HEALTHCARE WORKERS, VIOLENT PATIENTS AND WORKERS’ COMPENSATION: WHAT YOU NEED TO KNOW

Healthcare Systems have a high incidence of workplace violence.   Healthcare Workers experience five times the amount of violence in comparison to the average worker in the United States.

Violent acts can cause work injuries both of a physical and mental nature.  Healthcare Workers, in these circumstances, may seek medical treatment and compensation via Workers’ Compensation.

This article will discuss the nature of the term “violence”, a worker’ compensation law addressing violent acts, the nature of violent encounters, and the rates of violence.

What Is Violence?

Violence can mean different things. There is physical violence, i.e. a patient striking a nurse,  and there is verbal violence, i.e. a patient threatening a nurse’s life.

Research has a more expansive definition. ” In the most basic of explanations, violence may present in the form of verbal threats, aggressive language, or escalate to physical assault.”

Verbal harassment includes racial slurs, attacking appearance or perceived sexual orientation, cursing, yelling at, or berating another person.”

Sexual harassment includes unwelcome sexual advances, insulting gestures, and verbal or physical conduct of a sexual nature.”

Verbal threats include statements of intent to cause harm, and threatening body language or gestures.”

Physical violence includes spitting, biting, pulling hair, and any other type of unwanted physical contact intending to cause harm.” Pitts E, Schaller DJ. Violent Patients. 2021 Jul 12. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan–. PMID: 30725966.

Comment:  The definition of violence used by researchers is quite expansive nature. .Hharassment  such attacks on  race, gender or sexual orientation have been included.

How Does Workers’ Compensation Laws Address Violence?

California Workers’ Compensation Law addresses both the physical and verbal aspects of violence.  Workers’ compensation claims can be filed for injuries that are physical in nature.  Thus, if a nurse was assaulted and hurt their back, they can get treatment and compensation for the claim.  Further, a nurse was subjected to racial harassment, they would be able to pursue a psychological or stress injury.  Sometimes, violence can lead to both physical and mental injuries.  A claim can include both types of injuries.

Are There Any Special Laws Concerning Violent Acts?

Yes. The threshold for psychiatric claims of injury is lowered if there is a claim of violence.  Labor Code Section 3208.3 provides that “ in the case of employees whose injuries resulted from being a victim of a violent act or from direct exposure to a significant violent act, the employee shall be required to demonstrate by a preponderance of the evidence that actual events of employment were a substantial cause of the injury.” Substantial is defined as 35 to 40 percent.

How Significant Is It Within the Health Care Industry?

“In 2016, health care workers made up 69% of all reported workplace violent injuries, according to the Bureau of Labor and Statistics.” Pitts E, Schaller DJ. Violent Patients. 2021 Jul 12. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan–. PMID: 30725966.

In sum, an overwhelming amount of workplace violence occurs within the healthcare profession.

Are There Different Violence Rates Among Occupation?

Yes. Violence rates can vary based upon occupation and sex.

Paramedics

They are subject to the highest amount of verbal violence

Nurses/Physicians

They are subject to the highest amount of verbal threats

Nurses

They have the highest rate of violence threats by visitors.

Female Nurses

They are at far greater risk of being a victim of violence versus their counterpart.

Pitts E, Schaller DJ. Violent Patients. 2021 Jul 12. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan–. PMID: 30725966.

Who Commits the Violence in Healthcare Settings? 

Males, 35 years and younger, have been found to be the highest offenders of violence against healthcare professionals.” Pitts E, Schaller DJ. Violent Patients. 2021 Jul 12. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan–. PMID: 30725966.

It has been found that 9 factors can be indicators of violence at the time of admissions. These include a “diagnosis of psychosis or bipolar disorder, history of psychiatric disorder, male gender, age younger than 35 years, below-average intelligence, no history of employment, homelessness, and agitated behavior.” .” Pitts E, Schaller DJ. Violent Patients. 2021 Jul 12. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan–. PMID: 30725966.

What Are the Causes of Violence in the Health Care?

The Healthcare system, but its very nature, has elements that can contribute to violence.  These include “[[l]ong waiting times, lack of security, lack of adequate staff, and patient areas being open to the public.” .” Pitts E, Schaller DJ. Violent Patients. 2021 Jul 12. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan–. PMID: 30725966.

Are There Other Factors that Can Impact Violence in Health Care?

“There are many factors thought to increase the risk of violence among ED workers, including an increased number of patients and visitors using alcohol and drugs, psychiatric disorders, dementia, the presence of weapons, stressful environment, overcrowding, prolonged waiting times, and flow of violence from the community into the ED.” Pitts E, Schaller DJ. Violent Patients. 2021 Jul 12. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan–. PMID: 30725966.

Is There Anything Special About Emergency Departments?

