Opinion ID: 2851063
Heading Depth: 1
Heading Rank: 2

Heading: analysis

Text: When considered together, Good Samaritan’s assignments of error present two issues. The first issue is whether Malin’s opinions had sufficient foundation. Good Samaritan claims that Malin did not possess sufficient facts to form a reliable opinion regarding Hynes’ condition. The second issue is whether the compensation court erred in considering the second and third incidents in its determination of Hynes’ disability. Good Samaritan asserts that there was no proof Hynes suffered a physical injury in either the - 766 - Nebraska A dvance Sheets 291 Nebraska R eports HYNES v. GOOD SAMARITAN HOSP. Cite as 291 Neb. 757 second or third incident and that, therefore, neither was independently compensable. Consequently, Good Samaritan contends that the court should not have considered these incidents in its analysis and that Malin’s inclusion of such incidents in her report makes her opinions irrelevant. This argument suggests that each incident must be independently compensable under the Nebraska Workers’ Compensation Act in order to be relevant. Foundation for M alin’s R eport We first address Good Samaritan’s foundational objection to Malin’s opinions. The compensation court found that Malin’s opinions had sufficient foundation and were credible and reliable. The court adopted the opinions as carrying the greater weight of evidential probability with respect to causation, diagnosis, and need for medical care. Good Samaritan claims Malin was unaware of various pertinent facts, such as previous psychological counseling, supposed visual and auditory hallucinations, past work in psychiatric units at hospitals, a past sexual assault, sexual promiscuity, physical and mental abuse by a former fiance, a terminated pregnancy, and Hynes’ continued work at Good Samaritan after the first assault. It argues that because Malin did not consider these facts, her opinions were based on insufficient information and, therefore, lacked sufficient foundation and should have been excluded. Good Samaritan claims that without Malin’s opinions, Hynes has no evidence of causation and failed to meet her burden of proof. [4,5] Admission of evidence is within the discretion of the Workers’ Compensation Court, whose determination in this regard will not be reversed upon appeal absent an abuse of discretion. Olivotto v. DeMarco Bros. Co., 273 Neb. 672, 732 N.W.2d 354 (2007). Expert testimony should not be received if it appears the witness is not in possession of such facts as will enable him or her to express a reasonably accurate conclusion, as distinguished from a mere guess or conjecture. City - 767 - Nebraska A dvance Sheets 291 Nebraska R eports HYNES v. GOOD SAMARITAN HOSP. Cite as 291 Neb. 757 of Lincoln v. Realty Trust Group, 270 Neb. 587, 705 N.W.2d 432 (2005). It is within the trial court’s discretion to determine whether there is sufficient foundation for an expert witness to give his or her opinion about an issue in question. American Central City v. Joint Antelope Valley Auth., 281 Neb. 742, 807 N.W.2d 170 (2011). We conclude that the Workers’ Compensation Court did not abuse its discretion in finding Malin’s opinions had sufficient foundation. We reach this conclusion for several reasons. First, Good Samaritan makes some factually incorrect allegations regarding Malin’s report. It claims Malin stated that Hynes did not experience hallucinations in her discussion of symptomology, but Malin’s report notes that Hynes exhibited “an increase in intensity of symptoms of Major Depressive Disorder that featured frequent suicidality as well as emergence of psychotic symptoms, including hallucinations.” Malin later states: “She continues to have fluctuating suicidality and intermittent hallucinations.” Good Samaritan also alleges Malin was unaware that Hynes continued to work after the first incident, which occurred on April 16, 2008, but this is contradicted by the fact that Malin considered the second and third assaults that occurred while Hynes worked at Good Samaritan. Another basis for our conclusion is Malin’s statement that she formed her opinions following a detailed review of Hynes’ psychiatric records. Those records detailed Hynes’ personal and psychological history that Good Samaritan alleges was not considered by Malin. We have previously held that for purposes of determining whether a medical expert’s testimony is admissible, it is acceptable, in arriving at a diagnosis, for a physician to rely on examinations and tests performed by other medical practitioners. Carlson v. Okerstrom, 267 Neb. 397, 675 N.W.2d 89 (2004). The defense expert, Davis, conceded that he used many—if not all—of Hynes’ records as a basis for his opinion. Regardless of whether the information was disclosed in an