Debate on Liens vs. Petitions Belies Reasonableness

One of the big legal arguments going on now in California as a result of SB 863 is who exactly becomes subject to a lien filing or activation fee.

More precisely stated, must interpreters and copy services file a lien, and thus pay either the filing or activation fees? Or can they simply file a petition for costs and avoid the fees?

The convolution of the Labor Code and its interpretive regulations, and the manner in which SB 863 was drafted, complicate what otherwise should be a simple answer.

The drafters of SB 863 did no one any favors by painting all lien claimants into a single category in the minds of the public - if you filed a lien then you were dirt.

I've called into question in the past the statistics that were bandied about in the lien filing fee argument, and I've called into question the motivations for this new law.

In the past attempt to impose a filing fee on lien claimants it was discovered that the Division of Workers' Compensation was woefully unable to account for, or collect, those fees. The practice was abandoned by the DWC before it was legally deactivated.

SB 863 reintroduced those fees, and those dealing with EAMS JetFiling have felt the pain of DWC's implementation of fee collection electronically.

And, of course, there is some question as to whether those fees are even legal.

Regardless, the vendors who are most impacted by the filing and activation fees are those with low value bill - interpreters and copy services. These vendors' bills are usually in the low to mid hundreds of dollars - so a one hundred dollar filing fee may be up to half the value of the underlying bill.

No reasonable business person is going to pay one hundred dollars, that can't be recovered unless thousands of dollars are spent in litigation, to collect two hundred dollars. So a petition for cost fits the business models of interpreters and copy services nicely.

Then again, maybe the intent of the filing fees was to starve out low dollar vendors.

The defense community's answer to petition for costs is that if it smells like a lien, tastes like a lien, looks like a lien - it must be a lien.

They question why, in the past, did a vendor not file a petition for cost instead of a lien when the do so now?

The answer to that question is simply culture - filing a lien was how it was done and no one questioned the practice. In fact, my guess is that if a vendor had filed a petition for costs in the past, doing so would have been called into question.

A few days ago I posted some vignettes and some extrapolated statistics demonstrating what, anecdotally, seems to be a more common practice than not - payers' unreasonable delays and denials. I don't have any data, but it seems to me that ever since Labor Code section 5814 was eviscerated by the Schwarzenegger Administration reforms that payer accountability towards benefit payment obligations has deteriorated.

If you recall the press at that time, 5814 was vilified by the payer community as an abused, overreaching bonus payment to injured workers even when there was no true harm to the claimant.

Audit standards, methodology, and budgeting were also trimmed. Now, I argue, the DWC Audit Unit has neither the manpower nor the legal power to conduct any meaningful enforcement against payers. And the applicant attorneys have no motivation to pursue enforcement since 5814 is of limited value.

And when you get down to it, the payer community, in delaying or denying benefits, including interpreter and copy service bills, is simply doing what would be natural in the financial industry - maximizing cash flow for increased investment returns.

Petition for costs versus liens ... the truth of the matter is that neither would be an issue if payers just paid what reasonably is owed.

What is reasonable for interpreter fees and copy service fees is presently a topic under debate and research - the DWC is going to issue a fee schedule for both services.

Until then, what is reasonable is interpretive - but clearly paying nothing, or ten cents on the dollar, for legitimately incurred services is NOT reasonable.

Folks - dispute resolution starts with eliminating the dispute in the first place. If there is no dispute, then there is no need for resolution.

In the same breath, if there is no dispute then there is no lien or petition for costs.

As much as some vendors game the system with extraneous claims, some payers game the system with obfuscation and delay.

The blame game is in full deployment - vendors blame payers and visa versa.

The truth, of course, is somewhere in between.

Claim what is reasonable. Pay what is reasonable. If you can't figure that out then the DWC will have a fee schedule for you.

Freshman Texans and Boneheaded Proposals

I've hailed Texas as a low cost workers' compensation state where insurance companies actually make an underwriting profit due to the competitive nature of the market in the subscription-optional state.

Now some freshman lawmakers want to demonstrate the political football that workers' compensation becomes in negotiations despite the state's success, and want to show just how low they can kick the injured worker.

