After a heavily armed San Bernardino County employee and his wife attacked a county holiday event last Dec. 2, killing 14 people and wounding 22, county leaders sounded a clear message of support for their workers.
“The events of that day could have torn us asunder. They have not. They have drawn us closer together and rebounded our commitment to take care of one another,†Board of Supervisors Chairman James Ramos said at a memorial in January.
But a year later, some county employees who were victims of the attack, including witnesses and those who were physically injured, say such pledges ring hollow.
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In interviews and at a recent public meeting, employees described struggling to cope with a callous county bureaucracy that provided little comfort as they tried to heal. Instead, they were left scrambling for help and tangling with a county-administered workers’ compensation program that has led to delays and denials of needed medication and treatment, the employees said.
Ray Britain was in the room on Dec. 2 when two heavily armed terrorists opened fire, killing 14 people and wounding 22 others.
(Irfan Khan / Los Angeles Times)
“There’s a level of secondary trauma that has occurred to all of us,†said Ray Britain, who was interim division chief for the county’s Division of Environmental Health Services on the day of the attack. “We were abandoned and betrayed by a co-worker, and when we asked our employer for help, a lot of us were abandoned and betrayed by them.â€
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Several employees said they have struggled to cope with constant uncertainty about whether treatment or medication will be approved. In some cases, they said they were made to repeatedly argue and appeal when treatment was denied.
County spokesman David Wert said caring for those affected by the terrorist attack has been a top priority of the county.
“Workers’ compensation requires many parties to do their respective parts, and it doesn’t always run as smoothly as it should,†he said in a written response to questions. “The county has always acted in the best interests of the wounded, improving practices along the way, and will continue to do so.â€
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Some of the problems appear inherent to California’s workers’ compensation programs, which can be difficult to navigate and often rely on precise guidelines for treatment approval. But the county also has latitude to affect the process.
Christine Baker, director of the California Department of Industrial Relations, said she reminded the county this week that it has “full discretion to provide medical care even after a review of the guidelines.â€
“We’ve told the county these are unusual circumstances and they’ve got to take extraordinary steps to take on these issues,†she added.
After county workers recently began to air their concerns publicly, county officials said Monday they would hire a firm dedicated solely to helping process paperwork for those affected.
But that has been little comfort to victims who have struggled for the past year.
“I don’t feel like they have had any compassion for us,†Sally Cardinale, 35, a program specialist, said of the county. “We were victims when it was convenient for them.â€
Hanan Megalla, 48, was shot four times on Dec. 2, in the head, arm and chest.
She suffered nerve damage and bone fractures. She lost function in one arm, has difficulty sleeping and is frequently in pain.
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“Her doctors keep asking for physical therapy. They keep asking for medication,†said her husband, Osama Megalla, 51. “Each time the doctor writes a prescription … they shoot it down.â€
After pushing back, he said, some of her medications have been approved.
But, he added, “they keep telling you it’s only approved for one time only. Which means that every month we have to go through this refill drama again. It’s unbearable.â€
Britain, 48, who supervised most of the workers in the room on Dec. 2, was seated at a table when the shooters entered the room.
“I sat at the head of the table and watched it all happen,†he recalled recently. “I froze as he entered, and I think I was just in shock and disbelief at what I was seeing.â€
Though he escaped physically uninjured, he soon realized he would need psychological treatment.
When he sought it, he said, county officials “made us feel ashamed that we even needed help if you weren’t physically injured.â€
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“Everything has been a fight,†Britain said. “I had to fight to get into the workman’s comp process. Once in the workman’s comp process, you realize that’s a flawed system. … Every month you’re wondering if your medication is going to be approved, what’s going to be denied, what’s going to be delayed.â€
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Friends and relatives of Sierra Clayborn gather for her funeral at Mt. Moriah Missionary Baptist Church in South Los Angeles.
(Luis Sinco / Los Angeles Times)
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A memorial service was held for Nicholas Thalasinos on Saturday morning at the Shiloh Messianic Congregation in Calimesa.
