MWCC NO: 97 09148-G-1496
ONEIDA SIMS CLAIMANT
vs.
WACKENHUT CORRECTIONS CORPORATION
EMPLOYER
AND
THE INSURANCE COMPANY OF THE STATE OF PENNSYLVANIA
CARRIER
REPRESENTING CLAIMANT:
Honorable Charles Baglan, Attorney at Law, Batesville, Mississippi
REPRESENTING DEFENDANT:
Honorable Kenneth Giles Perry, Attorney at Law, Jackson, Mississippi
The Commission heard the above styled cause on November 20, 2000, in the offices of the Mississippi Workers' Compensation Commission, Jackson, Mississippi on the Employer/Carrier's "Petition for Review" by the Full Commission.
Having heard the arguments offered on behalf of the parties and having thoroughly studied the record and the applicable law, the Commission affirms the "Order of Administrative Judge" dated July 24, 2000.
SO ORDERED, this the 20th day of November, 2000.
MISSISSIPPI WORKERS' COMPENSATION COMMISSION
BY: BARRETT SMITH
BARNEY SCHOBY
ATTEST:
Joann McDonald, Secretary
___________________________
ONEIDA SIMS CLAIMANT
vs.
WACKENHUT CORRECTIONS CORPORATION
EMPLOYER
AND
THE INS. CO. OF THE STATE OF PENNSYLVANIA
CARRIER
REPRESENTING THE CLAIMANT:
Charles Baglan, Attorney at Law, P. O. Box 1289,
Batesville, Mississippi 38606
REPRESENTING THE EMPLOYER-CARRIER:
Kenneth Perry, Attorney at Law, P. O. Box 157,
Jackson, Mississippi 39205-0157
On June 16, 1997, claimant was assaulted by inmates
during a prison riot in the course of her employment as an assistant supervisor
for Wackenhut Corrections Corporation. The employer and carrier paid claimant
medical benefits and temporary total disability benefits until she reached
maximum medical improvement on February 2, 1999. The only issue to be resolved
is the extent of permanent disability attributable to her injury.
1 . Claimant's average weekly wage on June 16, 1997, was $375.00.
2. Claimant reached maximum medical improvement
on February 2, 1999.
The only issue is the existence and extent of
permanent disability attributable to claimant's work-connected injury on
June 16, 1997.
Claimant is a 46-year-old resident of Oxford, Mississippi. She graduated from high school and entered the military. During her ten-year stint in the U. S. Army, she received three different certificates of completion in supply and communication, data communication, and recruitment. She left the military to enter junior college where she took courses in sociology and cosmetology. She was worked as a teacher's aide at North Mississippi Retardation Center for one year during this time. She later worked as a child care director at a domestic violence center and as a deputy sheriff/jailer for the Lafayette County Sheriff's Office from 1987 to 1996.
In April 1996, claimant was hired by Wackenhut Corrections Corporation as an assistant supervisor for the Marshall County Detention Center, a minimum security prison for minimum violent offenders. Claimant testified she accepted employment with Wackenhut Corrections Corporation because it offered her better opportunities for advancement, training and benefits. She testified her goal was to remain in law enforcement and ultimately join an undercover unit.
As assistant supervisor of the Marshall County Detention Center, claimant was in charge of security for twenty-two to twenty-eight officers. She was also in charge of the housing, feeding, movement and medical care of approximately one thousand inmates. Claimant testified that she loved her work and that she was a good employee. The officers who were not assigned to her team wanted to work with her because she was fair and firm with both inmates and officers. Although scheduled to work twelve-hour shifts, she generally worked sixteen to eighteen hours a day.
On June 16, 1997, claimant was contacted at home at 4:00 a.m. and advised that a riot was under way at the prison. She immediately reported to work. During a debriefing session, she heard on the radio that a fellow officer was down. She took seven officers with her to assist the downed officer. She was unarmed. During the rescue attempt, she observed the inmates surrounding one of her male officers. She pulled her radio to call for help as her fellow officers fled, leaving her locked in with the inmates. She testified she next recalls her hospitalization at the Marshall County Hospital. She also testified that she did not know "what happened to me," but she suffered a broken nose, a puncture wound to her nose, an injury to her right eye, a broken jaw bone, and other injuries to her mouth, right arm, left leg and head. Her injuries required multiple surgeries and extensive dental work.
