{ "id": 4362802, "name": "MARGARET M.M. TRACE, Worker-Appellee, v. UNIVERSITY OF NEW MEXICO HOSPITAL, Self-Insured, Employer/Insurer-Appellant", "name_abbreviation": "Trace v. University of New Mexico Hospital", "decision_date": "2015-05-28", "docket_number": "Docket No. 32,413", "first_page": "361", "last_page": "366", "citations": [ { "type": "official", "cite": "2015-NMCA-083" } ], "court": { "name_abbreviation": "N.M. Ct. App.", "id": 9025, "name": "Court of Appeals of New Mexico" }, "jurisdiction": { "id": 52, "name_long": "New Mexico", "name": "N.M." }, "cites_to": [ { "cite": "331 P.3d 992", "category": "reporters:state_regional", "reporter": "P.3d", "weight": 3, "pin_cites": [ { "parenthetical": "internal quotation marks and citation omitted" } ], "opinion_index": 0 }, { "cite": "2014-NMCA-082", "category": "reporters:neutral", "reporter": "NMCA", "case_ids": [ 4239941 ], "weight": 2, "pin_cites": [ { "page": "\u00b6 10" }, { "page": "\u00b6 9" } ], "opinion_index": 0, "case_paths": [ "/nm-app/6/0459-01" ] }, { "cite": "112 N.M. 354", "category": "reporters:state", "reporter": "N.M.", "case_ids": [ 720265 ], "weight": 2, "opinion_index": 0, "case_paths": [ "/nm/112/0354-01" ] }, { "cite": "1991-NMCA-068", "category": "reporters:neutral", "reporter": "NMCA", "pin_cites": [ { "page": "\u00b6 7" } ], "opinion_index": 0 } ], "analysis": { "cardinality": 697, "char_count": 13928, "ocr_confidence": 0.75, "pagerank": { "raw": 4.03580807328026e-08, "percentile": 0.1487760483333198 }, "sha256": "514c1cacaf85e26465774f3844eda700510c50507569b76b28063a686c189c50", "simhash": "1:ad806fedf8a9813a", "word_count": 2156 }, "last_updated": "2023-07-14T20:13:54.428467+00:00", "provenance": { "date_added": "2019-08-29", "source": "Harvard", "batch": "2018" }, "casebody": { "judges": [ "MICHAEL E. VIGIL, Chief Judge", "WE CONCUR:", "MICHAEL D. BUSTAMANTE, Judge", "J. MILES HANISEE, Judge" ], "parties": [ "MARGARET M.M. TRACE, Worker-Appellee, v. UNIVERSITY OF NEW MEXICO HOSPITAL, Self-Insured, Employer/Insurer-Appellant." ], "opinions": [ { "text": "OPINION\nVIGIL, Judge.\n{1} This is a workers\u2019 compensation case which presents us with a question of first impression: whether the appointment of a case manager for ongoing coordination of health care services by a workers\u2019 compensation judge (WC J) constitutes a \u201clitigation expense\u201d in connection with a proceeding before the Workers\u2019 Compensation Administration (WCA), thereby exempting the case manager\u2019s fee from the Procurement Code. We conclude that such services do not constitute a \u201clitigation expense\u201d and reverse the order of the WCJ to the contrary.\nI. BACKGROUND\n{2} Worker was a registered nurse, working the night shift at University of New Mexico Hospital when she injured her back while lifting and turning a patient on October 5, 1994. On September 1, 1995, Worker filed a claim with the WCA against University of New Mexico Hospital and its insurer, New Mexico Risk Management (collectively Employer). From the beginning the case was combative. There was disagreement regarding the compensable injuries, allegations that the employer unilaterally changed treating physicians, that Employer improperly refused payment for necessary medical services, that Employer\u2019s agent interfered with the doctorpatientrelationship, that medical services were unjustifiably curtailed or terminated, and that compensation benefits were improperly curtailed.\n{3} Trial was finally held on May 7-8, 1996, before WCJ Wiltgen, who entered a compensation order on June 3, 1996, concluding that as a direct and proximate result of the October 1994 accident, \u201cWorker suffered an injury to her low back with additional effects on her shoulder, elevated blood pressure and emotional overlay.\u201d WCJ Wiltgen further found that \u201cWorker\u2019s present condition and disability are permanent\u201d and that Worker had \u201ccontinuing need for medical care of her job-related injuries including psychological treatment.\u201d\n{4} Worker asserts that after entry of the compensation order, Employer\u2019s adjuster \u201ccontinued to deny various treatments and medications\u201d and that \u201cW orker had increasing pain; some symptoms related to the previous injuries, and other new symptoms.