Author: WorkCompAcademy

Justin W. Webster was a San Francisco police officer who was injured in the course of his employment. After a full evidentiary hearing, the administrative law judge denied Mr. Webster’s application for Industrial Disability Retirement (IDR). The administrative law judge found the retirement system’s medical expert more persuasive than Mr. Webster’s medical expert. Specifically, the administrative law judge found Mr. Webster’s medical expert did not rely on “objective evidence.” After the decision, Mr. Webster filed a petition for writ of administrative mandate.

Additionally, Mr. Webster sought to return to work as a police officer. Before Mr. Webster could return to work, he was required to complete a medical examination. After completing this examination, the medical doctor found Mr. Webster was “not fit for duty.”

In a companion workers’ compensation case, another medical doctor found Mr. Webster was not capable of performing his job duties. Mr. Webster filed a second IDR application. The retirement system declined to process his second IDR application.

The superior court granted in part Mr. Webster’s petition for writ of mandate, setting aside the denial of his IDR application. The court rejected the retirement system’s argument that Mr. Webster had failed to exhaust all administrative remedies. The court ruled that requesting a rehearing based upon the same facts and law would have been futile. Finally, the court, relying on the two new medical reports, remanded the case for reconsideration.

The court of appeal affirmed the trial court in the unpublished case of Webster v. S.F. Employees’ Retirement System -A168995 (September 2024).

San Francisco Employees’ Retirement System appeals from the superior court order setting aside an administrative agency’s denial of respondent’s Industrial Disability Retirement (IDR) application and remanding the case to be reconsidered in light of new evidence pursuant to Code of Civil Procedure section 1094.5, subdivision (e). It argues the superior court erred in finding that respondent’s writ was not barred by failing to exhaust all administrative remedies and admitting two new medical reports.

“While it is true the superior court did not reverse or affirm the agency’s decision, the court decided all issues presented to it. The court set aside the agency’s decision denying respondent’s IDR application. Under section 1094.5, the court exercised its discretion to consider the two new medical reports and remand the case back to the agency to reconsider its decision in light of the new evidence. At that point there was nothing left for the superior court to do. Moreover, dismissing the appeal now could moot the issue of whether respondent had exhausted all administrative remedies before he sought a petition of writ of administrative mandate. We therefore conclude the challenged order is appealable.”

“Because the two additional medical reports were not available within 30 days after the hearing officer’s decision had been served, both sides appear to agree the only basis respondent had for requesting a new hearing was ‘that the evidence did not justify the decision.’ “

“Here, the applicable charter section designates the review hearing as permissive not mandatory. Respondent had no new evidence or legal arguments to present at a review hearing where the same judicial officer would be presiding. Requesting a duplicative hearing on the same facts and law would have been meaningless, costly, and inefficient.“

Appellant also contends the superior court erred by admitting two additional medical reports and remanding the matter back to the agency to consider the new reports.

When the Legislature granted the superior court the discretion to receive “relevant evidence which, in the exercise of reasonable diligence, could not have been produced at the administrative hearing,” it reasonably may be inferred that it meant to authorize the receipt of evidence of events which took place after the administrative hearing. (Curtis v. Board of Retirement (1986) 177 Cal.App.3d 293, 299 (Curtis).)

“Here, the court did not err by considering the two medical reports that were prepared after the hearing. Moreover, section 1094.5 gives the court the option to remand the case in light of the new evidence or admit the evidence and proceed with the court’s independent review.”

“Contrary to Appellant’s argument, the court here merely considered the new medical reports in deciding to remand the matter back to the agency; the court did not admit the medical reports into the record.”

“The superior court made a reasonable determination that the new evidence was sufficient to require the agency to reconsider its decision. Indeed, it is preferred ” ‘that the administrative agency should have the first opportunity to decide the case on the basis of all the evidence’ ” and that the better practice is to remand the action in light of the new evidence.

The American Hospital Association (AHA) released a new report finding that hospital and health system performance on key patient safety and quality measures was better in the first quarter of 2024 than it was before the COVID-19 pandemic, and that hospitals made these improvements while caring for patients with more significant health care needs.

For the report, Vizient provided a risk-adjusted analysis of data from a wide spectrum of 715 general acute care hospitals across 49 states and the District of Columbia with data from the fourth quarter of 2019 through the first quarter of 2024. The 2023 and 2024 data provide a timelier snapshot on hospitals’ performance on key measures compared to some other reports that often use older or outdated data.

Key findings from the report include:

– – Despite being sicker and having more complex conditions, hospitalized patients in the first quarter of 2024 were on average over 20% more likely to survive than expected given the severity of their illnesses compared to the fourth quarter of 2019.
– – Based on Vizient’s analysis, the AHA using national hospitalization data projects that while caring for sicker patients, hospitals’ efforts to improve safety led to 200,000 Americans hospitalized between April 2023 and March 2024 surviving episodes of care they wouldn’t have in 2019.
– – Hospitals cared for more patients overall in the first quarter of 2024 than in the last quarter of 2019, including providing care to a sicker, more complex patient population.
– – Hospitals’ central line-associated bloodstream infections (CLABSI) and catheter-associated urinary tract (CAUTI) infections in the first quarter of 2024 were at rates lower than those recorded in 2019.
– – Not only did multiple key preventive health screenings rapidly rebound to pre-pandemic levels, but ongoing improvement has led to a 60%-to-80% increase in breast, colon and cervical cancer screenings compared to 2019.

