Possible Sources of Biased Research and
Information:
Dr. Jack
Richman:
Canadian Institute for
the Relief of Pain and Disability (CIRPD)
Assessmed Inc. / Complete Medical
Associates
Canadian Society of Medical Evaluators
Canadian Pain
Society
"Disability Medicine" Periodical of the American Board of
Independent Medical Examiners (ABIME)
International Association for the
Study of Pain
The Ontario Society of Occupational and Environmental
Medicine
Accreditation Association for Ambulatory Health
Care
International Conference in New York on "Back Pain and Disability -
Unraveling the Puzzle"
International Conference on Symptom, Diagnostic and
Disability Validity: Improving Patient Outcomes
American College of
Occupational and Environmental Medicine
American Board of Independent
Medical Evaluators
Work Fitness / Disability Evaluation Section
AMA
Guides to the Evaluation of Permanent Impairment Newsletter
"The Medical
Disability Advisor". - publication
Journal of Occupational &
Environmental Medicine
Canadian Pain Coalition
Canadian Institutes of
Health Research (CIHR)
The Canadian Cochrane Network and
Centre
Iniversite de Montreal (University.of Montreal) - Insurance Medecine
and Medicolegal Evaluation (Insurance Medicine and Medicolegal Expertise
Program) - uses the CMSE (Canadian Society of Medical Evaluators) and Jack
Richman as speakers
*** NOTE*** regarding American College of
Occupational and Environmental Medicine (ACOEM) above, see
ACOEM Guidelines "Highly
Controversial" for WCB Pain Claimants - analysis by Pain Physicians
Dr. Sheldon
Levy:
Riverfront Medical
Evaluations Limited
TEKSMed / QuikCare / QuikCare Pro
|
AMA Guides - see
New York
State Rejects AMA Guides
"60 Summits Project" and ACOEM:
The
60
Summits Project is promoting adoption of the American College of
Occupational and Environmental Medicine's (ACOEM) guideline
"Preventing Needless Work Disability by Helping People Stay
Employed" throughout Canada and the US. This guideline advocates paying
SOME doctors - but not all doctors, saying: "Make billing for these services
a privilege, not a right, for providers and make that privilege contingent on
completion of training and an ongoing pattern of evidence-based care and
good-faith effort to achieve optimal functional outcomes."
(The CIWS believes that the insurance industry and
workers compensation boards should not be involved in interfering with the
medical profession. Privileged payment schemes to SOME doctors would constitute
interference.) (Prudential Financial, Inc. has teamed up with the 60
Summits Project to promote adoption of the above ACOEM
guideline.) Also related to this group are the "Florida Stay at Work Consortium" and the "Summit on Preventing Needless Work Disability".
Cancer research
based on the findings of Oxford University's
Sir Richard Doll because of findings by
injurywatch of
possible conflicts of interest regarding "substantial payments from
variously Turner and Newall, the notorious asbestos company, Monsanto the
American chemicals giant, and from the industry body, the Chemical
Manufacturers Association."
|
The following are, or
have been funded or controlled by WCBs and so are corporate-funded research
agencies whose research may or may not be tainted by this funding
relationship:
Bancroft Institute - an organization that does not reveal its funding structure publicly
Canadian Institutes of Health Research - - see Jack Richman above and also affiliated with the WCB-controlled Institute for Work & Health
Research Action Alliance on the
Consequences of Work Injury - administered through the
University of Toronto and allied with the Bancroft Institiute, an organization that does not reveal its funding structure publicly. RAACWI is also allied with the WCB-controlled Institute for Work and
Health
Canadian Association for Research on Work and Health -
- Organized and/or funded by the WCB-controlled Institute for Work and Health
Occupational Health and Safety Research Institute (IRSST)-
- funded and/or controlled by WCB and employer lobby groups
Institute for
Work and Health - - core funding by the WSIB (WCB)
Program of Care for Lower Extremity Injuries (Lower Extremity Injuries Program of Care) - WSIB funded and controlled research
Chronic Pain Program of Care - WSIB funded and controlled
Chronic Pain
Expert Advisory Panel - WSIB funded and controlled
Centre of
Research Expertise in the Prevention of Musculoskeletal Disorders (CRE-MSD),
- funded by the WSIB
Centre of Research Expertise in Occupational Disease
(CRE-OD), - funded by the WSIB
Centre of Research Expertise in Improved Disability Outcomes
(CRE-IDO
)- funded by the WSIB
Solutions for Workplace Change- funded by the WSIB
The following are
largely governed, controlled or highly influenced by the American Insurance
industry:
Workers Compensation Research Institute
(WCRI): (see article)
Expert
Clinical Benchmarks (ECB) - a research subsidiary of MedRisk,
Inc.
