IMPERIAL TRASH SERVICE, et al.
v.
GAIL DOTSON, et al.
No. 1191-93-4
July 5, 1994
Decided July 5, 1994
Summary
Employer
appealed the decision of the Workers' Compensation Commission awarding
benefits. Employer argued the commission erred in finding that the injury arose
out of and during the course of employment.
The Court of
Appeals affirmed, holding that the commission's findings were supported by
credible evidence.
Affirmed.
Headnotes
(1)
Workers'Compensation--Benefits--Standard.--An employee's injuries must result
from an injury or accident arising out of and in the course of employment; an
employee must prove a causal connection between his particular work conditions
and the resulting injury and if the injury or death results from, or is
hastened by, conditions of employment exposing the employee to hazards to a
degree beyond that of the public at large, the injury or death in construed to
be accidental.
(2) Workers'
Compensation--Appellate Review--Standard.—Where there is conflict in the
evidence concerning cause of death, the commission's finding of fact is
conclusive when supported by credible evidence; a question raised by
conflicting medical evidence is a question of fact.
(3) Workers'
Compensation--Injury Arising From Employment--Standard.--An accident may have
more than one proximate cause.
(4) Workers'
Compensation--Injury Arising From Employment --Standard.--There must be an
identifiable incident or sudden precipitating event that results in an obvious
sudden mechanical or structural change in the body for the employee's
work-related injury to be compensable; to constitute an injury by accident, it
is not necessary that there should be an extraordinary occurrence in or about
the work engaged in.
(5) Workers'
Compensation--Benefits--Standard.--When medical opinions conflict, the general
rule is that when an attending physician is positive in his or her diagnosis of
a disease, great weight will be given by the courts to that opinion.
(6) Workers'
Compensation--Injury Arising From Employment--Standard.--Once an injury is
compensable, the employer is liable for the full extent of the injury; the fact
that complications arise or that the injury worsens does not alter the
compensable nature of the injury and when the primary injury is shown to have
arisen out of and in the course of employment, every natural consequence that
flows from the injury likewise arises out of the employment, unless it is the
result of an independent, intervening cause attributable to the employee's
intentional conduct.
Counsel
Charles F. Midkiff (Midkiff & Hiner, P.C., on briefs),
for appellants.
Christopher Paul Schewe, for appellees.
Opinion
COLEMAN, J.
We hold that credible evidence supports the Virginia
Workers' Compensation Commission's finding that Thurman Dotson, the employee,
suffered from heatstroke that arose out of and during the course of his
employment. We hold that the commission did not err in relying on the opinion
of the employee's attending physician that the consequences of the employee's
heatstroke caused his death. Accordingly, we affirm the decision of the [602]
commission.
On July 10,
1990, Thurman Dotson began his first day of work for the Imperial Trash
Company, picking up recyclable materials during the morning hours. George
Mickelson accompanied Dotson to teach the new employee the route and to do most
of the heavy lifting. Dotson drove the truck with the windows down. It was not
air conditioned. After Dotson and Mickelson had picked up material, weighing
fifteen to thirty pounds, at over seven hundred houses in 86 degree
temperature, Dotson became confused and began losing his balance. Dotson said,
""this heat has gotten to me.'' Mickelson, who realized that Dotson
was in some distress, placed Dotson in the shade of a tree and finished the
route alone. When Mickelson returned to the tree, Dotson was in critical
condition. Within minutes, Dotson was taken to the hospital, unconscious, with
a body temperature of 110 degrees. While at the hospital, Dotson's condition
improved; he regained consciousness and was able to answer questions. However,
Dotson died in the hospital of cardiac arrest seventeen days later.
Dotson's
physician, Dr. Michael Tsun, filed a report stating that the cause of death was
""acute deep vein thrombosis and pulmonary embolism as a result of
severe dehydration and heatstroke.'' At the time of Dr. Tsun's report, he knew
that Dotson's medical history included the fact that he was obese, was on
anti-depressant medication, had arteriosclerosis, and had previously suffered a
pulmonary embolism. Dr. Tsun took the history twenty-four hours after Dotson
was admitted to the hospital.
At the
compensation hearing, two physicians opined that Dotson had not suffered a
heatstroke but that he suffered from Neuroleptic Malignant Syndrome (NMS)
instead, a condition with symptoms that mimic heatstroke. At the time of the
episode, Dotson was taking anti-depressant medications, which the doctors said
impair a person's ability to regulate body temperature. Dotson had
arteriosclerosis and a history of pulmonary emboli on two occasions. Based on
these facts, the two physicians concluded that, in their opinions, Dotson did
not die from the consequences of heatstroke.
The commission
found that Dotson died as a result of cardiac arrest caused by heatstroke
suffered on July 10, 1990, in the course of and arising out of his employment
with Imperial Trash [603] Company.
