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On August 13, 2014 Miami-Dade 11th Circuit Judge Jorge Cueto in Florida Workers’ Advocates v. State of Florida held that the Florida Workers’ Compensation Act, as amended effective October 1, 2003, is unconstitutional as long as it contains the exclusive remedy provision (Section 440.11, Florida Statute). The reason he provided for this conclusion is that the benefits provided under the Act do not medical-legal-ACAprovide the worker “a reasonable alternative to the tort remedy supplanted.”

In 2003 reforms were enacted to increase the availability and affordability of coverage and reduce litigation. Since those reforms premium rates have been reduced by approximately 56 percent.

Some provisions of the bill effective on October 1, 2003:

  1. The workers’ compensation accident must be the major contributing cause for disability or the need for treatment.
  2. Elimination of the payment of permanent partial disability benefits available in certain cases.
  3. Permanent total disability benefits were changed to end at age 75 in most cases.
  4. Permanent total disability benefits are payable for no more than 5 years, if the employee was 70 or older at the time of accident.
  5. Limited the fees paid to attorneys in workers’ compensation.

Precedential Value

This circuit court opinion does not establish any precedent for trial courts in the rest of the state. Unless and until this decision is addressed by an appellate court, it has no precedential value. Moreover, since the issue of whether an employer is immune from tort liability in any given case is not one that concerns the Judge of Compensation Claims (JCC), the Circuit Court’s ruling has no effect on pending or future workers’ compensation claims.

 Background and Case Summary

This issue began with a complaint for damages brought by Julio and Nelida Cortes who alleged injury due to the negligence of his employer, Velda Farms. The employer raised the affirmative defense that workers’ compensation was the employee’s exclusive remedy. The complaint was then amended to seek a declaration that the exclusive remedy provision was invalid because it violated the due process clause of the 14th amendment of the U.S. Constitution as well as various rights guaranteed by the Florida Constitution.

Florida Workers’ Advocates (FWA) and Workers’ Injury Law & Advocacy Group (WILG) sought and were granted the right to intervene as plaintiffs. Thereafter, Velda Farms abandoned its exclusive remedy defense. FWA and WILG moved to sever the declaratory relief action from the personal injury litigation. This motion was granted and the matter was allowed to proceed independently although the only defendant, Velda Farms had been dismissed. Elsa Padgett, through her counsel moved to intervene and the motion was granted, although her employer was not named as a defendant. The attorney for Ms. Padgett happens to also be the attorney for the defendant in the Westphal v. City of St. Petersburg case pending before the Florida Supreme Court. See below for detail on this case.

The State of Florida, Office of the Attorney General was notified of the proceedings, but did not intervene except to file a response to the court’s order to show cause why the state’s workers’ compensation exclusive remedy provision should not be declared unconstitutional.

The Office of the Attorney General argued the following in their response:

  • The trial court did not have jurisdiction to consider the claim because there is no defendant,
  • The Florida workers’ compensation framework is constitutional, and
  • Workers’ Compensation benefits have always been limited, and a change to benefits is within the Legislative prerogative.

What’s next?

The Attorney General has not announced whether or not the decision will be appealed. If appealed, the case will be heard by the 3rd District Court of Appeal in Miami.   The appeal court can uphold or reverse the ruling.  If the appeal court upholds Judge Cueto’s opinion the case would be heard by the Florida Supreme Court.

The appellate court can also “pass” on review of the decision and send the case directly to the high court.

If not appealed, this circuit court opinion has no precedential value for trial courts in the rest of the state.

What do we expect to be the immediate effect of this decision?

It is likely that more negligence lawsuits will be filed by injured employees against their employers in Miami-Dade County. As pointed out in the decision, Florida changed from a contributory negligence state to a comparative negligence state in 1973, which improves an employee’s chance of recovery if suing the employer for negligence.

Since in general there is a four year statute of limitations applicable to legal actions founded on negligence in Florida, there may be instances of workers’ compensation claimants resolving their workers’ compensation claim and then pursuing a tort action against the employer.

What is your reaction to this ruling? As an employer are you concerned about the ruling or do you think it is much ado about nothing?

Sedgwick will continue to update our clients and stay actively involved in monitoring the judicial process and engaging our clients, as appropriate in the legislative process. Watch for additional updates as the ruling passes through the judicial process.

