tag:blogger.com,1999:blog-8489363879633129568.post8271478288268143179..comments2023-11-13T11:54:56.769-08:00Comments on DePaolo's World: The Word Didn't Get ThereAnonymoushttp://www.blogger.com/profile/02446191842560064784noreply@blogger.comBlogger7125tag:blogger.com,1999:blog-8489363879633129568.post-91929126918344858612014-09-04T04:49:19.314-07:002014-09-04T04:49:19.314-07:002 of 2
DISCUSSION
Falls and sprains generally do n...2 of 2<br />DISCUSSION<br />Falls and sprains generally do not come in the same day unless they are serious.<br />Red flag #1.<br /><br />The initial evaluating physician on the date of injury was concerned enough that he immediately obtained x-rays and apparently clinically by history of how hard the fall was, the level of pain, and exam findings he was concerned that there could be a fracture, serious disruption or derangement that needed STAT specialty surgeon care.<br />Red Flag #2<br /><br />The surgery consult may even have been done without authorization due to the 4 day speed with which the patient was seen by the hand surgeon.<br />Red Flag #3<br /><br />The hand surgeon evaluated the patient and was also concerned that there was a serious derangement and depending on the type of derangement the patient may need STAT surgery.<br />Red Flag #4<br /><br />The "3 week surgical window" to try for a good surgical result noted by the IMRO radiologist warrants commensurate speed for review.<br />Red Flag #5<br /> <br />Few doctors with experience taking care of these injuries take them lightly. <br /><br /> The IMRO radiologist cited the importance of early surgery then disregarded his own citation in his decision. <br /><br /><br />The treatment should have been immediately authorized.<br /><br /><br />The Medical Board review can be funded by the insurance carrier payments the same way they fund the IMR. The Medical Board can select a panel of specialists that may confer and render decisions.<br /><br />Physicians reviewing cases for the Independent Medical Review Organization (IMRO) as well as regular UR physicians need to be answerable since insurance companies are using opinions from these practitioners to make decisions regarding how medicine will be practiced on the patient.<br /> In turn the insurance company may hold the vendor responsible for not providing a capable physician. <br /><br />Anonymoushttps://www.blogger.com/profile/02917115934232001155noreply@blogger.comtag:blogger.com,1999:blog-8489363879633129568.post-54475489211764874462014-09-04T04:48:25.517-07:002014-09-04T04:48:25.517-07:001 of 2 Jeffrey Stevenson, M.D.
INDEPENDENT MEDICA...1 of 2 Jeffrey Stevenson, M.D.<br />INDEPENDENT MEDICAL REVIEW ORGANIZATION (IMR) decision.<br /><br />A UR physician and a follow-on IMRO radiologist denied complete imaging for STAT MRI and CT for possible early surgery for possible scapholunate disruption and scaphoid fracture that had a 3 week post injury window for repair. The UR and IMRO delayed the imaging and the window for optimal repair was lost. <br /><br />There were 5 Red Flags on this case missed by the UR physicians.<br /><br />THE CASE<br />1-4-2013 DATE OF INJURY<br />1-4-2013 DATE OF INITIAL PRIMARY MD EVALUATION:<br />58 yo worker fell and injured his left wrist.<br />He was seen same day and x-rays were ordered by the evaluating physician.<br />The plain films were negative, but the physician was concerned and referred him to a hand surgeon.<br /><br />1-8-2013 ORTHOPEDIC SURGEON EVAL AND REQUEST FOR STAT MRI AND CT WRIST<br />The hand surgeon saw him within 4 days and ordered STAT wrist MRI and CT and was concerned he may have a scaphoid fracture and or a scapholunate ligament tear and may need surgery and apparently noted a 3 week surgical window for repair.<br /><br />1-18-13 INITIAL ADJUSTER-UR DENIAL<br /><br />1-25-13 3 WEEK WINDOW FOR SURGICAL REPAIR CLOSED<br /><br />1-28-13 IMR APPLICATION RECEIVED:<br />IMRO REQUESTED AND WAS GRANTED A TIME EXTENSION ON THIS EXPEDITED APPEAL<br />IMRO radiologist reviewed this case and authorized the MRI and denied the CT noting the hand surgeon should wait and see what the MRI showed then request the CT.<br />The IMRO radiologist had noted the fact that that the repair within 3 weeks of the injury was important.<br /><br />2-5-13 IMRO APPROVED THE MRI:<br />2-5-13 IMRO DENIED THE CT:<br /><br /> STAT PREOP WORK-UP STILL NOT COMPLETE<br /><br />ESTIMATED ADDITIONAL TIME TO DO THE STAT SURGERY:<br />These are optimistic estimates.<br />10 days to schedule the MRI and see the patient and check MRI.<br />3 days for new CT request with dictation to insurance carrier-UR<br />10 days for STAT UR to review and authorize the CT<br /> (This is the time for the initial UR evaluation).<br />5 days to get CT scheduled and see the patient back again.