Academy of Chiropractic’s

Lawyers PI Program 264

From the Desk of :
Mark Studin DC, FASBE (C), DAAPM, DAAMLP

"The Master Plan"

Disclaimer:This consultation is not designed to tell you instruct you on how to set your fees. That is entirely your decision, however I am going to present the argument for one method. As always, you make the decision for your practice. 
 
 
This past week I lectured at the Massachusetts Association of Trial Lawyers and we had a representative group of lawyers from the entire state in attendance. Usually it takes a few years for the trial lawyers association to notice us as group and invite us "into the fold." In New Jersey it took 4 years, in Delaware it took 3 years, but in Massachusetts it only took 1 year. The reason; the message works and they want what we have.
 
To be more precise, they want what I have during my presentation and my goal is to get them to want what you have. No matter whether I am physically present or I am doing a live video presentation we have accomplished transferring  the lawyers wanting me to wanting you in their offices at the end of the presentation. We have perfected a formula that ensures that virtually 100% of the audience will write on a piece of paper their names and addresses and ASK you to meet with them ASAP. That is perhaps the coolest part of the process. We instantly get the lawyers to run after you.  
 
That part of the process has been figured out and has been working well over the last few years and we have perfected it to be reproducible every single time...but we have now taken the next step based upon the totality of the program and what I learned in New Jersey and shared with you in consultation #263 (the last one.)
 
These seminars are where I experiment, ask questions, get feedback and in business terms are my "test markets" to see what works and doesn't. I realized a long time ago that I can learn just so much in my office, or from asking you questions about what works in your offices. The reality is...we don't know crap and if we are to work in the medical-legal arena, we have to learn from the legal side or we are doomed to fail over (a short) time. 
 
At the seminar in Massachusetts, I was invited to speak after 1 of their members heard me speak and they wanted to give me an audience to see if I was worthy of a larger group. At the end of the meeting, the executive director informed me that the next time I would either be the keynote speaker at their statewide convention. Basically...the game is over and we will get every lawyer that represents inured patients in one room for me to speak.  The same has occurred in New Jersey and Delaware. Since it is not physically possible for me speak in all 50 states, I have set my sights on being the keynote speaker at the national Trial Lawyers Convention to accommodate the entire country in one meeting.
 
However, during this seminar in Massachusetts, because it was a modest group I was able to interact on an individual basis and have in-depth question and answer session during the program. The first questions that were asked where the obligatory questions about disc pathology and anatomy as lawyers are still confused no matter how many years they are in practice. Perhaps this is a result of their opponents trying to win in court with arguments based in rhetoric, half truths, bullcrap and more bullcrap in order to win their argument and cases. This is also why you need to be EXPERT and CREDENTIALED on MRI Spine and disc. 
 
During this presentation, I went into great depth about refuting improper IME and peer reviews. They went from very attentive to being "laser locked" on my every word. Then the questions started and for the first time, the right questions were asked to resolve the most important issues in breaking the barriers between the chiropractor and the lawyer. 
 
The first question that hit the mark was "if an orthopedic surgeon writes a negative IME that is deemed improper, what can a chiropractor do to refute it? You are not orthopedic surgeons and basically are powerless against them."
 
My answer was the following: 
 
Both chiropractic and medicine have the same provisions for telling the truth as a standard of their licenses. In the Massachusetts Board of Registration in Medicine Section it states in 243 CMR §1.03: 5  
 
(5)   Grounds for Complaint. 
(a)   Specific Grounds for Complaints Against Physicians.  A complaint against a physician must allege that a licensee is practicing medicine in violation of law, regulations, or good and accepted medical practice and may  be founded on any of the following:
 
10.   Practicing medicine deceitfully, or engaging in conduct which has the capacity to deceive or defraud.
 
NOTE: It always goes back to regulation and law. You do not need to argue your point, simply quote the law and often the argument never begins. 
 
Medical doctors including orthopedic surgeons and every other MD and DO are subject to the same rules as every other professional licensed in the Commonwealth of Massachusetts in respect to telling the truth.  
 
The next question was more specific, "How can a chiropractor in its scope refute a report from the orthopedist assuming they do not tell the truth."
 
The answer was so simple "If a doctor misquotes research, the proof is not in the standard of the license, it is in the words utilized by the IME or peer review doctor. Simply get a copy of the report and compare the actual research to what is being reported."
 
