Prosthetic "Parity" in California Has a Long Way to Go

In the fall of 2010, I was starting to have a lot of problems with my stump, skin irritation leading to scarring and an eventual minor surgery to remove scar tissue.  During this time, my employer changed insurance providers, and I was introduced to the OG of managed health care:  Kaiser Permanente.  My new docs referred me to the Kaiser prosthetic clinic, and I thought all was well.

Then, I got a phone call.  The amputee clinic scheduler couldn't schedule me.  Why?  I didn't have coverage for prosthetics.  "Now," I thought, "that can't be right.  I've been assured that California had prosthetic parity laws."  Well.... kinda.  California's Health and Safety Code Section 1367.18 reads, in part:

(a) Every health care service plan, except a specialized
health care service plan, that covers hospital, medical, or surgical
expenses on a group basis shall offer coverage for orthotic and
prosthetic devices and services under the terms and conditions that
may be agreed upon between the group subscriber and the plan. Every
plan shall communicate the availability of that coverage to all group
contractholders and to all prospective group contractholders with
whom they are negotiating. Any coverage for prosthetic devices shall
include original and replacement devices, as prescribed by a
physician and surgeon or doctor of podiatric medicine acting within
the scope of his or her license.

So they have to cover prostheses... if you opt for the coverage.  So obviously my first thought was that my boss opted to not buy the coverage, and I was quite upset.  Of course, this was not the case; the broker who sold the plan never offered it, in direct violation of the law.  Should be an easy fix, right?  Appeal the denial, point out the error, and they'll fix it.  Well, not quite.

After the denial, I sent a letter to KP's Member Case Resolution Center, quoted the relevant section, and demanded coverage.  After a second denial, I filed a complaint with the Department of Managed Health Care, which regulates HMOs in California.  It seems I was the first person to make a complaint with regard to this law, so what was supposed to be a two-week review process stretched to nearly three exhausting, infuriating months.

In the end, the DMHC saw things my way.  Kaiser upgraded me to a plan that included coverage for prothetics.  Of course, it took them another three or four months to approve the new socket I needed, but at least I finally won.

The lesson, of course, is that prosthetic parity laws are often not all  they're cracked up to be.  Limbs are not a luxury item, and we all--amputees and not--need to keep working to improve them.  And be prepared to fight for what you need from any insurer.  They're all evil.

Felony Charges in UCLA Lab Accident

The chemistry blogs today are abuzz with the news that University of California regents and a professor at UCLA are facing felony charges after the death of a lab assistant in a lab fire back in 2008.  The UC system and Professor Patrick Harran face three counts each of willfully violating occupational health and safety standards.

In the years I've spent in labs, both as an undergraduate and as a professional, safety has been treated in a fairly cavalier manner.   Sure, each lab course would give you a safety lecture, maybe show a video, give a little quiz.  But my biggest quibble is with the lack of training for and communication of specific hazards.  The lab assistant in this case, Sheri Sangji, had an undergraduate degree in chemistry; but was she ever trained in proper handling technique for pyrophoric materials?  Well...the prof says yes, but he never documented any such training (as required by Cal/OSHA and UCLA), so we may never know.  In addition, it is likely the lack of a lab coat that killed her.  Two months before the fire, a UCLA safety audit noted that safety glasses, lab coats, and gloves were not being worn in Harran's lab.  They were given a December 5th deadline to take corrective action.  Sherri Sangji's accident occurred December 29th.

So are the professor or the UC at fault?  This is a dicey question.  Glancing through the chemistry blogs and comments today, no one seems to think that professor Harran should serve time.  But most seem to feel that this may be the kick in the butt that academia needs to improve its laboratory safety culture.  But what about industry?  Most of what I've read on the tubes today seems to imply that industrial safety practices are far superior to those in academia, and that professionals are responsible for their own safety.

This is all fine and good when your lab is made up of PhD- and MS-level chemists.  The industry I work in, environmental analysis, is a different horse altogether.  The vast majority of analysts I've worked with had an undergraduate degree--in science.  For example, my BS is in Molecular Biology.  Yes, this is a great foundation for any laboratory work, but the amount of chemistry I didn't take means that I was not as well prepared as a chem grad might be.  In addition, a lot of work in our labs is performed by technicians, most of whom have never taken a chemistry course, and some of whom can barely speak or read English.  How can we just give these guys a stack of MSDS sheets and hope all goes well?

Some things I've seen that scared me:

- Analysts working with concentrated mercury salt solutions without gloves
- Folks walking around the lab with gloved hands, touching doorknobs, telephones, keyboards, etc.
- Technicians synthesizing diazomethane
- Organic extractions and metals digestions performed in the same hood; the supervisor didn't even know the dangers of nitroacetone

That's just a few I could remember off the top of my head.  So if these charges are going to clean up academic lab safety, what will it take to clean up industry?

