What will the Next 30 Years Teach Us

The Center for Disease Control (CDC) appears to be quietly working on guidelines for physicians prescribing opioids. There are a few truths that influence the debate and likely there are some misconceptions and misperception also. One truth is that bodily injury can result in pain. Anyone that has ever so much as suffered a stubbed toe can testify on this point. 

From that point, however, the debates can become heated. How long will pain last? How can pain be best controlled? What are the detriments associated with various treatments for pain? Is holistic better that pharmaceutical" Should it be therapy, adjustment, feedback, pharmacy? There is no shortage of points for discussion. 

The current debate at the CDC was featured in a WorkCompCentral article in late November. The CDC is reportedly moving towards a standard regarding how much opium is appropriate for the treatment of pain. It has not reportedly been a rapid process. 

Government can move nimbly when it decides to, as it has demonstrated recently with its pursuit of regulation for remote control toys. Possibly that (toys) is pejorative, these toys have the potential to cause harm, but it seems to pale compared to the known harm that opioids can cause, see EForce and Kasper, and What Worthwhile can you do in 11 Minutes?

We know that an airliner could be damaged in the event of a collision with a drone. There have been reports of these drones close to airports and airliners. If an airliner were damaged and a crash resulted, hundreds of people could die, and that is serious. While registration of drones may or may not address that threat, the point is that the Federal Aviation Administration perceived a potential threat and has acted very rapidly to address its registration concerns.

The threat on the pharmaceutical side is not hypothetical or merely probable. The simple fact is that opioids are currently killing thousands of people every year. This detriment is real, current, credible, and serious. Despite this, the CDC effort is not moving as rapidly as the drone regulation effort. According to sources quoted in the WorkCompCentral article, the distinction may be because the opium industry is more established, politically powerful, and resists the establishment of guidelines. A copy of the proposed guidelines is here.

One interest group that has criticised the CDC effort is the American Cancer Society. There are some illnesses that are incurable and excruciatingly painful, cancer is one. Anyone who has witnessed someone experiencing end-stage cancer is likely thankful for opium. Anyone who has watched a family member or friend live through that end is likely to conclude that such patients should have access to as much as they desire in terms of pain relief of whatever they like. But the cancer argument is a red-herring. The proposed guideline excludes that paradigm at the outset, saying these guides are for physicians prescribing for "chronic pain outside of end-of-life care."

Opium use for pain in America is nothing new. Its use dates at least to the Civil War, more than 150 years ago. An interesting PowerPoint on the history of opium is here. But the current state of affairs with opium appears to have begun in earnest in the 1980s with advocacy for opium use to treat chronic pain for the cancer patients. It was found effective for end-stage cancer. An unfortunate feature of the cancer paradigm is that long-term effects of opium were not studied; long-term use is not a risk in end-of-life usage. The great boon to cancer patients has no corresponding "long-term risk" counterbalance. 

In the 1990s this usage advocacy spread to the treatment of chronic pain for injuries. This paradigm does have the "long-term risk" implication. The use for chronic pain naturally implicated workers' compensation, a population of people with injuries; the encroachment into workers' compensation was entirely logical. The results have been troublesome in some regards though; people are dying from prescription medication. Those who study drug abuse tell us that opioids (if they themselves do not kill the patient) are leading people to street drugs like Heroin also. 

The results are disturbing. These results are from a substance approved in many forms by the Food and Drug Administration. It is a widely studied and accepted substance, despite risks. One of the risks identified by the Drug Enforcement Agency is its addictive nature. There are risks associated with opium and thirty years after its use began to escalate in workers' compensation, this industry is recently taking opium risks seriously. Workers' compensation now searches for answers and solutions for a population at risk of harm from, or already addicted to, opioid.

Marijuana is recently becoming part of workers' compensation. As we reflect on the history of workers' compensation opium, we stand at the dawn of medical marijuana. In thirty years, the marketplace will have the benefit of retrospection to appreciate how marijuana affects people. In thirty years, we will know whether it is a boon or a bust. Could marijuana be a solution to pain treatment, or will we perceive it in retrospect the way we perceive opioids today? Will it take us thirty years to know the answers?

A recent study from the Cambridge Journal Psychological Medicine provides some interesting insight into effects of marijuana. Since marijuana has its nose under the proverbial tent of workers' compensation, we might be well served to begin to understand the potential implications of use. 

There has been a trend to legalizing medical marijuana in various states. In 2016, we see credible indications that it may spread to Florida. Recently, we have heard of states moving to include "pain" as justification for marijuana use in other states; one of the current Florida proposals includes pain as a justification. Marijuana could become a drug of choice for treating workers' compensation pain. 

The "legalization" is intriguing because marijuana is illegal under federal law. When states have taken a stand regarding opium, the federal government has intervened to impose federal law instead. When states have similarly taken a stand to legalize marijuana, the federal government has taken a hands-off, "don't ask don't tell" approach. The incongruity of these seemingly divergent federal approaches is interesting. History will judge whether either posture was appropriate. 

Medical marijuana became a credible workers' compensation issue in 2015. A doctor in New Mexico had a patient present for care. The patient informed the doctor that he was already, illegally, using marijuana, and the doctor therefore recommended marijuana. The first critical point is that the doctor did not prescribe marijuana. The second is that the doctor did not identify a problem for which he/she would independently recommend marijuana. 

The doctor's logic was apparently that the patient would use the substance in any event (the patient was already, illegally), and the doctor's recommendation (not "prescription" as that is not allowed because marijuana is illegal under federal law) would allow that use to be "legal" under state law. That is, the doctor's recommendation was merely to render the existing illegal use "medical marijuana." 

This is curious. Present to your physician and report that you have resorted to heroin and ask that she/he recommend heroin so that you can obtain and use it legally. How would a physician react to that? Some will say this is not a valid argument because "is is only marijuana." Time will tell if that is valid or not. 

Following this medical recommendation, the injured worker asked a New Mexico judge to require his employer to pay for the (now) medical marijuana. There is a rub here. Because marijuana is illegal under federal law, there are a variety of federal laws that implicate involvement with it. One avenue that the federal government has used to combat marijuana is banking laws. Bankers that do business with drug dealers face restrictions and complications. Whether states (or the DEA for that matter) enforce federal laws or not, those who sell marijuana are nonetheless still drug dealers in the eyes of the federal government.

