Hall v. United Rentals, Inc.

• Decision Date: 23 October 2006
• Docket Number: No. 4166.,4166.
• Citation: 636 S.E.2d 876
• Court: South Carolina Court of Appeals
• Parties: John C. HALL, Claimant Respondent, v. UNITED RENTALS, INC., Employer and Cambridge Integrated Services, Inc., Carrier, Appellants.

636 S.E.2d 876

John C. HALL, Claimant Respondent, v. UNITED RENTALS, INC., Employer and Cambridge Integrated Services, Inc., Carrier, Appellants.

No. 4166.

Court of Appeals of South Carolina.

Heard October 10, 2006.

Decided October 23, 2006.

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Darryl D. Smalls, of Columbia, for Employer/Carrier/Appellants.

Thomas W. Greene, of Charleston, for Respondent.

ANDERSON, J.

In this workers' compensation case, the Appellate Panel of the Workers' Compensation Commission found Hall (the claimant) had not reached maximum medical improvement and ordered United/Cambridge (employer/carrier) to pay for additional medical treatment that United/Cambridge did not authorize. The circuit court affirmed and United/Cambridge appealed, contending (1) the Appellate Panel's requiring payment for unauthorized medical treatment violated section 42-15-60 of the South Carolina Code, and (2) the Appellate Panel's finding Hall had not reached MMI was not supported by "reliable, probative, and substantial evidence." We affirm.

FACTUAL/PROCEDURAL BACKGROUND

John Hall sustained a back injury while working for United Rentals Inc. on October 1, 1999. Hall was treated by Dr. James Aymond who performed a L5-S1 discectomy and a bilateral decompression. Following his back operation Hall began having right leg pain. In April 2000, Hall had additional surgery on his back. Subsequently, he began experiencing swelling and pain in his right knee. He was referred to Dr. John McCrosson, who performed a right total knee arthroplasty in February of 2001. Dr. McCrosson discharged Hall at maximum medical improvement with regard to his knee on June 29, 2001 with 37% impairment to the lower extremity. Additionally, Dr. Aymond observed that Hall had developed depression secondary to his chronic pain and referred him to Dr. Samuel Rosen for psychiatric treatment. United/Cambridge accepted the back injury and provided temporary benefits and medical treatment but denied compensability for the injury to his right leg and depression. In the initial workers' compensation action, the single commissioner found the injury to Hall's right leg and depression were causally related to the work injury. The Appellate Panel adopted the findings of the single commissioner and ordered payment of expenses related to the right leg injury and depression. The circuit court affirmed.

After the two back surgeries, Hall continued to experience back and lower extremity pain. A regimen of physical therapy, epidural steroid injections, and an array of medications, including Oxycontin, Oxycodone, Neurontin, and Bextra, was required to manage Hall's pain. The use of a temporary spinal stimulator reduced the pain in Hall's lower extremities but did not alleviate any of his back pain. In March 2002, Dr. Aymond noted, "unfortunately, Mr. Hall is approaching the end of all possible options with respect to his discogenic pain. In my opinion, he is not a candidate for a lumbar decompression and fusion as he has multiple levels involved." Dr. Aymond indicated Hall would "likely be at maximum medical improvement" at the time of his next visit.

On June 14, 2002, Dr. Aymond opined Hall had reached maximum medical improvement and was not capable of returning to work. Dr. Aymond estimated Hall's impairment to be 14% of the spine. Hall sought a second opinion from Dr. Jeffrey Wingate regarding treatment for his back pain. Based on Dr. Wingate's review of Hall's x-rays, a previous MRI, and new discography studies, Dr. Wingate advised that conservative treatment had failed and suggested surgical intervention. After meeting with Dr. Wingate and discussing options, Hall requested United/Cambridge's authorization for surgical treatment by Dr. Wingate. United/Cambridge denied Hall's request. Nevertheless, Hall proceeded with the recommended surgery.

In June 2002, Hall underwent a posterior lumbar interbody fusion with instrumentation. Two weeks after surgery, Dr. Wingate reported "John has done well since going home. He has continued decreasing his pain medication and takes a single Lortab less than once every 6-8 hrs." On Hall's July 2002 follow up visit, Dr. Wingate noted, "[f]or the most part his back and legs feel much better." Dr. Wingate indicated Hall was "walking well and [had] return[ed] to a better activity level."

At his five-week follow up visit after surgery, Hall's chief concern was left shoulder pain. Dr. Wingate explained, "[h]e complained about the left shoulder early after surgery. He seems now to be developing a more global problem with it." Later records revealed Hall suffered a left brachial plexus injury which likely resulted from his positioning on the operating table during the back surgery performed by Dr. Wingate. In addition, Hall sustained paralysis of his left hemidiaphram during the surgery. Consequently, Hall consulted additional doctors, including Dr. Wayne Vial and Dr. George Khoury, to treat the diaphragm and shoulder injuries. However, Hall's shoulder pain continued to worsen and he experienced shortness of breath after minimal physical activity.