Claimant testified that one of her doctors referred her to psychiatrist Dr. Jan Goff in Tupelo. Dr. Goff treated her for post-traumatic stress disorder from August 1997 to February 1999. He prescribed anti-depressants and referred her to Betty Brown, a licensed practical counselor, for therapy. Claimant testified she needed psychiatric treatment because she did not trust anyone, had sleep disorders, and did not want to leave her home: "The things that happened to me shouldn't have happened to me . . . I needed some help to overcome it." In April 1998, she saw Dr. Joel Reisman, a psychiatrist referred by the employer and carrier. She testified that talking about the incident to medical providers also upset her and made it hard to sleep.
At the evidentiary hearing, claimant testified that she is still employed by Wackenhut Corrections Corporation, although she has not tried to return to work for the employer since Dr. Goff released her in February 1999. She testified she cannot drive in the direction of the building, that she does not know what she can do now because she is afraid to trust people, and that she would have a hard time working in an office because she does not like being in a closed or locked room. She also testified she is afraid to leave her home because "this may happen again."
However claimant testified that she wanted to work because she did not want to sit at home: "That's not me, I've worked all my life." Since October 1999, she has earned $45.00 a week baby-sitting her seven-year-old nephew. In April 1999, she applied for work with a Juvenile Detention Center in Louisiana although she did not feel she could work there due to the possibility of a recurrence. She testified that she did not think she could return to work in any prison environment, but she "had to try" in order to overcome her problems and reach her goals. Claimant was not offered employment at the Juvenile Detention Center. Claimant also applied for a clerical position with Jeffcoat Construction Company, but she was not offered employment.
In October and November 1999, she applied for work with the Oxford Police Department. She asked Captain Pettis for a position as a patrol officer although she was not sure she could work in an atmosphere involving criminals. Captain Pettis told her that a meter maid job may be available, and that such a position would allow her to work alone outside an office environment.
Claimant testified she had also met with Vocational Rehabilitation several times per Dr. Goff's recommendation. Vocational Rehabilitation will provide her with counseling, job placement and training services, but they have not made any referrals pending receipt of Dr. Goff's records. She last met with Vocational Rehabilitation in October 1999. She also applied for a job with Personal Finance in October 1999. She had also looked for work through the Shelby County Employment Office in Memphis. Claimant testified that she wanted to work with the government but needed to work alone instead of with a crowd.
Claimant testified that her current routine is to stay in her bedroom most of the time. She does not go to restaurants or grocery stores. She shops in small convenience stores and frequents the drive-thru lanes of fast food restaurants. She testified that before the injury she was a strong person who was dependable and who could do things for people. Now, "everybody knows what happened to me and stares at me." She also testified that she currently takes Prozac as prescribed by Dr. Goff.
On cross-examination, claimant testified that she had good people management skills and good people skills before the injury, "but that's all been taken away from me." She also testified that she had seen a medical doctor only once -- in November 1999 -- since Dr. Goff released her in February 1999, and that the physicians who had treated her for her physical injuries had released her. She also testified that she had been to the Tunica casinos with friends or family once or twice for enjoyment, that she sometimes played the slots, but that she did not go to any nightclubs.
Claimant also testified on cross-examination that on or about August 25, 1999, she met with Connie Chapin, the employer's vocational expert, and Morris Selby, claimant's vocational expert in her attorney's office. Claimant was not aware until the week before the evidentiary hearing that Chapin had located thirty-eight jobs in the Oxford area. Claimant testified she had not applied for these jobs because she did not have a list identifying the prospective employers and because she did not know of their existence until the week before the hearing.
Connie Chapin, the employer's vocational rehabilitation counselor, testified she met with claimant and claimant's vocational expert in claimant's counsel's office. She was not allowed to interview claimant outside the presence of the claimant's vocational expert or claimant's counsel. Chapin later performed a job survey in Oxford and Batesville on September 15, 1999. She identified thirty current job openings. Six other employers advised they were accepting applications because they had openings in the near future. On September 21, 1999, Chapin wrote Dr. Goff (with a copy to claimant's counsel) regarding claimant's capacity to perform these jobs. She testified that Dr. Goff approved the jobs, and that this information was supplied to claimant's counsel by letter on November 1, 1999. Chapin also testified that her follow-up with the prospective employers indicated that claimant had applied for work with only one employer.
