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The Apple of America’s Eye

What the CLM is doing to combat a national epidemic of prescription drug abuse.

December 12, 2013 Photo
Kim sits in her hospital bed a few days after Thanksgiving, facing a troubling set of heart attack-like symptoms—and a diagnosis of two newly found spots on her lungs. The nurse enters and announces that one dosage of Percocet—a powerful but common painkiller—has been approved for her pain, but there is going to be a delay for anything more than that. “The doctor is swamped with a million messages,” the nurse says. “Everyone wants painkillers on a Saturday night, and it takes the doctor awhile to find the legitimate requests. You’re probably in for a long wait.”

It’s a startling scenario, but the nurse’s comments reflect real-world statistics. The Centers for Disease Control and Prevention says that more than 12 million people reported using prescription painkillers nonmedically in 2010. The CDC also says that although many types of prescription drugs are abused, nearly three out of four prescription drug overdoses are caused by prescription painkillers—also called opioid pain relievers.

The unprecedented rise in overdose deaths in the U.S. parallels a 300 percent increase since 1999 in the sale of strong painkillers. These drugs were involved in 14,800 overdose deaths in 2008, more than cocaine and heroin combined. Painkillers, indeed.

These statistics make clear that the abuse of prescription painkillers isn’t just a problem; it’s an epidemic—and it’s only getting worse. But it’s not just a problem for those who abuse them; it’s a major problem for everyone involved in the management of the complex medical, pharmaceutical, and legal issues involving workers’ compensation claimants and plaintiffs who are experiencing pain and its associated problems.

To help its members and fellows fight back and reverse the negative trends, the CLM is launching the Claims Medical Legal Summit this January to provide all of the education needed to find success in combatting these problems. And as with all CLM events, this one is put together by some of the best and brightest minds in the industry.

Planting the Seed

The Claims Medical Legal Summit provides current practical knowledge, tools, and techniques for participants to use in their day-to-day claims work or litigation practice. It’s the guiding principle behind its creation, and it’s what its steering committee has kept in mind during its development.

“As an industry, we’ve been dealing with the opioid epidemic as well as issues involving appropriate medical treatment plans and programs for quite some time,” says Julie Fortune, senior vice president and chief claims officer for Arrowpoint Capital, who is one of the summit’s biggest backers. “Internally at Arrowpoint, I have put together three medical legal programs in the past four years to help our claims people and partners clearly understand the issues we face. The goal was to get a good discussion going on as to what was happening, what we were dealing with, and how we could better leverage our collective knowledge and expertise.”

Soon after launching the training program, Arrowpoint’s adjusters and partners—including their lawyers—were thriving. Instead of feeling bewildered by medical jargon and intimidated by physicians, the company’s staff was being supported with education straight from experts and doctors. Innovative sessions like “Ask a Doctor” and “Ask a Pharmacist” provided adjusters with opportunities to pose specific scenarios from their claims files, and, in return, receive practical advice and solutions.

As a prominent and active fellow with the CLM since 2008, Fortune found an avenue to expand her program to a broader audience.

“I wanted to take what we did internally and provide a similar program for CLM members and fellows, since no one else was doing it in a way that I thought was appropriate,” she says. “Since I’ve been working on developing this summit, I’ve met a lot of new and amazing experts in the field, and we’re going to be able to share some new expertise in Orlando, the inaugural location of the event.”

Al Luther, vice president claims audit and litigation management for CNA and a CLM fellow since 2012, is heavily involved in the planning, as well. As such, he has a good grasp on the issues at hand.

“In some lines of business, like workers’ compensation, the biggest driver of increasing claims costs is the price of medications needed to respond to complaints of pain,” he says. “The ripple effect of the cost of treating pain is felt across all types of claims. These situations also raise issues of patient safety, knowledge of prescriptions by multiple medical providers, and mistakes made by medical providers.  There is no uniformity across states in dealing with these issues, which raises the level of complexity faced by claim professionals.”

Feeding and Weeding

Fortune, Luther, and the other members of the summit’s steering committee have developed a cadre of speakers for this event that promise to be both educational and entertaining.

