THE OFFICIAL PUBLICATION OF AWCCA, INC. In this issue Arizona voters passed the Arizona Medical Marijuana Act (“AMMA”) in November 2010, and since then, the Arizona Department of Health Services (“ADHS”) has developed a medical marijuana program to administer the certification of qualifying patients and license the dispensaries. The first dispensary was opened in December 2012, after Maricopa County Attorney Bill Montgomery unsuccessfully challenged ADHS’s authority to license marijuana dispensaries. Mr. Montgomery has appealed the court’s ruling and continues to argue that the AMMA is in violation of the federal Controlled Substances Act. In the meantime, however, the AMMA is in effect and patients who hold a valid medical marijuana card are protected from state prosecution for using marijuana. This presents concerns for employers, carriers, and third-party administrators in the workers’ compensation industry, so my intent with this article is to inform you about how the AMMA works and what it allows and disallows. The Construct of the Statute The purpose of AMMA is to protect seriously ill patients from state prosecution for using medical marijuana under their doctor’s recommendation. It allows a “qualifying patient” to possess up to 2.5 ounces of usable marijuana or 12 marijuana plants. ADHS only issues medical marijuana cards to “qualifying patients,” and in order to be deemed a qualifying patient, the individual must suffer from a “debilitating medical condition.” The statute defines a “debilitating medical condition” as follows: A. Cancer, glaucoma, HIV+, AIDS, hepatitis C, ALS, Chrohn’s disease, Alzheimer’s, or the treatment of these conditions; B. A chronic or debilitating disease, medical condition, or its treatment that produces: a. Cachexia or wasting syndrome b. Severe and chronic pain c. Severe nausea d. Seizures e. Severe and persistent muscle spasms The physician that prescribes marijuana must make or confirm the diagnosis of a debilitating medical condition, and must examine the patient regarding the debilitating medical condition within 90 days Medical Marijuana and Arizona Workers’ Compensation Continued on page 2… Medical Marijuana and Arizona Workers’ Compensation ...................... Page 1 Let the AWCCA Job Referral Line Work for YOU!… ........... Page 4 State Legislators Across U.S. Reform in Dispensing of Opioids… ........................ Page 5 ICA to Hold Fee Schedule Hearing................................ Page 5 NCCI Study Analysis: Effects of an Aging Workforce .......... Page 6 Red flags in back pain When to worry and what to do .......................... Page 10 Winter/Spring 2013 By Rachel Brozina, Esq., Lester & Norton
16
Embed
In this issue Medical Marijuana and Arizona Workers ...€¦ · Medical Marijuana continued from page 2 medical marijuana. In the meantime, SCF Arizona has publicly announced its
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
T H E O F F I C I A L P U B L I C AT I O N O F A W C C A , I N C .
In this issue
Arizona voters passed the Arizona Medical
Marijuana Act (“AMMA”) in November 2010,
and since then, the Arizona Department of
Health Services (“ADHS”) has developed a
medical marijuana program to administer
the certification of qualifying patients and
license the dispensaries. The first dispensary
was opened in December 2012, after
Maricopa County Attorney Bill Montgomery
unsuccessfully challenged ADHS’s authority
to license marijuana dispensaries. Mr.
Montgomery has appealed the court’s ruling
and continues to argue that the AMMA is in
violation of the federal Controlled Substances
Act.
In the meantime, however, the AMMA is
in effect and patients who hold a valid
medical marijuana card are protected from
state prosecution for using marijuana. This
presents concerns for employers, carriers,
and third-party administrators in the workers’
compensation industry, so my intent with this
article is to inform you about how the AMMA
works and what it allows and disallows.
The Construct of the Statute
The purpose of AMMA is to protect seriously
ill patients from state prosecution for using
medical marijuana under their doctor’s
recommendation. It allows a “qualifying
patient” to possess up to 2.5 ounces of
usable marijuana or 12 marijuana plants.
ADHS only issues medical marijuana cards
to “qualifying patients,” and in order to be
deemed a qualifying patient, the individual
must suffer from a “debilitating medical
condition.”
