Department of Industrial Relations

Industrial Medical Council Public Meeting

Holiday Inn - LAX, Los Angeles

Thursday, February 15, 2001

1. The meeting was called to order by Co-Chair Dr. Richard Pitts at 10:17 A.M.

Members present:

Maria Mayoral, M.D. Michael Roback, M.D.

Robert Larsen, M.D. Lawrence Tain, D.C.

Steven Nagelberg, M.D. Paul E. Wakim, D.O.

Jonathan Ng, M.D. Gayle Walsh, D.C.

Richard Pitts, D.O. Benjamin Yang, C.A. OMD

Glenn Repko, Ph.D.

Members absent:

Marvin Lipton, M.D.

Patricia Sinnott, PT, MPH

Richard Sommer, Esq.

Dr. Pitts asked the audience and Council Members to introduce themselves.

    1. Consent Agenda

a. Executive Medical Director's Report:

Dr. D. Allan MacKenzie indicated his EMD report stood as written. He commented on some issues that came up at the Executive Committee meeting. He said he has been invited to speak at the Assembly Insurance Committee regarding background information for the next Work Comp Reform Act. He also commented on the feedback from the Med Legal Report Writing course that took place February 3. Comments have been positive.

He reminded the Council of the suggestion made by one of the Council Members at the last long range planning meeting, to form a Committee on Disability Management. He felt that it is important for the Council to work on these issues.

Dr. Pitts also commented on the Med Legal Report Writing course. He stated it was a superb staff effort and recognized Dr. Anne Searcy and Dr. Susan McKenzie for their hard work. He also thanked Dr. Allan MacKenzie for his leadership.

b. DWC Report:

Mr. Richard Gannon reported that the Official Medical Fee Schedule revision process has begun. He also touched on the In-Patient Hospital Fee Schedule. Mr. Gannon mentioned that the proposal for cost outliers had gone out that day and the revised cost outlier proposal is being sent out for a 15-day comment period. He reported on the Judicial Study. The Commission on Health Safety and Workers Compensation agreed that it was an important issue, funded a study, put out an RFP, and went through a process of selection and that the Rand Corporation Institute for Civil Justice was selected to perform the study. The study will address resolving disputes before for the DWC Adjudication system. The Rand Corporation will be soliciting information from various practitioners who deal with the courts. It was suggested that the IMC and the medical community would be interested in this. Mr. Gannon introduced Mr. Nick Pace, project coordinator for Rand, who has experience in evaluating court systems' disputes.

Mr. Pace informed the audience that they are a public policy research group and talked about their history. He mentioned they were a sub-unit within the Rand Corporation and have been around since the early 80's and look at areas involving court case management, alternative litigation, arbitration, resolution processes, class action work, auto accident compensation systems, healthcare injury claims and the like. They have studied 94 federal districts. One was a report for the Administrative Office of the United States Courts and the Judicial Council of the United States for studying court and case management processes in the Federal district courts. They have looked at court delay issues for the Los Angeles Superior Court and others as well. His corporation was invited by the Commission of Health Safety and Workers Compensation to look at the WCABs adjudicative process. Mr. Pace stated that he was informed of the ongoing legislative debate over the workers compensation judicial process, on claims cases taking too long to resolve, policies and procedures vary from office to office, and that administrative costs have been increasing without some sort of commensurate increase in system efficiency. He said that these problems could be addressed through a comprehensive cost delay program. He stated that the cooperation and input is needed from the bench, the bar and other parties in the system to understand the roots of the problems in order to design a successful strategy for the long run. In the study, they propose to address concerns of legislatures and others through research. They will look at WCABs organization and its work flow and support infrastructure. Mr. Pace stated that they will gather data from a wide variety of sources and went into detail on how and whom they would gather the information from. He stated it was on ongoing process and has set up a group of experts to assist them for help. He also stated that six courts were selected as representative site courts that exhibit variations of management practices and times to resolution of different cases. He elaborated on this. They are trying to get ongoing input from a public website and through submissions of anonymous forms. From there they will produce a preliminary report consisting of only imperical findings and distribute as widely as possible with the hope of getting additional public input. At that point they will publish their recommendations. He gave the name of their website for those who wish additional information and to encourage ongoing input for now before the preliminary report. He stated he would give the information to Dr. MacKenzie and Mr. Fisher and they will pass the information to the Council Members. He opened the floor for questions.

Dr. Roback commented that they were looking to see how the medical information and treatment procedures by physicians are affecting the ability to make judicial decisions. He was not sure if it was appropriate for Rand to work with the IMC or members to try and divide some of the work. Discussion ensued.

    1. Adoption of the Minutes and Notice of Actions:

The Co-Chair, Dr. Pitts, asked for a motion to approve the minutes of the IMC meetings on February 15, 2001.

ACTION: The Consent Agenda was approved unanimously.

d. Legislative Update:

Nothing to report.

