Robin Gross v. Gates Corporation d/b/a The Gates Rubber Company

ISSUED BY DIVISION OF WORKERS’ COMPENSATION

AWARD

Employer: Gates Corporation d/b/a The Gates Rubber Company

Additional Party: None

Insurer: Self-insured t/p/a Gallagher Bassett Services

Hearing Date: Commenced: February 7, 2007

Checked by: LK/kh

Completed: March 9, 2007

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? No.
4. Date of accident or onset of occupational disease? N/A.
5. State location where accident occurred or occupational disease contracted: N/A
6. Was above employee in employ of above employer at time of alleged accident or occupational disease? Yes.
7. Did employer receive proper notice? N/A.
8. Did accident or occupational disease arise out of and in the course of the employment? No.
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: N/A.
12. Did accident or occupational disease cause death? N/A.
13. Parts of body injured by accident or occupational disease: N/A.
14. Nature and extent of any permanent disability: N/A.
15. Compensation paid to date for temporary total disability: $\ 5,290.00
16. Value necessary medical aid paid to date by employer-insurer? $\ 13,418.33
17. Value necessary medical aid not furnished by employer-insurer? N/A.
18. Employee's average weekly wage: $\ 475.01
19. Weekly compensation rate: $\ 316.67
20. Method wages computation: By agreement.
21. Amount of compensation payable: None.

Second Injury Fund liability: N/A.

Future requirements awarded: None.

Said payments to begin (see findings) and be payable and be subject to modification and review as provided by law.

The compensation awarded to the claimant shall be subject to a lien in the amount of 25 % of all payments hereunder in favor of the following attorney for necessary legal services rendered to the claimant: N/A.

On February 7, 2007, the employee, Robin Gross, appeared in person and by her attorney, Steve Taylor for a hearing for a final award. The employer was represented at the hearing by its attorney, Ken McManaman. Also present for the employer was James Moss, its' Human Resource Manager. St. Francis Medical Center filed a Direct Medical Fee Dispute, and a notice of the hearing was sent to St. Francis Medical Center and its' attorney. No one was present for the health care provider at the hearing. 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 the findings of fact and rulings of law, are set forth below as follows:

1. The parties agreed to a change of venue from Mississippi County to Cape Girardeau County Missouri.
2. Gates Corporation d/b/a The Gates Rubber Company was operating under and subject to the provisions of the Missouri Workers' Compensation Act and was duly qualified as a self-insured employer through a third party administrator, Gallagher Bassett Services.
3. On or about September 15, 2003, Robin Gross was an employee of Gates Corporation d/b/a The Gates Rubber Company.
4. The employee's claim was filed within the time allowed by law.
5. The employee's average weekly wage was $\ 475.01 and the rate of compensation for temporary total, permanent total and permanent partial disability is $\ 316.67 per week.
6. The employer has paid a total of $\ 13,418.33 in medical aid.
7. In August of 2004, an advance of $\ 5,290.00 was made to the employee. The employer is entitled to a credit in that amount for any sums awarded for temporary total disability, permanent partial disability or permanent total disability. With regard to any attorney's fees, Mr. Taylor is to be awarded 25 % of the sum after the $\ 5,290.00 credit is taken.

1. Accident or Occupational Disease.
2. Notice
3. Medical causation
4. Claim for previously incurred medical bills.
5. Medical fee dispute of St. Francis Medical Center
6. Claim for mileage under Section 287.140 RSMo. (During the hearing, the parties agreed that this issue was no longer in dispute. The employer agreed to and shall pay the employee the sum of $\ 772.80 for 2,240 medical miles at 34.5 cents per mile. This agreement was in effect regardless of the rulings on the other issues.)
7. Claim for additional or future medical aid.
8. Nature and extent of disability
9. Attorney's fees and costs under Section 283.203 RSMo and/or 287.560 RSMo for the employee.

The following exhibits were offered and admitted into evidence:

Employee's Exhibits

A. Medical records

B. Withdrawn prior to being offered

Critchlow did not diagnose a kidney problem, she was positive that the pain that she was experiencing was kidney pain.

Hearing: The employee was being treated for depression but stated that she did not really have a history of depression. Prior to her injury she was on Zoloft for post traumatic stress syndrome.

There was a notation from a July 9, 2000 record, that the employee had pain in during sex. The employee testified that after the hysterectomy she did not have a problem with that. The past medical history showed depression and anxiety but the employee stated that was not the case. When she saw Dr. Bryant on August 26, 2003, he did a complete physical and she had no back complaints.

On Monday, September 15, 2003, the employee was scheduled to work her usual shift which was from 2:00 to 10:00 p.m. She requested to work over her shift because on Wednesday, September 17, she was going to miss the first 4 hours of her shift due to taking her daughter to a doctor's appointment in St. Louis. She was approved to work an additional 4 hours, until 2:00 a.m. on September 16. Prior to that shift, she had no back or leg pain like she had after. Part of her job was to load boxes of hose spools onto a pallet. She would pick up a box on her right and would pivot to the left with her body to put the box onto a pallet. Around 1:15 a.m. she picked up a box that weighed 20-25 pounds and swung around too quickly, and lost her grip on the box. It startled her and she tightened up her body, arched her back, and caught the box with her chest and arms. She had a significant sharp pain or twinge in her upper low back like someone had stuck a knife in her back. She then put the box on the pallet. For the next few minutes she leaned against the pallet due to the pain and to catch her breath. As soon as she was able to cope with the pain, she finished out the shift. She did not report it to anybody because she thought she had just strained muscles like she had before. Those prior muscle strains had gone away. The pain that she had that day was in a totally different place and was a different type of pain than the earlier pains with her urinary tract and kidneys. The employee testified that at the time of the accident she was aware of the requirement to report the injury to her employer and was aware of the signs throughout the plant to report an injury no matter how small it was. She was aware of the policy to report immediately to her supervisor injuries that may have occurred on the job. She was not aware of the policy that a report of injury should be filled out within 5 days. When asked why did not report the injury to Mr. Turner her supervisor, or Mr. Moss, the employee testified that if every employee would report every small injury the office would be full 24 hours a day, 7 days a week. She did not think she needed medical attention at that time. She thought it was a really bad muscle strain in her back.

