WORKPLACE SAFETY AND INSURANCE BOARD
APPEALS RESOLUTION OFFICER DECISION
decision number:
20210017
OBJECTING PARTY:
worker
REPRESENTED by:
worker representative
RESPONDENT:
employer
HEARING:
VIDEOCONFERENCE – July 22, 2021
HEARD by:
l. diaz, appeals resolution officer (ARO)
OBSERVER:
NICOLE FRANCIS, ARO
DATED: July 30, 2021
ISSUE
The worker objects to the Case Manager’s June 25, 2020 decision which denied initial entitlement to a heart condition under the claim.
BACKGROUND
On May 20, 2020, the worker reported experiencing extreme pain in her shoulders which radiated to her jaw while at work. She attended City General Hospital and was diagnosed with a non-ST-elevation myocardial infarct (NSTEMI). The worker was discharged from hospital on May 22, 2020 and has remained off work since that time. She was in her 50s at the time of her myocardial infarct (MI) and has been with her employer since May 2007.
The worker claimed that her MI was directly related to the stress of an impromptu meeting as a result of undergoing further investigation by the Office of Independent Police Review Director (OIPRD), in relation to a complaint initiated by an accused individual.
Under a separate claim, claim XXXXXXXX, the worker was granted entitlement to post-traumatic stress disorder (PTSD) under policy 15-03-15, Posttraumatic Stress Disorder in First Responders and Other Designated Workers, as it was presumed the worker’s PTSD had arisen out of the course of her employment. Entitlement to LOE benefits was initially denied by the Case Manager under claim XXXXXXXX as the Case Manager concluded the medical information confirmed the worker’s inability to remain at work appeared to be related to the ongoing OIPRD complaint.
However, in a more recent February 23, 2021 decision under claim XXXXXXXX, the Case Manager determined that from January 11, 2021 onwards, the worker was entitled to LOE benefits as the medical information supported the worker’s inability to return to work was predominantly related to her PTSD.
Case Manager’s June 25, 2020 decision
Under the present claim, the Case Manager concluded in the June 25, 2020 decision that the May 20, 2020 meeting was not a significant contributing factor to the worker’s MI, and as a result, denied entitlement under the claim to a heart condition.
Worker’s position
On behalf of the worker, the worker representative argued the worker had a significant emotional stress reaction to what had occurred as a result of the May 20, 2020 meeting, and that there was no other factor which precipitated the MI. She indicated the investigation had impacted the worker emotionally, both professionally and personally.
AUTHORITY
Operational Policy Manual
Published
15-03-10, Heart Conditions
October 12, 2004
ANALYSIS
I have carefully considered all of the available information, legislation and relevant operational policies in reaching this decision. I find the worker does not have initial entitlement to a heart condition under the claim. The reasons for this decision will be explained in the body of this decision.
Worker’s testimony
The worker testified she had been employed in the Special Victims Unit since 2018 where she had investigated child abuse and sex assaults. She indicated her mental health had been fine, that she had been a coach officer and a SOCO officer. With respect to her performance, the worker advised she had always met or exceeded the requisite standards, and that she had no history of disciplinary issues.
The worker also advised that her life outside of work was quite good. Although she had left her husband, she had her own home where she and her son resided, had a boyfriend, and was on friendly terms with her ex-husband.
With respect to a family history of cardiac issues, the worker reported that her maternal grandmother and uncle had passed away as a result of MIs. However, her cardiologist had assured her that cardiac history was only relevant when it stemmed from the paternal side.
The worker then related what had caused the OIPRD investigation. She explained that 18 months earlier she had arrested a female and male for assault with a weapon. The victim was a young female in her early teens. The accused female she had arrested was the young victim’s stepmom and the accused male was the young victim’s father. The accused stepmom’s ex-husband was a Police Officer in the City Police Department. The accused stepmom was employed as a Registered Nurse (RN) at a local hospital. The worker advised these types of cases can be challenging, particularly as she had the victim’s mom texting her almost every day. The worker advised it had absorbed a lot of her time.
When the day came that she had to arrest the accused individuals, she called them in the morning to advise them both that they would be arrested and charged. She arranged a time for both of them to come in to the police station. She took this approach as neither individual was considered ‘high risk’. In addition, the worker stated that she always treated any individual she was charging and arresting with respect, particularly under the present circumstances, i.e. accused female was a RN and her ex-husband was a Police Officer. They agreed to come into the station after 11:00 am for processing.
