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(c) 2010-2024 Jon L Gelman, All Rights Reserved.

Thursday, March 11, 2010

NYC Settles 9-11 Rescue Workers' Suit for $657.5 Million

A lawsuit, involving over 10,000 9-11 Ground Zero workers, has been reportedly settled for $657.5 reports the NY Times. The case pending in US District Court has been pending for years on behalf of rescue workers and first responders for adverse health effects as a result of the explosion.


The read more about 9-11 claims click here.

Tuesday, March 9, 2010

Citing Violations Medicare Ends Contract with Fox Insurance Company Drug Plan

The Centers for Medicare and Medicaid Services has issue an announcement of the immediate termination of Fox Insurance Company.

Members Will Be Provided Access to Drugs While Transitioning to New Plans.

The Centers for Medicare & Medicaid Services (CMS) today terminated its contract with Fox Insurance Company. After an onsite review of the plan and its services, CMS determined that the plan’s significant deficiencies – not meeting Medicare’s requirements to provide enrollees with prescription drugs according to recognized standards of care – jeopardized the health and safety of Fox enrollees. CMS found that Fox committed a series of violations, including improperly denying its enrollees coverage of critical HIV, cancer, and seizure medications. The termination of the contract is effective immediately.

The immediate termination will not impact or delay access to drugs for the more than 123,000 Medicare beneficiaries currently enrolled in Fox plans. Beginning tomorrow, all enrollees will obtain their drugs through LI-NET, a program run by Medicare and administered by Humana, to ensure that beneficiaries receive their Medicare prescription drugs. Fox enrollees will be able to choose a new Medicare prescription drug plan through May 1, 2010. Current enrollees who do not choose a plan will be enrolled into a new plan by Medicare.
“The immediate termination of Fox as a Medicare prescription drug plan demonstrates our commitment to protecting the health of some of their most vulnerable enrollees from getting necessary drugs, in some cases life-sustaining medicines. CMS’s immediate action was essential to protect members’ health and safety – an integral part of our contract with all Medicare beneficiaries,” said Jonathan Blum, acting director of CMS’ Center for Drug and Health Plan Choices. “Fox enrollees also need to know that they are not losing their drug coverage and will continue to have access to needed medicines. We will be sending letters explaining the steps we are taking to ensure they continue to get their medicines. They can also call 1-800-MEDICARE or their local state health insurance assistance programs if they have questions.”

CMS issued an enrollment and marketing sanction to Fox on Feb. 26, 2010, because the organization was not following Medicare’s rules for providing prescription drug coverage to its enrollees. After an onsite audit, which ran between March 2 and March 4, CMS found Fox’s problems persisted and it continued to subject its enrollees to obstacles in getting needed and, in many cases, life–sustaining medicines. CMS also found that many of the obstacles were in place to limit access to high-cost drugs, which could have led to enrollees’ clinical needs not being met. In many cases, Fox enrollees were required to have unnecessary and invasive medical procedures before they were able to obtain drugs. Fox was unable to satisfactorily address these compliance concerns and furnish medicines to its Medicare enrollees.

Among the audit findings CMS found include:

· Failing to provide access to Medicare prescription drugs benefits by imposing unapproved prior authorization and step therapy criteria that made it more difficult for beneficiaries to get drugs that are protected by law.

· Not meeting the plan’s appeals deadlines,

· Not complying with Medicare regulations requiring enrollees to be transitioned to new drugs at the beginning of the new plan year.

· Failing to notify enrollees about prior authorization and step therapy determinations as required by Medicare.

According to CMS auditors, Fox was unable to satisfactorily address compliance concerns cited in the enrollment and marketing sanction and meet contractual obligations to provide medicines to Medicare beneficiaries enrolled in their plans.

“We take our oversight role of Medicare prescription drug plans seriously,” said Blum. “We review and take action on all complaints received about Medicare health and drug plans and will take appropriate and immediate actions wherever necessary.”

CMS encourages Medicare prescription drug plan enrollees having concerns with access to drug coverage to contact 1-800-MEDICARE (1-800-633-4227) or the state health insurance assistance program (SHIP) to help get them resolved. Medicare enrollees, their families and their caregivers can contact a SHIP near them by visiting:http://www.medicare.gov/Contacts/staticpages/ships.aspx

# # #

NOTE: States in which the Fox plan was available were: Arkansas, Arizona, California, Colorado, Connecticut, Florida, Georgia, Hawaii, Illinois, Louisiana, Maryland, Missouri, North Carolina, New Jersey, New York, Nevada, Ohio, Pennsylvania, South Carolina, Texas and West Virginia.