|
Dr. Jack Richman - AssessMed / Complete Medical
Associates:
The CIWS is not alleging any misconduct on the part of Dr.
Richman or AssessMed, however, we feel it important to outline Dr. Richman's
network of influence amongst the medical and research communities in light of
his company's legal history (see CBC case below and another case here).
Canadian Institute for the
Relief of Pain and Disability (CIRPD)- Dr. Jack Richman -
President
Assessmed Inc. / Complete Medical
Associates - Dr. Jack Richman - Executive Vice President and
Medical Director
Canadian Society of Medical
Evaluators - Dr. Jack Richman - Past President and lecturer as of
Jan. 2007
Canadian Pain Society - Dr. Jack
Richman - founding Member
"Disability Medicine"
Periodical of the American Board of Independent Medical Examiners
(ABIME)- Dr. Jack Richman - on the editorial advisory board up to
2003
International Association for the Study of
Pain - Dr. Jack Richman - founding Member
The Ontario Society of Occupational and Environmental
Medicine - Dr. Jack Richman - founder and first
president
Accreditation Association for Ambulatory
Health Care. - Dr. Jack Richman - served on the Board of
Directors
International Conference in New York on
"Back Pain and Disability - Unraveling the Puzzle" - Dr. Jack
Richman - served on the Scientific Planning Committee
International Conference on Symptom, Diagnostic and Disability
Validity: Improving Patient Outcomes - Dr. Jack Richman - was on
the Scientific Planning Committee and Co-Chair
American College of Occupational and Environmental
Medicine - Dr. Jack Richman - past Chair of the Committee for
Accreditation in Occupation and Environmental Medicine Quality Assurance and
presenter at the American Occupational Health Conference (as of 2007).
Work Fitness / Disability Evaluation Section - Dr.
Jack Richman - Chairman and developing standards for disability
evaluations,
AMA Guides to the Evaluation of Permanent
Impairment Newsletter - Dr. Jack Richman - consultant
"The Medical Disability Advisor". - publication- Dr.
Jack Richman - is on the Medical Advisory Board
Journal of Occupational & Environmental Medicine-
Dr. Jack Richman, Paul Green, et al - "Objective Tests of Symptom
Exaggeration in Independent Medical Examinations". This study used the Medical
Symptom Validity Test (MSVT) to examine disability claimants and concluded that
exaggeration of cognitive symptoms is widespread in disability-related
evaluations. However, Paul Green is the sole distributor of the MSVT software
and all the assessments were done at AssessMed (see above as well as court case
below).
Canadian Pain Coalition - The Canadian
Pain Society (above) and the Canadian Institute for the Relief of Pain and
Disability (CIRPD) (above) are partners.
Canadian
Institutes of Health Research (CIHR) - the Government of Canada's health
research funding agency collaborates with the Canadian Institute for the Relief
of Pain and Disability (CIRPD) (above).
The Canadian
Cochrane Network and Centre - lists the Canadian Institute for the
Relief of Pain and Disability (CIRPD) (above) as an affiliate.
Dr. Jack Richman and Dr. Shah, who worked for
AssessMed, were plaintiffs in a lawsuit alleging the CBC program 'Prove It If
You Can' defamed them. On November 10, 1998 CBC-TV aired a 26-minute segment on
its program "The Fifth Estate" entitled, PROVE IT...IF YOU CAN. Three disabled
individuals and their experiences with insurance companies were highlighted,
including the experience with THE INDEPENDENT MEDICAL EXAMINATION conducted at
AssessMed Ltd.. The theme of the case is that AssessMed Inc. believes that the
words and actions of the CBC series "The Fifth Estate" in their broadcast of
the program "Prove It...If you Can" were defamatory and brought into question
their impartiality, competence and credibility. As a result, AssessMed Inc.
feels that their business as Independent Medical Examiners is being threatened.
