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California hopes to curb opioid abuse with new regulations, better monitoring

Posted on 10 April 2013 by admin

by Sheena Harrison of Business Insurance

California lawmakers and workers compensation regulators want to curb prescription opioid abuse, and they are turning to Washington state for inspiration in the fight against narcotic addiction and deaths.

Last fall, prescription drug abuse provisions were left out of a California workers compensation reform bill to help the legislation win passage, experts say.

Now that those reforms are being implemented, California is attacking opioid painkillers on several fronts, including new workers comp medical regulations and a push to boost funding for the state’s prescription drug monitoring program.

“There’s a lot of interest in the opioid abuse issue, which was not addressed in” the recently passed law, said Marjorie Berte, Western region vice president at the American Insurance Association.

California’s Division of Workers’ Compensation is devising new medical treatment guidelines similar to those used by Washington, sources say.

Dr. Gary Franklin, a neurologist and medical director for the Washington State Department of Labor & Industries, is advising the California workers comp division, but he declined to discuss details.

Dr. Franklin’s research and recommendations helped spur development of the Washington state medical treatment guidelines adopted in 2007.

After adoption, Washington saw a 23% drop in prescription painkiller-related deaths between 2008 and 2011, the latest data available. That compared with an eightfold increase in such deaths during the previous 10 years, according to a statement the Washington State Department of Health released in January.

Among other recommendations, Dr. Franklin says opioid prescriptions should be provided for a maximum of six weeks after an acute injury or surgery, and that nonopioid pain relievers should be used as a first line of pain management for nonacute cases.

“Give people the comfort they need, but make sure that they’re improving from what you’re doing,” Dr. Franklin said. “And maybe think about using opioids intermittently instead of increasing doses every day.”

Also, Dr. Franklin said states should require doctors to keep opioid doses at less than a morphine equivalent of 120 milligrams per day, a threshold dosage that could lead to opioid overdose if exceeded.

“There’s no way to stop this public health emergency unless you do something” about dosage, he said.

Dr. Franklin shared his thoughts last month during a joint hearing of the California Senate Labor Committee and the Assembly Insurance Committee.

During the three-hour hearing that focused on opioids in workers comp, California Insurance Commissioner Dave Jones said California has no guidelines for the use or prescription of opioids. He said Washington state could serve as a model for guidelines being developed by California.

California could consider adopting a prescription drug formulary that limits the use of certain medications, if the pending guidelines aren’t effective, he said.

“This may be an acceptable approach in the case of some of the most powerful and risky types of opioids,” Mr. Jones said in a video of the hearing.

William Zachry, vice president of risk management at supermarket operator Safeway Inc. in Pleasanton, Calif., said he’s hopeful the Washington medical treatment guidelines will become the standard for opioid regulation in California and other states.

“I strongly believe that if California and the other states adopt the treatment guidelines that have already been established in the state of Washington, it will be easier for implementation throughout the United States to have just one set of guidelines instead of having (varying) sets of guidelines trying to control opioids,” Mr. Zachry said.

In addition to workers compensation regulatory efforts, a bill introduced in the California Senate in February aims to bolster the state’s prescription drug monitoring program and help identify problematic opioid prescriptions.

Another Senate bill on the table could go further to help curb opioid abuse in workers comp and California’s overall health care system.

Introduced in January, this legislation would require coroners to file a report when they think a death is caused by prescription drug use.

The measure the Senate unveiled in February would establish a state fund to pay for the Controlled Substance Utilization Review and Evaluation System, known as CURES.

The database, operated by the California Department of Justice, allows physicians, pharmacists and other providers to see whether a patient already has prescriptions for controlled substances, before they issue a new prescription for such medications. The state’s pharmacists and clinics are required to submit prescription information into the database but doctors that dispense prescriptions from their offices do not.

However, the controlled substance review system may be taken down in July because it does not have an operational budget, according to a January report from the Oakland-based California Workers’ Compensation Institute.

That report estimated that California’s workers comp system could save $57.2 million in prescription drug costs by keeping the controlled substance review database running and allowing third-party payers to access it.

Institute President Alex Swedlow said the database could be a critical component of the state’s efforts to curb prescription drug abuse.

“Payers in workers comp have a very limited view about the total medications that are being delivered to the injured workers under their review,” Mr. Swedlow said.