Darrell-Brown-Sedgwick-180px

 

 

 

Darrell Brown, Chief Performance Officer

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RiskResource-ERMblog022014Providing safe care to children and avoiding liability is a top concern for most emergency department (ED) providers and facilities. ED use by children under age six is frequent, accounting for more than 30 million encounters and 24 percent of annual ED visits in the U.S., according to a 2012 National Report on Health Statistics.1 Three quarters of pediatric emergency visits are to hospitals that are not children’s hospitals.2 Recognizing this, the American College of Emergency Physicians (ACEP) currently offers its members an online course, culled from its 2013 scientific assembly entitled, “The Pediatric “Risk-Free” Emergency Department: Reducing Malpractice Exposure” (http://virtual.acep.org/ common/presentations.aspx/4/18/390).

Indeed, ACEP, along with the Emergency Nurses Association (ENA) and the American Academy of Pediatrics (AAP) published a Joint Policy Statement setting forth guidelines and the resources necessary for EDs to serve pediatric patients.3 According to the joint guidelines, the first essential for managing pediatric emergency care is to appoint physician and nurse coordinators for the care of children in the department. Having these coordinators in place supports responsibility for ensuring provider and staff competencies in pediatric care, implementation of risk management/patient safety/quality improvement activities, and development of appropriate policies and procedures for pediatric emergency care.

A useful self-assessment checklist to assess ED readiness to safely care for children has been developed based on the joint guidelines. The checklist is available online at the ENA website: http://www.ena.org/about/position/jointstatements/Documents/GuidelinesfortheCareofChildreninED2010.pdf.

Top areas of risk for pediatric emergency care include communication breakdowns during transitions of care and handoffs, barriers to obtaining adequate histories and presenting problems, and challenges with ensuring safe medication prescribing and administration. These areas are compounded when the culture in the ED is not conducive to teamwork and the work environment does not allow staff to speak up when there are concerns about safety and quality.

Strategies to address these top areas for pediatric safety improvement in the ED center on enhancing teamwork, implementing standardized communication tools, and using evidence-based safe practices. Resources to implement these strategies include the following:

TeamSTEPPS® – an evidence-based teamwork system to improve communication and teamwork skills in support of a culture of safety. Higher hospital patient safety culture survey scores have been associated with lower adverse event rates.4 TeamSTEPPS is freely available from the Agency for Healthcare Research and Quality. See http://teamstepps.ahrq.gov/.

ED “Safer Sign Out” protocol – this team-based intervention to improve safety and prevent communication failures during shift changes and care transitions that can lead to patient harm and liability is promoted by and readily accessible through The Emergency Medicine Patient Safety Foundation. See http://safersignout.com/.

Joint Commission Sentinel Event Alert: Preventing pediatric medication errors – this literature contains guidance on pediatric medication safety in the emergency department.5 See: http://www.jointcommission.org/sentinel_event_alert_issue_39_preventing_pediatric_medication_errors/.

There is increasing evidence of a significant correlation between the frequency of adverse events and malpractice claims. 6 Examination of serious safety events and liability claims can also reveal high-risk areas and diagnoses or conditions ripe for risk prevention efforts. Diagnostic error is a frequent allegation in claims involving pediatric patients, 7and conditions related to these errors include infections such as meningitis, appendicitis, and sepsis. Both cognitive and system factors contribute to diagnostic error.

Analysis of a high-profile ED case involving the death of a 12-year-old in New York from streptococcal toxic shock in 2012 revealed several possible cognitive and system factors leading to error in diagnosis. Possible contributing cognitive factors include: 8

  • Availability bias: Gastroenteritis was prevalent at the time
  • Received diagnosis: Reliance on diagnosis from referring provider
  • Premature closure: Assuming first diagnosis is accurate without considering another
  • Anchoring bias: Not considering new information/not listening to the patient

Possible contributing system and communication factors include:

  • Initial vital signs lacked a temperature
  • Discharge vital signs not reviewed by the physician
  • Abnormal labs not reviewed or not acted on

Here are five strategies for mitigating these cognitive and system/communication factors and reducing risk of diagnostic errors that can result in patient harm and expose ED providers to liability include:

  • Awareness of cognitive factors by ED providers, deliberate self-assessment, and cross monitoring with peers
  • Use of algorithms and screening tools for high-risk conditions such as sepsis and abdominal pain
  • Implementing decision support systems that prompt considerations of alternative diagnoses
  • Auditing compliance with patient intake, assessment, and discharge procedures and correcting noncompliance
  • Establishing protocols for communicating and acting on diagnostic results and assigning accountability for carrying out the protocols

Ongoing training and education in the care of children –ACEP, ENA, AAP, and other professional societies provide clinical education programs to develop and maintain pediatric competencies and skills.

What has been your experience regarding pediatric saferty in the ER? I look forward to hearing from you.

Kathleen Shostek, RN, ARM, BBA, FASHRM, CPHRM
Sedgwick

 

References

1. National Center for Health Statistics. Health, United States, 2012: With Special

Feature on Emergency Care. Hyattsville, MD. 2013.

