Transcontinental Ins. Co. v. Crump

• Court: Texas Court of Appeals
• Writing for the Court: John S. Anderson
• Citation: Transcontinental Ins. Co. v. Crump, 274 S.W.3d 86 (Tex. App. 2008)
• Decision Date: 26 August 2008
• Docket Number: No. 14-06-00905-CV.,14-06-00905-CV.
• Parties: TRANSCONTINENTAL INSURANCE COMPANY, Appellant, v. Joyce CRUMP, Appellee.

274 S.W.3d 86

TRANSCONTINENTAL INSURANCE COMPANY, Appellant, v. Joyce CRUMP, Appellee.

No. 14-06-00905-CV.

Court of Appeals of Texas, Houston (14th Dist.).

August 26, 2008.

Rehearing Overruled November 20, 2008.

David L. Brenner, Austin, for appellant.

Peggy M. Campbell, Peter Michael Kelly, Thomas James Barnes, Houston, for appellee.

Panel consists of Justices YATES, ANDERSON, and BROWN.

OPINION

JOHN S. ANDERSON, Justice.

In this worker's compensation death benefits judicial review proceeding, appellant, Transcontinental Insurance Company, appeals a judgment in favor of appellee, Joyce Crump. Finding no error, we affirm the trial court's judgment.

FACTUAL AND PROCEDURAL BACKGROUND

Appellee was married to Charles Crump, a longtime employee of Frito Lay. Mr. Crump worked in the packaging department at Frito Lay and on May 9, 2000, while training another employee, he struck his right knee on a tape dispensing machine. Because his knee injury occurred at work, Mr. Crump sought, and received, workers' compensation benefits from appellant. Beginning with his workplace knee injury, Mr. Crump's physical condition began a downward spiral until he died on January 23, 2001, only eight months after the injury. The overarching dispute in this appeal is whether Mr. Crump's May 9, 2000 knee injury was a producing cause of his death.

A. Mr. Crump's Medical History Prior to May 9, 2000

Mr. Crump received a kidney transplant in 1975. To help prevent his body from rejecting the transplanted kidney, Mr. Crump was prescribed immunosuppressant drugs. While these drugs helped his body to not reject his transplanted kidney, they also made it less likely he would be able to resist an infection if it should occur. In addition, in 1978, Mr. Crump contracted meningitis, and in 1994, Mr. Crump had his gallbladder removed. Despite these medical issues, appellee testified that before Mr. Crump's May 9, 2000 work injury, he was healthy, active, had no problems, and, with the exception of his gallbladder surgery, rarely missed a day from work. Appellee also testified neither she nor her husband were aware he had hepatitis C or any liver or kidney problems. Both medical doctor expert witnesses who testified also confirmed Mr. Crump's medical records did not reveal, besides his transplanted kidney and immunosuppressant therapy, any medical issues immediately prior to the May 9, 2000 workplace injury.

B. Mr. Crump's Medical History From May 9, 2000 Until His Death

After striking his right knee on the tape machine, Mr. Crump came home and was in some pain. According to appellee, Mr. Crump complained his leg was bothering him and he laid around more than normal. Because his leg continued to bother him and he was running a fever, Mr. Crump went to Dr. Khalid Chaudhary about his leg injury on May 15, 2000. Dr. Chaudhary diagnosed a contusion to the right knee and a large hematoma¹ on the inside area of the knee and lower thigh. Dr. Chaudhary prescribed analgesics and antibiotics. With this initial visit to Dr. Chaudhary, Mr. Crump began an eight month medical odyssey that included at least eighty days in three different hospitals, continuous treatment with antibiotics, and finally ended with his death on January 23, 2001.

Mr. Crump saw Dr. Chaudhary three more times because his knee injury would not resolve. On June 6, 2000, because Mr. Crump was complaining of fever and burning pain in his right leg, Dr. Chaudhary, concerned a secondary infection had developed in the contused area of Mr. Crump's right leg, referred him to Dr. Camille George, an orthodpedic doctor.

Mr. Crump saw Dr. George the next day. Mr. Crump complained of increased pain, swelling, fever, and warmth in his right leg and ankle. Upon examining Mr. Crump, Dr. George noted extensive swelling and warmth along his inner thigh, calf, and ankle. Her impression was Mr. Crump had cellulitis² of the right thigh, the same area where the May 9th injury occurred. After conservative treatment failed, on June 14, 2000, Dr. George recommended immediate hospitalization for the administration of intravenous antibiotics and blood cultures.

