Ex parte El Reposo Nursing Home Group, Inc. PETITION FOR WRIT OF MANDAMUS (In re: Carole Patterson v. El Reposo Nursing Home Group, Inc.)

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REL: 09/16/2011 Notice: T h i s o p i n i o n i s s u b j e c t t o formal r e v i s i o n b e f o r e p u b l i c a t i o n i n t h e advance s h e e t s o f Southern R e p o r t e r . R e a d e r s a r e r e q u e s t e d t o n o t i f y t h e Reporter of Decisions, Alabama A p p e l l a t e C o u r t s , 300 D e x t e r A v e n u e , M o n t g o m e r y , A l a b a m a 3 6 1 0 4 - 3 7 4 1 ((334) 2 2 9 - 0 6 4 9 ) , o f a n y t y p o g r a p h i c a l o r o t h e r e r r o r s , i n o r d e r t h a t c o r r e c t i o n s may b e made b e f o r e t h e o p i n i o n i s p r i n t e d i n Southern R e p o r t e r . ALABAMA COURT OF CIVIL APPEALS SPECIAL TERM, 2011 2100745 Ex p a r t e E l Reposo Nursing Home Group, Inc. PETITION FOR WRIT OF MANDAMUS (In r e : Carole Patterson v. E l Reposo Nursing Home Group, I n c . ) (Lauderdale C i r c u i t Court, CV-07-205) THOMAS, J u d g e . 2100745 This i s t h e second time that E l Reposo Nursing Home G r o u p , I n c . ( " E l R e p o s o " ) , h a s s o u g h t mandamus r e l i e f f r o m an order o f t h e L a u d e r d a l e C i r c u i t C o u r t r e q u i r i n g E l Reposo t o "immediately Patterson's] assume injury 2006, w o r k - r e l a t e d by E l Reposo. Inc., Civ. payment f o r treatment and p a i n " arising injury Patterson See E x p a r t e App. 2011) . [Carole o u t o f an A p r i l 2 1 , s u s t a i n e d w h i l e employed E l Reposo N u r s i n g [Ms. 2100113, M a r c h 25, 2011] of So. 3d The f a c t s u n d e r l y i n g Home G r o u p , , (Ala. the p e t i t i o n , w h i c h E l Reposo a g r e e s , were s e t o u t i n o u r e a r l i e r with opinion: " I n A p r i l 2006, C a r o l e P a t t e r s o n was e m p l o y e d b y E l Reposo N u r s i n g Home G r o u p , I n c . , a s a c e r t i f i e d n u r s i n g a s s i s t a n t i n a n u r s i n g home r u n b y E l R e p o s o . On A p r i l 2 1 , 2006, P a t t e r s o n was a s s i s t i n g a r e s i d e n t o f t h e n u r s i n g home a n d she f e l l . She r e p o r t e d t h e i n c i d e n t , a n d E l R e p o s o f i l e d an Employer's F i r s t Report o f I n j u r y i n d i c a t i n g t h a t P a t t e r s o n had p u l l e d h e r back a s s i s t i n g a p a t i e n t . P a t t e r s o n was s e n t t o s e e a p h y s i c i a n , who d i a g n o s e d her with an 'upper t h o r a c i c s t r a i n , ' a n d she r e t u r n e d t o work t h e f o l l o w i n g day. P a t t e r s o n l e f t t h e employment o f E l Reposo i n May 2006. " P a t t e r s o n h a d s e e n a p h y s i c i a n i n 2004 a n d h a d u n d e r g o n e an MRI a t t h a t t i m e . The 2004 MRI r e v e a l e d a b u l g i n g d i s k a t C6-7. Patterson had begun seeing her personal p h y s i c i a n , Dr. J e f f Goodman, i n F e b r u a r y 2006, c o m p l a i n i n g o f p a i n i n h e r s h o u l d e r s , n e c k , b a c k , a n d arms. P a t t e r s o n h a d s e e n D r . Goodman on A p r i l 12, 2006, f o r t h o s e same complaints. 