Fall 2010
T H E O F F I C I A L P U B L I C AT I O N O F AW C C A , I N C .
In this issue
Federal Judge Short-Circuits
RICO Claim
By Jim Gill, Editor, The Examiner
Federal Judge Short-Circuits RICO
Claim.................................... Page 1
The 2010-11 AWCCA Job Referral
In a case that has national workers’
contended that Cassens and Crawford
compensation implications, a federal judge in
deliberately selected unqualified doctors,
Michigan has stifled an attempt to circumvent
including Margules, to give “erroneous medical
Program Open For Any Industry-
the exclusive remedy doctrine by an employee
opinions” to support denials of work-related
Related Opportunities ........... Page 2
who alleged violations of the Racketeer
injury claims filed between 2000 and 2002.
Surgicenters’ Bills Can Be
Reduced................................ Page 3
Influenced and Corrupt Organizations (RICO)
Act as a result of his claim being denied.
Plaintiffs Brown, Fanaly, Orlikowsky and Way
described Margules as a “cut off doctor” and
In a September 27th ruling, U.S. District
contended he was part of a RICO “enterprise”
Court Judge Paul Borman dismissed the case
concocted by Cassens and Crawford to deny
Evolution of a Charity:
of Brown v. Cassens Transport Company,
benefits plaintiffs were allegedly due under the
Phoenix Children’s Project...... Page 6
effectively affirming that the exclusive remedy
Michigan’s workers’ compensation laws.
President’s Message............... Page 4
for the injured worker’s claim falls within
Investigator’s Field Notes –
the administrative scheme set forth in the
Part 2…................................. Page 9
Michigan Workers’ Disability Compensation
Fred Brick Memorial Fund
Act (WDCA).
The defendants argued that the plaintiffs
were impermissibly attempting to bypass the
exclusive administrative scheme for recovery of
benefits as outlined in the WDCA and that, even
Rehabilitant of the
Plaintiffs Paul Brown, William Fanaly, Robert
assuming a claim outside that statutory scheme
Year Award.......................... Page 11
Orlikowsky and Scott Way sued Cassens
was viable, the plaintiffs were unable to establish
Transport Company and its third-party
several essential elements of a RICO claim
administrator, Crawford & Company, along
including (1) an injury which is compensable
New Hope for Failed
with Dr. Saul Margules, alleging the defendants
under RICO, and/or (2) the existence of a
Back Syndrome.................... Page 18
engaged in “various acts of mail and wire
RICO enterprise. Cassens also argued that the
fraud” in violation of the RICO Act in order
claims against it were preempted by the Labor
AWCCA Again Offers Continuing
to support denial of their respective industrial
Relations Management Act (LRMA) while Dr.
Education Credits................. Page 21
injuries. Two other plaintiffs, Charles Thomas,
Margules argued that the plaintiffs couldn’t
Gary Riggs, made similar allegations against
establish that he “conducted the affairs” of the
Cassens and Crawford as a result of medical
alleged RICO enterprise.
Happy Anniversary............... Page 13
opinions rendered by other doctors, although
neither was seen by Margules. The plaintiffs
Continued on page 5…
The 2010-11 AWCCA Job Referral Program Open
For Any Industry-Related Opportunities
The AWCCA Job Referral Program
private investigators, IME or DME
is open for business and can be used
companies or any other insurance-
by any industry-related employee or
related organization that has a job
employer looking to match up the
opening. And, industry professionals
right person with the right position.
in any insurance-related field can post
As always, through the AWCCA’s
their bios using the AWCCA’s website.
program, employers and industry
So, if you are a claim manager looking
professionals can post job openings
to replace an experienced senior
or short professional bios on the
examiner, a doctor looking for a
AWCCA website for positions in
workers’
compensation
qualified billing clerk, a work comp
claims
attorney looking for a paralegal, or if
adjusting. However, the program can
you’re an adjuster, private investigator
also be used by medical professionals,
or voc rehab consultant looking for
vocational rehabilitation companies,
a new opportunity in the work comp
industry, Joe Strange, the AWCCA’s Job
Referral Coordinator, is waiting to hear
from you.
The AWCCA offers an excellent,
cost-free way to match up qualified
employees with ANY job opportunities
in the Arizona workers’ compensation
industry.
To post an opening or a bio, or to learn
more about the AWCCA’s Job Referral
Program, contact Joe Strange via e-mail
at [email protected] or, by
phone at 480-483-4323.
