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HARRISBURG, Pa.—The daughter of a worker who died from an overdose of opioids prescribed for a work injury is entitled to benefits despite a utilization review finding that the drugs were not necessary, a Pennsylvania appellate court has ruled.
Friday's ruling by the Commonwealth Court of Pennsylvania in J.D. Landscaping vs. Workers Compensation Appeal Board upholds the finding of a workers compensation judge. The judge's ruling also was affirmed by Pennsylvania's Workers' Compensation Appeal Board in August 2010.
Decedent James Heffernan injured his lower back in July 2002. In 2007, he was found unresponsive in his bed with a box of fentanyl patches in his hand. A forensic pathologist's report stated that Mr. Heffernan “died from drug intoxication due to an overdose of fentanyl prescribed for his work injury.”
Also in 2007, Mr. Heffernan's daughter, Casey Lynn Heffernan, filed a workers comp claim alleging that her father died of multiple drug intoxication.
But his employer had filed a utilization review request in 2006. A doctor conducting the utilization review concluded that all treatment provided to Mr. Heffernan by Dr. George L. Rodriguez—including prescriptions for docusate, fentanyl, oxycodone, Fentora, Lyrica and Sonata—was neither reasonable nor necessary, court records show.
Based on that information, the employer denied Ms. Heffernan's claim. But in 2009, a workers comp judge granted the claimant's request for benefits, finding that Mr. Heffernan's death was causally related to an accidental overdose of pain medications, primarily fentanyl, that were prescribed for the work-related back injury.
The employer appealed, arguing that the judge erred in granting the claim because the man died as a result of an accidental overdose of prescription pain medications found by a utilization determination to be neither reasonable nor necessary.
But the man also had been treated and prescribed drugs by Dr. Rodriguez's sister, Dr. Daisy Rodriguez.
So the appeal board ruled the utilization review finding applied only to treatment rendered by Dr. George Rodriguez. It also ruled that Dr. Daisy Rodriguez prescribed the medications that caused the man's death.
On appeal to the Commonwealth Court, J.D. Landscaping argued that the utilization review determination should also apply to Dr. Daisy Rodriguez's treatment because she wrote prescriptions identical to those issued by her brother.
The Commonwealth Court disagreed. It ruled unanimously that the utilization review determination concerned only reasonableness and necessity and was irrelevant in determining whether Mr. Heffernan's death was causally related to his work injury.
The appellate court, therefore, ruled that the appeal board did not err in granting the claimant's fatal claim petition.