A Florida appellate court ruled that a state judge of compensation claims erred when the JCC awarded benefits to a correctional officer under the state’s Heart-Lung statute, which generally provides firefighters, law enforcement officers, correctional officers, and certain others with a rebuttable presumption that heart attacks and pulmonary conditions arise out of and in the course of their employment [Department of Corr. v. Junod, 2017 Fla. App. LEXIS 5231 (Apr. 13, 2017)]. The Court said the JCC had improperly relied upon testimony offered by an expert medical advisor (EMA) who had admitted that he had assumed that Claimant worked as a correctional officer for at least two years before the heart attack at issue, when in fact, the heart attack occurred after only three months on the job. The Court also indicated the EMA improperly bolstered his opinion by relying upon scholarly epidemiological articles written by another physician.
Prior to his hire, Claimant underwent a required pre-employment medical examination that failed to show any existing tuberculosis, heart disease, or hypertension. The exam report noted that Claimant was 5 feet, 8 inches tall, weighed 210 pounds, had elevated glucose, and a family history of heart disease or heart attack. The exam report did not include a lipid panel, which would have indicated Claimant’s cholesterol levels. Nor did it report Claimant’s blood pressure. An electrocardiogram was, however, normal.
Just over three months after beginning work as a correctional officer, Claimant suffered a heart attack while asleep at home. He returned to work within a couple of weeks, however. Thereafter he took an unrelated job with another employer, but was rehired by the correctional facility.
Four years and eight months after the heart attack, Claimant sought workers’ compensation benefits, contending that until one month before filing his claim, he did not know that his heart attack might be covered under the heart-lung statute. The JCC accepted this explanation and the case moved forward.
Expert Medical Opinions
Claimant’s independent medical examiner (IME) reviewed Claimant’s records without examining him and concluded that he was unable to determine the cause of Claimant’s heart attack. The employer’s IME reviewed the records, examined Claimant, and concluded within a reasonable degree of medical certainty that Claimant developed atherosclerosis over a period of years prior to his employment as a correctional officer, and that the atherosclerosis in turn was caused by Claimant’s multiple risk factors unrelated to his employment. The employer’s IME concluded within a reasonable degree of medical certainty that these factors, and not Claimant’s employment, caused Claimant’s heart attack.
While technically there was no actual conflict between the IME opinions, the parties agreed to the appointment of an EMA who concluded that the predominant etiology of the heart disease was work-related, in spite of the fact that Claimant had several coronary risk factors traditionally associated with coronary artery disease.
The EMA examined Claimant five years and four months after the heart attack. On cross-examination, the EMA admitted that when he examined Claimant and prepared the EMA report, he did not know that Claimant had worked as a correctional officer for only about three months before the heart attack. Instead, he assumed Claimant had worked as a correctional officer for “several years” or about “2 years” after passing his December 2008 pre-employment physical.
The EMA also opined that Claimant’s heart attack was work-related based on several articles by another doctor that described epidemiological studies covering only police officers and firefighters. The EMA acknowledged that the articles did not cover correctional officers, and he knew of no studies that did pertain to correctional officers, but the EMA considered the articles analogous based on his own experience.
Presumption was Rebutted
The appellate court indicated the employer had successfully rebutted the heart-lung presumption. Claimant’s IME had offered no opinion. The employer’s IME testified with the requisite degree of medical certainty that Claimant suffered from multiple pre-existing risk factors that, alone or in combination, caused Claimant’s atherosclerosis and resulting myocardial infarction. He excluded any work-related causes.
The court added that the EMA’s opinion lacked an accurate factual basis and, as indicated above, had relied on improper bolstering. The JCC’s decision was reversed and the case remanded for entry of a judgment in favor of the employer.