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Gallup v. State Compensation Insurance Fund

Court of Workers Compensation of Montana

February 9, 1996

DEBBIE I. GALLUP Petitioner
v.
STATE COMPENSATION INSURANCE FUND Respondent/Insurer for AMEX TAX AND DUTY FREE SHOPS Employer.

          Date Submitted: November 7, 1995

          FINDINGS OF FACT, CONCLUSIONS OF LAW AND JUDGMENT

          Mike McCarter Judge

         Summary:

         36-year old sales and delivery person developed a blister on the left side of her groin after unexpectedly performing delivery work involving substantial exertion in pantyhose and new slacks. The blister developed into an abscess and, despite medical treatment, claimant continued to develop abscesses and sores diagnosed as hidradenitis suppurative, a chronic disease. The insurer accepted the claim and conceded liability for treatment and disability associated with abscesses near the original blister, but disputed continued liability for claimant's chronic condition.

         Held:

         From the medical evidence presented, WCC concluded that medical science is currently unable to determine what causes hidradenitis. Applying a line of cases decided under pre-1995 statutes, beginning with Moffett v. Bozeman Canning Co., 95 Mont. 347, 26 P.2d 973 (1933), and most recently including Prillaman v. Community Medical Center, 264 Mont. 134, 870 P.2d 82 (1994), the WCC held that where the etiology of a condition is not known, the presence of ongoing symptoms of the disease post-injury, joined with medical testimony that the condition may spread from one infected site to another, creates strong evidence that claimant's condition became symptomatic because of the industrial injury.

         Topics:

Causation: Medical Condition. 36-year old sales and delivery person developed a blister on the left side of her groin after unexpectedly performing delivery work involving substantial exertion in pantyhose and new slacks. The blister developed into an abscess and, despite medical treatment, claimant continued to develop abscesses and sores diagnosed as hidradenitis suppurative, a chronic disease. The insurer accepted the claim and conceded liability for treatment and disability associated with abscesses near the original blister, but disputed continued liability for claimant's chronic condition. From the medical evidence presented, WCC concluded that medical science is currently unable to determine what causes hidradenitis. Applying a line of cases decided under pre-1995 statutes, beginning with Moffett v. Bozeman Canning Co., 95 Mont. 347, 26 P.2d 973 (1933), and most recently including Prillaman v. Community Medical Center, 264 Mont. 134, 870 P.2d 82 (1994), the WCC held that where the etiology of a condition is not known, the presence of ongoing symptoms of the disease post-injury, joined with medical testimony that the condition may spread from one infected site to another, creates strong evidence that claimant's condition became symptomatic because of the industrial injury.
Medical Conditions (By Specific Condition): Hidradenitis. 36-year old sales and delivery person developed a blister on the left side of her groin after unexpectedly performing delivery work involving substantial exertion in pantyhose and new slacks. The blister developed into an abscess and, despite medical treatment, claimant continued to develop abscesses and sores diagnosed as hidradenitis suppurative, a chronic disease. The insurer accepted the claim and conceded liability for treatment and disability associated with abscesses near the original blister, but disputed continued liability for claimant's chronic condition. From the medical evidence presented, WCC concluded that medical science is currently unable to determine what causes hidradenitis. Applying a line of cases decided under pre-1995 statutes, beginning with Moffett v. Bozeman Canning Co., 95 Mont. 347, 26 P.2d 973 (1933), and most recently including Prillaman v. Community Medical Center, 264 Mont. 134, 870 P.2d 82 (1994), the WCC held that where the etiology of a condition is not known, the presence of ongoing symptoms of the disease post-injury, joined with medical testimony that the condition may spread from one infected site to another, creates strong evidence that claimant's condition became symptomatic because of the industrial injury.

         The trial in this matter was held on October 13, 1995, in Great Falls, Montana. Petitioner, Debbie I. Gallup (claimant), was present and represented by Mr. Cameron Ferguson. Respondent, State Compensation Mutual Insurance Fund, was represented by Ms. Ann E. Clark. Exhibits 1 through 9, 11, and 14 through 20 were admitted without objection. Exhibits 10, 12, and 13 were withdrawn. Claimant and Dennis Small were sworn and testified. Additionally, the depositions of claimant, Dr. Robert F. Stanchfield, Dr. David Baldridge and Dr. Paula A. Lantsberger were submitted for the Court's consideration.

