Waiting In Florida

Some excerpts from the South Florida Sun-Sentinel:

Heather Noble's heart is so weak the doctors tell her not to laugh too hard. She had a stroke during heart surgery, and now speaks with a slur and can't recall her baby's name. Her doctors say she can't work.

Two years later, the former UPS worker and mother of two from North Lauderdale has become destitute while waiting for Social Security to decide whether she qualifies for disability benefits. Noble, 41, is trapped in a growing backlog of 750,000 unresolved disability cases — about 8,100 in South Florida and 37,500 in the state. Some injured and ill people have become homeless or bankrupt while waiting for rulings. ...

Over two years, Social Security has resolved all 200,000 cases that are more than 900 days old. Officials hope to bring the backlog to a manageable 430,000 by 2013, said Frank Cristaudo, chief administrative law judge for the agency.

"It will take a while," Cristaudo said. "Things are getting a little better." ...

Nora Staum, a Coral Springs disability attorney, said one client was dropped from a local kidney transplant list because he had no income or medical coverage until Social Security declared him disabled. Another family that needed an oxygen machine but couldn't pay their electric bill came within a day of losing power.

"The system is failing people who need it the most," said Lyle Lieberman, a South Florida attorney and former president of the trade group National Organization of Social Security Claimants' Representatives.

Why is Judge Cristaudo saying things are getting better? He knows that is not true. The backlogs are getting worse. Maybe they are getting worse at a slower rate than the used to, but that does not mean that things are getting better. There is an election campaign going on. Pretending things are getting better when they are getting worse is the sort of thing one expects from a politician, but not from a civil servant.

Hurricane Forces Office Closures

The Social Security Administration has announced that the following offices will be closed today:

Louisiana:

Lake Charles

Texas:

Alice

Angleton

Beaumont

Brenham

Bryan

Conroe

Corpus Christi

Galveston

Houston Downtown

Houston Northeast

Houston Northwest

Houston Southeast

Houston Southwest

Lufkin

Pasadena

Port Arthur

Victoria

Update: the DeRider and Leesville, LA offices have been added to the list.

Witness List For House Social Security Subcommittee Hearing

The House Social Security Subcommittee has posted the following witness list for the hearing it will hold on September 16 on the "Performance of Social Security Administration Appeals Hearing Offices:"

• The Honorable Frank Cristaudo, Chief Administrative Law Judge, Social Security Administration
• The Honorable Patrick O’Carroll, Inspector General, Social Security Administration
• Ethel Zelenske, Co-Chair, Consortium for Citizens with Disabilities Social Security Task Force
• Kathy Meinhardt, Principal Executive Officer for Federal Managers Association Chapter 275, Social Security Office of Disability Adjudication and Review, Federal Managers Association, Minneapolis, Minnesota
• Sylvester J. Schieber, Chairman, Social Security Advisory Board
• The Honorable Ron Bernoski, President, Association of Administrative Law Judges, Milwaukee, Wisconsin
• James Hill, President, Chapter 224, National Treasury Employees Union, Cleveland, Ohio

Social Security In The Aftermath Of the September 11, 2001 Attacks

From the November 1, 2001 testimony of Larry Massanari, then Acting Commissioner of Social Security, to the House Social Security Subcommittee:

In the aftermath of the attacks, SSA took immediate steps to ensure that we stayed open for business, for routine business as well as for those who lost family members or were injured that day. All Social Security offices in New York City and the Washington D.C. area were immediately closed on September 11 to protect both the public and our employees, while SSA assessed the severity of the situation and the need for increased security.

The next day, all Social Security offices and the national 800 number were open, with the exception of field offices in New York City, the Northeastern Program Service Center in Jamaica, and the hearing office and the Disability Determination Services (DDS) office in lower Manhattan. The New York Regional Office also remained closed, but we opened a command center in the Grand Central field office. All of our offices-except for those in lower Manhattan-reopened on September 13. We redeployed employees from the closed offices to offices that were open.

