Homeland Security Takes Lead in Flu Pandemic Pointing to Compensation Programs

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 the threat in an effort to secure the Nation's critical infrastructure and key resources (CI/KR). The viability of business in the US remains a critical aspect of the plan and the workers' compensation system is critical tool in the implementation of the response.

The threat is defined as serious. "The (1918 Spanish Influenza} epidemic killed, at a very, very conservative estimate, 550,000 Americans in 10 months; that's more Americans than died in combat in all the wars of this century." Alfred W. Crosby, Influenza, 1918, The American Experience.

While pandemics are unpredictable, the USDHS has estimated that the disease attack rate will be 30 percent in the overall population during the pandemic. The agency estimates that an average of 20 percent of working adults will become ill during a community outbreak. Multiple waves of the disease will occur with each lasting 2 or 3 months.

The approach taken by the Federal government will be to assess the threat and direct coordination with the State agencies. A fundamental part of the plan is to provide psychosocial support and meet the informational needs of the workforce and develop contingency plans for absenteeism, especially among health department groups and develop workforce resiliency.

As the situation unfolds, workers' compensation programs will be tasked to new limits. Much is unknown, "...We are telling everyone to prepare for a pandemic. It's tricky....This is scary and we don't know....That's the message." Dick Thompson, World Health Organization. By directing ill workers to appropriate compensation programs, the USDHS has taken the initial steps necessary to respond to changing conditions and rumors.

HIPPA Privacy Modifications Under Presidential Emergency H1N1 Flu Order

Under the emergency declaration for H1N1 flu signed by President Obama on October 24, 2009, the HIPPA Privacy rule is not waived according to Federal HHS interpretation; however, "the Secretary of HHS may waive certain provisions of the Rule under the Project Bioshield Act of 2004 (PL 108-276) and section 1135(b)(7) of the Social Security Act."
 
Those modifications are:
 
"If the President declares an emergency or disaster and the Secretary declares a public health emergency, the Secretary may waive sanctions and penalties against a covered hospital that does not comply with certain provisions of the HIPAA Privacy Rule:

•  the requirements to obtain a patient's agreement to speak with family members or friends involved in the patient’s care (45 CFR 164.510(b)) 
• the requirement to honor a request to opt out of the facility directory (45 CFR 164.510(a)) 
• the requirement to distribute a notice of privacy practices (45 CFR 164.520) 
• the patient's right to request privacy restrictions (45 CFR 164.522(a)) 
• the patient's right to request confidential communications (45 CFR 164.522(b)) 

"If the Secretary issues such a waiver, it only applies:

1. In the emergency area and for the emergency period identified in the public health emergency declaration.

   2. To hospitals that have instituted a disaster protocol.  The waiver would apply to all patients at such hospitals.

   3. For up to 72 hours from the time the hospital implements its disaster protocol.

"When the Presidential or Secretarial declaration terminates, a hospital must then comply with all the requirements of the Privacy Rule for any patient still under its care, even if 72 hours has not elapsed since implementation of its disaster protocol. 

"Regardless of the activation of an emergency waiver, the HIPAA Privacy Rule permits disclosures for treatment purposes and certain disclosures to disaster relief organizations. For instance, the Privacy Rule allows covered entities to share patient information with the American Red Cross so it can notify family members of the patient’s location.  See 45 CFR 164.510(b)(4)."

Similar rule modifications were invoked during the Katrina disaster.

To read more about medical record privacy and workers' compensation, click here.

CVS Stores Stop Selling All Tobacco Products

Today's post is shared from nytimes.com At a CVS store near Times Square, the shelves are notable for what they no longer display: cigarettes. Now the only smoking products to be found are those that could help customers quit. As of midnight on Tuesday, all 7,700 CVS locations nationwide will no longer sell tobacco products, fulfilling a pledge the company made in February, as it seeks to reposition itself as a health care destination. The rebranding even comes with a new name: CVS Health. The decision to stop selling cigarettes is a strategic move as pharmacies across the country jockey for a piece of the growing health care industry. Rebranding itself as a company focused on health could prove lucrative for the drugstore as it seeks to appeal to medical partners that can help it bridge the gap between customers and their doctors. “CVS is really trying very hard to position themselves as the winner in that marketplace,” said Skip Snow, a health care analyst at Forrester Research. “If they can be perceived as a place to go to receive health care, and buy health care products, as opposed to the place to go to buy a bottle of whiskey or get your film developed, then they can capture more of the retail medicine dollars.” CVS already operates 900 walk-in medical clinics, or “minute clinics,” where customers can get relatively simple services like blood pressure tests and flu vaccines. By dedicating space for these services, CVS and other major retailers like Walmart are diving into...

