Fresenius Medical Care v. Glen Woolfolk
Annotate this Case
Download PDF
IN THE COURT OF APPEALS OF THE STATE OF MISSISSIPPI
NO. 2004-WC-00756-COA
FRESENIUS MEDICAL CARE AND CONTINENTAL
CASUALTY COMPANY
APPELLANTS
v.
STELLA L. WOOLFOLK, DECEASED, BY AND
THROUGH HER HEIR-AT-LAW, GLEN WOOLFOLK
DATE OF JUDGMENT:
TRIAL JUDGE:
COURT FROM WHICH APPEALED:
ATTORNEYS FOR APPELLANT:
ATTORNEYS FOR APPELLEE:
NATURE OF THE CASE:
TRIAL COURT DISPOSITION:
DISPOSITION:
MOTION FOR REHEARING FILED:
MANDATE ISSUED:
APPELLEE
3/17/2004
HON. JANNIE M. LEWIS
YAZOO COUNTY CIRCUIT COURT
CLIFFORD B. AMMONS
ANASTASIA G. JONES
JANICE T. JACKSON
WILLIAM JOSEPH KERLEY
CIVIL - WORKERS’ COMPENSATION
AFFIRMED THE DECISION OF THE
COMMISSION AWARDING MEDICAL AND
DISABILITY BENEFITS TO THE CLAIMANT
REVERSED AND RENDERED: 09/27/2005
BEFORE KING, C.J., IRVING AND BARNES, JJ.
IRVING, J., FOR THE COURT:
¶1.
Fresenius Medical Care and Continental Casualty Company appeal from a judgment entered by
the Circuit Court of Yazoo County affirming the decision of the Workers’ Compensation Commission
awarding benefits to the Estate of Stella Woolfolk.1 The issue presented in this appeal is whether there was
1
As will be discussed in greater detail later in this opinion, Stella Woolfolk suffered an aneurysm
rupture after receiving a telephone call from a patient of the Central Dialysis Center in Yazoo City,
Mississippi where Woolfolk worked. She never recovered, and her son, Glenn Woolfolk, was eventually
substantial evidence to support the Commission’s finding that the telephone call from the patient on the
morning of March 28, 2000, was an untoward event that caused, exacerbated, and/or aggravated
Woolfolk’s aneurysm, causing it to rupture.
¶2.
We find a lack of substantial evidence to support the Commission’s finding that Woolfolk suffered
a work-related injury, or stated another way, that the telephone call which Woolfolk received on the
morning of the rupture of her aneurysm was an unnerving, untoward event which caused, exacerbated, or
aggravated Woolfolk’s aneurysm. Therefore, we reverse and render the judgment of the circuit court
affirming the decision of the Commission.
FACTS
¶3.
A petition to controvert was filed on behalf of Woolfolk by her son, Glenn Woolfolk, seeking
disability benefits and payment of medical costs. Woolfolk’s claim was thereafter submitted to an
administrative law judge of the Workers’ Compensation Commission on written stipulation, deposition
testimony of medical experts, and written briefs by counsel. The administrative law judge ruled in favor of
Fresenius Medical Care and Continental Casualty Company, finding that Glenn Woolfolk, as conservator
of Woolfolk’s estate, failed to meet his burden of proof; therefore, the administrative law judge denied the
claim.
¶4.
Woolfolk appealed to the Full Commission. In a split decision, the Commission reversed the
administrative law judge and held that there was substantial evidence to support the finding that Woolfolk
suffered a compensable work-related injury. Upon appeal by Fresenius and Continental, the Yazoo
County Circuit Court affirmed the decision of the Commission.
appointed conservator of her person and estate, and it is he who prosecutes this appeal on behalf of
Woolfolk’s estate.
2
¶5.
The operative facts are these: Stella Woolfolk worked as a registered nurse at Central Dialysis
Center in Yazoo City, Mississippi. She became ill on the morning of March 28, 2000, after receiving a
telephone call at work between 5:30 a.m. and 6:00 a.m. from a patient who had undergone dialysis at the
clinic the day before. The patient told Woolfolk that the patient thought that the patient was over her
proper fluid weight and was experiencing shortness of breath. Shortness of breath is a known symptom
of fluid retention in dialysis patients, and on the rare occasion this occurs, the patient is asked to come back
for re-dialysis the next day. Woolfolk advised the patient to return to the clinic for re-dialysis after
determining that a place was available that morning. Thereafter Woolfolk proceeded to review the patient’s
chart with a coworker.
