HomeMy WebLinkAbout1993-04-29 - Agendas - FinalAGENDA
FIREMEN'S PENSION AND RELIEF BOARD
April 29, 1993
11:00 a.m.
City Hall Room 326
1. Approval of the minutes of the March 25, 1993 meeting
2 Approval of the Pension List for May, 1993
3 Old Business
A. Medical Bills for Arvil King (copy attached)
B. Other
4 New Business
• A. Investment Report
•
B. Other
5. Adjournment
1r
MINUTES OF A MEETING OF THE FIRE PENSION BOARD
A meeting of the Fayetteville Firemen's Pension and Relief Board
was held on Thursday, March 25, 1993, at 11:00 a.m. in Room 326 of
the City Administration Building, 113 W. Mountain, Fayetteville,
Arkansas.
PRESENT:
ABSENT:
CALL TO ORDER
Mayor Hanna called the meeting to order.
MINUTES
Marion Doss, Pete Reagan, Retiree Richard Baird,
Mayor Fred Hanna, City Clerk Sherry Thomas, and
Administrative Services Director Ben Mayes.
Danny Farrar and Retiree Darrell Judy
Doss stated paragraph 8 and line 2 of paragraph 11 on page 2 should
be deleted.
Reagan, seconded by Baird, made a motion to approve the minutes as
corrected. The motion passed unanimously.
PENSION LIST
Thomas stated three widows had passed away and have been deleted
from the pension list -- Mrs. Gladys Cole, Mrs. Madge Murphy, and
Mrs. Letha Brown.
Doss, seconded by Baird, made a motion to approve the pension list.
The motion passed unanimously.
OLD BUSINESS
MEDICAL BILLS FOR ARVIL KING
Thomas stated she has received a bill for $40.00 from Dr. David
Davis of the Neurological Associates and a bill for $856.00 from
Springdale Memorial Hospital for an MRI. These are the result of
the requirement for Arvil King to have a medical examination
because of his medical retirement.
Doss asked if the Pension Board would be responsible for the MRI.
Reagan stated King had tried to get in to see his regular doctor
from Fort Smith, but the doctor kept canceling the appointments.
King told Reagan Dr. Davis was requiring an MRI.
Mayor Hanna asked if a retiring employee can keep his health
insurance through the City.
Baird stated he could for 18 months to 2 years, but the rates and
• the deductible go way up from those paid while employed.
Reagan stated the fire fighters had brought this before the
legislature, but the Municipal League fought this issue.
Mayor Hanna stated he felt a retiree should still be able to be a
member of the group and take advantage of the city rates.
City Attorney Rose stated the Board might want to write a letter to
King stating they will not pay any continuing medical bills.
Mayor Hanna stated if the Board is satisfied as to the condition of
King, they may decide to take no further action and incur no
additional expenses.
Rose stated the Board would be obligated to pay for the MRI since
it was used as a part of the diagnosis.
Thomas suggested next time a medical examination was requested, the
Board should specifically outline what they want and what they will
pay for.
•
•
Reagan, seconded by Baird, made a motion to approve payment of the
medical bills. The motion passed by a unanimous vote.
SURVIVING SPOUSE AND "RELIEF" OUESTIONS
Mayor Hanna stated the memo from City Attorney Jerry Rose answers
the questions asked of him by the Board at their last meeting.
Rose stated the "relief" portion of the pension fund does not give
the Board any powers broader than what are in the statutes.
Baird asked when a wife is designated the beneficiary, is that the
wife the fire fighter has at the time of retirement. In other
words, if a retiree remarries after retirement, there will be no
payments to the new wife.
Rose stated this was the way he understood the statute.
ROY SKELTON CASE
Reagan asked if there had been any new developments regarding the
Roy Skelton case.
Rose stated he has not received anything from the Circuit Court as
of this date.
