The Life~Future Care Cost Analysis & Its twisted role today Clae - - PowerPoint PPT Presentation
The Life~Future Care Cost Analysis & Its twisted role today Clae Willis MSc MHA CLCP CRTWC CVE FAAPM Overview of Presentation: Flow 1. FCCs in the BIG Picture 2. Legal Standard 3. Definitions & concepts 4. Purpose of a
2009 CANLii 28648 ON SC
Awards for Future Care Costs, McCague Borlack LLP, Jim Tomlinson and David Olevson)
injury, though it may be necessary for a plaintiff to prove on the balance of probabilities that the tortious act or omission was the effective cause of the harm suffered, it is not necessary for him to prove that future loss or damage will occur, but only that there is a reasonable chance of such loss or damage
fact and should be ignored, whereas substantial possibilities based on such expert or cogent evidence must be considered. This principle applies regardless of the percentage of possibility, as long as it is a substantial one, and regardless of whether the possibility is favourable or unfavourable. Thus, future contingencies which are less than probable are regarded as factors to be considered, provided they are shown to be substantial and not speculative: they may tend to increase or reduce the award in a proper case. “
(Source: Combined definition of the University of Florida at their 2nd Annual Life Care Planning Conference, the International Academy of Nurse Life Care Planners, presented at the Forensic Section Meeting, NARPPS Annual Conference, Colorado Springs, Colorado and agreed upon April 3, 1993).
In theory, a claim for the cost of future care is a pecuniary claim for the amount which may reasonably be expected to be expended in putting the injured party in the position he would have been in if he/she had not sustained the injury. Obviously, a plaintiff who has been gravely and permanently impaired can never be put in the position he/she would have been in if the tort had not been committed. To this extent, restitution in interim is not possible. Money is a barren substitute for health and personal happiness, but to the extent within reason that money can be used to sustain or improve the mental or physical health of the injured person it may properly form part of a claim. Contrary to the view expressed in the Appellate Division of Alberta, “there is no duty to mitigate, in the sense of being forced to accept less than real loss” (Supreme Court Dickson, January 1978).
(CRCC, 2002; Barros-Bailey & Neulicht, in press).
Was this a recommendation from a reputable objective provider, or a hired gun
The recommendation is not within ---------------scope of practice/ nor has it been generate and or reviewed by a regulated health professional and/or treating practitioner or service provider that would actually supply the suggested goods or services.
Currently in use and expected to continue
The recommended goods and/or services does not appear to extraordinary/probable /reasonable based on my review of the medical documentation and ------------- rationales; not incident related.
Twenty four hour care forever…
CLAE WILLIS MHA MSc FAAPM CRTWC CLCP
www.ClaeWillis.com Tel: 1-877-CARE-PLAN (227-3752)
Reintegration Counselling~Post Trauma Management
With extensive Rehabilitation experience, Mr. Willis has provided Vocational Assessment and Re-integration Services, Future Care Cost Analysis and Disability Management with; Chronic Pain, Acquired Brain Injury, Spinal Cord Injury and orthopedically injured clients and their families. Mr. Willis holds a Masters in Health Care Management, a Masters of Science and degree in Clinical Psychology. Also a Bachelors Diploma in Human Resource Management and he has completed his Fellowship with the American Academy of Pain Management. He also possesses a Graduate Diploma in Catastrophic Case Management ~ Life Care Planning, a Graduate Certificate in Trauma Counselling, Graduate Diploma in Solution Focused Brief Therapy and is a Certified Return to Work Coordinator. Disability Management: As a Case~Care Coordinator, Mr. Willis provides the organizational and facilitating role within the Rehabilitation Team. He strives to understand all trauma conditions in which he works plus the various public and private Accident Benefits system protocols for which individuals and their families may be eligible. Over the last 20 years, Mr. Willis has established a wide community network; enabling access to a large resource base of independent Work Trial/Placements, Medical Assessors, Service and Treatment Practitioners.
be considered a disease~syndrome caused by a single pathologic state of an organ system. Perceived functional pain barriers are primary concern that we deal with in Vocational and/or scholastic re-integration and are addressed utilizing a Solution Focused model of intervention. Vocational Services: My employability reports serve to identify a realistic vocational options for a client by evaluating; learning ability, academic achievements, cognitive abilities, working aptitudes, physical capabilities, transferable training as well as employment history, experience and labour market
vocational implications of various impairments~disabilities allows us to provide the client with the necessary tools, skills, motivation and resources to adopt a realizable labour market re-entry plan. Future Care Cost Analysis: I provide true Life / Future Care Cost Analysis (FCCA), which is a published procedure for assessing and projecting diagnostic treatment, maintenance needs and costs of impaired client’s care. Also I complete critiques which facilitate and provide an objective review of the relevance and appropriateness of another supplier’s Future Care Cost Assessment (Life Care Plan) Projections.
