The Louisiana Claims Association (LCA) Educational Conference and Expo wrapped up yesterday after three days of networking and learning in the Old South town of Natchez, Mississippi. The Baton Rouge-based organization represents claims professionals from all over the state of Louisiana via its local chapters, and the conference is open to adjusters and vendors from most surrounding states (Arkansas, Mississippi and Alabama).
The first of three days of continuing education kicked off on Monday with a unique ethics presentation by Matthew Monson of the Monson Law Firm, using the NBC series The Office to illustrate key ethical dilemmas and tenets of professionalism in the insurance industry. The lecture was followed by the “Mark Twain” reception at the Dunleith Plantation, a historic locale that dates back to 1856.
Workers’ comp adjusters, attorneys and other professionals gathered Tuesday for the bulk of their CE. in the third of three “tracks” provided by LCA to customize offerings for the range of industries in attendance at the conference. Two medical presentations in the workers’ comp track stood out as detailed and particularly informative.
Dr. Warner Talks MRI for Low Back Pain
First, Dr. Meredith Warner discussed magnetic resonance imaging (MRI) in the context of symptomatic and asymptomatic lumbar spine injuries. Dr. Warner, an orthopedic surgeon with her own Warner Orthopedics and Wellness in Baton Rouge, emphasized the misuse of MRI in her presentation, explaining the history of the technology and how it can do more harm than good when used as a diagnostic tool for non “red flag” (e.g. cancer, fracture, etc.) cases of low back pain.
“Ninety percent of people will have low back pain in their lives,” Warner explained. “Half will be better in a week, 90 percent will be better in two months. Less than five percent enter that ‘chronic pain’ category. Maladaptive behavior, inactivity especially, increases the chances of chronic pain – we know that.”
Referring to the state of care across the country, Dr. Warner lamented the immediate use of imaging and narcotics to treat idiopathic low back pain, on which the over utilization of MRI is one part. Further, she questioned the motivations of the doctors that perform MRIs repeatedly when not indicated, citing her extensive history performing second medical opinions and independent medical examiner services.
“What I see all the time with IMEs and SMOs is the lumbar strain or sprain diagnosis, but no one has actually defined what that is,” she said pointing to comparative MRI images from her patients. “See if you can find a lumbar strain or sprain here. You’re not going to find it [on an MRI].”
Dr. Warner said that to use MRI to detect an actual injury, she looks for edema (bone bruising) in some cases, fractures and other recognizable trauma, rather than a bulging disc on its own, as such features can be the result of age-related degeneration. Heading off criticism about the extent to which age-related degeneration can explain MRI findings, Dr. Warner pointed to a wealth of twin studies showing that genetics is the primary factor as to the rate and profundity of age-related degeneration, not simply the aging process itself. She cited several studies that showed that 74 percent of lumbar disc degeneration was heritable, along with 73 percent of cervical disc issues.
Defense Strategies for Interventional Spine Claims Center Around Professional Guidelines and Evidence of Ineffective Treatment Methods
Later on Tuesday, attorneys Kyle P. Kirsch and Peter J. Wanek with McCranie, Sistrunk, Anzelmo, Hardy, McDaniel & Welch in New Orleans teamed up to speak about defending interventional spine claims, offering a step by step look at some of their successful cases and pointing to the importance of checking doctors’ work. In particular, Kirsch and Wanek discussed botched epidural steroid injections and medial branch blocks as points to watch.
In that vein, Wanek discussed a case he defended on behalf of Chik-Fil-A in which a 29-year-old employee slipped and fell and claimed that he was chronically in pain, despite a lack of findings on several and repeated imaging and other tests.
“Know the literature, know the science behind it, and get a good expert,” Wanek advised. “In this case, our expert Dr. Charles Aprill looked at the fluoroscopic images which were used by the pain management doctor in performing the ESIs. What he found was astounding. First of all, the doctor wasn’t using contrast dye to guide the needle. Secondly, he found that the needle used was not even long enough to penetrate the skin and fat tissue to get to the site where he was claiming the pain generator was located.”
Kirsch then took over to discuss medial branch blocks, another therapy that they have successfully challenged in his firm’s cases, plus the growth of spinal cord stimulators in the pain management industry.
Attendees closed out Tuesday with an after party Bowie’s tavern, featuring a band and libations to celebrate another year of LCA. A half day on Wednesday included several more presentations before business ended and all exhibitors and conference-goers headed back over the Louisiana border.