Title: Twice Over Clean, Inc. v. Industrial Comm'n

State: illinois

Issuer: Illinois Supreme Court

Document:

Docket No. 98748-Agenda 15-January 2005.
TWICE OVER CLEAN, INC., Appellee, v. THE INDUSTRIAL 							
COMMISSION et al. (Howard Haulk, Appellant).
Opinion filed March 24, 2005.
	JUSTICE KILBRIDE delivered the opinion of the court:
	This case is before us again following our supervisory order (188
Ill. 2d R. 383) directing the appellate court to reconsider its opinion
setting aside an award of compensation to Howard Haulk (Twice Over
Clean, Inc. v. Industrial Comm'n, 337 Ill. App. 3d 805 (2003)) in the
light of our decision in Sisbro, Inc. v. Industrial Comm'n, 207 Ill. 2d 193 (2003). The appellate court vacated its original opinion (348 Ill.
App. 3d 638, 639) and again set aside the Industrial Commission's
award of compensation to Haulk, holding that "in light of his
susceptibility to a heart attack outside of work, he failed in the first
instance to prove a 'sufficient causal connection' between his work
and his injury." 348 Ill. App. 3d at 652. We granted Haulk's petition
for leave to appeal (177 Ill. 2d R. 315). We allowed Rush University
Medical Center, United Wisconsin Insurance Company, and IPC
International Corporation to file an amicus curiae brief in support of
Twice Over Clean. 155 Ill. 2d R. 345. We now reverse the judgment
of the appellate court and affirm the judgment of the circuit court.

BACKGROUND
	The record reveals that Haulk was employed as a laborer for
Twice Over Clean in Peoria, Illinois. He was assigned to an asbestos
removal job in Minneapolis, Minnesota, in December 1996. On
January 2, 1997,while performing heavy labor, he suffered chest pains.
After he finished work, he went to his hotel and did not feel like
eating. He again experienced chest pains and broke out in a cold
sweat. He was taken by ambulance to Hennepin County Medical
Center (the hospital), where he was admitted and diagnosed with an
acute inferior myocardial infarction. Upon his release, he returned to
Peoria, where he received additional care from his internist and a
cardiologist.
	Haulk filed an application for adjustment of claim pursuant to the
Workers' Compensation Act (820 ILCS 305/1 et seq. (West 1996))
with the Industrial Commission (Commission),(1) seeking compensation
for his heart attack. The claim was heard before an arbitrator. The
principal disputed issue was whether the injury arose out of and in the
course of Haulk's employment (820 ILCS 305/1(b) (West 1996)).
	At the hearing, Haulk testified that his work assignment on
January 2, 1997, was to assist in the removal of 500 to 700 bags of
asbestos, each weighing 45 to 50 pounds, located on the top floor of
an unheated four- to five-story building in downtown Minneapolis.
The temperature in the building was approximately five degrees
Fahrenheit. Haulk carried the bags down the stairs and outside to a
Dumpster located approximately 100 feet from the building, where he
had to pile the asbestos bags high in the dumpster. While performing
this task, Haulk was required to wear a large, air-pack-driven facial
respirator and protective clothing. At about 2:30 p.m., while
performing this work, he noticed pains in his chest, neck, and left
shoulder. The pains subsided when he sat down and rested for 10 to
15 minutes, but returned when he resumed working. He left work
around 4:30 p.m. The pains never stopped entirely, although they
were more severe at times. Ultimately, he began having cold sweats
and nausea, an ambulance was called, and he was taken to the
hospital. Haulk denied experiencing chest pain prior to January 2,
1997.
	The hospital records for Haulk's treatment were admitted in
evidence. An unsigned resident's history and physical form, dated
January 3, 1997, noted that Haulk was evaluated for chest pain
beginning while he was "lifting items" around 8 p.m. that evening and
returning while he was in bed around 10 p.m. An admission data
profile, also dated January 3, 1997, signed by the person preparing it,
recited that Haulk described getting "chest pain yesterday afternoon
while loading a truck," but that it went away. A signed inpatient
consultation stated that Haulk presented with an onset of acute chest
pain while lifting weight. Narrative notes dated January 3, 1997,
signed by a treating physician, referred to Haulk as a patient with
"angina x 4 wks." who experienced "severe pain starting at about
10:00 p.m. today." A critical care flow sheet dated January 3, 1997,
signed by a nurse, recorded that Haulk had chest pain with exertion in
the morning that subsided on its own. Haulk was diagnosed with and
treated for acute inferior myocardial infarction. Coronary angiography
revealed a 90% obstruction in a portion of the right coronary artery.
