REGIONAL NEWS - August 2019

Ex-Viking’s claim is denied

A former Vikings defensive lineman who claims his dementia is related to multiple concussions during his years on the gridiron had his permanent total workers’ compensation award thrown out by the Minnesota Supreme Court JulyThe claim was made by Alapati “Al” Noga.

Noga and his advocates have contended that his injuries weren’t treated properly. But the court agreed that the Vikings’ treatment of Noga’s headaches with over-the-counter medicines was sufficient. The court also agreed, in a 6-0 decision, that the claim filed in 2015 is too late. Noga’s lawyers, John Lorentz and Ray Peterson, issued a statement, saying they’re disappointed and concerned about retired athletes in Minnesota who suffer Noga’s fate: slow, progressive dementia caused by work-related concussions that occurred decades ago.

“The workers’ compensation system was adopted to provide compensation and care for injured workers,” they wrote. “Under today’s decision, many professional athletes in this situation will not receive that compensation and care.”

Noga had been awarded disability by a lower court. He played for the Vikings from 1988-1992 and tackled with a “head-first style” that he carried
over from prep playing days.

When he played in the NFL, Noga continued to lead with his head, something the league has since banned as awareness of the long-term impact of concussions has grown in recent years.

While playing with the Vikings, Noga suffered “a number of orthopedic injuries that kept him from playing games periodically,” and also experienced head injuries and headaches, the court said. When Noga had a headache after a hit, team trainers and doctors would give him Advil or Tylenol.

Through weighing of multiple factors, the court determined that the Vikings didn’t have “a conscious sense of obligation” for Noga’s later dementia.

The court also said he should have filed his claim for dementia compensation no later than 2010 to stay within the statute of limitations.

“Medical awareness of the connection between and among head injuries, possible concussions, and the potential long-term neurological effects of those events had not yet developed” at the time Noga played for the Vikings, the court ruling stated. (Source: Star Tribune)

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St. Louis County scrutinizes sidewalks

Fifty-three miles of St. Louis County sidewalks aren’t in compliance with the Americans with Disabilities Act (ADA) A new county plan released for public review is calling for more than $25 million worth of compliance improvements to sidewalks, traffic signals and curb ramps.

After an unflattering portrait of its pedestrian facilities showed numerous instances of non-compliance with federal disability law, St. Louis County set forth the draft of a plan this week outlining an estimated $25.4 million worth of compliance updates.

The plan features an 87-page inventory of county pedestrian facilities categorized by curb ramps, traffic signals and sidewalks. The ratio of noncompliance-to-compliance is not an appealing balance. An estimated 76 percent of county sidewalks (53.2 miles) and 951 curb ramps failed to fully meet Americans with Disabilities Act standards.

“My initial reaction was, ‘Gee, I didn’t know we had that much non-compliant stuff,” St. Louis County traffic engineer Vic Lund said. “That was a surprise.” County Board Chair Patrick Boyle praised the plan for outlining a path to compliance.

“I am pleased to present this ADA Transition Plan as the guiding document to ensure county roads are accessible for all residents,” Boyle said in a document-opening statement.

A four-month self-evaluation in 2018 of county pedestrian facilities yielded the following results: 24 percent of sidewalks met accessibility criteria, 37 percent of curb ramps met accessibility criteria and 38 percent of traffic-control signals aligned with current standards for push-button technology.

Duluth-based county facilities were by and large more compliant, Lund explained, while places in the northern part of the county, Eveleth and Ely, for instance, showed numerous county pedestrian features dinged for non-compliance. Towns under 5,000 residents don’t qualify for state-aid highways, meaning more roads, and subsequently sidewalks, in smaller towns fall under county jurisdiction. (Source: Duluth News-Tribune)

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Housing options are scarce

The mostly poor, disabled or elderly tenants of a nearly 50-year-old Fairmont apartment building are reeling from a steep rent increase that they fear will force them to move in a region with few affordable housing options.

The 64-unit, three-story building known as Fairmont Square was built in 1972. Four partners bought it several years ago. In June, partner David N. Olshansky, a Twin Cities businessman, bought out the remaining partners and began a long-overdue rehabilitation project, tearing off the old cedar siding with plans to replace it along with the windows.

On July 9, the property manager slipped a letter under tenants’ doors notifying them that for many, rents would more than double when they renew their leases. For those on monthly contracts, that could mean as soon as September.

“There’s nothing in town that’s within the price range of most of the residents here,” said Brandon White, a long-time tenant. “We are in the middle of nowhere.”

Today, one in four households across Minnesota pays more than they can afford for shelter, forcing them to cut back on necessities such as food, education and medicines, according to a recent assessment by the Minnesota Housing Partnership. That problem is exacerbated in southern Minnesota, an area with the second-largest number of renters and where wage depreciation has made housing even harder to afford.

In Martin County, where Fairmont is located, median rents increased 22 percent from 2000 to 2017 while renter income increased just 8 percent. Olshansky, a Russian immigrant and former dentist who owns Home Health Care Inc. in Golden Valley, among other investments, declined to comment on Fairmont Square.

Several Fairmont Square residents, meanwhile, are rallying tenants to see if the rent hike can be softened. They’ve counted 67 to 70 residents in the building, including about 20 children. Some residents have lived there for decades. They said at least 20 have home health care or personal care attendants, and 26 get Section 8 rental assistance. (Source: Star Tribune)

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Metro Mobility drives to Lakeville

Gov. Tim Walz in July signed a ceremonial bill bringing Metro Mobility to Lakeville starting in January 2020.

