Category Archives: Workers’ Compensation

What It’s Like To Be a Provider at U.S. HealthWorks

We recently asked our providers to share stories about their experiences in providing care at U.S. HealthWorks. We thought this piece from Dr. Donna Diziki, Center Medical Director of our Edison, NJ, clinic, was a great example of what’s it like to practice medicine and be part of the U.S. HealthWorks team.


The word conjures up images of sweaty men on chain gangs hammering railroad ties.

Life’s work.

Now that image is quite different in your mind’s eye – sunshine on a flowering meadow, commitment, fulfillment.

But how do you merge these two visions?

As physicians, we must decide our paths early on in our training. Sometimes this path has no exit or detours, such as choosing to be a surgeon, and we follow the colleagues before us. With these career choices, there is little control over the work; rather, the work steers the provider.

Others have the luxury of career options and ways to broaden the spectrum of their training. In my opinion, these are lucky ones. These doctors can venture down alternate routes on their career paths and find amazing destinations where fulfillment and growth are possible and encouraged.

Not all of us are meant to be solo providers, so the tricky part is finding a place where one can practice medicine in a meaningful way and be allowed to grow in a position. How do you find such a place?

U.S. HealthWorks has given me that elusive blend of a fulfilling medical practice coupled with an opportunity to fill my need to develop new skills in the areas of management, business practices and marketing. I joined the company hoping to be able to have a little control of the daily running of a medical office without the financial burden of opening my own clinic. What I have found is a company that encourages me to push my boundaries to make our collective futures successful.

The Managing Physician program at U.S. HealthWorks allows the participating physicians to play a vital part in the management team. It is a reflection of the company’s commitment to support physicians, and it enables them to be professionally successful. The program empowers me to learn new skills, innovate new policies and motivate staff. U.S. HealthWorks offers me the tools I need to lead and flourish in both the business and medical arenas. When the local centers are successful, the company is successful.

I have the utmost respect for the employees of U.S. HealthWorks. How many companies would entrust a physician with operating a medical office where the only rules are “Do your best” and “We will give you what you need to succeed”? They have the faith that the physician will perform to his or her potential, and the company will assist in areas that need cultivating. We have open access to upper management at all times – this awe-inspiring fact makes U.S. HealthWorks a truly unique place to work.

There’s that word again. Work. Some days it feels like the chain gangs are toiling on the railroad. But most of the time, working at U.S. HealthWorks is more in line with what I see as my life’s work: working for a company committed to our mutual success, fulfilling my needs as well as the needs of those we serve.

Santa Clarita Valley Signal Features U.S. HealthWorks

This week The Santa Clarita Valley Signal featured in great detail some of the services we provide our clients and patients.

Local medical provider helps injured employees
Health: HealthWorks treats workers that have job-related injuries

By Jana Adkins
Signal Business Editor
February 9, 2011

U.S. HealthWorks Medical Group provides medical care and claim management to companies whose employees have experienced work-related injuries.

The Valencia-based company, founded in 1995, has more than 130 medical centers in 13 states, 15 additional work-site centers and 2,000 employees, including nearly 350 affiliated physicians.

One of the largest private providers of occupational health care in the country, the medical organization manages lost work time and specializes in early return-to-work, injury prevention and wellness programs for employers.

Additionally, U.S. HealthWorks provides urgent-care service at many of its locations, including the Valencia office.

Read the rest of the article here.

Working the Night Shift and Getting Enough Sleep

The struggle to get adequate daytime sleep when working nights is familiar to many of us. In fact, 15 million workers – or 20% – of the American workforce work other than the typical 9 to 5 shift. Some are swing shift, some graveyard and some even rotate shifts between days and nights. Many people simply do not acclimate to this unnatural pattern of waking and sleep. The resulting sleep deprivation leads to increased short-term illness and long-term medical problems. A much higher incidence of accidents and mistakes are associated with sleep deprivation. The loss of productivity alone is estimated to be in the billions of dollars.

Night shift workers simply get less sleep. In many industries, rotating work schedules often do not allow for adequate time off. Most notable are the transportation industries such as railroads, commercial trucking and airlines. The National Highway Traffic Administration estimates more than 100,000 police-reported crashes occur annually due to driver fatigue, resulting in 1,550 deaths and 71,000 injuries in 2008. The monetary losses exceeded $12 billion. Motor vehicle accidents are more likely after 11 p.m. and greatest between 1 a.m. and 7 a.m.

