Lewis v. Am. Gen. Media

2015 NMCA 090, 8 N.M. Ct. App. 454
New Mexico Court of Appeals·Decided June 26, 2015·No. 33,236·Published·Cited by 6 cases

Opinion

1 IN THE COURT OF APPEALS OF THE STATE OF NEW MEXICO 2 Opinion Number: __________ 3 Filing Date: June 26, 2015 4 NO. 33,236 5 SANDRA LEWIS, 6 Worker-Appellee, 7 v.

8 AMERICAN GENERAL MEDIA and 9 GALLAGHER BASSETT,

10 Employer/Insurer-Appellant.

11 APPEAL FROM THE WORKERS’ COMPENSATION ADMINISTRATION 12 Terry S. Kramer, Workers’ Compensation Judge

13 Peter D. White 14 Santa Fe, NM

15 for Appellee

16 Paul L. Civerolo, L.L.C. 17 Paul L. Civerolo 18 Albuquerque, NM

19 for Appellant 1 OPINION 2 WECHSLER, Judge. 3 {1} We are again called upon to address the application of the Workers’ 4 Compensation Act, NMSA 1978, §§ 52-1-1 to -70 (1929, as amended through 2013), 5 to a worker certified to receive treatment with medical marijuana under the Lynn and 6 Erin Compassionate Use Act (Compassionate Use Act), NMSA 1978, §§ 26-2B-1 to 7 -7 (2007). In Vialpando v. Ben’s Automotive Services, we held that the Workers’ 8 Compensation Act authorizes reimbursement for medical marijuana and declined to 9 hold that federal law required a different result. 2014-NMCA-084, ¶¶ 1, 16, 331 P.3d 10 975, cert. denied, 331 P.3d 924 (2014). In Maez v. Riley Industrial, we considered the 11 sufficiency of the evidence that supported reimbursement for medical marijuana for 12 the worker in that case. 2015-NMCA-049, 347 P.3d 732. 13 {2} In this case, Gallagher Bassett and its insurer American General Media 14 (collectively, Employer) challenge the sufficiency of the evidence supporting the 15 conclusions of the Workers’ Compensation Judge (WCJ) that the use of medical 16 marijuana by Worker Sandra Lewis constituted reasonable and necessary medical 17 care that required reimbursement. Specifically, Employer argues that the evidence 18 offered by Worker’s authorized health care provider was insufficient and that the 19 WCJ erred by relying on testimony from an unauthorized health care provider who

1 had provided a certification for Worker’s use of medical marijuana under the 2 Compassionate Use Act. Employer further argues that the conflict between New 3 Mexico and federal law concerning the use of medical marijuana precludes the 4 validity of the amended compensation order in this case. We hold that the medical 5 certification forms and notes of Worker’s authorized health care provider were 6 substantial evidence to support the WCJ’s conclusion that Worker’s use of medical 7 marijuana constitutes reasonable and necessary medical care and that, as discussed 8 in Vialpando, the conflict between New Mexico and federal law does not support 9 failing to give recognition to the amended compensation order. We therefore affirm. 10 BACKGROUND 11 {3} Worker suffered a compensable, work-related injury to her lower back in 12 December 1998. She underwent several surgical procedures and currently suffers 13 from post-laminectomy syndrome in the lumbar region. She suffers chronic pain. 14 Since her injury, Worker has taken numerous drugs as part of her pain management, 15 including Oxycontin, oxycodone, Soma, Norflex, gabapentin, Lyrica, Percocet, 16 fentanyl, and Zantac. 17 {4} The issues concerning Worker’s treatment began on April 16, 2012, when 18 Employer filed an application requesting an independent medical examination (IME) 19 in order to determine the scope of reasonable and necessary treatment for Worker’s

