Column: Injured workers in Hawaii deserve much better care

“You work that you may keep pace with the earth and the soul of the earth. For to be idle is to become a stranger unto the seasons and to step out of life’s procession.”

— Kahlil Gibran

We might complain about our jobs and look forward to our next vacation, but to work is a sacred honor. In exchange for our toil, we earn a living that puts food on the table, keeps a roof over our heads and enables us to care for our ohana. Work is an opportunity for creative expression, for service to the world we live in, and should involve a fair wage for the goods and services we provide. When, as employees in Hawaii, we become injured in the line of duty, we have the right to reasonable, appropriate and necessary medical care. There is still much to be done to ensure that this right is protected.

Under workers’ compensation insurance in Hawaii, as appropriate, injured workers are entitled to up to 15 visits for each of the following services within the first 60 days without prior authorization: physician care including naturopathy, physical therapy, occupational therapy, acupuncture, massage therapy and chiropractic. X-rays and medication are also not subject to prior authorization. After 60 days, authorization becomes necessary for the above services as well as any consultations, additional diagnostics studies and surgery. The exception is emergency care.

Manakai o Malama Integrative Healthcare Group and Rehabilitation Center offers all of the above services, and for almost 20 years has treated many tens of thousands of injured workers utilizing a measured, team- based approach to care. Because we are across from the Blaisdell and close to the Honolulu Police Department headquarters, we have had the privilege of caring for many injured officers and appreciate how important it is to return them safely back to work.

That’s the good news. The bad news is that too often, with other employers, long-term employees once held in high esteem suddenly become characterized as a malingerers when they become injured, and necessary care can be obstructed. It happens often enough that primary care providers almost never take these cases. As such, most injured workers are cared for in one of several larger facilities around the islands that offer occupational medicine services.

Several years ago some of the physicians who see the greatest numbers of injured workers in Hawaii met at my home, and we founded the Work Injury Medical Association of Hawaii (WIMAH). The mission of WIMAH is to engage workers’ compensation insurers, legislators, physician colleagues and other stakeholders in an effort to ensure fair treatment for injured workers.

To date, WIMAH has accomplished a great deal: We currently hold annual workers’ compensation summits to bring together stakeholders for constructive discussion and collaborative decision-making. Injured workers are now entitled to bring a chaperone who may record an “Independent Medical Evaluation.” WIMAH also has safeguarded the ability of treating physicians to dispense necessary medication.

There is still work to be done, though. It is important to curtail the tactic some insurers use to deny treatment to injured workers known as “denied pending investigation.” Independent medical evaluators must be chosen not simply by insurers who pay them handsomely, but by mutual agreement. It is also critical to help make government more efficient by curtailing misleading and unnecessary billing reviews for reasonable and appropriate services rendered.

Long ago, together, the people of Hawaii established an important social contract: When our workers become injured, they are entitled to reasonable and necessary medical care. The system in place is, at its foundation, a good one, but we must pull together to ensure it functions as it was intended.

WIMAH will hold its next Workers’ Compensation Summit on Sept. 28 from 7 a.m. to 5 p.m. at Aloha Tower. For more information, contact wimah808@gmail.com.

Ira Zunin, M.D., is a practicing physician. He is medical director of Manakai o Malama Integrative Healthcare Group and Rehabilitation Center and CEO of Global Advisory Services Inc. His column appears the first Saturday of every month. Please submit your questions to info@manakaiomalama.com. For more information, go to manakaiomalama.com.