Gary E. SPRAGUE, Claimant-Appellant, v. CALDWELL TRANSPORTATION INC., Employer, and Aetna Casualty & Surety, Surety, Defendants-Respondents.
No. 17081.
Supreme Court of Idaho.
May 12, 1989.
On Denial of Rehearing Sept. 7, 1989.
779 P.2d 395
Imhoff & Lynch, Boise, for respondents. Thomas P. Baskin III, argued.
BISTLINE, Justice.
The Commission concluded that claimant‘s medical treatment occurring subsequent to April 10, 1985, was not “reasonable,” and therefore the surety was not obligated to pay such costs under
A.
Claimant Gary Sprague suffered a back injury on June 5, 1984, which arose out of and in the course of his employment with Caldwell Transportation Company. While fueling a vehicle, Sprague fell backward from the third step of a gasoline tank when his feet got tangled in a gasoline hose. He fell about three feet, landing on his back and head. Sprague immediately consulted with Dr. John Downey, a chiropractic physician from Caldwell.
Dr. Downey diagnosed Sprague‘s injury as a compression fracture of the 12th thoracic vertebrae and a subluxation complex of the lumbar spine. Dr. Downey treated Sprague on a frequent basis, submitting periodic reports and billings to the surety, Aetna Casualty. In September 1984, the surety arranged for a consultation with Dr. Floyd Johnson, an orthopedic surgeon. The surety subsequently notified Dr. Downey and claimant Sprague that further chiropractic treatment would not be authorized because Dr. Johnson indicated that Sprague should not receive manipulative treatment, but only passive treatment (e.g., ultrasound and traction). However, Dr. Johnson later reported that chiropractic treatment would be appropriate. Sprague
The surety subsequently arranged consultation with another orthopedic surgeon, Dr. Keith Taylor, in April of 1985. Dr. Taylor concluded Sprague had received enough chiropractic therapy and that Sprague should engage in back exercises. Thereafter, the surety requested that Dr. Downey send his final report and bill. On April 15, 1985, Dr. Downey sent a report stating the “patient has been finalized and has reached his MMI” (maximum medical improvement). The surety paid all of Dr. Downey‘s charges through April 10, 1985, in the total amount of $5108.71.
Sprague nevertheless returned to Dr. Downey a week later for further treatment of back pain. This appeal focuses on the treatment received after April 10, 1985. Sprague received 34 additional treatments in 1985 and 13 in 1986. The bill for this treatment totalled $1,848.96. The referee found that during the period of treatment after April 10, 1985, Sprague “made gradual improvement.” The referee further found that the post April 10, 1985, “charges were fair, reasonable and similar to others in the same profession.” Surprisingly, however, the referee also concluded that the treatment was not reasonable under
B.
Our scope of review in appeals of this kind is well established. The
The provisions of the Worker‘s Compensation Law are to be liberally construed in favor of the employee. Jones v. Morrison-Knudsen Co., 98 Idaho 458, 567 P.2d 3 (1977); Burch v. Potlatch Forests, Inc., 82 Idaho 323, 353 P.2d 1076 (1960). Liberal construction in favor of the worker is required to enable the act to serve the humane purposes for which it was promulgated, “leaving no room for narrow, technical construction.” Hattenburg v. Blanks, 98 Idaho 485, 485, 567 P.2d 829, 829 (1977).
C.
The sole issue presented on this appeal is whether the treatment Sprague received from his physician subsequent to April 10, 1985, was “reasonable” under
“The employer shall provide ... reasonable medical ... treatment ... as may be required by the employee‘s physician....”
