In this issue Medical Marijuana and Arizona Workers ...€¦ · Medical Marijuana continued from...

T H E O F F I C I A L P U B L I C AT I O N O F A W C C A , I N C .

In this issue

Arizona voters passed the Arizona Medical

Marijuana Act (“AMMA”) in November 2010,

and since then, the Arizona Department of

Health Services (“ADHS”) has developed a

medical marijuana program to administer

the certification of qualifying patients and

license the dispensaries. The first dispensary

was opened in December 2012, after

Maricopa County Attorney Bill Montgomery

unsuccessfully challenged ADHS’s authority

to license marijuana dispensaries. Mr.

Montgomery has appealed the court’s ruling

and continues to argue that the AMMA is in

violation of the federal Controlled Substances

Act.

In the meantime, however, the AMMA is

in effect and patients who hold a valid

medical marijuana card are protected from

state prosecution for using marijuana. This

presents concerns for employers, carriers,

and third-party administrators in the workers’

compensation industry, so my intent with this

article is to inform you about how the AMMA

works and what it allows and disallows.

The Construct of the Statute

The purpose of AMMA is to protect seriously

ill patients from state prosecution for using

medical marijuana under their doctor’s

recommendation. It allows a “qualifying

patient” to possess up to 2.5 ounces of

usable marijuana or 12 marijuana plants.

ADHS only issues medical marijuana cards

to “qualifying patients,” and in order to be

deemed a qualifying patient, the individual

must suffer from a “debilitating medical

condition.”

The statute defines a “debilitating medical

condition” as follows:

A. Cancer, glaucoma, HIV+, AIDS,

hepatitis C, ALS, Chrohn’s disease,

Alzheimer’s, or the treatment of these

conditions;

B. A chronic or debilitating disease,

medical condition, or its treatment

that produces:

a. Cachexia or wasting syndrome

b. Severe and chronic pain

c. Severe nausea

d. Seizures

e. Severe and persistent muscle

spasms

The physician that prescribes marijuana

must make or confirm the diagnosis of

a debilitating medical condition, and

must examine the patient regarding the

debilitating medical condition within 90 days

Medical Marijuana and Arizona Workers’ Compensation

Continued on page 2…

Medical Marijuana and

Arizona Workers’

Compensation ......................

Let the AWCCA Job Referral

Line Work for YOU!… ........... Page 4

State Legislators Across U.S.

Reform in Dispensing

of Opioids… ........................ Page 5

ICA to Hold Fee Schedule

Hearing ................................ Page 5

NCCI Study Analysis: Effects

of an Aging Workforce .......... Page 6

Red flags in back pain

When to worry and

what to do ..........................Page 10

Winter/Spring 2013

By Rachel Brozina, Esq., Lester & Norton

www.AWCCA.org: Your L ink to the Ar izona Work Comp Indust r y!

If you’re looking for information on AWCCA membership, upcoming events, past issues of The Examiner, links to AWCCA sponsor websites or contact information for

AWCCA Executive Committee Members, be sure to visit www.awcca.org.

For quick access to the most current AWCCA news, remember to bookmark www.awcca.org in your internet browser.

… Medical Marijuana continued from page 1

of prescribing marijuana. The physician

must also review the patient’s medical

records for the past 12 months to evaluate

the patient’s responses to other forms of

treatment. Finally, the physician must fill

out a document to attest that the patient

is likely to receive a therapeutic benefit

to alleviate the effects of the debilitating

condition.

ADHS will permit one dispensary for every

10 pharmacies permitted each year. The

dispensaries must be operated as not-for-

profit entities, and must contract with an

Arizona-licensed physician to act as its

medical director. ADHS does not provide

a list of dispensaries to the public; rather,

it will provide a list to a qualifying patient

when it assigns the person a medical

marijuana card.

Impact on Employers

The AMMA precludes Arizona employers

from discriminating against marijuana

cardholders in hiring, termination, or

imposing employment conditions.

