Here’s the background.

A bolt weighing several pounds fell from above, striking Bruce Stewart while he was working for AltairStrickland in Texas. An MRI showed minor disc bulges at three levels on his cervical vertebrae. His doctor prescribed hydrocodone.

Three months later, Stewart died from an overdose of hydrocodone according to a toxicology report.

Stewart’s wife sought death benefits. The Texas Division of Workers’ Compensation ruled Stewart failed to comply with his doctor’s instructions. For that reason, it denied the request for death benefits.

The issue went to trial, and a jury found Stewart’s death did result from the treatment for his compensable injury. Therefore, his wife was eligible for death benefits.

The company took the case to a Texas appeals court. It argued the evidence was insufficient to show that Stewart’s death resulted from medical treatment for his compensable work injury.

The appeals court said the issue in the case comes down to this question:

Was the evidence sufficient to support the jury’s implicit finding that Stewart’s death did not result solely from his intentionally or knowingly failing to comply with his doctor’s instructions?

Stewart’s wife testified that there were times when he got confused about whether he had taken his pain medication. She said particularly in the last few days before he died, he was getting “really bad” about forgetting that he had already taken his medicine.

Doctors, including a forensic toxicologist, also testified that one of the side effects of such pain medications is confusion.

The company argued that the expert testimony supporting this “side effects” theory was insufficient.

However, the court said the expert testimony wasn’t even needed in this case. The jury was asked to determine what caused Stewart to take a lethal amount of the drug.

“It takes no specialized knowledge for a juror to conclude, for example, that a patient exhibiting symptoms of disorientation and memory loss may unwittingly take an excessive amount of prescribed medication,” the court noted. “The connection … is apparent to a casual observer.”

The appeals court said the lay testimony from Stewart’s wife and others about his confusion was enough to support the jury’s verdict.

The appeals court ruled that Stewart’s wife should get workers’ comp death benefits.

Another note about this case: Testimony from the forensic pathologist who performed the autopsy on Stewart confirms what’s been noted more and more in the media, that it’s not uncommon for injured workers to overdose on these medications. The doctor testified in court:

“Well, I see it a lot. I do autopsies on people with chronic pain a lot … they increase the drugs to try to alleviate the pain more and pretty soon they’re taking more than prescribed and pretty soon they will overdose … And when they die it’s usually a low lethal range.”

The level of the painkiller in Stewart’s blood was in that low lethal range.

What can companies do about this? Employee education is the first step. Let workers know the dangers of prescription painkillers … whether they’re for a work or non-work injury. As this case shows, misuse can be fatal.

What do you think about the court’s decision? Let us know in the comments below.

(Commerce & Industry Insurance Co. v. Ferguson-Stewart, Court of Appeals of Texas, 13th Dist., No. 13-10-00554-CV, 5/10/12)

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It’s none of those. Employee use of prescription opiates jumped 18% from 2008 to 2009 and has increased 40% from 2005 to 2009, according to Quest Diagnostics, Inc.

Also, 2009 post-accident drug tests found opiates up to four times more often than in pre-employment tests.

The Quest results are consistent with a recent report from the U.S. Dept. of Health and Human Services. The report showed a 111% increase in the estimated number of emergency department visits for nonmedical use of opioid analgesics from 2004-2008.

Quest notes that both prescribed use and misuse of opiates appear to be on the rise, and that’s something employers with safety-sensitive jobs should be aware of.

Semi-synthetic opiates had higher positive rates. Hydrocodone, the most prescribed generic drug for the past three years, registered a 1.3% positive rate in Quest’s 2009 general U.S. workforce data. Oxycodones showed a 1.0% positive rate and hydromorphone reached 0.82%. Naturally occurring opiates, such as codeine and morphine, had positive rates below 0.5%.

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