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

Wednesday, October 24, 2012

Doctors, Patients and Opioid Abuse

Getting to the real reasons why doctors prescribe opioids to opioid abusers is an apparent challenge to the essence of the nation's workers' compensation system. In a recent article in the New England Journal of Medicine it is revealed that doctors continue to prescribe opioids to abusers because of "...Recent changes in medicine's philosophy of pain treatment, cultural trends in Americans' attitudes toward suffering, and financial disincentives for treating addiction ..."

Until the workers' compensation medical delivery program furnishes treatment delivery in an effective and efficient manner the challenge of drug addiction will tragically continue.


More about drug addiction
Jul 27, 2012
Pharmaceutical reform has been a major topic of interest and reform efforts nationally in the workers' compensation arena. More particularly the alledged abuse of opioids have received particular attention. Several physicians ...
May 24, 2012
A recent Texas case holding an employer liable holding an employed liable for a fatal opioid overdose arising out of work-related event highlights again that, the workers' compensation medical delivery system just isn't ...
Jan 28, 2012
Nursing Home Abuse: Drugging of Patients. Many seriously injured workers end up living in nursing homes for convenience and care. Workers compensation act usual pay for nursing home care, but do they really know what ...
Oct 28, 2009
The Wall Street Journal reports today about a claim against pharmacies as a result of customer drug abuse. In the State of Nevada a case is pending that may confer liability upon a drugstore for the consequences of an ...

Minimal Light Duty Doesn't Limit Temporary Disability Benefits

A NJ Compensation Court ruled that an employer was unable to limit the payment of temporary disability benefits based an mere limited light duty.

Petitioner filed a motion in which he requested supplemental temporary disability benefits. Respondent objected and argued that, because the petitioner was returned to only minimal light duty work, his temporary disability benefits should be limited by the amount earned in such light duty capacity (rather than an amount based upon regular wages. The judge disagreed as he found that allowing a respondent to provide only minimal light duty work and thereby reduce a petitioner's temporary disability benefits would defeat the purpose of the temporary disability provisions of the workers' compensation statutes. Petitioner's motion was granted. 

"As stated earlier, temporary disability is intended to provide Petitioner with an amount which the legislature has determined to be sufficient for his living expenses while temporarily disabled.  Light duty, on the other hand, provides the injured worker an opportunity to transition back to his or her regular job by performing less strenuous duties for his/her employer until such time as he or she is able to perform his or her regular tasks.  The emphasis here is the benefit of the program to the employee.  We cannot lose sight of the fact that this is workers’ compensation.  Respondent’s position here would turn this aspect of the program into virtually an employer’s compensation, since an employer in Respondent’s situation will benefit financially the longer Petitioner remains on light duty status."

Soto v. Herr's Foods, Inc.
11-18325, decided September 7, 2012 by the Honorable Emille Cox, J.W.C.

Halloween Safety Tips

Halloween traditionally infers scary and dark. Those elements, complicated by sensory limiting costumes and environment, gives rise to the need for elevated safety concerns in the workplace and at-home surrounding Halloween events.

From a fall resulting in a dislocated shoulder, to an open flame resulting in second degree burns, each year the US Consumer Product Safety Commission (CPSC) receives reports of injuries involving Halloween-related costumes, décor, and lighting. These incidents are preventable. Using CPSC's three-step safety check (pdf), consumers can ensure that their fright night fun is not haunted by Halloween injuries

"Too often Halloween make believe has resulted in real life injury," said CPSC Chairman Inez Tenenbaum. "Fortunately, prevention is simple. Choose flameless candles, flame-retardant materials, and well-fitting costumes to reduce the risk of injury this Halloween."

With CPSC's quick and easy Halloween safety check (pdf) and just five minutes of inspection, consumers can avoid problems that previously have plagued the trick-or-treat trail. This safety check will help consumers to: (1) prevent fires and burns, (2) ensure that kids can see and be seen, and (3) outfit kids for safety.

