Case Title: State ex rel. Wyoming Workers' Compensation Div. v. Girardot

Citation: 

Docket Number: 

State: wyoming

Court: Wyoming Supreme Court

Date: 1991-03-14T00:00:00Z

Document:
State ex rel. Wyoming Workers' Compensation Div. v. Girardot1991 WY 33807 P.2d 926Case Number: 90-55Decided: 03/14/1991Supreme Court of Wyoming
STATE of Wyoming ex rel., WYOMING WORKERS' COMPENSATION DIVISION, 
Appellant (Objector-Defendant),

v.

Lorance L. GIRARDOT, 
Appellee (Employee-Claimant).

Appeal from the District 
Court, SheridanCounty, James N. Wolfe, 
J.

Joseph B. Meyer, Atty. 
Gen. and Ron Arnold, Sr. Asst. Atty. Gen., for appellant.

Clay B. Jenkins, 
Sheridan, for appellee.

Before URBIGKIT, C.J., 
and THOMAS, CARDINE, MACY and GOLDEN, JJ.

URBIGKIT, Chief 
Justice.

[¶1.]     AppelleeLoranceI. 
Girardot, age sixty-two, had an unknown and potentially life threatening 
coronary artery condition initially discovered when he was examined for surgery 
for a work related hernia. Expensive coronary artery surgery was first performed 
before the medical attention to the hernia could reasonably be given. These 
facts frame this appeal and its issue addressing the state worker's compensation 
fund obligation for treatment for a major preexistent physical condition in 
order to treat the relatively minor work related injury.

[¶2.]     The Wyoming Workers' 
Compensation Division's administrative hearing officer denied the coronary 
by-pass surgery expenses. The district court, on judicial review, reversed and 
we reverse the district court to reinstate the benefit denial. The appeal 
presents no factual dispute. The decision is resolved by examination of the 
statutes and application of common law precedent.

[¶3.]     On September 4, 1987, 
Girardot slipped on a wet floor while working as a janitor. From the fall, he 
sustained a compensable hernia injury. On September 10, 1987, he went to The 
Billings Clinic, Billings, 
Montana, for corrective surgery. 
While he was undergoing preoperative examination, his cardiogram appeared 
abnormal and, following an angiography, it was discovered he suffered from a 
severe arterial blockage of the heart, near critical in nature, requiring 
by-pass surgery before the hernia operation could be safely pursued. Without any 
contact made to the Workers' Compensation Division by either the medics or 
Girardot, the by-pass surgery was performed and then followed in due time by the 
corrective hernia operation.

[¶4.]     The medical expense 
claim for the by-pass surgery totalled approximately $35,000, while the hernia 
operation cost approximately $3,790. Temporary total disability claims were made 
and paid until recovery from the hernia surgery was complete. Both the employer 
and the Workers' Compensation Division objected to the payment of the heart 
surgery cost.1 The issue is compensability of the 
cost of the medical care for the unrelated by-pass heart surgery untreated and 
unknown until after the occurrence of the work related injury. We directly 
consider statutory application to medical benefit payment where major medical 
care is required before treatment of the work related injury can be safely 
performed.

[¶5.]     The Workers' 
Compensation Division cites two statutes in support of benefit denial, W.S. 
27-14-102(a)(xi)(F) and 27-14-501(a). W.S. 27-14-102 states in pertinent 
part:

(a) As used in this 
act:

* * * * * *

(xi) * * * "Injury" does 
not include:

* * * * * *

     (F) Any injury or 
condition preexisting at the time of employment with the employer against whom a 
claim is made.

W.S. 27-14-501(a) reads 
in part:

Any tests to be 
administered or other services proposed to be rendered by a health care provider 
which are clearly not germane to the injury shall be disclosed to the injured 
employee, if possible, and the employee shall be advised that the cost of the 
tests or services will be the responsibility of the employee if he consents to 
the tests or services.

Girardot takes comfort 
from entitlement by advancing W.S. 27-14-401(a), which states, in part, that 
"[t]he expense of medical and hospital care of an injured employee shall be paid 
from the date of the compensable injury * * *."

[¶6.]     Our decision is 
determined by statutory interpretation and judicial application. Girardot 
directs us to the preoperative treatment rule of Arizona for persuasive authority differing 
from states with statutory language which would be dispositive. Crow v. Guy 
Scoggins General Oilfield Contracting Co., 248 Miss. 1, 158 So. 2d 1 (1963). See also 2 
Larson's Workmen's Compensation Law § 61.13(e) (1989).

