SHAME! How Michigan Lawmakers and the Insurance Lobby Failed the State's Catastrophically Injured

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Richard Helppie

Hello, welcome to The Common Bridge. I'm your host, Richard Helppie. Today we have with us Dr. Owen Perlman to talk about changes in insurance. It is in the state of Michigan, but it does have national implications; something everybody should be aware of, particularly in these times of insufficient reporting. The Common Bridge, of course, is available on substack.com. Just go to substack.com enter the Common Bridge in the search bar and subscribe. We are on most major podcast outlets, YouTube TV, and of course, if you've got the Radio Garden app and Mission Control Radio with our good friend and contributor, Carl Bingle. Dr. Perlman is a graduate of the University of Michigan Medical School, he completed his residency in physical medicine and rehabilitation at the University of Michigan and served as the chief resident in his senior year. He's board certified in physical medicine and rehabilitation and he practices today, in Ann Arbor, Michigan. We recently had an episode on to talk about the $400 coming back to drivers in Michigan, and what some of the costs might be. And today, you're going to hear a lot about the impacts on human beings for this decision. So Dr. Perlman, thank you so much for joining us today. Looking forward to a great conversation. (Dr. Perlman: My pleasure.) Dr. Perlman, our audience likes to know a little bit about our guests, so if you don't mind, could you maybe tell us a little bit about your early days, where did you grow up and maybe a little bit more color on your academic and then a thumbnail of your professional work?

Dr. Owen Perlman

Certainly, I grew up in Detroit right in the city, between Seven and Eight Mile off of Schaffer and went to Henry Ford High School. Totally enjoyed growing up there and took advantage of all the things that were going on at that time. Came out to Ann Arbor in 1969, to go to undergrad and then to medical school and then did my residency all at the University of Michigan. I had a lot of side jobs through those years, including some fun ones. I was a truck driver for Mcinerney Miller Brothers Poultry down in the Eastern Market for a number of years during school breaks. I delivered the Detroit News for many years, as well. And I also had such a thing as what we would call a bagel route or a grocery route on Sunday mornings where I would deliver to customers, as well. In college, I worked as a travel agent and sold trips to the Bahamas and Jamaica, Nassau, Acapulco, etc. to other students and also to teachers who were taking breaks at that time as well and worked as a dishwasher at a sorority house. During my residency, I was moonlighter out at Jackson prison, running the infirmary there on weekends as well.

Richard Helppie

Today you founded a group practice in physical medicine and rehabilitation. Tell us a little bit about that.

