LESLIE HINKS, Employee, v. GARY WEBB SERVS. and HARTFORD INS. GROUP, Employer-Insurer/Appellants, and MEDICARE adm=d by NORIDIAN ADMIN. SERVS., Intervenor.
WORKERS= COMPENSATION COURT OF APPEALS
SEPTEMBER 7, 2004
EVIDENCE - RES JUDICATA. Where the employee=s claim for medical expenses covered a time period after a previous Decision and Order denying payment of medical benefits, and included treatment for conditions different from the condition covered in the previous litigation, the employee=s claim was not barred by res judicata or collateral estoppel.
MEDICAL TREATMENT & EXPENSE - SUBSTANTIAL EVIDENCE. Substantial evidence supported the compensation judge=s conclusion that the employee=s 1952 personal injury was a substantial contributing cause of his need for the disputed medical care and the award of medical expenses.
Determined by Johnson, C.J., Wilson, J. and Rykken, J.
Compensation Judge: Gregory A. Bonovetz
Attorneys: Adam S. Wolkoff, Law Offices of Adam S. Wolkoff, Eagan, MN, for the Appellants. Melanie P. Persellin and Patrick M. Spott, Orman Nord & Spott, Duluth, MN, for the Respondent.
THOMAS L. JOHNSON, Judge
Gary Webb Services and Hartford Insurance Group appeal the compensation judge=s award of medical benefits contending the doctrine of collateral estoppel bars the employee=s claim for payment of the disputed medical expenses. We affirm.
Leslie Hinks, the employee, sustained a personal injury on July 26, 1952. The employee was then working at an automobile repair shop when a vehicle slipped into reverse and pinned the employee against his work bench. The employer and insurer admitted liability for the employee=s personal injury.
The employee was hospitalized following the accident and was determined to have sustained fractures of multiple transverse processes of the lumbar vertebrae and fractures of the eighth and eleventh ribs on the right. The employee underwent a lumbar laminectomy in the late 1950s and a fusion in the late 1970s for treatment of chronic low back pain secondary to his personal injury. Since his injury, the employee has consistently experienced pain and discomfort of varying intensity in his low back. In 1991 and 1992, the employee received physical therapy under the direction of Dr. Van Den Broueck. In September 1992, the employee was admitted to St. Luke=s Hospital complaining of intractable lower lumbar pain secondary to his 1952 injury. A lumbar MRI scan showed an L1 through L3 fusion with dorsal kyphosis at L2-3, lateral stenosis from L2 through L4 on the left, and annular bulging and facet degeneration from L3 through L5 with stenosis at L4-5. Dr. Niles Batdorf diagnosed chronic pain with a left L5-S1 disc herniation and degenerative facet joint pain from L4 to S1. In October 1992, Karen Ensley, a physical therapist, diagnosed continuing chronic debilitating back pain following a regimen of physical therapy. In March 1993, Dr. Bruce Yee diagnosed chronic low back pain following the 1952 injury and provided epidural blocks at L5-S1 and L1-2. In August 1994, the employee was seen at the emergency room at St. Luke=s Hospital. Dr. Franzel diagnosed chronic low back pain. In September and October 1994, the employee was again seen at the emergency room at St. Luke=s Hospital for chronic back pain. In December 1994, Dr. Van den Broeck prescribed Tylenol with codeine for pain for which he stated the employee=s 1952 work injury was the permanent trigger.
The employee was seen at St. Luke=s Hospital in October 1999 complaining of severe back pain. An x-ray showed a moderate anterior wedge compression fracture involving T7 and moderate thoracic spine degenerative changes. The employee was hospitalized in November 1999 with a diagnosis of pneumonia, probable chronic obstructive pulmonary disease and lower thoracic back pain. A lumbar MRI scan showed the fusion from L2 through L4 with mild retrolisthesis of L3 onto L4 and spinal stenosis with mild foraminal narrowing at L3-4 and L4-5 with moderate degenerative changes at all three levels of the lumbar spine. An MRI scan of the thoracic spine showed the wedge compression fracture of T7 and kyphosis of the thoracic spine. In November 2000, Dr. Batdorf noted the employee=s T7 compression fracture was secondary to osteoporosis.
In March 2000, the employee filed a Medical Request seeking payment of medical bills incurred in October and November of 1999 at St. Luke=s Hospital, Radiological Associates and P.S. Rudie and Associates. In a Decision and Order filed March 2, 2001, a compensation judge found the need for medical care was caused by the employee=s pneumonia and osteoporosis, not the personal injury. Accordingly, the insurer was not liable for the bills of St. Luke=s Hospital and Radiological Associates. The compensation judge found the medical treatment provided by the physicians at Rudie and Associates was causally related to the employee=s personal injury and ordered the insurer to make payment of the bills, subject to the fee schedule. No party requested a de novo hearing.
In 2001, 2002 and 2003, the employee was seen by Dr. Batdorf on numerous occasions complaining of chronic low back pain. On various occasions he prescribed Percocet, Lortab, Vicodin, Neurontin and Darvocet for pain. A lumbar MRI scan in April 2003, showed a severe compression fracture at L4 with prominent kyphosis through the area and significant spinal stenosis at L3-4. In April 2003, the employee saw Dr. Batdorf complaining of substantially increased low back pain with leg pain. The doctor diagnosed an exacerbation of pre-existing lumbar pain with compression fractures and admitted the employee to St. Luke=s Hospital for physical therapy and pain control. Dr. Daniel Wallerstein examined the employee and diagnosed chronic low back pain with significant degenerative changes at L3-4 with spinal stenosis. Dr. Konasiewicz, a neurosurgeon, also examined the employee and reviewed the MRI scan. The doctor concluded some of the employee=s symptoms were due to kyphosis, some due to lumbar spinal stenosis and some likely due to osteoporatic compression fractures. The doctor opined the employee might benefit from a decompressive lumbar procedure and fusion. The employee was again hospitalized in June and July 2003, for chronic severe intractable low back pain. The employee was seen in the emergency room of St. Luke=s Hospital on November 5, 2003, again complaining of chronic low back pain. Dr. Patricia Mayer diagnosed intractable chronic thoracic and lumbar back pain and prescribed Demerol and Toradol. The employee was admitted to the hospital and seen by Dr. Matthew Harrison who diagnosed mechanical low back pain, suspicious for lumbar radiculopathy, depression and chronic pain syndrome.
