Tag Archives: Florida

Florida lawmakers pass bill for Canadian drug importation – Sun Sentinel

From the Overnight News Desk:

Richard’s Note: My late mother worked for a local company that imported drugs for seniors from Canada, the UK, and Israel. The seniors would bring the prescription from the doctor to their office, the employees would fax the prescription and any other documents to the pharmacies in those countries, who would then ship the medications directly to the seniors, without the drugs ever going to the company’s office.

As the two articles cited below state, this would be a departure from Republican orthodoxy on prescription drugs, and could be a model for other states to pursue to bring down the cost of drugs, at least as far as senior citizens are concerned.

I post these articles to honor my mother for her work to help fellow seniors to get less expensive versions of their medications.

Here are the two articles:

Floridians could eventually gain access to cheaper Canadian prescription drugs under legislation the state House has sent to Gov. Ron DeSantis.

Source: Florida lawmakers pass bill for Canadian drug importation – Sun Sentinel

Source: Florida Gov. Ron DeSantis defies GOP orthodoxy with drug importation plan

ARAWC Strikes Again: Opt-out Rolls On

“Just when I thought I was out… they pull me back in.”

Michael Corleone, Godfather, Part III

Source: https://www.pinterest.com/Mamzeltt/famous-movie-quotes/

When Michael confronts Connie and Neri in the kitchen of his townhouse, he warns them to never give an order to kill someone again (in this case, it was Joey Zaza), and goes on to state that when he thought he had left the mob lifestyle, they pull him back.

Thus, is the case with opt-out, as I discussed in my last post on the subject.

Kristen Beckman, in today’s Business Insurance, reminds us that opt-out, like the Mob, is pulling us back into the conversation.

As I reported last time, a bill in Arkansas, Senate Bill 653, pending in that state’s legislature’s Insurance & Commerce Committee since the beginning of March, proposes an alternative to the state system.

Ms. Beckman quotes Fred C. Bosse (not Fred C. Dobbs), the southwest region vice president of the American Insurance Association (AIA), who said that the bill is an attempt to keep the workers comp opt-out conversation going.

Mr. Bosse said that the AIA takes these bills seriously (good for them) and engages legislators to dissuade progress of such legislation the AIA believes could create an unequal benefit system for employees. (They haven’t drunk the Kool-Aid either)

Arkansas’ bill is the only legislation currently under consideration, but a state Rep in Florida, Cord Byrd (there’s a name for you), a Republican (it figures) from Jacksonville Beach, promoted legislation last year, but never filed it.

South Carolina and Tennessee, where bills were previously introduced within the past two years has gone nowhere.

And once again ARAWC rears its ugly head. For those of you unfamiliar with ARAWC, or the Association for Responsible Alternatives to Workers’ Compensation, it is a right-wing lobbying and legislation writing group based in Reston, Virginia. (see several other posts on ARAWC on this blog)

A statement ARAWC sent to BI said that these bills are beginning to pop up organically to model benefits that companies have seen from Texas’ non-subscription model. (Organically? That’s like saying mushroom clouds organically popped up over Hiroshima and Nagasaki)

Here’s a laugh for you, straight from the ARAWC statement:

Outcomes and benefits for injured workers have improved, employers are more competitive when costs are contained and taxpayers are well served by market-driven solutions,” They further said, “We recognize that each state is different and that the discussions at the state level will involve varied opinions.”

Of course, we cannot really know if injured workers are benefitting, or just being denied their rights, and it seems that opt-out is only to help employers and taxpayers get out of their responsibility to those who sustain serious injuries while employed.

In another post, the notion that Texas’ system could serve as a model for other states was outlined in a report by the Texas Public Policy Foundation (don’t you just love the names of these reactionary groups?)

Bill Minick, president of PartnerSource, praised the report, according to Ms. Beckman, and said that competition has driven down insurance premium rates and improved benefits for Texas workers. (That’s what he says, but is any of it true, I wonder? I doubt it.)

ARAWC has listed a laundry list of benefits they say responsible alternative comp laws could provide:

  • Better wage replacement
  • Reduced overall employer costs
  • Faster return to work
  • Fewer claims disputes (yeah, because they would be denied)
  • Faster claim payouts
  • Faster closure (well, when you deny claims, they can be closed faster, duh!)

