SB 626 Restores Equity and Balance to Workers' Comp
Wednesday, February 27, 2013 | 0
"How to Practice Medicine without a License" was the title of my op-ed in the San Francisco Chronicle on Aug. 29, 2008. The inequities described in that piece have been operative ever since, but now legislation by Calif. state Sen. Jim Beall, D-San Jose, Senate Bill 626, will try to restore balance and equity. Comments from the Legislative Counsel's Digest, 2/22/13, explain how.
Under current law pursuant to SB 863 an Independent Medical Review (IMR) process is empowered to resolve disputes over utilization review for injuries occurring on or after 1 January 2013 and for decisions communicated to the requesting physician on or after July 1, 2013, regardless of the date of injury. In this way injured workers are deprived of diagnostic studies or treatment recommended by their Primary Treating Physicians (PTPs). The dispute then gets settled by the IMR process.
Unfortunately, under current law, neither the UR doctors nor their IMR counterparts need to be licensed by the Medical Board of California. No matter how harmful or egregiously wrong their decisions are, they are not subject to the same discipline as the PTPs all of whom are licensed in the states in which they practice.The American Federation of State, County and Municipal Employees (AFSCME), AFL-CIO, passed a resolution at its International Convention in Chicago in 2006. The resolution stated that "physicians working for utilization review companies reviewing the claims of injured workers be licensed in the states in which their decisions are used and where their decisions may influence the provision or denial of medical care to injured workers."
SB 626 would mandate that medical treatment reviews and independent medical reviews be done by physicians or medical professionals with the same California license as the requesting physician.
Incredibly, under current law, a cadre of secret doctors has been empowered. The names of the IMR doctors are "protected" by law, which means concealed from view. Our previous blogs on SB 863 discuss this ablation of due process in more detail.
SB 626 would delete the requirement that IMR doctors' names be kept secret.
When AFSCME in California supported SB 863 in 2012, the organization actually voted against its own organization's International Resolution. The political pressures to do so at the time were intense (Governor Brown wanted it; see previous blogs re why). We look forward to AFSCME's coming on board with SB 626.
Not only that. SB 863 actually prohibits due process and fair play because it prohibits workers' comp administrative law judges, the WCAB or even higher courts from making determinations of medical necessity that would set aside an IMR ruling against an injured worker. SB 626 would delete this provision.
More to follow. Stay tuned. But first, get on board!
Dr. Robert L. Weinmann is a practicing neurologist in San Jose, Calif. This column was reprinted with his permission from his Politics of Health Care blog.
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