Barrett 530 User Manual
Study examines reliability of clinical and pathological diagnoses of Barrett’s esophagus May 14, 2009 OAK BROOK, Ill. – May 14, 2009 – In a review of more than 2,000 patients coded for Barrett’s esophagus, electronic diagnosis overestimated the prevalence of the disease according to researchers in California.
Plaintiffs sued a staffing company that provided employees for public recycling facilities under contracts with Los Angeles County Sanitation Districts, in a class action under the Labor Code. The trial court found that the prevailing wage law did not apply and the Labor Code section 226.7 remedy was the exclusive remedy for shortened meal periods, an additional hour of pay at their regular rate. The court of appeal reversed. The prevailing wage law applies; plaintiffs were engaged in “public work” within the meaning of the Labor Code. The amount of back pay to which plaintiffs are entitled for that violation, and whether plaintiffs are entitled to additional damages arising from the breach, are matters for the trial court on remand. The remedy for improper shortening of meal periods consists of one additional hour of pay for every shortened meal period under section 226.7 plus payment of wages for actual time worked during the shortened meal period.
Plaintiffs are not entitled to be compensated for the time during which they were free from employer control. Because plaintiffs were entitled to wages for actual time they were required to work during their meal periods, defendants may be subject to “waiting time penalties” that apply when an employer willfully fails to pay any wages of an employee who is discharged or quits (section 203(a)).
Defendants are also subject to civil penalties (section 1197.1) for payment of wages less than the legal minimum. Filed 11/30/18 CERTIFIED FOR PUBLICATION IN THE COURT OF APPEAL OF THE STATE OF CALIFORNIA SECOND APPELLATE DISTRICT DIVISION EIGHT DAVID KAANAANA et al., Plaintiffs and Appellants, B276420, B279838 (Los Angeles County Super.
BARRETT BUSINESS SERVICES, INC., et al, Defendants and Respondents. APPEALS from a judgment and a postjudgment order of the Superior Court of Los Angeles County.
John Shepard Wiley, Jr., Judge. Reversed in part, vacated in part and remanded with directions. Hayes Pawlenko, Matthew B. Hayes and Kye D. Pawlenko for Plaintiffs and Appellants. Hinshaw & Culbertson, Frederick J.
Ufkes and Filomena E. Meyer for Defendants and Respondents.
SUMMARY These are appeals from a judgment and a postjudgment attorney fee order in a class action alleging Labor Code violations. The case presents two principal issues. The first is whether plaintiffs should have been paid the prevailing wage applicable to workers employed on public works.
The second is the applicable remedy when an employer violates statutory and regulatory provisions requiring employers to provide workers with a duty-free 30-minute meal period, by shortening the meal period by three to five minutes. On the second issue, there is no dispute that plaintiffs are entitled to the statutory remedy under Labor Code section 226.7 – an additional hour of pay at their regular rate.1 But plaintiffs contend they are also entitled to payment of the minimum wage for the entire 30-minute meal period, while defendants contend they are entitled to nothing more than the section 226.7 remedy. The trial court found (1) the prevailing wage law did not apply to plaintiffs; and (2) the section 226.7 remedy was the exclusive remedy for the shortened meal period. We disagree with both conclusions and hold: First, the prevailing wage law applies; under wellestablished principles of statutory interpretation, plaintiffs were engaged in “public work” within the meaning of the Labor Code. The amount of back pay to which plaintiffs are entitled for the prevailing wage law violation, and whether they are entitled to additional damages arising from the breach, are matters left to the trial court in the first instance on remand.
Further statutory references are to the Labor Code unless otherwise specified. 1 2 Second, the remedy for defendants’ improper shortening of plaintiffs’ meal periods consists of (1) one additional hour of pay for every shortened meal period (so-called “premium pay”), as provided under section 226.7, and also (2) payment of wages for actual time worked during the shortened meal period. Plaintiffs are not entitled to be compensated for that part of the meal period time during which they were free from employer control. Because plaintiffs were entitled to payment of minimum wages for actual time they were required to work during their meal periods, defendants may be subject to the “waiting time penalties” that apply when an employer willfully fails to pay any wages of an employee who is discharged or quits (§ 203, subd. In addition, defendants are subject to civil penalties under section 1197.1 for payment of wages less than the legal minimum. Finally, because the case must be remanded to recalculate plaintiffs’ recovery, we will not consider plaintiffs’ claims of error in the attorney fee award, as that award is vacated to permit the trial court to reconsider attorney fees following remand.
