill (H.R. 3590), on page 836 (Section 1881A Medical Coverage for Individuals Exposed to Environmental Health Hazards), is the new occupational medical care model, “Libby Care.”  The Manager’s Amendment, embracing the concept of universal occupational health care, inserted in the final moments of the debate, will make all the difference in world to the future of medical care and the handling of work-related illnesses.

What We Learned From History

Historically it is well known that occupational diseases are problematic issues confronting workers’ compensation.They are problematic for all stakeholders in the system. For employers, it is difficult to defend a claim that may occur over a lengthy working period, ie. 280 days per year. Defending occupational disease claims has always been an elusive and a costly goal for employers and insurance carriers. Employees also are confronted with obstacles in obtaining timely medical benefits. Occupational disease claims are universally contested matter and medical care is therefore delayed until the claim is successfully litigated and potentially appealed. This process results in delay and denial of medical care and sometimes death.

In the 1950’s the insurance industry put tag-along verbiage in the statute to modify the 1911 workers’ compensation act to encompass occupational disease claims. This was not a philanthropic gesture, but one rather intended to shield Industry from rapidly spreading silicosis liability in civil actions emerging in the 1950s.

Over time, the failure of the workers’ compensation system to provide adequate medical care to injured workers suffering from occupational illness has given rise to the emergence of several attempted collateral benefit systems by the Federal government. The Black Lung Act-The Federal Coal Mine and Safety Act of 1969 established the Federal Black Lung Trust Fund, which obtained its revenue from the assessment of a percentage tonnage fee imposed on the entire Industry. In October 2000, the Federal government established The Energy Employees Occupational Compensation Program Act that provided a Federal bailout of liability for the monopolistic beryllium industry. The hastily enacted Smallpox Emergency Personnel Protection Act of 2003 (SEPA) shielded pharmaceutical manufacturers from liability.  Following the horrific events of September 11, 2001, the Federal government quickly established The Victims Compensation Fund to compensate the victims and their families through an administrative system.

The largest transfer of economic wealth in the United States from Industry to the private sector, other than in the Attorney General’s thirty-eight State tobacco litigation, emanated from asbestos litigation which had its geneses in workers’ compensation.   The late Irving Selikoff, MD’s pioneering efforts in providing expert testimony, based upon his sentinel studies of asbestos workers in Paterson, NJ, created the trigger mechanism for a massive wave of claims for occupational health care. The program never did adequately nor efficiently or expeditiously provide medical care.

The workers’ compensation system did not provide an adequate remedy because of a constellation of reasons, and subsequently, the wave spread to civil litigation out of desperation for adequate benefits. Asbestos litigation has been named, "The Longest Running Tort” in American history. While the Fairness in Asbestos Resolution Act of 2003, failed to be release from committee, the insurance industry tried to stifle the litigation but the effort failed.  Asbestos litigation expanded into  bankruptcy claims that continue unabated and the epidemic of disease continues. The remaining cases in the Federal court system were transferred to Federal Multi District Litigation (MDL 875) and the majority are finally concluding after twenty years of Panel consolidation. Medical benefits were not a direct component of that system. Unfortunately, asbestos is still not banned in the United States and the legacy of disease continues at historic rates.

The Costs

In a study prepared in 2000 by Dr. Steven Markowitz for a book entitled “Cost of Occupational Injuries  and Illnesses”, it was revealed that the direct medical costs attributed to occupation illness by taxpayers, amount to $51.8 Billion dollars per year for the hospital physicians and pharmaceutical expenses. Overall workers’ compensation is covering 27% percent of the cost. This amounts to 3% of the National Gross National Product. The cost is passed on to: employers, insurance carriers, consumers, injured workers and the taxpayer. Medicare, a target of the cost shifting mechanism employer by Industry, continues its “pay and chase” policy in an effort to seek reimbursement under the Medicare Secondary Payer Act. All the stakeholders and the compensation systems have become increasingly bogged down as cost-shifting continues by Industry. The workers' compensation claims process has become stagnant. 

Reportable Data A Questionable Affair

The quantification of occupational illness data has been very problematic as it is based on sources of questionable reliability. The US Bureau of Labor Statistics (BLS) based its collection on employer driven safety reporting, ieNCCI), keeps its data and procedures under wraps.

Both the NY Times and Nebraska Appleseed have reported that there exists underreporting of occupational disease conditions in epic proportions. They report that the elements of fear and intimidation directed to injured workers compound the defense attitude of employers and the insurance industry resulting in a massive underreporting of occupationally related medical conditions.

Increased Hurtles for Compensability

There have been attempts over the years to integrate more claims statutorily into the workers’ compensation system to shield employers from civil action and resultant large liability verdicts. This resulted in a flood of occupational exposure claims into the workers’ compensation arena. An effort in the mid-1980’s, following the asbestos litigation explosion, was by Industry to contain costs and restrict the payment of occupational disease claims even further in the workers’ compensation.

The initial effort was to create higher threshold standards and requirements in the area of mental stress claims. That was quickly followed by efforts to limit orthopedic and neurological carpal tunnel claims.  Restrictive language interpreting what is peculiar to employment further limited all occupational disease claims.

