19-12WC. Theresa Westover v. North Country Hospital.

• Court: Vermont

Vermont Workers Compensation 2012. 19-12WC. Theresa Westover v. North Country Hospital Theresa Westover v. North Country Hospital(July 20, 2012)STATE OF VERMONT DEPARTMENT OF LABORTheresa Westover v. North Country HospitalOpinion No. 19-12WCBy: Jane Woodruff, Esq. Hearing Officer For: Anne M. Noonan CommissionerState File No. BB-01023OPINION AND ORDERHearing held in Montpelier, Vermont on March 29 and 30, 2012 Record closed on May 4, 2012APPEARANCES:Charles Powell, Esq., for Claimant David Berman, Esq., for DefendantISSUES PRESENTED: 1. Does Claimant suffer from complex regional pain syndrome causally related to her August 16, 2009 work injury and if so, what is the appropriate medical treatment for this condition? 2. Is Claimant's lumbar pain causally related to her August 16, 2009 work injury and if so, what is the appropriate medical treatment for this condition? 3. Were Claimant's medical and temporary total disability benefits appropriately discontinued on November 11, 2011 on the grounds that she had reached an end medical result? 4. Has Claimant had a work capacity at any time since August 30, 2010? EXHIBITS: Joint Exhibit I: Medical records Claimant's Exhibit 1A: Illustration of the Lisfranc joint complex Claimant's Exhibit 1B: Illustration of axial loading at the Lisfranc joint complex Claimant's Exhibit 1C: X-ray of the Lisfranc joint complex Claimant's Exhibit 2: Claimant's statement, November 17, 2011 Defendant's Exhibit A: Email from Attorney Johnson to Attorney Powell, November 30, 2011 Defendant's Exhibit B: Deposition of George Holmes, M.D., March 19, 2012 Defendant's Exhibit C: Deposition of Kern Singh, M.D., March 22, 2012 CLAIM: Temporary total disability benefits pursuant to 21 V.S.A. §642 Medical benefits pursuant to 21 V.S.A. §640 Interest, costs and attorney fees pursuant to 21 V.S.A. §§664 and 678 FINDINGS OF FACT: 1. At all times relevant to these proceedings, Claimant was an employee and Defendant was her employer as those terms are defined in Vermont's Workers' Compensation Act. 2. Judicial notice is taken of all relevant forms contained in the Department's file relating to this claim. 3. Claimant started working for Defendant in September 2005 as a certified nurse assistant and unit clerk. Her duties included ambulating patients, giving them snacks, getting them ready for bed and assisting the nurses with any procedures they needed to perform. Claimant's August 16, 2009 Work Injury 4. On August 16, 2009 Claimant was assisting a nurse to transfer a patient from one unit to another. As she was pulling the patient's bed through some sliding glass doors, the doors began to close. She put her arm up to stop the doors, but the nurse on the other end of the bed continued pushing. The bed struck the back of Claimant's right foot, pushed her heel up and crushed her foot forward into the floor, causing her to lunge forward. Claimant's description of this mechanism of injury was credible in all respects. 5. Claimant immediately felt excruciating pain at the back of her right heel, the top of her right foot and her toes. A nurse helped her to a chair and gave her ice to apply to her foot. Thereafter, she was transferred via wheelchair to Defendant's emergency department for assessment. X-rays revealed a possible fracture of her fifth metatarsal (the long bone on the outside of the foot that connects to the little toe), but this later was determined to be an old, likely unrelated finding. Claimant was diagnosed with a right foot sprain and contusion and discharged home, first with crutches and later with an equalizer boot. 6. Defendant accepted Claimant's injury as compensable, and began paying workers' compensation benefits accordingly. Claimant's Course of Treatment 7. From August through December 2009, Claimant treated with Dr. Peer, an orthopedist, and his physician's assistant. During that time, Claimant wore a splint, was assigned only sedentary duties at work and was unable to resume her regular daily living activities. She continued to experience swelling, and also complained of tenderness at the Lisfranc joint complex, the area between the mid- and forefoot that includes the five metatarsal joints. The joint appeared intact on x-ray, however. 8. In November 2009, Dr. Peer's physician's assistant first mentioned the possibility that Claimant might be suffering from reflex sympathetic dystrophy. Now commonly referred to as complex regional pain syndrome (CRPS), Type I, this neurological pain disorder is characterized by an abnormal increase in nervous system activity resulting from an inciting event such as controlled or accidental trauma. 9. At Dr. Peer's referral, in February 2010 Claimant underwent an evaluation with Dr. Michelson, an ankle and foot specialist. Though read by the radiologist as normal, to Dr. Michelson's eye an MRI study demonstrated increased signal at the base of the third tarsometatarsal joint. Dr. Michelson interpreted this finding as indicative of a ligamentous injury to the Lisfranc joint, in precisely the area where Claimant was most tender. This analysis was also consistent with Claimant's report of the mechanism of her right foot injury, which involved axial loading to that joint. 10. As treatment for her ongoing symptoms, Dr. Michelson proposed surgery, specifically a third tarsometatarsal fusion at the Lisfranc joint. Defendant agreed to pay for this procedure, which Claimant underwent in March 2010. Among Dr. Michelson's operative findings, he observed that the joint was grossly unstable, which can be indicative of an injury in that area. 11. Unfortunately, Claimant's symptoms failed to resolve with surgery. To the contrary, her right foot and ankle pain worsened, to the point where her right leg became affected as well. She developed lower bone density at the fusion site, and when her walking boot was removed in July 2010 she was unable to bear any weight on her right foot. 12. Despite her ongoing symptoms, in mid-July 2010 Dr. Michelson released Claimant to return to work in a modified duty position. To accommodate her restrictions, Defendant fashioned a job for her as a greeter at the front of the hospital. Claimant could sit, stand, elevate her leg and/or use a wheelchair as necessary. 13. Claimant worked at this position for approximately one month, until August 23, 2010 when she suffered a severe flare-up of pain in her right foot. After a week of half-time work, on August 30, 2010 Dr. Michelson determined that she was again totally disabled from working. Defendant resumed paying temporary total disability benefits accordingly. 14. Dr. Michelson questioned whether Claimant's pain might be due to neuritis, that is, nerve inflammation emanating from her foot but originating in her spine. He thus referred her to Dr. Rinehart, a spine specialist, for further evaluation. 15. Dr. Rinehart evaluated Claimant in September 2010. By this point, she was still unable to weight bear on her right foot, and her pain was worse than it had been at the time of her fusion. Dr. Rinehart concluded that Claimant's symptoms were not the result of neuritis, but rather likely represented reflex sympathetic dystrophy. 16. Shortly after Dr. Rinehart's evaluation, Claimant and her husband moved to the Chicago area to be closer to family. They had made the decision to do so some time earlier, because Claimant's husband was suffering from a debilitating disease and could no longer take care of their Vermont property. The sale of their house, which had been on the market since February, closed on September 15, 2010. Claimant was credible in her...