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In re Workers' Compensation Claim of Hildebrant

Supreme Court of Wyoming

March 24, 2015


Appeal from the District Court of Fremont County. The Honorable Norman E. Young, Judge.

For Appellant: Frank B. Watkins, Frank B. Watkins, PC, Riverton, Wyoming.

For Appellee: Peter K. Michael, Wyoming Attorney General; John D. Rossetti, Deputy Attorney General; Michael J. Finn, Senior Assistant Attorney General; Samantha Caselli, Assistant Attorney General.

Before BURKE, C.J., and HILL, KITE, DAVIS, and FOX, JJ.


Page 876

FOX, Justice.

[¶1] Dean Hildebrant suffered a compensable workplace injury when he fell while working for Central Wyoming College in Riverton. As part of his treatment, Mr. Hildebrant's doctor recommended implantation of a spinal cord stimulator in his back. The Wyoming Workers' Safety and Compensation Division (the Division) denied preauthorization for the implant. Mr. Hildebrant requested a contested case hearing, and at its conclusion the Office of Administrative Hearings (OAH) determined that the implant was premature and upheld the Division's denial. Mr. Hildebrant appealed to the district court which affirmed the OAH's decision. We likewise affirm the determination of the OAH.


[¶2] 1. Was there substantial evidence to support the OAH's decision to uphold the Division's denial of Mr. Hildebrant's preauthorization request for implantation of a spinal cord stimulator?


[¶3] On August 3, 2011, Mr. Hildebrant was working as an HVAC technician at Central Wyoming College in Riverton, Wyoming, when he fell approximately twenty feet from a ladder. Unable to move, Mr. Hildebrant summoned help by radio. An ambulance was called, and Mr. Hildebrant was taken to the local hospital where he complained of lower back pain and pain in his right shoulder and leg. After an initial examination at Riverton Medical Center, Mr. Hildebrant was transferred to Wyoming Medical Center in Casper for further evaluation. On September 20, 2011, Dr. Joseph G. Sramek, the physician who treated Mr. Hildebrant at Wyoming Medical Center, described Mr. Hildebrant's injuries:

Page 877

Mr. Hildebrant is a pleasant 48-year-old male who is status post a fall that occurred on 08/03/2011. . . . He has some ongoing neck pain. He has ongoing right shoulder pain. He has pain that is in his mid-back, and he states that his right leg occasionally wants to give out on him. . . . He had an MRI of his right shoulder which again showed some thinning and increased signal of the central supraspinatus tendon, consistent with tendinitis or small partial tear, and a bone bruise in the superolateral portion of the humeral head. With regards to his cervical, thoracic, and lumbar spine, he has some degenerative disc changes at C5-6 and C6-7. These do not appear to be causing neural impingement centrally or foraminally. He has a small compression fracture of T7; . . . the overall sense is that this appears more chronic, although I cannot absolutely rule out that this did not occur with the fall. In any regards, this should heal well over time with nonoperative intervention. His lumbar spine shows postoperative changes but nothing to suggest superfusion, stenosis, or any acute traumatic changes.
. . . .
Patient has ongoing pain. This slowly seems to be improving. I see nothing on his cervical, thoracic or lumbar spine that warrants any type of surgical intervention at this time.

[¶4] Mr. Hildebrant applied for workers' compensation benefits, and the Division found that he had suffered a compensable injury as a result of the fall. The Division determined that the body parts to be covered included the " low back (lumbar), mid back (thoracic), and right shoulder." Mr. Hildebrant received treatment from various providers. Much of his treatment focused on pain management from Dr. Anthony P. Williamson,[1] which included substantial doses of narcotic pain medication. Dr. Williamson concluded that treatment with narcotic pain medication was " not going to be a long term solution," and referred Mr. Hildebrant to Dr. Todd Hammond[2] for further treatment.

[¶6] Dr. Hammond recommended that Mr. Hildebrant undergo steroid injections in an attempt to neutralize the pain. Following two such injections without significant pain relief, Dr. Hammond recommended a spinal cord stimulator trial.[3] Dr. Hammond submitted a request to the Division for preauthorization of the spinal cord stimulator trial on July 18, 2012. Upon receipt, the Division submitted the case to two independent physicians for review in accordance with the Division's rules and regulations. [4]

After a review of the records provided by the Division, Dr. Robert A. Narotzky recommended that the Division deny the preauthorization request. In his initial report, Dr. Narotzky concluded that the spinal cord stimulator trial " would not be unreasonable for treating the patient's back and leg pain but as noted above I do not believe his back and leg symptoms are related to his work injury nor does it appear to be his primary problem."

[¶7] Dr. Brian H. Wieder also reviewed the case and likewise determined that the preauthorization request should be denied. Dr. Wieder concluded:

I cannot recommend authorization of the [spinal cord stimulator trial]. I recommend a concerted effort of nicotine cessation, conditioning, and psychologic re-evaluation with the purpose of evaluating pain

Page 878

behaviors, magnification, motivation for improvement . . . . With efforts on behalf of the patient to terminate nicotine, and show motivation for improvement, and psychologic assessment that demonstrates the patient to be a favorable prognostic candidate for spinal cord stimulator placement, then I would anticipate approval of the study based on the guidelines the Division has set forth, however, prognosis remains guarded.

Based on the opinions of Dr. Narotzky and Dr. Wieder, the Division denied the preauthorization request. Mr. Hildebrant requested a contested case hearing.

[¶8] Prior to the hearing, the Division submitted additional materials to Dr. Narotzky and Dr. Wieder which included Mr. Hildebrant's substantial medical history. The Division requested that the physicians review the additional materials and provide any supplemental opinions arising as a result. Mr. Hildebrant's medical history revealed that he had suffered substantial injury to his back from prior workplace injuries, undergoing no fewer than four back surgeries between 1986 and 1997. He was also classified as 100% disabled by the workers' compensation division in New Jersey as a result of a workplace injury to his back. Despite this disability rating, Mr. Hildebrant returned to work in the construction industry in 1997. In 2007, he again injured his back ...

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