*1
Joseph HENRY, Claimant-Appellant,
v. CORRECTION, Em-
DEPARTMENT OF Fund,
ployer, and Insurance Sure- State
ty, Defendants-Respondents.
No. 39039-2011. Idaho,
Supreme Court
Boise, November Term.
Jan. 2013.
Rehearing Denied March 2013. *2 having an by cardiologist
diagnosed a myocardial infarction posterolateral “acute right circumflex blockage to a due cardiologist marginal artery.” The obtuse a surgery place performed emergency later, days in the Ten stent occluded Henry event another cardiac Mr. suffered test, and undergoing a cardiac stress while bypass following day triple he underwent surgery. 2010, Henry complaint April Mr. filed a
In in which the Industrial Commission with attack that his heart on November contended 15, 2009, an industrial accident. constituted bypass triple He also contended the heart attack surgery was related to preex- his heart attack exacerbated his disorder, totally rendering him isting permanently disabled. evidentiary hearing, parties had an 24, 2011, referee, a and on June before findings of fact proposed referee issued failed Henry that Mr. had conclusions law con- employment caused or prove his Owen, ap- Nampa, argued for Richаrd S. heart attack. The Commis- tributed his pellant. findings adopted proposed the referee’s sion Special Deputy Attor- Bridget Vaughan, A. an that Mr. and conclusions and issued order Boise, General, argued respondents. ney an prove had failed to he suffered timely then industrial accident. EISMANN, Justice. appealed. appeal is an from decision of This finding that the claim- Industrial Commission II. attack prove that the heart ant failed Apply Did Industrial Commission at work was an industrial he suffered while Wrong Burden of Proof cardiologist accident because his could to Causation? plaque rupture determine whether triggered attack caused in this case the cause issue occurring before or after the claimant events undisput heart attack. It is arrived at We hold that the Commis- preexisting that he had medical conditions ed clearly errone- findings of fact are not sion’s likelihood and activities that increased the denying compеnsa- ous and affirm its order His that he would suffer heart attack. tion. certainly pre preexisting condition would under him from awarded
clude benefits “Compensa the worker’s law. I. employee’s work tion is recoverable where Background. Factual aggravates causes an ... accident (Mr. 2009, previous disease condition Joseph accelerates On November employee must estab shortly employee, after and an Henry) a heart attack suffered employment caused or contributed arriving employment with the lish his place his injury myocardial infarction.” Department his of Correction where Idaho —here 107 Ida Logging, v. Pine guard. was trans- Horner Ponderosa prison worked as a He (1985). 695 P.2d and was ho ported hospital ambulance Henry argues diagnosed sleep apnea that the Commission mis- was subse- by requiring prove prescribed him to applied quently C-Pap the law device. accident was the sole causе diagnosed hypercholesterolemia industrial he was -with preexisting 298; of his heart attack and with a total cholesterol level of As conditions were not a cause. will be prescribed medication for that condition in *3 sufficiency discussing the of the shown when 2006; and a he had cholesterol level of 328 on support the Commission’s conclu- evidence 21, At March 2008. the time of his heart sion, Henry’s Mr. is The assertion incorrect. attack, smoking cigarettes he had been for Henry require not that Mr. Commission did years about 38 and smoking was one and solely prove that his heart attack was caused packs day. one-half a primarily by employment. or even Rath- attack, On the of his heart Henry Mr. er, a it found that he “failed establish to atherosclerosis, preexisting had with three probability that his reasonable medical heart coronary different having arteries some de- triggered by attack was his activities at work gree of due to buildup plaquе. stenosis of 15,2009.” on November right coronary artery occluded, His but supported by it collaterals from
III. marginal system. the obtuse branch Findings Are the of Commission’s Fact right of coronary artery occlusion Supported by Substantial and causing any symptoms. not then Mr. Hen- Competent Evidence? ry’s heart attack occurred when the obtuse this a “When Court reviews deci marginal of coronary branch the circumflex Commission, sion of the it Industrial exercis artery became occluded. He was transferred law, questions es free over review but hospital, where he underwent a cardiac questions only determine reviews fact procedure angioplasty catheterization and an competent whether and substantial evidence procedure. days stent spent He two in the supports findings.” the Commission’s Eacret hospital fully and recovered from that heart Indus., 733, v. Clearwater Forest 136 Idaho A attack. stress test ten days conducted (2002). 735, 91, 40 P.3d 93 and Substantiаl after the attack right revealed the cor- competent evidence is relevant evidence that artery occlusion, onary he for which under- might accept support a mind a reasonable triple bypass surgery. went conclusion. Id. the Commission is Because fact, the finder of its conclusions on the Henry’s Mr. preexisting condition credibility weight and will evidence receiving is not bar “An benefits. em appeal be disturbed on unless are clear ployer employee takes an as it finds him or ly Id. not weigh erroneous. This Court does her; preexisting infirmity does elimi it evidence or consider whether would opportunity compen nate for worker’s have reached a different conclusion from the claim provided employment aggra sation presented. evidence Id. Whether the Com injury vated or accelerated the for which correctly applied mission the law to the facts sought.” Spivey v. Novartis is an issue of lаw over we which exercise free Inc., 29, 33, 788, Seed 137 Idaho 43 P.3d 792 State, Special v. review. Combes Indus. In (2002). “Aggravation preexisting aof condi- Fund, 430, 432, dem. Idaho 130 942 P.2d may injury tion constitute an if it is precip- (1997). 