What was supposed to be an average day on the farm changed Doug Boswell’s life.
On a cold November day in 2017, Boswell was feeding his cows in Stockton, and he left the gate open. When he returned to feed them, he realized three of the cows had escaped.
He managed to corral two of them back with his tractor, but one was still loose. So, he got on the nearby all-terrain vehicle and chased the cow. But then, his ATV flipped.
He tried to move, but he couldn’t.
“I just couldn’t believe I was paralyzed,” he said.
Boswell lay on the ground for about 45 minutes. He didn’t have his phone with him. His wife, Teresa, was waiting for him in the truck by the barn. They were planning to eat after he fed the cows.
Eventually, his wife realized something was wrong. She walked down the hill from the barn and saw the still-running tractor with two bales on it.
“Then I looked over to the right, and I saw my four-wheeler on its side, and then I looked down and I saw him. And then I just ran,” she said.
She called 911, and when first responders arrived, they checked Boswell’s pulse. It was low. The ambulance to take him to the trauma center was too far away, so they called a helicopter to take him to the hospital.
“All I remember was the scream when they rolled him over to put him on board the helicopter," Teresa Boswell said. "It was pretty intense.”
Her husband had shattered his right shoulder, punctured a lung and broken two ribs and his back. And he was paralyzed.
Dozens of accidents like this one happen every year on farms across the state.
Every day, tasks on a farm carry the risk of injury or death. Tractors tip over and crush the operator. Farmers drown in grain silos. Grain augers tear off limbs. Hair gets caught in spinning tractor parts.
Agriculture is one of the most hazardous industries alongside construction, according to the National Safety Council. In 2015, almost 36,000 farmworkers experienced an injury, according to the Bureau of Labor Statistics Survey of Occupational Injuries and Illnesses.
The injury rate on farms in Missouri is almost double the national average for all occupations, according to a survey by the Central States Center for Agricultural Safety and Health, located in Omaha, Nebraska.
Farm injury and safety is an ongoing issue, said Scott Heiberger, health communications manager for the Marshfield Clinic Research Institute, based in Wisconsin, and president-elect of the International Society for Agricultural Safety and Health.
“Whenever I go into a room of farmers or people who work on farms and I just ask for a show of hands: ‘How many people in here personally know somebody who was killed in a farm incident?’ Hands always go up."
‘How many people have personally experienced a serious farm injury?’ And hands always go up. … That tells us that farm injury and farm safety is an ongoing issue,” Heiberger said.
Missouri is home to nearly 100,000 farms. Those farms make up two-thirds of the state’s land, according to the Missouri Department of Agriculture. More than 96 percent of the state's farms are considered family-owned, according to the national Census of Agriculture.
Small farms — those with fewer than 10 people working on it — are exempt from federal investigations into workplace injuries. The Occupational Safety and Health Administration doesn’t enforce workplace safety on any farm operation with 10 or fewer employees. So if there is a traumatic injury or death on a small farm, OSHA does not investigate.
For families, an investigation helps them understand exactly what happened to their loved ones, said Tonya Ford, a workplace advocate and executive director of the United Support and Memorial for Workplace Fatalities.
“It also provides answers to the farm or the company in regards to what happened and how we can prevent it from happening again, so others don’t get injured or killed doing the same job,” Ford said. “So a lot of it is prevention and making sure it doesn’t happen again.”
Finding data on small farm injuries can be difficult. The Central States Center for Agricultural Safety and Health collects news clippings on farm injuries and deaths. It also conducts a survey sent to farmers in several states, including Missouri.
The news clips counted more than 250 incidents since 2012 in Missouri. More than 100 of these incidents were fatalities, and the main cause was related to some type of tractor accident.
Some tractor accidents involved riders being ejected or pinned beneath their tractors. In others, someone was run over by a tractor.
In 2018, a 69-year-old man in Mammoth Spring, Arkansas, at the Missouri-Arkansas border, died when he was pinned by his tractor while trying to unload barrels from the bucket of the tractor. Another man died while pinned under a tractor with a rotary cutter after running into a tree while cutting on a slope in Doniphan, Missouri.
“Missouri has a phenomenal rate of tractor rollover incidents,” said Ellen Duysen, community outreach specialist for the Central States Center, which is funded by the National Institute for Occupational Safety and Health.
Duysen said she believes many of Missouri’s farms are small and have outdated equipment, which adds to the injury risk.
Other fatalities have included ATV accidents, suffocating in a grain bin, getting entangled in heavy machinery and being killed by an aggressive bull.
Missouri had 5.66 injuries per year per 100 farmers, according to the Central States Center survey. That was fewer than the other six states in the survey, but about twice the rate of injuries for all jobs reported to OSHA in 2015.
Across the seven states surveyed, 56 percent of injuries required a doctor or clinic visit and 12 percent required hospitalization. The average cost per incident was $35,000, including medical costs and lost productivity.
All told, the Boswells have had more than $1 million in expenses since the accident, Teresa Boswell estimated. Boswell had a long road to recovery. When he arrived at Mercy Hospital in Springfield, he needed two surgeries — one on his back and one on his shoulder.
He was in the hospital for about three weeks, transferred to another hospital for three weeks and a nursing home for another five before physical therapy began at Craig Hospital in Denver.