These records were sent to Haulk's internist in Peoria, Dr. Brian
Cohen.
	Upon his return to Peoria, Haulk consulted Dr. Cohen, who in
turn referred him to a cardiologist, Dr. Frank Gold. Those doctors
provided care for Haulk beginning January 16, 1997, and continuing
until he was released to return to work on June 30, 1997.
	Haulk had recurring chest pain in February 1997, and was
admitted by Dr. Cohen to Methodist Medical Center in Peoria, where
he was seen in consultation by Dr. Mark Shima. The consultation
record was admitted in evidence. Dr. Shima's impression was:
"Atypical resting chest discomfort which radiates to the back and the
back of neck. Despite this, this is the same discomfort the patient feels
that he had in the pre-infarction period of the day or so prior to an
inferior infarct occurring in January of 1997 for which he underwent
angioplasty at Hennepin County Hospital in Minnesota." Dr. Shima
found no evidence of a myocardial infarction on the occasion of this
February 1997 consultation.
	Two written reports from Dr. Gold were admitted at the hearing.
The first, dated January 16, 1997, was a letter to Dr. Cohen,
confirming that Haulk clearly sustained a myocardial infarction and
was not capable of returning to his duties as a laborer. Dr. Gold stated
that, apart from smoking, Haulk had limited risk factors for coronary
artery disease. He reported Haulk advised him that he underwent
acute salvage angioplasty in Minneapolis, and that the doctors told
him "there was a 50% residual stenosis." In the second report, dated
April 10, 1997, Dr. Gold opined that Haulk was then totally disabled
as a result of a myocardial infarction sustained while working in
Minneapolis, Minnesota.
	The report of Dr. Cohen, dated December 4, 1998, was admitted
at the hearing. In the report, Dr. Cohen wrote: "The myocardial
infarction that Howard Haulk, Jr. suffered at 9:00 P.M. on January 2,
1997, in my medical opinion, was precipitated by the heavy lifting that
he did all day long at work. He was actually experiencing the chest
pain while doing the lifting, and probably was developing his heart
attack at that time."
	The evidence deposition of Dr. Cohen, taken on March 10,
1999,was admitted at the hearing. Dr. Cohen testified that he was
board certified in internal medicine. Prior to January 13, 1997, he had
seen Haulk on only two occasions in 1990, when he performed a
physical examination and some follow-up studies. The examination
revealed no problems. He and Dr. Gold both followed Haulk's
progress after January 13, 1997. Dr. Cohen was primarily concerned
with risk factors for coronary disease. He prescribed medication for
elevated cholesterol and provided care through February 1999.
	Dr. Cohen was asked to assume hypothetically that Haulk
performed the work duties Haulk described in his testimony under
those same conditions. He then was asked whether he had an opinion
"based upon a reasonable degree of medical certainty as to whether
the myocardial infarction that Mr. Haulk suffered as indicated in the
records from the hospital in Minneapolis might or could have been
caused by the physical activity engaged in on January 2nd, 1997." Dr.
Cohen responded affirmatively and stated "that activity very likely
could have led him to have a heart attack." He further opined, based
on a review of enzyme studies taken on January 2 and 3, 1997, that
Haulk's heart attack could have occurred around 2 p.m.
	On cross-examination, Dr. Cohen conceded the arteriogram taken
at the time of his initial work up in Minneapolis, showing a 90%
occlusion of the right coronary artery, was "very significant" and that
any activity or no activity by a person having that degree of occlusion
could put sufficient stress on the heart to result in a myocardial
infarction. He testified that "anybody can experience a myocardial
infarction at rest, really." He also agreed with the cross-examiner's
statement that "a person with that degree of occlusion is basically a
heart attack waiting to happen." On redirect, Dr. Cohen stated that
physical activity contributes to the risk of myocardial infarction in
persons having Haulk's degree of occlusion, and the kind of lifting
Haulk was doing in the afternoon is "tremendous stress and causes a
very high work load on the heart and the heart muscle."
