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Workers’ comp problems

Most Americans assume if a loved one or breadwinner is killed or seriously injured on the job, insurance — at the very least, the workers’ compensation insurance that states generally require employers to carry — will help with the resulting expenses.

But a pair of recent cases cast doubt on whether this system is working the way most participants expect.

Retired 26-year Las Vegas police sergeant Stan Cooper, 72, was working as an armed and uniformed security officer at the Lloyd George U.S. Courthouse in downtown Las Vegas, sitting in a chair near the metal detector when a disgruntled federal benefits claimant walked in and killed him with a shotgun blast on Jan. 4, 2010.

Yet Mr. Cooper’s son Marty was advised last month that his claim for payment under the 1976 federal Public Safety Officers’ Benefits Act had been denied, the Justice Department in Washington ruling “Claimant has not established that Court Security Officer Cooper was a public safety officer serving a public agency in an official capacity at the time of his death.”

Because Mr. Cooper was not married, no one is receiving his pension. His son also says no one in the family is eligible for any workers’ compensation benefits related to his death. “Every time we turn around, everything is just completely denied.”

In a separate and perhaps more outrageous case, we also learn this week of the plight of Mark Lindquist, 51, whose survival is considered a medical miracle. He has been honored as “a true hero and inspiration to others” by both houses on the Missouri legislature.

Mr. Lindquist, who earned slightly above minimum wage, felt he couldn’t afford medical insurance. But he would surely appear to have been “on the job” as he watched the skies darken on the evening of May 22 while driving to the Joplin group home where he was employed as a social worker, helping three middle-aged residents with Down syndrome.

The tornado sirens began to blare. Because there was no basement or shelter and the three residents moved too slowly to relocate, Mr. Lindquist and co-worker Ryan Tackett placed mattresses over the men, and then climbed atop the mattresses to add their own weight to the makeshift shelter.

More than 7,000 homes were destroyed. Sadly, the three men Mr. Lindquist was trying to protect were among the 162 dead. After the storm, rescuers found Mr. Lindquist buried in rubble, impaled on a piece of metal. Large chunks of his flesh were torn away. The bones in his shoulder crumbled as he was placed on a stretcher. All his ribs were broken, and most of his teeth were knocked out. He was in a coma for two months and had been rendered so unrecognizable that it took three days for his family to locate him in an area hospital.

Though he still carries his right arm in a sling, Mr. Lindquist can use the hand. He can see and walk and speak. Doctors consider his recovery amazing.

But perhaps not as amazing as the fact that, while Mr. Lindquist has run up $2.5 million in medical bills, Accident Fund Insurance, his employer’s workers’ compensation carrier, has denied his claim “based on the fact that there was no greater risk than the general public at the time you were involved in the Joplin tornado.”

Yes, insurers have to examine claims closely, aiming to keep premiums down by rooting out frivolous filings or outright fraud. But if these two claims haven’t resulted in expected benefits being paid, why are employers obliged to pay premiums to “insurers” with money that otherwise could be handed to workers for use to buy their own, private coverage, or simply to salt away against a future time of need?

Workers’ Comp Results Deteriorated for Northeastern States Last Year

Most states in the northeastern region reported deteriorating workers’ compensation underwriting results last year, according to latest data from A.M. Best.

Pennsylvania, New Jersey, Delaware, Maine and Rhode Island were especially hard-hit.

Pennsylvania’s direct premiums written fell 8.6 percent last year. New Jersey’s fell 8.3 percent. Delaware’s was down by 8.1 percent. Maine fell 5.5 percent while Rhode Island was down 5.2 percent. The total U.S. direct premiums written fell by 5.4 percent last year.

New York, on the other hand, bucked the downward trend. The Empire State saw its direct premiums written volume increase last year. It went up by 5.8 percent to $3.62 billion.

Higher Loss Ratios

Eight states in this region (New York, New Jersey, Massachusetts, Connecticut, Maryland, Rhode Island, Vermont and Delaware) had higher direct incurred loss ratios last year compared to the previous year. New York(95.8 loss ratio in 2010), Maryland(91.3), Vermont(71.5) and Delaware(89.0) all reported loss ratio hikes of around 10 points or more.

Three northeastern states — Pennsylvania(69.7), Maine(61.5) and New Hampshire(68.4) — as well as the District of Columbia(52.4) had lower direct incurred loss ratios last year compared to the previous year. Both New Hampshire and D.C. saw their loss ratios fall by around 10 points.

The total U.S. workers’ comp loss ratio rose to 74.7 in 2010, up from 68.1 in 2009.

Loss ratios show how much of the premiums collected are going out to pay for actual losses. The higher the percentage, the less likely an insurer will be able to post a profit after other expenses are factored in.

A.M. Best said workers’ comp results deteriorated sharply in 2010. The U.S. calendar-year combined ratio rose nearly seven points to 118.1, up from 111.2 in 2009, and the highest level since 2000.

The ratings agency predicted the workers’ comp line’s underwriting performance will continue to weaken before it improves. That’s because several adverse conditions that led to the deterioration in recent years are expected to continue over the medium term.

