Beyond the costs of an injury

By Mark Leung, BWC Technical Medical Specialist,
Recently promoted from the BWC Safety & Hygiene Fellowship program

Occupational health and safety has been a public health focus for many years. Emphasizing worker protection and well-being advances the overall goal of reducing negative health outcomes in the future. The need to address health disparities within the working population is paramount to public health practitioners. In doing so, there have been many discussions about the actual costs of an injury or illness. However, is there a true quantifiable cost an occupational injury or illness creates?

We typically link occupational injuries and illnesses with their financial burden in the form of direct and indirect costs. Direct costs of an injury or illness relates to the medical treatment and rehabilitation of the worker, workers’ compensation costs and legal expenses. Indirect costs may include: lost productivity, training and compensating replacement workers, repairing damaged property, low employee morale, poor community relations, reputation, penalties, etc. The indirect costs of injuries and illnesses vary widely, and may be up to 20 times higher than direct costs.1

These costs are usually in the economic frame of reference for the employer. However, we must not lose sight of the social costs of an occupational injury or illness on the individual, community and societal level. Depending on the severity of the injury or illness, the worker’s quality of life suffers on the individual level. Quality of life goes beyond physical limitations, such as psychological well-being, social interactions and other non-work activities. In some cases, the diminished quality of life is a permanent reality as it influences the worker’s health behaviors and health trajectory for the rest of their lives.

Additionally, the lasting effect of the injury or illness can cause a ripple in an individual’s network. The quality of life for family members and friends may be diminished if they are involved in social interactions and the caregiving process with the affected worker. Even as part of their profession, caregivers and medical professionals carry a burden as a part of the treatment and rehabilitation portion of the process. Every social factor the worker experiences influences the community level in some shape or form. The summation of social costs may influence societal systems, including:

  • Stressing social safety nets;
  • Changing retirement trends;
  • Shaping laws and regulations;
  • Use of medical resources;
  • Changing population health outcomes.

The societal level offers us a call for action in the form of prevention, rather than a reactive approach.

The burden of an occupational injury or illness does not just fall on a worker and the employer. It is truly a social issue that has an impact on multiple layers of society. While it may be difficult to quantify a complete cost of an occupational injury or illness, our efforts to proactively address workplace risks and safeguard worker well-being as public health practitioners remain. Thus, it is ever so important to embrace occupational health and safety beyond the workplace.

1 Source: ASSE

Return to Work – Yes You Can!

Brain Injury Association of Ohio’s TBI Summit Panel Discussion

By Jeff Buffer, MA, CRC, BWC Vocational Rehabilitation Supervisor

I had the opportunity to participate in the Brain Injury Association of Ohio’s TBI Summit held at OSU’s Fawcett Center last month.  The conference’s goal was to help persons with traumatic brain injury (TBI), their families, and providers learn strategies that can help with community and work re-entry during recovery from a brain injury. The summit included information about brain injury treatment, services and therapies that can assist with those goals.

Brain injury survivor panel member

BWC’s Nurse Director Mary Charney, BSN, RN, and I co-presented in a panel titled, Return to Work-Yes You Can! Kara Moore, an Ohio Health speech and language pathologist, also joined us. Kara shared tips for working with employers of persons with a brain injury and she shared her perspective as a brain injury survivor after a motor vehicle accident and the challenges she experienced during her return to work.

Some tips she shared included following advice from doctors and therapists as to how much a person can do when they first attempt to go back to work after a brain injury, and letting the employer know about issues the worker with a brain injury is having and how they might be addressed. This could include being assigned a lighter work load initially or having a coworker help with more complex tasks.

Kara also talked about going back to work gradually and taking frequent rest breaks as needed. She mentioned types of job site modification that can be done to help with symptoms of a brain injury, such as changing the type of overhead or desk lighting in a work setting.

Preventing injuries, case management

Mary, who has extensive health-care experience in occupational medicine, presented on the importance of BWC’s injury prevention programs as they relate to reducing the number of brain injuries. BWC’s Division of Safety and Hygiene offers statewide safety awareness campaigns for slips, trips and falls, safety education and training programs, and safety grants that assist employers to purchase equipment designed to reduce workplace hazards.

She also discussed the importance of medical case management and care coordination, especially during the acute phase of care and rehabilitation. Patients with catastrophic injuries see multiple specialists and are faced with many complex decisions.  It’s the catastrophic case manager’s role to help the patient navigate confusing and complex health instructions and appointments and ensure the lines of communication remain open between the patient, family, providers and others involved in the case.

