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innovations in learning. A video journal that's interactive with discussion.
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Now available on podcasts of all of its 200 programs on Apple, Amazon, and Spotify.
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In association with SI, Surgical Neurology International, an Internet Journal with Nancy and as its editor-in-chief, are pleased to present another of the SI Digital Investigative Report series.
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For today is Dr. Ramzaskali, who is board certified in neurosurgery and ACESIA, Critical Care and Pain Medicine, and is unique in his background and is in solo practice, the only practitioner in
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Illinois.
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His investigative report today will be on case on
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the practice of medicine.
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and the topic will be Workman's Compensation Insurance. One person's story.
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Dr. Galia's clinical professor of neurosurgery andesthesiology, neurocritical care and pain management in his board certified in every one of those specialties. He can be re-reached at Galia
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neurosurgical associates in Aurora, Illinois, the phone is listed
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As is his email, Dr. Galia was born in Egypt. He's a coptic Christian, escaped from persecution for his religious beliefs, came to the United States and overcame many challenges to become the
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only physician in the world with four sports certifications. He's offered 24 books and many scientific papers.
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Just some brief background on workman's compensation church.
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Workman's compensation insurance was the first form of social insurance initiated in the early 1900s in the United States to protect workers who were working in mines or in very difficult and
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dangerous jobs.
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Workman's compensation insurance is funded through employer paid mandatory premiums and it will provide cash benefits and medical care when employees suffer work-related injuries or illnesses or
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survivor benefits to the dependence of workers who deaths resulted from this kind of work. In exchange for receiving these benefits, the workers are not allowed to bring a tort suit against their
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employers for any kind of damages. He presents a series which is new on SNI Digital On case examples from his own private practice and comments, on the practice of medicine.
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And the topic of today's talk is gonna be Workman's Compensation Insurance, one person's story. And he'll go into this in some detail and so forth. So, Ramses, you can go ahead and start sharing
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and start your presentation.
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Thank you, Phyllis. Thank you very much. You're the two last men for the opportunity I appreciate very much what you do in improving the medicine that it's going on today.
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This is the first slide. That's it in
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WC. So, it's - Workman's Compensation in America, right? Yeah, so this is really the summary of this case and I wanted to bring a
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live case They're just happening in the last two. weeks. So this is extremely new and it's an additive story.
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So this is me and I've been in my own practice, Gala Neurosurgical Association since 1995. I was employed twice and then I decided to go on my own and I've been in my since 2004. My practice
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patients comes is a word of mouth, is referral and usually the patients that cannot find the help they still suffering and they don't know where to go and my practice as Dr. Asman said is totally
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independent. I don't get any support or referrals from doctors or hospitals and the and I don't have criteria for which patient to accept. Usually the patient asks to see if I can help but I Was he
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him regardless? Okay, so the objectives here is the recent case story and understand the backgrounds of the work that is associated with that and open the discussion. So this patient really is a
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game because in July 14, he had a typical worker related injury. He does work as a delivery parts, wait about 880 pounds repetitive He's a young man, 39 years old, hardworking, been in this
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business for more than 20 years. So he's been working since age of 18. He has a very supportive and loving family.
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So since July 14, the pain that much works to the degree that starts in the back, went down to the left leg is excruciating, is with numbness and tingling, profound weakness of the leg And when
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you listen to the patient, it's. typical S-1 radical apathy was no doubt, which is the para, the hamstring, the calf, the lateral side of the foot, and unable to use his foot because it's so
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hurting. He can't stand and he can't sit because any time he puts weight in the spine, the pain become unpurable to him. So he's been like this, laying in the floor, or laying in the bed and his
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family is feeding him while they're sitting in the dining table, feeding him in the floor to the degree that they came and said, we are sick to treat our own son as a dog and feeding him like a dog.
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So this man went to the occupational health, which is a work come injury, what you do, you file. So you file for the claim. He cannot go back to work at all. They sent him to an occupational
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health, they call it And then from there, he went to his own family practice. And then from there, he decided that is not getting the help. He went to the emergency room twice. They drug him,
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give him medication, send him home. The hospital were only allowing him to do a CAT scan. And the CAT scan showed that there is a bulging desk. Obviously, the man needs an MRI. The dad is fully
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knowledgeable, as well as the son. He tried to get an MRI, absolutely nobody approved it So he decides to go to the local chiropractor. The local chiropractor tried him for two weeks with his own
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therapy and manipulation and so forth, no help, disasters outcome. So finally, he was able to order an MRI. And the MRI showed that there was a large disk herniation. The patient was asked to
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see a neurosurgeon or a spine surgeon. He calls it the spine surgeons in the area, and nobody wants to see him. They said we need an approval from work camp. which he has not because the worker
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did not send him to a surgeon yet. And then they ask him and he does not have insurance because it's very expensive. So he continued with the chiropractor looking for any doctor. He got shut down
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by several of the local spine surgeons. He got shut down by the local spine surgeon that actually employed by the hostel and they suppose and they obligated to see the patient once he came to the ER.
