Why do we need QMEs?  Or  AMEs, for that matter?  Why can’t the primary treating physician make a full review of the records, provide measurements and a list of subjective complaints following the evaluation, and then allow the attorneys or the DEU to plug those measurements into the AMA Guides and come up with a whole person impairment rating?

After all, your humble blogger is a doctor of sorts, and why can’t the Juris Doctorate be applied to fill in the role for the doctor?  It’s not like I would be performing surgery, and I’ve seen enough episodes of House and Scrubs to wing this whole medical stuff, right?

Oh… well fine!

In that case, let me tell you about the recent panel decision in the matter of Tallent v. Infinite Resources, Inc.  Mr. Tallent was employed as a mechanic (what kind of mechanic? A very Tallent[ed] one!)

All kidding aside, Mr. Tallent sustained very serious injuries, and his treatment included orthopedists and neurosurgeons, among others.  In the course of his treatment, he became depressed and was referred to a psychologist.

Ultimately, the QME, a chiropractor, wrote a report in which he provided ratings for all impairment, including psyche and the results of the spinal surgeries.  In writing this report, he apparently relied on the findings of the various treating physicians and his training as a chiropractor and a QME.

Well, as one can imagine, the defendant had a problem with that.  Defendant made the argument that a chiropractic QME cannot comment on the impairments that fall outside of his or her scope of practice.

The WCJ considered both sides of the argument, but ultimately ruled that a Chiropractor QME could and should render opinions on all sections of the AMA Guides, and such opinions did not constitute providing medical treatment outside the scope of the chiropractor’s medical license.  The Chiro QME’s report was supported by the reports issued by treating physicians, which were incorporated into his own.

The WCAB denied reconsideration and adopted the WCJ’s report.

Now, your humble blogger can’t help but ask, as discussed above: why do we need QMEs?  Can’t a primary treating physician take measurements? Can’t a DEU rater be trained in the AMA Guides and just plug those ratings into the AMA charts and graphs?  For that matter, can’t this all be done with software?

If a professional’s expert opinion is valid because of his or her training, rather than any particular license, why can’t the DWC just provide the AMA Boot Camp and call it quits on the whole QME system?

Furthermore, at what point would a chiropractic QME feel qualified in disagreeing with a neurosurgeon or psychologist as to findings, treatment, or causation?  And if the medical referee does not have the training or experience to provide a meaningful second opinion on an issue, what is the point in the objection and the QME/AME process?ss