On cross-examination, Chapin testified that she understood that claimant was unable to work around prisoners. Chapin noted that her August 27, 1999 report states that claimant related being very mistrustful and uncomfortable around other people. She admitted that claimant could not perform any of the jobs that she had identified if claimant's statement were true. She also admitted that she had no evidence that claimant's statements were not true. She further admitted that she did not tell any of the prospective employers that claimant had PTSD because she was not performing job placement services for claimant. Her only goal was to perform a job survey.
Chapin also testified that, when conducting her job survey, she did not consider Morris Selby's vocational tests which indicated claimant had a seventh grade reading level and a fourth grade math level. She admitted that, compared to claimant's wages with the employer, claimant would earn $11,500 less per year as a teacher's assistant in the Oxford School District, $11,000 less per year as a typist for the University of Mississippi, $10,788 less per year as a teacher's assistant at the Oxford University School, $ 7,100 less per year as a food service employee, at least $6000 less per year as a hotel desk clerk, and $4000 less per year as a secretary for the North Mississippi Regional Center.
Chapin testified that although claimant had an excellent work record before the injury, prospective employers may have many reasons not to hire a former worker's compensation claimant, including increased insurance costs and the possibility that PTSD may erupt in the middle of a work day.
William Morris Selby, a vocational expert for the claimant, testified that he met with Connie Chapin, the employer's vocational expert, to perform a vocational assessment of claimant. He interviewed claimant and reviewed her medical records. He also administered achievement tests which indicated she performed at a seventh grade reading level and a fourth grade math level. He concluded that, considering her college training, claimant was underachieving on the tests due to "her mental status on the date she took the tests." He recalled that she was tearful throughout the interview. She also complained of pain and headaches, both of which may have impaired her ability to concentrate.
Selby also assessed claimant's transferable skills and identified jobs she could obtain with those skills. He concluded that claimant was unemployable because of her inability to function around people or groups of people and her feelings of depression. In support of his conclusion that claimant was unemployable pending further treatment, he cited the June 15, 1998 evaluation of Dr. Joel Reisman, a psychiatrist retained by the employer and carrier. Dr. Reisman concluded that claimant had not reached maximum medical improvement and would need further therapy. Selby concurred with Reisman's recommendation for further medical and psychiatric care. He concluded that claimant could be made employable with long-term treatment.
Selby also conducted a labor market survey of the jobs identified by Connie Chapin for claimant. He admitted that most of the jobs identified by Chapin were available. However he testified that, because employers do not update the service when positions are filled, it is not unusual for jobs listed with the state employment service to have been filled for three or four months. He also testified that applicants for jobs as teacher's assistants are required to take an examination which is given only in June and December. He found that there were no openings at Oxford University School for a teacher's assistant or at North Mississippi Regional Center for a secretary. He noted that several of the hotels listed by Chapin had changed their names since her job search was performed. Selby also testified that he did not think Dr. Goff had enough information regarding the jobs identified by Chapin to assess claimant's capacity for reemployment.
The records of psychiatrist Dr. Reisman shows he issued a narrative report dated June 15, 1998 regarding his evaluation of claimant at the employer/carrier's request. He diagnosed claimant with PTSD and depression attributable to her work-connected injury. He noted that she was then taking Prozac which may have been somewhat helpful, but she was being seen by her psychiatrist only every three months. He also noted that the supportive psychotherapy claimant was receiving had not been beneficial to date. He recommended more appropriate therapy and "much more aggressive psychiatric follow-up with consideration of medication to help [claimant] sleep." Dr. Reisman also supported Dr. Goff's referral to vocational rehabilitation as a "way of helping a patient refocus her thinking and begin to move toward normalization of her life." He noted claimant would need help from a therapist "to go through this undertaking." He concluded that she was not at maximum medical improvement, and that she could not be expected to reach maximum medical improvement until "at least six to nine months of treatment." Anticipating she would make progress within the next year, he declined to assess a permanent impairment rating at that time.
Psychiatrist Dr. Jan Goff testified by deposition on June 4, 1999 that he first saw claimant on August 18, 1997. She was referred by Dr. John F. Laurenzo for anxiety and depression attributable to having been beaten during a prison riot. She complained of insomnia and of nightmares about being kicked. She avoided people and was very suspicious. She slept with the door open and had recurrent memories and anxieties about the riot. She also complained of excessive appetite, crying spells, and drinking much more heavily than usual. Dr. Goff diagnosed PTSD, rule out alcohol abuse, complicated by worker's compensation problems. He diagnosed an anti-anxiety/anti-depressant medication and recommended counseling.
