Means v. Baltimore County

Page 661

344 Md. 661

689 A.2d 1238

Doreen Kay MEANS v. BALTIMORE COUNTY, Maryland.

No. 20, Sept. Term 1996.

Court of Appeals of Maryland.

March 4, 1997.

Harry W. Blondell (Bruce D. Hechmer, William J. Blondell, Jr., Chartered, on brief), Baltimore, for Appellant.

Mathew A. Weir, Assistant County Attorney (Virginia W. Barnhart, County Attorney, all on brief), Towson, for Appellee.

Argued before BELL, C.J., and ELDRIDGE, RODOWSKY, CHASANOW, KARWACKI, RAKER and WILNER, JJ.

RAKER, Judge.

In this Workers' Compensation case, we must decide whether post-traumatic stress disorder (PTSD) unaccompanied by physical disease may be compensable as an occupational disease under the Maryland Workers' Compensation Act, now codified as Title 9 of the Labor and Employment Article of the Maryland Code (1991 Repl.Vol., 1996 Cum.Supp.). ¹ We shall hold that PTSD can be compensable as an occupational disease.

I.

Appellant Doreen Kay Means has been employed by Baltimore County since 1986. She was initially hired as a Certified Respiratory Therapist, also known as a paramedic, based at the Towson Fire Station. Her duties as a paramedic involved responding to emergency calls and rendering aid at the scenes of accidents and other emergencies. Means filed the workers' compensation claim at issue in this case in February, 1994. She claimed that she "was diagnosed as suffering post-traumatic stress syndrome as a result of working a medic unit." Because Means's alleged PTSD is based on events occurring several years before the claim was filed, we turn now to a chronology of those events.

Means contends that the PTSD she allegedly suffered was caused by a particularly severe accident in 1987 involving a van carrying five teenagers. As the first medical personnel crew on the scene, she provided aid and declared the teenagers dead. A few days after this accident, Means responded to another emergency call, with equally serious injuries and fatalities.

Shortly after these incidents in March, 1987, Means was transferred, upon her request, to the Brooklandville Fire Station, a station with a reputation for receiving few emergency calls. After a year, Means was transferred to the Randallstown Fire Station where she remained until February, 1992.

Sometime prior to February, 1992, Means requested a demotion from paramedic to firefighter. In conjunction with the demotion to firefighter, she was transferred back to the Towson station. Although she had been demoted, she was on several occasions required to act as a paramedic at the Towson station. In 1992, Means was required to serve as the paramedic at a particularly gruesome motorcycle accident. The victim had not been wearing a helmet and his scalp had been torn away from his skull. After this accident, Means felt that she "woke up" and remembered the particularly traumatic accidents in 1987 when she had previously worked out of the Towson station.

After the motorcycle accident, Means frequently missed work and began seeing a psychiatrist and a therapist at the Psychological Services Section of the Baltimore County Police and Fire Departments. In her initial visit to the therapist on June 15, 1992, Means reported suffering from flashbacks of the van accident, headaches, crying spells, and difficulty concentrating. She reported that her return to the Towson station had "really upset her and brought back painful memories." In clinical intake notes dated June 17, 1992, the therapist treating Means noted that her "symptoms sound as though they could possibly be part of a post-traumatic reaction or disorder." The following notations appear at the conclusion of the clinical intake notes from Means's first meeting with the therapist:

INITIAL DIAGNOSIS (DSM-III-R)

Axis I R/O Post Traumatic Stress Disorder

Axis II Deferred

Axis III None noted.

The therapist concluded that "[f]urther evaluation is necessary to determine if client may be experiencing a post-traumatic reaction of delayed onset." Means remained under the therapists' care at the County's Psychological Services Section until October, 1992. Means was subsequently evaluated in July and October, 1995, by Dr. Joseph M. Eisenberg. Dr. Eisenberg wrote in his evaluation of Means that it was his "opinion that the initial diagnosis in 1992 should have been Post-Traumatic Stress Disorder, delayed onset." Means proffered that Dr. Eisenberg would testify that she suffered from PTSD caused by her employment as a paramedic.

Means filed a workers' compensation claim for PTSD in February, 1994, seeking compensation for 110 hours of missed work. She identified February 1, 1992, as the date of disablement, the same date as her transfer back to the Towson station. On January 6, 1995, the Workers' Compensation Commission held a hearing on Means's claim and concluded that she had not suffered an occupational disease arising out of and in the course of her employment. Means filed a petition for judicial review in the Circuit Court for Baltimore County. See § 9-737.

