Author: WorkCompAcademy

The Division of Workers’ Compensation (DWC) has posted proposed “Chronic Pain Medical Treatment Guidelines” to its online forum. Members of the public may review and comment on the proposal online until Thursday, December 18.

The current Medical Treatment Utilization Schedule (MTUS) Chronic Pain Medical Treatment Guidelines is based on a “frozen” 2009 adaptation of the Official Disability Guidelines (ODG) published by the Work Loss Data Institute.

The proposed guidelines consist of an edited version of the ODG “Treatment in Workers’ Compensation – Chapter on Pain (Chronic),” published April 10, 2014, which DWC has adapted with permission from the publisher. The proposed guidelines were developed in cooperation with the multidisciplinary Medical Evidence Evaluation Advisory Committee (MEEAC) and are based on the best available medical evidence and scientific studies.

“Chronic pain is a public health problem, a significant factor in delayed recovery, and the main reason for medical treatment disputes in the workers’ compensation system,” said DWC Executive Medical Director Dr. Rupali Das. “A key goal of these guidelines is to incentivize a multidisciplinary approach to chronic pain treatment to restore function and reduce pain and ultimately to encourage return to work following injury. The guidelines promote an evidence-based, comprehensive approach to treating pain, emphasizing measures that prevent or reduce chronic pain, suffering, and disability.”

The proposed MTUS “Chronic Pain Medical Treatment Guidelines” provide a set of best practices for considering a multidisciplinary approach to the management of chronic pain issuing from work-related injuries. The guidelines consist of an introduction (Part 1) and specific recommendations on interventions and treatments for chronic pain (Part 2), in addition to extensive bibliography and reference summaries. Specific guidance on opioid use is not contained in the “Chronic Pain Medical Treatment Guidelines” but is provided in a separate MTUS chapter. The proposed new guideline presents a 132 page “menu” of procedures in alphabetical order similar to the existing guideline. Next to each procedure or topic, the “Summary of Medical Evidence” is given with a conclusion such as “recommended” or “not recommended.” After the procedure summary, the Guideline lists the citations to the scientific studies used to support the conclusion for a total of 964 pages contained in the proposed new guideline.

“Chronic pain is a national concern. By issuing these guidelines, California continues to be on the forefront of providing appropriate care and improving outcomes,” said Department of Industrial Relations (DIR) Director Christine Baker. DWC is a division of DIR.

The MTUS regulations can be found in Title 8 of the California Code of Regulations, beginning with section 9792.20. The proposed guidelines are in section 9792.24.2.

Isaiah J. Kacyvenski is a former football linebacker of the National Football League. He was drafted by the Seattle Seahawks in the fourth round of the 2000 NFL Draft. Kacyvenski played six-plus seasons with the Seahawks recording 267 tackles in 90 games and was elected as the Special Teams Captain 3 years in a row. In 2002, Kacyvenski earned the starting job at Middle Linebacker, after battling for the position with Orlando Huff. In 2005, Kacyvenski was Special Teams Captain of the Seahawks and helped lead the team to Super Bowl XL, which was played in Detroit, Michigan. He was released by the team on September 30, 2006. Kacyvenski then signed a one-year contract with the St.Louis Rams on October 3, 2006, and played in ten games for them during the remainder of the 2006 season. As an unrestricted free agent in the 2007 off season, Kacyvenski then signed a one-year contract with the Oakland Raiders on July 11. He was placed on season-ending injured reserve on August 7 and released with an injury settlement a week later after undergoing microfracture surgery on his leg. In September 2008, it was reported that Kacyvenski had decided to retire.

On May 8, 2008, Kacyvenski filed an Application for Adjudication of Claim alleging that he sustained cumulative injury through 2007 to various body parts while a professional football player for the Raiders. The Raiders admitted left knee injury, and the Rams were joined as defendants. At the Mandatory Settlement Conference of July 8, 2014, Kacyvenski elected to proceed solely against the Raiders under Labor Code section 5500.5(c). As a result of the election against the Raiders, the Rams did not appear at the scheduled trial of August 20, 2014, during which time the Raiders and Kacyvenski entered into the Stipulations with Request for Award. The WCJ issued the Joint Award against the Raiders and Rams the same day based on stipulations between the Raiders and Kacyvenski.This Joint Award provided that applicant sustained cumulative injury to various body parts from October 3, 2006 through August 13, 2007 while employed as a professional athlete, resulting in 44% permanent disability and a need for medical treatment.

