Commission on Health and Safety and Workers' Compensation
Minutes of Meeting
December 13, 2002
Public Utilities Commission Building
San Francisco, California
Chairman Tom Rankin
Commissioners Allen L. Davenport, Jill A. Dulich, Kristen Schwenkmeyer, Darrel "Shorty" Thacker, John C. Wilson
Christine Baker, Executive Officer
Commissioners Leonard C. McLeod and Robert B. Steinberg
Call to Order / Minutes from the November 20, 2002 meeting
Chairman Rankin called the meeting to order at 9:10 am and asked for a motion on the draft minutes of the November 20, 2002 CHSWC meeting. Commissioner Dulich moved to adopt the minutes, Commissioner Schwenkmeyer seconded and the motion passed unanimously.
Presentation on CHSWC Study of California Workers Compensation Insurance Market
Brandon Miller, Project Manager, Hays Companies
Ms. Baker introduced Mr. Miller to present the Hays Companies proposal on the study of the California Workers Compensation Insurance Market. Ms. Baker commented that this is the same proposal that the Hays Companies presented as part of the Request for Proposals (RFP) evaluation process.
Mr. Miller gave an overview on the Hays Companies scope of the proposal, work plan and choice of team members, previous experience relating to workers compensation insurance, methodology and tools, and the Hays communications plan. Mr. Miller stated that although the study has 17 objectives, many of these overlap. The Hays Companies has identified and will be looking at three broad areas: financial oversight and regulation, benefit delivery and access to and affordability of mandated workers compensation insurance coverage. Mr. Miller further emphasized that the Hays Companies will prepare a comprehensive report by mid-year 2003 with practical objective recommendations. During the course of the project, the Hays companies plans to inform CHSWC on the studys progress through bi weekly updates, written reports, and occasional meetings.
Public Comments and Questions
In response to a question from Mark Webb, AIG Group, Mr. Miller stated that the study would look at the issue of privatizing the State Compensation Insurance Fund (SCIF).
In response to questions from Ed Walters of Clarendon Insurance regarding examining SCIFs practices, Mr. Miller noted that the study would be looking at claim practices in the industry which will include SCIF as well.
Jim Fisher of the Industrial Medical Council asked if the study will look at the issue of access to reinsurance. Mr. Miller replied that this was one of the objectives of the RFP and the study will be examining this.
Physicians Disciplined by the Industrial Medical Council
Susan McKenzie, MD, Executive Medical Director, Industrial Medical Council (IMC)
Jim Fisher, Attorney, Industrial Medical Council
Sherry Smith, Steward with Local 707, Injured Worker
Chip Atkin, Social Worker, Local 707
At the April 2002 CHSWC meeting in Los Angeles, the Industrial Medical Council (IMC) staff made a presentation on its disciplinary procedures. At that time, Commissioner Davenport requested that CHSWC hold the QME disciplinary matter open for further investigation or public testimony at a CHSWC meeting in Northern California. Following Commissioner Davenports request, Dr. Susan McKenzie, Ms. Sherry Smith, Mr. Chip Atkin and Mr. Jim Fisher presented various aspects on the issue of physicians disciplined by the IMC.
Susan McKenzie, IMC Executive Director
Dr. Susan McKenzie explained the disciplinary staffing and procedures of the Industrial Medical Council. Dr. McKenzie stated that the disciplinary process has been impacted by budget cuts and the hiring freeze. The Council has experienced loss of personnel and currently has a staff of 1.2 attorneys, 1.5 investigators and 1 workers compensation consultant appointed to the project.
Dr. McKenzie stated that the Industrial Medical Council has a highly structured process in place to deal with disciplinary issues and commented on the ways in which injured workers are informed about disciplinary action taken against physicians. According to Dr. McKenzie, some of the ways the IMC provides such information are through an annotated list of doctors who are on the QME panel and a web site containing a list of disciplined physicians. The IMC also has a QME database online which it updates daily and the Council is working on annotating the disciplined doctors on the database.
Dr. McKenzie further noted that there are eight licensing boards linked to the IMC website and injured workers can search appropriate licensing boards for more information on the physicians. The IMC has perceived delays between the time the licensing board files an accusation and IMCs action. She commented that the IMC attempts to maintain a good working relationship with upper levels in the system in order to reduce the time of this delay.
