Some of the biggest names in health science have agreed to speakduring the “Breakout on Using Health Science to Resolve WorkersCompensation Claims,” today from 10 a.m. to 4:15 p.m., at the 66thAnnual Workers' Compensation Educational Conference (WCEC). The“National Workers Compensation Review” has also included thesespeakers on its agenda.

This breakout focuses on two goals:

1. Making the resolution of workers compensation claims easier andmore efficient.
2. Fighting the scientifically established trend for involvementin workers' compensation to be harmful to the health ofclaimants.

This year's program will include the following components.

The Health Benefits of Returning to Work

Dr. James Talmage is quite possibly the finest medical educatoron the planet. He has a stellar history of lecturing and writingfor the American Medical Association (AMA), the American Academy ofDisability Evaluating Physicians (AADEP), other healthcareacademies, and governmental agencies internationally. Thanks to thesupport from the AMA, we have finally been able to recruit him tospeak at the WCEC.

Earlier this year, the AMA published the second edition ofTalmage's book, “AMA Guides to the Evaluation of Work Ability andReturn to Work.” Talmage's talk will focus on this new book,including the strategies that doctors can use to help patientsreturn to work and stay at work. Both editions of this book havebeen of historical importance, as they have highlighted scientificfindings along the following themes:

• Withdrawing from work is hazardous to a patient's physical,mental, and social well-being.
• Doctors should strongly urge patients to return to work and tostay at work.
• Doctors should decline to certify disability unless it isobvious.
• There is little to nothing in the training of the overwhelmingmajority of doctors that would credibly allow them to claim thatthey are the experts of choice in determining whether a claimant iscapable of working.
• Most claims of disability are rooted in a non-medical issue,specifically the patient's intolerance of the demands of the job(i.e., the patient reports that his or her pain is too severe forthe demands of the job).

Lumbar Fusion: Potential Harm

Earlier this year, a prominent medical journal (Spine)published a large-scale research project whose results indicatedthat lumbar fusion is harmful to workers compensation claimants.The results have indicated that fusion was followed by increasedrates of disability and increased use of harmful narcoticmedications.

The primary researchers from that project (Dr. Trang Nguyen andDr. David Randolph) have agreed to speak about their project, andabout other science similarly indicating that fusion is associatedwith a significant risk of harm.

Randolph and Nguyen have long histories of teaching doctorsinternationally about scientifically credible healthcare. Throughtheir lecturing, research, and organization of continuing medicaleducation, they are prompting a change of historical proportions.The primary example is the leadership role that they have played inelevating the AADEP to the point of being the primary medicalacademy for applying credible health science to medical-legalclaims.

Additionally, I will contribute a discussion of steps that canbe taken to protect claimants from such potentially harmfultreatments.

How to Prevent Disability

Florida's own Dr. Carson Caruso has chaired the disabilityprevention committee for the American College of Occupational andEnvironmental Medicine (ACOEM). His work resulted in thepublication of ACOEM's new disability prevention guidelines earlierthis year. Those guidelines are quite possibly the mostcomprehensive review of the relevant science that has ever beenundertaken.

The themes of those guidelines include:

• Disability is not directly determined by injury or any othergeneral medical issues.
• Psychological and social issues play a primary role inpredicting disability.
• Disability can often be prevented by successfully addressingthe psychological and social issues that are predictive ofdisability claims.
• When doctors take a patient away from work for any reason, theyare substantially increasing the risk of a poor health outcome(including death).

Specific recommendations for improving health outcomes andpreventing disability include:

• Claimants should maintain involvement in work, unless it isobjectively impossible to do so.
• Doctors should make returning to work and staying at work acentral part of every treatment plan.
• Psychological factors that predict disability should beinvestigated, and the findings should be acted on.
• Healthcare should be based on scientifically credibleguidelines.
• Avoid the medicalization of nonmedical issues (i.e., avoidfalsely claiming that common back pain indicates that an injury hasoccurred).
• Avoid aggressive, extensive, or prolonged healthcare for benignconditions such as chronic pain.
• Avoid a focus on pain relief, instead of functionalrestoration.
• Avoid early or prolonged use of narcotic medications.
• Avoid work restrictions that are based on the patient's pain,preferences, or fears.
• Avoid premature referral for diagnostic imaging, specialistevaluation, or extensive rehabilitation in the absence of red flagsor failure of simple, scientifically credible care.
• Avoid prolonged or extensive passive treatments, such asphysical therapy and chiropractic manipulation.
• Patients should be educated in regard to scientificallyestablished risk factors for poor health outcomes and disabilitythat might otherwise be overlooked, so that they can make informeddecisions (for example, involvement in workers' compensationsystem, hiring a lawyer, etc.).

Impairment Evaluation: Comparing Florida's System to theAMA Guides

Dr. Marjorie Eskay-Auerbach is a contributing editor for thecurrent edition of the AMA's Guides to the Evaluation ofPermanent Impairment. Barth reports, “She has also become oneof America's most in-demand speakers on the subject ofscientifically credible healthcare.”

Thanks to the sponsorship of the AMA, Eskay-Auerbach has agreedto speak about a recently published comparison of the AMA'sinternational gold-standard impairment rating system to Florida'sidiosyncratic system.

Unlike Florida's system, the AMA's system has a goal ofscientific credibility. For example, when science indicates thatthere is no permanent impairment associated with a diagnosis, theAMA's system mandates an impairment rating of zero. In contrast,Florida's system allows for an impairment rating greater than zeroin such cases. Such non-credible impairment ratings are harmful toclaimants because it sends a clear and horrifying message thatdoctors have determined that they are permanently impaired, evenwhen there is no actual impairment.

Working with Science in Defending or Prosecuting aClaim

In order to insure that participants gain the best possibleunderstanding of how to apply credible health science to anyindividual claim, the breakout opens with a panel of attorneysaddressing exactly that issue.

John McLain and Robert Donahue (from Rissman, Barrett, Hurt,Donahue & McLain, PA) are members of this panel. They havecontributed to the breakout every year, having been the originalcreators of the breakout. They are joined this year by MichaelCeleste (of Celeste & Associates).

Acknowledgements

This Health Science Breakout is an annual event unlike anythingavailable elsewhere. It is the only event that focuses on thedirect application of credible health science to medical-legalclaims, and thereby simultaneously promotes the two goals offacilitating claim resolution and improving health outcomes.

The idea for creating the breakout originated with Barth andConference Chairman Steve Rissman. Rissman (of Rissman, Barrett,Hurt, Donahue & McLain, PA) receives primary credit for makingthis a reality, along with the other conference organizers. BillPipkin (of Austill, Lewis, Pipkin & Moore, P.C.) and the otherorganizers of the National Workers Compensation Review have alsocontributed to the viability of this program. The AMA has providedsponsorship which has made it possible to recruit some of thespeakers listed above. And the speakers themselves have volunteeredtheir time and expertise for this effort (none are beingcompensated).