Back Clinic Med-Legal Corner. Medical law is a branch of law that concerns the prerogatives and responsibilities of medical professionals and the rights of the patient. It should not be confused with medical jurisprudence, which is a branch of medicine, rather than a branch of law. The main branches of medical law are the law of torts (most notably medical malpractice) and criminal law in relation to medical practice and treatment. Ethics and medical practice are a growing field.
After working in chiropractic for 30+ years, especially in personal and work injuries. In the Med-legal corner, Dr. Jimenez knows the ins and out’s of what goes into personal and work injury claims. Receiving chiropractic care from a personal injury doctor after suffering an injury can be a lifesaver. As a personal injury chiropractor has attended post-graduate training in accident injury evaluation and treatment which can guarantee a more effective diagnosis and care.
An added bonus is that the chiropractor can do depositions and testify in court. A personal injury doctor works closely with multiple attorneys. The best chiropractors maintain a list of attorneys they know can deliver quality results to their patients in a car accident and personal injury cases. A doctor that has connections with more than one attorney offers a wide variety of experienced personal injury claim professionals to choose from, who can better accommodate you to solve your specific case after an accident. For answers to any questions you may have please call Dr. Jimenez at 915-850-0900
When the aberrant sequela to victims in car crashes has been investigated, providers often overlook and concurrently underestimate the tissue pathology and resultant biomechanical failures of spinal ligamentous damages commonly known as �strain � sprain.� In addition, the courts have been �blinded� by rhetoric in allowing this pathology to be deemed transient. There is an ever growing body of scientific literature that verifies strain – sprain as permanent pathology, which is the standard being taught in today�s medical and chiropractic academia.
In addition, strain � sprain as sequela to whiplash, renders a 25% whole person impairment based upon the American Medical Association�s Guide to the Evaluation of Permanent Impairment fifth and sixth editions.
Whiplash Associated Disorder Sequela Injuries
Juamard, Welch and Winkelstein (2011) reported:
��Rear end accelerations have been used to study the response of a variety of soft tissues in the cervical spine, including the facet capsular ligament. For simulations of whiplash exposures, the strains in the capsular ligament were found to be two � five times greater than those sustained during physiological motions of the cervical spine. In a similar but separate study, the facet joints of the cervical spine�s that were previously exposed to a whiplash injury ridden exercise under low � level tension and found to undergo elongations nearly 3 times greater than on exposed ligaments for the same tensile loads. Those capsular ligaments were also found to exhibit greater laxity after the purported injury. Since increased laxity may be linked to a reduction in the joints ability to stabilize the motion segment during sagittal motion, this finding suggests that whiplash exposure may alter the structure of the individual�s tissues of the facet, such as the capsular ligament, and/or the mechanotransduction processes that could maintain and repair the ligamentous structure. Accordingly, such an injury exposure could initiate a variety of signaling cascades that prevent a full recovery of the mechanical properties of the tissues of the facet joint.� (Pg 15)
Simply put, if we focus on the last sentence above, this �prevents a full recovery of the mechanical properties of the tissues of the facet joint,� which is referencing the ligaments of the spine that make up the tissues of the facet joint. In lay terms; it means that once injured, a joint is permanently damaged and it is demonstrable on x-rays with an extension and flexion view that does not have to show a full dislocation. Therein lies the core of the issue. Most radiologists are not trained in the latest literature on biomechanical tissue failures and therefore underreport the pathology.
Last month I attended a presentation by Michael Modic MD, Neuroradiology, a nationally renowned educator in neuroradiology who focuses on spondylolisthesis (vertebral segmental abnormal movements) and I asked a simple question �why don�t radiologist report more on abnormal positioning due to biomechanical failure as a result of ligament pathology� and his answer was �because their training focuses more on disease pathology.� Although I agree that is critical, so are biomechanical failures that lead to chronic degeneration, which is epidemic in our society. Simply look at the posture of our elderly for verification and much of that started with a simple �fender bender� years ago where the strain-sprain was either undiagnosed or deemed transient and not treated.
