APPEAL from the Circuit Court of Cook County; the Hon. EDWARD
J. EGAN, Judge, presiding.
MR. JUSTICE MEJDA DELIVERED THE OPINION OF THE COURT.
Defendant, Municipal Employees Annuity and Benefit Fund of Chicago, appeals from an order entered by the trial court upon administrative review which reversed a decision of defendant's Retirement Board (Board) as contrary to the manifest weight of the evidence. The Board in its decision had denied duty disability benefits for a disability resulting from a heart attack which Thomas R. Tyrrell had allegedly suffered in the performance of his duties as an assistant attorney employed by the Chicago Board of Education. Tyrrell died while the cause was pending in the trial court and his administrator has been substituted as plaintiff.
Upon appeal defendant contends that the decision of the Board that Tyrrell was not disabled as a result of an accidental injury incurred in the performance of his duties was not contrary to the manifest weight of the evidence, and that the cause of action is barred by a statutory amendment, effective subsequent to the decision of the Board but prior to the order of the trial court, which amendment removed heart attack as a ground for the award of duty disability benefit. The following is a brief narrative of the pertinent facts.
On October 16, 1970, Thomas R. Tyrrell filed an application with the Board for duty disability benefits under the provisions of section 8-160 of the Pension Code (Ill. Rev. Stat. 1969, ch. 108 1/2, par. 8-160). *fn1 He set forth that on June 1, 1970, he had suffered a heart attack while running up two flights of stairs at the Monroe Street Court, known as Branch 28 of the Municipal District of the Circuit Court of Cook County. At the time, he had been making his way to the courtroom of Judge Margaret O'Malley where he had been assigned to assist a teacher in the defense of criminal charges in a case pending on the trial call. Police personnel at the scene took Tyrrell into the judge's chambers and an ambulance was called; he was taken to St. Luke's-Presbyterian Hospital where a diagnosis of acute myocardial infarction was made. He was placed in the intensive care unit where he remained for 4 weeks. Following his discharge Tyrrell continued under the care of a physician and never returned to his employment.
In an affidavit accompanying the application, Tyrrell stated that he had parked his automobile at a Board of Education facility a half block from the courthouse; that he had hurried on foot down Monroe Street, carrying a portfolio in one hand and a briefcase in the other; that when he reached the courthouse he raced up the stairs to the second floor; that he then experienced sharp chest pains, heavy perspiration, and labored breathing; further, that in the previous few weeks he had been under great strain as a result of increased legal work he was handling and the temporary absence of two other attorneys in the law department. He filed affidavits of two Chicago policemen and a written statement of Judge O'Malley which corroborated the circumstances of his attack. Also filed was a statement of Dr. William Phelan of St. Luke's-Presbyterian Hospital that Tyrrell had developed severe anterior chest pains "while climbing stairs at his work," which pains were diagnosed as an acute myocardial infarction. In addition, James Coffey, chief attorney for the Board of Education, submitted a letter to the Board stating that on June 1, 1970, Tyrrell was to have appeared before Judge O'Malley in the regular course of his duties.
On December 18, 1970, the Board denied Tyrrell's application for duty disability benefits upon the basis that his disability had not been incurred in the performance of an act or acts of duty as required by section 8-160 of the Pension Code (Ill. Rev. Stat. 1969, ch. 108 1/2, par. 8-160). However, the Board granted Tyrrell ordinary disability benefits from September 1970 through January 1971, under the provisions of section 8-161 of the Code (Ill. Rev. Stat. 1969, ch. 108 1/2, par. 8-161). Subsequently, Tyrrell filed a complaint for administrative review of the decision of the Board. After a hearing the trial court entered an order on April 8, 1971, reversing the decision of the Board, and remanded the cause for further hearings on the application for duty disability benefits.
