[MCOH-EH] Work injury/illness causation

[Fung, Fred]

This is an important topic. Thanks to Dr. McKenna for raising it.
I agree with Dr. Yarborough. It depends on what type of causation is at issue, and whether or not directing care (to include work relatedness, diagnostics, treatment, disability ...) by any and all parties (insurance, employer, attorney, treating physician supervisor, union rep...) are likewise prohibited.
Work Comp is a legal system that varies from state to state. Most work comp laws are liberally construed and the fact finders (administrative judge, attorneys, investigations) have more factual information than healthcare professionals. Most work comp systems in US do not have jurors. In addition, most treating physicians are not considered as experts. Furthermore, the legal standard of "causation" for industrial injury/occupational disease is quite different from that of scientific/medical causation. For example, causation analysis (including aggravation of pre-existing underlying condition) is based on case law. For California, the standard is Southcoast Framing v WCAB  S215637 Ct. App. 4/1 D063945.  The legal standard always supersedes medical (expert) opinions. However, as healthcare professionals, we must abide by the scientific causation analysis under the excellent document of ACOEM Guideline. We should let fact finders argue and weigh admissible evidence on causation/compensability.
Fred Fung, MD, JD, Esq.

From: MCOH-EH <mcoh-eh-bounces at mylist.net> On Behalf Of Charles Yarborough
Sent: Friday, November 25, 2022 6:59 AM
To: mcoh-eh at mylist.net
Cc: McKenna, Patrick <Patrick.McKenna at nationwidechildrens.org>
Subject: Re: [MCOH-EH] Work injury/illness causation

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It may be there is lack of clarity on what type of causation is the issue, i.e. legal or medical (see attached ACOEM Guideline). If it is truly the latter, then violation of state workers' compensation regulations for provision of medical care may be raised since the exposure (medical cause) guides the treating occ med physician in treatment, return to work, work restrictions, PPE, and so on. At least in some states, if not all, interfering with medical care is forbidden, not to mention impinging on medical ethics.
Hope this helps.

________________________________
From: MCOH-EH <mcoh-eh-bounces at mylist.net<mailto:mcoh-eh-bounces at mylist.net>> on behalf of McKenna, Patrick via MCOH-EH <mcoh-eh at mylist.net<mailto:mcoh-eh at mylist.net>>
Sent: Wednesday, November 23, 2022 9:24 AM
To: mcoh-eh at mylist.net<mailto:mcoh-eh at mylist.net> <mcoh-eh at mylist.net<mailto:mcoh-eh at mylist.net>>
Cc: McKenna, Patrick <Patrick.McKenna at nationwidechildrens.org<mailto:Patrick.McKenna at nationwidechildrens.org>>
Subject: [MCOH-EH] Work injury/illness causation


Has anyone in this group encountered the employer telling the occupational health medical provider (physician, NP/PA, or nurse) that they are not to opine on the causation of an injury or illness, either in counseling the injured/ill worker or in medical documentation of the illness/injury?



Anything anyone is able to share would be very helpful.

Thanks!



Patrick McKenna, DO MPH FACOEM

Employee Health Medical Director

Nationwide Children's Hospital

700 Children's Drive Room  A1034

Columbus, OH 43205-2664

Office: 614-355-4135





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