The New Mexico judge did not order the employer to purchase marijuana for the injured worker. Instead, the judge ordered the employer to reimburse the injured worker for marijuana he himself had purchased. This removed the employer from the role of doing business with drug dealers, and allows the employer/carrier to merely reimburse someone who does business with drug dealers. This opened another interesting debate on the role of illegal marijuana in workers' compensation.

The decision compelled New Mexico to lead the nation with an effort at regulating medical marijuana in workers' compensation. WorkCompCentral reported in October that the regulations are now in place. Medical marijuana-using injured workers in New Mexico may be reimbursed for up to 8 ounces per quarter, or two pounds of marijuana per year. Some have posited that this is a notable (some say excessive) quantity. 

How do we measure things though? I recently noted that some measures may be more effective than others. In Its not the Age its the Mileage, I noted that how hard one works may have as many implications as how long one works. One of the issues with marijuana is that it is not "a thing," but is a myriad of things. Different strains of marijuana have different chemical compositions and therefore different strengths. There is no grading or "proof" as we see with alcohol. 

So, the New Mexico regulation could provide you with two pounds of marijuana. How much is that? Well, how many cigarettes, or "joints" are in an ounce? The Weed Blog says you cannot answer that. It is like "how many drinks are there in a can of soda," and the answer is that "it depends on how large the drinks." How many joints in an ounce is dependent on how large the joints are. 

What if a physician recommended alcohol for the treatment of chronic pain? Before this is decried, consider whether it is really that different than the New Mexico physician's recommendation. A patient presents with pain, admits self-medicating with alcohol, and the doctor therefore recommends it as a treatment (as our New Mexico doctor concluded, the patient is using it anyway so why not?). What then if New Mexico (sorry to pick on them, but this is the reality) decided to quantify how much alcohol is an appropriate annual limit?

It would be absurd to define in a way that is not uniform, such as a "case" or "bottles," of alcohol. A case of liquor might be six bottles or might be 120, it depends on how much is in each bottle. So, like the methodology for marijuana, might we measure in ounces? That is, instead of allowing two cases of alcohol annually, might the state allow 614.4 (12 bottles per case times 25.6 ounces) ounces of alcohol annually? Is this a rational measure? 

Anyone who has consumed alcohol can tell you that how much is enough (or too much) depends on how strong the alcohol is. As the National Institute on Alcohol Abuse and Alcoholism notes, "the amount of liquid in your glass . . . does not necessarily match up with how much alcohol is actually in your drink." The Institute says that beer has 5% alcohol content, malt liquor has about 7%, wine about 12% and liquor has 40% (80 proof) to 95% (Everclear, 190 proof). 

So, if your 614.4 ounces of medical alcohol was beer, that would be one thing. If it was Everclear medical alcohol, that would be something else entirely. The 614.4 ounces of beer, at 5% would be 30.7 ounces of actual alcohol. The 614.4 ounces of Everclear would be 584 ounces. Very different outcomes, depending on the strength of the particular product being consumed. 

Is it logical to measure usage based solely on volume? That you may have two pounds of marijuana each year is about as logical as saying you may have 614 ounces of alcohol each year. Both are objective, measurable, and utterly irrelevant without a definition of what we mean by "alcohol," that is beer versus Everclear. "Marijuana" is likewise not a generic, all-encompassing term. Some may be stronger. In deciding how much is appropriate, would it not make sense to have some measure of strength?

While that is logical in terms of deciding how much is appropriate, from the state's perspective, would it be any less appropriate from the individuals perspective? Before picking up the glass from the bar, would you not want to know whether the liquid in the glass contained 5% or 95% alcohol? For the sake of your body, would you not want to know the "proof" of what you are taking? From both the patient and state perspective, the "ounces per year" limitations seem ill-advised, poorly defined, and ineffective. 

If long-term opium use had been studied in the 1980s and 1990s, the long-term detrimental effects with which we as a nation currently struggle might have been identified. That was not the apparent path travelled (the "opium road") in America. Instead, without extensive study of the long-term effects and risks, multitudes followed each other off the lemming-cliff of opioid dosing. The results have been marked, with opioid prescription sales quadrupling in the first ten years of this century.

This year, we will see more states venture into the medical marijuana arena. Inevitably, more states will see medical marijuana become implicated in workers' compensation. Those decisions in New Mexico came without study of the implications and risks, and it is unlikely that other states will proceed differently. 

Before workers' compensation stumbles into another potential pandemic of sympathetic reaction, it might do well to investigate how to rationally quantify use ("proof" for the intoxicant). When a doctor prescribes opium, she/he does so with a set dose, on a particular schedule, and can measure use. With the current perspective and science on marijuana, that is not occurring and does not appear to be in the cards. 

As the "recommendation" of marijuana is upon us, it is unlikely that long-term effect studies can now be undertaken. However, it is possible that such studies already exist elsewhere. Is there science upon which medicine might rely, from countries that relaxed use or legalized earlier, in determining long-term concerns and fixing appropriate dosage? 

Should there be definitions of "appropriate" volume now, before Marijuana becomes the next opium? The CDC struggles today to define opioid standards, against a backdrop of decades of use; could Marijuana's definitions be set now, at the outset of its involvement in workers' compensation?

George Santayana is credited with saying "those who cannot learn from history are doomed to repeat it." We have learned a great deal about opioids in the last thirty years, the hard way. What will the next thirty teach us about marijuana?

Fraud and Financial Forfieture

Getting there may be half the fun, but being there is critical. This is true for a variety of occupations, but recent news stories suggest that it is particularly important for professionals who are billing someone for being there. Another old saying is that "it is not how much you make, it is how much you keep." These two sayings have been attributed to many over the years. 

Much of the professional world works on what is called a "fee-for- service" basis. It could be based on the time required for the service or the completed service itself. For example, I could agree to paint your garage for $1,000. In this instance, I am taking the risk regarding whether I make a profit or loss. If supplies are $200, and I want to make $20.00 per hour, I need to spend 40 hours or less on the work($800/$20) painting. If I work faster, and finish in 30 hours, I make more than $20 per hour; work slower, and I make less. 

Or I might agree to perform the work on an hourly basis. In this paradigm, I agree to paint your garage for $20.00 per hour. I know at the outset I will make my desired hourly rate. You take the risk. If I finish in 30 hours, you saved $200; if I take 50 hours it costs you $200 more than the $1,000 expected or estimated. Both examples of fee-for-service have this similarity, one will pay the fee and the other renders a service. Seems simple. 

