HARRY BURNS, Employee/Appellant, v. MID CONTINENT ENG’G, INC., and SENTRY INS. GROUP, Employer-Insurer, and MERCY HOSP., ALLINA MED. CLINIC, SUBURBAN IMAGING, ADVANCED SPINE ASSOCS., ST. PAUL RADIOLOGY/MIDWEST RADIOLOGY, and INJURED WORKERS’ PHARMACY, Intervenors.
WORKERS’ COMPENSATION COURT OF APPEALS
APRIL 29, 2008
SETTLEMENTS - INTERPRETATION. The compensation judge properly interpreted the parties’ stipulation for settlement to relieve the employer and insurer of liability for narcotic medication expenses based on the employee’s breach of his agreement to abide by a narcotics agreement with his treating physician.
Determined by: Wilson, J., Johnson, C.J., and Pederson, J.
Compensation Judge: Rolf G. Hagen
Attorneys: Thomas A. Klint, Babcock, Nelson, Mannella & Klint, Anoka, MN, for the Appellant. David J. Klaiman, Aafedt, Forde, Gray, Monson & Hager, Minneapolis, MN, for the Respondents.
DEBRA A. WILSON, Judge
The employee appeals from the compensation judge’s finding that, pursuant to the parties’ settlement agreement, the employer and insurer are not liable for payment of narcotic medication costs. The employer and insurer cross-appeal from the judge’s finding that the narcotic medication treatment regimen was reasonable and necessary to cure or relieve the effects of the work injury. We affirm on the employee’s appeal, rendering consideration of the cross-appeal unnecessary.
The employee sustained work-related injuries to his neck, back, shoulder, and knee on June 4, 1968, while working for Mid Continent Engineering, Inc. [the employer]. The employer and its workers’ compensation insurer accepted liability for the injuries.
As a result of these work injuries, the employee has had multiple surgeries and suffers from chronic pain, primarily affecting his low back. In September of 2006, the parties entered into a stipulation for settlement, wherein the parties agreed that Dr. Manan Shukla would be the employee’s treating doctor and that,
upon his next treatment with Dr. Shukla and/or any other physician, the employee will sign an opiate/narcotics contract. The employee agrees that should he violate this contract, the employer and insurer shall have no obligation to pay for further narcotics medications or associated expenses.
An award on stipulation was filed on January 5, 2007.
On January 26, 2007, the employee was seen by Dr. Shukla, at Allina Medical Clinics in Coon Rapids, and he and Dr. Shukla signed a narcotics contract called a Chronic Controlled Substance Treatment Agreement. That contract indicated that the employee was being prescribed Oxycontin, Percocet, and Valium, and the employee agreed that he would obtain prescriptions for these medications only from providers at Dr. Shukla’s clinic, that he would use only one pharmacy to obtain his medications, and that his treatment could be terminated if he violated the agreement.
On February 18, 2007, the employee was seen at Mercy Hospital, requesting a shot to dull his pain. Provider notes from that date reflect that “his behavior is consistent with drug seeking.” He was given a shot of dilaudid IM and discharged with directions to inform his primary doctor that he had been treated.
On March 15, 2007, the employee was seen by Dr. Garry Banks at Advanced Spine Associates, P.A. On that date, Dr. Banks reported that the employee had been receiving Oxycontin from Dr. Pierre Herard but noted, “[a]pparently Dr. Herard will not be able to refill prescriptions until his further treatments are approved through Worker’s Compensation.” Dr. Banks then refilled Oxycontin, prescribing 60 tablets, telling the employee to take no more than two tablets per day.
On March 30, 2007, the employee was seen by Dr. Herard, also of the Advanced Spine Associates. Dr. Herard indicated that Dr. Shukla had been providing some medication but that “the numbers were not adequate” and that the employee had increased his medication dosage and was afraid to go through withdrawal. Dr. Herard gave him 20 Oxycontin to get him through until he saw Dr. Shukla the next week.
The employee returned to Dr. Banks on April 9, 2007, for further evaluation of his back. Dr. Banks prescribed Soma at that time. On April 23, 2007, Dr. Banks examined the employee again and noted that the employee had contacted him “last weekend” and that he had prescribed 40 tablets of Vicodin. On the date of this examination, Dr. Banks prescribed 40 tablets of Oxycontin.
On May 18, 2007, the employee was seen by Dr. Shukla, requesting a prescription for Oxycontin. Dr. Shukla noted that the employee was not due for a refill until May 26, 2007, and advised the employee that he would only give him a prescription for Oxycontin and Valium for May 25, 2007. The doctor did, however, give the employee some extra Percocet. At the employee’s request, the doctor also wrote a letter stating that the employee was following his narcotics agreement. The doctor’s office note reflects that more than 50% of his time with the employee that day had been spent “counseling about the back pain, importance of narcotics, and detailed discussion about the contract.”
The employee was seen in follow up by Dr. Shukla on June 1, 2007. Dr. Shukla noted that he had received a letter from the insurer indicating that the employee had been obtaining medications from other sources and was breaking his narcotics contract. The office note reflects that Dr. Shukla reminded the employee that, per the narcotic contract, the employee was not to get medication from other sources. The employee apparently responded that he had misunderstood. Dr. Banks was the only alternate source for medication referenced in Dr. Shukla’s office note. Dr. Shukla indicated that he would no longer prescribe medications for the employee because he had breached the contract, but, on June 11, 2007, when the employee returned to Dr. Shukla requesting oxycodone, Dr. Shukla prescribed Oxycodone-acetaminophen, 120 tablets, to be taken no more than four times a day. Dr. Shukla also had the employee sign a new narcotics contract on that date.