It is good to know that the AIA is critical of the report, and that in their opinion, it is unworkable to allow employers to adopt a separate, but unequal system of employee benefits.

And as we have seen with the defeat of the AHCA, leaving a government-sponsored program up to market-driven forces is a recipe for disaster that should not be repeated in workers’ comp, no matter what flavor the Kool-Aid comes in.

Tracking Poll Highlights Americans Views on Health Care Issues

The Kaiser Family Foundation released its Health Tracking Poll for August 2016.

The issues polled ranged from the ACA to Medicare and to Zika funding, as well as travelling to areas of Florida where Zika was found (would that I could leave this overdeveloped, bug infested, alligator crawling and now disease-ridden swamp).

Sorry, Rick Scott…Florida is not in a good place right now, thanks to your lousy leadership.

Here are the findings from the poll:

  • Two-thirds of voters say the future of Medicare and access and affordability of health care are top priorities for the candidates to be talking about during the 2016 presidential campaign.
  • More voters trust Hillary Clinton to do a better job dealing with health care issues than trust Donald Trump, although few believe their own ability to access affordable health care would get better regardless of which candidate is elected. Voters, age 65 and older, are split between which candidate they trust to do a better job dealing with the future of Medicare with a similar share saying they trust Trump (44 percent) as say they trust Clinton (47 percent).
  • Almost all Americans have heard or read about the Zika virus (92 percent), and one-third (36 percent) say that passing new funding to deal with the outbreak in the U.S. should be a top priority for Congress, with an additional 40 percent saying it should be an important but not a top priority. A large majority of all partisans say that new Congressional funding should be at least an important priority for Congress.
  • About half of the public says they would not feel comfortable traveling to places like parts of Florida where people have been infected with the Zika virus by mosquitoes. In addition, three-fourths (77 percent) say these places are generally unsafe for pregnant women. The Kaiser Family Foundation has been tracking public opinion on Zika since February 2016; for more poll results, visit the up-to-date Zika slideshow.
  • About half of Americans are concerned that an unauthorized person might get access to their confidential records and information; despite this, 80 percent say it is important that their doctors use online medical records.
  • Americans’ opinion of the health care law remains split, with 40 percent saying they have a favorable view and 42 percent saying they have an unfavorable view.

Florida WC Rates to Rise

As reported Tuesday on Insurance Journal.com, the National Council on Compensation Insurance (NCCI) has proposed a nearly 20% increase in the combined average rate increase from 17.1 percent to 19.6 percent.

This rate increase is in response to the decisions in the Westphal and Castellanos cases from the Florida Supreme Court last month and in April.

The Westphal  decision has prompted NCCI to propose a 2.2 percent projected increase. The court reinstated the 260-week limitation on temporary total benefits, which was limit before the 1994 reform. The Castellanos decision has prompted NCCI to propose a 15 percent projected increase. And a 1.8 percent projected rate increase related to updates within the Florida Workers’ Compensation Health Care Provider Reimbursement Manual (HCPR Manual) per Senate Bill 1402. The manual became effective on July 1, 2016.


I am willing to work with any broker, carrier, or employer interested in saving money on expensive surgeries, and to provide the best care for their injured workers or their client’s employees.

Ask me any questions you may have on how to save money on expensive surgeries under workers’ comp.

I am also looking for a partner who shares my vision of global health care for injured workers.

I am also willing to work with any health care provider, medical tourism facilitator or facility to help you take advantage of a market segment treating workers injured on the job. Workers’ compensation is going through dramatic changes, and may one day be folded into general health care. Injured workers needing surgery for compensable injuries will need to seek alternatives that provide quality medical care at lower cost to their employers. Caribbean and Latin America region preferred.

Call me for more information, next steps, or connection strategies at (561) 738-0458 or (561) 603-1685, cell. Email me at: richard_krasner@hotmail.com.

Will accept invitations to speak or attend conferences.

Connect with me on LinkedIn, check out my website, FutureComp Consulting, and follow my blog at: richardkrasner.wordpress.com.

Transforming Workers’ Comp Blog is now viewed all over the world in over 250 countries and political entities. I have published 300 articles and counting, many of them re-published in newsletters and other blogs.