    1. Committee Reports

a. Education Committee Report and Recommendations for Action:

Dr. Walsh reported that the staff reviewed several course providers. For continuing education courses there were five renewals: the International Chiropractic Association of California, Lifewest Chiropractic College, Industrial Medical Seminars, Industrial Claims Association and Northern California Neuropsychology Forum.

Dr. Walsh: Motion: The Committee moves to approve renewal of the following five continuing education course providers: the International Chiropractic Association of California, Lifewest Chiropractic College, Industrial Medical Seminars, Industrial Claims Association and Northern California Neuropsychology Forum.

It was seconded.

Action: Motion passes unanimously.

Dr. Walsh reported that the committee moves to approve two new continuing education course providers: White Memorial Medical Center, a cranial facial pain clinic, is giving a course on cranial facial pains, designed for dental physicians. Dr. Alexander Zaks, MD is doing a six-hour program on general continuing education material.

Dr. Walsh: Motion: The Committee moves to approve two new providers, the White Memorial Medical Center and Alexander Zaks, MD.

It was seconded.

Action: Motion passes unanimously.

Dr. Walsh reported that there are three providers for the Med Legal Report Writing Course. With Livingston-Lopez, there was a question as to whether the syllabus met the eight-hours as outlined in our regulations. Initially, no syllabus was attached. This month the syllabus was submitted but not the rest of the material. The Committee could not move forward with this as a recommendation until both packages are submitted together. The Committee recommended to table this program until next month. A request was received from the Orthopedic Association for a 12-hour computer course. Our regulations do not allow for a 12-hour computer course. The Committee recommends that this be given as a continuing education program and once we have input as to how it works, we may be able to approve this as a distance learning program. The Committee is not approving it at this time. A third request was received from Dr. Plato, who teaches an IDE program for chiropractic physicians and wanted to break out 12-hours of med legal report writing. The outline submitted used two hours out of the 12 for billing issues. The Committee recommended sending it back to the provider for resubmission and not recommending approval at this time. Dr. Walsh turned to Mr. Fisher for an update of the QME regulations.

Mr. Fisher reported that a hearing will be held after the IMC Public meeting on regulations pertaining to new applicants to become QMEs. He said that the close of business this day, will be the close of the comment period. The regulations for reappointment of QMEs, comments were received and we putting together the transcripts of the hearings that were held on those. A report and recommendation will be given at the March Public meeting.

    1. IMC/DWC Liaison Work Group Report:

Dr. Roback reported that they will be interfacing with the WCAB to identify medical issues which are causing problems and try to analyze those and answer those problems. He stated he sent IMC Council Members a letter for participation and the response was not overwhelming. Discussion ensued.

Dr. Mayoral had some suggestions regarding patients having difficulty obtaining treatment within the workers comp system and had a few ideas. She asked some of the Doctors why they were not interested in treating workers comp patients and she had put some of the responses received in letter form. She distributed copies to Council Members.

c. Fee Schedule Committee Report:

Dr. Susan McKenzie stated that the Committee met and discussed three items related to the revision of the Official Medical Fee Schedule. First, the Council is still awaiting an opinion on the protest that was filed on the RFP and hopes to move forward with the Lewin contract in the near future. Second, the Committee discussed the interim revision which DWC is planning to do on the OMFS to meet the deadline in April 2001 and to clarify some of the minor issues that are causing problems in the Fee Schedule now. Third, the Committee discussed IMC/DWC plans to review the Federal payment policies to see if there is a reason to bring any of them into the OMFS. The current plan is to retain the CPT ground rules, to evaluate the federal ground rules for adoption, and to review ground rule issues and updating the CPT codes in the physical medicine section.

d. Discipline Committee Report:

Dr. Ng stated that the Committee had met and there was nothing to report.

4. Announcements

Dr. Pitts announced that the next meeting will be on March 15, 2001 in South San Francisco.

Meeting adjourned at 11:15 A.M.

IMC Staff present:

Gerry Evans Sylvia Martell

James Fisher, Esq.

Elizabeth Ignacio

David Kizer, Esq.

Allan MacKenzie, M.D.

Susan McKenzie, M.D.

Members of the public present:

Barry Adelman, USH Vern Goldschmid, CAAA

Sylvia Aubrey, DOI Doug Hikawa, Priority Comp Net

Steven Becker, CCA Jan Nguyen, Care Solutions

Carl Brakensiek, CSIMS Jennifer Orosz, HNC Ins. Solutions

Jenifer Brockway, Intercommunity Med Grp. Nick Pace, Rand

Dr. Timothy Collins Michael Pulley, Workers' Comp Adv

Linda Coltrin, CA Chiropractic Assoc. Diane Przepiorski, COA

Rea Crane, CWCI Kim Wiswell, Wiswell Consulting

Benita Gagne, Intercommunity Med Grp. Katie Vu, Corvel Corp

Ken Young, OPSC