556 by an itated accident.” Painter v. Potlatch is undisputed Corp., to his heart 138 Idaho 63 P.3d 438 attack, (2003). Henry preexisting Mr. An “accident” “an is defined as unex- pected, conditions that increased his risk of a heart undesigned, mishap, and unlooked for attack, event, At time attack. of the heart Mr. or untoward connected with indus- Henry years age. try occurs, He had suffered in which it years, reasonably from chronic about 14 place for located as to time when occurred, causing injury.” 2004 he had been instructed to resume I.C. 72-102(18)(b). taking hypertension § that he prove medication “The claimant must prescribed in In 2001 degree probability had been 2003. to a reasonable of medical ing. me that he was late claimed Mr. tells which benefits are injury for that the work, job, and occurring in worried about his walked to an accident causally related yards he Stevens-McAtee could last employment.” fast course 325, 332, 179 Corp., Idaho cold weather. v. Potlatch (2008). 288, 295 P.3d By got time to the front Mr. building, he was sweat- door of the second Henry’s cardiologist was In this ing profusely and his co-workers immedi- regard- expert who testified only medical ately alright. if was asked He of the heart attack. causation ing the was taken to indicates break attack was caused the heart explained that room sat the next half down. Over plaque in atherosclerotic preexisting hour, profusely, to sweat he continued artery ruptured, which was the symptoms racing, heart was and these con- coronary thrombosis. inciting event of a *4 gradually got By tinually and worse. 7:00 to was whether respect causation issue with a.m., Henry notified boss that he Mr. causally to related plaque rupture was having a pretty was certain that he was Henry’s employment. Mr. transported heart attack and asked to be that mental cardiologist testified The hospital. to the exercise, stress, anxiety, and cold weather cardiologist responded by stating The that pressure go up, can cause blood temperature, day, time of the activi- “the artery, hemodynamic on the and puts stress under, ty level and mental stress hemodynamic probably stress and that “the quite likely I think it is that those factors are re- factors that hormonal related other myocardial contributed to his infarction that during and hormones stress lease of certain day.” plaque an anxiety can cause atherosclerotic cardiologist hearing, deposition, Hen- ex- Prior to the Mr. his later rupture.” stress, cardiologist anxiety, physical ry’s attorney plained that mental sent letter exertion, specified being conditions and weather were asking whether certain cold Henry’s respect trigger could a heart at- Mr. circumstanсes that that existed with at- attack could employment have caused his heart tack. He stated that heart could stress, triggers happened included mental without such and tack. conditions exertion, that anxiety, physical being and cold that one could never be certain these However, attorney trigger. described them in circumstances were the weather. The explained only “you he that make the the letter follows: that because the heart attack oc- conclusion Henry for work on the Mr. arrived day, curred on that and those activities were 15, 2009, very early, morning of November time, occurring at that were those events Henry tells it 6:30 a.m. Mr. me that about occurring, that has to be some contri- there freezing, windy at below dark out day.” that attack on that He bution to prison south of Boise. the state triggers added that were the sole Henry got to work and out late attack, opinion but in his cause of the heart quickly car walked to the first of his contributors which were re- were 50% building Henry ap- tells which Mr. me is causing the sponsible for heart attack. yo yards away proximately [sic] By parking from the lot. the time Mr. Respondents’ then asked car- counsel Henry got the first administration build- diologist to consider factors that were occur- very good, had a ing he did not feel kind of ring prior to Mr. arrival work. malaise, feeling spe- but no general They that Mr. was aware he was symptoms. cific running leaving late before his home Cald- well, getting went administration that he was anxious about time, building parked his car out- where it nice and warm and work on that weather, and through process night re- all in the cold that he through went check side by ear left for work without quired employer. He then went started the attorney up it to warm first. The allowing outside and walked as fast as back thought yards cardiologist that to a second build- asked whether the could another may afterwards, triggered factors those didn’t rеlate to me those events____ morning. attack of the heart onset cardiologist answered those factors pin you So I can’t that down to in a considered, but he have been could should certainty preceding in the— —earlier trig- not tell the heart attack was whether preceding events earlier what the circumstances that gered them or that, contributed to percent. Very what arrived at occurred after give you discrete, difficult me to for He testified as follows: scientifically based answer.
