Alaska School Nurse doesn't Connect Child's Death to her Mental Injury

Juneau, AK (WorkersCompensation.com) -- It’s unarguably stressful for a school nurse to attempt to save a child’s life only to have that child later die from the injuries the nurse was attempting to treat. 

However, as Alaska’s top court in Patterson v. Matanuska-Susitna Borough School District, No. 7635 (Alaska 12/23/22) held, that stress won’t always be enough to support an award of workers’ compensation benefits. 

Attempt to Save

While at work for her Alaska school district, a school nurse had an experience in which children, screaming that a child was choking on his lunch, came running into her office one day. The nurse ran to assist the child, who was turning blue when she arrived. 

The nurse tried to clear the child’s airway and helped perform CPR until emergency personnel arrived and rushed the child to the hospital. 

The child later died as a result of the choking incident. 

Because the nurse had been exposed to the child’s bodily fluids, she had medical tests to screen for diseases. The tests came back negative. The district reported the nurse’s injury to the Alaska Workers’ Compensation Board, indicating that it affected multiple body parts, with the cause of injury shown as “absorption, ingestion, or inhalation.” The district paid the nurse temporary total disability benefits for about three months. 

Additionally, the nurse sought counseling and was eventually diagnosed with adjustment disorder and post-traumatic stress disorder. 

The district required the nurse to be evaluated by a psychiatrist. The psychiatrist did not think the nurse had mental health concerns related to work and diagnosed a non-work-related mood disorder. He acknowledged that the choking incident would be “quite distressing” but thought the nurse could have dealt with the distress and returned to work after a few sessions with her counselor. 

In the psychiatrist’s view, “aspiration crises with small children” would not be unsual events for a school nurse. 

The nurse sought temporary total and temporary permanent disability benefits. The district admitted that it had paid TTD benefits and denied that it was liable for further payments. The nurse eventually submitted her resignation, incorrectly believing that her retirement benefits had vested. 

In the nurse’s case before the board, the board concluded that the nurse did not prove a “sufficient causal connection with the mental health problems for which she sought compensation.” Instead, the board gave weight to a doctor’s testimony during the hearing indicating that the nurse’s counseling needs stemmed from a pre-existing personality disorder, not PTSD. 

On appeal, the state commission agreed with the board, prompting the nurse to appeal to court. 

Physical, Mental

Under Alaska law, mental injury claims are analyzed differently depending on whether the alleged cause of the mental injury is a physical injury or mental stress. 

For a “physical-mental” claim, an employee attaches a presumption of compensability by showing evidence of a causal link between the work and the disability for medical treatment. An employer may rebut the presumption by presenting substantial evidence that the disability or need for medical treatment was not work-related. If the employer does so, then the board must weigh the evidence and determine whether employment was, in comparison with other causes of the disability or need for medical treatment, “the most important or material cause with respect to the benefit sought.” 

For a “mental-mental” claim, work stress must be: 

1. Extraordinary and unusual in comparison to pressures and tensions experienced by individuals in a comparable work environment. 
2. The predominant cause of the mental injury. 

The Alaska Supreme Court found that the commission did not err in denying the nurse’s “physical mental” and “mental-mental” claims. 

‘Physical-Mental’ 

Although the nurse’s exposure to bodily fluids was a sufficient injury to attach the presumption of compensability for a “physical-mental” claim, the evidence did not show that the nurse’s physical injury was the substantial cause of her mental health condition. 

According to the court, the board was free to accept the diagnosis and opinion that the nurse did not have a work-related mental health condition. Notably, even the doctor that testified in the nurse’s favor opined that the nurse’s PTSD was attributable to her “exposure to actual or threatened death,” not due to the student’s bodily fluids getting on her. 

‘Mental-Mental’ 

The court found that while the board and commission failed to consider details about the severity of the choking incident, the mental stress of the incident was not the predominant cause of the nurse’s mental injury.

As with the “physcial-mental” claim, the board was entitled to credit the doctor’s opinion arguing against a work-related cause of the nurse’s condition.  

“The board evidently was not persuaded by [the nurse’s] assertion that [the doctor] had a bias that made her opinions unreliable,” the court explained. 

As a result, the court upheld the commission’s upholding of the board’s decision. 

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