In the service industry, both providers and payers negotiate their respective roles in these exchanges. Each is perhaps seeking some modicum of certainty or predictability. Each is perhaps taking some risk. The painter may want the certainty of the hourly rate or the potential for profit. The garage owner may want certainty of a capped price or the potential for savings. In either instance, however, fee for service requires two basic factors. One party delivers a service and the other party delivers the fee. 

Fraud is essentially the intentional deception of someone for gain, often monetary gain. In the examples above, perhaps I purposely work slowly to drag out the time required for that painting. This might be fraud, or it may be I am a slow and careful painter. There could be debate on cause and effect, fraud or lack of competence. 

But what if I do not show up at all, do not paint at all, and yet I still bill you for the garage painting? When you find out that I did not paint the garage, how do you get your money back? Will you get your money back?

Recently there have been allegations of egregious behavior in the workers' compensation industry. A pain physician in Buffalo New York was recently accused of billing for services that he did not provide. We hear of this on a small scale periodically, doctor sees patient, performs two services, bills for three. Provider spends ten minutes on something, bills for fifteen. Mistake? Arguable? Perhaps.

The Buffalo News reports, however, that this doctor had a successful practice and was privileged to travel to some interesting locations including "Moscow, Berlin and St. Thomas. And Athens, Istanbul and Ukraine a year later." Travel and site-seeing is a great distraction. 

The doctor allegedly did not let his absence from the office affect his earnings, however. Travel, after all, can be expensive. Prosecutors allege that over a 4 year period this doctor submitted over 2,000 identified charges for seeing patients in the workers' compensation system. The prosecutors claim the doctor's "credit cards, bank accounts and airline records indicate he was out of town at the same time he claimed to be treating patients" for those identified charges in Buffalo. Mistake? Unlikely perhaps. 

More recently, ABC News reported a raid on nine southern California sites and the arrest of multiple conspirators in an alleged fraud. Owners and employees of G&G Translation submitted billings for services and are accused "that $24.6 million of those billings from 2008 to 2012 were fraudulent billings." That averages to about $6 million per year.

The California Insurance Commissioner says that the translation company "got a hold of patient lists and sent bogus bills to the insurance companies." They billed for services that they did not render. Similarly to the Buffalo doctor who allegedly billed for service rendered while out of the country, some of the translations services billed appear to be impossible. 

The California officials claim that "$422,000 in charges racked up" were attributable to a translator "who never even set foot in a clinic." They claim they know this is true "because she was incarcerated." In fact, they claim this translator not only was incarcerated at the time of the supposed services, but is "in fact still in state prison today." 

Fraud can be subtle. This seems less than subtle. 

The California case made headlines. Anytime you mention $24 million dollars in fraud, you are likely to get headlines. But it was not the only translator fraud case to make news in 2015. According to the Washington State Department of Labor and Industries, a translator there was accused of "several schemes to steal from the state." These included billings for "appointments that never occurred." Her records document billings for "physically impossible" trips, some of which overlapped. Essentially, the billings had to be lies unless the translator had a DeLorean with a flux capacitor (see Back to the Future). 

What is the detriment for such behavior? Some people's moral compass alone would keep them from stealing money. The fact that stealing is wrong would be enough. This is apparently just not enough for everyone. 

This is not limited to doctors and translators. I clerked at a firm with another law clerk a great many years ago. We were each employed by an attorney and were paid by the hour. The other clerk made a great deal more money than I did, though I spent more time at the office. Curious. One day he bragged to a group that from the moment he awakened each day he was "thinking of (insert case name)" and that it was therefore appropriate that he "was billing his time" to that client. 

The attorney in charge laughed at this comment uproariously. I realized that the attorney did not care. The clerk was being paid $15 per hour for that fraudulent time. Yes, "fraudulent." Sorry, but billing a client for time you spend eating breakfast, showering and commuting is beyond questionable. The attorney, though, was in turn billing his client $75.00 per hour for this reported "paralegal work." The attorney, knowing of the clerk's admission, was gleaning a $60.00 per hour profit on this inflated or conflated time. I left that position shortly after that, and frankly never looked back. Neither that clerk nor that attorney saw anything wrong with their behavior.

What is the detriment, to deter those without a moral compass? There is the potential for incarceration. Those who commit these offenses can be locked-up in a jail for some time period in hopes that this will prevent them from further theft and that it will deter such behavior. We do not see a great many situations in which people are actually put in jail though. There was a recent case of employer fraud with jail time, but they are just not that common. Time will tell if the Buffalo doctor or the translators are actually convicted and put in jail. 

Additionally, there is the detriment of having to repay the stolen money, or "restitution." In the case of the Buffalo doctor, officials were able to identify assets that were related to the money allegedly taken. The Federal Bureau of Investigation seized two of the doctor's cars "a $126,000 Ferrari and a $103,000 Ford GT Coupe." These assets can be sold, and the resulting cash can repay those who were defrauded. 

While the story does not explain completely, I am doubtful this $239,000 will cover the extent of the allegations. They allege that there are over 2,000 instances in which he billed for services when he was physically not present. The $239,000 divided by 2,000 is only about $119.00 per instance. That would seem low for a doctor's appointment. The total attributable to the 2,000 instances alleged would seem likely to have yielded more than $239,000.

Recent news has included civil forfeiture as a possible detriment. In the physician dispensing paradigm, WorkCompCentral reported in December that a doctor might lose thirteen cars including Ferraris, Lamboghinis, Mercecedes and an Aston Martin. 

The Washington translator was allowed to enter a "diversion program." These are usually for relatively minor crimes and for first-time offenders. She will spend a year in the program, pay court costs and program costs ($150 monthly) and "obey the law." If she does so for a year, the charges will be dropped. 

So the question is how "the system" will deal with these individuals. The Washington translator has conceded the charges are true. Will the criminal system determine the Buffalo doctor and the California translators are guilty? Will they have to pay the money back? Will the translators have assets like Ferraris to pay those moneys back? After all, it's not how much you make it's how much you keep. If they have spent the $24 million, what are the odds that they can ever figure out a legal way to make the cash to repay that amount?

Will the doctor and translators spend time in jail? If so, will these examples deter others?

Are these examples indicative of widespread issues with blatant fraud? Is it a coincidence that these cases, involving impossible billings, are coming to light recently? With these blatant examples in the news, how common are more subtle varieties of fraud? How much of the billions of dollars spent in this system is wasted on fraud? 