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Work resumes at federal public health agencies

Today's post was shared by CIDRAP and comes from www.cidrap.umn.edu

Congressional agreement on a funding bill that reopened government yesterday got the gears turning again with several key public health tasks, such as flu surveillance, science communication, and lab testing. Within hours of President Obama's signing of the legislation, some of the US Centers for Disease Control and Prevention's Twitter accounts crackled to life again, including one used by its director, Tom Frieden, MD, MPH, who wrote, "So relieved to have the best and brightest back to work protecting and promoting health. Hope for no relapse…" Government employees who had been furloughed were asked to return yesterday. At the CDC all but 4,000 of about 13,000 employees were furloughed. A few were called back to manage a Salmonella Heidelberg outbreak linked to three Foster Farms processing facilities in California. Barbara Reynolds, PhD, who directs the CDC's division of public affairs, was the point person who fielded media queries while many of her colleagues were furloughed. She told CIDRAP News yesterday that the CDC is operating as it did before the shutdown, and that its scientists and health officials can resume needed travel and attend meetings. Throughout the day yesterday, the CDC posted several notices on its Web site signaling that its activities were returning to normal. It posted a notice that its weekly FluView surveillance reports would return today, but in an abbreviated form, after a 2-week absence. The lack of reports created an...

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Official Disabilities Guidelines Now Covers Diabetes

Today's post comes from guest author Paul J. McAndrew, Jr. from Paul McAndrew Law Firm.

While diabetes is not a work injury or illness, it can have a serious impact on the rate at which an injured worker recovers. For instance, people with diabetes may have a much harder time healing from a foot or leg injury.

The latest edition of the annual Official Disabilities Guidelines (ODG) has been released, including the latest ODG volume on treating patients. ODG Treatment is the nationally recognized standard for medicine in determining the scope and duration of medical treatment in workers’ compensation.

Vaccinating Workers’ Compensation Against Flu Claims

The spread of influenza A has now reached pandemic proportions. The focus has now been directed to creating a vaccine to halt the rapid community spread. The next challenge to workers’ compensation systems may be claims resulting from adverse reactions to employer sponsored vaccination programs.

The World Health Organization (WHO) had now declared the outbreak of the novel influenza A to be a world wide pandemic. Dr Margaret Chan, Director-General of the World Health Organization, announced today, “The world is now at the start of the 2009 influenza pandemic.” “The virus is contagious, spreading easily from one person to another, and from one country to another. As of today, nearly 30,000 confirmed cases have been reported in 74 countries.”

The need for the development and distribution of a preventative vaccine is of critical importance. Dr. Chan stated, “WHO has been in close dialogue with influenza vaccine manufacturers. I understand that production of vaccines for seasonal influenza will be completed soon, and that full capacity will be available to ensure the largest possible supply of pandemic vaccine in the months to come.”

Workers’ Compensation programs have been challenged by compensable claims in the past resulting from adverse reactions to vaccines. In many jurisdictions, vaccinations afforded to employees which provide benefit to the employer against possible disastrous business consequences have been considered to be a mutual benefit. Therefore any disease arising from such vaccination has been deemed compensable.

To shield both employers and pharmaceutical companies from liability claims, the federal government established a no-fault program entitled the Smallpox Emergency Personnel Protection Act of 2003 (SEPPA) in an effort to provide benefits and/or compensation to certain individuals, including health-care workers and emergency responders, who are injured as a result of the administration of smallpox countermeasures including the smallpox (vaccinia) vaccine. SEPPA also provides benefits and/or compensation to certain individuals who are injured through the result of accidental vaccinia inoculation through contact.

