dead is better would said the i did procedure is simply a situation where you inject a probe into the disc in the back and it heats up and it can shrink the disks for teachers in the disk area and they also say can possibly cauterize not quite sure what the the mid medicinal value of the of the treatment is but nevertheless it is claimed by some to work in the disco gram is a as of course probably familiar from other cases is a situation where the needle is inserted in the center of a disc and dye is inserted it's visible on the x ray the injection creates a pressure and it's used to allegedly identify whether or not a disk is contributing to the problems now in this case reports are yes and i want to make sure that the court and since we're not asking the court to give that a heightened level of that i'm certain we could well be because it contradicts a staff and i don't think that's what the the the legislature intended when it passed that it's supposed to be considered as with other evidence our position in this case is even when you give it the same consideration as other evidence what evidence is there to contradict the detail findings of the utilization report and it says that these two procedures are not reasonable and not necessary what how they have been lacking over time they've demonstrated that they're not as effective as they once claimed and i think the utilization reports go through and they are not granted they're not the easiest thing in the read but when you look through them they document according to national fact based glazers records when we see the discussions that he has i think i'm almost comfortable saying this is a conversation they has it with with the petitioner there is no opinion in this case there's no testimony in this case that says that these procedures were reasonable necessary to a medical degree yes in this case i don't think so we put all the evidence together in this case when we look at the nature of this injury we look at a low back strain from the relatively minor in significant event listing plastic trays away in less than five pounds he's diagnose the hospital and by the iranians have any low back strain he goes in for five months of medical treatment one hundred forty some thousand dollars clearly this is a situation where it's sending the patient around to various places and run up the medical bills that's exactly what happened in this case and these procedures were created by the general assembly to help give us his employer as a means to come in and say these are on these are on necessary in israel reasonable procedures where they're too frequent and the utilization reborn is our process for doing that and we did so in this case they did not file a review and they did a review and i said they did not appeal pursuant to the a pillar provisions which are provided for the usa should be they did not challenge that all they had to do was get a letter from this doctor said these are reasonable and necessary from another doctor they could have brought in and i and they don't produce the results that are claimed to have produced and just false that's not dispositive i agree with you i certainly agree with you but let's look at dr glaser's records from april and at most all we have is a conversation where he discussed the pros and cons of these procedures to let you decide this case on its records alone but the problem is these records lack any kind of causation opinion and i don't think we can rest on the fact that these procedures were discussed with the petition and there ought to be a higher level of requirement and there ought to be a higher level requirement when we come in with a document or report from a organization that uses national guidelines evidence based fact based guidelines and says these are these according to the procedures in the literature good afternoon your honor when it was matt jones here on behalf of the apple we mr joshua garcia bought several points at issue first and foremost you know this is an issue as mr eldred it stated solemnly with regard to these two procedures not as to whether trying you know we're not merely dealing with you know bumps and bruises and i think of the a lot of the case this point substantiates that secondly with regard to your honor touched on this from the very start i do believe that it's exactly your honor and quite frankly i that i think that every if this were the requirement on a public policy matter if it were held that without the magic language as you put it is not present in a medical record then you're going to have doctors that are just rubber stamping their magic language on every single piece of paper i believe that this x ray is medically reasonable and necessary with a reasonable degree of medicals medical and surgical certainty will have that no be meaningless actually because every doctor will do it for every single thing that he ever does as anything other than an order for treatment a recommendation for treatment i believe is a basket misconstruction of facts and evidence as to the facts and evidence themselves i work here on a manifest weight issue as counsel correctly state it is not as though the commission looked at this and decided that when i decided nothing at all never commented never did anything just a word of the treatment the commissioners specifically discussed these reports specifically addressed the criteria being used and issued to specific decisions stating that they considered it and believe that criteria is not appropriate essentially they have found the witness at issue in this a report tendered by going to she cites to various literature the report tendered by a are trained medically speaking they understand that they've dealt with these issues i think it is well within their right to look this whole burnside this criteria although you've got plenty of literature explaining at this result and that result sixty thousand times prior to june twentieth absolutely you know most of the tapes that there is the other procedure to this was done on a regular basis absolutely as a alternative to lumbar fusion which is exactly how dr glaser phrased it in his report so certainly i had as it's been addressed i after unsuccessfully to serve the treatment of my client a very young man at the time i is absolutely on and the commissioner in fact stated in the initial statements regarding and you know this to be considered as relevant evidence though not dispositive which is precisely the language set forth in section eight point seven and it is it's my contention that the commissioner the commissioner is decided that this evidence was as set forth by a witness you know it that it was not credible evidence and i think that the contention i need to specifically work by evidence was  commission's decision where they say that the that the rules interim report may have been too strict or it might be unduly rigid and i guess i would i would say based on what we're seeing evidence if there was some type of an opinion or a deposition when the doctor was asked about these types of procedures and he gave them interpretations and they made these findings i would lose i would lose that but based on one where is the evidence in the record to support these two fine and by the commission it's not in there he talks about the opinions of dr glacier what opinions they have a conversation about the risks and benefits you know if we talk about bread i want to jump off a bridge and you say well we're going to talk about the risks and benefits and put down the same as you saying europeans are reasonable thing for me to do just because you have a discussion and you require the fact that we have the discussion about me wanting to do that because the risks and benefits what does that tell us it doesn't tell us anything requiring them to put language in it it says to reasonable degree of medical certainty i think that i think that's what their burden is their burden is to come in and to demonstrate that this is a reasonable and necessary to them medical a reasonable degree of medical certainty and they didn't do it thank you