“There are more people in chronic pain in America today than diabetics, those with heart disease, those suffering from strokes, and those with cancer combined.” – Dr. Joel Morton
The prevalence of chronic pain across the United States is certainly associated with the overuse of opiates, opioids, and narcotics, three words that are used interchangeably. While there are requirements surrounding the improper prescribing of highly-addictive pain relievers, they have been widely unenforced. The question remains, how do we address an individual’s problem of chronic pain without causing widespread opiate addiction issues.
In this episode of Workers Comp Matters, Alan Pierce interviews Dr. Joel Morton about the association between chronic pain and opioid addiction, alternative treatments to long-term opioid prescription, and how his company, Summit Pharmacy, works to help injured workers and has guidelines to recognize potential overuse. Dr. Morton describes the need for a mental evaluation of a patient for depression or a history of addiction before prescribing highly addictive products. He discusses alternatives such as anti-seizure medication, anti-inflammatory drugs, muscle relaxants, and antidepressants as well as cognitive behavioral therapy, physical therapy, exercise therapy, and acupuncture. In the end, Dr. Morton says, it is the chronic pain issue that the medical, legal, and criminal community need to address.
Summit Pharmacy is a mail-order pharmacy that works alongside injured workers and attorneys to help them manage the claim and filling patients’ prescriptions regardless of claim status. Listen to this interview to learn more about the company.
Dr. Joel Morton is the medical director of Summit Pharmacy, Inc. He graduated from Philadelphia College of Osteopathic Medicine in 1988 and he is a board-certified family physician. He has had extensive experience as a physician in charge of workers compensation clinics in North Carolina and throughout the United States. Dr. Morton also has training in sports medicine. He is a recently retired lieutenant colonel in the US Air Force reserve and he served active duty in Iraq in 2005 in Operation Iraqi Freedom.
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Workers Comp Matters: Chronic Pain, Opioid Addiction, and Injured Workers – 3/27/2015
Advertiser: This is Workers Comp Matters, hosted by attorney Alan S. Pierce. The only Legal Talk Network program that focuses entirely on the people and the law in workers compensation cases. Nationally recognized trial attorney, expert and author, Alan S. Pierce is a leader, committed to making a difference when workers comp matters.
Alan Pierce: Welcome to Workers Comp Matters, here on the Legal Talk Network. This is Alan Pierce, i am your host, I practice law in Salem, Massachusetts where my firm Pierce Pierce and Napolitano concentrates on the representation of injured workers and their families as a result of on the job injuries. With coming today on this show of Workers Comp Matters, from the Annual Convention of WILAG. WILAG is the Worker’s Injury Law and Advocacy Group. It is a claimant-based Bar Association dedicated to the representation of injured workers and we are holding our convention in Santa Barbara, California. Before we get started, we would like to thank our sponsors, Case Pacer, practice management software dedicated to the busy trial attorney. To learn more, go to CasePacer.com. And also, PINow, find a local, qualified private investigator anywhere in the US. Visit PINow.com to learn more. I am delighted to have our guest this morning, Dr. Joel Morton. Dr. Morton is the medical director of Summit Pharmacy, and Dr. Morton is a board-certified family physician. He has had extensive experience as a physician in charge of workers compensation clinics in North Carolina and elsewhere. He has also had training in sports medicine and he is a recently retired lieutenant colonel in the US Air Force Reserve. He served active duty in Iraq in 2005 in Operation Iraqi Freedom, and for that, we and all of us thank you for that service to our country. Dr. Morton, you are associated with Summit Pharmacy as medical director and perhaps co-founder. Could you describe just very briefly for us what Summit Pharmacy is and how important it is in the workers compensation field?
Dr. Joel Morton: Sure. Summit Pharmacy is a pharmacy that specializes in care of the injured worker across America today. We ensure that proper care is being delivered to patients as prescribed by physicians and support your claim as you’re litigating your patient’s case and make sure they get the care that they so richy deserve.
Alan Pierce: And you dispense medications in what fashion?
