Duvall v. St. Francis Cabrini Hospital

805 So. 2d 418, 1 La.App. 3 Cir. 0905, 2001 La. App. LEXIS 3157, 2001 WL 1670128
CourtLouisiana Court of Appeal
DecidedDecember 28, 2001
DocketNo. 01-0905
StatusPublished
Cited by1 cases

This text of 805 So. 2d 418 (Duvall v. St. Francis Cabrini Hospital) is published on Counsel Stack Legal Research, covering Louisiana Court of Appeal primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Duvall v. St. Francis Cabrini Hospital, 805 So. 2d 418, 1 La.App. 3 Cir. 0905, 2001 La. App. LEXIS 3157, 2001 WL 1670128 (La. Ct. App. 2001).

Opinion

I t SAUNDERS, Judge.

On January 1, 1997, Deborah Duvall was injured in the course and scope of her employment with St. Francis Cabrini Hospital. She filed a claim for workers’ compensation benefits, penalties, and attorney fees. The workers’ compensation judge awarded Duvall $2,000 in penalties and $4,000 in attorney’s fees. Both parties now appeal this judgment.

[420]*420Factual and Procedural Review

Plaintiff, Deborah Duvall (“Duvall”), was employed by Defendant, St. Francis Cabrini Hospital (“Cabrini”), as a registered nurse, when she sustained an injury during the course and scope of her employment. Duvall has received workers’ compensation benefits and continues to receive benefits.

On July 7, 2000, Duvall filed a disputed claim for compensation, alleging arbitrary and capricious failure to authorize payment for epidural steroid injections, failure to timely approve prescription medications, and for penalties and attorney fees. On September 6, 2000, an amended and supplemental disputed claim was filed alleging the arbitrary, capricious, and unreasonable failure of the Defendant to approve blood work and a gastrointestinal evaluation. The claim based upon the failure to timely approve prescriptions was later withdrawn.

Lindsey Morton Claims Services was the third party administrator for Cabrini. The adjuster for Lindsey Morton Claims Services, Mr. Clint Dobson (“Dobson”), received a call on June 7, 2000, from the office of Dr. Joe Crapanzano. Dr. Crapan-zano was Duvall’s pain management physician, who planned to perform the epidural steroid injections, if approved by the workers’ compensation carrier. Although Dob-son had repeated references in the medical record explaining why Duvall was referred to Dr. Crapanzano, Dobson did not review any of his records. Rather, Dobson chose to ask Duvall’s treating physician, Dr. Blotner, for more | ¿information regarding whether the recommended treatment was work-related. Upon receiving a faxed letter from Dr. Blotner indicating that the treatment was medically necessary, Dob-son ultimately authorized the treatment on July 10, 2000.

With respect to the gastrointestinal evaluation, the record shows that Dobson was aware of the gastroscope as early as February 15, 2000, and at least by June 8, 2000. At trial, Dobson indicated that as early as February 15, 2000, he found references in his records indicating that some of the treatment Duvall was receiving, in connection with her work-related injury, was upsetting her stomach. Dobson further testified that based on the April 12, 2000 report by Dr. Blotner, he was aware of the scheduled gastroscope. Finally, Dobson demonstrated his knowledge of the upcoming gastroscope in his June 8, 2000 letter to Dr. Blotner. Although aware of the upcoming gastroscope, Dobson did not approve the gastroscope evaluation because of a question regarding the relation of the evaluation to the workers’ compensation injury.

At trial, the workers’ compensation judge found that Dobson should have authorized the treatment by Dr. Crapanzano when he called on June 7, 2000, and that it was unreasonable for Dobson not to review his records or authorize the treatment. The trial court also found that there was no reason for Dobson’s failure to approve the gastroscope. As a result, the trial court awarded $2,000 as penalties for arbitrary, capricious and unreasonable failure to timely approve and authorize payment for epidural steroid injections and for failure to approve gastrointestinal studies prescribed by Dr. Blotner. Moreover, the trial court awarded Plaintiff $4,000 in attorney fees, legal interest and all court costs.

From this judgment, both Plaintiff and Defendant appeal. Defendant asserts the following assignments of error:

|al. The finding of the Office of Workers’ Compensation in favor of Plaintiff and against Defendant is manifestly er[421]*421roneous and not supported by the record.
2. The Office of Workers’ Compensation erred in failing to find that the Defendant was not arbitrary, capricious or unreasonable in refusing to authorize medical treatment which had not been formally requested.
3. The Office of Workers’ Compensation acted improperly when it considered evidence of a claim by Plaintiff for authorization of medial treatment with Dr. Price, occurring after the date the Disputed Claim for Compensation was filed, in awarding penalties and attorney fees.

Plaintiff asserts the following assignments of error:

1. The trial court erred in assigning only one penalty for various arbitrary, capricious and unreasonable acts of Defendant.
2. The trial court erred in finding that the penalty to be awarded on the failure to approve the epidural steroid injections was based on three (3) days of unreasonable behavior.
3. The trial court erred in failing to find that Defendant arbitrarily, capriciously and unreasonably denied blood work recommended by one of Plaintiffs treating physicians, Dr. Blotner.
4. The trial court erred in awarding attorney’s fees that are excessively low.

Law and Analysis:

It is well established that the standard of review in a workers’ compensation case is governed by the manifest error or clearly wrong standard. Desselle v. Oaks Care Ctr., 01-0044 (La.App. 3 Cir. 5/2/01); 787 So.2d 500, 502; Russell v. State, DOTD., 00-0932 (La.App. 3 Cir. 2/21/01); 782 So.2d 1099, 1102. In applying this standard, the court must determine not whether the trier of fact was right or wrong, but whether the conclusion was a reasonable one. Russell, 2000-0932; 782 So.2d 1099.

Defendant’s first two assignments of error:

The Defendant asserts that the trial court’s finding in favor of Plaintiff is manifestly erroneous and unsupported by the record, and the court erred in failing to | ¿find that the Defendant was not arbitrary, capricious or unreasonable. Having reviewed the record, we find no error in the trial court’s ruling in favor of the Plaintiff.

The record shows that, on or about June 7, 2000, Defendant, through its third party administrator (Dobson), received a phone request for approval of the epidural steroid treatment. Dobson testified that he considered this phone request to be a formal request, and that he routinely approves similar phone request. Furthermore, as revealed by the record and recognized by the trial court, medical records supporting the necessity of the procedure were in Dobson’s possession when he received the phone request, and had Dobson simply reviewed his files he would have realized that he had enough information to authorize the procedure. Nonetheless, Dobson chose to write Dr. Blotner asking for an opinion indicating that the procedure was a medical necessity. Finally, after receiving the report from Dr. Blot-ner, the treatment was approved on July 10, 2000. Because the approval of the treatment took over a month from the time of the request even though Defendant had enough information to approve the request immediately, we find the ruling by the [422]*422workers’ compensation judge to be appropriate.

The record further reveals that the trial court’s finding in favor of Plaintiff with regard to the gastroscope was also appropriate.

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Harbor v. St. Frances Cabrini Hosp.
817 So. 2d 1269 (Louisiana Court of Appeal, 2002)

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Bluebook (online)
805 So. 2d 418, 1 La.App. 3 Cir. 0905, 2001 La. App. LEXIS 3157, 2001 WL 1670128, Counsel Stack Legal Research, https://law.counselstack.com/opinion/duvall-v-st-francis-cabrini-hospital-lactapp-2001.