Editor in Chief

Bernadette M. O'Brien is an attorney at law in California.

She is the author of the popular Lexis Nexis publication Labor and Employment in California; A guide to Employment Laws, Regulations and Practices Second Edition which has been in publication since 1992. The book covers an array of employment related issues including discrimination, sexual harassment, wage and hour, family Medical Leave Act, and Privacy in the workplace.

She is of counsel with the Law Offices of Floyd, Skeren & Kelly, LLP in the firm's Sacramento office.

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Rene Thomas Folse, JD, Ph.D. is an attorney at law and licensed psychologist in California.

He has practiced workers' compensation law for 35 years. His focus of practice involves claims of mental health injury where forensic psychology is involved in the evaluation of the claim. He has been an instructor and lecturer for many organizations and educational institutions and teches continuing education courses for attorneys, physicians and psychologists.

Recent Workers' Compensation News for Nov 26, 2014

DWC to Impose $500/Day Penalty for Late IMR Records
Wed, 26 Nov 2014 09:38:11 - Pacific Time
The Division of Workers’ Compensation announced it will initiate the procedure to assess administrative penalties for claims administrator failure to timely submit relevant medical records in cases currently pending Independent Medical Review (IMR).

Under Labor Code section 4610.5(i), DWC is authorized to assess penalties against claim administrators whose conduct has the effect of delaying the IMR process. Under current regulations, Maximus Federal Services, Inc., the organization designated by DWC to conduct IMR reviews, sends the claims administrator a Notice of Assignment and Request for Information (NOARFI) in an IMR case. The notice advises of the relevant medical records to be submitted, which must be provided to Maximus within 15 days of the date on the NOARFI. The regulatory requirements for submitting records can be found at California Code of Regulations, title 8, section 9792.10.5.

Under California Code of Regulations, title 8, section 9792.12(c)(6), failure to submit the records within those 15 days will subject a claims administrator to an administrative penalty of $500 for each day the records are untimely, up to a maximum of $5,000. DWC will send an Order to Show Cause to claims administrators who may be liable for a penalty, with the facts upon which the penalty is based, the penalty amount, and the administrative process for contesting a penalty.

The procedure to assess administrative penalties will commence in cases where there is a failure to timely submit medical records dated on and after December 1, 2014. For IMR cases currently pending at Maximus as of December 1, 2014, the penalty procedure will commence if the relevant medical records are not received on or before December 15, 2014.

DWC will continue to post updates and notifications regarding the IMR system on the IMR page. Read More...

SubRosa Nails San Diego Nurse After Two-Week Jury Trial
Wed, 26 Nov 2014 09:38:03 - Pacific Time
A workers’ compensation fraud defendant was sentenced to six years of local custody after being convicted by a jury of 12 felony counts including perjury and insurance fraud for her role in defrauding her employer out of more than $300,000 over a seven-year period. Golnaz Gholipour, 35, was sentenced to three years in local prison and three years of mandatory supervision. A restitution hearing will be held at a future date to determine how much she will pay in restitution to Sharp Healthcare for costs they incurred in handling her fraudulent claim.

Gholipour was a nurse at Sharp Hospital who initially told her doctors in January 2007 that she injured her back while waking up from a nightmare. She first filed for state disability benefits, but after learning that the most she could receive from state disability was $4,515 based on the fact that she’d only been employed in California a few months, she filed for workers’ compensation benefits.

All of the defendant’s medical expenses were covered and she received more than $88,000 for the two years she claimed she could not work after her injury. In May 2010, after all conservative care was exhausted, Gholipour had back surgery. By April 2013, when Ghoilpour continued to claim she was worse off than before the surgery, the insurance company hired a private investigator.

The defendant was filmed on several occasions in a normal state with no apparent injuries. Only when she was going to doctor’s visits or attending legal meetings did Gholipour appear hurt and in need of a walker. At her deposition, Gholipour testified that she lived with her parents and that her mother had to bathe her and help her get dressed. She claimed to need to use the walker at all times, that she was depressed, had not gone out on any dates and was not involved in any relationships. She also said she had significant gastro-intestinal problems and generally stayed at home groggy from her medications.