1 condition. In its application, Employer stated that Worker had been using medical 2 marijuana and taking prescribed pain medication, which was inconsistent with 3 Worker’s belief that medical marijuana “is now the most effective medication from 4 all of her different treatment and she is concerned by potential side effects.” The WCJ 5 appointed Dr. Carl Adams, a psychologist, “to address Worker’s ongoing pain 6 management and use of pain medications.” Dr. Adams’ recommendations, issued 7 September 17, 2012, supported Worker’s request to use medical marijuana to control 8 her pain as reasonable and appropriate. 9 {5} Worker was originally certified to participate in the New Mexico Department 10 of Health Medical Cannabis Program (the program) on March 22, 2010. On July 31, 11 2012, Dr. Carlos Esparza, Worker’s authorized health care provider, provided the 12 written certification under the Compassionate Use Act for Worker to re-enroll in the 13 program. As required by the Compassionate Use Act, Dr. Esparza certified that 14 Worker had “debilitating” medical conditions (painful peripheral neuropathy and 15 severe chronic pain) and that Worker had “current unrelieved symptoms that have 16 failed other medical therapies.” Dr. Esparza stated that the “benefits of medical 17 marijuana outweigh the risk of hyper doses of narcotic medications.” 18 {6} On May 30, 2013, Dr. Stephen I. Rosenberg, after a medical consultation as a 19 second doctor required for certification of Worker’s re-enrollment, also signed a

1 certification form for Worker’s re-enrollment in the program, listing Worker’s 2 condition as severe chronic pain and making essentially the same certifications as Dr. 3 Esparza. On July 31, 2013, Joel Gelinas, a physician’s assistant in Dr. Esparza’s 4 office, also signed a certification form for Worker’s re-enrollment in the program. He 5 listed Worker’s condition as severe chronic pain and certified that Worker’s condition 6 was debilitating and that “standard treatments have failed to bring adequate relief.” 7 {7} After trial, conducted on August 8, 2013, the WCJ found that Worker’s 8 authorized health care provider was Dr. Esparza and physician’s assistant Joel 9 Gelinas and that “the office of Dr. Esparza” had recommended Worker “as a 10 candidate for medical marijuana under the Compassionate Use Act.” The WCJ 11 concluded that Worker’s use of medical marijuana under the program constituted 12 reasonable and necessary medical care and required Employer to reimburse Worker 13 for the receipts she submitted for her certified purchases. Employer filed this appeal. 14 REASONABLE AND NECESSARY MEDICAL CARE 15 {8} As its first main argument, Employer challenges the sufficiency of the evidence 16 supporting the WCJ’s conclusion that Worker’s use of medical marijuana constituted 17 reasonable and necessary medical care. Employer asserts this challenge in two ways, 18 arguing that (1) “[t]he record does not support [the WCJ’s] finding that [W]orker was 19 recommended as a candidate for medical marijuana under the [C]ompassionate [U]se

1 [A]ct through the office of Dr. Esparza” and (2) the WCJ “went outside” the Workers’ 2 Compensation Act and interpreting case law “to rely on testimony by an unauthorized 3 provider” to make its finding of reasonable and necessary care. 4 Testimony of an Unauthorized Provider 5 {9} We first address Employer’s argument that the WCJ improperly relied on the 6 testimony of an unauthorized health care provider in determining that Worker’s use 7 of medical marijuana constituted reasonable and necessary medical care. In this 8 regard, Employer contends that because Worker needed the certification of two health 9 care professionals to be able to use medical marijuana under the Compassionate Use 10 Act, the WCJ necessarily relied on the certification of Dr. Rosenberg in the WCJ’s 11 determination of the necessity of medical marijuana care. Thus, according to 12 Employer, the WCJ improperly considered the certification of Dr. Rosenberg who 13 was not qualified to present testimony under the Workers’ Compensation Act because 14 he was neither Worker’s authorized health care provider nor a health care provider 15 authorized to perform an IME. See § 52-1-51(C) (“Only a health care provider who 16 has treated the worker . . . or the health care provider providing the independent 17 medical examination . . . may offer testimony at any workers’ compensation hearing 18 concerning the particular injury in question.”).

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Lewis v. Am. Gen. Media, 2015 NMCA 090, 8 N.M. Ct. App. 454 (N.M. Ct. App. 2015).

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