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Farmington Country Club11/22/2005
The Farmington Country Club, Inc., and its insurer, Great American Insurance Company/Ohio Casualty Group (hereinafter collectively "employer"), appeal a decision of the Workers' Compensation Commission holding that employer is responsible for payment for the prescription medication Nexium for Frank Wayne Marshall (claimant) to treat his gastro-esophageal reflux disease (GERD). On appeal, employer contends the evidence is insufficient to prove claimant's GERD is causally related to his compensable industrial injury. It contends further that, even if the GERD is causally related, it is a consequence of a compensable consequence and, thus, that the causal connection is too attenuated to be covered under the Workers' Compensation Act. For the reasons stated, we find the commission erred in finding the necessary causal connection between claimant's industrial injury and his GERD. Thus, we reverse the commission's award of medical benefits.
I. BACKGROUND
On September 6, 2000, while working as a painter for employer, claimant fell twelve feet from a ladder onto a wall, injuring his back. He was diagnosed with "T8 through L1 fractures" and "thoracic spinal cord contusion with an ASIA level B paraplegia." He received emergency treatment and spent five weeks in a rehabilitation facility.
While in the rehabilitation facility, claimant received numerous medications for pain, muscle spasms, and insomnia. He also was prescribed various medications for indigestion, nausea, bloating, and gas, including Famotidine, Maalox, Simethicone, and a "GI cocktail" of "lidocaine viscous" and "donnatal elixir." On claimant's discharge from the rehabilitation hospital on October 17, 2000, he was instructed to continue taking numerous medications for pain. He was also prescribed Protonix, a drug similar to Nexium, to be taken as needed. Finally, he was "instructed . . . to wear a soft corset" and "to use his wheelchair as provided with no unassisted ambulation."
Pursuant to a commission award entered May 21, 2001, claimant received medical benefits and ongoing temporary total disability benefits beginning September 7, 2000. In September 2002, claimant began treatment with Dr. Robert L. Muller, a licensed clinical psychologist. Dr. Muller noted claimant experienced chronic pain and had significant depression and anxiety secondary to his medical problems and permanent disability. Claimant obtained treatment from Dr. Muller intermittently through at least January 2004.
In 2004, nearly 4 years after the injury, claimant was initially diagnosed with GERD. On June 18, 2004, family physician Dr. William R. Dandridge prescribed Nexium for the treatment of claimant's GERD. Claimant sought payment from the employer for the prescription, and when employer denied coverage, claimant sought a ruling by the commission.
Medical evidence before the commission included statements from several of claimant's treating physicians. Dr. Alan Alfano, one of the physicians who treated claimant at the rehabilitation facility shortly following his injury, was asked, " lease advise of your opinion as to whether or not Mr. Marshall's GERD is a result of his back injury . . . ." In response,
Dr. Alfano opined on July 15, 2004, that "I don't believe that [claimant's] GERD is irectly caused by his [spinal cord injury]. However, I do believe that it is indirectly related to his injury in that it is likely exacerbated by stress. I have referred the treatment of his GERD to his [primary care physician]." (Underlining in original.)
On July 27, 2004, Dr. Martin D. Katz, a partner of Dr. Dandridge, opined as follows: "[Claimant] had no history of gastric reflux or gas
Page 1 2 3 4 5 6 7 8 9 Virginia Personal Injury Attorneys
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