Opinion
W.C. No. 4-399-491
July 25, 2000
FINAL ORDER
The respondents seek review of an order of Administrative Law Judge Rumler (ALJ) which awarded death benefits. The respondents contend the ALJ erroneously found the decedent's death was proximately caused by the industrial injury. We disagree, and therefore, affirm.
The respondents are liable for the natural consequences of an industrial injury. Vanadium Corp. of America v. Sargent, 134 Colo. 555, 307 P.2d 454 (Colo. 1957). Death benefits are payable to the dependents of a deceased worker where the decedent's death is the proximate result of an industrial injury. Section 8-42-115(1), C.R.S. 1999.
On June 9, 1993, the decedent suffered an admitted back injury. As a result of the injury the treating physicians prescribed narcotic pain relievers. Prior to the injury the decedent had a history of drug abuse. In 1995, back surgery was canceled when testing revealed nonprescription narcotics in the claimant's system. The surgery was rescheduled after the decedent underwent a four week in-patient treatment program for drug abuse. The respondents paid for the decedent's inpatient drug treatment. At the time of his release from the drug treatment program the decedent was still taking prescription narcotics. Following surgery, Dr. Goldstein prescribed Dilaudid. On April 13, 1998, the decedent died as a result of an overdose of prescription and non-prescription drugs.
Dr. Deters, performed an autopsy and was unable to state whether the decedent's death was caused by an overdose of prescription drugs or nonprescription drugs. (Deters p. 25). However, Dr. Deters testified that Dilaudid is a synthetic opiate which is seven to ten times more potent than morphine and highly addictive. (Deters depo. pp. 20, 23). Dr. Deters opined that it is common for patients to develop a tolerance to Dilaudid, such that a higher dosage is required to create the same effect. (Deters depo. p. 23).
Dr. Gendel, an expert in addictive psychiatry, testified that the decedent suffered from an addictive illness which pre-dated the industrial disease. However, Dr. Gendel opined that the decedent had been in remission for at least four years before the industrial injury, with the exception of two periods of relapse. (Tr. pp. 42, 46, 56, 70). He also opined that the opiates prescribed to treat the industrial injury triggered a recurrence of the decedent's addictive illness. (Tr. pp. 59, 69). Further, Dr. Gendel testified that the loss of control over drug use is an essential feature of an addictive illness and that opiate pain relievers such as the ones prescribed to treat the industrial injury are renowned for increasing a patient's tolerance to high dosages of medication. (Tr. pp. 62, 66).
The ALJ found the decedent suffered from an addictive illness which predated the industrial injury. However, the ALJ found that, with the exception of two periods of relapse, the decedent was in remission for several years before the industrial injury. Crediting Dr. Gendel's testimony the ALJ further found that the narcotic medication prescribed to treat the industrial injury triggered the decedent's preexisting addictive illness, which ultimately resulted in his death. Therefore, the ALJ found that the death was the proximate result of the industrial injury.
On review the respondents contend that the decedent's drug overdose was an independent, intervening event which severed the causal connection between the industrial injury and the decedent's death. In support, the respondents assert that the "correct use" of the prescription narcotics could not have caused the decedent's death.
The respondents also contend that this matter is factually indistinguishable from Hines v. American Parts System, Inc., W.C. No. 4-279-291 (March 26, 1998), aff'd., Hines v. Industrial Claim Appeals Office (Colo.App. No. 98CA0719, February 25, 1999) (not selected for publication), where we upheld an ALJ's determination that an injured worker's death from a morphine overdose was not the proximate result of the industrial injury. Therefore, the respondents contend the ALJ erred in finding the decedent's death was the natural and proximate consequence of the 1993 industrial injury. We disagree.
Admittedly, a self-inflicted death or suicide is considered an independent, non- industrial, intervening event which severs the causal connection between the injury and the death. Section 8-41-301(1)(c), C.R.S. 1999. An exception exists where the injury caused a deranged mental condition which is the proximate cause of the suicide. See Dependable Cleaners v. Vasquez, 83 P.2d 583 (Colo.App. 1994). Here, there is no finding or assertion that this decedent intentionally caused his own death.
An accidental death caused by prescribed narcotic medications is compensable if the use of such drugs aggravates an underlying propensity to abuse them. See Larson's Workers' Compensation Law, § 10.09[1](1999). Even where there might appear to have been a substantial quantity of employee fault, a death from narcotic addiction is compensable if the final result was the product of a strong causal force emanating from the employment. The use of drugs in treatment combined with some frailty on the part of the employee in succumbing to an addiction is sufficient to establish the requisite causal connection to the employment. Larson, § 10.09[5].