Temecula Saturday

To mark our three-month anniversary, Mrs. Pegleg and I went out to Temecula, a local wine region, and one of the first places we went when dating.  We made a lunch reservation at Pinnacle Restaurant at Falkner Winery, and headed out to check out Chapin Family Winery beforehand.

We drove past the place at first, then realized it was the neighbor of another small winery we'd visited.  It's a tiny spot, what was originally the house for the plot is in the middle of being converted into a large tasting room.  In the meantime, we were hosted in the barn by a very knowledgeable employee named Gabriel, and met the owner, Steve Chapin.

The wines were excellent, and all bottle aged before release.  The estate vines are just coming to fruition, so expect more Italian varietals soon.  We went beyond our usual wine budget and grabbed a bottle each of the '07 Syrah and '07 Cab at $30-ish each.  They had an older Cab that was fantastic, but expensive.

We arrived for lunch a touch early, thought about doing a tasting first, but balked at the crowd.  Headed in to the restaurant, which wasn't crowded, and got seated immediately.  The decor was very nice, and the view of the valley from the hillside perch was awesome through floor-to-ceiling windows.

They must be getting a deal on ducks, because for the month of December they're doing weekend chef's duck specials.  Mrs. Pegleg had a blackened duck breast with gorgonzola mashed potatoes--she loved it, and I stole some bites and ate most of the blackened fat.  Mmmm....duck fat.  I had a very nice swordfish fillet with an artichocke risotto; swordfish is the other other white meat.

Since we visited Chapin, we've been to every winery currently open in the Temecula valley.  More wine reviews to come.

Fermented Foods

This piece about fermented foods and their recently renewed popularity appeared in my RSS feed last week.  As a disclaimer, it’s not much of a column, really more of an ad for some dude named Andy’s slaw.  Also, it’s written by a chiropractor; you know, the semi-crazy sort who gives nutritional advice.  In this case, though, she’s probably right; I believe that cutting down on probiotics, as well as our new obsession with sterilizing our houses like operating rooms, is doing a great deal of harm to our immune systems.  Heck, it might be behind the recent surge in extreme food allergies.

At any rate, I was immediately reminded of a recent experience with fermented octopus:

Yeah, not so good.  However, my good friend Robert recently hooked me up with a great recipe for fermented peppers that promises to be quite tasty:

What you need
Fresh chilis, as much as you want.
Unprocessed sea salt
An airlock (Google has results for DIY and commercial mason-jar airlocks)


Grind up the chilis, add 8-15% salt by weight.  Put under airlock (Robert recommends using glass marbles to keep chilis below the liquid), and age three months.  Note that you can make a sweeter version of this by adding sugar, but it requires a starter.

Does this beer make my ass look fat?

Interesting chart I found at realbeer.com.

Damn, it seems I intake a hell of a lot of calories via beer.  My favorite seasonal, Sierra Nevada Celebration Ale comes in at 214.  I guess thank FSM for my metabolism!

San Diego Bay Wine and Food Festival

So last Saturday, November 19th, Mrs. Pegleg and I woke up quite early and headed to SD for our volunteer shift at the San Diego Bay Wine and Food Festival Grand Tasting at Embarcadero Park. We talked the in-laws into dropping us off, decided to take the train home so we could both enjoy all of the fine wine and spirits available. Arriving at six-thirty in the AM, we were there to work exhibitor support in the US Foodservice tent (they supplied all of the cups, forks, plates, napkins, ice, etc. for exhibitors). Work a six-hour shift, get a free $180 ticket to the event, great deal.

The event opened to VIP ticketholders at eleven o'clock, so of course the (286!) exhibitors didn't start arriving en masse until about 10:15. Since our shift ended at twelve thirty, we had pretty light duty; I'm sure emergency supply runs were getting crazy after the event opened to all at noon. Twelve thirty came, time to take off the volunteer shirts and get to drinking! And eating, of course.

Being San Diego, seafood was at the forefront, to my joy and the missus' chagrin. The most interesting dish had to have been the Black Cod Foie Gras from Sea Rocket Bistro, who had a crew of young, gangsta-looking chefs. My personal favorites were the Beet-Cured Salmon (served with watercress and a lemonade foam) from the Red Marlin and fresh crab claws from Truluck's. Mrs. Pegleg's favorite was Fleming's Prime, who had some delicious steak skewers, along with an even more delicious chipotle mac 'n' cheese. We both loved the pizza from Spinelli Mobile Wood-Fire Oven Catering--the mobile oven is a uniquely awesome setup. The new Aaron Sanchez-created menu at House of Blues was repped by a white chocolate banana bread pudding that was very tasty.

