Hosp. Housekeeping Sys. v. Labor Comm'n

535 P.3d 409

HOSPITAL HOUSEKEEPING SYSTEMS and Safety National Casualty Corporation, Petitioners,

v.LABOR COMMISSION and Leticia Rueda Vargas, Respondents.

No. 20220191-CA

Court of Appeals of Utah.

Filed August 17, 2023

Brad J. Miller and Rachel M. Konishi, Attorneys for Petitioners

Jose A. Loayza, Salt Lake City, Attorney for Respondent Leticia Rueda Vargas

Judge Ryan D. Tenney authored this Opinion, in which Judges Michele M. Christiansen Forster and John D. Luthy concurred.

Opinion

TENNEY, Judge:

¶1 In May 2017, Leticia Rueda Vargas injured her knee at work while employed by Hospital Housekeeping Systems (HHS).¹ HHS later refused to pay for some of Vargas's treatments, so Vargas filed a claim with the Labor Commission. During the ensuing litigation, an administrative law judge (the ALJ) ordered HHS to cover "all future medical expenses necessary to treat" Vargas's injury. HHS did not challenge that order.

¶2 A few years later, HHS refused to pay for an injection that a doctor recommended as part of Vargas's ongoing treatment, claiming that Vargas's continued knee pain was not caused by the workplace accident. The ALJ disagreed and ordered HHS to pay for the injection, and the Labor Commission subsequently affirmed that decision. HHS now appeals. For the reasons set forth below, we decline to disturb that decision.

BACKGROUND

The Work Injury & Early Treatment

¶3 Vargas was employed by HHS as a housekeeper at Tooele Hospital. During a shift in May 2017, Vargas was changing the linens on a hospital bed when the bed suddenly rolled forward and hit the wall, causing the corner of the bed to impact Vargas's left knee. Vargas went to the emergency room later that day, where she presented with "a contusion, decreased range of motion, pain[ ] that is acute, swelling, [and] tenderness" in her left knee. A week later, Vargas returned to the emergency room and was diagnosed with an infected patellar bursa in her left knee.

¶4 Over the next several months, Vargas sought treatment for her ongoing knee pain from various providers, including physical therapists and orthopedic specialists. In November 2017, Vargas was evaluated by Dr. Mark Anderson, a medical consultant retained by HHS. Dr. Anderson concluded that "the work accident medically caused [Vargas's] traumatic pre-patellar bursitis in her left knee that had not reached medical stability."

¶5 Vargas continued receiving treatment for her ongoing knee trouble. In May 2018, Vargas had an MRI of her left knee, which revealed "grade 2 patellofemoral chondromalacia, trace joint effusion," "[s]uperficial and deep infrapatellar bursitis," "[m]ild distal patellar tendinosis," and "[s]emimembranosus and pes anserine bursitis." These diagnoses had not been noted previously. In August 2018, a provider who had worked with Vargas since her injury opined that Vargas had now "failed all conservative treatment options." The provider recommended "a left knee shaving chondroplasty, synovectomy, and possible partial medial/lateral meniscectomy."

Case 18-0680

¶6 In October 2018, Vargas filed an application for a hearing with the Labor Commission (which was then captioned as case 18-0680) because of a dispute with HHS about its obligation to cover the costs of her ongoing treatment.

¶7 In January 2019, Vargas was evaluated by Dr. Anthony Theiler, another medical consultant retained by HHS. Dr. Theiler concluded that Vargas could "be deemed maximally medically improved as it relates to the incident in question." He further opined that "no further medical care was required and that [Vargas] had required treatment on an industrial basis only through mid-July 2017."

¶8 Given the conflicting evidence regarding causation, the ALJ referred the matter to a medical panel. See Utah Admin. Code R602-2-2 ; Utah Code § 34A-2-601 ; Brown & Root Indus. Service v. Industrial Comm'n of Utah , 947 P.2d 671, 677 (Utah 1997). In August of 2019, a medical panel consisting of Dr. Matthew Hughes and Dr. Jeremy Biggs evaluated Vargas and reviewed her claim. This panel subsequently provided a report in which it concluded that Vargas "ha[d] not reached MMI [maximum medical improvement], as she would likely benefit from additional conservative measures, or may benefit from a surgical excision of the chronically inflamed bursa."² The medical panel recommended that Vargas see Dr. Travis Maak, an orthopedic surgeon, based on his conservative treatment approach. In a later follow-up, the medical panel noted that "[i]n some cases, recalcitrant chronic knee bursitis may be treated with surgery to remove the bursa (excision of bursa, bursectomy )."