Emergency Departments have a number of factors that can contribute to violence they can include “an increased number of patients and visitors using alcohol and drugs, psychiatric disorders, dementia, the presence of weapons, stressful environment, overcrowding, prolonged waiting times, and flow of violence from the community into the ED.” Pitts E, Schaller DJ. Violent Patients. 2021 Jul 12. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan–. PMID: 30725966.

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 27 years. Contact us today for more information.

Workers’ Compensation In the News, Episode # 3: Even Super Heroes Get Hurt: What You Need to Know

Holy Cow Batwoman! Pow, Kabam! Ouch!

Ruby Rose, who played Batwoman, on the CW Television Show reported that she sustained two injuries while working on the program.

While wearing a latex Batwoman Mask, she developed an allergic reaction.  She also had an accident on the set which required back surgery. foxnew.com

Can An Allergic Reaction Be An Industrial Injury? 

Yes. Allergic reactions can be work-related injuries.  If so, the Injured Worker will receive medical treatment paid for by the insurance company as well as monetary compensation.

Allergic Contact Dermatitis (ACD) is an inflammation of the skin caused by an immunologic reaction triggered by dermal contact to a skin allergen. For ACD to occur, a worker must be first sensitized to the allergen. Subsequent exposures of the skin to the allergenic agent may elicit an immunologic reaction resulting in inflammation of the skin. The reaction is not confined to the site of contact and may result in systemic responses. ACD may be caused by industrial compounds (i.e. metals, epoxy and acrylic resins, rubber additives, chemical intermediates), agrochemicals (i.e. pesticides and fertilizers), and commercial chemicals.

A common allergic reaction is latex allergies. Per the CDC, Latex Gloves have proved effective in preventing transmission of many infectious diseases. But for some workers, exposures to latex may result in allergic reactions. Reports of such reactions have increased in recent years–especially among Health Care Workers.

Can An Accident at Work Be An Industrial Injury? 

Yes. Workers’ Compensation is “no fault.”  Thus,  if Ruby Rose had hurt her back by an accidental trip, she would still be able to have a valid claim.  The claim would have paid for her back surgery, paid her compensation for her time off of work as well as provided her additional benefits.

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 27 years. Contact us today for more information.

AMPUTATIONS AND WORKERS’ COMPENSATION: WHAT YOU NEED TO KNOW

Amputations can be a life-changing event for a Worker.  Workers may lose their ability to perform their job as well as perform activities of daily living.

The Workers’[ Compensation Community is concerned about amputation cases as they involve  extensive medical costs and missed time from work.

This article will discuss amputations, special laws concerning amputations, and interesting data derived from a recent study.

What Is an Amputation?

The Workers’ Compensation Appeals Board defined amputation.  In Cruz vs. Mercedes Benz, 72 C.C.C. 1281 (Panel Decision), the WCAB indicated “ Defining amputation as the severance or removal of a limb, part of a limb, or other body appendage comports with the ordinary meaning, and includes the range of potentially compensable scenarios, including both traumatic loss of a body part in an industrial injury and surgical removal during treatment. This definition conforms to our understanding of the common meaning of the term “amputation,” which encompasses external projecting body parts, not internal parts, even if they include bone. It is also consistent with the definitions in the International Dictionary of Medicine and Biology, Dorland’s Illustrated Medical Dictionary, and Stedman’s Medical Dictionary. To the extent that some definitions refer to organs, appear to encompass all body parts, or include an equivocal “etc.,” we reject them or interpret them in a manner consistent with our understanding of the term “amputation.”

Thus, surgery on a lumbar disc was found not to constitute an amputation.

Why Is an Amputation Important in California Workers’ Compensation?

An amputation in a workers’ compensation case triggers entitlement to additional periods of total temporary disability. 240 weeks is allowed in the case of amputations. Labor Code Section 4656.  In these cases, there is no requirement that the temporary disability period be connected to the amputation. Jon Van Ness, Applicant v. Barbara Herzstein, 2007 Cal. Wrk. Comp. P.D. LEXIS 239 (Panel Decision)

How Do Amputations Occur on an Industrial Basis?

Occupationally related amputations can occur for many reasons.  The accident itself can be the source of the amputation, i.e. a skill saw cutting off a finger.  They can result of a crush injury which necessitates an amputation. They can be the result of post-surgical infection.  They can be the result of an industrially related disease process such as diabetes.

Interesting Amputation Facts Are:  

Males vs. Females

Men sustain most of the work-related amputations.  (84.8%) Gomez NG, Gaspar FW, Thiese MS, Merryweather AS. Trends in incidence and correlation between medical costs and lost workdays for work-related amputations in the State of California from 2007 to 2018. Health Sci Rep. 2021 Jul 1;4(3):e319. doi: 10.1002/hsr2.319. PMID: 34250271; PMCID: PMC8247939.

