12-0071. CYNTHIA FOSHE Employee v. TOK CLINIC LLC Employer and HELMSMAN MANAGEMENT SERVICE/ LIBERTY NORTHWEST Insurer Defendants.
Court | Alaska |
Alaska Workers Compensation Decisions
2012.
Workers' Compensation Board
12-0071.
CYNTHIA FOSHE Employee v. TOK CLINIC LLC Employer and HELMSMAN MANAGEMENT SERVICE/ LIBERTY NORTHWEST Insurer Defendants
ALASKA
WORKERS' COMPENSATION BOARDP.O. Box 115512 Juneau,
Alaska 99811-5512 CYNTHIA FOSHE,
Employee, v. TOK CLINIC, LLC, Employer, and HELMSMAN MANAGEMENT SERVICE/
LIBERTY NORTHWEST, Insurer, Defendants.AWCB Decision No. 12-0071Filed with AWCB Fairbanks, Alaska on April 9,
2012AWCB Case No. 201017736INTERLOCUTORY DECISION AND ORDERTok Clinic (Employer) and Helmsman Management Service's
(Insurer)(fn1) December 28, 2011 Petition to Strike Second Independent Medical
Evaluation (SIME) Records #0239-0370 and 0409-0453; Cynthia Foshe's (Employee)
February 17, 2012 Petition objecting to the selection of Dr. Lipon as the SIME
physician and for modification of Foshe v. Tok Clinic, AWCB
Decision No. 11-0158 (Foshe I); and Employee's March 7, 2012
Petition to Strike SIME Records #04580589 were heard on March 15, 2012, in
Fairbanks, Alaska. The hearing proceeded with a two-member panel, a quorum
under AS 23.30.005(f). Attorney Michael Jensen appeared telephonically and
represented Employee. Attorney Nora Barlow appeared telephonically and
represented Employer and Insurer. There were no witnesses. The record closed at
the conclusion of the hearing, on March 15, 2012.
ISSUES
Employee contends Foshe I should be modified
because an SIME should not have been ordered. Specifically, Employee contends
because Lawrence Feltman, M.D., owner of the Tok Clinic, opined Employee's work
for Employer is the substantial cause of her need for medical treatment, no
medical dispute exists warranting an SIME. Employee contends Employer did not
agree to the scheduling of an employer's medical examination (EME) with John
Ballard, M.D., and therefore the EME is inadmissible. Excluding the EME, no
medical opinion exists in the record stating Employee's need for medical
treatment is not work related.
Employer and Insurer contend Employee has failed to demonstrate
a change of conditions or mistake of fact, and is thus not entitled to
modification of Foshe I. Employer and Insurer further contend
the board did not grant Employee's November 9, 2011 petition for
reconsideration and Employee merely seeks to relitigate her petition for
reconsideration in her February 17, 2012 petition for modification.
1)Shall Foshe I be modified?
Employee contends the board designee failed to confirm Dr.
Lipon is truly independent before assigning him as the SIME physician, as
required by 8 AAC 45.092(e)(1)-(6), and therefore Dr. Lipon is inappropriate to
perform the SIME.
Employer contends Employee's petition objecting to the
selection of Dr. Lipon should be denied as there is no evidence Dr. Lipon is
not impartial. Employer contends the board designee went "above and beyond"
what was required of her to ensure the SIME physician was free of conflicts
before scheduling the SIME appointment.
2)Did the board designee follow the requirements of 8 AAC
45.082(e)(1)-(6) in selecting Dr. Lipon as the SIME?
Employee contends it is unreasonable to require her to travel
from her home in Tok to Bellevue, Washington to attend the SIME appointment
with Dr. Lipon, as her treating physician Stephen Wahl, M.D. has provided
travel restrictions related to Employee's medical condition. Employee
further contends because Dr. Lipon is licensed in Alaska, he
should travel to Alaska to evaluate Employee.
Employer and Insurer contend Employee should have informed the
board she had travel restrictions prior to the assignment of Dr. Lipon as the
SIME physician. Employer and Insurer further contend Employee has demonstrated
she is able to drive from Tok to Anchorage, as she attended her deposition in
Anchorage in January 2012 and Dr. Eule's deposition in Anchorage in February
2012.
3) Shall Employee be required to travel to Bellevue, Washington
to attend the SIME appointment with Dr. Lipon?
Employee contends Foshe I requires the SIME be
conducted by a physician specializing in orthopedic surgery, and because Dr.
Lipon is a doctor of osteopathic medicine, he is an inappropriate selection to
conduct the SIME.
Employer and Insurer contend Employee's objection to Dr. Lipon
on the basis of his specialty is a "desperate attempt to exclude [him]," as Dr.