On June 18, 2007, the employee was seen again by Dr. Banks, who prescribed 30 tablets of Oxycontin, to be taken two times a day. The employee then returned to Dr. Shukla on June 22, 2007. Dr. Shukla’s office notes reflect that he discussed the pain contract in detail with the employee again and explained that if he broke the contract he would not get any more medicine. Dr. Shukla noted, “as per patient, he did not break the contract and he will never.” Dr. Shukla prescribed 60 tablets of Oxycontin and 90 of Valium. Just five days later, the employee returned to Dr. Herard, indicating that Dr. Herard was to take over his pain management care. Dr. Herard prescribed Oxycontin.
The employee subsequently saw Dr. Shukla for refills of medications on July 3, 2007, July 20, 2007, and August 10, 2007. Records from Injured Workers’ Pharmacy reflect the filling of prescriptions issued by Dr. Shukla on August 14 and 15, 2007, September 7 and 10, 2007, October 3 and 15, 2007, and November 21, 2007.
The employee filed a medical request on August 30, 2007, seeking payment of various medical expenses, including expenses incurred at Injured Workers’ Pharmacy. The employer and insurer responded that, because the employee had violated his narcotics contract with Dr. Shukla, they would not be reimbursing or paying for expenses associated with narcotic medications.
The medical request came on for hearing on November 29, 2007. In findings and order filed on December 28, 2007, the compensation judge, in unappealed findings, found that, during the period from January 26, 2007, through June 27, 2007, the employee had violated the controlled substance treatment agreement a minimum of six different times; that the employee had obtained prescriptions for narcotic medications from Drs. Herard and Banks, that neither doctor had entered into a controlled substance treatment agreement with the employee, and that those doctors were not associated with Dr. Shukla or his clinic; and that the employee knew or should have known that obtaining prescriptions for narcotic medications from any doctor other than Dr. Shukla was a violation of the controlled substance treatment agreement. The judge went on to find that, by virtue of the employee’s violation of the narcotic contract, the employer and insurer were not responsible for payment of the outstanding bill with Injured Workers Pharmacy, and the claimed out-of-pocket expenses were also denied. The employee appeals from that finding. The employer and insurer cross-appeal from the judge’s finding that the narcotic treatment regime was otherwise reasonable and necessary.
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 (2008). 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 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 indicates in his brief that the judge’s decision cuts the employee off “from any and all future medication for his work injuries,” which does not conform with the intent and purpose of the Workers’ Compensation Act. That statement is inaccurate. The judge’s decision only enforces the stipulation for settlement, which the employee and his attorney reviewed and signed and which provided that the employer and insurer would “have no obligation to pay for future narcotic medications or associated expenses” if the employee violated his narcotics contract. In unappealed findings, the judge found that, in a five-month period, the employee breached/violated the narcotics contract a minimum of six times and that the employee knew or should have known that he was violating the contract.
The employee also contends that there is a long-established policy against full, final and complete settlements and that a findings and order that “effectively cuts off any and all future prescription medications for Mr. Burns” must be clearly erroneous. However, as explained above, the compensation judge’s decision does not cut off all prescription medications, only narcotic medications, and the stipulation for settlement is not before us on a petition to vacate. In addition, the stipulation on its face does not close out future narcotic medications; rather, the stipulation placed the onus on the employee to abide by his narcotic contract in order to qualify for future narcotic medications. It was the employee’s subsequent actions alone that relieved the employer and insurer of liability for future narcotic expenses.
The employee also appears to contend that the stipulation for settlement is ambiguous as to just what future narcotic medications are covered by the agreement. We find nothing at all ambiguous about the language in question. The provision indicating that “the employer and insurer shall have no obligation to pay for future narcotics medications or associated expenses” means just that. That is, the language of the stipulation for settlement clearly and unambiguously relieves the employer and insurer of liability for all future narcotic medications if the employee breaches his narcotic contract.
The employee also suggests throughout his brief that he “inadvertently” breached his narcotic contract and that, while he “inadvertently” breached the January 2007 contract, “he has not had any incidents with regard to his contract since June of 2007.” The judge, however, found that there were a minimum of six instances of breach and that the employee knew or should have known that he was breaching the contract. This finding was not appealed. We also note that Dr. Shukla’s June 1, 2007, office notes indicate that he specifically told the employee that he could not get his medications from other sources, that the employee signed a new narcotic contract with Dr. Shukla on June 11, 2007, that Dr. Shukla discussed the narcotic contract in detail with the employee again on June 22, 2007, and that the employee nevertheless again secured narcotic medicines from a different doctor on June 27, 2007. There is not only evidence that the employee breached the January 2007 contract but that he also breached the June 2007 contract. It is difficult to see how the employee’s actions can be characterized as “inadvertent.”
The stipulation for settlement did not constitute a full, final, and complete settlement of medical expenses related to an admitted injury. Rather, the stipulation merely set some reasonable conditions, for obtaining narcotics, for an employee who had earlier been observed to exhibit drug- seeking behavior. The employee is not foreclosed from making future claims for medications, he is foreclosed only from making claims for narcotic medications. We affirm the judge’s finding that the employer and insurer are not responsible for payment of the outstanding bill of Injured Workers Pharmacy or for the claimed out-of-pocket expenses.
 The Oxycontin was to be taken two times per day and the Valium three times per day.
 At which time he also signed a new narcotics contract.
 On October 29, 2004, Dr. Peter Dorsen terminated the employee from his care due to overuse of Percocet and misuse of Oxycontin.
 Because we have affirmed the judge’s decision on this issue, we need not address the employer and insurer’s cross-appeal as to the reasonableness and necessity of the narcotic medications.