Omron Electronics v. The Illinois Workers' Compensation Commission

2014 IL App (1st) 130766WCNo. 1-13-0766WC
Opinion filed November 14, 2014
________________________________________________________________________
IN THE
APPELLATE COURT OF ILLINOIS
FIRST DISTRICT
WORKERS' COMPENSATION COMMISSION DIVISION
________________________________________________________________________
OMRON ELECTRONICS, ) Appeal from the
) Circuit Court of
) Cook County.
Appellant, )
)
v. ) No. 12 L 51148
)
ILLINOIS WORKERS' COMPENSATION )
COMMISSION, et al., )
) Honorable
(Craig Bauer, deceased, by E. Belinda Bauer, ) Eileen Burke,
Special Administrator, Appellee). ) Judge, Presiding.
________________________________________________________________________
JUSTICE STEWART delivered the judgment of the court, with opinion.
Presiding Justice Holdridge and Justices Hoffman, Hudson, and Harris concurred
in the judgment and opinion.
OPINION
¶1 This matter involves a claim under the Illinois Workers' Compensation Act (the
Act) (820 ILCS 301/1 et seq. (West 2006)) and the Workers' Occupational Diseases Act
(Occupational Diseases Act) (820 ILCS 310/1 et seq. (West 2006)) filed by E. Belinda
Bauer, wife and special administrator for Craig Bauer (employee), for benefits in
connection with the death of the employee due to alleged exposure to Neisseria
2014 IL App (1st) 130766WCmeningitides while on a business trip to Brazil for the employer, Omron Electronics. The
arbitrator denied compensation finding that the special administrator had not proven
causation and exposure arising out of and in the course of the decedent's employment
with the employer. The special administrator appealed to the Illinois Workers'
Compensation Commission (Commission). The Commission unanimously reversed the
arbitrator's decision and held that the special administrator had proven by a
preponderance of the evidence that the employee had contracted Neisseria meningitides
during his business trip to Brazil. The employer filed a timely petition for review in the
circuit court of Cook County which confirmed the Commission's decision. The employer
appeals.
¶2 BACKGROUND
¶3 The following factual recitation is taken from the evidence presented at the
arbitration hearing conducted on May 24, 2011.
¶4 The special administrator testified that the employee had worked for the employer
for four years as the company's president and chief operating officer. She testified that
the employee traveled to China and Japan on June 7 through June 14, 2006. He then
returned to Chicago and worked from his office in Schaumburg. The employee's travel
itinerary was admitted into evidence. On June 20, 2006, he left Chicago at 2:55 p.m. and
flew to Sao Paolo, Brazil. He arrived at 7:52 a.m. on June 21, 2006. He left Brazil on
June 22, 2006, at 9:50 p.m. and arrived in Chicago at 9:30 a.m. on June 23, 2006.
2
2014 IL App (1st) 130766WC¶5 The special administrator testified that when the employee returned home on June
23, 2006, she noticed that he was pale. They drove to their second home in Lake Geneva,
Wisconsin. Instead of going out to dinner like they normally did, they opted to eat at
home because the employee did not feel well. She stated that the employee was very
tired, felt a little achy, and thought he might have the flu. On June 24, 2006, the
employee awoke early and went to have his hair cut. When he returned home he laid on
the couch because he had a fever and was feeling very achy. She testified that throughout
the day he continued to get worse. By late afternoon he developed little black spots all
over his face and down his arms. The employee asked the special administrator to take
him to the hospital. She took him to the Mercy Walworth Hospital and Medical Center
emergency room in Walworth, Wisconsin. By the time they arrived at the hospital the
employee's rash had spread all over his body. The employee continued to get worse and
the medical staff decided to move him to an intensive care unit in Janesville, Wisconsin.
He was taken by ambulance to St. Mercy Health System in Janesville, Wisconsin. He
died there on June 25, 2006. The special administrator testified that the employee died of
Neisseria bacterial meningitis.
¶6 The medical records from the Mercy Walworth Hospital and Medical Center
emergency department were admitted into evidence. In patient notes written by Dr.
