Tag Archives: Hispanics

Los inmigrantes latinos sufren lesiones más Construcción

Trabajadores latinos e inmigrantes frente a los riesgos mortales desproporcionados en la construcción, según un informe publicado ayer por el Comité de Nueva York para la Seguridad y Salud Ocupacional (NYCOSH), e informaron hoy en Immigrants.com Trabajo.

El informe, “El Precio de la Vida: 2015 Informe sobre la construcción muertes en Nueva York”, dijo que los latinos constituyen el 25% de los trabajadores de la construcción del estado de NY, pero representa el 38% de las víctimas mortales de la construcción en Nueva York en 2012.

A nivel nacional, las muertes de construcción latinos aumentaron de 182 en 2010 a 233 en 2013, según el informe.

Algunos de los otros resultados reportados por los inmigrantes que trabajan son las siguientes:

• Un estudio de los registros médicos de 7.000 estadounidenses trabajadores de la construcción Latino encontró que eran 30% más propensos que los blancos no latinos trabajadores que se lesionan en el trabajo. Varios estudios han demostrado que la falta de formación es una de las razones por las tasas de lesiones más elevadas de trabajadores de la construcción hispanos.
• Además, muchos trabajadores de la construcción de Nueva York son los no ciudadanos, de acuerdo con la Encuesta de la Comunidad Americana del Censo de Estados Unidos, incluyendo 40% de los 124.240 trabajadores de la construcción de Nueva York, el 36% de los 7.710 instaladores de paneles de yeso, 28% de los 10.405 techadores y el 25% de los 88.475 carpinteros. Ellos, también, tienen menos probabilidades de recibir formación en seguridad.
• Las personas de los trabajadores de color y de la construcción inmigrantes tienen más probabilidades de trabajar fuera de los libros, para ser clasificado erróneamente como contratistas independientes, para trabajar como jornaleros, o tener conocimientos limitados de Inglés que no suele incluir términos técnicos, y por lo tanto es menos probable que recibir capacitación en seguridad.
• El 80% de los trabajadores inmigrantes en la construcción son latinos. Un Centro para la Democracia Popular informe hallazgo mostró que el 60% de la caída de la construcción de Nueva York muertes OSHA investigó 2003-2011 eran latinos y o inmigrante. Además, los contratistas no sindicalizados tienen menos probabilidades de proporcionar condiciones de trabajo seguras, entrenamiento OSHA y equipos de seguridad.
• Los trabajadores indocumentados son menos propensos a negarse a trabajar en condiciones peligrosas o de hablar a favor de mejores condiciones de salud y seguridad por temor a ser despedidos o deportados. En profundidad es la información sobre todos los casos difíciles de conseguir, ya que muchas muertes se anuncian antes de los nombres de ser liberado, y no hay seguimiento de los informes de los medios de comunicación.

Esta no es la primera vez que hablé de la difícil situación de los trabajadores latinos en ciertas industrias de alto riesgo, que incluyen la construcción. Mi post, una alternativa a cirugías de alto costo para los reclamos de compensación laboral en virtud de los programas de recapitulación, discute este tema con más detalle, y señala al lector a los artículos anteriores he escrito, y para artículos de Joe Paduda y Peter Rousmaniere, que escribió hoy pieza.

La gente sigue preguntándome donde la propuesta de valor es para el empleador y el empleado en tener la cirugía realizada en un país distinto de los EE.UU., y especialmente en el país de origen del trabajador lesionado, por lo que no existen barreras idiomáticas o culturales.

Bueno, esa es una propuesta de valor, ya que al ser capaz de entender el proceso de reclamaciones y el procedimiento quirúrgico en el lenguaje de la propia proporciona la confianza de que el paciente está recibiendo la mejor atención médica posible. No siempre tiene que ser un valor en dinero de por qué la cirugía en el extranjero es mejor que recibir en un hospital de Estados Unidos donde la lengua y la cultura son impedimentos.

La segunda propuesta de valor de tener el paciente ir al extranjero, especialmente a un trabajador latino, es que los amigos y familiares que siguen en el país de origen pueden visitar al paciente y hacerle sentir mejor acerca de su ser sin trabajo temporalmente.

Estas son las propuestas de valor intangible que no se puede poner un precio, pero que pueden dar lugar a una recuperación más rápida y un empleado más feliz cuando lo hace volver al trabajo. Eso por sí solo vale la pena la inversión.

Pero como para el empleador, si el costo de la cirugía y la factura total del hospital es miles de dólares menos en un centro médico del turismo extranjero de lo que pagarían en un hospital local, entonces el valor para el empleador es que él está ahorrando un mucho dinero, especialmente si la mayor parte de su fuerza de trabajo es latina.

