Department of Industrial Relations
Industrial Medical Council

Holiday Inn, LAX
Thursday, October 17, 2002

Members present:

Barry Halote, Ph.D.
Robert Larsen, M.D. 
Maria Mayoral, M.D.
Ira Monosson, M.D. 
Jonathan Ng, M.D., J.D. 
Glenn Ocker, DPM, MS 


Richard Pitts, D.O
Patricia Sinnott, PT, MPH
Lawrence Tain, D.C
Paul E. Wakim, D.O.
Gayle Walsh, D.C.
Benjamin Yang, C.A. OMD

Members absent:

Steven Nagelberg, M.D. 
Michael Roback, M.D. 

Richard Sommer, M.Phil., J.D
Kenneth Sim, M.D.

1. The meeting was called to order by Co-Chair Dr. Richard Pitts.

2. Consent Agenda:

  1. Adoption of the Minutes and Notice of Actions: Dr. Pitts asked for a motion on the Draft Minutes and Notice of Action of the September 19, 2002 IMC meeting. Dr. Walsh proposed minor changes/corrections to the Minutes:
    Action: The Consent Agenda was approved unanimously.

  2. Executive Medical Director's Report: Dr. Susan McKenzie indicated that her EMD report stands as written.

  3. Legislative Report:Nothing added to what is in the packet.

  4. DWC Report:
    Administrative Director Richard Gannon was not able to attend, so Ms. Jackie Schauer gave the report. DWC is facing budget reductions as previously discussed. In an effort to meet these reductions, they are going to hold an open meeting in November to discuss which projects should be given the highest priority. They are accepting comments for 15 days on the draft of Regulation Section 9785. They are also going to post on the web proposed ground rules for the upcoming Fee Schedule revision and will hold a public meeting in the future.

3. Education Committee Report:

Dr. Gayle Walsh reported that the Committee reviewed and recommended approval of an application for reaccredidation as a provider for continuing education by the Insurance Education Association (IEA) for three programs: Cost of Words-Medical Reports in the Workers' Compensation System-a distance learning program; From Medicine to Psychology-Approaches to Patients with Multiple Problems, and the Workers' Compensation for the Medical Provider.

Dr. Walsh: Motion: That the Council approve the renewal application of the above provider for continuing education courses. The motion was seconded.

Action: Motion passed unanimously.

Dr. Walsh said that the Committee is committed to revising the Regulations, as it does not have a major revision for several years. They reviewed areas that she thinks need to be revised. The IMC Staff will collate these suggestions so that they can be discussed at an hour-long committee meeting in November.

On Foot and Ankle Guidelines, Dr. Glenn Ocker mentioned several typographical errors in the document that was sent in the packet. The errors were corrected in the draft of the Guidelines that was available on the table at the meeting. The public did not submit any suggestions.

Dr. Ocker: Motion: that the Council accept the corrected Foot and Ankle Guidelines and then be sent to the Office of Administrative Law (OAL) for approval. The motion was seconded.

Action: Motion passed unanimously.

4. Fee Schedule Committee Report:

Dr. Susan McKenzie reported that the Committee met this morning and talked about some changes made on the last presentation of the Practice Expense Study. The Lewin Group issued a draft report of the RBRVS Study, copies of which was distributed to the public present today. This RBRVS report is a report of the initial impact analysis done almost a year ago. It discusses the methodology for the study. The Lewin Group will remodel that impact analysis and will incorporate any proposed changes to the fee schedules in the future. The numbers in this initial RBRVS report will change.

Dr. McKenzie also recapped what the Council has done on the entire RBRVS project to date. In 1998, they had public discussions about the revisions for the 1999 fee schedule. During these discussions and revisions, the community encountered a number of problems in updating relative values and discussed replacing the relative value scale. So in 1999, the IMC initiated an educational study that was done by UCLA headed by Gerald Kominski, Ph.D. So the Council moved on from that and hired the Lewin Group through an RFP. The Lewin Group did an initial impact analysis, the results of which you received today. At the same time, the Council decided to undertake two studies of Evaluation and Management codes to determine whether or not there is a difference between physician work and practice expenses in the workers' compensation setting and the non workers' compensation setting. The studies were undertaken by the Lewin Group, a premier health care consulting group in this field. The study methodology was rigorous and both studies showed that there was a difference.

Dr. McKenzie said that the Lewin group would come back when they do the final model that will incorporate these studies in the rule making.

5. Overview of the Work of the NIH Advisory Council for Complementary & Alternative Medicine:

Dr. Pitts introduced Dr. Benjamin Yang who was recently appointed by the President to the NIH National Center for Complementary and Alternative Medicine. Dr. Yang gave an overview of the Council, their funding, budget and mandates. They fund research that is carried out around the world on nontraditional medicine. The budget for 2002 is $104 million and for 2003 will be $113 million. Dr. Yang also announced their telephone number - 1-888-644-6226 and their website for those who are interested.

The Council meeting closed for discussion on disciplinary issues.

6. Discipline Committee Report:

When the meeting opened again, the Council announced that the settlements on Dr. Michael Uzelac, DDS and of Dr. Margaret Howell, DC were accepted. The accusation on Dr. Robert Glover, DC was tabled until the next meeting.

7. Announcement:

Dr. Pitts announced that the next month's meeting November 21, 2002 would be in South San Francisco and the December meeting will be on December 12, 2002 in Los Angeles.

8. Meeting adjourned at 1:30 p.m.

9. AD Hoc Committee on Education Statements - Fibromyalgia:

Council Members and most of the guests stayed for the discussion on Fibromyalgia. Dr. Paul Wakim and Dr. Ira Monosson are co-chairmans of this Committee.

IMC Staff present:

Susan McKenzie, M.D
Anne Searcy, M.D.
Mila Diadula

EMD James Fisher, Esq. 
Rainier Arenas

DWC Staff present:

Jacqueline Schauer, Esq.
Larry Williams

Members of the public present:

Diane Przepiorski, COA 
Carl Brakensiek, CSIMS 
Marta Callotta, DC 
Lauren Zeiner, COMPIQ Corp. 
Philippe Lippe, MD, CANS, AAPM 
Bill Hutchins, CPTA 
Kimberly Wiswell, Kaiser Permanente
Craig Gunderson, AFICC
Mary Jartcky, Calif. Patient Resource 
Peggy Sugarman, CAAA 

Mike Sacket, DC, SCUHS
Rea Crane, CW
Roberta Lenzini, Vision Quest
James Spivey, COMPIQ Corp.
Gary Schultz, DC, SCUHS
Tom Bakman, APIU
Dough Hikawa, Medex HCO
Barry Apelman, US Healthworks
Carlos Jimenez, Translating Sources
Linda Coltrin, CA Chiro. Assn.