Friday, October 31, 2014

Not Ready to Die

Regular readers of this blog know that Mom is 90, has moderate stage dementia, and lives in a very nice memory care facility.

Fortunately because I'm the boss, I get to visit Mom a couple of times per week.

And it's my duty, really, since I'm trustee and Dad entrusted me with making sure Mom is well taken care of after his death.

A few weeks ago I got a call from the lead nurse at Mom's facility seeking authorization to send Mom to the hospital. In a rapid turn of events, Mom had developed pneumonia, nearly overnight.

At 90 years of age, pneumonia is usually fatal - the frail immune system of someone that age generally is not able to overcome such an attack.

I authorized transportation to the local hospital (an excellent facility by the way, just a few miles from Mom's residence) via ambulance, where she was admitted and promptly treated.

I had visited Mom at the hospital the next day. Mom looked terrible. She was clearly weak, on oxygen, tubes and wires all over her ... but she had Mom spirit. When she saw me she raised her weak arm to wave me into the room and smiled pleasingly.
Mom - radiant!

The charge nurse gave me her status and treatment plan. She also advised that they had ALREADY begun various therapies: rehabilitative, occupational, pneumatic, etc. I was surprised at the early intervention of therapeutic modalities but the nurse explained that it was important for a quick recovery, particularly with elderly people.

She was released from the hospital after only two nights. I thought after the next visit with Mom at her residence following hospital release that The Time was near. Mom was in a wheelchair, on oxygen, coughing up phlegm, her lungs still sounding under water, eating a pureed diet.

The head nurse at Mom's residence advised that they would be particularly aggressive with therapies, and would have her walking shortly and off oxygen in a few day. I was skeptical, but hopeful.

All of this happened about a month ago.

Yesterday, however, Mom looked and sounded wonderful, back to her "normal" pre-pneumonia dementia-based life: no coughing, no phlegm, no oxygen, regular food and appetite, good color in her skin, and back up to "normal" ambulatory status (with a walker).

I was completely astounded that not only did she beat pneumonia at age 90, when most people would have died, but that her recovery was so complete and quick.

I'm convinced that this miraculous event was due mostly from prompt and proper medical response.

The staff at her residence noted immediately disease symptoms, and nearly as immediately sought and obtained medical intervention.

The hospital not only treated the pneumonia, but introduced immediately therapeutic modalities for early rehabilitation.

You know why this happened? Because I was the Utilization Review authority with the responsibility and obligation to ensure prompt medical attention within the authority provided by estate documents - the requests were not subject to secondary review, were not subject to additional layers of decision adjustment, were not part of a financial process.

There were no perverse motivations interfering with my decision making process.

Unlike workers' compensation, where the "no fault" doctrine has been perverted to "no responsibility" through years of "reform" agendas perpetrated by vendors (and I use that term broadly to include carriers, TPAs, physicians, attorneys, bill review, utilization review, etc.) rather than the only original parties to the "no fault" bargaining table: employers and their workers.

Workers' compensation CAN perform similarly to how Mom got her treatment - but all of the vendors need to get off the trough and frankly the only way to make that happen is to remove them from the "no fault" protection of comp.

Mom got well because people were responsible. She wasn't ready to die yet.

I appreciate that.


  1. We have to love our mama's, my relationship with my mother has suffered because she and her heart can not take me fighting city hall/workers comp, who she feels I will never win. Putting me and my family at risk. Im obsessed with comp and justice, not just for my self, but for all.... my mother endured my Step Fathers fight for 9 years 35 years ago now, and so she can't take me fighting it now.. I try and tell her it is like slavery years ago. Just because that is the way things are, does not mean that some one did not have to stand up and fight back against the oppression. If not for the folks who ran the under ground rail road ect.... things would have never changed.

    So we have not communicated for at least a year now. Do to my fight with workers comp.

    Cherish every moment you have with your MOM, that is more valuable than any thing ells in this world. Peace

