Monday, March 20, 2006
Workers’ Compensation World-view
Let’s pretend that from our safe and lofty position on this Summit, all the visionaries in attendance discovered a safe place buried deep within the cutthroat workers’ comp jungle where each affected group involved in this safari would find their individual Shangri-La. Beyond the dense smoke and foggy mirrors of second-opinions, peer/utilization review, retrospective hospital bill audits and never-ending record reviews; treacherous three-card Monty attempts to find-the-lower-premium; quicksand bog of paralysis by analysis and countless strategies littering the rainforest landscape with unfunded legislative mandates and other ‘comprehensive solutions’ designed to eradicate the serpentine-like rising costs contributing to choking off and polluting the business environment to the point of extinction. Not too mention the anaconda of run-on sentences …
After much discussion, it was agreed that the time for action was NOW. The land was too contaminated to rehabilitate, let alone restore and recover. The visionary leaders agreed to assemble a revolutionary new concept called the Telescope-of-Hope (ToH) and dialed in on a fixed point on the horizon where they believed Workers’ Compensation Shangri-La was located. In order to gain consensus to rally the troops, they invite each representative from the various stakeholders to come and see for themselves.
At that moment, the Telescope of Hope had been inadvertently and unfortunately transformed into the Kaleidoscope of Chaos (KoC). Each stakeholder who stepped up to the ToH adjusted the viewfinder by just one click and then moved on ~ satisfied the utopian scene identified by the visionary leaders was made even more beautiful because of their ‘insightful’ input.
The visionary leaders’ Telescope of Hope never moved from the originally agreed upon fixed point on the distant horizon, yet their Vista of Victory had been lost forever. Why? Because each constituent representative who looked through the ToH adjusted the view to fit their own ideal image for the Garden of Eden and, from that point forward, no two stakeholders could ever agree what Nirvana looked like.
This was not the first time a calamity like this occurred. The Tower of Babylon was never completed after each constituent’s “voice was heard”. When Moses led the mass exodus out of slavery from Egypt, he had the distinct advantage of Divine Intervention when He parted the Red Sea to evade Pharaoh’s army. One would think that act, on its own merits, would generate a lifetime of loyalty, however, non-committed people forget. It’s always, “What have you done for me lately?” So, it’s easy to understand why Moses wandered aimlessly in the desert for forty years until the original Chosen Constituents died off before he delivered their beneficiaries to the Promised Land. Perhaps the ultimate example of passive-aggressive servant leadership … but I seriously digress.
It’s not the big things that keep us from getting to the Promised Land. It’s the little things constantly challenging our worldview. As we go through life relying on our individual moral compass guided by our personal values, beliefs and ideals; our professional constituency’s stakeholder paradigm is driven and defined by its own mission, vision and values of those we serve, lead or follow.
Employers must acknowledge their role in this crisis. Regardless of their current posturing – they are not victims. Employers are the ONLY ones who can actually change their status quo. The greatest problem facing occupational health professionals may be one of our own making. We may have inadvertently ‘helped’ our employer-clients become corporately co-dependent. By consistently framing the workers’ comp problem in a manner that triangulates the power shift labeling the employer and injured employee as the persecuted, we (providers) help perpetuate the myth that employers are powerless from managing their destiny. And to make matters worse, we are now struggling with the concept of leading an intervention with an unwilling participant who refuses to acknowledge their behavior as a mitigating factor in their ongoing financial misery.
Employers have a duty to pay for any injuries and/or illnesses their employees may experience while performing their jobs. They also have a duty to provide a safe workplace and minimize the risks their employees may be exposed to while performing their jobs. So, it stands to reason that the most cost effective risk management strategy available to employers is a comprehensive absence management program beginning with recruitment, orientation, safety/prevention training, ongoing skills improvement, post-injury transitional duty assignments and an array of other programs designed to help employees become accountable for their actions, behaviors and decision-making.
The chief executive and senior management team must be role models demonstrating their commitment to transforming the workplace culture from what it is to what they want it to become. There is no room for lip service or empty promises in this quest for excellence. And there cannot be any of the usual abdication of corporate responsibilities and accountabilities to any third party. As they pay for the band, they call the tune. The time has come for Corporate America to step up and replace their wishbone with a backbone.
