CLAIM NO. E615492
Before the Arkansas Workers’ Compensation Commission
OPINION FILED JULY 16, 1998
Upon review before the FULL COMMISSION, Little Rock, Pulaski County, Arkansas.
Claimant represented by ROBERT CORTINEZ, Attorney at Law, Little Rock, Arkansas.
Respondent represented by MICHAEL J. DENNIS, Attorney at Law, Pine Bluff, Arkansas.
Decision of Administrative Law Judge: Reversed.
[1] OPINION AND ORDER[2] Respondent appeals from a decision of the Administrative Law Judge filed November 24, 1997 finding that the claimant is entitled to additional benefits. Specifically, the Administrative Law Judge found that the treatment the claimant received from Dr. Scott Schlesinger was authorized, reasonable and necessary and related to her compensable injury of June 16, 1996. Based upon our de novo review of the record, we find that the claimant has failed to meet her burden of proof. Accordingly, we reverse the decision of the Administrative Law Judge. [3] The claimant sustained an admittedly compensable injury on June 16, 1996. The claimant received initial treatment by Dr. Robert Prosser and was diagnosed with a lumbar strain. Dr. Prosser referred the claimant to Dr. Willis Courtney, a neurologist, whom she began seeing on October 29, 1996. Dr. Courtney referred the claimant to Dr. P.B. Simpson for a neurosurgical evaluation. On November 19, 1996, Dr. Simpson performed an evaluation and determined that the claimant suffered from “nothing more than some central disc bulging at L5-S1.” Dr. Simpson concluded that the claimant was not a surgical candidate and he had nothing to offer the claimant except suggesting that she do back strengthening exercises. [4] The claimant returned to Dr. Courtney who then recommended physical therapy. The claimant received physical therapy from Professional Rehabilitation Associates beginning in November, 1996, and lasting through the early part of January 1997. [5] The claimant returned to Dr. Courtney on January 15, 1997. Dr. Courtney stated at that time:
[6] The claimant returned to Dr. Courtney after only working for one day. The claimant complained that she still experienced pain and could not perform her job duties. Dr. Courtney informed the claimant that she may experience some discomfort since she had just returned to work but that her symptoms would continue to improve with time. Dr. Courtney prescribed the medication for the claimant. [7] The claimant continued to complain of pain and on February 10, 1997, she was seen by Dr. Bruce Safman, a physiatrist, at the respondent’s expense. Dr. Safman agreed with Dr. Simpson that the claimant suffered from a soft tissue strain and did not have clinical evidence of radiculopathy. He further noted:In my medical opinion, Ms. Bass has reached maximal medical improvement with regard to the injuries sustained as a result of the work-related incident that occurred on 6/16/96. As a result, I am releasing her from my care. The patient was instructed to return to work full-time without restrictions on 1/20/96 and to contact my office PRN.
[8] On March 3, 1997, Dr. Safman returned the claimant to her regular job noting her symptoms were significantly better. On March 17, 1997, the claimant returned to Dr. Safman who noted that she had returned to normal work but still complained of pain. Dr. Safman at that time opined that the claimant had reached maximum medical improvement. [9] Based upon the reports from Dr. Safman and the findings of Dr. Simpson and Dr. Courtney, the respondent determined that further treatment of the claimant’s work-related injury would not be beneficial to the claimant and was not reasonable and necessary. Three doctors stated that they could do nothing more for the claimant and two opined that she had reached maximum medical improvement. The respondent informed the claimant that they were suspending her benefits. [10] The claimant presented herself again to Dr. Courtney’s office on April 7, 1997 complaining of back pain. Dr. Courtney examined the claimant and sent her to see Dr. Scott Schlesinger for another neurosurgical evaluation. It is of note that the respondent filed Form AR-E with the Commission and stated that the claimant would not receive benefits after March 17, 1997. The respondent also denied the claimant’s request for a formal change of physician and refused to pay for her April 7 visit to Dr. Courtney. [11] Dr. Schlesinger evaluated the claimant on April 11, 1997 and noted that the claimant had some degenerative disc changes at L5-S1 but no evidence of disc herniation or nerve root compression. Dr. Schlesinger opined that he did not see anything that could help the claimant from a surgical standpoint. Dr. Schlesinger’s opinion was simply a restatement of Dr. Simpson’s opinion of November 19, 1996. Dr. Schlesinger sent the claimant to see Dr. Slayden and Dr. Smith. [12] The respondent contended that the treatment received by the claimant from Dr. Schlesinger was not reasonably necessary and was not an authorized referral. Further, the respondent argued that Dr. Schlesinger’s treatment was a needless duplication of treatment that the claimant had already received from Dr. Simpson. We agree. [13] Arkansas Code Ann. § 11-9-508 (Repl. 1996) provides:I believe that we are dealing with a soft tissue problem, which one would have expected to have resolved a long time ago with the treatment she has already received. It is of note that there was no objective pathology on examination. The broad base bulge at L5-S1 noted on the MRI is the only objective pathology to date that I could discern from the medical records that I received.
