Vann v. J & M Ranch, Inc

OJCC Case No. 16-030531NPP (FL.Off.Judge.Comp.Cl. November 22, 2021)

KK TAKEAWAY:

The use of an in-home spa is not medically necessary from a pain management perspective when aquatic therapy in a public setting would provide the same medical benefit(s).

KK TAKEAWAY:

The use of an in-home spa is not medically necessary from a psychiatric perspective in the absence of competent substantial evidence indicating that the use of a spa in a public setting causes a claimant anxiety.

BACKGROUND:

On November 22, 2021, JCC Pitts issued a Final Compensation Order on the Claimant’s request for authorization of an in-home swim spa per authorized treating pain management physician, Dr. Miranda. By way of background, the Claimant was involved in a compensable work accident on May 10, 2013 when he was run down by a cow. He sustained significant injuries in the accident and underwent lower back surgery, a total knee replacement, and has been accepted a permanently and totally disabled.

On April 15, 2021, the Claimant followed up with Dr. Miranda’s office, but did not see Dr. Miranda. Rather, he saw the physician assistant (PA), who wrote the Claimant a prescription for a swim spa. The Claimant again followed up with Dr. Miranda on June 10, 2021 and they discussed the in-home swim

spa. Dr. Miranda agreed to the request, as the Claimant had tried a number of other treatment modalities and the Claimant thought a swim spa would benefit his for overall health and/or conditioning. At his deposition, Dr. Miranda testified that a person with chronic pain, inflammation, and musculoligamentous symptoms would benefit from having a jetting massage or warmth for improvement of those symptoms. However, Dr. Miranda related the benefits to aquatic therapy in general and not specifically an in-home spa. He further testified that the aquatic therapy could be done at a YMCA or at a public facility, and that it was not medically necessary that the recommended aquatic therapy be provided in the form of an in-home spa. The parties each obtained psychiatric Independent Medical Examinations (IME). While the Claimant IME did testify that the Claimant would benefit from an in-home spa, he deferred the decision of whether aquatic therapy would be provided at home or at a public facility to the pain management physician. Additionally, he testified that an inhome spa is not something he would consider in his specialty. As for the Employer/Carrier IME, he testified that the Claimant had generalized anxiety disorder and improved depression. However, in his 30-year career, he has never prescribed or reviewed any literature which supports using an in-home spa to treat anxiety disorders. He further testified that the Claimant does not have a psychiatric disorder which warrants the use of an in-home spa versus aquatic therapy at a public facility. In his decision, JCC Pitts reasoned that the Claimant did not testify regarding his anxiety related to going to public facilities to use a spa, nor did the Claimant testify that he used a public facility, found it helpful, but did not wish to continue in a public setting due to anxiety. He rather testified that he is in constant pain and wants an in-home spa to see if it would help his condition. JCC Pitts found that the Claimant did not meet his burden of proof to establish that an in-home spa, as opposed to aquatic therapy in general at a public place, is reasonable and medically necessary. This finding related to both a pain management and a psychiatric perspective. From a pain management perspective, JCC Pitts accepted Dr. Miranda’s opinion that while aquatic therapy in general was reasonable and medically necessary, he did not testify that the use of an in-home spa was medically necessary. From a psychiatric perspective, JCC Pitts pointed to a lack of competent substantial evidence that an in-home spa would have been reasonable and medically necessary from a psychiatric treatment consideration, and how the psychiatric IME deferred to the pain management physician as far as the issue of whether the recommended aquatic therapy would be provided at home or at a public facility. Based upon the foregoing, the Claimant’s request for an in-home spa was denied.