However, if an employer is at risk for

losing benefits under federal law, it is not

precluded from discriminatory practices.

Furthermore, employers cannot penalize

a cardholding employee for a positive

drug test, unless the employee used,

possessed, or was impaired by marijuana

on the employer’s premises or during

the employee’s working hours. In other

words, the mere fact that a cardholding

employee’s drug test is positive for

marijuana metabolite is not sufficient for

the employer to penalize the employee.

In the absence of evidence that the

employee used or possessed the

marijuana on the premises or during

working hours, there must be evidence

that the employee was impaired by

marijuana. Because our statute is relatively

new, we have not had any cases that

lend us guidance as to what constitutes

“impairment.”

ADHS has an online verification system

that employers may access to verify

whether an employee’s marijuana card

is valid. However, employers’ access to

the system is limited to verifying a card

that the employee produces; employers

cannot access the system to check

whether it is employing any cardholders.

Impact on Workers’ Compensation

Benefits

It has already been established that a

workers’ compensation claim cannot

be denied solely on the basis that an

injured worker has marijuana (or alcohol

or other drugs) in his/her system. As long

as the necessary risks and dangers of the

employment cause or contribute to the

injury, the claim is compensable even

in the face of a positive drug test. (See

Grammatico v. Industrial Comm’n, 117

P.3d 786 (2005)).

If an injured worker is prescribed

marijuana for an industrial injury, does the

carrier have to pay for or reimburse the

injured worker for the marijuana? Because

our statute is relatively new, we have not

had an opportunity to see how this plays

out in our workers’ compensation arena.

However, our neighbor to the west recently

took this issue up.


In Cockrell v. Farmers Insurance and

Liberty Mutual Insurance Company,

an injured worker sought to have the

California Workers’ Compensation Judge

order the carrier to reimburse him for

the costs associated with purchasing

marijuana that had been prescribed by

a physician. The evidence showed that

the injured worker had complications with

using Oxycontin, so the marijuana was

intended to replace that medication.

The judge awarded the injured worker

reimbursement for the purchase of

marijuana, and the carrier was ordered

to pay the value of the medication that

the marijuana was intended to replace

(Oxycontin). The carrier appealed the

judge’s decision, citing to a provision in

California’s medical marijuana statute

that provided that the statute does “not

require a governmental, private, or any

other health insurance provider or heath

care service plan to be liable for any

claim for reimbursement for the medical

use of marijuana.” (See Health and Safety

Code Section 11362.785(d)). The Appeals

Board remanded the matter back to

the lower level for the judge to make a

determination as to how that provision

applies to the case. Thus far, a decision

on this point has not been published.

The AMMA includes a specific provision

that is very similar to the California

provision cited above. Our statute

indicates that it does not require private

or public health insurers to reimburse a

patient for the costs associated with the

use of marijuana. Although our statute

does not require the carrier to pay for or

reimburse for the cost of marijuana, it does

not necessarily preclude an injured worker

from seeking reimbursement in a workers’

compensation matter because the use of

marijuana could be deemed a medical

benefit under our workers’ compensation

statute. It is worth noting that federal law

(the Controlled Substances Act) does not

recognize the medical use of marijuana

and it prohibits the cultivation, sale,

distribution, and possession of marijuana

under any circumstance. A pertinent

question is whether our Administrative Law

Judges interpret the interplay among the

Controlled Substances Act, the Arizona

Medical Marijuana Act, and the Arizona

Workers’ Compensation Law to permit

our judges to order a carrier to pay for

… Medical Marijuana continued from page 2

medical marijuana. In the meantime,

SCF Arizona has publicly announced its

position on this issue and it will not cover

the cost or reimburse injured workers for

the use of medical marijuana.

The impact of AMMA on our workers’

compensation system is yet to be

determined, but with over 35,000 medical

marijuana cards issued and a handful

of dispensaries open for business, it will

serve us all well to be aware of potential

complications.

