Hoffman v. Labor Comm'n

536 P.3d 143

Elizabeth A. HOFFMAN, Petitioner,

v.LABOR COMMISSION, Delta Air Lines, North River Insurance Company, and Hartford Insurance Company, Respondents.

No. 20200184-CA

Court of Appeals of Utah.

Filed August 24, 2023

David J. Holdsworth, Sandy, Attorney for Petitioner

Christin Bechmann and Rachel Konishi, Attorneys for Respondents Delta Air Lines, North River Insurance Company, and Hartford Insurance Company

Judge David N. Mortensen authored this Opinion, in which Judges Gregory K. Orme and Michele M. Christiansen Forster concurred.

Opinion

MORTENSEN, Judge:

¶1 Elizabeth A. Hoffman suffered a work-related injury that resulted in multiple surgeries and chronic pain. Her doctors prescribed her opioids and other medications. For many years, Delta Air Lines (Delta) and its insurance carrier, Hartford Insurance Company (Hartford; collectively, Respondents), paid for these medications. But after a doctor hired by Hartford performed a medical examination of Hoffman (an insurance "defense exam") and recommended weaning with professional assistance, Respondents stopped paying for Hoffman's medications altogether and made no provision for weaning. Hoffman initiated a formal adjudicative proceeding against Respondents through the Utah Labor Commission (the Commission), and a medical panel opined that a level of opioid use lower than Hoffman had previously taken was historically necessary. Regarding future expenses, the panel indicated that Hoffman should undergo a formal weaning program to stop using opioids or else reduce her opioid use to a certain lower level.

¶2 An administrative law judge (ALJ) ordered that Respondents reimburse Hoffman for past expenses and follow the panel's recommendations in providing a weaning program and covering the cost of the panel's recommended lower opioid dosage if complete weaning was unsuccessful. Upon review, the Appeals Board of the Utah Labor Commission (the Board) interpreted the ALJ's decision as covering the lower opioid dosage in the future without waiting for a weaning opportunity to trigger the reduced coverage, though it indicated that Respondents would be liable for the costs of a weaning program if Hoffman elected to participate in one. It also modified the order as to past expenses to cover only the dosages of opioids the panel had indicated were "necessary." Hoffman now seeks judicial review of the Board's decision. We conclude that the Board's decision concerning the compensability of Hoffman's past and future expenses for medications is supported by the medical panel's report and is therefore supported by substantial evidence. Accordingly, we decline to disturb its decision.

BACKGROUND

¶3 Hoffman sustained a work-related traumatic back injury in 1986 while working for Western Airlines, which later merged with Delta. For some thirty years, Hartford paid for Hoffman's industrial medical expenses and prescription medications. During that time, Hoffman underwent five back surgeries. After the last surgery in 2002, she had to stop working due to debilitating chronic back pain and pain in her right leg. Her physicians prescribed opioid pain medication to treat her pain, and she has taken these without cessation—though in varying amounts—since 2002. Her doctors also prescribed benzodiazepines, to treat the anxiety that Hoffman developed after the injury, and Soma, a muscle relaxant.

¶4 In 2006, the parties entered into a stipulated settlement wherein Hartford agreed "to continue paying reasonable medical expenses related to the accepted injuries."

¶5 In January 2016, Hartford required Hoffman to undergo a defense exam with Dr. Deborah Mattingly. In short, Dr. Mattingly recommended that Hoffman be weaned from her medications under the supervision of a specialist. Soon thereafter, Hartford stopped paying Hoffman's medical and prescription expenses. Initially, Hoffman's private medical insurance paid for her medications, but when it too stopped, she began paying for them out of pocket.

¶6 Hoffman initiated a formal adjudicative proceeding against Respondents. The ALJ first assigned to the case, Judge Colleen Trayner, identified that the "only issues before the Court [were] necessary medical care from 2016 to the present and recommended medical care to treat [Hoffman's] industrial ... condition." Utah law dictates that an injured employee's "employer or the [employer's] insurance carrier shall pay reasonable sums for medical, nurse, and hospital services [and] for medicines ... necessary to treat the injured employee." Utah Code § 34A-2-418(1).

Judge Trayner's Findings

¶7 Judge Trayner entered the following findings of fact:

On January 12, 2016, [Hoffman] underwent [a defense exam] with Dr. Mattingly. Dr. Mattingly opined that the only recommended treatment is to wean [Hoffman] from her opioids, benzodiazepines[,] and Soma. Dr. Mattingly opined that [Hoffman] requires a weaning from the opiates under the supervision of an addiction or pain specialist. This should not take more than six months. Dr. Mattingly also recommends a regular exercise program.

