Sanjanette Rixner Versus Jefferson Parish Hospital Svc. District No. 2

SANJANETTE RIXNER NO. 24-CA-74

VERSUS FIFTH CIRCUIT

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

ON APPEAL FROM THE OFFICE OF WORKERS' COMPENSATION,
DISTRICT 7, STATE OF LOUISIANA
NO. 22-253,
HONORABLE SHANNON BRUNO BISHOP, JUDGE PRESIDING

October 30, 2024

FREDERICKA HOMBERG WICKER
JUDGE

Panel composed of Judges Fredericka Homberg Wicker,
John J. Molaison, Jr., and Scott U. Schlegel

AFFIRMED
FHW
JJM
SUS

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

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

WICKER, J.

Claimant seeks review of the workers’ compensation court’s October 9,

2023 judgment rendered in favor of her former employer, dismissing her claim for

reimbursement of medical expenses for shoulder surgery. For the following

reasons, we affirm.

FACTS AND PROCEDURAL HISTORY

On August 27, 2013, claimant, Sanjanette Rixner, filed a disputed claim for

compensation in the Office of Workers’ Compensation against her employer,

Jefferson Parish Hospital Service District #2, d/b/a East Jefferson General Hospital

(“East Jefferson”), alleging she suffered injuries to her neck and left arm as a result

of a work-related accident that occurred on December 13, 2012.1 Ms. Rixner

contends she was assisting in bathing an obese patient when she felt pain in her

neck, arm, and shoulder, particularly on the left side. The parties proceeded to trial

on August 27, 2014. On December 4, 2014, the workers’ compensation court

rendered a judgment finding Ms. Rixner injured her neck and left arm on

December 13, 2012, while in the course and scope of her employment with East

Jefferson, and awarding indemnity and medical benefits.

Several years later, on January 19, 2022, Ms. Rixner filed a new, disputed

claim for compensation against East Jefferson, seeking reimbursement for medical

expenses incurred for left shoulder surgery she underwent in 2021, as well as

penalties and attorney fees. According to Ms. Rixner, East Jefferson is responsible

for her surgery expenses, because her shoulder injury was caused by the December

13, 2012 work-related accident.

Trial of this matter was held on May 4, 2023. At trial, the parties submitted

several joint exhibits, including Ms. Rixner’s discovery responses and medical

1
Claimant had two additional work-related accidents at East Jefferson, on December 7, 2011 and October
2, 2012. However, the December 13, 2012 accident is the only work-related accident at issue in this case.

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records. The issue for the Court to consider was whether Ms. Rixner’s left

shoulder surgery was related to or caused by the December 13, 2012 work-related

accident and thus, compensable.

The only witness called to testify at trial was Ms. Rixner, who stated that on

December 13, 2012, she was working as a nurse at East Jefferson and was helping

to bathe an obese patient by lifting and holding up her arm, when she felt pain in

her arm, shoulders, and neck area. She testified she ignored the pain in her neck

and shoulder for about two weeks, but then saw Dr. Brett Rothaermel at East

Jefferson Occupational Clinic on January 3, 2013, with complaints of pain in her

neck and her arm.

The medical records from Ms. Rixner’s January 3, 2013 visit to Dr.

Rothaermel indicate Ms. Rixner reported pain in her left shoulder and arm, and

tenderness and soreness in her left arm after the incident. The records indicate she

also had longstanding neck and lower back pain. Dr. Rothaermel’s diagnosis was a

left shoulder strain with radiculopathy. Ms. Rixner saw Dr. Rothaermel again on

March 22, 2013, with complaints of neck, left shoulder, and arm pain.

According to Ms. Rixner, the next doctor she saw was Dr. Rand Voorhies, a

neurosurgeon, with complaints of neck, shoulder, and back pain, as well as pain

radiating down her arm. The medical records show she was examined by Dr.

