By Katie Bernard, Kacen Bayless
The Kansas City Star
TOPEKA, Kan. — At his lowest point Mike Lewis was keenly aware that it would be cheaper to spend 97 cents on a bullet than it would be to spend $150 an hour on therapy for his post-traumatic stress.
The Butler County paramedic has been haunted since October 2013 when he was on a reserve EMS team and responded to a call from his father the night his mother died.
Lewis was still in training and promised his mom at the time that he would finish to become the best paramedic he could be. But what followed was “bad call after bad call, after bad call.”
In 2020, on the anniversary of his mother’s death, a six-month-old infant died in his arms on a call.
“That pushed everything that I was boxing up off the shelf,” Lewis said.
Lewis spent the next two years in a dark place. He relied on alcohol to get to sleep at night. He got divorced and, for a period of time, slept in his car in a WalMart parking lot. On Christmas of 2021 he attempted suicide but his gun didn’t go off.
Lewis didn’t see treatment as an option. His employee benefits would cover six therapy visits per year, not nearly enough to help him manage a diagnosis of post-traumatic stress, anxiety, depression and suicidal ideation. After the six visits were used any future visits would come out of pocket. A father of three, he couldn’t afford that on his paramedic salary.
“I had zero support is what I thought,” Lewis said.
In February of 2022 Lewis eventually got the help he needed through Warriors Ascent, a Kansas City nonprofit that runs a five day retreat program for first responders and veterans suffering from post-traumatic stress.
Next month a law will go into effect in Missouri making it clear that first responders are eligible to claim workers’ compensation for post-traumatic stress disorder incurred as a result of their work. The law provides a list of eligible incidents, including directly witnessing the death of a minor and witnessing a person “who has suffered serious physical injury of a nature that shocks the conscience.”
A separate provision in the new law allows first responders, such as EMTs, firefighters and 911 operators, to receive benefits for behavioral health care services and treatment for PTSD.
Lewis is convinced that this sort of coverage, eliminating a key barrier to treatment, would have saved his marriage and led him to treatment far earlier.
But Lewis serves in Kansas, where for three years lawmakers have essentially ignored a bill to expand that coverage. If Lewis is physically injured on the job, his care is covered, including any mental health care need, but psychological injuries alone don’t count.
“There’s no difference between a broken femur and pronouncing a five-month-old dead in your arms,” Lewis said. “The five-month-old dead, that hurts way more, that’s a longer-lasting effect. But people don’t see it like that.”
Roadblocks in Kansas
Kansas advocates are hoping Missouri’s movement on the policy will spur momentum in the neighboring state.
Kansas Gov. Laura Kelly, a Democrat, specifically called for expanded benefits in her State of the State address in January, but a bill to do so did not even earn a hearing in the Senate Commerce Committee this year.
The proposed policy has been hung up on financial and political barriers since Kansas state Rep. Eric Smith, a Burlington Republican, first introduced it in 2021.
When the bill got a hearing in 2021 the Kansas Chamber of Commerce, one of the state’s most influential lobbying interests, testified in opposition. In joint testimony with the National Federation of Independent Business, the chamber argued that allowing mental health to be covered by workers compensation would result in litigation and drive up premiums.
“The problem with PTSD as a workers compensation claim is separating… the physical injury and mental injury is less clear that the workplace incident was the prevailing factor in the development of PTSD in first responders,” the written testimony said. “These will not be easy cases to determine which extends the duration of a case, increasing the financial award to the individual and liability to public and private employers.”
The chamber and NFIB did not respond to requests for comment for this story.
The inaction has grown frustrating for advocates. The COVID pandemic was especially rough on first responders and call volumes continue to increase as staffing numbers wane.
A 2022 study by the Ruderman Family Foundation found firefighters and police officers are more likely to die by suicide than in the line of duty. According to the Centers for Disease Control and Prevention, EMS workers are 1.39 times more likely to die by suicide than the general public.
“Myself as well as others have grown tired of losing friends or having friends that are suffering so terribly from PTSD and mental health from what they see at their job,” said Chrissy Bartel, president of the Kansas Emergency Medical Services Association’s Peer Support Society.
