CALIFORNIA FIREFIGHTERS AND WORKERS’ COMPENSATION: FIRE FIGHTERS, WORK INJURIES AND THE MOST RECENT RAND STUDY: WHAT YOU NEED TO KNOW

California Firefighters are tasked with some of the most difficult jobs.   California is perhaps the Forest Fire Capitol of the United States or even the World!  Firefighters provide a vital services in ensuring that we live in safety.

In performing their duties, Firefighters get hurt and have industrial claims.   California Firefighters’ work injuries have been studied by the Rand Corporation and they have prepared a recent report. The study is entitled The Frequency and Economic Impact of Musculoskeletal Disorders for California Firefighters: Trends and Outcomes of the Past Decade, Dworsky, Seabury, and Broten.

This article will address the most recent Rand Corporation Study and what it means to Firefighter and their careers with respect to their work injuries.

What Is the Rand Corporation? What Did It Study?

Rand Corporation is commonly known as a “think tank.”   According to Rand, it “was established over 70 years ago to strengthen public policy through research and analysis. Over seven decades, our research teams have answered the difficult questions and generated actionable insights by combining the very best analytical tools and methods with a distinct, interdisciplinary approach.”  They are frequently used by government, such as the State of California to do research.   The term “public policy” implies that their results can impact laws and proposed legislation.   For our purposes, their conclusions may become the impetus for new changes in workers’ compensation law.

The Rand Corporation Study, with respect to California Firefighters was done with “[t]he purpose of this report was to provide new information to policymakers about the frequency, nature, and consequences of firefighter injuries in California, with a particular focus on MSDs.”  In other words, the State of California may use the data to change workers’ compensation law with respect to Firefighters, or Fire Departments may change their risk management approaches to attempt to reduce claims.

What Did the Rand Study Find?

Highest Rate of Injuries

The Rand Study found that “firefighters are significantly more likely to be injured than workers in other occupations.”

Highest Rate of Musculoskeletal Disorders (MSDs)

The Rand Study found that “ a larger share of those injuries are MSDs.”

Specifically, we found that nearly half (47 percent) of firefighter injuries are MSDs, compared to 38 percent for police officers, 42 percent for other public-sector workers, 37 percent in our private-sector comparison group with similar job requirements to firefighters, and 42 percent for other private-sector workers.

Spine and Knee Injures Are More Common Than Upper Extremity Injuries

The Study found that there were “differences in the nature and cause of firefighter injuries. Compared to other occupations, injuries to firefighters are less likely to involve the upper extremities and significantly more likely to involve lower extremities or the trunk. Strains are the modal cause of injury for firefighters.”

Burn Injuries Are More Significant Than Other Occupations

The Rand Study found that “burns are significantly more common among firefighters than other workers but still represent a small share of injuries (6 percent) in comparison to MSDs.”

Cumulative Trauma vs. Specific Dates of Injury

The Rand Study found that “a lower share of firefighter injuries were reported as being due to cumulative trauma than workers in other occupations.”

Psychiatric Injuries for Firefighters

The Rand Study shows that the dated indicated that “firefighters and police have similar rates of psychiatric comorbidities. However, perhaps surprisingly, incidence rates of psychological injuries—including PTSD—for public safety workers are substantially lower than rates observed among other public-sector workers or comparable private-sector workers.”

Note: as noted in the study, Firefighters may carry with them a stigma concerning mental health issues.   Firefighters with mental health concerns may seek treatment privately rather than file a work injury claim.

Is There Any Good News for Firefighters with respect to the Study?

There was some good news in the Rand Study for Firefighters. The economic consequences of musculoskeletal disorders was less serve than for other similar occupations.   It was noted the Fire Departments appear to do better than other employers, including other public sector employers, at retaining Injured Workers.   Also, SB 863, a recent law change, provided for higher ratings for MSD injuries for Firefighters.  Finally, there was no evidence found that treatment caps for chiropractic, occupational therapy, or physical medicine treatments did not substantially impact most Firefighters.

What is there to Make of the Rand Study?

In light of the findings, it would appear that there would be no effort to try to increase additional indemnity to Firefighters.   Further,  it would appear that there would be no effort to change treatment protocol as well.  Perhaps, injury rate reduction would be explored.   In sum, risk management for the departments may try to take steps to reduce injuries.  Any reduction may be difficult to achieve due to the job’s physical demands.

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.

THE WONG BAKER PAIN SCALE AND WORKERS’ COMPENSATION: INJURED WORKERS, PAIN SCALES AND WORKERS’ COMPENSATION: WHAT YOU NEED TO KNOW

Frequently Injured Workers, when attending workers’ compensation evaluations and treatment are asked to fill out a lot of questions and forms.   One of these forms that they may have to fill out is the Wong-Baker FACES® Pain Rating Scale.

