VICP Registry Case Source Bundle Canonical URL: https://vicp-registry.org/case/USCOURTS-cofc-1_90-vv-01637 Package ID: USCOURTS-cofc-1_90-vv-01637 Petitioner: David Bradley White Filed: 1990-03-09 Decided: 1993-03-09 Vaccine: DPT Vaccination date: 1964-10-07 Condition: drowning with aspiration of gastric content secondary to seizure disorder Outcome: denied Award amount USD: AI-assisted case summary: David Bradley White's mother, petitioner Abbott, filed a petition on March 9, 1990, seeking compensation from the Vaccine Injury Compensation Program following her son's death. David received a series of diphtheria-pertussis-tetanus (DPT) vaccinations beginning on October 7, 1964, at approximately two months of age. He developed a residual seizure disorder, which is a Table injury under the DPT vaccine, and sustained neurological damage of such severity that he required lifelong placement in a group home for developmentally disabled adults. On the evening of September 5, 1987, when David was approximately twenty-three years old, a staff member of the group home assisted him in his bath and then briefly left him unattended. During that interval, David experienced a seizure and drowned. His death certificate recorded the immediate cause of death as "drowning with aspiration," attributing it to or as a consequence of his seizure disorder. The autopsy report similarly listed the cause of death as "drowning with aspiration of gastric content secondary to seizure disorder." The special master found that David died "from the consequences of the presumptively vaccine-related residual seizure disorder he sustained after his October 7, 1964 DPT vaccination" and authorized an award of $250,000, the statutory death payment under the Vaccine Act. Respondent appealed. The Court of Federal Claims, in an opinion by Judge Wiese issued on March 9, 1993, reversed the special master and ordered the petition dismissed. The sole question on appeal was whether David's death constituted an "acute complication or sequela" of his Table injury, the standard required by 42 U.S.C. § 300aa-14 for compensating a death arising from a vaccine-related injury. Drawing on standard medical dictionaries, the court defined "complication" as a morbid process occurring during a disease that may result from it or from independent causes, and "sequela" as a condition following as a consequence of a disease. Both terms, the court held, refer to somatic or pathological conditions—events recognizable as the pathological sequence or result of an existing disease, not accidents externally precipitated by that disease. David's death was not caused by pathological forces set in motion by his seizure disorder. It was caused by suffocation from an external force—water filling his lungs. His drowning was an accident precipitated by his disorder, but not a medical consequence of it. The court noted that the contemporaneously proposed HHS regulatory definition of "sequela," requiring cause-in-fact proof of a logical sequence of cause and effect, supported the same interpretation. Petitioner's counsel argued on appeal that the record did not resolve whether David drowned from aspiration of water or aspiration of vomitus, and sought a remand. The court rejected this argument, finding that the autopsy report's language ("drowning with aspiration of gastric content") and David's mother's own affidavit (attributing death to "drowning in a bathtub due to a seizure") were inconsistent with the theory that the death was caused by aspiration of vomitus rather than water. The public decision does not name petitioner's counsel, respondent's counsel, or the Special Master by name. Theory of causation field: Petitioner David Bradley White, via his mother Abbott, alleged that a DPT vaccine series administered on October 7, 1964, at approximately two months of age, caused a residual seizure disorder (a Table injury). David died on September 5, 1987, at approximately age twenty-three, from drowning with aspiration of gastric content secondary to his seizure disorder while unattended in a bathtub during a seizure. The Special Master authorized a $250,000 death payment, finding the death was from the consequences of the vaccine-related seizure disorder. Respondent appealed. The Court of Federal Claims (Judge Wiese, March 9, 1993) reversed, holding that drowning was an external accident precipitated by the seizure disorder, not an "acute complication or sequela" (a pathological consequence) of the Table injury as required by 42 U.S.C. § 300aa-14. The court defined "complication" and "sequela" based on medical dictionary definitions, concluding they refer to pathological conditions, not accidents. The court rejected petitioner's argument for remand regarding aspiration of water versus vomitus, citing the autopsy report and petitioner's mother's affidavit. The petition was dismissed. The public text does not name petitioner's counsel, respondent's counsel, or the Special Master. Public staged source text: ================================================================================ DOCUMENT 1: USCOURTS-cofc-1_90-vv-01637-cl6643558 Date issued/filed: 1993-03-09 Pages: 1 Docket text: lead-opinion -------------------------------------------------------------------------------- OPINION WIESE, Judge. The National Childhood Vaccine Injury Act (Vaccine Act), 42 U.S.C.A. §§ 300aa-1-300aa-33 (West 1991 & Supp.1992) permits an award of compensation to the estate of a decedent whose death ensued from a vaccine-related injury or from an acute complication of such an injury. In this case, the special master authorized an award for the death of petitioner’s adult son whose drowning was traceable to a neurological impairment (a residual seizure disorder) resulting from the administration of a vaccine in early childhood. The issue we now have before us on respondent’s appeal is whether the relationship between decedent’s vaccine injury and his death satisfies the causal standards of the Vaccine Act. Specifically, the question is whether decedent’s death may be considered an acute complication or sequela of a vaccine injury. We hold that it may not and therefore vacate the special master’s decision and order the petition be dismissed. I David Bradley White became afflicted with a seizure disorder following administration of a series of diphtheria-pertussis-tetanus (DPT) shots in 1964. Ultimately, the neurological damage associated with this condition required his placement in a residential care facility (a group home) for developmentally disabled adults. *793During the evening of September 5, 1987, David was assisted in his bath by a member of the group home’s staff. The staff member allowed David to remain unattended in the bathtub for a brief period and it was during this interval that David experienced a seizure that led to his drowning. David’s death certificate records the immediate cause of death as “drowning with aspiration” and identifies the event as “due to or as a consequence of seizure disorder.” Based on this opinion and its later endorsement by petitioner’s expert (in the proceedings subsequently brought before the special master), the special master concluded that David died “from the consequences of the presumptively vaccine-related residual seizure disorder he sustained after his October 7,1964 DPT vaccination.” Abbott v. Secretary of the Dep’t of Health & Human Servs., No. 90-1637V, slip op. at 7, 1992 WL 300899 (Cl.Ct.Sp.Mstr. Oct. 5, 1992). Accordingly, the special master determined that David’s estate was entitled to the $250,000 death payment authorized by the Vaccine Act. II Section 2114 of the Vaccine Act (42 U.S.C.A. § 300aa-14) contains a table of the vaccine-related injuries for which compensation may be awarded. In the case of the DPT vaccine, the listed injuries include anaphylaxis1 (and anaphylactic shock), encephalopathy 2 (and encephalitis), shock-collapse3 (and hypotonic-hyporesponsive collapse), and residual seizure disorder.4 Under the scheme of the Vaccine Act, a table injury is presumed to have been caused by a vaccine where the onset of that injury (i.e., the first symptom) occurs within a specified time period. (In the case of a residual seizure disorder, the time period is three days). In addition to the listed injuries, the table also includes as a basis for compensation “[a]ny acute complication or sequela (including death)” of a listed injury, provided the first symptom of that listed injury had occurred within the prescribed time period. Since it is agreed that David’s vaccine injury satisfies the temporal requirements of the statute (the first symptoms of his seizure disorder appeared within the prescribed three-day period), the single question we address is whether David’s death may be considered an “acute complication or sequela” of his residual seizure disorder. In determining the meaning of this phrase, we start with the proposition that the intention of a statute is to be found in the words that it contains. Unless the context shows otherwise, words of everyday usage are to be accorded their ordinary and everyday meaning, Avery v. Commissioner, 292 U.S. 210, 214, 54 S.Ct. 674, 676, 78 L.Ed. 1216 (1934); similarly, “where Congress has used technical words or terms of art, ‘it [is] proper to explain them by reference to the art or science to which they [are] appropriate.’ ” Corning Glass Works v. Brennan, 417 U.S. 188, 201, 94 S.Ct. 2223, 2231, 41 L.Ed.2d 1 (1974) (quoting Greenleaf v. Goodrich, 101 U.S. 278, 284, 25 L.Ed. 845 (1880)). In this case, our concern focuses on a statute, 42 U.S.C.A. § 300aa-14, whose words are not those of common usage. Rather, they are words of specialization drawn from the vocabulary of the field of medicine. Indeed, that point is brought home by the fact that, in addition to its list of table injuries, the statute also contains a *794section titled “Qualifications and aids to interpretation” (42 U.S.C.A. § 300aa-14(b)) that lists the symptoms and other indicia— again, in words common to medical phraseology — from which the likelihood of a vaccine-caused injury may be inferred. Clearly, by its choice of words and interpretive aids, Congress intended this statute to be understood — and to be applied — as it would be by a medical professional. It follows, therefore, that in the context of a statute so technically elaborate, the words “acute complication or sequela” are likewise to be taken as words of art that carry their own precise and special meaning. What then are the meanings of the words in question? To consider first the word “complication,” standard medical usage defines that term as “[a] morbid process or event occurring during a disease which is not an essential part of the disease, although it may result from it or from independent causes.” Stedman’s Medical Dictionary 336 (25th ed. 1990). Put more succinctly, it is “a disease or diseases concurrent with another disease.” Dorland’s Ill. Medical Dictionary 368 (27th ed. 1988). As to the term “sequela,” this is defined as “[a] condition following as a consequence of a disease,” Stedman’s at 1407, and also as “any lesion or affection following or caused by an attack of disease.” Dorland’s at 1509. Guided by these definitions, it is clear that the circumstances of David’s death do not bring that event within the framework of a table injury. As indicated, the terms “complication” and “sequela” refer to somatic conditions or events recognizable as the pathological sequence or result of an existing disease or disorder or as an independent accompaniment of such a disease or disorder.5 David’s death was not due to pathological forces set in motion by his vaccine injury. Rather, his death was the result of a suffocation brought on by an external force — the filling of his lungs with water. That fact is confirmed by the medical examiner’s autopsy report which lists as the cause of David’s death “drowning with aspiration of gastric content secondary to seizure disorder.”6 His death, therefore, was an accident, precipitated perhaps by his disorder but not the medical consequence of that disorder. Ill The special master’s decision holding David’s death to be a compensable table injury reflects an incorrect understanding of the term “acute complication or sequela” and is therefore wrong as a matter of law. David Bradley White’s death was not a table injury. Accordingly, we grant respondent’s motion. The decision of the special master is reversed and the petition is ordered dismissed. . Anaphylaxis refers to "a manifestation of immediate hypersensitivity ... in which exposure of a sensitized individual to a specific antigen or hapten results in life-threatening respiratory distress, usually followed by vascular collapse and shock and accompanied by urticaria [hives], pruritus [itching], and angioedema [swelling].” Dorland’s Ill. Medical Dictionary 72 (27th ed. 1988). . Encephalopathy refers to "any degenerative disease of the brain.” Id. at 550. . Shock (and shock collapse) refers to "a condition of profound hemodynamic and metabolic disturbance characterized by failure of the circulatory system to maintain adequate perfusion of vital organs.” Id. at 1515. . Seizure refers to "an attack of epilepsy,” i.e., "paroxysmal transient disturbances of brain function that may be manifested as episodic impairment or loss of consciousness.” Id. at 1503; 568. . Although not controlling in this litigation, it is instructive to note that the Secretary of Health and Human Services has recently proposed a rule to clarify that, under the Vaccine Injury Table, a "sequela” requires a showing that a subsequent event or condition was caused in fact by a table injury. The proposed rule reads as follows: The term “sequela" means a condition or event which is caused by a condition listed in the Vaccine Injury Table. The petitioner must prove by a preponderance of the evidence that the condition listed in the Vaccine Injury Table is the cause-in-fact of the resulting sequela. The petitioner must prove a logical sequence of cause and effect supported by a generally accepted medical or scientific explanation. 57 Fed.Reg. 36882, 36884 (1992) (to be codified at 42 C.F.R. pt. 100) (proposed Aug. 14, 1992). As the court reads it, the proposed rule offers a definition of sequela that corresponds with the interpretation reflected in this opinion. . During the argument of this case, petitioner's counsel made the point that the record before the special master did not resolve the question whether David’s drowning was due to the aspiration of water or the aspiration of vomitus. Hence, it was argued that the case should be remanded for further testimony on this point. The court does not accept this argument. As noted, the autopsy report lists the cause of David’s death as a "drowning with aspiration of gastric content____” and not as a drowning by aspiration of gastric content. The language of the autopsy report is inconsistent with counsel’s position. So too is the affidavit of David's mother, petitioner in this case. Therein she ascribes the cause of death as "drowning in a bathtub due to a seizure.”