[14] What constitutes reasonable and necessary medical treatment under this section of the statute is a fact question for the Commission. Wright Contracting Co. v. Randal, 12 Ark. App. 358, 676 S.W.2d 750 (1984). Also, whether the medical treatment is actually provided is reasonable and necessary is a question of fact for the Commission. DeBoard v. Colson Co., 20 Ark. App. 166, 725 S.W.2d 857 (1987). However, injured employees have the burden of proving by a preponderance of the evidence that the medical treatment is reasonably necessary for the treatment of the compensable injury. Norma Beatty v. Ben Pearson, Inc., Full Workers’ Compensation Commission Opinion filed February 17, 1989 (D612291). When assessing whether medical treatment is reasonably necessary for the treatment of a compensable injury, we must analyze both the proposed procedure and the condition it is sought to remedy. Deborah Jones v. Seba, Inc., FC Opinion Dec. 13, 1989 (D512553). Also, the respondent is only responsible for medical services which are causally related to the compensable injury. [15] In our opinion, the medical treatment that the claimant received from Dr. Schlesinger, Dr. Slayden and Dr. Smith subsequent to March 17, 1997 was not authorized treatment. The claimant had her benefits suspended by the respondent at that point because two physicians were of the opinion that she had reached maximum medical improvement and that there was nothing further medically to offer her. The claimant subsequently sought treatment from Dr. Slayden, Dr. Smith and Dr. Schlesinger after the respondent suspended benefits in March of 1997. The claimant cannot show that the treatment she received after March 17, 1997 was reasonable and necessary. In fact, Dr. Schlesinger’s evaluation of the claimant was nothing more than a confirmation of what Dr. Simpson had found months earlier. [16] The claimant seems to be under the impression that the treatment she received from Dr. Schlesinger, Dr. Slayden and Dr. Smith was reasonable and necessary because it occurred through a normal chain of referral. This is not the case. The treatment that the claimant received from Dr. Schlesinger, Dr. Smith and Dr. Slayden were not authorized by the respondent. [17] Dr. Courtney sent the claimant to Dr. Schlesinger for a neurosurgical evaluation. The evidence shows that this is the same evaluation that Dr. Simpson had performed five months earlier. Dr. Schlesinger simply confirmed what Dr. Simpson had already found: The claimant was not a neurosurgical candidate. The claimant is not entitled to duplicate treatment. Under the provisions of the statute, the claimant is only entitled to reasonable and necessary medical treatment. The medical treatment the claimant received from Dr. Schlesinger, Dr. Smith and Dr. Slayden is not reasonable and necessary in relation to the claimant’s compensable back strain. In our opinion, any medical treatment the claimant received after March 17, 1997, was not reasonable and necessary medical treatment. We note that the claimant was attending beauty school the entire period she was seeking treatment for her back strain. [18] Therefore, based upon our de novo review of the record, and without giving the benefit of the doubt to either party, we find that the claimant has failed to meet her burden of proof. Accordingly, we reverse the decision of the Administrative Law Judge. [19] IT IS SO ORDERED.(a) The employer shall promptly provide for an injured employee such medical, surgical, hospital, and nursing services, and medicine, crutches, artificial limbs, and other apparatus as may be reasonably necessary for the treatment of the injury received by the employee.
ELDON F. COFFMAN, Chairman MIKE WILSON, Commissioner
[20] Commissioner Humphrey dissents.