Now, part 2 of our series of reports examining San Bernardino County's resistance to awarding worker's compensation benefits to county employees who survived the 2015 San Bernardino terror attack. Reporter Benjamin Purper speaks with a survivor about his efforts to get treatment for PTSD.
Ray Britain is a survivor of the December 2nd terrorist attack in San Bernardino. He was the supervisor of all the employees in the room, and he was there but not injured.
At his house, Britain shows me an example of a denial he received through utilization review. That’s the process where the county of San Bernardino decides whether or not to approve a treatment requested by a doctor.
Britain was denied psychotherapy after the incident, and since denials last a year, he couldn’t revisit that request for 12 months.
“I was denied psychotherapy from the beginning. Went all the way through the workman comp, the California state workman comp system, went to UR, non-certified, was appealed, independent medical review, the decision was upheld, I could not revisit that for over a year.”
It took a media campaign to finally get Britain’s therapy approved. About a year after the incident, a group of survivors started speaking to outlets like the New York Times and PBS about their struggles with workers’ comp. And all that publicity did change the county’s behavior. 19 months after the initial request, they finally approved his therapy.
"After 19 months and a big media campaign and push on our par, the county and workman comp did start to approve some services. At that point, I was able to, I had psychotherapy and EMDR which was approved. So, limited sessions for the first time. Limited sessions, but they did make that approval. I don’t believe that it would’ve been approved without the media exposure. I think it was a result of us bringing this out.”
San Bernardino County Representative David Wert disagrees. He says the process of utilization review, which determines which treatments are approved through workman’s comp, has worked the way it should.
He says it protects patients from being over-prescribed things like opioids. I asked him how that principle applies in the case of mental health counseling.
"There seems to be a feeling out there that you can never have too much counseling, that counseling’s always a good thing. If you could have it seven days a week, that’s better than having it 5 days a week. And on its face, whether or not you’re in workers’ comp, that’s not the case. Endless counseling doesn’t necessarily solve a problem.”
Plus, he says, it can be hard to tell when counseling is working for someone.
“If someone is undergoing therapy for six months or a year, and the reports filed by their own doctors show there is no improvement, there's an obligation on the part of workers comp to say wait a minute, nothing is happening here. We need to try something else. Or if a doctor reports, this is as well as I can make this person, they're not going to get any better no matter how much counseling they have, no matter how good the counseling might make you feel, they're not going to improve, again workers comp has to say, workers comp no longer applies here. So if someone has reached that point in their treatment where their own doctors say, you're not getting any better, further treatment is not going to help you, but a patient feels, "I still want counseling, I still need counseling, counseling makes me feel better," there are other forms of treatment available, there are other avenues to have that treatment covered, not just workers' comp.”
But Ray Britain says the frustration of dealing with the workers’ comp system has led to secondary trauma for the survivors. And while he says he can’t speak for all of them, none of the ones he keeps in contact with are satisfied with the process.
“I don’t know anyone that’s satisfied with this process. And again, it’s very complex, it’s very humbling to be in the workman comp system. So nobody is satisfied, I think everybody wishes that this would’ve occurred, if it had to occur, if it would’ve occurred outside of work hours. We all believe it would’ve been a much different outcome for healing. And everyone has experienced that level of secondary trauma.”
That secondary trauma, he says, has continuing effects on the survivors’ mental health.
“So that sense of abandonment, from what happened in the room, to what’s happening now trying to get care and medical services, very similar and they would feed on each other. So, I believe that the way that this was handled, and that secondary trauma that we talk about, it really kept the event from not being processed fully for us.”