Emerg Services Ethical dilemma, claim process

[gealach]

I had a confusing (for me) conversation with WCB about my ptsd claim. I've been fighting with wcb about my diagnosis since last April, they deny the ptsd but I've been diagnosed with it by a T who is independent from them, so... pissing contest with ptsd as the prize. The claim is now in appeals, and my T is sticking with her diagnosis, even when her job was threatened if she refused to change her opinion (whole other ethical issue there).

WCB today hinted that if I want my claim approved, I need to focus on the ugly parts of patient care, and the paramedic suicide epidemic here, and stop talking about the bullying and harassment I experienced. The problem is, I'm not bothered by the "ugly parts" of patient care. Patients experience horrible shit, sometimes they live, sometimes they don't. I always give my best effort, whether it's a hangnail or a gunshot wound, so their outcome doesn't bother me.

I'm quite literal, no imagination, and I believe in 100% honesty. I can't lie. The few times I've tried, outside of being a young child of course, it's been really obvious and ended badly. I can't even play poker!!! I feel like I'm being asked to lie, in order to have my claim approved. Like I need to turn the patient's bad experience into my bad experience, in order to be covered for therapy. But it wasn't MY bad experience, and I don't actually feel bad about what I've seen. I've never had a nightmare, or a flashback, or an intrusive memory, about a patient. I've never lost sleep wondering "what if". I was told by wcb that I'm just under reporting how I REALLY feel about the things I've seen.... what??? I've seen horrible things with patients, and I have ptsd, but one is not related to the other. I have non-patient related Crit A trauma, why isn't that good enough? No where in the DSM does it specify that paramedics can only be diagnosed with ptsd if their crit A is related to patient care, not another trauma at work.

Am I nuts, just blocking out the bad patient stuff? Do I lie? HOW do I lie?

I can speak honestly about our suicide epidemic. No lies or ethical dilemma there.

Minimizing the threats, bullying, and harassment? That seems fundamentally wrong to me. That enables the bullies, and those who have a duty to investigate but didn't. That allows them to get away with what they did. And, most importantly, it allows them to continue their behaviour, and victimize someone else.

Lying about the cause of my trauma, to get my claim approved, WILL give me nightmares. What do I do?

 

[EveHarrington]

Threats, bullying and harassment are harder to “prove” as causing PTSD as it doesn’t squarely/clearly fall under criterion A so in that sense, it make sense that they are denying you.

It sounds like you have more than your share of criterion A trauma, it may just not be manifesting itself as ptsd symptoms that support your claim.

A hard one for sure!

 

[Freida]

My pstd diagnosis is for my military stint but I've been amazed how different 911 calls, that didn't bother me, are tied in with the triggers of ptsd. I don't say that to encourage you it's ok to lie! Just an observation from my brain

As for your WCB people. Yea, my HR director just asked for ALL my medical records, including my therapy notes and emails between my T and anyone else so that they (hr) can determine when I can come back to work. Seriously WTF is wrong with these people?!!!

 

[gealach]

Threats, bullying and harassment are harder to “prove” as causing PTSD as it doesn’t square...

I agree. Management didn't document or investigate anything when I reported, so there is no "proof" of anything, and so it's difficult to apply to the claim. They did, however, admit to giving me an EAP brochure, at a meeting that they claimed never happened, for complaints that they claim I never made. They're having some trouble explaining that. Knowing EMS culture here, my complaints are known to be accurate, even if they're not provable after this length of time. And yes the bullying and harassment aren't the Crit A trauma, they are the complaints that I'm the most emotional (?) about, and the ones that finally had me circling the drain, after the Crit A trauma. The Crit A was something else, still work related but not patient care related. They're trying to lump it in with the bullying and harassment, and so... shh, don't talk about it, and my dilemma. :banghead:

 

[Justmehere]

Bullying and harassment can cause many symptoms. Unless it endangered or threatened your life or physical safety or threatened sexual assault, it is unlikely to be the cause of the PTSD symptoms.

That being said, if being bullied and harassed on a job that deals with life and death issues, I’m not sure this can all be separated out into neat little boxes. If people were bullying you while you are trying to do a job to save lives, that ties the bullying with the life and death matters of the job.

The other thing to consider is the stress cup model. https://www.myptsd.com/threads/the-ptsd-cup-explanation.13737/ The life and death patient situations probably helped fill up your stress cup, and the other issues put it over the edge.

You say they are asking you to lie. I think they are actually just asking you to focus on a different topic. If there is no impact from that topic, why not humor them and talk that subject through for a bit?

As to what is the cause of PTSD, tell them you are not able to diagnose yourself and let the therapist be the diagnostician as to what the cause of your symptoms. Let her argue it out with them with the credentials she has in this. She appears to be willing and able.

Is an attorney helping you with your case?

 

[gealach]

My pstd diagnosis is for my military stint but I've been amazed how different 911 calls, that didn't bot...

If the calls didn't bother you, how do they tie into your ptsd triggers? Do you mean that you didn't acknowledge that it was bothering you? or it took some time to realize that it bothered you?

 

[scout86]

Have you discussed this with your T?

