[Hpn] Disabled Poor Being Cheated

chance martin streetsheet@sf-homeless-coalition.org
Thu, 21 Dec 2000 13:56:12 -0700

Disabled Poor Being Cheated, Suit Says
Activists contend aid is often illegally denied
Bob Egelko, Chronicle Staff Writer
Thursday, December 21, 2000
©2000 San Francisco Chronicle


Advocates for poor people applying for disability benefits say the state is
illegally denying aid in thousands of cases by manipulating medical evidence
and ignoring the applicants' doctors.

A suit filed yesterday in U.S. District Court in San Francisco accuses the
state Department of Social Services of routinely violating federal
regulations that require the state to give preference to a diagnosis by a
treating physician in deciding whether an applicant is disabled.

In the case of poor applicants, the state often disregards the treating
doctor's diagnosis, or does not even attempt to obtain it, and instead
orders an exam at one of a small number of clinics that do business only
with the government, the suit alleges. It says those "consultative
examinations" are brief and cursory, and frequently find no disability.

"The supervising agencies' overuse of (consultative examinations) as a
substitute for the development of direct evidence drawn from the applicant's
medical record and history affects poor, homeless and mentally ill claimants
disproportionately," the suit says.

As a result, thousands of Californians are improperly denied federal and
state Supplemental Security Income of $700 a month, said attorney Patricia
Wall of the nonprofit Homeless Action Center in Berkeley. She said the SSI
denial also makes them ineligible for Medi-Cal and leaves them dependent on
county hospitals for health care.

"There's a bias against the places where poor people get treated," Wall
said. "A homeless person who's been treated in the San Francisco General
Hospital emergency room dozens of times is sent to a consultative exam . . .
for a few minutes, and the doctor says this person's fine, when the records
would show otherwise."

The suit also accuses federal Social Security Administration officials of
not supervising the state agency, which determines eligibility for the
federal program. A proposed statewide class action filed on behalf of seven
rejected SSI applicants in San Francisco and Alameda counties, the suit asks
for a court order requiring the agencies to stop the allegedly improper use
of consultative exams, and to reconsider all applicants denied because of
those exams. 

The Department of Social Services did not return a telephone call asking for

One of the seven plaintiffs, Edgar Copeland, is described in the suit as a
53-year-old San Francisco man who suffers from depression and anxiety, has
periodic seizures and has been unable to keep a job.

A San Francisco Department of Public Health psychologist diagnosed numerous
physical and mental disorders. But without waiting for that report, the
state's Disability Adult Programs Division ordered a consultative exam,
which found that Copeland's problems were alcohol-related, contrary to his
medical records, the suit said. Denied SSI, Copeland lives on food stamps
and $364 a month in general assistance.

Wall, a lawyer in the suit, said federal regulations allow agencies to order
consultative exams only when records from the applicant's treating physician
are inadequate or unavailable. She said numerous clients have found that the
state agency instead orders the exams as a first resort, always from the
same small group of clinics that depend on government contracts.

"These clinics are, in effect, on the payroll," said Robert Borton, a lawyer
from the firm of Heller Ehrman White & McAuliffe also taking part in the
suit. "They're high-volume providers of this service to the state agency and
the SSA. The exams are done too quickly, scheduled too close together, and
often don't have the advantage of existing medical records or background."

E-mail Bob Egelko at begelko@sfchronicle.com.

©2000 San Francisco Chronicle   Page A28


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