Doctors Getting Rich With Fusion Surgery Debunked by Studies

Many of my workers' compensation clients suffer from work-related back injuries. They range from simple pulled muscles and pinched nerves to full blown herniated discs to severed spinal cords causing a paralyzing condition. The treatment for these injuries can be as simple as rest to physical therapy all the way to serious spine surgery.

One of the types of spine surgeries that many of my clients have undergone is spinal fusion surgery. This surgery entails screwing together, with a metal cage, several vertebrae in the spine in order to limit painful movement in the vertebrae. Here is a picture of what a typical fusion surgery looks like:

I recently came across a Bloomburg article about fusion surgeries that was very disturbing. From the article, I learned that the number of fusions at U.S. hospitals doubled to 413,000 between 2002 and 2008, generating $34 billion in bills, data from the federal Healthcare Cost and Utilization Project show. The number of the surgeries will rise to 453,300 this year, according to Millennium Research Group of Toronto.

In and of itself, the rise in the number of fusion surgeries should not be a concern, assuming the procedure helps patients live productive, relatively pain free lives. But the studies say different.

It’s amazing how much evidence there is that fusions don’t work, yet surgeons do them anyway,” said Sohail Mirza, a spine surgeon who chairs the Department of Orthopaedics at Dartmouth Medical School in Hanover, New Hampshire. “The only one who isn’t benefitting from the equation is the patient.

The Evidence

British and Norwegian researchers found fusion no better than physical therapy for disc-related pain in three studies, totaling 473 patients, published in the journals Spine, Pain and the British Medical Journal between 2003 and 2006. A 2001 Swedish study of 294 patients in Spine found fusion better than physical therapy that was less structured than the kinds used in the other studies.

Rates of complications from surgery in three of the European studies -- including bleeding, blood clots, and infections -- were as high as 18 percent. None reported complications from physical therapy. The four studies are cited in journals as the only head-to-head, randomized comparisons between the two treatments.

In a U.S. study in Spine in 2007, surgeons reported fusion was successful in only 41 percent of 75 patients suffering from lower-back disc degeneration. Success measures included pain reduction. Two years earlier in the same journal, surgeons found a 47 percent success rate among 99 patients, 80 percent of which were taking narcotics for pain two years later. Both studies compared fusion to artificial disc replacement in trials submitted to the FDA.

The Blommburg article, from which this information was taken, is quite extensive and has many personal examples of how this surgery has not helped people, but ruined their lives. In my practice, I have seen both sides of this issue. I have clients who have undergone the surgery and have had a good result and I have had clients have a bad result and have to return to the surgical table and ultimately, be diagnosed with failed back syndrome.

If you are contemplating undergoing this type of surgery, please consider all of the factors. Also, always obtain a second opinion. If this is a Pennsylvania workers' compensation injury, you would have a right to a second opinion that the insurance company would have to pay for.

Minimum Wage Laws

Many, many of our Pennsylvania workers' compensation clients also have wage law questions. These laws determine what employers can give as minimum wages and the hours that are set. These laws control how many hours an employee can work during the week as well as over time wages and breaks, etc. The laws can be very confusing given the many categories of employees and how the laws apply to each category. The following is a basic primer on minimum wage law, including Federal and State. I thank Attorney Darryl Parker, who is a Seattle employment lawyer, for some of this information.

Federal minimum wage is currently set at $7.25 an hour, with some states individual minimum wage set at higher or lower or the same as the Federal limit. Minimum wage laws are very confusing for both employers and employees alike, and is different from state to state, but that does not give a business an excuse for failing to properly pay its employees. I believe that with coherent information on how these laws work, everybody will be able to have a better understanding of the minimum wage. In this article, I will address some of the most common concerns on minimum wage.

Who has to be paid the minimum wage? The vast majority of employees fall under the umbrella of minimum wage laws. There are, however, a few types of employees that do not have to be paid minimum wage. Students working internships fall under this category. As long as the internship provides an academic experience, the student can receive compensation in the form of experience and school credit instead of money. There are also certain types of contract employees that may establish rates as they see fit with whoever is hiring them. These rates do not have to be at the minimum wage level. It is also important to note that the minimum wage is meant for people that are 16 years and older. This does not prevent 14 and 15 year olds from working, though. Their minimum wage is legally set to 85% of the normal minimum wage.

