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The disability dilemma

Three years after Lloyd Wes Vaughan’s on-the-job injury, he has reached a settlement with the city. In many workers’ compensation cases, the struggle lies in who determines the level of disability.
Sunday, November 14, 2004 | 12:00 a.m. CST; updated 6:05 p.m. CDT, Friday, July 18, 2008

Lloyd Wes Vaughan is seldom without a hat, but not because he wants to make a fashion statement. He’s hiding the hole in his head.

Vaughan is a former maintenance mechanic for the city of Columbia. On Aug. 8, 2000, he was replacing a cracked window on a transformer at Columbia’s Wastewater Treatment Plant on Gillespie Bridge Road when a current surged through the electrical system. Vaughan touched the steel frame on the transformer box, and nearly 14,000 volts of electricity ran through his body, exited out his skull and left the indelible half-dollar-sized souvenir in his head.

Vaughan has not worked since the accident and now uses a wheelchair. Weak and in pain, he struggles to carry out routine chores such as washing dishes or doing laundry.

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“Sometimes I just go outside and scream,” he said. “Sounds pretty crazy, doesn’t it? But it feels good.”

After the accident, Vaughan reported his injury to the city of Columbia and filed a claim with the Missouri Division of Workers’ Compensation, which provides medical care and benefits to injured workers.

Vaughan trusted the workers’ compensation system and the city of Columbia as his employer to take care of him, but he soon found himself enmeshed in a system that is stacked against severely injured employees.

Under Missouri’s system, the employer chooses which doctors and medical facilities are used to treat the injured employee. There are only a dozen other states, including Kansas and Iowa, that don’t give workers the right to choose their physicians.

Columbia attorney Scott Wilson, who handles workers’ compensation cases, said the employer’s power to direct the health-care decisions of injured workers skews the system against them. Employers, he said, “are able to send the patient to their doctors, perhaps with a little wink-wink and nod-nod, for another opinion.”

In Vaughan’s case, the health-care decisions were up to the city’s risk-management department and its third-party claims administrator, Corporate Claims Management Inc.

Vaughan was initially evaluated at University Hospital and then referred to Rusk Rehabilitation Center, which specializes in rheumatic illnesses and brain traumas, including electrical injuries. The physicians there declared Vaughan permanently and totally disabled in spring 2001.

In other words, he would not be able to work again.

Although Vaughan’s doctors decided he was permanently and totally disabled, the city and its claims representative didn’t agree.

Sarah Perry, who administers the city’s risk management department, said no city worker has ever been compensated for being permanently and totally disabled. Statewide, only 18 cases of 143,244 injuries reported to the Division of Workers’ Compensation in 2003 resulted in decisions that the workers were permanently and totally disabled.

The workers’ compensation system is designed to resolve disputes between employees and employers about on-the-job injuries, but the stakes become higher with more serious injuries.

“Overall, the difficult part is with employees who have significant injuries,” said Columbia attorney Tim Harlan, a former state representative with experience in insurance issues. “If the injury is something simple that can be cured with a few trips to the doctor,” he said, the system “works fine. But if the treatment goes for six months or a year or longer, that’s a different story.”

Harlan said that if an injured worker is still experiencing pain several months after the injury occurred, the insurance company or employer often will deny authorization for any further treatment to avoid having to pay for additional treatment out of their pockets.

“You have to remember that the insurance companies aren’t there to help people,” Harlan said. “Their first question always is ‘How much does it cost?’”

Deterioration ongoing

The accident left Vaughan with second-degree burns along the right side of his body, a third-degree burn on his head and a deep puncture wound in his skull. In the weeks that followed, doctors said his short-term memory began to fail, turning trips to the grocery store into unplanned visits to his mother. Vaughan’s cognitive processes also weakened, making it difficult to connect ideas and concepts. Following the storyline of a TV show or reading a newspaper became nearly impossible.

He suffered from occasional seizures and frequent debilitating headaches that were intensified by light. Once known for his physical strength, Vaughan struggled to lift a brick or a jug of milk.

Vaughan’s initial physician, Boyd Terry, director of the burn unit at University Hospital, said Vaughan’s slow but steady deterioration is typical of electrical injuries.

“As the effects of electricity slowly express themselves in the body, the damage spreads, too,” Terry said. “Not all problems manifest themselves at once.”

