Case Title: Murray v. Industrial Commission

Citation: 349 P.2d 627, 87 Ariz. 190

Docket Number: 

State: arizona

Court: Arizona Supreme Court

Date: 1960-02-24T00:00:00Z

Document:
87 Ariz. 190 (1960) 349 P.2d 627 Roy Lee MURRAY, Sr., Petitioner, v. INDUSTRIAL COMMISSION of Arizona and Benevolent & Protective Order of Elks, No. 385, Respondents. No. 6674. Supreme Court of Arizona. February 24, 1960. *191 Udall & Udall and Paul G. Rees, Jr., Tucson, for petitioner. James D. Lester, Phoenix, John R. Franks, Donald J. Morgan, Robert K. Park, and Frances M. Long, Phoenix, of counsel, for respondent Industrial Commission. YALE McFATE, Judge. The petitioner, Roy Lee Murray, Sr., on February 7, 1955, while employed as a cook by respondent B.P.O.E. No. 385 (Elks Club at Tucson), slipped on an ice cube and fell, injuring his lower back. He was first attended by Dr. E.J. Nagoda, who sent him to the hospital on April 1, 1955. About May 17, 1955, at Dr. Nagoda's request, he was examined by Dr. Stanley S. Tanz, orthopedic surgeon. Dr. Tanz diagnosed a severe lumbosacral sprain, with possibility of injury to the lumbosacral disc, prescribed medication for pain, back brace, and other conservative treatment. A few days later, petitioner was discharged from the hospital and continued with treatment at home. He *192 was able to get up and around the house, but was unable to do any type of work because of limitation caused by back pain. He failed to respond to treatment and a myelogram was made. His pains became more severe. On October 4, 1955, he was examined by a medical board consisting of Dr. Nagoda and three orthopedic surgeons, Doctors Cortner, Tanz and Dixon. At that time, petitioner's medical history indicated that he had felt no relief from the back pain since the injury, although prior thereto he had never experienced any trouble with his back. The board concluded that "Despite the constant defect found in the myelogram, it is very difficult at this time to evaluate how much symptomatology is based on organic disease and how much is based on functional overlay." "Functional overlay" or "functional symptoms" were defined by Dr. Tanz as those symptoms for which the doctor can find no organic basis, such as pain which would be throughout a limb and which would not follow a particular nerve route. The medical board recommended that petitioner be examined by a neuropsychiatrist, and he was accordingly referred to Dr. Lindsay E. Beaton, who found, among other things, as follows: Dr. Nagoda concurred in the foregoing findings. On March 5, 1956, petitioner was further examined and evaluated by the Industrial Commission Medical Advisory Board in Phoenix. This board found petitioner was afflicted with a "gross psychiatric disorder," recommended surgery for removal of a protruded intervertebral disc, and a lumbosacral fusion, and stated its opinion that "even with ideal surgical treatment, there may be residual functional symptoms." On April 26, 1956, petitioner was operated on by Doctors Fonseca and Tanz. A herniated disc was removed and the lumbosacral joint fused. On the following day, after a cottonoid sponge was reported missing, the wound was re-opened and re-explored for the missing sponge, but none was found. Dr. Tanz, on September 17, 1956, requested the patient be again examined by the Medical Advisory Board at the earliest possible date; that he had been a very difficult psychological problem. A medical advisory board consisting of Doctors Tuveson, *193 Findlay, Hastings, Saba and Beaton examined petitioner on November 5, 1956, and reported that the patient complained of numbness and burning pains in the right thigh, but found these complaints were purely functional and that "apparently, all his anxiety has been converted into hysterical somatic symptomatology." The board concluded that the fusion was quite stable and "* * * there is no reason why the patient could not become more active, even to the point of returning to some form of gainful occupation which would not involve heavy lifting or straining. He should then be seen by a group of consultants for final evaluation and disability rating in three months following such a period of rehabilitation." The Commission, on November 19, 1956, ordered petitioner to make a sincere, honest and conscientious effort to obtain light work of such nature as he was physically capable of performing and which he was competent to perform. On February 15, 1957, petitioner was examined by Doctors Tanz and Cortner, orthopedic surgeons, who concluded that petitioner had sustained a 15% general physical functional disability, and that there existed a severe overlying hysteria. These doctors noted that probably the patient would not be satisfied with a settlement based on 15% disability, but that they could find nothing objectively to warrant a greater degree of disability rating. Dr. Tanz testified at a hearing on July 15, 1957, that various attempts were made to rehabilitate petitioner by way of exercises, increased activity and light work, but such attempts failed because of petitioner's functional, emotional and subjective symptom complex; that with proper rehabilitation petitioner could return to work and do heavy lifting, if it were not for his functional overlay and emotional attitude toward his injury and physical condition. On August 22, 1957, the Commission rendered its decision and findings, in effect finding that petitioner sustained a 15% general physical functional