Hamilton v. Southwire Co.
191 So. 3d 1275
| Miss. Ct. App. | 2016Background
- In 2005 Hamilton sustained compensable foot/ankle injuries while working for Southwire; he later was diagnosed with alleged complex regional sympathetic dystrophy (RSD) and received a spinal cord stimulator in 2006.
- Southwire voluntarily paid temporary disability; indemnity issues were later settled. This appeal concerns a 2013 motion to compel medical treatment and prescription coverage.
- Hamilton sought approval for a stimulator revision by Dr. Daniel Hoit and continued coverage of multiple pain-related prescriptions prescribed by Dr. Kevin Vance (including ED drugs Cialis and Testim).
- Employer-ordered IME Dr. Rahul Vohra concluded Hamilton did not have RSD, had reached MMI, and recommended psychological evaluation and tapering off pain meds; psychiatrist Dr. Mark Webb similarly concluded many complaints were psychiatric (bipolar disorder, somatization).
- An AJ granted Hamilton’s motion to compel treatment and medication coverage; Southwire filed a motion to reconsider (targeting ED drugs) and a petition for review to the full Commission. The full Commission later reversed the AJ on the stimulator revision, required tapering-assistance (but not continued care by Dr. Vance), and denied payment for ED drugs; Hamilton appealed.
Issues
| Issue | Hamilton's Argument | Southwire's Argument | Held |
|---|---|---|---|
| Whether Commission erred by denying compulsion of stimulator-revision surgery/Dr. Hoit | The treating physicians say revision is necessary and must be provided if "necessary and reasonable." | IME and psychiatric opinions show no RSD, surgery not causally related or medically necessary. | Affirmed: Commission may credit IME/psychiatrist over treating docs when credible countervailing evidence exists. |
| Whether Southwire must pay for continued treatment by Dr. Vance (pain management) | Continued prescribing by Dr. Vance was necessary for injury recovery. | Vohra/Webb opined meds not required for compensable injury; tapering off is appropriate. | Affirmed: Commission credited Vohra/Webb and ordered tapering assistance but not continued Dr. Vance treatment. |
| Whether refusing to fund alternative treatment violated claimant’s statutory right to choose physician | Denial of Dr. Vance’s continued care infringes right to select physician under §71-3-15(1). | Employer must not pay for services not medically necessary or not related to the compensable injury. | Held: No violation — employer need not pay for unnecessary services; Commission may require different, necessary treatment. |
| Whether Commission erred by denying payment for ED drugs (Cialis, Testim) | Dr. Vance’s marked response (attorney form) ties ED to pain meds; that suffices as medical evidence of causal relation. | Even if ED caused by pain meds, if pain meds are not compensable/treatment-related then ED drugs are not either; form answer is weak/conclusory. | Affirmed: Commission permissibly rejected conclusory/unexplained mark and found no medical evidence of causal relation to compensable injury. |
Key Cases Cited
- Spann v. Wal-Mart Stores Inc., 700 So.2d 308 (Miss. 1997) (treating physician’s recommendation compels coverage only absent credible contrary evidence)
- Hardaway Co. v. Bradley, 887 So.2d 793 (Miss. 2004) (Spann limited where competent contrary medical opinion exists)
- Lott v. Hudspeth Ctr., 26 So.3d 1044 (Miss. 2010) (standard of review: Commission decision affirmed if supported by substantial evidence)
- Raytheon Aerospace Support Servs. v. Miller, 861 So.2d 330 (Miss. 2003) (when medical testimony conflicts, Commission’s credibility choices are controlling)
- Day Detectives Inc. v. Savell, 291 So.2d 716 (Miss. 1974) (motion to reconsider tolls time to appeal an AJ’s order)