{"id":"alj-H302552-2024-07-02","awcc_number":"H302552","decision_date":"2024-07-02","opinion_type":"alj","claimant_name":"Sarah Papp","employer_name":null,"title":"PAPP VS. AIRGAS DRY ICEAWCC# H302552July 2, 2024","outcome":"denied","outcome_keywords":["dismissed:1","denied:2"],"injury_keywords":["neck","shoulder","back","cervical","herniated","hip","strain","lumbar"],"pdf_url":"https://www.labor.arkansas.gov/wp-content/uploads/PAPP_SARAH_H302552_20240702.pdf","source_index_url":"https://labor.arkansas.gov/workers-comp/awcc-opinions/administrative-law-judge-opinions/","filename":"PAPP_SARAH_H302552_20240702.pdf","text_length":49824,"full_text":"BEFORE THE ARKANSAS WORKERS’ COMPENSATION COMMISSION \n   \n CLAIM NO.  H302552 \n \nSARAH SIX PAPP, Employee                                                                        CLAIMANT \n \nNORTHWEST MEDICAL CENTER BENTON CO., Employer                 RESPONDENT                                                     \n \nGALLAGHER BASSETT SERVICES, Carrier                                          RESPONDENT                                                   \n \n \n \n OPINION FILED JULY 2, 2024 \n \nHearing before ADMINISTRATIVE LAW JUDGE GREGORY K. STEWART in Springdale, \nWashington County, Arkansas. \n \nClaimant represented by EDDIE H. WALKER, JR., Attorney, Fort Smith, Arkansas. \n \nRespondents represented by JAMES A. ARNOLD, II, Attorney, Fort Smith, Arkansas. \n \n \n STATEMENT OF THE CASE \n  \n On June 5, 2024, the above captioned claim came on for hearing at Springdale, \nArkansas.  A pre-hearing conference was conducted on November 1, 2023 and a pre-\nhearing  order  was  filed  on  that  same  date.    A  copy  of  the  pre-hearing  order  has  been \nmarked as Commission’s Exhibit #1 and made a part of the record without objection. \n At the pre-hearing conference the parties agreed to the following stipulations: \n 1.   The Arkansas Workers’ Compensation Commission has jurisdiction of the \nwithin claim. \n 2.     The  employee/employer/carrier  relationship  existed  among  the  parties  on \nJanuary 20, 2023. \n 3.   The claimant was earning sufficient wages to entitle her to compensation at \nthe  maximum  rates  of  $835.00  for  total  disability  benefits  and  $626.00  for  permanent \n\nSix Papp (H302552) \n2 \n \npartial disability benefits. \n 4.   Respondents have controverted this claim in its entirety. \n At the pre-hearing conference the parties agreed to litigate the following issues: \n1.   Compensability of injuries to claimant’s neck, left shoulder, upper extremities \nand back on January 20, 2023. \n2.    Temporary total disability benefits. \n3.     Medical benefits. \n4.      Attorney’s fee. \nAt the time of the hearing claimant clarified that she is requesting temporary total  \ndisability benefits from January 23, 2023 through a date yet to be determined. \nThe  claimant  contends  that  she  sustained  job  related  injuries  to  her  neck,  left \nshoulder, upper extremities and back.  She contends that her injuries occurred as a result \nof the combined effects of her job activities on January 19, 2023 and January 20, 2023.  \nClaimant  contends  that  although  the  pain  started  on  January  19th,  her  job  duties  on \nJanuary  20th  caused  her  disability.    She  requests  payment  of  reasonably  necessary \nmedical treatment, temporary total disability benefits, and a controverted attorney fee.  \nThe respondents contend that without waiving other defenses, the claimant did not \ninjure herself while in the course and scope of her employment.  \n From a review of the record as a whole, to include medical reports, documents, \nand other matters properly before the Commission, and having had an opportunity to hear \nthe testimony of the witness and to observe her demeanor, the following findings of fact \nand conclusions of law are made in accordance with A.C.A. §11-9-704: \n \n\nSix Papp (H302552) \n \n3 \n \n  FINDINGS OF FACT & CONCLUSIONS OF LAW \n \n 1.      The  stipulations  agreed  to  by  the  parties  at  a  pre-hearing  conference \nconducted  on November  1,  2023 and  contained  in  a  pre-hearing  order  filed  that  same \ndate are hereby accepted as fact. \n 2. Claimant has failed to meet her burden of proving by a preponderance of \nthe  evidence  that  she  suffered  a  compensable  injury  to  her  neck,  left  shoulder,  upper \nextremities and back on January 19, 2023 and/or January 20, 2023. \n \n \n FACTUAL BACKGROUND \n The claimant has been employed as an emergency room (hereinafter “ER”) nurse \nsince September 2021.  Claimant testified that she worked a double shift on January 19, \n2023 and January 20, 2023.  Claimant testified that on January 19, 2023 she had a patient \nthat weighed 347 pounds who needed to be moved in his bed and that her only help was \na paramedic. \n She also testified that on Friday, January 20, 2023, she and several other nurses \nand two security guards had to physically restrain a combative psychiatric patient in Room \n4  of  the  ER.    Claimant  testified  that  the  patient  was  hitting,  kicking,  and  spitting.    She \ndescribed the patient as belligerent, noncompliant, combative, psychotic, and violent. \n Claimant  testified  that  she  felt  like  she  had  strained  something  but  continued  to \nperform her job duties until time to clock out.  She testified at  her deposition that at the \ntime she clocked out she had some neck pain, upper back pain, and left upper back pain \nat the scapula. \n\nSix Papp (H302552) \n \n4 \n \n Claimant testified as following with regard to Friday night: \n  Q Tell me what happened Friday night. \n \n  A Well, I had left work.  I got off shift.  We were off shift \n  18:30.  That’s when we go through shift change.  I don’t know \n  exactly what time I clocked out.  I clocked out and went home, \n  and I tried to take some ibuprofen, and I tried to take a hot \n  shower, and my symptoms kept getting worse and worse.  I \n  kept having more and more pain.  At some point Friday night, \n  1:00/2:00 a.m. I finally dozed off and fell asleep for a little \n  while.  And whenever I woke up after two or three hours, I \n  woke up because the pain was so bad I couldn’t sleep any- \n  more.  I got up and my arm was paralyzed, couldn’t lift it.  I \n  had no movement in it. \n \n \n Claimant testified that her symptoms continued to worsen over the weekend and \non Monday, January 23, 2023, she called her supervisor, Calley Lanier, at 7:03 a.m. and \ninformed her that she had a “rough shift”; was having pain; and would not be able to work \nthat day.  