Well, when you falsely accuse a (very) competent public servant of malfeasance and get rid of him, you get what you deserve.
That’s exactly what’s happening in North Dakota. The state workers comp fund (WSI) is dealing with two separate scandals, one involving alleged illegal removal of a nurse’s entry from a claim file, and the other alleged efforts by management to manipulate WSI’s Medical Director to change his medical opinions.
You would think that the current CEO, Bryan Klipfel, would be on this like white on rice. Alas, Klipfel stumbled into this job, with a grand total of zero prior experience in workers comp, insurance, medical care, rehab, finance, or customer service. But he was a “good listener…”
According to press reports, WSI’s “chief doctor who reviews injured North Dakota workers’ compensation claims said he twice resisted efforts by agency managers to alter his medical opinion.
Dr. Luis Vilella, the medical director for Workforce Safety and Insurance, said he refused to change his medical opinions when asked to do so on two occasions in February or March of 2010.”
I don’t know if the recent effort by WSI management to establish more control over their medical directors is related to those two earlier attempts to get Viella to alter his opinion, but the coincidence is certainly worthy of investigation.
Reading Klipfel’s comments on these issues, it is easy to see just how big a screw up the powers that be made in ousting Sandy Blunt and putting Klipfel, a complete newcomer to business, let alone insurance, never mind workers comp, in charge. Evidently WSI was working on this “policy”, but only submitted it to the state board of medical examiners after Viella asked for the Board’s help. According to press reports, Kilpfel said: “This is a draft policy…We were going to have some work done on it. We want to make sure the policy we have reflects the longstanding policy that legal never drives medical in handling our claims.”
As anyone who knows anything about comp learns on day one, you do NOT mess with medical opinions, and you most certainly do NOT try to get your medical director to alter his or hers’. Yet WSI was in the process of reviewing a policy that would “dictate how medical opinions are to be transcribed, documented, or recorded.”
That’s not all. A WSI nurse case manager found that her entry in a claim file was deleted by a claims manager who didn’t like that the case manager’s statement strengthened the claimant’s case.
Well, folks, you get what you deserve. The real reason Sandy Blunt was prosecuted was because he was working his butt off to reform a dysfunctional state agency that had long been subject to political manipulation; Blunt didn’t stand for that. Now he’s out, a complete incompetent is running the place, and the citizens of North Dakota are paying the price.
The chickens are coming home to roost. Someone is going to have a big job shoveling out the coop after Klipfel et al move out.
Or, as Bob Wilson notes, the dodos are the ones doing the roosting..

I received an email from an individual who attended a “hearing” on a workers comp bill in Hawai’i. It’s compelling for two reasons – it clearly illustrates the comp system’s vulnerability to manipulation by those seeking ever-greater profits and ever-lesser oversight, and the weakness and inadequacy of employers’ and insurers’ efforts to prevent that manipulation.
Here’s the perspective of Charlie Donovan – and no, Mr Donovan is not an insurance guy; in fact he works for a group of physicians that serve workers comp claimants.
“I was bothered by the fact that one of the biggest supporters of the [IME] bill, and from my understanding one of the most active participants in fundraising for Senator [Josh] Green [orthopedic surgeon and drug dispensing physician], was not only given the chance to testify, but was called upon again to answer questions in front of the committee.
I was incensed that there were 2 orthopedic surgeons with over 50 years of combined experience treating patients, performing surgery, and conducting IMEs sitting 10 feet in front of Sen. Green who were not given the time of day.
And it seemed so blatantly unfair that an injured worker who had driven in “all the way from Waianae” was given a chance to testify, but that a neurologist with over 30 years of experience who flew in from Maui to give testimony was not afforded the chance to speak.
But when testimony was closed, I looked at my watch and saw that barely 40 minutes had expired since the hearing was gaveled to order. With easily 2 dozen more people anxiously waiting to have their opinions heard, it was over.
Epiphany!!! The entire hearing had been a charade. The members of the committees who graced us with their presence (all 6 of them) were not interested at all in being educated, or in hearing what the “public” had to say. Passage of that bill was a “done deal” before anyone walked into the room, and the hearing was nothing more than an inconvenience for the committee members.
I suppose that I was naïve for thinking that “public testimony” really mattered, that years of experience, statistical data, and the opinions of other professionals would trump fundraising donations. I suppose that somewhere down deep I knew that politics was a dirty business, and that “public service” was a catch-phrase of absolutely no significance. But part of me didn’t want to admit it, until it was rammed down my throat in the most transparent piece of kabuki I have ever seen.
