Friday, May 5, 2017

Wall of Shame-Dr. Alexander Doman

Many of you have had experience with Dr. Alexander Doman, one of OWCP's best 'hit men' who, in my opinion deserves his place on my wall of shame.

I have written and submitted a formal complaint to OWCP in regard to Dr. Doman on behalf of all claimants who have experienced one of his "examinations".

If you have been directed by OWCP to attend an exam with Dr. Doman and his report indicates you exaggerated or magnified your symptoms, intentionally deceived him or were malingering, I highly recommend that you include your information in the complaint and submit it to OWCP as well.

OWCP will not stop using physicians like Dr. Doman unless or until the evidence against THEM is overwhelming and can no longer be ignored.

In addition, claimants can get copies of all the complaints against a physician by doing a FOIA request (see the How To section). By receiving the complaints, you have an argument against a physician.

For instance, if just ten of you insert your information and send your complaints to OWCP then these complaints should remain on file. Through a FOIA request other claimants can get redacted copies of the complaints. Those ten complaints can be used as an argument that Dr. Doman is biased and his report is not valid.

After OWCP receives three complaints against a doctor they're supposed to investigate.

Multiple complaints have the power to make OWCP and/or the ECAB take notice or at the very least provide an argument that can overturn OWCP's decision to give Dr. Doman's report weight of medical evidence in your claim. But imagine what twenty or thirty or fifty complaints would do.

Unless claimants band together and file complaints against these physicians, nothing is going to change. In the case of Dr. Doman, I've made it really easy to get these complaints filed.

A copy of the complaint is below which you can cut and paste and insert your information I've indicated in Red.

 Here is a copy of the complaint:

Date: Insert Date

Office of Workers’ Compensation Programs
P.O. Box 8300
London, KY 40742

Insert your name

OWCP Claim Number: Insert your claim number
Date of Injury: Insert your date of injury

To Whom It May Concern:

Consider this my formal complaint of bias against Office physician, Dr. Alexander N. Doman.

Dr. Doman has performed second opinion and Referee examinations for the Office for at least twenty (20) years in at least eight (8) states (GA, MA, WI, NY, NC, VA, TX and TN) although a valid medical license could only be found in the state of GA (license #033313).

In addition, Dr. Doman was the Office referral physician in ECAB docket number 15-0640 issued 06/11/2015 in Guam.

Physicians do not normally practice medicine in multiple states especially without being licensed in the state(s) in which they practice. This leads one to believe Dr. Doman isn’t practicing medicine in multiple states, but performing examinations in multiple states for the Offices’ purposes.

It is unreasonable to think that the Office could not find a qualified second opinion or referral physician in the state in which the claimant lives and had to fly Dr. Doman in at great expense to examine claimants. This would give the appearance of bias as Dr. Doman consistently provides opinions against a claimant.

During an Office-directed second opinion examination of December 11, 2014 under claim number 062216370 Dr. Doman stated;

“There is also evidence of both symptom exaggeration during the examination.” [sic]
“It is again noted that there is strong evidence from the examination today of significant symptom magnification”

Dr. Doman provides the Office no rationale on how he arrived at this opinion. Nor does Dr. Doman provide or discuss the “strong evidence” he refers to in his December 11, 2014 second opinion report.

During an Office-directed second opinion examination of June 06, 2015 under claim number 142007938 Dr. Doman stated;

“This lady’s subjective complaints do grossly outweigh and do not correspond to the objective findings. The findings on examination indicate gross and intentional symptom exaggeration.”

Dr. Doman did not provide the Office any medical rationale as to how he came to this conclusion.

During an Office-directed second opinion examination of March 29, 2016 under claim number 140266302 Dr. Doman stated;

“The rationale for this is because this claimant’s physical examination clearly indicates that this claimant is exhibiting gross and extreme symptom magnification for the purposes of deceiving this examiner.”

During an Office-directed referee examination of August 02, 2016 under claim number 062353031 Dr. Doman stated;

“Gross and intentional symptom magnification for purposes of deceiving this examiner with complaints of severe back pain while in the prone position with simple attempts to flex her knees while in this position.”

During an Office–directed second opinion examination of 03/14/2017 under claim number 060661746 Dr. Doman stated;

“This gentleman has traumatic findings of intentional symptom magnification with complaints of severe back pain with simple attempts to flex both his left and the right knee while in the prone position on a nonphysiologic and nonanatomic basis.”

Additionally, Dr. Doman indicated “Malingering” as a diagnosis in this report. Malingering is considered conscious and willful with intent, the deliberate and fraudulent feigning of symptoms for which a person can be prosecuted for fraud. This is a serious allegation which Dr. Doman indicated was a “Diagnosis”, yet Dr. Doman provides no explanation as to how he arrived at the intent of this claimant’s alleged malingering.

