MSIA 2011 Fall Conference

8/3/2019 MSIA 2011 Fall Conference

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HEAD, SHOULDERS, KNEES, AND TOES

2011 Fall Conference

Suburban Collection Show Place

Novi, Michigan


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2011 MSIA FALL CONFERENCEGOLD EXHIBITORS

CompOne Administrators, Inc.888-298-9043www.compone.net

Brown Rehabilitation Management, Inc.

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888-464-3639www.genexservices.com

PTPN

800-349-7774 - www.glptpn.comMedical Care Coordinators

800-382-1841www.medcarecord.com

Advantage Consulting, Inc.

248-689-0468www.advconsultinginc.com
http://www.compone.net/http://www.brownre.com/http://www.datasurveys.com/http://www.genexservices.com/http://www.glptpn.com/http://www.datasurveys.com/http://www.advconsultinginc.com/http://www.advconsultinginc.com/http://www.datasurveys.com/http://www.glptpn.com/http://www.genexservices.com/http://www.datasurveys.com/http://www.brownre.com/http://www.compone.net/


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CALL FOR PRESENTATIONS 2012 CONFERENCES

*Submissions accepted through December 31, 2011

The Michigan Self-Insurers Association (MSIA) is acceptingproposals for educational presentations for the 2012 SpringConference. The event will take place May 30, 2012 June 1, 2012at 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


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Agenda

8:00 8:45 AM Registration & Breakfast

8:45 9:00 AM Welcome / Overview / Business Meeting

9:00 10:00 AM Changing Times

Jerry Marcinkowski - Executive Secretary , MSIAJay Quist - Director of Employment Services DivisionKevin Elsenheimer -Director, Workers Compensation Agency

10:00 10:30 AM Break / Visit Exhibitors

10:30 10:45 AM Re-enactment of a complex claim scenarioRose Wohlgemuth, Trinity HealthPatricia Stegner, ESIS Inc.Mari Beth Jelks, City of Grand Rapids

10:45 11:35 AM Mock Psychiatric IME & ResultsDr. Harvey Ager, M.D., P.C.

11:35 1:00 PM Lunch/Visit Exhibitors

1:00 2:00 PM Mock Orthopedic Upper Extremity IME & ResultsMock Orthopedic Lower Extremity RSD/CRPS IME & ResultsDr. Mark Kwartowitz, D.O.Dr. Ronald Lederman, M.D.

2:00 2:30 PM Break/Visit Exhibitors

2:30 3:00 pm RSD/CRPS It happened to meSusan Cyrulnik, Schoolcraft College

3:00 3:15 PM Prizes / CEUs / Adjournment


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2011 MSIA FALL CONFERENCE

Business Meeting

Audit Committee

Nomination of Officers Ratification of Board Members


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Michigan Self-Insurers Association

AmwayLorraine Climer

City of Grand RapidsMari Beth Jelks

Consumers EnergyDoug Wright1stVice Chair

DTE EnergyDoug Green

Ford Motor CompanyJonathan ParkerChairperson

Kellogg CompanyTara Albaugh

Gerald M. Marcinkoski - Executive Secretary

General Motors Corporation LLCSusan Azar

Ilitch Holdings, Inc.C. Michael HealyTreasurer

Kelly ServicesLesley Zielinski

Marathon PetroleumBarbara Parker2ndVice Chair

MeijerSherri Miller

Smith Haughy Rice & RoeggeDanielle Susser

BOARD OF MANAGERS

Advisory Group

Libby Child

Chrysler LLCNeil Levins

Michigan Chamber of CommerceWendy Block

AT & T MichiganLisa Bruno

Spectrum HealthSteve Ohman

Trinity HealthTeresa Fisk

Wayne State UniversityPamela Galloway

Wayne Co. Airport AuthorityLeigh Stepaniak

Parker Hannifin CorporationSally Perrin

Michigan Manufacturing AssociationJennifer Spike


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Agenda







10:45

11:35 AM Mock Psychiatric IME & ResultsDr. Harvey Ager, M.D., P.C.