FACTS AND PROCEDURAL BACKGROUND Plaintiffs sued defendant Barrett Business Services, Inc., a company providing staffing and management services. Defendant provided employees for two publicly owned and operated recycling facilities under contracts with Los Angeles County Sanitation Districts. The class consisted of “belt sorters” employed by defendant at those facilities between April 15, 2011, and September 30, 2013. Plaintiffs alleged failure to pay minimum wages, overtime, and all wages owing at termination (all based at least in part on alleged noncompliance with the prevailing wage law); failure to provide meal periods; unfair 3 competition; and civil penalties under sections 558, 1197.1 and 2698 (PAGA, the Private Attorneys General Act of 2004).2 Defendant brought a motion to strike the prevailing wage claims, contending it was not required to pay the prevailing wage as a matter of law. The trial court granted the motion in January 2016, concluding the work plaintiffs performed sorting recyclables did not come within the definition of “public works” under the prevailing wage law. Thereafter, the parties stipulated to certain facts, and to the admissibility and authenticity of certain evidence, for purposes of trial on plaintiffs’ other claims.
Central to these claims was defendant’s policy of requiring belt sorters to return to their stations at the conveyor belt before the end of their 30minute meal break. The stipulated facts included, in addition to points already mentioned, the following. The class members are all former employees of defendant. The belt sorters stood at sorting stations along a conveyor belt, removing recyclable materials from the conveyor belt and placing them in receptacles at their sorting stations. The lead belt sorters would turn the belt off for meal breaks, and the belt sorters were required to clock out for meal breaks, which they all took together. The lead belt sorter was responsible for rounding up the belt sorters to clock back in after Plaintiffs also alleged a representative claim under PAGA for civil penalties against Michael Alvarez, defendant’s onsite manager.
The trial court held Mr. Alvarez jointly and severally liable for the penalties awarded against defendant. We use the singular “defendant” throughout for convenience.
2 4 meal breaks. Plaintiffs were paid a base hourly rate between $8.25 and $10.75 during the class period. The parties further stipulated that deposition testimony could be substituted for live testimony for any witness, and the deposition transcripts were deemed authentic. Only one witness presented live testimony at the trial: plaintiffs’ expert witness on damages, who was cross-examined by defendant. The parties filed pretrial and posttrial briefs, and the court heard oral arguments after the posttrial briefing. Plaintiffs asserted two theories of recovery on the wage and hour violations, both based on the meal period defendant provided.
Barrett 530 User Manual
The first was that defendant failed to provide at least 30 minutes of duty-free time during meal periods, requiring plaintiffs to return to the conveyor belt (which was turned off for just 30 minutes during meal periods) three to five minutes before it restarted. This made defendant liable under section 226.7 for meal period premiums (one additional hour of pay) for each workday that a full 30-minute meal period was not provided.
The amount claimed was $227,190.73. In a class action under the Labor Code, the court of appeal finds prevailing wage violations and clarifies the remedy for improper shortening of meal periods.Disclaimer: Justia Annotations is a forum for attorneys to summarize, comment on, and analyze case law published on our site. Justia makes no guarantees or warranties that the annotations are accurate or reflect the current state of law, and no annotation is intended to be, nor should it be construed as, legal advice. Contacting Justia or any attorney through this site, via web form, email, or otherwise, does not create an attorney-client relationship.
ResultsA total of 2470 patients coded with Barrett’s esophagus underwent record review; a subgroup (616) received manual pathology slide review. Review confirmed a Barrett’s esophagus diagnosis for 1533 (61.9%) patients: 437 of 798 subjects (54.8%) with a SNOMED diagnosis alone, 153 of 671 subjects (26.8%) with an ICD diagnosis alone, and 940 of 1101 subjects (85%) who had both a SNOMED and an ICD diagnosis. The same metaplasia diagnosis occurred with 88.3% of subjects (original vs referral pathologist, interrater reliability; κ =.42, 95% CI, 0.34–0.48). The referral pathologist made the same metaplasia diagnosis twice for a given patient for 88.6% of subjects (intrarater reliability, 2 reviews by same pathologist; κ = 0.65, 95% CI, 0.35–0.93). The importance of accurate methods for the assignment of clinical diagnoses cannot be overemphasized; the management of patient conditions, the identification of patients for clinical research, health care financial compensation, and the assignment of human resources all depend at least partially on recorded diagnoses. Pathology classifications are required for many clinical diagnoses, yet few studies examine whether these assignments are reproducible for many GI diseases. Similarly, electronic diagnoses, such as those found in large administrative data sets (eg, health plans and Veterans Affairs hospitals), the U.S.
