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Editor’s note: Steve Fraser is a writer, historian and editor-at-large of the journal New Labor Forum. His first book, “Labor Will Rule: Sidney Hillman and the Rise of American Labor,” won the Philip Taft prize for the best book in labor history. He is a visiting professor at New York University.

New York (CNN) — The 100th anniversary of the Triangle Shirtwaist Co. Fire this Friday should throw into sharp relief recent efforts by lawmakers in Wisconsin and other states in the industrial heartland to curtail collective-bargaining rights for state employees.

The Triangle fire in New York City on March 25, 1911, killed 146 people, mainly women, mainly young immigrant women. Some were girls of 14 and 15. The fire broke out on the upper floors of the factory, too high for fire department ladders of those days to reach. People gathered on the street below watched in horror as women and men jumped to their deaths to avoid the enveloping flames. Observers talked of the sky raining flaming bodies. Many of the workers trapped inside were burned beyond recognition.

It was all over in half an hour. But the events of that day were permanently burned into the collective memory of the city and the nation. New Yorkers were shocked and grief-stricken. Some 100,000 people filed by the makeshift coffins gathered on the 26th Street Pier, which became known as “Misery Lane.” A few days later, 350,000 people turned out for a march through through Lower Manhattan, many to vent their anger and express their determination that tragedies such as this should never be allowed to happen again.

After all, the tragedy was not a natural disaster but a man-made one, too, frighteningly typical of this age of laissez-faire capitalism. The technology to prevent or confine such fires — sprinkler systems, fire walls, secure and ample fire escapes — all had been available for years. Moreover, fires had broken out at Triangle before, as they had in many other industrial workplaces. But no local, state or federal law required that these safety devices be installed or that safety protocols be followed. And manufacturers like the owners of the Triangle Co. didn’t want to spend the money.

Children died that day because laws or public agencies back then did not exist to prohibit such child labor. Nor were there laws to police other labor abuses regarding hours, wages and conditions of work, abuses that were common throughout American industry at that time.

One reason so many perished is that the owners had locked one of the exit doors. They had done that to prevent pilfering of shirtwaists and materials by their workers, whose average income, according to public authorities, was pathetically inadequate — between $800 and $900 a year — not enough for a family of three or four people to survive decently. There was no law establishing a minimum wage.

Most important of all, the owners of the Triangle Co. were adamantly opposed to the unionizing efforts of their employees. In “Triangle: The Fire That Changed America”–widely considered a definitive account of those times–historian David Von Drehle described the Triangle owners resorting to spies, thugs and a company union to intimidate and blacklist workers who sought to organize and had actually gone on strike a little more than a year before the fire. While the strike had compelled the owners to improve wages and hours a bit, they would not budge when it came to recognizing the garment workers union.

Like other manufacturers, the Triangle owners exercised a kind of industrial autocracy. There were no laws then that guaranteed the elementary right of workers to unionize and engage in collective bargaining, nor any government agency to prevent employers from engaging in what later came to be known as “unfair labor practices” (like keeping such blacklists or firing someone for his or her union sympathies).

The workers had virtually no voice in determining the most vital circumstances that would determine their fates in the workplace. Had they had such a voice, there is no question that matters of safety, especially given the company’s history of fires, would have been a top priority.

One reason the Triangle fire has lodged so deeply in the public memory is that it marked a watershed in the nation’s public life. Before the fire the situation was this: No one with the power to do anything about it was watching. No union, no government agencies, no laws and regulations prevented employers from doing what they willed. The workplace was a black box insulated against public inspection by the inviolate sanctity of private property. After the fire, all that changed.

A factory inspection committee established by the New York state Legislature exposed occupational dangers to health and safety in the garment and other industries and promulgated a series of laws and regulations that would drastically reduce the incidences of death and injury.

Similar steps were taken in other industrial states. Workers’ compensation laws were passed and disability insurance became customary. Government bureaus were established specifically to monitor the labor of women and children.

Eventually, Franklin D. Roosevelt’s New Deal saw the passage of the Fair Labor Standards Act, which established a national minimum wage, maximum hours and outlawed child labor. The New Deal’s Wagner Act inscribed in law the right of workers to organize a union and engage in collective bargaining. These reforms and others democratized and civilized what had been a savage version of free-market capitalism.

