Case Name: LOUIS DUDOVITZ v. SHOPPERS CITY, INC., AND ANOTHER
Court: Minnesota Supreme Court
Jurisdiction: Minnesota
Decision Date: 1969-01-31
Citations: 282 Minn. 322
Docket Number: No. 40771
Parties: LOUIS DUDOVITZ v. SHOPPERS CITY, INC., AND ANOTHER.
Judges: 
Reporter: Minnesota Reports
Volume: 282
Pages: 322–343

Head Matter:
LOUIS DUDOVITZ v. SHOPPERS CITY, INC., AND ANOTHER.
164 N. W. (2d) 873.
January 31, 1969
No. 40771.
Gerald B. Forrette and Joseph Harkness, Jr., for relator.
Scholle, Sckweiger & Kalina and Leslie C. Scholle, for respondents.

Opinion:
Knutson, Chief Justice.
Certiorari to review a decision of the Industrial Commission denying compensation to an employee who suffered a heart attack while on the job.
The only question before us is whether the evidence sustains the commission's finding that there was no causal relationship between the heart attack and the employment.
The facts pertinent to our inquiry may be briefly summarized: Louis Dudovitz, the relator, was bom on July 17, 1908, and was 56 years of age at the time of the hearing before the Industrial Commission. He was a high school graduate. For over 40 years he had been employed as a produce buyer for various food markets in the St. Paul area. On July 31, 1963, he was employed as a supervisory employee and produce department manager for Shoppers City, Inc., a large supermarket. He normally worked 10 to 12 hours daffy in supervision of produce department operations, which included buying produce and arranging it on counters where it was offered to the public for sale. He normally commenced his work about 4:30 a. m. in order to be at the produce market in time to purchase the required produce. He normally worked until 5 or 6 p. m. each day.
On July 31,1963, Shoppers City was having an advertised sale of early-season com at reduced prices. In order to obtain the com required for the sale, Mr. Dudovitz went to the market, where he supervised the purchase of some 3,000 dozen ears of com. His work required that he sometimes climb up on the trucks, open sacks of vegetables, and make inspection of the various vegetables he was to purchase. He had done the same type of work for years. He did not recall having to load any of the corn or any other produce purchased on that day into the station wagon used to transport it to Shoppers City. Usually this was done by someone else. After he arrived at the store, he did not carry any corn from the cooler to the display counter, but was in the act of lifting a crate of celery, which weighed from 50 to 60 pounds, when he developed severe pain in the upper chest area, began to sweat profusely, and had to stop work. He was hospitalized by his family doctor, and there is no dispute that at the time involved he suffered a coronary occlusion with subsequent posterior myocardial infarction.
Prior to July 31, 1963, Mr. Dudovitz had received no medical treatment for heart trouble although he had been hospitalized on a number of occasions for unrelated illnesses. Most of these involved nervous disorders for which he had received shock treatment and other therapy.
The referee found that the employee sustained a personal injury in the nature of a myocardial infarction which arose out of and in the course of his employment. On appeal, the Industrial Commission reversed by unanimous decision, finding that there was no causal relationship between the myocardial infarction and the employment.
The doctor who attended relator shortly after the heart attack did not testify, as he also had become disabled as the result of a heart attack.
Relator called Dr. Markle Karlen, a specialist in internal medicine, who stated that in his opinion there was a causal relationship between the heart attack and the employment. The employer called Dr. Dean K. Rizer, who also specializes in internal medicine. He was of the opposite opinion, stating that in his opinion there was no causal relationship between the heart attack and the employment. Both doctors agree on the diagnosis stated above. They differ only as to causal relationship, or, in other words, what precipitated the heart attack. No one questions the qualifications of either doctor, and it is apparent that they based their opinions on their own honest judgment as to what brought about the coronary occlusion and resulting myocardial infarction.
This case is no different from the numerous cases that have come before us in which medical opinions differ on whether there is a causal relationship between an occurrence which causes an employee disability or death, such as a heart attack or the onslaught of a disabling disease, and his employment. In these cases we have held that it is for the triers of fact to say which opinion is right, and if there is credible evidence upon which they base their finding we have consistently held that we are bound by it. The cases are collected in 21 Dunnell, Dig. (3 ed.) § 10426(13), note 16. We have repeated this rule so often that it is trite to repeat it again, and a review of our cases can serve no useful purpose except, perchance, to discourage useless appeals in this area when there is competent and credible evidence from which the factfinder might draw inferences either way, since we have so often held that we are bound by the determination of the commission.