•
•
•
FEW BUSINESS
March 25, 1993
MERRILL LYNCH INVESTMENT REPORT
Curtis Williams, with Merrill Lynch (ML), stated New Mexico Capital
had shown an increase of 19.7% in 1991, about 9.87% in 1992, and
was up almost 4% this year. Roxbury was up about 40% in 1991,
about .25% in 1992, and is down 1.53% for this year. He stated ML
would be closely watching the performance of Roxbury. The income
account was up 12.7% in 1991, 5.5% in 1992, and is up 3.4% this
year.
Reagan stated he was concerned about the year end report on
Roxbury. He stated it was ML's job to advise the Board about what
is going on with the money managers.
William stated 1992 was not a good year for growth stocks. Many of
the large money managers ended 1992 in the negative. However,
Roxbury continues to underperform compared to the market. They
would like to see them become more consistent.
Williams explained to the Pension Board why ML sometimes sells an
investment before maturity. For instance, ML sold a CD that had
two more years to maturity. If they had kept the CD to maturity,
the income would have been $8,763.75. On the day of the sale, the
CD sold for $3,463.00. The difference between the two amounts,
$5,299.25, is the yield. They took the money received from the
sale of the CD and purchased City Corp. at a 9% rate for 5 years.
In the long run, this move will make more money for the fund.
Williams explained the history of interest rates in this country.
The interest rates peaked in 1981 because (1) the baby boomers
entered the spending market, which increased the cost of money, and
(2) there was a real estate boom during the 1960-1980's. Now, the
tax laws have been changed so that investing in commercial property
is no longer a tax benefit --no more passive losses. So, there is
now plenty of existing office space in this country. The average
yield in this country has been lower than it is now 90% of the
time. Inflation is now at about 3%. We are experiencing a slow
growth economy and unemployment will be a problem for a long time
to come. The demand for fixed income investments will grow. ML
feels interest rates will go up some for a short period of time,
about 18-36 months. The pension fund's portfolio value will then
go down. ML is trying to keep a position in the market to best
deal with this type of changing environment.
Baird asked what about the fiduciary responsibility for the pension
fund. He asked who is liable for decisions on investments.
Williams stated everyone involved with the pension board is
responsible. You can't transfer that responsibility to someone
else. He stated the Board has been very responsible in dealing
March 25, 1993
• with the pension fund. Eight years ago they established investment
guidelines. You attend the meetings to keep current on the
investments, and you ask questions. By doing these things, you are
doing everything you can to do what is best for the fund. Williams
stated there was no way to legally get rid of the fiduciary
responsibility. The pension board is ultimately responsible for
the smooth operation of the fund. He stated ML has a fiduciary
responsibility to monitor the money managers, and the Board has the
responsibility to listen to ML.
Baird stated he had been told a different story about fiduciary
responsibility.
Williams stated the only way to get rid of the fiduciary
responsibility is to terminate the fund.
•
•
Baird stated the seminars several of them attended did not say
that.
Williams stated the seminar discussion was telling you to do what
you have already done --like setting goals and objectives, following
them out, and getting qualified people to assist the pension board.
Baird stated he would like to see something in writing. He sees
the loss in the account Williams just went over as wrong if the
Board lets it go on and does not do anything to try and correct it.
Williams stated that is only a short term
money manager every time they have a loss,
constantly.
Baird stated he could understand not making much, but losing money
is a different story. The money would earn 2 1/2% by just putting
it in a bank savings account. He has seen no earnings over 10% in
all the records he has been reviewing.
loss. You can't fire a
or you would be changing
Williams stated the 10% was an average that was established before
the market crash in 1987.
Baird stated he had nothing on paper that says ML is assuming any
fiduciary responsibility.
Williams stated ML does have fiduciary responsibility, but not all
of it. Ultimately, it comes back to the pension board to decide if
ML is doing right or wrong with the money. Williams stated legally
everyone who deals with the plan is fiduciarily responsible.
