All posts by Paul J. McAndrew, Jr.

Reversing OSHA Rules Will Undercut Workplace Safety

Today’s post comes from guest author Jon Rehm, from Rehm, Bennett & Moore.

President Trump recently signed a Congressional resolution revoking an Obama administration OSHA rule that required employers to retain records of work injuries for five and that prohibited retaliation against workers for reporting injuries. The revoked OSHA rule would have also limited drug testing of employees who reported injuries.

Debbie Berkowitz of the National Employment Law Project and a former OSHA official criticized the action because limiting the amount of time an employer must retain records about injuries because it doesn’t provide enough information to identify recurring safety issues.

At least in Nebraska, employers are required to file First Reports of Injury with the Nebraska Workers Compensation Court. The information contained in those reports serves a similar function to OSHA logs and would allow workers, unions, attorneys and or regulators to identify recurring safety problems. Those reports are also public records. I recently testified against an insurance industry supported bill in the Nebraska legislature that would have made those reports confidential records.

The recently revoked OSHA rule also would have prohibited retaliation against employees who report OSHA violations. Nebraska already has anti-retaliation laws that protect employees who claim workers’ compensation benefits that would cover many cases where an employer would have to record an injury for OSHA. My opinion is that the OSHA General Duty clause which states that employers have a duty to provide a workplace free of recognizable hazards provides additional anti-retaliation protections to Nebraska employees through our state whistleblower statute. But the revocation of the OSHA anti-retaliation rule may weaken those protections.

The OSHA record keeping/anti-retaliation rule was revoked through the Congressional Review Act. You can read more about that law works here. Congress and President Trump have also revoked an executive order that would have prevented employers who violated fair employment laws from obtaining federal contracts. You can read more about that rule here.

Occupational Skin Diseases

Today’s post comes from guest author Anthony L. Lucas, from The Jernigan Law Firm.

Occupational skin diseases are one of the most common occupational diseases. The National Institute for Occupational Safety and Health estimates that in the United States more than 13 million workers are potentially exposed to chemicals that can be absorbed through their skin. In 2015, the last year for which data is available, over 15% of the reported occupational diseases were skin diseases.

 

These diseases include, but are not limited to, contact dermatitis (eczema), allergic dermatitis, skin cancers, and infections. Contact dermatitis, which has symptoms of painful and itchy skin, blisters, redness, and swelling, is the most commonly reported occupational skin disease. Workers in food service, cosmetology, health care, agriculture, cleaning, painting, mechanics, and construction industries and sectors are at risk of developing these diseases.

 

This type of occupational disease is clearly preventable. To control and prevent exposure to chemicals that cause occupational skin diseases, OSHA recommends that employers switch to less toxic chemicals, redesign the work process to avoid the splashes or immersion, and have employees wear protective gloves and clothing.

Watching a Paraplegic Walk!: A Work Comp Success Story

The ReWalk Device

Today’s post comes from guest author Charlie Domer, from The Domer Law Firm.

I just witnessed someone without the use of their legs actually walk! 

A young paraplegic—supposedly bound to a wheelchair on a permanent basis—used a robotic device and actually stood upright and walked forward.  The emotions involved defy adequate description, especially for someone included on the team that made this event happened.


CBS 58

This story begins, like many work injuries, with an unexpected traumatic event.  On November 13, 2008, Matt Nevaranta was a 22-year-old working a construction job in hopes of saving enough money to continue his college career.  Those dreams were cut short when 3,000 pounds of metal forms fell on Matt, severing his spinal cord.  Matt was lucky to be alive.  However, the injury damage resulted in permanent paraplegia—an inability to use his legs and all bodily functions below his waist.   Matt presumably was constrained to a wheelchair for his life.

For many individuals, such an injury could drastically alter their outlook on life.  Matt, though, is a unique young man, who I had the privilege to get to know and represent as his worker’s compensation attorney.  Despite his condition, Matt remained positive and persevered daily.  He continued to better himself since his traumatic injury.

Matt vigorously pursued his educational opportunities.  After the initial shock and recovery from the injury, Matt reenrolled in college, beginning online.  He ultimately attended full-time at Cardinal Stritch University (in Milwaukee, WI)—actually driving himself and using his wheelchair for classes.  While many worker’s compensation insurance companies demean or question the motivation level of injured workers, Matt disproved those misplaced assumptions.  Matt graduated from Cardinal Stritch in the spring 2016 while his bachelor’s degree.  Moreover, he volunteers at the Milwaukee County Courthouse in a legal clinic, and he now has applied for law school!

