# Supreme Court of Louisiana

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FROM: CLERK OF SUPREME COURT OF LOUISIANA

The Opinions handed down on the **29th day of June, 2017** , are as follows:

**BY JOHNSON, C.J.** :

2016 -C-2 267 DARVEL BURGESS v. SEWERAGE & WATER BOARD OF NEW ORLEANS ( Office of Workers’ Compensation, District 8)

We remand this matter to the OWC for a determination of whether IWP is a permissible out

- of

- state provider under La. R.S. 23:1203(A). If so, the OWC judge must then determine the amount of reimbursement due after application of La. R.S. 23:1203(B), Lafayette Bone & Joint, and La. R.S. 23:1142. REVERSED AND REMANDED TO THE OFFICE OF WORKERS' COMPENSATION FO R FURTHER PROCEEDINGS CONSISTENT WITH THIS OPINION.

JOHNSON, C.J., additionally concurs and assigns reason s. HUGHES, J., dissents and will assign reasons. GENOVESE, J., dissents and assigns reasons.06 /2 9/ 20 17 SUPREME COURT O F LOUI SI ANA

No. 2 01 6- C-2 26 7

DARVEL BURGES S

VERSUS SEW ERAGE & W ATER BO ARD OF NEW ORLE ANS

ON WRI T OF CERTI ORARI T O TH E COURT OF APPEAL, FOURTH CIRCUI T, OFFICE OF WORK ERS’ COMPE NSATI ON DIS TRI CT 8

JO HNSO N, Chief

Ju st ic e

In th is wor k ers ’ co m

pe ns at io n cas e, th e cl ai m an t, Darv el Bu rg es s, fil ed a

Dis pu te d Cl ai m fo r C o mp en sa ti on aft er hi s em pl oyer, S ewera ge & W at er Bo ard of

New O r l e a n s (“ S&WB”), refu se d to pa y a $1 3,1 10 .02 ou ts ta nd in g bi ll fo r

pr es cri pt io n m ed ic at io ns fro m In jure d W or ke rs Ph arm acy (“ IWP”). The un de rlyin g

le ga l iss ue is whe th er t he in jure d em pl oyee is en ti tl ed to hi s cho ic e of ph arm acy, or

whe th er th at rig ht be lo ng s to th e em pl oyer un de r th e Lou is ia na W or ke rs

Co m pe ns at io n Act (“ LW CA”). W e gr an te d th is writ ap pl ic at io n to res ol ve a sp li t in

ou r ci rcu it co ur ts of ap pe al on th is is su e. Afte r rev ie w, we h o l d th e ch oi ce of
ph arm acy in a wo rk ers ’ co m pe ns at io n c as e b el on gs to th e em pl oyer.

FACTS AND PROCEDURAL HIST ORY

Darv el Bu rg es s su st ai ne d a w or k- rel at ed in jury on Octo be r 13 , 20 08

. On
Sep te m be r 18 , 20 12 , Mr. Burg es s fil ed a Dis pu te d C la im fo r Co m pe ns at io n aga in st

hi s em pl oyer, S&WB, as se rti ng i n p a r t a di sp ut e ov er un pa id m ed ic al bi ll s an d

en ti tl em en t to pe na lt ie s an d at to rn ey fees

. The m at te r was su bm it te d to th e Lou is ia na

Offi ce of W or ke rs ’ Co m

pe ns at io n (“ OW C”) so le ly on br ie fs an d ex hi bi ts

. The on ly

di sp ut ed is su es pr es en te d to th e OW C jud ge were un pa id bi ll s fro m IWP an d

Adv an ced Neu ro di ag no st ic Cen te r, as well as Mr. Burg es s’ en ti tl em en t to pe na lt ie s

1an d a tt or ne y fees as a res ul t o f S&WB’s fai lu re t o t im el y pa y th es e b il ls

. 1

In hi s br ie f su bm it te d to th e OW C, Mr. Bu rg es s as se rte d he is en ti tl ed to ha ve

al l ne ces sa ry an d rel at ed m ed ic al tre at m en t an d pr es cr i p t i o n s pa id by hi s em pl oyer

pu rs ua nt to La. R.S. 23 :1 20 3( A). He arg ue d th e un pa id bi ll s were rel at ed to tre at m en t 2

fo r hi s wor k- rel at e d i n

ju ry , in cl ud in g m ed ic at io ns pr es cri be d by hi s tre at in g
ph y si ci an , an d as su ch were reas on ab le an d ne ces sa ry

. Mr. Bu rg es s fu rth er req ue st ed

an award fo r pe na lt ie s and at to rn ey fees

. S&WB arg ue d i t i s n ot res po ns ib le for th e

ou ts ta nd in g IWP bi ll pu rs ua nt to La. R.S. 23 :1 14 2( B) beca us e it no ti fie d all in jure d

wor ke rs on Octo be r 10 , 2 01 1, t ha t h en cefo rth Co rv el Care m ark Ph arm acy pro gr am

was th e ap pr ov ed pr ov id er fo r pr es cri pt io n se rv ic es an d fai lu re of th e in jure d wor ke r

t o us e th e ph arm acy card pr ov id ed m ay res ul t in no n- pa y m en t of m ed ic at io ns

.
Add it io na ll y , S&WB no te d IWP was no ti fie d on Apr il 12 , 20 1 2 , t h a t i t was no t an

ap pr ov ed ph arm acy pr ov id er fo r S&WB’ s w o r k ers ’ co m pe ns at io n cl ai m s an d bi ll s

su bm it te d b y

IW P wou ld be de ni ed

.
On Ju ne 18 , 20 15 , th e OW C j ud ge is su ed a jud gm en t ord eri ng S&WB to pa y

th e ou ts ta nd in g $1 3,1 10 .82 bi ll fro m IWP an d al l ou ts ta nd in g m ed ic al ex pe ns es owe d

to Adv a n ced Neu ro di ag no st ic Cen te r “ vi a th e fee sc he du le .” The OW C jud ge

award ed Mr. Bu rg es s a $2 ,00 0 pe na lt y an d $ 2,0 00 in att or ne y fees du e to S&WB’ s

fai lu re to ti m el y pa y th es e bi ll s. S&WB su sp en si ve ly ap pe al ed th e jud gm en t, bu t on ly

as to th e IWP bi ll

.
The co ur t of app eal affi rm ed in a 2- 1 de ci si on

. Bur ge ss v. Se wer ag e & W

at er

Boa rd of New Orl ea ns , 15 -0 91 8 (La

. A p p

. 4 Ci r. 2/ 3/ 16 ), 18 7 So

. 3d 49 (“ Bur ge ss

I .”). In so do in g, th e Fo ur th Ci rcu it co nc lu de d th e ch oi ce of ph arm acy be lo ng s to th e

em pl oyee, no t th e em

pl oyer. 18 7 So. 3d at 57

. The co ur t no te d La. R.S. 23 :1 20 3( A)

The Adva

nced N eurodia g nostic Center bill is not at issue in thi s court. 1

For the full text of the statutes re fer red to in this section, see DISCUSSIO N , infra

. 2

2r e q ui res th e em pl oyer to pr ov id e th e em pl oyee wit h al l ne ces sa ry pr es cri pt io n

m ed ic at io n. Id

. at 51

. The co ur t of ap pe al refe ren ced an Alab am a c a s e , Dav is

Plu mbi ng , In c. v. Bur ns , 96 7 So

. 2d 94 (Ala

. Ci v. App

. 20 07 ), whi ch he ld th e ch oi ce

of ph arm acy un de r a si m il ar Alab am a st at ut e be lo ng ed to th e em pl oyee. Id

. at 52

. In

a d d i t i o n , t he co ur t an al y zed each Lou is ia na ap pe ll at e co ur t cas e on th e su bjec t an d

th e di ffer in g ou tc om es

. The co ur t of ap pe al co nc lu de d t ha t Lou is ia na is

ov erwh el m in gl y a pa ti en t’s ch oi ce st at e , o b s e rv in g th at twen ty-th ree ot he r st at es

ex pr es sl y pr ov id e fo r em pl oyer ch oi ce of tre at in g ph y si ci an an d th re e l i mi t th e

em pl oyee’s ch oi ce to a li st pr ov id ed by th e st at e ag en cy

. Id

. at 57

. In ad di ti on , th e

co ur t no te d th e LW CA co nt ai ns no pr ov is io n gr an ti ng th e em pl oyer th e rig ht to se le ct

th e ph arm acy th at th e em pl oyee m us t us e. To th e co nt rary, th e LW CA ob li ga te s th e

em pl oyer to pa

y fo r th e em

pl oyee’s reas on ab ly ne ces sa ry pr es cri pt io n m ed ic at io n an d

co nt ai ns no ex cep ti on fo r si tu at io ns in whi ch th e em pl oyer ob jects to th e p ha rm acy

th e em pl oyee se le ct s. Id

. The co ur t al so reject ed S&WB’ s rel ia nc e on La. R.S.

