Opinion ID: 2576202
Heading Depth: 2
Heading Rank: 1

Heading: Did the Industrial Commission Err in Denying Reese Medical Benefits for the Surgery Performed by Dr. Jorgensen?

Text: The Industrial Commission held that Reese was not entitled to benefits related to the second surgery because he had failed to comply with Idaho Code § 72-432. The relevant portions of the statute provide as follows: (1) The employer shall provide for an injured employee such reasonable medical, surgical or other attendance or treatment, nurse and hospital service, medicines, crutches and apparatus, as may be reasonably required by the employee's physician or needed immediately after an injury or manifestation of an occupational disease, and for a reasonable time thereafter. If the employer fails to provide the same, the injured employee may do so at the expense of the employer. . . . . (4)(a) The employee upon reasonable grounds, may petition the commission for a change of physician to be provided by the employer; however, the employee must give written notice to the employer or surety of the employee's request for a change of physicians to afford the employer the opportunity to fulfill its obligations under this section. If proper notice is not given, the employer shall not be obligated to pay for the services obtained. Relying upon subsection (4)(a) of the statute, the Industrial Commission stated, The Claimant could have (1) asked a treating doctor for a referral, (2) asked Defendants for a change, or (3) sought a change of physician under Rule 20, J.R.P. Instead, he went out on his own and failed to disclose the fact to Defendants until after the surgery was performed. It concluded, Surety refused the one treatment Dr. DuBose recommended. Surety obtains a windfall because Claimant acted in desperation. In reaching its decision, the Commission construed § 72-432(1) very narrowly. The first sentence of the subsection states in broad terms the medical care that an employer is required to provide to an injured employee. The second sentence states, If the employer fails to provide the same, the injured employee may do so at the expense of the employer. The Commission construed the words the same to refer to the specific treatment that the employer failed to provide. It then construed the injured employee's right to do so at the expense of the employer as the right to obtain only that specific treatment at the employer's expense. Thus, when V-1 failed to provide the spinal cord stimulator trial reasonably required by Dr. DuBose, Reese was only entitled to obtain a spinal cord stimulator trial at V-1's expense. V-1 could not be required to pay for any other type of treatment, even if it was reasonably required . . . or needed. The worker's compensation law is to be liberally construed in favor of the claimant in order to effect the object of the law and to promote justice. Haldiman v. American Fine Foods, 117 Idaho 955, 793 P.2d 187 (1990). The humane purposes that this law seeks to serve leave no room for a narrow technical construction. Id. V-1 was required to provide Reese with such reasonable medical, surgical or other . . . treatment . . . as may be reasonably required by [his] physician or needed immediately after [his] injury . . . and for a reasonable time thereafter. I.C. § 72-432(1). V-1 provided Reese with back surgery and thereafter with medications and therapy in an attempt to eliminate or reduce Reese's continuing back pain. When the medications and therapy proved unsuccessful to reduce the pain to a manageable level, Reese's treating physician recommended the spinal cord stimulator trial as the best modality available. It was also, at that point, the treating physician's only recommended treatment. As the Commission found, neither the family practitioner who initially treated Reese nor the neurological surgeon who performed the first back surgery would treat Reese further. Likewise, Dr. DuBose would not provide any further treatment other than the spinal cord stimulator. V-1 challenges that finding, arguing that there is no evidence that the family practitioner, the neurological surgeon, or Dr. DuBose refused to see Reese again. Reese was not seeking companionship from these physicians. He did not want simply to see them. He wanted treatment for his continuing back pain. On July 1, 2002, Reese came to Dr. DuBose seeking more narcotic pain medications. Dr. DuBose met with Reese for about thirty minutes, informing him that narcotics were not particularly effective for his type of pain and that Dr. DuBose would not prescribe any more narcotic pain medications for him. Reese asked if there were other options for dealing with his pain, and Dr. DuBose responded that the spinal cord stimulator was the best modality available, and he recommended that treatment. On July 30, 2002, Reese returned to his family practitioner seeking pain