Sep 27, 2009

Double Amputee Waiting

From the Belleville, Illinois News-Democrat:
Jennifer Moore was 15 months old when surgeons at the Shriner's Hospital in St. Louis amputated her disfigured left leg below the knee. Three years later they did the same thing to her right leg.

As if being a double-amputee wasn't enough of a challenge, Moore, 21, has battled a host of other birth defects, including an upside-down kidney and a blocked urethra, the tube to her bladder, making her susceptible to kidney infections.

What's making her struggle even tougher, though, is the fact she can't find a job.

Which means she can't get health care insurance. Which means she doesn't have a primary care physician.

So when Moore gets sick -- which is often -- her only recourse is to spend hours waiting in hospital emergency rooms for a doctor to see her. ...

Moore's been waiting more than a year for a chance to appeal the Social Security Administration's decision before an administrative law judge -- a situation made worse by a flood of new disability applications from newly jobless middle-aged workers, said Tom Yates, a spokesman for Health & Disability Advocates in Chicago.

The agency that reviews Social Security disability claims in Illinois has seen a 100 percent increase in initial claims, Yates said.


Anonymous said...

Interesting case,at least by these facts. Wonder if ssa employees will approve?

Anonymous said...

Stories like this make me sick, not only because of this woman's personal tragedy, but because of the misleading nature of the report. I wonder why it's posted here as an SSA problem. Why not put the blame where it really belongs, and that is firmly in the lap of the State of Illinois and its Medicaid agency.

The problem is that the States have consistently used the Social Security disability process to make medical determinations for them, something that they should be equipped to do on their own.

This isn't an SSA problem. It's a State Medicaid problem. But that's too much detail for the press to report, and I'm sure certainly not as sensational.

Anonymous said...

I guess this is one of many news stories that we will be bombarded with that if only the government provided everyone health care it would be a wonderful world
and her $12,000 medical care would magically cost nothing.

Nancy Ortiz said...

Medicaid is enacted in T19 of the Social Security Act, but is state administered. I don't think it's ever been contemplated to have the states do their own Medicaid determinations. But, someone who knows better is welcome to correct me on this point.

In any event, this unfortunate claimant has an unusual condition(s) and they can be hard to document to pass PER reviews. One way or another, this is bad stuff. Govt health care won't solve every problem in our HC delivery system--but, this situation doesn't occur in other Western democracies. American is exceptional in this as in many other things. This case is an example of when exceptionalism conveys no advantage.

Anonymous said...


Oh yea, I get it. Clearly possible that the same fools who missed a double amputee at the state agency could miss it at region.

The whole thing stinks. Her photo should be on the front page. Maybe the egregious denials like this would strike a chord. Disgusting.

Anonymous said...

I took a hearing request in the FO several years ago from someone who had been denied with a condition that seemed pretty severe to me. I looked up the listings, and lo and behold, there it was in black and white--totally ignored by DDS at the initial level. When it went to OHA, it was quickly caught and reversed. Another time, I took a hearing request on a case where the DDS ignored the claimant's own physician's medical report. I found that out by talking to the claimant and reviewing what was in eview. I pointed that out in the hearing request, and again, a quick reversal--it was reviewed by attorney adviser and decided right away--just earlier this year. This kind of thing happens all the time, but more often than not is not corrected, because SSA does not have enough personnel to take the time to look carefully with the attitude of helping the claimant. Now, it is just the reverse--file online, where you are on your own. It is only going to get worse, Mr Astrue's fantasies notwithstanding. You should see some of the fouled-up online retirement claims that are popping up now. What a disaster.

Anonymous said...

I am an agency employee, my wife recently filed for disability on-line. The application went OK, then she was advised to print out authorizations and was told to bring them in signed. She got to the office took a number, waited, spoke to receptionist, waited again. One hour to submit the signed forms. In my opinion, on-line filing leaves a great deal to be desired.

Nancy Ortiz said...

As A#6 says, it takes time--time CR's don't have--to look at the meds, the decision, and the regs to spot a bad disallowance. I used to perform that function in my DO. Then, I'd solve the problem, one way or another. I've called my peers in DDS, RO, ODAR, ODO--whatever it took. But, I was the only one with the time. POMS doesn't tell anyone to do what I did. It's just the way the job should be done, is all. Good for A#6--that's what I call good service! :)

Anonymous said...

As an employee of the Agency, this makes me sick. What is going on with the DDSs? This case should be fast tracked before a Senior Attorney who would pay it in a heart beat, because it deserves to be paid. Get rid of DQB. Staff the DDS properly or shut them down. Then OHA will get the really hard cases and the backlog should be positively affected because the obvious pays are being paid.

Just call me Alice.

Anonymous said...

Of course, everyone is quick to blame the DDS without actually reading listing 1.05B. After a (short) lifetime of using prostheses, she must be able to function with them pretty well. The other conditions seem to be acute and do not meet the duration requuirement. She is only 21 and if she can function, she is better off working than going on the rolls. Inability to find a job is NOT a disability.

Nancy Ortiz said...

What's the phrase? Oh, yes, "Against equity and good conscience." I think this phrase sums up the exception to every rule of adjudication. What do you do when the decision the rules call for isn't the right thing to do?

You do the right thing. Or not. It's a matter of judgement.

Anonymous said...

To Anon who cited the listings:

I rest my case. Why do the DDSers insist that a person who does not meet/equal a listing is not disabled? Why do they segment each impairment? Do they every even bother to look at the Regulations as a whole?

Just because a person does not meet or equal a listing does not mean they are not disabled. You need to look at all the vocational factors, hence the regs and the Grids. Further even in the absence of an exertional impairment you must look at whether or not the person can sustain competitive employment.

Duration requirement? Oh, believe me, there is a very special place in h-ell for people who use this basis for denials. As you burn to a crisp you will be told: "oh don't worry you have less than 12 months to go and then the burning will stop". Right next to you will be the DDS medical consultants who will be told not to worry about the burns over 90% of their body because the MER is insufficient to make a determination that they are really suffering.

Like I said retrain and correctly staff the DDSs as well as get rid of DQB. (How those particular people sleep at night, I will never know.) Or just get rid of the DDS as they are basically worthless as they stand.



Anonymous said...

This case illustrates why we need to scrap the entire social security system (and all other public welfare assistance) and institute a flat tax which includes a "negative income tax". Any American citizen who has no income for whatever reason would not pay any tax and would receive an income at subsistance level on a regular basis. It could be indexed to earned income to encourage work, but anyone unemployed for whatever reason & without savings could receive a check from the Federal government.