Title: Pirelli-Armstrong Tire Co. v. Reynolds

State: iowa

Issuer: Iowa Supreme Court

Document:

562 N.W.2d 433 (1997) PIRELLI-ARMSTRONG TIRE COMPANY and Travelers Insurance Company, Appellants, v. Vern REYNOLDS, Appellee. No. 96-471. Supreme Court of Iowa. April 23, 1997. *434 Steven M. Nadel of Ahlers, Cooney, Dorweiler, Haynie, Smith & Allbee, P.C., Des Moines, for appellants. Robert W. Pratt and Max Schott, Des Moines, for appellee. Considered by McGIVERIN, C.J., and LARSON, NEUMAN, SNELL, and ANDREASEN, JJ. LARSON, Justice. This is an appeal by Pirelli-Armstrong Tire Company and its insurer (collectively Pirelli) from a district court judgment affirming an industrial commissioner's order approving a worker's application for alternative medical care under Iowa Code section 85.27 (1993). We affirm. Vern Reynolds, a Pirelli employee, suffered a work-related knee injury in November 1993. Because of persistent symptoms stemming from the injury, Reynolds requested medical attention. Pirelli referred him to Dr. Breedlove, Pirelli's authorized physician, in February 1994. Dr. Breedlove recommended a peroneal nerve decompression, a procedure, which, the doctor explained, involves certain risks. Reynolds originally agreed to the surgery, but he later decided against it because of the risks. Reynolds requested a second opinion, and Pirelli referred him to a Dr. Kirkland, who saw him for the first time in May 1994. Dr. Kirkland recommended foregoing surgery in favor of anti-inflammatories and a quadriceps-strengthening program. In June and July of 1994, Reynolds returned to Dr. Kirkland, complaining of continued pain. Dr. Kirkland again recommended against surgery and reaffirmed his original recommendation of the more conservative treatment. During the following year, Reynolds' condition worsened. The original company doctor, Dr. Breedlove, examined him again in April of 1995. He noted that Reynolds suffered "fairly significant pain" and diagnosed Reynolds' condition as a "mild peroneal nerve compression syndrome, right knee." Dr. Breedlove again suggested that Reynolds have surgery. Reynolds again declined. In May 1995, a year after he was first seen by Dr. Kirkland, Reynolds' pain was more intense, and he returned to Dr. Kirkland for another examination. Dr. Kirkland stated in his report: Reynolds decided to see a third doctor, Dr. Riggins, who recommended "diagnostic arthroscopy with arthroplasty of the right patella." In layman's terms, as Reynolds put it, he would have his knee "scoped" and a "rough edge buffed down." Reynolds was amenable to Dr. Riggins' recommendation, and he requested that Pirelli approve this procedure, which would be done by a Dr. Kimmelman. Pirelli refused. Reynolds filed an application for alternative medical care under Iowa Code section 85.27, and that is the basis of this appeal. Section 85.27 provides in part: (Emphasis added.) After a hearing on the application, a deputy industrial commissioner authorized the alternative medical care, stating: This decision is based on two alternative grounds: (1) the care provided by Pirelli was not "reasonably suited to treat the injury without undue inconvenience to the employee" as required by Iowa Code section 85.27; and (2) Dr. Kirkland, in effect, referred Reynolds to another doctor by stating to Reynolds that "he is free to get a second opinion and I would welcome it." (A referral to another doctor does not require the employer's consent or the industrial commissioner's approval, according to the commissioner's interpretation of section 85.27. See Antelman v. Holmes Oldsmobile Co., No. 988000, Iowa Industrial Commissioner (arb. dec.) (June 1993)). As to the first basis for the decision, Pirelli contends that substantial evidence does not support the deputy's findings of unreasonableness and that the deputy erred in characterizing Dr. Kirkland's conservative care as "no care" at all. The second ground for the decision is erroneous, according to Pirelli, because Dr. Kirkland's generalized statement about seeing another doctor could not, as a matter of law, be considered to be a referral. *436 We conclude that the deputy's first-stated ground is based on substantial evidence and was not affected by an erroneous application of the law. We therefore affirm the ruling on that ground and decline to address Reynolds' argument that he was referred to another doctor. The Iowa Administrative Procedure