Category Archives: Medical Malpractice

Cut the C**P!

For my 300th article, I want to address the medical travel industry and its failure to rid itself of the crooks, liars, shysters, and phonies who prey upon the desperate.

Case in point, the article last Wednesday in the New York Times by Gail Kolata about one man’s experience getting stem cell therapy through medical travel.

This case is endemic of the industry’s impotence to police itself and get rid of those medical providers and hucksters who use slick promotional material to sell useless and often dangerous treatments or dubious procedures.

But what do you expect from an industry whose major organization is merely a conduit for funneling money into the pockets of the organization’s founders and their friends?

What do you expect from an industry that emphasizes attending conferences and not on standardizing the laws and processes for the provision of medical care across national borders.

When I started this blog over three years ago, I had high hopes that the industry would listen to what I had to say, and to at least consider offering medical travel to injured workers in the US. But as happened with the workers’ comp industry, no one has stepped up and offered to work with me.

I’m not mad at everyone in the industry. Many of you are very nice people and work very hard, but your focus is on such medical care as dentistry, cancer, cosmetic/plastic surgery, and other treatments not available in the US, or too expensive.

But helping those who are injured on the job, and many of whom are from many of the countries in this hemisphere who offer medical travel services, should be something some of you might want to do.

It was my hope that this industry would offer me a chance to change direction, but that has not happened, and now I am not sure if it ever will.  There does not seem to be any financial or employment opportunities here, just a lot of conferences and hyperbole.

Prove me wrong.


I am willing to work with any broker, carrier, or employer interested in saving money on expensive surgeries, and to provide the best care for their injured workers or their client’s employees.

Ask me any questions you may have on how to save money on expensive surgeries under workers’ comp.

I am also looking for a partner who shares my vision of global health care for injured workers.

I am also willing to work with any health care provider, medical tourism facilitator or facility to help you take advantage of a market segment treating workers injured on the job. Workers’ compensation is going through dramatic changes, and may one day be folded into general health care. Injured workers needing surgery for compensable injuries will need to seek alternatives that provide quality medical care at lower cost to their employers. Caribbean and Latin America region preferred.

Call me for more information, next steps, or connection strategies at (561) 738-0458 or (561) 603-1685, cell. Email me at: richard_krasner@hotmail.com.

Connect with me on LinkedIn, check out my website, FutureComp Consulting, and follow my blog at: richardkrasner.wordpress.com.

Transforming Workers’ Comp Blog is now viewed all over the world in over 250 countries and political entities. I have published nearly 300 articles, many of them re-published in newsletters and other blogs.

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Más preguntas, preguntas: Una llamada para obtener respuestas de la industria del turismo médico

En los últimos dos años que he estado escribiendo este blog, he tenido contacto con muchas personas en la industria del turismo médico. Algunos que he conocido en línea, y otros que conocí en las tres conferencias de turismo médico que he asistido desde octubre de 2012.

La mayoría de ustedes está en partes del mundo que están demasiado lejos para que muchos norteamericanos viajar a, especialmente aquellos que podrían beneficiarse de ir al extranjero para la cirugía como un paciente de compensacion de trabajadores. Así que me he centrado mi atención en la América Latina y el mercado caribeño, ya que generalmente existe una creciente población latina en Estados Unidos y dentro de la fuerza de trabajo en particular.

Así que mi propósito en este artículo es obtener respuestas a preguntas que planteé anteriormente, y que se han planteado recientemente por individuos seguros que he estado en contacto quienes no están seguros mi idea es viable. Por lo tanto, esta convocatoria de respuestas de la industria del turismo médico.

Estas son algunas de las preguntas por estos individuos:

¿Cómo se logran seguimiento post operatorio a veces durante semanas o meses? ¿El tiempo y el esfuerzo de los repetidos viajes desalentará a la gente? ¿Esos costos adicionales compensará cualquier ahorro en el costo básico de la cirugía? ¿Si se desarrolla una grave complicación post-operatoria (infección del sitio quirúrgico, neumonía, problemas cardiacos, etc.), allí será doctores en los Estados Unidos que están dispuestos a aceptar al paciente de complicación de otro médico? Si se produce por negligencia (y será), ¿por qué un médico estadounidense querría convertirse en un participante en caso como riesgo eventualmente fue nombrado como un acusado? Yo no lo haría, y abogados ir después de que el médico más vulnerable y fácilmente sued (médicos extranjeros están a salvo de mala praxis americano). ¿Donde PT se realiza después de la operación? ¿Qué garantías los empleadores tienen que un médico extranjero entiende el concepto de retorno al trabajo adecuado o incluso se preocupa por los efectos de que la pérdida del trabajador tiene en su negocio? ¿Qué recurso tiene el trabajador lesionado si el médico extranjero arruina todo lo relacionado con el reclamo de compensación de trabajo?

