Title: JAMES E. TUSSEY, DECEASED, BILLY TUSSEY, ADMINISTRATOR V. COOK FAMILY FOODS, LTD., ET AL.
Citation: N/A
Docket Number: 2006-SC-000132-WC
State: Kentucky
Issuer: Kentucky Supreme Court
Date: November 22, 2006

LM-PORI-ANTNO yE NOTTD BEPUBLISHED-OPINION THIS OPINIONISDESIGNATED "NOT TO BE PUBLISHED. " PURSUANT TO THE RULES OF CITIIL PROCEDURE PROHULGATED BY THE SUPREME COURT, CR 76.28 (4) (c), THIS OPINION IS NOT TO BE PUBLISHED AND SHALL NOTBE CIIED OR USEDASAUTHORITYINANYOTHER CASE -INANY COURT OF THIS STATE. 0 S~t~x~a9 alTurt of ~k 2006-SC-000132-WC JAMES E . TUSSEY, DECEASED, BILLY TUSSEY, ADMINISTRATOR APPELLANT APPEAL FROM COURT OF APPEALS V. 2005-CA-000846-WC WORKERS' COMPENSATION NO . 04-WC-00139 COOK FAMILY FOODS, LTD ., AND HONORABLE JAMES L. KERR, ADMINISTRATIVE LAW JUDGE, APPELLEES MEMORANDUM OPINION OF THE COURT AFFIRMING RENDERED : NOVEMBER 22, 2006 NOT TO BE PUBLISHED 'L02,'A7 VS-Qko s C `~C. KRS 342.035(3) prohibits compensation for a worker's death if it is caused by an unreasonable failure to follow competent medical advice . An Administrative Law Judge (ALJ) dismissed a claim for death benefits after finding that James Tussey failed to follow competent medical advice, that his behavior was unreasonable, and that it caused his death. The Workers' Compensation Board (Board) and the Court of Appeals affirmed . Nonetheless, the administrator of his estate continues to assert that there was no substantial evidence of an unreasonable failure to follow competent medical advice and no substantial evidence that such a failure caused Tussey's death. Convinced that the ALJ's decision was reasonable and adequately supported by the evidence, we affirm . Tussey twisted his right knee on December 21, 2001, while working, and sought treatment from Dr . T . Robert Love, an orthopedic surgeon . Dr . Love recommended arthroscopic surgery, and Tussey underwent the procedure on January 8, 2002 . On January 14, 2002, he died at King's Daughters' Medical Center. His death certificate listed a pulmonary embolism as being the cause of death . The administrator of Tussey's estate filed an application for death benefits, asserting that his death resulted from the work-related injury. The employer defended the claim on the ground that Tussey's death resulted from his unreasonable failure to follow competent medical advice . The employer submitted a deposition and affidavit from Wilda McDaniel, a registered nurse and office manager for Dr . Love's practice ; a deposition and affidavit from Nanci Davis, a medical assistant in the practice ; and a deposition and medical records from Dr . Love . The administrator cross-examined the employer's witnesses and submitted some medical records from Dr. Love . Ms . McDaniel testified that an "op consent" form listed the risks and potential complications of Tussey's procedure, among which were the risk of a blood clot forming and death. Before he underwent the procedure, Dr. Love discussed it with him, and they signed the form . Dr. Love then had her review the form with Tussey . After he read it, she asked if he understood the risks and potential complications . When he confirmed that he did, she had him initial the form and then initialed and dated it herself. It was sent to King's Daughters' with his chart . She explained that another set of initials appearing on the form with the date and time "1/8/02 12:40" indicated that a nurse at the hospital had reviewed the form with him again before the surgery. Ms. Davis's testimony and notes in Tussey's medical records indicated that on January 11, 2002, she had a telephone conversation with a woman who reported that Tussey was experiencing calf pain . She advised both the caller and Tussey, himself, that the situation was serious; explained the danger that a blood clot had formed and would travel to the heart and lungs or brain, causing him to die ; and advised them that he should undergo an ultrasound exam immediately. She put the call on hold and arranged for the test to be performed at Our Lady of Bellefonte Hospital as soon as Tussey arrived . He indicated that he would arrange for a ride to the hospital . On January 14, 2002, a representative of Our Lady of Bellefonte Hospital informed Ms. McDaniel that Tussey had been brought to the hospital that morning and had died of a pulmonary embolism . She testified that she inquired .about the outcome of the ultrasound and was informed that hospital records did not indicate that he appeared for the test . Dr. Love confirmed Ms. McDaniel's testimony regarding the procedure that he follows with every patient for discussing the risks and benefits of a proposed surgery and obtaining the patient's consent . He testified that calf tenderness is "a cardinal sign of a blood clot." Because such complaints are very serious, his office