Court Opinion

ID: 9961277
Source: CourtListenerOpinion
Date Created: 2024-04-18 15:10:50.895971+00
Date Added: 2024-06-11T08:20:31.714485
License: Public Domain

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        NOT TO BE PUBLISHED OPINION

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                                                 RENDERED: APRIL 18, 2024
                                                    NOT TO BE PUBLISHED

              Supreme Court of Kentucky
                              2023-SC-0288-WC

BLUELINX                                                          APPELLANT

                 ON APPEAL FROM COURT OF APPEALS
V.                        NO. 2022-CA-1027
               WORKERS’ COMPENSATION NO. WC-19-64871

ESTATE OF DAVID WILLIAMS; GREG                                    APPELLEES
HARVEY, ADMINISTRATIVE LAW
JUDGE; ELIJAH WILLIAMS, MINOR
CHILD; TRACEY BURNS, EXECUTRIX;
AND WORKERS’ COMPENSATION
BOARD

                 MEMORANDUM OPINION OF THE COURT

                                 AFFIRMING

      In this workers’ compensation case, David Williams underwent a work-

related surgical procedure on his ankle. Tragically, Williams passed away two

days later. After considering competing expert opinions, the Administrative

Law Judge (ALJ) concluded that the surgery proximately caused Williams’

sudden cardiac death and awarded death and dependent benefits. Bluelinx

argues on appeal that the ALJ’s determination that the surgery was the cause

of Williams’ death was not based on substantial evidence. Upon review, we

agree with the Court of Appeals and the Worker’s Compensation Board (Board)
that the ALJ’s Opinion properly considered the expert opinion offered on behalf

of Williams’ Estate.

                 FACTUAL AND PROCEDURAL BACKGROUND

      On October 25, 2019, fifty-year-old Williams underwent a left insertional

Achilles debridement and repair with excision of Haglund’s deformity, and a left

flexor hallucis longus transfer. The surgery proceeded with no complications,

and he was discharged the same day. Two days later, Williams’ experienced

difficulty breathing, and his son called 911 and performed CPR. EMS found

Williams unresponsive. EMS took Williams to the emergency room, where he

was pronounced dead. Williams’ medical records indicated he had multiple

and co-morbid health conditions including congestive heart failure, deep vein

thrombosis, diabetes, liver abscesses, obesity, bacteremia, hypertension, gout,

and cellulitis. An autopsy was not performed and the death certificate

identified the cause of death as “complications of congestive heart failure.”

      Tracey Burns filed an Application for Benefits on behalf of her deceased

brother. One of the contested issues, and the related issue in his appeal, was

whether the work-related surgery caused Williams’ death. 1 Dr. Wunder, a

physiatrist, and Dr. Corl, a cardiologist, provided expert medical opinions. Dr.

Wunder and Dr. Corl disagreed as to whether Williams had congestive heart

       1 There is no dispute that in September 2018 Williams sustained a work-

related left ankle injury and that the October 2019 surgery was medically reasonable
and necessary to treat the work injury.

                                          2
failure and the surgery caused Williams’ death. 2 Dr. Corl expressed that he did

not think the surgery had any role in Williams’ death. Dr. Corl was of the

opinion that there was no direct causal relationship between Williams’

      2 The ALJ’s opinion summarizes the expert evidence and states in part:

              Dr. Wunder reviewed Williams’ medical records. He opined that
      prior to the work injury Williams had congestive heart failure, DVT,
      diabetes, liver abscesses, obesity, bacteremia, hypertension, gout, and
      cellulitis. . . . Dr. Wunder reviewed and made note that Williams’
      preoperative cardiac condition was stable and well controlled. Dr.
      Wunder noted Williams’ two hospital stays in 2014. He had chest pain
      and was initially diagnosed with congestive heart failure. His symptoms
      recurred and a CT scan revealed the presence of liver abscesses and
      bacteremia. Williams spent over 40 days in the hospital due to the liver
      abscesses. Dr. Wunder opined Williams’ diabetes and congestive heart
      failure were controlled and appropriately treated prior to the surgery.
      However, he opined Williams’ cardiac condition put him at higher risk of
      complications or death during any surgical procedure.

             Dr. Wunder opined the surgery on October 25, 2019, caused
      Williams’ heart to fail which resulted in his death.

             Given the well-documented stable condition of Mr. Williams’
             congested heart failure, it is unlikely he would have
             succumbed to congestive heart failure on October 27, 2019,
             or a reasonable time thereafter, if he had not undergone the
             work-related surgery on October 25, 2019. As noted above,
             there is perioperative risk factor of death congestive heart
             failure.

