Court Opinion

ID: 9672589
Source: CourtListenerOpinion
Date Created: 2023-08-24 03:57:38.413566+00
Date Added: 2024-06-11T18:16:17.380342
License: Public Domain

Sam Robinson, Associate Justice (dissenting). It might be well to keep in mind undisputed facts in this case. The employee was injured August 23,1960; he went to see Dr. Napper (presumably a doctor of his own choice) for about a week and then returned to work; he continued working every day and did not again go to a doctor until he went to Dr. Nixon about five months later on January 18, 1961. Dr. Nixon saw him again on February 20, March 14, and October 6; a total of four times in about 10 months. All during this period the employee was working every day. In the meantime, the employee had visited Dr. Murphy on August 8, 1961. At that time Dr. Murphy reported.: “Mr. Caldwell is a 31 year old white male who, in my opinion, lias a disc problem. ... It is possible that surgery will have to be resorted to, but, of course, this depends on the symptoms and the wishes of the patient. At this time the patient has a disability in the neighborhood of 15% as related to the body as a whole. Whether or not this will improve will depend on future evaluations.” The employee had been injured for about á year and had a disability of only 15%. The employee’s visit to Dr. Murphy was more than six months after the injury occurred and the doctor was promptly notified that the employee was not authorized to engage the doctor’s services and that he must not look to the employer for his fee. Following the visit to Dr. Murphy on August 8, the employee went to Drs. Kuhl and Kuhl, chiropractors, on August 18, 1961. During all this time the employee was working daily. After his fourth visit to Dr. Nixon over a period of about 10 months, the doctor recommended that he be referred to Drs. Watson, Adametz & Porter, neurosurgeons. On October 18, the employee went to see Dr. Hundley, an eminent orthopedic surgeon, who recognized at once that the man had disc trouble and that an operation might be necessary, but thought it advisable to first try conservative treatment. Just 12 days later, at a time when the employee had led Dr. Hundley to believe he was improving with the conservative treatment, he went to see Dr. Murphy, who performed an operation the very next day. If the employer is liable for Dr. Murphy’s fee for operating on the employee, such liability must be based on Ark. Stat. Ann. § 81-1311 (Repl. 1960) which provides: “The employer shall promptly provide for an injured employee such medical, surgical, hospital and nursing service, and medicine, crutches, artificial limbs and other apparatus as may be necessary during the period of six [6] months after the injury, or for such time in excess thereof as the Commission, in its discretion, may require. If the employer fails to provide the services or things mentioned in the foregoing sentence within a reasonable time after knowledge of the injury, the Commission may direct that the injured employee obtain such service or thing at the expense of the employer, and any emergency treatment afforded the injured employee shall be at the expense of the employer.” In my opinion, the above statute does not make the employer liable for Dr. Murphy’s fee for the operation, and there is no other statute or law making the employer liable under the facts in this case. Before the employer would be liable for Dr. Murphy’s fee for the operation, the treatment would have to be given within six months after the injury occurred, or such treatment must have been authorized by the Commission, or it must have been emergency treatment. None of these requirements existed. The treatment was not given within six months after the injury occurred; the treatment was not authorized by the Commission, and there Avas no emergency. According to the undisputed evidence, the treatment did not occur within six months after the injury, and the Commission did not authorize it. That leaves the question of whether an emergency existed. The Commission held, in effect, that there was no emergency; there is more than substantial evidence to support that finding. The injury had occurred 14 months previously and the employee had worked every day for more than 13 months immediately preceding the operation. It appears that the majority bases the decision in this case on a finding made by this court—not by the Workmen’s Compensation Commission—that Dr. Murphy had correctly diagnosed the case and that Dr. Nixon and Dr. Hundley had made an incorrect diagnosis. Even if the record justified such a conclusion—and in my opinion it does not—under the laAv the employer would not be liable because the treatment Avas given more than six months after the injury occurred, the Commission did not authorize the treatment, and no emergency existed. The record does not justify a finding that any of the doctors Avere mistaken in the diagnosis. The last time the employee saAV Dr. Nixon Avas on October 6, 1961. The doctor suggested that he be transferred to Drs. Watson, Adametz & Porter for a neurological evaluation and treatment. These doctors are neurosurgeons who perform disc operations. There is weighty medical authority to the effect that only neurosurgeons should do this type of operation. It is shown by evidence that the Veterans Administration will permit only neurosurgeons to do this operation, and this is also the policy of Campbell’s Clinic, Mayo’s Clinic, and Johns Hopkins Hospital. Definitely, the record shows that Dr. Hundley did not incorrectly diagnose the case. In fact, Dr. Hundley stated in his diagnosis: “It is felt that this patient very definitely presents organic evidence of an injury to his lower back which may consist of a mild herniation of the nucleus pulposus and certainly the great probability of this mildly degenerative disc at L5-S1. I have advised him to continue with his regular work, report daily for physical therapy and carry out the exercise in which he was instructed today.” Dr. Hundley’s diagnosis was made the first day he saw the man, October 18, 1961. Of course no emergency was involved, the employee had been injured approximately 14 months before Dr. Hundley saw him, and furthermore, he was off from work for only a few days following the injury and had worked every day for more than 13 months at the time Dr. Hundley saw him. In these circumstances, the doctor thought conservative treatment was in order. In Gray’s Attorneys’ Textbook of Medicine, Vol. 1, Page 304, in speaking of herniated nucleus pulposus (intervertebral disc) it is said: “Love (22) concludes all such diagnostic procedures and operations for removal of a nucleus pulposus to be of major significance. He recommends against operations except in cases of long standing with major symptoms, such as those who have spent perhaps six months in bed. Barr, Hampton and Mixter (14) point out that visualization by x-ray is an exacting procedure. They insist that treatment for sciatica should long be attempted before resorting to operation. ’ ’ Perhaps the majority opinion holding the employer liable for the surgeon’s fee is based entirely on the theory that Dr. Hundley had diagnosed the case as being one of a herniated disc, but when the operation was performed an extruded disc was found. For all practical purposes, where the condition of the disc is causing trouble there is no valid distinction between an extruded disc, a ruptured disc, and a degenerated disc. Prior to the operation the doctors do not appear to have laid any stress on the distinction. Even after the operation Dr. Murphy used all three terms in describing the employee’s condition. In a letter written by him to the insurance carrier regarding the employee following the operation, Dr. Murphy said: ‘ ‘ The following morning surgery was done. An extniclecl disc was noted at this level. ... I have conscientiously examined him, diagnosed his condition as a herniated disc, confirmed this with a myelogram, and rendered what I regard as competent treatment.” (our emphasis). In his testimony Dr. Murphy stated: "Now disc problems are not static. They are dynamic. There is a constant changing, depending upon whether or not the disc deterioration or degeneration continues to take place or remains static. Here we have an excellent example of injury caused by a known accident, causing the degeneration . . .” (our emphasis). The distinction between an extruded, herniated, or degenerated disc appears to be a nice perception seized upon after the operation to make it appear that qualified orthopedic surgeons furnished by the employer had not correctly diagnosed the case. Just because appellee voluntarily furnished able and competent doctors after the six month period does not mean that the employee was at liberty to engage at the employer’s expense, a doctor unacceptable to the employer; one who had been notified that the employer would not pay his fee. I might add that there is no question about the right of the employee to select his own doctor. Of course he has such a right, but there is no law that gives him the right to engage a surgeon to perform an expensive operation more than six months after the injury solely on his own initiative, and require his employer to pay the bill. For the reason that I do not believe the law requires the employer to pay the surgeon’s fee in the circumstances of this case, I respectfully dissent.