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HomeMy WebLinkAbout96-05075 'l ~ ~. .. ..:! ~ ~ '1 ) ...: ~ ~ ...... ~ ! '~ f ),. .... '" "::t ~-~;~\;. ~\ . " \ :. \ -",,-,,~ 0;, "."-,,, - which is not the result of his Ilwn negligence. he is nllt responsihle if her makes a mistake in judgment in getting out. e\'en if it wlluld ha\e been beller ifhe had time tll deliberate. Lewis \'. Mellor. 259 Pa. Super, 509. 526. 393 A.2d 1)..1 (19781. Troutman \" Tahh. 285 (la. Super, 353. 360.427 A,2d 673 (1981 I, Rosatav, Nationwide Insurance Co.. 263 Pa, Super, 3..0. 3.... n.1. 397 A.2d 1238 (19791. 21. ia that negligence may not be implied because of a failure to act so as to a\'oid a gerous situatilln arising so suddenly and unex~'Ctedly that there was no opportunity to a hend the situation and tll act according to the exigency. When onc sition of danger which is nllt the result of his ncgligcncc. he is not responsible i e makcs a mistake in judgmcnt in attempting to get out of it. An honest exereise nt is all that is requif\-d of him. even if he could ha\'e done better had he had timc to .berate. l.iuzzo v. McKav. 396 Pa, 183. IS::! A.2d ::!65 (19591. Unanl.!st \'. Whitehouse. 235 Pa. Superior Ct. "58. 344 A.2d 695 (19751. 2::!. The defendant claims that the plaintiff was contributory negligent. Contributory negligence is negligencc on the part of a plaintilT that is a suhstantial factor in hringing about the plaintiffs injury, The bunko is not on the plainlilTto pro\'c her fm.-dom fnl/tl contributor)' negligence, The defendant has the burdt:n of prm'ing contributory Ih.'glil,'l:nce by a fair preponderance of the cmIible e\'idmx. You must detennine \\hethcr the dcfcndant has pro\C1l that the plaintiff. under all the circumstances present. faik-d to exercise reasonable care for his own protection: The defendant C\mtentls that p1aintitl' lkmadine Ckprer faikd to exen:ise re:uonabIe cart for her ll\\ n !!oilli.'t} in the t~'" t\f ber \ rlIkk If) oulintl b) a \'f\-rofItlcrancC' of the e\ ~~ tMt rtaintiO. ('~ laikd to C'..ercise ~>NbI.: care in hecli~ \\aminis about the 1\ ; J /~ / .,/" ../ .-- -n. be. "",l~/n Ih c/'<';lI~tU I'o~. 71e .AU,,~o:I 'Iotl!l;. j)/r;"Ht:~ A~~tI(-' ~.,h ~u not /II--.I'w, c:: <1tJ:-Iy 0/''''' a c1~ljI('1t. ~ t:7h .,4'~abz all '1 e;>..I" (11/ /,(JS;;tI~ a C (u,....e..Cc.+- / ho",~~r t"~"'l.>k. I.oc~''', lisT-, >42 PA. /'-( I I ,,5 A. '2cI 1171. (I "S). . .1. 11.( AU",-e" (''In,. Z>/J;....,,~ A'to<<!' Iluk ~,.r" 0-1 ell"ly ,. r yo'" I.'NO' -IJ~~ ~ IS ~c~ ~d CaccSCl' ~ del ~ ...,t. k ""'4"'" ..,Ie.r?'P/ ~Ifj S" C Ill".'" -/'1 ~ fed , ew c1~~"~ ;" a/',--,....,..c-e ~ ~ r~Al',....."'/ j?Joenk#t-fd,.;wr ~J HQ'T Jt~.lu~ /~ *- .,r,,.~ iJt ~~. ~ do"" 1\ / ,,/ FiS'~ .. 6HJr"ell, :IN. P., SW'I'#r, S,,~, .,1.3 A.~d I O'lz. ( l"U'3), 1>Ak. ; 9 /1 '7/~ {(eS,~ t ff." "'1 s ,,'-'..:Me", ~;:?~/,,-I - ,,-;;> . ~....1 {I.. ~ I J,,1.,....~ J fl~. (He 'h~... Wlc~~"'f~ ..~. l?"4llttl ~ (tf.J. 12/1 AJ. fV.....t N'~ po 'Nt ~:rn ~")"-t, P..... 1"'7/10- ($3.. A J+w"''fl 4 O..~...~-.A-, -2- PLAINTIFFS' POINT FOR CHARGE NO, 2 In civil cases such as this one, the plaintiff has the burden of proving those contentions which entitle her to relief. When a party has the burden of proof on a particular issue, her contention on that issue must be established by a fair preponderance of the evidence. The evidence establishes a contention by a fair preponderance of the evidence if you are persuaded that it is more probably accurate and true than not. To put it another way. think, if you will. of an ordinary balance scale, with a pan on each side. Onto one side of the scale, place all of the evidence favorable to the plaintiff; onto the other. place all of the evidence favorable to the defendant. If. after considering the comparable weight of the evidence you feel that the scales tip, ever so slightly or to the slightest degree. in favor of the plaintiff, your verdict must be for the plaintiff. If the scales tip in favor of the defendant, or are equally balanced. your verdict must be for the defendant. In this case. Mrs. Clepper has the burden of proving that Mr. Nelson was negligent and that his negligence was a substantial factor in bringing about the accident. If. after considering all of the evidence. you feel persuaded that these propositions are more probably true than not true, your verdict must be for Mrs. Clepper. Pa. SSJI Otherwise, your verdict J tClv. tIS. J 8.,de. of should be for the Defendant. Proof. ~ PLAINTIFFS' POINT FOR CHARGE NO.6 The law provides that an operator of a motor vehicle must travel at a speed that is consistent with existing road conditions. Thus, the operator of a motor vehicle traveling in adverse weather conditions must travel at a speed that will permit him to control his vehicle. Smith v. Brooks, 394 Pa. Super 327, 575 A.2d 926 (1990), ~ ali2. 