The County filed a motion for summary judgment. The County presented two arguments: (1) that as a matter of law, Means failed to establish that she suffered from PTSD; and (2) that as a matter of law, PTSD may not form the basis of an occupational disease claim. The trial court granted the County's motion for summary judgment on the second ground. Means noted a timely appeal to the Court of Special Appeals, and we granted certiorari before consideration by that court. We shall reverse.

II.

A.

In Maryland, workers' compensation encompasses two categories of compensable events: accidental personal injury and occupational diseases. §§ 9-501, 9-502; Lovellette v. City of Baltimore, 297 Md. 271, 279, 465 A.2d 1141, 1146 (1983). Section 9-101(b) defines "accidental personal injury" as follows (b) Accidental personal injury.--"Accidental personal injury" means:

(1) an accidental injury that arises out of and in the course of employment;

(2) an injury caused by a willful or negligent act of a third person directed against a covered employee in the course of the employment of the covered employee; or

(3) a disease or infection that naturally results from an accidental injury that arises out of and in the course of employment, including:

(i) an occupational disease; and

(ii) frostbite or sunstroke caused by a weather condition.

This Court has described accidental injuries as those that involve "the injury and destruction of tissue by the application of external force, such as a blow." Foble v. Knefely, 176 Md. 474, 486, 6 A.2d 48, 53 (1939). Occupational disease is defined in § 9-101(g) of the Act as follows:

(g) Occupational disease.--"Occupational disease" means a disease contracted by a covered employee:

(1) as the result of and in the course of employment; and

(2) that causes the covered employee to become temporarily or permanently, partially or totally incapacitated.

While the Act does not further define "occupational disease," this Court has further delineated the term

as some ailment, disorder, or illness which is the expectable result of working under conditions naturally inherent in the employment and inseparable therefrom, and is ordinarily slow and insidious in its approach.

Foble, 176 Md. at 486, 6 A.2d at 53.

Not all diseases which meet this definition are compensable. Section 9-101(g) must be read in conjunction with § 9-502(d). ² Section 9-502 reads, in pertinent part (d) Limitation on liability.--An employer and insurer are liable to provide compensation ... only if:

(1) the occupational disease that caused the death or disability:

(i) is due to the nature of an employment in which hazards of the occupational disease exist and the covered employee was employed before the date of disablement; or

(ii) has manifestations that are consistent with those known to result from exposure to a biological, chemical, or physical agent that is attributable to the type of employment in which the covered employee was employed before the date of disablement....

The limitations imposed by § 9-502(d) seek to ensure that only those diseases directly caused by the employment be compensable. Davis v. Dyncorp, 336 Md. 226, 236, 647 A.2d 446, 451 (1994).

Occupational diseases have not always been compensable under the Act. The legislative history of the Act suggests that the General Assembly was reluctant to recognize occupational diseases as compensable under workers' compensation. See Miller v. Western Electric Co., 310 Md. 173, 181, 528 A.2d 486, 490 (1987); see generally Thomas S. Cook, Workers' Compensation and Stress Claims: Remedial Intent and Restrictive Application, 62 NOTRE DAME L.REV. 879, 889-91 (1987) (discussing state legislatures' early and continuing reluctance regarding occupational disease claims). In 1939, however, the General Assembly recognized occupational disease "as a problem, like on-the-job accidental injury, that an industrial society had to address in a comprehensive fashion," and enacted Maryland's first occupational disease statute. Miller, 310 Md. at 182, 528 A.2d at 491; see 1939 Md.Laws ch. 465.

Chapter 465 of the Acts of 1939 enumerated thirty-four diseases that were compensable under the Act as occupational diseases. The statute required employers to compensate only for those thirty-four specified diseases and only when caused by the process or occupation specified. For example, asbestosis was compensable if arising out of "[a]ny process or occupation involving an exposure to or direct contact with asbestos dust." 1939 Md. Laws ch. 465, § 1, at 995. In 1951, the occupational disease statute was repealed and reenacted, 1951 Md. Laws ch. 289, § 1, at 752, replacing the schedule format with the more general definition of occupational disease that remains in effect today. With this statutory framework and history in mind, we now turn to examine the compensability of PTSD under Maryland's Act.

B.

The compensability of work-related mental disabilities...