Title: SHERRY LANE WALTER v. STATE OF WYOMING, ex rel., WYOMING WORKERS' SAFETY AND COMPENSATION DIVISION

State: wyoming

Issuer: Wyoming Supreme Court

Document:

SHERRY LANE WALTER v. STATE OF WYOMING, ex rel., WYOMING WORKERS' SAFETY AND COMPENSATION DIVISION2011 WY 52Case Number: S-10-0087Decided: 03/24/2011NOTICE: This opinion is subject to formal revision before publication in Pacific Reporter Third. Readers are requested to notify the Clerk of the Supreme Court, Supreme Court Building, Cheyenne, Wyoming 82002, of any typographical or other formal errors so correction may be made before final publication in the permanent volume.
OCTOBER 
TERM, A.D. 2010

 
 
SHERRY 
LANE-WALTER,Appellant(Petitioner),v.STATE OF 
WYOMING, ex rel., WYOMING WORKERS' SAFETY AND COMPENSATION 
DIVISION,Appellee(Respondent).

 
 
Appeal 
from the District Court of Johnson County

 
 

Representing 
Appellant:

George 
Santini of Ross, Ross & Santini, LLC, Cheyenne, WY.

 
 

Representing 
Appellee:

Bruce 
A. Salzburg, Wyoming Attorney General; John W. Renneisen, Deputy Attorney 
General; James Michael Causey, Senior Assistant Attorney General; and Kelly 
Roseberry, Assistant Attorney General.  
Argument by Ms. Roseberry.

 
 
 
 

HILL, 
J., 
delivers the opinion of the Court; BURKE, J., files a special concurrence, 
with whom VOIGT, J., 
joins.

 
 

HILL, 
Justice.

 
 
[¶1]      Appellant, Sherry 
Lane-Walter (Lane-Walter), challenges an order of the district court which 
affirmed the decision of a Medical Commission Hearing Panel (Medical 
Commission).  The Medical 
Commission's order denied the benefits Lane-Walter sought for a back surgery 
procedure.  Benefits were denied on 
the basis that the surgical procedure at issue, to implant an X STOP®1 device in Lane-Walter's back, did 
not qualify as "reasonable and necessary medical care."  Lane-Walter contends that she was 
entitled to that "medical care" under paragraph 7 of the settlement agreement 
that she reached with the Wyoming Workers' Safety and Compensation Division on 
May 19, 1997.  In addition, 
Lane-Walter sought preauthorization for the surgery and was told by the Wyoming 
Workers' Safety and Compensation Division (Division) that preauthorization was 
not required in her case.  After the 
surgery had been successfully completed and Lane-Walter had recovered much of 
her ability to perform the usual activities of her daily life, albeit with some 
disability still remaining, all of the claims submitted to the Division by her 
health care providers were denied.  
The basis for the denial was that the surgery at issue was "not 
reasonable or medically necessary."

 
 
[¶2]      We will reverse 
the order of the district court which affirmed the Medical Commission's 
decision.  Furthermore, we remand 
this matter to the district court with directions that it further remand it to 
the Division with directions that Lane-Walter's claims for the X STOP surgery be 
paid because the Division's and the Medical Commission's decisions that the 
surgery was not "reasonable or medically necessary" are not sustainable under 
our prevailing standard of review, given the unique facts and circumstances of 
this case.

ISSUES

 
 
[¶3]      Lane-Walter poses 
these as the issues for our resolution:

 
 
1.  Is 
the decision of the Medical Commission arbitrary and capricious for the reason 
that it omitted material evidence from its Findings of Fact, Conclusions of Law 
and Order?

 
 
2.  Did 
the Medical Commission improperly [rely] upon medical opinions which were based 
upon an inadequate foundation?

 
 
3.  Was 
it arbitrary, capricious, and an abuse of discretion to apply the Wyoming 
Workers' Safety and Compensation Division's preauthorization guidelines to deny 
claims for medical treatment when [Lane-Walter] and her treating surgeon were 
informed  [by the Division] that 
those guidelines and procedures were not applicable to her 
claim?