Dr. Joel Morton: We’re a mail order pharmacy. We use several carriers to overnight deliver medications to patients if indicated. Refills can certainly go out to patients monthly and so the patients get things delivered directly to their door. They don’t have to go down the street to a pharmacy and wait in line or wait for prior authorization or anything of that nature. We get the medications directly to the patient
Alan Pierce: I have a very active practice of workers compensation claimants and I know over the last several years a lot of the larger workers comp carriers, insurers, have relationships with a variety – I guess I would call them your competitors – that provide the same type of service. Tell us why Summit Pharmacy might be different from some of these other insurance-driven pharmacy companies?
Dr. Joel Morton: We’re going to continue being the patient advocate, and we’re working to ensure that the physicians prescribing habits are followed and their care is followed as well; working closely along with our attorneys to help manage their claim and make sure the patient is getting what they deserve and they get the medications that have been ordered.
Alan Pierce: If I were to talk to my staff and ask them and my colleagues in my office and the colleagues in the practice of workers comp law, what is probably the single most vexing problem and the most troublesome, almost daily phone call we get from our clients, it would be: I can’t get my medication approved, I’ve paid for the medication and I’ve submitted my receipts to the insurance company and they’re not reimbursing me, and I’ve started using Summit Pharmacy. Tell our audience how you have helped on that issue.
Dr. Joel Morton: We help several patients when it comes to this kind of a problem. We’ve found across the country that many patients – for instance, we had a gentleman who walked up to the Brick & Mortar in his city to pick up his medication and he was told by the pharmacist that he can’t have that because his claim is not accepted at this point. And at this point then the patient had to then walk out again, certainly dejected, tried again the next day and wasn’t able to get that. At Summit Pharmacy, as we work closely with your law firm and talk to you about the validity of this claim and how good a claim this is, we’re going to fill that patient’s medications because we understand that the patient needs this treatment and their care to be able to return to work. And so we’re a partner in your case with you by handling this claim, making sure the patient gets their care, and then handling some of the paperwork and some of the phone calls and the issues that frequently vex your office. Certainly, we take those cares on and our staff – many – are folks who have worked with me in the past as a physician. They have great patient care experience and they’re very good at talking with patients and explaining the whole procedure and how they’re going to get their medications. In fact, no patient receives medication without a phone call from someone at Summit Pharmacy to make sure that we have a good idea of where they live, who their attorney is, who their physician is, and then of course various medical questions we ask them to make sure they get the appropriate care and they get their medications where they need them.
Alan Pierce: And you bill the insurance company directly?
Dr. Joel Morton: We bill the insurance company directly, we never bill the patient.
Alan Pierce: And if the insurance denies or the bill builds up, what’s your mechanism of getting paid? I know in the course of my handling a claim, we’ll have to file the claim for reimbursement, and like I say, always hope to be successful.
Dr. Joel Morton: Yes. Well, we’re partners with you in that whole deal. And as you work on that claim and as we work to get that claim litigated and accepted, we’re going to continue to be a partner with you, and as you basically go out on a limb for that client, we’re going to go out on a limb with that patient and work with you in that case to make sure we get paid. We will not bill your patient or your client.
Alan Pierce: And what I’d really like to do right now is turn to one of the reasons you’re here today at this conference. You’re one of the presenters, you are speaking at some point today in this program. And I know one of the hot topics here and the hot topics nationally, whether it’s injured worker representatives, Bar association, or the defense insurance groups, the biggest crisis I think out there is chronic pain and opioids. Give us a little idea of the depth and breadth of this as a problem.
Dr. Joel Morton: I think you can’t understate the whole problem there, and I’m glad that you called it what you did. It’s a huge problem across America, the problem of pain. And you can’t separate the problem of pain with the opioid problem as well. As the folks at the CDC said, we’ve got an epidemic of opioid prescription medication abuse, but we also have a public health problem and that is chronic pain. There are more patients or more people in chronic pain in America today than diabetics, those with heart disease, those suffering from strokes, and those folks who are suffering from cancer combined. So it’s a huge amount of people and it’s a large problem because these people have chronic pain, they’re suffering, and we’re trying to find – as physicians – proper ways to treat them.
Alan Pierce: And how have the various jurisdictions in which Summit Pharmacy operates, and I guess you’ve covered 49 or all of 50 states, you’re in California now.
Dr. Joel Morton: We are in California now.
Alan Pierce: What is the drug or the prescription that is the most abused? Is it the hydrocodons, the oxycodones? That whole classification.