The Comp Awakens!

I hope you have concluded your annual Christmas, Festivus, Hanukah, Kwanza, or “other” celebration. The year draws inexorably to a close. I reflect back this week on the year that was, a collection for all of us of ups, downs, and so much in between. This is my last post for 2015. 

You may have noted that our year-end included a subtle reminder of 1977. Some of you will have been to see the seventh Star Wars (for the first time a Star Wars sequence and Episode coincide). It is titled The Force Awakens. Some fans avoided it, because of their disappointment with the fourth through sixth Star Wars movies, which were in fact the first through third Episodes (prequels). Some die-hard fans despise these. They decry anything but the original Star Wars movie, episode four, and its sequels, Episodes five and six, the second and third movies. That may seem a little closed-minded? Do the prequels not, at least potentially, add something to the discussion?

2015 was a year of workers’ compensation challenges. A primary feature is our ongoing inability to get a handle on drug abuse. An American dies every 11.2 minutes from drug abuse. Much of it is prescription medication; some is street drugs, which many claim was that person’s destination to which prescription drugs paved the path. We need to address this in 2016. Just today, some encouraging news that one manufacturer of Opiods has agreed to pay a state allegedly damaged by Opiods. 

In Revenge of the Sith (Episode III, the sixth movie, “Revenge”), Yoda tells Obi-Wan "in a dark place we find ourselves, and a little more knowledge lights our way." As an industry and a nation we need to find that knowledge regarding pain and dealing with it. Opiods are killing people. We know how pain has been treated historically, with ever-increasing dosages of medication. In The Empire Strikes Back (Episode V, the second movie, “Empire”) Yoda tells Luke that "you must unlearn what you have learned." In other words, continuing to do what we have always done may not be the solution. 

We have seen criticism of the concept of workers’ compensation in 2015. ProPublica has published a series of critical articles. Some people assert these articles are one-sided or unbalanced; others refer to them as “attacks.” In Return of the Jedi (Episode VI, the third movie, “Jedi”) Obi-Wan Kenobi tries to explain to Luke that Anakin became Darth Vader, but they are different people. He says "many of the truths that we cling to depend on our point of view." Can the combatants step back from the fight and consider each other’s perspectives? 

Is workers’ compensation ideal, or perfect? Unlikely. But is workers’ compensation “the dark side?” That is just as unlikely. Can we try to put our points-of-view aside and work toward a system that is less-than-ideal for anyone but a reasonable compromise for everyone?

I think that workers’ compensation can be improved. I have had many an “expert” knowingly shake her/his head in pity as they tell me in response that it cannot be fixed. My response is the same as Han Solo’s in Empire, "never tell me the odds." See, I know a great many people who have devoted their professional lives to comp. I have seen many changes in statute, regulation and interpretation, in Florida and elsewhere. We have to believe that this system can be improved, nothing and no one is perfect. We are each other’s solution if we think about it. 

Some suggest that “the solution” is to involve the federal government. One lonely Jedi has been wandering for 40 years preaching the federalization solution to whoever will pause to listen. This year we have again heard rumblings of federalization. What would that mean? Would Congress act to nationalize the system, pre-empt if from the states? With the current interpretations of the Commerce Clause, it seems likely Congress could. Legal scholars might argue over the Commerce Clause, the “dormant” Commerce Clause, and more. Some even question whether the executive branch could pre-empt the states without Congress. There are some intriguing aspects to this. 

From where will leadership for workers’ compensation come? There are a great many pundits and prognosticators. They are quick to tell us what we can or cannot do. I am reminded of Qui-Gon Jinn’s advice to Jar Jar Binks in The Phantom Menace (Episode I: the fourth movie, “Menace”). He says “the ability to speak does not make you intelligent." Perhaps the same could be said for some of those (us?) prognosticators? Defending himself a bit, Obi Wan in A New Hope (Episode IV, the first movie, “Hope”) questions "who's more foolish? The fool or the fool who follows him?" We might do well to ask ourselves that of anyone who would have us blindly follow to her or his solutions? Feel free to remind them, as Watto did in Phantom, “mind tricks don’t work on me;” I think for myself. 

To change workers’ compensation, you will have to believe. In Empire, Yoda uses telepathy to lift a spaceship out of a swamp. Our hero, Luke Skywalker, expresses his disbelief at this feat. Yoda acknowledges Luke’s disbelief and says “that is why you fail.” If you think you can’t, you certainly won’t. Yoda reminds us that we may "do or do not. There is no try."

2016 will bring plenty of activity on the current state-centric regulatory scene. States will continue down the formulary path, but will Florida? States will likely continue to work on treatment guidelines and evidence-based medicine. Virginia has already struggled with a medical fee schedule, and that appears to be a debate that will continue in 2016. Attorney’s fees will be of interest; In Florida, this could have very interesting consequences. Constitutionality will be of interest here and elsewhere. The debate over sufficiency of benefits is also likely not over. The market has seen instability from the failure of stare decisis and that trend too may continue. There will be change in 2016. As Shmi Skywalker said in Menace, “you can’t stop change any more than you can stop the suns from setting.”

The courts have demonstrated some long timelines in 2014 and 2015. We enter 2016 hopeful that there will eventually be resolution and guidance. In Florida, we await word from the Florida Supreme Court. History has demonstrated minimal Florida Supreme Court involvement in workers’ compensation, about one case per year, since the elimination of the Industrial Relations Commission and the establishment of exclusive appellate jurisdiction of the First District Court. But we now await three major decisions from the Florida Supreme Court, and we wait, and we wait. But as Yoda told Luke in Empire, “Patience you must have, my young Padawan."

So, let’s look to that future. As Shmi Skywalker encourages young Anakin in Menace: "now, be brave and don't look back. Don't look back." We may learn from the past, but we have to look to the future. Across the continent, there will likely be legislation and regulation that is characterized as proactive and reactive. Some will lead, others will follow. Where is workers’ compensation going in 2016? As Yoda noted in Empire, the future is “difficult to see. Always in motion is the future.”

So what advice for 2016? Well, I would wish you “good luck,” but like Obi Wan teaches in Hope: “there is no such thing as luck.” I would remind you of the advice of Gold Five in Hope, as Luke vacillates taking his shot, that we must all “stay on target,” focused on the destination that we each believe will bring progress (we could all be right or wrong, but our focus and perseverance could perhaps drive some productive conversations?) Unlike the Hope fans whom refuse to see the other movies, perhaps no one can have it all their way? Perhaps the origins of Comp, like Hope, cannot be the “end-all;” perhaps progress could mean something other than steadfast insistence on clinging to the original? 