Share this article, or leave a comment below.

Florida Workers’ Comp Outcomes Similar to 14 Other States

Introduction

Earlier this week, the Workers’ Compensation Research Institute (WCRI), released a study that compared the outcomes for injured workers across 15 states. It can be purchased here.

Each state has a separate, multi-page report, so I requested a copy of the report for Florida, as that is where I currently reside (offers of employment elsewhere are greatly appreciated).

As this report has over 100 pages, it is reasonable to assume that 15 such reports would have a combined 1500 pages or more. So, I took the easy way and just looked at one state.

In the introduction to the report, there are two key dimensions of the performance of any workers’ comp system in the US:

  1. Post-injury outcomes achieved by injured workers and;
  2. Costs paid by employers.

The study measured the following worker outcomes:

  • Recovery of physical health and functioning
  • Return to work
  • Earnings recovery
  • Access to medical care
  • Satisfaction with medical care

The study was also conducted in three phases:

  • Phase 1: Eight states (IN, MA, MI, MN, NC, PA, VA, WI)
  • Phase 2: Four states: (IA, AR, CT, TN)
  • Phase 3: Three states: (FL, GA, KY)

The WCRI will collect data from other states and revisit states from earlier phases that implemented reforms to measure the impact of those reforms on outcomes in subsequent phases.

Key Findings for Florida

The WCRI found that workers in Florida reported outcomes that were similar to the median study on some of the key measures, but they reported somewhat higher rates of problems accessing desired services, accessing desired providers, and higher dissatisfaction with overall medical care.

For Recovery of physical health and functioning, they found that for Florida, it was similar to the other 14 states.

For Return to work, injured workers in Florida reported rates of return to work in the middle range of the study. 14% of Florida workers with more than seven days of lost time reported never having a return to work that lasted at least one month due to the injury as of three years’ post-injury; 17% reported no return to work within one year of injury. The median worker in Florida had a return to work about 12 weeks after injury.

For Earnings Recovery, 11% of Florida injured workers reported earning “a lot less” at the time of return to work; the median was 8%.

For Access to care, 21% of Florida injured workers reported they had “big problems” getting the services they or their provider wanted; 20% reported “big problems” getting the primary provider they wanted. Florida was among the states, the study reported, with higher rates of problems of access to care and providers, and higher or somewhat higher than in nine or eight other states.

For Satisfaction with care, the study found nearly three in four Florida workers were “somewhat” or “very” satisfied with their overall care (71%); however, 20% said they were “very dissatisfied”. This was higher than the median of the states, and higher than in 10 states.

Table 1 is a comparison of the medical costs and outcomes between Florida and the other 14 states in the WCRI study. What is interesting to note is that when compared to the other 14 states, Florida had similar outcomes in many of the measures, as the study suggested.

Table 1

Source: WCRI

The study found that medical costs in Florida, recovery of health and functioning, rates of return to work, duration of time before return to work were typical, while problems with getting desired services, and providers were somewhat higher or higher. Satisfaction was lower, but dissatisfaction was higher.

What I found interesting, and perhaps a little disturbing, but not unexpected, was that with the exception of the percentage of satisfaction, all the figures were below 50%, and while the score mechanism for recovery of health and functioning is not further discussed in the Summary, but is mentioned in the notes, those also seem to be very low.

I am not surprised that Florida has a higher percentage of dissatisfaction with medical care, this despite the fact that everywhere you look in Florida cities and towns, there are hundreds of medical offices, clinics, and many hospitals; some large, some small.

What to make of this?

While it is too early to tell how these 15 states compare with the other 35 states, what we can gather from this data is that the workers’ comp systems in these states are falling far short of where they should be in almost all of the measures.

Satisfaction percentages, notwithstanding, there are real issues with the way injured workers are treated in these 15 states.

That Florida is similar to 14 other states in five outcome measures, and not even above 50%, tells me that the industry needs to stop kidding itself that everything is honky-dory. It’s not.

How worse do you think it would be if the only current alternative being suggested is the opt-out option? If workers are not getting back to work or getting better care or better health and functioning under the current state systems, how do you think it would be if states like FL, GA, KY, NC, TN and VA go to opt-out as ARAWC is trying to do?