¶6.
Within about five minutes after taking the phone call, Woolfolk called for a coworker to help her,
stating that her head was hurting. By the time her coworker reached her, Woolfolk began to complain that
her legs were feeling weak. Woolfolk asked one of her coworkers to assist her to a chair. After assisting
Woolfolk to a chair, the coworker propped up Woolfolk’s legs. Woolfolk began rubbing her own legs.
Woolfolk also put her hands behind her head and neck and stated that she had a headache. She became
unresponsive. A coworker immediately checked Woolfolk’s blood pressure, but the pressure was
reportedly too high to be recorded on the automatic machine. A manual machine was then used and a
reading of more than 200 over more than 130 was obtained. Woolfolk’s speech became slurred, and she
became agitated and scared. Woolfolk then became disoriented and an ambulance was summoned by a
call to 911. Emergency personnel soon arrived and obtained a blood pressure reading of 232 over114.
¶7.
Due to the very high reading, Woolfolk was transported to King’s Daughters Hospital where a
brain scan was done. The scan showed that she had a brain hemorrhage, and she was immediately
3
transported by ambulance to University Medical Center in Jackson, Mississippi. Testing revealed that
Woolfolk had a pre-existing five millimeter aneurysm that ruptured, resulting in a stroke.
¶8.
Woolfolk underwent surgical procedures for her aneurysm at the University Medical Center on
March 28 and 29, 2000, after which she improved to be awake, alert, and oriented with good speech and
no focal neurologic changes. However, nine days following her hemorrhage, she became confused. On
April 6, 2000, Woolfolk underwent an angioplasty procedure. Woolfolk never regained consciousness
after receiving the angioplasty procedure, and she remained in a vegetative state until her death on February
28, 2003. She was fifty-six years old.
¶9.
Dorothea Lockwood, Woolfolk’s supervisor, testified by stipulation that Woolfolk was a
competent nurse who always received positive annual evaluations. Lockwood stated that Woolfolk had
never received a written reprimand, although she had received a “correction” once for failing to contact a
patient’s physician before changing the patient’s calcium. Lockwood went on to state that by the time she
arrived at work on March 28, 2000, the ambulance had already arrived to attend to Woolfolk. Lockwood
also stated that before Woolfolk was carried out, Woolfolk simply told her, “Hi, Dorothea, I just got a
headache.” Woolfolk did not make any other statements before being taken to the hospital.
¶10.
Lockwood remembered talking to the patient, who telephoned Woolfolk, when the patient came
to the dialysis center that morning, and the patient was not upset over the fact that she had to come back
for additional dialysis. According to Lockwood, it is not unusual for patients to be re-dialyzed, and
Woolfolk followed the standard protocol by having the patient come back that morning. Also, according
to Lockwood, Woolfolk never liked to re-dialyze patients, but she knew that it was protocol to do so when
necessary. Lockwood stated that the type of incident involving the patient who called on the morning of
March 28, 2000, was a common event in all dialysis centers operated by Fresenius, and such incidents had
4
happened before and have happened since Woolfolk’s aneurysm ruptured. Lockwood also stated that
Woolfolk would not have been reprimanded for the incident.
¶11.
Keith Alderman supervised the nine dialysis centers operated by Fresenius in Mississippi. In his
stipulated testimony, Alderman stated that he generally telephoned once a week and visited the Yazoo City
facility once a month and that at no time did Woolfolk ever mention or complain to him about any problems
she might be having at work. Alderman’s stipulated testimony corroborated Lockwood’s testimony that
(1) Woolfolk followed standard protocol in having the patient come back in to be re-dialyzed, (2) Woolfolk
would not have been reprimanded for having the patient be re-dialyzed, (3) patients being re-dialyzed are
not an every day occurrence, and (4) patients sometimes have to be re-dialyzed.
¶12.
