Wednesday, September 20, 2006

Cooking the Books, Part II: The Stick and The Doctor

Note: The entire four-part series can be read here.

Yesterday, we described how KFM cooked the books by using “the carrot” to discourage workers from reporting injuries or illnesses. Monetary incentives were given to every level of employees for meeting quality and completion timeline goals, but only if no Log 300 recordable injuries are reported.

Today, Part II discusses how KFM used “the stick” and its own doctors to cook the books.


Cooking the Books: The Stick

When the financial incentives were not enough to suppress reports of recordable injuries and illnesses, Bay Bridge threats of discipline, suspensions and layoffs were used by supervisors to maintain an accident-free record, according to statements given y workers' to Cal/OSHA.

KFM’s formal policy states that workers are required to report each and every injury, from simple first aid cases to recordable injuries and illnesses needing medical treatment. Failure to report any workplace injury or illness could be the basis for disciplinary action against workers.

As Daniel Otto, a fit-up and welding crew foreman, told Cal/OSHA, the KFM “safety program was organized to look good on paper, but actual practice on the job was different.” Combined with the incentive system, workers were left feeling as if “they got you coming or going – if you report, then everyone loses the money; if you don’t report, then they can use that against you in a disciplinary action,” according to the Cal/OSHA file.

Mechanic Keith Bates told Cal/OSHA:

Everyone was on ‘pins and needles’ all the time because everyone wanted to keep their jobs, but it was clear that if any injury or illness was reported, there would be adverse consequences…KFM discouraged reporting of accidents because it threatened crew cash bonuses and crew barbeques. Workers were individually warned by foremen and superintendents, but we were never threatened at the mass safety meetings. Employees who made safety suggestions or expressed concerns were ‘black-balled’ by supervisors…definitely a disconnect between the stated policy and what really happened on the job.
Otto told Cal/OSHA he was

personally involved with superintendents [Dave Polette] and foremen [Doug Silverwood, Jim Belcher and Tim Peeler] who discouraged the reporting of injuries. This happened in my own case, and with Fernando Rivera, Francisco Aguirre, Dave Dixon and Chris Hallstrom.
Otto said that superintendents and foremen “conducted reprisals against employees in the form of verbal humiliation in public,” and also in “laying off injured workers, such as Fernando Rivera, Dave Dixon and Chris Hallstrom, to send a message to the crew.”

Welder Chris Hallstrom reported to Cal/OSHA that

Randolph got hurt when he was struck on the head, and he insisted on getting a medical evaluation [which means an injury report is filed]. [Foreman] Jim Belcher told everyone on the boat going out to the pile – welding and fit-up crews together, more than 30 workers – “here’s the guy who lost you the incentive.”

Jim Belcher was then the welding foreman and Belcher hounded Randolph after his injury. He [Randolph] got fired for something Belcher made up. It was made clear that this would happen to everyone,
Later on, when Hallstrom wanted to get a medical evaluation of his swollen knee, “Jim Belcher said to me, ‘do you want to be another Randolph?”

David Roundtree, a welder who left KFM on his own initiative in June 2004, told Cal/OSHA that
the incentive plan works against reporting injuries. Everybody trying to keep their jobs – don’t make waves. When you reported injuries, they treated you as a criminal…KFM created an atmosphere where you didn’t want to report. They called everyone ‘whiners’ and ‘crybabies’…There was self-generated pressure not to report, especially among Latino workers. Almost no Latinos ever reported any of the injuries they had.
Francisco Aguirre, an apprentice welder at the bridge, confirmed the harsh atmosphere in the KFM work site to Cal/OSHA:
There was a lot of pressure from supervisors (Dave Polette, Jim Belcher and Tim Peeler) not to report injuries because they will lose safety cards for themselves and cash bonuses for the crew…The pressure from above was very intensive – we had to finish by some time and no accidents.
An investigator for the Bureau of State Audits wrote up his interview notes with welder Mario Armani as follows:
he [Armani] said that he raised his concerns but was told to ‘find another job.’ One time, he was boxed in by KFM management, after he had raised concerns, and was told that he had better weld very fast or they would fire him for working too slow.”
The BSA report issued in February 2006 noted
of 139 current and former KFM employees who responded to our survey, 52 indicated that they had been injured while working on the Skyway project, and 24 of these injured employees indicated they felt pressure to not report their injury. Although we did not specifically ask about safety incentives in our survey, five workers mentioned them as a reason why injuries were not reported. However, a more frequent concern, expressed by 14 of the workers, was that they believed they would lose their jobs or face lesser forms of retaliation if they reported an injury.
Cooking the Books: The Doctors

Another key to maintaining miraculously low injury and illness rates at the Bay Bridge was careful management of the “work status reports” received by KFM from its contract first-aid personnel on site, from the three occupational health clinics under contract to diagnose and treat injured workers, and from the third party administrator of its self-insured workers compensation insurance.

