Court Blasts Accident Board for Unsupported Order to End Worker’s Drug Therapy

The Superior Court of Delaware has reversed an order of the Industrial Accident Board (IAB) that an injured former employee stop her doctor-prescribed morphine treatments within six months. The court blasted the IAB for “clearly” abusing its discretion with its order that was “not supported by any evidence at all.”

A former employee of Delaware Park Racetrack & Slots sought expenses for morphine treatment related to a slip and fall in 2001. Delaware Park sought to terminate her disability benefits in late 2021. The IAB denied that employer’s request in May 2022, but ordered the woman to wean off narcotics medication by the end of the 2022. The IAB ordered her to reduce her current narcotic dependence from a level of 75 milligram equivalents per day to zero. She appealed this ruling.

The Superior Court has found that the IAB erred in mandating that the worker reduce her morphine intake to zero within six months and reversed the IAB’s decision.

In December 2001, the plaintiff sustained injuries to her head, neck, and back. Delaware Park’s workers’ compensation insurance carrier accepted her injury claim that year and she underwent surgery for her back injury in 2002. She received her disability benefits without interruption for 18 years. In May 2020, however, Delaware Park moved to terminate benefits, disputing her need for continued medical treatment.

The IAB partially granted the petition in January 2021, finding her treatments were no longer compensable. But the board stopped short of halting the treatment altogether; instead, it ordered Delaware Park to continue compensating her for a reduced amount of her morphine medication, from 300 milligram equivalents to 90 milligram equivalents, over the next 10 months.

After 10 month Delaware Park ordered a medical examination, which revealed the injured employee was still taking 300 milligram equivalents of morphine. Consequently, Delaware Park led a renewed bid for termination of her benefits in October 2021.

Delaware Park again complained of the insured’s noncompliance with the order to reduce her morphine intake and, again, challenged the reasonableness and necessity of the treatment. Delaware Park did not request the board to reduce her morphine intake to zero. It did, however, encourage the IAB to compel that she comply with the weaning process ordered in January 2021.

The renewed petition was heard in March 2022. Dr. John Townsend, Delaware Park’s medical expert, was deposed. Townsend’s was the sole medical testimony presented at the hearing.

In response to Delaware Park’s questioning, Townsend stated that “as long as the patient’s tolerating it and she’s, you know, not having withdrawal or increases in her baseline pain levels, then it’s reasonable to continue with a weaning program.”

The plaintiff worker’s lawyer asked Townsend if he would defer to her treating physician in terms of whether it’s appropriate to continue the present dosage, depending upon her response to the weaning process. He answered, “Yes, I mean, again, he’s the one who’s seeing her, you know, and if she is tolerating [the weaning], then it’s reasonable to continue. If she’s not tolerating [the weaning], then I assume that he won’t continue, and that would be reasonable.”

The IAB ultimately found in favor of Delaware Park and ordered her to reduce her morphine dose to zero within six months.

Delaware law requires the employer to pay for reasonable and necessary medical “services, medicine, and supplies” causally connected with an injury. The employee seeking compensation bears the burden of proving that a work-related accident caused the injury. The court noted that where compensation has been established and the employer seeks to terminate the benefits, the burden of proof to terminate rests with the employer.

Court’s Analysis

The Superior Court limited its review to whether the IAB’s decision was free from legal error and supported by substantial evidence, which it called evidence that “a reasonable mind might accept as adequate to support a conclusion.” Where substantial evidence supports the administrative decision, the court must affirm the ruling unless it identifies an abuse of discretion or clear error of law.

The plaintiff argued that the IAB committed reversible error by issuing an order in contrast with Delaware Park’s expert and applicable law; ordering her to wean off narcotic medications without providing notice, in violation of her due process rights; and granting Delaware Park relief it did not seek in its petition.

The court began and ended its analysis with the testimony of Dr. Townsend. He testified that the insured was in compliance with the treatment plan ordered in January 2021 and that further reducing her narcotics would be appropriate only if her treating physician deemed it so.

If “read generously,” Townsend’s testimony suggested the insured should begin the weaning process, the court said. But, the court continued, Townsend clearly stated the decision of whether to entirely wean off narcotics should be left to the discretion of her treating physician. “At no point did he indicate she should halt usage by a date certain,” the court stressed.

The court reprimanded the IBA for “clearly” abusing its discretion, commenting that the IAB “obviously” is not the woman’s treating physician, and the IAB “obviously” is not in position to act as such. Thus, the order requiring the worker to entirely wean off narcotics within six months is “not only unsupported by substantial evidence; it is not supported by any evidence at all.”