Medical management’s goal is to return every injured worker back to his or her optimal level of function, maximum quality of life and return him or her to work when possible.

Vocational rehabilitation in workers’ compensation

My presentation, drawing from over 30 years of vocational rehabilitation experience, included eligibility for services, when a person with a TBI might be ready to participate, and which services are considered the most effective when working with persons with brain injuries and employers. We discussed Information about being ready for vocational rehabilitation services for persons with brain injuries, plus the challenges they face, including a lack of understanding by employers and coworkers about brain injuries and accommodating the TBI employee’s needs.

Services that make a difference

Other challenges include identifying providers who have a knowledge of working with persons who have a brain injury. Some positives included vocational rehabilitation can develop specialized plan services to meet the TBI worker’s unique needs, and these services can focus on the whole person.

Services that help persons with a TBI include vocational case management and employment services such as a work trial, situational assessment, employer-based work adjustment or job coaching services.  Return-to-work (RTW) incentive services such as a gradual RTW plan or employer incentives for when a person’s productivity might be limited initially can be helpful. Other employment-based services such as on-the-job training, job modification, ergonomics and tools/equipment may also assist the worker.

In addition, supportive services such as adjustment to disability counseling and living maintenance can make a big difference when a person with a TBI is attempting to RTW in a vocational rehabilitation plan. It’s rewarding when all parties work together for one common goal to return a worker with a TBI back to the job.

Jackie Stanton, Ph.D., CRC, a case manager for Metro Health Rehabilitation Institute of Ohio’s Work Matters Program, facilitated the panel. The audience asked good questions about the information presented, and the current director of the BIAO, Stephanie Ramsey, (former BWC medical services director), commented that the presentation was well received and included needed information.  The attendees were persons with brain injuries, their families and providers – including psychologists, therapists and nurses, as well as case managers.

Focus on survivor’s strengths

Overall, the panel emphasized the importance of everyone working together as a team, including the person with a TBI, their family or support system(s), their employer and coworkers, doctors, psychologists, case managers, vocational providers and therapists.  It’s also important to focus on a patient’s strengths, and what they can do after a TBI, as this keeps the person engaged in the overall medical and vocational recovery process.

The more a person with a TBI learns about their new level of functioning after a brain injury, the more prepared they are to get back to activities of everyday life including employment.

Note: Here is a short video about an injured worker describing his experiences with a TBI who is back to life.

2018 Ohio Workers’ Compensation Medical & Health Symposium third year of success; adds provider staff forum track

We did it again with the help of Ohio’s providers!

Based on accolades from our 2018 Ohio Workers’ Compensation Medical & Health Symposium participants, the symposium’s third year was a smashing success.

Despite dealing with a snow storm, nearly 600 health-care professionals attended this unique, multi-disciplinary event held March 8 – 9 at the Greater Columbus Convention Center.

Thank you!
Together, symposium participants share our joint passion for the comprehensive care of Ohio’s injured workers.

We centered the program around injured workers’ total care.

To assist with this process, we offered up to 12.75 continuing education credits for 10 health-care professions this year.

A special thanks to the symposium’s outstanding presenters, exhibitors and participants as well as our Medical & Health Division for leading this event that we offer participants at no cost. We continue to offer state, national and international experts for our provider clinical education sessions.

The Medical and Health Symposium​ featured two outstanding speakers who shared their inspiring stories of overcoming obstacles and adversity while recovering from injuries. They offered tips for injured workers, providers and family members on how to deal with sudden change following a catastrophic injury. Now they are giving back to others from their life experiences.

Brad Hurtig lost both hands in a workplace accident while in high school, and Dale Hull, M.D. became a tetraplegic following a trampoline accident.

Here is an earlier BWC story about Hurtig’s injury and recovery. He has come full circle in his recovery.

What was new this year?
This year our annual symposium included a full-day provider staff forum track (March 9) designed specifically for office support staff.

BWC and managed care organization experts led lively sessions that included panel discussions and questions and answers.


Again, the exhibitor area was a big success with 21 exhibitors who help care for Ohio’s injured workers.


Ohio State Chiropractic Association (OSCA): OSCA representatives reach out to symposium participants about the latest trends and advantages in chiropractic care for Ohio’s injured workers to help them get back to work, back to life.

We couldn’t be more pleased with the symposium’s success. Thank you for joining us and for helping us in taking care of Ohio’s workers – at home and at work.

