Last week, I featured Dr. Lynne Bell in “The Gang of Seven”, a blog series devoted to identifying some of the insurance industry’s most frequently-used “independent” medical examiners. “The Gang of Seven” include: Dr. David Bauer, Dr. Lynne Bell, Dr. Dennis Chong, Dr. Keith Holley, Dr. Stephen Marble, Dr. Patrick Radecki, and Dr. Marilyn Yodlowski.
If your insurance company sends you to any of these doctors, beware!
Today’s installment features Dr. Dennis Chong, a physiatrist (physical medicine and rehabilitation) who has been practicing for 26 years. He currently has no disciplinary actions nor reported medical malpractice cases. https://fortress.wa.gov/doh/providercredentialsearch/
His Healthgrades review is 3 stars. One of the comments was: “If you have an IME scheduled with this guy watch out.”
Interestingly, the Alaska Workers Compensation Board as stated that Dr. Chong is less credible due to his extensive contact with the insurance industry. His first job was a ten-year stint as a medical director of a Cigna. His second job was as a medical director for Blue Cross. It was his job to tell the doctors what they could and could not do in treatment of patients. He has only been in private practice since 2009.
Alaska Cases
The following are a selection of cases in which he testified in Alaska. The overall trend of these decisions is that the Board rejected Dr. Chong’s opinions because he didn’t rely on the legal standard for causation in his opinions.
Umiker v Bristol Bay Area, Seabright Insurance Company. AWCB Decision No. 15-0006 January 21, 2015
The Employee was injured on the job while working for Employer as a registered nurse on November 15, 2011. Employee contends the work injury caused significant time loss from work, medical expenses, and required considerable treatment, including surgery, to address pain in her back, legs, buttocks, and foot.
On August 8, 2012, Employee was examined by Dennis Chong, MD, for an Employer's Medical Evaluation (EME). Dr. Chong's EME report states, in relevant part: Diagnosis: By historical record in proximate physician and chiropractic examination, bilateral knee contusion, related to the industrial event on November 15,2011. Neck strain and thoracic area back strain, related to the industrial event of November 15, 2011. Development of right buttock pain at the end of January 2012 as reported to her chiropractor after chiropractic adjustments at greater than two months subsequent to the industrial event of November 15, 2011. This is most likely not related to the industrial event of November 15, 2011.Pre-existing severe degenerative disk disease, L5-S1, with grade 2 spondylolisthesis of L5 on S1. This is not related to the industrial event of November 15, 2011 ....
Regarding causation, Dr. Chong opined: The work injury of November 15, 2011 is the substantial cause of bilateral knee contusion and neck strain and thoracic back strain.
Regarding further medical treatment, he stated: With regard to Ms. Umiker's spondylolisthesis, I would recommend that further diagnostic imaging of the lumbar spine ... be obtained to assess for stability. .... However, this would not be related to the claim under study. There is no further medical treatment recommended for conditions related to the November 15, 2011 injury. Ms. Umiker's work related conditions are medically stable at this time. She is currently not stable with regard to her pre-existing condition. There is no impairment to rate with respect to her work-related condition
The Board held that in context of a back injury, a common industrial injury often difficult to objectively diagnose or describe, the Employee's credible testimony concerning her suddenly deteriorating physical abilities after November 15, 2011, was given significant weight. Her testimony is strongly corroborated by changes in her life following the work injury. Further, Dr. Chong's report opined the medical condition, spondylolisthesis combined with pre-existing degenerative disc disease, is not related to the work injury. However, that is not the legal issue. The question is whether the work injury is the substantial cause for the need for medical treatment or disability. Therefore, the EME and SIME reports of Drs. Chong and Pitzer are given less weight.
Employee won medical benefits, TTD, PPI and reemployment benefits.
Nielson v Alaska Teamster Local 955, AWCB Decision No. 19-0019, February 15, 2019
On April 21, 2008, Employee rammed his head onto a truck differential housing while working as a mechanic for Employer.
On June 25, 2011, Scott Fechtel, D.C., M.D., saw Employee for an EME. There was no evidence of preexisting neck or head pain. Dr. Fechtel found “rigid paraspinal muscles” and diagnosed among other things severe neck pain with severe guarding, muscle spasm and limited motion, which appeared to be neurogenic, and a possible posttraumatic cervical dystonia. He offered the posttraumatic dystonia as why Employee's magnetic resonance imaging (MRI) findings were not sufficient to explain all his symptoms, particularly the muscle rigidity. Dr. Fechtel found posttraumatic cervical dystonia present in the medical literature and associated with past, violent neck movements, which could suggest an alternative therapeutic approach to Employee's symptoms. He recommended electromyography (EMG) with an evaluator “comfortable with cervical dystonia evaluation.” Dr. Fechtel endorsed recommendations from Thomas Grissom, M.D., and added Botox injections as an added treatment.
