Opinion
No. 4-780 / 04-0410
Filed January 26, 2005
Appeal from the Iowa District Court for Polk County, Michael D. Huppert, Judge.
Donald Cline appeals the district court's ruling on his petition for further review. REVERSED.
Timothy Semelroth of Riccolo Baker, P.C, Cedar Rapids, for appellant.
Harry W. Dahl, Des Moines, for appellees.
Considered by Vogel, P.J., and Miller and Eisenhauer, JJ.
Donald Cline appeals the decision of the district court reversing the decision of the Worker's Compensation Commissioner ("Commissioner") and remanding it for either clarification of prior findings or additional findings. The court's decision modified the reimbursement to be received by Donald's wife, Donna, for services she provided Donald following a work-related injury. Because we agree with Donald that the Commissioner's decision is supported by substantial evidence, we reverse the district court.
I. Background Facts and Proceedings
On April 26, 1995, Donald sustained a catastrophic spinal cord injury while in the employ of BTR Dunlop, Inc. ("Dunlop") that has left him essentially a quadriplegic . On April 20, 1996, Donald returned home from the hospital and has been cared for in his home by Donna and an assortment of nurses and nurse's aids. Donna is a licensed certified nursing assistant ("C.N.A."), having first been licensed in Illinois in the late 1980's and then in Iowa following her husband's accident. In addition to the training Donna received to become a C.N.A., she also received some training on how to provide for her husband's specific needs.
Donald's treating neurologist, Anil Dhuna, M.D., describes Donald as having quadriparesis and that he is paraplegic. This distinction appears to be based on the fact that he does have limited use of his hands.
In March of 2000 Donald filed a petition for workers' compensation benefits asking that Donna be compensated for the services that she has provided him at home since his injury. Following a hearing, a Deputy Workers' Compensation Commissioner issued an Arbitration Decision concluding that Donna's services were compensable "nursing services" and that Dunlop should pay for Donna's services on the basis of three hours per day (on days where Donald was on bed rest) and 4.5 hours per day (on days where Donald is not on bed rest) at an hourly rate of $18.00 per hour. This decision was appealed to the Commissioner who affirmed and adopted the Arbitration Decision with some additional analysis.
Dunlop filed a petition for judicial review with the district court. On February 27, 2004, the district court found:
it is clear that some but not all of Donna Cline's activities would qualify as compensable `nursing services.' This is due to the nature of the services provided; those that cannot reasonably be distinguished from typical household chores or routine attendance are not compensable . . . to the degree the commissioner based his award of nursing services on these disallowed activities, his decision was contrary to existing law and should be reversed. As to the allowed activities, the commissioner did not break out the time spent on each individual task. As a result, this case will need to be remanded to the agency for determination of the time spent on the allowed activities.
The district court also reversed the agency's valuation of Donna's services and ordered that the agency determine the compensation rate based upon what is paid to persons in the locality for the services provided. Donald appeals.
II. Scope of Review
Under Iowa Code chapter 17A (2001), our review is for correction of errors at law, not de novo. Wal-Mart Stores, Inc. v. Caselman, 657 N.W.2d 493, 498 (Iowa 2003). The district court was bound, and we are bound, by the agency's factual findings if they are supported by substantial evidence. IBP, Inc. v. Harpole, 621 N.W.2d 410, 414 (Iowa 2001). The ultimate determination is not whether the evidence supports a different finding, but whether it supports the finding the commissioner actually made. Murillo v. Blackhawk Foundry, 571 N.W.2d 16, 17 (Iowa 1997).
III. Issues
A. Reasonable Nursing Services
The district court's decision is based on its determination that certain activities performed by Donna were not compensable under Iowa Code section 85.27 (1999) as "reasonable nursing services" so that the agency approved compensation for more hours of activities than permissible. This presents us with the following two issues. First, whether Donald's claimed expenses for home nursing services are compensable under Iowa Code section 85.27. This is a question of fact, so that the agency's finding on this matter is binding upon us if supported by substantial evidence. See Quaker Oats Co. v. Ciha, 552 N.W.2d 143, 154 (Iowa 1996) (noting that the commissioner's finding that expenses were reasonable under Iowa Code section 85.27 "must be affirmed if supported by substantial evidence."). Second, whether substantial evidence supports the agency's determination that Donna should be compensated for three to 4.5 hours of "reasonable nursing services" per day.