\u201d Worker asserts that there were disputes between Worker\u2019s attorney and Employer\u2019s adjuster and the nurse case manager, as well as a number of claims, for exacerbations or new injuries \u201cdue to the denial of care and medical bills,\u201d and complaints for a \u201cpattern of bad faith and unfair claims processing.\u201d Consequently, there were additional mediation conferences and hearings before the WCA, with the result that on October 27,1999, WCJ Wiltgen appointed Ms. St. Martin as \u201cindependent nurse case manager\u201d to \u201ccoordinate future medicals and treatment and act as nurse case manager.\u201d\n{5} Additional claims, responses, and motions followed, and issues remained unresolved. Following another mediation conference in December 2003, the parties agreed that Ms. St. Martin would pick a physician to conduct an independent medical examination. Following the independent medical examination and Ms. St. Martin\u2019s review, she determined that an independent medical panel should be convened. WC J Wiltgen retired, and the case was reassigned to WCJ Griego in January 2004.\n{6} Worker filed an amended complaint on April27,2004. Following additional hearings, discovery, and the independent medical panel review, a final hearing on the April 27, 2004 amended complaint was set. The final compensation order, filed on February 22, 2006, determined that Worker suffered multiple injuries as a result of the 1994 accident, and that medical treatment, treatment modalities, and alternative therapies \u201cmay be necessary in the future,\u201d which \u201cwill be authorized in collaboration with the treating physician and nurse case manager.\u201d The compensation order further ordered that \u201cMs. ... St. Martin shall continue to act as the court ordered nurse case manager concerning [Worker\u2019s] work related injuries[.]\u201d\n{7} In 2012, Employer moved that Ms. St. Martin be discontinued from serving as the court-appointed nurse case manager because her employer\u2019s contract with the WCA had expired, and Employer asserted, her continued appointment violated the Procurement Code. WCJ Griego denied the motion, on the basis that the Procurement Code \u201cdoes not apply to Administrative/Court Ordered Decrees.\u201d Employer moved for reconsideration, and at the hearing WCJ Griego expressed his understanding that because Ms. St. Martin\u2019s appointment was court ordered, it qualified as a litigation exemption under the Procurement Code. WCJ Griego therefore denied the motion in a memorandum opinion reasoning:\nServices can be directed to be paid by Risk Management under the Workers\u2019 Compensation Act to providers who have not entered into a contract with State Risk Management under the procurement code. For example, professional services to a worker from an attorney or a physician can be ordered paid by court order. It is not necessary for those services to be provided under a contractunder the procurement code.\nThere is no question that the procurement code would be applicable if State of New Mexico were voluntarily providing services without intervention of the administration. However, the distinguishing characteristic here is that the services being provided are by direction by court order and not being voluntarily provided by Risk Management.\nEmployer appeals.\nII. DISCUSSION\n{8} Employer makes two arguments on appeal: First, the WCA has a statutorily and administratively created system of case management and a WCJ cannot unilaterally order case management by circumventing the system. Second, the WCJ\u2019s order exceeds the W CJ\u2019s authority and violates the Procurement Code because the code requires a contract for professional services.\n{9} In response, Worker argues that Employer did not preserve the issues on appeal. Worker reasons that Employer has complied with Ms. St. Martin being the court-appointed case manager for fifteen years without incident, and this appeal is the first time Appellants have raised the issue. Worker also argues that the WCJ\u2019s order falls within the Procurement Code\u2019s litigation exemption.