King v. Burwell: Supreme Court case could wreak havoc on working families, state governments and health providers
“Established by the state.” Those are the four words at the center of an upcoming Supreme Court case that could strip affordable health insurance coverage from millions of working families and result in billions of dollars in uncompensated care costs.
The case is known as King v. Burwell and at its core is the question of whether residents who live in states with federally administered health insurance marketplaces, versus state-run marketplaces, are eligible to receive insurance subsidies. The plaintiffs in the case claim that those four little words in one section of the entire Affordable Care Act — “established by the state” — mean that Congress never intended for federal subsidies to be available to people living in states where the feds set up the health insurance exchange. (A little background: As authorized in the ACA, the federal government will set up an exchange in a state where state lawmakers choose not to do so on their own.)
However, legal observers and advocates argue that the plaintiffs are simply taking the words out of context and if one looks at the ACA as a whole, it’s clear that Congress intended all Americans to have access to federal subsidies and thus, affordable health insurance. The Supreme Court is scheduled to hear arguments in the case next Wednesday.
“The motivation is to undermine the ACA and the system that sets it up,” Sarah Somers, managing attorney at the North Carolina office of the National Health Law Program and an attorney with the Network for Public Health Law, told me. “This was a legal theory that was designed to bring this litigation. …It doesn’t make any sense that Congress would put that kind of poison pill in the legislation. Why would they do that?”
This is the language that’s in question — it’s known as Section 36B of the Internal Revenue Code as authorized by the ACA: the monthly premiums for such month for 1 or more qualified health plans offered in the individual market within a State which cover the taxpayer, the taxpayer’s spouse, or any dependent (as defined in section 152) of the taxpayer and which were enrolled in through an Exchange established by the State under 1311 of the Patient Protection and Affordable Care Act…
But in examining references to the exchanges within the ACA’s thousands of pages, it’s clear that the concepts of a state-administered exchange and the federal exchange are interchangeable, Somers said. In an amicus brief that the National Health Law Program signed onto along with AARP, Services and Advocacy for Gay, Lesbian, Bisexual and Transgender Elders, and the National Council On Aging, the authors noted:
Petitioners’ acontextual interpretation of a single phrase in one provision of the Act—if accepted—will make insurance unaffordable in the 34 states that use the Federally Facilitated Exchanges, harming low- to moderate-income residents of those states. It would also render meaningless other key provisions of the ACA designed to increase access to affordable health insurance for all.
Somers said a Supreme Court ruling in favor of the plaintiffs could have a “massive impact — it’ll affect millions of people and will cause incredible difficulty, if not chaos, for federal governments, state governments and the insurance companies.” So, just how many people are at risk for losing subsidies in the 34 states that now depend on federally facilitated health insurance marketplaces? According to a map from the Kaiser Family Foundation, more than 13 million Americans estimated to benefit from subsidies in 2016 could be impacted, with the numbers ranging from about 32,000 residents in Alaska to more than 784,000 residents in Georgia to more than 1.7 million in Texas.
“It’s amazing to think what a wreck this would be,” Somers told me.
Earlier this month, the Urban Institute released a report on what a ruling for the plaintiffs would mean for uninsured rates and health care spending. That report estimated that a ruling for the plaintiffs — a ruling that would prohibit federal subsidies in 34 states — would result in 8.2 million more uninsured people, including thousands of children, who would have otherwise spent more than $27 billion on health care in 2016. Without federal subsidies that enable people to buy affordable health coverage, the reports estimates that those newly uninsured would spend only $5.3 billion on health care, with another $12 billion provided in uncompensated care. (The uncompensated care estimate is based on the assumption that governments would fund such care and health care providers would make in-kind contributions at the same rates they had previously.)
However, the ACA was specifically designed with the assumption that demand for uncompensated care would go down — for example, the law reduced certain Medicare and Medicaid hospital payments that had historically gone to cover uncompensated care. Those types of funding reductions coupled with additional revenue losses resulting from a rise in the uninsured rate could be disastrous for providers. In addition, losing health insurance and the opportunity to access preventive care as well as care in the earliest stages of an illness has tragic effects on people’s health and mortality risks. In an amicus brief in support of the defendants, the American Public Health Association along with a host of deans, chairs and faculty within schools of public health write:
Because of the interrelationship between insurance coverage, health care access, and population health, a decision striking down the IRS rule (on federal subsidies) can be expected to lead to a loss of improvements in access to care, worsening health, and more preventable deaths. Applying the results of a prior study estimating mortality declines linked to the first four years of health reform in Massachusetts, a loss of health insurance by estimated 8.2 million persons can be expected to translate into over 9,800 additional deaths annually.