(Michael Robinson Chavez / Los Angeles Times)
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A Shabbat service was part of the memorial for Nicholas Thalasinos at Shiloh Messianic Congregation in Calimesa, where Thalasinos and his wife, Jennifer, were integral parts of the congregation.
(Michael Robinson Chavez / Los Angeles Times)
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A hired mover carries out personal items from the home of San Bernardino shooters Syed Rizwan Farook and Tashfeen Malik.
(Gina Ferazzi / Los Angeles Times)
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Residents turn out to greet President Obama’s motorcade in San Bernardino.
(Michael Robinson Chávez / Los Angeles Times)
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President Obama and First Lady Michelle Obama greet San Bernardino Mayor R. Carey Davis, center, and Supervisor James Ramos outside Air Force One at the San Bernardino airport on Friday night.
(Wally Skalij / Los Angeles Times)
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President Obama and First Lady Michelle Obama leave in a motorcade, after arriving at San Bernardino International Airport, to meet privately with the families of the victims of the San Bernardino terrorist attack.
(Gina Ferazzi / Los Angeles Times)
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President Obama and First Lady Michelle Obama depart Air Force One at San Bernardino International Airport.
(Gina Ferazzi / Los Angeles Times)
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San Bernardino residents Ashrie Matthews, left, Leah Brown and James Matthews line the street to cheer the president’s motorcade.
(Michael Robinson Chavez / Los Angeles Times)
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President Obama stopped in San Bernardino on Friday evening to privately visit with the families of some of the victims of the Dec. 2 terrorist attack. Ashrie Matthews, left, Leah Brown and James Matthews joined others to cheer as the president’s motorcade passed.
(Michael Robinson Chavez / Los Angeles Times)
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Anti-Obama protester Deann D’Lean, right, holds some of the many signs she brought to a small protest. In the background, Paul Rodriguez, Jr., with America First Latinos holds a bullhorn. Protesters were out on some San Bernardino street corners voicing their opposition to the president and Islamic State.
(Michael Robinson Chavez / Los Angeles Times)
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People continue to visit the memorial just down the street from where the terrorist attack occurred.
(Michael Robinson Chavez / Los Angeles Times)
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Family members and friends pay their respects to Robert Adams, one of the 14 victims killed in the San Bernardino shooting, during his graveside funeral service at Montecito Memorial Park in Colton.
(Gina Ferazzi / Los Angeles Times)
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Summer Adams, center, grieves at the graveside ceremony for her husband, Robert Adams, at Montecito Memorial Park in Colton.
(Gina Ferazzi / Los Angeles Times)
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A mourner sits on the curb with her head in her hands during the graveside ceremony for San Bernardino shooting victim Robert Adams at Montecito Memorial Park in Colton.
(Gina Ferazzi / Los Angeles Times)
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Mourners embrace at the funeral for Aurora Godoy at Calvary Chapel in Gardena on Wednesday. Godoy was one of 14 killed in the attack in San Bernardino on Dec. 2. (Michael Robinson Chavez / Los Angeles Times)
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Mourners embrace at the funeral for Aurora Godoy at Calvary Chapel in Gardena on Wednesday. Godoy was one of 14 killed in the attack in San Bernardino on Dec. 2.
(Michael Robinson Chavez / Los Angeles Times)
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Mourners arrive for the funeral for San Bernardino shooting victim Aurora Godoy at Calvary Chapel in Gardena on Wednesday.
(Michael Robinson Chavez / Los Angeles Times)
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Shemiran Betbadal, mother of Bennetta Betbadal, is hugged by family after funeral services at Sacred Heart Catholic Church in Rancho Cucamonga.
(Barbara Davidson / Los Angeles Times)
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Pallbearers carry the casket of Bennetta Bet-Badal during funeral services Monday at Sacred Heart Catholic Church in Rancho Cucamonga. Bet-Badal was one of the 14 people killed in the San Barnardino shooting rampage.
(Barbara Davidson / Los Angeles Times)
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The husband and children of Bennetta Bet-Badal hug Monday following her funeral services at Sacred Heart Catholic Church in Rancho Cucamonga.