A provision in the transportation budget omnibus bill allocates nearly $2 million for the low cost, door-to-door transportation service in Lakeville, according to a news release from Rep. Alice Mann, DFL-Lakeville.

Metro Mobility serves riders who can’t use regular buses because of disability or health conditions.

State Sen. Matt Little, DFL-Lakeville, said he’s been working on getting Metro Mobility to Lakeville for six years, since he was the city’s mayor. He said Lakeville was successful because it has 65,000 people and is located off Interstate 35.

“I want people to be able to live in Lakeville,” he said. “If you have a disability where you can’t drive, you don’t really have any options in Lakeville.”

Metro Mobility is a shared public transportation service for certified riders who are unable to use regular fixed-route buses due to a disability or health condition. Rides are provided for any purpose. (Source: Star Tribune)

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Man turned away from ride

A young man from Wright County who uses a prosthetic device is pushing for ValleyFair amusement park to change its policies on rides. According to KMSPTV,

Juan Cambara was told he could not ride the “Delirious” ride. He and his girlfriend were visiting the Shakopee amusement park when told they could not board the ride due to security reason.

ValleyFair’s website indicates that the amusement park doesn’t allow prosthetics on certain rides, unless riders can assume that a device is properly secured and will remain in place during the ride. Some ride manufacturers, including the maker of the Delirious ride, call for no one with a prosthetic device to ride their rides. Cambara has an artificial arm. He said it is secure and wouldn’t come off. He objected to being banned from the ride.

The amputee group Wiggle Your Toes is calling for ValleyFair to use the experience as a teaching moment, and for park staff to educate themselves about today’s prosthetics. The group’s founder said that prosthetics that are properly used don’t provide a danger.

ValleyFair has responded by saying that it will provide a personalized experience plan for guests with disabilities. Its ride operators go through training and have a focus on safety. (Source: KMSP-TV)

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Opioids prescriptions are eyed

More than 16,000 Minnesota health care providers serving Minnesotans on Medicaid and MinnesotaCare will receive reports in coming weeks comparing their opioid prescribing rates to those of their peers as part of a quality improvement effort led by the Department of Human Services in collaboration with the medical community.

The first-ever reports in Minnesota aim to create awareness among providers about their individual prescribing behavior. That knowledge can signal a dramatic turning point, as evidenced in this short video about how one Greater Minnesota doctor reframed the conversation about pain management and opioids with his patients after learning how his opioid prescribing rates compared to his peers.

The reports were announced last month by Tony Lourey, before he stepped down as DHS commissioner, “The health care community plays an important role in addressing the opioid crisis, and these opioid reports give health care providers invaluable insight and information into how their prescribing stacks up against others in their specialty,” said Lourey. “Such awareness is always the first step toward change.”

Minnesota law requires DHS to share the individualized, anonymous opioid prescribing reports annually and manage a quality improvement program for providers whose reports show they continue to prescribe outside of community standards.

Health care providers who prescribed at least one opioid to a Medicaid or MinnesotaCare enrollee in 2018 will receive their report over the coming weeks. This includes physicians, dentists, physician assistants and nurse practitioners. The reports assess prescribing behavior based on seven key measures using claims data, excluding data on opioids used to treat opioid use disorder and those prescribed to individuals in inpatient settings, with cancer, or who receive hospice or palliative care services.

About a quarter of Medicaid- and MinnesotaCare-enrolled providers who wrote at least 10 opioid prescriptions in 2018 are above the quality improvement threshold for at least one of the measures. See a sample opioid prescribing report and a guide to understanding the reports.

DHS and the Opioid Prescribing Work Group developed the prescribing measures used in the reports in collaboration with the medical community. The measures are supported by clinical recommendations in the Minnesota Opioid Prescribing Guidelines.

This first set of prescribing reports serve as baseline information only. A quality improvement program begins next year based on the release of a follow-up set of opioid prescribing reports.

Starting in 2020, providers required to participate in the quality improvement program will submit improvement plans to DHS for review. State law permits DHS to terminate providers from serving Medicaid and MinnesotaCare enrollees if they fail to demonstrate improvement in opioid prescribing behavior over time. Disenrollment will occur in 2021 or subsequent years only for those whose prescribing is considered unsafe.

The need to improve opioid prescribing behavior and reduce overprescribing is demonstrated in the wide variation in the state’s opioid prescribing rates, which cannot be fully explained by differences in patient demographics or geography. For example:
• County-based opioid prescribing rates in Minnesota varied from 27.4 prescriptions to 98.6 prescriptions per 100 residents in 2017.
• In emergency medicine, the top quartile of opioid prescribers has a prescribing rate 2.8 times higher than the median of their peers.
• In family medicine, the top quartile of opioid prescribers has a prescribing rate 3.8 times higher than the median of their peers.

The good news is that a culture shift has already begun in opioid prescribing behavior, as health care professionals weigh the risks and benefits of opioids for each individual patient. DHS launched an education campaign in March to help medical providers weigh the appropriateness of opioid therapy, determine if tapering should be discussed, have conversations with their patients about opioid therapy and pain management, and answer difficult questions. See the Flip the Script campaign. The state also previously released opioid prescribing guidelines to provide a framework for safe and judicious opioid prescribing for pain management. (Source: DHS)