LORRINDA SMITH, Employee/Appellant, v. BECKLUND HOME HEALTH CARE, and MARP/WAUSAU INS. CO., Employer-Insurer.
WORKERS= COMPENSATION COURT OF APPEALS
JULY 18, 2005
MEDICAL TREATMENT & EXPENSE - REASONABLE & NECESSARY; SETTLEMENTS. The record as a whole, including expert opinion, supported the compensation judge=s denial of claimed antidepressant medication expenses, both on grounds that the medication was not reasonable and necessary to treat chronic pain and on grounds that the medication expense claim was barred by a closeout of claims for psychological and psychiatric treatment.
Determined by: Wilson, J., Pederson, J., and Rykken, J.
Compensation Judge: William R. Johnson
Attorneys: Howard S. Carp, Borkon, Ramstead, Mariani, Fishman & Carp, Minneapolis, MN, for the Appellant. Vincent A. Petersen, Cousineau, McGuire & Anderson, Minneapolis, MN, for the Respondents.
DEBRA A. WILSON, Judge
The employee appeals from the compensation judge=s finding that her prescription for Wellbutrin was not a reasonable and necessary medical expense. We affirm.
The employee sustained work-related injuries to her low back while working for Becklund Home Health Care [the employer] on December 8, 1992, and May 4, 1993. The employer and its workers= compensation insurer admitted liability for the injuries.
The employee has treated with Dr. Kinga Kocsis, a family practice doctor, since 1986. Dr. Kocsis was one of the doctors that referred the employee for fusion surgery in 1996 and has prescribed pain medications, muscle relaxers, and antidepressants since the surgery. Dr. Kocsis initially started the employee on the antidepressant Zoloft because the employee was voicing symptoms suggestive of depression, and the doctor testified that Aalso in my studies antidepressants were known to be very helpful as an adjunct of therapy in chronic pain.@ When Zoloft lost its effectiveness, Dr. Kocsis switched the employee to Celexa and eventually to Wellbutrin.
In December of 2002, the parties entered into a stipulation for settlement, wherein the employee was paid $83,000 in a lump sum, plus periodic payments, in exchange for a close out of workers= compensation benefits, with the exception of future reasonable and necessary medical expenses. The stipulation specifically closed out Apsychological or psychiatric expenses.@ An award on stipulation was filed on December 20, 2002.
The employee filed a medical request for payment of her prescription for Celexa on July 20, 2004. The matter proceeded to a medical conference, and, after the issuance of that decision and order, the employee filed a request for formal hearing.
On October 25, 2004, Dr. Kocsis wrote a prescription switching the employee from Celexa to Wellbutrin Afor daytime anxiety/depression [secondary] to chronic pain/past injuries & surgery.@ On January 3, 2005, psychiatrist Dr. Thomas Gratzer completed a review of the employee=s medical records for the employer and insurer. In his report of that date, Dr. Gratzer diagnosed the employee with an adjustment disorder and opined that she was not a candidate for antidepressants. He also opined that Wellbutrin was not a reasonable and necessary treatment for pain management or difficulty sleeping.
The employee=s request for formal hearing proceeding to hearing, and, in a findings and order filed on February 10, 2005, the compensation judge found that Wellbutrin was not an appropriate treatment for chronic pain but was intended for treatment of major mood disturbances such as major depression. The judge went on to find that such treatment had been closed out by the stipulation for settlement. The employee appeals.
STANDARD OF REVIEW
On appeal, the Workers' Compensation Court of Appeals must determine whether "the findings of fact and order [are] clearly erroneous and unsupported by substantial evidence in view of the entire record as submitted." Minn. Stat. ' 176.421, subd. 1 (2004). Substantial evidence supports the findings if, in the context of the entire record, "they are supported by evidence that a reasonable mind might accept as adequate." Hengemuhle v. Long Prairie Jaycees, 358 N.W.2d 54, 59, 37 W.C.D. 235, 239 (Minn. 1984). Where evidence conflicts or more than one inference may reasonably be drawn from the evidence, the findings are to be affirmed. Id. at 60, 37 W.C.D. at 240. Similarly, findings of fact should not be disturbed, even though the reviewing court might disagree with them, "unless they are clearly erroneous in the sense that they are manifestly contrary to the weight of the evidence or not reasonably supported by the evidence as a whole.@ Northern States Power Co. v. Lyon Food Prods., Inc., 304 Minn. 196, 201, 229 N.W.2d 521, 524 (1975).
The employee contends that Athe overwhelming weight of the evidence@ supports the employee=s claim for Wellbutrin, in that Dr. Kocsis testified that Wellbutrin worked in concert with the employee=s prescribed painkillers to help the employee function on a daily basis, and the employee testified that the Wellbutrin helps her to sleep. The employee also testified that, if she does not take all of her medications together, then her symptoms impact her lifestyle. We are not persuaded.
Dr. Kocsis testified that her studies have shown that antidepressants are helpful as an adjunctive therapy in chronic pain cases, offering two articles in support of her position. In the article entitled APain Management Drug Decisions for Patients with Chronic Noncancer Pain Syndromes,@ the author discusses the analgesic benefits from different types of adjuvant medications, including some antidepressants. The table included with the article, however, does not list Wellbutrin as one of the antidepressants commonly used as an adjuvant medication. The second article, entitled AThe Management of Chronic Pain in Older Persons,@ indicates that tricyclic antidepressants have the most support in medical literature for use as an adjuvant medication for treatment of chronic pain. Again, however, the table listing antidepressants for this use does not include Wellbutrin, and the product information for Wellbutrin received into evidence indicates that Wellbutrin has a chemical structure Aunrelated to any other antidepressant medication.@ In addition, in a report dated January 10, 2005, Dr. Gratzer opined that neither of the two articles in question made reference to Wellbutrin and that the articles did not support the use of Wellbutrin to treat chronic pain.
The compensation judge indicated in his memorandum that he had adopted the opinions of Dr. Gratzer over those of Dr. Kocsis. A judge=s choice of expert opinions in generally upheld unless the facts assumed by the expert in rendering his opinion are not supported by the evidence. Nord v. City of Cook, 360 N.W.2d 337, 37 W.C.D. 364 (Minn. 1985). While the employee contends that Dr. Gratzer=s opinions are based on Ainadequate factual foundation and are of little evidentiary value,@ the employee does not point to any specific facts assumed by Dr. Gratzer that are not supported by the evidence.
Substantial evidence establishes that the Wellbutrin was prescribed for treatment of depression. Dr. Kocsis testified to this effect and her written prescriptions also support this conclusion. Depression is generally considered a psychological or psychiatric condition, and the stipulation for settlement specifically closed out expenses for psychological or psychiatric treatment. In addition, the judge=s finding that Wellbutrin is not reasonable and necessary treatment for chronic pain is supported by the opinion of Dr. Gratzer. Accordingly, the findings and order of the compensation judge are affirmed in their entirety.
 Specifically, Dr. Kocsis testified that the employee Ahad a situational depression and [I] wanted to improve her emotional functioning because of this.@