Baird stated he had asked Richard Yada about this and asked if ML
went bankrupt, what would become of the pension fund. Yada told
him ML would be gone and out of the picture.
•
•
March 25, 1993
Williams stated ML does not control a dime of the pension fund's
money. If ML goes under, none of the money goes to ML. The
pension board would just have to transfer the money to a new
custodian. You are insured up to $25 million per account to cover
your investment.
Williams stated ML would not tell the pension board what to do, but
they will give you information, and you will be the ones who makes
the ultimate decision. ML is trying to balance the fund through
diversification.
Doss stated Boeing is losing, but it looks like the stock will go
back up.
Williams stated he personally does not like the Boeing stock, but
he would be taking on the fiduciary responsibility and removing it
from New Mexico Capital by telling them to sell that individual
stock.
Williams stated the pension board could not just blame someone if
this does not work. It would be great, but it does not work that
way.
Reagan stated Roxbury has made more money for the fund than would
have been made by simply investing in CD's.
Baird stated John Lewis and Bob Hall have been doing some figuring
for him, and he would like for the Board to hear what they have to
say.
Reagan asked Baird if he was unhappy with ML or just did not want
to listen to them or what.
Baird stated he would just like to hear from them.
Reagan stated the Board heard from them earlier and has gone
through several money manager hunts when they had every local firm
making presentations.
Williams stated every money manager has a program they offer. By
firing the lowest producing money manager every two years, the
Board could be doing more harm than good. He stated the Board does
have two equity managers now. The Board chose to have only two
when ML suggested listening to a third manager.
Doss stated the members on the pension board change, and there is
nothing wrong with hearing another point of view. But, there are
a lot of companies, and they would all be interested in this
account.
• Doss stated he felt the Arvest seminar they attended started out as
a "let us do it" sales pitch seminar.
March 25, 1993
Williams stated ML has always told the Board they have a service to
sell. They feel they do it better than anyone else.
ADJOURNMENT
The meeting adjourned at 12:24 p.m.
PLEASE
DO NOT
STAPLE
IN THIS
AREA
FAYETTEVILLE FIRE FIGHTER
PENSION BOARD
113 W MOUNTAIN
FAYETTEVILLE AR 72701
lip
.PICA HEALTH INSURANCE CLAIM FORM INS PICA
1. MEDICARE MEDICAID CHAMPUS CHAMPVA GROUP FECA CH HER
HEALTH PLAN BLK LUNG
1a. INSUREDS I.0 NUMBER i FOR PROGRAM IN ITEM II
_
-1 (Madicare1)
(Medicaid M)
(Sponsor's SSN)
[ 1 I VA Foe #, L_ (SSN or 10) n (SSN(
IX
I (ID)
D
2. PATIENTS
KING
NAME (Last Name. Fi sl Name. Middle
ARVIL
Initial)
W
3. PATIENT'S BIRTH DATESE%
MM DD VV
06 14 43 Ni
N1
iI
4. INSUREDS NAME (Last Narne. Firs! Name. Middle Initial)
KING ARVIL W
5. PATIENT'S ADDRESS (No., Street)
6. PATIENT RELATIONSHIP TO INSURED
7 INSURED'S ADDRESS (No. Streell
905 LAKE SEQUOYAH DR
Seri)( Spousel"11, Child[ 1 Other[
I
905 LAKE SEOUOYAH DR
CITY
STATE
8. PATIENT STATUS
GIT( r STATE
z
FAYETTEVILLE
AR
Single[ Married [' Other
I--
FAYETTEVILLE !AR
0
ZIP CODE
TELEPHONE (Include Area Code)
ZIP CODE
TR E PHONE;INCLUDE AREA CODE:
a
X
72701
521-0412
((501) 521-0412
r-
_J
Full Time - Part.Time
student _ Student
L
- -
1
72701
1 ( )
O
9. OTHER INSUREDS NAME (Last Name, First Name. Middle Initial)
10. IS PATIENT
S CONDITION RELATED TO'.
