Last March, when the COVID-19 pandemic had just reached the U.S., Clarence Scott, DO, MBA, was a 67-year-old family physician at a small independent practice in Fort Myers, Florida. At his practice, he worked alongside another physician who was planning to retire soon; Dr. Scott intended to take over the practice at that point.
Dr. Scott and his DO partner dutifully followed the official guidelines on keeping their practice safe; as advised, they directed patients with COVID-19 symptoms to the emergency room. However, at the time, the only known symptoms of COVID-19 were fever, cough and shortness of breath.
An increasing number of patients with different symptoms—muscle aches, chills, diarrhea—began visiting Dr. Scott’s clinic, and he saw them, unaware that they, too, likely had COVID.
The Centers for Disease Control and Prevention expanded its list of COVID symptoms at the end of April. But by then, Dr. Scott had already contracted the virus.
Dual stresses of COVID and health care costs
In May, Dr. Scott started a hospital stay that would continue until his death on Nov. 10. As a “long-haul” COVID patient, he was on and off ventilators and oxygen and suffering from neurological issues caused by the virus.
In the months before his passing, Dr. Scott’s family faced significant financial stress on top of their worry about his health. Due to Medicare coverage limits, Dr. Scott was near his limit of Medicare-covered hospital days when he died. The cost of his hospital stay was about to shift to himself and his family, and it would have likely been astronomical. The Scott family was also concerned about the income Dr. Scott lost while hospitalized.
At his practice, Dr. Scott was covered by worker’s compensation, so his family filed a claim, and were told that they would need to prove that Dr. Scott contracted COVID-19 while at work. Because testing was limited in the early months of the pandemic and many COVID-19 patients Dr. Scott saw weren’t aware that they had the illness, this was an impossible task.
To protect health care workers during COVID-19, some states have changed the provisions of worker’s compensation to presume that they acquired the infection on the job. But this hasn’t happened yet for private-sector employees in Florida.
‘We are asking that something be done to help others’
“I was stunned when I heard that in the state of Florida, we don’t take care of physicians from a worker’s comp standpoint,” said Edward Dupay Jr., DO, in a video the Scott family created to share Dr. Scott’s story. “They were right on the front lines.”
Dr. Scott’s family is advocating that this change be made nationally or at the state level.
“Our state and federal governments have put up billions, trillions of dollars to take care of businesses in the middle of this pandemic,” said Dr. Scott’s son Mike Scott in the video. “Yet when it comes time to actually take care of the medical workers that are taking care of us, many states have not taken any action to take care of these people.”
The Scott family is also advocating for additional legislation at the federal level, such as a health care fund for COVID-19 frontline workers similar to the 9/11 victims compensation fund, to ensure no other health care worker is left in Dr. Scott’s position.
They created the aforementioned advocacy video and a website sharing their father’s story and asking health care workers and others to demand change to ensure health care workers’ COVID-19 medical bills are covered.
“Dad was a hero in our eyes,” says Dr. Scott’s son John Scott. “He practiced medicine knowing that he possibly could get COVID, and he knew that it could be his time. We are asking that something be done to help others who are in the same situation. We know what the problem is now, we need to find a solution to it.”
Worker’s comp legislation at the state level
A number of U.S. states have taken action to extend worker’s compensation coverage to include COVID-19 as a work-related illness. However, most have restricted the coverage to certain employees, such as essential workers, first responders and health care workers.
As of December 2020, 17 states and Puerto Rico had taken such action, according to the National Conference of State Legislatures (NCSL).
In Florida, where Dr. Scott lived, an administrative policy change created a presumption of coverage for various first responders and state-employed health care workers. And earlier this month, legislators in the Florida House of Representatives filed a bill that would provide presumption of coverage to state-employed public safety workers. However, neither the policy change nor the bill would have helped Dr. Scott or others in his situation.
The NCSL’s state-by-state list, last updated in December 2020, is available here. The National Council on Compensation Insurance also maintains a list of pending and enacted state legislation pertaining to worker’s comp and COVID-19; it is updated weekly.
The AOA is monitoring proposed legislation in several states that creates a presumption that workers who contract COVID did so at work for workers’ compensation purposes. Should these bills get scheduled for hearings, and if other states introduce bills, the AOA plans to support them.
The AOA is also watching for proposed federal legislation to provide additional support to health care workers, such as a national health care fund for essential workers.
Throughout the pandemic, the AOA has also been heavily involved in supporting funding and policies to increase the availability of PPE, enhanced coverage for telemedicine, financial relief and liability protections for physicians, graduate medical education funding, and to protect patient access to care and physician payment. Both of the COVID-19 relief packages passed last year included multiple provisions that the AOA and its partners advocated for.
Acute problems for long-haul COVID patients
Dr. Scott’s story highlights the unique challenges faced by long-haul COVID patients–those who still experience symptoms of the disease months after contracting it. Common symptoms that long-haul patients experience include fatigue, shortness of breath, a racing heart, brain fog and memory and attention problems. In some cases, such as Dr. Scott’s, the symptoms are debilitating and require hospitalization or extended time off of work.
Research on long-haul COVID is ongoing; an August 2020 BMJ article estimated that roughly 10% of COVID patients experience prolonged illness after contracting the virus.
Like Dr. Scott, such patients can face enormous challenges if their illness requires lengthy hospital stays that are beyond what their health insurance will cover; they also could grapple with lost wages.
The Scott family would also like to see federal funding and legislation to support all patients with long-haul COVID, not just health care workers.
“As time goes on, we’re finding out that this virus is affecting people in ways we didn’t even know it was affecting them,” John Scott says. “It’s going to become a bigger issue in health care because more people are going to be diagnosed with it.”