Court Opinion

ID: 9862439
Source: CourtListenerOpinion
Date Created: 2023-09-25 01:10:35.45371+00
Date Added: 2024-06-11T11:25:33.327710
License: Public Domain

JUSTICE WOODWARD, dissenting: I respectfully dissent. The evidence does not support the Commission’s decision as to causal connection and for that reason a review of the facts and testimony of the doctors is most important. Both Dr. Lesch and Dr. Greenberg agree that decedent suffered myocardial infarction (MI) several days prior to January 22, 1985. No one, including the decedent, was aware that decedent had an MI prior to the events that occurred shortly after noon on January 22, 1985. On that morning decedent was at work and prepared batches of sausage from 6:15 a.m. to 10:30 a.m., lifting meat out of barrels with pitchforks and grinding the beef. Around 10 a.m., decedent’s right hand appeared bluish in color as witnessed by two people; however, he continued to do his regular work. At approximately 12:25 p.m., he began unloading a delivery consisting of cases of meat, each weighing between 50 to 75 pounds. While unloading the boxes of meat off the loading dock, decedent was exposed to a temperature of 20 degrees or less. Carrying a fifth or sixth case of meat, decedent tripped and fell forward into a table; decedent struck his head on a shelf, fell forward and “just laid there.” He was taken to the hospital emergency room where CPR was administered; post mortem medical records stated that decedent died of a rupture of his previously infarcted heart (MI). On the morning of January 22, 1985, Steve Magrini, another employee, confirmed that he and the decedent unloaded barrels weighing 150 pounds of different kinds of meat which were later converted into sausage. After several batches of sausage, decedent and Magrini began grinding beef. At approximately 12:15 p.m., the decedent went downstairs with Patrick Joslin, another employee. While working downstairs unloading boxes of meat with Joslin, the decedent tripped and struck his head as previously stated. Decedent’s widow, the claimant, stated that the decedent was 56 years old, stood approximately 5 feet 10 inches tall and weighed 228 pounds at the time of his death. He smoked half a pack of cigarettes a day for an unspecified number of years. Claimant and decedent owned a two-story building in Berwyn, Illinois, which had a frozen pipe problem during the weekend preceding her husband’s death. Decedent and his son went to the building to work on the plumbing on Monday, January 21, 1985, and possibly on the day before which was Sunday, January 20, 1985. On Monday, January 21, decedent left for the building at approximately 4 p.m. and returned home around 6:30 p.m. Doctors Greenberg and Lesch agree that the decedent had suffered an MI in the days preceding his death. They concurred that the rupture of the heart at the site of the MI caused his death. They each agreed that the proper care of a post-onset MI patient was hospitalization and rest. They further agreed that such treatment was to permit the MI to adequately scar over and thereby prevent a rupture. Dr. Lesch stated that the average hospital stay following an MI was between 8 and 15 days; that the patient should remain in bed for three days; on the fourth day, while still hospitalized, he will become ambulatory and his condition is monitored regularly. Dr. Lesch stated that during hospitalization the standard treatment now includes the patient engaging in a low level of exercise, one that is well below the maximum level that a patient might otherwise achieve. No lifting is allowed and the MI patients are limited to walking. From this testimony it is clear that if the decedent had been under a physician’s care immediately following the onset of the MI, he would have been hospitalized for a significant period of time and would not have been allowed to return to work until his condition had stabilized. In this case, the decedent continued to work in a physically demanding job following his MI, which both doctors agree had occurred a few days prior to the date of his death. Dr. Lesch admitted that he would not permit a post-MI patient to lift 50 to 100 pounds of boxes as decedent did immediately prior to his death. Dr. Lesch acknowledged that it would be inappropriate to send an MI patient back to work to perform lifting tasks within a two-week period following an MI. Dr. Lesch’s admissions concerning the proper treatment of an MI patient seriously undercut his opinion that no causal connection existed between decedent’s work activities and his death due to a ruptured MI. Dr. Lesch appears to want it both ways. On the one hand, he subscribes to a treatment modality which hospitalizes MI patients and permits them only minimal physical activity. On the other hand, he finds that decedent’s lifting of 50- to 100-pound boxes of meat and tripping and falling forward, following a morning of substantial lifting, played no part in the Mi’s rupture. Either exertion is a causative factor in the rupture of a myocardial infarction or it is not. Dr. Les-ch’ s statement as to his treatment of MI patients clearly admits that exertion is a critical factor