Sheila Murphy was employed by the County of Sonoma on January 20, 2019. On that day she was hiking through tall grass while checking trail cameras. That evening she found a tick embedded on her right hip. She later developed a rash and became concerned that she might have contracted Lyme Disease, and so presented at Kaiser in Santa Rosa where her primary care physician prescribed antibiotics.

On March 19, 2019 she visited Kaiser Occupational Medicine department. At that time, it was the opinion of the Dr. Yee that it was unlikely that she had Lyme Disease. Nevertheless, it appears that an antibody test, referred to as the “ELISA” test by Dr. Leonard, was performed. The result of that test was negative.

There was a difference in opinion between the applicant’s initial treating doctors, affiliated with Kaiser, and the applicant’s subsequent treating doctor, Dr. Gitlin. The Kaiser doctors felt that applicant did not contract Lyme disease and Dr. Gitlin believed that she did, and diagnosed the disease by symptomology alone.

Applicant’s Kaiser physicians performed the ELISA test and applicant tested negative for Lyme disease. Notwithstanding these findings, the Western Blot test was requested by Dr. Gitlin and performed. The result of that testing, however, “also support[ed] the conclusion that applicant did not contract Lyme disease.” Applicant therefore tested negative on both counts.

Given this divide, the parties retained Dr. Leonard as the panel QME. Dr. Leonard reviewed literature concerning diagnosis of Lyme disease and found that there was a two-step process which consisted of an ELISA test, which, if positive for findings of Lyme disease, required completion of a second test, called the Western Blot test. “[W]ith a negative ELISA” it was understood that “further testing is not necessary.”

Based upon the above referenced test results, an evaluation of the applicant, and a review of the complete medical record, the QME found no injury AOE/COE. Within his reports and during his deposition, the QME explained the basis for his opinions and explained his reasoning for the findings. The QME ultimately issued a total of three reports.

August 9, 2022 Findings and Order by the WCJ found that applicant, while working as a park aide for defendant, “did not contract Lyme disease as a result of a tick bite on January 20, 2019.” The WCJ’s decision was based upon the findings of the panel Qualified Medical Evaluator (QME), Dr. Thomas Leonard.

Reconsideration was denied in the panel decision of Murphy v County of Sonoma/Regional Parks Division – ADJ13607768-1 (July 2024).

Applicant makes several arguments. First, applicant argues that Dr. Leonard does not have the requisite experience to be considered an expert on the diagnosis of Lyme Disease.

In response the WCJ in his Report said the “court disagrees. Although the doctor states that he has seen only 10 cases in his career, the undersigned has never seen a Lyme Disease case in 22 years of workers comp practice and on the bench.” “Ten cases seems like a significant number, enough to establish sufficient expertise for a Qualified Medical Evaluator.”

Finally, the applicant noted that “Dr. Leonard and the trial judge placed considerable weight on the two tests applicant took for Lyme disease, the ELISA and the Western Blot, both of which were negative for Lyme disease.”

To this the WCJ responded that the “reason for this considerable weight is that Lyme Disease is caused by bacteria, which, if it is present in the body, elicits an immune response. The presence of the bacteria causes human body to manufacture antibodies which are detectable in the blood. If the bacteria are present, antibodies will appear. If the antibodies do not appear, the bacteria is not present, and the individual does not have Lyme Disease.”

And he went on to say “the workers’ compensation system is ill equipped to address unusual, even ground breaking, medical situations. The workers’ compensation system deals with “reasonable medical probability” and evidence based peer reviewed medical consensus. In the present case, this means looking at the generally accepted methods of diagnosing Lyme Disease. In this case that compels a finding that the applicant does not have Lyme Disease.”

In denying the Petition for Reconsideration the WCAB panel said “Having reviewed the trial record we see no evidence which is inconsistent with the QME’s opinions, and we see no support for applicant’s argument that the QME reports are not substantial evidence. We also see no evidence of bias, speculation, or inexperience on the part of the QME, as asserted by applicant. We therefore agree with the WCJ that the reports from QME are substantial medical evidence.”