Many questions remain unanswered including: the ultimate spread of the disease, the development of an effective vaccine, and whether the workers’ compensation system will need to absorb claims resulting from adverse reactions. One thing is for sure, as Dr. Chan declared today. “We are all in this together, and we will all get through this, together.”

For more on workers compensation and the flu pandemic visit the Workers' Compensation Blog.

FDA takes action against thousands of illegal Internet pharmacies

The U.S. Food and Drug Administration, in partnership with international regulatory and law enforcement agencies, took action this week against more than 4,100 Internet pharmacies that illegally sell potentially dangerous, unapproved drugs to consumers. Actions taken include civil and criminal charges, seizure of illegal products, and removal of offending websites.

The announcement takes place during the 5th annual International Internet Week of Action (IIWA), a global cooperative effort to combat the online sale and distribution of potentially counterfeit and illegal medical products. This year’s effort – Operation Pangea V – operated between Sept. 25 and Oct. 2 and resulted in the shutdown of more than 18,000 illegal pharmacy websites and the seizure of about $10.5 million worth of pharmaceuticals worldwide.

The goal of this annual effort, which involved law enforcement, customs and regulatory authorities from 100 countries, is to identify producers and distributors of illegal pharmaceutical products and medical devices and remove these products from the supply chain.

“Consumers in the United States and around the world face a real threat from Internet pharmacies that illegally sell potentially substandard, counterfeit, adulterated or otherwise unsafe medicines,” said FDA Commissioner Margaret A. Hamburg, M.D. “This week’s efforts show that strong international enforcement efforts are required to combat this global public health problem. The FDA is committed to joining forces to protect consumers from the risks these websites present.”

Last week, the FDA reinforced its online efforts with the launch of a national campaign to educate Americans about the risks of buying prescription medications over the Internet. BeSafeRx – Know Your Online Pharmacy seeks to raise public awareness about the health risks of using fraudulent Internet pharmacies and what consumers can do to protect themselves.

During Operation Pangea V, the FDA targeted websites selling unapproved and potentially dangerous medicines. In many cases, the medicines can be detrimental to public health because they contain active ingredients that are approved by FDA for use only under the supervision of a licensed health care practitioner or active ingredients that were previously withdrawn from U.S. market due to safety issues.

Among the illegal medicines identified through the operation were:
Domperidone: This medicine was removed from the United States market in 1998 because it may cause serious adverse effects, including irregular heartbeat, stopping of the heart, or sudden death. These dangers could convey to the nursing baby of breastfeeding women, who may be using domperidone to try increase milk production (which is not an approved use).

Isotretinoin (previously marketed as Accutane in the United States): This medicine is used to treat severe nodular acne and carries significant potential risks, including severe birth defects if pregnancy occurs while using this medicine. To minimize potential risks to consumers, FDA-approved isotretinoin capsules are only available through restricted distribution in the United States.

Tamiflu (oseltamivir phosphate): This medicine, which is used to treat the flu, is often sold online as “generic Tamiflu.” However, there is no FDA-approved generic version of Tamiflu. Previous FDA tests found that fraudulent versions of “generic Tamiflu” contained the wrong active ingredient, which would not be effective in treating flu. In these cases, the wrong active ingredient was similar to penicillin and may cause a severe allergic reaction, including a sudden, potentially life-threatening reaction called anaphylaxis, in consumers allergic to penicillin products.

Viagra (sildenafil citrate): This medicine is used to treat erectile dysfunction. Due to its vasodilation effects, sildenafil citrate should not be used by consumers with certain heart conditions. Consumers taking this medicine without the supervision of a health care professional may not learn about potential drug interactions, such as increased blood pressure lowering effects of organic nitrates when taken with sildenafil citrate.

The FDA sent Warning Letters to the operators of more than 4,100 identified websites. As a follow up, the agency sent notices to Registries, Internet Service Providers (ISPs), and domain Name Registrars (DNRs) informing them that these websites were selling products in violation of U.S. law. The FDA is working with its foreign counterparts to address the remaining websites that continue to offer unapproved or misbranded prescription medicines to U.S. consumers.