At Rusk Rehabilitation Center, Vaughan underwent physical and pharmacological therapy. He was prescribed a pill for his pain, one for his anxiety, another to help him sleep. He also was treated for depression and started seeing a psychologist.

“It was so bad that one night, I had a shotgun loaded, sitting on the table,” he recalled. “I was going to blow my head off. I looked in the living room and saw my Bible sitting on the coffee table. That was the only thing that kept me from blowing my head off that day.”

He found the side effects of the veritable cocktail of drugs he was taking to be intolerable. Vaughan began to fear the medicine — and his doctors. He stopped taking his medication and missed several doctor appointments.

After he failed to attend a stop-smoking seminar recommended by the city’s case manager, his benefits were cut off, the city contending that Vaughan had failed to comply with his treatment.

Terry objected to the decision, and in a handwritten letter to Corporate Claims case worker Rose Miller, said that while smoking is inarguably an unhealthy habit, it has no impact on how someone recovers from an electrical injury.

Eventually, Vaughan’s attorney, Mark Pfeiffer, persuaded his client to return to physician Jon Rupright at Rusk, and Vaughan’s benefits were reinstated. But the patient’s long-term outlook remained bleak.

In spring 2001, several months after the accident, Rupright and Pfeiffer met with the city’s risk manager, Sarah Perry, and a Corporate Claims representative to determine how Vaughan’s medical care was progressing. Pfeiffer recalls that the meeting was going well until Rupright said Vaughan could be rehabilitated to function somewhat independently, but would probably never be employed again, in any line of work.

Boyd Terry, Vaughan’s physician at University Hospital, shared that opinion.

In August 2001, Vaughan showed up at Rusk Rehabilitation, barely able to stand on his own. Rupright wanted to admit Vaughan, but was denied authorization by the city’s claims representative. Rupright was told that if Vaughan needed to be hospitalized, he would have to go to Boone Hospital where Rupright did not have privileges to practice. For follow-up care, the city and Corporate Claims referred Vaughan to doctors in St. Louis.

Perry said she doesn’t know why the sudden switch occurred because the decision was made by the city’s claims administrator. She refused to discuss Vaughan’s case in any detail, and Miller did not return phone calls.

Doctors “handpicked”

One of Vaughan’s new doctors was David Peeples at St. Luke’s Hospital in St. Louis.

According to a Missouri Department of Industrial Relations database, Peeples has testified in nearly 50 workers’ compensation cases over the past decade in which the rulings of an administrative law judge were challenged. In a dozen of those cases, and often on the basis of a single examination, Peeples offered the opinion that the injury was not work-related. Peeples acknowledged that work-related injuries had caused severe impairment in only three cases. He declined to be interviewed.

Vaughan felt Peeples and the other second-choice doctors didn’t believe that his injury was as severe as Rupright and Terry had determined.

The city and its representatives “chose excellent doctors to treat Lloyd in Columbia, and those doctors had a treatment plan,” Pfeiffer said. “But once those doctors told the city that they believed their job was to improve his quality of life, and they would never get him back to work, they were, coincidentally, fired by the city and replaced with doctors in St. Louis who, coincidentally, didn’t believe Lloyd’s injuries were very severe.”

Truman Allen, a former administrative law judge who used to preside over workers’ compensation disputes, said decisions made by employers and claims administrators to suddenly switch doctors are defended as simply an opportunity to get a second opinion on an injury. He said referring injured workers to specialists in St. Louis or Kansas City is a common tactic.

“But what the employers leave out is that the specialist is hand-picked to not find a severe injury or causation, if any, between the job and the injury,” Allen said. “For the doctor to go against” the employer or insurance company “would be the surest way to not get referrals from the employers. Not all employers do it, but enough do that it’s a real problem.”

Tammy Cavender, spokeswoman for Missouri Department of Labor and Industrial Relations, noted that workers do have a right to seek their choice of doctors at their own expense. “The department rarely receives complaints of doctor shopping and wouldn’t investigate if a complaint was received since it’s not a crime in Missouri,” she said.

Joel Jeffries is a Columbia physician who has had many patients involved in the workers’ compensation system. He said he has been approached by employers, case managers, nurses and lawyers with the implicit request to lean their way with his diagnosis of injured workers.