These adverse factors include competitive pricing, rate decreases, high unemployment, decreased payrolls, rising medical costs and claims severity steadily trending upward.

Study finds no link between elderly patient activity and hospital falls

Elderly patients who suffered in-hospital were found to be no more active than patients who did not fall, according to a study from the University of Texas.

Investigators for the retrospective case-control study, published in the Archives of Physical Medicine and Rehabilitation, analyzed the mobility patterns of elderly patients aged 65 years or older who were fitted with small electronic devices that counted their steps.

“We matched 10 patients who had fallen with 25 who had not fallen based on age, gender, reason for admission, illness severity and mobility status before admission,” Steven Fisher, PT, PhD, stated in a University of Texas press release. “All of these people had worn step activity monitors during their stay in the hospital and when we analyzed the data from these devices, we found no statistical difference in the amount of walking between the groups.”

Best Ways Seniors Can Avoid the Hazards of Winter

 

(HealthNewsDigest.com) – NEW YORK — Winter is a special time for celebration. It should also be a time for added caution if you or someone in your family is an older adult. It is the season for falls, slips on icy streets, and other dangers that can be especially harmful for older adults.

“Something as simple as a fall can be devastating for older men and women,” says Dr. Evelyn Granieri, director of the Division of Geriatrics at NewYork-Presbyterian Hospital/The Allen Hospital. “Before the cold weather arrives, it is important to prepare.”

Dr. Granieri addresses some of the most pressing concerns mature adults have about their health and safety during the winter:

* The flu. Influenza is a serious illness that can be fatal in older adults, who often have chronic medical conditions. The vaccine offers some, if not complete, protection against the flu and can be administered as early as September. The flu season begins in mid-October and runs through March.

* Hypothermia. Keep your thermostat set to at least 65 degrees to prevent hypothermia. Hypothermia kills about 600 Americans every year, half of whom are 65 or older, according to the Centers for Disease Control and Prevention. Also, keeping the temperature at 65, even when you are not at home, will help prevent freezing pipes by maintaining a high-enough temperature within your walls.

*Icy streets. Navigating through icy streets can be intimidating. Wear comfortable shoes with anti-slip soles. If you use a cane, replace the rubber tip before it is worn smooth and becomes slippery on the wet ice.

*House fires. Make sure your smoke alarms are working. If you live in a house rather than an apartment, you should also have carbon-monoxide alarms.

*Falling in the home. Older people often have difficulty adjusting to changes in light, and high contrasts increase the risk of slip and falls. Make sure there are no great lighting contrasts from one room to another. Also, use night lights, and don’t have loose extension cords lying around — tape them to the floor. Make sure rugs are not wrinkled or torn in a way that can trip you up as you walk.

*Strenuous activities. Try to avoid strenuous activities like shoveling snow. If you must use a shovel this winter, warm up your body with a few stretching exercises before you begin and be sure to take frequent breaks throughout.

*Dehydration. Drink at least four or five glasses of fluid every day. This should not change just because it is winter. While you may not feel as thirsty as you do in the summer months, if you are older than 60 your body can dehydrate quicker, putting you at greater risk for colds, arthritis, kidney stones and even heart disease.

*Winter itch. Wear more protective creams and lotions to prevent the dry and itchy skin commonly experienced in the colder months when humidity levels are lower.

*Home emergencies. For older persons living alone, it is a good idea to have a personal emergency response system — a device worn around the neck or on a bracelet, that can summon help if needed. Wear this device all the time, and use it.

For more information, patients may call (866) NYP-NEWS.

NewYork-Presbyterian Hospital
NewYork-Presbyterian Hospital, based in New York City, is the nation’s largest not-for-profit, non-sectarian hospital, with 2,242 beds. The Hospital has nearly 2 million inpatient and outpatient visits in a year, including more than 230,000 visits to its emergency departments — more than any other area hospital. NewYork-Presbyterian provides state-of-the-art inpatient, ambulatory and preventive care in all areas of medicine at five major centers: NewYork-Presbyterian Hospital/Weill Cornell Medical Center, NewYork-Presbyterian Hospital/Columbia University Medical Center, NewYork-Presbyterian Morgan Stanley Children’s Hospital, NewYork-Presbyterian Hospital/The Allen Hospital and NewYork-Presbyterian Hospital/Westchester Division. One of the largest and most comprehensive health care institutions in the world, the Hospital is committed to excellence in patient care, research, education and community service. NewYork-Presbyterian is the #1 hospital in the New York metropolitan area and is consistently ranked among the best academic medical institutions in the nation, according to U.S. News & World Report. The Hospital has academic affiliations with two of the nation’s leading medical colleges: Weill Cornell Medical College and Columbia University College of Physicians and Surgeons.

Paralyzed man’s mind moves prosthetic arm

U. PITTSBURGH (US) — Seven years after a motorcycle accident damaged his spinal cord and left him paralyzed, 30-year-old Tim Hemmes reached up to touch hands with his girlfriend in a painstaking and tender high-five.

