Case Title: DAVID B. STEWART V. STATE OF WYOMING, ex rel., WYOMING WORKERS' SAFETY AND COMPENSATION DIVISION

Citation: 

Docket Number: 06-154

State: wyoming

Court: Wyoming Supreme Court

Date: 2007-04-11T00:00:00Z

Document:
DAVID B. STEWART V. STATE OF WYOMING, ex rel., WYOMING WORKERS' SAFETY AND COMPENSATION DIVISION2007 WY 58155 P.3d 198Case Number: 06-154Decided: 04/11/2007
APRIL 
TERM, A.D. 2007

 
 
DAVID B. 
STEWART,

 
 
Appellant

(Employee/Petitioner),

 
 
v.

 
 
STATE OF WYOMING, ex rel., WYOMING WORKERS' SAFETY AND COMPENSATION 
DIVISION,

 
 
Appellee

(Objector/Respondent).

 
 
Appeal from the 
DistrictCourtofTetonCounty

The Honorable Nancy J. 
Guthrie, Judge

 
 
Representing Appellant:

David M. Gosar, Jackson, Wyoming.

 
 
Representing Appellee:

Patrick J. Crank, Attorney General; John W. 
Renneisen, Deputy Attorney General; Kristi M. Radosevich, Assistant Attorney 
General.

                                    

Before 
VOIGT, C.J., and GOLDEN, HILL, KITE, and BURKE, 
JJ.

 
 
BURKE, 
Justice.

 
 

[¶1]      After undergoing 
surgery for a work-related injury, Mr. Stewart suffered an anoxic brain injury 
due to an accidental overdose of narcotic medications.  Mr. Stewart sought worker's compensation 
benefits for the brain injury pursuant to the second compensable injury 
rule.  The Office of Administrative 
Hearings ("OAH") denied benefits finding that the use of his wife's narcotic 
pain medication broke the chain of causation and, consequently, Mr. Stewart 
failed to meet his burden of proof.  
Mr. Stewart challenges the order denying benefits.  We 
affirm.

 

 

[¶2]      Mr. Stewart presents the 
following issues for review:

 
 

I.                     
Did the Office of 
Administrative Hearings err as a matter of law when it concluded that Mr. 
Stewart's use of non-prescribed medication to treat pain resulting from surgery 
for a work-related hernia  medication that when added to the prescription pain 
medication he also used caused anoxic brain injury  disqualified him from 
workers' compensation coverage for the brain injury?

 
 

II.                   
Was the essential finding 
that Dr. Ferguson's opinion was "speculative" not supported by substantial 
evidence and/or arbitrary and capricious?

 
 
The Wyoming Workers' 
Safety and Compensation Division ("Division") states the issue 
as:

 
 
Whether substantial 
evidence supports the hearing examiner's decision that [Mr.] Stewart failed to 
establish his anoxic brain injury, caused by an overdose, was a compensable 
injury as defined by the Wyoming Workers' Compensation 
Act?

 
 

 
 

[¶3]      On September 8, 2003, Mr. 
Stewart sustained a left inguinal hernia while lifting construction materials 
for his employer.  Outpatient 
surgery was performed on September 18, 2003, by Dr. Poore to repair the 
condition.  Mr. Stewart tolerated 
the procedure well and was released to his wife's care later that 
afternoon.  

 
 

[¶4]      Dr. Poore prescribed pain 
medication, Lortab and Percocet, to assist Mr. Stewart in dealing with the pain 
as he recovered from the surgery.  
According to Dr. Poore, Mr. Stewart was to take the Lortab if he was 
experiencing mild pain and Percocet for severe pain.  He did not intend that Mr. Stewart take 
both medications at the same time.  
Although he had no independent recollection of a specific discussion 
regarding the prescriptions with Mr. Stewart, Dr. Poore indicated that he 
frequently gives these prescriptions and typically discusses proper use of the 
medications with the patient.1  

 
 

[¶5]      Mr. Stewart testified 
that he did not recall receiving those instructions.  Instead of taking either the Lortab or 
the Percocet depending on the degree of pain he was experiencing, he took both 
pills every four hours.  According 
to Mr. Stewart, he felt it was permissible to combine the medications because 
nothing contained in the written hospital discharge instructions or on the 
prescription bottles indicated that the two could not be taken 
together.

