Maybe the Evian, Perrier and San Pellegrino drinkers among us are on to something? Maybe it's not just snobbery, but rather a matter of self preservation.

Blind tastings have shown that tap water often tastes as good as pricey
waters from the Swiss and Italian Alps. But....

Consider the recent reports. An Associated Press investigation reveals
antibiotics, anti-convulsants, mood stabilizers and sex hormones are now found in American water supplies. Check this out:
http://www.insidebayarea.com/oaklandtribune/ci_8519245

The long term significance of this isn't yet scientifically known. Could modern medicine's pill-popping culture eventually be our undoing?
The pharmacy component of workers' comp is huge. I would never begrudge injured workers what they need for pain relief.

But it does make you wonder. Are those workers' comp medications winding up in our drinking water?

Food (or drink) for thought.

I'll be sharing further info on the recent DWC annual conference in my next post. Stay tuned.

Julius Young
http://www.boxerlaw.com/news.html

Lacking lawyers, justice is denied.

That's the title of a major piece by Daniel Costello in yesterday's Los Angeles Times.

Costello examines the effects of the 1975 cap on California medical malpractice awards known as MICRA. MICRA (the Medical Injury Compensation Reform Act) puts a $250,000 limit on awards for non-economic damages (such as pain and suffering, loss of consortium, and so forth).

The $250,000 cap hasn't been adjusted in over 32 years. That's 32 years unadjusted for inflation.

Meanwhile, insurer malpractice insurers are reaping large profits. Costello notes that since 1991 the national average payout of malpractice insurers is 63 cents on the dollar, but in California, it's 39 cents on the dollar.

Voila! Medical malpractice insurers are making profits almost as great as the workers' comp carriers.

Medical malpractice case filings are down significantly. In Los Angeles County, they are down 48% since 2001- to their lowest level per capita in four decades.

An injured worker who is harmed by the medical negligence of a doctor or hospital will often find it hard to locate an attorney to sue the medical provider. The civil jury trial lawyers at Boxer & Gerson do take these kinds of cases, but the cost of handling these cases (expert witnesses, depositions and trial) are often prohibitive unless there are substantial economic damages, such as large future earnings losses.

Among the groups that have a particularly hard time finding attorneys are low wage earners, minorities, and the families of infants and the elderly who die at the hands of medical providers. Rural Californians-who often have limited incomes and who do not have access to top quality care in the first place-are also in that group.

It's unlikely that the Schwarzenegger administration will look favorably on any adjustment to MICRA.

But it will be interesting to see how the presumptive Republican gubernatorial candidate Steve Poizner develops his position on MICRA. At some point, it's hard to keep justifying a three decades-old cap while insurers pocket big profits. Something has to give.

You can find the LA Times article by clicking here:
http://www.latimes.com/business/la-fi-m ... ome-center

Stay tuned. Over the next week, I'll be doing a recap of the key 2007 comp developments and a piece on projections for 2008.

Julius Young
www.boxerlaw.com
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One of my heroes died recently. Evel Knievel. Knievel staged death-defying jumps over impossibly long barricades and into huge river canyons. Part athlete, part showman, part insane man, Knievel was the Harry Houdini I dreamed about as a little kid.

As readers of the column know, my mind works in strange ways.

Today, as I sat pondering Knievel, I came upon the California Workers' Compensation Institute (CWCI) of California workers' compensation medical treatment over the past few years. The study was undertaken by the Oakland-based CWCI at the request of the Oakland-based WCIRB (Workers Compensation Insurance Rating Bureau). Apologies to Gertrude Stein, but there IS a there there in Oakland.

The study shows a steep falloff on some types of workers' comp treatment over the past several years-particularly for chiropractic treatment. The falloff has been steeper than many of Knievel's jumps. The percentage of claims involving chiropractic fell by 68.6% between 2002 and 2006.

There were significant declines in utilization of physical therapy and radiology procedures.

Rather than summarize the study, here's a link so you can see it yourself:
http://www.cwci.org/pdfs/Research_Update1207.pdf

ACOEM and utilization review have shrunk treatment utilization, wringing billions out of the system. But it's also left many workers and physicians frustrated, with a resulting exodus of many doctors from the system.

To see how treatment denials have affected some workers, I'd recommend a visit to this site:
www.denialofcare.org

Stay tuned.

Julius Young
www.boxerlaw.com
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Human behavior is a fascinating thing.

People lining up in the dead of night outside electronics stores for a chance to stampede for teaser deals. Long haul truckers taking philosophy classes downloaded into their iPods off of iTunes. We're all writers and editors now. There's an encyclopedia-Wikipedia.org-that everyone, everywhere is free to create and edit.