75 Pa.C.S.A. 53361. . PLAINTIFFS' POINT FOR CHARGE NO. 14 Under Pennsylvania law, Mrs. Clepper may recover non-economic loss damages (pain and suffering) in this case if she can show by the greater weight of the evidence: (11 Mr. Nelson was negligent in one or more ways as I described to you in my instructions. (2) Mr. Nelson's negligence was a substantial factor in bringing about Mrs. Clepper's injury. (31 Mrs. Clepper's injury resulted in non-economic damages. (41 Mrs. Clepper suffered a serious .: U l impairment of a body function. To decide this last and additional element of proof, you must decide, based upon the evidence, (11 Whether the injuries sustained by Mrs. Clepper in the accident injured or impaired one or more body functions. (21 Whether that injury or impairment of a body function was serious. In determining whether the injury or impairment of a body function was serious, you should consider such factors as the extent of the impairment, the particular body function impaired, the length of time the impairment lasted, the treatment required to correct the impairment, and any other relevant factors. An impair1'l\ent need not be peI1lloJ.nent to be serious. The terms"serious' . i"r'. "irnpair1'l\ent." and "body function" have no special or technical meaning ir.. the law and should be considered by you in the ordinary sense of their cOllllllOn usage. Pa, SSJI IClv.1 56.020 and 1~ Pa.C.S,A. 51704. . , PLAINTIFFS' POINT FOR CHARGE NO. 30 In calculating the amount of Mrs. Clepper's loss of future earning capacity, you must include the entire amount without any attempt to reduce the amount to its present value. Raczkowski v. Bolubasz, 491 Pa. 561, 421 A.2d 1027 (1980). . 1 2 NAME 3 BRUCE GOODMAN, M.D. . BY: MR. LUTZ 5 BY: MR. HILDABRAND 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 ...~,. 25 2 WITNESSES DIRECT CROSS 3 16 3 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 BRUCE GOODMAN, M.D., called as a witness, being duly sworn, testified as follows: DIRECT EXAMINATION BY MR. LUTZ: Q For the record, would you please state your name? A Bruce Goodman, Q Your profession? A I am a physician, medical doctor, Q I understand you are an orthopedic physician? A Yes, Q How long have you been an orthopedic surgeon, doctor? A I finished my training in 1960, and have been in Harrisburg since 1960, Q Would you please summarize for the jury your educational background and your training? A I am a graduate of the Jefferson Medical College in Philadelphia. I interned at the Jefferson Medical College in Philadelphia and did a five year graduate prQ9ram. I spent a year as the chief resident in orthopedic surqsry at the State Hospital for crippled Children in Elilabethtown. I ca.. into Harriaburq in 1960 and vas on the staff at Elilabethtown as one of the clinic chiefs, and t 4 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 worked out of the Harrisburg Hospital, ultimately the Holy Spirit Hospital, and today I am on the staff of the Harrisburg Hospital, Polyclinic Hospital, Holy spirit Hospital and Rehab Hospital. I have confined my practice to orthopedic surgery, Q Over the years, have you come to treat people that have been involved in motor vehicle accident trauma? A Yes, MR. LUTZ: At this point, I am going to move to have Dr. Goodman admitted as an expert in orthopedic surgery and ask if there are any questions on qualifications? MR. HILDABRAND: I have no questions regarding the doctor'. qualifications. BY MR. LUTZ: Q Doctor, we're now going to direct our questions to the care and treatment that you provided to Hrs. Clepper. When did you first meet Hrs. Clepper? A Hrs. Clepper was originally evaluated by me on the 12th of Hay of this year. Q At that point in time, did you obtain a hi.tory fros her? A Q Ve., Did you also have sose medical records? 5 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 A I did. Q Could you tell us, generally speaking, what recorda that you had? A I had office notes from Dr. Douglas Sanderson, her attending physician for many years. Q And did you obtain a history directly from Mrs. Clepper? A Yea. Q Could you tell the jury what Mrs. Clepper told you had happened? A She told me that ahe sustained an injury subsequent to being impinged, that is caught, between a parked vehicle and a moving vehicle, And she was taken by ambulance to the Holy Spirit Hospital where she was admitted with a fractured pelvis aa well as some soft tissue injuries in the lower abdominal wall. That'a the part of the abdomen down near the pelvis. And she had been treated and evaluated by a general surgeon, an orthopedic surgeon and was .een by a neurological physician. Q Eventually, she was discharged? A Certainly. o And did she tell you what treat.ent that she received after being discharged? A She was s_n 1n .. very intenaive fash10n by her 6 1 orthopedic surgeon for a prolonged period of time as an 2 out-patient, 3 Q Doctor, did Mrs. Clepper give you any history 4 with regard to her employment status? 5 A Yes, 6 Q Could you tell us about that, please? 7 A She never went back to work performing any type 8 of work activities until about ten months after her injury, 9 which would bring it up to about october of 1995, and she 10 was working about eight hours of work a week. 11 Q After obtaining the history, did you then perform 12 a hands-on physical examination? 13 A Yes, I did. 14 Q And could you tell the jury the highlights of 15 your examination? 16 A Well, prior to doing the examination, I took a 17 history relative to her complaints so that I would know 18 exactly what to examine, and her complaints referred to 19 discomfort in the inguinal regions. 20 They're the regions that are coamonly called the 21 groin. 22 She also had soae uroloqical problem. because of 23 urinary incontinency; in other words, she would wet herself 24 either with sneezing or coughing or someti..s just before 25 she could qet to the bathrooa. . .