He hablado con varias personas acerca de esta idea, y, sin embargo, algunos de ellos no ven el valor en el ahorro de dinero en cirugías costosas. Sólo puedo suponer que les gusta pagar por la nariz para la cirugía en una rodilla, cadera, hombro o muñeca.

O tal vez, sienten que está bien para un trabajador para ir al extranjero en virtud de salud de grupo (como una compañía en Carolina del Norte ha hecho), pero no en un borrador de los trabajadores. ¿Eso no golpear de sesgo de clase?

He escrito mucho sobre el alto costo de sistema de compensación de nuestros trabajadores, sus fracasos y deficiencias, pero sin embargo, nadie está dispuesto a admitir a sí mismos, y mucho menos este escritor, que tal alternativa es realista.

Para ser justos, he tenido algunas conversaciones con algunas personas que lo consiguen, pero por desgracia, no hay segundo partido dispuesto a explorar esto. A medida que la fuerza de trabajo se vuelve más latino, y como un borrador de trabajo está bajo asalto en muchos frentes, puede haber algunos empleadores, intermediarios, transportistas por ahí que lo escuche.

Mientras tanto, voy a seguir escribiendo, a pesar de que me estoy haciendo nada para hacerlo. Prefiero ser ganar honorarios de consultoría o incluso un cheque de pago, pero hasta entonces, voy a seguir creyendo que el turismo médico no es sólo para la gente blanca con grandes bolsillos de seguros y profundos, o para grandes empresas con planes de salud de grupo, o para aquellos la búsqueda de la cirugía estética o plástica, etc., pero para todas las personas, ricos y pobres.

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Some Late Afternoon Reading Before the Weekend

Here are a few links to articles found today on Twitter:

http://www.businessinsurance.com/article/20150508/NEWS08/150509850/young-hispanics-at-small-construction-firms-at-highest-safety-risk?tags=|338|308|92|304

http://www.jdsupra.com/legalnews/the-oklahoma-option-benefit-plan-follows-84596/

Have a good weekend!

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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.

Affordable Care Act to Lead to Physician Shortages ― What it Could Mean for Medical Tourism in Work Comp

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Last week, the Workers’ Compensation Research Institute (WCRI) held its annual conference in Boston. I did not attend,  but thanks to WCRI’s Andrew Kenneally for inviting me.

However, Joe Paduda did attend, as did David De Paolo. The subject of last week’s conference was the Affordable Care Act (ACA) and its impact on Workers’ Compensation. One of the presentation sessions Joe and David attended was given by the WCRI’s Executive Director, Dr. Richard Victor.

In this presentation, Dr. Victor mentioned some key issues that the expansion of Medicaid would have under the ACA that could impact Workers’ Compensation. As reported by Joe, an expansion of Medicaid could lead to a shortage of providers to treat workers, which may lead to longer disability and higher costs. Joe went on to add that Dr. Victor gave the opinion that in states where Medicaid expands shortages will be greater than in non-expansion states.

But what really caught my attention were which states, according to Joe, and predicted by the WCRI, will have primary care shortages. These states are:

California

Florida

Louisiana

Texas

New Mexico

Nevada

Mississippi

It occurred to me that most of these states, with the exception of Louisiana and Mississippi, have the highest percentage of Hispanics (Mexican and others) in the US. So in order to prove that, I went online to see if I could find data to back up my hypothesis. What I found by going to Wikipedia was the following:

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Note: Four states have expanded Medicaid: AZ, CA, NV & NM.

These are the states with the highest % of Hispanics. TX is the lone

exception.

In those states that have already expanded Medicaid, the percentage of Hispanics range from 29.6% to 46.3%. They will also be, according to the WCRI, some of the states that will experience a shortage of providers to treat injured workers.

Those states that have not expanded Medicaid will also see a shortage of providers, so whether or not Medicaid is ever expanded in those states, an alternative must be found to alleviate the shortage in all of these states. That will require a radical re-thinking of who is currently allowed to provide medical care to injured workers.

And given the increasing number of Hispanics in the total population of the US, cross-border medical care (tourism, if you like) and actual medical tourism to other countries in the Western Hemisphere, will increasingly seem like a logical and necessary solution to the shortage of workers’ compensation medical providers.

This is already happening in the counties bordering Mexico in California, as I have previously mentioned in Cross-border Workers’ Compensation a Reality in California, but for states like Texas (where I understand many legislators were interested in the idea, but physicians along the border were against it, and it went nowhere), Arizona, New Mexico, Nevada and Florida, the increase in Hispanic population may eventually force their legislators to consider cross-border or medical tourism as an option to the physician shortages in their states.

I also mentioned the issue of physician shortages due to the ACA in my post, Will Medical Tourism Relieve the Doctor Shortage Due to Obamacare? 

The pressure to do so may not exist for some time in Louisiana and Mississippi, given their low percentage of Hispanics. Like the expansion of Medicaid in those states that have not expanded, only time will tell if they will consider medical care abroad.