Wyoming Worker Fails to Connect the Dots Between Original Surgery and Subsequent Procedure to Alleviate Continued Pain

The Supreme Court of Wyoming affirmed a finding by a state district court that an injured worker failed to establish a causal connection between her 2013 need for shoulder surgery and either her original 2004 shoulder injury or the 2005 right shoulder arthroscopy to treat the original injury, in spite of some medical evidence that during the 2013 procedure, her surgeon spotted and repaired what may have been a defect in the earlier surgery [see In re Claim of Price v. State ex rel. Dep’t of Workforce Servs., 2017 Wyo. LEXIS 16 (Feb. 16, 2017)(emphasis added)]. The Court also indicated the worker had failed to show that the soft tissue calcification in her shoulders, which may have been at least part of her pain problem, was causally related to the original injury.

Background

Price hurt her right shoulder at work in 2004, when she took the trash outside and slipped and fell on ice. As a result, in 2005 she had a right shoulder arthroscopy, which was covered by the Division. She reported continued right shoulder pain over the following years. In 2013, she saw a second surgeon for right shoulder pain, and he diagnosed calcification and recommended arthroscopic debridement. The second surgeon noted that he had reviewed the x-rays from 2005, and at that time, there was not much calcification in the rotator cuff, but in the 2013 images, there was a significant amount of soft tissue calcification. He also noted that there was significant calcification in Price’s left shoulder in spite of the fact that it had not been injured in the 2004 fall.

“Related to” and “Caused by” are Two Different Points

When asked it Price’s calcific tendinitis was related to her 2004 workplace injury, the second surgeon was cautious. He indicated it was certainly “related,” in that it was on the same side and in the same joint, but he added that he did not think the 2004 fall caused Price later to develop calcific tendinitis, again primarily because the condition existed within her other, uninjured shoulder.

Second Surgery Repaired Possible Defect in First Procedure

The surgeon added, however, that during the 2013 procedure, he noted “a large hole in the acromioclavicular joint where the previous procedure apparently caused the fascia to separate or perhaps it was never repaired.” He indicated that since the hole was communicating fluid to the joint surface, he repaired it.

Was the Repair Actually “Necessary?”

When asked if it had been necessary to repair the hole, the surgeon said that he did not know if “necessary” was the right word. He added that basically, when a surgeon had a patient who suffered pain, the surgeon attempted to correct any abnormality that he or she found so that one could minimize the chance that the patient would continue to experience pain. The surgeon added that it was possible that the fluid leakage caused Price’s pain, although he thought it doubtful.

The Court indicated that although the record supported the existence of a causal connection between the 2005 surgery and the hole in the fascia, it did not establish that the repair to the hole was actually necessary. Without such evidence, the Division could not order payment. Nor could it apportion the cost of the second surgery, based on the repair. Here, the surgeon was unaware of the hole in Price’s fascia until he had completed the repair of the calcification in her shoulder.

The Court indicated the state’s Worker’s Compensation Act required an employee’s medical and hospital care to be “reasonable and necessary” in order to be covered. The evidence revealed that the condition giving rise to Price’s subsequent shoulder surgery was calcific tendinitis, which was not related to her work injury. There was no evidence that the hole in the fascia contributed to her pain or that its repair was necessary to treat her symptoms. Thus, the Commission’s conclusion that the 2013 treatment and surgery were not compensable by worker’s compensation was supported by substantial evidence.

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