Department of Industrial Relations

Industrial Medical Council Public Meeting

Best Western Grosvenor Hotel, So. San Francisco



Thursday, March 15, 2001

1. The meeting was called to order by Co-Chair Dr. Richard Pitts at 10:35A.M.

Members present:

Barry Halote, Michael Roback, M.D.

Robert Larsen, M.D. Patricia Sinnott, PT, MPH

Maria Mayoral, M.D. Lawrence Tain, D.C.

Ira Monosson, M.D. Paul E. Wakim, D.O.

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

Glenn Ocker, Benjamin Yang, C.A. OMD

Richard Pitts, D.O.

Members absent:

Marvin Lipton, M.D.

Steven Nagelberg, M.D.

Richard Sommer, Esq.

Dr. Pitts introduced two new IMC Council Members and Dr. MacKenzie then gave their particulars: Dr. Barry Halote, a native of Southern California, has been a licensed Psychologist since 1984 and a QME since 1994. He has a BA in Psychology from Cal State, a Masters in Psychology from Cal State LA, and his Ph.D. from USC. Dr. Pitts then swore him in.

Dr. Glenn Ocker was born and raised on the East Coast. He received his Doctor of Podiatric Medicine in Philadelphia, his Master of Science in San Francisco, and his Master of Education from Pepperdine. It was noted that he is the first Podiatrist to serve on the IMC. Dr. Pitts swore him in.

    1. Consent Agenda
    2. a. Adoption of the Minutes and Notice of Actions: The Co-Chair, Dr. Pitts, asked for a motion on the Draft Minutes and Notice of Action of the February 15, 2001 IMC meeting.

      ACTION: The Consent Agenda was approved unanimously.

      b. Executive Medical Director's Report:

      Dr. D. Allan MacKenzie indicated his EMD report stood as written. He commented on the QME Proficiency exam that will be held on March 17. There are approximately 300 registrants with two-thirds from Southern California and one-third from Northern California. Dr. MacKenzie also commented on the IMC's Med Legal Report Writing Courses (MLRWC). Since the last course held in San Francisco on February 3, corrections were made to the content of the course and the sequence in which it was delivered. He stated that constructive criticism had been received and was circulated to Council Members. Also, the IMC staff is receiving the "practice" med legal reports from some of the QME candidates. To date, they look good! As the reports come in, the candidates are being sent their 'certificates of attendance and completion.'

      Dr. MacKenzie acknowledged the help received from the work comp community including Mr. Art Azevedo and Dr. Dave Willat who were in the audience. The MLRWC educational faculty agreed to help on zero notice and then they gave their very best effort, all of which is very much appreciated by IMC/DIR. He also acknowledged Judge Pam Foust who gave five days of her time to the course and to IMC quality improvement over the last two months. Dr. MacKenzie has asked DIR to help the IMC in the recognition of the contributions of these people.

      Dr. Pitts also acknowledged Dr. Mayoral for coming to UCLA and giving an excellent talk on the evaluation and report writing of the behavioral/psychological aspects of work comp. He also acknowledged Dr. Monosson, who gave the medical section at UCLA and Ms. Sinnott for her input in San Francisco. A round of applause was given.

      c. DWC Report:

      Dr. Linda Rudolph, reporting on behalf of Mr. Richard Gannon, gave an update on various projects from DWC. She noted that it is anticipated that the exemption of re-inplantables and hardware from the Hospital Fee Schedule for spine surgeries will take effect on April 13. She stated they are working on an interim fee schedule revision that will address technical changes in the current fee schedule in the next couple of months and that the IMC staff is working with them on a larger revision which will facilitate moving toward an RBRVS-based schedule.

      Dr. Rudolph reported that the Judicial Study continues to move forward and they hope to have at least some preliminary findings by the end of May. She also reported that the enrollment in workers comp health care organizations (HCOs) has been rapidly increasing. The are more than 125,000 enrollees at present. There are also a number of applications pending for large healthcare delivery systems to become HCOs.

      She also mentioned a grant that they received to improve the quality of care that injured workers receive and that they have done focus groups to explore different perceptions of the quality of medical care. She also mentioned a new project they are working on called the CORA project. National Institute of Occupational Safety and Health's National Occupational Research Agenda. They are working with the Department of Health Services and the Division of Labor Statistics and Research and the Commission regarding the need for more applied research and occupational health in the State.

    3. Committee Reports

a. Fee Schedule Committee Report:

Dr. Susan McKenzie stated that the protest filed by one of the bidders during the RFP process was not upheld by the hearing officer and the Council is free to move forward with the Lewin Group contract to do the RVRBS study. The tentative start date on the contract is April 1 and the completion dates is through September 20. At the start of the contract, we would like to have the Lewin Group meet with the members of the workers Comp community in order to provide an overview of what they plan to do and give the Council and public an opportunity to ask questions. She stated that the IMC may be having a free standing Fee Schedule public meeting that will be announced in advance. She invited the Council Members and the public to attend. She informed that the IMC and DWC had a productive meeting on the ground rule issues and how to review them. An expeditious way was found to update the ground rules and come up with a format for the Fee Schedule that will be user friendly and an update on an annual basis in order to be current with the CPT. She discussed the Evaluation and Management study that was voted on in 2000 to compare and evaluate the work done under the Evaluation and Management Codes in workers comp as compared to the work in other payment systems. It would look at report writing, the work that goes into evaluating disability, psychosocial issues in workers comp etc.

