Evangelical Lutheran Good Samaritan Soc'y v. Rowland

2022 Ark. App. 322

652 S.W.3d 594

The EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY, Appellant/Cross-Appellee

v.Tara ROWLAND, Appellee/Cross-Appellant

No. CV-21-543

Court of Appeals of Arkansas, DIVISION I.

Opinion Delivered September 14, 2022

Worley, Wood & Parrish, P.A., by: Jarrod S. Parrish, Little Rock, for appellant/cross-appellee.

Frederick S. "Rick" Spencer, Mountain Home, for appellee/cross-appellant.

BART F. VIRDEN, Judge

The Evangelical Lutheran Good Samaritan Society (ELGSS) appeals the Arkansas Workers’ Compensation Commission's (Commission's) decision that Tara Rowland's 2014 work-related compensable injury is causally linked to her tooth decay and that her subsequent need for dental implants is also related to the injury. On cross-appeal, Rowland argues that the Commission erred in finding that her May 24, 2019 surgery was not a medical emergency. We affirm on both direct appeal and cross-appeal.

I. Relevant Factual History

On April 14, 2014, Tara Rowland, who was employed in patient care by ELGSS, was struck on the right side of her face by a patient while at work. One of Rowland's teeth was chipped, and an MRI showed that Rowland suffered a bilateral disc displacement and that there was "bone to bone contact in right TMJ." ELGSS accepted the injury as compensable. In April 2015, Dr. Kyle Wendfeldt and Dr. Scott Bolding recommended an initial surgery to stabilize the occlusion of her TMJ (temporomandibular joint), followed by orthodontic braces, and possibly orthognathic surgery after the braces were removed. Rowland underwent TMJ surgery and tooth repair, but the surgery did not stabilize the occlusion as hoped. After several attempts to stabilize the joint with splints, Dr. Kyle Wendfeldt and Dr. Bolding recommended going forward with braces and orthognathic surgery. ELGSS controverted the necessity of the braces and additional surgery, arguing that there was no causal connection between the compensable injury and the recommended treatment. In December 2016, the administrative law judge (ALJ) found the recommended treatment to be reasonably necessary in connection with Rowland's compensable injuries.¹ In 2017, Rowland began wearing braces; however, during the next two years, she developed dental caries, and in May 2019, her upper maxilla became infected. Due to the infection, Dr. Bolding determined that it was necessary to extract all of Rowland's upper teeth and on May 24 did so without seeking preauthorization for the procedure. In his June follow-up letter, Dr. Bolding recommended dental implants, an interim prosthesis while the implants were healing, and a final prosthesis after Rowland had healed. Dr. Bolding opined that Rowland's remaining lower teeth would also require extraction and dental implants, and he attributed her condition to the delays in treatment caused by ELGSS's controversion of her claim. ELGSS controverted the necessity of this treatment, arguing that there was no causal relationship between Rowland's 2014 injury and her dental caries and the subsequent extraction of her teeth and need for dental implants. ELGSS also contended that Rowland failed to obtain preauthorization for the May 24 surgery; thus, the procedure was not compensable. ELGSS argued that Rowland's dental caries were related to "dry mouth" caused by her use of opioids and other medications, kidney disease, and Sjögren's syndrome (a recently diagnosed autoimmune disorder.) Dr. Bolding testified by deposition that Rowland took opioids for the pain exacerbated by her delayed treatment and that he believed with a reasonable degree of medical certainty that the dental caries were related to her wearing braces for two years. The ALJ found that Rowland's dental caries were causally linked to her original injury, and the dental implants were reasonably necessary in connection with the compensable injury claim; however, the Commission found that Rowland was not entitled to the May 24 surgery and the costs related to that surgery because she failed to obtain preauthorization for the nonemergent procedure. ELGSS appealed the ALJ's decision, and the Commission affirmed. ELGSS timely filed their notice of appeal. Rowland timely filed her notice of cross-appeal.

II. Standard of Review

In appeals involving claims for workers’ compensation, the appellate court views the evidence in the light most favorable to the Commission's decision and affirms the decision if it is supported by substantial evidence. Prock v. Bull Shoals Boat Landing , 2014 Ark. 93, 431 S.W.3d 858. Substantial evidence is evidence that a reasonable mind might accept as adequate to support a conclusion. Id. The issue is not whether the appellate court might have reached a different result from the Commission but whether reasonable minds could reach the result found by the Commission. Id. Additionally, questions concerning the credibility of witnesses and the weight to be given to their testimony are within the exclusive province of the Commission. Id. When there are contradictions in the evidence, it is within the Commission's province to reconcile conflicting evidence and determine the facts. Wilson v. Smurfit Stone Container , 2009 Ark. App. 800, 373 S.W.3d 347. Finally, this court will reverse the Commission's decision only if it is convinced that fair-minded persons with the same facts before them could not have reached the conclusions arrived at by the Commission. Prock , supra.

