Balt. Cnty. v. Quinlan

• Decision Date: 30 August 2018
• Docket Number: No. 319, Sept. Term, 2017,319, Sept. Term, 2017
• Citation: 192 A.3d 886,238 Md.App. 486
• Parties: BALTIMORE COUNTY v. Michael QUINLAN
• Court: Court of Special Appeals of Maryland

238 Md.App. 486

192 A.3d 886

BALTIMORE COUNTY

v.Michael QUINLAN

No. 319, Sept. Term, 2017

Court of Special Appeals of Maryland.

August 30, 2018

Argued by: Mark S. Henckel (Michael E. Field, County Attorney, on the brief) Towson, MD, for Appellant.

Argued by: Nicole C. Lambdin (P. Matthew Darby, Berman, Sobin, Gross, Feldman & Darby, LLP, on the brief) Lutherville, MD, for Appellee.

Panel: Leahy, Reed, Shaw Geter, JJ.

Leahy, J.

A jury in the Circuit Court for Baltimore County found that Mr. Michael Quinlan ("Appellee") suffered an occupational disease in the form of degenerative tears in the medial and lateral menisci in his right knee arising out of and in the course of his employment as a paramedic/firefighter for Baltimore County ("Appellant" or the "County"). The County appeals that decision, presenting a single issue for our review: "Whether right knee degenerative tears of the medial and lateral menisci and their underlying cause, osteoarthritis

, constitute[ ] an occupational disease as defined by the Maryland's Workers' Compensation Act[.]"

The Workers' Compensation Act (the "Act") provides that a covered employee may recover for an occupational disease that "is due to the nature of an employment in which hazards of the occupational disease exist and the covered employee was employed before the date of disablement." Maryland Code (1991, 2016 Repl. Vol.), Labor & Employment Article ("LE"), § 9-502(d)(1)(i). Mr. Quinlan established through testimony presented at trial that repetitive kneeling and squatting is (1) a regular part of a paramedic's job and (2) a risk factor for developing menisci tears and, in turn, osteoarthritis in the knees

. We hold that Mr. Quinlan presented sufficient evidence at trial establishing that the degenerative menisci tears he suffered were an occupational disease for which he may recover under LE § 9-502(d)(1)(i).

BACKGROUND

A. Mr. Quinlan's Workers' Compensation Claim

Mr. Quinlan filed an employee's claim with the Workers' Compensation Commission ("Commission") on October 19, 2015, asserting that he developed meniscal tears in his right knee due to his job duties as a paramedic/firefighter. The Commission held a hearing on March 31, 2016, on the following issues regarding Mr. Quinlan's claim:

1. Did the employee sustain an occupational disease arising out of and in the course of employment?

2. Temporary Total Disability

3. Average Weekly Wage

On April 5, 2016, the Commission found that Mr. Quinlan "did not sustain an occupational disease of Right Knee degenerative tears arising out and in the course of employment as alleged to have occurred on February 11, 2015," and issued an order disallowing Mr. Quinlan's claim. The Commission noted that the second issue (temporary total disability) was raised but not litigated and found Mr. Quinlan's average weekly wage to be $2,082.16. Later that month, on April 29, he filed a petition in the Circuit Court for Baltimore County for review of the Commission's decision and requested a jury trial.

B. Trial in Circuit Court

The circuit court held a jury trial on April 19-20, 2017. Mr. Quinlan testified first. At the time of trial, he was 51 years old, 5'9? tall, and weighed between 230-240 lbs. He explained that he has worked for the Baltimore County Fire Department as a paramedic since September 1994. The job requires him to work four days on followed by four days off; the first two days on are ten-hour shifts and the second two are fourteen-hour shifts. Over those four days, he responds to about 26 to 30 calls that last an average of 60-90 minutes each. According to Mr. Quinlan, calls for paramedics range from "anything from patient assist, meaning like just helping somebody off the floor, to cardiac arrest

to rescues to chest pain[.]" Because many of the calls are in response to people who are in a heightened state of anxiety or pain and the patients may be on the floor, a couch, or a bed, and may be unconscious, Mr. Quinlan has to "kneel down to their level while [ ] talking to them instead of hovering over top of them." When he kneels, he'll often do so on his right knee. In some situations, for example, if a patient is in cardiac arrest

, he will "be on the floor for a little while, either doing compressions, airway managements," or "doing an I.V." While working, he also has to carry patients and equipment up and down steps.

