Q & A:
How did we get here?
Our American system of workers' compensation came to us early in the last century from Germany, via Great Britain.1 While other countries have made changes, we have continued the original no-fault system – and that is the core of the problem. Under workers' compensation, the employer is protected from tort liability. Thus the worker cannot sue his/her employer for work injury, illness, or death. The quid pro quo is supposed to be swift and certain compensation and medical care in exchange for having given up the right to sue. What has happened over the years is that the freedom from lawsuit prevails, while worker medical treatment and wage compensation have been delayed and denied away. There is no monetary disincentive for employers and insurers failing to pay for the disease that cripples, or the corporate negligence that injures or kills. It's in the corporation's best monetary interest not to pay. The longer the money stays in the insurer's pocket and investment portfolio, the more desperate the worker's situation becomes.
Aren't there laws or regulations that hold corporations accountable when they cause the destruction of health or life of their employees?
The Occupational Safety and Health Administration (OSHA) has the responsibility for setting safety and health standards, monitoring and ensuring the safety and health of the workplaces. OSHA is woefully underfunded and understaffed.
OSHA fines for citations (violations) have been so minimal that it's generally cheaper for the corporation to pay the fines than it is to provide a safe workplace.
In its forty years of existence, federal OSHA has referred only a minute number of cases to US Department of Justice (DOJ) for criminal prosecution, and only a minute number of those were pursued by DOJ. In those few cases when OSHA does deem a citation "willful," (a prerequisite for referral to DOJ for prosecution) the crime is considered a mere misdemeanor punishable by a small monetary penalty, or by imprisonment for not more than six months, or both.
For a more detailed exploration of what usually happens in a workplace disaster, see Chapters 2 and 4. In some cases, (see Chapter 5) there aren't even any OSHA regulations in place to protect workers from injury and death. (See also Chapter 12, Recommendation 6).
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What about medical treatment under workers' compensation? Aren't employers obligated to provide that?
The abuses in medical treatment under workers' compensation are legion and varied. Themes that run throughout the experience of injured workers are the delays; the denial of treatment; the inadequate, inappropriate, and cursory medical treatment; inhumane treatment; and the shunting of costs that should be paid by workers' compensation to others, primarily injured workers and their families, and taxpayers. Most occupational diseases never went the through the workers’ compensation system at all, primarily because of the long latency period between the exposure to toxic chemicals in the workplace and the manifestation of the disease.
Workers' compensation insurers and their powerful lobbyists, supported by employers, regularly persuade state legislators to shrink even the meager legislated health and wage compensation and to further limit worker attorney fees, claiming its too costly for employers. The injured and the families of the deceased have weak voices, if they are heard at all in state legislatures. And legislators, who are generally ignorant of the workers' compensation system, and concerned for the pockets of business, acquiesce to the demands of the insurers. (See Chapter 8)Occupational illnesses and injuries are now thought to be among the five leading causes of illness and death in our nation.7 (see Introduction, Chapter 8, 12, Recommendations 2, 4).
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If employers and insurers aren't paying for worker injuries, toxic exposures and deaths, then who is paying?
Employers and their insurers pay only about one quarter of the costs of occupational injuries, illnesses and deaths. In the Introduction, I cite rigorous research that shows that the lion's share of the costs of occupational injuries, illnesses, and deaths are paid by the victims and their families; with a sizable portion paid by taxpayers.2
Is there an environmental impact to the toxic exposures that occur in the workplace?
One cannot witness the repeated toxic chemical exposure of workers without also seeing its fallout on communities. There are long-term consequences to this devastation for individual workers, for their families, for communities, for society, and ultimately, for our planet. Why is it that the connection between the tens of millions of workers exposed to toxic metals, neurotoxic solvents, other toxic compounds and carcinogens is not identified as the monumental environmental disaster that it is? Like the canary in the coal mine, worker toxic exposures are the harbinger to environmental devastation.
While the United States has only set permissible exposure limits on less than 500 of the hundreds of thousands of chemicals in use in workplaces throughout our country,3 the European Union regulates 30,000 chemicals utilized in their workplaces, and many that we allow here have been banned for years in the EU.4 Even the small number of chemicals, upon which exposure limits have been set in the US, are grossly out of date based on more recent scientific data.
Increasingly as a nation, we have been all too willing to push corporate costs onto workers, their families, and taxpayers; and all too willing to cut protections for workers, communities, and the environment. Chapter 11 gives many examples of how our failure to regulate occupational toxins that kill workers is devastating communities and the environment, now and into the future. (See also Chapter 1 Addendum and Chapter 10).