Shirley Broomfield, a very good friend of Woolfolk, was a registered nurse and a staff nurse at
Central Dialysis Center. In her stipulated testimony, Broomfield confirmed that Woolfolk sought her
assistance after taking the phone call from the patient that wanted to be re-dialyzed. Broomfield testified
that Woolfolk complained of a headache and that her legs were weak, but Woolfolk never said anything
to her about being upset over the phone call from the dialysis patient on the morning of March 28, 2000.
Broomfield acknowledged that patients occasionally had to be re-dialyzed and that such an event was not
unusual, although it was rare.
¶13.
Daphne Bryant, a patient care technician at Central Dialysis, was on duty on the same shift as
Woolfolk on the morning of March 28, 2000. In her stipulated testimony, Bryant stated that she and
Woolfolk reviewed the treatment sheet of the dialysis patient who called on the morning of March 28,
2000, and it was their opinion that there was no reason for the patient to come back in, but it was normal
protocol to have the patient come back if the patient wanted to do so. According to Bryant, Woolfolk was
never upset during Woolfolk’s discussion about the patient coming back in, but was only concerned about
5
whether or not the patient would actually need to be re-dialyzed. Bryant stated that there was never any
discussion about Woolfolk’s job being in jeopardy or about Woolfolk being reprimanded by her supervisor
because of the patient having to be re-dialyzed. Bryant also stated that following the phone call from the
patient, Woolfolk was concerned only as a nurse would normally be concerned about a patient, but nothing
out of the ordinary happened involving the phone call.
¶14.
Woolfolk’s mother, Alice Tate, Glen Woolfolk, and Angela Garner, the mother of Woolfolk’s
grandchild, each testified that they heard Woolfolk state either that her job was stressful or that she had a
stressful relationship with her supervisor, Lockwood.
¶15.
It was stipulated that Woolfolk had no recorded medical history of elevated blood pressure prior
to March 28, 2000, and that her initial blood pressure reading, as obtained by emergency personnel at
around 6:00 a.m. on March 28, 2000, was 232 over 114. This was a very high pressure reading.
¶16.
Dr. Lynn Stringer, a Jackson neurosurgeon, testified in support of Woolfolk’s claim. Dr. Stringer
never treated Woolfolk, and his testimony was based on the available medical records, as well as
deposition testimony of certain lay witnesses. Dr. Stringer opined that being emotionally upset or stressed
can cause a sudden elevation of blood pressure, that elevated blood pressure can exert increased pressure
on the wall of a blood vessel in the brain, and that such increase in pressure can cause an existing aneurysm
to rupture. Dr. Stringer conceded that there was no medical literature supporting his theory, which he said
was based on “common sense.” Dr. Stringer also conceded that Woolfolk did not have a history of
hypertension and that there was no way anyone could have known what her blood pressure was at the
moment her aneurysm ruptured. At a later point in his deposition, Dr. Stringer acknowledged and
reiterated that his opinion about the cause of the rupture of Woolfolk’s aneurysm was based on the
assumption that the phone call from the patient was emotionally stress-inducing.
6
¶17.
Dr. Winfield Fisher, III, a practicing neurosurgeon and a professor of neurosurgery, served as the
employer and carrier’s medical expert. Like Dr. Stringer, Dr. Fisher never treated or examined Woolfolk
and gleaned his knowledge of her particular case from pertinent medical records and deposition testimony
of certain lay witnesses. Dr. Fisher opined that it could not be proven that any stress related to her job,
especially in relation to the telephone call, caused Woolfolk to suffer a bleed out of her aneurysm or a
subarachnoid hemorrhage. Dr. Fisher stated in his deposition that there is no literature to support the notion
that stress is a cause for subarachnoid hemorrhage. Dr. Fisher was also of the opinion that it is impossible
to state that a stressful phone call could be the cause for a subarachnoid hemorrhage or could exacerbate
or accelerate a bleed out of an aneurysm. Dr. Fisher further testified that he has observed an elevated
blood pressure in patients waiting to undergo aneurysm surgery, but the elevation in blood pressure
occurred after the rupture of the aneurysm, not before.
STANDARD OF REVIEW
¶18.