So is there time when he’s been ex- described, posed to the scenario For to ask me what’s the contribu- up leading helping prepare to or morning getting tion of the cold in the car occlusion, it, is this a contributor and the drive to Boise me is for too fine a really points into fine becomes are so point give you to be so accurate to scientifically difficult to factual or based just on what contribution —I can’t you just distinguish can’t that exact give that. degree of contribution. interpreted The Commission the cardiolo- going don’t know what’s on We inside gist’s testimony to identify able thatWas a small —had blockage occurred during rupture that time when he symptoms, because there was an onset of *5 but car? got happening first in the Was it as identify unable to the plaque whether he driving? split- was Was it little bits of rupture blockage that caused the occurred as ting cap? of that atherosclerotic Were a result of prior stressors to Mr. Henry things beginning develop back then? arriving at or work after he had arrived at certainty you With scientific can’t work. The Commission stated: question. say answer that You can’t that emerges The that quoted sense from the you that happening. know that was What testimony blockage that of artery the scientifically you say can is when the onset immediately leads to symptoms typically occurred, symptoms artery of the at that myocardial associated with a infarction. close, began time did and the heart attack Therefore, can one determine when the at that time. blockage by looking occurred to the onset say you along day But can the or However, symptomatology. of car- [the day stressing the before what was the his diologist] circumspect was much more system, this —when was the in- identifying about the event or events thing going evitable that this made blockage the occurrence of the inev- it, think, happen? You have to I look at impossible, words, itable. It is in other major and minor stressors stressors. say the inciting whether that led events know, you And if at things, you look the plaque rupture prior the occurred car, wheel, steering cold the cold the driv- premises, Claimant’s arrival on the or sub- traffic, ing through were those stressors sequent thereto. contributing? likely that They could been, been, you know, should Commission, “The Industrial as you considered. But far can factfinder, the —hоw free to determine the get dissect that down? I That’s where weight given testimony be to the of a dissecting those, you trouble of down all Eacret, expert.” 136 Idaho at know, begin minute events that to occur. 40 P.3d at deciding weight 95. “When the you’d And I that go given opinion, can’t fine for be an expert the Commission discerning like me to can certainly expert’s which was the the consider whether one, car, wheel, steering cold reasoning was it the methodology and has been suffi traffic, getting Certainly ciently out? and or disclosed whether perception, my history his at the time of into all takes consideration relevant him, taking during the time it and facts.” Id. The Commission found that the then subsequently going depth cardiologist into more opine “was unable to which of In had the post-arrival] Mr. at work or [pre-arrival these ulti proving that the event which burden it that made inevitable activities/events blockage artery mately caused the the November 15 suffer Claimant would The Commission found that work related. when he thrombosis did.” failed so because the cardiolo had to do that Commission argues rupture— gist plaque that could state cardiologist clear erred because ultimately caused block event testimony artery unequivocal age at work. The Commission —occurred arrival blockage after occurred analysis stating: concluded its Henry points to analysis, cardiologist’s] final [the In the artery think that closed testimony: “I don’t is insufficient to establish morning in the car that getting he was post-arrival were re- Claimant’s from Caldwell to Boise. he drove or when causing contributing for or sponsible walking up those think closed when it in- myocardial occurrence of Claimant’s stairs, very suddenly.” it hit him How- just easily sup- farction. The evidence ever, not when the issue of causation is something ports the it was proposition that is when the became blocked. happened prior to arrival Claimant’s ultimately rupture occurrеd that his heart attack at the worksite made blockage. caused the it inevitable and caused to occur when it did. how stated that opinion, the Commission its (Citation omitted.) to the record was “ascertain- pivotal issue of causation determined that Mr. Commission actually oc- ment when the thrombosis prove failed to suffered “if the circumflex curred” because An accident is industrial accident. industrial to Claimant’s arrival blockage occurred undesigned, unexpected, as “an defined impossible to associate workplace, at the it is event, mishap, con- unlooked untoward activities.” post-arrival with his event occurs, industry nected with the in which then discussed evidence Commission *6 reasonably to and which can be located as symp- an of suggested that it stated onset occurred, place when and it caus- time Henry’s toms at work.1 prior to Mr. arrival 72-102(18)(b). ing injury.” § an I.C. The Henry Mr. that the Commission contends rupture certainly unexpected, “an plaque by relying upon such to dis- erred evidence mishap, un- undesigned, and unlooked for to cardiologist’s count when the certainly it an toward event” and caused the occurred. occlusion right injury blockage of the circumflex —the above, As the issue of causation stated However, marginal artery. be an obtuse to hinges upon ruptured, not plaque when the accident, the must one industrial accident ultimately occurred. Al- the occlusion any “arising of and in course out the of though is the Commission stated “there by com- employment covered the worker’s testimony suggest 