in-person examination of Hynes or noted - 768 - Nebraska A dvance Sheets 291 Nebraska R eports HYNES v. GOOD SAMARITAN HOSP. Cite as 291 Neb. 757 in a report, we find that Malin possessed the relevant information by virtue of her review of Hynes’ records. Whether Malin possessed or considered the entirety of Hynes’ personal or psychological history in forming her opinion ultimately concerns the weight to be given to Malin’s opinions by a trier of fact, rather than the admissibility of the opinions. An appellate court is not a superexpert and will not lay down categorically which factors and principles an expert may or may not consider; such matters go to the weight and credibility of the opinion itself and not to its admissibility. State v. Davlin, 263 Neb. 283, 639 N.W.2d 631 (2002). Malin’s opinions had sufficient foundation based on her review of Hynes’ medical records and her in-person evaluation of Hynes. Causation We next consider Good Samaritan’s challenges to both the compensation court’s and Malin’s consideration of the second and third incidents in their analyses of Hynes’ injuries. At trial, Good Samaritan conceded that the first incident resulted in physical injury and was compensable. At oral arguments, it conceded that the second and third incidents occurred. However, Good Samaritan claims that Hynes failed to present any evidence to demonstrate she suffered physical injuries associated with the second and third incidents and that, therefore, neither incident is compensable. Based upon this premise, it asserts that the second and third incidents were irrelevant to the determination of the causation of Hynes’ injuries. Good Samaritan’s relevancy objection to Malin’s report was based on Malin’s consideration of the second and third incidents in forming her opinions regarding Hynes’ injuries. These incidents were the basis of Malin’s opinion that the injury sustained by Hynes in the first incident was exacerbated or aggravated by those incidents. As discussed in detail below, each incident was not required to be independently compensable to be considered by either Malin or the court. - 769 - Nebraska A dvance Sheets 291 Nebraska R eports HYNES v. GOOD SAMARITAN HOSP. Cite as 291 Neb. 757 [6,7] In order to recover under the Nebraska Workers’ Compensation Act, a claimant has the burden of proving by a preponderance of the evidence that an accident or occupational disease arising out of and occurring in the course of employment proximately caused an injury which resulted in disability compensable under the act. Manchester v. Drivers Mgmt., 278 Neb. 776, 775 N.W.2d 179 (2009). A worker is entitled to recover compensation for a mental illness if it is a proximate result of the worker’s injury and results in disability. Id. [8,9] A claim for a psychological or mental condition requires that the mental condition must be related to or caused by the physical injury. See Zach v. Nebraska State Patrol, 273 Neb. 1, 727 N.W.2d 206 (2007). An injury caused by a mental stimulus does not meet the requirement that a compensable accidental injury involve violence to the physical structure of the body. Id. [10] On appellate review of a workers’ compensation award, the trial judge’s factual findings have the effect of a jury verdict and will not be disturbed unless clearly wrong. Visoso v. Cargill Meat Solutions, 285 Neb. 272, 826 N.W.2d 845 (2013). Using this standard, we first review the compensation court’s findings regarding the second incident. The court stated: “This Court finds that [Hynes] was a credible witness at this second trial. This Court finds the three incidents in this case happened as [Hynes] described.” It also determined that “[t]here is evidence that the first and second assaults involved physical injury with psychological injury.” Good Samaritan argues that the compensation court erred in finding that Hynes suffered a physical injury in the second incident, because she did not present evidence of such injury. We disagree. Evidence was provided by Hynes’ testimony and the notes of her employee assistance program counselor. Hynes testified that an assault occurred in which a patient bit her on her forearm, causing a welt and bruises, and then kicked her several times. The incident was reported to the counselor, who recorded the incident and symptomology in - 770 - Nebraska A dvance Sheets 291 Nebraska R eports HYNES v. GOOD SAMARITAN HOSP. Cite as 291 Neb. 757 her medical notes. The incident report noted bruising to Hynes’ right forearm. That Hynes did not receive immediate medical treatment for a physical injury does not negate the fact that she sustained one. [11] Good Samaritan claims that Hynes’ testimony regarding the assault was self-serving, suggesting that the compensation court should not have accepted it. But this is a matter