Voorhies on June 20, 2013, and he found she had full range of motion in her

shoulders and no tenderness over the shoulder. On August 15, 2013, Ms. Rixner

saw Dr. Horace Mitchell, a neurosurgeon, with complaints of neck, arm, and left

shoulder pain. Ms. Rixner testified that Dr. Mitchell recommended neck surgery.

The records also show she saw Dr. Eric Lonseth for pain management days later on

August 21, 2013, and he found she had full range of motion and no tenderness in

her left shoulder.

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Ms. Rixner testified she had neck surgery in October of 2013, and she had

two back surgeries in 2015. She began treating with Dr. Patrick Waring in 2016

for interventional pain management. Ms. Rixner asserts she consistently reported

pain in her left shoulder to Dr. Waring, and the records confirm she complained of

left shoulder pain at times. She also testified that Dr. Richard Meyer, an

orthopedic surgeon, evaluated her in 2019 and found impingement in her left

shoulder.

On August 16, 2020, an incident occurred when Ms. Rixner was using the

bathroom. She testified that when she started to wipe herself, she heard a clicking

sound and her arm “got stuck.” Ms. Rixner went to the emergency room the next

day for pain in her arm and shoulder. The medical records reflect she reported

acute, severe pain in her left shoulder, and that she heard a “pop” and felt “a

shooting pain with associated numbness to the left upper extremity” during the

bathroom incident. The records after the bathroom incident indicate she had

painful, decreased range of motion in her left shoulder, pain with abduction or

external rotation, and spasm.

After the bathroom incident and emergency room visit, Ms. Rixner followed

up with Dr. Waring for her shoulder pain and also saw Dr. Michael O’Brien. Dr.

O’Brien’s records indicate she saw him on August 24, 2020, and reported she

injured her left shoulder at home on August 16, 2020, when she felt a “pop” in her

shoulder while wiping herself in the bathroom. The records indicate she reported

pain and numbness in her left arm, was diagnosed with calcific tendonitis and

impingement of her left shoulder, and received an injection in her left shoulder.

According to Mr. Rixner, she started physical therapy, and the therapist told

her she had a tear in her shoulder and would need surgery. Ms. Rixner testified

that Dr. Waring then referred her to Dr. Felix Savoie, an orthopedic surgeon, who

ordered an MRI that revealed two tears in her left shoulder, one of which showed

24-CA-74 3

her rotator cuff was almost completely torn off. Dr. Savoie’s records indicate he

recommended left shoulder surgery.

Ms. Rixner testified that East Jefferson initially agreed to pay for the

shoulder surgery, but then denied coverage after it was cancelled and they tried to

reschedule it. Nevertheless, Ms. Rixner indicated she had health insurance and Dr.

Savoie performed the surgery on her left shoulder in October of 2021.

On cross-examination, Ms. Rixner testified she did not feel a “pop” in her

left shoulder during the August 16, 2020 incident when using the bathroom, but

she felt some pain. Ms. Rixner denied she injured her left shoulder on August 16,

2020; rather, she maintained the injury occurred during her work-related accident

in December of 2012. She asserted she complained of left shoulder pain multiple

times prior to August 16, 2020, but she did not have any imaging of her left

shoulder before that time, because “[e]verything was focused on my neck.”

Counsel for East Jefferson asked about the range of motion in her shoulder after

the December 13, 2012 accident but prior to August 16, 2020, and Ms. Rixner

replied, “[i]t wasn’t good at all. That’s why I had physical therapy.” When counsel

showed her a report from Dr. Chadwick Murphy, who examined her on May 24,

2018, Ms. Rixner acknowledged the report indicated she had full range of motion

in her left shoulder, but she added, “That’s his opinion.”

Ms. Rixner also acknowledged she saw Dr. Samer Shamieh on March 13,

2015, and he found she had normal range of motion in her left shoulder, with no

tenderness or impingement. Ms. Rixner further agreed she saw Dr. Mehdi Soltani

for sleep apnea on August 12, 2016, and his records indicate she reported back and

neck pain, but not shoulder pain. She also agreed that Dr. Soltani’s records

indicate a physical exam was performed and she had full range of motion in her

left shoulder.

