Opinion
No. W2001-00785-COA-R3-CV
Filed July 29, 2002
An Appeal from the Circuit Court for Shelby County; No. 306433-8 T.D. D'Army Bailey, Judge.
Reversed.
Sam L. Crain, Jr., Burch, Porter Johnson, of Memphis, Tennessee, for the appellant, City of Memphis.
Clyde W. Kennan, Keenan, Dabbous Lazarini, of Memphis, Tennessee, for the appellee, Joseph W. Laurenzi.
Holly Kirby Lillard, J., delivered the opinion of the court, in which W. Frank Crawford, P.J., W.S., and David R. Farmer, J., joined.
This is an action by a police officer for on-the-job-injury benefits. The police officer joined the city police department in 1967. In 1998, it was discovered that he had coronary heart disease, and he underwent triple by-pass surgery. He applied for on-the-job-injury benefits, but his application was denied. In January 2000, the officer filed this lawsuit against the city, asserting that he was entitled to benefits. After a bench trial, the trial court granted the officer benefits, finding that the city failed to produce sufficient evidence to rebut the presumption in Tennessee Code Annotated § 7-51-201 that the officer's heart condition was caused by his employment. The city now appeals. We find that the city submitted competent medical evidence sufficient to rebut the statutory presumption, and that the burden then shifted to officer to show that his condition was precipitated by a specific stressful job-related event. Because the officer failed to do so, we must reverse the award of benefits.
OPINION
Plaintiff/Appellee Joseph W. Laurenzi ("Laurenzi") joined the Memphis Police Department ("Department") as an officer in 1967. The Department had established an On-the-Job Injury Program ("OJI") under which Department employees are compensated for any condition or impairment of health resulting from a personal injury sustained in the line of duty or course of employment. When Laurenzi joined the Department in 1967, he passed a physical examination which revealed no evidence of heart disease.
Over thirty years later on September 20, 1998, Laurenzi went to a hospital emergency room complaining of tightness in his chest. There he was evaluated by his physician, Robert M. Kraus, M.D. ("Dr. Kraus"), a specialist in internal medicine. At Laurenzi's follow-up appointment about ten days later, Dr. Kraus administered tests which showed that Laurenzi had elevated stress scores, high blood pressure, and other symptoms of heart problems. Dr. Kraus then referred Laurenzi to a cardiologist. In October 1998, Laurenzi was diagnosed with coronary heart disease and underwent triple by-pass heart surgery.
On approximately October 28, 1998, Laurenzi submitted an application to the City of Memphis ("City") for OJI benefits for his heart disease. See Tenn. Code Ann. § 7-51-201. The City denied his application on the grounds that Laurenzi did not suffer from a condition or impairment of health that was caused by his employment. On January 19, 2000, Laurenzi filed this lawsuit, asserting that he was entitled to OJI benefits. On March 5 and 6, 2001, a bench trial was held on stipulated facts. The parties submitted the evidentiary depositions of four physicians: Dr. Kraus, Kerry Dean Morgan, M.D. ("Dr. Morgan"), Otis S. Warr, III, M.D. ("Dr. Warr"), and Paul A. Thompson, M.D. ("Dr. Thompson").
The complaint was erroneously entitled "Complaint for Workers Compensation", but it is undisputed that the City has elected not to be covered under the Tennessee Workers' Compensation Law, Tennessee Code Annotated § 50-6-101, et seq., pursuant to § 50-6-106(5).
At trial, Laurenzi argued that he was entitled to the presumption set forth in Tennessee Code Annotated § 7-51-201 that his heart condition was caused by his employment. This statute provides:
(a)(1) Whenever the state of Tennessee, or any municipal corporation or other political subdivision thereof that maintains a regular law enforcement department manned by regular and full-time employees and has established or hereafter establishes any form of compensation to be paid to such law enforcement officers for any condition or impairment of health which shall result in loss of life or personal injury in the line of duty or course of employment, there shall be and there is hereby established a presumption that any impairment of health of such law enforcement officers caused by hypertension or heart disease resulting in hospitalization, medical treatment or any disability, shall be presumed (unless the contrary is shown by competent medical evidence) to have occurred or to be due to accidental injury suffered in the course of employment. . . . Such law enforcement officer shall have successfully passed a physical examination prior to such claimed disability, or upon entering governmental employment and such examination fails to reveal any evidence of the condition of hypertension or heart disease.
