by Heather Grace, IPJ Staff Writer

The deadline to get your comments to Legislators regarding AB 369, the ‘Fail First’ bill, is rapidly approaching. My letter is enclosed, below. Won’t you share YOUR story, too?

April 21, 2011

Dear Legislators,

I am writing you today to request that you support AB 369. This legislation is critical to ensuring that medical decisions regarding prescriptions and treatments for pain are made by the direct patient care providers (physicians, nurse practitioners and physician assistants), and not insurance administrators.

AB 369 will help medical professionals do what they do best practice
health care. Step therapy or “fail first” therapy occurs when an insurer requires that other therapies must be tried and must fail, before people with pain can obtain the appropriate treatment, recommended by their physician.

AB 369 will save countless people from permanent disability. I know, because I am a victim of Step Therapy in the CA Worker’s Comp System.

I spent over 9 years working for a medical education company. I started
out as an Intern. Thanks a lot of hard work and dedication, I soon became the company’s Webmaster, as well as Web Department Manager. I loved what I did, truly!

I never dreamed that a spinal injury would change my life forever–especially because it didn’t have to. When I realized something was wrong with my neck (in addition to neck pain and headaches, my arms were going numb) , I did what I was supposed to: I told my employer. Their Workers Compensation carrier examined me and did an x-ray. Seeing no broken bones, they announced it was a ‘soft
tissue injury,’ even though I had a nagging feeling it was something

It took OVER TWO YEARS of heat, ice, physical therapy and Tramadol for
anyone to listen to me. When I finally got an MRI, I was relieved. There was a disc pressing against my spinal cord, causing the numbness. I had an answer! Now they would patch me up, good as new, wouldn’t they? A simple surgery could make things right again. Except, that’s not what happened…

Instead, I got… more of the same. Nerve glides, physical therapy, acupuncture, occupational therapy, over-the-counter medication, muscle relaxers, non-opioid pain relievers, stretching machines, home exercises, TENS units, sound waves, spinal decompression, ultrasound.

It was enough to make me want to lay down and die. I had been working
through all of these useless steps, trying to keep as normal a life as
possible as I was slowly being driven insane, with pain. There was no
rhyme or reason to any of it–it was just a bunch of stall tactics. What did they think would happen? Would I spontaneously heal?

By the time I got disc replacement surgery, I was dropping things. I was useless physically, and the pain was getting worse and worse. I was scared,
confused, mostly really depressed. I’d lost my dream job to a ‘layoff’–my employer got tired of waiting for me to get back to ‘normal.’ This only gave me more time to think about how miserable I was! It felt as though the Work Comp system’s steps were really a bunch of hoops. And, I was too sick to jump through them anymore.

Fail first in the Workers Compensation system is truly akin to medical neglect! No one’s ever that concerned if a certain treatment does not work. Being in a holding pattern–one useless treatment after the next–was hell on earth. I was in such severe pain, I was SUICIDAL. My WC lawyer said his hands were tied. The WC doctor said it was up to the insurer. The insurer refused to give a ‘yes’ or a ‘no’ to a question that should have been a no-brainer.

From the time I reported my injury til the time I got the one treatment
that would actually help–disc replacement surgery–took SEVEN LONG YEARS! That length of time in Worker’s Compensation without the appropriate therapy should be criminal! By the time my surgery was granted, it was too late…

Most people agree that the best they can ask at the end of their lives is a peaceful death. So many people don’t realize that it is possible to live with severe constant pain for years–or worse, for the rest of your life, due to step therapy.

Only when I decided to leave the Work Comp system and seek out a doctor
who could treat my pain, did I find any humanity. Finally, I had a doctor that focused on my symptoms–he was not bound by red tape. Still, he had bad news: because my spinal cord injury has gone untreated for so long, I had developed a nerve injury. There would be no cure for me, the ‘system’
and its hellacious steps had seen to that. I was destined to live with
this pain, indefinitely.

I will remember that day for the rest of my life. I was 33, and I had been in constant pain for almost 5 years. Though I was glad to finally have answers, I never expected I would be
permanently disabled by pain!

There *IS* a fate worse than a painful death, and I am living it. I’ve been given a life sentence, forced into a lifetime of pain. My sin? Trusting a system that did not care if I lived or died. I had begged, pleaded for their help. One WC Adjuster actually quit–I would like to think it was because of the guilt he felt over his part in my case. I told him I was suicidal due to the severity of the pain, and I still didn’t get surgery for another four months!

I’ve been coping with constant pain for nearly a decade now, and I am not even 40 yet. I’ve been in severe constant pain for so long, I cannot remember what it is like to be without it. People take for granted a life lived without pain and I am facing another 40 years of Intractable Pain.

Am I angry? Feel cheated? Sure, absolutely. I wish I had recourse for
what was done to me–a way to prevent WC from doing this to anyone
else, ever again. All I have is my story and the will to fight. And, you have the power of this bill in your hands. Please put an end to the nightmare of ‘fail first.’

You have the power to right a horrible wrong. Maybe not for me, but for
others who are destined to go down the same road I did. Though I am
thankful for good pain management, my life just isn’t the same. CONSTANT, SEVERE PAIN has taken away my ability to work a normal 40-hour per week job. It prevents me from being the productive person I once was. Though my heart and mind are stronger for what I have been through, I am a prisoner in this worn out body.

Now more than ever, we need AB369! PLEASE, HELP PREVENT STEP THERAPY

Improper or inappropriate care invariably leads to more persistent
illness and complications, which is far more expensive in the long run. True health care cost containment can be realized with bills like AB 369. Restoring a much needed balance in the provision of appropriate health care is good for everyone. Please give this bill your support!

Thank you,
Ms. Heather Grace
CA State Leader
American Pain Foundation
Twitter @intractablepain

Want to share your story, and help your legislators understand what AB 369 means to you? Visit to send your letter to legislators, instantly!

© 2011 Intractable Pain Journal & Heather Grace. All rights reserved.