Case Name: PUBLIX SUPER MARKETS, INC. and Hartford Insurance, Appellants, v. Arleen J. McGUIRE, Appellee
Court: Florida District Court of Appeal
Jurisdiction: Florida
Decision Date: 1993-10-12
Citations: 629 So. 2d 862
Docket Number: No. 92-884
Parties: PUBLIX SUPER MARKETS, INC. and Hartford Insurance, Appellants, v. Arleen J. McGUIRE, Appellee.
Judges: BOOTH, SMITH, MINER, ALLEN, WOLF, KAHN and LAWRENCE, JJ., concur.
Reporter: Southern Reporter, Second Series
Volume: 629
Pages: 862–872

Head Matter:
PUBLIX SUPER MARKETS, INC. and Hartford Insurance, Appellants, v. Arleen J. McGUIRE, Appellee.
No. 92-884.
District Court of Appeal of Florida, First District.
Oct. 12, 1993.
Rehearing Denied Dec. 9, 1993.
Lynn H. Groseclose, of Lane, Trohn, Clarke, Bertrand & Williams, P.A., Braden-ton, for appellants.
Edward S. Eno, of Tanney, Forde, Dona-hey, Eno & Tanney, Clearwater, for appellee.

Opinion:
MICKLE, Judge.
The Employer/Carrier ("E/C") appeal a final order of the Judge of Compensation Claims ("JCC") finding a compensable accident and requiring the E/C to provide Arleen J. McGuire ("Claimant") with 1) temporary total benefits, to be paid in a lump sum, 2) unpaid medical expenses relating to Claimant's coronary artery spasm, and 3) remedial medical care and attention, and 4) requiring the E/C to reimburse Blue Cross and Blue Shield and Claimant for unpaid as well as paid medical bills. The JCC made no finding that Claimant "was subject to an unusual strain or overexertion resulting from a specifically identified effort not routine to the type of work [s]he was accustomed to performing at the time" she suffered the coronary artery spasm. Richard E. Mosca & Co., Inc. v. Mosca, 362 So.2d 1340, 1342 (Fla.1978). We conclude that the JCC erred, as a matter of law, in failing to apply the test from Victor Wine & Liquor, Inc. v. Beasley, 141 So.2d 581 (Fla.1961) and Mosca. Accordingly, we must reverse and remand for further proceedings consistent with our holding. See Zundell v. Dade Co. Sch. Bd. and Gallagher Bassett Serv., Inc., 609 So.2d 1367 (Fla. 1st DCA 1992) (en bane) (affirming order denying claim for benefits, where in-tracerebral subarachnoid hemorrhage suffered by claimant/teacher during confrontation with student was not a compensable injury under Victor Wine and Mosca).
At issue is the applicability, to the instant facts, of the following rule promulgated by the Florida Supreme Court in Victor Wine, 141 So.2d at 588-89:
[W]e adopt the following rule for heart cases: When disabling heart attacks are involved and where such heart conditions are precipitated by work-connected exertion affecting a pre-existing non-disabling heart disease, said injuries are compensa-ble only if the employee was at the time subject to unusual strain or over-exertion not routine to the type of work he was accustomed to performing.
In Mosca, the supreme court extended the applicability of this stricter test of compensa-bility to "other internal failures of the cardiovascular system." 362 So.2d at 1341; University of Florida v. Massie, 602 So.2d 516, 521 (Fla.1992). In Zundell, which was decided subsequent to the date of the hearing in the instant case, we rejected the principle that "a pre-existing condition is a necessary element of proof' before the rigorous test from Victor Wine and Mosca can be applied. 609 So.2d at 1370. See Zundell, 609 So.2d at 1373 (Webster, J., concurring and dissenting in part). The ease sub judice requires us to determine whether, as a matter of law, a coronary artery spasm is an "internal failure of the cardiovascular system" as contemplated in Mosca, so that the Victor Wine test applies.
