San Bernardino County Goes To Court Against Employees Seeking Treatment After 2015 Terror Attack
We continue our series of reports this week on why many of the San Bernardino County employees who survived the 2015 terror attack at the Inland Regional Center have had to hire lawyers and take on a years-long battle with San Bernardino County government for disability compensation. San Bernardino County has repeatedly denied many of its employees’ compensation claims for physical, psychological and emotional injuries. The following segment - part 3 in our series by KVCR’s Benjamin Purper - begs the question: why is San Bernardino County government resistant to helping its employees who were were affected by the aftermath of the deadly shooting spree by a county employee at a county work event?
Valerie Weber was one of the most severely injured out of everyone who survived the Inland Regional Center attack. She was shot twice by semi-automatic weapons, and spent 93 days in the hospital immediately after the attack.
She’s had multiple, extensive surgeries since then, and she still needs more. But her wounds aren’t just physical; they’re also psychological. Weber suffers from PTSD and depression as a direct result of her experience and injuries.
Weber: “I’ve gone a very long time without therapy. It was like catch-and-release in the first year and a half. I’d get therapy, I’d be happy, then I’d be denied. Then we’d have to fight, I’d get therapy, they would never honor the doctor’s orders, and I was seeing a doctor from workman’s comp.”
Eventually, Weber decided to get a lawyer to help her get the treatment she needed, and the benefits she’s entitled to.
For two years after the incident, Weber received what’s called temporary total disability. That’s income she gets while she’s unable to work.
She says San Bernardino County refused give her an increase in her temporary total disability rate she was entitled to according to a memorandum of understanding, or MOU, with her union. When the issue went to trial, the judge ruled in her favor.
Gary Kaplan, Weber’s lawyer, picks up the story from here.
Kaplan: “The county, with the knowledge of this collective bargaining agreement and knowing that they were required by law to increase the temporary total disability benefits for all of the people that fell within the category, didn’t do it. They refused. So we were actually required to go to trial on the issue, believe it or not.”
Public records of Weber’s case obtained by KVCR show that the judge ruled in her favor, and ended up fining the county of San Bernardino. They ended up paying Weber the full rate.
For Kaplan, this is just another example of how the workers’ comp system is not set up in workers’ best interests.
Kaplan: “It’s not a system designed to provide treatment. It’s not. It’s a system designed to find a way to minimize medical treatment costs and maximize revenue to the carriers.”
Kaplan says utilization review, or UR, limits the amount of care that employers have to provide. He also says the process where utilization review decisions are reviewed and adjudicated, called independent medical or IMR, serves only to uphold UR decisions.
Kaplan: “So the bottom line is, they control your doctors, they control the UR process, and the IMR process is meaningless.”
County spokesman David Wert disagrees. He says he doesn’t believe that survivors have gone without treatment that they need because of any action by the county. He says that out of 3,000 individual treatments requested by the 59 survivors, less than 7 percent of those were denied.
Wert: “The people out there saying utilization review is a bad thing are primarily doctors and workers’ comp attorneys. People who stand to profit by not having their work reviewed.”
Wert says utilization review is there for a reason: to protect patients from inappropriate or excessive treatment.
Wert: “If a patient is undergoing some type of psychological therapy that isn't appropriate for what they're experiencing or if it's not making them any better, but the doctor keeps prescribing it because the doctor is getting paid for every visit, that's when utilization review steps in and goes, hold on a minute, this isn't working.”
I asked Valerie Weber to respond to this argument, that utilization review protects injured workers from inappropriate treatment. Weber tells me a story of how she was on antidepressants which were suddenly denied. If she hadn’t ended up paying for the medication out of pocket, she would’ve had to stop that medication cold-turkey.
Weber: “Once you’re on a psychotropic medication, you can’t just be taken off of it. That’s the time that you’ll commit suicide, or overdose, it’s those kinds of situations – again, I’m not a doctor – but I do know that you’re not allowed to stop cold-turkey. So, now what does the county have to say? How are you protecting me when you’re taking medication away that states, do not, do not, do not stop this medication at any time. You have to be weaned off that medication.”
Weber says she’d like to see legislation to change the way this system works.
Weber: “I’d like legislation to change, especially for catastrophic injuries. I’m not the only person that has been injured to this extent. Some are paraplegics and quads and things of that nature, and I think what the motto of workman’s comp is, is deny them until they go way, away, and a lot of people don’t have the stamina and will and maybe education that I have, and they fall through the cracks and it saddens me very much.”