Title: Rish v. Home Depot

State: idaho

Issuer: Idaho Supreme Court (civil)

Document:

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IN THE SUPREME COURT OF THE STATE OF IDAHO   
Docket No. 43677 
CHANNEL (BLACKER) RISH, 
 
           Claimant-Appellant, 
 
v. 
 
THE HOME DEPOT, INC., Employer, and 
INSURANCE COMPANY OF THE STATE 
OF PENNSYLVANIA, Surety, 
 
           Defendants-Respondents. 
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Twin Falls/Valley High School 
November 2016 Term 
 
2017 Opinion No.  22 
 
Filed:  February 28, 2017 
 
Stephen W. Kenyon, Clerk 
Appeal from the Industrial Commission.  
Industrial Commission order denying benefits, vacated and remanded for further 
proceedings. 
Curtis & Porter, PA, Idaho Falls, for appellant.  Andrew A. Adams argued.   
Bowen & Bailey, LLP, Boise, for respondents.  W. Scott Wigle argued.   
_________________________________ 
 
BURDICK, Chief Justice 
 
This appeal arises from an Industrial Commission (the Commission) order denying 
medical care benefits to Channel Rish. The Commission held that Idaho’s Worker’s 
Compensation Act did not require Respondents to pay for the medical care Rish received after 
she achieved maximum medical improvement because that medical care was deemed 
unreasonable. On appeal, Rish contends the Commission’s order is not supported by substantial 
and competent evidence, and moreover, the Commission misapplied the governing legal standard 
when determining whether the medical care was reasonable. We vacate and remand. 
I. 
FACTUAL AND PROCEDURAL BACKGROUND 
Rish worked as a cashier at Home Depot. While working on October 30, 2005, Rish 
slipped on a floor mat and injured her right knee. The injury ultimately required Rish to undergo 
three knee surgeries, which Dr. Casey Huntsman performed in 2005, 2006, and 2007.  
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On August 9, 2007,1 roughly three months after Rish’s third surgery, Dr. Huntsman 
concluded Rish had achieved maximum medical improvement (MMI). Dr. Huntsman, however, 
further noted that Rish “definitely needs . . . continued pain management” with Dr. Holly Zoe.  
To that end, Rish visited Dr. Zoe for pain management treatment. But because that 
treatment did not improve Rish’s knee pain, Respondents grew skeptical as to Rish’s continued 
medical care and surmised that Rish was merely seeing Dr. Zoe to get pain medication. 
Therefore, in January 2008, Respondents arranged for Rish to receive an independent medical 
examination (IME) with Drs. Robert Friedman and Christian Gussner. Those doctors concluded 
Rish had not yet achieved MMI and recommended Rish attend a chronic pain management 
program while being weaned off pain medication. Rish never attended that chronic pain 
management program and instead continued seeing Dr. Zoe for treatment throughout 2008.  
As such, Respondents remained skeptical as to Rish’s continued medical care with Dr. 
Zoe. Thus, in January 2009, Respondents arranged for Rish to receive another IME, this time 
with Drs. Christian Gussner and Michael McClay, a psychologist. Dr. Gussner “was unable to 
detect any ongoing problem with [Rish’s] right knee” and recommended she stop taking pain 
medication. Dr. McClay concluded Rish had a “long history of personal problems and medical 
problems” and advised that Rish “need[ed] to be out of the workers’ compensation process as 
quickly as possible.”  
Respondents gave the January 2009 IME results to Dr. Zoe, which caused Dr. Zoe to 
begin tapering Rish’s pain medication. In addition, Respondents stopped paying for Rish’s 
medical care after the May 1, 2009 visit with Dr. Zoe. In February 2010, Rish filed a worker’s 
compensation complaint to seek past and future disability benefits and medical care. 
Respondents answered and conceded Rish was entitled to the already-paid disability benefits and 
medical care, but Respondents disputed whether she was entitled to additional disability benefits 
and medical care. After a hearing, the Commission held in Respondents’ favor. The Commission 
noted that Rish did not timely raise the issue of disability benefits, but concluded Rish was 
nevertheless entitled to no additional disability benefits. Further, the Commission concluded 
Rish was entitled to no additional medical care benefits because the medical care Rish received 
after August 9, 2007—the date when Dr. Huntsman deemed her at MMI—was unreasonable.  
                                                 