2. Schappert SM, Bhuiya F. Availability of pediatric services and equipment in

emergency departments: United States, 2006. National health statistics reports; no

47. Hyattsville, MD: National Center for Health Statistics. 2012.

3. AAP Joint policy statement—guidelines for care of children in the emergency

department. Pediatrics 2009 Oct;124(4):1233-43. http://pediatrics.aappublications org/content/124/4/1233.full.html.

4. Mardon, et al. Exploring Relationships Between Hospital Patient Safety Culture and

Adverse Events. Journal of Patient Safety, 2010. Vol. 6 (4) 226-32.

5. Cadwell S. Pediatric medication safety in the emergency department. J Emerg Nurs

2008;34:375-7.

6. Greenberg MD, Haviland AM, Ashwood JS, Main R. Is better patient safety

associated with less malpractice activity? RAND Institute for Civil Justice, 2010.

Available at http://www.rand.org/pubs/technical_reports/2010/RAND_TR824.pdf.

7. Data Sharing Project 1985-2010. Physician Insurance Association of America (PIAA),

Rockville, MD.

8. Ryan R and Fischer S. Risk and Claims in Pediatrics: A case study in sepsis. Available

online

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MH900309611

You need to be prepared when they do! Because we are the leave administrator for many large employers, since the first of the year, Sedgwick has received an increased number of requests to assist our clients with Department of Labor (DOL) inquires including but not limited to the Family Medical Leave Act (FMLA). This should come as no surprise to employers. At the Disability Management Employer Coalition annual compliance conference earlier this year, Helen Applewhaite, DOL Branch Chief for the Wage and Hour Division (WHD), stated “2014 is a pivotal year for FMLA enforcement”. The DOL’s Wage and Hour division has approximately 1000 field investigators who are responsible for all Wage and Hour Division investigations, including the FMLA. So they are staffed and ready to carry out their mission!

The DOL is no longer focused on investigating a single complaint. They are now looking more broadly and will be undertaking systemic – on site investigations and looking at employer’s practices from top to bottom. In their “Fact Sheet #44: Visits to Employers,” the DOL states “WHD does not typically disclose the reason for an investigation. A full version can be found here: http://www.dol.gov/whd/regs/compliance/whdfs44.pdf

So what can you expect when the DOL shows up without an explanation? Here are four steps to take prior to a potential DOL meeting:

  1. Host an opening conference with investigators and employer representatives – be sure to engage your employment counsel
  2. Review leave records typically for a two year period – contact your leave administrator as soon as possible, if applicable, so they can assist in gathering this information for you
  3. Conduct interviews with a “representative number” of your employees – this will require some preparation with the staff that is chosen
  4. Organize a closing conference to discuss the results of the investigation – again, you may want to engage your employment counsel here as well

Since FMLA is a Federal entitlement the DOL takes it very seriously when they think an employer is attempting to interfere with an employee’s right to take leave or worse, terminate an employee who was using FMLA protected time!

What can employers do to help avoid the DOL visit?

Train your front line mangers! This was another message I heard loud and clear from the DOL Branch Chief, who stated “Human Resources has everything perfect, but front line managers are not aware.” Be sure your managers understand the requirements of the FMLA. Stress the importance that prior to taking any adverse employment action, they must do their homework to determine if there is any potential FMLA overlap between the adverse employment action they are contemplating and FMLA protected time. Even if the adverse employment decision has nothing to do with their FMLA claim, it can get tricky if the employee has an approved FMLA leave. If you have outsourced your leave administration, managers should be trained to contact the leave administrator to ensure managers have all the facts around the employee FMLA leave.

I would like to hear from you if the DOL has already knocked on your door. What was the outcome? As always our team of Sedgwick experts would be happy to assist you in this area.

Sharon Andrus
Director National Technical Compliance
Sedgwick

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medical-legal-ACAWhen the Affordable Care Act (ACA), courts and differing points of view are all mentioned in the same sentence it should not surprise anyone, should it? If you watch Jimmy Fallon on the Tonight Show, he has a regular feature called “Pros and Cons” of current social topics. Let’s take our own pro/con look at recent movement in the courts and what – if any – impact it might have on the workers’ compensation arena.

Con

A three-judge panel of the U.S. Circuit Court of Appeals for the District of Columbia ruled that the Affordable Care Act does not allow subsidies on federally run exchanges. This includes plans that have been purchased in the 36 states currently supporting the health insurance exchange.

Pro

The same day (and hours apart), the U.S. Court of Appeals circuit in Richmond, Va., issued a conflicting ruling that upheld the legality of the healthcare law’s tax subsidies.

What should I do now?