We immediately worked with the Treasury Department and the Postal Service to make sure that, where normal processes remained in place, benefit checks and electronic funds transfer payments continued to be sent. Where service was disrupted, we tried to find ways to mitigate delays. ...

By September 24, all of our offices were open, with the exception of the Manhattan DDS, which had been located near the World Trade Center. Some of the DDS staff is being temporarily housed in the Northeastern Program Service Center in Jamaica. Others have been sent to work in other offices.

All 15,000 claims that had been pending in the DDS were removed from the building and sent to a contractor for cleaning and decontamination. All cases have been cleaned and sent back to the DDS. The DDS personnel are in the process of recontacting claimants to update the medical evidence and explain the delay in processing.

Massanari hardly touched upon what may have been the most heroic thing that Social Security employees did after the September 11, 2001 attacks. They continued to open huge quantities of mail, despite a very real anthrax threat. I do not believe the Social Security employees who opened that mail have ever gotten the recognition they deserve.

Appropriations Situation

I hate to yank your chain, but this is from The Hill:

Senate Majority Leader Harry Reid (D-Nev.) cautioned Republicans Monday against forcing a government shutdown over expanded oil drilling ...

With no appropriations bills signed by President Bush, lawmakers’ chief task this month is to pass a stopgap measure to fund the federal government in the fiscal year beginning Oct. 1.

Republicans are mulling whether to press the offshore oil drilling fight by blocking the funding resolution, which contains the congressional moratorium on such drilling.

Reid reminded the GOP that its government shutdown led by former House Speaker Newt Gingrich (R-Ga.) during the Clinton administration was met with widespread public disapproval.

Hearing On Social Security Hearing Office Performance

An announcement from the House Social Security Subcommittee:

Congressman Michael R. McNulty (D-NY), Chairman, Subcommittee on Social Security of the Committee on Ways and Means, today announced that the Subcommittee will hold a hearing on the performance of the Social Security Administration’s (SSA’s) appeals hearing offices. The hearing will take place on Tuesday, September 16, 2008, in room B-318 Rayburn House Office Building, beginning at 10:00 a.m.

In view of the limited time available to hear witnesses, oral testimony at this hearing will be from invited witnesses only. However, any individual or organization not scheduled for an oral appearance may submit a written statement for consideration by the Subcommittee and for inclusion in the printed record of the hearing.

BACKGROUND

Over the past several years, SSA’s disability claims backlogs have grown to unprecedented levels, with more than 1.3 million Americans currently awaiting a decision regarding their claim. Backlogs are particularly severe for the more than 765,000 Americans who have had their cases denied at an earlier stage of the process and have requested a hearing before an Administrative Law Judge (ALJ). These individuals now wait an average of 532 days for a decision on their appeal. Recognizing the central role that prolonged underfunding and staffing shortfalls have played in the development of these backlogs, in combination with rising workloads, last year Congress provided SSA with $150 million more in administrative funding than the President had requested – the first such increase in ten years.

The Subcommittee has examined the backlog crisis from a number of perspectives, including the need for more administrative funding and adequate staffing, the agency’s ability to hire more ALJs to hear disability appeals, proposals to improve the disability determination process, and initiatives that SSA has undertaken to reduce the backlog. This hearing will focus on the performance of SSA’s hearing offices and SSA’s overall management of these offices.

SSA’s hearing process is an important one for claimants, as new medical and other available evidence is added to their claim and they have the opportunity to meet face-to-face with the judge who is deciding their claim. Approximately two-thirds of those who appeal to the ALJ level are awarded benefits. However, the process is very labor intensive for SSA, typically requiring clerical staff to prepare the case file, obtain evidence and schedule the hearing with all necessary experts and other participants; ALJs to review the case, conduct the hearing, and make a decision; and attorneys or paralegals to draft the decision and accompanying legal rationale for it, based on the judge’s instructions.

