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King v. Credit General Insurance Co.11/10/1999
and/or atherosclerosis on top of that. Also, obesity can enlarge the heart, so there are three reasons." (Id. )
From examination of the decedent's respiratory system, Dr. Chute found indication of acute failure of the left side of King's heart. (Id. at 29-30). The doctor opined that King died of atherosclerotic cardiovascular disease, categorizing the death as a "natural" disease process. (Chute Dep. at 31; Ex. 3.) He further opined that death was immediately preceded by an arrhythmia, or abnormal electrical activity in the heart, which he called "the mechanism of death." (Chute Dep. at 32.) Based upon the autopsy findings, Dr. Chute opined that the arrhythmia was sudden, "meaning it could take seconds to minutes to develop." (Id. at 42.) He did not find evidence of a myocardial infarction, but indicated that King died before any indication of that condition would arise. (Id. at 28.)
Dr. Chute testified that the degree of King's atherosclerosis put him at considerable risk for either a myocardial infarction or a heart arrhythmia. (Id. at 34.) He noted that either an arrhythmia or myocardial infarction may occur spontaneously, even when a triggering event is not apparent. (Id.) He indicated, however, that cardiac arrhythmia probably had some trigger. (Id. at 39.) When asked to assume that Mr. King had spent thirty minutes in the hot sun, in temperature of 85 degrees, with humidity of 90 percent, and had been moving around working with strapping to tighten down a load on a truck, then went into an air conditioned cab of the truck, Dr. Chute gave the opinion those events would be sufficient to trigger an arrhythmia. (Id. at 40.) Dr. Chute maintained, however, that the cause of death "was the underlying severe atherosclerotic disease." (Id. at 48.)
Both parties retained expert medical witnesses to review the autopsy results and the circumstances of King's death. Claimant retained Dr. James H. Oury, a cardiovascular surgeon with extensive experience in cardiac surgery and research. Credit General retained Dr. Stan Wilson, a cardiologist whose practice emphasizes treatment of coronary artery disease. Both doctors have impressive medical credentials. During his career, Dr. Oury has performed between 5,000 and 7,000 heart surgeries as lead surgeon. Dr. Wilson performs over 500 cardiac catheterizations annually.
At trial, Dr. Oury opined that King's activity in helping to move the tarps triggered an arrhythmia leading to death. In his opinion, the activity caused the plaque rupture in the left anterior descending artery, which in turn triggered the arrhythmia. Dr. Oury agreed that King's atherosclerosis provided the substrate for deadly events on August 26, 1999. He testified that the greater the occlusion of the arteries, the less work it takes to trigger a fatal event. (Tr. Test and Dep. at 33-37). Dr. Oury suggested use of a "work product" formula to illustrate the relationship of physical exertion to heart trauma. (Id. at 36-37.) The formula uses the product of an individual's heart rate, pulse, and systolic blood pressure as a measure of stress placed on the heart. As the degree of occlusion increases, the amount of work necessary to increase the work product criticality decreases. Dr. Oury opined that decedent's moving of the tarps was sufficient to trigger the events leading to his death even if his activities on that day were typical of the work King performed daily as a truck driver.
Dr. Oury acknowledged that plaque ruptures and sudden coronary failure often occur in the absence of physical activity. He also agreed that decedent's medical records referenced several factors associated with the risk of death from coronary disease, including modera
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