Joy Howard is more than a doctor. As head of Baltimore's medical clinic for city employees, she also oversees an often-abused benefit called "A-time."
A-time is short for "accident time" -- paid leave that allows an injured worker up to a year to recuperate. When employees are injured on the job, they visit the city-run clinic on South Gay Street where Howard's staff members evaluate them and decide how much A-time to grant.
In her 10 years at the clinic, Howard watched as some employees came to view A-time as a right, even if they could work.
But Mayor Martin O'Malley's administration has been cracking down on abuses and trying to keep more workers at work. Officials say they've achieved some success.
Union leaders acknowledge some problems but say city administrators share responsibility. Individual workers have reacted sometimes angrily to the clinic's tougher approach.
"We've been threatened: 'I'm gonna go get my gun and blow your head off.' We've had people throw furniture, threaten to punch us in the face," said Howard, who has a city police officer stationed outside the waiting room.
"People tell me, 'That's my money.' And I tell them, 'It's Baltimore citizens' money, and I don't want to squander it.' So if I don't feel that person's injury is worth A-time, I don't give it to them."
City officials have for years been aware of A-time abuses, which is one piece of the vexing problem of high absenteeism among 16,000 city workers. In recently months, the city has made some of its strongest reform efforts ever.
A project internally called the "return to work" initiative has resulted in 30 percent to 60 percent cuts in A-time at most city departments. Injuries are investigated more regularly, and those caught cheating the system are fired. Employees with minor injuries are, instead of getting A-time, being given "light duty" in other departments; others are receiving vocational rehabilitation training. The result, say officials in O'Malley's office, is that 100 more people are in city jobs each day, compared with a year ago.
"The administration is trying to be more a prudent manager, monitoring the use of A-time and doing prudent investigations," said city solicitor Thurman W. Zollicoffer Jr. "Not in an effort to terminate people but in an effort to give the people of Baltimore a good return on their investment in employees' salaries."
Other efforts to regain control of A-time include:
An independent analysis of the city's personnel department is being conducted by the Greater Baltimore Committee and the President's Roundtable, groups of business leaders that presented O'Malley last year with a long list of suggested cost-cutting moves. The groups are particularly interested in the clinic and A-time.
Officials began last year, for the first time, keeping detailed statistics on A-time in each city department. Those numbers are fed into Citistat, the city's new computerized statistic-tracking system that is guiding O'Malley's efforts to make city government more efficient.
The clinic created an automated scheduling system for doctors' appointments, with a goal of getting people in and out in less than an hour. And a van drives people back to their work sites after examinations. "They used to wait around for someone to pick them up. That's too much down time," said former Personnel Director Jesse Hoskins.
Last week, a small group of independent consultants began meeting with Howard and the clinic staff, as well as employees who handle the city's workers' compensation claims. That analysis was prompted by rising costs associated with workers' compensation claims paid to injured workers and "indemnity" costs, which is the salary paid to an employee who is on A-time.
"In terms of dollars going out the door, those have increased steadily year after year," said Rick Jarry, the city's risk management officer. "The efforts [to cut A-time] unfortunately haven't been as fruitful as we'd like to see."
Union officials say supervisors are also to blame for lax enforcement of A-time rules, but they acknowledge some members manipulate the system.
"Of course A-time costs the city money," said Sheila Jordan, president of the City Union of Baltimore (CUB), which represents 5,000 employees. "And there are some pattern abusers."
But Jordan said employees have complaints about the A-time system and the clinic, which some workers call a "Band-Aid approach."
"In some cases, people felt they were being placed back in work too soon," Jordan said.
Howard said her office has been careful to provide vocational rehabilitation services, such as physical therapy, to injured workers. And a new software program listing vacant city positions allows her office to transfer injured workers to "light duty" assignments in departments other than their own.
Still, some work very hard to avoid work, she said.
"It's a financial incentive for them to stay out of work for as long as possible, and that makes it difficult for us to get them back to work," she said.
"It's just killing us, it really is. And I hope somebody will do something about it. The perception is that we're just doling out accident time like it's candy, but it's just the opposite."
Every day, Howard's clinic is bombarded with workers who've been hurt on the job. They fall off garbage trucks or slip on spilled milk in a school cafeteria, incurring legitimate injuries that require time away from work to recuperate. But many employees' pains are bogus or exaggerated.
"It's a minority of patients we see over and over again," Howard said. "The majority of people do have legitimate injuries."
In the minority are those like the woman who started her city job Dec. 11 and arrived at the clinic with an alleged injury -- the afternoon of Dec. 11. She's been back to the clinic twice.
"Those types of people shouldn't be kept," said Howard, who keeps an eye out for people who cringe or howl before she's touched the reportedly injured knee or back; "inappropriate pain behavior" is the medical term for it.
On the flip side are those who want to return to work. An employee whose leg was amputated last year after a severe fall off a truck is back at work, fitted with a prosthesis that helps him drive.
"That's my role, to help people return to work," said Howard, who keeps a poster over her desk that reads, "All I need to know about life I learned from Star Trek."
Officials say the return-to-work initiative is too new to claim significant success. But there are some encouraging numbers. For example, during the two-week period that ended Nov. 1, 240 employees passed through the clinic and received A-time or had their A-time extended. For the two-week period that ended Feb. 2, the clinic had 124 A-time cases.
"To me, that's not a trend, that's a blip," said Bob Knowles, the personnel department's policy analyst. "But I look at that as a good sign."
Hoskins, who was personnel director for 13 years before retiring Friday to take a job with the federal government in Washington, said the message has been spreading that the city wants its employees back at work "and not sitting at home all the time."
"The message is: You just can't come to the clinic and get release time," he said. "It was a bit looser before, but we've been tightening up on it. I think it's sinking in. People are being more attentive."
The message hasn't reached everyone. The city's bureau of solid waste regularly clocks 300 hours of A-time in a two-week period -- the equivalent of four idled employees getting full salaries for two weeks. And Howard's office gets anonymous letters or phone calls about an allegedly injured employee who is working another job or playing golf. Howard's office hires a subcontractor to conduct surveillance on workers suspected of lying to the city.
"People can't get away with these outrageous kinds of things," she said. "But I think that things are changing, and people are getting the feeling that you can't get away with it anymore."