Kevin Parciak, he noted that the employee was examined on June 24, 2006, for a
complaint of a rash. The employee told Dr. Parciak that he had started to feel some mild
upper respiratory tract illness symptoms approximately one week prior consisting of
general malaise, nonproductive cough, and intermittent low-grade temperatures. He told
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2014 IL App (1st) 130766WCDr. Parciak that his symptoms had improved somewhat over the course of the week. The
employee reported that at about 5:00 p.m. on June 24, 2006, reddish-purplish spots
started appearing on his bilateral lower extremities and gradually ascended throughout
the rest of his body over the course of the ensuing hours up until the time of presentation.
The employee told Dr. Parciak that his only medication was Mucinex that he started
taking that afternoon for a cough. The employee denied any specific bug bites, exposure
to exotic foods, or exposure to any sick contacts specifically when travelling. Dr. Parciak
noted diffuse nonpalpable purpuric rash lesions. His impression was purpuric rash due to
infectious etiology. Dr. Parciak wrote that he "entertained the possibility of this patient
having meningococcemia," but did not have a "high suspicion" of meningitis because the
employee did not have a significant headache, neck pain, neck stiffness, or photophobia,
although meningitis was still possible. He opined that it was likely that the employee was
"septic from some unknown bacteria or viral cause which is especially concerning
because of his recent travel history." The ambulance was contacted to transport the
employee to St. Mercy Health System in Janesville, Wisconsin, and Dr. Parciak noted
that the employee did not exhibit any signs of deterioration.
¶7 Dr. Badar Kanwar treated the employee on June 25, 2006, at St. Mercy Health
System in Janesville. In his patient notes he wrote that the employee had been sick with
cold like symptoms since he returned from Japan, but that he only developed a rash,
generalized malaise, and weakness that day. When the employee arrived at the hospital
after transfer from the emergency room at Mercy Walworth Hospital and Medical Center,
he was able to talk and answer Dr. Kanwar's questions appropriately. Dr. Kanwar noted
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2014 IL App (1st) 130766WCthat the employee appeared to be in respiratory distress. The employee appeared very
cyanotic and had a diffuse purpuric rash all over his body. He wrote that the employee
was intubated and sedated when he became bradycardic, went into asystole, and died.
Unsuccessful efforts were made to resuscitate the employee. Dr. Kanwar noted that his
total time caring for the employee was 90 minutes.
¶8 The autopsy report from St. Mercy Health System in Janesville was admitted into
evidence. The final diagnosis was hemorrhagic adrenals consistent with Waterhouse-
Friderichsen Syndrome, and pre-mortem blood culture positive for Neisseria
meningitides.
¶9 Dr. Charles Stratton testified by evidence deposition on behalf of the special
administrator. He is the clinical director of the microbiology laboratory, an associate
professor of pathology and medicine, and an associate director of the pathology residency
program at Vanderbilt University in Nashville, Tennessee. He is board certified in
internal medicine, infectious diseases, medical microbiology, and public health and
medical microbiology. He testified that he had treated people with Neisseria
meningitides since 1971.
¶ 10 Dr. Stratton testified that he had reviewed the employee's medical records from
Mercy Walworth Hospital and Medical Center in Lake Geneva, Wisconsin, St. Mercy
Health System in Janesville, Wisconsin, the death certificate, the autopsy report, and his
itinerary. He stated that the report from Mercy Walworth Hospital that the employee had
a purpuric rash that was even on his palms and soles of his feet was very significant
because one of the few illnesses that causes a rash on a person's palms and soles is
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2014 IL App (1st) 130766WCmeningococcemia. Dr. Stratton testified that the clinician at Mercy Walworth Hospital
diagnosed the employee with disseminated intravascular coagulation which means sepsis
syndrome. He stated that sepsis involves a cytokine storm which makes blood vessels
leaky as evidenced by the purpuric rash. Once the employee arrived at the hospital in
Janesville, the medical records indicate that he had acute respiratory failure. Dr. Stratton
stated that leaky blood vessels in the lungs caused this acute respiratory distress. He
stated that the employee was intubated and sedated, then his heart stopped.
