Case Title: State ex rel. Sellards v. Indus. Comm.

Citation: 2006-Ohio-1058

Docket Number: 20050019

State: ohio

Court: Ohio Supreme Court

Date: 2006-03-22T00:00:00Z

Document:
[Cite as State ex rel. Sellards v. Indus. Comm., 108 Ohio St.3d 306, 2006-Ohio-1058.] 
 
 
THE STATE EX REL. SELLARDS, APPELLANT, v. INDUSTRIAL COMMISSION OF 
OHIO ET AL., APPELLEES. 
[Cite as State ex rel. Sellards v. Indus. Comm.,  
108 Ohio St.3d 306, 2006-Ohio-1058.] 
Workers’ compensation — Determination of maximum medical improvement — 
Physician’s finding of maximum medical improvement does not support 
denial of temporary total disability compensation when finding is 
contemporaneous with commission’s approval of claimant’s treatment 
plan — Judgment reversed. 
(No. 2005-0019 — Submitted September 27, 2005 — Decided March 22, 2006.) 
APPEAL from the Court of Appeals for Franklin County, 
No. 03AP-987, 2004-Ohio-6604. 
Per Curiam. 
{¶ 1} Temporary total disability compensation is prohibited after a 
claimant’s condition has reached maximum medical improvement.  R.C. 
4123.56(A).  Although one doctor assessed appellant, William E. Sellards Jr., as 
having reached maximum medical improvement, another physician’s plan for 
further treatment was approved by the Industrial Commission the same day as the 
assessment.  We must determine if the opinion regarding maximum medical 
treatment is invalidated due to the physician’s lack of awareness of the approved 
plan.  We find that it is. 
{¶ 2} Sellards injured his back in an industrial accident in 1998.  He was 
deemed to have reached maximum medical improvement of his back injury in 
January 2001.  In November 2001, he began seeing a psychiatrist, Dr. J. T. Spare, 
for depression.  Dr. Spare prescribed an unspecified antidepressant and initiated 
“supportive psychotherapy.” 
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{¶ 3} On July 17, 2002, appellee Industrial Commission of Ohio 
additionally allowed Sellards’s workers’ compensation claim for “major 
depressive disorder, single episode.”  On October 17, 2002, Dr. Spare submitted a 
C-9 treatment-plan application that sought approval, without elaboration, for 
psychotherapy and “medication management.”  That application was approved by 
the commission on October 22, 2002. 
{¶ 4} Coincidentally, also on October 22, Sellards was examined by 
another psychiatrist, Dr. Allen B. Levy, concerning the extent of his psychiatric 
disability.  After examining Sellards and thoroughly reviewing his records (which 
did not include Dr. Spare’s treatment plan), Dr. Levy concluded that Sellards’s 
psychiatric condition had reached maximum medical improvement: 
{¶ 5} “There has been some improvement since he began medication 
treatment and more substantial improvement since he was awarded compensation 
for temporary total disability.  He, nonetheless, continues to experience sufficient 
depression symptoms to render him disabled, and I believe this disability to be 
permanent.  I believe he has reached MMI [maximum medical improvement].  He 
is unlikely to show any further improvement in his condition.  * * * It is unlikely 
that he will experience any significant further improvement in his depression so 
he is at MMI and is permanently disabled.  It would be useful for him to continue 
to receive counseling and medication management at a frequency of once every 
month for the next three to four months then decrease the frequency of these visits 
to every couple of months.  It is likely that he will need indefinite care from a 
psychiatrist and therapist.” 
{¶ 6} Dr. Spare responded to Dr. Levy’s report on November 26, 2002: 
{¶ 7} “I have reviewed Dr. Levy’s report and would certainly agree that 
Mr. Sellards continues to have some residual symptoms which impair his 
functioning.  These tend to vary a bit from week to week and, at times, appear to 
vary independently of the situation and at times seem to be a pretty direct result of 
January Term, 2006 
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intercurrent stress.  Dr. Levy points out that we have not changed treatment in the 
recent past.  Unfortunately, much of this is because the BWC [Bureau of 
Workers’ Compensation] or the employer continually impairs the patient’s ability 
to have his medication paid for.  We have been, to some extent, limited on the 
options available as Mr. Sellards consistently reports that when he takes his 
prescriptions to the pharmacy, he is told that they are not compensated and 
therefore he cannot afford to get them filled.  As a consequence, we have been 
using office samples in an attempt to treat him but, unfortunately, many of the 
things that I would otherwise use are not available in that form.  * * * I think with 
optimizing medication and continued psychotherapy, he can make additional 
progress.”   
{¶ 8} This letter contained the first mention of any problem with 
payment for medication. On December 23, 2002, Sellards’s counsel phoned the 
bureau regarding prescription payment.  The bureau responded with a letter the 
next day indicating that an error had occurred and, as of that date, had been 
corrected. 
{¶ 9} At about the same time, a commission district hearing officer 
found, based on Dr. Levy’s report, that claimant had reached maximum medical 
improvement and therefore terminated temporary total disability compensation as 
of the December 18 hearing date.  Sellards appealed and obtained another letter 