Nothing. Right now there is no impact or change to the law and the ACA will continue to roll along as it is currently defined. In April of this year, I blogged on “The impact of the ACA on workers’ compensation,” and you can refer back to better understand the interconnection of workers’ compensation and the Affordable Care Act. The reality – these are just two of what will be many more court cases and rulings to come in weeks and months ahead of us. I feel fairly certain, as do other experts who have already written in recent days, that this will ultimately end up in the Supreme Court.

You can count on Supreme Court action not happening for a few months and most likely we are looking at years before a possible definitive Supreme Court case is fought. A new administration and a different-looking congressional body will also be in place by that time. As pointed out in this Washington Post article, Federal appeals courts issue contradictory rulings on health-law subsidies, the court rulings were heavily influenced by appointed judges of each party. The article provides a great overview of how the courts are aligned and strategies for appeal if you are interested in additional perspective.

Keep calm and carry on.

As the popular shirts and posters say, “keep calm and carry on” for now. The way patients are treated and their access to care will not change or stop in light of either of these two rulings. What we must do in the industry is help the injured worker become more engaged and part of their healthcare decisions as the legal decisions continue to rage on and unfold.

What I can definitively say is we will continue to closely monitor all these changes. The future will not be boring nor easy to navigate. Please feel free to ask questions or reach out on how your organization should be preparing for the future of the ACA as it relates to workers’ compensation.

Kimberly George, SVP, Senior Healthcare Advisor

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stress-in-the-workplaceStress in the workplace is a public health issue that the World Health Organization called the “health epidemic of the 21st century.”

According to the 2013 Stress in the Workplace national survey by the American Psychological Association, 65% of U.S. adults cited work as a significant source of stress and 35% of working Americans reported that they typically feel stressed during the workday.

As pointed out in the University of Illinois at Chicago (UIC) research study on stress in the workplace, there is a widespread understanding that high amounts of stress are unhealthy and can play a contributory role in or exacerbate mental health conditions, as well as chronic physical conditions like hypertension, cardiovascular disease, diabetes, obesity, asthma, cancer or a weakened immune system.

The costs of employee stress to American businesses are substantial and include healthcare costs nearly 50% greater for workers reporting high levels of stress, diminished productivity, increased risk of occupational injury, absenteeism, employee turnover and workers’ compensation awards.

Were this outbreak an infectious disease that we could vaccinate against with costs and prevalence rates this significant, we would mount an urgent national effort.

In concluding our series on stress in the workplace, let’s look at just what are employers’ obligations to address and proactively manage this issue.

A wide range of workplace laws is in place to protect employees and to ensure fair treatment. Some of those laws employers should consider when employees report being highly stressed or dealing with mental issues include:

  • OSHA: Under OSHA’s General Duty Clause, Section 5(a) (1), employers must maintain a workplace free from recognized hazards that are causing or are likely to cause death or serious physical harm. While stress or mental illnesses are not specifically addressed, OSHA has issued guidelines for establishing programs to minimize workplace violence.
  • Workers’ compensation:  Claims for work-related stress under workers’ compensation benefits may be the first indicator of a workplace issue. The availability for benefits varies from state to state for work-related stress.
  • EEOC guidance on psychiatric disabilities under the ADA: The EEOC has issued guidelines to facilitate the enforcement of the Americans with Disabilities Act (ADA) for individuals alleging discrimination on the basis of psychiatric disability. Whether job-related stress falls within the purview of the ADA has been considered by several courts and, to date, the majority of courts have held that job-related stress is either not a disability or handicap, or that the employee is not entitled to reasonable accommodation.

Because of the complexity of these laws and the risk involved, employers should seek advice from legal counsel and medical health professionals when addressing them.

In addition to the laws mentioned above, the Affordable Care Act (ACA), building on the Mental Health Parity and Addiction Equity Act of 2008, requires coverage of mental health and substance use disorder benefits for Americans in the individual and small group markets who previously lacked those benefits. The ACA also expanded parity requirements to apply to millions of Americans whose coverage did not previously comply with those requirements.

While there are currently no specific laws dealing with stress in the workplace, most businesses recognize a responsibility to treat the wellbeing of their employees as an important business obligation that is important to their success.

What can employers do to address high levels of stress in the workplace? As an initial framework, the UIC study recommends a discussion beginning with three areas: organizational change; screening and outreach; and managing the risk of prescription drugs that impair performance. 

Stress in the workplace is a growing issue and we encourage employers, risk managers, clinicians, public health advocates, ethicists, elected officials and policymakers to engage on how to attack the problem.

