Case Name: Hammie DUPLECHIEN, Plaintiff-Appellant, v. STATES EXPLORATION COMPANY et al., Defendants-Appellees
Court: Louisiana Court of Appeal
Jurisdiction: Louisiana
Decision Date: 1957-03-25
Citations: 94 So. 2d 460
Docket Number: No. 4363
Parties: Hammie DUPLECHIEN, Plaintiff-Appellant, v. STATES EXPLORATION COMPANY et al., Defendants-Appellees.
Judges: 
Reporter: Southern Reporter, Second Series
Volume: 94
Pages: 460–470

Head Matter:
Hammie DUPLECHIEN, Plaintiff-Appellant, v. STATES EXPLORATION COMPANY et al., Defendants-Appellees.
No. 4363.
Court of Appeal of Louisiana. First Circuit.
March 25, 1957.
Rehearing Denied May 2, 1957.
Alfred R. Ryder, Oberlin, for appellant.
Lawes, Cavanaugh, Hickman & Brame, Lake Charles, for appellee.

Opinion:
TATE, Judge.
In these proceedings for workmen's compensation, plaintiff's present disability from an accident in the course of his employment is admitted. The principle question is whether plaintiff's refusal to submit to a tendered operation is so arbitrary and unreasonable as to relieve defendant employer and its co-defendant compensation insurer from the obligation of paying further compensation unless plaintiff employee agrees to submit to the operation in question.
Defendants paid all workmen's compensation benefits due from the initial wrist injury of November, 195S up through April 27, 1956. Compensation payments were terminated when plaintiff through his attorney refused surgery recommended as able to end his disability. The operative procedure in question is a resection of the distal ulna of the right arm, that is, a cutting off of the lower % inch of the inner bone of the right forearm.
Both the orthopedic specialist and plaintiff's family physician agree that, by eliminating pain in ordinary use of the wrist, this operation would substantially relieve plaintiff's present disability and permit him to return to the type of work in which engaged at the time of the industrial accident herein.
In Borders v. Lumberman's Mutual Casualty Co., La.App., 90 So.2d 409, certiorari denied, this Court recently had occasion to summarize the jurisprudence on the question: While "the courts may not compel an injured employee to submit to surgery, the courts may order compensation payments withheld when an employee unreasonably refuses to submit to surgery which will remove his disability," 90 So.2d 411. Further, the relative criteria in determining whether an employee's refusal to submit to operative procedure is reasonable are:
(1) Can the operation reasonably be expected to relieve the legal disability?
(2) Will it cause the claimant a minimum of danger to his life and a minimum of pain ?; and
(3) Is there substantial agreement among all medical witnesses testifying as to the necessity for the operation and the probability that the disability will be cured without recurrence?
Although one reason the plaintiff was unwilling to submit to the operation in question was his personal fear that the condition of his arm would not be materially improved despite his subjecting himself to the risk of surgery, nevertheless as above stated, the medical testimony is in entire agreement that, medically, the relatively minor operation should be performed, with excellent prospects of relieving the disability in question within 3-5 months under supervised therapy thereafter.
The chief legal question remaining is whether the danger involved in the use of general anesthesia is so relatively insubstantial under the facts of this case, that the employee's failure to accept the suggested operative procedure is not reasonably based under the facts in this case. (The medical witnesses testified that due to the difficulty of anesthesizing the bone that would have to be cut or sawed off, local anesthesia is impractical, although not impossible.)
The claimant objected to undergoing general anesthesia (being "put to sleep") because of fear of same, based upon his conversations with a nephew who had undergone an (unsuccessful) knee operation.
Both the orthopedic specialist and plaintiff's family physician testified that in general health he was a good candidate for surgery, as did an internal specialist called upon to examine plaintiff especially for this purpose. A physician anesthesiologist who examined plaintiff and used the findings of the internal specialist, described the procedure to be involved and estimated that the mortality rate concerning a man in plaintiff's physical condition (with a physician anesthesiologist administering the anesthesia) would he less than one in five thousand; he further stated that according to recent statistics from the Massachusetts General Hospital, with the use of physician anesthesiologists (as compared to non-physician anesthetists) the mortality rate had been less than one in ten thousand cases. The medical witnesses admitted that unusual fear could increase the danger of surgery under a general anesthesia, but stated that with proper premedication (the use of calming drugs) such fear would not play a calculable part in the risk of death from operation.
The physician anesthesiologist testifying frankly admitted that "anesthesia is an approach to death, but it should be a controlled approach," (Tr-69). The substance of all this medical testimony is that whether or not the general anesthesia is dangerous or suitable as to a particular person depends upon all the circumstances surrounding the particular person and the particular operation in question.
The majority of this Court frankly admits that it approached study of this question with some doubt that an injured claimant should ever be required to submit to surgical procedure requiring general anesthesia and the consequent some risk to life. But on the basis of the record presently before us, and the surrounding facts and circumstances, we are unable to hold manifestly erroneous the District Court's determination that in this particluar case the risk of death or danger through use of general anesthesia is not substantial enough so as to excuse the employee's continued refusal to submit to surgery after a final judicial assessment of the risk as such.