[¶7.]     Consideration starts 
with the provisions of W.S. 27-14-102(a)(xi)(F) endorsed by the Workers' 
Compensation Division. Analysis of its provisions does not answer the present 
question since there is no doubt about injury in this case. The issue is 
statutory responsibility for extended scope of treatment. We have a 
similar problem with the germaneness test of the second cited statute, W.S. 
27-14-501(a). In the real world, it was germane to his survival that the major 
problem first be addressed before the hernia surgery was attempted. 
Additionally, the record is settled that the treating doctors would not take the 
risk even if the patient might have been willing to gamble his extended 
expectancy by first having the minor surgery.

[¶8.]     The statute identified 
by Girardot, W.S. 27-14-401, provides no further preclusive legislative 
direction. Its reference to medical and hospital care clearly involves the 
hernia correction, which was the work related injury, and does not assist us in 
adding or rejecting heart surgery as an insured right of the employee. This is 
particularly true where clearly, under our case law, the heart condition, in 
itself, would not have been an insured injury or a compensable condition without 
meeting other supplementary requirements to make the heart problem into a "work 
related injury." Matter of Desotell, 767 P.2d 998 (Wyo. 1989); Bridge v. Eisenman Transport, Inc., 742 P.2d 768 (Wyo. 1987); State, ex rel. Wyoming Worker's Compensation Div. v. Van Buskirk, 721 P.2d 570 (Wyo. 1986); Naunes v. State ex rel. 
Wyoming Worker's Compensation Div., 694 P.2d 86 
(Wyo. 
1985).

[¶9.]     Lacking any 
determinative statute, Girardot directs us to cases creating or following a 
principle developed in Arizona cases. The three cases characterized 
to be "exactly on point" outline what can be described as the Arizona rule. We do not 
find that principle to be so far reaching as contended and will determine this 
case without necessarily rejecting some consideration within the included 
medical attention criteria for compensability addressed in those cases. We do, 
however, distinguish those cases factually and leave for the legislature in 
future enactments to provide for an extension of the benefits for this character 
of additional medical care for the worker if that should be its choice. We 
decline to provide that result here by adjudicatory legislation. Brown v. State 
ex rel. Morgan, 79 Wyo. 355, 334 P.2d 502 (1959).

[¶10.]  The lead case cited by Girardot was 
Allstate Ins. Co. v. Industrial Commission, 126 Ariz. 425, 616 P.2d 100 (1980), 
where other medical problems were encountered by the employee when he entered 
the hospital to undergo a diagnostic myelogram and subsequent back surgery. In 
preparing for testing and surgery, atrial fibrillation and renal shutdown were 
encountered. Stabilization of both conditions was obtained and a lumbar surgery 
was satisfactorily performed. In that case, the court distinguished the earlier 
case of Ramonett v. Industrial Commission, 27 Ariz. App. 728, 558 P.2d 923 
(1976), where other medical condition treatment benefits had been denied, and 
observed:

     The circumstances in 
the case before us differ from those presented in Ramonett. Here, there is no 
contention that the petitioner employer and carrier should be liable for any 
underlying heart or kidney condition from which the claimant may suffer. Rather, 
the appellee contended that he was entitled to medical benefits for the 
preoperative procedures in the hospital which became necessary because of the 
impending surgery for the industrial injury.

Allstate Ins. Co., 616 P.2d  at 101-02. The hearing officer's approval of payment was consequently 
affirmed.

[¶11.]  Factually, Allstate Ins. Co. does not 
extend beyond procedures required for stabilization of the heart beat and 
correction of the renal shutdown in order that the basic injury might be 
treated. Underlying medical conditions as permanent care were not considered or 
approved for benefit payment. The case itself rested on the reasonable inference 
due for appellate review of the hearing officer's decision which justified 
affirming the award previously given.