\n{10} We first address Worker\u2019s preservation concerns, then we examine the WCA and the Procurement Code.\nA. Preservation\n{11} \u201cTo preserve a question for review it must appear that a ruling or decision by the [tribunal] was fairly invoked[.]\u201d Rule 12-216(A) NMRA. The principal purpose of this rule is to alert the trial judge to the claimed error, giving the trial court an opportunity to correct the matter. Madrid v. Roybal, 1991-NMCA-068, \u00b6 7, 112 N.M. 354, 815 P.2d 650. Worker argues that Employer failed to invoke a ruling by the WCJ in order to preserve its argument on appeal. We disagree.\n{12} Followingthe initial August 29,2012 order, Employer made a motion to reconsider the order continuing St. Martin as the nurse case manager. In its motion, Employer asserted that the appointment of St. Martin without a contract violates the Procurement Code. WCJ Griego then held a hearing to address the controversy of St. Martin\u2019s status as the nurse case manager. All parties had the opportunity to address their concerns at the hearing. After hearing Employer\u2019s argument again that the August 29, 2012 order violates the Procurement Code, WCJ Griego disagreed and reaffirmed his ruling.\n{13} We therefore conclude that Employer alerted the W CJ to the asserted error it now argues on appeal and that the issue was properly preserved for appellate review.\nB. Standard of Review\n{14} Our review requires us to examine the Workers\u2019 Compensation Act, NMSA 1978, \u00a7\u00a7 52-1-1 to -70 (1929, as amended through 2013), NMSA 1978, \u00a7 52-4-3 (1990), regarding case management for health care services, and NMSA 1978, \u00a7 13-1-30 (2005) and NMSA 1978, \u00a7 13-1-98 (2013), of the Procurement Code. \u201cWe apply de novo review to interpret the meaning of a statute.\u201d Jones v. Holiday Inn Express, 2014-NMCA-082, \u00b6 10, 331 P.3d 992. \u201cWhen engaging in statutory construction, our primary concern is to determine and give effect to legislative intent.\u201d Id. (internal quotation marks and citation omitted). \u201cIn discerning the Legislature\u2019s intent, we are aided by classic canons of statutory construction, and we look first to the plain language of the statute, giving the words their ordinary meaning, unless the Legislature indicates a different one was intended.\u201d Faber v. King, 2015-NMSC-_, \u00b6 9, __ P.3d __ (Nos. 34,204 and 34,194, Mar. 12, 2015) (alteration, internal quotation marks, and citation omitted). We also consider the statute\u2019s function in the comprehensive legislative scheme. Id.\nC. Workers Compensation Act\n{15} The Act requires the WCA to establish a \u201ccase management\u201d system providing for \u201cthe ongoing coordination of health care services provided to an injured or disabled worker}.]\u201d Section 52-4-3(A)-(B). Thus, in providing ongoing coordination of health care services, case managers may be used for developing a treatment plan, monitoring the treatment, and the injured worker\u2019s progress, determining whether other health services are appropriate and cost-effective, and formulating a plan for the injured worker to return to work. Section 52-4-3(B).\n{16} Further, the Act directs that the W CA \u201cshall contract with an independent organization\u201d to assist with the administration of the case management system. Section 52-4-3(C). The administrative rules of the WCA define a \u201ccontractor\u201d as \u201cany organization that has a legal services agreement currently in effect with the [WCA] for the provision of utilization review or case management}.]\u201d 11,4.7.7(L) NMAC (12/31/2011). When case management is required, \u201cThe WCA will assign cases to its contractor for case management, as provided by the contract in effect.\u201d 11.4.7.14(G)(1)(a) NMAC (01/14/2005) and when the WCA refers a case to a case manager, \u201cthe W CA shall pay for the case management services pursuant to the contract.\u201d 11.4.7.14(G)(l)(e)(i) NMAC (01/14/2005).