“There are medical prostitutes on both sides,” Jeffries said. “I decline the invitation to change what I believe is medically right. I tell them I’m not going to go there.”

Letting employers decide on physicians is fundamentally demeaning to the relationship between doctors and their patients, Jeffries said, adding that getting patients to trust a doctor they would choose for themselves is a challenge in itself. Getting a patient to have faith in a treatment provider that an employer handpicks, he said, is even more difficult.

“If patients trust me on every level, they believe the care they receive is in their best interest,” Jeffries said. “Whereas sometimes the relationship they have with their employer is either absent or adversarial.”

Allen, who now represents injured workers, said the workers’ compensation system is least effective in cases that involve serious injuries. “It’s not greed that sends claimants to my office,” he said. “It’s need.”

Circuit Court judge Chris Kelly said he saw both sides veer from the medical truth during his tenure as chairman of the Labor and Industrial Relations Commission.

“We should strive for doctors who are known for producing objective medical evaluation,” Kelly said. “A good change would be if the evaluation of the patient were made by a doctor chosen by the administrative law judge. It would be cheaper and more objective.”

For the most part, Kelly said, letting employers decide on treating physicians is “not a terrible handicap for the system.” The problem, he said, is that when employers hire outside groups to handle workers’ compensation cases, the interest of the individual employee can be compromised.

“The interests are focused on how to hold down costs,” Kelly said. “When the employers aren’t the decision maker, they aren’t burdened with the need to look at the injured worker as a person. They are looked at as an economic calculation.”

Malingerers are the minority

Employers need to be protected from workers trying to manipulate the system in their favor, but the Missouri Department of Labor and Industrial Relations said malingerers aren’t much of a problem.

The city deals with “the occasional malingerer,” Perry said, “but they are in the minority. Our workers — most are honest and work with the city and doctors to get back to work as soon as possible, if possible. Most are good folk.”

Although he displays it with hesitant pride, Vaughan has proof that the city once thought he was one of the “good folk.” It’s a plaque, presented in April 2000, honoring him for being the Columbia Regional Wastewater Treatment Plant Employee of the Year.

“I got the award and a pat on the back,” Vaughan said. “But once the accident happened,” he said, the city didn’t care “if I was dead or alive. They didn’t know me.”

As Vaughan’s case moved toward a hearing with an administrative law judge in the Division of Workers’ Compensation, it began to seem to him that the city wasn’t acting in his best interests.

Rick Montgomery, a private attorney for the city, notified Vaughan’s lawyer in June 2002 that the city was in the process of scheduling a vocational rehabilitation assessment. When Pfeiffer proposed that the assessment be performed by Gary Weimholt, a vocational rehabilitation consultant in Jefferson City, the city balked. In a letter to Pfeiffer, Montgomery complained that Weimholt had never testified on behalf of employers or insurers.

Pfeiffer’s response to Montgomery pointed out that, not only had Weimholt testified on behalf of employers on numerous occasions, he had testified on behalf of the city of Columbia — and had actually been used by Montgomery’s law firm.

Without the city’s blessing, Weimholt evaluated Vaughan in September 2002 and determined that he was permanently and totally disabled. The city declined to share the cost of the specialist’s services. .

Pfeiffer requested a hearing on Nov. 19, 2002, but Montgomery objected, saying he was not ready. The two attorneys agreed to a Dec. 12 hearing, but because the parties had previously engaged in an informal mediation with the administrative law judge, the city’s attorney asked that the judge excuse himself from the case. Another hearing was set for Jan. 24 of the following year, but was again cancelled due to scheduling conflicts.

At Boyd Terry’s deposition in December 2002, Montgomery suggested that Vaughan’s disability was attributed to past alcohol and drug use or his family’s history of mental illness and alcoholism.

On the new date of the final hearing, in February 2003, the involved parties met. Vaughan and Pfeiffer decided to settle out of court; the city required that the amount of the settlement be kept confidential.

Vaughan could now choose his own doctors and hospitals, and he hoped to put the legal hassles behind him.

“Honestly,” Vaughan said, the amount of the settlement “is a slap in the face. But it sure beat them slapping me more like they’ve done since it all started. Two and a half years of this drove me crazy, and it was a lot more trouble than it was worth.”


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