Precedent South Carolina Workers' Compensation "Victory"
for Chronic Lyme Patient
(part 3)
by Kathleen Liporace
This decision in favor of Phil holds promise for those who suffer from chronic Lyme disease. It attests to the authenticity of Lyme, and it underscores the necessity of long-term treatment for chronic Lyme disease. That's important because many insurers now limit treatment to 30 days, resulting in extensive out-of-pocket costs for the continued, long-term treatment of this multi-systemic condition.
Phil was found to be a believable claimant by all Workers' Compensation decision makers. The Commissioner found Wood to be a "credible" individual. The Full Commission "found Mr. Wood to be very credible and it is respectively submitted that his testimony should be accorded the same high level of credibility by this Honorable Appellate Panel."
Despite the overwhelming evidence that supports the case for chronic Lyme disease, there exists a misguided controversy about Lyme due to many health insurers and the "elite" Lyme disease guideline writing members of the Infectious Disease Society of America (herein referred to as the IDSA). Insurers are concerned about the bottom line of money as is clearly confirmed by Phil's case and ongoing struggles by this claimant. Insurer's interest is for profits rather than patients. They push for guidelines, not for better treatment of patients, but solely to manage the cost of patient care.
Insurers are supposed to uphold the doctrine of utmost good faith and yet they are the worst offenders of that pivotal legal doctrine as evidenced in Mr. Wood's legal ordeal to obtain coverage for the disease he contracted while working in the field as a timber buyer. Insurance companies need to be held accountable, by legal action and or legislation that prevent them from denying coverage to patients like Phil Wood who dearly need it. Unfortunately, treating physicians and Lyme patients end up in a position of detrimental reliance with insurers all too often. Physicians need to make a living and Lyme patients need to be able to access affordable, knowledgeable healthcare that is paid for until the patient's health is indemnified. Proof exists which clearly shows that insurers are slowly picking off Lyme literate physicians by instigating bogus actions through medical boards. This predatory practice must stop. For insurers, it is easier to pick off one physician, thereby removing hundreds of patients from their balance sheets. It is a cold, calculated move on the part of insurers that have been left unchecked. Insurers have gone as far as threatening physicians to cease treating Lyme patients.
Insurance companies are aided and abetted by the Infectious Disease Society of America. This organization, as well, does not represent the interests or health of Lyme patients. Their guideline writers have stated conflicts of interest. Some of the IDSA member conflicts of interest are: holding patents on fragments of the bacteria, developing substandard Lyme test kits and performing insurance reviews that deny patients the care that they need. As well, informed consent is also ignored by the IDSA camp that endorses short courses of treatment, when there are two sets of treatment guidelines in the National Guideline Clearinghouse. Notably, as of yet there is no reliable test in existence that assures any patient of being cured after the IDSA's recommended 30 day course of antibiotics.
To date, there exists a sizeable quantity of information on chronic Lyme disease and some of the initial peer-reviewed information on chronic Lyme was written by those IDSA "elite" who now oppose their own prior scientific findings. This definitely raises a red flag! Lyme disease is a health crisis that is ignored. As a result, many are suffering due to an epidemic of ignorance that is rampant in the medical community. An example of this ignorance is that during the course of Phil's legal battle to obtain coverage for Lyme, he was sent by the Defendants to an Infectious Disease physician in Charleston who thought that Phil didn't have Lyme disease. Nor did this doctor believe that Lyme disease even exists in the State of South Carolina. The Defendant's physician was ignorant of even how to interpret a Western Blot Lyme test and was not familiar with even the Centers of Disease Control (herein referred to as CDC) surveillance criteria. This doctor diagnosed Phil with a sleep disorder instead and suggested he get a shot in the foot. Sadly, ignorance travels faster than knowledge.
