MARLENA WOODWARD, Claimant,
v.
NORTHWEST PARAMEDIC ASSOC, Employer,
and
IDAHO STATE INSURANCE FUND, Surety, Defendants.
No. IC 2007-036361
Idaho Workers Compensation
Before the Industrial Commission of the State of Idaho
August 21, 2015
FINDINGS OF FACT, CONCLUSIONS OF LAW, AND
RECOMMENDATION
R.D.
Maynard, 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 Boise, Idaho, on November 7, 2014.
Claimant was represented by Sam Johnson, of Boise. Gardner W.
Skinner, Jr., of Boise, represented Employer and Surety. Oral
and documentary evidence was admitted. Post-hearing
depositions were taken and the parties submitted post-hearing
briefs. The matter came under advisement on July 6, 2015.
ISSUES
By
agreement of the parties, the issues to be decided are:
Whether
and to what extent Claimant is entitled to the following
benefits:
a. Medical care; and
b. Attorney fees.
Claimant's
(potential) future income, impairment and disability issues
are reserved.
1
CONTENTIONS
OF THE PARTIES
Claimant
asserts that she is entitled to ketamine infusion therapy
followed by intensive physical therapy to treat her accepted
Complex Regional Pain Syndrome (CRPS). Depending on how she
tolerated physical therapy, Claimant, with input from her
treating physicians, would subsequently consider enrolling in
the LifeFit functional restoration therapy program.
Defendants are liable for attorney fees for their
unreasonable file adjusting and refusal to timely allow
Claimant's infusion treatments.
Defendants
argue that past ketamine infusion has provided Claimant with
no gradual improvement. Continuing such a regimen is
unreasonable. While Defendants are willing to approve the
ketamine infusion therapy if Claimant immediately thereafter
enrolls in LifeFit or a comparable functional restoration
therapy program, she has refused to participate, in spite of
her treating physician recommendations. The treating
physician, not the Claimant, should be entitled to direct
Claimant's appropriate health care. Defendants are not
liable for attorney fees.
EVIDENCE
CONSIDERED
The
record in this matter consists of the following:
1. Hearing testimony of Claimant and State Insurance Fund
examiner Diane Evans;
2. Claimant's Exhibits (CE) A through O, admitted at
hearing;
3. Defendants' Exhibits (DE) 1through 31 –
including supplemental subparts for exhibits 6, 12, 19, 20,
24, and 25 – and 33 through 40, admitted at hearing;
4. The post-hearing deposition transcript of Michael
Severson, M.D., taken on February 12, 2015; and
5. The post-hearing deposition transcript of Nancy Greenwald,
M.D., taken on March 6, 2015.
All
pending objections preserved during post-hearing depositions
are overruled. Having considered the evidence and briefs of
the parties, the Referee submits the following findings of
fact and conclusions of law for review by the Commission.
FINDINGS
OF FACT
1. On
October 17, 2007, Claimant, while acting in the course and
scope of her employment, injured her neck and right shoulder
while transporting an unresponsive infant by ambulance to a
medical helicopter.
2.
Claimant has developed Complex Regional Pain Syndrome (CRPS)
as the result of the accident. The diagnosis was made in
September 2008, although it was suspected as early as late
April 2008.
3.
Claimant has had an involved and varied course of medical
treatment and therapy since 2007. A visit-by-visit narrative
is not needed to determine the limited issues involved
herein. Instead, a summary of events and medical provider
records relevant to understanding Claimant's course of
treatment is more appropriate.
2 However, a detailed analysis of
portions of Claimant's medical history since 2007 is
provided where necessary to address a particular point in
question.
Medical
Provider Summary
Dr.
Hajjar
4.
After her initial ER visit on the day following the accident,
Claimant came under the care of Michael Hajjar, M.D., with
whom she had formerly treated for accident-related back,
neck, and left-sided upper extremity symptoms. Dr. Hajjar had
performed a C5-6 decompression and fusion surgery in March
2007 to treat Claimant's neck symptoms from her previous
accident.
5. From
the date of the subject accident until September 2011, Dr.
Hajjar's involvement in Claimant's care was primarily
focused on ordering and reviewing diagnostic films, ruling
out surgical treatment for her ongoing neck, back, and upper
extremities complaints, prescribing medications, and
authorizing physical therapy.
6. On
September 19, 2011, Dr. Hajjar surgically implanted a spinal
cord stimulator (discussed in greater detail hereinafter) in
Claimant's cervical spine via a C5-6 laminectomy
procedure. The stimulator was designed to address
Claimant's ongoing CRPS involving her right upper
extremity.
7. Of
significance to the issue at hand, Dr. Hajjar, on March 3,
2013 agreed in a letter to Surety that Claimant "should
attend LifeFit" and further opined that Claimant
"has to follow through with the recommendations
including things that may not sound very attractive such as
functional restoration" if she wants to be successful in
overcoming her CRPS. DE 11, p.82.
Dr.
Morland
8.
James Morland, M.D. provided Claimant pain management care
from January 2008 through mid-April 2011. It appears the two
parted company when Dr. Morland refused, based on
Claimant's psychological testing, to endorse
Claimant's use of a spinal cord stimulator.
9. By
March 2008, Dr. Morland determined Claimant's complaints
could not be explained with objective testing; he suggested a
pain psychologist. Claimant was also taking the opioid pain
medication Dilaudid, and participating in physical therapy.
10. On
April 11, 2008, Dr. Morland released Claimant to full duty
work for four hours per day. He also suggested a work
hardening program. Claimant was using a TENS unit, and had
prescriptions for Neurontin, Lidoderm patches, and
Darvocet-N, in addition to the Dilaudid.
11. At
her April 28 2008 office visit, Claimant suggested trigger
point injections; Dr. Morland acquiesced to a series of
injections over the next several weeks. He also prescribed a
Medrol Dosepak to address his CRPS suspicions.
12.
Claimant asked Dr. Morland to take her off of Neurontin in
early May, due to her belief it was making her gain weight.
Dr. Morland moved her to Cymbalta.
13. On
her May 20, 2008 office visit, Claimant requested more
trigger point injections, which Dr. Morland performed. He
also started her on Fosamax for her CRPS.
14. At
her next appointment, Claimant reported that she had seen the
psychologist, Robert Calhoun, Ph.D., and he had suggested a
repeat MRI prior to Claimant's inclusion in a work
hardening program. That suggestion did not make its way into
Dr. Calhoun's written records, but nevertheless Dr.
Morland ordered one, even though his review of her prior MRI,
taken three months earlier, showed no abnormality whatsoever.
Dr. Morland felt a repeat MRI could make it "100%
sure" there were no issues with Claimant's cervical
spine when she proceeded to a work hardening program. The MRI
was negative for any new developments.
15. On
June 18, 2008, Claimant told Dr. Morland the Darvocet was no
longer working and she wanted Ultram. Dr. Morland complied.
She also indicated Dr. Calhoun wanted her off work until he
could "reevaluate" her. There is no evidence in Dr.
Calhoun's provided records to support this statement.
16. By
September 3, 2008 Claimant had stopped counseling with Dr.
Calhoun, was still complaining of neck and right upper
extremity pain, numbness and weakness, and had gained
significant weight, presumably due to certain medications.
Dr. Morland diagnosed CRPS, which he had suspected for some
time. During this visit, Claimant informed Dr. Morland that
she had been researching spinal cord stimulation. Dr. Morland
wanted Claimant to resume seeing Dr. Calhoun, and return to
work in a light duty capacity.
17. On
September 10, 2008 Claimant reported she saw Dr. Calhoun, who
was in favor of her enrolling in a multidisciplinary...
