Detox program, morphine pump reasonable and necessary for chronic pain
Case name: Poynter v. Barren-Metcalfe Ambulance Service, No. 2011-SC-000044-WC (Ky. 08/25/11, unpublished).
Ruling: In an unpublished decision, the Kentucky Supreme Court held that the treatment recommended by a university evaluator for a paramedic's chronic back pain was reasonable and necessary in the future.
What it means: In Kentucky, an injured worker's desire to not undergo the implantation of a morphine pump will not prevent a finding that the surgery is reasonable and necessary.
Summary: A paramedic sustained a low back injury while lifting a patient. He underwent surgeries. The ambulance service agreed to pay permanent total disability benefits and future medical expenses. The paramedic underwent various injections, medications, and therapies to try to manage his chronic back pain. His doctor recommended injections. The service contested the reasonableness and necessity of the injections and medications. A university evaluator recommended an inpatient detoxification program followed by the surgical implantation of a morphine pump. The Kentucky Supreme Court held that the treatment recommended by the evaluator was reasonable and necessary in the future.
The court found that the evaluator's testimony supported a conclusion that the present doses of narcotic pain medication would do more harm than good if continued. The evaluator opined that the high dosage of opioids the paramedic had taken for a long time produced hyperalgesia and hypogonadism and also contributed to his depression, obesity, and sleep apnea.
The paramedic did not wish to undergo the implantation of a morphine pump due to the risk of an infection or immune reaction. He asserted that his refusal to undergo an additional surgery was not unreasonable and that he was entitled to choose another reasonable treatment option. The court disagreed. Nothing indicated that the implantation of a morphine pump would involve major surgery. Also, nothing showed that the program or pump would present a risk to the paramedic's life or health greater than the risks of his treatment at that time. The evaluator opined that small doses of opioid medication administered directly to the spine via a pump would be effective and provide the paramedic with greater pain control without the harmful side effects.
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October 3, 2011
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