Charles v. Travelers Ins. Co.
| Decision Date | 29 November 1993 |
| Docket Number | No. 93-C-0900,93-C-0900 |
| Citation | 627 So.2d 1366 |
| Parties | Antoine A. CHARLES v. The TRAVELERS INSURANCE CO., et al. |
| Court | Louisiana Supreme Court |
Louis D. Bufkin, McHale, Bufkin & Dees, Lake Charles, for applicant.
Jere J. Bice, Lake Charles, for respondent.
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The issue squarely presented in this case is whether La.Rev.Stat. 23:1021(7)(e), which places a strict burden of proof on a claimant seeking worker's compensation for a "heart-related or perivascular injury," applies to a claimant who is seeking compensation for a cerebrovascular accident (a stroke) which occurred while the plaintiff was working.
La.R.S. 23:1021(7)(e) 1 provides:
Heart-related or perivascular injuries. A heart-related or perivascular injury, illness, or death shall not be considered a personal injury by accident arising out of and in the course of employment and is not compensable pursuant to this Chapter unless it is demonstrated by clear and convincing evidence that:
(i) The physical work stress was extraordinary and unusual in comparison to the stress or exertion experienced by the average employee in that occupation, and
(ii) The physical work stress or exertion, and not some other source of stress or preexisting condition, was the predominant and major cause of the heart-related or perivascular injury, illness, or death. 2
On June 25, 1990, plaintiff Antoine A. Charles, an employee of R.E. Heidt Construction, felt fine when he arrived at work in the early morning to assist in installing a new parking lot. Plaintiff's duties mainly included raking the asphalt and smoothing it into place, although he also assisted in shovelling the asphalt from the delivery trucks.
At approximately 9:00 a.m., plaintiff began to experience severe headaches, and his speech became slurred. At approximately 10:30 a.m., plaintiff's son visited his father at the work site and noticed his condition. The son advised the plaintiff to go to the doctor, but the plaintiff refused, denying there was anything wrong with him. Plaintiff's supervisor inquired as to whether plaintiff was feeling bad and told plaintiff to sit down for a while if he began to feel worse. 3
When plaintiff arrived home at the end of the work day, his wife insisted he go to the hospital. Upon admission at Lake Charles Memorial Hospital, plaintiff was diagnosed with "acute hypertensive encephalopathy," or swelling and irritation of the brain due to hypertension. Over the next few days, plaintiff's condition worsened. Plaintiff's diagnosis upon release several days later was a "completed cerebrovascular accident secondary to hypertension," or a stroke. The stroke commenced while plaintiff was working, but did not conclude until several days later.
Plaintiff requested workers' compensation benefits from his employer. R.E. Heidt's workers' compensation insurer, Travelers, refused to pay on the basis the claim was not compensable under La.R.S. 23:1021(7)(e). Plaintiff filed a claim for temporary total disability benefits with the Office of Workers' Compensation. The hearing officer found that plaintiff's cerebrovascular accident or stroke was a "perivascular injury" included under La.R.S. 23:1021(7)(e), and that plaintiff failed to carry his burden of proof under the statute. 4
Plaintiff appealed to the third circuit court of appeal. The appellate court held (1) that La.R.S. 23:1021(7)(e) applied to plaintiff's stroke, and (2) that plaintiff failed to meet his burden of proof thereunder because his treating physician concluded the ultimate cause of the stroke was hypertension, and because plaintiff admitted the work he was doing on the day of the accident was no different from that done by his co-employees.
