MSIA 2011 Fall Conference

HEAD, SHOULDERS, KNEES, AND TOES 2011 Fall Conference
Suburban Collection Show Place

Novi, Michigan
2011 MSIA FALL CONFERENCE GOLD EXHIBITORS

CompOne Administrators, Inc. 888-298-9043 www.compone.net Brown Rehabilitation Management, Inc. 800-575-5175 www.brownre.com Data Surveys, Inc. 800-284-7001 www.datasurveys.com GENEX Services, Inc. 888-464-3639 www.genexservices.com PTPN 800-349-7774 - www.glptpn.com Medical Care Coordinators 800-382-1841 www.medcarecord.com Advantage Consulting, Inc. 248-689-0468 www.advconsultinginc.com
CALL FOR PRESENTATIONS 2012 CONFERENCES *Submissions accepted through December 31, 2011
The Michigan Self-Insurers Association (MSIA) is accepting proposals for educational presentations for the 2012 Spring Conference. The event will take place May 30, 2012 June 1, 2012 at the Grand Traverse Resort & Spa in Acme, Michigan. We are also accepting proposals for our 2012 Fall Conference, which will take place at the Suburban Collection Showplace in Novi, Michigan on Thursday October 18, 2012.
Check your attendee and exhibitor packets for application and details
Agenda
8:00 8:45 AM 8:45 9:00 AM 9:00 10:00 AM Registration & Breakfast Welcome / Overview / Business Meeting Changing Times Jerry Marcinkowski - Executive Secretary , MSIA Jay Quist - Director of Employment Services Division Kevin Elsenheimer -Director, Workers Compensation Agency
10:00 10:30 AM Break / Visit Exhibitors

10:30 10:45 AM Re-enactment of a complex claim scenario Rose Wohlgemuth, Trinity Health Patricia Stegner, ESIS Inc. Mari Beth Jelks, City of Grand Rapids 10:45 11:35 AM Mock Psychiatric IME & Results Dr. Harvey Ager, M.D., P.C.
11:35 1:00 PM
1:00 2:00 PM
Lunch/Visit Exhibitors
Mock Orthopedic Upper Extremity IME & Results Mock Orthopedic Lower Extremity RSD/CRPS IME & Results Dr. Mark Kwartowitz, D.O. Dr. Ronald Lederman, M.D. Break/Visit Exhibitors
2:00 2:30 PM
2:30 3:00 pm
3:00 3:15 PM
RSD/CRPS It happened to me Susan Cyrulnik, Schoolcraft College

Prizes / CEUs / Adjournment
2011 MSIA FALL CONFERENCE Business Meeting Audit Committee Nomination of Officers Ratification of Board Members
Michigan Self-Insurers Association

Gerald M. Marcinkoski - Executive Secretary BOARD OF MANAGERS
Amway Lorraine Climer City of Grand Rapids Mari Beth Jelks Consumers Energy Doug Wright 1st Vice Chair DTE Energy Doug Green Ford Motor Company Jonathan Parker Chairperson Kellogg Company Tara Albaugh General Motors Corporation LLC Susan Azar Ilitch Holdings, Inc. C. Michael Healy Treasurer Kelly Services Lesley Zielinski Marathon Petroleum Barbara Parker 2ndVice Chair Meijer Sherri Miller AT & T Michigan Lisa Bruno Spectrum Health Steve Ohman Trinity Health Teresa Fisk Wayne State University Pamela Galloway Wayne Co. Airport Authority Leigh Stepaniak Parker Hannifin Corporation Sally Perrin
Advisory Group
Libby Child Chrysler LLC Neil Levins Michigan Chamber of Commerce Wendy Block Michigan Manufacturing Association Jennifer Spike Smith Haughy Rice & Roegge Danielle Susser
Agenda
8:00 8:45 AM
8:45 9:00 AM 9:00 10:00 AM
Registration & Breakfast