Wednesday, July 27, 2005
When he was over there the last time he got pulled onto 'special detail'. Since he was 'fortunate' enough to be on a team that made 'smart bombs' with GPS (global positioning systems) out of our old, just drop em from the sky bombs, they were loading the B-52s in England to bring us "Shock and Awe". Well, our beloved Uncle Sam then had him join a demolitions team (providing security) and recover UXO's (unexploded ordinance) from all over the place 'over there'.
The kicker is - flyboy wasn't supposed to be involved in that sort of thing when he went over to The Gulf. So, what happens when he comes home?Yup, you guessed it. The 1,000 yard stare; can't sleep at night because he can't get the pictures out of his head; two of his buddies killed on ambush that he was supposed to have been on so he's got survivor's guilt; and a host of other BS symptoms that no 22 year old should have to deal with.
So, like the true eagle he is - he rises above the storm by turning into it. He signed up for the toughest training program the armed forces has to offer. Now he's a month away from completing demolitions school then he goes off to HALO (high altitude-low opening) jump school because that's how the Army Special Ops boys get to where they have to go. And what's their precious cargo?
Yup, once again you guessed it - it's flyboy. Only this time, flyboy is their version of MacGuyver with blow em up stuff. They have to go find and disarm the Improvised Explosive Devices before they can be left on the sides of roads, driven into crowded markets or carried onto buses and/or walked into police stations.
I'm proud of my son and pissed at our Uncle Sam.
Monday, July 25, 2005
Tribute to My Father
A Tribute To My Father
Robert S. LeClair
(3/1/1930 – 5/16/2002)
Our father, who art in heaven
Were the last words Dad heard spoken.
When he joined our mother on Thursday
The Circle of Life no longer was broken.
Thank you all for coming
As we pay tribute, remember and share
Dad earned a place in each of our hearts,
For this man’s name is Robert S. LeClair.
He was born on March 1st in 1930
Which made him a young 72.
Most of the stories you’ll be hearing
Have elements that might just be true.
Dad got his start in Long Island, NY
As the youngest he wasn’t much fuss.
He had two older siblings to help him
His sister, Mae and a big brother, Russ.
The details of his childhood remain sketchy
As he described the neighborhood he roamed.
One thing was certain and all would agree
His love of music was learned in his home.
His father, George was a professional musician
A soft-spoken man with plenty to say.
But he would let his fingers do the talking
Having the music express the words he would play.
Grandpa was a gentleman’s gentleman.
Who went to work each day in a tux.
Dad also carried those traits inside him
But he worked with vacuums and big fire trucks.
Horoscopically, dad was a Pisces
So, it’s no wonder he was drawn to the sea.
Crabbing and Clamming in Sag Harbor
The best part is knowing it’s free.
During high school he loved to go bowling,
And even got a job setting pins by hand.
But, he yearned to get back to the water
leaving this manual labor on land.
After high school he got a job on a tugboat,
Learning all sorts of nautical knots.
Which helped him decide on his future
To focus on dashes and dots.
Dad signed up and went into the Coast Guard
His enthusiasm to learn new skills never slowed.
He trained as a Radio Operator
To send messages in Morse Code.
Dad met Mom at a Northbrook house party
and they married and moved back east.
Dad was back working on a tugboat
Which Mom didn’t care for … in the least.
Within two years they were back in Glencoe
And the first of seven children started to arrive.
In 1953, Dad joined the Fire Department
And wondered how they going to survive.
Twenty-four on and Forty-Eight off
Is the schedule firefighter’s keep.
It’s not too bad if you have another gig
Otherwise, you’ll find yourself in too deep.
So, Dad became a Renaissance Man,
trying different jobs to make extra bucks.
Lumberjack, cabbie, and lubricant sales rep
were tried before there was Electrolux.
Starting in 1961
and for the next 37 years,
Dad was “The Electrolux Man”
and he had to overcome his shyness fears.
I know this fact may come as a shock
to anyone who knows Bob LeClair.
But, before he studied Dale Carnegie’s stuff
he wouldn’t public speak on a dare.
Dad studied and practiced to overcome
the fear he felt inside.
Once he discovered the secret to life,
his inner shadow man up and died.
Dad realized early on
that mediocrity just wouldn’t do.
Why live only half a life,
when the decision is up to you?
Love your neighbor as yourself
might better describe Dad’s life.
He was a true humanitarian
trying to lift people out of their strife.
