Wilson v. Shady Grove Adventist Hospital

DAVIS, Judge. Appellant, Shannon Wilson, appeals from the judgment of the Circuit Court for Montgomery County in favor of appellees, Shady Grove Hospital and Sisco Insurance Company, finding that his left knee condition was not causally related to an earlier work-related accidental injury, reversing the decision of the Workers’ Compensation Commission (WCC). On appeal, appellant presents this Court with two questions, which we have rephrased as follows: ⁵⁷¹ I. Did the trial court err in instructing the jury on the law of proximate cause in a workers’ compensation case?

II

Did the trial court err in submitting to the jury the issue of whether the left knee condition was proximately caused by a pre-existing back injury? For the reasons that follow, we answer the first question in the affirmative and decline to reach the merits of the second question. Accordingly, we reverse the decision of the circuit court. PROCEDURAL AND FACTUAL BACKGROUND Appellant worked for appellee, Shady Grove Hospital, as a psychiatric technician.

His duties included monitoring psychiatric patients, recording their vital signs and progress and, from time-to-time, restraining the patients for their safety. On July 14, 2006, while restraining a patient, appellant fell to the ground and injured his right knee. Accordingly, appellant sought and obtained treatment from Dr. James Weiss, an orthopedic surgeon. Pursuant to Dr. Weiss’ recommendation, appellant underwent surgery on his right knee in November 2006 and again in June 2007.

In May 2007, appellant began complaining of pain in his left knee and Dr. Weiss ordered an MRI of the left knee. Appellant sought approval of the MRI of the left knee from the Workers’ Compensation Commission. A WCC hearing was held on March 31, 2008 on the issue of whether appellant’s left knee injury was causally related to the work-related injury that occurred on July 14, 2006. 1 Before the WCC, appellant testified that, after both of the surgeries to his right knee, he was required to wear a leg brace that immobilized his right leg which, he testified, caused him to favor his left leg, ultimately producing pain in his left knee due to overuse. Appellant also submitted the deposition testimony of Dr. Weiss, which we shall highlight infra.

On April 22, 2008, the WCC issued an Order, finding that “the disability of [appel ⁵⁷² lant’s] left knee and medical treatment is causally related to the aforesaid [July 14, 2006] accidental injury.” Accordingly, the WCC authorized the MRI of the left knee. Appellees appealed the decision of the WCC to the Circuit Court for Montgomery County. A two-day trial was held from December 18, 2008 to December 19, 2008. The crux of appellees’ case in the circuit court was that appellant’s left knee injury was not causally related to the July 14, 2006 injury.

In their opening argument, appellees asserted that appellant had suffered an earlier back injury in 2004 for which appellant had been receiving treatment from Dr. Weiss through 2008. As a result of that injury, appellant experienced numbness and pain running down his right leg and foot and, occasionally, his left leg. Appellees presented the expert testimony of Dr. John O’Donnell, 2 an orthopedic surgeon, who had examined appellant on multiple occasions. Dr. O’Donnell’s opinion was that appellant’s left knee pain was not causally related to “overuse” as a result of his compensation for his right knee injury.

He testified, in pertinent part, as follows: Appellees’ counsel: And Doctor, based upon your experience, your review of the medical records, the diagnostic studies, your physical examination of [appellant], do you have an opinion within a reasonable degree of medical probability as to whether the left knee complaints are causally related to the July 14, 2006 work injury involving a (unintelligible)? Dr. O’Donnell Yes. That they are not related. He wasn’t — he didn’t injure himself.

He didn’t injure his left knee on July 14, 2006. And he had, to my knowledge, no history of an injury on or about that time. ⁵⁷³ Appellees’ counsel: And doctor, again, ... do you have an opinion as to whether or not [appellant’s] left knee complaints are causally related to overuse after having surgery on the right knee, putting more pressure on the left knee, and that’s the cause of his knee complaints? Dr. O’Donnell: Yes, I do____I don’t believe it has anything to do with his right knee. Dr. O’Donnell further testified that, in his opinion, due to appellant’s right knee pain, appellant was more likely to have reduced his amount of physical activity in general.

But he further testified that, even assuming that appellant did not decrease his activity, there was “no evidence in orthopedic literature that increasing activities is bad for you,” and that orthopedists routinely send their patients to physical therapy post-surgery for the very purpose of increasing physical activity in order to strengthen muscles. Thus, Dr. O’Donnell concluded that he did not “believe that favoring the left knee because you can’t put weight on the right would have any influence on this particular problem.” By contrast, appellant’s expert witness and treating physician, Dr. Weiss, testified that appellant’s left knee pain was causally related to the July 14, 2006 injury. Dr. Weiss testified, in pertinent part, as follows: There’s a couple of reasons. One is [appellant] has no known history of knee problems, at least none I’ve ever seen documented prior to his injury.

