Darvel Burgess v. Sewerage & Water Board of New Orleans

225 So. 3d 1020, 2017 WL 2836062, 2017 La. LEXIS 1387
CourtSupreme Court of Louisiana
DecidedJune 29, 2017
Docket2016-C-2267
StatusPublished
Cited by10 cases

This text of 225 So. 3d 1020 (Darvel Burgess v. Sewerage & Water Board of New Orleans) is published on Counsel Stack Legal Research, covering Supreme Court of Louisiana primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Darvel Burgess v. Sewerage & Water Board of New Orleans, 225 So. 3d 1020, 2017 WL 2836062, 2017 La. LEXIS 1387 (La. 2017).

Opinions

JOHNSON, Chief Justice

| fin this workers’ compensation case, the claimant, Darvel Burgess, filed a Disputed Claim for Compensation after his employer, Sewerage & Water Board of New Orleans (“S & WB”), refused to pay a $13,110.02 outstanding bill for prescription medications from Injured Workers Pharmacy (“IWP”). The underlying legal issue is whether the injured employee is entitled to his choice of pharmacy, or whether that right belongs to the employer under the Louisiana Workers Compensation Act (“LWCA”). We granted this writ application to resolve a split in our circuit courts of appeal on this issue. After review, we hold the choice of pharmacy in a workers’ compensation case belongs to the employer.

FACTS AND PROCEDURAL HISTORY

Darvel Burgess sustained a work-related injury on October 13, 2008. On September 18, 2012, Mr. Burgess filed a Disputed Claim for Compensation against his employer, S & WB, asserting in part a dispute over unpaid medical bills and entitlement to penalties and attorney fees. The matter was submitted to the Louisiana Office of Workers’ Compensation (“OWC”) solely on briefs and exhibits. The only disputed issues presented to the OWC judge were unpaid bills from IWP and Advanced Neurodiagnostic Center, as well as Mr. Burgess’ entitlement to penalties |2and attorney fees as a result of S & WB’s failure to timely pay these bills.1

[1022]*1022In his brief submitted to the OWC, Mr. Burgess asserted he is entitled to have all necessary .and related medical treatment and prescriptions paid by his employer pursuant to La. R.S. 23:1203(A).2 He argued the unpaid bills were related to treatment for his work-related injury, including medications prescribed by his treating physician, and as such were reasonable and necessary. Mr. Burgess further requested an award for penalties and attorney fees. S <& WB argued it is not responsible for the outstanding IWP bill pursuant to La. R.S. 23:1142(B) because it notified all injured workers on October 10, 2011, that' henceforth Corvel Caremark Pharmacy program was the approved provider for prescription services and failure of the injured worker to use the pharmacy card provided’ may result in non-payment of medications. Additionally, S & WB noted IWP was notified on April 12, 2012, that it was-not'an approved pharmacy provider for S & WB’s workers’ compensation claims and bills submitted by IWP would be denied.

On June 18, 2015, the OWC judge issued a judgment ordering S & WB to pay the outstanding $13,110.82 bill from IWP and all outstanding medical expenses owed to Advanced Neurodiagnostic Center “via the fee schedule.” The OWC judge awarded Mr. Burgess a $2,000 penalty and $2,000 in attorney fees due to S & WB’s failure to timely pay these bills. S & WB suspensively appealed the judgment, but only as to the IWP bill.

The court of appeal affirmed in a 2-1 decision. Burgess v. Sewerage & Water Board of New Orleans, 15-0918 (La. App. 4 Cir. 2/3/16), 187 So.3d 49 (“Burgess /.”). In so doing, the Fourth Circuit concluded the choice of pharmacy belongs to the employee, not the employer. 187 So.3d at 57. The court noted La. R.S. 23:1203(A) |srequires the employer to provide the employee with all necessary prescription medication. Id. at 51. The court of appeal referenced an Alabama case, Davis Plumbing, Inc. v. Burns, 967 So.2d 94 (Ala. Civ. App. 2007), which held the choice of pharmacy under a similar Alabama statute belonged to the employee. Id. at 52. In addition, the court analyzed each Louisiana appellate court case on the subject and the differing outcomes. The court of appeal concluded that Louisiana is overwhelmingly a patient’s choice state, observing that twenty-three other states expressly provide for employ-ér choice of treating physician and three limit the employee’s choice to a list provided by the state agency. Id. at 57. In addition, thé court noted the LWCA contains no provision "granting the employer the right to select the pharmacy that the employee must use. To the contrary, the LWCA obligates the employer to pay for the employee’s reasonably necessary prescription medication and contains no exception for situations in which the employer objects to the pharmacy the employee selects. Id. The court also rejected S & WB’s reliance on La. R.S. 23:1142(B) in an attempt to obtain the benefit of the choice of pharmacy, finding prescription medication is not part of “nonemergency diagnostic testing or treatment” under the statute, and further noting the purpose of the statute is to allow the employer to contest unnecessary or unreasonable medical care, not to allow employers to bargain shop. Id. at 57-58. -

Judge Lobrano dissented, finding a determination of whether the employee is entitled to his choice of pharmacy did not end the inquiry of whether payment of the disputed pharmacy expenses is due or in what amount. Id. at 58. (Lobrano, J., dissenting).. She noted IWP is an out-of-state provider, and La. R.S. 23:1203(A) provides in pertinent part, “[mjedical care, services, [1023]*1023and treatment may be provided by out-of-state providers or at out-of-state facilities when such care, services, and | ¿treatment are not reasonably available within the state or when it can be provided for comparable costs.” Further, La. R.S. 23:1203(B) limits the employer’s obligation to “reimbursement,. .as determined under the reimbursement schedule.. .pursuant to R.S. 23:1034.2, or the actual charge made for the service, whichever is less.” Id, at 58-59. Judge Lobrano found the record lacked any evidence of whether IWP fit the criteria for a permissible out-of-state provider under La. R.S. 23:1203(A) or any evidence of the reimbursement schedule set forth in La. R.S. 23:1034.2, and the OWC judge erred by failing to consider these issues. Id. at 59. Judge Lobrano opined the case should be remanded to the OWC to determine whether pharmacy expenses are due to IWP as an out-of-state provider, and if so, the amount of expenses due pursuant to the reimbursement schedule. Id.

S & WB sought supervisory review in this court. While the application was pending, this court rendered its opinion in Lafayette Bone & Joint Clinic v. Louisiana United Business SIF, 15-2137 (La. 6/29/16), 194 So.3d 1112, which addressed, but did not decide, the choice of pharmacy issue. In that case, the claimants, who were injured in the course of their émplóyment, were treated by physicians at the Lafayette Bone & Joint Clinic (“LB & J”). During the course of treatment, the physicians prescribed medications which were dispensed directly to claimants by LB & J employees. 194 So.3d at 1115. On June 5, 2008, the workers’ compensation payor, Louisiana United Business SIF (“LUBA”), sent letters to LB & J and its physicians, stating that LUBA would no longer pay for prescription medications directly dispensed by LB & J and directing LB & J physicians to issue future prescriptions to be filled by local retail pharmacies. Despite these notices, LB & J continued to dispense prescription medications directly to claimants throughout 2008 and to submit requests for reimbursement to LUBA. LUBA declined payment, citing its June 5, 2008 notice. | fiLB & J filed a disputed claim with the OWC, seeking to recover the costs of the medications dispensed, along with penalties and attorney fees. Id.

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225 So. 3d 1020, 2017 WL 2836062, 2017 La. LEXIS 1387, Counsel Stack Legal Research, https://law.counselstack.com/opinion/darvel-burgess-v-sewerage-water-board-of-new-orleans-la-2017.