State Ex Rel. Newark Group v. Indus. Comm., Unpublished Decision (5-5-2005)

2005 Ohio 2201
CourtOhio Court of Appeals
DecidedMay 5, 2005
DocketNo. 04AP-594.
StatusUnpublished

This text of 2005 Ohio 2201 (State Ex Rel. Newark Group v. Indus. Comm., Unpublished Decision (5-5-2005)) is published on Counsel Stack Legal Research, covering Ohio Court of Appeals primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
State Ex Rel. Newark Group v. Indus. Comm., Unpublished Decision (5-5-2005), 2005 Ohio 2201 (Ohio Ct. App. 2005).

Opinion

DECISION
ON OBJECTIONS TO MAGISTRATE'S DECISION
{¶ 1} Relator, The Newark Group, Inc., commenced this original action requesting a writ of mandamus that orders respondent Industrial Commission of Ohio (1) to vacate its order authorizing arthroscopic surgery for diagnostic purposes, as well as post-surgery physical therapy twice a week for four weeks following surgery for respondent Rick R. Barnett ("claimant"), and (2) to deny the request in its entirety as not supported by some evidence in the commission's record.

{¶ 2} Pursuant to Civ.R. 53 and Section (M), Loc.R. 12 of the Tenth Appellate District, this matter was referred to a magistrate who issued a decision, including findings of fact and conclusions of law. (Attached as Appendix A.) In her decision the magistrate determined the commission reviewed all the evidence in the record, and the evidence in the record supports its decision and order. Accordingly, the magistrate concluded the requested writ should be denied.

{¶ 3} Relator has filed objections to the magistrate's decision:

Newark objects to the Magistrate's characterization of the January 21, 2004 C-9 request for arthroscopic surgery and post-surgery therapy and the January 21, 2004 report of Dr. Berasi as some evidence to support the Industrial Commission's decision authorizing surgery. Put simply, Dr. Berasi only discusses surgical intervention for non-allowed conditions. Additionally, the remaining reports relied upon by the Industrial Commission speak only in terms of treating Barnett's allowed conditions with conservative measures. Beyond that, the Magistrate failed to consider the entire record, which includes the opinions of Dr. Finneran and Dr. Middaugh that arthroscopic surgery is not reasonable or appropriate in relation to the allowed conditions.

{¶ 4} Relator does not object to the magistrate's findings of fact, and we adopt those as our own. According to those facts, claimant sustained an injury at work on February 21, 2000, and his claim was allowed for "sprained left knee and leg; torn left lateral and medial meniscus; left chondromalacia patellae." (Magistrate's Decision, ¶ 15.) Claimant underwent arthroscopic knee surgery on April 21, 2000 and again on November 9, 2000, both under the care of Carl C. Berasi, D.O. Because claimant continued to experience pain, he was examined by a variety of doctors, including Dennis J. Taylor, M.D., David C. Randolph, M.D., Ira J. Ungar, M.S., M.D., James Kemper, D.O., and Susan Crapes, M.D.; on November 26, 2003, claimant again consulted with Dr. Berasi.

{¶ 5} Subsequent to his consultation with claimant, Dr. Berasi requested an MRI, which relator approved. Following the January 14, 2004 MRI, Dr. Berasi filled out a C-9 dated January 21, 2004 seeking for claimant pre-surgery testing, arthroscopic surgery for the left knee, and physical therapy for four weeks following the surgery; Dr. Berasi's C-9 failed to list the ICD codes regarding the treating diagnosis. Dr. Berasi's January 21, 2004 report to Dr. Crapes, however, noted his assessment as "degenerative arthritis, left knee — ICD code 715.16" and "probable loose bodies — ICD code 717.9."

{¶ 6} Because relator, a self-insured employer, initially denied the request, claimant filed a motion which was heard before a district hearing officer. The district hearing officer granted the request, and a staff hearing officer issued an order affirming the district hearing officer's order.

{¶ 7} In essence, relator's objections assert the staff hearing officer's order is not supported by some evidence in the record. The staff hearing officer's order specifies reliance on the (1) C-9's dated January 21, 2004 and December 16, 2003, (2) the December 16, 2003 report of Dr. Crapes, (3) the January 21, 2004 report of Dr. Berasi, and (4) the July 8, 2003 office note of Dr. Kemper.

{¶ 8} The December 16, 2003 C-9 of Dr. Crapes lists the appropriate ICD codes that correspond to the allowed conditions, but her request was not for pre-surgery testing, arthroscopic surgery of the left knee, and follow-up physical therapy; instead she sought medical management and visits for claimant. While Dr. Berasi's January 21, 2004 C-9 sought pre-surgery testing, arthroscopic surgery, and follow-up physical therapy for claimant, Dr. Berasi's C-9 fails to list any treating diagnosis or ICD codes. Thus, neither C-9 supports the staff hearing officer's order authorizing the requested testing, surgery, and physical therapy for claimant.

{¶ 9} The staff hearing officer also relied on the December 16, 2003 report of Dr. Crapes. Her report discusses claimant's condition and sets a course of treatment involving refills of medications, a coupon for a consultation regarding bariatric surgery, and periodic visits at her office. While she mentioned the allowed conditions here, her report does not recommend the procedures authorized under the staff hearing officer's order.

{¶ 10} The staff hearing officer also cited the January 21, 2004 report of Dr. Berasi as supporting authorization for the treatment claimant requested. Dr. Berasi's report, however, cites two ICD codes, one for degenerative arthritis of the left knee and the other for possible loose bodies, neither of which correspond to the allowed conditions arising from relator's work injury. Indeed, the commission notes that Dr. Berasi addresses conditions that "are not related to the allowed conditions." (Memorandum in Support of Magistrate's Decision, 3.)

{¶ 11} The commission nonetheless contends the existence of contributing non-allowed conditions is not a legitimate reason for refusing to pay for the requested treatment. While contributing non-allowed conditions may not be a legitimate reason for refusing the treatment, Dr. Berasi's report lacks the necessary causal link between the allowed conditions and the requested treatment. Accordingly, his report is not some evidence on which the staff hearing officer could rely to grant the requested treatment. Although the staff hearing officer also relied on the July 2003 office notes of Dr. Kemper, those notes do not suggest that the problem the doctor considered in that visit requires the requested treatment.

{¶ 12} In the final analysis, the evidence before the staff hearing officer did not support the order the staff hearing officer issued. Because none of the evidence cited in the staff hearing officer's order is some evidence supporting the order, we sustain relator's objections.

{¶ 13} Following independent review pursuant to Civ.R. 53, we find the magistrate has properly determined the pertinent facts, and we adopt those as our own. For the reasons set forth in this decision, however, we reject the magistrate's conclusions of law and instead, consistent with this decision, issue a writ of mandamus ordering the Industrial Commission to vacate the May 3, 2004 order of its staff hearing officer granting the requested medical treatment, and to issue an order denying the request for a lack of supporting evidence in the commission's record.

Objections sustained; writ granted.

Klatt and Bowman, JJ., concur.

Bowman, J., retired, of the Tenth Appellate District, assigned to active duty under authority of Section 6(C), Article IV, Ohio Constitution.

APPENDIX A

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Bluebook (online)
2005 Ohio 2201, Counsel Stack Legal Research, https://law.counselstack.com/opinion/state-ex-rel-newark-group-v-indus-comm-unpublished-decision-5-5-2005-ohioctapp-2005.