Baltimore Cnty. v. Quinlan

Baltimore County, Maryland v. Michael Quinlan, No. 50, September Term, 2018, Opinion by Adkins, J. MARYLAND WORKERS’ COMPENSATION ACT—OCCUPATIONAL DISEASE—LE § 9-502(D)—PARAMEDIC/FIREFIGHTERS—DEGENERATIVE MENISCAL TEARS: Pursuant to Maryland Code Ann. (1991, 2016 Repl. Vol.), § 9- 502(d) of the Labor and Employment Article (“LE”), an occupational disease is only compensable if: (1) it is “due to the nature of an employment in which hazards of the occupational disease exist”; and (2) “it reasonably may be concluded that the occupational disease was incurred as a result of the employment of the covered employee.” Here, the record contained evidence that the nature of the job of a paramedic/firefighter involved hazards that place an employee at greater risk for degenerative knee conditions than those faced by the general public. The employee, Michael Quinlan (“Quinlan”), was a paramedic, and was required to engage in the activities that account for this increased risk. Moreover, he engaged in these activities repetitively over 24 years of employment.

This claim was not shown to involve a concomitant preexisting condition. Therefore, as a matter of law, the degenerative meniscal tears could be considered an occupational disease, and there was sufficient evidence for the jury to reasonably conclude that Quinlan’s degenerative knee tears were compensable. Circuit Court for Baltimore County Case No. 03-C-16-004811 Argued: February 5, 2019 IN THE COURT OF APPEALS OF MARYLAND No. 50 September Term, 2018 BALTIMORE COUNTY, MARYLAND v. MICHAEL QUINLAN Barbera, C.J. *Greene McDonald Watts Hotten Getty, Adkins, Sally D., (Senior Judge, Specially Assigned) JJ. Opinion by Adkins, J. Getty, J., dissents.

Filed: August 26, 2019 *Greene, J., now retired, participated in the Pursuant to Maryland Uniform Electronic Legal Materials Act hearing and conference of this case while an (§§ 10-1601 et seq. of the State Government Article) this document is authentic. active member of this Court; after being recalled Suzanne Johnson pursuant to the Md. Constitution, Article IV, 2020-04-21 10:07-04:00 Section 3A, he also participated in the decision and adoption of this opinion. Suzanne C. Johnson, Clerk “Definitions of ‘occupational disease’ should always be checked against the purpose for which they were uttered.” Arthur Larson, Lex K. Larson & Thomas A. Robinson, 4 Larson’s Workers’ Compensation Law § 52.03[1] (Matthew Bender, Rev. Ed. 2019). The purposes of Maryland’s Workers’ Compensation Act are manifold and, like others, involve a recognition of the many competing interests—“to protect capital and labor, employer and employee, and the State against the waste and distress incident to modern industry . . . .” Liggett & Meyers Tobacco Co. v. Goslin, 163 Md. 74, 80 (1932). Still, we bear in mind the sacrifice and special toll certain Maryland workers withstand in the course of their service.

The present case involves the claim of a veteran paramedic/firefighter regarding degenerative meniscal tears in his right knee. We review two questions, which we have rephrased and consolidated from the questions granted1 for clarity. First, we review 1 The questions, as granted, were as follows: (1) Did the trial court err in denying Petitioner’s motion for summary judgment, given the lack of a clearly defined occupational disease as the basis for the claim and evidence that the conditions were shown to be prevalent in all occupations involving heavy physical labor not uniquely related to the work of a paramedic or EMT as an inherent and inseparable risk? (2) Did CSA err in finding that Respondent met the statutory requirements set forth in LE § 9-502(d)(1) and that he had sufficiently established at trial that his condition resulted from an inherent hazard of his employment as a paramedic or EMT?