These Scales can impact an Injured Worker’s industrial claim.

This article will discuss the Wong-Baker FACES® Pain Rating Scale, how It is used in a Workers’ Compensation claim, and how it can impact an Injured Worker’s claim.

What is the Wong-Baker FACES® Pain Rating Scale?

The Wong-Baker Pain Rating Scale is a tool which is used to allow for patients to provide a self- assessment of their pain.  It was created by Donna Wong and Connie Baker in 1983 to help children communicate about their pain. .

Part of the goal is to improve the assessment by using the scale for the purposes of assisting in pain management.  The Wong-Baker Faces Foundation indicate that the Scale is self-assessment tool [that] must be understood by the patient, so [that[ they are able to choose the face that best illustrates the physical pain they are experiencing.  The Foundation note that the Scale is “not a tool to be used by a third person, parents, healthcare professionals, or caregivers, to assess the patient’s pain. There are other tools for those purposes”.

What Does the Scale Look Like? How It is Scored?

The picture above is a version of the scale. This picture was taken off of the Wikipedia article.   The Scale is copyrighted. The Scale is proprietary. Therefore, if you are interested in the material you should contact the Foundation.

The instructions for its usage is to “explain to the person that each face represent a person who has no pain(hurt), or some, or a lot of pain.”  “Face 0 doesn’t hurt at all.  Face 2 hurts just a little bit.  Face 4 hurts a little bit more. Face 6 hurts even more.  Face 8 hurts a whole lot. Face 10 hurts as much as you can imagine, although you don’t have to be crying to have his worst pain.”

The person is asked to choose the face that best depicts the pain they are experiencing. Supra.

Besides the Scale, the Patient may be asked to “to mark their areas of pain on a drawing of a human figure then rate each area using the faces scale.”.

What Was This Scale Designed for?  What is Your Opinion Concerning It?

Originally, it was designed for children to help them communicate their pain.

In California, there are a number of Injured Workers who do not speak English.   There are some Injured Workers who are illiterate.  Some are illiterate even in their language of origin.  This type of Pain Scale can assist these individuals express themselves with respect to their pain.  It is noted by the Foundation that for children there was “considerable difficulty using any scale with unfamiliar words or scales based on numbering or ranking concepts. The use of the Numeric Rating Scale [were] growing in popularity at this time, but young children had trouble using the numbers.”  Thus,  this type of scale is of some value with certain Injured Workers.

With respect to other workers, the Scale is more problematic.  In the world of workers’ compensation, there is a focus on activities of daily living and how an injury impacts them.   This particular scale, while it may be effective with respect to ascertaining pain information for other reasons, does not provide information used for disability assessment in the workers’ compensation system.

With respect to Adults, pain is viewed must differently than with children. Adults react to pain as an irritation, a distraction, frustration, and may generate anger and upset.  Adults do not necessarily cry because of their pain.   Most adults, however, can understand how the scale signifies a range from no pain to extreme pain.  In sum, its inquiry is superficial.   Again, this is not an indictment of the Scale, it is simply the problem that occurs when it is employed for something it was not intended for.

How Can The Wong-Baker Scale Be Used For In Workers’ Compensation?

In my opinion, the Scale may have some credibility value.   Also, it may document the trajectory of an Injured Worker’s condition.   If this Scale is used on multiple occasions, one can look to see how consistent the reporting it.   Also, it can possibly bring light to possible exaggeration.  Scores at level 10 may give rise to suspicion of exaggeration.

Any Advice Concerning the Scale?

It is very important for Injured Workers to try to be accurate with respect to the score.   While providing a “10” may be a “cry for help,” I would suggest that the Injured Worker actually “cry for help” and tell the evaluator or treater that they are experiencing some level of frustration with respect to their treatment and their relief from the pain.  This will prevent an allegation of exaggeration.

What If I Need 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.

 

OIL REFINERY WORKERS AND CARDIOVASCULAR DISEASE:  REFINERY WORKERS, HEART DISEASE AND WORKERS’ COMPENSATION: WHAT YOU NEED TO KNOW

Oil Refinery Work is unique. Workers at refineries have responsibilities that may place them at risk for cardiovascular disease.  If refinery job responsibilities impact a worker’s cardiovascular health, this industrially caused or aggravated cardiovascular condition is the basis for a workers’ compensation claim. A valid workers’ compensation claim would entitle the Injured Worker to receive medical treatment, compensation in the form of temporary and permanent disability benefits and vocational rehabilitation benefits.