Mark Sektnan, president of the Sacramento-based Association of California Insurance Cos., said the industry group hopes that the state will renew funding for the database and make the program mandatory for medical providers.

“Right now, it’s a voluntary program, so it tends not to be very robust,” Mr. Sektnan said. “So the information’s not very good. We need everybody to participate, and everybody needs to use the system.”

During last month’s legislative hearing, Mr. Jones said insurers have offered to help pay for the prescription drug database, if physicians are required to report when they dispense prescriptions through their offices, rather than through a pharmacy.

“I think that’s fair,” Mr. Jones said. “If employers are going to pay through their insurance premiums for CURES, we need to make sure that CURES is complete and robust and provides full information.”

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Los Angeles spends more on LAPD workers’ comp claims than for all others combined

Posted on 01 October 2012 by admin

By Rick Orlov 213-978-0390 Staff Writer

Posted: 09/29/2012 06:30:04 PM PDT

Updated: 09/29/2012 06:43:07 PM PDT

Los Angeles spends more each year on workers’ compensation costs for the Police Department than it does for all the other claims it gets, including for use of force and car accidents. The city’s newest Police Commission member wants to change that.

Commissioner Rafael Bernardino knows the complex maze of workers’ compensation costs – $65 million in 2010-2011 for LAPD – presents a challenge officials have been trying to deal with for years.

All other LAPD liability cases, such as use of force and traffic accidents, average $40million a year, officials said.

“We need the help,” City Administrative Officer Miguel Santana said. “It’s not just tilting at windmills, if he is able to serve as an advocate for change and can help us convince Sacramento of solid reforms that we need.”

Bernardino, an attorney, had been serving on the Police and Fire Pension Board before Mayor Antonio Villaraigosa asked him to transfer over to the Police Commission. He was confirmed by the City Council on Aug. 31.

In taking on the risk issue, Bernardino is moving cautiously as he tries to gather information on the extent of the problem. LAPD workers file an average of 250 claims a month.

Bernardino said his goal is to reduce the costs to the city, which could make more money available for policing and other programs.

“I’m just starting to gather information and am working to get a grasp of the extent of the problem,” Bernardino said. “Once I know the extent of the problem, then we can look for solutions.”

Councilman Dennis Zine, a former police officer and chairman of the Audits and Government Efficiency Committee, said he has been pressing the LAPD for years to be more proactive on liability cases and workers’ compensation.

“A dollar is a dollar, and what happens is these departments get their budget and don’t make any effort to save money and bring about reforms,” Zine said. “Finally, we have a risk manager in the LAPD, but we still see these million-dollar settlements come to us.

“I hope the commissioner can get a handle on it and force the department to make changes.”

Councilman Mitch Englander, chairman of the Public Safety Committee and a reserve LAPD officer, said he is prepared to help Bernardino.

“He and I talked at length, and all he wanted to discuss was the liability issue,” Englander said.

“One of the biggest problems we have is trying to be proactive to ensure that officers are safe. I think one of the things we need to do is have more training to avoid injuries and start it earlier in their careers. We also need to be more proactive in dealing with these issues rather than waiting for them to happen and then try to figure it out.”

Tyler Izen, president of the Los Angeles Police Protective League, said one of the biggest complaints he receives is the amount of time it takes to get treatment.

“If we have an officer come in with a rotator cuff problem, we know physical therapy isn’t going to fix it,” Izen said, “They are going to need an operation and the sooner it’s done, the sooner they are back at work.”

Santana said workers’ compensation costs are one of four drivers of the city budget deficit. Others include the costs of salaries, pensions and health care.

Much of the problem is due to the fact that state law mandates the level of workers’ compensation provided and that is a constantly shifting landscape.

State legislators approved a new reform, SB 893, this session that implements an independent medical review on claims, establishes a timeline for treatment and a number of other factors.

Santana said the city is still studying the measure to determine its full impact on workers’ compensation costs.

“The thing is, we aren’t alone in this,” Santana said. “It affects all large employers.”

Another factor that creates operational problems, he said, is the number of officers who are off duty at any given time.

“For the chief, they have to schedule all their shifts, without really knowing how many officers are off duty,” Santana said. “That’s part of the reason we needed to hire so many officers so he does have flexibility.”

