The LA County Observer

Observations of a LA County Resident

Virtual Tools to Support Nurses’ Mental Health

Written By: raconte - Jul• 01•20

The American Nurses Foundation recently launched “The Well-Being Initiative” to provide resources to support the mental health and resilience of nurses. This site can serve as an invaluable resource for nurse, especially during our current COVID-19 crisis. The link to the site and its resources can be found by following this link.

LOS ANGELES COUNTY ANNOUNCES NEW MENTAL HEALTH RESOURCES FOR LATINO COMMUNITIES AFFECTED BY COVID-19

Written By: raconte - Jul• 01•20

On June 22, 2020 the following press release was issued form the COVID-19 Emergency Operations Center. The press release announced efforts being made by LA County’s Department on Mental Health in partnership with the UCLA Hispanic Neuropsychiatric Center of Excellence to address the mental health needs of the County’s Latino communities. Below is the press release in full as well as a link to the video.

LOS ANGELES COUNTY ANNOUNCES NEW MENTAL HEALTH RESOURCES FOR LATINO COMMUNITIES AFFECTED BY COVID-19

In response to a growing body of data showing an increased need for COVID-19-related mental health services, LA County has announced specific resources for the Latino communities.

The County’s Department of Mental Health, in partnership with the UCLA Hispanic Neuropsychiatric Center of Excellence, is building up a team of 150 Spanish-speaking “promotores” – trusted messengers who will connect people with services –  who will work side-by-side with DMH clinicians to ensure vulnerable Latino communities are tested for COVID-19 and connected with improved and expanded mental health resources.

Since the COVID-19 pandemic began, data shows that the Latino community is one of the hardest-hit groups economically.

“Latinos make up significant portions of our hospitality, construction, and retail sectors of the labor market and comprise a large segment of LA County’s uninsured population,” said Los Angeles County Board of Supervisors Chair Pro Tem Hilda L. Solis. “Our communities of color are unable to telecommute, and they will not be paid if they miss a day of work, which adds to their levels of stress. Too many Latinos lack access to quality mental health services, and through our partnership with UCLA, we are ramping up our services to individuals who are suffering silently.”

A survey by the Pew Research Center conducted in March found that the Latino community was more likely to say that they or someone in their household had experienced a pay cut or job loss due to COVID-19.

Economic burdens along with stress, isolation, and high infection rates, highlight the structural inequities impacting LA County’s Latinx communities.

“There is no stigma in seeking help from mental health professionals. It is a sign of strength, and I want everyone to know they can reach out to us if they are feeling overwhelmed by COVID-19,” Solis said.

Many Latinos in LA County are essential workers who do not have the option of working from home, which puts them at a higher risk of exposure to the virus. Even though a high number of Latinos work in the hospitality, construction, and retail sectors, many lack medical insurance and access to quality mental health care, which adds to their anxiety and stress. In LA County, Latinx communities report the highest number of confirmed cases of COVID-19 and the highest death rate.

“Latinos have been disproportionately impacted by COVID-19, both physically and mentally, and they need access to culturally appropriate mental health services to heal,” said Dr. Cynthia Telles, director of UCLA’s Hispanic Neuropsychiatric Center of Excellence. “We are partnering with faith-based organizations, churches, community clinics, and local health centers to reach individuals who may be reluctant to seek professional care.”

UCLA and DMH have established bilingual support groups for Latino parents of children with disabilities and mental disorders, such as autism and ADHD, as many of these families are struggling due to the pandemic. There are bilingual support groups for elderly persons and caregivers who are also more likely to be struggling at home during this time.

In addition to work in the community, UCLA has created resiliency training for DMH psychologists to support them in dealing with their own burnout and grief.

“LA County’s Department of Mental Health is proud to support this unique initiative that offers Latino immigrants and other underserved communities greater access to mental health services that will help them navigate this difficult time, while mitigating further harm in the future.” said Jorge Partida, PsyD, chief of psychology for LA County’s Department of Mental Health. “We are training clinicians, promotores and other mental health professionals to be more culturally attuned when meeting the needs of Latinos who are experiencing depression and higher levels of mental health stressors due to COVID-19. Our communities of color have been on the frontline of this pandemic. Acting now will reduce further disproportionate impact in the future.”

At the June 23 virtual Board of Supervisors meeting, the Board will vote on a motion authored by Supervisor Solis, and co-authored by Supervisor Janice Hahn, directing the County to improve and expand mental health care for underserved Latino communities.