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So finally, the father knows me. So he called me up and see if I'm willing to see the patient without insurance
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and so forth. So I saw him, he was very desperate. And this is really what it is. So after all this summary that I told you about, The patient came, the father was. delivering his own son as a
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truck, as a supply, laying in the back of the truck. And this is how the patient came. Then he came, he immediately just crawled to my office and then laid it not floored. Examine him,
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typically S1, no doubt about it, who is fixed neurologic deficit, sensory loss and motor loss of the S1 rule. Had some medication that it did not work. So this is what it is I told the dad that
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let's repeat the MRI right away because if you're telling me that it's been like this and you did one MRI, let's make sure that this is what it is. And if this is the case, I will just unit surgery.
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So this is what I did. I did the MRI because the outside MRI was very poor quality, extremely poor So I did the MRI, it showed they herniated this. And this is how the patient came to me. This is
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literally how the patient came to me. He was in a truck, laying in a truck, and then he came crawling from outside to this. He cannot even use the walker or the cane or the wheelchair because he
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cannot sit. So this is what how he come to me. This is his dad having the phone and running around trying to find who can see his son for today
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And this is now we are now in mid of August,
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which is really almost four weeks like this, three to four weeks. So now I am confronted that this is a large disk. The right thing to do is to do surgery. And the surgery is straightforward. You
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do the surgery today. He goes home tomorrow. He gets an instant relief and the and the since the patient. doesn't have insurance and there is no approval and there is a lot of bureaucracy in the
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work come to get approved anything. So I decided to go ahead and do an epidural injection knowing that this epidural injection will not help. But at least I can put some local anesthetic. So I did
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transfer amino. In other words, I come to it from lateral in the foramen. I don't go inside the spinal canal. And this what I did and he got some relief. He was able to walk for one to two
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minutes. And two minutes walk for him. It was like a feast. This is the MRI now that I ordered a good quality MRI because it's a private MRI. It's only400, but it's a
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great quality. If you send it to a local hostel, it's5, 000 to charge and the quality is very poor. Most of the local hostels. So what you see here, if I may say, This is L5S1, this is the
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extruded test. and also there is a shadow of a bigger desk. And then if you go back and you see at L4-5, here's some more that could changes an annular tear. This is not really the main one. So
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if you look at the axial T2, here is the huge disk that you see. And the nerve is you hardly see it and is impacted and pinched under high pressure with this extruded desk. Again is the facet and
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again is the ligament is flat on. So there is no room to breathe and no room for the nerve to move. And this is important because any movement of the patient's training or whatever it is, it only
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damages that nerve even more. This is more to show you. The extruded disk is all soft disk, it's compatible with the patient's story, huge and is primarily partisan for this creation In the other
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side, what you see is the S-wander group. and you see the foramen is white, and there is fat, and this is what it should be. But here, no fat, the parasympan herniation will provide the entire
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foramen, and this is what we're dealing with. So my recommendation, you need an instant surgery. This is really the solution and all of this. Now we contacted, the patient went home, contacted
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the work com, they said we don't approve the case, and they need an IME. The patient was sent to two attorneys. The two attorneys got an emergency hearing in the judge in order to exobodyte and
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allow me to do the surgery. And this is for the husband's sake, because for me, I don't have to have the money this minute. I'm okay to just do it, to get rid of this suffering. But then the
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hospital is demanding this Otherwise, the husband wants him to have. 47, 000 and in an spot as one cash or65, 000 if he's not going to pay all in one time. The patients said I cannot afford that.