(1) To qualify
for workers' compensation benefits, an employee's injuries must result from an
injury or accident arising out of and in the course of his employment. Pinkerton's,
Inc. v. Helms, 242 Va. 378, 380, 410 S.E.2d 646, 647 (1991). An employee
must prove a causal connection between his particular work conditions and the
resulting injury. Brown v. Reed, 209 Va. 562, 564, 165 S.E.2d 394,
396-97 (1969). ""[I]f the injury or death results from, or is
hastened by, conditions of employment exposing the employee to hazards to a
degree beyond that of the public at large, the injury or death is construed to
be accidental.'' Robinette v. Kayo Oil Co., 210 Va. 376, 379, 171 S.E.2d
172, 175 (1969).
The employer
contends that Dotson did not suffer a heatstroke but that, even if he did, the
heatstroke was not caused by his work. According to the employer, the nature of
Dotson's duties did not place him at greater risk for heatstroke beyond that to
which the public is normally exposed.
(2)
""[W]here there is a conflict of evidence [concerning cause of
death], the Commission's finding of fact is conclusive'' when supported by
credible evidence. Byrd v. Stonega Coke & Coal Co., 182 Va. 212,
220, 28 S.E.2d 725, 729 (1944). A conflict in the medical evidence exists as to
whether Dotson suffered a heatstroke or died of NMS. ""The
Commission's factual findings are "conclusive and binding' . . . and a
question raised by "conflicting expert medical opinions' is "one of
fact.''' Eccon Constr. Co. v. Lucas, 221 Va. 786, 790, 273 S.E.2d 797,
799 (1981) (citation omitted). The determination of causation is a factual
finding that will be upheld on appeal if credible evidence supports the
finding. C.D.S. Constr. Servs. v. Petrock, 218 Va. 1064, 1070, 243
S.E.2d 236, 240 (1978).
Although the
doctors' opinions are in conflict as to whether Dotson suffered a heatstroke,
credible evidence supports the commission's finding that he did and that death
resulted as a consequence of the heatstroke. Dr. Tsun was Dotson's attending
physician. He treated Dotson just after he entered the hospital. Dr. Tsun was
the only physician who had treated and examined Dotson. Dr. Tsun knew Dotson's
medical history. He knew Dotson had taken lithium. He knew that Dotson had
previously suffered an embolism. Dr. Tsun was aware of the possibility of
Neuroleptic [604] Malignant Syndrome (NMS). Based on tests, Dr. Tsun determined
that Dotson did not have blood clots associated with NMS. Dr. Tsun testified
that Dotson suffered from symptoms associated with severe heatstroke. George
Mickelson's testimony concerning Dotson's condition and symptoms supports that
finding. George Mickelson worked closely with Dotson the entire morning before
Dotson's collapse. Both Dr. Tsun's and Mickelson's testimony provided credible
evidence to support the commission's finding that Dotson, as a result of his
exertion in the heat, became dehydrated and suffered a heatstroke and that as a
consequence of the heatstroke, he died.
We also must
decide whether the heatstroke was caused by the condition of employment, as
employee argues, or would have occurred under normal circumstances because of
conditions to which the public is customarily exposed. Credible evidence exists
to support the commission's finding that Dotson's heatstroke was caused or
""hastened by, conditions of employment [that] expose[d] the employee
to hazards to a degree beyond that of the public at large.'' Robinette,
210 Va. at 379, 171 S.E.2d at 175. Even though the public may also have been
exposed to the heat the morning Dotson collapsed, it was not the heat alone
that caused Dotson's heatstroke and death.
The commission
found that Dotson's employment exposed him to hazards over and above those to
which the public is exposed. The commission noted that ""the public
at large was not working within the confines of a [non-air-conditioned] truck,
repeatedly getting into and out of a truck, nor emptying from 350 to 400
containers into [it]. . . . This work was performed in temperatures which had
reached almost 90 degrees at the time Dotson collapsed. In addition, the
humidity had reached approximately 57 percent.''
(3) While the
employer argues that the evidence did not support the commission's factual
finding that Dotson emptied 350 to 400 containers, the significance of the
evidence, as recited by the commission, is not the number of containers he
lifted, but that his employment required him to do significant work and
exertion over a relatively short period of time in hot, humid conditions.
Dotson was obese, arteriosclerotic, and on medication, all factors that placed
him at greater risk for heatstroke. The commission could find, as it did, that
the combination of the heat, the humidity, the [605] physical exertion, and
working in the non-air-conditioned truck caused Dotson to become dehydrated and
to suffer a heatstroke. ""An accident may have more than one
proximate cause.'' Wyle v. Professional Servs. Indus., 12 Va. App. 684,
689, 406 S.E.2d 410, 413 (1991). Even though Dotson's physical condition may
have made him prone or more susceptible to becoming dehydrated and suffering a
heatstroke, the conditions of his employment were a primary cause of the
heatstroke. The employment required him to work in hot, humid conditions over a
period of time, a situation to which the general public is not regularly
exposed.