Later that day claimant telephoned her primary care provider’s office and stated \nthat  she  could not  raise  her  left  arm,  was  in excruciating  pain, and  believed  she  might \nneed  an  MRI.    She  also  sought  medical  treatment  from  Jaclyn  Crowder  at  Travis \nChiropractic for her left shoulder and midback pain.   \n On  January  24,  claimant  sought  medical  treatment  from  Christy  Anders, NP.  \nAnders ordered an MRI of the cervical spine which was performed on February 1, 2023 \nand read as follows: \n  IMPRESSION: \n  At the C4-5 level, there is significant worsening since 3 2020, \n  with there now being a moderate left posterolateral disc \n  herniation, as well as there being broad posterior disc \n  bulging/protrusion, mild-to-moderate central canal stenosis. \n \n  Broad disc bulging/protrusion at the C5-6 with moderate \n\nSix Papp (H302552) \n \n5 \n \n  central canal stenosis, mild/moderate bilateral foraminal \n  spurring at this level. \n \n \n On February 22, 2023, claimant was evaluated by Candace Harper, PA in Dr. Larry \nArmstrong’s office.  Harper assessed claimant’s condition as cervical radiculopathy at C5 \nand  C6;  cervical  stenosis  of  spinal  canal;  cervical  spondylosis  with  radiculopathy;  and \nherniated cervical disc.  Subsequently, on March 1, 2023, Dr. Armstrong recommended \nan anterior cervical discectomy with fusion at C4-5, 5-6, and C-7 levels.  This surgery was \nscheduled for April 14, 2023.    \n Claimant apparently canceled the surgery the day before it was scheduled and Dr. \nArmstrong would not reschedule the procedure.  Claimant then sought medical treatment \nfrom Dr. Jared Seale who agreed with Dr. Armstrong’s surgical recommendation.   \n Claimant has filed this claim contending that she suffered a compensable injury as \na  result  of  work  activities  that  occurred  on  January  19,  2023  and  an  injury  with  a \ncombative  patient  on  January  20,  2023.    She  requests  payment  of  temporary  total \ndisability  benefits  from  January  23,  2023  through  a  date  yet  to  be  determined;  related \nmedical benefits; and a controverted attorney fee. \n   \nADJUDICATION \n Claimant  contends  that  she  suffered  a  compensable  injury  as  a  result  of  work \nactivities  that occurred  on  January  19,  2023 and an  injury  with  a  combative patient on \nJanuary  20,  2023.     Claimant  essentially  contends  that  she  suffered  a specific \ncompensable injury while working for the respondent.  In order to prove a compensable \ninjury  as  the  result  of  a  specific  incident  that  is  identifiable  by  time  and  place  of \n\nSix Papp (H302552) \n \n6 \n \noccurrence, a claimant must establish by a preponderance of the evidence (1) an injury \narising out of and in the course of employment; (2) the injury caused internal or external \nharm to the body which required medical services or resulted in disability or death; (3) \nmedical evidence supported by objective findings establishing an injury; and (4) the injury \nwas caused by a specific incident identifiable by time and place of occurrence.  Odd Jobs \nand More v. Reid, 2011 Ark. App. 450, 384 S.W. 3d 630. \n After reviewing the evidence in this case impartially, without giving the benefit of \nthe doubt to either party, I find that claimant has failed to meet her burden of proving by \na preponderance of the evidence that she suffered a compensable injury while working \nfor respondent.  I make this finding regardless of whether claimant’s contention is that \nshe suffered an injury on January 19 and/or January 20.  Under any contention, claimant \nhas  the  burden  of  proving  by  a  preponderance  of  the  evidence  that  she  suffered  a \ncompensable  injury  which  arose  out  of  and  in  the  course  of  her  employment  with \nrespondent.  I find based upon the evidence that claimant has failed to meet that burden \nof proof. \n First, I note that claimant has a history of complaints involving her neck, back, and \nshoulder.  A report dated July 20, 2007 from Carolyn Dillard notes paravertebral spasms \nin the cervical spine.  In a report dated September 26, 2011, Dillard noted that: \n  She also presented with arm pain.  It is located left arm and \n  right arm.  It is described as numbness, acute and tingling. \n \n \n A Patient Case History form dated February 28, 2017 reflects constant low back \npain  with  frequent  neck  pain  or  stiffness,  pain  between  shoulders,  shoulder  pain  and \nsciatica.  In a report dated March 19, 2017, Stefanie Ellis, APN, noted that claimant’s \n\nSix Papp (H302552) \n \n7 \n \nexamination was positive for neck and back pain.  Because claimant was complaining of \ndizziness at that time, Ellis ordered an MRI scan of the brain.  This MRI was performed \non  April  21,  2017  and  was  read  as  normal  with  respect  to  the  brain.    However,  it  also \nnoted: \n  Moderate central disc protrusion at C4-5 indenting sub- \n  arachnoid space and cord.  MRI of cervical spine may be \n  of use. \n \n \n Based on this test result, Ellis did order an MRI scan of the cervical spine which \nwas performed on March 9, 2020.  That scan found a small disc protrusion at C4-5 with \nmild canal stenosis; spondylosis with disc protrusion at C5-6 with canal and biforaminal \nstenosis;  and  small  right-sided  disc  protrusion  at  C6-7  with  mild  right  lateral  recess \nnarrowing. \n Subsequent  records  from  Ellis  indicate  that  she  assessed  claimant  with  chronic \nneck pain and prescribed Norflex as needed.  Claimant was involved in a MVA in April \n2021, and she sought medical treatment from the Travis Chiropractic Clinic for complaints \nof neck, back, and  hip pain.  Claimant also returned to Ellis for additional treatment and \nin a report dated April 8, 2021 Ellis noted: \n  Video visit today for f/u with her mdd with reaction to acute \n  stress (not doing well emotionally, got in to a wreck with \n  being rear ended, flared up her neck pain)..... (Emphasis \n  added.) \n \n \n Ellis’ assessment included chronic neck pain and “Whiplash injury to neck, initial   \nencounter”.  Ellis continued claimant’s prescription for Norflex.  \n On April 22, 2021, claimant again visited with Ellis by video.  