Alabama Workers' Comp Blawg

  • 10
  • May
  • 2011

A Specific Purpose Doctor Cannot Make Referrals for Treatment that Fall Outside that Specific Purpose

On May 6, 2011, the Alabama Court of Civil Appeals released its decision in Ex parte Imerys USA, where it held that a referral by an authorized treating physician to another treating physician does not transfer the right to control all aspects of the employee’s medical treatment to the subsequent physician.

Charles Wilson suffered a back injury while working for Imerys in 2006. Wilson selected Dr. Dewey Jones, IV, an orthopedist, as his authorized treating physician from a panel of four. After treating Wilson for several months and then placing him at maximum medical improvement, Dr. Jones referred Wilson to Dr. Mark Downey for pain management treatment. Dr. Downey treated Wilson for several months with epidural steroid injections and then referred Wilson to Dr. Thomas Ryder for continued pain management treatment. After pain management treatment failed to resolve Wilson’s pain, Dr. Ryder requested authorization to refer Wilson to Dr. Andrew Cordover, an orthopedist, for a surgical consultation. Imerys did not authorize Dr. Ryder’s referral to Dr. Cordover because it asserted that Dr. Jones was already the authorized physician for the orthopedic aspect of Wilson’s treatment and Dr. Ryder was not authorized to make an orthopedic referral. A dispute ensued, and motions were filed by both parties. The trial Court ruled in favor of Wilson, ordering Imerys to authorize an orthopedic surgery consultation with Dr. Cordover. Imerys then filed a petition for writ of mandamus.

The Court of Appeals, relying on Ex parte Massey Chevrolet, 23 So.3d 33, 40 (Ala.Civ.App. 2009), held that a physician to whom an employee is referred by the authorized treating physician has implicit authority to control the particular aspect of treatment for which the referral was made, which includes the authority to refer the employee to another physician for that particular aspect of treatment. However, it held that a referral by the authorized treating physician to another physician does not transfer the right to control all aspects of treatment. The Court held that since Dr. Jones, the orthopedist, referred Wilson to Dr. Downey for pain management, Dr. Downey was authorized to control the pain management aspect of Wilson’s treatment only. Dr. Downey’s referral to Dr. Ryder for further or different pain management treatment was within the scope of Dr. Downey’s authority to control that aspect of Wilson’s treatment. However, Dr. Ryder’s subsequent referral to Dr. Cordover was not for pain management treatment but was, instead, for orthopedic treatment. Since Dr. Ryder was only authorized for pain management treatment, his referral to Dr. Cordover was not within the scope of his authority, and the employer did not have to authorize same.

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