Lipon has specialized in orthopedic surgery since his appointment to the SIME
panel.
4) Is Dr. Lipon a physician of the appropriate specialty to
perform the SIME in this case?
Employee contends SIME records #0238-0370 and #0409-0453 should
be forwarded to the SIME physician. Employee contends the medical articles
attached to letters signed by Employee's treating physicians are referenced in
those letters and relied upon by Employee's physicians, and it "wouldn't make
sense" to exclude the articles from the letters.
Employer and Insurer contend the "check-the-box" physician
letters and attached medical articles should be stricken as they are not
medical records and would not be helpful to the SIME physician in rendering his
opinion in this case.
5) Shall SIME records #0239-0370 and #0409-0453 (physicians'
statements and accompanying medical articles) be forwarded to the SIME
physician for review?
Employee contends the transcript of Employee's January 20, 2012
deposition should not be forwarded to the SIME physician for review in
preparation of his report, as a deposition transcript is not a "medical record"
under 8 AAC 45.092(h)(1), but rather a litigation tool. Employee further
contends Employer and Insurer may present Employee's deposition transcript to
the SIME physician at his deposition should they wish to depose him.
Employer and Insurer contend Employee's deposition transcript
may not be a medical record under the regulation, but it nevertheless would be
helpful to the SIME in conducting his evaluation and forming his opinion in
this case, and should therefore be forwarded to the SIME physician for
review.
6) Shall SIME records #00458-00589 (Employee's January 20, 2012
deposition transcript) be forwarded to the SIME physician for review?
FINDINGS OF FACT
A review of the available record establishes the following
facts and factual conclusions by a preponderance of the evidence:
1) On November 23, 2010, Employee reported "severe aggravation to [her] back due to extended periods of computer work" while working for Employer as a billing specialist. (Report of Occupational Injury or Illness, November 23, 2010).
2) On January 7, 2011, Employee saw James Eule, M.D. for lumbar pain. After reviewing imaging studies, Dr. Eule diagnosed unstable spondylolisthesis at L3-4 and stenosis at L4-5 bilaterally and L5-S1 on the right side. (Dr. Eule report, January 7, 2011).
3) On January 10, 2011, Dr. Eule performed a spinal fusion at L3-L4 and surgical decompression at L4-5 bilaterally and L5-S1 on the right side. (Dr. Eule operative report, January 10, 2011).
4) On January 16, 2011, Dr. Eule opined:
The fact that [Employee] has had no prior injury or problem with her back and the episode occurred at work we would have to conclude that her employment was the substantial factor in her injury and resulting in the need for surgery. (Dr. Eule report, January 16, 2011).
5) On February 23, 2011, John Ballard, M.D., performed an EME. Dr. Ballard diagnosed spondylolisthesis at L3-L4, with left-sided herniated nucleus pulposus, lumbar spinal stenosis L4-L5 bilaterally and right L5-S1, and multilevel lumbar spondylosis. He opined:
The mechanism of injury does not support the diagnoses and need for medical treatment. The majority of the findings on the MRI are of a degenerative nature, particularly the unstable spondylolisthesis and the stenosis. These findings are secondary to longstanding degenerative processes. Likewise, the disc herniation is secondary to weakening of the annulus, which allowed the disc to herniate. The purported mechanism of having to sit for long periods of time is not going to be an acute injury nor is it an accumulative injury and it is not a substantial factor in causing the claimant's low back symptoms. The only possible work-related condition would be the disc herniation, but the type of injury that would cause and be responsible for a disc herniation would be a significant amount of lifting or bending with an acute onset of leg symptoms, which was not the case. The work exposure of November 12, 2010 is not the substantial cause of the claimant's lumbar condition nor is it the substantial cause of her need for treatment. The substantial cause is her longstanding degenerative arthritis at multiple levels of her lumbar spine with resultant spinal stenosis. The disc herniation is a natural progression of the degeneration and weakening of the annulus. (Dr. Ballard's EME Report, February 23, 2011).
6) On March 28, 2011, Lawrence Feltman, M.D., owner of the Tok Clinic, Employer in this case, opined:
In regards to patient, Cindy Foshe; the substantial cause of her symptoms necessitating spinal fusion surgery was the years of sitting due to her job stressing her lower back. The constant sitting position, required of her, created the changes in her lumbar spine. (Dr. Feltman letter, March 28, 2011).
7) On October 26, 2011, Foshe v. Tok Clinic, AWCB Decision No. 11-0158 (Foshe I) issued, granting Employer and Insurer's October 6, 2011 Petition to continue the hearing set for November 17, 2011 and for an SIME. (Foshe I).
8) Foshe I...
To continue reading
Request your trial