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So the
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judge decided that no, the work has the right to get an IME, an IME means independent medical examiner This is an examiner, is a surgeon, unfortunately, like me and you, usually in the
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university sitting, or at least we know their names in the city of Chicago, that they are by, they're almost, you feel like they're 100 working
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for whatever is good for the work come. So, and the IME decided that the first IME for this guy, it will be in November So they want the patient to wait until November in order to get the IME in
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order one to approve then to approve the treatment that the patient received, and I am implemented. Otherwise, they don't want to deal with that. We ask if the nurse can come to my clinic to see
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the patient as in the old days and interview the patient and see how this patient is genuine, is not like deny
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until you're right. They refuse to come in person. They just sitting in their offices would like me to fax them the notes And this is it. The two attorneys, they said, unfortunately, Dr. Galli,
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it's all yours now. You want to do the surgery. You think it's an emergency. You take him and you take full responsibility to that. And that's it. The first attorney said to the patient, do not
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sign anything to the hospital to say you're responsible for this funds. So this is where we are. So I did the one injection health temporarily, he's still, he's still. crawling and still very bad
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shape. Then I told him, okay, while we're doing this, I'll send you to a local physical therapy and maybe I'll do another injection. All I need is for you to breathe a little bit until we decide
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what you're gonna do. In the meantime, I told him try to get public aid insurance in Illinois, at least you have something. So we did the second injection, absolutely no help. We did the second
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therapy, absolutely things is no help So I decided at that time that I will be more than happy to take the risks and operate in this patients without any insurance approval. So I told them basically
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go to the emergency room and the hospital where I do the surgery, they will call me and I will tell them that I'm gonna do the surgery next day. And this is what happened. And so I took him to
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surgery I was really sick of the family keeping. telling me, I am the parents, and I'm dealing with my son treating like a dog. I couldn't accept that. And then getting to know the family and
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getting to know that that the patient, how solid and genuine, and how it's working almost 20 years hard working,
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not wasting his money or life or any of those, then the least I can do is to serve him to get him better and make him like a human being His new deficit is the same. And I stopped you here for a
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minute, let's go back on that picture, don't show that picture yet. Okay, so just for summarizing it for the audience, this is a man 35 years old who has an acute onset of back and left leg pain,
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which is totally disabling him, forcing him to crawl, he can't sit, he can't stand, and he's totally disabled from it the work related injury, correct? work related injury. He has no insurance
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from his injury, but in Illinois and in all the states in the United States, there's insurance called Workman's Compensation. And with Workman's Compensation, if you have a work related injury,
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you can go and claim Workman's Compensation because your employer pays for insurance for you if you get injured on the job
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And what you said is that he went and, and since he didn't have any private insurance, no doctor would take care of him. The Workman's Compensation did not approve him at that point, it was very
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slow. And so the man was in constant pain, was not treated, came to you. You treated him for pain with some injections, which you didn't think were gonna be successful, but you had no
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alternative and he still goes and they want him to see.
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Another doctor working for workman's compensation in about four months, he can't possibly stand that.
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They wanted him to do some therapy, he did that. And at the end of all this, which is about two months or so, you said you will take personal responsibility, admit him to the hospital, operate
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it on him, and take responsibility for his costs Is that the correct summary? Yes, well, whatever the results is gonna be, yes. I didn't hear the last thing you said. Whatever results is gonna
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be. Yes, okay, so this is the story. And now you're about to show us what you found at surgery, right? Yeah, and then if I may add, as it almost can be considered a standard practice, There
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is no physician office.
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or a husband, or a corporate that will allow this patient to have surgery without insurance approval. Okay, that's a very important statement. Nobody is not going to allow him to be treated
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without insurance, even though he has Workman's compensation. And Workman's compensation has circumstances under which
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a patient like this can be operated very, can be treated quickly But this didn't happen, isn't that correct? And this is actually the current practice. So whatever you read, you think they have,
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they have. This is when it comes to the discussion section, this is what was
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our experience 20 years ago. Things completely now, again, it's the patient and the physician that is treating the patient. Okay, I wanted to say all this because there are people in other
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countries who don't have this problem. and may not understand it, but there are people in this country who would understand this. And so tell us about the surgery. What did you find? So the
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surgery here, I think that the pictures, the pictures talk, the pictures talk louder. And this is what I realize. So let's see though, this is under the microscope picture. Here is the nerve
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root. And the nerve root, the way it is speaks to volume for all of us This is how swollen and how slow this coloration is. And this is the impacted disc herniation, all what you see here. And I
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am trying, I'm going later on, and I'm trying to stay away from this nerve. I deroofed that nerve a little bit. I took a lot of the bone out and all of this as you can see. And now you can see it
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again here. And then I'm trying now to, you can see here, there is no pulsation and it's blue. you cannot get blue more than that. And here is a far view of the
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pictures. This is another view I'm trying to get this epidural veins out. And then this is
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what you're gonna see. So follow me. So all I did is just with microscissors, I did a opening into this
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buschirland litany ligament. And I'm trying to tease out this. The entire piece I was able to
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get from under the nerve is entire piece and it's still coming, as you can see, and it's still coming. So this is a extruded, many of you will say sequester, large desk and you please see as soon
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as you try to tease it out, here is the CCF going into and the nerve starts to breathe. This is the second picture you can tell. This is the disc, doesn't want to stop the herniated disc, It just
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keeps coming. So this is the extruded herniated desk that is compressing the nerve root. And this now after my decompression and removing the herniated desk, you can see now the nerve root looks
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normal to you the way it is. Obviously it's bruised, it's no longer yellow at least. And you can see that the blood supply is going good. Here is the S1 baricle and here is the foramen that I do
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roofed it And then you see the thical sac here is pulsating well. There is no way that anyone have any common sense that will say cortisone injection is worth a while, therapy is worth a while, or
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medication is worth a while. This is how these patients get addicted to drugs because we put them into drugs. And according to the guidelines for work come and others, You need to send them to pink
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clinic to give them drugs, to give them injection first. but this case, how can it be? So this is the picture, this is him. And the biggest testimony is a few hours after surgery, this is how
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the patient is. Can I ask you back to your pictures in just a minute? Yeah. Go back to the first picture. These are excellent pictures. Now the left side, show us the left side. The patient is
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laying so on, where's his left side? Wrong, yeah. No, no, this is the left side And the patient's laying prone. And this is picture under the microscope. So I'm doing only lift the lemon up
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from an army. So this is, here is the lemon up. I drill it to free this area. I took part of the facet. And now I'm looking under the microscope. And I'm teasing out the disc from underneath the
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nerves so that I don't cause compression of the nerves. Okay, okay, fine. And this is superior.