We have so many instances to call on
where Dad acted on this belief.
He sought to ease the suffering
when pain was borne with grief.
Barbershop singing was Dad’s vehicle
for spreading joy and goodwill.
There are so many stories of Dad’s kindness
that it just gives the heart a good thrill.
Operation North Pole is but one of these
that BBSing has played a major part.
By giving Christmas to families in need
and doing it from the heart.
Acting in groups to cover his tracks
Dad often would sneak away.
Then spring an unsuspecting miracle
and lift the spirits for someone’s day.
Dad was unique in a special way
he wore more than his heart on his sleeve.
When he monkeyed around with his Bud named Tyrone
Dad knew this Bud would never leave.
Tyrone could break down barriers
without ever saying a word.
It was just another way to communicate
by being seen and seldom heard.
Bob LeClair was more than unique
because he had this unending gift.
The cup of his love would fill and run over
when offered to someone needing a lift.
Dad has always been the adventurous type
just to see what’s on the other side.
The last adventure was a bit too much
and became his final ride.
Dad didn’t waste a moment,
thoughhe was courageous to the end.
He taught us more about living
and how to be a better friend.
Dad’s doc is a guy named Dragon
who lives to fight the Big C.
His staff did their best with Chemo-Fest
All the while maintaining Dad’s dignity.
There’s too many in Dad’s support chain
to try and mention and get them all.
Please know Dad’s life was greatly enriched
by your thoughts and prayers and occasional call.
Dad believed in Random Acts of Kindness
practiced on a daily basis.
If you’d like to honor Bob LeClair
become someone’s unexpected oasis.
Dad also believed that life goes on …
a Celebration in constant transition.
Life is too short. Don’t wait till tomorrow.
Live your dreams without inhibition.
The truth embodied in the saying,
“A house divided cannot stand”
Thanks for the support provided by our spouses
with their much needed, helping hand.
Just when you thought it was over,
the next time you twist and shout …
What if the Hokey Pokie
Really IS what it’s all about?
Dad’s final request is simple
and it takes place right next door.
It’s called an After-Glow Reception
with great singing, food and much more …
May 22, 2002
Tommy's Tribulations Part 2
Before I update you on Tommy's situation, I must clarify two major overstatements on my part. The first deals with the family's move to Florida. It was nothing like the picture I inadvertently painted: The family coming home from the hospital and hurriedly tossing clothes into bags on the way to the airport like they were refugees or in some kind of late night relocation exercise for the witness protection program. In fact, it was very orderly move over a period of several weeks. Secondly, if Tommy didn't have this experimental procedure, it wouldn't be the end of the world for him. I wrote with an extreme sense of urgency that, Tommy would die unless he was fast-tracked for this procedure. The reality is found somewhere on the slippery slope of his quality of life. The procedure would greatly improve his chances for experiencing an improved childhood experience.
I didn't mean to create an aura of hysteria or extreme absolutes in my initial post. I was writing with a sense of mission and license to convey the urgency and seriousness of Tommy's condition necessitating the call for prayers of support, strength and spiritual renewal for Tommy, his parents and family.
The consultation with the two specialists went great. A major factor weighing in on the consideration for a procedure of this magnitude is the patient's emotional state - their will to survive. Without a healthy spirit, the physical toll is too much of a burden. For a five year old, Tommy's got a will of supernatural elasticity and resilience.
The doctors gave Tommy a green light for doing the experimental bone marrow transplant procedure. Thank you, Lord! When Tommy left Florida, his quality of life index was about 10%. By receiving the bone marrow transplant procedure, his quality of life index can improve to 60%.
The next step is gaining full approval from the Florida Department of Medicaid to pay for the procedure - or at least 80-85% of it. Once Medicaid approves their portion, then the family can start the process to collect the remaining $80,000.00.
Tommy's still a long way from being out of the woods. At least he's received the ok from the doctors who will do the procedure. In fact, they sent their letters to Tommy's specialist in Florida for his application to Medicaid within two weeks of his consultation. If that's not a sign of good faith on their part, then I don't know what is.
In case you're wondering what the Florida Department of Medicaid will be considering when they review Tommy's case - it all comes down to dollars and sense. Without the procedure, the Florida Department of Medicaid will continue to spend about $1, 200,000.00 per year on treatments that won't improve his condition, just maintain his current course of treatment. In fact, as his health deteriorates, his medical costs will escalate.
