Do we have an "advocate"?
 

iwanta know if there's an advocate group that can help me as i struggle thru RSD while "fighting" w/worker's comp?? i need someone that can tell me: u need 2 say this or u need 2 do this! i'm not getting treatment i need because of w.c. "crazy people" (who don't know RSD!)..... Help! :confused:

Hi Nancy,
I, too, am in warfare with W.C. !! I injured my ankle at work in '06 and had surgery in '08 and developed RSD..(not sure if the RSD happened before or after surgery, but we think it was after...)
I happened to be in the right place at the right time when a doctor recommended I have an attorney to advocate for me and represent me ...and he recommended some one he knew..
WC wanted to do a QME exam a long time ago with a completely inapporpriate examiner..my attorney intervened and arranged the QME exam with an agreed upon examiner that he trusted...
I anticipate another battle with approval for some equipment and it is comforting to know that the attorney will help me with that ...
It would really be great to have an additional "advocate" in addition to the attorney..maybe some of the RSD organizations can provide some info and insight into such a person!
Thinking of you,
Hope4thebest

Dear Nancy -

You need to speak with a lawyer ASAP. Subject to correction, it is my understanding Cal. declared -- by statute -- about 3 - 4 years ago that RSD and Fibro. woudn't be covered by WC. Period. A horrible thing, but there it is.

That said, if you are still within the statute of limitations for bringing a claim of negligence against your employer, you may be able to do so, where it shouldn't be able to assert the defense of "workers' comp. pre-emption" if RSD is no longer a covered claim for WC purposes. Put it another way, to remove any remedy for your injury could be argued to rise to the level of a "takings" under the Fifth and Fourteenth Amendment of the US Constitution. But please get on this quickly.

Mike

Hello Nancy,

My RSD is not the result of a job injury. However, my long term disability insurance wanted to cancel my benefits. They claimed RSD is a mental not physical condition and they only cover mental conditions for 2 years.
I talked with my physcologist who recommened an attorney who helped to change the insurance companies view.
I recommend you consult an attorney. WC like insurance companies want to get out of paying so they make it soooo difficult to get proper care.
I know how frustrated you must feel. It's bad enough dealing with all that RSD does to our bodies and mind without adding the frustrations of legal matters. However, that's the way the WC system works. They almost force you get an attorney to get proper care and attention. (My husband had a WC injury from his job as a firefighter).
Take care of yourself the stress, alone, from dealing with WC will keep your pain flared.
I hope you can make some progress soon.
Sherrie

Hi FMichael,

When you write that " California declared ---by statute---about 3 or 4 years ago that RSD and Fibro wouldn't be covered by W.C. " what does that entail?
Doe sit mean that you are unable to get life-time medical benefits, or a settlement or? My diagnosis is RSD, confirmed with a second opinion by a reputable university hospital.

W.C. has paid thus far for al my medical expenses, albeit, it's like extracting a needle from a two ton haystack..but eventually they do approve most authorization requests...eventually...

Which statute are you referring to...it has me worried!!!!!
Thanks for the info!!!
I hope you are doing well !
Hope4thebest

thks 4 all ur advice! my accident occurred in my new computer lab - fell down a step where the silver strips hadn't been placed on the steps. broke left wrist in 2 plcs, thus RSD! have been speaking 2 a good attorney.... eventually might result in a claim of negligence against employer. still wish i had a good advocate 2 advise me..... thinking of everyone!

Nancy
Everything will work out ok,,do your part,and rely on the Lord in prayer,,he will deliever you ,, bobber

Sorry it's taken me so long to answer Hope4thebest, but this was one of those situations where although I remembered the net result properly, I ran into nothing but frustration in trying to do online statutory research in order to retrace my steps, plus my friend the WC attorney who confirmed my understanding of what SB 899 meant when it passed in 2004 has been in an ICU for the last two weeks.

The good news is as follows: (1) my friend and father of my oldest son's best friend of many years standing is going to pull through and (2) in a published decision of the full (en banc) Workers' Compensation Appeals Board that came down in February of 2009, referred to as the Almaraz-Guzman Opinion, http://www.csims.net/pdf/Almaraz%20-...0en%20banc.pdf, the court held that the presumptions created in the "Schedule for Rating Permanent Disabilities" of the California Department of Industrial Relations, Division of Workers' Compensation, http://www.dir.ca.gov/dwc/PDR.pdf, which in turn incorporates the American Medical Association (AMA) Guides to the Evaluation of Permanent Impairment, 5th Edition, are rebuttable.