Which brings us back to Madison, Wisconsin. True, no one is yet proposing to repeal the Fair Labor Standards Act or abolish occupational health and safety regulations. Still, to chip away at one of the great achievements of 20th-century American democracy by curtailing the right to collective bargaining is to take a dangerous step backward in time.

Those 146 men and women died in part because they had been denied a voice in determining the basic conditions of their working lives. Their deaths were redeemed by an aroused citizenry that had come to realize that such a right was a matter of life and death and of human dignity.

It would be a second tragedy and an insult to the memory of those who died there, were we to return, even in part, to those dark ages.

For the second time in six years, the North Carolina legislature is considering amendments to the workers’ compensation benefits. Among the heavily debated proposals is the elimination of lifetime disability benefits — instead injured workers would be limited to nine and one-half years of benefits.

Business Competition and Job Creation in North Carolina

Some proponents of benefit changes say North Carolina must reform its workers’ compensation law in order to compete for business and new jobs. Yet figures from the Bureau of Labor Statistics and state Governor’s Office show that North Carolina ranks third in the nation for declining unemployment and fourth in the nation for job creation, with 36,000 jobs created in the last 12 months. Among the top ten states in business climate rankings by CEO magazine, Forbes, CNBC, Site Selection magazine, Pollina Corporate Real Estate and Business Facilities magazine, many would consider North Carolina a national leader in business development.

Workers’ Comp Reform and Premium Rates

Workers’ compensation premiums are at $2.12 per $100 of payroll; while that places North Carolina slightly above the national median of $2.04, according to a 2010 ranking by the Oregon Department of Consumer and Business Services, this rate is lower than 22 other states. In fact, North Carolina is faring better in premiums than California, Texas, New York, Pennsylvania and South Carolina — all which have recently passed workers’ compensation reform laws.

Despite the push for “reform” from the North Carolina legislature, from 2008 to 2010, premiums in North Carolina dropped 15 percent — more than in the reform states of California, Texas and New York during that same period. Indeed, Elizabeth Crum, deputy secretary for compensation and insurance in the Pennsylvania Department of Labor & Industry, concedes that reforms in Pennsylvania have only had a “subtle” effect on workers’ comp premiums in that State. Crum says the workers’ comp dollar has gone up due to utilization review. Thus, rather than spending money on injured workers, the insurance companies are spending money on “armchair” physicians who review a worker’s medical records from a remote location, and often second-guess the worker’s own treating physician’s recommendations.

Workers’ Comp Reform and Benefits

Short of fraudulent claims, “savings” realized through workers’ compensation reform may actually amount to a shifting of expenses from employers and their insurers to the public sector, including taxpayers, Medicare, Medicaid, Social Security Disability Insurance (SSDI), and other social services. A number of workers’ compensation experts testified before a Congressional subcommittee about what they called an erosion of benefits over the last decade and the barriers to qualification that various states have erected. And the U.S. House of Representatives Committee on Education and Labor has requested the Government Accountability Office to evaluate the extent to which state cuts in workers’ comp benefits are transferring costs to SSDI.

RAND Institute for Justice prepared a research report recently for the CCHSWC in which it was found that the state’s “permanent partial disability benefit levels fell short of the generally accepted two-thirds income replacement level of adequacy.” Additional changes have cut these benefits even further while also making it more difficult to qualify for benefits. To compensate for the shortfall in income and healthcare coverage, injured or ill workers are looking to unemployment benefits, Social Security, Medicare and Medicaid, and employer-sponsored health insurance programs.

Meanwhile, although New York increased the maximum weekly benefits to $760, it also discontinued lifetime benefits; all benefits now expire within ten years. In Florida, the formula for figuring attorneys’ fees allows for no upward adjustment meaning that in some cases attorneys could be making approximately $8 an hour. This means that many injured workers are forced, unable to find representation, to accept whatever benefits are offered, if any at all.