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Page 2
Surgicenters’ Bills Can Be Reduced
By Shala Morley, Special for The Examiner
A September ruling by the Arizona
and SCF’s past payments (in conjunction
Ambulatory Surgery Center routinely
Court of Appeals spoke to private
with their own algorithms) to create
accepts 30% or less from insurers and
companies, and the message was clear:
a methodology for reimbursement,
El Dorado Surgery Center routinely
billed amounts for work-related injury
which ultimately resulted in a reduction
accepts 24% or less from insurers, the
care will not necessarily be paid in full
of payment to the surgery centers. The
centers themselves had acknowledged
by insurers.
centers’ lawsuit challenged that by
“the true measure of reasonable value
adopting a new payment procedure,
of services”. Judge Burke also deduced
SCF had failed to abide by “rulemaking”
that the correct standard for implanting
procedures
the
the fair market value of services was not
Administrative Procedures Act (APA).
a provider’s list price, but rather “what
The court rejected the claim that SCF
a seller actually accepts from a willing
was subject to the APA sanction.
buyer”.
claimed that by refusing to reimburse
An advisory jury awarded Canyon
Attorney Mark Worischeck, counsel
the full amounts submitted for payment,
Ambulatory Surgery Center and El
for SCF Arizona, offered his appraisal
SCF was in breach of implied contract
Dorado
damages
in an official statement, pronouncing
and therefore liable for restitution.
totaling about $1.1 million each, or 70%
that the ruling “strikes a blow to health-
of originally billed charges. Maricopa
care providers who seek to impose their
County Superior Court Judge Edward
unreasonable charges on Arizona’s
Burke, presiding over the appellate
employers”.
Two private care facilities, Canyon
Ambulatory Surgery Center and El
Dorado Surgery Center, filed suit
against Arizona’s largest workers’
compensation insurance provider, SCF
Arizona (SCF). The surgery centers
In the past, SCF routinely paid bills
submitted
by
non-ICA-fee-schedule
care providers in full. Then in 2003, as
a cost-containment effort, SCF hired
Oregon-based firm Qmedtrix to review
their reimbursement practices and make
recommendations for improvement.
Qmedtrix used other carriers’ payments
mandated
Surgery
Center
by
court, set that judgment aside, agreeing
that SCF had reimbursed a reasonable
portion of the billed amounts, which
exceeded 40% of the original total.
The court noted that since Canyon
Attorney James Craft representing
the plaintiff surgery centers, plans to
appeal the appellate court’s decision to
the Arizona Supreme Court.
Ad d AW CCA t o y o u r Bo o km a rks !
If you’re looking for news about AWCCA membership, upcoming events, past issues of
The Examiner, information on AWCCA sponsors or contact information for AWCCA Executive
Committee Members, be sure to visit
www.awcca.org.
Please remember to save www.awcca.org in your Internet Explorer “bookmarks”!
Page 3
President’s Message
By Donell Hewett, AWCCA President
AWCCA Mission
Statement:
The purpose and objectives of this
association shall be to promote
“Community”. Miriam-Webster’s dictionary defines it as people with common interests
the general welfare of its members
living in a particular area.
by developing close relationships
In today’s hectic world, it is good to have contact with others who have similar experiences
and from whom we can draw advice. This is primarily why AWCCA, Inc. was created: to
allow a venue where we, the members, could meet and share our successes and defeats; to
interact with others who share a common goal; to find answers to the questions we face in
this ever-changing field we work in.
among
the
those
engaged
handling
of
in
workers’
compensation claims; to promote
cooperation by mutual exchange
of experiences and information
and discussions thereon and, to
We all have to look at what we do and from what areas we can shave time in order to meet
educate its members.
other obligations. It may be tempting to eliminate attending the monthly dinner meetings,
but it is important now more than ever to maintain a sense of belonging, and to use the
opportunity to network. It is beneficial for us to de-stress with folks who understand.
We also use the opportunity to educate ourselves, not just meet over drinks and regale each
other with the biggest tales. When we meet, we also find that we have a need to use the
energy we generate to a good purpose. In this way, we each contribute in small ways to
create a larger outcome and this is important to each and every one of us. In the last fiscal
year, the AWCCA gave $61,500 to charity. We all had a part of that, and we all own that
sense of accomplishment! Give yourself a pat on the back for a job well done!
The Examiner is published
quarterly by the Arizona Workers’
Compensation Claims Association,
P.O.
AZ,
Box
44941,
85064-4941.
appearing
in
this
Phoenix
All
articles
publication
contain the opinions of the authors
and not necessarily the opinions
So as you look at the end of this year and look forward to next year, make the AWCCA
of the AWCCA, its officers or
an ongoing commitment, or renew this commitment to yourself. You will find it to be
editors. The AWCCA encourages
rewarding, and if you have ideas for ways to continue the great success we share, maybe you
the submission of new ads and
will also find time to participate on the Board. We welcome you!
articles, subject to editing. Signed
I wish each and every one of you Happy Holidays and remember what is important. Stay
connected and you will reap the rewards of a community!
letters to the editor are welcome.