When she woke up the next morning, September 16, she had a catch in her right hip socket at top of her thigh and there was a sharp pain more in the front. She had never had anything like that before. She went into work that afternoon at 2:00 p.m. and finished her shift at 10:00 p.m. She did not report it or tell anyone about her problem. She did not connect the problem with her hip and back to the incident and did not know what was causing it. The problems got worse during the day. She had a lot of problems driving home that night and could not sleep due to pain in her hip radiating down her leg.

Deposition: The employee testified that on September 16, during the day she had a stabbing twinge pain in her back that would happen when she would twist or bend. She frequently twisted and bended and when she did she felt the stabbing pain. After her shift ended that evening, the employee testified that with the amount of pain she was in, she was almost positive that she would have taken a pain reliever such as Ibuprofen or Tylenol. She did not sleep well at all that night. Her pain was radiating down from her right hip to her knee and the pain was so intense that it was hard to pinpoint.

Hearing: On Wednesday, September 17, the employee took her daughter to St. Louis. She started off driving but after they got to Ste. Genevieve she had to stop due to the pain in her legs. Her husband had to drive the rest of the way. She had to lie down in the back seat. She went into work that day at 6:00 p.m. She was supposed to work until 10:00 p.m. Her supervisor, Mr. Turner, asked her to stay over. She talked to him about her problems including the sharp pain in her right hip that radiated down the front of her leg to her knee. He was an EMT so she thought he might know what was causing it. He thought it might be a pinched nerve. She worked to 2:00 a.m. The pain was getting worse every day.

On Thursday, September 18, she started work at 2:00 p.m. During her break at 3:30 p.m., she was limping. James Moss asked why she was limping. She told him that she was not sure but explained that it felt like she had whacked her funny bone. She may have repeated what Mr. Turner told her about a pinched nerve. Mr. Moss told her that she needed to be seen. She made an appointment with Dr. Bryant.

Deposition: On September 19, she worked but her leg pain was worse and was becoming more frequent. The employee had been having back pain that week when she was bending and twisting but that appeared to be getting better. The employee did not mention to anybody that her back and leg pain was work related.

Hearing: The employee saw Dr. Bryant on September 22. She told the doctor that her main complaints were her hip and leg. When asked about no trauma being listed in his records, the employee testified that Dr. Bryant asked if she had been in a car accident or had fallen or something like that, and she told him no. The employee stated that she did not think that a box hitting her in the chest would be trauma. She did not tell him about that incident because she did not think that the two things were related. Dr. Bryant asked her how long she had been hurt, and she told him for a few days. She does not know why the record was changed to weeks. The employee testified that the pain was different than the pain she felt with her kidneys. When asked why she did not remember to tell Dr. Bryant about the work incident she stated that her chief complaint was hip and leg pain and she did not have any idea what had caused her leg to hurt, and she did not relate the symptoms with the work incident.

Deposition: The employee stated that she did not remember if she mentioned her low back problems to Dr. Bryant and did not tell him anything about work or that she may have been hurt at work.

Hearing: She saw Dr. Bryant about a week later. Her main problem was her hip and the front of her leg. Dr. Bryant ordered an MRI. On October 7, the employee spoke to Dr. Bryant's nurse who said that there was a protruding disc and spinal compression and the doctor had put her on a light duty restriction. An appointment was made with Dr. Park. The employee brought the light duty restriction to Mr. Moss, and told him what the nurse had said. The employee still had not put the work incident together with her problems. Mr. Moss got in touch with Mr. Turner and found a light duty position. When she spoke to Mr. Moss she was very concerned with her job and spoke to him about those concerns.

Deposition: Even though the employee had been working, bending, stooping and feeling pain in her low back and her leg, she did not make the association between work and that pain until she got her MRI results.

Hearing: The employee testified that it took a while to figure out that the incident on September 15 had caused all of her problems including the leg pain. The employee testified that on October 7, Dr. Bryant's nurse told her that a back injury could cause leg problems. On October 8, she gave more thought to what the nurse had told her. The employee turned the incident in as a work injury. When she reported that her problems were work related, Mr. Moss sent the employee to Dr. Heath. That was first time she told a doctor about the September 15, 2003 work injury.

Deposition: The employee did not say that she got the idea that it was work related from talking to Dr. Bryant's nurse. She testified that all of a sudden she felt that it was related to her work. She then told Mr. Moss that she was almost certain that it was a work related incident. She believed it was because her problems started on September 15/16. The employee testified that she went to work on the $15^{\text {th }}$ with no pain, left work in a considerable amount of pain, and has been in pain ever since. She very strongly believed that was when she was injured.

Hearing: She saw Dr. Park on October 13 and told him how she was injured.

After a myelogram, Dr. Park scheduled surgery. He told her that she had a herniated disc that was compressing her spinal cord and was causing severe weakness in her lower extremities. She had surgery on October 28. After surgery, she continued to have weakness, numbness and pain in her lower extremities. On December 1, Dr. Park told her that her recovery was normal. She was on medication and was still in a brace. On December 3, she woke up and went to the restroom. As she was getting up, she went to take a step, her knees buckled and her legs gave out, and she fell and struck the floor hard. She had a sharp stabbing tearing pain in her neck and right shoulder blade. She did not sleep the rest of the night due to the pain. She called Dr. Park's office that morning, and spoke to a nurse. She told her that her legs had given out; she had fallen, and hurt her neck and shoulder. She tried to relay how serious her symptoms were. The nurse told her unless she fell directly on the incision, she did not need to come in. The nurse said that the numbness and weakness in her legs at that stage was normal. Prior to December of 2003, she did not fall but her legs had given out on her.

Deposition: The employee stated that she told Dr. Park that she was having a lot of leg weakness and that her leg was giving out on her when she saw him on December 1 or 2, 2003. She stated that he was aware of her leg weakness. To the best of her recollection, Dr. Park told her that at that stage of her recovery the weakness was to be expected. On December 2, 3 or 4 , she injured her neck at home when she fell after her right knee buckled. She had a sharp stabbing pain in her neck and beneath her right shoulder blade that occurred upon falling.

Hearing: The next time she was scheduled to see Dr. Park was in February of 2004. She got by the best that she could. When she did see Dr. Park, she told him about her neck and shoulder pain. He ordered an MRI and told her that she had spinal cord compression at C5-6 and C6-7. Dr. Park recommended surgery but let her

try therapy first. The therapy did not help and she had surgery on March 18, 2004. On June 21, Dr. Park released her and referred her to her primary care doctor for pain management.

