Articles Posted in Medical News

How many times must an injured worker in PA hear something like, “Why are you still out of work – it was just a bruise?”  What is not widely understood is that a bruise, or a contusion, can, indeed, be a serious injury with very severe consequences.  Recently, we saw an example of this in the sports world.

Tyler Lockett, a wide receiver for the Seattle Seahawks in the NFL, suffered a bruised lower leg in a game on November 11, 2019.  According to an article in the Washington Post, Mr. Lockett was hospitalized overnight as a result of the injury.  In addition to causing pain and immobility, a bruise or contusion can also cause swelling.  This swelling, when in a small area, such as a lower leg, can instigate “compartment syndrome.”  According to the article, “Compartment syndrome is a rare but potentially dangerous condition in which pressure builds to extreme levels in a limb after it undergoes some sort of trauma, either from a big hit or simple exercise.”

On the website for the American Academy of Orthopaedic Surgeons (AAOS), it is reiterated that compartment syndrome can result from badly bruising a muscle, which we do often see in PA workers’ compensation cases.  When this compartment syndrome is the result of acute trauma, it is a medical emergency.  Immediate treatment is necessary to avoid permanent damage to muscle, nerve and tissue.  There is no non-surgical treatment for compartment syndrome.  Specifically, the treatment involved would be:

The vast majority of work injuries in Pennsylvania heal with conservative treatment, allowing the injured worker to return both to work, as well as to activities of normal life.  However, there are certainly the more serious injuries, where more invasive medical treatment is required.

Often the more invasive treatment options entail surgery.  When we are talking about work injuries to the neck and back, the procedures we usually see are laminectomy, microdiscectomy and traditional lumbar fusion.  For a description of each of these, and more information regarding these procedures, check out this post from Penn Medicine.  For our purposes today, we are looking at the traditional lumbar fusion.  As explained in the Penn Medicine article:

Traditional spinal fusions are used to treat instability of the spine, scoliosis, severe degeneration of the discs, or a combination of these issues.  A fusion involves using bone from the patient’s body to fuse one vertebrae to another.  Often, metal screws (pedicle screws) are placed into the vertebrae to assist with the fusion process.”

While we are very conscious of being available to our clients as much as possible, the practice of PA workers’ compensation law, and the litigation process, means we are not always in our offices.  Sometimes, in addition to being at workers’ compensation hearings and depositions, our attorneys attend events or presentations that may help us better perform our job protecting the injured worker in PA.

And, so it follows, our attorneys were invited by Rothman Institute to attend their Workers’ Compensation Conference, being held all day on Friday, October 24, 2019.  We sincerely apologize if this means we are not available to help our clients on that day directly, though our office staff certainly remains available (and can reach the attorneys for any emergencies).  As our clients know, it is the practice of Brilliant & Neiman LLC for the clients to speak directly to the attorney, rather than being forced to always speak to support staff.  We apologize for this deviation from our regular course of business.

The Workers’ Compensation Conference will no doubt provide our attorneys with additional tools to help us best protect the rights of injured workers in PA.  Topics being presented will include 3-D printing in orthopedic surgery, issues with complex rotator cuff surgery, as well as general updates regarding treatment options for injuries to the neck, back and knees.  The Workers’ Compensation Conference will be moderated by Dr. Nicholas Taweel, and will include presentations from Dr. Pedro Beredjiklian, Dr. Mark Lazarus, Dr. Michael Molter, Dr. Howard Yeon and Dr. Paul Steinfield.

Left Fielder Corey Dickerson, of the Philadelphia Phillies, was just diagnosed with a broken foot.  Why is that relevant to injured workers?  Because it confirms that an injury is not always what it initially appears.  Unlike a major league baseball player, however, an injured worker is not always given the benefit of the doubt.

On September 4, 2019, Dickerson fouled a ball off his left foot.  They took x-rays that night, which were negative for a fracture.  Since he was diagnosed with just a bruise (or, the fancy word, “contusion”), Dickerson then played, in pain, in the next several games.  When the pain continued, additional testing was performed.  Only then did a CT scan reveal a fracture of the left foot.  Indeed, Dickerson may now require surgery.

Too often in PA workers’ compensation cases, we see an insurance carrier grab on to an initial negative test like a dog with a bone.  Unlike a professional athlete, however, an injured worker can have great difficulty getting additional diagnostic testing.  With the workers’ comp insurance carrier failing to provide pre-approval, getting an MRI, CT scan or bone scan, can be problematic.

As far back as 2008, our blog reported on a marked increase in the number of total knee replacements that were being performed.  This trend seems to have been continuing, and, perhaps, not for the best.  According to a recent article in The Intelligencer, a rather high number of patients who elected to have a total knee replacement performed, were dissatisfied with the results.  According to the article:

Research suggests that up to one-third of those who have knees replaced continue to experience chronic pain, while 1 in 5 are dissatisfied with the results. A study published last year in the BMJ found that knee replacement had “minimal effects on quality of life,” especially for patients with less severe arthritis.”

In Pennsylvania workers’ compensation, a total knee replacement is a procedure with see with some regularity.  Whether the injured worker had a preexisting arthritic condition, which was aggravated by a work injury, or whether the work injury itself led directly to the procedure, a total knee replacement is not uncommon in a workers’ comp case.

