Opinion ID: 891587
Heading Depth: 3
Heading Rank: 2

Heading: Admissibility of Medical Expert Testimony of Worker's HCPs Regarding Treatments Rendered Before They Became Authorized HCPs

Text: {26} We now address Worker's argument that once her doctors became treating HCPs under the Act, they not only could testify at a hearing, they could testify about the entirety of Worker's relevant medical history, including treatment they had provided and observations they had made before they were lawfully designated as Worker's treating HCPs. {27} Resolution of this issue requires us to interpret Section 52-1-51(C) of the Act, which provides: Only a health care provider who has treated the worker pursuant to Section 52-1-49 NMSA 1978 or the health care provider providing the independent medical examination pursuant to this section may offer testimony at any workers' compensation hearing concerning the particular injury in question. {28} The WCJ concluded that this statutory provision precluded testimony of Worker's authorized HCPs regarding treatment they provided before they became HCPs. Our review of that conclusion presents a pure matter of statutory interpretation, because the predicate facts are established. It is undisputed that Employer selected the initial HCP, Concentra, in February 2004, and that Worker did not give statutory notice of a requested change in HCP until July 15, 2005, some six months after beginning her consultation and treatment with Drs. Whalen and Gelinas. It is also undisputed that Employer did not object to the HCP change, and neither party challenges the WCJ's conclusion that Drs. Whalen and Gelinas became Worker's authorized HCPs as of July 18, 2005, over a year before the October 11, 2006, trial. Although Drs. Whalen and Gelinas each provided some treatment after they became HCPs, the most important testimony they could offer related to Worker's medical history before they became HCPs, including their observations and treatments. The question before us is whether the Act limits the scope of the testimony of qualified HCP witnesses to matters they personally participated in during the time they were authorized HCPs. {29} The first and most obvious guide to statutory interpretation is the wording of the statutes themselves. See State v. Davis, 2003-NMSC-022, ¶ 6, 134 N.M. 172, 74 P.3d 1064 (providing that where a statute has a plain meaning, it is to be given effect as written without room for construction). On its face, Section 52-1-51(C) specifies which medical experts are permitted to testify. Drs. Whalen and Gelinas, as duly designated HCPs who had treated the worker pursuant to Section 52-1-49 NMSA 1978, were authorized to offer testimony at any workers' compensation hearing concerning the particular injury in question by the express terms of Section 52-1-51(C). The Act simply says that authorized HCPs may testify. There is nothing in the plain language of Section 52-1-51(C) or any other part of the Act that textually limits the scope of admissible testimony to events that occurred during the time a doctor was an authorized HCP. Normally, that should end the inquiry. However, to the extent that the language could be considered ambiguous, we can consider principles of statutory construction that are employed with statutes that are unclear. In doing so, we must attempt to construe a statute according to its obvious spirit or reason. State ex rel. Helman v. Gallegos, 117 N.M. 346, 348, 871 P.2d 1352, 1354 (1994). {30} One guide to finding legislative intent is to strive to read related statutes in harmony so as to give effect to all provisions. N.M. Indus. Energy Consumers v. PRC, 2007-NMSC-053, ¶ 20, 142 N.M. 533, 168 P.3d 105. The only two apparently related statutory provisions are the remaining parts of Section 52-1-51, particularly subsections (A) and (D), and Section 52-1-49, which is specifically referenced in Section 52-1-51(C) itself. {31} Section 52-1-51(D) provides: If, pursuant to Subsection C of Section 52-1-49 NMSA 1978, either party selects a new health care provider, the other party shall be entitled to periodic examinations of the worker by the health care provider the worker previously selected. If the Act did not allow a provider to testify about treatment that may have occurred at a time when that provider was not acting any longer as a treating HCP, then this provision to permit examinations by the previously selected HCP would result in an absurdity: The previously selected HCP who is no longer providing treatment, but who is authorized to continue conducting examinations would not be able to offer any expert testimony about the need for or propriety of any of the treatment rendered by the new HCP. Of what value would the examination be if the formerly selected HCP could not testify about any opinions regarding what happened to the worker after a new HCP was selected? Similarly, Employer's construction would preclude the ability of an HCP, who had treated a worker before the relevant work-related injury, from testifying about the worker's complete medical history. This would inhibit a full analysis of the causation issues that may be so critically important in these cases. In effectuating the intent of the Legislature, we must avoid any interpretations that would lead to absurd or unreasonable results. Chavez v. Mountain States Constructors, 1996-NMSC-070, ¶ 24, 122 N.M. 579, 929 P.2d 971; see also W. Investors Life Ins. Co. v. N.M. Life Ins. Guar. Ass'n (In re Rehab. of W. Investors Life Ins. Co.), 100 N.M. 370, 373, 671 P.2d 31, 34 (1983) (Statutes must be construed so that no part of the statute is rendered surplusage or superfluous.). {32} A central factual issue in this case was whether Worker's medical condition resulted from a work-related injury or a pre-existing condition. It is unlikely that any of the medical experts could testify on that subject without an examination of the entire history of the patient, including the diagnostic and treatment history that predated any designation of an HCP in this case. In fact, the doctor performing the IME, who may be designated by the WCJ only after a conflict between the parties' respective HCPs, provides no treatment whatever