A recent study was conducted with respect to health issues for Refinery Workers. The findings of the study examined the refinery workers’ shifts. See  Carvalho FC, Godinho MR, Ferreira AP. Cardiovascular risk factors among oil refinery workers: ecological study. Rev Bras Med Trab. 2020;18(1):11-19. Published 2020 Aug 4. doi:10.5327/Z1679443520200476

What is Shift Work?

Shift Work is a term that is used for the set hours that employees work. “Shift work is work that takes place on a schedule outside the traditional 9 am – 5 pm day. It can involve evening or night shifts, early morning shifts, and rotating shifts. Many industries rely heavily on shift work, and millions of people work in jobs that require shift schedules.” https://www.sleepfoundation.org/shift-work-disorder/what-shift-work

With respect to refineries, there are number of these facilities that require shift work.

Are There Health Risks With Shift Work?

“Several studies sought to identify such factors in different groups of people10,18,19,20,21, and shiftwork was found to contribute to serious physical, mental and/or social problems.” Carvalho FC, Godinho MR, Ferreira AP. Cardiovascular risk factors among oil refinery workers: ecological study. Rev Bras Med Trab. 2020;18(1):11-19. Published 2020 Aug 4. doi:10.5327/Z1679443520200476.

“Shift work can also affect workers’ quality and length of life by making them more prone to various disorders, including cardiovascular disease.” https://www.sleepfoundation.org/shift-work-disorder/what-shift-work

What are Cardiovascular System Diseases?

The Cardiovascular System Diseases many medical conditions. These include acute myocardial infarction, angina, arrythmias, congestive heart failure, coronary artery disease, hypertension, and valvular heart disease.

Note: Not all cardiovascular disease may have an industrial contribution.  Medical Analysis and Medical Expert Witness Opinion is required to make such a determination.

What Was the Shift Work That Was Subject to the Study?

In the study, “[e]mployees with fixed schedule work Monday to Friday from 7:30 to 16:30, being off duty on weekends and holidays to a total of 40 hours/week. Shiftwork was implemented to ensure uninterrupted operation, through five rotational teams under three 8-hour shifts – 7:00 to 15:00, 15:00 to 23:00 and 23:00 to 7:00 – all seven days of the week, including holidays, with rest between shifts, to a total working time of 32 hours/week. These workers receive additional pay. The work/rest schedule was approved by the corresponding trade union and complies with the labor laws in force.” Carvalho FC, Godinho MR, Ferreira AP. Cardiovascular risk factors among oil refinery workers: ecological study. Rev Bras Med Trab. 2020;18(1):11-19. Published 2020 Aug 4. doi:10.5327/Z1679443520200476

What Were the Findings of This Study?

The study found that

“[t]he highest odds of hypertension and high LDL corresponded to men above 40 and shift workers.

The highest odds of diabetes were exhibited by workers above 40 and those with fixed work schedule independently from sex. Risk of CVD was moderate, despite young age, high educational level and available resources at the company.

The results further indicated a high rate of employees exposed to three or more risk factors, whence one may infer a need for multiple interventions. Carvalho FC, Godinho MR, Ferreira AP. Cardiovascular risk factors among oil refinery workers: ecological study. Rev Bras Med Trab. 2020;18(1):11-19. Published 2020 Aug 4. doi:10.5327/Z1679443520200476

Thus we found higher prevalence of hypertension and high LDL among shift workers compared to employees with fixed work schedule. Carvalho FC, Godinho MR, Ferreira AP. Cardiovascular risk factors among oil refinery workers: ecological study. Rev Bras Med Trab. 2020;18(1):11-19. Published 2020 Aug 4. doi:10.5327/Z1679443520200476 [emphasis added]

I am a Refinery Worker, What Does This Mean?

Performing shift work may have an impact on your cardiovascular health. If you work at a refinery, perform shift work, and are having cardiovascular system issues, it may be in your interest to consider whether it is in your interest to pursue a workers’ compensation claim.

What If I Need 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.

 

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.

STONE FABRICATION WORKERS AND LUNG PROBLEMS: INJURED WORKERS WITH SILICOSIS AND WORKERS’ COMPENSATION: WHAT YOU NEED TO KNOW

Stone Fabrication Workers are at risk for occupational lung problems.  These problems stem from exposure to silica dust.  It is noted in the article that “[o]ver the past few decades, great attention has been paid to the emergence of silicosis cases that are associated with occupational exposure to silica dust generated by the manufacturing, finishing, and installation of AS kitchen and bathroom countertop products, both in fabrication shops and during in-home assembly procedures.” Artificial Stone Associated Silicosis: A Systematic Review, Leso,  Int. J. Environ. Res. Public Health 201916(4), 568; https://doi.org/10.3390/ijerph16040568

Rose C, Heinzerling A, Patel K, et al. Severe Silicosis in Engineered Stone Fabrication Workers-

In California, Stone Fabrication Work is very popular.  Many Homes, Office Buildings, Commercial Buildings, and Apartments have beautiful countertops that are made out of silica-based engineered products.   To produce and install these countertop products, there are many skilled workers who are exposed to this harmful respirable crystalline silica.   This exposure can cause serious damage to the lungs.  This damage, caused by an industrial exposure, gives right to the Injured Worker claiming their benefits and medical care under Workers’ Compensation.