Treatment for injuries that only require “first aid” is not recordable, but lost or restricted workdays are. Work status reports are a key trigger for recording “lost work days” and/or “restricted work days” on the OSHA Log 300. KFM’s safety staff spent a lot of time, according to Cal/OSHA’s investigative file, riding herd on the diagnosis and treatment of injured workers to ensure that they didn’t turn into “lost” or “restricted” work days.

Former Field Safety Manager Winston Peart, who worked for KFM between April 2003 and March 2004, gave a written statement to BSA investigators in the fall of 2005.

KFM had an on-site first aid office in which contract nurses who were on call would treat injured workers. It was my experience with KFM, and with other companies that I have worked for, that these nurses are aware of the criteria defining what is a first aid and what is "medical treatment beyond first aid." To help an injured patient, these nurses sometimes conduct "medical treatment beyond first aid." However, they know to document the procedures as first aid to avoid making the injury recordable…I saw numerous embedded object eye injuries, and frequently these injuries required medical attention beyond first aid. However, I do not believe that all of these injuries were reported on KFM’s 300 logs…

It is my understanding that Mr. Hughes [KFM Safety Director Robert Hughes] would accompany the victim to the clinic because Mr. Hughes knew the doctors there and had some degree of influence in persuading them to classify injuries in a way as to not make them either reportable or recordable, depending on the severity of the injury....In essence, the clinic is selected based on its willingness to classify most injuries as return-to-work injuries. From my conversations and experience with Robert Hughes, I believe that he selected the Skyway Project’s medical clinic based on this criteria.
Welder Chris Hallstrom told Cal/OSHA that when he
was being seen by Dr. Stephen Nord at Premier Care Medical Group in Pleasanton, he was always accompanied into the exam room by safety managers Rob Hughes or Chuck Chartrey. "The safety guy would bargain with Dr. Nord. They would bargain over the wording of the work status report and the job restrictions." Hallstrom asked to see Nord alone, "but Chuck Chartrey would not permit it. The safety people would sit there saying "no problem, he’s on [unofficial] light duty" so that the doctor would not write up any official days of RWD [restricted work days] on the work status reports.
Employer knowledge of the diagnosis and work status is a key determinant of any Log 300 entry. Under California’s workers compensation law, the employer has the right to “designate” the physician treating work-related injuries and illness for the first 30 days of treatment, unless the worker “pre-designates” a physician prior to any accident. The employer’s designated doctor keeps control of injury treatment and work status reports after the first 30 days, unless workers formally ask to be treated by another physician.

But Foreman Daniel Otto told Cal/OSHA that injured workers were “extremely discouraged to go to their own doctor.” And it appears the discouragement worked: the Cal/OSHA case file indicates that not one injured worker had pre-designated a non-KFM doctor.

Specialty Risk Services (SRS) is the third party administrator of KFM’s worker compensation self-insured insurance policy. When KFM workers did not pre-designate their own doctor for the first 30 days of treatment, and if the workers did not ask to transfer their treatment after 30 days to their own physicians, then SRS would only pass on to KFM the work status reports of KFM's “designated” doctors, as allowed by law.

The Cal/OSHA case file indicates that SRS acted as a “knowledge screen,” blocking the transfer of information from non-KFM physicians to KFM managers responsible for Log 300 entries. Even when workers decided to go to their own doctors after the first 30 days of treatment, it appears that SRS did not transmit the non-KFM physicians’ work status reports to KFM. If KFM didn't see the reports, then they could not be the basis for any lost or restricted work day entries on the Log 300.

Foreman Paulson told Cal/OSHA that after his knee injury at work, he was sent to a KFM-designated clinic, U.S. Health Works,
who prescribed him aspirin and sent him back to work. [Paulson] then went to Kaiser immediately after work, where the MD prescribed crutches and RWD [restricted work days] for 14 days as well as Vicodin. [Paulson] "could not report [his visit to Kaiser] to KFM or I would have been fired or laid off right away."
At Paulson’s next visit to U.S. Health Works, the doctor there told him he did not need crutches and sent him back to work with a “return to full duty” work status, which would not trigger a Log 300 entry, according to the Cal/OSHA files.

Carpenter Steve Swanson, who suffered a hernia working at the Bay Bridge, said
KFM is so paranoid about injuries – ‘do not go to your own doctor, go to our doctor.’ They are set up with their own doctor – he works for them – it’s an insurance thing to keep down workers comp cases.
Swanson’s hernia was declared to be “non-industrial” by the physician at U.S. Health Works in Berkeley, so the injury was not entered onto the Log 300, and Swanson did not qualify for workers comp medical coverage, according to the Cal/OSHA files.

Welder Venture Ochoa told Cal/OSHA that KFM
safety staffer Chad Hoople threatened to "send me home for telling On-Site [contract first aid provider at the worksite] that [he] should be sent to a doctor at the clinic," [even though] KFM doesn’t want any records of injury and they doesn’t have a real doctor....The company doctor is on KFM’s side; he doesn’t care about the workers.
Tomorrow -- Cooking the Books, Part III: The Industrial Hygiene Consultant, the Real Decision Makers and Why KFM Does It.