After her deposition, Gholipour was filmed over an eight-hour period as she went shopping, dined at restaurants, and moved about in a normal fashion without any sign of pain or discomfort and without a walker. On another occasion, she was filmed during a 12-hour period during which she moved potted plants on her balcony, went shopping, walked several hundred yards to go to a picnic and back and went to a movie. In the videos, she was observed with the same man who is now her husband and they appeared to be living together.

After a two-week jury trial, the defendant was convicted on eight counts of perjury and four counts of insurance fraud. Read More...

DWC Posts More Proposed Changes to MTUS Regs
Tue, 25 Nov 2014 07:55:09 - Pacific Time
The Division of Workers’ Compensation has posted a second 15-day notice of modification to the proposed Medical Treatment Utilization Schedule (MTUS) regulations to the DWC website. Members of the public are invited to present written comments regarding the proposed modification to dwcrules@dir.ca.gov until 5 p.m. on Tuesday, December 9. The proposed modifications include:

1) Re-organization of section 9792.21 to clarify the MTUS shall be the primary source of guidance for treating physicians and physician reviewers for the evaluation and treatment of injured workers.
2) Addition of a new section, 9792.21.1 - The Medical Evidence Search Sequence. The Medical Evidence Search Sequence was separated from section 9792.21 to clarify the steps required to find medical evidence. Any search for medical evidence begins, and likely ends, with the MTUS. Searching for medical evidence outside the MTUS is limited to situations where a medical condition or injury is not addressed by the MTUS or if the MTUS’ presumption of correctness is being challenged. (Note: A flow chart is included in the Notice of Modification to Text of the Proposed Regulations to provide a visual aid for the Medical Evidence Search Sequence.)
3) Specification that a treating physician who seeks treatment outside of the MTUS bears the burden of rebutting the MTUS’ presumption of correctness by a preponderance of scientific medical evidence.
4) Requirements that shall be included in a Request for Authority, Utilization Review Decision and Independent Medical Review Decision. Any citation provided by a treating physician or medical reviewer shall be the primary source relied upon which contains the recommendation that guides the reasonableness and necessity of the requested treatment that is applicable to the injured worker’s medical condition or injury. If more than one citation is provided, then a narrative shall be included in the three aforementioned documents explaining how each guideline or study cited provides additional information that guides the reasonableness and necessity of the requested treatment applicable to the injured worker’s medical condition or injury but is not addressed by the primary source.
5) Details of the citation format requirements.
6) Revision of The MTUS Methodology for Evaluating Medical Evidence to clarify when it must be applied by a reviewing physician and how to evaluate the quality and strength of medical evidence used to support a recommendation.
7) Amendments to citations in sections 9792.23, 9792.24.1 and 9792.24.3 referencing the sections currently being revised in rulemaking to sections 9792.20 - 9792.26.

The DWC has also prepared a graphical flowchart that depicts the decision making process of a medical treatment review.

The notice and text of the regulations can be found on the proposed regulations page. Read More...

Monterey County Contractor Sentenced for 2nd Offense
Tue, 25 Nov 2014 07:55:15 - Pacific Time
Jose Valdez, 41 of Seaside, has been sentenced on one felony count of fraudulent use of a contractor’s license and one misdemeanor count of failing to secure workers’ compensation insurance, according to Monterey County District Attorney Dean D. Flippo.

Valdez was doing business as Angel Valdez Landscaping. The defendant was also sentenced on a misdemeanor violation of probation case involving the same and similar charges.

Judge Larry E. Hayes sentenced Valdez to five years probation on the new case and reinstated his probation in the earlier case on the same terms as previously ordered. He was then sentenced to 180 days in jail on the new case with that term suspended and 180 days on the violation of probation to run consecutive. His terms and conditions of probation include, but are not limited to, obey all laws including Labor Code and Business & Professions Code laws, regulations and other ordinances and pay over $20,000 in fines. Read More...

Appeals Court Affirms "Dual Occupation Rule" for Rating Formula
Mon, 24 Nov 2014 08:53:31 - Pacific Time
Pope Powell sustained an industrial injury to his shoulders and elbows while employed by respondent City and County of San Francisco. The injury caused permanent partial disability. The parties disputed the occupational group to be used in the rating formula for his injury.

