Laura Wyatt (“the employee”) was employed by Baptist Health System, Inc. (“the employer”), as a patient-care technician at Shelby Baptist Medical Center. On November 28, 2015, the employee was carrying a bag filled with bed linens and towels to the utility room. When she lifted the bag and twisted to place it on the top of the linen cart, she felt a sharp pain in her back followed by a burning sensation and pain down her legs into her toes. She was ultimately diagnosed with transverse myelitis and still suffers from weakness in her legs, trouble with walking and with balance, and issues with her bladder and bowels.

At trial, the employee’s treating physician, Dr. Meador, testified that the employee’s transverse myelitis was caused by impingement of her artery of Adamkiewicz, which, he concluded, was caused by the twisting and lifting motion the employee made on November 28, 2015. Dr. Gordon Kirschberg and Dr. Diane Counce disagreed with Dr. Meador’s conclusions, both indicating that transverse myelitis is not caused by such an insignificant trauma as a twisting and lifting motion. Further, Dr. Counce testified that certain medical records she had reviewed indicated that the employee had not suffered an impingement of the artery of Adamkiewicz and that she believed that the employee suffered from myelopathy resulting from a severe vitamin B-12 deficiency.

After trial, the trial court entered a judgment in favor of the employer, concluding that the employee had failed to prove that her condition had resulted from a work-related accident. On appeal, the employee argued that the trial court failed to address whether she had established legal causation of her injuries; that the trial court incorrectly concluded that she had not proven medical causation; that the fact that she suffered previous back injuries should not prevent her from receiving compensation; and that the trial court “mischaracterized” the testimony of Dr. Meador, and improperly relied on that mischaracterization to determine that the employee was not entitled to compensation.

The Alabama Court of Civil Appeals began its discussion in stating “It is well settled that, under Alabama law, an employee must establish both legal causation and medical causation in order to be entitled to workers’ compensation benefits.” The Court then noted approvingly that the trial court explained that it had found the testimony of Dr. Gordon Kirschberg and Dr. Diane Counce “more well-reasoned, medically sound, and persuasive than the testimony offered by” Dr. William Meador. After concluding that “substantial evidence supports the trial court’s conclusion that the employee did not establish medical causation,” the court noted it need not address legal causation. 

Felisha Bailey (“the employee”) was employed by Jacksonville Health and Rehabilitation Center (“the employer”) as a certified nursing assistant. The employee sought under the Alabama Workers’ Compensation Act (“the Act”) for her alleged contraction of scabies and her alleged resulting psychological injuries. The employer moved for summary judgment, and argued that the employee had not contracted scabies and that she had not suffered a psychological injury compensable under the Act. The employer’s motion was supported by excerpts from the employee’s deposition, excerpts from the deposition of Dr. Janet Cash, and an affidavit from Dr. Glenn O. Archibald. After a hearing, the trial court entered a judgment in favor of the employer.

The evidence presented revealed that in June of 2012, the employee noticed a rash on her arms and face, and explained that the employer had experienced an outbreak of scabies at its facility during this time frame. The employee sought treatment from her personal physician, Dr. Johnnie Stevens, on June 25, 2012. She reported that she had been exposed to scabies and lice during her employment. Dr. Stevens diagnosed her with “a rash that is erythematous urticarial.” The employee sought additional medical treatment at Stringfellow Memorial Hospital on June 28, 2012. On that date, she was seen by Dr. Kevin Sells, to whom she reported that her place of employment had suffered an outbreak of scabies. The employee was next examined by Dr. Michael K. Morris on July 10 and 19, 2012. Dr. Morris’s notes indicated that the employee reported that she was being treated for scabies. His examination revealed no rash on her neck, face, or hands, but he noted that examination of the employee’s limbs revealed “several punctuate [sic] lesions with scabs.” Upon his reexamination on July 19, 2012, Dr. Morris noted “no rash, including no punctuate [sic] lesion, scabs, or burrowing” on her limbs. Dr. Morris diagnosed the employee with a mite infestation.

Dr. Janet Cash, a dermatologist, examined the employee on October 11, 2012. She testified in her deposition that the employee was not suffering from scabies at the time of the October 2012 appointment. Dr. Cash noted that the employee had reported that she had had scabies on her face and scalp, which, according to Dr. Cash, scabies do not inhabit. Dr. Cash also pointed out that Dr. Stevens, who saw the employee in June 2012, had diagnosed the employee with a “rash that is erythematous urticarial,” which, Dr. Cash explained, is hives resulting from an allergic reaction. Dr. Cash further testified that, although she was aware that other physicians had diagnosed the employee with scabies, she had not seen any evidence or documentation that supported that diagnosis. Based on her examination, Dr. Cash opined that the employee likely never had scabies; however, she indicated that, had the employee had scabies in June or July 2012, she would not have had an infestation in October 2012 if she had taken the medications she had been prescribed. Finally, Dr. Cash opined that the employee likely suffered from an underlying psychological issue, delusional parasitosis, which is a disorder that causes a person to believe that they are being infested by parasites. Dr. Cash explained that delusional parasitosis arises from an underlying anxiety problem and thus, the employee’s psychological problems were not related to her employment.

The Alabama Court of Civil Appeals found that the trial court’s conclusion that “the only objective, verified, credible and authoritative medical evidence, which is undisputed, is the testimony of ... Dr. Janet Cash, a Board Certified Dermatologist, who testified with a reasonable degree of medical probability and a reasonable degree of medical certainty that [the employee] did not contract scabies ....” was improper, and “the trial court erred by determining that Dr. Cash’s testimony was the only ‘credible’ evidence regarding whether the employee contracted scabies.”

To the contrary, the Court of Civil Appeals stated: “The totality of the evidence before the trial court, viewed in the light most favorable to the employee, indicates that, since June 2012, the employee has had a firm belief that she is infested by scabies or other bugs despite the medical evidence indicating that she either was not ever or is no longer infested and that she suffers from anxiety, depression, and occasional psychoses that prevent her from functioning in a work environment. If the employee proves that she did, in fact, contract scabies such that she suffered a physical injury, the evidence recited above could form the basis of a conclusion that the employee’s psychological condition is related to the contraction of scabies during her employment.” Thus, the Court held that a genuine issue of material fact existed regarding whether the employee’s alleged contraction of scabies caused her to develop delusional parasitosis or another psychological disorder, and the summary judgment in favor of the employer on that issue was improper.