This One is Personal

I’ve had most of this post written for more than a year but was advised by our attorney not to publish it until the issue was resolved. Yesterday was resolution day. Please bear with me because although this is a little long I’ll get to the story shortly.

Laws should, above all, protect citizens.

Government’s primary function is protecting its citizens and it does so in two primary ways:

  • First, government must obviously protect us from foreign threats, and in that regard our government has done a good job overall.
  • Second, government is responsible for protecting us from each other. This was probably the first function of the first governments several thousand years ago. Population density reached the point that people increasingly had trouble getting along, so a government (probably a tribal leader or council) was given the authority to pass laws. Some of this is pretty obvious. Government passes laws that prohibit killing each other, robbing from each other, assaulting each other, and much more.

People often forget, however, that under this second area of protection, protecting us from each other, government should also protect us from unscrupulous corporations or other organizations that are too large for individuals to combat alone. This means that laws are passed to restrict banking practices to protect our money, limit air pollution for obvious reasons, require regular inspection of airplanes, and allow governmental officials to ensure that factories, mines and other workplaces are as safe as possible. We know from history that without governmental intervention some factory owners will pollute the air and water, will provide unsafe working conditions for employees, will employ children, and will engage in other unscrupulous behavior.

We also know that some areas of regulation are more effective than others. Why?

Well, those folks being regulated often oppose government’s restrictions and, depending on the wealth and influence of that group, may be able to impede or even control the government’s regulations.

A few examples should suffice. Bankers don’t like being restricted, so they form powerful lobby groups to put pressure on the government to minimize regulations.  Coal producers and others that benefit economically from relaxed environmental control may be successful in their attempts to achieve looser regulations. Those standing to profit from the collection of personal internet data may successfully lobby the FCC  and political parties to reverse net neutrality laws on the collection and dissemination of that data.

The best interests of citizens often suffer while powerful groups benefit.

And by the way, for my friends who use such examples to argue in favor of increased state and local control and minimizing the national government’s power, it is no better on the lower levels. Local realtor organizations have a great deal of control over zoning boards and local cities council, and they fight for zoning ordinances that favor realtors. An organization of undertakers likely has control over state laws regarding embalming or other aspects of our burial. State bar associations have control over laws regulating the practice of law, thus protecting the interests of lawyers. You get the idea.

A personal issue for me is workers’ compensation.

On September 8, 2013 my wife, a nurse, was hurt helping move a patient onto a hospital bed. The pain was in her neck and shoulder and by the end of her shift she could not even turn a door knob. That night we went to the emergency department and, of course, they referred her to the work comp doctor.

FYI: Work comp doctors work for the insurance companies not the workers in spite of the Hippocratic Oath.

Without an x-ray, MRI, or CT Scan the doctor diagnosed my wife with a “dislocated rib” and sent her to months of extremely aggressive physical therapy (the therapist was the doctor’s wife, by the way). I actually went with her to PT once after she told me how painful it was. The therapist was twisting her into unnaturally contorted positions, often leading to tears. After these PT sessions she often could not return directly to work because she needed time to compose herself, an accommodation thankfully made by her supervisor. The pain became increasingly worse during the next four months of physical therapy so the work comp doctor finally referred her to another doctor who actually did order an MRI.

As it turns out she NEVER had a dislocated rib. Instead she had two bulging cervical discs (neck) that had actually herniated since the injury, almost certainly caused by the physical therapy. So instead of making her better, the work comp doctor made her much, much worse, and a $150 x-ray could have avoided it. And then after she had the accurate diagnosis (now several months after the injury) the work comp doctor decided the injury WAS NOT WORK RELATED although three other healthcare professionals had witnessed the injury. The doctor dismissed her from treatment.  At this point most injured workers tend to give up, but not my wife.

