The claimant, Timothy Bauer, was employed as a paramedic for the Miller County Ambulance District when, on October 9, 2003, he responded to two locations involving fatalities, the first, a motor vehicle accident involving one fatality, the second, a self-inflicted gunshot wound, also resulted in a fatality.
On November 19, 2003, Mr. Bauer was admitted to St. Francis Hospital and Health Services in Maryville, Missouri, after threatening a woman he had been dating and threatening suicide. The discharge summary contains the following history:
The patient was brought in by Maryville Police Department after a call came in suggesting that Mr. Bauer had made a threat to a girl that he is dating, her children and her estranged husband. Then reportedly remarked that he would then kill himself. This gentleman denies homicidal and suicidal thought on admission. He says that a girl that he was going with near Columbia kicked him out of the house at 10:00 at night. He immediately came to the Maryville area to stay with a currently separated woman and her children, that he is "in love with" and when told that she planned on getting back with her husband, he became enraged. He has an ex-wife and three children near St. Louis where his parents live. On admission, there were multiple track marks noted on his right arm. On admission, he told the nurse that he had planned on letting the blood out of his vein and putting in air. He works as an emergency medical technician part time. By the time I talked with him he denied suicidal ideation and said he was just upset over his girlfriend's decision to go back with her husband. He was evaluated on the $11^{\text {th }}$ and at that time reported thoughts of suicide, lots of stress but remarked that he would not harm himself.
The records of St. Francis Hospital and Health Center contain multiple references to Mr. Bauer's "breaking point was when girlfriend went back with ex." Also noted is Mr. Bauer's statement that he had considered suicide for 20 years. There is one reference in the records to "lots of job stress and bad calls. Patient says a 14-year-old died on his shift and that has bothered him a lot."
Dr. Ann Duncan, a licensed psychologist, examined Mr. Bauer and had Mr. Bauer participate in psychological tests. Dr. Duncan found Mr. Bauer to have had a brief psychotic reaction in November of 2003. Dr. Duncan testified that the calls in which Mr. Bauer participated on October 9, 2003, on behalf of the ambulance district could arguably be called instrumental in causing Mr. Bauer's November 19, 2003 psychological problems, but also testified that it was the dissolution of his relationship with a girlfriend that "put him over the edge."
In her written report, dated July 18, 2005, Dr. Duncan referred to a "Brief Psychotic distorder with marked stressors" and referred to the precipitating event as "the deaths on October 9, 2003." Dr. Duncan referred to Mr. Bauer's continued "stress, anxiety, and anger over the denial of his workman's compensation claim."