Bockus v. First Student Services

384 P.3d 801, 2016 Alas. LEXIS 131, 2016 WL 7030290
CourtAlaska Supreme Court
DecidedDecember 2, 2016
Docket7137 S-15784
StatusPublished
Cited by2 cases

This text of 384 P.3d 801 (Bockus v. First Student Services) is published on Counsel Stack Legal Research, covering Alaska Supreme Court primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Bockus v. First Student Services, 384 P.3d 801, 2016 Alas. LEXIS 131, 2016 WL 7030290 (Ala. 2016).

Opinion

OPINION

BOLGER, Justice.

I. INTRODUCTION

A school bus driver injured his back moving a gate. He had two spinal surgeries, and his surgeon ultimately recommended a third. About the same time, the driver’s employer scheduled a medical examination, which delayed the planned surgery: the driver’s surgeon would not schedule the surgery while the employer’s medical evaluation was pending. So the driver filed a workers’ compensation claim for the third surgery, and the employer’s doctor ultimately agreed another surgery was appropriate. The Alaska Workers’ Compensation Board awarded the driver his attorney’s fees under AS 23.30.145(b), finding the employer had resisted these benefits, but the Alaska Workers’ Compensation Appeals Commission reversed the fee award. We conclude there was substantial evidence supporting the Board’s finding and therefore reinstate the award.

II. FACTS AND PROCEEDINGS

Jonathan Bockus worked as a substitute bus driver for First Student Services in Fairbanks. In March 2013 he injured his back pulling open a chain-link gate; 'he felt a pop in his back and had severe pain radiating into his legs shortly afterwards. He was taken by ambulance to the emergency room at Fairbanks Memorial Hospital, where an MRI showed a large disc herniation at T10-T11 and resulting spinal cord impingement. Because no neurosurgeon was available in Fairbanks, Bockus was medivaeed to Anchorage. In .Anchorage a repeat MRI showed the same problem as well as cord edema. Dr. Kim Wright, a neurosurgeon, recommended surgical decompression of the spinal cord.

Dr. Wright attempted to perform a right T10-T11 laminectomy on March 8, but during surgery he was not able to locate the correct level of the spine due to Boekus’s “body habitus.” After making an incision and beginning the surgery at what he thought was the correct' level, Dr. Wright did not find the expected amount of disc material. He nonetheless removed a calcified ligament and a synovial cyst. He thought he might have been .off one level, but he decided it would be better to end the surgery, have a repeat MRI,.and decide what to do next rather than continue to try to locate the correct level.

Another MRI done later that day showed a continuing disc herniation and “cord distortion” at T10-T11 as well as surgical changes at T11-T12. Dr. Wright performed another surgery the following day, this time at the correct level; decompressed the spinal cord; and removed a calcified ligament and “a size-able free fragment disc herniation.” Bockus reported feeling better the following day. The imaging studies done after the second surgery showed some residual problems at the T10-T11 level, but Dr. Wright recommended to Bockus that he try conservative management because surgical treatment would require fusion.

In correspondence related to the surgery, the workers’ compensation carrier asked Dr. Wright whether Bockus’s work-related injury was the substantial cause of the first surgery, at the T11-T12 level; Dr. Wright responded that it was, even though the cyst was likely a preexisting condition, and explained that the work-related ruptured disc caused the need for any surgery at all. The carrier then sent Bockus’s medical records to its doctor, Dr. Paul Williams, also a neurosurgeon, for review. Dr, Williams agreed both surgeries were reasonable and necessary and additionally gave the opinion that the work-related accident was the substantial cause of Boc-kus’s thoracic back condition.

Bockus had several post-surgery visits with Dr. Wright and his staff, for which First Student paid. Bockus reported recurring pain *804 in his mid-baek, and Dr. Wright initially suggested continuing conservative care. An MRI from June showed residual disc material at T10-T11 as well as cord impingement and “severe right neural foraminal stenosis.” Over the next few weeks Bockus’s pain increased, Dr. Wright recommended a third surgery, and the earner decided to have Bockus undergo an employer’s independent medical evaluation (EIME) in Anchorage with Dr. Williams.

Bockus and Dr. Wright discussed further surgery in mid-July, when Bockus “reported] significant pain” with numbness; after considering his options Bockus decided to have a fusion surgery. At about the same time, the adjuster scheduled the EIME, initially for Saturday, July 27. Bockus had already spent a significant amount in nonrefundable fees to attend a family reunion that day, so the EIME was rescheduled for September 27, Dr. Williams’s next available in-person appointment. When Dr. Wright’s scheduling assistant called the workers’ compensation carrier to verify coverage for the surgery, the carrier told her that the claim was open and billable but that an EIME was scheduled. The assistant did not schedule the surgery then because of offiee policy not to schedule surgery in the face of a pending EIME; according to the assistant this policy is meant to protect patients from being stuck “with a huge bill that they can’t pay,” presumably in ease the EIME leads to a contr-oversion. 1 The assistant would have gone ahead and scheduled the surgery, even with a pending EIME, if the carrier had “authorized it,” but the earner did not do so in July.

After the adjuster found out that Dr. Wright had recommended another surgery, she asked Dr. Williams to perform a records review in lieu of having an in-person appoint ment; she testified that Dr. Williams “was not able to opine on any of the issues because he wanted to do a physical evaluation of Mr. Bockus first.” Dr. Williams’s second records examination, dated July 29, indicated that he reviewed the June MRI and gave the opinion that the March work-related injury was the substantial cause of Bockus’s current condition and that the preexisting conditions Dr. Williams identified in the report were not the substantial cause of Bockus’s condition. He also wrote that he was “unaware of an alternate explanation” that might exclude the work-related injury as the substantial cause of Bockus’s “medical complaints.”

Dr. Williams declined to answer a number of other questions, including one about the reasonableness or necessity of a list of nine treatment options, without first examining Bockus. None of the questions informed Dr. Williams that Dr. Wright had recommended a third surgery and thus did not ask Dr. Williams to give an opinion about whether a third surgery was necessary and “within the realm of medically accepted options” 2 for treating Bockus’s condition.

Bockus saw Dr. Wright again in early August and reported increased pain. He said he could no longer stand completely upright because of the pain; the chart notes reflect that Bockus was “ready to proceed with surgery but his workers!’] compensation company will not approve it until the [E] IME is completed.” The care plan section of the chart notes says, “We are simply awaiting his new [E] IME and approval for surgei'y.” The care plan also indicates that Bockus asked to see a pain management doctor “to be able to get through” until the EIME.

After contacting Dr. Wright’s office and the compensation carrier several times about the surgery, Bockus sought the assistance of an attorney. The attorney wrote to the adjuster “informing [her] that the treating phy *805

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Bluebook (online)
384 P.3d 801, 2016 Alas. LEXIS 131, 2016 WL 7030290, Counsel Stack Legal Research, https://law.counselstack.com/opinion/bockus-v-first-student-services-alaska-2016.