[¶12.]  Allstate Ins. Co. was followed in Arizona 
by Arrowhead Press, Inc. v. Industrial Com'n of Arizona, 134 Ariz. 21, 653 P.2d 371 (1982), where the payment for prescription drugs was contested. The claimant 
was involved in an automobile accident with resulting impact injuries requiring 
knee surgery. The hearing officer again granted benefits for treatment of a 
bronchial condition preparatory to the use of an anesthesia for the knee 
operation. The court found "there was sufficient evidence to support the 
administrative law judge's finding that the hospital treatment of the bronchitis 
was reasonably necessary and was incurred to place claimant in a condition to 
undergo surgery for her industrial injury." Id. 653 P.2d  at 373. The court further 
recognized in regard to Allstate Ins. Co. and its concept:

We note that the limits 
of this principle have not been defined, but petitioners do not here contend 
that the treatment for claimant's bronchitis during the hospital stay was in any 
way unreasonable or that it was disproportionate to the magnitude of claimant's 
industrial condition. In reviewing this question, we must view the evidence in a 
light most favorable to sustaining the award, and the findings will be upheld if 
reasonably supported by the evidence.

Id. at 373. On these facts, 
the relationship of the usage of prescription drugs to stabilize bronchitis in 
order to administer an anesthesia defines the limitation to which the principle 
was extended from Allstate Ins. Co. to Arrowhead Press, Inc.

[¶13.]  The third case cited by Girardot is, 
Williams v. Gates, McDonald & Co., 300 Or. 278, 709 P.2d 712 (1985). After 
sustaining a work related injury, the worker underwent a C5-6 spinal fusion. The 
neurosurgeon, in preoperative examination, found a carotid artery defect. It was 
his medical opinion that it would be necessary to retract, or move, the artery 
in the course of the spinal fusion surgery. The surgeon performed a preparatory 
right carotid endarterectomy in September which was followed with the spinal 
fusion in October. As a result of the arterial endarterectomy, the claimant 
contended she suffered brain damage from either a mild stroke or reduced oxygen 
during surgery.

[¶14.]  The implicit findings which obviously 
followed from her general contentions were that the endarterectomy was necessary 
to permit the fusion and the permanent mental condition was the result of the 
preparatory surgery. The court found the unsuccessful results of that first 
endarterectomy procedure became compensable as resulting from "total medical 
treatment. Treatment was necessitated by the injury." Id. at 714. Compare, 
however, Vester v. Diamond Lumber Co., 21 Or. App. 587, 535 P.2d 1373 (1975), 
noncompensable pre-existing aneurism; and Matter of Compensation of Brooks, 55 
Or. App. 688, 639 P.2d 700 (1982), pre-existing knee condition; neither of which 
were cited by the Oregon Supreme Court in Williams. Permanent disability 
consequently resulting from the unfortunate effects of ancillary treatment is 
not an issue presented here. Treatment complications for work related injuries 
present an entirely different subject from a preexisting medical problem which 
may create complications in any general medical care for the patient. See 1 
Larson's Workmen's Compensation Law, supra at § 13.21(a).2

[¶15.]  There is a case of converse persuasion 
specifically addressing unrelated ailment medical treatment, Quality Wood 
Products Corp. v. Industrial Com'n, 97 Ill. 2d 417, 73 Ill.Dec. 571, 454 N.E.2d 668 (1983). A factual recitation first stated:

[I]n addition to medical 
attention for his lumbar fracture, which alone would have required only a 
week-long stay in the hospital, claimant was treated for an intestinal blockage 
known as a paralytic ileus, pulmonary emboli, acute bronchitis superimposed on 
emphysema, ischemic heart disease and congestive heart failure. The testimony of 
both doctors indicates that claimant received psychiatric care. Dr. McKechnie 
testified that claimant's ileus condition was probably caused by the lumbar 
fracture and that the symptoms caused by the ileus could have contributed to his 
mental confusion. Dr. McKechnie further stated that the treatment for claimant's 
ischemic heart disease, congestive heart failure, bronchitis and emphysema was 
not connected with the lumbar fracture. Dr. Tuli testified in a similar vein, 
noting that the lumbar fracture, by creating the need for bedrest, could have 
indirectly caused the pulmonary emboli, and that the emboli or the heart disease 
could have indirectly caused claimant's hallucinations by lowering the oxygen 
level in his blood. Other than the fracture, the bronchitis and the emboli, 
however, claimant's infirmities were characterized by Dr. Tuli as chronic and 
neither caused nor aggravated by the lumbar fracture.