En orden para que usted pueda ser capaz de responder a éstas y otras preguntas, yo estoy restaurando tus recuerdos de los últimos artículos que escribí que cubría algunas de estas preguntas.

Vuelta en enero de 2014, escribí un artículo titulado, “preguntas, preguntas — cómo turismo médico puede convertirse en una alternativa Real en cuidado de la salud y qué significa para la compensación de trabajadores“.

El artículo discute varias preguntas que la industria del turismo médico suficientemente no ha respondido, como responsabilidad legal y mala praxis médica. Estas preguntas para que la implementación del turismo médico en compensación de trabajadores, como su aplicación en general salud puede lograrse la satisfacción de todos los actores involucrados en las reclamaciones de compensación de trabajadores.

Estos actores van desde el trabajador lesionado él/ella, a su empleador, la compañía de seguros (si está asegurado a través de seguros comerciales), el Gerente de riesgo para la empresa, los gerentes de recursos humanos, su corredor (otra vez, si comercialmente asegurado) y cualquier otra entidad involucrada con la colocación o la administración del programa de compensación para trabajadores. También implica cualquier terceros administradores y médicos.

También debatió la cuestión de las clasificaciones de deterioro en el artículo y se indica los tipos de deterioro de los médicos de calificaciones deben estar certificados para asignar a los pacientes. La comprensión de estas calificaciones es necesaria para los médicos que tratan a los trabajadores lesionados, pero no para aquellos que están cubiertos por planes de salud colectivos o privados pago seguro.

En febrero de 2013, escribí un artículo titulado “qué papel puede turismo médico juegan en terapia física y rehabilitación para la compensación de trabajadores?”.

En ese artículo, os hablé de la diferencias significativas en el tipo y la duración de la terapia física proporcionada a los demandantes de compensación de trabajadores. mencioné un estudio que encontró que tres conclusiones principales:

  • Centros corporativos fisioterapia facturados para visitas más y más unidades por episodio que otras configuraciones de práctica.
  • Hubo una “gran diferencia en la utilización de tratamiento entre las regiones geográficas, independientemente de la configuración de práctica, diagnóstico, intervención quirúrgica y tratada de parte del cuerpo”
  • Estos centros corporativos facturados por “una menor proporción de agentes físicos, lo que indica un mayor uso de las intervenciones apoyadas por directrices basadas en la evidencia (terapia manual y ejercicio) comparadas con otras opciones de práctica”.

Entonces concluí el artículo diciendo que la terapia física y rehabilitación servicios podrían ser empaquetados junto con la cirugía y proporcionarían al paciente con un mejor resultado.

Por último, para que la gente en la industria del turismo médico pueda entender comp qué trabajadores es todo esto, escribí un artículo titulado, “Cartilla de compensación A los trabajadores para la industria del turismo médico” que te di las definiciones de conceptos y términos de compensación a los trabajadores comunes.

Lo que pido a todos ustedes que hacer ahora es esto: me dan respuestas a las preguntas que planteé anteriormente, y que ahora están siendo criados por aquellos en el corretaje y campos de la medicina que han criticado mi idea para implementar el turismo médico en compensación de trabajadores.

Se podría decir que yo estoy pidiendo que ponga para arriba, o callarse sobre cuánto mejor turismo médico es y puede ser, porque estas personas necesitan ser vendidos en esto, y ustedes son los únicos que pueden hacer la venta.

A continuación las principales áreas de preocupación a la dirección:

Responsabilidad legal y mala praxis médica

HIPAA (mencionado en mi libro blanco)

Terapia física y rehabilitación

Asistencia y seguimiento

Si quieres negocio compensación de los trabajadores, es usted, no yo, quien tiene que responder a estas preguntas primero. Entonces yo puedo transmitir las respuestas a los de industria comp y seguro de los trabajadores que están haciendo las preguntas.

