Miller County v. John David Stewart

NOT DESIGNATED FOR PUBLICATION ARKANSAS COURT OF APPEALS

ANDREE LAYTON ROAF, Judge

DIVISION IV

MILLER COUNTY

APPELLANT

v.

JOHN DAVID STEWART

APPELLEE

CA00-612

MARCH 7, 2001

APPEAL FROM THE ARKANSAS WORKERS' COMPENSATION COMMISSION E813005

AFFIRMED

Miller County appeals from an order of the Workers' Compensation Commission finding that surgery was reasonable and necessary medical treatment for appellee John David Stewart's compensable back injury and awarding Stewart temporary-total disability (TTD) benefits from October 13, 1998, to a time yet to be determined. On appeal, it argues that the Commission's finding that the back surgery was reasonable and necessary medical treatment was not supported by substantial evidence and consequently, the back surgery, which it did not authorize, constituted an independent-intervening cause so as to relieve it of any liability for temporary-total disability from the date of the surgery forward. We affirm.

Stewart worked as a heavy equipment operator for Miller County and was operating a sweeper machine on October 13, 1998, when he was rear-ended. Stewart was injured in the accident, aggravating a pre-existing lower-back condition. Miller County accepted the injury as compensable, and paid benefits to Stewart including TTD and medical treatment by Dr. Freddie Contreras. Ultimately, Stewart underwent surgery to alleviate his condition, but Miller County denied that the surgery was reasonable and necessary and cut off TTD payments, asserting that the unauthorized surgery was an independent intervening cause for which it owed no temporary-total disability benefits were owed.

At an August 19, 1999, hearing before an administrative law judge (ALJ), Stewart testified that he had back problems prior to being involved in the October 13, 1998, accident; however, he claimed that on the day of the accident he was "functioning normally" and able to do his job. When the road sweeper that he was driving was hit in the rear by another motorist, he was knocked over the controls onto the machine's core, the part that sweeps the roads. According to Stewart, he reached up from the core to turn the machine off and fell onto the core and then onto the ground. He tried to stand up, but was unable to because his right leg "would not work." A passerby, Gary McAdams, assisted Stewart off the highway, and he was transported by ambulance to Wadley Regional Medical Center. Stewart claimed that prior to the accident he was able to run heavy equipment eight hours a day, forty hoursa week, do yard work, hunt, fish, and make love to his wife, but that after the accident he could "hardly" walk on his right leg. He claimed that any movement or riding in a car for more than thirty minutes caused him pain. Furthermore, he claimed that prior to the accident he had no hip or leg pain, and that his pain was confined to his back. He also stated that Dr. Contreras did not recommend surgery prior to the accident, but that he did recommend and perform surgery after the accident. According to Stewart, he "had to have surgery to live [his] life." He claimed that the surgery relieved his leg pain and allowed him to be able to mow his yard "a little bit here and there."

On cross-examination, Stewart admitted that he had been treated by Dr. Contreras for his pre-existing back condition beginning in February 1998, that he had received six epidural steroid injections, was using a TENS unit, had been placed on light duty restrictions, and that an August 1998 MRI revealed that he had degenerative-disk disease. It was also demonstrated that in a deposition taken on April 20, 1999, Stewart had stated that he believed that after the surgery, he had only improved "slightly" and that he still had lower back pain.

Gary McAdams testified that he arrived at the accident shortly after it happened and observed Stewart lying on the pavement. According to McAdams, Stewart tried to get up, but fell back down. McAdams stated that he and his son, Randy McAdams, helped Stewart to the side of the road. Randy McAdams confirmed that when he and his father arrived on the scene, they observed Stewart trying unsuccessfully to raise himself off the pavement.

Dr. Contreras, a neurosurgeon, testified that he began treating Stewart for backproblems in February of 1998. Dr. Contreras stated that although Stewart initially complained of lower back pain and pain between his shoulder blades, his neurological exam did not reveal any abnormalities. An MRI indicated a small disk rupture at L5-S1; however, a subsequent mylogram did not confirm this problem. Stewart underwent a series of injections to manage the pain, which, according to Dr. Contreras, provided some relief between February and August of 1998. However, in August of 1998, Stewart presented complaining of increasing back pain, similar to the pain he first complained of in February of 1998, but also some pain in his right hip and right leg. Stewart underwent an MRI, a mylogram, and a CAT scan. Dr. Contreras stated that based on these tests, he concluded that Stewart had a bulging disk, not a rupture, and the pain could be managed without surgery, although he expected "flare ups." Dr. Contreras stated that he first saw Stewart for treatment after the accident on November 5, 1998. At that time, Stewart told him that he had been doing "fairly well," but since the accident he was suffering from low back, right hip, and right leg pain. According to Dr. Contreras, his examination of Stewart produced different results, a positive straight leg raising test on his right leg and a loss of right-ankle reflex, which Dr. Contreras stated was a "neurological deficit." Dr. Contreras stated that loss of "ankle jerk" is specific to the S1 nerve root, which would get "pinched"by a disk rupture at L5-S1. An MRI performed subsequent to the accident indicated that Stewart was now a surgical candidate. Stewart underwent a spinal laminectomy, and in the course of the operation, Dr. Contreras stated that he was able to visually identify a right paracentral disk rupture. Dr. Contreras stated that he had diagnosed Stewart with only a disk bulge prior tothe accident, which he could "get over" without surgery, but Stewart had developed a disk rupture that was "temporally" related to the accident, and that made him a surgical candidate. Dr. Contreras specifically opined that Stewart's disk rupture was caused by the accident. On cross-examination, Dr. Contreras noted that an MRI in August of 1998 was read by Dr. William R. Brown to indicate that there was a small annular tear in the L5-S1 disk. He conceded that "all the radiological studies and MRIs that were performed on Appellee prior to the accident provide evidence that the condition for which surgery was performed was in existence prior to the accident,"and that he based his decision on whether to recommend surgery on Stewart's complaint that his pain had gotten "really severe again." However, he did not change his opinion that the accident caused the disk rupture.