1 Both the record and briefing feature conflicting dates. Some documents in the record and parts of the briefing 
identify the date as August 7, 2007. Other documents in the record and parts of the briefing identify the date as 
August 9, 2007. Because Dr. Huntsman deemed Rish at MMI on August 9, 2007, we assume that is the proper date.  
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Rish timely appeals the Commission’s denial of continued medical care benefits.  
II. 
ISSUES ON APPEAL 
1. 
Did the Commission err by holding that the medical care Rish received after August 9, 
2007 was unreasonable? 
2. 
Should attorney fees be awarded on appeal? 
III. 
STANDARD OF REVIEW 
“This Court exercises free review over the Commission’s legal conclusions but does not 
disturb factual findings that are supported by substantial and competent evidence.” Neel v. W. 
Const., Inc., 147 Idaho 146, 147, 206 P.3d 852, 853 (2009). “Substantial and competent evidence 
is relevant evidence which a reasonable mind might accept to support a conclusion.” Luttrell v. 
Clearwater Cty. Sheriff’s Office, 140 Idaho 581, 583, 97 P.3d 448, 450 (2004) (citation omitted). 
“Substantial and competent evidence is more than a scintilla of evidence, but less than a 
preponderance.” Hope v. Indus. Special Indem. Fund, 157 Idaho 567, 570, 338 P.3d 546, 549 
(2014). 
IV. 
DISCUSSION 
The main issue we address is whether the Commission erred by holding that the medical 
care Rish received after August 9, 2007 was unreasonable. Additionally, Rish requests attorney 
fees on appeal.  
A. 
The Commission erred by holding that the medical care Rish received after August 
9, 2007 was unreasonable. 
Under Idaho’s Worker’s Compensation Act, an employee who suffers a compensable 
injury at work is entitled to “reasonable” medical care. I.C. § 72-432(1). As Idaho Code section 
72-432(1) provides: 
[T]he employer shall provide for an injured employee such reasonable medical, 
surgical or other attendance or treatment, nurse and hospital services, medicines, 
crutches and apparatus, as may be reasonably required by the employee’s 
physician or needed immediately after an injury or manifestation of an 
occupational disease, and for a reasonable time thereafter.  
The Referee deemed as reasonable the medical care Rish received from October 30, 2005 
until August 9, 2007. However, the Referee deemed as unreasonable the medical care Rish 
received after August 9, 2007 because that medical care “was merely palliative and failed to 
restore function to any useful degree.” The Referee concluded Respondents were not required to 
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pay for the medical care Rish received after August 9, 2007. The Commission entered an order 
adopting the Referee’s findings of fact and conclusions of law.  
Rish challenges the Commission’s order on two bases. She first contends substantial and 
competent evidence does not support the Commission’s order because it is primarily based on 
Rish achieving MMI on August 9, 2007. Rish highlights how the Referee’s findings repeatedly 
emphasize her date of MMI. Indeed, the Referee explained that Dr. Huntsman’s “opinion that 
[Rish] was at MMI as of August 9, 2007 carries the most weight.” We hold that the Referee’s 
findings illustrate error. As we have explained previously, substantial and competent evidence 
“is relevant evidence which a reasonable mind might accept to support a conclusion.” Luttrell, 
140 Idaho at 583, 97 P.3d at 450 (emphasis added). MMI, however, is not relevant to the 
reasonableness of continuing medical care. To be sure, MMI is relevant insofar as it defines the 
“period of recovery” for disability benefits. See, e.g., Hernandez v. Phillips, 141 Idaho 779, 781, 
118 P.3d 111, 113 (2005). But nothing in the plain language of Idaho Code section 72-432(1) 
suggests MMI is relevant as to whether continued medical care is reasonable. Nor have we ever 
held that MMI is relevant as to whether continued medical care is reasonable.  
Rish’s second argument is that the Commission’s order contravenes this Court’s holding 
in Chavez v. Stokes, 158 Idaho 793, 353 P.3d 414 (2015), because the Referee primarily 
determined reasonableness by retrospectively analyzing the efficacy of the medical care. At issue 
in Chavez was whether a helicopter trip to the hospital constituted “reasonable” medical care 
under Idaho Code section 72-432(1). Id. at 796–99, 353 P.3d at 417–20. The employee in Chavez 
injured his hand while working and was helicoptered to the hospital for treatment. Id. While the 
Referee concluded the helicopter trip was unreasonable because, in hindsight, the employee 
could have taken an ambulance to the hospital, the Commission rejected those findings and 
instead held that the helicopter trip was indeed reasonable. Id. at 795, 353 P.3d at 416. 
Our decision in Chavez affirmed the Commission. Id. at 799, 353 P.3d at 420. Chavez 
cautioned against a myopic, retrospective analysis and held that the Commission’s “review of the 
reasonableness of medical treatment should employ a totality of the circumstances approach.” Id. 
at 798, 353 P.3d at 419. Chavez attributed the proper inquiry to Justice Bistline, who posited: 
“The reasonableness of a doctor’s determination that treatment is indicated should be measured 
at the time the doctor prescribes treatment, not by ‘armchair doctoring’ afterwards with the 
benefit of hindsight.” Id. (quoting Hipwell v. Challenger Pallet & Supply, 124 Idaho 294, 300, 
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859 P.2d 330, 336 (1993) (Bistline, J., concurring in part and dissenting in part)). As Chavez 
explained, a retrospective analysis “would serve only to second-guess the treatment requirement 
of the physician without a fair consideration of the information known at the time and place of 
treatment and any exigent circumstances.” Id. 
Here, the Commission misapplied Chavez by retrospectively analyzing the efficacy of 
Rish’s continued medical care to determine reasonableness. The Referee acknowledged Chavez 
when recognizing that “[o]ne factor among many in determining whether post-recovery 
palliative care is reasonable is based upon whether it is helpful, that is, whether a claimant’s 
function improves with the palliative treatment.” But the Referee did not treat the efficacy of 
Rish’s continued medical care as just one factor; instead, it was the thrust of the Referee’s 
analysis. For instance, the Referee noted that Rish’s visits with doctors in “June and July 2011 
showed no objective improvement in function,” despite the continued medical care. The Referee 
further noted that Rish’s “reports of pain increased,” despite physical therapy in summer 2012. 
Similarly, a steroid injection in September 2012 “merely increased [Rish’s] pain.” And in “early 
2014 physical therapy failed to produce positive results.” As a result, the Referee concluded the 
medical care Rish received after August 9, 2007 was unreasonable because it “merely provided, 
at best, palliative treatment which subjectively, temporarily, decreased [Rish’s] complaints of 
pain but did not provide any curative measures or restore functions in a measurable way.”  
 
