Opinion
No. 2-254 / 01-1394
Filed October 16, 2002
Appeal from the Iowa District Court for Polk County, Gary G. Kimes, Judge.
The employer and its workers' compensation insurance carrier, appeal the decision of the district court on judicial review affirming the decision of the deputy workers' compensation commissioner to authorize alternate care for the claimant. AFFIRMED.
Charles E. Cutler and Ryan M. Clark of Patterson, Lorentzen, Duffield. Timmons, Irish, Becker Ordway, L.L.P., Des Moines, for appellant.
Martin Ozga of Max Schott Associates, Des Moines, for appellee.
Heard by Sackett, C.J., and Vogel and Mahan, JJ.
The employer, R.R. Donnelley and Sons, and its workers' compensation insurance carrier, Gallagher Basset Services, (defendants) appeal the decision of the district court on judicial review affirming the decision of the deputy workers' compensation commissioner to authorize alternate care for the claimant, Erma Younger.
I. Background facts and proceedings
On or about June 25, 1998 claimant, Younger, suffered an injury to her right foot when a forklift ran over it in the course of her employment with R.R. Donnelley Sons. As a result of the work injury, Younger was offered medical care with Dr. Kessler, who performed surgery on September 10, 1999. Younger continued to experience pain after the surgery and was referred by Dr. Kessler to Dr. Bahls, for treatment of the pain. The limited treatment was not successful and Dr. Kessler, the authorized treating physician, referred Younger to Dr. Iqbal in March 2000. Dr. Iqbal diagnosed chronic regional pain syndrome category one, secondary to the foot injury. Dr. Iqbal recommended several courses of treatment. The initial options did not work, so Dr. Iqbal recommended that Younger try a sympathetic nerve block, utilizing a series of injections, and if that did not work that she try a spinal cord stimulator. If the stimulator worked then Dr. Iqbal recommended that it be permanently implanted. At that point defendants denied authorization for continued treatment by Dr. Iqbal, claiming the treatment was not solely for pain from her injured foot. Younger received no treatment of her foot between March 24 and August 8, when she returned to Dr. Kessler for a functional impairment rating at the request of the defendants. The report was issued in November, with a specific referral to Dr. Iqbal for continued treatment. Claimant was examined by Dr. Iqbal again, who reiterated his diagnosis and treatment plan, and again defendants denied authorization for treatment. On or about October 20, 2000 claimant expressed dissatisfaction with the denial of continuing medical care. She requested continuing medical care as recommended by Dr. Iqbal. On February 14, 2001, Younger again expressed her dissatisfaction with the lack of medical treatment. On February 16, the defendants again refused to provide the care requested by Younger. The defendants offered an evaluation by a physician in Omaha. Younger declined the offer on March 14. On March 20, she filed her application for alternative medical care. Defendants offered an evaluation by Dr. Marsh, orthopedic surgeon at the University of Iowa Hospitals and Clinics in Iowa City.
Deputy Workers' Compensation Commissioner Devon M. Lewis was assigned to the case and, on March 30, he issued a decision granting the alternate medical care Younger sought. This decision was based on the expert opinion of Drs. Kessler and Iqbal. In his ruling the deputy commissioner found the "treatment offered by Gallagher Bassett was not reasonably suited to treat [Younger's] injury without undue inconvenience." Deputy Commissioner Lewis concluded that, because Dr. Kessler was the authorized treating physician and he had made multiple specific referrals to Dr. Iqbal, petitioners could not interfere with the doctor's medical judgment.
On April 24, the defendants filed a petition for judicial review of the deputy commissioner's decision. They sought a reversal of the decision of the deputy commissioner, arguing Younger did not meet her burden of proof in establishing the requested treatments were reasonable and necessary to treat a work-related condition. They also requested a temporary injunction to prevent Younger from undergoing the costly procedure recommended by Dr. Iqbal during the pendency of the judicial review proceedings. The district court affirmed the deputy commissioner's decision to award alternate medical care, concluding substantial evidence supported the deputy's decision. Based on its affirmance, the district court found the request for an injunction was moot. The defendants appeal.
II. Claims on appeal
The defendants raise two issues on appeal. They contend the district court's finding that Younger proved the alternative medical treatment was reasonable and necessary to treat her work-related condition was unsupported by substantial evidence or in violation of statutory provisions. They also claim the court's finding the care offered by the defendants was unreasonable was unsupported by substantial evidence or in violation of statutory provisions. Younger responds (1) the district court correctly determined the deputy commissioner's decision was supported by substantial evidence, (2) the recommended treatment was for her work-related condition, and (3) the defendants' right to select her care is conditioned on the care being prompt, reasonably suited to treat the injury, and without undue inconvenience to her.
III. Scope of review
Our review of the district court's decision is well settled:
Statutory law dictates how we review appeals from administrative actions. Iowa Code § 17A.19[10] (1999). "On review of agency actions, this court functions solely in an appellate capacity to correct errors of law on the part of the agency." Ahrendsen ex rel. Ahrendsen v. Iowa Dep't of Human Servs., 613 N.W.2d 674, 676 (Iowa 2000) (citing Glowacki v. State Bd. of Med. Exam'rs, 516 N.W.2d 881, 884 (Iowa 1994)).