Halloween-related incidents can involve a number of hazards, including burns from flammable costumes that come into contact with open flames-particularly candles used to illuminate jack-o-lanterns; falls and abrasions from ill-fitting costumes, shoes, and accessories; and fires caused by burning candles left unattended, near combustible decorations or knocked over by kids and pets.

The federal Flammable Fabrics Act (FFA) requires costumes sold at retail to be flame-resistant. To prevent costume-related burns, CPSC enforces this requirement and recalls costumes and other products that violate the FFA. When making a costume at home, CPSC encourages consumers to use fabrics that inherently are flame resistant, such as nylon and polyester.

According to the National Fire Protection Association (NFPA), Halloween ranks among the top 5 days of the year for candle-related fires. To prevent candle fires, CPSC encourages consumers never to leave a burning candle unattended. Battery-operated flameless candles and other flameless lighting are safe alternatives to traditional candles.

Unique jack o' lanterns and creatively-carved pumpkins are a new popular trend. Read CPSC's OnSafety blog on pumpkin-carving injuries and how to prevent them

Additional safety tips to help make this year's holiday safe:

Decorations
Keep candles and jack o' lanterns away from landings and doorsteps, where costumes could brush against the flame.


Remove obstacles from lawns, steps, and porches when expecting trick-or-treaters.
When indoors, keep candles and jack o' lanterns away from curtains, decorations, and other items that could ignite. Do not leave burning candles unattended.

Whether indoors or outside, use only decorative light strands that have been tested for safety by a recognized testing laboratory. Check each set of lights, new or old, for broken or cracked sockets, frayed or bare wires, or loose connections. Discard damaged sets.

Don't overload extension cords.

Costumes
When purchasing costumes, masks, beards, and wigs, look for flame-resistant fabrics, such as nylon or polyester; or look for the label "Flame Resistant." Flame-resistant fabrics will resist burning and should extinguish quickly. To reduce the risk of contact with candles and other fire sources, avoid costumes made with flimsy materials and outfits with big, baggy sleeves, large capes, or billowing skirts.


Purchase or make costumes that are light colored, bright, and clearly visible to motorists.
For greater visibility during dusk and darkness, decorate or trim costumes with reflective tape that will glow in the beam of a car's headlights. Bags or sacks also should be light-colored or decorated with reflective tape. Reflective tape is usually available in hardware, bicycle, and sporting goods stores.

Children should carry flashlights to be able to see and to be seen.

To guard against trips and falls, costumes should fit well and not drag on the ground.
Children should wear well-fitting, sturdy shoes. High heels are not a good idea.
Tie hats and scarves securely to prevent them from slipping over children's eyes and obstructing their vision.

If your child wears a mask, make sure it fits securely, provides adequate ventilation, and has holes for eyes large enough to allow full vision.

Swords, knives, and similar costume accessories should be made of soft, flexible material.

Treats
Children should not eat any treats before an adult has examined them carefully for evidence of tampering.

Carefully examine any toys or novelty items received by trick-or-treaters who are younger than 3 years of age. Do not allow young children to have any items that are small enough to present a choking hazard or that have small parts or components that could separate during use and present a choking hazard.

Tuesday, October 23, 2012

Laboratory Workers and Contacts Warned of Accidental Flu Pandemic

Safety in the laboratory workplace is of critical concern as many research laboratory employees suffer from exotic diseases that become workers' compensation compensable events. Limited knowledge of the facts of the exposures creates yet another level of concern and  anxiety as employees attempt to cope with unusual symptomatology.

Authors Marc Lipsitch and Barry R. Bloom have authored an article appearing in the Journal of the American Society for Microbiology highlighting the potential for a pandemic.

"If accidentally released, mammalian-transmissible influenza A/H5N1 viruses could pose a greater threat to public health than possibly any other infectious agent currently under study in laboratories, because of such viruses’ likely combination of transmissibility and virulence to humans. We advocate explicit risk-benefit assessments before work on such pathogens is permitted or funded, improvement of biosafety practices and enforcement, and harmonization of criteria for permitting such experiments across government agencies, as well as internationally. Such potential pandemic pathogens, as they have been called, jeopardize not only laboratory workers and their contacts, but also the wider population, who should be involved in assessments of when such risks are acceptable in the service of scientific knowledge that may itself bear major public health benefits."

