Continuing a pain management protocol that includes an opioid prescription is “not reasonable and necessary” for a Pennsylvania worker with a nine-year-old back injury, a state court ruled on Tuesday.
Since his 2010 injury, Jason Golembesky, who was injured while working for Pipersville,
Pennsylvania-based Worth & Company Inc., a manufacturer of mechanical systems, had been on what testifying doctors considered to be higher doses of the potent opioid oxycodone. In 2016, his employer filed a utilization review petition requesting review of the “reasonableness and necessity of the treatment,” according to documents in Jason Golembesky, v. Workers' Compensation Appeal Board (Worth & Co. Inc.), filed in the Commonwealth Court of Pennsylvania in Harrisburg.
A utilization review doctor, in examining Mr. Golembesky’s treatment history and talking to his doctor, determined that the opioid prescription was excessive. Mr. Golembesky filed a petition for review of the doctor’s findings.
In testifying before a state workers compensation judge, Mr. Golembesky said that “he tried physical therapy at three different facilities, had 12-14 injections, and had a trial stimulator implanted, all of which were ineffective.” He also testified that “when he was taking the prescribed opioids, the medication managed his pain enough to allow him some increase in daily activity, such as taking walks,” documents state.
At the time of testifying he had been in a detoxification program and had not been taking opioids but that he had significant pain. His plan was to eventually “start from the beginning” with a lower dose of opioids to manage his pain.
His employer, in turn, submitted into evidence the findings of an independent medical review doctor who opined that Mr. Golembesky’s opioid prescriptions were “excessive” and that he believed that “while Claimant was taking ‘massive dosages, essentially three times what is considered a high dose of morphine equivalent,’ Claimant reported only a 5-10% improvement of his pain and symptoms.” The doctor also “believed that, due to Claimant's high intake of opioids, Claimant has some degree of opioid-induced hyperalgesia, which may have contributed to Claimant's ongoing symptoms as well as his general lack of motivation, fatigue, and depression.”
The judge ruled in favor of the employer, stating that the court found both testimonies by the reviewing physicians as “credible” and that the testimony of Mr. Golembesky’s doctor “lacked critical pieces of information, such as the results of any clinical examination, the risks of long-term narcotics use, and the presence or absence of any side effects from the opioids or the results of the urine screen tests.”
On appeal to the Workers’ Compensation Appeal Board, Mr. Golembesky argued “that the WCJ erred by crediting the opinions of (the reviewing physicians) over (his) Provider's opinion.” The board affirmed the judge’s ruling, which was then appealed to a higher court for review.
“The WCJ credited the testimony of (the reviewing physicians) that the risks of long-term opioid treatment outweighed the minimal benefit that Claimant was receiving, and that credibility determination is not subject to challenge on appeal,” the court wrote in its ruling Tuesday.
The employer and attorneys involved could not immediately be reached for comment.
Louise Esola - Business Insurance