Court Opinion

ID: 9766229
Source: CourtListenerOpinion
Date Created: 2023-08-29 04:37:38.226525+00
Date Added: 2024-06-11T07:30:20.034662
License: Public Domain

John A. Fogleman, Justice, dissenting. Because of a failure of appellant to show causation by medical testimony, I would affirm the circuit court, in spite of the commission’s holding. How the doctor’s testimony can be said to lend substantial support to the commission’s finding is beyond my comprehension. The doctor’s admission that there- could be a connection between the decedent’s work and a heart attack was a reluctant and highly speculative one to say the least. His testimony on this point follows: Q. I say, in your opinion, is there a relationship between the degree of stress and strain from his occupation and the occurrence of his condition? A. Well,-- Q. I am referring to the condition of chronic bronchitis and pneumoconiosis, as well as his subsequent fatal heart attack. A. I think these would have to be separated. I couldn’t give you one answer for both. Q. Okay. Is there a definite relationship between a degree of stress and strain on his bronchitis and pneumoconiosis and his occupation? A. I would think so, yes. Q. And was there a relationship, assuming that he had a heart condition, was there a relationship between what he was called on to do in his occupation as to his condition of heart disease? Was there a relationship with the stress there? A. I don’t believe I could answer that, because I don’t know how much stress he had. Q. Could you better answer it, Doctor, if you heard some of these witnesses testify as to what his activities were at the gin? A. Possibly. Can I make a statement to sort of clarify some _ Q. Yes, go right ahead, Doctor. A. The coronary artery disease is a process that occurs over many years, and whether a person is working or whatever his activity, the ultimate cause of this or the gradual buildup of these plaques in the arteries are on a physiologic basis, not so much on his activity. Q. I know that, Doctor, but couldn’t a stress or trauma or sudden exertion cause one of these plaques to dislodge? A. Could precipitate an attack, yes. Q. So, then, Doctor, is it correct to state then, if he was engaged in the type of work that tended to create stress or exertion, that it could precipitate an attack? Is that correct? A. I am afraid I can’t answer that for sure. Q. Well, Doctor, I am not trying to make you say, Doctor, that he went to work that morning, and this work made him have a fatal heart attack. I am saying he was doing the type of work that there could be a causal relationship between this work and his heart attack. Do you agree with that? A. You’re saying there could be? Q. Yes, there could be. A. I could1 say there could be,1 yes. Q. Now, Doctor, in your opinion, then, did Mr. Kearby’s work at the gin contribute to his heart attack? A. I am afraid I can’t answer that. Q. Doctor, now you did state that this fluid in the chest, which was an indication of bronchitis and pneumoconiosis, would place or could place stress on the heart, is that correct? A. Yes. * * * Q. And you know that he had coronary artery disease? A. I don’t know myself, other than his record. Q. Well, his record shows that? A. Yes. Q. Which is a condition not necessarily caused by any particular activity, is that right? A. That is correct. Q. Physiological in nature? A. That is correct. Q. And referring to the death certificate, it is your opinion that he had a thrombosis of a coronary artery, one or more, is that right? A. That’s right. Q. Producing a' myocardial infarction, is that right? A. That’s true. Q. Or what we layman call a heart attack? A. Right. Q. And he died? A.. Right. Q. Do you know, beyond that, what caused his death, other than that he had coronary artery disease that resulted in-'a thrombosis that resulted in a heart attack. A. I do not. Q. You are not telling this Referee that, if indeed he had chronic bronchitis and pneumoconiosis, this caused his heart attack, are you? A. No. Q. You are not telling him that? A. No. Q. And you -are not telling the Referee that, if he did any work on November Seventeen or the day before or the week before, that that caused his heart attack? A. No. I agree that the referee’s finding is- not for consideration by the courts, and that there was no proper- basis for die referee to resort to his personal knowledge. He was correct, however, in his statement that there was no expert medical opinion to rely upon. With all due respect, I suggest that the majority of the commission, consciously or unconsciously,, did the same thing the referee did without saying so, Ú e., make a finding without medical testimony upon which to rely. I do not think that anyone could argue that the question posed on this appeal is not addressed peculiarly to the realm - of scientific knowledge or that it is the sort of determination that the Workmen’s Compensation Commission could make independently upon the basis of its own medical conclusions. See W. Shanhouse & Sons, Inc. v. Simms, 224 Ark. 86, 272 S. W. 2d 68. I was confident that this court had reached the extreme limits on uncertain medical testimony in heart cases in Bradley County v. Adams, 243 Ark. 487, 420 S. W. 2d 900. I adhere to the views I expressed there, but even if I did not, this evidence is far too conjectural to justify the commission’s finding of fact in a case where the question was peculiarly within the realm of scientific knowledge.2  Of course, mathematical certainty is not required to show a causal connection, but reasonable medical certainty should be. Without saying so, we recognized this principle in Georgia-Pacific Corporation v. Craig, 243 Ark. 538, 420 S. W. 2d 854. There we said that the doctor’s testimony was less positive than medical testimony in some cases, but pointed out that he stated his personal opinion that death resulted from the deceased’s long work hours on the day of the attack from which death ensued. We once recognized that there was a difference in a “possibility” and a “probability” in evaluating medical testimony as to causal connection. See Chapman v. C. Finkbeiner, Inc., 230 Ark. 655, 324 S. W. 2d 348. I submit that this is an appropriate distinction. We appear in this decision to be abandoning these appropriate distinctions. Professor Larson, in 2 Workmen’s Compensation Law 304 § 79.59 (1969), has this comment on the subject: * * * The increasing tendency to accept awards unsupported by medical testimony should not be allowed to obscure the basic necessity of establishing medical causation by expert testimony in all but- the simple and routine cases — and even in these casés such evidence is highly desirable and is part of any well-prepared presentation. I regret that this court is applying a rule followed by a decided minority of jurisdictions on the authority of an intermediate appellate court. In addition to authorities cited in my dissenting opinion in Bradley County v. Adams, supra, I should like to call attention to the following: Award reversed where only medical testimony was that causal connection was remotely possible, because medical evidence must show probability, not mere possibility. Stacey v. Carnegie-Illinois Steel Corp., 156 Ohio St. 205, 101 N. E. 2d 897 (1951). Where causal relationship between injury and alleged accident is not obvious, unequivocal medical testimony is necessary. Lingle v. Lingle Coal Co., 203 Pa. Super. 464, 201 A. 2d 279 (1964). Claimant must provide expert medical testimony to establish causation as a medical probability. Gammon v. Ebasco Corp., 74 N. M. 789, 399 P. 2d 279 (1965). Medical evidence that there was a possibility that fatal coronary occlusion was caused or aggravated by work exertion, held not to support an award. Southwestern Bell Telephone Company v. Gregory, 399 P. 2d 484 (Okla. 1964). With the uncertainty of the testimony of the witness, and his extreme reluctance to even admit a possibility of causal connection, I am unable to fathom the reasoning by which the majority finds substantial evidence to support this finding by a divided commission. I would affirm the circuit court’s judgment. Brown, J., joins in this dissent.  Emphasis mine.   In Bradley it could have been more easily said that the attack was caused by "accident” or unusual exertion and that the death soon thereafter was logically attributable than in this case.