It Was 41 Years Ago…and I Made It Through. Thank You Teri!

Reading Time: 4 minutes

On June 15, 1979 I was in a car accident…and I made it through (duh, I’m writing this!). Just a remember to myself how important rehabilitation following an injury really is. And a shout out to you my attorney readers to realize rehabilitation is so important for so many people for so many reasons.

Thank all rehabilitation counselors and all the people who care about other people’s life!

Read more about it (the car accident) here How did I Get into Rehab Counseling? Here’s a Little Story  posted November 21, 2011.

What makes my story even more special to me is that I “ran” into the woman who saved my life a few years back on a Saturday (June 6, 2015) at the Iowa Falls Boat Club for a memorial service (for a friend of many who committed suicide).

I was sitting across from a woman at a banquet table with my sister Janice and two other people. After chatting with the two, I asked the woman directly across the table what her name was (silly me). 

Teri  knew who I was and after it dawned on me (because my sister whispered to me) I stopped, thanked God, thanked Teri, and asked her if I could give her a hug! Which I did.

I did visit her back in 1979 and brought her a thank you gift after I was feeling okay to do so, but I hadn’t seen her for a long time so I didn’t recognize her.

2015-06-06 14.34.18Thank You Teri

Upon considering all that happened that day, I was 15 and Teri was 17 or 18, and she literally saved my life!  Teri came upon the scene that night, called 911 and  stayed with me until the ambulance arrived, even riding in the ambulance until we arrived at the hospital in town. She didn’t leave me until I was transported to another hospital out of town (Mason City). From what I heard later, the medical staff and others involved in my early care thought she was a nurse!

Green Gran Torino

Green Gran Torino

I was riding in the car behind the passenger seat of a green Gran Torino, and I was not wearing a seatbelt. I used to despise Gran Torinos, especially green ones, until Randy pointed out the bulk of the front end of the vehicle was another huge part in saving my life.

While at the Boat Club (the club on the river has an interesting history and continues to store memories), before the lovely boat ride on the Scenic City Empress, I took a picture of a picture. Here’s Arthur, my neighbor in Iowa Falls for many years, skiing many moons ago. He really was talented!

Arthur Skiing
Arthur Skiing

2015-06-06 17.37.14

I also took a picture of this chair made of old skis. Pretty cool, huh! 

Here’s the waterfall on the Iowa River, (shh, it’s “man” made)! Janice, my sister, is the blonde with her hand over her face.

2015-06-06 Waterfall Iowa River

Life really brings surprises, talent and beauty. Live it to it’s fullest and you won’t be disappointed. Each and every day is a new beginning. I know what it’s like to almost lose your life.

Use What You Got! If you click here you’ll read a 2011 article about me from the Des Moines Register (and see another picture of the Iowa River.)

So, in closing of this blog, I stray from my loving attitude and will end this post as such:

Rock Island Flip Off

You can find this train car in Hampton, Iowa and flip it off if you’d like…for me!

The lawsuit against Rock Island Railroad was a failure. Maybe we chose the wrong attorney, perhaps the timing was bad as the railroad went bankrupt, perhaps we should’ve settled, or perhaps the jury simply wasn’t given all the information or didn’t understand the case.

There were no cross bucks….the train had parked for the night until the conductor or whoever realized the few box cars (no caboose) were covering the tracks. You see that’s why the train moved, dragging that green car with me (my head that is) implanted on one of the bolts of the box car…. Thank goodness the car stopped right before the ravine.

It’s ironic to me that in the earlier years of my career (as a self-employed rehabilitation counselor), I worked on many railroad cases involving disability (the workers’ compensation cases were assigned to me from a rehabilitation counselor out of Omaha).

I learned a lot of the nature of the work involved and to this day, I am prepared, willing and able to do all I can to help you represent your client. Let me know how I can help you with your legal cases. 

515-778-0634 or amyebotkin@lcpresourcesplus.com

___________________

My professional rehabilitation counseling practice is focused on helping people participate in the world around them, particularly in their own world of work.

Like Mother, Like Daughter, One Tough Cookie! Want One in the Courtroom?

Reading Time: 6 minutes

Thursday, May 28th, is my daughter’s 24th birthday. I am proud of her in every way (currently she’s into gardening)! She’s physically and emotionally strong, independent, and One Tough Cookie!  Off the top of my head, here’s a few memories of my daughter and her “toughness” over the years. 

One Tough Cookie!

Before she was born, let alone named, her birth cord was wrapped around her neck while she was being delivered. As I was pushing down as one is to do during natural child birth, the doctor told me to STOP!

What? Stop? So I did and, (not knowing what was going on) he very quickly cut the cord from around her neck, and blood shot above me onto the ceiling. Nice, huh, and yuck! My new baby girl scared her parents alright! She was just fine though and had a good APGAR. Rather quickly, the housekeeper came in the room and cleaned the blood off the ceiling with a mop as I was still lying in the bed. Yuck again! She was doing her job and it was much appreciated!

Pin on blouse mtrl

Arin was a calm baby!

I remember the first day of her life, Arin seemed to care more about how the nurses felt when holding her than actually being the new baby in the room. And her eyes were (and still are) so huge, she kinda looked like an alien with eyes on both sides of her head! 

Later in her babyhood, heck, I cut her toenails too short and they bled. I felt horrible, and this was my 3rd child, but she didn’t cry.