2 2100745 " A f t e r h e r a c c i d e n t on A p r i l 21, P a t t e r s o n n e x t saw D r . Goodman on May 31, c o m p l a i n i n g o f t h e same general symptoms i n her neck and shoulders. P a t t e r s o n d i d n o t t e l l D r . Goodman t h a t she had i n j u r e d h e r s e l f a t work on A p r i l 21. In f a c t , a l t h o u g h P a t t e r s o n saw D r . Goodman on A u g u s t 3, October 18, and October 28, 2006, each time c o m p l a i n i n g o f t h e same o r s i m i l a r symptoms t h a t had c o n t i n u e d t o worsen, P a t t e r s o n never mentioned her April 21 w o r k - r e l a t e d a c c i d e n t t o D r . Goodman. P a t t e r s o n f i r s t r e l a t e d h e r symptoms and t h e p a i n she was f e e l i n g t o t h e A p r i l 21, 2006, a c c i d e n t on O c t o b e r 9, 2007, when she s o u g h t pain-management t r e a t m e n t f r o m D r . M i c h a e l Gosney. D r . Goodman t h e n r e f e r r e d P a t t e r s o n t o an o r t h o p e d i c s u r g e o n f o r c o n s u l t a t i o n and p o s s i b l e s u r g e r y . " I n May 2007, P a t t e r s o n f i l e d an a c t i o n a g a i n s t E l Reposo i n w h i c h she s o u g h t w o r k e r s ' c o m p e n s a t i o n benefits. On P a t t e r s o n ' s m o t i o n , t h e t r i a l c o u r t b i f u r c a t e d t h e t r i a l , h o l d i n g a t r i a l on t h e i s s u e o f c o m p e n s a b i l i t y o n l y on May 29, 2009. A f t e r t h a t h e a r i n g , i n June 2009, t h e t r i a l c o u r t e n t e r e d a judgment f i n d i n g P a t t e r s o n ' s i n j u r i e s compensable. In p e r t i n e n t p a r t , t h e c o u r t ' s o r d e r , w h i c h d i d n o t c o n t a i n d e t a i l e d f i n d i n g s o f f a c t s and c o n c l u s i o n s of law, reads: "'On May 29, 2009, t h e c o u r t c o n d u c t e d a t r i a l on t h e i s s u e o f l e g a l and m e d i c a l c a u s a t i o n , which addressed coverage of t h i s c l a i m under the Workers' Compensation A c t . " ' "'The court finds that [Patterson] p r e s e n t e d s u b s t a n t i a l e v i d e n c e t h a t she s u f f e r e d an i n j u r y a r i s i n g o u t o f and i n t h e c o u r s e o f h e r employment as t h e p h r a s e i s d e f i n e d i n t h e Code o f A l a b a m a . The c o u r t t h e r e f o r e f i n d s the t o t a l i t y of the 3 2100745 e v i d e n c e s u b s t a n t i a l enough t o s a t i s f y t h e r e q u i r e d showing of medical c a u s a t i o n . ' "In October 2009, D r . Martin Jones, the physician El Reposo selected as Patterson's a u t h o r i z i n g t r e a t i n g p h y s i c i a n , examined P a t t e r s o n . Dr. J o n e s d e t e r m i n e d t h a t P a t t e r s o n was n o t a candidate f o r c e r v i c a l disk surgery. He s a i d t h a t Patterson would benefit from pain-management treatment but f u r t h e r s t a t e d t h a t such treatment s h o u l d be p a i d f o r by p r i v a t e i n s u r a n c e ' s i n c e she was h a v i n g t h e same symptoms p r i o r t o h e r [ w o r k r e l a t e d ] i n j u r y . ' B a s e d on Dr. J o n e s ' s o p i n i o n t h a t any pain-management t r e a t m e n t was n o t n e c e s s i t a t e d by t h e w o r k - r e l a t e d i n j u r y , E l Reposo r e f u s e d t o a u t h o r i z e pain-management t r e a t m e n t f o r P a t t e r s o n . P a t t e r s o n t h e n f i l e d a m o t i o n s e e k i n g t o have E l Reposo h e l d i n c o n t e m p t and t o o r d e r E l R e p o s o t o p r o v i d e pain-management t r e a t m e n t . "The t r i a l c o u r t d e c l i n e d t o h o l d E l Reposo i n contempt. However, t h e t r i a l c o u r t o r d e r e d t h a t E l Reposo e i t h e r p r o v i d e a n o t h e r o r t h o p e d i c p h y s i c i a n to examine P a t t e r s o n t o d e t e r m i n e t h e n e c e s s i t y o r appropriateness of s u r g i c a l i n t e r v e n t i o n or provide P a t t e r s o n pain-management t r e a t m e n t . E