Author: Janet

CANADIAN PAIN COALITION BULLETIN January 30, 2017

President’s Letter

CPC Members, Colleagues and Friends,

The Canadian Pain Coalition is pleased to provide you with information and links regarding the release today, January 30, 2017, of the 2017 Draft Recommendations for the Use of Opioids in Chronic Non-Cancer Pain.

As you may remember, the Canadian Pain Coalition participated as an expert panel member for the original 2010 Guidelines and I represented CPC as a voting panel member for this update.

Follow the link below to learn more and to provide your feedback about the guidelines by the end of February at: http://nationalpaincentre.mcmaster.ca/guidelines.html

Media coverage:
• Hamilton Spectator, January 30, 2017 http://www.thespec.com/news-story/7092508-mcmaster-releases-draft-opioid-guideline/
• Globe & Mail, January 29, 2017 http://www.theglobeandmail.com/news/national/canadas-proposed-new-opioid-guidelines-dont-address-prevention-sources-say/article33821459/

Sincerely,
Lynn Cooper BES
President

Excuses for missed hearings by WorkSafe boss don’t sit well with tribunal chair

Daniel Theriault objects to explanation MLAs heard for WorkSafe’s absence from appeal hearings
By Jacques Poitras, CBC News Posted: Jan 24, 2017 6:00 AM AT Last Updated: Jan 24, 2017 8:32 AM AT

The CEO of WorkSafeNB is being accused of giving misleading information to a committee of MLAs at the legislature last week. Tim Petersen was explaining last Thursday why his Crown corporation had not even shown up to argue against rulings by an appeal tribunal, rulings that drove up costs now being passed on to employers. But several of Petersen’s statements are being challenged by Daniel Theriault, who chairs the independent Workers Compensation Appeal Tribunal.

WorkSafe decisions on benefits for injured workers are appealable to the tribunal, and the tribunal has issued several rulings overturning decisions and forcing the corporation to pay out higher benefits.

Standing was not denied
Petersen said WorkSafe wanted to defend its decisions but was turned down. “We have in fact sought standing at a number of different appeal hearings, unsuccessfully,” he told the committee. He also said his predecessor had made a “commitment” to Theriault that WorkSafe would avoid “seeking standing” except in specific cases “so as not to bog down the process” of a worker being awarded benefits.

Theriault said Monday that Petersen was wrong on both counts. He said WorkSafe doesn’t have to “seek” standing to defend its decisions. “The way the legislation is worded,” he said, “WorkSafe is a party to each and every hearing automatically. So they don’t have to seek standing.”

And he said he was not aware of any commitment by WorkSafe to limit its appearances to avoid bogging down the process.

Bogging down not a worry
In fact, Theriault said, WorkSafe attendance at a hearing would only add an hour or two to the entire processing of a worker’s claim. “Their attendance would not bog our process down,” he said. “Our process is set, dates are set, so there’d be nothing to bog it down.”

Petersen was careful last week to tell MLAs he was not criticizing the decisions by the tribunal, which began operating in April 2015 as an independent appeal body for WorkSafe rulings. “They’ve been legislated to do a job and they’re doing that job, so [it’s] not a judgment about that,” he said.

But even so, he said, several rulings had created precedents that forced WorkSafe to pay out higher benefits or account for its costs in a different way.

Blamed tribunal for part of increase
That was responsible for about 15 cents of the 37-cent increase employers were hit with on Jan. 1, he said. Employers have been complaining that the increase, to $1.48 from $1.11 for every $100 of payroll, would make it more expensive for them to hire more workers.

Petersen said one appeal ruling in particular was costly: a tribunal ruling that WorkSafe could not reduce benefits if workers’ retirement money invested in the markets lost value during a downturn.
– ‘Significant’ hike in WorkSafeNB rates likely in 2018, employers told
– Workers’ Compensation Appeals Tribunal overturns 90% of cases 

“If I’m not mistaken, we did not have notification of that appeal,” Petersen told reporters. He attributed that to the fact it happened just as the tribunal was starting to operate. “Any time there’s that type of transition, there are sort of bumps along the way, and that was probably a result of that,” he said. If WorkSafe had known, he added, “that’s one we probably would have definitely considered appearing on.”

WorkSafe wrong on all counts
But Theriault said Petersen was wrong about that, too. He said the tribunal has held six hearings since April 2015 on cases relating to the negative value of retirement benefits. “I’ve double-checked our records and on each case, [WorkSafe] was notified of the hearing date,” he says. “They chose not to attend any of the six.”