from Dr. Spare.  Dated January 7, 2003, the letter stated: 
{¶ 10} “Mr. Sellards continues to be symptomatic.  * * * The intensity of 
these experiences seem [sic] to fluctuate, to some extent, and clearly there has 
been some improvement over baseline.  However, the symptoms remain severe to 
moderately severe * * *.  As I had previously noted, the patient persistently 
reports that attempts to get his prescriptions filled at the pharmacy are frustrated 
by the pharmacist who claims that these psychiatric items are not compensated.  
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Mr. Sellards’ antidepressant treatment has been, to some extent, limited as we 
have been providing him with office samples to keep him in treatment. 
{¶ 11} “I know there has been some attempt to address this issue since his 
last visit.  However, so far as I am aware, the situation has not changed. 
{¶ 12} “In any case, Mr. Sellards likely would have some opportunity to 
benefit from alternative medication or augmentation with a mood stabilizer; 
however, these approaches would require closer monitoring, blood testing and the 
availability of medication on a continuous basis.  Given the uncertainty of the 
situation, I have been a bit reluctant to proceed with that because there are some 
risks involved, particularly if the medication cannot be continuously monitored 
appropriately.” 
{¶ 13} A staff hearing officer affirmed the district hearing officer’s order 
on February 6, 2003.  She reasoned: 
{¶ 14} “Although Dr. Levy does indicate that counseling and medication 
management should continue, he indicates it is unlikely that the claimant will 
experience any further improvement in his psychological condition despite that 
treatment.  The Staff Hearing Officer further finds that although the psychological 
condition was not formally recognized in this claim as an allowed condition until 
July of 2002, the claimant has been receiving regular treatment with Dr. Spare 
since at least November of 2001.  Although the claimant just recently reported a 
problem to the BWC in getting his prescriptions filled, it is noted that Dr. Spare 
has been providing the claimant with free medication samples to treat the allowed 
psychological condition.” 
{¶ 15} The staff hearing officer’s decision prompted a third letter from 
Dr. Spare on February 17, 2003.  The letter reviewed the history of Sellards’s 
treatment and suggested that Sellards would have been afforded more thorough 
treatment but for a delay in approving the psychiatric condition and getting 
Sellards’s medications paid.  The report, however, was vague about what 
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specifically Dr. Spare would have done differently and what he would now do 
differently following approval of his treatment plan: 
{¶ 16} “[H]is treatment was, to some extent, limited by inability to 
provide intensive treatment and limits on the medications which were available.  
As I previously commented, we did provide him with office samples of several 
antidepressants but they were incompletely effective.  In such cases, augmentation 
strategies which involved the prescription of mood stabilizers or small doses of 
major tranquilizers or more typical antidepressants are often prescribed.  Some of 
these strategies require medication which is not available as samples as well as 
blood monitoring which is also expensive.  As a consequence, our attempts at 
treatment were limited and Mr. Sellards has not had all of the available aggressive 
treatments for his depression.” 
{¶ 17} Further appeal and an additional request for reconsideration were 
denied, generating Sellards’s mandamus petition to the Court of Appeals for 
Franklin County.  The court of appeals denied the writ after finding that the 
commission order was supported by evidence. 
{¶ 18} This cause is now before this court on an appeal as of right. 
{¶ 19} The single issue presented is an evidentiary one.  Sellards 
challenges Dr. Levy’s opinion of maximum medical improvement as premature 
based on Dr. Spare’s contemporaneously approved treatment plan and urges its 
disqualification.  We agree with Sellards and accordingly reverse the judgment of 
the court of appeals. 
{¶ 20} Prior to his examination by Dr. Levy, Sellards struggled to get the 
treatment recommended by his treating physician, Dr. Spare, who believed that 
Sellards would benefit from medication and psychotherapy.  The commission, in 
approving that treatment, obviously wanted to give Sellards the opportunity for 
further treatment.  We believe that Sellards merits that opportunity before 
maximum medical improvement is assessed.  Dr. Levy’s opinion was premature 
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based on the commission’s contemporaneous approval of Dr. Spare’s treatment 
program.  Dr. Levy’s opinion could not, therefore, serve as evidence supporting 
denial of temporary total disability compensation. 
{¶ 21} The judgment of the court of appeals is reversed. 
Judgment reversed. 
 
RESNICK, PFEIFER, LUNDBERG STRATTON, O’CONNOR and LANZINGER, JJ., 
concur. 
 
MOYER, C.J., and O’DONNELL, J., dissent. 
__________________ 
Stewart Jaffy & Associates Co., L.P.A., Stewart R. Jaffy, and Marc J. 
Jaffy, for appellant. 
Jim Petro, Attorney General, and William J. McDonald, Assistant 
Attorney General, for appellee Industrial Commission. 
______________________