COURT OF APPEALS OF VIRGINIA
Present: Judges Elder, Bray and Senior Judge Overton
THE UNINSURED EMPLOYER'S FUND
MEMORANDUM OPINION*
v. Record No. 1677-00-3 PER CURIAM
NOVEMBER 21, 2000
DARYL CLARK CHILDRESS AND
CARILION ROANOKE MEMORIAL HOSPITAL
FROM THE VIRGINIA WORKERS' COMPENSATION COMMISSION
(Mark L. Earley, Attorney General; John J.
Beall, Jr., Senior Assistant Attorney
General, on brief), for appellant.
(Robert E. Evans, on brief), for appellees.
The Uninsured Employer's Fund (the Fund) contends that the
Workers’ Compensation Commission erred in holding it liable for
Daryl Clark Childress's (claimant) medical expenses incurred for
inpatient acute care at Roanoke Memorial Hospital (RMH) between
January 24, 1996 and March 11, 1996. The Fund contends that
such expenses were not "necessary medical treatment" within the
meaning of Code § 65.2-603. Upon reviewing the record and the
briefs of the parties, we conclude that this appeal is without
merit. Accordingly, we summarily affirm the commission’s
decision. See Rule 5A:27.
On appeal, we view the evidence in the
light most favorable to the prevailing party
* Pursuant to Code § 17.1-413, this opinion is not
designated for publication.
below. In addition, the commission's
factual findings will be upheld if supported
by credible evidence. "However, the
question of whether the disputed medical
treatment was necessary within the meaning
of Code § 65.2-603 is a mixed question of
law and fact." Accordingly, the
commission's conclusions as to the necessity
of the disputed medical treatment are not
binding upon this Court. "However, both the
purposes of the Workers' Compensation Act
and the equities of the situation guide us
in affirming the commission's award."
Papco Oil Co. v. Farr, 26 Va. App. 66, 73-74, 492 S.E.2d 858,
861 (1997) (citations omitted).
Claimant suffered a traumatic closed head injury on October
12, 1995, as a result of a compensable automobile accident. The
commission awarded claimant temporary total disability benefits
and lifetime medical benefits. Claimant received acute care at
RMH from October 12, 1995 through March 11, 1996, when he was
transferred to a skilled nursing facility.
On August 16, 1999, claimant filed a Claim for Benefits,
alleging that the Fund had paid only part of his RMH bill for
inpatient services rendered between October 12, 1995 through
March 11, 1996 and that the Fund owed RMH $30,437.32.
At the hearing on claimant's claim, the parties stipulated
"that the claimant did not require an acute inpatient level of
care after January 24, 1996, and that he could thereafter from a
medical standpoint been treated at a lower level of medical
service, such as a skilled nursing facility."
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In holding the Fund liable for claimant's medical expenses
incurred at RMH between January 24, 1996 and March 11, 1996, the
commission found as follows:
[Melinda Shelor-]Rogers[, a licensed
clinical social worker assigned to
claimant's case,] testified that she treated
claimant's case as she would any other
patient case. She worked from January 1996
to March 1996 to place the claimant in a
facility which would accept him and which
would be located within a reasonable
distance from the claimant's family and
caregivers. She submitted documentation of
her efforts and explained that many of the
facilities declined the claimant's case due
to the nature of his injuries, his age, and
his lack of funding. When Medicaid funding
came through, Rogers was able to quickly
expedite a transfer to RMH rehab on a trial
basis. She continued to update several
other facilities in case the trial period
did not work out.
Rogers also credibly explained that
[RMH] did not have a facility on site to
provide the necessary lower-level of care.
Nor could the hospital, as the Fund
suggests, simply supply the claimant with a
lesser level of care to reduce the costs.
Although the Carilion nursing facilities
were owned by the same corporation as [RMH],
Rogers testified that she could not force a
transfer to these facilities but had to
follow the same procedures as for any other,
non-associated facility.
In its role as fact finder, the commission was entitled to
conclude that Rogers's testimony was credible. Her testimony
supports the commission's factual findings. Based upon those
findings, the commission held that "the care the claimant
received at [RMH] was 'necessary medical treatment' within the
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meaning of Code § 65.2-603. In so ruling, the commission found
as follows:
We do not find the six week period it
took to find suitable placement for the
claimant unreasonably lengthy. Nor do we
find that [RMH] failed to take necessary
steps to place the claimant more quickly.
[RMH] was not equipped to provide the lesser
care the claimant required. Its discharge
planner, Rogers, worked quickly to secure
funding, a necessary prerequisite to
placement in a facility, and to find
placement for the claimant which was
satisfactory and within a reasonable
distance from the family. [RMH] had a duty
to treat the claimant and . . . Rogers could
not have compelled alternate placement
before March 11, 1996, and the hospital
could not simply discharge the claimant,
given the grievous nature of his injuries.
We note that "Code § 65.2-603 should be construed liberally
in favor of the claimant, in harmony with the Act's humane
purpose." Id. at 74, 492 S.E.2d at 861-62.
Based upon Rogers's credible testimony regarding her
ongoing efforts to obtain funding and to place claimant in
another facility, the severe nature of claimant's injuries, and
the lack of evidence of any appropriate and reasonable
alternative to continuing to provide claimant acute care at RMH,
the commission did not err in holding that claimant's treatment
through March 11, 1996 was "necessary medical treatment" within
the meaning of Code § 65.2-603. Contrary to the Fund's
contention, the fact that the claimant "could" have, "from a
medical standpoint," been treated at a lower level of medical
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service after January 24, 1996, did not compel the conclusion
that his treatment at RMH through March 11, 1996 was not
"necessary medical treatment" under Code § 65.2-603.
For these reasons, we affirm the commission's decision.
Affirmed.
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