In her report of that \n\nSix Papp (H302552) \n \n8 \n \ndate, Ellis again noted that claimant’s neck pain had worsened following the MVA and \nthat “last night has actually increased her lower back pain doing super man on the bounce \nball, low back strain, LLE with numbness and tingling....”    Ellis prescribed claimant a \nmuscle relaxer for severe pain. \n Claimant underwent a lumbar MRI scan on May 7, 2021 which revealed a central \nright lateral protrusion at L4-5 with degenerative changes.  Claimant continued to receive \ntreatment  at  Travis  Chiropractic  and  from  Ellis.    In  a  report  dated  July  15,  2021,  Ellis \nstated: \n  She has had chronic neck pain.  She has had MRI in the \n  past.  Patient states her Norflex seems to work the best \n  for this problem. \n \n \n When claimant’s chronic neck pain continued, Ellis in a report dated December 12, \n2021 referred claimant to a pain clinic.  Claimant was seen by Dr. Brian Goodman, Pain \nManagement, on February 8, 2022.  He noted that claimant’s neck extension was limited \napproximately 10%; neck flexion limited by approximately 50%; right neck rotation limited \nby approximately 10%; and left neck rotation limited by approximately 10%.  His diagnosis \nof claimant included cervical radiculopathy left C8 and cervical spondylosis.  He did not \nfeel  that  a  surgical  referral  was  necessary  but  instead  recommended  cervical  steroid \ninjections;  home  exercises;  continued  use  of  medication;  and  no  activity  restrictions.  \nClaimant  chose  not  to  undergo  the  cervical  steroid  injections,  but  instead  continued  to \nsee Ellis for chronic neck pain and refills of Norflex for that condition. \n Clearly, claimant had an extensive history of chronic neck pain prior to January 19, \n2023.  However, a claimant may suffer a compensable injury if a pre-existing condition is \n\nSix Papp (H302552) \n \n9 \n \naggravated by a work-related injury. \nAfter her alleged injury with respondent, claimant underwent another cervical MRI \nscan on February 1, 2023.  The MRI report states: \n   \nAt the C4-5 level, there is significant worsening since 3 2020, \n  with there now being a moderate left posterolateral disc \n  herniation, as well as there being broad posterior disc \n  bulging/protrusion, mild-to-moderate central canal stenosis. \n \n  Broad disc bulging/protrusion at the C5-6 with moderate \n  central canal stenosis, mild/moderate bilateral foraminal \n  spurring at this level. \n \n \n As  previously noted,  claimant  eventually  came under  the  care of Dr.  Seale  who \nhas recommended surgery on claimant’s cervical spine.  In a letter dated August 23, 2023, \nhe stated that he had reviewed claimant’s cervical MRIs from 2020 and 2023.  It is his \nopinion that the 2023 cervical MRI scan shows disc protrusions at C4-5 and C6-7 which \ndid  not  exist  on  the  MRI  from  2020.    He  then  indicates  that  based  on  the  onset  of \nclaimant’s symptoms after January 20, 2023, which did not exist prior to that date, that \nthe  disc  protrusions  occurred  during  a  work-related  injury  and  resulted  in  her  current \nsymptoms and need for surgery.  Dr. Seale reiterated this opinion after being provided \nwith chiropractic records from 2021 and at his deposition.   \n However, Dr. Seale’s opinion regarding causation is based upon the history of \ninjury given to him by claimant.  Dr. Seale describes himself as a patient’s advocate and \nwith respect to claimant stated – “That was my gut, but I’m also biased toward the patient, \nas always, as I should be.”   Certainly one would expect a physician to believe their patient \nand advocate for them with respect to medical matters.   However, this advocacy does \n\nSix Papp (H302552) \n \n10 \n \nnot extend to the issue of causation to the extent that it requires a weighing of the totality \nof the evidence and credibility of witnesses.  That is a function of the Commission.   \n After my observation of claimant’s demeanor at the hearing and after consideration \nof her testimony, I do not find the claimant’s testimony to be credible.  To the contrary, I \nfound her testimony to be evasive, argumentative, and contradictory at times.    \n One example of this involves whether claimant had complaints involving her left \nscapula  prior  to  January  20,  2023.    At  her  deposition  claimant  was  asked  about  her \nsymptoms on January 20, 2023.   \n  Q Where? \n  A Neck, back.  So upper back, central upper back, \n  behind my left scapula. \n \n  Q Had you had any of those symptoms prior to this \n  incident on January the 20\nth\n? \n \n  A Not the pain in my - - behind my scapula, not there. \n  I had not had that before.  That was new. \n \n \n Claimant was again asked about prior scapula pain at the hearing. \n  Q Do you recall telling me when I took your deposition \n  on October the 31\nst\n of last year, we talked about your neck \n  and upper back pain and all that kind of stuff and you said \n  you had this problem after 1/20, after January 20\nth\n. \n \n  A Uh-huh. \n \n  Q “I felt like I had strained something.  I had pain and \n  some kind of throbbing going on.” \n    \n“Where” \n \n   “Neck and back.  So upper back, central upper back, \n  behind my left scapula.” \n  \n\nSix Papp (H302552) \n \n11 \n \n   And I said, “Had you had any of these symptoms \n  prior to the incident on January the 20\nth\n?” \n   And you said, “Not the pain in my - - behind my \n  scapula.  Not there.  I had never had that before.  It was \n  new.” \n \n  A That is correct. \n \n  Q That is correct and it is your testimony you have never \n  had left scapula pain before? \n \n  A And it shows on the MRI. \n \n  Q Answer my question.  Did you tell me that you never \n  had any left scapula pain before January 20, 2023? \n \n  A I had never had pain in my infraspinatus and supra- \n  spinatus that shows up on the MRI from February the 9\nth\n \n  of 2023.  I never had that pain before. \n \n  Q You never had the pain in your left scapula before, \n  correct? \n \n  A I had never had the pain that was related to acute \n  edema that was diagnosed on February the 9\nth\n of 2023.  I \n  never had that pain before. \n \n      *** \n \n  Q On October the 31\nst\n, we were talking about what your \n  problems were after whatever this date is in January of 2023 \n  and we talked about the fact that you felt at that time neck, \n  back, upper back, central back, central  upper back, behind \n  my left scapula, and I asked you the following question: \n  “Had you had any of those symptoms prior to this incident \n  on January the 20\nth\n?” \n \n  A The answer would be yes. \n \n  Q Why did you tell me then that you have not had the \n  pain behind your scapula?  “I had not had that before.  That \n  was new.”  \n \n  A You are misinterpreting me right here, right here in \n  this moment.  I just want you to understand that you are \n\nSix Papp (H302552) \n \n12 \n \n  misinterpreting exactly as I said it.  I have had some pain, \n  some stiffness in certain parts in the past, but the pain \n  that I felt behind my left scapula, which shows up as a \n  new and acute injury due to the acute inflammation, so \n  that is proven.  It is new and acute proven on that MRI. \n  That pain I had not had - - \n \n \n Thus, at her deposition claimant clearly indicated that she had not had any pain \nbehind  her  left  scapula  before  but  that  it  was  a  new  symptom after  January  20,  2023.  \nHowever, at the hearing claimant attempts to parse that testimony and state that any pain \nbehind her left scapula was new because it was proven on an MRI. \n This testimony is significant when one considers the chiropractic report submitted \nby respondent dated June 9, 2021.  That medical report contains the following notation: \n  L scapular region “stabbing”   \n  \n This chiropractic report from June 9, 2021 would contradict claimant’s deposition \ntestimony that she had never had any left scapular pain.  Therefore, claimant attempted \nto distinguish one type of left scapular pain from another in her testimony at the deposition \nand at the hearing.  However, claimant was even unwilling to admit that the “L scapular \nregion” even refers to left as opposed to something altogether different.   \n  Q Have you seen this report from your chiropractor from \n  June 9, 2021, which appears at Respondents’ Page 55? \n \n  A I don’t know.  You would have to show it to me. \n \n  Q Okay.  Let me show it to you.  Why don’t you read \n  this part right over here under nursing notes. \n \n  A (Witness reading document.) \n \n  Q What does that say? \n \n\nSix Papp (H302552) \n \n13 \n \n  A I don’t know.  I am trying to make it out what this \n  actually says.  Something movement.  Overall addition. \n  Something of - - something region stabbing.  I don’t know. \n \n  Q Left scapular region stabbing; is that what it says? \n \n  A I don’t think that that actually says left. \n \n  Q Okay.  Well, what do you think that L stands for? \n \n  A Could be a lot of things. \n \n  Q What else could it be other than left? \n \n  A I think that says improvement.  I think you are mistaken. \n \n \n Clearly the handwritten chiropractic notation does indicate that claimant had some \nimprovement overall.  However, it also indicates the left scapular region.  Claimant’s \ninability to even admit that the “L”  likely stands for left strains credibility given the fact that \nclaimant is a nurse.  \n Another  example of evasion occurred  in  discussing  the history  claimant  gave  to \nher treating physicians beginning on January 23.  The following questioning took place \non cross examination: \n  Q Well, go back to this - -  I am going to wind up  \n  introducing the entire deposition, but you told me when \n  I took your deposition you didn’t have any pain until \n  after the 20\nth\n. \n \n  A I had soreness.  Excruciating pain began on the \n  20\nth\n as well as the loss of function.  I no longer had function \n  of my left arm after the PM hours of the 20\nth\n.  My left arm \n  became weak and I was no longer able to use the left hand \n  as I lost the motor control. \n \n  Q Well, that was a very specific incident.  That happened \n  right after this.  Why didn’t you tell your chiropractor when you \n  saw him on the 23\nrd\n?  You didn’t mention the incident on the \n\nSix Papp (H302552) \n \n14 \n \n  20\nth\n with a combative patient at all.  You said that \nyou had been lifting some heavy patients.  Why did  \nyou not tell your chiropractor about this combative \npatient that you had to wrestle with? \n \n  A I had very specific patients that I got on the 19\nth\n \n  that I carried their - - I had the same patients on the 20\nth\n. \n  The exact, same patients, if you go back in history, it will \n  prove that I had the same patients on the 19\nth\n and 20\nth\n, \n  as well as the documented event that happened on the \n  20\nth\n. \n \n \n Instead of answering the question as to why she did not report a specific incident \nto  her  chiropractor  when  she  saw him  on  January  23\nrd\n,  claimant  instead  indicated  that \nshe  had  the  same  patients  on  the  20\nth\n as  she  had  on  the  19\nth\n.    Her  answer  was  not \nresponsive to the question and is another example of her testimony being evasive. \n In addition, I note that there are many contradictions in claimant’s testimony and \nthe  remaining  evidence.    For  instance,  in  describing  the  incident  with  the  combative \npatient  on  January  20,  2023,  claimant  indicated  that  she  participated  in  returning  the \ncombative patient to the ER room from which she had escaped. \n  Second security guard – his name is Darrell, younger \n  healthier in nature.  When that happened, there was \n  myself, Kim, Lindsey Long, Jerica, were all somewhere \n  close.  We get up and attempt to help get this patient and \n  return her back to her room.  (Emphasis added.) \n \n \n In addition, at the hearing claimant also described this event as follows: \n  I was walking towards this event and as I walked towards \n  this, I helped to restrain the patient and put the patient back \n  to the psychiatric treatment room.  (Emphasis added.) \n \n \n Claimant’s testimony that she helped restrain the claimant and return her to the \n\nSix Papp (H302552) \n \n15 \n \nexamination room is contradicted by the testimony of two co-workers, Darrell Robinson \nand Mike Carney.   According to their testimony, they were the individuals who subdued \nthe  patient  and  took  her  back  to  the  examination  room.    Darrell  Robinson  testified  as \nfollows: \n  And he [Mark Carney] stated that a patient was leaving out that \nwas kind of combative.  So I went one direction and he went the \nother and I stopped the patient, grabbed her, and he helped and \nwe took her to ER 4.....  At that time, only I stopped her.  I grabbed \nher upper torso.  