Rael v. Wal-Mart Stores, Inc.

871 P.2d 1, 117 N.M. 237
CourtNew Mexico Court of Appeals
DecidedFebruary 2, 1994
DocketNo. 14749
StatusPublished
Cited by7 cases

This text of 871 P.2d 1 (Rael v. Wal-Mart Stores, Inc.) is published on Counsel Stack Legal Research, covering New Mexico Court of Appeals primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Rael v. Wal-Mart Stores, Inc., 871 P.2d 1, 117 N.M. 237 (N.M. Ct. App. 1994).

Opinion

OPINION

BLACK, Judge.

Jonathan Rael (“Worker”) injured his back and herniated two discs in an on-the-job accident. Worker’s back did not improve and his doctor, Peter Stern, M.D., proposed a disco-gram and excision of the abnormal discs. Worker decided against surgery. Dr. Stern then prepared a report indicating that, in the absence of surgery, Worker had reached maximum medical improvement (“MMI”). At the hearing on the merits, the record indicated Worker had a physical impairment rating of 18% and the Worker’s Compensation Judge (“WCJ”) calculated compensation to be 26%, pursuant to the Workers’ Compensation Act of 1990, NMSA 1978, Sections 52-1-1 through 52-10-1 (Repl.Pamp.1991) (“the Fourth Act”). Worker argues the WCJ erred in his interpretation and application of Section 52-1-24.1 (maximum medical improvement) and Section 52-1-51(1) (effective January 1, 1991) (refusal of medical treatment) of the Fourth Act. We disagree and affirm.

MAXIMUM MEDICAL IMPROVEMENT

Worker argues that the WCJ erred in finding Worker had reached MMI on February 10, 1992. Worker relies on Dr. Stern’s testimony that Worker’s condition without surgery would probably disintegrate to the extent that he could not bear the pain and then would elect to have the surgery, to support his argument that he cannot be found to have reached MMI prior to the time he decides to have surgery. We disagree. Such an interpretation of the Act would allow a worker to choose the pace of medical treatment designed to produce MMI. We do not believe the Legislature contemplated granting a worker control over scheduling when he will achieve MMI, and the resulting reevaluation of total disability. Cf. § 52-1-26(A) (every worker who suffers compensable injury “should be provided with the opportunity to return to gainful employment as soon as possible with minimal dependence on compensation awards”).

As a part of the Fourth Act, the Legislature adopted the following definition of MMI:

[The] “date of maximum medical improvement” means the date after which further recovery from or lasting improvement to an injury can no longer be reasonably anticipated based upon reasonable medical probability as determined by a health care provider defined in Subsection C, E or G of Section 52-4-1 NMSA 1978.

Section 52-1-24.1. Based on this statute, we agree with Worker’s counsel that “[t]he sole inquiry is whether there is a probability of further recovery or lasting medical improvement.” However, reasonable medical probability can only be given in reference to a definable period of time. Dr. Stern’s testimony in response to his understanding of the meaning of the term “maximum medical improvement” is enlightening in this regard:

A I think the legal profession asks us doctors to say, “Doctor, is this patient as good as he’s going to get in this particular time frame.” And that’s what I understand maximum medical improvement to mean. It’s a useful concept for clearing litigation and for awarding damages. And I subscribe to it in the sense that if I’m asked is this patient as good as he’s going to be, at this point in time, and for the foreseeable one to three years, if I feel that is the case, I "«411 say the patient is at maximum medical improvement.
Q As I understand your definition of maximum medical improvement, does that mean that he’s reached a plateau in his treatment and won’t get better or worse over the next year to three years?
A I think it is a judgment call. I don’t think much will happen in an individual who is at maximum medical improvement. He may have variation from week to week but, generally, the impairment percentage won’t change. That’s the best. And we’re betting, to some extent, on chance because, certainly, any individual can turn quickly in response to his name and, at the same time, sneeze and at the same time find himself holding a pail of water because his helper abandoned him and his disc could slip out much more. And that could be three days after a respected orthopedic surgeon says an individual is at maximum medical improvement. So, what we’re really saying is, the chances are that a given patient will be about like as he was now, which I think in the context of maximum medical improvement means a year or two.

We cannot say Dr. Stern’s understanding is inconsistent "with the definition of MMI contained in Section 52-1-24.1. Dr. Stern testified that, without surgery, Worker had reached MMI as of February 10, 1992. This is sufficient basis for the WCJ’s conclusion that Worker had reached MMI as of that date.

Worker further argues that Dr. Stern testified that Worker is likely to receive lasting improvement from three forms of nonsurgical treatment. We do not believe that Dr. Stern’s testimony, taken as a whole, supports such a conclusion. It is certainly true Dr. Stern recognized that “a fitness program would likely improve [Worker’s] situation and decrease his percentage of impairment.” However, Dr. Stern was realistic about the potential for a patient like Worker to successfully complete such a fitness program. He testified, for example:

A I’m talking about fitness where he becomes a conditioned individual either through bicycling, water aerobics, step aerobics or aerobic dancing with rapid walking. I would not recommend long-distance running for this individual. I’m talking about a fitness program where he trims his fat down, increases his percentage of musculature and leanness and builds muscle around his trunk and abdomen so that things stay in place, so to speak.
In our experience, if you can get an individual who is not fit to become fit, athletically fit, the results are quite encouraging. But it takes a lot of work and a lot of cooperation on the part of the patient. Here’s an individual with low back problems and we’re telling him, “We want you to exercise more, do this and this.” Sometimes it’s just not possible. The patients hurt too much to do sit-ups. They cannot bicycle. If they walk for more than 10 or 15 minutes, they have pain. But, in the best of all situations, when you can get someone fit, the pain perception decreases. Their tolerance of such conditions, as we talked about, increases.
Q Is that something you recommend Mr. Rael try?
A It’s worth a try.

If anything, this testimony reinforces Dr. Stern’s conclusion that MMI is not a totally static concept. If Worker should successfully engage in such physical conditioning, it may affect Dr. Stern’s conclusion that Worker will probably choose surgery within the next five to ten years and it could also lead to Employer filing a motion to decrease benefits. However, as Employer points out, even under the best scenario, including surgery, Dr. Stern estimated Worker’s physical impairment is only likely to decrease from 18% to 14% and Worker would still probably only be able to engage in the same type of medium-duty employment for which Dr. Stern previously provided a release. Therefore, the fact that the physician supervising Worker’s fitness program had not released Worker to return to work as of February 10, 1992 does not invalidate the foundation for the WCJ’s finding.

REFUSAL OF MEDICAL TREATMENT

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Bluebook (online)
871 P.2d 1, 117 N.M. 237, Counsel Stack Legal Research, https://law.counselstack.com/opinion/rael-v-wal-mart-stores-inc-nmctapp-1994.