Conversations, ideas, compromise? Perhaps we can bring “balance to the force?” as Obi Wan noted in Sith. No one is all-powerful. As Padme reminds young Anakin in Attack of the Clones (Episode II, the fifth movie): “you're not all-powerful, Ani.” As with too many others', Anakin’s hubris shines in his response, telling her “well, I should be.” It is perhaps easiest to know we are right (whatever we individually believe) and to know we “should be” all powerful and able to “fix” it as we each individually would. But, we all know that is neither rational nor practical, and so we must work together. 

Finally, in the spirit of a team approach, let’s share. As Yoda advised Luke in Jedi, “always pass on what you have learned." All the lessons we can learn through study and cooperation may prevent us from having to make each of the possible mistakes ourselves. 

Happy New Year.

Oh, to be a Federal Bureaucrat

In November, the Wall Street Journal (WSJ) ran an interesting opinion piece by Mac Zimmerman, who is director of policy at Americans for Prosperity. It was titled "The Sweet Gig of Being a Bureaucrat."

This caught my eye because, like it or not, I have been a "bureaucrat" (I hope not in the pejorative sense) for a good many years. The WSJ story is focused on those employed by the federal government generally, with emphasis on Washington D.C. Mr. Zimmerman contends that the story is emblematic of problems in government (I hope he means federal government).

He builds from the recent revelations regarding the Department of Veterans Affairs, which he describes as "a well-known sinkhole of mismanagement." CNN in one article reports that the VA may be responsible for 1,000 veteran's deaths over the past decade. Its own inspector general issued a report that says hundreds of thousands of American veterans may have died awaiting care from that bureaucracy. So, take your pick deaths it has caused or deaths it has allowed.

These Veterans are the people who served to protect us all from threats foreign and domestic. Their injuries and conditions are something we all agreed to care for in a social contract.

Mr. Zimmerman notes that the VA, despite its publicized issues and failures, "handed out more than $142 million in bonuses last year." That is tax revenue paid to employees of the VA, an agency that has been credited with making delay a veritable art form. That is reward and incentive money. We hear about the bonuses paid on Wall Street in the wake of financial collapse, but not much coverage out there on the $142 million paid by the VA to reward its performance allowing hundreds of thousands to die waiting for treatment.

He brings our attention to a recent report of the Cato Institute, concluding that "the average federal employee earned $84,153 in 2014—roughly 50% more than the average worker in the private economy." This does not include "benefits like health care and pensions." If the full compensation package is considered, the "average federal worker’s compensation rises to $119,934—nearly 80% higher than everyone else." This apparently does not include any bonus money, like the millions doled out at the VA.

This has not occurred in state government, at least not in Florida. Pay for state employees has been markedly flat over the last decade in Florida. With budget and economic challenges, there has been significant competition for revenue, and the raises or bonuses have for the most part been few and far between for Florida state workers.

In fact, though the U.S. Government has led us to believe that inflation has been minimal in recent years, most employees of Florida state government are effectively making less today than they made in 2000.

An analysis of the last 25 years makes some sense, since the WSJ article makes such a comparison. In 1990 a Florida Judge of Compensation Claims earned about $79,359 annually. Today a JCC earns 123,564. A dollar in 1990, according to the government's own calculator, would be worth $1.82 in today's dollars. That $79,359 in 1990 would be equal to about $144,197 in today's dollars. This is illustrative of many Florida state employees. Yes, we earn less today than we did 25 years ago, while federal government jobs are making more and more.

The Cato report concludes that “The federal government has become an elite island of secure and high-paid employment.” Mr. Zimmerman concludes that "pay for federal employees has grown significantly faster than for private employees." In fact, "the percentage difference between the two has doubled in the past 25 years" (since 1990, the 25 year comparison in his analysis that can be compared to the 25 year decline in Florida employee earnings).

According to the report, "the median household income in September hovered a little above $56,000. That is only 1% higher than in 2009 when the recession officially ended, and 0.5% lower than before the recession began." Average American income has decreased, Florida state employee income has decreased, but federal employee income has increased.

Conversely, he notes that "consumer prices increased 10.6% over the past six years." In other words, living is increasingly expensive, federal employees are increasingly compensated and provided significant benefits, and the rest of us, well, not so much perhaps. And, despite the protestations that inflation is not an issue, the prices have increased 10.6%. Those increases are making living more expensive.

It is curious that one segment of society. would do so well, compared to other segments like private and state government employment. That their performance would be called into question with something like 307,000 Veterans dying while awaiting these bureaucrat's attention only makes the situation more curious.

Veterans deserve better. Why is this growth in federal payroll and benefits receiving so little attention? Why are the Veterans receiving so little attention? How does a government running trillion dollar deficits, with a national debt that has doubled in the last seven years, find money to pay $142 million to some of the best paid employees in the country?

There are many questions raised by this WSJ piece. 

How will You be Known?

Do you have a reputation? Perhaps everyone does, and it is just a matter of what reputation?

There was a great movie a few years back, The Pirates of the Caribbean. Johnny Depp plays the part of Jack Sparrow, an intriguing pirate. He is introduced early in the film, shown sailing into port and cavalierly abandoning his sinking/sunken boat dockside.

Shortly thereafter, he rescues the movie's heroine, only to be confronted by the local law, in the person of Commodore Norrington. An exchange ensues between the Commodore and Jack Sparrow.

Examining Captain Sparrow's belongings, the Commodore examines a flint-lock pistol and says "no additional shot, nor powder. [opens Jack's compass] A compass that doesn't point north. [smirks; partially un-sheaths Jack's sword] And I half expected it to be made of wood. [re-sheaths the sword]. You are, without doubt, the worst pirate I've ever heard of." Captain Sparrow with a grin proudly replies "but you have heard of me."

Long before Pirates, Irene Cara won an Academy Award in 1980 for her hit song Fame. In it she questions "don't you know who I am? Remember my name." She says she's "got what it takes," and reiterates throughout the refrains "remember my name" and "fame," and "I'm going to live forever." The message is catchy.