(Emphasis added.)1 The clearly expressed intent of the legislature must be given effect; there is no occasion for construction where language is unambiguous. Ottesen v. Bd. of Comm‘rs of Madison Co., 107 Idaho 1099, 695 P.2d 1238 (1985). Thus, the mandate of the statute requires the employer to pay for the costs of reasonable medical treatment required by the employee‘s physician. Chiropractic physicians are
First, as noted, the Commission found that “during the period of treatment by Dr. Downey subsequent to April 10, 1985, Sprague made gradual improvement.”2 (Emphasis added.) Second, the uncontradicted evidence establishes that Dr. Downey was of the unequivocal opinion that in his judgment the medical treatment Sprague received was required.3 Third, the Commission found that the treatment Sprague received “was within the standard of the practice of chiropractic. The charges were fair, reasonable and similar to charges of others in the same profession.”4 These facts are beyond cavil or dispute.
The Commission determined, however, in the conclusions of law that the chiropractic treatment was “unreasonable” under
But here the pertinent facts are uncontroverted. Instead, the issues turn upon the proper application of the law to the undisputed [or found] facts.... Hix v. Potlatch Forests, Inc., 88 Idaho 155, 159, 397 P.2d 237, 241 (1964), citing Johnston v. A.C. White Lumber Co., 37 Idaho 617, 217 P. 979 (1923); Ybaibarriaga v. Farmer, 39 Idaho 361, 228 P. 227 (1924). The standard is one of free review. The Honorable Donald L. Burnett, Jr., of our Court of Appeals, has written: ‘An appellate court is expected to declare the law and may substitute its view for that of a trial court or agency upon a legal issue.’ Standards of Appellate Review in State and Federal Courts, § 3.2, p. 3-3, Idaho Appellate Handbook (Idaho Law Foundation, Inc., 1985).
112 Idaho at 1051, 739 P.2d at 350.
The Commission‘s finding that Sprague‘s accident and injury “did not necessitate the type of care provided to [Sprague] by Dr. Downey subsequent to April 10, 1985” incorrectly focuses on the necessity of the treatment, rather than on whether it was reasonable and was required by Sprague‘s physician.
Under the circumstances of this case, there is no dispute that: a) the claimant made gradual improvement from the treatment received; b) the treatment was required by the claimant‘s physician; and c) the treatment received was within the physician‘s standard of practice the
Reversed. Costs to claimant; no attorney fees on appeal.
SHEPARD, C.J., and HUNTLEY and JOHNSON, JJ. concur.
BAKES, Justice, dissenting:
A.
The majority opinion reverses the Industrial Commission, exercising so-called “free review” of what is supposedly the Commission‘s conclusion of law that the chiropractic treatment provided by Dr. Downey after April 10, 1985, was “unreasonable.” Being a conclusion of law, according to the majority opinion, we are not bound by the constitutional prohibition in
By this appeal we are reviewing a factual finding by the Industrial Commission that
However, the Commission did enter Finding of Fact IX, and therein it found that “the claimant‘s accident and injury did not necessitate the type of care provided to the claimant by Dr. Downey subsequent to April 10, 1985, and that therefore such care and treatment was not reasonable, not necessary and not within the obligation of the employer and surety to provide to the claimant.” The majority errs egregiously when it concludes that it can exercise “free review” of those findings of fact, merely because the Commission also referred to them in Conclusion of Law II. The Court‘s action is a clear violation of
B.
The majority opinion further errs when it states, in footnote 3, ante at 722, 779 P.2d at 397, that Dr. Downey‘s opinion, to the effect that his care and treatment of Mr. Sprague during 1985 and 1986 was required by the injury, was “uncontradicted testimony” which must be accepted as true. That statement totally ignores the testimony and medical records of the orthopedic surgeons, Dr. Floyd Johnson and Dr. Keith Taylor. As the Commission correctly noted in its Finding of Fact IX, “there is a conflict in the evidence as to whether the chiropractic care received by the claimant subsequent to April 10, 1985, was reasonable care which the claimant needed as a result of the accident of June 5, 1984.” A complete review of the record clearly demonstrates the error in the majority‘s claim that Dr. Downey‘s testimony was “uncontradicted.” In fact, Dr. Downey‘s testimony and his medical records were self-contradictory, so even without considering the testimony and evidence of Doctors Taylor and Johnson, the Commission was entitled to disregard the chiropractor‘s testimony. Smith v. Idaho State University Fed. Credit Union, 114 Idaho 680, 685, 760 P.2d 19, 24 (1988) (the Court need only accept the uncontradicted and unimpeached testimony of a witness. Dr. Downey‘s testimony was self-contradictory, as well as contradicted by the testimony and records of Drs. Taylor and Johnson).
