Medical and Legal Symposiums

Lower Back Pain: A Fresh Look

with a Special Focus on Psychological Comorbidities                      & Patient Selection for Intervention

 

Program & Schedule

7:30 – 8:30 am

Registration & Continental Breakfast

 

8:30 – 8:45 am (15 min)

Welcome and Framing of the Conference Objectives

Mitchell S. Nudelman, MD, JD, FCLM

 

8:50 – 9:35 am (45 min inc. 10 of Q&A)

Session I:  Evidence Based Differential Diagnosis of Low Back Pain: Covering the Basics

Keith C. Raziano, MD, (Moderator, Michael G. Regas II, Esq.)

 

  • Anatomy: The Good, The Bad and The Ugly

  • How Much Back Pain is Normal?

  • Discogenic Pain & the Report of the NIH Task Force On Research Standards For Chronic Low Back Pain

  • Causes for Back Pain that May be Mistaken for Injury

  • Ruling a Diagnosis In or Out: When the Rules of Evidence meet Medical Probability and Possibility

  • The Law of Physics and the Mechanism of Injury

 

9:40 -10:10 am (30 min inc. 5 of Q&A)

Session II:  Understanding Sacroiliac (SI) Joint Pain & Some Unique Ethical Considerations

Frederick C. Flandry, MD

 

  • Where and What is the SI joint?

  • What causes SI Joint Pain & How Common Is It?

  • Evidence Based Diagnosis & Treatment of the SI Joint

  • Sacroiliac Fusion or Pinning for the treatment of LBP

  • Who is a Qualified Specialist to do the Evaluation and Perform Surgery?

  • So What Could Go Wrong?

 

10:10 – 10:30 am (20 min) BREAK 


10:30 – 11:10 am (40 min inc. 10 Q&A)

Session III: Aggravation/Exacerbation of Pre-Existing Degenerative Disc Disease: A Challenging Legal Issue

Grant B. Smith, Esq., (Moderator, C. William Hinnant, Jr., MD, JD, FCLM)

 

  • Is there a Legal Significance between Aggravation and Exacerbation?

  • Factors that May Accelerate the Degenerative Process and How to Distinguish from the Natural Progression of the Degenerative Disease?

  • What does an Attorney Need to Know from a Physician?

  • Making it Back to Baseline & How Do We Know When?

  • Functional Work Capacity and reasonable Restrictions/Limitations Upon Activity

 

11:15 am – 12:00 pm (45 min inc. 10 Q&A)

Session IV:  The Psychological Aspects of Low Back Pain & Their Medical Legal Implications

John O. Gaston, MD, (Moderator, Marjorie Eskay-Auerbach, MD, JD)

 

  • Recognizing the Impact of Past Medical & Psychiatric Comorbidities – How important is an Accurate and Reliable Medical/Surgical History?

  • Somatic Symptom Disorder and other Psychological Disorders with Propensity for Pain

  • Addictive Personalities and LBP

  • Obesity and Low Back Pain

  • Smoking and Low Back Pain

  • Psychological Barriers to Making it Back to Baseline & How Do We Know When?

  • The Significance of Non-Compliance and How to Recognize a Pattern

  • Any role for Cognitive Behavioral Therapy (CBT)?


12:00 - 12:30 pm BREAK -  GOURMET Boxed Lunch

(take a break, choose your lunch box, return to your seat)


12:30 – 1:30 pm (60 min inc. 15 Q&A)

Session V: Red Flags in Patient Selection: Increasing the Probability for Optimal Outcome After Surgical Intervention, including Implantable Devices

James Weisberg, PhD (Moderator, Mitchell S. Nudelman, MD, JD, FCLM)

 

  • What is Failed Back Syndrome? What are the Risk Factors and is it Predictable?

  •  Preoperative Psychological Screening for LBP Patients

    • What is the appropriate evaluation?

    •  Psychiatrist, Psychologist or both?

    • Testing

  • Is litigation a legitimate factor to consider?

  • Is Smoke Cessation a Pre-requisite?

  • Is Weight Loss Required?

  • Red flags that may foretell Interventional failure


1:35 – 2:25 pm (50 min inc. 10 Q&A)

Session VI: Evidence Based Interventional Treatment of Low Back Pain – What Works and What Doesn’t?