The subsequent appeal of the district court's review of the agency decision "is limited to determining whether the district court correctly applied the law in exercising its section 17A.19 judicial review function." Id. However, the district court, as well as this court, is "bound by the commissioner's factual findings if they are supported by substantial evidence in the record." Bergen v. Iowa Veterans Home, 577 N.W.2d 629, 630 (Iowa 1998). The district court may reverse the agency finding if it is not supported by substantial evidence. Iowa Code § 17A.19(10)(f). Upon our review of the district court's reversal, "we apply the standards of section 17A.19 to the agency action to determine whether our conclusions are the same as those of the district court." IBP, Inc. v. Al-Gharib, 604 N.W.2d 621, 627 (Iowa 2000). We will affirm if the district court satisfied its standard of review.
IBP, Inc. v. Harpole, 621 N.W.2d 410, 414 (Iowa 2001). Evidence is substantial if a reasonable mind would accept it as adequate to reach the conclusion at issue. Kostelac v. Feldman's, Inc., 497 N.W.2d 853, 856 (Iowa 1993). The fact that we could draw inconsistent conclusions from the same evidence does not mean substantial evidence does not support the agency's finding. Id. The ultimate question is not whether the evidence supports a different finding but whether it supports the findings the agency actually made. Terwilliger v. Snap-On Tools Corp., 529 N.W.2d 267, 271 (Iowa 1995). The 1998 amendments to the judicial review provisions of Iowa Code section 17A.19 did not change our scope of review. Although they did add definitions for key concepts, such as "substantial evidence" and the "record viewed as a whole," see Iowa Code § 17A.19(10)(f)(1), (3), an examination of prior cases demonstrates the new subsections serve only to clarify and codify preexisting case law. See, e.g., Dunlavey v. Econ. Fire and Cas. Co., 526 N.W.2d 845, 853 (Iowa 1995) (ascribing to the agency the duty to assess credibility and weigh evidence); Freeland v. Employment Appeal Bd., 492 N.W.2d 193, 196 (Iowa 1992) (finding substantial evidence is that from which a reasonable person could draw the same conclusions as the decision maker); Briggs v. Bd. of Dirs. of Hinton Cmty. Sch. Dist., 282 N.W.2d 740, 743 (Iowa 1979) (requiring consideration of detracting evidence); City of Davenport v. Pub. Employment Relations Bd., 264 N.W.2d 307, 311 (Iowa 1978) (requiring consideration of the entire agency record, not merely evidence supporting the agency decision).
IV. Discussion
A. Was the requested treatment reasonable and necessary to treat a work-related condition? The employer and insurer point to mention in Dr. Iqbal's records of complaints other than those associated with Younger's injured foot and the accompanying complex regional pain syndrome (CRPS). They argue the proposed treatment was not solely for the treatment of the work-related injury. The district court concluded Dr. Iqbal's records indicate the proposed treatment was to alleviate the problems arising from Younger's foot injury. Finding no evidence Dr. Iqbal's treatment was focusing on any of the other complaints mentioned in his notes, the court concluded substantial evidence supported Deputy Lewis's finding the treatment was directed only at the problems causally related to Younger's work-related injury. From our review of the record before us, we reach the same conclusion as the district court.
B. Was the care offered by the employer and insurer unreasonable? Iowa Code section 85.27 provides, in pertinent part:
[T]he employer is obliged to furnish reasonable services and supplies to treat an injured employee, and has the right to choose the care. The treatment must be offered promptly and be reasonably suited to treat the injury without undue inconvenience to the employee. If the employee has reason to be dissatisfied with the care offered, the employee should communicate the basis of such dissatisfaction to the employer, in writing if requested, following which the employer and the employee may agree to alternate care reasonably suited to treat the injury. If the employer and employee cannot agree on such alternate care, the commissioner may, upon application and reasonable proofs of the necessity therefore, allow and order other care.
Iowa Code § 85.27 fourth unnumbered paragraph. Appellants argue this language requires some cooperative effort and implies enough time between the employee's communication of dissatisfaction and the application for alternate care for the parties to attempt to reach an agreement. Appellants claim Younger did not communicate her dissatisfaction until February 14, 2001, and she filed her application for alternate care less than five weeks later. They also argue there was no attempt on Younger's part to reach an agreement; she simply communicated she "was not favorably disposed" to seeing the doctor in Omaha proposed by appellants.
The deputy found appellants denied continued treatment by Dr. Iqbal about March 24, 2000; Younger expressed dissatisfaction with the lack of continued care about October 20, 2000; and despite another specific referral to Dr. Iqbal in November, 2000, and his reiteration of his diagnosis and proposed treatment plan, appellants refused to authorize the treatment about February 16, 2001. Appellants offered Younger an evaluation by a doctor in Omaha, Nebraska, and an evaluation by a doctor in Iowa City. The deputy found "the treatment offered by defendants is not reasonably suited to treat the injury without undue inconvenience to claimant" and granted her request for alternate care. The district court concluded the deputy's finding was reasonable as the treatment offered by appellants would require Younger to travel halfway across the state for appointments.
Younger is five feet two inches tall and weighs 230 pounds. She was being treated for intense pain in her injured foot and leg. She normally keeps her leg elevated at home. She cannot wear her regular shoes or put her foot on the floor normally. Substantial evidence in the record supports the deputy's finding the care offered by appellants was not reasonably suited to treat her injury without undue inconvenience.
We also affirm the district court. In doing so we do not agree with the district court that the treatment offered by the appellant necessarily required the appellee to travel halfway across the state. Nor do we find that the travel required to see doctors designated by the appellant in and of itself makes offered treatment unreasonable. Consequently, to the extent, if any, the district court's ruling considers it, we disagree with that portion of the ruling particularly where, as here, we are dealing with a specialized area of medicine where specialists are not readily available in all areas of the state.