THE STATE OF SOUTH CAROLINA
In The Supreme Court
Jane Doe, Claimant, Petitioner,
v.
South Carolina Department of Disabilities and Special Needs, Employer, and State Accident Fund, Carrier, Respondents.
ON WRIT OF CERTIORARI TO
THE COURT OF APPEALS
Appeal from Florence County
James E. Brogdon, Circuit Court Judge
Opinion No. 26465
Heard December 5, 2007 - Filed March 24,
2008
REVERSED
Edward L. Graham, of Graham Law Firm, P.A., of Florence, for petitioner.
T. McRoy Shelley, III, of Rogers, Townsend & Thomas, PC; and Cynthia B. Polk, all of Columbia, for respondents.
JUSTICE MOORE: We granted a writ of certiorari to review the Court of Appeals decision in this workers compensation case.[1] We reverse.
FACTS
In 1979, petitioner (Claimant) began employment as a licensed practical nurse (LPN) with respondent South Carolina Department of Disabilities and Special Needs (Department). Claimant worked at a Department facility that housed patients in various units. She was the only LPN on first-shift duty in her unit. It was her responsibility to give basic patient care and administer medications.
During the spring of 1997, Department began downsizing the facility. Higher functioning patients were moved to community homes and the remaining patient units were consolidated. As a result, the patient population in Claimants unit changed from being a passive group to a mixed group of passive and aggressive patients. The record indicates Claimants unit went from being a fairly pleasant unit to work in to being kind of a dumping ground where none of the other nurses wanted to work.
The level of noise and violence in Claimants unit increased dramatically in the spring of 1997. With the combination of patients, the aggressive patients attacked the passive ones and Claimant was forced to intervene. Patient and staff injuries increased significantly. The number of reported incidents in Claimants unit increased from eleven in March 1997 to 128 in May 1997.[2] Claimant suffered a number of minor physical injuries, including having feces smeared in her face.
After the spring of 1997, Claimant began having problems with depression. She received psychiatric care, including medication and electro-convulsive treatment, and was hospitalized for severe depression in 1998. Dr. Lowe gave his medical opinion that Claimants depression was caused by her job situation. He noted that Claimant was previously a well-integrated and functioning person and her sense of self-worth declined when her work situation fell apart. Claimant finally resigned in June 1998 as a result of her inability to work.
Claimant filed this claim for workers compensation benefits alleging a stress-related mental injury.[3] The single commissioner denied the claim. His findings were adopted by the appellate panel of the full Commission (hereinafter the Commission). The circuit court found these findings were unsupported by substantial evidence and reversed. The Court of Appeals reversed the circuit courts order and reinstated the Commissions ruling that Claimant was not entitled to benefits.
ISSUE
Is there substantial evidence to support the Commissions decision regarding causation?
DISCUSSION
Our standard of review requires that we determine whether the circuit court properly found the Commissions findings of fact are not supported by substantial evidence in the record. Baxter v. Martin Bros., Inc., 368 S.C. 510, 630 S.E.2d 42 (2006).
Mental or nervous disorders are compensable provided the emotional stimuli or stressors are incident to or arise from unusual or extraordinary conditions of employment. Powell v. Vulcan Materials Co., 299 S.C. 325, 384 S.E.2d 725 (1989) (adopting analysis of Stokes v. First Natl Bank, 298 S.C. 13, 377 S.E.2d 922 (Ct. App.1988)). In Shealy v. Aiken County, 341 S.C. 448, 535 S.E.2d 438 (2000), we surveyed different approaches to determining what constitutes an unusual and extraordinary condition of employment. We concluded the standard to be applied is whether the work conditions at issue were unusual compared to the particular employees normal strains. 341 S.C. at 457, 535 S.E.2d at 443 (citing 2 Arthur Larson & Lex K. Larson, Larsons Workers Compensation Law 44.05(4)(d)(i) (1999)).
Here, the commissioner found there were no extraordinary or unusual conditions in Claimants employment. He concluded it was not unexpected that patients would be moved from one facility to another, that workers would be subjected to aggressive behavior from patients, or that the amount of care needed by patients would change. The circuit court found the commissioners findings, adopted by the full Commission, were unsupported by substantial evidence. The court focused on the fact that the mix of passive and aggressive patients was an extraordinary and unusual condition in Claimants employment and concluded this caused Claimants stress-related mental injury. We agree with the circuit courts analysis.
The record indicates that in the spring of 1997, with the new mix of passive and aggressive patients in Claimants unit, behavior problems escalated because of the domino effect created when an aggressive patient acted out. Claimant had never before worked with a mix of passive and aggressive patients. No other unit had a mix of passive and aggressive patients. In fact, Department made changes after a DHEC survey criticized Department for housing diverse patients together.
The Court of Appeals reversed the circuit court, finding substantial evidence in the record that supported the Commissions conclusion there were no extraordinary and unusual conditions in Claimants employment. The Court of Appeals relied on the testimony of Claimants two co-workers, Tenia Rae Allen and Kim Willis. A review of the record, however, indicates that the testimony relied upon is taken completely out of context and does not support the Court of Appeals conclusion.
First, the Court of Appeals noted the testimony of Tenia Rae Allen, a nurse supervisor, stating that it was not unusual for nurses to deal with aggressive patients and nurses were injured even before aggressive patients were transferred to Claimants unit. Nurse Allen never stated that it was usual for a nurse to deal with a mix of passive and aggressive patients. In fact, she testified that Claimants unit became pretty chaotic with the new mix of patients and there was a significant increase in violent behavior even among the patients who formerly were fairly well-controlled. She observed that the change in Claimants unit was pretty dramatic, and yes, I think it could really depress somebody to be there. Other units housed only volatile patients but were smaller units and the staff was used to handling those patients. As a whole, Nurse Allens testimony supports the conclusion that the mix of passive and aggressive patients in Claimants unit was an extraordinary and unusual condition compared to the normal strains of Claimants employment.