City Controller Wendy Greuel, who has released a number of audits critical of how the city handles it workers’ compensation cases, said Bernardino’s work will be an asset to the city.

“I would encourage him to look at anything we can do to reduce workers’ comp, particularly at what we can do to get people back to work,” Greuel said. “The longer they are off duty, the more difficult it is to get them back to work.”

Greuel said she would urge Bernardino also to try to find areas where there are common problems and what steps can be taken to deal with those.

Bernardino said he plans to take all those matters into consideration as he also plans to look at the training of officers and see where improvements can be made.

“A lot of the liability we face is for momentary lapses,” Bernardino sad. “Seconds of a mistaken judgement can cost the city millions.

Original posting

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Cuestionan compensaciones a lesionados en California

Posted on 20 September 2012 by admin

El gobernador Jerry Brown está a punto de convertir en ley, la SB863 una medida del senador demócrata de Los Ángeles, Kevin de León y del asambleísta demócrata de Santa Ana, José Solorio.



Analistas sostienen que de convertirse en ley, la nueva medida perjudicará a los trabajadores más seriamente lesionados.

Foto: Archivo/AP


SACRAMENTO.- Como todos los días en su jornada laboral, Marcela Tapia caminaba apurada, cargando rollos de plásticos cada vez más pesados, hacia la máquina de empacado de verduras cuando sintió que le tronó la espalda y el dolor la paralizó.

Han pasado diez años, desde esa mañana que cambió la vida para siempre de Marcela Tapia, quien ahora tiene 46 años.

“No pude volver a trabajar. Me incapacitaron de por vida. Llevo dos cirugías en la espalda y me quieren hacer una tercera. Tengo que usar un caminador o un bastón para moverme en mi casa. Y para salir necesito una silla de ruedas. Ni que decir, el dolor es permanente”, cuenta Marcela Tapia.

Junto a la discapacidad física vinieron los problemas financieros. El sistema de compensación de los trabajadores lastimados le dio durante siete años, 557 dólares al mes. Hoy sólo le dan 60 dólares al mes, y el seguro social le entrega 393 dólares al mes por su discapacidad.

Pese a que a quienes quedan impedidos para laborar de por vida, luego de una lesión en el empleo, son compensados con poco dinero como lo demuestra el caso de Marcela Tapia, California tiene uno de los sistemas de compensación más caros del país. Los costos aumentaron de 14,800 millones de dólares a 19,000 millones de dólares en dos años.

Así que en busca de reducir sus costos, proteger a los negocios, y evitar más pleitos en las cortes, el gobernador Jerry Brown está a punto de convertir en ley, la SB863, una medida del senador demócrata de Los Ángeles, Kevin de León y del asambleísta demócrata de Santa Ana, José Solorio.

Según los autores de la medida, a partir de 2013, habrá en promedio un 30% de incremento en todos los beneficios para las personas permanentemente discapacitadas en todas las categorías.

El aumento es posible al reducir costos administrativos por 1,000 millones de dólares.

Al mismo tiempo, la inminente ley detiene los aumentos constantes de los montos que pagan los empleadores.

Crea además un programa por 120 millones de dólares para ayudar al grupo de trabajadores cuya compensación es desproporcionadamente baja comparado con lo que dejaron de ganar por la lesión.

Y previene demandas al establecer un sistema médico independiente de evaluación basado en usar evidencias médicas para resolver disputas, lo que ahorrará también dinero al sistema, 152 millones de dólares.

“En el papel, esta legislación parece muy buena, pero en la práctica, desafortunadamente reduce los beneficios de discapacidad a los trabajadores más seriamente lesionados, y les hará más difícil obtener el tratamiento médico que necesita”, dijo Bret Graham, presidente de LatinoComp, una organización no lucrativa de abogados que defienden a los trabajadores lesionados, médicos e intérpretes.

Añadió que el impacto en la comunidad latina será muy fuerte, ya que en promedio ganan al año 30,000 dólares en los empleos más pesados y más peligrosos.

“Los trabajadores serán obligados a sobrevivir de la asistencia pública, la discapacidad del seguro social o la caridad de sus familias o iglesias”, indicó.