US Supreme Court to Review Employee Privacy Issues

The US Supreme Court has granted certiorari in a case involving the application of the constitutional right to informational privacy to an employee questionnaire. NASA, et al. v. Nelson, Robert M., et al. No. 09-530, March 8, 2010.


The Supreme Court will be reviewing a 9th Circuit Court of Appeals decision involving contract employees of the Jet PropulsionLaboratory (JPL) who filed suit against the National Aeronautics and Space Administration (NASA) and others. The suit claims that contract employees in non-sensitive or “low risk” positions should not be required to submit to in-depth background investigations.


The Circuit Court below held:
We have repeatedly acknowledged that the Constitution protects an “individual interest in avoiding disclosure of personal matters.” In re Crawford, 194 F.3d 954, 958 (9th Cir.1999). This interest covers a wide range of personal matters, including sexual activity, Thorne v. City of El Segundo, 726 F.2d 459 (9th Cir.1983) (holding that questioning police applicant about her prior sexual activity violated her right to informational privacy), medical information,Norman-Bloodsaw v. Lawrence Berkeley Lab., 135 F.3d 1260, 1269 (9th Cir.1998) (“The constitutionally protected privacy interest in avoiding disclosure of personal matters clearly encompasses medical information and its confidentiality.”), and financial matters, Crawford, 194 F.3d at 958 (agreeing that public disclosure of social security numbers may implicate the right to informational privacy in “an era of rampant identity theft”). If the government's actions compel disclosure of private information, it “has the burden of showing that its use of the information would advance a legitimate state interest and that its actions are narrowly tailored to meet the legitimate interest.” Crawford, 194 F.3d at 959 (internal quotation marks omitted). We must “balance the government's interest in having or using the information against the individual's interest in denying access,” Doe v. Att'y Gen., 941 F.2d 780, 796 (9th Cir.1991), weighing, among other things:
“the type of [information] requested, ... the potential for harm in any subsequent nonconsensual disclosure, ... the adequacy of safeguards to prevent unauthorized*878 disclosure, the degree of need for access, and whether there is an express statutory mandate, articulated public policy, or other recognizable public interest militating towards access.”
Id. (quoting United States v. Westinghouse Elec. Corp., 638 F.2d 570, 578 (3d Cir.1980)) (alteration in original).
Both the SF 85 questionnaire and the Form 42 written inquiries require the disclosure of personal information and each presents a ripe controversy."

".....The balance of hardships tips sharply toward Appellants, who face a stark choice-either violation of their constitutional rights or loss of their jobs. The district court erroneously concluded that Appellants will not suffer any irreparable harm because they could be retroactively compensated for any temporary denial of employment. It is true that “monetary injury is not normally considered irreparable,” L.A. Mem'l Coliseum Comm'n v. Nat'l Football League, 634 F.2d 1197, 1202 (9th Cir.1980), and the JPL employees who choose to give up their jobs may later be made whole financially if the policy is struck down. "




Commercial Driver Fatigue Questioned as a Pre-exisiting Condition?

Falling asleep at the wheel is a common cause of accidents for commercial drivers. The Federal Motor Carrier Safety Administration  (FMCSA) of the U.S. Department of Transportation is exploring  the issue that such conditions as excessive  daytime sleepiness should be evaluated by medical examination in an effort to predict future probabilities of having a bad day at the wheel and potential crashes at the wheel because of sleepiness. 

If a sleep disorder can be identified and documented, that condition maybe determined to be a pre-exisiting medical condition. Apart from the third party liability that could be imposed upon an employer for identification and non-identification of the medical condition, the issue of an allocation for a pre-exisitng medical conditions (prior-functional credit) may exist in a workers' compensation claim as well as an event that can be attributed to a risk in the course of employment.

The term "prior functional credit" refers to the credit given to the employer, or to the employer's insurance carrier, for the loss of function of any part of the body which an employee had sustained before a subsequent injury or occupational disease for which the employer in question is responsible.  Over the years there have been dramatic changes enacted by the Legislature accompanied by varying interpretations by the courts with regard to the law addressing credits to be afforded to the employer for both non-work and work connected injuries.