Injured workers and their families should protect their rights by immediately contacting a workers’ compensation attorney. A lawyer can advise clients of the current state of the workers’ compensation law and work to maximize benefits for sick or hurt employees.

Sophisticated urine analysis of employees on workers’ comp could become a bulwark in the fight to control the epidemic use and abuse of narcotics.

As a method to detect whether an injured worker is taking the medications prescribed to them, the use of quantitative clinical urine analysis hasn’t really come into vogue just yet.

According to some experts, it’s only been in the last 18 months to 24 months that a more widespread use of the technique known as tandem mass spectrometry has come into play to determine whether an injured worker is taking the drugs they’ve been prescribed, and not coupling them with illicit drugs, or not taking them at all and instead selling medications on the street.

The technology shows promise as a valuable tool in not only saving money on prescription medication, but as a method of determining whether a worker is following their workers’ compensation treatment plan in good faith.

“Patients not taking medications as the doctors prescribe them has been an issue not just in comp but in our overall healthcare industry,” says Jim Andrews, the senior vice president of pharmacy services for Atlanta-based Healthcare Solutions, a worker’s compensation claims management company.

“There is a significant disconnect from the time the doctor writes a prescription and the way the patient gets it filled at the pharmacy and takes the medication,” Andrews says.

For Bob Steggert, the Bethesda, Md.-based vice president of casualty claims, for Marriott International Inc., the information his claims department has been able to gather from drug testing has shown him beyond any reasonable doubt that many workers who are prescribed medications aren’t taking them properly, if at all.

Marriott rolled out the use of high-level urine analysis nationwide in 2010, according to Steggert, and he says some of the statistics produced by such testing are very much worth noting.

Only 36 percent of patients who underwent urine analysis were found to be taking medications in the manner in which they were prescribed, Steggert says. In addition, 52 percent of patients had “not expected” results, which meant that they either didn’t have all of the drug in their system or they had other drugs in their system which hadn’t been prescribed.

“So what we are looking at as a payer and especially as a payer who is paying for expensive drugs that are designed to cure and relieve, and it is not completely in their system it raises questions that we think are bona fide questions to address,” Steggert says.

Health Solutions’ Andrews says there could be one of at least three things going on when a urine test reveals that a worker isn’t taking a medication properly.

One, the worker may want the drug as a benefit extension but doesn’t really need it. Two, the worker could be taking too much or too little of the drug and getting results that are different from what the prescriber expects. And three, the worker could be taking illicit drugs on top of the prescribed drug “and all three of those things could contribute to less-than-predictable outcomes,” Andrews says.

Sophisticated drug testing has value and has more recently become more affordable.

According to Frank Fornari, the CEO of Dominion Diagnostics, the lab that Steggert and Marriott use, a thorough test costs between $300 and $500. And with prescription medications sometimes costing hundreds of dollars per pill, there are savings to be realized.

“The drug test can cost less than the one pill that you’re not taking,” Fornari says.

But Fornari and others say that for sophisticated urine analysis to really gain traction there is a lot of ground to be made up between treating physicians and the companies and carriers who might be paying for drugs that workers are not taking at all or not taking properly.

One big issue, according to Fornari and others, is the issue of physician reimbursement.

“You’ve got to attack this a number of ways,” says Fornari. “You’ve got to incentivize physicians for actually being pharma vigilant.”

Fornari says physicians who work with companies and carriers to carry out urine testing that reveals that prescribed medications aren’t being taken should be rewarded for the savings they help create for the company.

“Say I test you and you are getting eight prescriptions from me and you are only taking three of them. I take five away from you and I don’t fill them anymore and the savings I just made for the company, I get paid for that,” Fornari says.

Historically, Fornari says, physicians who were inclined to participate in urine analysis as a workers’ comp cost and care-management technique may have become dispirited when they weren’t reimbursed for their labor and time in collecting specimens and reporting data.

Also, historically, the techniques that could produce bankable results weren’t yet developed or affordable says Jerry Fogel, founder of Imagine Clinical, a healthcare and workers’ compensation consultancy based in Coral Springs, Fla.