He is the human resource manager. The first time after the alleged incident that he spoke to the employee was on September 18, 2003, three days after the alleged accident. He saw the employee and noticed that she was limping. He asked the employee what was wrong and she told him that her family doctor said she had a pinched nerve. He told her that she needed to get it taken care of.

October 7, 2003 was the next time he and the employee communicated. The employee had a light duty restriction from a doctor. He contacted Mr. Turner, the employee's supervisor. All three of them discussed the jobs that met the restrictions. The employee asked how much sick leave she had left. She did not have much sick leave and was concerned about attendance and did not want to get terminated.

The employee did not indicate that she had been injured on the job either on September 18 or October 7. The first time that he received information that the employee may have been injured on the job was at the end of her shift on October 8. The employee told him that she remembered when she had injured herself. It was September 15 when she had to stay over past her shift and she injured herself packing on the fuel line. An incident report was filled out on October 8. That was the first time the company had paperwork that the employee had a work related injury. The company policy is to report injuries immediately no matter how insignificant. The purpose is to have a record and to provide treatment. After the employee reported the injury, he referred the employee to Dr. Heath, the company doctor.

In the handwritten incident report, the employee wrote twinge in back during lift. The electronic version of the report, states strain, foot, leg, back. The word "twinge" cannot be used in the electronic system. There are some subtle differences in the two reports.

On March 22, 2000 the employee saw Dr. Said for a history of kidney stones and acute inflammation of the kidneys. In 1998, the employee had passed a kidney stone. On March 14, the employee went to the emergency room with fever, severe right flank pain and severe urine infection with a positive culture for E-coli. She was prescribed an antibiotic. The employee was improved but still had flank pain and no energy. On March 22, her urinalysis was clear and her chemistries were normal with normal kidney function. Due to persistent flank pain, the doctor ordered an IVP to rule out kidney stones which was normal. In the hand written notes, the employee was complaining of right low back pain with some pain in the left. She had a history of urinary tract infections and kidney stones twice. On April 5, the employee did not have any symptoms and her flank was not tender. The urinalysis showed a trace of leukocytes. Dr. Said stated that the acute kidney inflammation had resolved and the employee had a possible recurrent urinary tract infection.

In June of 2001, the employee saw Dr. Roberts for a bladder infection. The urinalysis showed moderate leukocytes, trace protein, and small blood. His impression was acute urinary tract infection and prescribed medication.

In October of 2001, the employee saw Dr. Roberts for a 12 day headache. The employee had more family stress with health issues for her daughter and granddaughter. Dr. Roberts diagnosed anxiety, depression and headache, prescribed Zoloft, and discussed stress reduction techniques. In November, Dr. Roberts saw the employee for management of depression. The employee was feeling better and more active with the Zoloft. She was up every day and was looking for a new job. Dr. Robert's impression was improved depression. He prescribed Mobic. In January of 2002, Dr. Roberts showed a positive history of depression/anxiety but the employee was not on any medication at that time.

In early April of 2002, the employee saw Dr. Robert with complaints of burning with urination for four days and painful or difficult urination for three days. The employee had flank pain for one day. She had fatigue and a low grade fever. The urinalysis was positive for leukocytes, nitrates, and a trace of blood. Dr. Roberts assessed a urinary tract infection and prescribed medication.

At the end of April, the employee saw Dr. Roberts for painful urination. A urinalysis was done. The employee was referred to Dr. Jacobs for painful intercourse. The employee saw Dr. Roberts on May 20, 2002 for follow-up management of chronic painful menstruation, pelvic pain and painful intercourse. The employee planned to see Dr. Jacobs for a hysterectomy. Dr. Robert prescribed Darvocet and referred her to Dr. Jacobs. In mid June of 2002, the employee saw Dr. Roberts for a possible urinary tract infection. The urinalysis showed a trace of protein and trace of leukocytes. Dr. Roberts prescribed medication for the urinary tract infection.

The employee saw Dr. Jacobs in July of 2002 for unremitting pelvic pain which was uncontrolled with Darvocet. The employee had painful menstruation and painful intercourse. Past medical history was significant for depression. Dr. Jacobs performed a hysterectomy with removal of the ovaries.

The employee saw Dr. Critchlow on May 30, 2003 with back pain. The history stated that the employee woke up that morning and was having a lot of discomfort in her back in the lower thoracic area. The pain did not radiate. The employee stated she had enough urinary tract infections to know that was what was causing it. The urinalysis was completely normal. Dr. Critchlow stated that the employee was already on Bextra so he told her to continue with it. Listed in the urgent care registration form as to what the employee was being seen for was "kidney infection?"

On August 26, 2003, the employee saw Dr. Bryant. In the complaints section, it stated would like to meet new doctor. In the history it stated that the employee was there to make his acquaintance as her new physician and she was also complaining of menopausal symptoms related to recently stopping her Estradiol. She had no other acute complaints, questions or concerns. In her past medical history it showed recurrent kidney stones and recurrent kidney inflammation. The surgical history was a hysterectomy. The assessment and plan was that the employee had climacteric symptoms. Dr. Bryant put her back on Estradiol.

The workers' compensation section of the Gates Associate Handbook, states, "It is important that you immediately report any work related injuries or illnesses to your supervisor or manager. Failure to do so may result in a reduction of benefits."

The reporting accidents section of the Gates personnel policy, states, "Associates claiming on the job injuries must report them immediately to their supervisor;" It further states "associates requiring medical attention must report to an authorized Gates medical physician, clinic, or hospital . . ."

A photograph of a notice states "Notice: Report all injuries immediately no matter how slight", and appears to be attached to a column.

The employee saw Dr. Bryant on September 22, 2003 with a complaint of leg pain. In the history it states that the employee came in with a two day history of pain in her right lumbar spine that radiated into her right lower extremity posteriorly. The type written word "day" is crossed out and hand written is the word "week". The employee recalled no trauma. The employee had no numbness or weakness in the affected extremity. She had no history of back problems. The physical exam showed no neurologic deficit. The assessment was back pain with radiculopathy. Dr. Bryant prescribed Vioxx.

On October 1, Dr. Bryant noted that the employee's pain was no better. She had continued pain radiating into her right lower extremity with no frank numbness or weakness. The employee recalled no trauma. Dr. Bryant assessed back pain with radiculopathy, ordered an MRI of the lumbar spine, and prescribed Darvocet for pain. The MRI was performed on October 5, 2003. The impression of the radiologist was at T12-L1, there was a left paracentral disc protrusion that compressed and flattened the left anterolateral aspect of the cord. At L4-5 there was a minimal annular disc bulge causing minimal right inferior neural foraminal encroachment. At L5-S1 there was a small central disc protrusion that did not contact or displace the nerve roots.