AWCCA seeks to provide a forum
for the free exchange of ideas and
opinions.
Contacting AWCCA the
“Old Fashioned” Way…
All U.S. mail correspondence including checks, membership applications, hard copies of Letters to the Editor of The
Examiner and other items addressed to the organization or its officers should be sent to:
AWCCA, Inc.
P.O. Box 44941
Phoenix, AZ 85064-4941
Page 4
… RICO Claim continued from page 1
In October of 2008, the Sixth Circuit
actions in state and federal courts as well as
the Michigan workers’ compensation
U.S. Court of Appeals ruled that the six
actions in workers’ compensation courts,
administrative scheme. The judge further
employees of Cassens Transport could
thereby
“exclusive
ruled that even if a claim could be raised
proceed with their RICO suit. Cassens
remedy” scheme that governs workers’
outside of the WDCA’s jurisdiction, the
then petitioned the U.S. Supreme Court
compensation law in all 50 states.
plaintiffs failed to allege an “injury to
to review the appellate court’s decision. In
amicus briefs filed by the National Council
of Self-Insurers, and by the Michigan and
Illinois Self-Insurers Associations, the
self-insured representatives argued that
compromising
the
The Supreme Court denied Cassens’
Certiori Petition, thereby allowing the case
to resume.
After assignment to the court of Federal
if the appellate decision was affirmed,
Judge Paul Borman, Borman ruled that
employees who said they were injured at
Page 1
AWCCA Ad 01
8/9/10
1:20 PM
work would be able to prosecute RICO
that the plaintiffs’ exclusive remedy for
their alleged fraud claims rested within
ACTIVE. PRODUCTIVE.
PAIN-FREE LIVING.
Our physicians are experts in
diagnosing and treating nerve, joint,
spine, back, neck and muscle pain
with nonsurgical solutions.
RICO Act and that the plaintiffs’ claims also
failed for this separate and independent
reason.
The Cassens decision is consistent with the
March 2010 decision of another Eastern
Michigan District Court Judge who, on
virtually indistinguishable facts, had reached
the same conclusion in Jackson v. Sedgwick
et al. In that action, plaintiffs Clifton
Jackson and Christopher Scharnitzke also
alleged that their self-insured employer,
Coca Cola Enterprises, conspired with
Sedgwick, its TPA, and with physician Dr.
Paul Drouilliard to deprive them of their
workers’ compensation benefits in violation
of the RICO Act.
We are board certified in Physical
Medicine & Rehabilitation. We are
specialists in treatments for chronic
and acute pain, including spine, sports,
industrial and work-related injuries.
•
•
•
•
•
business or property” as defined under the
Last March, Judge Nancy G. Edmunds
granted Coca Cola’s and Sedgwick’s
motions to dismiss, saying that the exclusive
Michael Wolff, M.D.
Jonathan Komar, M.D.
Anthony Lee, M.D.
Miriam Griggs, M.D., FAAPMR, PT
Jason Sherman, M.D.
remedy provision in Michigan’s workers’
compensation law barred RICO and other
remedies.
Jackson and Scharnitzke however, are
appealing Judge Edmund’s decision. If
Judge Edmund’s decision is reversed, it
will have the effect of nullifying the Sixth
Circuit’s decision on Cassens.
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Page 5
Evolution of a Charity:
Phoenix Children’s Project
By Mary Frieling, Founder/Director
Although I’m not comfortable writing
about myself, Examiner Editor Jim Gill,
asked me to share the story of Phoenix
Children’s Project, an organization
which I have been blessed to have
made a part of my life for the past 15
years, and which has been supported
so generously by the AWCCA and its
wonderful members.
The story of the organization’s birth
and growth began for me in the mid90s. For quite some time, I’d felt the
need and the social obligation to help
people who are less fortunate than I
was. In 1995, I became involved with
the Boys and Girls Club as a volunteer,
and as one of my first projects, I took
a young brother and sister out to buy
some new school clothes and supplies
as part of a back-to-school shopping
program. When I drove them home,
I saw their home for the first time. My
heart sank at the realization that these
two beautiful children lived in squalor,
surviving in a dilapidated house that
they shared with the grandmother and
grandfather who were raising them.
When I went home that evening, I
couldn’t get them off my mind. So I
contacted Boys and Girls Club the next
day wanting to know if I could take
them trick or treating on Halloween.
Amazingly, the children didn’t even
know what Halloween was…
The Boys and Girls Club made
arrangements for me to pick them up
and from that day forward, I did my best
to continue to help these children and
their family on my own. As the weeks
Continued on page 7…
Page 6
… Phoenix Children’s Project continued from page 6
went by, I found myself bringing food
and clothing to these two children and
their family. Soon, other poor families
in the neighborhood began to see me
dropping off items for the children and
they asked for help as well.
