Jones v. Emmett Manor, 25317.

• Citation: 997 P.2d 621,134 Idaho 160
• Decision Date: 31 March 2000
• Docket Number: No. 25317.,25317.
• Parties: Joyce K. JONES, Claimant-Respondent, v. EMMETT MANOR, Employer, Defendant-Appellant.
• Court: Idaho Supreme Court

997 P.2d 621

134 Idaho 160

Joyce K. JONES, Claimant-Respondent, v. EMMETT MANOR, Employer, Defendant-Appellant.

No. 25317.

Supreme Court of Idaho, Boise, January 2000 Term.

March 31, 2000.

Lawrence G. Sirhall, Jr., Boise, for appellant.

Hugh Mossman, Boise, for respondent.

SCHROEDER, Justice.

Emmett Manor appeals the decision of the Industrial Commission awarding worker's compensation benefits to Joyce Jones (Jones).

I. BACKGROUND & PRIOR PROCEEDINGS

Jones began work at Emmett Manor as an aide in May of 1995. She bathed, cleaned, dressed and generally cared for the eight patients living at Emmett Manor. She also worked part-time for the Department of Health and Welfare, performing general cleaning tasks.

Jones claims that she injured her back on two separate occasions while employed at Emmett Manor. The first injury occurred in September of 1995 while she was lifting a patient. Her employer disputes this fact, maintaining that the patient whom Jones allegedly helped move was not at Emmett Manor at the time. The employer supported this assertion with discharge records which indicated that the patient was transferred on August 31, 1995, prior to the time Jones claimed the injury occurred. However, the Commission made the following observation in its Findings of Fact: "The original resident Admission and Discharge Register ostensibly indicates that [the patient] left Emmett Manor on `8/31/95,' however, the entry may have been altered from 9/31/95." This observation by the Commission is important because the Commission was required to make credibility determinations between Jones and the employer.

After the first injury, Jones immediately informed her employer that she had hurt her back, but she continued to work and did not seek treatment for this incident. According to Jones, the pain decreased with time.

The second injury occurred on November 20, 1995, when Jones was showering an Alzheimer's patient who became confused and sat down in the shower, causing Jones to fall. Jones experienced a tearing sensation in her lower back. She told her employer about this incident. The pain increased, and Jones decided to see a doctor in January of 1996. Jones and her employer had a dispute about Jones' desire to see a doctor. As a result of this dispute, Jones either quit or was fired on January 4, 1996. At about this time the employer discovered that it did not have worker's compensation insurance.

Dr. Barclay first saw Jones on January 8, 1996. He diagnosed lumbrosacral spine somatic dysfunction resulting from lifting a patient. Dr. Barclay hospitalized Jones briefly, treating her with prescription medications and traction. Jones was not employed between January of 1996 and June of 1996. However, she did work in her garden during this time period and made tacos at the Emmett Cherry Festival in June. She returned to work in August of 1996, when Dr. Barclay released her to return to work.

Jones filed a worker's compensation complaint against her employer, and a hearing was conducted by a referee. Jones testified and supported her claim with medical records. No doctor testified. Based on the evidence submitted to the referee, the Commission found that Jones was entitled to $4,695.41 in medical benefits. The Commission relied on the medical records and Jones' testimony to determine causation. The total temporary disability benefits covered the time from January 8, 1996, through August 9, 1996. Because the employer did not have its insurance obligations covered under the worker's compensation act at the time of the accident, the Commission awarded attorney fees, costs and a penalty against the employer pursuant to I.C. § 72-210. The employer appealed, asserting that there was not substantial, competent evidence to support the Commission's decision. The employer maintains that Jones was not credible and challenges the Commission's use of medical records without medical testimony to determine causation.

II. STANDARD OF REVIEW

The issues raised in this appeal involve both questions of law and questions of fact. Whether a physician's records, without additional expert medical testimony, may satisfy the requirement that medical evidence be provided is a question of law. Whether those records contain adequate information to support the Commission's finding is a question of fact. Therefore, the question of whether the evidence was sufficient to support the Commission's decision is a mixed question of law and fact. The right to an award of attorney fees pursuant to I.C. § 72-210 is strictly a question of law in this case.

When reviewing Industrial Commission decisions on appeal, the Court reviews questions of fact only to determine if there is substantial and competent evidence to support the findings of the Commission, but exercises free review over questions of law. IDAHO CONST. art. V, § 9; Langley v. State, 126 Idaho 781, 784, 890 P.2d 732, 735 (1995).

III.