‘Sucker-punch to the gut of the middle class’
Linda Blumberg, an economist and senior fellow at the Urban Institute, described the plaintiffs’ arguments as “very flimsy,” as it seems clear that they’re taking the four words at the center of the case out of context. Blumberg was involved in the process of providing technical assistance to states as they decided whether to set up state-run exchanges or let federal officials take over. She told me that the question of whether that decision would jeopardize the availability of federal insurance subsides never came up — not once. If Congress had intended to use federal insurance subsidies as a way to pressure states into setting up their own exchanges and ultimately punish states that chose not to — as the plaintiffs argue — it’s incredible that no state took notice, she told me.
“You can’t create this coercive situation with very substantial consequences for a state without it being noticed,” said Blumberg, who also co-authored the Urban Institute report cited above. “It’s kind of impossible to have been part of the conversation around reform and believe that there’s legitimacy to this case. Having been a part of the policy process, I just don’t see any legitimacy in their argument whatsoever.”
In addition to an increase in the uninsured rate and uncompensated care, Blumberg explained how a ruling for the plaintiffs could upset the very foundation of the ACA, much of which builds off the premise of a mixed insurance pool of healthy and sick people. She said that if insurance subsidies disappear in states that depend on federally administered exchanges, the rise in some residents’ monthly insurance bills would exempt many from the ACA’s individual insurance mandate. That means some people could drop insurance coverage without facing a penalty. Blumberg said in that scenario, it’s likely that the first people who drop coverage will be healthy people — people who use the least amount of health care. That means that sicker people who use more health services remain in the insurance pool, which pushes premiums up. From there, it can be a domino effect — as premiums go up, more and more healthy people leave the insurance market and a primary mechanism for controlling health care costs starts to disappear.
“We have a situation in which we’ve created all these consumer protections that let everyone (access the insurance market), but if the only people coming in are sicker and more costly, you have a very bad dynamic,” she told me.
Regarding the four words at the core of King v. Burwell, Blumberg argued that for all intents and purposes, every exchange is established by the state — “regardless of the semantics over who’s doing the administrative role, all of these are exchanges established by the state by either the state setting it up themselves or by choosing to let the federal government set it up for them.”
“The legal folks that I listen to and trust seem cautiously optimistic and feel the case against the plaintiffs is incredibly strong on its merits,” Blumberg said.
Jane Perkins, legal director for the National Health Law Program, told me that the plaintiffs have to prove that the “statute is unambiguous on its face” and as a result, the IRS regulations about federal subsidies are beyond the agency’s authority. However, Perkins said that a hallmark of statutory construction is to determine the meaning of words by looking at the statute as a whole — in other words, you don’t untether a small group of words from its statutory context.
“The intent and wording throughout (the ACA) is to extend coverage to as many Americans as possible and the whole statute is set up to do just that,” Perkins said. “I think if the court ruled for the plaintiffs, it would not only upset (the entire) ACA, it would be reworking the rule of statutory constructions that has applied in cases for generations.”
Regarding the ruling’s potential impact, Perkins said “it would be a sucker-punch to the gut of the middle class if this ruling came down in favor these politically driven plaintiffs.” She noted that the great majority of those affected if subsidies go away would be working people. However, she also said that if the Supreme Court rules in the plaintiffs’ favor, Congress could still step in to fix the law’s language or help states convert as seamlessly as possible to state-operated insurance exchanges.
“But it would be a very bumpy road,” Perkins said.
Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for more than a decade.
John P. Stoll, 58, suffered fatal traumatic injuries on Friday, February 20, 2015 while working at a construction site in the 1100 block of John Nolen Dr. in Madison, Wisconsin. Channel3000.com reports:
- EMS was called to the scene at 7:38 am to respond to “an entrapment”
- Firefighters said a crew was “working on a stairwell when it collapsed”
- When completed, the construction project will be the site of the Watermark Lofts, an apartment and retail space scheduled to open this summer.