l Reposo offered Patterson an a p p o i n t m e n t w i t h a s e c o n d o r t h o p e d i c p h y s i c i a n , who P a t t e r s o n r e j e c t e d . El Reposo t h e n p r e s e n t e d P a t t e r s o n w i t h a p a n e l o f f o u r orthopedic physicians from which to choose; P a t t e r s o n s e l e c t e d Dr. E. C a r t e r M o r r i s . "Dr. M o r r i s e x a m i n e d P a t t e r s o n on M a r c h 22, 2010. Like Dr. J o n e s , Dr. M o r r i s felt that P a t t e r s o n was n o t a g o o d c a n d i d a t e for cervical surgery. He a l s o s t a t e d t h a t he a g r e e d w i t h D r . Jones that Patterson may need pain-management t r e a t m e n t b u t t h a t any s u c h t r e a t m e n t ' s h o u l d be p a i d f o r by h e r p r i m a r y health insurance.' An excerpt of Dr. Morris's deposition testimony i n d i c a t e s t h a t he d i d n o t t h i n k t h a t t h e p a i n 4 2100745 management t r e a t m e n t s h o u l d be p a i d f o r b y E l Reposo because P a t t e r s o n h a d been 'showing e v i d e n c e o f p a i n before the i n j u r y . ' Dr. M o r r i s a l s o t e s t i f i e d t h a t he d i d n o t t h i n k t h a t P a t t e r s o n ' s symptoms r e l a t e d t o P a t t e r s o n ' s A p r i l 2006 c e r v i c a l s t r a i n o r a n y o f t h e f i n d i n g s on h e r MRI s c a n s . He s t a t e d t h a t he b e l i e v e d t h a t P a t t e r s o n h a d r e a c h e d maximum m e d i c a l i m p r o v e m e n t ('MMI') a n d t h a t , i n h i s p r a c t i c e , he t y p i c a l l y p l a c e d a p e r s o n who s u f f e r e d a c e r v i c a l s t r a i n a t MMI b e t w e e n t h r e e a n d s i x months a f t e r t h e injury. B a s e d on D r . M o r r i s ' s o p i n i o n , E l Reposo a g a i n r e f u s e d t o p r o v i d e pain-management t r e a t m e n t to P a t t e r s o n , prompting h e r t o f i l e another motion t o h o l d E l Reposo i n c o n t e m p t a n d t o s e e k an o r d e r compelling medical treatment. "The t r i a l c o u r t g r a n t e d P a t t e r s o n ' s m o t i o n on S e p t e m b e r 27, 2010, a n d o r d e r e d E l Reposo t o p r o v i d e pain-management t r e a t m e n t t o P a t t e r s o n w i t h i n 10 days. In i t s order, the t r i a l court stated that i t had ' p r e v i o u s l y found t h a t [Patterson] presented s u b s t a n t i a l e v i d e n c e t h a t h e r i n j u r i e s a n d symptoms o f p a i n a r e t h e r e s u l t o f an i n j u r y a r i s i n g o u t o f and i n t h e c o u r s e o f h e r employment on A p r i l 2 1 , 2006.'" Ex p a r t e E l Reposo N u r s i n g Home G r o u p , B a s e d on o u r h o l d i n g i n E x p a r t e 2090734, J a n u a r y 2 1 , 2011] So. 3d 2011), which r e q u i r e d t h a t t h e t r i a l So. 3 d a t Cowabunga, , - . I n c . , [Ms. ( A l a . C i v . App. c o u r t i n t h a t c a s e make d e t a i l e d f i n d i n g s o f f a c t a n d c o n c l u s i o n s o f l a w i n an o r d e r determining review compensability the determination Reposo's first petition so t h a t t h i s c o u r t c o u l d p r o p e r l y on mandamus review, f o r the writ 5 of we d e n i e d E l mandamus and 2100745 instructed the t r i a l addressing the compensability Nursing Home complied, court Group, entering to "enter issue." So. 3 d a t a detailed order an amended Ex p a r t e . on E l Reposo The t r i a l March order court 31, 2011, e x p l a i n i n g i t s d e t e r m i n a t i o n t h a t P a t t e r s o n ' s A p r i l 2 1 , 2006, i n j u r y a n d t h e p a i n r e s u l t i n g f r o m i t were