Those who missed today’s live broadcast can view the video here.

Important Mental Health meetings and webinars to join/attend to network, advocate, collaborate during COVID-19 “Safer at Home order”

Written By: raconte - May• 31•20

Many in LA County have lost and are continuing to lose family and community to COVID-19. While many more are afraid because they’ve lost their jobs, may lose their homes, and the unsure future.

I hope the information and resources below will help to inform and empower your community and you during these “interesting times” I hope that you’ll take this as a call to action to protect your communities, your family and you as both LA County and the State of California move forward during and after this COVID-19 pandemic.

Meetings and webinars you can join/attend if you want to network, advocate, collaborate, or be better informed:

State

Department of Health Care Services

Stakeholder Advisory Committee and Behavioral Health Stakeholder Advisory Committee Webinar – May 27, 2020

Link: https://www.dhcs.ca.gov/Pages/DHCSStakeholderAdvisoryCommittee.aspx

Mental Health Services Oversight and Accountability Commission (MHSOAC)

Event Calendar

Link: https://www.mhsoac.ca.gov/news-events/events

LA County

LACDMH MHC Full Commission Meeting

Event Calendar

Link: https://dmh.lacounty.gov/events/category/general-event/2020-06/?tribe_events_cat=general-event&tribe-bar-date=2020-06

Los Angeles County Board of Supervisors

Link: http://bos.lacounty.gov/Board-Meeting

Los Angeles City Council

Link: https://www.lacity.org/government/meeting-calendars/city-council-meetingsagendas

Los Angeles County Underserved Cultural Communities (UsCC)

Access for All Underserved Cultural Communities (UsCC)

Link: https://dmh.lacounty.gov/about/mhsa/uscc/access-for-all-uscc/

African/African American (AAA) Underserved Cultural Communities (UsCC)

Link: https://dmh.lacounty.gov/about/mhsa/uscc/african-african-american-aaa-uscc/

American Indian/Alaska Native (AI/AN) Underserved Cultural Communities (UsCC)

Link: https://dmh.lacounty.gov/about/mhsa/uscc/american-indian-alaska-native-ai-an-uscc/

Asian Pacific Islander (API) UsCC

Link: https://dmh.lacounty.gov/about/mhsa/uscc/asian-pacific-islander-api-uscc/

Eastern European Middle Eastern (EE/ME) Underserved Cultural Communities (USCC)

Link: https://dmh.lacounty.gov/about/mhsa/uscc/eastern-european-middle-eastern-eeme-uscc/

Latino UsCC

Link: https://dmh.lacounty.gov/about/mhsa/uscc/latino-uscc/

Lesbian, Gay, Bisexual, Transgender, Queer, Questioning, Intersex, Asexual, Two-Spirit (LGBTQIA2-S) Underserved Cultural Communities (UsCC)

Link: https://dmh.lacounty.gov/about/mhsa/uscc/lgbtqia2-s-uscc/

Service Area Leadership Team (SALT – formerly known as Service Area Advisory Committee/SAAC)

Link: https://dmh.lacounty.gov/about/salt/

Cultural and Ethnic Services Organizations

Disability Rights California

Link: https://www.disabilityrightsca.org/events

Virtual Wellness Circles

Link: https://www.eventbrite.com/e/virtual-wellness-circles-tickets-105245094912

#Out4MentalHealth Los Angeles Virtual Gathering

Link: https://us02web.zoom.us/meeting/register/tZYpdeysqTsoE9yVO-tkjixy5eSMBtCPF8F6?fbclid=IwAR29a1YAsP8WKo81_Y4QzfAjVfjUO1lh3MXtiNGTZEp9iXjKe-nw9UZmhls

Los Angeles Region Empowerment Workshop & Leadership Training

Link: https://attendee.gototraining.com/r/3234342502804928001

Los Angeles Region Empowerment Leadership Training

Link: https://attendee.gototraining.com/r/6446779028608255489

Advocacy groups to join

Peer Voices of California a Client Advocacy Coalition

Link: https://www.accesscalifornia.org/peeradvocacycoalition

Disability Voices United

Link: http://www.disabilityvoicesunited.org/1/get-involved/

 

 

 