 

The project, one of two brain-computer interface (BCI) studies under way at the University of Pittsburgh, used a grid of electrodes placed on the surface of the brain to control the arm.

It was a unique robotic arm and hand, designed by the Johns Hopkins University Applied Physics Laboratory, that Hemmes willed to extend first toward the palm of a researcher on the team and, a few minutes later, to his girlfriend’s hand.

“I put my heart and soul into everything they asked me to do,” he said immediately after his achievement. “I got to reach out and touch somebody for the first time in seven years.”

“Seeing Tim reach out with a mechanical arm to touch his girlfriend was an unexpected and poignant bonus for all of us who are involved with this exciting project,” says co-principal investigator Michael Boninger, M.D., director of the UPMC Rehabilitation Institute.

“This first round of testing reinforces the great potential BCI technology holds for not only helping spinal cord-injured patients become more independent, but also enhancing their physical and emotional connections with their friends and family,” adds Boninger, who also is professor and chair of the physical medicine and rehabilitation department. “It further motivates us to make this technology useful and available to those who need it.”

Grid of electrodes

On Aug. 25, an electrocortigraphy (ECoG) grid, about the size of a large postage stamp, adapted from seizure-mapping brain electrode arrays, was placed on the surface of Hemmes’ brain during a two-hour operation performed by co-investigator and UPMC neurosurgeon Elizabeth Tyler-Kabara, assistant professor of neurological surgery.

“Before the procedure, we conducted several functional imaging tests to determine where his brain processed signals for moving his right arm,” she says. “We removed a small piece of his skull and opened the thick layer of protective dura mater beneath it to place the grid over that area of motor cortex. We then put the dura and skull back with the wires on the outside of the skull but under the scalp.”

Tyler-Kabara tunneled the connecting wires under the neck skin to exit from the upper chest, where they could be periodically hooked up to computer cables. Six days per week for the next four weeks at home and on campus, Hemmes and the team tested the technology.

The researchers used computer software they developed in earlier studies to interpret the neural signals sensed by the brain grid.

’100 percent brain control’

After watching a computer-generated figure move an arm, Hemmes began trying to guide a ball from the middle of a large television screen either up, down, left or right to a target, within a time limit. With practice, he could do this two-dimensional task without any computer assistance or what the researchers call “100 percent brain control.”

He then performed a similar task with the arm, reaching out to touch a target on a large, desk-mounted panel.

It wasn’t the simultaneous thought-and-move process that he knew before becoming paralyzed. Instead, he imagined flexing his thumb, which created a brain signal pattern that the computer then interpreted as “move left,” or bending his elbow to move the object right, explains co-principal investigator Wei Wang, assistant professor of physical medicine and rehabilitation.

“He mentally associated specific motor imageries with desired movement direction,” he says. “It required concentration and patience, but this process seemed to get easier for him with practice, just like when someone learns to drive a car with a manual transmission.

“In future studies, we also will test other approaches, including the participant simply thinking up for up, down for down, and so on.”

After about eight sessions, Hemmes tackled more complicated tasks. While wearing special goggles to properly view a three-dimensional TV screen, he moved the ball in the previous directions, and also to the front or back.

He also practiced moving the arm in all directions, culminating in the joyful moments after formal testing had been completed when he reached out to Wang and to his girlfriend.

Tyler-Kabara removed the ECoG brain grid and wiring in a short operation the next day.

Tests continue

The researchers are now analyzing the data, and are seeking at least five more adults with spinal cord injuries or brainstem strokes who have very little or no use of their hands and arms for additional studies.

They also are looking for participants for a year-long trial of another kind of brain-computer interface that is a 10-by-10 array of tiny electrode points that penetrate the brain tissue by less than 1/10th of an inch and pick up signals from 100 individual neurons.

Two of these grids will be put in place, one in the brain region that controls hand movement, and one in the region that controls the arm, says co-principal investigator Andrew Schwartz, Ph.D., professor of neurobiology.

“We anticipate that these penetrating grids can pick up very clear signals from the brain to reveal what motion is intended by the participant,” Schwartz says. “The second grid will allow us to see what might be possible in controlling the fine movement of the fingers and hand, which is far more complicated but also could offer more useful function for the participant.”

In his other experiments, a monkey implanted with the penetrating grid has been able to use an APL arm to reach out and hold a doorknob-like object, building on earlier work in which a monkey was able to grasp a marshmallow with a gripper device on a less sophisticated robotic arm and feed the treat to itself.

The team plans to make the technology wireless, and to include sensors in the prosthesis that can send signals back to the brain to simulate sensation.

It might be possible to connect brain-computer interfaces to existing devices that stimulate muscle fibers in the arm and hand, in effect bypassing the spinal cord injury to allow these individuals to use their own limbs again, the researchers say. That approach could be studied in future trials.

The project is being funded by the National Institutes of Health; the U.S. Department of Defense’s Defense Advanced Research Projects Agency; and the U.S. Department of Veterans Affairs, as well as the University of Pittsburgh.

For more information about the trials, call 1-800-533-UPMC (8762).

More news from the University of Pittsburgh: www.upmc.com/MediaRelations

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