	Twice Over Clean presented the evidence deposition of Dr. Gary
N. Wilner of Evanston, Illinois, taken November 15, 1999. Dr. Wilner,
who is board certified in both internal medicine and cardiovascular
diseases, was engaged by Twice Over Clean to evaluate Haulk's
medical records. He did not physically evaluate Haulk. In his opinion,
Haulk's work activity was not a factor in his myocardial infarction,
based on the enzyme levels he had at the time of his admission. Those
levels were within normal limits, indicating the infarction had not
occurred prior to the preceding five or six hours. He admitted on
cross-examination that other studies might be found that would
support a different conclusion.
 	The arbitrator found the heart attack arose out of and in the
course of Haulk's employment and entered an award in his favor. The
Commission affirmed and adopted the arbitrator's decision, with one
commissioner dissenting. The circuit court of Peoria County
confirmed the Commission's decision. The appellate court reversed,
holding the evidence established that Haulk's physician agreed Haulk
was a "heart attack waiting to happen" and could have suffered a
heart attack even while at rest. Therefore, the normal daily activity
exception applied to defeat Haulk's claim. Twice Over Clean, Inc.,
337 Ill. App. 3d at 810-11.
	Haulk petitioned for leave to appeal to this court. We initially
denied leave to appeal, but entered a supervisory order directing the
appellate court to reconsider its opinion in the light of our recent
pronouncement in Sisbro. Twice Over Clean, Inc. v. Industrial
Comm'n, 205 Ill. 2d 650 (2003) (supervisory order). The appellate
court vacated its opinion and issued a new opinion, again reversing the
circuit court's judgment and setting aside the award of the Industrial
Commission. 348 Ill. App. 3d at 652. This appeal followed.

ANALYSIS
	In Sisbro, we rejected the argument that the "normal daily
activity" exception bars recovery when the claimant's physical
condition has so deteriorated that the condition of ill-being could have
been produced by normal daily activity, despite a causal connection
between the work and the condition. Sisbro, 207 Ill. 2d  at 208-09.
Instead, we held "whether 'any normal daily activity is an
overexertion' or whether 'the activity engaged in presented risks no
greater than those to which the general public is exposed' are matters
to be considered when deciding whether a sufficient causal connection
between the injury and the employment has been established in the
first instance." Sisbro, 207 Ill. 2d  at 211-12. We observed this court
has never initially found a causal connection to exist between work
and injury and then, as a further analytical step, denied recovery based
on a " 'normal daily activity exception.' " Sisbro, 207 Ill. 2d  at 212.
We then analyzed the evidence of record and concluded the manifest
weight of the evidence supported the Commission's decision awarding
compensation, despite testimony by respondent's expert witness that
claimant's condition was the result of the normal degenerative process
of his preexisting diabetic condition. Sisbro, 207 Ill. 2d  at 215. We
held:
			"When an employee with a preexisting condition is injured
in the course of his employment, serious questions are raised
about the genesis of the injury and the resulting disability.
The Commission must decide whether there was an
accidental injury which arose out of the employment, whether
the accidental injury aggravated or accelerated the preexisting
condition or whether the preexisting condition alone was the
cause of the injury. *** However, the Commission's decision
must be supported by the record and not based on mere
speculation or conjecture. If there is an adequate basis for
finding that an occupational activity aggravated or
accelerated a preexisting condition, and, thereby, caused the
disability, the Commission's award of compensation must be
confirmed." Sisbro, 207 Ill. 2d  at 215.
	From our review of the record, we then determined that a
legitimate inference arose from the evidence before the Commission
that the claimant's occupational activity was a causative factor in
hastening the onset of his disabling condition. Accordingly, we
confirmed the Commission's award of compensation. Sisbro, 207 Ill. 2d  at 215.
	Sisbro established the standard for reviewing the Commission's
findings where a preexisting condition may be a cause of the disability.
