California debates extending PTSD coverage to more first responders

Reviewed by Emily Henderson, B.Sc.May 9 2023

If you or someone you know may be experiencing a mental health crisis, contact the 988 Suicide & Crisis Lifeline by dialing "988," or the Crisis Text Line by texting "HOME" to 741741.

A paramedic for about 30 years, Susan Farren knew all was not well with first responders: Eight of her colleagues had died by suicide. Others had grappled with substance abuse or gone through painful divorces.

So, in 2018, Farren founded a nonprofit in Santa Rosa to train and support emergency personnel struggling with trauma and stress. Hundreds of firefighters, police officers, and other first responders have since availed themselves of the organization's timely help.

"Nobody prepares you to walk into a house where four people have been murdered," said Farren, executive director of First Responders Resiliency, Inc.

Firefighters, paramedics, and police often respond to the worst days of people's lives — accidents, deaths, fires, and other distressing events. After the deadly mass shootings earlier this year in Monterey Park and Half Moon Bay, and countless others across the country, awareness of how such trauma affects first responders has grown.

But there is no national consensus on when and which emergency personnel should be provided workers' compensation benefits.

“We wouldn’t think twice about taking care of a first responder who broke their leg, and we shouldn’t think twice about taking care of their mental health needs," Karen Larsen, CEO of the Steinberg Institute, a nonprofit public policy institute, said in an email.

This year, there has been a push in California by first responders for laws that expand access to workers' compensation for post-traumatic stress injuries among their ranks. But some business groups and local governments want to pump the breaks, citing worries about potential fraud or abuse of the workers' compensation system.

The allegation that some people could take advantage of a more open workers' compensation system should not deter California from providing immediate access to mental health treatment to those who need it, said Farren, who noted that many of the first responders she works with are denied workers' compensation coverage or have to go through many steps to get it approved.

"That shouldn't keep us from getting help to those who really need it. That help should be available often, and affordably, and it should be available immediately," Farren said.

Perceptions about employers' responsibility for alleviating work-related mental stress have changed over time, and that's showing up in workers' compensation. Each state has its own workers' compensation laws, which provide benefits like disability pay and medical care to workers injured or sickened on the job.

More than half have enacted PTSD policies or policy changes since 2018, according to a 2021 report by Optum, a company that creates workers' compensation programs. Coverage varies widely for post-traumatic stress injuries, which can be triggered by a single traumatic event or continued exposure to high stress and traumatic events.

In 2019, Gov. Gavin Newsom signed legislation into law to give California firefighters and police officers a stronger chance at earning workers' compensation. The bill, SB 542, authored by state Sen. Henry Stern (D-Calabasas) changed state law so that post-traumatic stress "injury," such as PTSD, is legally presumed to be work-related for those first responders.

It was a small step by lawmakers in a state where recognition of work-related injuries for workers' compensation has typically been limited to physical illnesses such as heart disease and cancer. Previously, psychiatric conditions were handled differently, with employers and insurance companies long contending that psychological injuries can have many sources and might be too easy to blame on work.

Researchers at the Rand Corporation suggested in a 2021 report that further study is needed to evaluate the financial toll the 2019 law has had on employers — particularly counties and other municipalities that pay for police, firefighters, and other publicly employed first responders. Rand researchers estimated the added costs for local governments and the state to cover post-traumatic stress injuries could rise from $20 million to $116 million annually.

Firefighters and police in most cases now no longer have to prove that work was mostly responsible for their PTSD. But the law sunsets in 2025 and excludes many other first responders, including dispatchers, paramedics, and first responders at state hospitals.

This year, legislation by state Sen. John Laird (D-Santa Cruz), SB 623, co-sponsored by an advocacy group representing firefighters in the state — California Professional Firefighters — would extend PTSD workers' compensation coverage until 2032 and open it up to state firefighters, additional law enforcement officers, public safety dispatchers, and other emergency response communication employees who work for public agencies. The Senate Labor, Public Employment and Retirement Committee unanimously approved the bill in April, and it is awaiting a vote by the Senate Appropriations Committee.

Business groups and local governments — many of which opposed the 2019 law — are lobbying against more expansion. In letters to lawmakers, groups including the California Chamber of Commerce, California Coalition on Workers' Compensation, California Hospital Association, and California State Association of Counties warned that pending legislation could "open the door to abuse and fraud."

"There is no evidence that workers are being inappropriately denied the care or benefits that they need," Virginia Drake, a spokesperson for the California Coalition on Workers' Compensation, told KFF Health News. The group represents employers, cities and counties, insurance brokers, and government agencies on issues of workers' compensation.

Legislation that would extend benefits to more first responders would "put taxpayer funds at risk by tying the hands of public employers and forcing them to pay even the most questionable claims," she added in a statement.

In addition, there does not seem to be consensus on which emergency personnel should get covered.

A measure by Assemblymember Freddie Rodriguez, a Democrat from Chino who worked as an emergency medical technician for three decades, has stalled. AB 597 would expand workers' compensation coverage to paramedics and emergency medical technicians, but it didn't get a hearing in the Assembly. Unions representing paramedics and EMTs in California did not return messages seeking comment.

"It's a very stressful job," said Rodriguez, who told KFF Health News that two of his paramedic friends had died by suicide. "It affects people differently."

Clearing a path to speedy mental health recovery, particularly after traumatic incidents, "should be automatic," he added.

It's unclear if Newsom will back Laird's bill extending coverage for groups of emergency responders, amid a projected $22.5 billion deficit. A spokesperson for his office, Omar Rodriguez, said the governor typically does not comment on pending legislation and "will evaluate the bills on their own merits if they reach his desk."

Last year, the Democratic governor vetoed similar legislation, saying in a statement that it would be premature to shift coverage of PTSD before any studies had been conducted on how the current law has worked for those who are covered.

Broadening coverage, Newsom wrote, "could set a dangerous precedent that has the potential to destabilize the workers’ compensation system going forward."

This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.