Dr. Joel Morton: It’s certainly in the opioid class, the oxycodones, the hydrocodones are very abusable. The oxycodone that you speak of years ago, there was some formulation changes that made it much more difficult to abuse. And the shorter-acting medications, the hydrocodones, especially the oxycodones, are far more abusable and easier to get. I think one of the things to underline is that abuse oftentimes comes from diversion. So the patient who received the prescription might not be the person abusing it, it could be somebody who stole it or got some leftovers. We find that those medicines are getting to people who shouldn’t be using those medications from other avenues and not quite as frequently from one doctor to one patient.
Alan Pierce: And I know the medical community and the legal community and the criminal authorities are looking into this. There are a variety of requirements that may have always been there but now need to be enforced, and that would be – and I’ll have you expand on it – the contract with the physician, the testing for underuse or overuse. And tell us about those requirements and how they impact the delivery of your product.
Dr. Joel Morton: Sure. There’s a lot of things and a lot of fixes that we need to start trying to apply here, and we’ll start at the top with the states and at the state level with prescription drug monitoring programs. Most states – we have one state that’s lagging behind – does not have a prescription drug monitoring program. And that’s where when physicians prescribe, hopefully we can get to that database and find out has the patient been shopping around and going elsewhere. As one of your clients should see a physician who is prescribing opioids. They should be seeing somebody who’s well-versed in opioid and chronic opioid therapy and that would include several things. And the first one, as you mentioned, was an opioid contract. That contract should tie the patient to one physician, and I believe the physician should tie that patient to one pharmacy to receive their opioids. That physician should also have the patient sign onboard with certain monitoring procedures, whether it be pill counts – so requiring the patient to come in with pills. Whether it be urine drug testing, and this is clinical urine drug testing, not forensic urine drug testing. So this is testing that helps the provider continue to monitor his patient’s care as he moves along. And then the patient should be required also to not be able to call in and look for refills and need more medications. Those are kind of signs that maybe the patient is abusing that medication or something. So the physician needs to be well-trained and well-versed in these kind of things to be able to provide that kind of care to the patient.
Alan Pierce: Let’s try to define some terms. We’ve been using the word opioid, is that interchangeable with opiate?
Dr. Joel Morton: That is interchangeable with opiate.
Alan Pierce: And that’s a poppy-based derivative that we see in heroin and we see in other class 1 drugs?
Dr. Joel Morton: Class 2’s and class 3’s, yes.
Alan Pierce: What about the word narcotic, is that synonymous or is that more synthetic?
Dr. Joel Morton: I think in today’s market you can use those together synonymously and most people do, they’ll call it an opiate or they’ll call it a narcotic. Narcotic is a little more broad ranging because you get the synthetic, the semi-synthetic opiates as well at that point of the semi-synthetic medications that we’ve been able to produce in the pharmacological world.
Alan Pierce: Now as far as Summit is concerned, are any pharmacy service that delivers via mail or delivery service, are there certain prohibitions or requirements for narcotics or opiates as opposed to the more standard medications?
Dr. Joel Morton: I think there are certain things we put onto ourselves to make sure that the medication gets to the correct person and it gets delivered appropriately and we get the correct signature for that. So we certainly don’t give those medications without signatures and somebody has to be there to accept that kind of a medication.
Alan Pierce: We’ve heard a lot – at least in the legal circles and the claim circles – of formularies and close formularies to find that for us. What is that and where’s the controversy?
Dr. Joel Morton: So the formularies are a way for the PBM or the insurer to-
Alan Pierce: The PBM means?
Dr. Joel Morton: Excuse me, that’s the pharmacy benefit manager and or the insurers – to control a bit the prescribing habits of the physician. Formularies in and of themselves are not necessarily bad or inherently evil. I always harken back to that if the formulary’s patient-based and based on the patient given the appropriate care, then it’s not necessarily a bad thing. But the formulary basically would say these are the set of medications or set of drugs you can order as a provider for this patient. If you want to order something different, then formularies will either require a prior authorization or there may be a tiered level. So a tier 1 costs a certain amount of money, a tier 2 costs a certain amount of money and a tier 3 is something else. Some of the controversy comes when patients are denied certain medications that the physician feels are very strong when indicated in that case and there are some things that can happen with that. The patient’s been on the medication a long time and whether they are dependent on it or they withdraw from that kind of a mediation, or if there’s significant delay that comes along with the formulary. Whether there’s an administrative problem and it takes 7 days, 10 days, 14 days for the patient to receive care. Suddenly we’re delaying care that is indicated and probably necessary when written for in that nature. So the delay is a problem and then the level of administrative duties that a formulary may place on a physician’s office, oftentimes, is too difficult for the physician to do, so they merely comply. They change their treatment course and merely comply with what the formulary states, or they try to get the right people in place so that they can do all the prior authorizations and administrative duties.