Full-Time vs. Part-Time Employees

Full-Time Employees were more likely to sustain amputation versus Part-Time Workers. (71.7%.) Supra.

Most Amputated Parts

Most claims consisted of partial-hand amputations (82.0%).  Most of those were partial-hand amputations, 66.7% were fingers without the loss of the thumb. Following partial-hand amputations, partial-foot amputations were the next most common claim  at 5.9%.  Supra.

Type of Business

Manufacturing is the industry with the highest number of claims (24.1%.) Supra.

What Should an Injured Worker Take from This Study?

The study noted that “[a]mputations represent high medical costs and number of lost workdays.” Gomez NG, Gaspar FW, Thiese MS, Merryweather AS. Trends in incidence and correlation between medical costs and lost workdays for work-related amputations in the State of California from 2007 to 2018. Health Sci Rep. 2021 Jul 1;4(3):e319. doi: 10.1002/hsr2.319. PMID: 34250271; PMCID: PMC8247939.

Due to the increased medical expense and missed time from work, Insurance Companies will make efforts to control the costs.  They may do so by employing a Defense Counsel as well as a Nurse Case Manager.

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 27 years. Contact us today for more information.

THE EMPLOYEE’S DISABILITY QUESTIONNAIRE AND WORKERS’ COMPENSATION: WHAT YOU NEED TO KNOW

Injured Workers, in their Workers’ Compensation Claim, may be evaluated by a Qualified Medical Evaluator (QME) or an Agreed Medical Evaluator (AME.)

With respect to these Evaluations, Injured Workers are required to fill out a variety of forms.     The DWC-AD Form 100 is one of those forms. It is the “Employee’s Disability Questionnaire.”

This article will discuss the “Employee’s Disability Questionnaire,” the questions that are asked, and how an Injured Workers’ case can be impacted  the form.

Why is the DWC-AD 100 A Disability Evaluation Unit (DEU) Form?   

QME reports or AME reports are sent to the Disability Evaluation Unit (DEU) are often sent to the DEU for a rating.  Ratings determine Injured Workers’ Permanent Disability Percentages.

The form’s questions assist the DEU with information that impacts the rating formula.

What Is the Form’s Purpose?

The form is intended to “aid the doctor in determining your permanent impairment or disability.”

Who Gives the Injured Worker the Form?

Generally, the form may be sent to the Injured Worker in advance of the QME or AME evaluation.   Sometimes, the evaluator’s offices will provide it to the worker.

What Happens to the Form?  

The evaluator includes the form as part of their report.  Insurance Companies, Attorneys and Injured Workers will receive it.  For Unrepresented Injured Workers, the report, with the form,  will be sent to the DEU for a rating.

What Questions Are Asked?

General identification information are requested which include providing your name, your social security number, your mailing address, your date of birth, and your date of injury.

You will also be asked your Employer’s Name, and the nature of Employer’s Business.  You will be asked for the insurance company’s claim number(s.)

There are questions about the evaluation. You will also be asked how the Evaluator was selected.  This can be by panel, agreement or sometimes at the request of a Workers’ Compensation Judge.   They will ask evaluation details including the name of the doctor and the date of the examination.

Your will be asked about your job duties at the time of injury.

You will be asked about the disability caused by your injury. Note:  Since this is form is attached to the QME report, it is your one opportunity to write down your unedited and unfiltered complaints. Judges, Insurance Companies, and Attorneys will be able to view your form and compare them to the QME’s reporting.

You will be asked about how the injury affects your work. Note: again, this is your one opportunity to write down to tell everyone involved your unedited and unfiltered opinion.

You will be asked as to whether you had a disability as a result of another injury or illness, If so, they ask you when and to describe it.

Why Are These Answers Important?

Your questionnaire’ answers assist the DEU with generating a Permanent Disability Rating.  The for helps the DEU specifically with two issues: Occupational Group Number and Apportionment.

The Occupational Group Number can change a disability rating.  It can cause it so go up, go down or remain the same.

The DEU will use the form to address apportionment.  The questions provides information for  the Disability Evaluation Unit so that they may make an annotation concerning apportionment.   Apportionment determines how much of the disability relates to the injury.  DEU ratings will often contain notes on apportionment.

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 27 years. Contact us today for more information.

CALIFORNIA BACK INJURIES AND TREATMENT GUIDELINES: EVIDENCE BASED MEDICINE (EBM) AND WORKERS’ COMPENSATION:  WHAT YOU NEED TO KNOW

California Workers’ Compensation has embraced Evidence Based Medicine (EBM) to dictate industrial medical care authorization.

