In part one of this two-part series, Michelle Despres of One Call shares how she broke her leg while on the job and what happened as she entered the workers’ comp space as an injured worker for the first time.
Picture this: San Antonio, with its beautiful River Walk, Tex-Mex food around every corner, and a conference center large enough to host those in-person events we’ve all been missing for the better part of two years.
When Michelle Despres landed in the city from Jacksonville, Fla., her eyes were set on the big prize: Three whole days of in-person events for the annual American Physical Therapy Association’s (APTA) conference, held February 2-5 this year.
As the vice president of product management and national clinical leader for physical therapy at One Call, Despres was looking forward to the lessons APTA 2022 was bound to provide. Little did she know, the biggest lesson would come not from the city streets themselves.
“San Antonio had experienced unprecedented winter weather,” she recalled.
The roads were wet that chilly afternoon of February 3. Despres reminded herself to walk with caution, because even though it did not appear like it, ice could be a possibility.
“I had crossed this particular crosswalk many times because I had been at the conference a couple of days early for meetings,” she said. “When I went to cross, the light was green. I didn't need to slow down, stop or wait. I kept walking at a rapid clip and stepped off the curb. As soon as my foot hit the ground, I slipped. I heard the snap; I felt the snap.”
Despite a long road to recovery, Michelle is all smiles.
Her leg broke, shattered to the point that one physician later told her it looked like someone had taken hammers to her bone. The pain, she said, was instant. Fortunately, she was surrounded by professionals and students attending a conference all about healing after injury.
“A group of PT students scooped me up, carried me inside the building, called 911, and the ambulance came,” Despres said. (She remains in contact with the Oklahoma-based students to this day.)
Pain control began immediately. Despres was administered opioids in the ambulance, followed by more pain control medication at the hospital. An x-ray and CT scan showed a spiral fracture of Despres’ tibia with comminuted fractures of the tibia and fibula bones. In Despres’ words, “My foot was going east and west, but my leg north and south.”
All the while, Despres was on the phone, communicating with work, her husband, the hotel, and so many others. Her husband was desperately trying to get out of Jacksonville, only to face flight cancelations and delays due to weather. Her colleagues were alerting the right groups within One Call to get her workers’ compensation claim started, her medical bills handled, and her workload off her shoulders.
“I work with a great company. I work with people who are friends. Reaching out to them got things rolling,” she said.
That night, as the initial report of injury was on its way to open Michelle’s workers’ compensation claim, the medical team needed to reduce Despres’ fracture and splint it for her to be admitted to a room. Surgery was slated for the next day.
“Since I couldn't tolerate anybody touching me, they attempted to sedate me with propofol,” Despres said. “That did not work. They came in with ketamine – I had heard the name before, but I didn't know anything about it.”
She soon learned ketamine is an injectable medication used for pain management and surgical anesthesia. It is a very strong drug; however, it can sometimes cause hallucinations.
“The ketamine worked, but induced a really horrific death-ride dream,” Despres shared. “I woke up and asked the doctor, was I dead?”
Michelle rests at the hospial in San Antonio after a severe leg break.
It was not an easy start for Despres. And it would not be smooth sailing for quite some time.
After the fracture was set, she spent the night in the hospital. Early the next morning, her surgeon broke the news – the surgery she needed could keep her off her feet and in San Antonio for up to 12 weeks. In addition, he said travel would require strict accommodations.
“San Antonio is not my home. I didn't have a support system there. Even if I stayed at the Marriott, where I was booked, they weren’t doing room service at that time,” Despres said.
All those years focusing on the biopsychosocial model in workers’ comp became a reality. If Despres were to remain in San Antonio, she would face many factors that could easily become obstacles to her recovery. Where would she go? How would she eat? Who would be able to assist her with her leg out of commission?
The doctor gave her about 25 minutes to see if she could find a surgeon in Jacksonville as well as a safe way home. The choices were to either have full internal fixation and stay in San Antonio up to three months or have an external fixation, which would be enough to get to Jacksonville and find a surgeon willing to take on the internal fixation. Due to the ice storm and cancelled flights, her husband was still in transit. Her claim was in the process of being opened, but an adjuster hadn’t been assigned yet.
“Mind you, it's the next morning. I'm still on a lot of pain control, and I'm by myself. I had nobody there to say, ‘These are good questions’ or ‘Let's talk through it,’” Despres said.