And without going into the details of each states report, it is hard to know just how much of these outcomes are related to common workers’ comp surgeries that could be provided for by outside medical facilities in other nations in the Western hemisphere?

Denying injured workers, the access to the services and providers they want or need is not a sign that everything is okay, having long-delayed return to work three years after injury is not okay, and earning less after an injury is also not okay.

WHEN ARE YOU GOING TO WAKE UP OUT OF YOUR DREAMSTATES AND REALIZE THERE ARE MAJOR PROBLEMS HERE THAT ARE NOT BEING SOLVED?

WHEN ARE YOU GOING TO STOP LISTENING TO PEOPLE WHO DO NOT WANT TO IMPROVE THE SYSTEM BECAUSE IT ONLY SERVES TO MAKE THEM WEALTHIER OR SOMEONE ELSE WEALTHIER?

WHEN ARE YOU GOING TO REALIZE THAT AMERICAN PHYSICIANS ARE NOT THE ONLY ONES WHO CAN PRACTICE MEDICINE, AND MAY EVEN BE BETTER THAN THOSE HERE WHO ARE ONLY IN IT FOR THE MONEY?

No matter how many studies or reports the WCRI or NCCI, or anyone else issues, until you disavow yourselves of the notion that workers’ compensation is failing and that there are ways to fix it, it will just get worse, until one day it is no longer here for anyone.


I am willing to work with any broker, carrier, or employer interested in saving money on expensive surgeries, and to provide the best care for their injured workers or their client’s employees.

Ask me any questions you may have on how to save money on expensive surgeries under workers’ comp.

I am also looking for a partner who shares my vision of global health care for injured workers.

I am also willing to work with any health care provider, medical tourism facilitator or facility to help you take advantage of a market segment treating workers injured on the job. Workers’ compensation is going through dramatic changes, and may one day be folded into general health care. Injured workers needing surgery for compensable injuries will need to seek alternatives that provide quality medical care at lower cost to their employers. Caribbean and Latin America region preferred.

Call me for more information, next steps, or connection strategies at (561) 738-0458 or (561) 603-1685, cell. Email me at: richard_krasner@hotmail.com.

Will accept invitations to speak or attend conferences.

Connect with me on LinkedIn, check out my website, FutureComp Consulting, and follow my blog at: richardkrasner.wordpress.com.

Transforming Workers’ Comp Blog is now viewed all over the world in over 250 countries and political entities. I have published nearly 300 articles, many of them re-published in newsletters and other blogs.

Share this article, or leave a comment below.

“Florida, We Have a Problem”

Tuesday, Judge David Langham, Deputy Chief Judge of Compensation Claims for the Florida Office of Judges of Compensation Claims and Division of Administrative Hearings, wrote a rather lengthy post about the differences between cost-shifting and case-shifting in workers’ comp.

Much of what the Judge wrote were subjects that I already discussed in a number of previous posts about cost-shifting and case-shifting, so I won’t go into it here. I am only focusing on the parts that relate to Florida workers’ comp. You can read the entire article yourselves.

But what caught my attention was what he said about Florida and what the Workers’ Compensation Research Institute (WCRI) reported in some of their studies on these issues.

As Judge Langham wrote this week, he wrote a post two years ago that asked the question “Why Does Surgery Cost Double in Workers’ Compensation?”

Judge Langham noted in that post that Florida employers have been documented paying almost double for shoulder or knee surgery that is paid for under workers’ compensation, compared to group health costs.

The implication of case-shifting in Florida, he says, could arguably be a doubling of cost.

He cited a WCRI report released earlier this year that suggests however that case-shifting is perhaps not as likely in Florida.

According to the report, Judge Langham continues, “as of July 2011, six states had workers’ comp medical fee schedules with rates within 15% of Medicare rates. They were California, Massachusetts, Florida, North Carolina, New York and Hawaii.”

However, Judge Langham pointed out that the WCRI concluded that case-shifting is more likely in states where the workers’ compensation fee schedule is 20% or more above the group health rates, and not in Florida.

Judge Langham stated that this analysis of workers’ compensation fee schedules does not appear to include analysis of the reimbursement rates for hospitals, and that It also seems contradictory to the assertions that Florida workers’ compensation costs for various surgeries have been documented as roughly double the group health rates (100% higher, not 15% higher).