23 :1 14 2( B) in an at te m

pt to ob ta in th e be ne fit of th e ch oi ce of ph arm acy, fin di ng

pr es cri pt io n m ed ic at io n is no t pa rt of “ no ne m erg en cy di ag no st ic te st in g or tre at m en t”

un de r th e st at u te , an d fu rth er no ti ng th e pu rp os e of th e st at ut e is to al lo w th e

em pl oyer to co nt es t un ne ces sa ry or un reas on ab le med ic al care , no t to al lo w

em pl oyers t o b arg ai n s ho p. Id . at 5 7- 58

.
Ju dg e Lob ran o di ss en te d, fin di ng a de te rm in at io n of whe th er th e em pl oyee is

en ti tl ed to hi s ch oi ce of ph arm acy di d no t en d th e in qu iry of whe th er pa y m en t of th e

di sp ut ed ph arm acy ex pe ns es is du e or in wha t am ou nt

. Id

. a t 58

. (Lob ran o, J.,

di ss en ti ng ). Sh e no te d IWP is an ou t-o f-s ta te pr ov id er, an d La. R.S. 2 3 : 1 2 0 3 (A)

pr ov id es in pe rti ne nt pa rt, “ [m ]edi cal care , se rv ic es , an d trea tm en t m ay be pr ov id ed
by ou t-o f-s ta te pr ov id ers or at ou t-o f-s ta te faci li ti es whe n su ch c a r e , se rv ic es , an d

3tre at m en t are no t reas on ab ly av ai la bl e wit hi n th e st at e or whe n it can be pr ov id ed fo r

co m pa rab le co st s.” Fu rth er, La. R.S. 23 :1 20 3( B) li m it s th e em pl oyer’s ob li ga ti on to

“ rei m bu rs em en t...as de te rm in ed un de r th e rei m bu rs em en t sc he du le ...pu rs ua nt to R.S.

23 :1 03 4.2 , or th e act ua l ch arg e m ad e fo r th e se rv ic e, whi ch ev er is le ss .” Id

. at 58 -5 9.

Ju dg e Lob ran o fo un d th e reco rd la ck ed an y ev id en ce of whe th er IWP fit th e cri te ria

fo r a pe rm is si bl e ou t-o f-s ta te pr ov id er un de r La. R.S. 23 :1 20 3( A) or an y ev id en ce of

th e rei m bu rs em en t sc he du le se t fo rth in La. R.S. 23 :1 03 4.2 , an d th e OW C jud ge erre d
by fail in g t o co ns id er th es e is su es

. Id

. at 59 . J ud ge Lob ran o op in ed th e cas e sh ou ld

be rem an de d t o th e OW C to de te rm in e whe th er p ha rm acy exp en se s ar e d ue to IW P

as an ou t-o f-s ta te pr ov id er, an d if so , t h e a mo u n t of ex pe ns es du e pu rs ua nt to th e

rei m bu rs em en t s ch ed ul e. Id

.
S&WB so ug ht su pe rv is or y rev ie w i n th is co ur t. W hi le th e ap pl ic at io n was

pe nd in g, th is co ur t ren de red it s op in io n in La fa yet te Bon e & Jo in t Cl in ic v. Lo ui si an a

Uni te d Bus in es s SI

F , 15 -2 13 7 (La. 6/ 29 /1 6)
, 19 4 So

. 3d 11 12 , whi ch ad dr es se d, bu t

di d no t de ci de , t he ch oi ce of ph arm ac y i s s u e

. I n th at cas e, th e cl ai m an ts , wh o were

in jure d in th e co ur se of th ei r em pl oym en t, were tre at ed by ph y si ci an s at th e Lafayette

Bo ne & Jo in t Cl in ic (“ LB&J ”). D u r i n g th e co ur se of tre at m en t, th e ph y si ci an s

pr es cri be d m ed ic at i o n s whi ch were di sp en se d di rect ly to cl ai m an ts by LB&J

em pl oyees. 19 4 So

. 3d at 11 15

. On Ju ne 5, 20 08 , th e wor ke rs ’ co m pe ns at io n pa y or ,
Lo ui si an a Uni te d Bu si ne ss SIF (“ LUBA”), se nt le tt ers to LB&J an d it s ph y s i c i a n s ,

st a t i n g th at LUBA wou ld no lo ng er pa y fo r pr es cri pt io n m ed ic at io ns di rect ly

di sp en se d by LB&J an d di rect in g LB&J ph y si ci an s to is su e fu tu re pr es cri pt io ns to be

fil le d by lo cal ret ai l ph arm aci es

. Des pi te th es e no ti ces , LB&J co nt in ue d to di sp en se

pr es cr ipt ion m ed ic at io ns di rect ly to cl ai m an ts th ro ug ho ut 20 08 an d to su bm it req ue sts

fo r rei m bu rs em en t to LUBA. LUBA de cl in ed pa y m en t, ci ti ng it s Ju ne 5, 20 08 no ti ce.

4LB&J fil ed a di sp ut ed cl ai m wit h th e O WC , s eek in g to reco ve r th e co st s of th e

m ed ic at io ns di sp en se d, al on g wit h pe na lt ie s an d at to rn ey fees

. Id

. Afte r a tri al on th e

mer i t s , t h e OW C is su ed jud gm en t in fav or of LB&J , bu t or de red th at reco ve ry fo r

m ed ic at io ns di sp en se d aft er Ju ne 5, 20 08 , was li m it ed by La. R.S. 23 :1 14 2( B) to $7 50

fo r each cl ai m an t. The OW C refu se d to award at to rn ey fees an d pe na lt ie s in li gh t of

LUBA’ s no ti ce to LB&J

. The co ur t of ap pe al rev ers ed
, award ed at to rn ey fees an d

pe na lt ie s, an d re m ov ed th e $ 75 0 c ap

. Id . at 1 11 6.

The m ajor it y of th is co ur t rev e r se d th e co ur t of ap pe al ’s m od ifi cat io n of th e
$7 50 cap an d ot he rwis e affi rm ed

. As a th res ho ld m at te r, th is co ur t no te d th e sp li t in

th e ci rcu it s on th e ch oi ce-o f-p ha rm acy is su e, in cl ud i n g Bur ge ss I , bu t fo un d th e

ev id en ce pr es en te d di d no t rai se a te na bl e em pl oyee ch oi ce i s s u e b e cau se th e

ev id en ce an d te s t i mon y di d no t es ta bl is h th at th e in jure d em pl oyees in th es e cas es

m ad e an affi rm at iv e ch oi ce of LB&J as th ei r pr es cri pt io n m ed ic at io n pr ov id er. Id

. at

11 17 -1 8. Ho w e v e r , th is co ur t fu rth er fo un d th e ch oi ce-o f-p ha rm acy is su e was no t

di sp os it iv e o f th e $ 75 0 c ap is su e:

Nor wou ld res ol ut io n of th e ch oi ce-o f-p ha rm acy is su e be di sp os it iv e of th e m at te rs be fo re th e co ur t. A s we ha ve st at ed
, th es e cas es hi ng e on LSA-R.S. 23 :1 14 2( B)’s ad m on it io n th at a “ he al th care pr ov id er m ay no t in cu r m or e th an a to ta l of sev en hu nd red fif ty do ll ars in no ne m erg en cy di ag no st ic te st in g or tre at m en t wit ho ut th e m ut ua l co ns en t of th e pa y or
an d th e emp l o y ee.” In th es e cas es , we co nc lu de he rei na fte r th at th e p l a in ti ff/ he al th care pr ov id ers di d no t ha ve th e co ns en t of th e pa y or , LUBA, ev en if th ey ha d ob ta in ed th e co ns en t of th e in jure d em pl oyees, to di sp en se pre sc rip ti on m ed ic at io ns aft er J un e 5 , 20 08

.
Id . at 1 11 8.

Thi s co ur t fo un d LUB A ’s au th or iz at io n fo r th e em pl oyees to ob ta in m ed ic al

tre at m en t fro m LB&J ph y si ci a n s di d no t en co m pa ss th e di sp en si ng of pr es cri pt io n

m ed ic at io ns by L B&J . Spe ci fic al ly, th is co ur t re as on ed :

Eve n th ou gh
, pr io r to Ju ne 5, 20 08 , LUBA m ay ha ve ob li ga te d it se lf to

re im bur se the pla int if

f/ he al th ca re pr ovi de rs fo r pr es cri pt io n m ed ic at ions

5di sp en se d t o in jure d em pl oyee pa ti en ts du rin g in -o ffi ce m ed ic al tre at m en t by LB & J ph y si ci an s, LUBA’ s Ju ne 5, 20 08 le tt er no ti fie d LB & J an d it s ph y si ci an s th at it wou ld no lo ng er pa y fo r LB & J di sp en se d pr es cri pt io n m ed ic at io ns ; th eref or e, an y o n g o in g co ns en t to , or
au th or iz at io n of

, in -o ffi ce di sp en si ng of pr es cri pt io n m ed ic at io ns by LB & J ph y si ci an s was ter m in at ed

.
Id

. at 11 19

. Thi s cou rt l im it ed LB&J ’s reco ve ry to $7 50 of m ed ic at io n cos ts aft er it

was no ti fie d t ha t i t wo ul d n ot be rei m bu rs ed for

m ed ic at io ns it di sp en se d. Id

.