The surgeon did not have any recommendations for where she could go in Jacksonville, but he did do a quick Google search and found a surgeon with reviews and skills he thought would be a good match.
But when Despres called, she was met with an interesting roadblock. The woman who answered told her the Jacksonville surgeon would only treat traumas that happened in Jacksonville.
“I said, ‘What?’ I didn't mean ‘what’ as in I didn't understand what she said. I meant ‘what’ as in that doesn't make any sense.”
After a few more exchanges, Despres was hit with another doozy – the woman told her Florida workers’ comp law states that she couldn't be treated for 90 days post-injury. Despres knew for a fact that was wrong. She hung up the phone.
At a loss and out of time, she went through with the external fixation surgery in San Antonio with the hope that plans could be made for a return to Jacksonville safely to perform the final fixation there.
Michelle's husband arrives in San Antonio to help with logistics and provde emotional support.
After surgery, Despres did not give up on getting home. In the hours that followed, she contacted everyone she could think of to alert them of her situation. She was hopeful for a solution. Her husband finally arrived the evening following her surgery, so she had some assistance.
Her search started with flights out of San Antonio to Jacksonville, but with the type of injury and her risk of blood clots, flight logistics didn’t line up. But One Call came through – the team set up an air ambulance to get her home when she was able to be transferred.
Now all Despres needed was a place to go. Her adjuster and case manager began working with the hospital’s case manager on her transfer plans.
Four days post-injury, the hospital nurse case manager came through with a detailed plan. Despres would be sent to a skilled nursing facility until an outpatient office visit with a surgeon could take place. But the office visit was days away, and it was with the same group she reached out to 25 minutes prior to surgery.
Despres was skeptical of the plan. Knowing multiple transports and appointments could delay surgery for another three to four weeks, she suggested a hospital-to-hospital transfer. After voicing her concerns, she was met with the hospital case manager’s response, “We’ve done what we can.”
In the meantime, Despres’ husband continued making calls. In addition to the calls being made by the adjuster and case manager, the couple reached out to facilities in Jacksonville, to Despres’ co-workers, and to anyone who might be able to get her someplace where her follow-up surgery and appointments would be handled in a way that gave her peace of mind.
“Ultimately, we reached out to a friend who’s a surgeon at a local hospital and explained to him what was going on. He said, ‘Give me 20 minutes,’” Despres said. He got the head of trauma on the phone who said while the trauma center was filled, he’d make it work.
Despres breathed a sigh of relief. One Call’s coordinated air ambulance service took her from her hospital bed to the airfield in San Antonio, then to the airfield in Jacksonville, and finally to the trauma center there.
One Call to the rescue: Michelle takes flight in an air ambulance.
Recovery from that point continued to have its challenges.
Several roadblocks presented themselves at the hospital in Jacksonville, including spending a night in the trauma emergency hallway area while hoping a patient room would become available.
She received so many IV lines between the two hospitals that she still had bruises on her arms eight weeks post-surgery.
She found x-ray imaging from the initial intake in San Antonio was missing from her files.
She had to make several phone calls to get certain medications filled on time.
“When I was discharged, it became abundantly clear I was limited in a lot of ways. I was limited in my ability to get dressed, to bathe independently, and to manage simple tasks,” she said.
Her husband did what he could while also running his own business, but Despres needed more assistance. Her father stepped in. After the unexpected death of his wife last fall, the family was grieving, but he embraced the opportunity to give Despres the hands-on assistance she needed for several weeks following her second surgery in Jacksonville.
“Getting in and out of cars was difficult. Getting in and out of bed was difficult. Getting up from the chair was difficult. I couldn't make a meal because I couldn't stand independently,” Despres explained. “My father, who was dealing with the loss of my mom, came every single day between 5-6 a.m. He helped me with everything until my husband came home in the afternoon."
Despres has faced many trials in her journey thus far, but there have also been triumphs.
For starters, the team at One Call has given her unyielding support. From day one, they eased her mind about care and equipment needs and told her to focus on healing.
“The workers’ compensation component started within two hours of injury. After I talked to my colleague, she reached out to our senior vice president who called me and said, ‘This will be taken care of under work comp. You're on a work trip.’ And she spoke with someone in the emergency room to give them all the pertinent information,” Despres said.
“She did my first notice of injury right away and started making phone calls.”