Injured workers who missed work in the Florida workers’ compensation system could be compensated in 2016 at a rate as high as $862.51 per week, the “maximum compensation rate.”

So, if recovery from such a “soft-tissue” injury required ten weeks off-work, he wrote, the case-shifting to workers’ compensation might add another four to nine thousand dollars to the already doubled cost of surgical repair under workers’ compensation.

This could be directly borne by the employer if the employer is self-insured for workers’ compensation; or, if the employer has purchased workers’ compensation insurance, the effect on the employer would be indirect in the form of potentially increased premium costs for workers’ compensation following such events and payments, Judge Langham states.

According to WCRI, the Judge quotes, “policymakers have always focused on the impact (workers’ compensation) fee schedules have on access to care as well as utilization of services.

This has been a two-part analysis, he says:

First, fee schedules have to be sufficient such that physicians are willing to provide care in the workers’ compensation system; and second, the reimbursement cannot be too high, or perhaps overutilization is encouraged.

Lastly, Judge Langham points out that the disparity between costs has also been noted in discussions of “medical tourism.”

The last question he posits is this, “might medical decision makers direct care to more efficient providers, across town, across state lines?”

What about national borders?


I am willing to work with any broker, carrier, or employer interested in saving money on expensive surgeries, and to provide the best care for their injured workers or their client’s employees.

Ask me any questions you may have on how to save money on expensive surgeries under workers’ comp.

I am also looking for a partner who shares my vision of global health care for injured workers.

I am also willing to work with any health care provider, medical tourism facilitator or facility to help you take advantage of a market segment treating workers injured on the job. Workers’ compensation is going through dramatic changes, and may one day be folded into general health care. Injured workers needing surgery for compensable injuries will need to seek alternatives that provide quality medical care at lower cost to their employers. Caribbean and Latin America region preferred.

Call me for more information, next steps, or connection strategies at (561) 738-0458 or (561) 603-1685, cell. Email me at: richard_krasner@hotmail.com.

Will accept invitations to speak or attend conferences.

Connect with me on LinkedIn, check out my website, FutureComp Consulting, and follow my blog at: richardkrasner.wordpress.com.

Transforming Workers’ Blog is now viewed all over the world in 250 countries and political entities. I have published nearly 300 articles, many of them re-published in newsletters and other blogs.

Share this article, or leave a comment below.

Courts Striking Down Work Comp Laws

Coming back around to the constitutionality of aspects of the various state workers’ comp laws, an article by David De Paolo last week, suggested that rather than corporate America dismantling workers’ comp, it is the courts who are actually doing so.

David says that state supreme courts will be the ones doing the dismantling this year, piece by piece.

A week and a half ago, I wrote that the Oklahoma WC statute relating to the permanent partial disability deferral provisions of the state’s workers compensation statutes of 2013, was struck down in a 7-2 decision.

This decision was first reported in The Oklahoman.

And David also reported in the same article, that the 1st District Court of Appeals in Florida said that the state’s statutory limits on the payment of attorneys for injured workers was unconstitutional.

So while ProPublica and others rightly or wrongly accuse corporate America, the Koch Brothers, ALEC, ARAWC, the Illuminati, Martians, and anyone else we left out, it is the men and women who wear black robes who are striking down the workers’ comp laws in their states.

Is this a coincidence? Is this a vast conspiracy of right-wing jurists and those who put them on the bench? That is hard to say because we don’t know these people at all, who appointed them, and what their individual political motives are.

But if these decisions are any indication, the courts are ruling more in favor of injured workers, than their employers.

If you read De Paolo’s article and the cases linked to them, as well as the OK case, you will see that the courts are generally siding with workers.

What does this mean?

Well, it is too early to tell, but if these trends continue this year, 2016 may be the year the injured worker gets a little break. But we still have laws, regs, and rules in place that are holding back workers from getting the best health care available, at lower cost, no matter where that happens to be, even if it is not within the borders of their state or the country.

And that is something courts in the future will have to decide.