Remember to log in to the Attendee Service Center no later than April 11 to evaluate your sessions and print attendance certificates.

Here’s a look back in photos and tweets!

We’re off and running! Registration was in full swing at our 2018 Ohio Workers’ Compensation Medical & Health Symposium.

Comprehensive Care: BWC’s Chief Medical Officer Dr. Terry Welsh kicks off the symposium emphasizing continuing education’s value for providers at all stages of their careers.

When Change Chooses You:  Dr. Dale Hull of Utah shares his story of dealing with tetraplegic paralysis following a spinal cord injury. He reviewed what he learned as a patient that he would have ignored as a physician.

Return to function: Dr. Ranavaya, who is also an attorney, reviewed stay/return to work strategies for injured workers. He also discussed how to help methodically determine disease causation in another session.

Speakers who kicked off the symposium: They are from l. to r. Dr. Hull who had a life-changing accident that lead to paralysis; Dr. Mohammed Ranavaya of Marshall University School of Medicine who reviewed how providers can help injured workers stay/return to their jobs and our Dr. Welsh, a physical medicine and rehabilitation specialist.

Moving Toward a Targeted Approach to Concussion:  Dr. Alicia Sufrinko of the University of Pittsburgh Medical Center Sports Medicine Concussion Program, discusses the framework for looking at an injury and how assessments lead to certain clinical profiles for concussions.


Shoulder Injuries – Treatment, Referral, Surgery and Return to Work: Dr. Matthew Levy, orthopedic surgeon of St. Vincent Charity Hospital, Cleveland, answers questions about different surgical techniques for repairing shoulder injuries.


Wellness and Total Worker Health: Dr. Otto Schmidt discusses warning signs or red flags to look for when taking care of an injured worker’s total health with a fellow chiropractor.



Diversity – Cultural Competencies lead to better Outcomes: Dr. Alejandro Diez, Ohio State University, explains how demographic changes in Ohio’s population form the current diversity of our patient population.

He discussed cultural issues that impact patients’ health and well-being.


Pharmacy trends: Dr. Amanda Waltemath, Healthesystems of Florida, discussed current and emerging pharmacy trends and their impact on workers’ compensation.


Neurobiology of Addiction – Science Meets Recovery: Dr. Susan Blank, chief medical officer and founder, Atlanta Healing Center, says the American Society of Addiction Medicine defines addiction as a primary chronic disease of the brain. It influences the mind, body and soul.
Pharmacy blogger: Mark Pew, senior vice president of PRIUM (right) discusses the genesis and scope of the opioid epidemic with symposium participants and with our Pharmacy Director Nick Trego (left).




Health and Behavioral Intervention:
Dr. Michael Sullivan of McGill University, Canada, reviewed a behavioral/health program to assist injured workers in getting back to work, back to life.

BWC Initiatives and Strategies: From a medical perspective, Administrator/CEO Sarah Morrison reviewed BWC’s new initiatives that impact providers and their patients.

Find A Way: BWC Administrator/CEO Sarah Morrison stands with motivational speaker and injured worker Brad Hurtig before Hurtig’s presentation that closes out our symposium with a standing ovation. 

Hurtig was tragically injured in high school at a local manufacturer and lost both his hands. But, he turned obstacles into opportunities by continuing to play football and leading his team to victory.

See you in 2019! Thank you for helping injured workers get back to work, back to life.

Finding a way: Injured worker triumphs through tragedy

Brad Hurtig, a double amputee, inspires audience at BWC medical symposium

By Tony Gottschlich, BWC Public Information Officer

The workplace accident that took Brad Hurtig’s hands in 2002 could have taken so much more from the high school student-athlete — his place as a star linebacker on the football team, his hopes, dreams and career goals.

But Hurtig, who gave the final lecture Friday at the 2018 Ohio Workers’ Compensation Medical & Health Symposium, wouldn’t let that happen, thanks to a coach who wanted him back on the team and a water bottle on the practice field.

“He invited me to practice when I got out of the hospital,” Hurtig recalled to hundreds of health care providers gathered at the Greater Columbus Convention Center. “It was in late July, super hot and muggy. There was a water bottle on the ground, and I asked my coach for a drink. Well, he paused for a moment, looked at the water bottle, then up at me and said something that would ultimately change my life: ‘If you’re thirsty enough, you’ll find a way.’”

Hurtig found a way, along with a new motto that propels him to this day as a motivational speaker and youth minister.

