Slip and Fall (Premesis Liability) and No-Fault Medical Coverage

Slip and Fall (Premises Liability) and No-Fault Medical Coverage

As my avid blog followers are already well aware, I am a Baltimore chiropractor that spends the majority of my time treating personal injury clients that usually include motor vehicle collision injuries and worker’s compensation injuries. One form of personal injury that we see from time to time is a “slip and fall” injury, otherwise known as premises liability.

Stated basically, every commercial property must carry liability insurance to make sure to protect themselves against a loss that occurs on their property. They have to carry certain limits of liability (typically in excess of 1 million dollars) to make sure that if someone were to be injured on their property that they would not lose the business. With such large limits of liability it is not surprising that large retails are often the target of opportunistic criminals who want to take advantage of the insurance to file false claims.

One less known component of these liability insurances is known as Med Pay. It is a non-fault benefit available to non-employees that happen to be injured on another’s property. In fact, if you review your own home owner’s policy there is likely a small med pay provision on there, typically 5,000 or $10,000.

Here is why the Med Pay no-fault coverage is important. I had a patient about two weeks ago who was at Giant super market. She walked by the milk fridge and slipped and fell back backwards striking her head and lower back. As it turns out she slipped on some leaking refrigerant from the cooler. Unfortunately for this patient she did not have any health insurance coverage available to her. Luckily for her she had a good Baltimore personal injury attorney that understands premises liability. He contacted the grocery store and filed a claim. He was able to determine that Giant does, in fact, offer Med Pay benefits for people injured in their store, regardless of fault. The patient was relieved to find out that she has access to these funds to pay for chiropractic care, physical therapy, x-rays, and a hospital bill. Our office was able to treat this patient since Giant offered a Med Pay benefit as part of their commercial liability package.

There are many nuances to premises liability cases in Baltimore. I do not pretend to be an expert on them, as I spend the majority of my time treating auto accident patients in Baltimore. However, if you have been injured as a result of a slip and fall injury in Baltimore (Baltimore premises liability) you may have benefits available to treat your injuries. If you have questions or are not certain whether or not these benefits may be available to help cover the cost of healthcare associated with your injuries, please contact Mid-Atlantic Spinal Rehab & Chiropractic at (443) 842-5500. We would be happy to offer you a free no-cost, no obligation consultation.

Dr. Gulitz

Why Did You Become A Baltimore Chiropractor?

I spent a great weekend at the Maryland Chiropractic Association’s Spring Convention over this past weekend. Along with approximately 80 other Maryland licensed Chiropractors I was able to collect about 12 continuing education credits while listening to some of the best speakers across the nation.

We had the pleasure of attending a lecture by Dr. Fabrizio Mancini, the president emeritus of Parker University in Texas. He has gone on to to become an international best seller, motivational speaker, and guest on “The Doctors”. He shared with us the story of how he became a Chiropractor and then offered each provider in the room an opportunity to share their story of why they became a chiropractor. He challenged us not to forget why we set out on this path to heal the sick and injured in spite of insurance hurdles and daily gripes that we face each day. Unfortunately I got back from the bathroom break too late to share my story, so I figured I would share it here for all those that are interested.

I was about 19 years old and was just getting into weight lifting with some friends. Like most amateurs I thought that if some weight was good on an exercise, that more would be better. I was naturally strong but I decided to “push it” one day. I was performing an inclined leg press with about 700 pounds on the rack. I had done about 2 or 3 repetitions and on the final one the weight fell back onto me, compressing me like an accordion. I did not take proper precautions and have a spotter to help me. I had to wiggle my way out from underneath the weights. Too embarassed to admit that I was over-doing it, I just took some weight off the machine and continued.

That night I couldn’t sleep. I had tremendous back pain and I started to feel some burning pain into my right hip. I was PANICKED! This was the time before we had internet access at my house (I know I am dating myself with that reference). I decided to do what most people do – I took about 3 weeks off from the gym and the pain worsened. Only now I started to feel some tingling down my leg. Again panicked, I spoke to my “expert” on all health matters, my father. I use the term expert in quotations because my father is not knowledgeable about health and he is not a doctor, he is just my father. He told me that I had to travel about 50 miles by train to get an appointment with an orthopedic specialist at NYU.

