Doris Dobbs v. Jefferson Memorial Hospital

(Affirming Award and Decision of Administrative Law Judge)

Injury No.: 03-145703

Employee: Doris Dobbs

Employer: Jefferson Memorial Hospital

Insurer: Self-Insured

Additional Party: Treasurer of Missouri as Custodian of Second Injury Fund (Dismissed)

The above-entitled workers' compensation case is submitted to the Labor and Industrial Relations Commission (Commission) for review as provided by section 287.480 RSMo. Having reviewed the evidence and considered the whole record, the Commission finds that the award of the administrative law judge is supported by competent and substantial evidence and was made in accordance with the Missouri Workers' Compensation Law. Pursuant to section 286.090 RSMo, the Commission affirms the award and decision of the administrative law judge dated February 8, 2010. The award and decision of Administrative Law Judge Carl Strange, issued February 8, 2010, is attached and incorporated by this reference.

The Commission further approves and affirms the administrative law judge's allowance of attorney's fee herein as being fair and reasonable.

Any past due compensation shall bear interest as provided by law.

Given at Jefferson City, State of Missouri, this $24^{\text {th }}$ day of June 2010.

LABOR AND INDUSTRIAL RELATIONS COMMISSION

William F. Ringer, Chairman

Alice A. Bartlett, Member

John J. Hickey, Member

Attest:

Employee: Doris Dobbs

Injury No. 03-145703

Dependents: N/A

Employer: Jefferson Memorial Hospital

Additional Party: SIF (Voluntarily Dismissed)

Insurer: Self-Insured

Hearing Date: October 29, 2009

Checked by: CS/rf

1. Are any benefits awarded herein? Yes
2. Was the injury or occupational disease compensable under Chapter 287? Yes
3. Was there an accident or incident of occupational disease under the Law? Yes
4. Date of accident or onset of occupational disease? November 1, 2003
5. State location where accident occurred or occupational disease contracted: Jefferson 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 (See Findings)
9. Was claim for compensation filed within time required by law? Yes (See Findings)
10. Was employer insured by above insurer? Yes
11. Describe work employee was doing and how accident happened or occupational disease contracted: Employee developed bilateral carpal tunnel syndrome as a result of her work activities.

1. Did accident or occupational disease cause death? N/A
2. Parts of body injured by accident or occupational disease: Bilateral Upper Extremities at the Level of the Wrist
3. Nature and extent of any permanent disability: 18% of the right wrist at the 175 week level 18% of the left wrist at the 175 week level 15% multiplicity factor.
4. Compensation paid to date for temporary total disability: 0.00
5. Value of necessary medical aid paid to date by employer-insurer: 0.00
6. Value of necessary medical aid not furnished by employer-insurer: EI to hold EE harmless on 10,135.83 (See Stipulation 7)
7. Employee's average weekly wage: 477.23
8. Weekly compensation rate: 317.84 for temporary total disability 317.84 for permanent partial disability
9. Method wages computation: By Agreement
10. Amount of compensation payable: 6 weeks of temporary total disability: (1,907.01) (See Stipulation 7) 72.45 weeks of permanent partial disability: (23,027.51) 2 weeks of disfigurement: (635.68) TOTAL: 25,570.20
11. Second Injury Fund liability: None (Voluntarily Dismissed)
12. Future requirements awarded: N/A

Said payments shall be payable as provided in the findings of fact and rulings of law, and shall 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: Thomas P O’Driscoll.

On October 29, 2009, the employee, Doris Dobbs, appeared in person and by her attorney, Thomas P O'Driscoll, for a hearing for a final award. The employer-insurer was represented at the hearing by its attorney, Dennis Tesreau. 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. On or about November 1, 2003, Jefferson Memorial Hospital was 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 November 1, 2003, the employee was an employee of Jefferson Memorial Hospital and was working under and subject to the provisions of the Missouri Workers' Compensation Act.
3. On or about November 1, 2003, the employee sustained an occupational disease.
4. The employer had notice of employee's accident.
5. The employee's average weekly wage was $\ 477.23, her rate for temporary total disability and permanent partial disability is $\ 317.84.
6. The employer has paid no temporary total disability benefits.
7. Written "Stipulation of Facts for Hearing Dated October 29, 2009" signed by both parties' attorneys and attached hereto and fully incorporated herein by this reference.

1. Arising out of
2. Statute of Limitations
3. Medical Causation
4. Nature and Extent

The following exhibits were offered and admitted into evidence:

Employee's Exhibits

A. Medical Records of Jefferson Memorial Hospital

B. Medical Records of Dr. Kevin Sides

C. Medical Records and Bills of Dr. Dwayne Helton

D. Medical Records and Bills of Dr. John McGarry

E. Medical Records and Bills of Dr. Jeffrey Draves

F. Medical Records and Bills of Dr. Craig Ruble

G. Deposition of Dr. Robert Margolis

H. Job Description of Physical Therapy Technical Aide

Employer-Insurer's Exhibits

1. Deposition of Dr. R. Evan Crandall (as highlighted); and
2. Jefferson Memorial Hospital Position Description for Rehab Technician effective August 5, 2002.