         Issues presented: Claimant contends that her continuing hidradenitis suppurative is the result of the industrial injury she suffered on May 18, 1992.

         Having considered the Pre-trial Order, the testimony presented at trial, the demeanor and credibility of the witnesses, the depositions and exhibits, the Court makes the following:

         FINDINGS OF FACT

         1. Claimant is 36 years old. She has a high school education. She lives on a 20-acre farm on the outskirts of Sweetgrass, Montana, with her husband and 12 year old son.

         2. On May 18, 1992, claimant was working as a sales and delivery person for Amex Tax and Duty Free Shops. Claimant's job required she take items purchased from the shop and transport them to the custom's station on the U.S./Canadian border. It was a very hot day and the claimant did a lot of walking, running and climbing stairs while delivering the goods. She did not anticipate working as the delivery person that day; rather, she thought she would be cashiering and had worn new slacks, pantyhose and heels. The clothes were inappropriate for delivery work; the combination of the heat and her physical exertion caused the inseam of her slacks to wear through the pantyhose, raising a blister on the left side of her groin.

         3. The blister developed into an abscess and the claimant sought medical care from Dr. Robert F. Stanchfield on June 1, 1992. Dr. Stanchfield excised the apocrine (sweat) gland around which the abscess had developed and placed claimant on a course of antibiotics. (Ex. 3 at 1.)

         4.Claimant's condition was diagnosed as hidradenitis suppurative (hidradenitis). (Id. at 4.) Hidradenitis is a chronic disease that causes recurring abscesses and draining sores in the groin, armpits, and/or anal/genital region. The condition occurs when bacteria, usually pyogenic, gain access to the apocrine glands through some sort of lesion in the dermis. The gland becomes infected and fills with pus. The resulting abscess eventually erupts, extending the infection to adjacent apocrine glands. Ultimately other bacteriological organisms may be introduced which result in "mild chronic inflammation that smolders despite resolution of the acute pyogenic lesions." (Ex. 20 at 1.)

         5. Prior to May 18, 1992, claimant had never experienced an outbreak of hidradenitis. The Court notes that by that time claimant was 32 years old.

         6.Claimant developed several additional abscesses on the left side of her groin over the course of the next year. Claimant testified at trial that almost immediately after removal of the sutures from the first excision, a second abscess developed directly in front of the original one. Shortly thereafter, a third abscess developed posteriorly to the original. These were excised in Dr. Stanchfield's office on December 29, 1992 and January 20, 1993, respectively. (Ex. 3 at 5, 8.)

         7.Claimant underwent yet another excision on February 23, 1993, at the Toole County Hospital. (Ex. 9 at 1.)

         8. Claimant was seen for follow-up of her February surgery on several occasions over the next six weeks. She appeared to be improving, however, she continued to have drainage and swelling. (Ex. 3 at 11-12.) At her six week post-operative follow-up examination on April 7, 1993, the doctor reported she was "doing well and then began to have some increased pressure and firmness over the excision area with some serosanguinous drainage the last few days." (Id. at 12.)

         9.The State Fund accepted liability for the blister and initial hidradenitis. It paid temporary total disability benefits through April 7, 1993. At that time, the State Fund contends claimant had recovered from all aspects of the disease attributed to the work-related blister. However, claimant continued to experience work-related, recurrent episodes of hidradenitis.

         10. Claimant called Dr. Stanchfield on September 15, 1993, reporting a recurrence of her hidradenitis. He prescribed antibiotics. (Ex. 3 at 13.)

         11. Antibiotics were renewed in March 1994 due to swelling in her groin. (Id.)

         12. Claimant was seen by Dr. Stanchfield on June 10, 1994. His medical report states" she is not having any problems with the cysts on her groin, but she does have an area on her right gluteus that festers up and drains once in awhile." (Id. at 15.)

