Academy of Chiropractic Personal Injury & Primary Spine Care Program

Quickie Consult 238

From the Desk of Dr. Mark Studin
Academy of Chiropractic
Preamble: Many of the issues I bring to you are very small, yet each issue is just that, an issue. If you take care of the small issues, then you will be able to build and more importantly, focus on the bigger issues...a larger practice and more family time.

“I Spoke to 110 Lawyers Last Night and They Said...”

"The lawyers in the room were quite honest in saying that as a profession, the chiropractor is one of the worst professionals in caring for the trauma case. A point that I readily agreed with!" 
Dr. Mark Studin,  June 10, 2011

Last night, I was in front of 110 lawyers in New Jersey and they confirmed what I have learned from coast to coast, only in greater detail, as this is the 8th or 9th time I have presented to the same core group of lawyers with at least 50% of the audience having heard me speak multiple times. The thing about New Jersey lawyers is that they are usually not politically correct and are aggressively in your face. If there is something they don't like, you will know about it. If they have an opinion, you will also know it rather quickly. In the audience were both plaintiff and defense lawyers, New Jersey State Superior Court judges, arbitrators, legal consultants and people ranging in experience levels from newly admitted lawyers to seasoned veterans of over 50 years. We had the full rainbow of the legal community spectrum represented.
I learned a lot last night. The newest issue discussed was the parameters for ordering MRI's. It appears that the reasons for ordering MRI's are becoming a "hot issue" in both the insurance carrier realm and the courts. One lawyer who is a legal educator spoke to me for quite some time and grilled me because she disagreed with my parameters for ordering MRI's and how the courts would accept my opinion as expert based upon my protocols. I explained that my protocols state that either a radicular or myelopathic finding necessitates an immediate MRI. Her opinion, based upon the rulings of the courts, backed up by the pressure of the carriers, is that without gross motor or sensory deficits, it is unreasonable and therefore, should necessitate 4 weeks of conservative care prior to ordering an MRI.
After 15 minutes of going in circles with her, I got her to realize what I had spent the last 3 hours teaching, that radiculopathy and myelopathy are gross motor and/or sensory deficits. I also explained that in the absence of either, I wait 6 weeks post-conservative care before ordering an MRI if symptoms persist, 2 weeks longer than the courts would accept the referral for. (The courts readily accept 4 weeks post conservative care). The root of the problem is the courts have accepted the 4 week timeframe for all cases, radicular, myelopathic or neither. They treat all patients the same. 
The argument that tipped the scales didn't come from me. It came from Dr. Richard Sabbagh from Patterson, New Jersey and the owner of the sponsoring MRI company for the evening. They both shared with the legal consultant that if the patient has either a radiculopathy or myelopathic component and the doctor documents the case properly and forwards that documentation to the MRI company, the company will get paid. All pre-certifications will be approved and the denials from the carriers will not be available to use in court against the patient because they will not exist. The doctors also said to the lawyer that both radicular or myelopathic findings have either gross motor or sensory deficits. A point the consulting lawyer did not fully understand prior to the clarification. This is the core of the problem. You have lawyers who are trained in collateral estoppel and res judicata making policy on cord compression, myelopathy and stenosis with no medical training.  Occasionally, there are lawyers who hold dual degrees in medicine or chiropractic and that makes the decisions and policies easier to conform with the truth, but that is a rarity. 
The real issue for both the carriers and the courts is how will the MRI change the treatment plan?  You need to demonstrate the urgency of the MRI where based upon the clinical findings, an immediate surgical consultation is warranted. Explain that not having the MRI can delay possible necessary surgery or aggressive conservative corrective treatment which will result in carriers approving the MRI. In 31 years, I have never had a carrier deny care with that language. The MRI companies have always been paid with that type of letter of necessity and more importantly, you can create an accurate and timely diagnosis, prognosis and treatment plan WITHOUT GUESSING.
This was the theme of last night along with the lawyers clamoring for all of the research that I presented. The last few bi-monthly fliers posted on the Web site with the associated research papers (produced by Dr. Owens who gets credit for creating them) have seemed to gain more interest as we are keying in on issues that lawyers are confronted with more regularly in the courts today. On the "course evaluation" paper that I have every lawyer fill out in order to get their CLE credits for the evening, the #1  comment was that the lawyers want to have the full research papers handed to them at the meeting. This is something the doctors deliver afterwards to review the educational binder. My job is to get every lawyer in the room to invite you into their offices. Something that is waaaaay easy for me to do as almost every lawyer in the room fills out a request form for the  sponsoring doctors to visit them ASAP. 
The last topic was credentials. We spent quite some time explaining the credentials of the doctors in the room. The lawyers in the room were quite honest in saying that as a profession, chiropractors are some of the worst professionals in caring for trauma cases, a point that I readily agreed with! That might surprise you, but it shouldn't. Think of where you were prior to the Lawyers PI Program; how deficient your reports were and how horrible your CV was and how clueless most of you were in MRI, electrodiagnostics and triaging of the injured. That is how the lawyers have been judging us as a profession for 116 years and unfortunately, our brother and sister chiropractors are currently doing nothing to change the culture of our profession. As a result, that is what the legal community and courts see on a regular basis. 
I explained to the lawyers that I agree with them and that all chiropractors are NOT ALIKE. The doctors in the room were all "trauma specialists" with credentials verified on their CVs to back that up. I further explained that each of the doctors in the room were trained in triaging trauma cases, can interpret their own MRIs, have credentials in accident reconstruction and are expert at documenting their findings in an admissible format focused on causality, bodily injury and persistent functional loss.
Just as the lawyer doesn't want a gynecologist or general medicine doctor caring for their clients, they also do not want the family chiropractor caring for their clients. THEY GOT IT!

The 110 lawyers in the room also had the CVs of the sponsoring chiropractors in the room as a handout to review and verify what I was saying. THAT is the primary reason for referrals; they can get the doctors testimony entered into evidence based upon those credentials. The bottom line will always be about clinical excellence based upon verifiable credentials and being the "real deal."

All throughout the seminar, I had the doctors stand up and explain different parts of the program. I then shared with the lawyers that it was all extemporaneous and every doctor in the room could answer every question, no matter who I had stand up to do to so, because every doctor in the room was clinically excellent and had been trained in trauma.
The days of smoke, mirrors and bullcrap are long over and in New Jersey, with those wonderfully polite, yet "in your face" lawyers who I  appreciate tremendously, the message was delivered clearly.  You have to triage based upon documented clinical necessity that changes your treatment plan and you have to be a trauma specialist through verifiable credentials on your CV. The lawyers around the country who say they do not need or want your CV need to be educated about you and your credentials and you need to train them on how to use it. 110 lawyers in New Jersey clamored for them as have lawyers in the other 22 states I have lectured in. In order to win, you now need to be both the best through clinical excellence and the teacher who instructs the lawyers on how to understand the medicine of the bodily injury and how to incorporate you into their practices.

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