This new page came about as the result of an LA RSI member writing the following letter:

"I am tired of feeling as if I AM a willing victim. Attached you will find a letter of complaint about the Q.M.E. that I sent to The California Industrial Medical Council and also to the physician licensing board. Feel free to distribute it to the network as a draft for other people to adopt as they see fit. I believe it will not be until we make our voice heard to the Legislature, the licensing board, The California Industrial Medical Council, the division of insurance, and the governor that we will make much progress.
    There is a second motive to my madness. My attorneys have told me that I will be sent back to the same Q.M.E. If I have filed a complaint against him, it would be a conflict of interest for him to see me and review me again. Hopefully, I will be able to get someone more honest.
    What you think about a place on our web site called fighting back? We all could send sample letters. This would make it easier to write complaint letters to various parties. The names of the doctors, adjusters, etc. could be x'd out."

She then wrote this letter to The California Industrial Medical Council:

February 8, 2001

MY ADDRESS

The California Industrial Medical Council

Dear Council:

I wish to bring to your attention what appears to be questionable practice by one of your QMEs - Dr. James J. XXXXX, orthopedic surgeon, of XXXXX, Brea. At the request of RSKco, a Workers Comp carrier, Dr. XXXXX performed a qualified medical examination with review of medical records on October 14, 1999.
    I am a Harvard Ph.D. and former CEO. My work injury includes bilateral carpal tunnel, bilateral ulnar neuropathy, herniated cervical discs, and probable thoracic outlet syndrome. The insurance carrier, RSKco, sent me on a long drive past many other QMEs to Dr. XXXXX.
    Dr. XXXXX used trick questions in his exam, turning lack of pain with "give a little cough" into "coughing does not cause pain." (My medical records document a history of seeking care for coughing that nearly tears my head and neck apart.) Dr. XXXXX cited as pre-existing orthopedic problems, symptoms taken out of their medical record context. Thus shooting back pains during flu became a pre-existing orthopedic problem. Thus, twitching limbs on hospitalization for dehydration became a pre-existing orthopedic problem. In addition, his written recommendation that I wear cock-up splints for computer keyboard work is inconsistent with the RSI medical literature, which warns this may cause further nerve damage.)
    I would hope that a QME, no matter which side he represented, would interpret rather than rewrite the medical record and findings. I do not believe this happened in my case. I would be happy to provide documentation and look forward to your response.

Sincerely,
XXXXX.

cc: Medical Board of California, Central Complaint Unit
1426 Howe Avenue, Suite 54, Sacramento, CA 95825-3236

NOTE: The California Industrial Medical Council is on-line at www.dir.ca.gov/IMC/imchp.html. Here's an excerpt from their FAQ:

1. How should I complain about a QME?

Any complaints should either be put in writing and sent to the IMC (attention Legal Unit) or you can make an anonymous complaint by calling our hotline at (800) 999-1041. We prefer that you give us your name and address or phone number so that we can reach you if we have a question.


POSSIBLE ACTIONS FOR RSI DAY, February 28 or for any day throughout the year - for any time you start to feel like a victim and want to FIGHT BACK!

A. Federal OSHA's Ergonomics Standard

Call the field reps at the local offices of Senators Dianne Feinstein and Barbara Boxer, as well as your local representatives, to (a) ask for a brief appointment to visit them on International RSI Awareness Day, 2/28/2001 [this plan is preferable]; or (b) write letters to thank them for their support of the ergonomics regulation (if applicable), or urge them to ensure that the OSHA standard is allowed to be retained. (For transcripts of Senate and House debates, and information on where your representative stood, see http://www.nycosh.org/sen_erg1.html; http://www.nycosh.org/sen_erg2.html; and http://www.nycosh.org/Update7_Oct-Dec_2000.html#anchor353910.) The AFL-CIO's update on possible scenarios is particularly chilling, and we need to do everything we can to retain the standard:

Senator Mike Enzi (R-WY) issued a press release on February 13 announcing that he plans to work closely with a group of his colleagues in the coming weeks to strike a "last minute" Clinton Administration rule on ergonomics which became effective on January 16. Enzi claimed that the ergonomics standard would "hurt workers and consumers alike by paralyzing businesses across the country and causing dramatic price hikes for goods and services." Enzi chairs the Senate subcommittee that has oversight over OSHA.

