Safety and OSHA News

Widow wants death benefits because husband died of drug overdose

The family of a worker who died from an accidental overdose of prescription drugs filed for workers’ comp death benefits, arguing that the drugs were prescribed for a work injury. Did a court grant the benefits? 

In September 2008, Brandon Clark, 36, fell 8 to 10 feet while working as a carpenter for South Coast Framing Inc. in California. He suffered neck, back and head injuries.

Clark’s workers’ compensation doctor prescribed Elavil (an antidepressant), Neurontin (a neuronal pain reliever) and Vicodin (a codeine-based pain reliever).

Three months later, Clark’s personal doctor also prescribed Xanax (an anti-anxiety medicine) and Ambien (a sleep aid). Clark wasn’t sleeping well due to his injuries.

On July 20, 2009, Clark’s wife couldn’t wake him. He was pronounced dead at the scene.

At the time of his death, Clark had Elavil, Neurontin, Xamax and Ambien in his blood. Vicodin was detected in his urine.

The autopsy surgeon concluded the death was accidental and “is best attributed to the combined toxic effects of the four sedating drugs detected in his blood with associated early pneumonia.” A report stated:

“the specific combination of medicines he was on, which included Xanax, Ambien, Flexeril, Neurontin, Elavil and Vicodin, all separately and in combination had the capacity to induce respiratory depression, and even respiratory arrest.”

Clark had told his wife and brother he was having black-outs. The autopsy physician wrote theses black-outs were “probably warning episodes of untoward synergistic respiratory depression and/or central nervous system depression.”

There was no dispute that Clark died from some combination of the drugs he was prescribed. The question was which drugs played a role and how big that role was.

When South Coast disputed the request for workers’ comp death benefits from Clark’s widow, both parties agreed on Dr. Thomas Bruff as a qualified medical examiner to issue a report.

Dr. Bruff said:

  • Neurontin didn’t have a role in Clark’s case
  • Blood tests showed Clark was taking the Elavil as prescribed, which was a low dose.
  • But the Ambien and Xanax were found in excess of what would be considered normal blood concentrations.
  • Therefore, the Ambien and Xanax together “caused sedation significant enough to result in Clark’s death.”

In effect, Dr. Bruff was saying that it wasn’t the drugs prescribed by the workers’ comp doctor that killed Clark – it was the drugs prescribed by his personal physician.

At a hearing by a workers’ comp judge, Dr. Bruff’s testimony retreated somewhat from what he wrote in the report.

He said Elavil “may have had a small role at the levels found.” He could not “absolutely slam the door and say Elavil had no effect.”

When asked if Elavil, in combination with Ambien and Xanax, could be a contributor to Clark’s death, Dr. Bruff was reluctant to say at first. The doctor was asked whether Elavil “might have been what just put it over the edge” for Clark, and Dr. Bruff agreed it was possible.

When the judge asked Dr. Bruff to assign a percentage of causation attributable to the Elavil, the doctor eventually said, “It’s not zero, but it’s certainly not 20% either.” Dr. Bruff eventually assigned 1% causation to the Elavil.

The workers’ comp judge awarded the death benefits to Clark’s widow and three minor children. The company asked the workers’ comp board to overturn that decision, but the board refused.

South Coast took the case to a California appeals court. The appeals court overturned the workers’ comp judge, saying that there wasn’t substantial evidence to support the finding. The court found Dr. Bruff’s testimony “was largely based on surmise, speculation, conjecture and guess.” The court wrote:

“If Elavil played a role at all, it was not significant such that it constituted a material factor contributing to Clark’s death.”

Clark’s widow took her case to the California Supreme Court.

Only needs to be ‘contributing factor’

The California Supreme Court said the appeals court applied the wrong legal precedents to this case. In the workers’ comp system, the injury only needs to be a contributing factor to the death for benefits to be awarded. Tort law, on the other hand, requires the injury be a substantial factor.

The supreme court found there was enough evidence to support the workers’ comp judge’s finding that Elavil and Vicodin contributed to Clark’s death.

Both doctors, whose reports and testimony were entered in this case, attributed the cause of Clark’s death to the combination of all sedative drugs in the worker’s system. It wasn’t necessary to say that the drugs prescribed by the workers’ comp doctor were the primary causes.

For that reason, the California Supreme Court overturned the appeals court’s ruling and reinstated what the workers’ comp judge first found – that drugs prescribed for Clark’s workplace injuries were a contributing factor in his accidental overdose death, therefore his widow and three minor children should receive worker’s comp death benefits.

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

(South Coast Framing Inc. v. Jovelyn Clark et al, Supreme Court of California, No. S215637, 5/28/15)

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