UTILIZATION REVIEW AND PROCURED MEDICAL TREATMENT:

None submitted by insurer; therefore, per Labor Code section 4610(g) and WCAB en banc decision Sandhagen vs. Cox & Cox Construction; SCIF (2004) 69 CCC 1452, no forthcoming utilization review (“ UR”) opinions are allowable.

JUSTIFICATION OF PROCURED CHIROPRACTIC CARE:

As confirmed in the medical record, this patient presented to our clinic in an acute state as her condition had been exacerbated from work.

The American College of Occupational and Environmental Medicine’s Occupational Medicine Guidelines (“ACOEM”), which are presumed correct per Labor Code section 4604.5(a), are silent with regard to treatment recommendations for injured worker’s who have suffer pain for longer than 90 days (chronic); this contention has been opined in two WCAB panel decisions: Hamilton v. State Compensation Insurance Fund (2004) 32 CWCR 249 WCAB Panel Decision and Los Angeles Times v. WCAB (2005) (Herbinger) 70 CCC 504 WCAB Writ Denied Decision.

In situations where ACOEM is silent, Labor Code section 4604.5(e) mandates that “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." Therefore, in order to support my treatment to this patient, I offer the Guidelines for Chiropractic Quality Assurance and Practice Parameters ("Mercy Guidelines"):

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.

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.”