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Jones v. North Arkansas Regional Medical Center

Court of Appeals of Arkansas, Division II

April 27, 2016



Odom Law Firm, P.A., by: Conrad T. Odom, for appellant.

Wright, Lindsey & Jennings LLP, by: John D. Davis, for appellee.


Appellant Karen Jones appeals from a September 11, 2015 opinion by the Arkansas Workers' Compensation Commission ("Commission") affirming and adopting the findings of fact and conclusions of law made by the Administrative Law Judge ("ALJ") in favor of appellee North Arkansas Regional Medical Center ("NARMC"). On appeal, appellant contends that the Commission erred in denying her requested MRI treatment as reasonably necessary in connection with her compensable leg injury. We affirm.

It is undisputed that appellant sustained a compensable work injury to her left leg on February 27, 2012, after she fell from a stepladder while changing the curtains in an isolation room at NARMC. After her fall, Jones was diagnosed with a left proximal tibia fracture, and Dr. Tarik Sidani performed surgery on February 28, 2012, and on March 13, 2012. Subsequently, Jones received physical therapy, and on September 26, 2012, Dr. Sidani placed Jones at maximum medical improvement with a final impairment rating of eight percent to the lower extremity. He also noted that Jones had no permanent restrictions and recommended that Jones return to full activities at work and in daily life.

The medical evidence reflects that Jones was later evaluated by Dr. Terry Sites on March 12, 2013. Dr. Sites noted that Jones had complained of pain in her leg from her knee to her lower leg and foot and of numbness and tingling over the lateral side of her foot. Dr. Sites recommended that she see Dr. Michael Morse to evaluate whether there was anything that he could do "to help with her neuropathic leg pain." On January 28, 2014, Dr. Sites recommended that she refrain from squatting, climbing, or sitting or standing for more than four hours at a time.

On July 15, 2014, Dr. Sites noted that the electromyography/nerve conduction velocity ("EMG/NCV") study performed by Dr. Morse did not reveal any specific nerve injury in the left lower extremity and that the MRI requested by Dr. Morse had been denied. Jones had complained that she was experiencing pain that radiated from her knee to her ankle. Therefore, after subsequent visits and a cortisone injection, Dr. Sites noted in the patient notes that he had discussed the possibility of other treatment options for her leg, including arthroscopy. Regarding the MRI that Dr. Morse recommended, Dr. Sites stated the following in the patient notes:

Karen returns to the clinic today noting her left knee feels better after the 10-07-14 cortisone injection. She had great relief for three weeks with some return since. She has been seen by Dr. Morse in Fayetteville, who ordered an MRI of what sounds like her lumbar spine, currently denied by Worker's Compensation. In my opinion, this is a critical component of diagnostic testing to help determine the source or sources of her pain. She had numbness and tingling in her left lower extremity from the hip area down to and past the knee, numbness on the bottom of her foot. She has pain in that distribution, as well as pain at the knee. . . . She notes she has a court date upcoming as it relates to getting her MRI.

Dr. Morse initially saw Jones on May 7, 2013. His notes reflect that Jones complained of constant throbbing pain and that she was having difficulty sleeping at night. He additionally noted that she had indicated that she had "minimal back pain and has a history of 'degenerative discs in my back' dating back to 2000 when an x-ray was taken apparently showing disc space narrowing." After his physical examination, he noted that Jones had an absent left-ankle jerk, "which takes this outside the distribution of the peroneal nerve and puts it more in the S1 distribution which would imply either a sciatic neuropathy or a S1 radiculopathy." Therefore, he noted that he intended to conduct an EMG/NCV study, and "[d]epending on what that shows, she may need a MRI of the lumbar spine."

On May 14, 2013, Dr. Morse wrote that he conducted an EMG/NCV study in the left lower extremity and that he did not find any active or chronic denervation or any delay across the fibular head when the peroneal nerve is stimulated. Therefore, he excluded entrapment neuropathy and stated,

She does have some sensory loss and absent left ankle jerk which places this more in a S1 distribution. I would like to do a MRI of the lumbar spine to make sure there is no lumbar radiculopathy.
I also put her on gabapentin for pain. She is on 300 mg tid without side effects. It is too early to tell if it is going to work.

In a form provided by Jones's counsel dated August 14, 2014, Dr. Morse checked "Yes" to the statement that it was his opinion that the injury that Jones had to her lower back was related to her ...

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