Opinion ID: 1494966
Heading Depth: 1
Heading Rank: 1

Heading: The Commissioner's Decree

Text: Claimant argues that the Commissioner's decree was legally and factually in error. We do not doubt that under 39 M.R.S.A. § 65 [1] a claimant's unreasonable refusal to submit to surgery or any reasonable examination attendant thereto is an affirmative defense to the employer's obligation to continue to provide compensation benefits and that the employer has the burden of proof on this issue. See Stratakos v. Wright, Pierce, Barnes & Wyman, Me., 272 A.2d 363 (1971). Pursuant to 39 M.R. S.A. § 65, the Commissioner found that the claimant had symptoms of Raynaud's phenomenon with vascular spasms secondary to injury, the recommended treatment for which is a sympathectomy, the success of which can be partially determined by the performance of a nerve block. The Commissioner also found that the risks attending a nerve block are negligible. We believe that these findings of fact are supported by the evidence and are therefore final. The sole question on this matter is whether the employer has sustained its burden of proving that the claimant's refusal to submit to the nerve block procedure is unreasonable. We do not believe that it has. The question of what constitutes an unreasonable refusal to submit to medical treatment under 39 M.R.S.A. § 65 has never been decided by this Court. In the one case where the issue did arise ( Beaulieu's Case, 124 Me. 83, 126 A. 376 (1924)), we upheld the Commission's finding that the claimant's refusal to submit to surgery was reasonable where medical testimony established that the operation was painful and the success of the proposed surgery was in doubt. Although not decided under 39 M.R.S.A. § 65, our affirmation of the Commission's finding in that case could reasonably imply the obverse of the proposition there establishedthat is, where the risk of surgery is insubstantial and the probability of its success high, the claimant's refusal to submit to the operation is unreasonable and will result in a forfeiture of compensation benefits. Kentucky, which has a statute similar to 39 M.R.S.A. § 65, has adopted a like standard under which a claimant's refusal to submit to a major operation is reasonable unless the prospects for failure and the risk to health are minimal. Beth-Elkhorn Corp. v. Epling, Ky., 450 S.W.2d 814 (1970); Hefley v. E. I. duPont de Nemours & Co., Ky., 424 S.W.2d 396 (1968). This standard requires the Commission to make its decision as to the reasonableness of the claimant's conduct by weighing the probability of the success of the proposed treatment against the risks to the claimant, thus providing an objective limitation on the Commission's authority to deny compensation once the claimant's right to benefits under the Act has already been established. Such a calculus of risk and success would embrace a multitude of variables, including the claimant's age and condition. In the instant case, the Commissioner's decree requires the claimant to submit to a diagnostic procedure as a preliminary to a surgical procedure. The Commissioner's conclusion that the risks of the nerve block procedure were negligible was supported by the record below. However, his evaluation of its probable benefits were premature. The purpose of the nerve block is only to aid in determining the probable efficacy of a later sympathectomy, the probable success and risk of which will ultimately be in issue. Dr. Sensenig testified that although the sympathectomy involves a very small statistical risk of death, it was a major surgical endeavor and would not be undertaken without a complete evaluation of this particular patient's fitness to withstand surgery. Until this workup is done and its results obtained it cannot be known whether this patient would be a proper subject for a sympathectomy. The nerve block, of course, could be of no benefit at all if the employee is unfit for the surgery. Although the risks involved in a nerve block may be negligible, it constitutes a substantial invasion of the patient's person and one which we believe the employee should not be required to undergo until it can be determined that he should also reasonably submit to the ultimate surgical procedure in the event the nerve block does indicate its appropriateness. [2] The reasonableness of this particular employee's submission to the surgery cannot yet be determined. Although the employee has thus far expressed an unwillingness to have either the nerve block or the surgery, this disinclination would become moot if he is found to be an unfit subject for surgery. We must therefore reverse the Commissioner and deny the employer's petition for its failure to prove that the refusal was unreasonable.