SUDI DAVIS, Claimant,
v.
EDGEWOOD SPRING CREEK SODA SPRINGS, LLC, d/b/a EDGEWOOD VISTA, Employer,
and
TRAVELERS PROPERTY & CASUALTY COMPANY OF AMERICA, Surety, Defendants.
Nos. IC 2016-020326, IC 2017-001300
Idaho Workers Compensation
Before the Industrial Commission of the State of Idaho
May 28, 2020
FINDINGS
OF FACT, CONCLUSIONS OF LAW, AND RECOMMENDATION
Thomas
P. Baskin, Chairman.
INTRODUCTION
Pursuant
to Idaho Code § 72-506, the Idaho Industrial Commission
assigned the above-entitled matter to Referee Brian Harper,
who conducted a hearing in Pocatello, Idaho, on July 8, 2019.
Darin Monroe represented Claimant. W. Scott Wigle represented
Defendants. The parties produced oral and documentary
evidence at hearing and submitted post-hearing briefs. Three
post-hearing depositions were taken. The matter came under
advisement on April 5, 2020.
ISSUES
The
parties agreed to the following issues for this bifurcated
adjudication:
1.
Whether the condition for which Claimant seeks benefits was
caused by the industrial accidents; and
2.
Whether and to what extent Claimant is entitled to the
following benefits:
a. Medical Care;
b. Temporary partial and/or temporary total disability
(TPD/TTD); and
c. Attorney Fees.
All
other issues are reserved.
CONTENTIONS
OF THE PARTIES
Claimant
asserts she injured her low back to the point where surgery
was required as the result of two industrial accidents which
occurred in July 2016. She is entitled to medical care and
temporary disability benefits associated with the surgery and
related care. She also is entitled to attorney fees based on
Defendants’ unreasonable denial of such benefits.
Defendants
argue that Claimant may have temporarily aggravated her
lumbar spine in the industrial accidents, but her need for
surgery was due to the natural progression of her
longstanding degenerative low back condition and prior fusion
surgery at the level just below her most recent surgery. In
fact, Claimant’s low back became symptomatic shortly
before her industrial accidents. Defendants are not liable
for any of the medical expenses or benefits claimed in this
matter and attorney fees are unwarranted.
EVIDENCE
CONSIDERED
The
record in this matter consists of the following:
1. The testimony of Claimant taken at hearing;
2. Joint exhibits (JE) A through N admitted at hearing; and
3. The post-hearing deposition transcripts of Nita Weber,
D.O., James Bates, M.D., and Lynn Stromberg, M.D., taken on
September 12, September 24, and December 17, 2019,
respectively.
FINDINGS
OF FACT
1. At
the time of hearing Claimant was a 57-year-old woman living
in Soda Springs, Idaho. She had worked for Employer for
several years in nursing and supervisory capacities.
PRE-EXISTING
LOW BACK HISTORY
2. In
or around 1999, Claimant underwent lumbar spine surgery which
fused the vertebrae at L5-S1. Claimant had no appreciable
residual low back issues after this surgery until 2016.
Exactly when in 2016 Claimant’s lower back became
symptomatic is a key dispute in this case and will be
discussed in greater detail hereinafter.
INDUSTRIAL
ACCIDENTS
3. On
July 12, 2016, Claimant was assisting a resident from a
toilet to her wheelchair. As Claimant pivoted to set the
patient in the chair Claimant felt a sudden onset of
excruciating pain in her low back and right thigh. Claimant
testified she had not experienced that type of pain at any
point prior.
4.
Claimant did not seek medical treatment after this event. She
left work early and stayed home for the next couple of days.
Her initial pain lessened over time with ice and
anti-inflammatories. Claimant assumed she has strained her
low back.
5.
Claimant avoided heavy lifting when she returned to work but
was able to do her regular duties as the director of nursing
services.
6. On
July 25, 2016, Claimant was lifting a piano bench at work. As
she did so she felt immediate pain in her right thigh and low
back. The pain was so severe she fell to the ground and could
not get up by herself. Two co-workers assisted her into a
standing position and helped her to her office. Claimant
sought immediate medical care with her regular physician,
Nita Weber, D.O.