Ligament Pathology Diagnosis and Prognosis
The above scenario is why the American Medical Association values ligament pathology at 25% whole body impairment. There is also a growing body of doctors who are trained and credentialed in Spinal Biomechanical Engineering that understand how to create a diagnosis and prognosis, along with treatment plans around ligament pathology and fully understand the long-term effects of damaged facet joint tissues. These doctors are currently educating, based upon the current scientific literature their respective radiology communities to be able to diagnose and document the full extent of the injuries sustained.
We must also recognize that there is a significant amount of evidence in the scientific literature that verifies ligamentous damage as permanent and refutes the rhetorical claim of �transient.� In the end, it must be the facts of human physiology verified by science that sets the standards of healthcare and not deceptive rhetoric at any level.
The scope of our information is limited to chiropractic and spinal injuries and conditions. To discuss options on the subject matter, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .�
References:
Cocchiarella L., Anderson G., (2001) Guides to the Evaluation of Permanent Impairment, 5th Edition, Chicago IL, AMA Press
Juamard N., Welch W., Winkelstein B. (July 2011) Spinal Facet Joint Biomechanics and Mechanotransduction in Normal, Injury and Degenerative Conditions, Journal of Biomechanical Engineering, 133, 1-31
Additional Topics: Weakened Ligaments After Whiplash
Whiplash is a commonly reported injury after an individual has been involved in an automobile accident. During an auto accident, the sheer force of the impact often causes the head and neck of the victim to jerk abruptly, back-and-forth, causing damage to the complex structures surrounding the cervical spine. Chiropractic care is a safe and effective, alternative treatment option utilized to help decrease the symptoms of whiplash.
Ohio Attorney General Mike DeWine is suing five makers of opioid painkillers for their role in the state’s opioid epidemic.
The five companies named in the suit are Purdue Pharma, Johnson & Johnson, Teva Pharmaceuticals, Endo Health Solutions and Allergan.
This is the second suit of its kind brought by a state, after Mississippi.
Ohio attorney general sues 5 pharma companies over their role in the opioid epidemic��
Ohio Attorney General Mike DeWine is suing five makers of opioid painkillers for their role in the state’s opioid epidemic.
The suit, which DeWine said is the second by a U.S. state, after Mississippi, claims the drugmakers violated multiple state laws, including the Ohio Corrupt Practices Act, and committed Medicaid fraud.
Purdue Pharma, Johnson & Johnson and its Janssen Pharmaceuticals unit, Teva Pharmaceuticals and its Cephalon unit, Endo Health Solutions and Allergan are all named in the suit.
“In 2014 alone, pharmaceutical companies spent $168 million through sales reps peddling prescription opioids to win over doctors with smooth pitches and glossy brochures that downplayed the risks” of the medicines,” DeWine said at a press conference Wednesday. Last year, he said, 2.3 million people in Ohio, or about a fifth of the state’s population, were prescribed opioids.
In a statement, a spokesman for Purdue Pharma, which manufactures OxyContin, said the company shares the attorney general’s concerns about the opioid crisis and that it is “committed to working collaboratively to find solutions.”
“OxyContin accounts for less than 2% of the opioid analgesic prescription market nationally, but we are an industry leader in the development of abuse-deterrent technology, advocating for the use of prescription drug monitoring programs and supporting access to Naloxone � all important components for combating the opioid crisis,” he said.
Allergan declined to comment, as did a Teva spokeswoman, who said, “We have not completed review of the complaint.”
J&J’s Janssen unit said the company believed the allegations in the lawsuit were “both legally and factually unfounded.”
“Janssen has acted appropriately, responsibly and in the best interests of patients regarding our opioid pain medications, which are FDA-approved and carry FDA-mandated warnings about the known risks of the medications on every product label,” said Jessica Castles Smith, a Janssen spokeswoman.
Endo officials weren’t immediately available to comment.
The Ohio action follows suits from counties and cities seeking to hold accountable the industry that produces, markets and distributes opioid painkillers. DeWine said the Ohio suit, filed Wednesday morning in Ross County, “would compel these companies to clean up this mess through several remedies,” including an injunction to stop “continued deception and misrepresentation in marketing,” damages paid to the state for money spent on the crisis, and repayment to consumers.