¶ 11 Dr. Stratton testified that the premortem blood cultures on June 24, 2006, grew
Neisseria meningitides which was significant because it confirmed the clinical impression
from the first physician who examined the employee that he indeed had Neisseria
meningitides in his blood. Dr. Stratton testified that Neisseria meningitides is another
term for meningococcemia.
¶ 12 Dr. Stratton testified that he reviewed the autopsy report which indicated that the
employee died of meningococcemia. The death certificate listed the cause of death as
Neisseria meningitides bacterium. He agreed with the cause of death listed on the death
certificate.
¶ 13 Dr. Stratton testified that humans are the only natural reservoirs of Neisseria
meningitides meaning that it is not something a person could get from drinking water,
petting a cat, or cleaning a chicken coop. A person can only contract the infection from
another human. Dr. Stratton testified that an individual can be exposed to meningococcal
disease and become colonized, but not infected. These people are then carriers of
meningococcal disease. Dr. Stratton stated that the most common method of
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2014 IL App (1st) 130766WCtransmission of Neisseria meningitides is airborne respiratory droplets. He stated that if a
person is in an area with other people and someone who has colonized Neisseria
meningitides coughs, sneezes, talks, or sings, the aerosolized droplets from his
nasopharnyx get into the air and can be inhaled by someone else causing that person to
contract the organism. The droplet nuclei remain in the room and circulate until the air
system replaces the air with other air. He stated that depending on the air circulation, the
droplet nuclei can float around for weeks as was learned from the spread of diseases on
submarines during World War II. He opined that, more likely than not, the Neisseria
meningitides was transmitted to the employee through airborne respiratory droplets.
¶ 14 Dr. Stratton testified that the early symptoms of Neisseria meningitides are
nonspecific meaning the patient does not feel good, may have a low-grade fever, and has
malaise. The symptoms do not include a sore throat, runny nose, cough, or sneezing, and
it does not act like a cold or upper or lower respiratory tract infection. Dr. Stratton stated
that a person who already had an upper respiratory tract infection is at greater risk to
develop Neisseria meningitides. Dr. Stratton noted that the employee's medical records
show that he had a mild respiratory tract infection. Dr. Stratton testified that because the
employee had a respiratory tract infection he was "primed or he had a cofactor that would
make the likelihood of him not only becoming colonized but becoming infected with the
Neisseria meningitides more likely."
¶ 15 Dr. Stratton testified that the incubation period for meningococcemia is 2 to 10
days. He stated that in the employee's case the concomitant respiratory tract infection
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2014 IL App (1st) 130766WCacted as a cofactor and facilitated the meningococcemia so he thought the incubation
period would be 2 days rather than 10 days.
¶ 16 Dr. Stratton testified that it was well known that international travel increases the
risk for Neisseria meningitides infections. He stated that "Sao Paolo is well known in the
medical literature, as well as among infectious disease specialists, as an area where
there's an increased prevalence of Neisseria meningitides." He stated that the endemic
rate of Neisseria meningitides is 2 to 5 per 100,000 people in Sao Paolo versus 1 per
100,000 in the United States.
¶ 17 Dr. Stratton testified that the employee was in Sao Paolo from June 21 to June 23,
2006, and became ill on June 24. He stated "the respiratory tract infection plus the
likelihood of acquiring this organism while in Sao Paolo is the perfect - - it's very good
timing for the acquisition and dissemination of this organism, which became clinically
apparent by June 24th." Dr. Stratton testified that "My opinion is that it was his
international travel, specifically the trip to Sao Paolo, that allowed the meningococcemia
that he died from to occur. Had he not gone to Sao Paulo or had any international travel,
then it's my opinion that he wouldn't have died of Neisseria meningitides." He further
stated that it was his opinion to a reasonable degree of medical certainty, that the
employee acquired meningococcemia in Sao Paolo as a result of his travel to that city.