and necessarily bases his or her testimony on treatments provided and diagnoses made by others, both HCPs and non-HCPs, during the relevant history. See § 52-1-51(A) (In the event of a dispute between the parties concerning ... the cause of an injury or any other medical issue, ... either party may petition a workers' compensation judge for permission to have the worker undergo an independent medical examination.). {33} The propriety of a testifying medical expert's reliance on treatments and records other than those resulting from his or her own HCP activities was specifically approved in Lopez v. City of Albuquerque, 118 N.M. 682, 884 P.2d 838 (Ct.App.1994). Lopez affirmed a WCJ ruling that permitted an authorized HCP to base his medical opinion testimony on otherwise inadmissible records from a non-HCP doctor. Id. at 682, 884 P.2d at 838. After sustaining an injury at work and being treated and released by his employer's authorized HCP, a worker later sought treatment by another doctor, who never became an authorized HCP. Id. at 682-83, 884 P.2d at 838-39. The employer's HCP in Lopez, the same Dr. Gelinas who sought to testify as Worker's HCP in this case, reviewed the records of the non-HCP doctor and relied on them heavily in arriving at his own opinions, which supported the worker's position. Id. at 683, 884 P.2d at 839. The employer objected to introduction of Dr. Gelinas's deposition testimony concerning the treatment of the worker by a non-HCP doctor and introduction of the supporting non-HCP's medical records on the ground that nothing generated by a non-HCP's treatment could be considered in a hearing under the Act. Id. The Court of Appeals upheld the WCJ's determination that the testimony and records were properly admitted as a part of the basis for the expert testimony of the statutorily-qualified HCP under Rule 11-703 NMRA. Id. at 684, 884 P.2d at 840. We agree with the reasoning of Lopez, including its observation that its holding does not contravene the rule that only authorized health care providers may give evidence. Id. {34} We also find guidance in the provisions of Section 52-1-49, which not only spell out in subsections (B)-(F) the procedures for notice and selection of HCPs, but also unambiguously specify in subsections (D) and (G) that employers are liable for payment of health care expenses only if they are incurred at a time when the health care provider was the statutorily authorized HCP, after the required ten-day notice of HCP selection. The Legislature obviously knew how to spell out those specific health care payment consequences of late compliance with the HCP designation provisions of the Act, as contrasted with the lack of any corresponding provision imposing a limitation on the scope of testimony of authorized HCPs. {35} We are sensitive to the obvious intent of the Legislature to avoid testimony-shopping and to limit the use and number of experts in workers' compensation cases. Grine, 2006-NMSC-031, ¶ 19, 140 N.M. 30, 139 P.3d 190. That goal is accomplished, however, by use of the limited ability of the parties to name new authorized treating HCPs through the notice, objection, and WCJ approval requirements set forth by the Legislature in Section 52-1-49. If Employer had been concerned that an approved designation of Worker's HCPs, and consequential entitlement to offer their testimony in this case, would have been inappropriate in any way, the Legislature provided an avenue for objection and resolution of the issue by the WCJ. An objection by Employer did not occur in this case, and Worker's doctors were therefore HCPs who were authorized to provide testimony on the issues in the case. While it certainly would have been desirable for Worker not to have made such a belated designation of her treating physicians as HCPs, and while she certainly ran the risk of their not being designated as such by the WCJ, we find no authority in the Act for a truncation of their authorized testimony. {36} In Grine, we noted that the Act limits testimony at the compensation hearing to a treating physician or a HCP who has provided an independent medical examination pursuant to the Act. 2006-NMSC-031, ¶ 19. Our reading of the record in this case indicates that Worker's HCPs had provided treatment after their official designations, and our holding is premised in part on that understanding. This case is therefore unlike Grine, in which we excluded the testimony of a doctor who never treated the worker at all and who was retained by the employer simply to review the case and offer expert testimony, meeting with the worker for an evaluation on only one occasion for a total of just ten minutes. Id. at ¶ 25. Our opinion explained why that reviewing doctor could not be considered a treating physician under the Act: We reiterate that `[t]he expertise of a treating physician is the training, experience and familiarity with the patient whom he or she is treating. The expert testimony required by Section 52-1-28(B) refers to testimony based on this training, experience and familiarity.' Id. (citation omitted). {37} Because we have determined that the testimony of Worker's HCPs should not have been categorically excluded, we reverse and remand to the WCJ to ensure that the testimony of Worker's HCPs are fully considered. In doing so, we wish to emphasize that nothing in this Opinion is intended to comment on the weight that should be given to the testimony of the late-designated HCPs or any other authorized medical witness. See Chapman v. Jesco, Inc., 98 N.M. 707, 708, 652 P.2d 257, 258 (Ct.App.1982) (holding that the WCJ, as fact finder, is free to reject expert opinion evidence in whole or in part). {38} In that regard, we are mindful of language in the WCJ's meticulous findings and conclusions that appears to indicate that the WCJ may have fully reviewed the proffered testimony of Worker's HCPs and intended to make alternative findings of fact that their testimony was less persuasive than that of Dr. Diskant. We remand to the WCJ so that the WCJ may reconsider [her] alternative findings of fact and conclusions of law in light of our disposition. Reichert v. Atler, 117 N.M. 623, 627, 875 P.2d 379, 383 (1994).