The Arizona Department of Health

Services has an excellent website for

the Arizona Medical Marijuana Program.

You can access it at www.azdhs.gov/

medicalmarijuana/

For further information, please contact

Rachel Brozina at 602-357-1162, or via

e-mail at: [email protected]

AWCCA Mission Statement:

The purpose and objectives of this

association shall be to promote

the general welfare of its members

by developing close relationships

among those engaged in

the handling of workers’

compensation claims; to promote

cooperation by mutual exchange

of experiences and information

and discussions thereon and, to

educate its members.

The Examiner is published

quarterly by AWCCA, Inc., P.O.

Box 44941, Phoenix AZ , 85064-

4941. All articles appearing in this

publication contain the opinions

of the authors and not necessarily

the opinions of AWCCA, Inc., its

officers or editors. AWCCA, Inc.

encourages the submission of

new ads and articles, subject to

editing. Signed letters to the editor

are welcome. AWCCA, Inc. seeks

to provide a forum for the free

exchange of ideas and opinions.

Neither Snow, Nor Rain…

Yes--you can still contact AWCCA the “old school” way, via the U.S. Postal Service!

All U.S. mail correspondence including checks, membership applications, hard copies of Letters to the Editor of The Examiner and other items addressed to the organization or its officers should be sent to:

AWCCA, Inc.P.O. Box 44941 • Phoenix, AZ 85064-4941

You’re a claim manager whose senior

examiner just quit to compete in the

new reality TV show “The Voice…of

Workers’ Compensation”. Or, you’re

a doctor whose office manager just

resigned to put together an exploratory

committee for her 2016 presidential

campaign.

How are you going to fill those

positions?

Simple: contact AWCCA’s new Job

Referral Coordinator Linda Barton

to post your open positions on the

AWCCA’s Job Referral Line.

Whether you’re an employer looking

for the perfect new hire, or an

adjuster, private investigator or voc

rehab consultant looking for a new

employment opportunity in the work

comp industry, AWCCA may be able

to help.

As a no-cost service to employers in

the Arizona workers’ compensation

community, companies looking to hire

claims adjusters, supervisors, managers

or support staff can post job openings

on the AWCCA website. Additionally,

individuals seeking positions as

adjusters, supervisors, managers or

support staff employees can post

short professional bios on the AWCCA

website. Further, the Job Referral

Line can also be used by medical

professionals, vocational rehabilitation

companies, private investigators, IME

or DME companies or any other

insurance-related organization that

has a job opening. And, industry

professionals looking for employment

in any insurance-related field can post

their bios using the AWCCA’s website*.

The AWCCA offers an excellent,

cost-free way to match up qualified

employees with ANY job opportunities

in the Arizona workers’ compensation

industry.

To post an job opening or an

employment bio, or to learn more

about the AWCCA’s Job Referral

Program, contact AWCCA Job Referral

Coordinator Linda Barton via e-mail

at [email protected].

*Note: The AWCCA Job Referral Line is a service provided for individuals seeking employment with an organization in the Arizona workers’ compensation industry. It is not a forum for vendors to advertise their qualifications, goods or services. AWCCA reserves the right to screen, edit or reject all Job Referral Line submissions based on this criteria.

Let the AWCCA Job Referral Line Work for YOU!

State Legislators Across U.S. Reform in Dispensing of Opioids

The National Conference of Insurance

Legislators (NCOIL) agreed at its Spring

Meeting to develop best practice

strategies for states debating possible

reforms to curb opiod abuse. NCOIL’s

move to develop guidelines instead of

model legislation came after discussion

at a special session in Washington D.C.

NCOIL is a national organization of state

legislators whose main public policy

interests are insurance legislation and

regulation. Most NCOIL legislators either

chair or are members of committees

responsible for insurance legislation

within their respective state legislatures.

Arizona is a general member, but not a

contributing member of NCOIL.

