CT High Court Says Transplanted Heart is Not a Prosthetic Device
The Supreme Court of Connecticut held that a transplanted heart is not in the nature of a prosthetic device. Accordingly, where a police officer sustained a compensable rare autoimmune disease — giant cell myocarditis — and received a successful heart transplant, the state’s board did not err in concluding that, following maximum medical improvement, the officer had sustained a 23 percent permanent partial disability rating under Conn. Gen. Stat. § 31-308 (b) [Vitti v. City of Milford, 2020 Conn. LEXIS 192 (Aug. 24, 2020)]. The officer had not lost his heart in the sense that it had been replaced with living tissue.
Background
The city of Milford (“the city”) employed the plaintiff as a police officer from 1993 until his retirement in 2014. In August, 2010, the plaintiff began experiencing nausea, abdominal pain, and shortness of breath, which subsequently led to his diagnosis of giant cell myocarditis, a rare autoimmune disease. The plaintiff received a heart transplant on September 28, 2010. The heart transplant was successful, and the plaintiff returned to work in a part-time capacity in 2011, subsequently returning to a full-time schedule in 2012. As a result of the transplant operation, the plaintiff follows a daily medication regimen and has various activity limitations, including a reduced capacity to exercise and to travel via air to the same extent he could prior to the surgery.
In September, 2010, the plaintiff filed for workers’ compensation benefits pursuant to the Heart and Hypertension Act [see Conn. Gen. Stat. § § 7-433c]. The commissioner issued a decision finding that the plaintiff had reached MMI on November 21, 2013, three years after his successful heart transplant. Crediting the testimony of two medical expert witnesses and the plaintiff’s description of his condition, the commissioner found that the plaintiff was entitled to an award of 23 percent PPD benefits.
The plaintiff appealed from the commissioner’s finding and award to the board, claiming that the commissioner improperly failed to award him 100 percent permanent partial disability benefits as a result of the removal of his native heart during the transplant procedure. The board affirmed the commissioner’s finding and award, concluding that the commissioner had properly considered the function of the transplanted heart in awarding permanent partial disability benefits. The board disagreed with the plaintiff’s argument that a transplanted heart should be treated as akin to a prosthetic device for purposes of awarding benefits. The Appellate Court of Connecticut affirmed.
Supreme Court Decision
The Supreme Court initially noted that it was important to understand that the Act provided for two unique categories of benefits: (a) those designed to compensate for loss of earning capacity and (b) those awarded to compensate for the loss, or loss of use, of a body part [Author’s comment: Many jurisdictions refer to this second category as a “scheduled injury.” See Larson’s Workers’ Compensation Law, § 86.01, et seq.]. The Court said total or partial incapacity benefits fell into the first category; disability benefits, also referred to as specific indemnity awards or permanency awards, fell into the second category.
The Court stressed that the plaintiff’s contention that § 31-308 (b), which governs the loss, inter alia, of an “organ,” was triggered automatically upon the removal of a native organ, without regard to the ameliorative effects of a transplant, would be inconsistent with nearly one century of case law governing the concept of maximum medical improvement. The Court drew an important distinction between heart transplant surgery vis-a-vis an amputation. A transplant is not a procedure concerned solely with removal; it has the ultimate goal of replacement.
The Court added that , unlike the prosthetic devices referenced by the plaintiff, a transplanted heart is, consistent with the dictionary definitions, composed of organic, living tissue and performed the same function that the native heart did, albeit at an increased functional level. A transplanted heart was not akin to an artificial prosthetic device. Based on that understanding, the Court concluded that the board correctly determined that a functionality analysis of the transplanted heart, after a finding of maximum medical improvement, was appropriate in fashioning the plaintiff’s specific indemnity award in the present case because the transplant meant that the plaintiff had not suffered a complete loss of his heart within the meaning of § 31-308 (b).