He stated "I think that's the most likely source given the incidence of this pathogen in Sao
Paolo as well as the timing of the trip and the subsequent meningococcemia. It all fits
together quite nicely with acquisition of the organism while he was in Sao Paolo,
probably facilitated or even accelerated due to a cofactor of the respiratory tract infection
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2014 IL App (1st) 130766WChe was known to have - - or reported to have, and that the timing is very consistent with
acquisition of this organism." Dr. Stratton stated that while the most likely location that
the employee contracted Neisseria meningitides was Sao Paolo, "[o]bviously, anything is
possible."
¶ 18 Dr. Stratton testified that his opinions were based on his experience and training,
and his ability to interpret the medical literature. He stated that he provided medical
articles to support that he used evidence-based medicine in terms of coming to his
decisions. The articles were admitted into evidence.
¶ 19 Dr. William Lawrence Drew testified by evidence deposition on behalf of the
special administrator. He is the director of the virology laboratory at the University of
California at San Francisco and the chief of infectious disease at the University of
California San Francisco Medical Center. He has a Ph.D. in experimental pathology with
an emphasis on virology and is board certified in internal medicine with a subspecialty in
infectious disease.
¶ 20 Dr. Drew testified that he reviewed records from Mercy Walworth Hospital and
Medical Center in Lake Geneva, Wisconsin, and St. Mercy Health System of Janesville,
Wisconsin. Dr. Drew testified that as soon as he saw that the employee had been to
Brazil, it was "a very major red alert to someone in [his] field because Brazil is known
for an ongoing problem with meningococcus, this organism from which he expired, and
they have had an ongoing problem for years and years, and the estimates are they have at
least three to six times the amount of problems with this organism in Brazil than we have
in the U.S."
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2014 IL App (1st) 130766WC¶ 21 Dr. Drew testified that the employee's death certificate listed the cause of death as
Neisseria meningitides bacterium and he agreed with this finding. He found it significant
that the death certificate noted an interval between onset and death of one to two days.
He felt this supported a very brief incubation period and a connection to the employee's
exposure in Brazil. Dr. Drew stated that Neisseria meningitides is transmitted by the
respiratory route. He testified that, "there's no debate that he had meningococcal
infection, and meningococcal infection is more prevalent in Brazil than it is here in the
U.S. and his incubation period is completely compatible with having acquired it in Brazil.
So, putting those two pieces of evidence together, yes, my opinion is that it's more
probable than not that that is what took place." He stated that he believed that the
employee acquired Neisseria meningitides as a result of his travel to Sao Paolo. He
testified that the last day that the employee could have contracted the Neisseria
meningitides bacteria was on June 22 or early on June 23, 2006, and the earliest he could
have contracted it would have been June 14, 2006. Dr. Drew testified that "I can say that
[the employee] would not have died at this time in his life from this infection had he not
made that trip [to Brazil]."
¶ 22 Dr. Drew testified that typically a person who is infected with the Neisseria
meningitides bacteria does not develop the clinical disease. A small subset may develop
respiratory symptoms such as a pharyngitis, a sinusitis, or a runny nose. An exceedingly
small subset will develop a more serious disease such as meningococcemia or
meningococcal meningitis. Dr. Drew testified that the mild upper respiratory tract
symptoms that the employee told Dr. Parciak about could have been due to Neisseria
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2014 IL App (1st) 130766WCmeningitides, but in his opinion were likely to have been a separate illness acquired
before going to Brazil. He stated that it is the opinion of many experts that an ongoing
prior infection may weaken a person's defenses against Neisseria meningitides. He stated
it would be "hard to sort out whether this was really due to - - all of it due to Neisseria
meningitides or there was another process and then superimposed Neisseria meningitides
acquisition in Brazil."
¶ 23 Dr. Drew testified that he reviewed Dr. Stratton's report and he agreed that he is
someone who has sufficient expert qualifications to write opinions concerning Neisseria
meningitides. He further averred that he agreed with Dr. Stratton's opinions.