- ~......- 7 1 They were her main complaints, And they both 2 related back to the state immediately after the accident. 3 My physical examination noted that she was able 4 to walk in a perfectly normal fashion, There was no 5 evidence of a limp, 6 She was capable of walking on her toes and heals, 7 all of this is significant because it suggests to me that 8 there is not a problem with the nerve roots in the lower 9 back. 10 She had a full range of motion both forward and 11 backwards, side to side and turning side to side in the low 12 back, although she had some discomfort at the extremes, 13 I examined her hips, and they were perfectly 14 normal. I found some tenderness when I palpated or pushed 15 in the inguinal areas. 16 And it was my impression according to what her 17 syaptoas were and her examination that this lady had what is 18 called. meralgia paresthetica, which would be an 19 affectation of so.e of the nerves that run under the 20 inguinal ligament and were obviously traumatized at the time 21 of her pelvis fracture. 22 I wasn't at all certain about her urinary 23 incontinence because that could have been caused fro. her 24 accident, so that t made arranq.ments for her to underqo a 25 uroloqical consultation. -.J 8 1 Q Did you subsequently find out from the urologist 2 that in his opinion it was not related to the accident? 3 A That is correct. She had a urinary tract 4 infection which for some reason or other had not been 5 treated, and it was treated and her symptoms subsided. 6 Q Now, doctor, with regard to your diagnosis, was 7 that for both of her legs? 8 A She had primarily -- she did have tenderness in 9 both areas, yes. 10 Q What was your treatment plan given your 11 diagnosis? 12 A Well, this is a tough diagnosis because it 13 depends entirely on what the patient tells you as well as 14 your findings to feelings, But it's nothing that you can 15 feel, but if you can produce pain by pushing over certain of 16 the nerves, that's abnormal and it represents some 17 sensitivity on behalf of the nerves. 18 So I thought that she should be seen by soaeone 19 like an anesthesiologist who could do two things. They 20 could do what we call a diagnostic and therapeutic block; in 21 other wor~, if the block -- if by putting any type of 22 novocaine In there took away her syaptoms, that would be 23 diagnostic because that would tell .., "ell, apparently 24 that's where her pain is coslng from. 25 And therapeutlc because you also put ao.. 9 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 2) 24 2~ steroids, some type of cortisone or the derivative in there to hope actually make the inflammation go away. o In fact, did Krs, Clepper undergo such a nerve block? A She did. o And was that at your direction? A It was at my consultation, She was seen by an anesthesiologist, Dr. Komin, o Did you receive a report from Dr. Komin as to what he did to Krs, Clepper? A I did, o Could you tell the jury in layman's terms what Dr, Komin did according to the records that you have in front of you? A Well, he examined her, and he too felt that she probably had clinical bilateral, bilateral means both sides, .eralgia paresthetica, that's just a long terminology for the particular nerves that have been effected and they were probably irritated as a result of her injury, Under fluoroscopic control, in other words, under the fluoroscope, so that he knows exactly Where he's putting this, he did put sose cane, Which is an anesthetic, in the are. and then use so.e steroid or sose sort cortisone derivative, And following the blo.:k. ahe did have decreaeed _,,_vl 11 1 about six weeks. 2 Q Doctor, before we get to that six week visit, do 3 you have a diagram here in your office that you could show 4 the jury, that you can better show the jury the injury we 5 are talking about? 6 A I have a diagram. Hopefully I can make it a 7 little clearer. S MR. LUTZ: Why don't we go off the record at this 9 point and we will ask Dr. Goodman to go up to the diagram, 10 (Pause off the record.) 11 THE WITNESS: This is a picture of an individual 12 obviously facing forward. And from the back, we're not 13 interested in this back view, we're interested in this 14 forward view. 15 This area denoted by this thick black line, 16 that's the inguinal area. That's the area of the groin, 17 And underneath and in this inguinal area there is a very 18 thick ligament called the inguinal ligament. 19 I-n-q-u-i-n-a-l. 20 And the inguinal ligament, in the area of the 21 pelvi8, these are the pelvic bones are under there too, but 22 under the inguinal ligament run so.. very vital structure8, 23 among them the feacral artery, and the feacral nerve, and 24 the feacral vein, This is the feacral artery or vein. 2S Obviously, if they're c~pr~i.ed, that'. . ___..0.._" ,J 1 serious matter. 2 They -- it was felt according to Dr, Sanderson's 3 original report that I reviewed that she had some type of 4 affectation to this nerve, 5 But I think at the time she also had an 6 affectation of this nerve, and this is the iliohypogastric 7 nerve. It's right under the skin, And it does produce an 8 entity called meralgia paresthetica. 