Accordingly, the Commission committed two main errors: (1) relying on MMI, which is 
irrelevant to continued medical care; and (2) misapplying Chavez. Taken together, these two 
errors caused the Commission to wrongly hold that palliative care is compensable only if it 
actually improves the medical condition, thereby discrediting the important role of pain 
management. For instance, according to the Referee, any medical care Rish received after 
achieving MMI was “at best, palliative treatment which . . .  did not provide any curative 
measures or restore function in a measurable way.” This linkage of palliative care with 
functional improvement is inconsistent with our precedent. We have instructed that “the word 
‘treatment’ is a broad term and is employed to indicate all steps taken in order to effect a cure of 
an injury or disease.” Hamilton v. Boise Cascade Corp., 84 Idaho 209, 214, 370 P.2d 191, 193 
(1962). Thus, palliative, pain-killing “treatments can be compensable even though they will not 
necessarily cure the employee’s condition.” Poss v. Meeker Mach. Shop, 109 Idaho 920, 924, 
712 P.2d 621, 625 (1985) (citing Hamilton, 84 Idaho at 215–16, 370 P.2d at 194). We decline to 
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deviate from this principle, even if the pain management treatment consists of prescribed pain 
medication that results in addiction or dependency, which, in turn, requires additional treatment. 
See Burch v. Potlatch Forests, Inc., 82 Idaho 323, 327, 353 P.2d 1076, 1078 (1960) (“We believe 
it was the intention of the legislature that the injured employee is entitled to such medical, 
surgical or other treatment as may be reasonably required to relieve him from the effects of his 
injury and arrest and stay further damage which would naturally flow from the injury.”). 
Requiring an injured worker to endure pain resulting from an industrial accident without 
assistance of analgesic medications is scarcely consistent with the “humane purposes” for which 
Idaho’s worker’s compensation laws were promulgated. See, e.g., Clark v. Shari’s Mgmt. Corp., 
155 Idaho 576, 579, 314 P.3d 631, 634 (2013). Therefore, we vacate and remand for proper 
application of the governing law, with the specific instruction that palliative care may be, but is 
not necessarily, reasonable, even if it is ineffective. 
B. 
Rish is not entitled to attorney fees on appeal. 
Rish requests attorney fees under Idaho Code section 72-804, which permits “attorney 
fees on appeal where the employer or its surety unreasonably brought or contested a claim.” 
Morris v. Hap Taylor & Sons, Inc., 154 Idaho 633, 640, 301 P.3d 639, 646 (2013). 
Although Rish is the prevailing party on appeal, Respondents did not unreasonably 
contest her claim. Conflicting medical evidence in the record illustrates that Respondents had a 
reasonable factual basis to contest at least some of Rish’s medical treatment. We decline to 
award attorney fees on appeal. 
V. 
CONCLUSION 
 
