In 2004, the Legislature passed SB 899 which was a major reform of the California workers’ compensation system. As a part of that reform, SB 899 required the DWC to create an evidence-based set of medical guidelines to ensure that injured workers were receiving consistent, appropriate treatment from physicians. In the intervening period, SB 899 required that physicians use the ACOEM guidelines, which are a set of widely-utilized evidence-based, peer reviewed medical guidelines that continue to be used in California’s workers’ compensation system and many other state workers’ compensation systems.

In 2009, the DWC promulgated the California-specific workers’ compensation system medical treatment guidelines known as the Medical Treatment Utilization Schedule or “MTUS.” The MTUS utilized many of the chapters that make up ACOEM, but also referenced additional guidelines or developed independent guidance on medical treatment. As such, while ACOEM is still used as a part of the MTUS, it no longer operates as a stand-alone guideline, and the references to it in the Labor Code can be confusing and cause practitioners to fail to refer to the MTUS.

The DWC has suggested to the legislature that the Labor Code be cleaned up to reflect the fact that the references to ACOEM are no longer accurate, and could potentially be confusing. SB 914 signed into law by Governor Brown this month is intended to accomplish this goal.

The California Neurology Society California, the Society of Industrial Medicine and Surgery and the California Society of Physical Medicine and Rehabilitation voiced support for the new law. There was no opposition reported in the legislative record.

SB 914 takes effect next January.

Although the words “American College of Occupational and Environmental Medicine’ s Occupational Medicine Practice Guidelines” or ACOEM Guidelines as they are generically known disappear from Labor Code section 4614.4, much of the actual text of ACOEM Guidelines remains as part of the MTUS which is adopted by DWC regulation. A review of the bulk of the MTUS chapters shows a straightforward citation directly to the equivalent chapter of ACOEM as follows:

Section 9792.23.1 – Neck and Upper Back Complaints (ACOEM Chapter 8)
Section 9792.23.2 – Shoulder Complaints (ACOEM Chapter 9)
Section 9792.23.3 – Elbow Complaints (ACOEM Chapter 10)
Section 9792.23.4 – Forearm, Wrist, and Hand Complaints (ACOEM Chapter 11)
Section 9792.23.5 – Low Back Complaints (ACOEM Chapter 12)
Section 9792.23.6 – Knee Complaints (ACOEM Chapter 13)
Section 9792.23.7 – Ankle and Foot Complaints (ACOEM Chapter 14)
Section 9792.23.8 – Stress Related Conditions (ACOEM Chapter 15)
Section 9792.23.9 – Eye (ACOEM Chapter 16)

Thus, although the ACOEM Guideline will no longer be with us by name, it most assuredly will be by substance. The DWC has however added chapters to the MTUS where ACOEM did not address needed topics. For example, the MTUS has its own chapter on Acupuncture, Chronic Pain, and Post Surgical Treatment.