Haftsavar v. All American Carpet & Rugs, Inc.

• Decision Date: 14 February 2012
• Docket Number: Record No. 0873–11–4.
• Citation: 721 S.E.2d 804,59 Va.App. 593
• Parties: Bahman HAFTSAVAR v. ALL AMERICAN CARPET AND RUGS, INC. and Twin City Fire Insurance Company.
• Court: Virginia Court of Appeals

59 Va.App. 593

721 S.E.2d 804

Bahman HAFTSAVAR

v.ALL AMERICAN CARPET AND RUGS, INC. and Twin City Fire Insurance Company.

Record No. 0873–11–4.

Court of Appeals of Virginia, Alexandria.

Feb. 14, 2012.

David L. Bayne, Jr. (Ashcraft & Gerel, Alexandria, on briefs), for appellant.

William T. Kennard (O'Connell & O'Connell, LLC, on briefs), for appellees.

Before: HALEY, BEALES and ALSTON, JJ.

ALSTON, Judge.

Bahman Haftsavar (“claimant”) appeals a decision of the Virginia Workers' Compensation Commission (“commission”) denying claimant's request for All American Carpet and Rugs, Inc. (“employer”) to compensate claimant for treatment of his heart condition. Claimant contends that the commission erred in failing to hold employer responsible for treatment of claimant's heart condition, which occurred prior to repair of his compensable right inguinal hernia. For the following reasons, we conclude that the commission did not err in this regard and affirm the decision below.

I. BACKGROUND

On January 5, 2007, claimant sustained a compensable right-sided inguinal hernia arising out of and in the course of his employment with employer while attempting to lift and pull a large box. On June 8, 2007, Dr. Albert Herrera, a primary care physician, saw claimant in his office and conducted a pre-operative clearance evaluation. During this visit, Dr. Herrera observed that claimant's electrocardiogram (“EKG”) results were abnormal and referred claimant for further cardiac evaluation.

Claimant saw Dr. Harvey Sherber, a cardiologist, on July 1, 2007. Dr. Sherber conducted a stress test on claimant and found the results “markedly abnormal.” Consequently, Dr. Sherber recommended cardiac catheterization with possible angioplasty and/or stenting. Two days later, Dr. Sherber performed cardiac catheterization on claimant, which revealed significant obstructions in claimant's coronary arteries. As a result of Dr. Sherber's findings, claimant underwent coronary bypass grafting surgery on July 5, 2007. Dr. Sherber wrote a letter to Dr. Herrera concerning the results of claimant's cardiac catheterization and stated: “[T]he patient was thought to be a better candidate for aortocoronary bypass surgery.... I think that he was fortunate that critical coronary artery disease was detected before the patient had a myocardial infarction [i.e., a heart attack].”

From July until March 16, 2008, claimant recovered from his heart surgery and prepared for his hernia surgery. On March 17, 2008, claimant underwent hernia surgery. Employer accepted the hernia injury as compensable and paid claimant temporary disability benefits through April 13, 2008. On December 3, 2009, claimant filed a change-in-condition application for hearing, asking for payment of all medical costs related to his bypass surgery.

On March 25, 2010, the deputy commissioner held an evidentiary hearing. Employer opposed the change-in-condition application because it believed there was no causal connection between claimant's need for bypass surgery and his work-related injury. As the only witness, claimant testified consistently with the facts and events described above regarding his medical care. Claimant further testified that he had no prior indications of a heart condition, including shortness of breath, chest pain, or a family history of heart disease.

Claimant and employer submitted medical records indicating that claimant's heart condition was severe enough to warrant surgery on the same day it was detected, July 5, 2008. These included Dr. Sherber's July 6, 2007 report to Dr. Herrera about the results of claimant's cardiac catheterization, and a May 5, 2009 letter from Dr. Herrera summarizing claimant's treatment, including the delay in his hernia surgery. The letter stated that a necessary cardiac catheterization revealed severe significant coronary artery disease, and this catheterization resulted in claimant undergoing emergency coronary bypass graft surgery.

The deputy commissioner concluded that employer was responsible for treatment of claimant's heart condition, adopting the analysis of the commission's decision in Ball v. Asplundh Tree Expert Co., No. 209–17–09 (Va. Workers' Comp. Comm'n Oct. 5, 2004).