24-CA-74 4

Additionally, Ms. Rixner acknowledged she saw Dr. Roy Baker in Georgia

on June 9, 2014, and his notes indicate she said she could not lift her left arm, but

his physical exam revealed she had full range of motion in her left shoulder and no

weakness of her upper extremities. When asked if there was any reason why this

medical record would be false, Ms. Rixner stated that Dr. Baker was lying because

he works with East Jefferson. She also stated that the other doctors who found full

range of motion in her left shoulder were mostly second medical opinions and/or

worked with East Jefferson.

The record shows that Dr. Savoie, who performed Ms. Rixner’s shoulder

surgery and whom she classified as a wonderful doctor, did not find her left

shoulder injury was related to the December 2012 accident. The record contains a

letter from the workers’ compensation administrator to Dr. Savoie asking, “Is it

your opinion that the current treatment and diagnosis are all related to Ms. Rixner’s

12/13/12 work injury?” Dr. Savoie replied on August 2, 2021, “I don’t know—see

my note & Dr. O’Brien’s.”

On October 9, 2023, the workers’ compensation court rendered a judgment

in favor of East Jefferson, finding Ms. Rixner failed to meet her burden of proving

her shoulder injury was related to the December 13, 2012 accident and dismissing

her case with prejudice. Ms. Rixner appeals.

LAW AND DISCUSSION

An employee is entitled to workers’ compensation benefits if he or she

suffers a personal injury by accident arising out of and in the course of her

employment. La. R.S. 23:1031(A); Morris v. Louisiana Machinery Co., L.L.C.,

12-222 (La. App. 5 Cir. 12/18/12), 106 So.3d 1173, 1179. It is the claimant’s

burden to prove the chain of causation required by the workers’ compensation

scheme, by establishing the accident was work-related, that the accident caused

injury, and that the injury caused the disability complained of. Dragon Express v.

24-CA-74 5

Chesser, 09-1041 (La. App. 5 Cir. 5/25/10), 40 So.3d 1030, 1033, writ denied, 10-

1477 (La. 10/1/10), 45 So.3d 1101. A claimant must establish a causal connection

between the accident and resulting disability by a preponderance of the evidence.

Id.

The workers’ compensation court’s determinations as to whether the

claimant’s testimony is credible and whether the claimant has discharged his/her

burden of proof are factual determinations that should not be disturbed on appellate

review unless they are manifestly erroneous or clearly wrong. Brown v.

Entertainment Partners, LLC, 19-118 (La. App. 5 Cir. 10/2/19), 279 So.3d 1057,

1064; Dean v. Southmark Construction, 03-1051 (La. 7/6/04), 879 So.2d 112, 117.

In applying the manifest error standard, the appellate court need not determine

whether the trier of fact was right or wrong, but whether the fact finder’s

conclusion was a reasonable one. Lopez v. Marques Food Distributors, 11-424

(La. App. 5 Cir. 12/28/11), 80 So.3d 1248; Stobart v. State through Dept. of

Transp. and Development, 617 So.2d 880, 882 (La. 1993). In order to reverse a

factual finding of the workers’ compensation court, the appellate court must find

that a reasonable factual basis does not exist for the court’s finding and that the

record establishes it is clearly wrong. Forbes v. Metropolitan Developmental

Center, 09-901 (La. App. 5 Cir. 3/9/10), 35 So.3d 377, 382; Mart v. Hill, 505

So.2d 1120, 1127 (La. 1987).

On appeal, Ms. Rixner argues the trial court erred by finding she failed to

meet her burden of proving her left shoulder injury and the resulting surgery were

related to the December 13, 2012 work-related accident, and denying her claim for

reimbursement for the expenses incurred in connection with the surgery. She

asserts she never had a problem with her left shoulder before the 2012 accident and

she has consistently reported left shoulder pain to her doctors since that time.