¶ 24 A report from Dr. Jeffrey Coe dated November 15, 2006, was admitted into
evidence. Dr. Coe is board certified in occupational medicine. He wrote that he
reviewed medical records at the request of the employer relating to the care of the
employee. Dr. Coe wrote that the employee became acutely ill with symptoms and
clinical findings consistent with bacterial meningitis following his return from a business
trip. He stated that Neisseria meningitides is spread through direct hand contact or
droplets spread by coughing or sneezing from an asymptomatic carrier. He noted that the
incubation period varies from 2 to 10 days. He opined that based on the information
reviewed, it was his opinion that it would be impossible to state to a reasonable degree of
medical certainty that the employee contracted bacterial meningitis during his business
trip to Brazil in June 2006. He based this opinion on the fact that because the incubation
period ranges from 2 to 10 days, it would be impossible to determine whether the
employee was exposed to the bacteria before or during his trip to Brazil.
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2014 IL App (1st) 130766WC¶ 25 A report from Dr. Fred Zar dated August 22, 2007, was admitted into evidence.
He is a professor of medicine, the vice head for medical education, and the program
director for internal medicine at the University of Illinois at Chicago. Dr. Zar wrote that
after reviewing the employee's medical records at the request of the employer, it was
clear that the employee died of meningococcal meningitis despite receiving timely and
appropriate care. He wrote that carriers transmit the bacteria to another person via
respiratory secretions. He wrote that the typical clinical manifestations of infection
include an acute onset of fever, nausea, vomiting, headache, altered mental state, severe
muscle aches, and about 50 % of infected people will have a rash. Dr. Zar noted that the
incubation period for Neisseria meningitides is 4 days with a range between 2 and 10
days. The first symptom specific to meningococcal meningitis in the employee appeared
to have been the rash which occurred on the evening of June 24, 2006. Dr. Zar opined
that the bacterium was acquired 2 to 10 days prior to the appearance of the rash or
sometime between June 14 and June 22, 2006. Because the average incubation period is
four days, he opined that June 20, 2006, was most likely the date that the employee
contracted the bacterium. Because of the incubation period, Dr. Zar opined that it was
impossible for him to tell with any degree of medical certainty whether the employee
contracted this bacteria in the United States or Brazil.
¶ 26 On December 3, 2008, Dr. Zar amended his report. He wrote that because the
employee was only in Brazil for about 36 hours, the time period represents only 19% of
the total range of known incubation for the disease, thus making it statistically more
likely than not that it was not acquired in Brazil. He further noted that it was unlikely
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2014 IL App (1st) 130766WCthat the employee contracted his meningococcal infection on his flight to or from Brazil.
Furthermore he provided printouts of information appearing on the Centers for Disease
Control website that provides advice to travelers on risks of infectious diseases in Brazil.
He noted that the website did not list an increased risk of meningococcal infection from
travel to Brazil, nor did it recommend that travelers to Brazil receive the meningococcal
vaccine.
¶ 27 Ricardo Moura testified by telephonic evidence deposition. He testified that he
worked as a general manager for the employer in Sao Paolo, Brazil. He stated that he
was interviewed for this position by the employee on June 22, 2006. He stated that he
met with the employee at an employment agency's office. The meeting took about one-
half hour. Mr. Moura testified that the employee "looked like a person that was a
hundred percent fit and one that makes sports."
¶ 28 Marcos Ito testified by telephonic evidence deposition. He stated that he worked
as the technical support manager for the employer in Sao Paolo, Brazil. Approximately
30 people worked at that office. He stated that on June 21, 2006, he met with the
employee and Eduardo Penteado. Later the three had dinner together at a restaurant.
Dinner lasted 45 minutes to one hour. The next day, the employee arrived at the office
around noon after conducting interviews at the employment agency's office. Mr. Ito
testified that the employee left the office at around 3:00 p.m. to go to the airport.
¶ 29 Eduardo Penteado testified by telephonic evidence deposition. He stated that he is
the marketing and technology manager for the employer. He stated that he picked the
employee up from the airport on June 21, 2006, and took him to the employer's office.
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2014 IL App (1st) 130766WCFifteen to twenty people worked inside the office. Mr. Penteado testified that the
employee met with him and Mr. Ito, and possibly someone named Adriana. The meeting
lasted two to three hours. He stated that he had dinner with the employee and Mr. Ito.
