DECISION AND ORDER

___ (Climant) challenges the decision of an Independent Review Organization (IRO) denying her request to preauthorize surgery for a AdeQuervain’s release to relieve symptoms related to carpal tunnel syndrome on her right hand. The Claimant’s employer, Fort Worth Independent School District (the Carrier) is self insured under the workers= compensation system and denied the claim as medically unnecessary. The IRO upheld that decision. This decision finds that the requested procedure should not be preauthorized.

I. JURISDICTION, NOTICE, AND PROCEDURAL HISTORY

Administrative Law Judge (ALJ) Kerry D. Sullivan held the hearing on this matter on May 25, 2004. The Claimant represented herself, with the assistance of Commission Ombudsman Juan Mireles. The Carrier was represented by William E. Weldon. Proper notice of the hearing was provided as set out in the findings of fact and conclusions of law. The record closed on May 25, 2004.

II. BASIS FOR DECISION

A. The Evidence

The documentary record in this proceeding consists of several hundred pages of medical records. In addition, the Claimant testified on her own behalf with the assistance of a certified language interpreter. Neither side presented live expert testimony.

On ___, the Claimant, who was a cook with the Fort Worth Independent School District, suffered a compensable injury to her right forearm, wrist, and hand when her arm was crushed between a mixer and a bowl. The Claimant was initially treated with conservative care. On March 14, 2003, she underwent a carpal tunnel release and decompression of deQuervain’s tenosynovitis^[1] symptoms on her right hand, after which she underwent additional extensive conservative care. Since her injury, the Claimant has had significant amounts of chiropractic care, physical therapy, pain medications, and underwent an unsuccessful work hardening program.

ccording to the Claimant, the surgical procedure proved unsuccessful. She reports being in more pain now than she was in before the operation. Her chiropractor has now referred her to another hand surgeon, Walter D. Gracia, M.D. Dr. Gracia examined the Claimant and found her symptomatic for de DeQuervain disease. According to Dr. Gracia’s correspondence, AIt is possible there is a second compartment within the first compartment for the abductor pollicis longus or extensor pollicis brevis exists (sic) that was not released by the first surgery. . . . Dr. Gracia also observed that a recent arthrogram revealed a Atear of the triangular fibrocartilage. Because of a Astrongly positive Finkelstein test, he believed, however, that the deQuervain disease was the primary problem, and that it would be resolved by the requested release.^[2]

The Crrier disagrees, as did the IRO. The IRO doctor stated it was unlikely the first surgeon would have missed another compartment available to be released because the first surgeon’s operating report indicates he Aactually lifted the tendons out of the grooves. . . .^[3] Additionally, James A. Scott, M.D., the Commission’s designated doctor, reported that he was not optimistic that further surgical intervention would be beneficial, and he reported that his own physical findings of the patient were not nearly as suggestive of deQuervain’s disease as were Doctor Gracia=s. In his view, it was Aspeculative that the requested procedure would provide relief.^[4]

B. Analysis

The Claimant is plainly in a difficult situation. She has suffered a significant work related injury that has kept her from returning to employment for nearly two years. And although the Ombudsman provided her appropriate assistance during the hearing, the Claimant was unable to present any witnesses to explain the perceived need for the repeat operation.

Ultimately, the ALJ finds that the Claimant has not proven the medical necessity of the requested deQuervain’s release. Because the first operation did not provide even temporary relief, either the deQuervain’s release was not the problem or it was not performed properly. Through the Ombudsman, the Claimant argues that the first operation was, in fact, not done correctly. But there is no direct evidence to support that assertion. No party could point to anything in the medical documentation to indicate an error. To the contrary, the notes indicate the surgeon manipulated the tendons adequately to spot any compartment requiring release. Additionally, the designated doctor who examined the Claimant and reviewed the surgeon’s report described the surgical intervention as Aappropriate.^[5] Along this same line, the IRO decision observes that the Claimant had only Amild neural dysfunction prior to surgery and even less afterwards.^[6]

The pparent basis for Dr. Gracia’s suspicion of ongoing deQuervain’s disease is the Astrongly positive Finkelstein’s test. But the designated doctor found only moderate Finkelstein signs. Neither the degree of certainty to be attributed to this test nor the impact of fluctuating test results are explained in the record. Under these circumstances, and in light of the other documentation discussed above, the ALJ finds that these test results do not establish the need for a repeat deQuervain’s release operation. Accordingly, the petition is denied.

