In American Medical Response et al., v. Workers’ Compensation Appeals Board and Ronald Westerman, an unpublished opinion, the Second Appellate District reviewed a WCAB’s finding that the respondent, a former paramedic, sustained a stroke arising out of and in the course of employment. The WCJ in that case found that the paramedic was entitled to temporary disability and that he was permanently totally disabled.
That case involved a paramedic who suffered a stroke while at home, following a 36-hour work shift. The evidence showed that his job was stressful, involved long hours, required heavy lifting, and required significant periods of time during which he was sedentary. Additionally, he was 50 years old and may have been overweight at the time of the stroke. The evidence showed that he required home healthcare assistance and was not able to have gainful employment.
The injured worker’s treating physician determined that the stroke had an industrial component and that it could have been causally affected by hypertension, diabetes, hyperlipidemia and other stressors. A qualified medical examiner, however, concluded that the stroke was caused by a blood clot that traveled through a hole in the heart to the brain, but rejected as speculation the treating physician’s theory that hypertension, diabetes, stress and weight gain caused the stroke. The medical examiner stated that a “paradoxical embolus” brought about the stroke, conditional on the existence of a hole in the paramedic’s heart. He contended that a diagnostic test—specifically, an echocardiographic shunt study—could determine the existence of this defect in the atrial septum. The examiner also testified that, to a reasonable medical probability, the injury was industrial, based on the assumption that the paramedic had an intracardiac shunt.
The WCJ found that the stroke arose out of and in the course of employment. The WCJ also accepted the medical examiner’s conclusion that non-industrial causes of the stroke had been ruled out and that it was due to a paradoxical embolus.
The employer’s petition for reconsideration argued that the medical examiner’s opinion and conclusion did not amount to substantial evidence without the diagnostic test. It further contended that it had “authorized and agreed” to pay for the echocardiogram shunt test, but that the paramedic’s wife, as guardian ad litem, refused to allow the test based on her husband’s fragile health.
The WCJ recommended denial of reconsideration, rejecting the argument that the medical examiner’s diagnosis had to be supported by the echocardiographic shunt study. The WCJ stated that the diagnostic test was an invasive procedure and that the injured worker’s wife was justified in not agreeing to it. Moreover, the WCJ found that only reasonable medical probability, not reasonable medical certainty, was the standard for whether the injury was industrial.