Thoracic Outlet Syndrome (TOS) and Brachial Plexopathy are two conditions we see representing injured workers in Pennsylvania.  These conditions were recently in the news in the Philadelphia area, with the report that Phillies pitcher Vince Velasquez underwent surgery for TOS in the previous offseason.  Indeed, it is not an uncommon injury for a professional baseball pitcher; our firm has represented a former major league pitcher with the condition (of course, we have represented many more types of injured workers with this condition than professional athletes!).

Both TOS and brachial plexopathy are sort of general terms, each regarding issues in the brachial plexus area (think of it like a big city train station, where it is many branches of nerves coming together rather than railroad tracks).  There are many forms of these conditions, making diagnosis difficult.  As we have mentioned previously on this blog, brachial plexopathy can be confused for conditions in the shoulder and/or neck of the injured worker.  This difficulty is also mentioned in the Medical FAQs on our website.  In the PA workers’ compensation system, we are often litigating to have TOS or brachial plexopathy accepted as part of the work injury (since such conditions are rarely, if ever, voluntarily accepted by the workers’ compensation insurance carrier).

Part of the problem in getting TOS or brachial plexopathy accepted as a work injury is the fact the conditions can be caused in various ways.  In fact, some occurrences are “idiopathic,” meaning that there is no known cause.  On the other hand, trauma is an established cause of the conditions.  It is also important to note that when we talk of “trauma” as a cause of TOS or brachial plexopathy in a work-related injury, we are speaking both of a single injury, as well as some type of repetitive motion kind of injury.  As we have discussed on this blog, repetitive motion injuries are just as much “work injuries” as single traumatic episodes.

Recently, we discussed the status of Senate Bill 936, which was passed by the House.  We are pleased to relate that Governor Thomas Wolf has vetoed this legislation, recognizing that it was a thinly disguised attack on injured workers and not a solution to any problem.

As discussed in the Morning Call, Gov. Wolf said:

Make no mistake, Senate Bill 936 is not a bill designed to fight the opioid crisis. Senate Bill 936 threatens health care for millions of workers who could be injured on the job, including police, corrections officers, and firefighters, who put their lives on the line every day, and whose injuries can be unique, debilitating and severe. It is wrong to sacrifice health care for our first responders to protect the bottom-line for insurance companies and corporations.”

Previously, we have warned of the pending legislation that will restrict the access of injured workers across the State of Pennsylvania to get medications they need.  Now, thanks to the House passing Senate Bill 936, the legislation heads to the Governor.  It is not bad enough that innocent people suffered injuries at work, now they have to deal with the reality that they will be treated different than patients who are not in the Pennsylvania workers’ compensation system.

As noted in an article on Pennlive.com, this legislation “was drawn up in response to reports in the Philadelphia Inquirer and Daily News about doctors and law firms specializing in worker’s compensation that were operating their own pharmacies.”  Perhaps someone would be kind enough to explain why the legislation did not simply prohibit the ownership of pharmacies by these groups?  Instead, this legislation does not even deal with this issue.  At all.  Rather, the legislation makes medications (all medications, not just the opioids that caused all of the supposed angst) more difficult for an injured worker in PA to obtain.

And, again we ask, is this fair?  Is this how our elected representatives protect us?  By making sure that we have difficulty getting medications if we are unlucky enough to be injured at work?  We urge all injured workers, those who care about injured workers and those who care about fairness and justice, to reach out to their legislators, and reach out to the Governor’s office, and let everyone know this will not be done without a fight!

Pennsylvania’s legislators try their best to represent their constituents; I believe this is true the vast majority of times.  But, there are certainly times when the results of their actions are very difficult to reconcile with the best interests of those they have sworn to protect.

Currently pending in the PA legislature is House Bill 18/Senate Bill 936.  If passed, this legislation would completely change how an injured worker in Pennsylvania can receive medications.  A “drug formulary” would be set up.  This means that no longer would a patient be treated based on the individual needs of the patient, and the individual judgement of his or her doctor.  Nope.  Instead, decisions would be based on “evidence-based medicine.”  That means that what medications would generally be prescribed for a given condition, for the period generally prescribed, would be all that an injured worker in PA could receive.

Therefore, the individual judgment of the doctor is totally irrelevant.  The needs of the patient?  Not a factor.  This is an absurd system, since medicine is not an exact science.  Indeed, any physician will openly admit that not every patient will react to every condition in the same way.  Some heal faster than others.  Not every patient has exactly the same symptoms or limitations, even from the same condition.

House Bill 18 has made it out of committee and is expected to be voted on early next week (Tuesday).  This bill would drastically change how injured workers in Pennsylvania would get their medications (and what medications they could get).  Basically, the Bill introduces “Evidence-Based Medicine” to PA workers’ compensation prescriptions.  This means that patients of a work injury would no longer be able to have care (or at least medicine usage) dictated by treating physicians; instead, the use of medications would be through established guidelines (amassing statistical data).  This, of course, ignores the simple fact that every patient is different and requires different care.  One cannot treat every person identically the same.

This could just be the first step in making “Evidence-Based Medicine” the care for every aspect of a work injury.  Imagine that your treating doctor is powerless to order care as he or she feels best, but is instead limited to what statistics say should be done for the majority of patients.  It is an absolute disgrace that Pennsylvania legislators think so little of injured workers to subject them to this kind of dangerous and substandard care.

Call your State legislators and tell them how you feel, before this Bill becomes reality!