“Hospitals and health systems are continuously working to advance patient safety and quality – which is always the hospital field’s top priority,” said AHA President and CEO Rick Pollack. “This report shows hospitals have made significant improvements on pre-pandemic performance in key patient safety outcomes. Hospitals’ commitment to improving patient outcomes and enhancing the patient experience continues to drive these efforts forward.”

“The data in this report underscore the resilience and unwavering commitment of hospitals and health systems – and the millions of hospital team members across the country – to delivering better care and outcomes to the patients and communities they serve,” said AHA Chief Physician Executive and Senior Vice President Chris DeRienzo, M.D. “While hospitals are proud of the progress they continue to make, they also recognize that there is still work to be done.”

“The recent findings from the American Hospital Association highlight the critical role of data in understanding hospital performance on essential patient safety and quality measures,” said Vizient Chief Medical Officer David Levine, M.D.

The emergence of medical innovations, new technologies and cutting-edge procedures spurred most of the annual changes presented in the release of the Current Procedural Terminology (CPT®) 2025, the nation’s uniform data-sharing code set for medical procedures and services published by the American Medical Association (AMA).

“The CPT code set is the foundation for the efficient and effective exchange of standardized information in a data-driven health system, facilitating the reporting, measuring, analyzing, researching, and benchmarking of medical services and procedures with the goal of delivering better patient care, improved outcomes and lower costs,” said AMA President Bruce A, Scott, M.D. “The latest updates to the CPT code set reflect advancements in contemporary clinical practice and ensures the code set fulfills its vital role as the trusted universal language of medicine.”

There are 420 overall updates in the CPT 2025 code set, including 270 new codes, 112 deletions, and 38 revisions. The CPT code set continues to expand in new areas of medicine with proprietary laboratory analyses assigned to the largest proportion of new codes (37%), mostly for novel genetic testing. Category III CPT codes for emerging medical services accounted for about a third of new codes (30%).

Updates to the CPT code set are considered through an open editorial process managed by the CPT Editorial Panel, an independent body convened by the AMA that collects broad input from the health care community and beyond to ensure CPT content reflects the demands of a modern health care system. This rigorous editorial process keeps the CPT code set current with contemporary medical science and technology so it can fulfill its vital role as the trusted language of medicine today and the code to its future.

Key updates in the CPT 2025 code set include:

– – Digital medicine – Remote therapeutic monitoring (RTM) services were editorially revised. Code 98975 was updated to include digital therapeutic intervention, while codes 98976-98978 were revised to include device supply for data access or data transmissions to support RTM of patients.
– – Augmented/Artificial Intelligence (AI) – The AI Taxonomy introduced in 2023 has been implemented in category III CPT codes to classify AI medical services and procedures as assistive, augmentative, or autonomous based on the work performed by the AI application on behalf of the physician or other qualified health care professional (QHP). Seven category III code have been established for AI augmentative data analysis involved in electrocardiogram measurements (0902T and 0932T), medical chest imagining (0877T-0880T), and image-guided prostate biopsy (0898T).
– – General surgery – Updates were made to CPT’s general surgery section to reflect novel approaches in skin grafts for wound care and recovery (15011-15018) and advancements in surgical techniques for the elimination of tumors within the abdomen (49186-49190).

The AMA invites the health care community to the world’s only medical coding event delivered by the authority on the CPT code set. Get guidance on the updates for the CPT 2025 code set by virtually attending the CPT & RBRVS 2025 Annual Symposium in November.

Coding books and products are available from the AMA Storefront on Amazon, including the CPT 2025 Professional Edition codebook. CPT data products, including the CPT 2025 Standard Data File, are available via the AMA Intelligent Platform.

Anna Nicole Smith was an American model, actress and television personality. On February 8, 2007, Smith was found dead at the Seminole Hard Rock Hotel and Casino in Hollywood, Florida. Broward County Medical Examiner and Forensic Pathologist Dr. Joshua Perper announced that Smith died of “combined drug intoxication” with the sleeping medication chloral hydrate as the “major component.”

Dr. Perper claimed that Dr. Khristine Elaine Eroshevich, an Encino psychiatrist had issued 11 prescriptions to Smith. Eroshevich was with Smith when she checked into the Florida hotel, where she later died. More than 600 pills – including about 450 muscle relaxants – were missing from prescriptions that were no more than five weeks old.

Eroshevich also is the teal party in interest and lien claimant who seeks payment for services rendered to workers’ compensation claimants in approximately 1,100 lien claims. Much of the history in this case appears in a 2020 Opinion and Decision After Reconsideration in her consolidated cases.

