Opinion
Record No. 0109-93-1
December 21, 1993
FROM THE VIRGINIA WORKERS' COMPENSATION COMMISSION.
Cecil H. Creasey, Jr. (Sands, Anderson, Marks Miller, on brief), for appellants.
Stephen A. Strickler (McCardell Inman, P.L.C., on brief), for appellee.
Present: Judges Baker, Coleman and Bray.
Argued at Norfolk, Virginia.
Pursuant to Code § 17-116.010 this opinion is not designated for publication.
In this appeal from a decision of the Virginia Workers' Compensation Commission (commission), Weston Truck Lines, Inc. and its insurance carrier, jointly referred to herein as employer, assert that the commission (1) denied employer due process; (2) erred when it held that employer was responsible for medical expenses incurred by John Ewing Pepper (claimant) for treatment not authorized by employer; and (3) erred when it held that claimant's medical condition was causally related to his compensable injury. For the reasons hereinafter stated, we affirm the commission's decision.
On March 26, 1986, in the course of his employment with employer, claimant sustained work-related injuries (leg fractures) for which compensation was awarded.
On April 28, 1992, claimant filed an application for a hearing with the commission requesting payment of medical expenses incurred as a result of his treatment for "venous stasis insufficiency." Claimant alleged that the condition was causally related to his March 26, 1986 compensable injury.
As used in the medical reports, the commission's opinion and here, "venous" pertains to veins, "stasis" refers to the stoppage of the flow of blood in tissue, and "insufficiency" is the inability of a tissue to perform its function adequately.See J.E. Schmidt, Schmidt's Attorneys' Dictionary of Medicine (1965).
After reviewing the evidence, the deputy commissioner found that claimant's request should be granted. The commission approved the deputy's finding, and this appeal emanates from that decision.
We state the facts in the light most favorable to the party who prevailed below. Crisp v. Brown's Tysons Corner Dodge, Inc., 1 Va. App. 503, 504, 339 S.E.2d 916, 916 (1986). In the March 26, 1986 accident, claimant sustained fractures of both legs. Dr. Sidney W. Tiesenga, an orthopedist, became claimant's treating physician. When an ulcer appeared on one of claimant's ankles, Dr. Tiesenga referred claimant to Dr. W.E. Moreland, a dermatologist. Dr. Moreland's Attending Physician's Report filed with the commission diagnosed and treated claimant for an "ankle ulcer" on February 3, 1987.
On June 8, 1992, Dr. Tiesenga acknowledged that the injuries claimant sustained in 1986 "undoubtedly involved some deep vein thrombosis even though this never became significant at the time of his treatment for these fractures."
Thrombosis is the development or presence of a clot that obstructs the flow of blood. It may occur as the result of a contusion. See 3 Roscoe N. Gray, M.D., Gray's Attorneys' Textbook of Medicine, § 91.27 (3d ed. 1965).
In early 1988, claimant was permitted to return to light-duty work. By August 1988, claimant was deemed by the treating physician, Dr. Tiesenga, to have reached maximum improvement and his permanent disability was rated at nineteen percent permanent partial impairment of his right leg. However, claimant's left ankle ulcer failed to respond to treatment and, without prior approval or referral from the treating physician, on October 25, 1988, he sought the services of Dr. David Pariser, a dermatologist. On December 22, 1988, upon a reference from Dr. Pariser, claimant was seen by Dr. Stanley Snyder, a vascular surgeon. In August 1991, Dr. Snyder admitted claimant to a hospital to be treated for venous stasis insufficiency. After various treatments for cellulitis with an infected venous stasis ulceration, claimant's condition improved and he was discharged from the hospital.
In December 1991, Dr. Snyder again admitted claimant to a hospital where he came under the care of Dr. Lynne Clark. Dr. Clark reported that claimant's past history "is significant for bilateral lower extremity fractures 5 years ago which necessitated prolonged immobilization and resulted in venous insufficiency."
On April 22, 1992, Dr. Snyder reported that he strongly suspected that claimant's vascular problems had existed from the time of his work-related injury. On June 8, 1992, Dr. Tiesenga wrote:
The fractures that Mr. Pepper sustained in his on the job injury on the 26th of March 1986 undoubtedly involved some deep vein thrombosis even though this never became clinically significant at the time of his treatment for these fractures.