¶9 Vargas followed the medical panel's recommendation and met with Dr. Maak in December 2019 for an evaluation. In his progress notes from that visit, Dr. Maak noted that he believed "a non-operative approach" to treatment of Vargas's left knee was "the best option," but he also recognized "the potential need for arthroplasty in the future." Vargas subsequently continued receiving treatment from Dr. Maak.

¶10 In July 2020, the ALJ issued a decision in case 18-0680 in which she found that Vargas's "industrial accident was the medical cause of a left knee contusion and an injury to the patellar bursa of the left knee, which remained symptomatic." The ALJ also found that Vargas's industrial accident met the standard for legal causation. The ALJ awarded Vargas coverage for "all future medical expenses necessary to treat [her] May 4, 2017, industrial injuries, including evaluation by an orthopedic surgeon." HHS did not appeal or administratively challenge that decision.

Case 20-0785

¶11 Sometime after the decision was issued in case 18-0680, Dr. Maak opined that Vargas "ha[d] reached MMI at this time." Vargas continued receiving treatment from Dr. Maak, however, and in November 2020, Dr. Maak noted that Vargas

was seen in my office today for a scheduled appointment to follow up her ongoing knee pain. Upon review at her appointment today, it was decided that we would not proceed with another cortisone shot as she did not get relief with it but instead we will try and get a Synvisc One injection approved with workers compensation and see if she gets better relief with that.

After HHS refused to pay for the Synvisc injection, Vargas filed another application with the Labor Commission, which was captioned as case 20-0785.

¶12 In April 2021 (and apparently at the request of HHS), Dr. Theiler revisited his 2019 evaluation. Although Dr. Theiler had not met with Vargas a second time, he reviewed her updated medical records and issued an amended report in which he opined that "there is absolutely no basis for any further treatment for an anterior left knee contusion." A few months later, HHS sent Dr. Maak a copy of Dr. Theiler's amended report with a cover sheet that asked Dr. Maak to choose "yes" or "no" in response to the question: "After reviewing Dr. Theiler's opinion, do you agree that [Vargas's] underlying degeneration is not related to the work event of May 4, 2017?" Dr. Maak marked "yes." Dr. Maak then wrote a letter of his own, in which he stated that "[t]he fact that [Vargas] has continued pain for over two years after the initial injury suggests that her current symptomology is likely unrelated to the original accident."

¶13 In August 2021, the ALJ held a hearing for case 20-0785 at which Vargas and HHS presented arguments about whether HHS should pay for the Synvisc injection. In September 2021, the ALJ issued an order resolving the dispute. With respect to the causation question, the ALJ held that the prior causation adjudication from case 18-0680 was the "law of the case" here. The ALJ said that she was

at a loss to understand why [HHS] has engaged Dr. Maak in a discussion of medical causation and retained Dr. Theiler to reiterate his opinions regarding medical causation. The Court has already ruled that [Vargas's] left knee injury is industrially caused, and that ruling has not been overturned. If the Court erred by failing to state explicitly that the injury included both chondromalacia and bursitis as found on [the] MRI, the Court corrects that error now. There has been no significant change in circumstances that would justify review of [Vargas's] award of benefits in this matter.

In an apparent reference to Dr. Maak's plan for a Synvisc injection, the ALJ then ordered HHS to "pay for [Vargas's] continued care with Dr. Maak or other orthopedic surgeon," and she further ordered that if "conservative care fails to improve [Vargas's] left lower extremity functionality and her chronic pain, [HHS] shall pay for surgery as recommended by [Vargas's] orthopedic surgeon."

¶14 HHS petitioned for review with the Labor Commission. In January 2022, the Labor Commission issued an order affirming the ALJ's decision. Consistent with the approach taken by the ALJ, the Labor Commission ruled that the prior medical panel's "opinion on the extent of [Vargas's] work injury was adopted by" the ALJ in the earlier case "and represents the law of the case."

The Labor Commission further concluded that case 18-0680's "award of future medical care became a final order of the [Labor Commission], which represents the law of the case in this matter." And the Labor Commission agreed with the ALJ that HHS's "attempt to reopen the issue by offering a reiterated opinion from Dr. Theiler and an opinion from Dr. Maak regarding medical causation [did] not warrant a change in the award of benefits to [Vargas] from case number 18-0680." The Labor Commission accordingly "concur[red]" with the ALJ's "order in the present matter outlining the award of benefits to [Vargas] for her work-related left-knee injury."

¶15 HHS now seeks judicial review of the Labor Commission's decision.

ISSUES AND STANDARDS OF REVIEW

¶16 HHS first argues that the Labor Commission had an insufficient basis for ordering it to pay for Vargas's ongoing treatments for her knee injury. HHS suggests that its challenge is legal in nature, but as explained below, we vie...