Sanjanette Rixner Versus Jefferson Parish Hospital District No. 2

SANJANETTE RIXNER NO. 19-CA-595

VERSUS FIFTH CIRCUIT

JEFFERSON PARISH HOSPITAL DISTRICT COURT OF APPEAL
NO. 2
STATE OF LOUISIANA

ON APPEAL FROM THE OFFICE OF WORKERS' COMPENSATION,
DISTRICT 7
STATE OF LOUISIANA
NO. 17-7327
HONORABLE SHANNON BRUNO BISHOP, JUDGE PRESIDING

May 27, 2020

JOHN J. MOLAISON, JR.
JUDGE

Panel composed of Judges Fredericka Homberg Wicker,
Jude G. Gravois, and John J. Molaison, Jr.

AFFIRMED
JJM
FHW
JGG

COUNSEL FOR PLAINTIFF/APPELLANT,
SANJANETTE RIXNER
Michelle M. Sorrells

COUNSEL FOR DEFENDANT/APPELLEE,
JEFFERSON PARISH HOSPITAL DISTRICT NO. 2
Meghan E. Ruckman
Adam M. Stumpf

MOLAISON, J.

In this workers’ compensation case, appellant/claimant, Sanjanette Rixner,

challenges the lower court’s finding that certain recent medical treatments were not

related to claimant’s initial work injury. For the reasons that follow, we affirm.

PROCEDURAL HISTORY

This matter comes before us for the second time on appeal. In Rixner v. E.

Jefferson Gen. Hosp., 15-143 (La. App. 5 Cir. 9/23/15), 176 So.3d 677, writ

denied, 15-1935 (La. 11/30/15), 184 So.3d 35, we affirmed the Office of Workers’

Compensation (“OWC”) judge’s ruling that claimant, Sanjanette Rixner’s, pre-

existing condition1 was aggravated by three work-related accidents2 during her

employment as a nurse at Jefferson Parish Hospital Service District # 2, d/b/a East

Jefferson General Hospital (“EJGH”). We also found that the judgment regarding

what medical expenses EJGH was to pay was indeterminate, and accordingly

remanded the case for a determination of the exact dollar amount of medical

expenses incurred as a result of claimant’s work-related accidents.3

On November 11, 2017, claimant filed a new disputed claim for

compensation, related to “treatment for Thoracic spine.” A trial on the claim was

held on June 12, 2019, following which the OWC judge determined that claimant

1
The record shows that claimant was involved in three motor vehicle accidents in 2004, 2005 and
2007, in which she sustained cervical and lumbar injuries.
2
In our previous opinion, we summarized claimant’s work accidents and related injuries as
follows:
On December 8, 2011, Claimant allegedly injured her back during the course and
scope of her employment while helping transfer a patient from a bed to a wheelchair.
Thereafter, on October 2, 2012, Claimant suffered a second work-related accident when
she stepped on a rug that shifted, causing her to fall onto her right knee and land on her
back and buttocks. Two months later, on December 13, 2012, Claimant had a third work-
related accident when she experienced left arm pain after helping turn a 600 lb. patient.

Id. at 679.
3
We also found that, based on the factual and medical information EJGH possessed, EJGH had
articulable and objective reason to deny benefits. Accordingly, we reversed that portion of the judgment
that imposed penalties against EJGH pursuant to La. R.S. 23:1201(F).

19-CA-595 1

had failed to establish by a preponderance of evidence that her alleged thoracic

pain was related to her workplace accidents. The instant appeal follows.

ASSIGNMENT OF ERROR

The Office of Workers' Compensation Judge erred in the determination

that claimant's thoracic complaints were not caused by her work-accidents.

LAW AND ANALYSIS

In the instant case, claimant asserted at trial that she had pre-existing mid-

back pain that had previously resolved but was re-injured in a work accident on

December 12, 2012. She stated that her pain had increased since that time.

Claimant testified that her physician, Dr. Waring, recommended nerve blocks and

injections to treat her mid-back area. She was not sure if Dr. Waring was the only

doctor who related her thoracic pain to her workplace injury. The proposed

treatments were submitted to Workers’ Compensation and denied.

Claimant conceded that she was not treated for thoracic pain by any of the

five neurosurgeons, or several orthopedic doctors, that she consulted. She also

confirmed that thoracic pain was not mentioned in the medical records of Dr.

