Sick nurses must prove they got COVID-19 on the job

A longtime Sonoma County nurse first felt sick in March, starting with a sore throat and stuffy nose, followed by a deep fatigue. Nearly two weeks later, a confirmation: she had contracted COVID-19, the respiratory disease caused by the coronavirus.

But where did she get it? At the hospital where she works? Or somewhere else in the community?

For her and other health care workers on the front lines, the answers to those questions are critical. They determine whether their treatment is covered by a limited bank of paid sick days and health insurance or by workers' compensation, an employer-funded system that offers expanded benefits ­- including lost wages, job protection guarantees and death benefits - to workers who are hurt on the job.

While local health care workers say that going to work is the riskiest thing they do when it comes to contracting COVID-19, some local hospitals are pushing back against claims they got sick while performing their duties.

Hospitals have told employees they must prove they were exposed to the coronavirus at work in order to qualify for workers' compensation benefits, according to several local nurses, including the longtime employee of a local hospital who spoke on condition of anonymity because she feared losing her job if she was identified.

Sonoma County's three largest hospitals said they were following the law by requiring employees to document a connection between their work and their illness. One, Sutter Health, changed its internal policies earlier this month and now assumes that all employees infected with the virus were exposed at work, unless proven otherwise. The two remaining hospital companies, Kaiser Permanente and Providence St. Joseph Health, make decisions about employees' claims on a case-by-case basis but have increased sick leave granted to workers exposed to the virus.

North Coast Assemblyman Jim Wood, D-Santa Rosa, chairman of the Assembly's health committee, was surprised and alarmed to learn of the nurses' experiences from The Press Democrat. He said he would look into the issue to see if new laws are needed to protect essential workers who are risking their health at work while most others isolate at home.

“It's going to require a legislative fix,” said Wood, who said he would raise the issue with lawmakers when the Assembly reconvenes in May.

“You shouldn't go to work and get sick on the job and not be able to have the protections of workers' compensation - that's my opinion,” Wood said. “Today, you can still file a claim but the burden of proof will be really difficult.”

Labor unions are pushing employers to give greater protection to hospital staff and other essential workers who get sick with COVID-19. Such protections are critical, particularly at a time when protective masks, gowns and other gear are in short supply, said Cyndi Krahne, chief nurse representative with California Nurses Association, which represents about 1,230 registered nurses in Sonoma County and 100,000 statewide.

“It's really exhausting that we have to fight for personal protective equipment, then fight to prove we were infected at work,” said Krahne, who works for Kaiser Permanente in Santa Rosa. “Nurses are already anxious and exhausted trying to care for patients.”

Protecting the health of their workers and the patients they serve is a top priority, representatives of all three Sonoma County hospitals said. To reduce their risk of exposure to the coronavirus, they said their hospitals adhere to the latest guidelines from public health authorities, including the Centers for Disease Control and Prevention.

When employees have been stricken with the virus, particularly at the beginning of the pandemic, all three hospitals said they followed state regulations to determine whether the illness qualified for workers' comp. Those regulations require an employee demonstrate the illness or injury was related to the job.

“We do not hold our employees to any different standard regarding workers' compensation claims for COVID-19,” said Debora Catsavas, senior vice president of human resources for Kaiser Permanente Northern California.

States take action

Statewide, local health departments have reported 2,789 health care workers have tested positive for COVID-19, according to data released Tuesday by the California Department of Public Health. In Sonoma County, 33 health care workers have tested positive, accounting for 1 in 5 of the county's confirmed cases as of Tuesday. The concentration of cases reflects, in part, the priority placed on testing health care workers, county spokeswoman Jennifer Larocque said.

In recognition that these workers are uniquely at risk for contracting the virus, Gov. Gavin Newsom last week announced the state would begin providing low-cost or free hotel rooms for health care employees who are exposed to or test positive for COVID-19 so they have a safe place to isolate apart from their families.

Some health care employers, including Kaiser, are offering a variety of new benefits for employees who get sick with the new disease, such as additional leave. For some staff those added benefits are sufficient. But for others, they may not offer enough job protections against an illness that can involve a lengthy recovery and possible death.

Workers' compensation provides guarantees that employees can return to a job when they recover - and if they die from a work-related illness or injury, their families will receive death benefits.

