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NO.
COA05-1026
NORTH
CAROLINA COURT OF APPEALS
Filed:
20 June 2006
CYNTHIA ESTELLE BOOKER-DOUGLAS,
Administratrix of the Estate of
LEROY DOUGLAS, JR.,
Deceased
Employee,
Plaintiff,
v. North
Carolina Industrial Commission
I.C.
File No. 550114
J & S TRUCK SERVICE, INC.,
Employer,
LIBERTY MUTUAL INSURANCE COMPANY,
Carrier,
Defendants.
Appeal
by plaintiff from an opinion and award filed 26 May 2005 by the North Carolina
Industrial Commission. Heard in the
Court of Appeals 16 March 2006.
Law
Offices of Kathleen G. Sumner, by Kathleen G. Sumner, for plaintiff appellant.
Hedrick
Eatman Gardner & Kincheloe, L.L.P, by Tonya D. Davis and Jeffrey A. Doyle,
for defendant appellees.
McCULLOUGH,
Judge.
Cynthia
Booker-Douglas appeals from an opinion and award of the North Carolina
Industrial Commission denying her claim for death benefits following the death
of her husband. We affirm the
challenged opinion and award.
Facts
On
19 September 1985, decedent Leroy Douglas, Jr., was employed as a truck driver
for defendant J & S Truck Service.
On that particular date, Douglas was assigned to a long distance drive
with at least one other driver. While
Douglas was asleep in the passenger seat of the truck, the other driver lost
control of the vehicle. The ensuing
accident caused irreparable injury to Douglas’ spinal cord, and rendered him
quadriplegic. From the date of Douglas’
accident through 6 October 1994, he received temporary total disability
benefits. He thereafter received
permanent total disability benefits until his death. Douglas died on 6 April 2001 of sudden cardiac death, and the
autopsy revealed that he had hypertrophic heart disease, or an “enlarged
heart.”
In
August of 1991, Cynthia Booker-Douglas began working part-time as Douglas’
certified nursing assistant. In 1995,
when Douglas moved from High Point to Greensboro, Booker-Douglas became his
sole care-giver. She provided
twenty-four-hour care for Douglas, for which she was paid $1,517.40 per week by
J & S’ workers’ compensation carrier.
She and Douglas were married on 8 November 1997.
Following
Douglas’ death, Booker-Douglas filed a claim on behalf of his estate with the
North Carolina Industrial Commission.
Booker-Douglas’ claim alleged that Douglas’ 19 September 1985 spinal
cord injury caused the hypertrophic heart disease which resulted in his
death. Booker-Douglas sought death
benefits, and burial expenses.
At
a hearing before the Industrial Commission, J & S Truck Service and its
workers’ compensation carrier, Liberty Mutual Insurance (hereinafter
“defendants”), presented evidence tending to show that Douglas’ fatal hypertrophic
heart disease was not caused by his compensable quadriplegia. According to the testimony of Dr. Sewell
Dixon, an expert cardiovascular surgeon retained by defendants, hypertrophic
heart disease is an enlargement of the heart muscle, resulting from the heart
having to work harder to pump blood throughout the body. According to Dr. Dixon, it also can be
caused by cardiomyopathy, an abnormality in the muscle of the heart which
causes the rest of the heart to work harder to compensate.
Booker-Douglas
averred that Douglas’ heart was enlarged due to his quadriplegia; however, Dr.
Dixon testified that, with quadriplegics, physical inactivity generally causes
the heart to atrophy, because the body’s muscles require less oxygen, not more. Dr. Dixon stated that there are two ways
that quadriplegia could be related to sudden cardiac death. One way is if the death was the result of a
pulmonary embolism. A pulmonary
embolism is when a blood clot forms in the leg and travels up through the heart
and causes a sudden obstruction of blood flow to the lungs. Pulmonary embolisms are common in people who
are inactive because blood clots are more likely to form in areas with
decreased blood circulation, a common result of inactivity. However, the pathologist performing Douglas’
autopsy found no evidence of a pulmonary embolism.
