Portsmouth (City Of) School Board v. Harris, 58 Va. App. 556

Claimant Harris sustained a compensable left shoulder injury on September 20, 2005.
Claimant reported to his physician that a spa pool might help with neck, back and shoulder pain; May 31, 2007 letter from Dr. Kirven recommended a spa pool but was not transmitted to the employer with no accompanying medical report.
On June 11, 2008 Dr. Kirven prescribed a spa pool; adjuster Wyvette Johnson initially declined reimbursement due to lack of prescription in file.
Claimant purchased a six-seat spa pool for $5,200 on June 16, 2008; medical insurance partially covered cost; Dr. Kirven had not prescribed this specific appliance.
The deputy commissioner and the Workers’ Compensation Commission ruled the employer was responsible for the spa pool as a medically necessary appliance prescribed by the treating physician.
The Virginia Court of Appeals reversed, holding that a non-specific prescription for a spa pool did not establish medical necessity for the specific home appliance purchased.

Issue	Plaintiff's Argument	Defendant's Argument	Held
Is the spa pool medically necessary and reasonably related to the injury?	Harris argues prescription supports medical necessity.	School Board contends prescription is non-specific and insufficient to show necessity.	Medically necessary standard not met; reversal of award.
Does a generic prescription for a 'spa pool' bind the employer to pay for any home appliance?	Harris relies on treating physician's prescription to cover the cost.	Board argues unspecific prescription requires additional proof of necessity for the exact appliance.	Unspecific prescription cannot bind employer; not medically necessary as purchased.
Did the claimant prove there were no adequate alternatives to home spa pool treatment?	Harris contends spa pool uniquely beneficial for his condition.	Board argues absence of proof of alternatives waives entitlement.	Record lacks evidence that home spa pool was uniquely necessary or that alternatives were unavailable.
Should the Commission have limited or clarified the scope of the treatment and appliance when applying Code § 65.2-603(A)(1)?	Harris asserts the prescription should be interpreted to cover prescribed appliance.	Board asserts need for specific medical guidance on appliance and capacity.	The court adopts limit: a generic prescription requires supporting evidence for the specific appliance.

Volvo White Truck Corp. v. Hedge, 1 Va. App. 195 (1985) (burden on employer when treating physician prescribes treatment)
Jensen Press v. Ale, 1 Va. App. 153 (1985) (employer bears burden when treatment is prescribed by authorized physician)
Lynchburg Foundry Co. v. Goad, 15 Va. App. 710 (1993) (specific ordering of treatment matters for necessity)
City of Waynesboro v. Harter, 1 Va. App. 265 (1985) (mixed questions of law and fact are reviewed de novo)
Papco Oil Co. v. Farr, 26 Va. App. 66 (1997) (courts may limit scope when treatment exceeds prescribed parameters)