(3) Should this Court review the decision below under the statutory requirements and existing case law, particularly Black and Decker Corporation v. Humbert, 189 Md. App. 171 whether the trial court erred in denying the County’s motion for summary judgment, and, if not, whether the trial court erred in finding that Quinlan met the statutory requirements set forth in LE § 9-502(d)(1) that his alleged occupational disease was “due to the nature of an employment in which hazards of the occupational disease exist . . . .” We conclude that the trial court did not abuse its discretion by denying the motion for summary judgment; nor did it err in concluding that Quinlan’s degenerative meniscal tears could be classified as an occupational disease. FACTUAL OVERVIEW AND PROCEDURAL POSTURE In October 2015, Michael Quinlan (“Quinlan”) filed a claim with the Workers’ Compensation Commission (“the Commission”) against his employer, Baltimore County (“the County”). In it, he asserted that he “developed meniscal tears” in his right knee due to his job duties as a “Paramedic/Firefighter.”2 The Commission held a hearing regarding Quinlan’s claims and evaluated, among other things, whether he “sustain[ed] an occupational disease arising out of and in the course of his employment[.]” Ultimately, the Commission disallowed the claim, concluding that Quinlan “did not sustain an (2009), which similarly ignores the legislative requirement that a disease is only occupational if it is “due to the nature of an employment in which the hazards of the occupational disease exist” (LE § 9-502(d)(1)(i)), to provide clarification and guidance on the requirement for establishing a legally sufficient claim for occupational disease? 2 Quinlan described his occupation as consisting of 95% paramedic duties, as opposed to those of a firefighter. Thus, we will refer to him as a paramedic throughout this opinion. 2 occupational disease of the [r]ight [k]nee degenerative tears arising out [of] and in the course of” his employment.

Quinlan then sought review in the Circuit Court for Baltimore County, requesting a jury trial. In appeals from the Commission, the trial court’s role is to determine whether the Commission “justly considered all of the facts,” “exceeded the powers granted to it,” or “misconstrued the law and facts applicable in the case decided.” Md. Code Ann. (1991, 2016 Repl. Vol.), § 9-745(c)(1)–(3) of the Labor and Employment Article (“LE”). The Commission’s decision is presumed “prima facie correct” and the party challenging the decision has the burden of proof.

Id. § 9-745(b)(1)–(2). Prior to trial, the County filed a motion for summary judgment arguing that Quinlan failed to present evidence that his knee injury was an occupational disease or that it was related to the nature of his employment as a paramedic. Quinlan opposed this motion. Based on the parties’ competing submissions, the trial judge denied the County’s motion for summary judgment concluding that there was “absolutely a material dispute of fact.” The case proceeded to trial on April 19 and 20, 2017.

Quinlan, 51 years old at the time, testified first. He began by describing his occupation and the general duties thereof. Over the course of his career, he had served 29 years as a paramedic, the last 24 with Baltimore County. Typically, his schedule consisted of two 10-hour days of work, followed by two 14-hour nights, and four days off.

During these four-day shifts, he stated, paramedics generally “run” 26–30 calls, which last 1–2 hours each. Quinlan also described the activities undertaken on a “typical” emergency call that might impact his right knee, including: climbing in and out of emergency vehicles, carrying up to 50 pounds of gear, 3 crouching to address and service patients, administering compressions or other aid, lifting patients onto stretchers and moving stretchers, and taking patients up and down stairs.3 He also stated that he is “right dominant,” meaning he uses his right leg more often during the above tasks. Quinlan testified that he started experiencing pain and “clicking” in his right knee in 2014, causing him to seek out a doctor. Although he had seen a doctor in 2005 regarding a knee injury, he did not necessarily see the two phenomena as related.

Ultimately, Quinlan underwent surgery to repair his meniscal tears. The parties each introduced the same experts before the trial court as they had used before the Commission. Quinlan presented a video deposition of Barbara A. Cochran, M.D. (“Cochran”), a physician with specialties in internal, occupational, psychiatric, and pulmonary medicine.

Cochran’s testimony was based on her research, her review of Quinlan’s medical records, and her phone examination of Quinlan, although she never physically examined him. Cochran said that Quinlan had a tear in both his medial and lateral menisci. These tears “extend[ed] to the articular surface of the tibia,” which Cochran identified as important because that “is where the bones come together” which can lead to osteoarthritis. Cochran described Quinlan’s meniscal tears as “part of the continuum of osteoarthritis.” Accordingly, she focused on repetitive use as the primary risk factor for 3 In addition to his paramedic duties, Quinlan also testified that he had been a competitive bench press weightlifter, and that he golfed, sometimes sailed, and lived in a home with stairs. 4 his knee issues.

She explained that repetitively using a knee with meniscal tears can lead to osteoarthritis because such use leads to inflammation in the joint that is not healed before its next use. She described this process as a cycle of inflammation, followed by partial healing, followed by inflammation, and so on. Alternatively, the osteoarthritis can contribute to degeneration and tears in the meniscus in a similar manner. She also addressed other risk factors for degenerative knee issues, such as gender, age, weight, genetics, and prior injury.

Quinlan was five feet and nine inches tall and weighed approximately 235 pounds. Cochran stated that gender, age, and weight were unlikely to be the primary factors here because Quinlan’s knee damage was confined to his right knee. Moreover, she opined that Quinlan’s 2005 knee injury likely had no relation to his osteoarthritis based on the symptoms and complaints he presented at the time of his injury. She did not have enough information to address genetics.

