JUSTIFICATION OF CARE: The Exacerbation of Acute & Subacute Pain

The patient has suffered an exacerbation of her pain and is in need of further chiropractic care, past the one month that is allowed per ACOEM. Since ACOEM is silent regarding exacerbations of either an acute or chronic condition, we must look to Labor Code § 4604.5(e) for guidance. Code 4604.5(e) states:

"For all injuries not covered by the American College of Occupational and Environmental Medicine's Occupational Medicine Practice Guidelines… authorized treatment shall be in accordance with other evidence based medical treatment guidelines generally recognized by the national medical community and that are scientifically based." (Bold and underline added.)

Therefore, I shall use the Guidelines for Chiropractic Quality Assurance and Practice Parameters ("Mercy Guidelines") to support my care:

The Mercy Guidelines are both nationally recognized and based upon scientific medical evidence. In fact, Chapter 8 alone was developed using 67 peer-review quality investigations, text book citations and/or other state treatment guidelines. With regard to reasonable chiropractic treatment frequency for “exacerbations” of acute injuries, page 125; chapter 8, subsection "E" of said Mercy Conference Guideline, entitled “Acute Episode,” allows for the following:

(1) "three to five treatments per week" during the first "10-14 days,"

(2) “up to three treatments per week” for “six to eight weeks.”

Thus a maximum of 34 chiropractic treatments are allowed, per Mercy, for exacerbations of acute pain conditions. Noteworthy is the fact that a recent WCAB panel decision (Casillas vs. The County of San Luis Obispo (2005) 33 CWCR 217 WCAB Panel decision) used these same Mercy guidelines, “arguendo” to successfully rebut the presumption that ACOEM carries.