On August 25, 1997, Dr. Goff switched claimant's anti-anxiety/anti-depressant medication from Paxil to Serzone. On September 19, 1997, claimant reported she had seen a counselor and was better. She continued to have a depressed affect and complained of insomnia, nightmares, fearfulness and shakiness. Dr. Goff increased her dosage of Serzone. He also noted that, unlike those who work with military personnel, he was not an expert on PTSD.
On February 3, 1998, claimant reported that she had stopped the medications in January because it was slowing her down. She also reported that she was socially withdrawn and irritable with family members. She was more comfortable when alone and sometimes sat in her home for two or three consecutive days. She had a depressed affect. Dr. Goff again switched her anti-depressant/anti-anxiety drug. He diagnosed residual depression at a dysthymic level, "chronic but not terribly intense." He also noted that medication was not as helpful as it would have been with major depression.
On May 5, 1998, claimant reported she had done well until April 22 when she saw the psychiatrist referred by the employer and carrier and had to recall the details of her work-connected injury. She had been sleeping in the living room and reported being scared, angry and distrustful. Dr. Goff diagnosed an angry affect although claimant remained organized and coherent with no psychosis. He noted she could not work around inmates. He increased her Prozac and added another medication for sleep.
On August 3, 1998, Dr. Goff noted claimant still had irritable moods perhaps two times a week which sometimes lasted two to three days. Claimant reported trying to socialize but feeling like a stranger to others. She had a constricted affect. Dr. Goff increased claimant's Prozac and recommended she continue therapy and begin vocational rehabilitation.
When Dr. Goff last saw claimant on February 2, 1999, she reported getting nervous when she thought about past events. She still felt anxious and distrustful. She was angry about the reevaluation requested by the employer and carrier. Dr. Goff noted that the lack of resolution of the worker's compensation litigation was prolonging her complaints and symptoms. Claimant had stopped the Prozac because she felt it was a social stigma. Dr. Goff commented that continuing therapy may be counterproductive. He also noted that claimant's exam, except for irritability, was unremarkable.
Dr. Goff concluded that claimant had reached maximum medical improvement as far as he was concerned, and he referred her to vocational rehabilitation for therapy. He also recommended she again begin Prozac. His final diagnosis was residual symptoms of PTSD, chronic, as it had persisted more than six months. He noted that PTSD can go on for years, and that there was no evidence that claimant was malingering. He doubted claimant could return to work in the penal system. He did not think it was unreasonable for her to attempt to perform a clerical position, to work as a typist, or to oversee people. However he noted that employment in a setting that reminded her of her former injury might "stir things up and cause her problems."
The records of Betty Brown, an outpatient counselor at the Behavioral Health Center of the North Mississippi Medical Center, are marked Exhibit 5. They concern Brown's treatment of claimant between October 1997 and May 1998.
Dr. Judith A. Lyons, a clinical psychologist currently employed by the VA Medical Center in Jackson, Mississippi, conducted an independent medical examination at the request of this Administrative Judge on March 2, 2000. Dr. Lyons' report dated March 21, 2000 states that she has expertise with Post-traumatic Disorder secondary to work place violence and other forms of trauma. The evaluation which included psychological testing was conducted from 8:15 to 11:30 a.m. Dr. Lyons' report recites a detailed history of claimant's family and medical background.
Claimant told Dr. Lyons that she was beaten unconscious by inmates during a prison riot on June 16, 1997. She did not know how long she was beaten or what else might have been done to her before the staff were able to gain access to the area and rescue her. Dr. Lyons noted that claimant's accounting of the event and her subsequent mistrust centered on her co-workers having abandoned her. She experienced intrusive images shortly after the injury, but these were ultimately replaced by bitter ruminations of having been left behind and self-conscious, somewhat paranoid ruminations that people were staring and talking about her. Dr. Lyons also noted that claimant's body image was significantly impaired. She perceived that she was grossly disfigured in a way that was apparent to others although Dr. Lyons was unable to detect the deformity that claimant described.