Powell’s job title was Director of Fleet Management and Operations. He supervised five employees; dealt with budgets and requests for proposals; and wrote contracts, policies, and procedures. According to Powell’s undisputed testimony, to perform his job duties he spent 80 to 85 percent of his time on a computer performing tasks such as emailing, creating spreadsheets and budgets, and drafting various documents. The parties disputed the appropriate occupational group for Powell. Powell contended occupational group 112 applied; the City contended occupational group 212 applied. The WCJ agreed with the City, and a majority of the Board affirmed the WCJ. The dissenting Board member contended that a third group, 211, was the most appropriate.

The WCJ and the WCAB awarded benefits based upon group 212, which is undisputedly appropriate for Powell’s "managerial" duties: "Mostly Professional and Medical Occupations [¶] Work predominantly performed indoors, but may require driving to locations of business; less use of hands than 211; slightly higher demands on spine than 210 and 211. [¶] Typical occupations: Chemist, Dialysis Technician, Secondary School Teacher." (Schedule, supra, at p. 3-30.)

Group 112, which Powell argues is the most appropriate: "Mostly Clerical Occupations [¶] Highest demand for use of keyboard; prolonged sitting. [¶] Typical occupations: Billing Clerk, Computer Keyboard Operator, Secretary." (Schedule, supra, at p. 3-29.)

Group 211, which the dissenting Board member found the most appropriate: "Mostly Clerical Occupations [¶] Emphasis on frequent fingering, handling, and possibly some keyboard work; spine and leg demands similar to 210. [¶] Typical occupations: Bank clerk, Inventory clerk, License clerk." (Schedule, supra, at p. 3-30.)

The Board majority affirmed the WCJ’s classification of Powell in group 212, quoting with approval from the WCJ’s opinion. The dissenting Board member disagreed. While agreeing that Powell’s job was "managerial in nature," the dissenting member found "[h]is computer use . . . was necessary and integral to the successful performance of the duties and responsibilities inherent in his position." Applying the dual occupation rule, the dissenting member found occupational group 211 "the most appropriate." The Court of Appeal reversed in the unpublished case of Powell v WCAB.

More than one occupational group may apply to an applicant’s job. In such cases, "[t]he employee is entitled to be rated for the occupation which carries the highest factor in the computation of disability. Labor Code section 3202 provides that the provisions of the Workmen’s Compensation Act ‘shall be liberally construed by the courts with the purpose of extending their benefits for the protection of persons injured in the course of their employment.’ It has been determined that where the duties of the employee embrace the duties of two forms of occupation, the rating should be for the occupation which carries the higher percentage." (Dalen v. Workmen’s Comp. Appeals Bd. (1972) 26 Cal.App.3d 497, 505-506 (Dalen); accord, National Kinney v. Workers’ Comp. Appeals Bd. (1980) 113 Cal.App.3d 203, 215 (National Kinney).) "[N]o precise percentage of time for [performing the duties of the higher percentage occupation group] is required but rather the pertinent inquiry is whether [performance of those duties] is an ‘integral part of the worker’s occupation.’ " (National Kinney, supra, at p. 216.)

The Court of Appeal agreed with the dissenting Board member that the proper focus is on the claimant’s physical work activities. The Board majority’s statements that Powell’s " ‘integral job duties . . . were managerial in nature’ " and his "job required the use of a computer to fulfill the managerial responsibilities inherent in [his] position . . . , not as his core task," erroneously focus on a characterization of his job duties as "managerial." Group 212, which contemplates some small amount of keyboard use, is only partially appropriate in classifying Powell, who spent a substantial amount of his work time on a computer or other keyboard. Read More...

CWCI Says Pharmaceutical and DME Costs Increased Sharply
Mon, 24 Nov 2014 08:53:24 - Pacific Time
Payments for pharmaceuticals and durable medical equipment (DME) in California workers’ compensation continue to increase sharply, adding pressure against the recent reforms to the system according to a new CWCI study that examines medical and indemnity payment trends from accident years (AY) 2002 to 2014.