According
to Dr. Dixon, another way quadriplegia could cause sudden cardiac death is if a
decedent had significant coronary artery disease. There is a high correlation between people who are obese, have
high blood pressure, smoke, and do not get enough exercise, and coronary artery
disease. However, there was no evidence
that Douglas had coronary heart disease.
Booker-Douglas
averred that Douglas had lung and heart problems prior to his death that went
undiagnosed and that these problems caused his enlarged heart. This averment was based on an autopsy that
revealed that Douglas had pulmonary congestion and edema, i.e., fluid in
the lungs. Booker-Douglas claimed that
fluid in Douglas’ lungs would have caused the heart to work harder, and
therefore become enlarged. When
examined on this point, Dr. Dixon explained that an enlarged heart is usually
the cause, not the result, of pulmonary edema.
Dr. Dixon testified that Douglas’ pulmonary congestion or edema was most
likely caused by the attempts to resuscitate Douglas.
A
Deputy Commissioner with the Industrial Commission denied Booker-Douglas’ claim
on 27 May 2004. On an appeal by
Booker-Douglas, the Full Commission (hereinafter “the Commission”) also denied
Booker-Douglas’ claim, based on a finding that Douglas died of a fatal
arrythmia due to an enlarged heart that was caused by cardiomyopathy, and that
there was no causal relationship between the cardiomyopathy and Douglas’
quadriplegia or his compensable injury.
Booker-Douglas
now appeals to this Court.
Standard
of Review
The
standard of review for an opinion and award of the North Carolina Industrial
Commission is “(1) whether any competent evidence in the record supports the
Commission’s findings of fact, and (2) whether such findings of fact support
the Commission’s conclusions of law.” Creel
v. Town of Dover, 126 N.C. App. 547, 552, 486 S.E.2d 478, 480 (1997). “The Commission’s findings of fact are
conclusive on appeal if supported by competent evidence, notwithstanding
evidence that might support a contrary finding.” Hobbs v. Clean Control Corp.,
154 N.C. App. 433, 435, 571 S.E.2d 860, 862 (2002). In determining the facts of a particular case, “the Commission is
the sole judge of the credibility of the witnesses and the weight accorded to
their testimony.” Effingham v.
Kroger Co., 149 N.C. App. 105, 109‑10, 561 S.E.2d 287, 291 (2002)
(citations omitted). “This Court
reviews the Commission’s conclusions of law de novo.” Deseth v. LensCrafters, Inc.,
160 N.C. App. 180, 184, 585 S.E.2d 264, 267 (2003).
Legal
Discussion
The
dispositive issue on appeal is whether the Commission erred by determining that
Douglas’ death of hypertrophic heart disease was not causally related to the
quadriplegia which resulted from his 1985 compensable injury. We discern no error in the Commission’s
determination.
Workers’
Compensation death benefits are governed, as follows, by section 97-38 of the
North Carolina General Statutes:
If death results proximately from a compensable injury or occupational disease . . . the employer shall pay or cause to be paid, subject to the provisions of other sections of this Article, weekly payments of compensation equal to sixty‑six and two‑thirds percent (66 2/3%) of the average weekly wages of the deceased employee at the time of the accident . . . and burial expenses . . . .
.
. . .
When
weekly payments have been made to an injured employee before his death, the
compensation to dependents shall begin from the date of the last of such
payments. Compensation payments due on account of death shall be paid for a
period of 400 weeks from the date of the death of the employee; provided,
however, after said 400‑week period in case of a widow or widower who is
unable to support herself or himself because of physical or mental disability
as of the date of death of the employee, compensation payments shall continue
during her or his lifetime or until remarriage . . . .
N.C.
Gen. Stat. §97-38 (2005). For death
benefits to be awarded under this statute, a compensable injury must be the
proximate cause of the employee’s death.
Id.
