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IN THE COURT OF APPEALS OF IOWA No. 8-835 / 08-0222 Filed October 29, 2008

PELLA CORPORATION, Petitioner-Appellant, vs. MARY JANE FRANKS, Respondent-Appellee. ________________________________________________________________

Appeal from the Iowa District Court for Polk County, Carla T. Schemmel, Judge.

Employer appeals from the district courts ruling on its petition for judicial review affirming the workers compensation commissioners award of mental health treatment benefits to employee. AFFIRMED.

David L. Jenkins of Bradshaw, Fowler, Proctor & Fairgrave, P.C., Des Moines, for appellant. Dennis L. Hanssen and Wendy D. Boka of Hopkins & Huebner, P.C., Des Moines, for appellee.

Considered by Huitink, P.J., and Vaitheswaran and Potterfield, JJ.

2 HUITINK, P.J. Pella Corporation (Pella) appeals from the district courts ruling on its petition for judicial review affirming the workers compensation commissioners award of mental health treatment benefits to Mary Jane Franks. Pella complains Franks mental condition is not causally relate d to an injury to her fingers and therefore it should not be held responsible for treatment. Pella also argues that even if it is properly obligated to provide mental health treatment, the agency erred in concluding treatment should continue with providers chosen by Franks. We affirm. I. Background Facts and Proceedings. Franks sustained a work-

related injury to her right hand on January 25, 2000, while employed by Pella. Four fingers of Franks right hand were cut when her hand was pulled into machinery and pinched between rollers of the machine and the glass of the window on which she had been working. The cuts required several sutures and resulted in permanent restrictions. On March 11, 2002, Dr. Kip Burkman evaluated Franks and his "Impressions of Findings Caused By 1-25-00 Work Injury" included "development of multiple right finger contractures . . . [s]econdary effect of right shoulder pain . . . [s]econdary depression." Following the January 2000 injury, Franks was no longer able to use her right hand, but doctors could find no physiological reason for the condition. A deputy workers compensation commissioner

determined Franks sustained a fifty percent disability to her right hand and awarded permanent partial benefits.

3 In July 2004 Franks filed a petition for medical benefits seeking to have her ongoing psychological care paid for by Pella. Pella denied responsibility for any work-related injury involving a mental or psychological component. A

hearing was scheduled before a deputy commissioner to determine whether Franks was "entitled to additional medical care in the form of psychiatric and psychological care to treat an alleged work related mental or psychological condition." Franks sought a continuance of the hearing in order to obtain deposition testimony of her treating psychiatrist, which she had been unable to obtain earlier due to scheduling conflicts. The hearing proceeded as scheduled, and the

deputy allowed additional time after the hearing for the parties to submit "additional expert testimony . . . needed by both sides." At the hearing held on April 19, 2005, Franks testified about her hand injury, the "loss" of her hand, and her subsequent feelings of depression, including thoughts of suicide. She testified she had experienced depression

since the injury and that she had "tried to manage it" on her own until March 2003 when she "couldnt take it anymore." She testified she told Dr. Alan Jensen she was extremely depressed and he prescribed antidepressants. (Alan Jensen,

M.D., was the doctor to whom she had been referred for treatment in the form of pain management. Apparently, neither Franks nor Pella was aware that Dr.

Jensen was a psychiatrist, as well as physician.) She testifie d Pella "fired Dr. Jensen" and referred her to Dr. Jay G. Shaaf. She testified at the time of hearing she was receiving mental health treatment from Dr. Michael Egger, M.D., and

