Iowa Workers Compensation – Sixteen tons, what do you get… Saint Peter don't you call me 'cause I can't go … I owe my soul to the company store…

The bill before the Iowa Legislature that would grant workers the right to choose their own treating physician isn’t about jobs so much as it’s about respect for another human being and their right to control their own body and what is going to happen to it.

When a worker in Iowa is hurt on the job and needs medical care, it’s covered under the employer’s workers’ compensation insurance. One of the initial decisions is to choose a treating physician. Under Iowa’s workers’ compensation law it is the employer that has the right to choose the treating physicians. So long as what that physician does is “reasonable” the employer can continue to direct the medical care.

But choosing a treating physician really isn’t about what labor backs or employer’s bottom line.

To those not involved with the Iowa workers’ compensation system it may seem like not that big of deal but it is to someone needing surgery. The moment you realize surgery is going to be required that decision becomes the watershed of how you may live the rest of your life. In selecting the physician the employer also selects the anesthesiologist, the surgical team and the hospital. That’s about as un-American as you can get. It’s about as far removed from the Bill of Rights as China is from allowing criticism of corrupt government officials taking bribes and letting dairy producers add melamine to infant formula.

Doctor’s know who has the right to choose them and the doctors can’t help but cozy up to the insurance companies with their opinions. Doctors that are thought by the insurance industry to be “too liberal” are in most instances simply professionals that care deeply for their patients. Those doctors will often times exercise discretion in favor of the patient; rather than what the insurance company wants them to do. The doctors who put marketing ahead of patient care will always cow-tow to the wishes of the insurance adjuster and the case mismanagers. These doctors most workers know as the company doctor because they associate them with the company. This part of Iowa’s workers compensation system reminds me of the town described in the Tennessee Ernie Ford song, Sixteen Tons.  More on that in a minute.

A doctor pandering to the insurance industry isn’t anything new and wouldn’t shock anyone. But consider for a moment that the “insurance industry” isn’t just a big company with educated people running the ship. Insurance adjusters may or may not have a college education. Insurance adjusters aren’t doctors. They don’t hold a medical degree. If the adjuster does have an education that education, or lack thereof, may or may not include subjects like anatomy, physiology, psychology and other subjects that prepare them to understand how to make decisions about medical care. It’s not like that pimply faced kid just out of business school knows anything about medicine. You would think the doctor controls medical care decisions but he/she does not. In practice the adjuster isn’t likely to just go along with the doctor. In my 28 years of practicing workers’ compensation law, the adjuster micro-manages, second guesses and overrides the doctor’s advice. Essentially what happens is the adjuster gets to practice medicine by substituting his or her own judgment for that of the doctors. Yes you can do that test; no you can’t do this one. Yes you can perform and X-ray but no to the CT scan or MRI. Surgery? Why now? Let’s try conservative treatment first and see if a miracle happens. To hell with the idea of permanent nerve damage in the spine; stay the course, no surgery.

Consider for a moment that you are the injured worker. The doctor, that you didn’t select and who really doesn’t even like you has made it clear from the beginning he thinks your just another injured worker trying to get rich off of workers compensation benefits. (The concept of getting rich off of w.c. benefits is just a popular myth. Remember no one every got rich off of $200.00 a week when the bills are $1,500.00 per week.)  The doctor ignores most of what you say, mischaracterizes what you do say and ignores 90% of the questions you ask. You get the picture there isn’t a lot of love in the exam room. So here you are with this doctor now wanting your approval to cut into your back, down to the spine and then with hammer and chisel remove bone spurs and a ruptured disc. If he screws up you’ll live the remainder of your life confined to a wheel chair if lucky, if not so lucky lying in bed or a coffin.

So who selected this surgeon and what made him so qualified? It’s not like anyone gave you the doctor’s credentials and asked you what you think; quite the opposite. You’re pretty much told it’s none of your business, just be quiet and answer his questions. Most of the time there is a high priced spy, called a case manager, hired by the insurance company, who tells the doctor what’s good for the patient and what the insurance company will tolerate to authorize.  She’s probably there looking not too happy that surgery is being recommended. At this moment the doctor just wants you to okay him cutting on you.

Which brings me back to the song Sixteen Tons. All you can think of is, “Saint Peter don't you call me 'cause I can't go, I owe my soul to the company store.” Sixteen Tons sold 20 million copies. Twenty million people knew enough about the company doctor to realize he shouldn’t be cutting into their spine without having first been selected by the patient. Choose your version from YouTube and then sing along, … another day older and we’re deeper in debt….

Tennessee Ernie Ford – 1956 – 20 million copies sold.

Johnny Cash – Live performance. A bit hazy.

Johnny Cash updated version with workers loading coal in a mine.

 SIXTEEN TONS

Some people say a man is made outta mud
A poor man's made outta muscle and blood
Muscle and blood and skin and bones
A mind that's a-weak and a back that's strong

You load sixteen tons, what do you get
Another day older and deeper in debt
Saint Peter don't you call me 'cause I can't go
I owe my soul to the company store

I was born one mornin' when the sun didn't shine
I picked up my shovel and I walked to the mine
I loaded sixteen tons of number nine coal
And the straw boss said "Well, a-bless my soul"

You load sixteen tons, what do you get
Another day older and deeper in debt
Saint Peter don't you call me 'cause I can't go
I owe my soul to the company store

I was born one mornin', it was drizzlin' rain
Fightin' and trouble are my middle name
I was raised in the canebrake by an ol' mama lion
Cain't no-a high-toned woman make me walk the line

You load sixteen tons, what do you get
Another day older and deeper in debt
Saint Peter don't you call me 'cause I can't go
I owe my soul to the company store

If you see me comin', better step aside
A lotta men didn't, a lotta men died
One fist of iron, the other of steel
If the right one don't a-get you
Then the left one will

You load sixteen tons, what do you get
Another day older and deeper in debt
Saint Peter don't you call me 'cause I can't go
I owe my soul to the company store

20 Million Reasons Why Iowa Workers Should Have the Right to Choose the Treating Physician