The 23rd Annual LASIE Conference continued Thursday with several panels on claims management and hiring practices. However, it was the medical treatment disability evaluation session that gave attendees a true taste of the technique, as Dr. Barton Wax and Dr. Trang Nguyen discussed both specific injuries and how the Official Disability Guidelines (ODG) work with particular injuries.
Dr. Wax, a member of the American Academy of Orthopedic Surgeons and the American Society for Surgery of the Hand, presented a case study of a crush injury to the hand, and gave the audience an in-depth look at his treatment plan.
The 30 year old patient’s injuries (x-ray shown at left) resulted from a large pipe used in offshore work rolling on his hand. In the aftermath, the worker suffered partial amputation of the distal phalanx of his middle finger, as well as several fractures and a subungual hematoma (bleeding under the nail).
As for the immediate surgical requirements, Dr. Wax explained the variety of procedures necessary to allow his patient to make as full a functional recovery as possible which included: evacuation of the hematoma, setting the fractures, and mitigating the damage to the partially amputated finger in order to close the wound and prevent infection.
Once the surgery is performed successfully though, the real daily challenges of the claim come to the fore. Often, the adjuster on a claim, already juggling many cases, is disconnected from the specifics of the treatment plan. Dr. Wax gave a comprehensive example of how postop procedures and visits should occur. Additionally, he addressed one of the looming issues for comp claims in Louisiana – opioids.
“One week postop,” Dr. Wax said. “That’s really when we’ve got to have a heart to heart about the narcotics prescription for the pain and decide what we’re going to do next.” However, he also indicated that the decision to end narcotic treatment for pain can be difficult when bone healing is involved, since common NSAID antinflammatory medications can slow the healing of bone, and thus, keep an injured worker off the job and on medication longer.
Regarding return to work, Dr. Wax emphasized the need for decisions to be made on a case by case basis, but he insisted that for all but heavy duty jobs, a month or six weeks should be sufficient healing time. For the patient example with the severe crush injury, Dr. Wax said that he was able to return to his duties job after just six weeks, with his pain largely resolved. However, he also performs a fourth postop visit three or four months after the injury to make sure that the wound is healing, do a final x-ray, and discuss any difficulties the claimant may have at work, including whether or not he or she feels they can safely do their job again.
Dr. Nguyen followed with a discussion of the related ODG specifics related to crush injuries and opioid prescriptions, citing in particular the guideline that states: “opioids are not generally recommended for acute pain, except for severe cases, [and] not to exceed two weeks. When used only for a time-limited course, opioid analgesics are an option in the management of patient s with acute pain.”
Overall, both speakers were adamant about communicating expectations to the patient, as well as keeping to a specific treatment plan. Both of those methods help keep workers satisfied, healthy and ready to return to work.
Surgery will also be considered in Friday’s final session of the conference: Pain Management and Surgical Outcomes with Dave Randolph and Meredith Warner.