Aside from work, Mr. Quinlan testified that he golfs recreationally, lifts upper body weights, and occasionally rides a bike or goes sailing with friends. The County established on cross-examination that he has also posed for a picture squatting next to a dog and that he sometimes carries groceries or a laundry basket up the 10-20 stairs at his house.

In 2005, Mr. Quinlan hurt his right knee on the job while assisting a patient down a set of stairs; he saw a doctor a few times for the pain at the suggestion of an officer at work. Then, around 2014, Mr. Quinlan saw a doctor again for more problems associated with his right knee. He testified that after a shift, he was experiencing pain and "thought it was something that might just go away on its own" but the next day he noticed clicking when he walked. When he tried to pop his knee to alleviate the pain, "it just hurt more." Although he felt knee soreness and stiffness throughout his career, he indicated that this time felt more severe and consistent, and that the clicking was a new development. His personal physician told him to get an MRI and referred him to an orthopedic surgeon. In February 2015, Mr. Quinlan underwent a partial meniscectomy

on his right knee. After surgery, he returned to work.

1. Dr. Cochran's Testimony

Following Mr. Quinlan's own testimony, he presented a video deposition of Dr. Barbara Cochran, who specializes in internal medicine, occupational medicine, psychiatry, and pulmonary medicine. Dr. Cochran testified that she evaluated Mr. Quinlan to determine whether his right knee issue was related to his occupation as a paramedic. She explained that her evaluation procedure includes reviewing a patient's medical records and any medications he or she may be on, speaking to the patient, and looking at the patient's occupational history and job functions. She then reviews peer-reviewed medical literature to incorporate into her report. Dr. Cochran said that understanding the patient's job functions, shift work, and whether he or she takes breaks is vital to forming a reliable opinion relating to osteoarthritis

.

Dr. Cochran highlighted the functions of EMT/paramedic work that require paramedics like Mr. Quinlan to transport heavy patients, get them on stretchers or into the ambulance, and bend down to take vital signs, talk to, or triage patients. Regarding lifting patients onto stretchers, she stated, "they're low to the ground. So you're in [a] squatting position, which puts a great deal of stress on the knee, because you know you're going to lift with your knees, you don't lift with your back."

Mr. Quinlan had tears in his medial and lateral menisci when surgery was performed on his right knee. Dr. Cochran explained that tears of the menisci are "part of the continuum of osteoarthritis

." She stated that "any type of motion or repetitive trauma" will cause "inflammation [of the] synovium, which is the covering over the bone[,] and then that progresses and so then you can get abnormal bone formation or you can get, again, changes in the meniscus."

As for risk factors, Dr. Cochran opined that age played a role in Mr. Quinlan's osteoarthritis

in the sense that

as you age you have that many more moments ... where you can [ ] injure your knee[.] ... [I]t's a risk factor in terms of how many times you were walking or how many times you were kneeling or bending. But his particular case, he developed this at a much earlier age than one would expect to see it.

Gender was not a risk factor for him because osteoarthritis

occurs more frequently in women and Mr. Quinlan was diagnosed in only one of his knees, and no genetic factors have yet been identified as risk factors. Joint injuries were another risk factor, according to Dr. Cochran, but Mr. Quinlan did not appear to have any. Having reviewed Mr. Quinlan's medical records from 2005, Dr. Cochran testified that Mr. Quinlan's injury back then was not the type of joint injury contemplated as a potential risk factor: "He had a totally normal examination of his knee, there wasn't any infusion, there wasn't any swelling, there wasn't any laxity, there's nothing there that indicated he had any significant injury to his knee."

Dr. Cochran explained that overuse or repetitive trauma is another risk factor. She then outlined the stress that squatting can put on the knees and observed that "as you come up and unbend you're exerting tremendous forces downward on the structures and they're going to again protect the ligaments and protect the joint integrity, but they're going to put pressure on the meniscus." She continued:

When you do repetitive motions, ... what happens is that you have an inflammation and it doesn't have to be big inflammation, it can be a small inflammation. But what happens is you get, the body will repair itself as long as there is enough time for the reparative molecules, which are called ... cytokines, but there's pro-inflammatory and they're healing and there's a number of different structures, or things that do that but, again, when you do this on a repetitive basis, the body does not have time to compensate and repair. So, you have inflammation, partial healing, inflammation, so it builds up.

She then discussed one study that showed "repetitive kneeling and repetitive squatting" can "markedly increase[ ] risk" for osteoarthritis

, which "is a cumulative injury," and another study that showed fire fighters have a "significant" relative risk of osteoarthritis

. Specific to Mr. Quinlan, Dr. Cochran opined that, based on two different types of causation analysis, including a six-step occupational-practice guideline...