The standard of review in workers’ compensation cases is limited. Weatherspoon v. Croft
Metals, Inc., 853 So. 2d 776, 778 (¶6) (Miss. 2003). The substantial evidence test is used. Id. (citing
Walker Mfg. Co. v. Cantrell, 577 So. 2d 1243, 1245-47 (Miss. 1991)). The Workers’ Compensation
Commission is the trier and finder of facts in a compensation claim. Id. This Court will overturn the
Workers’ Compensation Commission decision only for an error of law or an unsupported finding of fact.
Id. (citing Georgia Pac. Corp. v. Taplin, 586 So. 2d 823, 826 (Miss. 1991)). Reversal is proper only
when a Commission’s order is not based on substantial evidence, is arbitrary or capricious, or is based on
an erroneous application of the law. Id. (citing Smith v. Jackson Constr. Co., 607 So. 2d 1119, 1124
(Miss. 1992)).
7
¶19.
Both parties have raised the issue of whether the Daubert standard2 should apply to the expert
testimony of Dr. Stringer.3 In essence, Daubert requires that expert testimony be based upon a reliable
foundation and be relevant to the task at hand.4 There is no question that Dr. Stringer’s deposition
testimony wass relevant to the task at hand. However, he cited no studies or medical literature to support
his opinion (1) that being emotionally upset or stressed can cause a sudden elevation of blood pressure,
(2) that elevated blood pressure can exert increased pressure on the wall of a blood vessel in the brain,
and (3) that such increase in pressure can cause an existing aneurysm to rupture. He clearly testified that
this opinion was based upon certain factual assumptions and “common sense” analysis. Because we find
that there is no substantial evidence supporting a critical fact assumed and relied upon by Dr. Stringer —
that the call from the patient to Woolfolk emotionally upset Woolfolk and induced stress in her — we do
not find it necessary to reach the merits of whether Dr. Stringer’s testimony complied with the Daubert
standard. We do point out, however, that the Workers’ Compensation Commission operates under a
relaxed evidentiary standard. See Miss. Code Ann. § 71-3-55 (1) (Rev. 2000); M.W.C.C. Procedural
Rule 8 (1993).
ANALYSIS AND DISCUSSION OF THE ISSUE
¶20.
The primary issue in this case is whether there was substantial evidence to support the
Commission’s finding that the phone call from the patient on the morning of March 28, 2000, was an
untoward event that caused, exacerbated, and/or aggravated Woolfolk’s aneurysm, causing it to rupture.
2
Daubert v. Merrell Dow Pharmaceuticals, Inc., 509 U.S. 579, 597 (1993).
3
The Mississippi Supreme Court adopted the Daubert standard in Mississippi Transp. Comm’n
v. McLemore, 863 So. 2d 31, 39 (¶5) (Miss. 2003).
4
Daubert, 509 U.S at 597.
8
¶21.
It is undisputed that Woolfolk suffered a ruptured aneurysm, resulting in a hemorrhagic stroke,
while acting in the scope of her employment. It is also admitted that she had a pre-existing aneurysm.
The central question here is whether there is substantial evidence to support the Commission’s finding that
Woolfolk’s employment contributed to her fatal condition.
¶22.
Fresenius and Continental argue that there is no substantial evidence to support the Commission’s
finding that Woolfolk’s injury is compensable. In support of this argument, Fresenius and Continental
assert that Woolfolk’s entire theory of liability relies on the finding of fact that the phone call was stressful,
causing her blood pressure to increase and her pre-existing aneurysmto bleed. Fresenius and Continental
contend that there is no evidence in the record that the phone call was stressful, nor is there any evidence
that even implies that the phone call was stressful. Although there was ample evidence that there was an
increase in blood pressure after the rupture of the aneurysm, Fresenius and Continental contend that there
is no evidence that there was an increase in blood pressure prior to the rupture of Woolfolk’s aneurysm.
In other words, Fresenius and Continental contend that there is no evidence that the spike in blood
pressure caused the rupture as opposed to being a condition of the rupture.
¶23.
The estate counters that the Commission had substantial evidence to support its finding that
Woolfolk’s injury was compensable. The estate maintains that the expert testimony and stipulated
testimony of various lay witnesses support the conclusion that the stressful work relationship with her
supervisor, in conjunction with the stress caused by an emergency type of phone call from a dialysis
patient, caused her elevated blood pressure and the rupture of her pre-existing aneurysm.