We live in an era where you can choose; you can create or you can grab stuff off the shelf.

So it is in comp. too. The California Division of Workers' Compensation has now shifted direction on implementation of post-surgical therapy limits.

Instead of drafting its own regulations, the DWC now intends to use the ODG guidelines on post-surgical therapy treatment.

For background on this, see my October 26, 2007 post "Implementing the Nava Bill":
http://www.workerscompzone.com/index.ph ... 026-102628

This is an issue of great importance for disabled workers who have surgery. The Nava bill (AB 1073) loosened the rigid limitations on therapy in post-surgical cases.

On November 20th, the DWC announced that it was adopting the ODG guidelines that are created by the Work Loss Data Institute. Those proposed guidelines are now available for public comment:
http://www.dir.ca.gov/dwc/ForumDocs/Pos ... ations.pdf

As of today there has been only one public comment. It's hard to believe, but during many "forums" on DWC's regulations there have been very few members of the public commenting. It would appear that injured workers and members of of the "comp community" aren't paying all that much attention to the regulatory process.

After the public comment period, these guidelines will go through the formal rulemaking process. Stay tuned.

You can subscribe to the blog by using the RSS buttons at the lower right hand menu bar.

Julius Young
http://www.boxerlaw.com/verdicts.html
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Hey, it's the weekend, and my mind works in strange ways.

Remember the 1950s/1960s Japanese monster films, many of which are now cult classics? Mothra vs. Godzilla was in 1962:
http://en.wikipedia.org/wiki/Mothra_vs._Godzilla

I couldn't help thinking of those classic monster films this week as I saw ACOEM doing battle with IJOEH in the press. The battle of the acronyms.

ACOEM is the American College of Occupational and Environmental Medicine. ACOEM's cookbook of medicine is now the official standard for treatment for California's workers' comp system (with a few exceptions, such as for acupuncture and chronic pain treatment, which will have other guidelines).

ACOEM is now under scrutiny by academics specializing in occupational and environmental health.

ACOEM appears to be a professional organization in service to industry.

The charge is made by researchers including University of California at San Francisco professor Joseph LaDou in an article in this month's International Journal of Occupational and Environmental Health (IJOEH). LaDou is a professor of Occupational and Environmental Medicine at UCSF.

The IJOEH charges against ACOEM are serious and detailed. Here's a long quote from the preface to the article summarizing the full
contents on ACOEM:

"The American College of Occupational and Environmental (ACOEM) is a professional association that represents the interests of its company employed physician members. Fifty years ago the ACOEM began to assert itself in the legislative arena as an advocate of limited regulation and enforcement of occupational health and safety standards and laws, and environmental protection. Today the ACOEM provides a legitimizing professional organization for company doctors, and continues to provide a vehicle to advance the agendas of their corporate sponsors. Company doctors in ACOEM recently blocked attempts to have the organization take a stand on global warming. Company doctors employed by the petrochemical industry even blocked the ACOEM from taking a position on particulate air pollution. Industry money and influence pervade every aspect of occupational and environmental medicine. The controlling influence of industry over the ACOEM physicians should cease. The conflict of interests inherent in the practice of occupational and environmental medicine is not resolved by the ineffectual efforts of the ACOEM to establish a pretentious code of conduct. The conflicted interests within the ACOEM have become too deeply embedded to be resolved by merely a self-governing code of conduct. The specialty practice of occupational and environmental medicine has the opportunity and obligation to join the public health movement. If it does, the ACOEM will have no further purpose as it exists, and specialists in occupational and environmental medicine will meet with and be represented by public health associations. This paper chronicles the history of occupational medicine and industry physicians as influenced and even controlled by corporate leaders."

Way to go, Mothra! Take that, Godzilla!

You can read the entire paper online by clicking here:
http://www.ijoeh.com/pfds/IJOEH_1304_LaDou02.pdf

You can see ACOEM defend itself in this "open letter" from its President:
http://www.acoem.org/ResponseToIJOEH.aspx

Don't count Godzilla out, but Mothra has definitely drawn blood in this fight. ACOEM's defense will undoubtedly be subject to further scrutiny in the academic press.

The IJOEH article notes that ACOEM refused to share information in its archives with the UCSF researchers.

Why does any of this matter? ACOEM has adopted a smug patina of invincibility as the arbiter of "best practices" in workplace medicine.

But the emperor may have no clothes.

Stay tuned. You can subscribe to the blog via RSS by clicking on the buttons at the lower right menu bar.

Julius Young
http://www.boxerlaw.com/attorney_bios/julius_young.html
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