Maryland Court of Appeals Holds That for Occupational Diseases, It’s About the Whole Picture

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In a recently reported opinion, the Maryland Court of Appeals held that the Circuit Court for Baltimore County did not abuse its discretion in finding that the claimant, an employee of Baltimore County, had degenerative meniscal tears classifiable as an occupational disease arising out of and in the course of his employment. Baltimore County. v. Quinlan, 215 A.3d 282 (Md. 2019).

In October 2015, the claimant filed a claim against Baltimore County with the Maryland Workers’ Compensation Commission, asserting that he had developed meniscal tears in his right knee due to his job duties as a paramedic/firefighter. Subsequently, the commission held a hearing to determine, among other things, if the claimant had sustained an occupational disease arising out of and in the course of his employment. The commission disallowed the claim, finding that the claimant’s right knee injuries did not substantiate an occupational disease arising out of and in the course of his employment.

Following this ruling, the claimant appealed the case to the Circuit Court for Baltimore County, whereupon a jury trial was held. During the trial, the claimant, then 51 years old, testified that he had served as a paramedic for Baltimore County for the past 24 years. Within that role, the claimant would work two 10-hour day shifts, followed by two 14-hour night shifts, and would then typically have four days off. During these four shifts, the claimant estimated that he would respond to approximately 26-30 total calls, each of which would last between one to two hours. In responding to these calls, the claimant was required to climb in and out of his emergency vehicle, carry up to 50 pounds of gear, crouch to assist and service patients, administer compression or other aid, lift patients onto moving stretchers, and carry patients up and down stairs.

The claimant further testified that he started experiencing pain and “clicking” in his right knee in 2014. Upon seeing a doctor, the claimant was diagnosed with right knee meniscal tears and subsequently underwent reparative surgery.

In support of his case, the claimant presented the testimony of Dr. Barbara A. Cochran, an internist, who opined that the tears in the claimant’s right knee were “part of the continuum of osteoarthritis,” and emphasized the repetitive use of the knee as the primary risk factor. She further reasoned that the claimant’s age, weight, and gender were not primary factors for the injuries, as the knee damage was limited to the claimant’s right knee. Notably, Dr. Cochran identified a study that revealed that for every 100 cases of degenerative knee tears in the general population, there are 293 cases of paramedics/firefighters with degenerative knee tears.

Baltimore County responded by introducing the testimony of Dr. Richard Hinton, an orthopedic surgeon. Dr. Hinton opined the claimant’s “other risk factors” for knee problems, such as weight and age, were the primary causes of his degenerative knee tears. However, he also admitted that the claimant’s job as a paramedic was a potential or arguable cause of them.

Following deliberations, the jury returned a verdict for the claimant, stating that he had sustained an occupational disease of right knee degenerative tears arising out of and in the course of his employment. Upon appeal, the Court of Special Appeals confirmed the jury’s finding.

The primary question on appeal with the court of appeals was whether the trial court erred in finding that the claimant met the statutory requirements of Labor and Employment Article (LE) Section 9-502(d)(1). The court was tasked with determining whether the claimant’s alleged occupational disease was “due to the nature of an employment in which hazards of the occupational disease exist.”

In Maryland, in order for an employer to be held liable for an occupational disease, the disease must be an expectable result from working under hazardous conditions naturally inherent in and inseparable from the employment. Additionally, on the weight of the evidence, the trier of fact must be able to reasonably conclude that the disease was incurred as a result of the employment.

The court disagreed with the defense’s argument that the commonality of knee injuries among other professions would preclude the injuries sustained by the claimant from reaching occupational disease status. The court countered, stating that uniqueness is not a required element of LE Section 9-502(d)(1) and held that it is “inconsequential that degenerative knee conditions are not exclusively within the purview of paramedic work.” Instead, the court relied upon Lettering Unlimited v. Guy, 321 Md. 305, 582 A.2d 996 (1990), a case in which it was held that ordinary or usual job-related repetitive trauma may form the basis for an occupational disease claim. The court further noted that this holding was consistent with its historical characterization of occupational diseases as being slow and insidious in nature.

In this case, the court concluded that the nature of the job of a paramedic/firefighter places one at greater risk for degenerative knee conditions. This conclusion relied, at least in part, on the study presented by Dr. Cochran, but also upon the claimant’s extensive testimony during trial in which he persuasively identified the strenuous tasks associated with his position and the considerable length of time in which he was subjected to these strains. Based upon this uncontroverted testimony, the court found the claimant’s degenerative knee conditions likely developed progressively as a result of repetitive trauma, and arose from the natural consequences of his job functions. Thus, the court held that the claimant’s development of degenerative knee conditions were “adequately demonstrated to be within the ambit of a paramedic’s role.”

In this instructive opinion, the court of appeals places great emphasis in analyzing occupational disease claims with a wide and exploratory lens. The nature of the employment, the respective hazards associated with the employment, the comparative risks of these hazards against the general population, and the specific employees’ exposure to these hazards are all to be evaluated in detail and reinforced by fact. In Maryland, understanding the complete picture of a claimant’s employment history, medical history, and job functions is essential to litigating and succeeding in an occupational disease claim.