Opinion ID: 2633391
Heading Depth: 2
Heading Rank: 2

Heading: Are the Industrial Commission's findings of fact supported by substantial and competent evidence?

Text: On July 29, 1998, G. Keith Mackenzie, M.D., examined Gooby at the request of the surety. He found no objective evidence to support any claim of pain or problems with her neck and back, and he found nothing from a physical standpoint that would prevent her from working on a daily basis. Although he opined that she would have some days of absence, he believed she would continue to do her job over the years, but she should have a job that would allow her to change her position as needed. Dr. Mackenzie did not place any lifting restrictions on Gooby, but he opined that most of her lifting activities would be light and that she would rarely lift items that weighed more than twenty pounds. It was apparent that the Commission placed great weight upon Dr. Mackenzie's opinions. Dr. Mackenzie did not testify during the hearing. He submitted a written report that was admitted into evidence at the hearing without objection. When expressing his opinions in that report he did not use the words reasonable degree of medical probability. Gooby contends that the Commission erred in relying upon Dr. Mackenzie's opinions because he did not expressly state that they were given to reasonable degree of medical probability. The proper standard for the admission of an opinion held by a medical expert is that the opinion is held to a reasonable degree of medical probability. Bloching v. Albertson's, Inc., 129 Idaho 844, 934 P.2d 17 (1997); Bowman v. Twin Falls Constr. Co., Inc., 99 Idaho 312, 581 P.2d 770 (1978). Whether or not the Commission can rely upon a medical opinion, however, does not depend upon the exact language used by the expert in expressing that opinion. Paulson v. Idaho Forest Industries, Inc., 99 Idaho 896, 591 P.2d 143 (1979). Even though the medical expert does not use the words reasonable degree of medical probability, the Commission can rely upon the expert's opinion if it is clear from the context that the expert was expressing an opinion based upon medical probability rather than merely upon medical possibility, speculation, or conjecture. Jensen v. City of Pocatello, 135 Idaho 406, 18 P.3d 211 (2000). From reading Dr. Mackenzie's report, it is clear that when expressing his opinions regarding Gooby's diagnosis and prognosis, he was expressing opinions that he believed were more probably true than not true. There is nothing in the report to indicate that he was merely speculating, conjecturing, or expressing mere possibilities. Gooby also argues that the Commission should not have relied upon Dr. Mackenzie's report because he examined Gooby on July 29, 1998, over one year before the hearing, and during that one-year period Gooby's treating physician Dr. Coffin stated that Gooby was making progress. Gooby therefore argues that Dr. Coffin's testimony shows that Gooby was not medically stable at the time of the hearing and that Gooby's improvement during the year following Dr. Mackenzie's examination showed that his opinion should not be given much weight. Dr. Mackenzie's opinion was that Gooby would not make significant improvement in the future. In his report, he stated, Prognosis is that I do not anticipate the patient's reported symptomatology is going to change significantly over future years. He further stated, At this time, I do not feel that further medical treatment is likely to produce any curative lasting benefit. She will need some ongoing pain management support in terms of medications, but these medications will be designed to help control her pain and will not provide a curative benefit. Dr. Coffin began treating Gooby on October 9, 1997, and her deposition was taken on August 23, 1999. In her deposition, Dr. Coffin stated that she thinks Gooby will slowly improve. She expressed her opinion as follows: Q And as I understand your testimony today, you feel that she can get better enough to work in time; is that correct? A I'm hopeful that she can. I don't think that there's no chance. I'm always hopeful until proven completely wrong, and I feel a little bit at a disadvantage because I'm not going to see her through the end of that process. I think she's made enough headway to this point without really stepping up all the therapies as much as I would ideally like. I think it would be great if she had somebody in Sandpoint who would take her swimming, teach her how to strengthen her upper body, really crank up her exercise program carefully and continue to see Dr. Vereen [a physician specializing in osteopathic manipulative medicine] and Greg Dudson [a chiropractor]. I think that would be ideal, but I don't think that's going to happen. So I think we work with what we've got, which is she's willing, she's trying, she's coming in as often as she's able and whenever she can get appointments with Dr. Vereen. And I think she'll improve just slowly. ... Q And under Client can work, it says, Not at all until she improves. So I assume that goes back to your prognosis that you feel she will improve enough to work? A My gut feeling is that she ought to be able to. I haven't found anything other than all the stuff we've talked about today that is keeping her from healing. There may be this collagen vascular disease, but people work with that. Dr. Coffin testified that although Gooby's condition was unchanged from March 1998 through May 1999, she started to improve during the last couple months preceding Dr. Coffin's deposition. Gooby was also examined on March 10, 1998, by a two-physician panel comprised of a neurosurgeon and an orthopedist/orthopedic surgeon. Their opinion was that as of the date of the examination, Gooby's condition was fixed and stable, she did not require any further treatment, and she was able to return to work without restrictions or limitations. As the factfinder, the Commission is free to determine the weight to be given to the testimony of physicians. Rivas v. K.C. Logging, 134 Idaho 603, 7 P.3d 212 (2000). The Commission is not bound to accept the opinion of the treating physician over that of a physician who merely examined the claimant for the pending litigation. Poss v. Meeker Mach. Shop, 109 Idaho 920, 712 P.2d 621 (1985). Absent evidence of abuse of discretion in weighing the evidence, and as long as the Commission's findings are supported by substantial and competent evidence, the Supreme Court will not disturb the Commission's findings on appeal. Kinney v. Tupperware Co., 117 Idaho 765, 792 P.2d 330 (1990).
During the course of her treatment, Gooby took various medications, some of which caused significant side effects. When describing the various symptoms about which Gooby complained to her physicians, the Commission listed side effects or minor adverse reactions to various medications prescribed for her. Gooby argues that the side effects she suffered from some medications were much more serious than minor adverse reactions, that they are nonmedical factors that the Commission should have taken into consideration, and that if the Commission mischaracterized the severity of the side effects it did not properly take them into consideration. During the hearing, Gooby testified that the medications she was currently taking were Cardizem and Adreninol for her heart and blood pressure; Relafen, an anti-inflammatory; Effexor, an antidepressant; and Hydrocordone, a pain medication. She testified that when she took the Effexor at a high dosage it made her vomit, but it did not cause side effects at the lower dosage she was now taking. The Relafen likewise did not cause her problems once she learned to take it all the time rather than only when she felt she needed it. At times, instead of Relafen she takes Ibuprofen, which she feels relieves pain faster than the Relafen, but she thinks the Ibuprofen causes stomach cramps. Finally, she stated that taking one Hydrocodone pill causes her to have a dry mouth and to become a little sick to my stomach and a little bit dizzy and a little bit tired. If she takes two pills, she becomes sick to her stomach, but she learned that if she lays down and takes the pills with food, it seems to pass. She added that she does not drive when she takes Hydrocodone because I don't feel responsible at the wheel on pain pills, but that when she was working she only took the Hydrocodone when she came home after work. In addition, Gooby described the significant adverse side effects she experienced with other medications that her physicians had tried earlier. Although Gooby certainly experienced significant adverse side effects with some of the medications, her testimony showed that by changing medication and altering dosages she was able to keep the side effects to a manageable level where they would not interfere with her ability to work.