Smith, Angel v. TrustPoint Hospital, LLC

2021 TN WC App. 44
CourtTennessee Workers' Compensation Appeals Board
DecidedJanuary 6, 2021
Docket2018-05-1098
StatusPublished

This text of 2021 TN WC App. 44 (Smith, Angel v. TrustPoint Hospital, LLC) is published on Counsel Stack Legal Research, covering Tennessee Workers' Compensation Appeals Board primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Smith, Angel v. TrustPoint Hospital, LLC, 2021 TN WC App. 44 (Tenn. Super. Ct. 2021).

Opinion

FILED Jan 06, 2021 10:17 AM(CT) TENNESSEE WORKERS' COMPENSATION APPEALS BOARD

TENNESSEE BUREAU OF WORKERS’ COMPENSATION WORKERS’ COMPENSATION APPEALS BOARD

Angel Smith ) Docket No. 2018-05-1098 ) v. ) State File No. 894-2018 ) TrustPoint Hospital, LLC, et al. ) ) ) Appeal from the Court of Workers’ ) Compensation Claims ) Robert V. Durham, Judge )

Affirmed and Remanded

In this interlocutory appeal, the employer asserts the trial court erred in ordering it to provide additional medical benefits as recommended by the authorized treating physician, arguing that the need for additional surgery arose primarily from the employee’s pre- existing medical condition. The employer further asserts the trial court erred in awarding temporary partial disability benefits pending a final determination of maximum medical improvement or the employee’s return to work. Upon careful review of the record, we affirm the trial court’s order and remand the case.

Presiding Judge Timothy W. Conner delivered the opinion of the Appeals Board in which Judge David F. Hensley and Judge Pele I. Godkin joined.

Marcia Dawn McShane, Nashville, Tennessee, for the employer-appellant, TrustPoint Hospital, LLC

R. Stephen Waldron, Murfreesboro, Tennessee, for the employee-appellee, Angel Smith

Factual and Procedural Background

Angel Smith (“Employee”) worked as a certified nursing assistant at a medical facility operated by TrustPoint Hospital, LLC (“Employer”). On December 31, 2017, Employee was helping a nurse move a patient when she felt a pop in her left shoulder. She reported the incident to Employer and received emergency care at a local hospital. Thereafter, she was evaluated by Dr. Frank Thomas at Concentra, who prescribed medications and ordered physical therapy and an MRI of her shoulder. Dr. Thomas noted in his January 4, 2018 report that Employee was “not tolerating therapy well.” He

1 diagnosed left shoulder impingement syndrome and recommended a referral to an orthopedic specialist.

The left shoulder MRI was interpreted as revealing “rotator cuff tendinosis/tendinopathy” with “minimal partial-thickness articular surface and bursal surface tears.” In his January 16 note, Dr. Thomas reiterated his request for a referral to an orthopedic specialist. Employer provided a panel of orthopedic physicians, from which Employee selected Dr. Kyle Joyner with Tennessee Orthopedic Alliance.

Employee first saw Dr. Joyner on February 7, 2018. Following his initial evaluation and review of diagnostic reports, Dr. Joyner diagnosed left shoulder pain “with presumptive aggravation of the AC joint, with a component of underlying impingement.” He injected medication into Employee’s shoulder and prescribed an additional course of physical therapy. During a March 6 visit, Employee reported no significant improvement with the previous injection or continued therapy. Dr. Joyner discussed the possibility of surgical intervention and Employee agreed.

On March 9, 2018, Employer’s utilization review (“UR”) provider issued a report in which it declined to certify the requested surgery after the reviewing physician opined that objective findings did not support a conclusion that Employee had exhausted conservative treatment options. However, according to Dr. Joyner’s May 1, 2018 report, authorization for the surgery was eventually obtained, and he performed the surgery on May 7.

