Nate Willems served in the Iowa House from 2009 through 2012 and practices law with the Rush & Nicholson firm in Cedar Rapids. This essay previously appeared in The Prairie Progressive.
A single mom works as a certified nursing assistant (CNA) in a hospital. One night, she is assigned to give a shower to a patient who has dementia. As she starts to shower him, he growls. He calls her a Nazi. She tries to calm him. He calls her a Nazi again and louder.
Without warning, he puts a hand on her throat and begins to squeeze; with his other hand, he seizes the showerhead and beats her in the face. The worker is pinned in and tries to scream. A nurse walks in. Instead of helping, she says, “I’ll go look for help.” The attack ends only when the dementia patient stands up and walks stark naked out into the hallway.
In the ensuing months, the CNA attempts to return to work. She is watched closely. The employer reprimands her if she clocks in one minute late. The employer reprimands her for going to the bathroom too often. She is harassed by management until she has a breakdown.
A middle school band teacher spends 30 years working for her school district. One August, her principal asks her to coach 7th grade volleyball. The teacher responds she does not know anything about volleyball or coaching and is not certified. The principal tells her if she does not agree to coach, they simply will not have a team. So, she agrees.
The school serves a low socio-economic community. This is the first volleyball experience for many of the kids. They lose a lot. In the last match, they face a team from a wealthy school. This is not the first volleyball experience for the wealthy kids. The match is not competitive. Kids lose their tempers and some refuse to take the bus home.
When the bus arrives home, a mob of angry parents is waiting. As the band teacher exits the bus, a mother steps up and punches her in the face, knocking her to the ground. The school suspends the teacher. After an investigation finds no wrongdoing by the teacher, the school district threatens to fire her if she does not agree to sign their resignation forms. This is how her career ends.
Both of these attacks on workers are workers’ compensation events. In Iowa, an employer and its workers’ compensation insurance carrier are required to pay all costs for all physical and mental health care stemming from a work injury.
Both of these workers suffer from some combination of depression, anxiety, and PTSD. Both of these women relive their experiences in nightmares and with particular everyday triggers.
Injured workers like these two often find twin antagonists: their employer and the insurance company. The employer often treats its injured workers like enemies. The workers may be put under a microscope, receive discipline as a form of harassment, or simply not be allowed to return to work. Workers often leave unpleasantly and are made to feel guilty for simply being in the wrong place at the wrong time.
To add insult to injury, there is the workers’ compensation insurance company. Though required under law, mental health care is typically not provided at the outset. The worker must request it. The insurance company may ignore requests for care—maybe for months, maybe for years.
Next, the insurance company will want to send the worker to a psychologist for an evaluation. There is a cottage industry of people with degrees in mental health who make themselves available to insurance companies to provide the opinions sought. Assuming the person with a degree plays their expected role and finds the worker is exaggerating symptoms, malingering, or suffering from a pre-existing condition, that likely closes the books on providing care.
Occasionally, though, the facts are so stark the insurance company cannot figure out a way out of providing mental health care.
But if it takes one or two years before the employer or insurance company fulfills its legal duty to provide care, there is no financial penalty. The injured worker suffering from PTSD after a work injury cannot recover anything for pain and suffering. And in the worst-case scenario, if someone suffering from untreated mental illness stemming from a work injury takes his or her own life, the insurance company is off the hook from having to pay anything.
When there is no penalty for noncompliance with the law, when there is no accountability, the results are predictable. Ignore. Delay. Deny. Shame the injured worker and try to make them go away.
These are the trademark characteristics experienced by Iowans hurt on the job and needing mental health care. It is a gauntlet that only those who are courageous, and probably a bit lucky, will successfully navigate.
Top photo is by Dragana Gordic, available via Shutterstock.