On September 23,2009, Dr. Eroshevich was charged with six felony counts. On October 28,2010, and after more than two months of trial, Dr. Eroshevich was found guilty by a jury of Count 7, conviction for prescription fraud.

On October 12, 2011, The Medical Board of California, Department of Consumer Affairs issued an accusation against Dr. Eroshevich seeking disciplinary action pursuant to Business and Professions Code section 2236, based on her conviction for “a crime substantially related to the qualifications, functions, or duties as a physician and surgeon.”

On January 19, 2012, the California Attorney General and Dr. Eroshevich entered into a Stipulated Settlement and Disciplinary Order (Medical Board Stipulation) based on the First and Sixth cause for discipline. The Stipulation contains the following reservation: “The admissions made by Respondent herein are only for the Pgrpgse.s of this proceeding, or any other proceedings in which the Medical Board of California or other professional licensing agency is involved, and shall not be admissible in any other criminal or civil proceeding.”

On May 6,2016, the Medical Board terminated probation and reinstated Dr. Eroshevich’s license based on good cause pursuant to Business and Professions Code section 2307 and California Code of Regulations, title 16, section 1360.2.

On February 16,2018, the Chief Judge of the Department of Workers’Compensation issued a Consolidation and Order Staying Liens.On March 14, 2018, lien claimant filed a response to the Consolidation Order requesting that her suspension from the workers’ compensation system be vacated.

This matter went to trial on September 10, 2019. The WCJ admitted into evidence the parties exhibits and found as follows: Dr. Eroshevich was convicted of four felony counts that were reduced to one misdemeanor; Dr. Eroshevich stipulated to a determination by the Medical Board of California based on certain acts in workers’ compensation claims such that her medical license was suspended after a stay of revocation; Dr. Eroshevich was suspended from participating in the Workers’ Compensation system pursuant to an order issued on November 29,2017; and that Dr. Eroshevich filed liens in each of the cases involved in this consolidated matter.

The WCJ further found that lien claimant failed to meet the burden of proof required to rebut the presumption of Labor Code3 section 139.21(9). Erosevich’s Petition for Reconsideration was granted, and the WCAB rescinded the F&O, and returned this matter to the trial level for further proceedings consistent with this decision.in Tang (1) v Solar Link International, Dr. Khristine Eroshevich Real Party In Interest -SAU6852145 (April 2020).

Following remand, another Findings of Fact & Order after Remand by the Workers’ Compensation Appeals Board (F&O), issued on September 22, 2020 by a workers’ compensation administrative law judge (WCJ). The WCJ found in pertinent part that lien claimant was convicted of a misdemeanor for fraudulently prescribing a controlled substance in violation of Health and Safety Code section 11173, subdivision (a) (11173(a)); that this conviction was the only basis for the WCJ’s determination; and, that lien claimant failed to meet the burden of proof required to rebut the presumption set forth in Labor Code2 section 139.21, subdivision (g) (section 139.21(g)); and, therefore, all liens and underlying bills for service and claims for compensation from lien claimant arise from the conduct set forth in the Order of Suspension of lien claimant pursuant to section 139.21, subdivision (a)(1)(A)(iv) (section 139.21(a)(1)(A)(iv)). And that lien claimant’s liens be dismissed with prejudice and that lien claimant shall have no right to payment on all underlying bills for service and claims for compensation within the jurisdiction of the workers’ compensation system.

Sometime after the September 22, 2020 Finding of Fact & Order, the WCAB again granted the Petition for Reconsideration filed by lien claimant Kristine Eroshevich, M.D., Ph.D. “in order to study further the legal and factual issues raised therein.” . It was arguably what is referred to as a Grant-and-Study Order.

Then the Court of Appeal issued three different published opinions indicating that Grant-and-Study orders are not compliant with the Labor Code, and that the WCAB lacks jurisdiction to grant reconsideration if its fully reasoned grant of reconsideration did not occur within 60 days. See Earley v. Workers’ Comp. Appeals Bd. (2023) 94 Cal.App.5th 1 – Zurich American Ins. Co. v. Workers’ Comp. Appeals Bd. (2023) 97 Cal.App.5th 1213 – And recently Mayor v. Workers’ Compensation Appeals Bd A169465 (August 2024).

Nearly 4 years after the September 22, 2020 Findings of Fact & Order after Remand the WCAB issued its “Opinion and Decision after Reconsideration” on August 30, 2024 in the case of Tang (2) v Solar Link International, Dr. Khristine Eroshevich Real Party In Interest -SAU6852145 (August 2024), and affirmed the F&O in part, but amended the Findings of Fact and the Orders to find that lien claimant did rebut the section 139.21(g) presumption; that lien claimant’s lien claims are not dismissed with prejudice; and, that adjudication of the merits of lien claimant’s lien claims are deferred pending decision by the workers’ compensation administrative law judge pursuant to section 139.21, subdivision (i), whether to adjudicate the liens or to transfer the liens back to the district offices having venue over the cases in which the liens were filed.