Maher v. Workers' Comp. Appeals Bd.

Decision Date25 April 1983
Citation661 P.2d 1058,33 Cal.3d 729,190 Cal.Rptr. 904
CourtCalifornia Supreme Court
Parties, 661 P.2d 1058 Carol A. MAHER, Petitioner, v. WORKERS' COMPENSATION APPEALS BOARD, San Clemente General Hospital et al., Respondents. L.A. 31640.

Byhower & Petherbridge and Merle C. Rabine, Santa Ana, for petitioner.

Zonni, Ginocchio & Taylor, Leonard J. Silberman, Richard A. Krimen, Michael J. Brodie, Arthur Hershenson, Fernando Da Silva and Robert J. La Porta, Santa Ana, for respondents.

C. Gordon Taylor, Kegel, Tobin & Hamrick, David E. Lister and Stephan G. Thompson, Los Angeles, as amici curiae for respondents.

BIRD, Chief Justice.

Is an employee entitled to compensation benefits for an injury sustained during treatment for a preexisting disease if the treatment is required as a condition of continued employment?

I.

Petitioner, Carol Maher, obtained employment as a nurse's assistant at the San Clemente General Hospital on April 20, 1979. By law, all prospective hospital employees are required to undergo a physical examination which includes a test for tuberculosis. (See Cal.Admin.Code, tit. 22, § 70723.) 1 Maher's examination took place on April 21, 1979. Two days later, the hospital's nurse-epidemiologist, Helen Kapuzki, notified Maher that her tuberculosis skin test was positive, indicating that she had been exposed to and might have contracted the disease sometime prior to her employment. Maher's chest X-ray tended to confirm the results of the skin test. At a meeting with Kapuzki the following day, Maher was told that she would be required to undergo treatment for tuberculosis in order to continue working at the hospital. She was given the choice of obtaining such treatment either through the county health department or from a private physician.

Maher agreed to undergo treatment at the Orange County Health Department. The therapeutic regimen required her to take a combination of three antituberculosis drugs. While undergoing treatment, she continued to work at the hospital.

Maher soon developed a significant adverse reaction to the drugs. She suffered from dizziness, headaches, and frequent bouts of nausea, vomiting and diarrhea. When these symptoms persisted, despite efforts to alleviate them, Maher asked the hospital if she could stop taking the drugs. She was told that she could not do so if she wished to continue working at the hospital. Not surprisingly, Maher continued taking the medications.

In June of 1979, Maher's condition worsened. She developed blurred vision and a partial paralysis of her left side. Kapuzki then referred her to a local physician for examination and treatment. The symptoms persisted, and on July 24, her doctor ordered her admission as a patient at San Clemente General Hospital. When she was released from the hospital on July 31, Maher still suffered from residual visual loss and weakness on her left side.

On September 10, 1979, Maher returned to work. However, her continuing disability made it impossible for her to perform her duties. As a result, the hospital terminated her employment. Subsequently, Maher filed a claim for workers' compensation benefits based on the disability she sustained as a result of her treatment for tuberculosis.

San Clemente General contested the claim and argued that Maher's injury did not arise out of or in the course of her employment. The workers' compensation judge agreed with the hospital. He found that the injuries sustained by Maher were not compensable since the tuberculosis patch test was merely diagnostic and had been given to Maher before she commenced her duties at the hospital. The Workers' Compensation Appeals Board denied Maher's petition for reconsideration and this petition followed.

II.

To be compensable, an injury must "aris[e] out of and in the course of the employment." (Lab.Code, § 3600.) 2 This two-pronged requirement is the cornerstone of the workers' compensation system. (See 2 Hanna, Cal.Law of Employee Injuries and Workmen's Compensation (2d ed. 1982) § 10.01 (Hanna ).) In applying it, this court must be guided by the equally fundamental principle that the requirement is to be liberally construed in favor of awarding benefits. (Lab.Code, § 3202; Laeng v. Workmen's Comp. Appeals Bd. (1972) 6 Cal.3d 771, 777-778, 100 Cal.Rptr. 377, 494 P.2d 1; Garza v. Workmen's Comp. Appeals Bd. (1970) 3 Cal.3d 312, 317, 90 Cal.Rptr. 355, 475 P.2d 451; Scott v. Pacific Coast Borax Co. (1956) 140 Cal.App.2d 173, 178, 294 P.2d 1039.)

The principal issue presented here is whether the injury Maher sustained as a result of the medical treatment required by her employer meets this standard.

