Betty Jaynes v. Beverly Health & Rehabilitation

1. Are any benefits awarded herein? No
2. Was the injury or occupational disease compensable under Chapter 287? No
3. Was there an accident or incident of occupational disease under the Law? Yes
4. Date of accident or onset of occupational disease? April 24, 1999
5. State location where accident occurred or occupational disease contracted: Cape Girardeau County, Missouri
6. Was above employee in employ of above employer at time of alleged accident or occupational disease? Yes
7. Did employer receive proper notice? Yes
8. Did accident or occupational disease arise out of and in the course of the employment? Yes
9. Was claim for compensation filed within time required by law? Yes
10. Was employer insured by above insurer? Yes
11. Describe work employee was doing and how accident happened or occupational disease contracted: Employee tripped over a light cord and fell while taking care of a patient
12. Did accident or occupational disease cause death? Non
13. Parts of body injured by accident or occupational disease: No permanent disability
14. Nature and extent of any permanent disability: None
15. Compensation paid to date for temporary total disability: None
16. Value necessary medical aid paid to date by employer-insurer: None
17. Value necessary medical aid not furnished by employer-insurer: None
18. Employee's average weekly wage: $\ 520.00
19. Weekly compensation rate: $\ 346.67 for temporary total disability or permanent total disability and $\ 294.73 for permanent partial disability
20. Method wages computation: By agreement
21. Amount of compensation payable: Claim denied
22. Second Injury Fund liability: Claim denied
23. Future requirements awarded: None

On April 20, 2005, the employee, Betty Jaynes, appeared in person and by her attorney, Mr. Jeff Gault, for a hearing for a final award. The employer-insurer was represented at the hearing by its attorney, Mr. Rich Fitzgerald. The Second Injury Fund was represented at the hearing by Assistant Attorney General Jeff Koch. At the time of the hearing, the parties agreed on certain undisputed facts and identified the issues that were in dispute. These undisputed facts and issues, together with a summary of the evidence and the findings of fact and rulings of law, are set forth below as follows.

1. On or about April 24, 1999, Beverly Health and Rehabilitation was a covered employer operating under and subject to the provisions of the Missouri Workers' Compensation Act and was duly qualified as a self-insured employer.
2. On or about April 24, 1999, Betty Jaynes was an employee of Beverly Health and Rehabilitation, and was working under the provisions of the Missouri Workers' Compensation Act.
3. On or about April 24, 1999, the employee sustained an accident which arose out of and in the course of her employment.
4. The employer had notice of the employee's accident.
5. The employee's claim for compensation was filed within the time allowed by law.
6. The employee's average weekly wage was $\ 520.00 per week and her rate of compensation is $\ 346.67 for temporary total disability and permanent total disability and $\ 294.73 for permanent partial disability.
7. No medical aid was furnished by the employer-insurer.
8. No temporary total disability benefits were paid by the employer-insurer.

1. Medical causation
2. Additional medical aid
3. Nature and extent of disability
4. Liability of the Second Injury Fund

At the time of her accident, the employee, Betty Jaynes, was employed as a charge nurse in a long-term nursing care facility for Beverly Health and Rehabilitation. Prior to her April 24, 1999 accident, the employee had two minor back injuries that were each settled for 71 / 2 % of the body as a whole, and a right thumb injury that was settled for 5 % of the thumb (Employee's Exhibits T, U and V). According to the employee, neither her thumb nor her back were bothering her prior to her April 24, 1999 accident. The medical records also confirm that the employee had problems with depression prior to April 24, 1999, but only sought treatment from a psychiatrist on one occasion. The employee acknowledged in her medical records that on several occasions she had treated herself with her husband's medication (Employee's Exhibit B).

The employee's April 24, 1999 accident occurred when she was attempting to take care of a resident and tripped on an electrical cord. The employee testified that she fell flat on her face with her arms extended. The employee testified that she believed she may have been unconscious for a brief period of time. The medical records from her September 27, 1999 visit to the St. Francis Medical Center emergency room, contradict the employee's version of her accident. The emergency room physician notes:

This 52 year-old female caught her right leg on a cable Saturday, fell, and twisted her right leg. Also landed on her back. She was not knocked unconscious. No nausea or vomiting. She complains of back pain and leg pain. No headaches mentioned to me. Headaches mentioned in nurse's note (Employee's Exhibit A).