The Board conducted additional hearings on May 18, 1971, and June 18, 1971, pursuant to the order of the trial court. On May 18, James Coffey testified that it was within Tyrrell's duties to answer trial calls. Dr. William Fitzsimmons testified on behalf of Tyrrell that an examination reflected that he had suffered a myocardial infarction which had produced a condition of permanent disability; that there was no evidence of a prior heart condition; and that there could have existed a causal connection between the attack and the effort expended in hurrying up the stairs of the courthouse. Dr. Nathanial Greenberg testified for Tyrrell that upon an examination he found similar permanent disability and lack of evidence of previous heart abnormality, and that in his opinion the act of running up the stairs had brought on and caused the myocardial infarction. The medical history taken at the hospital at the time of Tyrrell's admission on June 1, 1970, indicated that he had suffered chest pains in a lawnmower accident in 1968. Dr. Greenberg testified, however, that Tyrrell was unconscious at the time of his admission to St. Luke's-Presbyterian Hospital and that the medical history was provided by an unknown party who had accompanied him to the hospital. Tyrrell introduced into evidence a statement of Dr. William Phelan of St. Luke's-Presbyterian Hospital that the exertion and stress of hurrying up the stairs of the courthouse was a precipitating factor in the myocardial infarction and as such could be considered a causative factor. Tyrrell also introduced into evidence the medical records of his 1968 hospitalization at Resurrection Hospital for a lawnmower accident in which one of his fingers had been partially amputated. These records contain no mention that he complained of chest pains, nor do they indicate any heart abnormality. The electrocardiogram (EKG) taken at Resurrection Hospital in 1968 was introduced into evidence by Tyrrell at the later hearing held on June 18.
Dr. Robert Mustell, an examining physician employed by the Board, first testified at the May 18 hearing that there could have been a causal connection between Tyrrell's myocardial infarction and his running up the stairs of the courthouse. However, when again called to testify on June 18, Dr. Mustell stated that in his opinion Tyrrell had suffered a heart attack in 1968 which developed into a chronic heart condition. He stated that evidence of a pre-existing heart condition was to be found in the records of St. Luke's-Presbyterian Hospital as chest pains suffered by plaintiff in 1968, and the EKG taken in 1968 at Resurrection Hospital which indicated a flattened "T wave" reading. Dr. Mustell then stated that it was his further opinion that there was no connection between Tyrrell's myocardial infarction on June 1, 1970, and his duties as an attorney for the Board of Education. On cross-examination, Dr. Mustell admitted that the radiologist's report which accompanied the 1968 EKG stated that the reading was within normal limits, and that other physicians could reasonably interpret the same EKG as reflecting no heart disfunction. Defendant introduced into evidence a letter dated May 10, 1971, from Dr. James A. Hunter to Dr. Mustell, listing the findings upon a referral examination which stated that a current EKG test revealed an "old infarction with no acute change."
On September 17, 1971, the Board again denied the application for duty disability benefits but granted ordinary disability benefits. After filing an amended complaint for administrative review of the decision, Tyrrell died on December 31, 1971. His administrator was given leave to substitute as plaintiff and filed a second amended complaint which prayed duty disability benefits from June 1, 1970, to the date of death. At a hearing before the trial court on May 23, 1972, defendant sought to justify the decision of the Board upon the sole basis that the heart attack bore no causal connection to the performance of his duties of employment. The trial court then entered an order which reversed the decision of the Board. Defendant now appeals from that order.
Defendant first contends that the trial court erred in holding that the decision of the Board that Tyrrell was not disabled as the result of accidental injury incurred in the performance of his duties was contrary to the manifest weight of the evidence. We disagree.
• 1 Section 8-160 of the Pension Code (Ill. Rev. Stat. 1969, ch. 108 1/2, par. 8-160) provides for the payment of duty disability benefits to an employee who becomes disabled as the result of accidental injury incurred in the performance of an act or acts of duty. Although the statute has not been the subject of judicial interpretation, we are in agreement with the parties that an appropriate construction would be one analogous to the standard applicable under the Workmen's Compensation Act where recovery is allowed if an employee's injury arose out of and in the course of his employment. (Ill. Rev. Stat. 1969, ch. 48, par. 138.2.)
