Watson v. Labor Comm'n

480 P.3d 353

Susan M. WATSON, Petitioner,

v.LABOR COMMISSION, Horizon Home Health, and American Liberty Insurance, Respondents.

Horizon Home Health and American Liberty Insurance, Petitioners,

v.Labor Commission and Susan M. Watson, Respondents.

No. 20200231-CA

No. 20200297-CA

Court of Appeals of Utah.

Filed December 24, 2020

Loren M. Lambert, Midvale, Attorney for Susan M. Watson

Chad P. Curtis, Attorney for Horizon Home Health and American Liberty Insurance

Judge Gregory K. Orme authored this Opinion, in which Judges Jill M. Pohlman and Ryan M. Harris concurred.

Opinion

ORME, Judge:

¶1 Susan M. Watson and Horizon Home Health (Horizon) both seek review of the Utah Labor Commission's award of temporary total disability benefits and medical expenses to Watson based on a workplace injury.¹ Watson argues that the Commission erred in not awarding her permanent total disability, while Horizon argues that the Commission erred in not completely denying Watson's claim for benefits due to a pre-existing condition. We decline to disturb the Commission's order in either respect.

BACKGROUND²

¶2 On June 1, 2015, while working for Horizon as an in-home nurse, Watson arrived at the home of a severely disabled toddler (Toddler) for whom she provided care. Toddler suffers from a syndrome that stunts the growth of the joints in her body, causing them to contract and resulting in Toddler's body, including her legs and arms, becoming "distorted." To assist her breathing, Toddler had undergone a tracheotomy, which left a hole through the front of her neck into her trachea that was connected to a respirator via a tube. Upon Watson's arrival, she witnessed Toddler in her bed "covered from head to toe with diarrhea." Watson became alarmed because Toddler could experience life-threatening complications if excrement entered the tracheotomy hole.

¶3 In response to this medical emergency, Watson immediately picked up Toddler, who weighed approximately 25 pounds, and rushed up a flight of stairs to a bathroom to clean her off as quickly as possible in an attempt to prevent the excrement from entering Toddler's tracheotomy tube. Watson "carried [Toddler] with her left hand cradling [Toddler's] head and shoulders and her right hand supporting [Toddler's] bottom," which "was a little different than [carrying] a regular child because [Toddler's] bottom was twisted out of alignment with her torso and her back and head were arched."

¶4 Once in the bathroom, Watson attempted to place Toddler, who was "slippery ... because she ha[d] stool all over her," onto a shower chair in a shower-bathtub combination, while being careful not to allow any excrement into the tracheotomy tube. To put Toddler in the bathtub, Watson had to sidestep between the toilet and the tub, which were approximately 18 inches apart. As Watson "extended her arms ... to lay [Toddler] down onto [the] shower chair inside the bathtub that was about 2 feet high, ... she jerked her head up and to the left to look for the shower head." The moment she did this "she felt a ‘hot poker’ shock sensation in her neck that travelled down to the base of her spine." Despite the pain, Watson was able to finish cleaning Toddler and then went home, where she began to experience numbness and tingling in her extremities.

¶5 Before this accident, Watson had experienced numerous problems in her neck and spine. In 1988, she had a discectomy and decompression surgical procedure, as well as "another surgery in 2002 to fuse vertebrae with plate fixation at the C4-7 levels of her cervical spine." She also suffered two additional neck injuries: one resulting from a car accident in 2009 and another from a workplace accident while working for a different employer in 2013.

¶6 On June 4, 2015, Watson sought medical treatment at a local clinic and was diagnosed "with central canal stenosis at the C3-4 level of her cervical spine with spinal-cord compression and a disc bulge." She was referred to an emergency room and, that same day, "[s]he underwent surgery to remove the previous instrumentation, decompress the nerves at C3-4, and extend the fusion of her cervical vertebrae."

¶7 Soon after this surgery, Watson's longtime treating physician (Treating Physician) examined her. Treating Physician opined that "Watson's neck symptoms were medically caused by the [June 1,] 2015 work accident" but that her "pre-existing neck condition ... contributed to the injury." Horizon's medical consultant also examined Watson and agreed that "Watson's pre-existing neck condition contributed to her work injury and need for emergency surgery," but he opined that she "would have required surgical intervention at some point regardless of the work accident." Horizon's consultant also stated that Watson should be restricted to lifting 10 pounds, should not do any overhead work, should not drive for work, and should be allowed "frequent position[ ] changes."

