A decorated firefighter, Rusty Butler spent more than two decades running into burning buildings for the city of Jacksonville.
In 1996, he had to retire. He was diagnosed with heart disease and high blood pressure.
He retired qualifying for Florida's Heart/Lung bill, which mandates that police and firefighters' medical bills related to heart disease and high blood pressure be paid for because the conditions are presumed connected with their jobs.
For seven years, Butler said he had no problems getting heart-related medical bills paid, but something changed in 2003:
The city stopped paying and started denying.
Since mid-November, First Coast News has investigated why Jacksonville denied Butler and hundreds of other police and firefighters their benefits. But the city office of general counsel and the city's risk manager would not comment. Finally, Jacksonville Mayor John Peyton has come out to discuss the matter, but with slim results and few explanations.
According to information provided by the city, since 2006 the number of heart and lung workers' compensation cases being denied has continued to rise, from 30 percent in 2006 to 71 percent in 2007 to 72 percent in 2010. More than 65 percent of cases were denied over five years.
Peyton, the city Office of General Counsel and the city's risk manager would not comment. Last week, Peyton said that the city is trying to cooperate.
"We take our claims seriously and we try to protect employees' interest; we also try to protect the taxpayers interest."
When asked about the 65 percent of police officers and firefighters dealing with denied claims, the mayor said that not all claims are valid.
"Not everything that happens to a human while they are working for the city is covered. That's just not an accurate statement," he said. "We try to strike a fine balance making sure we have a fair and equitable workplace, and also protecting the taxpayers' interest where claims need to be investigated. It's a fine balance."
Retired judge Ivy Cream-Harris said she has handled hundreds of workers' compensation cases in 17 years on the bench.
"Very simply, it creates a presumption that if you have a condition related to hypertension, tuberculosis, heart disease then ... it was job related. Therefore it's compensable under worker's compensation," said Cream-Harris.
Cream-Harris said because the presumption is there in favor of firefighters and law enforcement, the burden falls on the city to prove the condition is not job related.
"It's not an automatic. It's not a proverbial slam dunk...If the city can't come forward with sufficient evidence, it's automatic," said Cream-Harris.
When asked about the hundreds of thousands in taxpayer money used to investigate comp claims, and take (claims) to court only to have the city end up paying for the benefits, Peyton said the city is obligated to challenge all claims it thinks are illegitimate.
"It is our job to protect the taxpayers' interest," Peyton said.
He defended employees in the risk management department saying they take their jobs seriously and protect taxpayer interests.
"I respect your efforts to get to the bottom of this, but this is virtual tabloid journalism because the reality is we have very smart, capable people that take their job seriously. Yes, there are lawyers who make a living pursuing these claims...but we have a job to do and that is to protect taxpayer interest and also create a fair workplace."
In fact, lawyers representing police and firefighters are making hundreds of thousands of dollars on denied heart and lung cases.
In five cases reviewed by First Coast News, taxpayer dollars reimbursed more than $241,000 to attorneys representing claimants because the city lost in court.
The city has not provided a total of how much money has been spent on legal fees, and Peyton said he could not talk about the amount of fraud that was caught.
"Let me tell you there are HIPAA (medical privacy) laws that keep us from disclosing any kind of medical records as you know and as you should respect so were gonna comply with the law," he said.
"We take seriously the notion of trying to find folks that are gaming the system; that's what we do to protect the taxpayers. That's our obligation. We're going to continue to do that."
The cost benefits of pursuing workers' compensation cases are on the shoulders of city workers who process the claims.
"They're paid to make the judgement call on which cases they think are legitimate, which ones are being used to game the system and take advantage of taxpayer dollars," said Peyton.
"There's never been a time where we need to scrutinize government spending more than we do now. And this is an area where we think we can capture savings if the system is not being respected and managed properly."
When we asked how much in savings, the mayor replied, "Whatever the managers think is the balance between following the case and getting the return. And you have to make that adjustment."
When asked for records of cost savings from workers' compensation fraud investigations, Peyton said the city was prepared to comply with public records requests. "You're entitled to that and whatever you want, you are going to get as long as we are not in violation of HIPAA laws. That's the only reason we would not share, is if we were in violation of HIPAA laws."
But Peyton said he could not say if fraud had been caught. He said, "I can promise you that we have caught fraud in our efforts over time."
He told First Coast News, "I think the way you're handling the story is irresponsible."
First Coast News has requested numerous documents from the city:
- In September 2010, we asked for the amounts of money being spent on surveillance of city workers in the last five years.
- In November, we asked for the amount of money being paid to Jacksonville doctors and surveillance video done on workers comp cases.
- In December, we sent 41 questions to the city since it refused to interview. We asked for the number of cases.
- We asked why cases were being denied and the amount of money spent on surveillance and attorneys fees.
- We asked how many fraud cases have been found.
- We asked about the doctors the city was using and why the city was sending injured workers to out-of-county doctors.
- In January 2011, we asked for more detailed answers to the number of cases handled. We asked for more information on the amount of money paid to attorneys.
- We asked for a videotaped deposition for one case.
We are still waiting.
Peyton said the city complies with Sunshine Laws. "We share info all day, every day and I think the way you're handling the story is irresponsible."
"We challenge claims that we don't think are legitimate," he said. "They have to make a judgement call on legitimate claims and illegitimate claims, and we got to protect the taxpayer in the process and that's what they try to do everyday."
First Coast News investigated the doctors the city was using to examine patients making workers' compensation claims.
A breakdown of how much nine doctors selected from the city's 2009 directory were paid by the city in the last three years showed some made a few hundred dollars. But two brothers who specialize in orthopedics were paid $1.3 million over three years.
When asked about the doctors being used by the city, Peyton said, "just because you think it appears some are being used more than others, doesn't mean it's a fact, number one. Number two, we have the right to use whoever we want; that's part of the process. These managers are hired to make management decisions they select doctors they think are effective."
Peyton reiterated "competent managers" at city hall handle workers' compensation claims. "They make the call in what they think is legitimate and what they think is fraudulent."
"And they have to decide, are we going to protect the taxpayer interest when the system is being gamed, or are we gonna try and make sure someone is being treated fairly? And they strike that balance every single day."
After First Coast News' meeting with Peyton, his office called and agreed to an interview with his chief of staff. Hear what the mayor's Chief of Staff Adam Hollingsworth has to say Wednesday on First Coast News at 11.