Way before Fame, Napoleon Bonaparte is credited with saying that "glory is fleeting, but obscurity is forever." Is there benefit in notoriety, fame or glory? Some seek it, others have it thrust upon them. William Shakespeare wrote "some are born great, some achieve greatness, and some have greatness thrust upon them." Is fame or recognition really any different?

Does fame or greatness find you through your actions in this community of workers' compensation? Is there someone out there that might say "you are, without doubt, the worst (adjuster, lawyer, nurse case manager, risk manager, etc.) I've ever heard of?" Should your response be a proud homage to Captain Sparrow, "but you have heard of me?" 

Or are you anonymous, working the continuous and unfortunately sometimes contentious world of claims litigation? Might someone say of you "you are, without doubt, the BEST (adjuster, lawyer, nurse case manager, risk manager, etc.) I've ever heard of?" My hope is that we would each strive for our reputation to be that; I hope we would never be satisfied with simply "but you have heard of me" for any reason, perhaps bad, perhaps the worst?

In February, the OJCC will sponsor another free continuing education program in Tallahassee. It will be a phenomenal event. The leader that organized this program is Hon. John Lazzara, a name that has become synonymous with Florida workers' compensation adjudication. I dread the day there is no Judge Lazzara in the OJCC. A committee of Judges Anderson, Dietz, and Humphries have also played a huge role in conceiving and planning this program.

We were privileged to have a phenomenal group of professionals volunteer their time and resources to present and moderate the 2016 program. Some will travel hundreds of miles to make their contribution. Some you may know already, and the others you will come to know. They are the kind of professionals you will hear of for the right reasons. 

Today I thank the following (in alphabetical order after our hosts), without whom we simply could not produce this program. 

Hon. Clayton Roberts, Chief Judge, Florida First District Court of Appeal

Steve Rissman, Esq., WCI Program Chair

Hon. Wilbur Anderson, Daytona Beach

Crystal Chancey, WC Claims Manager, Publix Supermarkets

Steve Coonrod, Esq., Tallahassee 

Mary Cruickshank, Esq., Tallahassee

Hon. Robert Dietz, Melbourne

Hon. Judge Richard Ervin (ret.), Tallahassee

Corlis Hill, Claims Adjuster, City of Tallahassee

Hon. Marjorie Renee Hill, Gainesville 

Hon. Ray Holley, Jacksonville 

Kathleen Hudson, Esq., Florida First District Court of Appeal

Hon. Ralph Humphries, Jacksonville

Mary Ingley, Esq., Florida First District Court of Appeal

Paolo Longo, Esq., Orlando 

Hon. Ellen Lorenzen, Tampa 

Hon Tom Portuallo (Ret.), Jacksonville 

William Rogner, Esq., Orlando 

Todd Sanders, Esq., Florida First District Court of Appeal

Sara Steele, Esq., Florida First District Court of Appeal

Tod Stupski, Deputy Director, State Employee Workers’ Compensation Claims 

Michael Winer, Esq., Tampa 

Hon. Nolan Winn, Pensacola 

Also a big thanks to our co-sponsor, WCI. Without the help of the WCI and Resource Managers Inc. (RMI), we could not produce a program like this; our thanks to: 

Jim McConnaughhay WCI

Stephen Rissman (WCI)

Cathy Bowman (RMI)

Woody Douglas (RMI)

Shirley Kendall (RMI) 

Kathy Shelton (RMI)

The registration information is attached to an e-newsletter sent in November. It is here if you wish to review the program details and register. See you in Tallahassee!

Attorney Fee Reform

Attorney's fees are in the news. Not in Florida, here we await the next development from the Florida Supreme Court in Castellanos and those other cases upon which the Court has invited briefs (the "companion cases"). 

But  in June, the Oregon Governor signed a new attorney fee bill. According to WorkCompCentral, the result will be that "claimants' attorneys" will be compensated "for more services," and they will be able to "collect interest in cases where the employer challenges an award of attorney fees." These are two interesting topics.

There are limits on attorney fees in Oregon. Attorneys fees there are capped at $4,000 "where an attorney successfully argues a carrier or self-insured employer unreasonably delayed or denied payments." Before this reform bill was signed, attorneys were not "paid for working on these cases." 

So, one might argue that before the recent Oregon reform Florida's attorney fee provisions were more generous than Oregon's. That is hard to quantify. I have read fee statutes from a variety of states, and they are very difficult to compare to one another. The specificity of their provisions, in some cases to particular classes or periods of benefits, is interesting and intriguing. 

Generally, when the statutory law is changed in Florida, the substantive provisions apply prospectively, to the future, only. If a procedure is changed, then that procedure may be applied to cases involving accident dates before the law was enacted. Generally speaking, procedural changes are applied retroactively and substantive changes only prospectively. 

It is a fair bet that an attorney fee statute change like this would be deemed substantive in Florida and applied only to recent and future claims. The Oregon bill, however, is specifically intended to apply to any "decision issued on or after January 1, 2016." (emphasis added). The legislature intends that regardless of the date of accident involved in a particular case, or when a claim was filed in that case, the new fee statute applies if the decision on the fee comes after December 2015. That is interesting. 

Some would argue that this puts a burden on the party paying. They would argue that the insurance premium collected back in 2010 was based on what claims might cost under the law in effect that year. To now add liability for those past claims might seem to add cost without compensation. Most benefits are fixed by the law in effect on the workers' compensation date of accident, for this reason. 

Others might argue that restrictions on fees or benefits, fixed in a particular year, do not keep pace with the market when inflation changes the relative value of goods or services. Inflation may change what fixed dollar amounts are actually worth. 

Another interesting element of the law will require some consideration of the effects of inflation. The Oregon Workers' Compensation Board will now have to "review attorney fees every two years to ensure payment is reasonable for the amount of work lawyers put into representing injured workers." 

Inflation is a complex subject. There are multiple ways of considering inflation, and to some extent your conclusions about whether there is inflation, and how much, is a product of what you analyze (or buy). The U.S. government defines what is considered in determining the Consumer Price Index, or CPI. That calculation measures a "market basket" of certain consumables. By comparing the cost of that basket today against the same basket at some point in the past, they tell us if prices are rising, declining, or static. 

This does not always necessarily equate to our personal experience in a micro-sense. Though the government tells us that inflation is minimal over the last few years, the price of bread, milk and eggs have certainly increased in my neighborhood. Possibly, other good's prices have decreased, which could make the whole "basket" look reasonably similar. Or, it could be that bread and milk are not included in the basked of what is calculated. 