Opponents of the standard, led by the Chamber of Commerce, want Enzi and their other friends in Congress to use the Congressional Review Act (CRA) to rescind the standard. The CRA is the nuclear bomb of deregulation. Under this law, Congress can act to overturn issued rules. Under the CRA's streamlined procedures, a resolution to disapprove a rule can't be amended or filibustered and there is no provision for input from affected workers. If a rule is overturned and repealed, the agency is prohibited from issuing another similar rule unless Congress gives special permission. This would make it almost impossible for OSHA ever to set a strong standard to protect workers from ergonomic hazards, which are the nation's biggest job safety problem. Hundreds of thousands of workers would be needlessly injured and crippled each year.

Tell your representatives your stories and stress that workers need and deserve these protections to prevent crippling workplace injuries. Ask them to support the OSHA ergonomics standard and to oppose any attempts to take away this important worker protection. A copy of the standard and background information can be found on OSHA's website at www.osha.gov. Sample letters to members of Congress and a directory of representatives can be found at the NYCOSH web site, at http://www.nycosh.org/Update7_Oct-Dec_2000.html#anchor219558.

B. Workers' Comp Legislation, State of California

Call the field reps at the local offices of your state senators and Assembly members to (a) ask for a brief appointment to visit them on International RSI Awareness Day, 2/28/2001 [this plan is preferable]; or (b) write letters to them to make what you think are the most important of the points noted below. We are unlikely to get more than a 10-minute appointment -- see Trina's cautions at the bottom of this note -- and all of the points below would take more than 10 minutes to discuss. However, they are good talking points. Raise as many as you feel comfortable discussing during the time that is likely to be allotted.
    Check your legislators' local addresses on their web pages or through the information provided at www.assembly.ca.gov, and www.senate.ca.gov. The state's new home page is www.ca.gov/state/portal/myca_homepage.jsp; click on "visit the Governor's new home page" on the upper R to reach Gray Davis at offices throughout the state.
NOTE: The Electronic Activist has links for all the addresses and phone numbers for California's U.S. and state senators and legislators by district at www.berkshire.net/~ifas/activist/index1.html.

1.   California's injured workers desperately need an increase in WC benefits. We have the 44th lowest level of benefits in the country and the highest living expenses. Urge legislators to pressure the governor to sign the legislation he vetoed two years in a row (look up Senate Bill 996, or SB 996, and the Governor's veto message). Give them your personal stories, if possible, of what has happened to you because the low benefits do not provide enough to live on in California. Hearing a true-life example from a constituent can be more powerful than statistics.

2.   An increase in WC benefits is needed for people to eat, and should not mean one has to give up rehab. The present vocational rehab system doesn't serve anyone well. By definition, workers who need VR are usually badly injured and need much longer deadlines to develop a plan, and much higher vocational rehab benefits. The $16K limit on rehab is a cruel hoax for many workers. Perhaps the system should be funded in a different way: instead of contracting with private rehab counselors, give the state Dept. of Rehab. a significant budget increase and charge them with helping us. The money may be spent more effectively, with oversight and accountability that are now lacking.

3.   Low WC benefits also affect the kind of legal help we get. Applicant attorneys can't afford to take cases that are unlikely to bring in a lot of money, so many people who desperately need advice and assistance go without representation and usually receive only a pittance (For example, single parents usually can't afford to take a disability leave, so they keep working and end up with permanent disabling injuries; then, to add insult to injury, because they never took a leave they are considered to be less severely injured, get much lower permanent disability ratings, and the smallest of settlements.) If lawyers got more money -- not through an increase of the percent of the settlement but just because the settlements will be larger -- they will be able to afford to take more of these small cases, as they did before 1993.

4.   Separate the attorney's fee from the future medical part of WC settlements. That change, combined with higher medical benefits, will discourage attorneys from seeking C&R, which doesn't really help a great many injured workers, in the long run, especially those of us with RSIs, which often have permanent consequences.

5.   Urge the state to set aside a small portion of WC funds (less than 1%) to fund the following essential programs: (a) prevention programs in the form of health and safety training aimed at giving workers the tools to play a full role in preventing injuries/illnesses - including hazard recognition, speaking up in the workplace, and mandatory participation on health & safety committees; and (b) establish a better system for tracking data collected by different state agencies so the state is better able to address workplace problems and prevent future injuries and illnesses. [This was part of the two preceding WC bills that occasioned the veto. This year, however, we hope to have more ducks lined up in favor of this kind of set-aside.]