A three-sport jock, Hurtig had broken a school record for tackles as a middle linebacker his sophomore year. After his accident and a failed stint as a placekicker (“I was terrible”), he returned to his old position his senior year, broke more records (111 tackles) and made all-state honors in his division.

Now 33, the northwest Ohio resident travels the country talking to high schoolers, the media and others about perseverance through adversity. He calls his lecture, Find a Way: Turning Obstacles into Opportunities.

BWC Administrator Sarah Morrison stands with motivational speaker Brad Hurtig before Hurtig’s lecture Friday afternoon at the Ohio Workers’ Compensation Medical & Health Symposium.

Speaking for about an hour to the symposium audience, Hurtig recalled the June day of his accident 16 years ago, shortly after finishing his sophomore year, and the journey that followed.

He was working in a friend’s family business, a metal shop, placing sheet metal in a 500-ton power press that stamped metal into automotive parts. One sheet was misaligned. He attempted to straighten it, but his friend at the control switch didn’t notice. The press came down, severing Hurtig’s right arm below the elbow and crushing his left hand.

“The first thing I remember wasn’t really the pain or even the physical sensation, it was hearing someone scream when they looked at me,” he said.

Hurtig spent 11 days in a Toledo hospital and endured multiple surgeries. In the weeks and months that followed, he worked closely with his medical team and BWC to adapt to his new life and make life adapt to him. BWC provided equipment so he could drive, open doors, turn the shower on and operate a computer. Key to his recovery were myoelectric prosthetic arms.

He removed his prosthetics and explained to the audience how they work. He spoke of the family, friends and health care providers who supported him throughout his ordeal, the empathy of doctors and others who seemed genuinely caring and dedicated to his recovery. “BWC was huge,” he said.

He also shared a couple of workplace safety tips:

  • Stop and think. Impulsive, snap decisions get us into trouble.
  • “If I just communicated with my friend, I would still have my hands.”

“The reality is we all have challenges in life, we all have setbacks, and I can tell you that how we handle those setbacks will in many ways define our lives,” he said. “Excuses will only get you so far. If you’re truly thirsty enough, you will find a way.”

For more on Hurtig, visit

Report: Ohio in poor health

‘We need to step up our game,’ chiropractor says

By Tony Gottschlich, BWC Public Information Officer

When it comes to health and wellness, Ohio is in pretty shabby shape, a Cleveland chiropractor told hundreds of health care providers Thursday afternoon at the Ohio Workers’ Compensation Medical & Health Symposium.

Dr. Otto Schmidt, referring to America’s Health Rankings for 2017 by the United Health Foundation, said Ohio ranks 39th in overall health and wellness compared to the rest of the country.

“I saw where Ohio is ranked, and it kind of took me back,” Schmidt told an audience at the Greater Columbus Convention Center. “I find that a little disconcerting as a health care provider. We have to ask ourselves, can we do better?”

Schmidt pointed to several health indicators where Ohio ranks near the bottom: cancer deaths (40th), heart attacks (39th), smoking (45th) and drug deaths per 100,000 people (46th). But Ohio ranks highly in the number of primary care physicians (13th) and number of hospitals (5th).

“We need to step up our game,” Schmidt said.“In workers’ compensation, we need to focus not just on the trauma of the injury but on the wellness of the injured worker.”

That means looking at the total person and recognizing “red flags,” he said.These includes physical and behavioral barriers that complicate an injured worker’s recovery, co-morbidities such as obesity, diabetes and smoking, anxiety, poor attitude and other self-defeating behaviors.

He said getting injured workers back to work takes a team effort from all stakeholders involved,including physicians and other health care providers, injured workers and their support network, and even employers.

Schmidt, who also serves on BWC’s HealthCare Provider QualityAssurance Advisory Committee, noted two BWC programs that incorporate those elements, physician-driven models that stress coordinated care. They include the Enhanced Care Program, a pilot program focused on knee injuries, and the Health and Behavior Assessment and Intervention rule, which offers coaching and counseling sessions to help patients overcome negative thinking, poor coping skills and other behavioral barriers to recovery.

BWC also is addressing worker health and wellness with a free program it launched Feb. 1. The agency’s Better You, Better Ohio! program offers health risk assessments, biometric screenings, personalized health plans, coaching and more to Ohioans who work for companies with 50 or fewer employees in certain high-risk job classifications, such as construction, manufacturing, agricultural, and others.