Around age 3,  Arin fell from a chair at the babysitter’s kitchen table while she was eating lunch. Upon facial impact with the floor, her  front tooth was knocked out, and said tooth landed down in the heater vent, where it potentially could have trace elements today.  She was whisked to the ER by her sitter, but there isn’t much one could do for this injury, other than wait! 

Baby With One Tooth ClipartIt took years for her new tooth to come in.

Last year around this time, she had four wisdom teeth removed. She was tough with that surgery and the healing time involved…and her poor face was so swollen. This link takes you to a blog for a bit on costs of the procedure!

When she was a little older, around 8ish, we were working in the basement and somehow the iron got knocked off its board and landed on her foot. Her big toe sure bled a lot and a deep bruise definitely developed and stuck around. Luckily the toe wasn’t broken and the iron wasn’t hot! Yikes!

Here’s another story of my dauther’s toughness: As were in the process of remodeling our house (in 2009), Arin would’ve been age 13, she was cleaning our new windows (with water and an ecloth!) and the larger kitchen window suddenly fell down (the type of windows that fold into your house), whacking her head.  Her head broke the glass, and the glass shattered on to the floor. Arin immediately felt a headache, but there was no blood involved and we didn’t take her to the doctor, but I certainly cared for her closely and watched like a hawk for any concussive symptoms! I informed the salesperson who sold us the windows of this mishap, and he showered her with gifts. He was probably pretty darn grateful that we didn’t, gasp: sue! But no we did not, and her strong head was fine. 

With New Nordic Emojis, Give Your Texts That Finnishing Touch ...

Moving on into her middle school years, from what I was told by said daughter, she went snow shoeing on recess. Somehow her tongue landed on a metal pole, got stuck and she had to pull away from the pole. Yep, her tongue ripped and yep it bled and yep it hurt like he double toothpicks. 

She said this was a dare; the sticking her tongue out purposely onto a cold pole in the middle of winter. But in reality, I believe she fell into the pole because she wasn’t very good at snow shoeing. Again, nothing really you can do for this injury but give the tongue time to heal!Image result for tongue pierced cartoonA while later she got her tongue pierced anyway! She also pierced her septum; eyebrow too. Don’t forget thee belly button piercing! (I actually did that once, but let it grow back because it bothered me when I did a yoga pose or exercised on my stomach).

And speaking of, both her ears have pretty good sized gauge holes! I’m not including the numerous tattoos Arin has received.  To me, getting a tat seems a little too drawn out painful.

ColorColorful AJ

Colorful AJ

One last story off the top of my head at this time, and I’m not happy at all with how this happened. In early March 2019, Arin was at a birthday party held at a hotel for her friend Taylor. Arin was picked up and thrown (grrrr) into the pool. Kassidy, who she landed on, hurt not only her head, but bit down and injured her tongue; and Arin ended up breaking two ribs.

Image result for xray ribs cartoonHowever, Arin didn’t find out her ribs were broken until almost a week later when she was in much pain and having problems at work. On a Sunday she had to be taken to the ER which included x-rays and a pain prescription.  Again, this involved a long rehabilitation / healing period.

Okay, enough writing for now. Like mother, like daughter!  Yep, considering I was able to live through hitting a train headfirst!  I believe this “toughness” is heredity, and comes from my mom.

Last year (2019), my mom was experiencing an acute medical condition while visiting us from her home in Florida. As we were waiting at the airport for her and her new husband’s flight home departure, she took a dive (right in front of the drinking fountains by the rest rooms on the main level) on to her face, breaking her glasses. She ended up in the ER for numerous stitches rather than on the flight home. Mom didn’t cry or wince, or even complain a bit.

The bottom line of this post is to let you, my Attorney Reader, know that I am a strong “tough-minded” resilient person who has the capacity to face difficult facts and long odds with resolute optimism.

I define a tough-mind as having the resources, mental skills, and physical capabilities to confront difficulties of all kinds. And then afterwards, the resiliency to slow down and relax.

I know if I succeed, I caused it and if I failed, yep, I caused that too. (Don’t worry, I won’t say yep during testimony.) I will be tough for you and I will be tough for your client.

I won’t be so tough you may choke, but I will be tough enough with your case where it counts: in my reports and in the courtroom and in my resolve to never give up. I got this strong “tough minded” trait from my mom and have passed it on to my daughter and I am proud of it!

Thank you for reading my post. Let me know about a case I can help you with that involves disability and rehabilitation. I believe rehabilitation is the care that can help an individual get back, keep, or improve abilities needed for daily life. I’m a rehabilitation counselor who cares.

Contact me, Amy Botkin at 515-778-0634 or amyebotkin@lcpresourcesplus.com 

___________________

 My professional rehabilitation counseling practice is focused on helping people participate in the world around them, particularly in their own world of work.

Hello My Attorney Reader! Want to Buy Some TIME From Me…a Consultant and an Educator?

Reading Time: 3 minutes

You’re a good attorney, and you care about the people you represent. You’re busy working on cases and spend a lot of time on time. In fact, you even buy TIME! I’m writing to help you make a more comfortable TIME purchase from me, a consultant who is also an educator!

MoneyTime

I fully realize attorneys buy TIME

Time – Because you bill by the hour (and so do I), I promise to help you be more productive and, thus, more successful by providing value laden services.

Pinky SwearI promise to always respect your time.