Following surgery, Dr. Joyner prescribed another course of therapy, but Employee attended only two of five appointments. In a June 17 discharge summary, the therapist noted decreased range of motion, weakness, and difficulties with lifting, reaching, and activities of daily living. However, in his June 19 report, Dr. Joyner noted good range of motion in the left shoulder and “good clinical function” in the rotator cuff. Due to “residual pain,” Dr. Joyner offered an injection, which Employee received. Dr. Joyner noted he was transitioning her to a home exercise program.

On July 1, 2018, Employee was seen at St. Thomas Rutherford Hospital’s emergency room complaining of severe shoulder pain at her incision site. X-rays did not reveal any evidence of fracture or dislocation. The attending physician diagnosed “post- surgical complications” and released her with a recommendation to follow up with her treating physician. Upon her return to Dr. Joyner on July 5, Employee complained of persistent shoulder pain but no radicular pain. Dr. Joyner noted “[s]he does have some longstanding numbness and tingling in the hand secondary to carpal tunnel that is unchanged,” but she had no complaints of neck pain. Dr. Joyner ordered another MRI of the shoulder.

2 The July 7 left shoulder MRI revealed “[s]mall partial-thickness bursal and articular surface tears” with rotator cuff tendinosis. The MRI report also noted “[s]evere AC joint osteoarthropathy with surrounding inflammation and AC joint effusion.” In a July 18 report, Dr. Joyner noted the MRI findings, which he felt were consistent with post-surgical inflammation. He injected Employee’s shoulder with a pain medication and documented her work restrictions. When she returned with persistent pain on August 21, Dr. Joyner again offered her an injection and noted that “[i]f her pain does not improve, we may give consideration to further intervention.”

During the next visit on September 18, 2018, Dr. Joyner discussed additional surgery due to “persistent pain in the AC joint.” He recommended proceeding with an “open AC joint left shoulder decompression and possible interposition.” Employer submitted this request to its UR provider and, in a report dated September 21, 2018, the reviewing physician recommended the surgery not be certified. The reviewing physician concluded there were “limited objective findings to support the request for surgery” and that “[q]uantifiable [range of motion] and provocative testings were not presented.” The UR non-certification was appealed to the Tennessee Bureau of Workers’ Compensation’s Medical Director’s office, where it was reviewed by Dr. James Talmage. In an October 8, 2018 letter, Dr. Talmage upheld the UR denial but suggested that the treating physician:

[R]esubmit this care to Utilization Review documenting presence of rheumatologic disease, and what joints are active, labs for inflammatory disease, re-examination during pharmacologic activity of local anesthetic injection into AC joint area, and documentation of psychiatric status.

There is nothing in the record indicating that Dr. Joyner re-submitted the recommended surgical treatment to UR. In his October 17 report, Dr. Joyner reiterated his recommendation for surgery because “[c]onservative care to this point has failed regarding continued pain in the AC joint.”

On February 18, 2019, Dr. Joyner responded to a questionnaire from Employee’s attorney by stating he had not had the opportunity to review previous diagnostic test results or make a comparison of pre-accident and post-accident MRIs of the left shoulder. He explained he could not provide an opinion regarding permanent impairment but stated he believed Employee had reached maximum medical improvement (“MMI”). He further noted that permanent restrictions would be addressed through a functional capacity evaluation (“FCE”) and that permanent impairment would be addressed after completion of the FCE. He also provided the following causation statement: “[G]iven her history, it is likely that her most recent injury has exacerbated the condition of her shoulder necessitating further treatment at this time.”

3 Thereafter, an FCE was completed on March 20, 2019, which indicated Employee was capable of functioning in the sedentary physical demand category. The therapist noted that Employee gave “acceptable/good effort” and that her pain profile was “moderate to high.” In his subsequent April 2 report, Dr.

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2021 TN WC App. 44, Counsel Stack Legal Research, https://law.counselstack.com/opinion/smith-angel-v-trustpoint-hospital-llc-tennworkcompapp-2021.