Desiree Tolbert, National Technical Compliance Manager

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I think everyone reading this blog has been touched by alcohol or substance abuse in their lifetime, whether personally or through the experience of an acquaintance, a family member, a close friend, a classmate or a colleague. We know the dangers of illegal drugs and overindulging in alcohol, but not as many of us understand the dangers of misusing prescription drugs. We rely on our pharmacists and our doctors to educate us on the medications we take. But what if we receive prescriptions from multiple doctors or fill our prescriptions at multiple pharmacies – maybe one close to work and one close to home? What percentage of the population reads the drug warnings that come with medications?

CDC-for_one_death_600w-ns

Recently I was very surprised to learn that an acquaintance is a recovering addict. She doesn’t fit the description of what I would consider a drug addict (not that there really is a profile for a drug addict); she comes from a supportive middle-class family, she’s educated, pretty, active, has a good job, lives in a nice community and loves animals. She talked about her past drug abuse, the people in her Narcotics Anonymous meetings and her seven years sober. Although she knew that I worked as a product manager doing something in the “medical field,” she was equally surprised to learn that part of my job is to develop narcotic management strategies for employers. She asked me how prevalent prescription painkillers are in the United States, so I shared with her the following facts:

  • The Centers for Disease Control and Prevention reported that enough narcotic painkillers are prescribed in the U.S. to medicate every adult American 24 hours a day for 1 month. Said another way, enough narcotic painkillers are prescribed to medicate 1 in 12 adult Americans around the clock for a year.
  • More people die from accidental prescription drug overdoses than car accidents.
  • More people die from accidental prescription drug overdoses than heroin, cocaine and all other illicit drugs combined.
  • The U.S. consumes 80-90% of the world’s supply of prescription painkillers, yet represents only 4.4% of the world’s population.
  • The street value of Oxycontin can reach up to $1/mg so an 80mg pill can fetch up to $80, making it significantly more expensive than heroin.
  • The #1 prescribed medication in the U.S. in 2012 was hydrocodone/acetaminophen (Vicodin).
  • 70% of all Americans who took a prescription drug for non-medical use obtained the drug from a friend or family member.

With every statistic, her jaw dropped lower. I will spare you all the details of our 45-minute conversation, but I will share with you her immediate response: “What can I do?” She wanted to help. Here’s what I told her:

  1. Don’t give your family or friends your unused medications.
  2. Keep all medications in a locked cabinet away from children, teenagers, family members and friends.
  3. Properly dispose of old prescriptions. The Drug Enforcement Agency created a national take-back program where Americans nationwide can dispose of unused, unwanted or expired medications on the last Saturday in April and the last Saturday in September/October. The program’s website also lists ways to dispose of medications properly if one of the 6,072 collection sites is not convenient.
  4. Assist elderly relatives in disposing of unused or expired medications.
  5. Educate others on the risk of combining alcohol with opioids. Alcohol and opioids are respiratory depressants, meaning they reduce our drive to breathe and can cause breathing to stop. Combine alcohol, opioids and benzodiazepines and the risk of accidental overdose increases significantly.
  6. When in doubt, ask your doctor or pharmacist about drug, food and vitamin interactions.
  7. Read the labels on medications; there is valuable information about the risks associated with the medication and how to take it safely.
  8. Don’t take expired medications or medications prescribed to others.
  9. Answer your doctor’s questions honestly.
  10. Only take medications as prescribed.

When taken properly, prescription painkillers can greatly reduce pain while the body heals after an injury or surgery. However, they can have unintended consequences if used improperly. We all have a stake in controlling the prescription painkiller abuse epidemic – from the drain on our emergency rooms, the cost to our healthcare system and, most importantly, the tragic loss of human life.

So I ask what are you going to do to be part of the solution?

Additional information can be found on the Centers for Disease Control and Prevention website.

Jamie Harer, Managed Care, Specialty Products Manager

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stress-in-the-workplacePost-traumatic stress disorder (PTSD) has gotten a lot of national attention lately due to several disturbing events on military bases. However, PTSD is not limited to veterans and those who have been exposed to war. It is a complex disorder that can affect anyone who has been involved in or witnessed a serious life-threatening event. Recently, the Center for Employee Health Studies at the University of Illinois at Chicago (UIC) released the results of a study on the consequences of stress in the workplace. Their research indicates that “while PTSD is most frequently associated with veterans, approximately 3.5% of American adults in the civilian population suffer with PTSD in any given year (NIMH, 2013). Women are twice as likely to be affected as men; the lifetime prevalence of PTSD among men is 3.6% and is 9.5% among women.” It is obvious that PTSD has become a major public health issue since the massive traumatization caused by September 11, Hurricane Katrina, and events like the Asian tsunami and the earthquake in Haiti.