A Gates memo, dated October 9, 2003 and signed by James Moss, stated that during the afternoon of September 18, 2003 Mr. Moss was in the spiral finishing area and noticed the employee walking with a limp. Mr. Moss asked the employee what the problem was. She told him that her doctor said she had a pinched nerve. On October 7, the employee stopped by Mr. Moss's office at 1:30 p.m. She had a statement from her family physician that she could not do any heavy lifting. The employee was concerned about her attendance, the fact that she had very little sick days and was concerned about losing her job. Mr. Moss contacted P. E. Turner, the employee's supervisor. There was a discussion as to what jobs in spiral finishing that did not require heavy lifting. The employee agreed that a box maker did not require heavy lifting. On October 8, the employee stopped at Mr. Moss' office at about 1:45 p.m. She stated that Dr. Bryant made the employee an appointment with Dr. Park, a neurologist. The employee stated that she remembered what caused her condition. On September 15, 2003, she stayed over past the end of her scheduled shift to pack fuel line and while she was moving a full box over to stack on the pallet, she felt a sharp pain in her lower back but then the pain went away.

On October 8, 2003, the employee was sent to Dr. Heath by the employer. On October 7, the employee told the employer that she had sustained an injury on September 15 as she was loading some coils of hoses onto a pallet that was at eye level. She was swinging the hoses from the right to the left and developed pain in the low back and down the buttocks. It was noted that the employee did not think anything about it and did not report it to anybody at that time. Over the next several days, she started having some discomfort in the back but primary a numb/burning sensation in her buttocks and down the right leg. She was treated by Dr. Bryant and had an MRI. Yesterday, the employee was given a verbal report of the MRI and she informed the employer of the alleged work incident. The employee denied any past history of significant back injury. Dr. Heath's impression was lumbosacral strain, abnormal MRI and lumbar radiculopathy. Dr. Heath noted that the employee was to see Dr. Park on Monday. Dr. Heath noted Dr. Bryant made the appointment with Dr. Park and was not

aware that it was a work related injury. Dr. Heath suggested the employee keep the appointment with Dr. Park. Dr. Heath made it clear to the employee that since it was not reported in a timely fashion she would have to address that with her employer.

There is a Gates incident investigation report for the alleged injury with the accident date September 15, 2003 at 1:15 a.m. and the date it was reported was October 8, 2003. The nature of the injuries listed was a strain, foot/leg/back. The description of the accident was that the employee was staying over four hours to make up some time. She was packing fuel line. She was behind so she got in a hurry trying to get caught up. When she lifted a box of fuel line over her head she felt a sharp pain in her lower back, and then the pain went away. The investigative report is all typed.

Also included was a copy of a hand written incident investigative report that was filled out and signed by the employee, with no date of signature. There are several differences in the handwritten report as compared to the type written report. Described in the nature of the injury was "twinge in back during lifting". Severity of incident stated was "thought to be mildly insignificant at the time". In the description of accident it was stated "I stayed over four hours... to make up time. I was packing fuel line... I was behind, so I was trying to get caught up -. When I lifted a box onto the pallet, I was hurrying. The pallet was at eye level at the time and when I lifted it up over my head, I felt a sharp twinge and then the pain subsided."

Dr. Park saw the employee on October 13 with a chief complaint of back pain. In the history it stated that the employee on September 15, 2003 felt a sharp twinge in her back. Every since then she has been having progressively worsening numbness and weakness of her legs, worse on the right than the left. The medical history showed kidney stones and kidney infections. Dr. Park stated that the MRI showed a T12-L1 left sided disc herniation causing compression of the spinal cord; at L4-5 a disc desiccation and bulge; and at L5-S1 a small central disc protrusion. Dr. Park stated that the employee had a L5-S1 small disc protrusion causing back pain but more of a concern was the T12-L1 disc which was causing spinal cord compression and probably leg weakness and numbness. He ordered a myelogram. Dr. Park performed the CT scan and myelogram on October 16. At T12-L1 there was a disc herniation which was causing indentation and flattening of the spinal cord centrally and on the left side. There was a mild disc bulge at L4-5 and L5-S1 which did not cause significant canal stenosis.

On October 20, Dr. Park noted that the myelogram confirmed the disc herniation at T12-L1 which caused compression of the spinal cord. Dr. Park recommended surgery with a posterior fixation with fusion.

The medical records from St. Francis Medical Center on October 27 stated that the MRI showed problems in the T12L1 region as well as in the L4-5 and L5-S1 region. A myelogram confirmed a disc herniation at T12-L1 and it was determined that her symptoms were coming from that level. Dr. Park's impression was that the employee's symptoms correlated with her MRI and myelogram. She was symptomatic from the spinal cord compression at T12-L1 from the disc herniation. On October 28, Dr. Park performed a T12-L1 left sided microdiscectomy with a posterior fusion using a bone graft from the right iliac crest.

On December 1, 2003, Dr. Park noted that after surgery her leg strength was improving and reported only occasional numbness instead of much more frequent numbness. Dr. Park stated that he would keep her in a back brace for two more months.

On February 2, Dr. Park noted that the employee's left leg was doing well including strength and numbness. The employee fell about two months ago while she was in her brace and tried to catch herself. She injured her neck and right shoulder. Dr. Park suspected a possible disc herniation in the cervical spine and ordered an MRI.

The February 10 MRI showed a C5-6 central disc protrusion which caused minimal canal stenosis and a C6-7 central disc herniation with mild compression of the spinal cord. On February 12, Dr. Park noted that the employee was doing reasonably well from the thoracic surgery. The employee reported that since December she had been having pain in her neck which went into her arms and was gradually getting worse. Dr. Park ordered therapy for two weeks.

In the health facilities rehab evaluation done on February 16, 2004, the employee reported on September 16, 2003 she injured her back at work, and had a fusion at T12 and L1 on October 28. The employee reported on December 3, 2003 that her legs gave away and she fell and injured her neck.

On March 4, Dr. Park the employee developed weakness of her legs from that with spinal cord compression of the C6-7 level. Physical therapy did not help. On March 18, Dr. Park performed a C6-7 anterior cervical microdiscectomy, interbody fusion with instrumentation and plating.

