now if i may quote from the commission decision the medications in the city's system at the time of his that were not per square i were taken at the direction of the position from whom he was receiving treatment at the time your honour's how was there cause relationship between the work injury in january two thousand and one and is that in march two thousand and three when what caused his death was not prescribed by treat or who was treating mr  none of the medications in the system were prescribed this is what this is exactly what was quoted in the commission decision on what was deemed to be the cause of death was the actually kono which it appears he obtained over the internet when he just want to make the point that it wasn't prescribed by any of the doctors that were treating the working dish that was purposefully understood by the or would trigger the commission everybody up and down the line right that's true on ground here today because i believe the manifest would be evidence dictates that the the opinion that even though the medication had not been prescribed that the course of treatment that he had received from his work related injury good condition in his system we have other explanations that he gave other explanations would put it to you that how can it be that the acts occurred on which was not prescribed as any kind of treatment related to the working theory which was the causes that we have an accidental drug overdose which was the cause of this the i would put it to you that there is no connection to hindsight get on his medications from all these doctors he's following the consistent approach from the doctors and they believe the release of code of quote these medical prescriptions and treatments condition his system to break and then nightmare the treatment that he was undergoing even just in the vendor of two thousand and one we got the m r i and then my finally back to kramer and then three subsequent diagnoses which are all different just in the month of november two thousand when i can briefly run  concussion syndrome so now we've got a new man and in my finding early november he keeps treating goes the merits of all doctors keep skipping these different diagnoses and what he's getting out of the subsequent treatment is basically access to more prescription you know we have mr x basically outsmarting the doctors commissioner lambourn noted the seed and successfully received prescribed medications ten different physicians in a span of twenty six months we're talking about fifteen different medications this is confirmed by heavy anti psychotic medications prescribed to him and if you've got some things that maybe he wasn't supposed to does that mean that he doesn't recover it has to be workable correct correct that not i would say that the treatment was on track only up to a certain extent your honor it seems like fairly quickly the treatment got off track with mr ochs specifically seeking out different doctors and access to different medications apparently through the internet if i'm not sure your honor it could have either been but i know he probably has some left over the record does indicate that he wasn't prescribe anything within the previous four months to is that drugs are not part of any post actually treating him and therefore the bed should not be considered directly related to the accident in the doctor's opinion the polypharmacy was created by deceit not by the medical treatment as commission rambling pointed out we have two conditions here we've got to be working three gang rape ninth two thousand one and then a concurrent drug addiction which greying at the same time as the work injury and which ultimately was the cause of his that that drug addiction led to the drug with that is that basically what he said that all of these various psychotic medications that i'm on the trail that were brought down his system isn't that sort of resentment to track you and i believe that if each of the doctors that would have known what the other doctors were prescribing and the regimen of medication that he was on that they would give adjusted the medication to be in a proper ratio or however you want to say it so that he wouldn't ha such adverse effects well that's exactly what the really sad right he had nightmare treatment he was going to ten different doctors they were all prescribe being large dosage and are psychotic medication pot pharmacy we understand that he was seeking out treatment seeking out medications which weren't prescribed by doctors which are treating his working mission the result of seeking out that medication is what caused the overdose have basically two conditions here we've got the work injury and then a drug how did he put a complete concurrent drug addiction which was running contemporaneously while he was training for the work injur but i would put you on it they were just name that the drug addiction was a separate condition which mr x suffered from as a result of that condition that's why he died and not to say there's no evidence the record he ever fisher was and then my at this time now we generally want to player x alliance upon reasonable medical opinion or when there are conflicting medical opinions penalties ordinarily are not imposed this is pursuant to grow the products case the test is rather than first conduct in relying on the medicare medicare painting considered to contest liability is reasonable under the circumstances presented and there's nothing in the graphics indicate that respondents opinion to cut off the t v now i certainly understand that the commission way disturbance against the subsequent medical opinions and in their t t d was proper pastorally november two