Sits And Thinks or Just Sits

"Sometimes I sits and thinks and sometimes I just sits" is a classic quote from baseball great Satchel Paige.

That quote from Paige seems appropriate for this stage of California workers' compensation politics. A couple years ago some folks sat and thought, and what we got was SB 863.

And right now it seems that we should just be sitting and letting this thing work its way through the growing pains.

But others have been thinking.

Sen. Jim Beall, D-Campbell, introduced SB 626, a bill that employer and insurance groups say will not only unwind major components of SB 863, but will introduce more chaos, more uncertainty and more unnecessary costs into the system.

The bill would remove the restriction against judicial overview of medical treatment approval or denial decisions. Currently once a medical treatment determination has been made through the Independent Medical Review process it can be overturned only under very limited circumstances.

The volume of IMR reviews and the quality of those determinations is currently the subject of debate and public meetings with the Division of Workers' Compensation starting today.

Other IMR language in SB 626 would require doctors performing independent medical review and utilization review be licensed in California.

The bill would also strike SB 863's prohibition against the use of psychiatric disorders when calculating impairment ratings and language that has been in place since 2004 prohibiting chiropractors from serving as the primary treating physician after 24 office visits by eliminating the 24-visit cap on chiropractic, occupational and physical therapy.

Finally, SB 626 would increase the number of voting members on the Commission on Health and Safety and Workers' Compensation to 10 from eight. The two new members would be appointed by the governor, with one representing injured workers and the other representing employers.

Beall told WorkCompCentral that his biggest concerns with the current law is that it forces workers to use prescription medications for pain by cutting them off from chiropractors after just 24 visits and it limits the compensability of certain mental conditions.

The California Workers' Compensation Institute in 2011 reported that 50.2% of prescriptions for Schedule II opioids such as oxycodone and fentanyl were for back injuries with no spinal cord involvement, meaning strains and sprains.

It seems to me that the cure for this conflict is for claims adjusters to approve reasonable chiropractic and physical therapy beyond the 24 visit cap in lieu of a doctor's recommendations for pain medication - I'm sure physicians who practice pain control would agree that successful pain management requires a multi-faceted approach that may include some chiropractic, some physical therapy, some counseling or other mental health care, and perhaps some medication.

Each case is different.

One of the more difficult things facing the folks making decisions about the provision of care is what is appropriate for any particular individual. This can not be remedied by broad strokes of the legislative brush.

Because each case is different, reasonable minds will differ. What may be appropriate for one individual will not be appropriate for another. Some discretion is necessary. Some folks will be happy. Some folks will not be happy. Those that are not happy will be louder about their plight.

In the meantime the economic recovery is resulting in an increase in injuries.

The number of reported work injuries and illnesses increased 2.4% in 2012, but because of an increase in the number of people working in the state, the frequency of injuries per 100 workers was unchanged, the California Workers' Compensation Institute said Friday.

Public and private sector employers in California reported 451,500 work injuries and illnesses in 2012, 10,600 more than they did in 2011.

The injury and illness rate was highest among local government workers, who averaged 7.4 cases per 100 workers in 2012, down slightly from 7.5 in 2011. State government workers had the second-highest rate in 2012 with 5.9 of every 100 workers reporting an injury or illness, up from 5.4 in 2011.

Nationwide, the injury and illness rate across all sectors stayed the same at 3.7 per 100 workers from 2011 to 2012. California's overall rate for all sectors during the same period was 4.

The numbers might be alarming - after all why are government jobs so much more likely to generate injury claims?

But when one considers that many government jobs, particularly municipal, involve public safety it is not surprising at all. Alex Rossi, Los Angeles County Workers' Compensation Chief Program Specialist once said in a presentation I attended that, unlike the private sector, when someone yells, "fire!" his employees run to it...

Listen, SB 863 changed the playing field. A lot. There's no question that the bill was manhandled through the Legislature. And there's no question that there are some questionable elements in SB 863 and that many provisions require a lot of work by the regulators and system professionals.

But it's not time to take the bill apart. A change as massive as those introduced by SB 863 is not only disruptive, but is a huge cultural shock. We are still experiencing the ripples of the big rock that was thrown into the pond.

In other words this thing is going to take time - a lot of time.

In the meanwhile, while not getting any better in terms of costs, California's economy is just starting to get back on its feet. For instance, the LA Times reported yesterday that the Central Valley's almond industry supplies over 80% of the entire world's consumption creating jobs, and of course stress on resources. This means that more people working are going to result in bigger insurance premiums and ultimately more workers' compensation claims.

In other words, this is a period of time where we need to just sits. It's not time for SB 626. At least not yet.