Advocacy Group Petitions Florida Supreme Court to Review Work Comp Constitutionality

As I reported three weeks ago in “Breaking News on ACA and Exclusive Remedy”, the issue of constitutionality of Florida’s workers’ comp system was settled by the 3rd District Court of Appeal.

However, Stephanie Goldberg reported today in Business Insurance that an advocacy group has petitioned the Florida Supreme Court to review the case that challenges the constitutionality of the state’s workers’ comp system.

The Florida Workers’ Advocates filed an appeal with the Court to review The State of Florida v. Florida Workers’ Advocates et al.

The case questions whether workers’ comp is an adequate exclusive remedy for injured workers. This issue was discussed in my previous articles, “Constitutionality of Workers’ Comp Challenged: What that could mean for Medical Travel” and “Update on Constitutionality of Work Comp in Florida“.

As far as Florida Workers’ Advocates are concerned, the issue of the constitutionality of workers’ comp has not been settled, so expect more on this in the future.

What does it mean for you?

Probably nothing, because the Supreme Court will probably uphold the District Court of Appeal ruling that the plaintiffs had no legal standing to challenge the constitutionality, and that will settle the matter.

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I am willing to work with any broker, carrier, or employer interested in saving money on expensive surgeries, and to provide the best care for their injured workers or their client’s employees.

Call me for more information, next steps, or connection strategies at (561) 738-0458 or (561) 603-1685, cell. Email me at: richard_krasner@hotmail.com.

Ask me any questions you may have on how to save money on expensive surgeries under workers’ comp.

Connect with me on LinkedIn, check out my website, FutureComp Consulting, and follow my blog at: richardkrasner.wordpress.com. Share this article, or leave a comment below.

Rick Scott is a Crook

rick_scott

Kaiser Health News reported yesterday on a study in Health Affairs that some US hospitals charge patients more than 10 times the rates paid by Medicare.

Of the 50 U.S. hospitals with the highest charges, 49 are for-profit institutions, and 20 operate in Florida, and half are owned by a single chain, the study reported.

Yet, not all patients end up paying those charges says Jenny Gold, of Kaiser Health News.

Private insurers, she said, are able to negotiate the sticker price down significantly, and patients paying out of pocket can often negotiate discounts or get charity care if they are low-income.

However, the average U.S. hospital charges a somewhat less staggering sum: 3.4 times the rates paid by Medicare, according to Gold.

But the crux of the article has to do with the hospital chain that owns half of the 20 highest charging hospitals in the country.

That chain is Community Health Systems, a for-profit chain with 199 hospitals. In 2014, the company made $18 billion in profits, 45 percent more than in 2013.

Florida most likely had the most high-charging hospitals because it has an exceptionally high proportion of for-profit hospitals, according to consumer advocates, and North Okaloosa Medical Center, a CHA hospital in the Florida panhandle, was mentioned as having the highest charges of all: 12.6 times Medicare’s rate.

The highest charging hospitals, Gold wrote, besides Florida, were in 13 states, mostly in the South: Alabama, Arkansas, Arizona, California, Kentucky, New Jersey, Oklahoma, Pennsylvania, South Carolina, Tennessee, Texas, and Virginia.

So when you hear that Florida Governor Rick Scott is suing the federal government to get billions for Florida’s hospitals because he won’t expand Medicaid, you have to wonder if he’s not doing so because he wants to funnel that money to for-profit chains like Community Health Systems.

After all, he did steal millions from the government once before and got away with it. Why should now be any different?

When will people realize our health care system is a scam. I am seeing this in the articles I am reading, the articles I am writing, and in my personal life, but too many of you out there are convinced this is the right way to handle health care. It isn’t.

As I wrote in the following two posts, “We’re No. 1!”, NOT! — Why the US Health Care System is Not the Best in the World and Why Implementing Medical Tourism into Workers’ Comp Could Improve Outcomes, and in, “We’re Not No. 1!” We’re No. 11, we are fooling ourselves when we say we have the best health care in the world. We have the most expensive health care, and health care should not be expensive.

But we continue to bury our heads in the sand and allow men like Rick Scott and others to skim off the top, all the while elderly parents go without the medical care they need and the home care they need, younger people are forced onto sub-standard plans because there are no employers nearby who will hire them and put them on their company plans, or they are ineligible to apply for the exchanges because of politics or IRS rules, as well as many other reasons why other Americans are not completely covered, and are left out of the system altogether.

