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University of Central Arkansas v. Srite

Court of Appeals of Arkansas, Division II

November 6, 2019

UNIVERSITY OF CENTRAL ARKANSAS and Public Employee Claims Division, Appellants
Elizabeth SRITE, Appellee


          Charles H. McLemore Jr., for appellants.

         Gary Davis, for appellee.


         BART F. VIRDEN, Judge

          Appellee Elizabeth Srite was employed by appellant University of Central Arkansas (UCA) on February 13, 2017, when she injured her lower back while lifting a box. UCA and appellant Public Employee Claims Division initially accepted the claim as "medical only" but later controverted Srite’s claim. An administrative law judge (ALJ) found (1) that Srite notified her employer of her injury on May 5, 2017; (2) that Srite had proved that all the treatment she had received was reasonable and necessary and that appellants were responsible for treatment that occurred on and after May 5; (3) that Srite had proved entitlement to additional medical treatment of her injury as recommended by Dr. Cassat, as well as ongoing prescription pain medication; (4) that Srite had proved that she is entitled to temporary total-disability (TTD) benefits from October 18 through November 22, 2017; and (5) that Srite had proved that her attorney was entitled to a controverted fee on the indemnity benefits awarded. Appellants appealed the ALJ’s decision to the Arkansas Workers’ Compensation Commission (Commission), which affirmed and adopted the ALJ’s opinion.[1]

          On appeal to this court, appellants argue that the Commission erred in finding (1) that appellants are liable for medical treatment that Srite underwent on her own after she had received the Form AR-N notice because that treatment was unauthorized; (2) that Srite was entitled to additional medical treatment, including ongoing prescription pain medication, when she had been treating her lower back with pain medication for years; and (3) that Srite was entitled to TTD benefits from October 18 through November 22 because she chose to take herself off work despite being accommodated by her employer, and the only doctor who had taken her off work was an unauthorized physician. We affirm.

          I. Hearing Testimony

          Srite testified that she began working for UCA in April 2007. At the time of her injury, she was working in the Office of the Registrar as an administrative specialist assisting students with transcripts, graduation applications, diplomas, and commencement ceremonies. On February 13, 2017, while moving offices, Srite lifted a box, felt a pain in her back, and fell to the floor with the box. No one witnessed the incident. She continued with her duties that day but left early because she did not feel well. Srite said that the pain was initially in her back but that it later spread down her left leg.

         The record shows that Srite went to the Conway Regional Health System emergency room on February 13 where she was diagnosed with a foot contusion and low-back strain. She was referred to Dr. Billy McBay. She went back to the ER on February 19 with abdominal pain and calculus of the ureter. Srite said that she was suffering from kidney stones, which she thought had been the source of her back pain. Records show that she was treated with a "stent/surgery" for the kidney stones.

         Srite eventually called a nurse because her kidney stones, which had been on her right side, had resolved, but her back and left leg were still hurting. She was sent to the Student Health Clinic on May 5, 2017, where she was seen by Dr. Randy Pastor. Srite reported low-back pain and pain shooting down her left leg from a work-related injury. She signed the Form AR-N on May 8. Dr. Pastor later received the x-rays that had been taken when Srite went to the ER, and he noted that the x-rays were normal. Dr. Pastor recommended physical therapy at Ortho Rehab & Specialty Centers. Srite said that she had about six physical-therapy sessions but that they did not help.

         On August 10, Srite saw her family doctor, Dr. Bill B. Lawrence, for chronic low-back pain, and she requested refills of her pain medication. Dr. Lawrence referred her to Dr. William E. Ackerman III. Dr. Ackerman ordered an MRI of Srite’s lumbar spine, which was performed September 5. On September 20, Srite saw Trent Tappan, P.A., at Arkansas Specialty Orthopaedics, who noted that Srite had low-back pain radiating down the back of her left leg. The radiology report noted "multilevel degenerative changes most significant at L3-4 and L4-5" and "foraminal stenosis most severe on the left at L4-5." Tappan conferred with Dr. Wayne Bruffett, who agreed with Tappan’s recommendation that Srite consider injections given by Dr. Ackerman. On September 25, Dr. Ackerman gave Srite a sitting/standing desk prescription to give to UCA. He also refilled her pain medication. Dr. Ackerman advised Srite to remain off work from October 18 through November 2, and he later extended it through November 22. Because of her worsening back pain, Dr. Bruffett directed that she have a CT scan of her lumbar spine at St. Vincent Health System on November 27. Dr. Bruffett noted degenerative changes and suspected "a prior compressive injury in the anterior superior endplate of T12," which likely represented an old healed injury. In a follow-up office visit on November 27, Tappan noted that Srite had a transforaminal steroid injection at L4-5 but that it had not brought her much relief. He and Dr. Bruffett did not recommend surgery, and Tappan noted that Srite wanted to revisit Dr. Ackerman about more injections, which he thought was reasonable.

          On May 2, 2018, appellants sent Srite to Dr. Michael Cassat at the UAMS Orthopedic Clinic for an independent medical evaluation (IME). He diagnosed chronic bilateral low-back pain with left-sided sciatica. He wrote:

Overall the patient has a quite complex history. She has chronic degenerative changes in her lumbar spine that are likely responsible for her axial type back pain. Her radicular leg pain could be explained from her chronic disc changes at L3/4 and L4/5. Although she reports increased pain since her work-related injury, I cannot identify any acute findings that were not previously described prior to her injury at work. She has self-reported chronic axial and radicular pain for years, and has been taking opiates with poor control per her self-rated pain scores. Her previous MRI described in her pre-injury clinic notes is unavailable for my review personally. I cannot compare the changes seen in her L3/4 and L4/5 discs to this to determine if there was any worsening that would have caused new nerve root compression. As such I cannot completely exclude an acute worsening of a chronic disc injury being responsible for her radicular leg pain.
As far as future care recommendations, I have recommended that she see interventional pain management, undergo medial branch blocks for her facet arthropathy that is likely the cause of axial back pain. Would also recommend that she have a better quality lumbar spine MRI to evaluate for far lateral stenosis at L3/4 on the left. Her previous injections have been at L4/5. If this is confirm[ed] then I would recommend a transforaminal epidural steroid injection on the left at L3/4 if her ...

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