Furthermore, scientific evidence proof requirements became increasingly difficult to surmount. Daubert type arguments emerged by the defense in the nations’ workers’ compensation forums where simplicity of a remedial and efficient benefit delivery program had existed in the past. Where a biological marker was not present, as was in asbestos exposure claims, the establishment of causal relationship was universally challenged.

Pre-existing and co-existing factors soon became other hurtles for injured workers and their families.  Medical histories of orthopedic difficulties such as back conditions soon complicated repetitive motion trauma litigation. Co-existing and pre-existing smoking habits, family genetics and obesity were yet another obstacle to recovery.

Societal Habits Changed

Life and the way we look at work have changed dramatically with the onset of technology. Off-premises work is becoming more and more common with the advent of Internet access and economic globalization. Defining the barriers between work and pleasure has grown to be exceedingly difficult.

People are working harder and longer. More chronic conditions are prevalent in older workers. Disease increases with age and results in more total disability claims.

Occupational Medical Costs

The compensability of occupational claims is much more difficult to sustain in court. In recent studies over 99.9% of occupational deaths and 93.8% of the medical costs of occupational disease were held to be non-compensable. Over 50% of the lifetime medical costs are incurred during the last year of one’s life.

The Legacy of The Libby Montana Gold Rush

In 1881 gold miners discovered vermiculite, a form of asbestos in Libby, Montana. In 1920 The Zonolite Company was established and began to commercially mine vermiculite. W.R. Grace bought the mining operations in 1963. In 1990 the mine was closed and production ended.

For decades W.R. Grace belched over 5,000 pounds of asbestos into the air in and around Libby on a daily basis. The residents who worked at the plant and their families and household contacts were exposed to asbestos fiber.  Mineworkers brought home the asbestos on their clothing. The unknowing inhabitants and their families  used the asbestos to fill their gardens, their driveways, the high school track, the little league field and in their attics for insulation.

The US Environmental Protection Agency (EPA) visited Libby in 1999 and investigated the incidence of disease and the contamination of the site. The EPA declared Libby a Superfund site in October 2002 and a physical clean-up began of the geographical area. The question of who would pay for the medical care of Libby remained an unknown.

A Manager’s Amendment

Senator Max Baucus (D-MT), Chair of the Senate Finance Committee, utilizing a mechanism known as “A Manager’s Amendment,” at the last moment, modified the Senate’s version of the Health Care Reform Bill. The Patient Protection and Affordable Care Act passed the Senate, ultimate cleared the House and was signed into law by President Obama on March 23, 2010. Section 10323, Medicare Coverage for Individuals Exposed to Environmental Health Hazards, 2009 Cong US HR 3590, 111^th Congress, 1^st Session (December 31, 2009).

Senator Bacus said,  “This provision is important because it will provide vital medical services to American who—through no fault of their own—have suffered horrible effects from their exposure to deadly poisons. It will provide vital medical services we owe these Americans under our commitment in the Superfund Act.”  The amendment initially provides for screening and medical care to residents of the Libby Montana asbestos contaminated site that was owned and operated by W.R. Grace. It essentially provides for universal health care.

“Libby Care” Is The New Occupational Medical Care Model Legislation

The Libby site qualified for the medical program because the hazardous asbestos contaminated site in Libby was deemed to be “a public health emergency” on June 17, 2009 as defined by the Comprehensive Environmental Response, Compensation, and Liability Act of 1980 (CERCLA). While there are 1700 designated Superfund sites, Libby is the first site in the history of the program that has been designated as “a public health emergency.” The program may be expanded in adopted to other communities at the discretion of the Secretary of of the Department of Health and Human Services (HHS). 

The plan authorizes a grant for initial medical screening purposes. The screening would determine if a medical condition is present that is attributable to the environmental exposure. It allows those individuals with a diagnosed medical condition due to the environmental exposure at the site to get Medicare services. The Secretary of the Department of HHS may establish additional pilot programs to provide additional medical care appropriate for the residents of contaminated communities so designated. The delivery of Medicare medical benefits will be directed to those “who have suffered horrible effects from their exposure to deadly poisons.”

The purpose of the legislation is  “…. to furnish such comprehensive, coordinated and cost-effective care to individuals…..” p2224 l3-1. It mandates the furnishing of “Flexible Benefits and Services,” for items, benefits or services NOT covered or authorized by the Act. It further authorizes the institution of “Innovative Reimbursement Methodologies,” for reimbursement subject to offsets for individuals “eligible to receive public or private plan benefits or legal agreement.” p2226 ll8-11. The Secretary of HHS will maintain “waiver authority.”

Charting A New Course

After a century of struggle, the United States now embarks upon a new course for occupational medical care. The law charts a new path for the delivery of  occupational disease medical benefits on a timely basis. It will permit researchers an avenue for the collection of epidemiological data so that the workplace can be made safer. All will benefit. The innovative legislation provides for a long awaited and much needed initiative to provide an efficient, responsive and coordinated treatment plan and preventive health program that hopefully will expand and will vastly improve occupational health care.

