By Jennifer Moody
Albany Democrat-Herald | Posted: Sunday, October 7, 2007 12:00 am
Christi Freitag's wrist tenses against the rope loop in her therapist's hands. Her freckled arm strains.
She hunches forward, stretching the back of her T-shirt and the words printed there: "The Lord has done great things for us, and we are filled with joy."
"It's not working, it's not working!" the 19-year-old Albany woman calls as her arm slips from the rope, her shoulders thump back onto the cushioned table. Physical therapist Peter Spaulding offers the rope again.
"Pull pull pull pull, come on, come on, pull!" Spaulding calls as Christi struggles to heave her unresponsive torso upright. Her legs twitch reflexively. "Can you get one arm behind you?"
She angles her free arm onto the cushioned table behind her as a prop. Spaulding sits back, smiling.
"That worked OK," he tells her. "We're getting better."
Christi beams, braces glinting, blue eyes bright under blond-streaked bangs. Spaulding chuckles.
"This is Christi," he tells the photographer chronicling the therapy session at Samaritan Albany General Hospital. "She falls, and she smiles."
Some days, it's very hard to smile.
Some days, it's very hard to be who she is, instead of who she used to be.
Christi Freitag's body is paralyzed from the chest down. Her fingers curl in her lap, only partially responsive.
The muscles above the bend in her elbows retain some power, but not enough to fully compensate for what the muscles just below her shoulders used to do. Ace bandages on her legs help keep her blood pressure up so she won't pass out.
She tries not to think about the teenager who used to love to swim and race across town on her bicycle. She concentrates instead on her education, on the single credit she has left to complete to graduate from high school, on the classes she'll take for college and the writer she hopes to become.
She concentrates on who she will be: someone whose gifts will help others like herself, who suddenly find their futures look very different from their pasts.
"Just because you've been injured doesn't mean your whole world ended," she says. "You can choose to sit there and just mope around and let depression take over your life - or you can go out and live your life."
'Don't let me die'
Bandon, Oregon, June 25, 2006. Eight days before Christi's 18th birthday.
It was too cold to swim, so Christi and a friend wandered over to her father's house to jump on the outdoor trampoline.
A family friend who'd come over for dinner joined them on the trampoline for a game called "crack the egg." Christi wrapped herself into a tight ball and the others jumped around her, trying to make her unfold.
When she did, she didn't so much roll as flop. And the world went numb.
Doctors told her later the way her neck bent made her spine shift and fold, pinching it under her skull like a wad of Play-Doh.
All Christi knew was she suddenly felt nothing from her chest down. She yelled for her friend to call 911. And she began to cry.
"I was scared. I thought I was going to die," she says. "I was crying when my mom got there, and I kept apologizing to her."
Her mother, Deanna, was always getting on her case about wearing a helmet when she rode her bike. Being safe. Remember, she'd tell her, we don't have medical insurance. Don't you get in an accident and leave me to pay all those bills.
That was all Christi could think of as the paramedics arrived - that, and whether she would make it. "Please, God," she remembers begging, "don't let me die."
The next few days blurred past. A flight to Oregon Health & Science University. Spinal column fusion surgery. Lung collapse. Oxygen deprivation leading to an hourlong grand mal seizure. A doctor telling her mother: "I have never had anybody come back who's been gone this long."
Deanna remembers being met by "a big John Goodman-looking guy, with reading glasses on the end of his nose and a clipboard in hand," in the waiting room of OHSU.
"He asked questions about Christi's history and the accident, and then moved closer to me and said I had to make an immediate decision that was going to affect Christi for the rest of her life," she says. "He asked if I was willing to stay with Christi, even move into the hospital to learn her care and take care of her so that I could take her home some day - or she would be placed in a nursing facility and the state would assume her care.
"He said that I had to decide right away. I replied, 'I'm not leaving her.'"
Christi remembers waking up with something in her throat: the tracheotomy tube she would wear for the next three months. She had to relearn how to breathe.
The doctor would turn off the ventilator for a few minutes at a time so she could make her lungs work on their own. The experience terrified her. "I just lay there, bawling and crying because I wanted to be on the ventilator," she recalls.
She was in rehab at Legacy Emanuel Hospital in Portland when a nurse dropped her, causing a new break in her neck. By the time doctors found the break it had calcified, forcing them to rebreak it to allow another fusion surgery.
"Christi and I felt like we woke up one day on Mars, where nothing would ever be the same again," Deanna says.
Finding the balance
Christi's parents had divorced years ago. Deanna left her job as a school bus driver to be by her daughter's side, and the two of them moved to Albany last fall after she got out of the hospital. Christi's two older brothers live here, and an older sister lives in Alaska.
They needed help - medical and educational - and Linn-Benton Community College was a magnet.
"Bandon has no resources," Deanna says. "It's a tiny little place with three stoplights. So we moved here."
Now mother and daughter work each day to strike the balance between family love and too much dependence, between empowerment and disability.
Every day, something happens to make them renegotiate that balance. On this particular day, it's transportation.
The handicapped-accessible van wouldn't start, so Christi took a taxi to her therapy appointment. Her mother had to lift her in and out of the vehicle and into an old folding wheelchair that had belonged to her grandmother.
Still, Deanna says, she doesn't like to stay with Christi during therapy. That's Christi's time, to learn what she needs by herself.
