Fred Levy, senior co-director of the Center for Medicine and Law in Baltimore, said emergency-room doctors certainly see people who are reluctant to take the recommended time off. He'd like to see more research into the costs and benefits of paid leave.

"This may be beneficial, but it's a question we can attempt to answer a little more rigorously before marching forward," said Levy, whose center is part of the Johns Hopkins School of Medicine and the University of Baltimore School of Law.

The local Working Matters coalition — launched by the Public Justice Center and United Workers as well as the Job Opportunities Task Force — is holding a forum Wednesday in Baltimore to kick off its paid-leave efforts. Details still need to be hammered out, but the task force's Perkins-Cohen hopes that the General Assembly will consider a leave proposal in the session that starts in January.

The idea can be a tough sell. A Denver ballot initiative was voted down nearly 2 to 1 last year after the city's mayor gave it a thumbs down and an opposition campaign characterized it as a job-killer and too broad.

"They called it paid sick leave, but there was no requirement that an employee produce any evidence that they were sick," said Pete Meersman, president of the Colorado Restaurant Association.

Erin Bennett, Colorado director of 9to5, a national group that advocated for the Denver law, said paid-leave proponents should take a lesson from that campaign and prepare for big-spending business groups "spreading misinformation."

Employees wouldn't have had to provide a doctor's note for illnesses lasting two days or less, but Bennett said research into sick-leave use contradicts claims that workers would abuse it. The typical worker in San Francisco uses three days a year, less than the maximum allowed, the Institute for Women's Policy Research said.

Rojas, the Baltimore restaurant worker, said she needed three days to recover from a cold in October. No paid leave meant no wages, which was a problem. But she said she had a bigger problem while working at the Cheesecake Factory in Baltimore three years ago.

Rojas, who made pizzas and salads there, said she tried to reach managers by telephone after a clinic diagnosed her with pneumonia, but she said no one would talk to her. She said she brought her clinic paperwork in after she recovered. But over the next few weeks, her hours were reduced to zero, she said.

Sidney Greathouse, vice president of legal services at the Cheesecake Factory, which operates more than 170 restaurants nationwide, said the company obeys all sick-leave laws.

"It is not the company's policy to reduce hours following, or as a result of, a permitted leave of absence," he said in a statement, adding that the company doesn't comment about individual workers.

Ellen Bravo, executive director of Family Values @ Work, a network of state coalitions that advocate for policies like paid sick days, said it's hard for big businesses to make the case that they can't afford it. So groups lobbying against paid leave "wrap themselves in the flag of small shops," she said.

"In San Francisco, after huge outrage and 'the sky will fall,' not only do 6 out of 7 employers say there was no negative effect … two-thirds now say they support it," Bravo added.

Elizabeth Torphy-Donzella, an employment-law attorney with Shawe Rosenthal in Baltimore, said it's not unreasonable to point to the effect on small businesses because large employers "already typically provide paid leave." She said she represents a family-owned restaurant that tries hard to provide its 50 employees with benefits, but finds it a struggle.

"The concern that I have is while it would be good for everyone to have paid leave, that which is good can't always be legislated because someone has to pay for it," said Torphy-Donzella, a member of the Maryland Chamber of Commerce's legislative committee.

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