Cochran also testified about the relationship between Quinlan’s degenerative knee tears and his occupation as a paramedic. Specifically, she pointed to a study that concluded that paramedic/firefighters have a “relative risk” of developing knee osteoarthritis of 2.93 compared to the general population, meaning that there are 293 cases of degenerative knee tears in paramedic/firefighters for every 100 cases in the general population. Based on this study and her examinations, she concluded that Quinlan’s “essential job functions . . . which include considerable repetitive kneeling, bending, [and] stress on the knee, [were] the cause of his knee osteoarthritis.” Next, the County introduced the video deposition of its expert witness, Richard Hinton, M.D. (“Hinton”), a specialist in orthopedic surgery.

Hinton had examined Quinlan 5 and explained that his knee tears were classified as “complex,” meaning that they could be wholly degenerative or acute tears that degenerated over time. Still, he opined that Quinlan’s other risk factors for knee problems, such as weight and age, were the primary causes of his degenerative knee tears, not his occupation. Specifically, he stated that the “primary or direct cause of [Quinlan’s] meniscus issues”—which Hinton believed contributed to the osteoarthritis—were not “his duties as a firefighter and EMT.” During his physical examination of Quinlan and in making his report, Hinton did not know that Quinlan had sustained an on-the-job acute injury to his knee in 2005. Upon learning of this fact during his deposition, Hinton stated that his “occupational injury . . . could contribute to long-term knee problems.” He later opined that, although Quinlan’s job was not the “primary cause” of his knee problems, it was a “potential” or “arguable” cause of them.

He also recognized that “there is literature to suggest that people who are in firefighter or EMT positions have higher rates of both meniscus tears and of arthritis, as do people in many physically demanding jobs.” The jury returned a verdict for Quinlan, stating that he had “sustain[ed] an occupational disease of right knee degenerative tears of the . . . medial and lateral menisci . . . arising out of and in the course of his employment[.]” During the County’s appeal, the Court of Special Appeals ruled that “Quinlan met the statutory requirements of LE § 9-502(d)(1) by establishing at trial that the degenerative menisci tears were an occupational disease . . . .” Balt. Cty. v. Quinlan, 238 Md. App. 486, 509 (2018). Moreover, it said, Quinlan successfully established that “repetitive kneeling and squatting” 6 are: (1) “a regular part of a paramedic’s job,” and (2) “a risk factor for developing menisci tears . . . .” Id. We granted the County’s petition for writ of certiorari.

DISCUSSION Denial of Summary Judgment Motion We first address the trial court’s denial of the County’s motion for summary judgment. The County argues that the trial court erred in denying its motion for summary judgment because Quinlan’s initial Employee Claim Form listed the occupational disease as “meniscal tears,” but the evidence and testimony at trial involved “degenerative meniscal tears,” which includes the osteoarthritis. The County argues that by “extract[ing]” the meniscal tear claim and excluding any reference to the osteoarthritis, Quinlan avoids “any argument or burden of proof that inter-related conditions, such as ‘osteoarthritis,’ exist and affect the same body part,” and also that the osteoarthritis was in the “nature” of the employment. The County asserts that “[t]he claimant should not be able to avoid its burden by choosing only a portion of the overall ailment” for the claim, thereby avoiding the “burden of proof as to the entire disorder . . . .” Quinlan states that denial of the motion for summary judgment was proper because there was a dispute of material fact as to the cause of the meniscal tears and the “incidence of meniscal tears” in his work as a paramedic.

Typically, we review the denial of a motion for summary judgment for abuse of discretion. See Hous. Auth. of Balt. City v. Woodland, 438 Md. 415, 426 (2014).

There are occasions in which the appellate court reviews non-discretionary matters without deference to the trial court, even on denials of summary judgment. See Presbyterian Univ. 7 Hosp. v. Wilson, 337 Md. 541, 549 (1995) (stating that “to the extent that the issue of personal jurisdiction [was] a question of law, it is not properly submitted to the trier of fact to resolve,” and, therefore, there was “nothing to preclude our review of this issue”). Even so, in the interest of “promot[ing] justice,” the trial court ordinarily “possess[es] discretion to refuse to pass upon, as well as discretion affirmatively to deny, a summary judgment request in favor of a full hearing on the merits; and this discretion exists even though the technical requirements for the entry of such a judgment have been met.” Metro. Mortg.