 
 

[¶6]      At 
approximately 5:00 a.m. the following morning, Mr. Stewart awoke his wife 
complaining of pain and an inability to sleep.  He demanded that she give him her 
prescription pain pills because his medications were not working.  He testified that he shook her and said, 
"[Y]ou got to give me a Methadone, I can't stand all of this."  Pursuant to his request, Mrs. Stewart 
gave her husband two Methadone pills for his pain and one Xanax pill to help him 
sleep.2  When Mrs. Stewart awoke the next 
morning, she noted that Mr. Stewart was resting comfortably.  However, when she attempted to wake him 
at 9:00 a.m., Mr. Stewart did not respond.  
She summoned an ambulance and Mr. Stewart was taken to the emergency room 
for treatment.  Mr. Stewart was 
diagnosed with an anoxic brain injury resulting from an overdose of mixed 
medication.3  After remaining unresponsive for a week, 
he was transferred to a hospital in Salt Lake City for further treatment.  Mr. Stewart responded favorably to the 
continued treatment and, although he had not fully recovered, was released from 
the hospital on October 1, 2003.  
Mr. Stewart testified that his condition has improved over time, but he 
continues to suffer residual effects as a result of his brain 
injury.

 
 

[¶7]      Mr. Stewart applied for 
worker's compensation benefits.  The 
Division approved benefits related to the hernia, but denied coverage for the 
anoxic brain injury.  Mr. Stewart 
timely objected to the Division's decision.  A contested case hearing was held before 
the OAH.  The hearing examiner 
upheld the denial of benefits finding that "[b]ecause [Mr.] Stewart ingested 
narcotic medication that was not prescribed for his work injury, [Mr.] Stewart's 
original injury was not the direct cause of the subsequent anoxic brain 
injury."  Mr. Stewart appealed to 
the district court, which affirmed the decision of the OAH.  This appeal 
followed.

 
 
STANDARD OF 
REVIEW

 
 

[¶8]      Our review of 
administrative decisions is limited to the factors specified in Wyo. Stat. Ann. 
§ 16-3-114(c) (LexisNexis 2005), which states: 

 
 

(c)               
To 
the extent necessary to make a decision and when presented, the reviewing court 
shall decide all relevant questions of law, interpret constitutional and 
statutory provisions, and determine the meaning or applicability of the terms of 
an agency action. In making the following determinations, the court shall review 
the whole record or those parts of it cited by a party and due account shall be 
taken of the rule of prejudicial error. The reviewing court 
shall:

 
 

 

 
 
(ii)        Hold 
unlawful and set aside agency action, findings and conclusions found to 
be:

 
 
(A)       Arbitrary, 
capricious, an abuse of discretion or otherwise not in accordance with 
law;

(B)       Contrary to 
constitutional right, power, privilege or immunity;

(C)       In excess 
of statutory jurisdiction, authority or limitations or lacking statutory 
right;

(D)       Without 
observance of procedure required by law; or

(E)       Unsupported 
by substantial evidence in a case reviewed on the record of an agency hearing 
provided by statute.

 
 
When conflicting evidence 
is presented at the administrative hearing, as is the case here, we review the 
administrative decision pursuant to the substantial evidence test.  Newman v. State ex rel. Wyo. Workers' Safety 
& Comp. Div., 2002 WY 91, ¶ 22, 49 P.3d 163, 171 (Wyo. 2002).  Substantial evidence is relevant 
evidence which a reasonable mind might accept in support of the agency's 
conclusions.  Id., ¶ 12, 49 P.3d  at 168.  It is more than a 
scintilla of evidence.  Id.  
"[W]e examine the entire record to determine whether there is 
substantial evidence to support an agency's findings.  If the agency's decision is supported by 
substantial evidence, we cannot properly substitute our judgment for that of the 
agency and must uphold the findings on appeal."  Id.  Additionally, however, 

 
 
[e]ven when the factual 
findings are found to be sufficient under the substantial evidence test,  this 
court may be required to apply the arbitrary-and-capricious standard as a safety 
net to catch other agency action which prejudiced a party's substantial right to 
the administrative proceeding or which might be contrary to the other WAPA 
review standards.  

 
 

 Spletzer v. State ex rel. Wyo. Workers' 
Safety & Comp. Div., 2005 WY 90, ¶ 9, 116 P.3d 1103, 1109 (Wyo. 2005) (quotation marks omitted).  

 
 

 
 

[¶9]      Mr. Stewart contends that 
he is entitled to receive worker's compensation benefits for his anoxic brain 
injury pursuant to the second compensable injury rule.  He claims that the OAH erred when it 
concluded he was disqualified from coverage due to his use of his wife's 
prescription medication.  Mr. 
Stewart contends that he would not have suffered the anoxic brain injury if he 
had not been attempting to cope with the pain caused by his workplace 
injury.  He further contends that 
the medication overdose was purely accidental and, consequently, 
compensable.