Pitching a budget deal that favors pension reform, 11 freshman lawmakers introduced more than 30 amendments to a general appropriations bill that would eliminate or significantly reduce various state agencies and programs.

One of them is State Rep. Craig Goldman (R-Fort Worth) who wants to eliminate $8.2 million of yearly funding from the Office of Injured Employee Counsel (OIEC), which helps unrepresented injured workers navigate the workers' compensation system.

In past fights OIEC argued, correctly, that "a reduction in OIEC's funding would not save the State of Texas any money" because "it would reduce the maintenance tax levied on workers' compensation insurance companies." In 2010, the OIEC noted that it is administratively attached to TDI and does not receive funding for consumables, facilities or other items.

"The Texas Legislature appropriates funds from a general revenue dedicated account to agencies that participate in or contribute to the regulation of insurance, prevention of insurance loss, and administration of workers' compensation," the OIEC wrote. "OIEC is funded by this dedicated account within the same operating account as TDI. Both the Texas Insurance Code and Texas Labor Code require that maintenance taxes levied against insurance companies be set with the intention of collecting the revenue needed to fund authorized expenditures from this account."

Texas isn't the most generous workers' compensation states around, nor is it the least beneficial. But for that class of workers whose injuries and consequential disabilities don't attract private counsel, OIEC is absolutely necessary.

And, I would argue that OIEC actually saves employers money by providing timely, relevant counsel. Workers' compensation is a complex system. The sooner an injured worker is able to access the system, attain necessary treatment while still paying the bills, the sooner that person is going to return to work lowering the impact on the employer's experience.

Slashing the funding of OIEC is either a misguided, shortsighted "statement" or it is just a plain mean-spirited stab at the working class.

The likelihood that this legislation makes it to the governor's desk for signature is probably low. This maneuver is a way for rookie lawmakers to make a name for themselves by getting heard on budget issues.

Rep. Charles Perry (R-Lubbock), a member of the House Appropriations Committee, told the Texas Tribune that the freshman lawmakers are looking for a way to have more of a say in the budget process. Perry said he suggested that the rookie lawmakers consider targeting unfunded liabilities such as the TRS-Care, and to target it in the budget amendment process.

"It's how, if you're not on the Appropriations Committee, you can have your voice heard," he said.

But Perry should have counseled Goldman and these other rookies a bit more to pick on something they understand and that makes sense.

It's one thing to make a name for oneself and to get heard.

It's another to propose something boneheaded and construct a reputation for making law that isn't well researched or well thought out.

Anecdotes and Extrapolations Paint Troublesome Picture

The workers' compensation system is obsessed with costs. Reform legislation around the country is nearly uniformly about controlling costs.

The driving mantra behind California's last monster reform bill was costs were out of control.

High medical costs are blamed on unscrupulous profiteers. High indemnity costs are blamed on litigation and the claimant attorneys milking the system.

Ancillary vendors, such as interpreters and copy services, receive the heat as much as the more major cost contributors.

We read, hear and watch numerous reports every day about some claimant fraud, vendor fraud, employer fraud and once in a while some insurance company fraud. None of this compares, even cumulatively, to what I would characterize as outright system manipulation - intentional or not - by claims payers, which include the now publicly confirmed rumors about claims payers yanking the chains of lien claimants over filing fees.

Here are a couple of anecdotal vignettes recently posted in the WorkCompCentral Forums - they may not be typical (though as you will read below I believe that this is more representative than not) but they demonstrate some BIG issues. I have edited them for readability, but otherwise the factual contentions are as posted by the original authors.

After these short vignettes, employer consultant Bill Cobb gives us some real food for thought that demonstrates the enormity of the issue - and of course this would not be MY blog if I didn't opine one way or the other.

First Anecdotal Post:

Topic: Unrep PQME - Inappropriate Authoization Denial (California)

An unrepresented  applicant sets a Panel Qualified Medical Examiner (PQME) appointment and the cover letter is sent by the adjuster. The PQME sees the applicant and asks for a "consultation" from a specialist to help determine severity of damage and recommendations for further care. The PQME sends out the initial report explaining the need for the consult - not for treatment.