Welcome / Overview / Business Meeting Changing Times Jerry Marcinkowski - Executive Secretary , MSIA Jay Quist - Director of Employment Services Division Kevin Elsenheimer -Director, Workers Compensation Agency
10:00 10:30 AM Break / Visit Exhibitors 10:30 10:45 AM Re-enactment of a complex claim scenario Rose Wohlgemuth, Trinity Health Patricia Stegner, ESIS Inc. Mari Beth Jelks, City of Grand Rapids 10:45 11:35 AM Mock Psychiatric IME & Results Dr. Harvey Ager, M.D., P.C. 11:35 1:00 PM 1:00 2:00 PM Lunch/Visit Exhibitors Mock Orthopedic Upper Extremity IME & Results Mock Orthopedic Lower Extremity RSD/CRPS IME & Results Dr. Mark Kwartowitz, D.O. Dr. Ronald Lederman, M.D. Break/Visit Exhibitors RSD/CRPS It happened to me Susan Cyrulnik, Schoolcraft College Prizes / CEUs / Adjournment
2:00 2:30 PM 2:30 3:00 pm 3:00 3:15 PM
Changing Times
H.B. #5002
A Summary
What H.B. #5002 does:

Modernizes Workers Compensation Act
Fixes Trammel Interest Professional Athletes for whatever reason language
What H.B. #5002 does:

Codifies Current Case Law
Vacillations of Supreme Court H.B. 5002 puts Rakestraw/Stokes-Sington into statutes H.B. 5002 puts Loftons understanding into statute Corrects Petersen Extends time of employer control over treatment
What H.B. #5002 does not do:

Change law on police and firefighters
Adopt theoretical wage earning capacity
Who to contact regarding H.B. #5002

Delaney Newberry
Michigan Manufacturers Association Phone: 517-487-8530 E-mail: newberry@mma-net.org
Wendy Block
Michigan Chamber of Commerce Phone: 517-371-7678 E-mail: wblock@michchamber.com
Department of Licensing and Regulatory Affairs [LARA]

Steven H. Hilfinger Director
Mike Zimmer Chief Deputy Director
Steve Arwood, Deputy Director Employment Security and Workplace Safety
Michigan Administrative Hearing System [MAHS] Mike Zimmer Executive Director
Workers Compensation Agency Kevin Elsenheimer, Director
G. Jay Quist, Division Director Employment Services
Lisa Klaeren, Chairperson Board of Magistrates
Jack Wheatley, Chairperson Michigan Compensation Appellate Commission
Agenda
8:00 8:45 AM
8:45 9:00 AM 9:00 10:00 AM

2:00 2:30 PM 2:30 3:00 pm 3:00 3:15 PM
Agenda
8:00 8:45 AM
8:45 9:00 AM 9:00 10:00 AM

2:00 2:30 PM 2:30 3:00 pm 3:00 3:15 PM
CLAIM SCENARIO
Mary is an inventory clerk for Builder Bobs Home Improvement Stores She took a tumble in aisle 7, near Tubs & Tiles where she injured her right wrist, shoulder, and struck her small toe
CLAIM SCENARIO CONTD

Employer Complications:
Late Reporting Late Authorization of Surgery Lack of modified duty work availability Delay in providing proper safety training Employer has pre-conceived notions regarding the value (or lack thereof) of nurse case management

Initial Diagnosis: Comminuted fracture of the right wrist (distal radius), right shoulder contusion, left small toe fracture Pre-existing medical: Non-insulin dependent type II diabetic, high blood pressure Prior history of being on a medical leave for depression

Employee Complications:
Husband is unemployed due to prior injury Employee takes care of 6 year old grandson Financial hardship Narcotic & anxiety medication being prescribed by the treating physician Indications of depression due to her injuries and additional stressors at home secondary to the injury Husband is not supportive

Updated Status Mary has had surgery of the right distal radius to reduce the fracture. Pins and metal plate were inserted into the wrist during surgery Therapy began 2 weeks post-op Hardware was removed 6 weeks post-op

Increase of complaints regarding left foot Burning, electric shock type pain Cannot stand anything to touch the foot Unbearable pain with temperature changes Ongoing pain in right wrist Therapist feels symptoms in foot point to CRPS/RSD