Jesse Cisneros, de, otro grupo defensor de los trabajadores lastimados criticó la reforma porque dijo se hizo para favorecer a las corporaciones con el apoyo de algunos sindicatos.

“Se trata de una medida negociada en secreto y llevada con premura a la legislatura en los últimos días del ciclo legislativo, promovida como un aumento en los beneficios que en realidad reduce los beneficios de los lastimados”, anotó.

El senador De León refutó los señalamientos en contra de su propuesta de ley. “Yo defiendo los intereses de los trabajadores latinos y no haría nada que los lastimara. En cambio quienes se oponen son gente que lucra en los juicios con los trabajadores lesionados como los abogados y médicos que quieren seguir manteniendo el control de un sistema fracturado”, afirmó.

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AM Alert: Governor scheduled to sign workers comp bill

Posted on 18 September 2012 by admin

The Sacramento Bee

CapitolAlert ®

AM Alert: Governor scheduled to sign workers comp bill

The day starts with another – make that two more – bill signing ceremonies for Gov. Jerry Brown, Senate President Pro Tem Darrell Steinberg and Assembly Speaker John A. Pérez, who will be in the south state trumpeting SB 863. The bill makes major changes to California’s workers compensation system by eliminating areas that are subject to a lot of litigation, cutting costs for employers and increasing benefits to permanently injured workers. It was negotiated among labor union leaders and some of the state’s major employers, who are expected to be on hand for the signing ceremonies.

The first one is at a San Diego printing company at 9:30 a.m. Then the group heads to Burbank for a 2 p.m. signing at the Disney studios, a company that played a role in negotiating the bill.

CALLING AN AD AN AD? Political bloggers, tweeters and comment-posters may want to tune in to the Fair Political Practices Commission today. It’s taking comment on a new proposal aimed at informing the public when campaign funds are used to pay for blog posts and social media use. The idea has drawn ire from bloggers on both ends of the political spectrum.

FISHIN’ FOR TUITION California State University trustees are meeting today in Long Beach to take on some fiscal what-ifs. What if the governor’s tax initiative passes? What if it fails, and the state cuts CSU by $250 million? If voters approve Proposition 30 in November, CSU is planning to refund students the 9 percent tuition increase they are paying this semester. If it fails, a contingency plan trustees are considering today calls for increasing tuition by 5 percent in January.

Cal State trustees are also considering several new fees unrelated to the outcome of Proposition 30: $372 per unit for “super seniors” who keep taking classes even though they have enough units to graduate; $100 per unit for repeating classes; and $200 per unit for taking an extra-large course load of 17 units or more. The university estimates it could generate $35 million a year with those combined fees.

DEATH PENALTY: Under the dome, the joint Public Safety Committee will hold a 10 a.m. hearing on Proposition 34, which calls for repealing the death penalty in California and replacing it with life without parole. Opponents of the measure are holding a campaign kick-off event later in the afternoon, with Sacramento County Sheriff Scott Jones, former NFL player and crime victim advocate Kermit Alexander and San Mateo County DA Steve Wagstaffe.


Want The Latest from Capitol Alert on your mobile device? Check out our mobile site.


Got a news tip? Send it our way at

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Families can’t sue for workplace fatalities; check database

Posted on 25 July 2012 by admin

Brandan Kalmerton was 26 when he was killed on the job in 2010.

He had been repairing a drill head that had failed in a trench near U.S. 41 in Oshkosh. His family and friends suspected immediately that safety rules hadn’t been followed. They were right.

Federal safety regulators inspected the scene and filed a final report six months after the incident that cited four violations they called “serious.”

Kalmerton and one of his Northwest Cable Construction coworkers — Paul Tijan, 37, of Gale — were working in a trench more than 9 feet deep and 4½ feet wide. The safety “trench box” they were in — built to prevent cave-ins — was only 6 feet tall, leaving 3 feet unprotected.


Database: Search OSHA inspection results on fatal work site accidents in Wisconsin from 2000 to 2010.


Kalmerton and Tijan heard the wall of gravel and dirt shifting above them. In an instant, tons of earth crashed down, partially burying them both.

The weight crushed Kalmerton, breaking his ribs and fracturing his skull. The Oshkosh man died at the scene.

The Occupational Safety and Health Administration issued four fines totaling $13,200, but Northwest Cable promised to address safety problems and negotiated a deal to reduce the fines to $9,000.