The employee saw Dr. Park on April 15, and noted that her arms were better. Dr. Park noted that the employee complained of persistent low back pain which may be due to her L4-5 and L5-S1 disc herniation. On May 24 Dr. Park noted that the May 20 CT scan showed a solid fusion at T12-L1. The employee was having pain involving the lower back at L4-5 and L5-S1 where she had degenerated discs. He ordered physical therapy.

In the therapist evaluation on May 26, the employee stated she was injured at work about eight months ago and underwent a fusion. The employee also had discs at L4-5 and L5-S1. The employee had central low back pain into her left extremity down to her mid foot and loss and strength in her right lower extremity. On June 18, the employee had no relief in her low back and was starting to complain of new pain in her central thoracic region radiating anteriorly into the ribs with difficulty breathing. On June 21, Dr. Park noted that the CT scan of the cervical spine showed a solid fusion at C6-7 level and he released her from his care. It was his opinion that the employee had chronic pain and recommended a pain management specialist.

The employee saw Dr. Richard Katz on August 31. The employee reported to Dr. Katz that on September 15, 2003, she was loading a box weighing 25-30 pounds onto a pallet. When she went up with the box, she lost her grip and tried to catch it and felt a sharp pain in her back. The employee sought treatment for her own doctor and was seeing him for leg pain and not for back pain. The employee continued to work for the next three weeks. Dr. Katz diagnosed back pain with radiculopathy and no numbness or weakness, right SI joint pain and a lumbosacral spine strain. Dr. Katz stated that the employee's overriding present problem was a major depressive disorder which was under treated. Dr. Katz stated that the MRI results showed that there were two radiological relevant lesions at T12-L1 and C6-7. Dr. Katz stated that the employee was clearly being treated for a low thoracic problem prior to the reported date of injury. There was clear documentation on the May 2003 note. It was Dr. Katz's opinion that this condition was pre-existing and the reported incident was not a significant aggravating factor.

Dr. Katz stated that the employee benefited from the T12-L1 surgery but could not comment on the appropriateness of the C6-7 surgery. Dr. Katz stated that the employee's presentation was chronic pain state with a major depressive disorder. Dr. Katz suggested that the employee be weaned from narcotics, optimally treated with non-narcotic analgesics in conjunction with far more aggressive treatment of her major depressive disorder. Dr. Katz said that those treatments would be the result of her thoracic fusion and were not work related.

On February 9, the employee was sent to Dr. Katz for treatment. The employee's pain was largely in her right leg, the right buttock, extending to the right inguinal area and knee. Dr. Katz prescribed Zoloft, Amitriptyline, and therapy.

The employee was evaluated at Mid America Rehab on February 11. The handwritten notes indicated a September 15, 2003 injury where a box fell off a pallet and the employee twisted to catch the box. The employee had surgery at T12L1. On December 3, 2003, the employee's legs gave out and she fell and ruptured two discs in her neck and surgery on March 18, 2004. The typewritten note stated that the employee was injured at Gates on September 15, 2003, when she developed low back pain when she tried to catch a box which was falling off a pallet at work, and developed a subsequent herniated disc. She had T12-L1 fusion surgery by Dr. Park. She was injured again on December 3, 2003, when her "legs gave out on her at work". She had a cervical herniated disc after the fall.

The employee was treated by Dr. Katz and with physical therapy in February, March and April of 2005. At MidAmerica Rehab the employee told the therapist that she developed low back pain when she tried to catch a box which was falling off a pallet off work and developed a subsequent herniated disc. The employee reported being injured again on December 3, 2003, when her legs gave out on her and she developed a subsequent cervical herniated disc following the fall. In April Dr. Katz stated that the employee was at maximum medical improvement.

A letter from Dr. Park dated May 12, 2005 addressed causation of the C6-7 disc herniation with the T12-L1 injury. Dr. Park stated that the history reflected that the employee sustained the T12-L1 injury with disc herniation causing spinal cord compression on the left side and causing left leg weakness. The employee had a neurological deficit and that was the reason for the surgical intervention. Despite the surgery, the employee had some residual weakness and that is why the leg gave out. She fell and sustained a C6-7 disc herniation which required surgery. It was Dr. Park's belief that the T12-L1 injury was a significant factor in the employee ultimately requiring C6-7 discectomy and fusion.

The report and deposition of Dr. Levy was admitted into evidence. Dr. Levy saw the employee on November 11, 2005. Dr. Levy stated that on September 15, 2003 the employee was loading a pallet with boxes weighing 25-30 pounds. She had to lift the boxes to about eye level. As she raised one of them over her head, she lost her grip. It startled her and she arched her back under the box to try to catch it and when she caught it with her arms and her chest she developed acute onset of a sharp pain in the upper part of the low back which radiated down toward her tail bone. She sought medical attention on her own. Dr. Park performed a discectomy and fusion at T12-L1 on October 28, 2003. Approximately four weeks after the procedure her leg gave out and she fell. She had immediate onset of pain which radiated up to her neck. She had neck fusion surgery on March 18, 2004. The employee denied any prior problems to her neck or back.

It was Dr. Levy's opinion that the employee was status post discectomy and fusion at T12-L1. She had a herniated disc at L4-5, a ruptured disc at L5-S1, and a chronic lumbosacral strain. The employee was also status post discectomy and fusion at C6-7 and had a herniated disc at C5-6 with a chronic cervical strain. It was Dr. Levy's opinion that the accident on September 15, 2003 was the overall overriding and prevailing cause of those conditions. During cross-examination, when asked if she might have told any of the other physicians something different about how her accident occurred, Dr. Levy

stated that Dr. Bryant's September 22, 2003 record was different from what he was told including the date of the injury. Dr. Levy noted that the October 1 history recalled no trauma. He stated that Dr. Bryant's records are different than what he was told. It was Dr. Levy's opinion that the employee's injury at the C6-7 level was causally connected because the employee had surgery at T12-L1, was wearing a back brace and her leg gave out. Dr. Levy stated that the leg problems stemmed from the high lumbar-low thoracic disc compression of the cord. The employee was having leg problems, her leg gave out which caused her to fall, and the fall caused the neck problem.