Medicare program, and endoscopic databases, provide abundant opportunities for identifying patients for clinical care (eg, recalling patients who need cancer screening or surveillance for high-risk conditions) and for research studies, but little is known about the overall accuracy of many common GI diagnoses, including Barrett’s esophagus. The validation of pathologic and clinical diagnoses for this condition would inform clinicians, researchers, and policy makers whether these codes can be used alone for decision making or whether additional verification is required.Prior studies have evaluated interobserver variation for the diagnosis of dysplasia in Barrett’s esophagus –; however, a literature search by our group did not identify any studies that directly evaluated the accuracy of a coded diagnosis of Barrett’s esophagus itself. Similarly, another search identified only a single study of 5 patients that evaluated the reproducibility of a histologic diagnosis of esophageal intestinal metaplasia (using search terms for Barrett’s esophagus combined with the terms classification, interobserver, or intraobserver), although the presence of intestinal metaplasia is required for a Barrett’s esophagus diagnosis by most criteria. –We thus evaluated the accuracy of diagnostic codes for Barrett’s esophagus by contrasting codes from electronic databases with diagnoses from a detailed medical record review.
We also evaluated the reproducibility of a pathologic diagnosis of Barrett’s esophagus (defined here as the presence of esophageal intestinal metaplasia) between 2 pathologists and between a single pathologist on 2 different occasions. METHODSWe conducted a study within the Kaiser Permanente, Northern California (KPNC) population, an integrated health services delivery organization. KPNC contains approximately 3.3 million members (approximately one third of the insured population in the region). Research within this setting encompasses practice patterns across a broad geographic area that includes 17 medical centers plus additional free-standing offices and endoscopy units; its membership demographics closely approximate the underlying census population of Northern California. We identified all persons who received a Barrett’s esophagus diagnosis between 1994 and 2005 according to the International Classification of Disease, 9th revision (ICD-9), codes 530.2 and 530.85, which at KPNC were uniquely coded on reporting sheets as “Barrett’s esophagitis” at the time of an outpatient visit, and the Systematized Nomenclature of Medicine (SNOMED) code (Barrett’s esophagus). SNOMED codes are commonly used by pathology departments for assigning specific diagnoses.
This search identified 5953 persons with an electronic diagnosis of Barrett’s esophagus: 1803 (30.3%) with only a SNOMED diagnosis, 1630 (27.4%) with only an ICD-9 diagnosis, and 2520 (42.3%) with both a SNOMED and an ICD-9 diagnosis. From the written and electronic medical records, we retrieved EGD and relevant pathology reports from a subset of 2470 subjects (not the entire group due to resource limitations) for manual verification of the Barrett’s esophagus diagnosis. These included all subjects with a new electronic diagnosis of Barrett’s esophagus between October 2002 and September 2005 (these patients were then used as part of a case-control study) and serial subjects (both new and prevalent diagnoses) extending before and after these dates within funding limitations. Reviews were performed by a board-certified gastroenterologist (D. C.) for 1221 subjects and by professional medical record data abstractors (trained by the gastroenterologist and approximately a 10% subset reviewed by the gastroenterologist) for 1249 subjects; the verification rates for both groups were comparable and are presented together.
The reviewer recorded whether each subject met the criteria for diagnosis, and if they did not meet the diagnosis why they were excluded or whether there was insufficient information to make an assignment. Subjects were confirmed to have a diagnosis of Barrett’s esophagus if the endoscopist clearly described a visible length of columnar-type epithelium proximal to the gastroesophageal junction/gastric folds, this area was biopsied, and the pathologist reported specialized intestinal epithelium. A diagnosis was not confirmed if the endoscopy did not clearly describe the above findings, no biopsy was taken, the pathology reports did not describe intestinal metaplasia, or if, to minimize misclassification, the report described biopsy specimens only from an irregular squamocolumnar junction (ie, an “irregular z-line”). Statistical analysisStandard descriptive statistics were calculated.
The κ statistic was calculated for agreement between the first and second pathology reviews. The κ statistic is the proportion of agreement achieved beyond that expected to occur by chance. The κ statistic performance was rated according to standard nomenclature. Record reviewAfter medical record review, an assignment of “Barrett’s esophagus” was confirmed in 1530 (61.9%) and rejected in 848 (34.3%), and there were insufficient data in 92 (3.7%) of all subjects. A diagnosis was confirmed among 437 of 798 persons (54.8%) with a SNOMED diagnosis alone, 153 of 571 patients (26.8%) with an ICD diagnosis alone, and 940 of 1101 persons (85.4%) who had both a SNOMED and an ICD diagnosis of Barrett’s esophagus. If any ICD diagnosis was used (regardless of whether a SNOMED diagnosis was assigned), a diagnosis was confirmed among 1093 of 1672 persons (65.4%).The reasons for exclusion are outlined in. These included only an irregular z-line for 88 subjects (3.6%), no clearly described endoscopic findings consistent with Barrett’s esophagus for 228 (9.2%), no intestinal metaplasia on biopsy for 214 (8.7%), and neither endoscopic nor pathologic findings consistent with Barrett’s esophagus for 240 (9.7%) patients.The endoscopic findings among persons excluded are described further in.
