NC Employee’s Injuries From Fainting After Toking on E-Cigarette Did Not Arise From the Employment

The North Carolina Court of Appeals affirmed the denial of workers’ compensation benefits to a city employee who sustained serious injuries to his right hip, back, and head when he passed out and fell to the ground after getting choked on an e-cigarette [Brooks v. City of Winston-Salem, 2018 N.C. App. LEXIS 504, COA17-1208 (May 15, 2018)]. Noting that at the time of the injury the employee suffered from extremely elevated blood pressure and blood sugar levels and experienced a vasovagal response triggered by uncontrolled coughing, the court drew a sharp distinction between an unexplained fall, which generally is said to arise out of and in the course of the employment, and an idiopathic fall, which does not.


Brooks was employed as a Senior Crew Coordinator in the city’s Utilities Department. On the date of injury, Brooks and his crew decided to take their lunch break at a Sheetz gas station located near where they were working. Brooks ate in a city utility truck while the remainder of the crew sat at a table outside the gas station premises.

Near the end of the lunch break Brooks went into the station and purchased an electronic cigarette, a type of cigarette he had never smoked. Returning to the truck, he ignited and took several puffs. He testified it “cut off [his] wind” and he began to cough uncontrollably. He opened the truck door and stepped out of the truck to get some air, all the while continuing to cough. He then passed out and fell to the ground, sustaining his injuries.

When EMS technicians arrived, they recorded Brooks’ blood pressure as 194/120. His blood sugar level as 312, both of which are extremely elevated readings. Later, at an urgent care facility, Brooks’ BP measured 182/112, still abnormally high. Brooks told the medical staff there that he was diabetic and had been “off his medicine” for approximately six months.

A medical expert said that extremely elevated blood pressure and blood glucose readings, such as those experienced by Brooks at the time of the injury, can cause a person to pass out. The expert also testified that when a person coughs uncontrollably, he or she can pass out from a vasovagal response. The expert opined that in Brooks’ situation, he fainted likely because of a combination of the three factors.

Commission’s Decision: No “AOE/COE”

The Commission concluded that because no risk or hazard incident to Brooks’ employment duties combined with his idiopathic conditions to contribute to his injuries, his accident did not arise out of his employment and, therefore, was not compensable.

Court of Appeals: “Idiopathic” Must be Distinguished from “Unexplained”

The appellate court said the doctrine of unexplained falls was not applicable in this case. It acknowledged that Brooks would not have been at the gas station but for his job, but that was not the issue. According to the Court, Books’ own actions and idiopathic condition were the sole forces causing his injuries.

The Court noted that when a fall is unexplained, and the Commission has made no finding that any force or condition independent of the employment caused the fall, then an inference arises that the fall arose out of the employment. Here, however, the Commission had expressly found that Brooks’ idiopathic condition was the sole cause of his fall. His fall was not “unexplained.”

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