In non-transportation industries, 25% of night shift workers reported that their work schedules do not permit sufficient sleep time, and 33% reported getting less sleep than needed to do their best work.

Asleepphoto © 2008 David Joyce | more info (via: Wylio)

All shift workers do not suffer from sleep disorders; however, the longer a given individual is on the night shift, the more likely he or she will suffer some medical consequence or have issues with productivity. The effects of sleep deprivation on alertness, judgment and productivity have been quantitatively compared to the effects of alcohol. Just the loss of several hours of sleep can result in impairment comparable to several drinks. This worsens with increasing sleep loss. The message is that sleep deprivation from night shift work is fairly common and associated with physical and emotional distress. The net result is increased accidents, injuries and loss of productivity.

Since night shift work is necessary, how can we manage the side effects and prevent some of the problems that arise? Educating management and workers regarding the risks and being proactive can have a positive impact. Workers will benefit from healthy habits, diet and exercise. If they are having difficulty sleeping, they should consult a health care provider to asses any underlying medical conditions or medications that can influence sleep patterns.

Good sleep hygiene can be very beneficial in acclimating to night shift work. Some tips include:

• Have a quiet sleep area with black-out curtains.
• Avoid caffeine, nicotine or alcohol before sleep.
• Try using sunglasses during the morning drive home to minimize light exposure.
• Refrain from a large meal, excess fluids or vigorous exercise prior to sleep.
• Avoid radio and TV when attempting to get to sleep.
• Although melatonin has been touted by some as a sleep aid, it is not FDA-approved and has inconsistent results as a sleep aid. It does not provide any improved alertness during the subsequent work shift.
• Sometimes, short-term use of a prescription hypnotic drug can be beneficial for those struggling with disordered sleep.
• Controlled and timed exposure to light during the work shift has also been beneficial in some to reset circadian rhythms and restore a better sleep/wake pattern.
• Power naps before the work shift increase alertness, increase reaction times, productivity and do not usually interfere with the daytime sleep for the night shift worker.

Although somewhat unnatural, the night shift has become a necessary part of our working lives. Getting adequate sleep is integral in keeping alert, staying productive and reducing the risk of injuries while on the clock.

– Dr. Bruce Kaler

Letter from a U.S. HealthWorks Patient

The following is an unsolicited letter written by a patient to one of our Southern California clinics.

I just wanted to write a note to thank you for providing some of the best doctors I have known. I came to you as a workers’ compensation case, and to be honest I was a little worried about the care I would get because of that.

The first few months was trying to just stabilize my back injury without much progression, and after a few months I landed in Dr. Wood’s care – wow, what a difference!

Sadly I have had to challenge his limits as everything we were trying from chiropractic, physical therapy and epidural treatments weren’t quite delivering the relief I needed. You should first know I am extremely fearful of needles. I am still quite amazed I allowed the epidural treatment to happen, but I knew I was in good hands. In fact, I can remember telling Dr. Wood on a re-check after the epidural, “You said I would be OK, and not only was I OK, but I’m pain free (which I was for 6 months). I’m pretty sure that’s the only time a man has told me the truth.” That was said sarcastically, of course.

As I mentioned, the epidural treatment didn’t last as long as we hoped, and I hate taking medications. I don’t want to do anything invasive as long as I don’t have to. Dr. Wood suggested I try acupuncture. Voodoo acupuncture?! I was pretty skeptical of acupuncture. I’d never had it, and I didn’t even know how it worked. I reminded Dr. Wood of my fear of needles, to which he said “The good news is it’s in your back, so you won’t see it. The bad news is it IS needles, however, not invasive and something we can do indefinitely unlike epidurals.” Again, I trust him.

I began seeing Dr. Arman, and I have to admit the first 3 or 4 appointments weren’t great for me. I came out of there feeling worse than when I went it, limping out of there at times. I liked Dr. Arman enough to give him one last try before calling it quits. On my fifth visit, he took the time to try and figure out why was happening. In my case, the commonalities of the “extras,” such as the infrared, the electric stimulator and heat, were something that had been applied during PT and chiropractic, which he had also been trying. He decided to try straight up acupuncture and voila! Magic! It was that simple. The last few treatments I hopped off the table, rather than not slid, stood up straight, not hunched, walked one foot in front of the other, not dragging. I think Dr. Arman is a fantastic doctor and person. I think he truly cares for his patients. He took the time to figure out why the acupuncture wasn’t working for me and adjusted it. He was willing to adjust the “norm” to get it to work for me, and it did!