Horace Mitchell for October 18, 2012 through October 24, 2012. The River Parish

Chiropractic reports dated April 11, 2012 and October 10, 2012, similarly do not

identify a thoracic injury. Also, the February 6, 2012 report from Dr. Brett

Rothermal and the report from Dr. Bui dated September 24, 2013, both do not

indicate thoracic injury. Claimant also confirmed that a thoracic injury was not

previously identified in her answers to interrogatories.

None of claimant’s treating physicians testified at trial.

The independent medical examination

La. R.S. 23:1123, which provides for the appointment of an independent

medical examiner (IME) when there is a conflict in the medical evidence, states

that the report of the IME shall be prima facie evidence of the facts therein stated.

19-CA-595 2

The courts have interpreted La. R.S. 23:1123 to mean that an IME's medical

conclusions should be given significant weight because the IME is an objective

witness. Fritz v. Home Furniture–Lafayette, 95-1705 (La. App. 3 Cir. 7/24/96),

677 So.2d 1132, 1136. Nevertheless, the opinion of the IME is not conclusive, and

the trial judge must evaluate all of the evidence presented in making a decision as

to the claimant's condition. Jennings Am. Legion Hosp. v. Daigle, 01-621 (La. App.

3 Cir. 11/14/01), 801 So.2d 550, 553 writ denied, 01-3294 (La. 9/5/03), 852 So.2d

1038. The weight given to the testimony of an IME can be lesser or greater

depending on the qualifications or expertise of the physician, the type of

examination he performs, his opportunity to observe the patient, his review of

other physicians' examinations and tests, and any other relevant factors. Id. A trial

court’s assessment of the necessity of medical treatment pursuant to La. R.S.

23:1203(A) is a factual determination subject to the manifest error standard of

review. Ramogasse v. Lafitte Welding Works, 93-682 (La. App 5 Cir. 12/13/95),

666 So.2d 1176, 1178.

In the instant case, Dr. Karen Ortenberg was appointed by the OWC judge to

conduct an IME of the claimant. In her March 11, 2019 report, Dr. Ortenberg

noted that one of the claimant’s concerns was that her prior treatments and

diagnostic studies never addressed her thoracic spine pathology and that claimant

was convinced that “something is wrong.” Dr. Ortenberg concluded, in summary,

that claimant’s complaints of thoracic pain were not related to any of the three

work injuries and “do not require any medical treatment, diagnostic studies, and/or

medical interventions.” The conclusion was based on several factors, including:

claimant’s own written account of her work injuries never mentioned thoracic pain;

out of the 10 doctors that claimant had consulted over the years for treatment, only

Dr. Waring mentioned the need for evaluation or treatment to the thoracic spine,

and; one MRI taken of claimant’s cervical spine showed the upper thoracic levels

19-CA-595 3

within normal limits, and a second MRI of the lumbar spine was interpreted as

normal.

The trial court’s ruling
In its reasons for judgment, the OWC judge first noted that while the

claimant’s treating physician concluded that claimant’s thoracic complaints are

related to her work accident,4 EJGH’s second medical opinion doctor5 concluded

that the thoracic spine pain was not related to claimant’s work injury. The OWC

judge then recounted that the court had appointed Dr. Karen Ortenberg, a Board

Certified Physical Medicine and Rehabilitation doctor, as an independent medical

examiner to examine claimant, review past medical records, and give an opinion

regarding whether claimant's thoracic complaints are related to the work accident

and whether Claimant required additional treatment for the thoracic complaints.

The OWC judge referenced Dr. Ortenberg’s conclusion that claimant’s complaints

of thoracic pain are not related to any of the three work injuries and do not require

any medical treatment, diagnostic studies, and/or medical interventions. The OWC

judge opined:

Based on a review of the facts and evidence, the Court cannot find that
Claimant's work accident caused or aggravated, accelerated, or combined
with the preexisting condition produced an injury resulting in a compensable
disability. As such, this claim for the thoracic spine is dismissed with
prejudice.