With the procedure, Tommy's health status and the quality of his life (not too mention his family's) will improve from 10% to 60%. The costs associated with daily medications and weekly treatments will fall off dramatically as well.
Of course, I'm only providing a snapshot of this entire panoramic landscape of medical marvels and managed cash roulette.
The point is, this is a good deal for Florida taxpayers, legislators and the Florida Department of Medicaid bureaucrats - that is, those who say "The system is already overburdened and we can't afford to provide experimental bone marrow transplant procedures for anyone - let alone children.
The first year alone should provide a Return-On-Investment of 3:1.
Even Ebenezer Scrooge wouldn't pass on deal like that.
Monday, June 27, 2005
Imagine one day your eighteen-month old toddler wakes up from his nap with one of his ankle's swollen to the size of a twelve-inch softball, it's all red and warm to the touch. You know he didn't fall down or slam it between a door or something like that. He just woke up and there it was - something is definitely wrong with this picture. So you take him to the doctor to see what might have caused this spontaneous fireball in his ankle. The doctor refers you to the local children's hospital for more extensive diagnostic tests to figure out what's causing this 'infection'. A few more tests and the answer comes: severe onset juvenile rheumatoid arthritis. What the ???? Arthritis is for grandma and grandpa - not for children - especially a toddler whose learning how to get around.
For God's sake - he hasn't even begun to get into all the things you KNOW he's going to ... and even more things you have no idea how he could possibly get into.
Tommy has become somewhat notorious in pediatric medical circles up and down the East Coast. When he was a respectable northeastern Children's Hospital, his diseased little body became a bad news incubator - with each course of treatment would come side effects and undesirable clinical outcomes. That's a sterile way of saying "We don't know what is going on inside his body. Everything we try creates another set of problems that we've not seen before. And, by the way, all these medicines we're pumping into his little body - they've never actually been tested for children - let alone sick ones as young as Tommy." This is guesswork. Very expensive guesswork. And you can imagine how insurance companies love paying for guesswork-related medical treatment plans.
Over the course of the next eighteen months, Tommy got sicker and sicker. In fact, he became the sickest child with juvenile rheumatoid arthritis (JRA) the jra experts had ever seen. They tried everything known to medical science that was approved and those experimental treatments being developed. Everything.
At one point, Tommy was so sick, the doctors told his parents there was nothing left but to take him home and "start making final arrangements". He might have another twenty-four hours, but who really knows? God, who can bare to hear those words? Tommy's mom and dad asked if getting him to a warmer climate would make a difference. After all, Arizona and Florida aren't filled with old people trucking around on those mobile scooters because they have liberal road rules for slow moving vehicles. Or, maybe they do, but that's not entirely the point here. The doctors said maybe. Well, that's different and a whole lot better than "start making final arrangements". What would you do at that point? WWYD?
That night, with only a bagful of clothes, they took the next plane to Florida. Fortunately, Tommy's grandparents lived near Daytona Beach and Tommy's dad grew up vacationing down there when he was a boy. There was hope, faith and a lot of praying going on. Please God, don't take Tommy back without giving him a chance to experience just a little bit of life without the daily hell of pain beyond description. And, you know what? It was without description from Tommy's lips. Tommy didn't complain about how much it hurt him to have both his ankles, knees, hips, wrists, elbows and shoulders swelled with inflammatory poisons eating away at his innocence, let alone his childhood. Tommy didn't complain about the pain when the chemo was coursing throughout his arteries and veins when 'treatment' was taking him to the brink of death in the hopes of wiping out the insidious, cellular evil-doers bent on taking over this little boy's body. He didn't complain. He would cry when he saw how this was impacting his heroes, Mom and Dad. They were there for him. Every day in every way. He reacted to their pain, but he wouldn't cause any on his own account. He was a blessing from God who was going to teach the world how to live with courage, strength, dignity and love. Tommy is on a mission.
Welcome to the Sunshine State! Tommy responded to his new digs. He cleared the critical juncture that had the experts giving up. He wasn't healed, not by a long shot. But he wasn't on deathwatch either. It took awhile, but Tommy's parents found him a new doctor, another specialist in pediatric rheumatology who put Tommy first. Not that his previous doctors didn't have Tommy's best interests in mind; they did all they could and everyone can be proud. But this was out of their hands. After all, it's a God thing. Always was. Always will be.
