1. No News is Probably Good News
2. Work Comp Report Writing
3. A Time to be Heard/ A Time to Plan
4. An AMA Report Worth Reading

1. Legislators Take a Break
I suspect the general lack of news for this month may be a reflection of lawmakers hitting the road for summer break. The Feds are still ruminating over changing the Medicare payment formula to forestall a 4+% decrease for next year and the House of Representatives has once again passed the medical liability reform bill which includes a 250K cap for pain and suffering. The Senate continues to be Mount Doom into which we will have some difficulty throwing the malpractice reform ring.

2. Medical Legal Reports for Work Comp
Two newsworthy items here.
First, the Administrative Director (AD) of the Division of Industrial Relations was considering some significant changes in the Official Medical Legal Fee Schedule (OMLFS) which would have reduced payment for those of you that do Agreed Medical Evaluations and Qualified Medical Evaluations. I have it on some authority (Phil Lippe, CANS Work Comp guru) that she was persuaded to drop the payment reduction provisions but left intact some slight increases. I wish I could report that CANS played a role in this but it appears the ball was carried by the California Medical Association without the help of our lobbyist. Oh well, it’s the outcome that counts.

Second, for those of you hoping to apply the old State of California Schedule for Permanent Disabilities, 1997 edition to those Comp cases well established prior to the new rules requiring the use of the AMA Guides that went into effect in April of 2004, a recent Appeals Court decision suggests that if the comp case was not closed prior to April, 2004, all disability ratings will have to employ the AMA Guides. The court noted that all pending workers’ compensation cases are subject to the provisions of SB 899 (which includes the AMA Guides provision) regardless of the date of injury. Based on an analysis of legislative intent by the seventh division of the Second District Court of Appeal, the court concluded that injuries occurring before the effective date of the amendments are subject to SB 899 if no final judgment has been entered in the case.

As previously noted in this newsletter, if you want to write these reports, you need to get familiar with the AMA Guides. CANS plans to sponsor a course in using these guides at the 2006 meeting in San Diego .

3. CANS Autumn Board Meeting/ Annual Meeting in San Diego
The CANS Board of Directors will meet on September 17th in Squaw Valley . The meeting will be held in conjunction with the Western Neurosurgical Society’s annual meeting. The location is not too conducive for CANS membership attendance, which is always encouraged, so if you have a gripe or an issue you feel needs attention, contact Janine Tash (see above), our intrepid Executive Secretary, to suggest items for discussion.

Further, it is never too early to plan for our annual meeting. CANS will hold its 33rd Annual Meeting the weekend of January 13-15, 2006 at the Sheraton Suites, downtown San Diego . In addition to updates on timely socio-economic topics, members will have an opportunity to attend a 6-hour QME course on the above-mentioned AMA Guides or to receive 4 CME hours of pain management or both. Registration material will be sent to all members in about a month.

4. One Man can make a Difference
Don Prolo files this report about the recent House of Delegates meeting of the AMA:

The Treaty of Paris that followed the Spanish-American War of 1898 ceded the Philippines and Guam to the United States , alas affording the United States an “Open Door” to China . A century later Thomas Shieh, M.D., Guam’s AMA delegate, reversed passage by engaging the AMA in a series of 10 resolutions to elevate health care and the lot of patients and physicians who live in this U.S. territory. In a spectacular display of creative energy Tom introduced and marshaled these Resolutions through four reference committees dealing with a gamut of key issues: (1) Eliminate the unfair gross receipts taxation of physicians; (2) Restore health care to an island population of 150,000 people, now plagued by the departure of 36% of the population of physicians, shrinking from 110 to 70 because 100% of them lack professional liability coverage; (3) Promote patient and physician autonomy, eliminate claims denial of payment by insurers and reduce the 40% number of uninsured; (4) Promote health coverage for the greatest number of children, adolescents and pregnant women; (5) Cap damages in medical liability awards in Guam where 100% of private physicians carry no insurance; (6) Eliminate capitation in the Medicaid arena for island territories of the USA; (7) Encourage Guam’s Legislature and Governor to establish 21 as the legal drinking age, 0.04 percent blood alcohol as per se illegal for driving; (8) Support legislation for smoke-free public places; (9) Enlist our AMA to work with the Guam Medical Society to reverse precertification programs, including Milliman and Robertson Guidelines that interfere with patient care; (10) Engage AMA support in the quest for the Medical Staff at the island’s only hospital, Guam Memorial, to maintain autonomy and self-governance. Tom Shieh’s energy and prodigious display of understanding the doctors’ dilemma captures the entire spectrum of perturbations in the House of Medicine: public health; doctors’ economic viability and autonomy; patient advocacy, including rights to care, protection of medically indigent and vulnerable children and women; medical staff privileges tied to enforced hospital and emergency call; a cancerous medical liability system in Guam.

But the story did not end on June 22 and continues to evolve. Tom returned to Guam, was elected President of the Medical Staff, and with 24 other MDs in white coats confronted the Governor to ask for $10.9 million to subsidize the public hospital’s pharmaceuticals, general supplies and doctors’ on-call funds. The doctors were initially denied but persisted, and the Governor was pressed to call an emergency session of the Legislature. He responded and the disgruntled legislators returned to pass a bill for $12.5 million for the hospital to pay debts, purchase medicines and compensate doctors for hospital and emergency room call.

What a tour de force by Tom! His message: doctors working together with patients can move mountains and slay the alligators of the governmental and insurer’s swamp.

Fulfilling the duties of an AMA delegate is an enormous load concentrated over five days. Tom Shieh of Guam with his ambitious mission was an inspiration to all. He demonstrated how much the AMA could accomplish for physicians of courage, resolute tenacity and lofty purpose working together. He has led for change in his community, as we also can in ours.

Thanks, Don.

Randy Smith, M.D., Editor

The newsletter is a mix of fact, rumor and opinion. The facts are hopefully clearly stated. The rest is open to interpretation. The opinion is mine. R.S.

The assistance of Janine Tash and Michael Edwards in the preparation of this newsletter is acknowledged and appreciated.