 
 
The 
Division articulates the following as the pertinent 
issues:

 
 
I.  Are 
the findings of the Medical Commission arbitrary, capricious, or otherwise not 
in accordance with Wyoming law?

 
 
II.  Can 
the Medical Commission's use of the FDA Preauthorization Guidelines to determine 
medical reasonability and necessity be properly raised for the first time on 
appeal, and does it exceed its authority?

 
 
FACTS 
AND PROCEEDINGS

 
 
[¶4]      Lane-Walter 
worked for FMC Corporation in Sweetwater County, Wyoming.  She operated a roof bolter in an 
underground mine.  She suffered an 
injury to her back in November of 1982, and again in November of 1984, when she 
was approximately 30 years of age.  
The record demonstrates that Lane-Walter never went back to any 
meaningful work after her 1984 injury, although the details of all the surgical 
procedures that were performed between 1984 and 1994 are not included in the 
record on appeal.  It suffices to 
note here that Lane-Walter's post-injury medical condition appears to have been 
exacerbated by a series of unsuccessful surgeries that were intended to restore 
her to a condition of health so that she could return to some form of gainful 
employment.  That goal was never 
reached.  Because she lived in 
southwestern Wyoming, Lane-Walter received much of her initial medical treatment 
in Utah, and she continued to rely on those physicians even after she moved to 
northern Wyoming.

 
 
[¶5]      The record also 
reflects that Lane-Walter's interaction with the Division was extremely 
unsatisfactory, in her eyes, and that her efforts to obtain medical treatment 
and worker's compensation benefits were often frustrated by the Division.  See, e.g., FMC v. Lane, 773 P.2d 163 (Wyo. 1989).  On May 19, 1997, the Division and 
Lane-Walter entered into an agreement that was entitled "Order Approving 
Stipulation and Awarding Benefits":

 
 
1.  The 
Employee-Claimant [Lane-Walter] was injured in an industrial accident on 
November 15, 1984.

 
 
2.  [Lane-Walter] 
has already received substantial payments for temporary total disability, 
permanent total disability, extended benefits pursuant to § 27-14-405(b) W.S. 
1977 (1983 repl.), and payment of substantial medical bills. 

 
 
3.  [Lane-Walter's] 
claims for extended permanent total disability benefits pursuant to § 
27-12-405(d) W.S. 1977 (1983 repl.), and subsequent revisions thereof, and any 
and all future awards for disability, including but not limited to permanent 
partial, temporary total, loss of earnings or extended benefits are settled for 
the one time lump sum payment of $70,000.00.

 
 
4.  [Lane-Walter] 
shall submit to a complete Independent Medical Evaluation with Dr. Nielsen of 
Provo, Utah, or Dr. Stephen Emery of Cody, Wyoming. 

 
 
5.  [Lane-Walter] 
shall submit to a functional capacities examination to evaluate her current 
physical capabilities, including progress, malingering, regression, symptom 
magnification or status quo.

 
 
6.  [Lane-Walter] 
shall submit to a complete psychological evaluation.  Said evaluation will include all current 
psychological conditions, all pre-existing psychological conditions and all 
psychological conditions which are a result of the industrial 
injury.

 
 
7.  The 
Division will pay only for medical treatments related to the work place injury, 
as per statute and fee schedule.

 
 
8.  The 
Division will pay all travel costs associated with the above described 
evaluations and assessments. 

 
 
9.  Except 
for the evaluations specified in paragraphs 4, 5, and 6 above, the Division will 
not pay travel expenses for any out of state medical treatments or procedures 
for [Lane-Walter] in the future.  
The Division will continue to pay travel expenses for in state treatments 
or procedures for [Lane-Walter] which are related to the industrial 
injury.

