Tuesday, April 22, 2008

Doctors Feel Push to Downplay Injuries

Doctors Feel Push to Downplay Injuries

By Ames Alexander

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Group tells OSHA of pressure by companies.

New York - A leading group of occupational doctors is taking the unusual step of speaking out publicly against pressure from companies to downplay workplace injuries.

To outline their concerns, the physicians have sent a letter to federal workplace safety regulators and held a conference session in New York City on Monday. They're also planning to testify before Congress.

If successful, their campaign could affect the treatment of injured workers and might help change how the government assesses workplace safety.

"Our members feel they are being methodically pressured ... to under-treat and mistreat," said Dr. Robert McLellan, president of the American College of Occupational and Environmental Medicine. "... This is a grave ethical concern for our members. It's a grave medical concern."

His group represents 5,000 doctors; some treat workers referred to them by employers, while others work directly for companies.

Employers are supposed to record all injuries requiring time off work or medical treatment beyond first aid. It's an honor system, and the injury logs are used by regulators and others to gauge plant safety. Low injury rates allow companies to avoid scrutiny from workplace safety regulators and may help managers earn four-figure bonuses.

In a hotel meeting room in New York, doctors said this helps explain why some employers urge them not to treat injuries in a way that would make them reportable. A cut, for instance, must be recorded if the worker gets stitches, one doctor told the room of more than 60 colleagues. But if the doctor simply covers the cut with a bandage, it doesn't have to be reported.

Workplace injury and illness rates - a key factor in determining whether regulators inspect a company - have been declining nationwide in recent years. But some experts suspect that's partly because employers aren't reporting all on-the-job injuries.

McLellan, an associate professor at Dartmouth Medical School in New Hampshire, says he thinks employers are "vastly underreporting" the extent of workplace injuries.

"Players in the system may willfully produce records that don't reflect reality," he said in an interview.

He said he grew more concerned about corporate pressures on doctors in September, during a conference in the Carolinas. Since then, he said, he has heard from dozens of doctors.

That led him to contact the U.S. Occupational Safety and Health Administration, and he expects to discuss his concerns with top agency officials next month. His group will likely propose that OSHA more vigorously investigate the accuracy of company injury logs. It may also ask regulators to rely on a broader array of workplace safety measures - and to rewrite rules so that companies have fewer incentives to underreport.

McLellan also wants occupational doctors to testify before congressional committees examining workplace safety.

Ethical physicians sometimes lose business to those who bend to the wishes of employers, some doctors and workers' compensation lawyers say.

In the Carolinas and some other states, injured workers generally must visit doctors approved by their employers if they want workers' compensation to pay for the treatment. Companies incur higher costs for compensating workers for medical care and lost wages when they're injured on the job.

Employers tend to send workers to doctors who can help them keep costs low and productivity high, according to attorneys who represent injured workers. Doctors become popular with companies if they rarely order time off work for injured employees, or if they seldom recommend costly treatments or conclude injuries are work-related, those lawyers say.

"If you get past the infirmary and sent to a doctor, you're getting sent to a doctor that lives on the plant," said lawyer David Davila, who until recently worked in Columbia, S.C.

Atlanta lawyer Bruce Carraway has represented more than 400 injured poultry workers and says that in more than half of those cases, independent physicians gave different assessments than the company doctors.

Dr. Josephus Bloem, an orthopedic surgeon from Rocky Mount, said he used to get referrals from Perdue Farms. But in the 1990s, the company became unhappy that he usually recommended surgery for workers with carpal tunnel syndrome.

"Their top doctor once visited me and complained that I was too expensive, which I took as pressure to review my approach," Bloem said. Not long afterward, the referrals stopped.

Dr. Roger Merrill, Perdue's chief medical officer, said the company had discovered that many workers who got less invasive treatment - such as splinting, exercise and ibuprofen - fared better than those who got surgery. "We had a better way to treat folks," he said.

But Bloem wondered whether health concerns were the only factor. "In the end," he said, "the money wins."

In their quest to keep injuries off logs, company officials without medical training sometimes provide inappropriate treatment, doctors at the New York conference said.

Dr. Peggy Geimer, corporate medical director for a chemical company in Connecticut, spoke of the "tremendous amount of pressure" on company staff to provide treatment beyond their level of expertise.

She recalled how one supervisor dealt with an injured worker who spilled an acidic chemical on his arm: He applied potash, which is sometimes used to clean up chemical spills - unaware that it would only make the burn worse.

McLellan said he doesn't recall his group ever before taking such a strong stance on the issue. As one doctor at Monday's conference put it: "We need to treat the patient. Not the log."

Many Injuries Unreported in Poultry Industry

In a recent investigation of working conditions in the poultry industry, the Observer found that many on-the-job injuries aren't being reported.

One N.C. poultry company, House of Raeford Farms, has repeatedly failed to record injuries on government safety logs. The newspaper also found that some company first-aid attendants have prevented poultry workers from receiving care that would cost the company money.

House of Raeford says it follows the law, provides good care and strives to protect workers.

A record-keeping expert for the U.S. Occupational Safety and Health Administration told the Observer that his agency is allowing employers nationwide to vastly underreport the number of workplace injuries. The true rate for some industries, including poultry processors, is likely two to three times higher than government numbers suggest, Bob Whitmore said.

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