b o t h r e l a t e d t o t h e a c c i d e n t t h a t had occurred e n g a g e d i n h e r work d u t i e s . order on t h a t d a t e while P a t t e r s o n was I n p e r t i n e n t p a r t , t h a t amended reads: "The C o u r t r e c o g n i z e s t h a t Ms. P a t t e r s o n h a s a history o f neck p a i n over t h e course of her employment; h o w e v e r , s h e h a d t r e a t e d w i t h D r . Goodman on A p r i l 12, 2006, i m m e d i a t e l y p r i o r t o t h e a c c i d e n t on A p r i l 2 1 , 2006. D r . Goodman d i d a c e r v i c a l s p i n e s e r i e s w h i c h r e v e a l e d no f r a c t u r e s , d i s l o c a t i o n s , t u m o r s , o r l y t i c l e s i o n s . The C o u r t a l s o f i n d s t h a t a t a l l t i m e s d u r i n g Ms. P a t t e r s o n ' s employment w i t h t h e d e f e n d a n t , E l R e p o s o , up t o t h e a c c i d e n t on A p r i l 2 1 , 2006, Ms. P a t t e r s o n was performing a l l of the duties of her job without restrictions. II "2. ... A t t h e t i m e o f t h e i n j u r y on A p r i l 2 1 , 2006, Ms. Patterson was performing without restriction a l l o f t h e d u t i e s r e q u i r e d by h e r employment a t E l Reposo N u r s i n g Home. The C o u r t f i n d s t h a t a l t h o u g h she was b e i n g t r e a t e d a t t h e t i m e o f t h e A p r i l 2 1 , 2006, a c c i d e n t b y D r . Goodman f o r b i l a t e r a l r o t a t o r c u f f t e n d i n i t i s and a s s o c i a t e d p a i n r a d i a t i n g i n t o t h e n e c k , ... t h e r e was no 6 2100745 e v i d e n c e at t h a t time of a h e r n i a t e d d i s c or s e r i o u s n e c k r e l a t e d i n j u r y . The C o u r t f i n d s Ms. Patterson's t e s t i m o n y o f new and e x c r u c i a t i n g p a i n w h i c h she had n e v e r f e l t b e f o r e d u r i n g t h e i n c i d e n t o f A p r i l 21, 2006, t o be c r e d i b l e , r e l a t e d t o t h e i n c i d e n t o f A p r i l 21, 2006, and c o n s i s t e n t w i t h Dr. Goodman's d e p o s i t i o n t e s t i m o n y t h a t on May 31, 2006, d u r i n g h i s e x a m i n a t i o n , he n o t e d t h a t h e r c o n d i t i o n seemed t o be w o r s e n i n g w i t h sudden movements, t h a t she had p a i n a t n i g h t , t h a t t h e p a i n was throbbing nd and n a t u r e , and t h a t she had numbness and t i n g l i n g , a l l o f w h i c h were new and d i f f e r e n t c o m p l a i n t s f r o m h i s e x a m i n a t i o n p r i o r t o A p r i l 21, 2006. The Court therefore finds the totality of the evidence s u b s t a n t i a l enough t o s a t i s f y t h e r e q u i r e d s h o w i n g of medical c a u s a t i o n . "3. The C o u r t n o t e s t h a t [ P a t t e r s o n ] p r i o r t o t h e o n s e t o f h e r i n j u r y on A p r i l 21, 2006, was a b l e to perform a l l the duties of her occupation, i n c l u d i n g h e a v y l i f t i n g , and t h a t a f t e r t h e s a i d i n c i d e n t , she i s no l o n g e r a b l e t o do s o . The C o u r t f i n d s t h a t t h e h e r n i a t e d d i s c s a t C5-C6 and C6-C7 and t h e r e s u l t i n g p a i n i n h e r n e c k w h i c h r a d i a t e s t o b o t h arms a r e t h e r e s u l t o f t h e a c c i d e n t on A p r i l 21, 2006, and i s a c o m p e n s a b l e i n j u r y u n d e r t h e Workers' Compensation A c t of Alabama." El Reposo a g a i n s e e k s a w r i t o f mandamus d i r e c t i n g t h e trial c o u r t t o v a c a t e i t s S e p t e m b e r 2010 2011 amended provide and order pay insofar as they order require and El f o r pain-management