She taught me a LOT!

My mother taught me TO APPRECIATE A JOB WELL DONE.
³If you¹re going to kill each other, do it outside. I just finished cleaning.²

My mother taught me RELIGION.
³You better pray that will come out of the carpet.²

My mother taught me about TIME TRAVEL.
³If you don¹t straighten up, I¹m going to knock you into the middle of next week!²

My mother taught me LOGIC.
³Because I said so, that¹s why.²

My mother taught me MORE LOGIC.³If you fall out of that swing and break your neck, you¹re not going to the store with me.²

My mother taught me FORESIGHT.
³Make sure you wear clean underwear in case you¹re in an accident.²

My mother taught me IRONY.
³Keep crying, and I¹ll give you something to cry about!²

My mother taught me about the science of OSMOSIS.

³Shut your mouth and eat your supper.²

My mother taught me about CONTORTIONISTS.
³Will you look at that dirt on the back of your neck!²

My mother taught me about STAMINA.
³You¹ll sit there until all that spinach is gone.²

My mother taught me about WEATHER.
³This room of yours looks as if a tornado went through it.²

My mother taught me about HYPOCRISY.³If I told you once, I¹ve told you a million times, don¹t exaggerate!²

My mother taught me the CIRCLE OF LIFE.
³I brought you into this world, and I can take you out..²

My mother taught me about BEHAVIOR MODIFICATION.
³Stop acting like your father!²

My mother taught me about ENVY.
³There are millions of less fortunate children in this world who don¹t have wonderful parents like you do.²

My mother taught me about ANTICIPATION.

³Just wait until we get home.²

My mother taught me about RECEIVING.
³You are going to get it when you get home!²

My mother taught me MEDICAL SCIENCE.
³If you don¹t stop crossing your eyes, they are going to get stuck that way.²

My mother taught me ESP.
³Put your sweater on; don¹t you think I know when you are cold?²

My mother taught me HUMOR.³When that lawn mower cuts off your toes, don¹t come running to me.²

My mother taught me HOW TO BECOME AN ADULT.
³If you don¹t eat your vegetables, you¹ll never grow up.²

My mother taught me GENETICS.
³You¹re just like your father.²

My mother taught me about my ROOTS.
³Shut that door behind you. Do you think you were born in a barn?²

My mother taught me WISDOM.
³When you get to be my age, you¹ll understand.²

My mother taught me about JUSTICE.³One day you¹ll have kids, and I hope they turn out just like you!²

The Pennsylvania Commonwealth Court, in a decision published late last month, seized upon Fentanyl (ACTIQ), a highly addictive opioid, 100 times more powerful than morphine, when it ruled specifically that Fentanyl lozenges were not appropriate as treatment for a workers’ compensation low back injury. According to defense counsel, Ronald A. Varga, the decision of the Court “could be significant” as it provides carriers with “a mechanism to cut of this medication and switch to something else”.

The original dispute occurred after Utilization Review findings concluded that the Fentanyl lozenge was not appropriate and necessary treatment for a low back injury because of its highly addictive nature and because its only approved use is listed as end stage cancer pain. The original decision, made by the Workers’ Compensation Board, found that the risk of addictive and potential danger to the patient is a valid and reasonable basis for the determination of the appropriateness and necessity of a treatment regimen. Upon appeal, however, divided Workers’ Compensation Appeals Board (WCAB) overturned the decision, noting that the availability of alternative treatment options “does not, in and of itself, render claimant’s current pain management unreasonable or unnecessary”.

The Commonwealth Court, in its reinstatement of the original ruling, noted the following:

1. The utilization review process is the sole method for determining if a disputed treatment is reasonable and necessary.
2. In making its determination of reasonableness and necessity, it is entirely appropriate for UR reviewer to consider the risk to the patient.
3. The reviewer in this case was within his rights to “consider whether it is reasonable and necessary for a provider to expose his patient to the level of risk presented by a medication”.
4. The weight and credibility of a utilization reviewer’s findings is for the workers’ compensation judge to decide.

As a resource for other employers, it is likely that we’ll see this decision cited as justification to contest the use of this very dangerous opioid. If an employer or insurance company can obtain objective medical opinion that the treatment the patient is receiving is highly addictive and there are alternatives to the use of narcotics, this case will certainly support an effort to challenge the prescription.

For more information on the decision and its implications, see https://ww3.workcompcentral.com/news/story/id/b8df217867f36a5641fbd85e9bcb5dd7s (subscription required).