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Linda Mantia v. MODOT

Decision date: April 28, 201526 pages

Summary

The Commission reversed the administrative law judge's decision and awarded compensation for a psychiatric injury sustained as an occupational disease arising from the employee's 20+ years of work as a highway supervisor responding to fatal motor vehicle accidents. The employee's mental stress injury was found to be causally related to extraordinary occupational exposures including witnessing multiple fatalities and traumatic accident scenes.

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Caption

FINAL AWARD ALLOWING COMPENSATION (Reversing Award and Decision of Administrative Law Judge)
Employee:Linda Mantia
Employer:MODOT
Insurer:Self-Insured
Additional Party:Treasurer of Missouri as Custodian of Second Injury Fund
This workers' compensation case is submitted to the Labor and Industrial Relations Commission (Commission) for review as provided by § 287.480 RSMo. We have reviewed the evidence, read the briefs, heard the parties’ arguments, and considered the whole record. Pursuant to § 286.090 RSMo, the Commission reverses the award and decision of the administrative law judge.
Preliminaries
The parties asked the administrative law judge to resolve the following issues: (1) whether employee suffered a psychiatric injury by occupational disease which arose out of and in the course of her employment; (2) whether employer received proper notice of an occupational disease injury; (3) whether employee’s psychiatric injury is medically causally related to her work activities; (4) whether employer is liable for future medical treatment for psychological injuries; (5) whether employer is liable for either permanent partial disability or permanent total disability benefits; (6) whether the Second Injury Fund is responsible for permanent partial or permanent total disability benefits; (7) whether certain portions of employer’s Exhibit 4 are admissible; and (8) whether employer’s Exhibit 6 is admissible.The administrative law judge concluded, as follows: (1) employer’s Exhibits 4 and 6 are admissible; (2) employee did not sustain a mental stress injury that arose out of and in the course of employment; and (3) all other issues are moot.Employee filed a timely application for review alleging the administrative law judge erred in misinterpreting the extraordinary stress standard for establishing mental disability claims.
Findings of Fact
Employee worked for employer for over 20 years as a highway worker. Employee became a crew leader in the early 1990s, and eventually became a supervisor. Employee’s last position was Urban Metro Maintenance Supervisor.Employee’s duties for employer involved assisting and providing traffic control at scenes of motor vehicle accidents on the highways. Early in her career, employee observed accident scenes as often as four times per week. Later, in the 1990s, motorist assist workers began handling the less serious accidents, and employee and her crew responded to only the worst of accidents, which often included fatalities.

In 1987 or 1988, employee responded to an accident where a car was on fire. A little boy was trapped inside the car, and there was no way for employee or anyone else to reach the car or help the child. Employee listened to the child's screams as he burned to death.

In 1989, employee responded to an accident scene and observed the slumped, grayishwhite body of a deceased young man sitting in a car. Employee observed that the young man's eyes were partially open.

In 1990, employee arrived at a single vehicle accident where the victim was ejected and the car rolled over the victim. Employee wasn't paying attention to her feet and, as she approached the scene, accidentally kicked the victim's decapitated head.

In 1991, employee saw a woman jump to her death from the Dougherty Ferry Bridge onto Highway 270. The woman's body bounced after striking the pavement. Employee stopped traffic and called the highway patrol.

In 1992, employee was called to help control traffic at the scene of an accident. Employee observed two mothers dead in the front seats of the vehicle, and watched as emergency responders pulled two children, still alive, from the back seats. Both children appeared to be about 3 years old, and had bandages around their heads and blood spots where their eyes should have been.

In 1993, a coworker with whom employee worked as often as once a week was killed by a drunk driver. The coworker, John Smith, was working on a flashing arrow that needed repair; employee observed him working as she drove past him. Later, as employee approached the same area, she observed ambulances and fire trucks where Mr. Smith had been working.

In 1996, another coworker, Bill Weeda, died after a highway worker backed over him while repairing potholes. Employee responded to the scene and observed Mr. Weeda's body on the ground; his head had been crushed. The worker who killed Mr. Weeda was still sitting in the truck rocking back and forth and incoherent. Employee was tasked with trying to help this young man get out of the truck.

In 1997, employee responded to an accident where the victim's body was thrown from the vehicle and struck several trees. Employee accidentally tripped over the victim's body while distracted by another worker. Later, the victim's wife arrived and grabbed employee and started hugging her and crying.

In 1999, employee responded to an accident where the victim's car hit the end of a guardrail, and the victim was consequently impaled. Employee observed that the victim's hands still gripped the steering wheel, and that her eyes were wide open.

In 2000, employee responded to an accident where a distraught mother began screaming at employee to get her daughter out of the car. Employee was there by herself. Employee went over to the car to see what could be done, and observed that the teenage girl was obviously dead.

In 2001, employee responded to an accident where a dump truck driver was ejected and partially decapitated.

In 2003, employee responded to an accident scene where a driver struck a truck in which her coworkers were riding. The vehicle that struck the truck was unrecognizable, as there was so much debris thrown about the scene. As employee approached, she saw that half of the driver's head was gone.