The Daily Reporter says Mr. Stoll was an employee of Badgerland Metal Building Erectors, but their story does not name the project’s general contractor.
Badgerland Metal Building Erectors was subject to two OSHA inspections in 2013, one at a site in Cudahy, WI and the other in Mequon, WI. Those inspections resulted in citations for three serious violations, including improperly erected scaffolding and inadequate examination of the workplace for hazards. OSHA proposed penalties totally $13,200 for the violations. In settlement agreements, the company paid $4,800.
Each year, about 100 workers in Wisconsin are fatally injured on-the-job. The Bureau of Labor Statistics reports 96 work-related fatal injuries in Wisconsin during 2013 (preliminary data, most recent available.) Nationwide, at least 4,405 workers suffered fatal traumatic injuries in 2013.
The AFL-CIO’s annual Death on the Job report notes:
- Federal OSHA has 36 inspectors in Wisconsin to cover more than 138,000 workplaces.
- The average penalty for a serious OSHA violation in Georgia is $2,207.
Federal OSHA has until mid- August 2015 to issue any citations and penalties related to the incident that stole John P. Stoll’s life. It’s likely they’ll determine that Stoll’s death was preventable. It was no “accident.”
This week the differences between OSHA’s and MSHA’s websites were oh so obvious. The Mine Safety and Health Administration (MSHA) released a new on-line tool to allow users to compare a mining operation’s violations of selected safety standards to the national average. For years, mine-specific violations, penalties, injury reports, exposure sampling results, and other data have been available on MSHA’s website, but this new tool offers something different. It focuses on a subset of safety violations which most frequently cause or contribute to fatalities and serious injuries.
While MSHA continues to make its vast trove of enforcement data available to the public—not just available, but easily searchable and accessible—OSHA’s website has been floundering. For at least the last month, the simplest query of OSHA’s “Establishment” or “Specific Inspection” search tool results in the message “Temporarily Unavailable.”
The system is especially annoying because it teases you. You don’t know from one hour to the next whether the system is working or still in disrepair. I can conduct a search at one moment, and it might spit out the data I requested. Yeah! I think the programming glitches have finally been fixed, but only minutes later, I’m frustrated again. The next query ends with the message “Temporarily Unavailable.” It feels a little like fall 2013. That’s when I was attempting, night after night, to get onto the original Obamacare website.
I realize that OSHA’s and MSHA’s core function is enforcing safety and health regulations and helping employers comply with them. It’s not about having a splashy website or data search tools that have all kinds of bells and whistles. But the public, especially reporters, have come to rely on getting basic inspection data from the agencies’ websites. Users have become accustomed to finding out whether a particular establishment has had previous OSHA inspections, and if so, whether citations and penalties were proposed and the disposition of them.
Now that I’ve grown used to getting OSHA inspection data, it’s frustrating to get the error message “Temporarily Unavailable.” I’m not sure the phrase “Temporarily Unavailable” really communicates what users should expect. After weeks and weeks of this problem, “Temporarily Unavailable” really doesn’t cut it. How about a message to users:
“Data will only available intermittently. Upgrades expected to be completed by X date.”
Maybe the agency could provide users a bit of information to manage their expectations. Is it a problem with the dataset, the interface between the dataset and the website, or the website platform? Should we start to see incremental improvements in the site, or will there be a master unveil? Is the problem unique to OSHA or should we be dreading the same fate in the future for MSHA’s on-line search tools? (I’ve got my fingers crossed to stave off the latter.)
As for the subset of violations featured in MSHA’s new on-line data tool, it includes standards such as keeping workers away from suspended loads of material or equipment, ensuring machinery is not used beyond its intended design, and locking out equipment during repair or maintenance. MSHA calls them the “Rules to Live By” standards. Companies are just asking for trouble—and gambling with workers’ lives—when they disregard these important protections.