<br />3 days to request surgery with dictation.<br />10 days for STAT review with UR.<br />3+ days to get into surgery.<br />_____<br />44 days ADDITIONAL TIME FOR WORKUP<br />31 DAYS TO GET IMRO MRI AUTHORIZATION<br />_____<br />75 DAYS TO GET TO SURGERY ESTIMATED<br /><br />COST OF IMAGING (the highest prices I could find in the OMFS)<br />$521.91 MRI WRIST 73221<br />$307.58 CT WRIST 73220<br />$160.00 RADIOLOGIST READ AND REPORT<br />_______<br />$989.49 TOTAL IMAGING COST<br /><br />WPI MAX 39%<br /> (36%+3%pain add-on,Table 16-18,Page 499,AMA Guides,5th Ed)<br /><br />TEMPORARY TOTAL DISABILITY ADD-ON TO GET TO SURGERY<br />$9,000 = 10 weeks @ $900.00/week<br /><br />PROBABLE 2 years total TTD<br />(Salvage surgery, poor result, physical therapy, pain management, revision surgery, pain management)<br />$90,360.00 = 104 weeks at $900/week<br />$150,000 COST OF CARE <br /> Surgeries, PT, meds, pain management (no FRP)<br />$100,00 RESERVES<br />__________________<br />$340,360 TOTAL including reserves<br /> Poor result, arthritis with chronic pain, depressed<br /> marginally employed, no longer paying taxes or union dues.<br /><br /> ______________________________________________<br /><br />THE OTHER WAY IT COULD HAVE GONE:<br /><br />1-4-13 DATE OF INJURY AND FIRST EXAM<br />1-8-13 DATE OF HAND SURGEON MRI, CT REQUEST<br />1-8-13 DATE ADJUSTER WITH STAT PHONE CONSULT AUTH'd<br /> (Hard staff push for STAT care)<br />1-12-13 DATE FU MRI, CT REVIEW AND SURGERY REQUEST<br />1-12-13 DATE ADJUSTER AUTH'd SURGERY BY PHONE + FAX<br /> ADJUSTER HAS UR CONSULTING SURGEON WITH EXTENSIVE TRAINING.<br />1-13-13 SURGERY DONE<br />7-13-13 6 MONTH POST OP DECENT RESULT,<br /> RETURN TO WORK<br /> P+S<br /> 7% WPI<br /> MINIMAL FUTURE MEDICAL AND NO MEDS<br /><br />TEMPORARY TOTAL DISABILITY<br />$23,000 = 26 weeks @ $900/week<br />$30,000 = Cost of care, surgery x 1,PT,Meds<br /> (No pain management, no FRP)<br />$15,000 = RESERVES<br />________<br />$68,000 = TOTAL including reserves.<br /> Decent result and return to work gainfully employed<br /><br /><br /><br /><br />Anonymoushttps://www.blogger.com/profile/02917115934232001155noreply@blogger.comtag:blogger.com,1999:blog-8489363879633129568.post-14666324223576779742014-09-02T14:15:38.825-07:002014-09-02T14:15:38.825-07:002 of 2 comments: After the 3rd epidural, I demand...2 of 2 comments: After the 3rd epidural, I demanded to see the AME again, he then diagnosed me with degenerative disc disease, less than a year after his first report wherein he told me, that I didn't show any sign of DDD. I was told by the AME's legal staff that my 5 page letter describing to him some of the chain of events and how I kept getting hurt and much more, was removed from his file for my protection, as it was "exparte". I don't believe it was removed for my benefit, I believe that it was removed because it specifically set forth some of the crimes committed against me and the chain of events. I am told and have read, that he, the AME, had an obligation to report the wrongdoing or suspicion of wrongdoing. Instead, his report calls into question my mental health and has no reference to what I verbally told his historian on the phone and in the 5 page letter. The AME would not allow me to have a "patient advocate" with me during his evaluations either. In fact he refused to do an evaluation and left the room. Granted, my patient advocate was my sister. <br /> <br />I am hoping to get a mandated disclosure to benefit injured workers. That would include the right to a patient advocate, the right to have any medical evaluation with an AME, QME, IMR and any medical appointment with a medical provider of any kind including the patient’s primary treating physician - video and audio taped. In my case, it was the primary treating physician who either maimed me or set me up to be maimed during the 3 ESI's. <br /> <br />There is no doubt that a major part of the strategy behind my and other injured workers experiences is to destroy the patients credibility by having them sight the outrageous and malicious things that are happening to them since they filed their WC case. I hope that the good people of workers comp will stand up for the souls who are regularly abused in the workers comp system. <br /><br />Anonymoushttps://www.blogger.com/profile/04875716916450552906noreply@blogger.comtag:blogger.com,1999:blog-8489363879633129568.post-84573701482881988082014-09-02T14:14:28.445-07:002014-09-02T14:14:28.445-07:001 OF 2 COMMENTS: Thank you Mr. DePaulo for this a...1 OF 2 COMMENTS: Thank you Mr. DePaulo for this article. The lives of many injured workers are devastated by the terrible things that the defense is willing to do to the injured worker. <br />Yesterday, I read another article by Cathy Albisa of Palm Beach, FL. In it she sights that 10 years ago, she interviewed an injured worker who told her his / her experience in a workers comp claim. She states, "The abuse faced by injured and ill workers needs to come out of the shadows and receive the attention it deserves. Ten years ago, I sat down for my first interview with an injured worker. That worker told me a story so outrageous and convoluted that I worried about his mental health. But, as I continued to interview workers, more than 100 injured workers that year alone, we heard similar stories of abuse over and over again."