The QME Process: Forensic Reform or Doctor Roulette?

The QME Process: Forensic Reform or Doctor Roulette

By: Marjory Harris, Esq.

SB 899 changed the way parties could obtain forensic evaluations of disputed medical issues. For injuries occurring on or after 1/1/05, the parties were limited to one Qualified Medical Evaluator per injury, to be chosen from a panel of three names. If the worker was represented, there was the option of using an Agreed Medical Evaluator. There was no longer any right for both sides to get their own QME.

This change in the rules of the game meant that the medical-legal issues could be decided not by a forensic expert of an attorney’s choice, but by a name drawn at random by an unknowing worker at the start of the case, from a limited list of names, without regard to whether that doctor could write a report that constituted “substantial medical evidence.”

Here is a real life example from my own caseload: an Asian immigrant works for years as a janitor, injures his back, and is sent the QME form by the adjuster. He selects a name because the address is near a bus stop. The doctor he selects, David E. Fisher, M.D., has been sued many times for medical malpractice and publicly reprimanded by the medical board. He is not Board certified. He does not use an inclinometer or question the worker about ADLs. He offers no “how” or “why” for his opinions on causation of injury or causation of permanent disability. He examines workers at 97 locations throughout California (including two locations in Fresno). A search on the QME database reveals he has 288 records on three different panels. In fact, the other two docs on this worker’s panel were not Board certified either, one was on the discipline list, and both examine at numerous offices throughout the state.

The workers’ compensation judge rejected the unrepresented worker’s settlement documents as inadequate because of the QME reports, forcing the worker to hire an attorney. Yet the claims examiner refused to discuss using an AME, forcing the issue to a petition to strike.

In a state like California with so many Board-certified orthopedists, why are there so many non-Board certified ones on the QME ortho panels? There is no shortage in the ortho panels (as compared to urology and dermatology), so why are the same docs allowed to examine in so many locations?

We need to look to who runs the QME casino to find the answer, which is “follow the money.” The current administration is more concerned with employers than workers, and in saving employers money rather than fairly compensating injured workers. Why not stack the deck with malpracticing doctors, retired doctors, doctors who haven’t practiced for eons and the like, as these docs usually believe that most workers are committing frauds at worst or exaggerating at best?