On Thursday, Sam’s mother called in a panic.

"He’s punching holes in the wall, Doc. Please do something."

When he arrived in the clinic, Sam — not his real name — explained that despite every effort on his part, his TDI (temporary disability insurance) check hadn’t come, he couldn’t pay his rent and his landlord evicted him with 24-hour notice. About to be homeless, he became frantic.

Sure, Sam had drug problems in the past, but for two years he had been drug-free and was working happily as a line cook until an infection in his leg caused me to place him on temporary disability. The Disability Compensation Division that is meant to administer the TDI law and the workers’ compensation law is increasingly underfunded and short-staffed. Many hard-working people who live hand to mouth experience long delays. I’ve had two other patients in the past three months lose their homes while waiting for their TDI checks.

Shortages at the Disability Compensation Division also limit its ability to protect the rights of workers injured on the job. Because they must now wait months or even years for a hearing, some unscrupulous carriers and their employer clients have taken advantage of the situation.

As a result, many individuals and their families have been plunged into crisis. It’s an ongoing problem.

Injured workers in Hawaii also experience mounting problems in finding providers willing to care for them. Since 1995 the number of physicians willing to accept workers’ compensation insurance has dropped precipitously from 8 out of 10 to 1 out of 10. Many providers cite administrative delays, problems gaining approval for care and difficulty receiving reimbursement for services rendered in good faith. This is particularly onerous because the reimbursement rates in Hawaii are at rock bottom compared with the rest of the country, while cost of living is at the top.

I recently had the honor of meeting with Dwight Takamine, director of the Department of Labor and Industrial Relations, a longtime advocate for workers’ rights. Together with Dr. Josh Green (D, Kohala-Kona), chairman of the Senate Health Committee, and physician leaders representing occupational medicine, orthopedics and physical medicine, we discussed details of the current crisis. All present reaffirmed their commitment to improving the situation while remaining respectful of the government’s limited resources, challenges faced by employers and views of the insurance industry.

Below are some of the potential solutions under discussion:

» Improve the Disability Compensation Division hearing process by decreasing wait times and enhancing the education of hearing officers.

» Normalize reimbursement of health providers who treat injured workers, and separate rates from Medicare reimbursement, which is expected to decrease as pressure mounts on entitlement programs.

» Establish a system of "Agreed Independent Medical Evaluations" and change the perception of medical experts being used as "hired hands" to deny care.

» Limit the ability of workers’ compensation carriers to use delaying tactics such as "claim denied pending investigation."

There is no quick fix to the problems faced by Hawaii’s workers. It will take time to arrive at a consensus on the best solutions and time to implement them.

No individual has the power to make sweeping changes overnight. Still, Hawaii is failing to address the needs and rights of too many its hard-working people. Corrective action is sorely needed.

Ira Zunin, M.D., M.P.H., M.B.A., is medical director of Manakai o Malama Integrative Healthcare Group and Rehabilitation Center and CEO of Global Advisory Services Inc. Please submit your questions to info@manakaiomalama.com.