Defendants-appellants re-urge by answer to the appeal their plea of pre-maturity, overruled by the District Court. This plea is based upon LSA-R.S. 23:1314, which provides that the employee instituting suit for compensation must allege that he is not being paid the workmen's compensation benefits to which he is entitled, and:
" when such allegations are contained in such petition and are denied by the employer at the time fixed thereunder by the court, if it be shown that such allegations are without reasonable cause or foundation in fact, such petition shall be dismissed; and the question of whether or not such allegations of nonpayment or of failure to render medical attention or failure to furnish medical reports is justified under the facts shall be determined by the court before proceeding with the hearing of the other issues involved." (Italics ours.)
With considerable logic defendants urge that when it is judicially determined after trial that an employee's refusal to submit to a tendered operative procedure is not reasonably based, then ispo facto the employee's allegation that he is not being paid compensation to which he is entitled is thus found to be "without reasonable cause," and the allegation of nonpayment is found not "jttstified"; and the employee's suit must be dismissed.
As the able District Court pointed out in overruling this exception, it would not be fair to characterize the present employee's refusal to submit to the recommended surgery as so "unreasonable"— when, in his words "there is some likelihood that there will be disagreement on this point among the judges of the various trial and appellate courts" — as to justify dismissal of his suit, and loss of workmen's compensation benefits due in the interim. The question of whether the employee's refusal to accept the tendered surgery is reasonable, is not a medical question; it is a legal question, involving not only an assessment of the medical testimony, but of the circumstances surrounding this particular employee under the particular facts of this particular case, and an application to these facts of the legal standards evolved and evolving through the jurisprudence. We are inclined to believe that such determination can never properly be made ex parte by one of the interested parties, but only by the court after a judicial assessment of all the surrounding facts and circumstances of the particular case concerned.
We are fortified in these conclusions by the following comments of that eminent authority, Dean (now Under-Secretary) Larson, in his treatise, Workmen's Compensation Law, Volume 1, pp. 189-191, Section 13.22 (footnotes omitted):
"The question when compensation should be suspended because claimant refuses to submit to reasonable treatment or surgery is one of the most delicate medico-legal issues in the entire realm of workmen's compensation. It is easy enough to state a general rule that such unreasonable refusal becomes an independent intervening cause responsible for persisting consequences which the treatment or surgery would have cured. The difficulty arises when 'reasonableness' has to be defined. The judgment usually resolves itself into a weighing of the probability of the operation's successfully reducing the disability by a significant amount, against the risk of the operation to the claimant. If the risk is insubstantial and the probability of cure high, refusal will result in a termination of benefits. But if there is a real risk involved, and particularly if there is a considerable chance that the operation will result in no improvement or even perhaps in a worsening of the condition, the claimant cannot be forced to run the risk at peril of losing his statutory compensation rights. In the commonest operations presenting this problem —hernia, intervertebral disc, and amputations — most courts will not at present disturb a finding that refusal to submit to the operation is reasonable, since the question is a complex fact judgment involving a multitude of variables, including claimant's age and physical condition, his previous surgical experience, the ratio of deaths from the operation, the percentage of cures, and many others. The matter cannot be determined automatically as a matter of medical statistics and expert testimony. The surgeon who sees several operations every day and who testifies that the chance of fatality is 'only five per cent' naturally has a different point of view than the claimant who has never had a major operation and might quite understandably prefer to enjoy life as best he can with his injury; rather than take a one-in-twenty chance of being dead. On the other hand, refusal of surgery cannot be deemed reasonable when the only reason shown for the refusal is the claimant's subjective fear of the operation." (Italics ours.)
Considering the remedial nature of the workmen's compensation statute, the burden is and should be put upon the employer to secure a judicial determination of the necessity of the surgery, rather than upon the employee to prove that his own refusal to submit to same is reasonably based. This is certainly so in the present instance, when the employee's initial refusal to submit to an operation was based on grounds not patently trivial.
Our able brother in his learned and acute dissent points out abuses on the part of employees which may occur through dilatory refusals to accept undoubtedly reasonable surgery. The present case does not concern such an instance.
Further, the workmen's compensation statute is protective in purpose and is designed to "insure that an employee whose wages were discontinued as the result of injury sustained during the course of his hazardous employment would be paid weekly compensation on which to subsist during the period of his disability," Puchner v. Employers' Liability Assurance Corporation, 198 La. 921, 5 So.2d 288, 291, 292. Just as abuses on the part of unscrupulous employees taking advantage of the present ruling may be imagined, so may abuses on the part of unscrupulous employers and insurers (if such there be), should upon the contrary ruling they be legally entitled to disrupt compensation payments permitting minimum subsistence to admittedly disabled employees, ex parte and without judicial sanction.
