Court of Appeals of Missouri, Western District, Second Division
from the Labor and Industrial Relations Commission
Karen King Mitchell, Presiding Judge, Cynthia L. Martin,
Judge and Gary D. Witt, Judge.
Cynthia L. Martin, Judge.
White ("Patricia") appeals from the Labor and
Industrial Relations Commission's
("Commission") decision denying compensation for
the death of her husband, Ulysses White
("Ulysses"). Patricia asserts that the Commission erred
in concluding that she failed to sustain her burden to prove
that Ulysses's work environment was the prevailing factor
in causing her husband's death at work because: (1) the
Commission improperly applied the prevailing factor test to
her entire case and not just to the issue of injury; and (2)
the Commission arbitrarily ignored lay testimony that would
have coupled with credible expert testimony to establish that
Ulysses's death came from a hazard or risk of employment.
Because the issue to be determined in this case was whether
Ulysses's death came from a risk or hazard unrelated to
employment, and not whether work conditions were the
prevailing factor in causing Ulysses's death, we conclude
that the Commission committed legal error. We affirm in part,
reverse in part, and remand for further proceedings.
and Procedural History
worked for ConAgra Packaged Foods, Inc. ("ConAgra")
for twenty-four years in Marshall, Missouri. At the time of
his death, Ulysses worked in ConAgra's machine shop
making parts for the facility's production line. The
machine shop did not have air conditioning but did have
windows and fans to help cool the building. Ulysses's job
required him to use machinery such as mills and lathes, and
required him to wear a long-sleeved uniform and hard hat.
Ulysses's typical work schedule was from 5 a.m. to 3:00
p.m., six to seven days per week.
30, 2012, Ulysses reported to work for his usual shift.
Ulysses was wearing a leg brace due to a tendon injury in his
foot. When Ulysses arrived at work, he spoke with his
supervisor, Abraham Sellers ("Sellers"). Sellers
warned Ulysses about the forecasted heat that day and asked
Ulysses to watch for signs of heat stress. Sellers informed
Ulysses that there would be a scheduled power outage that
morning and instructed Ulysses to ensure that the waste water
system's pumps restarted following the outage.
began his work day in the machine shop making parts.
Following the scheduled power outage that occurred sometime
between 9:00 a.m. and 9:30 a.m., Ulysses walked from the
machine shop to the waste water system pumps to ensure they
had restarted. Ulysses then walked back to the machine shop,
where he continued his work until taking a thirty-minute
break for lunch at 11:00 a.m.
Ulysses's co-workers found him collapsed on the floor in
the machine shop at approximately 11:45 a.m. Despite
receiving medical attention, Ulysses died the same day. An
autopsy revealed that the cause of Ulysses's death was
"a cardiac arrhythmia resulting from severe coronary
artery disease." The autopsy noted evidence of
pericardial adhesions, coronary artery disease, and
filed a claim for compensation in January 2013, alleging that
Ulysses suffered a "[h]eat stroke and/or cardiac injury
resulting in death" while he was working in
ConAgra's machine shop. During a hearing in front of an
Administrative Law Judge ("ALJ"), Patricia and
ConAgra each presented expert witness testimony about the
cause of Ulysses's death through deposition testimony and
expert witness, Dr. Stephen Schuman ("Dr.
Schuman"), specializes in internal medicine and
cardiology. Dr. Schuman opined that the "work activities
of 06/30/12 were the prevailing factor causing
[Ulysses's] cardiac arrest and death." Dr. Schuman
I would say the physical work he was doing [was the most
important factor that caused Ulysses to have a cardiac event
on June 30, 2012]. When you're operating a lathe,
you're using the upper extremities to some extent.
There's some isometric component to that effort. He was
doing that in a hot environment, and that is a type of
pathologic stress on the cardiovascular system that could
cause ischemia, electrical instability, cardiac arrest. It
can cause infarction, a rise of troponin, those sort of
problems. And if you add in the additional problems,
ambulating with a brace on his leg and whatever discomfort he
was having in the foot and ankle, then that would add to
additional stress, additional increased heart rate, blood
pressure, coronary, tone, et cetera, on his cardiac work,
basically on his cardiovascular system.
. . . .
He was in an indoor environment where it was probably hotter
than outside, the environmental temperature, plus he was
working. He was doing physical effort. There was a component
with his arms working on the lathe. And he would have been
more overheated than the average person with a brace on his
leg, a long-sleeved shirt and a hard hat.
