Western Occupational & Environmental Medical Association
Leading Occupational & Environmental Medicine

Welcome to the WOEMA WINDOW, our e-newsletter sent to members by email on a monthly basis. The newsletter links to this page. Below are the items that appeared in the July 2017 issue.



A Message from WOEMA President Robert Blink, MD


We are now about midway through 2017, and health care has been one of the centers of national discussion, though no concrete changes so far in the centerpiece, the Affordable Care Act (ACA). Meanwhile there have been other changes afoot in neighboring realms that are of direct concern to OEM practitioners: a proposed 40% reduction in NIOSH funding; marked changes in immigrant labor; likely postponement of federal OSHA regulations including enforcement of the new silica rule; and climate change denials. While these developments are national or international in scope, they have significant bearing at the state and local level as well.

I like to think of WOEMA’s role as comprising three kinds of action, geared toward three audiences: the workplace, the public at large, and ourselves as occupational medicine practitioners.

We are constantly monitoring legislation and regulations of the US and in all five WOEMA states (AZ, CA, HI, NV and UT), and frequently offer our analysis and suggestions, support or opposition on complex topics that we are uniquely able to address. With attention to worker protection, practicality for employers, and efficiency concerns, we use as our compass the realities of threats to worker health, buttressed by Evidence Based Medicine and other scientific approaches whenever possible. WOEMA “punches above its weight” because we are viewed as a reliable and honest source of information and high-quality analysis.

We also address public policy regarding population health/ health care and environmental health concerns, with a similar emphasis on real-world threats and scientific analysis.

WOEMA is a vigorous advocate for improved compensation for high-quality medical services and for smoother functioning of workers’ compensation systems. For instance, in the past few years we have been an important contributor to successful efforts to increase Evaluation and Management payments in California.

Finally, through our educational programs, from WOHC (come to Hawaii!) to bi-monthly webinars, we are always looking to help keep our members up to date on relevant topics. In next month’s WOEMA Window, President-Elect Dr. Sachin Kapoor will report on progress in an exciting new venture underway, to create a Certificate educational program for providers in the California workers’ compensation system that will be a trailblazing way to attain and show proficiency in this area, filling a gap left by government.

Your support for WOEMA allows us to work together and achieve great things.


Legislative Affairs Committee Update



June 16, 2017

  • Cal/OSHA Lead Standard – The Legislative Affairs Committee met Wednesday with Cal/OSHA Chief Juliann Sum, DIR Director Christine Baker, and DIR Legislative Director Victoria Hassid regarding the lead standard. DIR has contracted with UC Berkeley economist to conduct the SRIA economic analysis. It is unknown if the current bill SB 772 (Leyva), which exempts worker safety regulations from the SRIA process, would apply to the pending lead standard.
  • Interstate Medical Licensure Compact – ACOEM supports the compact, which allows for greater reciprocity between states regarding physician licensure.  CA and HI are two WOEMA states that have not adopted the compact.  The Legislative Affairs Committee will check with the MBC and CMA regarding their respective positions on this.
  • QME – The Committee discussed the article in Work Comp Central in which some QMEs are objecting to DWC’s apparent change in QME oversight, which includes expelling QMEs owing to their billing patterns, and only notifying QMEs of problems at time of recertification.  Dr. Feinberg noted the complaints from QMEs are widespread and pervasive, and that many are choosing to stop participating.  Other Legislative Affiars Commitee members noted that many QMEs write poor reports and that fraud is common. The Committee discussed the prospect of querying/surveying WOEMA CA members about their own experiences as QMEs.
  • Genetic factors/apportionment – The Committee discussed a WCAB case in which a young worker with a low back injury worked only a short term for a particular company.  QME apportioned the case citing hereditary factors, given that the worker was too young to otherwise exhibit a degenerative condition. The question is whether this reasoning could be applied to more conditions and create confusion in the system.


June 23, 2017

  • SB 562 (Lara/Atkins) – The Legislative Affairs Committee anticipates no significant change this year.  There is a question of funding and how this would impact the current health care model.
  • American Health Care Act (AHCA) – The AHCA Discussion draft to decrease the Medicaid expenditure at a rapid rate.  After 2020, no further subsidized coverage for the lower income family, which would result in the loss of healthcare coverage for many people.  Prevention and mental health services may be cut/reduced as well.  This is an important issue that would impact us all.  Also, the ACA Discussion draft proposed a concept of “health sponsor.”  “Health Sponsor” can sell health care policies to employers of different states after paying $5000 fee to become a sponsor.  This would decrease the quality of coverage and result in difficulty monitoring such a health plan.  Further details and updates to be discussed.
  • Cal/OSHA Lead Standard – The Committee proposed a letter to CMA in order to request that CMA take an official position on the lead standard.  This would allow CMA to be aware of the WOEMA’s support on the lead matter, and CMA is reminded that WOEMA should be considered the consulting expert in these issues of occupational/environmental medicine.


June 30, 2017

  • SB 562 (Lara/Atkins) – The Committee reviewed the demise of this bill. This year’s CA single-payer legislation’s biggest challenge was the Senate’s deferral on setting out a funding proposal, leaving the Assembly to do the heavy lifting.
  • SB 617 (Bradford) – Set for hearing in Assembly Insurance July 12. Whether SB 617 can receive additional amendments or will become a two-year bill depends on the hearing.

