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Bocalbos v. Kapiolani Medical Center for Women and Children3/9/2000
e much orthodontic and orthognathic[ ] treatment done first. She is missing 54321|12,[ ] which make this case very difficult and also very extensive.
t is difficult to determine the exact cost and length of treatment, since it mainly depends on the orthodontic and orthognathic results, and the implantology results. This combined treatment is most definitely necessary to stabilize the crainiomandibular dysfunction. . . . (Some emphases added.)
According to Knouse's report dated November 3, 1992, prosthodontic treatment consists of surgical implants and prosthetic treatment. First, the report indicated implants would need to be surgically placed, which might require bone removal, spreading, and augmentation. After the surgical procedures, prosthetic treatment consisting of dental bridgework would commence.
On December 8, 1992, Bryce Potter, DMD/MD (Potter) completed still another IME report requested by Employer. In this report, Potter opined:
It seems highly unlikely that [Bocalbos] would benefit from any type of orthodontic therapy when she has only six teeth remaining in the upper arch. She could, however, very easily undergo a comprehensive reconstruction of the teeth without ever going through orthodontic therapy. I qualify this by stating I have not looked at [Bocalbos's] x-rays and have not examined her. (Emphasis added.)
McRoberts's fee schedule indicated that on May 11, 1993, he treated Bocalbos through the " nstall[ation of an] orthopedic appliance" which he described as a "Complex modified Crozat with temporary partial for upper teeth." (Emphasis added.) As defined in the record, a "Crozat" is a removable orthodontic appliance, usually made of a precious metal, used to align teeth during orthodontic therapy."
On September 13, 1993, McRoberts made a note with respect to "Questions," in which he stated that Bocalbos was "currently under orthodontic treatment for cranio-mandibular problems (including TMJ dysfunction) resulting from the accident when the ceiling tile collapsed on her head, neck, and shoulders." (Emphasis added.) According to McRoberts, treatment required a "multiple modality approach" which included "dental work"
to restore as much of the proper functions of the neck and cranio-mandibular areas and at the same time alleviate the numerous discomforts that result from such dysfunctions such as severe headaches, eye pain, difficulty swallowing, neck and shoulder pains, chronic fatigue, insomnia, and other symptoms mentioned in prior reports.
The standard of care currently advocated by those claiming to be specialists in TMJ problems include a multiple modality approach such as dental work, physical therapy, psychological support, and medications for pain, anxiety, depression. . . . It appears that [Bocalbos] responds best to orthodontic correction with concurrent osteopathic manipulation. (Emphases added.)
B.
The following decisions and orders are relevant.
On January 5, 1989, the Director of the Department of Labor and Industrial Relations (the Director) held a hearing to determine disability benefits that should be awarded to Bocalbos. In a February 22, 1989 decision, the Director found that Bocalbos was authorized to receive temporary total disability benefits, and that her "TMJ condition is related to the injury of July 25, 1986[.]" The Director also concluded that Bocalbos "suffered aggravation of her psychological condition as a result of the injury of July 25, 1986[.]" Bocalbos was awarded temporary total disability benefits and, inter alia, Employer was held responsible for Bocalbos's TMJ treatment for certain periods from August 10,
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