Re: IME discussion - long post

[Guest guest]

Great perspective Minga.

Ron Grice, DC

Albany, OR

On 3/2/2012 9:15 AM, AboWoman@... wrote:

Everyone,

After listening to the entire testimony at the IME

House Health Committee meeting,

I feel compelled to speak about how our board works,

from personal experience. For those who are new to

this list, I served 6 yrs on the OBCE, with more than

4 yrs as board president.

When a ruling is made that revokes a doctor's license,

it's not just the board members that make this

decision. Although the seated board is responsible for

the final decision, the decision in all revocation

cases and all the IME cases I was involved in;

included months of investigation and review by 12-20

peers who review the material - plus an assistant

attorney general, lay public members (2); and a review

of background cases of similar nature. Some of those

cases could take 6-12 months of review and many more

meetings than the standard board meetings. There are

meetings with board members and Peer Review, by Peer

Review alone, Meetings by board members out of state

to gather information from DC boards across the nation

to see how they handle similar cases. Always

anonymous, never divulging any doctor's name being

investigated. When a member of the board or

sub-committees are involved in a complaint, the board

must send the complaint to an outside source.

Otherwise, there is a conflict of interest or bias

connection that can negate the rulings. This is

common practice. There are many reasons for

this. Some of which I do plan to review in the

upcoming sexual boundary course (but only as it

relates to that type of case).

That being said, there are also times when a board may

choose to meet with a doctor and other times where

this is denied. I won't speculate on recent reasoning,

but can only relate come cases where it was denied. In

one case, we'd allowed a meeting; in spite of the

doctor's verbal interactions; which were passionately

angry and argumentative. The evidence was sound

against the doctor according to over 15 peers and the

AG office, yet we did vote, with hesitancy, to allow

an audience. I had my hand squeezed so hard by the doc

that it bruised the entire snuff box because the doc

was a large, muscular person who squeezed as he looked

into my eyes, gripping longer than a normal handshake;

seemingly as a challenge. The hand shake hurt. I

couldn't hold a pen for the rest of the day. By the

evening a bruise appeared, covering the entire snuff

box. It was hard for me to adjust for the better part

of a week. Did he mean to hurt me? Could I prove it?

Or would he just say, I didn't realize my own strength

and was only giving a professional and firm handshake?

On another instance, I feared for my safety at my own

home following a veiled threat. I would not vote to

allow a doctor making threats to have a face to face

meeting, altho I could be over-ruled by a majority

rule. No one member controls the board.

I do not personally feel that, in this case, there

would have been any fear of board member safety.

I just want those who've never served on a board, to

realize there are reasons the board chooses not to

grant an audience. I won't even try to speculate on

anything else in the case we're discussing. I see both

sides. I feel the unprofessional comments on this

list, towards IME peers are not productive. Foul

language whether directed at a colleague, to an

insurance company or other entity, on the list,

whether metaphorical or not, is not productive and can

be perceived as mean-spirited. I also understand that

a majority of DCs in the field who've spoken to me or

reported here, receive negative feedback and

terminated care with IME reviews. Medical doctors in

the community where I work, also report a

preponderance of negative IME reviews on their patient

care. It's not just our profession. I don't know what

the answers are. This email is not to speculate on

that issue. Just to say that our comments should be

more professional and without cursing.

Another thing to consider is the aspect of being fair

in granting an OBCE audience to all who face

violations. If the board grants an audience to the

doctor, to be fair, they should call the complainant

and offer equal time or they could also be accused of

bias.

In almost all cases, the complainant doesn't appear

before the OBCE either. I would safely say that 99.9%

of the cases I sat on the board for did not have a

face to face meeting with the complainant.The board

reads the complaint and listens to the investigator's

report, reviews copious files, including any Peer

Review reports. The Peer Review Committee (PRC)

reports are usually given directly by a PRC member,

who stays and undergoes rigorous questioning by the

board.

It's the investigator who meets with most

complainants and doctors. If there is a bill requiring

the OBCE to grant / offer an audience 100% of the

time; it will require an increase in workload for all

staff and board members. There are 15-20 cases per

meeting. Meetings last an entire day to cover that

case load. I would guess it could double expenses and

time to resolve cases, to grant 2-sided interviews.

I see 's Burke's point in explaining where he

took this grievance, even if I may not have agreed

with all the testimony presented against the OBCE.