We vacate the Commission’s denial of medical care benefits and remand for further 
proceedings consistent with this opinion. We award no attorney fees or costs on appeal.  
 
Justices EISMANN, HORTON and J. JONES, PRO TEM, CONCUR. 
Justice W. JONES specially concurring.   
I agree with the majority that the Commission applied incorrect legal standards in this 
case. Whether a claimant has reached MMI is not determinative of whether continued care is 
reasonable. Palliative treatment may be, but is not necessarily, reasonable, even where it turns 
out to be ineffective in retrospect. Accordingly, I concur with the majority’s conclusion to vacate 
the Commission’s denial of benefits and remand for further proceedings.  
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I write in order to emphasize that this Court has vacated, and not reversed, the 
Commission’s conclusion that the continued prescription of opioids to Rish was unreasonable. 
Opioids are highly addictive and can cause significant harm to a patient over time. While 
palliative care can, and often does, reasonably include the temporary prescription of opioids for 
pain relief, an indefinite prescription of opioids may cause more harm than good. It is proper for 
the Commission to consider whether a claimant was suffering from opioid addiction at the time 
opioids were prescribed in determining whether said prescription was reasonable.  
It is not within my purview to make a determination as to whether or not the continued 
prescription of opioids was reasonable or unreasonable, or whether Rish was suffering from 
opioid addiction. Such a determination will be left to the Commission on remand. However, 
there were a number of red flags in this case that must be considered. Specifically, Rish 
demonstrated a distinct pattern of seeking opioid pain medication from different physicians, and 
abandoning those physicians as soon as they took measures to wean her off of opioids. This 
behavior was exemplified by Rish’s reaction to Dr. Zoe’s attempt to titrate her opioid medication 
over a several-week reduction period. The Referee found that when Dr. Zoe informed Rish that 
she would be weaned off of opioids she “started screaming,” and thereafter “did not make or 
attend any follow-up appointments to cooperate with attempts to wean her from her opiate 
addiction.” Drs. Friedman, Gussner, and Cook each also concluded that Rish should be taken off 
of opioids. But, Rish appears to have been unwilling to take steps towards weaning herself off of 
opioids, even going so far as to refuse the opportunity to enter into a rehabilitation program at 
Elks Hospital. This behavior led the Referee to conclude that “[Rish] has refused some 
conservative treatment measures and has been uncooperative with others. She has changed 
physicians when a discontinuation of narcotics prescriptions was announced or seemed 
imminent.” This finding is unrelated to MMI and should be considered in determining whether 
the continuation of opioid treatment was reasonable. 
In conclusion, I would emphasize that because the Commission’s original order has been 
vacated, it is now up to the Commission to determine whether or not facts other than MMI and 
the retrospective efficacy of treatment lead it to the same ultimate assessment of the 
reasonableness of the treatment provided to Rish.