4 Susan Narducci, M.S., which she found helpful. She also testified she was

contemplating the amputation of her index finger on her right hand. Exhibits submitted to the deputy include notes from Dr. David Clough, who treated Franks for her hand injury. Dr. Clough referred Franks to Dr. Jensen for pain management. Dr. Jensens notes of March 3, 2003, indicate that Franks brought up the fact that she is totally depressed . . . she sees her situation as hopeless and helpless. . . . At this point, I believe that she has developed a mood disorder, secondary to her general medical condition or an adjustment reaction with mixed emotional features. I believe that she is off of work completely due to the depression that is related to her Workers Compensation -related injury. A letter dated April 11, 2003, from Pellas insurer to Dr. Jensen stated: It is my understanding that this patient was referred to you for pain complaints to her hand, which was injured at work on 1/25/00. It is our position that she was not referred to you for orthopedic treatment of the shoulder, nor was she referred to you for treatment of depression. Please be advised that we will not authorize any more treatment for depression or the shoulder. .... We would ask that you confine your activities to the condition for which the referral was made. Dr. Jensen continued to treat Franks for the next five months and then referred her to Dr. Schaaf. Pella authorized Dr. Schaaf to treat Franks for pain, but not for depression. Dr. Schaaf continued to treat Franks for depression, but Franks was required to pay for her Zoloft prescription, an anti-depressant medication. On April 16, 2003, Pella sent Franks for evaluation by Dr. Bruce Gutnik, a psychiatrist. Dr. Gutniks report summarizes his opinion: Ms. Franks has an Anxiety Disorder NOS [not otherwise specified] that includes some symptoms of depression and a history of phobias. At the present time she has either a Conversion Disorder or is Malingering his [sic] physical symptoms, and in either case these are not a result of the injury per se, but rather, unconscious

5 or conscious secondary gain. Since Ms. Franks physical symptoms are in my opinion not caused by a physical injury, it follows that her Anxiety Disorder NOS is also not related to the physical injury. In my opinion, with a reasonable degree of medical certainty Ms. Franks suffers from no psychiatric or psychological symptoms directly related to her physical injury. By letter dated July 3, 2003, Dr. Jensen provided Franks with the following medical opinions: 1. The last time I saw Mary Franks was on 6/20/03. The history that she had given me was that she had improved with the Zoloft, Seroquel, Bextra and Lasix. However she still has issues surrounding her ability to work and felt that she had been discarded by Pella Windows. She still had depressive features of a sleep disturbance, decreased interest in her activities, a degree of hopelessness and helplessness regarding her present situation after hand injury at Pella Windows, a decreased energy level, some degree of impairment of memory and concentration . . . . My diagnosis at this time was depression secondary to a general medical condition related to her hand. . . . 2. I believe that Ms. Franks depressive features are directly causally related to the work related injury that she sustained at Pella Windows in January 25, 2000. Referring to the proper definition outlined in your letter, a work related injury is a substantial factor in bringing about the change in her mood and her inability to adjust to her present circumstances after her injury. 3. I would recommend that Mary continue with the Zoloft . . . I would like to have her see a vocational counselor for a two-fold purpose. I would like to see her get help in obtaining employment for which she will be capable within the context of her injury. In addition, I would like her to see a counsel who would be able to deal with the psychotherapeutic issues of adjustment reaction with mixed emotional features. . . . . I believe that if Ms. Franks psychiatric symptoms are addressed in the above manner she will have an optimal outcome. However, I believe that if she does not have significant intervention at the time that she may become permanently totally disabled from a psychiatric basis. I believe that the further investment by the workers compensation carrier are minimal compared to what has already been invested, and both the carrier and Ms. Franks will reap maximum medical benefit from a timely intervention as outlined above.

6 Dr. Egger, practicing psychiatry with Alegent Health Psychiatry

Associates, first examined Franks on March 10, 2004. He diagnosed Franks with a major depressive disorder, status post right hand injury with contracture. Dr. Egger recommended drug therapy and psychotherapy. Franks began seeing Susan Narducci, an associate at Alegent Health for cognitive therapy. Also submitted was deposition testimony of Dr. Gutnik, taken on March 23, 2005 prior to the workers compensation benefits hearing. Dr. Gutniks deposition testimony includes the following exchanges: Q. It seemed like there was some conflict then as to the information she gave you as to when these various signs or symptoms began. Did you ever resolve the conflict? A. The best I could resolve it was the notion that shes given me a history suggestive to me of the correct diagnosis of anxiety disorder not otherwise specified, which entails not only anxiety symptoms, but signs of depression when stressed. And she had a history of several depressive episodes when stressed, and it appears to me that thats where her depression came from. So its all part of an ongoing long-term kind of problem. I got the impression that she

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