Appeal from the Circuit Court of Cook County, the Hon. Arthur
L. Dunne, Judge, presiding.
MR. JUSTICE RYAN DELIVERED THE OPINION OF THE COURT:
This workmen's compensation claim was brought by Rosalie Rogers against the County of Cook for compensation for an injury allegedly arising out of her employment in the Cook County recorder's office. On February 8, 1971, she suffered a stroke as she was arising from her desk to go to lunch. The arbitrator denied compensation; however, the Industrial Commission awarded compensation and the circuit court of Cook County confirmed the decision of the Commission. The county appeals directly to this court under our Rule 302(a) (58 Ill.2d R. 302(a)). The sole question on this appeal is whether the disability resulting from the stroke arose out of and in the course of the plaintiff's employment.
On February 8, 1971, the date of the incident in question, Rosalie Rogers was 50 years old. She had been employed in the office of the recorder of deeds in Cook County for about one year. For 10 years prior to this employment, she had been a housewife. The record does not reflect any other employment. For more than 10 years she had suffered from hypertension. She testified that she had been hospitalized for two weeks in 1960 because of her high blood pressure and again in 1965 she was hospitalized for three weeks for the same cause. She had been under the care of Dr. Arthur Savitt since 1964. Dr. Savitt testified that in 1965 her blood pressure ranged from between 210/140 and 170/120. The doctor further testified that a normal reading for a woman her age would be 140/90. On June 18, 1970, her blood pressure reading was 220/160; on January 8, 1971, 220/148; and on January 28, 1971, 204/130.
For the first six months that she worked in the recorder's office her duties were "writing up sheets for the binders and the books." Later she did "searches" which involved handling large books that weighed approximately 35 pounds. She began to feel dizzy, tired and exhausted at the end of the day and, about three weeks before the incident in question, she went to see Dr. Savitt. She continued to work until January 29, 1971. During that last week of work she had seen her doctor twice. He advised her to stay home and rest and increased her medication. She remained home from work for one week.
She returned to work on Monday morning, February 8, 1971. At about 11:45 a.m. as she prepared to go to lunch, she pushed her chair back from her desk and started to get up from a sitting position. While bent over in a stooped position, she felt dizzy and "it seemed like something heavy hit me on top of my head." She temporarily lost consciousness and fell over on an adjacent desk. The county nurse was called, and the claimant was taken to Henrotin Hospital, where it was determined that she had an aneurysm of the right cerebral artery with a cerebral hemorrhage resulting in some paralysis which is now considered permanent.
The claimant was the only witness to testify before the arbitrator; however, her hospital records were admitted into evidence. The county introduced into evidence a report of Dr. Steinberg, who stated that in his opinion there was no causal connection between the occupational duties that Mrs. Rogers performed as a clerk in the recorder's office and her stroke and disability. The arbitrator found that the claimant had failed to prove that she had sustained accidental injuries arising out of and in the course of her employment.
On review before the Industrial Commission the claimant offered the testimony of Dr. Savitt, who had been her physician from 1964 to February 8, 1971. Following his testimony concerning her hypertension over a period of years, he testified concerning causal connection in response to a hypothetical question. The hypothetical question actually asks for three separate opinions which relate to causal connection between (1) the condition of ill-being and the episode the hypothetical person had, as described on February 8, 1971, or (2) if that condition might or could be connected with the hypothetical person's work activities in the last week of work involving the lifting of books, and (3) "whether or not there might be a causal connection between either the lifting or the getting up from the desk and the pushing of the chair out from under the desk in the semi-stooped position." In response to this multiple question, including the either/or disjunctive question listed as No. 3, the doctor answered simply "I think there might be a connection" without specifying to which part or parts he was responding. When asked to state the basis of his opinion his answer indicated that in his opinion the increased pressure in the brain caused by the getting up from the chair and being in a stooped position could have been the precipitating factor in causing the aneurysm to rupture. He was then asked what significance "might be attached" to the work activity the last week in January 1971, including the lifting of the heavy books. Dr. Savitt replied "I think every time this person lifted a heavy object it tended to increase the pressure in the brain and with the background of hypertension, I would think that every additional increase in the pressure in the brain might tend to weaken the aneurysm to the point where it ruptured." (Emphasis added.)
It is well established that an employee is entitled to recover for all the consequences of an aggravation to a pre-existing condition and where one sustains an accidental injury which aggravates a diseased condition, or where, in the performance of his duties and as a result thereof, he is suddenly disabled, an accidental injury is sustained even though the result would not have obtained had he been in normal health. The accident need not be the sole cause or even the principal cause of the disability. The employee must only prove that it was a causative factor. Leason v. Industrial Com. (1973), 55 Ill.2d 486; Gus T. Handge & Son Printing Co. v. Industrial Com. (1965), 33 Ill.2d 201.
It is also well established that it is within the province of the Industrial Commission to determine disputed questions of fact, to draw inferences from the evidence and to resolve questions of causal relationship based upon conflicting medical testimony and that a reviewing court will not disturb the finding of the Industrial Commission unless against the manifest weight of the evidence. Illinois Institute of Technology v. Industrial Com. (1975), 60 Ill.2d 64; Lewandowski v. Industrial Com. (1969), 44 Ill.2d 204.
However, the claimant has the burden of proving that his injury arose out of and in the course of his employment, and it is the duty of the court on review to examine the record and determine whether the finding of the Industrial Commission is supported by the evidence. If the finding of the Commission that the claimant's condition arose out of his employment is not supported by the evidence in the record the award must be set aside. Liability under the Act cannot rest upon imagination, speculation or conjecture, but must be based solely upon the facts contained in the record. Schroeder Iron Works v. Industrial Com. (1967), 36 Ill.2d 519; A.O. Smith Corp. v. Industrial Com. (1965), 33 Ill.2d 510.
Considering the testimony of Dr. Savitt and his response to the hypothetical question, it would appear from his comment when he stated the basis for his opinion that "there might be a connection" that he was referring to the increased pressure in the brain caused by the effort expended in getting up from the chair and from being in a stooped position. With regard to the work activities during the last week of work, including the lifting of the heavy books, it is plain that his testimony in that regard did not rise to the level of an assertion based upon a reasonable degree of medical certainty. From the words italicized in the quoted testimony above, one can only conclude that the doctor was speculating or conjecturing what could have been the effect of the lifting of the books. He was testifying as to no more than mere possibilities, which is not sufficient under the Act to establish a connection between the employment activities and the claimant's condition (Sanitary District v. Industrial Com. (1931), 343 Ill. 236). It should also be noted that the question which evoked the quoted response from the doctor did not request that the answer be based upon a reasonable degree of medical certainty but only asked what significance "might be attached" to the work activity.
Assuming, as we shall, that the Industrial Commission rejected Dr. Steinberg's statement that there was no causal connection between claimant's work and her injury and accepted Dr. Savitt's testimony, the evidence in the record establishes no more than that there was a causal connection between claimant's getting up from the chair and the rupture of her aneurysm.
On cross-examination Dr. Savitt said that if a person for many years never had a diastolic pressure of under 120 that would "exacerbate this aneurysm"; that the process of bending down and getting up increases the pressure in the brain; that pressure would be increased by bending over and putting on shoes and stockings, getting in or out of bed, or any bending over below the level of the heart; and ...