I just wanted to let you know, you have TWO great doctors located in your facility. Professionally, they are outstanding. Personally, they have great attitudes, and I guess it was lucky for me that I found them. I hope they will continue in your establishment, and I hope they, in the very near future, won’t be seeing me any longer as they have finally been able to get me on the path of standing up straight, walking without a limp, disconnecting from my heat pad and feeling great. They are amazing!

Not that I won’t miss them and know that if needed, they will be there, but I am looking forward to pain free days of not seeing doctors as often as I do.

I can’t thank them enough for working with me, not over me, for listening to me, for believing me and working so hard to get me out of constant agitating pain. The time I wait for Dr. Wood has drastically improved. The time I wait for Dr. Arman has always been great. Additionally, your facility is clean, the staff is pleasant including Dr. Wood’s assistant. She is wonderful about always getting me any assistance I need. She is friendly and always smiling.

I spend enough time at your facility to know if it’s just a fluke or if they are just genuinely great people – and they are.

Keep up the great work!

Keralea Pratt

Working for Safety

Injuries are the sworn mortal enemy of every safety manager in the country. Many companies see zero injuries as both an achievable and realistic goal, and an opportunity for cost savings. Some companies even try to keep their injury rate low by denying there are injuries. Proactive measures generally work out better.

Let’s break down various ways to prevent injuries in the workplace:

Built-In Safety
An engineering approach to injury prevention is used whenever possible. This approach is the most sure-fire. Like the airbags in your car, no operator action is required; the safety is built in. There are many examples of this in various workplaces – non-skid matting, saw guards and electrical grounding of machines. An engineering approach is often used after an injury calls attention to a problem. It’s even better to go through the workplace with a safety expert to identify problems and look for engineering solutions proactively.

The next avenue of injury prevention is training. While teaching someone to pump their brakes in an emergency stop will never be as good as anti-skid computerized breaking (an engineering fix), trained individuals will do better than untrained ones. Some work activities are inherently hazardous, even with the best safety engineering. In these instances, training and retraining are the best you can do. The more involved and participatory the employee is in the training, the better the outcome. Training needs to be designed to help keep someone’s attention (we all know what it’s like to watch those dreaded training videos). Repetition also reinforces the training. In the best model, the information is presented at intervals and in different formats to avoid loss of interest. Live demonstration is the best. Show people exactly how to do something and then evaluate how well they do it on their own; give them feedback and help them properly adjust their body to suit the task. Specialists such as U.S. HealthWorks know how to perform these critical evaluations. Ask them or other similar experts for help.

Motivation is also used for injury prevention. Motivation, however, sometimes seems to follow the law of unintended consequence. Offering a reward for no injuries in a given month or quarter both motivates employees to work safer and to not report their injuries. On the surface, this would seem to be desirable to the employer. Unfortunately, not all injuries heal properly without care; some get considerably worse, and will end up hurting the employee and his employer much more. So, motivation is useful, but it needs to be carefully considered to avoid unintended results.

Occupational Medicine Providers
Picking a good occupational medicine provider is also useful in preventing injuries. Some injuries are minor and need little more than some evaluation (attention) and reassurance. Your provider should have the expertise to determine whether these are first aid-only visits.

Always Report
Some employers do injury “prevention” by intentionally not reporting the injury. This is not without risk in several ways. The Occupational Safety and Health Administration (OSHA) can impose some daunting fines for those who deliberately avoid reporting an injury. The untreated employee’s injury could worsen, sometimes into something permanent. That is a tragedy for the employee and can be a legal battle for the employer for years to come. Even a late reporting of an injury can cause problems when it’s finally evaluated – the claim is likely a mess. The late report calls the patient’s integrity into question by the carrier and even the physician which could result in delayed care, further compounding the patient’s injury.

Injury prevention is an active field of research. There are experts in the field that can help you safely lower your injury rate. Having a good working relationship with your employees goes a long way to getting their support in this quest. Having a doctor you trust also helps.