Plaintiff's application to this court for a writ of certiorari was granted. 5
We hold today that an employee who has experienced a cerebrovascular accident, or stroke, has suffered a "perivascular injury" as used in La.R.S. 23:1021(7)(e). We arrive at this conclusion by analyzing the apparent intent of the legislature based on the status of the law at the time of the enactment. Although the definition of "perivascular" may not be precise or its meaning immediately discernable, what is obvious in the statute is that the legislature, by the use of the term "heart-related," clearly intended that myocardial infarctions, or heart attacks, be placed under the scope of 23:1021(7)(e). Inasmuch as this court and the courts of appeal have historically applied the same analysis to heart attacks and to strokes when determining whether the two injuries "arise out of" the claimant's employment under La.R.S. 23:1031, the inquiry thus becomes whether the legislature intended the increased burden of proof required under the statute to apply not only to heart attacks but also to strokes. 6
In Guidry v. Sline Industrial Painters, Inc., 418 So.2d 626 (La.1982), this court was faced with determining whether an employee's heart attack, which occurred while the employee was at work, arose out of his employment. After noting the heart attack was an injury by accident occurring in the course of the claimant's employment, the court turned to whether or not the heart attack arose out of his employment under La.R.S. 23:1031. 7
In its review of the pertinent jurisprudence relating to whether a heart attack arises out of employment, the court included several cases which involved cerebrovascular accidents, specifically, Ferguson v. HDE, Inc., 270 So.2d 867 (La.1972) and Leleux v. Lumbermen's Mutual Insurance Co., 318 So.2d 15 (La.1975). Although those two cases involved claimants who had suffered strokes, the Guidry court cited their holdings, particularly Ferguson's, as applying also to heart attack claimants. 8
This court then formulated a test for determining when a heart attack arises out of employment. We held the plaintiff must prove by a preponderance of the evidence that the physical stress, strain or exertion "in reasonable probability contributed in some degree to the heart accident." 9 If the plaintiff has preexisting heart disease, then he must also prove the employment exertion, stress or strain is of a degree greater than that involved in the everyday non-employment life of the average non-worker. 10
In Reid v. Gamb, Inc., 509 So.2d 995 (La.1987), the court addressed the issue of "whether the Guidry formula for proof of a causal link between job and accident, which was adopted in a heart attack case involving physical stress, should also apply in a cerebral vascular accident case." The court held the Guidry test should also be applied in cerebral vascular accident cases. The Reid court also held that contrary to its previous disparate treatment of physical exertion and mental exertion, 11 it would no longer distinguish between whether the employment stress was physical, mental or emotional. Additionally, the court rejected the requirement that the stress be "extraordinary" as previously required under McDonald and Ferguson for heart attacks and strokes resulting from mental or emotional work stress. 12
Because it is clear that by the use of the term "heart-related", the legislature obviously intended, in enacting La.R.S. 23:1021(7)(e), to overrule this court's pronouncements on the determination of whether a heart attack arises out of employment, and because this court used that same analysis in stroke cases, we believe the legislature, by the use of the word "perivascular," also intended to overrule the jurisprudence applying that same analysis in stroke cases.
That La.R.S. 23:1021(7)(e) intended to legislatively overrule not only Guidry and Carruthers but also Reid is made even more apparent when one focuses on the new statute. La.R.S. 1021(7)(e) now requires that for a "heart-related" or "perivascular" injury to be compensable at all under the Act, the plaintiff must:
(1) demonstrate by clear and convincing evidence,
(2) that his physical work stress was extraordinary and unusual in comparison to the stress experienced by the average employee in that occupation, and
(3) that his physical work stress, and not another source of stress or a preexisting condition, was the predominant and major cause of the illness or death.
It was the Reid opinion, and not the Guidry or Carruthers opinions, which held (1) that it was no longer relevant whether the stress was physical, emotional or mental, and (2) that the stress need not be extraordinary. Therefore, it is clear the new statute was directed specifically to two of the precepts formulated in Reid, a stroke case.
"Perivascular" is defined in various medical sources as "situated around a blood vessel." See, e.g., Dorland's Illustrated Medical Dictionary 1133 (24 ed. 1965); Medical Dictionary for Lawyers 558 (3d ed. 1960); and Schmidt's Attorneys' Dictionary of Medicine P-136 (1990). As noted in Reid, a stroke is caused by some interference with the blood supply to the brain. This interference can be caused by a ruptured blood vessel in the brain, resulting in a hemorrhage or aneurysm, or by a blockage of a vessel, caused by an embolism (blockage caused by a blood clot or other particle) or a vasospasm (spasm of a blood vessel).
The legislature's choice of the word "perivascular" rather than "cerebral vascular" or "cerebrovascular" appears to have as its basis the medical fact that embolisms and aneurysms do not only occur in the cerebral area but may also occur in virtually any blood vessel throughout the entire body. For example, aneurysms can be abdominal, aortic, axillary (in the axillary vein in the arm), thoracic (in the chest), or crisp's (in the splenic artery). Likewise, embolisms can be spinal, lymph, pulmonary or retinal. 13 Several courts of appeal had treated these types of vascular injuries the same as strokes and heart attacks, and applied the heart attack and stroke/cerebrovascular accident jurisprudence to determine...
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