 
 

[¶10]   We have recognized that a 
claimant is entitled to receive additional worker's compensation benefits if "an 
initial compensable injury ripens into a condition requiring additional medical 
intervention."  Carabajal v. State ex rel. Wyo. Workers' 
Safety & Comp. Div., 2005 WY 119, ¶ 12, 119 P.3d 947, 951 (Wyo. 2005) 
(quoting Yenne-Tully v. State ex rel. 
Wyo. Workers' Safety & Comp. Div., 12 P.3d 170, 172 (Wyo. 2000) (Yenne-Tully I)).  To be eligible for benefits, "the 
original compensable injury must be the direct cause of the subsequent 
injury."  Yenne-Tully v. State ex rel. Wyo. Workers' 
Safety & Comp. Div., 2002 WY 90, ¶ 10, 48 P.3d 1057, 1062 (Wyo. 2002) 
(Yenne-Tully II) (emphasis 
omitted).  As the claimant, Mr. 
Stewart bears the burden of proving the causal connection between his brain 
injury and the course of his employment.  
Stuckey v. State ex rel. 
Wyo. Workers' Comp. Div., 890 P.2d 1097, 
1098 (Wyo. 
1995).  

 
 

[¶11]   In this case, the hearing 
examiner concluded that Mr. Stewart failed to meet his burden of proving that 
the original injury was the direct cause of his subsequent anoxic brain injury 
because the intentional ingestion of his wife's pain medication broke the causal 
chain.  Mr. Stewart does not deny 
taking non-prescribed narcotic medication; however, he contends that the hearing 
examiner erred by focusing exclusively on this fact.  He claims that the "legal key to 
deciding this case [is] whether the overdose was accidental."  Mr. Stewart cites to the following cases 
which he claims are supportive of his proposition that accidental consequences 
following a work-related injury are compensable:  Osborn v. Ohio Bureau of Workers' Comp., 
731 N.E.2d 1189 (Ohio Ct. App. 1999) (awarding benefits for death resulting from 
the claimant taking more of his medication than was prescribed); Eagle Safe Corp. v. Egan, 842 S.W.2d 438 
(Ark. Ct. App. 1992) (finding death resulting from an overdose compensable 
because the doctor prescribed the medication as part of the treatment for the 
work-related injury); Bruning v. 
Sheffield Farms Co., 187 N.Y.S.2d 666 (App. Div. 1959) (claimant's death 
from overdose of sleeping pills following surgery for a work-related injury was 
compensable because an inference could be drawn that the pills were given to 
decedent while he was at the hospital to be taken at home as the need 
arose).  

 
 

[¶12]   The cases cited by Mr. 
Stewart are distinguishable.  In 
those cases, the claimants accidentally overdosed by taking medication that was 
prescribed and/or provided to them by their physician.  As the hearing examiner noted, "[Mr.] 
Stewart did not follow his physician's orders, did not call his physician to 
report his problems with pain, or seek less drastic alternatives for problems he 
was having after his minor hernia procedure."  Mr. Stewart did not take his wife's 
narcotic pain medication by accident or mistake.  He demanded that she give him her 
prescribed medication.  A subsequent 
injury, whether an aggravation of the original injury or a new and distinct 
injury, is not compensable unless "it is the direct and natural result of a 
compensable primary injury."  1 
Arthur Larson & Lex K. Larson, Larson's Workers' Compensation Law § 
10.01, at 10-2 (2006).  Mr. 
Stewart's intentional conduct was an independent intervening cause of the 
subsequent brain injury.  There is 
substantial evidence in the record to support the hearing examiner's decision 
that Mr. Stewart's brain injury was not the direct and natural result of the 
initial compensable injury.

 
 

[¶13]   Mr. Stewart also points 
to our decisions in Brierley v. State ex 
rel. Wyo. Workers' Safety & Comp. Div., 2002 WY 121, 52 P.3d 564 (Wyo. 
2002) and State ex rel. Wyo. Workers' 
Comp. Div. v. Ramsey, 839 P.2d 936 (Wyo. 1992), where we upheld an award of 
benefits for suicidal acts, to suggest that it would create an anomaly in the 
law to award benefits for intentional acts on one hand and to deny benefits in a 
case involving an accidental overdose on the other.  We do not find this argument 
persuasive.  Those cases were 
governed by Wyo. Stat. Ann. § 27-14-102(a)(xi)(B)(II), which excludes from the 
definition of a compensable injury "[t]he employee's willful intention to injure 
or kill himself or another."  The 
cases interpreting that provision determined that suicide is compensable if the 
original injury "produces mental derangement and the mental derangement produces 
suicide."  Brierley, ¶ 12, 52 P.3d  at 569.  The statutory exclusion reflected in 
Wyo. Stat. Ann. § 27-14-102(a)(xi)(B)(II) is not at issue here.  Mr. Stewart's burden was to prove a 
direct causal connection between the original injury and the subsequent injury. 