¶8 Watson brought a claim for workers’ compensation benefits based on this injury, claiming temporary total disability and permanent total disability. An administrative law judge (the ALJ) held an evidentiary hearing and, given Watson's pre-existing condition, applied the more stringent legal standard of causation laid out in Allen v. Industrial Commission , 729 P.2d 15 (Utah 1986). The ALJ determined that Watson did not meet this standard and denied her claim for benefits. Watson appealed to the Commission, which determined that Watson satisfied the more stringent standard and therefore set the ALJ's ruling aside with instructions for the ALJ to make determinations regarding Watson's level of disability and the benefits to which she was entitled.

¶9 On remand, the ALJ referred Watson's claim to a medical panel. The medical panel determined that the incident with Toddler "medically caused [Watson] to suffer an acute cervical-disc herniation at the C3-4 level that led to cervical-spine myelopathy." This necessitated surgical treatment, physical and occupational therapy, and medication. The medical panel "assessed [her] with a 20% whole-person impairment rating" as a result of the injury and placed the following work restrictions on her: "no overhead work, no lifting more than 10 pounds, no driving or operating machinery, no patient transfers, no climbing stairs or ladders, and no safety-sensitive work." The medical panel also opined that "[t]his particular injury has not allowed ... Watson to return to baseline as she suffered a significant spinal canal stenosis that has resulted in continued neurological symptoms that cause her to be unsteady, weak, and have coordination issues."

¶10 The ALJ then held an evidentiary hearing at which Watson testified to the following:

a. On the six to eight days per month that she was most active, she had to take breaks throughout the day totaling between four and five hours.

b. On her "good days," she could continuously sit for only 30 to 45 minutes at a time without having to get up.

c. On her active days, she could stand for only 15 minutes at a time, for a total of an hour and a half per day, at most.

d. She was limited in the work she could do with her hands because she lost coordination in them and could not feel her fingers.

e. She used to be able to type sixty words per minute, but after the injury she could not type at all.

f. Her "pain has been unbelievable," she still could not feel areas of her legs, she had severe pain in her feet and hands, and the pain in her midsection frequently restricted her breathing.

g. It takes her approximately an hour and a half after she wakes up to be able to balance and navigate around the house.

h. She allowed her nursing license to expire because she could no longer perform any nursing duties.

i. She tried for approximately two years to obtain employment as a nurse in a call center but could not even get an interview.

¶11 Following Watson's testimony, a vocational expert (Expert) testified on behalf of Horizon. Expert testified that at the time of Watson's injury, she was qualified to be a nursing director, an audit nurse, an internal review/utilization health nurse, a hospital discharge planning nurse, and a telephonic health nurse—all of which Expert labeled as sedentary jobs. Expert also testified that based on Watson's "medical restrictions," there was nothing "that would keep her from doing the [job of a] nursing service director." Regarding the telephonic health nurse position, Expert stated that it required "very little typing"—typically around nine to twelve minutes in an eight-hour work day—and there is "no speed requirement" for the typing. Regarding the audit nurse position, Expert opined that Watson "could actually sit and stand if the doctor indicated she would be able to look down at a computer screen" so long as no overhead work was required. Expert also testified that the review/utilization nurse position would require Watson to "review[ ] information either on a computer screen or [by] ... actually having a physical file in your hand to go through."

¶12 On cross-examination, Expert explained that these jobs could entail up to a little more than two and a half hours per day of "reaching, fingering, and handling." Expert also stated that Watson's potential inability to maintain her balance would not disqualify her outright, but he opined that "an employer is not going to put up with you [if there is a] risk of you falling," and Watson "probably would not be able to maintain employment if she's falling down." Expert further testified that if Watson "was only able to sit 30 to 45 minutes and would have to get up and walk around and leave the workstation," she would not be able to hold any of the positions he identified.

¶13 Relying on the medical panel's findings on medical causation and the Commission's determination that Watson satisfied the more stringent Allen standard for legal causation, the ALJ concluded that Watson was entitled to benefits. But the ALJ determined that she was eligible only for temporary...