The statute defines a “debilitating medical
condition” as follows:
A. Cancer, glaucoma, HIV+, AIDS,
hepatitis C, ALS, Chrohn’s disease,
Alzheimer’s, or the treatment of these
conditions;
B. A chronic or debilitating disease,
medical condition, or its treatment
that produces:
a. Cachexia or wasting syndrome
b. Severe and chronic pain
c. Severe nausea
d. Seizures
e. Severe and persistent muscle
spasms
The physician that prescribes marijuana
must make or confirm the diagnosis of
a debilitating medical condition, and
must examine the patient regarding the
debilitating medical condition within 90 days
Medical Marijuana and Arizona Workers’ Compensation
Continued on page 2…
Medical Marijuana and
Arizona Workers’
Compensation ...................... Page 1
Let the AWCCA Job Referral
Line Work for YOU!… ........... Page 4
State Legislators Across U.S.
Reform in Dispensing
of Opioids… ........................ Page 5
ICA to Hold Fee Schedule
Hearing ................................ Page 5
NCCI Study Analysis: Effects
of an Aging Workforce .......... Page 6
Red flags in back pain
When to worry and
what to do ..........................Page 10
Winter/Spring 2013
By Rachel Brozina, Esq., Lester & Norton
Page 2
www.AWCCA.org: Your L ink to the Ar izona Work Comp Indust r y!
If you’re looking for information on AWCCA membership, upcoming events, past issues of The Examiner, links to AWCCA sponsor websites or contact information for
AWCCA Executive Committee Members, be sure to visit www.awcca.org.
For quick access to the most current AWCCA news, remember to bookmark www.awcca.org in your internet browser.
Yes--you can still contact AWCCA the “old school” way, via the U.S. Postal Service!
All U.S. mail correspondence including checks, membership applications, hard copies of Letters to the Editor of The Examiner and other items addressed to the organization or its officers should be sent to:
AWCCA, Inc.P.O. Box 44941 • Phoenix, AZ 85064-4941
*Note: The AWCCA Job Referral Line is a service provided for individuals seeking employment with an organization in the Arizona workers’ compensation industry. It is not a forum for vendors to advertise their qualifications, goods or services. AWCCA reserves the right to screen, edit or reject all Job Referral Line submissions based on this criteria.
Let the AWCCA Job Referral Line Work for YOU!
Page 5
State Legislators Across U.S. Reform in Dispensing of Opioids
The National Conference of Insurance
Legislators (NCOIL) agreed at its Spring
Meeting to develop best practice
strategies for states debating possible
reforms to curb opiod abuse. NCOIL’s
move to develop guidelines instead of
model legislation came after discussion
at a special session in Washington D.C.
NCOIL is a national organization of state
legislators whose main public policy
interests are insurance legislation and
regulation. Most NCOIL legislators either
chair or are members of committees
responsible for insurance legislation
within their respective state legislatures.
Arizona is a general member, but not a
contributing member of NCOIL.
Accord ing to NCOIL Workers ’
Compensation Committee Chairman
Representative Bill Botzow of Vermont,
“opioid abuse is a growing epidemic
that reaches across state lines and may
be impossible to address with any single
approach. Because states are in different
places in their efforts to address opioid
abuse, the appropriate role for NCOIL is to
lay out guidelines for states to consider as
they develop their state-specific reforms.”
In light of legislative discussions at the
special meeting, the proposed best
practices will likely address a number of
issues including prescribing practices,
funding, drug monitoring program
reforms, and data sharing. Draft
guidelines will be considered at NCOIL’s
July 11 Summer Meeting in Philadelphia,
Pennsylvania.
The Industrial Commission of
Arizona (ICA) will hold its 2013
Fee Schedule hearing on April
17, 2013 at 10:00 a.m. in the first
floor auditorium of the ICA offices,
located at 800 W. Washington Street
in Phoenix. The Commissioners
will listen to public comments in
addition to considering a report
prepared by Commission staff as a
preliminary document created as a
foundation for discussions during
the hearing process. The document
can be viewed online at: http://www.
ica.state.az.us/Director/DIR_2013_
FS_preliminaries.aspx.
ICA to Hold Fee Schedule
Hearing
Page 6
NCCI Study Analysis: Effects of an Aging Workforce
The National Council on Compensation
Insurance (NCCI), a U.S. insurance rating
and data collection bureau specializing
in workers’ compensation, recently
conducted a study to address widespread
industry concern over the impact of the
“baby boomer” generation postponing
retirement, thus aging the workforce and
creating the potential for adverse impact
on workers’ compensation loss costs.
