“White Coat” Syndrome Could Explain Isolated Reading
As do a number of states, Florida provides a specialized presumption of compensability favoring certain law enforcement officers [see § 112.18(1), Fla. Stat.]. To take advantage of the presumption, a Florida claimant must show, among other things, that he or she successfully passed a pre-employment physical examination that “failed to reveal any evidence of such condition” [emphasis added]. A divided Florida appellate court recently held that an isolated elevated blood pressure reading at an officer’s pre-employment physical examination did not constitute evidence of the condition of hypertension [City of Tavares v. Harper, 2017 Fla. App. LEXIS 15183 (1st DCA, Oct. 24, 2017)]. The reading could have been explained by, among other things “white coat” syndrome—when elevated BP is observed only in a medical setting.
Claimant’s 2007 pre-employment physical examination report listed a single blood pressure reading of 140/60, which, according to the unrefuted medical opinions in the record, is considered high. The condition of hypertension, however, was not noted in the claimant’s report; in fact, the findings were described as normal. Furthermore, medical records documenting the claimant’s medical history from 2001 through the end of 2015 did not reveal any reference to hypertension or to any other elevated blood pressure readings.
Ultimately, the JCC found that the pre-employment physical examination did not show evidence of the condition of hypertension and concluded that the claimant was entitled to rely on the statutory presumption. The JCC relied on the opinion of claimant’s IME, who testified that there was a distinction between a single isolated measurement in the hypertensive range and the actual disease process of hypertension. In the doctor’s opinion, one high blood pressure reading could be evidence of hypertension; however, the doctor also testified that he found it “hard to believe” that the 2007 reading actually represented hypertension.
Employer: One Abnormal Reading = “Any Evidence”
The employer argued that the plain meaning of “any evidence” would include the one reading since “evidence” was broadly defined as anything. including testimony, documents, and tangible objects, that tended to prove or disprove the existence of an alleged fact. The employer added that even a false positive would also qualify as “any evidence.”
“Eviscerate the Presumption
The majority disagreed, noting that such use of “any evidence” would “eviscerate the statutory presumption” [ 2017 Fla. App. LEXIS 15183] and ignore the second part of the relevant portion of the statute which required that the evidence relate to the listed condition. Here, claimant was not diagnosed with hypertension until 2016.
The majority continued that its reading of the statute was consistent with its decision in Talpesh v. Village of Royal Palm Beach, 994 So. 2d 353, 354-55 (Fla. 1st DCA 2008), in which the JCC ruled—and the First District Court of Appeal affirmed the finding that the presumption under § 112.18(1) did not apply to that claimant’s coronary artery disease because the pre-employment examination revealed high blood pressure. Here, the findings of fact similarly established that the pre-employment examination failed to reveal the specific listed condition: i.e., hypertension.
Chief Justice Thomas dissented, arguing that the majority misinterpreted the statute by conflating the concepts of weight and admissibility. The chief justice added that there was no argument that the claimant’s 2007 blood pressure measurement was somehow unreliable, improperly read or invalidly administered; instead, the weight of the reading was disputed by the claimant. According to the chief justice, both the majority opinion and the JCC superimposed the requirement of a diagnosis in the statutory exclusion. Whether the claimant’s reading was a product of “white-coat” syndrome or any other non-hypertensive source, even if true, was irrelevant under the statute, wrote Chief Justice Thomas, because:
- The record contained the claimant’s pre-employment physical, which showed a reading of high blood pressure;
- Such a reading was an indication—i.e., “evidence”—of the existence of hypertension, although doctors could disagree as to how much weight to give this evidence; and
- The statute did not require any specific quantum of evidence to disallow the statutory presumption.
Finally, the chief justice argued that the majority opinion’s reliance on Talpesh was misplaced, because in that case, this court correctly held that high blood pressure is not, by its nature, medical evidence of coronary artery disease or heart disease. While high blood pressure may or may not be evidence of heart disease, it is evidence of hypertension [emphasis added]. Therefore, this court should have reversed with direction that the statutory presumption did not apply here as a matter of law.