Dr. B

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Expert predicts serious health effects from Gulf oil spill

This week, U.S. HealthWorks’ Dr. Donald Bucklin, AKA, “Dr. B,” was on ABC 15’s (Phoenix) morning show talking about the risk faced by workers cleaning up the oil spill in the Gulf.

For those closest to the spill in the boats, Dr. B warns that symptoms can include:

Short -term health hazards

Respiratory problems
Skin and eye irritation / rashes
Loss of coordination
Heat illness
Memory, hearing or color vision loss

Long-term health hazards

Kidney damage
Liver damage

Symptoms include:

Coughing / throat irritation
Redness / swelling of skin

You can watch the segment here.

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A New Frontier in Workers’ Compensation

From the Spring 2010 issue of the Journal of Osteopathic Physicians and Surgeons of California

By Minh Nguyen, DO

Look around and you see signs of a troubled economy everywhere – businesses closing, high unemployment numbers, and fewer crowds around shopping malls. No doubt businesses are struggling, and keeping costs down is a priority for businesses.

One of the areas where businesses are looking to contain costs is in workers’ compensation claims. As occupational medicine physicians, we play a significant role in helping employers effectively manage the care of their injured workers. Today’s environment provides us with an opportunity to reduce cost for businesses in the area of workers’ compensation without compromising the quality of patient care by incorporating a stewardship model of care.

Occupational medicine physicians serve as the steward of care for the injured worker. We are in the best position to facilitate communication, education, and participation of all stakeholders through this process. Being a steward of care requires identifying causation, secondary issues, and contributing co-morbidities while recognizing the behavioral and circumstantial realities as well as social and workplace issues.

At the initial visit, the treating physician establishes expectations including participation and compliance with the treatment plan. The treatment plan is re-emphasized and reviewed at every subsequent visit. Effective communication with the injured worker and the employer regarding expectations, responsibilities, and treatment plan is essential to getting the person back to his/her usual and customary job quickly.

The injured workers also need to be aware of the basic functioning and process of the workers’ compensation system. Understanding that the system’s ultimate goal is returning them to their pre-injured state, as well as knowing their rights and the limitations and strengths of the system, will help to reduce medical legal costs which represent a significant portion of the cost in workers’ compensation.

Over the past several years, the rise in California’s workers’ compensation costs has been attributed mostly to nonmedical costs and administrative costs. According to the Workers’ Compensation Insurance Rating Bureau, from 2005 to 2007, medical containment costs such as utilization review and nurse case management are up 51 percent, and medical legal expenses are up 59 percent during the same period.

Developing trust between the occupational physician and the injured worker by communicating all aspects of the care with the patient and involving the patient in the decision making process will help to foster a positive relationship that can help reduce unnecessary medical legal costs. Many studies have shown that legal costs are reduced when patients feel that their physician is empathetic towards them and has their best interests in mind.

Educating employers is also an essential role of the treating physician. Evidence has shown that early intervention and treatment of the workplace injuries and illnesses can positively impact outcomes. The treating physician has an obligation as the steward of care to educate the employer about this positive impact. Understanding the importance of having a return to work program is crucial. An injured worker is much more motivated to get healthy whey they stay in the work environment through return to work programs.

However, it is imperative that the occupational medicine physician communicates effectively regarding specific work restrictions. Restrictions should clearly define the functional capabilities of the injured worker. This will ensure that the injured worker will not be endangered while enabling them to still meaningfully contribute to their work place.

The occupational medicine physician is in a favorable position to exert positive influence on all stakeholders in the process. The measure of success is heavily dependent on good outcomes, and therefore delivering high quality of care is of the uttermost importance.

Evidence based medicine should be the standard of care, with recognition that each patient is an individual and that variance from common treatment guidelines may be needed in some cases. Practicing occupational medicine consistent with the American

College of Occupational and Environmental Medicine (ACOEM) Practice Guidelines as well as other established occupational standard of care provides the foundation for an effective treatment plan in accordance with best practices. Adjusting treatment plans as needed based on progression or regression of the condition through frequent communication and re-evaluation of patients is important.

The stewardship model for treating the injured workers seems simple, yet sometimes the simplest things can be the hardest things to accomplish. According to the Work Loss Data Institute’s 2010 State Report Cards for Workers’ Comp that was released March 15,

2010, California Workers’ Comp scored a grade “D” based on the state’s performance from 2000 to 2007. The report card provides five different outcome measures in the areas of incidence rates, cases missing work, median disability durations, delayed recovery rate, and on key conditions and compares the results among the states for each year.