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  6. 1 of 3 comments: David, I'm so glad that you mom is well and survived the illness. You are right to say that her medical treatment was not subject to all sorts of approvals and reviews. That is why she mended quickly. I’m happy for her and you.
    It is true that many injured workers are delayed or denied care due to UR and other “vendors” / profit centers. Some injured workers are maimed by the "network of medical providers". I was maimed likely, for many reasons including, retaliation, to create the look of several conditions, to transfer me off the books of the WC insurance carrier and onto social services. I’m still attempting to get SSDI as I have been denied twice due to obstacles in getting evidence of what has been done to my body. One attorney told me that the defense cannot allow me to get evidence of what they did to me. One Doctor said to me, “I’m not here to help you gather evidence of what they did to you, I’m here to help you. He then refused to see me after that unless it was out of the WC system as an expert witness, which I have no money to pay him. Thus, they have the upper hand, because I have no income, I cannot work, and the medi-cal Doctors that I go to outside of the workers comp system appear to be working together with the WC folks to deny me the ability to get legitimate evidence of the damage done to me. One WC insurance investigator showed up at the Doctors office. I recognized her immediately. She had NO business interfering with my attempt to get treatment outside of WC. There is much more on my seeking medical treatment, but I will refrain.
    The corruption in the workers comp system has been going on for years. It is pervasive. UR and many other obstacles, delays and denials are not the only problem. No fault is a huge problem. Injured workers have turned to law enforcement time and time again yet, they get no help, no investigation, no recourse for the crimes committed against them.
    I am convinced that a mandated disclosure to injured workers that warns them of the corruption and criminal activity that may befall them is absolutely needed. I SHOULD HAVE BEEN WARNED! Had I been warned, I would have known right from the beginning that I was a target for maiming as the first physical therapist that I was sent to, intentionally maimed my left lower lumbar within the first 15 minutes of my session with him. I was there for physical therapy for the initial injury to my right lower lumbar and middle of my back. He was an owner / partner in the facility & he participated in a criminal act of maiming an injured worker to start the “look of a condition”. Even the defense attorney points out in a letter to the first attorney that I signed with, in an effort to imbue my attorney to advise me to settle, that The applicant doesn’t seem to be benefiting from the treatment, in fact, it looks like the treatment from both the physicians seems to be harming rather than helping the applicant. The letter was written in August 2012, the “network Doctor” who was maiming me at all 3 epidurals, hadn’t begun his maiming of me yet as the first epidural procedure didn’t take place until November 9, 2012. The “harm” mentioned in his letter to my then attorney, was facilitated by the first physical therapist and a massage therapist. All of which are a part of the “network”. As soon as I read the letter, I knew that it was a vailed threat! Knowing what I know today, about injured workers getting treatment that actually makes them worse, knowing that many and likely all applicant attorneys are aware of these and other potential hazards, and the fact that I told the representative in the law firm that I signed with that I had been deliberately hurt by the first physical therapist, I ask the question, WHY WASN’T I WARNED?

  7. 2 of 3 comments: Why aren’t injured workers warned that they could potentially be targeted for maiming and many other crimes that include false documenting of medical issues, false medical reports, falsely designing medical reports to reflect a “condition”, altering of documents over and above the injured workers signature? I spoke to a attorney recently (last couple of months), I told him as much as I could while sitting in his office, about what has happened to me, being forced under anesthesia, maimed over and over again, he said, "Sometimes that happens." I asked him to help put together a mandated disclosure for all CA injured workers (and hopefully it will grow to a nationwide mandated disclosure) so that they could be made aware of the crimes of maiming, falsifying of medical reports, documents altered over and above the injured workers signature, false information that is geared or designed to show a pre-existing condition that in fact the medical provider's create along the way as they continue to maim the injured worker. His response was, "We have enough trouble trying to get our clients medical treatment." Medical treatment? Many injured workers are lured into medical treatments and are actually being made worse. Injured workers have a right to know.
    Can you tell me why our government does not STOP these crimes against injured workers? Why have injured workers sought out help through law enforcement for many, many years but to NO AVAIL. I have contacted police to file complaints against the Doctors and surgery centers who have committed crimes of maiming. Many of us injured workers have contacted District Attorney’s offices, government officials, I have contacted Governor Jerry Brown, news stations, TV shows, CA Workers Compensation Appeals Board and much more. A scheduled mandatory settlement conference that I was denied a request to have “taken off calendar”, I wrote to & told Judge Nelson of only some of what I have been through. She denied the TOC request. When I met her at the MSC, I again tried to explain to her some of what has happened. She asked no questions pertaining to the medical battery and contrary to my request, she ruled that my case must go to trial. I have no attorney.

  8. 3 of 3 comments: Could it be that my most recent attorney was correct? He told me that the legislators have been bought! Is that why he was not willing to “work” my case. He only wanted to settle. He did not want to include the heinous acts of maiming my person. The “Legislators have been bought” comment initially didn’t sound right to me. Certainly, that could be the case. Another professional in the industry told me in so many words to reflect on that. So, I have. The President of the workers comp insurance carrier in my case was the Chief Executive Officer of The Fund (Nevada) from 1995 to 1999 and its Chief Financial Officer from 1993 to 1995. Prior to joining The Fund, he served in senior insurance regulatory positions and as an advisor to the Nevada Governor’s Office. The defense attorney in my case, used to work as State Compensation Insurance Fund as an Adjuster, Hearing Rep., Staff Counsel, and Deputy Chief Counsel before becoming Chief Counsel for State Compensation Insurance Fund’s entire Legal Department. Correct me if I’m wrong but these are people that have worked with government officials and/or government agencies.
    Money SHOULD NOT be the deciding factor in medical care of any kind if and when the medical care is necessary. The No Fault system is only a protective measure for those willing to commit crimes against injured workers. I refuse to believe that there is no recourse for the defense in connection with the crimes that they have facilitated against me. I will do all I can to get justice for myself and to spread awareness of the heinous acts perpetrated against injured workers that have become so commonplace, that even applicant attorney’s feel that getting any treatment is more important than warning injured workers of the crimes that may befall them!