Before I knew it, I found myself
doing whatever I could to provide
assistance to an increasing number of
people in the economically depressed
neighborhood to which I couldn’t
stop returning. Soon, the number of
families with which I was involved had
grown to 50. With limited resources, I
eventually began to recruit some friends
and employers, asking if they could
help with donations of food boxes,
children’s clothes, money, etc. After
a few years, there were approximately
100 families that I was trying to help in
one way or another. Finally, one of my
friends suggested I start a 501(c) 3 nonprofit group so I could “raise serious
money and really help these kids”.
In January of 2004, Phoenix Children’s
Project (PCP) was formed as a 501(c)
3 charitable, tax exempt, non-profit
organization. PCP helps children living
below poverty level in Phoenix, Arizona,
detergent, toothpaste, toilet paper,
etc.)
and there are over 250 families and 650
children enrolled in the programs.
Some of our programs include:
• Food Box Program (through which
some families receive a food box
once a month)
• Family Matters Program (through
which we provide assistance for
everyday essentials such as laundry
• Christmas Program (through which
each child receives a new outfit,
shoes, underwear, socks and two or
more toys; the child’s family receives
a Christmas dinner, a laundry
basket filled with personal care
and household items, and a family
gift such as a new blanket or set of
towels)
• Birthday Club (through which each
child gets a party, cake, decorations,
and birthday gift on his/her
birthday)
• Welcome Baby (through which
expectant mothers will receive a
diaper bag filled with newborn baby
supplies)
Continued on page 8…
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… Phoenix Children’s Project continued from page 7
• Back 2 School Program (through
which we provide new backpacks,
uniforms, shoes, socks, underwear
and school supplies)
Phoenix Children’s Project is run solely
by volunteers; there are no paid staff
or administrative costs. Everything is
handled by donations and volunteers.
Every dollar donated to PCP goes to
the people we are dedicated to helping.
This is truly a grassroots, charitable
organization. Our mission statement
is:
PHOENIX CHILDREN’S PROJECT
is dedicated to improving the lives of
children living in poverty in Phoenix,
Arizona. Our goal is to help these
children become healthy, self-reliant
adults. First we help feed and clothe
them, and then we teach them how
to help themselves so they can “break
the chain” and create better lives for
themselves as adults. In turn, the
community benefits.
It was through my longtime friendship
with Jim Gill, who is now Immediate
Past President of AWCCA, that PCP
became associated with many of the
generous individuals in Arizona’s
workers’ compensation industry.
Having known Jim since I was a
teenager, he was one of the individuals
who I had spoken with about helping
support my early efforts to provide
assistance to a growing number of
impoverished families.
Through Jim’s many friends and industry
contacts, word of Phoenix Children’s
Project’s programs spread among the
workers’ compensation industry and as
a result, AWCCA has been an incredibly
generous PCP supporter over the
years. Not only has AWCCA provided
financial support, but many wonderful
AWCCA volunteers have joined our
e-mail database and contributed their
valuable time and effort to our projects
throughout the years.
Thanks to the support of the AWCCA
for many underprivileged children
• Sending over 20 children to summer
camp in northern Arizona (with
some of those children becoming
camp counselors once they were
teens)
• Arranging for many children to have
swim lessons and water safety classes
through the City of Phoenix
and other generous organizations and
individuals, some our accomplishments
are:
• Delivery in 2009 of over 5,000
Christmas presents and 100 holiday
dinners (bringing our total over the
years to more than 18,020 gifts and
275 holiday dinners!)
• Providing new beds and bedding
to over 35 children who otherwise
would be sleeping on the floor or the
couch
• Providing children with winter coats,
hats and gloves
• Providing eye exams and eye glasses
Page 8
• Guiding some below-poverty-level
families through the process of
purchasing their very own home
(which involved providing them with
a savings plan and credit-building
plan which eventually allowed them
to become proud homeowners!)
We are always in need of volunteers
and monetary donations. For more
information about Phoenix Children’s
Project, please check out our
website at www.phoenixchildren.org.
Fortunately, thanks to the generosity of
organizations such as AWCCA and its
members, we have been able to make a
huge difference in the lives of hundreds
of Arizona families and we thank each
of you for your wonderful support over
the years!
Investigator’s Field Notes – Part 2
By Mike Nathe, Certified Surveillance Expert, President Nathe & Nathe Investigations
In the first part of our investigation of the
deer, rainbow lorikeets (in their “forest”),
guests around the acreage looking at the
Interstate-10
corridor
donkeys, and goats. Visitors can also “fish”
ostriches from the safety of a roller cage.
attractions, we took you past Firebird Lake,
for ostriches by dangling an orange slice at
Loads of laughs and worth the stop.
the upcoming seasonal Santa’s Village, the
the end of a pole and watch the giant birds
now demolished Compton Terrace, and the
battle it out below. The ranch, of course,
golf ball driving range at the Buena Tierra
is all about the tourists and sells just about
campground.
