With respect to treatment frequency, ACOEM is completely silent. Therefore, as directed by Labor Code section 4604.5 (e), [FN#1] I shall use “other evidence based medical treatment guidelines generally recognized by the national medical community and that are scientifically based," i.e., the Guidelines for Chiropractic Quality Assurance and Practice Parameters ("Mercy Guidelines").

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 acute injuries, page 125; Chapter 8, subsection "E" allows the following treatment frequency for an acute episode or acute 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 the Mercy Guidelines for acute episodes of pain.

Noteworthy and relevant 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.”

I believe Casillas has established the Mercy Guidelines as substantial evidence for determining a reasonable chiropractic frequency for patients who have suffered an acute injury or an acute exacerbation of a chronic injury.

Therefore, up to 34 chiropractic visits would be supported by the Mercy Guidelines. If the patient suffered moderate to severe exacerbation of her pain thereafter that resulted in the patient becoming acute again, then additional chiropractic treatment could be supported by the same Mercy Guidelines.

[FN#1]Labor Code Section 4604.5 (e): “ For all injuries not covered by the American College of Occupational and Environmental Medicine's Occupational Medicine Practice Guidelines or official utilization schedule after adoption pursuant to Section 5307.27, 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.”