State ex rel. Wyoming Workers' Compensation Div. v. Girardot
Decision Date | 14 March 1991 |
Docket Number | No. 90-55,90-55 |
Citation | 807 P.2d 926 |
Parties | STATE of Wyoming ex rel., WYOMING WORKERS' COMPENSATION DIVISION, Appellant (Objector-Defendant), v. Lorance L. GIRARDOT, Appellee (Employee-Claimant). |
Court | Wyoming Supreme Court |
Joseph B. Meyer, Atty. Gen. and Ron Arnold, Sr. Asst. Atty. Gen., for appellant.
Clay B. Jenkins, Sheridan, for appellee.
Before URBIGKIT, C.J., and THOMAS, CARDINE, MACY and GOLDEN, JJ.
Appellee Lorance I. Girardot, age sixty-two, had an unknown and potentially life threatening coronary artery condition initially discovered when he was examined for surgery for a work related hernia. Expensive coronary artery surgery was first performed before the medical attention to the hernia could reasonably be given. These facts frame this appeal and its issue addressing the state worker's compensation fund obligation for treatment for a major preexistent physical condition in order to treat the relatively minor work related injury.
The Wyoming Workers' Compensation Division's administrative hearing officer denied the coronary by-pass surgery expenses. The district court, on judicial review, reversed and we reverse the district court to reinstate the benefit denial. The appeal presents no factual dispute. The decision is resolved by examination of the statutes and application of common law precedent.
On September 4, 1987, Girardot slipped on a wet floor while working as a janitor. From the fall, he sustained a compensable hernia injury. On September 10, 1987, he went to The Billings Clinic, Billings, Montana, for corrective surgery. While he was undergoing preoperative examination, his cardiogram appeared abnormal and, following an angiography, it was discovered he suffered from a severe arterial blockage of the heart, near critical in nature, requiring by-pass surgery before the hernia operation could be safely pursued. Without any contact made to the Workers' Compensation Division by either the medics or Girardot, the by-pass surgery was performed and then followed in due time by the corrective hernia operation.
The medical expense claim for the by-pass surgery totalled approximately $35,000, while the hernia operation cost approximately $3,790. Temporary total disability claims were made and paid until recovery from the hernia surgery was complete. Both the employer and the Workers' Compensation Division objected to the payment of the heart surgery cost. 1 The issue is compensability of the cost of the medical care for the unrelated by-pass heart surgery untreated and unknown until after the occurrence of the work related injury. We directly consider statutory application to medical benefit payment where major medical care is required before treatment of the work related injury can be safely performed.
The Workers' Compensation Division cites two statutes in support of benefit denial, W.S. 27-14-102(a)(xi)(F) and 27-14-501(a). W.S. 27-14-102 states in pertinent part:
(a) As used in this act:
* * * * * *
(xi) * * * "Injury" does not include:
* * * * * *
(F) Any injury or condition preexisting at the time of employment with the employer against whom a claim is made.
W.S. 27-14-501(a) reads in part:
Any tests to be administered or other services proposed to be rendered by a health care provider which are clearly not germane to the injury shall be disclosed to the injured employee, if possible, and the employee shall be advised that the cost of the tests or services will be the responsibility of the employee if he consents to the tests or services.
Girardot takes comfort from entitlement by advancing W.S. 27-14-401(a), which states, in part, that "[t]he expense of medical and hospital care of an injured employee shall be paid from the date of the compensable injury * * *."
Our decision is determined by statutory interpretation and judicial application. Girardot directs us to the preoperative treatment rule of Arizona for persuasive authority differing from states with statutory language which would be dispositive. Crow v. Guy Scoggins General Oilfield Contracting Co., 248 Miss. 1, 158 So.2d 1 (1963). See also 2 Larson's Workmen's Compensation Law § 61.13(e) (1989).
Consideration starts with the provisions of W.S. 27-14-102(a)(xi)(F) endorsed by the Workers' Compensation Division. Analysis of its provisions does not answer the present question since there is no doubt about injury in this case. The issue is statutory responsibility for extended scope of treatment. We have a similar problem with the germaneness test of the second cited statute, W.S. 27-14-501(a). In the real world, it was germane to his survival that the major problem first be addressed before the hernia surgery was attempted. Additionally, the record is settled that the treating doctors would not take the risk even if the patient might have been willing to gamble his extended expectancy by first having the minor surgery.
