What You Need To Know About The Cage-aid Questionnaire And Workers’ Compensation

Workers’ Compensation Medical Treatment can employ various questionnaires to assess an Injured Workers’ need for treatment.  One of these questionnaires is called CAGE-AID.

This article will discuss the purpose of the CAGE-AID questionnaire, how it is used in an industrial treatment setting, and how it may impact an injured worker’s treatment.

What is the CAGE-AID Questionnaire? 

The CAGE-Aid questionnaire is a substance abuse screening tool.  Substance abuse applies to alcohol, legal drugs and street drugs.

Why is Substance Abuse a Problem with Workers’ Compensation Treatment?

Substance abuse is a multi-factorial problem in workers’ compensation.  There are workers who, prior to their injury, have histories of either substance or alcohol abuse.  Further, there are workers, as a result of their injuries, begin to abuse drugs or alcohol.   This abuse can either be with prescription drugs, alcohol, or street drugs.  Finally, there are injured workers who, not as a result of their work injuries, engage in substance abuse.

Why is The Questionnaire  Called CAGE?

The abbreviation refers to some of the terms within the questions. The terms are cut, annoyed, guilty and eye opener.

What are the Questions Asked?

There are four questions.  They are:

Have you ever felt that you ought to cut down on your drinking or drug use?

Have people annoyed your by criticizing your drinking or drug use?

Have you ever felt bad or guilty about your drinking or drug use?

Have you ever had a drink or used drugs first thing in the morning to steady your nerves or get rid of a hangover (eye opener)?

How is it Scored?  

It is scored one for yes and zero for no.

How is The Score Interpreted? 

If one or more responses is yes, then it is regarded as a positive screening test.  Thus, possible substance abuse is something that the medical provider should explore with the partient.

How Should Injured Workers Answer the Questions?

These questions may impact medical treatment decisions.  Medical providers need accurate information in order to provide appropriate treatment.  Substance abuse, when combined with prescription drugs, can lead to harmful and deadly drug interactions.   Therefore, it is important to be honest when answering the questions.

Additionally, if an injured worker has a substance abuse problem that is preventing their recovery from a work injury, it is possible that the workers’ compensation medical system may provide some assistance with respect to substance abuse treatment.  This, however,  would be subject to the limitations within Labor Code Section 4600.

What If I Need Advice?

If you would like a free consultation regarding workers’ compensation, please contact the Law Offices of Edward J. Singer, a Professional Law Corporation. We have been helping people in Central and Southern California deal with their workers’ compensation cases for over 28 years. Contact us today for more information.

 

firefighter's cloths on a fire truck

EXERTIONAL HEAT SYNDROME: HEATED WORK ENVIRONMENTS, WORK INJURIES AND WORKERS’ COMPENSATION: WHAT YOU NEED TO KNOW

Heat Exertion can produce serious injuries in the workplace. The medical condition is commonly known as Exertional Heat Illness (ESI.) Heat Illnesses are multi-causal. Human’s body temperatures can be elevated by a number of factors. First, there is the heat and humidity in the environment. Second, there is the clothing and equipment being used by the worker. Third, there is the nature, extent and the duration of the activities.

This article is focused towards the Heat Exertion as opposed to the Heat Exposure. Note: Heat Exertional Illness is a huge concern for military. Thus, this matter has been studied within that context. Heat Exertion is a concern for all military personnel. Even Military Working Dogs have been studied. Predicting military working dog core temperature during exertional heat strain: Validation of a Canine Thermal Model Catherine O’Brien William J.Tharion Anthony J.Karis Heather M.Sullivan https://doi.org/10.1016/j.jtherbio.2020.102603Get rights and content

In the civilian setting, there are also various occupations that involve serious issues that can bring rise to heat exertional illness.

This article will discuss Heat Exertion Illness, risk factors involved with HEI, the nature and extent of injuries arising from heat exertion, and how it can be addressed within a workers’ compensation setting.

What Is Exertional Heat Illness (EHI)?

Exertional Heat illnesses (EHI) is essentially a variety of medical conditions that may occur during physical exertion that is performed in hot and humid environments. This can be the case when there is performance of strenuous physical activities for extended durations in hot environments.

In the civilian workforce, HEI may impact occupations such as Agriculture, Construction Workers, Police Officers, and Refinery Workers.