Act, Iowa Code section 17 A. 19, governs our review of this agency action. Christensen v. Snap-On Tools Corp., 554 N.W.2d 254, 257 (Iowa 1996). Long v. Roberts Dairy Co., 528 N.W.2d 122, 123 (Iowa 1995). In deciding whether substantial evidence exists, we view the record as a whole. Iowa Code § 17A.19(8)(f); Dunlavey v. Economy Fire & Cas. Co., 526 N.W.2d 845, 849 (Iowa 1995). Long, 528 N.W.2d at 123. In Long we made it clear that as a general rule the employer, not the employee, is permitted to choose the medical care to be furnished. The burden is on the employee to show that the care chosen by the employer is not reasonably suited to treat the injury. Id. Reasonableness, of course, is a fact question. Id. In Long the employer's doctor referred Long to an orthopedic surgeon, Dr. Reagen. When Long's pain persisted, Dr. Reagen recommended three options: (1) do nothing and continue with work activity as tolerated, (2) seek an additional evaluation either at Mayo Clinic or the University of Iowa Hospitals, or (3) consider a pain management clinic. Id. The insurer initially authorized Long to be examined by a doctor from Mayo Clinic but then refused to authorize the examination when the doctor required preliminary diagnostic testing that would have cost over $5000. Instead, the insurer arranged for Long to see a doctor at University Hospitals. Long refused and filed an application under Iowa Code section 85.27 for an order by the industrial commissioner requiring the insurer to pay for the examination at Mayo. The industrial commissioner refused to order the examination at Mayo because Long had failed to show that the treatment authorized by the insurer was not reasonably suited for his injury. The district court rejected this ruling, but on appeal, we sustained it and affirmed the commissioner's decision. We said: Long, 528 N.W.2d at 124. In Long we noted that the referring doctor proposed either the Mayo Clinic or the University Hospitals as "reasonable treatment alternative[s] from the outset" and that the care at the University Hospitals could not be shown to be inferior or less extensive than what Mayo could provide. Id. This is because, at that point, no one could say which facility would be more effective because Long had not received treatment at either. Id. Long must be distinguished from the present case. Here, there was substantial evidence that the care authorized by the employer was ineffective. Reynolds' pain had increased, and his leg had atrophied during the year he had been treated by the company-approved doctor. The ineffectiveness of an employer-authorized medical provider has figured prominently in courts finding that such care is not reasonably suitable. It has been observed that 99 C.J.S. Workmen's Compensation § 273, at 933 (1958). See generally Jane Massey Draper, Annotation, Workers' Compensation: Reasonableness of Employee's Refusal of Medical Services Tendered by Employer, 72 A.L.R.4th 905 (1989) (annotating cases interpreting "reasonableness" language of statutes similar to Iowa Code section 85.27). In Stufflebean v. City of Fort Dodge, 233 Iowa 438, 9 N.W.2d 281 (1943), we noted that an employee could not refuse treatment selected by the employer without losing workers' compensation benefits if that treatment "does not seriously endanger claimant's life or health and which is shown to be reasonably certain to minimize or cure the disability for which compensation is sought...." 233 Iowa at 440, 9 N.W.2d at 283 (emphasis added). In Bowles v. Los Lunas Schools, 109 N.M. 100, 781 P.2d 1178 (App.1989), the question was whether the worker had been justified in refusing the care proffered by the employer. The New Mexico court stated that, taken in the context of a New Mexico statute, Bowles, 781 P.2d at 1184 (citation omitted). In Joyce Western Corp. v. Workmen's Compensation Appeal Board, 518 Pa. 191, 542 A.2d 990 (1988), the court stated: Joyce W. Corp., 542 A.2d at 996 (footnote omitted). We conclude that when evidence is presented to the commissioner that the employer-authorized medical care has not been effective and that such care is "inferior or less extensive" than other available care requested by the employee, Long, 528 N.W.2d at 124, the commissioner is justified by section 85.27 to order the alternate care. We conclude that substantial evidence was presented to justify the commissioner's decision, and we therefore affirm. AFFIRMED.