Thursday, February 16, 2012

IA Case, Independent Exams, and Single Source

An argument I hear all of the time against a single source medical treatment system is that general health doesn't deal with return to work or indemnity issues, and is only concerned with making the patient feel better.

A recent Iowa case seems to refute this argument.

In Westling v. Hormel Foods Corp., No. 10-0795, 2/10/12, Donald Westling, a Hormel Foods Corp. employee, experienced a sharp pain in his right shoulder while removing casings from meat products with a "strip-out machine." The injury occurred on Jan. 5, 2006.

Westling felt a burning sensation and could not lift his arms above his head. He continued to feel pain while he worked.

On Feb. 16, 2006, Westling consulted with Dr. Ryan Thoreson, who diagnosed his injury as a rotator cuff strain. Physical therapy did not relieve his pain, and Westling saw an orthopedic surgeon, Dr. Philip Deffer. Deffer examined an MRI, and suspected that Westling had a partial rotator cuff tear.

Dr. Jason C. Hough performed surgery on Westling's right shoulder and discovered fraying along his labrum, as well as a bone spur. Hough did not discover a rotator cuff tear, but did remove the frayed labrum and freed the bone spur.

Westling reported a week later that he was "doing quite well," and Hough allowed Westling to return to full duty work in September 2006. Westling stated that while his condition had significantly improved, he still felt a burning sensation and pain when he extended his right arm over his head.

Hough wrote a letter to Hormel stating that the surgery did not cause Westling to have a permanent impairment. Westling voluntarily retired on Nov. 24, 2006 and then spent time between Iowa and Florida.

Later Westling sought permanent disability benefits and was denied. Westling sought judicial review of that decision.

Dr. Mary Shook performed an independent medical examination upon Westling's request, and Shook determined that he had a 2% whole person impairment rating for the right shoulder and a 3% whole person impairment rating for the left shoulder. She attributed both impairments to arthritis, and not to his work activities.

Westling's appeals were denied all the way to the state Supreme Court, which concluded:

"Westling's arguments on appeal fail for two reasons," the court wrote. "First, the record did not conclusively establish that the shoulder surgery caused permanent physical impairment. The evidence on this issue was mixed. Although the surgeon's surgical note provides evidence that structures in Westling's shoulder were removed and permanently altered, this evidence did not stand alone. The record also contains the surgeon's opinion that Westling did not suffer any permanent physical impairment because of the surgery and the opinion of the physician who performed the independent medical examination who opined Westling did not suffer any permanent impairment because of overuse while working for Hormel."

Secondly, even if Westling showed that he did suffer permanent impairment, he did not prove that his work caused that impairment, the court said.

Yes, treatment was provided on an industrial basis. But the determination of impairment was made independently.

What's even more interesting to me is that the industrial doctor cleared Westling to return to work. Westling's tolerance for work though seems to have been compromised, likely because he was at retirement age and Florida is warmer than Iowa most of the year.

Granted, in this case the physicians did not have to deal with return to work issues because the claimant retired. Regardless, Iowa, along most states, has in place a method for dealing with such issues that can be employed regardless of what treatment system is utilized. That method is called "medical-legal".workers compensation, work comp, injured worker

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