 

Information – Because I totally understand why you HATE looking stupid (and so do I), I will provide accurate information that you want or need.

Pinky SwearI promise to always ensure you have a good reason for working with me.

 

Money – Because saving money and making money are the goals for almost every law firm (and for every consulting firm too), I will effectively use all the resources available to help with your case.

Pinky SwearI promise to be accurate and fair with my billing.

 

Education – Because lawyers always need continuing education (and so do I) to maintain your license, I am available to present to any group that would benefit from learning about my work and rehabilitation consulting. In addition, as I’m a well-trained educator and counselor, I can help you and your client in many ways throughout the case and onto trial, where my educational background is useful in front of a jury.

Pinky SwearI promise to bring new light to your litigation strategies.

 

Time on HandsHow much TIME would you like to have on your hands, especially when working on a complex case that has to do with work and disability? So there it is!  But wait, there’s more:

I, Amy, promise to Always Be True at My Core, Apple Butterflybecause that’s all I have ever had and have ever needed and I’m willing to share what I know is true.

Enjoy a piece of quality fruit (I love organic apples) and then contact me, Amy E. Botkin, to discuss your case. I’m here to help you help your client!

Call me at 515-778-0634 or email me at amyebotkin@lcpresourcesplus.com to connect so we can discuss your case and how I might help! Thank you for reading.

___________________

 My professional rehabilitation counseling practice is focused on helping people participate in the world around them, particularly in their own world of work.

Balance Your Case With Your Client’s Real Story. I’d Love to Write it!

Reading Time: 4 minutes

In her teen days my sister Janice (the Floridian) was quite adept at gymnastics, particularly on the balance beam where she made great use of her balancing skills.

When Janice moved on to college, dad cut up the balance beam he previously made for her to practice on for a new use as exit steps from a sliding glass door to the back patio during a home renovation project!

Balance Beam

Dad constructed a balance beam and re-purposed it as well!
Balancing is involved in many areas of day-to-day living and is critical to an abundant life. People balance tires, bank accounts, relationships, priorities and work, we eat a balanced meal….we try to keep a balanced state of mind.

In my life, finding balance is an ongoing lifetime project. I’ve heard comments like: It’s good to fall / fail because it means you were trying. If you think about your success, you will be successful. If you think about your falls or your failures, you’ll learn to improve.

My dad’s balance had not been good lately, although he was working on improving it. He was receiving in home physical therapy through the VA and moved continuously during each day.

But a stroke and a fall down his basement steps lead to no return to life on earth. Before he was airlifted to the hospital in Mason City, my mom called and we drove in the middle of the night to be with him in the hospital room. And to help him die.

Highway Balance

Richard R. Prochnow

4/26/33 – 5/5/16

Dad died a week after he turned 83 in the morning on 5/5/16. I’ve blogged about Death as Part of Living, and can now fully realize one has to die from many things in order to move through life and live fully….and there’s always a story to tell.

As my dad aged, he never stopped working hard and to his best ability. There was a balance in how he lived his life, and I’ll never stop learning from him! I can calm my mind and simply hear his voice when he called on the phone….

“Hi Amy, this is your dad.” [Like I didn’t know it was him on the other end!] Then he’d talk about what was happening! And it was real, interesting and well-balanced for the soul.

In whatever situation you’re in, keep on practicing finding balance, and you’ll find a way to not fall; or a way to increase your sense of balance at its core.

You may lose direction or momentarily become blinded, but you’ll find your way again. Trust yourself. Just like my dad did driving thousands if not millions of miles on the road traveling to participate in the world around him.

On a lighter side (yes, I cried writing this, but I want you to think about your own life with no tears involved), as part of my personal story, I remember an incident a long time ago while I was working as a temporary banquet server for a hotel.

As I was walking into the room full of diners with a large tray of full drinking glasses (lemonade, tea and water)….well, never mind. Let’s say there was an imbalance that could’ve been disastrous!

Spilled Water

I learned to readjust the next tray and focus on my goal: just to get the glasses on the table safely without spilling any!
We balance our bodies in many, many ways. Balancing skills make use of poses and states of mind to focus attention on work, yoga, aerobics, tabata, healing touch, hiking, golfing, bike riding…being with the person you love. You get the drift, physical activity that involves any number of exercise moves or mental positions.

Yes, simply thinking with a sense of balance is very, very good and helps avoid failure (and falling). Jurists use a balancing test to weigh the importance of multiple factors in a legal case. If you want to highlight these factors, especially those that involve work and disability, let me know.

I will be prepared to help you bring a balanced case to court. I will write a report that tells your client’s real story, with a concentration on their vocational background and potential future. If you need a life care plan for your client, again, I can help write about why the plan is needed and the likely costs for the person’s care.

The Chinese Symbol for Balance
Please know my work is my life calling and I continuously learn and practice balancing all to help you help your client. I’m actually really good at balancing and am pretty happy with my physical and mental states of mind.

Call me at 515-778-0634 to tell me about your case. A vocational evaluation or a life care plan may provide just the balance you were looking for to tell your client’s real story.

___________________

My professional rehabilitation counseling practice is focused on helping people participate in the world around them, particularly in their own world of work.

Cross Examination is Like Playing Ms. Pac-Man & I Like it!

Reading Time: 4 minutes

I know that a good attorney who excels at cross examining an expert witness is thoroughly knowledgeable of their case. There’s volumes of information and data that needs to be absorbed and analyzed before going to court! 

