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Can nurse get workers’ comp benefits for PTSD?

A nurse says workplace training dredged up memories of abuse he suffered as a child, and that his resulting post traumatic stress disorder left him unable to work. Can he get workers’ comp benefits for PTSD?

William Ireton, an RN, worked as a nurse manager at Woods Memorial Hospital in Etowah, TN. Ireton’s duties included determining if patients would be appropriate for admission to the hospital’s psychiatric unit.

Ireton was required by his employer, Horizon Mental Health Management, to attend an annual conference which included training.

During the 2012 conference, employees attended a session led by another Horizon employee on trauma-sensitivity care.

Part of the training involved how to handle patients. According to Ireton, the session leader made this request to all attendees:

“I want you to put yourself in your patient’s shoes and imagine how it would feel when you’re asked, ‘Have you ever been physically, emotionally, or sexually abused?'”

Ireton says after hearing that suggestion, “emotion overcame him” immediately. He totally “freaked out.” He had flashbacks of when he had been raped at age 11 by a 17-year-old cousin.

He ran to the bathroom and splashed water on his face, but he couldn’t pull himself together. Ireton returned to the seminar, but he was still freaked out.

That evening, Ireton says he couldn’t sleep, had nightmares and flashbacks of his sexual assault, and cried. He says he never sought psychiatric help for the assault. However, he had undergone treatment previously for anxiety, depression, panic attacks, crying at work and suicidal thoughts. Despite that, Ireton says he had never experienced an emotional reaction like the one he had the day of the training.

Ireton’s last day of work was Nov. 7, 2012. He went to see his family doctor that month, and was referred to a psychiatrist and a psychotherapist.

Ireton applied for workers’ comp benefits. His employer denied his request, and the case went to trial. A trial court found he wasn’t eligible for benefits because the PTSD he suffered after the training seminar didn’t arise out of his employment.

An appeal from Ireton went to the special workers’ comp branch of the Tennessee Supreme Court.

Usual or unusual stress?

The state’s highest court had previously ruled that, for an injury caused by something purely mental or emotional to be compensable under workers’ comp, two requirements must both be fulfilled:

  1. The injury must have “resulted from an identifiable stressful work-related event that produced a sudden mental stimulus such as fright, shock or excessive unexpected anxiety, and
  2. “The stress produced may not be usual stress in comparison to the stress ordinarily experienced by an employee in the same type duty.”

Ireton said that in his previous training, he’d always been told to distance himself from patients – as a nurse in a crisis unit, you never placed yourself in the patient’s shoes.

His co-worker who provided the training said she expects a nurse assessing a patient to understand the patient to be able to discuss the patient’s admission.

Ireton’s treating psychiatrist testified the training seminar had been a triggering event that brought back Ireton’s symptoms of depression and PTSD. The psychiatrist said before the 2012 incident, Ireton, who worked as a psychiatric nurse since 1986, had no previous extended periods where he wasn’t able to work.

The psychiatrist considered the suggestion during the training to be somewhat unusual. According to the doctor, nurses are encouraged not to push people to describe their experiences, but rather to simply gather the information.

A psychiatrist hired by Horizon examined Ireton. This doctor said Ireton didn’t suffer PTSD as a result of the seminar. Ireton had an impairment, according to this psychiatrist, but it wasn’t linked to his work. The doctor’s diagnosis was that Ireton was feigning his illness.

On appeal, Ireton argued that the trial court had improperly used an objective measure of whether the stress he suffered through work was unusual. Instead, Ireton said the court should have used a more subjective test, taking his own personal circumstances into consideration.

But the appeals court disagreed with Ireton. It said Tennessee law and previous state supreme court decisions required the objective test of whether his stress was unusual.

The court noted Ireton himself testified that, in his experience as a psychiatric nurse, he routinely had taken patient histories and had performed patient assessments during which he asked about family trauma, including abuse.

Therefore, the appeals court upheld the trial court’s finding that Ireton’s PTSD didn’t arise out of his employment because the stress he experienced during the training seminar wasn’t unusual to his job.

What do you think about the court’s decision? Let us know in the comments.

(William Ireton v. Horizon Mental Health Management LLC, Supreme Court of TN, Special Workers’ Compensation Appeals Panel, No. 2013-CV-1081/19/16)

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