THERE WAS SUBSTANTIAL AND COMPETENT EVIDENCE TO SUPPORT THE INDUSTRIAL COMMISSION'S AWARD OF MEDICAL BENEFITS.

A. Physicians' Medical Records, Without Additional Expert Medical Testimony, May Be Sufficient to Satisfy the Requirement that Medical Testimony Be Provided on the Issue of Causation.

The Commission found that the injury to Jones arose in the course of employment, basing this finding upon Jones' testimony and the medical records of Dr. Barclay. Dr. Barclay diagnosed lumbrosacral spine somatic dysfunction and listed the cause as "lifting patient." The employer argues that there must be medical testimony to establish causation of the injury to a reasonable degree of medical probability. The employer also asserts that the medical records do not contain any opinion to a reasonable degree of probability.

A threshold question is whether Jones' medical records constituted substantial, competent evidence to support the claim or whether Jones was required to present a medical opinion by oral testimony. In Dean v. Dravo Corporation, 95 Idaho 558, 560-61, 511 P.2d 1334, 1336-37 (1973), the Court made the statement upon which Emmett Manor relies in its contention that oral medical testimony was necessary:

In order to recover in Workmen's Compensation cases there must be medical testimony supporting the claim for compensation with a reasonable degree of medical probability. Comish v. Simplot Fertilizer Co., 86 Idaho 79, 383 P.2d 333 (1963); Clark v. Brennan Construction Co., 84 Idaho 384, 372 P.2d 761 (1962); Laird v. State Highway Department, 80 Idaho 12, 323 P.2d 1079 (1958).

The medical testimony in Dean v. Dravo Corp. established a possibility, not a probability, that the claimed injury was caused by an accident arising out of the employment. Consequently, the award of worker's compensation was vacated. It is clear that the reference to medical "testimony" in Dean v. Dravo Corp. was not necessary to the decision. The thrust of the holding was that the medical testimony that was presented did not establish the cause of injury to a medical probability.

Language in Paulson v. Idaho Forest Industries, 99 Idaho 896, 591 P.2d 143 (1979), relying upon Dean v. Dravo Corp., suggests that medical testimony must be submitted in oral form. In Paulson, the Commission had medical reports from two doctors (Vincent and Bozarth), as well as the oral testimony of a third doctor, Dr. Cone. The Court relied upon the oral testimony of Dr. Cone, quoting the doctor's testimony at length in the opinion. The Court wrote: "Allowing that proof of such a causal relationship requires expert medical testimony, see Dean v. Dravo Corp., 95 Idaho 558, 511 P.2d 1334 (1973),

the testimony given by Dr. Cone will suffice." 99 Idaho at 900,

591 P.2d at 147. In Paulson, there was oral testimony of Dr. Cone to support the claim. The question was whether that testimony established the necessary causal connection for the payment of benefits or whether it simply established a possibility that the condition was work related. The adequacy of medical records as medical testimony was not decided by the Court.

The requirement of medical testimony was repeated in Soto v. Simplot, 126 Idaho 536, 540, 887 P.2d 1043, 1047 (1994): "We have held that there must be medical testimony with a reasonable degree of probability to support a worker's compensation claim. E.g., Fisher v. Bunker Hill Co., 96 Idaho 341, 528 P.2d 903 (1974)." However, in Soto the Court held that medical records were competent evidence in determining permanent impairment:

Soto invites us to conclude that medical records and opinions obtained from doctors for purposes of general diagnosis and treatment are not competent evidence in determining permanent impairment.

* * *

In making the "medical appraisal" of an injury's effect on daily living activities, there is a potentially wide spectrum of material and relevant evidence worthy of consideration, beyond the particular opinion of a physician asked to give an impairment rating. Such evidence, whether it tends to refute or establish the existence of an impairment, has a place in the Commission's effort to ascertain truth.

Soto v. Simplot, 126 Idaho at 539, 887 P.2d at 1046.

In Langley v. State, 126 Idaho 781, 786-87, 890 P.2d 732, 737-38 (1994), the Court approved use of medical records as competent evidence to defeat a claim for worker's compensation:

The Commission based its conclusion that Langley's respiratory condition does not qualify as an occupational disease on medical records Langley provided from four doctors, which detailed his complaints of respiratory problems from 1978 through 1990. While all of the doctors indicated, to varying degrees, that Langley's work environment may have irritated his asthma, none stated that, to a reasonable degree of probability, his shortness of breath was causally related to his work environment. Thus, the Commission's conclusion that Langley failed to prove that his asthmatic condition is causally related to his work environment is

...