The insurance company adjuster does not respond to the requests for authorization for a consult - the one time he does answers his phone we explain the need for consultation arising from the PQME. The conversation goes like this:

Adjuster wants to know why we are treating...

We say we are not treating, need consult for PQME.

Adjuster states you cannot treat, you are not in the MPN...

We say we are not treating, we need authorization to consult for the PQME.

Adjuster states the consulting doctor is not in the MPN...

We say we are not treating, we need authorization to consult for the PQME.

Adjuster asks why does the doctor need a consult?? 

We say see his report.

Adjuster says, NO you explain to me why the doc needs a consult...

We say we cannot due to exparte communication rules -- please see report and send your questions to the PQME in writing.

Adjuster faxes note to us stating: Not authorized due to not in the MPN and UR did not approve.

Applicant was seen by the PQME in 11/2012 - adjuster has been delaying as above since then.

Second Anecdotal Post:

Topic: UR Timeframes vs. IMR (California)

Patient burned, had treatment elsewhere, then was referred to us by an occupational medical group where he was treating. We contacted adjuster at the TPA, who authorized the consult. Burn needs grafting. We sent a detailed narrative PR-2 with a Request For Authorization, but now, two weeks later, we have no response. [emphasis original] After the first week, I called and spoke with the adjuster, who said that because it's going to cost so much they have to think about it!!!!!  

Now it's been two weeks, and the poor guy is still doing dressing changes.  This is not life-threatening, but he will have a much higher risk of scarring and need for scar revision down the road, and in the meantime, he cannot return to work because of risk of infection, which grows every day.  That has all been explained to the adjuster.  Patient so far is not represented.

****************************

Now that you've read, in my opinion, two alarming anecdotes about egregious claims behavior (and there's plenty more in the WorkCompCentral Forums), Bill Cobb comes along with some troubling conclusions based on extrapolations from actual Workers' Compensation Insurance Rating Bureau (WCIRB) and Division of Workers' Compensation (DWC) data.

By Bill Cobb:

Every year the DWC does an audit of the entities that do claims handling (self-administered carriers, self-insured employers and third party administrators). The results of the 2011 audit are published on the DWC web site. I’ve been following the results of the audits since 2003. It has always been a major shame and disgrace on the work comp carriers and their agents. But, for some reason, no one has given it much attention.

At the heart of the results (as you will see) is one of the primary reasons why injured workers litigate their claims. [Editor's note - from the data analytics standpoint; anecdotally see the two examples above.] 

Based on figures published by the WCIRB:

·        California has approximately 550,000 employers.

·        There are approximately 16.5 million workers.

·        Each year there are over 500,000 workplace injuries.

·        Med-Only claims account for 79%.

·        Indemnity Claims account for the other 21%.

·        The average Med-Only claim costs $713.

·        The average Indemnity claim costs $6,728 – UNLESS it litigates, then it costs $62,700.

·        Litigated claims make up 43% of all indemnity claims.

·        Litigated claims account for only 9% of all claims, yet they take up 82% of the costs.

The outcome is a main driver that causes the cost of work comp for employers to go up.

Let’s go over the figures:

·        The DWC audited 3,410 files – out of 200,000+ open files.

·        Of these, 444 (13.02%) had compensation that was owed to the injured worker, but was not paid.

·        The average amount owed was $1,468.87. That represents 3 – 4 weeks of indemnity payments not paid on each of those claims.

I’m assuming the DWC chose only 3,410 files to audit because their statisticians thought it was representative of the entire population of claims.  [Editor's note - the process of selecting audit subjects is found in Title 8, Regulation 10106.1 and the actual procedure is in Regulation 10107.1.] If we extrapolate those figures out over the entire indemnity realm, here’s what we would find:

·        Total indemnity paid in 2011 was $2,957,000,000 – that’s accrued, not actually paid.

·        That would leave $176,264,400 (yes, millions) in owed, but unpaid, benefits in the files of the carriers and TPA’s.

