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Burtell v. State Compensation Insurnace Fund3/18/2002
at she would rather have it out in Nebraska where her sick mother lives." (Ex. 17 at 200.) Dr. Hunter recalled his impression that claimant thought "surgery was going to be a quick fix. She'd be up and going and things would be wonderful." (Hunter Dep. at 12.) In his experience, the myofascial component of her pain indicated otherwise. He testified: the "myofascial part of things is not made better by surgery. For a lot of people, it actually sets them back quite a bit." (Id. at 12-13.) He also indicated that claimant's smoking reduced claimant's chances for a positive surgical outcome.
Dr. Hunter sent claimant to Helena Physical Therapy Associates for a program involving "stretching, strengthening and work hardening." (Ex. 11 at 161.) Claimant's first session was on August 2, 1991. (Id.) She cancelled her next scheduled session (August 5), stating she had "no car." (Id. at 165.) She reported for therapy on August 7, indicating "no change" in her condition. (Id.) On August 11, she called from Nebraska to cancel her appointment. (Id.)
On August 19, 1991, claimant returned to therapy but was unable to tolerate even the mildest massage. (Id.) On August 21, even with "treatment reduced to minimum," claimant would not tolerate therapy. The physical therapist wrote, "Will contact [doctor] seems to be unusually severe reaction to treatment done thus far." (Id. at 166.) Claimant returned to therapy on August 23, but was a "no show" on August 28 and August 30. (Id.) On September 4, 1991, the therapist informed Dr. Hunter's office that claimant had an extreme reaction "to treatment no matter how minimal or non-stressful." (Id.) Commenting on an upcoming functional capacity evaluation (FCE) which had been ordered, the therapist indicated that the FCE might not be useful given claimant's extreme reactions. (Id.)
Dr. Hunter testified claimant was not following his recommendations. She "hadn't followed up and had missed most of her appointments." (Hunter Dep. at 15.)
Claimant apparently went to Nebraska for a period of time, then returned to Helena and was again examined by Dr. Hunter on October 18, 1991. (Hunter Dep. at 16.) "She said that she was about the same, perhaps a little bit more pain on her right leg, in the front part of her leg." (Id.; Ex. 17 at 201.) Dr. Hunter believed this pain was "not neurologically likely to come at all from an L5, S1 disc, so it puts it back more into the myofascial type of thing rather than in the hard radicular part of things." (Hunter Dep. at 16.)
Dr. Hunter did not consider claimant at MMI at that point, primarily because she still had not been through an appropriate physical therapy program. (Id.) Nevertheless, he believed "she could do the light and sedentary type of work" and "thought that she could be returned to the type of work she was doing before if she could push through the therapy." (Id. at 17.) He referred claimant to Dr. Allen M. Weinert, Jr., a specialist in physical and rehabilitative medicine, for evaluation, nerve conduction studies, and "perhaps a functional capacity evaluation through therapy and getting her on line to get returned to work." (Ex. 17 at 201; Hunter Dep. at 17.)
Dr. Weinert thereafter examined and tested claimant. (Ex. 8 at 130-135.) Her EMG and nerve conduction tests were normal and he recommended that "she begin a supervised program for her low back through physical therapy," followed by a FCE. (Id. at 135.)
On March 12, 1992, claimant began a physical therapy program to instruct her in a home exercise and aerobic program, maintenance of a neutral spine position, and the use of passive lumbar extension exercises. (Ex. 10 at 155-57.) Claimant cancelled
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