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A Nashville company fires a recently paralyzed teenage employee, cutting off her medical coverage — and raising doubts about health care reform

The Unkindest Cut

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Just after 7 a.m. on Aug. 6, a clear Saturday morning, Chelsie Nitschke was driving south on I-65. Her destination: an Army training seminar for future soldiers.

Since graduating high school, the 18-year-old had made plans to join the armed forces, although not out of patriotism alone. Like so many young Americans without a trust fund or a four-year scholarship, Nitschke chose to enlist "to get a leg up on college before she started," her father, Michael Spencer, tells the Scene.

But in an instant, that future — and Nitschke's life — changed forever.

Without warning, the right front tire of her '02 Chrysler 300 came loose. It jettisoned from the car, causing the frightened teenager to lose control of the automobile. Panicked, she called her father for help once the vehicle came to a stop.

"I was explaining to her to call the police," Spencer recalls. "I was in the middle of talking to her [and] I wasn't quite sure what happened because the phone kind of went silent for a second."

That second of interruption was a minivan smashing into Nitschke's car, totaling it.

During and after the collision, Spencer says, the phone connection with his daughter remained active. On his end, he could hear her crying out in pain, helpless and bleeding.

Minutes later, police, firefighters and EMS responders converged on the scene. They cut Nitschke out of the twisted wreck, and she was soon rushed to Vanderbilt University Medical Center, her life hanging in the balance.

After she arrived at the intensive care unit, medical personnel conducted a full-body CAT scan. The news was devastating. The aspiring radiologist had sustained a broken neck with a fracture in her C4 vertebrae. The accident left Nitschke, who was slated to begin her basic training this October, virtually paralyzed from the neck down.

But more bad news was yet to come. What happened to Nitschke next — which her family regards as insult on top of catastrophic injury — illustrates some of the severe limitations of the "reformed" health care system.

Just days after the accident, Nitschke's employer, Plasma Biological Services, terminated her job as file clerk, a position she'd held for little more than a month. The firing meant that Nitschke's employer-provided health care coverage with Blue Cross-Blue Shield of Tennessee would be terminated as well.

The 2010 Patient Protection and Affordable Care Act — the much-maligned "Obamacare" — neither provides a public option nor fundamentally reforms the American for-profit system of employer-provided coverage. Thus Nitschke's family is now scrambling to find a means to cover her mounting medical bills. These will likely add up to tens of thousands of dollars.

So far, their options are limited. There's COBRA, the federal program that offers health coverage to workers who have lost their benefits. Then there's TennCare, the state system that offers Medicaid assistance to children, mothers and the disabled in the Volunteer State.

But those choices are as problematic as they are narrow. Due to the lapse of post-recessionary congressional assistance — which until last year covered much of COBRA-related premiums for the nation's most vulnerable — Nitschke would have to pay 100 percent of any premiums even if a bureaucrat deems her eligible for the costly program.

As for TennCare, although it occupies a quarter of the state's budget with 1.2 million on the rolls, it was dramatically slashed under former Gov. Phil Bredesen. The program purged 170,000 adults in an effort to save $1 billion in spending between 2005 and 2009 — a move that was recently lauded by the credit rating agency (and toxic housing-loan enabler) Moody's. Nitschke has applied, but since budget cuts have reduced reimbursements to hospitals, she — like everyone already enrolled in the program — would likely endure reduced services.

At first blush, Plasma Biological Services' decision to fire Nitschke might appear to run afoul of the federal Family & Medical Leave Act. The law mandates that companies with more than 50 workers in a 75-mile radius must grant up to 12 weeks of paid medical leave for employees with a serious health condition. PBS' parent company, Memphis-based The Interstate Companies, maintains plasma facilities and blood banks across more than a dozen states.

Due to a clause, however, that stipulates employees are only eligible if they have worked for an employer for at least 12 months, it appears that PBS was well within its federal rights. To Chelsie Nitschke's family, that leaves their newly paralyzed teenage daughter without medical benefits at the time she needs them most.

Larry Moss, president of The Interstate Companies, tells the Scene that because of her accident, Nitschke could not meet the requisite minimum 32-hour work week required of any worker to qualify for the company's health plan, and that keeping her on the payroll would've resulted in her coverage being dropped anyway.

"If we don't terminate her, she can't qualify for COBRA and she can't extend the insurance," Moss says. "And if she stays on the payroll and is not working the number of hours that it takes to qualify her for our medical program, then she gets dropped from the insurance and she has nothing. That's what we're trying to do for her."

Although Moss acknowledges that COBRA coverage carries with it "a different set of premiums," he bristles at the words "fired" and terminated."

"I understand it's traumatic to have what has happened to her family," he says. "To have someone say she's being terminated, it doesn't sound good, and I understand it doesn't sound good, but it's so she can continue to have insurance."

The entire situation has left Nitschke among an estimated one-fifth of Americans who report struggling to pay their medical bills, according to a Gallup-Lifeways poll conducted in late 2009. Thanks to the ongoing recession, that number is probably higher, as a more recent version of the poll depicts a 1.9 percent drop between July 2008 and July 2010 in the number of Americans who have basic access to health care.

And since the state of Tennessee has no regulations concerning terminations, Nitschke's only course of legal redress is with the American Disabilities Act, which generally applies to litigants on a case-by-case basis due to the variable circumstances experienced by claimants.

"These kinds of cases are very, very fact-dependent," says Nashville labor attorney Douglas Janney. "You can't make sweeping generalizations. If there's no chance that [Nitschke could perform another duty], I don't think the employer is obligated.

"But it doesn't mean they can't try and find something for her," he adds. "They could be a good employer, you know, and keep her on in some capacity." Moss says Nitschke is welcome to reapply for a job if she's able to work in the future.

Janney says PBS could have made some reasonable accommodation for the injured file clerk — for example, giving her a couple of months to recuperate, then return to answer the phones or perform other tasks that wouldn't displace current workers. But Spencer says not only was no accommodation considered, his daughter was terminated without being given a reason.

Now Nitschke is undergoing intensive physical therapy at the nationally recognized Shepherd Center in Atlanta, which specializes in brain injuries and spinal injury rehabilitation. Her stay is estimated at six weeks.

In the meantime, Spencer says he remains angry and frustrated by the way Plasma Biological Services treated his daughter.

"It's outrageous to me that they could do something like this," he says. "I guess when you're laid up in the hospital with a broken neck and you can't go to work, then you're fired."

Email editor@nashvillescene.com.

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