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Changing Times

H.B. #5002

A Summary


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What H.B. #5002 does:

Modernizes Workers Compensation Act

Fixes Trammel Interest

Professional Athletes

for whatever reason language


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What H.B. #5002 does:

Codifies Current Case Law

Vacillations of Supreme Court

H.B. 5002 puts Rakestraw/Stokes-Singtoninto statutes

H.B. 5002 puts Loftons understanding intostatute

Corrects Petersen Extends time of employer control over

treatment


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What H.B. #5002 does not do:

Change law on police and firefighters

Adopt theoretical wage earning capacity


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Who to contact regardingH.B. #5002

Delaney Newberry

Michigan Manufacturers Association

Phone: 517-487-8530

E-mail: [email protected]

Wendy Block

Michigan Chamber of Commerce

Phone: 517-371-7678

E-mail: [email protected]


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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 ZimmerExecutive Director

G. Jay Quist, Division Director

Employment Services

Lisa Klaeren, Chairperson

Board of Magistrates

Jack Wheatley, Chairperson

Michigan Compensation Appellate

Commission

Workers Compensation Agency

Kevin Elsenheimer, Director


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Agenda







10:45








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Agenda







10:45








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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


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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 nursecase management


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Initial Diagnosis: Comminuted fracture of

the right wrist (distal radius), right shouldercontusion, left small toe fracture

Pre-existing medical: Non-insulindependent type II diabetic, high bloodpressure

Prior history of being on a medical leavefor depression


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Employee Complications:

Husband is unemployed due to prior injury

Employee takes care of 6 year old grandson

Financial hardship

Narcotic & anxiety medication beingprescribed by the treating physician

Indications of depression due to her injuriesand additional stressors at home secondary tothe injury

Husband is not supportive


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Updated Status

Mary has had surgery of the right distalradius to reduce the fracture. Pins andmetal plate were inserted into the wristduring surgery

Therapy began 2 weeks post-op

Hardware was removed 6 weeks post-op


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Increase of complaints regarding left foot

Burning, electric shock type pain

Cannot stand anything to touch the footUnbearable pain with temperaturechanges

Ongoing pain in right wristTherapist feels symptoms in foot point toCRPS/RSD


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Physician has diagnosed Mary with

Chronic Regional Pain Syndrome (leftfoot)

Requesting referral to pain managementspecialist

Mary is requesting adjuster to pay forpsychiatric therapy and anxietymedication, as well as further care for herwrist pain


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Adjusters Plan of Action: Obtain a psychiatric IME to determinecausation of current depression/psychiatricconditions, 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 recommendedtreatment

Obtain an IME on the ongoing wrist complaintsto determine need for ongoing treatment, and

suggest treatment plan if necessary


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Agenda



9:00 10:00 AM Changing TimesJerry Marcinkowski - Executive Secretary , MSIAJay Quist - Director of Employment Services DivisionKevin Elsenheimer -Director, Workers Compensation Agency



10:45








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Psychiatric IME

& PresentationDr. Harvey G. Ager, M. D., P.C.

Board Diplomate, American Board ofPsychiatry & Neurology

29355 Northwestern Hwy., Suite 140Southfield, MI 48034

(P) 248-356-8050


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Differential Diagnosis of Pain

Somatoform disorders Pain disorders associated with psychological factors

Pain disorders associated with both psychological factorsand 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


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Dynamics of a PsychogenicPain Disorder

Predisposing personality issues: histrionic

and dependent

Primary gain: unresolved psychologicalconflicts

Secondary gain: External rewards(addictive drugs; sympathy from others;

financial gain; avoidance of unpleasanttasks)

Genetic factors


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Agenda






10:45








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Agenda






10:45








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Orthopedic ExamDistal 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


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Mechanism of Injury

Fall

Motor Vehicle Accident

Trauma


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Classifications(extensive and complex)

Extra articular

Intra articular

Displaced

Angulated

Comminuted


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Treatment Options

Conservative (non-operative)

Closed reduction

Cast immobilization

Splints


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Treatment Options

Surgical Intervention

Percutaneous pin fixation

External fixation

ORIF


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Associated Injuries

Ligamentous

Distal Radioulnar Joint

Nerve Injury


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Complications

RSD/CRPS

NonunionMalunion


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Orthopedic ExamRSD/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


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RSD/CRPS

May be caused by minor or major trauma


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Signs and Symptoms

Hypersensitivity

Skin Discoloration

Temperature ChangesNail Bed Changes

Hair Follicle Changes

AtrophyDecreased ROM


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Treatment Options

Aggressive ROM/PT

Desensitization/PTLyrica

Speed Gel 7

MLS Laser Therapy


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Agenda






10:45




2:00

2:30 PM Break/Visit Exhibitors




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Agenda






10:45




2:00





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It Happened to Me

My Journey to Recovery

Susan Cyrulnik, Schoolcraft College

& Workers Compensation Professional


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Happy Mothers Day

Beautiful Sunny Day

Enjoyed a wonderful Brunch with myfamily

Needed to walk off those calories

Lets go to the park and walk the dogs!