 
 
10.  [Lane-Walter's] 
claim for extended permanent total disability benefits as described above are 
dismissed with prejudice as to any future action.

 
 
11.  The 
Division reserves the right to object to the payment for any medical procedures 
or treatments which are not related to the industrial 
injury.

 
 
[¶6]      Lane-Walter had 
the last of her initial series of surgeries in 1994.  After the above-quoted agreement was 
finalized, Lane-Walter continued to treat with orthopedic surgeons Jonathan 
Horne, M.D., and then his brother, Robert Horne, M.D.  Although the subject of additional 
surgeries came up often in the meantime, Lane-Walter was opposed to any further 
surgery because prior surgeries had only served to increase her disability and 
loss of enjoyment in living.  As is 
evidenced in much of the material contained in this record, Lane-Walter not only 
suffered the back injury and its associated pain, but she also suffered 
generalized pain, depression, anxiety, sleeplessness, and hostility toward both 
her healthcare providers and the Division.  
As a generalization, we will note here that both the Division and Medical 
Commission treated these side effects as being very significant in denying her 
benefits in the instant proceedings.

 
 
[¶7]      The Medical 
Commission included in its findings a reference to one page of a four-page 
document, to which was appended a second document 19 pages in length.  Those documents appear to have 
originated from the Department of Health and Human Services, Public Health 
Service, Food and Drug Administration.  
The Commission included most of the conclusions that were drawn as to 
clinical studies (a description of the kinds of patients who were likely to 
benefit from its implantation) but deleted this:  "A significantly greater proportion of X 
STOP patients achieved overall treatment success, compared to control 
patients."  Immediately following 
the material quoted by the Commission is this:

 
 
The 
X STOP device met the primary clinical study endpoint for success, exceeding the 
success rate of the control in every statistical analysis.  The implant resulted in a low percentage 
of complications, each of which resolved without significant clinical sequalae 
and no neurological or vascular injuries.  
The X STOP implantation procedure is a much less invasive procedure than 
other surgical decompressive procedures such as laminectomy, and can often be 
performed under local anesthesia.  
The procedure preserves local anatomy so that, should device removal 
become necessary, additional surgical options such as laminectomy are not 
precluded.

 
 
[¶8]      Lane-Walter's 
attending surgeon testified at length about his assessment of her for the X STOP 
surgery.  That testimony established 
that Lane-Walter met all of the "Indications for Use" prescribed by the 
manufacturer.  Dr. Horne also 
testified that he had assured himself that Lane-Walter met all the criteria on 
the "Preauthorization Check Sheet," although he did not fill one out and send it 
to the Division, because the Division had informed him that was not 
necessary.

 
 
[¶9]      Lane-Walter 
finally began to move in the direction of reconsidering surgery in 2007, when 
Dr. Horne recommended an X STOP® implant and because the pain she was suffering 
had become intolerable.  Lane-Walter 
claimed, and the Division did not deny or in any way attempt to rebut, that she 
was told the surgery did not require pre-authorization.  The surgery was very much a success from 
Dr. Horne's and Lane-Walter's points of view.

 
 
[¶10]   In late 2007, the Division finally 
gave recognition to the X STOP procedure and created a preauthorization form for 
that procedure.  The evidence heard 
by the Medical Commission demonstrated that Lane-Walter's surgeon ascertained 
that she fit all of the criteria established by the manufacturer for use of the 
X STOP®.  However, her surgeon did 
not actually fill out the form because the Division determined that Lane-Walter 
was not required to obtain "preauthorization" and the document was entitled a 
"Preauthorization Checklist."  The 
documentation contained in the record on appeal reveals that the X STOP® has 
been in generalized use throughout the "industrialized democracies" of Europe, 
Asia, Africa, and the South Pacific since 2001, and was approved by the FDA in 
the United States in 2005.  The 
Division gave tentative recognition to it in late 2007.  Dr. Horne, who treated Lane-Walter, was 
deemed not to be a credible witness because he had been intemperately critical 
of the Division, the Medical Commission, and the experts hired by the Division, 
for their apparent ignorance with respect to the benefits of the X STOP 
procedure.  We think it hardly needs 
to be said that the Medical Commission acted arbitrarily and capriciously, if 
not punitively, in utilizing Dr. Horne's intemperate words as a factor in 
denying Lane-Walter benefits to which she was entitled under the terms of her 
settlement with the Division.

