Sunday, December 4, 2011

Pennsylvania Case of Back Pain and Another Tragic Outcome

Another tragic case of drug overdose in a workers' compensation setting was reported this morning in WorkCompCentral news.

In finding the overdose a compensable consequence, the court in the Pennsylvania case of J.D. Landscaping v. WCAB (Heffernan), No. 1866 CD 2010, 12/2/11 turned down the employer's argument, stating:

"In arguing that the Board and the WCJ nevertheless erred in granting Claimant’s fatal claim petition because of the June 4, 2007, UR determination, Employer contends, in essence, that there can be no causal relationship between a decedent’s death and a work-related injury where a decedent dies as a result of medical treatment deemed by a UR determination to be neither reasonable nor necessary. Employer misconstrues the import of a UR determination."

The court explained that UR determines whether treatment is "reasonable and necessary," which differs from the concept of "causation." Heffernan's family only had the burden to show that the fentanyl overdose was causally related to his work injury.

Here are the facts as related by the court's opinion:

James Heffernan herniated a disc in his back while working for J.D. Landscaping in July 2002. In March 2006, the employer filed a utilization review (UR) request, which rejected the medications prescribed by Heffernan's treating physician, Dr. George Rodriguez.

On June 4, 2007, Rodriguez had prescribed Sonata, fentanyl, oxycodone, Fentora, Docusate, and Lyrica. Utilization review again concluded that the prescription was not reasonable or necessary.

The pharmacy refuses to fill the prescription because of the UR denial.

It doesn't stop there - Hefferman sees another Rodriguez (it is unknown whether the two doctors are related). This time Dr. Daisy Rodriguez examined Heffernan, and prescribed the following:
  • Actiq, 800 mcg (fentanyl lozenge), once a day;
  • Duragesic (fentanyl patch), 50 mcg and 100 mcg in combination, once every other day;
  • Fentora (fentanyl tablet) 800 mcg, three times a day;
  • Ambien, 10 mg, as needed for sleep;
  • Colace, 100 mg, two times a day;
  • Lyrica, two times a day; and
  • Oxy IR (Oxycodone tablet), 5 mg, every four hours as needed.
Dr. Daisy Rodriguez's prescriptions were identical to Dr. George Rodriguez's prescriptions that were denied only two days earlier.

Somehow this prescription escapes UR and/or the pharmacy ignores UR and/or the drugs were dispensed by the physician. Regardless Heffernan died on June 18, 2007, as a result of a fentanyl overdose. Emergency responders noted that he had several fentanyl patches in his hand.

Although Daisy had prescribed only one fentanyl patch every other day, eight of the patches were missing.

I don't know what the malpractice law is in Pennsylvania, but the Rodriguez duo should be held accountable either through a direct claim by Hefferman's widow, or subrogation by the employer/carrier, or both.

Regardless - what is wrong with this picture? It's the same story we see occurring every day in this country:
  1. Claim of back pain - a diagnosis of herniated disc is, based on current scientific literature, inconsequential and should not be the basis of either opioid dispensation nor invasive treatment techniques;
  2. Physicians ignoring their Hypocratic Oath;
  3. An over-trusting person in pain hypnotized by our culture of surgery and drugs as the remedy for everything that ills us;
  4. A system that chalks this death up as just another number, another statistic, another casualty in the world of workers' compensation without learning anything about how, what, why needless disability and death is inflicted through our distorted sense of social entitlement.
The "war on drugs" should start in our own back yard.workers compensation, work comp, injured worker 

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