All together, it was four months before he could go back home.
A matter of life or death
When a farmer experiences a traumatic injury, every second it takes to get to a care facility is critical — and those care facilities are becoming fewer and farther between as rural hospitals close. According to Hospital Industry Data Institute Statistics, the average distance traveled by rural hospital patients who did not survive illness or injury either on the way to a care facility or at the facility was 32.1 miles, compared to 9.1 miles for non-rural hospital fatalities.
Boswell was 61 miles away from a trauma center that could treat his injuries.. And when first responders check his pulse, it was low -- around 32. So a helicopter had to airlift him to Mercy Hospital in Springfield.
Missouri has 13 providers of air ambulance services with rotary aircraft scattered over 36 bases, according to a report released in January by the Missouri Department of Insurance, Financial Institutions and Professional Registration.
The Missouri Hospital Association partners with Air Evac, and the company was responsible for 3,570 air evacuation transports in 2017, about a third of all air ambulance transports in the state that year.
The company owns its own helicopters, crew quarters and hangers and employs its own pilots and crew members.
Although air ambulance services can greatly reduce a patient’s time before receiving medical care, the cost can be expensive..
Air ambulance companies billed Missourians nearly $25.7 million billed for services in 2017 alone – an average of nearly $20,000 per individual, according to the January report. The U.S. Government Accountability office reported in 2017 that the median cost for helicopter air ambulance service doubled from around $15,000 to about $30,000 per transport between 2010 and 2014.
Because the air ambulance industry has very high fixed costs compared to “per trip” costs, patients are charged for even short flights that can run to tens of thousands of dollars, the report noted.
Air ambulance reimbursement rates are fixed by Medicare and Medicaid, and providers that participate in these programs have to accept these rates as payment in full – they cannot “balance bill” patients for amounts charged over the reimbursement rates.
Cost of safety
Some farmers can’t afford to pay for upgrades that increase safety on the farm.
“If you talk to a Missouri farmer, they know their farms aren’t safe, and it is too expensive to make it safe,” said Karen Funkenbusch, rural safety and health specialist with MU Extension.
Farm income is down as commodity rates have dropped and production costs have gone up, according to the Kansas City Federal Reserve.
Retrofitting rollover bars and safety belts on tractors can cost hundred of dollars for the farmer. With tight budgets, farmers often must choose between upgrading safety and paying for parts so their tractor will continue to run. In most cases, the decision is straightforward.
If there were some kind of government incentive program in place, Funkenbusch believes farmers would be able to have safer farms.
National ROPS rebate program, based in New York, tries to help farmers by offering rebates to those who install rollover protection.
The program is on a first-come,first-served basis, and at least 750 farmers are on a waitlist, including 23 from Missouri, said Pam Tinc, junior research associate for the program.
There are typically three approaches to farm safety, Heiberger said: education, engineering and enforcement.
“You get a room full farm safety experts in a room, and everyone has their favorite prong on that,” Heiberger said.
Missouri seems to be taking the education approach. Missouri has programs like Show-Me Farm Safety, a joint effort between multiple organizations such as the Missouri Department of Agriculture, University of Missouri Extension and Missouri Farm Bureau. The group brings information from the academic, private and public sectors together to create awareness and safety campaigns, said David Baker, MU extension broader impacts administrative consultant and co-chair of the program.
Path to recovery
Boswell said he has heard stories about farm machinery accidents over the years, but he never thought about the danger while working on his farm.
Boswell’s father, Roy, who has farmed most of his adult life, said he believes injuries are inherent to farming. Roy Boswell, now 76, got into an ATV accident himself in 1989 and needed 56 stitches in his head.
“When you’re on a farm, getting hurt is part of it,” he said. “There’s so many things that you do that you take for granted as you do it. And you do that so many times, the odds get stacked up against you. And sooner or later, you’re going to get whacked.”
Doug Boswell wanted to continue farming after his accident, even though he was paralyzed. In the Denver hospital, Boswell connected with AgrAbility, an organization that helps disabled farmers find the resources to keep working.
AgrAbility worked with the Missouri Division of Vocational Rehabilitation to help fund the technology Boswell needed. Now, he uses a track chair — a motorized wheelchair with treads. He also uses a chair lift to get into his car and tractor.
Funkenbusch, who is also the director of the Missouri AgrAbility program, said they can’t pay for assistive technology, but they can put him in touch with organizations that can potentially help pay. AgrAbility conducts roughly 80 farm assessments for disabled farmers each year, Funkenbusch said.
The Boswells continue to work on the farm and plan to build a house that is ADA accessible.
On the farm one day this spring, Boswell spent the morning using a system called a bud box to vaccinate his cattle. Cows were guided into the box, Boswell pulled a lever to keep their heads still and gave them a shot in the neck.
He had people to help, but soon he will be able to do it by himself. Later that day, he used hand controls to drive his truck to the barn and changed the oil in his tractor.
Working on the farm now is a slower process, he said, and there can still be difficulties. It took two hours for him to get his tractor out of his barn one day, for example.
The ATV still sits in a shed on the farm.
“That four-wheeler, I used it all the time working cattle,” Boswell said. “And why I went end over end, I don’t know that day. I’ve played it over and over in my head.”