According to a recent report from SSA’s Inspector General (IG), the productivity of SSA’s hearing process has improved in recent years. In 2005, SSA produced 421 dispositions per ALJ. By 2007, productivity had increased by 13 percent, to 474 dispositions per ALJ. However, hearing office performance varies significantly between offices. The IG found that productivity was often hindered by a lack of hearing office support staff, a conclusion the IG had also reached in a March 2005 report. Interviews with ALJs and hearing office staff also identified other factors that could affect productivity, including the use of a number of techniques to promote speedier processing (such as spending less time reviewing the case and conducting the hearing). Finally, the IG found that a small number of ALJs – approximately 1 percent – processed fewer than 200 cases per year even though they were employed as full-time adjudicators. At the same time, the IG reported that some judges – about 2 percent – issued more than 1,000 decisions in a year. This could raise concerns about the quality of these decisions.

As concern about the backlog has grown, SSA has undertaken a number of initiatives to improve the productivity of its hearing offices, including hiring more ALJs and support staff; reinstituting the Senior Attorney adjudication program to allow judges to focus on more difficult cases; developing automation improvements; and asking judges to issue 500-700 decisions per year. However, concerns have been expressed that the agency’s plans for hiring support staff are not sufficient to address the large hearings backlog, that planned automation improvements will not meet expectations, and that an overemphasis on speed could degrade quality or compromise program integrity.

In announcing the hearing, Chairman McNulty said, “Earlier hearings have demonstrated that prolonged underfunding has resulted in the loss of staff needed to process disability cases at the Social Security Administration. This has led to an unprecedented backlog of unprocessed claims and untold suffering. The agency must have the resources it needs to eliminate this unconscionable backlog. At the same time, we must ensure that SSA uses these resources as effectively as possible. This hearing will examine SSA’s management of its hearing offices, and explore measures that can be taken to improve productivity without compromising the right of claimants to a fair and impartial decision on their case.”

FOCUS OF THE HEARING

The hearing will focus on the performance of SSA’s hearing offices, factors that affect productivity, initiatives SSA is taking to increase efficiency and productivity, and other approaches to improving productivity without compromising the quality and impartiality of decision-making or the due process rights of claimants.

Raleigh Field Office Evacuated

The Raleigh, NC Social Security field office was evacuated this morning due to a powdery white substance found enclosed in an envelope. Probably nothing to it, but they have to be careful.

Average Patient On Liver Transplant List Doesn't Come Close To Meeting Listing

The Social Security Administration adopted new digestive system listings last October. The liver is part of the digestive system and is covered in the new listings. One of the ways to meet the liver listings is something labeled as the "SSA CLD" (Social Security Administration Chronic Liver Disease) score. This is computed using a complicated formula. The SSA CLD formula is the same as what is generally known in medicine as the MELD (Model for End-Stage Liver Disease) score.

I have wondered why Social Security wanted to avoid using the term MELD. My guess is that they did not want people thinking that one had to be in "End-Stage Liver Disease" to meet the listing. That just sounds so extreme.

The listing requires a SSA CLD (or MELD) score of 22 or higher to meet the listing. A recent issue of the New England Journal of Medicine has an article on liver disease. You can only read the abstract online, but the whole article includes a table showing that the median MELD score for those on the waiting list for a liver transplant is 15. One short quote from the article: "On average, the risk of death increased by 21% ... per unit increase in the MELD score." Not only must one be in end-stage liver disease to meet the listing on the MELD score; one must be well into end-stage liver disease and at great risk of death.

Where did the listing requirement of a MELD score of 22 come from? Why not 20 or 18 or 15? Did someone try to figure out how many more people would qualify if the MELD score requirement were lower and how much that would cost? Did someone try to figure out how many more expensive liver transplants Medicare would have to pay for if a lower MELD score was used? As it is now, people in end stage liver disease under age 65 are unlikely to live long enough to qualify for Medicare. Was the Office of Management and Budget involved in setting the MELD score requirement? Was someone thinking "Oh, the hell with them. Most of them are alcoholics anyway." You have to wonder how comfortable the physicans involved in creating this listing are with the requirement of a MELD score of 22.