thousand and one that i would certainly dispute the fact that penalties world order for this period based on the fact that it was not an arbitrator cerm a nation of benefits it wasn't the fact that we had no position to support the term nation benefits in early november two thousand which persons of the learning in their field might disagree but rather the question is the legal question of whether or not the finding of the commission which was confirmed by the circuit court is against the manifest weight of the evidence whether there any sufficient factual evidence in the record to support the commission's decision in this case we have the opinion of dr nelson borelli was a board certified psychiatry was on staff at northwestern university who stated in his opinion that mr oakes death was a direct relationship to the one thousand two thousand want to accident the poly pharmacy diagnosis was consisted with the record of mr oakes drug treatment starting at the time of his original accident in january of two thousand and one the day following the accident mr oakes started treating with various physician is due to his various different medical diagnoses he did not just have a post concussion syndrome he had a cervical injury had a back injury he had the pressure and anxiety that were related to his subsequent  medications he was under increased the risk of bad side effects and also increase the the risk of his death the post concussion syndrome was accompanied by the diagnosis of depression and anxiety now we look at the two medications that were found in the autopsy report that is a pm which was also known as valley m and x e coated which we know is a narcotic and we look at m coded so we have the treating pain management position prescribing the exact medication that mr oakes was found to have at the time of the autopsy in response to d millions of patients take the same types of medication and don't overdose the problem with that analysis is that mr oakes had acute injury necessitating medication but over a long long course of time to years in fact and also that he had a complicating factor in that he was having a psychological condition that was not being managed in fact back to claim it or the respond value him in the days of pan that he was taking but those medications were exactly the type that were being prescribed by dr heaney so mr oakes was aware of the medication may prescribe form and in fact he testified that he thought it times he was over medicated but he was just following the treatment prescribed by his doctors there is nothing in this record to establish the fact that mr oakes number one was a drug addict or that he was seeking drugs respondent stopped paying for any further treatment and any further disability so that so mr oakes testified that he had to go out and pay out of pocket many of the medications that he was undergoing at that time was not able to continue because at that point the case was disputed nothing further was being authorized the mr oakes testified that he was in i'm able to get medication through the worker's compensation carrier and so what would happen here is mr oakes is having to self medicate without any authorization without any further care or treatment being provided he's having him being forced to self medicate he's aware of the medications he was prescribed earlier and the record appears to show that he attempted to do self medication after his treatment was no longer authorized dr dr brawley indicated that the pharmacy track that he was on increased the risk of bad side effects and increased the risk of death dr brawley also indicated that for two years he was on his poly pharmacy track and so what unfortunately happened in this case is is mr oakes accidentally overdosed in taking these medications which were prescribed by him earlier with regard to the penalties issue that was raised counsel the rules require the rules require that the employer once be getting payment shall provide the employee with a written explanation of the basis for terminations or suspension or further benefits no later than the date of the last payment there's nothing in this record to show that the respondent or the insurance carrier ever sent written notification to mr oak that his benefits were being terminated or the basis of why they were being terminated in fact the noose case manager that was involved in the case was the one who told mr earle he was no longer going to get paid and then he should return to work per instructions of dr crane thus the employer in this case failed to provide any basis in notifying mr oakes for the rules rives benefits were terminated and i think it was that basis along with the fact that several other physicians after dr kramer in the killing their opinion said he could not return to work that was the basis for which the commission awarded penalties and fees as a result of respondents terminations of benefits i asked the court to the form of the solution of the commission in the circuit court in this case i refer the court to my brief for argument on the t t issues in the average were result of internet medications that's on page nine of their brief i would agree with the the self medication that counsel presented to you it's his hypothesis about this case that unfortunately it's self medication that went tragically wrong in this case and it up in the drug overdose and again it's our position strongly that this drug overdose not related to a working theory two years later and regarding penalties i mean i can't say for certain but i believe that dr kramer report would be forwarded to counsel probably documentation that no further t v benefits would be forthcoming based on that report