The second installment
everything ostrich-related from dusters
of this series begins with a roadside stop
to eggs. On the weekends, you can take a
that has, according to various web-based
45-minute monster truck ride with 20 other
Tucson/Phoenix
tourist advisories, apparently surpassed
“The Thing” in popularity.
One of the most memorable landmarks
in Arizona, and certainly between Tucson
and Phoenix, is the 1,500-foot Picacho
Peak (3,374 feet above sea level), also
off of the 219 exit. Besides the obvious
looming tower of the peak, this state park
attraction is infamous as the westernmost
I’m talking
location of a Civil War battle, where three
about Rooster Cogburn Ostrich Ranch, a
men were killed. Every March, dedicated
sort of “wildlife park” off of Exit 219 in the
hobbyists reenact the 1862 skirmish several
shadows of Picacho Peak.
times a day with a lot of yelling and pushing
The term “wildlife” is used loosely here.
Continued on page 10…
For a $4.00 cup of food, you can feed
Page 9
… Field Notes continued from page 9
while wearing dusty blue or gray period
piece uniforms. There generally are more
combatants than spectators, but there is
always ample coffee and parking.
Picacho Peak itself can be climbed via two
somewhat challenging trails on the backside
and, once on top, the view is pretty cool.
You can look down on the ostriches, the
freeway, and the snowbirds wandering
around a nearby RV Park to the south or,
when facing west, the awesome openness
of the unblemished Sonoran Desert. While
up there, however, just look out for the stray
musket ball.
Between Picacho Peak State Park and the
not offer any tours whatsoever and private
Town of Marana is the Pinal Air Park off
investigators who loiter are thoroughly
of Exit 232. This huge facility is a favorite
questioned before being escorted past the
“bone yard” for storing aging civilian
perimeter by seriously armed guards who
aircraft as the dry desert air apparently
follow in Evergreen Air trucks. Evergreen Air
keeps down corrosion. During World War
is a contractor for the federal government
II, however, this air field was an active army
and the space shuttle’s 747 transporter is
base and, to this day, it’s used for Apache
occasionally serviced there. This complex
attack helicopter training. When traveling
apparently has a number of older restored
along the freeway, look west and you’ll see
World War II aircraft on display but these,
row after row of decommissioned aircraft.
too, are off limit to the public.
The facility is also rumored by the more
In our next issue of The Examiner,
“credible” of the Roswell conspiracy
we’ll return towards Phoenix and start
crowd to be a UFO research site, similar to
scoping out what’s on the east side of the
Area 51 outside of Las Vegas, and nearby
Interstate-10 as we flip through more of the
Marana residents do periodically report
Investigator’s Field Notes.
odd nighttime lights. Pinal Air Park does
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Page 10
Fred Brick Memorial Fund
Rehabilitant of the Year Award
By Erin Finn, MBA, BSW
The Fred Brick Memorial Rehabilitant
of the Year Award is presented annually
to an injured worker who has overcome
significant obstacles and has reached his or
her highest rehabilitation potential. “Highest
potential” is relative to each injured worker
and should not be misconstrued as securing
and retaining competitive employment.
Awards are also distributed for each injured
worker nominated.
This process begins with people like you! If
not for the financial support and emotional
encouragement from professionals in the
workers’ compensation field, many of our
injured workers would have no one to rely
upon but themselves when attempting to
regain autonomy and hopefully return to
gainful employment.
The Fred Brick Memorial Rehabilitant of
the Year Award was established in 1992.
Fred Brick was a labor market consultant,
vocational counselor and valued member
of our community. He passed away
early in 1992 due to complications from
cancer. Fred’s presence has faded, but our
memory of him and all he accomplished
and contributed to our industry remains
strong.
Fred directed many meetings providing
legislative and educational information
both on a local and national level. He
willingly extended his knowledge and
assistance to others in the community.
He was unique in his ability to maintain
objectivity while still having compassion
and recognition for those who helped
themselves. It is in this spirit that the Fred
Brick Memorial Rehabilitant of the Year
Award was founded and continues.
While this award and recognition ceremony
began under the IARP State Chapter,
AWCCA subsequently agreed to keep
alive the tradition of this special event by
carrying the torch and continuing the award
to injured workers. AWCCA has graciously
committed to continued support of the
award fund. Other monies are solicited
from various community members such
Continued on page 12…
Valley wide locations • Hand Therapy • FCE’s • Ergonomics • Athletic Performance
Page 11
… Fred Brick Memorial Fund continued from page 11
as insurance carriers, law offices, medical
and rehabilitation facilities, as well as
individuals. The organization also holds
fundraising events throughout the year.