Iowa Code section 85.27 provides in pertinent part that "[t]he employer, for all injuries compensable under this chapter or chapter 85A, shall furnish reasonable surgical, medical, dental, osteopathic, chiropractic, podiatric, physical rehabilitation, nursing, ambulance and hospital services . . ." (emphasis added). In Henry v. Iowa-Illinois Gas Electric Co., 522 N.W.2d 301, 303 (Iowa 1994) our supreme court stated "we believe `nursing' denotes professional services `grouped with the services of physicians and surgeons and not with the services of cooks, chambermaids, etc, employed in purely ministerial and administrative functions." In Henry, the court based its holding that the services at issue were not compensable "nursing services" on the fact that they were "almost entirely household chores" that did not "require medical training or licensure" and that "neither person who provided the services was a registered nurse or licensed practical nurse." Henry, 522 N.W.2d at 303. The court in Henry further noted there was "no medical testimony or other medical evidence . . . [indicating] that [the injured worker] required `nursing' services." Id.
An unrebutted letter from Donald's treating neurologist, Dr. Dhuna, lists the tasks Donna performs. Those tasks include, helping him transfer from bed to chair, dressing, putting on his hose, assistance with putting on his utensil strap, assistance with feeding, dental care, changing his urine bag, administering his medications, cutting up his food, checking for choking, getting him into bed, changing his hose, dressing his catheter, tending to a bowel regimen, repositioning him two to three times per night, and giving him a sponge bath three to four times per week. Dr. Dhuna also states that Donna's certified nurse's aid status is the appropriate level of training for the level of care she provides for Donald. Dr. Dhuna concludes the letter by stating that "[t]hese are in my opinion the cares that Donald Cline requires as a result of his injuries. They need to be performed by a certified nurses aide particularly administering medications, dressing the superpubic [sic] catheter, and changing his urine bag." Thus, unlike the services provided in Henry, medical evidence demonstrates that most of the services provided to Donald by Donna were medically necessary, were not "household chores," required medical training, and were provided by a person with "medical training or licensure." Therefore, substantial evidence supports the Commissioner's conclusion that most of the services provided by Donna were compensable as "reasonable nursing services."
This conclusion disposes of Dunlop's argument in its cross-appeal that none of the services offered by Donna were "nursing services."
Moreover, the agency did not order compensation for all activities Donna listed to the agency. For instance, Donna requested compensation for up to 4.25 hours of services on days where Donald was confined to bed rest and for 5.5 hours on days where was not confined to bed rest. In ordering a lesser amount, the Commissioner noted,
[c]ertainly, the defendants are not required to pay claimant's spouse for activities that she would have been performing even if the injury had not occurred. These might include activities such as housecleaning, preparing meals, laundry and the like. They are not required to pay for activities claimant can do for himself without supervision. . . . The services ordered to be compensated are established by Dr. Duhna to be medically necessary and appropriately performed by a person certified as a nurse's aide.
Therefore, while a more detailed agency opinion may have aided judicial review, it is clear that the agency did exclude from compensation those activities not qualifying as "reasonable nursing services."
Accordingly, we hold that even though the services compensated for as "nursing services" were not itemized out by the agency, a reasonable mind would consider the medical evidence of Dr. Duhna adequate to reach the Commissioner's conclusion that Donna should be compensated for three hours of "reasonable nursing services" on days where Donald is at bed rest, and 4.5 hours when he is not. Therefore, the record, when read as a whole, provides substantial evidence that Donna provided the amount of "reasonable nursing services" compensated for by the final agency decision. Because the agency decision is supported by substantial evidence we must reverse the district court on this issue
B. Value of Services
Having determined that the claimed expenses are reasonable nursing expenses under Iowa Code section 85.27, we must now determine whether the valuation of these home nursing services is reasonable. This determination is again a question of fact so that the agency's finding in this regard must be affirmed if supported by substantial evidence. Ciha, 552 N.W.2d at 156; see also Allen v. Allen Water Wastewater Eng'g, 549 N.W.2d 516, 518 (Iowa 1996).
Donald bears the burden of proof regarding the rate of compensation for the nursing services provided by Donna. See Ciha, 552 N.W.2d at 156. In attempting to satisfy this burden, Donald offered into evidence a 2001 survey, conducted by Patricia McCollom, a registered nurse, of the current charges of over eighteen area providers of certified nurse aid services. Determining the rate of compensation for home nursing services using the local value of the service provided, and not the amount of the wage paid to a certified nurse aid, is the valuation method endorsed by our supreme court in Ciha. See id. (determining that the claimant carried his burden of establishing a reasonable compensation rate for the home nursing services provided by his wife, who was not a nurse, by presenting evidence obtained from "home nursing services in the area as to what would be charged if the same services were performed by a nurse."). Nurse McCollom's survey indicates that registered nurse services in the area are valued between $17.50 to $19.00 per hour. This evidence is more than adequate to allow a reasonable mind to reach the Commissioner's conclusion that the reasonable value of the services provided by Donna is $18.00 per hour. Consequently, the final agency decision is supported by substantial evidence and is reinstated.