The Toronto Star, Nov. 24, 2014
Giuseppe Chessari taps his toe against the stair riser and his computerized prosthetic limb bends at the knee so he can haul himself up to the next step, a process he will repeat with his other leg as he climbs to the second floor of a College St. building.
The double amputee lost his legs in 2009 after his boss told him to clear a clogged bailer at the Mississauga recycling company where he worked. Three seconds after he entered the idling machine – and just as he was giving his supervisor the OK – the hydraulics that push the cardboard and newspaper started forward and sliced his limbs off above the knee.
“As soon as I got in, the machine cut off (my legs) and I was on top of the table,” said Chessari.
Chessari then described how firefighters and paramedics appeared through a small hopper hole to rescue him and how they were able to find only one of his legs to take with them. The thought of the macabre search for his missing leg – whereabouts unknown – makes him laugh.
“You’ve got to laugh. Don’t you cry, please,” said Chessari. “I don’t cry.”
It’s that attitude that has given the 37-year-old Toronto resident the will to walk again full-time using prostheses, a herculean feat that could now be jeopardized because he is unwilling to accept the terms under which the Workplace Safety and Insurance Board (WSIB) says he can have new legs.
Yes to new state-of-the-art limbs, at a cost of $237,382.10.
Chessari’s old C-model legs are outdated, and the socket they attach to on his thigh causes him pain.
No to his request to go back to Hanger Inc., a U.S. prosthetics company that showed him how to walk on artificial limbs after he failed, he says, to progress far enough after rehab at West Park Healthcare Centre in Toronto.
Chessari crashed the company’s annual convention and boot camp in Las Vegas in 2010 – a private event – after his sister, Lisa Chessari, saw double-amputees online using their prostheses to walk.
The injured worker arrived in a wheelchair but left after Hanger vice-president Kevin Carroll took him under his wing, walking on his shortened limbs using a foot called a “stubby.”
“At that moment, I found myself free,” said Chessari, who went on to train and work his way up to full prostheses.
But his insistence he return to Hanger, which treated him officially in 2010 after the WSIB gave approval, may cost him his freedom.
The insurance board ruled in 2013 that Chessari can’t travel out of province again to get the prostheses, the custom-made socket and leg alignment that his doctor said is critical to his balance and ability to walk.
The board ruled the medical treatment was available here.
And in a letter dated Oct. 17, the WSIB states the injured worker’s benefits will be reduced or suspended if he doesn’t go back to George Brown College to finish the two-year electrical engineering technician program he agreed to complete, even if it’s in a wheelchair.
Chessari stopped attending in January because he can’t walk for long periods.
“I have reviewed the medical information provided by your physician, who confirmed that you have chronic phantom leg pain and have had this for quite some time,” states the letter from a WSIB case manager. “However the precautions given on the form indicate that you are still capable of performing sedentary activities, including attending school.”
The board said it was sending him a wheelchair, but Chessari refuses to use it to go back to school.
“Imagine,” he said, “if my friends who know me standing all the time would see me now in a wheelchair?” The deal with the WSIB is that when he finishes his course, they will no longer give him money to live on.
Michael Devlin, his doctor at West Park, said the board should let Chessari go.
Chessari “wants what he wants,” agreed Devlin, but at the same time, the doctor said that’s the type of person who will learn to walk using prostheses.
“It takes a very determined individual and a self-starter. It is hard work,” said Devlin. “For an individual who is walking, using a wheelchair is a step backwards.”
The Toronto rehab hospital has fitted about 15 patients with the Genium X3 state-of-the art prostheses that Chessari has been approved for, but all were single amputees.
The computerized Genium is unique in that it has a built-in alignment guide, which talks to the knee joint that does all the work.
But Devlin says the socket is also crucial.
“It’s difficult to walk all day, and if you don’t have a comfortable socket it doesn’t matter what you bolt underneath. It’s not going to work.”
The WSIB is unable to respond to comments on individual complaints, but in an email, spokeswoman Christine Arnott said the board “co-ordinates services with four Ontario medical facilities to provide expert health care to amputees. These hospitals are experienced in assisting people who have sustained complex and multiple amputations.”
“We can assure you that in all cases, the WSIB works collaboratively with workers, their families, employers and treating practitioners to ensure the best possible outcome for the injured worker,” Arnott wrote.
The board wouldn’t say why it won’t allow Chessari to go to Hanger this time, but the WSIB has been trying to cut costs since the province passed legislation requiring the board to rid itself of unfunded liability – the difference between what it takes in and what it needs to pay in benefits for injured workers – by 2027.
Double-amputees like Chessari – called bilateral transfemoral amputees because they have lost both limbs through the femur and have no working knee joint – are a “rare bird,” said Devlin. The hospital has had only two patients of that kind walk using older-model prostheses.
Devlin said West Park did teach the 38-year-old to walk.
But Chessari said he left there using two canes, was in constant pain, on heavy-duty painkillers and could manage walking for only short periods. The rest of the time he was in a wheelchair.
Hanger, based in Oklahoma, has treated injured military personnel from around the world.
Chessari says he left the Las Vegas boot camp after three days determined to “go and live his life” and did just that, getting off the prescription drugs and walking around with his shortened limbs until he worked his way up to extensions.
It takes amputees like Chessari “300 to 500 per cent more energy” to walk for longer periods on even the flattest surface, said Randy Richardson, a certified prosthetic assistant for Hanger, because the only joints left are the hips.
“To go through what you and I go through in our daily environment –
driving a car, walking up a hill – for a bilateral transfemoral amputee, that is incredibly difficult.”
A few months after the boot camp, when Chessari jokingly complained to Carroll that he was so short he had to pee on the street, the vice-president asked to see a video of him walking. When Carroll viewed it, he told Chessari he was strong enough for full prostheses.
The WSIB allowed Chessari to seek treatment there in 2010 after Devlin wrote a letter in support of Hanger, stating that there wasn’t a program like it in Canada because there were so few individuals with similar injuries.
That May, the insurance board decided it would send Chessari to Hanger so he could receive a new socket that could be fitted to his original prostheses from West Park.
The company sells a patented close-fitting socket and has performed hundreds of alignments.
Chessari went to the U.S. for three weeks and learned how to use his new knees and legs. He credits part of his success to peer support there.
“For anybody to walk and use prosthetic devices full-time is an absolute wonderful accomplishment,” said Richardson, “and something that gives them back a good quality of life.”
The WSIB paid for him to get running legs, swimming legs and skiing legs, which isn’t that unusual if the board believes that “whatever they are going to pay for serves the purpose to rehabilitate the person,” said Alberto Lalli, a licensed paralegal with the IAVGO community legal clinic, which represents injured workers.
“He’s a guy that hasn’t conformed to the double amputee mould,” said Lalli.
Chessari competed in five-kilometre runs, went on trips to Italy, got engaged and is now married, and went back to school.
The board has called his motivation “exemplary.”
When they approved his Genium X3 prosthetic legs, at a cost of $237,382, a WSIB manager wrote that she “would support the provision of the best equipment currently available.”
This January, Chessari went back to West Park to get fitted for new sockets, a process that took eight months, partly because Chessari was going to school and not always available. When the sockets were done, Chessari says, he found he couldn’t use them for any length of time.
He is now being fitted for new sockets at Sunnybrook hospital, but he’s not hopeful.
“I only trust one company. The one that helped me that day,” said Chessari.
If the Sunnybrook sockets don’t work and Chessari doesn’t return to school, his living benefits will be suspended “until you begin participating again,” according to the letter from the WSIB case manager.