11. INSURED 5 POL ICY GROUP OR FEGA NUMBER
ATT SHERRY THOMAS
a
Z
w
a. OTHER INSURED'S POLICY OR GROUP NUMBER
a. EMPLOYMENT? I CURRENT OR PREVIOUS)
- IVES LING
a INSUREDS DATE
MM
06 14
OF BIRTH SEX ¢
OD VV 7
43 MLX F cn
z
b. OTHER INSUREDS DATE OF BIRTH SEX
MM DD YY
b. AUTO ACCIDENT? PLACE (State)
b EMPLOYER S NAME OR SCHOOL NAME
M
F[I
'-1JJVES [NO
'a
c. EMPLOYERS NAME OR SCHOOL NAME
c. OTHER ACCIDENT'
c INSURANCE PLAN NAME OR PROGRAM NAME
~
Z
L IYES
L
NO
FAYETTEVILLE FIRE FIGHTER
R
d. INSURANCE PLAN NAME OR PROGRAM NAME
10d RESERVED FOR LOCAL USE
d I5
THERE ANOTHER HEALTH BENEFIT PLAN?
YES NO 11 yetreturn to and complete item 9 a d
a
Q.
READ BACK OF FORM BEFORE COMPLETING & SIGNING THIS FORM.
12 PATIENTS OR AUTHORIZED PERSONS SIGNATURE I authorize the release of any medical or other Inlormandn necessary
to process this claim. I also request payment of government benefits eitner to myself or to the parry who accepts assignment
below Signature on File
SIGNED _ DATE 12/23/93
13 INSURED'S OR AUTHORIZED PERSONS SIGNATURE I authorize
pigment of nIetlical benefits Io the undersgned physician or supplier for
servres described below
Signature on File
SIGNED
TE OF CURRENT:' ILLNESS (First symptom) OR
DD VY INJURY (Accident) OR
PREGNANCY(LMP)
15. IF PATIENT HAS HAD SAME OR SIMILAR ILLNESS
GIVE FIRST DATE MM DD YY
16 DATES PATIENT UNABLE TO WORk IN CURRENT OCCUPATION
MM OD vv MM UO vv
FROM TO
17 NAME
LARRY
OF REFERRING PHYSICIAN
C WEEKS,
OR OTHER SOURCE
DC
1'a
I.D
T91063
NUMBER OF REFERRING PHYSICIAN
t8 HOSPITAI IZATION DATES RELATED TO CURRENT SERVICES
MM 0D `CI MM DD YY
FROM TO
19. RESERVED FOR LOCAL USE
20
OUTSIDE LAB-? 3 CHARGES
YES 1 NO 1 .100
21. DIAGNOSIS OR NATURE OF ILLNESS OR INJURY OR ITEM
(RELATE ITEMS 1 2.3 4 TO 24E BY LINE)
. (724.5 3 729.5
1
22 MEDICAID RESUBMISSION
GODS
ORIGINAL REF NO
I
2. ' 4
23 PRIOR AUTHORIZATION NUMBER
24. A
0
C
0 I E
E
G
H
I . J
K
- PHYSICIAN OR SUPPLIER INFORMATION
-DATE'S) OF SERVICETo
Fromof
MM DD VY MM CO YY
Place
Servce
Type
of
Service
PROCEDURES, SERVICES. OR SUPPLIES(
(Explain Unusual Circumstances)