Be it a contribution of $10 or $1,000, this
money makes the Fred Brick Rehabilitant
of the Year Award possible.
If you are interested in nominating
someone for the award, your nomination
should include information concerning the
nature of the injury, the medical treatment,
obstacles experienced, descriptors of
support (i.e., family, community, etc.) as
well as the final outcome. Forms can be
found on the AWCCA website at www.
awcca.org. This information will be given
to the audience the evening of the annual
award dinner. Recognition of the nominees
and winner(s) will be made at the May
AWCCA dinner meeting. Recipients will
receive a cash prize as well as a certificate of
recognition. If you know of someone who
should be nominated for this recognition,
please complete and submit the nomination
form with a detailed narrative no later than
April 1st.
Nominations/donations can be mailed to
Erin Finn, Orchard Medical Consulting,
3033 N Central Ave #800, Phoenix, AZ
85012. For more information about the
Fred Brick Memorial Fund, please contact
Erin Finn @ 602-576-0015.
FRED BRICK MEMORIAL DONATION FORM
(Please make a copy for your receipt of charity donation)
Please find enclosed my donation for: $
Contributed by (Organization):
Contact Name:
Address:
Phone Number: Date:
Rebecca
Lollich
MA,
CRC
Vocational
Consultant
Labor
Market
Expert
office 480-451-5228
fax 480-515-1576
e-mail [email protected]
10115
E.
Bell
Road
Ste.
107,
Box
505
Scottsdale,
AZ
85260
465 E. Chilton Drive, Suite 6
Chandler, AZ 85225
Phone: 480-503-2100
Fax: 480-503-2131
2009 BC Redo.qxd:PTC Cards
11/18/09
7:22 AM
Page 1
John F. Fierro, ATC
Facility Manager
Sports Performance Specialist
Paul J. Gleason, PT
Principal
Our Services:
[email protected]
Physical Therapy Rehabilitation Services
Sports Medicine Rehabilitation
Industrial Rehabilitation
Sports Performance Training
Page 12
Physical Therapy Complete, PLLC
375 E. Virginia Avenue, Suite B
Phoenix, AZ 85004-1220
Phone 602 264-5323
Fax 602 264-5302
Sports Injury,
Industrial & Orthopedic
Rehabilitation
www.PTComplete.com
Happy Anniversary
By Chris Garland, Former Examiner Editor
Once upon a time, when diary was kept on
Barb Smith and Mike Salcido, the first issue
index cards and IMEs cost a little over $100,
of The Examiner hit the streets 20 years
a young claim adjuster full of ambition
ago.
and ideas determined AWCCA needed a
newsletter. The organization was already
to time. A column discussing the new
cases figured to be a popular feature.
But what to call it? I had no great
Chris,
ideas, but you came up with the
mailing out monthly dinner meeting notices
I certainly recall our lunch one day
title that has stuck: “From a Legal
so why not expand the mailing to include
at Macayo’s on Central way back
Standpoint.” Yes, it’s a tad generic, but
some case law and gossip?
when. You were eager to develop
it signals to the reader that its subject
The Examiner, and you invited me to
will be the cases that influence how we
contribute a column discussing recent
handle what younger attorneys will often
appellate
describe as a surprisingly sophisticated
The four-member Executive Committee
unanimously agreed but quickly left the
room realizing the enormity of this task
using only a type-writer and copy machine.
For the next few months, pavement was
pounded to sell advertising space and find
article writers.
court
opinions
involving
workers’ comp issues. It seemed like a
great idea, and it was: in my experience,
claims
professionals
love
keeping
current with legal trends. As a group,
you and your colleagues are far more
With only one full page ad sold and lots of
knowledgeable about this area of law
help from my friends Susan Strickler, Todd
than lawyers who dabble in it from time
Lundmark, Ysela Gaspar, Chris Kamper,
and complicated area of the law.
Although I authored this column for
a year or two, the busy pace of my
practice made it easy for me to pass
it along to other, equally competent
contributors, including yourself. My writing
the column, I must say, was always a
worthwhile exercise. As my father, a
career schoolteacher, used to say, if
you really want to understand a subject,
try teaching it to someone else. Writing
about the recent cases in a way your
audience would find both interesting
and entertaining always allowed me to
understand the cases better, too.
Has it really been 20 years? Like so many
things it my career, The Examiner doesn’t
seem to be that old. My congratulations
to you and your colleagues for keeping
it going all these years.
--Todd Lundmark, Esq.