On March 29, 2016, Catherine Harmston, FNP, filled out a Summary of Medical Evidence. ... Catherine Harmston opined that [Hoffman's] lumbar spine surgeries and opioid analgesics were necessary to treat [Hoffman's] 1986 industrial injuries. Catherine Harmston recommends physical therapy, consult with Dr. Nelson[,] and monthly medication.

On January 15, 2018, Dr. Stoddard filled out a Summary of Medical Evidence. Dr. Stoddard opined that [Hoffman's] opioid treatment was necessary to treat her 1986 industrial injuries. Dr. Stoddard recommends ongoing opioid treatment.

On January 29, 2018, Dr. Stoddard prescribed [Hoffman] a [Bowflex] machine, therapeutic hot tub[,] and housecleaning services every other week as a result of [Hoffman's] chronic back pain.

[Hoffman] underwent [a defense exam] with Dr. Jiricko on October 9, 2018. On December 14, 2018, Dr. Jiricko provided an addendum. Dr. Jiricko opined that he does not recommend a spinal cord stimulator or surgical intervention. Dr. Jiricko recommends weaning from the opioid medication. Dr. Jiricko notes that [Hoffman] requires a formal inpatient detoxification and/or a 4-week [structured intensive multidisciplinary program] .... [Hoffman] requires a consultation with an addiction specialist or psychiatrist. Dr. Jiricko recommends a robust cognitive behavioral therapy training ... and psychiatric evaluation for anxiety and medication management. Also, 10 to 12 sessions of physical therapy for [Hoffman's] right leg.

[Hoffman was] treated [by] Dr. Anden from November 1, 2018[,] through January 9, 2019.... Dr. Anden's last medical care recommendation [was] to continue [the] same medications [and] independent home/gym exercise program[,] which includes walking, back stretches, core strengthening, and weight management. ...

(Internal citations omitted.)

¶8 Judge Trayner then concluded that "[t]here is a dispute among physicians regarding medical care after 2016 and recommended medical care to treat [Hoffman's] back condition." Accordingly, she ordered "that the issues of medical and recommended medical care shall be referred to a medical panel for consideration." See Utah Admin. Code R602-2-2(A) ("A panel will be utilized by the Administrative Law Judge where one or more significant medical issues may be involved.").

The Medical Panel's Report

¶9 The medical panel's report, issued in July 2019, stated the following regarding past medical care:

Q: Please past medical care since 2016 been necessary to treat [Hoffman's] 1986 industrial back injury?^[1]

A: The term "necessary" is ... difficult to answer[,] especially in the setting of chronic pain. It is not considered medically necessary for her to continue with her opioids, benzodiazepine[,] and Soma because without those medications she would not die[,] and in reality, the use of these medications greatly increases her risk of death. However, her pain and anxiety would increase. From 2002–2016, she used excessive amounts of opioids at 440 mg of oxycodone [,] and to take away all the opioids quickly would be inhumane[,] and weaning would be mentally and physically challenging. We have had a difficult time deciding what is considered "necessary" in trying to balance humane treatment given her 14 years of continuous excessive opioid use with current medical standards for chronic pain and the risks and benefits of the opioids, benzodiazepine[,] and Soma.

We have decided that [Hoffman] "needed" the 120 mg of OxyContin (extended release oxycodone ) a day. This amount is still over what is recommended by CDC and ACOEM guidelines for treatment of chronic pain[,] but it is improved from the 270 mg of oxycodone she is currently using.

We believe the benzodiazepine and Soma are clearly not medically necessary and are not indicated to treat chronic pain. The oxycodone 30 mg 5X/day is excessive and not medically indicated. There is no objective or subjective evidence that these medications ever improved her pain score or improved her function. In fact, her pain score and function are unchanged from the 440 mg of daily oxycodone use compared to the 270 mg of daily oxycodone she currently uses.

¶10 The medical panel said the following regarding future medical care:

Q: What medical care, if any, is recommended to treat [Hoffman's] 1986 industrial back medical condition, including but not limited to medications, spinal cord stimulator, [Bowflex] machine, housecleaning and therapeutic hot tub?

A: We believe that Dr. Jiricko's plan is the most ideal. However, [Hoffman] has both psychologic and physical dependence o[n] the opioids (this is different [from] an opioid use disorder or opioid addiction)[,] and she is very anxious about not taking her medications. She is not psychologically ready to stop taking opioids[,] and having her go to treatment for the opioid dependence would not be successful until she wants to get off opioids. If she is unwilling to wean off her opioids, these are

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