The accused stepmom stated she had recently had breast reduction surgery and her chest was bandaged. As a result of her recent surgery, the worker advised she had treated her with kid gloves. The worker processed the accused dad first followed by the accused stepmom, completely in accordance with Policy. However, she also permitted the accused stepmom to retain her sweatshirt given her recent surgery as she was cold, despite the fact that this wouldn’t typically be permitted.
At no time during the booking or interview process did the accused stepmom ask for her medication or water, nor did she present as being uncomfortable. The worker advised that following that day, there were ongoing issues with the case that needed to be addressed.
The worker then recounted that on March 5, 2020, a Professional Standards Officer was waiting for her in her office at 2:00 pm when she arrived at work for her shift. He informed her of the complaint from the accused stepmom (which is on file). The worker recalls being in absolute shock, stating that the allegations were insane and all lies. In addition, all of the worker’s colleagues were in the vicinity and became aware of the allegations and investigation.
Because the complaint was filed 18 months after the accused stepmom was charged, the worker was informed that there was no cell block video, as they are not retained for that length of time given that any complaint must be filed within 6 months. The accused stepmom claimed that she waited that length of time prior to filing the complaint because she was waiting for the case to be dealt with. To this day, the worker does not understand how the complaint went straight to the OIPRD for a hearing as this is not typically the process which is followed.
The worker affirmed there were multiple lies in the statement made by the accused stepmom, that everything was awful and was intended to make the worker look awful. Unfortunately, the worker re-iterated there was no video to confirm how the worker treated the accused stepmom.
She advised she was proud to be a Police Officer and was worried and stressed as she was concerned that if the complaint made it to the news her dad would learn of it, and she didn’t want to disappoint him or anyone else. The worker stated that the complaint broke her heart, broke her as a Police Officer, and broke her as a person. She testified she dealt with sex offenders every day and had always treated all individuals with respect.
The worker recalls spending at least 10 hours preparing for the OIPRD hearing. Because of COVID, the hearing took place with the worker in a room via telephone conference with materials spread across the table. Following the 1 hour 7 minute hearing which took place in mid to late April 2020, she was advised that it could take up to 1 year for a decision to be rendered. She indicated she felt good about the hearing as she had been prepared and felt it went well.
Then on May 20, 2020, she arrived at work for the start of her shift and was called into her In
spector’s office. She proceeded to the Inspector’s office and was advised that OIPRD required additional information. The worker then started to cry as she couldn’t believe the investigation was still ongoing. She was informed that OIPRD required every email that had been issued involving the investigation. When she walked out of the office, she stated she felt angry, that she perceived her credibility was being questioned. She confirmed that 176 pages of emails were printed. As she was preparing the emails, she began feeling chest pain symptoms, similar to those she had experienced two weeks earlier. Nonetheless, she spent 2-3 hours ensuring she printed all the emails.
Following the above, the worker advised she was not feeling well. She purchased a cup of coffee and went for a one-hour aimless drive. When she returned to the station, she was experiencing pain in her arm and shoulders, and felt there was a lump in her throat. At approximately 10:45 pm she decided to take her lunch break late and proceed to the hospital emergency. A co-worker insisted on taking her.
Due to COVID restrictions, the worker went into the hospital by herself. She was given aspirin and had an ECG performed. As a result of the amount of pain she was in, she was also given nitroglycerin and morphine. The worker then learned that she had had a heart attack. She was admitted to hospital for three days.
With respect to the allegations brought forth by the accused, the worker advised that they were found to be false in August 2020. However, she stated that it still plagues her that the accused would have made those false allegations.
The worker advised that she has not returned to work as she feels this was a wake-up call, that the investigation broke her, and she is afraid to die.
The worker confirmed that approximately two months ago, she had another incident with symptoms and called Dr. Johnston who prescribed her nitroglycerin. She is next scheduled to be assessed by him in 2022.
Upon questioning, the worker confirmed she did not know why Dr. Ganapathy indicated in his May 21, 2021 report that the worker experienced chest pain following her 3 km run on May 20, 2021.