Therefore, Ms. Rixner claims she is entitled to a legal presumption that her

24-CA-74 6

shoulder problems are related to the accident. Further, she contends that while the

bathroom incident aggravated her left shoulder injury, East Jefferson is required to

pay for her shoulder surgery expenses, because it is responsible for any

aggravation of a work-related injury caused by an activity of daily living.

East Jefferson responds that Ms. Rixner suffered a new, left shoulder injury

on August 16, 2020, over 92 months after the December 13, 2012 accident, at her

home while using the bathroom, not while she was an employee of East Jefferson.

It further states that the December 4, 2014 judgment indicates the court found she

injured her left arm in the December 13, 2012 accident, not her left shoulder. East

Jefferson asserts that Ms. Rixner did not prove a causal connection between the

surgery and the accident by a preponderance of the evidence, and therefore, the

court correctly dismissed her claims.

In order to recover the medical expenses for surgery, a claimant must prove

by a preponderance of the evidence that the expenses were reasonably necessary

for the treatment of a medical condition caused by a work-related injury. Bush v.

Avoyelles Progress Action Comm., 07-685 (La. App. 3 Cir. 10/31/07), 970 So. 2d

63, 68. The Louisiana Supreme Court has held that recovery is generally available

for all natural consequences that flow from the primary injury absent an

independent intervening cause. Buxton v. Iowa Police Department, 09-520 (La.

10/20/09), 23 So.3d 275, 284. The key inquiry is the relationship between the

second injury and the initial, work-related injury. Id.; Loar v. Luba Worker's

Comp Terminix Service Co., Inc., 17-683 (La. App. 5 Cir. 9/19/18), 254 So.3d

1267, 1274.

A work-related accident is presumed to have caused a worker’s disability if

the worker proves that before the accident, she did not have any disabling

symptoms, and the disabling symptoms started when the accident occurred.

Namias v. Sunbelt Innovative Plastics, LLC, 15-1380 (La. App. 1 Cir. 2/24/16),

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190 So.3d 745, 753, writ denied, 16-482 (La. 5/2/16), 212 So.3d 1168. However,

there must be medical or circumstantial evidence indicating a reasonable

possibility of a causal connection between the accident and the disabling condition.

Id.

In the present case, Ms. Rixner is not entitled to a presumption that the

December 2012 accident caused the shoulder injury for which she had surgery.

The evidence does not establish a causal connection between the 2012 accident and

the tears in her shoulder. Although the medical records indicate Ms. Rixner

complained of left shoulder pain after the 2012 accident and was diagnosed with

radiculopathy and impingement, they also show she had full range of motion in her

left shoulder prior to the August 2020 incident. The emergency room records

reflect Ms. Rixner reported acute, severe pain in her left shoulder after reaching to

wipe herself in the bathroom on August 16, 2020, and she heard a “pop” and felt a

shooting pain with numbness in her left upper extremity. The records do not

reflect she had acute, severe pain in her left shoulder or any significant deficiencies

in range of motion until after the bathroom incident.

Moreover, Ms. Rixner agreed that none of her doctors recommended an MRI

of her left shoulder after the December 2012 work-related accident, and the records

do not indicate she suffered any tears to her shoulder prior to the August 16, 2020

incident. After the bathroom incident, Dr. Savoie recommended an MRI, which

revealed two tears in her shoulder. However, neither Dr. Savoie nor any other

doctor related the shoulder surgery to the 2012 accident or found Ms. Rixner was

predisposed or more susceptible to a shoulder injury or tear due to the 2012

accident.

In her 2013 disputed claim for compensation, Ms. Rixner sought workers’

compensation benefits arising from the December 2012 accident, alleging injuries

to her neck and left arm. In the 2014 judgment, the workers’ compensation court

24-CA-74 8

found she injured her neck and left arm in the 2012 accident. Ms. Rixner asserts

the 2014 judgment includes her left shoulder, because it is part of her arm.

However, the judgment does not refer to her shoulder. Even if we consider the left

shoulder to be included in the 2014 judgment, the medical records support a

finding that she suffered a new injury, not aggravation of a prior injury, during the

bathroom incident.