In 2006, employee responded to an accident where the car had exploded, burning the victim inside. When employee arrived, the air was filled with the scent of burning flesh. The victim was so badly burned that it could not be determined whether the victim was male or female. Employee observed as responders pulled the body from the seat, and as they did so she heard a spongy, squishy noise which she has never been able to forget. Two days later, employee went to the scene to clean the wall where the accident occurred; the victim's grandparents, who drove past the location every day, had requested that something be done. As employee prepared to sandblast the area, she observed fleshy material stuck to the wall.

In 2007, employee responded to an accident where a delivery truck driver lost control of his vehicle and was ejected from the truck. Employee and her crew were called out because there was orange juice, sour cream, and cottage cheese all over the highway. While walking near the scene of the accident, employee stepped on the victim's teeth.

Employee observed approximately 1000 accident scenes during the course of her career with employer. When employee first began responding to accidents involving violent scenes of death and dismemberment, she would get so sick she was unable to eat for a week. As her career progressed, employee coped with the emotional impact of witnessing and interacting with such scenes by assuming a cold, indifferent attitude. Other workers laughed and joked about the carnage they witnessed, and employee eventually found herself doing the same. As one of very few women in her role, employee wanted to avoid betraying any weakness around her male coworkers.

Eventually, employee began to suffer considerable psychiatric symptoms. Employee experienced rapid mood swings and increased irritability, and had trouble controlling her anger. Employee was previously very social but began to withdraw from family and friends. When employee saw accident scenes in person or on the news, she would experience feelings of panic, sweating, shortness of breath, tremors, and nausea. She also suffered from insomnia and disturbing nightmares. Employee was unable to grieve when her mother, father, or favorite uncles died, because her experiences caused her to view a family member in a coffin as something "laying out in the middle of the highway." Transcript, page 95.

Psychiatric treatment

Employee's psychiatric symptoms came on gradually, and she was unaware that anything was medically wrong with her until she saw her primary care physician, Dr. Devon Golding, on February 11, 2008. On that date, employee presented with complaints of feeling shorttempered and intolerant of people, and indicated she couldn't stand being near her family.

Dr. Golding had employee fill out a written test for depression, and diagnosed major depressive disorder. Dr. Golding prescribed Trazodone, Lexapro, and Xanax, and referred employee to Dr. Asif Habib.

Dr. Habib first saw employee on May 1, 2008, and took a history suggesting employee was then suffering from mood swings, low frustration tolerance, and depressive episodes with poor energy, poor sleep, and poor appetite. The note states employee further endorsed symptoms of increased energy, decreased need for sleep, and hyper-talkativeness, but also conflictingly states that employee denied these symptoms. Dr. Habib diagnosed employee with bipolar disorder, most recent depressed type. Dr. Habib's note of that date reflects his decision to "continue" employee on Celexa and Risperdal, despite the apparent absence of any preexisting prescriptions for these medications. Dr. Habib's later treatment notes suggest he instead continued Dr. Golding's prior prescriptions for Lexapro and Xanax, and added new prescriptions for Wellbutrin and Seroquel.

Employee saw Dr. Habib numerous times between May 2008 and September 2009, but stopped going to him because she felt he was not attentive and was overly interested in prescribing medications. Employee also received counseling from Dr. Timothy Jovick, a clinical psychologist, beginning in August 2008 and continuing into 2013. Dr. Jovick talked with employee about her experiences and psychiatric symptoms, and directed employee on therapeutic "field trips" such as forcing herself to drive somewhere she wished to avoid or participating in a group activity.

Employee continues to take Trazodone, Xanax, Wellbutrin, and Lexapro. Employee credibly testified (and we so find) that these medications, as well as psychiatric therapy, have helped to partially relieve her symptoms. Employee continues to suffer from reclusive tendencies and a lack of desire to be around others; she regularly isolates herself by locking herself in her room, sometimes for days at a time. Employee stopped seeking regular treatment with Dr. Jovick because she felt that talking to him caused her to relive her horrific experiences. Employee continues to have nightmares every couple of weeks. Employee avoids accident scenes or any situation or activity (such as watching the news) which might involve seeing an accident scene.

Expert opinion evidence

Employee advances expert testimony from Dr. Jovick, who believes that employee suffered major depressive and posttraumatic stress disorders (PTSD) due to the cumulative stresses attendant upon her position with employer. Dr. Jovick believes employee's nightmares, anxiety, and panic attacks are products of PTSD, and that employee's low selfimage and withdrawal from family and friends are products of major depressive disorder. Dr. Jovick conceded that "it must be kept in mind" that his opinions are those of employee's therapist, and that a "more comprehensive assessment" may be warranted for purposes of adjudicating workers' compensation matters. Transcript, page 362. Dr. Jovick indicated he plans to continue seeing employee in connection with her psychiatric condition, suggesting he believes employee has a need for further psychiatric treatment that flows from her injury.

Meanwhile, employer advances expert medical testimony from Dr. Way

Full decision text continues in the plain-text archive copy.

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