The real reason behind this mess is simple: profit and greed. The system is built for and on top of, the generation of profit and the process of greed.

Mother Jones magazine also discussed this issue yesterday. Here is the link to its article: http://www.motherjones.com/kevin-drum/2015/06/here-are-americas-top-50-health-care-thugs

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I am willing to work with any broker, carrier, or employer interested in saving money on expensive surgeries, and to provide the best care for their injured workers or their client’s employees.

Call me for more information, next steps, or connection strategies at (561) 738-0458 or (561) 603-1685, cell. Email me at: richard_krasner@hotmail.com. Ask me any questions you may have on how to save money on expensive surgeries under workers’ comp. Connect with me on LinkedIn and follow my blog at: richardkrasner.wordpress.com. Share this article, or leave a comment below.

Primary Language-Speaking Physician Ruled Not Medically Necessary

I came across an interesting article today from David DePaolo on his blog, DePaolo’s Work Comp World. The article, Comunicación No Es Médicamente Necesario, discussed a recent workers’ compensation case in Florida that involved the right to bilingual treatment.

A roofer in 2012, suffered a head injury when he fell 30 to 40 feet off of a ladder. His employer accepted the compensability of the injury and authorized treatment from several doctors, including a neurologist, Dr. Angelo Alves.

Dr. Alves recommended that the claimant undergo a neuropsychological evaluation for his memory, cognition and emotional state. The employer then arranged an appointment with Dr. Arthur J. Forman. Because Dr. Forman did not speak Spanish and the claimant only spoke limited English, his employer arranged for an interpreter for the claimant’s office visits

The claimant objected to the interpreter, and filed a petition for benefits, seeking authorization for an evaluation by a Spanish-speaking neuropsychologist. His reasoning was that he did not want to do it through an interpreter and talk about the intimate details of his life through another person.

Dr. Alves supported the claimant’s claim and testified that the claimant needed to have a neuropsychological evaluation performed by a Spanish-speaking psychologist. It was Dr. Alves’ position that having the evaluation through an interpreter was not the same as with a Spanish-speaking doctor, because the doctor could get the wrong information.

However, the Judge of Compensation Claims was not persuaded by that argument. The claimant appealed, but a split panel of the First District Court of Appeals agreed with the JCC.

The finding of the court was that while a Spanish-speaking provider was preferable, the evidence did not establish medical necessity.

Judge Scott Makar, an appointee to the First District Court of Appeals by current Tea Party-backed Florida governor, Rick Scott, in a concurring opinion, addressed the challenges of meeting health care expectations within the limited resources of any health care delivery system.

According the Judge Makar, “In an ideal world with unlimited resources patients would have health care information published in their own primary languages, and their health care service providers would speak their primary languages.” He went on to add, that since this ideal is “unattainable”, “the trajectory of the language access movement in the United States currently has gravitated to the use of translators (for written communication) and interpreters.”

The dissenting opinion, by Judge Bradford Thomas, an appointee of former governor Jeb Bush (who by the way speaks Spanish and is married to a Hispanic woman), argued “that no medical testimony supported the JCC’s view that the Spanish-speaking psychiatric evaluation was not medical necessary, and that the JCC had failed to give a “reason” for rejecting Dr. Alves’ opinion.”

David pointed out that Judge Thomas had the burden of proof backwards and ignored the substantial evidence standard. But, he also pointed out that the majority opinion seemed to take the position that Spanish is a “minority” language, which David points out in the rest of his article, it isn’t.

Before I tackle that issue, I would like to explain why I mentioned who appointed the concurring and dissenting judges, and what struck me as I read the court’s ruling in this case. Had Judge Makar been appointed by any other governor besides Rick Scott, I would have been puzzled as to why they would go out of their way to annoy a growing segment of Florida’s population such as Latinos, especially since they are sensitive to any form of discrimination against their community, such as restricting their right to vote.  This is especially true of non-Cuban Latinos who generally vote for Democrats.

That Rick Scott is a Tea Party-backed politician, and knowing that the Tea Party has elements in it that despises immigrants, both legal and illegal, who are usually Hispanic, Judge Makar’s opinion shows obvious Tea Party bias towards Spanish-speaking people in the state.