There are three individuals of the 14 member IDSA guideline writing committee who were also on the nine member panel who wrote the American Academy of Neurology Lyme guidelines. The three common guideline writers are John. J. Halperin, Eugene Shapiro and Gary Wormser. There are no listed conflicts of interest for these men in the American Academy of Neurology (herein referred to as the AAN) Lyme guidelines as those that were disclosed in the IDSA guidelines. There are 8,000 members in the IDSA; however the AAN has 20,000 members. This then gives the IDSA's guidelines an appearance of legitimacy. As a result, these harmful guidelines have been disseminated to 28,000 doctors respectively. Often these physicians take guidelines as gospel truth, without independently, logically examining the claims and interests of the writers. In the final analysis, the conclusions of these writers simply don't make sense in light of the considerable information available on the chronic nature of Lyme disease.
It is notable that the IDSA comes off as being concerned about patient health and not exposing them to needless antibiotics, and thus producing "super bugs". However, the argument doesn't fly when teenagers can have access to years of antibiotics for ACNE and that cattle are routinely given feed that contains antibiotics. So, why are Lyme patients routinely denied coverage for needed antibiotics as seen so clearly in Phil Wood's case? Why are Lyme literate doctors being persecuted for doing right?
The IDSA would like everyone to believe the fallacy that Lyme disease is hard to catch and easy to cure. Unfortunately, the opposite is true. Even the CDC notes that Lyme is underreported by ten-fold annually, so it's certainly not hard to catch. As well, the longer it takes to get diagnosed, the harder the disease is to cure, because it doesn't just circulate in the blood-stream. It has an affinity for collagen and sequesters itself in tissue to evade detection and eradication. Borrelia Burgdorferi, the causative agent of Lyme disease, is quite a sophisticated bacteria with a chromosome (macromolecule) that has 21 plasmids (DNA molecules distinct from the chromosomal DNA and able to replicate autonomously). As well, the bacteria also has 132 genes, compared to syphilis, which only has 22. This is a formidable disease that is not easily cured unless discovered speedily after the initial infection. We are dealing with an under-reported epidemic!
The few, brave, knowledgeable physicians who recognize the numerous manifestations of Lyme, find themselves harassed by insurance companies who hold the purse strings to the profits of their practices. Some have stopped treating Lyme disease, not because they don't know the truth about the chronic nature of the disease, but based on economics and a need to provide for their own families. Other doctors who have continued to stand against insurer tyranny, have been brought before medical boards on trumped up charges and end up losing their licenses or being severely censured for doing what they were taught to do, which is simply to heal the sick. This is a travesty of justice, because it is the very absence of justice to those brave and compassionate doctors. They care for a population of very ill individuals who are often maligned due to a lack of true understanding about the multi-systemic complications of this disease. One such patient whose deposition was taken on behalf of Phil Wood had noted after reading a symptom list for Lyme disease, she had 59 of the 60 symptoms listed!
Patients such as Phil Wood are suffering due to insurers adopting the IDSA guidelines as the only standard of care that they care to recognize. Patients are being defrauded by their own insurers! As a result, Wood's benefits have been further reduced by Liberty Mutual, medical bills remain unpaid, as well as the cost of prescriptions. This is an outrageous conclusion and "settlement" to this case!
People need to realize that Lyme does exist in South Carolina, as it also exists in the remainder of the 50 states. There are a few hundred cases of chronic Lyme disease in the upstate of South Carolina alone, not to mention the thousands across the nation.
Accurate information needs to be widely disseminated to doctors, citizens, industries of every kind and of course politicians. There exists a very real and present need to educate physicians, the general public and government officials about the signs and dangers of Lyme disease so that it can be detected and healed in its earliest and most treatable stage.
It is of utmost importance that advocacy is undertaken with speed and diligence, as the IDSA vigilantly continues, unabated to mow down any attempt on the part of states and the nation to enact meaningful Lyme legislation. This question of their vigilance arises: What does the IDSA stand to lose if proper legislation were in place to bring justice to the many who suffer with Lyme? The answer is likely, a loss of credibility and exposure of their decades of misdeeds in seeking to bury the truth about Lyme disease.
If you would like your chronic illness related legal cases highlighted in an upcoming article, please contact the author at (864) 704-2522 or e-mail at
greenvillelyme@bellsouth.net .