9 I have seen meralgia paresthetica in the past, 10 for an example, in the service, This would not be an 11 infrequent finding in military policeman because they would 12 hang their revolvers over their inguinal area and walk all 13 day and constantly do this. (Indicating) And they would 14 come in with a meralgia paresthetica, 15 All I have to do is give them a shoulder holster 16 and their symptoms would go away, 17 I have seen it in people that carry tools in a 18 belt area with the same thing. Walking around all day and 19 as soon as they change, their proble.s go away. 20 It'. not an uncommon entity. It's not a total 21 cripplinq entity, but it's an annoyinq entity and it's a 22 competent producer of discoafort, 23 Q Thank you, doctor. 24 (Brief pause.) . 2S IY MR. LlIT11 12 ..__.J 13 1 Q Doctor, I think that you were about ready to 2 discuss the fact that you referred her or ordered her to 3 return to you in six weeks. 4 Did she in fact come back to you again? 5 A Yes, 6 Q And when did you next see her? 7 A She was seen by me on the 7th of July, 8 Q How was she doing? 9 A She had been working four hours during the week 10 and six hours on Saturday having some difficulty with 11 prolonged standing relative to having some discomfort in the 12 groin area, She denied any other type of discomfort, 13 Q Doctor, did you at that point discuss with her 14 returning to more work than what she had been doing? 15 A Yes. 16 Q What did you tell her? 17 A I told her to gradually increase her work 18 capacity depending on how she felt. This woman was 19 significantly deconditioned as a result of not working, plus 20 she's an obese lady, And I it's not that -- quite that 21 siaple to return to an eight hour day for anyone who has 22 been off work, for anyone Who's been off work as long a. she 2) ha. been. 24 Q Doctor, you earlier aentioned in the history you 2S obtained, she had fractured pelvis that went on to heal, to 14 1 your knowledge? 2 A Yes, a fractu~ed pelvis is really per se not of 3 much consequence, most of her symptoms were soft tissue, but 4 in order to break a bone, she did have a broken bone in the 5 pelvic area. Even though it was an undisplaced fracture, 6 there was no surgery to be done, the bone didn't move, the 7 bone was cracked, but in order to have that amount of 8 pressure to crack a bone, that's significant pressure in a 9 woman this size. 10 And in order for that to get down to the bone, 11 that has go through an awful lot of soft tissue, and that's 12 where hers primarily was. 13 Q Doctor, as I understand it the last time that you 14 saw her was July 7th, 1997? 15 A Yes. 16 Q What would your prognosis be for the bilateral 17 meralgia paresthetica? 18 A Well, I as not too sure she say not need further 19 treatment. This sight be treated succe.stully with another 20 couple of nerve block.. 21 I have also advised her to get an evaluation at 22 this ti.. by a neurosurCJeon, and I know a neurosurqeon I 23 think who is very con.ervative. 24 I think she should .ee soeebody that 1. not going 25 to ru.h right in and do anythinq because if in fact this is -..-..________~__..~_".~".._ ""l 15 1 her diagnosis, the only thing that could be done would be to 2 take away the discomfort for some numbness, And that could 3 be done either by surgically interrupting the nerve or by 4 sclerosing it, 5 This is sort of out of my field, and I think it 6 is remote, but it is a possibility, 7 It's just as possible another couple of nerve 8 blocks might help her and it might cure her problem, 9 Q Doctor, based on the history that you obtained, 10 your review of Dr. Sanderson's records, your care and 11 treatment, the diagnostic studies, do you have an opinion 12 with a reasonable degree of medical certainty whether Mrs. 13 Clepper's bilateral meralgia paresthetica is causally 14 related to the December 14, 1994 accident? 15 A Prior to answering that, permit me to say I have 16 also made arrangements for her to have a repeat 17 electrodiagnostic study by Dr. Samuels. 18 It's possible that she has Borne involvement of 19 the femoral nerve which he originally demonstrated. 20 There ia no question in my mind, and I certainly 21 can state with very reasonable degree of medical certainty 22 that her pre.ent problea, whatever the extent is, bears a 23 direct and causal relationship to her original trauma. a. 0 And. doctor, w~ had .entioned the loss of work. as Would that in your opinion also be ~elated to the acci~nt? J 16 1 A I saw this patient for the first time in May of 2 this year, and I am not comfortable commenting on her 3 ability to work prior to that time, 4 MR. LUTZ: Thank you, doctor, cross-examination. 5 CROSS-EXAMINATION 6 BY MR. HILDABRAND: 7 Q Dr. Goodman, as I understand it May of 1997 is S when you first saw Hrs, Clepper? 9 A Yes, it is, 10 Q And her the accident that we have discussed 11 was December of 1994, correct? 12 A That is correct. 13 Q So to a large extent you were given records from 14 her prior orthopedic physician, Dr. Sanderson, and asked to 15 look over those, is that correct? 16 A Well, more than to a large extent, that was the 17 total exposure that I had to her prior history. 18 Q Okay. Were you given the hospital record as 19 well? 20 A I don't recall whether I had the hospital record. 