Appeal from the Circuit Court of Cook County, the Hon. Arthur
L. Dunne, Judge, presiding.
MR. JUSTICE MORAN DELIVERED THE OPINION OF THE COURT:
Respondent, the County of Cook, appeals the Cook County circuit court's judgment which confirmed the Industrial Commission's order awarding compensation to claimant, Claire Spiegel. Claimant is the widow of Albert Spiegel, a 63-year-old clerical worker who died from a heart attack on July 6, 1973. Spiegel, employed by the respondent in February 1971, worked at the statement counter in the Cook County treasurer's office. Prior to this employment, Spiegel had worked for 30 years as a supervisor for the Leader Laundry and Dry Cleaning Company. Mrs. Spiegel stated that during his employment with Leader her husband enjoyed good health.
In 1971, Spiegel was, on four occasions, hospitalized with a heart condition. After each hospitalization, he recuperated at home and returned to work, but he remained under medical supervision and took various types of medication on a daily basis.
According to Mrs. Spiegel's testimony, on Tuesday, July 3, 1973, her husband came home from work tired and he laid down to rest. The following day the Spiegels entertained relatives at their home, but, Mrs. Spiegel stated, there was no unusual excitement and her husband engaged in no physical activities. That afternoon Spiegel excused himself and rested. He made no complaint about feeling ill. He retired that night at about 10 p.m., but awoke later that night and told his wife he did not feel well. Hospital admission records, introduced into evidence by respondent, indicate that Spiegel had developed chest pressure at about 11 p.m., July 4, and took nitroglycerine medication, which provided complete relief. At about 2 a.m. he awoke, the chest pressure having returned, and took another nitroglycerine tablet for relief. At 2:45 a.m., the pressure returned and he again took nitroglycerine, but this time the pressure did not go away. Spiegel was taken to the hospital and admitted as an emergency case with an "impending myocardial infarction."
On cross-examination Mrs. Spiegel testified that her husband had had some eye trouble, and further that he had to watch his weight, especially after he developed his heart condition; that he never complained of chest pains at any time during June or during the first few days of July; and that during the prior weekend he had not exerted himself or been involved in any stressful situations. Medical records introduced into evidence by the respondent revealed that Spiegel had been overweight and had had a history of hypertension, diabetes and mild glaucoma, but that the diabetes problem had been apparently cured and the weight problem had been brought somewhat under control.
Joseph Armato, head supervisor of the office where Spiegel worked, testified on behalf of the claimant that Spiegel was one of four or five men who sat at the statement counter to receive real estate tax bills from taxpayers who came into the office to make payments. It was Spiegel's job to add up the amount due, clip the adding machine tape to the bill, initial it, return it to the taxpayer, and direct him or her to the cashier's cage where the actual payment was made.
Monday, July 2, 1973, was the final day that taxpayers could pay their first installments without incurring a penalty. Armato stated that this was their rush period, and that the counter men serviced an estimated 2,000 to 3,000 taxpayers each day during the week prior to the deadline. At the arbitrator's request, respondent produced records indicating the number of tax bills paid at the office during the final week. The records indicated that a total of 21,890 tax bills were paid: June 25, 2,705; June 26, 3,585; June 27, 3,619; June 28, 2,465; June 29, 5,394; July 2, 3,744; July 3, 378.
From time to time, Armato or his assistant would relieve the counter men so that they could take 15 minute breaks. Armato testified that he saw Spiegel on July 3, that he observed nothing unusual about Spiegel, and that Spiegel made no complaints. Armato noted that July 3 was a warm day, and that the men had to remove their jackets. Armato also said Spiegel was not a fast worker, but that he "kept up," and that all the counter men were fairly good workers.
Four of respondent's employees testified on its behalf. One witness testified that on July 3 Spiegel worked under her supervision transferring figures from tax statements onto small cards while seated at a desk. The witness described Spiegel as a slow worker, but stated that she did not push him. She also stated that six men had worked the counter on July 2. Another employee testified that only three men worked the counter. Several of the witnesses indicated that various employees, including themselves, assisted the counter men during the week when it was busy. Employees were also present to control the crowds, and if a taxpayer gave the counter men trouble, the men were to call their supervisor for assistance.
The office in which Spiegel worked was described as large, but not air conditioned. One witness stated that the office would become hot during the summer, even when the windows were open. Another witness, however, testified that during the preceding year he had not experienced discomfort due to heat, and said the men were not required to wear coats and ties.
In response to a hypothetical question describing Spiegel's prior heart condition, his work environment, and his work activities during the final week, Dr. William Fitzsimmons, claimant's medical expert, stated that in his opinion there could have been a causal connection between the facts stated and the hypothetical person's subsequent state of ill-being. He felt that such person would probably be predisposed to coronary artery disease and that the condition of work stress during the final week could have precipitated the heart attack.
On cross-examination Dr. Fitzsimmons stated that he had not examined any of Spiegel's medical records. After examining decedent's four 1971 hospital discharge summaries, Dr. Fitzsimmons testified that the information contained in the reports reinforced his opinion that the work stress might have precipitated the fatal heart attack. Dr. Fitzsimmons was then shown Spiegel's July 1973 hospital and medical reports, including the electrocardiogram and various enzyme tests. Dr. Fitzsimmons stated that, based upon his interpretation of the electrocardiogram and the enzyme tests, the onset of the myocardial infarction occurred sometime prior to Spiegel's admission into the hospital. On further cross-examination Dr. Fitzsimmons stated that the infarction could have been caused by many things, that the stresses on the job were one of many possibilities, and that Spiegel could have suffered an infarction even if he was not working.
Respondent did not introduce any expert testimony before the arbitrator, but on review before the Commission it offered the testimony of Dr. Henry Russe, a heart specialist. Dr. Russe testified in response to a hypothetical question that he could not assume the hypothetical person's death was causally related to his work activity. He premised his opinion on the fact that there was no evidence in either the question asked or in the 1973 medical reports which would indicate that the hypothetical person had manifested symptomatology of the type that one would associate with stress, if stress had been a precipitating factor. Specifically, Dr. Russe stated that if a person had had a previous myocardial infarction, as had Spiegel, a new cardiac injury would have been signaled by an increase in chest discomfort and an increase in the use of nitroglycerine. He stated that, on the basis of the information presented to him, there was no suggestion that there was a remarkable increase in symptomatology, specifically pain, nor an increase in the use of nitroglycerine. An examination of decedent's 1973 medical records, however, reflects that in the treating physician's final summary, which was available to respondent's expert, the physician ...