BEFORE:                                 HONORABLE PETER F. WOMACK
                                                Supervising Judge of Compensation

APPEARANCES: 

                                                GILL & CHAMAS, ESQS.
                                                By:       BORIS SHMARUK, ESQ.

                                                Attorney for the Petitioner

                                                BRAUSE, BRAUSE & VENTRICE, ESQS.
                                                By:       RANDY BRAUSE, ESQ.

                                                Attorney for the Respondent

In the matter of Florence Hill vs. Quick Chek Food Stores, Claim Petition 00-040967, petitioner had an accident on January 16, 1999 which was compensable.  The issue before the court is whether petitioner is entitled to medical treatment for her left knee and for both her hands.  The only part of the body that respondent treated the petitioner for arising out of that accident was the right knee and  it is respondent’s position that the left knee and her injury to her hands are not related to this accident. 

Petitioner testified that on January 16, 1999 while working for the respondent she was taking out garbage.  While she was going towards the dumpster she slipped on ice.  She fell on both knees and both hands.  She went to the Care Station three times a week for approximately two weeks.  Both her knees hurt but her right knee was worse and she could not stand on the right leg.  Dr. Gallick treated the petitioner until April 20, 1999 at which time he performed arthroscopic surgery on the right knee.  Afterwards she had physical therapy on that knee.  Petitioner stated that she had told Dr. Gallich about the left knee, however, Dr. Gallick said it was bruised and it probably would get better.  It did not hurt as much as the right knee, at that time.  When she went to physical therapy she was given exercises in both legs.  Petitioner went back to Dr. Gallick because of the left knee.  At a certain point she was sent to a Dr. Matthews.  She complained to Dr. Matthews about pain in both hands and pain in both knees.  At this point her left knee hurt her more than the right and was giving way and buckling and getting swollen.  She was also dropping things because of weakness in her hands.  She was also experiencing tingling and numbness in the hands.  If she goes up or down stairs it increases the pain in her left knee and getting out of her car causes pain in her left knee.  Her left knee hurts, swells, and gives way.  She cannot kneel on her left knee.  She goes up and down stairs backwards so that not to put pressure on the knee.  She has problems holding onto objects due to problems in her hands.  She cannot ride a bike or walk like she used to because of her knee. 

On cross-examination petitioner admitted when she went to Dr. Gallick, he primarily treated her right knee.  When confronted with the claim petition which she signed on December 13, 2000 it was noted that the only complaints were sprain of back and neck and injury to right knee.  There was nothing mentioned about the left knee.  Petitioner had no explanation for this lack of mention in the claim petition of the left knee.  Also, when confronted with the report from Sall Myers Medical Group on July 2, 2001, there was actually nothing about the left knee.  Petitioner felt that that was amazing since she felt she told Sall Myers about her complaints in her left knee.  She specifically asked  that when her left knee started hurting her in 2001 did she just attribute it to the accident? Petitioner was adamant that she actually had fallen on both knees.  There was also nothing in the claim petition or Sall Myers report about her hands. 

Dr. Calvin Matthews testified on behalf of petitioner as a treating doctor who has training in orthopedics and pain management.  Dr. Matthews saw the petitioner on March 25, 2002 and noted that she was a 65-year-old woman who fell on her knees and her hands carrying garbage.  She was treated for her right knee although she had complaints to her hands and left knee as well.  Dr. Matthews found weakness in both hands.  He thought there was some sort of pressure on the median nerve.  He found in the left knee tenderness at the joint-line and his physical examination showed indications of internal damage and perhaps a meniscal tear in the left knee.  He felt that petitioner had carpal tunnel or peripheral neuropathy in the hands.  Dr. Matthews felt the petitioner needed an MRI on the knee and some physical therapy on the left knee as well.  He apparently feels that the left knee is in need of present treatment.  Confronted with the lack of mention of the left knee in medical reports other than petitioner just mentioning the left knee about the time she fell, Dr. Matthews indicated petitioner probably has arthritis in both knees.  Arthritis was found in the right knee when the operation was performed.  Dr. Matthews indicated that with the pain in the right knee and the treatment to the right knee, petitioner would shift the main weight of her body to her left knee in getting around and he felt that this would cause increased pressure on the left knee which would in turn cause a progression of the arthritic condition.  Furthermore, this would very likely even cause a tear in the meniscus of the left knee.

