Did an employee’s “focus upon obtaining narcotic pain medication” affect her ability to get workers’ comp benefits for injuries from a fall on the job?
Katherine Harris was a school bus driver for 18 years in Idaho. On Jan. 9, 2008, Harris fell when exiting her bus.
At a hospital emergency room, she complained of neck, back, shoulder and knee pain. She also said before the fall, her back had been sore for a couple of days.
The ER doctor said she suffered a minor neck strain and a knee bruise. An X-ray showed some “straightening of the lordotic curvature” and “moderate degenerative changes” to her spine.
The doctor presribed 30 hydrocodone pills for pain, ordered Harris to take time off of work and discharged her.
Nine months after her fall, Harris sought workers’ compensation benefits. An Industrial Commission Referee held a hearing and found Harris wasn’t entitled to disability or medical benefits after Feb. 19, 2008.
Specifically, the Referee found that Harris’ consistent focus on getting narcotic pain meds and her “suspiciously timely” accident which occurred soon after her own doctor discontinued a prescription for narcotics damaged her credibility at the hearing.
The entire Commission confirmed the Referee’s finding. The case then went to the Idaho Supreme Court.
A substantial medical history
Since the Commission’s decision cited Harris’ history of pain medication use, the court reviewed her medical history in its decision.
It dates back to a 1984 motor vehicle crash which kept Harris from standing for long periods of time. In 1998, Harris fell and injured her shoulder for which she was prescribed hydrocodone.
As a school bus driver, Harris had to file a Medical Examination Report each year. In her 2006 report, Harris checked “Yes” to “narcotic or habit forming drug use.”
In August 2007, Harris saw her regular medical care provider (nurse practitioner Carmen Stolte), complained of sciatica and requested “something for pain.” She was prescribed narcotic pain medication.
In October 2007, Harris saw Stolte for back pain. She was taking Darvocet at the time. Stolte prescribed a hydrocodone-based painkiller.
Harris saw Stolte five days after her fall from the school bus and was prescribed hydrocodone and muscle relaxers.
Follow-up visits led to a prescription for Percocet on top of the hydrocodone.
The workers’ comp insurance company requested that an orthopedic surgeon evaluate Harris. On Feb. 19, 2008 the surgeon said he “did not identify any objective findings to corroborate her subjective complaints” and there were “no objective findings related to the accident that would preclude her from returning to her pre-injury position as a bus driver.”
A side note: The surgeon’s report noted that Harris’ range of neck motion was “grossly inconsistent.” While examined, she was only able to more to the right and left 30 degrees. However, when observed outside of the examination, she could move her neck 60 to 70 degrees.
Harris continued to see Stolte. After one visit, Stolte noted, “Her family has been bugging her so much about taking pain medication that she threw all of her Percocet away and would like to go back to hydrocodone.” Harris got the hydrocodone prescription.
On April 3, Harris contacted Stolte’s office. A call summary states Harris said she was “trying to be good” and not ask for pain medication, but she spilled her pills in the sink and only had three left.” A doctor prescribed Norco, another narcotic pain killer. The doctor also “discussed with Harris her concern over quantity of hydrocodone being used.”
On Dec. 24, 2008, Harris and Stolte put together a “Patient Contract Regarding Chronic Narcotic use for Non-Malignant Pain.” Among the conditions of the contract, Harris agreed that:
- there would be no change in her prescription over the phone or between regular monthly visits with Stolte, including the replacement of lost/stolen prescriptions, and
- only one physician would prescribe narcotics at any given time.
Within one month, Harris returned to the local hospital ER complaining of pain and requesting narcotics. Although this constituted a breach of her contract, Stolte agreed to give Harris one more chance.
On April 11, 2009, Harris went to a clinic in Forks, Washington, requesting pain medication. She said she was in town for her father’s funeral and half of her Demerol had been lost or stolen from her luggage, which she didn’t report to police. The clinic checked local pharmacies and found Harris had received 90 Soma pills (used to treat muscle pain) just two days earlier in Washington. Despite that, she was prescribed 40 hydrocodone pills.
Five days later, Harris returned to Stolte’s office where she said once again her medication had been stolen.
Stolte’s supervisor, Dr. Vicky Lott, met with Harris and discussed “having her narcotics stolen twice in the past week.” After a “very long discussion” with Harris and her husband, Dr. Lott prescribed 14 Demerol tablets and said they wouldn’t give her any more narcotics.
After reviewing the record, the Idaho Supreme Court concluded the Commission had substantial evidence that Harris lacked credibility:
- “The record is replete with Harris’ contradictions”
- “There is also evidence of her displaying a limited range of neck motion while being examined, but moving her neck ‘without any hesitation’ while not being directly examined,” and
- There was “substantial competent evidence that supported the Referee’s conclusion that Harris struggled with prescription narcotic overuse” that affected her credibility.
The court said the Commission didn’t err when it concluded Harris was only entitled to benefits for care provided up to the day the surgeon said she could go back to work, Feb. 19, 2008.
Much has been written in recent years about how the rise in prescriptions for narcotic painkillers has been behind dramatic increases in workers’ comp costs. And of course, an increase in prescriptions for narcotics also increases the chances they’ll be abused by injured workers. This case provides yet another angle: how an injured worker’s history of pain and narcotics use could impact a request for workers’ comp benefits.
As always, feel free to weigh in with your thoughts in the comments below.
(Harris v. Independent School District No. 1, Supreme Court of Idaho, No. 39968, 5/24/13)