To read more about health care and workers' compensation click here.

OSHA Needs To Be Strengthened

If workplaces were safer then there would be no reason to have a workers' compensation program at all. OSHA, The Occupational Safety and Head Health Administration (OSHA), does just that, but its enforcement powers are lacking.

OSHA was created legislatively by Congress in 1970. In the years following  The National

Commission on Workmen's Compensation Laws in 1972 reported that safety should be encouraged, and that, "....Economic incentives in the program should reduce the number of work-related· injuries

and diseases." 

Today, The New York Times reports that "Occupational illness and injuries ....cost the American economy $250 Billion per year due to medical expenses and lost productivity."

English: A picture of David Michaels, Assistant Secretary of Labor. (Photo credit: Wikipedia)

"OSHA devotes most of its budget and attention to responding to here-and-now dangers rather than preventing the silent, slow killers that, in the end, take far more lives. Over the past four decades, the agency has written new standards with exposure limits for 16 of the most deadly workplace hazards, including lead, asbestos and arsenic. But for the tens of thousands of other dangerous substances American workers handle each day, employers are largely left to decide what exposure level is safe.

***

“"I’m the first to admit this [OSHA] is broken,' said David Michaels, the OSHA director, referring to the agency’s record on dealing with workplace health threats. 'Meanwhile, tens of thousands of people end up on the gurney.'"

Click here to read the complete article,  As OSHA Emphasizes Safety, Long-Term Health Risks Fester

Trump Administration May Bring a Surge in Occupational Disease Claims

Mesothelioma death rates remain high in the US even on the eve of an anticipated national ban of the asbestos fiber. Things may radically change for the worse as the Trump Administration goes forward with its announced intention to dismantle environmental regulation now in place and placed on-track for enactment during the former Obama Administration. With anticipated less EPA and OSHA regulation under the Trump administration, there is the potential for a serious surge of future occupational disease claims in the United States.

Stephen Levin MD - Dies of Cancer

It is with sadness that I report of the passing of Dr. Stephen Levin.  Dr. Levin began an occupational disease evaluation practice in the office of Jack Sall, MD of Paterson NJ over 3 decades ago. He advanced to the Environmental Sciences Laboratory at the Mt. Sinai School of Medicine under the leadership of the late Irving J. Selikoff, MD, a pioneer in occupational disease research and more specifically asbestos related illnesses.


After the passing of Dr. Selikoff, Dr. Levin chaired the Environmental Sciences Department and maintained the archives of Dr. Selikoff. Dr. Levin was a leader and advocate for occupational disease research and treatment. His research work in post World Trade Center airborne toxins and disease build the foundation for the passage of the Zadroga 9-11 Health Benefits legislation enacted by Congress 14 months ago.


Joel Shufro, Executive Director of NYCOSH and Bill Henny, NYCOSH Board Chair, made the following statement, "He understood that the health of working people was directly tied to the health of the labor movement - that being organized into union or any other formation - was the first and most important step workers could take to protect their safety and health."


Stephen Levin championed the cause for helping victims of environmental and occupational disease. Ironically, like his predecessor, Dr. Selikoff, he also succumbed  to cancer, the disease that they both battled against for others. Dr. Levin's will be sadly missed but his legacy will on.

See also:
Dr. Stephen Levin dead of cancer NY Daily News
"As the medical director of Mount Sinai Medical Center’s Irving J. Selikoff Center for Occupational and Environmental Medicine, Dr. Stephen Levin had long known how damaging airborne toxins were to unprotected lungs."
A memorial service will take place Tuesday, February 21, 2012 at 4 p.m. at the Mount Sinai School of Medicine's Stern Auditorium, 1468 Madison Avenue (@ E. 100th Street, New York, NY 10029.

A Once-In-A-Generation Chance

The NY Times today called for passage of the Senate version of health care reform and salvage the opportunity for important change in the nation’s health care plan. More emphatically, the Senate version provides an opportunity for change in the way the nation’s century-old workers’ compensation system provides for the delivery of medical care in occupational disease claims.

The paper’s editorial rightly observes that one botched election in Massachusetts, a State that has already met the issue of universal health care, should not encumber the rest of country with horrors of a failed system. The Senate version of health care reform contains an opportunity to experiment and explore the opportunities on embracing the delivery of medical care and medical monitoring into a coordinated and national framework under the Medicare program. In the end it will be able to establish a unified epidemiological database to help prevent and treat occupational illnesses and lead the nation to a safer and healthier work environment.

The efforts of Senator Mat Baucus (D-MT) has made to craft an occupationally health care program has the potential for being the most extensive, effective and innovative system ever enacted for the delivery of medical care to injured workers. Libby Care [see Patient Protection and Affordable Care Act Sec. 10323 pp. 2222-2237] , and its envisioned prodigies, will embrace more exposed workers, diseases and geographical locations than any other program of the past. An ancillary benefit will be the integration of Centers for Medicare and Medicaid Services (CMS) and Centers for Disease Control (CDC) for the advancement of greater worker safety through organized data collection and research.

