This one comes to me from my dear one, Bob Richter, in his finest hour, along with DME doc Dr. Jason Brokaw. Dr. Brokaw is a pain management expert who has recently enjoyed his share of victories in the credibility contest. This case highlights an ongoing script for high-dose opioids which was non-certified by Utilization Review—quite remarkably, for an individual who was working heavy duty carpentry work.
So what was the diagnosis? Bulging discs at multiple lumbar levels (isn’t a bulging disc a clinical variation of normal?)
What were the meds? Oxycodone, 90 mg daily (6 daily), Flexeril and Ambien, plus Lidocaine cream
Co-morbidities? Obesity and 1 kidney (the kidney situation precluding the use of NSAIDs)
The outcome? The Board orders a weaning from Claimant’s current high level of opioid usage, with the following observations:
- Dr. Balu’s recordkeeping is so haphazard that a critical document (the Narcotic Noncompliance Documentation Report completed in April 2016) was not produced until December 2016.
- Of greater concern, is Dr. Balu’s failure to do what he himself states should be done…….. manage Claimant’s pain with the least amount of medication.
- Long-term opioid usage is not generally endorsed.
- Considering that Dr. Balu has, by his own admission, not even attempted to wean down the Claimant’s opioid usage, the Board accepts Dr. Brokaw’s opinion concerning that proper balance over that of Dr. Balu.
The case is Jeffrey Sprouse v. John L. Briggs & Co., IAB#1272196 (4/25/17). Let the good times roll on the medication weaning process……..next stop, medical massage?