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This is such a complex subject. Where did you start your research?
When I first started my research, I asked a simple question: What happens to injured workers one year, five years, ten years out from their injury? I thought that governmental departments with responsibility for compiling information on occupational injuries and illnesses would have that information. I was shocked that there was no one place that had the answers; and government did not even have the data on the occupational diseases and occupational disease deaths. The long-term impact from worker toxic exposures wasn't even on the radar screen. The number of worker fatalities is grossly under-reported. Worker deaths each year from toxic exposures, other work illnesses are conservatively estimated by researchers to be 50,000 – 60,000 deaths per year, or at least ten times the number of fatalities from work injuries. Yet, these deaths don't appear in the Bureau of Labor Statistics fatality data. The United States has no comprehensive health data collection system.
Other questions followed in order to comprehend the magnitude and complexity of the impact of this system on our society. Fortunately, there are epidemiologists, economists, environmental and occupational health specialists, public health specialists, other scientists, labor and academic scholars whose rigorous research of specific aspects of the medical and economic sequelae of the workers' compensation system have been reported in books and scientific journals, and whom I cite throughout Depraved Indifference: the Workers' Compensation System. I also relied on other governmental data, OSHA investigation reports, autopsy reports, local sheriff and police department reports of workplace fatalities, court cases, hearings, and settlement agreements, as well as personal interviews across industries and occupations, all across the country.
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What do you hope readers will take away from Depraved Indifference: the Workers' Compensation System?
There has been very little general public awareness of this system that maims and kills with impunity. The time is long overdue to re-evaluate a structure that evolved over one hundred years ago; and which clearly doesn't meet the needs of seriously injured, ill, or toxic chemical-exposed workers, or the families of workers who died from their work – a system that has fostered devastating and lasting damage to families, to communities, to our environment.
Each year in our country, an estimated 50,000 - 60,000 deaths occur which are attributable to occupational disease and occupational toxic exposure. These are conservative cancer and other disease death estimates.5 Occupational disease deaths get subsumed into the International Classification of Diseases (ICD) classification labeling the cancers and other diseases that are the final cause of death. No attention is paid to the toxic exposures that lead to the body systems breakdown resulting in death.
If occupational disease death proportion statistics were isolated, they would be more than total breast cancer deaths; over twice the number of prostate cancer deaths; more than deaths from colon and rectal cancer; or heart failure; about three times the number of deaths from leukemia; and four times the deaths from HIV.6 Yet each of these diseases gets far more government, public, and media attention than occupational diseases and resultant deaths. I should explain here that occupational diseases include all of the cancers named above, as well as leukemia. My point is that the numbers of occupational diseases and disease deaths are monumental, yet are not receiving the attention they deserve. Therefore, there is not the focus on eliminating the causes.The final chapter lays out thirteen recommendations and strategies for action to bring justice and fairness, corporate accountability, and disclosure to this system. It is my hope that a better understanding and awareness of the issues will inspire a willingness to work for change, to right this terrible, continuing American tragedy.
1 White, Lawrence. Human Debris: The Injured Worker in America. Seaview/Putnam, New York, 1983.
2 Leigh, J. Paul; Markowitz, Steven; Fahs, Marianne; Landrigan, Philip. Costs of Occupational Injuries and Illnesses. University of Michigan Press, 2000.
3 Markowitz, in Leigh, J. Paul; Markowitz, Steven; Fahs, Marianne; Landrigan, Philip. Costs of Occupational Injuries and Illnesses. University of Michigan Press, 2000.
4. U.S. House of Representatives. Hidden Tragedy: Underreporting of Workplace Injuries and Illnesses. A Majority Staff Report by the Committee on Education and Labor. Honorable George Miller, Chairman, June 2008.
5 Steenland, Kyle; Burnett, Carol; Lalich, Nina; et al.Dying for Work: The Magnitude of US Mortality From Selected Causes of Death Associated With Occupation, American Journal of Industrial Medicine, Vol 43, pp 461-482, 2003.
6 US Department of Health and Human Services, National Center for Health Statistics, Centers for Disease Control and Prevention, National Vital Statistics System, National Vital Statistics Reports, Vol 53, Number 5. Deaths: Final Data for 2002, Table 10 and Worktable I, pp. 1585, 1634, 1662, 1703, 2220-2224, at cdc.gov/hchs/data/dvs/mortfinal2002_workipt2.pdf.
7. LaDou, Joseph. Workers’ Compensation in the United States: Cost Shifting and Inequities in a Dysfunctional System. New Solutions: Journal of Environmental and Occupational Solutions. Vol.20,(3), pp. 291-302, 2010.