The employer no longer takes an employee as they find them. Belth v. Anthony Ferrante & Son, Inc., 47 N.J. 38, 219 A.2d 168 (1966). An individual suffered from asbestosis and bronchitis, and medical testimony was presented by the petitioner's expert apportioning a percentage of the functional loss to cigarette smoking.  The employer was awarded a credit for the previous loss of function which could be attributed to the employee's cigarette smoking, since the legislatively enacted amendments permitted the employer to receive credit for an employee's prior loss of function involving the same body part affected by the compensable occupational disease regardless of whether compensation was received for the earlier injury.  In effect, the employer no longer takes employees as it finds them.  The court stated that the credit to employers for previous loss of function, whether work-related or not, was an incentive to encourage employers to hire workers with pre-existing disabilities.  Field v. Johns-Manville Sales Corp., 209 N.J.Super. 528, 507 A.2d 1209 (App.Div.1986), certif. denied 105 N.J. 531, 523 A.2d 172 (1986); Dafler v. Raymark Industries, Inc., 259 N.J.Super. 17, 611 A.2d 136 (App.Div.1992).

Additional questions may arise as to whether the risk is actually associated with the employment. The Court may also evaluate the risk associated with the employment task in evaluating compensability.  Where the risk was not enhanced by the business interests of the employer, and there was no exercise of control by the employer over the employee, the event is usually deemed to be non-compensable. If the risk in indeed removed from the course of employment then the employer may be denied the exclusivity bar and liability on the employer could be imposed in a civil action. 

The FMCSA commented, "....measuring an individual’s sleepiness today is not going to predict how sleepy the person will be 6 weeks from now. Several factors influence sleepiness, including prior sleep time, medications, and time of day, so it is a very difficult thing to assess."


Click here to read more about "pre-exisiitng conditions" and workers' compensation.

Friday, March 5, 2010

OSHA is Listening

The Occupational Safety and Health Administration (OSHA) is soliciting suggestions and comments concerning workplace safety. OSHA's concern is that, "No one should have to be injured or killed for a paycheck."


The U.S. Department of Labor's Occupational Safety and Health Administration (OSHA) held a public meeting, "OSHA Listens," to solicit comments and suggestions from OSHA stakeholders on key issues facing the agency. The meeting was scheduled for Feb. 10 from 9 a.m. to 5 p.m. EST in Washington, D.C.

"Public involvement in the government's activities is a priority for this administration and is important to enhancing OSHA efforts to protect the safety and health of workers," said Assistant Secretary of Labor for OSHA Dr. David Michaels. "This public meeting gives us an opportunity to hear your ideas, suggestions and comments on key issues facing this agency."

Some of the questions OSHA invited public input on included:
  1. What can the agency do to enhance and encourage the efforts of employers, workers and unions to identify and address workplace hazards?
  2. What are the most important emerging or unaddressed health and safety issues in the workplace, and what can OSHA do to address these?
  3. How can the agency improve its efforts to engage stakeholders in programs and initiatives?
  4. What specific actions can the agency take to enhance the voice of workers in the workplace, particularly workers who are hard to reach, do not have ready access to information about hazards or their rights, or are afraid to exercise their rights?
  5. Are there additional measures to improve the effectiveness of the agency's current compliance assistance efforts and the on site consultation program, to ensure that small businesses have the information needed to provide safe workplaces?
  6. Given the length and difficulty of the current OSHA rulemaking process, and given the need for new standards that will protect workers from unaddressed, inadequately addressed and emerging hazards, are there policies and procedures that will decrease the time to issue final standards so that OSHA may implement needed protections in a timely manner?
  7. As we continue to progress through a new information age vastly different from the environment in which OSHA was created, what new mechanisms or tools can the agency use to more effectively reach high risk employees and employers with training, education and outreach? What is OSHA doing now that may no longer be necessary?
  8. Are there indicators, other than worksite injuries and illness logs, that OSHA can use to enhance resource targeting?
  9. In the late 1980s, OSHA and its stakeholders worked together to update the Permissible Exposure Limits (PELs) (exposure limits for hazardous substances; most adopted in 1971), but the effort was unsuccessful. Should updating the PELs be a priority for the agency? Are there suggestions for ways to update the PELs, or other ways to control workplace chemical exposures?
After a written comment period closes on March 30, 2010, a link to the Meeting Transcript will be posted on the Internet. Comments received through March 3rd are now available on line.


