Five years ago, Jodi Greggs, then a 38-year-old, much-in-demand Licensed Vocational Nurse, went to provide a "standby assist" for a 200-pound patient from his bed to his wheelchair. In making the transition, the patient slipped, and grabbed Jodi’s shoulder for support. That move was the first step in a series that led to profound and irrevocable changes in Jodi’s physical and emotional health.
The state’s workers’ comp system has been an integral part of what Jodi and her family have gone through since that day. It has delivered some help, although not as much as it should, never punctually and rarely willingly: She has gone to court "so many times I’ve lost count" to get the system to provide services it should be delivering routinely.
Yet as bad as the workers comp delivery system is now, if Gov. Arnold Schwarzenegger has his way it will grow far worse, depriving Jodi and tens of thousands of other suffering Californians of relief. The new governor, who spends his time schmoozing at thousand-dollar-a-plate dinners with insurers instead of meeting with ordinary Californians who are in pain, has been cooking up plans that will take away much of the little they have and halt any progress toward making the system work better for the state’s needy.
The Governor’s proposals fill Jodi with both a growing despair and a desire to fight.
Jodi’s story began in San Jose on Nov. 15, 1998. A native of Orange County, Jodi spent 12 years in the San Francisco area, and had moved recently to Sacramento. A sought-after LVN, she was working two jobs and bringing in roughly $4,000 a month.
Like many such injuries, hers didn’t kick in right away, when her patient slipped and grabbed her. "There wasn’t much pain at first," Jodi says. But there was at her next stop, where she began to hurt as she was changing a dressing. "I thought, oh my goodness." But she didn’t make a big deal out of it. "I thought maybe I pulled a muscle."
Jodi did the usual things: She iced her back. She went to Kaiser, whose doctor refused to take X-rays and told her to go home. She waited for her back to get better. Not long after, she tried a chiropractor, but "that didn’t work." The pain intensified, and "I called in the insurance company at that point."
The insurer stalled. Finally, 60 pain-filled days after the initial injury, it approved an MRI and an EMG. The former showed spinal stenosis and a ruptured disk. The latter proved nerve damage.
Jodi scheduled surgery, then discovered she was pregnant. She had thought she couldn’t have children, and regarded the baby as "a little miracle." She postponed the operation, and went through the pregnancy agonizing with back pain.
The back surgery, undertaken after the baby was born, was unsuccessful. Subsequent physical therapy didn’t work either. Jodi, the mother of an infant and in great physical pain, was now 100 percent disabled. Unable to work, she found herself at the mercy of the worker’s comp system.
The most immediate impact was financial. "My financial situation is destroyed," Jodi says. While workers comp is supposed to pay her at two-thirds of her salary, in fact she has gone from bringing home $4000 a month to bringing home less than $2,000. Her husband Walt, a web designer, has had to cut back his work in order to nurse his wife.
"We went from being somewhat affluent to being like being on welfare," Jodi says. "We had a very nice lifestyle. Now, there is not one bill that we are not late on."
Not far behind on the list of aggravations is the tendency of the insurers to "play games," as Jodi puts it. Often this involves bean-counters making medical decisions.
For example, when Jodi got pregnant with her second child, she sought the insurer’s approval to see the pain management specialist who had guided her through her first pregnancy. It took two and a half months to get the OK, and she had to go to court. The specialist prescribed a Class C pain killer that would give Jodi relief while ensuring that her child was not born addicted to drugs. The court also gave the OK to an epidural steroid injection.
But that wasn’t the end of it. The insurance adjuster called both the pharmacy and the surgery center that was to administer the epidural and told them that they couldn’t give her the prescription and the shot, despite the court order, because Jodi was expecting a child. Jodi prevailed, but it was a needless delay, fueled in part, Jodi believes, by the adjuster’s personal animosity toward her.
The subtext was that this particular adjuster was somehow punishing Jodi for having a second child, or silently encouraging her to have an abortion. But Jodi’s religious faith precluded an abortion, and even if it didn’t, she says she felt her child, like the first, was a gift from God. "It was like God was sending me this message," she says, her voice breaking, "giving me something to keep fighting for."
There are countless other frustrations in the way the workers’ comp system is carried out, Jodi says. In her case, for example, they provide day care for one child but not the second. They balk at providing home health care aides, or day care. They make you fight and claw for everything.
There is another toll to be paid for being injured, almost as bad as the injury itself. That is the emotional pain for everyone involved. "This has torn my husband apart emotionally, " Jodi says. "He’s got no life because he has to take care of me. This has been rough on my marriage."
And the children, one of whom is now 4 and the other 5 months? "I’ve got a very active four-year-old whose mother can’t take her to the park, or go down the slides with her, or even get down and play on the floor. She has to take care of me. And she has to know that Mommy’s sick."
Although they show love and support, it’s devastating and "very depressing" to know that you’re putting your loved ones through that.
Workers comp, if it were administered right, could ease some of the burden by providing such things as day care and home health aides, and in countless other ways. Instead the new governor is working on takeaways.
His proposal seeks to deprive patients of the right to choose their doctor. Schwarzenegger also wants to deny workers comp care to anyone who does not have an X-ray to verify the injury. But what if, as in Jodi’s case, the doctor won’t take an X-Ray? That is a huge escape tunnel for insurers.
If the governor’s new bill had been in effect five years ago, "I would have received no benefits," Jodi says.
Jodi would like to see reforms in workers comp and they are not the so-called "reforms" that Schwarzenegger seeks. Jodi would like to see the benefit raised, with no cap so that nobody has to suffer loss of income. She also says the system ought to look at its clients in the context of what the client needs to keep the family intact. That would include more home care and ay care, not less as the governor is proposing.
And finally Jodi would like to see accountability: to see insurers answer to someone so they can be called on the carpet for abuses. She tried to change adjusters, for example, but was told she couldn’t. "I want it to be fair."
Jodi pledges to fight now to hold on to the good things that insurers provide and to fight against givebacks. It isn’t easy because she is still in constant pain, often unable to get out of bed because back spasms cripple her when she tries. "I have my good days and I have my bad days," she says. She is trying to make the most of it.