On Our Sleeves – Mental Health Resources for Children in the time of COVID-19

Written By: raconte - May• 31•20
There are many great mental health resources available, and the current COVID-19 crisis has made it even more critical to have the ability to access them. Below is a link to mental health resource for children – the site is called On Our Sleeves and can be found following this link– https://www.nationwidechildrens.org/giving/on-our-sleeves?utm_source=facebook&utm_medium=social-paid&utm_campaign=oos-national&utm_content=image-v2&sc_camp=70C52223579542349A8D96B06E61978F&fbclid=IwAR256C_RE0RHetS3_xR3Z-DX5M-yvZAmoKIv1lRsu8abYwASCfuLhGtBg_0

This just in from the Los Angeles County Department of Mental Health! – WE RISE 2020 VIRTUAL MAY

Written By: raconte - May• 01•20
On May 1st at 10:00 AM Director Dr. Jonathan Sherin will announce:

  • May is celebrated nationally as Mental Health Awareness Month to spotlight the importance of mental health issues and access to care for everyone. The COVID-19 pandemic has increased fear, anxiety and stress dramatically, so visibility and awareness for this important issue are needed now more than ever.
  • In recognition of Mental Health Awareness Month, Mental Health will launch WE RISE 2020: Virtual May, a community capacity building celebration of healing, mental health and wellbeing powered by creative expression and connectedness. Now in its third year, our WE RISE campaign has been completely adapted for virtual platforms with original performances by diverse artists and celebrities, interactive workshops and unique programming with messages of inspiration and motivation and other special moments. Details are available on la – watch a collaboration with Get Lit and an event preview.

Free access to Headspace Plus, a gold-standard virtual guide to meditation and mindfulness. By going to headspace.com/lacounty, all Los Angeles County residents can access a free subscription. Available through 2020, residents can use this tool to get hundreds of science-backed guided meditations in English and Spanish, as well as mindfulness and sleep exercises to help address rising stress and anxiety.

You can watch live on May 1st at the following links:

WATCH LIVE:

  • Facebook at facebook.com/LACDMH
  • YouTube at youtube.com/lacdmh
  • Twitter at twitter.com/lacdmh
  • *Members of the public and media can listen in by telephone:
    • English:    (877) 873-8017, Access Code: 111111
    • Spanish:   (877) 873-8017, Access Code: 222222
    • Mandarin: (877) 611-4778, Access Code: 9516097
    • Korean:    (877) 611-4778, Access Code: 9275591

COVID-19 County websites:

Courtesy of the LA County Department of Mental Health – “Guide to Wellbeing Apps”

Written By: raconte - Apr• 19•20
Our Los Angeles County Department of Mental Health (DMH) has been hard at work keeping staff, stakeholders, and the community-at-large in the “loop” when it comes to mental health resources during this unprecedented time. Most recently, DMH has released a list of “well-being” apps to help LA County residents through this Coronavirus “stay-at-home” order. Below are some apps and their related links, all offer both a free version and a paid version, to avoid being charged just make sure you don’t enter a credit care number.

Physical Wellbeing

7-Minute WorkoutApple or Google Play

Access guided workouts for any activity level

FooducateApple or Google Play

Create your healthy diet toolbox

HeadspaceApple Google Play

Access guided meditations and mindfulness activities

Emotional Wellbeing

HappifyApple or Google Play

Play games to reduce stress, overcome negative thoughts, and build resilience

MindShiftApple or Google Play

Access resources to help manage anxiety

Happy ColorTM – Color by Number – Apple or Google Play

Engage in coloring activities as a positive coping strategy

Physical WellBring

HooplaVarious Platforms

Access e-books, music, audiobooks, and movies

Khan AcademyVarious Platforms

Learn online with interactive exercises and videos

LuminosityVarious Platforms

Improve memory and increase focus with brain training games

Financial Wellbeing

DPSS MobileApple or Google Play

Fill out forms and skip a trip to the office

KeeperVarious Platforms

Store and manage passwords securely

MintApple or Google Play

Develop and manage a personal budget

And remember you can always access Mental Health resources by following this link

LA County Department of Mental Health (LAC DMH) leading the way . . .