“We all have to be on the same page,” Schmidt stressed. “I don’t see any reason why we can’t go from 39th to the top 10. We just need to step up our game.”

The health symposium, which runs in conjunction with BWC’s Ohio Safety Congress & Expo, continues through Friday.

Safety, health and wellness – it’s a team effort!

Final day at the Greater Columbus Convention Center

The Ohio Safety Congress and Expo continues today with a total of nineteen educational sessions scheduled. Among them, a full day of leading edge technology. From 8:30 a.m. to 4:30 p.m. vendors and researchers will come together for a discussion on wearable devices known as industrial exoskeletons, developed to prevent workplace injuries. Read more about them here.

Take the Short North escalator to the second floor and you’ll find a full day of sessions at the Medical & Health Symposium. Presentations run from 7:45 a.m. to 3:30 p.m. Vendors will also be available to chat about their programs and services.

A list of all remaining OSC18 and Medical & Health Symposium sessions can be found here.

We’ll be live tweeting from the symposium, so stay tuned to hashtag #BWCmhs and share your experiences too!

Looking for a recap of yesterday’s activities? Take a look at Twitter hashtags #OSC18  and #BWCmhs  or follow us @OhioBWC.

Paralyzed doctor inspires at BWC health symposium

Dr. Dale Hull, the walking definition of irony

By Tony Gottschlich, BWC Public Information Officer

Assisted by a cane, Dr. Dale Hull walked slowly to the podium and pronounced, “I am a quadriplegic” to an audience Thursday morning at the Ohio Workers’ Compensation Medical & Health Symposium.

“You might be asking, ‘Are you sure about that? I just saw you walk to the podium and you’re moving your arms,’” Hull told a hushed audience at the Greater Columbus Convention Center. “I assure you, I am partially paralyzed from the mid-trunk down.”

Hull then shared the story of how a tragedy — a trampoline accident in 1999 damaged his spinal cord and upended his life as a successful obstetrician-gynecologist and married father of four sons in South Jordan, Utah — became a transformation.

“As we go through life, we make plans, we make choices, we feel like we’re in control and we choose to change at times,” he said before revealing the theme of his lecture. “But what happens when change chooses you?”

Hull, who was 44 at the time of his accident, explained that he struggled mightily in the early months of his recovery. The loss of independence was almost too much to bear. His prospects and outlook were dim, and seeing even the most mundane of activities — a neighbor mowing his lawn — would reduce him to tears.

“I felt like a modern-day leper, at times like I wasn’t even a worthwhile human being,” he said. “I thought it was so unfair for God to give me something I wasn’t prepared for.”

He said he had hoped he would just regain enough movement in one hand so he could maneuver a powered wheelchair. But in the months that followed, through faith, family and dedicated health care providers, he regained much more.

It started with a big toe, followed by slight movement in his legs, and then an index finger. He endured intensive physical and occupational therapy, and in two years he could walk again with the aid of arm crutches.

Not satisfied, Hull set his sights even higher. The Winter Olympics in Salt Lake City were coming up, and Hull wanted to carry the Olympic torch. In February 2002, he did just that, topping off the experience when he passed the flame to basketball superstar Karl Malone of the Utah Jazz.

“This was my George Bailey, It’s a Wonderful Life moment,” he said, referring to the Jimmy Stewart holiday classic.

Grateful for the strides he had made, Hull and physical therapist Jan Black started wondering how they could help others recovering from spinal injuries. Then he read a Mahatma Gandhi quote he hadn’t seen before: You must be the change you want to see in the world.

“When I read this quote, I said, ‘Are you kidding me?’ Because I knew what it meant.”

In 2004, Hull and Black founded a nonprofit, outpatient neuro-rehabilitation facility in a 1,000 square-foot store front and called it Neuroworx. In the years since, thanks to its success and generous benefactors, Neuroworx has grown into a modern, leading rehab facility with state-of-the-art equipment and a mission to serve adult and child patients alike, regardless of their ability to pay.

“This adventure has been so rich in its experiences and so amazing in terms of what I’ve learned,” Hull said. “If God or Buddha or even (Ohio State University head football coach) Urban Meyer told me I could have a fully functioning body again, but I’d have to forget everything I’ve learned over the last 18 years, I would say no thanks, don’t touch me.”

“I have no idea why I’m so blessed and so fortunate,” he said. “I just know that I am.”

You can watch Dr. Hull give a TEDx-talk about his journey here.

The health symposium continues through Friday.