Appeal from the Circuit Court of Tazewell County, the Hon.
John A. Gorman, Judge, presiding.
CHIEF JUSTICE RYAN DELIVERED THE OPINION OF THE COURT:
Rehearing denied September 30, 1983.
Clyde A. Hoshor, Jr., filed a claim under the Workmen's Compensation Act (Ill. Rev. Stat. 1975, ch. 48, par. 138.1 et seq.) for injuries arising out of and in the course of his employment with Caterpillar Tractor Company (Caterpillar) in East Peoria. Following three hearings, an arbitrator for the Industrial Commission awarded him 200 weeks of lost time benefits, which represents 40% permanent partial disability, $60 for medical expenses to purchase support stockings, and 125 weeks of temporary total disability benefits. The Industrial Commission affirmed the arbitrator's finding that the claimant had sustained an accidental injury relating to his employment, affirmed the award of 125 weeks of temporary total disability benefits, but set aside the arbitrator's award of 40% permanent partial disability. Instead, the Commission ordered Caterpillar to provide the claimant with physical and mental rehabilitation.
After the circuit court of Tazewell County confirmed the decision of the Industrial Commission, Caterpillar appealed from the Commission's finding that a causal connection existed between the accident and the claimant's injury. The claimant appealed from the provision of the Commission's order which vacated the award of permanent partial disability. These appeals have been consolidated for our review on direct appeal to this court under Rule 302(a) (73 Ill.2d R. 302(a)).
The claimant testified that he went to see Dr. William Mosiman, his family physician, on December 2, 1975, concerning lower abdominal pain and a backache which the claimant had been experiencing for several days. Dr. Mosiman prescribed medication, and the claimant returned to work. The next day, December 3, 1975, the claimant was operating a buffing machine when a piece of the spinning buffing pad, which weighed about two ounces or less, broke loose and hit him on the left side of his abdomen slightly above the belt line. The impact left a slight abrasion which began to scab the next day and healed within a few days. The claimant did not seek first-aid treatment, but he informed a trainee foreman of the occurrence. He finished his shift and continued to work for the next week.
On December 13, 1975, the claimant reported to Caterpillar's first-aid office complaining of back pain. He did not relate his pain to a work injury. On December 15, he again saw Dr. Mosiman, and the next day he was admitted to Proctor Community Hospital to determine the cause of his back and abdominal pain. Intravenous pyelograms revealed the existence of a tumor-like enlargement in the claimant's retroperitoneal space, which is located behind the peritoneal cavity, which contains the large interior organs of the abdomen. Dr. Stuart Roberts, a surgeon, evacuated a hematoma from the claimant's retroperitoneal space on December 26, 1975. The pathologist's report did not reveal evidence of a malignancy. On February 22, 1976, the claimant was again hospitalized for edema in his left leg. Dr. Roberts performed a second surgical operation on March 9, 1976, which resulted in the removal of a benign fibrous tissue and a benign lymph node from the claimant's inferior vena cava, the main vessel returning blood from the lower extremities. Additionally, Dr. Roberts also removed adhesions in the same area which had been causing a small bowel obstruction. After the second operation when malignancy had finally been eliminated as a cause, Dr. Roberts questioned claimant about a trauma. Claimant then told the doctor for the first time about the incident at work.
On November 17, 1976, the claimant was released for work by his doctor and returned to work at Caterpillar. Because of the existence of edema in his legs, he was assigned to train as a power-truck operator, which would enable him to sit during work. After one day, however, he did not return to this position because he claimed his legs throbbed and he was unable to perform the job. The claimant's present medical problems, which allegedly stem from the accidental injury, are bilateral varicose veins and mild swelling of the legs.
Testifying for the claimant, Dr. Roberts said that the industrial accident of December 3, 1975, probably caused the hematoma in the retroperitoneal area. He ruled out a spontaneous occurrence, because of the absence of certain conditions that would usually accompany such an occurrence. He also noted that spontaneous hematoma is unusual in a young, healthy boy. The hematoma, moreover, was localized in an area which precisely corresponded to the spot on the claimant's abdomen which was struck by the buffing pad. Dr. Roberts concluded that the cause of the hematoma was the trauma to the abdomen, regardless of how minor the blow might appear to have been.
Dr. Roberts classified the blow received in the accident as a blunt trauma, since the buffing pad did not penetrate the abdomen. Although the piece of the buffing pad weighed two ounces and could not have exerted significant force, Dr. Roberts said it was not unreasonable to conclude that the trauma was the cause of the retroperitoneal hematoma. He had observed from actual practice that an apparently insignificant trauma which occurs without recognition is often proved to be a satisfactory explanation of the cause of an abdominal hematoma.
Dr. Roberts testified that the hematoma could not have pre-existed the industrial accident. When examined by Dr. Mosiman on December 2, 1975, the claimant had an elevated white blood count. Upon admission to the hospital on December 16, 1975, the claimant also had a high white blood count, but it was not as high as on December 2, 1975. A high urinary white blood count indicates a urinary tract infection, but a hematoma which affects the urinary tract would result in the existence of red blood cells rather than an elevated white blood count. This indicates that the trauma to the abdomen which occurred on December 3, 1975, did not cause the elevated white blood count. In this case, the hematoma was cultured and was not infected. Since it was not infected, it could not have caused an elevated white blood count. The backache and lower abdominal pain which were experienced by the claimant prior to the accident are frequently symptomatic of a urinary tract infection. For these reasons, Dr. Roberts concluded the hematoma did not antedate the industrial accident.
On cross-examination, however, Dr. Roberts stated that the retroperitoneal area would ordinarily be protected from a blow to the abdomen by an object that only weighed two ounces. Since a blow from a two-ounce object does not exert much force, the abdominal wall and bowel area would protect the retroperitoneal space.
Dr. Roberts testified that although a spontaneous retroperitoneal hematoma is unusual, it could spontaneously occur without the presence of a trauma. He admitted that the backache and lower abdominal pain which had been reported by the claimant to Dr. Mosiman a day prior to the industrial accident could suggest the presence of a retroperitoneal hematoma. However, he believed that the presence of a urinary tract infection provided the better explanation of this pain. Because of these statements, the employer contends that Dr. Roberts' testimony is equivocal about whether the claimant's work injury caused the growth in the retroperitoneal space.
Dr. Robert Pflederer, who testified on behalf of Caterpillar, reached a different conclusion from Dr. Roberts. Dr. Pflederer, an internal medicine and nephrology specialist, concluded that a spinning projectile which only weighed several ounces, such as a buffing pad, could only cause an abrasive trauma upon impact, not a blunt one. He concluded, therefore, that the buffing pad could not have exerted sufficient force to push back the abdominal walls and the bowels thereby causing damage in the retroperitoneal space. Dr. Pflederer based this opinion on the theory that a superficial, nonpenetrating wound to ...