Petersen told MLAs last week that WorkSafe only has two lawyers on staff, making it difficult to take on a large number of appeals. But Theriault said he told Petersen that it doesn’t have to be a lawyer who attends the hearing. A claim manager would be enough.

He said that of 541 hearings the tribunal has held since April 2015, WorkSafe has shown up for four, which makes it difficult to consider the Crown corporation’s rationale for its decisions.

“Any argument WorkSafe would want to bring forward is not present to be considered by our tribunal,” he said. “If they’re arguing that it’s such a cost consequence to them, they should make every effort to rectify that consequence.”

Increased OHS vulnerability as measured by IWH tool linked to higher rates of self-reported injury

Institute for Work & Health’s OHS Vulnerability Measure can identify ways to reduce hazardous exposures and injury risk through improved policies, awareness and empowerment

January 13, 2017 (Toronto, Ont.)—Workers who report being vulnerable because they are exposed to job hazards from which they are not adequately protected by workplace policies, awareness programs or empowerment mechanisms also report much higher rates of work-related injury.
This finding was published today in the journal Safety Science (doi 10.1016/j.ssci.2016.12.021). It comes from an Institute for Work & Health (IWH) study looking into the relationship between occupational health and safety (OHS) vulnerability and work-related injury and illness.
Vulnerability in the study was assessed using a 27-item measure developed by a research team led by Institute Scientist Dr. Peter Smith. The tool assesses workers as vulnerable when their responses indicate they are exposed to workplace hazards, as well as inadequate protection in at least one of these three areas: OHS policies and procedures, awareness of health and safety-related rights and responsibilities, or empowerment to act to protect themselves and colleagues.
“The study suggests that IWH’s OHS Vulnerability Measure meaningfully assesses workplace hazards and OHS program shortcomings that are associated with the frequency of work injuries and, if addressed, will likely result in fewer work-related injuries and illnesses down the road,” says Morgan Lay, a research associate at IWH and lead author of the study. “In this respect, the measure can help to identify potential risk reduction strategies before work-related injuries and illnesses occur.”
The study is based on the responses of over 1,500 working adults in Ontario and British Columbia who completed the OHS Vulnerability Measure in the spring of 2015. Respondents were also asked if they had missed work or visited a doctor in the past year because of a work-related physical or mental health injury.
The research team then compared the self-reported rates of work-related injury requiring time off work or medical attention among the respondents based upon their level of vulnerability as assessed by the OHS Vulnerability Measure. After taking gender, age, employment relationship, place of birth, occupational group and province into account, the research found the following:
The most vulnerable workers—those who were exposed to hazards and not protected by adequate policies and procedures, awareness or empowerment—were more likely (up to twice as likely) to report being injured at work than less vulnerable workers who were exposed to hazards and protected by adequate policies and procedures, awareness or empowerment. The most vulnerable workers were also much more likely (3.5 to 4.5 times more likely) to report being injured at work than the least vulnerable workers—those not exposed to hazards and protected by adequate policies and procedures, awareness or empowerment.
Wherever possible, controlling or eliminating hazards is the preferred way of reducing vulnerability, Lay says. However, this study points to an opportunity to reduce work injuries in workplaces where exposure to hazards is embedded in the nature of the work. “In work settings where the hazard is difficult to eliminate, it appears that strategies to improve protective policies and procedures, to strengthen awareness and to better empower works can also reduce injuries and illnesses,” she says.
The OHS Vulnerability Measure is available for download from the IWH website: www.iwh.on.ca/ohs-vulnerability-measure.

WSIB lifts lid on drug secrecy for hurt workers; Board promises to increase transparency following criticism from out-of-pocket injured workers

Sara Mojtehedzadeh
The Toronto Star , Jan. 24, 2017

The list of drugs covered by the province’s compensation board is now publicly available, after years of criticism from labour advocates who claimed the board’s secretive drug policies put injured workers at risk.

The change, implemented Monday, makes the Workplace Safety and Insurance Board’s extensive drug formulary readily accessible to workers and their doctors through an online search engine.

“By publishing the formularies, we hope to provide more information to physicians and pharmacists to assist them in making decisions about an injured worker’s health care,” WSIB spokesperson Christine Arnott said.

The change means that when injured workers are entitled to benefits, it will be easier for doctors to prescribe treatments that are eligible for coverage. As previously reported by the Star, advocates had long claimed that employees hurt on the job sometimes had no idea whether their treatments would be subsidized until they turned up at the pharmacy – meaning some ended up paying out of pocket for medications.

“There’s a huge history behind this,” said Jessica Ponting, a community legal worker with Industrial Accident Victims’ Group of Ontario (IAVGO), a Toronto-based legal clinic. “It took years to even get this (information).”