(Barbara Davidson / Los Angeles Times)
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Funeral services were held for Bennetta Bet-Badal, one of the 14 people killed in the San Barnardino shooting rampage, at Sacred Heart Catholic Church in Rancho Cucamonga.
(Barbara Davidson / Los Angeles Times)
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Funeral services were held for Bennetta Bet-Badal at Sacred Heart Catholic Church in Rancho Cucamonga.
(Barbara Davidson / Los Angeles Times)
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Funeral services were held for Bennetta Bet-Badal at Sacred Heart Catholic Church in Rancho Cucamonga.
(Barbara Davidson / Los Angeles Times)
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Twelve days after the mass shooting attack at the Inland Regional Center in San Bernardino the flowers are beginning to wilt but hugs and paryers are still in abundance.
(Mark Boster / Los Angeles Times)
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Gwen Rodgers, assistant pastor at the Church of Living God, hugs Cindy Quinones, cousin of the slain Aurora Godoy, during a vigil at the makeshift memorial for the victims of the terrorist attacks in San Bernardino, Calif.
(Marcus Yam / Los Angeles Times)
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Visitors arrive to pay their respects at the makeshift memorial outside the fenced off Inland Regional Center, in the background, the site of the deadly terrorist attacks, in San Bernardino, Calif.
(Marcus Yam / Los Angeles Times)
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San Trinh, the longtime boyfriend of Tin Nguyen, 31, one of the victims of the San Bernardino terrorist attack, is consoled by family members as Nguyen’s casket is loaded into a hearse at St. Barbara’s Catholic Church in Santa Ana.
(Marcus Yam / Los Angeles Times)
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Cousins of Tin Nguyen -- Trang Le, left, Tram Le and Krystal Le -- hold onto some of her personal items and cry as they watch her casket being lowered into the ground at her funeral at the Good Shepherd Cemetery in Huntington Beach.
(Marcus Yam / Los Angeles Times)
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Pallbearers stand guard over the casket of the Tin Nguyen, a Cal State Fullerton graduate, at the start of her memorial service at St. Barbara’s Catholic Church in Santa Ana.
(Marcus Yam / Los Angeles Times)
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Van Thanh Nguyen shouts her daughter’s name during her funeral at the Good Shepherd Cemetary in Huntington Beach. Tin Nguyen was 31.
(Marcus Yam / Los Angeles Times)
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Family members and friends write messages on the side of the Tin Nguyen’s burial vault.
(Marcus Yam / Los Angeles Times)
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Van Thanh Nguyen places her hand on her daughter’s casket while surrounded by friends and family.
(Marcus Yam / Los Angeles Times)
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The casket of San Bernardino shooting victim Isaac Amanios leaves the St. Minas Orthodox Church during his funeral service in Colton.
(Wally Skalij / Los Angeles Times)
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Two women cry during Isaac Amanios’ funeral service at the St. Minas Orthodox Church in Colton. Amanios, 60, is survived by his wife and three children.
(Wally Skalij / Los Angeles Times)
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Funeral goers cry during Isaac Amanios’ service. Amanios had shared a cubicle with the male shooter at the San Bernardino County Public Health Department.
(Wally Skalij / Los Angeles Times)
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Frineds and family stand during the funeral service for Isaac Amanios.
(Wally Skalij / Los Angeles Times)
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Trenna Meins, center with daughters after the funeral for her husband Damian Meins at St. Catherine Of Alexandria in Riverside.
(Mark Boster / Los Angeles Times)
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Pallbearers escort the casket of Damian Meins at St. Catherine of Alexandria church in Riverside.
(Gina Ferazzi / Los Angeles Times)
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Mourners gather at St. Catherine Of Alexandria in Riverside on Friday morning for the funeral of Damian Meins, one of 14 people killed in the San Bernardino shooting.
(Mark Boster / Los Angeles Times)
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Trenna Meins places a cross on her husband’s coffin. Damien Meins was killed in a terrorist attack at the Inland Regional Center in San Bernardino.
(Mark Boster / Los Angeles Times)
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Mourners gather for the funeral of Damian Meins.
