Chronic condition

With an Enloe specialist’s departure, long-term workers’ comp patients have nowhere to turn for pain care

THE AGONY OF SITTING STILL<br>An injury two years ago has left Patsy Harting with chronic back pain that makes it impossible for her to sit for longer than a half-hour. Nevertheless, she now must travel to a clinic in Sacramento to receive care because her former doctor, an Enloe specialist, has left town.

An injury two years ago has left Patsy Harting with chronic back pain that makes it impossible for her to sit for longer than a half-hour. Nevertheless, she now must travel to a clinic in Sacramento to receive care because her former doctor, an Enloe specialist, has left town.

Photo By Andrew Boost

Turning the tables:
Before passage of AB 899, the workers’ comp reform bill, in 2004, insurance companies were required to accept physicians’ word on the necessity for treatment. Now it’s the other way around: Doctors must be able to show that the treatment they recommend is included in the ACOEM guidelines. “Cookbook medicine,” critics call it.

Two years ago, Patsy Harting suffered a serious back injury while working at Enloe Medical Center as a registered nurse. The chronic pain she now suffers has kept her from working and forced Enloe to let her go in 2005 after eight years of employment.

Now Enloe is letting her go once again.

The medical center notified the 66-year-old Magalia resident and 200 other patients like her that they no longer would be treated at Enloe for chronic pain suffered from injuries covered by workers compensation. In the letter, sent in June, officials cited the departure of the center’s chief occupational-health specialist as the cause. Reforms in the state’s workers compensation laws, the letter added, had led to a shortage of physicians willing to accept workers’ comp patients.

“When I got the letter, they let me know they would no longer be treating patients like me,” Harting said. “I think it was very wrong.”

Enloe’s Occupational Health Center, located in east Chico off Bruce Road, will still provide care for acute and sub-acute cases—broken arms, lacerations, that sort of thing. But those who suffer chronic pain—mostly neck and back patients—have been referred to clinics as far away as Sacramento and St. Helena.

“We are no longer able to provide that care because it is a specialty,” said Nora Shippelhoute, manager at Enloe Occupational Health Center. “It’s not typical for a health clinic to provide that care; we just had someone who could.”

Enloe is looking to replace former specialist Dr. Mark Bohlander, but believes it will be difficult to do so. According to the letter, guidelines set by the American College of Occupational and Environmental Medicine (ACOEM) have forced Enloe to shut its doors to current and future patients formerly under Bohlander’s care for chronic pain.

The passage of workers’ compensation reform (SB 899) in 2004 made ACOEM’s guidelines a standard for doctors, attorneys and insurance providers in deciding treatment and compensation for work-related injuries.

This gets to the crux of the problem long-term workers-comp patients have. Even though legally the ACOEM guidelines are supposed to apply only to injuries treatable within 90 days, insurance companies find it easy to use them to deny longer-term care, and doctors either don’t realize they can fight the insurance companies or they’ve given up trying.

Steve Foster, a Chico-based attorney, counsels Harting and others who find it next to impossible to get care because their doctors won’t deal with insurance claims.

“They’re being told they don’t want to treat anybody in the workers’ compensation system because it’s too difficult,” Foster said. “They’re happy to treat you if you have health insurance, if you have cash, or if you are on Medicare or Medi-Cal—but if you’re on workers comp, they don’t want to talk to you.”

Foster said the problem rests with doctors’ insistence on using ACOEM’s guidelines as the ultimate authority. He’s often told by clients that their doctors recommend treatment options but know they will be refused, so they won’t even ask.

“I don’t blame the doctors.” Foster said. “The ones that are still doing [occupational medicine] kinda got beaten down so much that they throw their hands up and give up.”

Susan Gard, spokeswoman for the California Division of Workers Compensation, has a different take on the matter. “To say that [Enloe and other practitioners] can no longer provide long-term care because of the guidelines is incorrect. You can go beyond the ACOEM guidelines as long as [medical care is] based on sound medical guidelines.”

Other CDWC officials emphasize that the guidelines are not a “bible” for diagnosis and treatment, but may have been interpreted that way.

“I think they were originally written as educational material for physicians,” said Anne Searcy, executive medical director for the CDWC. “There certainly has been a learning curve on this.”

Searcy is working with myriad professionals, from general practitioners to acupuncturists, to create supplemental guidelines for chronic pain treatment. The hope is to fix the flaws created by SB 899.

“My goal is to make sure injured workers get the proper treatment,” Searcy said.

There’s another problem, however: Long-term patients must be seen by specialists, and Shippelhoute says there are few in Chico who accept these cases.

“It’s very unfortunate for these patients,” Shippelhoute said of the lack of specialists in the workers’ comp insurance network. “We don’t have anywhere for patients to go when they need a specialist.”

Meanwhile, former Enloe patients will need to explore their options. For Harting, it’s hard enough dealing with the pain she experiences on a daily basis. To travel to a far-off clinic would be excruciating.

“I can [ride in a car] for about a half an hour, but then I have to walk around for a little bit,” she said.