I also see the board's point in not

granting an audience to 100% of all complainants and

doctors. I have no knowledge of the case or it's

specifics. I do, however, feel that

perhaps we should all re-visit the listserv rules

and see if we need to add to them. I

agree with Dr. in his entire interpretation,

including that no letter of the rule was broken.

One last point. In 2003, my first year

on the board, the question of IME doctor patient

relationship was discussed at great length in public

session. Burke testified at that meeting. If

memory serves me correctly, he was the only IME

doctor who testified that there IS a doctor patient

relationship and that the IME doctor should be

held to the same standards as we hold all DCs to. IT

took a lot of guts for him to do that, in my opinion.

He stood alone. His testimony, ultimately assisted the

OBCE in creating language that holds Chiropractic-IME

docs, to the same standards as all DCs.

Minga Guerrero DC

abowoman@...

[Guest guest]

Thank you for this explanation. I agree that divisiveness around this issue is not productive; we can do better. It's self-evident that we must all do our best when charting, as part of our responsibilities to the patient and to the profession. Now, the whole IME thing is confusing and seems adversarial. I've known Dr. Burke for years now and trust him to act according to his highest values. But this must be a matter of checks and balances that can be simply understood by all stakeholders.To follow up, here are the elements of the "Code of Ethics" AMA model that Mark Studin writes about in the Feb issue of "The American Chiropractor." (I assume the whole article will be online before too long . . . .) We can use it as a starting place."I strongly suggest that every state and national organization adopt a version of the following language as a code of ethics standard for all f their members:Chiropractic Code of EthicsA. Conduct of Independent Examiners (1) Evaluate objectively the patient's health or disability. In order to maintain objectivity, independent chiropractic/medical evaluations should not be influenced by the preferences of the patient-employee, employer, or insurance company when making a diagnosis during any type of independent chiropractic/medical examination, including, but not limited to, sequellae from auto accidents, on-the-job injuries and pre-employment physicals. (2) Maintain patient confidentiality ass outlined by the State of (add your state). (3) Disclose fully potential or perceived conflicts of interest. The doctor of chiropractic should inform the patient about the relationship between himself or herself and the third party as well as the fact that he or she is acting as an agent of that entity. This should be done at the outset of the examination, before health information is gathered from the examinee. Before the doctor of chiropractic proceeds with the exam, he or she should ensure to the extent possible that the patient understands the doctor of chiropractic's unaltered ethical obligations, as well as the differences that exist between the treating doctor's role and that of the independent examiner. (4) The examining doctor shall: 1. Include all pertinent and related diagnostic findings and test results in his/her report(s). 2. Consider all pertinent and related diagnostic findings and test results when rendering a diagnostic conclusion. 3. Include complete pertinent and related research, when applicable, in rendering a conclusion. 4. Perform examinations to the same standard as he/she does for all other patients with similar diagnoses. 5. Note in his/her report(s) the absence of any diagnostic or test findings when he/she does not have possession of said reports or results.Adopting these standards is taking the first step towards leveling the playing field to help ensure that our patients get the care they need and that doctors receive the payments they are entitled to for rendering necessary services. Sears, DC, IAYT1218 NW 21st AvePortland, Oregon 97209v: 503-225-0255f: 503-525-6902www.docbones.comOn Mar 2, 2012, at 9:15 AM, AboWoman@... wrote: Everyone, After listening to the entire testimony at the IME House Health Committee meeting, I feel compelled to speak about how our board works, from personal experience. For those who are new to this list, I served 6 yrs on the OBCE, with more than 4 yrs as board president. When a ruling is made that revokes a doctor's license, it's not just the board members that make this decision. Although the seated board is responsible for the final decision, the decision in all revocation cases and all the IME cases I was involved in; included months of investigation and review by 12-20 peers who review the material - plus an assistant attorney general, lay public members (2); and a review of background cases of similar nature. Some of those cases could take 6-12 months of review and many more meetings than the standard board meetings. There are meetings with board members and Peer Review, by Peer Review alone, Meetings by board members out of state to gather information from DC boards across the nation to see how they handle similar cases. Always anonymous, never divulging any doctor's name being investigated. When a member of the board or sub-committees are involved in a complaint, the board must send the complaint to an outside source. Otherwise, there is a conflict of interest