Wednesday, June 17, 2009


AB 933 (FONG) which would require doctors doing utilization review for California's injured workers will be taken up again starting in January of 2010. The bill was scheduled for hearing on 6/24/09 by the Senate Labor and Industrial Relations Committee; however, the bill's author, Assemblyman Paul Fong requested cancellation of the hearing.

This writer first sought review of the policy allowing non-California licensed doctors to overrule California-licensed treating physicians in a letter to the Office of Administrative Law in August of 2005. The effort to secure reform legislation countermanding the interests of insurance companies and the Schwarzenegger administration is now on its way to a fifth year.

The Schwarzenegger administration remains firmly committed to the wishes of the insurance companies who are supported by the Chambers of Commerce, the California Manufacturing Association, and the California State Association of Counties, all known for their positions against the interests of workers, in this case, injured workers in particular.

As the law stands now, medical directors who supposedly supervise utilization review are required to be licensed in California -- the striking exemption is that the doctors who actually do the reviews do not need to be licensed in California. By contrast, doctors who do the same job in Texas must be licensed in Texas. The upshot is that Texas-licensed doctors may do utilization review in California without California licensure whereas California-licensed doctors may not do utilization review in Texas unless they're also licensed in Texas.

The power point of politics in this case is that the only successful program the Schwarzenegger administration has implemented since 2004 is Workers' Compensation Reduction. The program has reduced employers' costs somewhat (including in my private office) and in so doing has boosted insurance company profits by leaps and bounds. The program also grinds a massive boot into the necks of injured workers whose benefits have been slashed and whose access to care has been cut.

The political lesson is this: one doesn't score easily when one asks an administration to alter the only successful program it has managed to implement in four years. Putting labor down while elevating the profits of insurance companies has been a goal of the Schwarzenegger administration. Both goals have been reached.

Even for labor the stake is modest: injured workers often are forced out of the workplace, cease to be union members, no longer pay union dues, and become of limited interest even to their former unions.

Doctors treating injured workers often see their treatment protocols tossed into the ash heap. Meanwhile, the same doctors remain responsible for the treatment that the insurance companies and their compliant utilization review companies have delayed or denied.

Requiring state-licensure doesn't solve the entire problem: there are still compliant doctors with state licenses who'll deny or delay care that their paymasters want denied or delayed. All the same, AB 933 would at least make non-California licensed doctors responsible to state standards, standards for which they're not currently responsible, for instance, California-licensure requires a 12-hour course in pain management. Non-California licensed doctors don't currently have to comply with this requirement.

The long and the short of it is this: last year Gov. Schwarzenegger vetoed a similar bill, AB 2969 (Lieber), and this year was poised to veto AB 933 (Fong). The idea now is to outwait the Governor. The time he has left to grind injured workers into the dirt is limited. Supporters of reform can wait until the tide turns.

Thursday, June 11, 2009


by Robert L. Weinmann, MD

In a masterpiece of timing just before Memorial Day, staff and residents of the Yountville Veterans' Home were told that the California Department of Veterans' Affairs is closing the acute care unit of the home's Holderman Hospital. Layoff notices have been sent.

1,100 veterans who reside at the home are being ignored as though they didn't exist, like battle-worn boots that saw their best days at Bastogne, or maybe somewhere in Korea or Vietnam. Eight layoff notices were received by doctors represented by the Union of American Physicians and Dentists (UAPD). Yountville's Home Administration office explained that the state needs to save money. Evidently, slicing medical care from veterans is California's preferred choice.

Stuart A. Bussey, MD, JD, president of the UAPD, declared that the California Veterans Affairs Department (CVDA) "is using the budget cuts as an excuse to close down this acute care unit and cut other medical servces, which it has wanted to do for a long time."

Bussey stated that the Yountville facility "is one of the largest groups of veterans in the country, and they need the care that this unit and these physicians provide." Bussey pointed out that providing equivalent care off-site will increase costs and that the premature layoffs are a thinly disguised method of unit closure before the actual closure.

This action by the state reportedly will save California about $4,000,000 in staff time. No mention was made about the $11,000,000 annual lost reimbursement to the state. No mention was made about the shoddy treatment shoved down the throats of America's veterans. No mention was made of the shame this move bestows on California.

The UAPD states that the CDVA is not following proper procedures such as allowing community involvement and advises concerned citizens to register protests with state legislators. points out that the State of California, simultaneously with this cutback to veterans, panders to the insurance industry and willingly foregoes fees that could be paid by out-of-state utilization review doctors (see stories about AB 933, Fong) to the benefit of California's coffer.

source: UAPD press release, 5/28/09,