The clinic has been battling for access to WSIB formularies since November 2013, out of concern for clients it said experienced difficulty accessing treatment. The board initially rejected the request. The province’s privacy commissioner was expected to rule this month on a freedom of information appeal on the subject.

In a letter to IAVGO on Monday, Ashleigh Burnet, a freedom of information specialist with the board, said improving service in the drug benefit program was “a priority.”

“Today, as part of our ongoing efforts to improve transparency, the WSIB has published its drug formularies and made them available in a digital, interactive web-based platform,” the letter said.

Maryth Yachnin, a lawyer with IAVGO, called it a good first step, but said the clinic “remained very concerned with the WSIB’s approach toward health care generally.”

The WSIB’s overall spending on drug benefits has dropped by more than 30 per cent since 2009, statistics requested by the Star show, from $93.63 million seven years ago to $62.34 million in 2015. The board
attributes this decline to the shrinking cost of generic drugs, a decrease in the number of claims and a crackdown on narcotics prescriptions.

Tom Teahen, the board’s chief executive officer, has previously told the Star that his organization is “committed to ensuring injured workers have the right medication, at the right time, for the right purpose.”
“No injured worker should be denied medication necessary to treat a work-related injury or illness,” he said.

Yachnin said many of her clients were having their treatment cut off too soon because of unrealistic recovery guidelines, set by the board’s own staff or independent medical consultants hired by the WSIB who don’t personally examine claimants.

“They say you should be better – if you’re not better, it’s not our problem anymore. And injured workers are cut off health care at that point,” she said.

“Many of our clients are relying on (drug) samples from their doctors or paying out of their very limited welfare. Or doing without,” she added.

ODSP Cases on the Rise as Link Between Poverty and Mental Health Strengthens

By Chris Montanini,
The Londoner, January 11, 2017

The number of disabled Ontarians accessing the Ontario Disability Support Program (ODSP) is on the rise and a large majority of the growing caseload is due to mental illness, according to data compiled by a pair of researchers at Kings University College in London.

For the past 18 months, social work professor Tracy Smith-Carrier and sociology professor Don Kerr have been combing through data from the Ministry of Community and Social Services that was previously unavailable to the public.

In collaboration with The London Poverty Research Centre at Kings and Western University PhD candidate Juyan Wang, Smith-Carrier and Kerr released a report in December highlighting a number of alarming trends buried in social assistance rates from the census metropolitan area of London and across Ontario.

Among the facts they’ve emphasized is a 65 per cent increase in the number of Ontarians on ODSP between 2003 and 2014, reaching a total of roughly 325,000. Only a small portion of that growth is due to population aging and the breakdown of physical health, according to the data. The largest factor about 64 per cent of the total growth of ODSP claims over that time frame is mental health disabilities such as depression and anxiety.

We have a lot of people moving towards retirement right now, so you’d think that would be an important part of it, Kerr said. But if we can estimate how important it is (about 20 per cent) of the increase is due to population aging, so it was surprising.

We were astonished by that, Smith-Carrier added. The number of people experiencing mental health issues is on the rise; that does seem to be consistent with the literature. But also I think poverty creates mental health issues.

There is a strong association between poor health and poverty but Smith-Carrier and Kerr suggest researchers have been hard pressed to find causality because of a chicken and egg problem. Does poor health and disability result in poverty or does poverty result in poor health and disability?

Either way, Smith-Carrier and Kerr point to the punishingly low levels of assistance vulnerable Ontarians are receiving as part of the problem. Ontario Works (OW) currently offers a single applicant $706 per month. ODSP is providing a single disabled Ontarian with $1,128 per month.

Both rates are well below the poverty line and, after adjusting for inflation, the report from Kings suggests Ontarians on social assistance are living on less today than they were in 1992.

Kerr added that the number of people on ODSP province-wide has eclipsed the number on OW. Hes interested in studying the number of OW cases that later wind up on ODSP, but in the meantime, there is plenty of information in the most recent report about the state of the provinces (and Londons) poorest people.