Tenn. Code Ann. § 7-51-201(a)(1) (1998). Thus, an employee's condition or disease is presumed to have been caused by his employment where the employee proves (1) that he was a full-time employee of the municipality's police department, (2) that he suffered from hypertension or heart disease which resulted in medical treatment, hospitalization or disability, and (3) that prior to this injury he underwent a physical examination that did not reveal the presence of the heart disease or hypertension. See Stone v. City of McMinnville , 896 S.W.2d 548, 550 (Tenn. 1995). Laurenzi satisfied all of these prerequisites.
The City did not dispute that Laurenzi was entitled to the statutory presumption that his heart condition was caused by his employment. It argued, however, that the depositions of Drs. Morgan, Warr, and Kraus constituted the "competent medical evidence" necessary to rebut the statutory presumption. The trial court rejected that argument. On March 21, 2001, the trial court entered a written order in favor of Laurenzi, determining that "[t]he medical evidence . . . is not sufficient to overcome the presumption established by TCA 7-51-201." Therefore, based on the statutory presumption, the trial court concluded that Laurenzi was entitled to OJI benefits. From this order, the City now appeals.
On appeal, the City maintains that the medical evidence was sufficient to rebut the statutory presumption, that the burden then shifted to Laurenzi to show that his condition or disease was caused by his employment, and that he failed to do so. We review the trial court's findings of fact de novo on the record, with a presumption of the correctness of the trial court's findings unless the preponderance of the evidence is otherwise. Tenn.R.App.P. 13(d). Where the issues involve expert medical testimony, and all the medical proof introduced at trial was deposition testimony, the appellate court may draw its own conclusions about the weight and credibility of the testimony because "we are in the same position as the trial judge." Krick v. City of Lawrenceburg , 945 S.W.2d 709, 712 (Tenn. 1997). We afford no presumption of correctness to the trial court's conclusions of law, and we review those conclusions de novo. See State v. Levandowski , 955 S.W.2d 603, 604 (Tenn. 1997)
The statutory presumption in Tennessee Code Annotated § 7-51-201(a)(1) may be overcome by the submission of "competent medical evidence," that is, "affirmative evidence that there is not a substantial causal connection between the work of the employee so situated and the occurrence upon which the claim for benefits is based." Stone , 896 S.W.2d at 550. There must be "a medical opinion provided by a competent medical expert" that the heart condition was not job-related. Benton v. City of Springfield , 973 S.W.2d 936, 937 (Tenn. 1998) (citing Krick , 945 S.W.2d at 713). The City argues on appeal that the physicians' depositions submitted at trial, on the whole, constitute such competent medical evidence. Thus, we must review the physicians' depositions. Id .
Dr. Kraus, began treating Laurenzi in December 1995 for back pain. At that time, he noted that Laurenzi had a history of high blood pressure and high cholesterol, and that he had a family history of heart disease. Dr. Kraus also noted that Laurenzi was obese, and that he told Laurenzi to lose weight "to reduce his risk factors for cardiovascular disease." In September 1998, after treating Laurenzi for tightness in his chest, Dr. Kraus referred Laurenzi to a cardiologist. Dr. Kraus believed that Laurenzi's heart problems were caused by his employment, because Laurenzi had a negative testing for coronary heart disease in 1990, but had developed the condition by 1998. However, Dr. Kraus acknowledged that Laurenzi had some of the related risk factors in 1990.
Laurenzi's mother died of a myocardial infarction at age 70.
The other three experts were independent physicians retained by the City to review Laurenzi's medical records and give opinions regarding whether Laurenzi qualified for OJI benefits. Two of the three physicians opined that Laurenzi's heart condition was not caused by his employment. Dr. Morgan, whose practice focuses on cardiology, testified that, in his opinion, Laurenzi's heart condition was not caused by his employment but was caused by risk factors such as high cholesterol and high blood pressure that went untreated for at least nine years. He stated that the blockage discovered in some of Laurenzi's arteries took around ten to fifteen years to develop. He acknowledged that stress could play a role in the development of heart problems. However, Dr. Morgan concluded that "the hypertension, high cholesterol, weight, all of those [risk factors] combined are much more likely to have caused the [heart] problem than his job."
At the time of his deposition, Dr. Morgan had recently taken his cardiology board exams and was awaiting his score.
