OARP 2001 Spring Conference Highlights

The Conference was held March 23 at the Namaste' Retreat & Conference Center in Wilsonville, Oregon. Listed below are some of the highlights at the Conference. The 2002 Spring Conference will be held at Chemeketa Community College on May 17, 2002. For more information on the 2002 Conference

He noted that ultimately, the test upon which we are judged is established by our profession itself; that as a body, we define the standard of care to which we must adhere.  He noted that when a counselor is sued that the allegation is that the professional had a Duty (based on the Standard of Care), that the Standard of Care had been Breached, and that there are resulting Damages.   He noted that this type of litigation is “hot” at present, particularly in suing alternative health care providers. 

 He discussed Nicholson v. Blachly (1988) which held that the vocational counselor was not protected under exclusive remedy as was the insurer ORS656.018.  Topolic v. Rolie (1994), on the issue of exclusive remedy, held that TPA’s were covered, but not vocational counselors.  

He noted that counselors must take care in selection of vocational opportunities / new jobs for clients to be sure that they are within the bounds of their abilities.  He recommends being certain that approvals are provided by the physician (not an assistant).  He cautions that case notes should document everything, and that when issues are explained, that the counselor have the client document that they received an explanation, and that above all, vocational counselors need to be careful to be objective in your notes which are discoverable.

Mr. Moscato indicated that his advice to us as a group is that we must lobby to be included in the exclusive remedy provision of the law for the work we perform for carriers.  He also advises that all counselors should be insured for at least a million dollars as lawsuits are rarely files for less than half a million.

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To intervene, some things that work include:  you must identify the gain, do a risk / benefit analysis, and work on a substitution of benefit for gain.  Sometimes work hardening can help, or psychological intervention.

Dr. Gwinnell also discussed pain programs.  She indicated that patients fear them because when they complete the program their money stops even if the program didn’t help, they take away their pain meds, and it’s like going to work … you have to keep to someone else’s schedule.  They don’t work for folks who aren’t ready to be helped, and they don’t address the individual and their problems.  They are more assembly line.  And they don’t work because the person often returns right back to the same environment with no follow up.  They can work for some, but you must reinforce what happened there by going over and over the workbook, and they need lots of external support and follow up.

OARP Board of Directors

Scott Stipe, incoming  OARP President, discussed that IARP is currently working towards unifying the profession by building partnerships, much like the partnership OARP has been building with our public sector counterparts.  He noted that we are a profession, not just a business, and that profession is the same whether we work in public or private rehabilitation, in the insurance arena or other venues.

He noted that over the course of time that the profession has become more data driven, that we can no longer rely only on our own experience, but must provide information that is “measurable”.  He noted it is a strange world where you can no longer get the “old” GATB, that the new GATB hasn’t yet been published, and that one agency of the Department of Labor refuses to use the O*Net, which was put together by the DOL.

  He noted that there is increasing emphasis on credentials in both the private and public sectors.  He noted that the State of Washington is requiring national certification within 5 years, and that public sector counselors in Oregon will need to be nationally credentialed in 10 years.  Other states require credentialing now.

  Scott indicated that it is his hope that OARP continues to improve, and that for that to happen requires commitment from the membership.  He asks that we all try to bring in new members and that we be active participants.

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Janine Kanable, RN and Michele Nielsen, RN  

...discussed Difficult Medical Diagnoses, causes, pathophysiology, treatment, and suggested solutions for return to work.  Lateral epicondylitis is reportedly caused by repeated forceful extension of the wrist which may be the result of multiple small tears within the tendon over time or possibly repeated inflammation cause by multiple sprains.  It can be treated in varying ways, including bracing, injections, PT or surgery.  Recommendations for RTW would be to ergonomically evaluate the work area, and look at nonrepetitive work. 

  Thoracic Outlet Syndrome is reportedly characterized by a “loss of grip strength, weakness, loss of sensation along the brachial plexus, and vasomotor instability with episodes of cyanosis and coolness”.  Causes may be “repetitive motion of the arms outstretched or overhead, trauma, thrombosis, or Paget – Schroetter Syndrome“.  Treatment can include NSAIDS, PT, first rib resection or scalenectomy.  RTW issues include potential work site modifications to keep work below shoulder level.

Post-Concussive syndrome is different from traumatic head injury.  In the later a person generally is diagnosed from a loss of consciousness of 30 minutes or more, a Glasgow Coma Scale of 13 – 15, and / or posttraumatic amnesia not greater than 24 hours.  Post Concussion  “occurs when a person has had a traumatically induced physiological disruption of the brain function that includes one of the following: any period of loss of consciousness, any loss of memory for events, any alteration in mental state at the time of the incident, focal neurological deficits that may not be transient.”  Treatment requires a multidiscipline approach including medical and psychological care, rehabilitation services including nurse case managers and vocational counselors.  RTW is dependent on the severity of the condition and the functioning of the individual.  

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He discussed myofacial spinal pain which may require additional intervention to determine the primary cause before treatment, and that trigger point injections are not always efficacious.  Neuropathic spinal pain considerations include acute radiculopathy, chronic focal peripheral pain, and generalized pain.  Spinal cord stimulation can be considered for focal peripheral neuropathy, toxic metabolic neuropathy, complex regional pain syndrome, post surgical spinal nerve injury and ischemic extremity and cardiac pain.  The anticipated outcome would be covering the painful area with paresthesia, improving neural ischemia, or improving limb or cardiac pain.

He discussed Facet Arthropathy and that injections are not validated for long term resolution, only for acute pain.   In mechanical spinal pain you need to know the level of the disc to determine where the pain is generated.  He discussed the IDET procedure which can be useful here, but which is so new that there is no data for what will happen at, for example 10 years.  It looks good at this point.

He noted that morphine pumps can be preferable to provision of significant pain medication as it skips the brain stem functions so less medication seem to control the pain better and patients have less medicated effect.  Other medications are prescribed along with the pump, like clonidine or a local anesthetic.  Studies have shown a 60 to 90% reduction in spinal pain with its use.  Facet denervation shows only a 50% reduction in pain over a year, while with IDET 80% of the people have at least 50% of reduction of pain and 70% functional improvement.  With intrathecals, 60 to 95% get 60% relief.

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