Scottsdale Memorial Hospital v. Industrial Commission

761 P.2d 169, 158 Ariz. 95, 16 Ariz. Adv. Rep. 18, 1988 Ariz. App. LEXIS 273
CourtCourt of Appeals of Arizona
DecidedAugust 30, 1988
Docket1 CA-IC 3796
StatusPublished
Cited by3 cases

This text of 761 P.2d 169 (Scottsdale Memorial Hospital v. Industrial Commission) is published on Counsel Stack Legal Research, covering Court of Appeals of Arizona primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Scottsdale Memorial Hospital v. Industrial Commission, 761 P.2d 169, 158 Ariz. 95, 16 Ariz. Adv. Rep. 18, 1988 Ariz. App. LEXIS 273 (Ark. Ct. App. 1988).

Opinion

OPINION

JACOBSON, Presiding Judge.

The primary issue raised by this review of an Industrial Commission award is whether inadequate notice under A.R.S. § 23-1062(A) of an imminent hospitalization, coupled with a failure to obtain authorization for a change of doctors under A.R.S. § 23-1071(B), operates to relieve a carrier for the costs of compensable medical care. Subsidiary issues include wheth *96 er claimant established to a reasonable medical probability that the industrial incident on April 23, 1986, was a substantial contributing cause of his depression and pain syndrome complex and whether the finding that claimant’s condition was not stationary was reasonably supported by the evidence.

On April 23,1986, Kirk A. McNatt (claimant) injured his lower back while riding in an elevator at Scottsdale Memorial Hospital when the elevator stopped suddenly several times. His claim for benefits was accepted by Argonaut Insurance Company (carrier), and claimant received conservative care from Dr. Donald W. Fischer, from May 5 to July 28, 1986. At that time Dr. Fischer released him to light work status. On July 28,1986, the carrier issued a notice of claim status placing claimant in a. temporary partial disability status effective that date.

Three days later, the carrier received a telephone call from St. Luke’s Medical Center seeking authorization to admit claimant to its Pain and Stress Center. The carrier refused to authorize the admission, but claimant was nevertheless admitted. At that time he was evaluated by Dr. Robert Barnes, a psychiatrist, and he also came under the care and treatment of Dr. Wayne S. Broky, a physiatrist. There is evidence that a Dr. Jones, a psychologist associated with the respondent employer, referred the claimant to the Pain and Stress Center. On August 22, 1986, the claimant requested a change of physician to Drs. Barnes and Broky. This request was granted by the carrier on August 27, 1986. He was hospitalized until September 10, was readmitted to the general psychiatric unit five days later because of depression, and was discharged on October 15.

Based upon an October 30 independent medical examination by the Southwest Disability Evaluation Center, the carrier issued a notice of claim status terminating claimant's temporary compensation and active medical treatment as of October 30, and finding that he sustained no permanent impairment. Claimant timely protested both notices of claim status, and requested a § 23-1061(J) hearing regarding the carrier’s obligation to cover his initial hospitalization at St. Luke’s pain and stress center.

At the consolidated hearings held on these issues, claimant and five doctors testified. After the hearings, the administrative law judge resolved conflicts in the medical testimony and found that claimant was not stationary or able to return to work as of July 28, 1986, was not stationary as of October 30,1986, or at the time of the hearings, and was in need of additional treatment. He also adopted Dr. Barnes’ opinion that claimant’s depression and pain syndrome complex were directly related to the April 23, 1986, industrial episode. He ordered the carrier to pay for all of claimant’s hospitalizations.

Based upon a request for review, the administrative law judge issued supplemental findings. He found that the claim for benefits was not barred simply because some medical care was received before the written authorization was issued, and that Dr. Fischer and the petitioners authorized the transfer to claimant’s care to Drs. Barnes and Broky.

In addition, the administrative law judge found that lack of adequate notice under A.R.S. § 23-1062(A) was immaterial because petitioners failed to investigate claimant’s need for care until after he filed a request for benefits pursuant to A.R.S. § 23-1061(J). Finally, in response to petitioners’ argument that same-day notice of an imminent hospitalization was inadequate because it was not an emergency admission, he found it was “inferentially, if not factually, an emergency admission when a severely depressed and extremely anxious patient such as [claimant] is admitted to an in-patient psychiatric facility for treatment.”

On review, petitioners argue that claimant’s admission to the Pain and Stress Center was not an emergency; therefore, notice to the carrier was required. Moreover, it is claimed that benefits are automatically forfeited before a written authorization to change doctors is issued; that claimant did not prove that the industrial injury was a substantial contributing cause of his de *97 pression; and that the administrative law judge improperly and incorrectly interpreted an X-ray report to award continuing benefits when claimant was already stationary.

Written Authorization to Change Doctors and Adequacy of Notice

The relevant statute provides: “No employee may change doctors without the written authorization of the insurance carrier, the commission or the attending physician.” A.R.S. § 23-1071(B). Petitioners argue that a claimant automatically forfeits the right to any benefits for medical care received before written authorization to change doctors is issued. We turn first to the question whether medical and hospitalization costs incurred prior to written authorization to change physicians are collectible against the carrier.

In making this argument, the carrier relies primarily upon Kennecott Copper Corp. v. Industrial Commission, 115 Ariz. 184, 564 P.2d 407 (App.1977), in which this court held:

... that the failure of Perez to comply with the statutory requirements of § 23-1071 for obtaining authorization to change physicians cannot be waived by Commission Rule 57 or granted through retroactive application.

However, this language was interpreting the rights of claimants to change doctors under A.R.S. § 23-1070(E). This statute deals with self-providing employers who have elected to directly furnish the medical benefits required by the workers’ compensation act rather than paying workers’ compensation insurance premiums to insure the payment of such benefits. As pointed out in Arizona Public Service Co. v. Industrial Commission, 27 Ariz.App. 369, 555 P.2d 126 (1976), employees of such employers do not have an unrestricted right to choose their own doctors, because to do so would require the employer to provide double medical coverage — that provided directly and that provided to the employee’s own doctor — contrary to the clear statutory scheme for § 23-1070(E) employees.

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Cite This Page — Counsel Stack

Bluebook (online)
761 P.2d 169, 158 Ariz. 95, 16 Ariz. Adv. Rep. 18, 1988 Ariz. App. LEXIS 273, Counsel Stack Legal Research, https://law.counselstack.com/opinion/scottsdale-memorial-hospital-v-industrial-commission-arizctapp-1988.