The study, which indeed confirms the labor
force’s share of older workers is increasing,
analyzes frequency and severity across
multiple age groups, identifies factors
accounting for the differences in severity
between each age group, and compares
the combined effects of frequency and
severity for each age group to determine
costs per worker.
Share of Older Workers Increasing
Study data shows workers over 45 years
old account for an increasing share of
the U.S. workforce. This group, commonly
referred to as “baby boomers”, was
divided into two separate groups for data
collection purposes. Cumulatively, the
45-and-older share increased from 34
percent of the workforce in 2000 to 42
percent in 2010. Separately, the share
of workers 65 and older is growing but
remains small, increasing from about 3
percent of the total workforce in 2000 to
just fewer than 5 percent in 2010, while the
45- to 54-year-old group has continued to
increase modestly. Notably, researchers
conclude “if the shares of older workers
are increasing, the shares of younger
workers must be decreasing. This is most
evident for workers 35 to 44.”
Continued on page 7…
By Shala Morley, Special for The Examiner
Page 7
ACCELERATEYOUR RETURN TO WORK
Accelerated Rehabilitation Centers690 S. Cooper, Gilbert AZ, 85234
480-503-2100On-site FCEs Work hardening Return-to-work conditioning ASTYM Headache Program
John F. Fierro, ATC, Facility Manager, Sports Performance Specialist
PUTTING PATIENTS FIRST | 877.97.REHAB (877.977.4322) | acceleratedrehab.com
Paul L. Wilson, MA, CRC - Vocational Consultant/Labor Market Consultant Robert Tremp, MA, CRC, CLCP - Vocational Consultant/Certified Life Care Planner
LOSS OF EARNING CAPACITY
RECOMMENDATIONS LABOR MARKET
RESEARCH JOB ANALYSES (DOI AND
POST INJURY) VOCATIONAL
REHABILITATION PLANS/COUNSELING SPANISH/ENGLISH
INTERPRETING
Page 10
Red Flags in Back PainWhen to Worry and What to Do
By Issada Thongtrangan, M.D. Spine Specialist, Valley Orthopedics
Most back pain is benign but some
isn’t. Five or six times a year, I treat
a patient who’s progressed from
backache to paraplegia over a few
months, via discitis or cancer or
cord/cauda equina compression. My
experience is not unique; these issues
are recognized around the world and
we will review some “red flags” which
will help protect the patients from
delayed treatment.
INCIDENCE
According to the U.S. Bureau of
Labor Statistics, there were 4.2
million nonfatal occupational injuries
and illnesses reported by private
industries in 2005. Sprains and
strains accounted for approximately
42 percent of injuries and illnesses
requiring time away from work.
The body part most often involved
in these injuries was the trunk, and
63 percent of injuries to the trunk
involved the spine. As many as 90
percent of persons with occupational
nonspecific low back pain are able to
return to work in a relatively short
period of time; however some aren’t
and need more attention especially
those who have “red flags”. As long
as no “red flags” exist, the patient
should be encouraged to remain
as active as possible, minimize bed
rest, use ice or heat compresses,
take anti-inflammatory or analgesic
medications if desired, participate in
Continued on page 11…
Page 11
Anthony S. Rhorer, MDBoard Certified ABOS
Director Orthopaedic Trauma, SHCOrthopaedic Trauma Surgeon 3126 N. Civic Center Plaza, Scottsdale, AZ 85251 | 480-398-4560 | fAx 480-874-2041
Please visit our website:
sonoranorthotrauma.com
Work Comp Specialist:• Same day appointments for acute patients
• Complex fracture work
• Revision fracture surgery
• Post traumatic reconstruction
• Surgical orthopaedic care
• Prompt second opinions
• Same-day reports (includes physical therapy and work restrictions)
• Bilingual staff
• Extended visit times (each patient receives up to 40 minutes of scheduled appointment time)
… Red flags in back pain continued from page 10
Continued on page 13…
home exercises, and return to work as
soon as possible.
