The chiropractic community apparently didn't get the memo from legislative leadership that the 2006 workers' compensation agenda was one issue—permanent disability—and that issue was going to be dealt with quietly and discreetly by the leaders and the governor. Instead, we have seen a flurry of bills, some of which are quite imaginative, expressing just how out of sorts these practitioners must be with the new world of SB 228 and SB 899. But their crankiness has not been met with much sympathy.

Their first salvo, dating back to last year, was AB 1209, authored by San Francisco Assemblymember Dr. Leland Yee, who is becoming chiropractors' go-to guy. That bill would repeal 24-visit caps added by Senator Alarcon in SB 228 and added to by Senator Poochigian in SB 899. The business community solidly opposes the bill, and it is widely assumed that the measure would be DOA at the Governor's Office were it to actually get there. It is currently parked in the Senate Labor & Industrial Relations Committee awaiting a hearing in mid-June.

Not content with that offering, the chiropractors then sponsored AB 2590 by Republican Assemblymember Rick Keene. This clever effort attempts to merge market-based medicine, apparently a new Republican concept—and one that would surely confuse Adam Smith—with workers' compensation.

If an injured worker wanted to pay for medical treatment, there should be no prohibition against that from a workers' compensation standpoint. Sounds simple enough, doesn't it?

Of course, if you are trying to manage a claim as an insurer or self-insured employer, having the worker trot off and get multiple chiropractic manipulations, perhaps from different chiros, likely will not simplify things. From labor's standpoint, there was concern that the injured worker's wallet was the real subject of manipulation.

We always thought the objective of the workers' compensation system was to make sure the employer provides all medical treatment for an injury? Needless to say, AB 2590 didn't make it out of the Assembly Insurance Committee.

Back to Dr. Yee, who is also a candidate for the Democratic nomination for State Senate in District 8. Undaunted, the chiropractors took another Yee bill, AB 409, for their newest effort. Apparently taking clues from the dissatisfaction aired at Senator Alarcon's recent oversight hearing on medical treatment issues, AB 409 now combines an "any willing provider" mandate on medical provider networks (MPNs) with state-run utilization review—sort of a "Kaiser merges with DMV" medical delivery model.

If a worker wants his or her physician—conveniently written to include chiropractors—to treat him or her, then the worker asks the medical provider network to bring the treater into the MPN after agreeing to a few things that should be relatively easy for the provider to bear. If the nasty MPN still doesn't let the physician in, then the injured worker can go out of the network.

Utilization review is done by the Division of Workers' Compensation, and the Administrative Director must hire or contract with all physicians who can treat, including chiropractors. Unless the insurer or self-insured employer agrees with the authorization request, UR is commenced after the insurer or self-insured employer pays a fee to have a chiropractor review the request for authorization for chiropractor care.

Sounds like the good old days before reform, doesn't it?

As can be expected, AB 409 has the business lobby in a panic. Of course, they have been looking for most of the session to find a reason to go to red alert, and Assemblymember Yee has given them the excuse they need. The bill is as preposterous as the initiatives filed late last year, and while on the one hand it serves to remind us of the many and varied ways vendors in the workers' compensation system can always find someone in Sacramento to champion their cause, it should also serve as a cautionary note that there are problems out there that need to be addressed, even if AB 409 doesn't solve any of them.

Besides, legislation (even bad legislation) always generates contributions from those for and from those against.

Is it possible Dr. Yee has a Chamber maid?