In the landmark decision of Santiago v. Metro North Railroad, the Administrative Review Board held that Federal Rail Safety Act “Section 20109(c)(1) bars a railroad from denying, delaying, or interfering with an employee’s medical treatment throughout the period of treatment and recovery from a work injury.” The Administrative Review Board also held that a prima facie FRSA violation is established “the instant that the railroad carrier directly or indirectly inserts itself into the process and causes a denial, delay, or interference with the medical treatment.” Such a railroad is liable under the FRSA unless it proves “by clear and convincing evidence that the result would have been the same with or without the railroad’s interference” with the medical treatment.
Now, in a follow up Santiago v. Metro North Railroad Decision, the ARB clarifies what a “clear and convincing” defense requires in medical interference cases.
The facts are these. When a chair at his Railroad work place collapsed as he sat down, Anthony Santiago suffered an injury to his low back. Metro North ordered him to go to its Medical Department, which confirmed he had an occupational back injury and advised him to see an orthopedic physician. For two months Metro North followed its policy of paying the medical bills for occupational injuries. However, when a MRI scan confirmed Santiago had a herniated disc and his doctor prescribed treatment for the disc, Metro North’s Medical Department immediately reclassified Santiago’s occupational back injury as “non-occupational” and refused to pay for the treatment. As a result, Santiago suffered a four month delay in his prescribed treatment and was forced to pay $16,520 in medical expenses out of his own pocket.
The Administrative Law Judge found Metro North illegally interfered with Santiago’s medical treatment when it stopped paying for his medical treatment based on the decision of its Medical Department to reclassify his injury as non-occupational. That left Metro North liable unless it could prove “it was highly probable a reasonable doctor acting independently, without Metro North’s involvement, would have determined that the prescribed treatment was medically unreasonable.” In other words, the Railroad had to prove its interference in the medical treatment did not make any difference because the result would have been the same even in the absence of its interference.
In its follow up Decision affirming the punitive and make whole damages awarded to Santiago, the ARB explains it is not enough for a railroad to present a competing medical opinion. Rather, a railroad has to prove that “any reasonable doctor” would conclude the prescribed treatment was medically unreasonable, and that means every doctor in a pool of independent doctors, not just one doctor paid by the railroad. Merely generating “a debatable point” fails to carry the railroad’s heavy clear and convincing burden of proof. This is a tough standard to meet, but the ARB stressed that “Congress has made it clear that it wants railroad companies to completely stop interfering with the ability of railroad workers to seek proper medical treatment for work injuries.”
For the complete text of the Decisions, here is the first ARB Decision, here is the ALJ’s Decision, and here is the follow up ARB Decision. For more on the FRSA, go to the Rail Whistleblower Library page or the Summary of Rail Whistleblower Rights.