Insert information from your Dr. Doman report here

There are a limited number of Dr. Doman’s opinions available to me, however in eighteen (18) cases in front of the Employees Compensation Appeals Board, (ECAB or the Board) Dr. Doman stated various ways he believed claimants were falsifying their symptoms, using very similar terms and phrases in each of his reports;

Docket #
Dr. Doman’s report stated
Appellant displayed markedly inappropriate behavior that was psychogenic in nature.
“Subjective complaints of pain [did] not correspond with the objective findings.”
A self-limited disorder
Intentional symptom exaggeration. Diagnosis is that of a malingering patient. Purposely exaggerating her complaints, in the opinion of this examiner, for purposes of secondary gain.
Intentionally exaggerating her complaints for purposes of secondary gain. Stated appellant was malingering.
“Gross signs of intentional symptom magnification....” Stated appellant was malingering.
Subjective complaints outweighed the objective findings.
He opined that appellant was malingering.
Obvious signs of symptom exaggeration.
Symptom magnification.
Malingering based on his normal orthopedic examination findings.
“Obvious signs of symptom exaggeration. Grossly exaggerated and in fact suggestive of a patient who is malingering.” 
Malingering for purposes of secondary gain.
Subjective complaints of pain grossly outweighed the objective medical findings.
Subjective complaints grossly outweighed her objective findings.
Subjective complaints grossly exaggerated for purposes of deceiving him
Malingering on either conscious or unconscious basis. Obvious signs of intentional efforts to deceive the examiner. Pain is psychogenic in origin.
Obvious signs of symptom exaggeration.

In none of the above cases did the Board indicate that Dr. Doman provided pervasive evidence as to how he arrived at his opinions on symptom magnification, symptom exaggeration and/or malingering.

Symptom magnification and/or symptom exaggeration are a psychiatric diagnosis. Dr. Doman does not explain how, as an orthopedist, he is qualified to make such a psychiatric diagnosis.

In addition, Dr. Doman often states the claimant has behavior that is psychogenic in nature. This indicates that each of the claimant’s he examines has a psychological condition. Yet Dr. Doman provides no referral to a psychologist/psychiatrist and provides no credentials that would qualify him to make such a diagnosis. 

Dr. Doman consistently suggests symptom magnification, exaggeration and/or malingering when bending the knees while in a prone position, yet I could not find a single case where Dr. Doman explained how flexing the knees while the claimant was in a prone position could not cause pain in the spine or how this one test result evidenced the claimant was exaggerating, malingering or attempting to deceive him.

In point of fact, there is no evidence based examination technique to determine a patient is malingering; there is no physical examination maneuver that can determine a patient’s external incentives. Yet Dr. Doman consistently uses this same examination maneuver to determine claimants are deceiving him, exaggerating their symptoms, magnifying their symptoms or malingering and the Office has accepted these opinions as factual to the detriment of claimants.

Dr. Doman simply makes offending allegations of symptom magnification, intentional deception, symptom exaggeration and malingering without providing the Office the medical rationale that formed his conclusions. Nor does Dr. Doman provide how he measured these intentional fraudulent behaviors. 

The Office then accepts these offending allegations as fact and issues negative decisions based on Dr. Doman's unproven allegations.

Dr. Doman has a propensity to opine claimants falsify their symptoms, yet I could find no case where Dr. Doman provided a discussion of the objective evidence he relied on that forms his opinions.

In addition to my claim, I am providing the Office twenty three (23) cases as cited above wherein Dr. Doman indicated a claimant was exhibiting symptom exaggeration, symptom magnification, malingering or other unsubstantiated negative comments in his reports while providing no medical rationale, evidence or criteria in how he arrived at these opinions.

Dr. Doman consistently uses the same phrasing no matter the claimant’s examination, medical record, test results, etc…It is suspicious that Dr. Doman uses these similar terms and phrases on a regular basis. The consistency in which Dr. Doman uses these derogatory phrases can only lead one to believe Dr. Doman is biased against the claimants he examines for his own secondary gain.

In addition, I have learned that Dr. Doman acting as the Office second opinion examiner has been paired with Dr. Harold H. Alexander acting as the Office referee examiner on at least four (4) separate occasions (docket number 10-0878 issued 12/17/2010, docket number 11-0931 issued 11/09/2011 and docket number 13-0159 issued 05/14/2013, docket number 14-1676 issued 11/2014.

Dr. Doman acting as the second opinion examiner has been paired with Dr. Charles Thomas Hopkins, Jr. acting as the Office referee examiner on at least five (5) separate occasions (docket number 10-0455 issued 09/15/2010, docket number 10-0981 12/09/2010, docket number 10-2372 issued 09/30/2011, docket number 11-1205 issued 02/24/2012 and docket number 13-1650 issued 02/10/2014).

As referee physicians are to be chosen on a random basis, it is highly suspicious that Dr. Doman has been paired with the same referee physicians on multiple occasions.

FECA Circular 00-08 (2007) states in part;

"Credible, reliable medical evidence is vital to the claims process and it is particularly important that OWCP-directed medical examinations are not compromised in any way. Where a complaint is received concerning a physician and/or challenging a medical report, the claims examiner should, [g]enerally, address the complaint in the context of the specific FECA case. The CE should first evaluate the charge and supporting evidence to determine how to proceed.”

