The administrative law judge erred in finding that the treatment sought by employee, specifically the corpectomy, was not causally related to the work injury. The administrative law judge agreed with employer that the corpectomy was not necessary to treat employee's condition. I believe the evidence suggests otherwise.
Under section 287.140.1 RSMo (2000), employer is responsible for providing treatment that may reasonably be required after the injury to cure and relieve the employee from the effects of the injury. Employee has shown that the treatment sought and rendered was reasonable and necessary to cure her from the effects of her work-related injury.
Employee has also shown that the past bills are causally related to the work injury. A sufficient factual basis to award past medical expenses exists when employee identifies all of the medical bills as being related to and the product of the work-related injury and the medical bills are shown to relate to the professional services rendered by medical records in evidence. Martin v. Mid-America Farm Lines, Inc., 769 S.W.2d 105, 111-112 (Mo. banc 1989). The employer may challenge the reasonableness or fairness of the bills or may show that the medical expenses incurred were not related to the injury in question. Id at 112.
Employer argued that the corpectomy was not necessary to treat employee's condition. Employer disputed that employee was in need of any additional medical care. Employer argues that Dr. Kennedy did not recommend a corpectomy and it was Dr. Kennedy's opinion that the corpectomy was neither reasonable nor medically necessary to treat employee's work-related injury. While Dr. Kennedy did not propose a corpectomy, he did indicate that employee was in need of further treatment and that his treatment course would include bracing, pain medication, and periods of limited duty. Employee was released from care and no further treatment options were provided by employer which resulted in the continued deterioration of employee's condition. Employer's failure to provide sufficient treatment left employee with no choice but to seek treatment from alternate medical providers. Employee should not be punished for seeking additional treatment as the record clearly demonstrates that her condition warranted further medical treatment.
Employee provided sufficient evidence that the corpectomy was necessary to treat her November 24, 1999 injury. After her fall, employee experienced an immediate onset of pain in her mid-back. Employee underwent testing which revealed abnormality in her thoracic spine and was eventually diagnosed with a compression fracture of the $8^{\text {th }}$ thoracic vertebra. The evidence showed that from the time of the accident until the time the corpectomy was performed, employee suffered from severe back pain that was treated only with physical therapy and medication. Employee's symptoms eventually progressed to the point where it was painful for her to sit and stand and excruciating for her to walk. Since conservative treatment was not resolving her symptoms, employee sought evaluation and treatment from a neurosurgeon, Dr. Wetherington. Dr. Wetherington performed a thoracic corpectomy on March 2, 2000. Following the surgery, employee reported absolutely no back pain.
Dr. Wetherington assessed employee and opined that the surgery was needed to treat the chronic back pain employee suffered as a result of her work injury. Employee was given the choice to proceed with the surgery or continue with medical management; but because employee was failing medical management, Dr. Wetherington felt surgery was warranted. Dr. Wetherington also believed performing the surgery was needed to further evaluate the abnormality present in employee's thoracic spine and to obtain a complete diagnosis. Dr. Wetherington believed that the surgery was necessary to distinguish between a tumor, infection and/or fracture. The surgery and subsequent testing neither revealed a tumor or infection; therefore, employee's diagnosis was a T8
compression fracture. Dr. Wetherington opined that it was reasonable to ascertain that the fracture was caused by a fall, as there was no other history of an incident that would cause the compression fracture. Dr. Wetherington noted in employee's June 2, 2000 and September 14, 2000 office visits that employee reported a complete resolution of her back pain.
Dr. Musich evaluated employee on March 6, 2001. Dr. Musich testified that a corpectomy is used to treat spinal pain, preserve vertebrae, or for pathologies, which can be consistent with infections or tumors. Dr. Musich testified that the surgery in employee's case was to treat her back pain. He testified that there was some suspicion of an abnormality, but that no one could come up with a diagnosis prior to the cervical intervention. The post operative diagnosis was T8 vertebral lesion consistent with bone necrosis. Dr. Musich testified that employee's compression fracture developed bone necrosis, and the bone necrosis is what turned up the abnormality on employee's x-rays. Dr. Musich testified that the surgery was performed because the patient had subjective pain in the back following the fall in November of 1999 as well as an abnormality in the x-ray of her thoracic spine; therefore the surgery was necessary to alleviate the pain employee was experiencing as well as to get a definitive diagnosis. Dr. Musich opined that the traumatic work injury on November 24, 1999 resulted in an acute fracture of the T8 vertebral body, which necessitated surgical intervention due to an unclear diagnosis and chronic pain evaluation.
The overwhelming weight of the competent and substantial evidence reveals that claimant's corpectomy was a natural and legitimate consequence of her fall at work. Employee satisfied her burden of proof as she properly offered into evidence all medical bills pertaining to treatment for her work-related injury and testified that such medical bills and treatment were related to and the product of that injury. Therefore, employee is entitled to reimbursement for past medical expenses for the treatment related to her work injury, including the corpectomy.