The statute identified by Girardot, W.S. 27-14-401, provides no further preclusive legislative direction. Its reference to medical and hospital care clearly involves the hernia correction, which was the work related injury, and does not assist us in adding or rejecting heart surgery as an insured right of the employee. This is particularly true where clearly, under our case law, the heart condition, in itself, would not have been an insured injury or a compensable condition without meeting other supplementary requirements to make the heart problem into a "work related injury." Matter of Desotell, 767 P.2d 998 (Wyo.1989); Bridge v. Eisenman Transport, Inc., 742 P.2d 768 (Wyo.1987); State, ex rel. Wyoming Worker's Compensation Div. v. Van Buskirk, 721 P.2d 570 (Wyo.1986); Naunes v. State ex rel. Wyoming Worker's Compensation Div., 694 P.2d 86 (Wyo.1985).
Lacking any determinative statute, Girardot directs us to cases creating or following a principle developed in Arizona cases. The three cases characterized to be "exactly on point" outline what can be described as the Arizona rule. We do not find that principle to be so far reaching as contended and will determine this case without necessarily rejecting some consideration within the included medical attention criteria for compensability addressed in those cases. We do, however, distinguish those cases factually and leave for the legislature in future enactments to provide for an extension of the benefits for this character of additional medical care for the worker if that should be its choice. We decline to provide that result here by adjudicatory legislation. Brown v. State ex rel. Morgan, 79 Wyo. 355, 334 P.2d 502 (1959).
The lead case cited by Girardot was Allstate Ins. Co. v. Industrial Commission, 126 Ariz. 425, 616 P.2d 100 (1980), where other medical problems were encountered by the employee when he entered the hospital to undergo a diagnostic myelogram and subsequent back surgery. In preparing for testing and surgery, atrial fibrillation and renal shutdown were encountered. Stabilization of both conditions was obtained and a lumbar surgery was satisfactorily performed. In that case, the court distinguished the earlier case of Ramonett v. Industrial Commission, 27 Ariz.App. 728, 558 P.2d 923 (1976), where other medical condition treatment benefits had been denied, and observed:
The circumstances in the case before us differ from those presented in Ramonett. Here, there is no contention that the petitioner employer and carrier should be liable for any underlying heart or kidney condition from which the claimant may suffer. Rather, the appellee contended that he was entitled to medical benefits for the preoperative procedures in the hospital which became necessary because of the impending surgery for the industrial injury.
Allstate Ins. Co., 616 P.2d at 101-02. The hearing officer's approval of payment was consequently affirmed.
Factually, Allstate Ins. Co. does not extend beyond procedures required for stabilization of the heart beat and correction of the renal shutdown in order that the basic injury might be treated. Underlying medical conditions as permanent care were not considered or approved for benefit payment. The case itself rested on the reasonable inference due for appellate review of the hearing officer's decision which justified affirming the award previously given.
Allstate Ins. Co. was followed in Arizona by Arrowhead Press, Inc. v. Industrial Com'n of Arizona, 134 Ariz. 21, 653 P.2d 371 (1982), where the payment for prescription drugs was contested. The claimant was involved in an automobile accident with resulting impact injuries requiring knee surgery. The hearing officer again granted benefits for treatment of a bronchial condition preparatory to the use of an anesthesia for the knee operation. The court found "there was sufficient evidence to support the administrative law judge's finding that the hospital treatment of the bronchitis was reasonably necessary and was incurred to place claimant in a condition to undergo surgery for her industrial injury." Id. 653 P.2d at 373. The court further recognized in regard to Allstate Ins. Co. and its concept:
We note that the limits of this principle have not been defined, but petitioners do not here contend that the treatment for claimant's bronchitis during the hospital stay was in any way unreasonable or that it was disproportionate to the magnitude of claimant's industrial condition. In reviewing this question, we must view the evidence in a light most favorable to sustaining the award, and the findings will be upheld if reasonably supported by the evidence.
Id. at 373. On these facts, the relationship of the usage of prescription drugs to stabilize bronchitis in order to administer an anesthesia defines the limitation to which the principle was extended from Allstate Ins. Co. to Arrowhead Press, Inc.
The third case cited by Girardot is, Williams v. Gates, McDonald & Co., 300 Or. 278, 709 P.2d 712 (1985). After sustaining a work related...
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