Lynchburg City Schools v. Snowie A.E. Dalton ( 1996 )

COURT OF APPEALS OF VIRGINIA
Present: Judges Benton, Coleman and Willis
LYNCHBURG CITY SCHOOLS
AND
TRIGON ADMINISTRATORS MEMORANDUM OPINION *
PER CURIAM
v. Record No. 2498-95-3 APRIL 23, 1996
SNOWIE A. E. DALTON
FROM THE VIRGINIA WORKERS'
COMPENSATION COMMISSION
(Gregory P. Cochran; Caskie & Frost, on
brief), for appellants.
(Sherwood S. Day; Day & Current, on brief),
for appellee.
Lynchburg City Schools and its insurer (hereinafter
collectively referred to as "employer") contend that the Workers'
Compensation Commission erred in holding employer responsible for
the cost of medical treatment rendered to Snowie A. E. Dalton by
Dr. Verna Lewis. Specifically, employer argues that the
commission erred in finding that Dalton had "good reason" for
seeking medical treatment from Dr. Lewis. Upon reviewing the
record and the briefs of the parties, we conclude that this
appeal is without merit. Accordingly, we summarily affirm the
commission's decision. Rule 5A:27.
On June 10, 1993, Dalton, a cafeteria worker, injured her
neck in the course of her employment. Employer accepted Dalton's
*
Pursuant to Code § 17-116.010 this opinion is not
designated for publication.
claim as compensable and the commission entered an award.
Dalton initially came under the care of Dr. Edward Stoll, a
general practitioner. Dr. Stoll treated Dalton conservatively,
and, upon his retirement, referred her to Dr. William Sullivan.
On July 2, 1993, Dalton began treating with Dr. Sullivan, who
diagnosed a cervical thoracic strain and treated Dalton
conservatively. On October 4, 1993, Dr. Sullivan released Dalton
to return to her regular work. However, due to Dalton's
persistent complaints of neck pain, Dr. Sullivan referred her to
Dr. Joseph H. Wombwell, an orthopedist.
On October 14, 1993, Dr. Wombwell noted "some definite
psychological factors," referred Dalton to a psychologist, and
Dr. Wombwell released her to return to work. When Dr. Wombwell
saw Dalton again on December 10, 1993, he offered her no specific
treatment and told her to return on an as-needed basis. On May
13, 1994, Dr. Wombwell found minimal narrowing at the C5-6 level.
He advised Dalton to do neck exercises, to return to work, and
to return to him if her pain worsened.
On September 27, 1994, Dalton sought medical treatment from
Dr. Lewis. Dalton took this action on the advice of her
attorney, because her symptoms had continued without relief and
without a known cause. Dr. Lewis ordered an MRI, which revealed
"moderate diffuse disc bulge . . . at C5-6 level causing moderate
anterior impression upon the thecal sac." Dr. Lewis prescribed
medication and ordered physical therapy.
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The full commission affirmed the deputy commissioner's
finding that Dalton had "good reason" to seek medical care from
Dr. Lewis. In so holding, the commission made the following
findings:
"[Dalton] complained of unremitting neck
pain" to her authorized physicians. These
doctors essentially concluded that [Dalton]
had a resolved soft tissue injury and her
remaining complaints were based on
"psychological" factors and "secondary gain."
The Deputy Commissioner concluded that
"[Dalton] understandably sought treatment
elsewhere" and "fortuitously underwent
cervical MRI scanning" by Dr. Lewis, who
detected a disc defect. Although Dr. Lewis
is not treating [Dalton] surgically at this
point, this avenue is now open to [Dalton] if
symptoms continue unabated.
Factual findings made by the commission will be upheld on appeal
if supported by credible evidence. James v. Capitol Steel
Constr. Co., 8 Va. App. 512, 515, 382 S.E.2d 487, 488 (1989).
"Without a referral from an authorized treating physician,
Code § 65.2-603(C) provides for treatment by an unauthorized
physician in an 'emergency' or 'for other good reason.'"
Shenandoah Products, Inc. v. Whitlock, 15 Va. App. 207, 212, 421
S.E.2d 483, 485 (1992).
[I]f the employee, without authorization but
in good faith, obtains medical treatment
different from that provided by the employer,
and it is determined that the treatment
provided by the employer was inadequate
treatment for the employee's condition and
the unauthorized treatment received by the
claimant was medically reasonable and
necessary treatment, the employer should be
responsible, notwithstanding the lack of
prior approval by the employer.
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Id. at 212, 421 S.E 2d at 486.
Dalton's testimony and the medical records provide ample
credible evidence to support the commission's factual findings.
These findings support the commission's conclusion that Dalton
acted in good faith when she sought treatment from Dr. Lewis,
that the treatment provided by Dalton's authorized physicians was
inadequate to diagnosis her condition, and that Dr. Lewis'
treatment was medically reasonable and necessary. Despite
Dalton's continuing cervical pain, none of her authorized
physicians determined the cause of her condition or offered her
the option of undergoing imaging studies.
We find that the commission did not err in holding employer
responsible for the cost of Dr. Lewis' treatment. Therefore, we
affirm the commission's decision.
Affirmed.
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