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Baltimore County v. Quinlan

Court of Appeals of Maryland

August 26, 2019


          Argued: February 5, 2019

          Circuit Court for Baltimore County Case No. 03-C-16-004811

          Barbera, C.J. [*] Greene, McDonald, Watts, Hotten Getty, Adkins, Sally D., (Senior Judge, Specially Assigned) JJ.


          ADKINS, J.

         "Definitions of 'occupational disease' should always be checked against the purpose for which they were uttered." Arthur Larson, Lex K. Larson & Thomas A. Robinson, 4 Larson's Workers' Compensation Law § 52.03[1] (Matthew Bender, Rev. Ed. 2019). The purposes of Maryland's Workers' Compensation Act are manifold and, like others, involve a recognition of the many competing interests-"to protect capital and labor, employer and employee, and the State against the waste and distress incident to modern industry . . . ." Liggett & Meyers Tobacco Co. v. Goslin, 163 Md. 74, 80 (1932). Still, we bear in mind the sacrifice and special toll certain Maryland workers withstand in the course of their service.

         The present case involves the claim of a veteran paramedic/firefighter regarding degenerative meniscal tears in his right knee. We review two questions, which we have rephrased and consolidated from the questions granted[1] for clarity. First, we review whether the trial court erred in denying the County's motion for summary judgment, and, if not, whether the trial court erred in finding that Quinlan met the statutory requirements set forth in LE § 9-502(d)(1) that his alleged occupational disease was "due to the nature of an employment in which hazards of the occupational disease exist . . . ." We conclude that the trial court did not abuse its discretion by denying the motion for summary judgment; nor did it err in concluding that Quinlan's degenerative meniscal tears could be classified as an occupational disease.


         In October 2015, Michael Quinlan ("Quinlan") filed a claim with the Workers' Compensation Commission ("the Commission") against his employer, Baltimore County ("the County"). In it, he asserted that he "developed meniscal tears" in his right knee due to his job duties as a "Paramedic/Firefighter."[2] The Commission held a hearing regarding Quinlan's claims and evaluated, among other things, whether he "sustain[ed] an occupational disease arising out of and in the course of his employment[.]" Ultimately, the Commission disallowed the claim, concluding that Quinlan "did not sustain an occupational disease of the [r]ight [k]nee degenerative tears arising out [of] and in the course of" his employment.

         Quinlan then sought review in the Circuit Court for Baltimore County, requesting a jury trial. In appeals from the Commission, the trial court's role is to determine whether the Commission "justly considered all of the facts," "exceeded the powers granted to it," or "misconstrued the law and facts applicable in the case decided." Md. Code Ann. (1991, 2016 Repl. Vol.), § 9-745(c)(1)-(3) of the Labor and Employment Article ("LE"). The Commission's decision is presumed "prima facie correct" and the party challenging the decision has the burden of proof. Id. § 9-745(b)(1)-(2).

         Prior to trial, the County filed a motion for summary judgment arguing that Quinlan failed to present evidence that his knee injury was an occupational disease or that it was related to the nature of his employment as a paramedic. Quinlan opposed this motion. Based on the parties' competing submissions, the trial judge denied the County's motion for summary judgment concluding that there was "absolutely a material dispute of fact."

         The case proceeded to trial on April 19 and 20, 2017. Quinlan, 51 years old at the time, testified first. He began by describing his occupation and the general duties thereof. Over the course of his career, he had served 29 years as a paramedic, the last 24 with Baltimore County. Typically, his schedule consisted of two 10-hour days of work, followed by two 14-hour nights, and four days off. During these four-day shifts, he stated, paramedics generally "run" 26-30 calls, which last 1-2 hours each. Quinlan also described the activities undertaken on a "typical" emergency call that might impact his right knee, including: climbing in and out of emergency vehicles, carrying up to 50 pounds of gear, crouching to address and service patients, administering compressions or other aid, lifting patients onto stretchers and moving stretchers, and taking patients up and down stairs.[3] He also stated that he is "right dominant," meaning he uses his right leg more often during the above tasks.

         Quinlan testified that he started experiencing pain and "clicking" in his right knee in 2014, causing him to seek out a doctor. Although he had seen a doctor in 2005 regarding a knee injury, he did not necessarily see the two phenomena as related. Ultimately, Quinlan underwent surgery to repair his meniscal tears.

         The parties each introduced the same experts before the trial court as they had used before the Commission. Quinlan presented a video deposition of Barbara A. Cochran, M.D. ("Cochran"), a physician with specialties in internal, occupational, psychiatric, and pulmonary medicine. Cochran's testimony was based on her research, her review of Quinlan's medical records, and her phone examination of Quinlan, although she never physically examined him. Cochran said that Quinlan had a tear in both his medial and lateral menisci. These tears "extend[ed] to the articular surface of the tibia," which Cochran identified as important because that "is where the bones come together" which can lead to osteoarthritis.

         Cochran described Quinlan's meniscal tears as "part of the continuum of osteoarthritis." Accordingly, she focused on repetitive use as the primary risk factor for his knee issues. She explained that repetitively using a knee with meniscal tears can lead to osteoarthritis because such use leads to inflammation in the joint that is not healed before its next use. She described this process as a cycle of inflammation, followed by partial healing, followed by inflammation, and so on. Alternatively, the osteoarthritis can contribute to degeneration and tears in the meniscus in a similar manner. She also addressed other risk factors for degenerative knee issues, such as gender, age, weight, genetics, and prior injury. Quinlan was five feet and nine inches tall and weighed approximately 235 pounds. Cochran stated that gender, age, and weight were unlikely to be the primary factors here because Quinlan's knee damage was confined to his right knee. Moreover, she opined that Quinlan's 2005 knee injury likely had no relation to his osteoarthritis based on the symptoms and complaints he presented at the time of his injury. She did not have enough information to address genetics.

