The WA Department of Labor and Industries issued updated guidelines for surgical treatment of foot and ankle injuries in October, 2017. The publication outlines trauma-related conditions and non-work-related conditions that can cause a worker to be predisposed to a foot or ankle injury, and/or can complicate treatment for a work-related condition.
Providers who are in the department’s Medical Provider Network are required to follow this guideline when treating injured workers.a The surgical criteria are used in the department’s utilization review program as the supporting evidence has shown these provide the best chance for injured workers to have a good surgical outcome.
To help ensure that diagnosis and treatment of foot and ankle conditions are of the highest quality, this guideline emphasizes:
Conducting a thorough assessment and making an accurate diagnosis.
Appropriately determining work-relatedness.
Making the best treatment decisions that are curative or rehabilitative.b
Facilitating the worker’s return to health, productivity, and work.
The guideline was developed in 2016-2017 by a subcommittee of the Industrial Insurance Medical Advisory Committee (IIMAC). The subcommittee was comprised of practicing physicians in rehabilitation medicine, occupational medicine, orthopedic surgery, and podiatry. The guideline recommendations are based on the weight of the best available clinical and scientific evidence from a systematic review of medical literature, and on a consensus of expert opinion when scientific evidence was insufficient or inconclusive.
The Acupuncture Pilot Project will collect information to inform the provision of acupuncture treatment for low back pain, including acupuncture provided by East Asian Medicine Practitioners (EAMPs), to injured or ill workers covered by Washington’s workers’ compensation system.
This project provides a structured environment for care delivery and capture of data that will inform future L&I payment and coverage methodology for acupuncture.
While the project is underway, the Department of Labor & Industries (L&I) will pay qualified providers participating in the pilot project to deliver acupuncture treatment to injured workers with low back pain related to an accepted condition on a workers’ compensation claim.
Treatment Must Focus on Functional Recovery and Return to Work
Under workers’ compensation insurance, acupuncture treatment must focus on helping occupationally injured and ill workers heal and return to work.
Treatment covered in the pilot project
Low back pain related to an accepted condition on a workers’ compensation claim.
When ordered by the workers’ attending provider, up to 10 treatments over the lifetime of the claim.
When documentation shows clinically meaningful improvement in pain and function.
Treatment NOT covered in the pilot project
Treatment beyond the medically necessary number of visits, not to exceed the 10 visit maximum.
Injured worker has reached maximum medical improvement.
Treatment that does not improve physical function of the industrial injury or occupational disease.
Any other modality not specifically listed.
Use of Oswestry Disability Index and 2-item Graded Chronic Pain Scale is required
The insurer uses the patients’ functional scores to assess the improvement in pain and function. Under the terms of the Acupuncture Pilot Project, must be completed and sent to the department as required under authorization and reporting.
Step into Mike Moon’s Madison, Wis., coffee roasting plant and the aroma of beans — from Brazil to Laos — immediately washes over you.
Moon says he aims to run an efficient and safe plant — and that starts the minute beans spill out of the roaster. He points to a cooling can that is “designed to draw air from the room over the beans and exhausts that air out of the facility. So it is really grabbing a lot of all of the gases coming off the coffee,” he explains.
Why are these gases so worrisome? Because they contain a chemical called diacetyl — a natural byproduct of the coffee roasting process that, in large concentrations, can infiltrate the lungs and cause a severe form of lung disease.
You might remember hearing about diacetyl several years ago, when a synthetic version of the chemical, which is used to give a buttery flavor to certain snack foods, was implicated in causing severe lung problems among workers at a microwave popcorn facility.
Now it looks like that chemical could affect the coffee world as well. People at home grinding or brewing up a pot need not worry, but the chemical could pose a danger to people working in commercial coffee roasting plants.
Worth thinking about – this upcoming SCOTUS decision could have a big impact on unions/union workers. Reposting from NPR.org. – kw
Listen to the Morning Edition article here:
It’s the showdown at the Supreme Court Corral on Monday for public employee unions and their opponents.
Union opponents are seeking to reverse a 1977 Supreme Court decision that allows public employee unions to collect so-called “fair share fees.”
Twenty-three states authorize collecting these fees from those who don’t join the union but benefit from a contract that covers them.
