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Commentary: The Zone of Danger, Physical Impact, and PTSD

Dr. Keram is Assistant Clinical Professor of Psychiatry, Psychiatry and the Law Program, Department of Psychiatry, University of California San Francisco School of Medicine, San Francisco, CA. Address correspondence to: Emily A. Keram, MD, Santa Rosa VA Mental Health Clinic, 3315 Chanate Road, Santa Rosa, CA 95404. E-mail: emilykeram{at}hotmail.com

The Federal Employer's Liability Act (FELA) exempts employers from providing mental health coverage to railway drivers who suffer work-related psychological trauma as the result of an incident that does include a threat of imminent direct physical impact. Tension exists between this legislation and the Posttraumatic Stress Disorder (PTSD) literature. Neurobiological research demonstrates that PTSD is associated with changes in brain imaging studies and neuroendocrinology, supporting the stance that PTSD is, in part, a physical illness. The FELA should be amended to cover this class of workers. Doing so would not place undue liability on employers.