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and this is the S1 bedacle. And underneath here is the disk space
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of L5 S1. And, okay, go ahead. Yeah, and then the L5 nerve root will be around here. Okay. Okay, and this is now going to be anatomy again, which is a good point. This is the midline with
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the spinous process. I lifted the spinous process intact, the ligaments intact. I did not do bilateral laminic to me or bilateral laminarctomy. I didn't want to stabilize that. Everything, I did
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a wide laminarctomy here and then a wide laminarctomy. And I do that far before I take the donated discount. And I do that by drilling. And then the distinct cortical chilobone, I will just remove
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it with microcaresins so that there would be no downward pressure in the nerve roots or any pressure in the neural elements. And then once I do this space, and deliver the
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rest of the herniated desk into the desk and then bring it out. And what you see here, this is the L5 S1 facet. I did about 15 faceted to me here, mesial. And then this is the remaining glemina
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of L5. And this is the remaining glemina here of the S1. This is the thickal sac, the remaining of the thickal sac. And you can see the S1 root is large There is a very good chance that, in my
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experience, that this is the ganglion. And when you have the ganglion here,
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when you have the ganglion here, it's usually the bane is excruciating and it's not phenomenal. So
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can you show the dural sac again up on top? Yeah, so this is the thickal sac. The thickal sac and the nerve root is that big round two coming out there, okay? And underneath that is the disc.
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is the disc, where the disc is between that cushion, between the two bony vertebra behind it, and you enter into that space, you took out this huge piece of disc fragment, which was pushing on
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this nice round tubular nerve, and causing him the pain, and you were just describing that, right? And the neurologic deficit, he already had a fixed neurologic deficit, yes. Oh, okay.
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So the
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bestest pneumonia is the patient, you see him next day, and look at that a few hours later, look at that. He is he very happy, he is his dad, he cannot believe that he can hold his hands and
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walk with him like a normal human being. Obviously, the patient was flashing back, it took me a lot to convince the patient, this walk slowly, and I will reassure you that you're not gonna have
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this horrific pain. So this is already developing a major psychological trauma to the patient with that. Absolutely, how long did the surgery take you? Oh, it's only two hours. I take my time,
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Dr. Osman, I don't rush it because one of the keys that you
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taught us and the good neurosurgeon taught us, you have to treat this nervous very gentle. It's not every half an hour you do one case and flip them over to the next And so the principle that I have
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learned in my life, many several things. One, take your time under the microscope and treat the nerves as gentle as you can. The second, do not leave the operating room without looking at the
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entire nerve root, the shoulder, the axilla, the sleeve, across the midline, above and below. I never, ever believe in this bogus, minimally invasive surgery and Buddha. tunnel and put the
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scopes and do all of the stuff because there is no way that you're going to see what I see. Look at the picture that I did. I have total control. I freed the nerves before and I'm not depending on
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a small lens to tell me. And why do I want it to do that? In order to make sure that the incision is small, who cares about the incision and the muscles? We care about the nerves. And this is
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what I did. And these patients, they can go home the same day or next day. And this has been my practice since you trained me and since 1995. And I hardly have maybe less than 10 of recurrent disc
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herniation within a year. The other thing that I strongly believe, some surgeons believe just take the herniated disc out. No, I in the spirit around. I take the herniated and the loose fragments.
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So this has been my practice. I have never ever seen people come back. mechanical instability and I take my time. I'm not that that one that there is a surgeon that does seven eight cases from
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seven thirty to twelve o'clock. This is not me or doing even in the surgery center. I don't I don't do that. I really don't and the the the the nerves as you taught us the brain and the nerves it's
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like very holy whether you touch in the small or big you already touch them. So you probably wanted to do the best job so you don't come back.