The decision later this year will have profound consequences not just for the California teachers in Monday’s case, but for police, firefighters, health care workers and other government workers across the country.
To understand what is at stake, here is a primer in how the labor law works in states that have authorized these fees.
If a majority of the public employees at a given site vote to be represented by a union, that union becomes the exclusive bargaining agent for the workers. In California, some 325,000 teachers in more than 1,000 school districts are represented by the California Teachers Association and, to a lesser extent, the California Federation of Teachers.
Of those, 9 percent have not joined the union, but under California law, any union contract must cover them too, and so they are required to pay an amount that covers the costs of negotiating the contract and administering it. The idea is that they reap the bread-and-butter benefits covered by the contract — wages, leave policies, grievance procedures, etc. — so they should bear some of the cost of negotiating that contract.
They do not, however, have to pay for the union’s lobbying or political activities; they can opt out of that by signing a one-page form.
In addition, the state Legislature has carved out certain hot-button matters that are not subject to bargaining at all. Specifically, the union can’t bargain over pensions or tenure.
In 1977, the Supreme Court upheld mandatory fees for non-union members as constitutional. The court said they were justified by the state’s interest in maintaining labor peace and eliminating “free riders” who gain benefits without paying their “fair share.”
But in recent years, five Supreme Court justices have signed on to opinions strongly hinting that they were ready to overturn that precedent. Indeed, Justice Samuel Alito, the author of two key opinions, all but invited the challenge posed by Monday’s case.
The Face Of The Case
Rebecca Friedrichs is the public face of the lawsuit that bears her name. After 28 years on the job, she is currently a third-grade teacher in Buena Park near Anaheim, Calif.
“The union’s supposed financial benefits aren’t worth the moral cost,” she said. “They protect teachers who are no longer effective in the classroom … and they’re more focused on self-preservation than they are on educating little children.”
Friedrichs is a strong opponent of the $650 in yearly fees she says she is forced to pay, arguing that everything the union does is political.
The fees are “used to promote the union’s political agenda,” Friedrichs said, contending that they violate her First Amendment right of free speech and association.
Eric Heins, the current president of the California Teachers Association, counters that what is purely political is the Friedrichs case.
“It’s really about an agenda to weaken and destroy unions,” he said.
Heins added that he in fact got involved with the union because of concerns about teaching — especially No Child Left Behind and its “incessant” testing.
Heins said the union contract has allowed him to advocate for “good teaching” for his students “without fear of retaliation.”
He compares the case against fair-share fees to a group of four people going out to dinner. Three vote for one restaurant, the fourth for another. The group goes with the majority; they enjoy the meal, but when the bill comes, the guy who wanted another restaurant tells his friends, “the rest of you have to pick up the tab” because the restaurant wasn’t my choice.
In the Supreme Court on Monday, lawyer Michael Carvin, representing the challengers, will tell the justices that what are technically called “agency fees” are unconstitutional.
“You’re forcing the employee to subsidize somebody else’s speech,” Carvin said. Negotiating a public employee union contract, he maintains, is different from negotiating one for workers in the private sector.
“When we’re talking about public unions,” he said, “everything they do is inherently a matter of public concern, because every time they get pension, health care and salary benefits, that comes out of the public fisc … so every dollar you spend on health care or salary is a dollar you can’t spend on roads or children.”
Lawyer David Frederick, representing the union, counters that what the challengers are seeking is a free ride on the union’s back.
“No one is precluding the right of teachers to speak publicly about their beliefs concerning merit pay, to lobby the Legislature” or express their views on important issues related to education, he said. “All we’re talking about here is an efficient means for the government to determine what its contract with its workforce is going to be.”
The union and the state of California are on the same page in this case. They say that agency fees give the union the resources to be able to make some hard deals, as they did in California during the Great Recession when they negotiated teacher furloughs and some reductions in pay so that more teachers could keep their jobs.
The union and the 23 fair-share states say that if the court were to overturn its 1977 decision, it would trample on states’ ability to govern their own affairs. And more importantly, it would inevitably weaken unions. They would have to raise dues, pitting those who do pay against those who don’t, and the unions would likely have to dig in their heels unreasonably in negotiating to prove their mettle.
Lawyer Frederick pointed to New York City and state in the 1960s and ’70s, a time when agency fees were not authorized.