The Court of Appeals also noted the testimony of Nurse Willis that, in her experience, there are always patients who are harder to deal with, she expects changes in the types of patients she deals with, and physical confrontation with patients is not unusual. Nurse Willis, however, never discussed caring for a mixed group of passive and aggressive patients. She did say that Claimants unit had an increase in patients with behavioral problems, including one patient who screamed continuously, and that the difference in caring for low level and high level patients was a substantial change.
Finally, the Court of Appeals observed that Claimant had non-work related stressors, including a prior bout with depression in 1980 and her fathers cancer and death in December 1997, that could impact her mental injury. There is no support in the record for the conclusion that any of these outside factors caused or even contributed to Claimants disability. The only evidence of causation is that Claimants mental injury was caused by her stress at work as stated by Dr. Lowe. Moreover, a history of pre-existing depression does not preclude workers compensation benefits for a mental-mental injury. See Ellison v. Frigidaire Home Prods., 371 S.C. 159, 638 S.E.2d 664 (2006) (an injured claimant is entitled to benefits for disability arising from a permanent impairment in combination with a pre-existing impairment if the combined effect results in a substantially greater disability).
CONCLUSION
We find no substantial evidence in the record to support the Commissions denial of benefits. Accordingly, we remand for the Commission to award benefits based on Claimants disability arising from her mental-mental injury.
WALLER, J., and Acting Justice Doyet A. Early, III, concur. TOAL, C.J., concurring in a separate opinion. PLEICONES, J., dissenting in a separate opinion.
Chief Justice Toal: I concur in the majoritys decision to reverse this case, but I write separately because I would resolve the case on different grounds. In my view, two of the tribunals below committed similar errors of law in failing to properly apply the standard for evaluating a workers compensation claim for mental injuries brought about by emotional stress or stimuli. Accordingly, I would reverse this case without determining whether the lower courts findings have evidentiary support.
The reasoning of the single commissioner shares a fatal flaw with that employed by the court of appeals in reinstating the single commissioners decision. In my view, that fatal flaw is the focus on the ordinary aspects of Petitioners employment to the exclusion of an examination of the extraordinary, and the consequent use of those ordinary aspects to support the conclusion that Petitioners injury is not compensable. In Stokes v. First Natl Bank, the court of appeals adopted the view that mental injuries are compensable if, as in heart attack cases, the mental injury is induced either by physical injury or by unusual or extraordinary conditions of employment. 298 S.C. 13, 21, 377 S.E.2d 922, 926 (Ct. App. 1988). We affirmed that decision, noting:
injury by accident . . . has been construed to mean not only an injury the means or cause of which is an accident, but also an injury which is itself an accident; that is, an injury occurring unexpectedly from the operation of internal or subjective conditions, without the prior occurrence of any external event of an accidental character . . . [i]n determining whether something constitutes an injury by accident the focus is not on some specific event, but rather on the injury itself.
Stokes v. First Natl Bank, 306 S.C. 46, 49-50, 410 S.E.2d 248, 250 (1991).
In my view, both the single commissioner and the court of appeals failed to consider whether the changed conditions of Petitioners employment were, for her, unusual or extraordinary, and similarly failed to evaluate how the changed conditions affected Petitioner. I believe this was error under Stokes, and based on this error of law, I would reverse.
JUSTICE PLEICONES: I respectfully dissent. I believe the Court of Appeals correctly held that the Commissions decision was supported by substantial evidence, and I would affirm the denial of benefits to Claimant.
Because we granted certiorari to review a decision of the Court of Appeals, our standard of review requires us to determine whether the Court of Appeals properly held that the Commissions findings were supported by substantial evidence in the record.[4]
While I am sympathetic to Claimants struggle with depression, I cannot find error with the Court of Appeals conclusion. Claimant was an experienced LPN whose patients suffered from severe mental retardation and cognitive disabilities. The Department produced sufficient evidence to show that: (a) the change in the type of patients under Claimants care was neither unexpected nor unusual; (b) Claimant was trained to handle aggressive patients; and (c) although unfortunate, it was not unusual for Department nurses to be subjected to aggressive and sometimes violent behavior. Despite the fact that Claimant presented ample evidence to support her position, the Commissions findings must be upheld if supported by substantial evidence. See Shealy v. Aiken County, 341 S.C. 448, 455, 535 S.E.2d 438, 442 (2000) (substantial evidence is not evidence viewed solely from one side; it is evidence, when the whole record is considered, that would allow reasonable minds to reach the conclusion the Commission reached).
The Commission found that Claimant was not exposed to unusual and extraordinary conditions in her employment, and in light of the entire record, this conclusion is tenable. Accordingly, I would affirm the Court of Appeals because the Commissions findings are supported by substantial evidence.
[1]364 S.C. 411, 613 S.E.2d 785 (Ct. App. 2005).
[2]The number of incidents decreased in June 1997 to 87 and continued declining until the fall of 1997.
[3]Claimant also alleged mental injury stemming from physical injuries she sustained on the job. This claim was denied and is not an issue here.
[4] Under the Administrative Procedures Act, we may not substitute our judgment for that of a state agency as to the weight of evidence on questions of fact, but we may reverse or modify decisions which are clearly erroneous in view of the substantial evidence on the whole record. Welch Moving and Storage Co., Inc. v. Pub. Serv. Commn of S.C., 301 S.C. 259, 261, 391 S.E.2d 556, 557 (1990). Baxter, cited by the majority as stating the applicable standard of review, does not apply to this case. Baxter involved a certified appeal directly from the circuit court pursuant to Rule 204, SCACR.