Alan Pierce: And we’ve been talking primarily about the pill to deal with chronic pain and most jurisdictions – and I know I practice in Massachusetts – we have adopted chronic pain guidelines or at least chronic pain guidelines that offer alternatives to taking that pill as needed or once a day or twice a day. As a physician, I think you will agree with me that when oxycontin first came on the market it wasn’t designed for open-ended long term end use. It was breakthrough pain for a defined period time, either post surgical or post some kind of painful treatment. It’s evolved into perhaps the easy fix for the patient who comes in and is complaining of pain, physician renews the prescriptions. What other and perhaps more appropriate ways that we really ought to be looking at more seriously for dealing and controlling chronic pain?
Dr. Joel Morton: I think there’s several things there that goes into that and one of the first things when it comes – since we’re speaking of opiates and things like oxycontin and things – is that an opiate should not be a sole treatment so there’s always a red flag. And even in our pharmacy there’s a red flag if we receive nothing but an opiate prescription. That physician routinely gets called and we start asking questions about that; so an opiate shouldn’t be the only course of treatment. Even before treatment starts, however, the American Pain Society, the American Academy of Pain Management, all suggest several things are to happen. That physician needs to do an excellent history in physical. That history and physical should include some mental health questions, whether the patient has battled with addiction in the past, whether there’s any depression in the past because of the potential of adding an opiate with depression and things of that nature. So there’s a lot that goes into things before a patient receives opiates, but if the patient has moderate to severe pain that’s uncontrolled and it’s affecting their quality of life, their ability to function well or the ability to even return to work, then an opiate may be an appropriate choice. And while we’re talking about opiates, we need more research. We don’t have a lot of good evidence base once we hit 3 or 4 months of what we should do with opiates. Beyond opiate use, there’s several other ways to go with things and this is important as well because there are good medications out there. Some, believe it or not, are anti-seizure medications that are wonderful for pain control. Some are antidepressants that are wonderful for pain control. Antiinflammatories which I’m sure you know about and muscle relaxers are all available to patients. And certainly, some of these should be first line medications before we start talking about chronic opiate use. There are other things that are important here and one of them is cognitive behavioural therapy. The American Academy of Pain Management certainly pushes that as one of the best psychiatric or best mental health ways to help treat patients who are in pain. And then many of the physical modalities, whether it be physical therapy, exercise therapy, modalities such as acupuncture, dry needling, and manipulative therapy. I’m an osteopathic physician, I would be remiss not to mention the fact that you can manipulate a lot of these spine injuries and give these people some relief. Finally back to the pharmaceutical side of things, I think some fairly newer novel therapies, whether it be compound in medications as one of those things should be entertained. They’re routinely dismissed by pairs for certain reasons and once again we’ve got a huge, huge problem of pain and a huge problem with opiate abuse and as such, we need to start entertaining whether these medications also would play a role in the treatment and care of pain.
Alan Pierce: When you mention cognitive behavioural therapy, I see that. I deal with my clients, sometimes daily, certainly weekly or somewhat frequently, and the impact of being out of work, being in pain, having the financial issues that contest a claim or benefit levels that may not be adequate in the dynamics in the family – this all swirls together so that pain and or dysfunction of any sort isn’t a single identifiable source. And it’s been clear to me for years that the physiological management of the patient is oftentimes critical and oftentimes early rather than later because the later this goes on, I think statistics will tell us the success rate goes down exponentially. Yet, I found through whatever reason insurance company’s claims reps are very loathed to get involved in the psychological or psychiatric end of things. they’re buying the side case, for some reason then gets out of control. And I know that in our treatment guidelines in Massachusetts they’ve recognized first and foremost that a comprehensive initial psychosocial, psychopharmacological evaluation is necessary. And I guess you can probably endorse that wholeheartedly.
