July 10, 2008

Disability Ratings with a Heart of Darkness

Imagine that you are a doctor participating in a compensation review board for wounded veterans. You are responsible for signing off on pensions that have been recommended by a politically connected doctor. Frequently, the diagnosis is "polyarthritis" and the disability rating is 85%. At first, your review committee is fully staffed, but the pressure to endorse the blatantly bogus claims is intense. Soon, only two doctors remain. You and your colleague sit together for long hours, re-examining "wounded" veterans and challenging hundreds of claims. As you reject one phony applicant after another, the doctor signing off on the original applications threatens you with bodily harm.

You cannot turn to the government for support, because senior members of the ruling party are collecting disability payments. The doctor determining the absurd ratings heads the War Veterans Association and has given himself a rating of 85% for "polyarthritis." He is so well connected, the country's president has invited him into the Cabinet (where a number of his fellow cabinet members, moving with no evident difficulty, have been classified as quadriplegics with disability ratings of 100%).

Where are we? What nightmare of a country operates in this fashion? We are in the tragic land of Zimbabwe, formerly Rhodesia. The doctor is writer Peter Godwin's mother, who has spent much of her life in Africa, struggling heroically to provide medical care to her impoverished patients. Her colleague, up until her retirement from the review board, was Dr. Edwin Mhazo. Alas, he died very suddenly, under mysterious circumstances.

The head of the veterans association and cabinet member who leads the corrupt drive for phony pensions is Dr. Chenjerai "Hitler" Hunzvi, who sat out the war for independence in Poland, well out of harm's way, but who returned after Robert Mugabe assumed (total) power. In 1997, when the government ran out of money to pay wounded veterans (some truly disabled, many not), Hunzvi led street demonstrations. Mugabe caved to the protesters, offering huge lump sum settlements and generous monthly payments to 50,000 war vets. The Zimbabwe dollar collapsed, never to recover.

NOTE: Godwin's fascinating memoir, When a Crocodile Eats the Sun, is available in paperback. Highly recommended.

The Politics of Disability
The thousands of practitioners who work in disability-related fields in this country take a lot for granted. The vast majority work with integrity and genuine compassion. We all recognize the importance of accurate disability ratings. When there are disagreements between insurance companies and claimants, the courts offer a complex but reasonably consistent "due process" to ferret out the truth. The system is not always fair and the outcomes on individual cases can be truly bizarre, but on the whole the results are within reasonable parameters.

What we see in Zimbabwe is a parody of the process: a totally corrupted means of securing wealth for people who do not deserve it. It is a compelling reminder that all social interaction is based upon good faith. When that faith is stripped away, when hearts of darkness prevail, good people and the values they embody are very much at risk.



This is disturbing, partly because of the content, but partly because the author uses the term "disability" incorrectly, at least in the second to last paragraph. Practitioners are not, in most states, supposed to rate "disability" - they are supposed to rate "impairment" under some version of the AMA or state specific Guides for doing so. When a practitioner makes that mental error, even the most scrupulous slip into "fudging" the ratings - Chris Brigham reports that a huge percentage of impairment ratings are inflated - largely because the practitioner is trying to do "justice" for his or her patient. It's the role of the Legislature to come up with an algorithm for conversion of impairment into disability, based upon their perception of the proper balance of societal costs and benefits - not the province of individual practitioners on a case by case basis. Inter-rater and intra-rater unreliability is one of the consistent complaints about the Guides, and is often caused by well-meaning practitioners making this same mistake. Access to the legal system for dispute resolution doesn't help matters - it's a major cost driver in WC - and it's only a decision machine that's not even designed to obtain "justice" (if it were designed to obtain "justice" would we ever suppress evidence?) By confusing terminology, the author helps perpetrate the very ill that is the subject of the posting, albeit on a much lesser scale....


Very interesting blog today. Very disheartening as well.

We all have heard the old saw "Power corrupts; absolute power corrupts absolutely" from Lord Acton.

The veteran's compensation fraud just reinforces what we have seen in the papers about the elections and the tragedy that Mugabe has made out of Rhodesia, once the breadbasket of Africa.

But a point I would like to make is concerning your quote; "Social interaction is based upon good faith". When others or I disagree with you and other bloggers, some times vehemently, it does not mean that either side necessarily lacks "good faith". We may have just have views of the world based on our upbringing, experience, training, politics and genetics that disagree.

Keep up the good work, your blog is one of the few I always read.




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This page contains a single entry by Jon Coppelman published on July 10, 2008 10:28 AM.

Heat stress: rules, reports, and resources was the previous entry in this blog.

Disability Fraud Closer to Home is the next entry in this blog.

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