The deposition of Dr. Katz was taken on February 8, 2007. Dr. Katz stated that the October 5, 2003 MRI showed a T12-L1 lesion. Dr. Katz stated if a disc had acutely herniated, it could cause cord edema (water infiltrating the spinal cord). Dr. Katz stated that the MRI showed no evidence of cord edema or syrinx and that made him suspicious that the lesion at T12-L1 was a chronic lesion and not one that had acutely ruptured within the prior several months. Dr. Katz stated if there had been an acute herniation of the disc that caused spinal cord impingement at T12-L1, it would have likely presented as an upper motor neuron insult or spinal cord injury. Such a person typically would have weakness in their lower extremity associated with difficulty with bowel and bladder. On physical examination, there would have been a heightened tone and heightened reflexes in the lower extremities and plantar response. Dr. Katz did not see any of that in the records. The employee never had such a presentation and the records both prior to her thoracic-lumbar surgery or subsequent to it that was suggestive of a spinal cord injury. It was his suspicion that the employee had an old chronic impinging lesion at the T12-L1 area.

Several days prior to the deposition, Dr. Katz reviewed some additional documentation including the employee's deposition, the May 30, 2003 note by Dr. Critchlow and the September 22 and October 1, 2003 notes from Dr. Bryant. (Note: The 7 day rule objection with regard to testimony regarding the additional records is overruled) When asked if any of those documents were inconsistent, Dr. Katz stated that there were certain things of note. The employee had been treated for lower thoracic pain on May 30, 2003 and that Bextra, a non-steroidal anti-inflammatory agent was not customary treatment for either urinary tract infections or kidney stones. Dr. Katz stated that it was likely that the employee was treated prior for musculoskeletal problems in the lower thoracic region. Secondly, when the employee saw Dr. Bryant on September 22, 2003, she did not recall any trauma that precipitated her lower extremity pain.

During cross-examination, Dr. Katz stated that it was his medical conclusion that the employee's lower thoracic problem was not the result of her work accident but rather was a pre-existing condition. It was his medical opinion that the low thoracic condition that necessitated the surgery and all of her care was not related to the September 15, 2003 incident. Dr. Katz stated that in the May 2003 records of Dr. Critchlow, there was no radiating pain mentioned. The employee was on Bextra which is a non-steroidal anti-inflammatory primary used for musculoskeletal pain. It was reasonable to assume that prior to May 30, 2003; the employee was being treated for musculoskeletal pain. Dr. Katz stated that non-steroidal antiinflammatory agents including Bextra are frequently prescribed for painful menstrual periods. The employee was on Bextra but there were no documents or records why the Bextra was prescribed. Dr. Katz stated the employee was evaluated on May 30, 2003 for thoracic pain and the advocated treatment was Bextra. That is important as it applies to the question of preexistence of thoracic pain. As to why she was on Bextra prior to that, it may or may not be relevant. The August 26, 2003 records show the employee was complaining of menopausal symptoms related to recently stopping her estradiol. Dr. Katz's conclusion that there was a pre-existing low thoracic condition was based on the one reference in the May 2003 note from Dr. Critchlow. It was Dr. Katz's opinion that the T12-L1 lesion was not related to the alleged September 15, 2003 accident, and that the cause was a chronic degenerative changes of the disc.

During redirect examination, Dr. Katz stated that it was his impression from reading the May 30, 2003, note that Dr. Critchlow was treating the employee with Bextra for presumed musculoskeletal pain. That was based on the fact that the employee came in with thoracic pain, the urinalysis was normal, and Dr. Critchlow allowed the employee continue with Bextra. The normal urinalysis made it highly unlikely but not impossible that she had a kidney stone or a urinary tract infection. Dr. Critchlow did not treat the employee for a urinary tract infection as no antibiotic was prescribed. He treated her with a pain medication most often used for musculoskeletal pain.

The employer has denied that the employee sustained an accident on or about September 15, 2003, and denied that the employee's injury and need for medical treatment was medically causally related to the alleged accident.

It is important to note that the burden of proof is on the employee to prove all material elements of her claim. See Marcus v. Steel Constructors, Inc., 434 S.W.2d 475 (Mo. 1968) and Walsh v. Treasurer of the State of Missouri, 953 S.W.2d 632,637 (Mo. App. 1997). The employee has the burden of proof that her injuries were the result of an accident that arose out of and in the course out of employment. See Strate v. Al Baker's Restaurant, 864 S.W.2d 417, 419-420 (Mo. App. 1993). The employee has the burden of proving both that there was a work related accident and that there is a medical causal relationship between the accident, the injuries, and the medical treatment for which she is seeking compensation. See Dolan

v. Bandera’s Café and Bar, 800 S.W.2d 163 (Mo. App. 1990). The employee has the burden to prove that her injuries arose out and in the course of employment. See Smith v. Donco Construction, 182 S.W.3d 693, 699 (Mo. App. 2006).

A claim for compensation may be decided solely upon a finding of lack of credibility of uncontradicted and unimpeached testimony. See Cox, General Motors Corporation, 691 S.W.2d 294 (Mo. App. 1985), Beyer v. Howard Construction Company, 736 S.W.2d 78 (Mo. App. 1987), Smart v. Chrysler Motors Corp., 851 S.W.2d 62, 64 (Mo. App. 1993) and Alexander v. D.L. Sitton Motor Lines, 851 S.W.2d 525 (Mo. Banc. 1993).

Given these established principles, there are a number of evidentiary problems that support a finding that the employee has failed to meet her burden of proof on the issues of accident and medical causation. These problems are addressed as follows:

The medical history given by the employee to the initial treating health care provider does not corroborate the testimony of the employee at the hearing regarding a specific incident on or about September 15, 2003.

The employee testified that in the early morning hours of September 16, she picked up a box that weighed 20-25 pounds and swung it around to load it onto a pallet. She lost her grip on the box which startled her. She tightened up her body, arched her back, and caught the box with her chest and arms. She had a significant sharp pain in her upper low back like someone had stuck a knife into her back. She had to lean against the pallet for a few minutes to catch her breath and cope with the pain.

On September 22, just six days after the alleged incident, the employee went to see Dr. Bryant. There is nothing contained in his medical record about the alleged work incident and Dr. Bryant specifically mentioned that the employee recalled no trauma. The employee reported a two day history of pain in her right lumbar spine that radiated into her right lower extremity. The type written word "day" was crossed out and replaced with the hand written word "week". The employee again saw Dr. Bryant on October 1, and again reported to him that she could recall no trauma. There is nothing in that record about the alleged work incident.

