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Jobe v. Dirne Clinic

Supreme Court of Idaho

December 21, 2017

RICHARD JOBE, Claimant-Appellant,
v.
DIRNE CLINIC / HERITAGE HEALTH, Employer, and IDAHO STATE INSURANCE FUND, Surety, Defendants-Respondents.

         2017 Opinion No. 129

         Appeal from the Industrial Commission of the State of Idaho.

         Industrial Commission decision denying that MRSA infection caused by employment, vacated and remanded.

          James, Vernon & Weeks, P.A., Coeur d'Alene for appellant. Stephen J. Nemec argued.

          H. James Magnuson, Coeur d'Alene, argued for respondents.

          BURDICK, Chief Justice.

         This 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 remand.

         I. FACTUAL AND PROCEDURAL BACKGROUND

         Jobe is 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.

         On May 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.

         Dr. 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.[1] 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 physician."

         Dr. 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.

         Dr. 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.

         After 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 statutes.

         On 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 ...


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