Physician has diagnosed Mary with Chronic Regional Pain Syndrome (left foot) Requesting referral to pain management specialist Mary is requesting adjuster to pay for psychiatric therapy and anxiety medication, as well as further care for her wrist pain

Adjusters Plan of Action:
Obtain a psychiatric IME to determine causation of current depression/psychiatric conditions, and if related determine appropriate treatment recommendations Obtain an IME to determine diagnosis of the left foot condition to rule in/out RSD diagnosis, & determine appropriate recommended treatment Obtain an IME on the ongoing wrist complaints to determine need for ongoing treatment, and suggest treatment plan if necessary
Agenda
8:00 8:45 AM
8:45 9:00 AM 9:00 10:00 AM

2:00 2:30 PM 2:30 3:00 pm 3:00 3:15 PM
Psychiatric IME & Presentation

Dr. Harvey G. Ager, M. D., P.C. Board Diplomate, American Board of Psychiatry & Neurology
29355 Northwestern Hwy., Suite 140 Southfield, MI 48034 (P) 248-356-8050
Differential Diagnosis of Pain

Somatoform disorders
Pain disorders associated with psychological factors Pain disorders associated with both psychological factors and a general medical condition Pain disorders associated with a general medical condition Hypochondriasis
Somatization disorder Mood Disorder due to a medical condition Factitious disorder Malingering
Dynamics of a Psychogenic Pain Disorder

Predisposing personality issues: histrionic and dependent Primary gain: unresolved psychological conflicts Secondary gain: External rewards (addictive drugs; sympathy from others; financial gain; avoidance of unpleasant tasks) Genetic factors
Agenda
8:00 8:45 AM
8:45 9:00 AM 9:00 10:00 AM

2:00 2:30 PM 2:30 3:00 pm 3:00 3:15 PM
Agenda
8:00 8:45 AM
8:45 9:00 AM 9:00 10:00 AM

2:00 2:30 PM 2:30 3:00 pm 3:00 3:15 PM
Orthopedic Exam Distal Radius Fractures
Mark Kwartowitz, D.O.

Board Certified & Fellowship Trained
Lederman Center for Orthopedic Surgery, Sports Medicine, & Physical Therapy Located in Lakes Medical Center West Bloomfield, MI
Mechanism of Injury
Fall Motor Vehicle Accident Trauma
Classifications (extensive and complex)

Extra articular Intra articular
Displaced Angulated Comminuted
Treatment Options
Conservative (non-operative)
Closed reduction Cast immobilization Splints
Treatment Options
Surgical Intervention
Percutaneous pin fixation External fixation ORIF
Associated Injuries
Ligamentous Distal Radioulnar Joint Nerve Injury
Complications
RSD/CRPS Nonunion Malunion
Orthopedic Exam RSD/CRPS of the Foot
Ronald Lederman, M.D.

Board Certified & Fellowship Trained
Lederman Center for Orthopedic Surgery, Sports Medicine, & Physical Therapy Located in Lakes Medical Center West Bloomfield, MI
RSD/CRPS
May be caused by minor or major trauma
Signs and Symptoms

Hypersensitivity Skin Discoloration Temperature Changes Nail Bed Changes Hair Follicle Changes Atrophy Decreased ROM
Treatment Options
Aggressive ROM/PT Desensitization/PT Lyrica Speed Gel 7 MLS Laser Therapy
Agenda
8:00 8:45 AM
8:45 9:00 AM 9:00 10:00 AM

2:00 2:30 PM 2:30 3:00 pm 3:00 3:15 PM
Agenda
8:00 8:45 AM
8:45 9:00 AM 9:00 10:00 AM

2:00 2:30 PM 2:30 3:00 pm 3:00 3:15 PM
It Happened to Me My Journey to Recovery
Susan Cyrulnik, Schoolcraft College & Workers Compensation Professional
Happy Mothers Day

