Opinion
No. 6-060 / 05-0046
Filed March 29, 2006
Appeal from the Iowa District Court for Woodbury County, Gary E. Wenell, Judge.
Petitioner appeals from the district court's decision on judicial review affirming the agency's decision on remand from the court of appeals. AFFIRMED.
Robert Green, Sioux City, for appellant.
Matthew Grotnes of Hopkins Huebner, P.C., Des Moines, for appellee Marian Health Center.
Heard by Sackett, C.J., and Vogel and Mahan, JJ.
Petitioner-appellant, Judy Sands, appeals from the district court's decision affirming the remand decision of the workers' compensation commissioner that determined the ending date for her healing period benefits. She contends the district court erred in concluding the commissioner's decision was supported by substantial evidence and in denying her motion for leave to present additional evidence. We affirm.
BACKGROUND FACTS AND PROCEEDINGS
Appellant was injured at work in September of 1992 when two fingers of her left hand were smashed between a cart she was pushing and a cart washer. Her family doctor referred her to a neurologist at appellee, who referred her to doctors at the University of Nebraska Medical Center. They diagnosed her as having reflex sympathetic dystrophy (RSD).
In February of 1996 appellee requested an independent medical examination by Dr. Donovan. He indicated the history of injury could be consistent with several different conditions, including RSD or a vascular disorder. Dr. Donovan recommended a bone scan and a vascular examination including an arteriogram in order to assist in his diagnosis. The bone scan was performed. According to Dr. Donovan, the bone scan did not show good evidence of the existence of RSD on the left side. His exam also showed hypervascularity in the right wrist. Appellant was scheduled to have an arteriogram, but declined to do so in June of 1996. Following appellant's refusal to submit to the arteriogram, Marian Health denied both healing period benefits and any further medical treatment.
In mid-1998, appellant had a stroke following gallbladder surgery. During her hospitalization, she was diagnosed with anticardiolipin syndrome, a condition which makes her highly susceptible to developing blood clots. Based on this information, Dr. Donovan concluded she had a hypercoagulative condition which was the cause of her symptoms that were diagnosed as RSD by the University of Nebraska physicians.
Appellant's medical records were evaluated by Dr. Leth, a specialist in pain medicine. He concluded appellant's injury in September of 1992 caused a disturbance of blood flow into the ring and small fingers of the left hand which was caused by a pre-existing hypercoagulative condition. Dr. Leth indicated the injury was confined to the two fingers and did not involve any other portion of appellant's body.
The agency found appellant had experienced a fifty percent loss of use of the ring and little fingers of her left hand. The agency found no ratings of impairment and determined appellant had failed to prove her present disability was related to RSD rather than an aggravation of a pre-existing vascular condition. Therefore, the agency determined appellant's condition was a scheduled member disability of the ring and little fingers on her left hand. It ordered Marian Health to pay appellant healing period benefits to June 18, 1996, the date she refused to undergo the arteriogram test, and twenty-two and one-half weeks of compensation for permanent partial disability beginning June 19, 1996.
Upon application for judicial review of the agency decision, appellant also sought leave to admit additional evidence — an independent medical examination. The district court affirmed the agency decision and refused to consider additional evidence. The first appeal followed.
In the first appeal, Sands v. Marian Health Ctr., No. 02-0643 (Iowa Ct.App. Feb. 12, 2003), appellant claimed appellee improperly terminated her healing period benefits and medical treatment in June 1996 based on her refusal to undergo the arteriogram. She argued she had not reached maximum medical recovery as set forth in Iowa Code section 85.34(1) (1999). This court concluded the agency's determination that appellant's healing period ended when she refused the test was not supported by substantial evidence. We reversed only that portion of the agency decision and remanded for a determination of when appellant met one of the criteria for the end of her healing period set forth in section 85.34(1) and computation of any healing period benefits due up to that date.
Appellant also claimed the district court erred in not allowing her the opportunity to have a current medical examination and considering the results of that examination as additional evidence under section 17A.19(7). The district court denied the request because appellant had "not shown that this additional evidence is material and has not given any good reasons why such evidence was not presented" to the agency. Because our conclusions were the same as those of the district court, we affirmed on that issue.
