Appeal of Estate of William Quinn

THE STATE OF NEW HAMPSHIRE

SUPREME COURT

In Case No. 2018-0310, Appeal of Estate of William Quinn,
the court on August 20, 2019, issued the following order:

Having considered the briefs and oral arguments of the parties, the court
concludes that a formal written opinion is unnecessary in this case. The
petitioner, Linda Quinn, as widow of William Quinn and beneficiary of the
Estate of William Quinn, appeals a decision of the New Hampshire
Compensation Appeals Board (CAB). The CAB denied the Estate’s request that
the respondents, the Disability Rights Center of New Hampshire (DRC), and its
insurer, Liberty Mutual Insurance Company, pay workers’ compensation
benefits to the Estate as a result of William Quinn’s death from “acute
intoxication by the combined effects of heroin and oxycodone.” We affirm.

The pertinent facts are as follows. On July 19, 2012, Quinn was involved
in a work-related accident in which he fractured his left ankle. Quinn
underwent multiple surgeries, and, as a result, suffered from persistent and
“profound” pain. He underwent various treatments for the pain, and was later
diagnosed with complex regional pain syndrome. Liberty Mutual paid workers’
compensation benefits for Quinn’s injury and treatments.

Quinn was prescribed opioid medications to manage his pain, and he
became dependent on them. In 2015, Quinn’s doctor attempted to wean him
off of the opioid medications, but Quinn experienced increased pain, attempted
suicide, and was hospitalized for further suicidal ideation. Later that year,
Quinn attended an in-patient program where he was successfully weaned off of
the opioid medications. Liberty Mutual paid workers’ compensation benefits
for the in-patient program. Afterward, Quinn did not use opioid medications
for a period of months; however, in September 2015, Quinn was again
prescribed oxycodone for his pain.

On January 23, 2016, Quinn’s body was found by his wife on the floor of
their second home. Near Quinn’s body were a bowl of crushed pills, a straw,
an approximately half full wine bottle, a small black case with another straw in
it, two unlabeled medicine bottles, and an oxycodone pill bottle — which had
been filled on January 11, 2016 — with about 70 pills gone. The medical
examiner, Thomas Andrew, M.D., concluded that the cause of Quinn’s death
was “acute intoxication by the combined effects of heroin and oxycodone” as a
result of “acute substance abuse.” Quinn had ingested heroin and oxycodone
— each in a dose likely sufficient, on its own, to have caused his death.
 The Estate filed a claim for workers’ compensation benefits attributable
to Quinn’s death. See RSA 281-A:26 (2010) (providing certain benefits in the
event of an employee’s death resulting from a work-related injury). Liberty
Mutual denied the claim. Thereafter, the Estate requested a hearing at the
New Hampshire Department of Labor. In September 2017, a Department of
Labor hearing officer denied the Estate’s claim for benefits. The Estate
appealed that decision to the CAB, which held a de novo hearing in February
2018.

In its March 30, 2018 order denying benefits, the CAB concluded that
RSA 281-A:14 (2010), which provides that “[t]he employer shall not be liable for
any injury to a worker which is caused in whole or in part by the intoxication
. . . or by the serious and willful misconduct of the worker,” precluded the
payment of benefits. The CAB found that “the consumption of the amount of
oxycodone at the time of death was inconsistent with [Quinn’s] prescribed
dosage,” and that “heroin was not part of [Quinn’s] prescribed medical
treatment.” The CAB noted that Quinn’s body was found lying on the floor,
near a bowl of crushed pills and other drugs and drug paraphernalia. The CAB
found that Quinn “intentionally ingested the heroin” — observing that the use
of heroin is illegal under both federal and New Hampshire law. The CAB
determined that Quinn’s “intentional ingestion of significant overdoses of both
heroin and oxycodone simultaneously constitute[d] serious and willful
misconduct.” The CAB also found that the intentional “actions and
misconduct of [Quinn were] an independent, intervening cause breaking the
‘chain of causation’ between his [compensable] work injury and his death,”
concluding that Quinn’s death “was not causally related to [his] work injury.”
The CAB denied the Estate’s motion for rehearing. This appeal followed.