(Mark Boster / Los Angeles Times)
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Community members sing Amazing Grace during a candlelight vigil for Nicholas Thalasinos and the 13 other San Bernardino shooting victims at Fleming Park in Colton, Calif.
(Gina Ferazzi / Los Angeles Times)
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COLTON, CA - DECEMBER 10, 2015: Jennifer Thalasinos,middle, fights back tears during a candlelight vigil for her slain husband Nicholas Thalasinos and the 13 other San Bernardino shooting victims at Fleming Park on December 10, 2015 in Colton, California.(Gina Ferazzi / Los Angeles Times) (Gina Ferazzi / Los Angeles Times)
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A portrait of Yvette Velasco, one of the victims of the deadly San Bernardino terrorist attacks, is placed at her funeral service at Forest Lawn Memorial Park, in Covina, Calif.
(Marcus Yam / Los Angeles Times)
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Robert Velasco, father of Yvette Velasco, consoles a family member during Yvette’s funeral service at Forest Lawn Memorial Park, in Covina, Calif.
(Marcus Yam / Los Angeles Times)
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COVINA, CALIF.--December 10, 2015 - The coffin of San Bernardino shooting victim, Yvette Velasco, is carried to the hearse following a private viewing for family at Forest Lawn Mortuary in Covina, Calif.
(Barbara Davidson / Los Angeles Times)
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An FBI dive team searches a lake located about two miles north of the Inland Regional Center in connection with last week’s terrorist attack and shootout that left the two attackers and 14 victims dead.
(Luis Sinco / Los Angeles Times)
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An FBI dive team searches a lake near the Inland Regional Center in connection with last week’s terrorist attack.
(Luis Sinco / Los Angeles Times)
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A memorial to victims of the terrorist attack in San Bernardino continues to grow near the Inland Regional Center, where the attack took place during a holiday party.
(Luis Sinco / Los Angeles Times)
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One week after the mass shooting at the Inland Regional Center in San Bernardino, the public is posting signs of gratitude and thanks like this one found at the San Bernardino Police Department.
(Mark Boster / Los Angeles Times)
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Family members and survivors paid their respects with a moment of silence at 11 a.m., exactly one week after the shooting occured at the Inland Regional Center.
(Mark Boster / Los Angeles Times)
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Customers wait for the doors to open at Turner’s Outdoorsman in San Bernardino Wednesday morning.
(Wally Skalij / Los Angeles Times)
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Speaking during a Dec. 8 news conference, dispatcher Michelle Rodriguez of the San Bernardino County Sheriff’s Department becomes emotional as she recounts the events of the deadly San Bernardino attack.
(Marcus Yam / Los Angeles Times)
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Trenna Meins, right, of Riverside, hugs friends and family during a vigil t the Riverside County Health Complex for her husband, Damian Meins, and 13 others killed in the San Bernardino shooting rampage.
(Gina Ferazzi / Los Angeles Times)
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On Dec. 8, people bring flowers, candles and remembrances to a memorial to the San Bernardino shooting victims near the Inland Regional Center, the scene of the attack.
(Brian van der Brug / Los Angeles Times)
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Frank Cobet of the Get Loaded gun store in Grand Terrace shows a customer an AR-15 rifle on Dec. 8.
(Barbara Davidson / Los Angeles Times)
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Monica Gonzales relights candles Tuesday morning at a memorial for victims of the shooting rampage in San Bernardino.
(Wally Skalij / Los Angeles Times)
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Community members and students gather for a Dec. 7 vigil on the Cal State San Bernardino campus to remember the victims of the deadly attack in the city.
(Marcus Yam / Los Angeles Times)
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Patricia Corona of Colton, Calif., holds her children, Dejah Salvato, 7, and Brandon Salvato, 9, as they attend a Dec. 7 vigil at the San Bernardino County Board of Supervisors headquarters to pay tribute to the victims of the city’s recent mass shootings.
(Rick Loomis / Los Angeles Times)
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A prayer is said at the San Bernardino County Board of Supervisors headquarters to honor the victms of the city’s recent mass shootings.
