Excerpted from SEAK’s stream on-demand course, “How to Start, Build, and Run a Successful IME Practice

Tony: Is the surveillance representative of the pathology? I use functional capacities at a time if it’s a complicated case. We want to see what they could do, what they can’t do, and also if they exhibit inappropriate, exaggerated behavior on the functional capacity as well as my exam so at least I have two opinions as to what’s going on.

Steve: Tony.

Tony: Yeah.

Steve: Let me say a word about video surveillance because somebody asked me about that earlier, I think, I don’t remember who it was. Video surveillance. Sometimes you’ll get surveillance from the [inaudible 00:00:37.847] company or the insurance company. They’ll send you a video, okay, and they’ll say we want you to look at the video to see if this impacts your opinion or your opinion about this case. First of all, make sure you’re gonna get paid for watching the video because sometimes the videos go on for quite some time and it’s not “Star Wars.” I mean, you’re watching people getting out of the car, you know, lifting up a little bag or whatever. So the question really becomes, you know, first of all, what’s the condition and what are they doing? Okay? So if the person has a musculoskeletal condition, claims that they can’t…have a bad limp or whatever, are they walking without a limp? Are they carrying something? Okay?

Sometimes they’ll have a bag. You can’t tell from looking at a bag how heavy it is, I don’t think. So the person could have marshmallows in there and it could be 1 pound of marshmallows or it could be 25 cans in there that weigh 45 pounds. So you have to really be somewhat cautious about video surveillance and, you know, reaching the conclusion of just because you have video surveillance, they’re doing something which is inappropriate or inconsistent with your opinion. Now, sometimes it’s pretty clear. You’ll see video surveillance of a person that can’t do anything and then they’ll be shingling a roof and they’ll be walking up and down a ladder to get to a roof and carrying bundles of shingles on their shoulders. And okay, that’s a clear-cut case and, in my mind, we can throw out all the medical diagnostic tests, everything else, if they’re doing that, whatever they’re claiming is not true, obviously, if you could see it. Assuming you get the right person, they could see it. And then there’s all kinds of variations on that. They’ll later say they can only do this for a short amount of time, they caught them on a good day, and so on and so forth.

So my suggestion to you is take a step back when you look at a video surveillance and think about what they’re surveilling and what the person is actually doing. Just because they have a video of somebody walking around doesn’t mean that they’re faking, okay? On the other hand, if they have them walking up and down a ladder or doing construction in their yard, chopping up a tree with an ax, that’s a different story. So you want to take it with a grain of salt as what you’re seeing and make sure that you don’t reach for a conclusion just because they sent you some surveillance. Very often the surveillance is not really very powerful. I mean, it’s a person walking into the house, getting out of a car, and so forth. It’s not always a big expose of, you know, a very clear-cut case of malingering or whatever else you want to call it.

Tony: I agree with that wholeheartedly and let me give you these couple of examples. I got sent this individual to treat him for a low back condition, okay. And I examined him and he had a mechanical low back pain and I called the case manager and I said, “Okay, I want to treat him with therapy for two weeks, passive-active modality. “Dr. Dordo [SP], didn’t you see the surveillance video?” I said, “No. Where is it?” He says, “We’ll send it to you.” So they sent it and I look at it and I look at it at home when everybody’s quiet and it showed this person with an SUV and there was a little boy there, person was smoking, and they had a little dog and the guy was bringing stuff in and out of the house. Oh, okay. So I had them send him back for a second evaluation. And my office overlooks the parking lot. He drove up, he had an SUV, but it was a green SUV, the one in the video was a brown SUV. Okay. The individual, I asked about his social history, he was a non-smoker. The person in the video was smoking.

Steve: I could see there might be a problem here, but go ahead.

Tony: Then I asked…he came with his little son and I said, “You know, I could make you a dog out of this balloon. You want it?” “Oh, no, no, no. We’re not allowed to have dogs, I’m allergic.” In the video was a dog. To make a long story very short, they got the wrong person. They did, it was the wrong person. And I called him up and I said, “Don’t show that video to anybody else, you got the wrong person for whatever reason.” I said, “Oh, Dr. Dordo, it’s a new company we’re using, we’ll never use them again.” Okay. So I went on to treat him, he got better and went back to the work.