His characterization of Spanish as a “minority” language is certainly not true to this former New Yorker who had gone through several areas of Miami, Fort Lauderdale and many other cities in South Florida and felt like I was in the minority. Also, his statement about an ideal world is typical of right-wing conservatives who are opposed to any accommodations to non-English speaking people.

I say this as the grandson of four immigrants who had to learn English and had to speak their native language, Yiddish, at home amongst themselves and other family members and friends, so that the “kinder” would not know what they were talking about. And since my family also came from what was once the Russian Empire, they had to know a smattering of Russian and maybe Polish to converse with neighbors and officials of the government.

But that was a different time in the US, when the National Civic Federation sponsored night classes in English to newly arrived immigrants so that they can assimilate. But it is different now with Latinos, and as has been pointed out before, the younger generation of Latinos already here, speak English and Spanish. I have had classmates in my MHA classes, and have met many others in all areas of South Florida who do.

On the other hand, Judge Thomas’s appointment by Jeb Bush did not surprise me, given his dissenting opinion. It recognizes the reality of life in Florida, and in other states, with regard to Hispanics, and does not, like the Tea Party often does, seek to turn the clock back to a time in the US when only one language was spoken.

Going back to David’s article, demographic research he points out, shows that the Hispanic population has outgrown that of the white population in David’s home state of California and New Mexico, as well as a few other states, according to a Pew Research Center study. The projections, David cites, are that these demographics will be reflected in the overall US population by 2040.

California has about 14 million Hispanics out of an overall population of 33 million. 47% of New Mexico’s population is Hispanic, and while the white population of Texas is still the majority that is projected to change soon, as the Hispanic population growth represents nearly 64% of all population growth since 2000.

Florida, by contrast, David states, has 4.5 million Hispanics, which represents 23% of the population. He notes that because workers’ compensation is state specific, relative to the overall population of the state, the decision by the First District Court of Appeals makes sense. However, that he says can change.

I have discussed the issue of immigration reform and its impact on workers’ compensation and medical tourism in earlier posts, and have cited statistics about the Hispanic population growth in such articles as Immigration Reform on the Horizon: What it means for Medical Tourism and Workers’ Compensation, Immigration and Workers’ Compensation: Round Two, and E PLURIBUS UNUM: Latin American and Caribbean Immigration, Workers’ Compensation and Medical Tourism.

It also occurred to me that the court that decided this recent case was the same court that decided an earlier case that I mentioned in Legal Barriers to Implementing International Providers into Medical Provider Networks for Workers’ Compensation: A White Paper.

In that case, AMS Staff Leasing, Inc. v. Arreola, FL 1st DCA, 2008, the First District Court of Appeals ruled that Arreola, who had been injured loading a truck, was entitled to get treatment in his hometown in Mexico.

The court ruled that “that state law did not preclude the foreign physician’s treatment of the claimant in Mexico. They stated that Florida workers’ compensation law contemplates coverage for non-citizens, and they cited an earlier case in which the court held that undocumented workers were entitled to workers’ compensation coverage in Florida…”

The court “also stated that Florida law indicates that an injured worker is not prohibited from moving from his pre-injury residence in the state, and receiving treatment outside of the state.”

This would appear to indicate that the court in 2008, before Rick Scott became governor, was willing to have workers’ compensation claimants get treated by physicians in their home country who could speak their language, but the court in 2014, with an appointee of Tea Party-backed, Rick Scott, ruled that the claimant in this case had no right to a physician who could speak his language, even if the claimant was seen here in Florida and not in his home country.

It would appear that judges appointed by Tea Party-backed governors, especially in a state like Florida, are trying to deny the rights of Hispanic claimants to Spanish-speaking doctors. Such a ruling in light of future increased Hispanic population growth is not only unconscionable, it smacks of racism and discrimination. But David DePaolo is correct in citing Bob Dylan’s song, “The Times, They Are A Changing.” Hopefully, future courts in Florida and elsewhere will correct this travesty of justice, and when medical tourism in workers’ comp becomes a reality, evaluations by Spanish-speaking physicians will be commonplace occurrences.