(Rick Loomis / Los Angeles Times)
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FBI agents put up a screen to block the view of onlookers as they investigate the building at the Inland Regional Center in San Bernardino.
(Joe Raedle / Getty Images)
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Syed Farook, father of the suspect in the San Bernardino mass shooting, Syed Rizwan Farook, arrives at his home to a swarm of reporters in Corona, Calif.
(Marcus Yam / Los Angeles Times)
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Roses are laid at the entrance to San Bernardino County headquarters as thousands of employees returned to work Monday, five days after Syed Rizwan Farook and Tashfeen Malik opened fire on a gathering of his co-workers, killing 14 people and wounding 21.
(Mark Boster / Los Angeles Times)
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Trudy Raymundo, director the the San Bernardino County Department of Public Health, is surrounded by San Bernardino County supervisors as she addresses the media during a press conference Monday.
(Mark Boster / Los Angeles Times)
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John Ramos of Riverside pays his respects Monday at a makeshift memorial site honoring Wednesday’s shooting victims in San Bernardino.
(Jae C. Hong / Associated Press)
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Claudia Zaragoza writes a message on a banner at the ever-growing memorial site to the victims of the recent mass shootings near the Inland Regional Center.
(Marcus Yam / Los Angeles Times)
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Caroline Campbell, from left, Jessie Campbell and Rylee Ponce embrace as they pay their respects at the ever-growing memorial site for the victims of the recent mass shootings.
(Marcus Yam / Los Angeles Times)
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Caroline Campbell embraces her son, David Malijan, 6, as they pay their respects at the ever-growing memorial site to the victims of the recent mass shootings near the Inland Regional Center.
(Marcus Yam / Los Angeles Times)
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The Zafarullah family of Chino, originally of Pakistan, watches Obama’s address. Arshia, at left, is holding her 18-month-old nephew, Sohail Ahmed.
(Barbara Davidson / Los Angeles Times)
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One of several signs supporting the city of San Bernardino hang above the 215 Freeway on Sunday evening.
(Rick Loomis / Los Angeles Times)
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Members of the Muslim community, such as Khadija Zadeh, lit candles and wrote messages to the families of victims of the San Bernardino shooting rampage during a memorial service at the Islamic Community Center of Redlands in Loma Linda.
(Barbara Davidson / Los Angeles Times)
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Ajarat Bada prays during a memorial service at the Islamic Community Center of Redlands in Loma Linda to remember the victims of the San Bernardino shooting rampage.
(Barbara Davidson / Los Angeles Times)
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Alaa Alsafadi, center, holds her son, Yousef, 4, during a memorial service at the Islamic Community Center of Redlands in Loma Linda.
(Barbara Davidson / Los Angeles Times)
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Riders from the Christian Motorcycle Association in San Bernardino pray at a growing makeshift memorial for San Bernardino shooting victims near the Inland Regional Center.
(Allen J. Schaben / Los Angeles Times)
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A candlelight vigil dubbed “United We Stand,†took place at Granada Hills Charter High School on Saturday evening. The event was organized by Muslim Youth Los Angeles and Devonshire Area in Partnership.
(Michael Robinson Chavez / Los Angeles Times)
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Ryan Reyes, boyfriend of San Bernardino shooting victim Larry Daniel Kaufman, hugs members of Dar Al Uloom Al Islamiyah of America mosque who brought roses to a memorial at the Sante Fe Dam on Saturday.
(Wally Skalij / Los Angeles Times)
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A bullet hole in the window of a pick up truck where the shootout took place on San Bernardino Avenue.
(Marcus Yam / Los Angeles Times)
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A composite photo of the 14 victims of the San Bernardino shooting rampage. (Courtesy of family / Los Angeles Times)
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People kneel in prayer for victims of the recent mass shootings at the Inland Regional Center, in San Bernardino.
(Marcus Yam / Los Angeles Times)
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After sunset, people continue to arrive at the memorial site for the victims of the recent mass shootings at the Inland Regional Center in San Bernardino.