In summary, the worker representative indicated the medical reports confirmed that the worker’s MI was likely stress-induced. She stated the worker had a stress reaction to what happened that day due to being informed that further information was being requested. The worker representative maintained there was no other cause for the worker’s MI, that no plaque or no pre-existing condition was responsible for her MI other than stress.
The worker representative referenced Policy 15-03-10 which specifies that entitlement to a heart condition can be accepted due to ‘acute emotional stress with no significant delay in the onset of symptoms’. She submitted the worker’s testimony supported that it met the criteria of ‘acute emotional stress’. The worker confirmed during testimony that as an individual she took great pride in her job as a Police Officer, that she had had no issues with her performance, and that other individuals had often come to her for assistance. The worker representative maintained that the incident had a significant impact on the worker emotionally. She indicated that the stress of that day had a marked emotional impact on the worker. She requested that initial entitlement to a MI be accepted under the claim and that the issue of entitlement to LOE benefits ought to be remitted to the operating area.
Analysis
Policy 15-03-10, Heart Conditions, records the following with respect to entitlement to heart conditions:
Guidelines
The WSIB accepts entitlement for cardiac conditions under any of the following circumstances:
traumatic injury, either penetrating or non-penetrating injuries to the chest wall
electric shock producing irregular cardiac rhythm
inhalation of smoke and various noxious gases and fumes, e.g., fire fighters, and
complication of treatment for a work-related injury, e.g., anaesthesia with an interval of hypotension, hypoxia or cardiac arrest.
NOTE
When entitlement is established under the above points for a cardiac condition, there will be no limitation of ongoing entitlement as long as the subsequent condition is related to the work-related cardiac condition,
or
unusual physical exertion for the individual and/or acute emotional stress with no significant delay in the onset of symptoms.
NOTE
This instance is allowed on the basis of aggravation of a pre-existing non-work-related condition. When entitlement is established, the condition has stabilized, and a permanent disability/impairment evaluation has been conducted, further entitlement will not be granted for a subsequent cardiac condition unless there is a new work-related occurrence, which merits allowance under a new claim.
I had regard for the relevant medical information submitted to file and concur with the worker representative, that it does not support the worker had any significant pre-existing cardiac conditions such as atherosclerosis or coronary artery disease (CAD) which could have precipitated her MI.
Prior to the incident under the claim, the worker underwent assessment by Dr. Johnston, Cardiologist, on May 16, 2020, who noted the worker was under an enormous amount of stress due to an internal investigation over alleged misconduct and due to personal issues. Dr. Johnston indicated that while recently driving into work, the worker noted the onset of tightness in her back that then radiated to the front of her chest and jaw. After getting to work and doing a Google search, the worker became alarmed that her symptoms represented a heart attack, but unfortunately she didn’t seek medical attention at that time, and instead decided to go home and lie down for two hours. Following this episode, the worker reported to Dr. Johnston that she felt well again. Dr. Johnston then recommended additional investigations.
It was only four days after being assessed by Dr. Johnston that the worker developed the MI symptoms which are documented under the claim.
Dr. Raso indicated in the May 21, 2020 hospital consult that the worker developed some chest tightness with radiation to her jaw and back shortly after commencing her shift at 2:00 pm, that it was brought about by stress at work. However, Dr. Raso noted the worker had had a similar episode three weeks earlier while resting at home that was not as intense and without radiation. Dr. Raso documented the worker had not been doing any routine physical activity over the last few weeks apart from a 3 km run earlier that day. However, Dr. Raso noted the run had not precipitated chest pain. The diagnosis as confirmed as non-ST elevation MI.
Dr. Ganapathy’s May 21, 2020 report recorded the worker had had a NSTEMI and that the most responsible diagnosis was ‘Troponin elevation likely stress induced’. This same report indicated the worker was ‘actually running when she had some chest tightness and a troponin elevation in the low 100s’. The worker’s angiogram was clear and the echocardiogram showed normal ventricular function. She only had minimal coronary artery disease as a minor plaque. Dr. Ganapathy indicated the differential diagnosis would be a mild plaque rupture which was improved with antiplatelet therapy versus stress induced vasospasm.
