Opinion ID: 11894
Heading Depth: 3
Heading Rank: 1

Heading: Maria de la Cruz

Text: In December 1992, Maria de la Cruz was working at the Whizard table when she reached out with her right hand to grab a bone from the conveyer belt. As she did, she felt something pop in her right wrist.4 Shortly thereafter, de la Cruz visited at least three doctors, seeking treatment and therapy. The records of these doctors indicate that de la Cruz suffered from a sudden injury to her right wrist.5 Nowhere in the medical records, however, does there appear to be a definitive diagnosis that de la Cruz's injury was a type of cumulative trauma disorder resulting from her use of the Whizard knife. The medical records indeed indicate that de la Cruz suffered injury to her right wrist, but her particular injury is not one that the evidence suggests is associated with cumulative trauma disorder. Dr. Royce C. Lewis, one of de la Cruz's examining doctors, noted in his referral letter to Dr. Tony Loggins that I 4 De la Cruz usually held the bones with her left hand because she operated the Whizard knife with her right hand. On this particular occasion, however, the bone had traveled past her, so she briefly switched the knife to her left hand and reached out with her right hand. 5 De la Cruz also complained of pain in her elbow, arm, shoulder, and back, but there is no diagnosis of such injuries anywhere in the medical records. really am not able to explain much from the standpoint [sic] etiology[6] of this woman's symptoms. She does not, I think, have a compression of the median nerve in the carpal tunnel, nor does she have any other localizing signs that I can demonstrate. Likewise, de la Cruz's third physician, Dr. Lloyd Garland, stated that tests have not been able to conform a true carpal tunnel syndrome. Dr. Garland did note that an MRI scan showed a torn triangular fibrocartilage with a small amount of fluid in the intercarpal compartment, and that there is obviously true pathology in the wrist. This evidence shows that de la Cruz suffered an injury, but it is insufficient to establish that the repetitive work at the Whizard table was the cause in fact of de la Cruz's injuries. De la Cruz presented no evidence suggesting that torn triangular fibrocartilage is an injury categorized as a cumulative trauma disorder. According to documents introduced into evidence, carpal tunnel syndrome and nerve compression are types of CTDs. Two of the doctors, however, concluded that de la Cruz does not suffer from either of these two injuries.7 Although one doctor noted at one point that de la Cruz's injury is work-related, that statement alone is not sufficient to establish causation. An expert opinion must rest in reasonable 6 Webster's Third New International Dictionary, Unabridged, defines etiology as a science or doctrine of causation or of the demonstration of causes. 7 An early diagnosis contained in the records indicates that it is possible that de la Cruz may have suffered from carpal tunnel syndrome or nerve compression. Later medical conclusions, however, more strongly suggest that she did not suffer from either of such disorders. medical probability to constitute evidence of causation, and [t]his rule applies whether the opinion is expressed in testimony or in a medical record. Burroughs, 907 S.W.2d at 500. Reasonable probability is determined by the substance and context of the medical opinion, and it does not turn on the use of a particular term or phrase. Id. The substance and context of the medical records of all three doctors indicate that de la Cruz does not suffer from an injury associated with repetitive trauma. She may well have suffered injury at work; the fact that she was injured at work, however, does not establish that such injury is cumulative trauma caused by Excel's breach of a duty regarding the Whizard knife. We do not suggest that all plaintiffs bringing negligence claims for cumulative trauma disorders must present medical or other expert testimony specifically stating that there is a direct causal link between a defendant's actions and a plaintiff's injury. There are certain risk factors present in the work-environment that are known to be associated with cumulative trauma disorder. Further, there are particular injuries collectively referred to as cumulative trauma disorders that are caused by a combination of these risk factors. If a plaintiff can establish that she was exposed to enough of the risk factors for a sufficiently long period of time, and that she suffers from a specific injury defined as a cumulative trauma disorder, then it is not, as a matter of law, necessary to present evidence directly stating that the work environment caused the injury. A reasonable jury could infer causation in these circumstances. But de la Cruz did not present such testimony in this case. Although she established that she was exposed to many risk factors during the period in which she operated the Whizard knife, her injury is not one associated with cumulative trauma. Furthermore, there is no evidence that cumulative trauma manifests itself in a sudden, sharp manner, as was the case here. The mere fact that de la Cruz presented evidence that she was exposed to risk factors known to be associated with cumulative trauma is insufficient to allow a jury to infer causation. See Beeson, 835 S.W.2d at 698 (noting that although a jury may draw inferences based upon a single fact situation, it may not stack an inference upon an inference). We affirm the district court's order granting Excel's motion for judgment as a matter of law regarding Maria de la Cruz.8