Friday, April 9, 2010

The worker’s comp game

Not my spine, but I did have instrumentation like it in there for about 18 months, along with bone grafts at the front of the spine.

Let me tell you something up front—this is a game you never want to have to start playing. It is a merry-go-round from hell if you receive an on-the-job injury that will require ongoing care.

My odyssey began in late April 1989. I’d hurt my back at the previous hospital I’d worked at, but nothing to the point of daily back pain. Actually my knees gave me more trouble back then. I left that job thinking the job at the prison would have been easier. And it was, physically that is.

Like all acute back injuries, a little bit of time, a little bit of physical therapy and you are right back at it. This one was different. The next day the pain radiated down both legs, and I felt like I’d been driven over by a truck. I went to my internal medicine doctor who prescribed me muscle relaxants and a referral to a neurologist. I seriously should not have seen that neurologist. What an arrogant quack!

Unfortunately for me, he’d examined my sister years before he’d examined me. But with her drug-seeking behaviors, he assumed I was just like her, faking or acting out an injury looking for drugs. So he ordered an MRI scan which he claimed showed no reason for my out-of-control back pain. Yes, there might have been a tiny herniation or two, but that wasn’t the problem. This doctor eventually released me back to work because he did not believe I was as crippled as I was.

I then went to the prison’s comp doctor who referred me to the Spinecare Group in Daly City. Up to that time I didn’t even have a diagnosis, a full eight months after the injury.

So for 21 years now, I have been a patient of Dr. James Reynolds. I don’t doctor-shop, I don’t poly-pharmacy, and I don’t supplement my meager pain medication with street drugs, marijuana or heroin. I take only what this ONE doctor prescribes for pain. And I have not been on pain medication continuously for 21 years!

To read one of the worker’s comp reports, you’d think I am a drug abusing faking malingerer who should be out of their hair by now. So, State Fund denied treatment my doctor ordered back in November, and they sent the denial notice so late that the doctor’s office could not file a timely appeal.

Yesterday I got a letter in the mail saying the procedure was denied, and that they would no longer approve the refills of pain pills. The reason for denial was that my doctor did not specifically define what makes me "bad" and what I can do when I am "good" after a rhizotomy. His stating "she is more active and improved after she receives the injections" and "she does not walk very far and has more pain when she needs the injections" is not specific enough for some quack who has never seen me and doesn't have half the surgical skills as Dr. Reynolds.

Mind you, this is a case that was settled back in 1995. You’d think the rules that applied then apply now.

Nope. They write ‘em up as they go. The scheduler at the doctor’s office assured me that this is the usual game of a worker’s comp carrier after the worker’s comp reforms were voted in. Delay delay delay; deny deny deny. Eventually the patient will give up and deal with it in whatever way possible.

I voted for those reforms, because there is much waste and malingering and misuse. But you’d think that three prior spinal surgeries indicates that there was indeed something wrong, and despite “fixing it,” something of that magnitude needs follow-up care.

Back when the case was settled, State Fund offered me $65K to walk away from medical benefits. I did not.

I’m guessing State Fund has to be such a bunch of assholes to a legitimate claim to save face for being so screwed over by Octomom.

At any rate, the doctor’s office was going to call the comp carrier and complain that they did not receive paperwork in a timely manner, and I told the clerk that she could tell the insurance adjuster that I am no longer driving, that I can’t sit at my desk for any length of time because my formerly perfect special chair doesn’t work anymore, and that in the morning the pain is so excruciating I cannot stand straight and walk with a shuffle for about an hour. It takes about 3 hours for my back to loosen up enough to move around like a semi-normal person.

I don’t sleep well; the pain breaks through the medication. And I am not taking anything particularly nasty—Double-strength Vicodin, which does not impair me in any way. It takes the edge off and I accept I will never be pain free.

So the timetable is another doctor’s appointment on May 11, then another THREE months before the comp carrier has to make a decision. UNLESS of course my doctor gets pissed off and calls someone while I am on the premises.

All I need are four little needles stuck into the facet joints on either side of L3-4 and L2-3, and zap the little buggers. I won’t be pain-free, but the nature of the pain will change and I’ll be able to walk the three blocks from the light rail to work, when I am required to work onsite. I’ll be able to take my cats for strolls around the neighborhood. And I might be able to sleep more than an hour or two at a time.

I am beginning to see how desperate people with back pain can become though. I am seriously considering packing it in, giving up trying to get jobs in the Bay Area, and return to crappy rural King City where there will be no jobs for me. I guess the advantage would be is I’d have lots of time to work on novels that may never be sold.

And it really scares me thinking I may be denied pain medication—will I turn to alcohol? Try pot? Or do what killed my sister and sister-in-law—go get stuff off the street? It makes me sick thinking about it, but I am beginning to understand the desperation.


Sabra said...

You, yourself, know why this is happening to you. "I voted for those reforms, because there is much waste and malingering and misuse." And, while I am sympathetic to your plight, I have also worked on the plaintiff's side of WC to know how much of the "malingering and misuse" takes place. Someone - and in your case, State Fund - has to do something. Unfortunately, it will have an effect on people like yourself instead of those malingering and misusing.

It makes me ILL to know that a man I know has a Son-In-Law that "hurt his back" at a prison in Connecticut 20-something years ago. He is as hurt as I am. Which is to say, there is nothing wrong with him. He expected a big settlement and instead receives little weekly checks. He cannot afford to support his family. Does he suck it up and try? Heck, no. That check gets to him on whatever day and he and his drug-addicted wife are off to Foxwoods. Any day now, they're going to hit it big! Sure. Sure they are. [Five kids. All boys. Age 10 to 21. The three oldest? Not one of them is a high-school graduate. Not one of them has a job. Why? Because the world OWES them! That's why.]

My brother worked on a barge in Mississippi. He herniated four dics in his back. Could not sit down. Could not lay down. Could stand. Quit eating because the pain to go to the bathroom was too much to cope with. Could he get taken care of by the WC system? Phuk no. Only the Rocky's of the world - see above - the guy that has scammed the system for twenty-something years - get taken care of.

I understand where you are coming from. But, again, having worked the plaintiff's side of Workers' Comp, I know how easy it is for the system to be misused and for people to malinger.

Good luck.

CaliGirl9 said...

Oh Sabra I agree with everything you said. I worked in worker's comp case management for about 18 months and couldn't stand it. The legit injured people got run-around and I had a hell of a time getting them timely care. I had one client with a back injury who was misdiagnosed because of a poor-quality MRI and he actually had fractures as opposed to "just a strain." He suffered for a year before I could get him to a proper spine doctor. By that time, he had permanent nerve damage. He was in his early 30s.
To contrast, I had another client who claimed a back injury and his main complaint was erectile dysfunction. He was a federal government employee. After a year of getting nowhere with him (he did have mechanical low back pain as a consequence of getting older and deconditioning), I took him to the same physician as the first patient. The diagnosis: diabetes. Not a worker's comp issue at all. Comp had purchased penis pumps, injectables (to get him erect) and they were about to be paying for Viagra.
I hate hearing what is happening for your brother. It's not right.

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