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And this man after surgery did not require a lot of pain medicine. You just gave him what title and all or something. So it's only takes Norco for a week about three, four tablets and muscle
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relaxant and then after that day is off completely. No medication. Excellent job. Okay. And the hour this is what you see after surgery this is the very simple, very simple. We don't use the
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expensive equipment. Here's the microscope. And it's the instruments that we're all using since the 1950s. There's no expensive instruments in this. And the OR, there's not a lot of monitors or
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things to this. And then this is the patient, and the patient cannot thank me enough. And they're writing, lift and ride, how I made a big difference into this. You can, by doing this, one,
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you treated the parents before the patient, because this is their only son. The parents were about to have a heart attack, both of them, because seeing their son like this. So this is the first
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one I treated. The smile came to them, they earned the son back. The second, the patient's one month of horrific flashback into what the hell they have done to him from all this horrific pain,
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which is unnecessarily. Now he's living with it. but with the support of the family and my reassurance to him. And then regarding the home health, he doesn't have insurance. So usually I would
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have a home health nurse to go to see him, to chicken him. So I became the nurse. So I did a telemedicine. I use my phone with the first time. I look at the incision. I teach the dad. I tell
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him go to amazoncom and start to purchase the pythadine, the dressing I send them the links and then I shadow them and I tell them how to do the dressing change. And this is how I continue to
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provide care for the next two weeks because nobody wants to see him. In addition to that, I clear them for surgery because no physician wanted to see the patient. I admitted them under my name
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because no physician will see a patient with their insurance. So I ended by doing all of this and I saw him in the clinic two and a half weeks later
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And this is he else. And no stables, no nothing is just a glue at the incision. It's much better than any. And look at that, it has no single pain. However, you still have the fixed neurologic
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deficit that happened in July 15th, that if I have done the surgery earlier, there will be much hope than now. However, I told the patient in eight months from now, just take your time. Now I
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cannot send him to physical therapy because nobody will take me So I taught him how to do some physical therapy to strengthen the leg. And until today, nobody gets bathed. What was his fixed
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deficit remissivity of a footer? His brain is the motor. He can't stand in the tiptoes at all. He lost that. The calf muscle is shrinking. And it's remained one to two over five. And the sensory
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loss in the S1 nerve, which is the numbness in the calf, the lateral side of the foot So much, please, please. In sensory and motor loss and S1 and he basically what his foot drop he can't stand
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on his foot, right? Yes, and this is in my experience is a visual problem in young adults because he cannot run. And in my experience, when people tell me I don't want the surgery, Dr. Asman,
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he doesn't come back. It never come back as the patient will go marathon and all of this. And that is why the key here, you have the diagnosis, you have the neurologic deficit. Any book in the
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work come or in medicine will tell you, chiropractor, stop, family practice, stop, ER, admit the patient, surgeon to the surgery. This is the right thing to do. But none of this, because the
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almighty God, the dollar is what is important and what is in the guidelines and what is in the protocols and the policies to do. And once me as a neurosurgeon accept the patient, it's a problem for
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me because I'm legally responsible, because all this around, they say you have a neurosurgeon, is responsible for you. Okay, let's stop here for a second. And I wanna, or you have some things
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you wanna say, go ahead, yeah, please. No, it's just that I said now that the, that attorneys and all what available in the system now cannot do anything, they can I need insurance to approve
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to pay him to get him to therapy. We need this and this, and the patient, by the way, is not getting paid a penny for not working. And he's back with his parents from going to the film deal. And
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he has nothing to do with this, except a hard working individual that everybody failed him, from the work to the, to the healthcare to all of that. And now he's sitting with his, with his parents
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and parents are feeding him and he's not getting any income and waiting for
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the IME in November. They told him that we cannot expedite it because our people that we want to send it to you, they're not available before that. That's it. Now I'm going to put discussion, Yak.
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Okay, so what you did is you had a patient who had this almost classic case of an S1 neurological deficit happen acutely. It was acutely disabling. He couldn't find it. He had no insurance
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workman's compensation, which is supposed to be a substitute for work-related injuries and give him insurance did not help. And in the end, you took it on your responsibility to operate on the man.