\n{17} The plain language of the statute demonstrates that the Legislature intended the case manager to be a contractor with a contract in effect. The administrative rules implement this intent by creating a framework requiring case managers to be contractors who are paid as provided in the contract. In this case, the contract with Ms. St. Martin\u2019s employer expired. We now turn to whether WCJ Griego could order that Ms. St. Martin continue as Worker\u2019s case manager in the absence of a contract under the Procurement Code.\nD. Procurement Code\n{18} The Procurement Code applies to all expenditures by state agencies for the procurement of goods and services from private entities, unless the Procurement Code itself provides otherwise. Section 13-1-30. Here, the WCA requires a contract for case management services and the Procurement Code requires a contract for any services, unless otherwise provided. The only exception which the Worker asks us to consider, and the only exception relied on by WC J Griego is the litigation exemption under Section 13-1-98(R). This provision of the Procurement Code exempts:\ncontracts and expenditures for legal subscription and research services and litigation expenses in connection with proceedings before administrative agencies or state or federal courts, including experts, mediators, court reporters, process servers and witness fees, but not including attorney contracts[.]\u201d\nSection 13-1 -98(R).\n{19} We are therefore asked to conclude that the fee of a case manager, responsible for the ongoing coordination of health care services provided to an injured or disabled worker, constitutes a litigation expense in connection with a WCA proceeding because the case manager is appointed by a WCJ. We decline the invitation on the basis that the services provided by a case manager under the WCA are not incurred \u201cin connection with\u201d litigation. Rather, such fees are incurred following a determination that a worker is injured or disabled and entitled to benefits under the W CA, and ongoing coordination of the healthcare services is required. Stated another way, while a case manager\u2019s fee may be the consequence of litigation, such fees are not an expense of litigation.\n{20} In this case, Ms. St. Martin has served as Worker\u2019s case manager since 1999, and she has acquired substantial knowledge about Worker\u2019s case, her issues, and her medical history. Continuing her services seems to be the most efficient means for coordinating Worker\u2019s future care. In addition, we note that since Ms. St. Martin became involved as Worker\u2019s case manager, the disputes between Worker, Employer, Employer\u2019s insurance adjusters, and Worker\u2019s medical providers seem to have significantly resolved. This may very well be the reason why WCJ Griego wished that her services continue. These are all excellent reasons for seeking an amendment to the appropriate statutes. However, that is not our prerogative. Nor can a WCJ exceed his statutory authority. See Jones, 2014-NMCA-082, \u00b6 9 (stating that workers\u2019 compensation courts are tribunals of limited and special jurisdiction and have only such authority as has been conferred on them by statute).\n{21} For the foregoing reasons, we reverse the WCJ\u2019s order appointing Ms. St. Martin to continue as Worker\u2019s case manager.\nCONCLUSION\n{22} The order of the WCJ is reversed.\n{23} IT IS SO ORDERED.\nMICHAEL E. VIGIL, Chief Judge\nWE CONCUR:\nMICHAEL D. BUSTAMANTE, Judge\nJ. MILES HANISEE, Judge\n11.4.7.14 NMAC was amended in 2013. We apply the administrative mies that were in effect when the order was entered in 2012.", "type": "majority", "author": "VIGIL, Judge." } ], "attorneys": [ "Margaret M. McNamara Trace", "Albuquerque, NM", "Pro Se Appellee", "Paul L. Civerolo, LLC", "Paul L. Civerolo", "Albuquerque, NM", "for Appellant" ], "corrections": "", "head_matter": "IN THE COURT OF APPEALS OF THE STATE OF NEW MEXICO\nOpinion Number: 2015-NMCA-083\nFiling Date: May 28, 2015\nDocket No. 32,413\nMARGARET M.M. TRACE, Worker-Appellee, v. UNIVERSITY OF NEW MEXICO HOSPITAL, Self-Insured, Employer/Insurer-Appellant.\nMargaret M. McNamara Trace\nAlbuquerque, NM\nPro Se Appellee\nPaul L. Civerolo, LLC\nPaul L. Civerolo\nAlbuquerque, NM\nfor Appellant" }, "file_name": "0361-01", "first_page_order": 377, "last_page_order": 382 }