Caring for those who have been the victims of occupational disease has been an illusive goal of the nation’s patchwork of workers’ compensation systems for over a decade. Occupational diseases were a supplement to the compensation system that developed when Industry tried to shield itself from the emerging economic liabilities that silicosis was generating.

History reflects that the system just didn’t work. The longest running tort, asbestos reacted illness, plagued the workers’ compensation system and produced a  plethora of problems that only created more delay and denial of medical care for injured workers.

Economically the costs of direct costs for occupational illnesses and diseases continue to soar. Unfair cost shifting continues. A study in the year 2000 indicated that direct costs amounts to $51.8 Billion per year for hospitals, physicians and drugs. Workers’ compensation was reportedly covering only 27% of the costs and taxpayers were sharing un even share of the burden. The costs of occupational disease amounted for 3% of the gross national product.

The problems of under-reporting of occupational illnesses and disease even compound the reporting the true reality of the issue even further. The recent NY Times and Nebraska Appleseed investigative reports indicate that true numbers are hard to come by because of the fear and intimidation injured employees suffer in reporting claims.

Since the enactment of workers’ compensation in 1911, there has never been a greater opportunity to provide meaningful change to make the workplace healthier and safer. Congress and the President Obama should take advantage of this one-in-a-lifetime chance and make the Senate version of health care reform the law of the nation.

Click here to read more about health care and workers' compensation.

Alice in Wonderland - A Lesson in Occupational Illness

Alice in Wonderland has been released in the movie theaters today. The National Institute of Occupational Safety and Health (NIOSH) has been quick to remind us of the Mad Hatter and mercury exposures.

"Society has made great progress in recognizing and controlling industrial hazards since Lewis Carroll's day. 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 other industrial workers at risk in 1865 are no longer tolerated," said John Howard, M.D., Director of the National Institute for Occupational Safety and Health (NIOSH).

"However," Dr. Howard emphasized, "the Hatter remains a cautionary figure, since exposures to mercury and other hazardous industrial substances can still occur in the workplace. Symptoms from chronic exposures to mercury, lead, and other neurotoxic substances, even at low levels, may be subtle in early stages. Sometimes, they may be mistaken for symptoms that can arise from other causes. Similar concerns exist about other adverse effects that are associated with exposures on the job. It is important to be vigilant about work-related illness, and to act decisively to protect workers' health."

In 1911, New Jersey adopted the Workers' Compensation Act.  The original Act did not recognize any occupational diseases as compensable events.  In 1924 there were early amendments to the Act which enumerated 9 diseases as compensable.  Those disease were: anthrax, lead poisoning, mercury poisoning, arsenic, phosphorous, benzene, wood alcohol, chrome and caisson disease. 

A utility man who was required to pour sixty pounds of mercury each day and who had mercury dust both on his face and his clothes developed muscular weakness.  The expert doctor testified that the disease was either caused by mercury poisoning or myasthenia gravis.  Even though his supervisor testified that daily showers were available to all employees, the treating doctor indicated that, as a result of positive clinical findings, diagnostic tests, and a history of exposure, the exposure was the cause of the petitioner's illness, namely muscular weakness, and was compensable.  Jackson v. Mallinckrodt Chemical Works, 25 N.J.Misc. 33, 50 A.2d 106 (Com.Pl.1946).

A hatter who was required to come into contact with furs that had been treated with mercury was awarded total permanent disability benefits as a result of his having contracted the occupational disease of mercurial poisoning during the course of his employment.  Horowitz v. Rothenberg Hat Co., 19 N.J.Misc. 284, 18 A.2d 852 (Dept. of Labor 1941), N.J.S.A. 34:15-31, L.1924, c. 124 (Sec. 1) 22b, p. 231.

An employee in the hat industry who had suffered from symptoms of mercury poisoning and who had notified the insurance carrier was deemed to have notified the employer as well, and compensation was allowed.  Yurow v. Jersey Hat Corporation, 131 N.J.L. 265, 36 A.2d 296 (1944), judgment aff'd 132 N.J.L. 180, 39 A.2d 371 (Err. & App.1944).

The Division of Epidemiology, Environmental and Occupational Health Services requires that treating physicians report to the State Department of Health any occupational or environmental diseases within 30 days of diagnosis or treatment.  These diseases include: lead toxicity, arsenic toxicity, mercury toxicity, cadmium toxicity and pesticide toxicity. N.J.A.C. 8:57-3.2.

Mad Hatter: "No wonder you're late. Why, this watch is exactly two days slow."

...

Click here to read more about occupational disease and workers' compensation.

Occupational Exposure to Diacetyl and Acetaldehyde Results in Compensable Colorectal Cancer

An employee exposed at work to flavoring ingredients including Diacetyl and Acetaldehyde, was awarded workers’ compensation benefits as a result of being diagnosed with colorectal cancer. The case is significant because the Court adopted scientific evidence that associated chemical exposure in the workplace to an increased risk of a malignancy based on expert testimony that by DNA testing, the exposed worker’s body could not detoxify from the hazardous chemical.

