Early Action, Stronger Recovery: Managing Spinal Cord Injuries

In this episode of MEC Connect Impact Stories, Tracie Lemus, RN, CCM, MSCC, National Medical Management Consultant at MEC, examines two devastating spinal cord injuries that highlight the life-changing impact of early, coordinated medical management. Through the stories of “Mr. A” and “Mr. B,” listeners gain a behind-the-scenes look at how MEC combines clinical expertise, proactive strategy, and close collaboration to improve outcomes in catastrophic claims.

From missed opportunities in early intervention to the critical role of specialized nurse case management and Centers of Excellence, the episode underscores how timing, communication, and experience shape recovery trajectories. It reflects MEC’s core philosophy—aligning skilled people, proven processes, and innovative solutions to drive meaningful, measurable results.

While the human impact remains central, these Impact Stories also demonstrate how thoughtful, outcome-driven care can help control long-term costs and reduce complications. At its core, this episode highlights MEC’s commitment to improving recovery experiences and delivering lasting value for injured workers, their families and our insureds.

Transcript

Welcome And Why These Stories Matter

SPEAKER_00 0:01

Welcome to MEC Connect Impact Stories for Midwest Employers Casualty. I'm Sarah Hance. This season, our medical management consultants are sharing impact stories. Real-world cases that demonstrate how strategic decision making, oversight, and collaboration can make a meaningful difference in complex claims. Today, Tracy Lemus joins us to discuss managing spinal cord injuries. Let's dive in.

Case A Starts With A T12 Injury

SPEAKER_00 0:28

Thanks, Sarah, for the introduction.

SPEAKER_01 0:30

I'm here today to talk with you about two workers' compensation catastrophic injuries. And my goal is to show what we strive here at Midwest to accomplish. These two injuries were devastating. They're going to have physical and possibly even mental residual effects for the rest of their lives. As an excess carrier, we want to provide clinical insight and strategies on catastrophic injuries. From the get-go, our goal is to get each and every injured person to their best overall outcome. And what that means is from a physical and functional status, from a medical status, as well as a mental and social standpoint. And we also want to do it in the most cost-productive way for our insureds. My first worker, we're going to call him Mr. A. Mr. A was a 33-year-old probation officer who was involved in a one-car motor vehicle accident. The only traumatic injury was that he had a burst fracture to the vertebrae that completely severed his spinal cord at the T12 level. And again, no other injuries occurred other than the spinal cord injury, no other fractures, internal injuries, anything like that. So to give some background, at the T12 level, his lower body function was damaged. So his legs were paralyzed, he couldn't walk, and he had no bowel or bladder control. He did have full use of his hands, arms, and shoulders, though. A thoracic injury can also impact the muscles in the abdominal area and can make it harder to have trunk and core stability as well. So sometimes thoracic injury patients will have problems sitting up straight and controlling that core body function. So unfortunately, as I did note earlier, the spinal cord was severed. And we refer to that as a complete injury, which means there is no signal being transmitted to and from the brain in the spinal cord. It also signifies that there's really no real chance for recovery of his paralysis. So a little social background on him, which is minor. He was married, but he had no children. Okay. So Mr. A was initially admitted to a level two trauma center. They immediately did surgery to stabilize his spine. He actually progressed very well after his surgery. Since he didn't have any other traumatic injuries from the accident, he was actually discharged to an inpatient rehabilitation center seven days later. Now, usually with a spinal cord injury of this type, people are in an acute hospital for much longer than that seven days. Sometimes it can be more like a month or even a few months. There was also not a nurse case manager assigned at the onset of the injury, and the impact of that I'll kind of discuss as I go on. So Mr. A goes to an inpatient rehab center seven days later, and again he does well there too, as he did have good overall strength. He was young and was motivated to recover. He was discharged to home three weeks after that with orders for a home health nursing, some aid care, as well as therapies. Actually, if I'm not mistaken, I think it was one month to the day of the