Although the Rams did not participate in the trial as the non-elected employer, the WCJ awarded benefits to applicant jointly and severally against the Oakland Raiders and against the Rams even though they did not sign the stipulation. The Rams filed a timely Petition for Reconsideration. In their petition, the Rams’ contended that: (1) the Joint Award is based solely on the Stipulations between the Raiders and applicant; (2) the Rams are not a party to the Stipulations and Joint Award since Kacyvenski previously elected to proceed against the Raiders under Labor Code section 5500.5(c); (3) applicant.’s election precluded the Rams’ participation at trial when the Raiders and applicant entered into the stipulated award; and (4) therefore the Joint Award against the Rams violates due process. The Rams contended that the Joint Award is in excess of the WCJ’s powers under section 5903(a}, and request the WCAB to grant reconsideration and order an amended Joint Award solely against the Raiders.

The WCAB agreed in the panel decision of Kacyvenski v Oakland Raiders and granted reconsideration for purposes of amending the Award to remove the Rams from joint and several liability.

It is fundamental that due process requires opportunity to participate in the proceeding determining liability before liability is imposed. (Katzin v. Workers’ Comp. Appeals Bd. (1992) 5 Cal.App.4th 703, 711-712 [57 Cal.Comp.Cases 230, 236]; Fidelity and Cas. Co. of New York v. Workers’ Comp. Appeals Bd. (Harris) (1980) 103 Cal.App.3d 1001, 1015 [45 Cal.Comp.Cases 381).)

Here Kacyvenski elected to proceed solely against the Raiders, and further participation by the Rams at trial resulting in the Joint Award was precluded under section 5500.S(c).

In September 2008, Kacyvenski, the first of five other former NFL players that soon followed, agreed to donate his brain upon his death to the Center for the Study of Traumatic Encephalopathy, a joint program between the Boston University School of Medicine and Sports Legacy Institute in order to have research into the effects of concussions on the human brain performed. Kacyvenski was elected to the Board of Directors of Sports Legacy Institute in 2008, and has used this as a platform for awareness surrounding head trauma and making contact sports safer to play. Kacyvenski now works for cutting-edge conformal electronics technology company MC10, running their Sports Business. He developed the technology behind the CHECKLIGHT, a head impact measurement system, in a partnership with Reebok that launched in June 2013

A stubborn stigma persists toward injured workers who file workers’ compensation claims, according to a new survey commissioned by Summit Pharmacy Inc. The survey revealed:

1) Nearly two in five Americans (37 percent) believe “most workers’ compensation claims are made by people who don’t want to work.”
2) One in three American workers (34 percent) believe if they were injured on the job, “it would be a nightmare process to get the pain medication(s) my doctor prescribed.”
3) More than one-third of Americans (35 percent) agreed with this statement: “You need a PhD to complete all the necessary paperwork associated with a worker’s compensation claim.”

Methodology: This survey was conducted online within the United States from September 29-October 1, 2014 among 2,016 adults ages 18 and older by Harris Poll on behalf of Summit via its Quick Query omnibus product. Figures for age, sex, race/ethnicity, education, region and household income were weighted where necessary to bring them into line with their actual proportions in the population. Propensity score weighting was used to adjust for respondents’ propensity to be online.

Respondents for this survey were selected from among those who have agreed to participate in Harris Poll surveys. The data have been weighted to reflect the composition of the adult population. Because the sample is based on those who agreed to participate in the Harris Poll panel, no estimates of theoretical sampling error can be calculated.

A former Ventura County neurosurgeon who was last based in Detroit, allegedly defrauded the Medicare health care program of millions of dollars by performing unnecessary spinal surgeries on patients, according to a criminal complaint recently unsealed in federal court. Neurosurgeon Dr. Aria Sabit is accused of performing lumbar spinal fusions on numerous patients and billing insurers despite failing to install medical devices in patients whose pain continued after surgery. The 40-page criminal complaint caps a lengthy investigation by the Federal Bureau of Investigation and U.S. Department of Justice that spanned at least two states, and involved multiple patients and tens of millions of dollars. The criminal complaint follows a civil case filed against the same doctor, and others, in Los Angeles federal court last September.

A disheveled, unshaven Sabit, dressed in jeans and a white T-shirt and wearing handcuffs and leg shackles, made a brief court appearance after his arrest. He could face 10 years or more in prison, if convicted.

According to the report in the Detroit News, Sabit, 40, was the focus of a front-page article in the Wall Street Journal last year that concluded he profited from implants he used in dozens of surgeries on patients, including at least one who died. The charges come two months after the Justice Department sued Sabit and a medical network over the alleged fraud. He is accused of using various businesses and medical practices to perpetuate the alleged fraud, including Southfield-based Michigan Brain and Spine Physicians Group. The firm allegedly billed health care programs for services that were not provided or overcharged for the services, according to the criminal complaint.