Dr. Joel Morton: Oh, I couldn’t say more and applaud you more than understanding the complexity of pain. And pain is not merely, I hit my finger with a hammer and it hurts. When pain becomes chronic, it pulls in psychological problems, as you’ve said the social problems. It’s a huge, huge monster to treat. And if we don’t attack or treat each of those levels, I think we run the risk of losing this patient. And I believe part of the problem with opiate abuse here and that we can work together – physicians, pharmacies, attorneys, the pairs – is understand that and realize that this delay and denied tactic throws the physician in a tough place. Because not many folks who are doing physical therapy or cognitive behavioural therapy are able to do what we do at Summit Pharmacy and basically get care to this patient while we’re waiting for this case to become a case that’s been accepted. And if we’re in this to fix the opiate problem, I think we’ve got to sit with the pairs and say look, this is well understood that this is a problem. We need to make sure our patients can get cognitive behavioral therapy, or can get their physical therapy and things sooner rather than later.
Alan Pierce: At this point I think we’re going to take a short break and when we return, we will pick up our discussion with Dr. Joel Morton of the Summit Pharmacy.
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Alan Pierce: Welcome back to our show on Workers Comp Matters, this is Alan Pierce, I’m with Dr. Joel Morton of Summit Pharmacy. We are talking about not only the product that Summit Pharmacy deals in which is the supply of pharmaceuticals to injured workers in a workers compensation claim, but also the bigger issue of chronic pain and how to deal with it. I know we started to get into a discussion of the alternatives to pain medication and we talked about the various modalities. I know that I’ve seen acupressure and acupuncture and facet injections. Tell us some of the other medical treatments for chronic pain outside of perhaps a psychiatric or psychological realm.
Dr. Joel Morton: Certainly. Some of the invasive treatments that you were just speaking of can go from acupressure which is more pressure to perhaps a trigger point area. And a trigger point area is an area of muscle that’s bound up and it’s a chronic pain producer, basically. Acupuncture, which is using a small needle to get to that area. And then there are some things , dry needling or even injections of a steroid or something into one of those areas that can help to relax that muscle and nerve area to decrease some of the pain. When you talk about facet injections, those are injections that actually go all the way down to the spine and to the part of the spine joint that causes most of the motion. And if somebody’s got an inflamed or irritated joint, or they’ve got some arthritis that was there before but they were injured and now that joint is irritated, you can inject the joint. It’s very similar to injecting, say, a knee joint, except it’s a little more difficult to get to and you require frequently imaging, like with a C-arm or it’s guided by imaging, by x-rays and things of that nature. So that’s a facet injection, and then right down to disc injections, which is an injection around a bulging disc that may be causing irritation to a nerve route. So there’s a lot of invasive treatments that can be performed to help alleviate some of the pain. A lot of this stuff would be focusing on the patient’s back, but even in things like carpal tunnel where you can inject the carpal tunnel with steroids or somebody who’s got a lateral epicondylitis or tennis elbow, there are different therapies whether it be steroid injections or platelet-rich plasma injections. There’s a lot of things out there that are available that are a little more invasive. And then finally I think the other physical modalities that we touched on briefly – physical therapy, exercise therapy, manipulative therapy – are always to help the patient. And not only to acutely help the patient but then teach the patient so that if their pain begins backing in or it starts worsening, give them a set of exercises, a set of tools that they can utilize to kind of decrease the amount of pain that’s going on. I’ll give you an example: I’ve suffered from back pain for the last 20-25 years. I used to do roofing and sighting and do a lot of construction work, and I’ve got a little bit of arthritis in my back and it flares up every now and then depending what I do. I see the physical therapist maybe once a year and get a new set of exercises to do, and the more I stay up with my exercise and keep my core strong and do the range of motion exercises that are particular to my low back, I have less episodes of pain. I wouldn’t say I never have pain, but less episodes of pain which help me function better and walk around and not be in pain. So all of these are very, very important in the treatment of somebody who has chronic pain.
Alan Pierce: And I noticed over the years that my clients are getting more injections, either lidocaine or novocaine or steroid injections; epidural for said joint, call it what you will. They seem to come in a series of perhaps 3 over a span of time or limited per year. Are they strictly palliative or short term or can they be – if not curative, longer lasting – or is it individual?