CPTIHCPC/HCPCS I MODIFIER
DIAGNOSIS
CODE
5 CHARGES
DAYS
t)R
UNITS
EPSDY
Family
Plan
EMG
COB
RFSEPVED FOR
LOCAL USE
102 22 93
3
3
9244
1
1,3
140.00
1.0
2
3
6
25. FEDERAL TAX I.D. NUMBER SSN EIN I 26. PATIENTS ACCOUNT NO 2'. ACCEPT ASSIGNMENT?
I For govt. claimssee back;
28 TOTAL CHARGE
29 AMOUNT PAID
l0 BALANCE DUE
0623045
I IX
23044-93120132 [
YEs
[j No
$ 140.00
s . 00
6 140.00
ATURE OF PHYSICIAN OR SUPPLIER 32. NAME AND ADDRESS OF FACILITY WHERE SERVICES WERE
01.1 UDNG DEGREES OR CREDENTIALS ' RENDERED Of other than home or office)
Icemfy mat meslalement on the reverse NEUROLOGICAL ASSOCIATES
applyto his tan are made a part CherCPJ f)
David Davis. MFAYETTEVILLE AR 72703
SIGNED DATE 1 2/23/93
33. PHYSICIAN �'.1�1IIBf1S 41L4112(11•411 TRF SS. ZIP CODE
& PHONE # I
Neurological Associates
1706 Joyce Blvd Suite 1
Fayetteville. AR 72703
Prno 1 GRP.
(APPROVED BY AMA COUNCIL ON MEDICAL SERVICE 8.88, PLEASE PRINT OR TYPE
APPROVED OMB 3934 0:;05 FORM HCFA 1 SCC 2-90). FORM PRE '500
APPROVED OMB -1215.0055 f ORM OWCP 1509 APPROVED OMB 0720.000t ICHAMPUSI
Has already made partial payment on all items marked 'X' in 24a
BECAUSE THIS FORM IS USED BY VARIOUS GOVERNMENT AND PRIVATE HEALTH PROGRAMS, SEE SEPARATE INSTRUCTIONS ISSUED BY
APPLICABLE PROGRAMS.
NOTICE: Any person who knowingly files a statement of claim containing any misrepresentation or any taise, Incomplete or misleading Information
may be guilty of a criminal act punishable under law and may be subject to civil penalties.
REFERS TO GOVERNMENT PROGRAMS ONLY
MEDICARE AND CHAMPUS PAYMENTS: A patient's signature requests that payment be made and authorizes release of any information necessary ,o
process the claim and certifies that the information provided in Blocks 1 through 12 is true, accurate and complete. In the case of a Medicare claim, the
patient's signature authorizes any entity to release to Medicare medical and nonmedical information, including employment status, and whether the person has
employer group health insurance, liability, no-fault, worker's compensation or other insurance which is responsible to pay for the services for which the
Medicare claim is made. See 42 CFR 411.24(a). If item 9 is completed, the patient's signature authorizes release of the information to the health plan or agency
shown. In Medicare assigned or CHAMPUS participation cases, the physician agrees to accept the charge determination of the Medicare carrier or CHAMPUS
fiscal intermediary as the full charge, and the patient is responsible only for the deductible, coinsurance and noncovered services. Coinsurance and the
deductible are based upon the charge determination.of the Medicare carrier or CHAMPUS fiscal intermediary if this is less than the charge submitted.
CHAMPUS is not a health insurance program but makes payment for health benefits provided through certain affiliations with the Uniformed Services.
Information on the patient's sponsor should be provided in those items captioned in "Insured"; i.e., items la. 4. 6, 7, 9. and 11.
BLACK LUNG AND FECA CLAIMS
The provider agrees to accept the amount paid by the Government as payment in full See Black Lung and FECA instructions regarding required procedure and
diagnosis coding systems.
SIGNATURE OF PHYSICIAN OR SUPPLIER (MEDICARE, CHAMPUS, FECA AND BLACK LUNG)
I certify that the services shown on this form were medically indicated and necessary for the health of the patient and were personally furnished by me or were
furnished incident to my professional service by my employee under my immediate personal supervision, except as otherwise expressly permitted by Medicare
or CHAMPUS regulations.
