Violating 'Comp' Policy?
City Tries to Limit Disabled Doctor Visits

By GINGER ADAMS OTIS

More than a dozen retired Emergency Medical Service employees who receive Workers' Compensation benefits from the city have gotten letters from the Law Department limiting the number of doctors' visits they can make each month.

PATRICK J. BAHNKEN: 'Morally reprehensible.'

The letters authorize the EMS workers, all of whom retired after suffering debilitating on-the-job injuries - two of them on Sept. 11 - to seek "symptomatic treatment (1-2 times per month)."

Broader Definition

But according to the definition provided by the state Workers' Compensation Board, symptomatic treatment is defined as medical care "as needed" to treat symptoms.

Jon Sullivan, a spokesman for the state board, urged any workers who felt they were being denied medical care that they were owed as part of their Workers' Compensation settlement to contact his agency's Worker Advocacy hotline.

He stopped short of saying that the city was breaking the law by setting a monthly cap on medical visits.

"At times insurance carriers seek to limit treatments to keep costs down," he said. "The board does not share their interpretation of their ability to do so."

CAUGHT IN THE SYSTEM: Richard McAllan (left) and William Dahl are among the former Emergency Medical Service workers who take issue with the city's attempt to restrict them to no more than two visits a month for treatment of their disabilities. Mr. Dahl asked, 'What am I supposed to do for the rest of the month - choke?'

Workers can appeal treatment denials to an Administrative Law Judge at a Workers' Compensation hearing, he said, but results are specific to the instances being grieved. The judge has no ability to compel a change in policy, meaning workers would have to grieve their claim for treatment every time they feel it's wrongly denied.

City Not Talking

Because of medical privacy regulations, the Law Department declined to comment on the letters it sent to the EMS workers. A spokeswoman also declined to speak generally about its policy regarding symptomatic treatment.

But statements made by a Law Department official at a court hearing involving retired Paramedic Richard McAllan revealed details of the department's approach.

Mr. McAllan, who has sued the city for infringing on his First Amendment rights, alleged that the city was denying him medical treatment that he was legally entitled to by his Workers' Compensation award in retaliation for his previous suits.

He brought his argument to U.S. District Court in Manhattan this summer (a decision is pending).

Mr. McAllan, as part of a Feb. 17, 2005 decision from the state Workers' Compensation Board that his on-the-job back injury was a "permanent partial disability," was granted permission to seek "symptomatic treatment."

According to court documents submitted by Mr. McAllan, the city refused to pay his chiropractor for treatments given to him on March 7, 12, 14, 19 and 23, April 9, 11, and 16, and May 14, 18 and 24 last year.

'Questioned the Need'

The Law Department sent his chiropractor a letter stating that the dates of service were denied "because we questioned the need and frequency of the treatment."

It continued, "Please be advised that Mr. McAllan was authorized for symptomatic treatment per hearing held 12/17/05. Symptomatic treatment is not an authorization for treatment twice a week. ... Dates of service that were denied must be referred to the New York Workers' Compensation Board for arbitration." During those hearings Mindy Roller, Deputy Chief of the Law Department's Workers' Compensation Division, offered a statement to the judge about how the department viewed symptomatic treatment.

After reiterating the facts of Mr. McAllan's case, including his Workers' Compensation award and permission to seek symptomatic treatment, Ms. Roller pointed out that "there is no specific frequency of treatment ordered in the WCB decision. However, the term 'symptomatic treatment' is a term of art frequently utilized in WCB decisions. ... [It] is generally understood by judges, attorneys and medical providers ... to mean medical treatment once or twice a month."

Challenge If More

She said that "in the ordinary course of business, the Workers' Compensation Division will challenge any claims for symptomatic treatment that occur more than one or two times a month."

Ms. Roller also stated that "the general policy of the Workers' Compensation Division is to question excessive treatment by medical providers where only symptomatic treatment has been authorized by the WCB. The city's decision ... was in complete compliance with the WCB's determination."

Leonard Schwade, a retired EMS worker who moved to South Carolina in August 2005, said he's had problems getting treatment from doctors who fear they won't get paid by the city. Although he had not sought symptomatic treatment for his disability - a nerve disorder known as Reflex Sympathetic Dystrophy - for several weeks, he too got a letter from the Law Department telling him he was only authorized for one or two visits a month.

While his symptoms have been in abeyance recently, he worries about the future.

Worst Kind of Side-Effect

RSD, a known potential side-effect of some surgeries, involves the body's mechanism for pain recognition. It upsets perception down the damaged nerve, setting off intractable pain that's often worse than the original injury. Over time RSD can spread as other nerves in the body's "sympathetic" central nervous system get affected.

Mr. Schwade had an electronic sensor similar to a pacemaker implanted in the vertebrae of his neck - it sends pulses through his arm that block the pain signals being sent to his brain.

The doctor that provides his regular medical care - not symptomatic treatment - is in New York and Mr. Schwade travels to see him. After eight surgeries and a bout of meningitis that almost killed him, his condition is fairly stable, but he has two doctors in South Carolina.

"The only problem is the city hasn't paid them since last year. I complained to the state, they got involved and I sent them all the bills," Mr. Schwade said. "The city said it had paid them, and now they just won't answer my queries. So doctors don't want to treat me, because they know they aren't going to get paid."

Trouble Being Seen

He goes to the chiropractor a few times a month and has a pain management specialist who refused at first to see him without approval from the city. Mr. Schwade got it, but because the city hasn't paid the doctor's bills, he has difficulty getting appointments.

"I worry about what would happen if I needed another implant, or the pain increased or some of the worse symptoms return," he said. "If I can't get treatment for something that's approved because doctors don't get paid, they certainly aren't going to give me symptomatic treatment the city has said it won't approve."

Retired EMS worker William Dahl, who was approved for a 9/11-related Workers' Compensation disability after developing severe respiratory problems in the wake of the disaster, has been waiting since Oct. 21 for approval of a scan to see if the nodes on his lungs have grown in the past year.

'City Won't Respond'

"It's fairly routine; my doctor told me, 'It's time for another lung scan to see what's going on,' and I can't get them to respond to his authorization request," said Mr. Dahl. He also got a letter telling him any symptomatic treatments would have to be limited to two times a month.

"I haven't needed that yet - I'm more worried about getting my regular medical care approved right now," he said.

But if his breathing were to worsen, for example, and he needed to see a pulmonologist to address the flare-up, Mr. Dahl worried that twice a month wouldn't be enough. "What am I supposed to do for the rest of the month - choke?" he asked.

Mr. Dahl learned last week that clearance for his lung scan had been denied. "The supervisor told me, it was a diagnostic test, and I was only authorized by the comp judge for symptomatic treatment," he said.

May Hold Hearing

City Councilman Joseph P. Addabbo Jr., who chairs the Civil Service and Labor Committee, said he was considering holding a hearing on the issue of symptomatic treatment.

DC 37 Local 2507 President Patrick V. Bahnken, who represents EMTs and Paramedics, encouraged retired and active EMS workers to arbitrate any problems they had with the Workers' Compensation system. He said the city had the right to challenge any invoice it felt was unauthorized, but said it would "lose a lot of money" if workers challenged them in return.

At the same time, he noted, the byzantine Workers' Compensation system was often too much for injured or ill people to tackle.

"I have no doubt that the Law Department can find the legal logic it needs to make sick people crawl across the grass on their hands and knees," he commented. "That doesn't mean it's not morally reprehensible."