In li gh t of ou r de ci si on in La fa yet te Bon e & Jo in t , th is co ur t gr an te d S&WB’ s

writ ap pl ic at io n a nd rem an de d t he cas e to th e co ur t o f ap pe al for reco ns id erat io n:

Wr i t gr an te d. The cas e is rem an de d to th e Co ur t of App eal fo r r e

br ie fin g an d reco ns id erat io n in a c co rd wit h th is Co ur t’s de ci si on in La fa yet te Bon e & Jo in t Cl in ic v. Lo ui si an a U n i t e d Bu si ne ss SI

F, et al c/ w Lafa yet te Bon e an d Jo in t Cli ni c v. Guy Hop ki ns Co ns tr uc ti on Co

., In c. , et a l. , 15 -2 13 7 c /w 1 5- 21 38 (La. 6/ 29 /1 6) , __ So .3d

__ .
Bur ge ss v. Se wer ag e & W

at er Boa rd of

New Orl ea ns , 16 -0 41 6 (La. 9/ 16 /1 6)
, 20 6 So

.
3d 19 9.

On rem an d fro m th is co ur t, th e co ur t of ap pe al reaf fir m ed it s or ig in al de ci si on

.
Bur ge ss v. Se w e r a g e & W

at er Boa rd of New Orl ea ns , 15 -0 91 8 (La. App

. 4 Ci r.

11 /2 3/ 16 )
, 20 4 So

. 3d 10 14 (“ Bur ge ss II ”). In pa rti cu la r, th e co ur t of ap pe al fo un d

La fa yet te Bon e & Jo in t was fact ua ll y di st in gu is ha bl e fro m th e in st an t case an d th us

in ap po si te

. 20 4 So

. 3d at 10 16

. As it di d in Bur ge ss I , th e co ur t fo un d in fav or of th e

em pl oyee on th e ch oi ce-o f-p ha rm acy is su e. The co ur t no te d La fa yet te Bon e & Jo in t

in vo lv ed ph y si ci an -d is pe ns ed m ed ic at io n, a fact ua l si tu at io n wit hi n th e sc op e of La.

R.S. 23 :1 14 2( B), whe reas th is cas e in vo lv ed an ou ts id e ph arm acy di sp en si ng

med i cat io n. As su ch
, th e Bur ge ss II co ur t he ld th at th e di sp en si ng of pr es cr i p t i o n

m ed ic at io n d oe s no t con st it ut e “ no ne m erg en cy di ag no st ic te st in g or treat m en t” an d

th us do es no t t rig ge r th e ap pl ic at io n o f La. R.S. 23 :1 14 2( B). Id . at 1 01 6- 18

.
Ju dg e Lob ran o ag ai n di ss en te d ba se d on reas on s si m il ar to th os e in he r or ig in al

di ss en t reg ard in g ou t-o f-s ta te pr ov id ers

. I d

. at 10 18

. (Lob ran o, J., di ss en ti ng ).

6Fu rth er, be cau se IWP is an ou t-o f-s ta te pr ov id er, s h e al so fo un d th e in st an t cas e

di st in gu is ha bl e fro m La

fa yet te Bon e & Jo in t , whi ch ad dr es se d th e ap pl ic ab il it y of La.

R.S. 23 :1 14 2( B) to in st an ces in whi ch an in -s ta t e p r ov id er of ph arm aceu ti cal s

in cu rred ex pe ns es wit ho ut th e co ns en t o f th e em pl oyer. Id

. at 1 01 9.

S&WB fil ed a se co nd writ ap pl i c a t i o n wit h th is co ur t, whi ch we gr an te d.

Bur ge ss v. Se wer ag e & W

at er Bd. of

New Orl ea ns , 16 -2 26 7 (La. 2/ 24 /1 7)
, --- So

. 3d

----.

DISCUSS IO N

In th is cas e we are in it ia ll y cal le d up on to de te rm in e whe th er, un de r th e

LW CA, it is th e in

jure d em pl oyee or th e em

pl oyer who is en ti tl ed to ch oo se th e
ph arm acy t o fu rn is h pr es cri pt io n m ed ic at io ns to th e cl ai m an t. Our de ci si on is

pr em is ed on th e pr op er in te rp ret at io n of pa rts of th e LW CA. Su ch co ns id erat io ns are

qu es ti on s of la w an d rev ie wed by th is co ur t un de r a de n o v o s ta nd ard of rev ie w.

Ca ta ho ul a Par

. Sc h. Bd. v. Lo ui si an a Mac h. Ren ta ls

, LLC , 12 -2 50 4 (La. 10 /1 5/ 13 ),

12 4 So

. 3d 10 65 , 10 71

. Afte r ou r rev ie w, we “ ren de r jud gm en t on th e reco rd
, wit ho ut

de fere nc e to th e le g a l co nc lu si on s of th e tri bu na ls be lo w. Th is co ur t is th e ul ti m at e

arb it er o f th e m ean in g o f th e la ws o f th is st at e.” Id

.
The em pl oyer’s du ty un de r th e LW CA to fu rn is h pr es cri pt io n m ed ic at io n is se t

fo rth in La. R.S. 23 :1 20 3 wh ic h p ro vi de s, i n p ert in en t p art :

A. In ev ery ca se co m in g unde r thi s Cha p ter, the employ er sh al l furn is h al l nece ss ar y drug s , su pp li es , ho sp it al care an d se rv ic es , m ed ic al an d su rg ic al tre at m en t, an d an y no nm ed ic al tre a tm en t

reco gn iz ed by th e la ws of th is st at e as le ga l, an d sh al l ut il iz e su ch st at e, fed eral
, pu bl ic
, or pr iv at e faci li ti es as wil l pr ov id e th e in jure d em pl oyee wit h su ch ne ces sa ry se rv ic es

. Med ic al care , se rv ic es , an d tre at m en t m ay be pr ov id ed by ou t-o f-s ta te pr ov id ers or at ou t-o f- st at e faci li ti es whe n
su ch care , se rv ic es , an d tre at m en t are no t reas on ab ly av ai la bl e wit hi n th e st at e or whe n it can be pr ov id ed fo r co m pa rab le co st s. (Em

ph as is ad de d)

B. The ob li ga ti on of th e em pl oyer to fu rn i s h s uc h care , se rv ic es , tre at m en t, dr ug s, an d su pp li es , whe th er in st at e or ou t of st at e, is li m it ed

7to th e rei m bu rs em en t de te rm in ed to b e th e m ean of th e us ua l an d

cu st om ary ch arg es f

o r su ch care , se rv ic es , tre at m en t, dr ug s, an d

su pp li es , as de te rm in ed un de r th e rei m bu rs em en t sc he du le an nu al l y pu bl is he d pu rs ua nt to R.S. 23 :1 03 4.2 or th e act ua l ch arg e m ad e fo r th e
se rv ic e, whi ch ev er is le ss

. Any ou t-o f-s ta te pr ov id er is al so to be su bjec t to th e pr oc ed ur es es ta bl is he d un de r th e of fic e of wor ke rs ’ co m

pe ns at io n ad m in is tra ti on ut il iz at io n re vi ew ru le s.

W hi le th is st at ut e ob li ga te s an em pl oyer “ to fu rn is h al l ne ces sa ry dr ug s” to th e in jure d

em pl oyee, it do es no t di rect ly ad dr es s who ha s th e rig ht to ch oo se th e ph arm acy to

di sp en se th es e dr

ug s. Alt ho ug h th is co ur t di d no t reac h th e ch oi ce-o f-p ha rm acy is su e

in La fa yet te Bon e & Jo in t , we di d reco gn iz e “ t he re is no ex pl ic it wor ke rs ’

co m pe ns at io n la w di rect in g th at on e p a r t y h a s th e ex cl us iv e rig ht to ch oo se a

pr es cri pt io n m ed ic at io n p ro vi de r.” 19 4 S o. 3 d a t 1 11 7.

Our co ur ts of ap pe al ha ve reac he d di ffer in g op in io ns on th e c h o ic e-o fph arm acy i s s u e

. In ad di ti on to th e Fo ur th Ci rcu it ’s ru li ng in th is cas e, th e Seco nd

Ci rcu it ha s als o hel d th e ch oi ce of ph arm acy be lo ng s to th e em pl oyee. Se e Na ro n v.

