A Consequence of a Compensable Injury

"Here, given the documented downturn in the decedent's mood and concerns her family had that
she might do herself harm, along with the autopsy report's conclusion that the manner of death
was suicide, the WCLJ had ample facts in the record to infer that the decedent's suicide was a
consequence of her compensable injury and consequential mental health condition.  Therefore, upon review of the record and based upon a preponderance of the evidence, the Board  Panel finds that the decedent's suicide was a consequence of her compensable injuries including  her established consequential depression."

Get used to language like this.  While we've made strides in workers' compensation with respect to opioids (see Peter Rousmaniere's special report out today), we still have a long way to go, particularly with so-called "legacy claims."  The decision quoted above comes from the New York State Workers' Compensation Board and covers the very sad story of woman injured in 1999 and the long, slow decline she experienced, resulting in her eventual suicide by oxycodone and diazepam.

You're going to be reading a lot more court decisions like this in the months and years to come.  The opioid prescription bonanza of the last 10 years is going to create a wave of cases like this over the next 10 years.  We're far more effective today than we've ever been in controlling early opioid use (though even in this category, we have a lot of work to do).  The challenge is going to be the claims that arose before we knew how severe this problem would turn out to be.

One of the many insights in Peter's report that struck me was the relative danger faced by injured workers in chronic pain.  He points out that the riskiest jobs in America (like logging, for instance) typically lead to about 1 death per 1,000 workers per year.  But injured workers on medium-to-high dose opioids for a year experience about 1.75 deaths per 1,000 patients per year.  

That's crazy.

Follow the link above, read Peter's report.  This should be required reading for everyone in work comp.

Michael
On Twitter @PRIUM1

A Warning to Work Comp Payers

This new ruling from West Virginia's Supreme Court reminded me of a post I first wrote almost exactly three years ago.  I decided to re-post it here today.  This WV case, in a nutshell, says that the illegal acts of the plaintiff (in this case, addicted opioid users) does not disqualify them from taking legal action against the defendants (in this case, physicians and pharmacies) for being at fault for their own harmful acts.  And as Stephanie Goldberg points out in the linked article, work comp payers should be on alert.  It's not a big leap in logic to apply this same line of reasoning to a payer who chooses to finance the addictive behavior of an injured worker instead of intervening to do something about it.

Here's my post from May 25, 2012:

We Know Too Much: New Liabilities Associated with Opioid Abuse

A new ruling from Texas adds to the list of states that have found payers liable for a range of opioid-related side effects ranging from addiction to death. In this particular case, the payer was found liable for death benefits in light of the injured worker's death caused by hydrocodone overdose. This adds to recent rulings in several other jurisdictions (e.g., Pennsylvania, Texas, North Carolina - these are the ones I've seen, I believe there are others) in which payers have found themselves on the hook for death benefits due to drug overdose.

Prediction: This is just the beginning. Why? Because we know too much. And our unwillingness (or inability), as an industry, to apply what we know is going to cause a lot of financial pain over the next several years.

We really do know too much. We have sound, evidence-based clinical guidelines. We have peer reviewed studies (many of which are incorporated into the guidelines) that suggest the limited benefits (and significant harm) that results from chronic opioid therapy. We have thought leaders, in both the clinical and business realms, offering a constant drumbeat of warnings that solutions are needed. We have industry conferences devoted entirely to this issue. We have a growing body of regulatory mechanisms intended to help control opioid misuse (e.g., Texas closed formulary rules, new Tennessee UR rules, Washington's guidelines, etc.) We have public health agencies, including the CDC, calling the issue of prescription drug abuse an "epidemic" and a "public health crisis".

I hear various excuses for why payer organizations aren't attacking the problem with greater force. "Look," they say, "this is really complicated... these people are addicted". Or "we don't have sufficient clinical resources"... or "we're pretty sure plaintiff's counsel is going to come at us pretty hard"... or "we're working on it"... or "our PBM has a handle on it".

Enough. There's going to be noise. Deal with it. We're on the right side of this fight. By taking aggressive action, we have the opportunity to improve overall patient health while simultaneously saving money. This is exactly what our health care system needs.

Let's get to work.

Michael

On Twitter @PRIUM1