For three years, doctors and injured workers have been lining up at the state Capitol to tell stories of botched medical care under a workers’ compensation system they say emphasizes cost-cutting over treatment.
Ronald Calvert of Aurora said he had to fight for 6 1/2 years to get the back surgery he needed for one ruptured and three bulging discs, after initially being told he had just a sore tailbone from a fall.
And Dr. Joseph Ramos, now an emergency medicine doctor and surgical instructor at the University of Colorado Health Sciences Center, tells of getting chewed out by a boss at a workers’ comp clinic because Ramos referred a man with a torn anterior cruciate ligament to an orthopedic surgeon.
At issue, they say, is the state’s 16-year-old workers’ compensation system, which gives workers little control over who treats their on-the-job injuries.
For three years, Democratic Rep. Morgan Carroll, a workers’ compensation attorney from Aurora, has been trying to change that. Today, the House is scheduled to debate her latest proposal, which would require employers to give hurt workers a choice between two doctors. It would also let them request a change of doctors at any time within their first 90 days of treatment.
Business groups and companies that provide workers’ compensation insurance have opposed her efforts as solutions to a problem that doesn’t exist.
“The current system … has worked well,” said Elizabeth Starkey, communications manager for Pinnacol Assurance, one of the state’s largest workers’ compensation insurance providers.
“Workers can still make a request to change physicians at any time. And very few do. In our history, less than four-tenths of a percent of our injured workers request a change.”
Carroll’s bill is weaker than past proposals – her first measure would have let hurt workers go to any doctor they chose. Still, Carroll said she is expecting a tough fight.
The current workers’ comp system – which was changed in 1991 in response to skyrocketing insurance premiums – operates somewhat like an HMO. For instance, an employer who buys insurance from Pinnacol sends its workers to a Pinnacol-approved doctor.
Even if you have private health insurance, you are forced to see your employer-approved doctor if you are hurt on the job, Carroll said.
Workers can request a transfer to their personal doctor, but Carroll and other lawyers involved in worker injuries say it is rarely granted.
Tim Fera of Morrison told the House Business Affairs and Labor Committee earlier this month that he petitioned for a new doctor four times in the 18 months before he was authorized to undergo surgery for a spinal injury that threatened paralysis. All requests were denied.
Colorado is one of only nine states that gives the employer complete control of what doctor an injured person sees, according to analysis by legislative council staff. Twenty-six states let employees choose, although in some states they must pick from a list of preferred providers.
Pinnacol and business groups say the Colorado system works, and has helped stabilize insurance rates.
“I think it’s been good for employers as well as injured workers because they have been treated by doctors who deal with industrial injuries, occupational injuries,” said Chuck Berry, president of the Colorado Association of Commerce and Industry and a former lawmaker involved in the 1991 overhaul. “Their whole purpose is to heal that person and get them back to work.”
That, Carroll and Ramos say, is part of the problem.
“For example, someone who is in substantial pain, you typically might give them a handful of narcotic pills” and an anti-inflammatory for a sprain, Ramos said.
In the workers’ comp system, he said, you give anti-inflammatories at only a nonprescription dose or the employee is eligible to miss work.
Ramos said he spent about a year in a workers’ comp clinic. The final straw, he said, was when his supervisor called to tell him he had mishandled a case by sending the man with the torn ACL to have an expensive MRI and surgery on his first visit.
He was told he should have sent the patient home with crutches for a few weeks to see if the injury was bad enough for him to come back.
Carroll said she would like to see broader reforms, but giving workers more choice is a key first step because the doctors who treat injured workers control much more than medical care. They also determine when you have to go back to work and whether you are eligible for follow-up or chronic-care treatment.
“That’s a lot of power in the hands of one person,” she said.
Capitol Bureau chief Jeri Clausing can be reached at 303-954-1555 or jclausing@denverpost.com.