LIGA , 49 ,99 6 (La. App

. 2 Ci r. 9/ 9/ 15 ), 17 5 So

. 3d 47 5. The Na ro n co ur t reas on ed th at

be cau se La. R.S. 23 :1 20 3 do es no t ad dr es s whi ch pa rty can ch oo se a ve nd or , bu t do es

se t fo rth th e em

pl oyer’s o bl ig at io n to rei m bu rs e a cl ai m an t fo r th e le ss er am ou nt in

th e fee sc he du le or th e act ua l co st fo r m ed ic at io n , t he em pl oyee was free to ch oo se

th e ph arm acy fro m whi ch he ob ta in ed hi s m ed ic at io n. Id

. at 47 7- 78

. By co nt ras t, th e 3

Thi rd an d Fi fth Ci rcu it s hav e he ld th e ch oi ce of pha rm acy be lo ng s to th e em pl oyer.

Se e Dow ns v. Ch at ea u Li vi ng Cen te r , 14 -0 67 2 (La. App

. 5 Ci r. 1/ 28 /1 5)
, 16 7 So

. 3d

87 5; Bor de lo n v. La

fa yet te Co ns ol id

at ed Gov er nme nt , 14 -0 30 4 (La. App

. 3 Ci r.

10 /1 /1 4)
, 14 9 So. 3d 42 1, wr it de ni ed
, 14 -2 29 6 (La. 2/ 6/ 15 ), 15 8 So. 3d 81 6; Si gl er

Howeve r, the N

a r o n co u rt also rec og nized the employ ee’ s choice of pharma cy is not 3 boundless, noting that L a. R

. S. 23:1203(A) provides that service s can be provided by out-of-state providers when the service s are not rea sonably available within the state or when it can be provided for compar able costs. The court held that reg ardle ss of whether an employ er is found to have violated its duty under L a. R.S. 23:1203(A)
, the employ ee is still bound by the constra ints of that statute in reg ard to out-of

-state pr oviders. 175 So. 3d at 478.

8v. Ran d
, 04 -1 1 3 8 ( La

. App

. 3 Ci r. 12 /2 9/ 04 ), 89 6 So

. 2d 18 9. In Si gl er , th e Thi rd

Ci rcu it fo un d th at th e em

pl oyer di d no t vi ol at e it s ob li ga ti on to th e in jure d em pl oyee

un de r La. R.S. 23 :1 20 3( A) to fu rn is h ne ces sa ry dr ug s si m pl y be cau se it ch os e to ha ve

th e em pl oyee’s pr es cri pt io ns fil le d by a d iff eren t p ha rm aceu ti cal co m pa ny. 896 So

.
2d at 1 9 8

. R e l y in g on Si gl er , th e Bor de lo n co ur t he ld th at th e em pl oyer m et hi s 4

ob li ga ti on un de r th e LW CA to pa y fo r m ed ic at io n by sp eci fy in g th e ph arm acy th e

em pl oyee co ul d us e. 14 9 So . 3 d at 42 3. Th e Fi fth Ci rcu it in Dow ns rel ie d up on th e

Thi rd Ci rcu it ’s op in io n in Bor de lo n to ho ld th at an em pl oyer do es no t vi ol at e it s du ty

un de r La. R.S. 23 :1 20 3( A) by ch oo si ng th e ph arm acy t o b e u s ed by an in jure d

em pl oyee. 16 7 S o. 3 d a t 8 81

.
Afte r rev ie w of th e la w an d th e ab ov e juri sp ru de nc e, an d co ns id eri ng th e

arg um en ts of t h e pa rti es , we ho ld th e Thi rd an d Fi fth Ci rcu it s ha ve co rrec tl y

de te rm in ed th e em

pl oyer ha s th e rig ht to ch oo se th e ph arm acy t o fu rn is h ne ces sa ry

pr es cri pt io n dr ug s to an in jure d em p l o ye e i n a wor ke rs ’ co m pe ns at io n cas e. Our

an al y si s b eg in s wi th th e ap pl ic ab le st at ut or y law.

The fu nc ti on of st at ut or y in te rp ret at io n an d th e c o n s t r uc ti on gi ve n to le gi sl at iv e act s res ts wit h th e jud ic ia l br an ch o f t h e go ve rn m en t. The

ru le s of st at ut or y co ns tru ct io n are de si gn ed to as cert ai n an d en fo rce th e in te nt of th e Leg is la tu re. Leg is la ti on is th e so le m n ex pr es s i o n o f le gi sl at iv e wil l, an d, th us , th e in te rp ret a t i o n o f le gi sl at io n is pr im ari ly th e se arch fo r th e le gi sl at iv e in te nt

. W e ha ve of te n no te d th e pa ram ou nt

co ns id erat io n in st at ut or y in te rp ret at io n i s as cert ai nm en t of th e le gi sl at iv e in te nt an d th e reas on or reas on s whi ch pr om pt ed th e Leg is la tu re to en act th e la w. The st art in g po in t in th e in te rp ret at io n of

an y st at ut e is th e la ng ua ge of th e st at ut e it se lf. W he n a la w is cl ear an d

un am bi gu ou s an d it s ap pl ic at io n do es no t le ad to ab su rd co ns eq ue nc es , th e la w sh al l be ap pl ie d as writ te n an d no fu rth er in te rp ret at io n m ay be

Although the court in Sigler found the employ er had the rig ht to choose the pharma cy , the 4
court also found the employ er violated its duties to the employ ee beca use the employ er’ s choice of pharma cy was unable to pro v i d e the medication to the employ ee in a timely fashion. The court explained: “I mplicit wit hin the require ment of L a. R.S. 23:1203(A) that the employ er ‘fur nish all

nece ssary drug s’ is that those nece ssary drugs b e provided timely

. ... [The employ er] eff ectively denied [t he employ ee] th e drug s neede d for his compensa ble injury by deny ing the timely availability of those presc ription drug s. I n doing so, [t he employ er] violated its duty under L a. R.S. 23:1203(A).” 896 So. 2d at 198-99.

9m ad e in se arch of th e in te n t o f th e Leg is la tu re. Howev er, whe n th e

la ng ua ge of th e la w is su sc ep ti bl e of di ffer en t meani ng s, it m us t be in te rp ret ed as ha vi ng th e m ean in g th at be st co nf or m s to th e pu rp os e of th e l a w

. M o r e ov er, whe n th e wor ds of a la w are am bi gu ou s, th ei r
m ean in g m

us t be so ug ht by ex am in in g th e co nt ex t in whi ch th ey oc cu r,
an d th e te xt of th e la w as a who le

. Fu rth er, th e Leg is la tu re is pr es um ed to act wit h fu ll kn owl ed ge of well -s et tl ed pr in ci pl es of s ta tu to ry
co ns tru ct io n.

Ca ta ho ul a Par

. Sc h. Bd.
, 12 4 So

. 3d at 10 73

. W it h th es e pr in ci pl es in m in d, we

ex am in e th e rel ev an t s ta tu te s.

As st at ed earl ie r, La. R.S. 23 :1 20 3( A) pr ov id es th at “ th e em pl oyer sh al l fu rn is h

al l ne ces sary dr ug s.” Nowh ere in th e st at ut e do es th e le gi sl at ur e pr ov id e th e em pl oyee

wit h th e rig ht to ch oo se a ph arm aceu ti cal pr ov id er fro m whi ch to ob ta in th e ne ces sa ry

pr es cri pt io n dr ug s. By co nt ras t, th e le gi sl at ur e ha s sp eci f i c a l l y d el eg at ed to th e

em p l o ye e t he ch oi ce of ph

ys ic ia n in La. R.S. 23 :1 12 1( B)(1 ), whi ch pr ov id es “ the

employ ee sh al l ha ve the r i g h t to se le ct on e tre at in g phy si ci an in an y fie ld or

sp eci al ty.” (Em

ph as is ad de d)

. Had th e le gi sl at ur e in te nd ed th e em pl oyee to ha ve th e

ch oi ce of ph arm aceu ti cal pr ov id er in La. R.S. 23 :1 20 3( A), th e le gi sl at ur e co ul d ha ve

eas il y pr ov id ed fo r th at ch oi ce as it pro vi de d for th e ch oi ce of p hysic ia n i n La. R.S.

23 :1 12 1. M or eo ve r, th e st at ut or y en ti tl em en t in La. R.S. 23 :1 12 1( B)(1 ) to ch oo se a
ph ys i c i a n can no t be read br oa dl y to in cl ud e an en ti tl em en t to ch oo se a ph arm acy.

