AB 1542 AND AB 2127 -- WILL THE GOVERNOR AVOID A COLLISION IN HEALTHCARE POLICY?

Governor Brown's healthcare policies are now colliding. In 2014 Governor Brown signed AB 2127 (Cooley) into law. As a result of this decision the California Education Code now requires that high school athletes who have sustained a cerebral concussion, even a mild one, must be evaluated by someone trained to make this evaluation before the athlete can return to play. The idea is to reduce the consequences of traumatic brain injury (TBI) which may follow a cerebral concussion or be delayed until a series of such concussions have occurred. The injured athlete is now required to get written clearance from a licensed health care provider trained in the management of concussions. This legislation is a step in the direction of protecting high school athletes.

Governor Brown now has a chance to sign legislation, AB 1542 (Mathis & Cooley),  that would similarly help injured workers. We have previously recommended that he sign this bill. Nonetheless, the bill remains subject to possible veto. Construction workers, roofers, persons who work at heights, are particularly prone to the type of injury that may cause cerebral concussion and lead to post-concussion syndrome secondary to TBI. California's injured workers deserve protection that is at least as cognizant of their well being as AB 2127 tries to be for high school athletes. That is in part why we ask again that Gov. Brown sign AB 1542, just as he signed AB 2127. In the case of the injured worker trained specialists in the form of NeuropsychQMEs are available and have been for 22 years. It makes no sense to cut this specialty out of the loop. They already are the "licensed health care provider" trained in the management of concussion that is required by law and by common sense. The injured worker who has sustained TBI should have this level of evaluation available.

AB 1542 also looks out for the employer because it provides a sound scientific basis whereby reassignment to modified work or to one's usual and customary job can be made with reasonable medical judgment. It is analogous to deciding whether or not injured athletes can return to play.
In the case of a TBI expertise is also needed for treatment decisions.

A veto of AB 1542 after having signed AB 2127 sends mixed messages on health care. Such a decision would relegate injured workers to a level of healthcare protection below that of injured high school athletes. We do not believe that Gov. Brown wants or needs such a healthcare policy collision.

AB 1542 (Mathis and Cooley): DRAMA IN THE CAPITOL

Now that AB 1542 (Mathis and Cooley) has passed the Senate, 39 to 0, having already passed the Assembly, 79 to 0, we have a unique situation wherein the Governor is being pressured by the Department of Industrial Relations (DIR)  to veto a bill that has unanimous bipartisan support. The reason given by DIR Director Christine Baker for public consumption is that "the California  Board of Psychology does not recognize neurospsychology as a subspecialty in psychology." 

On the other hand, the same California Board of Psychology accepts the American Psychological Association's (APA)  recognition of specialists in neuropsychology. In short, the APA recognizes neuropsychologists. Given these facts, it is difficult to fathom why DIR should object to AB 1542 unless there are other reasons we don't yet know about. What we are left with is that a specialty with national  recognition is being denied recognition in California. 

Medical specialists involved in the diagnosis and treatment of traumatic brain injury (TBI) also recognize the specialty role provided by the neuropsychology specialists, for instance, the American Academy of Neurology has published on this matter since 1966. 

In my personal letter to the Governor, I indicated that the DIR position, if the Governor bows to it, is likely to increase litigation since the current easy access to neuropsyche Qualified Medical Evaluations will be impeded. It will then be up to the applicants' lawyers to fight tooth-and-nail for neuropsyche evaluations for their TBI clients and for the defense lawyers to forestall successful litigation by the applicants' lawyers. Lawyers who fail to support their applicants' cases to the hilt may find themselves on the wrong side of a malpractice suit.

The same goes for the physicians who treat and evaluate injured workers. Failure to obtain neuropsyche assessment may be seen as a dereliction of duty by the physician, enough so that the physicians themselves become subject to potential liability or malpractice claims.

Disallowing recognition of neuropsychologists harms brain-injured workers and impairs the ability of the workers compensation system to take care of injured workers with TBI. Employers are also harmed when TBI patients are not properly assessed with reference to return to work status or feasibility for continued employment. 

AB 1542 preserves access of injured workers to neuropsychological expertise. I believe that should be enough reason for the Governor to sign AB 1542 into law.

References

"Reasons to Keep Neuropsychology as a Specialization in QMEs," Hannah Pence, MS, CRP, 09/01/2015;

"Three Comp Bills Left for Final Week of Session," workcompcentral, 09/04/2015;

"Does Somebody Want to Sabotage Neuropsychological Evaluations," workcompcentral, 5/20/2015;

"Neuropsychology Medical-Legal Evaluations (Neuropsyche QMEs): Does Somebody Want to Sabotage Neuropsychological Evaluations," The Weinmann Report, www.politicsofhealthcare.com, 4/25/2015;

"Is Mandatory Malpractice Ordered to Begin on Tuesday, 1 September 2015," The Weinmann Report, www.politicsofhealthcare.com, 8/27/2015;

"Neuropsychology -- The How and Why," James R. Cole, PhD, QME, California Society of Industrial Medicine and Surgery," 8/18/2015;

Analysis from Assembly Committee on Appropriations, 7/08/2015, Jimmy Gomez, Chair, prepared by Lisa Murawski.