At the time of the injury, Claimant was a five-year employee of Publix Super Markets, Inc., who worked part-time as a cashier in the Dunedin store. Additionally, she was employed by the City of Clearwater as a guard at a school crossing. Prior to the injury, Claimant was in good health but had a history of high blood pressure controlled by medication.
On October 26,1989, Claimant reported to work at Publix around 4:00 P.M. and went directly to her cash register. Soon she observed Frank Kapocsi, a Publix district manager, standing in front of the store. Claimant testified she began to worry that Kapocsi was there in response to a letter Claimant had written to Publix upper management in Lakeland complaining that she had not received a pay raise to which she felt entitled. Shortly after noticing Kapocsi, Claimant received a telephone call at her register requesting her to report to the cash office at the front of the store. Kapocsi was waiting for her in the office, and shortly after the meeting began, Kapocsi asked the store manager, Mr. Myers, to join them.
The meeting was held in a small, 10 x 10-foot room and lasted about 30 minutes, during which time Claimant remained standing. Claimant testified she was nervous and upset, and that Kapocsi said her letter did not look good for him. About five minutes after she was summoned to the room, Claimant began experiencing chest pains that continued for the duration of the meeting. Claimant was afraid she would be fired because she had bypassed Kapocsi by writing the letter of complaint without first communicating her grievances to the local management.
Certain facts about the meeting are disputed. Claimant testified that during the meeting, she informed Kapocsi and Myers that she was having chest pains and felt bad. Judging from the tone of his voice, Claimant believed Kapocsi was angry. Kapocsi, how ever, testified that Claimant did not mention chest pains then. According to Kapocsi, other than exhibiting some ordinary nervousness, Claimant conducted herself well during the meeting. He recalled the atmosphere was cordial, and he testified the discussion concerned payroll, pay scale, and Myers' reasons for not giving Claimant a raise. Kapoc-si explained the reason for not granting a pay raise then was that Claimant was inflexible in arranging a work schedule. Although Kapocsi acknowledged he would prefer employees to air complaints initially with their immediate supervisors, he said he was not upset with Claimant for writing the Lakeland office. As district manager, he responds frequently to similar concerns of employees. The JCC rejected Kapocsi's testimony that the atmosphere in the meeting was cordial, and we find competent substantial evidence to support the finding.
At the conclusion of the meeting, Claimant was permitted to return to her cash register. When she reported feeling pain and discomfort, Claimant was sent to the employees' room to sit down. Her son was called to take her to the hospital after several employees opined that Claimant might be having a heart attack.
An internal medicine specialist, Dr. Ña-man, treated her in the emergency room. Claimant, 57 years old, described the development of chest pain of 8 on a l-to-10 scale, radiating to her back. She gave the doctor a history of the onset of pain during a heated argument with her supervisor at work concerning a pay raise. By deposition, Dr. Ña-man testified that the results of blood work and repeated cardiograms revealed the presence of enzymes indicating heart damage. On the basis of the blood work, Dr. Ñaman initially thought Claimant had suffered a heart attack, a condition that he defined as the death of a muscle in the heart. A subsequent catheterization revealed 30-50% blockage of the left anterior descending, and 50% blockage of the circumflex, arteries. Such blockages, normally caused by plaque, were deemed mild to moderate in Claimant. The catheterization did not reveal any complete blockage. The doctor opined that Claimant would not have much potential for a heart attack due to the extent of the blockage alone. On the basis of the catheterization and blood work, Dr. Ñaman said that at some point, Claimant probably had sustained a coronary artery spasm. His opinion was that her coronary artery spasm was not caused by arterial blockage or plaque. Based on the history provided by Claimant, Dr. Ñaman opined that the most likely reason for, or event most likely precipitating, the coronary artery spasm was the emotional episode at the meeting.