They arrived at 8:00 or 9:00 p.m. The restaurant was two stories and it was not full.
They talked among themselves and the only other person the employee spoke with was
the waitress. He estimated that they were at the restaurant for two hours. He then drove
the employee to his hotel and dropped him off. Mr. Penteado testified that he picked the
employee up from the hotel at about 9:00 a.m. the next morning and took him to the
employer's office. He stated that he did not remember what the employee did that
morning. He stated that the employee interviewed Mr. Moura, but he did not remember
if that took place at the office or somewhere else. Mr. Penteado testified that if the
employee went to the employment agency's office, he probably took a taxi. The
interview was confidential and none of the employees at the employer's Sao Paolo office
knew about it. Mr. Penteado did not have breakfast or lunch with the employee and did
not know if he ate with anyone else. The employee's expense report was admitted into
evidence. It showed that he went to McDonald's on June 22, 2006. Mr. Penteado drove
the employee to the airport on June 22, 2006. He did not remember how early the
employee arrived at the airport. He stated that typically the employee arrived four to five
hours prior to his flight. Mr. Penteado testified that the employee did not look like he had
any symptoms that might have been the start of meningitis. He looked tired like a long
distance traveler.
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2014 IL App (1st) 130766WC¶ 30 The special administrator testified that the employee's health prior to June 25,
2006, was very good and that he was not under the care of a doctor for any reason. The
special administrator testified that she helped the employee pack for his trip to China and
Japan. She testified that he was physically fine and was excited about the trip because it
involved an acquisition. She stated that she did not observe any physical problems or
ailments on his return from China and Japan. She testified that before he left for Brazil,
he did not have any physical problems or ailments that she was able to notice.
¶ 31 Stephen Kozik testified that he had been employed by the employer for 19 years.
He stated that the employee was his mentor. He communicated with the employee daily
by telephone, in person, and by email. He testified that on June 20, 2006, in an email he
asked the employee how he was feeling and the employee responded "fine, but I think I
got the bird flu in China." Mr. Kozik testified that he did not "know if it was tongue-in-
cheek." He further testified that because the bird flu was news at the time, "he may have
been joking around about being in China."
¶ 32 The arbitrator held that the employee did not sustain an accident/exposure that
arose out of and in the course of his employment. He found that the special administrator
failed to prove, by a preponderance of the evidence, that the employee was infected with
Neisseria meningitides while in Brazil. He found that the evidence in total supported a
finding that the employee contracted meningitis while in the United States before he left
for Brazil.
¶ 33 The special administrator sought review of this decision before the Commission.
The Commission unanimously reversed the arbitrator's decision. It found that the special
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2014 IL App (1st) 130766WCadministrator proved by a preponderance of the evidence that the employee acquired
Neisseria meningitides during the course of his travels to Brazil. It found that the
opinions of Dr. Stratton and Dr. Drew were more persuasive than the opinions of Dr. Coe
and Dr. Zar. The Commission awarded the special administrator death benefits, burial
expenses, and reasonable and necessary medical expenses in the amount of $10,359.69.
The employer sought judicial review of the Commission's decision in the circuit court of
Cook County. The circuit court confirmed the Commission's decision. The employer
appealed.
¶ 34 ANALYSIS
¶ 35 The employer argues that the Commission's decision was contrary to law as the
evidence presented was legally insufficient to establish exposure. It argues that the
Commission's decision was based on the mere and remote possibility that the employee
was exposed to Neisseria meningitides at some unknown time, in an unknown location in
Sao Paolo, Brazil. It argues that the Commission's decision was thus based on
speculation and conjecture. The employer's argument is not a legal argument, but one
based on the sufficiency of the evidence. The Commission's factual findings are
reviewed under the manifest weight of the evidence standard. Johnson v. Illinois
Workers' Compensation Comm'n, 2011 IL App (2d) 100418WC, ¶ 17, 956 N.E.2d 543.