N o t a b l y, th e le gi sl at ur e ut il iz ed th e ve ry sp eci fic te rm “ ph y si ci an ,” rat he r th an t h e

m or e ex pa ns iv e te rm “ he al th care pr ov id er” whi ch is de fin ed in th e LW CA to in cl ud e
ph arm aci es

. 5

In Bur ge ss I , th e co ur t of ap pe al fo un d it in st ru ct i v e “t o co ns id er th e

L a. R.S. 23:1021(6) provides: “ ‘Health care provider’ m eans a h o s p i t al, a person, 5 corpor ation, fac ility
, or instit ution licensed by the state to provide health c a re or profe ssional service s
as a phy sician, hospital, dentist, reg istered or licensed prac ti ca l n u rse, pharm acist , optometrist, podiatrist, chiropra ctor, phy sical thera pist, occupational thera

pist, psy cholog ist, g radua te social worke r or lice nsed clinical social worke r, psy chiatrist, or license d profe ssional counselor, a nd any office r, employ ee, or

ag ent there by acting in the course and scope of his employ

ment.” (Empha sis added)

.
10juri sp ru de nc e ad dr es si ng th e rel at ed is su e of ch oi ce of ph y si ci an be fo re th e Lou is ia na

Leg is la tu re en act ed La. R.S. 23 :1 12 1” in reac hi ng it s de ci si on th at th e ch oi ce of
ph arm acy be lo ng s t o t h e e mp l o yee. 18 7 So

. 3d at 54

. The co ur t refe ren ced a Fi rs t

Ci rcu it cas e whe rei n th e co ur t “ co nc lu de d th at th e ch oi ce of ph y si ci an be lo ng ed to

th e emp l o ye e be cau se ‘[t]he tru st an d co nf id en ce ne ed ed in a pa ti en t-d oc to r

rel at io ns hi p is im

po rta n t t o s u c ces sf

ul tre at m en t whi ch can be be st ob ta in ed if th e

in ju r e d e mp lo y ee ha s th e ch oi ce of ph y si ci an fo r tre at m en t pu rp os es .’ ” Id

. (ci ti ng

Ki ns ey v. Tr av el er

s In s. Co

., In c ., 40 2 So

. 2d 22 6, 22 8 (La. App

. 1s t Ci r.19 81 )). The

Bur ge ss I co ur t no te d th is sa m e rat io na le -th e pa ti en t’s tru st an d co nf id en ce-h as be en

ap pl ie d in th e co nt ex t of de te rm in in g whe th er th e ch oi ce of ph arm acy be lo ng s to th e

em pl oyee, a lt ho ug h t he co ur t d id reco gn iz e ap pe ll at e juri sp ru de nc e, su ch as Si gl er ,
whi ch fo un d su ch rat io na le di d no t ap pl y to a ph arm aci st

. Id

. The co ur t of ap pe al

affi rm ed it s p os it io n i n Bur ge ss II.

Rel ia nc e on juri sp ru de nc e co nc er nin g ch oi ce of ph y si ci an is m is gu id ed

. Unl ik e

La. R.S. 23 :1 12 1( B) go ve rn in g ch oi ce of physic ia n, th e le gi sl at ur e ha s no t affo rd ed

th e em pl oyee an ab so lu te rig ht to se le ct a ph arm acy un de r La. R.S. 23 :1 20 3( A). Thi s

d i st in ct io n is lo gi cal co ns id eri ng th e im po rta nc e of th e do ct or -p at ie nt rel at io ns hi p

.
Unl ik e a pa ti en t’s pe rs on al rel at io ns hi p wit h hi s d o c t or , th ere is no m ean in gf ul

di ffer en ce rel at iv e to whi ch ph arm acy is us ed to di sp en se a pr es cri pt io n dr ug th at

wou ld m an da te em

pl oyee ch oi ce un de r th e LW CA. Thi s di st in ct io n was reco gn iz ed
by th e Thi rd Ci rcu it in Si

gl er , su pr a

. The Si

gl er co ur t di st in gu is he d it s pr io r de ci si on

in Lo ui si an a Cl in ic v. Pat in ’s Ti re Se rv ic e , 98 -1 97 3 (La. App

. 3 Ci r. 5/ 5/ 99 ), 73 1 So

.
2d 52 5, whi ch co nc ern ed whe th er th e em pl oyer ha d th e rig ht to ch oo se th e di ag no st ic

faci li ty to co nd uc t th e in jure d em pl oyee’s MRI s c a n

. In Pat in ’s , th e OW C jud ge

fo un d th at an em

pl oyee ha s no cau se of act io n un de r th e LW CA to ch oo se th e

11di ag no st ic faci li ty, rel y in g on La. R.S. 23 :1 12 1( B) whic h on ly al lo ws the em pl oyee

th e rig ht to ch oo se a tre at in g ph y si ci an

. The Thi rd Ci rcu it rev ers ed
, fin di ng th e
jud ge ’s rel ia nc e on La. R.S. 23 :1 12 1( B) to be m is pl aced

. 73 1 So

. 2d at 52 8. The co ur t

no te d it was th e tre at in g ph y si ci an , no t th e em pl oyee, who or de red th e MRI an d th e

em pl oyee was “ no t at te m

pt in g to ch an ge tre at in g ph y si ci an s bu t to ob ta in a di ag no st ic

te st at hi s ph ys i c i a n’s in st ru ct io n.” Id

. The co ur t fo un d no au th or it y th at al lo ws th e

em pl oyer or in su rer t o d ic ta te th e p la ce an d p hysic ia n t o p erfo rm di ag no st ic tes ti ng

or de red by a tre at in g ph y si ci an

. Rat he r, th e co ur t fo un d th e ch eck on th e em pl oyee’s

te st in g is th ro ug h La. R.S. 23 :1 03 4.2 an d 23 :1 14 2( B), whi ch pl ace a m on et ary li m it

on th e d ia gn os ti c te st in g. Id

.
The Si gl er co ur t de cl in ed to ap pl y th e sa m e reas on in g to th e ch oi ce of
ph arm acy. 86 9 So

. 2d at 19 8. “ Bec a u s e th e ad m in is tra ti on of m ed ic al di ag no st ic

te st in g, th e type of eq ui pm en t us ed
, an d th e in te rp ret at io n of th e res ul ts ob ta in ed fro m

th e te st in g in vo lv e in di vi du al sk il l le ve ls an d pe rh ap s co m fo rt le ve ls fo r pa ti en ts , we

fin d th at Pat in ’s do es no t ap pl y to th e ci r c u ms t a n ces of th is cas e. Unl ik e in th e

Pat in ’s cas e, th e m ed ic at io n Si gl er ob ta in ed was th e sa m e reg ard le ss of whi ch
ph arm aceu ti cal co m

pa ny p r o v i d e d i t.” Id

. W e ag ree wit h th e an al y si s of th e Si gl er

co ur t an d re ach th e sa m e co nc lu si on in th is cas e.

A dd it io na ll y , t he le gi sl at ur e ha s sp eci fic al ly d ire ct ed th at th e la ws co nt ai ne d

in th e LW CA be co ns tru ed as f ol lo ws:
(1 ) The pr ov is io ns of th is Ch ap te r are ba se d on th e m ut ua l ren un ci at io n of le ga l rig ht s an d de fen se s by em p l oyers an d em

pl oyees al ik e; th eref or e, it is th e sp eci fic in te nt of th e le gi sl a t u r e th at wor ke rs ’

co m pe ns at io n c as es sh al l b e d eci de d o n t he ir m eri ts

. (2 ) Dis pu te s co nc ern in g th e fact s in wor ke rs ’ co m pe ns at io n cas es sh al l

no t be gi ve n a br oa d, li be ral c o n s t r u c ti on in fav or of ei th er em pl oyees
or em pl oyers; the la w s pert ai ni ng to w or k ers ’ co m pens at io n sh al l be

co ns true d i n a cco rda nce w ith the ba si c pri nci pl es of st at uto ry
co ns truc tio n a nd no t in fav or of e ith er emplo ye r o r emplo ye e

.

12(3 ) Acco rd in g to Arti cl e III, Sect io n 1 of th e Co ns ti tu ti on of Lou is ia na ,

th e le gi sl at iv e po wers of th e st at e are ve st ed so le ly in th e le gi sl a t u r e ; th eref or e, whe n th e wor ke rs ’ co m pe ns at i o n s t at ut es of th is st at e are to be am en de d, th e le gi sl at ur e ack no wled ge s it s res po ns ib il it y to do so

. If th e w or k ers ’ co m pens at io n st at utes ar e to be li bera li zed, br oad en ed , or na rro w ed, su ch ac tio ns sh al l be t he ex cl us iv e purv ie w of the le gi sl at ure

.
La. R.S. 23 :1 02 0.1 (D) (Em ph as is ad de d)

. To ex te nd th e le gi sl at iv el y -g ran te d

em pl oyee ch oi ce of tre at in g ph y si ci an to in cl ud e th e ch oi ce of ph arm acy can on ly be

acco m pl is he d by gi vi ng an im

pe rm is si bl y ex pa ns iv e read in g to th e pr ov is io ns of La.