OVERVIEW
OF MEDICAL TREATMENT FROM JULY 2016
FORWARD
1
7. Upon
examination Dr. Weber recommended Claimant see a
neurosurgeon. In August 2016 Claimant was evaluated at the
Utah Spine, Sport & Rehab facilities in Ogden, Utah. In
mid-September 2016 Claimant underwent a spinal
MRI
2
which read to include a broad-based disc bulge at L4-5 with
moderate to severe foraminal stenosis right greater than
left. Claimant’s symptoms were increasing during this
time frame. Electrodiagnostic studies performed that same
month revealed evidence of mild right sided L5 acute
lumbosacral radiculopathy with a loss of reflexes at
Claimant’s right knee and bilateral ankles. Surgical
consultation was arranged with Dennis Winters, M.D., a spinal
surgeon.
8. Dr.
Winters ordered a third MRI in early October 2016, which
showed postoperative changes (from 1999 surgery) at L5-S1,
and a suspected focal disc protrusion/herniation at L4-L5.
Based on Claimant’s increasing symptoms and the MRI
findings Dr. Winters recommended a micro-discectomy at L4-5.
9.
After learning of Dr. Winters’ recommendation,
Defendants sent Claimant for an independent medical
examination with Lynn Stromberg, M.D., a spinal surgeon in
Idaho. Dr. Stromberg believed Claimant would benefit from
spinal surgery but disagreed that a micro-discectomy was the
proper procedure. Instead, Dr. Stromberg felt Claimant needed
a fusion surgery. However, Dr. Stromberg felt
Claimant’s need for surgery was unrelated to her
industrial accidents of July 2016.
10.
Claimant sought out another surgical opinion, this time from
Clark Allen, M.D., an Idaho Falls neurosurgeon. After his
evaluation Dr. Allen opined that Claimant needed a full
decompression and fusion surgery at L4-5. Defendants refused
to pay for the proposed surgery.
11. On
November 14, 2016, Dr. Allen performed a bilateral discectomy
and fusion surgery at L4-5. At surgery, Dr. Allen noted
Claimant’s exiting L4-5 nerve roots were severely
compressed, right greater than left. He also noted scarring
from the adjacent previously fused level which contributed to
Claimant’s L4-5 segment narrowing.
12.
Claimant had a good result from the surgery, and after a
period of recovery was released from care by Dr. Allen on
January 26, 2017. Thereafter Claimant returned to work for a
new employer.
DISCUSSION
AND FURTHER FINDINGS
13.
Claimant has the burden of proving the condition for which
compensation is sought is causally related to an industrial
accident. Callantine v Blue Ribbon Supply, 103 Idaho
734, 653 P.2d 455 (1982). The proof required is “a
reasonable degree of medical probability.” Anderson
v. Harper's Inc., 143 Idaho 193, 196, 141 P.3d 1062,
1065 (2006). Claimant is required to establish a probable,
not merely a possible, connection between cause and effect to
support her contention. Dean v. Dravo Corporation,
95 Idaho 558, 560-61, 511 P.2d 1334, 1336-37 (1973). In other
words, Claimant must show there is more evidence for
causation than against. Fisher v. Bunker Hill Co.,
96 Idaho 341, 528 P.2d 903 (1974). In determining causation,
it is the role of the Commission to determine the weight and
credibility of testimony and to resolve conflicting
interpretations of testimony.
14. The
fact that Claimant suffered a covered injury to a particular
part of her body does not make Defendants liable for all
future medical care to that part of her body, even if the
medical care is reasonable. Henderson v. McCain Foods,
Inc., 142 Idaho 559, 563, 130 P.3d 1097, 1101 (2006). In
the present case, it is undisputed that Claimant injured her
low back in July 2016 in one or more industrial accidents.
The debate is over whether one or more of these work
accidents necessitated or contributed to the need for
Claimant’s November 14, 2016, back surgery.
Medical
Record Dispute
15.
Defendants’ position centers in large part on a medical
records trail which began shortly before Claimant’s
industrial accidents. Defendants argue the records establish...