• 2, 3 The applicability of workmen's compensation benefits to disabilities resulting from heart attack has been addressed in a series of decisions. It has therein been established that mere proof that a heart attack incurred at work is insufficient to warrant an award of compensation to the employee, in the absence of further proof that a causal connection existed between the heart attack and some phase of the employment. (Orr v. Industrial Com. (1970), 47 Ill.2d 242, 265 N.E.2d 109; Rock Road Construction Co. v. Industrial Com. (1967), 37 Ill.2d 123, 227 N.E.2d 65.) Where it is demonstrated that some act or phase of the employment constituted a causal factor in bringing on the heart attack, recovery may be had, and it is not necessary that the employment be shown to have furnished the sole or even the principal causative factor. (Republic Steel Corp. v. Industrial Com. (1962), 26 Ill.2d 32, 185 N.E.2d 877.) An exception exists in cases where the employee has a previous heart abnormality which has degenerated to a state where it can be said that any exertion might be an overexertion. In those cases, compensation will be denied despite evidence that the employee had engaged in some work-related physical activity before the occurrence of the heart attack. (Williams v. Industrial Com. (1967), 38 Ill.2d 593, 232 N.E.2d 744; Illinois Bell Telephone Co. v. Industrial Com. (1966), 35 Ill.2d 474, 220 N.E.2d 435.) However, the fact that the employee suffered from a pre-existing heart condition does not in and of itself establish such degeneration, and recovery ultimately depends on a determination of whether the current heart attack resulted from the combined effects of the pre-existing heart abnormality and the employment, or the abnormality alone. Chicago Tribune v. Industrial Com. (1969), 42 Ill.2d 476, 248 N.E.2d 103; Bethlehem Steel Co. v. Industrial Com. (1955), 6 Ill.2d 290, 128 N.E.2d 714.
Defendant does not challenge that Tyrrell was engaged in the regular course of his duties as an attorney for the Board of Education at the time of his heart attack; rather, defendant argues that the attack did not have any causal connection with his duties and hence cannot be said to have arisen out of those duties. Four medical opinions were received by the Board on the question of whether a causal connection existed between the effort expended in hurrying up the stairs of the courthouse and the heart attack. Three of those opinions, namely, those of Dr. Fitzsimmons, Dr. Greenberg and Dr. Phelan, were to the effect that the activity either was a causal factor in producing the heart attack or could have been a causal factor. The fourth opinion was that of defendant's medical witness, the Board's physician, Dr. Mustell, who initially had also concurred. However, in his subsequent testimony, Dr. Mustell stated that it was his opinion that no connection existed between Tyrrell's heart attack and his duties as an attorney for the Board of Education. Nonetheless, the causation issue was the relationship of Tyrrell's act of running up the stairs and his heart attack, not the relationship of that attack to his duties as an attorney for the Board of Education. As a medical expert, Dr. Mustell was not competent to offer an opinion concerning Tyrrell's duties as an attorney, and the witness' opinion on such subject could not be reasonably relied upon by the Board in making its final decision. In the absence of Dr. Mustell's opinion there is nothing in the record to counter the testimony and statements of the other medical experts that a causative relationship did exist or could have existed between Tyrrell's activity and his heart attack.
Defendant further argues that the Board could have reasonably concluded from the evidence that Tyrrell had a pre-existing heart abnormality that had degenerated to a state where any exertion might be said to constitute an overexertion. The only evidence supporting such view is the testimony of Dr. Mustell in which he concluded that Tyrrell had suffered a prior heart attack in 1968 and had developed a chronic heart disorder. However, Dr. Mustell's own testimony indicates the unfounded nature of his conclusion concerning the previous medical history. He stated that the pre-existing nature of Tyrrell's heart abnormality was evidenced by the medical history taken at the time of his admission to St. Luke's-Presbyterian Hospital and by the EKG taken in 1968 at Resurrection Hospital. The medical history was not taken from Tyrrell but from a third party who had accompanied him to the hospital. Such statement, in the absence of personal knowledge by the informant, was inadmissible as "hearsay on hearsay" (Stewart v. DuPlessis (1963), 42 Ill. App.2d 192, 200, 191 N.E.2d 622). Furthermore, such history merely referred to the occurrence of chest pains at the time of a prior hospitalization, whereas the medical records of that hospitalization reflect that no heart dysfunction was either complained of or found. The 1968 EKG taken at Resurrection Hospital was accompanied by the radiologist's report that the readings were within normal limits. Dr. Mustell's interpretation of that test is made questionable by his admission that other physicians could interpret the same test as indicating no heart abnormality at all. ...