RR Donnelly & Sons v. Barnett
Decision Date | 08 October 2003 |
Docket Number | No. 01-1510.,01-1510. |
Parties | R.R. DONNELLY & SONS, Employer, and Gallagher Bassett Services, Inc., Insurance Carrier, Appellants, v. Cathleen BARNETT, Appellee. |
Court | Iowa Supreme Court |
Charles E. Cutler of Cutler Law Firm, P.C., Des Moines, for appellants.
Martin Ozga of Max Schott and Associates, P.C., Des Moines, for appellee.
In this appeal from judicial review of a workers' compensation decision dismissing an application for alternate medical care by an injured worker, we must consider an employer's future responsibility for unauthorized medical care where the employer has acknowledged the compensability of a portion of the injury. The workers' compensation commissioner dismissed the employee's application for alternate medical care, but held that the employer could not assert lack of authorization as a defense to a future claim by the employee for payment of medical care not authorized. The district court affirmed the decision of the workers' compensation commissioner on judicial review, but the court of appeals reversed the district court by striking that provision of the decision by the commissioner that barred the employer from asserting the lack of authorization as a defense in any future proceeding. We granted further review. On our review, we vacate the decision of the court of appeals and affirm the district court and the workers' compensation commissioner.
Cathleen Barnett was employed by R.R. Donnelly & Sons (R.R. Donnelly) in Des Moines. She was injured at work in 1998 when her left hand was crushed by a machine. She underwent surgery for the injury, but continued to experience intense and constant pain in her arm, shoulder, neck, and head. Several physicians have diagnosed the pain component of her injury as complex regional pain syndrome. She has not worked since the injury.
Barnett was evaluated and treated at the neurosurgery and pain departments of the University of Iowa Hospitals and Clinics, and was under the care of Richard Leth, M.D., a specialist in pain medicine in Des Moines, for a considerable period of time. She underwent numerous treatments and interventions for her pain, including epidural infusion and medications. Unfortunately, her condition has not improved. Barnett also suffers from mental illness, notably depression. Dr. Leth believed this illness exacerbated her condition and complicated the various treatment efforts. Dr. Leth was authorized to provide medical care to Barnett by R.R. Donnelly and its workers' compensation insurance carrier, Gallagher Bassett Services, Inc. Although R.R. Donnelly paid the cost of her medical care and treatment, Barnett eventually filed a contested claim for benefits with the workers' compensation commissioner.
In July 2000, Dr. Leth reviewed the various treatment options available to Barnett for her pain, including spinal cord stimulation, radiofrequency lesioning, oral medication, and the insertion of a permanent pump to infuse medication. Dr. Leth recommended she pursue spinal cord stimulation, but referred her to M.S. Iqbal, M.D., another pain specialist, for a second opinion. Dr. Leth also recommended continued psychiatric care, combined with a multidisciplinary pain management program for Barnett. However, he believed Barnett had reached her maximum medical improvement.
Dr. Iqbal recommended Barnett be treated for her pain condition by implanting a Medtronic SynchroMed Infusion System. This apparatus would pump medication to pain receptors in Barnett's spinal cord to inhibit the transmission of pain signals to the brain. On December 19, 2000, Dr. Iqbal requested authorization from R.R. Donnelly to perform the procedure to ensure payment for the treatment would be made. He also indicated the procedure needed to be performed promptly.
R.R. Donnelly did not immediately agree to the procedure, and Barnett filed an application with the commissioner for alternate medical care under Iowa Code section 85.27(4) (2003).1 The application included medical reports by Dr. Iqbal detailing his evaluation and treatment of Barnett. He also explained his reasons for the necessity of the pump implant.
R.R. Donnelly filed an answer to the application, claiming the treatment recommended by Dr. Iqbal was not reasonable. It also alleged that a significant portion of Barnett's disability claim was psychological in nature and not caused by the work injury. R.R. Donnelly attached numerous medical reports to its answer from Dr. Leth and other physicians who had treated Barnett following her injury. These reports concluded Barnett was not a good candidate for the implant due to her mental illness and because a catheter previously utilized to treat Barnett was unsuccessful.