Barrett 530 User Manual 2017
Among the persons excluded because of no definitive recorded endoscopic findings, the endoscopist frequently reported a hiatal hernia or esophagitis but did not clearly describe esophageal columnar metaplasia suspicious for Barrett’s esophagus. Other endoscopic findings within each exclusion category.Reason for exclusionTotal with exclusionEsophagitisHiatal herniaEsophageal ringStrictureMassIrregular z-line only.886 (6.8)28 (31.8)4 (4.5)3 (3.4)0 (0)No endoscopic findings clearly consistent with Barrett’s esophagus22862 (27.2)38 (16.7)12 (5.3)24 (10.5)4 (1.8)No intestinal metaplasia21458 (27.0)79 (36.7)4 (1.9)4 (1.9)0 (0)No endoscopic findings and no intestinal metaplasia24069 (28.8)37 (15.4)11 (4.6)12 (5.0)5 (2.1)Possible Barrett’s esophagus, no biopsies3716 (43.2)16 (43.2)0 (0)5 (13.5)0 (0). Reviews were conducted blinded to the assignment of the other pathologist.The overall agreement between the pathologists was 88.3%. Among the 580 patients with an initial diagnosis of intestinal metaplasia, an intestinal metaplasia diagnosis was also made by the referral pathologist for 513 subjects (88.4%). Among 36 patients with an initial diagnosis of gastric or columnar metaplasia, the referral pathologist similarly did not describe intestinal metaplasia in 31 (86.1%).
The κ statistic for interobserver agreement was 0.41 (95% CI, 0.34–0.48), indicating “moderate” agreement beyond that expected by chance alone.We evaluated intrarater reliability by having the referral pathologist conduct a blinded rereview of 44 slides he had previously reviewed during the 3-year duration of the study (see Methods). The overall intrarater accuracy was 88.6%, with κ = 0.64 (95% CI 0.35–0.93), indicating “substantial agreement” beyond that expected from chance alone.
The 2 reviews were conducted blinded to each other (see Methods).Among all patients receiving both written medical record review and manual review of their pathology slides, the pathologist’s slide review changed the classification (on the basis of the presence or absence of intestinal metaplasia) for 74 (12%) patients: from “include” to “exclude” in 58 (9.4%), from “exclude” to “include” in 5 (1%); among 11 persons with “uncertain” assignments from the medical record review, 4 were included and 7 were excluded. Among the 339 persons with a Barrett’s esophagus diagnosis by both SNOMED and ICD coding, the pathology review changed the assignments of 28 (8.3%) patients. DISCUSSIONThe accurate identification of patients with Barrett’s esophagus for either clinical care (eg, call-backs for surveillance examinations) or clinical research requires valid pathologic and clinical diagnoses.
Barrett 530 User Manual Free
The purpose of this study was to evaluate the reproducibility of a pathologic diagnosis of intestinal metaplasia and the accuracy of electronic diagnoses of Barrett’s esophagus compared with manual record review. We found that a pathologic diagnosis of esophageal intestinal metaplasia is highly likely to be reproduced by a separate review of the slides. In addition, the modest intraobserver variation observed for a single pathologist suggests that a proportion of the discordance for pathology reviews between different pathologists may result from somewhat random misclassification rather than from an incorrect reading by the original pathologist. In contrast, a coded diagnosis of Barrett’s esophagus was confirmed by record review only 61.9% of the time––a number that is likely too low by itself for either clinical or research uses without supplemental manual verification. However, among the substantial proportion of persons who had both a SNOMED and an ICD diagnosis, record review confirmed a diagnosis in 85.4%.
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It should be emphasized these numbers likely represent the minimum proportion of persons who had Barrett’s esophagus, given the strict criteria used. Persons excluded may have had endoscopic findings not adequately recorded by the physician that supported the diagnosis of Barrett’s esophagus, or the diagnosis may have been based on knowledge not discernible from available reports (for example, a remote examination that showed Barrett’s esophagus).This study expands the existing literature on the diagnosis of Barrett’s esophagus.