“If you are going to try and hold doctors accountable for practically managing their patients or if you are going to try and hold patients accountable for complying with their treatment protocols, you better have some good information to hold people accountable,” Fogel says.

Marriott’s Steggert says solid clinical evidence is something that will hold sway in court when a judge is determining what a settlement or benefit level should be in a workers’ compensation case.

“It depends on the complexion of the case and the degree of noncompliance and the precise findings,” Steggert says. “But there are not too many judges that want to hear that a patient is not compliant with a care plan, particularly if it involves drugs that are not in their system.”

“It means that they are not taken as prescribed or they are being diverted,” he says.

Drug testing for evidence of diversion is not solely in the interest of companies trying to protect their bottom line or even the health of their patients.

The United States is in the grip of a national epidemic around Schedule II narcotics, such medications sold under the brands Oxycontin and Actiq, highly addictive drugs that are worth a lot of money on the street. Oxycontin is worth $1 per milligram in illicit trade, according to a recent report in the New York Times.

According to the quarterly magazine Physician Pain News, published by the American Society of Interventional Pain Physicians, 80 percent of all narcotic medications consumed globally are consumed in the United States. And that’s in a country the population of which comprises only 4.5 percent of the world’s population.

“There is no exact roadmap, but bottom line, these are long-tail expensive cases,” Steggert says. “But with the known problems with drug diversion and dependency and frankly worsening conditions we think it makes eminent sense to stay on top of it. The only way you can do that for something like these drugs is periodic testing.”

“As a primary payer in the workers’ comp arena, we feel that we have an obligation not only from a fiduciary standpoint but to the broader social good to do what we can to root out diversion and pay only for what patients are taking as prescribed,” he says.

March 10, 2011

Copyright 2011© LRP Publications

The Triangle Shirtwaist fire, which claimed the lives of 146 mostly female immigrant garment workers in 1911, is credited with galvanizing support for labor unions, as well as spurring reforms in workplace safety and city building codes.

As we prepare to mark the 100th anniversary of the tragic fire, Metropolis spoke to Cornell University’s Lee Adler about the labor legacy of the fire and the widespread outrage it caused among New Yorkers and the nation. Adler teaches public sector collective bargaining at Cornell’s School of Industrial and Labor Relations. The interview has been edited.

There was an uneasy labor backstory at the Triangle Shirtwaist Co. Where did things stand before the fire?

Adler: The fire happened in a factory that did not sign on to the loose collective-bargaining agreement terms. It was something called the Protocols of Peace that was established after a very long strike in 1909 and 1910. So this factory was a bit of an outlier at the time, and that acted as a spur to labor activists after the fire.

Certainly the organization and determination of the needle trade unions was fortified by the aftermath.

Who are the major political or labor figures that emerged from the Triangle fire?

Adler: In the New York state Legislature there were two very young politicians — one was Al Smith, the other was Robert Wagner. They were interested at the time in picking up the mantle of the fire and passing legislation. Some dealt with fire-safety standards and ingres and egress standards.

Frances Perkins by accident saw the fire, and that had an influence on her for the rest of her life. She was, first of all, a health and safety person connected to the labor movement in the teens. Ultimately, Franklin Roosevelt appointed her to be labor secretary.

Walk me through the direct aftermath. The Triangle fire is often credited with spurring labor reforms, but how did that play out?

Adler: There was a rapid increase throughout America in the passage of workers’ compensation laws. Up until this fire, workers’ compensation bills were not terribly prolific in America. Oddly enough, given what’s going on now in Wisconsin, they passed the first successful workers’ comp legislation in 1911 -– more or less flowing out of this sutation. Within part because of the Triangle fire, in five years we see every state in America pass workers’ comp legislation.

In 1913, for the first time in the U.S. government, the Department of Labor was established. There had been previous things like it but there had never been a government agency. One of the first efforts was to compile statistics on workplace injuries. They looked at lead smelters, match factories, coal mines and steel making.

Did Triangle lead directly to a rise in labor unions?

Adler: I would describe the period immediately after the fire as one that was difficult for labor organizing. There was no mandatory legislation anywhere in the U.S. that permitted collective bargaining. There was no right to collectively bargain anywhere in America before 1935.