GILLARD CHIROPRACTIC POSITION:

(1) Chiropractic Care for Exacerbations of Chronic Pain:

Since ACOEM is silent with respect to exacerbations of a chronic condition [Hamilton v. State Compensation Insurance Fund (2004) 32 CWCR 249 WCAB Panel Decision & Los Angeles Times v. WCAB (2005) (Herbinger) 70 CCC 504 WCAB Writ Denied Decision], Labor Code section 4604.5(e) proclaims authorized medical 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 added.) Therefore, I shall present the Guidelines for Chiropractic Quality Assurance and Practice Parameters ("Mercy Guidelines") to support my recommended care. The Mercy Conference 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 acute injuries, page 125; chapter 8, subsection "E" of said Mercy Conference Guideline, entitled “Acute Episode,” allows the following treatment frequency for an "exacerbation of a chronic condition":

(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 allowable per Mercy for acute exacerbations of a chronic condition. Furthermore, 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 the Mercy Guidelines to support chiropractic treatment for exacerbations of a chronic condition. In pertinent part, the commissioners stated:

"We find in this case that the presumption would be rebutted by the reasoned opinion of the examining QME, the Mercy Guidelines, and the applicants experience in obtaining pain relief from acute exacerbations of her symptoms through the use of chiropractic care.”

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Chiropractic care has historically been very effective at quelling exacerbations of this patient's chronic pain.

The UR doctor’s opinion that chiropractic care for exacerbations of pain is not medically necessary was erroneous and improperly supported. More explicitly, the UR doctor erred by using the ACOEM guidelines as her sole justification for dening manipulation and physiotherapy for exacerbations of chronic pain, for ACOEM is silent regarding treatment recommendations for patient's suffering chronic pain. This contention (ACOEM is non-applicable for chronic pain patients) has been affirmed in both a WCAB panel (Hamilton v. State Compensation Insurance Fund (2004) 32 CWCR 249 WCAB Panel Decision) and a Writ Denied WCAB panel (Los Angeles Times v. WCAB (2005) (Herbinger) 70 CCC 504 WCAB Writ Denied Decision).

Since ACOEM is silent regarding exacerbations of a chronic condition, we must look to Labor Code § 4604.5(e) for guidance; this code 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. Furthermore, a recent WCAB panel decision (Casillas vs. The County of San Luis Obispo (2005) 33 CWCR 217 WCAB Panel decision) has used these same Mercy guidelines, “arguendo” to successfully rebut the presumption that ACOEM carries and award chiropractic care for exacerbations of chronic pain.

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 for exacerbations of chronic pain.

Therefore, chiropractic care on an exacerbation basis is certainly supported by “evidence based treatment guidelines,” as well as by the recent WCAB panel opinion of Casillas (supra) and needs to be paid for.