Column: Workers' Comp

Drug and Death Connection

By: | May 1, 2014

Roberto Ceniceros is a retired senior editor of Risk & Insurance® and the former chair of the National Workers' Compensation and Disability Conference® & Expo. Read more of his columns and features.

California’s Supreme Court is set to hear a case highlighting the dangers of prescribing multiple drugs to an injured worker, as similar claim narratives are repeated across the nation.

In South Coast Framing vs. Workers’ Compensation Appeals Board, the court will determine whether a commercial insurer should be financially responsible for the death of a worker who died from an accidental overdose a year after being injured on the job.

After Brandon Clark fell from a roof in 2008, and suffered head, neck, back and chest injuries, his workers’ comp doctor prescribed gabapentin, amitriptyline and hydrocodone, while his personal physician prescribed Xanax for anxiety and Ambien for sleeping difficulties.

A year later, he died from consuming a deadly combination of these legally prescribed drugs, several of which are commonly given to injured workers nationwide. Clark’s wife and three minor children are seeking death benefits, alleging his death followed from his fall and the “industrially prescribed medications.”

Now, California’s Supreme Court will decide whether a workers’ comp death benefit claim has a “causation standard and burden of proof requiring that an industrial injury constitutes a ‘material factor’ contributing to the employee’s death,” according to the court’s case summary.

South Coast Framing and its insurer, Redwood Fire and Casualty Co., a unit of Berkshire Hathaway Inc., argued during appeals court proceedings that Clark’s wife and children did not prove a causal connection existed between his death and the medication he took as a result of his work injury.

Thus far, the court proceedings reveal the medical and legal complexities of a case involving a worker’s comp claimant’s overdose death when multiple pharmaceuticals are involved and toxicology science has limited ability to parcel the role of each drug in a death.

Judges hearing the case have considered whether Clark’s consumption of each drug was related to his workplace injury and the probability that each of the drugs contributed to his death.

They also heard that he suffered from difficulty sleeping even before the accident, and had taken over-the-counter medication for the problem, according to his wife’s testimony.  A doctor testified, however, that Clark’s sleeping difficulties after his accident could have been caused by back pain or “stress at home.”

But when pharmaceuticals can potentially do as much harm as good and the supply of drug treatments isn’t slowing, workers’ comp payers have an important role to play, including continuing to drive down the long-term reduction in worker injuries.

Along with medical providers, lawmakers, claimants and others, payers can help mitigate potential pharmaceutical dangers by:

• Encouraging treating physicians to consult treatment guidelines.

• Offering cognitive therapies as alternatives to pain medications.

• Paying for pharmaceutical benefit managers to track prescriptions.

• Supporting legislation to address the prescribing and dispensing of drugs.

These measures add to payer expense and they won’t cure all the risks that accompany drug prescribing. But they can mitigate the potential of being held accountable for lost worker lives, drug addiction, and other dangers.

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