According to the Mayo Clinic, PTSD is a mental health condition that’s triggered by a terrifying event — either experiencing it or witnessing it. Symptoms may include flashbacks, nightmares and severe anxiety, as well as uncontrollable thoughts about the event. Additionally, this disorder can affect the memory and nervous system, emotional responses, and the ability to think. It can lead to chronic pain, depression, sleep disturbances, nightmares, and relationship issues including divorce, violence, and employment problems. Individuals suffering from PTSD commonly experience episodes of anger, stress, and some may even turn to drug or alcohol abuse. Symptoms can be triggered by an anniversary of the event, loud noises that remind the individual of what happened, or they may experience persistent thoughts and memories of the event.

From a workers’ compensation and disability perspective, these situations can often go unrecognized and appear as other conditions in a claim. Consider a retail situation where a store employee is robbed at gunpoint and injured in a physical struggle. We immediately recognize the employee’s physical injuries, but may fail to aggressively address their emotional issues. Healthcare workers encounter life threatening events every day. We have grown to expect these workers to confront life and death, and try their best to save the lives of their patients. Ask any healthcare worker (firefighter, paramedic, nurse, physician, etc.) and they will tell you about a patient they will never forget. That patient is forged in their memory forever and likely caused them many sleepless nights due to PTSD. These situations can also exist for individuals in other industries, such as truck drivers who have been involved in an accident or factory employees who have witnessed a severe injury.

PTSD can be treated; however, we need to be mindful that any trigger can cause the symptoms to re-occur. Fireworks, for example, can be a reminder of an explosion or a severe thunderstorm can be a reminder of a hurricane. The treatment options are limited, and may or may not be effective. Examples include:

  • Cognitive behavior therapy, family and group therapy, and exposure therapy where the person is slowly reintroduced to the setting where the event occurred
  • Eye movement desensitization and reprocessing therapy where a therapist guides the individual’s eye movements when the thoughts occur and works with them to change their thoughts to positive
  • Anxiety medications such as Zoloft and Paxil (please note, as I mentioned in my recent post, Mental health prescriptions pose workplace worries, employers need a clear plan of action to manage employees taking these medications. Dependency and addiction are real issues without easy solutions.)
  • Magnetic resonance therapy, which is a newer area for research

PTSD is a serious health concern and the data is clear that there are many people in the workforce today who are not combat veterans, but have been diagnosed with the disorder. What steps are you taking to address this in your organization? I look forward to hearing from you and of course encourage you to contact me for additional information on this important topic.

Dr. Teresa Bartlett, SVP, Medical Quality

Read more in our “stress in the workplace” series:

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US_Soccer_LogoIn just a few hours the United States men’s national soccer team will take on Belgium in the knockout round of the 2014 FIFA World Cup. With this global sporting event combined with a short work week (with the July 4th holiday falling on Friday) for most of the United States, employers may be wondering how this will impact workplace productivity all week.

Forbes reporter Susan Adams wrote that during last week’s match against Germany, conference calls were down 7% during the first half and continued to decrease as the game came down to the final five minutes. However, in the other net – so to speak – Forbes had a guest post by Neal Taparia, Co-CEO of Imagine Easy Solutions, who wrote that watching the World Cup will increase office productivity. Mr. Taparia discusses how encouraging employees to watch the matches can boost morale in the workplace. Is this similar to March Madness in the United States where the sentiment of employers sometimes is if you can’t beat them, join them?

The black and white answer to the question is yes. In pure terms of work getting done, many people will probably be watching the match or following on their smart phones or via social media. This means productivity will not be at its highest level during the three hours the match is occurring.

The bottom line is you as an employer have to decide if your workplace environment can embrace World Cup madness for a few hours. As pointed out by Mr. Taparia, there is a good case for building good will and embracing the event. Of course there will be environments where safety and other factors prevent taking this approach.

So today, when you hear “gooaaaaaal” erupt in your workplace, we at Sedgwick hope it is followed by chants of USA…USA, as we wish the USMNT good luck against Belgium.

And we wish each of you a safe and happy Fourth of July weekend.

Jonathan Mast, Director of Social Media

July 2, 2014: A follow up note. Some of our own Sedgwick colleagues in our King of Prussia, PA, office held their own world cup celebration. They hosted a ladder ball tournament and a cookout. This is just another example of how you can chose to build morale around various national or global events.

KingofPrussia-WorldCup2014-Sedgwick

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stress-in-the-workplaceThe University of Illinois at Chicago (UIC) research paper on Stress in the workplace highlights the costly impact of stress and mental health issues on workplace injuries and illness, including higher risk of injury, medical treatment, lost time from work and presenteeism. We also know that mental health issues, including depression, have been found to have a much higher impact on presenteeism than other chronic illnesses.[1] Mental health disorders often have symptoms that are not readily apparent; employees may attend work, but their underlying health condition affects their ability to do the work or even distracts them from safe work behavior.