Accord ing to NCOIL Workers ’

Compensation Committee Chairman

Representative Bill Botzow of Vermont,

“opioid abuse is a growing epidemic

that reaches across state lines and may

be impossible to address with any single

approach. Because states are in different

places in their efforts to address opioid

abuse, the appropriate role for NCOIL is to

lay out guidelines for states to consider as

they develop their state-specific reforms.”

In light of legislative discussions at the

special meeting, the proposed best

practices will likely address a number of

issues including prescribing practices,

funding, drug monitoring program

reforms, and data sharing. Draft

guidelines will be considered at NCOIL’s

July 11 Summer Meeting in Philadelphia,

Pennsylvania.

The Industrial Commission of

Arizona (ICA) will hold its 2013

Fee Schedule hearing on April

17, 2013 at 10:00 a.m. in the first

floor auditorium of the ICA offices,

located at 800 W. Washington Street

in Phoenix. The Commissioners

will listen to public comments in

addition to considering a report

prepared by Commission staff as a

preliminary document created as a

foundation for discussions during

the hearing process. The document

can be viewed online at: http://www.

ica.state.az.us/Director/DIR_2013_

FS_preliminaries.aspx.

ICA to Hold Fee Schedule

Hearing

NCCI Study Analysis: Effects of an Aging Workforce

The National Council on Compensation

Insurance (NCCI), a U.S. insurance rating

and data collection bureau specializing

in workers’ compensation, recently

conducted a study to address widespread

industry concern over the impact of the

“baby boomer” generation postponing

retirement, thus aging the workforce and

creating the potential for adverse impact

on workers’ compensation loss costs.

The study, which indeed confirms the labor

force’s share of older workers is increasing,

analyzes frequency and severity across

multiple age groups, identifies factors

accounting for the differences in severity

between each age group, and compares

the combined effects of frequency and

severity for each age group to determine

costs per worker.

Share of Older Workers Increasing

Study data shows workers over 45 years

old account for an increasing share of

the U.S. workforce. This group, commonly

referred to as “baby boomers”, was

divided into two separate groups for data

collection purposes. Cumulatively, the

45-and-older share increased from 34

percent of the workforce in 2000 to 42

percent in 2010. Separately, the share

of workers 65 and older is growing but

remains small, increasing from about 3

percent of the total workforce in 2000 to

just fewer than 5 percent in 2010, while the

45- to 54-year-old group has continued to

increase modestly. Notably, researchers

conclude “if the shares of older workers

are increasing, the shares of younger

workers must be decreasing. This is most

evident for workers 35 to 44.”


By Shala Morley, Special for The Examiner

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Frequency Across Different Age Groups

NCCI researchers note two key findings

from their frequency analysis. First, upon

analyzing occurrence of injury of full-time

(40 hours per week) workers from 1994 to

2009, a decline in frequency has occurred

for all age groups; second, the marked

differences among age groups in the

early 1990s had largely disappeared by

2009. In 1994, the incidence rate for 20- to

24-year- olds was 300 per 10,000 full-time

equivalent workers, while the rate for the

55- to 64-year-old group was 200 injuries

per 10,000. In 2009, although reduced,

those numbers were comparable at 97

and 93 injuries per 10,000, respectively.

In terms of frequency relative to older

workers, the injury rate for workers aged

55 to 64 was 16 percent lower than

frequency for all workers in 1994, but 1

percent higher in 2009. These findings

prompted researchers to conclude “the

differences in injury frequency among

age groups clearly have narrowed.”

Researchers offer that one likely question

is whether the narrowing in frequency of

injury is due to a change in the types of

jobs held by younger workers throughout

the study period. That question was

addressed by analyzing the days away

from work across all age groups and

occupations; all showed very similar

results. Researchers concluded while the

occupational mix may have changed

among age groups, all jobs are much

safer and do not affect frequency of

injury.