You my attorney reader, use intuition and instinct to discover weak points in the witness’ presentation, and in a fair and calm manner, formulate and ask clear questions to elicit precise information. This requires patience and self-control, especially when you’re working on the spot! Job well done!

I’ve been a vocational expert witness during workers’ compensation court proceedings about 12 times over the last 16 years. I have served in courtrooms (mostly conference rooms with a workers’ compensation deputy commissioner presiding) with up to eight people present. 

Recently, I’ve also testified in divorce court proceedings, personal injury and medical malpractice cases. For a copy of my most recent litigation history, please inquire and I’ll be happy to provide it to you.

From my side of the stand, I better be familiar with rough courtroom conditions!

I’ve experienced verbal assaults on my work, my credentials, my vocation, and even my personality (I’m too nice, huh? hahaha!!) by the opposing attorney. I learned a lot from prior mistakes but I learn even more from recent successes.

I remember my first court appearance many moons ago. I was the primary job placement specialist on a case when the opposing attorney stabbed my body language in an erroneous and made up way.  Because there was nothing to see because human bodies speak for themselves, he undermined his credibility not mine. And I remember that well.

Image result for old fart cartoonI have no idea what the old fart was trying to do, but the judge didn’t care for it either!

I remember another court case (this was in Council Bluffs) that involved typical cross examination, starting out with repeating basic questions to get different responses from me…then the pressure was applied! I used first-hand knowledge and communication skills to respond to his questions, remaining true to my convictions while expressing strong belief in my work.

Hopefully I revealed to everyone in the room that being confident, calm and polite is a respectful way to answer difficult questions (even personal attacks). The judge on this case was newly appointed at that time. I don’t know the decision nor have I reviewed the transcripts on that case. I suppose decisions and transcripts could help me to some degree, but I don’t ever have direct access to them plus to me it’s likely they are not pertinent to any future case other than learning from miscue or miscommunication errors.

My goal as an expert witness is to win over the people in the courtroom.

To prepare for cross, I think of all the factors that may arise on a case and pay close to attention to what I want to say about 5 to 7 main issues or circumstances most likely at the meat of the matter, commonly being extent of loss of earnings. I realize the cross examiner will try very hard to prove his or her theory of the case, while devaluing mine. The opposing attorney wants to discredit me, and will eat away at any potential weakness in what I said or reported.Ms Pac-Man

I’m  pretty good at Ms. Pac-Man! Wanna play?

I rely on my expertise, research on disability and rehabilitation, objective evidence, direct placement experiences, the principles of ergonomics along with the provision of reasonable accommodation to help determine an individual’s work potential.

I understand how worker profile changes may impact access to the labor market and wage earning capacity. I can respond creatively by highlighting the constructive and favorable strengths of how my work brings successful results and focus on the positive nature of change, motivation, and choice.

I educate everyone in the courtroom about the scope of my practice and how it works when the individual agrees with my approach. Most importantly, I match people within their own world of work which takes time, attention and a great appreciation for the jobs people do everyday.

Image result for jobs cartoon

Need help with your litigated case involving work and disability? Let me know what you see as the most important aspects of the case and I’ll let you know if I believe I’m the right person to help you help your client.  

I’ll view my  interests, do a conflict of interest check and consider whether or not the case is in my area of expertise. And keep in mind I work on both sides of the fence!  Need an expert?  Contact me at 515-778-0634 or amyebotkin@lcpresourcesplus.com

Thank you for reading!

___________________

 My professional rehabilitation counseling practice is focused on helping people participate in the world around them, particularly in their own world of work.

Rights of the Expert Witness ~ I’ll Take a Veggie Slice, Please

Reading Time: 3 minutes

Rights of the Expert Witness

expert

I continually assess and evaluate (there I go again!) my rights, values, professionalism, and of course ethics (which I really enjoy!?!) and am hopeful to write more on these topics and my career in the field of forensic rehabilitation consulting.

As far as rights, I found this great listing online (website is referred to below), and yes I added the graphics! I agree with the following essential considerations for taking on the role of expert witness:

  1. I have the right to be paid for my work.  Dream of Getting Paid
  2. I have the right to be prepped in advance of my testimony.
  3. I have the right to ask questions about the case.
  4. I have the right to work for either side, without fear of retribution.
  5. I have the right to change my opinion from previous testimony, as long as my opinion is evolving (based on new information, science and/or experience) rather than revolving (based on which side I’m working for). 
  6. I have the right to say “I don’t know”, if in fact, I don’t know. Just because I’m the expert doesn’t mean I have all the answers. I am clearly okay to say “I’m sorry, that’s outside my scope of practice”.
  7. I have the right to solicit objective feedback about my testimony from  the attorney who has called (and of course, they have the right to  decline to give it).
  8. I have the right to set limits with counsel about the scope of my testimony. 
  9. I have the right to disagree with another expert’s practices or  conclusions, even when I perceive that expert to be: a.) more educated;  b.) more famous; or c.) more experienced. 
  10. I have the right to disregard the initial instinct to view opposing counsel’s expert as the enemy, but instead recognize everyone’s role in the process and share pizza and a bottle of wine with that expert after trial is over.

Pizza

 Truly, it’s all good work!

I am glad my career continually evolves! I accept responsibility when providing forensic services to be clear, truthful and comprehensive in my evaluation and report products, and in my role as an expert witness. Thank you for reading!