This morning, I checked out this new MSHA on-line data tool. I queried the system for Newmont USA’s gold mine in Leeville, NV. A contract worker, Brian Holmes, 53, was fatally injured there on January 11, 2015. Plugging the mine’s unique identification number into the system, I learned something troubling: From 2012 through 2014, the rate of violations (per MSHA inspections hours) at this mine of the “Rules to Live By” standards was 2.38 compared to the national average rate of 0.77 for this type of operation. Gambling with workers’ lives indeed.
This data tool and the others available on MSHA’s website can provide valuable information to current and prospective workers, contractors, investors, competitors and the public about a specific mining operation or a group of mines owned by a particular company. It’s data that can help users make informed decisions.
Kudos to MSHA for developing new ways for miners, employers and the public to access the agency’s data. I hope your agency has a vaccine to avoid whatever is troubling OSHA’s website.
Higher income is linked to longer life expectancy, less activity limitation due to chronic illnesses, and fewer adults and children with reported fair or poor health. While discussions at the federal level on raising the minimum wage are going nowhere, state and local health commissioners are weighing in on the connection between income and health.
TPH’s Kim Krisberg writes in the March issue of The Nation’s Health on why increases in the minimum wage are a public health issue. Rex Archer, MD, MPH, Director of the Kansas City, MO Department of Health told Krisberg:
…[achieving] “a living wage has become one of the most important public health issues for us, period. …We can’t ignore the stress of not having a living wage and what that’s doing to our population.”
The minimum wage in Missouri is $7.65 per hour (the federal minimum wage is $7.25) and for tipped employees it is $3.825 per hour (federal tipped minimum wage is $2.13.)
Krisberg also spoke to Minnesota’s State Health Commissioner, Edward Ehlinger, MD, MSPH. That state’s lawmakers passed a bill in April 2014 increasing the minimum wage to $9.50 per hour by 2016. Beginning in 2018, it will automatically adjust for inflation.
“I’d argue that it was the biggest public health achievement in that legislative session—and probably in the four years I’ve been health commissioner. Not even the tobacco tax increase the year before is not as powerful as the minimum wage increase,” Ehlinger told Krisberg.
“If you look at the conditions that impact health, income is right at the top of the list. Anything we can do to help enhance economic stability will have a huge public health benefit. This is a major public health issue.”
Ehlinger is not shy about sharing his views. He writes a blog post every couple of weeks, and unlike most blog posts with bylines of an agency chief, Ehlinger’s read as original. Just before the state legislature completed deliberations on the minimum wage bill, a commentary by the health commissioner was featured in the Minnesota Post. He wrote:
“When people think about minimum wage, they most often think about the impact on their bank account and their job. But policies that impact employment and income are actually about health – the health of individuals, families and communities. …Health improves with increasing income, and the impacts of a rise in income are greatest for those at the lowest end of the wage scale. Moving from the lowest income level to the next lowest provides the largest percentage increase in life expectancy and health status.”
Ehlinger indicated the lawmakers’ plan to increase the minimum wage to $9.50 per hour would lift more than 350,000 Minnesotans out of poverty.
“As Minnesota’s health commissioner and as a physician, I prescribe an increase in the minimum wage to improve the lives and health of vulnerable children and families. It will be a great investment in the health of individuals, families, communities, and our state.”
It’s a toxic chemical that made headlines when it was linked to deaths and injuries among popcorn factory workers, and federal regulators are well aware of its dangers. But, unfortunately, diacetyl is still hurting workers. In “Gasping for Action,” reporter Raquel Rutledge at the Milwaukee Journal Sentinel writes about diacetyl, a chemical that tastes like butter and is used in food products and e-cigarettes, and the dangers it continues to pose to workers who breath it in, particularly coffee workers. She writes:
Coffee roasters sometimes add it to flavor coffee. High concentrations of diacetyl also form naturally during coffee roasting.
Whether natural or synthetic, the chemical can destroy the respiratory system when inhaled, according to Takayuki Shibamoto, a professor in the Department of Environmental Toxicology at the University of California, Davis.
“They are exactly the same,” Shibamoto said.
What matters most, he said, is the amount and concentration of exposure.
Yet after more than a decade of studies detailing diacetyl’s danger, the U.S. Occupational Health & Safety Administration, or OSHA, has failed to issue regulations specifying what a safe level of exposure might be.
