Work Comp Related Meningitis?

Medicare Set-Aside Blog on October 5, 2012
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Earlier this week, I noticed in the news that the nation is in the middle of a meningitis outbreak. The total count as of today is 35 cases reported in six states and more are anticipated. Five people have died. For those not familiar, meningitis is a bacterial infection of the membranes covering the brain and spinal cord. It will cause inflammation of the brain lining or central nervous system and can result in brain damage or death, so an extremely serious situation. Meningitis is not however contagious; therefore, the source of the outbreak is where the story became interesting to me.

The Wall Street Journal yesterday reported that New England Compounding Center recalled three lots consisting of a total of 17,676 single-dose vials of the steroid, preservative-free methylprednisolone acetates on September 26th which is linked to the outbreak. It is suspected that there is a contamination of the sanitizing iodine solution (the anesthetic) or the steroid itself. A national shortage of many drugs has forced doctors to seek custom-made alternatives from compounding pharmacies such as NECC; however, compounding pharmacies’ products are not subject to FDA approval.

If you haven’t guessed by now, all people infected to date became ill following spinal cord injections received to relieve back and neck pain.

Epidural Steroid Injections (ESIs) are the second most abused pain treatment in workers’ compensation, following excessive opioid prescribing, of course. Pain clinics throughout the nation routinely recommend ESIs, despite a failure to demonstrate a long term efficacy, particularly when they perform such procedures in their own offices. Depending upon the state fee schedule, ESIs can range in price from $750 to $3,000+ depending on the number of levels administered, whether performed bilaterally, and whether fluoroscopy is used or not. ESIs are generally administered in a series of three injections usually given in two-week intervals and are expected to provide relief for a few months and up to a year or more for some. Medicare and other private insurers will rarely approve the procedure again if only a few days or weeks of relief is obtained. Yet in workers’ compensation, we find claims with 10 to 12 injections a year all the time. In fact in Maryland, a recent release of finding of an investigation of several doctors at one pain clinic noted that one patient record indicated that she had received over 140 injections in a fairly short period of time. It is an extremely expensive procedure with questionable results and now a potentially deadly proposition.

The WSJ article yesterday reported 26 with cases in Tennessee, Virginia, Maryland, North Carolina and Florida with four deaths. Today, USA Today reported another four cases out of Minnesota, which they state brings the total to 35 with five deaths. The CEO of Medical Advances Pain Specialists, which owns the Minnesota surgical centers, says that they are trying to track down about 700 patients who have recently received injections. They received two lots from NECC on July 2nd and stopped using them on September 26th when notified of the recall. Unfortunately the first lot had been used on 100 people and the second on approximately 600. Tennessee, with 18 reported cases, has two clinics that received injections from NECC that were administered to more than 900 people. One clinic in Evansville, Indiana reports that more than 500 patients received injections from the suspected lots. A clinic in Berlin, Maryland has notified patients that it too received some of the tainted lots. It is reported that patients in 23 states are potentially at risk.

Now I am sure there are people with pain who are not on workers’ compensation that receive ESI treatments, but I just can’t help but wonder how many of these cases are going to be “work related”…

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