For instance, with respect to Wildland Fire Fighters, a study noted the nature and extent of the clothing and equipment that they carry. The study noted that “WLFFs wear standard fire equipment: Nomex long-sleeve shirt and pants, mid-calf leather logger boots, a 100% cotton short-sleeve undershirt, leather gloves, hard hat, and a 12 to 20 kg pack containing food, water, safety gear, and work tools.” High Work Output Combined With High Ambient Temperatures Caused Heat Exhaustion in a Wildland Firefighter Despite High Fluid Intake John S.Cuddy MS Brent C. Ruby PhD https://doi.org/10.1016/j.wem.2011.01.008

Why is EHI a Serious Concern?

Due to the fact that EHI can cause a variety of medical conditions, there is also a wide range of medical problems that EHI can cause.

Mild forms of EHI can include heat cramps. Severe forms of EHI can include heat stroke. Severe EHI can lead to multiorgan damage and death. Alele FO, Malau-Aduli BS, Malau-Aduli AEO, J Crowe M. Epidemiology of Exertional Heat Illness in the Military: A Systematic Review of Observational Studies. Int J Environ Res Public Health. 2020 Sep 25;17(19):E7037. doi: 10.3390/ijerph17197037. PMID: 32993024.

Does Body Temperature Play a Role?

Yes. Body Core Temperature plays a role in the severity of the injury. Temperatures less than 40 degrees Celsius (104 degrees Farenheit) percent are associated with milder symptoms and temperatures greater than 40 degrees Celsius brought on more serious symptoms which provided central nervous system symptoms such as dizziness, confusion, and loss of consciousness. Alele FO, Malau-Aduli BS, Malau-Aduli AEO, J Crowe M. Epidemiology of Exertional Heat Illness in the Military: A Systematic Review of Observational Studies. Int J Environ Res Public Health. 2020 Sep 25;17(19):E7037. doi: 10.3390/ijerph17197037. PMID: 32993024.

What are the Main Risk Factors in EHI?

There are a variety of risk factors that can impact EHI. The main risk factors in the study were gender, physical fitness, obesity, previous history of heat illness, motivation, hot environmental conditions, and service unit. Alele FO, Malau-Aduli BS, Malau-Aduli AEO, J Crowe M. Epidemiology of Exertional Heat Illness in the Military: A Systematic Review of Observational Studies. Int J Environ Res Public Health. 2020 Sep 25;17(19):E7037. doi: 10.3390/ijerph17197037. PMID: 32993024.

“[T]these risk factors into three groups—host (individual physiologically limiting), environmental and organizational (training organization) factors. Supra.

Are There Risk Factors of Interest?

Yes.

Females were more likely to experience EHI than males.

High Body Mass Index (BMI) individuals are more likely to experience EHI.

Lower Physical Fitness individuals are more likely to experience EHI.

Over Motivated Individuals are more likely to experience EHI. One reason being is that they may not pace themselves.

A prior history of heat illness makes individuals more susceptible to heat stroke or severe heat illness.

Hot conditions such as summer seasons and in hot weather conditions make individuals at greater risk of EHI.

Some Units, task dependent and equipment dependent groups, can have increased risk of EHI versus other units. . Alele FO, Malau-Aduli BS, Malau-Aduli AEO, J Crowe M. Epidemiology of Exertional Heat Illness in the Military: A Systematic Review of Observational Studies. Int J Environ Res Public Health. 2020 Sep 25;17(19):E7037. doi: 10.3390/ijerph17197037. PMID: 32993024.

If a Worker is Suffering from a Heat-Related Illness, What Should They Do?

If the Injured Worker was exposed to excessive heat in the workforce, they can consider filing a workers’ compensation claim. This would allow them to claim medical care, monetary benefits in the form of temporary and permanent disability benefits. Also, vocational rehabilitation benefits may be indicated. If a fatality situation, a death claim for the dependents may be indicated.

What if I Need Advice?

If you would like a free consultation regarding workers’ compensation, please contact the Law Offices of Edward J. Singer, a Professional Law Corporation. We have been helping people in Central and Southern California deal with their workers’ compensation cases for 27 years. Contact us today for more information.

ALTERED MEDICAL STATES (AMS) AND WORKERS’ COMPENSATION: INJURED WORKERS, MENTAL STATUS, AND WORKERS’ COMPENSATION: WHAT YOU NEED TO KNOW

Altered Medical States (AMS) is a medical condition of import within the Workers’ Compensation System.  Irrespective of whether the Injured Worker’s AMS is work-related or not, the fact that an Injured Worker has such a condition which may impact their ability to communicate and their ability to understand is of concern.

Workers’ Compensation is a medical-legal system.   An Injured Workers with an altered medical state raise both medical and legal concerns.  The Workers’ Compensation System requires Injured Workers to provide truthful and accurate information.   The System also allows for Injured Workers to enter into binding contracts and agreements.   Therefore, an Injured Worker’s mental state is important.