Marjorie Eskay-Auerbach, MD, JD

 

  • Conservative Treatment and What Constitutes a “Failure”

  • Trigger Point, Epidurals, Prolotherapy, and other Injective Therapy

  • Surgical Options: Indications and Contraindications

  • Artificial Discs and other New Technology


2:25 - 2:45 pm MILK & COOKIE BREAK (20 min) - but only if you are good :) 


2:45 pm – 3:15 (30 min inc. 5 Q&A)

Session VII:  Applying Pharmacy Management in Low Back Pain

Alan Rook, PharmD., ARM, CIC, AAI

 

  • The case for and against the use of narcotics/opioids

  • The case for and against the use of benzodiazepines, other muscle relaxants and sleep aids.

  • Urine Drug Screening as a Tool for Compliance

  • The Pharmacy Claims Report as a Routine Part of the File and How to Put it to Good Use

  • The Peril of Side Effects and Interactions

  • Querying the Georgia Prescription Drug Monitoring Program


3:20 - 4:05 pm (45 min inc. 10 Q&A)

Session VIII:  Ethical Concerns With & Determining Payment for Experimental/Investigational Treatment Using Evidence Based Medicine

Mitchell S. Nudelman, MD, JD, FCLM

 

  • The Ethical Problem of Calculating Damages on Medical Costs & Lien Based Medical Services: When the Treatment is Better for the Damages than the Patient?

  • What is E&I Treatment and How is is Determined? Is FDA Approval Enough?

  • A Few Common Examples: Topical Pain Creams and Scar Gels, Spinal Unloading Devices (e.g., VAX-D)

  • Hot Topic: Ketamine Infusion for RSD/CRPS - "Cutting Edge" or "Off the Ledge"?

  • Response to Audience to Their Therapeutic Modality Questions


4:05 - 4:15 pm (10 min)

Closing Comments & Adjournment by your host, Dr. Mitchell Nudelman


4:15 pm -  NETWORKING RECEPTION

 
 
Lower Back Pain: A Fresh Look
With a Special Focus on Psychological Comorbidities
and Patient Selection for Intervention
 
Faculty

 

MARJORIE ESKAY-AUERBACH, MD, JD, is an orthopedic surgeon with Fellowship training in Spine, attorney, medical-legal consultant with a special interest in spine care, author and frequent lecturer nationally.  Dr. Eskay-Auerbach earned both her undergraduate and medical degrees at the University of Michigan, where she was a student in the combined six year program. Thereafter she trained at Mt. Sinai Medical Center in NYC in general surgery, followed by her residency training in Orthopaedic Surgery at the University of Pittsburgh Health Sciences Center. Attorney Eskay-Auerbach received her JD from University of Arizona, in 2001, and is a member of the Arizona bar and is a member of the Forensic Expert Witness Association. Dr. Eskay-Auerbach is board-certified by the American Board of Orthopedic Surgeons and the American College of Spine Surgery. She is an active member of the North American Spine Society, and served as a member of the Board of Directors. She is an active educator for the AMA on the most recent edition of the AMA Guides to the Evaluation of Permanent Impairment, and was the contributing editor for the AMA Guides to Evaluation of Permanent Impairment, Sixth Edition musculoskeletal chapters, and co-author of Transition to the AMA Guides Sixth and a number of workbooks related to use of the Guides. She has contributed chapters to a number of AMA publications including Guides the Evaluation of Disease and Injury Causation, 2nd Edition and AMA Guides to the Evaluation Work Ability and Return to Work. She has taught multiple Continue Legal Education courses, including a course entitled, "Orthopedics for Lawyers,” and currently trains physicians in performing Independent Medical Examination and providing expert testimony. Dr. Eskay-Auerbach has over 30 years of clinical experience. Her current clinical practice in Tucson, AZ is in occupational orthopedics, and she practiced spine surgery and non-operative care of back and neck injuries in Phoenix previously. She performs medical-legal consultations, independent medical evaluations, review of impairment ratings and record reviews, and provides expert opinions and testimony. She holds medical licenses in AZ, CA, NM and OK.

http://www.impairreview.com (under construction) 

 

JOHN O. GASTON, M.D., is a board certified Psychiatrist, with a recently acquired sub-specialty in Psychosomatic Medicine; a new specialty under the American Board of Psychiatry & Neurology. Dr. Gaston completed his entire medical & residency training at Yale University School of Medicine and is an Associate Professor of Psychiatry at the Morehouse School of Medicine. Until recently and since 1998, Dr. Gaston also served as the Vice Chairman of the Department of Psychiatry at the Morehouse School of Medicine, and the Director of the Residency Training Program from 1998 to 2013. Since 1985, Dr. Gaston has also been the Associate Director & Senior Attending Physician - Division of Consultation & Liaison Psychiatry, at Grady Memorial Hospital. In a career spanning three decades practicing psychiatry, he has treated many chronic pain patients, as well as those with factitious disorder, somatoform disorders, addiction, and other psychiatric conditions that lead to symptom magnification.  