21 Q Now, as I understand it, the -- we have two 22 proble.. that she had as a result of this accident. We had 23 a fractured pubic raaus, nondisplaced, which went on to heal 24 without any probl.. in the noraal course of events, 1s that 25 correct? ~ 17 1 2 3 4 5 6 7 8 9 10 11 12 13 14 A That is correct, Q And the second problem that she had was this soft tissue injury that you have described involving the bruising to the abdomen and this nerve problem that you have described, is that correct? That's correct. A Q All right, Now, with respect to that nerve problem, you make reference, and did you make reference in your testimony, to the referral to Dr, Momin? A Momin, yes. Q Momin, I am sorry, And I have his evaluation reports which apparently he submitted to you, And he notes in the report of 5-14-97 do you have that one, sir? 15 A Yes, I do, 16 Q On the second page, under physical examination, 17 about half way through the paragraph 18 A May 14th, 19 Q Y... It look. liks that. 20 A Oh, that's -- I have two report. on May 14th, 21 that's why I "'.. confused. 22 21 24 25 Q A Q Okay. I have this, yes. Okay. Thank you. "e states there is . great deal ot tenderness ._.,,__.1 18 1 underneath her inguinal areas bilaterally, 2 A Vh-huh. 3 Q But there is a large abdominal mass that folds 4 over this area. 5 Now, that would be her obesity, is that correct, 6 sir? 7 A Yes. 8 Q And she had that at the time of this accident? 9 A That or maybe more, 10 Q All right, 11 Now, you described with the diagram, the police 12 officer with the gun or the handyman with the belt. 13 Does the excessive body weight act in the same 14 way to cause that irritation with the nerve? 15 A It could, I don't recall seeing an etioloqy of 16 that fact. certainly it would co.promise her ability to 17 improve. 18 Q It appears that throughout the treatment that she 19 has had that the physician. that have seen her have 20 reco..ended to her that she lose weight, is that correct? 21 A V.., 22 Q Did you aske that recommendation? 23 A No, I didn't make that reco...ndation, I, you 24 know, I a. sure it'. been asde to her many time. by many 25 phy.ician.. J 19 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 Q Did you see over the course of your treatment, did you see any indication that she had lost any weight? A She has lost no weight, I did see that, Q Now, Dr, Komin in his reports indicates that the way to treat her condition conservatively would be weight loss, isn't that true? A Well, I think that's a very naive statement, no, I don't think it's true, I think certainly that would be an adjunct, but I think it is awfully difficult to get somebody that's been told so many times to lose weight and is morbidly obese to lose weight, Obviously, if she lost weight, I think that would be an important conservative type of treatment. I am not sure that it would cure her. But obviously that would be the easiest thing to do and in the end she would gain more for that than anything, I did see his note, Q He did say that in his report there under plan and recommendations, isn't that true? A He said it may be the way to treat this conservatively, and certainly it aay be. Q All right. Now, the nerve block that you mentioned that she had received. that apparently provided benefit to her, isn't that true? A Te.porarily. ye.. 21 1 you obtained or the records that you reviewed regarding any 2 disability or any medical problems that Krs, Clepper had 3 prior to the accident in December of 19941 4 A If they're mentioned in the notes that I had from 5 Dr. sanderson, then I am sure I saw them; if they're not, I 6 did not see them, 7 I did review his notes. 8 Q There is a reference to some of her prior history 9 in Dr. Komin's report of 5-14-97 in which he indicates that 10 past medical history is significant for an MI many years 11 ago. MI meaning? 12 It Myocardial infarction, 13 Q Or heart attack? 14 It Yes. 15 Q Did you see any limitation or restriction on her 16 during the time that you treated her due to that? 17 It No, 18 Q It also notes that she has a history of urinary 19 incontinence which you described, and arthritIs. 20 Did you find that any of her arthritis was 21 effecting her abilities or her activities? 22 It No. 23 Q You have indicated that she should go back to 24 work, she should increase her working as she reels able. 25 Did your place any restrictions on her working? 22 1 A No. I told her to go up to her capability she 2 had in terms of lifting and she doesn't have heavy lifting, 3 Q Did she describe the type of work she had been 4 doing? 5 A I think she did and it was primarily clerical. 6 Q I think she indicated 7 A Cashier or -- 8 Q In deposition, she was a cashier at a deli or 9 Handy Market type store? 10 A That's my impression. 11 Q You felt that she could perform those duties 12 without any problem? 13 A Yes, up to her limit of toleration, 14 Q Okay. But placed no medical restrictions on her, 15 limited her hours or duties in any way? 16 A No, I told her to try. I really would like to 17 get her back doing something. 18 MR. HILDABRAND: Thank you, sir, that's all the 19 questions that I have. 20 REDIRECT EXAMINATION 21 BY MR. LUTZ: 22 Q Doctor, I just have a few follow-up questions. 23 You were asked questions about Dr. Maein's nerve 24 block studie.. 25 Did the results of those studies re-enforce or 23 1 reaffirm your diagnosis of meralgia paresthetica? 2 A Yes, 3 Q Why is that? 4 A Well, to begin with Dr. Homin concurred with the 5 diagnosis, and secondly, at least on a very temporary basis 6 her discomfort abated. 