Matt also forcefully pursued his physical betterment and the necessary medical equipment.  Under the Worker’s Compensation law, an injured worker receives medical treatment that is reasonably required to cure and relieve from the effects of the injury.  (Wis. Stat. Section 102.42(1)).   In Matt’s case, his worker’s compensation insurance company provided a number of medical items since the injury, including a seated wheelchair, an upright wheelchair, and home and car accommodation modifications.  None of this treatment, however, resulted in Matt walking.

ReWalk allowed Matt to walk.  ReWalk is a wearable robotic, motorized exoskeleton that allows individuals with spinal cord injuries to stand upright and actually walk.   During my representation, Matt asked if his worker’s compensation insurance company would pay for the ReWalk device.   Matt met all of the necessary criteria (as established by ReWalk) and had medical clearance to obtain the device.  More importantly, Matt’s treating spinal cord specialist and psychologist provided their medical opinions about the significant physical and psychology benefits involved in the potential use of this device.

A legal battle ensued.   In part, due to the “not-cheap” device cost, the worker’s compensation insurance company denied payment for the device.  The insurance company also hired their own “independent” medical record reviewer to question the benefits of the device.  We filed numerous medical literature studies showing the physical benefits of an upright motorized exoskeleton for paraplegics (notably, many of these devices have been used to assist returning military veterans).  We also filed medical opinions noting the potential cardiovascular, gastrointestinal, spasticity, life expectancy, and psychological benefits to the device.

The dispute over the ReWalk device went to a worker’s compensation trial.  (Note that worker’s compensation attorneys cannot receive a fee on medical treatment expenses, so this was pro bono representation).  Matt testified about his desire to use the ReWalk device.

And we won.  In a first-of-its-kind case in Wisconsin, the administrative law judge ruled that the ReWalk exoskeleton device was a reasonably required medical treatment or modality to cure and/or relieve from the effects of the work injury.  Thus, the worker’s compensation insurance company was ordered to pay for the device.

The parties struck a subsequent reasonable deal for the cost of the device to avoid further appellate litigation.  As part of this deal, we worked with the amazing crew at Marquette University’s physical therapy department (shown in the video clip in detail), who provided further training to Matt free of charge.   Matt now goes to training at Marquette, and I was privileged to watch Matt in action. 

I watched a paraplegic walk!

Such a worker’s compensation success would not be possible without an entire team supporting Matt, including the efforts from Domer Law, Matt’s family, the ReWalk team (especially Craig Peters), the physicians at Froedtert/Medical College of Wisconsin (especially Drs. Merle Orr and Brad Grunert), and Marquette University physical therapists.  But, of course, none of this would occur without the personal drive to excel found in Matt Nevaranta.  Great work Matt, and I wish you nothing but continued success. 

Workplace Safety and the Legacy of Martin Luther King, Jr.

Today’s post comes from guest author Jon Rehm, from Rehm, Bennett & Moore.

“It was horrible,” said the woman.

One minute she could see a sanitation worker struggling to climb out of the refuse barrel of a city garbage truck. The next minute mechanical forces pulled him back into the cavernous opening. It looked to her as though the man’s raincoat had snagged on the vehicle, foiling his escape attempt. “His body went in first and his legs were hanging out,” said the eyewitness, who had been sitting at her kitchen table in Memphis, Tennessee, when the truck paused in front of her home. Next, she watched the man’s legs vanish as the motion of the truck’s compacting unit swept the worker toward his death. “The big thing just swallowed him,” she reported.

Unbeknownst to Mrs. C. E. Hinson, another man was already trapped inside the vibrating truck body. Before vehicle driver Willie Crain could react, Echol Cole, age 36, and Robert Walker, age 30, would be crushed to death. Nobody ever identified which one came close to escaping. 

The horrific deaths of Cole and Walker on Feb. 1, 1968, set off the Memphis sanitation workers’ strike, where 1,300 mostly African-American public employees struck to protest poor working conditions, including the defective garbage truck that crushed Cole and Walker. Martin Luther King Jr. gave his famous “I’ve Been to the Mountaintop” speech in support of the striking sanitation workers in Memphis the night before he was assassinated.

