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

This breakout focuses on two goals:

1. Making the resolution of workers compensation claims easier and more efficient.
2. Fighting the scientifically established trend for involvement in workers' compensation to be harmful to the health of claimants.

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 educator on the planet. He has a stellar history of lecturing and writing for the American Medical Association (AMA), the American Academy of Disability Evaluating Physicians (AADEP), other healthcare academies, and governmental agencies internationally. Thanks to the support from the AMA, we have finally been able to recruit him to speak at the WCEC.

Earlier this year, the AMA published the second edition of Talmage's book, “AMA Guides to the Evaluation of Work Ability and Return to Work.” Talmage's talk will focus on this new book, including the strategies that doctors can use to help patients return to work and stay at work. Both editions of this book have been of historical importance, as they have highlighted scientific findings 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 to stay at work.
• Doctors should decline to certify disability unless it is obvious.
• There is little to nothing in the training of the overwhelming majority of doctors that would credibly allow them to claim that they are the experts of choice in determining whether a claimant is capable 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 for the demands of the job).

Lumbar Fusion: Potential Harm

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

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

Randolph and Nguyen have long histories of teaching doctors internationally about scientifically credible healthcare. Through their lecturing, research, and organization of continuing medical education, they are prompting a change of historical proportions. The primary example is the leadership role that they have played in elevating the AADEP to the point of being the primary medical academy for applying credible health science to medical-legal claims.

Additionally, I will contribute a discussion of steps that can be taken to protect claimants from such potentially harmful treatments.

How to Prevent Disability

Florida's own Dr. Carson Caruso has chaired the disability prevention committee for the American College of Occupational and Environmental Medicine (ACOEM). His work resulted in the publication of ACOEM's new disability prevention guidelines earlier this year. Those guidelines are quite possibly the most comprehensive review of the relevant science that has ever been undertaken.

The themes of those guidelines include:

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

Specific recommendations for improving health outcomes and preventing disability include:

• Claimants should maintain involvement in work, unless it is objectively impossible to do so.
• Doctors should make returning to work and staying at work a central part of every treatment plan.
• Psychological factors that predict disability should be investigated, and the findings should be acted on.
• Healthcare should be based on scientifically credible guidelines.
• Avoid the medicalization of nonmedical issues (i.e., avoid falsely claiming that common back pain indicates that an injury has occurred).
• Avoid aggressive, extensive, or prolonged healthcare for benign conditions such as chronic pain.
• Avoid a focus on pain relief, instead of functional restoration.
• 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, specialist evaluation, or extensive rehabilitation in the absence of red flags or failure of simple, scientifically credible care.
• Avoid prolonged or extensive passive treatments, such as physical therapy and chiropractic manipulation.
• Patients should be educated in regard to scientifically established risk factors for poor health outcomes and disability that might otherwise be overlooked, so that they can make informed decisions (for example, involvement in workers' compensation system, hiring a lawyer, etc.).

Impairment Evaluation: Comparing Florida's System to the AMA Guides

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

Thanks to the sponsorship of the AMA, Eskay-Auerbach has agreed to speak about a recently published comparison of the AMA's international gold-standard impairment rating system to Florida's idiosyncratic system.

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

Working with Science in Defending or Prosecuting a Claim

In order to insure that participants gain the best possible understanding of how to apply credible health science to any individual claim, the breakout opens with a panel of attorneys addressing exactly that issue.

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

Acknowledgements

This Health Science Breakout is an annual event unlike anything available elsewhere. It is the only event that focuses on the direct application of credible health science to medical-legal claims, and thereby simultaneously promotes the two goals of facilitating claim resolution and improving health outcomes.

The idea for creating the breakout originated with Barth and Conference Chairman Steve Rissman. Rissman (of Rissman, Barrett, Hurt, Donahue & McLain, PA) receives primary credit for making this a reality, along with the other conference organizers. Bill Pipkin (of Austill, Lewis, Pipkin & Moore, P.C.) and the other organizers of the National Workers Compensation Review have also contributed to the viability of this program. The AMA has provided sponsorship which has made it possible to recruit some of the speakers listed above. And the speakers themselves have volunteered their time and expertise for this effort (none are being compensated).