An employee in a workers’ compensation action has the burden of

establishing a causal link between the accident and the subsequent injury or

disabling condition. Peveto v. WHC Contractors, 93-1402 (La. 1/14/94), 630 So.2d

4
It appears from the record that Dr. Waring’s conclusion appears in a letter dated October 2,
2018, in which he states, in relevant part:

[Claimant] sustained a trip and fall work accident on 10/2/2012. She had a work related lifting
injury when moving a heavy patient on 12/13/12. She sustained injuries to her cervical,
thoracic and lumbar spine.
5
The record shows that the second opinion was rendered by Dr. Chadwick Murphy.

19-CA-595 4

689, 691. The appropriate standard of review to be applied by the appellate court to

the OWC's findings of fact is the “manifest error-clearly wrong” standard. Brown

v. Coastal Construction & Engineering, Inc., 96-2705 (La. App. 1 Cir. 11/7/97),

704 So.2d 8, 10 (citing Alexander v. Pellerin Marble & Granite, 93-1698 (La.

1/14/94), 630 So.2d 706, 710. Accordingly, the findings of the OWC will not be

set aside by a reviewing court unless they are found to be clearly wrong in light of

the record viewed in its entirety. Alexander, 630 So.2d at 710. Where there is

conflict in the testimony, reasonable evaluations of credibility and reasonable

inferences of fact should not be disturbed upon review, even though the appellate

court may feel that its own evaluations and inferences are as reasonable. Robinson

v. North American Salt Co., 02-1869 (La. App. 1 Cir. 2003), 865 So.2d 98, 105,

writ denied, 03-2581 (La. 11/26/03), 860 So.2d 1139. The court of appeal may not

reverse the findings of the lower court even when convinced that had it been sitting

as the trier of fact, it would have weighed the evidence differently. Robinson, 865

So.2d at 105.

Conclusion

Here, the claimant’s own testimony at trial was that she was not treated for

thoracic pain by any of the numerous doctors that she had consulted. Further, the

IME appointed by the court concluded, based upon a review of claimant’s medical

records, claimant’s subjective account of her medical history, and MRI films, that

claimant’s complaints of thoracic pain are not related to any of the three work

injuries she sustained while employed by EJMC. The trial court also had the

benefit of reviewing claimant’s medical records. Finally, although Dr. Waring did

generally opine that claimant had received injuries to her thoracic, as well as her

cervical and lumbar spine, Dr. Waring was not called as a witness to explain his

findings at trial.

19-CA-595 5

Based upon our review of the record before us, we cannot say that the trial

court’s conclusion, that claimant’s thoracic complaints are not related to a work

accident, is manifestly erroneous.

DECREE

Accordingly, for the foregoing reasons, the judgment of the OWC court is

affirmed.

AFFIRMED

19-CA-595 6

SUSAN M. CHEHARDY CURTIS B. PURSELL

CHIEF JUDGE CLERK OF COURT

MARY E. LEGNON
FREDERICKA H. WICKER
CHIEF DEPUTY CLERK
JUDE G. GRAVOIS
MARC E. JOHNSON
ROBERT A. CHAISSON SUSAN BUCHHOLZ
STEPHEN J. WINDHORST
FIRST DEPUTY CLERK
HANS J. LILJEBERG
JOHN J. MOLAISON, JR. FIFTH CIRCUIT
MELISSA C. LEDET
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NOTICE OF JUDGMENT AND CERTIFICATE OF DELIVERY
I CERTIFY THAT A COPY OF THE OPINION IN THE BELOW-NUMBERED MATTER HAS BEEN DELIVERED
IN ACCORDANCE WITH UNIFORM RULES - COURT OF APPEAL, RULE 2-16.4 AND 2-16.5 THIS DAY
MAY 27, 2020 TO THE TRIAL JUDGE, CLERK OF COURT, COUNSEL OF RECORD AND ALL PARTIES NOT
REPRESENTED BY COUNSEL, AS LISTED BELOW:

19-CA-595
E-NOTIFIED
OFFICE OF WORKERS' COMPENSATION, DISTRICT 7 (CLERK)
HON. SHANNON BRUNO BISHOP (DISTRICT JUDGE)
MICHELLE M. SORRELLS (APPELLANT) MEGHAN E. RUCKMAN (APPELLEE)

MAILED
ADAM M. STUMPF (ATTORNEY)
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SUITE 1100
METAIRIE, LA 70001