Rutledge writes about previous attempts to regulate diacetyl, industry opposition and OSHA’s response. She quoted OSHA head David Michaels, who had called for diacetyl regulations before he joined OSHA, as saying that diacetyl is one example of why a “chemical by chemical approach doesn’t work” when it comes to regulating worker exposure. Michaels said setting an exposure limit for diacetyl isn’t the answer, as manufacturers will simply substitute a new chemical that can be equally as harmful. Rutledge also chronicled the stories of sick workers:
James Stocks thought it odd when Emanuel Diaz de Leon showed up in his medical clinic huffing and puffing in December 2011. Diaz de Leon was 41, active and a nonsmoker.
“It just didn’t make sense,” said Stocks, a pulmonologist at the University of Texas Health Science Center at Tyler. “His chest X-rays and lung function were like that of a 70-year old or a 50-year-old who smoked two packs a day.”
Stocks asked Diaz de Leon where he worked and what he did for a living. The answer made him curious. Stocks knew a bit about flavors and had read medical journals and media reports about injuries popcorn workers had sustained from a flavoring chemical. But he hadn’t heard of anyone becoming ill working in a coffee roasting plant.
He asked Diaz de Leon to bring him the company’s material safety data sheets, which list the potential hazards of the ingredients that he worked with every day.
“The moment I saw the word diacetyl, I knew,” Stocks said.
To read the full story, visit the Milwaukee Journal Sentinel.
In other news:
Los Angeles Times: Last week’s explosion at a Torrance, California, oil refinery that injured four workers was triggered by pressure build-up inside a piece of equipment, reports journalist Veronica Rocha. The cause of the pressure build-up is under investigation. According to Rocha, the explosion sent ash filled with fiberglass and glass wool into the neighboring community, though local air quality officials said the ash did not contain asbestos. However, Emily Atkin and Sacha Feinman over at Think Progress report that health concerns are mounting, with local union officials calling on public health officials to take a deeper look. An ExxonMobil rep told Think Progress that the ash that fell over the refinery’s neighbors is “not expected to be hazardous.” A local union official said: “If this were a one-time, short-term exposure to the community, there is no need for them to be too concerned about it. But if it is toxic and not cleaned up, I have concerns about long term possible exposure and the health of this community.”
West Virginia MetroNews: West Virginia lawmakers have introduced legislation to guarantee workers paid sick leave. Reporter Shauna Johnson writers that eligible workers could earn one hour of sick leave for every 40 hours of work, with employers who don’t comply facing financial penalties and even misdemeanor charges. In related news, paid sick leave legislation in Oregon is heating up, with hundreds of residents recently showing up at a public hearing.
Huffington Post: Former U.S. Labor Secretary Robert Reich writes about the rise of the “independent contractor” classification and how that classification let employers sidestep labor laws and contributes to low wages, unstable working hours and job insecurity. He writes that instead of waiting for the courts to decide on a case-by-case basis whether an employer is wrongly classifying its workers — which recently happened to Fed Ex — he called on policy-makers to take action to protect all American workers. This is his suggestion: “Any corporation that accounts for at least 80 percent or more of the pay someone gets, or receives from that worker at least 20 percent of his or her earnings, should be presumed to be that person’s ‘employer.’”
MSNBC: Home health workers are joining forces across the nation to fight for better wages, writes reporter Suzy Khimm. Led by Services Employees International Union, the new push will include town halls and rallies in 21 cities, with workers calling for a wage increase as well as the right to unionize. Khimm writes that the nation’s 2 million home health workers have a median wage of just $10.01 per hour, with about half of such workers living in households with incomes below the poverty line. USA Today covered the new home health worker movement too. Reporter Paul Davidson writes: “Nearly half of the workers rely on public aid, a NELP report says. After logging 30 years in the field, Ethel Ayo, 59, of Aurora, Colo., earns $9.25 an hour caring for six Alzheimer’s patients in a boarding home. The 36-hour a week job ‘is very hard,’ she says. She gives resistant clients showers, among other duties, and sometimes diagnoses symptoms.”
Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for more than a decade.