… NCCI Study Analysis: continued from page 6



Severity Across Age Groups

The study analyzed both indemnity and

medical severity. Key findings are as

follows:

• Severity has been increasing over

time for all age groups and typically

is higher for the older age bracket.

• Relativedifferencesinmedicalseverity

by age have continued, but have

somewhat narrowed. Medical severity

for the 55- to 64-year-old group was

25 percent above average in 1995

and 17 percent above average in

2008; meanwhile, medical severity for

the 20- to 24-year-old group was 31

percent below average in 1995 and

23 percent below average in 2008.

• Overall, data shows that both

indemnity and medical severity

have exhibited steady increases over

time, with severity for older claimants

costing more.

• Medical costs were more than 50

percent higher for older workers. From

1996 to 2007, the average medical

cost for claims severe enough to

warrant temporary indemnity for 20-

to 34-year-olds was $5,073; 45- to

64-year-olds averaged $7,649, a 51

percent difference.

• Differencesinleadingtypesofinjuries

are a major factor in differences in

severity by age. Older workers tend

to have more rotator cuff and knee

injuries, while younger workers are

most often treated for back and ankle

sprains.

• Ontheindemnityside,higherwages

are a key factor leading to higher

claim costs for older workers; in terms

of medical costs, more treatments

per claim are a factor.


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Combined Effects (Costs per Worker)

When researchers took into account both

frequency and severity data to determine

costs per worker, the data showed

that when differences in wages were

accounted for, total cost differences by

age shrink across the board.

The overall conclusion of the study was

that the “baby boomer” generation

does not necessarily pose an adverse

impact on the work comp industry, as all

groups of workers aged 35 to 64 showed

similar costs per worker. From a workers’

compensation perspective, the higher

costs are offset by the higher premium

due to higher wages of older workers.


NCCI concludes, “Overall, the findings

can be viewed as reassuring, in that an

aging workforce may have less negative

impact on loss costs than originally

thought.”

The complete report can be accessed at

www.ncci.com.

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INTERPRETING

Red Flags in Back PainWhen to Worry and What to Do

By Issada Thongtrangan, M.D. Spine Specialist, Valley Orthopedics

Most back pain is benign but some

isn’t. Five or six times a year, I treat

a patient who’s progressed from

backache to paraplegia over a few

months, via discitis or cancer or

cord/cauda equina compression. My

experience is not unique; these issues

are recognized around the world and

we will review some “red flags” which

will help protect the patients from

delayed treatment.

INCIDENCE

According to the U.S. Bureau of

Labor Statistics, there were 4.2

million nonfatal occupational injuries

and illnesses reported by private

industries in 2005. Sprains and

strains accounted for approximately

42 percent of injuries and illnesses

requiring time away from work.

The body part most often involved

in these injuries was the trunk, and

63 percent of injuries to the trunk

involved the spine. As many as 90

percent of persons with occupational

nonspecific low back pain are able to

return to work in a relatively short

period of time; however some aren’t

and need more attention especially

those who have “red flags”. As long

as no “red flags” exist, the patient

should be encouraged to remain

as active as possible, minimize bed

rest, use ice or heat compresses,

take anti-inflammatory or analgesic

medications if desired, participate in


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… Red flags in back pain continued from page 10


home exercises, and return to work as

soon as possible.

PATHOLOGY AND NATURAL

HISTORY

Imaging pathology is very common

and usually false (positive), meaning

that it’s not indicative of a source

of symptoms. Odds are 50/50

that a claimant who was lumbar-

asymptomatic before an on-the-job

injury will have major degenerative

abnormalities in any imaging study

from x-rays to MRI, that don’t hurt

one bit. That’s why we’ve all been

taught that acute spine imaging is

useless and generally it is. That

bone spur or degenerated disc or

spondylolisthesis seen in an injured

worker’s x-ray was almost certainly

there last week too, when the

claimant felt fine!