Please contact me Amy Botkin for more information ~ 515-778-0634 or amyebotkin@lcpresourcesplus.com

I’ll take a veggie slice and a glass of Chardonnay please. You?

Source for Rights: http://www.forensichealth.com/2011/07/13/10-things-the-fho-expert-witness-bill-of-rights/

___________________

 My professional rehabilitation counseling practice is focused on helping people participate in the world around them, particularly in their own world of work.

“Somebody Call for An Expert?” I’ll Answer That Call!

Reading Time: 3 minutes

I’ve written about my fondness for Eeyore and want you to know I’m a bit attached to Gopher as well, especially when he comes to the rescue! You’ve heard the story when Pooh eats too much honey (honey is often on Pooh’s mind) at Rabbit’s place, gets rotund, and subsequently gets stuck in Rabbit’s front door.

45 Awesome winnie the pooh bees clipart Winnie The Pooh Pictures, Cute Winnie The Pooh, Winnie The Pooh Birthday, Whinnie The Pooh Drawings, Bee Clipart, Friends Wallpaper, Cute Disney Wallpaper, Cute Animal Drawings, Pooh BearRabbit is not happy and help is needed! Gopher recommends using dynamite, and he’s an expert with that subject, but Pooh isn’t so hot on the idea. If dynamite was needed, Gopher was ready for the rescue!Gopher

Popping out, Gopher exclaims “Somebody call for an expert?!” 

After thinking it through, Pooh, with assistance from his friendly team, realizes how to get unstuck. He agrees with Christopher Robin’s recommendations to patiently wait until he gets thin. Time passes, and it works (he gets thin!), however, he still needs a good jolt to move through the door. The team is successful and Pooh ends up in a happy place filled with honey! 

Related imageHoney! Yummy! Yummy!

I hope you appreciate this Pooh story.  I do. When called, I too, will use my expertise to help you and your team out in complex cases. I’ll answer just like Gopher but am not an expert in dynamite, I am in forensic rehabilitation consulting

Several years ago, I made an executive decision to study forensic rehabilitation counseling at George Washington University.  I started the post-graduate level educational on-line program on April 15, 2013 and graduated on August 15, 2014.

The coursework taught me more about courtroom testimony and how to function more effectively, efficiently and confidently within the legal system. I gained valuable insight into personal injury, medical malpractice, marital dissolution, product liability, and catastrophic injury cases.

A good expert has more than expertise that you can appreciate! It’s important for me to stand up under questioning (here’s a post on intimidation), commit to my opinion, and stay within my area of expertise. Thankfully, all my training including my background in Community Health Education helps! 

I strive to educate others in a clear manner and explain a complex subject to a lay audience in simple terms.

And you know what else, a good expert like me cares. I love my career, and deeply care for my work.

There’s plenty of satisfying work to accomplish and life constantly moves forward at a really swift pace so it’s important to not slow down. I work hard for my customers, for myself and for my family.

When labeled “a firecracker” by a classmate during our 15th year high school class reunion, I had to look up what that meant!

Yes, I realize I can be a bit firecracker-like, mostly because I’m a bold individual and will do what I have to do to accomplish my goals. I believe it’s always beneficial for lawyers and experts to spend time getting to know each other.

Yep, attorneys think differently than counselors. So, please let’s spend a little quality time together before we meet in a courtroom! It will truly prove beneficial.

You’ll find I’m a genuine person who truly cares about serving as an expert in the field. I’m ready, willing and able to offer my voice to help you help your client.  

Give me, Amy Botkin, a call at 515-778-0634 or email me at amyebotkin@lcpresourcesplus.com to start a discussion about your case. Thank you for reading!

___________________

My professional rehabilitation counseling practice is focused on helping people participate in the world around them, particularly in their own world of work.

 

Conflicting Medical Opinions? Handle With Care!

Reading Time: 8 minutes

Upon referral of a vocational case, I review a variety of  medical data (for example: treating physician reports, Functional Capacity Evaluations, Independent Medical Evaluations) and/or psychological data (for example: psychometric testing, psychological evaluations, psychiatric evaluations) found within the file.

During a workers’ compensation litigated claim, or on any claim that involves work and disability, it’s important for me to understand the individual’s medical situation based on the data contained in these records.

Related image

Good thing I’ve had medical records training and enjoy the review!

If a file contains more than one FCE and/or IME, I can expect the reports to have conflicting opinions. For example, one physical therapist will recommend the claimant has the physical capacity for light work, while the other physical therapist says medium work. Often the therapists also have conflicting information about the individual’s maximal (or lack of) effort put forth during the evaluation.I Did My Best

The claimant needs to honestly and sincerely say “I Did My Best!”

Assisting the individual (who can be referred to as the injured worker, the claimant, the patient, the testee, the evaluee, and potentially the client)  in returning to work following an injury is a central role in my specialty of placement. This involves finding the best occupational match within the individual’s own labor market. A person’s “doctor imposed restrictions based on an FCE” should not direct the provision of placement services. A person’s knowledge, skills, interests and abilities should!

Image result for opinionWith conflicting opinions from professionals, what data should I rely upon to perform a beneficial service?

To resolve discrepancies I first ask myself, why is an FCE being used for this specific claim? The utility of this type of scientifically based evaluation, the training sources, performance methods, test protocols and standards to measure them are numerous.

Conflicting options are influenced by components of context and can be derived from subjective views. 