t r e a t m e n t o f injuries. "'"[M]andamus i s a d r a s t i c and e x t r a o r d i n a r y w r i t t h a t w i l l be i s s u e d o n l y when t h e r e i s : (1) 7 i t s March Reposo to Patterson's 2100745 a clear legal right in the p e t i t i o n e r to the order sought; (2) an i m p e r a t i v e d u t y u p o n t h e respondent to perform, a c c o m p a n i e d by a r e f u s a l t o do so; (3) the lack of another a d e q u a t e r e m e d y ; a n d (4) p r o p e r l y invoked jurisdiction of the court." Ex p a r t e H o r t o n , 711 So. 2 d 979, 983 (Ala. 1998).'" Ex parte Builders Insurer's (quoting 821 Fund, Ex 980 parte (Ala. 2003), Inc., 23 So. El So. 2d Alloy overruled 635, 657 writ of that, in argues physicians usurped and the proper medical contends management t r e a t m e n t of in App. So. 2007) 2d 819, parte Ex DBI, support Generally, the the of its however, El court has trial authorized treating decision regarding made a m e d i c a l t o be p r o v i d e d t o P a t t e r s o n . i t i s not to Patterson M o r r i s have b o t h o p i n e d 882 Self- 2009)). i t s orders, treatment that Ltd., arguments role Mississippi g r o u n d s by mandamus. itself management t r e a t m e n t other of (Ala. Civ. Int'l, several the has on 1006 (Ala. for a Ass'n 1003, Wheels makes improperly Reposo Contractors Reposo petition Reposo 3d & required to because Dr. provide El pain- J o n e s and Dr. t h a t P a t t e r s o n does not r e q u i r e p a i n - t o t r e a t any 8 symptoms stemming f r o m her 2100745 work-related medical opinions contends, medical the El trial medical court and i s not order says E l Reposo, facts, free and, treating treatment that physician to of t h e i n j u r e d employee. I n c . , 794 So. 2d 1085, t h a t , as a " g e n e r a l rule," Reposo those that an i t i s the r o l e of Ex the parte ( A l a . 2001) the authorized are necessary. direct See 1088 El to disregard medical i s correct i n arguing authorized Stores, on opinions, t r e a t i n g p h y s i c i a n has n o t found Reposo treatment Those based opinions authorized the injury. medical Wal-Mart (explaining treating physician i s t o d i r e c t t h e t r e a t m e n t o f t h e i n j u r e d e m p l o y e e and t h a t an employer cannot refuse the injured employee treatment recommended b y t h a t p h y s i c i a n ) ; C i t y o f A u b u r n v. Brown, 638 So. the 2d 1339, authorized 1341 ( A l a . C i v . App. treating physician 1993) and not (stating the employer d i c t a t e the i n j u r e d employee's medical treatment). is t o pay also medical correct treatment work-related 1975, that § employer reasonably injury 25-5-77(a) must pay i t i s required (stating, for symptoms. among "reasonably 9 other i s to E l Reposo f o r only necessary to t r e a t and a s s o c i a t e d that that Patterson's See A l a . Code things, necessary that medical an and 2100745 surgical treatment"). whether a Of particular course r e a s o n a b l e , t h e i s s u e may resolution. course, i f a dispute a r i s e s § 25-5-77(a) of medical over treatment be s u b m i t t e d t o t h e t r i a l is court for ( p r o v i d i n g t h a t d i s p u t e s as t o t h e n e c e s s i t y o f m e d i c a l s e r v i c e s r e q u e s t e d a r e t o be determined by t h e c o u r t ) ; see a l s o Ex p a r t e S o u t h e a s t A l a b a m a Med. C t r . , 835 So. 2d 1042, e m p l o y e e has and 1046 n.4 received the second ( A l a . C i v . App. 2002) ("[W]here an recommendations from b o t h the authorized treating physicians in initial accordance w i