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Thursday, October 24, 2013

California: Medical Delay and Denial Protested

Sedgwick vs. The People
Round 4: Sedgwick v. Debbye Mazzucca

Operating Room Nurse’s Injury no Emergency to Kaiser, Insurer: Defy Judge’s Order, Refuse to Provide Urgent Medical Care Injured Workers’ Advocates to Seek Penalties, Investigation

Injured Kaiser OR nurse Debbye Mazzucca tells how Sedgwick defied a judge's order to provide careThe California Applicants’ Attorneys Association (CAAA), whose members represent Californians injured on the job, today held a news conference outside Kaiser Foundation Hospital with Debbye Mazzucca, a former operating room nurse who was injured while working there. They called for sanctions against Sedgwick Claims Services, Kaiser’s workers’ compensation insurer, for defying a judge’s order to provide Ms. Mazzucca urgently needed medical care, causing her to lose her teeth. On February 11, 2013, the Workers’ Compensation Appeals Board (WCAB) ordered that Sedgwick “shall” provide dental treatment to Ms. Mazzucca. After eight months, Sedgwick and Kaiser have still refused to do so. Sedgwick faces a relatively small monetary penalty for ignoring the court order, which means little to a huge corporation.

Operating Room Nurse Debbye Mazzucca, of La Mesa, has thirty-five years’ experience, and worked for Kaiser for 12 years. She was injured in 1998, when she tripped and fell over a parking lot barrier while at work. Kaiser treated her injured knee, but ignored multiple doctors’ reports that she had also injured her neck and back. In spite of four doctors reports confirming that fact, Kaiser denied that those injuries were from the fall. Now, due to complications from medications, and delays in approving medical care, Ms. Mazzucca has lost her teeth.

CAAA President Jim Butler said, “Insurers’ Utilization Review (UR) routinely delays and denies doctors’ legitimate requests for appropriate medical treatment. This is unnecessary and expensive, and has got to change. We’ve seen the evidence of out-of-control delay and denial in the 15,000 denials of recommended medical care in just the month of August. It’s time to bring UR to heel, and stop insurance carriers from using it as a routine roadblock.”

“A doctor, agreed to by the company and their insurer, determined this Kaiser operating room nurse’s injury was a result of her work accidents. The insurer still refused to provide urgent medical care. A judge ordered the insurer to provide urgently needed medical care. But Sedgwick continues to refuse medical care and Debbye lost all her teeth during the months of delay,” said Alicia Hawthorne, the president of CAAA’s San Diego chapter, and Ms. Mazzucca’s attorney. “This nurse has been in pain, and in need of medical treatment. Yet, the insurance company defied a judge’s order to provide care. Kaiser and its insurer have spent years fighting their responsibility to treat these injuries. Why does the State of California allow workers’ compensation insurance companies to further damage patients through delaying and denying medical care and disability compensation?”

 “Kaiser has failed to provide the care needed to heal my injuries,” Mazzucca told a news conference outside Kaiser Foundation Hospital in San Diego. “For years, all they would approve were painkilling drugs. These drugs’ side effects have caused more medical problems, including ‘dry mouth syndrome,’ which is insidious and dangerous. The drugs prevent your saliva glands from working properly, causing your teeth and gums to deteriorate.  Mine became infected, abscessed and threatened my health and my life. In 2010, my teeth started cracking and breaking off at the roots. I lost seven of my teeth this way.”

Sedgwick denied the dental treatment I needed, so Ms. Mazzucca took them to court.  In February 2013, the judge ordered Sedgwick to provide this urgent medical treatment. To this day, they have refused to do so. “It has been more than a year and a half since the medical expert the insurer agreed upon said I urgently needed dental care. The pain and infection became so unbearable in July that my doctor sent me to the emergency room, and 25 of my teeth were removed. I then spent the entire month of July in the hospital, in agony, and on painkillers. Kaiser and their insurance company are defying a judge’s order to provide urgently needed medical care,” said Mazzucca.

Today’s release is the fourth in CAAA’s series of cases spotlighting the abuse of Utilization Review (UR) and other methods for delaying and denying legitimate medical care and disability compensation in the workers’ compensation claims handling practices of insurers like Sedgwick Claims Management Services.