On remand, the agency issued a decision with detailed findings from appellant's medical records. It noted that, by January of 1996, appellant's "level of care [could] be accurately described as palliative or maintenance rather than recuperative." It found Dr. Donovan's February 1996 examination "offered a new perspective and a reason to anticipate improvement" because his examination suggested appellant's condition could be from a vascular condition instead of RSD. The agency further found:
Dr. Donovan recommended testing to investigate the possibility of a new diagnosis. . . . Dr. Donovan indicated at page five of his report, after the studies were completed, he would determine if claimant was at maximum improvement. What he implied, but did not expressly state, is that if the studies showed a new diagnosis that was amenable to treatment, then claimant would not be at maximum improvement until those treatment options were exhausted. If nothing new were discovered, there would be no new treatment options and she would be at maximum improvement. . . .
. . . No other physicians were proposing any new or different treatment options. Claimant's treatment had become palliative, chronic, or maintenance in nature. With nothing new in the way of treatment to change the then-existing status quo, it was unlikely to change. When claimant declined to proceed with Dr. Donovan's plan of treatment there was no longer any reason to anticipate that significant improvement from the injury would be forthcoming. Dr. Donovan's care extended the healing period from February 1996 to June 18, 1996. Once his care was discontinued there was no basis to anticipate improvement. June 18, 1996, therefore marks the latest possible date for ending the healing period consistent with the second of the three options listed in section 85.34(1).
Appellant sought review by the district court and also moved for leave to present additional evidence. Concerning her request to present additional evidence, the district court ruled:
Sands argues that she should be allowed to present additional evidence on judicial review in the form of a current medical examination to show whether there has been actual improvement of her condition, thus negating the determination that June 18, 1996 was the end of her healing period. This Court sees no context in how this possibly may be material because maximum medical improvement may not be considered in hindsight, and Sands presents no "good reason" for her failure to present this evidence before the agency in the initial arbitration proceeding. While Sands argues that she may have the possibility for further improvement and has improved since 1996, the recitation of facts from the Remand Decision indicates otherwise. The commissioner clearly delineates her history of medical care of the injury to that point and supports the indication that her care was basically palliative or maintenance in nature to June 1996. In addition, Sands cites no good reason why she failed to present the "new" medical evidence earlier. Sands' petition for arbitration before the commission was not filed until mid-1999, some seven years after the injury and three years after Marian declined further treatment and suspended her benefits. Sands has had over five years of proceedings to introduce this new evidence, as she should have already known at the time of the initial arbitration proceeding that improvement in her condition would be at issue in determining benefits. In fact, it appears from the record that Sands has attempted to introduce a current medical examination before the district court on the first judicial review and this was even addressed by the Court of Appeals. . . .
The Court of Appeals' reaffirming a previous denial in this case for additional evidence in the form of a current medical examination, along with this Court's determination that Sands has not shown how this evidence is material or good reason for failing to present it earlier, is conclusive on this issue.
The court overruled appellant's motion for leave to present additional evidence.
Concerning the agency's determination appellant's healing period ended on June 18, 1996, the district court ruled:
The treatment schedule and methods pursued by her doctors at this time circumstantially indicated that her condition was not expected to improve beyond her then-current state of injury, and it seems care was more geared toward helping her cope with and manage her pain. While others may disagree that Dr. Donovan's proposed course of action indicates that Sands had not reached maximum medical improvement, the fact remains that all of the surrounding circumstances concerning her treatment in June 1996 imply that Sands' condition was not improving under a diagnosis of RSD. The agency did note that Dr. Donovan suggested that new treatment options may be possible if a new diagnosis was reached, but due to several factors including Sands' unwillingness to submit to further medical testing a new diagnosis was never reached. The record is unclear what the precise cause of Sands' ongoing symptoms after the injury were, but this Court cannot substitute its judgment for the agency's when supported by substantial evidence on the record, even if another conclusion may be drawn from the record. The Court therefore finds that the agency's Remand Decision terminating Sands' healing period on June 18, 1996, is supported by substantial evidence, as detailed in the Remand Decision by an extensive review of her treatment and progress up to that date.