Dr. Lyons noted that although claimant's medical records showed that she was prescribed Prozac in 1995 to treat depression after the loss of her mother, she adamantly denied any history of counseling or psychotropic medication until after her injury at work. In August 1997, claimant began treatment with Dr. Goff who prescribed anti-depressant and anti-anxiety medication. Dr. Goff referred her to a licensed practical counselor with whom she had ten sessions from October 1997 to May 1998. The employer and carrier referred her to psychiatrist Dr. Joel Reisman whom she saw once in April 1998. Dr. Lyons concurred with Dr. Reisman's conclusion that claimant had received primarily supportive treatment which was minimally beneficial and not the most appropriate method of treatment for someone with PTSD. She concluded that essentially there had been no treatment for the past year, and that Dr. Reisman's statement in 1998 that there had been no treatment "specifically aimed at decreasing anxiety and avoidance of the work situation" was still true.1
Dr. Lyons also found that claimant's refusal to take her medication had complicated her recovery. Claimant told Dr. Lyons that she had stopped taking her medication regularly before February 1999 because her family called her "crazy" for taking psychiatric drugs. Claimant still had some medication left, and she occasionally took a single dose of Prozac when she was feeling particularly bad. She denied that she had never been told that the drug would be effective only if a steady drug level were maintained.
During Dr. Lyons' mental status evaluation of claimant, she noted that claimant appeared highly motivated to find help and return to her pre-injury level of social functioning. However she became defensive and briefly irritable when asked about her pre-injury Prozac prescription and when encouraged to think that a return to the work force was possible. Claimant also reported anxiety when she discussed the possibility of engaging in feared behavior (being in a locked area or being in a crowded area for an extended period). She identified her inability to trust as her primary symptom, although this was not a problem "before she was left stranded during the attack at work." She was particularly troubled by not knowing what happened during the attack. She also remained preoccupied with her appearance, saw herself as deformed, and believed that people were staring at her eyes and nose.
Dr. Lyons administered the Personality Assessment Inventory (PAI) during her evaluation of claimant. She concluded that claimant's clinical scores on the test were either an exaggerated representation of pathology that was present but in a milder degree than the profile scores would suggest or they were an inaccurate pattern due the deliberate distortion and fabrication of pathology that was not actually present.2 She concluded that, assuming the presence of actual pathology that was merely exaggerated but not entirely fabricated, the test profile could be interpreted to indicate that claimant was voicing a desperate cry for help and expressing high treatment motivation. However she also concluded that an extremely low degree of interpersonal warmth, limited empathy, and limited insightfulness were apt to impede claimant's active participation in treatment. Dr. Lyons further concluded that claimant's test results were consistent with post-traurnatic disorder.
She diagnosed claimant as having residual symptoms of PTSD, her depression having resolved. She also diagnosed a personality disorder, not otherwise specified, with features of borderline, paranoid, and schizotypal response styles apparent. Again, Dr. Lyons concluded that claimant's level of functioning had not changed significantly since she last saw Dr. Reisman in April 1998.
She recommended claimant undergo vocational rehabilitation to identify new career opportunities consistent with her skills, interests, and needs for accommodation. Although claimant was quite rigid that law enforcement was her desired career, Dr. Lyons concluded that claimant would never be able to tolerate a career that required prolonged time in an inescapable space or in which there was a relatively high probability of being assaulted/threatened with violence. Dr. Lyons stated that "working in a prison and working undercover law enforcement are impractical goals" due to claimant's injury. For the same reason, she did not recommend employment as a flight attendant, bank teller, or toll/gas station booth attendant.
Dr. Lyons also recommended group psychotherapy with other trauma survivors. She noted that participation in such a group (26 sessions a year for 1 to 2 years) in conjunction with vocational rehabilitation would enable claimant to return to the work force and to an active recreational life. She also recommended participation in a group focusing on coping skills training (26 sessions over 6-12 months) and individual exposure-based therapy consistent with Dr. Reisman's previous recommendation.
Dr. Lyons also made specific recommendations regarding claimant's need for accommodations. She stated that claimant should "be assigned to a work environment that would allow her to leave the area briefly on short notice if she felt too confined." She also stated that "[t]his is likely to be a life-long need." Dr. Lyons further recommended an environment where a minimal number of people were moving around claimant or in which the movement was limited to the direction that she would be facing. This would allow claimant the reassurance of being able to monitor potential threats. Dr. Lyons stated that this accommodation was likely to be needed only until claimant gained confidence in public settings, at which point it would no longer be necessary.