¶24.
In support of its argument, the estate cites Ins. Dep’t of Miss. v. Dinsmore, 233 Miss. 569, 102
So. 2d 691 (1958). In Dinsmore, the claimant suffered a stroke while performing her duties as an
employee of the Insurance Department of Mississippi. The court held that her injury was compensable,
9
even though there was contradictory medical testimony as to the cause of the stroke. However, the
court’s ruling was based largely on the fact that the claimant had a history of hypertension and had
suffered two previous strokes. Id. at 575, 102 So 2d at 692. In addition, there was ample evidence
from which the finders of fact were warranted in finding that the aggravation of the claimant’s pre-existing
hypertension was one of the factors which contributed to her stroke. Id. at 580, 102 So 2d at 695. We
find Dinsmore inapplicable because it is undisputed that Woolfolk did not have a history of hypertension,
and the evidence does not support an inference that her work environment aggravated any pre-existing
hypertension she may have had.
¶25.
In addition to citing Dinsmore, the Estate of Woolfolk also cites Riverside of Marks v. Russell,
324 So. 2d 759 (Miss. 1975) in support of its contention that the rupture of Woolfolk’s aneurysm is a
compensable work-related injury.
¶26.
In Riverside of Marks, the court held that the claimant’s cerebral vascular injury was work-
related. Id. at 762. However, we also find this case to be inapplicable because, unlike the claimant in
Riverside of Marks who suffered his cerebral vascular injury after having to constantly stoop over with
an estimated sixty to eighty pounds of luggage in hand in order to load the luggage into a plane’s baggage
compartment, there is no evidence in the record to support the contention that Woolfolk was engaged
in any strenuous physical labor when her pre-existing aneurysm ruptured.
¶27.
The Mississippi Supreme Court has stated that it is not within the authority of a reviewing court
to re-weigh the evidence in order to determine whether the preponderance of the evidence “might favor
a result that is contrary to the Commission’s determination.” Hollingsworth v. I.C. Issacs and Co., 725
So. 2d 251, 254 (¶11) (Miss. Ct. App. 1998). “So long as there is substantial evidence in the record
to support the Commission’s findings, this Court is obligated to affirm the Commission.” Id. at 254-55
10
(¶¶11-12). “Although it is true that the Workers’ Compensation Commission is the trier of facts and its
orders will be affirmed where there is substantial evidence to sustain its findings, nevertheless, the
substantial evidence rule is sufficiently flexible to permit the Court to examine the record as a whole to
check for errors.” Universal Mfg. Co. v. Barlow, 260 So. 2d 827, 831 (Miss. 1972). “Courts have
often reversed the Workers’ Compensation Commission when the Commission acted against the great
weight of the testimony.” Id. (citing M.T. Reed Constr. Co. v. Garrett, 249 Miss. 892, 164 So. 2d 476,
477-78 (1964)).
¶28.
Here, there is no substantial evidence that the phone call from the dialysis patient on the morning
of March 28, 2000, caused, exacerbated, or aggravated Woolfolk’s aneurysm. There is no credible
evidence in the record that Woolfolk suffered any stress or was in any way upset as a result of the phone
call. In fact, the testimony of every witness who was working with Woolfolk at the time of the call is
contrary to the contention that Woolfolk was upset as a result of the phone call. Shirley Broomfield and
Daphne Bryant, the two witnesses who had contact with Woolfolk immediately following the call, testified
that Woolfolk did not tell them that she was upset over the phone call nor did she appear to be upset as
a result of the phone call.
¶29.
Furthermore, there is insufficient evidence in the record to support a reasonable inference that the
phone call was stressful to Woolfolk. The testimony of each employee of Central Dialysis Center was
that patients do occasionally have to be re-dialyzed. Bryant testified that she and Woolfolk discussed the
patient’s treatment chart and jointly determined that there was no reason for the patient to come back in
that day. Also, Bryant testified that Woolfolk was never upset during Woolfolk’s discussions about the
patient coming back for treatment, but was only concerned about whether the patient would actually need
to be re-dialyzed. There is no evidence in the record to indicate that Woolfolk’s level of concern rose
11
above that of a nurse for the well-being of her patient. Nothing in the record indicates that Woolfolk
considered the phone call from the patient to be an emergency or urgent type of phone call. There is only
positive and corroborating testimony of employees of Central Dialysis Center that Woolfolk did not
appear to be upset as a result of the phone call.