The California Labor Federation is urging Newsom and legislative leaders to adjust existing regulations to ensure nurses and other essential workers will be able to automatically access workers' compensation benefits if they get sick.

“If they are infected with COVID-19, the workers' compensation system must quickly provide medical and indemnity benefits - such workers should not have to fight denials and delays while fighting for their lives,” the federation wrote in a March 27 letter to Newsom and legislative leaders.

There are states taking action. This week, the Illinois Workers' Compensation Commission announced that a broad range of essential workers - from health care workers to grocery store staff - would be automatically eligible for workers' compensation if they contract the novel coronavirus. Minnesota lawmakers passed legislation earlier this month extending workers' compensation benefits to first responders, health care workers and child care providers who contract the virus. And Missouri Gov. Mike Parson announced first responders such as law enforcement officers, firefighters and paramedics who get the virus would be automatically eligible for workers' compensation.

Newsom and state lawmakers have so far not publicly addressed the problem.

Burden on employees

Some hospitals have responded to the pressure, giving additional benefits and protections to employees. But the policies are uneven and voluntary, leading some to demand the state add COVID-19 to a list of conditions that, if acquired by certain people working on the front lines of the pandemic, will automatically be considered a workplace illness.

“Once it became community-acquired, a lot of employers saw that as an opportunity to not have to take responsibility for nurses being exposed,” said Deborah Burger, president of the California Nurses Association and National Nurses United.

Just as hospitals have been preparing for a surge of COVID-19 patients, employers of front-line workers are likely bracing for an uptick in staff illnesses and the costs associated with workers' comp claims, said Laura Rosenthal, a Santa Rosa attorney who specializes in workers' compensation law.

“A flood of claims - that's a potential disaster,” Rosenthal said. “If someone is on a respirator at a hospital, they have to look at how much it's going to cost. They want that employee's health insurance to pay for it.”

Givens said hospital workers aren't always notified if they came in contact with a patient or coworker who was later diagnosed. Some health care administrators have taken the stance that workers will not be considered exposed, even when caring for a patient known to have COVID-19, if they follow policies for protective gear and practices, she said.

Different approaches

In Sonoma County, the three major hospital systems have taken different approaches to coronavirus cases within their workforces.

Sutter Santa Rosa said it would begin implementing a new policy and “presume employees who work in clinical environments acquired the virus from a work-related exposure for compensation purposes unless definitively shown otherwise.”

Kaiser Permanente and Providence St. Joseph Health, on the other hand, make decisions about potential workers' comp claims on a case-by-case basis while increasing financial support for sick workers.

Kaiser's new benefits for employees includes up to 80 hours of additional paid time off on top of existing benefits, options for financial assistance, housing resources, mental health and wellness resources as well as child care, according Catsavas.

Providence St. Joseph Health, which operates Memorial Hospital in Santa Rosa, has created a paid leave program for any employee who tests positive, an emergency time-off benefit for caregivers and a partial income replacement program for those who become ill with COVID-19, according to a spokesman.

Sue Gadbois, president of the Staff Nurses Association of Santa Rosa Memorial Hospital, said none of the approximately 700 nurses it represents have contracted COVID-19. Gadbois applauded the hospital systems' plans for helping employees who do contract the disease.

“The hospital has indicated that if a nurse becomes ill, they want to make sure their regular wage is maintained if they're a benefited nurse,” Gadbois said.

‘It was scary'

For the longtime Sonoma County nurse with coronavirus since early March, she's learned firsthand the long course the disease can take. It wasn't until her third week of being ill that she drove herself to the emergency room because she couldn't stop coughing, couldn't catch her breath and her heart was racing.

“It was scary,” she said. “I had to drive myself because I didn't want my husband to get it.”

The local nurse said she's used up her sick time. She must return to work by a certain date to retain her benefits.

She's doing far better today but remains fatigued with a persistent cough. She does not want to return to work, concerned she might infect coworkers or patients while she still has symptoms.

She said she's called California lawmakers about the issue because she believes that health care workers need to have some certainty that they can take care of their health without worrying about the status of their jobs and benefits.

“It's not just the flu,” she said. “For some it might be, but how do you know if you're going to fight it well? There are going to be people who are worse off than me.”

You can reach Staff Writer Julie Johnson at 707-521-5220 or julie.johnson@pressdemocrat.com. On Twitter @jjpressdem.