In assessing the severity of claimant's condition, Dr. Lyons relied on the American Medical Association's Guides to the Evaluation of Permanent Impairment, 4th edition (1993). She stated that claimant currently has no impairment regarding activities of daily living or task completion (concentration, persistence and pace), although claimant has moderate/marked impairment regarding her social functioning. Regarding claimant's adaptation (potential for deterioration in work-like setting), claimant currently has a moderate impairment with the recommended accommodations and extreme impairment without the recommended accommodations.3
Dr. Lyons also assessed the severity of claimant's condition after completion of recommended treatments and with recommended accommodations. In that instance, claimant would have a mild impairment of her social functioning and a mild impairment of her adaptation (potential for deterioration in work-like setting).
In her summary, Dr. Lyons concluded that claimant's
overemphasis of her actual impairment may be due to characterological negativity
and not to deliberate malingering. She noted that the only difficulty likely
to be permanent would occur in situations that closely recreated the trauma
situation. Claimant would then experience extreme distress and impaired
functioning until she could escape the situation. However, Dr. Lyons concluded
that this would not constitute a full "disorder" and was unlikely to impair
work functioning if claimant received appropriate treatment and consistently
complied with the treatment protocol. Dr. Lyons also concluded that, "[t]he
more time that goes by without appropriate treatment and active follow-through
on treatment recommendations, the more entrenched Ms. Sims avoidance, mistrust
and self-consciousness will become."
1. Claimant has established by clear and convincing evidence that she has a permanent mental impairment attributable to her work-connected injury on June 16, 1997. Dr. Jan Goff, the psychiatrist who treated claimant from August 1997 to February 1999; Dr. Joel Reisman, the psychiatrist who conducted an employer medical examination in April 1998; and Dr. Judy Lyons, the clinical psychologist who conducted the independent medical examination in March 2000, all diagnosed claimant with PTSD attributable to her work-connected injury on June 16, 1997.
The parties stipulated that claimant reached maximum medical recovery from this condition on February 2, 1999 per Dr. Goff. On that date, Dr. Goff noted that claimant had residual symptoms of PTSD which could persist for years, that she had a permanent psychiatric impairment with no evidence of malingering, that she should resume Prozac, and that she should seek vocational rehabilitation as she could not return to work in the penal system.
As noted above, Dr. Reisman also diagnosed claimant with PTSD and depression in April 1998 attributable to the work-connected injury. He concluded that claimant had not reached maximum medical improvement pending (1) more appropriate therapy, (2) "much more aggressive psychiatric follow-up with consideration of medication to help her sleep," and (3) vocational rehabilitation as a "way of helping a patient refocus her thinking and begin to move toward normalization of her life."
Also as noted above, Dr. Lyons on March 2, 2000 found that claimant's level of functioning had not changed significantly since she saw Dr. Reisman in April 1998. Per the American Medical Association's Guides to the Evaluation of Permanent Impairment, 4th edition (1993), Dr. Lyons found that claimant has a moderate/marked impairment of her social functioning. Even more significantly, her adaptation impairment (potential for deterioration in a work-like setting) is moderate with recommended accommodations and extreme without recommended accommodations. Recommended accommodations included (1) the likely life long need for a work environment that would allow her to leave the area briefly on short notice if she felt too confined, and, (2) until she gains confidence in public settings, a work environment where a minimal number of people are moving around her or in which movement is limited to the direction she would be facing. Dr. Lyons specifically stated that claimant could not tolerate a career that required prolonged time in an inescapable space or in which there was a relatively high probability of being assaulted/threatened with violence.
In evaluating the evidence of claimant's permanent medical impairment, this Administrative Judge notes that claimant has no history of a pre-existing mental impairment or of any other stressors, past or present, aside from the stressors of her mother's death in 1995 and the litigation of her worker's compensation claim. However, as indicated by her nomination for "employee of the year" in January 1997 (Exhibit 2), she does have a distinguished history as a law enforcement officer who was dedicated to her profession.
In so holding, this Administrative Judge also overrules all objections on which rulings were reserved during the evidentiary hearing.
