Re: California -- Bradshaw Says New Committee Will Tackle Gui...

[Guest guest]

Thank you for this informative post. I am a QME specializing in industrial

related injury that includes environmental medicine. I have not been as active

in this area as I should and I hope to change this. Please continue to light

a fire under me with any information you can provide. Having suffered with

mold syndrome, I care deeply about the issues that affect us in our daily lives

and the uphill battle in the education of those that deny a problem exists.

Bobbins, RN, L.Ac, QME

In a message dated 4/21/06 2:55:30 PM Pacific Daylight Time, snk1955@...

writes:

> 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@...

>

>

>

>