Safety and OSHA News

Will widow get comp? Worker dies from prescription med overdose

A worker was prescribed pain meds for an on-the-job injury. He died from an overdose of the drugs. Will his widow get workers’ comp death benefits?

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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  1. The author says that employee education is the first step needing to be taken. I find it hard to believe that anyone doesn’t know you can overdose off a narcotic. I have a maintenance prescription that I refill once a month and along with every bottle a booklet is stapled to the bag listing all the possible side effects along with having them printed on the bottle. My doctor sat down with me and we went over all the possible side effects as well when it was prescribed. My medication isn’t even a narcotic but those precautions are taken. The injured man and his family were aware that he was abusing this medication (either purposely or not). Did he or the family ever contact the physician who prescribed the medication with these concerns?

    I don’t see how anyone can think this abuse was related to the treatment. I don’t know how the company is held responsible in the outcome.

  2. M. D. Hilton says:

    This case is another example of how the wrong conclusion is made from the evidence presented. Looked at in another way, if a youngster was permitted to over dose on a prescription drug, the parents would be found negligent and possibly facing criminal charges. Here we have an adult who took more medication than the doctor prescribed. Should not the wife, who will now be the receiver of the workcomp benefits not have some responsibility. This is simply another case where people believe workcomp is a right, and no one has to pay. Well this is just another reason why our jobs are being exported outside the USA. As Americans we need to wake up and realize that nothing is free in life…..someone pays!

  3. Safety Lady says:

    While I am usually firmly on the side of companies being abused by employees relating to WC, in this case I think the court got it right. While I have never had a severe injury I have known many including my brother that have, the pain in his back was so bad that as a 35 year old he was so stooped over that he could hardly move. The Doctors persribed medication for pain and told him that they were hesitant to do surgery. They did not feel that he could handle therapy. So really what was he suppose to do? He could be in such terrible pain that he couldn’t move or spend anytime with his young daughter or take a few extra pain pills. He has since had 2 surgeries and is doing much better.

    Additionally, unless we are Doctors we don’t know all side affects. I am very sorry for the ladies loss. I absolutly think the court got this one right.

  4. Here’s a solution. Have all work related prescription brought to the dcompany, who will assign someone to administer the meds as prescribed – 24-7. It would be cheaper than going to court and still having to pay for someone’s inability to follow instructions.

  5. If the prescribed dosage wasn’t helping the employee then he should have consulted his physcian. His wife, knowing that he was abusing his medication should have contacted his physician or made an appointment for him. How can anyone not be educated about their prescription medication with all of the information that is given out (stapled to the package) unless they are just irrisponsible and do not read it.

  6. This is just another example of the court saying people cannot be held accountable for their own actions. When the employee told his wife he was having trouble remembering shouldn’t she have stepped up to help him? I believe the courts should stop coddling the American people.

  7. I agree with the commit above. This is crazy to hold the company responsible. If the Family felt that he was confused their should of been some intervention . They (the family) should of set up and given him his meds or only allowed meds set up for the day or what ever worked, the Dr. should of been made aware and this problem dealt with.

  8. TedBean says:

    Isn’t there a fruit-of-the-tree principle in law? He had a legitimate work-related accident and whatever grows from that is still related.

  9. Have to agree with Tammie, Mike & Rhonda above. Were this my husband, you better believe I’d monitor the medicine he’s taking!! And at the 1st sign of confusion or forgetfulness, I’d have him at the dr’s office! The court was wrong; plain and simple.

  10. Darlene says:

    I think the court got this one very wrong. If the family (wife) were aware that he was experiencing some level of confusion they should have stepped up and make sure the dosages are being monitored. Did any of them contact the physician and make him aware of the side effects? I see no way a company can do the right thing in this scenario without being too intrusive in an employees private issues. We all know we don’t want Employers in the role of policing workers’ medication so why hold Employers responsible?

  11. I agree with all those that disagree with the courts. A person has to be willing to help themselves and stop blaming everyone else. I agree with a person using workers comp for a legitamate on the job injury but the job had nothing to do with the man and his wife’s lack of concern for themselves. Not only is there info on the packages and info from the doctors but it is also pasted all over the TV, and print ads about prescription drugs and their possible effects (whether it presents itself in a illegal or legal manner).

  12. Diane Larrivee says:

    When in doubt, the courts typically rule in favor of the injured worker or his/her beneficiaries. Except for suits invoving gross negligence, the employee gives up his/her right to sue their employer if the employer subscribes to workers’ compensation and doesn’t reject the Act (in most states that I am aware of). That’s the trade off. Right or wrong, in my experience I’ve seen many workers’ compensation claim circumstances where the question is asked “were it not for the work related injury, would the death, drug addiction, etc. have occurred?” And if the answer is “Yes, if the employee had not been injured, this result/condition would not have occurred” benefits are awarded.

  13. This verdict is ridiculous. Another example of the court system siding with the employee (in this case the widow) for actions that were clearly irresponsible on the part of the employee. As a Safety Manager, it is seldom that I can ever fight a case of a claimed injury, since all my state requires is the word of the employee. If an employee says he got hurt at work, we are guilty and on the hook for WC costs. I really don’t blame the judges or the juries, in most cases they are following the laws and case history. The WC laws in our nation need a major overhaul.

  14. I have to disagree with the court. To tailhook bad behavior into an injury makes no sense to me. Had he taken his life with a fire arm, would that have connected to WC as well? These entitlements are wrong.

