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[T] Pella Corp. v. Fogle11/17/2003
Employer appeals from alternate medical care decision. AFFIRMED.
Pella Corporation (Pella) appeals from a district court decision on judicial review which affirmed a final agency alternate medical care decision in favor of its employee, Theresa Fogle. The agency decision determined Fogle's care should be transferred to a neurosurgeon, whom Fogle had seen at her own expense. Pella argues the agency decision must be reversed because it was not supported by substantial evidence. We affirm.
Background Facts and Proceedings
On August 7, 2000, Theresa Fogle sustained an injury at work that resulted in lower back pain and leg pain. She was seen the next day by Dr. Lloyd Thurston, the employer's authorized physician. After reviewing an MRI, Dr. Thurston referred Fogle to neurosurgeon dr. David Boarini. Dr. Boarini examined Fogle, reviewed the MRI and a CT myelogram, and recommended an aggressive conservative treatment plan. He did not recommend surgery. Fogle was then referred to Dr. Donna Bahls, a physical medicine and rehabilitation specialist, who provided conservative, non-surgical care, including work restrictions, physical therapy, pain medications, and injections.
Fogle continued to experience pain and symptoms, and was convinced that her problem was surgical. In December 2000 she sought out, at her own expense, a medical opinion from University of Iowa neurosurgeon Dr. Ernest Found, Jr. After a physical examination and review of the previous MRI and CT meylogram, Dr. Found determined no surgical intervention was indicated, and recommended that Fogle continue with rehabilitation.
Fogle was placed at maximum medical improvement in February 2001 by Dr. Bahls, and was given a five percent whole person impairment. She continued to have low back pain, and Dr. Thurston recommended a referral. It was not authorized.
In April 2001 Fogle saw neurosurgeon Dr. Douglas Koontz at her own expense. After reviewing a lumbar discogram performed by Dr. Mohammad Iqbal, whom Fogle also saw at her own expense, Dr. Koontz recommended surgery. He diagnosed Fogle with lumbar discogenic disease at L4-5 and L4-S1, and symptomatic disc herniations at L4-5 and L5-S1. He noted that all modes of conservative treatment had been tried and failed, and opined "in order to try and help with her pain, she needs" surgical treatment, which "is the typical treatment for lumbar discogenic disease." Pella would not authorize the treatment, and in August 2001 Fogle filed a petition for alternative medical care with the Iowa Workers' Compensation Commissioner.
Written opinions and diagnostic notes were submitted from the relevant physicians. Dr. Boarini did not recommend surgery. While he stated Dr. Koontz's recommendation could be considered as a last resort, he opined that the chances of success with surgery were very low. Dr. Bahls also did not believe the condition was surgical, and recommended work restrictions and permanent pain medication. After considering records from Drs. Koontz and Found, Dr. Thurston stated he felt comfortable "with continuing [Fogle] with conservative treatment basically medications and work restrictions."
Fogle did not find the pain medication adequate relief, and testified that some of the treatments increased her pain and "made things worse." She stated that from the date of her injury she continued to have problems, and that "things have just went downhill and continually gotten worse." There was no medical testimony, however, that any of the authorized treatment worsened Fogle's medical condition. To the contrary, Dr. Thurston stated that he knew "of no instance of [Fogle's] care making her condition worse."
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