After x-rays taken of the employee's right knee and lumbar spine were negative, the emergency room physician diagnosed the employee as having a right knee sprain and low back strain, and prescribed Tylenol 3 and ibuprofen (Employee's Exhibit A).

Three days later on April 30, 1999, the employee was going with her husband while he sought treatment for his own psychiatric problems when she was found in their car attempting to cut her wrist with a pair of tweezers. The employee was admitted to Barnes Jewish Hospital where she was diagnosed as having major depression, and received electro shock therapy (Employee's Exhibit B).

The medical records from Barnes Jewish Hospital give no indication that the employee's depression and related treatment had any connection to her accident at work on April 24, 1999. To the contrary, the records from Barnes Jewish Hospital contain numerous entries that contradict the employee's claim that her current psychiatric problems are related to her work accident. The psychiatric intake assessments completed by Dr. Michael R. Jarvis included the following statements:

- "Chief complaint: This all has to do with Ronnie (employee's husband)."

- The employee saw a psychiatrist in the 1980s after experiencing symptoms of depression. She related this to having to deal with her husband's chronic mental illness.

- She started taking her husband's Darvocet and Amitriptyline in order to escape and possibly to kill herself.

- In 1994, she started taking her husband's Prozac because she was stressed over other social stressors.

- Over the last year, the patient exhibited increased stress and decreased mood. She has had a number of things that are interpreted as suicide attempts, for example, while coming home from work, she totaled the car.

- She had previously reported being depressed for years and using Xanax occasionally for sleep.

- Two days prior to her admission to Barnes Jewish Hospital, the employee reported taking 60 Xanax.

- She has been feeling increasing stress as well as low mood since early this year. She has been worried since her husband was being treated at Barnes Jewish Hospital for his psychiatric condition.

- Since February, her husband was having difficulties with his psychiatric condition and recently bounced a \$10,000.00 check.

- On Monday, the employee was involved in a motor vehicle accident where she totaled her car.

The extensive records of Barnes Jewish Hospital establish that during her admission, neither the employee nor the treating psychiatrist related any of her problems with depression to the April 24, 1999 accident at work.

After two weeks of treatment at Barnes, the employee had follow-up care for her depression with Dr. Jarvis. In November of 1999, her family became concerned that she would hurt herself, and obtained a court ordered psychiatric admission. Since that date, the employee has continued to see psychiatrists with Bootheel Counseling.

In addition to her psychiatric problems, the employee has also received limited treatment for physical injuries that she attributes to her April 24, 1999 fall at work.

Approximately nine months after her fall, the employee sought treatment from Dr. Hatfield at the Dexter Medical Center. She initially complained of pain in her right shoulder and right arm, but in March of 2000, she started complaining of pain in her right knee. The diagnostic testing ordered by Dr. Hatfield failed to reveal anything abnormal for the right upper extremity, and Dr. Hatfield felt she had early signs of osteoarthritis in her right knee (Employee's Exhibit F).

The employee also saw Dr. Steven Winters in March of 2000 with similar complaints of right shoulder and right knee pain. Dr. Winters' March 16, 2000 records note, "there is no reported shoulder injury, but she does remember falling upon the right knee last year" (Employee's Exhibit H). Dr. Winters injected the employee's right knee, ordered physical therapy and suggested a return visit after an MRI. There is no indication, however, that the employee returned to Dr. Winters after her initial visit (Employee's Exhibit H).

Physical therapy records from Dexter Regional Hospital indicate the employee did have several sessions of physical therapy in March of 2000. The employee advised her therapist that she was experiencing bilateral shoulder and elbow pain along with right knee pain. The employee attended five physical therapy sessions in March, and reported a significant improvement in her shoulder pain. The employee did not return for any follow-up therapy after her March 31, 2000 session (Employee's Exhibit G).

In May of 2000, the employee started seeing Dr. William S. Irvin, who is a rheumatologist at the Boone Clinic. By this time the employee was complaining of pain in her neck, both shoulders, both elbows, both wrists with numbness in her fingers. She also complained of pain in the joints of both hands, her low back, mid back and hips, both knees, her ankles and toes (Employee's Exhibit I).

The employee was attributing all of these symptoms to her fall at work, which occur