Arkansas Court Approves Award of Additional Medical Expenses Related to ER Visit Six Months After Initial Injury

An Arkansas appellate court affirmed a finding by the state’s Workers’ Compensation Commission that an employee was entitled to additional medical benefits when, some six months after an ankle injury, he presented to an emergency room complaining of shortness of breath and dyspnea [see Centria, Inc. v. Bailey, 2015 Ark. App. 271, 2015 Ark. App. LEXIS 333 (Apr. 22, 2015)]. Diagnostic tests consisting of a CT chest angiogram, ECG, and chest x-ray revealed no significant findings.

The employee had suffered a severe ankle injury when a bundle of sheet metal weighing approximately 1,200 pounds fell off a transfer cart and pinned his ankle underneath the bundle. He underwent multiple rounds of surgery and received extensive treatment, not only for his broken ankle, but for infection in his lower extremity. The employer and insurer refused to pay for the additional medical treatment and diagnostic testing, contending it was not related to the compensable injury.

The Commission found significant the fact that three days prior to the emergency room visit, the employee had a peripherally inserted central catheter (“PIC”) line placed to begin a six-week intravenous feed of Nafcillin, a medication to treat an ongoing infection associated with the employee’s injured ankle. The employer presented expert medical testimony that the employee’s symptoms did not appear to be a reaction to the Nafcillin. The employee countered that he had never experienced shortness of breath and difficulty breathing until three days after the PIC line was inserted. He testified that at the time he went to the emergency room he also noticed swelling in his hands and legs. He also testified that once his condition stabilized through emergency treatment he received, he had suffered no recurrence of his symptoms.

The appellate court noted that in Arkansas objective medical evidence was necessary to establish the existence and extent of an injury but was not essential to establish the causal relationship between the injury and a work-related accident in a workers’ compensation case. The determination of whether the causal connection exists was a question of fact for the Commission to determine. The Commission found the employee’s testimony credible and it was sufficient to rebut the evidence offered by the employer. The appellate court would not substitute its judgment for that of the Commission.