"If," I continued, "it's about the conclusion that is so far off, then it is incumbent to dissect the examination. First, it is important that I have every one of my patients bring a friend or family member to the examination. I also have them bring all films and advanced diagnostic reports, such as EMG's with them to the IME. The biggest impropriety the IME doctor makes, no matter the specialty, is to ignore the films, records and findings of the patient and solely goes on their physical examination. 
 
It is very easy to take liberties when concluding the results of physical findings when you are not reporting herniations, dislocations, radiculopathies or the myriad of other findings on the advanced imagining or electrodiagnostics. Conversely if you have  significant MRI finding of a myelopathy, it is difficult to say there is nothing wrong with the patient. 
 
Therefore, if the doctor does not comment on the images or reports brought with the patient to the examination, that is grounds for a complaint BY THE PATIENT against the doctor. 
If the doctor negatively comments on my conclusions, I will then write a rebuttal. If it is simply a disagreement about my opinion based on a valid physical examination with inclusion of all of the records I then have NO COMPLAINT.
 
However, if the doctor comments on his findings with only partial reporting of the records, I have a valid basis for my complaint. As a note, I NEVER send the MRI reports, only the films. Most IME doctors do not know how to interpret the images, thereby omitting a comment on the images. I then submit to the carriers and the licensure board that this doctor is not qualified to perform  the IME and reached a desired conclusion by omitting valid findings. I also insist that patient leave with all films they brought giving the doctor full access only during the time of the examination."
 
The lawyers in the room were very excited about this process and wanted to know who did these rebuttals. More on that later.
 
Another lawyer then said "I have been in court with a chiropractor going against an orthopedic surgeon and the defense said "The orthopedic surgeon is here (pointing to the ceiling) and the chiropractor is here  (pointing to the floor.) Who do handle that?
 
My response shocked everyone in the room, as it will you. "I agree with the defense lawyer! I wouldn't want 99% of the chiropractors in the Commonwealth of Massachusetts representing me either. HOWEVER, there are doctors in this room that I would want to go to battle for me. The doctors in this room are credentialed in MRI spine interpretation, triaging the injured, EMG/NCV interpretation, accident reconstruction and impairment rating. Their credentials are certified by various state's department of education, the Federation of Chiropractic Licensure Board and the State University of New York at Buffalo School of Medicine and Biomedical Sciences. The latter is the same body that certifies orthopedic surgeons for MRI interpretation."
 
In addition, these doctors are trained in research and how to effectively rebut and IME or peer review based upon regulation and will not allow improprieties to be perpetuated. 
 
This now got everyone's attention. Here is what closed the deal:
 
"Let's be realistic. You are not going to want a chiropractor to care for, nor act as expert for your clients with brain injuries, multiple fractures or dismemberments. You want the chiropractor for the soft tissue cases; the herniated discs or what has been typically labeled sprains/strained, which happen to be the bulk of your practices. In addition, you cannot afford to bring in the orthopedic surgeon or neurosurgeon for those cases because they charge between $8,000-$20,000 to testify on those cases. My fee for testifying on those cases is $0.00."
 
I continued, "I do not earn my living from testifying. I earn my living from treating patients and the few dollars I could earn from testifying do not matter to me.  I want to be YOUR INSURANCE policy. If you need to go to trial, I am there to stand behind my patients and I do willingly for no fee. In addition to testifying, I am also credentialed to testify on MRI, EMG/NCV, causality, etc..."
 
With the comment, the seminar ended to a very rousing round of applause. 
 
After the seminar ended, lawyers went up to the other doctors in the room telling them about the referrals they wanted to send and me as well. The lawyers wanted me to work with them to undo the unfair IME system and I have received e-mails and phone calls since to help them. To date, it has been the best received lecture I have ever given because we hit them at every level. 
 
We discussed, narratives, research, educational binders, P-IME's and everything else I teach in the previous 500+ consultations. 
 
This is the formula and the plan and as of today this is the focus because it is the heart of the problems that the plaintiff's lawyers face. In an honest and ethical manner, though clinical excellence is how you win if positioned properly. This can be done in a group setting as I did, or on an individual basis over breakfast.
 
Just remember to close the deal as I did.