The medical exhibits included Dr. Brown's dictation concerning the August 1998 MRI, which stated that the exam was consistent with an annular tear. Also included were the emergency room notes of October 13, 1998, from Wadley Regional Medical Center, which stated that Stewart's "reflexes are equal" and listed his diagnosis as an acute lumbar muscle strain and chronic back pain. Also included were reviews of the medical records and MRIs of August and October 1998 that Miller County had obtained from Dr. Anthony Russell and Dr. Jim J. Moore, who both opined that there was not a significant change in the disk and that Stewart was not a surgical candidate.

On review, Miller County argues that there is no substantial evidence to support the Commission's finding that all medical treatment directed by Dr. Contreras, including Stewart's surgery, was reasonably necessary in relation to the October 13, 1998,compensable injury. It asserts that the surgery was not "causally related" to the compensable injury and that it was "just as likely" related to Stewart's preexisting degenerative-disk disease. Miller County contends that Stewart's "objective findings" after the accident were "essentially the same" as before the mishap and that no "new objective findings" existed after the accident. Miller County urges this court to find dispositive the opinion of Dr. Anthony Russell that the accident did not cause a "significant change" in Stewart's "overall condition," an opinion that Dr. Jim Moore agreed with. It also argues that Stewart's subjective complaints of pain had "identical counterparts" prior to the accident and that "lack of benefit" realized by the surgery "refutes" the Commission's finding that it was reasonably necessary. Miller County further argues that there is no substantial evidence to support the Commission's finding that Stewart established his entitlement to benefits from October 13, 1998, to a date to be determined because there was no proof that he was within a healing period caused by the compensable injury or that he was totally unable to work after that date. It contends that Stewart "merely sustained a minor back strain" in the accident, for which he was treated and released the same day. Miller County asserts that the Commission "erroneously gave greater weight" to Stewart's subjective complaints of pain after the accident than it did the objective findings which it claims indicated no change in his condition. Furthermore, Miller County argues that the surgery itself constituted a "noncompensable independent-intervening cause" which resulted in Stewart's disability and need for treatment. We disagree.

When reviewing a decision of the Workers' Compensation Commission, we view theevidence and all reasonable inferences deducible therefrom in the light most favorable to the findings of the Commission and affirm that decision if it is supported by substantial evidence. Green Bay Packaging v. Bartlett, 67 Ark. App. 332, 999 S.W.2d 695 (1999). The issue is not whether we might have reached a different result or whether the evidence would have supported a contrary finding; if reasonable minds could reach the Commission's conclusion, we must affirm its decision. Id. What constitutes reasonable and necessary medical treatment is a fact question for the Commission. Gansky v. Hi-Tech Engineering, 325 Ark. 163, 924 S.W.2d 790 (1996).

While it is true that there are conflicting medical opinions in this case, there is the clear testimony from Dr. Contreras, the treating physician, that surgery was necessary to treat Stewart's compensable back injury. This testimony constitutes substantial evidence. The Commission has the duty of weighing medical evidence and, if the evidence is conflicting, its resolution is a question of fact for the Commission. Whaley v. Hardee's, 51 Ark. App. 166, 912 S.W.2d 14 (1995). Under our standard of review, we must decline Miller County's invitation to somehow determine that the opinions of the other doctors that it had hired were more persuasive.

Regarding Miller County's second argument, concerning Stewart's entitlement to TTD, it is, for the most part, disposed of by our holding that substantial evidence supports the Commission's finding that Stewart's back surgery was reasonable and necessary. Because the surgery was reasonable and necessary, it is not an independent-intervening cause. The balance of Miller County's argument, that the Commission "erroneously gavegreater weight" to Stewart's subjective complaints of pain after the accident than it did the objective findings that it claims indicated no change in his condition, is not cognizable under our standard of review. It is axiomatic that when we review an opinion of the Workers' Compensation Commission, we do not weigh the evidence.

Affirmed.

Robbins and Bird, JJ., agree.