Something I've noticed, with me anyway, is that there's a lot of stuff that I tend to think of as "normal" and "nothing but a thing", that actually HAS been kind of problematic. If you asked me, I'd probably say "it's not a problem". (I'm no better at lying than it sounds like you are.) I'd SAY that, but I'd be wrong. "Wrong" isn't a lie, it's a mistake. See what I mean? So, talk about this with your T. She gave you the diagnosis, see what she used as qualifications. And, be open to the possibility that you might not be seeing things clearly.

BTW, the whole "nothin' but a thing" deal CAN be minimizing. Doesn't have to be, but it can be, and that's a survival tool but it's also kind of a symptom.

 

[gealach]

"Bullying and harassment can cause many symptoms. Unless it endangered or threatened your life or physical safety or threatened sexual assault, it is unlikely to be the cause of the PTSD symptoms."

Yup, that's what happened. It's all fun and games until you introduce threats of physical assault or sexual assault, or actually assault your co-worker. I'm clear on what actually is involved in Crit A. I've seen co-workers assault each other, I've seen a co-worker involve a student in assaulting a patient, I've had a co-worker admit to covering up a really brutal assault on a patient, and then I was threatened, so I really had no reason to believe he wouldn't pick me up throw me into the wall and then throw me through a heavy glass door. Not the first time I've been threatened or actually injured by a co-worker, just the threat that bothers me the most. I reported, without names, but that got the ball rolling. This is what wcb wants me to shut up about. I'm just not sure what to do about that. In ems-land, not documented means it didn't happen. If I agree to shut up, it's not documented (again), and didn't happen (again).

"That being said, if being bullied and harassed on a job that deals with life and death issues, I’m not sure this can all be separated out into neat little boxes. If people were bullying you while you are trying to do a job to save lives, that ties the bullying with the life and death matters of the job."

Yup, this is also what happened. Refusing to assist with care or treatments, and refusing to take over as a higher level of care when required, for treatments that are out of my scope of practice. Basically, using the patient against your partner when you're pissed off at them. We don't audit 100% of charts, so much of it wasn't caught. The charts where I documented and they were caught on audit, I was questioned, not the medic that breached. Corrections staff here have recently complained of something similar, being threatened with being locked between gates with prisoners, trapped. Using prisoners against your partner when you're pissed off at them.

 

[Justmehere]

threats of physical assault or sexual assault, or actually assault your co-worker. I'm clear on what actually is involved in Crit A. I've seen co-workers assault each other, I've seen a co-worker involve a student in assaulting a patient, I've had a co-worker admit to covering up a really brutal assault on a patient, and then I was threatened, so I really had no reason to believe he wouldn't pick me up throw me into the wall and then throw me through a heavy glass door. Not the first time I've been threatened or actually injured by a co-worker, just the threat that bothers me the most

When you state it this way, it’s more clearly Criterion A trauma.

 

[Freida]

Do you mean that you didn't acknowledge that it was bothering you? or it took some time to realize that it bothered you?

It kind of ties into what @scout86 and @Justmehere are saying..

One of the job requirements is the ability to compartmentalize. If I don't acknowledge it, it wont bother me. But they do. They lay under the surface and pop up eventually. They can be the triggers for the trauma, or the trauma itself.

for example -- I took a call that was bad enough to land me in the dispatch shrinks office about 6 years ago. Thought I was good with it until it popped up one day in EMDR. It really freaked me out because it was the first time I had thought about it in years. But there one small part in that call- about 90 seconds - that somehow crosses into my original trauma. So we have spent the last 6 sessions working on how they are connected. The call itself doesn't' bother me. But it acts as a trigger for what does.

So I think the question that is coming up is -- could something in the field be the initial trauma and the bullying and such the trigger? Instead of the other way around?

 

[gealach]

Have you discussed this with your T?

Something I've noticed, with me anyway, is that there's a lot of...

Yeah, I got the call as I was going out the door to a session, so I did bring it up. She gets my whole 100% honesty thing, so she's going to work with me on preparing for the assessment.

She says I have the "I'm fine" wall up... smile, be polite, say you're fine, etc, but for the love of god don't let them see you cry. Is the wall up so high that I'm even fooling myself into thinking I'm okay? I don't know, I just don't have any emotions around patient care, none. Someone called, I responded, I did everything I could within my scope, clean, restock, document, and off to the next call. Sometimes I had a good partner, sometimes my partner was family, and sometimes my partner was a complete f*ckwad. That makes things more challenging, and irritating, it just means I have to do my job better to compensate.

When I get to the part where I have to explain the call that "caused" the ptsd, what the hell do I say? Uhhh, Uhhh, Uhhh isn't gonna cut it. Right now, I can't name one. But I have to. I can talk about calls that could be considered bad calls, but that feels like lying to me, they don't feel like anything, much less a bad call.

 

[gealach]

It kind of ties into what @scout86 and @Justmehere are saying..

O...

that makes a bit more sense to me.

How do I explain what's bothering me, when I'm not aware of what's bothering me? Like you weren't bothered by the call until it came up much later? I can't wait until later in therapy, they want to know now, and I don't know what to say.

The last threat of assault was definitely the last straw, and the bullying and harassment were definitely triggers after that, I'm just having trouble filling in the rest.