Many employers already offer health management benefits that provide employees with support for mental health and emotional well-being overall through employee benefit programs. This is partly because of other research, like that of UIC, demonstrating a strong relationship between these health issues and employee presenteeism, lost time from work, overall productivity and risk of injury/illness.

UIC researchers identified three key areas for employer initiatives. With National Post-Traumatic Stress Disorder Awareness Day approaching on June 27, we would like to build on their recommendations by offering some thoughts for additional actions employers can take – using available resources and medical/disability data – to mitigate the impact of lost productivity and presenteeism from stress and other mental health illnesses. We also encourage employers to develop initiatives that cross internal silos to share information and health intervention strategies for occupational and non-occupational injury and illness. Integration can vastly improve results in addressing this issue.

Organizational

  • Develop a broader organizational initiative to not only develop managers who are supportive of employees at work, but also to create a strong organizational culture – with C-suite leadership – that is supportive of employee health and well-being 24/7.
  • Ensure employee access to wellness and prevention offerings such as: employee assistance programs (EAP), disease management, personal financial counseling, stress management and resiliency training. Make sure managers are familiar with them and can talk to employees about using the services. For parents, services like same-day care services for sick children and flexible work schedules can be valuable stress alleviators that increase attendance as well as attention to work tasks.
  • Other stress reducers in the work environment can include offering exercise classes, group walks or walking contests and other social/community events that engage employees in building positive, friendly relationships with colleagues. Having community and shared experiences can reduce perceived stress and isolation.

Screening and supportive services for high-risk individuals

  • Use an employee health risk assessment (HRA). This self-assessment, offered to all employees, is a common employee benefits tool for identifying other individual and population risks. Many companies use employee incentives (cash, gift certificates or health premium reduction) to encourage high engagement levels.
    • HRA individual results are usually kept confidential from the employer. However, independent healthcare management vendors can be engaged to reach out to employees with health risk indicators and help guide them to intervention programs like EAP or provide referrals to mental health providers, etc.
    • HRA summary data information can be used to see the varying risks in the population as a whole; sometimes data can also be broken down by business unit or occupation. Interventions can then be designed – i.e. resiliency training for employees who are under high stress, or more visible communication on EAP resources, stress reduction techniques, crisis intervention initiatives, etc.
  • One data resource often overlooked is Family Medical Leave Act (FMLA) and short term disability (STD) frequency and cause of absence. High absence rates, especially in units that have high-stress environments, can be an important red flag. FMLA summary information can be reviewed in conjunction with summary data from HRA, STD and workers’ compensation reports to identify occupations and business unit populations where stress or depression may be a factor.
    • Integrated Benefits Institute (IBI) research in 2013 showed FMLA usage to care for a family member more than doubles the risk of an STD claim for employee disability[2] due to mental health issues within a year. It seems reasonable to think this stress could show up in other areas, as well, i.e. increased risk of presenteeism, work injury or extended disability while off work due to other health issues.
    • For many employers, FMLA intermittent leave has a high absence rate for mental health and depression, and often the reason for leave is available to the leave administrator. This is an area where referral to employee health resources can be a valuable intervention.

Managing the risk of prescription drugs that impair performance

  • Many employers have access to their prescription drug usage in summary data. Usually this data includes drug names, frequency of prescriptions and costs, as well as break-out by business locations or zip codes.
  • Use of this summary data to identify drug use in employee populations that may increase the risk of injury is a first step to understanding what risks may exist and what methods can be used to ensure all employees are safe to perform work tasks.
  • Use of the company medical director or a trusted physician consultant as an advisor to assist in this data review and in development of alternative intervention strategies is recommended. Interventions could have high impact on employees, as well as operations and safety. Incorporating legal and human resources into this process is also highly recommended.

Many employers are realizing that mental health and emotional well-being can greatly impact overall health issues, employee presenteeism, lost time from work, overall productivity and risk of injury/illness. Is this a growing concern for your organization too? I look forward to hearing your perspective.