Dr. Owen Perlman

So I finished my residency in 1981 and was hired at age 29, to be the Medical Director of the adult inpatient rehabilitation unit. For the 28 years prior to that it had been a 13 bed unit at the old university hospital. But based on what I decided - the approach I wanted to take - we were able to expand that. Within a short period of time, up to about 28 patients per day we were following and they moved us to another floor and gave us a 24 bed unit. In 1984 St. Joseph Mercy Hospital in Ann Arbor wanted to develop a rehabilitation program. They did a national search and fortunately for me, I was hired because they've been they've been great in terms of providing the resources to develop that program. And we immediately developed a 40 bed inpatient rehabilitation unit for patients with brain injuries, spinal cord injuries, strokes, MS, - multiple sclerosis - Parkinson's, etc. And in those days, people who had joint replacements could come to the rehab unit as well. That became what we call CARF Certified. Certified by the Commission on Accreditation of Rehabilitation Facilities. I developed an interest while I was still at the University of Michigan in traumatic brain injury. A real quick story since we're dealing with inflation right now again, some of us that are a little bit older might recall that in 1980, there was rampant inflation. In fact, the inflation got up to as high as 20 percent. And when I was hired for my job, one of the doctors who I worked with, was going to be moving to Portland, Oregon and he was our specialist in spinal cord injury. His name is Fred Maynard. He was really a knowledgeable doctor. And he was unable to move because the inflation was so high that he really couldn't afford the move. Nobody could buy his house. So he stayed. I was still allowed to stay as a medical director of the inpatient unit, but obviously I had to find a different niche. And so my niche became traumatic brain injury and in those days also chronic pain. So when I got over to St. Joe's, we developed a CARF accredited inpatient program with traumatic brain injury. And we were doing well and many people may know who Don Massey is - Don Massey of Don Massey, Cadillac. And Dan's wife, Joyce, unfortunately sustained a significant traumatic brain injury from a motor vehicle accident in the early 1980s. At that time, services in Michigan were just becoming more fully developed. And she got her care out at Craig Hospital in Denver, Colorado - Englewood, Colorado, (Rich Hellpie: Very famous place, yeah.) Exactly right. And when she was coming back Don wanted to find somebody who could manage her care, etc. So he interviewed people and he chose me to manage Joyce's care, we hit it off well. And under those circumstances, he donated a significant amount of money to help us develop the Joyce Massey Traumatic Brain Injury Day Treatment Service, an outpatient program for people who had sustained traumatic brain injuries, which also became CARF accredited. And then additionally, while we were there, we developed a return to work program - just called the McAuley Work Program - in those days for people who had been injured to be able to hone their skills and eventually get back to work, whether it was in factories, schools, etc. and those areas. As I became more involved with traumatic brain injury, I also became the medical director of several post acute residential programs; meaning after people left the hospital, those folks who couldn't go home because their care needs were so great, would go to residential programs where they could be treated and also receive their therapies. Those included programs in southeastern Michigan such as Special Tree and Rainbow Rehabilitation. And so at various times, I was the medical director at Special Tree; I'm still the medical director at Rainbow. Special Tree then merged with another company called Willowbrook Rehabilitation in Brighton, that I was also the medical director of; they are now named Rezalear Neuro, a very fine company and I'm the medical director there as well. I became more involved in the Brain Injury Association of Michigan, and have worked with them for years and years. And ultimately, in the past year, I was unanimously elected to the National Board of the Brain Injury Association of America. I've been involved in - for lack of a better term - I've been involved in the fight to protect and save auto No-fault insurance in the state of Michigan, going back many years, but in particular, since 1992 and 1994, when there were ballot proposals, at which time, we were able to save auto No-fault each time by 66% and 61%. So there the electorate was in support of maintaining auto No-fault.

Richard Helppie

And that foundation, where you've had a lifetime of caring for the long term needs of the acutely injured or the chronically injured. And, of course, brains can't be repaired, they can be retrained to an extent. But a person needing care needs that care and their respiratory functions may continue on, their heart functions may continue on, but they are severely disabled. And what people don't understand about this - and you've enlightened me somewhat with some of the material you sent me - is even a person, a pedestrian, could become horribly injured by an automobile. And we're going to talk today about the personal impacts and what this new legislation does.

Dr. Owen Perlman

Can I set that little background for people? (Rich Helppie: Sure.) Okay. I think it's important for everybody to recognize that both traumatic brain injury and spinal cord injuries really become chronic diseases for these individuals, just like having severe kidney disease or diabetes, etc, where they have to deal with it for the rest of their lives. When a person has a traumatic brain injury. It's not just a question of maybe having problems with their memory. A traumatic brain injury is an alteration of what we would call brain behavior relationships, a fancy way of saying it could impact the person physically, cognitively, emotionally and behaviorally. Physically is obvious; they could be paralyzed on one or both sides of their body, have problems with swallowing, could have a lot of other medical problems like seizures, etc. Cognitively means they could have difficulty being able to focus, pay attention, concentrate, remember, their processing speed can be off. They can have significant problems with what we call executive function - being able to make decisions, being able to understand what's going on around them. Emotionally, because of the changes in their lives, they could have a lot of sadness, because of chronic pain that they could have a lot of depression, etc. and behaviorally, we have many people that become quite impulsive, and their behavior becomes a danger to themselves and others that require a lot of supervision, medications as well. The folks with spinal cord injury, similarly have problems that are also lifelong. In addition to being paralyzed, they can have a lot of what you started to talk about - heart problems and lung problems, cardiac and respiratory problems like that. But they can also have significant problems with their bladder, with their bowel, with what we call spasticity, meaning the ability to control their body so it doesn't tighten up on them, etc. And all those things need to be managed, really, for the rest of their lives, and they need access to therapies for the rest of their lives. Otherwise, they're going to have many complications that will result in them having to go back into the hospital.