She had to fight the work comp insurance company to get another opinion. They finally sent her to St. Louis where a miracle occurred; she landed in the office of an ethical work comp doctor who said that not only was the injury work related, she should have had surgery five months earlier. She had surgery shortly thereafter fusing the two damaged discs. After a year one had not fused so she had to have a second surgery. Four years later both are now fused and she has been released by the surgeon.

OK. Other than having an opportunity to vent after watching someone I love suffer since September 8, 2013, knowing she will never again be completely pain free, will forever have a metal plate in her neck, and will never be able to practice bedside nursing (her passion) again, I do have a point. This was not necessary. It should not have happened. By misdiagnosing her injury without even an x-ray the work comp doctor changed the trajectory of our lives. Our lives have now been adversely affected by a workers compensation system that is broken. Why?

To a very large extent the insurance companies determine the laws for work comp, and I can assure you those laws do not always favor the workers.

  • If a worker takes one penny of work comp money that worker cannot bring malpractice claims against the physician regardless of how careless the doctor’s treatment. There is some evidence that doctors choosing to represent insurance companies are not among the best healthcare providers. One must wonder if they choose this medical path BECAUSE they can avoid malpractice suits.
  • The insurance company can reject the conclusion OF THE DOCTOR THEY ASSIGN TO THE CASE! Two years ago my wife’s surgeon said there was no clear evidence of fusion from the second surgery and wanted to keep treating her another year until fusion was clear. Rather than accepting that diagnosis the insurance company sent her to yet another doctor who told them exactly what they wanted to hear (that she was recovered and should be released). Thankfully her surgeon has an impeccable reputation and the company essentially had to reject their second doctor’s faulty conclusion.
  • “Pain and Suffering” are not a consideration in work comp cases. From watching what my wife has gone through the last five years I know that is just wrong.
  • When lawmakers succumb to the influence of insurance company lobbyists  and reduce long-term benefits to workers who are permanently disabled on the job, the taxpayers wind up paying for long-term healthcare for those workers through Medicare or other cost-shifting processes.
  • The system is based on patients giving up and not fighting for the benefits to which they are entitled by law. Most folks who are injured on the job either are unwilling to demand their lawful benefits or simply do not know how. We had to hire an attorney who helped ensure that her rights and benefits were protected.

I could continue because at this point I could write a book on problems with workers’ compensation laws. So what is my point?

Government should protect citizens and work comp is a perfect example of it not doing so. Because of powerful lobbyists protecting insurance companies, a work comp system specifically designed to protect workers often considers workers’ rights as secondary to insurance company profits.

Until we remove money from politics this will not change. We should begin with campaign finance and lobbying reform so that lawmakers care more about the voters than about the corporations that fund their campaigns or take them to dinner.

5 thoughts on “This One is Personal

  1. Our family had a similar experience with workers’ comp. When the insurance company dictates which doctor you must go to, that is a recipe for disaster. I hope things improve for your wife. Health care isn’t healthy for the care giver. Our family member was told that she faked the whole thing to “get” free surgery. Left with 35% use of the dominant hand, this was no act. The best part (note sarcasm) was that her financial compensation was calculated based on current income at the time. She was working for a government agency, and she was making about $13,000 per year, You do the math. Hopefully things will change one day.
    .

  2. I’m so happy this is all finally resolved for you both and so sorry you even had to deal with this. You know how I feel about insurance companies. Hugs to you and Lynette.

  3. David, my wife also had a work related injury approx 10 yrs ago and it was a nightmare at best trying to deal with Workers Compensation. I totally agree with you on this one. The system is broken. We must remove money from politics for it to improve. Campaign finance and Lobbing reform would certainly be a good place to start.

  4. Ralph Nader addresses this sort of topic often on his weekly radio show. I’ve recommended you to the producers of the show and shared this blog post with them.

  5. I am so sorry she has had so much pain and suffering and you watching her. I’m sorry for all you’ve both gone through emotionally and physically.
    Praying she gets better.
    love you

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