Medaille College, Buffalo, New York (1999 – 2002) MASTER OF SCIENCE (Thesis: Scholastic Re-entry / Re-education Post Trauma) Hawthorne University, Salt Lake City, Utah (1993 – 1996) MASTER OF ARTS – Health Care Administration Ryerson Polytechnic Institute, Toronto, Ontario (1990 – 1992) BACHELOR DIPLOMA – Human Resource Management McMaster University, Hamilton, Ontario (1984 – 1988) BACHELOR OF ARTS – Psychology University of Toronto, St. Michael’s College, Toronto, Ontario (2000 – 2001) GRADUATE CERTIFICATES: Solution-Focused Brief Therapy & Trauma Counselling University of Florida, Gainesville, Florida (1997 – 1999) GRADUATE DIPLOMA – Life Care Planning & Case Management Mohawk College /McMaster University – (2008-2012) Disability Management Diploma Program
(2006)
2000)
Report Structure
Referral Source: This file was referred to by . Reason for Referral: We have been asked to critique a report prepared by ---------------------The report was dated ----------------and was requested by -------------------. Assessors Qualifications: With over 20 years of direct Rehabilitation experience, Mr. Willis has specialized in the provision of Future Care Cost Analysis, Vocational Re-integration and Rehabilitation Counselling with; Chronic Pain, Acquired Brain Injury, Spinal Cord Injury, Orthopedically injured clients. The primary author of this report is Clae Willis; who has over 20 years of direct, Future Care Cost Analysis and Rehabilitation
clients and their families.
Management and Life Care Planning. As a Diplomat of the American and Canadian Academy of Pain Management, a Certified Care Manager, Certified Return to Work Coordinator as well as a Certified Life Care Planner, Mr. Willis has provided both reports and testimony in the areas of Vocational Assessment, Future Care Cost Analysis, Rehabilitation and Pain Management Counselling; within the Financial Services Commission of Ontario, the Superior Court of Ontario and Nova Scotia. Future Care Providers Credentials: Further, per the College of Nurses and I quote “No, we do not have a list of skills. Under the Regulated Health Professions Act nurses are authorized to carry out certain controlled acts. These controlled acts all relate to invasive procedure. A Future Care Cost Analysis Assessment is not included in these controlled acts and therefore not restricted to any particular profession under this legislation. This however is not taught in a nursing program. A nurse who takes this on would have to have had addition training in rehabilitation, research and data collection on the job or through education. Many nurses who work in the role of a rehab consultant are involved in this type of assessment. The fact that a nurse does not have formal education in this assessment does not mean they are not capable of carrying it out” (Margo Bonathan, Practice Liaison, College of Nurses of Ontario, 101 Davenport Road, Toronto, ON).
2014 (Future Care Cost Report., Ms. Orange, , R.N.,B.Sc.N,R.R.P, August 15,2013). Basically the report was completed with the following: 1) A client interview. 2) A medical chart review.
expertise regarding an injured person’s need for future treatment and care. According to these decisions, the role of the future care expert is to identify the specific device that meets a need articulated by an appropriate health professional and to provide evidence about the costs and life cycles of goods and services (Song v. Hong and Frazer v. Haukioja).
those needs, he must establish a realistic risk of the need arising, what the need will be and what the likely need will reasonably cost over time. It is not enough to produce a list and to expect the court to marry each listed item with any evidence heard that might possibly support some aspect of it (Frazer et al v. Haukioja COURT FILE NO: 02-CV-231638 CM1/.DATE: 2008/08/27).