 
 

[¶14]   Additionally, Mr. Stewart 
claims that his use of his wife's prescription medication is irrelevant because 
it was less powerful than the prescriptions issued by his physician.  He directs our attention to the 
testimony of his toxicologist, Dr. Ferguson, who testified that if Mr. Stewart 
had taken the Percocet and Lortab instead of his wife's prescriptions at 5:00 
a.m., he would have suffered the anoxic brain injury regardless.  Mr. Stewart claims that Dr. Ferguson's 
testimony was not refuted and he faults the OAH for giving little weight to this 
testimony.  He contends that Dr. 
Ferguson's testimony was sufficient to meet his burden of proof that the brain 
injury was not caused by taking his wife's medication.  In making his contentions, Mr. Stewart 
confuses the scope of our appellate review.  "[T]he agency, as the trier of fact, has 
the duty to weigh the evidence and determine the credibility of the evidence and 
the witnesses."  City of Casper 
v. Utech, 895 P.2d 449, 451 (Wyo. 1995).  Because of this duty, we defer to the 
fact-finder on these issues.  
Id., 895 P.2d  at 
452.  On appeal, we do not 
second-guess the agency's judging of witness credibility.  In re Licensure of Jerry Penny v. State ex 
rel. Wyo. Mental Health Professions Licensing Bd., 2005 WY 117, ¶ 35, 120 P.3d 152, 171 (Wyo. 2005).  Instead, 
we review the record to determine whether substantial evidence supports the 
hearing examiner's decision.  
Id.

 
 

[¶15]   In this case, conflicting 
evidence was presented to the hearing examiner at the administrative 
hearing.  In addition to the 
testimony of Dr. Ferguson, Mr. Stewart's treating physician, Dr. Poore, 
testified by way of deposition.  
Unlike the opinion of Dr. Ferguson, Dr. Poore opined that Mr. Stewart 
would not have experienced the anoxic brain injury if he had only taken the 
Percocet and Lortab, and that the ingestion of his wife's Methadone likely 
caused Mr. Stewart's problems.

 

[¶16]   As the finder of fact, the hearing 
examiner is charged with resolving conflicting testimony.  Hicks v. State ex rel. Wyo. Workers' Safety 
& Comp. Div., 2005 WY 11, ¶ 21, 105 P.3d 462, 471 (Wyo. 2005).  In doing so, the hearing examiner 
afforded little weight to Dr. Ferguson's opinion, describing the testimony as 
speculative and irrelevant.  The 
hearing examiner determined that "Dr. Ferguson's opinion that [Mr.] Stewart's 
condition probably would have resulted in an anoxic brain injury if he had taken 
two [P]ercocet and two [L]ortab is simply speculative as that did not happen in 
this case."  We have held that 
"speculative medical testimony is insufficient to satisfy a claimant's burden of 
proof."  Anastos v. General Chemical Soda Ash, 
2005 WY 122, ¶ 21, 120 P.3d 658, 666 (Wyo. 2005).

 
 

[¶17]   After weighing the 
evidence, the hearing examiner determined that Mr. Stewart failed to meet his 
burden of proof that the hernia was a direct cause of his subsequent anoxic 
brain injury.  There is no dispute 
that Mr. Stewart intentionally ingested his wife's pain medication.  Dr. Poore testified that Mr. Stewart 
would not have suffered a brain injury if he had only taken his prescribed 
medication and the hearing examiner was entitled to rely on that testimony.  Substantial evidence exists in the 
record to support the hearing examiner's decision that the brain injury was not 
the direct and natural result of the initial compensable injury and Mr. Stewart 
has failed to establish arbitrary or capricious administrative action.   

  

[¶18]   Affirmed.

 
 
FOOTNOTES

 
 

1Mr. Stewart 
testified that his wife, a retired registered nurse, cautioned him against 
taking both prescriptions at the same time.

  

2These 
prescriptions were issued to Mrs. Stewart for a back 
condition.

 
 

3The 
emergency room records revealed that Mr. Stewart's "[u]rine toxicity screen is 
positive for benzodiazepines, THC, and opiates."