Background Facts of Case
On October 20, 2006, Dr. Jack Rabin was a professor employed by the Pennsylvania State University. Sandra Rabin later pursued a fatal workers' compensation claim petition alleging Dr. Rabin's November 13, 2006 death resulted from work-related injuries incurred on October 20, 2006. At that time, Dr. Rabin already had several serious systemic conditions, including lymphadema, lower extremity cellulitis, uncontrolled diabetes, hypertension, breathing difficulties, cardiac problems, kidney function deficits, and infections.
Theodore Wachhaus testified in support of the fatal claim petition. He was preparing to defend his doctoral thesis before a dissertation committee, of which Dr. Rabin was the chairman. Mr. Wachhaus had worked closely with Dr. Rabin in crafting his dissertation. Mr. Wachhaus had regularly met with Dr. Rabin off-campus, for their mutual convenience, in order to discuss his doctorate, because he was teaching at Penn State during the day, while Dr. Rabin was teaching there during evenings.
On October 20, 2006, Mr. Wachhaus and Dr. Rabin met at a restaurant to discuss Mr. Wachhaus's dissertation. They arrived at the restaurant at noon and worked on the dissertation for over an hour. Then they served themselves their lunches at the restaurant's salad bar. While at the salad bar, Dr. Rabin fell, fracturing and dislocating a shoulder, and fracturing his humerus. Mr. Wachhaus testified that their meeting that day was expected to last until 3:00 p.m., and they planned to continue discussing scholarly topics relating to their profession after having served themselves from the salad bar.
On the day of injury, surgery for both the shoulder and arm fractures was performed. Complications, however, developed, including cardiac and respiratory distress. Dr. Rabin died November 13, 2006, and according to Dr. Acri, his treating physician, he expired due to multiple medical problems stemming from his upper extremity injuries. Dr. Acri explained that the injuries caused Dr. Rabin's kidneys to fail, liver abnormalities to develop, atrial fibrillation and heart failure to occur, and his immune system was suppressed to the point that he succumbed to aseptic pneumonia. Dr. Acri believed the October 20 trauma had triggered this cascade of events.
Another physician reviewed the case on Penn State's behalf. He had never examined Dr. Rabin and did not review Dr. Acri's treatment records from earlier in 2006. He agreed that Dr. Rabin's renal and heart failures compromised his immune system, pre-disposing him to infection. He concluded, though, that Dr. Rabin's fall injuries had not caused death. However, this physician was not sure exactly what medical problem had directly led to Dr. Rabin's death, indicating it was, "An infection or an infection-like syndrome, or possible multiple organ failure, one or the other or both."
The Workers' Compensation Judge (WCJ) credited Mr. Wachhaus' testimony regarding the activities surrounding Dr. Rabin's injury. He also credited Dr. Acri's testimony concerning cause of death, over the testimony of the other physician. The WCJ found Dr. Acri's opinions well-supported by objective test results, and ultimately concluded that Dr. Rabin's infection would not have occurred but for the trauma. The WCJ also concluded that Dr. Rabin was engaged in the furtherance of Penn State's business when he fell at the restaurant, and that he ultimately died due to these injuries. The fatal claim petition was granted. Employer's appeal to the Workers' Compensation Appeal Board (WCAB) resulted in the WCJ's decision being affirmed.
On appeal to the Commonwealth Court, Penn State argued Dr. Rabin was not in the course of his employment at the time of his fall, instead contending that, as a stationary employee at a Penn State campus, he was on a lunch break at a public restaurant when he fell, and was thus not acting in furtherance of Penn State's affairs at that time. Penn State also challenged the WCJ's crediting of Dr. Acri's causal opinion, alleging it was equivocal.
Commonwealth Court's Holding
Although he was off Penn State's premises at the time of the fall, Dr. Rabin was engaged in the furtherance of Penn State's business at that point, according to the Commonwealth Court's review of the evidence. Dr. Rabin had met his student off campus for teaching purposes during meetings leading up to October 20, 2006, in order to comport with their academic schedules. The anticipated multiple-hour meeting that day had included a working lunch in furtherance of Penn State's affairs and to discuss business of the university. The Court considered the injury as occurring during an inconsequential departure from Dr. Rabin's work as a professor, while serving himself at the salad bar. Thus, the Court agreed he was in the course of his employment at the time of the fall. In reviewing the evidentiary record, the Court also agreed that Dr. Acri's opinion, found credible by the WCJ, established the fall was a substantial contributing factor for cause of death. The Court noted that Dr. Acri explained the series of interrelating events between the fall and the conditions that thereafter developed. Dr. Rabin's past conditions were exacerbated by the trauma and the resultant treatment, causing massive multi-system failure of already compromised organs, and suppressing Dr. Rabin's immune system, leading to the development of aseptic pneumonia, septic shock, and death. Therefore, it was held that the burden of proof for the fatal claim petition was met, based upon persuasive expert medical opinion evidence, and the award was affirmed.
The medical conditions that ultimately evolved in this case were not clean-cut, like when an individual falls off a ladder in his workplace and fractures a leg. Dr. Rabin's fall, while serving himself at a restaurant salad bar, certainly did not occur on the employer's premises. His trauma and surgery were superimposed on multiple pre-existing serious medical conditions. The theory for the fatal claim petition was that the fall triggered a chain of events, including renal failure, respiratory distress, cardiac arrhythmia and failure, infection, aseptic pneumonia, and shock, involving organs already compromised, leading to death. Claimant had successfully pieced together all the medical causation elements necessary to establish the work-relatedness of the events and conditions. In defending against such a petition, make sure all interrelated elements necessary to credibly establish causation are present, as required by claimant's burden of proof, in order to prompt entitlement to benefits under the circumstances.
Furthermore, the Court agreed that it was established that Dr. Rabin's work duties were extended off campus in this situation, that the actual injury occurred during a temporary diversion away from those duties during a working lunch, and that the injury precipitating the cascade of events, ultimately leading to death, was thus compensable.