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.
OPINION
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.
FACTUAL
OVERVIEW AND PROCEDURAL POSTURE
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.
DISCUSSION
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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