There were “literally hundreds of work stoppages in the public sector — we’re talking about the subway system … firemen, police, teachers — who went out on strike,” he noted. “And just one week of a strike of the transit workers in New York could cost a billion dollars to the economy.”
There were on average 20 public-sector strikes a year in New York state in the 15 years prior to the Supreme Court’s 1977 decision. Many of them lasted a month or more and closed down schools and other public services, from senior centers to garbage collection.
Even laws imposing harsh penalties for public employee strikes were ineffective.
But after the Supreme Court upheld agency fees, the state quickly passed a law permitting them, and the rate of strikes plummeted by well over 90 percent to fewer than two per year.
In Monday’s case, the union and nearly half the states urge the Supreme Court not to risk that kind of chaos again.
Politics At Play
The unions have seen the consequences quite recently when Republican-dominated state governments eliminated fair-share fees. In 2012 union membership in Michigan declined by 7 percent, and “free-riding” more than doubled, after the state enacted a public-sector right-to-work law and prohibited school districts from collecting union dues by payroll deduction, according to the Economic Policy Institute, a left-leaning think tank.
But the challengers’ Michael Carvin dismisses such justifications outright:
“The proof is in the pudding. Most states don’t require agency fees. The federal government doesn’t require agency fees. And those unions do fine in that environment.”
But, he added, in a moment of puckish clarity:
“It may impede their ability to become the largest political contributors to the Democratic Party.”
The court’s 1977 decision is so wrong, he contends, that it is time to reverse it.
The union, the state of California, 21 other states and the District of Columbia warn that if that happens, it would unsettle tens of thousands of union agreements across the country, an assertion that Carvin also dismisses.
There is a second issue brought by the challengers — a secondary spear, as it were, aimed at the union’s heart. The challengers contend that the opt-out provision authorized by state law is also unconstitutional.
Under that provision, the union is required to send all nonmembers a one-page form allowing them to check a box and automatically be exempt from sharing the expense of the union’s lobbying and ideological activities. The challengers want to reverse the process, and be automatically exempt unless they opt in. The union contends that would require a far more costly canvassing process.
Both the union and the state argue that the opt-out process is an administrative choice made by the state, and that there is no need to “constitutionalize” it.
Monday’s arguments promise to range from lively to ferocious, with a decision expected by summer.
Photo Credit: Mark Ralston/AFP/Getty Images via NPR.org
Back in October, I was able to attend the Airport 101 educational program offered by the Port of Seattle, in partnership with The Common Acre. The program is part of the Port 101 Series offered each year and provides the public a chance to tour SeaTac’s airfield and learn about the current challenges facing the Airport, its projected growth and development plans, and its wildlife management program.
SeaTac Airport was the fastest-growing airport in the U.S. for 2014, and it’s not slowing down. The passenger growth rate was 4.7% for 2013, and 7.7% for 2014. As of October, the growth rate was already 13.4% for 2015, and this trend is expected to continue over the next 20 years. The Airport is projected to reach 66 million annual passengers in 2034 (compared to 37.5 million in 2014). The property’s size constraints (2.5 square miles) present a unique challenge when addressing this rapid growth.
The Sustainable Airport Master Plan (SAMP) is in development in order to help accommodate this level of growth, meet the needs of travelers, and reduce environmental impacts. SAMP’s focus areas include airfield enhancements, terminal development, roadway improvements, and expansion opportunities. Based on projected growth, it is estimated SeaTac will require 35 additional standard aircraft gates and 16 additional international wide-body gates. The International Arrivals zone is an especially high-need area, with peak passenger levels of 1,700 – 1,900 per hour in an area designed to accommodate 1,200 per hour.
You may recall the story of Captain “Sully” Sullenberger’s emergency landing on the Hudson River back on January 15, 2009, after his plane’s engines were disabled by a huge flock of birds flying directly into them. The large expanses of open land surrounding most airports have a tendency to attract wildlife which, as Captain Sullenberger learned firsthand, can be dangerous. In order to both maintain safety and protect local wildlife, SeaTac Airport employs a comprehensive wildlife management program. SeaTac became the first U.S. airport to employ a full-time biologist back in the 1970s, and became the world’s first airport to utilize aviation radar to detect on- or near-site bird activity in 2007. The program employs various methods to divert potentially hazardous wildlife – especially large flocking birds – from the airport area, including habitat modification, netting, and fencing.