“Internet pharmacies that illegally sell unapproved, counterfeit, or potentially adulterated or substandard drugs are an inherently international crime problem,” said John Roth, director of the FDA’s Office of Criminal Investigation. “The FDA is pleased to work with INTERPOL, the international police agency, to fight this problem. Because these criminals do not respect international borders, the international coordinated law enforcement response represented by Operation Pangea demonstrates that international cooperation is the best way to protect the American public from the risk of unsafe drugs.”

The FDA coordinated the efforts of this year’s Operation Pangea V, including screening all drug products received through the international mail facilities during the IIWA. Preliminary findings showed that certain products from abroad, such as antibiotics, antidepressants, and other drugs to treat high cholesterol, diabetes, and high blood pressure, were on the way to U.S. consumers. Many of those products can pose health risks if taken without the supervision of a health care practitioner or if the products have been removed from the market for safety reasons.

The FDA encourages consumers to report suspected criminal activity at www.fda.gov/oci.

The IIWA is a collaboration between FDA, INTERPOL , the World Customs Organization, Permanent Forum of International Pharmaceutical Crime, Heads of Medicines Agencies Working Group of Enforcement Officers, the Medicines and Healthcare products Regulatory Agency of the United Kingdom, the Irish Medicines Board, the London Metropolitan Police, the U.S. Department of Homeland Security, the Center for Safe Internet Pharmacies, and national health and law enforcement agencies from 100 participating countries.

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Sleep, Pain, and Hospital Workers

Today's post was shared by Safe Healthy Workers and comes from blogs.cdc.gov

Orfeu M. Buxton, PhD; Glorian Sorensen, PhD, MPH

We know that decreased sleep duration and extended shifts in healthcare workers are linked to workplace injuries.  The effects of decreased sleep on pain in the workplace are less clear.

New research from the Harvard Center for Work, Health and Wellbeing  –one of four NIOSH Centers of Excellence funded to explore and research the concepts of Total Worker Health™- examines the question: Does lack of sleep increase pain and limit function among hospital care workers? 

The study, published in the American Journal of Occupational and Environmental Medicine, finds that sleep deficiency (including short sleep duration, insomnia symptoms, sleep insufficiency, or all three) is significantly associated with pain, functional limitations of daily living tasks due to that pain, and difficulty performing work tasks due to that pain, among hospital care workers.

Shutdown’s science fallout could last for years

Today's post was shared by RWJF PublicHealth and comes from www.politico.com

The government may finally be on a path to reopening, but the shutdown’s effects will linger for scientists studying everything from climate change to cancer. Antarctica-bound field researchers stuck in budget limbo over the past three weeks fret that decades of data on penguins and ice sheets will end up with a glaring gap, undercutting their documentation of global warming. Doctors operating federal-funded clinical studies on Alzheimer’s, cocaine addiction and heart disease worry they’ve lost the trust of patients. Public health officials warn the country is still “flying blind” for the start of the flu season. “Even if the government opens tomorrow, a significant amount of damage has been done,” said Mary Woolley, president of Research!America, a nonprofit advocating for science-minded agencies. “This isn’t about a few people who can’t go to the labs like they’re on vacation or something. The whole research enterprise depends on operating 24/7.” Thinking more of the big picture, there’s also the little matter of keeping the best and brightest researchers working in, and for, the United States or seeing them flee to the private sector. It’s a realistic expectation after nearly three years of stop-and-go budget battles resulting in sequestration and now the cruel reality of laboratories ordered to keep the lights out. (WATCH: Who won the shutdown? Top 5 quotes) “Would you...

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Early screening spots emergency workers at greater risk of mental illness

Today's post is shared from sciencedaily.com

Emergency services workers who are more likely to suffer episodes of mental ill health later in their careers can be spotted in the first week of training. Researchers wanted to see if they could identify risk factors that made people more likely to suffer post-traumatic stress (PTSD) or major depression (MD) when working in emergency services.

Researchers from the University of Oxford and King's College London wanted to see if they could identify risk factors that made people more likely to suffer post-traumatic stress (PTSD) or major depression (MD) when working in emergency services.

Dr Jennifer Wild from the University of Oxford explained: 'Emergency workers are regularly exposed to stressful and traumatic situations and some of them will experience periods of mental illness. Some of the factors that make that more likely can be changed through resilience training, reducing the risk of PTSD and depression. We wanted to test whether we could identify such risk factors, making it possible to spot people at higher risk early in their training and to develop interventions that target these risk factors to strengthen their resilience.'