PATHOLOGY AND NATURAL
HISTORY
Imaging pathology is very common
and usually false (positive), meaning
that it’s not indicative of a source
of symptoms. Odds are 50/50
that a claimant who was lumbar-
asymptomatic before an on-the-job
injury will have major degenerative
abnormalities in any imaging study
from x-rays to MRI, that don’t hurt
one bit. That’s why we’ve all been
taught that acute spine imaging is
useless and generally it is. That
bone spur or degenerated disc or
spondylolisthesis seen in an injured
worker’s x-ray was almost certainly
there last week too, when the
claimant felt fine!
Even acute structural spine disease
gets better in most cases by ‘hand of
God,’ and time. Acute sciatica from
disc hernia resolves within weeks
in 60-75 percent of cases. Seventy
percent of acute symptoms from
spinal stenosis or spondylolisthesis
resolve within a few months, and
even insufficiency fractures heal
70 percent of the time to become
asymptomatic within three to four
months.
COST
Spine care is costly, but we know
that a small minority (10 percent) of
patients who have recurrent or chronic
pain generate 90 percent of the cost.
Most of these have nonspecific pain,
usually major secondary gain motives,
and a big behavioral component
to their pain; and honestly most of
the treatment applied here has been
shown to be ineffective. The elite,
KEEP LIFE IN MOTION®
Patients now have the ability to schedule an appointment 24 hours a day, 7 days a week by simply contacting our office at the number below.
1.866.974.2673w w w.thecore inst i tute .com
CENTRAL PHOENIX | GILBERT | MESA | NORTH PHOENIX | PEORIA | SUN CITY WEST
24/7 APPOINTMENT SCHEDULING
LIVE LIFE WITHOUT PAIN
The Center for Orthopedic Research and Education, The CORE Institute®, began practicing in 2005 to deliver comprehensive orthopedic care, one patient at a time. Our fellowship-trained physicians provide specialized care in the areas of surgical, non-surgical and rehabilitative hip, knee, shoulder, elbow and ankle procedures, joint replacement, sports medicine, arthroscopy, fracture management, orthopedic traumatology, hand and wrist procedures, complex articular cartilage restoration, musculoskeletal oncology, foot and ankle reconstruction, physical medicine and rehabilitation, comprehensive spine care and pain management.
Whether it’s for work or play, we understand that you want to get back to your life sooner. The CORE Institute team is dedicated to providing technologically advanced surgical techniques and rehabilitation in six locations in Arizona. With state-of-the-art research labs, less-invasive surgery, on-site MRI and physical therapy, we truly provide excellence in patient care.
Page 13
… Red flags in back pain continued from page 11
Continued on page 14…
evidence-based healthcare flagship
Cochrane Collaboration’s meta-
analysis website (www.cochrane.
org) uniformly reports little long-
term benefit from virtually all back
care treatments with the probable
exception of well-done cognitive
behavioral therapy (CBT) — which
doesn’t mean that every chronic back
pain patient is a hypochondriac;
it just means that many patients
benefit from therapeutic assistance
with understanding and coping
mechanisms.
So, most cases get better without
intervention, but some don’t. There
are several very real structural spine
pathologies that can benefit greatly
from acute diagnosis and care.
Things like discitis and metastatic
lesions and chronic cauda equina
syndrome are population-rare,
but all too common in a referral
spine practice like mine, and the
history is almost always one of
tragically delayed diagnosis and
compromised outcomes — including
paraplegia and death — from missed
opportunities for early care. There
are relatively few spine surgeons out
there but many primary caregivers, so
the burden of screening naturally falls
on general and family practitioners,
or in the case of the injured worker, it
can fall on the urgent care physician.
A lot can be achieved by remembering
the usual profile of benign back pain,
and also by knowing and recognizing
some red flags for low back pain,
which can be identified by asking just
a few simple questions.
ARIZONA ORTHOPEDICSURGICAL ASSOCIATES
AOSA
A Divison of OSNA, PLLC
602-795-6300 Phone623-414-3311 Fax
Steven R. Kassman, M.D.Diplomate American Board
of Orthopedic Surgery
20325 N. 51st Ave., Bldg. 4 Suite 124Glendale, Arizona 85308
(NE corner of 51st Ave. & Beardsley/101)
1840 W. Maryland Ave. #CPhoenix, Arizona 85015
www.arizonaorthomd.com
• Shoulder & Knee Surgery• Total Joint Replacement• Arthroscopic Surgery• Trauma & Fracture Care
Page 14
… Red flags in back pain continued from page 13
Continued on page 15…
THE PROFILE OF BENIGN
BACK PAIN
Benign chronic or recurrent back pain
generally presents around the 40s,
most often in the lumbar region of
males who do heavy physical work and
who have a history of work injuries
or other trauma. The pain episodes
are generally of stable or consistent
intensity; it gets better with rest/lying
down (it’s “mechanical”); there are
no neurological or constitutional
symptoms; and while there may be
work and activities disability, there is
almost never a locomotor disability.