The employee's explanation for the lack of medical history to Dr. Bryant is neither credible nor persuasive.

The employee testified that the reason she did not tell Dr. Bryant about the incident was that she had not connected her symptoms to the alleged incident. It is important to highlight the employee's testimony concerning her symptoms and problems from the time of the incident through the time she saw Dr. Bryant.

The employee testified that when she was injured at 1:15 a.m. on September 16, she had a significant sharp pain in her upper low back like someone had stuck a knife into her back. She had to lean against the pallet for a few minutes to catch her breath and cope with the pain. The employee thought it was a really bad muscle strain. She finished her shift at 2:00 a.m.

When the employee woke up on Tuesday, September 16, she had a catch in her right hip socket and a sharp pain at the top of her thigh. She worked from 2:00 p.m. to 10:00 p.m. In addition to her right hip and leg symptoms, she continued to have a stabbing twinge pain in her back during her frequent twisting and bending. Her problems continued to get worse but the employee did not connect her hip and back problems to the incident. After her shift ended, she was almost positive that she took a pain reliever due to the amount of pain she had. She did not sleep well that night due to intense radiating pain down her right hip to the knee.

On Wednesday, September 17, the employee had to stop driving her daughter to St. Louis due to severe pain in her legs and had to lie down in the back seat while her husband drove. That evening at work she talked to her supervisor about her problems including the sharp pain in her right hip that radiated down the front of her leg to her knee. The pain continued to get worse each day.

On Thursday, September 18, the employee was limping at work and was asked by James Moss why she was limping. She told him that she was not sure. During that week, the employee continued to have back pain when she bended and twisted.

On Monday, September 22, Dr. Bryant diagnosed back pain with radiculopathy and prescribed Vioxx. On October 1, Dr. Bryant noted that the employee's pain was not any better. He ordered an MRI and prescribed Darvocet for pain. The employee stated that when Dr. Bryant asked about trauma, she did not believe that the box hitting her chest was trauma. The employee did not relate her symptoms with the alleged work incident.

I find the employee's testimony that she did not inform Dr. Bryant about the work incident because she had not connected her symptoms to the alleged incident is not believable. When the employee allegedly had the work injury, she felt like a knife had been stuck into her back. The pain was so intense that she had to lean against the pallet for a few minutes to catch her breath and cope with the pain. Within 12 hours after the injury, she had pain that ran down her hip to her knee and continued to have stabbing back pain. She started taking pain medication, had trouble sleeping, had to stop

driving, and was limping shortly after the alleged injury. I find that her explanation is not persuasive and is not credible.

The gap in time between the alleged work incident and the reporting of the alleged injury does not support a finding that the employee sustained an accident on or about September 15, 2003.

The employee testified that at the time of the alleged accident she was aware of the policy to immediately report to her supervisor injuries that may have occurred on the job, she was aware of the signs throughout the plant to report an injury no matter how small, and was aware of the requirement to report the injury to her employer. The employee had the opportunity to report the injury when she talked to her supervisor, Mr. Turner on September 17, and to James Moss, on September 18, about her physical condition and problems. The evidence clearly established that the employee did not report the alleged work accident until October 8, 2003, which was 22 days after the alleged injury. This 22 day gap in time between the alleged work incident and the reporting of the alleged injury does not support a finding that the employee sustained an accident on or about September 15, 2003.

When asked why she did not report the injury to Mr. Turner or Mr. Moss, the employee testified that if every employee would report every small injury the office would be full 24 hours a day, 7 days a week. According to the employee's own testimony, her injury was not a small injury.

The employee wants the Court to believe that when she injured her back on September 16, the pain felt like a knife had been stabbed into her back. It was so intense that she had to lean against a pallet for a few minutes to catch her breath and cope with the pain. Within 12 hours after the injury, she had pain that ran down her hip to her knee and continued to have stabbing back pain. She started taking pain medication, had trouble sleeping, had to stop driving, and was limping shortly after the alleged injury. The employee's symptoms continued through October 7. The employee testified that it took a while (three weeks) to figure out that the incident was what caused her problems including the leg pain. The employee wants the Court to believe that it took until October 8, for the employee to realize that the symptoms that she had since September 16, were related to the alleged incident on September 16, 2003.

The testimony of the employee at the hearing and the employee's deposition testimony are inconsistent as to how she decided that the alleged incident was the cause of her problems. At the hearing, the employee testified that on October 7, Dr. Bryant's nurse told her the results of the MRI and that a back injury could cause leg problems. The doctor put her on light duty. The employee met with Mr. Moss and Mr. Turner regarding light duty work. At the meeting, the employee was very concerned about her job because of the small amount of sick leave that she had. The employee testified that she then thought more about what Dr. Bryant's nurse said, and she then turned her condition in as work related incident on October 8. In her deposition, the employee did not say that she got the idea that it was work related from talking to Dr. Bryant's nurse but testified that all of a sudden she felt that it was related to her work because when she went into work on September 15 she had no pain and when she left work she was in a considerable amount of pain after the incident. The inconsistency between the employee's testimony at the hearing and the employee's testimony at the deposition substantially affects her credibility. I find that her explanation for her failure to report the alleged accident until October 8 is not persuasive and is not credible.

It is important to note the evolution of the employee's version of the accident. The first version started on September 22, 2003, when she told Dr. Bryant that there was no trauma but she had a either two day or two week history of back and leg pain. The second version began on October 8, 2003, when the employee told James Moss that she had remembered what caused her condition, and that on September 15, she felt a sharp pain in her lower back when she was moving a full box to stack on a pallet. The employee prepared a report in her own handwriting which stated that when she lifted a box over her head onto a pallet she felt a sharp twinge. The third version began on August 31, 2004 when she told Dr. Katz that she was loading a box weighing 25-30 pounds onto a pallet. When she went up with the box, she lost her grip and tried to catch it and felt a sharp pain in her back. The fourth version began in November of 2005, when she told Dr. Levy a similar history as she gave to Dr. Katz but added when she lost her grip, it startled her and she arched her back under the box to try to catch it and when she caught it with her arms and her chest she developed acute onset of sharp pain in the upper part of the low back. This version continued at the employee's deposition and at the hearing.