This is money that is owed to the injured worker, but the payer is sitting on it. This causes a tremendous hardship on injured workers that are living from paycheck to paycheck. [Editor's note - also may be vendors seeking payment on legitimately owed bills but are being ignored or delayed as in the example anecdotes.]

So, let’s take a look at what the enforcement arm of the DWC did to punish the offenders:

·        The 444 files produced 4,465 violations.

·        The total dollar value of the violations cited was $1,411,128.

·        Of that figure, $1,209,325 was deemed ‘Not Subject to Assessment’.

·        The violators paid $201,803.

As you (or anyone for that matter) can see – it pays to cheat. They will get their hands slapped with only a small financial penalty and reporting in an obscure DWC filing.

Bill's idea is to:

·        Beef up the Audit Department so that EVERY file gets audited once a year.

·        It would be a ‘self-funding’ program based on a small premium surcharge to fund the initial startup.

·        Make EVERY violation subject to assessment and make them pay – or shut them down!

·        That should bring in $50 million to $100 million in assessments which can be used to fund the program.

·        Over the years, not only would the violations and assessments gradually reduce, so would litigation and, ergo, the amount of indemnity associated with litigation. The size of the audit unit could be reduced accordingly.

****************************

Radical? Yes. Objectionable by the claims community? Certainly. Effective? Beyond anyone's imagination, would be my guess.

As suggested by Bill's data, the two anecdotes above are certainly more representative than not.

So what have you Industry? Ready to put your money where your mouth is? 

***********

 Table of data:

	Total Audited - 2011			All Indemnity Paid - 2011
Total Files	3410	100%		Total Indemnity	$  2,957,000,000
Files with unpaid Indemnity	444	13.02%
Total Unpaid	$        652,178			Total Unpaid	$      176,264,400
Average Unpaid	$      1,468.87
Unpaid TTD	622.36	42.37%		Unpaid TTD	74,683,226
Unpaid PD	693.60	47.22%		Unpaid PD	83,232,050
Penalties	152.47	10.38%		Penalties	18,296,245

Repackagers Win FL Case, Or Do They?

The Florida 1st Court of Appeals (which handles all workers' compensation appeals in the state) concluded that a drug repackager, that had an assignment of receivables from physicians it contracted with, had standing to pursue collections against carriers.

Prescription Partners had contracts with various Florida doctors in which the doctors would assign their rights to payment for drugs dispensed to injured workers to the company. In exchange, Prescription Partners would pay the doctor a percentage of the claim's value, regardless of the amount Prescription Partners would ultimately collect.

Under Florida law, with limited exception, an employer or carrier must reimburse a medical provider for the full billed value of the services rendered to an injured worker. If full payment if not tendered, the employer or carrier must issue an Explanation of Bill Review setting forth the reason why it denied, disallowed or adjusted the payment.

Between 2011 and early 2012, Prescription Partners filed numerous petitions challenging alleged underpayments for medications dispensed to workers' compensation claimants, as was its standard practice. The Office of Medical Services adjudicated some in favor of Prescription Partners, but dismissed others as untimely.

Each time a petition was dismissed, Prescription Partners would receive a notice of the dismissal stating that it had a "right to an administrative hearing concerning this proposed agency action by the department under Sections 120.569 and 120.57, Florida Statutes."

Prescription Partners filed 96 requests for administrative hearings, but the Department of Financial Services dismissed them all last February as procedurally defective.

Prescription Partners amended and refiled 35 of them, and the department consolidated them all for an informal resolution by a hearing officer, who ultimately dismissed all of them on the grounds that Prescription Partners lacked standing, finding Florida Code Section 440.13(7)(a) only allowed "health care providers, carriers or employers" to file petitions, and Prescription Partners "fits into none of those categories."

 

Further, the department ruled that Prescription Partners did not fit within the statutory definition of a "party" under Section 120.52(13), because "its only interest in this proceeding is economic, to wit: the profit it expects to make by virtue of purported assignments of collection rights from individual doctors allowing it to retain all the monies it collects on their respective claims."

The 1st DCA said both of the hearing officer's conclusions were wrong. 

Since Physician Partners had an assignment of interests from its physician clients, it is "the party with the 'personal stake' in the outcome of the proceedings," as it "arguably stands to suffer immediate and significant monetary losses."

