Opinion ID: 4532444
Heading Depth: 1
Heading Rank: 2

Heading: the clarity of owen & the confused response to it

Text: The majority ties together a line of opinions from this Court, the Court of Appeals, and the Commission to support the assertion that a hip-replacement surgery, as a matter of law, can never constitute a maximum medical improvement, which is a precondition to any award of permanent, partial disability, see Hart, 218 Va. at 568. 1 The majority’s reasoning begins with Owen v. Chesapeake Corp. of Virginia, a case involving a worker who “suffered caustic acid burns to both eyes,” which caused him to have “industrial blindness” as a result of a loss of vision in both eyes. 198 Va. 440, 441 (1956). We found that the employee’s impairment rating should not take into account eyeglasses that could improve his vision. See id. at 442. Implicit in this holding was the truism that giving a worker a pair of prescription eyeglasses could hardly constitute a maximum medical improvement. The 1 See also 6 Arthur Larson et al., Larson’s Workers’ Compensation Law § 80.04, at 80-13 (2019); 15 Virginia Practice Series: Workers’ Compensation § 26:1, at 277 (2019-2020 ed.). 18 worker would immediately return to near total blindness as soon as he misplaced the glasses or accidentally dropped them on the floor. The majority reasons that a hip-replacement surgery cannot be deemed a maximum medical improvement any more than a pair of prescription glasses could in Owen. I do not see the logic of this argument. No doctor or patient would say that a hip-replacement surgery is not “medical,” or not an “improvement” if it was helpful, or not a “maximum medical improvement” if it achieved the best result that one could hope for. Richardson received, as his treating physician testified, a medical improvement in his condition because of the hip-replacement surgery. And it was the best (that is, the maximum) improvement that medical science had to offer him. The majority cites opinions from the Court of Appeals and the Commission ostensibly relying upon Owen. One Court of Appeals opinion deserves special attention because Richardson uses it as the fulcrum of his argument. In Creative Dimensions Group, Inc. v. Hill, a worker developed a cataract in one eye as a result of a work injury, and a surgeon replaced his natural eye lens with an intraocular lens implant, thereby improving the worker’s vision in that eye. See 16 Va. App. 439, 440-41 (1993). The medical evidence in the case, however, established that the intraocular lens implant “was not truly ‘permanent.’” Id. at 442. The treating physician itemized “the major problems associated with this procedure,” including: (1) retinal detachment; (2) cystoid macular edema; (3) secondary cataract or membranous cataract (a clouding of the membrane used to hold back the vitreous gel); (4) implant dislocation; (5) infection, either acute or slow endophthalmitis (which might necessitate removal); (6) glare or inflammation caused by the implant itself; and (7) damage to the cornea or angle of the eye bringing out glaucoma. Id. at 442 n.3. Surveying out-of-state cases specific to eye injuries, the Court of Appeals held that the Commission had had a sound factual basis for finding that the lens implant had put the 19 worker at risk of “major problems” and thus had not permanently improved his injured eye. See id. at 442-46 & n.3. The very nature of the lens implant and the procedure, the treating physician testified, demonstrated that the remedy was temporary. See id. at 442 & n.3. We need not strain to see the difference between the present case and Hill. In the present case, Richardson’s treating physician testified that the hip replacement had permanently restored Richardson’s use of his leg. No evidence suggested that the hip replacement would eventually fail, causing Richardson to revert to his prior condition. Nor did any evidence disclose any major problems with this procedure. By contrast, the treating physician in Hill testified that the intraocular lens implant presented the risk of multiple “major problems” and, as a result, could not be considered a permanent restoration of the claimant’s eyesight. See id. Treating this dispositive dissimilarity as insignificant, Richardson reconstitutes the holding of Hill into an axiomatic rule of law. The majority adopts it in full. See ante at 4-6. That rule can be succinctly stated as follows: When determining maximum medical improvement for purposes of calculating permanent losses compensable under § 65.2-503 of this Title, the medical use of a surgically implanted “prosthetic device” shall be excluded from consideration even if it is a medical improvement that maximizes the claimant’s capacity to use the damaged body part. This judicially crafted rule of law looks a lot like a statutory provision and functions very much like one. Perhaps it could be excused if it were an accurate restatement of “our precedent that dates back more than a half-century,” ante at 9. But if “our precedent,” ante at 9, means decisions of our Court, there simply are none.