He grabbed her lower torso, lower legs, limbs, \n  and we took her to the room. \n \n \n Likewise,  Mike  Carney,  a  security  officer  for  the  respondent,  testified  as  follows \nregarding this incident: \n  A  young woman who was standing at approximately ER 12 \n  was screaming obscenities at the nursing staff when I arrived. \n  when I arrived she turned and began to apply some obscenities \n  to me, told me to stay away from her, and was very much \n  physically out of control, turned around and ran from me, so \n  I followed her.  She was a lot faster than me because I’m older. \n  She turned left, and I thought she was going to go out the \n  ambulance doors, which sometimes that happens, but she \n  didn’t.  She turned left again and ran right into Darrell, my \n  boss.  Darrell put his arms around her.  She was kicking him, \n  so I ran to try to grab her legs and she kicked me in the left \n  foreleg, which I’m used to having collateral damage some- \n  times when people are physically out of control, but I did get \n  a hold of her legs.  We took her into a safe room, laid her \n  down, and six of the nursing staff came in the room and  \n  began to put the restraints on her.  When she was restrained, \n  Darrell and I left. \n \n \n Carney  was  subsequently  specifically  asked  whether  any  of  the  nursing  staff \nhelped restrain the claimant to get her back into the examination room. \n  Q While you and Darrell had this lady in a bearhug, - - \n \n\nSix Papp (H302552) \n \n16 \n \n  A Yes. \n \n  Q - - were any of the nurses there helping you restrain \n  her, or was it just you and Darrell? \n \n  A My recollection is Darrell and I took the girl into the \n  room and laid her down.  I don’t recall any nurse or any \n  other personnel grabbing a hold of that individual.  There \n  was nothing left to grab a hold of.  You know, he had the \n  upper body, I had her legs. \n \n  Q And you took her and laid her - - \n  \n  A Laid her down. \n \n  Q - - on the bed and stayed there until she was strapped \n  down? \n \n  A Correct. \n \n \n Thus, while there was clearly an incident in which a combative patient had to be \nsubdued and returned to an examination room, claimant has given the impression that \nshe participated in subduing the patient and taking her back into the examination room.  \nAccording  to  the  testimony  of  Carney  and  Robinson,  they  were  the  individuals  who \nsubdued the patient and carried her into the examination room.  The only thing the nurses \ndid  was  apply  the  restraints.   This  is  not  to  suggest  that applying  the  restrains  in  this \nsituation  would  have  been  a  simple  task or  that  claimant  could  not  have  been  injured \nwhile   applying   the   restraints.  However,  claimant’s  testimony  exaggerates  her \nparticipation in the subduing of the patient and returning her to the examination room. \n I also believe it is important to note that claimant testified that she had immediate \nsymptoms.  At her deposition claimant testified as follows: \n  Q When did you first notice any symptoms? \n\nSix Papp (H302552) \n \n17 \n \n  A Immediately. \n  \n Likewise, at the hearing claimant testified as follows: \n  Q Now, let’s talk about January the 20\nth\n.  Did your condition, \n  did your physical condition as far as you could tell, change \n  any after your experience with the combative patient as \n  compared to your condition on January 19? \n \n  A Yes, sir.  It was immediately noticed. \n \n  Q When you say immediately, what do you mean  \n  immediately? \n \n  A I mean in our world, within a few minutes or so.  Then \n  I felt sore.  I didn’t understand that I had an acute, severe \n  injury.  And whether that be from adrenaline, whether that \n  be from, you know, whatever endorphins that I had at that \n  time after having that experience with that combative patient, \n  it wasn’t known to me immediately that it was something that \n  was that severe. \n \n      *** \n  Q So when do you believe the injury occurred? \n \n  A On Friday, January the 20\nth\n. \n \n  Q When on Friday, January the 20\nth\n? \n \n  A It would have been Friday afternoon.  I only had a \n  couple, two or three hours left on my shift.  I knew that I \n  was injured.  I knew that I was hurting.  (Emphasis added.) \n \n \n Despite   testifying   that   she   knew   something   was   wrong   immediately   while \nrestraining the combative patient, and that she knew that she had an injury, claimant did \nnot mention any injury to anyone in the supervisory capacity before clocking out.  It should \nalso  be  noted  at  this  point  that  during  the  deposition  of  Calley  Lanier,  claimant’s \nsupervisor, a discussion occurred regarding an Event Reporting System or ERS.  Lanier \n\nSix Papp (H302552) \n \n18 \n \nwas asked about how that system worked. \n  Q And tell us a little bit about what that is and how it works. \n \n  A That is where a hospital personnel can go in and put in an \n  event that happened.  And then - - yeah.  Go ahead. \n \n  Q What would cause hospital personnel to file such \n  a report? \n \n  A Any number of things.  If someone were to get hurt; \n  if there was some kind of altercation; if there was mis- \n  management of meds; or if a bed rail wasn’t working or \n  something.  I mean any kind of things that go wrong. \n \n \n Notably,  no  ERS  was  completed  regarding  the  incident  of  January  20,  2023.  \nHowever, as Lanier noted, the filing of an ERS was not limited to supervisors but they can \nbe filed by any employee such as the claimant. \n  Q And as far as the ERS is concerned, if Sarah  \n  Six Papp was an RN in the emergency room department \n  on Friday, January the 20\nth\n, and an incident occurred in \n  which she was involved, either as the nurse  in charge of \n  the patient or as a member of the emergency room staff \n  that she thought resulted in something untoward happening \n  either to herself, to the patient, to another member of the \n  staff, could she have filed an ERS? \n \n  A Yes. \n \n     *** \n  Q If a person injured themselves at work, would they \n  have the ability to file their own ERS? \n \n  A Yes. \n \n \n Thus, claimant has testified that she knew immediately that she had been injured \nand had symptoms.  Despite that, she did not report the injury to anyone in a supervisory \ncapacity on January 20 and did not file an ERS report. \n\nSix Papp (H302552) \n \n19 \n \n Claimant  did  not  discuss  any  physical  problems  with  anyone  in  a  supervisory \ncapacity  at  the  respondent  until  Monday  morning,  January  23.    