In
the instant case, there was evidence that Douglas’ compensable quadriplegia was
not the cause of his death from hypertrophic heart disease. Specifically, Dr. Dixon offered the
following deposition testimony:
[DEFENSE COUNSEL]: . . .[D]o you have an opinion to a
reasonable degree of medical certainty as to whether or not there’s any causal
relationship between Mr. Douglas’ enlarged heart and cardiomyopathy and his
quadriplegia?
[DR. DIXON]: I don’t see how you can construct a logical
relationship, if that answers the question properly, and I think it does. My – my medical opinion is that there’s not
a relationship between quadriplegia and a cardiomyopathy.
[DEFENSE COUNSEL]: And what is your opinion with respect
to whether or not there’s a causal relationship between quadriplegia and an
enlarged heart?
[DR. DIXON]: I don’t think there is a causal
relationship. The literature, in fact,
says just the reverse occurs, that the heart would be -- tend to be smaller,
not enlarged.
On
appeal, Booker-Douglas makes several arguments as to why, in her view, the
Commission could not rely upon Dr. Dixon’s testimony to find and conclude that
there was no causal nexus between Douglas’ quadriplegia and death and why the
Commission was compelled to find that there was such a causal nexus. We find these arguments unpersuasive.
1.
Booker-Douglas
first contends that Dr. Dixon’s testimony was insufficient to establish the
lack of a causal nexus between Douglas’ quadriplegia and his death of heart
disease because the doctor’s testimony was speculative under the standard
established by Holley v. ACTS, Inc., 357 N.C. 228, 581 S.E.2d 750
(2003). We disagree.
In
Holley, our Supreme Court held that an award of compensation in a case
involving a complex medical question must be premised upon an expert’s
non-speculative opinion that a work-related accident caused an employee’s
injury. Id. at 234, 581 S.E.2d
at 754. In such cases, if an expert’s
opinion as to causation is based on speculation, his opinion is not competent
evidence which supports a finding that an accident at work caused the
employee’s injury. Id.; see also Young v. Hickory Bus. Furn., 353
N.C. 227, 233, 538 S.E.2d 912, 916 (2000).
However, medical certainty from the expert is not required, and even if
an expert is unable to state with certainty that there is a nexus between an
event and an injury, his testimony relating the two is at least some evidence
of causation if there is additional evidence which establishes that the
expert’s testimony is more than conjecture.
See Singletary v. N.C. Baptist Hosp., __ N.C. App. __, __, 619
S.E.2d 888, 893‑94 (2005); Adams v. Metals USA, 168 N.C. App. 469,
482, 608 S.E.2d 357, 365, aff’d per curiam, 360 N.C. 54, 619 S.E.2d 495
(2005).
In
the instant case, our review of the record reveals that Dr. Dixon’s testimony
concerning causation was not speculative.
Rather, his opinion was unequivocal as to a lack of a causal link
between Douglas’ compensable quadriplegia and his death of heart disease. Further, Dr. Dixon stated that his opinion
was based on his survey of medical literature.
Accordingly, the doctor’s testimony was not incompetent under our
Supreme Court’s decision in Holley.
2.
Booker-Douglas
further contends that Dr. Dixon’s testimony could not be considered by the
Commission because he was paid a fee which was outside of the fee schedule
established by the Commission for payment to medical providers. This contention also lacks merit.
Booker-Douglas’
argument concerning Dr. Dixon’s fee is premised upon her interpretation of
sections 97-26(a) and (b), 97-90(a), and 97-91 of the North Carolina General
Statutes. Section 97-26 provides, in
pertinent part, as follows:
(a)
Fee Schedule. ‑‑ The Commission shall adopt a schedule of maximum
fees for medical compensation, except as provided in subsection (b) of this
section, and shall periodically review the schedule and make revisions pursuant
to the provisions of this Article.
The
fees adopted by the Commission in its schedule shall be adequate to ensure that
(i) injured workers are provided the standard of services and care intended by
this Chapter, (ii) providers are reimbursed reasonable fees for providing these
services, and (iii) medical costs are adequately contained.
