spinal epidurals are not FDA approved (California) (Californ

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Re: spinal epidurals are not FDA approved (California) (Californ

Postby steve appell on Wed Jul 26, 2017 9:25 pm

So let me see if I get this right ....
The FDA is incompetent.
You do not want to ban epi injections but ...
The contents of an epi injection should made available.
Some docs over treat, and some treatment is not FDA approved.
All patients need to be more educated about their treatment.
There is still fraud in the system.

Did I miss anything?
Steve

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Re: spinal epidurals are not FDA approved (California) (Californ

Postby vampireinthenight on Thu Jul 27, 2017 8:21 am

I have to say, I don't really understand the proposed solution here. Doctors have rampant conflicts of interest with manufacturers of both on-label and off-label products. OK. I suppose a CE could demand dosages of epidurals. However, as we are now 13 years into UR, you are going to have to look pretty hard to find a CE that is used to practicing independent judgement for approvals of anything beyond basic therapies. So I guess you advocate stricter and more frequent UR reviews. While there is nothing wrong with that idea, it is counter to what IW advocates are calling for. IW and their representatives are calling for less UR/IMR and fewer denials or delays, especially for routine treatments like epidural injections.
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Re: spinal epidurals are not FDA approved (California) (Californ

Postby 4anewusers on Thu Jul 27, 2017 2:25 pm

Steve, you are correct.

Vampireinthenight do you think it would be too much to ask for the product being used and dose? Don't physicians have to state the dose of oral pain medication they are prescribing to UR? Why not a product being injected into the spinal canal that can cause devastating results? I would think the physicians who are doing the right thing would not mind at all. Most physicians are doing the right thing.It is the small group that are not that I am concerned about.
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Re: spinal epidurals are not FDA approved (California) (Californ

Postby vampireinthenight on Fri Jul 28, 2017 8:05 am

Maybe. More information is not always the answer. Slapping calorie counts on every fast food menu hasn't made us any less fat.

If I understand you correctly, there is no current threshold for the amount of steroid administered to the spine under the MTUS/ACOEM (honestly, I don't know the answer to this). Assuming that is true, the first step would be to ask whether there is any consensus in the medical community as to what would be a maximum dose? Or a recommended dose for a particular condition?
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Re: spinal epidurals are not FDA approved (California) (Californ

Postby vampireinthenight on Fri Jul 28, 2017 8:05 am

Maybe. More information is not always the answer. Slapping calorie counts on every fast food menu hasn't made us any less fat.

If I understand you correctly, there is no current threshold for the amount of steroid administered to the spine under the MTUS/ACOEM (honestly, I don't know the answer to this). Assuming that is true, the first step would be to ask whether there is any consensus in the medical community as to what would be a maximum dose? Or a recommended dose for a particular condition?
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Re: spinal epidurals are not FDA approved (California) (Californ

Postby LawAdvocate on Fri Jul 28, 2017 9:32 am

LOL...there are dozen of medical treatment protocols used by physicians as to the recommended ESI dosages with the variable factors for each patient.

SERIOUSLY? This is how real physicians avoid getting sued for medical malpractice - they follow a nationally recognized treatment protocol. I did medical malpractice defense - I have watched UR responses.

I have watched a whole lot of scientifically illiterate people consent to medical care to doctors who should not be practicing medicine. If you are consenting to any procedure and you don't understand what is being recommended and the specifics of what is being recommend, you secure a second opinion. It's that frigging simple.

The solutions proposed are outside of the jurisdiction of any party.
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Re: spinal epidurals are not FDA approved (California) (Californ

Postby jpod on Fri Jul 28, 2017 11:16 am

4anewusers I think what you are overlooking is the Legislature forbade CE's from modifying or denying medical care on the basis it is not consistent with what is reasonable and necessary medical treatment as defined in Labor Code 4600 et al. That is now handled by doctors and ultimately by doctors working for the AD of the DIR. I think the plea you are making should be directed to the medical community and AD, not the CE community.

I also think that if insurers had the right to sue a WC medical provider for malpractice that could help eliminate the bad actors from the system. As it is today patients have a hard time finding attorneys to take a malpractice case because of the limits on damages available. But insurers could pay attorneys outright (not via contingency fees) to pursue cases if the insurer felt it would help their bottom line.

The problem with this solution (which you seem to acknowledge in one of your subsequent posts) is that it uses a sledge hammer instead of a chisel. I suspect such a change would make malpractice insurance much more expensive for all doctors, even the majority who aren't contributing to the problem you feel needs to be addressed.
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Re: spinal epidurals are not FDA approved (California) (Californ

Postby vampireinthenight on Mon Jul 31, 2017 8:26 am

LOL...there are dozen of medical treatment protocols used by physicians as to the recommended ESI dosages with the variable factors for each patient.


So then I guess the OP is suggesting that UR be more vigilant in applying these protocols? As I stated earlier, there is not a lot of support in the IW community for stricter UR. When looking for broad, overarching solutions to what has been described as an isolated problem (as horrific as it may seem), there are unintended consequences that should not be ignored. Stricter UR means inevitably that more requests for ESIs will be delayed or denied altogether (with a 1-year wait time to request again). Would that be worth it? Maybe, I really don't know because I have not witnessed gross ESI abuse in my area.
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