And he developed left knee problems without any change in the status of his left knee problems without any change in his left knee, meaning there was no interceding injury to his left knee that I’ve ever seen documented. And that he has significant problems with his knee which has forced him to use his left knee to substitute for the function of his right knee to a significant extent and so the only conclusion I can come to is that he never had a problem with his knee before. He did not specifically have an interceding injury to his left knee, and he began to get symptoms in his left knee while he was favoring or trying to recover from his right knee. ⁵⁷⁴ So to me, the cause and effect is ... in that he has consistently complained of the transferring of stress to his left knee and resulting symptoms from his inability to use his right knee. At the conclusion of the evidence, the parties disagreed as to the proper instruction to be submitted to the jury on causation.

Over appellant’s objection, the trial court instructed the jury as follows: “In this case causation means that [appellant’s] work related injury of July 14, 2006, to his right knee, is a cause of the condition of his left knee.” The jury then began its deliberations with a verdict sheet that posed a single question: “Is the disability of the claimant’s left knee causally related to the July 14, 2006 injury?” The jury returned a verdict in favor of appellees. Appellant noted a timely appeal to this Court. Additional facts shall be supplied infra as warranted. STANDARD OF REVIEW In addressing the standard of review that we shall apply in this appeal, we initially observe that this case reached the circuit court in the form of an appeal from the decision of the WCC.

We have previously recognized that appeals from the decisions of the WCC may be reviewed by circuit courts through two different modalities: “The practice is that appeals are presented to trial courts in one of two fashions: (1) the submission of the case to the judge on the basis of the record made before the Commission; or (2) a de novo evidentiary hearing before the court sitting with or without a jury.” Bd. of Educ. v. Spradlin, 161 Md.App. 155, 167 , 867 A.2d 370 (2005) (quoting R.P. Gilbert and R.L. Humphrey, Maryland Workers’ Compensation Handbook, § 17.4, p. 342 (2d ed. 1993)). The appeal in this case proceeded before the circuit court by way of the latter modality with a jury, which has come to be known as an “essential trial de novo. ” Id. at 189, 867 A.2d 370 (explaining that “[t]he reason for these differences between an essential trial de novo and a true trial de ⁵⁷⁵ novo is to be found in the provisions of [Md.Code (2008 Rep. Vol.), Labor and Employment, L.E. § 9-745(b)]”). 3 “[Tjhe de novo jury does not, as might an ordinary jury, render an ultimate verdict but only makes specific findings of fact on specific issues that are carefully framed and submitted to it.” Id. at 190, 867 A.2d 370 . On appeal in this Court, we do not disturb the jury’s determinations of fact. [L.E. § 9-750] provides for appeal to this Court “as provided for other civil cases.” ...

Thus: ‘The verdict of a jury on a question of fact is conclusive on appeal.’ Fowler v. Benton, 245 Md. 540, 545 , 226 A.2d 556 (1967). It is not our function to inquire into the weight of the evidence, rather, we determine only whether there was legally sufficient evidence to support the jury verdict. Temoney v. State, 290 Md. 251, 261-62 , 429 A.2d 1018 (1981); Gray v. Director, Patuxent Inst., 245 Md. 80, 84 , 224 A.2d 879 (1966).’ Keystone Masonry Corp. v. Hernandez, 156 Md.App. 496, 506 , 847 A.2d 493 (2004) (quoting Fraidin v. Weitzman, 93 Md.App. 168, 193-94 , 611 A.2d 1046 (1992)). By contrast, when presented with questions of law, we engage in a de novo review.

Barnes v. Children’s Hosp., 109 Md.App. 543, 553 , 675 A.2d 558 (1996) (citing Heat & Power Corp. v. Air Products & Chemicals, Inc., 320 Md. 584, 591 , 578 A.2d 1202 (1990)). See also Wholey v. Sears Roebuck, 370 Md. 38, 48 , 803 A.2d 482 (2002). LEGAL ANALYSIS I Appellant initially contends that the circuit court erred in instructing the jury on the law of causation in a ⁵⁷⁶ workers’ compensation case. Appellant submitted the following proposed instruction to the trial court: “In workers’ compensation cases, proximate cause means that the accident could have caused the injury and no other efficient cause intervened between the accident and the injury.” Opposing the requested instruction, appellees insisted that “the word ‘could’ ” was problematic, “[b]ecause it does indicate that you can simply rule in that favor in terms of an uncertainty.” The trial court, hesitant to confuse the jury, declined to give appellant’s requested instruction, stating: [T]hat language was written for you and for me and for law professors to sort of think about all this.

But in the requested instruction, if I give it, I have to define the word proximate, I have to define the word accident. I have to define the word efficient. I have to define the word intervening. Because they’re going to say, “what is proximate cause,” or “what is an accident,” or “what is efficient,” or “what does intervene mean?” Thus, the trial court instructed the jury that “[i]n this case causation means that [appellant’s] work related injury of July 14th, 2006, to his right knee is a cause of the condition of his left knee.” Appellant insists that the causation instruction employed narrower language than required in workers’ compensation cases.