Why Early Nurse Involvement Changes Outcomes

SPEAKER_01 3:34

injury that he was discharged to home. So we're thinking, wow, that's great, right? It's a really good outcome. Four weeks, he's home. Well, actually, no. This is where at Midwest, our clinical insight and medical strategies impact the recovery of our injured workers. First of all, early nurse involvement from a work comp standpoint is key. They provide relationships with medical provider teams, the families, the injured worker, as well as keeping the adjuster and all the other work comp people informed. Their experience in catastrophic injuries, as well as relationships with number one trauma centers, the actual hospitals, are what makes this whole process so much smoother. So a nurse case manager in the very beginning could have possibly coordinated move to a level one trauma center and could have facilitated movement to a center of excellence. We usually recommend and advocate for admission to a center of excellence. This is a hospital that actually they specialize in spinal cord injuries. There's a team of skilled professionals from nursing to doctors to therapists, nutritionists, along with a large mental health component as well. You know, see, typically after a spinal cord injury, especially with a 33-year-old who was fully functional and active prior to being hurt, this center of excellence focuses on getting him to a point where we can reintegrate him back into society from work to the social interaction part and then to home. So they focus on the injured worker individually and they really make an impact in their recovery and how they will go on with their lives back at home. This is a process that can take several months. It could be from a couple months. I've seen them in there for nine months. It is not only good for the injured worker, but the family, which is an extremely important part of their recovery process, is also provided a lot of training, education, and support because they play a significant role in the injured worker moving forward with their lives. So moving on from the reporting of the claim, which was after he had gotten home, because everything moved so fast. The partnership between us, which is the excess carrier, and the adjuster was point on. The first thing we did was get to a work comp nurse case manager. We got her assigned. She was handpicked because she had experience in spinal cord injuries. And she ultimately was a large part of his recovery, not only from Mr. A, but also for his wife. We did hit some speed bumps as we moved along, though, through his recovery. But the combined expertise of Midwest, the TPA, and the

Preventing UTIs And Skin Breakdowns

SPEAKER_01 6:12

nurse case manager started with the home health company. We had a difficult time with the agency showing up initially, which left him in bed all day. He could not at that time get himself out of bed, showered, and dressed for the day on his own. So the nurse case manager was able to communicate what our expectations were for his care, and she facilitated a more dependable schedule, and he was able to develop a great rapport with his therapist. He continued his rehab and strengthening, which went on for several months. And, you know, normally though, after leaving a center of excellence, he would have been at a stage for outpatient therapy, not home therapy. But with the nurse's direct communication, he got what he needed with home therapy, which is very important. Nurse case manager coordinated his medical care. She spent a lengthier time overall throughout his recovery on instructions to prevent complications. And when complications did arise, she was able to assess and coordinate proper evaluation and treatments swiftly that resulted in a quick recovery. Some examples of these were in the beginning after coming home, he was getting UTIs, urinary tract infections, which is it is very common with spinal cord injury. He needed to be seen in the emergency room a few times, and she was able to coordinate specialized care. And then just some simple ongoing instruction, such as drink more fluids, proper self-catherization, all those techniques stopped the UTIs. We're two years into his injury and he's not had another UTI. Again, a lot of this stuff would have been facilitated at that center of excellence, and would he would have had months to practice that in a facility versus going home on his own. He had a few issues with wounds on his first outing from his home. He wore tennis shoes that he got blisters on one foot from, and that ultimately was healed with surgery. And it was more of a minor surgery. Basically, he simply was just not aware that the new normal for him was that he could not feel blisters forming. But quick assessment by that nurse case manager in coordination with a wound doctor, along with education of skin care to prevent wounds, was the key to healthy skin for him. So at one point, he's shown up to doctor's appointments with signs of minor injury, kind of bruising to open wounds around his ankles and feet. So the great communication, honestly, between myself and the nurse case manager, who in turn had great communication with Mr. A, all of this combined, we came to determine that he was bumping his feet on door jams and walls, which was causing the injuries. It was determined he was actually going barefoot while in the house because when he wore shoes and placed his feet on the wheelchair rests, they were falling off of the wheelchair rests. He needed larger foot rests. So on direction, the nurse approached the treating doctor and said, listen, this is what's happening. And we got him new rest for his wheelchair. It stopped the problem of injuries. And again, two years later, he's not had any wounds or any kind of injuries from that sort of thing. So these examples may seem minor, and they really are, considering the whole injury, but these are the things that can become costly in the future as their bodies are already compromised from spinal cord injury, as well as they're going to age and still have that spinal cord injury. So the early education is key to a successful life, and the nurse case manager was instrumental in that. An integral part of nurse case management was maintaining that contact with him and his wife during his recovery. She monitored his mental ability to cope with his injury, coordinating his medical as well as educating him and his family on the recovery process. He did maintain his motivated state of mind and he has done very well. He's actually returned back to work, to his prior job, in fact. He's stable and has had no reoccurrence of any of the UTI or wound issues, and has not had any new complications as well.

Return To Work And Lessons Learned

SPEAKER_01 10:15

So what I would like to note from Mr. A's injury, Midwest facilitated the onsite nurse case manager and provided our clinical expertise at times, and we promoted very beneficial outcomes. From a fiscal perspective, it's difficult to present a hard number for financial impact, but it is clear to see how effective upfront case management and care was very instrumental in bringing him positive results, and it did set him up for a better future with a spot on court injury.

