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Saylor v. Appalachian Regional Hospital

United States District Court, E.D. Kentucky, Southern Division, London

September 29, 2017

PATSY SAYLOR, Plaintiff,
v.
APPALACHIAN REGIONAL HOSPITAL, Defendant.

          MEMORANDUM OPINION & ORDER

          GREGORY F. VAN TATENHOVE, UNITED STATES DISTRICT JUDGE

         Patsy Saylor is challenging the denial of long-term disability benefits by Appalachian Regional Hospital (ARH) under an employee pension plan governed by the Employee Retirement Income Security Act of 1974 (ERISA). As explained below, Judgment will be entered in favor of ARH.

         I

         A

         Appalachian Regional Hospital (ARH) owes Sawyer a fiduciary duty when it comes to administering the ARH Pension Plan. The question here is whether that duty has been violated. The parties agree that the pension plan and its administration by ARH's Pension Committee is governed by the Employee Retirement Income Security Act of 1974, 29 U.S.C. §§ 1001. [R. 11-1 at 1, R. 12-1 at 2.]

         Saylor began working for ARH in Harlan, Kentucky on May 15th, 1978, and remained an employee, most recently as a Respiratory Therapist, until February 11, 2015. [R. 1-1 at 3.] As part of her employment, Saylor became a member of the ARH Pension Plan (the Plan), which provides disability retirement benefits to eligible employees of ARH. [R. 8-1 at 25.]

         On January 28, 2015, Saylor suffered a non-work related injury when she fell off her front porch and injured her lower back. [R. 11-1 at 3.] Saylor first sought medical attention approximately a week after the fall form her primary care physician Lisa Bennet, PRN, on February 5, 2015. [R. 8-2 at 45.] Bennett diagnosed Saylor as having “lumbago, ” or pain in the muscles or joints of the low back [Id. at 46], and maintained the same diagnosis after two follow-up visits with Saylor, ultimately prescribing a back brace on February 20, 2015. [Id. at 55.] The medical records from these three visits indicate that Saylor was off work at the time and “[felt] like a hindrance to her co-worker.” [Id. at 52.]

         Thereafter, Saylor was referred to Dr. Yasser Nadim for further evaluation on February 25, 2015. [Id. at 98.] Dr. Nadim diagnosed Saylor as having a compression fracture of her lumbar vertebra. [Id. at 99.] Dr. Nadim's diagnosis and course of action remained the same through multiple visits in March and April, recommending “conservative management” and use of the back brace. [Id. at 90, 93, 96.] Significantly, at no point before his submission of the Disability Certification Form on August 19, 2015 [Id. at 13] did Dr. Nadim explicitly state that Saylor could not return to her job as a Respiratory Therapist. [See Id. at 85, 99.] After Saylor's final appointment with Dr. Nadim on April 29, 2015, she had no further interaction with him until August of 2015 when she requested he complete paperwork for her application for disability retirement benefits through ARH. [Id. at 13-16.]

         Saylor also visited Dr. Jamal S. Bazzi, an orthopedic surgeon, on May 14, 2015. [Id. at 56.] Dr. Bazzi confirmed the prior diagnosis of a fracture of her lumbar vertebra, and noted “[i]t is unusual for a vertebra compression fracture to have this protracted course and to cause this severe pain after 4 months of the injury.” [Id. at 58.] Dr. Bazzi prescribed a “jewett brace” for comfort and protection and advised Saylor to engage in limited aerobic activity and to only lift objects in a certain restricted manner. [Id.]

         Following her May 2015 visit with Dr. Bazzi, Saylor again followed up with her primary care physician, APRN Bennett, complaining of back pain and stating she “could barely move.” [Id. at 63.] About two months later, Saylor came back to Bennett with “complaints of severe back pain, ” at which point Bennett advised another MRI. [Id. at 65-66.] The MRI results were in keeping with previous diagnoses, finding that Saylor showed “[s]igns of diffuse lumbar disc disease” in addition to a “[h]ealing moderate superior endplate compression fracture” and mild bulging discs. [Id. at 43.] Ten days later, a follow up with Dr. Rogelio L. Uy, indicated apparent progress, with the report stating that “[s]he feels better” and was “in no distress.” [Id. at 67-68.]

         Nevertheless, in October 2015, Saylor made an emergency room visit where the attending physician, Patricia Coldiron, APRN, stated that “[p]atient cannot walk without assistance” and further that “[p]atient is able to walk but does so with difficulty due to back pain.” [Id. at 72.] After the ER visit, in two November visits with APRN Bennett, Saylor again complained of severe back pain and Bennett continued with her diagnosis of lumbago, counseling Saylor to maintain the current conservative management after Saylor was told by Neurosurgeon, Dr. Bean that she was not a candidate for surgery. [Id. at 80, 82.]

         ii

         In the course of Saylor receiving medical treatment and assessment, the Social Security Administration (SSA) found her to be disabled and awarded Social Security Disability benefits. [Id. at 102.] This occurred in May 2015. Several weeks later, Saylor filed a claim for disability retirement benefits available through the ARH Pension Plan. [Id. at 3.]

         Next, ARH received a completed Disability Certification Form from the Plaintiff's treating physician, Dr. Yasser Nadim, which indicated that Saylor was permanently disabled and could not perform her duties as a respiratory therapist. [R. 8-2 at 13.] Dr. Nadim's submission triggered further medical review of Saylor's disability claim by ARH.[1] [R. 11-1 at 3-4, R. 12-1 at 8-9.]

         After this review, Dr. Bart Olash, ARH's reviewing doctor, recommended that Saylor could continue her job without restrictions. [R. 8-2 at 19.] In keeping with the procedures set out in Section 6.04(d) of the Plan, independent medical review was undertaken after Dr. Olash's recommendation. [Id. at 7; see R. 8-1 at 42.] Dr. Gregory T. Snider, the independent physician who then gave the “third, final[, ] and binding exam, ” [R. 8-2 at 7] in November 2015, concluded that Saylor was employable with restrictions. [Id. at 23.] Dr. Snider stated:

Although Ms. Saylor has had a significant injury, her complaints seem considerably out of proportion to the pathology defined.… While I do not doubt that she would have difficulty performing the work of a respiratory therapist, it is my opinion that she is not totally disabled based on the ...

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