On the issue of causation, the JCC stated as follows:
The logical cause doctrine in this case supports the claimant's position that the coronary artery spasm arose out of and was in the course of the claimant's employment with Publix because of the fact that the chest pains started during the meeting with Mr. Kapocsi and Mr. Myers on the store premises and cotinued [sic] without interruption until the hospitalization, and further, that the heart catheterization and Dr. Naman's testimony showed that the claimant would not have had a heart attack based or caused by blockage and that the most likely cause of the claimant's problem was a coronary artery spasm caused by the incident at work. There was no contrary evidence submitted [by] the employer/carrier. Therefore, the claimant's testimony and that of Dr. Ñaman establish within a reasonable degree of medical probability, the cause of the coronary artery spasm.
As the JCC's determination of causation is supported by competent substantial evidence in the record, that finding will not be disturbed on appeal. Dixie Lime & Stone Co. v. Lott, 196 So.2d 422, 423 (Fla.1967).
The JCC having found that Claimant had suffered a coronary artery spasm, the two key issues at hearing were 1) whether Claimant sustained an accident or disease arising out of and in the course of her employment, and 2) what was the appropriate rate for average weekly wage and compensation, in view of Claimant's working two jobs on the date of her injury. Only the first issue was raised on appeal.
Claimant maintained, and the JCC found, that under Florida law, "coronary artery spasms have historically been treated differently from heart attacks and have been found to be compensable, even if there is no unusual physical exertion or associated accident." The JCC based that determination on our decision in Citrus Central, Inc. v. Gardner, 466 So.2d 369 (Fla. 1st DCA 1985). The claimant, Gardner, usually worked as a forklift operator at a sheetmetal fabrication company, but several times a month was required to reheve production line workers banding the finished sheetmetal. While engaged in the latter activity, he experienced sharp pains and was admitted to the emergency room. The deputy commissioner relied on a physician's deposition testimony that Gardner had suffered a coronary artery spasm while engaged in non-routine work duties, and benefits were awarded. Id. at 371.
The E/C in Gardner challenged the finding of a compensable injury, but that portion of the JCC's order was affirmed. Id. at 370. However, in language that goes to the heart of the instant controversy, we stated:
The deputy commissioner's finding that Gardner suffered a coronary artery spasm while engaged in non-routine duties suggests a use of the test pronounced in [Victor Wine ] that the claimant be subject to unusual strain or over-exertion not routine to his work before the heart attack may be found compensable. Since Gardner suffered a coronary artery spasm, not a heart attack, there is no requirement of non-routine physical exertion. There is also no requirement it be shown that Gardner's injury was "preceded by some incident, such as a slip, fall or blow." Victor Wine, at 588.
Id. Claimant argues on appeal that Gardner is dispositive and requires an affirmance of the final order finding compensability without applying the stricter test promulgated in Victor Wine. We have carefully reviewed Gardner and the key decisions evolving from Victor Wine and Mosca. For reasons stated infra, we are compelled to disagree with Claimant's position.
Our research indicates that no other decision has cited Gardner for the proposition argued by Claimant, nor have we found another "coronary artery spasm" decision to support Claimant's position. Mosca is neither cited nor discussed in Gardner, and the evolving decisional law subsequent to Gardner convinces us that the Florida Supreme Court intended a broader application of the more rigorous Victor Wine burden of proof to cases involving coronary artery spasms. See Zundell.
