MTG Updates Hearing Focuses on Return-to-Work Link, Issues with Palliative Care

Today (10/28), the Louisiana Workforce Commission (LWC) held a public hearing on the proposed updates to the Medical Treatment Guidelines. The lengthy revisions are primarily based upon Colorado’s MTGs, as were the initial iteration, which took effect in 2011. In addition to the written comments admitted into the record (from Jill Breard of LWCC, Jeff Williams of the Louisiana Medical Society, and Michael Morris of the Louisiana Homebuilders Association) three attorneys representing workers’ compensation claimants spoke to their objections to the updates. Written comments submitted to the LWC are not read out in public hearings.

First to speak was Robin Krumholt, of Davoli, Krumholt and Price. Krumholt gave a detailed section by section analysis of her concerns about the proposed rules as published, focusing especially on her perception that the updates limit the ability of the treating physician and diminish individuality of care. She spoke extensively about the Guidelines’ use of statistical probabilities of success to either recommend or discourage treatment, as well as the short time limits for “progress” of an injured worker’s recovery. In particular, Krumholt took issue with “tying medical care to the ability to work,” saying that she finds the language delineating a link between return to work and medical treatment is inappropriate. “Indemnity and causation should be separate from medical treatment in workers’ compensation,” she explained.

Additionally, Krumholt, along with Chuck Davoli and Trey Mustian, who also commented in the hearing, had “strong objections” to the limits of palliative care in the updates, especially for opioid treatment and epidural steroid injections. Krumholt stated that there is an “implication” that palliative care will not be provided after a certain point. “None of this treatment [in the updated Guidelines] goes past a year,” she said. “What are we going to do with these people? Are they going to turn to street drugs? Are they going to kill themselves?”  She also warned against the presumption that anyone who is taking opioids long-term must be “addicted and drug seeking.”

Following Krumholt, Chuck Davoli, also of Davoli, Krumholt and Price, but representing the AFL-CIO in his capacity as a labor representative on the Workers’ Compensation Advisory Council, added to her points and emphasized his more general objections. Stating that he was in favor of the Medical Treatment Guidelines at the beginning of the process in 2008 because they could provide predictability, Davoli went on to explain that the system had become a “paint by numbers” game. “These are characterized as ‘Guidelines,’ but they’re being adopted by rule,” Davoli said. “They’ve gone beyond Guidelines and become regulations…some doctors are jettisoning their workers’ comp practice because the system has become just too onerous.”

Davoli also implied that the latest round of edits were not properly vetted, saying that he “did not have confidence” that Louisiana doctors, including the Medical Advisory Council, were adequately informed and that “transparency” in the process was not apparent.

Mustian, chair of the workers’ comp section of the Louisiana Association for Justice, followed the previous two commentaries by discussing especially the psychological evaluation requirement, saying that he has concerns about who chooses the doctor to perform the evaluation, the fact that they are unilaterally required for claimants that fail to return to work in six months, plus the removal of a previous provision requiring the visit to be conducted by a doctor who speaks the claimant’s primary language.

Davoli summed up the major issues of the day’s spoken commentary, explaining that, “The notion of making the injured worker whole is long gone…I’m coming close to the conclusion personally that Medical Treatment Guidelines are just counterproductive.”

The Louisiana Workforce Commission’s next step in the MTG updates process will be to consider both the written and oral comments, and possibly make changes before they go into effect.


Image Source: Philip Vermeulen,

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