On January 7, 2013, Dr. Kralick performed an anterior discectomy, spinal canal nerve root decompression and total disc arthroplasty at C6-7.
On August 18, 2014, Matthew Peterson, M.D., diagnosed Employee with chronic cervical spine pain, cervical spondylosis and postsurgical pain syndrome with previous disc replacement at C6-7. (Operative Report, August 18, 2014). On September 17, 2014, Dr. Peterson opined Employee had exhausted all medical treatment options and was at “maximum medical improvement.” His ongoing care was for “palliative pain management.”
On March 22, 2018, Dennis Chong M.D., examined Employee for an EME. He interviewed Employee and reviewed his medical records, including those recording his consistent complaints of neck and head pain through 2017…Based on his “Review of Symptoms,” itself based on the medical documentation and “an interview with the examinee,” Dr. Chong knew Employee had nausea, sleep problems and neck pain. He diagnosed a cervical and left shoulder ““sprain/strain” substantially caused by Employee's work injury “and long since resolved”; bilateral, curative shoulder surgeries; preexisting cervical spine multilevel degenerative disease and spondylosis, unrelated to, not caused by and not aggravated by the work injury; and a C6-7 disc arthroplasty, with a “postoperative explosion of subjective pain complaints” including headache, worsened left upper extremity symptoms, circumferential neck pain, upper torso pain and dysequilibrium. Dr. Chong opined Employee's symptoms “cannot be explained by an uncomplicated, technically successful C6-7 disc arthroplasty.” (Chong report, March 22, 2018).
The adjuster asked Dr. Chong to “identify all causes” of Employee's disability or need for medical treatment following his work injury (emphasis in original). He listed no causes and said no “anatomical or physiological cause” explained Employee's “current constellation of disparate symptoms to result in disability.” In response to this question, again identifying no “causes,” Dr. Chong stated the work injury has not been the substantial cause for any medical treatment since 2013, when Employee underwent cervical surgery assuming the disc arthroplasty was administratively accepted. He recommended no further care or prescription medication because, in his view, chronic opiate therapy “has not resulted in any functional improvement” and there was no evidence of signs or symptoms to support other medications.
The Board held: Dr. Chong's report and deposition testimony do nothing to clarify causation for Employee's continuing disequilibrium, head, left arm and neck symptoms post-surgery. He says there is no cause for Employee's pain but he never opines Employee has no pain. His opinion makes it impossible to evaluate the relative contribution of different causes of the need for medical treatment, since according to Dr. Chong, there is no cause. AS 23.30.010(a). Since there is no cause for the symptoms, he offers no cause with which to compare the work injury. Huit.
Dr. Chong admits he is not a surgeon and is unfamiliar with arthroplasty surgical techniques and expressly said he has no opinion on whether a cervical arthroplasty could cause post-surgical pain. Nevertheless, Dr. Chong concludes the work injury has not been the substantial cause of Employee's need for medical treatment since 2013. He could find no objective explanation for Employee's continued disequilibrium, cervical, left arm and head symptoms, because the arthroplasty was “technically successful.” But the Alaska Supreme Court has held the lack of objective signs of an injury does not preclude its existence because there are many injuries which are not readily disclosed by objective tests. Kessick. As Dr. Chong conceded, “any surgery ... can possibly result in any complications.” But he opines this surgery did not cause pain or other symptoms as a post-surgery complication apparently only because he cannot pinpoint the cause. Dr. Chong admitted there “is no machine that tells the truth about pain” and no way to objectively measure Employee's subjective pain. “So pain cannot be seen or shown.” Given this testimony, it is difficult to accept Dr. Chong's causation opinions as credible because they are simply conclusory and he offers no alternative explanation for Employee's undisputed symptoms. Further, though Dr. Chong applied, albeit incorrectly, CDC “domains” to derive his continued medical treatment opinion, his report never mentions activities of daily living upon which the CDC domains are reportedly based and cannot recall discussing them with Employee. Given this analysis, Dr. Chong's opinion is not credible and is given no weight. AS 23.30.122. Employee prevails on the entire presumption analysis as well.
The Board that Dr. Chong’s report did not rebut the raised presumption of compensability, that the Employee was entitled to palliative medical care, and that the Employer frivolously controverted Employee's right to benefits and his claims.
Hays v Arctec Alaska, AWCB Decision No. 18-0068 July 11, 2018
The Employee injured his right shoulder and neck while lifting a heavy bucket at work, and these injuries necessitated his participation in a work hardening program and physical therapy, which resulted in further injuries to his lumbar spine and left shoulder.