How is the minimum wage calculated? First, it should be noted that there is a Federal minimum wage and a State minimum wage. Employers are subject to abide by whichever number is higher. In Pennsylvania, the state level is the same as the the Federal level, and has been for a while. Because of this, businesses are required to pay their employees at least $7.25 an hour.

Can employers count tips in their calculation of minimum wage? Some states have a lower minimum wage for employees that make money off of tips, but Washington is not one of them. Valet parkers, waiters and anybody else who gets tips as a part of their job must still be paid the minimum wage by the business that employs them.

What can I do if my employer is not paying me minimum wage? If you are not being paid the minimum wage despite working a job that requires your employer to do so, then you should seek legal representation as soon as possible. The minimum wage is meant to protect employees and allow them to live on a reasonable wage. When employers do not abide by these rules, the employee should speak with an experienced employment lawyer about what they need to do to take legal action.

For more wage information, please see this quick reference guide. As always, if you have any questions, please call us for a free consultation.

The Wall Street Journal covers how the gas drilling boom has affected Towanda, PA

In an online slide show with accompanying article, the Wall Street Journal has written about how the gas drilling boom has affected Bradford County's capital, Towanda, PA.

See the slide show here.

Injured Workers Pharmacy

One of the many issues that haunt our Pennsylvania workers' compensation clients is the payment of work-related medical bills, particularly prescriptions. Often times, the insurance company withholds payments to the pharmacy or refuses to refund out of pocket prescription payments that the injured worker makes. Sometimes it's just a matter of too much red tape and paperwork that gets in the way, thus preventing injured workers their needed prescriptions in order to get better.

One of the ways to fix this problem is to insert a "middle-man" into the mix. That's where a company called Injured Workers' Pharmacy comes in. I'm not associated with this company in any way. However, many of my clients have used their resources.

Here's a blurb from their promotional materials:

IWP is a national pharmacy service working on behalf of injured individuals. As an advocate for those who have been injured, IWP takes the financial burden out of the medication process by shipping medications directly to the patient and collecting payment from the insurance company.

We provide Workers' Compensation medications for injured workers. We are an independent pharmacy service, which means we're concerned with your interest. And yours alone.

Call us and we'll ship your Workers' Compensation medications right to your door, hassle free. We'll work on your behalf, filling your prescription needs even if your claim has been denied or goes through litigation.

What Can I expect from IWP?

● Your prescriptions and medical equipment when you need it
● A dedicated customer service team
● Licensed pharmacists available for consultation
● Free next day home delivery for all approved claims
● Multi-lingual assistance
● Caring, respectful, professional service
● Freedom from time and stress spent on phone calls and paperwork

What Won't I Have to Worry About?

● Confusing claim forms
● Out-of-pocket expenses on approved Workers' Compensation claims
● Waiting for reimbursement

Pa. company admits crime in secret human bone-cement experiments

Because many of our clients undergo spine surgery to repair herniated discs caused by work injuries or automobile accidents, this story caught my eye. Basically, this company was giving untested bone cement to doctors to use during spinal surgeries, when the patients knew nothing of their guinea pig status. The company was experimenting on humans without their knowledge, and apparently, people died because of it.

What is unclear from the story is the role of the doctors. I could not confirm if any of the doctors who performed the surgeries were complicit in the crime.

The most painful warning sign EVER!

That looks like it hurts....

And that's why open machinery must be guarded, either by an actual guard or by distance or location. Many of our work injury cases stem from employees having their hands and arms caught in unguarded machinery, causing severe damage, including amputation.

What are the most important things an injured worker should know about Pennsylvania Workers' Compensation rights?

Below are some initial questions many clients have when they first contact Carroll & Carroll, P.C. The questions below may address many initial concerns you may have. If you don't find the answers here, you should contact us for answers to questions specific to your case. The consultation is free.

Q: What are the most important things an injured individual should know about workers' compensation rights?

