Court Opinion

ID: 9669109
Source: CourtListenerOpinion
Date Created: 2023-08-24 02:39:40.323465+00
Date Added: 2024-06-11T18:15:52.516570
License: Public Domain

LEIBSON, Justice,
dissenting.
Respectfully, I dissent.
In a well-considered, carefully written opinion in this case, the Court of Appeals defined and applied the correct standard for deciding whether the employer should pay for the surgery the employee has decided to undergo to treat her injury, on the advice of her attending physician.
As the Court of Appeals duly notes, the statute covering medical treatment at the expense of the employer, KRS 342.020, specifies that “the employer shall pay for the cure and relief,” and that “[t]he employee may select the physician to treat his injury, and the hospital in which he shall be treated.” It is undisputed the employee selected a highly qualified specialist, and her doctor believes there is a reasonable likelihood the treatment will be of benefit.
KRS 342.020(3) permits the employer the right to select the mode of treatment only if the employer proves:
"... that, because of the physician selected by the employee to treat his injury or *311disease, or because of the hospital selected by the employee in which he is being treated, that the employee is not receiving proper medical treatment and his recovery is being substantially affected or delayed; or that the funds for his medical expenses are being spent without reasonable benefit to the employee; or that because of the physician selected by the employee or because of the type of medical treatment being received by the employee that the employer will substantially be prejudiced in any compensation proceedings resulting from the employee’s injury or disease;
The Court of Appeals states and resolves the issue in the present case as follows:
“The issue in this case concerns what is reasonable medical treatment. More precisely, the primary issue is: when is a proposed course of treatment so risky or so lacking in benefit to the patient that an employer should not be required to pay for the treatment under KRS 342.020? The burden of proving the unreasonableness of medical treatment is on the employer. See National Pizza Co. v. Curry, Ky.App., 802 S.W.2d 949 (1991). So, the ultimate question is whether Square D has met its burden of proof in proving the scalenectomy to be performed by Dr. Atasoy is unreasonable. That is, may an employer sustain its burden simply by having [other] doctors state that they would not recommend or perform the proposed procedure?” [Emphasis original.]
The Court of Appeals’ Opinion then carefully reviews the evidence. Dr. Atasoy, the employee’s attending physician and surgeon, is very competent and highly respected in his field, but three physicians giving evidence for the employer testify they do not believe the contemplated procedure is of likely benefit. The Court of Appeals concludes:
“Their opinions are not really on point, however. An employee is entitled to medical treatment which will provide reasonable relief even when no cure is possible. KRS 342.020(1). Such treatment is required even though it can do no more than ease the employee’s pain and discomfort. National Pizza Co. v. Curry, supra. The fact that the treatment will not render the employee painfree and ready-to-work does not make the treatment unreasonable. See id. Moreover, we do not believe that a treatment must achieve some given percentage of effectiveness before it becomes reasonable.... Therefore, we hold that the proper test for reasonableness is whether a competent physician and an informed patient may reasonably believe that the benefits of the proposed procedure are such as to outweigh the risks.”
The Court of Appeals’ Opinion states the proper test, and the Court of Appeals properly decided that the evidence compelled the conclusion that in this case the proposed treatment met this test. The Administrative Law Judge had no right to play “big brother” in deciding for the employee whether to undergo medical treatment prescribed by her own qualified physician simply because other physicians testifying for the employer dispute the statistical probability of benefit.
As the Court of Appeals correctly stated: “The language in the statute exhibits a strong preference in allowing the employee and her physician to select the appropriate treatment. See KRS 342.020. The testimony cited by the ALJ in this case respecting the scalenectomy does not meet the standards outlined above. Thus, it cannot be considered as substantial evidence supporting the denial of the scale-nectomy. [Citations omitted.]”
Our decision permits an employer to put in issue an employee’s right to competent medical treatment for her injury simply by getting a second opinion. We are interfering with the employee’s right to decide for herself, with the advice of her doctor, whether to undergo surgery, when there is no proof that her decision is unreasonable. The only proof here is that other physicians have testified that in their opinion the prospect of benefit does not justify requiring the employer to pay for the procedure. This is not the test. This Opinion sends the wrong message.
COMBS and LAMBERT, JJ., join this dissent.