Traducido por Microsoft Translator

Sírvase responder en Inglés

Letting Problems Fester

 

Yesterday, my father was admitted to a local hospital reluctantly by his primary care physician, and on the wishes of my younger brother, who is also a physician. His doctor wanted to put him in a hospice; my brother had the good sense to convince the primary to admit him to the hospital.

My father has been ignoring a very a serious problem with his legs that has left them inflamed, infected and with open wounds and leaking. And despite pleadings and arguments with him from me, my brother, his doctor, and a home health agency we are using to take care of my mother, he has resisted going to the hospital, or even taking responsibility for the state of his health.

For a few years now, he has been treated for this condition by a dermatologist, who has wrapped his legs with bandages and put Calamine lotion on it. They have prescribed compression stockings for him to wear, but he has only worn them whenever he asked an aide to put them on for him.

But because of the leakage and bleeding, the aides and the agency have told him that they cannot do anything for him until his legs are treated.

I have told him that a dermatologist is not the right doctor to treat this problem, but he has insisted on going back there time and again because of the attention they paid to him in the past, especially one young woman who no longer works there who he was infatuated with.

I might add that this doctor was one of doctors in a database the New York Times published online of physicians who received a majority of the payouts from Medicare in 2012.

Hopefully, now that he is in the hospital, he will get the proper treatment and his legs will improve.

The reason I am telling you this is that the workers’ compensation system has so many “health problems” that are being ignored or treated with ineffective and useless treatments.

Sort of like what is wrong with my father…plenty of open wounds and sores, and other underlying issues that is being treated by the wrong kind of doctor.

These problems, as I have discussed in the past, such as the fraud and abuse of injured workers, the opioid abuse problem, general health care plans charged less for the same surgeries under workers’ comp, and so many other issues, have either been ignored, or are being mistreated because some in the workers’ comp industry are infatuated with the service they are receiving from their service providers and cannot understand that these companies are not interested in solving these problems, only prolonging them because they profit from it.

Also, they are pursuing “treatments” that are ineffective and only make the problems worse, as in the case of my father and his dermatologist.

But unlike my father who finally allowed his doctor to admit him to the hospital, the workers’ comp industry is refusing to seek proper treatment.

“Aged statutes and old case law” is one excuse they offer. Another is because doctors and lawyers are milking and gaming the system and they won’t or can’t do anything about this. And finally, they refuse to seek treatment because they are under the delusion that everything they have tried so far, or will try in the future to address these problems will work, if they only keep doing so.

But we have already seen that some states are allowing employers to opt-out of the system. In one state, a judge has ruled that that state’s system unconstitutional. Joe Paduda has been writing on his blog about private equity firms buying up Third Party Administrator companies and workers’ comp service providers in an effort to consolidate the workers’ comp claims process from right after the first report of injury to the management of the claim, to the management of the pharmacy benefits, and all other services.

As this vertical integration proceeds, it is likely that costs will go up, profits will flow to the top, meaning to the private equity firms and their investor clients, and services provided may not be adequate to treat the injured worker because of the demand for greater efficiency in the process and for ever more profits to be squeezed out of the system.

So, do we see if the “patient” still refuses to get the help it desperately needs, or does it go on pretending that there is nothing wrong, and dies a slow death.

I am glad my father finally agreed to get help. I am still waiting for the workers’ comp industry to do the same. It needs to go to the “hospital” not a hospice.

 

 

The Stench of Fraud, Continued

In The Stench of Fraud: Why Workers’ Comp Can No Longer Be a Closed System, I briefly mentioned the plight of one individual, who I called “Ms. X”.

I called her that because her case is still winding through the medico-legal system in her state, and I do not want to prejudice her case, or add to her woes by embarrassing her, even though she herself is bringing light to her situation by using all resources available to her,

But I felt that once I mentioned her in my previous post, it was alright to expound on the subject of fraud, and discuss her case without identifying her personally.

According to her own words to me [bracketed below] and in her correspondence to others, this is how her nightmare began:

I am an injured worker who was maimed by the medical providers in the insurance carrier’s network of medical providers. Mine is a long story that began December 12, 2011 when I was hurt at work.