So while facts comes before fundraising in the dictionary, I must now begrudgingly admit something that I probably already knew – that the order is obviously quite different in the world of politics.
Like wandering behind a horse and getting kicked, this is a lesson that will not have to be taught twice.”
What does this mean for you?
Insurers and employers better get real, and fast. You are going to get your heads handed to you if you don’t stop dissembling and focus on these issues.
Workers comp is a very, very soft target for profiteering physicians and the various businesses that have sprung up to suck money out of employers’ premium checks. They are organized, very well-funded, and aggressive.
Meanwhile, insurers and employers are sitting idly by while these bad actors use your dollars to buy political influence.

After posting last week on the politicization of the physician dispensing issue in Hawai’i, I heard from a number of stakeholders alarmed by that – and other issues.
Chris Brigham, MD, has been following what can only be described as an effort to eviscerate Hawaii’s workers comp system. He contributes these observations to MCM.
The Aloha State has been friendly to physician dispensing and to certain legislative officials, including Senator Clayton Hee, Chairman of the Senate Judiciary and Labor Committee, receiving funding from individuals and entities associated with physician dispensing companies [Hee’s contributors were identified in MCM last week; last week I referenced a physician dispensing cost control bill that would take steps to deal with this issue, however the bill is likely to end up in the Committee and die.]
Physician practices involved in physician dispensing lobbied very actively for another bill, a bill that would effectively thwart the independent medical evaluation process in Hawaii.
HB 466 was passed this week by the State’s Joint Committee on Judiciary and Labor and the Committee on Health (chaired by Senator Josh Green, MD, who has also been the recipient of fund raising by interests aligned with physician dispensing companies.) This bill would require independent medical evaluations (IMEs) to be performed upon mutual agreement of the injured employee and the employer. The attitude and behavior of the treating physician heavily influences the patient; if the treating physician feels threatened by the IME physician, it’s likely the treating doc will advise the patient to reject the evaluation. Thus, what this bill really means is the treating doctor and employer have to agree on an IME. If there is no agreement, the evaluation is assigned by the director to a doctor from a list of qualified physicians maintained by the state.
At the hearing, a physician who heads up a large practice involved in physician dispensing stated he would be pleased to provide names of physicians qualified to be on the “list”. Interestingly, documents reveal that certain physicians charge a fee of $3500 for an IME for one of their own patients and the resulting five page report. Curious how a doctor could perform an “independent” evaluation on his own patient…
This bill also limits IMEs to one per case, unless valid reasons exist with regard to treatment. How does this deal with various issues that occur during a life of a claim and to multiple problems? What is the rationale or need for this legislation? No studies have been performed to demonstrate a problem. Hawaii has been known for high quality IME reports and, according to data published in the AMA Guides Newsletter March / April 2010; Hawaii has the highest degree of accuracy in impairment ratings in the country.
How is this state going to deal with changes that are likely to dramatically increase costs and result in delayed case closure? This is particularly problematic given Hawaii’s state budget shortfall. This legislation appears to be responding to a non-existent problem, rather than addressing any issue of questionable care. If decision makers are rational, recognize the true issues, understand there is no money to pay for the proposed needless changes, and do not make decisions influenced by who sponsors their campaigns, there is still a slim opportunity for defeat. I’m not optimistic.
In terms of thwarting bad care, could it get worst for Hawaii? Yes.
The same parties are advocating passage of a bill to allow the Director to approve treatment plans without a hearing if they are disputed by the employer, a bill to permit the Director or claimant to reopen cases even years after they are resolved by settlement if a question arises concerning undue influence or the injured worker’s mental competence, and a bill to allow attorney’s fees to be awarded if a claim is prosecuted or defended without good cause. Attempts to bring evidence-based medicine to Hawaii have been thwarted.
What does this mean for you?
Beware of strategies by certain stakeholders who are attempting to alter the workers’ compensation system through legislation to be more “friendly” to them – even if it results in increased costs (human and financial).
Recognize that some of these stakeholders may well be seeking influence through contributions to key legislative decision makers; Money talks. Recognize despite its beauty, not all is perfect in Hawaii – it is a wonderful place to visit, however you probably would not want to have a business or be injured there.