The study, based on an analysis of 2.1 million claims involving $25.6 billion in benefit payments, breaks out results by accident year, noting average amounts paid for medical services at 3 through 60 months post injury. The latest data show that while average medical payments on lost-time claims in the first two years post injury grew a modest 2.3% between AY 2011 and AY 2012, average amounts paid for pharmaceuticals and DME increased 19.4% to $2,154 -- and that came on the heels of a 26% increase in the prior year. Following legislative reforms in 2003 and 2004, pharmaceutical and DME payments declined briefly, falling in both AY 2004 and 2005, but since then they have been the fastest growing medical component in California workers’ comp, increasing more than threefold over the past 7 years. In contrast to the ongoing double-digit increases in pharmaceutical and DME payments, the 2-year data on AY 2011 and AY 2012 claims show medical treatment expenses (i.e., payments to medical providers, hospitals, outpatient facilities, and for ancillary services such as X-rays and MRIs), which accounted for two-thirds of all medical payments on those claims, and medical management/cost containment expenses (i.e., medical bill review, medical case management, utilization review and medical network fees), registered only modest increases, while payments for medical-legal reports declined.

With growth rates varying among the medical subcategories over the past decade, medical treatment declined from 81.7% of all workers’ comp medical payments at 24 months in AY 2002 to 66.6% in AY 2012, while pharmaceutical/DME payments grew from 7.8% to 13.2%. Medical management payments grew from 6.6% to 14.2% over the same period, as those expenses escalated rapidly after AY 2005 as various managed care elements of the 2002-2004 reforms led to increased outlays for medical bill review, medical case management, and medical network access fees, though the 2-year data from AY 2011 and AY 2012 claims indicate they may have leveled off, albeit near record levels.

The study also offers a first view of medical experience for 2014 injury claims, showing total medical payments at 3 months post injury averaged $3,809, up 12% from $3,400 in the prior year, but such outcomes should be treated as preliminary as early treatment patterns often change due to market and regulatory factors. In addition to identifying medical payment trends, the Institute study also provided new trend data on indemnity benefits and length of temporary disability. Among the key findings at 24 months, total indemnity costs per claim for injury year 2012 were up 5.9 percent to $12,923. At 24 months, average temporary disability payments increased by 5.5 percent and paid temporary disability days increased by 2.9%.

The CWCI Research Update report, "California Workers’ Compensation Medical and Indemnity Benefit Trends, AY 2002 - 2014," is posted on the Institute’s website, and is available to CWCI members and Research subscribers who use their passwords to log in to the site. Read More...

Failure to Properly Communicate Invalidates UR
Fri, 21 Nov 2014 09:34:49 - Pacific Time
The phrase "What we've got here is failure to communicate" is a quotation from the 1967 Paul Newman film Cool Hand Luke. The WCAB said nearly the same phrase in the new significant panel decision of Bodam v San Bernardino County Department of Social Services as it invalidated the employer's UR decision. This famous film line should serve as a constant reminder about the implications of failing to follow the last steps of the UR process.

Timothy Bodam sustained industrial injury to his lower back on March 24, 2011 while employed by San Bernardino County Department of Social Services. His primary treating physician, Edward G. Stokes, M.D., referred applicant for a surgical consultation to Dr. Cheng of Loma Linda University Medical Center. On October 28, 2013, Dr. Cheng faxed an RFA to defendant’s adjuster State Compensation Insurance Fund (SCIF), requesting authorization to perform three-level fusion surgery at L3-S1.

SCIF referred the RFA to its UR agent Forté on October 28, 2013. On October 31, 2013, Forté made its UR decision to deny the treatment request based upon a report prepared by California-licensed and Board certified orthopedic surgeon David C Bachman, M.D., who reviewed the RFA and determined the surgery was not medically supported.

On November 5, 2013, defendant mailed written denial letters to applicant and to Dr. Cheng with copies to applicant’s attorney. There is no evidence that the October 31, 2013 UR decision was communicated to Dr. Cheng by fax, phone, or email within 24 hours after the UR decision was made. There is also no evidence that written notice of the October 31, 2013 UR decision was provided to applicant, Dr. Cheng, or applicant’s attorney within two business days after the UR decision was made.