 

FRED FLANDRY, M.D., earned his medical degree from Tulane University School of Medicine and completed his residency in orthopaedic surgery through Tulane University Affiliated Hospitals. In addition to a fellowship in sports medicine and arthroscopic surgery at Hughston Foundation, Dr. Flandry studied traumatology at major centers in the United States, Canada, and Europe. Certified by the American Board of Orthopaedic Surgeons and the American Academy of Pain Management, Dr. Flandry is associated with numerous medical organizations and holds memberships in 16 national and international specialty societies. In addition to his clinical practice, in which he does most of the SI cases at the Hughston Clinic, Dr. Flandry is deeply involved in research conducted through the Hughston Foundation.

 

C. WILLIAM HINNANT, JR., MD, JD, FCLM is a Diplomate of the American Board of Urology and Attorney, who practices both medicine and law in Anderson and Charleston, South Carolina.  In his law practice Medicolegal Consultants, LLC, he specializes in Plaintiff Medical Malpractice, Personal Injury, & Workers Compensation, and the defense of physicians who have been the subject of disciplinary actions and often “sham peer review” by the Medical Board, Hospital or other Healthcare entity or agency.  Dr. Hinnant is a Fellow of the prestigious American College Legal Medicine, where he is the current Treasurer and also General Counsel since 2007. Dr. Hinnant attended medical school at the Medical College of South Carolina and completed his Residency in Adult and Pediatric Urology at the University of Texas Southwestern Medical Center (1992).  He earned his law degree at Georgia State University School of Law (2001) and is a member of the South Carolina Bar.  

 

MITCHELL S. NUDELMAN, MD, JD, FCLM - your host for this event – has been Chief Medical Officer since he founded Medical Director Solutions LLC in 1997 (where his clients are mostly employers, carriers and those who represent them), and managing member of his boutique law firm Nudelman & Associates (serving plaintiff and defense parties alike), for about two decades. He is a fellow of the prestigious American College of Legal Medicine, the professional organization for those who hold degrees both in medicine and law. Dr. Nudelman earned his medical degree at the Universidad Tecnológica de Santiago in the Dominican Republic, and completed his internship and residency at St. Francis Hospital in Wilmington, DE, a community hospital affiliated with the Temple University School of Medicine Family Medicine program. After residency, he practiced clinical medicine for five years in various settings, all while attending the University of Miami School of Law, where Dr. Nudelman earned his JD. In 1991 Dr. Nudelman moved to Atlanta where he was the Medical Director to Aetna Health Plans of Georgia over an HMO and PPO plans, and his duties included all ERISA appeals to Delta Airlines. Board certified in Family Medicine since 1987 with a concentration in Behavioral Medicine, and a member of the Georgia Bar since 1991 where he has been in good standing since, Dr. Nudelman is a seasoned attorney and highly experienced medical director. He served as the sole Peer Review Physician to the Georgia State Board of Workers Compensation for more than a decade. His medical director experience includes tens of thousands of cases and adjudication of every type of claim involving medical peer review in most every setting.  Having seen thousands of cases of failed back syndrome after spine surgery, Dr. Nudelman strongly advocates for careful selection of patients who undergo such interventional procedures including surgery, especially those with psychiatric comorbidities and a propensity for addiction. N&A attorney bio. 

 

KEITH C. RAZIANO, M.D. is board certified in Physical Medicine and Rehabilitation and holds a subspecialty board certification with added qualifications in Pain Medicine,  and is the C.E.O. and Managing Director of the Physicians Spine and Rehabilitation Specialists of Georgia.  Dr. Raziano earned his is undergraduate degree in Biology from the University of Miami and his medical degree from the University of Miami School of Medicine. Later he completed a surgical internship at Orlando Regional Medical Center, followed by his residency training at Emory University Hospital, where he served as the chief resident and clinical instructor.  Dr. Raziano holds an academic appointment in the Department of Physical Medicine and Rehabilitation at Emory University, and was voted Attending of the Year in 2008.  He is especially well known in the area of workers compensation, where he is a highly respected expert, and in high demand as a speaker. 