6.   Revise the "independent" medical system so that it is more likely to operate free of bias by sending requests for evaluations through an agency like the Industrial Medical Council. If doctors don't know who sent the patient, they are less likely to be influenced by employers and insurance companies.

7.   Revise California's ergonomics standard to conform with the federal OSHA standard, thus strengthening it (and protecting California workers if the OSHA standard is reversed).

Cautions: Preparing for talks with legislative aides/ field reps You will be lucky to get more than 10 minutes with even a field rep or legislative aide, so it's best to follow the guidelines Trina prepared (in response to my saying, on good advice, that often we're not heard or are thought to be crazy, because sometimes we get so carried away talking about our own cases and problems that we can't see or speak to the bigger picture. I've seen this plenty of times at state hearings . . . )

Trina said, "if we were to do some big event on RSI Day it would have to be very carefully planned. Government staff have very short attention spans."

Make a list of the issues you want to present:
-- Write it down and edit it to death.<t;
-- TIME it. If you have three, five, teenn minutes, make sure what you have to say is w/in the parameters of the time given.
-- Practice it out loud. In front of a miirror and preferably in front of another person, for feedback, for tone, volume, etc.
-- Don't obsess or describe *every* minnuute detail--stick to the points.

Remember, the governor has an office in LA as well, and his staff should make time to hear you. Trina suggested making appointments, if you can at all -- 10 to 15 minutes at most -- and practice together. Either go in a group, if possible, or in several small groups.

Cheers!
joan
_________________________________

Joan Lichterman
(Founder and Coordinator, 1990-1999, East Bay RSI Support Group)
VP, CTD Resource Network, Inc. http://www.ctdrn.org
* Remember February 28, 2001 is International RSI Awareness Day: Because work shouldn't hurt! *
__________________________________


Here are some of the problems as injured workers see them. This succinct and compelling speech was delivered to the California Forum for Workplace Health and Safety earlier this month by Joan Lichterman (Founder and Coordinator, 1990-1999, East Bay RSI Support Group, VP, CTD Resource Network, Inc.:

California Forum for Workplace Health and Safety
(cosponsored by the Dept. of Industrial Relations, the Commission on Health and Safety and Workers' Compensation, and the UCB Center for Occupational and Environmental Health)
Panel Friday 2/9 8:30 a.m. Disability Management & Return to Work

Injured Worker Needs
Good morning! I?m glad to be here, and to see so many participants. As mentioned, I am vice president of the CTD Resource Network, which received federal nonprofit status in early 1999. It was created to bring together existing, online educational publications under a nonprofit organization and provide a vehicle to more directly assist those suffering from, or at risk of, cumulative trauma disorders. So far we offer web-based information related to computer injuries and MSDs generally--such as the Typing Injury FAQ, or TIFAQ, website--and links to a wide range of resources; we publish The RSI Network newsletter; moderate several online forums; host web pages for local RSI support groups; and list RSI and injured worker groups internationally. [Ironically, using computers.]

Before co-founding this organization, I founded and led an RSI support group in Oakland for more than 8 years, and helped give birth to a number of other such groups throughout the Bay Area. The format was monthly meetings with specialist speakers on topics covering the gamut of issues affecting injured workers. As word of the group spread, I began spending most of my free time listening to and counseling injured workers who phoned from all over the country. One year I received almost 1,200 calls!

With each call I became increasingly angry hearing about
* lives devastated by preventable injuries
* claims officers spending more money on blocking treatment than the treatment would have cost
* sending people to doctors who didn?t understand the nature of the injuries they were seeing
* so-called independent medical examiners who have forgotten the beginning of the Hippocratic oath: "First, do no harm"
* Employers discarding injured workers like pieces of trash

This the background for my discussion of four primary needs. [This says nothing about medical needs, which would be the subject of an entire forum in itself.]

I made an acronym to help you remember them: P A I R. Pair has another meaning in the context of work. It takes a pair to accomplish the mutual goals of management and labor. If management and labor are not working together cooperatively, many workers may get injured and a company will not be as effective or as profitable as it could be. If management takes care of its workers, workers will take care of the enterprise.

Now, to the acronym PAIR and four of the needs I see as critical: prevention, accommodation, information, and rehabilitation.

P is for prevention, and there are two aspects to it. The first is preventing work injuries to begin with. The second is preventing reinjury if workers do become injured and ultimately are able to return to work.