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….

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  1.973.696.7900  jon@gelmans.com  has been representing injured workers and their families who have suffered occupational accidents and illnesses.

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Central New Jersey facility to pay $273K, take corrective actions to resolve COVID-related respirator violations

OSHA finds employers failed to ensure safe respirator use while testing hundreds daily.

Influenza Vaccination Coverage Among Health Care Personnel — United States, 2013–14 Influenza Season

The figure shows the percentage of health-care personnel (HCP) who received influenza vaccination, by work setting and occupation type, in the United States for the 2010-11 through 2013-14... The Advisory Committee on Immunization Practices recommends that all health care personnel (HCP) be vaccinated annually against influenza (1). Vaccination of HCP can reduce influenza-related morbidity and mortality among both HCP and their patients (1–4). To estimate influenza vaccination coverage among HCP during the 2013–14 season, CDC analyzed results of an opt-in Internet panel survey of 1,882 HCP conducted during April 1–16, 2014. Overall, 75.2% of participating HCP reported receiving an influenza vaccination during the 2013–14 season, similar to the 72.0% coverage among participating HCP reported in the 2012–13 season (5). Coverage was highest among HCP working in hospitals (89.6%) and lowest among HCP working in long-term care (LTC) settings (63.0%). By occupation, coverage was highest among physicians (92.2%), nurses (90.5%), nurse practitioners and physician assistants (89.6%), pharmacists (85.7%), and "other clinical personnel" (87.4%) compared with assistants and aides (57.7%) and nonclinical personnel (e.g., administrators, clerical support workers, janitors, and food service workers) (68.6%). HCP working in settings where vaccination was required had higher coverage (97.8%) compared with HCP working in settings where influenza vaccination was not required but promoted (72.4%) or settings where there was no requirement or promotion of vaccination (47.9%). Among HCP without an employer requirement for vaccination, coverage...

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Yep, There's a Medical Code for Being Bitten by Shamu

Today's post was shared by Mother Jones and comes from www.motherjones.com

Sarah Kliff reports on the ongoing battle over the ICD-10, a set of medical codes for illnesses and injuries that's far more detailed than the current ICD-9: There are different numbers for getting struck or bitten by a turkey (W61.42 or W61.43). There are codes for injuries caused by squirrels (W53.21) and getting hit by a motor vehicle while riding an animal (V80.919), spending too much time in a deep-freeze refrigerator (W93.2) and a large toe that has gone unexpectedly missing (Z89.419). ....Hospitals and insurers have fought the new codes, calling them a massive regulatory burden....ICD-10 proponents contend that adding specificity to medical diagnoses will provide a huge boon to the country. It will be easier for public health researchers, for example, to see warning signs of a possible flu pandemic — and easier for insurers to root out fraudulent claims. “How many times are people going to be bitten by an orca? Probably not very many,” said Lynne Thomas Gordon, chief executive of the American Health Information Management Association. “But what if you’re a researcher trying to find that? You can just press a button and find that information.” Depending on who you listen to, we are either hopelessly behind the rest of the world in implementing common-sense international standards or else the only country in the world that's holding out against the madness. Read the whole thing and decide for yourself.

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Heath Concerns About the Misuse of Pesticides for Bed Bug Control

Hotel workers as well as consumes are being cautioned cautioned about exposure to pesticides to control bed bugs.
The Agency for Toxic Substances and Disease Registry (ATSDR) and the Centers for Disease Control and Prevention (CDC) are alerting the public to an emerging national concern regarding misuse of pesticides to treat infestations of bed bugs and other insects indoors. Some pesticides are being applied indoors even though they are approved only for outdoor use. Even pesticides that are approved for indoor use can cause harm if over applied or not used as instructed on the product label.
There has been a dramatic increase in the number of bed bug-related inquiries received by the National Pesticide Information Center (NPIC) over the past several years, with many involving incidents of pesticide exposure, spills, or misapplications. From January 2006-December 2010, NPIC reported 169 calls to their hotline where residents, homeowners, or pesticide applicators sprayed pesticides indoors to treat bedbugs. These cases involved pesticides that were misapplied, not intended for indoor use, or legally banned from use. Of those, 129 resulted in mild or serious health effects (including one death) for persons living in affected residences.
ATSDR warns that outdoor pesticides should not be used indoors under any circumstances. Homeowners and applicators should always carefully read the product label to make sure that:
it has an EPA registration number