 
 
[¶11]   After the surgery, Lane-Walter 
continued to use many of the same prescription medications, including pain 
medication, as she had before the surgery, but at a much reduced level.  Both the Division and the Medical 
Commission treated her continued use of those medications as proof that the 
surgery was not "reasonable or necessary" -- or successful -- even though both 
subjective and objective data pointed very much to the 
contrary.

 
 
[¶12]   The Division used two Independent 
Medical Evaluations (IMEs) to attempt to rebut Dr. Horne's testimony and the 
documentary record.  We note at the 
outset that the evaluations refer to documents, but there is no way to ascertain 
from the reports themselves which document is being cited or which, if any, of 
those "voluminous records" are actually in the record on appeal.  The first was done by Judson Cook, M.D., 
on April 10, 2008.  He did not 
actually see or talk to Lane-Walter.  
In his report, Dr. Cook concludes that he does not think the problems 
that Lane-Walter was encountering in 2008 could be related back to the original 
injury, although that was not at issue in these proceedings.  He also concludes that he would not have 
authorized the X STOP procedure had he been the attending physician, but he 
might change his mind if he saw additional documentation.  Such documentation existed, but Dr. Cook 
did not have it available to him.  
It could be said that he overruled the medical advice given by Dr. Horne, 
who was intimately familiar with Lane-Walter's 24-year-long medical history, 
with a two and one-half hour review of "some" of the pertinent medical records 
and without seeing any of the radiological data upon which Dr. Horne had 
relied.  Most importantly, Dr. Cook 
changed the tenor of his IME considerably when he testified at the 
hearing.

 
 
[¶13]   The second IME was done by Stephen 
F. Emery, M.D.  He prepared his 
report on May 5, 2008.  He too did 
not actually see or talk to Lane-Walter.  
He indicates in the first paragraph of his review that it was directed at 
ascertaining whether or not Lane-Walter met the criteria set out in the 
preapproval checklist and never really makes mention of the matter of whether it 
was reasonable or medically necessary.  
His conclusion is that a nurse said that Lane-Walter was still in a lot 
of pain after the surgery, and that the patient miraculously no longer felt 
numbness in her toes, even though the surgery could not have produced such an 
effect.  It is significant that Dr. 
Emery focused much of his attention on a 1992 psychological evaluation that 
indicated that Lane-Walter was not a good candidate for further surgery, at that 
time, nearly 16 years previous to the surgery at issue here.  He spent a total of six hours on his 
report.

 
 
[¶14]   What appears to be a fairly 
complete summary of Lane-Walter's medical history appears in the record on 
appeal in the form of an IME done by Karl Douglas Nielson, M.D., F.A.C.S., in 
1998.  It appears that this 
evaluation was done at the behest of the Division so as to establish a baseline 
for the administration of the settlement agreement reached between the Division 
and Lane-Walter.  It is evident that 
neither Dr. Cook nor Dr. Emery saw this document, although the Medical 
Commission made brief reference to it.

DISCUSSION

 
 
Standard 
of Review

 
 
[¶15]   The issue the Medical Commission 
considered was this:

 
 
Whether 
various medical treatments including preoperative tests/examinations, 
postoperative visits, and surgery that was performed on February 15, 2008, are 
considered reasonable and medically necessary as related to [Lane-Walter's] back 
injury that occurred November 15, 1984, and are therefore 
compensable.