The CBC's "The Fifth Estate", program entitled "Prove It If You Can"
told the stories of three individuals who suffered serious injuries in motor
vehicle accidents. It depicted how insurance companies did not always treat
accident victims fairly. The program alleged that insurers accomplished this,
in the Janet Hough case, by referring her to a medical assessment firm such as
AssessMed and obtaining a neuropsychological report which supported the view
that she was not disabled. Accident benefits payable under existing insurance
legislation were then discontinued, in spite of medical reports from her
treating physicians which supported her entitlement to these benefits.
Dr. Richman's allegations were struck down by
the judge in 2004 and this judge's decision was upheld by the Court of Appeal
in June 2006. The appeal judge stated:
http://www.ontariocourts.on.ca/decisions/2006/june/C39832.htm
| [72] The general
philosophy of AssessMed, the manner in which Dr. Shah crafted his
report, and the conclusions he expressed can also lead to a reasonable conclusion that his report was
biased. |
Dr. Richman has been a roster physician for the
Workplace Safety & Insurance Board of Ontario (WSIB).
Dr. Richman has been an expert witness in
arbitration, court, and WCAT (Workers' Compensation Appeals Tribunal)
hearings.
The following are excerpts from the court transcript:
COURT FILE NO.: 99-CV-162046 DATE: 20040302
http://www.canlii.org/on/cas/onsc/2004/2004onsc10581.html
BACKGROUND[5] The plaintiff
Jack Richman ("Richman") is a medical doctor. He
is a director of AssessMed and is its Chief
Medical Officer.[6] The plaintiff Hemendra Shah
("Shah") is a psychologist who worked under contract for
AssessMed.
[76] In September of 1998, an article entitled
"Manufacturing Disability", authored by Dr. Richman, appeared in this magazine.
(The Canadian Insurance Magazine) In this article, Dr. Richman asserted that,
having conducted medical assessments for more than 29 years, he found an
increasing number of claimants with minor injuries wilfully misrepresented
their situation, often backed by health care practitioners. He said that at
AssessMed, where more than 3,000 assessments had been done, only "approximately
ten percent of patients were found to have significant impairments". He said
that of this ten percent, only three percent required long-term disability
benefits. Of the remaining 90%, more than half wilfully failed to give a fair
effort. He accused the medical, psychological and rehabilitation community of
supporting these claimants, thereby manufacturing disability to obtain
lucrative disability benefits. He argued that pain could not be defined as an
impairment because it was subjective and could not be measured.[77] Dr. Richman
went on to say that the most appropriate measure to determine functional
abilities was an Independent Medical Evaluation plus a Functional Abilities
Evaluation. He alleged a majority of heath care workers, who were held in high
esteem by society, had become unaccountable and closed their eyes to fraudulent
behaviour, believing they would not be challenged. He argued these members of
the health care profession created illness and did far more psychological harm
than any accident could.[78] This article manifested an
intellectual tendency on the part of Dr. Richman to treat claimants with
suspicion and to question the validity of the opinions expressed by their
treating health care workers. It was an attractive approach for those insurers
who questioned the extent of their insured's disability, but left doubt as to
whether the approach resulting from this ideology was objective or
impartial. [79] While Dr. Richman's opinions find some support in
medical literature, they are considered too skeptical by others.
Dr. Richman's research in this area was based on
discussions with assessors at AssessMed but not on any empirical or validated
study. In my view, it reflected a tendentious approach to assessments, which
subjected AssessMed to being viewed as partial to insurers.
[250]
The evidence at trial does confirm that most of AssessMed's work was performed
on behalf of insurers. Dr. Richman's article supports the allegation that
most claimants assessed at AssessMed are not found to be
entitled to long-term disability benefits.
[194] The article 'Manufacturing Liability' authored by Dr.