The employee's version of the alleged accident started with low back and leg pain anywhere from around September 8 though September 19, 2003 with no specific incident or trauma causing it; then changed to a specific incident on September 15, 2003, when she was moving a box to stack on a pallet and felt a sharp twinge or pain in her lower back; then to a specific incident where she lost her grip on the box and tried to catch when she felt a sharp pain in her back; and finally to being startled when she lost her grip, arching her back, catching the box with her arms and chest, and having the onset of sharp pain. The evolving version of the alleged accident affects the employee's credibility.

The employee's testimony at the hearing and at the deposition and a statement she made to Dr. Katz is inconsistent with the other evidence.

At the hearing, the employee stated that she did not really have a history of pre-existing depression. The medical records show in October of 2001 Dr. Roberts diagnosed anxiety and depression. He prescribed Zoloft and discussed stress reduction techniques. In 2002, Dr. Jacobs stated that the past medical history was significant for depression.

In her deposition, the employee stated that she did not remember if she mentioned her low back problems to Dr. Bryant. The medical records from Dr. Bryant on September 22, show that the employee had right lumbar spine pain and was diagnosed with back pain and radiculopathy.

In her deposition, the employee testified that when she saw Dr. Park in early December of 2003, she told him that she was having a lot of leg weakness, her leg was giving out on her, and that he was aware of her leg weakness. The medical records from Dr. Park show that her leg strength was improving and the employee reported only occasional numbness.

The employee told Dr. Katz that she saw her own doctor for leg pain and not back pain. Dr. Bryant's records clearly show that the employee had low back pain in addition to leg pain.

These inconsistencies have an adverse effect on the credibility of the employee.

The employee's testimony concerning the alleged December of 2003 fall and injury is not credible.

The employee testified that on December 1, she saw Dr. Park and told him that she was having a lot of leg weakness, her leg was giving out on her when she saw him, and that he was aware of her leg weakness. On December 3, the employee testified that her knees buckled, her legs gave out, she fell and struck the floor hard. She immediately had a sharp, stabbing, tearing pain in her neck and right shoulder blade pain. She called Dr. Park's office that morning, and told the nurse what had happened and relayed how serious her symptoms were. The nurse told her unless she fell directly on her incision, she did not need to come in. The employee testified that she got by the best she could until she saw Dr. Park for her normal follow-up.

The employee's testimony concerning this alleged fall is not credible for the following reasons: Dr. Park's medical records on December 1, show that the employee's leg strength was improving and the employee was having only occasional numbness instead of much more frequent numbness. There is no mention in his records that the employee was having a lot of leg weakness and her leg was giving out on her. There is nothing in Dr. Park's records of the alleged December $3^{\text {rd }}$ telephone call to the nurse about the fall. Even though the employee had a herniated disc in her neck that led to surgery, the employee did not have medical treatment for that condition until her already scheduled visit with Dr. Park two months after the alleged fall.

The employee's testimony concerning the May 30, 2003 visit to Dr. Critchlow is not credible.

The employee testified that on May 30, 2003, she was positive that she was having kidney pain and thought she had a kidney infection. The pain was on her side and low back. She stated that it was lower than the thoracic area and she showed Dr. Critchlow where the pain was. The employee stated that she was on Bextra, an antiinflammatory, for a muscle strain under her arm pit which was prescribed by Dr. Jacob's nurse.

It is important to note that there are no medical records from Dr. Jacob's office concerning Bextra. Dr. Critchlow's records show that the employee's pain was in the lower thoracic area and the urinalysis was completely normal. Dr. Critchlow did not prescribe any antibiotics and told the employee to continue with the Bextra. The prior medical records for the employee's urinary tract infections and kidney problems show that the employee had flank pain and low back pain. The records never mentioned that the employee had thoracic pain associated with her urinary tract infections or kidney problems.

Dr. Katz stated on May 30, 2003, the employee was evaluated and treated for thoracic pain. Bextra is a non-steroidal anti-inflammatory agent primary used for musculoskeletal pain and is not customary treatment for either urinary tract infections or kidney stones. It was Dr. Katz's opinion that Dr. Critchlow treated the employee with Bextra for presumed musculoskeletal pain due to the fact the employee had thoracic pain, her urinalysis was normal, Dr. Critchlow continued Bextra and did not prescribe an antibiotic for a urinary tract infection.

Based on a review of the evidence, I find that the employee's testimony regarding the May 30, 2003 visit to Dr. Critchlow is not credible.

There is insufficient credible medical evidence to support a finding that the employee's present back condition is medically causally related to the alleged work injury on or about September 15, 2003.

It was Dr. Levy's opinion that the accident on September 15, 2003 was the prevailing cause of the discectomy and fusion at T12-L1, the herniated disc at L4-5, ruptured disc at L5-S1, and the chronic lumbosacral strain. Dr. Levy's opinion is substantially affected by the numerous evidentiary problems that are stated above and the fact that Dr. Levy testified that Dr. Bryant's September 22, 2003 record was different from what he was told including the date of the injury, and the employee recalled no trauma.

It was Dr. Katz's opinion that the employee's lower thoracic problem was not the result of a work accident but rather was a pre-existing condition. It was Dr. Katz opinion that the T12-L1 lesion was not related to the alleged September 15, 2003 accident, and that the cause was a chronic degenerative change of her thorocolumbar disc.

Based on a review of all the evidence, I find that the opinion of Dr. Katz is more credible than the opinion of Dr. Levy.

Based on a thorough review of the evidence including the cumulative effect of the evidentiary problems discussed above including the lack of credibility of the employee, I find that the employee failed to satisfy her burden of proof on the issues of accident and medical causation. I further find that the employee did not sustain a work-related accident on or about September 15, 2003, and that the employee's condition and need for the surgeries are not medically causally related to the alleged accident on or about September 15, 2003.

Given the employee's failure to prove that she sustained an accident and her failure to prove a medical causal connection between her back condition and the alleged accident on or about September 15, 2003, the employee's claim for compensation is denied. Given the denial of the employee's claim on the issues of accident and medical causation, the remaining issues are moot and will not be ruled upon.

In addition to the employee's claim, a medical fee dispute was filed by St. Francis Medical Center. Based on the denial of the employee's claim for compensation against the employer, the medical fee dispute filed by St. Francis Medical Center is also denied.

Date: $\qquad$ Made by:

Lawrence C. Kasten

Administrative Law Judge

Division of Workers' Compensation

A true copy: Attest:

Ms. Patricia "Pat" Secrest

Director

Division of Workers' Compensation