This article will discuss Altered Medical States, how Altered Medical States can impact medical treatment and reporting,  and how Altered Medical States can impact Workers’ Compensation Litigation.

What is an Altered Medical State?

Altered Medical State can range from “total loss of consciousness to extreme excitation.” Evaluation and treatment of altered mental status patients in the emergency department: Life in the fast lane Hai-yu XiaoYu-xuan WangTeng-da XuHua-dong ZhuShu-bin GuoZhong Wang, and Xue-zhong Yu World J Emerg Med. 2012; 3(4): 270–277 doi: 10.5847/wjem.j.issn.1920-8642.2012.04.006 PMCID: PMC4129809 PMID: 25215076

Altered Medical States include central nervous system inhibition which can include coma, drowsiness, and confusion.   It can include central nervous system stimulation including irritability and aggressiveness. It can include “abnormal behavior.” Supra.

What Are the Medical Causes of Altered Medical States?

There are many reasons as to why someone may have an Altered Medical State.  Many of these AMS conditions can be work-related.  Medical Causes of AMS include both Neurological and Non-Neurological Causes.

AMS causes differ based upon based upon age. Top causes of AMS for elderly patients can include cerebrovascular disease, systemic or organic failure and infection.   Top causes for non-elderly are drugs and toxic factors, systemic and organic failure, and metabolic and endocrine disorders.  Supra.

Various causes of AMS can include drugs and substance intoxication, infection, metabolic endocrine abnormalities, trauma, cancer, and system/organ dysfunction.  This can include acute alcoholism. It can also be caused by trauma, i.e. head trauma, and infection. Supra.

What are the Workers’ Compensation Concerns with respect to Injured Workers with AMS?

With respect to the Workers’ Compensation Claim, an Injured Worker with an altered medical state can have problems with respect to the medical-legal reporting to support the claim of injury.   If the work injury caused an altered medical state, then there is a likelihood that the immediate medical treatment may not have an accurate history as to how the injury/medical condition was work-related.    For example, there are times when an Injured Workers are found unconscious and is then sent for medical treatment.   In those circumstances, the initial medical providers may not be able to document any information that can support the work injury.

Altered Medical States can also be when an Injured Worker is attending workers’ compensation related medical appointments.   Injured Workers may be taking prescription medications that impact their abilities to comprehend and answer questions posed by medical providers.   This again can impact the quality of the medical-legal reporting as to both the history of injury and ongoing complaints.

An individual may be so intoxicated that evaluations may be terminated.   This problem does not only relate to prescription medications.   Injured Workers may consume alcohol or take street drugs that may impact their mental state.

In sum, there can be work-related and non-work related AMS issues which impact medical treatment and medical-legal reporting.

Additionally, there are some Injured Workers that suffer from severe mental health issues where they have problems being communicative.   Further, these Injured Workers may have such problems where the evaluators have serious doubt as to whether they can provide accurate information.

What are the Legal Concerns of Altered Medical States?

The Workers’ Compensation System is a legal system and statements made by Injured Workers are placed under a legal microscope.   False Statements can lead to allegations of Workers’ Compensation Fraud.   Criminal penalties can apply.

Thus, there is a concern as to whether an Injured Worker with an altered medical state is capable to speaking the truth.   For example, if the Injured Worker is having hallucinations, there may be some question as to whether they know what they are doing and saying.  Additionally, an Injured Worker may be taking medications when they are having their deposition taken.   The medications may impact on their ability to understand and answer questions in a truthful fashion.

Thus, if an Injured Worker has AMS issues, it is important that AMS be documented.  It may be needed to address accusation so fraud.  Note: there are three times in which reporting may be required: medical examinations and evaluations, the Injured Worker’s deposition, and the Injured Worker’s trial.

What Should Be Done with Respect to Injured Workers with AMS? Temporary versus Permanent AMS?

If an Injured Worker has a permanent AMS state, the use of a Guardian Ad Litem is indicated.   In other words, a trusted person, i.e. parent or spouse, should be appointed by the Workers’ Compensation Appeals Board to make decisions with respect to the case.

If the Injured Worker has a temporary AMS state, the parties should all take careful consideration that the Injured Worker is understanding what is going on and is making their decisions and statements in an unaltered state.   If there is some settlement, the fact that the individual is capable of entering into the agreement should be documented.

What If I Need Legal Advice?

If you would like a free consultation concerning any workers’ compensation case, please contact the Law Offices of Edward J. Singer, a Professional Law Corporation. They have been helping people in Central and Southern California deal with their worker’s compensation cases for 28 years. Contact us today for more information.

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