Joy v. Dep't of Labor & Indus.

• Decision Date: 11 September 2012
• Docket Number: No. 42118–6–II.,42118–6–II.
• Citation: 285 P.3d 187
• Court: Washington Court of Appeals
• Parties: Cheryl D. JOY, Appellant, v. DEPARTMENT OF LABOR AND INDUSTRIES, Respondent.

285 P.3d 187

Cheryl D. JOY, Appellant,

v.DEPARTMENT OF LABOR AND INDUSTRIES, Respondent.

No. 42118–6–II.

Court of Appeals of Washington, Division 2.

Sept. 11, 2012.

Frances R. Hamrick, Douglas Maclean Palmer, Busick Hamrick PLLC, Vancouver, WA, for Appellant.

Anastasia R. Sandstrom, Attorney General's Office, Seattle, WA, for Respondent.

William D. Hochberg, Attorney at Law, Rachel vs Hamar, Law Office of William D. Hochberg, Edmonds, WA, for Amicus Curiae on behalf of Washington State Labor Council.

VAN DEREN J.

¶ 1 Cheryl Joy appeals the trial court's order granting judgment as a matter of law ¹ to the Washington State Department of Labor and Industries (L & I). She argues that the trial court erred in concluding that RCW 70.14.120(3)² precludes a court's determination that spinal cord stimulation was a medically necessary and proper treatment in her case. ³ We hold that the trial court did not err in granting L & I judgment as a matter of law because RCW 70.14.120(3) precludes both court orders requiring L & I to provide spinal stimulation benefits and hearings to determine whether spinal cord stimulation is medically necessary or proper in individual cases. We affirm.

FACTS

¶ 2 On October 16, 2006, Joy suffered a neck injury at work resulting in chronic cervical neuropathic pain. L & I allowed her workers' compensation claim and provided medical treatment, including physical therapy, cortisone injections, surgeries, and pain medications.

¶ 3 Joy subsequently unsuccessfully requested L & I to authorize a spinal cord stimulator as necessary and proper medical treatment for her injury. The Industrial Insurance Medical Advisory Committee, which advises L & I on coverage decisions, had previously determined that coverage should not be allowed for spinal cord stimulation, based on a study showing that spinal cord stimulation showed a potential for harm, not benefits.

¶ 4 Joy appealed to the Board of Industrial Insurance Appeals (Board), and an industrial appeals judge (IAJ) issued a proposed decision concluding that Joy was not a good candidate for a spinal cord stimulator for her cervical condition, the procedure is not rehabilitative or curative, and the procedure is not within the standards of good practice for neurosurgery and pain management. Joy unsuccessfully petitioned the Board for review of the IAJ's decision, but the Board adopted the proposed IAJ decision in denying her appeal.

¶ 5 Joy then appealed to the superior court solely on the issue of whether spinal cord stimulation was a necessary and proper medical treatment for her that L & I should authorize. On October 22, 2010, while Joy's appeal in the trial court was pending, the Health Technology Clinical Committee (HTCC) found that spinal cord stimulation was “less safe than alternatives, is an invasive procedure, and has many adverse events,” and it determined that state health care programs will not cover spinal cord stimulation as a necessary and proper procedure. Clerk's Papers at 17.

¶ 6 Following Joy's presentation of her case to the jury, L & I moved under CR 50 for judgment as a matter of law because the HTCC's determination meant that L & I could not approve such treatment under RCW 70.14.120(3). Joy argued that RCW 70.14.120(4)⁴ still allowed the jury to decide whether spinal cord stimulation was a necessary and proper treatment in her case.

¶ 7 The trial court concluded that as a matter of law RCW 70.14.120(3) precluded L & I from authorizing spinal cord stimulation in any case, and it granted L & I's CR 50 motion. The trial court harmonized RCW 70.14.120(3) and .120(4), stating, “You can still appeal. You've your right to appeal but your issue on appeal cannot be whether or not this uncovered benefit is medically necessary or proper and necessary.” Report of Proceedings at 15. Joy appeals.

ANALYSIS

I. CR 50Standard of Review

¶ 8 RCW 51.52.140 provides that “the practice in civil cases shall apply to appeals prescribed in this chapter. Appeal shall lie from the judgment of the superior court as in other civil cases.” ⁵ We review motions for judgment as a matter of law de novo. Davis v. Microsoft Corp., 149 Wash.2d 521, 530–31, 70 P.3d 126 (2003). A trial court properly grants judgment as a matter of law when, viewing the evidence and all inferences in a light most favorable to the nonmoving party, substantial evidence does not exist to support the nonmoving party's claims. Schmidt v. Coogan, 162 Wash.2d 488, 491, 173 P.3d 273 (2007). Substantial evidence is the quantum of evidence sufficient to persuade a rational, fair-minded person the premise is true. Wenatchee Sportsmen Ass'n v. Chelan County, 141 Wash.2d 169, 176, 4 P.3d 123 (2000).