• it is intended for indoor use
• it is effective against bed bugs (the label should say it is meant to be used to treat your home for bed bugs) and
• you know how to properly mix the product (if a concentrate) and where and how to apply it safely within the home.
• ....
  Jon L.Gelman of Wayne NJ, is the author NJ Workers’ Compensation Law (West-Thompson) and co-author of the national treatise, Modern Workers’ Compensation Law (West-Thompson).  

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Consistent with an enforcement trend by the EU to reduce agricultural pesticides used by 50% between 2008-2018, a French court on Monday declared U.S. biotech giant Monsanto guilty of chemical poisoning of a French ...

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Intentional Tort Claim Against Employer Proceeds for Pesticide

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Mother's Occupational Exposure to Pesticide Increases Child's Risk

Jul 02, 2009

A recent study by the McLaughlin Centre for Population Health Risk Assessment of the University of Ottawa finds that an increased risk of childhood leukemia is associated with the mother's exposure at work to pesticides.

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Is the workers' compensation system ready for the COVID-19 [coronavirus] virus? Live Updates

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Carbon Monoxide Safety Facts and Tips – How to prevent poisoning from a gas with no odor

Today's post was shared by US Dept. of Labor and comes from www.nsc.org

NSC HOME > News & Resources > Resources > Carbon Monoxide         Carbon Monoxide Carbon Monoxide Safety Facts and Tips  Carbon monoxide (CO) is an odorless, colorless gas that interferes with the delivery of oxygen in the blood to the rest of the body. It is produced by the incomplete combustion of fuels. What Are the Major Sources of CO? Carbon monoxide is produced as a result of incomplete burning of carbon-containing fuels including coal, wood, charcoal, natural gas, and fuel oil. It can be emitted by combustion sources such as unvented kerosene and gas space heaters, furnaces, woodstoves, gas stoves, fireplaces and water heaters, automobile exhaust from attached garages, and tobacco smoke. Problems can arise as a result of improper installation, maintenance, or inadequate ventilation. What Are the Health Effects? Carbon monoxide interferes with the distribution of oxygen in the blood to the rest of the body. Depending on the amount inhaled, this gas can impede coordination, worsen cardiovascular conditions, and produce fatigue, headache, weakness, confusion, disorientation, nausea, and dizziness. Very high levels can cause death. The symptoms are sometimes confused with the flu or food poisoning. Fetuses, infants, elderly, and people with heart and respiratory illnesses are particularly at high risk for the adverse health effects of carbon monoxide. An average of 166 people die each year as a...

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Prevention For Profit: Questions Raised About Some Health Screenings

Today's post was shared by Kaiser Health News and comes from www.kaiserhealthnews.org

Messiah United Methodist Church in Springfield, Va., is unusually busy for a Thursday morning. It's not a typical time for worship, but parishioner Stacy Riggs and her husband have come for something a little different: a medical screening. "I'm getting ready to turn 50 sooner than I'd like to say, and just thought it was a good time to get an overall screening," said Riggs, of Fairfax, Va. She doesn't have any symptoms, but she stopped by the church, which is offering a day of testing by the company Life Line Screening as a service to parishioners. (Photo by Jenny Gold) Life Line Screening medical assistant Kennea Blake prepares Stacy Riggs for an atrial fibrillation screening at Messiah United Methodist Church in Springfield, Va. For less than $200, Riggs is getting six different screenings for stroke, heart disease and osteoporosis. Life Line says they've checked 8 million Americans this way at churches and community centers, and up to 10 percent of them are found to have some sort of abnormality. But several of the tests performed by Life Line are on a list of procedures for healthy people to avoid. The tests can potentially do more harm than good, according to the U.S. Preventive Services Task Force, an independent panel that recommends evidence-based treatments. Even though the screening tests may be noninvasive, follow-up exams and procedures often are not, and can increase a person's odds of being injured or over treated. One of those tests is the carotid artery...

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