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Whoops!!

Along come some joggers

Bump into me!

I fall, using my right hand to break the fallCRUNCH!

PAIN!

EMBARRASSMENTDogs!


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Hand Specialist

Confirmed the CRUNCH to be aComminuted Displaced Fracture

of the Distal Radius

Surgery

Metal Plate, Screws

Hospital Stay!

YIKES! I REALLY DID IT THIS TIME!


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The Hospital

No problem! No pain!

OMG! The anesthesia wore off!

PLEASE GIVE ME ANOTHER BLOCK!


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Post-Op

Keep your arm elevated at all times evenat night

Take your pain medicine!

Start occupational therapyExercise your fingers

Rotate your arm

Take your antibiotics. Do you need morepain medicine?


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Perfect Patient?

Doctor & Therapist I promise to followinstructions to the letter EXCEPT taking thatpain medication

I have seen too many injured workers become

addicted to pain medicine during my careerYou wont get addicted. You need to give your

body a rest from the pain


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Recovery

Still wearing a castOccupational therapy 3x per week

Fingers still swollen

Pain is tolerable

Exercising at home

Gee, I wish I could get a good nights sleep

already!


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Good News Bad News

It has been 6 weeks, lets remove the screws!Great! They are irritating, especially whenexercising!

Post-OpDr. isnt pleased. Hand is VERY red,swollen, warm and it feels like it is on FIRE!

This pain is differentPlease DO NOT touchmy hand!


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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


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I CANT HAVE

RSD!

This cant be

happening to

ME!


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Despair and Disbelief

How could this happen to me?

This is my dominant hand will I ever be able touse it again? Work again?

The pain is exhausting

Therapy is discouraging, my fingers are soswollen I cant bend them at all


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Dont Give Up Hope!

Let me introduce you to another patient with thesame injury and RSD diagnosis

She is 3 months ahead of you

My guardian angel!

She CAN bend her fingers now!


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Help Is On The Way!

Guardian angel turns out to be an orthopedic surgicalnurse

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!


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RSD Specialist

Physical Medicine & RehabilitationSpecialist:

You have 2nd stage CRPS

Caught relatively early may take up to TWOyears to fully recover BUT YOU CANRECOVER!

Need to reduce the pain and swelling

Neurontin for nerve pain

Cortisone injections for swelling

Nerve Blocks & LOTS of


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Nerve Blocks & LOTS ofTherapy

My least favorite part: Sympathetic nerveblocks Series of 3, every other day

Have block and head directly to therapy

Gives the therapist ability to be moreaggressive


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Danger Ahead

More surgery plate removal

Fear of what happened after last surgery

Doctors theory was that my bodyadversely reacted to the trauma of surgery

What if this happens again?


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Not AGAIN!

Had a block before surgery

CRPS Symptoms Returned -WORSE THAN BEFORE

Couldnt tolerate COLD

Keep the Faith


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Keep the FaithJust a Set-Back

Start over again More Blocks

More Cortisone

Increase Neurontin

Change therapy regime

Pain meds to sleep

Wear gloves to go outside


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Road to Recovery

Needed more than ever to adhere tohome exercise program and veryaggressive occupational therapy

KEEP A POSITIVE ATTITUDEDONTGIVE UP!


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Lessons Learned

CRPS is a real conditionIt is a very painful, emotionallychallenging, and life disrupting condition

Patients can feel hopeless

Treatment is costly an added worry topatients and/or employers

If caught early and treated aggressively,one CAN recover


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What helped my recovery?

Early diagnosisAggressive treatment plan

Positive attitude

Making recovery my job

Multifaceted medical team

Surgeon or PMR for initial injury

Pain Specialist

Physical or Occupational Therapist


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Encouragement

CRPS is real and can be a difficultdiagnosis in both work related and non-work related situations

There will be ups and downs, but with theright treatment and perseverance recoveryis possible!

Agenda


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9:00 10:00 AM Changing TimesJerry Marcinkowski - Executive Secretary , MSIA

Jay Quist - Director of Employment Services DivisionKevin Elsenheimer -Director, Workers Compensation Agency



10:45




2:00


2:30 3:00 pm RSD/CRPS It happened to meSusan Cyrulnik, Workers Compensation Professional



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Reminder:

Conference Evaluation Forms

Recycle Name Badgesat Registration Table

Documents

MSIA 2011 Fall Conference