"If OWCP receives a written complaint concerning a physician's professional conduct (which includes allegations concerning veracity, discrimination or bias) before or following an OWCP-directed medical examination, and that complaint is supported by credible evidence of the type detailed in the procedure manual, the CE may ask the DO manager or district medical director to help develop the evidence."

Dr. Doman is a less than reputable physician which is used by the Office to receive a guaranteed negative result against the claimant. As his bias is obvious, the Office has a duty to immediately remove him. 

Respectfully submitted,

Insert your name
Insert your address

Sunday, April 30, 2017

Schedule Awards-Revisions to FECA Manual

There have been some new revisions to the FECA Manual part two at 2-0808 that may have a positive result for schedule awards.

The first change has to do with the District Medical Adviser, (DMA). In the past, when OWCP sent you to a second opinion about your schedule award and the DMA did not agree with the second opinion this created a conflict in medical opinion that resulted in being sent to a referee physician.

The new change indicates that the DMA cannot create a conflict in medical opinion with a second opinion physician because both the DMA and the second opinion work for OWCP. A conflict in medical opinion occurs when a doctor on your side disagrees with a doctor on OWCP's side. Since both the DMA and the second opinion are on OWCP's side, there cannot be a conflict.

Instead, the DMA must provide a medical report with medical rationale stating why they don't agree with the second opinion and the CE is to ask for a clarification report from the second opinion if the DMA does not agree with the impairment rating.

After receiving the clarification from the second opinion, the Claims Examiner, (CE) must then weigh the medical evidence to see if there is a conflict in medical opinion between your doctor's rating and one of OWCP's physicians. There can no longer be a conflict in medical opinion between two of OWCP's doctors.

The next change concerns the referee physician. In the past, OWCP would send the referee report to the DMA for review. The new change indicates that if the referee's report resolves the conflict and provides a thorough explanation of the impairment and cites the proper tables and charts, then the referee opinion is determined to be accurate and review by the DMA is no longer necessary.

The CE may send the referee report to the DMA but this is no longer automatic. Instead, the CE only has the DMA review a referee opinion if there is an issue with the referee's report.

Also, if there is an issue with the referee report, the CE should ask for clarification from the referee and not send it to the DMA to clarify. Only the doctor who wrote the report can clarify their own opinion.

The last change is a big one for some claimants. In the past, OWCP only allowed ratings only for accepted conditions even though this is not how the law is written.

The new change indicates that OWCP MUST follow the law and impairment ratings should include both work-related and non-work-related conditions to the same covered body part (arm, leg, etc).

For instance let's say that OWCP has accepted a specific condition in your shoulder and OWCP approved surgery on the shoulder but that same shoulder has pre-existing arthritis that is not accepted.

In the past OWCP would only accept ratings that included the impairment due to the accepted conditions and not the pre-existing arthritis. Now OWCP has to accept the impairment rating that includes the pre-existing arthritis even though it isn't accepted by OWCP.

Or say you have a left knee condition that is not work-related but you also have an accepted left ankle condition and both of these conditions affect your left leg and cause an impairment. OWCP must accept the impairment to the left knee which is not accepted as well as the left ankle which is accepted.

Or say that OWCP did not accept all the conditions to a body part when the claim was accepted. The conditions OWCP did not accept must now be included in the impairment rating if they result in a loss of use.

In other words, OWCP has to accept the Total loss of the covered body part at the time of the rating and OWCP can no longer 'portion' out your rating, they must accept and pay for a rating that includes ALL conditions that affect the covered body part whether the conditions are accepted or not.

This could result in higher impairment ratings for people who have conditions to the same body part that are not accepted by OWCP or that pre-existed the work-related injuries.

The FECA Manual part two at 2-0808-5(d) has been changed to read:

"Rated impairment should reflect the total loss as evaluated for the scheduled member (i.e. arm, leg, etc.) at the time of the rating examination. See Raymond E. Gwynn, 35 ECAB 247, 253 (1983). There are no provisions for apportionment under the FECA. As such, schedule awards include permanent impairment resulting from conditions accepted by the OWCP as job-related as well as and any non-industrial permanent impairment present in the same scheduled member at the time of the rating examination.

As long as the work-related injury has affected any residual usefulness, in whole or in part, of a scheduled member, a schedule award may be appropriate. Similarly, an increase in schedule award may be appropriate as long as a material change in the work-related injury is at least in part contributory to an increase in impairment of the scheduled member.

For example, if an aggravation of left hip osteoarthritis is accepted as work-related but the claimant also suffers from non-industrial left knee osteoarthritis, both of which have resulted in permanent impairment, an  assessment of impairment should reflect the total loss of the left leg, to include both the industrial and non- industrial injuries."

Hopefully this will force OWCP to follow regulations. 

These changes should mean a faster turnaround time for schedule awards because less time is wasted on the DMA and there cannot be a conflict in medical opinion between the DMA and one of OWCP's physicians. 

It should also result in higher impairment ratings for some claimants because OWCP has to accept impairment ratings that include all conditions that impair the covered body part.

Link to FECA Manual: https://www.dol.gov/owcp/dfec/regs/compliance/DFECfolio/FECA-PT2/group2.htm#20808