So Oregon will now try to do an administrative evaluation bi-annually to assure that its workers' compensation attorney fees are reasonable. That is a different approach than we have taken by codifying an alternative fee in Florida for some (medical only) claims of up to ten hours at $150.00 per hour. That rate and hour limitation is in the statute, and has not changed since that provision was enacted, about fifteen years ago. 

Another element of the Oregon change worth further discussion, is allowing attorneys to "collect interest in cases where the employer challenges an award of attorney fees." In Florida, there can be delay that results from litigation. An attorney might claim fees are due, and that could be denied by the employer or carrier (e/c) The attorney would file a verified motion for fees, and the E/C is required to file a response. 

In the normal course of our procedure, it should take no more than 90-100 days for this issue to be heard, and our judges have been reasonably consistent in producing final orders within 30 days of trial. In all, a fee determination should usually be concluded with a trial order in less than six months; most are adjudicated more rapidly. Of course, the trial decision could be appealed, and review might take six months or more. 

But the point is that for this six months, or year if appellate review is sought, the claimant's attorney does not have the money for that fee. It appears that the Oregon law change will allow the attorney to collect interest on that fee amount. This may be an incentive for the E/C to resolve fees when they can, without litigation, because unresolved fees become more expensive the longer they require for resolution. 

As Florida waits for the Supreme Court, it is interesting that limits on attorney fees, and fee reform generally, are the subject in other states also. 

The Florida Court Declines Review of Padgett

In a brief order dated December 22, 2015, the Florida Supreme Court declined to review Padgett v. State of Florida. This saga began with a Miami Circuit Judge presiding over a case involving an injured worker, Cortes, and his employer, Velda Farms. Those two resolved their differences, but the Florida Workers' Advocates (FWA) and Workers' Injury Law and Advocacy Group (WILAG) had "intervened" in the case, meaning they also became parties.

With Velda Farms no longer in the case, a defendant was needed though. The trial judge allowed FWA and WILAG to change the name of the case. He allowed a new injured worker, Elsa Padgett, to join the plaintiffs' side of the case. Then the name was changed to Padgett and FWA v. State of Florida. 

At that point, it would have been helpful for the plaintiffs to "serve" The State of Florida. When a lawsuit begins, it is "filed" which creates the case with the court system. Then the defendants are "served" which is how the defendant knows that it or they are being sued. In America, this action of being "served" is important, because it is the "notice" that we call due process under the law. Procedural due process is protected by the Constitution, and it is comprised of two important rights, the right to "notice" and the right to an opportunity to tell your side of the story, called the "opportunity to be heard."

The Third District Court concluded that changing the name of the case to include "The State of Florida" as a defendant was not sufficient to put the State of Florida on notice. The Court concluded that sending the State of Florida a notice of the name change was likewise not sufficient for notice. The defendant has to be "served" with the lawsuit. The Third District also concluded that the question of constitutionality was moot by the time the Circuit Judge ruled on that question. The Third District's Opinion is an interesting read. 

Because the District Court disposed of the case with that decision, it never reached the due process question regarding Ms. Padgett's employer. She became a plaintiff in the case (Cortes' case against Velda). Her employer, from whom she was seeking damages in this lawsuit, was never invited to the case. Her employer, the one that would apparently have been liable to pay her damages if she prevailed in this lawsuit, was never named in the lawsuit, never served, and never (apparently to this day) given any opportunity to be heard in this case. That has often been mentioned by curious lawyers discussing the case. 

The Florida Supreme Court order of December 22, 2015, in the case now styled Florida Workers' Advocates, et al. v. State of Florida, Case Number: SC15-1255 (Lower Tribunal Case(s): 3D14-2062)(a/k/a Padgett) states: 

This cause having heretofore been submitted to the Court on jurisdictional briefs and portions of the record deemed necessary to reflect jurisdiction under Article V, Section 3(b), Florida Constitution, and the Court having determined that it should decline to accept jurisdiction, it is ordered that the petition for review is denied. No motion for rehearing will be entertained by the Court. See Fla. R. App. P. 9.330(d)(2).

About 60 years ago, writing for the United States Supreme Court in Brown v. Allen (1953), Justice Jackson observed that "we are not final because we are infallible, but we are infallible only because we are final." A paraphrase of this has been a favorite of Supreme Court scholars since: "the Court is not last because it is always right, but it is always right because it is last." As a general rule, the Supreme Court is the end of the road for litigation. Its decision is the last word.

There will be no rehearing or reconsideration of Padgett in Florida's courts, the Court's December 22, 2015 order says so. The Supreme Court can pre-emptively deny motions for rehearing that have not been written, filed or read yet.

There will be those who will immediately ask "can this order be appealed?" No, not "appealed." An Appeal is something to which we each have a right in Florida, but that right ends with one appeal. The "right" to appeal in this instance was the right to appeal to the Third District. Any appellate review beyond that is not a "right" but is instead what we call "discretionary review."

Certainly, the Florida Workers' Advocates could ask the U.S. Supreme Court to review the case further by petition for writ of certiorari (this is how discretionary review is requested, and is how FWA and WILAG unsuccessfully asked the Florida Supreme Court to review this). The old saying is that "if you do not ask, you do not get." So certainly, one could ask ("petition") the U.S. Supreme Court to review.

Certiorari has been sought in many cases over the years, and the U.S. Supreme Court accepts a very small fraction of such cases. In fact, that Court only reviews about 100 cases each year. Can the FWA, WILAG and Padgett seek review? The answer is absolutely "yes." Are the odds in favor of the U.S. Supreme Court reviewing it, clearly "no." The conclusions of the Third District Court of mootness and notice are unlikely to compel the attention of the Court.   

Rather, it would appear that the saga that has been Padgett and FWA and WILAG v. State of Florida (or as the Third District referred to it "Padgett v. [?]") has run its course and is now concluded. 

There remain other Florida Supreme Court cases in which we await decisions: Westphal v. St. Petersburg, Castellanos v. Next Door Company, and Stahl v. Hialeah Hospital. So many interesting issues. Last Christmas I said 2015 would be an interesting year at the Florida Supreme Court. I was wrong; for the most part it was quiet. Many of us spent the year marking our Thursdays with a rush to the Court's decision webpage, reminiscent of a child's rush to see what Santa left under the Christmas tree. We had a great many anticlimactic Thursdays in 2015. 