               Dr. J.D. Corl . . . reviewed Williams’ medical history and treatment
      . . . . Dr. Corl acknowledged Williams’ history of hospitalization for
      cardiac symptoms in January 2014, and a multitude of diagnoses
      including congestive heart failure . . . . Dr. Corl specifically identified
      Williams’ cardiac risk factors as being: elevated blood pressure,
      hyperlipidemia, diabetes, morbid obesity, and sleep apnea. The
      diagnosis of congestive heart failure was something Dr. Corl disagreed
      with. He did acknowledge that if Williams had congestive heart failure it
      would be another comorbid condition. He pointed out Williams’ history
      of non-compliance with medical treatment and poorly controlled diabetes
      and blood pressure. Dr. Corl noted Williams weighed approximately 370
      pounds and was diabetic. He opined that all of those conditions
      statistically make sudden cardiac death more likely.
                                           3
successful/uncomplicated elective outpatient left ankle surgery on October 25,

2019, and his sudden cardiac death on October 27, 2019.

      Dr. Wunder’s supplemental report, rebutting Dr. Corl’s opinion, is the

last medical evidence entered into the record. This report, the basis of

Bluelinx’s argument on appeal, states in relevant part:

      I am surprised by the statements by Dr. Corl, as it is irrefutable
      that cardiac complications occur in those undergoing major,
      noncardiac surgery. In fact, cardiac complications are common
      after noncardiac surgery, and include sudden cardiac death. The
      single largest cause of perioperative death, I would agree with Dr.
      Corl, would be major adverse cardiac events. The number of
      patients undergoing noncardiac surgery is wide and is growing,
      and annually 500,000 to 900,000 of these patients experience
      perioperative cardiac death nonfatal myocardial infarction, or
      nonfatal cardiac arrest. Noncardiac surgery is associated with
      significant cardiac morbidity, mortality, and cost. Patients
      undergoing noncardiac surgery are at risk for major perioperative
      cardiac events. Perioperative myocardial infarction occurs primarily
      during the first three days after surgery, as was noted here.[3]
      Some theorize that patients are receiving narcotic therapy and may
      not experience cardiac symptoms during a myocardial infarction.
      On studies which have examined perioperative cardiac death,
      authors attributed the cause to myocardial infarction in 66 percent
      of the cases and to arrhythmia or heart failure in 34 percent of the
      cases. It is felt that surgery with associated trauma, anesthesia,
      analgesia, intubation, extubation, pain, bleeding, and anemia all
      initiate inflammatory, hypercoagulable stress and hypoxic states,
      that are associated with perioperative elevations in troponin levels
      and mortality. It is irrefutable that general anesthesia can initiate
      inflammatory and hypercoagulable states, and a sudden cardiac
      death syndrome. The stress of the surgery also involves increased
      levels of catecholamines and increased stress hormone levels.
      Perioperative hypoxia can also lead to myocardial ischemia. It is
      felt that 75 percent of deaths after noncardiac surgery are due to
      cardiovascular complications, as outlined by Dr. Corl, and I am
      certain he must be aware of this. I have enclosed a review article
      from the New England Journal of Medicine supporting that
      noncardiac surgery can precipitate complications such as death

      3 Emphasis added.

                                        4
      from cardiac causes myocardial infarction or injury, cardiac arrest,
      or congestive heart failure. The number of patients receiving
      noncardiac surgery is increasing worldwide. More than 10 million
      adults worldwide have a major cardiac complication in the first 30
      days alter noncardiac surgery. As the New England Journal of
      Medicine article points out, if perioperative death were considered
      as a separate category, it would rank as the third leading cause of
      death in the United States. I am surprised that Dr. Corl was not
      aware of that. Surgery initiates an inflammatory response, stress
      hypercoagulability activation of sympathetic nervous system, and
      hemodynamic compromise, all of which can trigger cardiac
      complications.

      I am really confused as to what point Dr. Corl is trying to make.
      He seems to be arguing that the claimant did not have
      congestive heart failure. He points out that no autopsy was
      done, and the cause of death was speculation. In addition to
      cardiac complications, sudden death can also be associated with
      deep venous thrombosis and pulmonary embolism, and Mr.
      Williams had a history of DVT already. Whichever complication
      his cause of death is attributed to, (congestive heart failure or
      pulmonary embolism), they occur at an increased frequency in
      the perioperative state. There is no way that Dr. Corl can make
      the statement that there was no direct causal relationship
      between Mr. Williams noncardiac, left ankle surgery on October
      25, 2019, and his death on October 27, 2019. Sudden cardiac
      death is a known complication of noncardiac surgery.