Fund, Inc. v. Basiliko, 288 Md. 25, 28 (1980) (citations omitted). Such is the case here, so we review the trial court’s ruling for abuse of discretion. Before the trial began, the County filed a motion for summary judgment. In it, the County characterized Quinlan’s claim as one for “an unknown, unnamed, degenerative disease involving his right knee,” which was alleged to have resulted from his work as a paramedic/firefighter.

The County asserted that Quinlan “provided no evidence” regarding: (1) the occupational disease he suffered from; or (2) the disease’s relation to the “nature of his employment” and not some intervening factor. It also submitted Hinton’s medical examination report. Thus, it averred, the County was entitled to summary judgment as a matter of law. In response, Quinlan reasserted his claim that he had sustained “an occupational disease of degenerative tears of the posterior horns of both the medial and lateral menisci of his right knee.” He recounted the duties he undertook as a paramedic that caused the knee condition, including: lifting patients onto stretchers, kneeling to assess patients, and sometimes carrying patients.

These activities occurred consistently over his 26–30 8 emergency calls for each four-day shift. He also points to Cochran’s testimony asserting a causal link between “the meniscal tears and pathology” and Quinlan’s “essential job functions as a firefighter/EMT.” The trial court denied the County’s motion for summary judgment, concluding that there was “absolutely a material dispute of fact.” While the County states that Quinlan did not claim that the meniscal tears were degenerative, the County described the tears as degenerative in its own motion for summary judgment. It is plain that Quinlan had provided evidence regarding his alleged occupational disease and its relation to his employment in the form of the “Independent Medical Opinion and Causation Analysis” from Cochran, submitted to the Commission as part of his initial claim. To the extent that Quinlan had yet to provide evidence that meniscal tears and knee degeneration were within the “continuum of osteoarthritis,” the trial court still maintained discretion to “affirmatively . . . deny[] a summary judgment request in favor of a full hearing on the merits . . . .” Basiliko, 288 Md. at 28 .

The trial court was well within its discretion to deny the motion for summary judgment at this stage. Occupational Disease Preservation of “Sufficiency” Argument Quinlan argues that the County failed to preserve any argument regarding the sufficiency of the evidence by failing to make a motion for judgment pursuant to Maryland Rule 2-519. The consequence of failing to make a motion for judgment is that the party claiming insufficiency of evidence fails to preserve that issue for appeal. See, e.g., Barnes v. Greater Balt.

Med. Ctr., Inc., 210 Md. App. 457, 487 (2013) (“We decline to discuss 9 this issue because GBMC did not raise this issue in its motions for judgment. Instead, it was only raised in the motion for JNOV.”); Kent Village Assocs. Joint Venture v. Smith, 104 Md. App. 507 , 516–17 (1995) (applying Rule 2-519 to exclude appellate issue when argument on motion for judgment as too general).

Assuming without deciding that Maryland Rule 2-519 applies in a jury trial that is part of an appeal to the circuit court from a decision of the Commission, we nonetheless decline to decide this preservation issue. First, Quinlan failed to raise this preservation issue in the Court of Special Appeals. See Scott v. State, 454 Md. 146, 188 (2017) (“[T]o preserve an issue for this Court’s review, a party must raise the issue in the Court of Special Appeals if the case came before that Court.”). Moreover, the arguments made by the County in its brief are largely a bid for the Court to set limitations on what is considered an “occupational disease” within the meaning of LE § 9-502, which involves important legal issues that go well beyond sufficiency of the evidence in this case.

Finally, in the course of addressing the material legal arguments made by the County on appeal, Quinlan prevails. Thus, any issue about preservation of the County’s sufficiency of the evidence argument becomes moot. See generally Md. Rule 8-131. Compensability Under LE § 9-502(d) The parties’ principal disagreement centers around whether degenerative meniscal tears were both “caused” by Quinlan’s occupation as a paramedic and “due to the nature of an employment in which hazards of the occupational disease exist,” pursuant to LE § 9- 502(d).

In interpreting a statute, our overarching objective is to “ascertain and effectuate” the legislative intent underlying it. Shah v. Howard Cty., 337 Md. 248, 254 (1995) (citation 10 omitted). “The primary source from which to determine legislative intent is the plain meaning of the statutory language.” Uninsured Emp’rs Fund v. Danner, 388 Md. 649, 659 (2005) (citation omitted). Indeed, “[t]he language of a statute is its most natural expositor, and, where the language is susceptible of a sensible interpretation, it is not to be controlled by any extraneous considerations.” Victory Sparkler & Specialty Co. v. Francks, 147 Md. 368, 378 (1925) (citation omitted). We generally endeavor to interpret the provisions of the Workers’ Compensation Act, “liberally, where possible, in order to effectuate the broad remedial purpose of the statutory scheme.” Danner, 388 Md. at 659 .