Whether there is a causal connection between the industrial injury and the death of the decedent is a question of fact for resolution by the ALJ. Hembry v. Industrial Claim Appeals Office, 878 P.2d 114 (Colo.App. 1994). Consequently, we must uphold the ALJ's determination if supported by substantial evidence in the record. Section 8-43-301(8), C.R.S. 1999; Dover Elevator Co. v. Industrial Claim Appeals Office, 961 P.2d 1141 (Colo.App. 1998). Substantial evidence is probative evidence which would warrant a reasonable belief in the existence of facts supporting a particular finding, without regard to the existence of contradictory testimony or contrary inferences. F.R. Orr Construction v. Rinta, 717 P.2d 965 (Colo.App. 1985).
Under the substantial evidence standard we must defer to the ALJ's assessment of the sufficiency and probative weight of the evidence. Rockwell International v. Turnbull, 802 P.2d 1182 (Colo.App. 1990). Furthermore, insofar as the evidence is subject to conflicting inferences, it is the ALJ's sole province to determine the inferences to be drawn. Metro Moving Storage Co. v. Gussert, 914 P.2d 411 (Colo.App. 1995).
The respondents' arguments notwithstanding, there is substantial evidence in the testimony of Dr. Deters, Dr. Gendel and the decedent's spouse to support the ALJ's finding that the decedent's preexisting addictive illness was in remission at the time of the industrial injury, and that the decedent did not resume his drug abuse until he was prescribed addictive narcotics to treat the industrial injury. ( See Tr. pp. 85-87). Consequently, we must uphold the ALJ's determination that the claimants established a causal connection between the industrial injury and the decedent's drug abuse.
Moreover because the ALJ found the decedent's renewed addictive illness was aggravated by the industrial injury, and the decedent's death was the result of a drug overdose, the ALJ could, and did, find that the death was a proximate consequence of treatment for the industrial injury. See Dependable Cleaners v. Vasquez, 883 P.2d 583 (Colo.App. 1994) (death by overdose compensable where injury caused claimant's depression and depression triggered claimant's self-destructive actions); In the Matter of the Claim of Green, 789 P.2d 481 (Colo.App. 1990) (death from heart attack during vocational rehabilitation compensable). Accordingly, it is immaterial whether the "correct use" of the prescription medication would not have caused the decedent's death. See Nunnally v. Wal- Mart Stores, Inc., W.C. No. 4-168-841 (March 30, 1998) , aff'd., Wal-Mart Stores, Inc., v. Industrial Claim Appeals Office (Colo.App. No. 98CA0672, March 18, 1999) (not selected for publication) (ALJ not required to find intoxication "efficient intervening cause" of death where depression caused by work-related injury aggravated claimant's preexisting alcohol abuse).
Accordingly, this matter is factually distinguishable from the circumstances in Hines v. American Parts System, Inc, supra. In Hines, the treating physicians recognized the injured worker's potential for drug abuse and, therefore, designed a treatment plan to de- emphasize the use of narcotic medications. Furthermore, despite evidence the worker obtained symptomatic relief from non-narcotic treatment, he obtained and used unauthorized narcotic prescriptions. The worker was later hospitalized for treatment of pneumonia. Upon release from the hospital the treating physician prescribed time-release morphine. Three days later the worker died from "acute morphine toxicity." In rejecting the claim for death benefits, an ALJ found the worker engaged in "severe narcotic-seeking behavior" before the industrial injury which "continued to exist separate and apart" from the industrial injury. The ALJ also found that the worker's death was not caused by an overdose of medication prescribed to the industrial injury.
IT IS THEREFORE ORDERED that the ALJ's order dated January 12, 2000, is affirmed.
INDUSTRIAL CLAIM APPEALS PANEL
____________________________________ David Cain
____________________________________ Kathy E. Dean
NOTICE
This Order is final unless an action to modify or vacate this Order is commenced in the Colorado Court of Appeals, 2 East 14th Avenue, Denver, CO 80203, by filing a petition for review with the Court, within twenty (20) days after the date this Order is mailed, pursuant to § 8-43-301(10) and § 8-43-307, C.R.S. 1999. The appealing party must serve a copy of the petition upon all other parties, including the Industrial Claim Appeals Office, which may be served by mail at 1515 Arapahoe, Tower 3, Suite 350, Denver, CO 80202.
Copies of this decision were mailed July 25, 2000 to the following parties:
Giovannina Carollo-White and Jessica Amber Carollo-White, 1341 Lima St., Aurora, CO 80010
Platte River Plumbing, 4970 Monaco St., #D, Commerce City, CO 80022
Lana Hessenius, Hawkeye-Security Insurance, P. O. Box 5150, Denver, CO 80217
Kara T. Birkedahl, Esq., 1801 Broadway, #930, Denver, CO 80202 (For Claimants)
Michael Perales, Esq., 999 18th St., #3100, Denver, CO 80202 (For Respondents)
BY: A. Pendroy