The district court affirmed the decision of the agency.
CLAIMS ON APPEAL
On appeal, the appellant contends the district court erred in not accepting additional evidence and in determining the agency's finding that the healing period ended on June 18, 1996, was supported by substantial evidence.
SCOPE OF REVIEW
Review of agency action is limited to correction of errors at law. Iowa R. App. P. 6.4; IBP, Inc. v. Harpole, 621 N.W.2d 410, 414 (Iowa 2001). In reviewing a district court's decision on judicial review, we apply the standards of Iowa Code chapter 17A to determine whether our conclusions are the same as those of the district court. Grundmeyer v. Weyerhaeuser Co., 649 N.W.2d 744, 748 (Iowa 2002).
DISCUSSION
Additional Evidence.
Iowa Code section 17A.19(7) gives the district court discretion to "hear and consider such evidence as it deems appropriate," but prohibits the court from hearing "any further evidence with respect to those issues of fact whose determination" is entrusted to the agency. A party may apply to the court for leave to present additional evidence. Id. If the court is satisfied "that the additional evidence is material and that there were good reasons for failure to present it in the contested case proceeding before the agency," the court may order that such evidence be taken before the agency, which may then modify its findings and decision. Id. (emphasis added); see Interstate Power Co. v. Iowa State Commerce Comm'n, 463 N.W.2d 699, 701 (Iowa 1990).
In the current appeal, the appellant sought to present evidence from her own independent medical examination to "present the court with the true facts in the matter and establish whether she has or has not improved or could or could not improve." As good cause for her failure to present the evidence in the contested case proceedings before the agency, she claims lack of funds to obtain an examination on her own and the employer's termination of benefits on the date of the scheduled examination. The district court saw "no context in how this possibly may be material because maximum medical improvement may not be considered in hindsight." Furthermore, the court concluded the appellant did not present any good cause for her failure to present the new evidence in the years since her benefits were terminated.
This claim was raised in the first appeal and decided adversely to the appellant. See Sands, No. 02-0643 (Iowa Ct.App. Feb. 12, 2003). Generally, claim preclusion operates as a bar to claims that are substantially similar to those already fully litigated in a separate action. See Penn v. Iowa State Bd. of Regents, 577 N.W.2d 393, 398 (Iowa 1998) (noting claim preclusion bars all matters actually determined in the first action and all relevant matters that could have been determined). In oral argument, the appellant argued this request differs from the one denied in the first appeal in that she seeks an independent medical examination as an aid to determine when she reached maximum medical improvement — not to determine whether her injury was to a scheduled member or to the body as a whole. This claim was not raised in or decided by the district court, so is not preserved for our review. See Metz v. Amoco Oil Co., 581 N.W.2d 597, 600 (Iowa 1998); Benavides v. J.C. Penney Life Ins. Co., 539 N.W.2d 352, 356 (Iowa 1985). Appellant's new contention in her brief that she was without funds to obtain an independent examination was not raised in or decided in the district court, so is not preserved for our review. Benavides, 539 N.W.2d at 600. We affirm the district court's refusal to allow new evidence.
Ending Date for Healing Period.
Iowa Code section 85.34(1) sets forth three measures of the end of a healing period. It lasts
until the employee has returned to work or [2] it is medically indicated that significant improvement from the injury is not anticipated or [3] until the employee is medically capable of returning to employment substantially similar to the employment in which the employee was engaged at the time of injury, whichever occurs first.
Iowa Code § 85.34(1) (Internal numbering added).