.
. . .
(b)
Hospital Fees. ‑‑ Each hospital subject to the provisions of this
subsection shall be reimbursed the amount provided for in this subsection
unless it has agreed under contract with the insurer, managed care
organization, employer (or other payor obligated to reimburse for inpatient
hospital services rendered under this Chapter) to accept a different amount or
reimbursement methodology.
N.C.
Gen. Stat. §97-26 (2005). Section
97-90(a) states that
[f]ees for attorneys and
charges of health care providers for medical compensation . . . shall be
subject to the approval of the Commission; but no physician or hospital or
other medical facilities shall be entitled to collect fees from an employer or
insurance carrier until he has made the reports required by the Commission in
connection with the case.
N.C. Gen. Stat. §97-90(a), (b) (2005). Section 97-91 is merely a legislative instruction to the Commission that it should determine all workers’ compensation issues not settled by valid agreement of the parties.
Read
closely and in context, the foregoing provisions are not applicable to the fee
paid to Dr. Dixon. Sections 97-26 and
97-90(a) govern payment for “medical compensation,” which is defined by section
97-2(19) as
medical, surgical,
hospital, nursing, and rehabilitative services, and medicines, sick travel, and
other treatment, including medical and surgical supplies, as may reasonably be
required to effect a cure or give relief and for such additional time as, in
the judgment of the Commission, will tend to lessen the period of disability[.]
N.C.
Gen. Stat. §97-2(19) (2005). In the
instant case, Dr. Dixon was retained as an expert witness. He did not provide medical services to
Douglas. Expert witness fees are not
mentioned in section 97-26, 97-90(a), or 97-2(19). Further, it would be inappropriate to interpret these provisions
as being applicable to expert witness fees, given that the purpose of the
provisions is to ensure that injured employees receive medical treatment, see
N.C. Gen. Stat. §97-26(a), and given that, in some circumstances, medical
providers are permitted to negotiate a higher fee with a workers’ compensation
carrier, see N.C. Gen. Stat. §97-26(b).
Accordingly, Dr. Dixon’s testimony was not required to be excluded by
the Commission because of the fee paid to the doctor.
3.
Booker-Douglas
also challenges the Commission’s causation determination on the ground that the
Commission erroneously failed to apply a legal presumption that Douglas’ death
was caused by his compensable injury.
In support of her contention that such a presumption exists,
Booker-Douglas notes that a presumption of compensability arises “where the
evidence shows that death occurred while the decedent was within the course and
scope of employment, but the medical reason for death is not adduced.” Pickrell v. Motor Convoy, Inc., 322
N.C. 363, 369, 368 S.E.2d 582, 585‑86
(1988).
The
instant case does not involve a situation where an employee died within the
course and scope of his employment, and Booker-Douglas has cited no cases which
apply the presumption, from which she seeks to benefit, to circumstances
analogous to those presented in the instant case. Further, as already indicated, there was evidence from which the
Commission could find and conclude that Douglas’ death was not caused by his
quadriplegia and, therefore, was not causally related to his 1985 compensable
injury. Accordingly, even assuming arguendo
that Booker-Douglas was entitled to a presumption of compensability, the
Commission was not precluded from denying compensation in the instant case.
4.
Booker-Douglas
further asserts that the Commission should have applied a “chain of causation
test” to determine that Douglas’ death was caused by his work-related
quadriplegia. Booker-Douglas admits
that the cases applying this test involved employees who had committed suicide,
and she provides an entirely unprepossessing argument as to why this rule
should be applied in the instant case.
As already indicated, the Commission was not precluded from finding and
concluding that Douglas’ death was unrelated to the injuries he sustained in
the 1985 work-related accident.
5.
The
foregoing analysis makes it unnecessary for us to address Booker-Douglas’
claims regarding the level of benefits that she should receive.
The
assignments of error are overruled. The
Commission’s opinion and award is
Affirmed.
Judges
TYSON and LEVINSON concur.