Again,  despite  having \ntestified that she knew that she had been injured immediately, claimant still did not report \na work-related injury to her supervisor, Calley Lanier.  Instead, she simply informed Lanier \nthat she had a “rough shift” and would not be available to cover her shifts.  Claimant  \nadmitted at the hearing that she did not mention any specific injury to Lanier. \n  Q So did you at some point report to somebody in a \n  supervisory capacity with Northwest Medical Center that  \n  you felt like you had a condition that had been caused by \n  your work? \n \n  A Yes, sir. \n \n  Q And when did that happen? \n \n  A It was on Monday, July 23, 2023 and my supervisor \n  comes on shift at 0700 and I made a phone call at 0703 to \n  contact her and let her know. \n \n      *** \n  Q What I am asking you - - I am not asking you why you \n  told her whatever you told her.  All I am asking you is what did \n  you tell her? \n \n  A I told her that I was hurt; that we had a very rough shift \n  on Friday and that after I had gotten home, that my symptoms \n  continued to get worse.  And that I had suffered all weekend \n  and that she needed to find someone to cover my upcoming \n  shifts. \n \n  Q Now, we took Ms. Lanier’s deposition and I came away \n  with the impression that you did not report a specific injury. \n  Is that correct or incorrect? \n \n  A That is correct. \n \n  Q And why did you not report a specific injury? \n \n  A There are so many events that take place in one shift’s \n\nSix Papp (H302552) \n \n20 \n \n  amount of time, let alone two shifts.  I worked back-to-back \n  on the Thursday and Friday, the 19\nth\n and the 20\nth\n.  And from \n  those two shifts, I went to work one day and I left completely \n  different.  My health was fine.  I did  my job without any delay, \n  without any help, and my life changed in an instant in the same \n  day. \n \n  Q Now, which day are we talking about? \n \n  A January the 20\nth\n. \n \n  Q Okay.  From reading information that the Respondents \n  have submitted into evidence, it appears that you basically \n  didn’t know what was going on.  Is that right or wrong?   \n  when you reported this to Calley Lanier, did you know what \n  your problem was? \n \n  A No, I didn’t know.  No one would know - - \n \n      *** \n \n  Q So after you talked to Ms. Lanier, what happened? \n  I mean as far as your - - did you make it clear to her that \n  you wanted to file a workers’ comp claim? \n \n  A Yes. \n \n  Q And when you say yes, what did you tell her that in \n  your mind should have caused her to know that you wanted \n  to file a workers’ comp claim? \n \n  A I told her that there were - - that we had had a very \n  rough shift on Friday and she had asked - - she said, “Well, \n  what is going on?  What is going on?” \n \n   And I gave her my symptoms and I told her it just \n  continued to get worse and worse throughout the evening \n  and of course, over the weekend. \n \n   She had - - she had mentioned that - - she said, “Do \n  you know exactly what caused it?” \n \n   And I said, “At this time, no.”  I said, “I am in such \n  severe pain, I can’t hardly think.”  I did tell her that.  I did \n  tell her that I would think about it and at that time I was \n\nSix Papp (H302552) \n \n21 \n \n  just trying to seek help.  I mean medically, I need help. \n \n  Q So if you were asked by somebody in a supervisory \n  capacity if you knew what caused it, why would you say,  \n  “I will think about it,” if you knew what caused it? \n \n  A Well, I told her we had a rough shift, but she didn’t \n  ask very many questions as far as that goes.  I mean she \n  immediately - - she immediately just said, “Well, let me get \n  back with you on it.”  And I said, “Okay.” \n \n \n Likewise, on cross-examination, claimant testified as follows: \n  Q Okay.  So you are denying that you told Calley Lanier \n  on the 23\nrd\n at this very precise time that you recall that you \n  called her, you remember the exact minute that you called \n  her, but you don’t remember what you told her? \n \n  A I discussed that earlier. \n \n  Q Okay.  You didn’t tell her about the combative patient; \n  correct? \n \n  A I told her that we had a rough shift. \n \n  Q Okay.  You didn’t tell her about the combative patient. \n  You didn’t tell her about what you told the chiropractor about \n  lifting heavy patients. \n \n  A Well, that phone call would have been prior to me having \n  that chiropractic visit. \n \n  Q Okay.  According to the chiropractor’s records, which is \n  at Page 71 of our exhibits, there appears the following:   \n  “Thursday at work as a nurse.  She was pulling around a lot \n  on dead weight patients.  Since then, the pain started.” \n \n   Is that when your pain started that you are now contend- \n  ing began as a result of the incident with the combative patient? \n \n  A I had some soreness on the 19\nth\n.  The excruciating pain \n  in which I have suffered and endured with since January the \n  20\nth\n was a result of that event on January the 20\nth\n. \n \n\nSix Papp (H302552) \n \n22 \n \n     *** \n  Q Okay.  So you admit that you did not tell Calley \n  Lanier about the incident with the combative patient? \n \n  A I did not go into details with Calley Lanier. \n \n  Q “Yes” or “no”? \n \n  A No.  No, sir. \n \n  Q Okay.  You did not tell Calley Lanier specifically \n  about lifting heavy patients on Thursday? \n \n  A No, sir. \n \n  Q You just said a rough shift and you didn’t say which \n  date? \n \n  A That is correct. \n \n Again, claimant has testified that she immediately knew that she had been injured, \nyet  she  does  not  report  a  specific  injury  to  Lanier  on  January  23,  but  instead  simply \nindicates that she had a rough shift.  In fact, claimant acknowledges that Lanier asked \nher if she knew what caused it and claimant responded “no” and said that she would think \nabout it.  When asked why if she knew what had caused it she would indicate that she \nwould  think  about  it,  claimant  simply  responded  that  Lanier  didn’t  ask  very  many \nquestions.    