But the compensation act must be interpreted with a view to the vast mass of ordinary, decent employees, employers, and insurers concerned, not only to the extreme instances of unscrupulosity which may occasionally occur. The legislature has not provided that an employee's compensation payments may be suspended because of his unwillingness to submit to an operation; it is an equitable judicial doctrine. The employee is thus entitled to his day in court (including appellate review) to test the reasonableness of his grounds of unwillingness, under the circumstances of the particular case concerned. It is to be supposed that the vast mass of employees will not refuse on trivial grounds an operative procedure recommended, which may reasonably be supposed to end disability and pain and enable a return to earning decent wages again, greater than the bare subsistance payments of weekly compensation.
The vast mass of well-intentioned employees should not be deprived of their right to have this question judicially determined before subjecting them to any penalty for their refusal to accede to their adversaries' ex parte determination that the operation is reasonable, because of the mere possibility of abuse by an unscrupulous few —any more than the vast mass of well-intentioned insurers are penalized for nonpayment of weekly compensation which the courts find due after trial to an injured employee, Clements v. Liberty Mutual Insurance Co., La.App. 1 Cir., 85 So.2d 675, in the absence of arbitrariness or capriciousness, Fruge v. Pacific Employers Insurance Co., La.App. 1 Cir., 71 So.2d 625. Both are entitled to resist their opponents' demands until the courts order otherwise, without fear of penalty because they chose to assert their legal right to litigate the question.
For the above and foregoing reasons, the judgment of the District Court is affirmed, but must be recast due to the appellate delays which have intervened.
For the above and foregoing reasons, the judgment of the District Court is affirmed awarding plaintiff compensation at the rate of $30 per week, commencing November 14, 1955 (subject to credit of compensation paid), with legal interest upon such payments from date of delinquency until paid, and further assessing defendants with all costs of the proceedings below; such weekly compensation not to be paid exceeding four hundred weeks in all.
It is further ordered, adjudged, and decreed that plaintiff's right to receive compensation payments beyond those due up to sixty days from date of finality of this judgment, is conditioned however, that if within sixty days from date of finality of this judgment, plaintiff does not submit to an operation on his right wrist, as described in these proceedings, by a competent orthopedic surgeon of his own selection and at the exclusive cost of defendants (including hospitalization, etc.); on his refusal to submit to such an operation within that time and without reasonable grounds, then plaintiff's right to receive further compensation as the result of the present suit shall cease after the expiration of the said sixty days; provided further that at any time after the said operation herein ordered, the defendant is given the right to show that by reason thereof, or otherwise, plaintiff's disability no longer exists, and his compensation should cease.
The cost of this appeal would be assessed against plaintiff-appellant except that this suit is in forma pauperis.
Affirmed.
. We have some doubt in our mind that the issue of whether a refusal to take an operation is reasonable, is one properly to be raised by the plea of prematurity. We have pretermitted a discussion of this phase, because defendant by alternative rule in the nature of an answer admitted of the decree entered of suspension of compensation payments if the employee, after court determination, refused to submit to surgery.
The issue herein is one in the nature of "confession and avoidance" — "Yes, he is disabled, and nevertheless we have terminated his compensation payments, but we feel we have legal cause to do so". The delicate question of whether an admittedly disabled employee's rights to work men's compensation may be conditioned upon bis submission to surgery, goes to the heart of the merits of the suit. If the plea of prematurity lies in this case, then it also lies in every case where the employee's allegation of nonpayment of compensation to which the employee is entitled, is denied on the ground that the employee is not entitled to any because he is not disabled; which would include almost every compensation suit filed.
Construing the act as a whole, it seems that an employer in a compensation suit is required to file an answer in ten days, LSA-R.S. 23:1315, even if he files other pleadings; and in the failure to file an answer, the court shall "upon simple request" of the petitioner enter a preliminary judgment in his favor, LSA-R.S. 23 :1316; or, at the time set for hearing, shall hear the evidence, and shall "decide the merits of the controversy as equitably, summarily and simply as may be," LSA-R.S. 28:1317. This to our notion indicates that most probably the plea of prematurity raises only threshold questions of whether or not the workmen's compensation benefits due (accepting plaintiffs claim of disability as true) are being paid; because if so, the employee is not statutorily entitled to seek a judicial determination of the controversy. If the plea of prematurity goes to the merits, then unless set for trial at the same time as the answer, this raises the probability of a multiplicity of trials of essentially the same issues, in contravention of the simple and expeditious procedure envisioned by the Act.
When the employer denies any liability at all to an admittedly injured employee on the alleged ground that the payment of wages constituted the payment of compensation benefits due, the Supreme Court (reversing this Court) has ordered the plea of prematurity overruled, so that the rights and liabilities of the parties may be determined after a trial on the merits; D'Antoni v. Employers' Liability Assurance Corporation, 213 La. 67, 34 So.2d 378, Thornton v. E. I. Du Pont De Nemours & Co., 207 La. 239, 21 So.2d 46, 47. (See also, Scalise v. Liberty Mutual Insurance Co., La.App., 1 Cir., 84 So.2d 88 at page 98.)