Tripp v. Scott Emergency Commc'n Ctr.
| Decision Date | 03 June 2022 |
| Docket Number | 21-0841 |
| Citation | 977 N.W.2d 459 |
| Parties | Mandy TRIPP, Appellant, v. SCOTT EMERGENCY COMMUNICATION CENTER and Iowa Municipalities Workers’ Compensation Association, Appellees. |
| Court | Iowa Supreme Court |
Andrew W. Bribriesco (argued) and Gabriela Navarro of Bribriesco Law Firm, Bettendorf, for appellant.
Chandler M. Surrency (argued) and Jane V. Lorentzen of Hopkins & Huebner, P.C., Des Moines, for appellees.
This case requires us to determine whether Iowa's workers’ compensation statute places on emergency responders a different, higher bar to be eligible for benefits for trauma-induced mental injuries suffered on the job than workers in other roles with identical injuries.
Mandy Tripp, a sixteen-year veteran of Scott County's emergency dispatch system, answered a 911 call from a woman screaming over and over at a high pitch, "Help me, my baby is dead." The woman's screams continued for more than two minutes. Tripp eventually got the woman's address and dispatched first responders. She soon heard a report from a police officer that arrived on the scene about finding a dead infant that appeared to have been attacked with a claw hammer.
In the months that followed, Tripp couldn't shake the mother's screams from her mind or her ears. Loud noises, in particular, would trigger debilitating anxiety. Tripp sought medical help. A counselor and two doctors diagnosed her with PTSD resulting from the call. She was prescribed medication to address the PTSD and wore special headphones to drown out loud noises, sometimes even wearing special musicians’ earplugs under larger noise-canceling headphones. It helped, but not enough. Tripp found herself unable to perform her job duties as an emergency dispatcher as she had before.
Iowa's workers’ compensation law permits workers to receive compensation for injuries that they suffer arising from and in the course of their jobs. Injuries from mental trauma suffered on the job have long been recognized as a basis to provide workers’ compensation. But when Tripp applied for workers’ compensation based on her PTSD, her request was denied. Tripp didn't satisfy the test of legal causation, according to the workers’ compensation commissioner and district court, because 911 dispatchers routinely take calls involving death and traumatic injury, and the mother's harrowing call thus wasn't an "unexpected cause or unusual strain." Tripp appeals. Because Tripp has established that her PTSD resulted from a manifest happening of a sudden traumatic nature from an unexpected cause or unusual strain, we hold she has established legal causation.
Tripp began her career as an emergency dispatcher in 2002, first with the Davenport Police Department and then (when the police department's emergency dispatch system later combined with the county's system) with the Scott County Emergency Communications Center (SECC). Tripp soon was tabbed to train other emergency dispatchers. In a typical workday, Tripp estimated that she answered anywhere from 50 to 200 calls, including 911 emergency and nonemergency calls and administrative calls. An average call lasts thirty-five seconds.
On September 30, 2018, Tripp answered a 911 call from a woman The screaming continued for two minutes and fifteen seconds. Tripp struggled to calm the women enough to get an address to dispatch an ambulance. She ultimately got an address and transferred the call to a medical dispatcher who tried to instruct the mother on lifesaving measures until the ambulance arrived.
Tripp continued to hear ongoing radio traffic about the incident after she transferred the call. She heard the medical dispatcher tell the mother how to perform CPR on an infant. She heard the emergency medics who arrived by ambulance at the scene say that "[r]igor was already set in." And she heard police officers talking about "a potential crime scene" at the mother's home. Injuries to the child's face, according to one investigating officer speaking over the radio, suggested that the child had been beaten with a claw hammer. All the while, the child's mother screamed in the background.
Tripp's supervisor asked Tripp if she needed a break. Tripp declined, responding that she "needed another call" to get the mother's screams "out of my head." Tripp texted her husband, Dennis, a Bettendorf Police Officer with twenty-three years’ experience in law enforcement. She told him that she'd taken "a really bad phone call" and needed to talk to him just to hear another voice. It was, according to Dennis, the first time that she'd ever requested such a thing. Tripp remained at work and continued taking calls until her shift ended.
