ADJ12492033 · May 15, 2026

The Arbitrator found the opinion of the primary treating physician Dr. Savage, that the applicant's ITP was caused by the needle stick injury and subsequent medication, to be better reasoned and more persuasive than the QME's contrary opinion, supported by credible testimony and medical evidence showing symptoms immediately after medication and no intervening cause.

From the decision · page 1Defendant City and County of San Francisco seeks reconsideration of the Opinion on Decision and Findings (OD & F) issued on November 14, 2025, wherein a workers' compensation arbitrator (WCA) found that applicant sustained an injury arising out of an occurring in the course of his employment (AOE/COE) to his left hand, a needlestick injury, and injury in the form of blood and Hematopoietic Purpura (ITP).

Applicant developed symptoms immediately after taking prescribed preventive medications following the admitted needle stick injury.

Favours Applicant prevailed

This temporal relationship supported the primary treating physician's opinion that the medication contributed to the development of ITP, favoring the applicant's claim.

From the decision · page 8The primary treating physician's conclusion was based on several factors: the applicant developed negative reactions and symptoms immediately after taking the prescribed medications; he continued to complain of fatigue, brain fog, and blurred vision with floaters from the time he began the medication until May 2019, when the symptoms worsened; there was no intervening cause between the needlestick and the diagnosis of ITP; and the physician found an article [ ]. Therefore, the primary treating physician concluded, with reasonable medical probability, that the needlestick and the prescribed medication were 80% likely to be the cause of the applicant's development of ITP.

No intervening cause was found between the needle stick injury, medication, and diagnosis of ITP.

Favours Applicant prevailed

Absence of other causes strengthened the causal link between the industrial injury and the ITP, supporting the applicant's burden of proof.

From the decision · page 8The primary treating physician's conclusion was based on several factors: the applicant developed negative reactions and symptoms immediately after taking the prescribed medications; he continued to complain of fatigue, brain fog, and blurred vision with floaters from the time he began the medication until May 2019, when the symptoms worsened; there was no intervening cause between the needlestick and the diagnosis of ITP; and the physician found an article [ ]. Therefore, the primary treating physician concluded, with reasonable medical probability, that the needlestick and the prescribed medication were 80% likely to be the cause of the applicant's development of ITP.

The primary treating physician's opinion was found better reasoned and more persuasive than the QME's contrary opinion.

Favours Applicant prevailed

The Arbitrator's credibility determination of medical opinions was key to the outcome favoring the applicant.

From the decision · page 31Savage were the most persuasive and although in conflict with the report of the Qualified Medical Evaluator (Dr. Fishman), the Arbitrator found the opinion of Dr. Savage, finding the ITP was caused by the applicant taking the preventative drug [ ]. because of the industrial injury to better reasoned and more persuasive, especially considering the fact the applicant developed symptoms immediately after taking the drugs and the additional facts set for above.

Concluded with reasonable medical probability that the applicant's ITP was 80% likely caused by the needle stick injury and the prescribed preventive medication, supported by symptoms immediately after medication and no intervening cause.

The Arbitrator found Dr. Savage's opinion better reasoned and more persuasive than the QME's, based on detailed deposition and medical evidence.

From the decision · page 5e medical report of the primary treating physician, James Savage, M.D., the applicants developed ITP as a result of taking preventative medications [ ] that were administered because of the admitted needle stick injury. On December 8, 2025, defendant filed a Petition for Reconsideration on the following Grounds: 1. The WCAB should not accept the factual findings in this case as they are unreasonable, illogical, improbable and unequitable when viewed in light of the stature story scheme of Labor Code § 3202.5 which deems both parties, applicant and defendant equal before the law and requires applicant to bear the burden of proving industrial causation. 2. The opinion of Dr. Savage on upon which the Arbitrator relied is not substantial medical evidence as it is based on conjecture and not based on reasonable medical probability. 3. Applicant did not sustain the burden of proving that the ITP condition was work-related.

Disagreed that the medication contributed to the onset of ITP, stating the applicant had only brief exposure and the ITP developed 7.5 months after discontinuation, considering the ITP idiopathic and unrelated to medication.

The Arbitrator rejected Dr. Fishman's opinion as less persuasive and inconsistent with the applicant's symptoms and medical evidence.

From the decision · page 19He needs more information from the patient to conclude that the ITP was caused by the [prophylactic] medications. However, the temporal relationship, and the fact that the ITP resolved within a short period of time, and without explanation, certainly begs the question of cause and effect. Medical reports and deposition of Ira Fishman M.D. (QME) Medical Report of Ira Fishman M.D. dated February 17, 2020

Indicated need for more information to conclude causation but noted temporal relationship and resolution of ITP without explanation suggested cause and effect.

From the decision · page 17It is his opinion there is an 80% chance that applicant's ITP developed as a result of taking [the prophylactic drug]. Medical Reports and Deposition of Lloyd E. Damon, M.D. Medical Report of Dr. Lloyd E. Damon dated July 13, 2021.

Labor Code 3202.5

An injury arising out of and in the course of employment (AOE/COE) is compensable if the work is a contributing cause of the injury.

The applicant met his burden of proving industrial causation by reasonable medical probability, supported by medical evidence and testimony.

From the decision · page 1Defendant City and County of San Francisco seeks reconsideration of the Opinion on Decision and Findings (OD & F) issued on November 14, 2025, wherein a workers' compensation arbitrator (WCA) found that applicant sustained an injury arising out of an occurring in the course of his employment (AOE/COE) to his left hand, a needlestick injury, and injury in the form of blood and Hematopoietic Purpura (ITP).

Place v. WCAB (35 CCC 525)

The Appeals Board may choose among conflicting medical reports and rely on the relevant and considered opinion of one physician as substantial evidence, even if inconsistent with others.

The Arbitrator found Dr. Savage's opinion better reasoned and more persuasive than the QME's contrary opinion.

From the decision · page 29Because the issue involves a dispute between the opinions of the Primary Treating Physician and the Qualified Medical Evaluator, based on the law neither physician is given greater weight, as in the case of an Agreed Medical Evaluator. The Arbitrator must find which report is better reasoned and more persuasive based on the facts of the case, the medical evidence and the analysis contained in the medical reports.

McAllister v. Workers' Comp. Appeals Bd. (33 CCC 660)

Medical evidence that industrial injury was reasonably probable, although not certain, constitutes substantial evidence for finding injury AOE/COE.

The applicant's medical evidence met the standard of reasonable probability to establish injury AOE/COE.

From the decision · page 34Medical evidence that industrial injury was reasonably probable, although not certain, constitutes substantial evidence for the finding of injury AOE/COE. (McAllister v. Workers' Comp. Appeals Bd. (33 CCC 660)

Applicant's credible testimony and supported medical records

From the decision · page 34The Arbitrator finds that the applicant sustained an injury arising out of an occurring in the course of his employment to his blood and in the form of ITP based on the applicant's credible testimony, the supported medical records and the opinions of the primary treating physician Dr. Savage that are found more persuasive than the opinions of Dr. Fishman, the Qualified Medical Evaluator.

Medical reports and detailed deposition testimony of Dr. Savage

From the decision · page 30The Arbitrator determined that the medical report and note from Dr. Savage were not in and of themselves substantial evidence. However, when the report and note are read along with the detailed deposition of Dr. Savage taken on July 22, 2021, by both parties, combining both the medical reports, notes, and the deposition makes the opinions of Dr. Savage based upon substantial medical evidence.