 

MICHAEL G. REGAS II, Esq. is a partner of the law firm Houck Regas, LLC, specializing in Medical Malpractice and Personal Injury.  He enjoys an AV Preeminent® Peer Review Rating from LexisNexis Martindale-Hubbell, and has been honored to be included as a member of Georgia SuperLawers for 2009-2013 and as one of Georgia’s “Best Lawyers”.  Mike recently was board certified as a medical malpractice attorney by the American Board of Professional Liability Attorneys (ABPLA) and is a member of the Georgia Trial Lawyers Association (GTLA), the Atlanta Bar Association, Lawyers Club of Atlanta, and the American Association for Justice. Mike graduated the University of Georgia in 1987 with a BBA degree in finance 1987 and Georgia State University College of Law in 1991.  While in law school, he clerked for Justice Richard Bell of the Georgia Supreme Court.  

 

GRANT B. SMITH, Esq. is a partner at Dennis, Corry, Porter & Smith, LLP, where he serves as national or regional counsel for a number of large motor carriers. Mr. Smith received his Bachelors of Business Administration in 1983, a Masters of Business Administration in 1984, and a Juris Doctor in 1987, all from the University of Georgia. Recognized as a leader by his peers in numerous defense and transportation organizations, since his admission to the Bar in 1987, Mr. Smith has served as Vice President of the Georgia Defense Lawyers Association in 2001, Executive Vice President in 2003-2004 and President in 2004-2005. He has been a member of the Georgia Defense Lawyers Association Board of Directors since 1997 and chaired that organization's Motor Vehicle Committee from 1999-2000. Between 1999 and 2000, Mr. Smith chaired the Commercial Transportation Litigation Committee of the American Bar Association and has been a member of the committee since 1993.  Mr. Smith frequently lectures at national seminars including those sponsored by the Defense Research Institute, American Bar Association and the American Trucking Association's Litigation Center. 

 

ALAN O. ROOK, PharmD. is a Pharmacotherapy Consultant and Clinical Pharmacist with myMatrixx® – a Pharmacy Benefit Management company -  serving as a liaison between myMatrixx and clients. Alan is responsible for providing support for new customer implementations, clinical program development, and client service support which includes: data analytics, formulary management, and clinical evaluation. Additional responsibilities include providing onsite clinical services promote safe and effective drug therapy while controlling drug costs, and communicating and collaborating with various internal departments regarding clients’ clinical initiatives. He brings to our faculty an unusual professional background that has integrated Risk Management with Clinical Pharmacotherapy. After graduating from the University of South Florida with a business degree, Alan began his career providing insurance and risk management services as a broker, specializing in workers’ compensation, and has almost 20 years experience in the insurance industry.  Alan was on the Board of Directors (Vice Chairman, Treasurer) of Volunteers of America of Florida and eventually became the Risk Manager for the organization, before returning to the University of Florida College of Pharmacy. In 2013 he earned his Doctor of Pharmacy (Pharm.D.).  His professional designations include Associate in Risk Management (ARM), Certified Insurance Counselor (CIC), and Accredited Advisor in Insurance (AAI).  

 

JAMES WEISBERG, Ph.D., is a clinical psychologist specializing in the treatment of chronic non-malignant pain, and associate professor in the Department of Anesthesiology where he sees patients at the UAB Highlands Pain Treatment Clinic. He maintains an active clinical practice that focuses on cognitive-behavioral pain evaluation and treatment, in addition to his teaching responsibilities of medical students, residents and clinical psychology graduate students. Dr. Weisberg holds his undergraduate degree, a BA in Psychology and Philosophy, from the University of Boulder-Colorado, and a Masters in Clinical Psychology/Behavioral Medicine from North Texas State University. Subsequently, he earned his PhD in Clinical Psychology at the Ferkauf Graduate School of Psychology, Albert Einstein College of Medicine, Yeshiva University in New York. His post-doctorate training included Internship in Clinical Psychology at UNC Chapel Hill, followed by a Pain Psychology Fellowship at Duke University School of Medicine. Prior to his appointment at UAB Dr. Weisberg held an academic appointment Emory University Department of Orthopedics and Rehabilitation Medicine (Spine Section) and practiced at their Orthopaedics & Spine Center. He is licensed to practice Psychology in Georgia, Alabama and New York. His primary research area has been on the interaction between personality and pain, although he has published in other areas including the impact of weather on pain and daily coping with pain. He speaks nationally on the topics of personality disorders and chronic pain, as well as cognitive-behavioral pain management, multidisciplinary pain management, stress management and biofeedback.

 

 

 

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