Lack of records (California) (California)

[vampireinthenight]

Just do your best with what you have. Records make it easy, but sometimes there are few records and sometimes there are none.

Be careful throwing stones, even if you are really confident in your support staff. There are mailing issues, objections between the parties and other things you may not know about.

I can tell you about once every few weeks I get a QME/AME report claiming they don't have records even though I have the cover letter serving them and the copies sure as hell aren't in MY office! It's really interesting when they review one set of records that were sent and the others were lost. (Sorry, I mean "never sent"). I just called a well known AME office this week and was first told that the second set of records sent were still not received. With a little prodding, I was then told that the records were located in another room where the receptionist had dumped them because she thought they weren't important. This happens all the time. Records get found when there are a few phone calls about it. Of course, by that point, the initial report is already issued.

I don't know why this is happening more and more but it is aggravating from this side as well. I suspect it happens more when QMEs ask that the records be sent to a different location than the eval. I can tell you the more suspicious bunch are convinced that QMEs do this so they can bill for a separate supplemental report after the records are found...

[cmunday]

Twocents, Vampire et. al.

Indeed, we are all advised to be careful "throwing stones" and best to keep it neutral. Usually I will simply say something like "unfortunately, the medical file was not available for review at the time of my evaluation". I humbly acknowledge that there have been incidents where my office has been the culprit in my not receiving the records. "Stuff happens" for sure but at the risk of sounding preachy we all should try to be responsible for our own part of the process (easy to get caught up in criticizing others and not looking at our own flaws). But recently I've had several cases where the records were sent a day or two after the evaluation (as indicated in the date of the cover letter) which I must interpret as simply not being on top of things enough to get them to us on time. Again, when it's a "big" and complex case where the exam has been scheduled for months it's hard not to be a little irked. That said, I agree that one does the best one can and candidly explains the limitations, situations, etc.

I have heard that people intentionally game the system to get more supplemental reports. I guess I really am naive because I just can't fathom doing such a thing. I've also heard people who say don't bring a CV to the deposition, the attorneys can get the information on the record and you add 15 minutes to the deposition. I want to subject myself to a longer deposition to modestly increase the bill? When I'm that desperate to generate billings I will know it's time to retire.

Merry Christmas, Happy Hanukkah, Happy New Year to you all.

[mytwocents]

You make some very good points, Vampire. Certainly, there are situations where it’s the doctor who drops the ball rather than the attorneys. However, if the doctor notifies counsel that he doesn’t have the records, that should elicit a response even if it’s to say that the records were already sent. Likewise, if the records aren't received, the doctor should say something before it would be too late to send them in time for the evaluation. Email is best of all because it’s fast and it can’t get lost in the mail or the mail room. Everyone makes an occasional mistake. It's when they choose not to communicate that it becomes a problem.

As for the doctors who want the records to be sent to a location other than where the evaluation will take place, I always figured that the other address was where the QME management company’s medical record reviewers/summarizers were located. Sometimes the doctor then claims under penalty of perjury that he spent 25 hours doing it all himself. I have my doubts about some of those bills.

[tsfortruth]

While my2cents is technically correct, the DWC does not have jurisdiction over AMEs but will use what an AME does against them when it comes time to renew as a QME and there is nothing to stop them from doing so.

Again, turn out a report stating what you need to address the issues.

[vampireinthenight]

Hi Dr. Munday,

Just to give you some insight: There are times where I have been jammed up getting the records out. Usually it has to do with pro per applicants and the 20 day rule. We have to be extra careful with pro per applicants and make sure we serve them with things well in advance of the evaluation and give them time to object to them. There are arguments that one cannot object to medicals at all, but I believe the code says for us to send "relevant" medical records, which makes me conclude that an IW has the right to object to certain medicals as being non-relevant.

So, internally our offices have to run a calendar of the QME appointments, but then a separate calendar to alert us to serve records before the eval. If we calendar 20 days prior to the eval to serve the records, that means they will be sent the day of the eval. So we calendar about 40 days prior to the eval so you can get them 2 weeks prior to the eval. If we go any longer than that, the odds of the QME office misplacing them or losing them before the eval goes up dramatically. So there is this sweet spot to serve records around 45 days prior to the eval. So then there is a third date 2 weeks before the eval for the records to be sent.

Of course we need copies of the records made. So there's a forth date for the staff to remember to put in the copy order to have the copies ready by the 45th day to serve to the IW prior to the eval.

This of course assumes everything goes smooth and we actually have 2 months notice before an eval. And then an attorney realizes there are 5 evals coming up within the same week-and-a-half and all the cover letters need to be done and all the records packaged up and he/she has back-to-back trials and depositions during that 40-day target to send everything out and.....

Well, ish happens! Can you give me a little violin?

[cmunday]

Vampire

I appreciate the insight into "the other side". We are all under pressures at times that others don't see. I allow what I think is ample time to get reports done (and am very proud that I have not missed a 30 day deadline in several years) but sometimes it's 8 hours for record review and report prep and then sometimes 5 cases in a row come with multiple boxes of records and I have 5 to do that require 12-20 hours of record review and report prep (I've actually had cover letters where the attorneys said they recognized the case was extremely complex and to take the necessary time to do the job correctly and "don't worry" about the 30 day deadline). There's a fine line between taking responsibility (as in my office misplaced that supplemental request and I apologize for the delay) versus making excuses. Over time with repeat contacts I think most of us learn who leans in which direction. I suspect you know which Doctors are reasonably responsive and which always have an excuse for their lack of timeliness. I think it helps if we all have the attitude that we are working together to fairly and expeditiously resolve a case. I teach wannabe evaluators to look at the role of the AME/QME as being in service to the parties in trying to resolve often complex issues. We tend to think of the process being adversarial even as an AME - that often ends up being counterproductive.

Sorry but I'm much more of an electric guitar guy than a violin guy .