Disability applicants decry speedy exams
Friday, September 28, 2007
Jessie Johnson rolled his wheelchair into a small doctor's office for one of the most important appointments of his life.At 28, Johnson suffers from cerebral palsy, and he hoped a government disability exam would support his claim that he is too sick to work.
But in 16 minutes Johnson emerged, wondering what had just happened.
"I could have done that exam myself," Johnson said.
He is among hundreds of Charlotte area workers who file into Glenn Baumblatt's University City office each year seeking Social Security disability benefits.
Most times, the only person the government pays is Baumblatt.
N.C. doctors collected $12 million in fiscal year 2006 to perform disability exams. The Observer interviewed more than 40 current and former applicants across the region, and more than half described their visits as hasty, inadequate or unusual.
One applicant said a physician tried to persuade her to become a Seventh-day Adventist. Another said he suffered heart problems, but the doctor never checked his heart.
The exams often represent one of the last chances for help. Most applicants are rejected afterward. Some go on to lose their homes or fall into bankruptcy. Others have died during the appeals process.
State officials don't reveal how much exams factor into whether an applicant is approved or denied. They generally consider medical evidence along with a person's age, education level, daily activity and work history.
But people familiar with the system say exams are critical in every decision.
Often they are the driving factor, said Deborah Brogden, who worked for 20 years deciding N.C. disability claims.
"If you're someone too poor to have a doctor, it's the only medical evidence you have. It's going to carry the day," she said.
Doctors say exams are thorough. State officials who pay the physicians say they monitor them effectively and have weeded out poor performers.
"Most of the doctors I know want to do a good job," said Dr. Mohammed Ranavaya, president of the American Board of Independent Medical Examiners, which certifies doctors. "They don't compromise their professional integrity. Most doctors are very high-caliber professionals."
Critics of the federal program acknowledge not everyone deserves benefits.
However, they say the government too often uses the exams to justify rejecting claims -- another example, they argue, of how odds are stacked against applicants.
"The exams are bogus," said Linda Fullerton, president of the Social Security Disability Coalition, an advocacy group for the disabled. "The system is set up so you give up or die."
Thoroughness questioned
In the mid-1990s, Baumblatt moved to North Carolina and found a way to supplement his retirement: disability exams.He once had what he described as a thriving practice as a general physician in Ohio. But health problems sidelined him, and he said his patients found other doctors.
Now, Baumblatt typically sees 16 patients a week. In fiscal year 2006, the government paid him about $82,600, among the highest amounts paid to an N.C. disability doctor, records show.
Many of his patients are poor, he said, estimating that a quarter are homeless. He described others as drug addicts and ex-convicts.
"This is not easy," said Baumblatt, 77. "A lot of people lie to the government."
Baumblatt said he follows government guidelines.
But several patients told the Observer they had concerns about their visits.
Joan Murray, a former Bank of America vice president, sought benefits after a skydiving accident in which she suffered brain injuries and broke most of the bones on one of side of her body.
She was baffled when Baumblatt checked her heartbeat, tapped the bottom of her feet with an instrument, had her read an eye chart and said it was over.
"It lasted three to five minutes," Murray, 52, recalled.
Baumblatt said he didn't remember Murray's appointment.
In another case, Baumblatt's report seemed to contradict findings from the personal doctor of a patient suffering from fibromyalgia and depression.
Baumblatt wrote that the woman could "sit, stand, move about, lift, carry, handle objects, hear, speak and travel adequately." But her doctor of three years cited many physical limitations in his report, and he concluded that she was incapable of even "low stress" jobs.
Baumblatt said N.C. Disability Determination Services recently told him officials were pleased with his performance.
The agency this week said it has received at least one complaint about Baumblatt, but did not give details.
Applicants' complaints
For many former workers, the exams worsen a slow, confusing process.
Nearly every worker contributes to the system through payroll deduction in case illness or disease strikes and they need help. Average monthly benefits are about $947.
Last year, about 88,000 North Carolinians applied.
