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Travelers Property Casualty v. Martini6/6/2002
DECISION ON APPEAL
This is an appeal from a Department of Labor and Industry decision finding Travelers Property Casualty (Travelers) liable for medical services provided by a nurse practitioner employed and working under direct, actual supervision of Steven Martini, M.D., who was authorized to treat claimant. The appeal is without merit and the decision below is affirmed.
Discussion
This case involves treatment of Tamise Hill (Hill). Travelers does not dispute liability for Hill's claim and agrees that it authorized Dr. Martini to treat her. However, it has refused payment for services provided by Christine McGuire (McGuire), a nurse practitioner employed by, supervised by, and working under Dr. Martini. Its ground for refusing payment are technical: it alleges that McGuire was a treating physician; that it did not approve her as a treating physician; and that, in any event, her services were not authorized by statute. It urges that the hearing officer's findings are not supported by substantial evidence and are erroneous as a matter of law.
The facts found by the hearing officer in the proceeding below are straightforward and brief. I therefore repeat them here in full:
a Travelers Property Casualty authorized Dr. Martini as treating physician for Tamise Hill and to implement the treatment plan as outlined by Stanford Medical Center when she was seen for follow-up in April 2000.
b Dr. Martini conveyed his treatment plan for Hill to Travelers in his letter dated June 14, 2000. He anticipated that his treatment of Hill would consist primarily of pain management in terms of medications for disorders associated with her chronic pain syndrome (depression/anxiety, and so on).
c Dr. Martini personally treated Hill during office calls from the time he was authorized as treating physician until November 2000. He hired family nurse practitioner, Christine McGuire, about that same time to assist him in his practice. McGuire is licensed through the nursing board.
d McGuire is a full time hourly employee for Dr. Martini and works in his office and under his supervision. She performs services as authorized under her license and as directed by Dr. Martini. In performing services as directed by Dr. Martini, she began taking a number of office calls with Hill beginning in November 2000.
e Dr. Martini's patient ledger reveals that Hill consulted with McGuire on various occasions beginning November 21, 2000. Basically, all of the office calls managed by McGuire consisted of consultation with Hill about her chronic pain problems and addressing appropriate medical prescriptions. The ledger shows that McGuire consulted with Hill on 13 occasions between November 21, 2000 and July 27, 2001.
f With few exceptions, the office notes of McGuire indicate that she consulted with Dr. Martini concerning each of her contacts with Hill. Dr. Martini and McGuire sometimes discussed Hill's situation before her appointment and other times following what were essentially interviews with Hill about how well she was coping with her pain syndrome. Dr. Martini's initials appeared on almost every call handled by McGuire, and he consulted with her about Hill's pain treatment throughout the time periods in question.
g Dr. Martini never relinquished his treating physician status and nothing in the record indicates that Hill ever requested a change in treating physicians. He continued to supervise and manage Hill's case during the time periods in question.
h Travelers informed Dr. Martini that it was denying payment for certain services provided to Hill through McGuire. Specificall
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