In Schultz v. U. S. Bedding Co. 210 Minn. 68, 69, 297 N. W. 351, 352, we said:
"As is customary in such circumstances, the losing party makes much of alleged inconsistencies, claimed defects, lack of proof, etc., on the part of his opponent, the prevailing party before the triers of fact. But that, perhaps, is the kind of error for the correction of which no remedy has yet been found.
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"With ample evidence to sustain the commission's findings, we are bound thereby, since we do not try the facts nor determine the credibility of the testimony of witnesses, be they laymen or medical experts." (Italics supplied.)
In Saari v. Dunwoody Iron Min. Co. 221 Minn. 95, 96, 21 N. W. (2d) 94, 95, we said:
"We have often said that where the evidence is in conflict the findings of the industrial commission, if reasonably supported, are conclusive on review by this court. [Citations omitted.] And that, also, is the rule to apply where there is conflict in medical testimony. Like other testimony, the fact issue is to be resolved by the triers of fact."
In the Saari case we quoted from Swanson v. American Hoist & Derrick Co. 214 Minn. 323, 326, 8 N. W. (2d) 24, 25, as follows:
" Conflicts in medical opinions, like those in other testimony, must be resolved by the triers of fact. Here there was a direct conflict on the vital issue in the case between the view of employe's doctor and the view of the doctors who testified for the employer. The commission accepted the testimony of Dr. Hengstler and awarded compensation. Under our oft-repeated rule, we cannot go beyond its determination."
It is for the triers of fact to choose between conflicting evidence and also between conflicting inferences to be drawn therefrom. Hill v. Umbehocker, 201 Minn. 569, 277 N. W. 9.
The burden of proof is upon the employee to prove his claim by competent testimony. Schmillen v. Dave Schroeder Grocery, 250 Minn. 561, 566, 85 N. W. (2d) 740, 743. In that case, again, we said:
" We have held repeatedly in workmen's compensation cases that conflicts in medical opinion must be resolved by the triers of fact. We think the conflict in the instant case raises a fact issue concerning employee's physical condition and its cause, which was for decision by the Industrial Commission.
" Triers of fact in workmen's compensation proceedings must in determining their findings choose not only between conflicting evidence but also between opposed inferences."
Haskin v. County of Hennepin, 268 Minn. 21, 127 N. W. (2d) 522, involved the contraction of tuberculosis. In such cases, also, we often find a difference in medical testimony, but the same rule applies. We there said (268 Minn. 24, 127 N. W. [2d] 525):
" Determination of this question [the causal relationship between the contraction of the disease and the employment], of necessity, must rest largely on the acceptance of one of two divergent opinions of doctors experienced in this field. No one can demonstrate beyond dispute which of these two possibilities caused the active tuberculosis. The necessary inference to be drawn must be based on the factfinder's belief that the opinion of one doctor is more credible and more probable than the other."
In Peterson v. The Ruberoid Co. 261 Minn. 497, 500, 113 N. W. (2d) 85, 87, as in many other cases, we recognized the impossibility of determining beyond any question the precipitating cause of a coronary thrombosis :
"It is, of course, difficult to establish the precipitating causes of coronary thrombosis. The determination of whether the employment was a causal factor in producing the attack must necessarily rest upon competent medical testimony, and, where there is a conflict, the finding of the commission will not be disturbed on appeal."
The same rule is stated in Golob v. Buckingham Hotel, 244 Minn. 301, 304, 69 N. W. (2d) 636, 639, also involving a coronary thrombosis. We there said:
" [U]ntil the time comes when medical knowledge has progressed to such a point that experts in the field of medicine can agree, causal relation in determining compensable injury or disease will have to remain in the province of the trier of fact. Where qualified medical witnesses differ as they do here, it ordinarily is not for us on appeal to say that one is so eminently right and the other so clearly wrong that the fact finder was obliged to accept the opinion of one and discard the opinion of the other. The determination of this question is like the determination of any other question of fact, and it must depend to a large extent upon the credibility attached by the trier of facts to the opinion and testimony of the various witnesses who are expressing their opinions."
For other cases of interest, see Schroepfer v. Hudson, 214 Minn. 17, 7 N. W. (2d) 336; Nelson v. Creamery Package Mfg. Co. 215 Minn. 25, 9 N. W. (2d) 320; Erickson v. Knutson, 237 Minn. 187, 54 N. W. (2d) 118; Root v. City of Duluth, 247 Minn. 243, 76 N. W. (2d) 698; Olson v. F. I. Crane Lbr. Co. 259 Minn. 248, 107 N. W. (2d) 223; Luthens v. Glencoe Red & White Store, 264 Minn. 26, 117 N. W. (2d) 386; Hommerding v. Clarence Landwehr Heavy Moving, 273 Minn. 40, 139 N. W. (2d) 482; Knaeble v. Custom Tool & Mfg. Co. 273 Minn. 515, 142 N. W. (2d) 92; Stibbs v. Northwest Airlines, Inc. 277 Minn. 248, 152 N. W. (2d) 318.