On Monday, Martin Luther King Jr.’s birthday is celebrated as a holiday. But the rightful veneration of Dr. King should not, for the lack of better terms, wrongfully sanitize or whitewash the fact that what he fought for would be opposed by many who invoke his legacy today. The Memphis sanitation strikers are asking for the same thing that striking fast food and service workers are asking for in the Fight for 15 campaign. Most establishment types and so-called moderates in Memphis refused to support the striking sanitation workers. Today’s so-called moderates argue that paying employees a living wage is too radical and counterproductive. History has a way of repeating itself.

Nearly 50 years later, I still represent sanitation workers who are injured from defective equipment. However, bloody crush injuries like the ones that killed Cole and Walker are much less common. Part of the reason for the increase in workplace safety over the last 50 years was the passing of the Occupational Safety and Health Act. Dr. King was willing to risk bodily harm and ultimately ended up being killed supporting workers who were protesting unsafe work conditions. The passage of OSHA is a small but important and overlooked part of Dr. King’s legacy. History is repeating itself again as the business establishment applauds the expected rollback of OSHA enforcement under expected future Labor Secretary Andy Puzder.

Dr. King also deserves credit for his role in passing laws like Title VII that prohibited discrimination against African-Americans, which has allowed an increasing number of African-Americans to join the professional class and otherwise realize their potential as human beings. Dr. King’s legacy can also be seen in the expansion of rights for disabled Americans, and the fact that gays and lesbians are able to get married, and the real possibility that Title VII may end discrimination against lesbian, gay, bisexual and transgender people.

But by some economic measures, African-Americans are worse off now than they were 40 years ago. This fact can likely be attributed to overall increases in economic inequality over the last 40 years. The U.S. Department of Labor pointed out in a recent study that the gutting of state workers’ compensation laws has exacerbated inequality. Lawyers, legislators, academics and pundits have gradually forgotten about the risks faced by workers like Echol Cole and Robert Walker and how civil rights leaders including Martin Luther King Jr. saw the fight for workplace safety as a matter of basic human dignity and integral to the fight for civil rights.

The offices of Rehm, Bennett & Moore and Trucker Lawyers will be closed in observance of the holiday on Monday. We will re-open at 8:30 a.m. Central Time on Tuesday, Jan. 17. We encourage readers to think about Martin Luther King Jr. on the federal holiday and every day and continue to be both motivated and challenged by his words and works.

Workplace Safety Rules Could Be Reversed via Congressional Review Act

Today’s post comes from guest author Jon Rehm, from Rehm, Bennett & Moore.

In 2001, President George W. Bush, a Republican, overturned an Occupational Safety and Health Administration ergonomics rule designed to prevent repetitive stress injuries that was implemented by President Bill Clinton’s Labor Department, as he was Bush’s Democratic predecessor.

Around 16 years later, history seems poised to repeat itself.

A slew of workplace safety regulations regarding beryllium exposure, reporting of injuries, mine safety, and chemical storage implemented by President Barack Obama’s Department of Labor seemed poised for reversal by President Donald Trump’s administration that is eager to rollback Obama-era regulations through the Congressional Review Act.

The Congressional Review Act provides Congress a way to disapprove any regulation within 60 days of it being deemed final. But as pointed out in an explainer piece from the right-wing Heritage Foundation, Congress has 60 legislative days to disapprove a regulation. Sixty legislative days could be six to seven months in real time because of frequent congressional recesses. The act also restarts the 60-day clock for final rules that are implemented within the last 60 days of the previous legislative session. Heritage estimates that rules finalized back to June 3, 2016, could be subject to review.

Supporters of Obama-era workplace safety rules cannot rely on Senate Democrats to filibuster resolutions under the Congressional Review Act because the legislation does not allow for filibuster and has streamlined procedures for allowing legislation to be pulled out of committee.

Fortunately or unfortunately, depending on your perspective, the Congressional Review Act doesn’t allow rules to be bundled together. Congress must consider killing each regulation with a single piece of legislation. This feature of the Congressional Review Act may explain why the Clinton ergonomics rule was the only rule actually killed by Congress under the Congressional Rule Act. Finally, the Congressional Review Act prohibits an agency from proposing a substantially similar rule, which could explain why the Obama administration never tried to revive the Clinton-era ergonomics rule. 