Dr. Warr, who has been board certified in cardiology since 1973, testified that Laurenzi's combination of negative risk factors — family history, age, gender, obesity, elevated cholesterol, past smoking — caused his heart condition. Dr. Warr asserted that "[w]ork does not cause heart disease." He explained that, although stress can aggravate an underlying heart disease, stress "did not cause [Laurenzi's] heart disease." In drawing these conclusions, Dr. Warr did not review Laurenzi's preemployment physical.
Laurenzi smoked cigarettes for two years during his early twenties, but had not smoked for twenty years prior to his heart surgery.
Dr. Thompson's practice focuses on internal medicine, not on cardiology. Dr. Thompson testified that he believed that Laurenzi's heart condition was caused by his employment because his "cardiac workup" was "basically negative" in 1991, but that he required heart surgery in 1998. Dr. Thompson characterized Laurenzi's risk factors for heart disease as "weak." On cross-examination, Dr. Thompson was asked about the significance of Laurenzi's high cholesterol, family history, inactive lifestyle, weight gain, and past smoking. Dr. Thompson responded that he did not discount the fact that Laurenzi had some risk factors, but he did not consider them to be impressive or strong risk factors.
The trial court weighed the medical testimony and held in favor of Laurenzi. The trial judge noted that the testimony of Drs. Thompson and Kraus contradicted the testimony of Drs. Morgan and Warr on the issue of whether Laurenzi's heart condition was caused by his risk factors or his employment. In resolving the conflict, the trial court stated that "you've got a collision of expertise on this subject and you've got a statutory presumption. I rule in favor of Mr. Laurenzi."
In this appeal, we must determine whether the depositions upon which the City relies constitute competent medical evidence sufficient to rebut the statutory presumption that Laurenzi's heart condition was caused by his employment. Laurenzi does not assert that either Dr. Morgan or Dr. Warr is incompetent or unqualified to render an opinion on the issue. Rather, Laurenzi argues that the trial court appropriately weighed the evidence and found that Drs. Kraus and Thompson were more credible.
Laurenzi points out that Dr. Warr admitted on cross-examination that there is no type of test that would tell what, in fact, caused Laurenzi's heart problems. Laurenzi also noted that, over the two years during which he had been retained to review medical records for the City, Dr. Warr could not recall ever concluding that an employee's heart condition was job-related. Laurenzi claims that Dr. Morgan's testimony is less credible because he never reviewed the thallium stress test performed on Laurenzi in 1990 that showed that he had no heart disease.
The issue, then, is whether the trial court, in evaluating whether the City has presented "competent medical evidence" to overcome the presumption, is to weigh the credibility of admittedly competent physicians who give conflicting testimony on the cause of the claimant's heart condition. In Krick v. City of Lawrenceburg , 945 S.W.2d 709 (Tenn. 1997), a police officer sought disability benefits for his heart disease. In August 1993, the officer received a domestic call, and he and a fellow officer were forced to crawl though a house littered with debris searching for a woman who had reportedly been shot and was being held by force by her husband. Id . at 710. Later that day, the officer experienced chest pain. He was hospitalized, diagnosed with blocked arteries, and underwent quadruple bypass surgery. Id . at 711. The trial court found that the officer had suffered a compensable injury and awarded benefits. Id . at 710.
On appeal, the Krick Court reviewed the conflicting expert testimony, noting some expert testimony that the officer had long-standing coronary heart disease caused by risk factors such as smoking and hypertension, as well as other expert testimony from the officer's family practitioner that the stress of the officer's work "could lead to a coronary spasm, which could cause a complete blockage of the arteries." Id . at 711-12. The Court found first that the officer had met the prerequisites for the statutory presumption that his heart disease was due to accidental injury suffered in the course of his employment. Id . at 712. It then noted the expert testimony that there was not a substantial connection between the officer's work and his heart disease. Id . The Court found that the City had overcome the statutory presumption, observing that "[t]he chest pain experienced by the plaintiff at the time of the August 24, 1993 [domestic] call was a symptom of the heart disease, not the disease itself. Moreover, it defies common sense to assume that [the officer's] arteries became occluded as a result of the stress involved in the August 1993 call." Id . at 713. Thus, the Court in Krick appeared to engage in some evaluation of the credibility of the competing expert opinions, at least to the extent of determining that the expert testimony in favor of the officer "defie[d] common sense." Id .