Continued on page 14…
Page 13
… Happy Anniversary continued from page 13
Continued on page 15…
Page 14
… Happy Anniversary continued from page 14
Continued on page 16…
Page 15
… Happy Anniversary continued from page 15
Continued on page 17…
Page 16
… Happy Anniversary continued from page 16
A few more ads and we were able to
afford type-setting for the next issue. By
December, we had ads from Panarello
Adjustment,
Hitchcock
Investigation,
Vanguard Industrial Rehabilitation, Wesley
Rehab, Valley of the Sun Rehab Hospital
and the first ever IME service, O&C. My
favorite column, Shop Talk, eventually
disappeared but it was fun while it lasted
and I know that’s what everyone read first.
Reading through the first edition
of The Examiner, I’m struck at how
much has changed- and equally remained the same- over the last 20
years:
The newsletter had very humble beginnings. I remember sitting on my
living room floor putting labels on
the newsletter and organizing the zip
codes for bulk mail. It used to take
me AT LEAST 2 hours getting the
newsletter ready to mail and another
hour to stand in line at the Post Office. Now, The Examiner is electronic
and can be sent to thousands with the
push of a button.
The feature, ‘Shop Talk’ was literally
THE talk of the industry. If I recall,
quite a few leaked industry items
were printed in the newsletter. This
created major drama and even a few
reprimands, but it always blew over
until the next edition came out with
the new gossip!
Reading through all the familiar
names, I’m left with an amazing impression- the workers’ compensation
industry has always been, and continues to be, family.
So here’s to another 20 years with the
biggest, slightly dysfunctional, funloving family I know and am proud
to be a member of.
-Susan Stricker
After two exhausting years, I turned over
my editor position to Susan Strickler but
never in a million years dreamt it would
remain a fixture in the industry for 20 years.
Thank you to all the editors, advertisers and
contributors for appreciating the value and
importance of The Examiner.
Chris Garland
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Page 17
NEW HOPE FOR FAILED BACK SYNDROME
By Dennis Crandall, MD
Board Certified Orthopaedic Spine Surgeon
Sonoran Spine Center
Patients who had undergone prior back
performed, the pathology for which it is
surgery with persisting back or leg pain finally
performed, the patient’s overall mental and
got a name for their condition in 1951. It was
physical condition at the time of surgery, the
called failed back syndrome. Currently we
patient’s motivation to recover, underlying
define failed back syndrome as persisting
disease processes or health problems,
or recurring low back pain with or without
and many other factors. In general, failure
radiating leg pain following one or more
following lumbar discectomy is between
back surgeries. This condition is recognized
5 and 10%. Failure following spinal fusion
as a spectrum of organic diseases which
can be as low as 5% or as high as 50%,
can be complicated by learned chronic
depending on the series, disease process,
behaviors and secondary gain.
and patient population that is evaluated.
The incidence of failure following spine
surgery
depends
on
the
procedure
Treatment for these patients remains difficult
because the precise sources of pain are
sometimes difficult to define.
Page 18
Factors That Affect Failure
The reasons why some people do not
get better following spine surgery can
be grouped into preoperative factors,
operative factors, and postoperative factors.
Preoperative factors affecting outcomes
after spine surgery include selecting patients
likely to do well and making the correct
diagnosis.
Factors during surgery which
impact long term outcomes include failure
to fully decompress pinched or compressed
nerves, inadequate fixation of bone in spine
Continued on page 19…
… Failed Back Syndrome continued from page 18
fusion, and using bone graft techniques
spine that cause pain and other structures
that have not been shown to be successful.
which do not cause pain. Current imaging
Postoperative factors include failure of
techniques include MRI scan, CT scans with
the spine to fuse, infections, recurrent disc
contrast, facet blocks, discography, and
herniations, formation of scar tissue, and
other injection studies. These techniques
arthritis that can develop at the segments
can be helpful at pinning down a precise
adjacent to those which are operated on.
source of pain in someone who has
failed to improve after surgery. Sometimes
Determining the Pain Source
psychological testing is helpful at learning
The broad diagnosis of failed back syndrome
whether a patient is too psychologically
is not useful to spine care providers, since it
fragile to benefit from surgical intervention.
does not define where the pain is coming
from. We know from studies done operating
on patients under local anesthesia, that
there are specific structures within the
With a precise diagnosis of the pain
generator, an algorithm can be followed to
treat patients with predominantly back pain,
or predominantly leg pain.
Who Should Be Considered for Surgery?
For
patients
with
disc
herniation
not
responding to conservative care, our results
from 1995 through 2005 suggest a 95% rate
of improvement, and 4% rate of recurrent
disc herniation. These patients are typically
back to work between two and four weeks
and are stationary six to eight weeks after
surgery. Two years after their surgery, 86% of
these patients are still working.