• 
  Always report a work injury even if you might not lose time from work or need immediate medical care. It is critical that you require your employer to complete an accident report. Remember to keep an independent record of the date, time, and nature of your work injury. In addition, make a list of witnesses as well as the person to whom the injury is reported. Be sure to provide a complete and accurate account of the type of injury you sustained and how your injury occurred as well as your past medical history.
• If your employer fails to accept your claim within 21 days of the date you notify them, seek legal assistance and file a petition for compensation. Should your employer accept your injury, be certain that the wages upon which your compensation is based are accurate. In most cases your compensation should be 66 2/3% of your gross wages from all sources of employment.
• If, after receiving compensation, your employer or the insurance company asks you to see another physician, seek legal advice immediately as this is your employer's first step in their attempt to either terminate your compensation or modify your benefits. It is possible that your employer may offer you modified work based on medical proof that you are able to perform that work. This can cause you to lose your benefits by failing to accept the newly defined work.
• You might be contacted by a vocational rehabilitation firm attempting to find you a new job. Your compensation can be effected if you fail to cooperate with the vocational firm.
• Should you receive a petition in the mail to terminate, suspend or modify your compensation, seek legal advice. NEVER sign a supplement agreement or final receipt without having it reviewed by an attorney.

Slip and Falls during bad weather

It's that time of year again. The weather gets cold and the ice and snow start to fall. Un-cleared sidewalks become mine fields of danger. So, please be careful where and how you walk on slippery sidewalks.

As you know, we handle slip and fall cases at C&C Law. Either innocent pedestrians or innocent workers who slip and fall on snow/ice while working. So, here's a reminder to property owners. Make sure your public sidewalks and walkways are clear. Or you just might be getting a call from me....and you don't want that headache....

Here's a funny video to remind you of the dangers of slippery sidewalks.....

Moratorium on gas drilling passes New York legislature

On Monday evening, the New York State Assembly gave final approval to a six-month moratorium on natural gas extraction in New York, while state and federal agencies review its possible impacts.

The moratorium, which calls for no drilling permits to be issued until May 14, 2011, was approved by the state Senate in August, and then the Assembly approval that followed on Monday.

Here's the full article from the Towanda Daily Review.

In Pennsylvania Marcellus news, here's another article from the Towanda Daily Review about Governor-Elect Corbett and an advisory committee he has established. The gist of the article:

The 30-member panel includes former state environmental secretaries, environmentalists and alternate energy representatives as well.

Corbett formed the committee to advise him on issues and impending decisions involving the Department of Environmental Protection, Department of Conservation and Natural Resources and Public Utility Commission before he takes office Jan. 18.

These three agencies have a regulatory role over the natural gas drilling boom underway in Northeast Pennsylvania and other regions on issues ranging from drinking water protection, drilling on state forest land and pipeline safety.

Corbett has said he wants to develop the Marcellus Shale gas deposits as a long-term economic venture while maintaining environmental protections. Efforts to reach Corbett spokesman Kevin Harley Wednesday were unsuccessful.

The Marcellus lobbyists on the panel have other major businesses and organization clients too.

They include Peter Gleason of Kirkpatrick & Lockhart Gates who represents Cabot Oil & Gas Corp. and Chesapeake Appalachia, two firms active in Northeast Pennsylvania, according to lobbyist disclosure reports with the Department of State. Cabot is at odds with DEP over whether the company's natural gas drilling is responsible for water supply contamination in Dimock Twp.

Also lobbyist Stanley Rapp with Greenlee Partners who represents Range Resources-Appalachia, CNX Gas Corp. and NextEra Energy Resources. He represents PPL Corp. as well.

And lobbyist Pam Witmer with Bravo Group who represents Chief Oil and Gas, Chief Gathering LLC and RRI Energy.

The panel is chaired by David Kleppinger, an attorney with McNees Wallace and Nurick who lobbies for the Industrial Energy Consumers of Pennsylvania.

David Hess and Nicholas DeBenedictis, former DEP/DER secretaries under Govs. Mark Schweiker and Richard Thornburgh, are on the panel. So is John Oliver, a former DCNR secretary under Gov. Tom Ridge.

George Ellis, president of the Pennsylvania Coal Association, and Ellen Ferretti, Dallas, vice president of the Pennsylvania Environmental Council who works on Pocono land issues, are on the panel. Patrick Solano, Pittson, a former DEP deputy secretary, and John Rich, owner of a coal waste power plant in Schuylkill County, are members.

I wish the committee was made up of mostly environmental scientists and activists, as opposed to mostly industry puppets. We understand where Governor-Elect Corbitt's priorities are.