Nearly two decades later, Christopher Devoe still wakes from nightmares about the gruesome scene: bone fragments lodged in the ceiling, brain matter dripping above him and a hostage who had narrowly escaped before the suspect shot himself in the head.

The former Salisbury police lieutenant thought he had left those horrors behind — until panic attacks led him to avoid leaving home and consider killing himself.

“To this point, I wake up just about every morning … upset and pissed off that I didn’t die in my sleep sometimes,” Devoe said.

Devoe, 49, was diagnosed with post-traumatic stress disorder and depression stemming from trauma over 17 years as a SWAT leader. A state commission in March 2023 ordered his employer and its insurer, Chesapeake Employers Insurance Co., to pay continuing related medical expenses. But Devoe says he sometimes waits for months for approvals for medications and psychologist sessions.

Devoe and others who’ve been injured or sickened on the job in Maryland say their medical problems are compounded by lengthy battles over workers’ compensation delays, denials and appeals — including disputes over the cost of prescription drugs. Workers say they fight for appointments, medicine and procedures. Some say they’re forced to pay out of pocket or turn to their own health insurance for treatment they say workers’ compensation should cover.

“They go out of their way to not pay anything,” said a former Maryland State Trooper insured by the state employees’ workers’ comp system who suffered a heart attack — a stress-related, line-of-duty injury in Maryland — while on a bomb squad in 2007. The former trooper, who agreed to be identified by first name only, Derek, was determined to have a work-related permanent partial disability in 2008.

The workers’ struggles also raise questions about how the state oversees the system that has administered workers’ compensation benefits for Maryland state employees for more than three decades. State audits have repeatedly questioned its oversight and whether payments and administrative charges were properly handled.

In its self-insured system, the state pays claims and related expenses through a trust administered by the Injured Workers’ Insurance Fund, or IWIF. IWIF has had ties since 2013 to Chesapeake, a private, nonprofit carrier and the state’s largest workers’ compensation insurer.

Over the years, the state has not put IWIF’s work out for bid. In a 2025 memo of understanding that updates a 1990 arrangement, the state agreed to pay IWIF $58 million over four years.

The State Treasurer’s Office said the arrangement is authorized by law and exempt from competitive bidding. It said the fee is based on cost and that oversight has increased in response to audit findings. The office also said it was “not aware of complaints of this nature from injured state workers.”

Chesapeake officials, meanwhile, said they have no evidence of widespread problems with access to care or delays.

“Neither Chesapeake Employers nor IWIF, have been notified by the Workers’ Compensation Commission of any systemic complaints of delays or denials involving access to medical treatment or prescriptions,” Carmine D’Alessandro, Chesapeake’s chief legal officer, said in a statement on behalf of both. The commission oversees the state’s workers’ compensation system.

IWIF’s relationship with Chesapeake dates to a 2013 restructuring. Under legislation the previous year, IWIF transferred its insurance operations to the newly created Chesapeake, while retaining its role as benefits administrator. Chesapeake will become the successor to IWIF’s insurance business once all IWIF employees — who were hired before 2013 — leave the payroll. The insurer says its mission is to support an affordable, competitive and accessible workers’ compensation system and serve as the insurer of last resort for Maryland employers. Workers’ compensation typically covers medical treatment, partial lost wages and disability benefits.

State audits have repeatedly raised concerns about transparency. From 2007 to 2025, at least six reports from the Office of Legislative Audits said the Maryland State Treasurer’s Office could not demonstrate whether claims payments and administrative charges had been properly handled.

Since the last audit, the treasurer’s office said it has hired a staff member to conduct daily checks of first reports of injuries, weekly claims reviews and monthly financial reviews. The office said two to six claims are selected for audit each month, with any discrepancies sent back to IWIF to resolve.

In fiscal 2023, nearly half of all workers’ compensation claims in Maryland were disputed — meaning all or part of a request was rejected. Of 21,661 claims filed, more than 47% were disputed and nearly 3% were disallowed, with workers denied benefits because injuries were non-work related or for other reasons, the Workers’ Compensation Commission said in the most recent report detailing those statistics. Just over a quarter of the claims were settled. Workers in law enforcement/security, schools/colleges and warehouses filed the most claims, with the biggest share of injuries causing back, knee and shoulder disabilities.

Chesapeake covered about 20,000 Maryland employers and their workers last year, including private employers, municipalities and counties, but not workers covered through the IWIF state contract. It paid about $98 million in more than 6,500 claims. Through the separate contract, IWIF administered payments of about $72 million for nearly 7,500 claims in fiscal 2025. Chesapeake did not break out the number of workers covered, which was 188,000 as of its 2022 annual report, or provide the number of state employees covered through the IWIF contract.