Dr. Peter Blumenthal examined the petitioner on October 8, 2002 on behalf of respondent as respondent’s orthopedic expert.  He noted that although petitioner complained to having pain in her hands and wrists she did not complain in the claim petition or anywhere in the history of any problems to the hands.  Regardless of what petitioner has with her hands, Dr. Blumenthal clearly felt that it was not related to the accident.  As far as the left knee was concerned, Dr. Blumenthal indicated that the history of the treatment did not show any initial treatment of the left knee, only to the right knee.  He felt the left knee was not involved in the accident although petitioner did initially complain of falling on both knees.  Dr. Blumenthal further felt that when one knee is damaged and you put pressure on the other knee it does not cause any significant problems in that knee.  Dr. Blumenthal brought in what he described as a learned treatise from a doctor who was the head of orthopedic surgery in Toronto Hospital.  It seems that the Workers’ Compensation Appear Panel in Ontario, Canada had 13 appeals dealing with the concept that an injury to one leg caused pressure on the other leg causing damage to the other leg in accelerating arthritis.  The Workers’ Compensation Court in Ontario found in 11 of the 13 appeals, that this was the proper causal relationship of a damage of a second knee after treatment of the opposite knee.  The treatise took a position that the pressure on one knee would not cause a progression of the arthritis on that knee because of an injury to the leg.  This treatise did not really describe a medical test or any statistics. It was based on the doctor’s experience and his opinion.  Dr. Blumenthal indicated that he and his group, which are respondent oriented, were waiting for such opinion to appear in the medical journals.   I was not too impressed when I asked Dr. Blumenthal about the treatise.  There did not seem to be a real basis for it other than just a statement of an opinion.  However, I did ask whether a person, who is relatively heavy, puts pressure on her knees will cause an aggravation, acceleration and exacerbation of arthritis in the knees.  Dr. Blumenthal said that the weight would affect arthritis in the knees.  I asked if you take the same person and injure one knee and then a greater amount of weight is placed on another knee, would that not also affect the arthritis?  Dr. Blumenthal did not answer one way or the other.  I do not think he really needed to at the time.  It is kind of obvious if pressure of the weight of a person will affect and aggravate and accelerate arthritic condition of the knees, it is certainly logical that placing greater pressure on one of the knees would aggravate, accelerate the arthritic condition in that knee. 

Therefore, I find that both doctors essentially agree that pressure of weight on the knee will aggravate, accelerate and exacerbate an arthritic condition in the knees.  Dr. Blumenthal had no answer for that.  Dr. Matthews clearly felt that that would cause an acceleration of arthritis in this particular person’s knee. 