Written By: raconte - Mar• 29•20
The Los Angeles County of Mental Health Department (https://dmh.lacounty.gov/) staff has been hard at work keeping LA County residents informed during this period of crisis and uncertainty.  Dr. Sherin and his staff have worked hard at keeping the lines of communication open with stakeholders and community members alike. It’s not uncommon to get numerous emails though out the day alerting members of the disbursement list of their meetings that are being held via teleconference whether by telephone or Skype, providing links to various COVID-19 resources to inform and answer questions that LAC DMH stakeholders and community members may have, and to provide links and for assistance where stakeholders and community members who’ve been financially impacted by COVID-19 and the “shelter in place” order.

Video messages from Dr. Sherin can be seen on the LA County Facebook page. His most recent video message can be found by following this link – https://www.facebook.com/countyofla/videos/782227898847649/. Meanwhile the LA County Facebook page can be found following this link – http://www.facebook.com/countyofla where you can view the daily 12:30 briefing from various county officials.

Below you can find some COVID-19 resources (both in English and in Spanish), as well as a FEMA eligibility fact sheet (also in both English and in Spanish).

DH Patient education – COVID-19 overview and infographic

DH Patient education – COVID-19 overview and infographic – Spanish

DH Patient education – What to do if you are sick

DH Patient education – What to do if you are sick – Spanish

CA COVID-19 Eligibility Fact Sheet

CA COVID-19 Application Fact Sheet – PNPs

How many days does it takes LA County DHS to update one page of a website?

Written By: raconte - Nov• 26•19
Apparently it takes almost 63 days or nine weeks! That’s right!

Several weeks ago, I made an unannounced visit to the Harbor/UCLA Medical Center HUB. As usual there was quite a bit of traffic so I arrived after 6 in the evening and in the dark. I followed the directions provided by the LA County Department Health Services (DHS) to a bungalow identified on the website as “N26”. Imagine my surprised to find the bungalow dark and locked up tight, but wait there’s a paper note on the door detailing that the HUB has been relocated to the “Professional Building” in Torrance.

The note provides an address and with a little help from Google Maps I found the “Professional Building” just behind the hospital. I parked my car and walked up the steps to the building, which of course was closed because – it is after all a professional building, not a clinic or hospital. However, I found myself in luck as a county employee kindly lets me in and escorts me to the HUB, which is closed without a soul in sight because it is after all 6:15 pm and the HUB closes at 6:00 pm.

I chatted with the employee who shares what she knows about the building and the HUB, which she estimates, has been there for about six weeks now. So for at least nine weeks no change has been made to the Harbor/UCLA Medical Center website. The week following my visit, I informed the Board of Supervisors during the weekly meeting, I even provided photographs to illustrate the issue – still no change is made. It takes nearly another two weeks for the people at DHS to make the change, at least now providing the correct address. Unfortunately, the link to the campus map that is provided on the HUBs website takes you to; if you guessed it’s a map showing the HUB is located at N26, and not at the “Professional Building” you would be correct.

These HUBs provide a critical function when there is suspected child abuse. It’s bad enough that the HUBs aren’t opened on the weekends or late in the evening, but DHS Head, Dr. Christina Ghaly seems to only think that children are at risk only during business hours Monday through Friday; even after Ms. Hamai with permission from the Board of Supervisors has allocated additional financial resources to expand services, hire staff and what not. Not to mention that the Grand Jury made the recommendation that the HUBS should be opened 24/7 including weekends and holidays.

It angers me to see Dr. Ghaly spending taxpayer resources to allow a DHS employee to commute from Orange County to LA County using an Uber-like services, and to remodel an office including the purchase of new furnishings for said office. All the while Dr. Ghaly gives short shrift to our County HUBS and LA County children who are at the greatest risk, many of whom are children of color. I wonder how many more children must die before Dr. Ghaly’s failure to expand the HUBs is addressed by the LA County Board of Supervisors?

Now to answer my original question, not only did it take almost nine weeks, and numerous telephone calls from the folks at Hahn Hall of Administration to DHS to fix the problem. But after all of that: what the folks at DHS did in response was to remove the mismarked campus map – I guess correcting the mismarked campus map was beyond their ability, so they just took the map out.

Los Angeles County Supervisors “fiddle” while the Department of Health Services “burns”.