Pre-Incident Diagnosis Reference / Source
included occasional low back pain related to over-lifting at work, but he stated he never lost over a day’s work due to same. He also reported he has too many blood cells for which he undergoes a phlebotomy once every 3 months (blood taken/removal). He denies involvement in any other MVA’s or ever having broken a bones. Physiatrist, June 4, 2013 Dr. Green
Functional Opinion Reference / Source
quite functional in terms of his self care requirements as well as his activities of daily living. As for employment, he has tried to work return to work. This was approximately two to three months
standing and lifting. He managed to do this with difficulty but he had a lot of pain in his legs on that same day as well as the next day. This was his only attempt at work. He does not wish to try again due to the pain.
Vocational Opinion Reference / Source
vocational pursuits due to his physical issues caused by the motor vehicle incident.
Recommendation Reference / Source
analgesic, anxiolytic and sedative medications. Periodically, he will require involvement in physiotherapy and massage therapy to help him manage her symptoms. He is disadvantaged in taking strong medications because of the side effects, and hence, treatments that do not involve the use of medications would be preferred. Periodically, he will require attendance with a physiatrist or any other musculoskeletal specialist for consideration of cortisone injections as well as to manage his multiple soft tissue and chronic pain.
2013
Prognosis Reference / Source
and psychological issues due to the motor vehicle incident. His prognosis is guarded at this point in time.
2013
Professional Services Recommendation & Rationale Provided by Original Assessor Costing Details/Factors Provided by Original Assessor Clae Willis’ Views on Recommendations Clae Willis’ Estimated Cost Factors Speech-Language Pathology Duration: 2014 to 2016 Frequency: 1-2 session per month including travel per session for 2 years Unit/Initial Cost: $132.00 per session Total of all years or Cycles: $14,310.00 It is unclear to me base on the client’s current status and situation how any practical progress could be anticipated with the involvement of a Speech Language Pathologist. Further, this recommendation is not based on direct current consultation with any assessing or RHP therapist. We also note from the chart: Speech-language pathology intervention appears to have met it’s maximum benefit at this time. At this point in the rehabilitation process, I recommend the the team assess the overall approach to rehabilitation and streamline the number of active providers to maximize cost effectiveness. It is therefore in the client’s best interest to proceed to discharge and to await a future time when he might be better able to engage in therapy (Speech-Language pathology / Cognitive-Communication Assessment Report,, Breanda Breener, June 12, 2013. Further direct consultation with the assessing RHP’s indicate she is not in support $0.00
Attendant Care
Recommendation & Rationale Provided by Original Assessor Costing Details/Factors Provided by Original Assessor Clae Willis’/Views on Recommendation Clae Willis’ Estimated Cost Factors Personal Support Worker, Phase 1: Live-
less 8 hours RSW per week Duration: 2012 to 2014 Frequency: 168 hours per week less 8 hours PSW (2 weekly sessions @ 4 hours direct service each) for 2 years Unit/Initial Cost: $4,094.40 Per 1 year or Cycle: $212,908.80 Total of all years or Cycles: $425,817.60 Based on my review of the chart, I am at a loss as t how Mr. Ahmed required continued 24 hour attendant care at this time. I find it bizarre that a program would suggest a patient is incapable of self sustaining and ejects
at a time. It is clear that 24 hour attendant care is not being provided; if so, how would the music become too loud or friends come and go as they choose. >I presume the 24 Attendant Care “$6,000.00” per month is being utilized to fund the “Traverse Program”. The medical chart reveals 4 alternate views on attendant care >Dr. Clue: zero attributable (Feb. 15, 2012) >Dr. Green: >Dr. Pink: $0.00
Individual Cost Recommendation Comparisons Original Assessor Original Assessor Clae Willis Clae Willis Item/Service One Time Cost Period Cost One Time Cost Period Cost
$0.00 $65.00 $0.00 $0.00
Services, Initial – Phase 1 Total of all years
$29,662.50 $0.00 $0.00 $0.00
Services – Initial – Phase 2 Total of all years
$42,375.00 $0.0 $0.00 $0.00
Services – Initial – Phase 2 Total of all years
$30,510.00 $0.00 $0.00 Total of all years or cycles $33,052.50 5. Case Management Ongoing $0.00 $2,118.75 $0.00 Total of all years or cycles $10,594.00
Crisis $0.00 $875.00 $5,650.00 $0.00
Pathologist – In-home Phase 1 Total of all years
$14,310.00 $0.00 $0.00 $0.00
home – Phase 2 Total of all years
$10,732.50 $0.00 $0.00 $0.00