Meinhardt v. SAAD'S Healthcare Services, Inc., No. 2040192 (AL 11/18/2005)
| Decision Date | 18 November 2005 |
| Docket Number | No. 2040192.,2040192. |
| Parties | Cynthia Meinhardt v. SAAD'S Healthcare Services, Inc. SAAD'S Healthcare Services, Inc. v. Cynthia Meinhardt. |
| Court | Alabama Supreme Court |
Appeals from Mobile Circuit Court (CV-04-615.51)
Cynthia Meinhardt sued her employer, SAAD'S Healthcare Services, Inc. ("SAAD'S"), seeking workers' compensation benefits under the Workers' Compensation Act, § 25-5-1 et seq., Ala. Code 1975 ("the Act"), based on "severe physical and psychological" injuries she sustained after being stabbed repeatedly while working in the line and scope of her employment at SAAD'S. SAAD'S answered and admitted that Meinhardt had sustained injuries arising out of and in the course of her employment.1
Following an ore tenus proceeding, the trial court entered a judgment on August 23, 2004, finding Meinhardt had suffered a permanent and total disability. However, the trial court declined to award Meinhardt permanent and total disability benefits based on its finding that Meinhardt had unreasonably refused to accept medical services, including both psychological and psychiatric care. In light of that finding, the trial court found that Meinhardt had sustained a 90% physical impairment to her body as a whole and that, as a result of her physical and psychological injuries, Meinhardt had a 90% vocational disability. The trial court determined that Meinhardt had reached maximum medical improvement ("MMI") with regard to her psychological injuries on May 1, 2004. A postjudgment motion filed by Meinhardt pursuant to Rule 59, Ala. R. Civ. P., was subsequently denied. Meinhardt appealed, and SAAD'S cross-appealed.
Meinhardt was employed by SAAD'S as a home-health-care nurse; she began working for SAAD'S in July 2001.2 On March 7, 2002, Meinhardt visited the home of an elderly patient. Meinhardt testified that, after leaving the home, the patient's grandson called her cellular telephone and asked her to come back into the home. According to Meinhardt, she was attempting to talk on a telephone in the home when the grandson viciously attacked her. Meinhardt was stabbed over 47 times. Among the worst injuries she sustained from the assault were a cut to her jugular vein and the collapse of her right lung. Meinhardt spent one week in the hospital. After being discharged from the hospital, Meinhardt underwent two months of physical therapy. In physical therapy, Meinhardt worked on improving the use of her hands, right shoulder, and right arm. The parties stipulated before trial that Meinhardt had reached MMI with regard to her right shoulder on June 25, 2002, and that Meinhardt had reached MMI with regard to the remainder of her physical injuries on September 13, 2002.3
At trial, Meinhardt testified that she continued to have pain in her right arm and shoulder as well as pain in her right lung that she described as "cramps." Meinhardt explained that the pain from her injuries limited her activity. According to Meinhardt, she can cook and do light housework, but she must rely on her children to do the majority of the work around the house.
Meinhardt testified that she began to receive mental-health counseling approximately two months after the assault to address problems she had with nightmares and depression. Meinhardt first sought treatment on April 22, 2002, from Dr. Jake Epker, a psychologist. Meinhardt testified that she attended two or three counseling sessions with Dr. Epker before leaving his care because she "felt uncomfortable with him." While under the care of Dr. Epker, Meinhardt was referred to a psychiatrist, Dr. Marilyn Hammond, who prescribed Meinhardt medication to treat her depression and post-traumatic stress disorder ("PTSD"). At Meinhardt's request, Dr. Hammond referred her to Dr. Melissa Ogden, a psychologist practicing in the same office as Dr. Epker. Meinhardt testified that she attended seven counseling sessions with Dr. Ogden. According to Meinhardt, she felt that her depression and overall mood had improved while she was in counseling. Meinhardt last saw Dr. Ogden for treatment in October 2002. Meinhardt testified that she stopped seeing Dr. Ogden because she felt better.
Meinhardt testified that in November 2002 Dr. Hammond released her to return to work and that she immediately returned to work in the office of SAAD'S. Meinhardt testified that she cried while at work and that hearing a telephone ring at work upset her. Meinhardt worked intermittently over a two-week period before quitting her job. Meinhardt has not worked since November 2002.