It took me another month to get the appointment. I met the provider for approximately four minutes and he did the most cursory exam before declaring that I can take some medications for the rest of my life to help with the pain or I can have surgery. I was dumb founded. I couldn’t believe that one dumb mistake for a minute could cause me to either take medications for the rest of my life or to have sugery. I was just a kid! I asked if there was anything else he could offer me. He recommended that I try 6 weeks of physical therapy (again, 50 miles from my house three times a week). I agreed to that since it seemed like a less invasive approach.

Like so many before me, I committed to everything that the PTs recommended and I did not improve. That’s not to say that I don’t like physical therapy but my condition did not improve with care. I went home distraught and spoke with my parents about it. I told them that according to my orthopedist, I now have to choose between taking pain medications or having surgery at only 19 years old!

Sheepishly my mother chimed in that I should see her chiropractor. I still remember this conversation to this day. My exact response was “I’m not going to see one of your crazy witch doctors!” and I dismissed it. I decided to start a course of pain medications daily. I lasted about three days before I had to stop due to side effects – it made me sweat profusely and gave me bowel problems that I care not to share.

At my whits and and with no else to turn, I decided to go with my mother to her chiropractor. I had exactly zero expectations to feel better but I figured I could not possibly feel any worse. The Chiropractor recommended that I present for treatment 3x/week for two weeks and that he would reassess me.

By the end of the third visit (first week) I was feeling 90 percent better. It was as if a lightbulb went off in my head. How was it possible that I was feeling this good and yet everyone was telling me to get surgery or take pills? Why did no one recommend that I try a Chiropractor?

I am an inquisitive person by nature. I went to my local library (remember those?) and read everything I could about Chiropractors and chiropractic care. I spent evenings and weekends palling around with my chiropractor and I was obsessed from the beginning.

From that moment forward I wanted to help others the way I had been helped. I wanted to make sure that people don’t needlessly take drugs or have surgery. It became my mission and it still is after approximately 8 years in clinical practice. I am able to see this lightbulb go off in some of my patients each day and it drives me to continue to help and tell the chiropractic story. Each day I want to know how many future chiropractors that I will be able to inspire.

If you, or someone else you know, has general questions about Chiropractic care, please contact Mid-Atlantic Spinal Rehab & Chiropractic at (443) 842-5500. We would be happy to help!

Dr. Gulitz

Roll-Over Baltimore Car Accident Patient Presents with Neck Pain

As my avid blog readers are aware, I am a Baltimore Chiropractor that spends the majority of my time in the office treating patients with whiplash symptoms following Baltimore auto accidents. As a Baltimore auto accident chiropractor, most of my patients typically present with some constellation of symptoms that include headaches, neck pain, radiating arm pain, mid back pain, lower back pain, and occasionally numbness and tingling into the leg. Typically these symptoms manifest from some form a car accident – typically a rear-end impact, but occasionally side swipes, t-bone impacts, and even the occasional front-end (head-on) collision.

Just this past week I saw a new patient that had suffered from a different type of car accident that I do not come across that often. I found it interesting enough to be shared in this forum. This patient had been involved in a car crash that initial included a rear-end impact but then concluded with the car flipping several times over before landing on its roof upside down. The patient had to be extricated with the jaws of life before being taken to the hospital for emergency precautions.

The patient (whose name I can not use) presented to me approximately six weeks after his injury. That is, at the request of his medical doctor, he went to a physical therapy place close by to his house. The PT place took good care of him and helped him overcome some mid and lower back pain. What remained by the time he got to me was neck pain along with radiating and burning left sided interscapular pain, and some numbness and tingling pain down his left arm.

The patient asked me if I could “just crack” his neck on his first visit. I explain to him that due to the complex nature of roll-over injuries, and due to his size, that I felt safer first ordering an MRI of his neck, as I suspect that he had one or several disc herniations in his neck based upon the mechanism of injury and his size.

