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Thursday, February 22, 2018

The Chair of Truth

I once met a judge who had a special chair. This "chair of truth" was imbued with special powers. The judge confided in me how helpful this chair was, and encouraged me as Deputy Chief Judge to procure a similar chair for every Florida Judge of Compensation Claims. I declined that shopping trip, and at the first opportunity I saw to it that this particular "chair of truth" was disposed of appropriately

There are a variety of challenges presented by the role of Judge of Compensation Claims. Perhaps none is more frequent than the interpretation of scientific or medical evidence. Working with a variety of judges and administrators across the country, I have encountered several administrative law judges who felt they lacked the competence to make decisions regarding entitlement to medical benefits. One once confided in me "I'm no medical doctor, doctors should make those decisions." 

Those judges fail to understand that the doctors render their opinions and recommendations. Their burden is to explain those conclusions, and their logic paths, to others (judges) who lack their scientific expertise. One does not need to be a doctor to make credibility decisions, to discern which expert recommendation or opinion comports with logic, is best explained, and is persuasive. These determinations are absolutely the role of the "finder of fact," the judge or jury. This is true in the tort process and is consistently true in workers' compensation. 

Doctor's opinions are often unanimous or uncontradicted in a particular case. Science provides a process and testing provides foundations or support. But, often the question of whether a particular medical procedure is or is not appropriate comes down to the conflicting opinions of physicians. In those instances, the various experts explain their conclusions, their medical evidence, findings, and test results. And, the judge or jury finds one conclusion better supported, explained, and acceptable. 

That is the fallacy of "I'm no doctor." Opinions are expressed, foundations are explained and subjected to cross-examination, and someone has to decide which opinion, which doctor, is more credible. To some extent, these determinations often rely in part upon similar credibility determinations about any other, non-expert, witness. And, those credibility decisions may be dependent in part upon the credibility of the injured worker. The worker's complaints and symptoms are often part of the foundation upon which physician opinions are constructed. 

The Judge, in resolving conflicting testimony is not making a medical determination. The Judge neither has nor needs medical training. Certainly, some background in medical terminology may facilitate decision-making, but in the absence of it, a medical dictionary will more than suffice. The Judge is not making medical decisions, but merely credibility decisions. 

The Judge is merely choosing, as more credible, one expert's opinion over another. While this is primarily a medical opinion issue in workers' compensation, it can be as easily a decision as to which vocational expert is more credible, engineer, accident reconstruction expert, economist, and more. That a judge is not an expert in such a field does not render the judge ill-equipped to render a decision. One need not be an expert in a particular field to decide which expert's testimony is more credible and believable. 

In Florida, the courts have concluded that "credibility issues are for the judge of compensation claims to resolve as the trier of fact." Judges are presented with opinions and conclusions, which they may accept or reject. And, "the judge of compensation claims is not required to accept an opinion not supported by the facts of record."  ABC Liquors, Inc. v. Acree, 695 So.2d 813 (Fla. 1st DCA 1997). So, this is not necessarily an issue of whether particular care is appropriate or not. 

It may instead be an issue of whether the expert has done a competent job of explaining her/his conclusions of the appropriateness of care. Opinions rest upon factual predicates. Thus, the credibility of the factual predicate (presented by an injured worker or other lay witness) and the credibility of the expert formulating opinions may each be critical to a decision. In fact, in Florida, this means that "lay testimony can prove dispositive on entitlement to medical benefits, in an appropriate case." State, Fla. Div. of Risk Management v. Martin, 690 So.2d 651 (Fla. 1st DCA 1997).

Because of this critical element of credibility, evidence can be developed and presented that may not directly bear on the substantive issues in a case, but which does bear on the credibility, of the worker, an employer, a doctor, or otherwise. Credibility, it seems, might be an issue in any case. Of course, the party seeking to introduce such evidence has the burden of demonstrating that relevance. 

The law has changed and evolved in Florida over the years. Court interpret statutes and Legislatures construe their interpretations in constructing new statutes. in 1980, the Florida Legislature changed the standards for medical proof, later explained in Frank's Fine Meats v. Sherman, 443 So.2d 1055 (Fla. 1st DCA 1984). The court there noted that previous versions of Florida's workers' compensation statute somewhat allowed judges to make medical decisions more broadly. The court noted that 
The deputy may consider not only lay testimony, but also his own personal view of the claimant as well. See, e.g., Square G. Construction Company v. Grace, 412 So.2d 397 (Fla. 1st DCA 1982).
The deputy's observations of this distressed claimant, at the hearing, would be of considerable weight. Hillsborough Community College v. Miller, 440 So.2d 26 (Fla. 1st DCA 1983)
The Sherman court, interpreting the 1979 revisions to the Florida Workers' Compensation Law noted that "an accident occurring on or after August 1, 1979," was instead subject to the "very substantial changes to § 440.15(1)." Thus, the legislature altered the extent to which a Judge of Compensation Claims ("deputy")  could make and rely upon personal "observations" or "views" of the injured worker. 

And that returns me to the chair "of truth" that I encountered in 2006. A judge introduced me to an antiquated wooden chair, explaining that the antique chair was critical to decision-making. This chair, the judge assured me, had been the subject of discussion years prior between the judge and a local doctor. The doctor had confided in the judge, "off the record," that no person with a legitimate back injury could sit in that chair longer than 20 minutes without a break to stand and stretch. Thereafter, the judge had persistently arranged for injured workers alleging back complaints to be seated in just that chair. 

Thus was born the chair "of truth," and the judge confided in me that it had been most useful over the years in identifying injured workers who were exaggerating or fabricating complaints. There was no cross-examination of the doctor who had rendered such a broad conclusion about this chair. There had been no information provided to the injured workers who had sat in this chair over the years. However, I got the distinct impression that the chair had nonetheless played a significant role in various lives.

Clearly, the judge's job is to determine the credibility of witnesses. This includes workers, supervisors, coworkers, doctors, chiropractors, therapists, engineers, vocational experts, economists and more. In that role, the credibility may be judged by consistency or inconsistency, logic, thoroughness of explanation, and ability to withstand competent cross-examination. But, the judge is not a doctor or any of these other specialties. 

It seems incongruent and inappropriate for a judge to take some "off-the-record" supposition about a particular chair and apply that as fact in a variety of cases. In a more specific context, it seems inappropriate that any such measure or attribution of such a chair would reasonably be applicable to any and all back injuries. It seemed odd to me then, and remains inexplicable still. That is not to say that such a conclusion could not be true. That is to say that if sitting in that chair, by this worker, in this case, indicates a credibility issue. But, it seems that such a conclusion should be explained by an expert in this case, with this worker, and subject to cross-examination in this case. 

I doubt the chair "of truth," and suggest that decisions in workers' compensation cases should never be made based upon what a judge, or even "everyone," "knows." Decisions should be made in each case based on the evidence that is adduced and presented in that particular case. It is the responsibility of the parties to bring that evidence, to cross-examine other evidence, and to advocate their outcome. It is the judge's responsibility to evaluate that evidence as presented and to decide the claims and defenses based thereupon.