Gone to the Dogs – Idiopathic Fall Defense Fails in Case of Veterinarian Who Collapses During Surgery

Cases that review the "idiopathic fall" doctrine pop up in Delaware on an occasional basis at best and often present interesting facts.  In a recent decision of the Industrial Accident Board, Laci Nash v. Medical Management International, IAB Decision, Hearing No. 1320555 (June 23, 2009), a veterinarian collapsed while performing sequential surgeries in a poorly-ventilated operating room after skipping breakfast.  The claimant testified that the temperature in the room, which was eight by ten feet in dimension with no windows, was in the eighties, and that she began to feel ill 45 minutes into her fourth procedure.  Claimant passed out falling forward into the operating table, causing injuries to the face, teeth and temporomandibular joint.

 The employer denied the claim based on medical record entries suggesting a prior history of syncope with unknown etiology.  The neurologist who testified behalf of the employer agreed on cross-examination that fainting, or syncope, can be traced to a number of causes, many of which are benign, to include low blood sugar from skipping a meal, prolonged standing, environmental factors, stressful conditions, fatigue or dehydration.  A number of these circumstances were present at the time that the claimant collapsed at work.

In evaluating the employer's argument that the fall did not arise out of the employment because it was the result of a fainting spell bearing no relation to the employment activity, the Industrial Accident Board acknowledged the lack of any dispute regarding "course of employment"  as that term refers to the "time, place and circumstances of the injury." Rose v. Cadillac Fairview Shopping Center Properties (Delaware), Inc., 668 A. 2d 782, 786 (Del. Super. 1995) (citing Dravo Corp. v. Strosnider, 45 A. 2d 542, 543 (Del. Super. 1945 )), aff'd sub nom Rose v. Sears, Roebuck & Co., 676 A. 2d 906 (Del. 1996).  The Delaware course and scope statute, 19 Del. Code Section 2304 requires that injuries both arise out of and occur in the course of employment.  This syncopal episode was deemed in course and scope by virtue of occurring during the work shift and on the premises.

The requirement that an injury arise out of the employment relates to the etiology of the event .  As stated in Rose, there must be a reasonable causal connection between the injury and the employment." 668 A.2d at 786.  Recognizing that idiopathic falls are not compensable in Delaware, and that an "idiopathic fall" refers to one prompted by a medical condition unrelated to any aspect of the employment, the hearing officer who adjudicated this case distinguished these facts from Lecates v. Harrison House of Delmar, Del. Super., C.A. No. 89A-AP1, Lee, J. (September 28, 1990).  In Lecates, the claimant fainted at work while unloading a dishwasher; the only available medical evidence was that the collapse was due to a medical condition unrelated to any aspect of the work activity or working conditions.

In ruling in favor of the claimant and awarding benefits in Nash, the hearing officer dismissed the opinion of the only medical expert, Dr. Stephen Grossinger ,  who concluded on behalf of the employer that the claimant succumbed due to an unexplained syncopal syndrome dating back to her childhood.  His opinion was rejected given the absence of any evidence that claimant continued with any fainting episodes beyond her teen-age years and unrebutted  testimony as to the claimant's specific environmental conditions, suggesting they were indeed the catalyst for her passing out during surgery. The claimant and her husband, who was also present on the day in question and formerly employed by that facility, were both found to be credible as well as medically trained in the veterinary sciences and much weight was afforded to their testimony.

© Copyright 2009 Cassandra Roberts. Reprinted with permission.

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