Habitat modification helped pave the way for SeaTac’s honeybee conservation program. In partnership with The Common Acre, SeaTac became one of the first airports to host an apiary. On a 20-acre former golf course, the Port of Seattle planted over 20,000 plants to create a honeybee habitat. The area became home to 500,000 honeybees in June 2013. With bee populations in decline, the program’s goal is to help grow and sustain the local population, while contributing to the Port’s conservation efforts.
The program is part of a broader movement to restore honeybee populations, and the hives are managed by the Urban Bee Company, which produces and sells the cultivated honey and beeswax products.
A short video about the SeaTac honeybees is available via the Port’s website: Click Here
Also available is a video about the use of aviation radar at SeaTac: Click Here
I recently had the opportunity to tour Seattle’s Terminal 18 and BNSF’s intermodal rail yard as part of the Port 101 educational series offered by the Port of Seattle. The Cargo 101 class is provided in partnership with: SSA Terminals, BNSF Railway Company, International Longshore and Warehouse Union, and Puget Sound Pilots. During the 2-hour bus tour of the facilities, speakers representative of their fields described their roles in the movement of cargo from ship to truck to train.
The Ports of Seattle and Tacoma have joined forces to form The Northwest Seaport Alliance. Together, the ports form the third-largest container gateway in North America, provide significant revenue for the state, and support (directly or indirectly) nearly 50,000 jobs. These jobs include those in surface transportation (with trucking companies and railroads), warehouse work, longshore and dock work, and Port administration jobs.
Our first stop was Terminal 18, located southwest of Downtown Seattle, on the east side of Harbor Island. The largest container facility in the Pacific Northwest, Terminal 18 covers 196 acres and includes four vessel berths totaling 4,460 feet in length. It is operated by SSA Marine. Top trading partners include China/Hong Kong, Japan, Republic of Korea, Canada, and Australia. The top imports (by dollar value) are industrial machinery and computers, electronics, and vehicles and parts. Our Ports’ top exports (by dollar value) include oil seeds and grains; industrial machinery and computers; prepared vegetables, fruits and nuts; meat and meat products; and seafood.
One player in the supply chain is the marine pilot. During the tour, we heard from one of the 54 current members of Puget Sound Pilots. The pilots are highly skilled, specialized ship captains, thoroughly familiar with local waters, who help guide commercial vessels safely in and out of harbors, while protecting the local marine environment. When the pilot boards the ship, he or she becomes (as our speaker described) “the ultimate backseat driver,” directing the ship’s captain and crew through our local waters. Becoming a Puget Sound Pilot requires at least two to four years of captain experience, followed by passage of a written examination, and evaluation by pilots and other experts in order to be invited into the training program. The program lasts between one and three years. In addition, a pilot must earn a federal pilotage endorsement – which requires many months of local bridge experience and the ability to replicate local waterways navigational charts from memory.
From Terminal 18, we headed to BNSF Railway’s SIG (Seattle International Gateway) intermodal facility. Here, cargo containers are loaded onto railcars for delivery throughout the country. Containers are loaded and unloaded using fully-electric wide-span cranes. BNSF was the first North American railway to utilize these zero-emission cranes, and SIG was the cranes’ testing site. Installed as part of the yard’s expansion in 2008, the cranes nearly doubled the yard’s capacity for cargo, making it an important part of the Port’s operations.
The last player in the supply chain we heard from was a member of the Longshore Division of the International Longshore and Warehouse Workers Union’s Local 19. Put simply, a longshoreman loads and unloads ships’ cargo. Of course, the job is not simple, nor is building sufficient experience to make a living doing it. The work is highly skilled and can involve intense physical labor, heavy equipment operation, and working from heights. Beginners need to be prepared to go long stretches without available work, and almost certainly work another job until they can move up the union ranks. During our speaker’s first year, he worked one longshore shift. The Union’s website has a wealth of information on the history of the industry and the challenges these workers face (ILWU).
Photo credit: Kristen Wolf (I actually took it on our sailing trip, much better than anything I could get through a bus window).