Last week, FDA warned healthcare providers that the complex design of a piece of endoscopy eqiupment may make it hard to fully disinfect — which means that using it, even in accordance with the manufacturers’ instructions, might allow dangerous bacteria to spread between patients. The warning follows reports of seven patients from UCLA’s Ronald Reagan Medical Center becoming infected with the drug-resistant “nightmare bacteria” CRE (Carbapenem-Resistant Enterobacteriaceae) after undergoing procedures using ERCP endoscopes, or duodenoscopes. Of these seven patients, two died, and “the infection was a contributing factor in the death of two patients,” UCLA said in a statement. The health system notified 179 patients that they may have been exposed to CRE bacteria during diagnostic or treatment procedures performed between October 3rd and January 28th, and offered free home testing kits to see if they are infected.
In a piece for National Geographic’s Phenomena, Maryn McKenna notes that the UCLA episode follows outbreaks in other states, and that the weeks or months that can elapse between patients’ exposures and infection symptoms can make it hard to stop outbreaks quickly. She also interviewed CDC medical epidemiologist Dr. Alexander J. Kallen, who highlighted these alarming aspects of recent duodenoscope-associated CRE outbreaks (emphasis added):
… the outbreak we investigated in Illinois in 2013, which we reported in the Journal of the American Medical Association, is the first time that we know of where there was transmission of a highly resistant pathogen, from a scope, unrelated to an infection-control breach. You almost always see that someone forgot this step or that step. But in these last three outbreaks, there was persistent contamination despite not identifying a breach, and that is fundamentally different. It starts to raise the suspicion this is more a fundamental issue with these types of scopes, rather than just failures to adhere to recommendations for cleaning.
It appears that UCLA followed the FDA-validated disinfection instructions for the scopes, but two of the facility’s seven scopes harbored CRE bacteria anyway. Kallen also told McKenna that certain cleaning procedures might work to disinfect new equipment during FDA’s lab tests, but the same procedures might not be sufficient with older equipment as used and cleaned in practice. In any case, it’s a frigthening thought that a facility’s staff can do exactly what they’re supposed to do, but their patients can still end up with fatal infections.
FDA has recommendations for facilities, staff, and healthcare providers — and also for patients. “Discuss the benefits and risks of procedures using duodenoscopes with your physician,” the FDA Safety Communication suggests. “For most patients, the benefits of ERCP outweigh the risks of infection. ERCP often treats life-threatening conditions that can lead to serious health consequences if not addressed.”
As McKenna warned in her excellent and terrifying Medium piece “Imagining the Post-Antibiotics Future,” the spread of antibiotic-resistant bacteria means that medical procedures that are routine today, from dialysis to hip replacements, could become far more likely to result in fatal infections. FDA reports that US healthcare providers perform more than 500,000 ERCP procedures using duodenoscopes each year, because these are procedures are “the least invasive way of draining fluids from pancreatic and biliary ducts blocked by cancerous tumors, gallstones, or other conditions.” If cases of duodenoscope-linked CRE infections keep mounting, though, patients and providers might have to start rethinking treatments.
In his FY 2016 budget, President Obama has proposed a $1.2 billion federal investment in combating and preventing antibiotic resistance. That seems like reasonable sum to spend on something that could let us slow the arrival of the post-antibiotics future.
While silicosis-related deaths have declined, it remains a serious occupational health risk and one that requires continued public health attention, according to recent data from the Centers for Disease Control and Prevention.
In the Feb. 13 issue of CDC’s Morbidity and Mortality Weekly Report (MMWR), researchers noted that while annual silicosis deaths have dropped from 164 in 2001 to 101 in 2010, dangerous silica exposure has been newly documented in occupations related to hydraulic fracturing (fracking) and the installation of engineered stone countertops. Overall during the 2001-2010 time period, the report documented a total of 1,437 U.S. deaths with silicosis as an underlying or contributing cause. Preventable when workers are provided with adequate personal protective equipment, tools and training, silicosis is an occupational lung disease caused by inhaling respirable crystalline silica dust.
In analyzing the 2001-2010 mortality data for which silicosis was reported as an underlying or contributing cause, researchers found that 28 of the 1,437 deaths were among people ages 15 to 44 and men accounted for more than 95 percent of the deaths. Whites accounted for more than 1,200, or 86 percent, of the deaths; however, the rate of silicosis deaths among blacks was significantly higher than for white and other races. The researchers wrote that the disparities in sex and race “reflect differences in the composition of the workforces in the industries and occupations placing workers at risk for exposure to crystalline silica dust.”
