MEDICOLEGAL

1. MEDICOLEGAL NOTHING TO DISCLOSE

2. BAGNALL’S MAXIM POWERPOINT IS THE VIAGRA OF PUBLIC SPEAKING • DISCLOSURE: I HAVE NO INTEREST, WHATSOEVER, IN VIAGRA……….EVER!!

3. WHO AM I? • PRIVATE OUTPATIENT MSK/INTERVENTIONAL PAIN PRACTICE FOR 24 YEARS • AAPM&R BOG/ACADEMY WORK • TEACH AT THE LOCAL MEDICAL SCHOOL • STARTED MEDICOLEGAL WORK 24 YEARS AGO • MY FIRST EMPLOYER OUT OF RESIDENCY INTRODUCED ME TO PI CHART REVIEWS….IME’S/DEPS FOLLOWED • PI: LOCAL DOCTOR RUN REFERRAL SERVICE • WCI: TREATED PATIENTS, IME’S FOLLOWED

4. PHYSIATRISTS & MEDICOLEGAL • WE ARE THE PERFECT DOCS FOR THIS WORK • WE SEE THE WHOLE PERSON, MANY DISCIPLINES UNDER OUR UMBRELLA OF EXPERTISE, SYNTHESIZING MULTIPLE DATA POINTS (MULTISYSTEM) • WE KNOW HOW TO AVOID UNNECESSARY INTERVENTION & (SHOULD) KNOW THE CORRESPONDING LITERATURE • WE ARE DISABILITY/ABILITY SPECIALISTS

5. THE PI ARENA • WHAT IS PI? • CHART REVIEW VS OCCASIONAL IME • RULES OF EXPERT TRANSPARENCY • DISCOVERY DEPOSITION • EVIDENCE DEPOSITION • BINDING ARBITRATION VS OCC TRIAL • MANY SETTLE

6. THE WCI ARENA • WHAT IS WCI? • LAWS DIFFERENT (PAIN/SUFFERING) • ARBITRATOR/EV DEP • TREATED THESE PATIENTS • MET THE NCM’S • ADJUSTORS HEARD OF/LIKED ME (?) • TREATED THE NCM’S, ADJUSTORS &/OR FAMILY

7. DISABILITY ARENA • NON-SSDI EVALS • MAY HAVE CONCURRENT SSDI • USUALLY DISABILITY INSURANCE COMPANY EVAL (DEFENSE) VS ATTY REQUESTED (PLAINTIFF) • OFTEN NO ATTY INVOLVED • INJURY LITIGATION OFTEN N/A OR SETTLED

8. MEDICAL MALPRACTICE ARENA • MESSY • CAN’T AFFORD ME • PLAINTIFF OPINION WORK UNTIL……

9. HOW TO BE A GOOD EXAMINER • HAVE AN OPINION (TF) • TESTIFY WELL (GET YOUR INTENT ACROSS & HAVE FACTUAL SUPPORT) • TRY TO DO PLAINTIFF AND DEFENSE CASES • GIVE THE PATIENT BENEFIT OF THE DOUBT • DO NOT CHANGE AN IME REPORT…ADDEND • TELL THE TRUTH, BE HONEST • I’VE LOST BUSINESS FINDING MISSED PATHOLOGY

10. IME STANDARDS • SCHOFFERMAN J. PAIN MED. 2007 MAY-JUN;8(4):376-82 • MARTELL MF, ET AL. PHYS MED REHABIL CLIN N AM. 2001 AUG;12(3):571-85 • RICH BA. PAIN MED. 2006 SEP-OCT;7(5):460-3 • BAL S. CLIN ORTHOP RELAT RES. FEB 2009;467(2): 383-391 • KLEE CH. NEUROREHABILITATION. 2001;16(2):79-85

11. IME STANDARDS (CONT.) • REPORT TO AMA BOARD OF TRUSTEES, B OF T REPORT 5-A-98 • AMA “GUIDES NEWSLETTER” NOVEMBER/DECEMBER 2005 EDITION • http://www.ama-assn.org/ama/pub/physician-resources/medical-ethics/code-medical-ethics/opinion907.page • http://www.cbs.state.or.us/wcd/communications/publications/4913.pdf

12. MARKETING

13. MARKETING TO WCI • SYMPOSIA (CME?) • SEMINARS/SPEAK AT NCM ASSOCIATIONS (RING) • SEMINARS/SPEAK TO ADJUSTORS • SEMINARS/SPEAK TO SPECIAL INVESTIGATIVE UNITS OF INSURANCE COMPANIES • DO A GOOD JOB!

