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MRSA infection leads to impairment, return to work ruling

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A Tennessee maintenance technician who developed methicillin-resistant Staphylococcus aureus, a drug-resistant staph infection, from a work-related injury is entitled to a 7% impairment rating and was denied a “meaningful return to work,” the state's Supreme Court ruled Thursday.

Alfred Gamble worked as a maintenance technician for Montreal-based AbitibiBowater Inc., a pulp and paper manufacturing plant that now goes by Resolute Forest Products Inc., court records show. His job required him to work on heavy machinery while “bending, squatting, kneeling, crawling and climbing.”

On Jan. 27, 2011, Mr. Gamble remained in a kneeling position for several hours while working on a machine, according to records. He complained of bruised knees that afternoon and found it difficult to walk the next day.

A nurse and physician at the plant provided him with ibuprofen and told him to return if his condition didn't improve in a few days, records show. Mr. Gamble said he continued to experience pain and swelling. Since he was unable to walk, the company's safety director transported him to a physician in Cleveland, Tennessee, according to records.

Mr. Gamble was then referred to an orthopedic surgeon who performed surgery to drain an infection from his knee. He underwent three surgical procedures during his nine-day hospitalization after testing positive for MRSA, records show.

Nearly nine months after Mr. Gamble's injury, his surgical wound had healed, leaving a 2-by-14-centimeter “thick and sensitive scar,” according to records.

Upon returning to work, AbitibiBowater asked him if he could kneel or climb stairs, which he could not, records show. Mr. Gamble said he and his physician then “agreed to seek a second medical opinion to determine whether he could return to work without restrictions.”

According to records, another physician on Jan. 9, 2012, found that the MRSA infection had been cured. But because Mr. Gamble still had a “sensitive and painful scar and the onset of early arthritis behind the kneecap,” the physician recommended a home exercise program and suggested a restriction against “repetitive squatting or kneeling for four to six months.”

Several months later, Mr. Gamble's symptoms remained unchanged, but the physician released him to work without restrictions, saying that normal use of the leg might gradually diminish his symptoms, records show. However, the physician also said Mr. Gamble should avoid repetitive squatting and kneeling for an additional period of time.

In April 2013, Mr. Gamble filed a lawsuit seeking benefits for permanent and total disability. AbitibiBowater said Mr. Gamble had sustained a job-related injury to his left knee, but “denied the disabling nature of his injury and questioned his claim of no meaningful return to work,” records show.

At the request of Mr. Gamble, an orthopedic surgeon performed an independent medical evaluation about 18 months after the surgery, according to records. The physician assessed a 7% permanent medical impairment “for the lack of flexion, arthritic change, and damage to the weight-bearing function of the knee.” He assigned an additional 5% impairment for the surgical scarring, noting that Mr. Gamble's scar would continue to require protection from extreme temperatures, caustic materials, direct sunlight and glancing blows.

The Circuit Court for McMinn County, Tennessee, observed that Mr. Gamble hadn't had a meaningful return to work, as AbitibiBowater “declined to accommodate work restrictions,” and assessed a 7% impairment to his lower extremity, according to records. The trial court also assessed a 28% vocational disability for a total of $42,840, based on AbitibiBowater's compensation rate of $765 per week for 200 weeks.

On appeal, Mr. Gamble said he should have been granted an additional 5% for his surgical scar, equaling a medical impairment rating of 12%, records show. AbitibiBowater also appealed, arguing that the Circuit Court for McMinn County only should have awarded a 2% impairment, and that it erred by finding Mr. Gamble was denied a meaningful return to work.

The Tennessee Supreme Court Special Workers' Compensation Appeals Panel on Thursday affirmed the Circuit Court for McMinn County's ruling for a 7% impairment and that Mr. Gamble was denied a meaningful return to work.

“When an injured employee is not returned to work by the employer at a wage equal to or greater than his or her pre-injury wage, the employee may receive permanent partial disability benefits up to six times the medical impairment rating,” according to the state Supreme court ruling.