Kent Vosburg, EMS chief at the Junction City Fire Department, testified to lawmakers in 2021 about his own experiences as a first responder. He told The Star at the time that when he visited a counselor a decade ago to discuss his experiences, the counselor left the room crying.
Vosburg has met with lawmakers to advocate for the policy, but he feels as though he’s hit a brick wall.
He heard from lawmakers concerned about opening the door to any worker with PTSD. Another lawmaker, he said, told him she felt it came down to “saving as much money as possible.”
“It’s really hard to argue with a sentiment like that,” he said.
Kansas state Sen. Renee Erickson, a Wichita Republican who chairs the Kansas Senate Commerce Committee, said the PTSD policy would be considered in a comprehensive review of Kansas workers compensation laws she wants to pursue next year. Kansas has the lowest cap for workers compensation in the nation, blocking anyone from receiving more than $155,000 over the course of their lifetime.
But Ed Klumpp, a lobbyist for the Kansas Sheriff’s Association and Kansas Association of Chiefs of Police, said he wasn’t optimistic that PTSD would be included in the review.
“Nobody had reached out to us about that. We actually hadn’t had leadership or committee leaders reach out to us supportive of adding PTSD for first responders under work comp,” he said. “Until we get that kind of buy-in I’m not very optimistic.”
Missouri’s new law may offer model
Klumpp and other advocates see some hope in Missouri’s movement on the issue.
“Every time somebody passes a bill it gives you a chance to say look, look what they’ve done,” said Smith, the Kansas state representative who introduced the bill in 2021. He is also undersheriff in Coffey County.
Kansas state Rep. Stephanie Clayton, an Overland Park Democrat who sits on the state EMS board, said she believes Missouri’s actions could play a role in workforce shortages.
“Workers are going to go to the place that treats them better and provides them with more benefits,” Clayton said.
Heading into next year, Klumpp said Kansas advocates may consider changing the bill’s language to mirror what’s passed in Missouri.
The Missouri legislation, sponsored by Missouri state Sen. Lincoln Hough, a Springfield Republican, establishes PTSD as a compensable occupational disease for first responders. It doesn’t require first responders to have a physical injury to claim workers’ compensation but those with pre-existing PTSD are not eligible.
While proposals in Kansas have left proof of PTSD open-ended, just mandating that it be a result of the job, Missouri’s new law provides a list of requirements.
The provision allowing benefits for PTSD builds on a 2021 law that established a pool of state dollars to fund cancer treatments for firefighters who contracted the illness through their work — “like an Aflac insurance policy,” Hough said.
The new law broadens the scope of that pool to include PTSD as well as other first responders including EMTs, ambulance drivers and 911 operators, Hough said.
“We want folks to get the help that they need and, if they can, get back in the workforce,” Hough told The Star.
Hough said that firefighters, EMTs and other first responders have been supportive and thankful that lawmakers were able to get the legislation passed.
“I’ve gotten a bunch of those kinds of tear jerk phone calls and emails from folks who say ‘I don’t know if you know how important this is.’ And ‘I don’t know if you know how much of an impact this is going to have on someone that I work with, or me,’” he said.
Greg Brown, chief of the Eureka Fire Protection District and a district director at the Fire Fighters Association of Missouri, said that while first responders can receive workers’ compensation for PTSD, the new law lowers the burden of proof that first responders have to prove to receive it.
Brown said the benefits pool will also help “change the culture” surrounding behavioral and mental health for first responders. He said he is working on best practices that agencies can follow so that they can detect PTSD earlier so first responders can receive help.
“A lot of times workers’ comp doesn’t get brought in until somebody is really in a bad situation,” he said. “We’re going to try to identify things earlier. And get a handle on that before it’s become more severe.”
Hough said the goal of the legislation wasn’t to poach employees from surrounding states. But he hopes that neighboring states, such as Kansas, take notice.
“What I would really hope was that the Kansas Legislature would look at it, reach out to these groups, do a little research on their own, and model something similar to what we’ve done,” he said.
If you or someone you know is at risk of self-harm, the National Suicide Prevention Lifeline provides 24-hour support at 988.
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