Denise Fleury, SVP, Disability and Absence Management

Read more in our “stress in the workplace” series: part 1, part 2


[1] IBI Chronic Disease Profile, Depression, IBI, 2013
[2] “Early Warnings: Using FMLA to Understand and Manage Disability Absence,” IBI, 2013

 

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Prescription-drug-concerns

Imagine a young father of two (Jim) who goes to work one day and sustains a minor back injury. He sees a doctor and is told he can work, but could not lift over 25 pounds. Jim’s employer would not take him back unless he could perform all essential job functions without restrictions. The doctor gives him a few pills to reduce his back pain, but he is unable to easily play with his children or do household chores. Repeat doctor visits end up leading to more pain pills, and then antidepressants to help manage his mood and disappointment. Soon, the pain becomes a daily component of his life. He continues to take the medications and grows more anxious as time goes on. He wonders if he will lose his job. Do his family, friends and co-workers believe he has a condition? His physician had no plausible explanation for his pain. The diagnostic testing and physical examinations were normal, yet Jim still has pain. Should a surgeon be consulted? His doctor is stumped.

Jim’s life becomes very different due to the failure of many systems. The medical community let him down by over-treating his minor injury. He had multiple tests that never amounted to anything. He was sent to specialists who treated the “pain,” and was eventually given more and more medications. Off work for more than a year with essentially a minor back strain, Jim gains weight and is mostly inactive. No one ever spoke to him about healthy lifestyle choices, good nutrition and functioning with pain. Soon, he sits on the couch all day, does not participate in family functions and becomes more disconnected from family and friends. The pills begin to consume his life. He is constantly thinking about when he can take his next dose.

Each day, 22 people in the U.S. die from overdoses due to prescription pain pills or opioids. We know that pain medication and other medications cause great concern from a health and safety perspective once an employee returns to work. Many employers are not aware of the medications workers are taking until there is an accident. These drugs can inhibit sleep patterns, make employees drowsy during the day, impair judgment and lead to addiction. The risks associated with them are too numerous to count. The family dynamic is altered; the injured employee feels isolated and depressed, and is not functioning at optimal levels.

Opioids can be very dangerous when combined with other medications to treat anxiety, depression and sleep disorders, and patients must understand the risks. Physicians rarely take adequate time to explain all the risks, and the dos and don’ts associated with these medications. For example, all pills should be kept in a lock box to prevent others from accessing them. Also, no other medications should be taken with prescriptions unless first discussed with your doctor. Over-the-counter pain medications like acetaminophen or ibuprofen are usually components of prescription pain medications, and high doses can be toxic to the kidneys and liver. Allergy, cold and sleep medications should be avoided as combining them with opioids and anti-anxiety medications can result in overdose or death.

Proper attention should be given to the total morphine equivalent dose (MED) each day. Doctors can become overwhelmed with a patient who has pain and no real diagnosis. There are countless examples of physicians prescribing MEDs exceeding the daily maximum recommended. They often treat the symptoms and forget to treat the person by addressing healthy alternatives, such as exercise programs, smoking cessation and nutritional counseling, and explaining that each pain medication should be treated as a short trial. When the medication does not increase functional abilities or eliminate the pain, it is not working and should be discontinued immediately. 

Anti-depressants, anti-anxiety drugs, and managing employees who take them
Stress, depression and anxiety are consistently ranked among the top five causes of time away from work. These conditions are often undiagnosed, under treated, or over treated. Depression in particular is a major contributor to other conditions, such as diabetes, heart disease and muscle strain. It is well documented and known to delay healing in post-operative cases, which extends durations beyond the expected recovery time.

Anti-depressants require close monitoring and management to increase doses, add adjunct medications and ensure optimal therapeutic levels are maintained. Three to nine percent of individuals who sustain an accident or injury have taken or are taking these medications.

Anti-anxiety drugs are commonly prescribed to block pain and can also cause work-related issues. They relieve anxiety by slowing the central nervous system and reducing brain activity, and are used to treat sleeplessness or as a muscle relaxer. They may create unwanted side effects like sleepiness, a sensation of fogginess and a lack of coordination – all of which can make working and driving dangerous or difficult. Anti-anxiety drugs are often associated with and can cause depression, and long term use should be avoided.

Employers need a clear plan of action to manage employees taking these medications. Dependency and addiction are real issues without easy solutions. The best strategies include prevention and monitoring. Best practices for healthcare providers include:

  • Completing baseline urine drug screenings (first prescription not given if patient tests positive for opiates or barbiturates)
  • Conducting a risk assessment to understand if the patient has any risk of addiction, overdose or dependency
  • Signing an opioid agreement – with both provider and patient – prior to the first prescription to ensure the patient understands all health risks and side effects, as well as expectations including not taking other medications, avoiding alcohol and other illicit drugs
  • Counting pills and patches on every visit
  • Conducting random unannounced drug screenings
  • Focusing on function and return to normalcy
  • Reducing and eliminating the medications as soon as possible

A large-scale effort is needed to help employees obtain the most appropriate care for their injuries. Education and good communication are the keys to preventing misuse and avoiding addiction and dependency.

Dr. Teresa Bartlett, SVP, Medical Quality