Operators of RescueMeds, an Annapolis-based independent pharmacy that specializes in workers’ compensation-related medications, have challenged the insurer’s pharmaceutical reimbursement rates as too low and raised questions about state oversight of IWIF and Chesapeake.

The mail-order pharmacy says it is one of the few that fills and ships prescriptions to patients regardless of denials by insurance carriers and sees its role as filling gaps left by workers’ compensation delays. Colleen Shields, the pharmacy’s CEO and founder, said companies such as hers risk not getting paid and often wait months or years to collect. It has repeatedly disputed payment levels before the Workers’ Compensation Commission. This year alone, RescueMeds is appealing commission rulings on IWIF or Chesapeake payments in a dozen individual Circuit Court cases across Maryland.

Shields argues that Chesapeake’s position as Maryland’s largest workers’ compensation insurer, combined with its ties to IWIF, gives it significant influence over the system. Because the insurer refuses to pay the “usual and customary” rate for injured workers’ prescriptions paid by other insurers, she said, it has a lower rate of claims paid per employee than competing insurers.

“There is little to no oversight over Chesapeake, or their performance as it relates to the treatment of injured workers — especially their primary book of business being the Maryland State employees,” Shields said. “They are grossly negligent in their care of injured workers.”

Chesapeake maintains it is regulated like the state’s other authorized property and casualty insurers, while the Maryland Insurance Administration reviews IWIF’s services and costs to the state at least every five years.

Chesapeake also argues that some independent pharmacies, including those specializing in workers’ compensation, overcharge by hundreds of dollars per prescription. The insurer has accused them of exploiting Maryland’s lack of a fee guide for pharmaceutical services. Such pharmacies charge based on “an artificial price set by manufacturers that does not reflect actual purchasing transactions,” D’Alessandro said at a hearing during last year’s state legislative session when prescription reimbursement rates were debated.

“Certain pharmacies have exploited the system, resulting in excessive pricing disparities and rampant overcharging of insurers, counties, municipalities and the state,” D’Alessandro told the Senate Finance Committee.

The bill under consideration, supported by Chesapeake and opposed by RescueMeds, failed to advance. It would have set a prescription fee guide in Maryland based on the publicly published National Average Drug Acquisition Cost, or NADAC. Chesapeake argued that would better reflect what pharmacies actually pay.

RescueMeds maintains that the “average wholesale price” index, or AWP, is the national standard, used for workers’ compensation prescriptions in more than 30 states and recognized by insurers other than Chesapeake. Shields said Chesapeake pays on average 32% of billed amounts — less than the pharmacy’s cost — while all other carriers pay more than 100% of AWP.

D’Alessandro did not dispute RescueMeds’ figures, but said, “If payers are reimbursing more than 100 percent of Average Wholesale Price (AWP), that is not a defense of the price. That is evidence of the problem.”

The dispute is continuing in court. RescueMeds filed an appeal April 27 in Calvert County Circuit Court challenging a commission ruling earlier that month that said state law allows the NADAC index.

Meanwhile, Shields says, her company’s patients are left in limbo. One, a volunteer firefighter struggling with post-traumatic stress disorder, filed a claim in late September 2025, but hearings before the Workers’ Compensation Commission have been postponed, she said.

The firefighter’s claim stemmed from job trauma, including one incident in which a baby pushed in a stroller by his mother was fatally struck by a vehicle. RescueMeds has been filling his medications, free to the patient, and is waiting for reimbursement, Shields said. But she expects the case to drag on for another year.

Derek, the former state trooper, said he’s tired of fighting for medications and procedures his doctor believes could help reduce his need for treatment in the future. Workers’ compensation covers mostly generic rather than name-brand drugs, he said, with some causing him allergic reactions. He said he has had to work with an attorney to resolve insurance issues involving medication.

Derek, 64, has been prescribed medication used for weight loss that he said also helps heart attack victims prevent strokes and plaque buildup. He said workers’ compensation denied coverage, forcing him to pay out of pocket.

“Workers’ comp should be paying for it, but we get pushback,” he said.

Devoe, the former Salisbury police officer, said he’s come to depend on RescueMeds to provide medications he’d otherwise be waiting for insurers to approve. Insurance hasn’t covered inpatient treatment or a prescribed alternative treatment for his severe depression. He said insurance also has not covered doctor-referred therapy for recurrent nightmares and anxiety attacks — all of which make it difficult to hold down a job, he said.

“When it comes to mental health, you need help right then and there,” Devoe said. “I understand you have to keep an eye out for false claims, but my documentation has already been accepted as a workers’ comp claim. … I just want to be halfway close to where I was 10 years ago with my mental health. To live life without it is miserable.”

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