APPEAL FROM THE OFFICE OF WORKERS' COMPENSATION, DISTRICT 4, PARISH OF ACADIA, NO. 14-03815. SHARON MORROW, WORKERS' COMPENSATION JUDGE.
H. Douglas Hunter, Misti Landry Bryant, Guglielmo, Lopez, Tuttle, Hunter & Jarrell, L.L.P., Opelousas, Louisiana, Counsel for Defendant/Appellant: American Legion Hospital.
Thomas A. Budetti, Attorney at Law, Lafayette, Louisiana, Counsel for Plaintiff/Appellee: Jacquenette Guidry.
Court composed of John D. Saunders, James T. Genovese, and Phyllis M. Keaty, Judges.
[14-1285 La.App. 3 Cir. 1] KEATY, Judge.
Employer suspensively appeals from a judgment rendered by the workers' compensation judge (WCJ) reversing a decision of the Louisiana Medical Director to deny the claimant's request for a lumbar surgical procedure and, thereby, approving the procedure. We affirm.
FACTS AND PROCEDURAL HISTORY
Claimant, Jacquenette Guidry, a registered nurse, injured her back on June 12, 2012, in the course and scope of her employment with American Legion Hospital while transferring a patient into a bed. According to the medical records attached to her Form 1008 Disputed Claim for Compensation, she developed low back pain within fifteen to twenty minutes of
the transfer and was sent to the emergency room by her employer, where she was treated, released, and advised to seek follow-up care with her primary care physician. After seeing several physicians and obtaining no relief from physical therapy and a lumbar epidural steroid injection, claimant eventually sought treatment from Dr. Mark McDonnell, an orthopedic surgeon. On May 14, 2014, Dr. McDonnell submitted a Form 1009 Disputed Claim for Medical Treatment, together with thirty-eight pages of supporting medical documentation, seeking approval from the Medical Director of the Office of Workers' Compensation (the Medical Director) of a posterior lumbar decompression and fusion at L4-S1 with post-operative bracing that had been denied by Novare, the workers' compensation carrier of Guidry's employer. The Medical Director denied the requested procedure in a Medical Guidelines Dispute Decision (MGD) dated May 27, 2014. The MGD explained the denial as follows:
o For decompression indications as required in the MTG have not been met: records do not document radiculitis on exam; the imaging does not correlate for neural compression.
[14-1285 La.App. 3 Cir. 2] o For spinal fusion a specific indication for spinal fusion is not demonstrated at L4/5[.]
o All preoperative surgical indications as required in the MTG for fusion have not been met; a specific diagnosis or pain generator is not identified by exam, imaging, or diagnostic injection; ...