(Marcus Yam / Los Angeles Times)
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The scene after landlord Doyle Miller opened the doors and allowed the news media inside the Redlands town home where Syed Rizwan Farook and Tafsheen Malik, suspects of the deadly the recent mass shootings in San Bernardino, lived.
(Marcus Yam / Los Angeles Times)
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Josie Ramirez-Herndon, center, and her daughter, Chelsie Ramirez, bottom left, join other community members as they pray during a candlelight vigil.
(Marcus Yam / Los Angeles Times)
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Fabio Ahumada, a San Bernardino EMT, attends a vigil at San Manuel Stadium
(Barbara Davidson / Los Angeles Times)
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A couple embrace at the candlelight vigil to honor the victims of the mass shootings at the Inland Regional Center.
(Marcus Yam / Los Angeles Times)
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Angel Meler-Baumgartner 11, who was a member of the Inland Regional Center, where the shooting occurred, attends a vigil at San Manuel Stadium for the victims.
(Barbara Davidson / Los Angeles Times)
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The Ahmadiyya Muslim Community USA held a press conference and prayer vigil at Baitul Hameed Mosque in Chino. The group denounced the massacre.
(Michael Robinson Chávez / Los Angeles Times)
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Amy Mahmood, right, holds hands with a woman named Shenaz during the vigil at San Manuel Stadium.
(Barbara Davidson / Los Angeles Times)
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Ryan Reyes, center, breaks down after finding out his boyfriend of three years, Daniel Kaufman, 42, was one of those killed during Wednesday’s mass shooting at the Inland Regional Center in San Bernardino.
(Rick Loomis / Los Angeles Times)
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Ryan Reyes holds an image of his boyfriend Daniel Kaufman who was confirmed as one of the 14 victims of Wednesday’s mass shooting at the Inland Regional Center in San Bernardino.
(Rick Loomis / Los Angeles Times)
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Larry Jones, left, pastor of Crossover Outreach Church; Dr. Jeannetta Million, pastor of Victoria’s Believers Church; and Arnold Morales, pastor of King of Glory Church, pray for the victims and those involved in the mass shooting in San Bernardino.
(Marcus Yam / Los Angeles Times)
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A coalition of church leaders comes together to pray for the victims and those involved in the San Bernardino shootings.
(Marcus Yam / Los Angeles Times)
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FBI investigators inside the suspects’ Redlands home on Thursday morning.
(Irfan Khan / Los Angeles Times)
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The investigation continues Thursday morning on San Bernardino Avenue, where two suspects in the mass shooting at the Inland Regional Center died in a shootout with police.
(Irfan Khan / Los Angeles Times)
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Law enforcement stands guard at a police line as investigators work at a Redlands home after the San Bernardino attack.
(Marcus Yam / Los Angeles Times)
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A SWAT team stands guard with a rifle pointed at a home that is being investigated by police after today’s San Bernardino’s mass shootings.
(Marcus Yam / Los Angeles Times)
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Farhan Khan, second from right, who was identified as the brother-in-law of San Bernardino shooting suspect Syed Rizwan Farook, joins religious leaders during a news conference at the Council of American Islamic Relations in Anaheim.
(Luis Sinco / Los Angeles Times)
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San Bernardino County sheriff’s deputies draw guns behind a minivan on Richardson St. during a search for suspects involved in the mass shooting of 14 people at the Inland Regional Center in San Bernardino.
(Gina Ferazzi / Los Angeles Times)
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Marie Cabrera, Sonya Gonzalez and Christine Duran, all of San Bernardino, pray after the mass shooting in San Bernardino.
(Rick Loomis / Los Angeles Times)
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A woman and a man enter the Rudy C Hernandez Community Center after they and other people, who were at the scene of a mass shooting, arrived by bus to be reunited with their familys.
(Hayne Palmour IV / San Diego Union-Tribune)
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Emergency personnel bring in a wounded person into Loma University Medical Center after the shooting in San Bernardino on Wednesday.
(Barbara Davidson / Los Angeles Times)
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A SWAT unit is on the move in San Bernardino.