7 Q And secondly, you had mentioned that you were 8 considering EMG studies to be reperformed by Dr, Samuels, 9 Tell the jury what an EMG is and why you felt 10 that was necessary. 11 A Well, an EMG studies the irritability of nerves. 12 Now when she had this nerve block by Dr. Homin, she also had 13 some effect of the femoral nerve, And that is the nerve 14 that supplies the thigh muscles; in fact, she lost her 15 balance after that because it was weakened. 16 Dr. Samuels' initial EMG -- not initial, his 17 initial impression. referred to the fact that the femoral 18 nerve was effected at the time of his consultation, 19 It is possible that what we're looking at also 20 has a femoral nerve component, that's is why I wanted her to 21 be seen by Dr, Samuels and have all of these nerves tested. 22 Q What i8 the function and purpose of the femoral 23 nerve? 24 A Femoral nerve innervates mU8cles, among them the 25 stabililing muscles of our leg. 24 1 MR. LUTZ: Thank you, doctor. 2 RECROSS EXAMINATION 3 BY MR. HILDABRAND: 4 Q I am lOOking at your report of May 20, doctor. 5 Am I correct that when you examined Mrs. Clepper at that 6 time that she had normal hip flexion, extension, internal 7 rotation, the external rotation, abduction and adduction? 8 A Yes, her hips were normal. 9 Q Functionally everything is fine? 10 A Yes. 11 MR. HILDABRAND: Thank you. (Whereupon, the deposition was concluded at 12 13 2:05 p..,) 14 15 16 17 18 19 20 21 22 23 24 25 3 1 STIPULATION 2 It is hereby stipulated by and between counsel 3 for the respective parties that reading, signing, sealing, 4 certification and filing are hereby waived. 5 6 REZA G. AZIZKHAN, M.D., called as a witness, 7 being duly sworn, testified as follows: 8 DIRECT EXAMINATION ON QUALIFICATIONS 9 BY MR. LUTZ: 10 11 Q A Would you please state your full name? My name is R-e-z-a, Reza, first name; second 12 initial is G, that's for George; and the last name is 13 Azizkhan, the surname, A-z-i-z-k-h-a-n. 14 15 16 17 Q A Q A Your profession? I am a surgeon, sir. How long have you been a surgeon? Well, I would say I graduated from medical school 18 in 9/49, so virtually most of the time I have been a 8urgeon 19 apart from the other training I had. 20 Q Would you summarize for the jury your educational 21 background and training to become a surgeon? 22 A Well, first of all, of course. t graduated from 2) medical school. That was in Bombay University, India, and 24 after doing a little bit of Burgical training there I moved ;~, en tc) EncJl.tnd and Gr<!<lt Ihit.un and Illpl!nt approximately 10 0- .._.....__._. .____._,..._. ~'_''''''_'___'_'_'_ _"_~__'_~_____'_._'__"'__'~'" 4 1 years except for a very short break in between. 2 Most of the time was spent in England and 3 Scotland and I did British training in surgery, various 4 branches of surgery, but mainly general surgery. 5 Following that I took on an appoi~tment in a 6 place called Oarjeeling in the Himalayas and India where I 7 ran a hospital for three years where I did all types of 8 surgical work there; and then I came to America in 1964 9 where I -- I was fully trained at that time, I had all my 10 boards, surgical training boards from England, from Britain 11 and I had to do a certain amount of training over again to 12 satisfy the local regulations; so I did one year of rotating 13 internship which was needed to get a license in America; in 14 Pennsylvania, particularly, and two years of surgical 15 training in this country. 16 They gave me credit for my previous background, 17 so I was able to take the boards then with only two years in 18 this country of surgical training; so I sat for my boards in 19 surgery in January of 1968 and passed the American boards; 20 so I have the British boards and American boards in surgery. 21 0 Doctor. do you have any privileges at any of the 22 local hospitals? 23 A Yes, I have privilege at Holy Spirit general 24 hospital. I also am a .. because of my age 1 became a ~5 consultant. retired consultant. so to say. in Polyclinic "",,",,~."......-----~,~ 5 1 Hospital where I used to do a lot of my practice at one 2 time; but I decided to settle in one place only because of 3 my age and no running around from place to place, it became 4 a lot easier. 5 Q Doctor, as a general surgeon what do you do on a 6 daily basis? 7 A On a daily basis I just do surgery in some form, a either office work, operating room work, emergency work. I 9 just do surgery, that's my work. 10 Q Over the years have you come to treat patients 11 that have been involved in motor vehicle accident trauma? 12 A I have been involved with a large number of 13 patients over the years, 14 MR. LUTZ: At this point I'm going to move to 15 admit Dr. Azizkhan as an expert in general surgery and ask 16 if there are any questions on qualifications. 17 MR. HILDABRAND: Just a couple questions. 18 CROSS EXA.~INATION ON QUALIFICATIONS 19 BY MR. HILDABRAND: 20 Q Doctor, my name is Karl Hildabrand -- 21 A Yes. sir~ 22 Q.. we met prior to the deposition. You said ;1) that ~'Ou complet€'d yt'ur Run;ety E'xamiflilt ions in this country ':4 In 1968. IS th,lt Cvlle-:t, ",,''; A 1 did "'~' 1 $<it fvr and f"'lIs"d my boards in 19 20 21 22 2) H 2S 7 1 0 You are not retired in any way? 2 A No, The only way -- the only thing is that I 3 confine my work to this hospital. I do not go to other 4 hospitals. 