<br />She doesn't specify the particulars of any of the stories and experiences. I can only imagine what these souls have been through and may still be going through. As you know, I am an injured worker and I have been forced under anesthesia twice against my advanced requests / directives. At my 3rd epidural procedure, I was brutally forced under anesthesia. Each time I awakened with injuries / maiming in other parts of my body and injections in much of my person that were not a part of the ESI procedures. Too boot, I have experienced bizarre circumstances with Doctors, medical providers, hospitals, etc. All that I am sure was designed events to call into question my mental health should I file complaints for each happenstance. Interestingly, the AME in my case, after I demanded to see him again since I realized that I was being harmed on purpose, sights "ongoing psychological problems". For the record, I haven't any previous psych issues in my medical history. However, it has been suggested that I add a psych claim to my case. I would imagine that a psych claim would seal the mental health issue for the defense, thereby calling into question my credibility. I have discovered that surgery reports have false information documented in them, forms / documents that I signed have been altered with false info over and above my signature. Even the anesthesia form with my signature has the incorrect box checked for the 3rd epidural. When I signed the face page of that multiple copy form, it reflected "Local Anesthesia" pain blocker. I never agreed in writing to monitored or general anesthesia at the 3rd epidural. When I left the surgery center for the 3rd epidural, I was handed a copy of the anesthesia form with my signature on it that indicates "monitored anesthesia". <br /><br />I can only imagine what these other injured workers have endured that survived. I say survived because I have shared my experience with other injured workers, I was told that I am lucky to be alive, they could have killed me. I'm told that the biggest money looser for an insurance carrier is back injuries. <br /><br />What has happened to me and other injured workers is a well-orchestrated effort on the part of many people, including but not limited to medical providers, medical businesses, not just the Ortho Surgeon. For example in my case, the medical director at the 3rd surgery center was my anesthesiologist. He did nothing to protect me, the patient, in his surgery center. In fact, he participated by allowing the crime to take place in his surgery center. <br />Anonymoushttps://www.blogger.com/profile/04875716916450552906noreply@blogger.comtag:blogger.com,1999:blog-8489363879633129568.post-79081487366904686962014-09-01T13:18:05.522-07:002014-09-01T13:18:05.522-07:00Yep Yep Anonymoushttps://www.blogger.com/profile/17682181549172380545noreply@blogger.comtag:blogger.com,1999:blog-8489363879633129568.post-44385488804019391592014-09-01T01:14:30.727-07:002014-09-01T01:14:30.727-07:00Thanks David. That's also the view from the I...Thanks David. That's also the view from the Injured Worker perspective. Those 'foxes watching the hen house' might be better relocated to the State or Federal Penitentiary systems.<br /><br />Many injured workers would like to see Congressional investigations, indictments and proper trials... for what appear to be RICO and basic FRAUD violations and worse as a pattern of practice by profiting parties. I would like to see local and national investigations, that's for sure. <br /><br />They could even start with my case....and follow the money. It could be explosive. Big players. Mean crowd.<br /><br />One of these days, could you also tell your readers about FEHA and the Interactive Process and how it can be life saving for injured workers??<br /><br />After more than 2 5 years waiting for medically necessary treatments. ...authorizations are finally trickling in. Hooray. : /Lucy Occupyhttps://www.blogger.com/profile/05167518537609585687noreply@blogger.comtag:blogger.com,1999:blog-8489363879633129568.post-90128208206527682942014-08-26T14:42:44.291-07:002014-08-26T14:42:44.291-07:00Outstanding blog post, thank youOutstanding blog post, thank youAnonymoushttps://www.blogger.com/profile/09551833058647977830noreply@blogger.com