Ms. Rixner argues that a second injury occurring away from work can be

caused by a prior work-related accident and the resulting disability can be

compensable, as the Court found in Carter v. Rockwood Insurance Co., 341 So.2d

595 (La. App. 2 Cir. 1977). In Carter, the Court found that a second fall, resulting

in a fractured leg, was a reasonable, foreseeable, and natural consequence of a prior

work-related injury to her knee, and therefore, it was compensable. However, in

Carter, unlike the present case, the claimant’s treating physician opined that the

injuries suffered in the work-related accident were a contributory cause of the

second accident.

While the records show Ms. Rixner may have suffered some degree of injury

to her left shoulder in the 2012 accident, it was Ms. Rixner who bore the burden of

establishing a causal connection between the injury requiring surgery and the

work-related accident. Where the evidence is evenly balanced or shows only a

possibility of a causal connection between the work-related accident and the need

for surgery, the claimant fails to meet her burden of proof. Namias, 190 So.3d at

753; Miken Specialties v. Abarca, 16-231, 16-232 (La. App. 5 Cir. 12/7/16), 209

So.3d 268, 276, writ denied, 17-37 (La. 2/10/17), 216 So.3d 45; Summers v. Ritz-

Carlton New Orleans, 14-800 (La. App. 5 Cir. 5/28/15), 171 So.3d 329, 337, writ

denied, 15-1256 (La. 9/25/15), 178 So.3d 569.

In the present case, although Ms. Rixner denied injuring her shoulder on

August 16, 2020, the emergency room records from the following day indicate she

24-CA-74 9

reported hearing a “pop” and feeling shooting pain during the bathroom incident.

Also, Dr. O’Brien’s records from just a few days later reflect she reported injuring

herself at home on August 16, 2020. It was the workers’ compensation court’s

duty to assess Ms. Rixner’s credibility. Further, where no doctor related Ms.

Rixner’s left shoulder injury to the December 2012 accident and the records show

she had full range of motion prior to the August 2020 incident, a finding of

causation in this matter could only be based upon speculation, not a preponderance

of the evidence.

Based on our review of the entire record and the applicable law, we find the

workers’ compensation court’s determination that Ms. Rixner failed to meet her

burden of proving a causal connection between her left shoulder injury and the

2012 accident was reasonable and not manifestly erroneous. Accordingly, we find

no error in the workers’ compensation court’s ruling denying Ms. Rixner’s claim

for reimbursement of expenses for her left shoulder surgery.

DECREE

For the foregoing reasons, we affirm the workers’ compensation court’s

October 9, 2023 judgment, finding Ms. Rixner failed to meet her burden of proof

and dismissing her claims against East Jefferson with prejudice.

AFFIRMED

24-CA-74 10

SUSAN M. CHEHARDY CURTIS B. PURSELL

CHIEF JUDGE CLERK OF COURT

SUSAN S. BUCHHOLZ
FREDERICKA H. WICKER
CHIEF DEPUTY CLERK
JUDE G. GRAVOIS
MARC E. JOHNSON
STEPHEN J. WINDHORST LINDA M. WISEMAN
JOHN J. MOLAISON, JR.
FIRST DEPUTY CLERK
SCOTT U. SCHLEGEL
TIMOTHY S. MARCEL FIFTH CIRCUIT
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JUDGES 101 DERBIGNY STREET (70053)
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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
OCTOBER 30, 2024 TO THE TRIAL JUDGE, CLERK OF COURT, COUNSEL OF RECORD AND ALL PARTIES
NOT REPRESENTED BY COUNSEL, AS LISTED BELOW:

24-CA-74
E-NOTIFIED
OFFICE OF WORKERS' COMPENSATION, DISTRICT 7 (CLERK)
HON. SHANNON BRUNO BISHOP (DISTRICT JUDGE)
MICHELLE M. SORRELLS (APPELLANT)

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