The deputy commissioner rendered a decision on September 10, 1992, finding that claimant's deep vein thrombosis was causally related to the compensable injury. The employer requested that the commission review the deputy's award, asserting that the treatment for venous stasis insufficiency by Drs. Snyder, Pariser and Clark and the hospital was not authorized, and, hence, employer was not liable for the medical expenses incurred. In addition, employer argued that the medical evidence does not support the diagnosis of deep vein thrombosis or the finding that the venous stasis insufficiency condition suffered by claimant was causally related to a compensable injury. Employer further requested that if it failed in those arguments, a de novo hearing should be granted because until after the deputy's award was made employer was unaware of the June 8, 1992 opinion rendered by the treating physician, Dr. Tiesenga. In its December 30, 1992 opinion, the commission denied the request for a de novo hearing and held the evidence sufficient to support the award.
I. Due Process
In this appeal, employer alleges that it was denied due process because Industrial Commission Rule 17 requires that all relevant medical evidence be filed with the commission with copies provided to the opposing party. In its opinion, the commission found that claimant had mailed a copy of Dr. Tiesenga's June 8, 1992 opinion to the insurance carrier and that even if it had not been received, the employer was on notice of the extent of claimant's claim and could have reviewed the records on file and been advised of all medical evidence in support of claimant's application. Evidence in the record supports the finding that Dr. Tiesenga's opinion was mailed to employer and that is all that is required by Rule 17. Moreover, Dr. Tiesenga was the treating physician known to employer and was the logical person from whom to obtain a second opinion.
II. Unauthorized Treatment
Code § 65.2-603(A) requires that the injured employee select from a panel of three, the physician who will treat him for his or her injuries. Here, that physician was Dr. Tiesenga. The employer is liable only for the treatment rendered by the treating physician and other medical services that physician deems necessary. See Breckenridge v. Marval Poultry Co., 228 Va. 191, 194, 319 S.E.2d 769, 770-71 (1984). Here, Drs. Snyder, Pariser and Clark were not authorized physicians; however, the commission found that under the "other good reasons" clause of Code § 65.2-603(C), claimant was entitled to have employer pay for their services and for the hospital costs and supplies they deemed necessary. Evidence in the record supports that finding.
In early 1988, the treating physician permitted claimant to return to light-duty work and by rating his permanent injury declared that claimant had reached his maximum improvement. In his June 8, 1992 letter, Dr. Tiesenga admitted that a related condition existed but had not been discovered at the time of his treatment. Dr. Snyder diagnosed the cause of claimant's continued complaints which had been left untreated and in an April 22, 1992 report said:
The chronic venous stasis insufficiency at this time and subsequent venous changes are most likely secondary to sequelae of previous deep vein thrombosis.
On June 8, 1992, Dr. Tiesenga wrote:
The fractures that Mr. Pepper sustained in his on the job injury on the 26th of March 1986 undoubtedly involved some deep vein thrombosis even though this never became clinically significant at the time of his treatment for these fractures.
We find that these opinions sufficiently support the commission's finding of "other good reasons" to seek medical treatment that had not been specifically authorized. See Shenandoah Products, Inc. v. Whitlock, 15 Va. App. 207, 212-13, 421 S.E.2d 483, 485-86 (1992).
III. Causal Relationship
Employer does not contest that claimant currently suffers from a venous stasis insufficiency and, apparently, did not seek the opinion of Dr. Tiesenga as to the causal relationship between that condition and the job-related injury. Instead, it sought the opinion of Dr. Herbert W. Park, of Park Concepts, Inc., whose precise credentials are not clearly defined by the record other than he is an "M.D." Dr. Park disagrees with the foregoing recited opinions of Drs. Snyder and Tiesenga, creating a factual matter that has been adversely decided against employer. We are bound by the factual findings of the commission where, as here, credible evidence in the record supports its decision.Fairfax Hospital v. DeLaFleur, 221 Va. 406, 410, 270 S.E.2d 720, 722 (1980) (citations omitted).
For the reasons stated, the decision of the commission is affirmed.
Affirmed.