Notwithstanding the complications, Dr. Wingate's surgery reduced Hall's back and leg pain for a period of time. Three months after the surgery, Dr. Wingate observed, "[Hall's] having about half the level of back pain that he had pre-surgery. Overall he feels that his relief from the back and leg pain has been significant and worth the effort of going through surgery."

By May 2003, Hall was again reporting back and leg pain and it appeared the pain may be caused by the loosening of screws placed during the spinal surgery. Hall continued having shoulder pain as well, but the pain had decreased from previous reports.

Hall filed a Form 50, seeking workers' compensation coverage for Dr. Wingate's treatment. In addition, he sought payment for the treatment necessitated by the brachial plexopathy and the paralyzed diaphragm. The single commissioner found, "[t]he treatment by Dr. Wingate was necessary and tended to lessen Claimant's disability. No other alternative was offered by the Defendants." The single commissioner concluded:

The Employer shall pay or cause to be paid all causally related medical treatment from the date of Claimant's accident and continuing. This responsibility includes but is not limited to those providers approved by Commissioner Catoe's Order of October 23, 2001, and shall in addition include the treatment of Doctors Wingate, Vial, and Khoury, and any other physician that has treated or evaluated the Claimant with reference to his back injury and his brachial plexopathy and collapsed diaphragm which resulted from complications from his two level fusion by Dr Wingate.

The Appellate Panel adopted the findings and conclusions of the single commissioner and incorporated the commissioner's order into the final decision. The circuit court affirmed.

STANDARD OF REVIEW

The South Carolina Administrative Procedures Act (APA) establishes the standard for judicial review of decisions of the Workers' Compensation Commission. Lark v. Bi-Lo, Inc., 276 S.C. 130, 276 S.E.2d 304 (1981); Hargrove v. Titan Textile Co., 360 S.C. 276, 599 S.E.2d 604 (Ct.App.2004). Section 1-23-380(A)(5) instructs that a reviewing court:

may not substitute its judgment for the judgment of the agency as to the weight of the evidence on questions of fact. The court may affirm the decision of the agency or remand the case for further proceedings. The court may reverse or modify the decision if substantial rights of the appellant have been prejudiced because the administrative findings, inferences, conclusions or decisions are:

(a) in violation of constitutional or statutory provisions;

(b) in excess of the statutory authority of the agency;

(c) made upon unlawful procedure;

(d) affected by other error of law;

(e) clearly erroneous in view of the reliable, probative and substantial evidence on the whole record; or

(f) arbitrary or capricious or characterized by abuse of discretion or clearly unwarranted exercise of discretion

S.C. Code Ann. § 1-23-380(A)(5) (Act No. 387, 2006 S.C. Acts 387, eff. July 1, 2006).

A reviewing court may reverse or modify a decision of an agency if the findings, inferences, conclusions, or decisions of that agency are "clearly erroneous in view of the reliable, probative and substantial evidence on the whole record." Bass v. Kenco Group, 366 S.C. 450, 457, 622 S.E.2d 577, 580 (Ct. App.2005). Under the scope of review established in the APA, this court may not substitute its judgment for that of the Appellate Panel as to the weight of the evidence on questions of fact, but may reverse where the decision is affected by an error of law. Liberty Mut. Ins. Co. v. S.C. Second Injury Fund, 363 S.C. 612, 611 S.E.2d 297 (Ct.App. 2005).

The substantial evidence rule of the APA governs the standard of review in a Workers' Compensation decision. Gadson v. Mikasa Corp., 368 S.C. 214, 628 S.E.2d 262 (Ct.App.2006); Frame v. Resort Servs., Inc., 357 S.C. 520, 593 S.E.2d 491 (Ct.App.2004); Corbin v. Kohler Co., 351 S.C. 613, 571 S.E.2d 92 (Ct.App.2002); see Lockridge v. Santens of Am., Inc., 344 S.C. 511, 515, 544 S.E.2d 842, 844 (Ct.App.2001) ("Any review of the commission's factual findings is governed by the substantial evidence standard."). Pursuant to the APA, this court's review is limited to deciding whether the Appellate Panel's decision is unsupported by substantial evidence or is controlled by some error of law. Rodriguez v. Romero, 363 S.C. 80, 610 S.E.2d 488 (2005); Gibson v. Spartanburg Sch. Dist. # 3, 338 S.C. 510, 526 S.E.2d 725 (Ct.App.2000); see Grant v. Grant Textiles, 361 S.C. 188, 191, 603 S.E.2d 858, 859 (Ct.App.2004) ("A reviewing court will not overturn a decision by the Workers' Compensation Commission unless the determination is unsupported by substantial evidence or is affected by an error of law.").

The findings...