In the days that followed, Tripp was on the verge of tears, didn't want to answer calls, and didn't want to talk with anyone. Although she had taken emergency calls involving serious injuries to children in the past from people at the scene of fatal incidents, including three calls involving a dead infant, she had never before answered a call from a dead child's own mother. Tripp described the mother's screams as something beyond "normal" sounds: "guttural, awful." Tripp confided to her supervisor and several coworkers that she was struggling to deal with the call. She found herself constantly crying, unable to process her emotions, wanting to sleep, and becoming socially withdrawn.
Tripp initially sought treatment with Lisa Beecher, a licensed mental health counselor, to help her address her mental health, which had been in a state of freefall since the call. Tripp's employer approved the visit. Tripp saw Beecher at least five times over about a three-week period. Beecher diagnosed Tripp with post-traumatic stress disorder, a mental health condition commonly referred to by its acronym: "PTSD." Tripp took two weeks off work at Beecher's suggestion. When she returned to work, she did so with restricted hours.
Beecher soon determined that Tripp's condition wasn't improving. Beecher referred her to a psychologist, Dr. Robert Gillespie, who had treated other Davenport first responders and police officers. Gillespie also diagnosed Tripp with PTSD. He instructed her to seek medication from her regular physician to treat it. Tripp's physician prescribed her an antidepressant. Tripp took the prescribed antidepressants and continued to see Beecher for counseling and Gillespie for psychotherapy to treat her PTSD.
Gillespie's notes of his meeting with Tripp in April 2019 (more than six months after the call) recount that Tripp had been having suicidal feelings at work but had been able to work through them. She continued to struggle with "heightened levels of emotional responsivity" brought on by certain sounds, particularly high-pitched voices. And she continued to experience episodic recurrence of traumatic stress, but with some improvement in the frequency and intensity of the episodes.
In September 2019, another psychiatrist, Martin Carpenter, M.D., performed an independent psychiatric evaluation of Tripp for this litigation. He also diagnosed Tripp's condition as PTSD. Carpenter consulted the Diagnostic and Statistical Manual of Mental Disorders (the DSM-5), the fifth edition of a diagnosis manual for psychological disorders, in making his diagnosis. The DSM-5 states that PTSD can result from exposure "to actual or threatened death," either through directly experiencing a traumatic event or experiencing "repeated or extreme exposure to aversive details of" a traumatic event. Am. Psychiatric Ass'n, Diagnostic and Statistical Manual of Mental Disorders 271 (5th. ed. 2013). Carpenter recommended that Tripp, on top of her ongoing prescription drug treatment, use physical interventions to address her PTSD symptoms. Among other things, Carpenter recommended that she wear special earplugs to limit hearing loud noises, which were a significant trigger of anxiety since the incident.
Tripp filed an application for workers’ compensation benefits based on her PTSD. At the evidentiary hearing, both Beecher and Gillespie's reports found that Tripp's PTSD resulted directly from her involvement in the traumatic events of the mother's 911 call. Gillespie noted that the fourth edition of the DSM "explicitly contemplates the exposure risk for first responders, such as 911 operators." Gillespie testified to his opinion that, by May 2019, Tripp had reached "maximum medical improvement"—in other words, had achieved all the improvement that she reasonably would ever be expected to achieve—as to her PTSD. Tripp's PTSD thus, according to Gillespie, constituted a "chronic episodic condition" resulting in a permanent disability.
Carpenter similarly found that Tripp's diagnosis resulted directly from the events of the mother's 911 call. He concluded that Tripp's condition satisfied the PTSD criteria in the DSM-5 as a "traumatic exposure" in which she experienced a mother's discovery of a dead child in vivid and disturbing fashion. Carpenter also agreed that Tripp had reached maximum medical improvement and that she'd need both ongoing pharmacological management and psychotherapy to treat her PTSD.
Tripp's employer, the SECC, contested her petition for workers’ compensation and called three of Tripp's coworkers to testify at the evidentiary hearing: a medical dispatcher with twenty-four years’ experience (in fact, the same medical dispatcher who instructed the mother on CPR), the SECC's director (who previously worked as a dispatcher), and the SECC's deputy director (who also previously worked as a dispatcher). Each testified to their belief that calls...
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