‘I’ve Become a Number’

Edward Garcia often awakes from his nightmare in a sweaty panic over the still-vivid images of co-worker John Thome’s last living moments.

Six years ago, the two Caltrans workers were hit when an 18-wheeler smashed into Thome’s parked truck on the shoulder of the Pomona Freeway. Thome died instantly, and gruesomely. Garcia was pulled out of the burning wreckage with a crushed pelvis, spinal damage and a host of other injuries.

In his dreams, Garcia relives every instant leading up to the horrific crash. He awakes guilt-ridden, with the belief that Thome saved his life by taking the brunt of the impact.

Now something else terrorizes Garcia in the dark stillness of his bedroom, and during his waking hours too.

The state Compensation Insurance Fund, which administers claims for the Department of Transportation and other state agencies, has told him that as of May 1, it no longer would pay $1,800 a month for him to stay in the place he calls home--a breezy apartment in a Santa Monica assisted-living complex where he has been for more than three years.

“I thought that when you were injured, people stand by you. But it’s not that way,” Garcia said softly, almost wistfully. “The fact is, I’ve become a number to them, not a person.”

Like thousands of other sick and injured workers, Garcia is indeed locked in a numbers game.

Every day, California’s vast workers’ compensation apparatus--its claims adjusters and caseworkers, its lawyers and judges, and even its fraud investigators--must try to put a price tag on how much should be spent to rehabilitate people just like him. The interests of workers trying to get better must be compromised with those of employers trying to keep a lid on costs.

Disagreements are often prolonged and contentious, especially in “catastrophic” cases such as Garcia’s, where a worker may have mental as well as physical injuries that are enormously expensive to treat and could prevent them from ever returning to work, according to Ed Woodward of the California Workers’ Compensation Institute.

“How do you fix someone’s life?” asked Woodward. “It is very difficult.”

In Garcia’s case, he said Caltrans was good to him in his 12 years on the job, tending to freeway shrubbery, supervising work crews and operating heavy equipment. And he said it was generous afterward, during his initial recovery.

The state fund paid for more than a dozen surgeries, endless rounds of doctor visits, rehabilitation, medication and intensive psychological counseling. It paid for a specially designed computer, orthopedic chair and many other amenities, Garcia said. And the state is still paying for him to receive around-the-clock attendant care.

But Caltrans and its claims administrators are adamant about no longer paying for board and care at the facility, according to Garcia’s case manager, Richard Dier.

And that hurts Garcia, 52, who says he gave his prime working years to Caltrans. For him, it’s not just an apartment they are asking him to give up.

The brightly lit, ground-floor unit just east of Pacific Palisades has been a sanctuary, a safe place for a broken man to try and heal his wounds and, in his own words, gingerly try to “rejoin society.” It is not so important because of his physical injuries, but because Garcia is so traumatized, his doctors say, that he may never be able to fully care for himself.

Since moving to the Montana Gardens complex, Garcia has made progress in overcoming the emotional scars that made him an obese, paranoid recluse who had lost touch with all friends and family, and even, at times, the will to live, Dier and Garcia’s doctors say.

“This is my spot where I assure myself that everything is OK, that the world is still here and that I can live in it,” Garcia said, looking out his bay window at a trio of date palms.

Garcia had begun taking job training classes, learning computer skills and even venturing out, tentatively, into the world. Forcing him to move--even to another assisted-living complex--would destabilize Garcia, Dier said.

The state doesn’t see it that way.

Representatives of the claims administrator as well as Caltrans said they could not comment on any aspect of the case.

But Dier and Garcia’s lawyer, Todd Kelly, said the state fund has decreed, essentially, that Garcia must begin gaining some independence, including paying for his own living arrangements out of the $1,700 he receives in monthly disability pay.

The state fund also has moved to cut off payments for Dier, who for more than five years has helped shepherd Garcia through the maze of doctor visits, therapy and haggling over claims. Garcia’s doctors--including one appointed by the state fund--oppose that too, saying it would be tremendously detrimental to whatever recovery Garcia can hope to attain.

The state claims adjuster’s refusal to budge on the board and care payments prompted Kelly to seek redress through the Workers’ Compensation Appeals Board. A hearing is set for May 17.

For the time being, Garcia’s landlord isn’t forcing the issue, and Kelly’s firm has offered to cover his rent for a month or so.

Other Issues Also Cloud the Future

But whether an appeals board judge orders the state fund to reverse course and pay for Garcia’s assisted-living needs--and if so, for how long--is just one issue that weighs heavily on his mind.

Lawyers are also clashing over other matters, such as whether the state fund should pay for the Jenny Craig diet food that his doctors recommend, and for medications Garcia requires that are not directly related to his injuries.

But because of what seem to be escalating questions about what is covered, Kelly is trying to negotiate a lump-sum settlement for Garcia in lieu of lifetime care. He has proposed a $3.5-million payout.

Even more so, he said, his client needs the peace of mind that comes from not having to engage in skirmishes with the state.

So far, the state has not responded, Kelly said, adding that he thinks the sudden rent cutoff--given with 30 days notice--is “a strong-arm tactic to get Ed to accept a low settlement.”

For now, all Garcia can think about is whether he can stay at Montana Gardens. A large and usually gentle man, he said he is bewildered by the entire situation. He’s despondent and anxious, Dier and Kelly said. They said he again is bursting into the kind of uncontrollable rage that was frequent before he began taking a potent cocktail of antidepressants.

Consumed by his rent payment cutoff, Garcia now skips his classes, doctor visits and pretty much everything else in his recovery regimen.

“I didn’t ask to be hit by the truck,” he said. “I’m not asking for a golden bathtub. All I’m asking for is a shot at making the best life for myself. I think that’s what John would want for me. . . . Instead I’m involved in a full-out war.”