The Senate Ways and Means Committee, chaired by Sen. David Ige, essentially shelved two bills this week that would have helped repair the state’s workers’ compensation system, which is in great need of repair.

One bill was deferred and the other was reduced to a study of the issue, disappointing a conference room filled with occupational medicine physicians in white lab coats, patients and others who believed passage of the bills is critical to solving long-standing administrative problems suffered by injured workers.

House Bill 466 required both independent medical evaluations (IMEs) and disability evaluations for workers’ compensation claims to be performed by physicians mutually agreed upon by employers and employees or appointed by the director of the Department of Labor and Industrial Relations. The bill was passed by the House, crossed over to the Senate and passed by the joint Senate Health and Judiciary committees.

For far too long, workers’ compensation carriers have been able to dictate that injured workers be seen by hired hands. Carriers maintain a roster of IME doctors who too often simply use their credentials to give payers the opinion they want to hear, which is used to deny care.

The only recourse for the injured worker is to request a hearing at the Department of Labor, but, as the result of budget cuts, it can take two years before one is granted. While waiting, many injured workers lose their homes, turn to drugs or just give up.

Many IME physicians earn most or all of their income from these lucrative reports and treat few actual patients, if any. They also know that if their opinions are too "patient-friendly," they may be out of work because carriers will move on to others who more reliably provide the opinions they desire.

HB 466 was an attempt to remedy this situation and ensure that IMEs are more impartial and objective. Now the bill appears to be dead.

The second bill — HB 2152 — provided an across-the-board increase in workers’ compensation reimbursement from the current allowable Medicare payment plus 10 percent to Medicare plus 30 percent.

This bill followed a similar trajectory through the Legislature. It was passed in the House and was working its way through the Senate until the Ways and Means committee changed it into a bill that requests the state auditor conduct a study on workers’ compensation.

Sen. Ige said in the hearing on Wednesday that he wanted to defer both bills indefinitely. The auditor’s study seems to be just another way to defer the bill.

For years, Hawaii’s physician reimbursement for the treatment of injured workers has been among the lowest in the country. As a result, primary care doctors will rarely treat even their own patients when injured at work. Those who do cannot find specialists willing to accept workers’ compensation insurance.

Just Friday, a teacher flew to see me from Maui after a fall at work. She explained: "My regular doctor would not take workers’ comp and sent me to Kaiser although I am not a Kaiser patient. Kaiser said they were full and sent me to Maui Medical Group, which also declined to see me and sent me to the Aloha Pain Clinic. When finally seen there, I learned that this clinic only handled chronic pain and specialized in injections." As a last resort, she came to Oahu for care.

This week, the owner of a company that employs nurse case managers confirmed that injured workers on the neighbor islands cannot reliably access doctors to care for them.

Ige said that in the 1990s he worked to address escalating health care costs in the workers’ comp sector. He said that although the changes made were projected to hold down costs for only five years, they have kept costs in check for 16 years and counting.

The effect is fewer doctors willing to take workers’ comp cases and injured workers going untreated.

We don’t need more studies. We need to fix the workers’ compensation system and honor our social contract with workers.

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Ira Zunin, M.D., M.P.H., M.B.A., is medical director of Manakai o Malama Integrative Healthcare Group and Rehabilitation Center and CEO of Global Advisory Services Inc. Please submit your questions to info@manakaiomalama.com.