Sales of prescribed opioids � including oxycodone, hydrocodone and methadone � almost quadrupled in the U.S. between 1999 and 2015, according to the Centers for Disease Control and Prevention, contributing to a more than quadrupling of deaths from prescription opioids in that same period. Almost 2 million Americans either abused or were dependent on prescription opioid painkillers in 2014, according to the CDC.
“We understand what we’re taking on: five huge drug companies,” DeWine told reporters Wednesday. “I don’t want to look back 10 years from now and say we should have had the guts to file. � It’s something we have to do.”
For the second straight year, U.S. pedestrian deaths are setting alarming new records. The number of pedestrians killed on U.S. roads rose a projected 11 percent between 2015 and 2016, the largest year-to-year increase on record, according to a new Governors Highway Safety Association (GHSA) report.
During the first six months of 2016, preliminary data show 2,660 pedestrian deaths nationwide, compared to 2,486 for the same period during 2015. The year-long projection is based on those numbers. The report also projects a 22 percent rise in pedestrian deaths from 2014. Both estimates are sharply higher than the 9 percent increase in pedestrian deaths between 2014 and 2015.
“This is the second year in a row that we have seen unprecedented increases in pedestrian fatalities, which is both sad and alarming,” said report author Richard Retting, who’s with Sam Schwartz Transportation Consultants.
“It is critical that the highway safety community understand these disturbing statistics and work to aggressively implement effective countermeasures,” he added in a GHSA news release.
Pedestrian Risks and Automobile Accidents
Pedestrians account for about 15 percent of U.S. road deaths. In the first six months of 2016, the number of pedestrian deaths rose in 34 states, fell in 15 states and in the District of Columbia, and remained the same in one state. The report cited several possible reasons for the spike. They include Americans driving more due to lower gas prices; more people choosing to walk for health, transportation, economic or environmental reasons; and widespread use of smartphones, a distraction for walkers and drivers alike.
“Everyone walks, and we want to encourage that, but at the same time we want to make sure that we all get to our destinations safely,” GHSA Executive Director Jonathan Adkins said.
“Unfortunately, this latest data shows that the U.S. is not meeting the mark on keeping pedestrians safe on our roadways. Every one of these lives represents a loved one not coming home tonight, which is absolutely unacceptable,” he said.
One doctors’ group added that prevention — keeping your eyes and ears on your surroundings — is key.
“Today’s projected pedestrian fatalities — the highest ever recorded — are an urgent wake-up call that we need to work harder at consistently focusing on where and how we are walking,” said Dr. Alan Hilibrand. He’s a spokesman for the American Academy of Orthopaedic Surgeons.
“Pedestrians need to be mindful of their surroundings,” while walking, Hilibrand said. “Walking while looking at your phone or an electronic device can result in sprains, broken bones, and other serious, even fatal, injuries.”
SOURCES: Governors Highway Safety Association, news release, March 30, 2017; March 30, 2017, American Academy of Orthopaedic Surgeons
The scope of our information is limited to chiropractic and spinal injuries and conditions. To discuss options on the subject matter, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .
Brain injuries are common complications in our modern world. Approximately 2 million individuals experience a head injury in the United States alone each year. Although most brain or head injuries are not considered life threatening, they could sum up to billions of dollars in annual revenue. Brain injuries are often categorized according to patient response. Only 1 out of 4 reported brain injuries are considered moderate or severe.
In February, an immigration enforcement case in El Paso earned the attention of domestic violence advocates across the country. As the El Paso Times reported, an undocumented woman was detained by immigration officers right after she went to the courthouse to get a restraining order against a violent and abusive partner. Domestic violence advocates were horrified, worried that it would potentially deter undocumented people from reporting abuse to law enforcement. “It sends a powerful message to victims and survivors that there is no safe place,” Ruth Glenn, executive director of the National Coalition Against Domestic Violence, told Bustle in February.
