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Tanana Valley Clinic v. Adams12/14/2005
NOTICE Memorandum decisions of this court do not create legal precedent. See Alaska Appellate Rule 214(d). Accordingly, this memorandum decision may not be cited for any proposition of law or as an example of the proper resolution of any issue.
MEMORANDUM OPINION AND JUDGMENT
No. 1231
Before: Bryner, Chief Justice, Matthews, Eastaugh, Fabe, and Carpeneti, Justices.
The Alaska Workers' Compensation Board ruled that Liya Adams's claim for surgery preauthorization was neither medically reasonable nor necessary. This ruling was reversed by the superior court. Tanana Valley Clinic challenges the superior court's order in this appeal.
We agree with the superior court for the reasons it stated on the issue of the reasonableness of the surgery sought by Adams. We set out here the opinion of the court pertinent to this issue.
ORDER
Appellant, employee Liya Adams, appeals the decision of the Alaska Workers' Compensation Board in favor of Appellee, Tanana Valley Clinic, and the Board. In its October 31, 2002 decision, the Board determined that Adams's claim for surgery was not reasonable or necessary. The Board's decision is REVERSED.
Background
Prior to her February 2000 workers' compensation claim, the employee had a history of lower back problems dating back to the early 1990's. Various doctors in Fairbanks treated her and at one point she received traction therapy in China. She injured her lower back on February 25, 2000, lifting heavy items at work while employed as a Nursing Aide with Tanana Valley Clinic. Her claim was initially accepted as compensable and benefits were paid accordingly.
On April 24, 2000, Dr. Richard Cobden evaluated the employee. He recommended a conservative form of treatment during the six months following her injury, consisting of physical therapy, lumbar traction, ultrasound and soft tissue massage, myofascial release, and soft tissue mobilization techniques. On August 17, 2000, the physical therapist noted that the employee's complaints had improved, and she requested discharge from further physical therapy. She was discharged from physical therapy in the fall of 2000 and released to a home exercise program. Dr. Cobden noted on September 18, 2000, that there had been "no real change" in Adams's back, neck, and sciatica conditions "over the last six or seven years," and that, "she did have a flare-up in February, but it has settled down now." Dr. Cobden concluded that the flare-up was "now back down to its pre-existing status."
The employee was reexamined by Dr. Cobden on January 3, 2001. Dr. Cobden agreed to refer the employee to Dr. Jens Chapman in Seattle, Washington for surgical evaluation. Dr. Chapman evaluated the employee on April 17, 2001. He felt that the employee would benefit from a decompressive surgery together with posterior interbody fusion and posterolateral fusion and instrumentation.
On May 19, 2001, at the request of the employer, Dr. Thad Stanford examined the employee. Dr. Stanford reviewed the 1994 and 2000 MRI films and stated that he did not see a disc herniation. He recommended against surgery, and suggested an exercise program combined with anti-inflammatories. He opined that "the proposed surgery is not reasonable and necessary" and believed that Adams had unrealistic expectations about the surgery.
On May 30, 2001, the employer controverted the employee's claim because of Dr. Stanford's May 19, 2001 report. That resulted in the denial of benefits for an L5-S1 posterior lumbar interbody fusion surgery and related treatment from such surgery.
On June 5, 2001, Dr. Chapman revie
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