RSA chapter 541 governs our review of CAB decisions. See RSA 281-
A:43, I(c) (2010). The party seeking to set aside the CAB’s order bears the
burden of proof “to show that the [order] is clearly unreasonable or unlawful.”
RSA 541:13 (2007). “[A]ll findings of the [CAB] upon all questions of fact
properly before it shall be deemed to be prima facie lawful and reasonable.” Id.
“[T]he order or decision appealed from shall not be set aside or vacated except
for errors of law, unless the court is satisfied, by a clear preponderance of the
evidence before it, that such order is unjust or unreasonable.” Id. When
reviewing the CAB’s findings, “our task is not to determine whether we would
have found differently than did the [CAB], or to reweigh the evidence, but
rather to determine whether the findings are supported by competent evidence
in the record.” Appeal of Phillips, 165 N.H. 226, 235 (2013) (quotation
omitted). “The [CAB’s] findings of fact will not be disturbed if they are
supported by competent evidence in the record, upon which the [CAB’s]
decision reasonably could have been made.” Id. (quotation omitted). We review
the CAB’s rulings on issues of law de novo. See Appeal of Wingate, 149 N.H.
12, 14 (2002); RSA 541:13.

2
 The Estate argues that it is entitled to benefits because RSA 281-A:26
provides that, if an employee’s death “results from” a compensable work-
related “injury,” as defined in RSA 281-A:2, XI (2010), then the employee’s
dependents receive compensation. RSA 281-A:26. The Estate contends that
“where a work-related injury leads to addiction or substance abuse and,
ultimately, to death, that death is compensable by the workers’ compensation
carrier.”

DRC counters that the CAB properly denied benefits because Quinn’s
intentional conduct — the intentional ingestion of overdoses of heroin, an
illegal drug, and oxycodone, which had been used in an unprescribed manner
— was an independent intervening cause that broke the causal chain between
the injury and his death. In support of its argument, DRC cites Cate v. Perkins
Machine Co., 102 N.H. 391, 394 (1960) for the proposition that, even if an
employee has a compensable work-related injury, post-injury conduct by the
employee can operate to restrict or terminate the payment of benefits. We
agree with DRC.

“To recover under the Workers’ Compensation Law, an employee must
show that his injuries arose out of and in the course of employment.” Appeal
of Kelly, 167 N.H. 489, 492 (2015); see also RSA 281-A:2, XI (defining “injury”).
Here, there is no dispute that Quinn’s initial ankle injury arose out of and in
the course of his employment, and that, therefore, it was compensable under
the statute. Thus, the primary issue in this appeal is whether Quinn’s death
“result[ed] from” his initial compensable ankle injury, and thus, whether his
death is compensable. RSA 281-A:26.

In general, an injured employee is entitled to workers’ compensation
benefits for subsequent injuries, conditions, or necessary and reasonable
treatments that are the “direct and natural result” of the initial injury. See
Appeal of Bergeron, 144 N.H. 681, 684-85 (2000) (finding that, “absent an
independent, intervening cause,” an employer “has a continuing obligation to
provide or to pay for medical, hospital, and remedial care for as long as is
required by an injured employee’s condition where it bears liability for the
initial injury that necessitated the subsequent health care” (quotation
omitted)); 1 Arthur Larson et al., Larson’s Workers’ Compensation Law § 10.01,
at 10-2 (Matthew Bender, rev. ed. 2018) (“[A] subsequent injury . . . is
compensable if it is the direct and natural result of a compensable primary
injury.”). However, even subsequent injuries that are the “direct and natural
result” of the initial compensable injury can be ineligible for benefits when
there is an independent intervening cause of the subsequent injury. See
Bergeron, 144 N.H. at 684-85; Larson, supra § 10, at 10-1. “Our case law
examining independent cause primarily involves the effect of a second
identifiable incident.” Bergeron, 144 N.H. at 685. “To constitute an
independent cause of an injured employee’s condition, an incident must be
both a necessary and a material cause of that condition.” Id. (quotation