Richman did manifest an approach to medical evaluations where claimants were
treated with suspicion. In the program, Dr. Richman said there was an honest
belief in many claimants they saw that they are disabled, and they are not.
They are self-deluding.
[227] In the context of Dr. Richman's
article, 'Manufacturing Liability', AssessMed's approach and ideology, the
difficulties encountered by Ms. Hough in obtaining continued disability
benefits, and the conclusions of Dr. Shah in his report, I am satisfied that it was reasonable to state Dr. Richman was
a doctor who took a critical approach to claimants' positions in conducting
assessments for insurance companies -- that he did "play hardball for insurance
companies."
[241] The point made in the program was that there were three treating professionals who had views which
did not accord with Dr. Shah's opinion. Dr. Shah performed the
neuropsychological testing with the measures he chose and reached a conclusion which was at odds with those of Ms.
Hough's doctors.
[246] I am satisfied that Dr. Rathbone was
presented with Dr. Shah's report during his interview, and that he took the
time to review it. Although Dr. Rathbone testified that Englishmen are rarely
horrified, I accept that this was a reasonable characterization of his reaction
to Dr. Shah's report. He felt the report was biased and
clearly in error.
[249] Mr. MacIntyre stated in the broadcast:
"AssessMed do most of their evaluations for the insurance
industry. And – surprise, surprise – most of them go against accident
victims like Janet Hough." [250] The evidence at trial does confirm that
most of AssessMed's work was performed on behalf of insurers. Dr. Richman's
article supports the allegation that most claimants assessed at AssessMed are
not found to be entitled to long-term disability benefits. [251] The language used by Mr. MacIntyre was somewhat
colourful but the comment was not untrue.
[252]
The statement in the broadcast that Dr. Richman believes
most claims referred to AssessMed are fraudulent, is supported by Dr. Richman's
evidence at trial and his article, 'Manufacturing
Liability'.
[273] The philosophy and approach adhered to by
AssessMed, Dr. Richman's article, "Manufacturing Liability", and the
difficulties encountered by Prewer, Hough and MacMullin gave reasonable cause to believe accident victims were not
always treated fairly by insurers.
[298] The issue of Dr. Shah's
qualifications was raised and considered by the CBC. The program did not,
however, pursue that issue. Had the program been an attack of Dr. Shah, as is
urged by the plaintiffs, one would have expected the CBC to refer to
Dr. Shah's past difficulties with the College of
Psychologists, his educational background and experience. The CBC did
not purse that aspect of the research in its program. [299]
There was also evidence that another doctor at AssessMed
may not have been qualified to perform the assessments he undertook.
This was also left out of the program.
[311] On
the evidence before me, I cannot conclude there was spite, ill will, any
indirect motive or ulterior purpose on the part of the CBC. The
defendants honestly believed that what was said on the program was true. As a
result, the plaintiffs have failed to establish actual or express
malice.
[313] In this case, the plaintiff AssessMed Inc.'s claim is for
special damages, that is, its loss of business revenue in the years 1999 to
2003. Dr. Richman's claim is for general damages only. Dr. Shah claims general
damages as well as special damages for the decline in the number of assessments
referred to him by AssessMed, following the broadcast. [314] The plaintiffs
also seek aggravated and punitive damages.
[333] My assessment of the evidence is that the plaintiffs had an
excellent reputation with the insurers, but a poor reputation with the
claimants' representatives. [334] After the
broadcast, many insurance adjusters, who were the plaintiffs' primary clients,
stopped using AssessMed. They did so because it was felt AssessMed's reports
may no longer be given credence in the courts. Generally, the evidence
led by the plaintiffs was to the effect that although insurance adjusters did
not think less of the plaintiffs following the program, they ceased referring
work to AssessMed because AssessMed's reports would be subject to the criticism
they were biased in favour of insurers. [335] Dr.
Richman's reputation was tied to AssessMed's reputation because he was
considered to be the voice and the face of AssessMed. The insurance industry
held Dr. Richman in high esteem while claimants' lawyers viewed him as
favouring the insurers' interests. The article 'Manufacturing Liability'
enhanced Dr. Richman's position with insurance companies. Plaintiffs' lawyers
viewed that article as confirmatory of the bias Dr. Richman displayed against
injured people.
|
Dr. Richman has been a roster physician for the
Workplace Safety & Insurance Board of Ontario (WSIB).