The worker’s physician submitted a June 5, 2020 clinical note which confirmed that on May 4, 2020 the worker reported an episode of chest pain which occurred on May 2, 2020. She was assessed virtually due to COVID and had outpatient investigations completed on May 6, 2020. She was referred to Dr. Johnston on May 12, 2020 and was assessed virtually by Dr. Johnston on May 16, 2020, with a plan for additional outpatient investigations. She then presented to hospital on May 20, 2020 / early May 21, 2020 and was diagnosed with a NSTEMI.
The worker next had a telephone consult with Dr. Johnston on June 10, 2020. Dr. Johnston recorded the events of May 20, 2020 when the worker was called into her supervisor’s office regarding the ongoing investigation, and her subsequent symptoms onset. Dr. Johnston indicated that although the worker’s ECG and echocardiogram were normal, her troponin levels were significantly elevated. The worker’s presentation was felt to be on the basis of either plaque rupture with spontaneous thrombolysis versus stress-induced vasospasm. Dr. Johnston explained to the worker that although her angiogram revealed non-obstructive plaque, the fact that she had spontaneous chest pain with troponin elevation would mandate indefinite aspirin for the rest of her life and certainly statin therapy for a minimum of 1 year. Dr. Johnston also recommended the worker carry sublingual nitroglycerin to use for vasospastic angina. A discussion ensued with respect to the worker considering a lateral move within the police force as working in the Special Victims Unit and the related stress was not conducive to long-term good cardiovascular health.
There was no further relevant medical information submitted to file in relation to the worker’s cardiovascular issues.
Policy 15-03-10, Heart Conditions, specifies that entitlement to a cardiac condition may be accepted if there has been unusual physical exertion for the individual and/or acute emotional stress with no significant delay in the onset of symptoms.
The worker representative maintains that the worker experienced acute emotional stress on May 20, 2021, in accordance with the above policy, which precipitated the worker’s MI.
While I sympathize greatly with the worker for the investigation she endured by OIPRD which was ultimately found not to have any merit, I nevertheless find the worker has not met the criterion under the above Policy for the reasons explained below.
First, the above Policy clearly specifies that a worker must have sustained an acute emotional stress with no significant delay in the onset of symptoms for entitlement to be granted. The worker was called into her supervisor’s office on May 20, 2020 and was informed of the ongoing investigation following which she experienced MI symptoms. However, this investigation was not new. The worker confirmed during testimony that she was informed of the investigation on March 5, 2020, and that a hearing was conducted in late April 2020 in relation to the investigation. As a result, I find the circumstances of the worker’s MI which she reported developing after being advised that additional information was required would not meet the definition of ‘acute’ emotional stress. Overall, I found the worker presented as a very genuine individual, and I accept her testimony that she experienced emotional distress as a result of the unfortunate investigation. However, for the reason indicated above, I must nonetheless find that it does not meet the criteria of ‘acute emotional stress’ as recorded in the above Policy.
In addition, the medical evidence and the worker’s testimony clearly supports that she had experienced a similar episode, albeit more mild, only three weeks earlier while on her way to work, without any apparent precipitating factor. The medical evidence clearly supports the worker was exhibiting cardiac issues well before the May 20, 2020 meeting with her supervisor. As a result, I cannot conclude that the worker’s MI stemmed from being informed by her supervisor on May 20, 2020 of the ongoing investigation.
Furthermore, and more importantly, the Heart Conditions policy is not intended to address emotional stress involving potential disciplinary issues or investigations conducted by an employer. A worker’s emotional distress resulting from an employer’s actions or decisions relating to discipline, demotions, terminations, productivity, and investigations, is typically not recognized as compensable. Examples of situations where this particular portion of the policy would apply is if a worker were held at gun point, were attacked, or were robbed, i.e. acute/immediate emotional stressors, following which a worker sustains a cardiac event with no significant delay in cardiac symptoms.
In summary, for the reasons outlined above, I do not find the worker has met the criteria for entitlement to a cardiac condition under the Heart Conditions policy. As a result, I conclude the worker does not have entitlement to a heart condition under the claim.
CONCLUSION
I conclude the worker does not have entitlement to a heart condition under the claim.
The worker’s objection is therefore denied.
DATED July 30, 2021
L. Diaz
Appeals Resolution Officer
Appeals Services Division