Tuesday, May 31, 2022
Metadata and Makeup
Sunday, May 29, 2022
A Day to Reflect
Thursday, May 26, 2022
Your Chance to Speak is Now
"Ever since we crawled out of the ocean and stood upright on landThere are some things that we just don't understand"
"We're shakin' up those building blocks"Going deeper into that box- (Pandora wouldn't like it)"
Tuesday, May 24, 2022
Revisiting a Judicial Discipline
About a year ago, I wrote a post here about a judge who engaged in the practice of law. See Practice of Law (July 2021). The story is about a Judicial Qualifications Commission (JQC) report recommending discipline for a constitutional judge in Florida. The judge had been accused of practicing law on behalf of her son. I noted there that the story was rife with "reminders for judges."
Those included that judges have to remain aware of the actions and words of their staff; the Code of Judicial Conduct requires it. Furthermore, judges cannot practice law. There is an ever-present potential that some family member of a judge may fall into jeopardy and perhaps those are the times a judge must most forcefully remind her/himself of the Code. Those are times in which emotion may override judgment? In that instance, I suggested it would be interesting to see how the Supreme Court resolved the issue later in the fall. I was wrong about the timing.
On May 19, 2022, the Florida Supreme Court issued its decision in SC-20-605, Inquiry Concerning a Judge Re Barbara Kaye Hobbs. The Court noted that following a hearing the judge was "found . . . guilty of the three charges for which she had conceded guilt and one additional charge." The Hearing Panel "recommended that she be publicly reprimanded, suspended from office without pay for sixty days, and compelled to attend an employee management program."
The JQC argued to the Court that the judge should have been found "guilty as to all of the charges and that the seriousness of her misconduct warrants harsher discipline, up to removal from the bench." The Court agreed as to the additional finding of guilt and the insufficiency of the proposed punishment but disagreed that removal from office would be appropriate.
The Court was specific and critical as to the actions of the judicial assistant, for which the hearing panel had determined the judge was guilty. However, it is worth reiterating. It noted that "Judge Hobbs knew of the serious ethical breach by her judicial assistant and took no steps to counsel her, even after being directed by her chief judge to do so." The Court concluded that the assistant's actions could have been avoided "if she had taken appropriate action." And, as the judge did not, the "rules appropriately hold Judge Hobbs responsible for all of the actions of her assistant that could have been avoided."
Notably, those judicial assistant infractions occurred later. They are perhaps different than the judge's initial and immediate decision(s) to claim to represent her son following the alleged shooting. The judge's error in that emotional moment are perhaps more excusable or at least understandable than the failures to supervise staff and to correct behavior ("even after being directed by her chief judge to do so."). There is an expectation that we will strive to remediate mistakes or errors.
As to one of those actions, the "judicial assistant’s actions regarding the security badge," the Court held the Hearing Panel was incorrect and the Court concluded that despite the conduct being “so beyond the mainstream and improbable as to be unforeseeable by anyone,” the judge was nonetheless guilty. It explained that the assistant overall lacked "perspective, sense of propriety, and professional judgment" in her behavior, and thus "it is appropriate to hold Judge Hobbs accountable for her own failure to supervise, even if the specific preference given to her son may have seemed improbable before it occurred." The import is that the judge's overall deference to this staff member was inappropriate.
The Court reminded that it “gives the findings and recommendations of the JQC great weight.” However, that it not bound by those conclusions. It acknowledged the JQC recommendation that the judge's actions "demonstrate() unfitness to hold judicial office that warrants removal." However, the Court explained that "removal is the most severe form of discipline a judge may face, and it is typically reserved for when a judge" has committed intentional, “serious, and grievous wrongs of a clearly unredeeming nature.”
The Court concluded that the record demonstrated "a failure of judgment and a lack of appropriate boundaries between her judicial office and her personal life that cannot be tolerated." Furthermore, it reminded that “[A] ‘judge is a judge 7 days a week, 24 hours a day,’” an admonition that every judge might well bear in mind. The Court held that "Judge Hobbs’s misconduct goes to the heart of the public’s ability to trust Florida’s judges." Therefore, it elected to suspend the judge "for sixty days without pay" and to order that she "pay a fine of $30,000." The judge was further ordered "to attend an employee management program" in hopes of better staff management.
