Should a workers’ compensation carrier have to pay for an extended testing protocol after a hospital employee’s exposure to a patient’s blood? This was the question the Kentucky Supreme Court answered in Kentucky Employers Safety Assoc., v. Lexington Diagnostic Center, Ky. LEXIS 80.
The Facts of the Case
A health care employee’s face and eyes were splattered with blood and saline while flushing a patient’s intravenous (IV) line. The employee sought immediate medical attention. The post-exposure protocol required by OSHA was initiated. The protocol required a series of five office visits including tests for blood borne pathogens at a total cost of about $700.00. The carrier paid for the first two visits and part of the third. However, the carrier refused further payment as its policy was to pay for an initial test and one follow-up “as a matter of custom and practice and a courtesy to its members.” The carrier argued that the exposure had the potential to harm but did not constitute an injury until objective medical findings showed it had produced a harmful change in the human organism.
The Court Decision
The Kentucky Supreme Court said that being splattered in the face and eye with blood or other potentially infectious material was a traumatic event under Kentucky Revised Statute 342.0011(1). The court said that the presence of blood in the eye was an exposure as defined in 29 Code of Federal Regulations (CFR) 1910.1030(b), which showed a harmful change in the human organism, i.e., the introduction of foreign blood or potentially infectious material into the employee’s body. Appropriate medical treatment included not only treatment for the injury’s immediate effects, but also treatment to help determine if the exposure produced harmful changes not evident immediately. What treatment was reasonable and necessary depended on the circumstances.
The court upheld the Administrative Law Judge’s (ALJ) decision that the employee sustained an injury and that the carrier was liable for reasonable and necessary medical treatment, including both the initial treatment and post-exposure prophylaxis.
See generally Larson’s Workers’ Compensation Law §§ 5.05, 29.03, 42.01, 51.02, 51.06, 55.01, 55.02, 94.03.
Why Carriers Should Care
Health Care Workers Have More Cases than Construction Workers
According to the Bureau of Labor Statistics report, “Workplace Injuries and Illnesses,” education and health services workers had a higher incidence of recordable injuries for the than construction workers.
The report stated that
- The total recordable cases incidence rate in the private construction industry was 4.0 cases per 100 full-time workers —a seven percent decline.
- Specialty trade contractors reported a similar decline in the injury and illness incidence rate—falling to 4.3 cases per 100 full-time workers—and was largely responsible for the reported decline in the construction industry
- Health care and social assistance workers had an incidence rate of injuries and illnesses of 5.2 cases per 100 full-time workers. While this was a decrease of 5.4 cases, this was the lone industry sector in which both reported employment and hours worked increased.
Author Michael B. Stack, CPA, Director of Operations, Amaxx Risk Solutions, Inc. is an expert in employer communication systems and part of the Amaxx team helping companies reduce their workers compensation costs by 20% to 50%. He is a writer, speaker, and website publisher. www.reduceyourworkerscomp.com. Contact: [email protected].
WORKERS COMP MANAGEMENT MANUAL: www.WCManual.com
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
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