Dr. Joel Morton: It’s fairly individual, the response that somebody’s going to get from some of those injections. You can get anywhere from 0 relief to a month to 3 months to 6 months relief from some of these injections. Some of the thoughts are you get longer relief and when you get that relief, then you can parlay that into an exercise program or some kind of a physical program that the patient may not have been able to do initially but now they can do so they can maintain that and they’re not having those symptoms any longer. Certainly an epidural injection, if there’s a nerve route that’s being irritated by a bulging disc and we can decrease the swelling around that nerve route with an injection, then possibly there you’re getting a significant cure just by getting the pressure off the nerve routes of the patient’s not suffering from that nerve pain that they’re experiencing.
Alan Pierce: I’ve been doing workers comp for several decades now, and it seems that things come and go. We’ve had chemo papayan injections where they would inject an enzyme to shrink this issue. We’ve had thermograms that somehow could actually document the presence of pain with hotspots and a radiograph. We’ve seen a TENS unit and varieties of that. Tell us a little bit about the mechanism of somehow interfering with the pathways of pain, between the source of the pain, of the area of trauma in the brain, the electrical conduit, and how effective are TENS units and maybe what’s a current 21st century variation of a TENS unit. Describe what that is.
Dr. Joel Morton: That’s actually very interesting and a very interesting question because we certainly have plenty of medications that are also aimed at those pain fibers and the transmission of pain up and down the spine, as you were. So one of the things that you probably have seen or you’ve seen in your patients are a lidocaine patch, which you know is like novacaine. But that patch is applied not allowed necessarily to numb the back up, but it’s applied to interfere with – believe it or not – down with the cellular level or some of the potassium channels which interferes with that area, which reduces the amount of pain stimulation going from the pain site to the brain and back again. There are plenty of other medicines I mentioned earlier, some of the seizure medicines that we utilize and they work along that pathway as well; Gabapentin, which is one of the pain modulators as well. I’ll also say that many of the compounded medications that pain physicians are using – which are some of the newer things that we’re seeing in pain – have several of these things in there. So a pain compound may include something that’s a nerve blocker as well as a lidocaine-like medication, as well as a pain reliever and one compounded medication to deliver those medications directly to the site and hopefully work on that transmission of pain up and down those fibers.
Alan Pierce: And now it’s my turn to transmit a little bit of pain to you. We have a feature on Workers Comp Matters called Case of the Day, and certainly to me in the field of workers comp, some of the cases that somehow make the literature are interesting, oftentimes tragic, sometimes a little humorous and a combination of the two. But I’d like to put you on the spot a bit. I’m going to describe a case and I’m going to ask you to predict or give us your opinion as to how this case turned out. And of course as I always do, I do caution anybody listening that these cases are very specific and fact-specific to the case and they vary from jurisdiction to jurisdiction. But I found a case that comes to us from the state of Alabama. It is the case of Mercy Logging Company V. Johnnie Odom and this is a case where Johnnie Odom was a long-distance truck driver for Mercy Logging – I guess they hauled timber- and he and two other employees were driving down the road. And as they were driving down the road, they noticed a diamondback rattlesnake in the road. And they were very cognizant of these types of snakes because they go into the woods and they are a distinct hazard to loggers and other people in the woods. And Odom, who was driving the truck, said I’m going to run over that thing. And the co worker implored him, don’t run over it, let’s catch it. So Odom pulled over to the side of the road and he had some experience in gathering snakes, and he went and he used his hands. And it’s a 6’3 inch long diamondback rattlesnake. And as he picked it up from behind the head – of course, you can predict what happened – the snake bit him. And he had a very tragic and unfortunate result and brought a claim for workers compensation benefits. And this was resisted by the insurance company. The industrial board in Alabama awarded benefits and the case was reviewed and it went to the appellate level. And the position of the employer was that Odom undertook this on his own, that he could have just continued driving or he could’ve run over the snake. But when he went and actually picked it up and got bit, he should not be entitled to workers comp. So tell us how you think this case came out.
Dr. Joel Morton: That’s an interesting case. I would certainly have to understand where the insurance is coming from, as it doesn’t seem like it’s in the normal duties of a truck driver hauling wood. However, he was currently at the time hauling and delivering wood. So as he was working at the time that the accident happened, I’m going to have to say that they were in the favor of the worker who was removing the snake.