relating to the rupture of a MI. Another example of Dr. Lesch’s equivocation came in his response to the question, “Could lifting 50- to 100-boxes aggravate a preexisting myocardial infarction?” Dr. Lesch answered that it may or may not, that he could prove neither and that he could not disagree with the statement that it may. It is well established that a finding of a causal relationship may be based on a medical expert’s opinion that an accident “could have” or “might have” caused an injury. Mason & Dixon Lines, Inc. v. Industrial Comm’n (1983), 99 Ill. 2d 174. Further vitiating Dr. Lesch’s opinion as to causation is his admission that if CPU can cause an MI rupture, then certainly a blow to the chest such as falling forward while carrying a heavy box can cause a rupture. Dr. Lesch’s admissions concerning the proper treatment of a myocardial infarction patient seriously impair the weight of his opinion that no causal connection existed between decedent’s work activities on January 28, 1985, and his death due to a ruptured myocardial infarction. Moreover, as Commissioner Tansor pointed out in his dissent, decedent was trader greater physical stress than normal on the day in question. Witness Notoli acknowledged that unloading delivery trucks was not one of decedent’s regular duties. In direct contrast to Dr. Lesch’s wavering testimony is that of Dr. Nathaniel Greenberg, board certified in internal medicine. Dr. Green-berg’s review of the relevant records revealed the following. The postmortem examination revealed a myocardial infarction that had existed for a week to 10 days, with a rupture of the heart at the site of the infarction. The postmortem examination also indicated that approximately a pint of blood escaped through the rupture into the pericardial sac, which caused the decedent’s death. Dr. Greenberg opined that the unloading and carrying of the heavy boxes of meat in the cold environment put an excessive strain on the previously infarcted heart causing the rupture which lead to decedent’s collapse and death. Dr. Greenberg explained that infarcted heart muscle is at its weakest between 5 to 12 days following the infarct. For this reason, individuals who have suffered from myocardial infarctions are urged to stay at rest during that critical period. Dr. Greenberg testified further that heavy work and cold environment “[are] just the sort of circumstance that leads to rupture.” During cross-examination, Dr. Greenberg described a rupture as a very abrupt event. If the rupture is not repaired in a matter of minutes, the rupture will be fatal. Dr. Greenberg further explained that a rupture was not a result of a pinhole or slight aperture that expands over time due to blood pressure. Such expansion, if any, would occur over a period of seconds or minutes, not hours or days. Moreover, only a half dozen heartbeats were required to fill up the pericardium with blood if an individual sustained a one-half-inch rupture. Dr. Greenberg disputed the employer’s position that the decedent’s death could have been caused by repair work on frozen pipes performed the Sunday preceding his death. Dr. Greenberg explained that the decedent’s repair work on the Sunday preceding his death was not the cause of his death because the decedent’s heart did not rupture at that time. As to what actually happened to decedent, Dr. Greenberg believed that the rupture occurred while he was carrying a box of meat. Decedent then collapsed and died within seconds. When asked if a rupture could occur absent effort, Dr. Greenberg replied that such occurrences have been known to happen, but the frequency is very low. Dr. Greenberg testified further that standard works on cardiology would illuminate the relationship between physical activity and post-myocardial infarction ruptures. Citing works by White, Friedberg and Hurt, Dr. Greenberg explained that exertion markedly increases the likelihood of rupture. The principles established in heart attack cases are applicable here. Where an employee suffers a heart attack which produces disability or death, the disability or death is compensable under the Act if the heart attack is work related. Wheelan Funeral Home v. Wiggins (1991), 208 Ill. App. 3d 832. A preexisting heart condition does not preclude an award under the Workers’ Compensation Act (111. Rev. Stat. 1985 48, par. 138.1 et seq). (Ludwig v. Industrial Comm’n (1989), 192 Ill. App. 3d 729.) For a heart attack to be compensable, an employee must prove that some act of employment was a causative factor, but it need not be the sole or even a principal causative factor. Northern Illinois Gas v. Industrial Comm’n (1986), 148 Ill. App. 3d 48. Based on Dr. Greenberg’s testimony that the decedent’s physical exertion in a cold environment caused the rupture of his MI and the admissions elicited from Dr. Lesch as to the proper treatment of myocardial infarction patients, we find that decedent’s work-related activity was a causative factor in decedent’s death and that the Commission’s decision is against the manifest weight of the evidence. Accordingly, we would reverse the judgment of the circuit court. LEWIS, J., joins in this dissent.