Labor reporter Mike Elk, editor of Payday Report, is one of the few reporters or writers drawing attention to the fact that Obama-era workplace-safety rules are seriously vulnerable to reversal in the Trump administration. Elk’s reporting details how the chemical industry weakened rules on chemical storage after the West, Texas, chemical explosion and how the Obama administration allowed final approval of the rule to be pushed back to where it would be vulnerable to reversal under the Congressional Review Act. In some fairness, delay by OSHA could partially be explained by budget cuts to the agency by congressional Republicans.

I would encourage our readers to monitor this firm’s social-media feeds and my personal Twitter account, @JonRehmEsq to keep track of Congressional Review Act legislation regarding workplace safety. I would urge readers to contact their members of Congress and express their opposition to any proposed rollbacks of workplace-safety rules.

Drug Formularies, Part 2: Pharmacy Benefit Managers and Drug Prices

Mylan CEO Heather Bresch testified before the House Oversight Committee about her company’s increase in the price of life-saving EpiPens by more than 500 percent since 2007.

Today’s post comes from guest author Jon Rehm, from Rehm, Bennett & Moore.

This fall, most Americans were outraged at revelations that the price of life-saving EpiPens had increased by 600 percent since 2007. The anger over the drastic price increase for EpiPens focused attention on the role that pharmacy benefit managers play in the increase of drug prices. Pharmacy benefit managers administer drug formularies, so the use of drug formularies should also be questioned on prescription price control in addition to the question of whether drug formularies shift costs to more expensive treatment.

Pharmacy benefit managers have been praised for helping negotiate drug discounts. However, pharmacy benefit managers have been criticized on the same grounds because their profitability depends in large part on being able to pocket a percentage of the discount that they negotiate. This is a lucrative business. Express Scripts is described by Wall Street-types as a “pure play” pharmacy benefit manager. In the last quarter, Express Scripts made $722.9 million in profit, a 9 percent year-over-year increase.

In addition to being criticized for benefiting from the increase in pharmacy costs, pharmacy benefit managers have also been criticized for having conflicts of interest. Pharmacy benefit managers run drug formularies. However, since pharmacy benefit managers negotiate discounts with specific drug firms, pharmacy benefit managers have an incentive to put those drugs on drug formularies. These types of arrangements have drawn the attention of Preet Bharara, the high-profile United States attorney for the Southern District of New York. In 2015, Bharara settled a charge against Express Scripts for $45 million. The settlement came after an Express Scripts unit participated in a kickback scheme involving Novartis under the False Claims Act and the Anti-Kickback Statute.

In fairness to pharmacy benefit managers, there may be other factors driving increased prescription prices. Recently, former Democratic presidential candidate and current U.S. Sen. Bernie Sanders wrote a letter to the Federal Trade Commission alleging collusion among pharmaceutical companies in regards to insulin prices. Insulin is a generic drug, and generic are cheaper than so-called brand-name drugs. However, the increase in insulin prices is far from the sole example of drastic increases in generic drugs.

In 2015, the National Council on Compensation Insurance (NCCI) released a report on prescription drug prices in workers’ compensation. On page 36 of this report, NCCI pointed out that four of the 10 drugs most responsible for the increase in drug prices were generics. In 2014, the price of generic Oxycodone-Acetaminophen rose 35 percent, Oxycodone’s price rose 60 percent, the price of generic muscle relaxer Baclofen rose 86 percent, and the price of generic Morphine Sulfate ER rose by 25 percent.

There is strong evidence that pharmacy benefit managers do little to control prescription drug prices. There is also strong evidence that pharmacy benefit managers benefit from increases in drug prices. If advocates of workers’ compensation reform want to expand the use of drug formularies, they need to explain to policy makers how the pluses of pharmacy benefit managers outweigh the myriad problems related to pharmacy benefit managers.

Drug Formularies, Part 1: The Rest of the Story

Today’s post comes from guest author Jon Rehm, from Rehm, Bennett & Moore.

A drug formulary is a term describing a list of drugs that are covered by an insurance plan. In workers’ compensation, formularies are touted as a way to reduce prescription costs and lead to more effective care. Formularies are particularly pushed as a solution for opioid use and abuse for injured employees.