This article will discuss fabricators, how they are exposed to harmful silica, what lung diseases can be caused or aggravated by silica, and how workers’ compensation can assist Fabricators who suffer from industrial exposure to silica.

What is Silicosis?

Silicosis is a progressive, irreversible, and incurable fibrotic pulmonary disease that is caused by the inhalation of respirable crystalline silica (RCS) dust. Artificial Stone Associated Silicosis: A Systematic Review, Leso,  Int. J. Environ. Res. Public Health 201916(4), 568; https://doi.org/10.3390/ijerph16040568

How Do Workers Get Exposed to Silica? Why Is Important?

The exposure occurs when the “[a]Artificial stone is formed of finely crushed rocks that are mixed with a polymeric resin. Its silica content is approximately 90%, a much higher percentage than the silica content of natural marble (3%) or granite stones (30%) [18]. Through the cutting and grinding of AS slabs with high-energy, powerful devices may result in high levels of exposure to RCS dusts, although little information is currently available regarding concentrations in these specific workplace settings/tasks IIt should be noted that the Occupational Safety and Health Administration and the National Institute for Occupational Safety and Health have identified exposure to silica as a “health hazard to workers involved in manufacturing, finishing and installing natural and manufactured stone countertop products, both in fabrication shops and during in-home finishing/installation” Artificial Stone Associated Silicosis: A Systematic Review, Leso,  Int. J. Environ. Res. Public Health 2019, 16(4), 568; https://doi.org/10.3390/ijerph16040568

Work-related injuries require industrial exposure.  With respect to silica exposure cases, it is important that Injured Worker prove the nature and extent of their exposure.

The nature and extent analysis looks to the “lifetime cumulative exposure, total amount of inhaled RCS, and individual susceptibility Artificial Stone Associated Silicosis: A Systematic Review, Leso,  Int. J. Environ. Res. Public Health 2019, 16(4), 568; https://doi.org/10.3390/ijerph16040568

In sum, how long did the Injured Worker do this type of work? How much inhalation was there?  Was Personal Protective Equipment (PPE) used?  If so, what types of PPE did the Injured Worker use?  Were there any other safety precautions taken beyond the use of PPE?

What Happens When Silica is Inhaled?

“Mechanistically, when respirable silica particles are inhaled, they can reach the lower respiratory tract and the gaseous exchange zones where, after having been phagocytosed by alveolar macrophages, they can persist and then trigger an inflammatory process that is characterized by the production of reactive oxygen species (ROS). The inflammation that is generated by ROS damages the pulmonary parenchyma and the subsequent repair/regeneration process leads to fibrogenesis and carcinogenesis” Artificial Stone Associated Silicosis: A Systematic Review, Leso,  Int. J. Environ. Res. Public Health 2019, 16(4), 568; https://doi.org/10.3390/ijerph16040568

What Medical Conditions Can Come from Silica Exposure?

Silica Exposure has been linked to a variety of medical conditions. “Silicosis is an incurable occupational lung disease caused by inhaling particles of respirable crystalline silica. These particles trigger inflammation and fibrosis in the lungs, leading to progressive, irreversible, and potentially disabling disease. Silica exposure is also associated with increased risk for lung infection (notably, tuberculosis), lung cancer, emphysema, autoimmune diseases, and kidney disease.” Rose C, Heinzerlin A, Patel K, et al. Severe Silicosis in Engineered Stone Fabrication Workers-California, Colorado, Texas and Washington 2017-2019, MMWR Morb Mortal Wkly Rep 2019;68:813-818. [emphasis added]

What Should an Injured Worker Do?

If an Injured Worker who works with silica based products and suffers from the various medical conditions indicated above, they should strongly consider pursuing a workers’ compensation claim.

Why Should an Injured Worker a Workers’ Compensation Claim?

With respect to a Silica Exposure case, an Injured Worker may be entitled to workers’ compensation benefits.   This includes temporary disability benefits, permanent disability benefits, vocational rehabilitation benefits, and death benefits, if indicated.  Also, lifetime medical care will be provided.  Further, there are some special Labor Code Sections that may apply in these cases. Labor Code Section 4656 provides for additional temporary disability periods for chronic lung diseases beyond those for ordinary claims.

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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