Dr. McKenzie stated that the IMC voted in January 2000 to move forward on this study and asked for any objections to that action at this time. None were noted. Dr. Rudolph commented that it would be extremely helpful to the Administrative Director to have a study of this sort available at the time that DWC is going through their fee schedule revisions.

b. IMC/DWC Liaison Work Group Report:

Dr. Michael Roback suggested that the IMC coordinate its efforts with WCAB and DEU in order to assist them. He stated that the incentive for this was that some of the guidelines don't seem be used by the judges in their decision making, which may be due to it not being found in the Labor Code. Also, they have to write a request to receive them. There has been discussion concerning how the Guidelines can be made more appropriate and available. This project is being reviewed and all IMC Council Members and the community will have the opportunity to participate in giving ideas.

The DEU had mentioned their interest in receiving more information on organizing and systematizing disability evaluation for the concept of incontinence (separate from the cause). He informed the Council that Dr. Wakim will be writing something for the IMC newsletter to get participants from different specialties in order to have a systematic way of looking at the disability factors. He discussed the fact that one of the IMC's unique responsibilities is the education of QMEs. There are certain concepts that have been clearly defined such as the description for the intensity and duration of pain, i.e. constant and frequent, etc.

Dr. Roback also discussed the 'Tenet Case' (Tenet/Centinela Hospital Center v. WCAB (Rushing)(2000) 80 Cal. App. 4th 1041) which talks about the language doctors should be applying to the concept of treatment. He talked about the handout he passed out regarding future and continuing medical treatment and how it needs to be defined by the IMC in order for QMEs and treating physicians to apply it uniformly.

Ms. Sinnot asked for further explanation on the 'Tenet' decision and what it means in terms of the Physician Guide which was responded by Mr. James Fisher. He explained that the 'Tenet Case' comes up in the context of when does the QME process starts and the definition of when there is a dispute and when the applicant has to go through the QME process as opposed to changing the treating physician. The 'Tenet Case' does not have a direct impact on QMEs, but on treating physicians and whether there is a dispute between the applicant and the treater under regulation 9785. The discontinuity has more to do with when one can seek a subsequent treater and delay the QME process and not the awards of future medical care and the content of those awards by the WCAB. Discussion ensued regarding the language/terminology doctors should be using. Also discussion and comments ensued on the 'Tenet Case'.

Dr. Rudolph commented that if a change is made in 9785 it has to go through the rulemaking process. She recommended that as long as it suggested they be looked at to not change the Physician's Guide until that has been done so that the Guide and the rules are congruent.

Dr. Roback stated that the issue he wants to bring to the Council has to do with developing language that is taught to the people. This is because the way the current Guidelines reads does not distinguish those words that are required to distinguish. Discussion ensued.

    1. Education Committee Report and Recommendations for Action:

Dr. Walsh reported to the Committee that amendments to Sections 1, 11.5 and Forms 118 & 119, which went out for an additional 15-day comment period, had some changes and are ready for the Council to approve for filing with OAL.

Dr. Walsh: Motion: The Committee recommends approval of Section 1, 11.5 and Forms 118 & 119 to go to OAL.

Seconded: Ms. Sinnott.

Action: Motion passes.

Dr. Walsh reported that the next set of regulations deals with continuing education providers. Sections 11, 13 and Form 100. There were some changes on the form including changing it to booklet format for ease of usage and additional language in block 3.

Dr. Walsh: Motion: The Committee recommends that Sections 11, 13 and Form 100 go out for an additional 15-day comment period.

It was seconded.

Action: Motion passes.

Dr. Walsh reported the Committee had reviewed three providers for the med legal report writing courses. A program put on by Drs. James Platto and Seeno, is part of a 44-hour IDE program in which they have broken out 12-hours for report writing.

Dr. Walsh: Motion: The Committee moves to approve three providers for the med legal report writing course.

Seconded: Dr. Larson and Dr. Yang.

Action: Motion passes unanimously.

Dr. Walsh reported the Committee recommends for approval, with the stipulation of the staff, making sure that everything is included and that the program looks good as well as ensuring the hours are correct, CVs included etc. There are two additional programs, one by Livingston Lopez and one by Dean Falltrick. They have been course providers in the past, and they are said to have had good programs within IMC's regulation. The Committee recommends approval of those with the staff's final review.

Dr. Walsh: Motion: The Committee recommends approval of those two programs with the staff's final review.

Seconded: Dr. Larson and Dr. Yang.

Action: Motion passes unanimously.

d. Discipline Committee Report:

Dr. Ng reported that the Committee met and discussed several cases at different stages of investigation and stated a closed session will be needed for a settlement to be presented to the Council. Closed session on settlements on John Giddings, MD Case #97-2135 and Chandra Diane De Silva, MD, Case #99-3800 at 11:50a.m.

Meeting resumed at 12:44pm. The two settlements were approved with the standard conditions of probation.

4. Announcements

Dr. Pitts announced that the next meeting will be on April 19, 2001 in Los Angeles.

Meeting adjourned at 12:45pm.

IMC Staff present:

Lety Buenviaje Sylvia Martell

Gerry Evans Susan McKenzie, M.D.

James Fisher Teidi Lee Padua

Elizabeth Ignacio Anne Searcy, M.D

David Kizer, Esq. Larry Williams

Allan MacKenzie, M.D.

DIR Staff present:

Suzanne Honor

Linda Rudolph

CHSWC staff present:

C.L. Swezey

Members of the public present:

Carl Brakensiek, CSIMS Jennifer Orosz, HNC Insurance Solution

Linda Coltrin, CA Chiropractic Assoc. Michael Pulley, Workers' Comp Adv

Bill Hutchins, e-Rehab Peggy Sugerman, CAAA

Philipp Lippe, CANS David Willat, CCA

Melissa Marcil, Kaiser Permanente