Howell v. Charles H. Bacon Co., 1198.

• Decision Date: 24 May 1951
• Docket Number: No. 1198.,1198.
• Citation: 98 F. Supp. 567
• Parties: HOWELL v. CHARLES H. BACON CO.
• Court: U.S. District Court — Eastern District of Tennessee

98 F. Supp. 567

HOWELL v. CHARLES H. BACON CO.

No. 1198.

United States District Court E. D. Tennessee, N. D.

March 12, 1951.

Supplemental Opinion May 24, 1951.

Hodges & Doughty, Knoxville, Tenn., M. G. Goodwin, Lenoir City, Tenn., for plaintiff.

Clyde W. Key, Knoxville, Tenn., for defendant.

ROBERT L. TAYLOR, District Judge.

This is an action for recovery of death benefits under the Workmen's Compensation Law of Tennessee, Code sec. 6851 et seq. The employee, Roy Howell, was injured May 8, 1948, by a fall from a broken scaffold to a concrete floor, where he landed on his feet after a six-foot drop. Perceptible injury was to his left foot, which X-ray study disclosed to be a fracture of the heel bone, involving its joint with an adjacent bone. The direct cause of his death August 17, 1948, was a coronary thrombosis, and the problem here is to determine whether the original injury to the heel was the cause of the arterial condition that resulted in the coronary thrombosis, or a contributing cause of death by aggravation of a preexisting arterial disease.

Two days after the death the body was examined at the request of defendant's insurance carrier, the autopsy showing that a coronary artery had developed sclerosis, that a blood clot had formed in the constricted region of the artery of such character as to stop the flow of blood, and that no other organ of the body showed any serious abnormality. The parties have stipulated that the coronary thrombosis was the immediate cause of death. There is no question that the death is compensable if the necessary causal relation existed between the injury and the death.

In addition to the lay witnesses, five doctors have testified. From the medical testimony, it appears that the interior space or blood conduit of an artery is the lumen; that arteriosclerosis is a constriction of the lumen; that a thrombus is a blood clot that has formed in the locality of the constriction; that a coronary artery is one that supplies the heart muscle with blood; that an occlusion is a closing of an artery by the deposit of a thrombus or other type of blood clot at the point of constriction; that coronary thrombosis is a term commonly applied to the heart condition that results from the occlusion of the coronary artery by a thrombus. When the sclerotic condition is located near the point where the coronary artery receives its blood from the heart, an occlusion causes a complete stoppage in the coronary system, and death is immediate. Where the constriction occurs farther along in the coronary system, an occlusion does not result in a complete stoppage, and enough blood may reach the heart muscle to continue it in operation. Again, where the constriction is not attended by an occlusion, the blood may continue to flow, but in reduced quantity, with the result that complete heart failure is not necessarily immediate. In the case here, the autopsy showed that the constriction was some distance from the point at which the artery received blood from the heart, but not sufficiently far to allow passage of enough blood to the heart muscle to sustain life when the occlusion occurred. What caused the coronary "heart attacks" that Roy Howell had before the fatal one has not been explained otherwise than by the generalities heretofore mentioned, but it may be inferred that during the previous attacks the lumen became temporarily constricted or partially occluded to the danger point, producing what has been described as "a hurting in the chest."

According to the medical testimony, the cause of a sclerotic condition in an artery has not been conclusively determined, although a number of predisposing conditions are suspected of having a causal relation thereto, as excessive smoking, alcoholic drinks, worry, physical and mental pain, overexertion, and obesity and its resultant deposit of fatty materials in the blood stream. It is not known of a certainty how long Roy Howell was afflicted with a sclerotic condition. Mild discomforts may have passed unannounced, for "he was not one to complain." Doctors who saw him during the days and weeks closely following his injury discovered no symptoms and were given no history of a heart ailment, yet the medical testimony indicates that sclerosis may exist for a considerable time without its presence being suspected. According to the testimony of Dr. R. H. Baker, a heart and lung specialist of much experience, it is the consensus of medical opinion that five years of life may ordinarily be expected after a coronary first stroke. Dr. George S. Mahon, the pathologist who performed the autopsy and found the coronary occlusion, testified that a coronary occlusion is not produced all at one time, but over a period of months, or years. "The final closing," he said, "is the end result of a long process."

Roy Howell was injured May 8, 1948, and was the same day taken to a surgical clinic where his foot was examined by X-ray and he was given temporary treatment. He was sent home by the attending physician and instructed to return ten days later for further treatment. May 18, 1948, he was admitted to a hospital, and May 21, 1948, a fusion operation was performed on the heel joint and the foot and leg below the knee placed in a rigid cast. He was discharged from the hospital May 27, 1948. He made return visits to the clinic on June 3, June 24, and July 27, 1948. On June 24 a fresh cast was substituted for the original, and on July 27 a leather lacer brace was substituted for the cast. The clinical record indicated satisfactory progress toward fusion of bones in the foot, but lay testimony is in accord that the exterior of the heel did not regain a normal appearance. His widow, the plaintiff, testified that "the whole side of his foot was just black, just like it was bruised blood in there * * * it was still that way when he died." J. L. Brown, father of the plaintiff, testified that the foot was black and blue around the place where the operation was performed. Kenneth Leroy Howell, son of the deceased, testified that the black part of the foot was "as big as your fist," and that "it was just black and nasty looking."

Those three witnesses also testified that he was continually in pain from the time of his injury until his death; that he worried constantly about his condition; that he was unable to walk or bear weight on the injured foot, and that he walked on crutches to the nearby home of his father-in-law on the day of his death. His widow testified that he could not rest at night, that he put pillows under his injured foot, but that he "couldn't get it no way to where he could rest." The first attack of pain in the heart region of which he complained occurred about two weeks before his death when "he had a hurting in his chest." On the day before his death, he had another attack, more severe than the first. The third attack came about 4:00 p. m. of the day of his death. He rallied from this attack, but about 8:30 p. m. he had the fatal attack, his death being immediate.

Preponderance of medical opinion is, that the coronary thrombosis could not have been directly caused by the foot injury. This is explained by distinction between a thrombus, which is a blood clot formed in the locality of the sclerosis, and an embolus, which is a blood clot formed elsewhere. Autopsy revealed a thrombus, not an embolus. It would have been physically impossible for a blood clot formed in the foot to reach the coronary artery for the reason that the blood from the foot had to pass through the capillary systems of the liver and the lungs on its return to the heart and a blood clot could not have passed through the capillaries. This...