or bias connection that can negate the rulings. This is common practice. There are many reasons for this. Some of which I do plan to review in the upcoming sexual boundary course (but only as it relates to that type of case). That being said, there are also times when a board may choose to meet with a doctor and other times where this is denied. I won't speculate on recent reasoning, but can only relate come cases where it was denied. In one case, we'd allowed a meeting; in spite of the doctor's verbal interactions; which were passionately angry and argumentative. The evidence was sound against the doctor according to over 15 peers and the AG office, yet we did vote, with hesitancy, to allow an audience. I had my hand squeezed so hard by the doc that it bruised the entire snuff box because the doc was a large, muscular person who squeezed as he looked into my eyes, gripping longer than a normal handshake; seemingly as a challenge. The hand shake hurt. I couldn't hold a pen for the rest of the day. By the evening a bruise appeared, covering the entire snuff box. It was hard for me to adjust for the better part of a week. Did he mean to hurt me? Could I prove it? Or would he just say, I didn't realize my own strength and was only giving a professional and firm handshake? On another instance, I feared for my safety at my own home following a veiled threat. I would not vote to allow a doctor making threats to have a face to face meeting, altho I could be over-ruled by a majority rule. No one member controls the board. I do not personally feel that, in this case, there would have been any fear of board member safety. I just want those who've never served on a board, to realize there are reasons the board chooses not to grant an audience. I won't even try to speculate on anything else in the case we're discussing. I see both sides. I feel the unprofessional comments on this list, towards IME peers are not productive. Foul language whether directed at a colleague, to an insurance company or other entity, on the list, whether metaphorical or not, is not productive and can be perceived as mean-spirited. I also understand that a majority of DCs in the field who've spoken to me or reported here, receive negative feedback and terminated care with IME reviews. Medical doctors in the community where I work, also report a preponderance of negative IME reviews on their patient care. It's not just our profession. I don't know what the answers are. This email is not to speculate on that issue. Just to say that our comments should be more professional and without cursing. Another thing to consider is the aspect of being fair in granting an OBCE audience to all who face violations. If the board grants an audience to the doctor, to be fair, they should call the complainant and offer equal time or they could also be accused of bias. In almost all cases, the complainant doesn't appear before the OBCE either. I would safely say that 99.9% of the cases I sat on the board for did not have a face to face meeting with the complainant.The board reads the complaint and listens to the investigator's report, reviews copious files, including any Peer Review reports. The Peer Review Committee (PRC) reports are usually given directly by a PRC member, who stays and undergoes rigorous questioning by the board. It's the investigator who meets with most complainants and doctors. If there is a bill requiring the OBCE to grant / offer an audience 100% of the time; it will require an increase in workload for all staff and board members. There are 15-20 cases per meeting. Meetings last an entire day to cover that case load. I would guess it could double expenses and time to resolve cases, to grant 2-sided interviews. I see 's Burke's point in explaining where he took this grievance, even if I may not have agreed with all the testimony presented against the OBCE. I also see the board's point in not granting an audience to 100% of all complainants and doctors. I have no knowledge of the case or it's specifics. I do, however, feel that perhaps we should all re-visit the listserv rules and see if we need to add to them. I agree with Dr. in his entire interpretation, including that no letter of the rule was broken. One last point. In 2003, my first year on the board, the question of IME doctor patient relationship was discussed at great length in public session. Burke testified at that meeting. If memory serves me correctly, he was the only IME doctor who testified that there IS a doctor patient relationship and that the IME doctor should be held to the same standards as we hold all DCs to. IT took a lot of guts for him to do that, in my opinion. He stood alone. His testimony, ultimately assisted the OBCE in creating language that holds Chiropractic-IME docs, to the same standards as all DCs. Minga Guerrero DC abowoman@...

[Guest guest]

Thank you for taking  the time to give us your valuable perspective on this important issue Minga.You continue to be a treasure trove of good information and common sense for this profession in Oregon. Schneider DC

PDXOn Fri, Mar 2, 2012 at 9:15 AM, <AboWoman@...> wrote:

 

Everyone,

After listening to the entire testimony at the IME House Health Committee meeting, 

I feel compelled to speak about how our board works, from personal experience. For those who are new to this list, I served 6 yrs on the OBCE, with more than 4 yrs as board president.