The requirement of Labor Code section 3600 is twofold. On the one hand, the injury must occur "in the course of the employment." This concept "ordinarily refers to the time, place, and circumstances under which the injury occurs." (2 Hanna, supra, at § 9.01(1)(b), fn. omitted.) Thus " '[a]n employee is in the "course of his employment" when he does those reasonable things which his contract with his employment expressly or impliedly permits him to do.' " (State Comp. Ins. Fund v. Indus. Acc. Com. (1924) 194 Cal. 28, 33, 227 P. 168.) And, ipso facto, an employee acts within the course of his employment when " 'performing a duty imposed upon him by his employer and one necessary to perform before the terms of the contract [are] mutually satisfied.' [Citation.]" (Id., at p. 35, 227 P. 168, emphasis omitted.)

In this case, the parties do not dispute that San Clemente General Hospital required Maher to undergo antituberculosis therapy as a necessary condition of the performance of her employment contract. As such, there is no real dispute that Maher's injuries meet the requirement that they occur "in the course of" employment.

On the other hand, the statute requires that an injury "arise out of" the employment. Whether this standard has been met in this case is a more difficult question. It has long been settled that for an injury to "arise out of the employment" it must "occur by reason of a condition or incident of [the] employment ...." (Employers etc. Ins. Co. v. Ind. Acc. Com. (1953) 41 Cal.2d 676, 679, 263 P.2d 4.) That is, the employment and the injury must be linked in some causal fashion. (Kimbol v. Industrial Acc. Commission (1916) 173 Cal. 351, 353, 160 P. 150.) However, "[i]f we look for a causal connection between the employment and the injury, such connection need not be the sole cause; it is sufficient if it is a contributory cause. [Citation.]" (Employers etc. Ins. Co. v. Ind. Acc. Com., supra, 41 Cal.2d at p. 680, 263 P.2d 4.) 3

The particular question as to whether an injury which has been caused by an employer-required medical treatment for a preexisting, nonindustrial injury meets this standard appears to be one of first impression in this state. However, decisions rendered in analogous cases demonstrate that such injury conforms to the requirement set forth in section 3600.

The rule has been long established in workers' compensation cases that "an employer takes the employee as he finds him at the time of the employment." (Ballard v. Workmen's Comp. App. Bd. (1971) 3 Cal.3d 832, 837, 92 Cal.Rptr. 1, 478 P.2d 937.) In Ballard, for example, the employer's physicians prescribed drugs for treatment of an employee's industrial injury. However, the employee's own preexisting personality characteristics made him more susceptible to addiction and he became dependent on the drugs as a result. Yet, the court held that the employee was entitled to compensation for the disability caused by the addiction. (Id., at pp. 837-839, 92 Cal.Rptr. 1, 478 P.2d 937.) This case teaches that had Maher's tuberculosis been an industrially caused disease her propensity to react adversely to antituberculosis medication would not have barred her from compensation for the adverse effects of the medication.

Another line of cases holds that the presence of an industrial injury is not always a prerequisite for compensability where injury results from the medical care which was required by the employer. The rule is well settled that where an employee submits to an inoculation or a vaccination at the direction of the employer and for the employer's benefit, any injury resulting from an adverse reaction is compensable under the Workers' Compensation Act. (Roberts v. U.S.O. Camp Shows, Inc. (1949) 91 Cal.App.2d 884, 885, 205 P.2d 1116 and cases there cited.) The Roberts case illustrates this point.

In Roberts, U.S.O. Camp Shows, Inc. required one of its employees, a musician, to undergo various inoculations for immunization against certain diseases. As a result of the inoculations, which were provided by the employer's physicians, Roberts contracted encephalitis. The resulting incapacity was held to be compensable. The court noted that "in every American jurisdiction in which the question has arisen ... [it has been held that] '[i]ncapacity caused by illness from vaccination or inoculation may properly be found to have arisen out of the employment where such treatment is submitted to pursuant to the direction or for the benefit of the employer....' " (Roberts v. U.S.O. Camp Shows, Inc., supra, 91 Cal.App.2d at p. 885, 205 P.2d 1116, citations omitted, emphasis added; accord, Suniland Toys and Juvenile Furniture, Inc. v. Karns (Fla.1963) 148 So.2d 523 [adverse reaction to typhoid injections administered with employer's active assent and approval held compensable]; Alewine v. Tobin Quarries (S.C.1945) 206 S.C. 103, 33 S.E.2d 81 [death resulting from smallpox vaccination required by employer as a condition of employment held compensable].) 4

This case presents an issue similar to that involved in Roberts. In both Roberts and this case there was essentially no industrial injury in the traditional sense. Instead, compensability was found because the employer either directed or benefited from the requirement that the employee submit to medical...

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