For services to be considered as "incident" to a physician's professional service, 1) they must be rendered under the physician's immediate personal
supervision by his/her employee, 2) they must be an integral, although incidental part of aoered physictan s service 3) -they must -tie of kinds commonly -
furnished In physician's offices, and 4) the services of nonphysicians must be included on the physician's bills.
For CHAMPUS claims, I further certify that I (or any employee) who rendered services am not an active duty member of the Uniformed Services or a civilian
employee of the United States Government or a contract employee of the United States Government, either civilian or military (refer to 5 USC 5536). For
Black -Lung claims, I further certify that the services performed were for a Black Lung -related disorder,
No Part B Medicare benefits may be paid unless this form is received as required by existing law and regulations (42 CFR 424-32).
NOTICE: Any one who misrepresents or falsifies essential information to receive payment from Federal funds requested by this form may upon conviction be
subject to fine and imprisonment under applicable Federal laws.
NOTICE TO PATIENT ABOUT THE COLLECTION AND USE OF MEDICARE, CHAMPUS, FECA, AND BLACK LUNG INFORMATION
(PRIVACY ACT STATEMENT)
We are authorized by HCFA, CHAMPUS and OWCP to ask you for information needed in the administration of the Medicare, CHAMPUS, FECA, and Black
Lung programs. Authority to collect information is in section 205(a), 1862, 1872 and 1874 of the Social Security Act as amended, 42 CFR 411.24(a) and 424.5(a)
(6), and 44 USC 3101;41 CFR 101 et seq and 10 USC 1079 and 1086; 5 USC 8101 et seq; and 30 USC 901 et seq; 38 USC 613; E.O. 9397.
The information we obtain to complete claims under these programs is used to identify you and to determine your eligibility. It is also used to decide if the
services and supplies you received are covered by these programs and to insure that proper payment is made.
The information may also be given to other providers of services, carriers intermediaries, medical review boards health plans, and other organizatiol _
Federal agencies, for the effective administration of Federal provisions that require other third parties payers to pay primary to Federal program, and as
otherwise necessary to administer these programs. For example, it may be necessary to disclose information about the benefits you have used to a hospital or
doctor. Additional disclosures are made through routine uses for information contained in systems of records.
FOR MEDICARE CLAIMS: See the notice modifying system No. 09-70-0501, titled,' Carrier Medicare Claims Record,' published in the Federal Register, Vol. 55
No. 177, page 37549, Wed. Sept. 12, 1990 or as updated and republished.
FOR OWCP CLAIMS: Department of Labor, Privacy Act of 1974, "Republication of Notice of Systems of Records." Federal Register Vol. 55 No. 40, Wed Feb
28, 1990, See ESA -5, ESA -6, ESA -12, ESA -13, ESA -30, or as updated and republished.
FOR CHAMPUS CLAIMS: PRINCIPLE PURPOSES(S): To evaluate eligibility for medical care provided by civilian sources and to issue payment upon
establishment of eligibility and determination that the services/supplies received are authorized by law.
ROUTINE USE(S): Information from c aims and related documents may be given to the Dept, of Veterans Affairs, the Dept. of Health and Human Services
and/or the Dept. of Transportation consistent with their statutory administrative responsibilities under CHAMPUS/CHAMPVA; to the Dept. of Justice for
representation of the Secretary of Delense_in civil actions; to the Internal. Revenue Service private collection agencies, and consumer reporting agencies in -
connection with recoupment claims; and to Congressional -Offices in response to inquiries made at the request of the person ttams
tb whom a record pe"
Appropriate disclosures may be made to other federal, state, local, foreign government agencies, private business entities, and individual providers of care, on
matters relating to entitlement, claims adjudication, fraud, program abuse, utilization review, quality assurance, peer review, program integrity, third -party
liability, coordination of benefits, and civil and criminal litigation related to the operation of CHAMPUS.