 
 
[¶16]   We apply the standard of review we 
articulated in Dale v. S & S 
Builders, LLC, 2008 WY 84, 
¶¶ 22-24, 188 P.3d 554, 561 
(Wyo. 2008):

 
 
[I]n 
the interests of simplifying the process of identifying the correct standard of 
review and bringing our approach closer to the original use of the two 
standards, we hold that henceforth the substantial evidence standard will be 
applied any time we review an evidentiary ruling.  When the burdened party prevailed before 
the agency, we will determine if substantial evidence exists to support the 
finding for that party by considering whether there is relevant evidence in the 
entire record which a reasonable mind might accept in support of the agency's 
conclusions.  If the hearing 
examiner determines that the burdened party failed to meet his burden of proof, 
we will decide whether there is substantial evidence to support the agency's 
decision to reject the evidence offered by the burdened party by considering 
whether that conclusion was contrary to the overwhelming weight of the evidence 
in the record as a whole.  See, Wyo. Consumer Group v. Public Serv. Comm'n 
of Wyo., 882 P.2d 858, 860-61 (Wyo.1994); Spiegel, 549 P.2d  at 1178 (discussing 
the definition of substantial evidence as "contrary to the overwhelming weight 
of the evidence").  If, in the 
course of its decision making process, the agency disregards certain evidence 
and explains its reasons for doing so based upon determinations of credibility 
or other factors contained in the record, its decision will be sustainable under 
the substantial evidence test.  
Importantly, our review of any particular decision turns not on whether 
we agree with the outcome, but on whether the agency could reasonably conclude 
as it did, based on all the evidence before it.

 
 
            
The arbitrary and capricious standard remains a " safety net' to 
catch agency action which prejudices a party's substantial rights or which may 
be contrary to the other W.A.P.A. review standards yet is not easily categorized 
or fit to any one particular standard."  
Newman, ¶ 23, 49 P.3d  at 
172.   Although we explained 
the "safety net" application of the arbitrary and capricious standard in Newman, we will refine it slightly here 
to more carefully delineate that it is not meant to apply to true evidentiary 
questions.  Instead, the arbitrary 
and capricious standard will apply if the hearing examiner refused to admit 
testimony or documentary exhibits that were clearly admissible or failed to 
provide appropriate findings of fact or conclusions of law.  This listing is demonstrative and not 
intended as an inclusive catalog of all possible circumstances.  Id.

 
 
            
There will be times when the arbitrary and capricious standard appears to 
overlap with some of the other standards.  
For example, a decision against the great weight of the evidence might 
properly be called arbitrary or capricious in everyday language.  However, the words "arbitrary" and 
"capricious" must be understood in context as terms of art under the 
administrative review statute and should not be employed in areas where the more 
specifically defined standards provide sufficient relief.

 
 
[¶17]   This case presents an unusually 
narrow and ill-defined issue.  It 
was long-ago established, and it is still very much a governing fact, that 
Lane-Walter's back problems stemmed from a work-related injury, and that under 
the settlement agreement set out above, the Division is obligated to pay for 
reasonable and medically necessary treatment incidental to that injury.  In this proceeding, she did not carry 
any burden in that regard, i.e., her injury is work-related and the treatment 
was deemed reasonable and necessary by her attending physician.  The Division was not called upon to 
judge that decision and, to the extent that it had the opportunity to weigh in 
on it (preauthorization for surgery), it declined to do so.  Lane-Walter's credibility was not at 
issue because the only testimony she gave that was crucial to the resolution of 
this case was that she agreed to undergo surgery that was recommended to her by 
her treating physician of many years duration, and she had entered into a 
settlement agreement with the Division that the Division would pay for such 
treatment(s).