The agency determined appellant's healing period ended under option two because it found appellant's condition, absent a different diagnosis and different treatment, was not expected to improve significantly. Appellant contends the agency's determination on remand that her healing period ended on June 18, 1996, is not supported by substantial evidence. She argues that no doctor gave an express opinion that there would not be substantial improvement after June 18, 1996. She also asserts that Dr. Donovan's possible new diagnosis would present new treatment options and "could only mean the opportunity for continued improvement," which would indicate the healing period had not ended. The only authority appellant cites is the language of the statute.
Appellee argues the agency correctly based its finding on Dr. Donovan's implied opinion. After recommending a vascular examination, including pulse volume recordings of appellant's fingers "and possibly an arteriogram of the upper extremity," Dr. Donovan noted, "Once the above studies have been determined, I would then determine if the patient is at maximum medical improvement." The commissioner found:
What [Dr. Donovan] implied, but did not expressly state, is that if the studies showed a new diagnosis that was amenable to treatment, then claimant would not be at maximum medical improvement until those treatment options were exhausted. If nothing new were discovered, there would be no new treatment options and she would be at maximum improvement. Nothing new was discovered and no new treatment options became available.
This finding followed the commissioner's discussion of why the healing period should be extended from February, when no improvement in appellant's condition was apparent and treatment was essentially palliative, to June — the possibility of a new diagnosis and different treatment. The commissioner concluded that when the tests did not yield a different diagnosis, there was no medical basis for expecting further improvement in appellant's condition. This is the basis for determining appellant's healing period ended in June.
The district court carefully reviewed the agency decision, noting it contained extensive references to appellant's medical records. It noted appellant's treatment "indicated that her condition was not expected to improve beyond her then-current state of injury, and it seems care was more geared toward helping her cope with and manage her pain." The court concluded,
the record is unclear what the precise cause of [appellant's] ongoing symptoms after the injury were, but this court cannot substitute its judgment for the agency's when supported by substantial evidence in the record, even if another conclusion may be drawn from the record.
Iowa Code section 17A.19(10), governs our review of agency action. Wal-Mart Stores, Inc. v. Caselman, 657 N.W.2d 493, 498 (Iowa 2003). The agency, not the court, weighs the evidence; we are obliged to apply those findings broadly and liberally to uphold rather than to defeat the agency's decision. IBP, Inc. v. Al-Gharib, 604 N.W.2d 621, 632 (Iowa 2000) (citing Ward v. Iowa Dep't of Transp., 304 N.W.2d 236, 237 (Iowa 1981)). On review, the question for us is not whether the evidence supports a finding different from the agency's but whether the evidence supports the findings the agency actually made. Id. (citing City of Hampton v. Iowa Civil Rights Comm'n, 554 N.W.2d 532, 536 (Iowa 1996)). In other words, the agency's findings are binding on appeal unless a contrary result is compelled as a matter of law. See Ward, 304 N.W.2d at 238.
In the first appeal, we rejected the agency's determination that appellant's healing period ended when she refused the arteriogram test as not supported by substantial evidence. We remanded to the agency for a determination of when appellant met one of the criteria for the end of her healing period set forth in section 85.34(1). On remand, the agency reviewed appellant's medical records and determined she met the second criterion of section 85.34(1) in June of 1996, not based on her refusal to submit to the arteriogram, but on the conclusion that the lack of any new diagnosis or treatment options showed significant improvement from the injury was not anticipated. See Iowa Code § 85.34(1).
Treatment of pain, if not likely to decrease the extent of permanent disability, does not extend the healing period. See Pitzer v. Rowley Interstate, 507 N.W.2d 389, 392 (Iowa 1993). Apart from the potential of a new diagnosis and new treatment options, we do not see in the record any likelihood that appellant's condition was going to show any significant improvement. This meets the statutory criterion, "significant improvement from the injury is not anticipated." Iowa Code § 85.34(1). We conclude the agency's determination appellant's healing period ended on June 18, 1996 is supported by substantial evidence in the record. Because our conclusions are the same as those of the district court, we affirm. See Finch v. Schneider Specialized Carriers, Inc., 700 N.W.2d 328, 330 (Iowa 2005); Brown v. Quik Trip Corp., 641 N.W.2d 725, 727 (Iowa 2002).