Addressing the Critical Need for Regulatory Changes in Workers’ Compensation Laws—Starting with Hawaii

Honolulu, HI (WorkersCompensation.com) — The incident at Hawaii State Hospital in late 2023, in which workers witnessed the brutal murder of their colleague, Justin Bautista, has urgently exposed a critical flaw in the workers’ compensation system. Despite the undeniable trauma these workers experienced, their requests for mental health care were denied, leaving them without the support they desperately need. This situation underscores the urgent need for immediate and decisive regulatory changes to workers’ compensation laws.

The incident and its consequences

On November 13, 2023, Justin Bautista, a well-liked nurse at Hawaii State Hospital, was fatally stabbed by a patient with a history of violent behavior. Four of Bautista’s colleagues who witnessed the attack and tried to help him were subsequently stripped of workers’ compensation benefits for the psychological trauma they experienced. Dr. Scott Miscovich, who filed workers’ compensation claims on behalf of the workers, described the state’s actions as “unacceptable,” emphasizing that the delay in care would only worsen their trauma.

Bautista’s colleagues are not alone in their struggles. The psychological toll of witnessing such a violent event is immense, with potential long-term mental health effects. According to Dr. Miscovich, these workers experience symptoms typical of post-traumatic stress disorder (PTSD), including insomnia, anxiety and flashbacks. Still, the state Department of Human Resources Development has declined to approve their workers’ compensation claims, citing the need for further investigation.

Shortcomings of Current Workers’ Compensation Laws

This tragic event highlights the shortcomings of current workers’ compensation laws, particularly those related to psychological injuries. The state’s refusal to approve these claims quickly reflects a broader problem in the system: the need for timely and appropriate support for workers who have experienced traumatic events at work. The delay in approval means workers are left to seek treatment, often at significant personal cost, while they wait for a decision.

State Rep. Scott Matayoshi, chairman of the House Labor and Government Operations Committee, expressed frustration with the state’s handling of these claims. He noted that the state denies workers’ compensation claims at a much higher rate than other employers, something he plans to investigate further. Matayoshi’s concerns underscore a systemic problem that requires immediate attention and reform.

“These employees were clearly at work,” Matayoshi said. “I have a hard time understanding how this wouldn’t be covered by workers’ compensation. I just don’t see any other facts that would explain why this could be dismissed, even if it was dismissed pending an investigation.”

The human cost of delayed compensation

The human cost of delayed workers’ compensation claims is enormous. For Hawaii State Hospital workers, having their claims denied means they are unable to access the mental health care they need to cope with their trauma. This denial affects their mental health, their ability to return to work, and their overall quality of life. The financial burden of paying for treatment out of pocket can be overwhelming, adding to the stress and anxiety they already experience.

Dr. Miscovich has been outspoken about the need for these workers to receive prompt and appropriate care. He has seen firsthand the impact that workplace violence can have on healthcare workers, having treated scores of hospital workers injured by patients over the past decade. “This is something that can literally stay with them for the rest of their lives,” he said, emphasizing the long-term and potentially devastating consequences of untreated psychological trauma.

Wider implications for employees and employers

The denial of compensation to these hospital workers is not an isolated incident, but part of a systemic trend that affects many government workers. This situation raises a key question: Will health insurance fill the gap if workers’ compensation laws are not reformed to better support workers? The reality is that the cost of inadequate workers’ compensation ultimately falls on health insurance, burdening both employers and employees. When workers’ compensation claims are denied, health insurance often becomes the primary source of health care coverage, leading to higher premiums and higher overall costs for both employers and employees.

Employers need to recognize that failure to support employees through effective workers’ compensation will lead to an increase in health insurance claims, which can increase premiums and overall costs. Both workers’ compensation and health insurance are essential to protecting employees. Workers’ compensation is designed to cover medical expenses related to workplace injuries. When workers’ compensation claims are denied, health insurance often becomes the primary source of coverage for those injuries, leading to increased premiums and overall costs for both employers and employees. Employers need to understand that ignoring one will inevitably affect the other.

Financial and ethical imperative for change

From a financial perspective, the current system is unsustainable. Employers are required to have occupational injury and health insurance. However, the burden of untreated workplace injuries and traumas often transfers to health insurance when claims for compensation for occupational injuries are rejected. This change not only increases the cost of health insurance, but also leads to higher premiums for employers and employees. This is a vicious cycle that can only be broken through comprehensive regulatory reform.

Ethically, denying compensation for psychological injuries is indefensible. Employees who experience traumatic events at work deserve the same level of care and support as those who have been physically injured. Failure to acknowledge and address the psychological impact of workplace violence sends the message that mental health is less important than physical health, which is both outdated and harmful. It is time to uphold our moral responsibility and ensure that all workplace injuries are treated equally.

The need for regulatory change

The current regulatory framework for workers’ compensation needs to change to ensure that workers receive the care they need, particularly for psychological injuries. This care includes:

1. Timely Approval of Claims:Streamlining the workers’ compensation claim approval process, especially for psychological injuries, is key to ensuring that workers receive immediate support. This process can include establishing clear guidelines for assessing psychological injuries and providing a standardized approach to assessment. Additionally, reducing bureaucratic hurdles that delay approval can help workers access the care they need without unnecessary waiting periods.

2. Comprehensive insurance:Expanding coverage to include psychological injuries and trauma is essential to recognizing the profound impact they can have on the health and well-being of workers. Expanded coverage should include counseling, therapy, and other mental health services that are key to recovery and rehabilitation. The workers’ compensation system can better meet the health needs of workers by providing comprehensive support.

3. More responsibility:Holding employers and government agencies accountable for providing adequate support to workers is key to ensuring that claims are handled fairly and efficiently. This accountability can include regular audits of workers’ compensation practices, ensuring compliance with established guidelines, and identifying areas for improvement. Additionally, imposing penalties for unjustified denials can discourage negligent behavior and promote a more responsible approach to claims management.

4. Supportive work environments:Encouraging employers to create supportive work environments that prioritize employee well-being is fundamental to fostering a healthy workplace culture. This support includes training managers and employees to recognize and respond to psychological trauma, equipping them to provide appropriate support. Promoting a culture that values ​​mental health can lead to a more engaged and resilient workforce, which will ultimately benefit employees and employers.

5. Legislative Advocacy:Advocating for legislative changes that protect workers and provide them with the support they need is key to modernizing the workers’ compensation system. Policymakers must work together to update workers’ compensation laws to reflect the realities of today’s workplaces and the importance of mental health. We can create a more equitable and effective system that truly supports all workers by prioritizing these legislative efforts.

The case of the Hawaii State Hospital workers is a stark reminder of the urgent need for reform in workers’ compensation laws. Employers and policymakers must work together to create a system that truly supports workers in their time of need. Without these changes, we risk failing those who dedicate their lives to helping others. It’s time to prioritize the well-being of our workers by providing them with the care and support they deserve, whether it’s through workers’ compensation or health insurance.

In memory of Justin Bautista and in support of his colleagues, let us advocate for a more compassionate and effective workers’ compensation system.