He seemed surprised that I suggested that he obtained further advanced imaging, since he read our many positive reviews online from people who said that we were able to help them quickly, many times on the same day. I expressed to him that part of owning and running one of the leading Baltimore auto accident rehab clinics in Baltimore was knowing when to proceed with treatment and when to hold back. I told him that due to his large frame (he was approximately six feet four inches tall) it was not only possible but probable that during the roll-over portion of his injury that he compressed his neck on the roof of his truck. As such, we discussed that I did not feel safe manually adjusting his spine until I ordered an MRI to make sure that it was safe for me to do so.

The patient understood, but he was angry at my suggestion. I had my staff go through the process of referring him for an MRI to a local facility. This facility saw him within about a week. The problem was that he was too big for the machine and he was claustrophobic, so my office had to refer him elsewhere. Another week went by and at this point the patient was able to obtain his MRI imaging.

I scheduled for the patient to come back in the following week to review his findings. I hoped I was wrong about him needing an MRI. Unfortunately for him, I was not.

The patient’s MRI revealed three levels of disc protrustions/extrustions pressing upon his cervical spinal cord. There was some question about whether or not there was some ligamentous instability in his neck as a result of the trauma. I told him that as a result of the findings of his examination that I would be unable to offer him any spinal manipulative therapy. Instead, we put together a plan of action that included a referral to Dr. Sarah Merritt M.D. for pain management, and a neurosurgical consultation to consider surgery if he does not respond well to pain management.

After the results of the MRI were clear, the patient did eventually come around and thank me for using precaution with his clinical presentation. He admits that he wanted me to adjust his neck that visit and that he had even called a few other chiropractors that he was planning to see just to have someone do it for him. Fortunately, those other offices were too busy to see him and at this point, no manipulation has been performed on his neck.

Not all patients are the same following a Baltimore auto accident injury. Nor are all accident mechanisms the same. My staff and I are trained to ask specific detailed questions to determine if it is safe for us to treat you, or if you require further diagnostic analysis prior to treatment.

If you, or someone you know, has been a victim of a Baltimore auto accident injury and require treatment, please contact Mid-Atlantic Spinal Rehab & Chiropractic at (443) 842-5500. We would be happy to help!

Dr. Gulitz

Now Offering Pain Management For Baltimore Auto Accident Patients

As many of my blog readers are well aware, I am a Baltimore chiropractor that spends the majority of my time treating Baltimore auto accident injuries though chiropractic care. I routinely treat headaches, neck pain, and back pain. For the most part my patients improve with treatment over a short course of therapy and are able to reach maximum medical improvement with my therapy.

Other patients are not as fortunate. Some patients are so severely injured that no matter how much treatment they receive they may never reach pre-injury status. That is, for those patients, maximum medical improvement following their Baltimore auto accident injury, is some level of chronic pain. It is unfortunate when that happens, but that is the way it goes sometimes.

In an effort to help with the more complex cases that we are seeing in the office, I have recruited another provider to work alongside me. Dr. Sarah Merritt M.D. has joined the team and is available on Tuesdays from 3-7 pm to co-treat Baltimore auto accident injury patients. Dr. Merritt is is a pain management physician that owns her own practice in Bowie, MD and she moonlights in our clinic one day per week. Her role is simple – she is here to help to provide medications as needed and pain management interventions to help with acute and chronic pain.

She has been with us for several months and so far the results have been stellar. She has helped patients with acute knee pain, hip pain and shoulder pain, in addition to the “run of the mill” headaches, neck pain, and back pain patients that we usually see in my clinic. Besides prescribing medications, Dr. Merritt is able to perform some pain management injections which helps with localized swelling and inflammation. Dr. Merritt is also able to help me determine sooner which patients are responding well to treatment and which ones may require referrals to other specialists such as orthopedic surgeons, neurosurgeons, neurologists, etc.

As the saying goes, two heads are better than one. We are happy to have Dr. Merritt on-board one day per week. We look forward to her contributions to the clinic and we look forward to helping patients get well quickly. We are discussing the possibility of extending her to a second day per week in the near future.

If you, or someone you know, requires pain management following a Baltimore auto accident injury, contact Mid-Atlantic Spinal Rehab & Chiropractic at (443) 842-5500. We would be happy to help!