5 0 And do you see patients Monday through Friday in 6 your office? 7 A I have office hours on Monday, Tuesday and 8 Thursday, those are routine office hours. wednesday and 9 Friday I do elective surgery at Holy Spirit Hospital. 10 In between I see patients in the emergency room 11 or I operate on people on an emergency basis; so I do that 12 in between. 13 On weekends, most weekends I'm around, I'm on 14 call, I take call because I am in solo practice. I do get 15 some weekends off when colleagues take my call, but mostly 16 I'm around. 17 MR. HILOABRAND: That's all the questions I have, 18 thank you. DIRECT EXAMINATION BY MR. LUTZ: o Doctor. we're now going to direct our attention to the care and treatment that you provided to Mrs. Clepper aftet. an accident t.hat occurred December 14th. 19~4. Wh..n and Wh'H" did ~'Ou f i rat meet Mrs. Cleppel' after an accident? J '~~,",,~,,-<,",,".....c..,'''''''''''''''_''-_'---'-'.~'_''______''~'^.' 8 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 A I first met Bernadine Clepper in Holy Spirit emergency room. o When you first met her. did you obtain a history as to what had happened? A Yes, sir. At the time I saw her she stated that she had had an automobile accident where she was crushed between her vehicle and another disabled vehicle; so that's -- and she had numerous injuries from that. so that's why I was asked to see her. o Before you saw her, are you aware whether any 24 other doctors had seen her? A I believe she was in the emergency room when she was first brought to be seen there and then I took over at that point. They asked me to see her. o By the time you had seen her, had there been any diagnostic tests taken? A To my to the best of my knowledge I believe they had a cervical spine, a chest x-ray and an x-ray of the pelvis. ! think they had all that done. o And were any of those diagnostic tests showing anything? A Yes, sir. They -. she had a fracture of the left pubic ramus. Q Could you put that in layman'S terms? A That's palt of the pelvic bone. The pelvic bones 25 9 1 form like a ring and to the left of the midline is a part of 2 the pelvic bone called the pubis and the two pubes come 3 together in the midline; and the pubic ramus is a branch 4 ramus means branch -- a branch of the body of this pubic 5 bone; so it would be somewhere about here. 6 Q Can you hold that up so we can get that on 7 camera, Doctor? 8 A Somewhere about here. 9 Q All right. 10 A In front. 11 Q After obtaining this history from Mrs. Clepper, 12 did you do a hands-on physical examination? 13 A I did, sir. 14 Q And could you tell us the highlights of that 15 examination? 16 A The lady was, of course, quite distressed from 17 her injuries and the main things -- the salient features of 18 the examination really were extensive bruising of the 19 abdominal wall which extended from -. this is the -- this is 20 meant to be the belly button. 21 It extended all the way down the whole anterior 2~ abdominal wall, the whole frent, all the way down into the ~3 upper thighs; so all thiS area was extensively bruised. ::4 swollen. 2~ She was she had lugns of a lin Ie tenderrH~Sl! I L.__",.._..._ . 10 lover the pubic ramus. She obviously had a fracture there. 2 0 Doctor, anatomically speaking what causes 3 swelling? 4 A An injury would cause two things, it would cause 5 breaking of blood vessels that would cause seeping of blood 6 into the soft tissues. 7 Also, contusion of the fat or muscles, for that 8 matter; but in her case she was -- she had a good amount of 9 weight, so the fat was quite crushed and that crushing of 10 the fat and the bleeding will cause swelling like that. 11 0 When you examined her, could she walk? 12 A She was -- she was lying down when I saw her. 13 She wasn't walking when I saw her. 14 0 Doctor, based on the history of the accident, 15 your physical exams and the diagnostic tests, did you 16 formulate an initial diagnosis? 17 A Yes, I felt that the lady had multiple 18 contusions of the abdominal wall and upper thighs. She had 19 a fracture of the ramus of the pubis, of the left side of 20 the pubis, pubic bone, 21 She also had some trouble at that time urinating 22 because of the injuries that she had. She had to be 23 catheteriz:ed. 24 o Tell us what it mean. to be catheteriz:ed. What's 25 done? 12 1 so I called in Dr. Samuels, Todd Samuels, who was the doctor 2 who saw her, the neurologist. 3 Q Were there any other consultations besides Dr. 4 Sanderson and Dr. Samuels? 5 A In the hospital not that I knowof. I can't 6 remember anything else. Of course, there was the x-ray 7 people. 8 Q How long was she in the hospital? 9 A She was in the hospital approximately a week, 10 from December 14, 1994, to December 21st, 1994. 11 Q How did she do while she was in the hospital, 12 Doctor? 13 A She had a fair bit of pain, but she gradually 14 improved and she was, you know, given some encouragement to 15 move and walk and so on and when she was finally ambulating 16 sufficiently she was allowed home. 17 Q Was there any treatment with regard to the 18 urinary problem? 19 A Dr. Cochel just catheterized her and since she 20 was.- following that she was able to void herself; and she 21 had a urinary tract infection. so she was gi~~n medication 22 for that. 23 Q Wen! you thE' doctor that discharged her? HI 25 L..... A. Yes, snr. o loIlh\t Instn.,'t lor"ll did you qlv.. Mrlil. Clltppi!f upon 1 discharge? 