disability, and a 34 1/2% loss of earning capacity due to his injury. Timely protest and petition for rehearing was filed by petitioner contending among other things that he was not mentally able to perform any duties incident to gainful employment. On May 1, 1958, The Industrial Commission, after rehearing, rendered its decision and made findings and award for unscheduled permanent partial disability, affirming its prior finding of 15% disability and 34 1/2% loss of earning capacity, and finding further that he was able to perform the duties of a watchman, and awarded him $62.77 per month for permanent partial disability, pursuant to subsections C and D, A.R.S. § 23-1044. The Commission made the following additional specific findings: Petitioner, by certiorari, seeks to set aside the findings and award on the ground that the uncontradicted medical evidence proves that an existing psychoneurosis or hysterical reaction was produced or aggravated by the Industrial accident sustained, but nevertheless, was omitted from the Commission's consideration and is not reflected in its award, contrary to law. At the outset, we are met with the contention of the Commission that the award includes disability resulting from the functional overlay. There is no justification for this conclusion. The record shows clearly that the Commission determined that none of petitioner's disability due to mental disease was compensable. It specifically found that such disease was neither produced nor aggravated by the accident or the injury. Dr. Beaton testified as follows: Likewise, Doctors Tanz and Cortner pointed out that the patient would not be satisfied with a 15% disability because it did not include the overlying hysteria, which they rejected, because the absence of objective findings would not permit a higher rating. In its findings, the Commission *195 adopted this percentage and likewise adopted the medical conclusion that no causal connection existed as between the injury and the mental condition. Under these circumstances, we do not believe the Commission intended to include disability from hysteria in its 15% disability rating. Counsel for respondent has referred to certain evidence in the record which he contends shows that petitioner did not make diligent effort to obtain light work after he was ordered to do so by the Commission, and that he lacked a positive and competitive attitude towards obtaining work, and therefore is not in a position to complain about the fact that the Commission did not compensate him for disability resulting from hysteria. In this connection, there was no finding by the Commission that the petitioner failed to cooperate in the matter of seeking light work. He applied for light work, including that of watchman at the Arizona Employment Agency at Tucson, and he likewise applied at service stations, grocery stores and restaurants. He testified he had hunted for light work and had watched the ads in the newspapers and had not been able to find light work. It should be borne in mind that the mechanisms of hysteria in petitioner's case were purely unconscious mechanisms, and that his disabilities and pains were quite genuine to him, and if because of these factors he lacked some of the enthusiasm for work which he might otherwise have had, he should not be penalized therefor. Furthermore, the Commission denied compensation for psychoneurotic disability in this case, not on the basis of failure of petitioner to cooperate, but solely on the ground that such disability was not caused by the injury. Now the argument seems to be that because he is physically able to do light work, he is able to commence a program of self-rehabilitation which will eventually result in his complete recovery from psychoneurotic disability. If an injured workman is legally entitled to benefits by reason of a mental disease, the Commission has no authority to deny him such benefits as a means of enforcing rehabilitation. Simon v. R.H.H. Steel Laundry, Inc., 25 N.J. Super. 50, 95 A.2d 446. We now consider the primary issue presented by this appeal, namely, whether the petitioner's psychoneurosis was produced or aggravated by the injury he sustained as a result of the accident, and if so, whether he was entitled to benefits under the Workmen's Compensation Law. In substance, petitioner states the law to be that where there has been an industrial accident causing physical injury, compensable under the Arizona Workmen's Compensation Law, and as a result of that injury the workman develops a disabling psychoneurosis, and where the medical history and medical findings (as distinguished from medical opinions *196 or conclusion) demonstrate that such disability was proximately caused by the injury, the Commission should take the mental disease into consideration as well as the physical injury, in making the award. On the other hand, the Commission contends that the question of causal relation between injury and disability is peculiarly and necessarily within the singular knowledge of medical experts, and that their unanimous and uncontradicted opinions with respect to causation must be accepted by the Commission; that petitioner's neurosis is not compensable because although it resulted from circumstances arising out of and following the accident, it was not produced or aggravated by the injury suffered. In order to fairly present the issues it is necessary to set forth and analyze the medical testimony. There were no