t h t h e p r o c e d u r e s o u t l i n e d i n § 2 5 - 5 - 7 7 ( a ) , and t h e e m p l o y e e is able to prove that the treatment a u t h o r i z e d p h y s i c i a n s does not f a l l what would be has recommended but that another a treatment in the that first by to treat h i s or of her (unauthorized) p h y s i c i a n does or fall last within parameters, nothing 25-5-77(a), n o r o u r c a s e l a w , p r e v e n t s an e m p l o y e e f r o m sentences p r o c e e d i n g t o seek j u d i c i a l v i n d i c a t i o n of h i s [or her] to the w i t h i n the parameters 'reasonably necessary' i n j u r y or i l l n e s s , recommended such of § then right the l a t t e r t r e a t m e n t . " ) . Based trial on these principles, c o u r t e r r e d by d i r e c t i n g 10 E l Reposo argues that the t h a t E l Reposo p r o v i d e p a i n - 2100745 management t r e a t m e n t Jones and Dr. M o r r i s Patterson's the t r i a l 1 t h a t such treatment work-related injury. court i s attempting authorized medical t o P a t t e r s o n d e s p i t e t h e o p i n i o n s o f Dr. treating treatment. circumstances, Thus, E l Reposo contends, t o override the opinions of the physicians E l Reposo a trial would not r e l a t e t o and to direct admits that, Patterson's i n certain c o u r t may c o n s i d e r w h e t h e r a treatment d e c i s i o n made b y t h e a u t h o r i z e d t r e a t i n g p h y s i c i a n s h o u l d be disregarded; do so o n l y which, h o w e v e r , E l Reposo a r g u e s t h a t a t r i a l after E l Reposo evidence on t h e i s s u e has been a s s e r t s , has n o t o c c u r r e d c o u r t may adduced, i n the present case. A l t h o u g h P a t t e r s o n argues i n h e r response t o E l Reposo's p e t i t i o n t h a t n e i t h e r D r . M o r r i s n o r D r . J o n e s s h o u l d be c o n s i d e r e d h e r a u t h o r i z e d t r e a t i n g p h y s i c i a n b e c a u s e E l Reposo forfeited i t s right t o choose h e r a u t h o r i z e d treating p h y s i c i a n b y r e f u s i n g t o t r e a t h e r i n j u r y u n t i l a f t e r she h a d s u c c e s s f u l l y p r o v e d m e d i c a l c a u s a t i o n a t t r i a l , see F l u o r E n t e r s . , I n c . v . Lawshe, 16 So. 3d 96, 103 ( A l a . C i v . App. 2 0 0 9 ) , i t a p p e a r s t h a t , e v e n i f E l Reposo h a d f o r f e i t e d i t s right to select her authorized t r e a t i n g physician, a decision w h i c h we n e e d n o t make i n t h i s o p i n i o n , P a t t e r s o n p e r m i t t e d E l Reposo t o s e l e c t D r . J o n e s a n d t h e n demanded a p a n e l o f f o u r p h y s i c i a n s f r o m w h i c h she c h o s e D r . M o r r i s . We n e e d n o t r e s o l v e t h e i s s u e , however, and, t h u s , f o r p u r p o s e s o f o u r d i s c u s s i o n h e r e , we w i l l t r e a t D r . J o n e s a n d D r . M o r r i s as authorized treating physicians. 1 11 2100745 P a t t e r s o n argues, were not making a h o w e v e r , t h a t Dr. treatment J o n e s and decision but, c o n c l u d i n g t h a t any pain-management t r e a t m e n t Dr. Morris instead, by would r e l a t e to a p r e e x i s t i n g c o n d i t i o n and n o t t h e w o r k - r e l a t e d i n j u r y , were making a decision regarding symptoms, an issue which medical had causation already been P a t t e r s o n ' s f a v o r by t h e t r i a l court. c o n t e m p t and t o c o m p e l m e d i c a l treatment, to the mandamus p e t i t i o n , amended order indicate compensability of and that Patterson's t h e g