[A herniated lumbar disk from working in a sitting position in excess of 65 hours one week and during that week, picking up boxes of banking and files from time to time. I began to feel discomfort in my lower back, went home, took it easy over the weekend, went back to work on Monday, worked for approx. an hour or hour and a half, got up, went to the copy machine, made my copies, bent over to pick them up and then that is when the disk herniated.]

On the day that I was hurt at work, the human resources manager told me that she was going to call the insurance carrier to find out what to do or where to send me. When she returned, she wanted me to sign a “release letter”. I had just gotten that job on November 16, 2011. I got the message that someone there didn’t want me to file a WC claim by virtue of the effort to induce me to sign a release letter. I needed that job and hoped that my back would feel better. I didn’t sign a release letter but I did write a letter indicating that I was hurt at the copier but that I didn’t want to go to their Doctors. I asked if I could go home. At some point, the HR manager gave me a couple of Advil and water for the pain. I had gone home from there – Monday, 12/12/2011. By Thursday, 12/15/2011, my back did not improve, so I placed a call into the HR Mgr. and said that I need to see their Doctors… the HR Mgr. responded by saying something to the effect “Why, you don’t have any money to go to your own Doctor?” (Not verbatim). I was taken aback by this. She knew I was hurt at work. She continued by saying, “We have a release letter signed by you!”. I responded by saying something to the effect that I never signed a release letter. We argued… and so on.

She goes on to say in her correspondence that:

…former employer who fired me less than 3 months after I filed a WC injury. On the very day that I filed a WC claim, my employer placed an ad on Craigslist to replace me. I didn’t learn until sometime in May 2012 that my former employer lied to the insurance carrier about the circumstances of my injury and what I had said. For the record, I was hurt at work and due to the working conditions and surroundings, including my desk and number of hours that I had to work, 65-66 hours the previous week. Our office had very little storage, therefore, myself and the other Escrow Officer, had to pack up boxes of files for closings and banking. We lifted these boxes weekly and sometimes daily due to the lack of space.

Because of what has happened to me, I have been upfront with Doctors outside of the workers comp system. At one of the Doctors, a pain management Doctor that I went to see in early 2014 – March or so, one of the female investigators that I had seen near my apartment on prior occasions (or was her twin) showed up and was placed inside a room before I was, I arrived first, was placed inside the room next to her. During that visit to the Doctor after being placed in the room next to the investigator, the receptionist from the front desk asked me several times if I did recreational drugs and had I ever done recreational drugs. Clearly, a continued effort to create a negative review of me and/or my history. Another Doctor who I visited to get a referral to an orthopedic Doctor insisted that what I describe does not happen. She said that there are no instances in the US of a person being forced under anesthesia. Further, she said that I was delusional and that I should see a psychiatrist, and that the pain that I have is psychologically driven and not real pain.

She was given three epidurals, and this is what happened to her after the first epidural, which went without incident:

I was forced under anesthesia for simple lumbar epidurals. At the 2nd epidural procedure, after objecting to anesthesia, I was told I had no choice, that it was the policy of the surgery center (_____ ___ Outpatient Surgery Center) that all patients must undergo anesthesia. I awakened from that with severe neck pain and slight left arm pain. My Doctor had injected my neck, left side of my spine, left leg with some sort of chemical that tingled and popped like Alka Seltzer. In fact, the tingling went from my lower left lumbar down my left leg all the way up my back and felt like a popping sensation in my head. I was there to receive a lumbar steroid epidural injection and “trigger point shots” in the left side lumbar area.