The company’s experience is not unusual. The largest fine in a Gannett Wisconsin Media review of 240 workplace fatalities in Wisconsin over 11 years was a $117,000 payment by Lapham-Hickey Steel Corp. of Oshkosh in 2006, issued after a 28-year-old man was crushed by a 2,700-pound bundle of steel. The original fine of $217,000 was reduced through negotiations.


Even in the case of a death, Wisconsin law forbids employees’ families from suing employers for wrongful death. Their liability is limited to paying a death benefit and funeral costs.

That comes as a result of the deals cut in the landmark 1911 Wisconsin workers’ compensation law, the first in the nation, which provided unprecedented worker protection and rights but conceded the right to sue.


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Posted on 12 July 2012 by admin

Dignity Health Buyout of U.S. Healthworks


August’s planned buyout of U.S. Healthworks by Dignity Health is a red flag to injured workers who more than likely may be sent to a medical center owned by this behemoth by year’s end. As of now, U.S. Healthworks operates 172 medical centers nationally, and Dignity Health has 33 medical facilities throughout the state of California, four in Nevada and three in Arizona.

According to U.S. Healthworks CEO, Daniel Crowley, the buyout will provide a “great platform for us to continue growing our network to provide high-quality health care services throughout the country,” which he recently stated in a Modesto Bee article.

This medical conglomerate includes ambulatory surgery through its acquisition of United Surgical Partners International and imaging centers via its acquisition of SimonMedImaging. Dignity Health wants to expand its operations from coast to coast and increase their profits by an even more sizeable margin. It is a well-known fact that Daniel Crowley helped

What this means for injured workers is that any time there suffer a work-related injury and they are sent to one of Dignity Health/U.S. Healthworks facilities, be it urgent care, MRIs, or any other medical necessity, they will more than likely not be offered adequate medical assistance. U.S. Healthworks has a track record of focusing only on increasing their medical profits and not on offering the best medical care to injured workers. The level of occupational medicine will plummet and the ones who will suffer will be those who will be forced to find medical treatment at these facilities that do not have their best interests in mind.

The monopolization of occupational care is a manner in which to raise prices and offer less medical services for the amount. This in turn will hinder adequate medical treatment to injured workers and essentially prolong their rehabilitation process and an opportunity to work or have medical care for chronic conditions caused by occupational injuries.

Now is the time to act and stop this monopoly by contacting your state representatives. If we stand idly by – occupational health centers and providers that truly help injured workers will become a memory of the past and injured workers will be burdened by inadequate medical care, medications and rehabilitation.

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30-day grace period given for use of new fact sheet for use of QMEs and Agreed MEs

Posted on 18 June 2012 by admin

Division of Workers’ Compensation posts updated fact sheet explaining the use of qualified medical evaluators and agreed medical evaluators

30-day grace period given for use of new fact sheet

In April 2012, the Division of Workers’ Compensation (DWC) posted an updated fact sheet for injured workers on its Web site which provides answers to questions about qualified medical evaluators (QME) and agreed medical evaluators (AME). The division is providing a grace period until July 15, 2012 to use the revised fact sheet as required for issuance of benefit notices. Only the text is required for compliance.

Specific changes to the fact sheet:

• Information for the need to fill out and file the claim form was revised

• The explanation for treatment within a medical provider network (MPN) was reformatted to clarify questions for potential use of a QME/AME

The updated fact sheet, including the text only version, is available in English and Spanish and can be found on the Information &Assistance Unit Web page.

Original file at:

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California workers’ comp overhaul effort is stirring

Posted on 23 May 2012 by admin

By Marc Lifsher, Los Angeles Times

April 12, 2012

Labor unions and large employers are quietly crafting the biggest reform in a decade. The system’s pendulum, which swung in favor of business and insurers last time, appears to be moving toward workers.

SACRAMENTO — The two biggest players in California’s workers’ compensation system — labor unions and large employers — are quietly crafting the biggest overhaul of the mandatory insurance program in a decade.

The goal: provide more care to injured workers without raising premiums for businesses.

The negotiations are focused on squeezing waste from California’s $15-billion system, which, while huge, often delays or denies compensation and average compensation paid to California workers in cases of permanent partial disability was $12,000 last year. That’s down more than half from $25,000 in 2004, according to the UC Berkeley Survey and Research Center.