Dr. Richman has been an expert witness in
arbitration, court, and WCAT (Workers' Compensation Appeals Tribunal)
hearings.
|
|
Riverfront Medical Evaluations
Limited:
The following lawsuit concludes that:
"In my view
Riverfront in this case, went far beyond what can be considered a proper
“quality control” function. While I am not prepared to find that they
were motivated by a desire to assist the defendant, nonetheless I find their
actions constituted an unwarranted and undesirable interference with the proper
function of an expert witness."
While the CIWS acknowledges Justice
Spiegel in the court's assertion that it is not prepared to find that
Riverfront Medical Evaluations Limited were motivated by a desire to assist the
defendant (Sun Life Assurance Company of Canada), and therefore, stops short of
a finding of 'bias', the court's finding of "unwarranted and undesirable
interference with the proper function of an expert witness" gives us the moral
duty to alert the medical community to these important issues currently being
decided in the courts particularly considering that Riverfront Medical Evaluations Limited does work for the
Workers safety Insurance Board (WSIB).
Riverfront Medical Evaluations Limited does
evaluations for the Workplace Safety and Insurance Board of Ontario
(WSIB).
Lawsuit involving Riverfront Medical
Evaluations Limited:
Ontario Superior Court of Justice
2006
CanLII 41669 (ON S.C.) Citation: Macdonald v. Sun Life Assurance Company of
Canada,
Date: 2006-12-13 Docket: 99-CV-168309CM4
http://www.canlii.org/on/cas/onsc/2006/2006onsc16831.html
Excerpts:
[6]
. . . . However, it soon became apparent to me that the
text of the document before Dr. Lipson was different from the served
report.
[16] It need hardly be said that I found Dr.
Lipson’s evidence about the origin of the various documents filed as
exhibits to be confusing and in some respects self-contradictory. Before
adjourning on May 30th, I suggested to Dr. Lipson that he check his home
computer, his secretary’s computer as well as the computer at Riverfront
in order to determine when and how these documents were prepared.
[26] .
. . It was only on May 30, 2005 that he discovered that Riverfront had sent out
a report with his stamped signature affixed that was different from what he
expected.
[27] . . . He testified that these
changes must have been made by Riverfront without his
authority.
[28] Based on the evidence before me on the voir dire
I ruled that Dr. Lipson was not entitled to testify as an expert witness on
behalf of the defendant.
[30] Based on the uncontradicted evidence of
Dr. Lipson, the served report was not signed by him. . . .
Dr. Lipson has testified that he did not authorize his
signature stamp to be affixed to the report that was delivered by Riverfront to
the solicitors for the defendant.
[32] . . . If Dr. Lipson was
permitted to continue with his testimony it is obvious that he would have been
cross-examined at great length with respect to the discrepancies between his
draft report and the served report. The jury would likely have had to devote a
great deal of time in determining to what extent Dr. Lipson’s opinion was
influenced by the “quality control” activities
of Riverfront.
[33] Moreover in view of the unsatisfactory
nature of Dr. Lipson’s evidence with respect to the origin of the reports
in question, in addition to the undue delay which would be caused by the
presentation of his evidence, his evidence would be more likely to confuse and
confound the jurors rather than to assist them in their fact finding task. In
such circumstances, there is a residual discretion in the court on a cost
benefit analysis to refuse to admit the expert evidence[1].
[38]
Dr. Sheldon Levy is the President and principal
shareholder of Riverfront. He is a medical doctor who has been certified
as an internist since 1994. He purchased Riverfront from its founder, Dr.
Harvey Lewis in 2003. Prior to purchasing, he conducted 6 months of due
diligence. Riverfront has achieved an International Standards Organization
(ISO) designation that signifies that its administrative policies and
procedures comply with ISO standards. Riverfront provides
independent and impartial medical evaluations to insurance companies, the
Workers Safety Insurance Board, and lawyers representing defendants in
casualty cases. Riverfront produces 3500 – 4000 reports per
annum at an average cost of about $1,000 a report. It has 15 employees
with a payroll of about $800,000. There are about 350 physicians on their
roster across Canada. The largest fields of expertise are orthopedics,
physiatry, psychiatry, psychology and neurology.
