In This Corner By Keith More: It happened again! 

Keith More

What happened again? Well, a utilization review doctor by the name of Gerilyn Metoyer, MD with her office located at 1000 Medical Center Blvd, Lawrenceville, Georgia noncertified a request for a Standing Frame for a Paraplegic who has been wheelchair bound for 9 years. The medical report requesting the Standing Frame was dated 8/9/2022 and although sent to Dr. Metoyer she makes no mention of the report or the basis for the 9 year treating physician's request.

Although Dr. Metoyer is an internist she must not have read any studies on how "passive standing using a standing frame benefits bone density and bone loss." One such study, The Benefits of Standing After Spinal Cord Injury, published in December of 2020, found that standing frames can reduce the likelihood of pressure sores, help with blood circulation, expanding internal cavities and assist with muscle contractures." Gravity is the body's enemy, imagine sitting for 12 hours or more a day without the ability to stand for even 10 minutes.

Dr. Gerilyn Metoyer should take the challenge and sit for 12 hours a day without standing.  Spinal cord injuries require a lot of care.  For Zurich Insurance Company to use a doctor from Georgia to avoid it's responsibility in providing an agreed upon stipulation to provide lifetime medical care for Jose Pinon is awful. In fact, it is doubtful that Dr. Metoyer even read the noncertification and knows the basis for the denial. The denial makes absolutely no sense whatsoever and sets forth that Jose Pinon does not meet the criteria for DME. Interestingly, the criteria is not listed.

What is in it for doctors like Dr. Metoyer to deny paralyzed human beings medical treatment? That is the question we all want to know. Dr. Vasile from Long Beach, CA did the request. She stated the standing frame is medically necessary as the patient is developing decreased ROM, increased spasticity and increase in pain with a lack of routine program. The program outlined by Dr. Vasile includes weight bearing, CV and stretching to prevent complications.  Dr. Vasile even notes, "multiple referrals to adapted fitness programs have been denied."  These DME items will allow the patient to perform his fitness program in his home.

What is there to do, file for an independent medical review where 90% of the primary treating physicians' requests are noncertified. Is anyone else feeling like it is time for a change in a work comp system that allows billionaires to deny the basic care to the most severely injured?

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