The WCJ found after an expedited hearing that the Workers’ Compensation Appeals Board (WCAB) "has jurisdiction to adjudicate treatment when utilization review [UR] is untimely" and that defendant’s UR of the Request for Authorization (RFA) to perform spinal surgery submitted by one of applicant’s physicians, Wayne Cheng, M.D., was "untimely," and lacked a necessary signature. The WCJ further found that the record did not have substantial evidence to allow proper determination of the treatment request, and for that reason ordered the record "reopened" for development by submission of a supplemental report from Dr. Cheng concerning the proposed surgery.

The WCAB in what it classified as a "Significant Panel Decision" held that "the WCJ correctly determined that defendant’s UR decision was not timely communicated and therefore invalid. Further, the WCJ properly ordered further development of the record by directing the parties to obtain a supplemental report from Dr. Cheng." Accordingly removal was denied in the case of Bodam v San Bernardino County Department of Social Services.

After considering the provisions of Labor Code section 4610(g)(1) and (g)(3)(A) and AD Rule 9792.9.1(e)(3) the WCAB held that:

(1) A defendant is obligated to comply with all time requirements in conducting UR, including the timeframes for communicating the UR decision;
(2) A UR decision that is timely made but is not timely communicated is untimely;
(3) When a UR decision is untimely and, therefore, invalid, the necessity of the medical treatment at issue may be determined by the WCAB based upon substantial evidence.

Section 4610 provides time limits within which a UR decision must be made as well as when it must be communicated and the manner of transmittal. These time limits are mandatory. In Dubon v. World Restoration, Inc. (2014) 79 Cal.Comp.Cases 1298 (Dubon II), the Appeals Board held that the WCAB has jurisdiction to determine whether a UR decision is timely. If found untimely, the UR decision is invalid. Under those circumstances, the WCAB may decide the issue of the medical necessity of the requested treatment based on substantial medical evidence. The employee bears the burden of proving that the treatment is reasonably required. (Cf. State Comp. Ins. Fund v. Workers’ Comp. Appeals Bd. (Sandhagen) (2008) 44 Cal.4th 230 [73 Cal.Comp.Cases 981] (Sandhagen).)

In the present case, the RFA was received on October 28, 2013 and the UR decision was timely made three days later on October 31, 2013. However, a UR decision not only must be timely made; it must be timely communicated. A UR decision that is not timely communicated is of no use and defeats the legislative intent of a UR "process that balances the interests of speed and accuracy, emphasizing the quick resolution of treatment requests...."(Sandhagen, supra, 44 Cal.4th at p. 241.). Thus, section 4610(g)(3)(A) imposes further mandatory time requirements for communicating a UR decision. These time limits run from the date the UR decision is made, even if the UR decision is made in less than the five days allowed under section 4610(g)(1).                   Read More...

Employment Presumption Inapplicable in "Small Jobs"
Fri, 21 Nov 2014 09:34:42 - Pacific Time
Yeh Juin Tung hired Michael Waller, who owned Waller Tree Care, to perform services that included removing one tree and trimming four others. The price for the work was $400. Tung was unaware that Waller was not licensed; he knew only that Waller had advertised on Yelp.com as being bonded and insured. Waller did not have workers’ compensation insurance at that time.

On October 6, 2008, Waller appeared at Tung’s property to do the work. He was accompanied by Jose Luis Escalera. Escalara leaned a ladder against a tree and climbed up about 10 feet. As he began to cut branches with a handsaw, he fell. He did not know why he fell; as he stated in his deposition, "All I know is that the ladder went to one side and I wasn’t able to hold on."

Escalara filed a civil action in December 2009, alleging negligence against both Waller and Tung.

Tung moved for summary judgment, contending that plaintiff was not his employee but an employee of Waller, an independent contractor. He also disputed plaintiff’s negligence claim "because there is no evidence of any breach of any duty or any causation by Mr. Tung." In his opposition, plaintiff agreed that Waller was an independent contractor, but he raised the "peculiar risk" doctrine to argue that Tung was liable whether or not he was personally negligent, because plaintiff was performing "inherently dangerous work," and Tung must bear responsibility for all risks of injury to a worker, "regardless of fault." The parties debated the applicability of the exception to the peculiar-risk doctrine expressed in Privette v. Superior Court (1993) 5 Cal.4th 689.