Click Here to read WOEMA’s Policy Platform

The Legislative Affairs Committee is Co-Chaired by Dr. Rupali Das & Dr. Roman Kownacki, with Don Schinske as Policy Advisor. For questions or to get information about the WOEMA Legislative Affairs Committee, contact woema@woema.org 


Pearls of Wisdom
by Scott Krasner, MD, MPH, FACOEM


For those of us practicing in clinical Occupational Medicine, it is often difficult to provide appropriate treatment without taking sides. Who do we advocate for? Do we advocate for the injured employee; do we advocate for the employer? I am reminded of a medieval rack wherein the doctor is strapped down, with the injured employee tightening one end and the employer tightening the other end.

To help resolve this conflict, let me give you some pearls of wisdom. Remember to practice by these two rules:

Rule #1: Make medical decisions for medical reasons. Isn’t this another way of saying to practice Evidence Based Medicine? Medical decisions include medical treatment, ordering diagnostic tests, and instituting work limitations/restrictions. When such decisions are made by sound scientific principles, one can minimize any bias in the decision.

Rule #2: Stay out of politics. Politics is anything that is not medical. This includes company policies such as medication usage at work, or whether work restrictions can be accommodated. How many times have you heard patients say, “But doctor, there is no light duty work”? That may or may not be true, but it is not a medical issue and up to each company – Don’t fall into that conundrum.

By following these two rules, you will be able to provide the standard of medical care, and avoid being manipulated by either side. In essence advocate for medical truth, and in doing so you are really advocating for the injured employee AND the employer.



FREE CME: WOEMA Webinar Series
Tuesday, August 29 • 12:00 pm PDT



Knee Injuries: Pearls & Pitfalls

Presented by: Leslie Kim, MD

This presentation will highlight pertinent key points in evaluating and treating common–and some uncommon–knee conditions presenting to occupational medicine specialists. This will include identification of “red flags,” practical pointers on performing a knee examination, appropriate use of diagnostic studies, efficacy of certain treatment modalities, and timing of referral for orthopaedic consultation. Participants should be able to apply this information to more effectively and efficiently manage knee injuries in their practice.

Learning Objectives – After this webinar, participants will be able to:

  • Recall key questions when obtaining the patient’s history of knee injury
  • Describe the knee anatomy and clinical correlation to the physical examination
  • Appropriately use diagnostic testing and treatment modalities for different knee conditions
  • Identify urgent knee conditions that require timely referral


Dr. Leslie Kim is a board certified orthopaedic surgeon in active general practice with sub-specialization in shoulder and knee arthroscopy. His special interests include sports medicine, workers compensation, forensic (medico-legal) orthopaedics, and health care innovation. Dr. Kim is a graduate of Stanford Medical School. He completed general surgery internship and orthopaedic surgery residency at UCLA. He also received post-graduate fellowship training in arthroscopic surgery, orthopaedic trauma in Munich Germany, and reconstructive surgery at Scripps Clinic. Following Dr. Kim’s formal training, he gained additional experience working at the Olympics and serving as a local college team physician, as well as expertise in the workers compensation system as medical director of a large statewide medical group. Dr. Kim is presently the chair of the orthopaedic surgery department at Mills-Peninsula Hospital in Burlingame, and on staff at Seton Medical Center.




Western Occupational Health Conference 2017
September 13-16, 2017 // Maui, HI

Featured Post-Graduate & Plenary Sessions:

  • AMA Disability Text: Real World Examples & Case Discussions of Disability, Impairment, & Return to Work (PG-1)
    Many sources provide mixed messages to injured workers as to what is best for them. Do you know the spectrum of problems one might create as a clinician when we place patients off work? Learn the principles and practical pearls in “AMA Guides to Evaluation of a Work Ability and RTW”. Lock in the learning by group discussion of case presentations. Participants will also be provided with tools for managing difficult conversations. Earn 4 CME Credits
  • Changing World, Changing Practice: Challenges and Opportunities in Environmental Health
    Upon completion of this session, participants should be able to explain at least three emerging environmental health issues relevant to the practicing OEM physician, discuss at least two opportunities and two challenges from new environmental monitoring and chemical testing methods, and identify at least three reliable scientific sources for further information in environmental health. Earn 1.5 CME Credits
  • An OEM Perspective on Health & Safety in Agriculture: Farmers & Farmworkers
    The vulnerabilities of the agricultural worker have intensified and changed. Precarious work, poverty, fear of deportation, extreme housing conditions, heat stress (immediate and long term impact), co-morbidities and more. Learn how to identify, recognize, and treat from the research and case studies of the national experts. Earn 1.25 CME Credits

Click Here to View Full Session Schedule

Networking Opportunity:

Welcome Reception 
Thursday, September 14 •  4:00 – 5:00 pm

All conference delegates and their guests are warmly invited to attend the opening reception, our official kick-off to the conference. In addition to getting acquainted with conference attendees, you’ll meet our exhibitors who bring forward their latest products/services and provide a gateway to new ideas and opportunities.


Open Afternoon Activities:

Get more information at Wailea Marriott Concierge and the Maui Visitors Bureau


2018 AOHC Call for Proposals Now Open!

 Concurrent session proposals are now being accepted for the 2018 American Occupational Health Conference, to be held at the Hilton New Orleans Riverside, April 29-May 2, 2018. Resident and Individual scientific abstracts are being accepted as well.

 ACOEM is pleased to announce an improved online submission process. You will be able to save and edit your proposals and abstracts before final submission! For consideration, all proposals and abstracts must be received by the deadlines indicated below and by clicking on the following links:

Concurrent Session Proposals – Deadline: Sunday, August 6th, 2017 at 11:59pm (central)

Resident and Individual Scientific Abstracts – Deadline: Sunday, February 4th, 2018 at 11:59pm (central)