“The faculty includes medical directors, physicians, and other healthcare providers; defense attorneys; and claims professionals,” says Luther. “This summit provides an opportunity to examine complex medical and legal issues that affect just about every type of claims that our CLM fellows handle in their day-to-day work.  It also presents an opportunity for defense attorneys who handle different types of claims to share their knowledge and to better understand how these complex issues impact both the claims and litigation they handle as well as the claims and litigation they don’t handle. This broad overview of the complex issues and the discussion of how they apply to specific claims and litigation present a rare learning opportunity.”

Sticking to its goal of providing information and education in new ways, the summit is kicking things off with an innovative “movie night,” complete with pizza and popcorn.

“We’re going to be showing movie clips from two critically acclaimed and award-winning documentaries about Oxycontin,” says Fortune. “One is called ‘Oxyana’ and it’s about a small town in West Virginia by the name of Oceana; the other documentary is called, ‘Behind the Orange Curtain,’ and it’s about Orange County, Calif. What’s interesting about these documentaries is that Oceana is a very poor and economically depressed town in which many of the citizens are addicted to prescription drugs. That’s contrasted with Orange County, which has a higher level of means, but they also have a problem with prescription drugs.”

Former DEA Agent Rick Tucker will speak about the movies and about the prescription drug problem in America.

“The steering committee and I worked hard to make this conference different,” says Fortune. “I didn’t want people to just come and listen to the same old stuff, because that gets boring and redundant. So we thought about what would capture people’s attention and interests.”

There are several standout sessions that Fortune says will intrigue attendees, including how topics like cutting-edge, computerized prostheses, medical marijuana, and the fact that obesity is now classified as a disease can impact workers’ compensation claims.

“This summit is an opportunity to address complex issues from a broader perspective,” says Luther. “Often we see these pain management issues in the context of a particular claim or a particular line of business, but we rarely have the ability to bring together professionals who handle a wide variety of claims who all may be dealing with these complex issues in different ways.  This will be a great opportunity to educate claims professional and attorneys on new and arising issues.”

Another way the summit will share information about a variety of specific issues is through the use of “talking posters.” These posters will expose attendees to new and different issues and opportunities and will include information on where additional and more specific information can be found.

“We’re partnered with our sponsors to create a display of a topic that is either being discussed at the summit or is related to the conference in some way,” says Fortune. “This large poster contains information on it, but also includes a QR code that attendees can scan with their smartphones or tablet devices. The QR code takes them to a seven-minute presentation from an expert on the topic. It’s essentially self-serve education.”

Harvesting Results

Both Luther and Fortune hope the fruit of their labor opens eyes and minds about the scope and severity of the problem, as well as its uniqueness. It’s not about eliminating the use of prescription painkillers, but rather using and tracking it appropriately.       

“If you look at other countries, they don’t leverage drug therapy as the number one choice,” says Fortune. “They use alternative methods such as physical and chiropractic therapies, yoga, acupuncture, exercise, stretching, and cognitive behavioral therapy as their first, second, and third lines of defense.

“Unfortunately, our society leverages drugs in lieu of alternative therapies, and now we’re trying to deal with it,” continues Fortune. “I believe that as we become more and more sophisticated, there will be a big focus on making sure the patient or the workers’ compensation claimant is not being overprescribed.”   

Learning More

The first Claims Medical Legal Summit takes place in Orlando on Jan. 21-23, 2014, at the Sheraton Orlando Downtown Hotel. Costs are as follows; you can register online at https://www.theclm.org/Event/ShowEventDescription?id=1820.  

  • $199 Fellows (corporate counsel, litigation and risk management, insurance and claims professionals)
  • $399 Members (defense attorneys)


What to Expect

Participants will have the opportunity to attend sessions on:

  • Obesity
  • Amputations and the New World of Computerized Prosthetics
  • The Narcotic Epidemic
  • Social Media, Malpractice and Never Events, and Physician Misconduct
  • Prescription Drug Abuse
  • The Role of the Healthcare Extender
  • Complex Medical and Pharmaceutical Litigation
  • Medical Marijuana
  • Medical Directors Panel
  • Forensic Pharmaceuticals and the MSA Process and Legislation
  • Diagnostic Usage and Assessment
  • Impact of Healthcare Reform on the Insurance Industry
  • An Inside View of Jury Deliberations Involving Medical Cases
  • Return to Work and Resolution
About The Authors
Eric Gilkey

Eric Gilkey is vice president of content at the CLM, and serves as executive editor of CLM magazine, the flagship publication of the CLM.  eric.gilkey@theclm.org

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