The following is a summary of a series of questions and answers that recently comprised a discussion on the WorkCompCentral Professional Forums entitled Please share your exp. with MPNS. The Forum postings have been edited for readability.

Q My ER has just initiated, founded, grouped an MPN panel and since I haven't had the luxery to work with them yet, what can I expect?

I heard there are some really bad apples in some of these. What happens if the CA doesn't like the MPN doc?

Since the MPN were created by the employer, for the employer and not necessarily the will of the "people," wouldn't it look stupid to object to your own IC doctor?

A-1 I hate to say it, but most of the MPNs I have seen so far have had a fairly large selection of some pretty good docs.

The main problem I see is that some of the best docs refuse to join and there are a lot of newbies I never heard of before in the MPNs, but in all fairness, there are some good, reasonable treaters as well.

However, at the top of each specialty, e.g., the person who has a mangled hand, who got good emergency treatment, but problems remain and 2 or 3 or more delicate surgeries are now needed by a specialist at, e.g., Stanford, UCSF, UCLA, UC Davis, etc. Who is going to help these people?

I had a case with these facts earlier in the year. All of the above said they would take "med-evac" helicopter emergencies, but as to "routine" surgeries to be scheduled at everyone's convenience, "We don't take comp cases, even on a referral from a specialist, unless it is an emergency." I couldn't find a hand specialty clinic in the state that would take him, even with a referral from a well known AME.

Defendants are going to save a few bucks on a lot of treatment, but lose it back in decreased function and additional medical expense because of a lack of qualified physicians on the more serious cases.

A-2 I have handled many of the acute/traumatic injuries which you just commented on.

First of all, they don't belong in an MPN. They need trauma care, no matter what the cost. (We) can't expect a trauma unit, nor a great surgeon to put up with W/C BS.

Injuries such as this need immediate care and not have to (shouldn't have to) do the DANCE with a QME. Time is of the essence. I know I've mentioned this before, but I used to work in the ER at a small hospital.

I've worked many overtime hours trying to take care of I/W's, whether it be an acute or serious injury, or just because they needed their RX's filled before the weekend.

The worse case I ever witnessed was a Spanish speaking I/W who got his arm stuck in a printing press. Co-workers were of Asian speaking language. Two hours later, he appeared in the ER and lost his (crushed) arm. It made me sick. This of course pre-dated my W/C days.

A-3 You are right. According to the regulations governing MPN, a serious trauma injury I think would be considered an acute injury and therefore the injured worker would be allowed to continue to treat outside of the network for the duration of the acute condition.

A-4 MPN's - this is what I've learned so far:

1. Pamphlet, Posting, Pamphlet - this means the ER must have given the EE a pamphlet on MPN's, posted information on MPN, give the EE another MPN pamphlet at time of injury.

2. MPN - If #1 done, then the IC can direct the EE to an MPN facility or doctor for treatment. If the EE doesn't like that doctor or facility, he/she is entitled to choose any other doctor within the MPN.

3. MPN redirecting - for new injuries that occur after your MPN has been approved by the AD, the IC has 30 days to redirect an EE to an MPN facility (provided pamphlet, posting, pamphlet was done by ER) in order to have the MPN control of treatment.

4. EE disagrees with PTP on medical treatment issues - EE can change doctors within the MPN (treatment only, if disagree about TD status that is another issue).

Our company has used our MPN for about 2 months now, and since our MPN is a somewhat large one, there has so far not been too many problems with redirecting or ensuring EE's treating within the MPN. Even for litigated cases, the AA has not objected to the use of the MPN doctors as there actually is a large pool of doctors to choose from.

Very few EE's have actually pre-designated a PTP in post-MPN. Actually none so far for new injuries on my cases.

But as with everything else in work comp, proper notices to the EE are required to invoke the MPN control.

MPN's differ from HCO's in that medical control is supposedly for the lifetime of a claim (unless the AME/QME process is invoked) whereas medical control in HCO's usually runs from 90 days to 180 days of the claim only. MPN Medical Control doesn't expire unless IC objects to treatment or PD, TD levels....

A-5 The rationale for the insurance carrier not having an avenue to object to the PTP aside from the panel QME process is that the MPN was selected by the insurance carrier, not by the injured worker. So it would seem strange to object to your own MPN doctor. UR would be one way to object to an MPN doctor.

It isn't clear what happens if the IC raises a 4061/4062 dispute within the MPN, and goes through the panel QME/AME process. I've heard various things, including if IC objects to its own MPN doctor, this may take the EE out of the MPN after seeing the panel QME doctor. But this isn't definitive.

Also my understanding of medical control within the MPN is that the MPN really is the extent of the IC's control over treatment. The EE can choose any doctor within the MPN, the IC can't send the EE to another MPN doctor for treatment.

A-6 I've spent HOURS on this subject today and I think I've figured it out.

After notice by the ER, the I/W goes to MPN. If I/W disagrees with TX or DX, then they can request a second opinion, within the MPN. Refer to CCR 9767.7. Then, if I/W doesn't agree with 2nd opinion doc, can request a 3rd opinion doc within the panel. If after all the timeframes and paperwork, the I/W still disputes this, they must file a request with the A.D. for an "IME," (remember that from the days of yore???) Refer to LC4616.4.

Has anyone gone this far yet?

So far the times tables are as follows:
1) Within 3 business days upon notification of an injury, an ER/IC/TPA must arrange an appt.
2) Within 1 Day of filing a claim form, the ER/IC/TPA must arrange an appt.
3) If I/W disputes the TX or DX from the PTP, they must arrange for a 2nd opinion within 60 days or it's forfeited.
4) Same with the 3rd opinion or it's forfeited.
5) If still disputed, must apply for an IME.

NOW, does the IMC have IME's in place yet? Because they are supposed to render an opinion within 20 days after the exam or diagnostic tests, whichever comes later...

So we (all) are looking at (worst case scenario) about 3+, 60+, 60+, 20 for the final IME, if we follow the yellow brick road. That's roughly 21 weeks into a case after the I/W objects to the PTP within the MPN.

I'll click my Ruby Slippers 3 Times and say: "We're not in Kansas Toto --- We're in California and we need boots to wade through the landslides..."

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