Here are a few more highlights:
•About 40,800 persons are on social assistance in the census metropolitan area (CMA) of London as of 2014, with 21,300 on OW and 19,500 on ODSP. Thats roughly one in 12 people residing in the London CMA (which includes St. Thomas, among others). About one in 15 Ontarians are on social assistance by comparison.
•Around 8.1 per cent of the London CMA lives on social assistance (OW or ODSP) as of 2014. This is significantly higher than the provincial average at 6.7 per cent.
•Over the last decade, the number of persons on OW in London has increased at a rate that is more than double the CMAs rate of population growth (18.2 per cent relative to only 8.6 per cent for population growth over the full 2003-2014 period).
•Over the same period, the number of persons on ODSP has increased at a rate that is more than seven times Londons rate of population growth (up 63.6 and 8.6 per cent respectively).
•The largest group of social assistance beneficiaries in London is preschoolers (ages 0-4). One in eight preschoolers are on social assistance (12.3 per cent). Among women aged 20-24, roughly one in 9 Londoners are on social assistance (10.9 per cent), with a large proportion sole parents with young children.
•London has the second highest percentage of people on OW across nine CMAs in Southwestern Ontario. Windsor has the highest.
•Including both OW and ODSP, the London CMA has the third highest social assistance caseload in Ontario, with only Windsor and St. Catherines-Niagara with more.

Mental health isn’t the only underlying issue likely having an impact on poverty in Ontario. Smith-Carrier and Kerr pointed out that preschoolers represent the largest demographic on social assistance in London, which could mean childcare has become inaccessible, forcing low-income parents to stay at home until their children are old enough to go to school.

The London economy, slower to recover from the 2008 recession than other places in the province, has also had a major impact on OW caseloads.

We’re just starting to get out of the hole, Kerr said. In fact, if you look numbers from the Canadian Labour Force Survey, there are fewer people employed today than during the height before the recession. The thing that alarms us about that is over the same period weve seen population growth at the same time.

Smith-Carrier said number crunching began following an agreement between the Ministry of Community and Social Services and Statistics Canada to make social assistance data more accessible. She said three other research proposals are underway to study related social assistance issues particularly focused on immigrants and young women.

CMontanini@postmedia.com

Alberta Federation of Labour, CLC and Unions Call for Workplace Leave for People Fleeing Domestic Violence

The Alberta Federation of Labour, the Canadian Labour Congress and unions across the country are asking federal and provincial governments to follow Manitoba’s lead in providing workplace leave for people who are facing violence at home.
In March, Manitoba revised their Employment Standards Code to allow people dealing with domestic abuse to take time off from work — including five paid days — to seek medical attention, find a safe place to live, attend court hearings or get other services that can be hard to access outside working hours. The AFL is joining a national call from the CLC and other labour organizations for the rest of Canada to follow Manitoba’s example.
“Work should not be a barrier to someone getting themselves out of a dangerous situation at home,” Alberta Federation of Labour secretary treasurer Siobhan Vipond said. “Legislation that provides workers the ability to help themselves is the right thing to do – it’s also the smart thing to do. This is potentially a life-saving measure.”

Canadian Natural Resources Fined $10,000 Following Incident that Killed 2

Company also required to help develop new practice standard
By Ian Bickis (The Canadian Press) 01/05/2017|www.cos-mag.com

Canadian Natural Resources has been fined $10,000 by Alberta’s professional engineering society — the maximum allowed — following an investigation into an accident at an oilsands site that killed two and injured five.
The Association of Professional Engineers and Geoscientists of Alberta said Wednesday that it found the company engaged in unprofessional conduct by failing to make sure building plans were certified by an engineer and by contracting with a company without making sure it was competent to do the work.

The investigation looked into events on April 24, 2007, where workers were building a 20-metre high oil tank at the Horizon oilsands project north of Fort McMurray, Alta., when cables holding up a roof support structure snapped due to high winds.
The falling steel structure broke apart, with debris striking an electrical consultant, killing him. A scaffolder was crushed and died on the way to the hospital.
Two other workers were seriously injured and three others suffered minor injuries.
The engineering association found that the steel cables supporting the roofing structure were inadequate and did not meet regulations, and that the person who designed the construction procedures was not a professional engineer in Alberta.
“It was an extremely significant and unfortunate event,” said APEGA registrar Carol Moen. “This particular event is likely to be probably the most significant one from an impact and outcome perspective that APEGA has engaged in, in our history.”
Moen said the association levied the maximum amount allowable against the company. But, she added, work is underway to increase the maximum allowable fine for companies to $500,000 per violation as part of the first review of the provincial legislation that governs the engineering profession in about 30 years.
In addition to the fine, the association said Canadian Natural Resources will have to pay, up to a maximum of $150,000, to help develop a new practice standard on sourcing engineering and geoscience work outside of the province.
Moen said the work will help improve engineering practices across Alberta.
“Our goal is to not only make sure that CNRL understands the relative significance of what has happened, but also to raise the bar for the profession,” said Moen.
Canadian Natural Resources said in a statement that it’s looking forward to developing the new standards and that a senior member of its leadership team will actively participate and work together with the association on the initiative.
The company also said that it had changed its safety practices following the tragedy and now requires contracting companies to provide evidence of qualifications before engineering work is done.
“We take every incident seriously,” said company spokeswoman Julie Woo in an email. “Following this incident, CNRL took steps to advance our processes to ensure health and safety standards are consistently met by all contractors.”
Last February, Alberta Occupational Health and Safety released the results of its investigation into the accident and concluded that the company did not do enough to ensure that one of its contractors had construction plans certified by a professional engineer.
The Canadian subsidiary of Sinopec Shanghai Engineering, the Chinese engineering firm that Canadian Natural Resources contracted out to, pled guilty in 2012 to three workplace safety charges and was ordered to pay $1.5 million in penalties.
Canadian Natural Resources faced 29 workplace safety charges but they were stayed in 2012.