Now, a month later, the effect of fighting domestic violence is being felt. Sometime after the El Paso incident, Enrique Elizondo, a worker for a domestic violence hotline, received a call from an undocumented woman (I have not included any identifying details to protect her confidentiality), facing an abusive husband. According to Elizondo, she was at the point of fear that the abuse could become lethal. But, after selling all her belongings to come to the United States, she found herself feeling like she was out of options. According to Elizondo, her partner had specifically made threats about contacting Immigration and Customs Enforcement (ICE) and having her deported if she took action. The El Paso case made her fear he could. Elizondo tells Bustle he tried to help her contact legal help, but the woman asked him, Is this legal advocate going to deport me? Ultimately, Elizondo says he was able to get her legal help.
Supporting All Survivors on International Womens Day
As we celebrate International Women’s Day, it’s important to remember that ALL women deserve support and safety, regardless of race, religion, country of…
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According to domestic violence advocates interviewed for this article, these situations are becoming the norm for dealing with undocumented survivors of domestic violence. The 2013 re-authorization of the Violence Against Women Act (VAWA) protects survivors of abuse from deportation for reporting the crime, but, as fear in undocumented communities has grown due to more expansive calls for immigration enforcement under Donald Trump’s administration, it’s hard for the people helping survivors to convince them they’re safe.
The February El Paso case may very well have been a fluke according to the El Paso Times, the woman detained had further criminal complaints against her beyond her immigration status. But the publicity generated by a women detained while seeking help from a court has nevertheless led to worry among violence survivors. Already, four cases in Denver of domestic violence were dropped due to fears of the survivors about immigration status, according to Denver City Attorney Kristin Bronsonm who spoke to NPR about the situation.
“That case [in El Paso] alone, I am actually sure had a chilling effect,” Ruth Glenn tells Bustle a month after we initially spoke. Her organization, the National Coalition Against Violence, is working “to ensure that advocates know how to support those victims by making sure that they know what the laws and the rules are,” she says. Specifically, it has been focusing on helping shelters figure out how to deal with these issues such as knowing that they are expected to maintain the confidentiality of their residents even if ICE officers shows up at the door.
Unfortunately, some are prioritizing continuing to live with abuse.
Under the Obama administration, a 2011 legal memorandum required ICE to exercise prosecutorial discretion when dealing with victims or witnesses to crimes like domestic violence.
According to a statement from Letitia Zamarippa, spokeswoman for ICE, that memo is still in effect. U.S. Immigration and Customs Enforcement (ICE) officers will take into consideration if an individual is the immediate victim or witness to a crime, in determining whether to take enforcement action. Particular attention is paid to victims of domestic violence, human trafficking or other serious crimes.”
But even with the law officially in place, the uncertainty caused by Trump administration actions stepping up deportations and limiting restrictions on ICE causes fear among survivors.
The Trump administration’s recent actions taking aim at sanctuary cities, hoping to push local police agencies to enforce immigration laws, worries advocates, as well.
If you think about victims of domestic violence who are already being controlled by a perpetrator, that is compounded and exacerbated when you rely on that person to interpret the laws for you, who is filtering all that information to control you.”
“When you have your local sheriff, whose job is to come to domestic violence scenes and to be in the community if they’re also enforcing immigration law the question is whether victims are going to come call when they’re being abused or sexually assaulted,” says Huang. “Entire communities are afraid of reaching out for help. ICE officers are not always the best at finding out if there’s victims.”
Overall, the growing sense of uncertainty, the anti-immigration rhetoric, and the threats to sanctuary city are leaving a strong impact on domestic violence victims who live in a legal gray area and may not be well versed in their legal rights. “If you think about victims of domestic violence who are already being controlled by a perpetrator, that is compounded and exacerbated when you rely on that person to interpret the laws for you, who is filtering all that information to control you,” Monica McLaughlin, Deputy Director of Public Policy at the National Network to End Domestic Violence, tells Bustle.
The underlying problem is that even if undocumented immigrants can technically get help, McLaughlin explains, “if what’s been communicated indicates that they can’t because they’re not safe, then survivors really aren’t going to reach out to law enforcement for help.”
The owner of a Houston health clinic pled guilty to insurance fraud after billing for medical services � often provided to injured employees � despite having no licensed medical staff at the clinic. Instead, investigators found that the clinic was using foreign medical students to provide care.