Lipsitch M, Bloom BR. 2012. Rethinking biosafety in research on potential pandemic pathogens. mBio 3(5):e00360-12. doi:10.1128/mBio.00360-12.

....
For over 3 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 work related accident and injuries.

Read more about pandemics and workers' compensation
Sep 15, 2009
The 2009 influenza pandemic (flu) has created a new framework of acts and regulations to respond the World Health Organization's (WHO) phase 6 pandemic alert. Governmentally imposed employment disruptions resulting...
Apr 24, 2009
The Compensability of a Swine Flu Pandemic. The US Centers for Disease Control (CDC) has issued an alert for the spread of human swine flu virus. Employers and employees will now need to be alerted to preparations and ...
Aug 14, 2009
Employer Responsibility in the Flu Pandemic. The threat of the spread of flu this fall in the US is a major concern to infectious disease specialists. Healthcare workers are extremely apprehensive as the disease is beginning to...
Apr 27, 2009
The U.S. Department of Homeland Security (USDHS) has emerged as the lead agency in directing a response to the potential swine flu pandemic. The agency is following a well defined plan published in 2005 to respond to ...

Monday, October 22, 2012

Unintended Consequences - Spine Epidurals: Multistate Meningitis Outbreak

Note: This was the most actively read post of 2012. It has been updated with the current CDC case count information and reposted. 12/25/2012.

Workers' Compensation benefits generally are payable when a condition arises out of the employment including the consequences of medical treatment. Injured workers' who have suffered meningitis as a result of the consequences of an an epidural injection flowing from treatment from a compensable accident may be entitled to receive workers' compensation benefits for the infection. Additionally, there maybe a separate claim against the manufacturers or supplier of the tainted product.

Pharmaceutical products provided as a workers' compensation benefit have been the focus of national attention. Pricing and regulation of of pharmaceuticals have been an ongoing challenge to the delivery of adequate care to injured workers and the existence of product contamination will surely exacerbate the issue further.

See, Gelman, Jon L., The Complex World of Workers' Compensation and Pharmaceutical Benefits, New Jersey Law Journal, Vol. 206, p. 5, October 2011.


State
Total Case Counts
Meningitis (with or without other infection)*
Stroke without Lumbar Puncture only
Paraspinal/Spinal Infection only
Peripheral Joint Infection only
Paraspinal/Spinal + Peripheral Joint Infection
Deaths
TOTALS
620
367
8
218
26
1
39
Florida (FL)
25
20
3
2
0
0
3
Georgia (GA)
1
1
0
0
0
0
0
Idaho (ID)
1
1
0
0
0
0
0
Illinois (IL)
2
2
0
0
0
0
0
Indiana (IN)
68
47
1
20
0
0
7
Maryland (MD)
25
24
0
1
0
0
2
Michigan (MI)
223
64
1
137
20
1
10
Minnesota (MN)
12
10
0
2
0
0
0
North Carolina (NC)
5
3
0
2
0
0
1
New Hampshire (NH)
13
9
0
0
4
0
0
New Jersey (NJ)
43
39
0
4
0
0
0
New York (NY)
1
0
0
1
0
0
0
Ohio (OH)
19
16
0
3
0
0
0
Pennsylvania (PA)
1
1
0
0
0
0
0
Rhode Island (RI)
3
2
0
1
0
0
0
South Carolina (SC)
1
1
0
0
0
0
0
Tennessee (TN)
124
76
3
43
2
0
14
Texas (TX)
2
2
0
0
0
0
0
Virginia (VA)
51
49
0
2
0
0
2
* Some patients with meningitis had other infections diagnosed in addition; to date, all of these other infections have been paraspinal/spinal infections. The patient reported to have a peripheral joint infection and a spinal/paraspinal infection had both a joint injection and a spinal/paraspinal injection.
Case counts by state are based on the state where the procedure was performed, not the state of residence.