medications. The family practitioner gave him a one-time prescription, told him it would not be refilled, and referred him to Dr. DuBose. On September 4, 2002, Reese returned to his neurological surgeon seeking narcotic medications. The surgeon refused to prescribe the medications and referred him to Dr. DuBose. Thus, the family practitioner and the neurological surgeon would not provide Reese with any additional treatment for his pain, and the only treatment Dr. DuBose would provide was the spinal cord stimulator. With the Surety's refusal to authorize the spinal cord stimulator trial, these physicians had no other treatment to offer Reese for his continuing back pain. The Commission's finding that the physicians refused to treat Reese further is supported by substantial and competent evidence. Idaho Code § 72-432(1) requires an employer to provide an injured employee such reasonable medical, surgical or other attendance or treatment, nurse and hospital service, medicines, crutches and apparatus, as may be reasonably required by the employee's physician or needed immediately after an injury or manifestation of an occupational disease, and for a reasonable time thereafter. There is no difference between failing to provide medical treatment that is reasonably required by the employee's physician or needed immediately after an injury and failing to provide such treatment for a reasonable time thereafter. As we stated in Burch v. Potlatch Forests, Inc., 82 Idaho 323, 327, 353 P.2d 1076, 1078 (1960), the word treatment is a broad term and is employed to indicate all steps taken in order to effect a cure of an injury or disease. Once an employer wrongfully fails to provide medical treatment, the injured employee may do so at the expense of the employer. Reese was entitled to obtain, at V-1's expense, any medical care as may be reasonably required by the employee's physician or needed . . . for a reasonable time after the injury. The Commission found that the need for Reese's second surgery was caused by his work-related injury. It noted that Dr. Jorgensen had testified that in his opinion the L3-4 level in Reese's spine was either injured in the original accident or destabilized during the first surgery and that the fusion at L4-5 had placed additional mechanical stress on L3-4. V-1 argues, [T]the Idaho Code provides a clear option for a workers compensation clamant [claimant] dissatisfied with his or her physician or the physician's recommendations, and if Mr. Reese had followed that procedure, he would not have been faced with the `harsh results' Once it refused to authorize the treatment recommended by Dr. DuBose, V-1 was, in effect, no longer providing a physician for Reese. As mentioned above, Reese's reason for seeing these physicians was to obtain treatment for his back pain. There is no practical difference between not authorizing the treatment recommended by a physician and not providing the physician. Once V-1 had ceased providing a physician, Idaho Code § 72-432(1) authorized Reese to obtain medical care at V-1's expense. He was not required to seek permission to change physicians because V-1 was no longer providing a physician who could treat him. Indeed, there was no reason to require Reese to seek permission to change his physician. Reese was not dissatisfied with the medical care he was receiving from Dr. DuBose. V-1 had simply refused to provide what, at that time, was the only treatment recommended by Dr. DuBose. Because Dr. DuBose sought authorization from the Surety before proceeding with the spinal cord stimulator trial, and did not proceed with it after the Surety had refused that authorization, Dr. DuBose was apparently unwilling to provide that treatment without the Surety's prior approval. It is apparent that Reese lacked the financial resources to pay for that treatment himself. Under the Commission's reading of § 72-432(1), his only option would have been to seek a physician willing to provide a spinal cord stimulator trial without the Surety's prior authorization, which is unlikely. A change in physicians at that point would not be based upon any dissatisfaction with the care being provided or desire to try some other form of treatment. It would simply be to find a physician willing to extend Reese credit. The Commission erred in holding that Reese was required to seek permission for a change of physician once V-1 had wrongfully ceased providing medical care as required by Idaho Code § 72-432(1). The only reason for the denial of the medical benefits related to Dr. Jorgensen's surgery was the alleged failure to seek permission. The Commission found that such surgery was reasonably required by Reese's physician and that it was needed as a consequence of his work-related injury. We therefore reverse the Commission and order that Reese be awarded medical benefits related to Dr. Jorgensen's surgery.