The Medical Post December 05, 2000 Volume 36 Issue 41 WCB case management riles Sask. physicians Inconsistencies plague system as non-med personnel often intervene By Deana Driver REGINA – Non-medical personnel in Saskatchewan are making decisions affecting patient health, say physicians. And doctors want something done about it.    After much discussion and anecdotal evidence, the Saskatchewan Medical Association's (SMA) representative assembly approved a motion at their fall meeting to ask their board to contact the Workers Compensation Board (WCB) and Saskatchewan Government Insurance (SGI) to address inconsistencies in their case management, poor communication with physicians, and to improve management of coordinated care.    Dr. Briane Scharfstein, executive director of the SMA, told the delegates that this has been a long-standing issue with the WCB.    "We meet with them regularly. We've been asking them to do a survey of physicians for two and a half years and now they've agreed to do a survey."    Dr. Wayne Stanley, a general practitioner in Moose Jaw, said a physician might have two patients with carpal tunnel syndrome, only one of which is covered by WCB. At the minimum, physicians need criteria the WCB is using. He said forms filled out by physicians are not kept in the patient files but are reworded into a summary document by WCB staff and are often reworded incorrectly.    "WCB loves to phone patients and give them instructions over the telephone" and then there is no written record of what patients were told.    "When push comes to shove, WCB will not back up those claims," said Dr. Stanley.    Another physician said WCB and SGI appear to place the opinions of physiotherapists above those of physicians, which is sometimes done at the peril of the patient.    Dr. Bill Silver, an orthopedic surgeon, said he's heard stories of colleagues who have done a rotator cuff repair and then been told they have no input into the followup care of that patient.    "I, as a consultant, will ask for a specific therapy and am told by the compensation board they cannot get that sort of therapy for their patient," and so are excluded in the postoperative care, he said.    Dr. Ron Ailsby, a Regina orthopedic surgeon, said the WCB sends letters to family physicians telling them what method of treatment the board is imposing on the patient.    "It is a system thing and what they're doing is not our medical members that work for the WCB. It's been taken away from the medical physicians. It's being done by claims officers under the direction of directors, boards and other people," said Dr. Ailsby.    "We have non-medical people telling patients what they should do and should not do which it is totally medically non-indicated. We are fighting it and we are losing the battle," said Dr. Silver.    "So I guess we have to document this carefully, send it to Dr. Kendel (registrar of the College of Physicians and Surgeons of Saskatchewan), and say these people are practising medicine without a licence."   © Copyright 2006 The Medical Post. All rights reserved.

It occurs to me that the Saskatchewan Medical Association, and the College of Physicians & Surgeons, have more authority than they are currently exercising.  Both have been aware of the WCB's unlawful medical practices for years, yet they've done nothing to remedy this situation to date. There is no question that Board personnel are "Practicing medicine without a licence", and the majority of them have been in practice for quite some time. Anyone with reasonable intelligence knows that the Board's jurisdiction would not hold up against this charge in a court of law.

While I applaud the physicians who spoke out in this article, I strongly question the integrity of the self-governing body that licence them. My personal experience with this institution  has only managed to fuel this distrust (see Important Developments). It’s one thing for the College to dismiss the concerns of an injured worker; to dismiss the concerns of its member physicians is entirely another.