Physician Partners may have won the battle, but it is going to lose the war. This is the kind of case that outrages the public, outrages politicians, and just about everyone else that isn't on the payroll of the company.

Seeking to enforce a legal, but morally unjustifiable, position nearly always seals the deal on ponderous regulation. 

I have no doubt that there are some legitimate reasons, albeit limited, for repackaging and physician dispensing of pharmaceuticals.

But like anything else that is taken to extremes, when profit margins exceed reasonableness, and when cost trends spike sharply due to such profiteering, eventually the long arm of the law will seek control.

And Physician Partners' profit sharing deal with its clients are the kind of financial undertakings that promote questionable behavior.

Coincidentally, the same day that the 1st DCA opinion issued the Florida House Insurance and Banking Subcommittee approved House Bill 605, filed by Rep. Matt Hudson, R-Naples.

HB 605  would cap the price of repackaged drugs dispensed to injured workers at the average wholesale price set by the original manufacturer, plus a $4.18 dispensing fee.

The bill is now heading to the House Health and Human Services Committee. Three prior attempts to pass similar measures failed under intense lobbying by the repackaged drug industry.

But the Physician Partners case may be the end of politician's patience with the industry. At some point even those easily influenced by the political pandering of special interests get squeamish when court cases, and news stories, permeate the public conscience with tales of 100% to 400% (and sometimes even 700%) markups at a time when medical inflation is a huge public policy issue.

Repackagers may have met their match - themselves.

CA's AB 1138 - More Burdensome Paperwork

Onerous, punitive and impractical - that's how opponents describe California's recently amended Assembly Bill 1138 - and I'm one of them.

AB 1138, Ed Chau, D-Alhambra, was amended March 21 to add language that would require employers to post on their premises a list of all covered employees and update the information quarterly, or each time a covered employee is removed or added. The bill originally proposed nonsubstantive changes to a section of the Labor Code dealing with citations and penalty assessment orders on employers.

The recent amendments to AB 1138 would require employers to maintain a list of covered employees including names, addresses and the last four digits of Social Security numbers. The employers would have to provide the list to the Division of Labor Standards Enforcement (DLSE), the Department of Industrial Relations (DIR), the Department of Insurance, the Employment Development Department and its workers' compensation carrier.

The bill says “the exclusive remedy provision shall not apply for compensable injuries and illnesses suffered during a period that an employee is not included in a notice of covered employees or the list of covered employees.”

On top of that, the bill says that the “absence of the name of any employee on any notice of covered employees or any list of covered employees … conclusively establishes that the employer did not secure payment of compensation from an insurance carrier.”

Employers would be required to retain copies of all covered employee notices and lists for at least five years. Failure by an employer to retain each notice or each list or provide copies to DIR or DLSE would also conclusively establish that the employer was uninsured under the provisions in AB 1138.

Finally, an employer that fails to post a list of covered employees would face a fine of $100 per employee for the first violation and $500 per employee for additional violations. An employer that fails to turn over records when requested by a state agency is subject to a fine of $250 per employee for the first violation and $1,000 per employee for subsequent violations.

The bill is backed by the California Labor Federation - they say they don't intend to penalize honest employers but that they want employees to be able to see if they’re covered and make sure they actually are an "employee."

The goal, says labor, is to allow enforcement agencies, when making a call on an employer to audit employees versus independent contractors, to more easily discern which workers are, in fact, insured and which workers are not insured.

First off, most employers have no idea who is an independent contractor versus an employee under the eyes of the law - in particular since the standards concerning that distinction are different for Federal tax purposes and the definitions applicable to workers' compensation.

Second, employers already report on a quarterly basis employees to the Employment Development Department. Labor standards enforcement agencies should start there for the list of "employees" when the decide to audit an employer - no extra cost to the government or to employers since this is already in place.

Finally, I don't think any employee reads the mandated postings now, let alone some new posting with even more information. Most people don't care until something happens and some benefit is denied - then it's the lawyers that care and the issue of a posting becomes more of a litigation tool rather than an enforcement mechanism.