Other standouts included Donovan's Steakhouse, with some great steak sandwiches and filet burritos; the line there was never shorter than 30+ people. Fiscalini Cheese Co. had some fantastic cheeses out, I wanted to carry around a block while wine-tasting. Nobu brought a kimchi stew of sorts that I didn't particularly care for; kimchi is very hit-or-miss for my palate. Dick's Last Resort made a surprisingly good showing for a chain, their pulled pork was succulent, the sauce quite good. Whisknladle suckling pig cured meat (prosciutto?) was melt-in-your-mouth amazing.  Jake's Del Mar, a spot with a very good local rep, failed to impress with soft, fishy scallops.

On the beverage front, the folks we helped supply at the San Diego Symphony booth had some great symphony-branded wines from Fallbrook Winery, and were a great group of people. We found a local winery, Carruth Cellars, that we have yet to visit, and their wine was quite good. Our friends at Sunshine Mountain in San Marcos were out showcasing some of their fine wines as well. Other good wines were from Cliff Family and Gruet Winery, as well as import L'Aventure Languedoc. Indulge Wines is selling box wines minus the box, marketed as eco-friendly packaging. In my day, we called those space bags. Most Beavis-and-Butthead-funny name goes to Ca' Momi Wines.

Ty Ku, who we had seen earlier this year at the San Diego Spirits Festival, had some very good cold sake and soju, though it was somewhat jarring to drink among wines. Pucker was one of the larger companies out, it was, well, what Pucker is. Stella Artois had the best booth and best swag, giving out three different glasses with three different beers (Stella, Leffe, and Hoegaarden), as well as some Crown Royal-style velvet bags. The only drink I can remember really not liking was Magner's Irish Cider.

All in all a great day. Beautiful November weather on the San Diego Bay, tons of people, food and drink. We're told that this is now the second largest wine festival in the US, and I can definitely see why.

Master Chef Casting Call 2011

After a couple of weeks of recipe development, Saturday the 29th of October was go time. Headed to Hollywood for the Master Chef casting call at Le Cordon Bleu on Sunset. I'd auditioned last year and done well, getting a call back for an on-camera interview. A couple of days before the call, I got an email that I was a VIP--scheduled time to show up, no waiting in line. Sweet! Last year, I had to arrive hours ahead of time, and saw the VIPs walking right in. Well, this year it didn't work that way.

For some reason, the casting company decided to do a blog and radio giveaway for what appeared to be a ridiculous amount of VIP passes. Consequently, there was more VIPs than not. Add the fact that the entire casting crew took lunch while I was waiting in the hall, and I was there for like five hours, longer than last year! Finally into the food room, we had two minutes to plate our dish, ready for inspection by two "food experts" and our examination by casting personnel. My annoyance at the wait might have been apparent; although I got very good comments on my food I wasn't selected for a callback that day.

Here's the recipe for what I served the judges, Natchitoches Meat Pies with Cajun Mustard Aioil.

The filling:
1/2 pound ground chuck
1/2 pound ground pork or mild sausage
1/4 pound chicken livers, cleaned and chopped finely
3 large shallots, finely chopped
1 tbsp freshly ground allspice berries
1 tbsp freshly ground black pepper
1/2 to 1 tsp cayenne pepper
kosher salt, to taste
1/3 stick unsalted butter
1 bunch spinach or collard greens, cut and blanched
Melt butter in large skillet over medium-high heat, add shallots and sweat, then add meat. Cook until well-browned, stirring frequently and breaking up the meat. Drain and season.

The crust:
1 can evaporated milk (13 oz)
1 egg, beaten
1 tbsp salt
1 tbsp sugar
1 cup shortening
5 cups all-purpose flour
Mix the dry ingredients in a medium bowl, then whisk milk into egg until well, blended, set to side. Using a pastry blender or two knives, cut shortening into the dry ingredients. Add the egg-milk mixture slowly until moist. Do not overwork, or dough may be tough. Form a ball, flatten into a disc, wrap in plastic and chill for at least 1 hour (can hold up to three days), until dough is firm. Roll out to ~1/4 inch thickness, and use a bowl to cut 6-8 inch circles. Fill half with filling, add a few pieces of blanched greens, fold over, and crimp edges with a fork. Deep fry in oil quickly until crust is golden-brown and flaky.
　
The aioli:
2 cloves garlic, chopped
2 pinches coarse kosher salt
2 large egg yolks
1 tsp lemon juice
2 tbsp spicy brown mustard
1 tsp cayenne pepper
1 cup olive oil
Make a paste with the garlic oil and salt in a mortar and pestle or with the flat of your knife on a cutting board. In a bowl, whisk together garlic paste, cayenne, mustard, egg yolks and lemon juice. Whisking constantly, begin very slowly adding oil, starting drop-by-drop for the first 1/4 cup or so. If you overdo it and the emulsion separates, stop adding oil and whisk until it comes back together. Chill and serve.