DISCLOSURES: Voluntary; however, failure to provide information will result in delay in payment or may result In denial of claim. With the one exception
discussed below, there are no penalties under these programs for refusing to supply information. However, failure to furnish information regarding the medical
services rendered or the amount charged would prevent payment of claims under these programs. Failure to furnish any other information, such as a name or
claim number, would delay payment of the claim. Failure to provide medical information under FECA could be deemed an obstruction.
It is mandatory that you tell us if you know that another party is responsible for paying for your treatment. Section 11288 of the Social Security Act and 31 USC
3801-3612 provide penalties for withholding this information.
You should be aware that P.L. 100-503, the "Computer Matching and Privacy Protection Act of 1988", permits the government to verity information by way of
computer matches.
MEDICAID PAYMENTS (PROVIDER CERTIFICATION)
I hereby agree to keep such records as are necessary to disclose fully the extent of services provided to individuals under the State's Title XIX plan and to
furnish information regarding any payments claimed for providing such services as the State Agency or Dept. of Health and Humans Services may request.
I further agree to accept, as payment in full, the amount paid by the Medicaid program for those claims submitted for payment under that program, with the
exception of authorized deductible, coinsurance, co -payment or similar cost-sharing charge.
SIGNATURE OF PHYSICIAN (OR SUPPLIER): I certify that the services listed above were medically indicated and necessary to the health of this patient and
were personally furnished by me or my employee under my personal direction.
NOTICE: This is to certify that the foregoing information is true, accurate and complete. I understand that payment and satisfaction of this claim will bL
Federal and State funds, and that any false claims, statements. or documents, or concealment of a material fact, may be prosecuted under applic,....e
Federal or State laws.
NOTICE: Under penalty of perjury, I declare that I have read the foregoing, that the facts alleged are true to the best of my knowledge and belief, and that the
treatment and services rendered were reasonable and necessary with respect to the bodily injury sustained.
Public reporting burden for this collection of information is estimated to average 15 minutes per response, including time for reviewing instructions, searching
existing date sources, gathering and maintaining data needed, and completing and reviewing the collection of information. Send comments regarding this
burden estimate or any other aspect of this collection of information. including suggestions for reducing the burden, to HCFA, _Office of Financial Management,
•
00
f2
g
NEUROLOGICAL ASSOCIATES
1706 JOYCE BLVD. -SUITE 1
FAYETTEVILLE, ARKANSAS 72703
(501) 4424070 • FAX (501) 4429341
• DAVID k DAVIS, M.D. DAVID L BROWN, M.D. MICHAEL W. MORSE, M.D.
DIPLOMATES • AMERICAN BOARD OF NEUROLOGY & PSYCHIATRY
February 19, 1993
Larry Weeks, D. C.
2618 W. 6th
Fayetteville, AR 72701
Re: ARVIL KING
BRUCE D. ROBBINS, M.D.
(BOARD ELIGIBLE)
Dear Larry:
Mr. Arvil King was seen on February 19, 1993. He is a 49 -year-old white male who has chronic low back
pain. For the past six months, he has also been having pain from his left hip down his left leg into the left
foot. He has a feeling of tingling in his left foot. Both legs have felt weakened for the past year. His
examination is remarkable for pain in the lower lumbar area on lumbar range of motion and palpation.
�traight leg raising on the left at 45° results in left hip pain. He has no focal sensory or motor
normalities.
His left leg pain is suggestive of sciatica. For further evaluation, he is going to have an MR scan of the
lumbar spine. In the interim, he is going to take Anaprox DS one twice per day and cyclobenzaprine 10
mg. at bedtime. He was given a list of the side-effects of the medication
He has chronic low back pain which is said to be from degenerative disc disease. It is time for renewal of
his disability from being a fire-fighter. My understanding is that the fire -fighting occupation requires an
ability to cavy on heavy lifting, which he certainly could not do with his ever-present low back pain.
Therefore, he does seem to me to be disabled from being a fire-fighter.
He will be seen back in three weeks, sooner if there are problems.