The following is a summary of the evidence in the record, as found by the Industrial Commission, which clearly supports the Commission‘s (1) finding that there was “a conflict in the evidence as to whether the chiropractic care received by the claimant subsequent to April 10, 1985, was reasonable ...,” and (2) that “claimant‘s accident and injury did not necessitate the type of care provided to the claimant by Dr. Downey subsequent to April 10, 1985, and therefore such care and treatment was not reasonable [or] necessary.”
Claimant‘s back problems did not commence with the June 5, 1984, accident in question. In 1975 he had had an accident while employed with a different employer in which he seriously injured his back and right hip, and had seen numerous doctors during that time for his back problem. He began treatments with Dr. Downey, the chiropractor in question here, in 1982, two years before the June 5, 1984, accident involved in this case. He had numerous visits to Dr. Downey in 1982 and 1983 for his back and hip problems. Therefore, the June 5, 1984, accident in which claimant fell while stepping back from the fuel truck was not the beginning of claimant‘s back problems, but only a continuation of them. The claimant‘s testimony and the records
After claimant‘s accident on June 5, 1984, he immediately went to Dr. Downey who X-rayed claimant and diagnosed his injury as a compression fracture of the twelfth thoracic vertebra, and immediately commenced chiropractic treatment of the injury. He subsequently diagnosed a subluxation complex of the lumbar spine as well. The orthopedic surgeon Dr. Taylor would later disagree with that diagnosis. After the accident claimant had chiropractic treatment on almost a daily basis, although claimant was able to return to work after approximately two weeks. Dr. Downey‘s bills were submitted to and paid by the surety for the employer.
In September, 1984, three months after the accident, claimant was examined by Dr. Floyd Johnson, a Boise orthopedic surgeon, at the surety‘s request. Dr. Johnson reported on September 14, 1984, that claimant‘s symptoms had cleared quite well and he had very little back pain. Dr. Johnson advised claimant to continue wearing a brace, avoid heavy work but not to engage in aggressive chiropractic manipulation for at least six months after the injury. Dr. Keith Taylor, M.D., a Boise orthopedic surgeon, would later testify that chiropractic manipulation is not an indicated treatment immediately after a compression fracture of a vertebra.
On April 3, 1985, the surety arranged for Sprague to be examined by Dr. Keith Taylor, M.D. Dr. Taylor testified, and the Commission found, that at the time of that examination the claimant was “comfortable, doing well, able to move easily, and had no significant pain or tenderness.” The X-rays disclosed a healed compression fracture at the twelfth dorsal vertebra and that the claimant had a good range of motion in his back. A neurological evaluation was normal and Dr. Taylor found “no significant displacement or subluxation.” Dr. Taylor “recommended that the claimant continue an active exercise program with active back exercises. He believed that the claimant had received more than an adequate amount of chiropractic therapy.” Dr. Taylor testified that the claimant had a need to strengthen and relax his back muscles, and he testified that as a treating physician he would have prescribed physical therapy and an active exercise program as opposed to passive chiropractic modalities.