THE RED FLAGS
So, one red flag is a history of onset
at age either > 50 or < 20 years. A
second is the absence of a trauma/
injuries history (i.e. the spontaneous
onset of pain). The third red flag is
pain located outside the low back
region where cancers and fractures
and infections are actually quite rare.
A history of significant trauma should
be a fourth red flag for fracture, but
too often isn’t.
Any patient with a history of
cancer (there’s red flag number five)
who presents with new-onset low
back pain should be considered as
metastatic until proven otherwise.
And anybody with a history or
high risk of immunosuppression —
identified AIDS or HIV, recreational
needle drug users, taking steroids or
immunosuppressants — has a discitis
until proven otherwise (that’s red flag
number six).
Another red flag frequently
missed (number seven) is history
of neurological symptoms, like
numbness/tingling or claudication
(i.e. “I can only walk a short distance
or time before my back pain forces me
to stop”). Physicians shouldn’t depend
on concrete neurological findings on
physical exam — such symptoms are
often delayed and by then, it’s often
too late. The history is enough to alert
an examining physician, but he or she
must ask for it. Incredibly, just about
every year I see a patient who gets
to the point where they’re crawling
around the house on hands and knees
from pain, but because they don’t
have a weak ankle or numb toe, they
don’t get referred.
Constitutionality is red flag number
eight — the backache patient who is
losing weight or having fevers should
be taken very seriously indeed. Night
pain is less of a concern. We used to
think that pain at night was a red flag
but it’s been conclusively shown that’s
not so. Pain that isn’t mechanical,
that persists even when lying down,
can be red flag number nine.
The final red flag, number ten, is a
history of rapidly escalating pain.
These patients with chronic benign
Page 15
1850 North Central Avenue, Suite 1200 Phoenix, Arizona 85004
CorVel Provides The Following Services Enterprise Comp is CorVel’s Workers’ Compensation solution. Services include Claims Administration and Managed Care Services leveraging CorVel’s rules-‐based technology and multiple range of services:
• FNOL • Claim Management • PPO • Patient Triaging • Bill Review • Document Management • Pharmacy Program
CorCase – Patient Management Services
• On-‐site, Field Case Management and Telephonic Case Management • Vocational Rehabilitation • Nurse Liability Claim Reviews
CorVel’s PPO Network
• Exclusive access to Arizona’s Blue Cross Blue Shield Network • Access to a national network of more than 500,000 providers
MedCheck – Medical Bill Review Services • Fee Schedule, Usual & Customary • Bill Review for Workers’ Compensation,
Auto, Liability, and Group Programs • PPO Discounting/Re-‐pricing • Utilization Review Services • Check Writing Services • Extensive and transparent reporting
capabilities CareIQ – IME Program
• Board Certified Physicians • Wide Range of Medical Specialties • Peer Reviews • Record Reviews • Discounted IME Rates
CareMeridian’s 31-bed facility in Phoenix offers a 1:4 staff-to-patient ration and individual care plans to support individuals with brain and spinal cord injuries, as well as medically and orthopedically complex needs.
CareMeridian Phoenix has received accreditation from the Joint Commission on Accreditation of Healthcare.
For more information, contact Karen Christiana, LPN, Regional Director of Business Development, 480.254.6227
5301 E. Thomas Road • Phoenix, AZ 6512 E. Ludlow Drive • Scottsdale, AZCareMeridian Scottsdale provides supported living services to participants who have been discharged from a hospital or other more intensive facility with a brain or spinal cord injury, but still face challenges as they work towards increased independence and community integration.
CareMeridian Scottsdale is now accredited by CARF, the Commission on Accreditation of Rehabilitation Facilities.
Comprehensive treatment and support for people of all ages with brain, spinal cord and other life-altering injuries and medically-complex illnesses
Post-acute Care and Rehabilitation Options for Every Stage of Recovery