of witness credibility. As the trier of fact, the Workers’ Compensation Court is the sole judge of the credibility of witnesses and the weight to be given their testimony. Manchester v. Drivers Mgmt., supra. We decline to second-guess the Workers’ Compensation Court’s acceptance of Hynes’ testimony. Good Samaritan has not shown that the compensation court was clearly wrong in finding that Hynes suffered a physical injury during the second incident. [12-14] Next, we consider the compensation court’s inclusion of the third incident in its causation analysis. The issue is whether the court erred in considering the incident in its causation analysis notwithstanding the fact that the incident was not independently compensable. Good Samaritan claims that the court erred in “tying the three alleged incidents together and finding that [Hynes’] psychiatric issues flowed from some combination of them.” The determination of causation is ordinarily a matter for the trier of fact. Mendoza v. Omaha Meat Processors, 225 Neb. 771, 408 N.W.2d 280 (1987). When the question is whether compensability should be extended to a subsequent injury or aggravation related in some way to the primary injury, the rules that come into play are essentially based upon the concepts of “direct and natural results.” Stacy v. Great Lakes Agri Mktg., 276 Neb. 236, 753 N.W.2d 785 (2008). A cause of an injury may be a proximate cause, notwithstanding that it acted through successive instruments of a series of events, if the instruments or events were combined in one continuous chain through which the force of the cause operated to produce the disaster. Id. The compensation court found that “[t]he first (with physical injury) and the second and third incidents can combine in - 771 - Nebraska A dvance Sheets 291 Nebraska R eports HYNES v. GOOD SAMARITAN HOSP. Cite as 291 Neb. 757 one continuous chain through which the force of the cause operated to produce the totality of mental illness [Hynes] is suffering from.” It further reasoned: Although the third incident may not be an accident within the meaning of the Nebraska Worker’s [sic] Compensation Act (if it were the only incident and not the third this would be an issue) the result of the continued abuse which happened in the workplace on the underlying compensable mental injury is compensable. .... . . . The Court does not view [Hynes’] claim to be for three separate accidents but rather . . . as an initial accident with two subsequent incidents which aggravated or cumulatively added to the damage and injury to [her] mental health which began with the first accident. In this regard there is clear evidence that the first assault with physical injury caused immediate mental difficulties for which [Hynes] sought treatment. There is evidence that the first and second assaults involved physical injury with psychological injury. . . . There is evidence in the record to support a finding that the third assault aggravated the preceding compensable injuries all of which injuries are compensable under the Nebraska Workers’ Compensation Act. The parties stipulated that the April 16, 2008, assault involved a physical injury and was independently compensable. In its analysis, the Workers’ Compensation Court found that Hynes was not mentally stable or healthy after the first and second incidents and that her mental health deteriorated. This determination was not clearly wrong. A separate compensable injury for each and every work aggravation is not required if the initial cause of the injuries is a direct and natural result of the compensable injury. See Stacy v. Great Lakes Agri Mktg., supra. Good Samaritan claims the facts of the present case are similar to Sweeney v. Kerstens & Lee, Inc., 268 Neb. 752, 688 N.W.2d 350 (2004). We disagree. In Sweeney, the employee’s - 772 - Nebraska A dvance Sheets 291 Nebraska R eports HYNES v. GOOD SAMARITAN HOSP. Cite as 291 Neb. 757 depression was entirely attributable to a loss of earning capacity report that the employee believed would have a negative impact on the litigation. There was no physical injury that was related to the employee’s depression. We found that the worker’s litigation stress was an intervening event which broke the causal connection between his depression and the original work-related accident and that, therefore, the psychological injury was unconnected to a physical injury. We distinguished Sweeney from our decision in Kraft v. Paul Reed Constr. & Supply, 239 Neb. 257, 475 N.W.2d 513 (1991), in which we affirmed an award of workers’ compensation benefits to a worker whose traumatic neurosis was attributed to both his physical injury and the psychological loss resulting from the worker’s immobility and inability to work. In the case at bar, the psychological injuries resulted directly