The US Centers for Disease Control (CDC) is coordinating a multistate investigation of meningitis among patients who received epidural steroid injections (medication injected into the spine). Several of these patients have had strokes related to the meningitis. In several patients, the meningitis was found to be caused by a fungus that is common in the environment but rarely causes meningitis.
Current Situation
  • About the Investigation

    • CDC and FDA have confirmed the presence of a fungus known as Exserohilum rostratum in unopened medication vials of preservative-free methylprednisolone acetate (80mg/ml) from two of the three implicated lots from NECC (Lot #06292012@26, BUD12/26/2012 and Lot #08102012@51, BUD 2/6/2013).  The laboratory confirmation further links steroid injections from these lots from NECC to the multistate outbreak of fungal meningitis and joint infections.  Testing on the third implicated lot of methylprednisolone acetate and other NECC injectable medications continues.
    • As of October 22, 2012, a total of 54 patients have CDC laboratory-confirmed fungal meningitis. This form of fungal meningitis is not contagious. CDC’s laboratory has confirmedExserohilum rostratum in clinical specimens for all but two patients of these patients.  Of the other two patients, one has been found to be infected with Aspergillus fumigatus and one with Cladosporium. These fungi are common in the environment but were not a recognized cause of meningitis prior to this outbreak.
    • CDC continues to work with states to determine if there may be other fungal infections caused by exposure to NECC products beyond the three lots of preservative-free methylprednisolone acetate (80mg/ml) from NECC that were recalled on September 26, 2012. CDC does not have firm evidence that fungal infections have been caused by exposure to other NECC products.
    • CDC and state health departments estimate that approximately 14,000 patients may have received injections with medication from the three implicated lots of methylprednisolone and nearly 97% have now been contacted for further follow-up.
    • Patients and clinicians need to remain vigilant for onset of symptoms because fungal infectionscan be slow to develop. In this outbreak symptoms typically have appeared 1 to 4 weeks following injection, but it’s important to know that longer and shorter periods of time between injection and onset of symptoms have been reported. Therefore, patients and physicians need to closely watch for symptoms for at least several months following the injection. See updated Patient Guidance for more information, and contact your physician if you are concerned you may have become ill from your injection.
    • Information about the investigation and guidance for clinicians, including interim treatment guidelines, is available at  http://www.cdc.gov/hai/outbreaks/meningitis.html. CDC recommendations are subject to change as more information becomes available.

Total case count: 620 (Updated 12/17/12)
“All patients who may have received these medications need to be tracked down immediately. Patients can find the names of the clinics that used these medications on the CDC website,” said Benjamin Park, M.D., medical officer, Mycotic Diseases Branch, CDC. “It is possible that if patients with infection are identified soon and put on appropriate antifungal therapy, lives may be saved.”

Infected patients have developed a variety of symptoms approximately 1 to 4 weeks following their injection, including fever, new or worsening headache, nausea, and new neurological deficit (consistent with deep brain stroke). Some of these patients’ symptoms were very mild in nature. Cerebrospinal fluid obtained from these patients has shown findings consistent with meningitis.

On September 26, 2012, the New England Compounding Center voluntarily recalled the following lots of methylprednisolone acetate (PF) 80mg/ml:
Methylprednisolone Acetate (PF) 80 mg/ml Injection, Lot #05212012@68, BUD 11/17/2012
Methylprednisolone Acetate (PF) 80 mg/ml Injection, Lot #06292012@26, BUD 12/26/2012
Methylprednisolone Acetate (PF) 80 mg/ml Injection, Lot #08102012@51, BUD 2/6/2013

Physicians should immediately contact patients who have had an injection (e.g., spinal, joint) using any of the three lots of methylprednisolone acetate listed above to determine if they are having any symptoms. Although all cases detected to date occurred after injections with products from these three lots, out of an abundance of caution, CDC and the Food and Drug Administration (FDA) recommend that healthcare professionals cease use of any product produced by the New England Compounding Center until further information is available.

Patients who have had an epidural steroid injection since July 2012, and have any of the following symptoms, should talk to their doctor as soon as possible.
Worsening headache
Fever
Sensitivity to light
Stiff neck
New weakness or numbness in any part of your body
Slurred speech




Map of Healthcare Facilities that Received Three Recalled Lots* of Methylprednisolone Acetate (PF) from New England Compounding Center on September 26, 2012


See table for a complete list of health care facilities.