II. Medical Procedures Authorized under State Health Care Plans

¶ 9 Joy agrees that RCW 70.14.120(3) precludes L & I from authorizing medical procedures that the HTCC determines are not necessary and proper and that are consequently not covered under state health care plans. Nevertheless, she argues that the Board and reviewing courts may order L & I to authorize such treatment. L & I responds that when read in the context of the entire statutory scheme, the Board and reviewing courts must affirm L & I's denial of medical procedures that the HTCC has declared are not covered by state-provided benefits.

A. Standard of Review

¶ 10 We review de novo issues of statutory interpretation. Dep't of Ecology v. Campbell & Gwinn, LLC, 146 Wash.2d 1, 9, 43 P.3d 4 (2002). Our fundamental objective in statutory interpretation is to give effect to the legislature's intent. Campbell & Gwinn, 146 Wash.2d at 9, 43 P.3d 4. If a statute's meaning is plain on its face, then we give effect to that plain meaning as an expression of legislative intent. State ex rel. Citizens Against Tolls (CAT) v. Murphy, 151 Wash.2d 226, 242, 88 P.3d 375 (2004). We discern plain meaning not only from the provision in question but also from closely related statutes and the underlying legislative purposes. Murphy, 151 Wash.2d at 242, 88 P.3d 375. If a statute is susceptible to more than one reasonable interpretation after this inquiry, then the statute is ambiguous and we may resort to additional canons of statutory construction or legislative history. Campbell & Gwinn, 146 Wash.2d at 12, 43 P.3d 4.

¶ 11 We give effect to all statutory language, considering statutory provisions in relation to each other and harmonizing them to ensure proper construction. King County v. Cent. Puget Sound Growth Mgmt. Hearings Bd., 142 Wash.2d 543, 560, 14 P.3d 133 (2000). We avoid construing a statute in a manner that results in “unlikely, absurd, or strained consequences.” Glaubach v. Regence BlueShield, 149 Wash.2d 827, 833, 74 P.3d 115 (2003).

B. Creation of Health Care Authority and HTTC

¶ 12 In 2006, the legislature established the state health care authority (HCA) for purposes, in part, of “minimizing the financial burden which health care poses on the state, its employees, and its charges, while at the same time allowing the state to provide the most comprehensive health care options possible.” RCW 41.05.006(2); Laws of 2006, ch. 299, § 1. As part of this task, the legislature also provided that the HCA “shall coordinate state agency efforts to develop and implement uniform policies across state purchased health care programs.” RCW 41.05.013 (emphasis added); Laws of 2006, ch. 307, § 8. “ ‘State purchased health care’ ” or “health care” includes “medical and health care, pharmaceuticals, and medical equipment purchased with state and federal funds” by various state agencies, including L & I. RCW 41.05.011(21).

¶ 13 The legislature also created the HTCC, an 11–member panel of practicing licensed physicians and health professionals ⁶ selected by the HCA's administrator in consultation with participating state agencies. Laws of 2006, ch. 307, § 2; see alsoRCW 70.14.090 (enacted statute). The HTCC determines whether health technologies ⁷ selected for review by the HCA's administrator ⁸ will be included as a covered benefit in health care programs of participating agencies, i.e., L & I, the HCA, and the department of social and health Services. RCW 70.14.080(6), .110(1). ⁹

C. HTCC Coverage Determinations

¶ 14 RCW 70.14.120(1) provides that when the HTCC makes a coverage determination for a particular health technology, “[a] participating agency shall comply with a determination of the [HTCC].” (Emphasis added.) The plain language of RCW 70.14.120(1), read together with the requirement in RCW 70.14.120(3) that “a health technology not included as a covered benefit under a state purchased health care program ... shall not be subject to a determination in the case of an individual patient as to whether it is medically necessary, or proper and necessary treatment” unambiguously precludes L & I from determining whether health technologies subject to an HTCC non-coverage determination are a necessary and proper medical treatment in an individual claimant's case and from authorizing a request for such treatment. And Joy and L & I agree that the HTCC's non-coverage determinations for particular health technologies require L & I's compliance with the determination.

D. Reviewing Boards and Courts Are Not Exempt from HTCC Determinations

¶ 15 Although Joy acknowledges that RCW 70.14.120(1) expressly requires compliance with HTCC determinations by participating agencies, she argues that “[n]othing in RCW 70.14.120(3) limits the ability of reviewing agencies or the courts to make an individual determination on whether the treatment is medically necessary and proper.” Br. of Appellant at 6 (emphasis added). Accordingly, she urges us to adopt an interpretation that allows the Board or the superior court to make a “necessary and proper [medical treatment]” determination for an individual claimant and to issue an order or writ of mandamus requiring L & I to authorize such treatment. Br. of Appellant at 6. Her argument fails for several reasons.

¶ 16 But Joy...