Fatal Meningococcal Disease in a Laboratory Worker — California, 2012

Today's post is shared from Centers for Disease Control and Prevention

Occupationally acquired meningococcal disease is rare (1). Adherence to recommendations for safe handling of Neisseria meningitidis in the laboratory greatly reduces the risk for transmission to laboratory workers (2). A California microbiologist developed fatal serogroup B meningococcal disease after working with N. meningitidis patient isolates in a research laboratory (laboratory A). The California Department of Public Health (CDPH), the local health department, the California Division of Occupational Safety and Health (CalOSHA), and the federal Occupational Safety and Health Administration (OSHA) collaborated on an investigation of laboratory A, which revealed several breaches in recommended laboratory practice for safe handling of N. meningitidis, including manipulating cultures on the bench top. Additionally, laboratory workers had not been offered meningococcal vaccine in accordance with Advisory Committee on Immunization Practices (ACIP) recommendations and CalOSHA Aerosol Transmissible Diseases Standard requirements (3,4). In accordance with OSHA and CalOSHA regulations, laboratory staff members must receive laboratory biosafety training and use appropriate personal protective equipment, and those who routinely work with N. meningitidis isolates should receive meningococcal vaccine.

Case Report

On the evening of Friday, April 27, 2012, a microbiologist aged 25 years had onset of headache, fever, neck pain, and stiffness. The following morning, April 28, he was transported by automobile to the emergency department at hospital A, where he was employed in laboratory A as a researcher. While on the way to the hospital he lost consciousness. Upon arrival, the patient was noted to have a petechial rash, was suspected of having meningococcal disease, and was treated with ceftriaxone. He later had a respiratory arrest. Attempted resuscitation was unsuccessful, and he was declared dead approximately 3 hours after his arrival.

On the day of the patient's death, hospital A notified the local health department and CDPH of the case of suspected meningococcal disease. On April 29, hospital A notified OSHA, which notified CalOSHA that the deceased had worked in a laboratory conducting N. meningitidis vaccine research. Hospital A evaluated potentially exposed emergency department staff members and research laboratory employees; all persons found to have been exposed were immediately assessed for symptoms of meningococcal disease and offered postexposure chemoprophylaxis. Laboratory A voluntarily closed on April 30. No additional cases of meningococcal disease were identified among emergency department or laboratory staff members. The local health department identified other close contacts of the patient and ensured that they received postexposure chemoprophylaxis.

Blood and tissue specimens from the patient were sent to the CDPH Microbial Diseases Laboratory for isolation and serogroup identification. N. meningitidisserogroup B was identified in the clinical specimens by polymerase chain reaction. The patient had worked with N. meningitidis serogroup B isolates in the weeks and days before his death.

Investigation Findings

CalOSHA, OSHA, and CDPH initiated an investigation. Laboratory A was inspected, and employees were interviewed about their training as well as laboratory practices and protocols and were asked to demonstrate how procedures were performed. Multiple breaches in recommended laboratory safety practices were identified (Tables 1 and 2), including manipulation of N. meningitidis isolates on an open laboratory bench (2,5). The inspection team made recommendations for safe handling of N. meningitidis isolates and use of appropriate personal protective equipment. Laboratory A microbiologists working with N. meningitidisisolates had not been offered quadrivalent meningococcal vaccine, as recommended by ACIP (4). At the conclusion of the investigation, OSHA issued three citations classified as serious for failure to protect laboratory workers.

Discussion

Although occupationally acquired meningococcal disease is rare, it is a known risk among microbiologists who work with N. meningitidis isolates (6–8). Investigations of laboratory-acquired cases of meningococcal disease in the United States have demonstrated a many-fold higher attack rate for microbiologists compared with the U.S. general population aged 30–59 years and a case fatality rate of 50%, more than triple the 12%–15% case fatality rate associated with disease in the general population (9). In almost all cases, infected microbiologists had manipulated sterile-site isolates on an open laboratory bench outside of a biosafety cabinet (2,6). Manipulating N. meningitidis isolates outside a biosafety cabinet is known to be associated with a high risk for contracting meningococcal disease (7).

To decrease the risk of transmission to laboratory workers handling invasive N. meningitidis strains (serogroups A, B, C, Y, and W), CDC recommends the use of enhanced biosafety level two (BSL-2) containment practices, where BSL-2 requirements are met and some BSL-3 practices also are adopted (2). Updated recommendations for microbiologists manipulating N. meningitidis strains were published in January 2012 as a supplement to the Biosafety in Microbiological and Biomedical Laboratories guide and include the use of a nonrecirculating biosafety cabinet and the following personal protective equipment: disposable closed front laboratory coat, double gloves, fit-tested N95 filtering facepiece or higher level respiratory protection, and eye protection (2,5). In California, personnel using respirators also must be enrolled in a respiratory protection program (10).