* Lot #05212012@68, BUD 11/17/2012; Lot #06292012@26, BUD 12/26/2012; Lot #08102012@51, BUD 2/6/2013
** All vials of methylprednisolone acetate that were sent to Nevada were recalled prior to use.
List of Healthcare Facilities that Received Lots of Methylprednisolone Acetate (PF) Recalled from New England Compounding Center on September 26, 2012
Facility NamePhone NumberCityState
California
CYPRESS SURGERY CENTER559-740-4094VISALIACA
ENCINO OUTPATIENT SURGICENTER818-986-1037ENCINO CA
UKIAH VALLEY MEDICAL CENTER707-463-7345UKIAHCA
UNIVERSAL PAIN MANAGEMENT661-267-6876 x166PALMDALECA
Connecticut
INTERVENTIONAL SPINE AND SPORTS MED203-598-7246MIDDLEBURYCT
Florida
FLORIDA PAIN CLINIC352-237-5906OCALAFL
INTERVENTIONAL REHABILITATION CENTER850-484-8800PENSACOLAFL
MARION PAIN MANAGEMENT CENTER352-622-1845OCALAFL
NORTH COUNTY SURGICENTER561-626-6446PALM BEACH GARDENSFL
ORLANDO CENTER FOR OUTPATIENT SURGERY407-426-8331ORLANDOFL
PAIN CONSULTANTS OF WEST FLORIDA850-494-0000PENSACOLAFL
SURGERY CENTER OF OCALA352-237-5906OCALAFL
SURGICAL PARK CENTER305-271-9100 x226MIAMIFL
Georgia
FORSYTH STREET AMBULATORY SURGURY CENTER478-749-1610MACONGA
Idaho
PAIN SPECIALISTS OF IDAHO208-522-7246IDAHO FALLSID
WALTER KNOX MEMORIAL HOSPITAL208-365-3561 x3342EMMETTID
Illinois
APAC CENTERS FOR PAIN MANAGEMENT708-483-7007WESTCHESTERIL
APAC CENTERS FOR PAIN MANAGEMENT773-935-2760CHICAGOIL
THOREK MEMORIAL HOSPITAL773-975-6734CHICAGOIL
Indiana
AMBULATORY CARE CENTER LLC812-475-1800EVANSVILLEIN
FORT WAYNE PHYSICAL MEDICINE260-436-9337FORT WAYNEIN
OSMC OUTPATIENT SURGERY CENTER574-266-4173ELKHARTIN
SOUTH BEND CLINIC574-237-9372SOUTH BENDIN
UNION HOSPITAL812-238-4964TERRE HAUTEIN
WELLSPRING812-376-0700COLUMBUSIN
Maryland
BALTIMORE PAIN MANAGEMENT410-682-5040BALTIMOREMD
BERLIN INTERVENTIONAL PAIN MANAGEMENT410-641-3759BERLINMD
BOX HILL SURGERY CENTER410-877-8141ABINGDONMD
GREENSPRING SURGERY CENTER410-653-0077BALTIMOREMD
HARFORD COUNTY ASC, LLC410-538-7000EDGEWOODMD
PAIN MEDICINE SPECIALISTS410-825-6945TOWSONMD
SURGCENTER OF BEL AIR410-638-5523BEL AIRMD
Michigan
MICHIGAN NEUROSURGICAL INSTITUTE810-606-7112GRAND BLANCMI
MICHIGAN PAIN SPECIALISTS734-995-7246BRIGHTONMI
NEUROMUSCULAR & REHABILITATION231-935-0860TRAVERSE CITYMI
SOUTHEAST MICHIGAN SURGICAL HOSPITAL586-427-1000WARRENMI
Minnesota
MAPS-EDINA MEDICAL PAIN CLINIC763-537-6000MINNEAPOLISMN
MAPS-MEDICAL ADVANCED PAIN763-537-6000FRIDLEYMN
MEDICAL ADVANCED PAIN SPECIALISTS763-537-6000 x238SHAKOPEEMN
