On certification to the Superior Court, Appellate Division, whose opinion is reported at 194 N.J. Super. 366 (1984).
For affirmance -- Chief Justice Wilentz, and Justices Clifford, Handler, Pollock, O'Hern, Garibaldi and Stein. For reversal -- None. The opinion of the Court was delivered by Garibaldi, J.
The primary issue in this workers' compensation case is whether the construction of a self-contained apartment attached to the home of an injured worker's parents may constitute "medical, surgical or other treatment . . . necessary to cure and relieve" or "other appliance" under N.J.S.A. 34:15-15 of the Workers' Compensation Act (Act); and if so, whether there is sufficient credible evidence in the record to support the finding that the construction of the apartment addition was necessary and that its cost was reasonable.
The petitioner, Eugene M. Squeo (Squeo), is a quadriplegic. He was injured in 1978 when he fell from a roof while working for respondent, Comfort Control Corp. (Comfort Control). He is totally and permanently disabled. In 1979, a judgment ordering disability payments was entered by a judge of the Division of Workers' Compensation.
In February, 1982, Squeo filed an Application for Review or Modification of Formal Award seeking, inter alia, an order requiring Comfort Control to construct a self-contained apartment attached to the home of his parents. The compensation court ordered that such construction be undertaken. The Appellate Division affirmed the Order of the compensation court 194 N.J. Super. 366. We granted Comfort Control's petition for certification. 99 N.J. 148 (1984).
Squeo was 24 years old at the time of his accident in 1978. He is a wheelchair-bound quadriplegic. The compensation court concluded that his disability was orthopedic, neurologic, and neuropsychiatric involving residuals of multiple injuries including severance of the spinal cord. Dr. Richard Sullivan, Medical Director of the Kessler Institute of Rehabilitation, treated Squeo for several months. A witness on behalf of Comfort Control at the hearing, he testified that Squeo "had a terribly physical post injury course." Usually after about eight weeks a quadriplegic is "well, though disabled;" in contrast, Squeo was "unwell for probably about two, two and a half years after his injury." Dr. Sullivan attributed Squeo's emotional problems to his protracted physical ailments. He testified that Squeo
has had a terribly hard time. The man has had just about every complication that God ever put on this earth for him. Quadriplegic, the first year was devastating at the Veteran's Hospital and Hackensack because he went out of one problem into another and then when we saw him, immediately we had to do something to his urinary tract and surgery and then he came back and we had problems with skin breakdowns, rashes, you name the complications, this poor fellow had it. Then he developed a curvature of the spine and we had to send him for corrective surgery to the spine and this was completed, and as I say he's had one medical difficulty after another.
For several years prior to his injury, Squeo had lived independently of his parents. Since 1980, he has been confined to a nursing home with predominantly elderly patients. The institutional living and the nursing home environment caused Squeo to become severely depressed. His depression was so great
that on three occasions, while in the nursing home, he attempted suicide.
Because of the oppressive, institutional atmosphere that pervaded the nursing home, Squeo requested a modification of his disability award. Squeo testified at the compensation hearing that he wanted to "get on with life" which he "ha[d] not done in the last four years." He wanted to attend college and thereafter become gainfully employed. In order to do so, he felt it was necessary to be removed from the nursing home and "be rehabilitated into the world as a functional person again." He believed that the best way for him to be so rehabilitated was to live in a separate studio apartment attached to his parents' home.
At the compensation hearing Dr. Peter Crain, an expert in neurology and neuropsychiatry, testified on Squeo's behalf. Having examined Squeo, he diagnosed his condition as depression with suicidal tendencies. He explained that Squeo had developed ways of adjusting to his quadriplegia and had aspirations of attending college and thereafter being employed. The doctor opined that Squeo's depression was caused by the conflict between his ambitions and his perception of his future in the nursing home with older people with whom he had nothing in common. He resented being controlled by the institutionalized procedures of the nursing home.
Crain noted that Squeo had made three suicide attempts, which were rooted in his depression.
