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 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 acute pain conditions.

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 acute exacerbations of spine pain. In pertinent part, the commissioners stated, "we find in this case that the presumption [of ACOEM] 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.”

********************************CHRONIC SUPPORT****************************************

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 exacerbations of chronic conditions, 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 is/would be allowed, per Mercy, for acute exacerbations of a chronic condition. I shall report if the need for said care arises.

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 [of ACOEM] 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.”

********************************** QME SUPPORT ********************************************

To support my opinion on procured care, I would like to offer the Guidelines for Chiropractic Quality Assurance and Practice Parameters ("Mercy Guidelines"), since the presumed-correct ACOEM guidelines were found to be non-applicable to patients (such as this patient) suffering from chronic pain. (1,2)

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 exacerbations of chronic conditions, 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 is/would be allowed, per Mercy, for acute exacerbations of a chronic condition.

Further 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 [of ACOEM] 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.”

During the patient interview, he has stated that he uses chiropractic care ONLY for exacerbations of his chronic back pain. Therefore, based upon Mercy and Casillas, it is my medical opinion that the procured and future chiropractic treatment is reasonably necessary to cure and/or relief the patient from the effects of his chronic pain.

(1) Los Angeles Times v. WCAB (2005) (Herbinger) 70 CCC 504 WCAB Writ Denied Decision

(2) Hamilton v. State Compensation Insurance Fund (2004) 32 CWCR 249 WCAB Panel Decision