Id. 73 Ill.Dec. at 574, 454 N.E.2d  at 671. That court then determined:

     As earlier noted, claimants bear 
the burden of proving by a preponderance of the evidence all elements necessary 
to sustain an award of compensation. * * * [R]espondents may only be ordered to 
pay for treatment which is "reasonably required to cure or relieve from the 
effects of the accidental injury." [Illinois statute] * * * In view of the 
undisputed testimony indicating that claimant received treatment for ailments 
unrelated to his first lumbar fracture, the cost of which was apparently 
included in the unitemized bill, respondent's objection thereto should have been 
sustained. Since the Commission's finding that respondent should pay the entire 
cost of claimant's treatment is thus contrary to the manifest weight of the 
evidence, and there is in this record nothing enabling us to separate the 
eligible from the ineligible expenses, the cause must be remanded for the 
purpose of determining the extent to which the hospital charges represent 
expenses for which respondent is chargeable.

Id. 73 Ill.Dec. at 574, 454 N.E.2d  at 671. The award of non-itemized medical expense billing was remanded 
for recomputation to delete expenses for treatment of ailments unrelated to his 
lumbar fracture. See likewise Vester, 535 P.2d 1373.

[¶16.]  We would discern that in the absence of 
specific statutory direction, a rule of reason can be applied permitting 
inclusion of incidental or ancillary treatment procedures appropriate or 
necessary for proper attention to the work related occurrence as required or 
suggested by the medical practitioner, but not to include a more severe 
condition which predates the injury. The latter condition is found in the facts 
of this case. We are also realistically directed to this decision to avoid 
creating an impenetrable cost exposure barrier to employment of people with 
known handicaps which may in fact be only achieved age.

[¶17.]  Compensability will not be extended from 
work related injuries to also include major medical care for non-job incurred, 
preexisting physical problems. In the absence of a countervailing statute, we 
follow W.S. 27-14-102(a)(xi)(F) for principal injury treatment which was 
preexisting and not work related. The administrative rule of the Workers' 
Compensation Division is properly directed and also appropriately 
confined:

     Employees receiving 
injuries compensable under the Act shall be provided reasonable and appropriate 
health care benefits as a result of such injuries.

Wyoming Workers' Compensation 
Rules, Regulations and Fee Schedule, ch. IV, § 1(a)(i). See Yeik v. Department 
of Revenue and Taxation, 595 P.2d 965 (Wyo. 1979).

[¶18.]  There is no general Wyoming case law on this 
subject and, generally, these problems seem removed from mainstream litigation. 
The accidental occurrence injury of In re Scrogham, 52 Wyo. 232, 73 P.2d 300 
(1937) cited by Girardot does not extend to the other illness situation 
presented here. Following the thesis of W.S. 27-14-102(a)(xi)(F), a rule of 
reasonableness for fund obligation in case of a non-work related physical 
ailment should be applied. This court declines to reverse the decision of the 
hearing officer and extend medical care for treatment of this preexisting heart 
condition. The worker's compensation law should be liberally construed - but not 
extended beyond legislative authorization provided in the statutory language. 
Matter of Johner, 643 P.2d 932 (Wyo. 1982); Vester, 535 P.2d 1373.

[¶19.]  We reverse the district court and remand 
for restoration of the decision of the Workers' Compensation Division's 
administrative hearing officer.

THOMAS, J., filed a specially 
concurring opinion, with whom GOLDEN, J., joined.

CARDINE, J., filed a dissenting 
opinion.

 
 

FOOTNOTES

1 Originally, the Workers' 
Compensation Division objected to compensability of the hernia condition and any 
disability payment as well. The employer did not object to the hernia surgery or 
disability, and settlement was made favoring the employee before the hearing was 
completed and the only contested issue presented was the medical expenses 
involved in the heart surgery.

2 We do not find weight 
loss treatment-back injury cases cited by Girardot to provide persuasive 
authority for a heart condition-hernia operation situation. Braewood 
Convalescent Hosp. v. W.C.A.B., 34 Cal. 3d 159, 193 Cal. Rptr. 157, 666 P.2d 14 
(1983); Van Blokland v. OregonHealthSciencesUniversity, 87 Or. App. 694, 743 P.2d 1136 
(1987). Normally disciplined selfcare is both preferable and cheaper than 
introduction of the surgeon's knife for body invasion. Contra Clark v. 
Interstate Homes, Inc., 604 P.2d 937 (Utah 
1979) and Insurance Management Corp. of Tidewater/Baldwin Brothers & Taylor 
v. Daniels, 222 Va. 434, 281 S.E.2d 847 (1981).

