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HARRIS: Chiropractic treatment has often been used to treat work-related injuries. The recent “reforms” have threatened the scope of such treatment and greatly limited the rights of workers to choose this non-invasive healing modality. What do you see as chiropractic’s present and future role in the comp system?

AUERBACH: In my opinion, it isn’t so much that the “reforms” have threatened the scope of chiropractic practice, but rather have reduced the monetary compensation rate for certain services, and eliminated certain services overall from any payment for these services. The scope of chiropractic remains an issue before the Board of Chiropractic Examiners of the State of California. There is no doubt that the “reforms” have greatly limited injured workers’ rights to access non-invasive treatment modalities. Perhaps there are some who would say that there is still access, although it is extremely limited. It remains my belief that the chiropractor’s role in the present and future comp system should be that of the primary gatekeeper, along with administering care that is necessary to cure and/or relieve from the effects of the industrial exposure. This does not imply that this is an open ended unlimited opportunity for maintenance or lifetime chiropractic care.
“Chiropractic is a health care profession that focuses on disorders of the musculoskeletal system and the nervous system, and the effects of these disorders on general health. Chiropractic care is used most often to treat neuromusculoskeletal complaints, including but not limited to back pain, neck pain, pain in the joints of the arms or legs, and headaches.
Doctors of Chiropractic – often referred to as chiropractors or chiropractic physicians – practice a drug-free, hands-on approach to health care that includes patient examination, diagnosis and treatment. Chiropractors have broad diagnostic skills and are also trained to recommend therapeutic and rehabilitative exercises, as well as to provide nutritional, dietary and lifestyle counseling.” The American Chiropractic Association (AC)


HARRIS: In view of the restrictions on chiropractic treatments, is there still a role for the chiropractor as a Primary Treating Physician?

AUERBACH:
I believe that there will always be a role for a doctor of chiropractic as the primary treating physician. Those DCs who are well trained and continue to educate themselves on the ever-changing work comp system, provide an alternative to patients other than medication, injections, and surgical intervention, in the appropriate clinical scenarios.


For a summary of the workers’ compensation law relating to chiropractic treatment,
click here

HARRIS: What is your philosophy of treatment?

AUERBACH: I am conservative in my philosophy regarding treatment. An accurate diagnosis is at the basis for treatment of any condition, be it industrial or not. If a patient seeks chiropractic care and there has not been demonstrable change in their condition both symptomatically and objectively within a four week period of time, something else should be done by way of a diagnostic test, referral to an allied professional, or changing the course of treatment to assist that patient in achieving their goals for treatment.

 

HARRIS: How are you dealing with the restrictions imposed by the statutory requirement in Labor Code §4600(b) that your treatment be based on the ACOEM guidelines?

AUERBACH:
It is my opinion that the entire scenario with ACOEM was brought about because of the abuses within the system. The abuses manifested in all areas of the work comp system, not just chiropractic. It is my understanding that ACOEM guidelines or other nationally recognized guidelines can suffice as a basis for obtaining authorization for treatment. It is my understanding that the second edition of the ACOEM guidelines involved consulting with one doctor of chiropractic, which certainly would not be considered a fair representation of the profession as a whole. In my opinion, the second edition of the ACOEM guidelines are limited and don’t take into account an individual’s condition on a case-by-case basis.

Labor Code §4600(b)
As used in this division and notwithstanding any other provision of law, medical treatment that is reasonably required to cure or relieve the injured worker from the effects of his or her injury means treatment that is based upon the guidelines adopted by the administrative director pursuant to Section 5307.27 or, prior to the adoption of those guidelines, the updated American College of Occupational and Environmental Medicine's Occupational Medicine Practice Guidelines.

HARRIS: Letting the legislators or government bureaucrats decide on what treatments are appropriate, or how many of each will be allowed, scares me. "Cookie cutter" medical treatment can be disastrous in the individual case. Have you had any experiences where a patient has really been harmed by the limits on treatment imposed by the 2003-2004 legislation?

AUERBACH: I have not personally been involved in cases where a patient has been harmed by the limits on treatment imposed by the 2003-2004 legislation. However, it continues to be my opinion that a patient should have the option not to take medication to manage their musculoskeletal injuries, if this is their choice. The reforms definitely limit this option for patients.

 

HARRIS: I have received many calls from chiropractors wanting to "do lunch" and talk about how they can function as "gatekeeper" PTPs and refer my clients out for sleep studies, psychiatric evaluations, erectile dysfunction, etc. and then write AMA Guide reports that will get high overall ratings. I suspect they have been to seminars on practice preservation. What do you think of this post-reform development?

AUERBACH: I cannot personally tell you that there are seminars promoting this, since I have not attended those types of seminars. However, it would not surprise me. The concept behind the AMA Guides is that you have to take into account the “whole person”. As such, one has to be careful about how they address the other issues such as sleep deprivation, internal complaints, etc., and be prudent in recommending that the patient be referred out to the appropriate specialists for assessment of these conditions.

 

HARRIS: You serve regularly as an AME or QME. How have the "reforms" changed your forensic practice? Do you find it is taking much longer to do reports under the new system?

AUERBACH:
There is no doubt that the “reforms” have changed forensic practice. It takes a much longer time face to face with the patient to do the history and questionnaires, much longer than it did pre-reform. The medical-legal reporting requirements are also more entailed and do require a greater amount of time commitment on the part of the physician so that their report constitutes substantial medical evidence.

 

Tami S. Auerbach, D.C. practices in San Diego.
She received her license to practice chiropractic in 1985 and has been certified as a Qualified Medical Evaluator since 1994. For more information
click here.

Tami Auerbach, D.C.

2903 4th Avenue
San Diego, CA 92103-5901
Phone: (619) 542-1534

 
The Doctor's Office
Chiropractic: Interview with
Tami S. Auerbach, D.C.


In the fourth of a series featuring medical
professionals in the workers’ compensation
system, Marjory Harris interviews
Tami S. Auerbach, D.C.
> The Doctor's Office: Chiropractic
> Multiple Impairments & DFEC
> Defense Perspective: EAMS
> Computer Corner:
Getting on Top of ToDos
> Carving up PD: Part II