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You operated on him in two hours. You removed a very large disk. He was up and walking the next day back in the clinic a week later. He has a permanent deficit, at least at this point, which is
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basically he's got a foot drop and he's got sensory loss because he had this extreme pressure on the nerve for two and a half months or so. And now they schedule them to see an independent medical
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examiner and IME in four months. Yes,
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and before even accepting the case to start well or pay anyone, and we making sure that they receiving all my notes, like probably I saw him 15 times because I'm the only physician, not just a
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neurosurgeon, a primary physician also, a nurse, a physical therapist who will continue to provide the care, and I cannot get relief. Okay, let me share screen here. Let me see, I'm gonna try
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to find this. And okay, here is a slide, and once I start this, I'll have to stop it, but they're just a little, to get a little background for your discussion that follows. Workman's
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compensation, I got this out of Investopedia, which is a web-based source. And it says workman's compensation provides critical financial support. Can you read this? Can you see it on the? Do we
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employ East facing work related injuries? That was this patient. Yeah. Number two, this is mandated insurance. In other words, every employer has to have this insurance. Yes, insurance
38:04
coverage for medical expenses, law speeches, job retraining. It varies by state because each state does its own insurance And the government has its own workman's compensation insurance. In this
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case, this man, even though he applied and wanted that got nothing. Yes. It is funded. The program is funded through employer related premiums. The employer has to pay for this insurance. Okay.
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And once they, he accepts this program, then he can't sue anybody. Okay.
38:44
This comes out of the Social Security Administration, which is similar. This Workman's Compensation started in 1900 when workers were exposed to very dangerous jobs working in mines and they would
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get lung disease or they'd be working on nuclear projects and they would have radiation damage. So the government started a form of insurance, which was called Workman's Compensation. Now it's 125
39:11
years old Just for this particular person's kinds of problem and it provides cash benefits and medical cares when employees suffer work-related injuries. This man did not get any of that, correct?
39:27
Survivor benefits if the patient dies because of the sales and mine accident, dies goes to his family. That wasn't a problem here. In exchange for receiving benefits, the workmen are not allowed
39:39
to sue Okay, so this is the background then. of basically this program, right? Yes. Now I've got one of the slides I showed before. We
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talked about this and it's still up there. Here I'm gonna show you this. This is, comes out of the Social Security Administration. Okay? Yep. And it says, just what I told you, there's some
40:06
history of how it was happened and so forth and so on. Workman's compensation, here it says benefits, pays 100 of the medical costs for injured workers, pays cash benefits for lost time after a
40:21
three to seven day period. This man qualified but got nothing. And you had to assume responsibility. Three quarters of Workman's compensations involve only medical benefits. This man needed
40:36
surgery. Okay. And so forth and so on. And so this goes into, and it talks here, was at one of the section here, which talked about the amount of money involved. Here it is, covered state and
40:50
federal's compensation loss. When I told you the states have a system, the federal government has a system, they cover 135 million employees with this emergency insurance. And the total wages that
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these people make is over7 trillion I mean, this is a huge segment of the population, okay? And so forth and so on. So there's money in the system, but somehow or this man didn't get it. I just
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wanted to give you a little background and I'm gonna stop sharing and we can go ahead, discuss what you thought about this. So this is a good summary. Let me give you a little bit of the background
41:37
in many years ago. a work-on was a very attractive, very attractive to work with them because they care a lot about their employees. They wanted to get better and they actually pay fairly the
41:55
work-on. Then over the years, I admit that there was some sort of an abuse from surgeons, physicians, lawyers, chiropractors, all of this to the degree that sometimes you hear about dreams.
42:10
Like if the patient had injury in a in a billboard, you go to this person, this person sent to this and this and this. And then there starts to be some abuse regarding the surgery type. Let's do
42:22
fusion. Let's do this. There is a secondary gains as well. This is over the years. So we have seen work come deteriorated to the degree that became currently, you don't want to deal with it.
42:36
This is the bottom line. You call the. Primary physician, any physicians, most of them, they'd say, I don't want to deal with this. You either then, why? There's a lot of paperwork. Like
42:48
every time this patient come, I have to fax to the baby. I have to fill up the forms. And then this is not just the beginning. For the next five years, everyone will try to do both of me. And
42:59
then I need the records. Why the records is not complete? It become an ongoing, ongoing harassment. Can you? You said when the program started out, it was a very good program. And patients,
43:12
the problem is that the abuse started there. People would come to the doctor. The doctor said, Gee, I can make money with workman's compensation. His patient has back pain. Maybe he needs some
43:23
more surgery. He does the surgery. He gets compensated for it. And he makes money that way, right? The problem is, so the doctors could have abused the system also It's not it's it's it's This
43:37
didn't happen by accident. And so the cost for the workman's compensation, which is totally borne by the employer, then begin to go up. And then people know that there's this group of patients
43:50
called workman's compensation injury. And these are people who can keep coming to the office and taking more time. And then you were just talking about all the forms you have to fill out, but you
44:01
may operate on them once or twice or three times. But then they come forever and the doctors didn't want that So the doctors basically said, I don't want to deal with these people anymore. And it
44:12
was costing too much for the employers. And they said, we can't afford all this. And the people who are running the system then probably became more restrictive. And we wind up where we are now.