Alan Pierce: Well if I had the buzzer that they have in the game shows, you would get the buzzer. That is not how the reviewing court ruled, however, I think that’s how the way should rule. But you actually isolated a very important point. In order to be covered by workers comp, the injury not only has to arise out of the employment in the course of your employment, but it has to arise out of your employment. So the appellate court did, indeed, find that he was in the course of his employment. He was working, driving the truck. But when you got to the narrower issue, did it arise out of his employment, the court on review held that he voluntarily left the safety of his vehicle and that the snake posed no occupational risk. And that once he voluntarily exited the truck and attempted to catch the snake, the risk of his injury was personal to him and not sufficiently related to his employment to be covered. Now, I will tell you that that case could have turned out differently. There was a case in Massachusetts, very similar, didn’t involve a snake but it involved the driver of the vehicle down the highway and there was a coil of rope lying in the middle of the interstate that was posing a hazard to other vehicles. And that injured client, who became injured, parked over the side of the road, ran out between traffic, and got the coil of rope and got hit by a car. And he was denied workers comp but was reinstated in the Massachusetts Supreme Court on the Good Samaritan doctrine that he was in an act that – and while it may not have benefited his employer in a broader sense that he should not be penalized for performing that type of act of removing a hazard in the roadway. But you were right on the fact that he was in the course of his employment, but the Alabama court very narrowly construed whether this arose out of the incidence of his employment. And that’s how very technical and tricky these cases can become. So to sum up, I’ve got a claimant practice and I’ve got an injured worker who comes in and says Liberty Mutual, Travelers, AIG, they’re not paying for my prescriptions and I have a Summit Pharmacy contract. How do we initiate getting you folks involved, what’s the steps? You’re not located, there is no Brick & Mortar, there’s no store to go to and my client’s got the prescription or his doctor’s got it on file with CVS or Walgreens. How do you folks take it from there?
Dr. Joel Morton: Sure. So there’s several ways that can happen. If they’re sitting in your office, you can call us, that’s one of the easiest ways at our toll free number. And one of our girls in enrollment will take all the necessary information, your patient’s name and their physician’s name and things of that nature; so that’s simple and easy. If you’ve got your own enrollment form, you can actually fax it to us and then we’ll get in touch with your patient or your client and make sure that their medications are delivered to them. We’ve actually got an online portal where you can go on – and although I think our site’s under construction so don’t go right now – where you can do it online. Or the patient themselves can actually call us as well.
Alan Pierce: And how do you physically get possession of the actual written script?
Dr. Joel Morton: So once we get the information from the patient and we get the physician’s prescribing provider’s information, and we’ll call the provider themself. If it’s a non C2 or it’s not a scheduled drug, it’s not a narcotic or an opiate, then the provider will oftentimes fax us our they’ll eScribe us. If they’ve got an electronic record, they’ll eScribe us and we’ll get the prescription that way. If it’s a medication that requires we have the actual hard copy of the prescription, like all the C2’s do, then we will ask that the provider mail that to us or send it to us by FedEx. We’ll actually send one of the carriers out to the office and the carrier will pick it up from the doc’s office and we’ll get it sent directly to us overnighted so we can get the patient the medicines that they need. If it’s at another pharmacy, so if it’s at a CVS somewhere and we can get it transferred to us, then we’ll do a transfer from pharmacy to pharmacy.
Alan Pierce: well, Dr. Morton, I want to thank you very much. I know we covered a lot of ground in a short amount of time in a very complicated, controversial, and important area. It affects the lives of our clients, their families, their health, their well-being and their mortality. We didn’t even get into those statistics, but I think those listening can probably guess pretty well that long term opiate use does not have a good upcome in a lot of instances. How can people get in touch with you folks, and again, thank you very much for joining us on Workers Comp Matters.
Dr. Joel Morton: Well, you can find us at SummitRX.com. You can always call the pharmacy at (877) 678-5400; and we’d be glad to take care of your health and any cases that we can help you with.
Alan Pierce: Doctor, thank you very much for joining us on Workers Comp Matters, thank you.
Dr. Joel Morton: Thank you.
Alan Pierce: This is Alan Pierce, this is another edition of Workers Comp Matters; we’re thankful that you listened to our show, we hope that you listen to our other shows on Legal Talk Network and go out and make it a day that matters.
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