Now, I know that was an impossibly long and opaque sentence, but what it boils down to is pretty simple. Back in 2004, shortly after he assumed office, Arnold threatened to violate the California Legislature unless it passed "comprehensive workers' compensation reform," and the legislature obliged with the adoption of SB (Senate Bill) 899, the business end of which appears in Labor Code Sec. 4660, embracing the "evidence-based medicine" [Gawd, what a misnomer!] of the AMA Guides. And here's where my memory betrayed me: there is no reference to either CRPS or Fibro in the statute. My recollection now refreshed, I had to have read at the time what the adoption of the AMA Guides would have meant in practice for anyone with those pain conditions. It was this understanding that my friend Ted confirmed when this was going down. (And I realize that my "false memory" was correct in one sense. Everyone knew that the statute as written was designed to relieve industry of the burden of defending against trumped up claims of chronic pain, and if that meant throwing the baby out with the bath, so be it. Claims based on RSD and Fibro would not be allowed.)

For a terrifying screed by a leading physcian regarding the effect of the AMA Guides on (now past) RSD patients, as it appears on the RSD Foundation webpage, check this out: http://www.rsdfoundation.org/test/AMA.html. I would urge everyone to read it closely.

Bottom line: for patients in California, a rebuttable presumption is better than one that's irrebuttable, but a presumption it remains. Or don't try this at home. This is indeed where people need lawyers.

Mike

Thanks Mike. After reading Dr. Kirpatrick's letter and the response from the AMA official who recommended using a different chapter for rating purposes because it is kinder to RSD/CRPS patients, is alarming.

So there are two standards within the "Guides" in which to rate an RSD/CRPS patient. Pg. 343 and Pg 495, the former being apparently much kinder to the patient. So then what will happen is that those examiners who want to hammer the patient will use pg 495 and those who are more sympathetic, will use pg 343. More work for the judges, I guess. I will have to check to see what ACOEM says about this. Only in America!

Sorry, no clue. That would probably require the input of an in the trenches WC attorney. I just happened to stumbled upon the the Almaraz-Guzman Opinion becouse it came up when I searched under SB 899. Speaking of which, had you seen or heard of that decision and is there anything in there that might shine light on the question you posed? Do you see the opinion as having any potential effect in your own work?

As an aside, I'm so far out of my own former practice area - bankruptcy - that out of curiousity I opened an emailed invitation to an ABA Section meeting the other day, only to see a memorial award being given in the name of a lady law prof., with whom I used to be a good (professional) friend, in what seems a lifetime ago. :( A further search showed that she passed away 4 years ago. And being totally out of the national game, I knew none of it.

Hi fmichael and Dubious,
Thanks for the interpretation and the analytical questions about the worker comp information!! To the layman, the legal jargon is so intimidating...I don't even know if my attorney would know the details of this info....
There are so many trickster paragraphs..it is overwhelming...

I had read an article in a California newspaper that talked about how the "doctors" who determine authorizatons for treatment by looking through pages of a manual !!! (without even a look or glance at the human being involved!!!) aren't even licensed to practice in California...they are in another state... That way, if there is ever any litigation they would be exempt.......
The whole thing is criminal , but it is what it is..just like my RSD..
Thanks for the hours of research that you delve into and share with us!!!!!

Hope4thebest (doing my best not to let cynicism outweight the RSD!!!!!

Personally, I think it's a stretch to extrapolate this country's WC experience with the health care proposals in Washington. The WC situation exists - replete with payouts so low in California that many doctors will no longer accept patients with that "insurance" - because politically powerful business interests, the insurance companies and the employers who pay into them, are aligned on the one side, with no one to speak of on the other side. Nor does state house politics generate a lot of press in the local media. (I know that in LA, all of the local television stations closed their Sacramento bureaus decades ago.) While money still talks in D.C., this is a much higher profile event than what went on, according to Almaraz-Guzman, when, over time, some 40 states enacted laws incorporating the AMA Guides, to one degree or another.

