Howie v. Pennington County

• Citation: 521 N.W.2d 645
• Decision Date: 31 August 1994
• Docket Number: No. 18410,18410
• Parties: Kathy J. HOWIE, Appellant, v. PENNINGTON COUNTY and American States Insurance, Appellees.
• Court: Supreme Court of South Dakota

Page 645

521 N.W.2d 645

Kathy J. HOWIE, Appellant, v. PENNINGTON COUNTY and American States Insurance, Appellees.

No. 18410.

Supreme Court of South Dakota.

Argued May 23, 1994.

Decided Aug. 31, 1994.

Margo Tschetter Julius, William Jason Groves and Michael Buffington of Groves Law Office, Rapid City, for appellant.

John J. Delaney of Johnson Huffman, P.C., Rapid City, for appellees.

MILLER, Chief Justice.

Kathy J. Howie (Howie) appeals from a worker's compensation decision in which the Department of Labor (Department) denied her request for an addition to her home to enclose a hydrotherapy spa. The decision was appealed to the circuit court which affirmed the Department. We reverse and remand.

FACTS

Howie is totally and permanently disabled as a result of medical conditions described as bilateral carpal tunnel syndrome, reflex sympathetic dystrophy, Raynaud's Phenomenon, and upper limb dystrophy. Howie's medical condition has resulted in chronic pain in both arms and shoulders. She has sought continuing medical treatment, most of which has been unsuccessful in relieving her pain.

Dr. Steven K. Goff, M.D., a physiatrist, recommended that Howie undergo hydrotherapy to see if the treatments would relieve her pain. She began using the therapeutic pool at the Black Hills Rehabilitation Hospital and the treatments provided pain relief for a few hours. However, because Howie lives some eighteen miles from Rapid City, the benefits often faded by the time she arrived home. Additionally, because of the pain in her hands and arms, Howie had to be driven to and from rehabilitation. Further, the hydrotherapy pool was not available for therapy treatments everyday. Because of these obstacles, Dr. Goff prescribed a home spa therapy pool.

Howie argued that to receive the full benefits of the spa therapy, the hot tub needed to be in a heated environment. She claimed her existing house was too small and structurally unsound to support the spa, thus, it was medically necessary for the insurer to build an addition to her home to enclose the hot tub.

Department held administrative hearings on March 3, 1992, and April 28, 1992, to determine whether Howie was entitled to permanent total disability benefits, whether a lump-sum payment of those benefits should be given, whether a Grandee model home spa should be awarded, and whether an addition to her house to enclose the spa should be allowed. After the hearings, Department entered findings of fact and conclusions of law and entered an order in favor of Howie on all issues except modification of her home to enclose the spa.

Howie appealed to the circuit court which affirmed the Department's order. We reverse and remand.

STANDARD OF REVIEW

This Court will overrule an administrative agency's findings of fact only if we find them to be clearly erroneous. Guthmiller v. S.D. Dep't of Transp., 502 N.W.2d 586 (S.D.1993); Day v. John Morrell & Co., 490 N.W.2d 720 (S.D.1992); Lien v. Miracle Span Corp., 456 N.W.2d 563 (S.D.1990). Conclusions of law are given no deference by this Court on appeal and are fully reviewable. Permann v. Department of Labor, Unemp. Ins. Div., 411 N.W.2d 113 (S.D.1987). The test is whether, after reviewing all the evidence, we are left with a definite and firm conviction a mistake has been made. Guthmiller, 502 N.W.2d at 588. Mixed questions of law and fact are fully reviewable. Egemo v. Flores, 470 N.W.2d 817, 820 (S.D.1991). Worker's compensation laws are remedial in nature and are entitled to liberal construction to effect coverage. Phillips v. John Morrell & Co., 484 N.W.2d 527, 531 (S.D.1992); Oviatt v. Oviatt Dairy, Inc., 80 S.D. 83, 85, 119 N.W.2d 649, 650 (1963).

DECISION

South Dakota law requires employers to provide necessary medical services to employees covered by worker's compensation. SDCL 62-4-1 provides in relevant part:

The employer shall provide necessary first aid, medical, surgical, and hospital services, or other suitable and proper care including medical and surgical supplies, apparatus, artificial members and body aids during the disability or treatment of an employee within the provisions of this title[.]

We have previously stated: "It is in the doctor's province to determine what is necessary or suitable and proper." Hanson v. Penrod Const. Co., 425 N.W.2d 396, 399 (S.D.1988). Therefore, to support an award of an addition to the house, Howie needed to present a medical expert's opinion that the addition was "necessary or suitable and proper care" for her treatment.