Sabit performed surgery on almost everyone who walked through his office, an unnamed employee told an FBI agent. Sabit previously was licensed in California and was the subject of more than two dozen medical malpractice lawsuits between 2009-10. In July, he agreed to surrender his California medical license. The new criminal complaint references five former Michigan patients, four of whom were told by Sabit that they needed to undergo spinal fusion surgery. Subsequently, after continuing pain, all patients received second opinions from other doctors stating that no such spinal fusion had been performed and there was no evidence of any screw, or any medical device in the spinal column of the patient,

The United States has also filed civil complaints in a federal district court in Los Angeles, under the False Claims Act against Sabit, spinal implant company Reliance Medical Systems, a Utah company, two Reliance distributorships – Apex Medical Technologies and Kronos Spinal Technologies, both , Florida companies – and the companies’ owners, Brett Berry, John Hoffman and Adam Pike. Reliance Medical Systems allegedly sold spinal implants in Southern California through distributorships that it controlled, including Apex Medical Technologies and Kronos Spinal Technologies. Drs. Aria Sabit and Sean Xie were physician-investors in Apex, and Drs. Gowriharan Thaiyananthan who practices neurosurgery in Orange California and Ali Mesiwala who practices in Pomona California were allegedly physician-investors in Krons. The Los Angeles civil complaints allege that Apex Medical and Kronos Spinal paid physicians, including Sabit, to induce them to use Reliance spinal implants in the surgeries they performed. The litigation also involves Ventura County neurosurgeon Moustapha Abou-Samra, M.D. and Community Memorial Health System hospital in Oxnard. The private complaint alleges that in the spring of 2009, defendant Moustapha Abou-Samra, M.D. a Board Certified neurosurgeon and president of Ventura County Neurosurgical Associates with full privileges at Community Memorial Health System (CMH), recruited Aria Omar Sabit, M.D., a non-board certified neurosurgeon, to relocate from New Jersey to Ventura County, California to be employed by Abou-Samra’s corporation. Sabit was allegedly allowed to perform highly specialized neurosurgical operative procedures including spinal surgeries with open reduction and internal fixation, spinal fusions, laminectomies and pedicle screw implantation at CMH despite demonstrations that his surgeries were allegedly plagued with high infection rates, high return-to-surgery rates, violations of operating room protocols, failures in instrumentation, surgical mishaps, inappropriate case selection and high complication rates. Sabit had allegedly performed over 375 procedures from June 2009 to December 2010 while under provisional privileges at CMH. Some 27 patients who were injured by Sabit’s procedures brought individual lawsuits in the Superior Court of the State of California for the County of Ventura against Sabit and some of the other defendants for medical malpractice.

Sabit is originally from Afghanistan and is accused of illegally obtaining U.S. citizenship last year. Sabit allegedly failed to disclose that he knowingly committed health care fraud, prosecutors said. The government wants Sabit held in jail pending trial, noting that he was questioned in September in Atlanta while trying to fly to Dubai. Sabit told a customs officer that he owned a company involved in mining in Afghanistan. In his luggage, officers found a ruby and a 3.6-carat emerald, according to the complaint.

About 50,000 people are alive today because U.S. hospitals committed 17 percent fewer medical errors in 2013 than in 2010, according to a report in Reuters Health. The lower rate of fatalities from poor care and mistakes was one of several “historic improvements” in hospital quality and safety measured by the Centers for Medicare and Medicaid Services. They included a 9 percent decline in the rate of hospital-acquired conditions such as infections, bedsores and pneumonia from 2012 to 2013.

Secretary of Health and Human Services Sylvia Burwell is scheduled to announced the data at the CMS Healthcare Quality Conference in Baltimore. It is based on a detailed analysis of tens of thousands of medical records, but because data was collected differently before 2010, it is not possible to compare pre-2010 figures to later ones. CMS is a unit of Burwell’s department.

The deadly problem of hospital error burst into the national spotlight in 1999, when the Institute of Medicine estimated that as many as 98,000 people die every year because of hospital mistakes that allow patients to contract infections, fall, develop pneumonia from being on a ventilator, or suffer other serious but preventable harm.

In 2010, the HHS inspector general estimated that poor care in hospitals contributed to the deaths of 180,000 patients covered by Medicare, which insures the disabled and those 65 or older, every year. Officials offered several possible explanations for the steep decline in sometimes-fatal hospital-acquired injuries, infections and other conditions. Hospitals have made a concerted effort to improve safety, spurred in large part by changes in how Medicare pays them. President Barack Obama’s healthcare reform law requires CMS to reduce the reimbursement rate for hospitals that re-admit too many patients within 30 days, an indication of poor care the first time. As a result of the improvements in hospital safety, 1.3 million fewer patients suffered a hospital-acquired condition in 2013 than if the 2010 rate had remained steady, CMS Deputy Administrator Dr. Patrick Conway told reporters. That produced savings of some $12 billion from avoidable costs, such as for treating a single bloodstream infection due to a catheter, at a $17,000.