      The ALJ noted that Dr. Wunder supported his statements with an article

from the New England Journal of Medicine (NEJM) and that article details the

relationship between cardiac complications and a patient undergoing

noncardiac surgeries.

      Following the discussion of the evidence, the ALJ made his findings of

facts and conclusions of law. The ALJ stated in part:

            Dr. Corl’s deposition in this case is thorough and persuasive.
      The ALJ is very mindful of the temporal relationship between the
      surgery and Williams untimely death. Within two days of the
      surgery Williams died. . . . The law . . . dictates the undersigned
      decide this case based on the evidence from the medical experts.
      Dr. Wunder has offered a sound opinion regarding Williams’ death.
                                       5
However, Dr. Wunder is not a cardiologist and Dr. Corl is. Dr. Corl
thoughtfully explained why he did not believe Williams had
congestive heart failure. He explained the hospitalization in 2014,
and the role of Williams’ liver abscesses. Dr. Corl also explained
all the comorbidities Williams had that he believed contributed to
the sudden cardiac death. He was very speciﬁc that the surgery
played no role in Williams’ death. In the years after 2014, Williams
had no cardiac treatment and had normal cardiac functioning.
Post-operatively Williams’ heart was performing normally and he
was discharged home with normal cardiac performance.
        Dr. Wunder’s rebuttal report is also persuasive. In that report, Dr.
Wunder opined cardiac complications commonly occur in patients
who undergo noncardiac surgery. One of the things that occurs is
sudden cardiac death. He opined myocardial infarction following
surgery primarily occurs within three days of the procedure. He
also noted general anesthesia can cause inﬂammation and sudden
cardiac death. The report includes an article from the New
England Journal of Medicine that explores sudden cardiac death as
a consequence of noncardiac surgery.
       A reading of the totality of the evidence is important. The
undersigned interprets Dr. Wunder’s opinion to be that Williams
surgery resulted in a cardiac event that caused his death. Dr. Corl
also opines a cardiac event occurred that caused Williams death.
However, he is of the opinion that the surgery did not result in or
cause the cardiac event. Dr. Corl reasoned that events occur to all
persons who die from sudden cardiac death but that does not
mean that those events are causative.
       Here, the ALJ acknowledges Dr. Corl’s superior
qualiﬁcations on cardiac issues. However, Dr. Wunder has
responded to Dr. Corl’s opinion and cited evidence from the New
England Journal of Medicine. The question is whether the surgery
proximately caused the sudden cardiac death. Dr. Corl testified
about statistical probability based on the comorbid factors.
Williams had the same comorbid factors for years prior to the
surgical procedure. Two days after being placed under general
anesthesia he was found unresponsive and died. The ALJ agrees
with Dr. Corl that Williams did not have congestive heart failure
and that he suffered sudden cardiac death. However, the ALJ
finds Dr. Wunder’s opinion that the surgery caused the sudden
cardiac event persuasive. This is true in light of the facts that
Williams was not treating for congestive heart failure, did not have
pre-operative cardiac concerns or red flags. It is possible Williams
might have had a sudden cardiac event on October 27, 2019, if he
had not had surgery. It is also possible he could have had sudden
cardiac at any point for the years he carried the same
comorbidities described by Dr. Corl. However, Williams did not
                                  6
      have a sudden cardiac death until two days after the surgery. Dr.
      Wunder has offered sufficient evidence that noncardiac surgery is
      a known cause of sudden cardiac death. The facts coupled with
      Dr. Wunder’s opinion are persuasive to the ALJ and cause the ALJ
      to conclude Williams’ death by a sudden cardiac event was
      proximately caused by the work-related surgical procedure.

