Medical Legal Consulting News, June 2013
IN THIS ISSUE:
- Case Studies: Rock and Roll
- Vocabulary Quiz: Joint Replacement
Greetings! Welcome to the latest issue of Medical Legal Consulting News from MLCS, Inc. Hopefully by now you are beginning to feel like summer is finally here—even though the weather is still catching up. But then what else would we expect? After all, we are based in Chicago.
Continuing with our musical theme for 2013, MLCS’ Greatest Hits, in this issue we’ll explore two “rock and roll” medical record reviews. Both mechanisms of injury involved actual rocks. In the course of the reviews, we found a natural history of recovery (the melody line) buried in a mountain of medical records with a mix of excessive and unrelated treatment.
We welcome your feedback and appreciate any suggestions for case studies for upcoming newsletters. Look for our “blues” article in the Summer 2013 issue scheduled for August, when it should really feel like summer!
All the best,
Linda Luedtke, RN, MSN
President, Director of Consulting Services
Case Studies: Rock and Roll
MLCS hears the true melody in a lot of noise.
The greatest hits of MLCS have included some good ole’ rock and roll—record reviews involving slips, trips, and hits with rocks. This month, we look at two reviews in which rocks were involved in the mechanism of injury. Both included a lot of noise (complaints and treatments), and a loud bass line of excessive treatment that nearly covered the true melody of the natural history, the expected course of recovery for injury.
However, with their trained ears and the ability to “sight read” medical records, the MLCS nurses could identify the melody line and distinguish between the related and the unrelated treatment.
In Case I, MLCS was asked to review voluminous records and $100,000 in medical specials for a claimant who alleged injuries to the legs, both knee joints and the entire spine, as well as a migraine, from being struck by a boulder while at work. MLCS was asked to determine nature and extent of injury.
As would be expected when struck by a rock, we found objective evidence of soft tissue injuries and deep contusions, which resolved according to natural history. However, in the mix of this rock ballad, the claimant reported increasing knee joint symptoms, spinal complaints and headache, which did not fit the melody line.
The nurse’s review found clues of pre-existing factors contributing to the complaints and diagnostic abnormalities. There had been a history of prior lower body injury and leg fractures. The claimant’s physical job involved repetitive strain on several joints. He also had a history of participating in strenuous recreational activity. MRI scans of both knees revealed multiple abnormalities, but these were consistent with degenerative findings, particularly as the initial post-accident knee joint exams were normal.
The claimant went on to have surgery on both knees and progressed to increasing spinal complaints that did not improve with treatment, including injections and radiofrequency ablation.
The nurse consultant tracked inconsistencies in both complaints and treatments from numerous providers, and found that less than 10% of the medical specials were well supported by the provided records. Just like in bad rock and roll, when the bass is so loud you can’t hear the melody, extensive complaints and seeking treatment can cover up the expected course of the traumatic injuries.
But the MLCS nurse identified the notes consistent with the melody of natural history. Sometimes one has to “listen close” to hear the truth in the records.
Case II also involved a large volume of records dating back to the 1970s. The claimant alleged injuries to the back and a pre-existing knee joint replacement resulting from a fall on a rock. In this case, MLCS was asked to determine if there was an aggravation of pre-existing conditions—on top of examining nature and extent of injury.
While there was a ‘heavy bass line’ of multiple complaints and treatment in this review, as well, the nurse consultant could pick out a repeating refrain. The claimant’s post-accident symptoms and treatment were very similar to that documented pre-accident. There was a pattern of joint replacement complications (including an increased risk for falls) and repeated surgeries before the fall that continued post-accident.
Investigation into the nature of the prior joint replacement complications and the type of prosthetics demonstrated that the post-accident complaints were a continuation of the same melody. In other words, the treatment he required post-accident was not unexpected given his long history of treatment.
Medical literature supported that treatment rendered post-accident likely would have been required because of the joint replacement complications—regardless of intervening trauma. With knowledge of natural history for trauma, as well as the course of a complicated knee joint replacement, the nurse consultant was able to reduce over 30 years of records into a manageable and useful defense work product.
Vocabulary Quiz: Joint Replacement
Start off evaluating joint injury claims on the right note! Understanding terminology is a major key.