Howie claimed her home was too small to contain the spa she selected and the floor structure would not support its weight. Therefore, her husband designed an addition to their home to contain the spa. The proposed addition cost $18,293.62, was a story and a half high, 250 square feet, contained two sets of french doors, elevated decking, indoor lighting with dimmer switches and outdoor lighting. ¹

Department awarded the spa; it concluded "[t]he purchase of a home spa by the Employer and the Insurer is a reasonable expense related to the medical care and treatment of the Claimant." ² However, it denied the addition to the home. Specifically, Department's hearing officer found "it has not been convincingly demonstrated that this spa must be indoors."

Department's decision denying the addition to the house states that "many homes in South Dakota have fully functional outdoor spas, even in the dead of winter." However, there is no testimony or evidence in the record to support such a finding. Nor is there any evidence that Howie would be able to use the spa in the winter if it were placed outdoors. This finding of fact is clearly erroneous.

Dr. Goff testified at the hearing that he prescribed a spa "in" Howie's home and that he wanted Howie's hydrotherapy treatment at home to "provide a smaller-type version of what we were doing in the rehab hospital." It is undisputed that Howie suffers from Raynaud's Phenomenon, a syndrome which results in sensitivity to cold temperatures. Conversely, nowhere is Howie's sensitivity to cold linked to a medical necessity for the spa to be either sheltered or, alternatively, placed indoors.

Further, contrary to Howie's assertion, the record is unclear as to whether Dr. Goff considered the cost of the addition to the house in his recommendations. Although the cost of the addition was mentioned at the hearing, the doctor was being questioned about the basis for his recommendation as to the size of the spa required, not about the necessity or cost of an enclosure. ³ In the more than eighty pages of testimony by Dr. Goff at the hearing, nowhere did he unequivocally state that it was medically necessary for the spa to be enclosed, protected, sheltered, or placed indoors. "Where the claimant's medical experts are unwilling to express an opinion, this Court will not infer a medical prognosis." Guthmiller, 502 N.W.2d at 589. Similarly, we will not infer medical necessity from Dr. Goff's testimony.

Howie cites a number of cases from foreign jurisdictions to support her position that a special housing facility should have been awarded. Rieger v. W.C.A.B., 104 Pa.Cmwlth. 42, 521 A.2d 84, 87 (Ct.1987) (finding "simple, inexpensive remedy is available at hand" and allowing $433.02 to remodel home to facilitate access for wheelchair-bound claimant) limited by Bomboy v. W.C.A.B., 132 Pa.Cmwlth. 169, 572 A.2d 248, 250 (Ct.1990) (affirming denial of paraplegic's claim for $30,000-$50,000 modification for attached garage with wheelchair lift "as Rieger is limited to minor structural modifications"); R & T Construction Co. v. Judge, 82 Md.App. 700, 573 A.2d 96 (1990) aff'd in part and rev'd in part by R & T Const. Co. v. Judge, 323 Md. 514, 594 A.2d 99, 107 (1991); Squeo v. Comfort Control Corp., 99 N.J. 588, 494 A.2d 313 (1985) (awarding 24-year-old quadriplegic $65,000 addition to parent's home as only other alternative was to "house" him in "oppressive" elderly rest home where he had attempted suicide three times); Zephyr v. Industrial Commission, 215 Ill.App.3d 669, 159 Ill.Dec. 332, 576 N.E.2d 1 (Ct.1991) (awarding $275,491 to remodel residence to accommodate paraplegic claimant; claimant also had quadriplegic daughter so home needed to provide access for two wheelchairs and majority of cost was to remodel and provide access to bathrooms). ⁴

Based on the clearly erroneous finding of fact by Department and the ambiguous testimony at the hearing as to the medical necessity of placing the spa indoors, we are left with the definite and firm conviction that a mistake has been made. We reverse the decision and remand this case so that the Department may determine if it is medically necessary for the spa to be enclosed or placed indoors and, if so, the medical requirements of such an enclosure. Squeo, 494 A.2d at 323 ("While there are no monetary limitations on the cost of treatment set forth in the statute, the cost must be reasonable."). ⁵ We reiterate that an employer is only responsible for medical necessities, not conveniences, amenities or aesthetically pleasing accoutrements. We agree with the Maryland Supreme Court which stated:

We remain mindful that the act is to receive a liberal construction. Nevertheless, in the area of modifications to a residence, the concept of medical treatment under Sec. 37(a) must be limited to access for necessities. Here the purpose of the possible improvements goes beyond the necessities already being provided, and seeks to give Judge a sense of increased independence and self-worth. Under the circumstances here that goal is beyond the process of construction of Sec. 37(a). Were we to depart from the standard of access to medical treatment, there would be no statutory standard to guide the Commission in determining the extent of an insurer's obligation to make...