I made a presentation to the Saskatchwan Workmans Compensation Review Panel. Their report left out much of what I had to say so I am putting it here:
1) Case workers make patients worse and obstruct medical care:
One deadly tactic is to force a patient back to work or to inappropriate rehab just to see what will happen. I call it deadly because one of my patients with MRI evidence of a hot disc lesion was forced into inappropriate rehab and died 2 weeks later of his heart condition. I call this tactic “the Shakedown”.
Family physicians must be allowed to administer medical care without interference.
2) In Chronic Pain as little as 10% of cases are diagnosable by conventional examination, CT and MRI. If one wants to make a diagnosis discograms and selective nerve root blocks are necessary but are not made available to patients. hence patients are regularly terminated because “nothing was found”.
3) MRI’s and CT rarely are of use in CHRONIC pain and do not show the source of pain. Yet negative results are used to conclude the patient is faking
4) WCB recruits doctors who have similar outlooks to themselves. Without discograms, selective facet blocks, and selective nerve root blocks, they are not operating on tangible evidence; they are operating on their “feelings” on the matter. As disability ratings vary by over 30% by doctors, these feeling can be very inaccurate. The tragedy legacy of cancer patient pain undertreatment underscores how poorly doctors rate pain levels. Operating on feelings is a scam.
5) Multiple causes of chronic pain are missed by WCB who are supposed to give the patient the benefit of the doubt but do not.
6) Honesty tests like Waddell signs and consistency testing lack “consistency” and are invalid yet still used. They are as valid as witchhunting.
7) Psychological decompensation is to be expected in certain chronic pain conditions but is used to contend it is all in their head…
8) Computer testing for “suitable jobs” does not take into effect many patients have multiple things the matter with them above their main diagnosis and may be socially and otherwise handicapped. A supreme court case in Quebec made it clear handicap had to include ALL problems. There is no evidence counselling someone on a job possibility makes it happen in disabled cases. Canada Disability pension criteria had to be modified to include not just suitable jobs but AVAILABLE and giving sustantive gainful employment – measures ignored by WCB who will terminate cases for any excuse. I call this the “you could be a funeral director” scam.
9) People who don’t get better can be labelled as “Fibromyalgia” even by specialists. This diagnosis cannot be made in the face or injuries and has a very poor consistency record from doctor to doctor in the literature; it cannot be used to terminate benefits where there is doubt.
10) Several legal precedents have been made in the supreme court re WCB:
- Chronic pain without identifiable cause cannot be treated any different than other patient (Nova Scotia 2001)
- Chronic pain is a valid WCB claim and recompensable. Supreme court 2005
- Handicap includes more than just the original injury Supreme court Quebec
- A worker can refuse rehab s/he deems in inapproppriate without being cut off WCB
In an Alberta WCB Case it was ruled that a patient during appeal had the right to cross examine WCB doctors (who are working on their “feelings”) in the conduct of “natural justice”
11) The AMA Guide for disability is old – made before interventional techniques could more determine the cause of back and neck pains. It does not have ratings for chronic pain and does not take age or occupation into account when determining disability. Various Canadian provinces and for example California have had to make changes to how disability ratings are made; this needs to be legislated in Saskatchewan or will be backward and frankly illegally treat chronic pain patients of underdetermine cause (conveniently made by lack of appropriate testing).