72-102(18)(a). also of which would record § pensation law.” “The I.C. to symptomatology prior an Claim- onset of of been to refer to the words ‘out held not premises,” ant’s on the it did base arrival the the origin and cause of accident and upon testimony. After dis- time, its decision such ‘in to words the course of refer the stated, it, cussing the Commission “Consider- placе, and the circumstances under which the evidence, ing totality of even the fact Loving the the accident occurred.” Dinius v. Care More, Inc., post-arrival of Claimant’s worsened condition Idaho 990 P.2d and (1999). injurious ultimately 738, ultimately the fails to establish that The Commission ultimately blockage Henry the event which caused that Mr. failed determined of prove plaque rupture at the arose out occurred after Claimant arrived work- the added.) employment. in the (Emphasis site.” course feeling Henry when he came to he at that he well 1. Mr. testified arrived paid he work an unnamed coworker had stated that should have work that did look Another coworker testified feeling. well. to how he was attention attack, Henry that after the heart Mr. told him driving? split- he “has failed to establish to a Was little concluded that bits probability ting that his heart cap? of that atherosclerotic reasonable Were triggered by his activities at work things beginning develop attack was back then? finding in that on 2009.” Its November any certainty With scientific can’t clearly regard is not erroneous. question. say answer that You can’t happening. know that that was cardiologist What play tries to The dissent Henry’s scientifically you say can testimony that cardiolo- is when onset provide Mr. occurred, symptoms at that gist provide. The issue this was unable close, began occurred. time did and the heart attack case is not when the heart attack injury, The heart attack is the and for Mr. that time. to be entitled to there cardiologist say What did not after must an industrial accident that have been being informed of the stressors that existed injury. caused that the accident Henry’s prior signif- to Mr. arrival at is work rupture
would of ath- have to been the cardiologist icant. The did not exclude as a cardiologist plaque. erosclerotic As the tes- possible Henry’s cause of heart attack plaque rup- tified: “When atherosclеrotic prior stressors that were occurring tures, inciting coronary event of a Henry’s arrival at work. He did not weather, anxiety, physi- So cold thrombosis. long state that too those stressors occurred activity, you place cal have all milieu in symptoms precip- before the onset of to have coronary cause a thrombosis to occur.” rupture. not, itated the He did coagula- A is the “intravascular thrombosis dissent, prior asserted reaffirm his any part tion of of the circulato- the blood opinion that the cause of the heart attack was ry system,” http://dictionary.reference.com/ say work-related. All he could (accessed: January browse/thrombosis certainty was that scientific the heart attack 2013). cardiologist testify The did not as to occurred after at work. arrived long plaque rupture it would how after hearing required officer was not to form to have taken for blood clot Henry’s determinе the cause of Mr. heart extent that it blocked the required prove attack. Mr. cardiologist’s opinion as to the cause producing expert cause upon the tem- the heart attack was based showing plaque rupture that the was an in- poral relationship known between stressors cardiologist dustrial accident. His did not so attack. the occurrence As testify after he was informed of the stressors attack, of the heart he testified cause that existed to Mr. arrival at “you only make the conclusion that Although willing dissent to read *7 because the heart attack occurred on that and opinions the lines infer actu- between day, occurring and at those ally cardiologist, hearing rendered time, occurring, and those events were required officer was not to do so. that there has be some contribution to that day.” heart attack on When cardiol- IV. ogist that some of the stressors was informed Conclusion. prior Henry’s occurred to Mr. identified and whether arrival at work was asked We affirm of the Com- the order Industrial attack, triggered could have the heart he said mission, respondents costs on and we award question he could answer that with appeal. certainty. say scientific All that he could is attack that the heart occurred after Mr. Hen- and Justices W. JONES HORTON concur. ry testimony at work. His was as arrived JONES, Justice, dissenting. J. follows: I going don’t know what’s on inside dissent from the Court’s two We disregard- Was that a small reasons —the Commission erred in —had ing testimony Dr. Par- plaque rupture during that time when he the uncontradicted happening Henry’s the car? as to got first Was it ent the cause heart attack He testified heart attack. issue of after the findings on the and the Commission’s chest experienced Dr. Parent clearly erroneous. are causation trouble — precipitate the stress test: pain during factors that to the testified — precip- factors how those a heart attack When the stress had trouble for sure. He while he was Henry’s heart attack itated exer- performed, he had reduced test was stepped referee The Commission’s discomfort capacity, the onset of chest cise dabbled in fact-finder and role as out of her symptoms, he had EKG abnormalities diagnosis. threatening to that he was told us ease, worker’s In the usual under stress con- future heart attacks generally comes down issue ditions, tachy- the causation had ventricular and that he testifying that to the the more fied on the issue and determine and the a battle cardiologist, Dr. Commission case. contrary. employer/surety’s reliable. That Here, must experts which Parent, parse of causation was In those injury —the only expert who testi- expert’s through who did not expert claimant’s