Opinion No. 129
from the Industrial Commission of the State of Idaho.
Commission decision denying that MRSA infection caused by
employment, vacated and remanded.
Vernon & Weeks, P.A., Coeur d'Alene for appellant.
Stephen J. Nemec argued.
James Magnuson, Coeur d'Alene, argued for respondents.
BURDICK, Chief Justice.
appeal arises from an Industrial Commission order denying
that Dr. Richard Jobe's ("Jobe")
Methicillin-resistant Staphylococcus aureus
("MRSA") constituted a compensable occupational
disease. The Commission denied Jobe's claim because it
found he failed to prove that his MRSA colonization and
infection were caused by his employment with Dirne
Clinic/Heritage Health ("Heritage"). Jobe appeals,
arguing the Commission applied the wrong legal standard in
requiring him to prove his MRSA colonization and infection
were caused by his employment at Heritage. We vacate and
FACTUAL AND PROCEDURAL BACKGROUND
a licensed physician who began practicing in 1965. On October
8, 2012, he began his employment at Heritage as a physician.
After working approximately eight months at Heritage, Jobe
was diagnosed with a MRSA infection in his right hand on June
17, 2013. At the time of this diagnosis, Jobe told the
diagnosing physician the only likely cause of this infection
was a cat scratch that had occurred on his right hand a few
weeks previously. After this diagnosis, Jobe's MRSA
infection became systemic and spread throughout his entire
body. To manage this infection, Jobe underwent numerous
surgeries. Since June 2013, Jobe has also suffered two
strokes related to his MRSA infection. These strokes have
left him unable to effectively communicate. He now has
trouble in his movement and needs assistance with activities,
such as sitting, putting on his socks and shoes, and walking.
29, 2014, Jobe brought an occupational disease claim before
the Commission against Heritage and its surety claiming that
his MRSA is a compensable occupational disease that was
caused by his employment at Heritage. On June 17, 2014,
Heritage filed an Answer denying liability, claiming that
Jobe's MRSA was not caused by his employment at Heritage.
On March 4, 2016, a hearing was held by Referee Harper to
determine the cause of Jobe's MRSA. The medical evidence
at this hearing primarily consisted of testimony and reports
from three physicians: Dr. Souvenir; Dr. Hull; and Dr. Riedo.
Souvenir was Jobe's primary infectious disease physician.
He testified that it is difficult to assess where people
acquire MRSA bacteria. However, he noted that healthcare
workers as a general class have an increased incidence of
MRSA colonization. Individuals can carry colonized MRSA for
years without the bacteria producing an infection. However,
when colonized MRSA bacteria enter a person's
bloodstream, by, for example, entering through a break in
one's skin, it can cause an infection. Nevertheless, in
spite of not knowing the source of the MRSA bacteria, Dr.
Souvenir felt it was more likely than not that Jobe acquired
the bacteria "in the course and scope of his duties as a
Hull was hired by Jobe to assess the source of the MRSA
bacteria that caused his infection. He opined that Jobe
"more likely than not acquired the MRSA bacteria which
led to his infection from one of the patients he
examined" while working at Heritage in the months
preceding his infection. Much of his testimony revolved
around studies exploring hospital- caused MRSA infections.
For instance, Dr. Hull noted while between 1% and 1.5% of the
general public carries colonized MRSA bacteria, approximately
4% to 5% of healthcare workers carry the colonized bacteria.
Riedo was hired by Heritage to give an independent evaluation
as to the cause of Jobe's MRSA. He "did not believe
it was possible to establish if [Jobe's] MRSA
colonization or infection was acquired in the course of his
work" at Heritage. This was partially because Jobe also
had other risk factors that would increase his chances of
contracting MRSA. Jobe was "over 65, he has exposure to
animals, he had multiple surgical procedures and injections
over the years, and he had exposure not as a health care
worker but as a health care recipient." Accordingly, Dr.
Riedo concluded that it was not possible to attribute
Jobe's MRSA to his employment at Heritage, as opposed to
his exposure to the healthcare system as a patient, his
exposure to animals, or to his age.
reviewing the evidence and testimony, the Referee made his
conclusions as to the cause of Jobe's MRSA. With regard
to the cause of the infection, he concluded that MRSA
bacteria entered Jobe's bloodstream through the cat
scratch that occurred on his right hand a few weeks prior to
his infection. This conclusion was primarily based on the
finding that his right thumb joint was the first area of
infection diagnosed and treated for MRSA. With regard to the
source of the bacteria that caused the infection, the Referee
gave more weight to Dr. Riedo's expert opinion, in that
it was not possible to determine if the MRSA bacteria was
acquired at Heritage. The Referee stated he was giving Dr.
Riedo's opinion more weight because the other expert
opinions were based generally on Jobe's occupation and
did not explain why Jobe could not have been colonized with
MRSA while working as a physician prior to his employment
with Heritage. The Referee concluded:
[I]t cannot be said [Jobe] has produced evidence which
establishes that it is more probable than not that he was
colonized and infected with MRSA while working for [Heritage]
from October 2012 through June 2013. While certainly not all
the above-listed events are equally to have been the culprit
for [Jobe's] MRSA infection, only one event-[Jobe's]
employment with [Heritage]-would allow [him] to obtain
compensation under Idaho's workers compensation
September 23, 2016, the Commission entered an order adopting
the Referee's findings of facts and conclusions of law as
its own. The Commission concluded that Jobe "has failed
to prove his MRSA infection constitutes a compensable
occupational disease caused by his employment ...