The next epidural procedure, I made it clear I that I did not want to be placed under anesthesia not only on the phone (a day prior to the procedure) but also before the procedure in pre-op and I re-stated the same in the operating room for everyone to hear. I restated that I was to get a local pain blocker (just as I had during the first lumbar epidural). Instead, my Doctor abruptly shoved the needle into my back without any pain blocker whatsoever. I could feel the needle going through the textures of my back (not precisely or with care into the spinal area where the disk is). My head flew up as I screamed “Wait!” or “Stop!”. He would not relent! As my head hit the operating room table (where a towel and prop to lay my head was), he moved the needle inside me to the nerve in my back next to my spine and held it against the nerve! The pain was so excruciating that I bit into the towel that was for my head to rest on and screamed with the towel in my mouth. Pure agony! He would not stop! I had no choice once again but to give into anesthesia. When I awakened, I thought to myself, Oh my God, they didn’t! I had injuries now throughout my back, neck, shoulders and arm. I could feel the nerves firing all over my back and next to both sides of my spine from the injections of some sort of chemical (the Alka Seltzer feeling again) that over the coming months, burned and corroded the ligaments in my spine, tendons and muscles in my back. It felt as though I was being burned from the inside out. PAIN from burning, PAIN from damage and maiming! I can now and then could feel that some of the tissue/muscles were pushed away from my spine creating the feeling of divots or holes on both sides of my spine. I could feel what seemed to be a muscle pushed away and hanging down on to the right mid side of my person. The ligaments that are in my neck and run up into my skull feel damaged, sore. My spine felt “chiseled” in specific areas most prominently in the top of my back and neck and the bottom near the lumbar sacrum area. I now have instability in my spinal column. I can feel the vertebrae in my spinal column moving not in sync with the other vertebrae…

There is a lot more detail to her case that is beyond the scope of this blog to address, but I am sure my readers have gotten a clear idea of what she has gone through. As a former Claims Examiner and Claims Administrator for a wrap-up insurance program, I have never seen, nor heard of such abuse inflicted upon an injured worker.

This poor woman, who was just doing her job, was taken advantage of by a broken, corrupt and dysfunctional workers’ compensation system that makes the injured worker seem like the guilty party, when it is the providers and legal system who are guilty of injuring and maiming the worker.

To illustrate just how they are characterizing this woman, here is another part of her correspondence regarding an attempt to make her out to have a psychological problem:

The insurance carrier and/or it’s attorneys are working hard to impair my credibility. Several attempts to have me include a psych claim ,since I finally realized that I was being maimed, have been made. Even the AME has placed a notation in his last report that is false – saying that I have ongoing psychological “???”. For the record, I haven’t any history of psych issues. This is a lie that is meant to bode well in favor of the defense. I have never before had a psychological condition. I did mark on a form that I was depressed but that was due to the pain! Not anything else.

In my insurance career, I came across another poor soul who suffered from depression due to the pain he suffered as a result of his injury. At the time, I was the No-Fault Claims Supervisor of the NY office of an automobile insurance company that insured Black Car limousines (Owner and Owner and Another). A Coptic Christian gentleman from Egypt cried in my office before he was seen by our medical consultant. Recognizing that my job was to limit the amount of money we paid to this individual, I did speak to our consultant just prior to the examination. It was the least I could do for this person. So reading what Ms. X has written does not surprize me in the least.

A letter Ms. X forwarded to me from a defense attorney even stated that her epidurals were harming her and not helping. This letter was part of a plan to get her to settle for a few thousand dollars. The lawyer’s text is as follows:

Additionally, the applicant appears to not be benefitting from the treatment, in fact, the treatment by both the employer’s physician and your physician [addressing claimant’s former attorney] appears to be harming rather than helping the applicant.

She also stated in her correspondence that she discovered that:

…some of my medical forms, surgery reports, paperwork had been falsified, changed over and above my signature and due to the anesthesia form (copy handed to me) was marked differently than the first page that I signed and more.

Finally, to make matters worse, she received a letter from a law firm representing her workers’ comp primary physician, demanding her to cease and desist from making false and libelous statements on the internet about their client. From what I understand, this is the physician who the defense attorney said above was harming her. It is no wonder that by mistreating Ms. X this workers’ comp doctor prompted her to take the actions she did to warn people about his conduct.

As I mentioned in the last post on this subject, Ms, X would have been homeless if it was not for her sister. She was subsequently fired from her job as a Manager of her department by her employer after filing the workers’ comp claim.

The events and actions discussed by Ms. X and disclosed here by me, further elaborates just how much the stench of fraud and abuse in the system has become unbearable. These words that I have quoted are but a small part of the whole story Ms. X has told people about, but it is clear that there is something rotten in the state of CA, if not in the state of Denmark, paraphrasing Shakespeare. And we all know that when something is rotten, the stench is overpowering.

