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More Medical Treatment Guidelines!!

Today the Chair of the New York Workers' Compensation Board advised that new Medical Treatment Guidelines have been adopted.

In addition to existing Guidelines pertaining to treatment of non-acute pain, the mid and low back, the neck, knees, shoulders, and carpal tunnel syndrome, we have now been greeted with two new categories of Guidelines: hand, wrist, and forearm injuries; and occupational asthma.

I had an opportunity to skim the new Guidelines. Mind you, I am not a medical doctor.

Here are some interesting highlights:

1) The hand guidelines are organized by condition. Table 4 actually spells out "Diagnostic Criteria" for common conditions, including carpal tunnel syndrome, TFCC tears, and Quervain's Tenosynovitis. This include a "Mechanism of Injury" column. Every treating and consulting provider in the system ought to review this table carefully as it will undoubtedly become the topic of questioning at depositions and discussion at the Board on the issue of causal relationship.

2) Carpal tunnel syndrome has its own chapter spanning dozens of pages. Did not carpal tunnel syndrome already have an entire publication of the Medical Treatment Guidelines devoted to it?

3) There is a chapter devoted to "Non-specific Hand, Wrist and Forearm Pain." Preauthorized diagnostics and treatments include arthrocentesis, electrodiagnostic studies, and in excess of 15 physical therapy visits with documentation of functional improvement. How many times have we heard that "pain is not a diagnosis" at a hearing. Perhaps it is now.

4) There is a chapter dedicated to human and animal bites. And it does NOT recommend wound culture. Interesting. I guess if you think your dog bite wound is infected, good luck finding out what the pathogen is! The Board says you should just take prophylactic antibiotics. How can effective antibiotic therapy be rendered without know what organisms are responsible for the infection?

5) The asthma guidelines state, "at least one source of objective information is needed for evaluation of cases of suspected occupational asthma." See page 17. I.e., the claimant's self-reported history of exposure is not going to suffice to establish the asthma as being "occupational."

6) Respiratory protective devices are "not recommended". See page 29.

7) There is a chapter entitled, "Prevention and Exposure Control" that discusses use of PPE and eliminating the "agent". What does this have to do with treatment?

What did I take away from the new Guidelines from a first perusal? The new "Medical Treatment Guidelines" are discussing far more than "Medical Treatment." They are also discussing causative factors, including mechanism of injury, necessary sources of information to confirm a diagnosis, and how to deal with injurious exposure at the workplace, not in the doctor's office. Any legal practitioner should become familiar in particular with Table 4 in the hand guidelines. The criteria set forth therein will certainly turn up during and will be useful in depositions of medical experts on causality.

What do you think about the new guidelines? Comments and discussion are most welcome!

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