Sacramento, CA - Two years ago the Court of Appeal opened the Pandora's box of potential litigation against utilization review physicians in the published case of Kirk King v Comppartners, Inc. The California Supreme Court granted a Petition to Review the case, potentially leading to an end to this litigation expansion nightmare.
Oral argument in the case is now set for Tuesday, May 29, 2018, at 9:00 AM in the San Francisco Supreme Court.
Kirk King suffered anxiety and depression due to chronic back pain resulting from the back injury at work in 2008. In 2011, he was prescribed an anti-anxiety medication known as Klonopin to be provided through Workers' Compensation. The request for this medication was sent to UR.
Naresh Sharma, M.D, an anesthesiologist who conducted the utilization review determined the drug was unnecessary and decertified it. As a result, Kirk was required to immediately cease taking the Klonopin. Typically, a person withdraws from Klonopin gradually by slowly reducing the dosage. Due to the sudden cessation of Klonopin, King suffered four seizures, resulting in additional physical injuries.
In September 2013 another request for Klonopin was made by the PTP. Ali, a psychiatrist, conducted a second utilization review and also determined Klonopin was medically unnecessary. Neither Sharma nor Ali examined Kirk in-person, and neither warned Kirk of the dangers of an abrupt withdrawal from Klonopin. Sharma and Ali were employees of CompPartners a Workers' Compensation utilization review company.
King then sued CompPartners, Inc. and Sharma for (1) professional negligence; (2) negligence; (3) intentional infliction of emotional distress; and (4) negligent infliction of emotional distress. Kirk's wife, Sara King, sued for loss of consortium. The trial court sustained defendants' demurrer without leave to amend. The Court of Appeal sustained the demurrer but reversed the denial of leave to amend.
CompPartners contended the Labor Code set forth a procedure for objecting to a utilization review decision, and that procedure preempted the Kings' complaint. The Kings contend the trial court erred in sustaining the demurrer because their causes of action are not preempted by the Workers Compensation Act.
The Court of Appeal said that "To the extent the Kings are faulting Sharma for not communicating a warning to Kirk, their claims are not preempted by the WCA because that warning would be beyond the "medical necessity" determination made by Sharma. To the extent the Kings are faulting Sharma for incorrectly deciding the medical necessity decision because Klonopin was medically necessary until Kirk was weaned, and thus a particular number of pills, e.g., 10, 20, should have been authorized for weaning, the Kings' claims are preempted by the WCA because the Kings are directly challenging Sharma's medical necessity determination."
The decision concluded that the trial court "should have granted the Kings leave to amend because it is possible... that, when more details are provided they could support a conclusion that, under the circumstances, the scope of Sharma's duty included some form of warning Kirk of or protecting Kirk from the risk of seizures."
The King case will be the workers' compensation high profile case until resolved by the California Supreme Court. The list of Amicus parties already includes many stakeholder organizations such as the California Workers' Compensation Institute, the California Chamber of Commerce, the California Applicant's Attorneys Association and more. Workers' compensation UR and IMR seems to be constantly under attack. The King case provided another opportunity to open the floodgates of litigation against employers, and vendors in the compensation echosphere. Read More...