The One Call team was also quick to help set up accommodations for Despres at home. By the time she was discharged in Jacksonville, a ramp had already been installed at her house. A shower chair had been delivered. Arms for the commode had been sent. Her workload had been distributed amongst her co-workers so she could heal before returning to work remotely.
Above all, Despres’ experience has taught her a lot about the industry she works in every day.
“I have a new perspective on workers’ comp,” she said. “I’ve learned many lessons that I believe will help us improve our industry and better serve injured workers.”
And what are those lessons, exactly? Despres shares her insights in part two of this two-part series.
Michelle's recovery journey is ongoing, but she has learned a lot through the experience.
Written by Autumn Demberger. This article first appeared in Risk & Insurance.
In part two of this two-part series, Michelle Despres of One Call shares the critical workers’ compensation lessons she learned after breaking her leg during a business trip.
Michelle Despres, vice president of product management and national clinical leader for physical therapy at One Call, has had a rough 2022.
While attending the annual American Physical Therapy Association’s conference, held February 2-5 this year, she broke her leg walking across the crosswalk toward the conference center in San Antonio.
“I remember telling myself, ‘It could be slippery. Be super careful.’ But outside, the streets just looked wet,” she noted of the wintry weather conditions that fated February morning.
Still, she slipped and fell, resulting in a spiral fracture of her tibia with comminuted fractures of the tibia and fibula bones. In part one of this two-part series, Despres shared her story, from day one of her injury through her weeks of recovery.
“I had two surgeries in two cities, I've gotten 14 incisions, and I was hospitalized for nine days,” Despres said, who has 24 years of experience as a physical therapist in the workers’ comp space.
Throughout her recovery, Despres has had the opportunity to reflect on her workers’ compensation journey. Below, she shares the top lessons she’s learned throughout her harrowing experience.
Hear from Michelle as she shares her story and lessons learned.
Despres faced several challenges during her initial intake at a hospital in San Antonio, most importantly around where she would spend her time healing. As a Jacksonville, Fla. resident, Despres couldn’t spend the 12-week recovery period away from her home and support system.
She spent countless hours on the phone trying to get back to a familiar place to heal.
“Getting injured in a city that was not my home created unique problems, and the care coordination from the San Antonio hospital team was lacking,” Despres said. “I was pushed to make medical decisions quickly and alone. The physician did not suggest a viable plan, and the hospital case manager was not willing to find a better solution.”
She said it felt like the hospital team checked the boxes and left early for the day. She added that she was lucky, because she and her husband had a friend who was a surgeon in Jacksonville. He was able to help facilitate a hospital-to-hospital transfer and streamline next steps, which included the final surgery that occurred a day after traveling via air ambulance to Jacksonville.
But most injured workers are entering the workers’ compensation system for the first time and don’t have the same knowledge. Sometimes, she added, they might think they have the right advocacy, but they don’t. “I had a hospital case manager. It's her job is to make sure things are done right,” she stated. Unfortunately, the case manager left Despres feeling disappointed. Even something as minor as trying to get pain management medication or a muscle relaxer at night was a challenge.
Despres had to fight for her own voice to be heard, but that shouldn’t be the case in this industry.
Despite the challenges, Michelle tries to stay active and spend quality time with friends and family.
While dealing with a shattered bone, Despres had to figure out where to go and how to get there without much help from the San Antonio-based hospital team. The logistics of her injury — being in a different city, waiting for her husband to join her (hampered by flight delays/cancellations), having to make quick decisions about her care while also in pain — made for a mountain of stress that weighed on her.
Once Despres was back in her own home, she noticed other components of the biopsychosocial model at play during her road to recovery.
“My husband owns a business. He is not able to be a full-time caregiver and run his business,” she said. “It’s a challenging situation. We've always shared housekeeping responsibilities – the laundry, meals, and house cleaning. Now, he's doing all of that, and I'm doing very little. It’s stressful for him and frustrating for both of us.”
Despres unexpectedly lost her mother last year, as well, and the grief is still raw. Even though her physical injury requires time and attention, the emotional wounds from the loss of her mother require time too.
She’s also an active person. “I'm a hiker, runner, cyclist, and dancer – all things not currently possible because of my injury,” she said. She was very concerned about her ability to resume these activities, but first, she had to learn to walk again.
At home, she and her husband had to pause several ongoing renovation projects, leaving her personal space in a bit of disarray with no clear resolution date. She’s now at the point where she can use a short-rolling stool to do laundry and work on floor-level projects again.
