Tigue v. Caddo Minerals Co., 5--6209

• Decision Date: 05 March 1973
• Docket Number: No. 5--6209,5--6209
• Parties: Leroy TIGUE, Appellant, v. CADDO MINERALS COMPANY et al., Appellees.
• Court: Arkansas Supreme Court

Page 574

491 S.W.2d 574

253 Ark. 1140

Leroy TIGUE, Appellant, v. CADDO MINERALS COMPANY et al., Appellees.

No. 5--6209.

Supreme Court of Arkansas.

March 5, 1973.

Rehearing Denied April 9, 1973.

Hugh L. Brown, Little Rock, for appellant.

Wright, Lindsey & Jennings, Little Rock, for appellees.

JONES, Justice.

This is an appeal by Leroy Tigue from a circuit court judgment affirming a denial by the Workmen's Compensation Commission of Mr. Tigue's claim for compensation benefits. The question before the Commission was whether Mr. Tigue's chronic diarrhea was the result of antibiotic medication he received in the course of surgery and treatment for a ruptured disc sustained in the course of his employment by the appellee-employer, Caddo Minerals Company. The question before us on appeal is not whether there is substantial evidence in the record to sustain Mr. Tigue's claim; the question before us on this appeal is whether there is any substantial evidence to sustain the Commission's finding in favor of the employer. Arkansas Foundry Co. v. Cody, 251 Ark. 57, 470 S.W.2d 812. In arriving at an answer to this question we must give the evidence its strongest probative force in favor of the Commission's findings. Bentley v. Henderson, 251 Ark. 203, 471 S.W.2d 548.

The facts in this case appear as follows: In January, 1966, the appellant-claimant, Leroy Tigue, sustained a compensable injury resulting in the surgical removal of a ruptured disc. Mr. Tigue was given some antibiotics in connection with the disc surgery and within a few days after he was released from the hospital he developed a rather severe case of diarrhea. He attempted to control the diarrhea with Pepto-Bismol and other patent medicines and he was seen and treated for the condition by Dr. Jones, his hometown physician, for approximately two years. Following the onset of Mr. Tigue's diarrhea it was necessary for him to have another disc operation which was performed in December, 1967. The evidence indicates that the diarrhea would subside during periods of hospitalization or bed rest, but would recur at frequent intervals of from one to seven days duration when Mr. Tigue was up and about. The usual episodes were described as beginning about midmorning with intense abdominal pain followed by loosely formed or fluid bowel movements growing smaller and smaller in amounts and terminating in the passage of mucus which usually contained blood.

The issues before the Commission were apparently confined to whether or not Mr. Tigue's present diarrhea, which has become chronic, is a continuation of the diarrhea he suffered following his first disc operation and more particularly, whether the diarrhea was caused by the medication administered to him during the course of his disc operation. It was Mr. Tigue's theory and contention that the antibiotic therapy administered during the course of his disc surgery destroyed the normal bacteria in his intestinal tract resulting in the growth of yeast and the chronic diarrhea. The Commission, in effect, found that Mr. Tigue had failed to prove that his chronic diarrhea was a result of his antibiotic therapy and his claim was denied.

Mr. Tigue testified that his diarrhea was at its worse stage when he first went to Dr. Garratt of Hot Springs in the spring of 1967; that his condition improved under the treatment of Dr. Garratt but then 'just seemed to reach a standstill.' He testified that he has experienced no improvement in the condition since sometime in 1968.

Two medical bills from Dr. W. J. Jones were introduced in evidence. One of them dated June 12, 1967, shows a diagnosis: 'Diarrhea of undetermined etiology--Duration of 5 months.' The subsequent bill dated August 14, 1968, indicates the same diagnosis and contains the statement: 'This patient was referred to Dr. Burton for further treatment on the above diagnosis on March 1, 1967.'

Apparently Mr. Tigue was seen and examined by Dr. Frank M. Burton of Hot Springs who in turn referred him to Dr. Charles E. Garratt. After a considerable period of treatment by Dr. Garratt, Mr. Tigue was referred back to Dr. Burton for additional examinations requiring hospitalization. There is no report or testimony from Dr. Burton as to his initial examination of Mr. Tigue, but in the October, 1971, deposition of Dr. Garratt he testified that he first saw Mr. Tigue March 8, 1967, upon referral from Dr. Burton, and at that time Dr. Burton reported he found no problem in the colon and that the stool showed only yeast cells.

Under date of May 13, 1967, Dr. Garratt reported to adjuster White as follows:

'X-ray examination of colon by Dr. Burton was reported to be negative and stool examination showed no parasites or ova of parasites. Yeast was found.