44:23
Is that correct? Yeah, 100. And not only that, Dr. Osman, people who starts to have to take advantage of it. So if this patient, they're gonna say, work in a way, this case is gonna be
44:36
settled. 40, 000. The physical therapist and the chiropractor try to do as much of this to get this amount of money. And remember, regardless, the lawyer will take third of the money. Third of
44:50
the money that goes to the attorney. So at the end, the surgeon like me, that I did everything, the lawyer will say the case got settled. And by the way, you're going to get500. And
45:04
you need to sign this paper500. So everyone nibble from this and pick advantage of it. This is number one. That is why many have got screwed up really bad and said, wait a minute, I am not. Then
45:19
they said, you have to sign a lien. And this is that the attorney, well, will give you the money. So I remember where I stopped by. And then what I wanted also to inform you, that
45:33
there was a designated center. that only take work out. They have a system in place that they take and they love to take care of work out because they know
45:48
that it's a prolific if it's done right to gain money from it. All right, let's go to the solution for this problem. We'll spend a few minutes on that because I think you demonstrated the case very
46:01
well. You can get off a screen sharing, is this what is this? Yeah, so this is just a few slides at the end to add a little bit that - All right, we don't go through this. Yeah, so they don't
46:12
come in person anymore. You don't have an individual that he used to come to the office or the nurse to be the advocate of the patient and monitor his treatment. They're only now available by phone
46:24
and faxes and the physician find himself is the only mediator with this and this is a problem. And then we talked already about how much millions of dollars and the cases get settled for by the time
46:41
they get to the patient bucket and to the physician bucket, it becomes the money went somewhere else other than for the people that actually take care of the patients for that. I think the work I'm
46:53
betfuls now is too much paperwork, too much bureaucracy. You don't get paid, there's no grantee By the time the case get into the court and the work come, approve anything, you'll find that the
47:06
people took care of the patient, they're only taking pennies. And this is the current system. So why should we take care of them? And then there's a lot of conflicts, secondary gains. Sometimes
47:17
Dr. Asman, I hate to tell you that sometimes you feel like you're treating the attorney. Not the patient. The patient comes and his dialogue and his questions becomes different, you know? He's
47:28
asking you this and, How do you think is going to be the impact in my life? and then everyone, many of them, they'll put all their problems in that work injury because they want to get settled to
47:40
hide. So now, a couple of questions here, and then we'll close it up.
47:46
The first question is, the workman's compensation, you can stop sharing, right? The workman's compensation laws say that the patient cannot sue the employer. That was the agreement However, what
48:02
you're saying is the patient can get a lawyer to help him with this part of the case. And what the lawyer does is he takes the case and he says, I will take a certain percentageof the settlement.
48:17
Is that correct? He's a third. A third. And so now what we're supposed to go to the patient for his care and for all the expenses and his rehabilitation. the lawyer will come in and take a third
48:33
of that helping because he helped him get the money and the patient is left with less than what he should have had at the beginning. That was not the intent of the system, I assume, right?
48:46
So now, the reason I'm saying this is now everybody is going in there and taking part of what the patient really should have. If the patient's referred to therapists that are the patients referred
48:60
for injections or something else, all of those people have a cost, right? And they take from the big buy. And they take, eventually, the employer can't take all this because it's too costly. He
49:15
then makes the workman's compensation more restrictive, and the patient then has the same kind of problem this patient has where nobody wants to see him, and I don't want to take care of you, and
49:26
so forth. So that gets me to the final question, Ramses. You've seen this. How do you fix this system, or is this unfixable?