Based on the testimony of Doris Dobbs ("employee") and the medical records and reports admitted, I find as follows:

At the time of the hearing, the employee was 49 years old and had worked for Jefferson Memorial Hospital ("employer") for the past 20 years. According to her testimony, the employee first sought treatment for her wrists in 1997 with Dr. Sides who prescribed her splints. Additionally, she had nerve conduction studies from Dr. Keely on September 29, 1997 (Employer-Insurer Exhibit 1, Deposition Exhibit 2, Page 2). At that time, the employee was working as a physical therapy rehab technician/aide where she was required to repetitively use her upper extremities to move patients, utilize gate belts, push wheelchairs, and lift patients (Employee Exhibit H)(Employer-Insurer Exhibit 2). The employee continued to work for the employer for the next several years without missing work for her wrists' condition. The employee began working in the employer's histology lab in 2000. While in the histology lab, the employee was required to work with a microtone where she would roll a knob 50,000 to 60,000 times in a three hour period every day. For the rest of the day, the employee would pick up specimens, take requisitions, keep up stock, and do computer work. All of her duties at the histology lab required constant use of her upper extremities. Since she continued to have problems with her wrists, the employee sought additional treatment for her wrists on August 17, 2000. At that time, the employee complained of pain in her left wrist and pain in her right shoulder with occasional numbness in hands that comes and goes. Dr. Sides diagnosed her with right proximal biceps tendinitis and left wrist tendonitis (Employee Exhibit B, Page 3). The employee went through some physical therapy, and Dr. Sides noted that the left wrist strain was resolved by September 14, 2000 (Employee Exhibit A1, Pages 65-71)(Employee Exhibit B, Page 4).

The employee next sought treatment for her wrists with Dr. Dwayne Helton on October 10, 2003. At that time, Dr. Helton diagnosed the employee with carpal tunnel syndrome and planned to order bilateral upper extremity nerve conduction velocity studies (Employee Exhibit C, Pages 2-3). Dr. John McGarry performed the nerve conduction studies on November 4, 2003 and noted abnormal nerve conduction study with definite evidence for median nerve entrapment on each wrist with a greater abnormality on the right than the left (Employee Exhibit D, Page 10). On December 22, 2003, Dr. Helton diagnosed the employee with moderately severe bilateral carpal tunnel and planned to refer the employee out for a surgery consult since she has failed wrist splints (Employee Exhibit C, Page 4). While getting treatment from Dr. Jeffrey Draves, the employee complained of carpal tunnel in both arms on March 17, 2004. The

employee continued to work for the employer and did not miss any work due to her bilateral carpal tunnel syndrome. On January 27, 2005, the employee filed her claim for compensation against the employer.

Dr. John McGarry did a second nerve conduction study on August 30, 2005 that supported his previous diagnosis of median nerve entrapment at the wrist on the right more than left (Employee Exhibit D, Pages 4-7). On October 13, 2005, Dr. Craig Ruble reviewed Dr. McGarry's nerve conduction studies and noted that the employee complained of bilateral hand numbness, tingling and pain that she could not relate to anything other than activity at work. Dr. Ruble provided the employee with splints and anti-inflammatory medication with a discussion of the risks of surgery. On October 20, 2005, Dr. Ruble performed a right carpal tunnel release on the employee. He performed the left carpal tunnel release on November 10, 2005. After releasing her back to work on December 5, 2005, Dr. Ruble noted on December 20, 2005 that the employee complained of a little weakness with her grip strength, occasional tingling and a little bit of soreness over the incision but stated that her releases were doing well. As a result, Dr. Ruble released her from his care to return on an as needed basis (Employee Exhibit F).

On March 30, 2006, the employee saw Dr. Robert Margolis for an evaluation. Dr. Margolis issued his report on April 24, 2006 and gave his deposition on November 20, 2007. Following his evaluation of the employee and a review of her medical records, Dr. Margolis noted that the employee first developed upper extremity symptoms while working in the physical therapy department but further continued while she was a histology technician. Further, he diagnosed the employee with bilateral symptomatic carpal tunnel syndrome and opined that her employment at Jefferson Memorial Hospital is the substantial prevailing factor in causing her bilateral carpal tunnel syndrome. In addition to noting that there is a synergistic effect between both wrists, Dr. Margolis opined that the employee suffered a permanent partial disability of 30 percent of each upper extremity at the level of the wrist (Employee Exhibit G).

On September 5, 2006, Dr. R. Evan Crandall evaluated the employee and later gave his deposition on January 8, 2008. At the time of her initial appointment, the employee filled out a questionnaire where she was asked about what part of her job that she thought caused your problem. As a result, the employee provided a detailed description of her job as a physical therapy technician and noted that her hands hurt so much she had to find another job and that is when she went to the lab. At the time of the hearing, the employee testified that she thought Dr. Crandall wanted her thoughts of the original cause of her bilateral carpal tunnel. Af