Mr. Crump was admitted to Polly Ryon Hospital on June 14, 2000, where he remained until he was transferred to Memorial Southwest Hospital on June 23, 2000, for additional investigation. At the time he was transferred to Memorial Southwest, the doctors diagnosed Mr. Crump with cellulitis of both legs, hepatitis C,³ a history of kidney transplant, renal insufficiency, and hemochromatosis.⁴ Mr. Crump was hospitalized at Memorial Southwest from June 23 until June 26, 2000. At Memorial Southwest, the doctors thought Mr. Crump had a broad, opportunistic infection. According to Dr. John Daller, a transplant surgeon and one of Mr. Crump's many treating physicians, opportunistic infections tend to develop in people who are immunosuppressed. Organisms such as bacteria, fungi, or viruses that a normal person would not have a problem with, can make an immunosuppressed person very sick. Dr. Daller also explained the fact a person, such as Mr. Crump, is on immunosuppression therapy can delay the proper diagnosis of an infection. According to Dr. Daller, because a person's immune system is suppressed, the person's body does not react the way a normal person's would and it does not immediately produce pus in the infected area. Thus, the immunosuppression drugs can mask not only the existence of an infection, but also the severity of the infection.

On June 26, 2000, Mr. Crump was transferred to the University of Texas Medical Branch, Galveston ("UTMB") where Dr. Daller had agreed to treat him. At the time he was transferred, the physicians at Memorial Southwest believed Mr. Crump had sepsis or a body-wide infection with persistent fever. The Memorial Southwest doctors believed the source of the sepsis was Mr. Crump's lungs. On July 3rd, a blood culture showed Mr. Crump had a yeast infection, a type of fungal infection. So, in addition to the cellulitis in his right leg, Mr. Crump was now suffering from a yeast infection in his blood. According to Dr. Daller, with an immunosuppressed patient, the effort is to keep the patient balanced between sufficient immunosuppression to avoid rejection of the transplanted organ and, at the same time, avoid infection. When the immunosuppressed patient becomes infected, the balance is tipped and it can lead to worsening organ function. To deal with the yeast infection, Dr. Daller prescribed amphotericin B infusions.⁵ Dr. Daller also testified that, other than the immunosuppression drug therapy, he was not aware of any ongoing health problems Mr. Crump might have been experiencing prior to this May 9th knee injury. When UTMB discharged Mr. Crump on July 13, 2000, he still had cellulitis of his lower right leg, an infection of the blood from yeast, and there was concern the leg infection might include the yeast infection. Also, because of his critical illness (he had spent time in the intensive care unit at UTMB), Mr. Crump suffered a period of renal failure and his liver function had deteriorated because of his infection.

Following his discharge on July 13th, Mr. Crump went back to UTMB from July 22 through July 25, 2000, for angina-like chest pain and again from July 28 until August 4, 2000. During the late July hospitalization, Dr. Steve Weinman, a gastroenterologist, examined Mr. Crump. According to Dr. Weinman, Mr. Crump appeared to be a case of decompensation of HCV-associated cirrhosis of the liver⁶ which was triggered by his recent bout of sepsis/fungemia. According to Dr. Daller, Mr. Crump had chronic liver disease but was functioning well with it before the May 9th knee injury. But, once Mr. Crump injured his knee and developed the infection in his leg, this caused a decompensation, or worsening, of his liver disease.

On September 16, 2000, UTMB admitted Mr. Crump because of swelling in his right lower leg. He would not be discharged until October 3, 2000. During this hospitalization, Dr. Daller determined Mr. Crump had developed an abscess in the area of the May 9th injury. On September 26, 2000, Dr. Daller took Mr. Crump to the operating room where he made an incision and drained purulent material and obtained blood cultures. Because of concern over the possible existence of infection in the wound, Dr. Daller left the wound open to heal from the inside out. This wound had still not healed when Mr. Crump died nearly four months later. The blood cultures taken from Mr. Crump's thigh grew out as histoplasmosis. Histoplasmosis is an airborne fungus endemic to certain areas, including large portions of Texas. A person is normally exposed to the fungus by breathing it, and the fungus then colonizes the lungs and becomes resident flora. Most people exposed to histoplasmosis never develop an infection or any other symptoms; however, people with suppressed immune systems, such as Mr. Crump, are more likely to develop an infection once exposed. Even in people who are immune suppressed, once exposed, they can go years without an infection developing because, according to Dr. Daller, histoplasmosis usually requires a triggering event for an infection to develop. Dr. Daller opined Mr. Crump's May 9th knee injury served as that triggering event. Also, it is possible for the histoplasmosis infection to spread through the body either through the blood or the lymphatic system. Finally, cellulitis can be a side effect of a blood borne infection.

Mr. Crump entered UTMB again between October 13 and October 20, 2000, because of persistent fever and sinus pain. He also went to the Polly Ryon Hospital Emergency Room on October 22, 2000, with a nose bleed. UTMB admitted Mr. Crump again from November 6 until November 18, 2000, because he was experiencing seizures. When UTMB discharged Mr. Crump, his infection had still not resolved as he was taking amphotericin B, an anti-fungal agent, and vancomycin, an antibiotic. The doctors also...