He believed that since he's a young man, twenty-eight years old, to look forward to a life like this in the nursing home is no life at all and that he [sic] rather be dead than to have to live a life like this. Now, he admitted to me that the fact of carrying out suicide in itself is irrational but at those times when he particularly becomes frustrated, angry, upset, depressed, then his rationality goes out the window and all he can think about is how to do it, that's the only way to escape from this intolerable situation.
Crain opined that a change in Squeo's environment would have a beneficial effect on his depressed state, and that as long as he remained in the nursing home, there would be more suicide attempts.
Crain concluded that an addition to petitioner's parents' home, such as the one described by petitioner, would be the environment in which petitioner would function best, and having accomplished this, he "would feel much better." Crain did not think that government-provided living facilities designed especially for quadriplegics would be as beneficial to Squeo's well-being as the apartment addition to his parents' home inasmuch as "[h]e sees any institution as being an obstacle to his ability to function to his capability."
Squeo's next witness at the hearing was Deidra Davis, an expert in mainstreaming handicapped people back into society. She defined mainstreaming as allowing individuals with disabilities to participate as fully and completely as they can in all aspects of society. She emphasized the importance to a disabled person of independent living, a concept whereby the individual assumes total responsibility and direction for his or her own life.
Miss Davis testified that because nursing homes are geared primarily towards geriatric patients, they do not provide a psychological environment conducive to independent living for young patients like Squeo. Thus, to relegate a young man like Squeo to a nursing home would "shortchang[e] him of the life that he should have" and condemn him to "a fate worse, worse than death * * *." Squeo's ability to choose his own living environment was the "utmost important issue" for his physical and psychological health.
While government-provided facilities would be an improvement for Squeo over the nursing home environment, Miss Davis believed they would not be as beneficial to him as the apartment addition. The few independent living facilities established in this state are primarily occupied by the elderly and are more suited to those individuals who have been released from nursing homes and institutions and need a great deal of care. According to Miss Davis, such facilities are not as beneficial for
a person like Squeo, who, while in need of care, has a tremendous need to live as independently as possible.
Gordon Anthony, a quadriplegic and the executive director of Dial for Independent Living, also testified for petitioner. His organization helps disabled people to gain control over their own lifestyles and options. He testified that the disabled become angry, frustrated, and depressed by the lack of options available to them. Anthony stated that the best independent-living environment depends on the individual. Because Squeo reacted so strongly against the restrictions of institutional living, Anthony believed the nursing home was a terrible place for him.
Dr. Richard Sullivan, Medical Director of Kessler Institute of Rehabilitation, appeared as Comfort Control's main witness. He testified that in cases involving a quadriplegic, the usual practice at the Kessler Institute is a discussion between the employer or his insurance carrier and the patient about feasible housing plans for the patient. This practice was followed in this case. Dr. Sullivan spent a lot of time with Squeo's parents and his employer discussing plans to provide functional housing for Squeo. Among the alternatives considered were the conversion of the Squeos' basement to accommodate petitioner, a plan abandoned because the basement was considered to be too damp; a proposal to add a room and bath to the Squeos' house; and the attachment to their house of a mobile home, a plan unacceptable to the municipality. Unable to develop a feasible plan, Sullivan and Comfort Control advised the Squeos to meet with an architect to develop a plan. At that time, the Squeos were given a cost factor "that was compatible at that time with a room and bath addition to a home." He testified that the cost factor was based upon "the experience of the insurance company and ourselves as advisers in these conditions. We put many additions onto many homes for people."
Dr. Sullivan testified that the architect's recommendation surprised him. Instead of the usual addition of a room and
bath, with ingress to and egress from the home, the plan contemplated a separate apartment attached to the home. The apartment would contain a bedroom, kitchen, living room, bathroom, carport, basement, and hydraulic lift, and would require its own electricity, plumbing, and heating. The architect estimated the cost to be in excess of $65,000.
When questioned by the compensation judge, Dr. Sullivan conceded that the addition of the separate apartment "is not that bad an idea." However, he expressed ...