The headline numbers about the reduction of prescription costs look eye popping. One group of pharmacy benefit managers, the companies that manage drug formularies, claimed a 9 percent reduction in prescription costs over the last year. Ohio, which has the largest state-run workers compensation fund in the country, claimed a 16 percent reduction in prescription costs in the first three years after they implemented a drug formulary. Ohio reported 15.7 million fewer doses of opioids in that time period and a 36 percent reduction in opioid costs.

The Rest of the Story about Drug Formularies

Florida workers’ compensation judge David Langham has asked “what is the rest of the story” about drug formularies. If drug formularies are so effective, then why have they only been adopted in a few states for workers’ compensation?

While drug formularies are a relatively recent development in workers’ compensation, they are well established in the larger world of health insurance. Drug formularies have long been criticized for increasing costs in health insurance plans by reducing prescription usage because costs are shifted to insureds, which forces insureds to seek more expensive care, because chronic conditions go untreated. Overall costs are increased. The costs are also shifted onto insureds who have to pick up the costs for more expensive procedures that could have been taken care of through medication. Cost shifting from the employer onto the employee, other forms of insurance and the government is already a serious problem in workers’ compensation. Drug formularies in workers’ compensation could exacerbate the issue of cost-shifting.

Do Drug Formularies add up?  Cost = Price * Utilization

When you study drug formularies for any amount of time, you run across the equation that drug costs equal price multiplied by utilization. Proponents of drug formularies tout that they can decrease both the utilization and the price of prescription drugs. Ohio has provided detailed information about the decrease in the utilization of certain drugs like opioids because of formularies. However, the decrease in the utilization in opioids cited by proponents of drug formularies coincides with an overall long-standing decrease in the frequency or number of workers’ compensation claims. Fewer overall claims mean less overall utilization, which could explain some of the cost decrease. A better measure of the effectiveness in drug formularies in controlling costs would be measured by looking at prescription cost per claim. So far, drug formulary proponents have been unable to show that data. Even if drug formulary proponents could show that data, there is still the issue of whether reductions in prescription drug costs lead to increases medical costs by forcing injured employees to seek more expensive care that could have been taken care of by prescriptions.

On the price end of the equation, drug formularies are thought to control costs by having pharmacy benefit managers negotiate bulk discounts on prescription drugs. But pharmacy benefit managers have come under fire with allegations that they actually increase drug prices or at the very least are powerless to stop the increases in drug prices. The issue of drug formularies, pharmacy benefit managers and drug prices is complicated and will be addressed in Part 2 of this series.

The Safety Hazard Right Under Your Wheels

Today’s post comes from guest author Jon Rehm, from Rehm, Bennett & Moore.

The collapse of the Interstate Highway-35W bridge over the Mississippi River killed 13 people and highlighted the safety hazards related to poor infrastructure. But most drivers face a less dramatic, but no less dangerous, hazard:

Potholes.

According to www.pothole.info, nearly 1/3 of the 33,000 annual truck and auto fatalities are related to poor road conditions. At least 27 percent of the major roads in the United States have been rated to be in poor condition. Though potholes are regarded as a problem – with good reason – in cold-weather states like Nebraska and Iowa, the worst road conditions in the country are in the warm-weather areas like the Bay Area, southern California, and Tucson, Arizona.

Bumpy roads combined with poor suspension can even lead to back injuries. This is especially true for over-the-road-truck drivers who also face health problems from lack of sleep, lack of exercise, and poor diet due to the demands of trucking. Drivers for Crete Carrier Corporation, Shaffer Trucking, Werner and K&B Transportation usually must litigate their workers’ compensation claims in Nebraska. Fortunately, Nebraska would deem a back injury from driving over a pothole to be compensable, even if it were combined with a pre-existing condition. Other states have stricter causation standards that could preclude a driver from collecting benefits for such an injury.

Truckers who, according to one poll, supported President Donald Trump over Hillary Clinton 75 percent to 25 percent, may have some relief from rough road conditions coming. President Trump has announced that he plans to spend $1 trillion on infrastructure, and he has appointed a task force that includes high-level advisers and his influential son-in-law Jared Kushner. Some observers in the trucking industry have raised concerns that the Trump infrastructure plan could lead to more private and toll roads; however, everyone will get some benefit if road conditions improve within the United States.

Another forgotten piece of infrastructure is trucking parking, which I will address in an upcoming post.