Although this fatal case of serogroup B meningococcal disease was not vaccine-preventable by meningococcal vaccines currently licensed in the United States, licensed vaccines to protect against serogroup A, C, Y, and W-135 disease are available. ACIP recommends meningococcal vaccination for microbiologists who are routinely exposed to isolates of N. meningitidis (3,4). The CalOSHA Aerosol Transmissible Diseases Standard also requires that California employers offer all vaccinations as recommended by applicable public health guidelines for specific laboratory operations (1,4). A serogroup B vaccine (Bexsero, Novartis) was licensed in Europe, Australia, and Canada in 2013 and has received a "breakthrough therapy" designation from the Food and Drug Administration.

Employers should be familiar with laboratory biosafety recommendations and ensure that a laboratory biosafety program is in place. Employers also should ensure that laboratory staff are trained, adhere to recommended biosafety practices and procedures, and are offered recommended vaccines.

Acknowledgments

Linda Guthertz, MA, Heike Quinn, MS, Gillian Edwards, MS, Robin Hogue, Nancy Caton, Margot Graves, Barbara Materna, PhD, Sharon Messenger, PhD, Rita Brenden, PhD, Herschel Kirk, California Department of Public Health. Diane Portnoy, MPH, San Francisco Department of Public Health. Sandra Huang, MD, Alameda County Public Health Department. Occupational Safety and Health Administration.

1California Department of Public Health, 2California Division of Occupational Safety and Health, 3Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, CDC (Corresponding author: Channing Sheets, channing.sheets@cdph.ca.gov, 415-254-2582)

References

1. CDC. Laboratory-acquired meningococcal disease—United States, 2000. MMWR 2002;51:141–4.
2. CDC, National Institutes of Health. Biosafety in microbiological and biomedical laboratories. 5th edition. Washington, DC: US Department of Health and Human Services, CDC, National Institutes of Health; 2009. Available at http://www.cdc.gov/biosafety/publications/bmbl5.
3. California Division of Occupational Safety and Health. Aerosol transmissible diseases. Title 8 C.C.R. Section 5199 (2009). Available athttp://www.dir.ca.gov/title8/5199.html.
4. CDC. Prevention and control of meningococcal disease: recommendations of the Advisory Committee on Immunization Practices. MMWR 2013;62(No. RR-2).
5. CDC. Epidemiologic notes and reports: laboratory-acquired meningococcemia—California and Massachusetts. MMWR 1991;40:46–7,55.
6. Boutet R, Stuart JM, Kaczmarski ER, Gray SJ, Jones DM, Andrews N. Risk of laboratory-acquired meningococcal disease. J Hosp Infect 2001;49:282–4.
7. Sejvar JJ, Johnson D, Popovic T, et al. Assessing the risk of laboratory-acquired meningococcal disease. J Clin Microbiol 2005;43:4811–14.
8. CDC. Guidelines for safe work practices in human and animal medical diagnostic laboratories. MMWR 2012;61(Suppl).
9. Kimman TG, Smit E, Klein MR. Evidence-based biosafety: a review of the principles and effectiveness of microbiological containment measures. Clin Microbiol Rev 2008;21:403–25.
10. California Division of Occupational Safety and Health. Respiratory protection. Title 8 C.C.R. Section 5144 (1974). Available athttps://www.dir.ca.gov/title8/5144.html.

What is already known on this topic?

Working with Neisseria meningitidis isolates without adequate protection on the open laboratory bench can result in aerosol transmission of the bacteria. Meningococcal disease is severe and can be fatal. Among laboratory-acquired meningococcal disease cases, the case fatality rate was 50% in one study, significantly higher than the case fatality rate in the general population. The Advisory Committee on Immunization Practices (ACIP) has published immunization guidelines for laboratory workers who are routinely exposed to isolates of N. meningitidis.

What is added by this report?

A laboratory researcher who worked with N. meningitidis died from serogroup B meningococcal disease. An investigation identified deficiencies in training and practices in laboratory A, including manipulating cultures outside of a biosafety cabinet. Additionally, laboratory workers who routinely worked with N. meningitidis had not been vaccinated in accordance with current ACIP recommendations.

What are the implications for public health practice?

Adequate safety training for laboratory personnel, adherence to recommendations for safe handling of N. meningitidis isolates, and vaccination (where indicated) are necessary to reduce the risk for disease among laboratory workers.

September 5, 2014 / 63(35);770-772
Channing D. Sheets, MSEd1, Kathleen Harriman, PhD1, Jennifer Zipprich, PhD1, Janice K. Louie, MD1, William S. Probert, PhD1, Michael Horowitz, MS2, Janice C. Prudhomme, DO2, Deborah Gold, MPH2, Leonard Mayer, PhD3 (Author affiliations at end of text)

Click here to rread complete article (including table 1.

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Pulmonary Embolism Held to Be A Vascular Disease

The NJ Appellate Division held that a pulmonary embolism was a vascular disease and not compensable under the NJ occupational disease provisions of the Workers' Compensation Act. The Court distinguished the medical event from an occupational exposure. Vascular disease are governed by a more stringent standard (NJSA34:15-72).


In reversing the trial court the Appellate Division, held that 5 elements need to be present to prove an occupational condition:

"From our review of the history and application of Section 31, we extrapolate five common themes of occupational disease claims. First, the employee is exposed to conditions that would be viewed as creating a likely risk of injury. Second, there is continued exposure to the work conditions. Third, there is an inherent hazard of continued exposure to the conditions. Fourth, there is attached to that job a hazard that distinguishes it from the usual run of occupations. Fifth, the claim is made because of long-term exposure, not because of one specific event."