They are grateful for help they've received. A friend helped them find a decommissioned medical transport van, which people in Bandon helped to pay for.
Greater Albany Public Schools made arrangements for Christi to finish her high school classes online and provided her with a computer until the end of this past school year.
Greg Roe, executive director of the United Way of Linn County, took over after that. He worked with Jacob Johnson at the Boys & Girls Club of Albany to build Christi her own computer system.
He and other members of the United Way's board of directors personally donated enough funds to pay for her Internet access that will carry at least through her first year at LBCC. He wants to travel to Bandon this spring, when Christi hopes to finally receive a diploma from her former high school.
Looking ahead
Christi could have settled for a modified diploma or GED. She didn't want to.
"It's like quitting for me," she says. "I want to graduate. (Otherwise), what's the use of getting out of bed in the morning and continuing with education?"
"It's just amazing how much passion she has," Roe says. "She's one of my heroes."
Christi's fiercest advocate is her mother, the one who gets up with her more than a dozen times a night, the one who's been writing frantic letters to every branch of the government she can think of to try to preserve the settlement Christi received from her father's rental insurance policy. The state Department of Human Services has a lien against the settlement to recoup its costs, the terms of which Deanna is disputing.
At the same time, she's been thankful for the state's assistance for Christi, for the $20,000 wheelchair, the seven medications and the twice-weekly therapy sessions.
Deanna's designation as the home care provider allows her to receive roughly $2,200 a month. She combines that with child support plus the few hundred dollars of disability money Christi receives from Social Security to take care of the family's bills.
It may sound like a lot, Deanna says, but the two of them had to start from scratch. Most of their old furniture didn't fit in the tiny apartment. Even Christi's old jeans no longer worked as clothing.
"I've heard stories of moms sacrificing things," Christi says. "I think the best sacrifice my mom ever did was when she walked off her job and stayed with me. I think I'm one of the luckiest kids in the world, to have a mom like her."
"If she were by herself, she'd be in a nursing home. There's no way to support her," Deanna says. She smiles at her daughter. "She was well worth my time."
Help for Christi is an investment, as Deanna sees it, a steppingstone to the day when she'll be caring for herself. The gifts she receives now will one day become gifts to help another.
Christi looks to Joni Eareckson Tada, a Christian ministry speaker who was paralyzed in a diving accident in 1967, as a role model. She wants to minister to people like herself, "let them know that there are things out there you can still do."
Her body will never be the way it was. That's been the source of countless hours of tears, but Christy says she's determined not to let it be the end of the story.
"Don't let your injury define who you are."
WHAT IS A LIEN?
A lien is the legal claim of one party upon the property of another for payment of a debt or the satisfaction of an obligation. The state Department of Human Services puts liens on personal injury settlements to recover money owed to the state by DHS clients.
How does the state get involved?
Roy Fredericks, manager of the estate administration and personal injury liens unit for DHS, said the state becomes involved in the lien process when someone is receiving state assistance, such as Medicaid, and a financial claim is made involving a third party. That assistance could take the form of payments for prescriptions, surgery, equipment, therapy or any other aid directly related to the person's injury.
If the person files a claim against a possible responsible third party, such as the other driver in a car wreck, DHS then files a lien against any potential settlement to defray the costs it has incurred.
How much is the state seeking?
The state doesn't file for a specific amount, Fredericks said. Federal law just requires states to recoup expenses to the extent possible. The idea is to prevent private third parties from shifting their costs to the state.
The state's costs often exceed the amount of an insurance settlement, particularly if the injury is catastrophic, Fredericks said, but a second lien is possible only if there's another third-party settlement expected. "We may get a small fraction of what was expended" for the recipient, he said.
Sometimes liens are claimed against the estates of injured persons after they die, but there are restrictions on that, Fredericks said. Generally all that can be claimed is assistance rendered after the person turned 55.
Who pays?
In almost all cases, DHS negotiates with insurance carriers or their attorneys, Fredericks said. But if an insurance company makes a payment directly to the recipient without first satisfying the lien, the "third party" responsibilities transfer from the company to the recipient, he said.
"The recipient still has to satisfy our lien," he said.
What is the Ahlborn decision?
Ahlborn refers to a U.S. Supreme Court ruling on May 1, 2006, in a case called Arkansas Department of Health and Human Services v. Ahlborn.
Before Ahlborn, states would simply submit liens against the entire proceeds of a settlement, Fredericks said. According to the Trial Lawyer Resource Center, the Supreme Court unanimously affirmed the 8th Circuit's decision, which said a state's Medicaid department will be limited to reimbursement from only that portion of a judgment or settlement that represents payment for medical expenses, not for damages such as pain and suffering or wage losses.
The court held that the federal anti-lien statute prevents states from attaching or encumbering the non-medical portion of the settlement or judgment.
Oregon administrative rules have set a "rebuttable presumption" that damage settlements are medical unless the recipient provides evidence to the contrary, Fredericks said.
How does someone rebut this presumption?
The state almost always works with attorneys in lien situations, Fredericks said, but individuals can also send in evidence themselves. Notification in writing is preferred. No court hearing is required. Once the settlement occurs, the state has 180 days to file legal action to compel payment.
Fredericks said the department has not kept statistics on how many people have challenged DHS liens under Ahlborn, but it has happened before.
"If we can't come up with something reasonable, we let a court decide," he said.