14. WCI CASE MANAGERS • GIVE THEM A ROOM & A PHONE • AFTER AN IME MEET THEM & DICTATE IN THEIR PRESENCE • ANSWER THEIR QUESTIONS • HAVE AN OPINION • GIVE SPECIFIC RESTRICTIONS • REPORT PROMPTLY • BE AVAILABLE FOR APPOINTMENTS/CALLS

15. MARKETING TO PI • I DON’T….PERIOD • LISTS (PAID VS FREE) • LISTING/REFERRAL COMPANIES • ADS • ABIME, AADEP CERTIFICATIONS (INCLUDING ACRONYMS AFTER YOUR NAME) • IICLE TALKS

16. ACTUAL IME REPORT “THIS GENTLEMAN HAS AN EXCESSIVELY NONORGANIC EVALUATION, AS LISTED ABOVE. HE HAS MULTIPLE BIZARRE COMPLAINTS THROUGHOUT THE ENTIRE BODY, WHICH MAKE LITTLE, IF ANY, MEDICAL SENSE AND ARE NOT OBJECTIVELY SUPPORTED.”

17. PAIN DIAGRAM

18. IME REPORT (CONT) “NONE OF HIS TREATERS HAVE ACTUALLY GIVEN HIM ANY MEDICAL DIAGNOSIS OF ANY SIGNFICANCE. HE IS NOT A CANDIDATE FOR ANY FURTHER TREATMENT OR TESTING RELATING TO THESE COMPLAINTS.”

19. TESTIMONY GOALS • DISCOVERY: FIND OUT THE FACTS IN THE CASE • EVIDENCE: PRESENT THE EVIDENCE IN THE CASE TO A JUDGE, JURY OR ARBITRATOR/S • IMPEACHMENT ATTEMPTS • OPPOSING ATTY WILL ATTEMPT TO DISPROVE OR DISCREDIT YOUR OPINIONS &/OR YOUR QUALIFICATIONS • DAUBERT STANDARD MET

20. TESTIFYING WELL • LISTEN TO THE QUESTION: SINCE YOU SAID THE PATIENT IS RIGHT HANDED, DOES THAT MEAN…..? • ANTICIPATE EXACTLY WHAT THE ATTY WANTS TO KNOW BY ASKING THE QUESTION • TRY TO ANTICIPATE THE NEXT QUESTION • HYPOTHETICALS: IS IT POSSIBLE THAT A FAIRY SPRINKLED DUST ON THE PT WHILE THEY SLEPT? • HOW MUCH ARE THEY PAYING YOU FOR YOUR OPINION TODAY?

21. TESTIFYING WELL (CONT.) • A GOOD WITNESS MUST HAVE CONFIDENCE & FIRM BOUNDARIES • DO NOT THEORIZE: IS THE PATIENT HAVING PAIN? • DO NOT OVEREXTEND: DENTAL WORK, PSYCH • BE CONSISTENT (PRIOR TESTIMONY IS OUT THERE) • THIS IS NOT A CONVERSATION (BULLYING) • YOU CAN OBJECT TO A QUESTION! • IF YOU TEACH, YOU CAN TESTIFY

22. BUSINESS OF DOING BUSINESS • NO SHOW/LATE CANCELATION OF IME=FULL CHARGE • I BILL IME’S PER BODY PART, PER INJURY, EXTRA FOR COPIOUS RECORDS • TRAVEL TIME MAY BE BILLED (PORTAL TO PORTAL)

23. BUSINESS OF DOING BUSINESS (CONT.) • 2 HR DEP MINIMUM, NOT COUNTING PREP TIME • DEP CANCELATION=1 WEEK IN ADVANCE, GET DEPOSIT UP FRONT • ALWAYS GET PAYMENT UP FRONT…ALWAYS

24. DID I MENTION? ALWAYS

25. DID I HAVE AN OPINION?

26. IS SURGEON IN A BETTER POSITION?DISCREDITED?

27. AM I A PSYCHOLOGIST?DISQUALIFICATION?

28. IS HE A MALINGERER?OVEREXTENSION?

29. DON’T DO MEDICOLEGAL IF: • CAN’T ARTICULATE WELL DURING TESTIMONY • CAN’T BACK UP ARGUMENTS WELL WITH RELEVANT EVIDENCE BASED STUDIES • DON’T FEEL COMFORTABLE WITH TAKING ON DOCTORS WITH DIFFERING OPINIONS • CAN’T TAKE THE HEAT OF UNHAPPY PATIENTS (RATINGS) • CAN’T BE DECISIVE WITH DIFFICULT OPINIONS/RECOMMENDATIONS

30. DON’T DO MEDICOLEGAL IF (CONT.): • CAN’T BE PROMPT WITH (LONG) REPORTS • ARE BAD/INFLEXIBLE WITH DEADLINES • CAN’T BE AVAILABLE FOR SCHEDULING OF IME’S, DEPOSITIONS • CAN’T GET TO RECORD REVIEWS PROMPTLY • ARE NONCONFRONTATIONAL • DON’T LIKE TALKING TO LAWYERS

31. DESTINATION: TENACATITA