The government uses physical and psychological exams and other contracted work in about half the cases.
Officials say they order the exams to obtain more up-to-date information about former workers. Other times people are too poor to pay private doctors and need to be examined.
The Observer found:
• Frequent allegations that doctors spent too little time with patients. Federal rules require doctors to set aside at least 30 minutes to one hour per appointment. About half of those interviewed said their exams were shorter than 20 minutes.
• Former and current applicants and their attorneys who described odd behavior by doctors. Some complained of curious attire, such as a Hawaiian shirt. In another instance, an attorney said a doctor spent only minutes, discussing television shows, then dismissed his client.
Francisco Canales, 51, a Cabarrus County truck driver out of work because of back problems and depression, filed for disability six years ago. Social Security sent him for two exams, he said, each lasting about 15 minutes. A short time later, he received a letter saying he did not qualify for benefits.
"In 15 minutes, you can't tell whether a man is disabled or not," Canales said.
During the exams, he recalled, doctors checked his blood pressure, tested his memory and asked him to bend and turn.
He appealed the denial. Canales said he and his wife struggled to put two sons through college, but creditors foreclosed on their house and repossessed their vehicle.
In April, a federal administrative law judge overturned the denials and awarded him benefits.
"It's been something I wouldn't wish on my worst enemy," Canales said. "The system needs to change."
When asked to react to concerns from applicants and their attorneys, Rhonda Currie, Disability Determination Services administrator, said the allegations may be exaggerated.
Disability Determination Services conducts random patient surveys and sends employees to doctor's offices to monitor their methods, she said.
Cost of exams
N.C. doctors typically collect between $95 and $130 per disability exam. Some doctors perform only disability exams while others incorporate them into their private practice.MDSI Physicians Group, a Utah-based company, received roughly $350,000 in fiscal 2006, the most of any of the 636 companies, clinics or individual doctors that perform exams in North Carolina, documents show.
Mike Powell, chief operating officer, said his business helps states because they have difficulty finding doctors willing to do the work. Powell said the company has contracts with at least six doctors in North Carolina.
He said his company records when patients enter and exit examination rooms to ensure doctors are following government guidelines.
"Sometimes they spend too much time with a patient," Powell said.
Dr. Anthony Carraway collected about $265,000 in fiscal 2006, the most for any individual doctor. He did not return calls seeking comment.
In Charlotte, Dr. Earl Epps Jr. received roughly $150,000 for conducting exams. Epps said he follows government guidelines before declining further comment.
On the open market, doctors charge as much as $1,000 for disability examinations in legal cases, such as workers' compensation claims.
Some critics said government disability doctors rely on a high volume of cases to make up the difference in pay.
Charlotte attorney Paul Goodson, who represents disability applicants, said he is wary of doctors who do only disability exams.
"They are not thorough exams," Goodson said. "They are not given importance. They determine whether someone receives disability or has to wait another two years."
Incentive for rejection alleged
Cursory exams make it easier for the government to reject claims, said Brogden, the former state claims employee.
She said examiners face more scrutiny from superiors when they award benefits to workers. As a result, she said, examiners feel pressure to close out cases even if they have questions.
Doctors, she said, are often dismissive of claims and see themselves as "protectors of the vault."
Many disabled workers who eventually win their cases do so through perseverance.
Those who are denied twice by the state can appeal to a federal administrative law judge. Judges overturn state decisions about 60 percent of the time.
A judge awarded Alex Armstrong benefits in August. A former security guard and satellite television installer, he waited three years for assistance after being turned down twice. He said he suffers from back problems and depression.
He said he lost his house on Thanksgiving Day 2005 and now lives in the Uptown Men's Shelter for the homeless. He said he hasn't yet received his first payment but hopes to find a home when he does.
Recalling his visit to a disability doctor, he said it lasted about 15 minutes.
"If the exam was more extensive, I would have gotten benefits earlier," he said. "I would have been able to save my house."
Posted in Denied Insurance Claims