Stojanovich v. NANA Regional Corporation, Inc., 012615 AWCAC, 207

Docket Nº:Decision 207
Case Date:January 26, 2015
Zorislav M. Stojanovich, Appellant,
NANA Regional Corporation, Inc. and ACE American Insurance Company, Appellees.
Decision No. 207
AWCAC Appeal No. 14-001
AWCB Decision No. 13-0157
AWCB No. 201004694
Alaska Workers Compensation Appeals Commission
January 26, 2015
         Final decision on appeal from Alaska Workers' Compensation Board Final Decision and Order No. 13-0157, issued at Fairbanks, Alaska, on December 2, 2013, by northern panel members Amanda K. Eklund, Chair, Rick Traini, Member for Labor, and Krista Lord, Member for Industry.          Commission proceedings: Appeal filed January 2, 2014; briefing completed October 21, 2014; oral argument held on January 13, 2015.           Zorislav M. Stojanovich, self-represented appellant;           Robert J. Bredesen, Russell, Wagg, Gabbert & Budzinski, P.C., for appellees,           NANA Regional Corporation, Inc. and ACE American Insurance Company.           Commissioners: James N. Rhodes, S. T. Hagedorn, Laurence Keyes, Chair.           FINAL DECISION           LAURENCE KEYES, CHAIR.          1. Introduction.          Appellant, Zorislav M. Stojanovich (Stojanovich), was employed by appellee, NANA Regional Corporation, Inc. (NANA), which is insured for workers' compensation liability by appellee, ACE American Insurance Company. Stojanovich alleges that on March 23, 2010, he injured his right hip while working for NANA as a kitchen helper on the North Slope. After NANA controverted benefits, Stojanovich filed his first workers' compensation claim with the Alaska Workers' Compensation Board (board) on or about September 10, 2010. He filed subsequent claims on or about December 11, 2012, and April 10, 2013. The board held hearings on Stojanovich's claims on December 27, 2012, May 9, 2013, June 27, 2013, and September 19, 2013. It issued Interlocutory Decisions and Orders (ID&O) on February 22, 2011,1 October 31, 2012,2 and January 17, 2013.3 It issued two Final Decisions and Orders (FD&O), the first on July 25, 2013,4 and the second on December 2, 2013.5 Ultimately, the board held that Stojanovich's "disability or need for medical treatment for any body part did not arise out of and in the course of his employment with [NANA]."6          Stojanovich filed an appeal of the board's decision in Stojanovich V to the Workers' Compensation Appeals Commission (commission), essentially taking issue with the board's reasoning in denying his claims.7 We affirm.          2. Factual background and proceedings.          The board incorporated all findings of fact in Stojanovich I, II, III, and IV in its decision in Stojanovich V, and found them to have been established by a preponderance of the evidence.8 Those findings, paraphrased to some extent, are as follows.          For several years prior to the alleged work injury, Stojanovich treated with Brent A. Ursel, PA-C, and Robert Reeg, M.D., for chronic lower back pain. Beginning in 2006, he obtained prescriptions for narcotic pain medication from both PA-C Ursel and Dr. Reeg simultaneously and had them filled at different pharmacies. Neither PA-C Ursel nor Dr. Reeg was aware that Stojanovich was obtaining narcotics from more than one source.9          On July 19, 2009, Stojanovich appeared at the Providence Seward Medical Center emergency department complaining of heart palpitations. He was diagnosed with recurrent atrial fibrillation. As part of the routine diagnostic procedure, Stojanovich underwent a urine toxicology screen. Despite concurrent narcotic prescriptions provided by PA-C Ursel and Dr. Reeg, his toxicology results were negative for opiates.10          At Stojanovich's request, on January 18, 2010, Dr. Reeg wrote a "To Whom It May Concern" letter:
I am Zorislav Stojanovich's primary care provider. I have reviewed the letter from NMS [NANA Management Services] dated January 14, 2010, in regard to the job description for remote kitchen helper.