How the AMA was co-opted is of course another story, but the "Special Report: American Medical Association is Injuring Patients with RSD" of the International Research Foundation for RSD/CRPS, to which I linked earlier (and incorrectly identified as "a terrifying screed by a leading physcian [sic]") is pretty damning. Again, that can be found at http://www.rsdfoundation.org/test/AMA.html. My guess is that the link was forged out of two elements, class and racial bias on the one hand (one group of white shoe guys being sensitive to the needs of another), and economic interests on the other: where an award based high percentage lifetime disability will have a significant present value in to insurance carriers, they are in a better position to pay for expert witness testimony from physicians than are solo or small firm lawyers representing WC petitioners, who will have their fees, and possibly costs, capped by state laws.

But back to the point that was raised about national health-care legislation, there is more (or less) to the notion of "cost-containment" than (1) putting providers on salary as they are at the Mayo Clinic or the original HMO, Kaiser, or (2) having some centralized schedule mandating which test can be ordered for a patient. For a great recent article that explored why 2006 per capita Medicare spending was some fifteen-thousand dollars in the border town of McAllen, Texas - with a state of the art for-profit hospital in which all attendings not only owned a fractional interest but were directly paid off a schedule for each test they ordered - while 2006 per capita Medicare spending was only $6,888 in Rochester Minnesota, the home of the Mayo Clinic - please check out in full "The Cost Conundrum, What a Texas town can teach us about health care," Atul Gawande, The New Yorker, June 1, 2009, a summerizing excerpt follows:

The Mayo Clinic is not an aberration. One of the lowest-cost markets in the country is Grand Junction, Colorado, a community of a hundred and twenty thousand that nonetheless has achieved some of Medicare’s highest quality-of-care scores. Michael Pramenko is a family physician and a local medical leader there. Unlike doctors at the Mayo Clinic, he told me, those in Grand Junction get piecework fees from insurers. But years ago the doctors agreed among themselves to a system that paid them a similar fee whether they saw Medicare, Medicaid, or private-insurance patients, so that there would be little incentive to cherry-pick patients. They also agreed, at the behest of the main health plan in town, an H.M.O., to meet regularly on small peer-review committees to go over their patient charts together. They focussed on rooting out problems like poor prevention practices, unnecessary back operations, and unusual hospital-complication rates. Problems went down. Quality went up. Then, in 2004, the doctors’ group and the local H.M.O. jointly created a regional information network—a community-wide electronic-record system that shared office notes, test results, and hospital data for patients across the area. Again, problems went down. Quality went up. And costs ended up lower than just about anywhere else in the United States.

Grand Junction’s medical community was not following anyone else’s recipe. But, like Mayo, it created what Elliott Fisher, of Dartmouth, calls an accountable-care organization. The leading doctors and the hospital system adopted measures to blunt harmful financial incentives, and they took collective responsibility for improving the sum total of patient care.

This approach has been adopted in other places, too: the Geisinger Health System, in Danville, Pennsylvania; the Marshfield Clinic, in Marshfield, Wisconsin; Intermountain Healthcare, in Salt Lake City; Kaiser Permanente, in Northern California. All of them function on similar principles. All are not-for-profit institutions. And all have produced enviably higher quality and lower costs than the average American town enjoys.

I first saw the article in an email from the RSDSA and it appears on its site at http://www.rsds.org/5/news/2009/May/...er_27_185.html, along with a link to the article source at http://www.newyorker.com/reporting/2...urrentPage=all.

And not to worry. The article, written by a surgeon, doesn't endorse one particular plan or another, just requiring “collective responsibility” at a local level among health care providers.

Mike

ps If anyone wants to ask why attorneys aren't being asked to join into loose confederations of some sort, the answer is simple, there's no widespread analogue to health insurance or Medicare supporting their fees. Certainly not the folks in gleaming office towers with tasteful ash-trimmed interiors, unless they’re representing the governmental unit itself in high end litigation, real estate, bond financing, etc. And with the possible exception of attorneys representing disabled kids in IDEA contingency litigation, I can’t think of another area where a lawyer representing individuals and compensated out of public funds could possibly make enough to put his/her kids through a liberal arts college: something that’s generally not a great stretch for doctors at either Kaiser or the Mayo Clinic.

Of course, the reason that so many incredibly qualified people are willing to join the staff of the Mayo Clinic and live in Southeastern Minnesota is that they don’t have to run a business, just practice medicine with some of the best support services on this side of the solar system.

