California’s Supreme Court has agreed to hear arguments in a case where a man died of a prescription drug overdose and his widow argues she should receive workers’ comp death benefits because he was taking painkillers for a work injury.
When Jovelyn Clark first applied for death benefits, a workers’ comp judge (WCJ) concluded her husband, Brandon Clark, died as a result of medication he took after suffering a workplace injury.
Brandon Clark worked for South Coast Framing. In 2008, he suffered back, head, neck and chest injuries when he fell from a roof.
His workers’ comp doctor prescribed amitriptyline (an antidepressant), gabapentin (a pain reliever) and hydrocodone (Vicodin).
He was also taking Xanax and Ambien which were prescribed by his personal physician in January 2009. Xanax was prescribed for “ongoing anxiety,” and Ambien was prescribed for sleeping difficulties.
In July 2009, Clark died from an accidental drug overdose and “associated early pneumonia.”
Dr. Thomas Bruff, a medical examiner, reviewed Clark’s medical file, including autopsy and toxicology reports. In his own report, Dr. Bruff stated:
- Only amitriptyline, Ambien, Xanax, gabapentin and acetaminophen were found in Clark’s blood.
- Gastric specimens showed both Ambien and Xanax.
- In Bruff’s opinion, gabapentin didn’t have a role in this case.
- Amitriptyline was prescribed in a low dose and blood levels show it was likely taken as prescribed.
- Ambien and Xanax were found in excess of what would be considered normal blood concentrations.
- The combination of the Ambien and Xanax was significant enough to result in the events leading to death.
Dr. Bruff’s overall conclusion:
“It is my opinion that [Brandon] passed away as a result of the additive drug interaction between zolpidem (Ambien) and alprazolam (Xanax). The two additional medications present in the bloodstream, gapapentin and amitriptyline, were not high enough to result in any coincident drug interaction.”
During a deposition for this case, Dr. Bruff was asked if amitriptyline could have contributed to Clark’s death. The doctor said it was possible. However, he restated that Ambien and Xanax “carried the day.”
The ALJ found amitriptyline and hydrocodone contributed to Clark’s death, noting that Dr. Bruff said the two drugs were part of the causation pie, although very small parts.
South Coast asked the WCJ to reconsider her ruling, arguing Clark’s workers’ comp prescription meds didn’t materially contribute to his death.
The WCJ confirmed her original finding, explaining that it’s enough for an employment injury to be a contributing factor – it doesn’t need to be the sole cause.
The workers’ comp board adopted the WCJ’s opinion. South Coast took its case to a California appeals court.
Is ‘possible’ enough?
During his deposition, Dr. Bruff was repeatedly asked about the possible effects of amitriptyline in Clark’s death.
After repeated questions, Dr. Bruff said it was “possible” amitriptyline contributed to Clark’s death and it “could be an incremental contributor.” The doctor went on to say the drug had a “small role” in Clark’s death, but he also confirmed that he stood by his initial report: Ambien and Xanax were the primary drugs involved.
Despite that statement, Clark’s widow argued Dr. Bruff had changed his mind about the amitriptyline between the time of his report and his deposition.
The appeals court concluded:
“The evidence demonstrates that if amitriptyline played a role at all, it was not significant such that it constituted a material factor contributing to Brandon’s death. … We note that there is some dispute regarding whether Brandon was taking Ambien due to his industrial injury. Jovelyn testified that Brandon had trouble sleeping before his industrial injury. … In January 2009, Brandon’s personal physician prescribed him Ambien for his sleeping difficulties. The physician noted that Brandon was not experiencing pain during the time he had trouble sleeping.”
Based on that, the appeals court ruled the request for workers’ comp death benefits by Clark’s widow should be denied.
That’s where the case stands now. However, later this year, the California Supreme Court will hear additional arguments and reconsider the case.
What do you think about the court’s decision? Let us know in the comments.
(South Coast Framing Inc. v. Workers’ Compensation Appeals Board, Court of Appeal, Fourth Appellate District, Division One, CA, WCAB No. ADJ7324566, 12/9/13)