Steve: I have…

Tony: Let me just finish this. When you look at surveillance video, you want to be sure you could clearly identify the person. You want to be sure that if they’re in a car, they’re driving and you got the driver’s plates, plate lumber, and are they driving and what kind of vehicle it is. And are they doing sufficient physical effort that allows them to work? For example, I had a guy who was a roofer, hurt his back. They did a hemilaminectomy. So they had surveillance video of him coming out of Publix with a shopping…a small bag, put it in the trunk, and then driving off. That’s nothing, that’s not a big deal. But the best case of all that really brings this out is the following case. Steve, you want to say something?

Steve: No, you’re good.

Tony: Okay. I got a call from this case manager, “Dr. Dordo. We have a paraplegic for you to examine and we’re getting ready to pay off on a $3.5 million life care plan, but we won’t do it until we get your IME report.” Okay. Send her. So here’s the story. She was a big gal. She worked as an animal technician for a large veterinary clinic. She picked up a large dog, weighed 125 pounds. She said the dog struggled, she twisted her spine. They worked her up and she had two herniated discs, L4-5 and L5-S1. So they operated on what they felt was to be the most symptomatic one, L5-S1, sent her away. She still had pain, got her back and they operated at the next level, L4 and 5, sent her away.

The pain got worse. They did an MRI and they realized that she had an epidural bleed, she had an epidural hematoma, which was pressing on the cauda equina and she became paraparetic. They operated on for the third time. They evacuated the clot and they sealed up the bleeder. She spent a month-and-a-half in a good rehab hospital, a good rehab hospital. She was in a motorized wheelchair. She was in her early 40s. Her mother and daughter were getting paid $125 per day to do intermittent catheterizations 4 times per day. They just bought her a wheelchair-accessible van, $40,000. Okay. Plus there was a whole bunch of things in the life care plan they wanted to do.

So she comes in, she’s in a motorized wheelchair. She has shorts on, she’s got a Foley catheter going you know where with a leg bag on the side, half-filled with clear urine. Okay. I examine her, no atrophy. She says she couldn’t feel anything from here down. Reflexes were normal, no pathological reflexes, no spasticity. So I take off her shoes and socks and I did the foot exam and I’m pecking through the toes and I’m looking at her feet and I see she’s got calluses on her feet and on her heels are these little grease stains, these, like, black marks, you see that in people that walk barefooted. I put them back on. I said, “Okay, you can go.” So she leaves. I called up the case manager and I said, “You know, it doesn’t smell kosher, don’t pay that claim. Get some surveillance video on her, there’s more to it than meets the eye.”

Two weeks later, I get surveillance video, she’s at a garage sale. Her house is here, the neighbor’s house is there, and in the middle is an empty lot with a picnic table and an umbrella. And she’s walking back and forth, bringing stuff and selling it, making change and I could identify her. It was her, shorts on, no leg bag, no wheelchair. When it was all over, she goes out to the lot, cranks down the umbrella, lifts it up, walks it over to the house, puts it on the porch, goes back to the table, flips it on the side, folds the legs, pick it up, puts it back and puts it on the side of the patio. Okay. So I put that in my report, what I found and I said, “The woman had recovered, she doesn’t need any of those things,” and I send it in.

Two weeks later, I get more surveillance. And what is she doing? She’s working in her backyard by the pool, knocking down an old rotted wooden fence on her hands and knees, pounding with a hammer, digging up the old rotted wood, and throwing it in a construction company dumpster, back and forth, back and forth, back and forth. Then she must’ve caught wind somebody was in the neighborhood watching her. So what does she do? She goes into the house and she puts on a lumbosacral corset, the type that you see these guys at Home Depot wear, and bilateral Lofstrand crutches, forearm crutches. And she’s walking around like she’s a cripple. She does that for five minutes, then she goes into the house and never comes back again.

I did an addendum to the report and I told them what I saw. I said, “The woman has recovered. She does not need anything in the live kit.” Sent it in. Two weeks later, I get a call from the state attorney’s office. “Dr. Dordo, we have your two reports. We want to come down and take your sworn testimony.” “Come on down.” They swore me in, I gave the testimony. I told them what I saw. They charged her with fraud. She pled guilty. She had to pay back money. Now whether she did jail time or not, I don’t know, I lost track to the case, but that is a most extreme case of malingering and symptom magnifier that I’ve ever come across. Now, who has a Foley catheter put in, you know, to impress the doctor that they need something, okay? But there was a lot of money involved. That was the retirement program for the mother and the daughter.

Excerpted from SEAK’s stream on-demand course, “How to Start, Build, and Run a Successful IME Practice”