The other day, in discussing the seemingly alternative tests for diagnosing RSD in the AMA Guides, which were blasted in the "Special Report: American Medical Association is Injuring Patients with RSD" of the International Research Foundation for RSD/CRPS, Dubious asked:

After thinking this thru a little further, since there are 2 comparable but distinctly differenet standards and criteria within the same publication to determine impairment (really weird), which one is used more often and which prevails in court? Mike, do you know?

To which I punted. Having looked more carefully at the Special Report and in particular the corresponding pages of the AMA Guide, while I may not "know," I am prepared to accept the answer set forth by Dr. Anthony Kirkpatrick et al:

. . . contrary to what [Dr. Michael Maves, Executive VP and CEO of the AMA] stated, the neurology chapter does not contain any criteria to make the diagnosis of RSD. The chapter focuses instead on case reports intended to assist the physician in determining physical impairments in patients that have been diagnosed with RSD.

That said, anyone litigating this would also want to know the exact title of Sub-Chapter 16.5, which contains the language at pp. 495 - 496, so that it could then be compared with that of Sub-Chapter 13.8 ("Criteria for Rating Impairments Related to Chronic Pain") and the hypothetical at pp. 343 - 344.

Is this helpful?

Not sure. They now have a month to mull this over, and I suspect will come back with something more along the lines of what was suggested in The New Yorker article, where the mandate will be an economic incentive to enter into local confederations that will guarantee some economies of scale and provide at least some loose and locally agreed guidelines for treatment. By the way, what did you think of it? I was most struck by the around the table discussion with doctors in McAllen TX, who when asked what would happen to the 40 year old woman who complained of chest pains after a fight with her husband, one of them replied, "Oh yeah, she'd definately get the cath."

Mike

Post #15 above. Take care.

money talks: Doctors Hospital at Renaissance
 

I know we've moved on, but regarding the hospital in McAllen, Texas featured in the New Yorker article that was referenced in the previous posts, check out the front page story from today's N.Y. Times, and in particular the graphic showing per capita Democratic fundraising per 1,000 of population across the country, turns out that not only is McAllen is second in the country, well ahead of Aspen CO and just behind Jacksonson Hole WY, but when it comes to this Congress, its contributors get what they pay for:

July 30, 2009

Texas Hospital Flexing Muscle in Health Fight

By KEVIN SACK and DAVID M. HERSZENHORN

McALLEN, Tex. — One of the largest sources of campaign contributions to Senate Democrats during this year’s health care debate is a physician-owned hospital in one of the country’s poorest regions that has sought to soften measures that could choke its rapid growth.

The Democratic Senatorial Campaign Committee collected nearly $500,000 at a reception here on March 30, mostly from physicians and others affiliated with Doctors Hospital at Renaissance, financial disclosure records show.

The event was held at the home of a prominent McAllen developer, Alonzo Cantu, a hospital founder, investor and board member who has raised prodigious sums from the Rio Grande Valley for an array of Democrats.

Another event at Mr. Cantu’s home, in September 2007, brought in at least $800,000 for the committee’s House counterpart, the Democratic Congressional Campaign Committee, according to disclosure reports. The House speaker, Nancy Pelosi, was in attendance and cut a ribbon at the hospital’s new women’s center while in town.

The hospital, which is in Edinburg, adjacent to McAllen, is working both sides of the aisle. Its political action committee, Border Health PAC, split $120,000 last year among House and Senate candidates, including Republicans.

Although Congressional negotiations over health care legislation are continuing, Doctors Hospital seems to be getting much of what it wants. Thus far, physician-owned hospitals have been insulated from some of the most onerous potential restrictions in the health care legislation moving through Congress. . . .

http://www.nytimes.com/2009/07/30/us....html?_r=1&hpw

This is a lesson kids in my son's sixth grade learned big time this year, money talks now 'days in this blessed land, as it hasn't since before the Great Depression. Separate and apart from those students requesting financial aid, admittance to what was largely regarded as the best private high schools in the city was much more a function of family income (and ability to pledge large five or lower six figures in annual donations) over and above the not insignificant tuition that my mother in law is advancing us, than any metric pertaining to the kid or his/her performance. Having said this, my son came out fine but too many highly qualified kids didn't.

The only "good news" in all of this, at least from my prespective, is that with all these abject lessons of the disproportionate influence of wealth on matters of influence in our society, we're well on our way to breeding the next real generation of campus radicals.

Mike