Specifically, appellant takes issue with the trial court’s substitution of the phrase “a cause” for “could have caused,” and the omission of the qualifying language regarding the absence of an intervening cause. Appellant contends that the concept of proximate cause in workers’ compensation cases is broader than it is in tort cases. Appellant further avers that the trial court’s modified causation instruction had the effect of improperly shifting the burden from appellees to appellant. Appellees counter that the same concept of proximate cause applies in negligence cases and workers’ compensation cases and that the instruction was proper.

In reviewing a jury instruction, we look to whether the instruction as a whole accurately stated the law. “It is well ⁵⁷⁷ settled that if, when read as a whole, the court’s instructions to the jury clearly set forth the applicable law, there is no reversible error.” CSX Transp. v. Continental Ins. Co., 343 Md. 216, 240 , 680 A.2d 1082 (1996) (citing Nizer v. Phelps, 252 Md. 185, 202-03 , 249 A.2d 112 (1969); Alston v. Forsythe, 226 Md. 121, 135 , 172 A.2d 474 (1961)). See also Goldberg v. Boone, 396 Md. 94, 122 , 912 A.2d 698 (2006). Pursuant to L.E. § 9-101(b), before the WCC, a claimant in a workers’ compensation case must demonstrate a personal injury that “arises out of and in the course of employment.” As former Chief Judge Richard P. Gilbert and Robert R. Humpreys, Jr., Esq. explain in the Maryland Workers’ Compensation Handbook, not only must a claimant establish a work-related accident, but a claimant must also establish a causal relationship between the accident and the resulting injury.

Among other things, a claimant must prove that the benefits which are being sought are causally related to the injury. The claimant must first establish the occurrence of a compensable accidental injury. Once that has been shown, the claimant next must prove that the consequences of the injury “naturally resulted therefrom [i.e., a compensable accident].... ” It makes no difference whether the disability claimed to have resulted from the accident is usual or unusual. If a probable relationship between the accident and the injury is shown, and no other intervening cause is likely to have precipitated the disability, the claimant has proven sufficient causal relationship and eligibility for benefits which are appropriate to compensate for the resultant disability.

R.P. Gilbert and R.L. Humphrey, Maryland Workers’ Compensation Handbook, § 7.02 (3d ed. 2007) (footnotes omitted) (emphasis added). In this case, it was agreed that the July 16, 2006 accident arose out of and occurred during the course of employment. Thus, the only contested issue was the causal relationship between the accident and the left knee condition. ⁵⁷⁸ In support of his contention that the causation instruction was erroneous, appellant directs our attention to Continental Group v. Coppage, 58 Md.App. 184 , 472 A.2d 1014 (1984), a case in which this Court had occasion to review the evolution of the standard of causation in workers’ compensation cases. In Continental Group , an employee sustained work-related injuries to his head and back and the WCC determined that he had a five percent permanent partial disability.

Id. at 185 , 472 A.2d 1014 . Thereafter, the employee sought to reopen his claim because he began experiencing seizures that he claimed were causally related to the earlier accident. The WCC found no causal relationship. Id. at 186 , 472 A.2d 1014 .

The employee appealed to the circuit court and a circuit court jury reversed the decision of the WCC, finding the seizures to be causally related to the earlier work-related injury. Id. The employer appealed to this Court, claiming that the trial court erred in instructing the jury on causation. Id.

The employer requested the following instruction: For purposes of Workmen’s Compensation, ‘proximate cause’ means that the result could have been caused by the accident, and no other efficient cause has intervened between the accident and the result. However, the possibility that injury caused the result for which workmen’s compensation benefits are sought must amount to more than a guess and relation of accident to condition complained of in point and time of circumstance must not be mere fanciful, since law requires proof of probable, rather than merely possible, facts, including causal relationship. Id. The trial court declined to give the requested instruction and instead instructed the jury as follows: The law is that there must be a causal connection between the conditions under which the work is required to be done and the ensuing injury.

In this context, pro[x]imate cause means that, (1) the injury could have been caused by the accident; and (2) that no other efficient cause intervened between the accident and the result. ⁵⁷⁹ Proximate cause has further been defined as follows in one of the leading textbook authorities on Workmen’s Compensation Law. In Pressman, on Workmen’s Compensation, at page 409, under ‘Proximate Cause’, the author stated this: ‘Proximate Cause means that the result could have been caused by the accident, and that no efficient cause has intervened between the accident and the result. But, such a possibility must amount to more than a guess. Medical testimony is not essential where, by other evidence, causal connection may fairly and logically be shown.’ Id. at 186-87 , 472 A.2d 1014 .

The employer contended that the trial court’s failure to instruct the jury that “the law requires proof of probable rather than merely possible facts” was error. Id. at 187 , 472 A.2d 1014 . We affirmed the