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Murray v. State, Department of Labor & Industries

Court of Appeals of Washington, Division 2

October 24, 2017

MICHAEL E. MURRAY, Appellant,
v.
STATE OF WASHINGTON, DEPARTMENT OF LABOR & INDUSTRIES, Respondent.

          SUTTON, J.

         Michael E. Murray appeals the superior court's order granting the Department of Labor & Industries' (Department) motion for summary judgment affirming the Board of Industrial Insurance Appeals' (Board) decision to deny payment for his hip surgery. The Department's decision was based on the Health Technology Clinical Committee's (HTCC) decision concluding that Murray's proposed hip surgery was not a covered procedure under state health care law. Therefore, Murray was not entitled to an individualized inquiry as to whether the surgery was proper and necessary medical treatment. Murray argues that the delegation of authority to the HTCC is unconstitutional, thus, an HTCC decision cannot preclude review of an individualized inquiry into whether a specific medical treatment is proper and necessary. We hold that because there are appropriate procedural safeguards to control arbitrary action and prevent the abuse of discretionary power, the legislature's delegation of authority to the HTCC is constitutional.

         Murray also argues that we should overrule our holding in Joy v. Department of Labor and Industries.[1] He also argues that his procedural and substantive due process rights were violated because he was denied a review of the HTCC decision. We decline to overrule our holding in Joy. And, we hold that Murray has no vested right protected by due process, therefore, his due process claim fails. Accordingly, we affirm the Board's order denying Murray's claim for hip surgery.

         FACTS

         In 2009, Murray injured his right hip at work. The Department allowed his claim. In 2013, Murray sought authorization for surgical treatment of Femoral Acetabular Impingement (FAI) resulting from a labral tear in his right hip. The Department denied Murray's claim because, in 2011, the HTCC determined that the surgical treatment was not a covered benefit.

         Murray appealed the Department's decision to the Board. The Department moved for summary judgment. The Board concluded that the HTCC's decision could not be overruled by the Board and affirmed the Department's decision. Murray appealed the Board's decision to the superior court.

         The Department moved for summary judgment before the superior court. Murray filed a cross motion for summary judgment. The superior court denied Murray's motion for summary judgment and granted the Department's motion for summary judgment. Murray appeals.

         ANALYSIS

         I. Legal Principles

         "RCW 51.52.110 and RCW 51.52.115 govern judicial review of matters arising under the Industrial Insurance Act." Stelter v. Dep't. of Labor & Indus., 147 Wn.2d 702, 707, 57 P.3d 248 (2002). "When a party appeals from a board decision, and the superior court grants summary judgment affirming that decision, the appellate court's inquiry is the same as that of the superior court." Stelter, 147 Wn.2d at 707. A summary judgment motion will be granted only if after viewing all the pleadings, affidavits, depositions, admissions and all reasonable inferences drawn therefrom in favor of the nonmoving party, it can be said that (1) there is no genuine issue of material fact, (2) all reasonable persons could reach but one conclusion, and (3) the moving party is entitled to judgment as a matter of law. Walston v. Boeing Co., 181 Wn.2d 391, 395, 334 P.3d 519(2014).

         Under the Industrial Insurance Act[2] (IIA), a worker is entitled to medical treatment for work related injuries. RCW 51.36.010. Once a worker establishes that he or she is entitled to compensation, "he or she shall receive proper and necessary medical and surgical services." RCW 51.36.010(2)(a).

         II. HTCC Statutes

         In 2006, the legislature created the HTCC. RCW 70.14.090. The HTCC is comprised of eleven members appointed by the Health Care Authority (HCA) administrator. RCW 70.14.090. The eleven members of the HTCC are practicing physicians and licensed health professionals who use health technology in their scope of practice. RCW 70.14.090. The HTCC reviews health technology to determine:

(a) The conditions, if any, under which the health technology will be included as a covered benefit in health care programs of participating agencies; and (b) if covered, the criteria which the participating agency administering the program must use to decide whether the technology is medically necessary, or proper and necessary treatment.

RCW 70.14.110(1). The HTCC is required to make its determinations "in an open and transparent process" considering "evidence regarding the safety, efficacy, and cost-effectiveness of the technology." RCW 70.14.110(2)(a). The HTCC is also required to provide an opportunity for public comment. RCW 70.14.110(2)(b); RCW 70.14.130. And although the HTCC is not an agency subject to the Administrative Procedure Act (APA), chapter 34.05 RCW, it is subject to the Open Public Meetings Act of 1971, chapter 42.30 RCW. RCW 70.14.090(4), (5).

         All participating agencies under the HCA, including the Department, are required to comply with the HTCC s determinations. RCW 70.14.120. "A health technology not included as a covered benefit. . . shall not be subject to a determination in the case of an individual patient as to whether it is medically necessary, or proper and necessary treatment." RCW 70.14.120(3). However, RCW 70.14.120(4) provides:

Nothing in [this chapter] diminishes an individual's right under existing law to appeal an action or decision of a participating agency regarding a ...

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