R.S. 23 :1 20 3( A) an d La. R.S. 23 :1 12 1, t hu s br oa de ni ng th e em pl oyee’s rig ht s in

co nt rav en ti on of La. R .S. 23 :1 02 0.1 (D).

Thu s, whi le t h e in

jure d em pl oyee is en ti tl ed to ch oo se hi s tre at in g ph y si ci an

un de r th e LW CA, we ho ld th e la w do es no t pr ov id e th e em pl oyee a ri gh t t o c ho os e

a sp eci fic ph arma c e u t i c a l pr ov id er. W e th eref or e rev ers e th e ru li ng of th e co ur t of

ap pe al on th is is su e.

It is im po rta nt to reco gn iz e th at th e LW CA gi ve s th e em pl oyee pr ot ect io ns to

en su re t he em

pl oyer sa ti sf

ie s it s ob li ga ti on s un de r La. R.S. 23 :1 02 3. If an in jure d

em pl oyee ex pe rie nc es an y de la y s or ot he r di sc ern ab le de fic ie nc ie s in f i l l i n g hi s

pr es cri pt io ns th ro ug h th e em pl oyer-ch os en ph arm acy, co ns ti tu ti ng a vi ol at io n of th e

em pl oyer’s du ty un de r La. R.S. 23 :1 20 3( A), th e em pl oyee ha s a rem ed y fo r pe na lt ie s

pu rs ua nt to La. R.S. 23 :1 20 1( E). Se e Si gl er , 89 6 So

. 2d at 19 8- 99

. In th is cas e, th ere 6

is no ev id en ce S&WB vi ol at ed it s du ty un de r La. R.S. 23 :1 20 3( A) by req ui rin g Mr.

Bu rg es s t o u se a ph arm acy incl ud ed in th e Co rv el Care m ark Ph arm acy pro gr am

.
W e n o w tu rn to th e $1 3,1 10 .82 IWP bi ll fo r pr es cri pt io n m ed ic at io ns it

L a. R.S. 23:1201(E) provides: “(1) Medica l benef its pay able un d er t h i s Chapter shall be 6 paid within six ty

day s after

the employ er or

insurer rece ives written not ice thereof, if the provider of medica l service s is not uti liz ing the elec tronic billing rules and r egulations provided for in R.S. 23:1203.2; (2) For those providers of medical services who utiliz e the elec tronic b i l l i n g rules and reg ulations provided for in R.S. 23:1203.2, medical benef its pay able under this Chapter shall be paid within thirty day s afte r the employ er or insurer rec eives a complete elec tronic medical bill, as define d by rules promulg ated by

the L ouisiana Workforc e Commissi on.”

13d i s pe ns ed to Mr. Bu rg es s fro m Sep te m be r 1, 20 10 , to Decem

be r 7, 20 12

. O u r

res ol ut io n of th e ch oi ce-o f-p ha rm acy is su e do es no t fu ll y res ol ve th e is su e of whe th er

S&WB is res po ns ib le fo r pa y m en t o f th e ou ts ta nd in g IWP bi ll

. Bas ed on th e

pa rti cu la r fact s of th is cas e, th at de te rm in at io n al so req ui res co ns id erat io n of La. R.S.

23 :1 20 3( A) an d (B ), as well as La. R .S. 23 :1 14 2.

Not wit hs ta nd in g who ch oo se s th e he al th care pr ov id er , La

. R.S. 23 :1 20 3( A)

al lo ws fo r “ m ed ic al care , se rv ic es , an d t r e a t m en t” to be pr ov id ed by ou t-o f-s ta te

pr ov id ers on ly “ whe n su ch care , se rv ic es , an d tre at m en t are no t reas on ab ly av ai la bl e

wit hi n th e st at e or whe n it can be pr o v i d e d fo r co m pa rab le co st s.” It ap pe ars

un di sp ut ed by th e pa rti es th at IWP is an ou t-o f-s ta te ph arm acy. Add it io na ll y , th e IWP

bi ll in th e reco rd pr ov id es a Mas sa ch us et ts ad dr es s. Thu s, to be a pe rm is si bl e pr ov id er

un de r th e LW CA, th ere m us t be a sh o w i ng th at th e se rv ic es IWP pr ov id es are no t

reas on ab ly av ai la bl e in Lou is ia na or th at IWP’ s se rv ic es are pr ov id ed fo r co m pa rab le

co st s to Lou is ia na pr ov id ers

. Acco rd in g to th e reco rd be fo r e u s , t h i s is su e was no t

rai se d be fo re no r co ns id ered by th e OW C jud ge

. The reco rd co nt ai ns no ev id en ce

whe th er I W P fit s th e st at ut or y cri te ria in La. R.S. 23 :1 20 3( A). Bec au se IWP, as an

ou t-o f-s ta te pr ov id er, is bo un d by t h e c o n s tra in ts of La. R.S. 23 :1 20 3( A), we m us t

rem an d t hi s m at te r to th e OW C fo r a d et erm in at io n o f th is is su e.

Add it io na l l y, if IWP is fo un d to be a pe rm is si bl e ou t-o f-s ta te ph arm acy, th e

ch arg es fo r m ed ic at io ns it di sp en se d t o Mr. Bu rg es s wou ld st il l be su bjec t to th e

pr ov is io ns of La. R .S. 23 :1 20 3( B), wh ic h l im it s re im bu rs em en t t o “ th e m ean of th e

us ua l an d cu st o mar y ch arg es fo r su ch care , se rv ic es as de te rm in ed un de r th e

rei m bu rs em en t sc he du le an nu al ly pu bl is he d pu rs ua nt to R.S. 23 :1 03 4.2 or th e act ua l

ch arg e m ad e fo r th e se rv ic e, whi ch ev er is le ss .” Fees in ex ces s of th e rei m bu rs em en t

sc he du le are no t reco ve rab le ag ai ns t t he em pl oyee, em

pl oyer, or wor ke rs ’

14co m

pe ns at io n in su rer. La. R.S. 23 :1 03 4.2 (D). Mo reo ve r, th is co ur t reco gn iz ed in

La fa yet te Bon e & Jo in t th at La. R.S. 23 :1 03 4.2 (D) le av es op en “ th e p os si bi li ty th at

m ed ic al fees
, ev en th ou gh fal li ng wit hi n th e am ou nt s se t fo rth in th e rei m bu rs em en t

sc he du le
, m ay be de em ed un reas on ab le
, un ne ces sa ry , or no t ‘ us ua l and cu st om ary, ’

an d th eref

or e no t su bjec t to co m

pe ns at io n un de r cert ai n ci rcu m st an ces .” 19 4 So

. 3d

at 11 21 -2 2. Thi s co ur t fu rth er no te d “ th e ex pr es si on of le gi sl at iv e in te nt se t fort h in

LS A-R.S. 23 :1 02 0.1 m ak es it cl ear th at th e reas on ab le ne ss of m ed ic al co st s i s a n

im po rta nt co ns id erat io n.” Id

. at 11 22

. Thu s, o n r em an d, th e OW C jud ge m us t

co ns id er whe th er I WP i s a pe rm is si bl e ou t-o f-s ta te pr ov id er an d, if so , wh et he r th e

ch arg es in cu rred were reas on ab le an d wit hi n th e gu i d e l in es refe ren ced in La. R.S.

23 :1 20 3( B).

In th e in te res t o f jud ic ia l ec on om y , and to fu ll y in st ru ct th e OW C on rem an d

sh ou ld IWP be de te rm in ed to be a pe rm is si bl e ou t-o f-s ta te pr ov id er, we al so ad dr es s

th e ap pl ic ab il it y

of La. R .S. 23 :1 14 2( B), wh ic h p ro vi de s:

Exc ep t as pr ov id ed he rei n, ea ch hea lth ca re pr ov id er may no t in cur
m or e tha n a to ta l of s ev en hund red fif ty do ll ar s in no nemerge ncy di ag no s t i c t e st in g or trea tm ent w ith ou t the m utua l co ns ent of the pa yo r an d the employ ee as pr ov id ed by reg ul at io n. Exc ep t as pr ov id ed h e r ei n, tha t po rti on of the fees fo r no nemerge ncy se rv ic es of ea c h hea lth ca re pro vi der in ex ces s of se ve n hund red f i f t y do ll ar s sh al l

no t be an enfo rcea bl e ob li ga tio n ag ai ns t th e e mp l oyee or the employ er or th e em

pl oyer’s work ers ’ co m

pe ns at io n i ns ur er u nl es s t he

em pl oyee an d th e pa y or ha ve ag reed up on th e di ag no st ic te st i n g or tre at m en t b y

th e h eal th care pro vi de r. (Em ph as is ad de d)

.

