COURT OF CIVIL APPEALS HOLDS AUTHORIZED TREATING PHYSICIAN NOT PERMITTED TO CONTRADICT TRIAL COURT’S DIRECT FINDING ON MEDICAL CAUSATION

COURT OF CIVIL APPEALS HOLDS AUTHORIZED TREATING PHYSICIAN NOT PERMITTED TO
CONTRADICT TRIAL COURT’S DIRECT FINDING ON MEDICAL CAUSATION

In Ex parte El Repose Nursing Home Group, the Court of Civil Appeals reviewed a petition for writ of mandamus arising from an order compelling an employer to provide medical treatment. The plaintiff’s original injury occurred in April 21, 2006, and the employee was diagnosed with an upper thoracic strain. The plaintiff had a pre-existing injury to her C6-7 vertebrae, and had received treatment for this injury approximately a week before the alleged on-job-injury. Despite this evidence, on May 29, 2009, the trial court held a trial on the issue of compensability of the April 21, 2006 injury, and found that the evidence established medical causation of her injury and subsequent pain complaints.

Subsequent to that finding, the plaintiff’s authorized treating physician determined the plaintiff was not a candidate for surgery, but would benefit from pain management. However, the doctor opined that this treatment should be paid for by the plaintiff’s personal insurance, as it did not arise from the workers’ compensation injury. The employer refused to authorize pain management, based on the authorized treating physician’s recommendation. On the plaintiff’s motion, the trial court intervened ordering the employer to either provide another physician to determine the appropriateness of surgery or provide pain management. The second authorized physician, however, agreed that the plaintiff would not benefit from surgery and that the plaintiffs’ need for pain management was not related to the on-the-job injury. Based on the second authorized treating physician’s opinion, the employer again denied pain management treatment. Upon a second motion for contempt and to compel medical treatment, the Court ordered the employer to provide a pain management referral within 10 days. The employer sought mandamus review of this order with the Court of Civil Appeals.

In their mandamus petition, the employer argued that by ordering treatment despite the opinion from the authorized treating physician that the treatment was not work related, the court was usurping the authorized treating physician’s right to direct medical treatment. The plaintiff countered that her physicians were not directing medical treatment, but instead were opining on medical causation, which had already been determined by the trial court.

The Court agreed with the plaintiff, finding that implicit in the physician’s opinion was a conclusion that the plaintiff’s pain complaints arose from her pre-existing condition. The Court found that this was a legal question of medical causation, entrusted to the trial court. Because the trial court had already explicitly found that the plaintiff’s pain complaints were not related to the pre-existing condition, but instead arose from her April 21, 2006 injuries, the physician’s contrary opinions were meaningless. As the pain had already been tied to the injury by the Court, the employer was required to provide whatever treatment was recommended for that pain. The Court therefore denied the mandamus petition.

This case affirms the general rule that the issue of medical causation is a legal question for the trial court. Normally, the plaintiff is required to prove that all future medical treatment is related to the injury, even after an award of benefits. However, in this case, the particular medical problems complained of were specifically incorporated into the trial court’s order, which effectively resolved that issue.