California -- Bradshaw Says New Committee Will Tackle Guidelines: General [04/20

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California -- Bradshaw Says New Committee Will Tackle Guidelines: General

[04/20/06]

California Labor Secretary Bradshaw said Wednesday that the

Division of Workers' Compensation will release proposed regulations in about

two

weeks that would create a medical review committee to take the state's

utilization-review system beyond American College of Occupational and

Environmental

Medicine (ACOEM) treatment guidelines.

Bradshaw made herself available for media interviews in conjunction with the

second anniversary of the signing of Senate Bill 899. She touted the success

of the reform bill and said regulators are taking a careful, deliberate

approach toward further system changes.

One of those steps will be adoption of a more comprehensive set of treatment

guidelines, as mandated by SB 899. The reform bill imposed ACOEM as a

stop-gap until the DWC produced a more thorough set of guidelines.

Bradshaw said the proposed medical review committee will consist of medical

doctors, chiropractors and other providers appointed by the DWC

administrative director.

" The reality is nobody is going to be happy with one set (of guidelines), "

Bradshaw said. " The legislature adapted ACOEM and that was the best at the

time. Now what we are going to do is create the medical review committee to

look

at adjustments that need to be made, and (the committee) is going to

constantly evaluate it. "

Carlyle Brakensiek, executive vice president of the California Society of

Industrial Medicine and Surgery, said it sounds like the DWC is on the right

track. He said DWC acting Administrative Director Nevans has described

the medical review committee as a " blue-ribbon panel. "

Brakensiek said one of the problems with the use of ACOEM is they do not

cover the wide range of injuries experienced in industrial medicine, in part

because the panel of experts that crafted them did not include some

specialists.

He said no orthopedic surgeon was on the ACOEM panel and only one

chiropractor participated. And he happened to be an employee of Washington

state's

monopoly workers' comp insurer, Brakensiek said.

As a result, ACOEM has no guidelines for common industrial ailments, such as

head trauma or even headaches, which are commonly experienced by injured

workers due to exposure to toxic fumes, he said.

Brakensiek said the medical review committee could fill in the gaps.

" We would hope the panel of experts will be able to expand on the number of

injuries over which there will be recognized treating guidelines and expand

the number of modalities that are recognized, " he said.

One common complaint by medical providers and injured-worker advocates is

that claims adjusters routinely deny care because the treatment plan is not

included in ACOEM. Bradshaw said regulations recently sent to the Office of

Administrative Law for final approval should alleviate that problem. The

so-called utilization-review penalty regulations state explicitly that claims

adjusters may not use the absence of mention by ACOEM as a reason for denying

care,

and (these regulations) create stiff penalties against insurers, employers

and third-party administrators that show a pattern and practice of

inappropriately denying or delaying medical care.

Another major complaint by injured worker advocates has been California's

new " Permanent Disability Rating Schedule, " which studies show has reduced

permanent disability indemnity benefits by an average of 50%. Bradshaw said the

DWC is not going to rush into any changes until it collects 18 months of data

on ratings and their adequacy in replacing lost wages. She repeated earlier

comments by Nevans that the DWC needs to find out how well the return-to-work

provisions included in SB 899 succeed in getting injured workers back on

their jobs before determining the adequacy of disability awards.

And it appears that Nevans will remain in charge of that task. Bradshaw gave

no indication of when Gov. Arnold Schwarzenegger will appoint a permanent

administrative director to replace Nevans, but said the governor is " thrilled "

with Nevans performance so far.

" will remain there as long as she is needed, " Bradshaw said.

--By Jim Sams, WCC senior editor

jim@...