Patients who fail discectomy and continue
to have pain require evaluation according
to the back pain algorithm.
For patients who have spinal instability, pain
from facet joints (the smaller joints in the
Your Personalized Prescription
For
Orthopedic Sports-Healthcare
Knee and Shoulder IME
back of the spine) or from the disc itself, or
failed prior fusion may be candidates for
spinal fusion.
Using
current techniques
including Bone Morphogenic Protein (BMP)
for fusion (no bone grafting from the hip),
surgery is 95% successful at achieving a
solid fusion. The surgery is typically done in
Your Personalized Prescription
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Orthopedic Sports Healthcare
Knee and Shoulder IMEs
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two to four hours and the patient is in the
hospital for one to four days, depending on
their overall level of fitness.
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There is no substitute
Certain patients should not be offered
further surgical intervention for their failed
back syndrome. These include patients
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Continued on page 20…
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a division of OSNA, PLLC
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M.S. MacCollum, III, M.D.
J.F. James Davidson, M.D.
David W. Sanders, M.D.
Curtis D. Miller, M.D.
Kent H. Chou, M.D.
10450 W. McDowell Rd., Suite 102 � Avondale, AZ 85392
6760 W. Thunderbird Rd., Suite E110 � Peoria, AZ 85381
Tel: (623) 846-7614 � Fax: (623) 846-0993
Page 19
… Failed Back Syndrome continued from page 19
as demonstrated on the history, physical
95% for one-level fusions, 90% for two-level
the best way to also improve the lives of
examination, or specific testing.
these patients.
Patients
fusions, 87% for three-level fusions. Since the
who have pain in areas that don’t match
advent of Bone Morphogenic Protein, our
findings on imaging studies such as MRI
success rate for one and two-level fusions
or x-ray also should not be offered repeat
has been 100% and for three-level fusions,
Dr. Dennis Crandall received his medical
surgery. Patients with fibromyalgia, patients
97%. Following these patients for two years,
degree from St. Louis University School of
who are non-compliant and patients who
75% are working. Returning patients to work
Medicine and completed his orthopaedic
have been off of work for greater than six
and full function remains our main goal.
residency at St. Louis University Hospitals in St.
months deserve extra consideration and
caution before proceeding to surgery. And
© 2010 Sonoran Spine Center
Louis, Missouri. He completed a fellowship
Conclusion
in spinal reconstructive surgery, adult and
finally, it is our belief that a patient having pain
Failed back syndrome is a broad term
pediatric spinal deformity and spinal trauma
despite conservative care is not necessarily
that includes all patients who continue to
from the University of Maryland in Baltimore,
a reason to proceed with surgery.
If a
have pain after spine surgery. For most of
Maryland. Dr. Crandall is board certified by
patient is not a surgical candidate, surgery
these patients, a reason for the pain can
the National Board of Medical Examiners
should not be performed, regardless of the
be clearly identified.
For many of these
and the American Board of Orthopaedic
level of pain.
patients, a treatment program can be
Surgery. Dr. Crandall is medical director of
offered to decrease or eliminate their pain
the Sonoran Spine Center and president of
and get them back to work and an excellent
the Sonoran Spine Research and Education
level of function. Commitment to continuing
Foundation.
Before the use of Bone Morphogenic Protein
(1994 through 2003), our success rate with
spinal fusion as tracked by our research was
research in this area and improve results is
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The Center for Orthopedic Research and Education, The CORE
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orthopedic care, one patient at a time.
Fellowship-trained physicians providing specialized care in:
•Arthroscopy & Sports Medicine
•Foot & Ankle Reconstruction
•Fracture Care
•Hand Surgery
•Interventional & Non-Surgical Spine
•Pain Management
•Physical Medicine & Rehabilitation
•Shoulder & Elbow Surgery
The CORE Institute team is dedicated to providing technologically
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Page 20
AWCCA Offering
Continuing Education Credits
The AWCCA Executive Committee is
their WCCP (Workers Compensation
AWCCA Holiday Party on December
continuing its arrangement with the
Claims
in
14th, or for attendance at the May, 2011
Insurance Educational Association (IEA)
meeting their annual six-hour continuing
dinner meeting when the program will
to offer continuing education credits for
educational requirement.
honor winners of the Fred Brick Memorial
attendance at most of its monthly dinner
meetings for the 2010-11 meeting year.
Continuing education credits will also be
offered at the AWCCA Spring Seminar in
February. This will assist dinner meeting
and seminar attendees who have earned
Professional)
designation
Rehabilitant of the Year awards.
Continuing education credits will be
offered for the January, March and April,
For further information, please contact
2011 dinner meetings.
AWCCA President Donell Hewett at
[email protected].
No continuing education credits will
be offered for attendance at the annual
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Page 21
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