Rosemary Phelan, the owner of Rose�s Houston Healthcare Clinic, entered a guilty plea in Harris County Court and was sentenced to seven years deferred adjudication and ordered to pay $88,000 in restitution.
A joint investigation by the Texas Department of Insurance Division of Workers� Compensation and Texas Mutual Insurance Company revealed that Phelan�s clinic had no licensed medical providers on staff yet continued to accept patients. She would then file fraudulent workers� compensation claims to collect from insurers.
According to investigators, the clinic had a licensed doctor on staff at one time. When that doctor left in 2012, Phelan began hiring foreign medical students to act as doctors and treat patients.
Workers� Compensation Commissioner Ryan Brannan said this case was particularly egregious. �Someone filing false claims is bad enough,� he said. �But this scam put people�s health at risk. It�s unconscionable.�
Phelan submitted $166,843 in fraudulent workers� compensation claims, representing more than 50 injured employees, claiming they had been treated by the clinic�s previous doctor.
Phelan pled guilty to second degree insurance fraud and a felony charge of practicing medicine without a license. The investigation found that her clinic was supplying narcotics to patients using the credentials of doctors and physician assistants who no longer worked at the clinic without their knowledge.
You can report suspected cases of insurance fraud to TDI-DWC by calling the Consumer Help Line at 1-800-252-3439 or by visiting�www.tdi.texas.gov/fraud/report.html.�
For more information, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .
Additional Topics: Neck Pain and Auto Injury
During an automobile accident, the body is exposed to a sheer force from the impact which causes the head and neck to abruptly jerk back-and-forth in relation to the rest of the body, which remains stationary in the car seat. Due to this motion, it’s common for the neck to suffer from whiplash, a painful injury which leads to neck pain as well as other symptoms.
Remote doctor appointments could be coming soon to the school nurse’s office.
Starting Sept. 1, a new law will allow physicians to get paid for seeing children over a sophisticated form of video chat, as long as the student is at school and enrolled in the state’s Medicaid program for the poor and disabled. The law’s supporters say it could lead more schools around the state to set up nurse’s offices equipped to handle remote doctor visits — and save parents time and money.
They say adults shouldn’t have to take time off work and kids shouldn’t have to miss school to get routine health care, like when a child has an ear infection or skin rash, because modern technology allows a remote doctor to get high-quality, instantaneous information about patients. An electronic stethoscope allows the doctor to hear a child’s heartbeat, for example, and a digital otoscope offers a look into the child’s ear — all under the physical supervision of a school nurse.
Then, if the doctor makesa diagnosis, parents can pick up their child’s prescription from the pharmacy on their way home from work, said state Rep. Jodie Laubenberg, a Republican of Parker and the bill’s author.
“You want to talk about access? You want to talk about affordability? This is their access,” Laubenberg said. “We can treat the child, have him ready to go, and we can leave him here.”
“You don’t have to take off work,” she said. “He doesn’t have to leave school. It’s less disruptive.”
Texas is not the first state to pay doctors for school-based telemedicine for Medicaid patients. Georgia and New Mexico have similar laws on the books, according to the American Telemedicine Association.
Laubenberg said she wrote the bill to support programs like one put on with Children’s Health hospital system in North Texas. There, children from 27 grade schools in the Dallas-Fort Worth region have electronic access to three health care providers — one doctor and two nurse practitioners — while school nurses sit in on the visits. A spokesman for Children’s said the program will soon expand to 30 more schools.
In that program, school nurses — health care workers who don’t necessarily hold a nursing degree — can examine children, and, if they have an apparent health problem, send their information to Children’s to schedule an appointment. The program is currently funded by a five-year pot of mostly federal money.
Children’s says the new law will allow its program to remain financially viable when that funding source goes away, and allow similar programs to take hold across the state.
“Children’s Health in our programming is not going to be the [primary care provider] for every kid that walks through the door, so in order to sustain the program, we needed to be able to bill for that service,” said Julie Hall Barrow, senior director of healthcare innovation and telemedicine for the hospital system.