r o u n d t h a t she the her pain determined El w h i c h i s an c o u r t ' s March Reposo and exhibit 2011 disputed the associated pain not r e s u l t e d f r o m P a t t e r s o n ' s w o r k - r e l a t e d a c c i d e n t on 21, 2006. t h a t the t r i a l accident o f t h e d e t a i l e d M a r c h 2011 order court determined that Patterson's caused or c o n t r i b u t e d to her injury a preexisting injury. (Ala. 1994) See Ex p a r t e V a l d e z , (explaining that had April reveals work-related and resulting d i s a b i l i t y and t h a t h e r p a i n symptoms a r e n o t a t t r i b u t a b l e 405 on s u f f e r e d f r o m a p r e e x i s t i n g c o n d i t i o n and t h e r e f o r e t h a t any p a i n o r o t h e r symptoms she e x p e r i e n c e d A review in Patterson's motion f o r trial injury of 636 employment So. 2d must to 401, be a c o n t r i b u t i n g c a u s e b u t i s n o t r e q u i r e d t o be t h e s o l e c a u s e o f 12 2100745 an injury i n order f o r an injury t o be compensable). After r e s o l v i n g the i s s u e of c o m p e n s a b i l i t y , the t r i a l c o u r t f u r t h e r d e t e r m i n e d t h a t E l Reposo was to Patterson to associated pain The whether opined and treat her April opinions of her 2006, injury J o n e s and April continued 21, Dr. symptoms o b j e c t s to c h a r a c t e r i z i n g the did opinions not insists work-related are authorized entrusted treating specifically condition," s h o u l d be J o n e s and by t h o s e stated the injury, not to which the physician. that evidence provided Although Patterson in the 13 to E l judgments to Patterson court Dr. physicians According judgments trial from E l Reposo R e p o s o , b o t h p h y s i c i a n s were m a k i n g p u r e l y m e d i c a l r e g a r d i n g what t r e a t m e n t resolved result court. a preexisting condition. both compensability o f Dr. M o r r i s as b e i n g b a s e d on a d e t e r m i n a t i o n t h a t P a t t e r s o n had is this: 2006, i n j u r y had d e t e r m i n a t i o n p r e v i o u s l y made by t h e t r i a l her its M o r r i s , who P a t t e r s o n ' s w o r k - r e l a t e d i n j u r y , undermine the treat and by E l R e p o s o ' s p e t i t i o n Dr. that Patterson's that 21, care symptoms. question presented the required to provide medical El but to Reposo to the neither physician had materials a "preexisting attached to El 2100745 Reposo's conclude petition and Patterson's response t h a t Dr. Jones and Dr. M o r r i s b o t h leads us determined to that P a t t e r s o n ' s c o m p l a i n t s o f p a i n were n o t t r a c e a b l e t o h e r workrelated injury, a determination medical determination, causation issue, the that, although i s also at the heart certainly a of the medical- r e s o l u t i o n of which i s e n t r u s t e d not t o an a u t h o r i z e d t r e a t i n g p h y s i c i a n b u t t o t h e t r i a l court. t h i s case, the t r i a l c o u r t had a l r e a d y determined, i n the face o f t h e argument t h a t P a t t e r s o n ' s any resulting condition, in disability that the A p r i l some way t o P a t t e r s o n ' s injury, resulted pain from symptoms, a In and preexisting 2 1 , 2006, a c c i d e n t h a d c o n t r i b u t e d i n j u r y and t h a t h e r c o m p l a i n t s o f p a i n were t h e r e s u l t o f t h a t i n j u r y a n d n o t o f a p r e e x i s t i n g condition; i n o t h e r words, t h e t r i a l medical-causation c o u r t had r e s o l v e d the issue i n Patterson's favor. 