However, Krick was applied in Benton v. City of Springfield , 973 S.W.2d 936 (Tenn. 1998). As in Krick , Benton involved a police officer with coronary heart disease who sought disability benefits. Benton , 973 S.W.2d at 936. The officer proffered expert testimony that his job as a drug task force officer contributed to his heart condition, and the city put into evidence the testimony of a physician who opined that the officer's heart condition was not job-related. Id . at 937. The trial court had awarded disability benefits. Id . The Benton Court did not weigh the credibility of the conflicting expert testimony; rather, it simply stated that "[t]his Court recently held in Krick v. City of Lawrenceburg . . . that medical opinion provided by a competent medical expert was sufficient to rebut the presumption in Tenn. Code Ann. § 7-51-201." Id . Apparently concluding that the presumption had been rebutted by the testimony proffered by the city, the Benton Court then evaluated whether the officer had put on sufficient evidence to show causation by a specific stressful event. Id . The Benton Court ultimately concluded that the officer was not entitled to benefits. Id .
Thus, in Krick , the Court appeared to evaluate, at least in part, the credibility of the expert testimony, in order to determine if the testimony was competent. In Benton , the Court's analysis included virtually no credibility determination.
The similarities between this case and the facts in Krick and Benton are unmistakable. In this case, it is undisputed that Laurenzi had numerous risk factors, including high blood pressure, high cholesterol, a family history of heart disease, gender, and obesity. Laurenzi offered the testimony of two physicians who were not specialists in cardiology, opining that Laurenzi's heart condition was caused by his employment, despite the presence of several risk factors. However, the testimony of both specialists in cardiology was that Laurenzi's heart condition was not caused by his employment. Indeed, Dr. Morgan's testimony, that the blockage in some of Laurenzi's arteries took ten to fifteen years to develop, was unrebutted.
If, as in Benton , there is little or no evaluation of the credibility of the municipality's expert testimony to rebut the statutory presumption, clearly the City has put on competent medical evidence that is sufficient to do so. Even if the credibility of the medical testimony is evaluated, as in Krick , we must conclude that the evidence preponderates against the conclusion of the trial court that the City had not rebutted the statutory presumption. Thus, we must find that the medical testimony proffered by the City was sufficient to rebut the presumption.
Once the statutory presumption is rebutted, "it disappears, and the plaintiff must prove, by a preponderance of the evidence, that his condition resulted from an injury by accident arising out of and in the course of his employment." Krick , 945 S.W.2d at 713. When it is alleged that physical activity of employment caused a heart attack, a plaintiff must show that "the disabling heart attack [was] precipitated by the physical activity or exertion or physical strain of the employee's job." Id . (quoting Stone , 896 S.W.2d at 552). When it is alleged that emotional distress in employment caused a heart attack, it must be shown that the disabling condition was immediately triggered by a specific stressful event. Id . at 713-14, see also Benton , 973 S.W.2d at 937. In the instant case, Laurenzi did not suffer a heart attack. Rather, he underwent by-pass surgery after his heart disease was discovered. In any event, he must show that his condition was precipitated by a specific, sudden, stressful event. See Krick , 945 S.W.2d at 713-14 (concluding that, although plaintiff did not suffer a heart attack, he must still show that his heart disease was precipitated by a specific incident); see also Warren v. TML Ins. Pool , No. 02S01-9801-CV-00007, 1999 Tenn. LEXIS 107, at *9 (Tenn. Special Workers' Comp. App. Panel) (stating that "[i]t is well settled that the disabling condition must be precipitated by a specific, acute, or sudden stressful event"), aff'd , 1999 Tenn. LEXIS 106 (Tenn. March 1, 1999).
In this case, the parties stipulated at trial that the onset of Laurenzi's heart disease was not precipitated by any certain event. Laurenzi apparently has maintained that the ongoing stress of his job over a thirty-year period caused his heart disease. While we are sympathetic to Laurenzi's position, we must conclude that Laurenzi is required to show that a precipitating event in his employment caused his heart condition. He makes no such allegation, nor does the record include evidence that would support such an allegation. Consequently, we must find that Laurenzi has not carried his burden of showing that his heart condition was caused by his employment. See Warren , 1999 Tenn. LEXIS 107, at *9 (finding that it is insufficient to allege a series of stressful events over a twenty-year period to show that heart disease was related to job as a police officer).
The decision of the trial court is reversed. Costs are to be assessed to the appellee, Joseph W. Laurenzi, for which execution may issue, if necessary.