         Cochran also testified about the relationship between Quinlan's degenerative knee tears and his occupation as a paramedic. Specifically, she pointed to a study that concluded that paramedic/firefighters have a "relative risk" of developing knee osteoarthritis of 2.93 compared to the general population, meaning that there are 293 cases of degenerative knee tears in paramedic/firefighters for every 100 cases in the general population. Based on this study and her examinations, she concluded that Quinlan's "essential job functions . . . which include considerable repetitive kneeling, bending, [and] stress on the knee, [were] the cause of his knee osteoarthritis."

         Next, the County introduced the video deposition of its expert witness, Richard Hinton, M.D. ("Hinton"), a specialist in orthopedic surgery. Hinton had examined Quinlan and explained that his knee tears were classified as "complex," meaning that they could be wholly degenerative or acute tears that degenerated over time. Still, he opined that Quinlan's other risk factors for knee problems, such as weight and age, were the primary causes of his degenerative knee tears, not his occupation. Specifically, he stated that the "primary or direct cause of [Quinlan's] meniscus issues"-which Hinton believed contributed to the osteoarthritis-were not "his duties as a firefighter and EMT."

         During his physical examination of Quinlan and in making his report, Hinton did not know that Quinlan had sustained an on-the-job acute injury to his knee in 2005. Upon learning of this fact during his deposition, Hinton stated that his "occupational injury . . . could contribute to long-term knee problems." He later opined that, although Quinlan's job was not the "primary cause" of his knee problems, it was a "potential" or "arguable" cause of them. He also recognized that "there is literature to suggest that people who are in firefighter or EMT positions have higher rates of both meniscus tears and of arthritis, as do people in many physically demanding jobs."

         The jury returned a verdict for Quinlan, stating that he had "sustain[ed] an occupational disease of right knee degenerative tears of the . . . medial and lateral menisci . . . arising out of and in the course of his employment[.]" During the County's appeal, the Court of Special Appeals ruled that "Quinlan met the statutory requirements of LE § 9-502(d)(1) by establishing at trial that the degenerative menisci tears were an occupational disease . . . ." Balt. Cty. v. Quinlan, 238 Md.App. 486, 509 (2018). Moreover, it said, Quinlan successfully established that "repetitive kneeling and squatting" are: (1) "a regular part of a paramedic's job," and (2) "a risk factor for developing menisci tears . . . ." Id. We granted the County's petition for writ of certiorari.


         Denial of Summary Judgment Motion

         We first address the trial court's denial of the County's motion for summary judgment. The County argues that the trial court erred in denying its motion for summary judgment because Quinlan's initial Employee Claim Form listed the occupational disease as "meniscal tears," but the evidence and testimony at trial involved "degenerative meniscal tears," which includes the osteoarthritis. The County argues that by "extract[ing]" the meniscal tear claim and excluding any reference to the osteoarthritis, Quinlan avoids "any argument or burden of proof that inter-related conditions, such as 'osteoarthritis,' exist and affect the same body part," and also that the osteoarthritis was in the "nature" of the employment. The County asserts that "[t]he claimant should not be able to avoid its burden by choosing only a portion of the overall ailment" for the claim, thereby avoiding the "burden of proof as to the entire disorder . . . ." Quinlan states that denial of the motion for summary judgment was proper because there was a dispute of material fact as to the cause of the meniscal tears and the "incidence of meniscal tears" in his work as a paramedic.

         Typically, we review the denial of a motion for summary judgment for abuse of discretion. See Hous. Auth. of Balt. City v. Woodland, 438 Md. 415, 426 (2014). There are occasions in which the appellate court reviews non-discretionary matters without deference to the trial court, even on denials of summary judgment. See Presbyterian Univ. Hosp. v. Wilson, 337 Md. 541, 549 (1995) (stating that "to the extent that the issue of personal jurisdiction [was] a question of law, it is not properly submitted to the trier of fact to resolve," and, therefore, there was "nothing to preclude our review of this issue"). Even so, in the interest of "promot[ing] justice," the trial court ordinarily "possess[es] discretion to refuse to pass upon, as well as discretion affirmatively to deny, a summary judgment request in favor of a full hearing on the merits; and this discretion exists even though the technical requirements for the entry of such a judgment have been met." Metro. Mortg. Fund, Inc. v. Basiliko, 288 Md. 25, 28 (1980) (citations omitted). Such is the case here, so we review the trial court's ruling for abuse of discretion.

         Before the trial began, the County filed a motion for summary judgment. In it, the County characterized Quinlan's claim as one for "an unknown, unnamed, degenerative disease involving his right knee," which was alleged to have resulted from his work as a paramedic/firefighter. The County asserted that Quinlan "provided no evidence" regarding: (1) the occupational disease he suffered from; or (2) the disease's relation to the "nature of his employment" and not some intervening factor. It also submitted Hinton's medical examination report. Thus, it averred, the County was entitled to summary judgment as a matter of law.

         In response, Quinlan reasserted his claim that he had sustained "an occupational disease of degenerative tears of the posterior horns of both the medial and lateral menisci of his right knee." He recounted the duties he undertook as a paramedic that caused the knee condition, including: lifting patients onto stretchers, kneeling to assess patients, and sometimes carrying patients. These activities occurred consistently over his 26-30 emergency calls for each four-day shift. He also points to Cochran's testimony asserting a ...

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