DOCUMENTING CONTACT WITH VICTIMS
PROTECTION OF PERSONNE
All emergency service personnel should be aware of the risk of contracting a contagious disease and take precautions such as using surgical masks and gloves. You must also be aware that should you acquire a communicable disease, you must prove that the infection occurred while in the line of duty to be eligible for medical treatment or benefits under workers’ compensation or disability retirement programs. This burden requires the responder to establish a causal connection between the incident that gave rise to the exposure and the contraction of the communicable disease.
In Board of Trustees v. Powell, 554 A 2d 440 (Md. App., 1989), the Court of Special Appeals of Maryland examined the quality of evidence required to prove the causal relationship between a Baltimore firefighter’s employment as an EMT and his contraction of hepatitis-B. A medical exam taken upon Firefighter Powell’s entry into the department in 1980 indicated that he was not suffering from any type of disease. He was assigned as a firefighter and emergency medical technician and worked for the fire department until November 1986, when he was diagnosed as having hepatitis.
Powell filed an application for disability retirement benefits, indicating that the disability was hepatitis-B and that the cause was “unknown.” However, in a subsequent application, heal leged that he contracted hepatitis-B within a six-month period prior to diagnosis, and that he contracted it from “any number of trauma victims he had occasion to treat, via contact with blood or body fluids.”
At a hearing held by the trustees of the retirement board, Powell was unable to pinpoint any specific incident in which he treated or contacted a victim who had hepatitis-B. Co-workers testified on Powell’s behalf that there was a “strong possibility” that he contracted the disease from a victim he assisted. Several magazine articles that dealt with the dangers of hepatitis-B among prehospital care providers also helped his case.
The hoard awarded special benefits, adopting Powell’s argument that since he was free of the hepatitis-B when he was hired and had no explanation of how he may have acquired the disease except for his contacts as an EMT, his incapacity did arise out of the course of his employment.
On appeal, the court reversed the award of benefits, holding that Powell failed to prove a definite causal connection between the injury and the job through any sequence of events. “In the case at hand, appellee [Powell] could not ascribe any specific source of causation giving rise to his contraction of hepatitis. He failed to produce any evidence showing that any of the trauma victims he aided had the disease, relying instead on evidence which tended to show that it was possible that one or more of these people had the disease. Further, he failed to produce expert medical evidence of causation. Unfortunately, the mere possibility or speculation that he contracted the disease while performing his duties as an EMT was insufficient to establish the required causal connection.”
A similar case, Fulton-DeKalb Hospital Authority v. Bishop, 365 S.E.2d 549 (Ga. App., 1988), also led to the same result. Bishop was an EMT who contracted hepatitis-B and was awarded workers’ compensation benefits. On appeal by the hospital’s insurance carrier, the court reversed. The court established five criteria that must be met to support the award of benefits:
- a direct causal connection between the conditions under which the work is performed and the dis-
- ease;
- a natural incident of exposure by reason of the employment;
- the disease is not of a character to which the employee may have substantial exposure outside of employment;
- the disease is not an ordinary disease to which the general public is exposed; and
- the disease must have its origin in a risk connected with employment.
“Appellee [Bishop] testified that his work placed him in close contact with the bodily fluid of other people. However, appellee presented no evidence that any of the persons with whom he had work contact during the incubation period for hepatitis-B was a contagious carrier or victim of the disease.”
In both cases, the persons seeking the benefits were unable to link specifically their contraction of the disease with a patient treated during employment. One way to avoid this problem is for all emergency personnel to document all incidents with enough specificity to pinpoint which personnel contact patients. If patients are subsequently diagnosed as carrying any communicable disease at a later time during hospitalization, incident reports can then be recalled to provide early examination and treatment to any personnel who are exposed. Also, for those jurisdictions without it, legislation must be enacted to mandate that employees of a hospital or treatment facility who treat anyone testing positive for a communicable disease must immediately notify all emergency personnel who were in contact with the patient, as shown by the patient treatment report; the same also must be expected of coroners or medical examiners in their examinations of deceased persons.
As always, prevention of exposure through proper precautions is the primary goal for which all firefighters should strive. But for those unfortunate enough to suffer exposure, proper documentation and prompt notification are essential to overcome legal hurdles to obtain benefits.
