McDowell v. Town of Clarksville

• Decision Date: 19 May 1976
• Docket Number: No. 2--56738,2--56738
• Parties: Mable McDOWELL, surviving spouse of Robert G. McDowell, Appellee, v. TOWN OF CLARKSVILLE, Iowa, and Hawkeye Security Insurance Company, Appellants.
• Court: Iowa Supreme Court

Page 904

241 N.W.2d 904

Mable McDOWELL, surviving spouse of Robert G. McDowell, Appellee, v. TOWN OF CLARKSVILLE, Iowa, and Hawkeye Security Insurance Company, Appellants.

No. 2--56738.

Supreme Court of Iowa.

May 19, 1976.

Mosier, Thomas, Beatty, Dutton & Braun, Waterloo, for appellants.

Hagemann & Hagemann, Waverly, and Shepard & Shepard, Allison, for appellee.

Heard before MOORE, C.J., and LeGRAND, UHLENHOPP, REYNOLDSON, and McCORMICK, JJ.

UHLENHOPP, Justice.

This appeal in a workmen's compensation case presents a question of causation.

Robert G. McDowell, a truck driver, had a cerebral aneurysm (a permanent, abnormal dilation of a blood vessel resulting from disease of the vessel wall). The fact-finder could also find McDowell had high blood pressure.

McDowell was a member of the volunteer fire department of Clarksville, Iowa. On June 26, 1962, he was at home and heard the fire alarm. He drove to the fire station, where he learned that a flood had inundated a farmhouse. As instructed, he used a hydraulic end loader to fill a dump truck with sand. He drove the truck to the house and with some difficulty backed it into the driveway. Assisted by other workers, he then filled sandbags for approximately 20 minutes, alternately holding bags and shoveling. He also helped load the sandbags into a Jeep and a small boat, for transfer to the farmhouse.

McDowell then went to a firetruck at the site to call over a two-way radio for more sand. While talking on the radio he mumbled he did not feel well, and collapsed unconscious.

McDowell died the next morning at The University of Iowa Hospitals at Iowa City from massive bleeding (subarachnoid hemorrhage), following rupture of his cerebral aneurysm.

McDowell's widow, the claimant, asks workmen's compensation from Clarksville and its insurer (to whom we will refer collectively as employer). The parties have narrowed the case to one question: whether McDowell's activities which we have described constituted a proximate cause of the rupture of the aneurysm and resulting death.

Both sides as well as the trial court agree that an issue of fact exists on that question. A Deputy Industrial Commissioner first heard the claim. In addition to proof of the circumstances we have related, at that hearing claimant offered the deposition of R. A. Caulkins, a medical doctor who attended McDowell at University Hospitals. Dr. Caulkins is board-certified in psychiatry and neurology. His original deposition testimony was not strong for claimant.

At the hearing, the employer offered the depositions of two medical doctors, William F. McCormick, who supervised the autopsy and examined decedent's brain, and Norbert Enzer. Dr. McCormick, board-certified in pathology and neuropathology, teaches at The University of Iowa College of Medicine. Dr. Enzer is board-certified in pathology and clinical pathology. Dr. McCormick testified in his deposition that he could not be reasonably certain of any causal relationship between trauma, stress, strain, or violence and the rupture of an aneurysm, and that no causal relationship existed between present blood pressure and the likelihood of rupture. The employer asked Dr. McCormick his opinion on the causation issue in a hypothetical question incorporating the facts in evidence. The doctor answered, 'I think it is impossible to say with reasonable medical certainty that there is any causal relationship between rupture of the aneurysm and the hypothetical situation.'

When the employer put the phpothetical question to Dr. Enzer, by deposition, that doctor responded, 'It is my opinion that the activities described in your question did not have anything to do with the rupture of the aneurysm.' He stated, 'The relationship of stress, including emotional psychic excitement, these are, I think, within the area of sheer speculation,' and that '(T)he aneurysm of the group that we are dealing with in this case, located in the anterior communicating artery, is remote from the effects of stressful pressure and also remote from even direct violence.'

Before the original hearing closed, the parties stipulated that claimant could ask additional questions of Dr. Caulkins within 60 days. Claimant accomplished this by written interrogatories. She then made the interrogatories and answers a part of the record before the Deputy Commissioner.

Dr. Caulkins' responses to the written interrogatories were stronger than his original deposition testimony. In answer to a hypothetical question incorporating the evidence, he stated, 'In my opinion the rupture of Mr. Robert McDowell's aneurysm was directly related to the activities of the day, namely shoveling sand, filling sandbags and loading sandbags while hurried and under the stress of a natural disaster (flooding).' He also stated, 'In my opinion it is most likely that the rupture of the aneurysm found on the postmortem examination was directly related to the effort of shoveling sand and loading sand with haste and under duress.' He stated that in his opinion 'it is probable that the patient would be alive today had he not worked in the described way with the volunteer fire department.' He quoted a medical publication containing this statement: 'The relationship of environmental events to the onset of SAH (subarachnoid hemorrhage) has been considered. In one-third of the cases, SAH occurred during sleep or repose, and in another one-third it occurred during random activity. Nonetheless, certain specified events showed a higher frequency of association than might be expected. Prominent among those were lifting and bending, emotional strain, coitus and elimination.'

The Deputy Commissioner found as a fact that claimant had established causation, and awarded compensation. The employer petitioned for review by the Industrial Commissioner. See § 86.24, Code 1973.

The Commissioner held a hearing upon the record before the Deputy and the additional testimony of F. Miles Skultety, a medical doctor whom the employer produced as a witness. Dr. Skultety was one of the authors of the first chapter of the medical publication Dr. Caulkins quoted. Dr. Skultety is a board-certified neurosurgeon who heads the section of neurosurgery at the University of Nebraska. The employer put the hypothetical question to him embracing the evidence in the case and asked him the causation question which the previous doctors had answered. He responded, 'I don't believe there was a relationship.' Amplifying, he testified, 'I think that the rupture of an aneurysm is as of the present moment, to the best of my knowledge, and the knowledge that I have gained from such readings as I do and observations of patients, that it is a random event that occurs or can occur at any tiem and that at the present moment there is no evidence to indicate that what the patient is doing at the time precipitates the rupture of the aneurysm.' In answer to the inquiry, 'In your opinion, Doctor, is there any relationship to strenuous physical activity or emotional stress and the rupture of an aneurysm?' he responded, 'Not in my opinion.'

In his decision the Commissioner copiously quoted various parts of the testimony on causation. With reference to Dr. Caulkins' testimony, the Commissioner quoted from the weaker, earlier statements, but did not mention the stronger, later answers to written interrogatories. The Commissioner stated that claimant had the burden to prove her claim by a preponderance of the evidence. He then held, 'Under the evidence presented in this record, the claimant has failed to carry her burden of proof.' He found as a fact that McDowell did not sustain an injury arising out of and in the course of the employment, and he therefore denied compensation.

Claimant appealed to district court on the record before the Commissioner. §§ 86.26, 86.29, Code 1973. On September 13, 1973, the district court filed its decision. The court stated that there was 'a direct conflict in the medical testimony, taking into consideration the...