Court of Appeals Affirms Permanent Total Disability Award, But Denies Bariatric Surgery
In Mercy Hospital Iowa City v. Goodner, No. 12-0186 (Iowa App. Jan. 9, 2013), the Court of Appeals affirmed the finding of the commissioner that claimant was permanently totally disabled. The court also concluded that defendants were judicially estopped from contesting liability for the claim, and that defendants were responsible for paying for one half of the cost of family therapy sessions for claimant. The court reversed the finding of the agency that payment for bariatric surgery for claimant should be paid by the defendants.
Claimant, a doctor was exposed to mononucleosis as a result of her work. She later developed depression and chronic fatigue syndrome. Defendants' doctors indicated that she may not have had mononucleosis, but did have fatigue and memory loss. Claimant's doctors indicated that she had developed mononucleosis and this was one of a multitude of triggers for chronic fatigue syndrome. Following these developments, claimant began gaining weight and underwent bariatric surgery, following which she lost 70 pounds. A DME doctor opined that the mono could not have been transmitted in the way in which claimant indicated it had been, and further stated that the opinions of the other doctors were the result of "VIP syndrome" because those doctors had given credence to claimant because she was a doctor.
Claimant initially had her workload reduced, and ultimately left her medical practice. She attempted to perform a housecall business among the Amish, but was unable to do so. She was advised by the medical board to stop seeing patients, and her medical license was placed on inactive status.
The arbitration decision found PTD, relying on the odd lot doctrine., and also concluded family counseling should be paid for, as well as the costs of bariatric surgery. These findings were affirmed by the commissioner. On judicial review, the district court concluded that Mercy should be estopped from arguing liability because they had admitted liability in an alternate medical care proceeding. The district court affirmed the remaining items.
On appeal, defendants argued that Winnebago Industries v. Haverly, 727 N.W.2d 567 (Iowa 2006) should be overruled because it gave preclusive effect to alternate medical care proceedings, where an employer allegedly has few due process protections. The court spends a great deal of time discussing Haverly, which was the first workers' compensation case to apply judicial estoppel, before concluding that the court was without power to overrule that case, which was decided by the Supreme Court, and further concluding that Haverly had been properly applied.
Defendants also raised the question of whether claimant's medical evidence was scientifically reliable, and asserts that the Daubert standard should apply, and cites to Ranes v. Adams Laboratories, Inc., 778 N.W.2d 677 (Iowa 2010) which applied Daubert in Iowa courts. The court first found that a medical expert need not rely on published studies to conclude that a particular object caused a particular illness. The question of medical causation, according to the court, is essentially within the domain of expert testimony. The weight to be given the medical expert reports is for the agency to determine. Ultimately, the court decides on substantial evidence grounds that claimant's mononucleosis and chronic fatigue syndrome had arisen from events at work. The PTD award was also affirmed on substantial evidence grounds.
With respect to the bariatric surgery, the court, applying Bell Brothers, noted that claimant had to demonstrate that the surgery was both reasonable and beneficial. The court concluded the care was not beneficial because claimant had a weight problem prior to the injury, and although she lost weight following the surgery, she was still not in a position to work. The court found that the agency's conclusion that there had not been a weight problem prior to the injury was not supported by substantial evidence. Ultimately, however, the decision rested on the fact that since there was no return to the labor market following the surgery, the surgery was not beneficial. This is a troubling development with respect to Bell Brothers because it seems to make the determination of whether a procedure is beneficial rest on the industrial effects of the procedure rather than the health effects of the procedure. There was evidence presented that claimant had, in fact, lost weight as a result of the surgery, and this seems to be sufficient to support a finding that the surgery was beneficial.
Finally, the court concluded that paying for one-half of the family therapy was appropriate because this was proportionate to that part of the therapy that benefited claimant.
Claimant, a doctor was exposed to mononucleosis as a result of her work. She later developed depression and chronic fatigue syndrome. Defendants' doctors indicated that she may not have had mononucleosis, but did have fatigue and memory loss. Claimant's doctors indicated that she had developed mononucleosis and this was one of a multitude of triggers for chronic fatigue syndrome. Following these developments, claimant began gaining weight and underwent bariatric surgery, following which she lost 70 pounds. A DME doctor opined that the mono could not have been transmitted in the way in which claimant indicated it had been, and further stated that the opinions of the other doctors were the result of "VIP syndrome" because those doctors had given credence to claimant because she was a doctor.
Claimant initially had her workload reduced, and ultimately left her medical practice. She attempted to perform a housecall business among the Amish, but was unable to do so. She was advised by the medical board to stop seeing patients, and her medical license was placed on inactive status.
The arbitration decision found PTD, relying on the odd lot doctrine., and also concluded family counseling should be paid for, as well as the costs of bariatric surgery. These findings were affirmed by the commissioner. On judicial review, the district court concluded that Mercy should be estopped from arguing liability because they had admitted liability in an alternate medical care proceeding. The district court affirmed the remaining items.
On appeal, defendants argued that Winnebago Industries v. Haverly, 727 N.W.2d 567 (Iowa 2006) should be overruled because it gave preclusive effect to alternate medical care proceedings, where an employer allegedly has few due process protections. The court spends a great deal of time discussing Haverly, which was the first workers' compensation case to apply judicial estoppel, before concluding that the court was without power to overrule that case, which was decided by the Supreme Court, and further concluding that Haverly had been properly applied.
Defendants also raised the question of whether claimant's medical evidence was scientifically reliable, and asserts that the Daubert standard should apply, and cites to Ranes v. Adams Laboratories, Inc., 778 N.W.2d 677 (Iowa 2010) which applied Daubert in Iowa courts. The court first found that a medical expert need not rely on published studies to conclude that a particular object caused a particular illness. The question of medical causation, according to the court, is essentially within the domain of expert testimony. The weight to be given the medical expert reports is for the agency to determine. Ultimately, the court decides on substantial evidence grounds that claimant's mononucleosis and chronic fatigue syndrome had arisen from events at work. The PTD award was also affirmed on substantial evidence grounds.
With respect to the bariatric surgery, the court, applying Bell Brothers, noted that claimant had to demonstrate that the surgery was both reasonable and beneficial. The court concluded the care was not beneficial because claimant had a weight problem prior to the injury, and although she lost weight following the surgery, she was still not in a position to work. The court found that the agency's conclusion that there had not been a weight problem prior to the injury was not supported by substantial evidence. Ultimately, however, the decision rested on the fact that since there was no return to the labor market following the surgery, the surgery was not beneficial. This is a troubling development with respect to Bell Brothers because it seems to make the determination of whether a procedure is beneficial rest on the industrial effects of the procedure rather than the health effects of the procedure. There was evidence presented that claimant had, in fact, lost weight as a result of the surgery, and this seems to be sufficient to support a finding that the surgery was beneficial.
Finally, the court concluded that paying for one-half of the family therapy was appropriate because this was proportionate to that part of the therapy that benefited claimant.
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