from an assault in which Hynes suffered a physical injury. The causation opinion was that Hynes’ psychological injuries were the result of the physical injuries sustained during the assaults. In Malin’s report, she stated: It is my opinion beyond a reasonable degree of medical and psychiatric certainty that . . . Hynes sustained both physical and psychological injury as a proximate result of the work-related assaults detailed in medical records. . . . The first assault on April 16, 2008, . . . resulted in both physical and psychological injury. . . . .... . . . Hynes went on to experience two other assaults by patients in May and June 2008 . . . . These caused cumulative trauma to her already fragile [PTSD] as had been rendered with the April assault. Malin noted that “[t]he psychological injury that . . . Hynes sustained from this first assault . . . was apparent almost immediately.” Hynes reported difficulty sleeping and eating and having fear of returning to the unit where the assault occurred. The symptoms worsened with persistent flashbacks and greatly affected her personal, occupational, and social - 773 - Nebraska A dvance Sheets 291 Nebraska R eports HYNES v. GOOD SAMARITAN HOSP. Cite as 291 Neb. 757 functioning. Malin determined those symptoms were consist­ ent with acute stress disorder and PTSD, which eventually led to a major depressive disorder requiring several hospitalizations. She opined that Hynes was extremely cooperative with the evaluation and did not exhibit any common features of malingering. She further opined that Hynes has been unable to work since July 2008 and that all of Hynes’ medical treatment and therapy needs were caused as a result of the injuries—both physical and psychological—that she sustained in the course of her employment. [15,16] Good Samaritan argues, “At issue is whether there was sufficient competent evidence to support [Hynes’] alleged mental injuries . . . .” Brief for appellant at 1-2. In testing the sufficiency of evidence to support findings of fact made by the compensation court after rehearing, the evidence must be considered in the light most favorable to the successful party and the successful party will have the benefit of every inference reasonably deducible from the evidence. Miller v. E.M.C. Ins. Cos., 259 Neb. 433, 610 N.W.2d 398 (2000). If the record contains evidence to substantiate the factual conclusions reached by the trial judge in workers’ compensation cases, we are precluded from substituting our view of the facts for that of the compensation court. Pearson v. ArcherDaniels-Midland Milling Co., 285 Neb. 568, 828 N.W.2d 154 (2013). The record contains ample evidence to support the Workers’ Compensation Court’s findings. This includes Hynes’ testimony as to the facts surrounding her injuries. The court found that “[Hynes] was consistently employed from 1992 through 2008 without significant or relevant incident either physical or mental. During this time she worked, was married and had a family.” There is no indication that Hynes experienced symptoms of PTSD, major depressive disorder, or any other significant psychiatric problems in the 15 years prior to the initial assault in April 2008. Nor did she have any issues related to substance abuse in the decade prior to her injuries. Hynes required extensive treatment following the - 774 - Nebraska A dvance Sheets 291 Nebraska R eports HYNES v. GOOD SAMARITAN HOSP. Cite as 291 Neb. 757 three incidents, including electroconvulsive therapy, which Malin stated is “a treatment option of last resort for Major Depressive Disorders.” We find sufficient evidence to support the court’s determination that Hynes’ injuries arose as a result of her work-related accident. [17] Regarding the medical evidence, the compensation court found that Malin’s evaluation was credible and reliable, and it adopted and relied upon her opinions. Malin opined that the treatment Hynes received was directly related to the assaults, that she has been incapable of working since the assaults, and that she will require future treatment. It is the role of the Workers’ Compensation Court as the trier of fact to determine which, if any, expert witnesses to believe. Ludwick v. TriWest Healthcare Alliance, 267 Neb. 887, 678 N.W.2d 517 (2004). [18] The Workers’ Compensation Court was not clearly wrong in finding that Hynes’ injuries were the result of the initial “accident” which occurred on April 16, 2008, with two subsequent incidents that aggravated or cumulatively added to the injury. Where the evidence is sufficient to permit the trier of fact to find that a psychological injury is directly related to the accident and the employee is unable to work, the employee is entitled to be compensated. Worline v. ABB/Alstom Power Int. CE Servs., 272 Neb. 797, 725 N.W.2d 148 (2006).