Third, when treating a patient in a WC setting who mentions a potentially dangerous activity in her day-to-day job description, it is helpful to ask—with a healthy amount of skepticism—“Well, how are you going to do that?” Even more important, “How are you going to safely do that?” If you and the patient cannot come up with a good answer in the exam room, chances are that none will be found at the workplace, either; the activity in question should be curtailed. Throughout your rigorous examination of the patient’s work duties, use your skeptical voice to probe for unsafe situations and challenge potential workarounds.
Maintain genuine concern for the employee. If you are being pressured to return that employee to unsafe conditions, it is generally helpful to remind the party in question that a prematurely returned patient who deteriorates will become an employee who is out longer and drawing benefits longer. Further, any catastrophic loss related to an on-the-job injury will be borne by the carrier. So, if our stagehand sustains a serious injury after falling from 50 feet up (because she was distracted by the pain from the burn on her thigh), the employer/carrier will be liable for her lifelong treatment. Clearly voice your concern about the potential for the patient’s injury or reinjury and the substantial losses that could result.
Fourth, don’t let anyone influence your judgment inappropriately. This could be the carrier (who wishes to avoid financial liability), the employer (who wishes the employee to return to unrestricted work), your practice (which wishes to keep the carrier reasonably content for continued business), or the patient (who may wish to be excused from work without just cause—or, on the other hand, to return to work prematurely). Protect the patient and base your judgments on the facts. If you encounter any stiff resistance, solicit a colleague’s opinion.
Fifth, know whether other WC benefits have been paid out. If a previous injury has already been exacerbated, as in this case, take special efforts to ensure the patient’s condition does not worsen further.
Sixth, be wary of the impact of your intervention on the patient’s ability to work safely—including medications, and particularly narcotics. Think about it: You put the patient who works as a roofer on hydrocodone for back pain. The employer puts the patient on a roof, gravity puts the patient on the ground, and a lawyer puts you in court. You’ve indicated “no restrictions” for your patient to return to work as a roofer—although the hydrocodone bottle bears a sleepy-eye graphic right above the words “may cause dizziness.” A patient taking narcotics every four to six hours should not return to any job in which the effects of the medication themselves would be disqualifying. This also applies to any white-collar employees who may make suboptimal decisions as a result of taking such a medication. Therefore, view the injury and any potential adverse effects of your chosen therapy in light of the expected job duties. Where the two are incompatible, prohibit that duty.
Lastly, ask about driving: If driving lies within the employee’s scope of duties, it is directly addressable as a restriction. Although the patient with an acute neck strain may be able to sit in a cubicle in front of a monitor, he will not be able to drive a car safely.
Even when driving is not part of an employee’s duties, he still must drive to and from work. WC does not generally cover commuting; however, an employee on narcotics driving in the employer’s parking lot could present a hazard if he hits a co-worker. Therefore, make sure driving safety is thoroughly discussed with the patient and addressed. If driving is unsafe, make sure everyone knows it—even if it means the patient must find an alternative means of transportation to work. —DML
Cases reprinted with permission fromMedical Malpractice Verdicts, Settlements and Experts, Lewis Laska, Editor, (800) 298-6288.