Sherry Smith, Injured Worker, and Steward with Service Employees International Union (SEIU) Local 707
Sherry Smith outlined problems with the IMC disciplinary procedures and asked CHSWC to introduce Legislation revising the Labor Code to deal with the problems. She maintained that the IMC has failed to notify injured workers of disciplined physicians and that the information is not available to injured workers about different ways to access the information on disciplined QMEs.
Ms. Smith further commented that there are currently no Policies and Procedures about how the IMC handles disqualified QMEs. She pointed out that one of the problems with the IMC website is that once QMEs complete probation there is no annotation on the website that the physician ever had any action taken against him/her. Commissioner Wilson asked whether Ms. Smith had raised this issue at IMC formal hearings. She responded that she had not. (NOTE: Ms. Smith subsequently advised CHSWC staff that although she had not attended IMC meetings, she had expressed her concerns on several occasions in letters to the Industrial Medical Council.)
Chip Atkin, Social Worker, Member of SEIU Local 707
Mr. Atkins comments related to concerns over potential QME conflict of interest in evaluating injured workers cases. He stated that some QMEs are biased in their medical-legal evaluations due to their economic dependence on insurance companies. He recommended that information should be disclosed regarding the time the QME spends on doing medical legal evaluations versus other cases and suggested that a website should be developed to rank QMEs performance.
Dr. McKenzie commented that Ms. Smith has done a positive service to the Council and the community and requested that Sherry Smith submit her comments and recommendations for improvement to the Council.
Commissioner Dulich asked how long does it take for the IMC to post its information on the QME database and if the Administrative Director is notified of specific disciplinary actions taken by the IMC. Dr. Mackenzie responded that the information on QMEs gets posted immediately. Jim Fisher added that when doctors are placed on probation or an action is taken by the Council, multiple people such as the California Applicant Attorneys Association and the DWC Administrative Director are informed.
Commissioner Davenport said that he would like CHSWC to review the merits of the complaint made by Sherry Smith and other injured workers, as well as what has been accomplished to date.
In response to the Commissioners request, CHSWC staff will prepare an issue paper with recommendations for the February 2003 Commission meeting.
CHSWC Project to Develop a Workers Compensation Comprehensive Guide
Juliann Sum, Labor Occupational Health Program (LOHP), UC Berkeley
Ms. Sum briefed CHSWC on the status of the "Workers Compensation Comprehensive Guide." The Guide incorporates, consolidates, and updates the Workers Compensation Fact Sheets developed earlier by LOHP for the Commission. In addition, the Comprehensive Guide includes the recent workers compensation legislative changes of AB749 such as the increases in benefit payments. Ms. Sum related other changes and updates contained in the Comprehensive Guide which include: addition of new website addresses, role of acupuncturist, the explanation of the QME and AME process, and return to work rights.
Ms. Sum added that there are still minor changes that need to be added to the Guide such as: DWC fraud text and DIR photographs. She expects the text of the Guide with the minor changes to be completed at the end of December, with a final English version to be completed by the end of January. After the completion, the Guide will be available on the internet.
Commissioner Wilson moved to approve and release the draft of the Workers Compensation Guide with minor changes still to be incorporated. Commissioner Dulich seconded and the motion passed unanimously.
Election of 2003 CHSWC Chair
Commissioner Wilson moved to nominate Commissioner Jill A. Dulich as the next Chair of the Commission for the year 2003. Commissioner Schwenkmeyer seconded and the motion passed unanimously.
Bruce Smith, Principal with Research Solutions
Mr. Smith commented that he provided a draft paper to CHSWC entitled "Unintended Consequences and the Pharmaceutical Benefit Management (PBM) Provisions of AB 749." Mr. Smith reiterated that the AB749 legislation which allows employers and insurers to manage their pharmacy benefit through the use of contracting to PBM organizations has risks.
Chairman Rankin adjourned the meeting at 10:35 am.
__Signature on file____02/28/03________ __Signature on file___ _02/28/03_____
Jill A. Dulich, Chair Date Christine Baker, Executive Officer Date