2. Claimant's permanent medical impairment resulted in a loss of wage-earning capacity. Claimant has not worked or been employed since the date of injury except as a babysitter for her nephew earning $45.00 a week. She has made several efforts to return to work, but her efforts unfortunately appear compromised by her current impairment (for example, applying for law enforcement positions in pursuit of this now unrealistic goal). Although Connie Chapin, the employer's vocational expert, testified that claimant is employable, she admitted that claimant would be unemployable if, as indicated by claimant's undisputed testimony, she was very mistrustful and uncomfortable around people. She also admitted that several of the jobs she identified for claimant would result in at least a 50% loss of wage earning capacity, assuming claimant were able to obtain and maintain employment. Morris Selby, claimant's vocational expert, testified that, pending further treatment, claimant was unemployable considering her current level of psychological functioning.
Dr. Lyons, in her two-sentence summary regarding claimant's permanent mental impairment, stated that claimant's only likely permanent impairment would be in situations very closely recreating the trauma situation. However the detailed findings contained in her report consistently reiterate that claimant has PTSD, that her disorder has not changed since she saw Dr. Reisman in April 1998 because she has not received the appropriate treatment for her disorder, that she will require intensive group and individual therapy for one to two years, that she will also require significant, life-long accommodations because of her disorder, that she is impaired socially and occupationally even with the recommended accommodations, and that claimant's "avoidance, mistrust and self-consciousness" will become more entrenched as time that goes by without the appropriate treatment and active follow-through on treatment recommendations.
Considering (1) the nature of claimant's impairment as detailed in Dr. Lyons' report dated March 21, 2000; (2) the duration of her impairment and lack of progress for the last two years; (3) the severity of her impairment according to the Guides to the Evaluation of Permanent Impairment 4th edition (1993); (4) the accommodations recommended by Dr. Lyons to allow claimant to return to work; (5) claimant's need for vocational rehabilitation and both group and individual therapy on a regular basis for one to two years; (6) the findings of Dr. Reisman and Dr. Goff which corroborate claimant's diagnosis of PTSD; (7) claimant's inability to resume her career as a law enforcement officer; (8) her reasonable efforts to secure other employment; (9) the opinions of both vocational experts regarding her unemployability as noted above; and (10) claimant's credible testimony and distinguished work history as a veteran and career law enforcement officer; among other industrially related factors including her age, education, and geographic location, this Administrative Judge finds that she is permanently totally disabled as a result of the work-connected injury.
3. Claimant is entitled to permanent total disability benefits at the rate of $250.00 per week for 450 weeks beginning June 16, 1997, with proper credit for compensation paid by the employer and carrier during this period.
4. Claimant is entitled to all medical services and supplies required by the nature of her injury and the process of recovery as provided in Section 71-3-15 and the Medical Fee Schedule, including the treatment recommended by Drs. Lyons, Reisman and Goff.
5. Claimant is entitled to a 10% penalty on any untimely paid installments of compensation pursuant to Section 71-3-37(5).
IT IS THEREFORE ORDERED that employer and carrier pay compensation benefits to claimant as follows:
1. permanent total disability benefits at the rate of $250.00 per week for 450 weeks beginning June 16, 1997, with proper credit for compensation paid by the employer and carrier during this period;
2. all medical services and supplies required by the nature of her injury and the process of recovery as provided in Section 71-3-15 and the Medical Fee Schedule, including the treatment recommended by Drs. Lyons, Reisman and Goff; and
3. a 10% penalty on any untimely paid installments of compensation pursuant to Section 71-3-37(5).
SO ORDERED this the 24th day of July, 2000.
DENEISE TURNER LOTT
ADMINISTRATIVE JUDGE
ATTEST:
Joann McDonald, Secretary
___________________________
1. Dr. Lyons stated that few clinicians have the specialized expertise to conduct individual exposure-based therapy, and that some clinicians such as Dr. Goff steer clients away from processing memories of the trauma because they do not know that this is the recognized standard of care. Dr. Lyons also stated that Betty Brown's information sheet indicated that she incorporated extremely diluted elements of this treatment, such that, "again, it appears Ms. Sims may have received mixed or nonhelpful messages."
2. It is interesting to note that claimant's perceptions of her physical condition were also compromised by her mental impairment: she misperceived that she was grossly disfigured in a way that was apparent to others.
3. Dr. Lyons noted that the Guides define moderate impairment as compatible with some, but not all, useful functioning. Marked impairment is defined as an impairment level that significantly impedes useful functioning. Extreme impairment is defined as an impairment level that precludes useful functioning.