Upon receipt of Dr. Taylor‘s report the surety advised the claimant and Dr. Downey of the results of Dr. Taylor‘s examination. The surety requested that Dr. Downey send his final report and bill. The Commission found that “on April 15, 1985, Dr. Downey complied by sending a report to the surety stating, ‘Patient has been finalized and has reached his MMI’ (maximum medical improvement).” Commission Finding V. The surety subsequently paid all of Dr. Downey‘s charges up to that time. The Commission further found that “claimant understood upon receipt of the communication from the surety that the surety was taking the position that it would no longer be responsible for expenses incurred by further treatment by Dr. Downey.” Nevertheless, the Commission found that claimant made 34 additional visits to Dr. Downey in 1985 and 13 visits in 1986 for the total bill incurred by claimant subsequent to April 10, 1985, of $1,848.96, which is the claim which was sought in this proceeding before the Industrial Commission. Dr. Downey continued to send periodic reports to the surety, but the Commission found that “the reports are uninformative.” The Commission further found that “neither Dr. Downey nor the claimant requested that the surety authorize additional treatment by Dr. Downey, nor did Dr. Downey explain to the surety how the continued treatment related to the condition caused by the claimant‘s [industrial] injury after the doctor had reported that the claimant had reached maximum medical improvement by April 15, 1985.” Furthermore, Dr. Downey‘s reports reflect that at times Sprague was complaining of back pain at a level below the level of the June 5, 1984, injury, and at times was complaining of hip pain, and pain which
Claimant Sprague was again examined by Dr. Taylor on January 27, 1987, at the request of the surety. Dr. Taylor testified, and the Commission found, that at that time claimant had no complaints of discomfort or back difficulty, that claimant had no need for further treatment or chiropractic care. Dr. Taylor specifically testified that subsequent to April of 1985 he would have preferred a program of active exercise to strengthen muscles, and would not have used the type of passive therapy utilized by Dr. Downey.
Based upon that evidentiary record, the Commission in its Finding of Fact IX found that “the claimant‘s accident and injury did not necessitate the type of care provided to the claimant by Dr. Downey subsequent to April 10, 1985, and that therefore such care and treatment was not reasonable, not necessary, and not within the obligation of the employer and surety to provide for the claimant.” That finding of fact is amply supported by the evidence cited above. Therefore, under
C.
The Commission, in Conclusion of Law I, set out the statute
On appeal from decisions of the Industrial Commission, or for that matter decisions of the trial courts of this state, the evidentiary record must be viewed most favorably to the party who prevailed before the trier of fact, and all reasonable inferences must be resolved in favor of the prevailing party below. Parker v. Engle, 115 Idaho 860, 771 P.2d 524 (1989); Hazen v. General Store, 111 Idaho 972, 729 P.2d 1035 (1986); Higginson v. Westergard, 100 Idaho 687, 604 P.2d 51 (1979). Viewed in that perspective, the record in this case amply supports the Industrial Commission‘s decision in this case. It is only by overlooking Finding of Fact IX, and by quoting from only a selective and minuscule portion of the testimony (footnote 3, ante at 722, 779 P.2d at 397) that the majority opinion can conclude, as it does, that the record is “uncontradicted” that Dr. Downey‘s care and treatment subsequent to April 10, 1985, was required by the injury that he suffered in June of 1984.
Accordingly, I dissent.
OPINION ON DENIAL OF PETITION FOR REHEARING.
BISTLINE, Justice.
The Court has received and considered Caldwell Transportation‘s petition for rehearing. The petition is denied. We continue to adhere to the conclusion which was reached and the basis thereof. However, we have determined to clarify by adding an additional paragraph for insertion just prior to the last full paragraph of our opinion of May 12, 1989, which additional paragraph is as follows:
The Commission‘s finding that Sprague‘s accident and injury “did not necessitate the type of care provided to [Sprague] by Dr. Downey subsequent to April 10, 1985” incorrectly focuses on the necessity of the treatment, rather than on whether it was reasonable and was required by Sprague‘s physician.
I.C. § 72-432(1) obligates the employer to provide treatment, if the employee‘s physician requires the treatment and if the treatment is reasonable. It is for the physician, not the Commission, to decide whether the treatment is required. The only review the Commission is entitled to make of the physician‘s decision is whether the treatment was reasonable. Here, the Commission‘s attempt to premise a conclusion that the treatment was not reasonable on a finding that it was not necessary exceeded the Commission‘s authority.*
BAKES, C.J., and JOHNSON, J., concur.
HUNTLEY, J., fully concurred prior to his resignation on August 7, 1989.
SHEPARD, J., sat, but did not participate due to his untimely death.
* Editor‘s note: The additional paragraph has been inserted in the original opinion.