Beautiful Sunny Day Enjoyed a wonderful Brunch with my family Needed to walk off those calories Lets go to the park and walk the dogs!
Whoops!!
Along come some joggers Bump into me! I fall, using my right hand to break the fall CRUNCH! PAIN! EMBARRASSMENT Dogs!
Hand Specialist
Confirmed the CRUNCH to be a Comminuted Displaced Fracture of the Distal Radius Surgery Metal Plate, Screws Hospital Stay! YIKES! I REALLY DID IT THIS TIME!
The Hospital
No problem! No pain! OMG! The anesthesia wore off! PLEASE GIVE ME ANOTHER BLOCK!
Post-Op
Keep your arm elevated at all times even at night Take your pain medicine! Start occupational therapy Exercise your fingers Rotate your arm Take your antibiotics. Do you need more pain medicine?
Perfect Patient?
Doctor & Therapist I promise to follow instructions to the letter EXCEPT taking that pain medication I have seen too many injured workers become addicted to pain medicine during my career You wont get addicted. You need to give your body a rest from the pain
Recovery
Still wearing a cast Occupational therapy 3x per week Fingers still swollen Pain is tolerable Exercising at home
Gee, I wish I could get a good nights sleep already!
Good News Bad News

It has been 6 weeks, lets remove the screws! Great! They are irritating, especially when exercising! Post-Op Dr. isnt pleased. Hand is VERY red, swollen, warm and it feels like it is on FIRE! This pain is different Please DO NOT touch my hand!
What is Happening?
My hand is going from bad to WORSE
Occupational therapist calls the doctor

Back to the doctor:
Sometimes Susan, the nervous system has an adverse reaction to trauma Im going to change your therapy regime Are you taking your pain meds? You need to. Sometimes, but I really dont want to get addicted
I CANT HAVE RSD! This cant be happening to ME!
Despair and Disbelief

How could this happen to me? This is my dominant hand will I ever be able to use it again? Work again?
The pain is exhausting

Therapy is discouraging, my fingers are so swollen I cant bend them at all
Dont Give Up Hope!

Let me introduce you to another patient with the same injury and RSD diagnosis She is 3 months ahead of you My guardian angel!
She CAN bend her fingers now!
Help Is On The Way!

Guardian angel turns out to be an orthopedic surgical nurse Her recipe for success?
Get to a specialist in treating RSD Make your recovery a full-time job Stay off the internet! Too much gloom and doom!
RSD Specialist
Physical Medicine & Rehabilitation Specialist:
You have 2nd stage CRPS Caught relatively early may take up to TWO years to fully recover BUT YOU CAN RECOVER! Need to reduce the pain and swelling
Neurontin for nerve pain Cortisone injections for swelling
Nerve Blocks & LOTS of Therapy

My least favorite part: Sympathetic nerve blocks Series of 3, every other day Have block and head directly to therapy Gives the therapist ability to be more aggressive
Slow and Steady Progress

Swelling is down Pain is tolerable again Able to slightly bend my fingers and wrist Osteopenia is retracting
IM A HAPPY CAMPER!
Danger Ahead
More surgery plate removal Fear of what happened after last surgery
Doctors theory was that my body adversely reacted to the trauma of surgery What if this happens again?
Not AGAIN!
Had a block before surgery
CRPS Symptoms Returned WORSE THAN BEFORE Couldnt tolerate COLD
Keep the Faith Just a Set-Back

Start over again
More Blocks More Cortisone Increase Neurontin Change therapy regime Pain meds to sleep Wear gloves to go outside
Road to Recovery
Needed more than ever to adhere to home exercise program and very aggressive occupational therapy
KEEP A POSITIVE ATTITUDE DONT GIVE UP!
Lessons Learned
CRPS is a real condition It is a very painful, emotionally challenging, and life disrupting condition Patients can feel hopeless Treatment is costly an added worry to patients and/or employers If caught early and treated aggressively, one CAN recover
What helped my recovery?