Fast forward to January, 2005. Tommy has run the table a second time on all known clinical treatments for severe onset juvenile rheumatoid arthritis. His doctor is one of the leading pediatric JRA specialists out there. And she's there for him. But, she's at the end of her stethoscope, too. Tommy needs more. He'll always need more than mere mortals can provide. He will die soon unless he gets a medical miracle or divine intervention.
She calls her colleagues at one of the leading academic medical centers conducting research in bone marrow transplantation. They consult on Tommy's case and all agree he needs more than is available. In fact, he needs what's been theorized but never really tested. He needs a medical miracle. Remember the love shown by private insurance companies for procedures not guaranteed? Yeah, they're really pulling for Tommy, too! NOT. It's estimated to cost about $400,000.00 to harvest Tommy's bone marrow, scrub it, infuse it with T-cells, incubate it and then re-introduce it back into Tommy's system.
This medical center agreed to take Tommy's case. In addition to Tommy and his parents having to figure out how to raise the money, they also have to get him from Florida to Washington State. As sick as Tommy is, he needs special clearance from the FAA, TSA and the airlines in order to board the aircraft. Why? Because he must carry all his meds with him (20 plus) in a cooler, a wheelchair for the long walks in the airports, additional assistive technology and other stuff I don't need to go into right now. The point is, no matter what, this is not going to be easy ... it hasn't been for one minute since this odyssey started three and a half years ago.
Tommy's mom gets all the paperwork from the medical center clearing Tommy to arrive and be consulted by two different specialists. They also indicate clear as day that Tommy's care will be 'self pay'. The doctors have agreed to write off their professional fees for Tommy - all of them - and the multidisciplinary team is huge. This is Tommy's last chance to see his sixth birthday. There's a lot riding on this. Tommy has a lot of people praying for him - he needs more. Tommy is scheduled to get his consultation for the bone marrow treatment on Tuesday, June 28th.
On Wednesday, June 22, Tommy's mom gets a call from the medical center. They are told not to come because Florida Medicaid won't pay for the treatment. Even though the medical center told Tommy's doctor just the day before that everything was still a "GO", all of a sudden, it's off. It seems as though the Prince of Darkness has commandeered the controls of life's roller coaster that Tommy and his family have been on. You know there's trouble in River City ...
Tommy's mom called his doctor in Florida and relayed the news. His doctor called the medical center and arranged a conference call for Thursday to find out why they renegged at the last minute. TOMMY'S GOING TO DIE. This isn't about the money. It can't be. After all, the procedure they are going to do on Tommy has NEVER been tried before on a child. There are no known billing codes the medical center could use to even attempt to get reimbursed for providing the care. It has to be something else. But what?
The conference call must have stirred the pot something fierce. The call came late Friday afternoon that Tommy's consult is back on. He will be seen after all. They won't do the procedure until they personally meet Tommy and do an extensive consultation workup on him. After all, they have his entire medical record and every known diagnostic test and treatment plan tried so far. That's how they made the initial decision to bring him up to the medical center to try this experimental procedure.
Tommy and his parents left this morning for the medical center. They meet the doctors tomorrow. Will you light a candle and say a prayer for Tommy and his family? For the doctors, technicians and everyone involved in considering his plight? For the Tommy's yet to come, because you know they are out there ...
Wednesday, June 15, 2005
Jamming With Jesus
I've been lurking around a bit since being stumbling onto the Waiter's site (Waiter Rant) about two months ago. Since then, I've been slowly gaining my courage to let loose with my own thoughts, musings, observations and other ADD-fueled ramblings. Especially after having read the postings of two waiter picks: Clublife and The Family Guy. I'm thinking, "I can do this." Besides, the only who'll be reading these posts will be me for a while since nobody knows I'm out here ...
So, here goes ... I've fired up the engines and am rolling down the runway with no real clue how to get airborne and once I clear the powerlines, how to stay up there on my newfound Flights of Fancy. But, hey, who would of thought Michael Jackson would have been cleared from his flights of fancy? After all, I'm no Peter Pan ...
So, that buzzing you're hearing above is me. If it sounds like it's getting louder, it's because I'm trying to figure out these gauges, buttons, sticks, pedals, lights, blips, and voices in my head telling me to get out of restricted air space ...
Ready or not ... TheRainmanCometh