Treating surgeon makes case to repair hernia with cadaver material

In Michigan, the commission will not disturb the magistrate's decision to approve the treating doctor's recommended surgical procedure.

Case name: Burton v. Amway Grand Plaza Hotel/Alticor Inc., 23 MIWCLR 247 (Mich. W.C.A.C. 2009).

Ruling: The Michigan Workers' Compensation Appellate Commission affirmed the magistrate's decision granting the worker a proposed abdominal surgery with cadaver graft material.

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What it means: In Michigan, where the treating physician provides support for his choice of surgical material and the magistrate reasonably relies on the treating doctor's testimony, the commission will not disturb the magistrate's decision to approve the treating doctor's recommended surgical procedure.

Summary: A worker sustained an injury that caused a right-sided hernia that was surgically repaired that month. The hernia repair failed, and the worker underwent another surgery. The treating surgeon described the recurrent hernia as "massive," or about the size of a basketball. The worker developed a recurrent right-sided hernia for a third time. The treating surgeon testified the recurrent hernia was "complex." He proposed another surgery to repair the hernia, this time with cadaver tissue. The employer's expert recommended knitted polypropylene mesh material, noting it was less expensive and that he had had successfully used in the past. The magistrate relied on the credible testimony of the treating doctor and found the proposed cadaver graft surgery was reasonable and necessary. In affirming, the commission noted that the employer ignored the critical portion of the treating surgeon's testimony in which he explained why he believed that the cadaver graft was a better alternative for the worker. The commission determined the magistrate's analysis was accurate and well-reasoned and declined to disturb its decision.

The two physicians agreed regardless of which material was used, the surgical repair would be extensive and was further complicated by the lack of healthy remaining tissue. The treating physician agreed that the cadaver was not "better" than plastic mesh for the actual hernia repair. However, due to the extent of herniated bowel, the cadaver material would avoid a more serious complication.

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February 22, 2010

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