There was a history of a large amount of antibiotic therapy by mouth following surgery in another city for a ruptured disc in the lumbar spine. Prior to this the bowel pattern had been normal.

He stated that he had a high fever for some days following surgery and presumably the antibiotics were used to combat infection.

Mr. Tigue is gradually improving, to the extent of going for several successive days without bowel disturbance. He has not completely recovered and comes to the office now about once a week.

He has been told the nature of his trouble which probably is the bacterial flora change subsequent to antibiotics.'

Later, on March 18, 1968, Dr. Garratt reported to Mr. Tigue's attorney in part as follows:

'It is my opinion that Mr. Tigue's complaint originated from the use of antibiotics given following the original surgery on his lumbar spine. The condition which followed is an irritable colon manifested by attacks of frequent stooling with accompanying inflammation and tenderness of the membrane of the anal outlet. The chronicity of the annoying problems has tended to make the patient nervous, and oftentimes, weak.

The basic situation which was set up is an irritable colon. As a progress report, he has shown gradual improvement which has been interrupted at irregular intervals by acute attacks of diarrhea. These attacks have been of late less frequent and he has had relative freedom from the symptoms for periods as much as two consecutive weeks.'

While in the Baptist Hospital in Little Rock from July 14, 1966, through July 23, 1966, Panalba, an antibiotic, was given to Mr. Tigue on July 18 and the same medication was continued for three days. It was discontinued on July 21.

The deposition of Dr. Garratt was introduced into evidence. He testified that the only abnormalities in Dr. Burton's findings, as reported to him, were watery stool and blood and yeast cells. Dr. Garratt then testified as follows:

'Q. I believe you did mention that yeast was found in examination?

A. That's right.

Q. What is the significance--

A. * * * yeast is a secondary invader and comes at, oftentimes when the normal bacteria in the intestine have been killed or depleted, the yeast begins to grow in abnormal amounts.

Q. Was there an abnormal amount of yeast found on this examination?

A. Dr. Burton didn't say. He just said yeast cells.

Q. Would you normally expect to find some yeast cells?

A. As a rule, not enough for comment unless they were in excess. You wouldn't comment on them unless they are in excess.

Q. You assume there was some unusual level of yeast cells at the time of the examination?

A. That's right.

Q. All right, sir. Did you conduct any other type of examination, make any other findings which are noted in your records?

A. You mean of this initial--

Q. * * * on the initial examination.

A. No, sir.

Q. All right, sir. Did you come to any conclusion at that time what the cause of Mr. Tigue's problem was, his diarrhea?

A. Taking into account the laboratory work which had been done I based my conclusion on the fact that his antibiotics had destroyed the normal flora of bacteria in the bowel and produced dysentery or diarrhea.

Q. What are some of the other possible causes of diarrhea, of chronic diarrhea such as Mr. Tigue was experiencing?

A. Tumor, parasites, laxatives, irritants, that may be taken by mouth. That pretty well covers it.

Q. Irritants which may be taken by mouth?

A. That would be in the form of irritant laxatives.

Q. What about nerves, muscular problems, can that sometimes cause diarrhea?

A. Yes.

Q. Now, is there any way, Doctor, to positively determine that the normal flora or balance in the intestine has been upset by antibiotic therapy?

A. I do not know of one. It's an assumption to some extent but all of us have seen it so frequently that we look for it when patients develop a diarrhea during antibiotic therapy.'

Dr. Garratt testified that he had treated other patients suffering chronic diarrhea as a result of antibiotic therapy and that 'all of them either responded and overcame the problem in a shorter time than Mr. Tigue or else some other problem was found to be the background of the trouble.' He testified that Mr. Tigue's case was definitely unusual in that it was of much longer duration than he had ever seen. Dr. Garratt then testified that the antibiotic drug 'Lincocin' is an antibiotic having tremendous power to kill bacteria and unfortunately that type of medication kills the favorable as well as the unfavorable bacteria. He testified that the bacteria in some people might be highly sensitive to antibiotics and in others not so sensitive, and that the quantity of antibiotics necessary to kill the bacteria differs tremendously with individuals. Dr. Garratt then testified as follows:

'Q. All right, sir. Doctor, in those cases which, in your experience you have dealt with chronic diarrhea resulting apparently from antibiotic therapy and where no other contributing cause was found can you tell us what the average time of recovery is excluding Mr. Tigue's case?

A. Yes. His case is unique. It might be anywhere from three weeks to three months.

Q. But three months in your experience pretty much would have been a...