THOMAS, Justice, concurring 
specially, with whom GOLDEN, Justice, joins.

[¶20.]  I agree that the decision of the district 
court must be reversed in this case, and the case must be remanded for entry of 
an order reinstating the decision of the hearing examiner. I would premise that 
result upon the language of our statute, however, without reference to, or 
discussion of, precedent from foreign jurisdictions.

[¶21.]  Section 27-14-102(a)(xi), W.S. 1977 (June 
1987 Repl.), defines injury for purposes of the statute in this way:

"(xi) `Injury' means any 
harmful change in the human organism other than normal aging and includes damage 
to or loss of any artificial replacement and death, arising out of and in the 
course of employment while at work in or about the premises occupied, used 
or controlled by the employer and incurred while at work in places where the 
employer's business requires an employee's presence and which subjects the 
employee to extrahazardous duties incident to the business." (Emphasis 
added.)

Read in its entirety, the 
majority opinion simply holds that the arterial blockage and its complications 
did not constitute an injury under the statute even though discovered in 
connection with the examination for treatment of the hernia that admittedly was 
an injury within the statutory definition. The evidence in the record clearly 
establishes that, in the opinion of the treating physician, the coronary 
condition had no relationship whatsoever to Lorance L. Girardot's 
employment.

[¶22.]  We must afford a reasonably liberal 
interpretation to the Wyoming Worker's Compensation Act in order to accomplish 
the legislative goals, among which is the intent of the legislature that 
industry, and not the injured employee, should bear the burden of accident and 
injury occurring within the industrial setting. Seckman v. Wyo-Ben, Inc., 783 P.2d 161 (Wyo. 
1989). SeeState, ex rel. Wyoming Worker's Compensation Division v. Mahoney, 798 P.2d 836 (Wyo. 1990); Matter of Patch, 798 P.2d 839 (Wyo. 
1990). That rule of liberal construction, however, does not justify extending 
the beneficent purpose of the law to injuries that do not reasonably fall within 
the language of the statute. Deloges v. State ex rel. Worker's Compensation 
Division, 750 P.2d 1329 (Wyo. 1988). Girardot's coronary problems do 
not reasonably fall within the language of the statute, and he is not entitled 
to recover those expenses attributable to the treatment of that 
condition.

[¶23.]  I add, however, that I can find no 
justification for reliance by the hearing examiner upon the exclusion set forth 
in § 27-14-102(a)(xi)(F), W.S. 1977 (June 1987 Repl.), relating to "any injury 
or condition preexisting at the time of employment with the employer * * *." The 
hearing examiner made no finding as to when Girardot went to work for the 
employer nor when the coronary condition came into existence. It may be a fair 
inference from evidence in the record that it was a preexisting condition. The 
finding of fact to that effect was not made, however, and the hearing examiner's 
findings of fact fail to support the conclusion of law that the statutory 
exclusion is applicable. See FMC v. Lane, 773 P.2d 163 (Wyo. 1989); Larsen v. 
Oil & Gas Conservation Commission, 569 P.2d 87 (Wyo. 1977); Geraud v. 
Schrader, 531 P.2d 872 (Wyo. 1975), cert. denied sub nom. Wind River Indian 
Education Association, Inc. v. Ward, 423 U.S. 904, 96 S. Ct. 205, 46 L. Ed. 2d 134 
(1975).

CARDINE, Justice, 
dissenting.

[¶24.]  I would affirm the decision of the trial 
court. It is undisputed that appellee suffered a compensable injury, i.e., the 
hernia. The hernia could not be repaired without treatment of a preexisting 
condition, severe blockage of the coronary arteries. Appellee had an absolute 
right to have the hernia repaired. If it could only be repaired subsequent to 
treatment for a preexisting condition, then he was entitled to that treatment as 
the trial court found.

[¶25.]  The case is unusual and certainly 
expensive to the Worker's Compensation fund in this instance. However, these 
facts alone are not a basis for denying payment of this claim for medical 
treatment.

[¶26.]  Parenthetically, I note that the opinion 
of the court suggests a "rule of reason" be applied to determine whether this 
type medical expense is covered by Worker's Compensation. The suggested rule is 
that if the expense is small, pay it. If the expense is great, as in this case, 
refuse payment. An interesting rule, but surely not a rule of law.