      The ALJ awarded death and dependent benefits per KRS 342.750(6) and

KRS 342.750(3). Bluelinx filed a Petition for Reconsideration, arguing that the

ALJ committed patent error as his decision was not supported by “well-

reasoned substantive evidence of an expert witness.” Bluelinx argued that the

NEJM article was inapplicable as it discussed the cardiac complications arising

from major non-cardiac surgery and not cardiac complications arising from

minor non-cardiac surgery. In its Order denying the petition, the ALJ stated in

pertinent part:

      It is important to understand what the ALJ found. The
      undersigned found Dr. Wunder’s opinion that the surgery caused a
      sudden cardiac event that resulted in Williams’ death most
      persuasive. In making that finding the ALJ relied on the literature
      cited by Dr. Wunder and his opinion that surgical procedures
      increase the risk of sudden cardiac death within the first three
      days after the procedure. Those opinions were considered along
      with the fact that Williams’ risk factors for sudden cardiac death
      existed for years and that the only variable in the days prior to his
      death was the surgical procedure. Dr. Wunder offered a sound
      opinion that non-cardiac surgery increases the risk of a cardiac
      event in the three days that follow the procedure. Dr. Corl
      identified the risk for sudden cardiac death as building risk,
      continuous risk. He indicated Williams had comorbidities for
      sudden cardiac death for years. Nonetheless it was not until two
      days after the work-related foot surgery that Williams died of
      sudden cardiac death. The timing of Williams death, coupled with
      Dr. Wunder’s opinion regarding the role of non-cardiac surgery
      causing sudden cardiac death was persuasive to the ALJ.

      Bluelinx appealed to the Workers’ Compensation Board, and the Board

affirmed the ALJ. The Board considered that no objection was filed to the
                                       7
introduction of Dr. Wunder’s reports or the NEJM article attached to the

November 21, 2021 report and concluded that Bluelinx was precluded from

challenge/objection to Dr. Wunder’s report and his opinions. Accordingly, the

Board further concluded that the ALJ enjoyed the discretion to consider the

opinions expressed by Dr. Wunder. The Board also found Bluelinx’s assertion

that the NEJM article was inapplicable unconvincing. The Board observed that

Bluelinx’s argument that Williams underwent minor non-cardiac surgery is

unsupported by the medical evidence in the record. The Board also reviewed

the NEJM article and concluded that Bluelinx’s assertion, an assertion based

upon Bluelinx’s counsel’s interpretation only, that it only relates to high-risk

surgery was unsupported. Consequently, the ALJ was free to infer the NEJM

article was applicable to the instant case since no contradictory opinions were

proffered by Bluelinx. The Board concluded that the NEJM article constituted

probative medical evidence concerning the cause of Williams’ death.

      Bluelinx appealed to the Court of Appeals. Bluelinx argued that the

Board erroneously concluded that the ALJ’s judgment was supported by

substantial evidence when the basis of the judgment – Dr. Wunder’s causation

opinion and the NEJM article – are devoid of any probative value; Bluelinx

asserted that the facts espoused by Dr. Wunder are unsupported or are

gleaned from the irrelevant NEJM article. The Court of Appeals affirmed the

Board.

                                        8
                                     ANALYSIS

      Bluelinx maintains its argument that the ALJ’s conclusion that the

surgery was the cause of Williams’ death was not based on substantial

evidence and the ALJ’s Opinion must be reversed. Bluelinx asserts that the

ALJ’s award was based on a misrepresentation of the scientific literature and

that the ALJ’s Opinion is not based upon reasonable medical probability.

Bluelinx argues that the ALJ, the Board and the Court of Appeals didn’t

scrutinize Dr. Wunder’s references to the NEJM article to determine that it was

actually applicable to this claim.

      The ALJ, as fact-finder, has sole authority to determine the weight,

credibility, substance, and inferences to be drawn from the evidence.

Paramount Foods, Inc. v. Burkhardt, 695 S.W.2d 418 (Ky. 1985). When

conflicting evidence is presented, the ALJ may choose whom and what to

believe. Pruitt v. Bugg Bros., 547 S.W.2d 123 (Ky. 1977). The ALJ has the right

to believe part of the evidence, and disbelieve other parts of the evidence

whether it came from the same witness or the same total proof. Caudill v.

Maloney’s Discount Stores, 560 S.W.2d 15, 16 (Ky. 1977). If the decision of the

ALJ is supported by any substantial evidence of probative value, it may not be

reversed on appeal. Special Fund v. Francis, 708 S.W.2d 641 (Ky. 1986);

Newberg v. Armour Food Co., 834 S.W.2d 172 (Ky. 1992). “Substantial

evidence means evidence of substance and relevant consequence having the

fitness to induce conviction in the minds of reasonable men.” Smyzer v. B. F.

Goodrich Chem. Co., 474 S.W.2d 367, 369 (Ky. 1971) (citation omitted).