In Mrs. Hills’ case, she fell on both knees on January 16, 1999.  She also fell on her hands.  At the time she went to the Care Station, she complained about falling on both knees, however, the pain was clearly severe on the right knee and the treatment took place in the right knee.  The treatment was arthroscopic surgery on that right knee.  Petitioner may have hurt the left knee initially.  That did not seem or appear to be any further problem at that time involving the left knee and the problem was to the right knee.  Petitioner stated she always complained of her left knee but it clearly was not to the point of forcing any treatment of the left knee.  The treating doctors considered it complaints apparently so small not even to give consideration or mention it in the reports.  This is understandable.  Petitioner was having severe pain in the right knee.  She actually had an operation on her right knee.  It was after this operation on her right knee that petitioner’s complaints continued to get increased in the left knee.  Petitioner did not mention the left knee in her claim petition.  I can understand this since the petitioner’s main complaints were still the right knee and that is where the operation took place.  Petitioner stated she complained at Sall Myers about her left knee and she may very well have.  However, Sall Myers had the claim petition to look at which did not mention the left knee and the treating records did not put any pressure on the left knee and there would be no reason for them at this time to really get involved in the left knee. However, with the severe injury to the right knee and she indicated the right knee hurt and the arthroscopic surgery to the right knee would also cause the petitioner to shift weight naturally to the left leg.  Petitioner did not talk about shifting weight to the left leg or that it was causing her pain.  All she indicated that she was getting pain in the left knee and her pain in the left knee got worse.  With the shifting of weight to her left knee causing more pressure on a previous arthritic knee, I can see very well how the pain would get worse and worse and damage would be caused with the aggravation, acceleration and exacerbation of the arthritis in the left knee.  Dr. Matthews adequately explained how the pressure on the left knee from shifting weight to the right would cause in this case in his opinion did cause the further damage in the left knee.  It is a reasonable theory and acceptable based on the history of this case and it explains why petitioner’s left knee would continue to get worse somewhat after the accident and after the right knee was fully treated.  Dr. Blumenthal’s position is that pressure, if you shift weight from the right knee to the left knee this would not cause further damage to the left knee even if the petitioner had preexisting arthritis.  Dr. Blumenthal based this on a treatise by an orthopedic surgeon in Toronto.  It is, however, noted that the orthopedic surgeon in Toronto was not just laying out the accepted medical theory. He was arguing against was apparently were the accepted medical theories accepted by the Ontario Workers’ Compensation Appeals Committee that medically an injury to one knee would cause increased weight on the other knee and, therefore, cause an aggravation and further injury to the other knee.  Logically, if a heavy person putting severe weight on both his arthroscopic knees would cause an effect and obviously changes in the arthritis in the knees, there is no explanation of why increased weight on one knee would not cause further damage to that one knee.  In this case it would explain the history of the left knee.  Petitioner first falls on both knees and her complaints and the damage was basically to the right knee.  That is what the doctors treated.  That was the knee they operated on.  As they treated it, more and more pressure was placed on the left knee.  After the operation more pressure was put on the left knee and the left knee gradually became more and more painful.  Clearly, the weight bearing of the left knee was increased from the damage to the right knee.  This further aggravated, accelerated and exacerbated the arthritic condition in the left knee causing damage to the left knee.  So, therefore, the left knee damage does rise out of the accident, January 16, 1999, and the damage to the left knee is the responsibility of the respondent.  Dr. Matthews apparently is willing to treat.  Respondent can also if they wish send another treating doctor to treat the left knee if they so wish but it apparently needs to be treated now according to the testimony of Dr. Matthews.   Dr. Blumenthal did not argue that the left knee did not need to be treated.  He only argued on the causal relationship aspect.  The left knee is the responsibility of the respondent.

As far as the carpal tunnel question in the hands, I am not sure that Dr. Matthews could show a clear carpal tunnel situation but whether it is a sprain of the wrist or a real carpal tunnel situation in the wrist, and I do not see how there can be any causal relationship found.  Although petitioner initially fell on her hands along with her knees, there are no complaints to the hands all the way through the treatment.  There were no complaints of the hands in the claim petition, no complaints of the hands with Sall Myers. It is only  when she went to Dr. Matthews that apparently she first complained of pain in her hands.  Unlike the left knee, wherein I can see that a shifting weight could cause great pressure on a prior arthritic condition causing damage to the left knee, there was no weight bearing on the wrists.  There was nothing from the right knee that would cause increased pressure on the hands and wrists and, therefore, I find that the petitioner has failed to sustain the burden of proof showing any damage to her wrists arising out of the accident.  

Therefore, I do not find that the wrists are related to the accident.  I do find that the left knee is causally related to the accident.  It is up to respondent to treat that left knee whether they treat the left knee with Dr. Calvin Matthews or another doctor.  Since I am not awarding any present money on the left knee at this time, any attorney’s fees for the Motion of Medical and Temp will await the outcome of the case.  I will allow a stenographic fee of $350 payable by the respondent.  Petitioner’s  attorney will provide an Order in accordance with my findings.

                                                                        _______________________________

                                                                        Peter F. Womack
                                                                        Supervising Judge of Compensation

September     , 2003