MEDICAL ADVANCED PAIN SPECIALISTS.763-537-6000MAPLE GROVEMN
MINNESOTA SURGERY CENTER763-767-7139EDINAMN
MINNESOTA SURGERY CENTER-763-537-6000MAPLE GROVEMN
North Carolina
HIGH POINT SURGERY336-878-6048HIGH POINTNC
NORTH CAROLINA ORTHOPAEDIC CLINIC919-403-5148DURHAMNC
SURGERY CENTER OF WILSON252-237-5649WILSONNC
New Hampshire
DR. O'CONNELL'S PAIN CARE CENTER603-335-5070MERRIMACKNH
DR. O'CONNELL'S PAIN CARE CENTERS, INC603-692-3166SOMERSWORTHNH
New Jersey
CENTRAL JERSEY ORTHOPEDICS SPECIALISTS PC908-561-2122SOUTH PLAINFIELDNJ
EDISON SURGICAL CENTER732-452-0123EDISONNJ
IF PAIN ASSOCIATES / ISAIAH FLORENCE201-287-1100TEANECKNJ
PREMIER ORTHOPEDICS SURG. ASSOC., LLC856-690-1750VINELANDNJ
COMPREHENSIVE PAIN MANAGEMENT973-796-5216SPARTANJ
SOUTH JERSEY HEALTH CARE856-363-1558ELMERNJ
SOUTH JERSEY HEALTHCARE856-641-7557VINELANDNJ
Nevada
SAHARA SURGERY CENTER702-362-7874LAS VEGASNV
New York
BUTANI, SUNIL H., PHYSICIAN PC516-747-5042MINEOLANY
OBOSA MEDICAL SERVICES914-530-2323MOUNT VERNONNY
ROCHESTER BRAIN AND SPINE585-334-5560ROCHESTERNY
Ohio
BKC PAIN SPECIALISTS, LLC740-387-7246MARIONOH
CINCINNATI PAIN MANAGEMENT513-891-0022CINCINNATIOH
MARION PAIN CLINIC740-375-0200MARIONOH
ORTHO-SPINE REHABILITATION CENTER, INC.614-793-8817DUBLINOH
Pennsylvania
ALLEGHENY PAIN MANAGEMENT814-940-2000ALTOONAPA
SOUTH HILLS PAIN & REHAB ASSOCIATES412-469-7722JEFFERSON HILLSPA
Rhode Island
NEW ENGLAND ANESTHESIOLOGY (NEA)401-490-7530WARWICKRI
OCEAN STATE PAIN MANAGEMENT401-766-7700WOONSOCKETRI
OCEAN STATE PAIN MANAGEMENT401-884-6070EAST GREENWICHRI
South Carolina
INTERVENE MD843-216-4844MOUNT PLEASANTSC
Tennessee
PCA PAIN CARE CENTER865-835-5196OAK RIDGETN
SPECIALTY SURGERY CENTER931-484-2500 x125CROSSVILLETN
ST. THOMAS OUTPATIENT NEUROSURGICAL615-341-3425NASHVILLETN
Texas
DALLAS BACK PAIN MANAGEMENT214-445-5077DALLASTX
HARRIS METHODIST SOUTHLAKE CENTER817-748-8778SOUTHLAKETX
Virginia
INSIGHT IMAGING-ROANOKE540-581-0882ROANOKEVA
NEW RIVER VALLEY SURGERY CENTER540-639-5888CHRISTIANSBURGVA
West Virginia
PARS INTERVENTIONAL PAIN304-865-7277PARKERSBURGWV

From The New England Journal of Medicine

ORIGINAL ARTICLE

Brief Report: The Index Case for the Fungal Meningitis Outbreak in the United States

A.C. Pettit and Others

REVIEW ARTICLE

Current Concepts: Fungal Infections Associated with Contaminated Methylprednisolone Injections — Prelininary Report

C.A. Kauffman, P.G. Pappas, and T.F. Patterson

....
For over 3 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 work related accident and injuries.