situations, work-related, testified that testimony the evidence happen in testifying Henry’s expert ing recent And I believe because he beсame tional tacks, cardia, heartbeat, rhythm that he was which is heart ongoing ischemia. very rapid blood often :fc attacks, that chest an unstable life-threaten- provoked so anxious and so [*] running previous heart at- [*] pain patients pressure, he very occurred emo- with fast of self-inflict- in distress. was sort when Hen- precipitated heart attack was ed, anxiety you might say, from his state. climbing a of stairs at work. ry was set happened to anything new had Not ‘cause surety pro- employer nor the Neither the coronary arteries. opin- Dr. Parent’s expert duced an to contest Rather, testimony. the Commission’s ion foregoing, Dr. Parent As a result of advocate, discrediting played referee devil’s surgery, bypass immediate recommended but then opinion for lack of foundation day. performed that same posit relying of his on snatches Henry “is one of Dr. Parent testified that likely precipitated that the heart attack was people I’vе ever treated. the most anxious that occurred events anxiety major contribu- I think that And so, doing the referee arrival at work. recovery, func- ongoing symptoms, tor to transgressed from a finder appears to said that tionality patient.” in a Dr. Parent diagnosti- fact to somewhat of medical prison significant was a Henry’s work at the cian. anxiety. ex- source of his that Dr. Parent was It should be observed deposition change occurred at Dr. Parent’s at an gun, glances medical hired who not a time that respect and then injured worker’s medical records to work: released to return diagnosis. Dr. Parent is provides an erudite Q. [Henry’s Okay. The reason counsel] cardiologist who has been a board certified if said when he was ask is Mr. began in Boise since 1988. He practicing had a lot of released to return to work he treating Henry on November trouble, him to be around scared attack, treat- and continued date of his *8 thought that his and he blood inmates Thus, deposition when his ment thereafter. affected, I if pressure and wondered was 4, 2011, quite was taken on March of his reaction to you recollection Henry and the factors that familiar with returning to work? Henry’s cardiac health. affected your I concur with Parent] A. would [Dr. Parent’s thing that stands out Dr. One returning to work. about his statements significant role deposition high anxiety, yes. It caused him Henry’s anxiety played plays attack, Henry’s heart op- As to the cause of well-being. Dr. Parent had an cardiac predi- important to consider Dr. Parent’s during portunity to observe this first-hand testimony: deposition days conducted ten cate course of a stress test constricted, Q. [Henry’s right, All counsel] sir. veins are so it’s more difficult myself that, You’ve indicated in letters to and to for the heart to do and that causes pressure go up. counsel late to blood Am right I work, hurrying in from on a warm that? outside; building phys- to the cold that the pressure goes up A. The blood bеcause of triggered
ical stress of that exercise stress, anxiety and not because of—not as heart attack. you had stated. Doctor, you explain, Can effect of cold Q. Okay. efficiency of a weather on the heart and A. The causality there anxiety would be thinking, how that I’m works? What Doc- workload, pressure increased blood tor, always is we hear in the winter of rising. people shoveling who are out snow and Q. right. All you believe, Do continue to attacks, have heart I wondering and was if Parent, Dr. Henry’s physical ex- help why. could us understand against setting ertion of his underlying A very We know that arteries are personality was the factor and the cause of dynamic in their size and under certain his heart the morning attack on of Novem- stimuli will constrict. And cold ber 15 of 2009? anxiety weather and cause constriction of A. believe it was factor. size so it narrows the channel. added). (emphasis words, In other rupture stress, anxiety, We also knоw that mental plaque atherosclerotic can result from a exercise, weather, pressure and cold blood physical (narrowing cause relat- goes up, puts hemodynamic which stress ed anxiety to cold weather and and conse- artery, on the oxy- increases the need for quent pressure increase blood puts gen to the heart muscle. So at the same greater artery, stress on the which can dis- augmented, time flow needs to be there’s lodge plaque) or (anxiety-re- chemical cause now a reduction of flow because of con- lated release of certain hormones that can striction. rupture plaque), aor combination of the We hemodynamic also know that physical and causal chemical factors. Dr. probably stress other that are factors opined Parent that these precipitated factors hormonal related to release certain hor- Henry’s began heart attack climbing during mones stress stairs, which was somewhat over 30 min- plaque cause an rupture. atherosclerotic utes after he arrived at Q. sorry? I’m The referee discounted Dr. Parent’s medi- A. An plaque rupture. atherosclerotic opinion solely cal based on her conclusion Q. you. Thank that Dr. Parent had failed to consider Hen- A. ry’s When an atherosclerotic rup- arriving at work on tures, inciting that is the event a coro- November 15 and was unaware nary anxiety, thrombosis. So upon cold unwell According arrival work. weather, physical activity, you referee, all Dr. “[b]ecause Parent failed to place evidence, the milieu coronary cause a consider opinion lacked However, thrombosis to occur. foundation.” clearly the referee deposition failed to read Dr. Parent’s careful- Q. Okay. if I can Let me see summarize ly. When Dr. Parent was asked about fac- understand, way thаt in a that I Doctor. tors that contributed to heart attack please And if wrong. correct me I’m on November ex- is, way I if understand it change occurred: weather, anxious or cold the veins actu- ally