Same As It Ever Was: Court of Appeal Issues Opinion in Guzman Case
August 20, 2010
In the latest chapter of permanent disability litigation, the Sixth District Court of Appeal issued its highly anticipated opinion in Milpitas Unified School District v. WCAB (Guzman), which was certified for publication on August 19, 2010 (ADJ 3341185 / SJO 0254688).
The Appellate Court affirmed the WCAB's decision in Guzman II, holding that "the language of [Labor Code] section 4660 permits reliance on the entire [AMA] Guides, including the instructions on the use of clinical judgment, in deriving an impairment rating in a particular case."1 The issue raised on appeal was a narrow one: how are the Guides to be used in defining impairment? Must a physician strictly apply the descriptions and measurements set forth in the Guides, or may a physician incorporate any chapter, table or method he deems more appropriate?
In deciding this issue, the Appellate Court adopted a broad view of section 4660. Due to the "variety and unpredictability of medical situations," some injuries may not be accurately described by the classifications set forth in the Guides. While physicians must reference the descriptions, measurements and percentages set forth in the Guides and integrate them into their reports, they are not constrained by any particular chapter, section or method. The authors of the Guides explicitly recognized that a physician's "clinical judgment, combining the both the 'art' and 'science' of medicine, constitutes the essence of medical practice." As such, the Court rejected the notion that physicians are confined to "rigid and standardized protocol... devoid of any clinical judgment."
However, the WCAB's decision "does not disregard, retreat from, or compromise the requirement of substantial evidence." While a physician may still reference 'any chapter, table or method,' his ability to do so is limited, as he must set forth facts and reasoning to justify his departure from the typical chapter.
The bottom line of the Court's opinion is nearly identical to that of the WCAB: Impairment may be determined by reference to the entire Guides, as its authors could not anticipate and describe every conceivable impairment.
However, the Court seems to qualify its holding by noting that physicians are obliged to "exercise clinical judgment" to evaluate the impairment in these "complex or extraordinary cases." Unfortunately, the Court fails to provide parties with further guidance as to what would constitute a "complex" or "extraordinary" case. Defendants should, therefore, scrutinize reports where the physician deviates from the usual descriptions and measurements set forth in the Guides, to determine whether the case could be considered complex or extraordinary. Until the Court or WCAB clarifies this issue, defendants should argue that the physician's ability to reference atypical chapters, sections or methods within the Guides is restricted to truly exceptional cases.
1 While the WCAB had consolidated the Almaraz and Guzman cases, the instant Court of Appeals case is confined to the Guzman matter.
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