In terms of impact, the salary of a Circuit judge is $165,509. Thus, sixty day's earnings is $27,207.00 ($165,509/365 = $453.45; x 60). The fine of $30,000 more than doubles that, a total of $57,207 in financial impact, almost 35% of the annual salary. Overall, the impact is significant. The Court's reminders and explanations provide guidance for all judges. It is imperative that judges govern themselves at all times with the Court's admonitions in mind, remembering the potential for public scrutiny and financial penalty for direct failures and more indirectly those of the staff we supervise (or fail to).
Sunday, May 22, 2022
"It's coming around again"
I know nothing stays the sameBut if you're willing to play the gameIt's coming around again
Thursday, May 19, 2022
Allegations regarding Funds
"the lawyer shall prepare a closing statement reflecting an itemization of all costs and expenses, together with the amount of fee received by each participating lawyer or law firm. A copy of the closing statement shall be executed by all participating lawyers, as well as the client."
Tuesday, May 17, 2022
The Stress of Testimony
At the outset, this is a blog about workers' compensation. Periodically, I get feedback from the mis- (or un-) informed asking "what does this (whatever it is) have to do with workers' compensation?" While it may be that I take things for granted, I have striven in recent years to be more direct with the reader in this regard. Unfortunately, the world of workers' compensation too often includes litigation. And in those trials and hearings, there is almost always testimony from the injured worker, the employer, and various physicians. Notably, these are all either personally or professionally interested in the case, the issue, and the trial.
However, there are also a multitude of hearings in which there is/are a witness(es) that have no real interest in the case. She/he/they have been subpoenaed and brought to the hearing because of someone else's interest(s). Over decades of trying and hearing cases, I am familiar with their frustration, disappointment, and even anger at being reluctantly present. Much like being summoned to jury duty, such a subpoena can be unwelcome, feel like an intrusion or imposition, and lead to discomfort or worse. Without a doubt, the witness and the juror are indispensable to the justice system. Too often, the subpoenaed witness is unclear on her/his role, on the expectations of counsel, on the process and procedure(s), and on the duration of the commitment. There are additional challenges with being recompensed for one's time as well.
I was reminded of that as the news feed came up with coverage recently of a fact witness in a rather testy defamation action that is being played out in a Fairfax County, Virginia courtroom. In some ways, that whole legal affair perhaps started in the Washington Post, where one of the parties wrote an opinion piece on domestic relationships. Of course, it is also possible to discern from the testimony reported that the two parties have had a long-contentious relationship the erosion of which merely culminated in that newspaper. As it has played out in the press, it remains at best unclear where and when the parties relationship troubles began. The other member of that relationship filed a defamation suit regarding the Post article and there have since been allegations galore. The case has been intriguing to monitor.
It is not uncommon for allegations in claims and lawsuits to be viewed differently by the interested parties. Each has a distinct interest, there is disagreement, and hence a trial. Therefore, an independent witness that can corroborate or contradict either party may be of tremendous help to the judge or jury in making credibility decisions (deciding which party's story to believe). And, there are apparently some disagreement and credibility issues in this trial.
The story that inspired this post, however, is more specifically about an independent witness who was the doorman (or more aptly, perhaps, a "portal person") at a residence in which the (formerly) happy couple resided. The testimony largely focused on the portal person's investigation of a possible intruder, which he ultimately concluded was merely a dog. However, the portal person also noted his frustration with the case, while providing his deposition testimony while driving and vaping.
Sunday, May 15, 2022
Another Long-COVID View
WCRI presented a Long COVID seminar on May 3, 2022. This provided an excellent overview of the challenges of the health effects of the recent pandemic and infections. The presentation in some specifics echoed the program presented recently by the American College of Occupational and Environmental Medicine (ACOEM). That is overviewed in Long COVID Seminar (April 2022). That post contains a link to view the ACOEM program. I recommend watching each of these.
Francesca Beaudoin, a medical doctor with Brown School of Public Health presented an overview of symptoms and challenges that are alleged to be COVID-related. In a very practical argument, she stressed that the best methodology for avoiding the "Long COVID" effects would be to avoid the COVID period. The benefits of vaccination were thus stressed, and that answer is likely somewhat frustrating to those who have already suffered infection.
