One for the Books in Delaware: "Defecation Syncope"?

One for the Books in Delaware: "Defecation Syncope"?

Okay, this one calls for a little more restraint than my usual irreverent would be just too easy to go over the top with any number of puns and wordplay.  I might alienate some of my readers of the gentler sensibilities and I would be loathe to offend anyone. But in 27 years of legal practice focused on legal medicine, this is for the books.

Actually I found this somewhat older decision in a pile of case law hiding out in the bottom of my little SUV, which my daughters sometimes refer to as my "closet on wheels."  Judine Simms v. State of Delaware, IAB # 1340237 (4/5/10), dealt with a claim  of heat exhaustion experienced in a bathroom which the claimant contended was devoid of air conditioning.  Admittedly, the issue of air conditioning was one of credibility, as a co-worker who later found the claimant passed out on the bathroom floor testified that the air conditioning appeared to be fully functional during the period in question.   The claimant conceded that prolonged constipation in a restroom stall was a prelude to her experiencing a syncopal episode.

Critical facts:  Claimant had a longstanding prior back injury for which she was treating with Dr. Swaminathan and for which she was prescribed Vicodin and Percocet.  These narcotics cause constipation.  Dr. Swaminathan testified that the claimant had an acute syncopal episode likely resulting from heat stroke that aggravated the prior low back injury and produced new radicular symptoms when she fell to the floor.

Enter the defense medical expert, Dr. Fink, who testified that the claimant experienced "defecation syncope".  A review of the emergency room records reflected the claimant's narcotic prescription regimen and a history of constipation from the previous two days.  The syncopal episode at work was preceded by 45 minutes of straining for a bowel movement.  According to Dr. Fink, this is a well known condition where patients have a "particular propensity to have their heart rates slow down to the point where they faint when straining to have a bowel movement." This phenomenon is a subcategory of a vasovagal episode. Impacting Dr. Fink's deliberations on this issue was the collateral evidence from the co-worker that the bathroom was air conditioned.

The outcome? Hearing Officer Julie Pezzner is the author for the Board and the decision is tightly written with her usual grace and style. The opinion of Dr. Fink was adopted as credible with the commentary that "the event could have happened anywhere and is not causally related to Claimant's employment", noting that the circumstance of the event occurring at work was "incidental and due to a medical condition (or propensity) unrelated to employment and not triggered by something related to employment."

Props to attorneys Walt Schmittinger for giving Ms. Simms her day in court and to Bill Baker for a successful defense on behalf of the State.

This is a quirky little case and just when you think it has no precedential value whatsoever, I am convinced you may hear of a similar fact pattern once again in the future......  Kind of the same way that shoulder pads, hot pants and "big hair" may find their way back again....:>)  This decision is worth filing away, if you ask me.

Parting thought:  Could this whole DCD Petition have been avoided if the claimant had taken a glass of Metamucil and prune juice chaser the night before?

Cassandra Roberts

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