On March 13, 2013, Dennis Chong M.D., performed an employer's medical evaluation (EME). He diagnosed: 1) right shoulder labral tear with chronic impingement, status post historical previous rotator cuff repair, related to the March 8, 2012 injury; 2) status post right shoulder reconstructive surgery, related to the March 8, 2012 injury; 3) learned voluntary chronic contraction of right shoulder girdle musculature; and 4) chronic preexisting multilevel cervical spine degenerative disease with presumptive diagnosis of spinal stenosis, unrelated to the March 8, 2012 work injury. Dr. Chong did not think Employee's right shoulder was medically stable and cautioned against a third arthroscopic shoulder procedure since Employee's recovery from his March 22, 2012 surgery was unsuccessful. He also opined Employee's work injury aggravated a preexisting right shoulder rotator cuff condition and produced a permanent change, which necessitated Employee's need for treatment. The work injury was the substantial cause of Employee's right shoulder “condition,” according to Dr. Chong. (Chong report, March 13, 2013).
The Board held that weightiest causation opinions in the record come from Employer's medical evaluator, Dr. Chong, and the SIME physician, Dr. Scarpino. In contrast to Drs. Manion and Eule, Dr. Chong's opinions remained fairly consistent throughout this case's long pendency, at least with respect to right shoulder causation. He thought the March 8, 2012 work injury did aggravate a preexisting right shoulder rotator cuff tear, which he likened to frayed stitches on an old shirtsleeve, to produce the “final tear” requiring treatment. However, there is some vacillation in Dr. Chong's right shoulder medical stability opinion. In his January 22, 2015 report, Dr. Chong initially found Employee's right shoulder to have been medically stable by September 2012, but he later revised this date to April 2013.
Meanwhile, Dr. Chong did not find work to be the substantial cause of Employee's cervical spine, lumbar spine and left shoulder treatment. Instead, Dr. Chong thought the Employee required cervical fusion surgery because of “many life factors,” such as work activity, leisure activity, smoking, genetic predisposition and congenital factors. Similarly, Dr. Chong opines “[a]ll of life's activities,” including work, caused Employee's need for left shoulder medical treatment, and Employee's need for low back surgery was caused by decades of work activity, smoking and Employee's other back injuries. It is interesting to note, though Dr. Chong provides alternative explanations for Employee's need for treatment, each includes work as a partial, causative factor even though, in his opinion, it alone does not rise to being “the substantial factor.”
Between Dr. Chong and Dr. Scarpino, the Board held that Dr. Scarpino's opinions was afforded the most weight. Dr. Chong's credibility suffers a bit from his unusually close relationships with the insurance industry. Id. Even though it is not unusual for independent medical evaluators to perform a majority of their evaluations for the defense, Dr. Chong's background includes quite a bit more than merely performing these evaluations. Dr. Chong underwent training provided by CIGNA insurance company and worked as an Insurance Medical Director. He also participated in leadership training provided by a health insurance company and served as a reviewer for the publication Workplace Disability Guidelines, which was written as a guide for workers' compensation case managers to instruct them on the ordinary types and lengths of treatment. Therefore, while Dr. Chong is generally credible, his opinions are viewed with some skepticism since an inordinate amount of the achievements on his curriculum vitae have been provided by the insurance industry. Id.
The Employee won his claim for medical benefits, TTD, PTD, and PPI.
Drago v Scan Home, Liberty Northwest, AWCB Decision No. 12-0083 May 7, 2012
On November 6, 2009, Mr. Drago injured his lower back picking up a heavy box while working for Scan Home. (Report of Occupational Injury or Illness, November 11, 2009).
Mr. Drago returned to Dr. Kropp on July 20, 2011. Dr. Kropp noted that “[t]oday we met with the equipment representative and discussed a stimulator trial.”
Dr. Dennis Chong, a specialist in physical medicine and rehabilitation, also examined Mr. Drago at Scan Home's request. Dr. Chong also concluded that the November 6, 2009,work incident was the substantial cause of Mr. Drago's condition and his need for medical treatment. Dr. Chong stated, “Mr. Drago's current condition does not meet the most common indications for spinal cord stimulator placement,” and a “spinal cord stimulator trial is not recommended.”
The Employee was granted a second independent medical evaluation.
Keenan Powell has practiced Workers Compensation law in the State of Alaska for over 35 years and has dedicated her practice to Workers Compensation representing injured Alaskans. www.keenanpowell.com.
All consultations are free. To make an appointment, email: keenan@keenanpowell.com or call: 907 258 7663.