Case B With An Incomplete C4 Injury

SPEAKER_01 10:45

Okay, the second person I'm gonna discuss will call Mr. B. Mr. B was a 51-year-old police captain who slipped and fell on water, landing on his back. He did hit his head and he did lose consciousness briefly. When he woke up, he was not able to move any of his four extremities at all. He was transferred to a level one trauma center, and a nurse case manager was assigned immediately. This nurse case manager developed a good rapport with both the family and the hospital personnel right away. Mr. B was an incomplete C4 spinal cord injury with central cord syndrome. An incomplete injury means the spinal cord is not severed as it was with Mr. A. So Mr. B's spinal cord could still be able to transmit some signals to and from the brain. So the C4 level is a high level and it is a bad spinal cord injury. Okay. It affects the nerves control and the diaphragm that could lead to breathing difficulties and often requires a ventilator. But fortunately for Mr. B, he didn't have any issues with breathing. He did not require a ventilator and he did well from that standpoint. The C4 level causes loss of arm and leg function as well as bowel and bladder. So basically anything from that neck down, it's going to impact. But with an incomplete injury, they can regain some extremity movement and feeling. So there is a positive side to that, where with Mr. A, there really wasn't. He also had a central cord syndrome. And what that means is it's a type of incomplete spinal cord injury that primarily affects the arms more so than the legs. And it can really impact the fine motor control of the arms. So they really usually will have permanent issues with fine motor finger movements, wrists and hand movements. So that's usually what you see more so with central cord syndrome. Now, Midwest, we did recommend that center of excellence to the TPA and the insured who were completely on board, but the family was a little hesitant because it was out of state. There are only a few centers of excellence in the United States. There's four that we routinely like to use, and maybe another four that are also very good if we can't get them into the first four. So that nurse case manager was, again, instrumental due to his report with both the hospital and the family. He was able to go in and discuss the pros and cons of the center of excellence, which ultimately led to him being transferred

Center Of Excellence And Home Readiness

SPEAKER_01 13:20

to that. So we got him into a center of excellence. He too had issues with the urinary tract infections. He had a big issue with self-cathorization. It took a lot to teach him how to do that, but this was treated and educated on while he was in the facility. So when he went home, that was a done deal. He had that under control. He was active in all his therapies. He developed really good strength and coordination in his therapies. They did start to see as he moved along with his recovery that he had some brain issues that were due to hitting his head in the fall. These were addressed and treated. This was mainly memory loss and other minor symptoms. But again, while he was in the facility for the couple of months, they were able to address that. And so when we went home, we were able to address it from an outpatient standpoint. And he has done well. So one of his main issues was the social aspect. There was some dynamics within the family that had the providers concerned when he would be discharged, but they were actually all prior to his injury. And due to the multiple support systems from being in the Center of Excellence, from therapy to mental health, all of this was focused on and addressed before discharge. So once again, when he came home, that part of his injury was well under control. So after three months, he was discharged directly to home and continued to work with that nurse case manager that was initially inside assigned. So that was a really good thing. We were able to reestablish that relationship. He was ambulating with a walker. Ambulating with a walker, yes, that's what I said. He was walking when he left the facility. He was actually also able to fly independently home with his family. So he made significant strides. He didn't require any home health needs, and he was able to go straight to outpatient therapies. He was motivated with all outpatient treatment. And again, we're two years out. He's completed all his therapies. Now he's ambulating with the cane. He's currently living at home independently and has taken a medical retirement. Again, the Midwest TPA insured a nurse case manager was all the keys to his overall success. Midwest was instrumental in the center of excellence choice that provided him with a team of skilled professionals, well versed on spinal cord injuries. He was in a healing environment that addressed not only his medical needs while recovering, but also his psychological needs. Again, as with Mr. A, from a fiscal perspective, it's difficult to present a hard number for financial impact. But again, also clear to see how effective upfront care was in Mr. B's case.

Cost Mitigation And Long Term Success

SPEAKER_01 16:03

Because cost mitigation is an integral part of what Midwest strives to offer, we were eventually able to move Mr. B to our pharmacy provider vendor for all his medications, which did provide a savings of about $200 to $400 a month, depending on what was filled. So even though this is a more minor savings, especially with a catastrophic injury, we're always going to look for any savings that we can offer. So again, what I really want to place impact on is again, hard dollar cost savings is not always able to be measured, especially with these two cases. But I can't say enough how Midwest can impact our injured workers' lives and how our focus in providing oversight on these complex cases can provide optimal return to function and overall successful lives, even though they have a significant spinal cord injury.

SPEAKER_00 16:57

Thank you for listening to MBC Connect.

Final Takeaways And Thanks

SPEAKER_00 17:00

We hope today's impact story offered valuable insight into how thoughtful medical management can influence recovery, return to function, and long-term outcomes for injured workers. Thanks for listening.