always arranges for an emergency ultrasound . Dr. Love testified that had Tussey appeared for the test and been diagnosed with a blood clot in his leg, he would have admitted him to the hospital and prescribed medication that would have significantly decreased the risk of a pulmonary embolism . Although he acknowledged that the medication would not have eliminated the possibility of an embolism altogether, he stated that he had never had a patient die from an embolism due to a post-surgical blood clot in 17 years of practice . He also stated that he had referred dozens of patients for ultrasound based on -3- complaints of limb pain or tenderness following surgery and knew of none who had failed to undergo the test or the standard protocol for treating blood clots . Dr. Love was asked whether, within a reasonable degree of medical probability, Tussey would have developed a pulmonary embolism had he undergone the ultrasound . He stated that the embolism was "an entirely preventable event in someone who presents with calf tenderness three days beforehand." Dr . Love testified that he performed the surgery to remove loose calcium deposits that floated into the claimant's knee joint and caused it to lock up . He explained that the underlying condition was not work-related but that the twisting incident may have caused the deposits to get into the joint . Had the claimant reached maximum medical improvement after the surgery, he probably would have retained a 3% impairment . Among the exhibits attached to Dr. Love's deposition were copies of Tussey's death certificate and surgical consent form . The administrator alleged that work-related trauma caused Tussey to sustain two harmful changes, a locked knee and his death. A longstanding principle of Chapter 342 is that a worker may be compensated for all of the harmful changes that flow from a work-related injury that are not attributable to an independent, intervening cause . Beech Creek Coal Co. v . Cox , Ky., 237 S.W.2d 56 (1951) ; Elizabethtown Sportswear v . Stice, Ky.App., 720 S .W.2d 732 (1986) . Thus, KRS 342.0011(1) permits compensation for a harmful change in the human organism if work-related trauma is the proximate cause producing it . Consistent with the principle that an independent, intervening cause will break the chain of causation, KRS 342.035(3) precludes compensation when death or disability results from an unreasonable failure to follow competent medical advice . As explained in Allen v. Glenn Baker Trucking, Inc . , 875 S.W.2d 92, 94 (Ky. 1994), the statute encompasses medical advice that, if followed, would have prevented further injury or disability . Where a worker is unable to testify and there is unrebutted prima facie evidence that an injury is work-related, KRS 342 .680 affords a presumption of causation unless there is substantial evidence to the contrary. Tussey underwent surgery for the effects of the knee injury . Although a pulmonary embolism is a known risk of the procedure, the existence of substantial evidence that his death was caused by an unreasonable failure to undergo the ultrasound would deprive his estate of KRS 342.680's presumption that his death was work-related . A finding to that effect would also preclude compensation under KRS 342.035(3). See Luttrell v. Cardinal Aluminum Company , 909 S .W.2d 334 (Ky . App . 1995) ; Teague v. South Central Bell , 585 S.W .2d 425 (Ky. App . 1979). Teague , supra, and Luttrell , supra, explain that KRS 342.035(3) is an affirmative defense for which the burden of proof is on the employer. Therefore, the employer had the burden to prove that Tussey failed to follow competent medical advice, that his behavior was unreasonable, and that it caused his death. Fordson Coal Co . v . Palko, 282 Ky . 397, 138 S.W.2d 456 (1940), explains that a refusal to submit to treatment is unreasonable it the treatment is free from danger to life, health, and extraordinary suffering and if, according to the best medical or surgical opinion, the treatment offers a reasonable prospect of restoration or relief from disability . The AU determined that the employer met its burden of proof under KRS 342.035(3) and dismissed the claim . Mindful that KRS 342 .285 designates the AU as the finder of fact, the courts have explained that the AU has the sole discretion to determine the quality, character, and substance of evidence ; to draw reasonable inferences from the evidence ; and to decide whom and what to believe . Addressing the applicable standard for appellate review in Special Fund v. Francis , 708 S.W .2d 641, 643 (Ky. 1986), the court explained that a finding that favors the party with the burden of proof must be upheld if it is supported by substantial evidence and, therefore, is reasonable . The administrator relies on Teague , supra , as authority indicating that the employer failed to meet its burden of proving that Tussey's failure to undergo the ultrasound actually caused his death and or of proving an unreasonable failure to follow competent medical advice . Another related argument is that evidence of habit or custom was inadmissible to prove that Dr. Love and the nurses complied with their responsibilities . See Thomas v. Greenview Hospital, Inc . , 127 S .W.3d 663 (Ky. App . 