III. Direct Appeal

A. Whether the Commission Arbitrarily Ignored Medical Evidence that Rowland's Tooth Decay was Due to Noninjury-Related Reasons

ELGSS asserts that the Commission ignored evidence of Rowland's history of preinjury opioid use and continued opioid use, opioid withdrawal medication, kidney disease, and Sjögren's syndrome. We disagree.

Arkansas Code Annotated section 11-9-508(a) (Supp. 2021) requires an employer to provide medical services that are reasonably necessary in connection with the compensable injury. A claimant bears the burden of establishing by a preponderance of the evidence that the treatment is reasonable and necessary and bears a causal connection to the work injury. Cossey v. Pepsi Beverage Co. , 2015 Ark. App. 265, at 3, 460 S.W.3d 814, 817. Though causation need not be proved by medical-opinion evidence, when a claimant relies on medical opinion, that opinion must be stated within a reasonable degree of medical certainty. Ark. Code Ann. § 11-9-102(16) (Repl. 2012). Medical opinions based on "could," "may," or "possibly" lack the definiteness required to prove compensability. Frances v. Gaylord Container Corp. , 341 Ark. 527, 20 S.W.3d 280 (2000). Our law is clear that the Commission has the duty of weighing medical evidence, and if the evidence is conflicting, its resolution is a question of fact for the Commission. Clairday v. The Lilly Co. , 95 Ark. App. 94, 96, 234 S.W.3d 347, 349 (2006) The interpretation given to medical evidence by the Commission has the weight and force of a jury verdict, and this court is powerless to reverse the Commission's decision regarding which medical evidence that it chooses to accept when that evidence is conflicting. Id. However, the Commission may not arbitrarily disregard medical evidence or the testimony of any witness. SSI, Inc. v. Cates , 2009 Ark. App. 763, at 9, 350 S.W.3d 421, 426.

The Commission specifically considered the evidence ELGSS asserts was arbitrarily ignored, finding that

[t]hey have argued that the condition that necessitated Bolding's proposed treatment—Claimant's dental caries—are due to "non-work-related conditions and medications" and thus are not their responsibility. They have identified her as having such unrelated conditions as opioid use, Sjogren's Syndrome, and kidney disease.

To the extent that any of the above conditions had any role in the deterioration of Claimant's dental situation, they would not foreclose the responsibility of Respondents No. 1 for her treatment. The Commission credited Dr. Bolding's explanation that the breakdown of Rowland's teeth was caused by the deterioration of her TMJ, which had shifted to the left from being struck on the right side of her face. The Commission found credible Dr. Bolding's testimony that the braces necessary to correct the position of Rowland's teeth and jaw had caused her dental caries. The Commission also credited Dr. Bolding's testimony that the delay in her treatment exacerbated and worsened Rowland's condition, explaining that "[t]he evidence bears out that there was an extensive delay in the initiation of some of Claimant's dental treatment as a result of the controversion by Respondents No. 1." The delay in treatment caused Rowland's chronic pain necessitating her opioid use, which in turn caused Rowland to have the dry mouth condition that contributed to her dental caries. The Commission did not arbitrarily ignore the evidence but simply weighed it differently than ELGSS wanted. We do not reweigh evidence. See Hines v. Central Ark. Transit. Authority , 2019 Ark. App. 553, 590 S.W.3d 750.

B. The Factual Basis for Dr. Bolding's "Post-Operative Theories about Causation"

With the above discussion in mind, we turn to ELGSS's closely related second point on appeal. ELGSS argues that the Commission arbitrarily disregarded that, prior to Rowland's May 24, 2019 surgery, Dr. Bolding identified only "degenerative issues" and stated that "the only injury to Appellee's teeth attributed to the incident was a single chipped molar[.]" ELGSS argues that Dr. Bolding "is bound by his own documentation and reports," which do not show any causal relationship between Rowland's tooth decay and the 2014 injury. ELGSS's argument is not well taken.

Dr. Bolding's presurgical medical notes support his opinion that beginning in 2014 Rowland's dental and jaw problems, which eventually included dental caries, were the direct result of her work-related injury and the subsequent delays in treatment and the braces necessary to address her injury. In December 2014,...