Thus, we will apply that standard in determining whether the record
supports a legitimate inference that Haulk's occupational activity was
a causative factor in hastening the onset of his disabling myocardial
infarction, considering as a factor the preexisting 90% occlusion of his
right coronary artery and the likelihood his heart attack could have
occurred even without activity. The Commission is entitled to draw
reasonable inferences from the evidence, and we will not disregard
those inferences unless the Commission's decision is against the
manifest weight of the evidence. City of Des Plaines v. Industrial
Comm'n, 95 Ill. 2d 83, 90 (1983).
	Here, the appellate court majority held the normal daily activity
limitation bars compensation, based entirely on the admission of
Haulk's treating expert, Dr. Cohen, that " 'any activity or no activity
could put sufficient stress on the heart to result in a myocardial
infarction' " and his agreement with the cross-examiner's statement
that the claimant was a " 'heart attack waiting to happen.' " 348 Ill.
App. 3d at 651-52. As the dissent in the appellate court points out,
however, the majority made no reference to the extensive testimony
establishing that Haulk's symptoms began during his performance of
heavy labor under extreme temperature conditions. 348 Ill. App. 3d
at 654 (Goldenhersh, J., dissenting). The majority further ignored Dr.
Cohen's testimony that physical activity contributes to the risk of
heart attack in persons having Haulk's degree of coronary artery
occlusion, and that the heavy labor he was performing when his
symptoms began "is tremendous stress and causes a very high work
load on the heart and heart muscle."
	The appellate court majority held that "in light of his
susceptibility to a heart attack outside of work, he failed in the first
instance to prove a 'sufficient causal connection' between his work
and his injury." 348 Ill. App. 3d at 652. This conclusion completely
ignores competent testimony in the record establishing that Haulk's
work activity contributed to his risk of heart attack and that his
symptoms began while he was performing tremendously stressful
heavy labor. From this testimony a reasonable inference arises that the
work activity was a contributing cause of the heart attack, even
considering the 90% occlusion of a portion of Haulk's right coronary
artery. Thus, the Commission's determination that a sufficient causal
connection was demonstrated is not against the manifest weight of the
evidence. If a causal connection between the work activity and the
injury is shown by competent testimony, no "limitation" or
"exception" to compensation can be imposed to defeat a right to
recovery.
	In Rock Road Construction Co. v. Industrial Comm'n, 37 Ill. 2d 123 (1967), we affirmed an award of compensation for a fatal heart
attack. The decedent, an asphalt truck driver, was found dead in his
truck after the truck went out of control, lightly struck a guard rail,
and came to rest. He had previously suffered two myocardial
infarctions, carried nitroglycerin pills, and cold weather bothered him.
Rock Road, 37 Ill. 2d  at 125-26. The record established that the fatal
heart attack occurred shortly after the decedent finished rolling up and
down his tarpaulin and dumping a load of asphalt. Rock Road, 37 Ill. 2d  at 127-28. Conflicting expert medical testimony was offered, one
expert supporting the existence of a causal relationship between the
work activity and the heart attack, and three others denying any causal
connection. One of the experts believed decedent's death was
inevitable, regardless of his work activity. Rock Road, 37 Ill. 2d  at
126. We observed it was likely that the ultimate result of decedent's
heart condition would have been death at some indeterminate future
date, and possibly occurring in a situation wholly unrelated to work
or exertion. Nevertheless, we found the Commission's finding of
compensable injury was not against the manifest weight of the
evidence, noting conflicting evidence of the extent of deterioration of
the decedent's condition. Rock Road, 37 Ill. 2d  at 128.
	Similarly, in County of Cook v. Industrial Comm'n, 69 Ill. 2d 10
(1977), we confirmed an award of compensation for a fatal heart
attack when the victim had a prior history of myocardial infarction and
died following a period of an unusually busy workload in his office.
We held the employee need only prove that some act or phase of the
employment was a causative factor of the resulting injury, explaining
that "[t]he mere fact that an employee might have suffered a fatal
heart attack, even if not working, is immaterial." County of Cook, 69 Ill. 2d  at 17-18. We acknowledged the limitation that compensation
will be denied when it is shown that the employee's health has so
deteriorated that any normal daily activity is an overexertion, but
stated the application of this limitation presented a question of fact for
the Commission. County of Cook, 69 Ill. 2d  at 18.