III. FINDINGS OF FACT

1. On ___, (the Claimant) suffered a compensable injury to her to her right forearm, wrist, and hand as a result of an accident at her employment.
2. At the time of the Claimant’s injury, her employer, Fort Worth Independent School District (the Carrier), was self-insured for workers= compensation insurance coverage.
3. The Climant requests preauthorization for a repeat AdeQuervain’s release surgical procedure to relieve symptoms related to carpal tunnel syndrome on her right hand.
4. The Carrier denied the request for preauthorization.
5. The Claimant requested medical dispute resolution at the Texas Workers= Compensation Commission, which referred the matter to an Independent Review Organization (IRO).
6. The IRO found that the requested operation was not medically necessary.
7. The Claimant timely requested a hearing before the State Office of Administrative Hearings (SOAH).
8. Notice of the SOAH hearing was sent to the parties on April 28, 2004. The notice informed the parties of the date, time, and location of the hearing, a statement of the matters to be considered, the legal authority under which the hearing would be held, and the statutory provisions applicable to the matters to be considered.
9. The SOAH hearing convened and closed on May 25, 2004. The Claimant and the Carrier appeared and participated in the hearing.
10. On March 14, 2003, the Claimant underwent a carpal tunnel release and decompression of deQuervain’s tenosynovitis symptoms on her right hand.
11. During the March 14, 2003 operation, the surgeon manipulated the tendons adequately to spot any compartment requiring release.
12. The March 14, 2003 operation provided no relief to the Claimant.
13. There has been no showing that a repeat of the deQuervain’s procedure would be beneficial.

IV. CONCLUSIONS OF LAW

1. The Commission has jurisdiction over this matter pursuant to Section 413.031 of the Texas Workers’ Compensation Act (the Act), Tex. Lab. Code Ann. ch. 401 et seq.
2. SOAH has jurisdiction over this proceeding, including the authority to issue a decision and order, pursuant to Tex. Lab. Code Ann. ‘ 413.031(d) and Tex. Gov=t Code Ann. ch. 2003.
3. Adequate and timely notice of the hearing was provided in accordance with Tex. Gov=t Code Ann. ”2001.051 and 2001.052.
4. As the Petitioner, the Claimant has the burden of proof in this matter. 28 Tex. Admin. Code ‘148.21(h).
5. The Claimant failed to establish that the requested deQuervain’s release was medically necessary.
6. The requested preauthorization for repeat deQuervain’s release should be denied.

ORDER

IT IS ORDERED thatthe request submitted by ___ for preauthorization of deQuervain’s release surgery is denied.

Signed this 2nd day of July, 2004.

KERRY D. SULLIVAN
Administrative Law Judge
STATE OFFICE OF ADMINISTRATIVE HEARINGS

1. DeQuervin’s tenosynovitis is defined as Ainflammation of the tendons of the first dorsal compartment of the wrist, which includes the abductor pollicis longus and extensor pollicis brevis; diagnosed by a single provocative test (Finkelstein test). Stedman’s Medical Dictionary (27th ed. 2000).↑
2. Petitioner Ex. 1, p. 64.↑
3. Carrier Ex. 1, p. 68.↑
4. Carrier Ex. 3, p. 5.↑
5. Petitioner Ex. 1, p. 61.↑
6. Carrier Ex. 1, p. 9.↑