Thus, when a EBM study is published, the Workers’ Compensation Community looks to its conclusions. The community looks to see the results are aligned with the Labor Code’s mandate to provide treatment to cure or relieve from the effects of an industrial injury.

Back Injury treatment was assessed in a recent EBM study.  They looked to see if  guidelines treatment achieved favorable results.  The results of such a study can shape both insurance company and medical office policy.

This article will discuss the study which looked at California back injury treatment in light of EBM-related guidelines.

What Is Evidence Based Medicine?

Evidence Based Medicine “…integrates medical research with clinical expertise and patient values to support decision making based on the best available evidence.” Gaspar FW, Thiese MS, Wizner K, Hegmann K. Guideline adherence and lost workdays for acute low back pain in the California workers’ compensation system. PLoS One. 2021 Jun 17;16(6):e0253268. doi: 10.1371/journal.pone.0253268. PMID: 34138937; PMCID: PMC8211224.

In other words, an Injured Worker’s treatment is geared more towards past research and study results. The Injured Worker’s treating physician’s clinical impressions are viewed as secondary. Thus, EBM-like treatment is provided in an algorithmic or formulaic fashion.

What Was the Study’s Purpose?

“The aim of this study was to determine the influence of adherence to guideline recommendations on lost workdays for workers with acute LBP(low back pain) claims in California’s WC system.” Gaspar FW, Thiese MS, Wizner K, Hegmann K. Guideline adherence and lost workdays for acute low back pain in the California workers’ compensation system. PLoS One. 2021 Jun 17;16(6):e0253268. doi: 10.1371/journal.pone.0253268. PMID: 34138937; PMCID: PMC8211224.

In other words, treatment currently can be in a number of modality forms.  Some are within guidelines, some treatment which is not recommended by guidelines and some others.  During an accepted claim, Injured Workers’ treatment are usually authorized.  Sometimes, authorized treatment can be ones that are outside of the guidelines.

What Is Guideline Treatment?   

Guideline treatment is based upon the “American College of Occupational and Environmental Medicine (ACOEM)’s Low Back Disorders Practice Guideline was used as the source of guideline recommendations [16]. ACOEM’s treatment guidelines have been adopted in California’s Medical Treatment Utilization Schedule (MTUS), which determines what is reasonable and necessary medical care.” Gaspar FW, Thiese MS, Wizner K, Hegmann K. Guideline adherence and lost workdays for acute low back pain in the California workers’ compensation system. PLoS One. 2021 Jun 17;16(6):e0253268. doi: 10.1371/journal.pone.0253268. PMID: 34138937; PMCID: PMC8211224.

What Is the Criticism of the Study? 

The study did not look at every back condition.  The study limited itself to very specific back conditions.  Thus, the results are very limited.  The danger of such a study it will be interpreted to apply to back conditions that were not part of the study.

As noted in the study, “to focus on the treatment of uncomplicated LBP claims, claims were removed if they had an inpatient admission during the claim or a “red flag” diagnosis that may indicate treatment outside of guideline recommendations, such as fracture, cancer, infection, aortic aneurysm, and paralysis (S1 Table). Claims were excluded with stenosis diagnoses if they also had an accompanying surgical procedure (i.e., decompression, fusion, or adhesiolysis). Claims were also excluded if there had been a prior LBP claim to remove complicated clinical presentations due to LBP recurrences.” Gaspar FW, Thiese MS, Wizner K, Hegmann K. Guideline adherence and lost workdays for acute low back pain in the California workers’ compensation system. PLoS One. 2021 Jun 17;16(6):e0253268. doi: 10.1371/journal.pone.0253268. PMID: 34138937; PMCID: PMC8211224. [emphasis added]

Thus, the study should not be considered one that should be viewed in an expansive nature.   It was limited as many back problems were not addressed.  It only address uncomplicated back pain complaints.

What Did the Study Look at?

The workers were placed into categories concerning whether or not they received guideline treatment.   Likewise, there were categories in which they received no guideline treatment or no treatment at all. Gaspar FW, Thiese MS, Wizner K, Hegmann K. Guideline adherence and lost workdays for acute low back pain in the California workers’ compensation system. PLoS One. 2021 Jun 17;16(6):e0253268. doi: 10.1371/journal.pone.0253268. PMID: 34138937; PMCID: PMC8211224.

What Were the Study’s Results?

The results of the study were that “[w]hen workers received guideline-recommended interventions, they typically returned to work in fewer days. The majority of workers received at least one non-recommended intervention, demonstrating the need for adherence to guideline recommendations. Fewer lost workdays and improved quality care are outcomes that strongly benefit injured workers.”

The other result of interest was that “workers who received either no intervention or other medical interventions experienced more favorable outcomes than those who received non-recommended interventions”  This result suggests that alternative treatment or no treatment is better than non-recommended interventions.

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.

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