In La fa yet te Bon e & Jo in t , t hi s co ur t ap pl ie d t he pro vi si on s o f La. R.S. 23 :1 14 2( B)

to li m it rei m

bu rs em en t to $7 50 fo r pr es cri pt io n m ed ic at io ns di sp en se d di rect ly by th e

tre at in g ph y si ci an ’s of

fic e wit ho ut th e em

pl oyer/p ay or ’s co ns en t. 19 4 So

. 3d at 11 18

.

In Bur ge ss II , th e c o u rt of ap pe al di st in gu is he d th at fact ua l si tu at io n an d he ld th e

di sp en si ng of pr es cri pt io n m ed ic at io ns by a ph arm aci st , a s o p p os ed to a cl ai m an t’s

tre at in g ph y si ci an , di d no t co ns ti tu te “ no ne m erg en cy di ag no st ic te st in g an d

15tre at m en t” un de r th e st at ut e. 20 4 So

. 3d at 10 17

. W e reco gn iz e di sp en si ng m ed ic at io n

is di st in gu is ha bl e fro m pr es cri bi ng or ad m in i s te rin g m ed ic at io n. Howev er, we fin d

no lo gi cal reas on to fact ua ll y di ffer en ti at e th is cas e fro m La fa yet te Bon e & Jo in t

. In

bo th cas es th e he al th care pr ov id er so ug ht rei m bu rs em en t fo r th e co st of pr es cri pt io n

m ed ic at io ns is su ed to th e in jure d em pl oyee. The act of di sp en si ng p res cri pt io n

m ed ic at i o n s is th e sa m e, reg ard le ss of whe th er th e m ed ic at io ns were pr ov id ed by a
ph arm acy or a p hysic ia n’s o ffi ce.

Alt ho ug h we di d no t fu ll y an al y ze ap pl ic at io n of La. R.S. 23 :1 14 2( B) in

La fa yet te Bon e & Jo in t , im

pl ic it in o u r r u li ng was an ack no wled gm en t th at th e

di sp en si ng of pr es cri pt io n m ed ic at io ns is en co m pa ss ed in “ no ne m erg en cy di ag no st ic

te st in g or tre at m en t” un de r th e st at ut e. W hi le th e st at ut or y la ng ua ge do e s n o t

ex pr es sl y in cl ud e a refe ren ce to p r e s cri pt io n m ed ic at io n, we fin d th e wor d

“ tre at m en t” in th e st at ut e is br oa d en ou gh to en co m pa ss a ph arm acy di sp en si ng

pr es cri pt io n m ed ic at io n or de red by th e cl ai m an t’s tre at in g p hysic ia n as pa rt of th e

cl ai m an t’s treat m en t. Thus , we no w exp li ci tl y ho ld La. R.S. 23 :1 14 2( B) is pro pe rly

im pl ic at ed in co ns id eri n g a n e m pl oyer/p ay or ’s ob li ga ti on to pa y pr es cri pt io n

m ed ic at io n e xp en se s i n wo rk ers ’ co m pe ns at io ns cas es

.
La. R.S. 23 :1 14 2( B) req ui res a he al th care pr ov id er to ha ve th e co ns en t of th e

em pl oyee an d th e pa y or in or de r to r e c ei ve pa y m en t in ex ces s of $7 50 fo r 7

no ne m erg en cy care

. The st at ut or y req ui rem en t of “ m ut ua l c o n s e n t” ne ces sa ril y

i m pu te s so m e ob li ga ti on on th e pa rt of th e pr ov id er to ob ta in th e co ns e n t o f t h e

em pl oyer/p ay or

. La. R.S. 23 :1 14 2( B) do es no t su pp ly a sp eci fic fo rm ul a by whi ch th e

pa y or is to si gn ify hi s co ns en t, a n d t h e is su e of co ns en t is ne ces sa ril y de te rm in ed

ba se d o n t he fact s o f eac h c as e. O n r e m a n d
, s h o u l d I W P b e d e t e r m i n e d t o b e a

“Pay or” is de fined in R.S. 23:1142 a s the entity responsible for the pay ment of an injured 7 employ ee’ s medical tre atment.

16pe rm is si bl e ou t-o f-s ta te pr ov id er, th e OW C jud ge m us t ad dr es s th e is su e of co ns en t

co ns id eri ng th e ev id en ce in th e reco rd an d app lying th e rat io na le of La fa yet te Bon e

& Jo in t , to de te rm in e whe th er IWP is en ti tl ed to reco ve r ex pe ns es in ex ces s of $7 50

.
Fi na ll y , we fin d th e is su e of pe na lt ie s an d at to rn ey fees is no t pr op erl y be fo re

th is co ur t. In it s ap pe al to th e Fo ur th Ci rcu it
, S&WB fai le d to as si gn as erro r or br ie f

th is is su e. Alt ho ug h th e co ur t of ap pe al affi rm ed th e jud gm en t of th e OW C, th e co ur t

8

di d no t di rect ly ad dr es s th e pe na lt ie s an d at to rn ey fees award

. The refo re, we pr et erm it

di sc us si on of th is is su e. Se e Ru le 2– 12 .4 of th e Uni fo rm Ru le s– Co ur ts of App eal ;

St at e in In te re st o

f J.M. , 13 -2 57 3 (La. 12 /9 /1 4)
, 15 6 So

. 3d 11 61 , 11 64

. Se e al so

Bou dr ea ux v. St at e , 01 -1 32 9 (La . 2/ 26 /0 2) , 81 5 S o. 2 d 7

.
CONCLUSI ON

Fo r th e ab ov e reas on s, we res ol ve th e sp li t in ou r ci rcu it co ur ts of ap pe al on th e

ch oi ce-o f-p ha rm acy is su e in fav or of th e em pl oyer. Rel at iv e to whe th er S&WB i s

res po ns ib le fo r pa y m en t of th e ou ts ta nd in g IWP bi ll in th is cas e, we rem an d th is

m at te r to th e OW C fo r a de te rm in at io n of whe th er IWP is a pe rm is si bl e ou t-o f-s ta te

pr ov id er un de r La. R.S. 23 :1 20 3( A). If s o, t he OW C jud ge m us t t he n d et erm in e th e

am ou nt of rei m

bu rs em en t du e aft er ap pl ic at io n of La. R.S. 23 :1 20 3( B), La fa yet te

Bon e & Jo in t , and La. R.S. 23 :1 14 2.

DECREE

REVERSED AND REMANDED TO THE OFFICE O F WO RKERS’

COMPENSATI ON FOR FURTHER PROCEEDI NGS CO N SI STENT WI TH

THI S OPI NIO N.

S&WB did raise the issue in its second brief to the court of appea l following rema nd from 8 thi s court. Howeve r, this was not an appea l from the OWC judgme nt. The parties wer e mere ly order ed by the court o f ap p ea l to submit briefs addre ssing this court’s order rela tive to Lafayette Bone & Joint

.
1706 /2 9/ 20 17 SUPREME COURT O F LOUI SI ANA

No. 2 01 6- C-2 26 7

DARVEL BURGES S

VERSUS SEW ERAGE & W ATER BO ARD OF NEW ORLE ANS

ON WRI T OF CERTI ORARI T O TH E COURT OF APPEAL, FOURTH CIRCUI T, OFFICE OF WORK ERS’ COMPE NSATI ON DIS TRI CT 8

JO HNSO N, Chief

Ju st ic e , add it io na ll y

co nc ur s an d a ss ig ns reas on s.

I writ e se pa rat el y to ex pr es s m y op in io n on th is is su e of co ns en t pu rs ua nt to La.

R.S. 23 :1 14 2( B). As po in te d ou t in th e m ajor it y op in io n, La. R.S. 23 :1 14 2( B) do es

n ot su pp ly a sp eci fic fo rm ul a by whi ch th e pa y or is to si gn ify hi s co ns en t, an d th e

is su e o f co ns en t i s n eces sa ril y de te rm in ed ba se d o n t he fact s o f eac h c as e.

The reco rd in th is cas e is ex tre mely li m it ed , a nd th e ev id en ce rel at in g to th is

is su e co ns is ts of f

ou r it em s:
1) th e ou ts ta nd in g bi ll fro m IWP in th e am ou nt of $1 3,1 10 .82 fo r pr es cri pt io n

m ed ic at io ns di sp en se d to Mr. Bu rg es s fro m Sep te m be r 1, 20 10 , to Decem

be r 7, 20 12 ;
2) a le tt er fro m S&WB da te d Octo be r 10 , 20 11 , se nt to “ All In jure d W or ke rs ” st at in g:

Sewer ag e an d W at er Bo ard ha s pa rtn ered wit h Co rv e l Care m ark Ph arm acy Pro gr am fo r al l In jure d Em pl oyees. Thi s Ph arm acy card wil l rep la ce an y ph arm acy pr og ram th at y ou m ay be cu rren tl y us in g. It is y ou r res po ns ib il it y to pu rch as e al l m ed ic a t i on s rel at ed to y ou r in jury wit h t he att ach ed ph arm acy card.