Meeting Agenda

9 a.m.  Welcome and Introductory Comments
   David Michaels, Assistant Secretary, OSHA
   Deborah Berkowitz, Chief of Staff, OSHA
9:10-9:50 Panel 1
   Tonya Ford, Uncle killed at ADM facility in 2009
   Katherine Rodriguez, Father killed at British Petroleum in 2004
   Wanda Morillo, Husband killed in a NJ industrial explosion in 2005
   Celeste Monforton, American Public Health Association
   Linda Reinstein, Asbestos Disease Awareness Organization
9:50-10:30 Panel 2
   Marc Freedman, U.S. Chamber of Commerce
   Keith Smith, National Association of Manufacturers
   Frank White, ORC
   Stephen Sandherr, Association of General Contractors
10:30-10:40 Break
10:40-11:20 Panel 3
   Workers United
   Peg Seminario, AFL-CIO
   Scott Schneider, Laborers' Health and Safety Fund
   Mike Wright, United Steel Workers
11:20-11:50 Panel 4
   Chris Patton, American Society for Safety Engineers
   Katharine Kirkland, Association of Occupational and Environmental Clinics
   Aaron Trippler, American Industrial Hygiene Association
11:50-12:30 Panel 5
   Kathleen McPhaul, American Public Health Association, Univ. of Maryland Nursing
   Hestor Lipscomb, Duke University Medical School
   Rick Neitzel, National Hearing Conservation Association
   Matt Schudtz, University of Maryland Law School
12:30-1:30 Lunch
1:30-2:00 Panel 6
   Karen Harned, Nat'l Federation of Independent Business, Small Business Legal Center
   Cynthia Hilton, Institute of Makers of Explosives
   Thomas Slavin, Navistar, Inc.
2:00-2:30 Panel 7
   Andrew Youpel, Brandenburg Industrial Service Company
   Robert Matuga, National Association of Home Builders
   Tom Broderick, Construction Safety Council
2:30-3:00  Panel 8
   Don Villarejo, California Institute for Rural Studies
   Luzdary Giraldo, NY Committee for Occupational Safety and Health
   Roger Cook/Peter Dooley, Western NY Council on Occupational Safety and Health
3:00-3:40 Panel 9
   Rick Engler, NJ Work Environmental Council
   Tom O'Connor, National Council for Occupational Safety and Health
   Norman Pflanz, Nebraska Appleseed Center for Law
   Chris Trahan, Building and Construction Trades Department
3:40-3:50 Break
3:50-4:10 Panel 10
   John Masarick, Independent Electrical Contractors
   Davis Layne, VPPPA
4:10-4:40 Panel 11
   Bruce Lapham, Valcourt Building Services, LC
   Scott A. Mugno, FedEx Express
   Marc Kolanz, Brush Wellman Inc.
4:40-5:10 Panel 12
   Pamela Vossenas, Unite Here! International
   John Morawetz, International Chemical Workers Union Council
   Dinkar Mokadam, Association of Flight Attendants-CWA
5:10-5:50 Panel 13
   Rick Inclima, International Brotherhood of Teamsters
   Jason Zuckerman, Employment Law Group
   Richard Renner, National Whistleblowers Center
   Tim Sharp, Alaska Review Board & Laborer's Council
Click here to read more about OSHA 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."
...



Possible Vaccine for Mesothelioma

A vaccine has been demonstrated as safe for potential use against mesothelioma. The research, conducted by Netherlands scientists was reported in an advance publication of  the American Journal of Respiratory and Critical Care.


The scientists concluded that, This study demonstrated that autologous tumor lysate-pulsed dendritic cell-based therapy is feasible, well-tolerated, and capable of inducing immunological response to tumor cells in mesothelioma patients."

Mesothelioma is a rare and fatal  malignant tumor associated with asbestos exposure. Asbestos was mined and its fiber used for fire-retartant insulation properties. Asbestos use has resulted in an a legacy of illness and death decades following exposure because of the latent and progressive nature of the disease. Asbestos production is not yet banned in the United States.

Findings indicated that, "Administration of dendritic cells pulsed with autologous tumor lysate in mesothelioma patients was safe with moderate fever as the only side effect.There were no grade 3 or 4 toxicities associated with the vaccines or any evidence of autoimmunity. Local accumulations of infiltrating T cells were found at the site of vaccination. The vaccinations induced distinct immunological responses to KLH, both in vitro and in vivo. Importantly, after three vaccinations, cytotoxic activity against autologous tumor cells was detected in a subgroup of patients."


The Study: J. P Hegmans, J. D. Veltman, M. E Lambers, I. J. M. de Vries, C. G. Figdor, R. W Hendriks, H. C. Hoogsteden, B. N. Lambrecht, and J. G. Aerts , Consolidative Dendritic Cell-Based Immunotherapy Elicits Cytotoxicity Against Malignant Mesothelioma, Am. J. Respir. Crit. Care Med. 2010 0: 200909-1465OCv1-


More articles about this research:
Health Day: Vaccine for Asbestos-Related Cancer Looks Safe. In tests, novel immunotherapy appears to combat mesothelioma tumors.