2004) . The administrator's reliance on Tea ue, supra, is misplaced. Although Mr. Teague also died from a pulmonary embolism after a work-related injury, the facts were significantly different from those in the present case . Teague twisted his ankle at work. His treating physician diagnosed superficial thrombophlebitis and assented to treating him as an outpatient rather than in the hospital . The physician attributed the thrombophlebitic condition to the injury. Nothing in the record indicated that the physician informed Teague that his assent to outpatient treatment was against his better judgment . Nothing indicated that he informed Teague that the type of treatment would have been different had he been admitted to the hospital, and nothing in the record indicated that Teague was ever aware of the seriousness of his condition . His wife testified that he took the medicine his physician prescribed and kept the leg elevated, as directed . Finally, there was no evidence in the record that Teague's refusal to go to the hospital actually caused his death . Although some evidence from Dr . Love, Ms . McDaniel, and Ms . Davis concerned habit and/or custom, there was adequate evidence regarding their specific interactions with Tussey to support the ALJ's findings . The signed and initialed "op consent" form together with Ms. McDaniels' testimony established that Tussey was informed repeatedly that blood clots in the veins and lungs were a risk of surgery and had grave implications, including death. Ms. Davis's testimony and medical records established that when he complained of calf pain, Ms . Davis informed him that it was a serious symptom; that he should go to the hospital immediately for an ultrasound in order to determine if there was a blood clot ; and that a clot could travel to the brain, lungs, or heart and cause death . She testified that she arranged the emergency ultrasound during the telephone call with Tussey . Although he had indicated he would get a ride to the hospital for the procedure, hospital records did not indicate that he underwent the procedure . There was no evidence that the procedure was dangerous or even unpleasant. More than mere implication or supposition established that the unreasonable failure to follow medical advice resulted in death . Tussey was informed that his symptoms were life-threatening and advised to undergo an emergency ultrasound . He failed to do so and died three days later . His death certificate listed a pulmonary embolism as being the cause of death. Dr. Love's testimony established within a reasonable medical probability that the calf pain of which Tussey complained was a "cardinal sign of a blood clot;" that ultrasound performed on January 11, 2002, would have detected the clot; that medication administered at that time would have dissolved the clot ; and that the embolism would have been prevented . Under the circumstances, substantial evidence supported the findings that Tussey failed to follow competent medical advice, that his behavior was unreasonable, and that it caused his death. Substantial evidence established that it was the effects of his failure to undergo an ultrasound that caused his death . The decision of the Court of Appeals is affirmed . Lambert, C.J., and McAnulty, Minton, Roach and Wintersheimer, J.J ., concur. Graves, J., dissents by separate opinion in which Scott, J ., joins . COUNSEL FOR APPELLANT, BILLY TUSSEY, ADMINISTRATOR OF THE ESTATE OF JAMES E . TUSSEY : Robert W . Miller Law Offices of Robert W. Miller P.O. Box 357 Grayson, KY 41143 COUNSEL FOR APPELLEE, COOK FAMILY FOODS, LTD .: Gregory C . Shields Shields Law Offices P.O . Box 361 Catlettsburg, KY 41129 ,9~~rrt f~~aurf of ~.~fux.~~rr 2006-SC-000132-WC JAMES E . TUSSEY, DECEASED, BILLY TUSSEY, ADMINISTRATOR APPELLANT APPEAL FROM COURT OF APPEALS V. 2005-CA-000846-WC WORKERS' COMPENSATION NO . 04-WC-00139 RENDERED : NOVEMBER 22, 2006 NOT TO BE PUBLISHED COOK FAMILY FOODS, LTD., AND HONORABLE JAMES L. KERR, ADMINISTRATIVE LAW JUDGE, APPELLEES DISSENTING OPINION BY JUSTICE GRAVES Respectfully, I dissent . The embolism resulted from the surgery for the work- related injury . There is no proof that ultrasound and medication would have precluded the end result . Because of lack of understanding of the medical proof, the ALJ has drawn an erroneous legal conclusion . Scott, J ., joins in this dissent .