When a ruling is made that revokes a doctor's license, it's not just the board members that make this decision. Although the seated board is responsible for the final decision, the decision in all revocation cases and all the IME cases I was involved in; included months of investigation and review by 12-20 peers who review the material - plus an assistant attorney general, lay public members (2); and a review of background cases of similar nature. Some of those cases could take 6-12 months of review and many more meetings than the standard board meetings. There are meetings with board members and Peer Review, by Peer Review alone, Meetings by board members out of state to gather information from DC boards across the nation to see how they handle similar cases. Always anonymous, never divulging any doctor's name being investigated. When a member of the board or sub-committees are involved in a complaint, the board must send the complaint  to an outside source. Otherwise, there is a conflict of interest or bias connection that can negate the rulings. This is common practice. There are many reasons for this. Some of which I do plan to review in the upcoming sexual boundary course (but only as it relates to that type of case).

That being said, there are also times when a board may choose to meet with a doctor and other times where this is denied. I won't speculate on recent reasoning, but can only relate come cases where it was denied. In one case, we'd allowed a meeting; in spite of the doctor's verbal interactions; which were passionately angry and argumentative. The evidence was sound against the doctor according to over 15 peers and the AG office, yet we did vote, with hesitancy, to allow an audience. I had my hand squeezed so hard by the doc that it bruised the entire snuff box because the doc was a large, muscular person who squeezed as he looked into my eyes, gripping longer than a normal handshake; seemingly as a challenge. The hand shake hurt. I couldn't hold a pen for the rest of the day. By the evening a bruise appeared, covering the entire snuff box. It was hard for me to adjust for the better part of a week. Did he mean to hurt me? Could I prove it? Or would he just say, I didn't realize my own strength and was only giving a professional and firm handshake?

On another instance, I feared for my safety at my own home following a veiled threat. I would not vote to allow a doctor making threats to have a face to face meeting, altho I could be over-ruled by a majority rule. No one member controls the board.

I do not personally feel that, in this case, there would have been any fear of board member safety.  I just want those who've never served on a board, to realize there are reasons the board chooses not to grant an audience. I won't even try to speculate on anything else in the case we're discussing. I see both sides. I feel the unprofessional comments on this list, towards IME peers are not productive. Foul language whether directed at a colleague, to an insurance company or other entity, on the list, whether metaphorical or not, is not productive and can be perceived as mean-spirited. I also understand that a majority of DCs in the field who've spoken to me or reported here, receive negative feedback and terminated care with IME reviews.  Medical doctors in the community where I work, also report a preponderance of negative IME reviews on their patient care. It's not just our profession. I don't know what the answers are. This email is not to speculate on that issue. Just to say that our comments should be more professional and without cursing.  

 Another thing to consider is the aspect of being fair in granting an OBCE audience to all who face violations. If the board grants an audience to the doctor, to be fair, they should call the complainant and offer equal time or they could also be accused of bias.

In almost all cases, the complainant doesn't appear before the OBCE either. I would safely say that 99.9% of the cases I sat on the board for did not have a face to face meeting with the complainant.The board reads the complaint and listens to the investigator's report, reviews copious files, including any Peer Review reports. The Peer Review Committee (PRC) reports are usually given directly by a PRC member, who stays and undergoes rigorous questioning by the board.

 It's the investigator who meets with most complainants and doctors. If there is a bill requiring the OBCE to grant / offer an audience 100% of the time;  it will require an increase in workload for all staff and board members. There are 15-20 cases per meeting. Meetings last an entire day to cover that case load. I would guess it could double expenses and time to resolve cases, to grant 2-sided interviews.

I see 's Burke's point in explaining where he took this grievance, even if I may not have agreed with all the testimony presented against the OBCE.

I also see the board's point in not granting an audience to 100% of all complainants and doctors. I have no knowledge of the case or it's specifics. I do, however, feel that perhaps we should all re-visit the listserv rules and see if we need to add to them. I agree with Dr. in his entire interpretation, including that no letter of the rule was broken.

 

One last point. In 2003, my first year on the board, the question of IME doctor patient relationship was discussed at great length in public session. Burke testified at that meeting. If memory serves me correctly, he was the only IME doctor who testified that there IS a doctor patient relationship and that the IME doctor should be held to the same standards as we hold all DCs to. IT took a lot of guts for him to do that, in my opinion. He stood alone. His testimony, ultimately assisted the OBCE in creating language that holds Chiropractic-IME docs, to the same standards as all DCs.

Minga Guerrero DC

abowoman@...

-- Schneider DC PDX