Even acute structural spine disease

gets better in most cases by ‘hand of

God,’ and time. Acute sciatica from

disc hernia resolves within weeks

in 60-75 percent of cases. Seventy

percent of acute symptoms from

spinal stenosis or spondylolisthesis

resolve within a few months, and

even insufficiency fractures heal

70 percent of the time to become

asymptomatic within three to four

months.

COST

Spine care is costly, but we know

that a small minority (10 percent) of

patients who have recurrent or chronic

pain generate 90 percent of the cost.

Most of these have nonspecific pain,

usually major secondary gain motives,

and a big behavioral component

to their pain; and honestly most of

the treatment applied here has been

shown to be ineffective. The elite,

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evidence-based healthcare flagship

Cochrane Collaboration’s meta-

analysis website (www.cochrane.

org) uniformly reports little long-

term benefit from virtually all back

care treatments with the probable

exception of well-done cognitive

behavioral therapy (CBT) — which

doesn’t mean that every chronic back

pain patient is a hypochondriac;

it just means that many patients

benefit from therapeutic assistance

with understanding and coping

mechanisms.

So, most cases get better without

intervention, but some don’t. There

are several very real structural spine

pathologies that can benefit greatly

from acute diagnosis and care.

Things like discitis and metastatic

lesions and chronic cauda equina

syndrome are population-rare,

but all too common in a referral

spine practice like mine, and the

history is almost always one of

tragically delayed diagnosis and

compromised outcomes — including

paraplegia and death — from missed

opportunities for early care. There

are relatively few spine surgeons out

there but many primary caregivers, so

the burden of screening naturally falls

on general and family practitioners,

or in the case of the injured worker, it

can fall on the urgent care physician.

A lot can be achieved by remembering

the usual profile of benign back pain,

and also by knowing and recognizing

some red flags for low back pain,

which can be identified by asking just

a few simple questions.

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THE PROFILE OF BENIGN

BACK PAIN

Benign chronic or recurrent back pain

generally presents around the 40s,

most often in the lumbar region of

males who do heavy physical work and

who have a history of work injuries

or other trauma. The pain episodes

are generally of stable or consistent

intensity; it gets better with rest/lying

down (it’s “mechanical”); there are

no neurological or constitutional

symptoms; and while there may be

work and activities disability, there is

almost never a locomotor disability.

THE RED FLAGS

So, one red flag is a history of onset

at age either > 50 or < 20 years. A

second is the absence of a trauma/

injuries history (i.e. the spontaneous

onset of pain). The third red flag is

pain located outside the low back

region where cancers and fractures

and infections are actually quite rare.

A history of significant trauma should

be a fourth red flag for fracture, but

too often isn’t.

Any patient with a history of

cancer (there’s red flag number five)

who presents with new-onset low

back pain should be considered as

metastatic until proven otherwise.

And anybody with a history or

high risk of immunosuppression —

identified AIDS or HIV, recreational

needle drug users, taking steroids or

immunosuppressants — has a discitis

until proven otherwise (that’s red flag

number six).

Another red flag frequently

missed (number seven) is history

of neurological symptoms, like

numbness/tingling or claudication

(i.e. “I can only walk a short distance

or time before my back pain forces me

to stop”). Physicians shouldn’t depend

on concrete neurological findings on

physical exam — such symptoms are

often delayed and by then, it’s often

too late. The history is enough to alert

an examining physician, but he or she

must ask for it. Incredibly, just about

every year I see a patient who gets

to the point where they’re crawling

around the house on hands and knees

from pain, but because they don’t

have a weak ankle or numb toe, they

don’t get referred.

Constitutionality is red flag number

eight — the backache patient who is

losing weight or having fevers should

be taken very seriously indeed. Night

pain is less of a concern. We used to

think that pain at night was a red flag

but it’s been conclusively shown that’s

not so. Pain that isn’t mechanical,

that persists even when lying down,

can be red flag number nine.