It is only when the evidence is so conclusive that only one inference is permissible that this court on review may interfere with the finding of the Industrial Commission. This rule is particularly applicable to cases involving causal relationship between a heart attack of one kind or another and the employment. Here, probably more than anywhere else, it is next to impossible to determine causal relationship with any degree of certainty, and the factfinder's choice between permissible inferences must be based on the credibility of the medical experts in the case as applied to the other evidence in the case. And when they have divergent views it is not for us to say which was right. Dr. Karlen, who testified for relator, admitted that "the majority of so-called heart attacks occur either at rest or during no activity or mild activity." With respect to the certainty of diagnosis of precipitating cause of heart attacks, he said:
"Well, in no case can we if you want to get — I mean technically in no case can you say the same as you can say with respect to pneumonia that the cause of pneumonia is a bacterium pneumococcus; and a myocardial infarction you can say that the basic cause is coronary arteriosclerosis, but in no case can you say, sit down and say 100 percent sure that this man had the attack because he smokes too much; that's one of the factors, but you have no 100 percent cause if that's what you are asking, but that is true in any case in heart trouble not in just some cases as you alluded to."
He admitted that there are honest differences of opinion as to whether work activity may precipitate a heart attack.
Dr. Rizer, who testified for the employer, while admitting that there are two schools of thought on the subject, contended that the majority of the medical people in this field feel there is no relationship between the work of an individual and the onslaught of a coronary occlusion. He stated that it is due to a gradual change in the blood vessels, which finally reach a point where they do not carry a sufficient supply of blood to the heart, and that this may occur at any time. His testimony was as follows, without any qualification:
"Q. Your opinion as to the type of heart condition that he had and its cause and its possible relationship to work?
"A. Well, it appeared to be a perfectly straightforward coronary occlusion and posterior myocardial infarction. This represents a complication of arteriosclerotic and atherosclerotic heart disease. In terms of present day medical knowledge the exact cause of arteriosclerosis and atherosclerosis is unknown. However, there is a background of inheritance in this condition. It is also known that hypertension, diabetes, obesity and a diet high in saturated fats which is the standard American diet, and cigarette smoking all seem to be background factors of acceleration in this condition. It is known that hard physical work doesn't cause arteriosclerosis and atherosclerosis. Quite to the contrary, it appears to have a beneficial effect on the course of the disease. For example, farmers who maintain close to a normal weight tend to have their coronaries as a group about ten years later than their more sedentary urban workers. Mr. Dudovitz led an active and vigorous life. He was accustomed according to his work record to handling and moving and lifting sacks and baskets of produce weighing up to 50 pounds. The work that he did on the day in question, while heavy, was in no way unusual for him. To me, this indicates that an internal change must have occurred to produce his coronary rather than attributing it to external factors which had been fairly constant through his working life.
"Q. Well, what then, Doctor, would you state as your opinion with respect to causation between the work that he was doing for his employer at the time and the onset of this heart symptom?
"A. In my opinion this coronary is not work related." (Italics supplied.)
No one questions the doctors' qualifications in their field of medicine. Their opposite views are undoubtedly based upon an honest difference of opinion. It was for the Industrial Commission as the trier of fact to choose which opinion, based on all the evidence in the case, was entitled to the greater credit. Under these circumstances there is nothing we can do but affirm.
Some suggestion has been made that where the opinions of medical experts, apparently equally well-qualified, differ as to causal relationship between the onset of a heart attack or some other disease and employment, a neutral physician should be called by the Industrial Commission, as it may do under our statutes. Neither party urges this as a solution in the present case. It is obvious that the difficulty with this suggestion in an area where there are two schools of thought among medical people — as, in this case, over whether exertion or trauma may be the precipitating cause of a heart attack — is that the outcome might depend on the school of thought adhered to by the neutral physician. If a really neutral physician could be found it might be of some help; but it is doubtful that in this area, where the opinions of medical men seem to be so definite either one way or the other, such could be found. The Industrial Commission is not bound by the opinion of a neutral physician any more than it is bound by the opinion of any other doctor, Richter v. Shoppe Plumbing & Heating Co. 257 Minn. 108, 100 N. W. (2d) 96; and while there are cases where a neutral physician might be highly desirable, we doubt that this is one of them.
Affirmed.