Meinhardt testified that in February 2004 she sought treatment from Dr. William Wilkerson; at that time, Meinhardt had been without medication and mental-health counseling for approximately one year. Meinhardt testified that she returned for treatment after experiencing problems with persistent crying, restless nights, and major depression. According to Meinhardt, her condition when she saw Dr. Wilkerson was no worse than when she initially sought treatment in 2002. Meinhardt testified that Dr. Wilkerson prescribed Remeron, an antidepressant, and that the medication has helped "some." Meinhardt testified that she still suffers from depression. According to Meinhardt, she had not sought medical treatment for any of her physical problems in 2004 but had only sought treatment for her mental condition.
Dr. Hammond testified by deposition that she initially diagnosed Meinhardt with acute PTSD and major depression in June 2002. Dr. Hammond testified that she discussed with Meinhardt her diagnosis and explained the benefits of taking medication and participating in counseling. According to Dr. Hammond, she made it clear to Meinhardt that individual psychotherapy was necessary for the treatment of PTSD and in order for Meinhardt to make any improvement. Dr. Hammond prescribed Serzone, an antidepressant, to Meinhardt. Dr. Hammond testified that Meinhardt's initial prognosis was good given Meinhardt's compliance with treatment.
Dr. Hammond testified that Meinhardt's mental condition improved over the course of her treatment. During a September 23, 2002, session with Dr. Hammond, Meinhardt rated her mood an 8 on a scale of 1 to 10 with 10 being the best possible rating. Dr. Hammond noted after that session that Meinhardt was stable and planned to return to work. On November 4, 2002, Meinhardt again rated her mood an 8 on a scale of 10. Dr. Hammond testified that she released Meinhardt to return to work at that time. According to Dr. Hammond, Meinhardt had improved and was not showing any symptoms of PTSD or depression. Dr. Hammond testified that Meinhardt agreed that it was time to return to work.
On February 25, 2003, Dr. Hammond met with Meinhardt again and Meinhardt reported that her condition had worsened. Dr. Hammond testified that Meinhardt told her that she had quit taking her medication in November because "she thought she would be okay without [it]" and that she had quit attending counseling sessions. According to Dr. Hammond, this reaction was not uncommon, but, nevertheless, she was astounded that Meinhardt had stopped taking her medication. Meinhardt also informed Dr. Hammond that she had quit her job. Dr. Hammond testified that she immediately prescribed Meinhardt an antidepressant after learning this information.
On March 13, 2003, Meinhardt returned to Dr. Hammond for treatment. At that time, Meinhardt had been taking an antidepressant but had not yet returned to participate in counseling. Meinhardt rated her mood a 1 out of a possible 10. Dr. Hammond described Meinhardt's condition in March 2003 as "very poor." According to Dr. Hammond, Meinhardt's functional level had deteriorated because Meinhardt had stopped taking her medication and attending counseling sessions. Meinhardt missed follow-up appointments with Dr. Hammond in April and May.
Meinhardt testified that she stopped seeing Dr. Hammond for treatment in March 2003 because she believed that she was not progressing under Dr. Hammond's care. Meinhardt testified that she stopped taking her medication when she stopped seeing Dr. Hammond. Although Meinhardt admitted that her condition had improved while she was on the medication, she testified that she stopped taking the medication because "she felt like she was well." On cross-examination, Meinhardt admitted that her condition declined after she stopped taking her medication and attending counseling sessions. Meinhardt acknowledged that Dr. Hammond had emphasized the necessity of taking the medication and participating in counseling and that Dr. Hammond had warned her of the risks associated with not continuing the treatment. Meinhardt testified that Dr. Hammond encouraged her to return to therapy and to take her medication because, without them, her mental condition would worsen. Meinhardt further testified that Dr. Hammond had explained that her failure to take her medication would likely result in permanent problems. Meinhardt testified that after she stopped seeing Dr. Hammond in March 2003, she received numerous calls from her workers' compensation case manager encouraging her to return to Dr. Hammond for treatment or to seek treatment from another mental-health-care professional.
In a May 15, 2003, letter to Teresa Hamby, a workers' compensation case manager assigned to Meinhardt's case, Dr. Hammond expressed her concern over Meinhardt's deteriorated condition. Dr. Hammond noted that Meinhardt's PTSD and depression appeared much worse. In her letter, Dr. Hammond stated that she "believe[d] this could have been totally avoided had [Meinhardt] stayed on her medications and in therapy."
Dr. Hammond testified that in the spring of 2003 her medical opinion regarding Meinhardt's treatment was that medications would have improved Meinhardt's mental condition. Dr. Hammond explained that there were risks to taking Serzone, the antidepressant prescribed to Meinhardt, but that the risks were "fairly...
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