Q. constrict because [Respondents’ some of the cold counsel] And do weather and the anxious condition. have an toas the extent of the *9 contribution? anxiety and cold weather also re- quires Well, body’s telling the A. I [Dr. to stated on Parent] —the blood, think, pump before, supply percent faster to more but the letters I that 50 think, it, at I have to look pen? You percent 50a these —there’s that likelihood minor stressors. major stressors and day in of that causality of the attack. know, the heart triggering And, things, you the cold I at look if wheel, driving car, steering respect to the cold opinion your Q. Would traffic, were those stressors through the slightly different change under causation They likely could contributing? that were scenario, facts established if the factual been, know, been, you should have from Caldwell Henry commuted that you you how far can But can ques- considered. work; morning in on the that to his get in That’s where I that down? running late dissect he was was aware tion he those, you dissecting all down trouble reporting for prior to in still Caldwell while occur, know, begin that events facility; minute that he the correctional work he had not been that a vehicle entered added). then Dr. Parent was (emphasis outside, parked that had been up, warmed asked: to the same exposed presumably was your Q. counsel] Would [Respondents’ Caldwell, or close in temperatures affected evidence opinion at all be Boise, route to and on temperatures, same to be ill when he suggested appeared he vehicle, he and was aware in a although station, the first through cheek-in went commute, you do during that late was coming day after building he entered that may caused fаctors those think lot? parking from the myocardial infarction that onset of a nonmedical I think [Dr. Parent] A. morning? looking who’s late person at someone easily might and who’s under stress
work bending a stick and somebody’s little bit like health. judgment A. It’s a on make a breaking point going person is the who dis- saying, an anxious crack, pop, you it hear it you You hear occur? his sleeve and plays that on fi- you see some splinters, you see some that in him. see thing bers, breaks. and then added). So, Dr. Parent was filled (emphasis exposed he’s been a time when So is there allegedly that oc- the activities in as to all described, is that that to the scenario at work and of arrived curred before prepare ar- helping this leading up to or feelings relating of unwellness all evidence occlusion, this a contributor tery for this prior to the heart may have existed that it, really points into fine that becomes that Dr. Parent evalu- apparent attack. It is scientifically to be factual or are so difficult “major stressors considered ated what he just distinguish can’t that based considering pre- and minor stressors” degree contribution. exact that he considered the arrival activities and going on inside don’t know what’s “nonmedi- We made unwellness observations had a small Was giving critical persons cal” he rupture during that time when testimony: got happening car? Was it first closed when “I don’t think that was split- driving? it little bits of he was Was morning or getting the ear cap? Were ting of that atherosclerotic to Boise. he drove from Caldwell beginning develop back then? things walking up think it closed when stairs, very suddenly.” it hit him
those
So,
factors that
considering all of the
along
day even
you say
But can
taken
thought
have been
sys-
the referee
should
day
stressing his
before what was
account,
into
did take them
Dr. Parent
tem,
the inevit-
into
when was this —when was
reaffirming
opinion.2
hap-
account
thing
going
able
began climbing the
precipitated when hе
Parent’s
2. The referee also found Dr.
stairs,
required to "rule out”
was not
Dr. Parent
"because he failed to rule
insufficient and flawed
Rather,
required
forming
any particular factors.
morning
early
out the
activities.’’
Henry’s history,
that af-
the factors
to consider
stating
heart attack
*10
might
helpful
ably
if
have been
someone had
his arrival at the workplace.
by
Dr. Parent
he meant
the
asked
what
Specifically, Dr. Parent considered Claim-
artery closing
it was the constric-
ant’s exertional activities after he arrived
—whether
artery
narrowing
or
that
tion
of the
resulted
at
including walking
yards
work
from
rupture
in a
whether it was
his car to a security checkpoint, walking
occluding
plaque actually
the
the
circumflex
yards
another 25
into the Administration
However,
neither
the referee nor
Building, waiting
belongings
while his
were
expertise
Court has
this
the medical
sec-
inspected, walking through the Adminis-
ond-guess
opinion.
Dr. Parent’s
Presum-
Building
tration
passed
where he
through
ably,
cardiologist
a board-certified
is aware
security checkpoint,
another
walking
for
typically
rupture
of the time it
takes
yards
as fast as he could
until he
in an
it was
result
occlusion and
his
reached Unit
he climbed
stairs.
suddenly.
it occurred
Dr. Parent
that
However,
36.
is also
certainly
major
there
aware of the
stressors affect-
ing Henry, particularly
high anxiety,
record
suggest
the
which would
an onset of
workplace
anxiety Henry’s
environment
symptomatology prior to Claimant’s arrival
him,
anxiety
play
caused
the role
premises.
on the
regard,
In this
recall
causing plaque
and the
rupture,
confluence
that Mr. Kimmel
that
testified
Claimant
began
climbing
these factors as
the
reported feeling
during
unwell
his drive to
any
at
stairs
work on November 15.3 In
prison
and a eoworker commented that
event,
intermingles plaque rup-
the referee
he looked unwell on arrival at the Adminis-
ture, blockage,
and thrombosis
her find-
Further,
Building.
tration
Dr. Parent did
ings.
example:
For
pre-work
not consider Claimant’s
exertion-
question
In addressing
34.
of causa-
activities,
al
although
agreed they
tion in
pivotal
this
issue is ascer-
likely
fact,
contributory.