Early diagnosis Aggressive treatment plan Positive attitude Making recovery my job Multifaceted medical team
Surgeon or PMR for initial injury Pain Specialist Physical or Occupational Therapist
Encouragement
CRPS is real and can be a difficult diagnosis in both work related and nonwork related situations There will be ups and downs, but with the right treatment and perseverance recovery is possible!
Agenda
8:00 8:45 AM
8:45 9:00 AM 9:00 10:00 AM

10:00 10:30 AM Break / Visit Exhibitors 10:30 10:45 AM Re-enactment of a complex claim scenario Rose Wohlgemuth, Trinity Health Patricia Stegner, ESIS Inc. Mari Beth Jelks, City of Grand Rapids 10:45 11:35 AM Mock Psychiatric IME & Results Dr. Harvey Ager, M.D., P.C. 11:35 1:00 PM 1:00 2:00 PM Lunch/Visit Exhibitors Mock Orthopedic Upper Extremity IME & Results Mock Orthopedic Lower Extremity RSD/CRPS IME & Results Dr. Mark Kwartowitz, D.O. Dr. Ronald Lederman, M.D. Break/Visit Exhibitors RSD/CRPS It happened to me Susan Cyrulnik, Workers Compensation Professional Prizes / CEUs / Adjournment
2:00 2:30 PM 2:30 3:00 pm 3:00 3:15 PM
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HEAD, SHOULDERS, KNEES, AND TOES 2011 Fall Conference

Suburban Collection Show Place

2011 MSIA FALL CONFERENCE GOLD EXHIBITORS

10:00 10:30 AM Break / Visit Exhibitors

RSD/CRPS It happened to me Susan Cyrulnik, Schoolcraft College

Michigan Self-Insurers Association

Registration & Breakfast

2:00 2:30 PM 2:30 3:00 pm 3:00 3:15 PM

What H.B. #5002 does:

What H.B. #5002 does:

What H.B. #5002 does not do:

Who to contact regarding H.B. #5002

Department of Licensing and Regulatory Affairs [LARA]

Mike Zimmer Chief Deputy Director

Steve Arwood, Deputy Director Employment Security and Workplace Safety

Michigan Administrative Hearing System [MAHS] Mike Zimmer Executive Director

Workers Compensation Agency Kevin Elsenheimer, Director

G. Jay Quist, Division Director Employment Services

Lisa Klaeren, Chairperson Board of Magistrates

Jack Wheatley, Chairperson Michigan Compensation Appellate Commission

Registration & Breakfast

2:00 2:30 PM 2:30 3:00 pm 3:00 3:15 PM

Registration & Breakfast

2:00 2:30 PM 2:30 3:00 pm 3:00 3:15 PM

CLAIM SCENARIO CONTD

CLAIM SCENARIO CONTD

CLAIM SCENARIO CONTD

CLAIM SCENARIO CONTD

CLAIM SCENARIO CONTD

CLAIM SCENARIO CONTD

CLAIM SCENARIO CONTD

Registration & Breakfast

2:00 2:30 PM 2:30 3:00 pm 3:00 3:15 PM

Psychiatric IME & Presentation

Differential Diagnosis of Pain

Dynamics of a Psychogenic Pain Disorder

Registration & Breakfast

2:00 2:30 PM 2:30 3:00 pm 3:00 3:15 PM

Registration & Breakfast

2:00 2:30 PM 2:30 3:00 pm 3:00 3:15 PM

Orthopedic Exam Distal Radius Fractures

Mark Kwartowitz, D.O.

Classifications (extensive and complex)

Orthopedic Exam RSD/CRPS of the Foot

Ronald Lederman, M.D.

Signs and Symptoms

Registration & Breakfast

2:00 2:30 PM 2:30 3:00 pm 3:00 3:15 PM

Registration & Breakfast

2:00 2:30 PM 2:30 3:00 pm 3:00 3:15 PM

It Happened to Me My Journey to Recovery

Susan Cyrulnik, Schoolcraft College & Workers Compensation Professional

Happy Mothers Day

Gee, I wish I could get a good nights sleep already!

Good News Bad News

Occupational therapist calls the doctor

I CANT HAVE RSD! This cant be happening to ME!

Despair and Disbelief

The pain is exhausting

Dont Give Up Hope!

She CAN bend her fingers now!

Help Is On The Way!

Nerve Blocks & LOTS of Therapy

Slow and Steady Progress