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Proposed workers’ comp
guidelines won't help

Every year Hawaii's workers faithfully go to their jobs to perform their duties. And every year some of those workers have serious accidents at work. The great majority of these seriously injured workers try very hard to get better and to return to their jobs. I know, because it's my job to help those injured workers as their attorney; a job I've been doing in Hawaii for more than 12 years.

That's why I took a good look at Governor Lingle's proposed medical treatment guidelines, which will become law if not enough people object.

Think of the guidelines as a cookbook for doctors. Those trying to sell the cookbook say that it covers every injury and every "body" in Hawaii. This cookbook, which was written in California, will tell Hawaii doctors what to do and when to do it.

If the governor's guidelines are adopted, all of Hawaii's best caregivers will have to conform their treatment of injured workers to the cookbook's medical treatment recipes. And they will have to limit their treatment of injured workers to the treatment listed in the cookbook. If Hawaii's doctors want to give an injured worker additional treatment not in the cookbook, insurance companies can deny the treatment.

The governor says this isn't so bad because insurance companies even now can deny treatment requests. That's true. But currently when a worker gets to a legal hearing to decide if the treatment her doctor requested is necessary, the word of her doctor counts. She stands a good chance of getting approval for her treatment.

That is not how things will work under Lingle's proposal. Once a treatment request is denied under the new guidelines, Hawaii's medical specialist will be required to find medical research articles and other types of research evidence to support why the doctor thinks the worker needs the additional treatment. If the doctor does not supply the additional research, the treatment will not be allowed. Do our best doctors, who are rushing from medical crisis to medical crisis, from the surgery ward to their office full of waiting patients, have time to go to the medical library to find an article that tells them that the diabetic worker, with her prior knee injury, should have a little extra physical therapy or another shot for her painful knee?

I took it upon myself to ask a number of the state's best doctors what they thought about the governor's medical treatment cookbook. I talked to well-known surgeons, foot specialists, a spine specialist and one of Oahu's largest orthopedic groups.

I was sure that the governor, who prides herself on doing her homework, would already have asked these very good doctors what they thought about the guidelines before she proposed them. If her goal is to reduce workers' compensation costs, I'm sure she wouldn't want to propose guidelines that will discourage our best doctors from providing fast and efficient medical treatment to injured workers.

Here's what I learned. Fourteen of the 28 doctors I contacted responded to my short inquiry. Surprisingly, not a single one of those doctors said they had ever heard of the particular medical treatment cookbook from California that is being proposed by the governor. More important, not a single one felt that the guidelines would help them to provide good and prompt treatment to injured workers.

A majority of the doctors who responded even said that the forced use of the proposed cookbook will encourage them to no longer treat Hawaii's injured workers.

Think about that. If the best doctors in Hawaii decide not to treat injured workers, how is the injured worker to get better, back to work and off of workers' compensation benefits?

Answer: She isn't going to get better, she will not get back to work, she might bill her private heath-care provider in the future for the treatment ordered by her doctor and she might wind up on public assistance.

That is a lose-lose situation.

I don't claim to be as smart as our governor or her Department of Labor officials who are pushing this unknown medical treatment cookbook, but if our best doctors don't know about the cookbook, don't think it will help them treat injured workers and think it will force them to stop helping injured workers, then Lingle better get back in the kitchen. Because something about her medical treatment cookbook smells fishy.

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