(Marcus Yam / Los Angeles Times)
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A member of the San Manual Fire Department takes the names of people evacuated from the scene of a mass shooting in San Bernardino before they are loaded onto buses and taken away from the area.
(Rick Loomis / Los Angeles Times)
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Sheriff’s department SWAT members deploy on Richardson Street in San Bernardino on Wednesday.
(Marcus Yam / Los Angeles Times)
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Sheriff’s department SWAT members deploy near San Bernardino Avenue and Richardson Street in San Bernardino on Wednesday.
(Mark Boster / Los Angeles Times)
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Evacuated workers join in a circle to pray on the San Bernardino Golf Course across the street from where a shooting occurred at the Inland Regional Center.
(Gina Ferazzi / Los Angeles Times)
The policies and procedures required under workers’ compensation, which was never tailored for victims of terror attacks, can be daunting.
Workers must first submit a request to a county adjuster. If that person cannot approve it, the request is forwarded to “utilization review,†conducted by doctors at a firm hired by the county.
Baker, of the Department of Industrial Relations, said state officials have told the county that some treatments being submitted for higher review could be approved at the county level.
Often, employees and their family members said they have found themselves stymied each step of the process.
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But many have been particularly frustrated by decisions made during the review process by faraway doctors who do not treat the patient.
In one case reviewed by The Times, a woman who had been shot asked for authorization to consult with a psychologist.
Five months after the attack, she suffered from post-traumatic stress disorder and was having crying spells. She was unable to sleep and haunted by nightmares, according to records.
The utilization review doctor denied the request because “psychological evaluation and treatment has already been performed,†according to the records.
The county could change decisions made in utilization review, said county spokesman Wert, but he argued that doing so would be wrong.
“In cases of prescriptions and medical treatment it would be wrong for the county, which is not a doctor, to overrule a decision made by a doctor. It could harm the patient, make the county liable for anything that goes wrong and result in cancellation of the county’s insurance.â€
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The utilization review decision can also be appealed to the state for independent review.
Attorney Geraldine Ly, who represents nine of the victims, said that in her experience those appeals for treatment are overwhelmingly denied.
Wert said delays have often stemmed from employees’ doctors not submitting proper documentation to approve treatment.
For some patients, a number of treatments and medications recommended by their doctors were submitted with detailed documentation but denied because reviewing doctors determined that the recommended treatments did not meet their guidelines, records show.
Cardinale, the program specialist, was in a bathroom when the shooting started. She and three others hid in a stall, standing on a toilet so their feet would not show under the door.
She has wanted to go back to work — and did so for almost six months — but has suffered from anxiety and panic attacks.
In November, she received notice that her anxiety medication, antidepressants and others would not be approved.
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“The claimant should have already been completely weaned from this medication,†the determination read, even though Cardinale’s own doctor had prescribed it.
The same report noted that she suffered from PTSD and that her symptoms had been exacerbated by the anniversary of 9/11.
“My psychiatrist believes that I need to be on the medication. That’s why he wrote the prescription,†Cardinale said.
Cardinale and others said they were reluctant to raise their concerns publicly because talking about the attack and its aftermath is exceedingly painful.
But in recent weeks they decided to come forward, feeling that they were out of options.
On Monday, victims and their supporters spoke out at a Board of Supervisors meeting.
Julie Swann-Paez, who was shot, voiced her frustration at county supervisors for the way employees had been treated over the past year.
“We don’t feel as if we’re being treated as the county family,†she said. “More like the ugly stepkids, who if we were just out of the picture, it would make everything run more smoothly.â€
Paloma Esquivel is a reporter for the Los Angeles Times. She was on the team that won the 2011 Pulitzer Prize for public service for investigating corruption in the city of Bell and the team that won the 2016 Pulitzer Prize for breaking news for coverage of the San Bernardino terror attack. Prior to joining The Times in 2007, she was a freelance writer, worked in Spanish-language radio and was an occasional substitute teacher. A Southern California native, she graduated from UC Berkeley and has a master’s in journalism from Syracuse University.