(4) The
employer further contends that even if Dotson suffered a work-related
heatstroke, the condition was not sufficiently sudden to make it a compensable
accident. The employer argues that gradually incurred injuries, even if work
related, are not compensated by workers' compensation benefits. Aistrop v.
Blue Diamond Coal Co., 181 Va. 287, 293, 24 S.E.2d 546, 548 (1943). There
must be ""an identifiable incident or sudden precipitating event . .
. that . . . result[s] in an obvious sudden mechanical or structural change in
the body'' for the employee's work-related injury to be compensable. Morris
v. Morris, 238 Va. 578, 589, 385 S.E.2d 858, 865 (1989). ""To
constitute injury by accident [however] it is not necessary that there should
be an extraordinary occurrence in or about the work engaged in.'' Kemp v.
Tidewater Kiewit, 7 Va. App. 360, 363, 373 S.E.2d 725, 726 (1988) (quoting Derby
v. Swift & Co., 188 Va. 336, 344, 49 S.E.2d 417, 421 (1948)).
The commission
did not err by finding that in Dotson's case, ""a . . . precipitating
event [existed] that . . . resulted in an obvious sudden . . . structural
change in the body.'' Morris, 238 Va. at 589, 385 S.E.2d at 870
(emphasis in original). Lifting heavy materials and doing strenuous work over a
short period of time in hot, humid conditions were the precipitating events
causing Dotson to become dehydrated and to suffer a heatstroke. The fact that
Dotson lifted containers over a brief period does not make the heatstroke he
suffered a ""gradually incurred'' injury, as the employer contends.
While the Act does not compensate an employee for degenerative conditions
gradually occurring that resulted from repetitive trauma in the workplace, id.,
Dotson's heatstroke was not a gradually occurring condition. The heatstroke was
a sudden change in the body that was readily attributable to ""an
identifiable [606] incident'' or ""sudden precipitating event.''
After lifting the containers in a short period of time in hot, humid conditions,
Dotson's body temperature suddenly rose to 110 degrees. The exertion of lifting
the containers was the ""sudden precipitating event'' causing the
heatstroke. Within five minutes, Dotson collapsed and was taken to the
hospital. The anatomical changes in the body associated with heatstroke were an
""obvious sudden mechanical or structural change in the body.'' Id.
[Footnote 1]
____________
[Footnote 1] Unlike Lane Co. v. Saunders, 229 Va.
196, 326 S.E.2d 702 (1985), where the claimant sustained a back injury over a
period of two days and could not point to a ""single episode of an
injury,'' Dotson suffered heatstroke while performing job-related exertion by
lifting containers in hot, humid conditions, and, within minutes, he collapsed.
____________
The commission
did not err by relying on the opinion testimony of Dr. Tsun in determining that
Dotson's cause of death was related to his employment. Dr. Tsun was the only
physician who had treated and examined Dotson. The other doctors had not
examined Dotson.
(5) When
medical opinions conflict, the general rule is that when an attending physician
is positive in his diagnosis of a disease, great weight will be given by the
courts to his or her opinion. McPeek v. P.W. & W. Coal Co., 210 Va. 185,
188, 169 S.E.2d 443, 445 (1969). Dr. Tsun made a positive diagnosis that Dotson
had suffered a heatstroke. Dr. Tsun stated that Dotson's severe heatstroke
""caused acute deep vein thrombosis'' and that his death was the
result of ""severe dehydration, disseminated intravascular
coagulopathy, and prolonged bedrest due to weakness and disequilibrium.'' The
conclusion that Dotson's death was a consequence of the heatstroke is supported
by medical records and tests. The commission did not err in relying on Dr.
Tsun's, the treating physician's, testimony.
(6) The
evidence is sufficient to support the commission's finding that Dotson died as
a result of heatstroke, even though he had improved before dying seventeen days
after suffering the heatstroke. Once an injury is compensable, the employer is
liable for the full extent of the injury; the fact that complications arise or
the injury worsens does not alter the compensable nature of the injury.
""When the primary injury is shown to have arisen out of and in the
course of employment, every natural consequence that flows from the injury
likewise arises out of the employment, unless [607] it is the result of an
independent intervening cause attributable to claimant's own intentional
conduct.'' Morris v. Badger Powhatan/Figgie Int'l, Inc., 3 Va. App. 276,
283, 348 S.E.2d 876, 879 (1986).
Dr. Tsun stated
that, in his opinion, Dotson suffered from severe heatstroke causing
""deep vein thrombosis'' that ultimately caused his death. In Byrd,
the Supreme Court held that the claimant's death from a heart attack resulting
from heatstroke was compensable. 182 Va. at 216-17, 28 S.E.2d at 729. The Court
discussed the ""catastrophic'' effect of heatstroke on the human body
and held that the claimant established a prima facie case for compensability. Id.
at 217-18, 28 S.E.2d at 729-30. Like Byrd, Dotson died as a result of
heatstroke, even though the immediate cause of death was an embolism.
Therefore, his death is compensable.
Affirmed.
Fitzpatrick, J., and Hodges, S.J., concurred.