Professionals may have opposing views for their own reasons but I must be able to articulate their reports into vocationally-relevant terminology and tell a story about meaningful and gainful work. And it can be challenging to do this if I don’t understand the conclusion of the FCE report to begin with!

WORK

I love reading medical data rich in detail about a person’s world of functioning!  And I love writing reports rich with detail about a person’s world of work! 

A functional capacity evaluation is actually a term with various definitions, purposes and constructs. The purpose is to  evaluate an individual’s capacity to perform work activities related to his or her participation in employment. It seems that in essence, by having a functional capacity evaluation a person is likely to be put in an unfortunate position of deciding whether he or she is willing to return to work. 

If willing, there’s a way. If not, there’s no way.

From what I know, there are approximately 10 different types of commonly used functional capacity evaluations. Here in Iowa, I am most familiar with FCEs with names like the Isernhagen Work System, the Blankenship, Matheson, WorkWell and X-RTS. The reliability or validity of any system is somewhat irrelevant to me because the testing is already entered into “evidence”. What is relevant to me is whether or not I comprehend the results and recommendations contained within the evaluation. Sometimes I can, sometimes I cannot. I always use a “Does This Make Sense to Me? test!

Image result for conflictingIt’s up to the dualing physical therapists to make their best points during litigation, I’m not in that ring!

I feel fortunate of connections with several physical therapists allowing insight into their clinical practice. I attend continuing education programs, and recall one that helped me understand various approaches to FCE’s specifically the X-RTS Lever Arm.

Thinking Cap

The X-RTS Lever Arm passes my make sense test!

So within the context of my vocational consulting work while cautiously putting any judgment aside (which seems hard when I know I know certain things), I analyze and compare each FCE while considering the testing results.

I note whether the FCE report is readable and user friendly. I assess if I understand terminology and methods used, how long testing was administered, what actually was administered, the claimant’s behavior during the test, and how the evaluator came to his or her conclusions about the results. Does the conclusion make sense?

Are there concrete and realistic recommendations regarding strengths and weaknesses in relation to performing physical demand levels of various work situations? In other words, are there recommendations regarding real jobs found within the person’s labor market? Do the recommendations make sense?

I definitely look for the goals and expectations for the evaluation, and whether maximum and consistent effort was made by the evaluee. Comments on the suitability of the testee’s future employment options along with the evaluator’s observations are valuable and should be included.

It’s important to note what body part/extremity the therapist focuses on in relation to what body part/extremity was injured. For example in one report, the therapist discussed lower extremity activities, when in fact it was an upper extremity injury. If the report cites examples or uses too many percentages, it’s important to understand how the therapist justifies examples. I’m familiar with a therapist who changes the percentages of the same examples from report to report. That doesn’t make sense to me.

No sense

I try really hard to make sense of most things and situations!  

If I am able to square an FCE in my mind after careful and prolonged study, is it possible the evaluee could do the same? That  would be  fortunate, especially if the therapist offers good recommendations that make sense!

How does the evaluee, when not truly the therapists’  patient when referred for an FCE by their own work comp attorney; with an additional FCE visit to a different physical therapist by the defense attorney  (that makes 2 different reports prepared by 2 different therapists) perceive discrepancies in the results? Sadly, in my eyes the FCE often gets “interpreted” through an attorney. The repeated pattern of thinking of one’s functional capacity as “poor” does not help anyone return to work.

If there is an IME (Independent Medical Exam), it may seem more geared towards one of the FCEs. Regardless, I try to comprehend all reports, noting the one I understand the most. I’m not so sure that an IME is really a “fresh set of eyes” in the workers’ compensation cases I’ve worked on. This topic is another blog in itself.

Putting both, or multiple opinions in a vocational report and making use of other documentation to support my ultimate and final opinion is a great idea, however I have to be cautious to not put myself in a role that isn’t mine (which is making a medical opinion which I can’t do).

If I am able to provide a doctor (ideally the most recent treating occupational health or rehabilitation doctor) detailed information directly related to a specific occupation or line of work and any resources that could help the doctor understand how such work is performed in a smart, safe and effective manner, many benefits arise.

Related image

Clean your lenses!

There’s a clearer understanding of the vocational rehabilitation process and with agreement from all involved, there’s a higher likelihood one could see a successful common outcome (return to work). This certainly helps solidify my vocational opinion and make reasonable recommendations. Yet, this type of opportunity is not frequently available (it is for me to though through processing a life care plan!). Please know I always search for a way to best express my vocational opinion.

In my reports, I document what medical records I’ve reviewed and then use the actual words from the individual during an interview (or deposition review) describing how s/he details their physical impairment.  Often I hear verbatim what one doctor wrote in their restrictions. The evaluee will respond to my open questioning about any physical limitations (sometimes after the evaluee refers to his/her doctor’s letter) and read or have it memorized saying: “no lifting over 20 pounds, avoid twisting, bending, stooping, sit and stand as needed.”  No sense

What do those words really mean in real life? The individual doesn’t seem to know either. Ask an employer if they have a job that involves no lifting over 20 pounds, no twisting, no bending, no stooping, no this, no that…and that’s not talking their language!

The evaluee who responds to me in this fashion (using verbatim restrictive words) needs future vocational counseling. Vocational counseling (which may or may not be provided depending on the nature of the litigation) helps to gain a clearer understanding of how the person’s medical situation has changed their daily living (especially in the context of their own world of work). This understanding leads to the ability to articulate the individual’s capacity for success to others (family, friends, job interviewers, etc.).