	As in Rock Road, the record in this case raised a reasonable
likelihood that Haulk's heart attack was inevitable and could have
occurred in circumstances unrelated to work activities. The testimony
of Dr. Cohen, however, also provided a reasonable basis for the
inference that Haulk's heavy labor put extreme stress on his heart, and
this stress was in fact a cause of his myocardial infarction. Under the
standard we announced in Sisbro, it was the Commission's function
to decide whether, considering the extent of Haulk's right coronary
artery occlusion and its predicted effect, his preexisting condition was
aggravated or accelerated by the work activity, thus sufficiently
establishing a causal relationship between the work activity and the
injury.
	Twice Over Clean concedes in its brief that if Haulk's history of
the onset of symptoms is accurate, then Dr. Cohen's opinion on causal
connection based on that history had adequate foundation and is
entitled to be given weight by the trier of fact. Twice Over Clean also
concedes in its brief that if Haulk's testimony is accurate, the
arbitrator's reliance on that history is supported by the manifest
weight of the evidence.
	Twice Over Clean claims the history testified to by Haulk is
inaccurate because it conflicts with his description of the onset of
symptoms given to hospital personnel at the time of his admission.
Twice Over Clean contends those descriptions were contemporaneous
with Haulk's January 2, 1997, cardiac event and, thus, were made at
a time when the desire for proper diagnosis and treatment outweighed
any motive to testify falsely for gain. Accordingly, Twice Over Clean
argues Haulk's testimony contradicting the hospital records should be
disregarded.
	In Horath v. Industrial Comm'n, 96 Ill. 2d 349 (1983), this court
held the Commission's decision denying compensation was not against
the manifest weight of the evidence, despite the undisputed expert
medical testimony establishing a causal connection between the injury
and the claimant's disability. The Commission's opinion noted the
claimant gave a different account of his symptoms to treating
physicians immediately after the injury than he gave to the doctor who
testified at the hearing. Horath, 96 Ill. 2d  at 356. We held the finding
regarding causation involved the credibility of the claimant. The
assessment of credibility is a function of the Commission, not the
reviewing court. Thus, the Commission did not err in rejecting medical
opinions based on testimony found not credible. Horath, 96 Ill. 2d  at
356-57.
	It is true, as Twice Over Clean argues, that some of the
descriptions in the medical records reflect a different account of the
onset of symptoms than Haulk's testimony before the arbitrator,
particularly as to timing. However, the nature and progression of the
symptoms as described in both the records and Haulk's testimony are
similar. Only the record indicating the attack was preceded by
intermittent chest pain for four weeks sharply contradicts Haulk's
denial of prior chest pain in his testimony. The hypothetical question
posed to Dr. Cohen did not, however, include an assumption that
Haulk had no prior chest pain. In addition, Dr. Cohen was asked on
cross-examination the significance of intermittent chest pain for a
period of about a month. He stated it was consistent with stable
angina, a symptom of coronary artery disease, but added that other
sources of chest pain, including heartburn and muscle strain can mimic
angina. Regardless of whether Haulk had prior intermittent pain owing
to heart disease or some other cause, it is undisputed that Haulk's
right coronary artery occlusion preceded his heart attack.
	 We cannot say, based on this record, that the arbitrator's
acceptance of Haulk's testimony is without foundation or based on
speculation and conjecture. There was, accordingly, a reasonable basis
for acceptance of Dr. Cohen's opinion based on that testimony. We
hold, therefore, that he decision of the Commission is not against the
manifest weight of the evidence.
CONCLUSION
	There is an adequate basis in the record to conclude that the
work activity described by Haulk aggravated or accelerated his
preexisting coronary artery disease and was, accordingly, a cause of
the myocardial infarction resulting in his disability. The "normal daily
activity limitation," while relevant to the question of causation, cannot
be applied as a matter of law to defeat Haulk's claim. It was,
therefore, error for the appellate court to reverse the judgment of the
circuit court and set aside the decision of the Commission on the
ground that Haulk failed to prove a sufficient causal connection
between his work and the injury because of his susceptibility to a heart
attack outside of work. Accordingly, we reverse the appellate court's
judgment and affirm the judgment of the circuit court.

Appellate court judgment reversed;
circuit court judgment affirmed.
1. Now known as the Illinois Workers' Compensation Commission. 
See Pub. Act 93721, eff. January 1, 2005.