Dr. Gulitz

Do I Need an MRI after a Baltimore Auto Accident Injury?

As you no doubt are already aware, as a Baltimore Chiropractor that spends the majority of my time treating auto accident injuries and other personal injuries in Baltimore, I spend my fair share of time treating post-traumatic headaches, neck pain, back pain, and the occasional radiating arm or leg pain. I also treat patients that have not been involved in auto accident injuries but I find that the diagnosis and treatment of auto accident injuries is more interesting since it requires a deeper understanding of anatomy and physiology as well as more hands on “case management”. By that I mean I am often not just treating these Baltimore auto accident injury clients alone, I am part of a bigger team that usually involves a medical doctor, and perhaps even a pain specialist or orthopedic surgeon.

One of the questions that I often get asked by some patients is “Do I need an MRI?”. So let’s talk about that. First off, MRI is an acronym that stands for Magnetic Resonance Imaging. It is a sophisticated medical device that uses our bodies own atoms in a magnetic field to produce a truly amazing three dimensional rendering of the body in real time. We are truly looking inside a living being at a moment in time and assessing the structure of not only their bones, but also their intervertebral discs, ligaments, tendons, and blood vessels.

Typically following even low speed rear-end injuries I like to take x-rays of my patients. This allows me to assess their bony anatomy and draw inferences upon their intervertebral disc heights. This can help me better understand what is going on before I lay my hands on them in an effort to begin treatment. X-rays are, however, limited in the information that they convey. For the most part we can only discern fractures, dislocations, and hypermobile joints by way of xray. And on top of that we can only see bone. Don’t get me wrong- that information is incredibly useful if a patient is guarding or if there has been direct blunt force trauma to a window or if there has been airbag deployment. But after a few weeks of treatment there is little to no clinical benefit in performing repeat x-ray analysis.

After I evaluate a new patient following a Baltimore auto accident injury, I try and explain the courses of healing and how long a patient might expect to feel pain and remain under my care. I almost always suggest that within 10-12 visits (usually one calendar month) I will perform a similar re-evaluation and make future treatment recommendations. My goal by this second phase of care is to have determined whether or not I suspect the patient needs an MRI. I am typically looking for a return to pre-injury level of ranges of motion, and at least a 50 percent improvement in returns to activities of daily living and pain levels from the initial visit. That is, let’s say a patient presents day 1 with neck pain that is 9/10 and severely restricted ROM. By the 12th visit if all is going according to plan, they should be at or below a 4/5 out of 10 on the pain scale, should have nearly restored their neck ranges of motion in all planes, and should be working at full duty capacity. If those things (or more) are occurring by this stage, I am happy with their progress. I simply reduce their reliance on my therapy and see them only 1-2x/week for another 6-8 visits where I again monitor their progress.

But let’s say these patients are not that fortunate. Maybe the same example from above only sees an improvement to pain levels at an 8/10. Maybe they still can’t work because their neck is too stiff, and maybe they’ve developed some radiating numbness, tingling, and/or weakness into an arm. This is a completely different story in my eyes and one that requires further evaluation.

It is at this point that I will typically make sure that the patient is evaluated by either an orthopedic surgeron or a pain management specialist. I want to know if these other providers are “on board’ with my analysis that these clients are not improving and I want their “second opinion” as to whether or not any further diagnostic testing, such as MRI, may be helpful in the diagnosis and case management of our fictitious patient.

So to answer the question that I posed in the title “Do I need an MRI?” – the answer is, it depends on a case by case basis. We almost always try and utilize the least invasive modalities and procedures before taking the next step and coordinating for an off-site MRI. I tell most patients when they begin treatment that I hope that they do not need an MRI or to see a specialist, but if they fail to improve as expected then I will have my staff take care of a referral on their behalf. I always hope that MRIs are not necessary, but when they are, we are happy to coordinate care.

If you, or someone you know, has been injured as a result of a Baltimore auto accident, please contact Mid-Atlantic Spinal Rehab & Chiropractic. We would be happy to help, whether your care requires an MRI or not!

Dr. Gulitz