The Court distinguished the episode from an "occupational heart condition" which the NJ Supreme Court ruled was compensable condition in Fiore. That condition was a hybrid compensable condition crafted between the standards of NJSA 34:15-31 and NJSA 34:15-7.

Renner v. ATT Docket No. A-3237-09T3, 2010 WL 4811913 (N.J.Super.A.D. 2010)

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Innovation is Necessary to Meet the Challenge of COVID in 2022

COVID is the most extensive occupational exposure event in the history of the United States. Workplaces are now primed for a massive wave of compensation claims due to the Omicron variant. A recent study provides a potential opportunity for employers and insurance companies to reduce their risk exposure through early sequencing and treatment proactively.

Is Medicare-For-All a Prescription for Infectious Diseases in the Workplace?

The workers’ compensation system nationally has been challenged over the last two plus years of the COVID Pandemic. The multi-state administered workers’ compensation program is based on a litigious patchwork of state programs with varying degrees of eligibility, procedures, and benefits. 

Firefighter and Public Safety Officer Presumption Bill Advances

Firefighter and public safety officer presumption bill advances and creates a rebuttable presumption of workers’ compensation coverage for public safety workers and other employees in certain circumstances. 

The bill affirms that if, in the course of employment, a public safety worker is exposed to a serious communicable disease or a biological warfare or epidemic-related pathogen or biological toxin, all care or treatment of the worker, including services needed to ascertain whether the worker contracted the disease, shall be compensable under workers' compensation, even if the worker is found not to have contracted the disease. If the worker is found to have contracted a disease, there shall be a rebuttable presumption that any injury, disability, chronic or corollary illness or death caused by the disease is compensable under workers' compensation. 

The bill affirms workers’ compensation coverage for any injury, illness or death of any employee, including an employee who is not a public safety worker, arising from the administration of a vaccine related to threatened or potential bioterrorism or epidemic as part of an inoculation program in connection with the employee’s employment or in connection with any governmental program or recommendation for the inoculation of workers. 

The bill creates a rebuttable presumption that any condition or impairment of health of a public safety worker which may be caused by exposure to cancer-causing radiation or radioactive substances is a compensable occupational disease under workers' compensation if the worker was exposed to a carcinogen, or the cancer-causing radiation or radioactive substance, in the course of employment. Employers are required to maintain records of instances of the workers deployed where the presence of known carcinogens was indicated by documents provided to local fire or police departments under the “Worker and Community Right to Know Act,” P.L.1983, c.315 (C.34:5A-1 et seq.) and where events occurred which could result in exposure to those carcinogens. 

In the case of any firefighter with seven or more years of service, the bill creates a rebuttable presumption that, if the firefighter suffers an injury, illness or death which may be caused by cancer, the cancer is a compensable occupational disease. 

The bill provides that, with respect to all of the rebuttable presumptions of coverage, employers may require workers to undergo, at employer expense, reasonable testing, evaluation and monitoring of worker health conditions relevant to determining whether exposures or other presumed causes are actually linked to the deaths, illnesses or disabilities, and further provides that the presumptions of compensability are not adversely affected by failures of employers to require testing, evaluation or monitoring. 

The public safety workers covered by the bill include paid or volunteer emergency, correctional, fire, police and medical personnel. 

This bill was pre-filed for introduction in the 2018-2019 session pending technical review. As reported, the bill includes the changes required by technical review, which has been performed. 

The following bill(s) have been scheduled for a committee or a legislative session. 

The following bill(s) have been scheduled for a committee or a legislative session.
A1741:
Quijano, Annette/Benson, Daniel R./Lagana, Joseph A.
"Thomas P. Canzanella Twenty First Century First Responders Protection Act"; concerns workers' compensation for public safety workers.
6/20/2019 1:00:00 PM Assembly
Voting Session
Assembly Chambers
http://www.njleg.state.nj.us/bills/BillView.asp?BillNumber=A1741

S716:
Greenstein, Linda R./Bateman, Christopher
"Thomas P. Canzanella Twenty First Century First Responders Protection Act"; concerns workers' compensation for public safety workers.
6/20/2019 1:00:00 PM Assembly
Voting Session
Assembly Chambers
http://www.njleg.state.nj.us/bills/BillView.asp?BillNumber=S716

…. 

Jon L. Gelman of Wayne NJ is the author of NJ Workers’ Compensation Law (West-Thomson-Reuters) and co-author of the national treatise, Modern Workers’ Compensation Law (West-Thomson-Reuters). For over 4 decades the Law Offices of Jon L Gelman 1.973.696.7900jon@gelmans.com has been representing injured workers and their families who have suffered occupational accidents and illnesses.