Please keep in mind, the term “restriction” is not conducive to a successful job search. The ability to explain who you are and what you can do from a functional perspective to help a business make or save money is what is conducive to a successful job search. Restrictions should never be the focus of job placement. Skills are!

Rehabilitation counseling is especially important if the individual is searching for a job, requiring job seeking skills training on how to or (how not to) disclose disability or any functional limitation. The personal attributes gained from training helps the placement process move forward with common goals avoiding getting stuck within a few words that don’t apply to working reality.

WORKWhile staying true to my convictions and firm beliefs that a person can work if the person wants to work and has the capacity to work, I need to understand the dichotomy between science and clinical practice is more imagined than real.

If healthcare professionals submit conflicting reports on the same individual, I need to be able to resolve inconsistencies to better understand and appreciate the opinions offered. It is not my role to determine which opinion is correct. It is my role to utilize available information, provide a beneficial service, and make a sound vocational opinion regarding the individual’s strengths and weakness in relation to work capacity and employability.

Matching People With Their World of WorkIt’s rewarding when I can clarify a person’s sense of their own world of work.

I strive to extend the value of FCEs in the litigation process. I am trained not only in understanding a client’s functional abilities at work, but at home and at leisure.  Together, my knowledge with those of other experts, contributes to decisions about the economic losses, or damages, for which the person receives compensation.

Thank you for reading this long post! I’m here to help attorneys like you help your client. Contact me at amyebotkin@lcpresourcesplus.com  and let me get to work for you!

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 My professional rehabilitation counseling practice is focused on helping people participate in the world around them, particularly in their own world of work.

It Happens, Things Go Wrong. Need Help with a MedMal case?

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[Original post date: March 29, 2018] Time for a health update blog, a personal one, difficult to write with a mix of questions and a couple stories about medical practice and procedures. The point is my attorney reader, I want you to think about me as a forensic rehabilitation consultant, and how I can help you help your client who is involved in a medical malpractice lawsuit!

Randy’s heart took a detour late last summer, 2017 when the ticker was running really fast.  Randy doesn’t participate in races (I’m the competitive one!), but his heart sure was! He does however donate blood on a regular basis. In fact, he was donating early on a Saturday morning (he’s donated 14 gallons according to the sticker on our front door!) when the nurse at the blood center told Randy she thought his pulse was “strange.” His precious blood was still drawn (double reds)!  

Randy is a popular Type A- donor.  

Questioning here ??? Should the nurse have continued with the blood draw knowing the pulse was “strange?” Well, she did! Luckily, no harm done. When Randy got home (rode his bike at what speed I don’t know! to/from his blood donation date which is common cuz he’s an avid biker!), I took his pulse and in fact, it truly was “not right”.

A couple days later, he had a doctor appointment (I scheduled it out of wifely concern); and sure enough, we got tachycardia…going 144 bpm. This means a cardiologist is needed. BTW, thank you to the nurse at the blood center for catching this.

Following an array of testing, diagnostic procedures, and preparations, he received an ablation early November 2017. Thank God it worked! Randy’s back down to a regular beating heart and a normal pulse (his BP was never a concern.)

His cardiologist did an excellent job and Randy was back riding his bike in a short period of time. He wasn’t happy to be told not to ride! In fact, I know he disobeyed his doctor’s orders one day.

We expect our doctor to always be right. We expect our nurse to always be right. We expect all our health care providers to always be right. We in fact, expect our bodies’ to become “right” whenever we receive treatment in the medical field.

But things can go wrong and a patient can become injured during the course of treatment. That’s why we have attorneys to help, right!?! And yes of course we expect our attorney to always be right, too!

“Dr. NeverWrong”, the cardiologist who performed the ablation on my husband’s heart has this nickname! Charlie the RN, one of Randy’excellent nurses while hospitalized told me of this nickname and the fact that the cardiologist has a fan base (being only one of few docs in town we were told who performs ablations).  Because the doctor was humble, gracious, and ever so respectful, I’m sure he would not want to be called  Dr. NeverWrong! Can you guess who I’m referring to? What? Attorneys don’t guess! 

Okay, now on to me. Recently, I was involved in a medical situation which could be worthy of a claim. How do you help your clients decide whether to file a claim? If there’s been harm done? Here’s the abbreviated personal story. 

Image result for patient gown cartoonWhen preparing for a mammogram last October 2017 (sitting quietly in a heated gown!) and waiting for the machine set up, I informed the technician of an unusual skin issue I was experiencing thinking it was poison ivy. I’ve had my share of poison ivy issues, even a four day hospitalization for a severe case in the past (contacted through an outdoor camp fire.) Watch out when you burn wood, my reaction was horrible. Anyway, the technician dismissed my concern and we went ahead with the mammogram.

To not go into detail  uggh ; [   I ended up with a severe skin condition I believe was spread by the mammography machine.  Let it be known I truly love big machines, (especially cranes), yet this large machine is not one of my favorites following what I experienced.

I was absolutely miserable and the condition lasted too long. I ended up going to the ER once on a Sunday and urgent care twice during the weeks that followed. I made these visits because I couldn’t stand the physical and emotional toil…and my doctor’s office wasn’t open at the time of my needs!  Not until I went back to my personal MD to finally get the correct diagnosis and a prescription did I begin to feel a little better.  