                                        9
      Bluelinx argues that the ALJ relied upon evidence which was not of

probative value and upon which he could not draw inferences because he relied

on unsupported “facts” or statistics from Dr. Wunder and “scientific”

information which does not relate to this claim. Bluelinx asserts that the

opinions of the ALJ, the Board, and the Court of Appeals are unreasonable as

the “evidence” upon which they rely has no relevant consequence to this claim.

For example, Bluelinx points out that in the ALJ’s Order on Petition for

Reconsideration, the ALJ affirmed that he “relied on the literature cited by Dr.

Wunder and his opinion that surgical procedures increase the risk of sudden

cardiac death within three days after the procedure,” but argues that because

Dr. Wunder’s facts are not supported, i.e., he does not provide a reference for

his facts or statistics, there is no way to know whether these “facts” are

accurate.

      The Court of Appeals dealt with Bluelinx’s evolving argument in the same

manner as the Board. First, the Court of Appeals explained that

      To the extent Bluelinx claims that the ALJ was not permitted to
      rely on Dr. Wunder’s rebuttal opinion or the Journal article, it is
      notable that Bluelinx neither challenged the admissibility of this
      evidence in the proceedings before the ALJ nor raised the Board’s
      refusal to rule on the unpreserved claim in the matter at bar. As a
      general rule, “when the question is one properly within the
      province of medical experts, the [ALJ] is not justified in
      disregarding the medical evidence.” Kingery v. Sumitomo Electric
      Wiring, 481 S.W.3d 492, 496 (Ky. 2015) (quoting Mengel v.
      Hawaiian–Tropic Northwest and Central Distributors, Inc., 618
      S.W.2d 184, 187 (Ky. App. 1981)). Exceptions exist in cases
      involving observable causation, or if the medical opinion is the
      result of the claimant providing an inaccurate or misleading
      medical history. Id.; Cepero v. Fabricated Metals Corp., 132 S.W.3d
      839 (Ky. 2004). [The Court of Appeals] is unaware of a similar
      exception based solely on the expert’s failure to source his opinion,
                                        10
        and Bluelinx has cited no relevant authority in support. Here,
        whether the surgery was the proximate cause of Williams’ death
        two days later is clearly an issue to be resolved by medical experts,
        and there is no contention that Dr. Wonder was not aware of the
        precise surgical procedure Williams underwent or his relevant
        medical history. Accordingly, the ALJ was not, as Bluelinx asserts
        would be proper, permitted to wholly disregard Dr. Wunder’s
        opinion and accept Dr. Corl’s by default. Rather, the ALJ was
        required to weigh the evidence.

        We agree with the Board and the Court of Appeals. The ALJ had

discretion to consider both expert opinions when determining the facts of this

case.

        Finally, as to Bluelinx’s argument that when the Court of Appeals

concluded that the ALJ was able to rely on the opinion of Dr. Wunder because

the issue of causation is an issue to be resolved by medical experts, the Court

of Appeals missed Bluelinx’s point that almost every statement by Dr. Wunder

is inapplicable to the claim, we must conclude otherwise. The Court of Appeals

addressed Bluelinx’s challenge to the NEJM article’s relevance later in its

opinion. The Board had pointed out that Bluelinx had not preserved its

argument that Williams had undergone a minor surgery and therefore the

NEJM article was not relevant to this case. And the Court of Appeals explained

that while Bluelinx would have the appellate court evaluate the applicability of

the source material cited by the NEJM article, Williams would not have an

opportunity to respond to the argument that it did not constitute sufficient

evidence. Further, the Court of Appeals noted that it was not permitted to

consider matters not disclosed by the record. As the Board and Court of

Appeals have pointed out, Bluelinx did not seek redress of its complaints before

                                         11
the ALJ. Upon review of the record and the arguments, like the Board and the

Court of Appeals, we find no basis for concluding that the ALJ’s thorough

Opinion was not supported by substantial evidence.

                                  CONCLUSION

      For the foregoing reasons, the Court of Appeals’ opinion, which upheld

the Board’s decision in favor of the Appellees, is affirmed.

      All sitting. All concur.

COUNSEL FOR APPELLANT:

Mark Reynolds Bush
Samantha Steelman
Reminger Co., L.P.A.

COUNSEL FOR APPELLEES:

Michael Andrew Ryan
Lawrence & Associates

ADMINISTRATIVE LAW JUDGE:

Hon. Greg Harvey

WORKERS’ COMPENSATION BOARD:

Michael Wayne Alvey

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