39] . . . Eighty
percent of the assessments are performed at Riverfront’s offices at 180
Dundas Street West, Toronto. Riverfront provides the physical plant, i.e., the
examining room, necessary equipment, stethoscope, etc., a translator if
necessary. The physician will dictate his or her report on a cassette and
Riverfront staff will transcribe the report and put it in the format that
complies with ISO standards. The report is checked for spelling and grammar to
ensure that it reads well, is clear and concise and that it answers the
questions of the referring party. This is described
as a quality control function performed by Riverfront. The
report is then given back to the physician for review and
signature.
[41] No report is sent out
without it being “quality controlled”. . . .
When asked whether the Riverfront “edits”
the report he indicated that he resented the word
“edit”.
[42] As
Medical Director of Riverfront Dr. Levy reads the reports to ensure that they
answer the questions posed by the client. They also have a registered nurse
Anna Tsagerellis (Anna), the Marketing Director of Riverfront, who proofreads
the reports. . . .
43] Twenty percent of their
physicians conduct their assessments off site in which case the physicians will
prepare their reports and send it to Riverfront by fax or other electronic
means. Riverfront performs its quality control
function and sends the report to the physician for comments if required. . .
.
[44] In many cases
Riverfront has a signature stamp of the doctor, which the doctor authorizes
them in writing to use. . . .
[53] In a rather emotional statement Dr. Levy insisted that
at no time was there any intention to alter a report for the purpose of making
it better for a client. This would be a breach of his moral and ethical
standard.
Was Dr. Lipson's signature affixed to the
served report without his authority?
[87] . . . Taken at its highest
for Riverfront, the statement merely repeats what is undisputed in the
evidence, namely, that Dr. Lipson did not authorize
the deletion, but that he did not recall objecting to it either.
. . . In any event, the crucial issue is not whether
Linda affixed Dr. Lipson’s signature to the report knowing that she knew
was not authorized do so but rather whether Riverfront took reasonable steps
to ensure that the report that was sent out under Dr. Lipson’s signature
was in fact authorized by him. I must regretfully
conclude that they did not.
[88] It is stating the
obvious that an expert’s report delivered for the purpose of compliance
with the Rules of Civil Procedure and the Evidence Act is an extremely
important document. Anyone involved in the preparation of such reports must
know that courts place a very strong reliance on the contents of these reports
and that the proper administration of justice
demands that these reports accurately reflect the opinion of the expert who has
written them. The requirement in the Rules of Civil Procedure
and the Evidence Act that the expert sign the report is intended to provide
assurance that the statements in the report are those of the
expert.
Was it was proper for Riverfront to have suggested to Dr.
Lipson that highlighted portion be deleted?
[101]
In my view Riverfront in this case, went far beyond
what can be considered a proper “quality control” function.
While I am not prepared to find that they were motivated by a desire to assist
the defendant, nonetheless I find their actions constituted an
unwarranted and undesirable interference with the proper function of an expert
witness.
[102] The function of an expert witness is to
provide an independent and unbiased opinion for the assistance of the court. An
expert witness’ evidence should be and should be seen to be the
independent product of the expert uninfluenced as to form and content by the
exigencies of litigation.[2] This principle has often been cited with approval
in our courts, and has been considered a factor to be considered in assessing
the weight to be given to the expert’s testimony. It has occasionally been
treated as the basis for the disqualification of the witness
entirely.[3]
[103] In my view any activity that may tend to detract from
this all-important objective diminishes the integrity of the litigation and
trial process and should be met with appropriate
sanctions designed to send a clear message that such conduct will not be
tolerated.
H. SPIEGEL J. Released: December 13,
2006
http://www.canlii.org/on/cas/onsc/2006/2006onsc16831.html |
Riverfront Medical Evaluations Limited does
evaluations for the Workplace Safety and Insurance Board of Ontario
(WSIB). |
|
TAKE
ACTION:
SIGN THE
PETITION!
AND
JOIN the CIWS
Back to Top |