AB 1138 is just a bad idea and imposes more government on responsible employers and will do nothing to stop unscrupulous employers from subverting the law.

Chronic Pain, Opioids and Physician Risk

A few weeks ago I posted an opinion that Kentucky was leading the nation in the control of opioids.

Referencing their prescription drug database, KASPER, and a new law, I said opinions of the Kentucky Medical Association, Kentucky Pharmacy Association and Board of Medical Licensure that the new law was "workable" was "a pretty good endorsement for a law that has such broad and sweeping impact."

There are two sides (at least) to every story, and my opinion drew some criticism from some Kentuckians with first hand experience with the law and the KASPER system - their sentiments essentially were that Kentucky law (HB1) went too far, and that doctors now are too scared to prescribe ANY pain medication.

Here are some of the (edited) comments.

Justin wrote:

"I think someone should tell all the doctors in Kentucky that are refusing to treat chronic pain patients (even ones with clean KASPER's) since HB 1 (2012) was enacted that: 'the major players are, if not happy with the end result, at least are not unhappy with it.' and 'The Kentucky Medical Association, Kentucky Pharmacy Association and Board of Medical Licensure have indicated that the changes made by HB 217 are workable.' Because to a chronic pain patient in Kentucky who is unable to get their pain medications since HB1 was first enacted back in July of 2012, HB1 is pretty flippin' far from 'workable'!

"Since HB1 was passed in July of 2012, people in pain from all walks of life and from all kinds of circumstances have been unable to get treated for their pain! This includes chronic pain patients, emergency room patients, and even some hospice patients (which are some of the reasons why HB 217 was passed so darn quickly!). Chronic pain patients who have been going to the same doctor for years, who have taken the same medications for years without incident, and who have clean KASPER’s, can no longer get their pain medications because of HB 1! Doctors all over KY are now afraid of losing their license or being investigated by the DEA because of HB 1- they have been dropping their chronic pain patients left and right because they are afraid to prescribe any kind of narcotic to anyone for any reason!"

"HB 1 is a piece of 'shotgun legislation.' It was not well thought out, it had little input from the medical community, and no input from the people affected most by this heinous law- the chronic pain patients that depend on these medications for a certain quality of life! HB1 punished the many innocent for the acts of the guilty few!"

Laura added:

"HB1/HB217 does not address the needs of patients with chronic pain. While prescription drug abuse does need to be curtailed in Kentucky, this law passes the consequences of drug abuse from the abusers onto the backs of law abiding citizens and hard-working Ky families."

"Law abiding citizens who are the victims of violent crime, bad medicine (such as the rash of faulty female reproductive appliances such as Mirena and the Vaginal Mesh, and faulty replacement hips), and injured veterans should not have to suffer in pain or be treated like criminals because they need pain care."

Kim said:

"Not aware of any lab tests or diagnostic studies that can confirm three of my diagnoses: fibromyalgia, restless legs syndrome, or interstitial cystitis. Where would that put me in the "angry patients" theory that sorts out the fakers by confirming their need for pain medications through lab and x-ray results?"

Shiela wrote:

"This law was aimed at stopping abuse which is a great idea, however I do not think law makers thought this through on how it would hurt many many people. When people have had TEST AFTER TEST (TESTS SUCH AS MRI'S CATS SCANS, PET SCANS, EX-RAYS, ULTRA SOUNDS, ECHO'S ECT DO NOT LIE) to prove they have the medical condition in which they need medication for and Doctors will NOT even allow them to come to their office due to fear this law has created is a travesty. I for one have seen many many people suffer, including a family member that received a organ transplant and was allowed 3 days worth of pain medication after being released from UK hospital."

ewoods commented:

"The doctors should not stop treating patients just because they are being asked to run backgrounds on people. As soon as the law was signed my doctor refused to help me with my pain anymore. So why is it we have to suffer while the doctors can turn their back on us patients, and for those of us with no insurance we cannot afford to go to a pain clinic and there are very few that accept cash."

