The Disability Industrial Complex – a case of bad knees

Dr. Brad Rosedale quickly scanned the chart of a 48-year-old social worker who was claiming disability for an injury to her knees while on a work assignment.

“Ms. Skruge come on in  please,” he announced to the waiting room. A woman in a purple coat grasped two ski poles from against the wall, planted them in front of her, and hoisted herself out of the chair with a moan. Hyperventilating, she shuffled stiffly toward the man in the white coat, and they filed into an exam room. “Please have a seat,” he said, and positioned them in chairs on opposite sides of a small desk. It was a busy day, so he started right in. “I’m Dr. Rosedale. I see that you were walking across the street from the parking lot at work, and a car struck you.”

“This car came out of nowhere going 35 mph, hit me and threw me in the air…I landed on the hood and bounced back on the street about 20 feet away, landing on my knees.” Patti Skruge glared at him. “My life has never been the same since that day.”

The cover letter summarized a witness statement that was wildly at odds with the patient’s story. The car was moving slowly, and the front bumper contacted Ms. Skruge’s legs causing her to “tump over.” He then reviewed her symptoms questionnaire where she reported that she couldn’t climb steps, had constant 9/10 pain, and couldn’t sit in a chair or stand for more than 10 minutes. “My doctor says I will need knee replacements because of this accident,” she added.

“Please have a seat on the exam table, Ms. Skruge.” She hobbled to the table and climbed up with a sharp moan.

“Does this hurt?” he asked, lightly palpating a kneecap. She yelled out as if he was burning her with a hot poker and reached down to push his hand away. “Can you straighten your knee out and resist me?” She made a poor effort, then suddenly gave way, barely able to resist gravity. After a thorough examination punctuated with labored breathing and yelling, the doctor’s only objective finding was crepitus behind the kneecaps, and that was likely due to wear and tear from years of carrying around a body weight of 245 pounds. There was nothing to explain the severe disability she was claiming.

“I’m going to feel this for days,” she said. “You really hurt me!” Then, she calmly stepped down off the table and waltzed over to sit in the chair. She had convinced three other doctors that she was disabled in the 5 years since her injury and had no reason to think Dr. Rosedale would come up with a different conclusion.

“I see your having a lot of pain, Ms. Skruge, but your knees are stable. In my experience you could benefit from exercising and losing some weight…”

“What?!” she said, cutting him off, “I’ve been heavy since I was a kid, and my knees never bothered me before that car smashed them!” Her face reddened.

“Have you seen your records?” By law, she must have been provided them. He flipped through the medical records, which went back 15 years. Page after page reported knee pain and arthritis. At least one doctor had told her to lose weight.

“I never looked, my attorney has them and he told me to let him handle everything. Why what’s in them?” The pitch of her voice raised in suspicion.

“You were seeing doctors for knee pain and arthritis for years before this accident. One doctor told you…”

“I don’t remember! Ever since that terrible day my memory is going to. I think I must have hit my head too when I landed in the street.”

They had been in the room for over an hour and he had all the information he needed to write an orthopedic disability report.

“I’m done here, Ms. Skruge. Thanks for putting up with all this. Take care of yourself.” She lumbered out, stiff again, navigating with the ski poles. He submitted the 52-page report within two weeks, which ended with an erudite explanation of why she wasn’t eligible for disability retirement.

Months after the evaluation, an email arrived directing the doctor to call attorney Dennis Lamb, and prepare to discuss the Skruge case. He couldn’t remember her until he reviewed his report, then it all came back to him.

“This is Brad Rosedale, is this Dennis?” he said. The call went straight through.

“Hello Dr. Rosedale, yes Dennis Lamb here, and I have Brandy Robbins on the line. We are representing the county retirement board in the Patti Skruge case.”

“Hello doctor, this is Brandy, I’m the disability coordinator,” a woman said.

“Did you have a chance to look over her file?” said attorney Lamb. Brad knew him from a previous case. There had never been need for a 3way call; something was off here.

“Yes, she was the lady with the ski poles. Bumped by a car, emergency room reported bruises and scratches, and she was walking around like nothing happened. She tried to pull one over on me,” said the doctor. It was a brief defense for his opinion that she wasn’t disabled from the accident.

“She filed a formal complaint against you. She alleges that you were rude, called her fat, and didn’t believe her account of the accident.”

“Wow,” said Brad, “I probably shouldn’t have told her that losing weight would be good for her knees, but I never use the word fat, and I’m never, ever rude to a patient.”

“That brings in her attorney, which is why I’m calling. Ronald Roman and I had cases together, and this guy is a piece of work. He probably fabricated the entire complaint and had her sign it. Now he is trying to get your report thrown out as biased. But it is credible, and I believe the judge will admit it into evidence.”

“It is an excellent report and gives us a chance to overturn this wrongful claim,” said Brandy.  Her voice had a somber tone to it.

“The guy must be a sore loser!” Brad said, trying to break the tension.

“He doesn’t lose,” said Dennis. Well, that explained their solemnity on this call.

“No, he doesn’t,” said Brandy, “Mr. Roman carries a vendetta against doctors who testify against his clients.”

The call was concluded, and a trial was calendared.