Other programs may follow suit. Texas Tech University’s medical school has partnered with the school district in Hart to run a school-based telemedicine clinic for more than a decade. That, supporters say, has expanded access to health care in the rural community north of Lubbock.
“Ninety percent of what you would see in a general pediatric clinic, we can handle it by telemedicine,” said Richard Lampe, chairman of the Department of Pediatrics at the Texas Tech University Health Science Center. He said that included sports injuries, strep throat — and among middle and high school students especially, mental illnesses like anxiety and depression.
But there are still questions under the new law about how schools will decide which students are eligible to have virtual doctor visits. The state will only pay doctors for seeing kids if they’re enrolled in the Medicaid program.
“I think the question goes to, what happens if the kid gets sick and they don’t have Medicaid?” said Quianta Moore, a researcher at Rice University’s Baker Institute for Public Policy, who has written about school-based telemedicine.
That could raise questions about equity and access, Moore said, because doing “health intervention in school is actually very effective.”
Critics said expanding remote doctor visits into schools could lead to more doctors practicing medicine inappropriately on children.
“You’ll end up sometimes with a doctor that’s not adequately informed as to the patient’s history or allergies,” said Lee Spiller, the policy director for the Texas branch of the Citizens Commission on Human Rights, a nonprofit mental health watchdog. “How can you expect a kid to really be aware of risks, their allergies, medical history?”
Spiller also said he worried parents who signed blanket consent forms at the beginning of the school year would not fully understand what they were signing their children up for.
In Dallas, at Uplift Peak Preparatory, health office aide Ruby Jones said some parents chose not to sign consent forms, but if their children got sick and came to visit her, she would try to talk to them about the “amazing tool” of telemedicine.
Said Jones: “There’s nothing more rewarding when … you see a scholar walking down the hall and they say, ‘Thanks, Ms. Jones. I feel better.’”
Throughout August, The Texas Tribune will feature 31 ways Texans’ lives will change because of new laws that take effect Sept. 1. Check out our story calendar for more.
The Texas Tribune is a nonpartisan, nonprofit media organization that informs Texans — and engages with them – about public policy, pol itics, government and statewide issues.
Texas has some of the nation�s most affordable workers� compensation coverage, according to a 2016 study, which found that the Lone Star State had the 10th lowest rates among all states.
The study by the Oregon Department of Consumer and Business Services ranks all 50 states and Washington, D.C., based on premium rates that were in effect January 1, 2016. Texas, with premiums at $1.45 per $100 of payroll, ranked No. 10, four spots higher than the previous study in 2014.
�It�s great to see evidence of the progress we�ve made in affordability,� said Texas Commissioner of Workers� Compensation Ryan Brannan. �Lower injury rates, better return-to-work outcomes for injured employees, and reduced medical costs per claim are a big factor, but the results of the Oregon study are also proof that we�re becoming more efficient, proactive, and transparent.�
Texas Workers’ Compensation Rates
Texas� workers� compensation premium rates are about 21 percent lower than the median for all states, according to the study. California has the most expensive rates in the nation, at $3.24 per $100 of payroll. Rates in Texas are also favorable compared with other high-population states, such as Florida, Illinois, and New York. North Dakota had the least expensive rates, at 89 cents per $100 of payroll.
�The Texas workers� compensation system has been a model for other states in many ways,� Brannan said. �And we�re going to keep improving. We�re working on several efforts to keep our costs low. We�re cutting data storage costs by digitizing records, reducing prescription drug costs with a closed formulary, and eliminating waste and fraud with a new in-house fraud unit. We�ve also launched a statewide effort to streamline the dispute resolution process.��
For more information, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .
Additional Topics: Preventing Work Disability with Chiropractic
After being involved in an unfortunate accident at work, injuries and aggravated conditions resulting from the incident can often lead to a variety of painful symptoms and complications, if left untreated, along with missed days at work and lost wages. A new research study showed that workers who received regular chiropractic care experienced less work-related injuries.
IFM's Find A Practitioner tool is the largest referral network in Functional Medicine, created to help patients locate Functional Medicine practitioners anywhere in the world. IFM Certified Practitioners are listed first in the search results, given their extensive education in Functional Medicine
