New law journal article – coming soon

15 Responses

1. Quick let me buy a Parrot so I can line the cage with the article. Just kidding J.T. Congrats. I am proud and will be one of the first to read this article.

   Good luck in your journalistic endeavors.

   1. I was thinking about writing about the efficacy of MUA and devoting it to you and Sun…

2. Hey now, don’t suck me into this anti MUA parade, I only said it didn’t make sense to knock someone out for a MRI, not MUA. I really don’t know what the risks/benefits are, haven’t dealt with that in the briefs yet. Despite the extent I have screwed up the law for carriers, I’m only three years into the no-fault game.

   1. I am coming across many situations where elderly people with high blood pressure, aggressive diabetes and a cancer survivor (that was today’s EUO) were ushered into an MUA procedure. Should this concern me, or is it normal for these types of patients to undergo an elective procedure involving general anesthesia? I have been doing this for so long that there seems to be a blurring of the lines between “reality” and “no-fault reality”.

3. That would deeply concern me. I might do something about it. This is ridiculous. This is not a debate. For the record I was offered a slew of these cases and after consultation with the best doctor in this country — my sister — I said “go earn an honest living.”

   I represent chiros too. None of them would touch this.

4. Does med. necessity contemplate risk? I think you know where I would take this if I were in your shoes, JT.

   1. You raise a good point, and one that I have been incorporating into my handling of these limited types of cases. I have an interesting story, but I cannot share it on here, about an MUA case that turned into a potential medical malpractice inquiry, in which I ended up in the middle.

      On another note, I was driving out to Massapequa Park the other night, and passed Dr. Giugliano’s office (of Giugliano v. Merchants fame), which is located on the corner of Newbridge Road and Merrick Road (Rt 27-A) in Bellmore I think. On his storefront, he advertises “chiropractor, wellness, and manipulation under anesthesia”. I am not going to judge, but should someone be advertising MUA on their store front, especially since it is supposed to be a procedure of last resort?

5. Only surgeons, who have no business other than surgery, should be allowed to advertise like that?

   1. Despite my thoughts on MUA, I know a few chiropractors who perform or have performed the procedure. They do not advertise in bold letters that they perform MUA. I do not know many doctors who put on their office window, clearly visible from the street: “we perform surgery”. The sign seemed odd and out of place.

6. I don’t pay much attention to these things, but my guess is that doctor’s ads say “surgeon” or “surgery.” It’s probably visible from the street.

   And how many surgeries are performed each year, where treatment would work just as well? Or slightly less well, but without the risk? Do patients really understand the risk inherent in getting knocked out? Probably not. But most patients will do whatever they are told; whether it’s surgery or MUA. Some people are more risk averse than others. Some want immediate relief of whatever ails them.

   If MUA does what it’s supposed to do, then I say let people take the risk, if that’s what they want. If doctors and chiros want to take the risk (getting sued, dead patients, etc), I don’t see a problem.

   1. As Sun pointed out, does the risk and attendant circumstances play into the calculus of whether the service is medically appropriate? Also, does the lack of informed consent that I am seeing to often play into this? I sometimes feel like I am litigating one of my medical malpractice cases when foraging into these medical necessity issues.

7. As much as I would like to agree with risk being a factor in medical necessity I would not go that far. You cannot let the insurance company make decisions regarding risk that are solely within the domain of the doctor patient.

   What a horrible precedent that would set.

   My father utilized experimental drugs that turned 3 months into 19 — 15 of which were very good. Of course my sister and brother in law made one call each and got him everything he needed for free. But what of others.

   We already have too many insurance company execs making health decisions.

   Informed consent is another issue. I would argue that the provider not be paid for lack there of. But you must assert it in a timely matter.

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   1. Someone beat through my spam filter. I hit the approve button on one of the 50 spams I get a day. But, I always enjoy helping college students out.