The lower payouts are a result of laws approved by the Legislature in 2003 and 2004 aimed at reining in skyrocketing employer premiums. The changes provided relief to employers, who saw their premiums decline by about 60%. Insurers benefited with higher profits because they paid fewer and smaller claims.

But the changes have been tough on California’s injured workers, experts said. Workers can spend years wresting settlements from workers’ compensation courts while remaining too crippled to return to their old jobs.

“The disputes go on indefinitely. There are too many conflicting opinions,” said Sean McNally, a vice president of Grimmway Farms of Kern County, the country’s largest organic vegetable grower. His company, best known for its baby carrots, led the fight for workers’ comp reform last time around.

Now, consensus is forming that it’s time for the workers’ comp pendulum to swing back toward the victims that the system originally was set up to assist. The administration of Gov. Jerry Brown is hoping to broaden support for the changes by holding public forums up and down the state this month.

“It seems perfectly clear to the participants in this system that the permanently disabled worker is not being adequately compensated,” said Martin Morgenstern, a top advisor to Brown and secretary of the California Labor and Workforce Development Agency. “We have a serious problem, and it needs to be fixed, and fixing it isn’t going to be cheap.”

But the Brown administration concedes that it could be counterproductive to raise the cost to employers at a time when California is battling double-digit unemployment.

“We cannot raise premium costs to employers at this time,” Morgenstern testified at a recent legislative informational hearing. Money to boost disability benefits can be found within the workers’ comp system, he said.

An analysis of potential savings prepared in 2009 by workers’ comp experts in the administration of then-Gov. Arnold Schwarzenegger identified $793 million to $1.5 billion a year in potential savings.

The biggest savings could come by simplifying the criteria for calculating permanent disability compensation for injured workers, the 2009 report said. Other economies would come by tying fees for outpatient surgeries to the lower-cost state and federal Medi-Cal system and by cutting into a backlog of more than half a million outstanding medical bills that have been piling up in the Los Angeles workers’ compensation courts.

An updated version of the confidential analysis is being used as a template in the early stages of the workers’ comp overhaul negotiations.

Getting an agreement to strip “inefficiencies and frictions” from the system depends on everyone in the workers’ comp system “taking a haircut” by giving up some of their legal rights and privileges, said Angie Wei, the chief lobbyist for the California Labor Federation and the chairwoman of a state government research bureau, the Commission on Health, Safety and Workers’ Compensation. That includes injured workers, employers, doctors, hospitals and insurance companies, she said.

“There are too many lawyers in the system,” said McNally of Grimmway Farms. “We need to come up with one that’s more administrative, more predictable, more affordable, puts more money in the hands of injured workers and brings down the cost to employers.”

McNally’s call for streamlining comes as costs to insurers are starting to creep up again after plummeting from historical highs. Average insurance rates fell to $2.16 per $100 of payroll in 2008 from $6.29 in 2003, according to an industry statistical service, the Workers’ Compensation Insurance Rating Bureau. Since then, they’ve climbed to $2.37 per $100 of payroll.

At the same time, insurance companies report that they are spending more on claims, claims processing and general expenses than they are receiving in premiums paid by employers. In 2010, they spent $1.16 for every premium dollar, compared with 73 cents in payouts for each $1 in premiums in 2005.

read full article here

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The New Executive Medical Director of the DWC

Posted on 15 May 2012 by admin

Rupali Das, M.D., M.P.H., formerly Chief of the Exposure Assessment section of the Department of Public Health since 2009, was appointed as Executive Medical Director of the Division of Workers’ Compensation.

The move appears to be a measure to counter delays in prompt and adequate medical care for injured workers. Dr. Das’ experience in her capacity as Chief in Department of Public Health and in her previous post as Public Health Medical Officer within the same organization since 1998, will serve her well in determining policy that will be beneficial to injured workers since she is well-versed in issues that affect them as well as measures that should be taken to reduce these issues.

Also, her position as Associate Clinical Professor of Medicine in the Department of Occupational and Environmental Medicine at the University of California, San Francisco, position her to understand occupational health issues intricately as she prepares to carry out duties that will affect medical care and rehabilitation care for California’s injured workers.

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