Dr. Beaudoin stressed that many physicians are striving to treat "Long COVID." She mentioned that some are specializing with clinics that are dedicated with the challenges of long-term effects of the infection, while others are persevering in the midst of a broader clinical practice. There seems suggestion that the specialized focus may be of benefit to patients due to the complexity of the various impacts of this infection.
She mentioned National Institute of Health (NIH) has invested heavily in the research on Long COVID and has published information. However, it is notable that the publication began in September 2021. There has been some tendency for this pandemic experience to seem like it has gone on forever. But, it has been just over two years. See Happy Anniversary (March 2022). Thus, it is notable that the NIH publication of data is dated September 2021, just over six months ago. There is research, but it is just beginning, details are scarce, and science (evidence) is as yet somewhat elusive.
Dr. Beaudoin mentioned that there are burden of proof challenges in general, but that these are mentioned often in the workers' compensation context. The potential variety of patient subjective complaints is extensive. The CDC lists a panoply on its website (the entirety of this list is quoted verbatim from the CDC site):
"General symptoms
Tiredness or fatigue that interferes with daily life
Symptoms that get worse after physical or mental effort (also known as “post-exertional malaise”)
FeverRespiratory and heart symptoms
Difficulty breathing or shortness of breath
Cough
Chest pain
Fast-beating or pounding heart (also known as heart palpitations)Neurological symptoms
Difficulty thinking or concentrating (sometimes referred to as “brain fog”)
Headache
Sleep problemsDizziness when you stand up (lightheadedness)
Pins-and-needles feelings
Change in smell or taste
Depression or anxietyDigestive symptoms
Diarrhea
Stomach painOther symptoms
Joint or muscle pain
Rash
Changes in menstrual cycles"
The potential for multiple possible causes of many of these perhaps helps us all understand the physician's struggles. So many maladies might cause stomach pain, joint pain, headache, or fatigue (examples only, from the list above). A physician evaluating a patient might attribute such complaints to a vast array of underlying diseases, maladies, or pathology. Thus, there is a challenge here for the scientist and the patient. As we focus on workers' compensation, there is then a challenge for the risk manager, and in a variety of contexts for the human resource manager. In all, many challenges, questions, and few definitive answers as yet.
Dr. Beaudoin stressed that there are critical emotional health issues related to the complaints patients report. This is likewise similar to Dr. Kertay's comments and perceptions in the ACOEM program. Dr. Beaudoin explained that these complaints and symptoms are reasonably new, this pandemic is new. She explained that there are perceptions that patients are being extensively tested in regard to complaints and symptoms, and these pathways of testing are perceived by some patients as "being dismissed by the medical community." That is, essentially, that more testing is a way of doing something when there is frustration over not being able to provide definitive treatment.
"if the receiving physician cannot provide a more effective therapy than can the transferring physician, medical residents consider the transfer inappropriate, and call the patient a turf." J Gen Intern Med. 1999 Apr; 14(4): 243–248.
That is not new to workers' compensation. It is concordant with some perceived challenges of soft tissue injury, which are legendary in the field of occupational medicine. Patients often present with complaints of pains and discomforts that are perceived as discordant with other medical signs and symptoms, exaggerated, or otherwise questionable. In some instances, there is an incomplete or inaccurate description of the mechanics of injury that can be of interest or distraction.
It is not uncommon for a patient to be initially treated with conservative care and then receive referrals to a parade of specialists in search of anatomical and physiological explanations for symptom(s). The root cause of symptoms and complaints in soft tissue and orthopedics can be elusive, and there are instances in which doctors may be perceived as disbelieving or dismissing a patient. In the long run, it is likewise not uncommon for some persistent physicians to ultimately identify some pathology that is then addressed, often leading to symptom improvement. Some readily lament the delay that is at times seen in the process of reaching an ultimate diagnosis and instigating specific and focused medical care for it.
Dr. Beaudoin stressed that patient groups are interested in being believed and receiving treatment beyond testing and investigation. At this moment, only two years into this pandemic, the science is just beginning and there is likely some academic curiosity about each and every symptom, constellation, and presentation. But, as worthy as the efforts at research and measurement are in terms of future patients, doctors must remember that each present patient is in need and is seeking relief or amelioration, not merely study and evaluation.
Patients are said to be frustrated with the lack of definitive treatment specific to the "Long COVID-19" as opposed to more generic treatments and care usual for the spectrum of symptoms being reported such as respiratory challenges. They may benefit from generalized symptom amelioration but want to be confident that the constellation of COVID-19, their perceived cause, is being addressed.
