O'Guinn v. Little River Memorial Hospital

Citations: 2013 Ark. App. 593; 430 S.W.3d 150; 2013 WL 5740987; 2013 Ark. App. LEXIS 610Docket: CV-13-540

Court: Court of Appeals of Arkansas; October 23, 2013; Arkansas; State Appellate Court

Original Court Document: View Document

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Patsy Ann O’Guinn, a nurse’s aide, appealed a decision by the Arkansas Workers’ Compensation Commission regarding her request for a change of physician following the death of Dr. Harold Chakales, her treating orthopedic surgeon. O’Guinn had sustained a compensable back injury on May 29, 2009, and was initially treated by Dr. Kenneth Rosenzweig before changing to Dr. Chakales in 2010. After Dr. Chakales's death, O’Guinn sought to change her physician to Dr. Vestal Smith, but the Medical Cost Containment Division denied the request, stating that a ruling from an administrative law judge was necessary to establish her entitlement to additional benefits.

A hearing was held on October 4, 2012, to determine O’Guinn's eligibility for permanent partial-disability benefits and additional medical treatment. The administrative law judge denied her claims, a decision later affirmed by the Commission. O’Guinn argued that the Commission’s decision lacked substantial evidence, relied on unproven facts, and contained legal errors. 

The Arkansas Court of Appeals affirmed the denial of her claim for permanent partial impairment but reversed the denial of her request for additional medical treatment. The court ordered the Commission to grant her change-of-physician request, emphasizing that under Arkansas law, an injured employee has a statutory right to one change of physician and that employers must provide necessary medical services related to the injury. The court clarified that without an initial visit to the new physician, it would be impossible to determine the necessity of further treatment. Evidence considered included O’Guinn's medical records, her testimony, and correspondence from her previous doctors.

On March 20, 2010, Dr. Chakales expressed difficulty in assessing Ms. O’Guinn's injuries due to her inconsistent performance on a functional capacity exam conducted on March 3, 2010. In an office note dated October 19, 2011, he noted that Ms. O’Guinn had not received an MRI since 2009 and intended to schedule one. During her last visit on November 30, 2011, he indicated that the MRI request had not been approved and that she needed no pain medication. Ms. O’Guinn testified that she never received the MRI and continued to experience muscle tightness and worsening back pain, managing it with over-the-counter medication. She requested a change of physician to Dr. Smith, emphasizing her need for the MRI.

The Commission determined that Ms. O’Guinn did not prove that additional medical treatment was necessary for her compensable injury, making her request for a new physician moot. It noted that she had previously received a one-time change of physician to Dr. Chakales in 2010, whose treatment was covered by the respondents until his death in late 2011. The respondents contested the need for additional benefits after Dr. Chakales’s passing. The Commission concluded that Ms. O’Guinn failed to demonstrate by credible evidence that further treatment was necessary and denied her request for a substituted change of physician.

Despite an MRI revealing an annular tear and Dr. Chakales documenting muscle spasms, the Commission found that Ms. O’Guinn had pre-existing back issues and her inconsistent performance affected her credibility. No physician assigned her a permanent impairment rating, leading to the conclusion that her current conditions were not causally related to her 2009 injury. The Commission referenced previous case law, clarifying that the employer cannot evade responsibility for a change of physician based on claims that additional treatment is unnecessary.

Ms. Keys was authorized to change her physician to Dr. Chakales, who diagnosed her with chronic pain syndrome and prescribed medication during an initial visit on August 5, 2009. Although Wal-Mart covered this visit, it disputed further treatment expenses. Ms. Keys later sought unauthorized treatment from Dr. James Hawk due to Dr. Chakales's deteriorating health. Following Dr. Chakales's death on December 13, 2011, the Commission ruled that the change of physician order was nullified, allowing Ms. Keys to change to Dr. Hawk as if the initial change had never occurred. Upon appeal, the court affirmed the Commission's decision, agreeing that Ms. Keys was statutorily entitled to treatment, which was disrupted by Dr. Chakales's incapacity and death. 

In a parallel case regarding Ms. O’Guinn, the court found that the Commission erred by not granting her a change of physician after Dr. Chakales's death, entitling her to change to Dr. Smith. The summary also outlines the legal standard for permanent benefits, requiring that the compensable injury be the major cause of any permanent impairment or disability. It specifies that permanent impairment must be assessed based on objective medical findings, excluding subjective complaints of pain. Ms. O’Guinn contended that her preexisting condition did not affect the claim's compensability and that she had not reached maximum medical improvement, warranting further assessment of her condition. The Commission has the authority to evaluate medical evidence and assign impairment ratings using the AMA Guides.

Credibility is determined by the Commission, which may deny a claim if the claimant fails to meet the burden of proof, as established in Singleton v. City of Pine Bluff and Hamilton v. Gregory Trucking. In this case, the Commission recognized that Ms. O’Guinn’s 2009 lumbar MRI showed an annular tear and that muscle spasms were noted by Dr. Chakales. However, no physician provided her with a permanent impairment rating, and she acknowledged having preexisting back symptoms. The Commission found her credibility compromised due to inconsistencies in her functional capacity evaluation. Consequently, it ruled that Ms. O’Guinn did not prove that her annular tear or muscle spasms were causally related to her 2009 injury, leading to the affirmation of the denial of her claim for permanent partial impairment. The decision was affirmed in part and reversed in part. Judge Whiteaker concurred, agreeing with the majority on granting Ms. O’Guinn a change-of-physician order. He suggested that the legislature should clarify the statute regarding situations where a claimant loses a physician through no fault of their own, particularly in cases involving a physician’s death or retirement, advocating for legislative action over judicial interpretation.