¶ 36 An occupational disease is a disease arising out of and in the course of
employment. 820 ILCS 310/1(d) (West 2006). The claimant in an occupational disease
case has the burden of proving that he suffers from an occupational disease and that a
causal connection exists between the disease and his employment. Freeman United Coal
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2014 IL App (1st) 130766WCMining Co. v. Illinois Workers' Compensation Comm'n, 2013 IL App (5th) 120564WC, ¶
21, 999 N.E.2d 382. Whether there is a causal connection between the disease and the
employment is a question of fact. Id. It is the function of the Commission to decide
questions of fact and its determination on a question of fact will not be disturbed on
review unless it is against the manifest weight of the evidence. Id. A finding is against
the manifest weight of the evidence if an opposite conclusion is clearly apparent. Id.¶ 37 In the instant case there is no dispute that the employee died as a result of
contracting Neisseria meningitides. The issue is whether there was a causal connection
between the disease and his employment.
¶ 38 The Occupational Diseases Act provides:
"A disease shall be deemed to arise out of the employment if there is apparent to
the rational mind, upon consideration of all the circumstances, a causal connection
between the conditions under which the work is performed and the occupational
disease. The disease need not to have been foreseen or expected but after its
contraction it must be apparent to have had its origin or aggravation in a risk
connected with the employment and to have flowed from that source as a rational
consequence." 820 ILCS 310/1(d) (West 2006).
"Nothing in the statutory language requires proof of a direct causal connection." Sperling
v. Industrial Comm'n, 129 Ill. 2d 416, 421, 544 N.E.2d 290, 292 (1989). A causal
connection may be based on a medical expert's opinion that an accident "could have" or
"might have" caused an injury. Consolidation Coal Co. v. Industrial Comm'n, 265 Ill.
App. 3d 830, 839, 639 N.E.2d 886, 892 (1994). "In addition, a chain of events
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2014 IL App (1st) 130766WCsuggesting a causal connection may suffice to prove causation even if the etiology of the
disease is unknown." Id.¶ 39 The employer argues that the opinions of Dr. Stratton and Dr. Drew were not
based on relevant factual data concerning Neisseria meningitides infection rates in Brazil.
It argues that the articles provided by Dr. Stratton and Dr. Drew did not support an
increased risk of meningococcal infection for travelers to Brazil. The articles were
admitted into evidence and were considered by the Commission in making its
determination. Dr. Drew testified that Brazil is known for an ongoing problem with
meningococcus. Dr. Stratton testified that Sao Paolo was well known among infectious
disease specialists as an area where there is an increased prevalence of Neisseria
meningitides. He testified that the endemic rate of Neisseria meningitides infection in
Sao Paolo is 2 to 5 per 100,000 people and in the United States it is 1 in 100,000. Dr.
Drew testified that Brazil has "3 to 6 times the amount of problems with this organism"
than in the United States. The Commission was aware of the statistical chance for an
individual to contract Neisseria meningitides in Brazil.
¶ 40 The employer argues that the Commission's decision was based on the mere and
remote possibility that the employee was exposed to Neisseria meningitides at some
unknown time, in an unknown location in Sao Paolo, Brazil. It argues that the special
administrator did not present any evidence that the employee was exposed to a specific
carrier of Neisseria meningitides or that he was in any crowded areas in Brazil where
there might have been an increased risk of infection.
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2014 IL App (1st) 130766WC¶ 41 Dr. Stratton, Dr. Drew, Dr. Coe, and Dr. Zar all agreed that Neisseria meningitides
is transmitted through airborne respiratory droplets. Dr. Stratton and Dr. Drew testified
that most people who are infected with Neisseria meningitides do not develop the disease,
but are carriers. Dr. Zar wrote in his report that "once a new person acquires the
organism, the vast majority of the time the person makes proteins (antibodies) to prevent
the bacterium from penetrating the nasopharynx and entering the blood stream.
Individuals who successfully create antibodies will not develop the symptoms but will
become carriers." The employer argues that there was no evidence that the employee was
in a crowded setting. It is true that a crowded setting increases a person's risk of
contracting Neisseria meningitides because there is greater exposure to carriers.