49:37
You only can fix the system. If you have the leadership in the tab, which the administration are willing to fix the system. And if what I have heard that the lobbyists are so much of them strong to
49:56
maintain the system. And this is the issue Physicians like myself, I don't have a lobbyist that I can see that it can take care of the embarrassment. And remember, at the end of this, the money
50:11
of this patient is gonna go to the chiropractor, to the family practice to everyone. And by the time patient come to me to do the surgery, it's not gonna be the money left. And in fact, here is
50:24
the other sad part that I'm a victim of it is the work come and the attorney between both of them, they will give the money, the amount of money to the attorney to give the patient and the patient
50:42
goes and disappears. I had patient lift the country. I have patients lift the state without even letting me know because remember, this is gonna be getting paid five years from now
50:56
So you mean the lawyer and the company agree on a settlement, the money is given to the lawyer and you never see it? Yes, you say can. There's so many, so many, if I will, scams into this. And
51:14
that is why when people review my practice and what I do, they think I'm stupid I'm a stupid business because I'm supposed to get a lot of cash from the patient. I suppose to get deposits, I
51:31
suppose to do all of the not to do any surgery unless the insurance say yes and all of the stuff because otherwise you don't guarantee payments. Okay, so in this, this is a particular case in which
51:44
a man suffers an acute injury work related injury is a disabling deficit which prevents him from walking standing He's crawling. He tries to apply to get to a hospital since he had no hospital
51:58
insurance. He then he couldn't do that then he goes to workman's compensation. And they delayed is seeing him. They used to have people who would come out and see him and approve it. And so that
52:11
didn't work. He came to you and you personally, personally took on the responsibility of treating him actually for no charge at this point And that you'll get paid later. Eventually, it still
52:25
didn't work and you had to go ahead. And because the man was desperate, he was suffering a neurologic deficit which became permanent as a result of this, okay? And you took him to the hospital,
52:38
he operated on him, he was out of the hospital in 24 hours and he was up walking the next day and he's on his road to recovery. And where the money's gonna come, we don't even know because he
52:52
hasn't gone into workman's compensation yet And it's gonna be in four months. And who's gonna pay the hospital for their costs? Obviously their charges there. So this is an extreme example of the
53:09
system the way it is and you took responsibility for it. That was a wonderful thing to do. But it's an example of how the system is not serving the needs of the patient. Is that correct? Yeah,
53:24
the patient is not the center. Our practice nowadays is their practice nowadays, the corporate practice nowadays, is denied until proof otherwise. What is the advantage? Don't spend money and
53:37
then become this. So he's denied and you say that it didn't approve. It even goes beyond that. It's being rejected. I've been rejected as a neurosurgeon to take care of this patient. The patient
53:50
being rejected to be treated until he see the IME four or five month and God knows when. You call the people that try to be advocate to him. They say, what do you want me to do? That's it. You
54:04
know what I mean? So the question now, Dr. A, is what benefit if we can go to the Mars? If we have an AI and we cannot serve the patient? So can you tell me what is the difference between
54:18
America and Africa where there is no resources? They have the same results We don't do the right thing for the patient. but at least in the undeveloped countries, they don't have resources, but we
54:30
have resources here. So what is the AI will do to us here? What is the modern? What is, what is, what is, what is going to the Mars or spending500 to go to the moon and then out if you cannot
54:42
serve these people? Well, I'll make a final comment here because you've been at the meetings. And we do have meetings every month with our African colleagues And they have, most of the people
54:55
there don't have insurance and they have to pay for it themselves. And this is exactly, it's exactly like the cases we've seen. They get to the hospital and somewhere or other they find some money
55:08
and they are operated on, they're treated, they could wind up with a deficit. But what you're saying is here's a case example that's similar to what's going on in Africa today they don't have
55:22
insurance because the system hasn't developed to our level. we've developed it and still it's not available, okay? And the problem here is, well, the next answer is, well, the government ought
55:32
to mandate insurance for everybody and the government ought to take control of the system. The problem with that is here is a similar system, basically under government control in multiple states,
55:44
it is filled with corruption and people taking money and in the end, this patient winds up like he would have been in Africa. Is that correct? Yeah, 100 under, and I wanted to remind you because
55:59
maybe you forgot, we have robots, we have actually robots, we pay millions of dollars for robots, so what is the robots would do if we cannot serve these patients? And I'm talking about basics,
56:11
I'm not talking about anything else, just basic. Okay, well it's terrific, I just wanted, I think it's a terrific, we have what we call our SI Digital. independent investigation of various
56:27
areas of medicine. And you've been on some in healthcare we've had anyway, and you're very important to that in us. And this is an independent investigation from your own personal experience. Own
56:40
personal experience and practice. A man who is four boards is certified by four different specialties to practice medicine. There's no single person in the world or has that certification. You work
56:51
independently, which is also very unusual and very unique, particularly in Illinois, you're the only solo practitioner. And this is the example of the system as you see it, as you have
57:03
encountered it. And the answer from the investigative report is, how do we fix this system? This is widespread corruption. To me, the answer to this system is to get private practice and private
57:19
medicine and and a free market into this to solve this problem because the government can't do this. Yeah, I will not, if I'm employed or I'm a corporate, I will not be allowed to see this patient.
57:34
Right, and if you're in corporate practice, you can't see this patient, right? And then the other thing is I cannot see the patient because the patient call and say this, I have to demand like
57:45
them, I need to see an MRI first, I need insurance approval and all of that So the ultimate, the end results of this is the patient is the one that we are cared for, is suffering by himself, we
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cannot find way. So are you hoping? Our national associations are not
58:03
doing anything about this, nobody else seems to be involved in this problem. So I wanna thank you for this report, you did an excellent job, I compliment you on all personal sacrifices you made to
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do this It's just what a physician should be. human sensitive to other human's needs. And we congratulate you. We thank you for allowing us to film this. And we will see you some more with more of
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your investigative reports into medicine, okay?
58:36
We hope you enjoyed this presentation.
58:40
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