I can?t say enough about the importance of prevention, and the simple things that can often be done to prevent injuries. Some of them--like musculoskeletal injuries--that haven?t been treated early enough, are treated inappropriately, or are not amenable to a quick fix, can become chronic and lead to even more-disabling conditions. They can be catastrophic for workers and their families, for insurers, and ultimately for government entities to which disabled former workers are forced to turn for assistance. If employers had to bear the full costs of injuring workers, sometimes permanently, they would put far more effort into prevention.

A is for accommodation. This can mean accommodating injured workers? new needs to perform the same jobs.

However, there is a second kind of accommodation, which requires more imagination and creativity: assessing workers? strengths and helping them develop other skills, so they can build on their knowledge of the enterprise and continue to be important assets. Accommodation is a win/win for everyone. Workers will be able to reclaim their lives, and will be the most loyal employees.

*Especially* if employers have ignored prevention, they owe it to their employees to go out of their way to accommodate workers? return to the labor force. Many other employers won?t even consider hiring workers who need accommodation, despite the ADA.

I is for information, both pre- and post-injury.

When workers are hired, they need to know about the potential dangers of their jobs and how to avoid injury; that they have a right to treatment if they are injured and to predesignate a treating physician; that employers are required to have an Injury and Illness Prevention Program. California should mandate employers to involve workers in these programs; their contributions can be critical in changing problem jobs or work processes. California also needs to monitor compliance.

After an injury and throughout treatment, especially when workers have complex and often misunderstood conditions, information is needed on a wide range of subjects. Finding it is often exceedingly difficult even for highly educated, skilled workers, whether or not they have attorneys.

For unskilled, poorly educated, and immigrant workers--who are a growing part of California?s labor force--the situation is disastrous. A great number of them lack access to basic health care, few of them know about Workers? Comp, their entitlement to treatment, how to report injuries, or where they can get care. Rural workers have far greater difficulties getting help navigating through the system and getting fair settlements that will enable them to take care of their future injury-related medical needs. In addition, the method for assessing benefit levels for agricultural and other transient workers with multiple employers doesn?t allow enough money to live on.

Once people are injured they need more than piecemeal information about Workers? Comp. They need written information explaining their rights, giving an overview of how the medical-legal process works at different points, and where to get help. I?ve had to tell people about the *existence* of Information & Assistance offices! The Injured Worker Factsheets prepared for the Commission on Health and Safety and Workers? Compensation by LOHP are a good starting point. I think employers should be required to post them in a visible place, and insurers required to give them to workers as soon as injuries are reported.

As cases progress, injured workers often need much more specific information explaining the medical-legal process, how to change treating physicians, how to select QMEs, their rights to protect themselves from QMEs who may be dishonest or venal; how to appeal decisions; when they may need a lawyer, and so forth. Most of the injured workers I know see the system as a Kafkaesque, wasteful nightmare. Many employers here may share that sentiment. Peer support groups are few and far between, many people can?t get to meetings, and these volunteer groups lack the resources to meet more than a fraction of workers? informational needs.

This barely scratches the surface, but it?s time to move on to the fourth primary need.

R is for rehabilitation. Rehabilitation is an endangered, yet essential component in returning people to work and making them whole. Vocational rehabilitation needs to be retained, reformulated, and refunded. The present system serves few people well, especially those with serious chronic injuries. These are the people who are least likely to find jobs and the most likely to need help. For example, according to a number of rehab counselors, only a few percent of the available jobs can be done by people with chronic musculoskeletal injuries. More time is needed to develop rehab plans, considerably more money, and more assistance than injured workers get now--including help from trained social workers. This sounds to me like a job for a much better funded Department of Rehabilitation!

Poorly educated people with low-level work skills and limited English-language skills are not even on the charts when it comes to vocational rehab. Not everyone can return to work with a voice-activated computer, and not everyone will find jobs they are able to do. I wonder how many homeless Californians landed in their present situations because of work injuries . . .

And I wonder how long it will take before the expert staff at the agencies that designed this conference will begin a thorough redesign of Workers Compensation, looking holistically at all the interrelated parts--including prevention--in collaboration with occupational health specialists and labor economists in state agencies, the University of California, and elsewhere--and then work to convince state legislators and the governor to take a draught of courage and establish a system whose primary purpose is to help people, and not merely to limit employer liability.



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The LA RSI Support Group can be contacted at asklarsi@yahoo.com.