The superior court ruled in Tung’s favor. Addressing plaintiff’s assertion that Tung was vicariously liable because Waller had not procured workers’ compensation insurance, the court reasoned that "an employee of a negligent contractor can recover under the workers’ compensation system even if the contractor is uninsured." As plaintiff had not established a triable issue under the peculiar risk doctrine or supported a theory of direct liability, Tung was entitled to summary judgment. From the ensuing judgment on July 13, 2012, plaintiff brought an appeal. The Court of Appeal affirmed the dismissal in favor of the homeowner in the unpublished case of Escalera v. Tung.

On appeal, plaintiff does not suggest that he was Tung’s employee under the workers’ compensation system; he acknowledges that the Workers’ Compensation Act (§ 3200 et seq.) is inapplicable because he worked less than 52 hours on Tung’s property. Plaintiff does, however, assert that Tung was his employer for purposes of civil tort liability under section 2750.5. Plaintiff cites the undisputed facts that "Waller was a contractor who did not have a contractor’s license," that "Waller advertized [sic] his tree care business on Yelp, and that he did not state in his advertisement that he was not licensed under the contractors’ licensing law." From those facts plaintiff asserts that Waller is "conclusively presumed to be Tung’s employee" under labor code section 2750.5.

Under this statute Waller would be presumed to be an employee of Tung by performing a service for which a license was required, and plaintiff, by working for Waller, would then also be deemed an employee of Tung. A license is not required, however, for small jobs costing the hirer less than $500. (Bus. & Prof. Code, § 7048.) It was undisputed that the contract price for the tree trimming was $400; accordingly, the presumption would not have applied. Read More...

Santa Clarita Pain Doctor Resolves Whistleblower Claim for $1 Million
Thu, 20 Nov 2014 09:52:14 - Pacific Time
Narinder S. Grewal MD, who operates the Santa Clarita Surgery Center for Advanced Pain Management on the 23800 block of McBean Parkway in Valencia, agreed to pay $1,087,176.09 to the United States and $112,823.91 to California. The settlement concludes a federal "whistleblower" lawsuit filed by Chandana Basu, who used to provide billing and collection services to the Grewal’s clinic, according to the U.S. Attorney’s Office.

Basu’s lawsuit alleged that Grewal and his clinic obtained improper reimbursements from government-run health insurance programs, including Medicare, Medi-Cal and Tricare, a federal health insurance program for military and related military personnel, according to a statement Wednesday from federal prosecutors. The lawsuit also alleged that Grewal and his clinic submitted fraudulent claims by "upcoding" medical services, which means that he allegedly submitted bills that were not justified by the services that were actually provided.

The settlement was announced this month after United States District Judge Andrew J. Guilford unsealed the lawsuit. The parties have asked the court to dismiss the suit, which was filed pursuant to federal and state False Claims Acts.

The whistleblower provisions of the False Claims Acts permit a private person to sue on behalf of the United States and California, and to share in the proceeds of the suit. As a result of the settlement announced today, Basu will receive a total of $204,000.

The case was handled by the United States Attorney’s Office and the California Attorney General’s Office, in conjunction with the Department of Health and Human Services, Office of Inspector General, and the Department of Defense, Defense Criminal Investigative Service. Read More...

New Treatment to Restore Breathing After Long Term Paralysis
Thu, 20 Nov 2014 09:52:07 - Pacific Time
Severe spine injury cases involving paralysis are among the most costly industrial injuries  But now, Case Western Reserve researchers have developed a procedure that restores function to muscles involved in the control of breathing - even when they have been paralyzed for more than a year. The breakthrough offers hope that one day patients with severe spinal cord injuries will be able to breathe again without the assistance of a ventilator.

According to the report in Medical News Today, principal investigator Philippa M. Warren, PhD, presented the results at Neuroscience 2014, the annual meeting of the Society for Neuroscience. "We show that respiratory paralysis can be reversed at long intervals after spinal cord injury," said Warren, a neurosciences researcher at MetroHealth Medical Center, which is affiliated with Case Western Reserve University School of Medicine. "This has the potential to alleviate the long suffering of currently injured patients, improving their quality, and potentially length, of life."