Written By: raconte - Jun• 10•19

I submitted the “op-ed” below to the Los Angeles Times for consideration, the response I got back was “I don’t think we can run this as an op-ed…” I called to find out why and Robin (Editor, Op-ed) went on to explain that my op-ed was too personal.  Well, I’m sorry to say that to this LA County resident, health activist, and RN the health of our county’s health department is well – personal.  Just ask the residents of South Los Angeles if the loss of King/Drew wasn’t personal and the eight (8) years they waited for it to be rebuilt, personal.  Ask the allied healthcare workers, nurses, and physicians of our four (4) County hospitals if the health and wellbeing of these hospitals and assorted urgent cares and clinics aren’t personal.

Robin asked my permission to share my email with one of the LA Times reporter, but I’ve crossed paths with this reporter in the past so I won’t hold my breath waiting for her to call me back.  In the meantime below is my letter to the Los Angeles Times, more to come…

Los Angeles County Supervisors “fiddle” while the Department of Health Services “burns”.

The LA County Department of Health Services has seen a turnover of directors over the years, and filling that vacant position has often required a tedious and time-consuming search process.  So, its understandable that the LA County Board of Supervisors would choose to appoint an internal candidate, Dr. Christina Ghaly, as the new DHS director rather than undergo yet another long search.  However, choosing expediency over an actual job search process means our County is now paying the price.

Prior to Ghaly’s appointment as our new director of DHS she was appointed to head County LAC+USC.  During her tenure, she managed to lower LAC+USC’s Leapfrog score from a B to a D.  As if it wasn’t enough that Ghaly’s management style lead to a two grade drop in one County-run hospital we had to see if she could do it again, so she was later appointed to run Olive View.  True to Ghaly’s management style it wasn’t long before she drove Olive View from a B to a D grade.

After leaving Olive View, Ghaly was made the Chief Operating Officer for DHS before she was made Interim and then permanent Director.  She’s therefore really been “in charge” of DHS for 2.5 years now.  Only in LA County would this track record be rewarded with being offered the position of Director of the Department of Health Services.  If Ghaly’s past management failures weren’t enough to give the Supervisors reason to rethink their hiring decision, you’d think the recently revealed “2018 Patient Safety Culture Survey” by Press Ganey would.  That survey, completed by more than 12,000 DHS employees, showed DHS hospitals scored lower than the National Average and National Safety Net Hospital Average on all 24 of 24 questions asked.  These results are a damning summary of Ghaly’s leadership, as they reflect the perceptions of DHS employees regarding how DHS treats both its patients and staff.  The results of this survey were only revealed to the Supervisors after I handed copies of the one page aggregate to each of them, something Ghaly, herself should’ve done – but considering the dismal scores it’s not surprising that she was too ashamed to provide the information herself”.

Later, Ghaly would produce a 10-page report where she tried to explain away why our County hospitals ranked so poorly.  Ghaly even went so far as to try to rationalize that our County RNs and other advanced practice providers were using the survey as a negotiating tactic (a nursing strike loomed on the horizon), by writing the following: “In sub-group analysis, the negative trend was in large part driven by the responses of RN and Advanced Practice Providers within DHS. DHS will conduct a series of focus groups and perform other focused data analyses to determine why this change may have occurred, the extent to which it may have been related to ongoing labor negotiations that were occurring at the time of the survey, and how to address and improve perceptions among our nursing staff about the climate of safety across DHS.” 

The DHS system is in trouble.  The academic environment at Harbor-UCLA has been collapsing for some time.  Harbor-UCLA hasn’t been able to recruit a new Chair of the Department of Medicine after 5 years and 3 failed national searches.  Indeed they seem unable to recruit leaders generally; their Chairs of Surgery, Pediatrics, OB-Gyn, and Anesthesia are all internal promotions.  After Ghaly left LAC+USC as Interim CEO, their Leapfrog scores began to recover from the D back up to a B.  But since she took over as DHS COO and then Director, their scores have tanked back to a D.  This may have something to do with the fact that in a period of little more than a year, Ghaly has turned over leadership at the hospital an absurd amount of times—4 CEOs, 3 COOs, 3 CFOs, and 3 CQOs in such a short period of time.  Meanwhile, the medical staff at Olive View has been in revolt, forcing out their CMO, and complaining about DHS leadership.  There are fires burning all across DHS, and people are being hurt as a result.

Not to mention the enormous amount of money DHS has wasted under Ghaly in what can only be described as incompetence in modern data analytics.  The availability of data is the lifeblood of a quality improvement program—as I know well, having run QA at Cedars Sinai Medical Center in my past.  After spending years and tens of millions of dollars attempting to build an internal data repository known as CEDAR, DHS recently hired an expensive consulting firm, Gartner, to assess their data readiness.  I’m told that at a recent report-out downtown, Gartner assessed DHS as having the lowest possible data readiness, despite years and millions of dollars spent.