Image result for skin cartoonBut the prescription did NOT help and in fact the condition worsened. I literally had to just wait this one out and deal over time with the largest organ in my system: the skin. I was so distraught I even sought mental health care. I’m okay now, thank you! Whew!

I didn’t file a claim, should’ve/could’ve I? The time, energy, money and definitely my mental health was compromised and consumed in a fashion that I certainly didn’t choose. The only time I have filed a legal claim was when my parents sued the railroad for their negligence leading to my car/train collision and subsequent injuries, hospitalization and rehabilitation (there’s much to this personal story).I think the key into what makes or doesn’t make a person seek a lawyer when they think they’ve been wronged has to do with respect (or lack of) by a medical provider. Of course, everyone makes mistakes. But negligence, followed by covering up issues and not telling the truth is where the wrongs and not the rights come in to play.  That’s not where I come in just yet, that’s where you, the attorney is on the field. I enter the game by sorting out what the plaintiff needs and the costs of those needs.

If you need a life care plan for a client who has filed a medical malpractice claim, please contact me.  Following a needs assessment and subsequent life care plan, my recommendations are grounded in rehabilitation. I’m not saying I’m always right myself.  But I will tell you I care and I will do what I can do to help you help your client.

Please don’t contact me if you will act more like the red devil lawyer on the left. Sorry, I’m not interested in helping. However, if you are a good attorney like the white angel on the right who truly cares about your clients, contact me! I’m here to help!

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My professional rehabilitation counseling practice is focused on helping people participate in the world around them, particularly in their own world of work.

 

 

Happy Rehabilitation Counselor Appreciation Day!

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March 22 of each year is designated as a Happy Day to Celebrate Rehabilitation Counseling!   

A bouquet of pink roses, along with dark chocolate layer cake with vanilla bean ice cream help make the day turn even happier!

My career choice is Rehabilitation Counseling, a unique job for high-energy people who want to make a real difference in the lives of people with disabilities.  It’s also a challenging job that requires creativity and vision to see possibilities where others see only problems. 

Here’s a great brochure prepared by the Rehab Services Administration, Department of Education describing the profession, rehab jobs, and information you’ve always wanted to know!  It’s the source for some of the paragraphs in this post.

It seems when I reply that my master’s degree is in “Rehabilitation Counseling” often the person wants to know if that involves drugs and alcohol. The answer is no (although at times a case does involve an individual using some degree of drugs and alcohol in an unhealthy way). 

I explain to my listener that I chose a different path as a rehab counselor and provide consulting services on litigated cases involving work and disability.  Then I usually get a ‘oh that’s cool’ response and I continue the conversation, keeping in mind the context and scope of what I share about my work depends on the nature of the inquisition! (In other words, do I think the person asking really wants to know more about what I do or not?!) I definitely trust my intuition.

EnlighteningRehab Counseling is a High Energy Profession! 

In short, the goal of rehabilitation counseling is empowering people with (or even without) disabilities to make informed choices, build viable careers, and live more independently in their community.

Rehabilitation counseling trains professionals who will be dedicated to working with individuals with disabilities in order to help them achieve productive and independent lives. Just as other counseling tracks, rehabilitation counseling educational programs – in order to produce competent and certifiable professionals – are at the master’s level.

Drake University, School of Education, Des Moines, Iowa offers an excellent Council of Rehabilitation Education (CORE) accredited master’s level Rehabilitation Counseling Program.  This accreditation enables graduates of the program to become Certified Rehabilitation Counselors. The Commission on Rehabilitation Counselor Certification (CRCC) sets the standard for quality rehabilitation counseling services in the United States and Canada.

Image result for spike drakes mascotDrake’s Mascot Spike with a Nice Bike!

Below’s another great bulldog picture. She has experience in Drake’s Beautiful Bulldog contest! Her name is Fat Amy. She owns Jeska Reese Dean, a family friend.

FatAmyFat Amy is Experienced!

I completed all required coursework at Drake University in the Master of Science in Counseling program. In addition, I took extra coursework focusing on job placement and mental health.

I was then eligible to take a national examination which I took on October 30, 2004, and upon passing, I earned the coveted CRC (Certified Rehabilitation Counselor) designation. Since then, I re-certify every five years which requites earning 100 hours of continuing education, 10 which must be in ethics.

For background purposes, there are two main sections of the CRC exam:  Counseling and Rehabilitation/Disability.  A statistical procedure called equating is used to ensure all examinees demonstrate the same level of ability in order to pass the exam. Here’s my results:

Counseling Section:

Amy E. Botkin’s Scaled Score:       598        

Passing Scaled Score:   500

&

Rehabilitation/Disability  Section:

Amy E. Botkin’s Scaled Score:       628            

Passing Scaled Score:   500

TaDa

Here’s a copy of my CRCC Certificate (I know it’s a bit blurry): I love my career and every day try my hardest to use my talents wisely!

Please let me know if you have questions about the profession, my education, or the professional  associations and groups I belong to. It may be a good career option for someone you know!

If your career is in law, please contact me at 515-778-0634 or by email at amyebotkin@lcpresourcesplus.com to ask me questions regarding how my work helps attorneys help their clients!  BTW, when is Attorney Appreciation Day?

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 My professional rehabilitation counseling practice is focused on helping people participate in the world around them, particularly in their own world of work.