Wyatt v. Rescare Home Care

81 A.3d 1253, 2013 WL 6097901, 2013 Del. LEXIS 591
CourtSupreme Court of Delaware
DecidedNovember 20, 2013
DocketNo. 112, 2013
StatusPublished
Cited by27 cases

This text of 81 A.3d 1253 (Wyatt v. Rescare Home Care) is published on Counsel Stack Legal Research, covering Supreme Court of Delaware primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Wyatt v. Rescare Home Care, 81 A.3d 1253, 2013 WL 6097901, 2013 Del. LEXIS 591 (Del. 2013).

Opinion

HOLLAND, Justice:

The claimant-appellee and cross-appellant-appellant, Amanda Wyatt (“Wyatt” or the “Claimant”), appeals from a Superior Court judgment reversing an Industrial Accident Board (the “Board”) finding that she had a compensable, work-related injury. The employer-appellant and cross-ap-pellee-appellee is Wyatt’s former employer, Rescare Home Care (“Rescare”). Wyatt raises two claims on appeal. First, she contends the Superior Court erred in reversing the Board’s decision that her injury was a compensable industrial accident, since the Board’s decision was based upon substantial evidence. Second, she submits that the Board erred in denying the medical expenses for her emergency back surgery.

We have concluded that the Superior Court erred in reversing the Board’s decision that the Claimant had a compensable work related injury. We have also concluded that the Board properly determined that her back surgery was not compensa-ble. Therefore, the judgment of the Superior Court is reversed.

Facts

The facts as found by the Board are as follows. The Claimant worked for Rescare as a certified nursing assistant for four to five years before she was injured. She primarily worked with a five-year-old boy, Isaac, who was completely dependent upon her. In addition to other duties, Claimant was charged with bathing, feeding, and transferring Isaac from his chair to his stand or to the floor and back, all without assistance. The Claimant would perform transfers of Isaac throughout the day while attending to him at school, as well as at Isaac’s home three days per week. [1257]*1257Isaac weighed about fifty-five pounds at the time of the accident.

The Claimant began experiencing lower back pain on October 21, 2010 when she bent over to pick to something up in her home. After trying to work through the pain, she was eventually forced to go to the emergency room. She was diagnosed with a pulled muscle and given a prescription for both muscle relaxers and pain medication. No tests were ordered, and the Claimant did not attempt to seek further treatment at that time.

On Friday, December 10, 2010, the Claimant began experiencing lower back pain again. She thought it was simply the result of frequent work. She did not work that weekend, and took off an additional day on Monday, December 13, 2010 to rest.

On Wednesday, December 15, 2010, the Claimant met Isaac at his school in order to resume her work duties, though her lower back pain continued. When she transferred Isaac for lunch, the Claimant’s back pain ceased, but her leg went numb and she felt the urgency to urinate. She headed immediately for a restroom, and was witnessed by a school physical therapist to be dragging her left foot, which was numb. Her whole perineal area was numb when using the restroom.

The Claimant called her mother, who works for a general surgeon’s office. The Claimant’s mother relayed the above symptoms to Dr. Tatineni, one of the surgeons for whom the Claimant’s mother works. Dr. Tatineni said that the Claimant needed to see Dr. Balapur Venkatara-mana (“Dr. Venkataramana”), who is a neurosurgeon, right away. When an appointment could not be had before Monday, December 20, 2010, Dr. Tatineni called Dr. Venkataramana directly, and Dr. Venkataramana agreed to see the Claimant on Friday, December 17, 2010.

While in Dr. Venkataramana’s waiting room on Friday, December 17, 2010, Dr. Venkataramana’s receptionist overheard the Claimant speaking to her mother about work, and informed the Claimant and her mother that Dr. Venkataramana does not take workers’ compensation cases. She also informed the Claimant that if her case was a workers’ compensation claim, she would have to go elsewhere for treatment. The Claimant, fearful that she would not be able to be seen immediately by another doctor, told Dr. Venkataramana that the numbness began when she woke up, rather than when lifting Isaac, in order to receive treatment.

Dr. Venkataramana sent the Claimant to have an MRI, x-rays, and blood work in the same building and told her not to leave. Subsequently, he told the Claimant to meet him the next morning, Saturday, December 18, 2010, at Beebe hospital so that he could read the MRI. During that visit, Dr. Venkataramana informed the Claimant that she needed to have surgery the next day. Dr. Venkataramana performed spinal surgery on Sunday, December 19, 2010.

After the surgery, the Claimant told Dr. Venkataramana that the onset of the numbness actually occurred while lifting Isaac at school. After reviewing the Claimant’s medical history and records, including the medical examination performed by defense expert, Dr. Kevin Han-ley, Dr. Venkataramana testified during his deposition that the type of work that the Claimant does caused the disc herniation, and that cauda equina syndrome was the result. Dr. Venkataramana also testified that the Claimant could not have had the disc herniation and cauda equina syndrome before December 15, 2010, because she would not have been able to work [1258]*1258through the pain associated with the type of injury sustained that day.

The Claimant submitted to an examination by Dr. Hanley, an expert medical witness for the defense. Dr. Hanley agreed that lifting Isaac could have caused the Claimant’s injury, and also agreed that if the Claimant’s testimony regarding the lifting incident on December 15, 2010 is taken as true, then a work accident caused her herniated disc rupture. Because the Claimant initially did not tell Dr. Venka-taramana about the incident, however, Dr. Hanley opined that her injury was more likely caused by gradual onset due to sneezing, standing up, or bending over at home. Furthermore, Dr. Hanley denied that the Claimant had cauda equina syndrome, since her pain was mainly on the left side of her lower back.

Procedural History

The Claimant filed a Petition to Determine Compensation Due seeking acknowl-edgement that her lower back injury was a compensable industrial injury on June 10, 2011. The Board issued its decision on the merits on February 3, 2012, which: 1) made its findings of fact; 2) granted the Claimant’s petition; and 3) awarded her payment of medical bills, payment of total disability benefits from December 15, 2010 to February 1, 2011 at $364.33 per week, and attorney’s fees in the amount of $8,000.

Rescare filed a Motion for Reargument on the award of medical bills, on the basis that Dr. Venkataramana cannot be compensated under title 19, section 2322D of the Delaware Code because he is an instate provider who is not certified under the Health Care Payment system and did not obtain preauthorization for the treatments he provided. The Board agreed with Rescare, finding that the “emergency' exception” to title 19, section 2322D of the Delaware Code did not apply, and that Dr. Venkataramana’s services were not com-pensable. Nevertheless, the Board found that the Claimant’s other medical expenses would be compensable pending the submission of “clean claims.”

The Claimant and Rescare filed cross-appeals with the Delaware Superior Court. The Superior Court held that the Board erred when it found causation, i.e., that the Claimant’s injury was a compensable industrial accident, because there was not sufficient evidence in the record to support such a finding. The Superior Court placed particular emphasis on the fact that, in its view, Dr. Venkataramana was not aware at the time that he rendered his expert opinion that the Claimant’s injury occurred while lifting Isaac.

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Cite This Page — Counsel Stack

Bluebook (online)
81 A.3d 1253, 2013 WL 6097901, 2013 Del. LEXIS 591, Counsel Stack Legal Research, https://law.counselstack.com/opinion/wyatt-v-rescare-home-care-del-2013.