conflicting findings or opinions with respect to this matter of causation. Dr. Beaton's reports and testimony were the most explicit and are set forth below: In a letter to the Commission dated December 30, 1957, Dr. Beaton stated: *198 As to relation of accident and injury to hysteria, Dr. Beaton further testified as follows: An analysis of the foregoing evidence and testimony clearly indicates the following factual situation: To sum up, the injury resulting from this accident was the event which, in a natural and continuous sequence, unbroken by any efficient intervening cause, acting upon the particular personality configuration of this individual, produced the hysteria, and without which this particular hysteria would not have occurred. By definition, that is proximate cause. The injury need not be the sole cause of disability, if it is a producing cause. In the opinion of the doctors this injury did not "cause" the hysteria from a medical point of view. However, what constitutes proximate cause is a legal question primarily, dependent for its answer on the facts of the particular case. In the field of medicine, opinions of doctors qualified by training and experience as to causation are competent, and in many cases controlling and binding upon the trier of facts; however, when the medical facts on which such opinions are based are clearly shown, and the medical opinion as to causation conflicts with the inescapable legal conclusion, the former must give way to the latter. The difference in the medical and legal concept of cause results from the obvious differences in the basic problems and exigencies of the two professions in relation to causation. By reason of his training, the doctor is thinking in terms of a single, precise cause for a particular condition. The law, however, endeavors to reach an inference of reasonable medical certainty, from a given event or sequence of events, and recognizes more than one cause for a particular injurious result. In the law of torts, it is said that the tortfeasor is not entitled to a perfect specimen upon which to inflict injury. Likewise, in the field of Workmen's Compensation, the employer takes his employee as he is. In legal contemplation, if an injury, operating on an existing bodily condition or predisposition, produces a further injurious result, that result is caused by the injury. The conclusion herein reached is in harmony with the general law on the subject and prior decisions of this court. In Safeway *200 Stores v. Gilbert, 68 Ariz. 202, 203 P.2d 870, 871, this court said: In Vol. 1, Sec. 42.22, Larsen on Workmen's Compensation, it is said: In American Smelting & Refining Co. v. Industrial Commission, 59 Ariz. 87, 123 P.2d 163, a workman was injured by a large amount of rock falling on his shoulders, neck and back. Following medical treatment his left shoulder and arm became practically paralyzed. The Commission found he suffered a post-traumatic hysteria neurosis. It was held that a nervous shock caused by an accident arising out of and in due course of employment is a compensable injury within the meaning of our statute, and that since a shock is a compensable injury, and neurosis is a disease, a hysteria neurosis caused by a shock is a compensable disease resulting from injury. Respondent contends that any neurosis, to be compensable, must have been produced or aggravated by an injury sustained in a compensable accident, and that in petitioner's case his neurosis is entirely the result of circumstances arising out of and following the accident, without reference to the injury. Respondent calls attention to the holdings in Phelps Dodge Corporation v. Industrial Commission and Eads, 46 Ariz. 162, 49 P.2d 391, and the American Smelting & Refining case, supra, supporting this contention. In the Eads case the petitioner had been compelled to run some distance through poisonous gas caused by an explosion, and suffered temporary pulmonary disorders from the effects of the gas, and after the temporary effects had passed away, he suffered a neurosis. However, there was no evidence that the neurosis was caused by an injury received in the accident. In that case we said that if the evidence had shown that the neurosis had been caused by the injury, then the award would have been proper. In the American Smelting & Refining case, supra, 59 Ariz. at page 94, 123 P.2d at page 166, we pointed out this same distinction, in the last paragraph of the opinion, as follows: In the case at bar, the petitioner's neurosis was shown conclusively by the evidence to have been caused by the back injury he received. A workman covered by the Arizona Workmen's Compensation Law who is physically injured by accident arising out of and in the scope of his employment is entitled to accident benefits in the form of medical treatment and compensation for his disability until he is cured or until his condition is stationary and the permanent effects of the accident are evaluated. If such injury causes a disabling mental disease, he is entitled to the same benefits. The decision and award in this case deprived petitioner of such benefits with respect to his mental disease, and are therefore set aside. STRUCKMEYER, C.J., and PHELPS, JOHNSON and BERNSTEIN, JJ., concurring. NOTE: UDALL, Justice, having disqualified himself, the Honorable YALE McFATE, Judge of the Superior Court of Maricopa County, Arizona, was called to sit in his stead and participate in the determination of this appeal.