Yet, the medico-legal system is arrayed against Ms. X, and the end result, I am afraid will be that she loses, and her work comp settlement will be liened against by the primary physician’s attorney, or the case will be decided in the insurer/employer’s favor, and Ms. X will be unable to go back to work, and will be forever marked as someone who brings attention to herself and not in a positive light. And furthermore, she may be marked as having a psychological issue, when in reality, she is only trying to get the proper treatment for her herniated disk. This psychological defense strategy smacks of something the Soviets used to do to political dissidents.

One gets the feeling that even though the Soviet Union is no more, we are more like the Soviet Union and other authoritarian states, in that the individual is powerless against the power and prestige of physicians, hospitals, lawyers, the courts, and other medical providers, and the system itself.

If ever there was a more clearer case of why we need to transform workers’ comp from the broken, corrupt and dysfunctional system I have been describing these past two years, this case is it.

How different Ms. X’s life would have been if she had gone to an honest and reputable treating physician, received the proper medical treatment, and if necessary, gotten back surgery to repair her herniated disk, even if she received the surgery from her employer or insurance carrier in another country, as a medical tourism option.

And how different her life would be if she did not have to be threatened with a lawsuit from a shyster law firm that is representing a shyster physician, as well as being misrepresented by bad attorneys, so that I had to ask someone I knew if he could help her. There is a saying, “a fish rots from the head down”, and in this case, the stench of the fish called ‘Workers’ Comp fraud’ is taking down the entire system.

The Stench of Fraud: Why Workers’ Comp Can No Longer Be a Closed System

The subject of fraud in workers’ compensation usually refers to claimants who fraudulently file claims to get benefits that don’t belong to them.

But there is another kind of fraud in workers’ compensation…the kind of fraud perpetrated by physicians, hospitals, and other medical facilities, either against the injured workers or against the system itself.

Why this kind of fraud exists is for the same reason that fraud conducted by larcenous and bogus claimant’s exists. Greed.

In a post today on his blog, CA attorney, David De Paolo mentions several cases where physicians or hospitals were charged with using phony or unapproved implants on patients.

Kickbacks, defrauding of insurance companies, and compounding problems are just the tip of the iceberg. One individual, who I will call Ms. X, has been a victim of not only of fraud, but of abuse by the medical providers she was forced to go to under CA work comp laws.

To summarize her experience, let me just say that she endured three epidurals that not only hurt her, they may have damaged her muscles and nerves, and even a defense attorney, in a letter to convince her to settle for a few thousand dollars, said that she was being harmed. Anesthesia was administered against her will, and the legal system took advantage of her as well.

Medical records and forms were changed, doctors treated her with contempt, and her life has been turned upside down and would have been homeless if not for her sister.

Those of you who have read my blog these nearly two years, know that I have been passionate about giving injured workers the best medical care available, and at the lowest cost possible. I know that the American health care system is broken and dysfunctional, but now it seems that it is actually harmful to those whose medical condition is the result of a workplace injury.

Those who criticize my idea to implement medical tourism into workers’ comp should look themselves in a mirror and ask themselves this question: do we really provide injured workers with the best medical care possible, given our broken and dysfunctional health care and workers’ comp systems, and because we have been strait-jacketed into this situation by antiquated state statutes and laws that actually perpetuate this fraud and abuse?

To the medical tourism industry, I am asking the following question that you need to answer, and answer affirmatively so that the health care industry will take you seriously. Will you follow the lead of these fraudsters and hucksters and use phony or unapproved implants on your medical tourism patients, or will you guarantee that you will use FDA approved and legitimate implants and will dispense drugs that have not been compounded in suspect labs? And will you agree to weed out those providers, mostly in the cosmetic and plastic surgery arena, and see that they are turned into the appropriate authorities in their home countries, because they are giving medical tourism a bad name.

And will both the medical tourism and workers’ comp industry promise that patients such as Ms. X will not be maimed and battered by a corrupt and fraud-prone workers’ comp and health care system?

Maybe it is time to get rid of the bad doctors, medical facilities, lawyers, and workers’ comp personnel who care more about their jobs and the profits of the companies that provide services to the workers’ comp industry, than the health and welfare of every single injured worker. And maybe it is time to seriously look at some out of the box solutions to the problems our broken, corrupt, and dysfunctional system is causing injured workers. Medical tourism could be one of those solutions.