The Workers' Comp. Money Machine

Editor's Note: Below is a reprint of a letter written by Jeffrey Maehr, D.C., to a workers' compensation medical director. Dr. Maehr relates the disturbing practices he encountered working within the workers' compensation system.

October 28, 1991

Dear Dr. Casey:

I am writing this personal letter to you asking for your advice on the workers' compensation program, especially in its implementation in various clinical situations, and from the applicant end of the system.

I have been working with the medical profession directly for over six years, and in workers' compensation for approximately a year. In that time I have been confronted with a dilemma in striving to do my job.

Last June, I had to resign a position with an orthopedic group, headed by a qualified medical examiner (QME), because I was doing my job too well. I got along fine with everyone and still do and hold no grudges. I just have a hard time accepting the "policy" of such places. According to the administrator's own words, "I know this is a game and that 80 percent of these people aren't hurt, but this is a business, and business and "religion" don't mix." I was told that I needed to "embellish" the exam findings and to "play the game." I was even being discouraged from reading the reports which were generated from my exam findings because they often contained false or "creative" additions, and I simply slowed down the system when I sent the report back for correcting.

The patients and the attorneys were also becoming upset at my approach. I was being pressured to definitely rate the patients as permanently disabled or the attorney would not refer patients to our office. The attorney would also dictate when the patient was to be released. Even if I didn't agree, and the patient needed more care, it didn't matter.

Many of the patients wanted a doctor who blindly accepted every word about their "pain and discomfort" even though the exam and tests indicated otherwise. They were uncomfortable because I couldn't hide the fact that I knew they were lying, so they wanted a doctor who "played the game." Many of these patients were coached by their attorneys and told how to perform. That from the "horse's mouth."

Just minutes ago, I answered an ad for a similar position in a multispecialty group. In discussing the position with the doctor and owner of the multiple offices, this time a DC and, by the way, another QME, I was told that my duties would be exactly as in my previous position, and she was interested. I told her that I wanted to do my job and that I had no problem with dealing with people who were injured or sick, even to a minor degree, but to prolong the issue without justification was something I wouldn't do. In elaboration of my concerns, she quickly began to balk and tell me that she didn't think I'd be interested in this position and quickly hung up.

I have a genuine desire to continue this type of work, especially with the medical profession, but I am extremely disappointed in the direction which workers' compensation is being taken by the health and legal community. Is this the standard on which workers' compensation is supposed to be run? Is it merely to support business; i.e., the clinic, the attorney, and the patient, financially? I can't believe that all the clinics out there are simply functioning to make money. But a great many of them are.

How is it that we can allow the system to continue to run this way, with absolutely no incentive for any of the three parties mentioned above to expedite the patient through the system? Vested interests regarding all three parties seem to be continually rewarded as the system exists now. To add this up in dollars, it would reach astronomical proportions. That is nothing more than prostituting my license and being involved in an assembly line process where everyone's position in the office supports the money making machine.

The costs for health care in this country is going through the roof, and unless we address the obvious problems that continue to encourage this parasitic activity, everyone will continue to pay. The only reason it does continue is because carriers are still able to make their margin of profit. So even they aren't motivated to promote changes in the system.

I was recently certified in industrial injury evaluation with the expectation of applying for QME. It has been my hope that with that position I could honestly and ethically perform my job within the system, and do a genuine service. But now I'm not so sure that is what is wanted within the system.

That brings me to why I am writing. I am very interested in your input regarding this issue. With cumulative trauma and stress claims, among others, just now beginning to expand, there is going to be a major failure with the workers' compensation and health care system unless we confront the growing problem here and now.

Can't the workers' compensation system set a precedent which would address this problem in some way? I understand that there would be many financial toes stepped on in the process, but that is only because the toes have become fat and are sticking out where they don't belong. Just seeing the number of ads on television from attorneys and doctors encouraging employees to seek benefits for the slightest reason seems to be a conflict of interest. Then to have no controls on the attorney or clinic in the applicant process can only encourage "money pot," or "money machine" mentality. It's understandable, but it isn't right.

This is not coming from a self-righteous attitude, just a realistic one. Has this county gone so far as to not care that we are allowing such a system to run us?

I am sincerely interested in hearing from you on this issue. You are in a good position to spearhead changes that could change the entire face of the health care system, weeding out the greedy elements of health care and leaving the genuine and sincere practitioners who aren't placing money over integrity, ethics, and what is just plain right.

Thank you for your time.

Jeffrey T. Maehr, D.C.
Pasadena, California