2 We f a i l t o s e e how t h e o p i n i o n s o f D r . J o n e s a n d D r . M o r r i s , w h i c h directly conflict of with compensability the trial court's issue i n Patterson's resolution favor, serve the to prevent The t r i a l c o u r t a l s o d e t e r m i n e d t h a t P a t t e r s o n had p r o v e d l e g a l c a u s a t i o n , o f c o u r s e , b u t t h e i s s u e s p r e s e n t e d by t h i s mandamus p e t i t i o n do n o t i n v o l v e q u e s t i o n s r e l a t e d t o t h a t conclusion. 2 14 2100745 the inescapable causation conclusion determination that the trial forecloses court's mandamus medical- relief to El Reposo. As order, i s abundantly c l e a r from the t r i a l the argument trial that preexisting court the had pain Patterson condition and Patterson's work-related o f w h i c h she the complains; medical-causation medical suffers is determined El Reposo's related t h a t i s , the t r i a l issue instead c o u r t had i n Patterson's by Dr. opinion that Patterson's injury, El treatment for Patterson's concluded that medical conclusion causation, a that resolved favor J o n e s and before t h e n Dr. the Reposo pain i s not has the because causation exists. that trial pain El Morris. court properly the to trial to B a s e d on t h e established ordered El has trial medical Reposo c a r e s h o u l d i n c l u d e pain-management t r e a t m e n t care to P a t t e r s o n . to This because M o r r i s b e l i e v e t h a t such treatment 15 her provide court medical Dr. medical duty reasonably J o n e s and necessary Patterson related provide b o t h Dr. to o f w h e t h e r Dr. J o n e s and Dr. M o r r i s have f o r m e d t h e work-related court's had rejected 2011 i n j u r y r e s u l t e d i n t h e p a i n symptoms Reposo a u t h o r i z e d t r e a t m e n t Regardless already c o u r t ' s March is 2100745 w a r r a n t e d ; t h e i r f u r t h e r b e l i e f t h a t such treatment be c o n s i d e r e d should not t h e r e s p o n s i b i l i t y o f E l Reposo i s i r r e l e v a n t . We t h e r e f o r e deny E l R e p o s o ' s p e t i t i o n f o r a w r i t o f mandamus because i t cannot e s t a b l i s h a c l e a r l e g a l r i g h t t o the r e l i e f it seeks. 3 PETITION DENIED. Thompson, P . J . , c o n c u r s . Pittman, Bryan, a n d Moore, J J . , concur i n the r e s u l t , without w r i t i n g s . El Reposo a r g u e s v e h e m e n t l y t h a t a d e n i a l o f t h i s p e t i t i o n f o r a w r i t o f mandamus w i l l r e s u l t i n a g r a n t o f p e r m i s s i o n t o " e v e r y t r i a l j u d g e i n A l a b a m a ... t o o r d e r a r e f e r r a l t o a p a i n management p h y s i c i a n i n e v e r y c a s e where an i n j u r e d worker e x p e r i e n c e d p a i n as a r e s u l t o f a w o r k - r e l a t e d a c c i d e n t e v e n when t h e a u t h o r i z e d t r e a t i n g p h y s i c i a n does n o t t h i n k t h a t such treatment i s n e c e s s a r y t o t r e a t t h e work injury." Petition at (emphasis i n o r i g i n a l ) . We disagree. By d e n y i n g t h i s p e t i t i o n f o r a w r i t o f mandamus, this court i s not allowing the t r i a l court to direct Patterson's medical treatment. I n s t e a d , we a r e r e f u s i n g t o p e r m i t E l Reposo t o r e l y on a m e d i c a l o p i n i o n t h a t d i r e c t l y conflicts with the trial court's medical-causation d e t e r m i n a t i o n t o escape i t s o b l i g a t i o n t o p r o v i d e P a t t e r s o n medical treatment. 3 16

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