There is room for improvement. The occupational medicine physician serves as the bridge between the health care sector and the business sector. This unique role of the occupational medicine physician can help reduce costs for businesses while maintaining the highest quality of care in this time of economic challenges.

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How Dangerous is the Gulf Oil Spill to Clean Up Crews?

In the face of yet another Katrina-sized disaster, oil clean up duty will employ more workers than the U.S. Census effort.  The cost of this spill in environmental damage, human misery and loss of habitat is beyond imagination

And since we take care of injured workers, do we have any idea what the hazards are for this new and expanding work force?  Is it dangerous for them, or only for the ducks? 

A little background: this is oil straight out of the ground, not your average quart of Pennzoil.  By the time it reaches the beaches, this oil has changed, it’s been cooked in the sun, agitated by the waves, and mixed with chemical dispersants. 

This results in a complex stew of hydrocarbons.  But before that happens, the smallest chain hydrocarbons, which are volatile, evaporate from the oil pretty quickly after coming to the surface of the gulf.  That’s good, because these are chemicals we usually call industrial solvents; like benzene and toluene, which are known neurotoxins and very carcinogenic.

That said, these chemicals are potentially a hazard to boat-based clean-up workers near the spill, but are long gone by the time the oil reaches land.  That leaves the heavier hydrocarbons that form the thick tarry mess you see on TV.  Think dirty axel grease. 

So what about the EPA’s concern about chemical dispersants

The dispersants are fancy names for soap; like dish soap at home.  The soap makes the grease in the bottom of the pan dissolve.   This works by breaking down the grease into tiny droplets that the soap keeps dissolved in the water.  The grease didn’t go anywhere, it is just less concentrated.  That is good, according to the theory, “The solution to pollution is dilution.” (I quote my old German organic chemistry professor).  You probably know detergents come in green, and not-so-green.  So the detergents aren’t so toxic to us, but some have long-term environmental problems. 

So, the biggest heath problem then, for land-based clean up workers, is heat exhaustion.

Protective suits are hot, and Louisiana gets pretty steamy this time of year. The sludge on the beach is a mess of the nth degree, but not particularly dangerous if you don’t eat it and you’re not a duck.

And what if you fall in it, roll around a bit and get totally coated – while naked – like the birds we see on TV?  No worries. Despite 007 lore ie: Goldfinger, we breathe through our nose and mouth, not our skin, so you’ll survive.  The birds do worse because their feathers don’t work anymore – they can’t fly, float or stay warm. 

So why is everybody decked out in white suits?  It’s the World Trade Center Phenomenon: nobody thought working in a giant pile of rubble was particularly dangerous either, until later when many of the workers developed severe lung disease.  So some prudence is warranted. 

So, if in these times of scarce employment, you consider oil spill clean up duty; do it on land, stay well hydrated, and stay protected from the sun and you should be just fine.

You can see photos of the gulf oil spill cleanup effort here.

– Dr. Donald Bucklin AKA “Dr. B.”


CA Workplace Injury, Illness Rates on Decline

More Workplace Healthcare Options for Los Angeles in Vernon, Commerce

Last week, we announced the acquisition of both Technimed Occupational Medicine healthcare centers, located in Vernon and Commerce.  The acquisition of these centers expands the number of U.S. HealthWorks operated medical centers to 66 in California and 134 nationwide. 

Now employers and employees in the vicinity of 3364 East Slauson Avenue in Vernon and 4730 Eastern Avenue in Commerce can access quality injury and illness diagnosis and treatment, preventive services, pre-employment and post-offer exams and testing, and return-to-work programs.

The acquisition of these two centers enables us to better serve our Los Angeles-area clients and patients and we are very pleased to welcome the Technimed team into the U.S. HealthWorks family.

Dr. David B. Landers, the founder of Technimed said, "Having been in this market for over 25 years, it was very important to us that we transition to a recognized leader in the industry, one who will take good care of our patients and clients.  U.S. HealthWorks is uniquely positioned to provide a statewide network for employers, as well as, having real-time electronic access for employer clients, who are, more and more, frequently using online resources to better manage their claims. U.S. HealthWorks has it all, so our choice of a successor was a simple one.”

-Dr. Leonard Okun, National Medical Director