Dr. Parent
actually
tainment of when the thrombosis
quantified
neither
any
discounted nor
oth-
Obviously,
occurred.
if the circumflex ar-
morning’s
er of the
terms of
tery
blockage
occurred
Claimant’s
their contribution
closure of the
workplace,
impossible
arrival at the
it is
point
affected
at that
time. At
post-arrival
associate that
event with
juncture,
implied
one
Dr.
even
Parent
that
blockage
activities. Since it
is
activities from the
before could have
produces
symptomatology, it
put processes in
motion
made Claim-
possible,
should be
Dr. Parent
has not-
ant’s heart attack on November 15 inevit-
ed,
blockage
to ascertain
oc-
able.
curred, by determining
sympto-
when the
matology
Considering
totality
37.
began.
of the evi-
dence,
even the fact
Claimant’s wors-
suрposed
35. Dr. Parent has
post-arrival
ultimately
ened
condition
fails
blockage
Claimant
occurred after
arrived
injurious
to establish that the
event
premises,
on the
and there
evidence in
ultimately
proposition
blockage
support
record to
caused the
occurred
Claimant’s symptoms worsened consider-
after Claimant
arrived
the worksite.
health,
Henry's
anxiety played,
fected
and the activities
3. The
role
stress and
Henry engaged
opposed
temperature,
heightened
in both before and after
to the cold
arriving
by
finding
at work.
did so
Dr. Parent
in reaffirm-
the referee’s
that "the evidence is
ing
opinion during
taking
his initial
of his
insufficient to
Claimant
establish that
was actual-
deposition.
major
ly exposed
He considered
and minor
risk of vasoconstriction due to
apparently
temperatures.”
might question
stressors and
ruled out minor
cold
stres-
One
events,"
may
qualifications
sors that
"minute
been
of the referee to make
but, nevertheless,
reaching
expe-
finding
finding
his determination. Based on his
such a
ais
placed
expertise,
unequivocally
approved
rience and
testified
on the record
the referee and
precipitated
the heart attack was
at that
the Commission.
cold did not
If the
contrib-
ute,
place.
time and
This is not
situation where the
then the role of stress and
becomes
unknown,
And,
preeminent.
requiring
possible
nicely
cause is
that other
coincides
with Dr.
testimony.
causes be ruled out.
Parent’s
*11
been,
(“They likely could have
should
in
ered”
glaring errors
of
a number
There are
considered.”) And,
been,
know,
First, although Henry’s
findings.
foregoing
6,
April
in
just
reaffirming
opinion.
Dr. Parent
his
in
his
did
advised
counsel
Henry got to the
time
that all of Mr.
apparently
concluded
2010 letter
referee
very
Building “he did not feel
Henry’s pre-arrival
post-arrival
Administration
feeling ma-
general
words,
of
had a
good, kind of
In other
equal-value
were
stressors.
“had no
Henry
laise,”
reported
being
he also
into a cold car in Caldwell or
getting
It
true that
is
symptoms.”
specific
equal weight
late for work were entitled to
feeling “unwell”
workplace
told a co-worker
climbing a
at a
set of stairs
Henry told
Kimmel testified
that Mr.
anxiety.
great deal of
that caused
in
had come
to work
him that when
necessarily
Par-
the ease. As Dr.
That isn’t
“during
feeling
well”
day “he wasn’t
testified,
all
having
after
been advised of
ent
like that he should have
things
drive and
by Re-
pre-arrival
of the
activities asserted
to,
guess,
his own
paid attention
kind of
major
“you have to look at
...
spondents,
absolutely
of,”
is
no evi-
but there
feeling
There is no
and minor stressors.”
stressors
support
finding
in the record
dence
give great-
Dr. Parent did not
indication that
symptomology” prior
of
Henry had “an onset
stressors,
major
weight to
such as
er
work,
any pre-
he had
arriving at
or that
workplace, in form-
unusual
about his
considerably
“symptoms” that could
arrival
And,
ing
opinion.
there is no indication
his
There
no evidence
after arrival.
is
worsen
qualifi-
in the record that the referee had the
“unwell,”
why Henry felt
indicating
or
how
weigh the
positioned
or was better
cations
malaise was or that it
cause of the
what the
opin-
or to form a medical
various stressors
anything,
or to what
symptomatic
precipitated
the heart attack.
ion as what
during his
paid
attention
should
question or
Respondents wished to
Had the
in
There is no evidence
drive to work.
opinion testimony,
they
Dr. Parent’s
rebut
symp-
any of these factors were
record that
certainly
power
their
to hire
had within
attack. Dr. Parent knew
tomatic of a heart
doing
expert
purpose
own
for the
so.
their
general feeling of malaise
Henry had a
up
second-guess
It was not
to the referee to
opinion. The
initially formed his
when he
opinions.
Dr. Parent’s
or rebut
pre-
advised of that and the other
doctor was
In a
worker’s
1937
deposition, prior
during his
arrival factors
stated:
Court
testimоny
gave
doctor
his
the time that the
witnesses,
applicable to all
wheth-
opinion.
appears
initial
The rule
reaffirming his
impressed by
parties or interested in the event of an
was not much
er
the doctor
action, is,
board, court, or
persons, particularly
that either a
reports of “nonmedical”
reports
symptomolo-
positive, un-
jury
accept
there were no
must
as true the
testimony
that a board-certi-
gy.
