How to practice medicine without a license

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How to practice medicine without a license

L. Weinmann

Friday, August 29, 2008

Doctors not licensed to practice medicine in California are allowed to

practice medicine in California as long they restrict their decisions to

injured

workers who claim on-the-job injuries. This convenient niche is favored by

insurance companies and acquiescent utilization review companies retained by

the

insurance companies. They argue that utilization review doctors aren't

practicing medicine.

Here's how the scheme works. phine Hardhead reaches for a box of records

stashed on an overhead shelf. The box falls onto her head and neck. She

develops headache and neck ache that won't quit. Her primary care physician

prescribes MRI scanning. Instead of doing the prescribed scanning, the

insurance

company refers the prescription to a utilization review company where a doctor

who may be in another state and who has been hired to do utilization review

looks over the prescription.

The review doctor has authority to deny, delay or modify treatment. The

doctor who does the review may refuse to authorize the MRI even though the

review

doctor will not have interviewed or examined the injured worker. Under

California law, review doctors without California licenses are allowed to

overrule treating doctors even though the treating doctor is licensed to

practice

medicine in California. This aspect of the law would be stopped dead with the

signing into law of AB2969.

Meanwhile, phine can't wait for new laws. She can't shake the pain of

constant headache (cephalalgia) and chronic neck ache (cervicalgia). She gets

referred to a specialist in pain management who prescribes a course of

treatment that her industrial insurance company thinks is too expensive. The

workers' compensation insurer now refers this prescription to a utilization

review

doctor because, under California law, review doctors may deny authorization

for treatment, especially if they do so based on a document known as the

American College of Occupational and Environmental Medicine guidelines, which

in

California have the force of law. phine can go home and take another

aspirin.

That's when the rubber meets the road. Because the ACOEM guidelines are not

comprehensive, especially with reference to chronic pain, doctors licensed in

California are also held responsible for 26 pages of single-spaced rules

and regulations specific to California and are required to take a 12-hour

course in pain management. Yet their decisions can be overruled by utilization

review doctors without California licenses who are not responsible for either.

Utilization review doctors sometimes telephone the primary treating physician

of an injured worker and recommend modifications or reduction of treatment.

They may force the primary physician to cancel or reduce the frequency of

physical therapy or other treatment. The primary treating physician, though

caught between a rock and a hard place, still is not as bad off as the injured

worker whose treatment got canceled.

A huge snag in the system is that utilization review doctors without

California licenses cannot be disciplined by the Medical Board of California

for

unprofessional conduct because they aren't under board jurisdiction. Neither

can

they be prosecuted in the states in which they do have licenses, because

those states don't have jurisdiction in California.

The Medical Board of California says that utilization review is the practice

of medicine because " only a physician and surgeon licensed in California is

allowed to override treatment decisions. " The Medical Board of California,

the Osteopathic Medical Board of California, the Board of Chiropractic

Examiners, the Board of Podiatric Medicine, the California Medical Association,

the

California Labor Federation and the AFL-CIO are among many organizations that

support AB2969 (authored by Assemblywoman Sally Lieber, D-Mountain View),

which would require doctors who do utilization review for injured workers in

California to be licensed in California. This legislation is sponsored by the

California Society of Industrial Medicine and Surgery, the California Society

of Physical Medicine and Rehabilitation and the Union of American Physicians

and Dentists.

The bill awaits the governor's signature or veto - and be certain that

insurance company interests are lobbying the governor to veto the bill. The

general public understands that insurance companies decline coverage for

frivolous

reasons and should urge the governor to approve AB2969.

Dr. L. Weinmann maintains a private practice in neurology in San

. He was formerly president of the Union of American Physicians and

Dentists,

AFSCME, AFL-CIO (1989-2006) and is currently president of the UAPD

Independent Practice Association.

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