 
 
[¶18]   We also conclude that the principal 
burden of proof, in these unusual circumstances, was on the Division.  It was required to demonstrate that the 
treatment Lane-Walter received was not reasonable and not medically necessary.  Lane-Walter testified that the surgery 
was efficacious, i.e., it accomplished the intended goal of relieving some of her pain and lessening 
the degree of her disability.   
Neither she nor her attending physician ever suggested that the X STOP® 
 was going to be a miraculous "cure" 
for all that ailed Lane-Walter.

 
 
[¶19]   The burden of proof that the 
Medical Commission appears to have attempted to place on Lane-Walter is that 
which the Division claims to arise from Wyo. Stat. Ann. § 27-14-102(a)(xii) 
(LexisNexis 2009) (emphasis added):

 
 
            
(xii) "Medical and hospital 
care" when provided by a health care provider means any reasonable and 
necessary first aid, medical, surgical or hospital service, medical and 
surgical supplies, apparatus, essential and adequate artificial replacement, 
body aid during impairment, disability or treatment of an employee pursuant to 
this act including the repair or replacement of any preexisting artificial 
replacement, hearing aid, prescription eyeglass lens, eyeglass frame, contact 
lens or dentures if the device is damaged or destroyed in an accident and any 
other health services or products authorized by rules and regulations of the 
division.   "Medical and 
hospital care" does not include any personal item, automobile or the remodeling 
of an automobile or other physical structure, public or private health club, 
weight loss center or aid, experimental medical or surgical procedure, item of 
furniture or vitamin and food supplement except as provided under rule and 
regulation of the division and paragraph (a)(i) of this section for impairments 
or disabilities requiring the use of wheelchairs[.]

 
 
3 
Weil's Code of Wyoming Rules, Department of Employment, Workers' Compensation Rules, Regulations and 
Fee Schedules, 025 0220 001-1 through 025 0220 001-21 flesh out how the 
Division views the above language.  
For instance, ch. 1, § 4(al), 025 0220 001-5 (Sept. 2008) (emphasis 
added), provides:  "Medically 
Necessary.  Medically necessary 
treatment' means those health services for a compensable injury that are 
reasonable and necessary for the diagnosis and cure or significant 
relief of a condition consistent with any applicable treatment 
parameter."  Ch. 7, § 3(a)(i), 025 
0220 001-20 (Oct. 2006) provides that "[workers] with injuries compensable under 
the Act shall be provided reasonable and necessary health care benefits as a 
result of such injuries."  See Palmer v. State ex rel. Wyo. Workers' Safety 
& Comp. Div., 2008 WY 
105, ¶¶ 17-18, 192 P.3d 125, 129-30 (Wyo. 2008).

 
 
[¶20]   As noted above, Lane-Walter had her 
surgery on February 15, 2008.  About 
two and one-half months earlier, on December 5, 2007, the Division adopted "X-stop interspinous process decompression 
system preauthorization guidelines."  
The guidelines included a "Preauthorization Checklist."  The evidence adduced at the hearing into 
this matter established that Lane-Walter and her physician sought 
preauthorization but were told that it was not required in her case.  Why that was so is not explained by the 
record on appeal, but the Division did not contradict or otherwise challenge 
that claim.  It is unfortunate that 
Lane-Walter and her physician did not insist that it be placed in written form, 
and perhaps this case will serve as a warning in that regard for future 
claimants.  In any adversary 
setting, "getting it in writing" is just simply one of the ABC's, even if one is 
compelled to create one's own regularly kept business record to achieve that 
goal.  Past precedents establish 
that this is especially true with respect to worker's compensation claimants  
comprehensive documentation is always critical.