3
omitted). “When an employee suffers from an ongoing debilitative condition,
the second incident must ordinarily be a distinct and extraordinary trauma-
inducing event in order to qualify as an independent cause.” Id. at 685-86. In
Cate we endorsed the principle that, under certain circumstances, employee
conduct can operate to restrict or terminate the payment of benefits
attributable to a compensable work-related injury. See Cate, 102 N.H. at 394
(considering whether “the employee’s conduct in refusing to submit to the
[surgical] operation [was] so arbitrary and unreasonable that the continued
disability could be said to have resulted from his own misconduct.”).

Here, the CAB stated that “even if [it were] to accept that [Quinn] was
addicted to legally prescribed oxycodone as a direct result of the work injury,”
Quinn’s “intentional ingestion of significant overdoses of both heroin and
oxycodone simultaneously constitute[d] serious and willful misconduct.” The
CAB, therefore, concluded that “the actions and misconduct of [Quinn were] an
independent, intervening cause breaking the ‘chain of causation’ between his
[compensable] work injury and his death,” and that his death “was not causally
related to [his] work injury.”

In determining both causation and Quinn’s intent, the CAB resolved
questions of fact; therefore, we must deem its determinations prima facie lawful
and reasonable. See RSA 541:13; Appeal of Jenks, 158 N.H. 174, 178 (2008)
(“The determination of the parties’ intent is a question of fact . . . .”); F. A. Gray,
Inc. v. Demopoulos, 122 N.H. 495, 496 (1982) (“Whether the defendant’s
continued disability was causally related to his original accident at work is a
question of fact for the trial court . . . .”). Accordingly, the CAB’s findings —
that Quinn intentionally ingested significant overdoses of both heroin and
oxycodone, and that his intentional actions constituted an independent
intervening cause breaking the chain of causation — are entitled to deference.
See New Hampshire Supply Co. v. Steinberg, 121 N.H. 506, 508-10 (1981)
(deferring to the trial court’s finding that the decedent’s death was not caused
by his work because there was evidence to support such a finding). We will not
disturb the CAB’s findings if there is competent evidence in the record to
support them. See Phillips, 165 N.H. at 235.

The Estate argues that the CAB erred “by finding that Mr. Quinn’s opioid
abuse constituted an intervening cause when the uncontroverted medical
evidence indicated that it was instead merely another link in the causal chain.”
In so arguing, the Estate relies heavily on the opinion of its expert, Seddon
Savage, M.D., who opined that “it is highly unlikely, based on the history of
which I am aware, that Mr. Quinn would have developed an opioid use disorder
and died of an opioid overdose were it not for his work-related motorcycle
injury.” The Estate contends that the CAB could not disregard Savage’s
unrefuted opinion as to the causal connection between Quinn’s injury and his
death, because “medical causation is a matter properly within the province of
medical experts and the [CAB] is required to base its findings on this issue

4
upon the medical evidence.” (Quotation omitted.) DRC counters that the CAB
was reasonable when it did not give weight to Savage’s opinion because of her
“self-admitted bias and the fact that she did not treat [Quinn].” Thus, DRC
contends, the Estate did not meet its burden of proof to show a causal
connection between Quinn’s injury and his death. We agree with DRC.

In general, the Estate is correct that “[m]edical causation is a matter
properly within the province of medical experts, and the [CAB] is required to
base its findings on this issue upon the medical evidence rather than solely
upon its own lay opinion.” Appeal of Kehoe, 141 N.H. 412, 417 (1996)
(quotation and brackets omitted). However, “the [CAB] is entitled to ignore
uncontradicted medical testimony,” if it “identif[ies] the competing evidence or
the considerations supporting its decision to do so.” Id. at 418-19; see also
Town of Hudson v. Wynott, 128 N.H. 478, 484-85 (1986). Here, the CAB
observed that Savage was a “family friend of the [Quinns], who did not provide
clinical care to [Quinn],” and stated that it “[was] not persuaded by Dr.
Savage’s opinion.” See Kehoe, 141 N.H. at 417-18 (affording less weight to
opinions of medical experts who did not treat the claimant). Indeed, Savage
acknowledged that she did not treat Quinn specifically because of their family
connection. Thus, the CAB identified the reasons why it was not persuaded by
Savage’s opinion; it was, therefore, entitled to reach a different conclusion. See
id. at 418-19. Moreover, “[i]t is well settled that the weighing of the testimony
and the assessment of its credibility [is] solely within the province of the [fact-
finder] . . . [and] a reviewing court may not substitute its judgment for that of
the [fact-finder] even though contrary testimony received would have supported
a different result.” Steinberg, 121 N.H. at 509-10.