However, a person only needs to come into contact with respiratory droplets from one
carrier to become infected. While in Brazil, the employee interviewed candidates for the
position of general manager of the Sao Paolo office, traveled to the employment agency's
office, most likely by taxi, stayed in a hotel, ate at McDonald's and one other restaurant,
spent hours at the employer's Sao Paolo office, and spent several hours at the Sao Paolo
airport. He was in contact with numerous people during his trip to Brazil, any one of
whom may have been infected with Neisseria meningitides.
¶ 42 The employer argues that the employee had an upper respiratory tract infection
before he left for Brazil and that it was a manifestation of meningitis. It asserts that these
symptoms support a finding that the employee contracted Neisseria meningitides before
he left for Brazil. Dr. Stratton testified that the early symptoms of Neisseria meningitides
are nonspecific and do not include upper or lower respiratory tract infection symptoms.
- 19 -
2014 IL App (1st) 130766WCDr. Zar wrote in his report that the clinical manifestations of the infections are an acute
onset of fever, nausea, vomiting, headache, altered mental state, severe muscle aches, and
in 50% of infected people a rash. He did not indicate that the symptoms include
symptoms similar to those in respiratory tract infections. Dr. Drew testified that a small
subset of people who are infected with Neisseria meningitides may develop respiratory
symptoms such as pharyngitis, sinusitis, or a runny nose. Dr. Stratton testified that had
respiratory tract infection symptoms been symptoms of Neisseria meningitides, the
employee would have been sick in Brazil. No one testified that the employee was ill in
Brazil. In fact, Mr. Moura testified that the employee "looked like a person that was a
hundred percent fit and one that makes sports." Dr. Parciak testified that the employee
told him his respiratory tract symptoms had been improving. Based on this evidence, the
Commission could infer that the employee's upper respiratory tract infection was not a
manifestation of Neisseria meningitides.
¶ 43 Both Dr. Stratton and Dr. Drew testified that a respiratory tract infection would
weaken a person's defenses against Neisseria meningitides. Dr. Stratton testified that the
employee's respiratory tract infection "facilitated or even accelerated" his development of
Neisseria meningitides.
¶ 44 All four doctors agreed that the incubation period for Neisseria meningitides is 2
to 10 days. Dr. Stratton opined that to a reasonable degree of medical certainty, the
employee acquired meningococcemia in Sao Paolo. He felt that Brazil was the most
likely location that the employee contracted Neisseria meningitides based on when the
employee became ill, the timing of the trip to Sao Paolo, and the fact that the employee
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2014 IL App (1st) 130766WChad a respiratory tract infection that facilitated or accelerated his contraction of the
bacterium. Dr. Stratton averred that the incubation period in the employee's case was 2
rather than 10 days. Dr. Drew testified that the interval between the onset of the
employee becoming ill and his death supported a very brief incubation period. He opined
that the employee contracted Neisseria meningitides as a result of his travel to Sao Paolo.
Dr. Coe and Dr. Zar testified that, based on an incubation period of 2 to 10 days, it was
impossible to determine whether the employee was exposed to Neisseria meningitides
before or during his trip to Brazil.
¶ 45 The Commission found that the opinions of Dr. Stratton and Dr. Drew were more
persuasive than those of Dr. Coe and Dr. Zar. The Commission is charged with resolving
conflicts in medical opinion evidence. Bernardoni v. Industrial Comm'n, 362 Ill. App. 3d
582, 597, 840 N.E.2d 300, 312 (2005). It is the function of the Commission to judge the
credibility of witnesses, resolve conflicts in the evidence, assign weight to be accorded
the evidence, and draw reasonable inferences from the evidence. Hosteny v. Illinois
Workers' Compensation Comm'n, 397 Ill. App. 3d 665, 674, 928 N.E.2d 474, 482 (2009).
We cannot say based upon the record before us that the Commission's decision is
contrary to the manifest weight of the evidence.
¶ 46 CONCLUSION
¶ 47 For the foregoing reasons, we affirm the judgment of the circuit court confirming
the decision of the Commission.
¶ 48 Affirmed.
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2014 IL App (1st) 130766WC- 22 -