  15. This is clearly a fruit of the tree case. The confusion and resulting death are a result of the original injury-just quit tring to put the blame on someone else. The court process was followed to its conclusion and the results are what the results are.

  16. This is a disgusting outcome. 3 months of pain meds and he didn’t seek alternate treatment? Sounds like an addict or profession workmans comp guy… whether intentional or not. I still do not know how people relate the misuse and possible medical mistreatment to the company. They have ZERO to do with the TREATMENT of a patient. If they could have demanded surgery or 24hr hospice care to admin meds and didn’t, then I could see they had a slight, slight bit of responcibility. But they have NO CHOICE how the patient is treated and therefore cannot be responcible.

    AGAIN, the courts, jurors, insurance agents, and bleeding hearts completely missed the intent and made a terrible conclusion. I would continue to the Supreme court if I was the company. Absolutely disgusting how this came out.

  17. Poor call by the courts. 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. So this didn’t send up a red flag? This is when the family or whomever, needs to get involved. Don’t turn a blind eye. Get them help. They make little containers with the days on them to help avoid this type of thing. If they are so confused that the container wouldn’t help, give them there meds each day and help them keep track. A simple phone call to the doctor can’t hurt. The resources available today are endless and situations like this can be easily avoided. I am sorry about her loss. It didn’t have to end this way.

  18. I agree with you, Al. Had a compensable injury never happened, there wouldn’t be an opportunity for the employee to be confused regarding medication or die due to drug overdose and the courts rendered their decision accordingly. And subject to the circumstances, MimmiDunn will most likely be further distressed to discover regarding her question as to whether the employee’s death would be considered a compensable claim if he died as a result of a firearm rather than an accidental drug overdose, that depending on the circumstances it could be rendered compensable. If the employee was depressed about the pain, how long rehab was taking, extent of impairment, loss of consortium, etc. and as a result killed himself with a firearm and his mental issues were documented in the medical records, death by firearm (in some states) could be compensable! Psych claims in most states must meet a high standard to be considered compensable (along with heart attacks and other medical issues which are sometimes considered controversial) but, if a pathway to compensability is built connecting the mental state, addiction, cause of death, etc. to the original injury, benefits will be granted. Don’t shoot the messenger!

  19. TedBean says:

    If the logic used by many of you was applied to paternity, the only way a man would be responsible is if he were present at the birth of the child. Sure, he’s responsible for the sex, but after that, the woman is responsible. Isn’t that what you’re saying? The side effects of treatment are a resonable consequence of injury.

  20. I guess what you all are saying, is that the law is always going to be subjective to whoever is looking at it. I think both arguments are equally valid and pieces of both can be cherry-picked or ignored to make your points.
    My opinion is that personal responsibility should be given more weight when the courts decided. Some of the reasoning shows that others here don’t feel that way.

    How about this scenario: An insulator takes a reciprical saw blade, wraps tape around the handle, and uses it to cut foamglass (fairly common in the industry). His Safety Mgr catches him, confiscates the blade and makes him go buy a proper saw at a hardware store ($30). The guy now doesn’t have money to take his wife to the movies on friday night, suffers depression and kills himself with a firearm. Fruit of the Tree case? I’m sure somewhere out there you have a lawyer ready to take that case for the family.

    And I apologize to anyone offended by that analogy.

  21. VJ’s scenario would be difficult for the family to pursue as a compensable claim because there wasn’t an injury…..Psych claims in most states must meet a high standard to be considered compensable.

  22. Safety first says:

    I would like to know more about the injury. A several pound bolt strikes him from above- where in his head, his back? What was the nature of the injury, could physical therapy help instead of pain pills. Perhaps if company are to be held accountable for this type of overdose they should regulate the Doctors who prescribe the pills and only after a full medical and psychological evaluation have pain medication approved to be administered. Then the injured party could see their company doctor each day for the medication they need to control the pain. Doctors over prescribe pain meds all the time without caring about the consequence. The courts got this one wrong.

  23. Occ Health Nurse says:

    As many have mentioned, responsibility is key. It’s at a point that if a person does receive a work related injury, anything else that now happens in this persons life drags the work related injury into play. Wake Up America!!! Life and freedom aren’t FREE! Take some responsibility and be a grown-up.
    Cases like this make it appear that many of us lack common sense. . .how pathetic!

  24. Bill Johnson says:

    Hmmm… if the company tried to monitor his medication, and require a report on his intake… they would have been sued for invasion of privacy… If they don’t, and he overdoses… they get sued for causing his overdose through the accident…Sounds like the lawyers have this all figured out…they get to sue either way. Vultures.

  25. Again…. Where is the personal responsibility. It sounds like the the company does the right thing by accepting the work comp injury – The employee receives medical care – THE EMPLOYEE MAKES A MISTAKE. This is the issue with OUR society. No personal responsibility. Unfortunatley the woman lost her husband… that must be horrible. We are not baby sitters…. We are employers trying to ensure our injured workers are taken care of properly. If the pill bottle from the pharmacist says take so many per so many hours – simply follow the instructions. Let me see if I have this correct. If the company makes a mistake – they are held accountable and are liable. If the doctor makes a mistake – they are held accountable and are liable. If an employee makes a mistake they are not held accountable – SOMETHING IS WRONG!!!!!! Simple answer – it’s an injustice for the wife to receive comp. benefits.

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