Thomas v. Salvation Army

562 So. 2d 746, 1990 WL 61926
CourtDistrict Court of Appeal of Florida
DecidedMay 14, 1990
Docket89-1188
StatusPublished
Cited by14 cases

This text of 562 So. 2d 746 (Thomas v. Salvation Army) is published on Counsel Stack Legal Research, covering District Court of Appeal of Florida primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Thomas v. Salvation Army, 562 So. 2d 746, 1990 WL 61926 (Fla. Ct. App. 1990).

Opinion

562 So.2d 746 (1990)

Margaret THOMAS, Appellant,
v.
The SALVATION ARMY and Liberty Mutual Insurance Co., Appellees.

No. 89-1188.

District Court of Appeal of Florida, First District.

May 14, 1990.
Rehearing Denied July 5, 1990.

*747 C. Randal Morcroff, Deerfield Beach, for appellant.

Anthony J. Beisler, III, P.A., Fort Lauderdale, for appellees.

JOANOS, Judge.

Claimant in this workers' compensation case appeals an order of the judge of compensation claims denying payment of medical bills for treatment of claimant's high blood pressure and ulcer condition. The issues for review concern the propriety of the judge's rejection of medical testimony that claimant's high blood pressure is causally related to her industrial accident, and of the finding that claimant's ulcer condition is not related to her industrial accident. We reverse.

The record reflects that claimant suffered a back injury resulting from a fall on a cobblestone floor at work on April 15, 1988. Because claimant did not think her injury was serious, she did not seek medical help until three weeks later, when one morning she found herself unable to get out of bed. When informed that claimant was unable to work, the insurance carrier had her examined by an orthopedic surgeon. However, claimant continued to see Dr. Preste, the internist who is her family physician.

On November 16, 1988, claimant filed a claim for benefits, seeking authorization of, and payment for, Dr. Preste's treatment of her high blood pressure and ulcer condition. The carrier defended on the ground that the blood pressure elevation and ulcer condition were not causally related to the industrial accident or its treatment.

Dr. Preste's deposition reflects that he treated claimant on May 16, 1988, one month after her fall at work. At that time, claimant had diffuse muscle spasms in her back and neck. Dr. Preste found claimant's blood pressure borderline at that time, i.e., elevated, but not requiring medication. He prescribed Darvocet, and a return visit if the problems persisted. Claimant continued to have pain, and new prescriptions were ordered.

On August 17, 1988, claimant returned to Dr. Preste for treatment of a cold. At that time, claimant advised Dr. Preste that she had been to an orthopedist and had been diagnosed as having lumbar disc disease. Claimant returned to Dr. Preste on September 19, 1988, complaining of an upper respiratory infection, and of severe epigastric pains. Dr. Preste's physical examination revealed epigastric tenderness that accorded with clinical findings suggesting gastritis, inflammation, or ulcer. In addition, claimant's blood pressure was significantly elevated, so Dr. Preste started claimant on medication for hypertension at that time.

A reading of Dr. Preste's testimony indicates a reluctance to use, or an unfamiliarity with, the terminology normally employed in determining whether there is a causal relationship between a claimant's industrial injury and medical problems that develop afterward. For example, when claimant's counsel asked Dr. Preste whether he had an opinion, based on reasonable medical probability, as to whether claimant's ulcer problem and blood pressure problem were related to her industrial accident, the following responses were elicited:

If I might indulge you and let me paraphrase your question, you're asking me, *748 could her elevation in blood pressure from the first time I have it recorded to September 19th have been elevated because of her conditions that we were seeing her for, and I would have to say yes, I [sic] could be. Let me just make a qualifier here. Whether it was acutely elevated that day because of her pain, and then the next day she was on pain medication and it was back down, it's for conjecture, but yes, stress, anxiety can aggravate blood pressure.
Q. I have to ask you to understand precisely the questions being asked because in the legal context, the use of the word could as you have answered the question, would denote possibility. It's possibly caused by or related to. My question is specifically: Could you state within reasonable medical probability which means more likely than not, that the blood pressure elevation was probably related to the history and the subsequent treatment or the medications. Can you say that within probability, or is it your testimony that it is merely possibility?
A. I hate to be into words. I think it's a little more than possible. I think it would be between sixty and ninety per cent that her blood pressure was elevated due to her condition. (Emphasis supplied.)
.....
Q. Let me repeat my former question then. We now have the medical documentation in your own chart that she did have an acute peptic ulcer, correct?
A. Correct.
Q. The question is: Do you have an opinion whether or not the development or the aggravation of that peptic ulcer was in some way causally related to the industrial accident at work?
A. In my medical opinion, taking care of Margaret and getting to know her, yes, it could have causally been related.
Q. And again —
A. Let me —
Q. Okay.
A. And most likely was related to recent stress and tension from her accident — excuse me — from the pains involved secondary to her accident.

During cross examination, when asked whether claimant is a "high strung" individual, Dr. Preste said that she was more anxious in the period from May to September 1988 than he remembered her being from prior visits. Employer/carrier's counsel elicited the following responses from Dr. Preste concerning the causal relationship issue:

Q. During this entire time that you treated her, was the blood pressure at this slightly elevated stage?
A. When she was initially seen, it was slightly elevated, and it had that one peak, and we placed her — because of the elevation of the diastolic which is severe hypertension — meets the criteria for severe hypertension on a minimum, moderate, severe basis which is greater than one ten diastolic, and I treated her at that one peak, and she had normal blood pressure on several occasions afterwards.
Q. Now, you indicated that you felt that sixty to ninety per cent of this elevated blood pressure was due to her condition, and what do you mean by her condition?
A. Her increasing and more recent stress and anxious state.
.....
Q. And the ulcer, if I understand your testimony, you say that it could or that it medically probably is related to the industrial accident?
A. Probably related to the stress, anxiety from the pain secondary to the industrial accident.
Q. Has nothing to do in your opinion with the medications or anything else? If it has a relationship, it has a relationship through what you perceive as stress and anxiety this woman feels, is that it? Is that a fair summation of —
A. I'm not sure I follow what that summation represents —
Q. Stress, tension, anxiety and the lady is uptight, and that's probably what's causing her ulcer, and that's all because of this slip and fall at work?
A. Yes.

*749

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Bluebook (online)
562 So. 2d 746, 1990 WL 61926, Counsel Stack Legal Research, https://law.counselstack.com/opinion/thomas-v-salvation-army-fladistctapp-1990.