Meanwhile, I started receiving calls and e-mails from many County employees, including physicians, complaining about Ghaly.  Many explained that she rules through fear and intimidation, and that she doesn’t listen to anyone, including many people who have far more experience than she does.  Many also said that she brags that she only answers to the Board of Supervisors.

I’ve also heard that she seems to prefer to hire “yes people” who ask no questions and never challenge her, rather than hiring the quality of people to ensure the highest quality of service to staff and patients in the Health System.  I’m not sure how true this is, but I can tell you that after Mr. James Brady was hired over Ms. Pam Griffith the DHS Dashboard has been riddled with a computer glitch that yields “N/A” which provides no information on some key and critical data points.  A glitch that Mr. Brady hasn’t been able to resolve which might’ve something to do with that fact that his experience is with two small hospitals in the self-developed Kaiser system rather than Cerner/Orchid  (which the County uses) which Ms. Griffith fully understood and was proficient in.

Not all that long ago our Board of Supervisors failed to recognize that King/Drew Medical Center was in critical condition and by the time they did; all the corrective action taken wasn’t enough to stop King/Drew Medical Center from losing its accreditation and closing.  It’d take nearly 8 years to re-open the Martin Luther King, Jr. Community Hospital, a much smaller hospital with a smaller footprint and mission.  I hope that the current red flags being revealed in various safety surveys and key indicators aren’t a warning that the Supervisors will choose to ignore.  It’s often hard to acknowledge that as a group you made a bad choice, but as the evidence continues to mount the Supervisor’s need to rethink their original decision. Raising all the money in the world shouldn’t offset the fact that Ghaly appears to be hiding critical performance and safety issues from the Supervisors and that’s called dereliction of duty.

The Supervisors should remember that Ghaly is an “at-will-employee” and can on any given Tuesday by a vote of three be sent packing.  This LA County health activist and RN wonders how many more of our at-risk children need to die or how much lower in quality of care must the hospitals that so many of our most vulnerable residents rely on for their care must fall before the Supervisors take that vote of three?

Geneviève M. Clavreul, RN, PhD

Suicide and Workers’ Compensation

Written By: raconte - Feb• 07•17
I’ve often wondered how many injured workers either contemplate or commit suicide out of despair and feeling that suicide is their only recourse to ending the constant pain in which they’ve been forced to live with. I’ve grown accustomed to the blank stares that I receive when I’ve poised this question to various “leaders” in our state’s workers’ compensation system. No one seems to be able to provide me with a definitive answer to my question so I decided to do an Internet search. The search failed to provide any links to statistics of how many injured workers commit suicide, but it did provide pages of links about individual injured workers who had committed suicide. Most notable was an article from the Insurance Journal. Apparently in September 2007 a Massachusetts Appeals Court in Suffolk County found that a suicide qualifies for benefits if it is “simply causally connected to the unsoundness of mind resulting from the injury, without having to show any particular quantity or quality of that cause.” A very interesting finding, no doubt.

An investigative report by NBC Bay Area ran a three-part investigative news story, and in Part II they share the story of Nurse Lorrie Mays, who was injured at work in 2003 and ended up taking her own life in 2016.   Her mother, Ms. Dismuke, cited a letter her daughter received in February from an Independent Medical Review denying her appeal for additional treatment for her depression, as the proverbial last straw for her daughter. Mays committed suicide shortly thereafter. Dismuke share with the NBC Bay Area reporters about finding additional letters written by her daughter that described her despair and frustrations trying to get appropriate medical care that she thought would make her better. You can read more about her story, here.

Below you’ll find a few more links that show a link between lack of appropriate medical care and suicide.

http://www.nbcbayarea.com/investigations/Workers-Comp-Drags-Out-Medical-Care-Injured-Workers-and-their-Doctors-Say-390979441.html

http://www.abajournal.com/magazine/article/insult_to_injury_texas_workers_comp_system_denies_delays_medical_help/

http://scholarship.law.duke.edu/cgi/viewcontent.cgi?article=5648&context=faculty_scholarship

http://www.insurancejournal.com/news/east/2007/09/17/83508.htm

Next up the link between financial stress and suicide