In workers’ compensation cases, “[a]ppeals to the appellate courts are limited strictly to issues of law. . . . [Appellate courts] decide whether the trial court has correctly determined the appeal from the Commission.” Richard P. Gilbert, et al., Maryland Workers’ Compensation Handbook § 16.08, at 16-16 (4th ed. 2013). Therefore, rather than reviewing the factual determinations of the Commission or a circuit court, “to which we would owe deference,” Pro-Football, Inc. v. McCants, 428 Md. 270, 282 (2012), we review the conclusions of law regarding the construction and application of LE § 9-502(d). The County argues that the Circuit Court decision was based on an erroneous construction of the Workers’ Compensation Act, contrary to the plain language of LE § 9- 502. This is especially so, it states, because the Commission’s decision is entitled to a presumption of prima facie correctness.

The County describes the case as involving two distinct questions of law: (1) “whether the specific characterization of the claim was legally sufficient as an occupational disease under LE § 9-502”; and (2) “whether the condition described as ‘degenerative tears of the posterior horn of both the medial and lateral 11 meniscus’ can qualify as a matter of law as an occupational disease for a Paramedic/Firefighter.” Regarding the first question, the County maintains that Quinlan’s characterization of his occupational disease on the initial Claim Form was not legally sufficient. Quinlan, it argues, is attempting to advance an osteoarthritis claim, as well as a meniscal tears claim. Yet, it states that Quinlan never included osteoarthritis in a description of occupational disease, so it should not have been considered by the trial court. As to the second question, the County argues that there are “no inseparable and unavoidable characteristics of the job duties and responsibilities that have been shown to result in ‘degenerative meniscal tears of the right knee’ as the ‘natural and expected result’ of [Quinlan’s] occupation.” Pointing to multiple previous Maryland cases, it states that the present claim lacks a “distinctive employment hazard” associated with Quinlan’s job.

The County also warns that Quinlan’s argument will result in preexisting conditions no longer being a defense or deduction for employers, but now being a “bonus” for employees, resulting in massively increased costs. Instead, the County encourages the Court to look to other Maryland cases, such as Davis v. Dyncorp, 336 Md. 226 (1994), to guide it in this case and reject Quinlan’s claim. Quinlan maintains that the jury was entitled to find that his degenerative knee tears were a compensable occupational disease arising out of and in the course of his employment. He characterizes the County’s argument as asking the court to re-weigh the facts, as opposed to taking issue with the law itself.

Pointing to expert testimony, Quinlan contends there was sufficient evidence that his knee degeneration and meniscal tears are characteristic of his employment, especially considering the occupational disease need not 12 be “unique” to paramedics alone. He also argues that there was sufficient evidence for the jury to find a causal relationship between his occupation and the degenerative meniscal tears. The Workers’ Compensation Act provides compensation for, among other things, “covered employees” who become “partially or totally incapacitated” due to an “occupational disease” acquired in the course of their employment. LE § 9-502(a). “Occupational disease” is defined in LE § 9-101(g) as a disease contracted “(1) as a result of and in the course of employment; and (2) that causes the covered employee to become . . . incapacitated.” Alone, this definition is quite broad, but employer liability is limited when this provision is read in conjunction with LE § 9-502(d).

Under this section, occupational diseases are compensable only if the following statutory conditions are met: (1) the occupational disease that caused the death or disability: (i) is due to the nature of an employment in which hazards of the occupational disease exist and the covered employee was employed before the date of disablement; or (ii) . . . ; and (2) on the weight of the evidence, it reasonably may be concluded that the occupational disease was incurred as a result of the employment of the covered employee. Id. § 9-502(d) (emphasis added). Determining applicability under this section can be divided into two steps. First, the court must identify the professional tasks of the specific employee, remembering that “function outweighs form.” Clifford B. Sobin, 1 Maryland Workers’ Compensation § 7.2, at 197 (2018).

Next, the court determines whether: (a) the 13 “nature” of the employment includes the hazards of the ailment the employee suffers from to a greater degree than that present in general employment; and (b) whether the employee’s job functions expose the employee to those hazards. Id. at 196–97. We have already described the factual evidence presented regarding the tasks Quinlan performed as part of his paramedic role, and we will return to them below. We now move to the second “step” and consider our prior cases and how they contour the edges of what qualifies as a “hazard” within the “nature” of a given employment.

It is useful