William G. Akins, an orthopedic surgeon, examined the employee on December 1, 2003, at the request of the employer and insurer. The doctor=s diagnoses were a history of a work-related accident on July 26, 1952, chronic pain syndrome, severe emphysema, codeine dependency and generalized osteoporosis. The doctor stated the employee=s T7 compression fracture in 1999 and the L4 compression fracture in 2003, were consistent with severe osteoporosis and thoracic kyphosis and were not due to the 1952 personal injury. The doctor further opined the central stenosis and degenerative disc disease at L3-4 were also unrelated to the 1952 injury. The doctor stated the true source of the employee=s pain remained to be defined and stated the hospitalizations on numerous occasions throughout the entire year of 2003 were not caused by the 1952 injury, but were brought on by the employee=s lack of self-directed personal health care activities.
The employee filed a Medical Request seeking payment of medical expenses, including expenses at St. Luke=s Hospital, medical providers, prescriptions and reimbursement to Medicare. In a Findings and Order, filed January 20, 2004, the compensation judge found the requested medical expenses were reasonable, necessary and causally related to the employee=s 1952 personal injury and ordered the insurer to pay the bills subject to the applicable fee schedule. The employer and insurer appeal.
In his 2001 Decision and Order, Compensation Judge Arnold concluded the employee=s pneumonia, thoracic osteoporosis and resulting T7 compression fracture were unrelated to the 1952 work injury. The medical records, the appellants contend, establish that the employee=s hospitalizations in 2003 were also due to osteoporosis and kyphosis secondary to the T7 compression fracture. Since these conditions were determined by Judge Arnold to be not work-related, the appellant argues the doctrine of collateral estoppel bars the employee=s claims for payment of the disputed medical benefits. We are not persuaded.
The principles of res judicata are applicable in workers= compensation proceedings. Abrahams v. University of Minn.- Duluth, 61 W.C.D. 103 (W.C.C.A. 2001). The doctrine precludes litigation of issues and claims that were in fact decided in an earlier decision. Fischer v. Saga Corp., 498 N.W.2d 449, 48 W.C.D. 368 (Minn. 1993); Westendorf v. Campbell Soup, 243 N.W.2d 157, 28 W.C.D. 460 (Minn. 1976). Collateral estoppel is a limited form of res judicata whereby a prior judgement is conclusive in a later suit between the same parties as to determinative issues finally decided in the former suit. Travelers Ins. Co. v. Thompson, 163 N.W.2d 289 (Minn. 1969). The Minnesota Supreme Court has held that the principles of collateral estoppel are appropriately applied in the following circumstances: (1) the issue is identical to one in a prior adjudication; (2) there was a final judgment on the merits; (3) the estopped party was a party or in privity with a party to the prior adjudication; and (4) the estopped party was given a full and fair opportunity to be heard on the adjudicated issue. Nelson v. American Family Ins. Group, 651 N.W.2d 499, 511 (Minn. 2001). The court has also held that Aneither collateral estoppel nor res judicata is rigidly applied,@ and the focus is on Awhether its application would work an injustice on the party against whom estoppel is urged.@ Johnson v. Consolidated Freightways, 420 N.W.2d 608, 613-614 (Minn. 1988).
As a general proposition, an employer is required to provide all medical treatment reasonably necessary to cure and relieve the employee from the effects of a work-related injury. Minn. Stat. ' 176.135 (2002). The issue before Judge Bonovetz was whether the medical treatment received by the employee in 2003 was causally related to the 1952 personal injury. That issue was not before Judge Arnold in 2001. Judge Arnold denied the employee=s request for payment of medical expenses associated with thoracic back pain secondary to a compression fracture of T7 secondary to osteoporosis. Based upon the medical evidence, the compensation judge could conclude the employee=s medical treatment in 2003 was not solely for treatment of the same condition for which he was hospitalized in 2001. Thus, the issues in the two proceedings were not identical.
In July 2003, Dr. Tim LaMaster reported the employee was hospitalized with Asevere multifactorial back pain, due to a combination of spinal stenosis, lumbar and thoracic compression fractures, osteopenia and severe kyphosis.@ The employee has demonstrated lumbar stenosis and kyphosis since at least the lumbar MRI scan in 1992. In November 2003, Dr. Stenehjem diagnosed intractable back pain present since the 1952 personal injury. Dr. Harrison diagnosed mechanical low back pain, depression and chronic pain syndrome. The employee underwent a lumbar laminectomy in the late 1950s and a fusion in the late 1970s for treatment of chronic low back pain. The medical records document continued complaints of severe low back pain by the employee since his personal injury together with extensive medical treatment for that condition. The compensation judge could reasonably conclude the employee=s claims did not cover the identical condition previously litigated and, accordingly, was not barred by the doctrine of collateral estoppel.
Based upon the evidence submitted, the compensation judge reasonably concluded the employee=s personal injury was a substantial contributing cause of his need for the disputed medical care. The compensation judge=s decision is supported by substantial evidence and must be affirmed.