Upon review at employer's request, the commission reversed the deputy commissioner's decision on this issue and found employer not responsible for the cost of claimant's heart surgery. In its reversal, the commission concluded that holding employer responsible for every unrelated condition which requires treatment before the compensable injury can be treated, regardless of whether treatment for the unrelated condition is needed independent of treating the compensable injury, contradicts the Workers' Compensation Act's (“the Act”) objectives. The commission enunciated a new test for future claimants with similar medical issues to claimant, stating:

[W]e find that the appropriate test is whether the treatment for the unrelated condition would be necessary if surgery for the compensable condition was not contemplated. In other words, the issue is whether the primary motivation for treatment of the unrelated condition is to allow the claimant to undergo the compensable treatment, or whether it is to treat the unrelated condition. If the unrelated condition would require treatment without reference to the compensable treatment, then there is simply no causal connection between the treatment for the unrelated condition and the compensable injury. Under these conditions, compensability should be denied.

Applying this test to the facts of the present case, it is clear [employer] should not be responsible for treatment of [claimant's] heart condition.

In support of the determination that claimant's heart surgery was not compensable as other necessary medical attention without a “causal connection between the treatment for the unrelated condition and the compensable injury,” the commission made the following factual findings: 1) there was no evidence that claimant's heart condition was materially aggravated or accelerated by his compensable injury; 2) there was no evidence that the compensable injury accelerated the need for treatment of claimant's heart condition; 3) according to Dr. Herrera, claimant had an urgent need for emergency coronary bypass surgery; and 4) claimant's need for cardiac surgery was completely unrelated to his impending hernia surgery and was necessary, independent of that upcoming surgery, to save his life.

The dissenting commissioner agreed with the deputy commissioner's conclusion on this issue and would have required employer to compensate claimant for his heart surgery under a different test. The dissenting commissioner stated: “The test for determining whether the employer is responsible for medical care prior to a compensable surgery is (1) whether the medical condition was discovered during the pre-operative evaluation and (2) whether the medical treatment is necessary so that the injured worker can safely undergo the compensable surgery.”

Claimant noted this appeal to the commission's decision. At oral argument, a panel of this Court requested supplemental briefs from the parties regarding the Act's requirement for a causal connection between medical treatment and a compensable injury, along with suggestions for a brightline test in cases similar to the one at bar.

II. ANALYSIS

A. The Act Does Not Require Employers to Cover Treatment of Medical Conditions Completely Unrelated to a Compensable Injury or Illness

Code § 65.2–603(A) states:

Pursuant to this section: 1. As long as necessary after an accident, the employer shall furnish or cause to be furnished, free of charge to the injured employee, a physician chosen by the injured employee from a panel of at least three physicians selected by the employer and such other necessary medical attention.

Whether disputed medical treatment is compensable as “other necessary medical attention” within the definition of Code § 65.2–603 presents a mixed question of law and fact, which this Court reviews de novo. Lynchburg Foundry Co. v. Goad, 15 Va.App. 710, 712–13, 427 S.E.2d 215, 217 (1993). “The services which an employer has to furnish under the Work[ers'] Compensation Act are necessary services incident to the treatment of an injury sustained in a compensable accident.” Ins. Mgmt. Corp. of Tidewater/Baldwin Bros. & Taylor v. Daniels, 222 Va. 434, 439, 281 S.E.2d 847, 849 (1981). Subject to the commission's review, the employer is responsible for medical attention if 1) a causal relationship exists between the workplace accident and the treatment, and 2) the attending physician deems it necessary. See Goad, 15 Va.App. at 714, 427 S.E.2d at 217–18. The claimant, however, bears the burden of proving by a preponderance of the evidence that disputed treatment was medically necessary. McGregor v. Crystal Food Corp., 1 Va.App. 507, 508, 339 S.E.2d 917, 918 (1986).

Since our decision in Goad, we have carved out some exceptions to the general rule requiring a causal connection between the compensable injury and the treatment. Our case law has recognized both the doctrine of compensable consequences and the “two causes rule.”

The doctrine of compensable consequences states: “ ‘When the primary injury is shown to have arisen out of and in the course of employment, every natural consequence that flows from the injury likewise arises out of the employment, unless it is the result of an independent intervening cause attributable to claimant's own intentional conduct.’ ” Morris v. Badger Powhatan/Figgie Int'l, Inc., 3 Va.App. 276, 283, 348 S.E.2d 876, 879 (1986) (quoting A. Larson, The Law of Workmen's Compensation §§ 13 and 81.30). We have applied the doctrine in more than one context. See e.g. Williams Indus., Inc. v. Wagoner, 24 Va.App. 181, 189, 480 S.E.2d 788, 791–92 (1997) (requiring employer to compensate claimant for treatment of avascular necrosis of hips three years after claimant had back...