. . . .
[Y]ou dissipate heat from your head. About 25 percent of heat
loss from the body is from the head of the top of the head.
. . . .
[H]e had long pants and long sleeves, and you put that all
together, and he's going to get a little hotter than the
average person in Marshall, Missouri that day who might not
have been dressed -- might have been dressed more for the
weather and might not have been doing physical work.
Schuman acknowledged on cross-examination that Ulysses had
high cholesterol and hypertension. He also acknowledged that
Ulysses had an 80 percent occlusion in the left descending
coronary artery and a 75 percent circumflex occlusion. Dr.
Schuman noted that an occlusion increases the risk of
ischemia if the heart is required to work harder, demanding
more blood flow. However, Dr. Schuman opined that
Ulysses's ischemia was not caused by his pre-existing
conditions, but was instead caused by the stress imposed on
Ulysses by the conditions of his work on the day of his
expert witness, Dr. Michael Farrar ("Dr. Farrar"),
is an adult cardiologist. Dr. Farrar opined that Ulysses
"died of sudden cardiac death related to the prevailing
causes of underlying severe coronary artery disease and
hypertensive heart disease, caused by traditional risk
factors." He explained:
[Ulysses] almost certainly died from ventricular fibrillation
(sudden cardiac death) due to a combination of severe
coronary artery disease and hypertensive heart disease with
consequent left ventricular hypertrophy. Myocardial ischemia
secondary to the above would have resulted in the
arrhythmias. No thrombus was noted in the coronary arteries,
indicating absence of acute plaque rupture and subsequent
myocardial infarction, but this is the case in about 50% of
cases of sudden cardiac death. The finding at autopsy were
caused by traditional risk factors of hypertension,
dyslipidemia, prior cigarette smoking and lack of regular
physical exercise. His poor functional capacity on stress
testing indicating an increased risk of future adverse
cardiac events. His cardiac enlargement and left ventricular
hypertrophy also increased his risk of sudden cardiac death.
Sudden cardiac death is the initial manifestation of coronary
artery disease in about 15% of patients with coronary artery
disease and is certainly common.
Farrar dismissed the possibility of heat as a factor in
Ulysses's death because Ulysses had worked in similar
conditions for many years and was likely acclimated to the
addition to this expert testimony, Patricia testified about
the extreme heat during the week of Ulysses's death. She
testified that the temperature reached 96 degrees at 11:00
a.m. the day before Ulysses died. Numerous exhibits were
admitted, including the depositions of Sellers, Patricia, and
other workers--Pedro Estrada, Jose Sanchez, and Charles
Vandiver. United States Government Weather Station
information regarding the temperature in the area on the day
of Ulysses's death indicated a high of 100 degrees and a
low of 76 degrees.
denied compensation. The ALJ concluded that Patricia
"failed to sustain her burden of proof that [Ulysses]
sustained an accident or occupational disease." The ALJ
observed that both Dr. Schuman and Dr. Farrar "agree
that the mechanism of death was ischemia or lack of blood
flow to [Ulysses's] heart which caused ventricular
fibrillation and cardiac death." And the ALJ observed
that "[b]oth physicians also agree that the coronary
artery could not supply adequate blood to [Ulysses's]
heart." The ALJ then concluded:
While Dr. Farrar does not believe that the temperature was a
factor in the sequence of events leading to Mr. White's
death, Dr. Schuman opines that the physical work at the lathe
in a hot environment could cause ischemia, electrical
instability, cardiac arrest, infarction and a rise of
troponin. However, Dr. Schuman concedes that the prevailing
factor was [Ulysses's] heart having to work harder than
the severely compromised left anterior descending coronary
artery would allow. In other words, [Ulysses's] heart
needed more blood than the left anterior descending coronary
artery which had a blockage of 80 percent could deliver. Even
Dr. Schuman agreed that there was nothing unusual or
different about [Ulysses's] work on June 30, 2012, only
that the heart needed more blood than the artery could
supply. Dr. Farrar and Dr. Schuman's opinion is supported
by the autopsy report which also refers to cardiac arrhythmia
caused by the severe coronary artery disease.
appealed the ALJ's decision to the Commission. The
Commission affirmed the decision of the ...