Monday, April 30, 2012

Louisiana Case: Correlation and Causation

Louisiana's First Circuit Court of Appeal has offered a ruling on a work comp case that (finally) highlights an example of how an employer might effectively deal with the compensability issues that arise from chronic opioid use.  The case is John Morgan vs. Barber Brothers Contracting Co., which began when Mr. Morgan suffered a legitimate, industrial-related neck injury in 1997.  Cervical fusion followed... then 14 years of prescription narcotics to deal with the pain.  Roberto Ceniceros offers a great overview on Business Insurance here.

Before we get into the specifics, let's discuss one of the great statistical misunderstandings of our time.  We're constantly bombarded with news stories about the latest, greatest "study" that says "product x causes cancer" or "playing video games makes us smarter" or some other eye-catching claim.  The first thought I have when I hear about one of these studies?  Is this correlation?  Or causation?  Are the two activities ("eating ice cream" and "being diagnosed with cancer") simply correlated?  Or does "eating ice cream" actually cause cancer?  (Let's hope not).  Get into the habit of asking yourself this question.  The answer is often unknown, which should cause us to look at these studies with a bit more skepticism than we often do. 

Back to Mr. Morgan.  After 14 years of using prescription narcotics, Mr. Morgan developed sleep issues, depression, lethargy, fatigue, and sexual dysfunction.  When asked to pay for sleep apnea testing and treatment for the sexual dysfunction, the employer refused. 

You see, the doctor had also ordered an inpatient treatment program to wean the narcotics (enlightened!).  This left a question for the employer: Was the sleep apnea and sexual dysfunction simply correlated with the opioid use?  Or were these conditions actually CAUSED by the opioid use? 

The answers here go to the core of the intransigent nature of the opioid over-utilization in work comp.  If someone gets hurt and ends up on chronic opioid therapy, has the payer automatically accepted the need to pay for all of the other (correlated?  or causal?) issues that arise from the use of these drugs over the long term? 

The First Circuit in Louisiana has done a potentially great service to the world of work comp.  Rather than declare the payer liable or not liable, they've essentially taken the position that the patient should go through detox first to better ascertain whether the sleep issues and sexual dysfunction are actually caused by the drugs themselves. 

Brilliant.  Now let's hope this catches on in other jurisdictions. 

On Twitter @PRIUM1

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