Fai lu re to ad he re to th is pr act ic e may r es ul t in no n- pa y m en t of y ou r W or ke r’s Co m

pe ns at io n m ed ic at io ns

. By y ou r si gn at ur e be lo w y ou ack no wled ge th at y ou wil l ad he re to th e Sewer ag e an d W at er Bo ard ’s W or ke rs ’ Co mp e ns at io n Ph arm acy Pro gr am

.
Mr. Bu rg es s s ig ne d t he let te r on Octo be r 18 , 20 11

.

13) a le tt er fro m S&WB to IW P d at ed Apri l 1 2, 2 01 2, s ta ti ng :

Pl eas e be ad vi se d th at y ou r co m pa ny is no t an ap pr ov ed ph a r m acy pr ov id er fo r th e Sewer ag e an d W at er Bo ard of New Orle an s (“ Bo ard ”) pr es cri pt io n cl ai m s. In Octo be r 20 11 , th e Bo ard pr ov id ed each cl ai m an t wit h a pr es cri pt io n card an d th e em pl oyee is req ui red to us e th e card fo r
an y an d al l pr es cri pt io n dr ug s. The refo re, y ou r ph arm acy sh ou ld no t

acce pt pr es cri pt io ns fro m th e Bo ard ’s in jure d wor ke rs

. If an y pr es cri pt io n bi ll s a r e s ub m it te d by y ou r co m pa ny pa y m en t wil l be de ni ed

. 4) a le tt er fro m

S&WB to IW P d at ed Aug us t 22 , 20 12 , refe ren ci ng two da te s

of ser vi ce fo r Mr. Bu rg es s, J ul y 10 , 20 12 , and Aug us t 2 , 20 12 :

On Octo be r 10 , 20 11 al l in jure d em p l o yees were no ti fie d an d si gn ed [an ] ag reem en t to ad he re to [th e] ph arm acy pr og ram. On Feb ru ary 13 , 20 12 a le tt er was se nt to Att or ne y s an d y ou r c o mp a n y w a s co pi ed on th is m em o. Als o, on Apr il 12 , 20 12 a le tt er was is su e[d ] di rect ly to y ou r
co m pa ny in fo rm in g y ou no t to acce pt pr es cri pt io ns fro m Sewer ag e an d W at er Bo ard of Ne w Orlea ns

.
Sewer ag e a n d W at er Bo ard is no lo ng er pa y in g bi ll s su bm it te d fro m In jure d W or ke rs Ph arm acy be cau se we ha ve a ph arm acy pr og ram p r o v i d e [d ] fo r ou r in

jure d wor ke rs , an d y ou r co m pa ny is no t an ap pr ov ed p h a r mac y pr ov id er. The refo re, y ou r req ue st fo r pa y m en t fo r Darv el Bu rg es s i s d en ie d.

It is al so rel ev an t th at , by S&WB’s o w n ad m is si on , it pa id ap pr ox im at el y
$1 2,0 00 to IWP fo r pr es cri pt io n exp en se s in cu rred by Mr. Bur ge ss ov er a peri od of

ti m e p rio r to sel ect in g t he Co rv el Care m ark Ph arm acy pro gr am

. 1

Co ns id eri ng th e rec or d, an d a pp lying th e sa m e rat io na le th is co ur t ap pl ie d i n

L a f a y et te Bon e & Jo in t , I wou ld fin d IWP’ s reco ve ry of ex pe ns es fo r m ed ic at io ns

di sp en se d t o M r. Bu rg es s af te r Apr il 12 , 20 12 , is li m it ed by L a. R.S. 2 3: 11 42 (B) t o
$7 50 be cau se th e m ed ic at io ns were cl earl y di sp en se d by IWP wit ho ut th e co ns en t of

th e pa y or , S&WB. Bas ed on th e pa rti cu la r fact s of th is cas e, I do no t fin d th e Octo be r

10 , 20 11 , le tt er to Mr. Bu rg es s r e l e v a n t t o th e co ns en t is su e. It is un di sp ut ed th at

S&WB in it ia ll y pa id IWP’ s bi ll
, th ereb y pr ov id in g ta ci t co ns en t to Mr. Bu rg es s’ us e

At oral arg ument befor e this c o u r t, c o u nsel for S&WB aff

irmatively stated S&WB paid over 1 $12,000 to I WP rela tive to Mr. Bur g ess’ pre scription expenses.

2of

IW P as a ph arm acy pr ov id er. Based on th e reco rd
, th ere i s n o e vi de nc e IWP was

no ti fie d or ot he rwis e aware of th e wit hd rawal of th at co ns en t pr io r to th e Apr il 12 ,
20 12 le tt er fro m S&WB. Th us , I f i n d t h a t un ti l it rece iv ed th is no ti ce, IWP h ad th e

co ns en t of S&WB to di sp en se pr es cri pt io n m ed ic at io ns to Mr. Bu rg es s fo r pu rp os es

of La. R.S. 23 :1 14 2( B).

Fu rth erm or e, al t h o u gh IWP is en ti tl ed to rei m bu rs em en t fo r pr es cri pt io ns

di sp en se d to Mr. Bu rg es s pr io r to Apr il 12 , 20 12 , I no te th e ch arg es fo r th es e

m ed ic at io ns are st il l su bjec t to th e r e a s o n a bl en es s an d co st li m it at io ns in La. R.S.

23 :1 20 3( B). Bec au se th ere is no ev id en ce in th e reco rd on th is is su e, th e OW C m us t

de te rm in e th e am ou nt of rei m bu rs e men t d u e to IWP fo r ch arg es in cu rred pr io r to
Apr il 12 , 20 12

.

306/29/2017

SUPREME COURT OF LOUISIANA

No. 2016 -C- 2267

DARVEL BURGESS

VE RSUS

SEWERAGE & WATER BOARD OF NEW ORLEANS

ON WRIT OF CERTIORARI TO THE COURT OF APPEAL, FOURTH

CIRCUIT, OFFICE OF WORKERS’ COMPENSATION DISTRICT 8

GEN OVESE, Justice , dissenting.

I respectfully dis sent from the majority decisi on . Of particular concern is the
judicial edict , without specific legislative authority, tha t the choice of pha rmacy in a
workers’ compensation case belongs to the employer, disregard ing the legislature’s

directive in La.R.S. 23:1020.1(D) (2) that the Louisiana Workers’ Compensation

Law shall not be construed “in favor of either employer or employee.”
Louisiana Revised Statutes 23:1203(A) delineates the obligation of an
employer t o “furnish” an injured worker “ all necessary drugs, supplies, hospital care
and services, medical and surgical treatment, and any nonmedical treatment
recognized by the laws of this state a s legal . . . .” It does not necessarily give the
employer the right to choose the pharmacy. The key word in La.R.S. 23:1203 is

“furnish.” The dictionary definition of f urnish is “to provide ” or “to supply .” It

could be literally interpreted to mean the employer itself would have to
provide/ supply the necessary drugs , etcetera, to the employee . I seriously doubt that
was the intent of the legislature. E mployer s cannot be deemed pharmacies . I view
and interpret the word “furnish” to mean “ to be resp onsible for,” not be able to
control, dictate, or choose the employee’s drug provider.
Lafayette Bone & Joint Clinic v. Louisiana United Business SIF , 15

- 2137

(La. 6/29/16), 194 So.3d 1112, dealt with whether reimbursement was warranted for
medications pr escribed by physicians and dispensed by employees of the Lafayette2 Bone & Joint Clinic , an issue which tested the applicability of La.R.S. 23:1142(B)

. Finding that the evidence did “not raise a tenable employee choice issue,” this Court

declined t o addres s the choice

- of

- pharmacy question. Id . at 1117. There is no
dispute in the instant matter that Injured Workers’ Pharmacy is an out

- of

- state
provider. Louisiana Revised Statutes La.R.S. 23:1203(B) specifies the employer’s
obligation under the reimburseme nt sch e dule.
Ready and quick access to medication is essential, and the employee should

be abl e to choose his/her pharmacy. It is not inconceivable that the employer’s
pharmacist or the employer may insist upon the use of generic drugs or insist up on

one form of medication over another. The majority decision in this case will subject
the employee to the whim of the employer’s pharmacy, an d the law does not state

such. Further, the law as written contemplates disputes over reasonableness and cost

when th e choice is made by the employee, it does not contemplate a scenario such
as when the obligations of the employer imposed under La.R.S. 23:1203 a re tested
by a reasonableness and cost dispute with a pharmacy chosen by t he employer

. This

is a matter for th e legislature
, whose duty it is to make the law

— not the courts . It is
injudicious to read the law in order to achieve a desired result. The law
, as it stands
today does not give the employer any preference over the employee to choose a
pharmacy.