|KATU 2 News - Portland,
Dealing With SAIF - Sick and feeling like a criminal
December 15, 2004- by Eric Mason, KATU News
Salem, Ore. - Teresa Westmoreland says she's used to feeling sick, out of money and unable to work. The hard part she says is being treated like a criminal.
Westmoreland says battling what her doctors call a toxic reaction to mold, has been debilitating. But worse than all that, the 44-year teacher is being treated like a crook by the State Accident Insurance Fund (SAIF) "like I'm trying to get something from someone," she says.
The accusations come from what's known as IME's, independent medical exams that SAIF officials use to weed out false claims against the insurer. Westmoreland may have real reasons to suspect the bias of the exams.
A survey just released by The Department of Consumer and Business Services, a regulating agency; found 53 percent of IME doctors thought there was bias in the work they did.
After linking memory loss, muscle coordination and flu-like symptoms to a severe reaction to mold in her classroom nearly two years ago, Westmoreland has found herself in a treacherous netherworld between medicine and law where every victim is a suspect and every claim a potential legal battle.
Such are the chances you take when you claim you got sick or injured on the job in Oregon. But now, it's a world getting added scrutiny from state regulators in Oregon as well as state senators like Eugene's Vicki Walker.
"There are starve-out tactics that are being used," says Walker. "Delaying claims so these people can't put food on their table and can't pay their bills - so that they're forced to sign agreements."
Walker has been a critic of SAIF for more than a year, from the way it paid exorbitant consulting fees to former governor Neil Goldschmidt, to the way she says SAIF mishandled public records.
SAIF officials say they only deny 17 percent of all claims, and the new head of the agency, Brenda Rocklin is quick to defend the agency.
"We pay claims promptly and we treat injured workers responsibly," says Rocklin.
Agency officials declined to talk specifics about the Westmoreland case or allow their contracted doctors to speak with KATU citing the confidentiality of medical records.
In Westmoreland's case the exam was scheduled by SAIF to determine if mold from the Talent Middle school was indeed the culprit behind the teacher's illness.
"It was the most degrading and humiliating experience I think I've ever been through," says Westmoreland. "It was as if the doctor had already made up his mind in advance."
Westmoreland also says the doctor treated her in a disrespectful and condescending manner.
The exam was scheduled by SAIF for October 20th of 2003 at Oregon Health Sciences University in Portland. But before Westmoreland made the 10-hour round trip to Portland she was curious about the doctor who would be examining her.
In a Google search Westmoreland found numerous hits for the doctor she was scheduled to see, Emil J. Bardana Jr. MD. He was a well-respected allergy specialist and had published numerous articles about mold in the work place.
"There was just one problem," says Westmoreland. "It didn't look like he believed mold was a serious long-term health problem."
"Basically I told SAIF I want another doctor, and they said 'no' I had to go or the claim would be denied," she says.
Westmoreland's worst fears were confirmed when Bardana filed his report to SAIF on November 3, of 2003.
Bardana's report issued to SAIF found, "no logical explanation for the symptoms," found certain neurological problems to be "bizarre" and further believed that she was being "led astray" by her personal physician and other specialists that said that mold had indeed been the culprit.
While SAIF officials will not release the exact amount paid to Bardana the do say the average fee for such an exam ranges from $500 to 600. But they say that fee does not affect the objectivity of the studies.
Among those who challenge Bardana's assertions are Westmoreland's personal physician, and specialists from well-respected medical schools including University of Southern California.
"There's a lot of second guessing here," says Michael Stone MD of Ashland referring to Bardana's opinion. "There's nothing about this she wants…the only thing she gets from this is a lot of frustration."
Countering Bardana's assertions, in a medical report filed in August of this year, Kaye Kilburn of USC medical school reported that Bardana's implication regarding a lack of mold sensitivity is "wrong and reflects naivete." He also referred on one occasion to Bardana's "shallow approach."
SAIF also ordered an Independent Neuropsychological Evaluation of Westmoreland. The report by Donna C. Wicher concluded that Westmoreland suffered from a Conversion Disorder.
Defined in the report the disorder is not an intentional production of physical symptoms but have a psychological component.
Wicher also concluded that Westmoreland's test results were inconsistent which suggested that her symptoms were the result of a "personality structure."
While each physician spent several hours with Westmoreland, those who've spent years teaching alongside her can't believe that her symptoms are all in her head.
"The first time I heard that I laughed, "says Heather Ayers. "It's hogwash." Ayers, who hired Westmoreland at Talent middle school as a health teacher in 1995 says her colleague was one of the hardest workers at the school.
"She's a person of amazing integrity," says another teacher, Toni Drew, "I've never seen someone put so many volunteer hours into anything."
From grants to public service awards Westmoreland seemed to be on the track to being a principal until she started feeling ill two years ago. Now Westmoreland says she can't complete the most simple of tasks including how to estimate when her daughter needs to be picked up from the bus stop.
But Westmoreland is not alone. Four others including teachers Cari Baker and Lisa Wileman also have claims against SAIF for mold related illness at Talent middle school.
"This is like some kind of nightmare," says Lisa Wileman "Our credit cards are maxed—I can't go to the store and buy a sack of groceries right now."
Baker, Wileman and Westmoreland are all financially strapped. Westmoreland's unpaid medical bills alone total nearly $50,000.
All three cite the IME process as flawed for its lack of objectivity.
"It's a joke---they're not independent at all," says Wileman.
After the three women received a copy of their IME, they began comparing notes. What they found was disturbing to say the least, and a sign that the reports may be cut and pasted by those contracted by SAIF.
In Baker and Westmoreland's reports there are two identical paragraphs which include the pronoun "she" when referring to conversations with other teachers at the school.
One of the sentences includes a grammatically incorrect sentence. It reads, "She apparently was also driving in a vehicle had onset of symptoms."
Baker also says that in her report she noticed that Bardana had included a sentence about a growth on her breast that did not happen to her but to a colleague. Also, says Baker, there were comments about alcohol use that were untrue.
A public affairs spokesperson from OHSU told KATU that the errors in cutting and pasting were "inadvertent."
The teachers also say they were sent bills for the IME's that demanded immediate payment.
Rocklin says if a bill was sent it was in error because the exams are paid for by SAIF.
The teachers say the bills were sent repeatedly and constituted harassment.
All three say they have suffered, not just at the hands of SAIF but also from a school district that has failed to support them and in some cases discredited them professionally.
Rocklin, who faced a handful of suspicious senators in Salem at yet another hearing about IME's is clearly trying to the bottom of the controversy.
"Clearly we don't want workers to feel any intimidation," says Rocklin.