A telephonic hearing on the application was held and the issue was submitted to a deputy workers' compensation commissioner based on the written record. The deputy commissioner issued a prompt decision. Based on R.R. Donnelly's assertion that a portion of Barnett's claim was psychological and not related to a work injury, the deputy dismissed the application. The deputy found the alternate medical care provisions were not available to Barnett as long as R.R. Donnelly denied liability for a portion of the disability claim. The deputy determined it was "impossible to separate out what portion, if any, of Barnett's pain management needs is physical as opposed to mental." Additionally, the deputy ruled R.R. Donnelly could not defend against any future claim by Barnett for the alternate medical care on the basis that the care was not authorized.
R.R. Donnelly filed a petition for judicial review in the district court. The district court affirmed the decision of the deputy commissioner. It found substantial evidence to support the finding that the employer disputed the claim. It also found that an administrative rule utilized by the deputy commissioner guided the decision. This rule provided for the dismissal of an application for alternate medical care "where the liability of the employer is an issue." Iowa Admin. Code r. 876-4.48(7). The district court also found the corollary of this rule was that an employer who disputes liability and does not authorize medical care might be liable for the cost of such care if liability is ultimately determined. R.R. Donnelly filed an appeal and we transferred the case to the court of appeals. The court of appeals found R.R. Donnelly should not be precluded from asserting an authorization defense, and modified the decision of the deputy commissioner by striking the provision. The court of appeals reasoned that it would be unfair for the workers' compensation commissioner to deny an application by an employee for alternate medical care but allow the employee the opportunity to relitigate the issue while precluding the employer from using the authorization defense. We granted further review.
We apply the standards of Iowa Code section 17A.19 in our review of workers' compensation decisions. Our review "from a district court decision on judicial review of an agency decision `"is limited to determining whether the district court correctly applied the law in exercising its [review]" ' under Iowa Code section 17A.19(8)." Excel Corp. v. Smithart, 654 N.W.2d 891, 896 (Iowa 2002) (citation omitted). The commissioner's factual findings are binding on us "`"if they are supported by substantial evidence in the record."'" Id. (citation omitted).
We begin our resolution of the dispute in this case by reviewing the statute that lies at the core of the parties' disagreement. Iowa Code section 85.27 addresses a variety of medical care issues faced by injured workers, but foremost requires employers to furnish reasonable medical services and supplies "for all injuries compensable under" the Workers' Compensation Act and the Iowa Occupational Disease Law. Iowa Code § 85.27(1). In connection with imposing the obligation on the employer "to furnish reasonable services and supplies to treat an injured employee," the statute in return gives the employer "the right to choose the care." Id. § 85.27(4). However, it qualifies this right by requiring the treatment to be "offered promptly and be reasonably suited to treat the injury without undue inconvenience to the employee." Id.; accord West Side Transp. v. Cordell, 601 N.W.2d 691, 693 (Iowa 1999)
(. ) The statute anticipates that disputes may arise between employers and injured employees over the reasonableness of the medical care provided by the employer. The statute provides, in relevant part:
If the employee has reason to be dissatisfied with the care offered, the employee should communicate the basis of such dissatisfaction to the employer, in writing if requested, following which the employer and the employee may agree to alternate care reasonably suited to treat the injury. If the employer and employee cannot agree on such alternate care, the commissioner may, upon application and reasonable proofs of necessity therefor, allow and order other care.
Iowa Code § 85.27(4) (emphasis added). The statute outlines a procedure for the commissioner to hear and decide disputes upon the filing of an application for alternate medical care. See id. The procedure permits disputes over the medical care for compensable injuries to be quickly resolved in advance of a contested case hearing on a claim for workers' compensation benefits. See id. If the treatment provided by the employer is not prompt, not "reasonably suited to treat the injury," or is unduly inconvenient to the employee, the commissioner has authority to order the alternate care. West Side Transp.,601 N.W.2d at 693. The burden to prove that the care authorized by the employer is unreasonable is on the employee. Pirelli-Armstrong Tire Co. v. Reynolds, 562 N.W.2d 433, 436 (Iowa 1997).
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