         13. Claimant was examined again by Dr. Stanchfield on July 15, 1994. Claimant had an abscess or boil on her perineum and a "little swollen, tender nodule rather high in the groin area on the left." (Id. at 15.)

         14. On August 8, 1994, Dr. Stanchfield examined claimant and found she now had infected glands on the right side of her groin. (Id. at 16.)

         15. Claimant testified at trial that she has had six or seven cysts excised. Additionally, she has had four or five more cysts drained. Symptomatically, she has pain, swelling, and discharge from the abscesses. She also experiences swelling and pain in her legs. (Ex. 3 at 23.) Dr. Baldridge testified swelling of this nature can occur in severe cases. (Baldridge Dep. at 16.) Claimant can feel the cysts beginning to develop below the surface of her skin. She testified that taking antibiotics helps, but that she can usually feel a new cyst developing shortly after finishing a course of antibiotics.

         16. Claimant self-treats her condition when possible. (Gallup Dep. at 14, 17.) She testified that she sometimes drains the abscesses at home due to her dislike of surgery, the expense of medical care and embarrassment. Also, around the time she began having problems with the right side of her groin, she avoided scheduling appointments with Dr. Stanchfield in consideration of personal difficulties the doctor was experiencing. (Id. at 20.)

         17. The claimant has demonstrated, both through her testimony and the medical records, that she has had active symptoms of hidradenitis constantly since June 1, 1992, the date she was first seen by Dr. Stanchfield. I found claimant's testimony credible.

         18. At the request of the insurer, claimant was seen by Dr. David Baldridge for an IME on August 22, 1994. Dr. Baldridge specializes in dermatology and has treated several dozen cases of hidradenitis. Dr. Baldridge confirmed the diagnosis of hidradenitis. He noted that in the past her lesions were limited to the left side of her groin but were now beginning to appear on the right. (Ex. 14 at 2.) Dr. Baldridge testified by deposition. He gave the following opinions:

a .The cause of hidradenitis is unknown. (Baldridge Dep. at 7.)
b. While it is unclear what causes lesions to break out, there is evidence that tight fitting clothes exacerbates the disease. (Id. at 8.) Dr. Baldridge did not believe the work-related blister could be "blamed for causing the whole cascade of events of hidradenitis." (Id. at 12.)
c. At the time of his examination, claimant had a right-sided lesion and also a plugged pore "very distant from the original area that was excised." Dr. Baldridge did not believe these could be related to the original outbreak. (Id. at 14-15.) Counsel for respondent then asked the doctor about theoretical subsequent lesions closer to the original outbreak:
Q. Okay. If she developed subsequent lesions that were a quarter of an inch away from the original scar, the original area, are those related to the original one ?
A. Quarter inch, they could be.
Q. And could they not be ?
A. Yes.
Q. Is there any way of knowing ?
A. No.

(Id. at 15-16.)

d. He indicated that "there's no question that once this problem begins and you have significant inflammation and damage to the sweat ducts in the area, then it can trigger the same problem locally." He felt that because Dr. Stanchfield aggressively treated the initial cyst, it was unlikely others developed as a consequence of the first. (Id. at 18-19.) But he later testified that the first abscess led to further problems in the immediate area of the first abscess. (Id. at 27.)
e. Dr. Baldridge rejected the notion that the claimant's present symptoms of hidradenitis are related to the blister she developed at work. He candidly admitted, however, that he did not know what caused the current condition:
Was that one day at work the cause for it? Was it another day when she was walking one day and some irritation was caused and that triggered it? Was it a combination of events? I don't know. But just because it wasn't there before that event at work doesn't establish that was the cause of it.

(Id. at 21.)

f. He testified that the scarring caused by healing abscesses can "cause further ducts to become blocked and inflamed and trigger further lesions, so it can promote the disease further." (Id. at 28.)
g. He testified that if claimant was having ongoing problems in the area of the original cyst, he would consider those problems to be related to the initial abscess. (Id. at 30.)
h. On cross-examination, Dr. Baldridge was asked how far from the initial cyst a subsequent cyst may develop and be considered to have arisen due to the first:
Q. And so again, it can spread from the initial break out situation to an ...

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