Last year, the Department of Labor and Industries (L & I) in Washington state dipped into the kitty to pay $240 million in workers' compensation medical claims. This year, L & I is out to cut the waste in the state's workers' compensation insurance program.
L & I is currently attempting to fine and/or suspend 16 doctors, 14 DCs and two osteopaths. In addition, L & I has 70 other providers under review, over half of which are DCs.
Is L & I on a witch hunt? Will chiropractic be the brunt of a utilization Inquisition? The Washington State Chiropractic Association (WSCA) thinks chiropractors are the targeted group. Does L & I have a basis for their actions?
The Department of Labor and Industries claims to have chosen to investigate doctors whose treatment patterns deviate excessively from the norm. Using that broad criterion, the department then begins investigating individual doctors, reviewing the doctors' last 25 cases that involved four months or more of treatments.
The headline in the Seattle Times of May 17, 1992 said it all: "900 visits to doctor but no cure." The headline referred to the medical audit of John Vukovich, D.C. of Tacoma. The astonishing number of treatments were totaled over a 4-year period (1985-89), and included a staggering 144 x-rays. The recipient of all this attention was an ironworker suffering from acute back pain. The medical review alleged the patient benefitted little from all the therapy.
Dr. James Turney, an osteopath, faired little better under the scrutiny of the investigation. One patient visited Dr. Turney 500 times over eight years. The treatment protocol: a plethora of prescription sedatives and addictive pain-killers.
While the physicians under review represent a small fraction of the state's health care providers, Chuck Holmquist, deputy director of L & I, assessed the reviews thus far as "much worse abuses than what we expected."
L & I is seeking reimbursement from the 16 doctors they claim have abused the workers' compensation system. Two examples suffice: James Turney, D.O. is being ordered to pay the state $90,000; Andrew Isaccs, D.C., of Seattle may have to reimburse $76,000 to the state coffers.
The Washington State Chiropractic Association and a number of DCs have filed suit against L & I. The suit is based on the contention that L & I never stopped payments to the doctors accused of overutilization, and only now, retroactively, are attempting to discipline the doctors.
Why did L & I continue to pay excessive treatment claims? "In the past," said L & I Director Joe Dear, "we did one thing with bills: We paid them." L & I contends that the review system previously had no program to stop the abuses; this coupled with lack of expertise by claim managers, and case overload allowed the abuses to continue.
The lines are drawn: The overutilization and inappropriateness of treatment have been documented. L & I feels retroactive accountability is justified. Their logic dictates that abuses of the workers' compensation system, regardless of when the misconduct occurred, should be punished and require reimbursement.
The WSCA and the doctors under review who have filed suit against L & I, believe it's an unfair system that pays doctors' claims without question, only to years later demand recompense and seek suspension of licenses.
To add to the woes of chiropractic in Washington, L & I has begun a process to limit chiropractic treatments to an initial assessment and 16 visits. The process will require a public hearing, yet to be scheduled.
The WSCA continues to wage its battle in the courts to challenge the audit process of the L & I investigation; now in the face of all the adverse publicity, the WSCA is in the precarious position of trying to convince the state not to limit chiropractic treatment under workers' compensation.
Steve Kelly
Assitant Editor
Editor's Note: The WSCA will be presenting their view of this situation in an upcoming issue.
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