Furthermore, as the CAB correctly observed, Savage did not disagree
with the opinion of the medical examiner, Andrew, that the medical cause of
Quinn’s death was “acute intoxication by the combined effects of heroin and
oxycodone.” Nor did she disagree that Quinn had ingested each drug in a dose
likely sufficient, on its own, to have caused his death. Notably, Savage did not
conclude that the act of ingesting fatal doses of heroin and oxycodone was
unintentional. Savage’s opinion does not foreclose a finding of an independent
intervening cause. See Bergeron, 144 N.H. at 684-85; Larson, supra § 10, at
10-1.

“In a workers’ compensation case, the claimant bears the burden of proof
on the issue of causation.” Tzimas v. Coiffures by Michael, 135 N.H. 498, 500
(1992); see also Appeal of Lalime, 141 N.H. 534, 537 (1996) (“To obtain
workers’ compensation benefits, a claimant has the initial burden to establish
a prima facie case.”). “In order to prove causation, the plaintiff must produce
evidence to prove it is more likely than not that [the] injury was work-related.”
Tzimas, 135 N.H. at 501. Here, the physical circumstances surrounding
Quinn’s death, taken together with Andrew’s opinion as to the cause of death,
support the CAB’s finding of an independent intervening cause. The CAB was

5
not persuaded by Savage’s opinion on the issue of causation, where the Estate
bore the burden of proof. Because “our task is not to determine whether we
would have found differently . . . or to reweigh the evidence, but rather to
determine whether the findings are supported by competent evidence in the
record,” Phillips, 165 N.H. at 235 (quotation omitted), we conclude that the
CAB did not err when it found that the intentional “actions and misconduct of
[Quinn were] an independent, intervening cause breaking the ‘chain of
causation’ between his [compensable] work injury and his death.”

Other courts, when faced with similarly tragic factual scenarios, have
reached the same conclusion. See, e.g., Kilburn v. Granite State Ins. Co., 522
S.W.3d 384, 392 (Tenn. 2017) (finding that fatal overdose of oxycodone was
independent intervening cause where employee failed to take medication in
accordance with doctor’s instructions); Sapko v. State, 44 A.3d 827, 843-44
(Conn. 2012) (finding that fatal interaction of excessive doses of oxycodone and
seroquel was independent intervening cause that broke the chain of causation);
Williams v. White Castle Systems Inc., 173 S.W.3d 231, 234, 236 (Ky. 2005)
(finding that employee’s use of non-prescribed Demerol, in addition to
prescribed medications, caused his death and broke the causal link between
his work-related injury and his death).

For the reasons set forth above, we conclude that the CAB’s decision to
deny workers’ compensation benefits — on the ground that Quinn’s intentional
conduct was an independent intervening cause that broke the causal chain
between his initial compensable work-related injury and his death — is amply
supported by competent evidence in the record. Accordingly, the Estate has
not met its burden to show that the CAB’s order is unjust or unreasonable.
See RSA 541:13; Phillips, 165 N.H. at 235. In light of our decision, we need
not address the CAB’s alternative ground under RSA 281-A:14 for its decision
to deny benefits, nor the parties’ arguments related thereto.

Affirmed.

LYNN, C.J., and HICKS, BASSETT, HANTZ MARCONI, and DONOVAN,
JJ., concurred.

Eileen Fox,
Clerk

6