Share Your Story With the Alberta WCB Review Panel

Workers’ Compensation was set up to help people when they’re injured.

The system is failing. People are suffering.

Share your story. Be Heard.

Note: The WCB Review has extended the deadline until January 9. Make sure to write in before then!

Send a message to the WCB Review.

Visit the following link http://www.behumanwcb.ca and complete the form online.

Dear WCB review panel,

I am writing because I want to see a Workers’ Compensation system that looks after people, and to share my experiences with the current system.

*YOUR STORY HERE*

Currently, Alberta’s Workers’ Compensation system is not working the way it is supposed to. It is my sincere hope that the work of this panel will lead to a fairer, more human WCB system.

Albertans deserve a Workers’ Compensation Board that treats injured workers with humanity.

Alberta WCB Review Midway Report

By Karen Bartko
Online Journalist Global News

An update on the ongoing review into the Alberta Workers’ Compensation Board found people appreciate that it exists, but there is big room for improvement in a system described by some as disrespectful” and “dehumanizing.”

The Workers’ Compensation Board is an employer-funded provincial agency that provides compensation to Albertans who have been hurt or disabled on the job. Since March, the three-member panel has been looking into the board’s governance, effectiveness, principles of compensation and policies.

The panel sought feedback from organizations, such as unions and businesses, and individuals. Over 2,000 responses were received via online questionnaires and written submissions. Due to injuries or illnesses, some injured workers were not able to give written feedback, so four in-person group meetings were held in Edmonton, Calgary and Lethbridge.

“They helped us see firsthand how the system directly impacts the lives of Albertans and their families, and they offered insights about the system’s strengths and opportunities for improvement,” the report read.

More Bad than Good
The midway report said the review process evoked strong emotions and opinions from Albertans regarding the WCB. While some people said they had a good experience, many others described their dealings with the board as “disrespectful,” “angering,” “frustrating” and even “dehumanizing.”

“A widespread view is that the WCB operates its claims process in a way that presumes injured workers are lying about their injuries or illnesses, and looks for any possible reason to deny an injured worker’s claim, lower their compensation, refuse their requests and ‘cut them off,’” the report reads.

“Some feel the WCB deliberately makes its process complex so that injured workers will abandon their claims out of frustration.” The more complex, the worse the experience.

The report also found that the claims process works well when injuries are minor and the circumstances straightforward. But when the situation is more complex the process bogs down, causing anxiety for people already dealing with illness or injury.

“Delays result in lost income to the worker and a prolonging of their pain and suffering,” the report read.

Other Highlights From the Report
There is an appreciation that the WCB can provide timely treatment for injured workers, but there are concerns it does not allow people to choose their own health providers or professionals.
Respondents said when a worker’s personal health professional disagrees with the opinion of the WCB-retained health professional, things become contentious. There are concerns that doctors who are being paid by the WCB are quicker to claim a worker is ready to return to work.

While the emphasis on healing workers so they can return to work is good, the timelines can be too aggressive, opening up the risk of re-injury. Workers need to be willing to consider returning to “modified work” when it is available, instead of waiting to return to their original job.

Some respondents expressed concerns that, over time, the system has evolved to focus too much on the bottom line.
The WCB should be more involved in injury and illness prevention programs.

What’s Next For the Review
The report did find while there are flaws with the existing system, Albertans see the WCB as a preferable alternative to litigation between employers and workers.
The panel expects to meet with more employers, unions and industry associations this month and next to delve deeper into the complex issues the WCB system faces.
It will then hold a symposium in January to review the data. A final report and recommendations are expected in spring 2017.

The chair of the panel is Mia Norrie, who is a human resources and labour relations consultant. John Carpenter, a partner with Chivers Carpenter law firm, and Pemme Cunliffe, in-house counsel with Covenant Health, round out the board.
It’s been 15 years since the last formal review was conducted on the WCB.