Numerous decisions of the supreme court as well as our own court have demonstrated the continuing viability of the Victor Wine test not only in cases involving heart attacks, see City of Miami v. Rosenberg, 396 So.2d 163,164-65 (Fla.1981) (acute myocardial infarction with acute atrial fibrillation and left bundle branch block); Richards Dep't Store v. Donin, 365 So.2d 385 (Fla.1978) (subendocardial-myocardial infarction); Skinner v. First Florida Bldg. Corp., 490 So.2d 1367 (Fla. 1st DCA 1986) (affirming order denying claim based on rupture of congenital cerebral (berry) aneurysm, absent showing required under Victor Wine), but also in cases where the claimant sustained "other internal failures of the cardiovascular system." Mosca, 362 So.2d at 1341 (applying Victor Wine test and finding ruptured congenital cerebral aneurysm not compensable in absence of showing of unusual strain or overexertion); Zundell, 609 So.2d at 1367; Diaz v. City of Miami, 427 So.2d 1085 (Fla. 1st DCA 1983) (absent evidence of unusual strain or overexertion, order was affirmed, denying benefits to claimant with labile hypertension and premature heartbeats, who began suffering from chest pains, shortness of breath, and left arm pain while at home). Cf. Wolbert, Saxon & Middleton v. Warren, 444 So.2d 511, 513-14 (Fla. 1st DCA 1984) (reversing award of benefits to claimant suffering from chronic asthma attacks brought on by "an internal failure of the pulmonary system," absent any precipitating work-related physical condition or other unusual physical effort or event). Emotional strain alone, independent of any activity evincing unusual physical strain or overexertion, is insufficient to meet the test of compensability under Victor Wine. See Mosca, 362 So.2d at 1342; Hicks v. Jockey Club of Ocala and CIGNA/INAJAetna, 557 So.2d 117 (Fla. 1st DCA), rev. den., 569 So.2d 1279 (Fla.1990); Hammersmith v. Zanfardino, 425 So.2d 80, 81 (Fla. 1st DCA 1982), rev. den., 436 So.2d 101 (Fla.1983).
To determine the proper scope of Mosca, we note that "cardiovascular" pertains to heart and blood vessels. An artery is "a vessel through which the blood passes away from the heart to the various parts of the body." Dorland's Illustrated Medical Dictionary 138 & 275 (27th ed. 1988). Claimant's physician described a coronary artery spasm as "for all practical purposes [a] complete blockage of that artery." The hospital discharge summary states that "the patient has had myocardial injury secondary to coronary artery spasms, obtained a[t] the time of injury." Our thorough review of the medical testimony in the case at bar, and our interpretation of the reasoning underlying Mosca and its progeny, lead us to the inescapable conclusion that a coronary artery spasm is an internal failure of the cardiovascular system. Accordingly, we must recede from Gardner to the extent that it excludes coronary artery spasms from "other internal failures of the cardiovascular system." Mosca, 362 So.2d at 1341. Because the JCC erred, as a matter of law, in failing to apply the Victor Wine and Mosca test to determine whether the facts surrounding Claimant's injury prove com-pensability, we must reverse and remand the cause for further proceedings consistent herewith.
As in Zundell, Claimant likewise had manifested "no preexisting non-disabling heart disease" such as was contemplated in the previously quoted language from Victor Wine, 141 So.2d at 589. Because we can foresee the potentially broad ramifications of this issue, we certify the following question to be of great public importance:
WHETHER THE "RULE FOR HEART CASES" ANNOUNCED IN VICTOR WINE & LIQUOR, INC. V. BEASLEY AND LATER EXTENDED TO "OTHER INTERNAL FAILURES OF THE CARDIOVASCULAR SYSTEM" BY RICHARD E. MOSCA & CO., V. MOSCA IS APPLICABLE TO CASES IN WHICH THERE IS NO EVIDENCE THAT THE CLAIMANT SUFFERED FROM A "PRE-EXISTING NON-DISABLING" CARDIOVASCULAR DEFECT, FAILURE, OR DISEASE, THEREBY REQUIRING PROOF THAT, AT THE TIME OF THE INJURY, A CLAIMANT WAS "SUBJECT TO UNUSUAL STRAIN OR OVER-EXERTION NOT ROUTINE TO THE TYPE OF WORK" A CLAIMANT WAS ACCUSTOMED TO PERFORMING.
REVERSED and REMANDED for further proceedings.
BOOTH, SMITH, MINER, ALLEN, WOLF, KAHN and LAWRENCE, JJ., concur.
WEBSTER, J., specially concurs with written opinion in which BARFIELD, J., concurs.
JOANOS, J., dissents with written opinion in which ZEHMER, C.J., and ERVIN, J., concur.
ZEHMER, C.J., dissents with written opinion in which ERVIN, J., concurs.