Sick & Tired stated:

"Lawmakers obviously didn't consider the suffering of cancer, hospice/end of life and surgery pain to begin with. Are we to assume they didn't have the knowledge or do they lack compassion or both? It's scary to think they're deciding who suffers and who doesn't. ... I've never been to a pill mill but thanks to HB 1 my legitimate doctor can't prescribe this legitimate chronic pain patient with the small amount of medication that helped make life worth living without too much suffering."

Perhaps its serendipity, but a recently introduced California bill, SB 410 (Leland Yee, D-San Francisco), would give state physicians immunity from disciplinary action for prescribing and dispensing dangerous drugs to treat chronic pain.

The bill, which is sponsored by the California Society of Anesthesiologists, would amend Business and Professions Code Section 2241.5 to say, “A physician and surgeon may prescribe for, or dispense or administer to, a person under his or her treatment for a medical condition dangerous drugs or prescription controlled substances for the treatment of pain or a condition causing pain, including, but not limited to, chronic pain or intractable pain.”

Presently the Intractable Pain Law, which was enacted in 1990, says a physician should exercise “reasonable care” to determine when a referral or consultation with a more qualified pain or addiction specialist is necessary. It also notes that “no physician and surgeon shall be subject to disciplinary action for prescribing, dispensing or administering dangerous drugs or prescription controlled substances in accordance with this section.”

The opposition to SB 410 says that under Yee’s bill, a doctor could prescribe narcotics to anyone who reports any kind of pain, not just to cancer patients or patients with other terminal diseases.

The debate, the experiences of those in Kentucky, the difficulty in drafting laws to accomplish reasonable controls over pain medication while still providing adequate enforcement provisions and protection of patients, shows how incredibly difficult it is to accommodate the needs of society.

The problem is a uniquely complex balancing of the needs of law-abiding, chronic pain sufferers seeking some semblance of quality of life versus unscrupulous profiteers with no respect for the law or the health of individuals.

I don't have a solution. I do appreciate the complexity of the issue and it is likely that many others, such as those who took the time to write me from Kentucky, will be unnecessarily adversely affected while the profiteers find some other way to advance their own interests.

Survey Shows Work Comp Foreign to Immigrants

The New Hampshire Department of Health and Human Services (DHHS) reported that a recent survey of immigrants on occupational health and work safety showed that most of them never heard of workers' compensation.

In order to assess knowledge of workers’ compensation, participants were asked if someone in the U.S. ever told them that their medical bills would be paid by workers’ compensation insurance if they are hurt because of their work. If respondents answered yes, they were asked to write down who told them.

227 participants out of 366 (62%) were not aware of workers’ compensation. Only 76 individuals out of 126 who said yes to understanding workers’ compensation wrote who told them. Sources identified included supervisors, human resources, family members, friends, doctors, co-workers, teachers, and NH Coalition of Occupational Safety and Health (COSH) through safety training classes.

Of the 366 participants in the survey, 29 noted they had been injured at work.

Common body parts affected included hands, fingers, wrists, backs, knees, feet, elbows, and abdominal regions.

The majority of those injured on the job had been in the U.S. for either 4-6 years or 6+ years.

Out of those 29, 17 were lost time claims.

23 told their supervisors of their injuries. 4 did not report their injuries because they left the job due to the injuries, a finger cut was not considered "serious," one felt that if the injury had been reported "nothing would change," and one said they would be fired.

The survey reflects that the respondents felt that their jobs involved injurious work conditions more often than not, which would be reflective of the manual labor conditions one would expect immigrant labor to be performing.

Of these conditions, respondents felt more often than not that safety issues were known but not taken seriously.

But the overall experience of respondents is that there is generally good supervisor support and that "bad treatment" was almost never experienced.

The top three jobs reflected in the survey were factory/production, cleaning, and food service - in total representing 67% of all job responses.

Perhaps reflecting a shift in immigration patterns, 44% reported country of origin being Asia with other nationalities substantially less.

The sampling reflected 28% with some college education, and 32% graduating high school levels.

It's a small sampling so the study has its limitations - those are noted in the report. Nevertheless it is telling that even with a relatively educated immigrant working population, workers' compensation seems either misconstrued or suspect as a protection system.

The report is here.