Every eight minutes in America, someone dies from a work illness or injury - more deaths than from most diseases. Depraved Indifference: the Workers’ Compensation System dissects a system that destroys the health and life of workers, while throwing the preponderance of costs onto families and taxpayers.
There has been very little general public awareness of this system that allows employers to maim and kill with impunity. The time is long overdue to re-evaluate a structure that evolved over 100 years ago, and doesn’t meet the needs of seriously injured, ill, or toxic chemical-exposed workers, or the families of the estimated 66,000 who die each year from their work – a system that has fostered devastating and lasting damage to families, to communities, to our environment.
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Woeppel explains the problem and also lays out a solution, November 13, 2008 By
Midwest Book Review (Oregon, WI USA) -
"Depraved Indifference: The Workers’ Compensation System" is a scholarly look at the American workers’ compensation laws and how they are unjust for today's world filled with high risk jobs and deadly chemicals that many must work with almost daily. With a suggested reform model presented, Woeppel explains the problem and also lays out a solution, giving "Depraved Indifference" a critical recommendation.
Medical Treatment Under Workers’ Compensation 129
Reville and Schoeni (2003/2004) found that 36.3% of adults ages 51–61 years
who are disabled, and 28.9% of all persons with a disability receiving social security
disability, are disabled due to work. Yet, only 5.3% ever received workers’
compensation. The cost in Medicare and Social Security Disability for workplace
injuries/illnesses is estimated at over $33 billion annually in 2001 dollars.15 The
medical component of workers’ compensation in 1996 was estimated at $24 billion
annually.16
A former California Insurance Commissioner, John Garamendi, is said to
have proposed a unified health care system incorporating the medical component
of workers’ compensation into traditional group health, in order to control health
care costs. It would avoid duplication, thus increasing administrative efficiency
and generating savings that could be applied toward universal coverage in the
state. Workers’ compensation insurers fought hard against it. They were worried
about losing control over the medical portion of the workers’ compensation premium,
and its accompanying big bucks. The bill died in the state legislature.17
The serious underreporting of work-related injuries and diseases in BLS and
OSHA data has other consequences, particularly in the ability to identify and
treat occupational diseases, especially those with a long latency period, such as
toxic exposures.
Another factor in the failure to correctly diagnose occupational diseases is the
scant attention paid to training of physicians to identify occupational illness. For
the 1991/1992 academic year, the amount of time devoted to teaching occupa-
130 depraved INDIFFERENCE: the Workers’ Compensation System
tional health/illness issues, in those US medical schools that include it in the curriculum
at all, was an average of 6 actual hours.18
Milton, et al.(1998) reviewed 67 medical charts for patients in a Massachusetts
HMO with adult, or late, onset asthma. Fourteen cases were identified as
“attributable to occupational exposure.” None were treated under workers’ compensation.
Of the 14 work-related cases, only two had been asked about their
work by the treating physician, and in neither case were work-related symptoms
noted by the physician. Workers’ compensation paid for none of the 14 cases,
nor were any of the cases reported to the state’s program for recording occupational
risks.19
In California during the 1980s, although almost two-thirds of the physician-
reported occupational illnesses were eye and skin problems, “almost no
occupational cancers were reported.”20
In cancer cases, Dr. Samuel Epstein, Professor Emeritus of Environmental and
Occupational Medicine at University of Illinois School of Public Health, Chicago,
sees a pattern of “blame the victim,” i.e., by blaming smoking, aging and/or
genetics for cancer. He cites NIOSH surveys that as many as 15 million workers
“are exposed to cancer-causing chemicals and radiation on the job, and that as
much as 40% of cancers may be occupational.”21
Qualified occupational medicine physicians are in limited supply. At the same
time, this is the expertise that “should be required of either treating or consulting
physicians, when the illness or injury is unusual or rare outside the workplace.…”
22
But even when a proper diagnosis is made, corporate and other pressure may
be brought to bear on the physician.
This appears to have been the experience of one board certified radiologist at
an upstate New York hospital who had relocated after years of experience at a
large New York City hospital. He began to see the distinctive signs of asbestosis
in the lung x-rays that he was reviewing. Week after week, he was seeing classic
signs of asbestosis. As he explained, asbestosis is so unique on x-ray that it can be
nothing else.
Some hospital physicians wanted to attribute it to smoking. Others diagnosed
it incorrectly as emphysema, which as this radiologist noted, shows up on an
x-ray as an over-expanded lung, the opposite of what you would see in asbestosis.
These were miners; and what this radiologist found was that no one was willing
to stand up for them, and some were dying.
He reportedly sent 50 cases to the state health department. The state had his
diagnoses confirmed
15. Reville, R.T., Schoeni, R.F. The fraction of disability caused at work. Social
Security Bulletin, 65:4, 2003/2004, www.ssa.gov/policy/docs/ssb/v65n4/
v65n4p31.html.
16. Himmelstein, J., Rest, K. Working on reform: how workers’ compensation
medical care is affected by health care reform. Public Health Reports, 1996;
111: 12–24.
17. ibid.
138 depraved INDIFFERENCE: the Workers’ Compensation System
18. Burstein, JM, Levy, BS. The teaching of occupational health in US medical
schools: little improvement in 9 years. American Journal of Public Health,
1994; 84:4: 846–849.
19. Milton, DK., Solomon GM., Rosiello, RA., Herrick, RE. Risk and incidence
of asthma attributable to occupational exposure among HMO members.
American Journal of Industrial Medicine 1998; 33:1–10.
20. Landrigan, PL., Markowitz, S. Current magnitude of occupational disease in
the United States. Estimates from New York State. Ann. New York Academy
of Sciences, 1989; 572:27–60, cited in Azaroff, LS, Levenstein, C, Wegman,
DH. Occupational Injury and Illness Surveillance: Conceptual Filters
Explain Underreporting. American Journal of Public Health, 2002:92:9, p.
1421–1429.
21. Dr. Samuel Epstein, Chairman, Cancer Prevention Coalition, cited in Death
on the Job: The toll of neglect. 13th edition, AFL-CIO, Washington, D.C.,
April 2004, p. 15.
22. American College of Occupational and Environmental Medicine. ACOEM’s
Position Statement: Eight Best Ideas for Workers’ Compensation Reform.
Committee Report, www.acoem.org
23. Schneider, A. Special Reports. Pushing for asbestosis study cost doctor his
job. Seattle Post-Intelligencer, June 22, 2000.
Additional information can be found at www.patricewoeppel.us