Based upon the information that I have available and from my interactions with the patient, I do believe that Mr. Stojanovich can perform the requirements of the job without presenting a health or safety risk to himself or anyone else.11
         Less than a week later, on January 20, 2010, Dr. Reeg reported:
Patient is a 54 year-old male here to pick up the letter I wrote stating that it would be acceptable to perform a job for which he has applied. He also requests additional opiate prescription as he states that apparently the previous prescription was written for one OxyContin b.i.d. instead of two b.i.d. Approximately one week ago, I was contacted by Costco Pharmacy reporting some irregularities in patient filling his medications. He had filled a week's supply of his OxyContin four different times within a 12-day period. This prompted a call from Costco Pharmacy. I initially had been under the impression that patient's prescriptions were filled by Purdue. I had thought that he was getting prescription assistance from Pardue (sic) and had to get his medications there. It came to my attention that patient was seeing Brent Ursel, physician's assistant in town, and getting a monthly supply of Vicodin in addition to having OxyContin and Percocet prescribed by me, so this is a clear violation of his pain contract.
Patient initially denied that he had gotten prescriptions filled at Costco. It is still not clear to me what the role of Purdue Pharmaceuticals has been in filling his prescriptions as it appears that his prescriptions have been filled at Costco. Nonetheless, I had a frank discussion with the patient, stating that his filling opiate prescriptions at two different providers is a clear violation of his pain contract. I will discuss that I will no longer provide opiates for chronic management of his pain. I have asked the Medical Assistant to contact Purdue Pharmaceuticals tomorrow to get further information as to what exactly has been dispensed from them.[12]
         The following day, January 21, 2010, at Stojanovich's request, Dr. Reeg prescribed a tapering schedule, to limit the discomfort of opiate withdrawal.13          On March 23, 2010, Stojanovich alleged he "turned suddenly to the right and felt sharp pain in [his] right hip, [he] felt something pop inside [his] hip" while working for NANA.14 The same day, he saw NANA's on-site medic, Jose Diaz, PA. Stojanovich described his injury as "twisted my body to the right and hurt my hip and behind the butt." He indicated the injury occurred at 4:00 a.m. PA Diaz diagnosed right hip pain and recommended over-the-counter pain medications.15 Later in the day, Stojanovich returned to the on-site medical clinic, where he was diagnosed with "hip pain – probably exacerbation [of] prior personal condition" and received acupuncture treatment.16 The following day, March 24, 2010, he was sent home for additional treatment.17          On April 2, 2010, Stojanovich saw PA-C Ursel, complaining of right hip pain. He reported he "was at work on March 23rd. He was standing at his station. He went to turn, and heard a click in his right hip. He had immediate pain." PA-C Ursel noted that Stojanovich walked with a limp and had difficulty rising from a chair. X-rays taken that day were negative for fracture or dislocation. PA-C Ursel referred Stojanovich to Richard W. Garner, M.D., an orthopedist and excused him from work until April 15, 2010.18          Stojanovich saw Dr. Garner on April 19, 2010, reporting he "was working on [t]he North Slope at a kitchen counter, when he turned suddenly to the right and had immediate sharp, stabbing pain in the anterior right hip." The nurse's notes from that visit indicate Stojanovich "thinks [he] twisted not sure if had foot planted." Dr. Garner ordered a magnetic resonance imaging (MRI) study and diagnosed a probable labral tear. He noted, "It was my comment to the patient that his medication should be more than adequate, and I specifically declined to order him anything additional, nor would I go so far as to use the fentanyl patch, were that my decision."19          Stojanovich underwent a hip MRI on April 22, 2010, which revealed subchondral cysts, labral tear, and early degenerative changes in the articular surface of the femoral head.20 He followed up with Dr. Garner, who diagnosed a labral tear, probably acute, in the right hip superimposed on a moderate degree of osteoarthritis. Stojanovich described his pain as "unrelenting," and he walked with a "markedly antalgic gait on the right." Dr. Garner prescribed Percocet for pain, but noted Stojanovich was already on a fentanyl patch with Norco for breakthrough pain, as prescribed by PA-C Ursel, and "I informed him...

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