Addressing the Urgent Need for Regulatory Changes to Workers’ Compensation Laws – Starting with Hawaii

Honolulu, HI ( — An incident at Hawaii State Hospital in late 2023, where workers witnessed the brutal murder of their co-worker Justin Bautista, has brought to light a critical flaw in the workers’ compensation system. Despite the undeniable trauma these workers experienced, their claims for psychological care were denied, leaving them to struggle without the support they so desperately need. This situation underscores the urgent need for immediate and decisive legislative changes to workers’ compensation laws.

The incident and its aftermath

On November 13, 2023, Justin Bautista, a beloved nurse at Hawaii State Hospital, was fatally stabbed by a patient with a history of aggressive behavior. Four of Bautista’s coworkers, who witnessed the attack and tried to help him, were subsequently denied workers’ compensation for the psychological trauma they suffered. Dr. Scott Miscovich, who filed workers’ compensation claims on behalf of these workers, described the state’s actions as “unconscionable” and stressed that this delay in care will only worsen their trauma.

Bautista’s coworkers aren’t the only ones struggling. The psychological toll of witnessing such a violent event is immense, with potential long-term effects on mental health. According to Dr. Miscovich, these workers have experienced symptoms typical of post-traumatic stress disorder (PTSD), including insomnia, anxiety and flashbacks. Despite this, the state’s Department of Human Resources Development has refused to approve their workers’ compensation claims, citing the need for further investigation.

The Shortcomings of Current Workers’ Compensation Regulations

This tragic event underscores the shortcomings of the current workers’ compensation system, particularly with respect to psychological injuries. The state’s refusal to approve these claims quickly reflects a broader problem within the system: the need for timely and appropriate support for workers who experience traumatic events on the job. The delay in approval means that workers must seek treatment on their own, often at significant personal expense, while they wait for a decision.

State Rep. Scot Matayoshi, chairman of the House Labor and Government Operations Committee, expressed frustration with the way the state is handling these claims. He noted that the state denies workers’ compensation claims at a much higher rate than other employers, an issue he plans to investigate further. Matayoshi’s concerns highlight a systemic problem that requires immediate attention and reform.

“These workers were clearly working,” Matayoshi said. “I have a hard time imagining how this would not be covered by workers’ compensation. I just don’t see any other facts that would explain why this could be dismissed, even if it is dismissed pending investigation.”

The human cost of delayed compensation

The human cost of delayed workers’ compensation is immense. For the employees of Hawaii State Hospital, the denial of their claims means they are unable to access the psychological care they need to cope with their trauma. This denial impacts their mental health, their ability to return to work, and their overall quality of life. The financial burden of paying for treatment out of pocket can be overwhelming, adding to the stress and anxiety they already experience.

Dr. Miscovich has been vocal about the need for these workers to receive prompt and appropriate care. He has seen firsthand the impact that workplace violence can have on healthcare workers, having treated countless hospital workers who have been injured by patients over the past decade. “This is something that they can literally carry with them for the rest of their lives,” he said, emphasizing the long-term and potentially devastating effects of untreated psychological trauma.

The broader implications for employees and employers

The denial of compensation to these hospital workers is not an isolated incident, but part of a systemic trend affecting many government workers. This situation raises a critical question: Will health insurance fill the gap if workers’ compensation laws are not reformed to better support workers? The reality is that the cost of inadequate workers’ compensation ultimately falls on health insurance, placing a burden on both employers and employees. When workers’ compensation claims are denied, health insurance often becomes the primary source of coverage for the resulting health care costs, leading to higher premiums and overall costs for both employers and employees.

Employers need to realize that failing to support employees through effective workers’ compensation will result in more health insurance claims, which can drive up premiums and overall costs. Both workers’ compensation and health insurance are essential to protecting employees. Workers’ compensation is designed to cover the medical costs associated with workplace injuries. When workers’ compensation claims are denied, health insurance often becomes the primary source of coverage for these injuries, resulting in higher premiums and overall costs for both employers and employees. Employers need to understand that neglecting one will inevitably have consequences for the other.

The Financial and Ethical Need for Change

From a financial perspective, the current system is unsustainable. Employers are required to provide workers’ compensation and health insurance. Yet, the burden of untreated workplace injuries and trauma often shifts to health insurance when workers’ compensation claims are denied. This shift not only increases the cost of health insurance, but also results in higher premiums for employers and employees. It’s a vicious cycle that can only be broken through comprehensive regulatory reform.

Ethically, denying workers’ compensation for psychological injuries is indefensible. Employees who experience traumatic events on the job deserve the same level of care and support as employees who sustain physical injuries. Failure to recognize and address the psychological impact of workplace violence sends the message that mental health is less important than physical health, a notion that is both outdated and harmful. It is time to uphold our moral responsibility and ensure equal treatment for all workplace injuries.

The need for regulatory change

The current workers’ compensation regulatory framework needs to be revised to ensure that workers receive the care they need, particularly for psychological injuries. This care includes:

1. Timely approval of claims:Streamlining the process for approving workers’ compensation claims, particularly for psychological injuries, is critical to ensuring that workers receive immediate support. This process may include establishing clear guidelines for assessing psychological injuries and providing a standardized approach to evaluation. Additionally, reducing bureaucratic hurdles that delay approval can help workers access necessary care without unnecessary wait times.

2. Comprehensive coverage:Expanding coverage to include mental health injuries and trauma is essential to recognize the profound impact they can have on workers’ health and well-being. This expanded coverage should include counseling, therapy, and other mental health services that are critical to recovery and rehabilitation. The workers’ compensation system can better address workers’ health needs by providing comprehensive support.

3. More accountability:Holding employers and government agencies accountable for providing adequate support to workers is vital to ensuring that claims are handled fairly and efficiently. This accountability may include regular audits of workers’ compensation practices, ensuring compliance with established guidelines, and identifying areas for improvement. Additionally, imposing penalties for wrongful denials can discourage negligent behavior and promote a more responsible approach to claims management.

4. Supportive work environments:Encouraging employers to create supportive work environments that prioritize employee well-being is fundamental to fostering a healthy workplace culture. This support includes training managers and staff to recognize and respond to psychological trauma, and equipping them with the skills to provide appropriate help. Fostering a culture that values ​​mental health can lead to a more engaged and resilient workforce, ultimately benefiting employees and employers.

5. Legislative advocacy:Advocating for legislative changes that protect workers and ensure they have the support they need is critical to modernizing the workers’ compensation system. Policymakers must work together to update workers’ compensation laws to reflect the realities of modern workplaces and the importance of mental health. By prioritizing these legislative efforts, we can create a fairer, more effective system that truly supports all workers.

The case of the Hawaii State Hospital workers is a stark reminder of the urgent need for reform in workers’ compensation laws. Employers and policymakers must work together to create a system that truly supports workers in times of need. Without these changes, we risk failing individuals who dedicate their lives to helping others. It’s time to prioritize the well-being of our workers by ensuring they receive the care and support they deserve, whether that’s through workers’ compensation or health insurance.

In memory of Justin Bautista and in support of his colleagues, we are committed to building a more compassionate and effective workers’ compensation system.