“Significant injuries create numerous small and large challenges,” she said of the key lesson the industry can take from her experience. “It’s frustrating having to depend on others. The earlier independence is achieved, the better. Sometimes, that independence is measured via small victories.”
For her, a small victory was being able to put on her pants by herself — an everyday task we take for granted until we can’t do it anymore.
As she continues to recover, Michelle places an even greater value on collaboration from all parties within the industry.
During her stint in San Antonio, Despres quickly learned there was a gap in the workers’ comp system when it came to information being provided by healthcare folks who should be workers’ comp experts.
“If you work at an orthopedic practice and your title is workers’ compensation coordinator, you should have a solid understanding of your physicians and workers’ comp regulations. You should not be telling people incorrect information. Lacking knowledge of basic aspects can derail the solution,” she said.
Her real-life example came in the form of a phone call with a Jacksonville-based surgeon’s office where the woman on the phone told her Florida workers’ comp law states she couldn't be treated for 90 days post-injury.
As someone who works in this industry, Despres knew that information was wrong; however, she is the exception because she works in workers’ comp. Injured workers who are told incorrect information are likely to believe it instead of question it.
Despres experienced additional hurdles in the workers’ compensation process. The pharmacy failed to accept the field case manager’s authorization, and it took numerous phone calls to get the medication filled the next day. In addition, a supplier initially refused to fill the order for her bone stimulator, stating they did not have a prescription. After sending the request up the supervisory chain, Despres discovered they only had one page of the two-page DWC-25 form needed to fill the order, an issue that could have been resolved much earlier in the process.
“There were a few times when alignment was not present. Given I understand the industry, it wasn’t the worst thing that could happen. But someone who's not familiar with the workers’ comp system is not going to know,” she said.
“They're going to assume whatever someone says or does is the right thing, and that may not always be the case. Collaboration and communication amongst all stakeholders matters.”
Michelle and members of the One Call product team who have supported her throughout this journey.
While Despres has had obstacles to overcome, she also has an appreciation for all the things that have gone well.
“Early engagement – the importance of starting care early – is something I talk about often, but now I've lived it,” she said. "This experience confirmed for me that those first steps are so critical. The last steps matter, but the first steps matter even more.”
The support from her adjuster, telephonic and field case managers, employer, and co-workers enabled an early return to work and a sense of normalcy. In fact, ODG lists anticipated return-to-work best practice as 51 days, but the average is approximately 115 days. Despres was able to return to work by day 18. On day 74, her physician approved plane travel. The approval removed all restrictions from her work ability and put her one step closer to full independence.
Workers’ comp is excelling in its use of technology.
“Texting in response to DME requests was fast and easy. We can text any time, from anywhere. That’s not always the case with phone calls,” she said.
Constant communication puts injured workers at ease. Despres’ adjuster worked hard to keep her informed, and her telephonic nurse case manager helped guide the process and identify areas that needed to be addressed. This helped Despres feel in control of her own recovery and provided much-needed peace of mind.
Throughout the ups and downs, if there’s just one thing Despres wants the industry to remember it’s this: injured workers have very little understanding of the system and what to expect.
“They need our guidance, advocacy, and expertise. It could be the difference between a successful recovery journey or one that leads to less desirable and costly outcomes.”
Written by Autumn Demberger. This article first appeared in Risk & Insurance.
As workers’ compensation professionals, we work hard to remove any barriers that could derail an injured worker’s road to recovery. We seek to understand the impact of comorbidities, job responsibilities, and psychosocial factors. Everyone involved in the care journey is expected to be an expert in their area – an expert who delivers exceptional service and products.
With nearly 25 years in this industry, I am a seasoned expert in navigating the workers’ compensation system, especially as it relates to injured worker rehabilitation and physical therapy. On February 3, 2022, I suffered a work-related injury that left my bones shattered, my confidence shaken, and my outlook uncertain. The situation was made even worse when I realized there were many professionals in my field who lacked the knowledge and empathy necessary to fulfill my needs as an injured worker.
Here are just a few critical things I discovered during my journey:
My journey was course-corrected more than once because I have a solid understanding of the system; however, without that knowledge, my recovery would have been delayed and my outcomes potentially disastrous. Unlike me, most injured workers do not possess the understanding or resources to address issues as they arise.
Join me as I share the good, the bad, and the ugly of my personal workers’ compensation recovery journey. Together, we’ll discover better ways to collaborate, educate one another, and ultimately, drive outcomes.