It is understandable
of a credible wit-
contradicted
cardiologist might
experi-
ness,
testimony
inherently
feel his own
fied
unless his
general,
important
is more
than the
improbable,
ence
rendered so
facts and
or
lay persons
hearing
uninformed observations
at the
or
circumstances disclosed
Yet,
diagnosis.
Co.,
formulating a medical
Manley Harvey
174
trial.
v.
Lumber
Commission
placed great store
layper-
[175]
Minn.
489,
221
N.W.
913,
914.
In
reports
discounting
Dr.
Trouse,
538,
son unwellness
Jeffrey
100
50 P.2d
v.
Mont.
testimony.
Parent’s
trial
it is held that neither the
arbitrarily
capri-
jury may
оr
court nor
Dr. Parent
The referee also asserted that
testimony of a wit-
ciously disregard the
Henry’s pre-work
did not consider
exertional
by any
unimpeached
of the modes
ness
developing
opinion.
activities in
his
As
law,
if
does
known to the
such
above, however,
consid-
shown
Dr. Parent
And, in Arundel v.
probability.
exceed
unequivocally
reaf-
ered those activities
487,
Turk,
293,
486,
P.2d
Cal.App.2d
firming
opinion. The referee claims Dr.
488,
“Testimony
the rule is stated thus:
likely
“agreed
Parent
contributo-
may
dis-
inherently improbable
be
deposition,
which is
ry.” That is not correct.
* * *
such action
regarded,
but to warrant
they should be “consid-
Dr. Parent
testified
physical impossi-
say
there must exist either
science can
that if certain symptoms
true,
bility
present
probability
evidence
its
are
is a
there
that cer-
falsity
apparent,
must
without
present.
re-
tain disease is
The probability is
to inferences or deductions.”
stronger
sort
in the identification of some dis-
others,
eases that it
depending
upon
Gray’s
Shop, 58
Auto
Idaho
Pierstorff v.
what has been learned about the causes for
(1937).
447-48,
74 P.2d
See also
particular
diagnosis
disease. The
ain
*12
Finch,
620, 626-27,
v.
Dinneen
100 Idaho
603
particular case involves the reasoning that
575,
(1979);
Hoglund,
Wood v.
P.2d
581-82
since
probability
this
has been established
(1998).
700, 703,
383,
Idaho
963 P.2d
386
general
in
in
probability
eases
the
in
exists
Furthermore,
has
this Court
held that
particular
the
being diagnosed.
In
ease
findings
the
the
Commission “are
the
showing
absence of evidence
that the
substantial,
supported by
competent
evi-
particular
distinguishable
case in issue is
dence, they
binding
conclusive,
are not
or
from
in general
eases
it must
accepted
be
upon appeal
will be set aside.” Dean v.
that where medical science
proba-
finds a
Corp., 97
Dravo
Idaho
540 P.2d
relationship
ble causal
general
for the
(1975).
findings
the
Whether
are
group
legal
probable
cause is established
substantial,
by
supported
competent evidencе
particular
for
being
the
case
litigated. 454
question
by
is a
of law to
determined
be
the
P.2d at 631.
Dravo,
Id. In
Court.
the Court was consid-
Dravo,
161-62,
upon physician asserts, here, of medical conclusions science Dr. Parent did demonstrating you exactly that certain diseases can say certainty can’t bent, traced to certain causes. These conclu- when a stick will when it is break absolutes; they exactly sions are not go stated are can’t inside an to see expressed in probabilities. plaque ruptures, terms of From when a and that can’t empirical study many say cases medical for certain a minor might stressor largely unique contributing brought to a on of his part in because minute play some opinion knowledge Dr. Parent stated state. With and his anxietal attack. heart closed when expertise, bywas far unquestioned stairs, very sud- causing him to climbing the position players of all of the deter- best he reaf- attack and denly experience precipitated Henry’s heart attack. mine what fully briefed opinion after firmed that referee, Neither nor the Commission and activities. pre-work factors all of the referee, upon findings of the which relied fully of what aware Respondents else, anyone position nor was in a better be, yet testimony would Dr. Parent’s make that determination. There absolute- try expert to bring in their own failed to reject grounds disregard Dr. ly no Anyone who has apart. opinion pick Parent’s and the Commission erred causality involving medical a case tried doing so. would reverse the Commis- try prevail upon it is unwise to knows that decision. sion’s a case. such cross-examination *13 intimate Dr. had an Parent concurs. Chief Justice BURDICK heart, workings of knowledge of the to, stress and responded how what well-being, part large in its
played might precipitate a thrombosis factors
what Indeed, days after the heart. ten
in that attack, opportunity Dr. Parent had the replay test
during the stress to see a virtual Henry came to a heart attack close
wherein