NY Court Affirms Board’s Decision to Require Weaning From Opioids
A New York appellate court affirmed a decision by the state’s Workers’ Compensation Board that directed that a claimant be weaned from his narcotic prescription medications in accordance with the report of an independent medical examiner in spite of the fact that the claimant’s treating physician said that course of treatment was contra-indicated [Matter of Forte v. Muccini, 2020 N.Y. App. Div. LEXIS 1924 (3d Dept., Mar. 16, 2020)]. The court noted that the IME’s opinion was consistent with the Board’s Non-Acute Pain Medical Treatment Guidelines; the treating physician’s suggested tapering program was not.
Background
Claimant sustained a work-related back injury and his claim was established for an occupational disease of the back with a date of disablement of June 1, 2003. He was found to have a PPD. Claimant underwent back surgery in 2005, at which time he was prescribed narcotic medications for pain. For many years thereafter, he continued to seek medical treatment for chronic pain, was prescribed various types of opioid medications and was diagnosed with opioid dependence in 2015. A WCLJ subsequently amended the claim to include consequential arachnoiditis, a pain disorder caused by inflammation of the membranes that surround and protect the nerves of the spinal cord, for which there is no medical treatment.
During the proceedings, the employer’s carrier requested the WCLJ to direct that claimant be weaned from opioid medications based upon the medical opinion of an IME, who conducted a pharmacological chart review of claimant’s medications and determined that weaning was appropriate based upon the Workers’ Compensation Board’s Non-Acute Pain Medical Treatment Guidelines (see 12 NYCRR 324.2[a][6].
Board Directed Claimant Be Weaned
The WCLJ denied the request, but the Board modified the WCLJ’s decision and directed that claimant be weaned from his narcotic medications in accordance with the weaning program devised by the IME. Claimant appealed.
Claimant contended that the Board erroneously relied upon the opinion of the IME instead of the opinion of his treating physician. The appellate court disagreed, saying it was undisputed that the amount of opioids claimant was taking was far in excess of the amounts set forth in the guidelines. Claimant’s treating physician acknowledged this, but stated that claimant had been tolerant to a high dosage of opioids over a long period of time and warned that weaning him could result in increased blood pressure and other medical problems. Considering all factors, the treating physician said he did not believe that it is was necessary to follow the weaning protocol set forth in the guidelines, opting instead to follow his own tapering regiment.
The IME stated, in relevant part, that the use of a high dose of opioids, particularly in the amounts taken by claimant, posed an increased risk of morbidity and mortality.
The appellate court indicated that although claimant’s physician and the IME gave differing opinions regarding the advisability of weaning claimant from his opiate medications, as well as the manner in which it should be accomplished, the Board was vested with the authority to resolve conflicting medical opinions. The Board could choose to credit the opinion of the IME, which was in accordance with the applicable guidelines, over that of claimant’s treating physician. Substantial evidence supported the Board’s decision.