Investigators focused their research on a group of nerves that extend from the respiratory control center in the brain stem down to the C3 through C5 vertebral levels of the spinal cord located in the middle of the neck. These fibers, or brain axons, control the diaphragm muscle in its critical function of breathing. Any injury to the spinal cord above the C3 vertebra can cause widespread muscle paralysis leading to difficulties in breathing, but also moving, regulation of cardiac output, and sexual function. Unfortunately, these injuries high in the neck are the most common among sufferers of spinal cord trauma.

Following injury to the spinal cord, damaged nerve fibers die, causing loss of the connections between the brain and muscles of the body. To help preserve tissue immediately after injury, a scar forms at the site of the trauma and extends the distance of several inches up and down the spinal cord. This scar tissue is very dense, contains sugars that inhibit new neuronal growth, and does not reduce in length or intensity over time. The consequence is that new connections cannot form to enable muscle function after injury, which is exceptionally important to breathing.

Spinal cord injury-induced paralysis of the respiratory muscles causes low oxygen in the blood, increases the body's drive to breathe and drives any functioning respiratory muscles to work harder. The breathing capacity of the spinal cord-injured is often not enough to fully support a patient's life. However, if new nerve fibers or connections can form in the spinal cord, then pathways can be activated to restore respiratory function. So Case Western Reserve researchers devised a technique to treat the injury site with a specially designed enzyme to reopen connections and to apply respiratory therapy to strengthen the remaining functioning respiratory muscles.

In laboratory animals, investigators used the combination technique to restore respiratory function many months after the injury. First, they injected the chondroitinase enzyme at the site of respiratory nerves in the spinal cord to remove the inhibiting sugars from scar tissue. The action of the enzyme enabled both the formation of new connections and stimulation of latent pathways in the respiratory motor system. Second, the animals were exposed to brief periods of conditions with low oxygen, making them breathe harder and faster to rehabilitate the respiratory muscles. This treatment approach is referred to as intermittent hypoxia.

The combination enzyme injection and intermittent hypoxia treatment boosts levels of serotonin. Commonly known to help relieve anxiety disorders, serotonin also acts more broadly as a neurotransmitter to help stimulate nerve cells. By increasing serotonin at nerve connections and at the specific receptors on the fibers themselves, the researchers were able to help restore diaphragm function back to normal levels in the animals. This finding is extraordinary not only because function to the paralyzed muscle was completely restored, but also because researchers were able to achieve breathing in animals that had been injured for a year and a half.

"It is remarkable to reactivate the diaphragm and breathing in a chronically injured animal that has had a paralyzed half diaphragm most of its life," said Jerry Silver, PhD, a Case Western Reserve professor of neurosciences who collaborated in the research.

While these results are encouraging, more research is required to perfect the treatment. More than two-thirds of the animals in the study responded to the combined treatment strategy, while the treatment had no effect on the remaining animals. Two thirds of the animals that responded to the combined treatment resumed normal breathing, while the other third experienced erratic breathing in the injured muscle. Read More...

Past Week News Archive

Fresno Applicant Attorney Prevails in Legal Malpractice Case: Wed, 19 Nov 2014 10:15:47 - Pacific Time: Read More...

How Hard is it to Stop a Rogue Doctor?: Wed, 19 Nov 2014 10:15:40 - Pacific Time: Read More...

Nationwide Study Highlights Claim Adjuster Operational Challenges: Tue, 18 Nov 2014 09:58:59 - Pacific Time: Read More...

Drug Agents Launch Inspections of NFL Teams: Tue, 18 Nov 2014 09:58:52 - Pacific Time: Read More...

Orange County Corrections Officer Faces 17 Year Sentence: Mon, 17 Nov 2014 09:34:03 - Pacific Time: Read More...

Commissioner Adopts 2015 Comp Premium Increase: Mon, 17 Nov 2014 09:33:56 - Pacific Time: Read More...

DWC Posts More Changes to EDI Implementation Guide: Fri, 14 Nov 2014 11:51:21 - Pacific Time: Read More...

Cal/OSHA Fines Fuel Distributor Nearly $100 K For Fatal Explosion.: Fri, 14 Nov 2014 11:51:13 - Pacific Time: Read More...

FDA Approves Customized Spine Implant: Thu, 13 Nov 2014 08:20:21 - Pacific Time: Read More...

Obamacare Open Enrollment Brings Higher Costs: Thu, 13 Nov 2014 08:20:15 - Pacific Time: Read More...