Thanks again for allowing me to assist in this patient's care. If you have any questions, please don't
hesitate to call.
•ADIs
David A. Davis, M. D.
NEUROLOGICAL ASSOCIATES
1706 JOYCE BLVD. -SUITE 1
FAYETTEVILLE, ARKANSAS 72703
( 501) 4424070 • FAX (501) 442-9341
•DAVID A. DAVIS, M.D. DAVID L BROWN, M.D.
•
•
MICHAEL W. MORSE, M.D. BRUCE D. ROBBINS, M.D.
(BOARD ELIGIBLE)
DIPLOMATES • AMERICAN BOARD OF NEUROLOGY & PSYCHIATRY
CONSULTATION
ARVIL W ICING
FEBRUARY 19, 1993
HISTORY: Mr. Arvil King is a 49 -year-old white male who began to have low back pain
seven years ago and was found to have a herniated disc. He was evaluated by Dr. McDade,
who did not recommend surgery, though he did recommend that Mr. King retire from the
Fire Department. The patient's low back pain persists. It is essentially continuous in the
middle of the low back, at and a little above the belt line. The pain is made worse with
prolonged sitting, lying for long periods of time, being overactive. It is made better if he is
up walking, if he is mildly active.
About six months ago, he began to have left hip and leg pain for no apparent reason. The
pain goes from the left hip down the back of the leg to the entire left foot. It is made worse
with sitting, better if he is up. He has tingling of the left foot in its entirety, though
sometimes it is just on the top or just on the bottom Both legs have felt weak in the past
_year Bowel and bladder function have been normal. He has had no staggering or
dysequilibrium.
He denies headaches, loss of consciousness, dizziness, difficulty with mood or mentation.
REVIEW OF SYSTEMS: HEENT - No difficulty with eyes, nose, ears, throat. Lungs - No
cough, shortness of breath, coughing up blood. Cardiovascular - No history of rheumatic or
organic heart disease, palpitations, PND. GI - No nausea, vomiting, constipation, diarrhea.
GU - No dysuria, frequency, hesitancy.
PAST HISTORY: The patient's only other health problem is hypertension. His only prior
hospitalization was in 1989 to stop alcohol use. He is on no medications. He cannot take
DARVON. He has no other medicine allergies.
SOCIAL HISTORY: He doesn't drink alcohol. He smokes two packs of cigarettes per day.
He has 8 or 10 cups of coffee per day, mostly decaffeinated. He is right-handed and lives
with his wife He is on disability from being a fire-fighter because of his back pain.
r
CONSULTATION - Pg. 2
• ARVIL W ICING
FEBRUARY 19, 1993
FAMILY HISTORY is that his father is 79 years old with no health problems. His mother is
76 and has some sort of esophageal problem
PHYSICAL EXAM showed the patient to be a well-developed, well-nourished, white male
who is in no apparent distress. HEENT showed the head to be normocephalic. Sclerae were
clear. Pupils were 2.5 mm. bilaterally, round, and reactive to light. Discs were sharp
Tympanic membranes were clear. Throat was clear. The neck was supple. Flexion of the
neck resulted in left hip pain. Lungs were clear Heart had a regular rhythm without
apparent murmurs, rubs, or gallops.
Mental status seemed normal although not formally tested. Cranial nerves 2 through 12 were
intact. Sensory exam showed normal vibratory sense in both lower extremities. Pinprick and
temperature were intact throughout. Motor exam showed normal bulk, tone, and strength.
Toes were downgoing bilaterally. Reflexes were normal. Cerebellar exam showed normal
fmger-nose-forger, heel -knee -shin, tandem gait. Romberg's test was negative.
• The patient could flex forward at the waist so that the low back was at about 30' from
vertical This resulted in pain in the lumbosacral junction m the midline, as did extension to
about 10' Straight leg raising on the left resulted in pain m the left hip at about 45'. It
was negative on the right. Patrick's test was negative on the left.
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