Hopefully 2016 will bring decisions in some of these cases? In Home, singer Daughtry cautions us "be careful what you wish for, you just might get it all, and then some you don't want." Keeping this in mind, I still wish for 2016 to bring closure for Florida on some of these important issues. There are those out there that think Jerry Clower's idea ("shoot up here amongst us") is not such a bad idea; maybe Florida "has got to have some relief" in 2016?

Form Letters

In October, 2015, a story was published about some letters sent regarding workers' compensation claims in Ft. Worth, Texas. At best, the letters were insensitive. It may be that the furor over the letters is worse because of previous issues with the city's workers' compensation program.

In workers' compensation some businesses buy insurance, and the insurance company, or "carrier," covers the risk and provides the adjusting of the claims. Some employers instead "self-insure" the risks, meaning that the employer will be responsible for losses. These are usually large businesses or in some states smaller businesses may form groups for this purpose. Some really large employers hire adjusters and do their own management of claims, check writing, etc. And some of these self-insured employers instead hire a third party administrator, or "TPA," to do their adjusting and management of claims. The TPA model seems to be the more common approach for self-insureds. 

Ft. Worth's workers' compensation program is administered by a TPA or "servicing agent." These companies adust workers' compensation and other kinds of risks, but do so with money that is the client's (Ft. Worth) or perhaps an insurance company (a carrier who is covering a risk may find it beneficial to hire a TPA if the carrier does not do a volume of business in a location and desires local adjusters and managers). Either way, these TPA companies are focused primarily on delivering a service. 

Recently, in Ft. Worth, this company sent out letters. It sounds as if they may have gone to a large number of recovering workers. It also sounds like they were form letters. Many companies use form letters. They are a convenience. They may help to provide information to large populations of people that have common interests.  

According to NBC 5 in Dallas-Ft. Worth, the letters informed recipients that Ft. Worth would be changing adjusting companies. So the old service provider mailed these letters to inform recovering workers of the identity of the new service company. That makes sense. The TPA would be the point of contact if a check is late arriving, if a treatment requires authorization, if a medical appointment is needed, etc. The recovering worker needs to know who to contact with questions or issues. 

Some took issue with the letters though. Specifically, the story mentions that the families of two deceased employees received letters. That seems logical, because families that survive someone killed in a workers' compensation claim may be entitled to ongoing workers' compensation benefits. It would perhaps be helpful for them to know who to contact with questions, issues, etc.

These two employees happened to be police officers. Each passed following injuries suffered in the line of duty. There has been a fair amount in the news lately regarding police officers, and the dangers that they face. Most of us face injury risks everyday. The statistics support that some occupations are more dangerous than others. I am confident that being a police office has a higher risk associated with it than being a judge. I sit at a table all day staring at a computer screen, which is perhaps very low risk, and by comparison there are some very dangerous jobs out there. 

While informing everyone of the change in companies makes sense, the phraseology of the letters caused concern and upset. These letters named the new company, the effective date of the change, and then closed with "we wish you a speedy recovery." Survivors of the two deceased employees found the statement difficult. Of course, those deceased employees are not going to recover, quickly or otherwise. As one put it, they made "the ultimate sacrifice."

One of the widows found the choice of words "disrespectful" and commented that she "hope(d) they would learn how to handle their business better." Another employee of the city was more critical, saying that "to get a form letter in this manner is just despicable."

A representative of the TPA company that sent the letters sought to reassure, saying "this oversight was not intentional," and that the company "regrets any hurt its communications caused these fine families."

Form letters. This story reminded me of having little kids around the house. I realize that seems an odd transition, but stick with me. I remember many occasions when falls and bumps led to those little kids visiting the pediatrician. I would make a co-payment, and the bill would go to the health insurance company for processing and payment. 

Afterward, the mail would always deliver an explanation of benefits, or EOB. I have a business degree and a law degree and those EOBs have never made any sense to me. I just look at the bottom line and see if there is a "+" figure (I need to send a check) or a "-" meaning I might get some money back. More often than not, there was no "-."

But more curiously, having taken a 6 year old to the pediatrician, I almost always received a form letter from the group health carrier about collateral sources (in other words, a question as to whether someone other than group health carrier should pay that bill). The question was always the same, "was this injury suffered at work?" I found these letters somewhat humorous. 

I sometimes thought about writing back and telling the health insurer that my 6 year old was injured at work. I thought of providing a long, detailed, description of the child's work, the long hours, and the resulting accident. Most parents would probably tell you that the majority of pediatrician visits involved virus or infections. The diagnosis of "ear infection" is not likely to suggest workers' compensation at any age, but I digress. 

I restrained myself from writing a sarcastic letter because I believed that anyone incapable of noting that the injury or illness was to a 6 year old might be as incapable of appreciating the sarcasm of such a letter. I also appreciated that I was already wasting money mailing back their form and more waste in the time to write a letter was not going to improve my bottom-line in the relationship. 

I also thought about writing back to them and suggesting that they, and I would save money if they quit sending those letters regarding 6 year old children. There was postage and the paper. I am fairly confident that sending the letters was an automated process, but as confident that someone at the health insurer had to open my return form, read it, make a note in some file or system. A monumental waste of everyone's time and an expense for the health insurer. But even when I sent the form back, I would often get an identical form a few weeks later. I was not at all certain that those on the other end were paying much attention to their own forms and frankly doubted they would read a suggestion letter.

Computers are wondrous tools. Keeping people informed is important, and on that level the Ft. Worth TPA should be praised for informing the workers' and their families of a change. But it seems that a computer could be programmed to not send "work related?" letters regarding injuries and illnesses to 6 year old children with green nasal discharge or "speedy recovery" letters to the families of police officers that died in the line of duty (or any families of any deceased employees). We have come a long way and computers are not the glorified memory-typewriters that they once were. 

At the end of the day, it may come down to a quote I heard many years ago, that "common sense is not that common." or, perhaps it comes down to the fact that "the devil is in the details." But it may also just come down to the fact that everyone is human and we will all periodically make mistakes? Computers are merely tools that do as we tell them, in a very literal sense. Computers do not make mistakes, but we that run them are very capable of doing the mistake-making for them. 

Mitch Radcliff is credited with the quote that "the computer allows you to make mistakes faster than any other invention." That may be something to remember. 

Maybe the computer can be programmed to do a better job on these form letters? While they are at it, perhaps an EOB can be designed that does not require a PhD. or an accountind degree to understand?