 
 
[¶21]   In its findings, the Medical 
Commission carefully and selectively edited out all evidence offered by 
Lane-Walter which explained her side of this case.  The Medical Commission's findings reveal 
that it did not understand the burden of proof applicable in this case nor did 
it understand its role in presenting an accurate summary of the evidence that 
Lane-Walter offered in support of the very limited proof that she was required 
to present in this case.  The 
Medical Commission relied very heavily upon Dr. Emery's IME.  Virtually all of his "opinions" were 
based upon dated materials which he summarized inaccurately and in a manner that 
shed the worst possible light on Lane-Walter.  The record also reflects that 
Lane-Walter was sent to see Dr. Emery for an IME in 1997, but he refused to see 
her.  Fortunately, a thorough IME 
was done by Dr. Nielsen of Provo, Utah, in 1998.  The Medical Commission relied on that 
report to determine that she was not a good candidate for the X STOP surgery in 
2008 (a non-invasive procedure not developed until well after 1998, and one that 
can be undone readily without any significant damage to the patient).  The Medical Commission also concluded 
that, because of the seven failed surgeries which exacerbated her seemingly 
relatively minor back injury of 1984, she was not a good candidate for the X 
STOP®  in 2008.  It is evident from the transcript of the 
hearing that Lane-Walter's surgeon, Dr. Horne, and the Medical Commission's 
expert witness, Dr. Cook, came pretty close to seeing eye-to-eye about Lane 
Walter's treatment by the end of the hearing process.  The only exception to that was the 
failure to complete a comprehensive pre-surgery authorization, which the 
Division did not require in this case.  
Finally, we must note with a sense of bewilderment that Lane-Walter was 
considered to be a dishonest witness because she claimed that numbness in three 
of her left toes was improved by the X STOP surgery, whereas Dr. Emery said it 
was not possible that the surgery could have had that beneficent effect.  We are unwilling to accept such a leap 
of logic.  Lane-Walter said her toes 
were improved and there was no meaningful testimony in this record to dispute 
that.  Moreover, even assuming for 
the purpose of argument that Lane-Walter was describing something that medical 
science cannot measure, one way or the other, it is not the "stuff" that a fact 
finder could use to label all of her testimony as 
"incredible."

 
 
CONCLUSION

 
 
[¶22]   To the extent that Lane-Walter had 
a burden of proof in this case, we hold:  
There is not substantial evidence to support the agency's decision to 
reject the evidence offered by Lane-Walter.  We reach that decision by considering 
whether the Medical Commission's conclusions were contrary to the overwhelming 
weight of the evidence in the record as a whole.  The Medical Commission's determinations 
that both Dr. Horne and Lane-Walter were not credible witnesses are not 
supported by substantial evidence, i.e., there is not relevant evidence in the 
record which a reasonable mind might accept in support of the Medical 
Commission's conclusions.  The order 
of the district court affirming the Medical Commission is reversed.  Furthermore, this matter is remanded to 
the district court with directions that it further remand it to the Medical 
Commission with directions that it direct the Division to pay the claims 
submitted by Lane-Walter and her health care providers for the reasonable and 
necessary medical treatment at issue in this case.

  

BURKE, 
Justice, 
specially concurring, with whom VOIGT, Justice, 
joins.

 
 

[¶23]   I 
concur in the result reached by the majority.  I write separately because I disagree 
with the majority's conclusion that the burden of proof was on the Division "to 
demonstrate that the treatment Lane-Walter received was not reasonable and not medically necessary."  (Emphasis in original.)  I am unable to join in that 
determination for several reasons.

 
 
[¶24]   First, the issue was not raised by 
Claimant at the hearing level, on appeal with the district court, or in the 
appeal to this Court.  The 
Commission, in its Order, specifically determined that Claimant had the burden 
of proof.  Claimant has never 
challenged that determination.  
Because the issue has never been raised, the Division has had no 
opportunity to present its position regarding the proper allocation of the 
burden of proof.  Compare Guier v. Teton County Hosp. Dist., 2011 
WY 31,      P.3d       (Wyo. 2011) (where we considered the 
proper allocation of the burden of proof when that issue was raised at the 
administrative hearing and on appeal, and was adequately briefed to this 
Court).  Claimant has never argued 
that the Commission applied an incorrect burden of proof.  She simply asserts that she satisfied 
her evidentiary burden at the hearing.  
Because the issue has never been raised, this Court should not consider 
it.  Duffy v. State, 730 P.2d 754, 758 (Wyo. 1986) 
("Under the settled authority of this court we will not consider [those] points 
which have not been briefed." (quoting Zanetti v. Zanetti, 689 P.2d 1116, 1123 (Wyo. 1984))). 