Dr. Beaudoin added that the Americans With Disabilities Act (ADA) now contemplates Long COVID being "a disability," in that it may "substantially limit one or more major life activities." It is important to focus on the word "may." The ADA has published a guidance on this topic. Remember that diabetes is listed as potentially being an ADA disability, but that millions live with that disease and are not necessarily disabled. It is not the diagnosis of a condition that equates to disability, but the impact of that diagnosis or disease. The government has an extensive publication of COVID-19 considerations as regards disability.
Dr. Beaudoin noted that the issues of disability are complicated by the lack of empirical data regarding whether a particular patient was or was not even infected (see above, the best way to avoid "Long COVID is to avoid infection). She opined that antibody testing is not yet of significant assistance in differentiating between a patient that has been affected by the disease/infection as opposed to one that has antibodies from vaccination efforts. She describes how the challenges of differentiation are further frustrated by the early periods of the pandemic when testing availability and reliability were challenging, a situation that may have even persisted during more recent pandemic times in certain areas and communities. Without a test to authenticate the initial infection, the proof of relationship of ongoing symptoms may be challenging.
Employer groups have been concerned with disability, but also with issues around the legal constraints of vaccination requirements, the ADA, and more. There is a desire for clearer understandings of the potential legal exposures, the operational processes that are appropriate, and the determination of both diagnosis and impairment or disability. The mention of these challenges was an appropriate adjunct to this presentation, but in all sincerity the legal challenges are as broad and difficult as the medical and could easily overwhelm the full time of a separate seminar dedicated to them.
Of interest, there are seemingly issues with the need for documentation and accommodation of the impacts of COVID. These are not necessarily different challenges than workers' compensation experiences in a variety of maladies and conditions, including even the most common orthopedic or soft-tissue issues. The differentiation of effects of current trauma from the potential pre-existing maladies, conditions, and effects has been part of the diagnosis and treatment challenge in various workers' compensation cases forever. There have long been forensic evaluation challenges to make such determinations in the context of "major contributing cause" and other similar statutory standards. That this is not different in "Long-COVID" is likely neither surprising or encouraging from any perspective.
Teasing the cause of current symptoms from a spectrum of complaints that may relate to COVID or a variety of comorbidities and pre-existing conditions is seen as a medical challenge. Dr. Beaudoin opined that differentiating will be dependent upon critical analysis of prior medical history, various testing, and studies. Her discussion seemed to make reference to a forensic approach to differentiating former symptoms, diagnoses, testing, and the current symptom universe in a particular patient. In that context, it is notable that the volume of patients appears significant and the population of available physicians really has no potential for expansion (the existing profession will perhaps have to divert attention to "Long-COVID" to the potential detriment of other maladies and conditions).
The doctor noted there are "knowledge gaps today." There is more that remains unknown about COVID-19 than is known. This is frustrating for all involved, and is likely impacting the emotional function and recovery of the patient. The patient, at a minimum, believes her/himself to be suffering from the long-term impact of this viral assault. With all of the questions and unknowns, much remains to be studied, cataloged, documented, and analyzed.
And, it is possible that medical progress may be years in addressing some issues related to COVID-19 just as there have been long challenges with a variety of human ailments including the previously mentioned diabetes, as well as cancers, lupus, Parkinson's, and the list goes on. To further frustrate matters, there are questions of the impact that various COVID variants may cause and how changes in the virus itself may impact the progress of individuals and the medical reactions to those symptoms and challenges.
Dr. Beaudoin concludes that the situation overall is not under control and that science and medicine are struggling with "Long-COVID." Her perspective and comments had parallels to the ACOEM conclusions but brought a somewhat different perspective and focus. The presentation is well worth viewing. As the scientists bring more study and results, it is probable that future presentations will bring further edification and progress. However, for now, the information in such programming is a fundamental necessity for those in claims, employee relations, and more.
Thursday, May 12, 2022
The Best of NCCI's Symposium
Tuesday, May 10, 2022
Immunity, Coworkers, Clarity
"The owner of a motor vehicle is liable for an injury caused by the negligent operation of the motor vehicle whether the negligence consists of a violation of a statute of this state or the ordinary care standard required by common law"