The report notes that workplace exposure to crystalline silica dust has long been documented in sectors such as mining, quarrying, sandblasting, pottery making, rock drilling, road construction, stone masonry and tunneling construction. However, such exposure is being documented in additional occupations as well, such as among technicians responsible for sandblasting in dental labs, workers involved in the fabrication and installation of certain kitchen and bathroom countertops, and those employed in the fracking industry. Report authors Ki Moon Bang, Jacek Mazurek, John Wood, Gretchen White, Scott Hendricks and Ainsley Weston write:
Because of the serious health and socioeconomic consequences of silicosis, new operations and tasks placing workers at risk for silicosis, and the continuing occurrence of silicosis deaths among young workers, effective primary prevention through elimination of exposure to respirable crystalline silica is critical. At the same time, because of the sometimes long latency of silicosis, with cases diagnosed years after exposure and often in retirement, ongoing silicosis surveillance is needed to track its prevalence in the United States.
The authors did caution that the MMWR report is subject to some limitations. For instance, work history is not reported on death certificates and so it’s not possible to report in which occupational industries the deceased were exposed to crystalline silica. Also, exposure to crystalline silica can cause diseases other than silicosis, such as lung cancer and chronic obstructive pulmonary disease. This MMWR report only focused on silicosis deaths.
In 2013, OSHA proposed lowering the allowable silica exposure limit — the Pump Handle’s Celeste Monforton wrote about that proposal here and here. It’s estimated that about 2 million U.S. workers continue to be exposed to the dangerous dust.
Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for more than a decade.
Norberto Romero, 49, suffered fatal traumatic injuries on Monday, February 16, 2015 while working at Thomas Concrete on Canton Road in Marrietta, GA. The Examiner reports
- The incident occurred at about 3:05 pm “when someone called 911 to report that someone was trapped inside a concrete silo”
- Firefighters worked “throughout the evening to free the man’s trapped body….[it] was recovered around 9 pm”
WXIA explains that Romero, 49, was one of
- “two subcontractors from Texas [who] were cleaning the inside of the cement silo. …Romero attempted to unclog a ‘hopper’ in the silo, he fell into and there was a collapse. The second worker tried to help him and there was another collapse, burying Romero.”
The Marietta Daily-Journal offers information provided by a spokesperson with the Cobb County Fire Department:
- “…the man worked for a company hired to clean the inside of the silo”
- “…the silo was about 40 feet tall and about 20 feet across”
- “…the sand and gravel mixture was so unstable that rescuers couldn’t safely get inside the silo. ‘We ended up having to basically dismantle the bottom of the silo where the drain was, or the hopper,’ said the spokesperson, ‘and that’s how we were able to recover the body.’”
I’ve been unable to determine yet the name of Mr. Romero’s employer. The silo in which he was working belongs to Thomas Concrete. The firm says
“we’re one of the largest producers in Georgia dedicated exclusively to ready mix concrete and we’ve expanded our operations in the Carolinas.”
In 2012, a Thomas Concrete plant in Raleigh, NC was cited by North Carolina OSHA (NC-OSHA) for numerous serious safety violations, including for hazards related to workers entering confined spaces. The agency proposed a penalty of $5,775. Through a formal settlement with NC-OSHA, the company paid a $525 penalty for two serious violations.
Each year, dozens of workers in Georgia are fatally injured on-the-job. The Bureau of Labor Statistics reports 70 work-related fatal injuries in Georgia during 2013 (preliminary data, most recent available.) Nationwide, at least 4,405 workers suffered fatal traumatic injuries in 2013.
The AFL-CIO’s annual Death on the Job report notes:
- Federal OSHA has 49 inspectors in Georgia to cover more than 214,000 workplaces.
- The average penalty for a serious OSHA violation in Georgia is $2,061.
Federal OSHA has until mid- August 2015 to issue any citations and penalties related to the incident that stole Norberto Romero’s life. It’s likely they’ll determine that Romero’s death was preventable. It was no “accident.”