 
 
[¶25]   Second, placing the burden of proof 
on the Division conflicts with our precedent.  We have steadfastly held that the 
claimant in a worker's compensation case bears the burden of proving all 
elements of her claim for benefits.  See, e.g., Kenyon v. State ex rel. Wyo. 
Workers' Safety & Comp. Div., 2011 WY 14, ¶ 21,       P.3d       (Wyo. 2011); Bailey v. State ex rel. Wyo. Workers' Safety 
& Comp. Div., 2010 WY 152, ¶ 15, 243 P.3d 953, 957 (Wyo. 
2010); Alphin v. State ex rel. Wyo. Workers' Safety 
& Comp. Div., 2010 WY 39, ¶ 17, 228 P.3d 61, 68 (Wyo. 2010); 
Glaze v. State ex rel. Wyo. Workers' Safety 
& Comp. Div., 2009 WY 102, ¶ 13, 214 P.3d 228, 231 (Wyo. 2009); Dale v. S & S Builders, 
LLC, 2008 WY 84, ¶ 35, 188 P.3d 554, 563 
(Wyo. 2008).  We should not 
depart from our precedent in this case.  
Ms. Lane-Walter, as Claimant, had the burden of 
proof.

 
 
[¶26]   Third, the majority cites no legal 
authority for switching the burden of proof to the Division.  The sole 
justification offered is that it is appropriate "in these unusual 
circumstances."  The specific 
circumstances significant to the majority's decision are not easily identified 
from the opinion.  Is it the prior settlement agreement?  The representation by a Division employee 
that prior authorization was not required?  The evidentiary conflict arising from the 
testimony of the medical experts?  All of those reasons, or just some of 
them?  Or another reason 
entirely?  The majority opinion provides no guidance as to what facts and 
circumstances will mandate a reallocation of the burden of proof in future 
cases.  

 
 
[¶27]   Fourth, switching the burden of 
proof to the Division in this case will cause problems in future cases.  Here, the Commission and the parties 
proceeded with the understanding that Claimant had the burden of proof.  
Accordingly, Claimant's counsel made the initial opening statement, followed by 
an opening statement from counsel for the Division.  Claimant then 
presented her evidence.  After Claimant rested, the Division presented its 
evidence.  As I understand the majority opinion, this procedure was 
incorrect.  Because the Division had the burden of proof, it should have 
made the initial opening statement and presented its evidence first.  Prior to this decision, in similar 
cases, the parties and the Commission understood who had the burden of 
proof.  Now, because of this 
decision, there will be doubt.  Are the facts of the next case "unusual" 
enough to justify switching the burden to the Division?  How will that decision be made?  When should it be made?  In this case, the majority has apparently 
concluded that the decision can be made after evidence has been presented and 
can be based upon evidence presented at the hearing.  That procedure is 
simply unworkable.  It is essential 
that the parties and the Commission understand prior to commencement of the 
hearing which party bears the burden of proof.  Ex post facto assignment of the burden 
of proof to a particular party based upon evidence presented at the hearing will 
only cause confusion.

 
 

FOOTNOTES

1The X STOP® is an interspinous decompression system.  This medical device is indicated for 
treatment of patients age fifty (50) or older suffering from intermittent 
neurogenic claudication secondary to a confirmed diagnosis of lumbar spinal 
stenosis.  It is a titanium implant 
that fits between spinous processes of the lumbar spine.  It is made from titanium alloy and 
consists of two components: a spacer assembly and a wing 
assembly.