However,  Lanier  specifically  asked  the  claimant  of  what  had  caused  her \nproblems and claimant indicated that she did not know and would have to think about it. \n Claimant  was  again  asked  about  her  failure  to  report  this  incident  on  cross \nexamination. \n  Q So this was an unusual occurrence [restraining a  \n  combative patient], and yet you didn’t tell anybody about \n  it? \n \n\nSix Papp (H302552) \n \n23 \n \n  A Kim Meyers reported it under the Event Reporting \n  System, underneath an ERS because of the level - - the \n  level that it was taken to, so an ERS was filed that day \n  under the patient’s primary nurse, who was Kim Meyers, \n  who was also present in the room. \n \n  Q So we have this unusual event, the extraordinary \n  event, and yet you don’t tell anybody about it when you are \n  saying something is wrong with my shoulder? \n \n  A It is not everyday that you get spit in the face by a \n  patient, no, sir. \n \n  Q Memorable? \n \n  A Memorable, being spit in the face is quite memorable. \n \n  Q And if you had related your problem to this incident, \n  don’t you think you would have told somebody about this \n  incident rather than I had a rough shift or I was dragging \n  around an overweight patient the day before? \n \n  A We vent to our fellow nurses.  It is how we cope.  It \n  is how we are able to maintain our own sanity.  And yet still \n  go back the next day and perform the exact, same job duties \n  with the exact, same work restraints with the exact, same, \n  you know, normal mindset to be able to do that kind of job \n  everyday.  We vent to our fellow nurses. \n   \n  \n Notably, claimant again did not answer the question as to why she did not report \nthis memorable incident rather than simply indicating that she had a rough shift; instead, \nshe simply explained how nurses vent to each other.  This answer is not responsive to \nthe question as to why claimant did not relate her problem to this memorable incident. \n With  respect  to  this  issue,  I  note  that  Calley  Lanier  in  her  deposition  testimony \ntestified as follows: \n  My recollection is she reached out and said she didn’t know \n  what had happened.  And I felt sorry for her because of her \n  arm, but she didn’t know what had happened.  She thought \n\nSix Papp (H302552) \n \n24 \n \n  maybe - - I don’t want to misspeak.  I don’t recall, but I do  \n  know she didn’t know what happened. \n \n  And then she said she had to lift a really heavy patient that \n  was dead weight and that might have been it. \n \n \n Lanier also testified that as a result of this conversation with claimant she wrote an \ne-mail  dated  January  25,  2023  to  various  individuals  at  respondent  setting  forth  the \nconversation.  According to Lanier’s testimony, her e-mail would be an accurate reflection \nof her conversation with claimant in January 2023.  In that e-mail, Lanier stated: \n  I have an RN in our Bentonville ED that called me Monday \n  morning 1/23 to tell me that she would potentially be out \n  Tuesday and Wednesday due to her not being able to lift \n  her left arm.  She states that she doesn’t understand what \n  happened and she did nothing so she can’t figure out why \n  her arm was in pain and she couldn’t lift it. \n \n \n Finally, there are various histories given by claimant to her medical providers.  In \na medical report dated January 23, 2023, electronically created by Francisco Porras, he \nrelated a phone conversation with claimant as follows: \n  Patient states she can not raise her left arm up, is in \n  excruciating pain.  Does not know if she hurt it at work \n  or what happened.  Patient believes she may need an \n  mri.  (Emphasis added.) \n \n \n Shortly  thereafter,  claimant had  a  telephone  conversation  with  Theron Likens,  a \nlicensed practical nurse.  Her report states as follows: \n  Received call on red phone and pt has hurt her arm at \n  work.  And she can’t lift it.  Informed to go to ER. \n \n \n On that same date a consultation form was completed with the following history: \n\nSix Papp (H302552) \n \n25 \n \n  Thursday at work as a nurse she was pulling around a \n  lot on dead weight patients.  Since then the pain started. \n \n \n Also on January 23, 2023, claimant was seen by Jacqueline Crowder at Travis  \nChiropractic with the following history: \n  Thursday at work as a nurse.  She was pulling around a lot \n  on dead weight patients since then the pain started. \n \n      *** \n  Thursday at work, as a nurse, the patient had to lift on two \n  different patients that were dead weight and lift them \nto move them.  Since then, her mid-back and her left \n  shoulder pain have gotten wore.  Her left arm feels \n  heavy and she can only lift it to less than shoulder \n  level without pain.  She can use her right arm to lift \n  her arm above her head. \n \n Finally,  on  January  24,  2023,  claimant  was  seen  by  Nurse  Practitioner  Christy \nAnders.  Her report of that date contains the following history: \n  Patient presents with left shoulder arm pain that began \n  approximately 3 days ago while she was at work.  She \n  denies any known injury but while at work developed \n  left arm pain 3 days ago.  (Emphasis added.) \n \n \n Again, according to claimant’s testimony she knew that she had immediate pain \nand had injured herself as a result of the incident with the combative patient on January \n20,  2023.    However,  claimant  did  not  mention  that  incident  to  any  of  these  medical \nproviders on January 23 or January 24. \n Furthermore,  with  respect  to  lifting  heavy  patients  on  January  19,  claimant \nspecifically testified at the hearing that she did not suffer an injury on January 19. \n  Q So do you think you got injured on January the 20\nth\n or \n  on January the 19\nth\n? \n \n\nSix Papp (H302552) \n \n26 \n \n  A January the 20\nth\n. \n \n      *** \n  Q So you say that - - well, so you are telling us now that \n  you did have some pain on the 19\nth\n, but that was just due to \n  what nurses do all the time? \n \n  A There is some type of soreness that we get from doing \n  our jobs.  There is some type of - -  you know, sometimes it \n  feels like we have some sort of strain, whatnot, just from \n  repetitive movements or from lifting that day, most nurses \n  can tell you that that is a daily occurrence. \n \n     *** \n  Q On January 19, did you believe you had sustained any  \n  kind of injury during the course of your employment on that \n  date?  On that date is what I’m asking you.  I am not asking \n  you to reflect as of today.  I am saying on that day, did you \n  think you had sustained any injury? \n \n  A I don’t believe I sustained a true injury on the 19\nth\n, no, \n  sir.  (Emphasis added.) \n \n   \n In  summary,  there  is  no  question  that  on  January  20,  2023 a  combative  patient \nwas restrained in the ER of respondent.  The question is whether claimant has proven \nthat she suffered a compensable injury as a result of that incident.  Dr. Seale’s opinion \nthat claimant’s current symptoms and need for surgery is causally related to an injury \nwhich  occurred  on  January  20,  2023  is  dependent  upon  her  credibility  that  the  events \noccurred as she related them to Dr. Seale.  For the reasons discussed herein, I do not \nfind the claimant’s testimony to be credible.  To the contrary, I found her answers to be \ncontradictory,  evasive,  and  non  responsive.    Claimant  has  testified  that  she  had \nimmediate pain while helping restrain a combative patient and knew that she had been \ninjured.    Despite  that  testimony,  claimant  did  not  report  it  to  anyone  in  a  supervisory \ncapacity on January 20.  Nor did claimant complete an ERS report which she could have \n\nSix Papp (H302552) \n \n27 \n \ndone to report an injury as a result of that incident.  Even when claimant telephoned her \nsupervisor, Calley Lanier, on Monday, January 23, claimant did not report an injury to her.  \nInstead, she indicated that she had had a “rough shift” and would not be able to work.  \nAccording to the claimant herself, Lanier asked her what had caused her problems and \ninstead  of  mentioning  this  incident  where  she  knew  that  she  had  been  immediately \ninjured, claimant instead indicated that she did not know what had caused her injury and \nthat she would have to think about it.  Likewise, claimant did not mention this incident to \nthe  medical  providers  on  January  23,  but  instead  mentioned  having  moved  heavy \npatients.  However, she has also testified that she was not injured on January 19. \n Perhaps claimant’s statement to Lanier that she did not know what had caused her \nproblem and would have to think about it is the most accurate description of this case.  \nClaimant did work two shifts on January 19 and January 20.  On January 23, 2023, she \nsought medical treatment for various complaints including her cervical spine.  However, \nclaimant has the burden of proving by a preponderance of the credible evidence of record \nthat she suffered a compensable injury as a result of her job duties with the respondent \non January 19 and/or January 20.  Here, according to claimant’s own testimony she did \nnot suffer an injury on January 19.  Furthermore, for reasons previously discussed, I do \nnot  find  that  claimant  suffered  a  compensable  injury  on  January  20.    Her  actions  and \nstatements do not support such a finding.  While claimant has testified that she did not do \nanything  after  leaving  work  on  January  20  until  her  symptoms  began,  one  has  to  find \nclaimant’s testimony credible to accept this as a fact.  For reasons discussed herein, I do \nnot find the claimant’s testimony credible to support a finding of compensability. \n The final issue for consideration involves claimant’s contention that a camera was \n\nSix Papp (H302552) \n \n28 \n \npresent in ER Room 4 on the date of this incident and video footage exists of the incident \nbut was not properly maintained by the respondent and therefore constitutes spoilation \nand creates a presumption that the content of that video footage would be adverse to the \nrespondent.  First, I note that there is no evidence that any such recording ever existed.  \nWhile there is testimony that a camera was present in Room ER 4, the evidence indicates \nthat that camera was for surveillance only and did not record.  Testifyhing by deposition \nwas Mike Carney, a security officer for the respondent.  Carney testified that a camera is \nin Room ER 4, but it is not a recording system.  He testified that they are only able to sit \nin  an  office  and  watch  a  patient,  but  are  not  allowed  to  film  patients.    Likewise,  also \ntestifying by deposition was Billy Lindsey, the Director of Plant Operations at Northwest \nHealth  in  Bentonville.  Lindsey  testified  that  he  was  responsible  for  all  maintenance, \nenvironmental care, security and safety in the facility.  Lindsey testified that in January \n2023 there were some cameras in operation; however, they were only for surveillance.  \nThe camera in Room 4 did not record activities. \n  Q  So is it your testimony that on January 20\nth\n, 2023, this \n  facility did not have a recorder that recorded activities in Room \n  4? \n \n  A Correct. \n \n  \n Lindsey went on to state that since that time they have upgraded their cameras \nand that recordings are now made in common areas such as the parking lot and hallway.  \nHowever, Lindsey testified that even now cameras do not record in holding rooms or in \nthe emergency rooms themselves.  According to Lindsey, these recordings are not made \nin  order  to  ensure  patient  confidentiality.    When  asked  why  someone  would  think  that \n\nSix Papp (H302552) \n \n29 \n \nthere is a recording, Lindsey responded that people see a camera and assume that it is \nrecording. \n Based upon this testimony and the lack of any credible evidence indicating that a \nrecording ever existed, I find no merit to claimant’s contention that respondents are guilty \nof spoilation of evidence. \n \nORDER \n \n Claimant has failed to prove by a preponderance of the evidence that she suffered \na  compensable  injury  on  January  19  and/or  20,  2023.    Therefore,  her  claim  for \ncompensation benefits is hereby denied and dismissed. \n Respondents are liable for payment of the court reporter’s charges for preparation \nof the hearing transcript in the amount of $780.45. \n IT IS SO ORDERED. \n \n      _____________________________________ \n       GREGORY K. STEWART \n       ADMINISTRATIVE LAW JUDGE","preview":"BEFORE THE ARKANSAS WORKERS’ COMPENSATION COMMISSION CLAIM NO. H302552 SARAH SIX PAPP, Employee CLAIMANT NORTHWEST MEDICAL CENTER BENTON CO., Employer RESPONDENT GALLAGHER BASSETT SERVICES, Carrier RESPONDENT OPINION FILED JULY 2, 2024 Hearing before ADMINISTRATIVE LAW JUDGE GREGORY K. STEWART in Springdale, Washington...","fetched_at":"2026-05-19T22:50:44.755Z","links":{"html":"/opinions/alj-H302552-2024-07-02","pdf":"https://www.labor.arkansas.gov/wp-content/uploads/PAPP_SARAH_H302552_20240702.pdf","source_publisher":"https://labor.arkansas.gov/workers-comp/awcc-opinions/administrative-law-judge-opinions/"}}