Updated: 06-15-2019

EC Publishes Criteria to Diagnose Occupational Illness

The European Commission has published a listing of the criteria for diagnosis occupational disease. The 272 page report is available on-line. It reviews hundreds of established occupational medical conditions.

a) The clinical features must fit in with what is known about the health effects following  exposure to the specified agent. The symptoms and signs should fit, and this may be supported in some cases by suitable diagnostic tests.

b) There must be indication of sufficient occupational exposure. Evidence on exposure may be obtained through taking the occupational history, results of occupational hygiene measurements taken at the workplace, biological monitoring results, and/or records of incidents of over-exposure.

c) The time interval between exposure and effect must be consistent with what is known about the natural history and progress of the disease. Exposure must precede health effects. However, in some conditions such as occupational asthma, a past history of childhood asthma and/or asthmatic attacks occurring before occupational exposure, does notautomatically rule out the possibility of a workplace agent causing subsequent asthmatic attacks.

d) The differential diagnosis must be considered. There are non-occupational conditions that have similar clinical features as occupational diseases, and a physician will have to take this into account before diagnosing or excluding an occupational disease.


To read more about occupational exposures and workers' compensation.

Click here for more information on how Jon L Gelman can assist you in a claim for workers' Compensation claim benefits. You may e-mail Jon  Gelman or call 1-973-696-7900.

Another Hurdle to Prove an Occupational Disease Claim

An attempt to restrict the admission of scientific evidence has been proposed on the Federal level. Even though states have maintained their independence for the most part on this issue, the suggested changes signal an emerging national effort to restrict further the admissibility of scientific evidence that may trickle down to the state judicial systems.

How To Determine If A Substance Causes Cancer at Work

The National Institute for Occupational Safety and Health (NIOSH) is seeking public input to determine what substances cause cancer and at what level of occupational exposure.

"The National Institute for Occupational Safety and Health (NIOSH) of the Centers for Disease Control and Prevention (CDC) intends to review its approach to classifying carcinogens and establishing recommended exposure limits (RELs) for occupational exposures to hazards associated with cancer. As part of this effort, NIOSH is requesting initial input on these issues (including answers to the 5 questions in the following section), to be submitted to the NIOSH Docket number 240, for a comment period lasting through September 22, 2011. This information will be taken under consideration and used to inform NIOSH efforts to assess and document its carcinogen policy and REL policy regarding occupational hazards associated with cancer. NIOSH has also created a new NIOSH Cancer and REL Policy Web Topic Page [see http://www.cdc.gov/niosh/topics/cancer/policy.html] to provide additional details about this effort and progress updates."

"NIOSH is announcing a Request for Information on key issues identified and associated with the NIOSH Carcinogen and REL policies. Special emphasis will be placed on consideration of technical and scientific issues with the current NIOSH Cancer and REL Policies that require further examination including the following:Show citation box

(1) Should there explicitly be a carcinogen policy as opposed to a broader policy on toxicant identification and classification (e.g.carcinogens, reproductive hazards, neurotoxic agents)?Show citation box

(2) What evidence should form the basis for determining that substances are carcinogens? How should these criteria correspond to nomenclature and categorizations (e.g., known, reasonably anticipated,etc.)?Show citation box

(3) Should 1 in 1,000 working lifetime risk (for persons occupationally exposed) be the target level for a recommended exposure limit (REL) for carcinogens or should lower targets be considered?Show citation box

(4) In establishing NIOSH RELs, how should the phrase “to the extent feasible” (defined in the 1995 NIOSH Recommended Exposure Limit Policy) be interpreted and applied?Show citation box

(5) In the absence of data, what uncertainties or assumptions areappropriate for use in the development of RELs? What is the utility of a standard ”action level” (i.e., an exposure limit set below the REL typically used to trigger risk management actions) and how should it be set? How should NIOSH address worker exposure to complex mixtures?

Public Comment Period: Comments must be received by September 22, 2011.

The concept of a compensable industrial disease has developed only recently and its acceptance has lagged far behind that of industrial accidents. The original Workers' Compensation Acts, as promulgated from the year 1911 forward by many of the states, did not provide for the recognition of occupational illness and disease as compensable events. As demands have been placed upon the medical system to treat and to prevent occupational illness, the legal system, under social, economic, and political pressure, has sought to provide a remedy for the thousands of injured workers who have suffered and who are continuing to suffer from occupational illness and disease. 

For over 4 decades the Law Offices of Jon L. Gelman  1.973.696.7900  jon@gelmans.com have been representing injured workers and their families who have suffered occupational accidents and illnesses.

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Zika: The Next Compensable Infectious Disease - Benefit Challenges Begin

Workers' Compensation insures for the consequences of infectious diseases arising out of and in the course of employment. Is the system ready for a potential onslaught of Zika claims?

The line in the sand has been drawn in the State of Florida, where an infected Miami Beach police officer has been denied benefits. The union has actively supporting the municipal employee in an effort to rule the claim compensable.

The NJ Supreme Court in establishing compensability in an occupational disease cited Justice Learned Hand, “Few adults are not diseased … an infection mastered, though latent, is no longer a disease, industrially speaking, until the individual's resistance is again so far lowered that he succumbs.” Bober v. Independent Plating Corp., 28 N.J. 160, 145 A.2d 463 (1958).