- Whether the employer is obligated to pay past medical expenses of $\ 967.00.
- Whether the claimant has sustained injuries that will require future medical care in order to cure and relieve the claimant of the effects of the injuries.
- The nature and extent of permanent disabilities, including permanent total disability from January 1, 2003.
- The liability of the Second Injury Fund for permanent total disability or enhanced permanent partial disability. FINDINGS OF FACT:
The claimant is currently 65 years old. After high school she worked in primarily clerical jobs. In May 1977 she went to work for the employer. Her position was Vice President in charge of Human Resources. She oversaw all personnel issues for the employer including the payroll departments. This covered approximately 450 employees of the hospital and their nursing home. She had six staff members that personally reported to her. In addition, she oversaw several other areas including volunteer services, administrative matters, and various committees such as safety, risk management and quality. In performing her duties, she was required to physically reach, bend, stoop, sit for long periods of time and traveled often. She often attended meetings. Her office was located in a separate building across a parking lot from the hospital. She was required to walk approximately 50 feet across the parking lot to attend meetings in the hospital building.
Prior to this injury she had problems with her cervical neck, shoulder, arm, thumb and index finger on her left side. She would experience hot sensations in her neck and shoulder and have shooting pains in her arm. Her forearm was numb as well as her thumb and index finger. She began treating with Dr. Bruce in 1988 in Kansas City, and after 1995 she treated with Dr. Nichols in Joplin. During this time she did not treat constantly. She used over-the-counter medications.
Because of the problems with her left upper extremity, she modified how she performed functions of her job, such as how she would carry or grasp something. She would try to baby this arm and was able to perform her job duties. She is right-handed. She has no problems with her right hand and arm and would use it to compensate lifting items. She worked an average of 50-60 hours a week.
On March 16, 2001, she was going up some steps. She stepped on an item on a step and fell. When she fell, she was
thrown forward. She felt immediate pain in her low back on the right and in her neck. She landed on her hands and lacerated her palms and both knees. Sharon Johnson, the Employee Health Nurse and case manager for workers' compensation cases, was with her.
Immediately after the fall she went home. She reported the injury to Sharon Johnson, to whom work related injuries were to be reported to.
The claimant was required to go to a meeting in Florida. Her back pain increased while she was on this trip. She described driving pain that started a few days after the fall. While she was on the trip, she had problems sitting and driving. She was gone for about a week. When she returned home, she went to Dr. Meisenhimer, a chiropractor, on her own.
When her condition did not improve, and in fact worsened, she talked to Sharon Johnson. Ms. Johnson referred her to Dr. Compton, an orthopedist. Dr. Compton examined the claimant on April 16, 2001. Her complaints at this time were pain in her low back, hip and leg. He performed x-rays which showed degenerative disc disease at L4-5 and L5-S1. An MRI was recommended. Dr. Compton prescribed conservative treatment including medication and physical therapy. The claimant continued to see him until late June 2001 and continued physical therapy until late July 2001. The physical therapy helped relieve some of the pain, especially in her leg but never totally eliminated it.
On September 6, 2001, claimant began treating with Dr. Booth at the pain clinic. In the month since she had stopped physical therapy, her pain had begun to increase and had become excruciating. Dr. Booth performed two epidurals and physical therapy. An MRI done on September 6, 2001, showed generalized annular bulges at L3-4, L4-5, and L5-S1 and a moderate size right-sided L5-S1 disc herniation. She was referred to Dr. Karshner on October 1, 2001.
Dr. Karshner found claimant had radiculopathy. He prescribed medications and physical therapy. She continued to treat with Dr. Karshner through February 2002 when he recommended a surgical evaluation.
Dr. Nichols evaluated the claimant on February 26, 2002. She recommendeda hemilaminotomy and discectomy. This was performed on March 6, 2002. The claimant testified that after the surgery, she continued to have undiminished pain but also began to have muscle spasms about one month after surgery. These spasms have continued to occur two to three times a day to the present. The claimant also said that she still has pain down her leg.
At the claimant's request, on April 22, 2002, Dr. Nichols allowed her to return to work with restrictions. The claimant said that she had problems and struggled to work. She could not sit or stand for long. She needed to lie down and could not. This caused her problems staying focused. She would need to sit through meetings and testified that she would sometimes have to stand up. She felt this was sometimes inappr