¶30.
Even if we were to accept the claimant’s contention that the phone call was stress-inducing, we
find no evidence in the record to support the contention that the phone call caused an increase in
Woolfolk’s blood pressure or that it was an increase in blood pressure which caused her pre-existing
aneurysm to rupture. While there is ample evidence that Woolfolk’s blood pressure was elevated after
the rupture, there is no evidence that Woolfolk’s blood pressure was elevated prior to the rupture. In
other words, as Fresenius and Continental contend, there is no evidence to indicate that the elevation in
Woolfolk’s blood pressure caused the rupture as opposed to the elevation in blood pressure being a
condition of the rupture.
¶31.
The Mississippi Supreme Court has held that “whenever the expert evidence is conflicting, the
court will affirm the Commission whether the award is for or against the claimant.” Int’l Paper Co. v.
Greene, 773 So. 2d 399, 401 (¶6) (Miss. Ct. App. 2000) (citing Kersh v. Greenville Sheet Metal
Works, 192 So. 2d 266, 268 (Miss. 1966)). “The Commission, as fact finder, is entitled to weigh the
competing testimonies and render its decision accordingly, provided that the acceptance of the testimony
over that of the other did not result in a decision which was clearly erroneous.” Int’l Paper, 773 So. 2d
at 402 (citing Baugh v. Central Miss. Planning and Dev. Dist., 740 So. 2d 342, 344 (¶8) (Miss. Ct.
App. 1999)).
¶32.
In the case at bar, the Commission placed more weight on the testimony of Dr. Stringer than it
did on the testimony of Dr. Fisher. That was certainly the Commission’s prerogative. However, as stated
12
earlier in this opinion, Dr. Stringer’s expert opinion was based on the assumption that the phone call from
the patient was stress-inducing. There is simply no evidence to support this factual assumption. Dr.
Stringer’s opinion was also based on the assumption that the stress from the phone call caused
Woolfolk’s elevated blood pressure and that the elevated blood pressure caused Woolfolk’s pre-existing
aneurysm to rupture. Again, there is no evidence in the record to support any of these factual assumptions
on which Dr. Stringer’s opinion relies. Dr. Stringer admitted in his deposition that he did not know what
Woolfolk’s blood pressure was prior to her bleed out. Both experts agreed that by the time emergency
personnel arrived at the dialysis center and obtained a reading of Woolfolk’s blood pressure, she had
already had her bleed out. It is stipulated in the record that Woolfolk had no recorded medical history
of elevated blood pressure.
¶33.
The Commission noted that “a fair preponderance of the evidence presents, at worst, a doubtful
case which [it] was duty bound to resolve in the claimant’s favor.” Big “2" Engine Rebuilders v.
Freeman, 379 So. 2d 888, 889 (Miss. 1980). Were there facts to support the assumptions made by
Dr. Stringer which undergird his opinion, we might be inclined to agree with the Commission. However,
if the premise upon which Dr. Stringer’s opinion was based is flawed, then it necessarily follows that the
opinion is also flawed. Accordingly, we find a lack of substantial evidence to support the finding of the
Commission that Woolfolk suffered a compensable work-related injury. Therefore, we reverse and
render the decision of the Commission and the judgment of the circuit court affirming it.
¶34. THE JUDGMENT OF THE CIRCUIT COURT OF YAZOO COUNTY AFFIRMING
THE DECISION OF THE WORKERS’ COMPENSATION COMMISSION IS REVERSED
AND RENDERED. ALL COSTS OF THIS APPEAL ARE ASSESSED TO THE APPELLEE.
KING, C.J., BRIDGES AND LEE, P.JJ., MYERS, CHANDLER, GRIFFIS, BARNES
AND ISHEE, JJ., CONCUR.
13
Some case metadata and case summaries were written with the help of AI, which can produce inaccuracies. You should read the full case before relying on it for legal research purposes.
This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.