The final red flag, number ten, is a

history of rapidly escalating pain.

These patients with chronic benign

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• On-‐site, Field Case Management and Telephonic Case Management • Vocational Rehabilitation • Nurse Liability Claim Reviews

CorVel’s PPO Network

• Exclusive access to Arizona’s Blue Cross Blue Shield Network • Access to a national network of more than 500,000 providers

MedCheck – Medical Bill Review Services • Fee Schedule, Usual & Customary • Bill Review for Workers’ Compensation,

Auto, Liability, and Group Programs • PPO Discounting/Re-‐pricing • Utilization Review Services • Check Writing Services • Extensive and transparent reporting

capabilities CareIQ – IME Program

• Board Certified Physicians • Wide Range of Medical Specialties • Peer Reviews • Record Reviews • Discounted IME Rates

CareIQ – Ancillary Services

• Discounted Durable Medical Equipment • Imaging Services • Transportation • Translation



back pain often have a slowly

escalating analgesic requirement

as their livers respond to the stress

challenge of metabolizing their

prescribed drugs and they become

habituated. But that evolves over

months and years. When injured

workers need more and more

drugs daily or weekly, there’s often

something very bad going on.

WHAT TREATING DOCTORS

SHOULD ASK:

A screening can be done in just a few

seconds.

How old are you? (1st red flag)

Where’s the pain? (3rd)

How did it start, with no injury (2nd)

or serious trauma? (4th)

Any history of cancer (5th), immune

suppression or recreational drug

use? (6th)

Neurological symptoms? (7th)

Fever or weight loss? (8th)

Does it get better when you lie down,

or not? (9th)

Is it pretty stable in intensity or is it

worse than it was last week? (10th)

WHAT IF SCREENING IS

POSITIVE?

As long as no “red flags” exist, an

injured worker should be encouraged

to remain as active as possible,

CareMeridian.com

Phoenix Scottsdale

CareMeridian’s 31-bed facility in Phoenix offers a 1:4 staff-to-patient ration and individual care plans to support individuals with brain and spinal cord injuries, as well as medically and orthopedically complex needs.

CareMeridian Phoenix has received accreditation from the Joint Commission on Accreditation of Healthcare.

For more information, contact Karen Christiana, LPN, Regional Director of Business Development, 480.254.6227

5301 E. Thomas Road • Phoenix, AZ 6512 E. Ludlow Drive • Scottsdale, AZCareMeridian Scottsdale provides supported living services to participants who have been discharged from a hospital or other more intensive facility with a brain or spinal cord injury, but still face challenges as they work towards increased independence and community integration.

CareMeridian Scottsdale is now accredited by CARF, the Commission on Accreditation of Rehabilitation Facilities.

Comprehensive treatment and support for people of all ages with brain, spinal cord and other life-altering injuries and medically-complex illnesses

Post-acute Care and Rehabilitation Options for Every Stage of Recovery


minimize bed rest, use ice or heat

compresses, take anti-inflammatory

or analgesic medications if desired,

participate in home exercises, and

return to work as soon as possible.

Patients whose answers raise red

flags should be referred immediately

to a qualified spine surgeon and/or

appropriate subspecialties. However,

some of the “red flags” might indicate

a pre-existing condition and not a

work-related injury. By understanding

this we can channel the patients to

the right doctor very quickly with less

confusion in regard to “work-related

injury” vs. “pre-existing injury”

CONCLUSION

Keep all these “red flags” in mind

because all injured workers with back

pain are not the same. We should

identify these “red flags” and refer

as indicated to prevent a disastrous

consequence. Some of the “red flags”

indicate work-related injury but

some don’t. This is very important

to differentiate industrial-injury-

related conditions from pre-existing

conditions. Be sure the physicians

you’re relying upon pay attention to

detail.

For information on how to contact

Dr. Thongtrangan, go to: www.

arizonaspinedoctor.com or www.

valleyorthoaz.com

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