2 A 13 Well, she should -- she was to rest at home. She 3 was to see Dr. Sanderson for follow-up. Physical therapy 4 and so on would be arranged through him. 5 I gave her some pain medication. I asked her to 6 come back to see me for follow-up in my office, 7 Q Doctor, what was your diagnosis as of the time of At the time of discharge my final diagnosis was 10 fractured pelvis of the left pubic ramus, extensive hematoma 8 discharge? 9 A 11 formation and bruising involving the lower abdominal wall 12 and upper thighs. 13 Traumatic fat necrosis. 14 The next diagnosis was contusion of the right 15 femoral nerve. That means bruising of the right femoral 16 nerve from the injury. 17 The fourth thing was temporary urinary tract 18 difficulties with retention and infection. That was the 19 discharge diagnosis, 20 Q 21 A 22 penpheral I 2J thlgh. It .24 I frD!n und.H )') I e....')~~.9 d<)wn I 1 , What is the right femoral nerve? The right fernor'al nerve is a major' nerve, Mnve In tbe [',-,<1,' wlllch comes out in front of the CO!ll<!1l (.ut ft,.,." h"'le \mdt'!'l the it comes out this what"", call the inguinal ligament and tho'! thl<}h and It $UPpllt'!'$ In.. !1U1Sd~s of the 14 1 thigh and front of the thigh; that's the anterior thigh, 2 innervates these muscles and controls motor function of 3 these thigh -- anterior thigh muscles. 4 They also supply some degree of sensory function, 5 feeling; so in her case it seems to be more a motor thing, 6 she's not able to move the leg very well. 7 You had also mentioned the term necrosis. Would Q 8 you please explain that to the jury in layman's terms? 9 A Necrosis strictly means something that dies. If 10 something dies. it's -- it tends to go necrosis. 11 This lady had fat necrosis, so because of the 12 contusion, severe crushing force of her abdominal wall ani 13 thigh, especially to the front, this fat had undergone some 14 changes due to the crushing, there was some necrotic 15 changes. 16 This is what we call an aseptic necrosis; in 17 other words, it is not a necrosis with sepsis like some 18 like gangrene of the foot, for instance, is necrosis, too, 19 but that's obviously infection there. 20 This fat necl'osis usual! y comes f rom a crushing 21 injury, so that's what she had; so there was a temporary 22 ,n I ::. I JS t I L destruction of the fat, some loss of blood supply from the severe contusion; 90 th~t 's neclosis. o Do.::tor. rGu h.lc1 lndu:dtt'!'d that L').n~ of the In.:1t-f-uctlons ''.is th~'t $ht? W~hJ t"~) S~~ ,'t)U \1\ )"OUf arf lC~ 15 1 after discharge? 2 3 That's correct, sir, A o Could you tell us the dates you saw her, how she 4 was doing and what you did for her? 5 A I saw her initially on January the 24th, '95. If 6 I may refer to my notes here. 7 January the 24th, '95 was the first office visit 8 and she was concerned at that time about the lower abdominal 9 walls which were very thick and I described as being 10 indurated, which means thickened. 11 This was from the fat necrosis. Most of the 12 bruising had gone, but there was residual thickening 13 apparent and I thought this was from the traumatic fat 14 necrosis of the abdominal wall peniculus. 15 peniculus means the fold of fat which people have 16 and I explained that to her. She also complained of pain in 17 the left hip with some difficulty in raising the left leg. 18 She walked at that time with a limp, the left leg moving 19 less well than the right. 20 She also said the right hip bothered her before, 21 but it had recovered now. She had recovered all sensation 2;' whIch she had lost and she was !.Ieeing Or. Sanderson for a ~3 follOW-Up and also 01'. Todd Sa!llu~l. fer a follow,up. 2.- At that time I .. , since Dr. Sanderson was the 2~ main person involved with ner care, at that point tasked ..""~-,~.,~-"-_......,-,--...,~--_._--~~'-_._- -..._-- ,,,._--_._._-....-..._~,- ----~~....._---.--.._.~_....._..~--_.~,.,-...,.,........ -- ., 17 1 which was, I felt, unrelated to her injuries. 2 Q Okay. And, Doctor, did you see her in June of 3 1995 for accident related problems? 4 A I saw her again June 20th, 1995. She came back 5 mostly for the lipoma problem which had been excised, but 6 also I did. of course, evaluate her generally for injuries 7 that she had. 8 9 10 Q A Q What did your evaluation show? She appeared to be progressively improving. Just so the jury understands, the lipoma is not 11 related to the motor vehicle accident? 12 A That's correct, sir. 13 Q Just so the jury understands, what is a lipoma? 14 A Li poma is a fatty tumor. lS Q Okay. 16 A It's, in the vast majority of cases, a benign and 17 nonmalignant, fatty tumor. 18 Q When did you see Mrs. Clepper again, Doctor? 19 A We saw her again in December of -- 12/1~/95. 20 That was the next time I saw her. 21 Q And how was she doing at that point in time? 22 A At that ti~ she was still complaining of some 23 limplng and sorene.s in her right hip on and off, she was ;14 see tng Ill'. Sanderson every lllOnth for this. 2') She was noted to "...ave some limitaUon in ftIObility ---'---,............."--_.......~~--'''',_....._--_......''-,.-",..''''._....-",_.~".~'-"'."",""""_...---~~~~......"'..-_,.,.--...._-...-------_..,~'" 1 Yes, sir, I feel sure that these were related to A 2 that, because I saw her just after the accident. 3 MR. LUTZ: Thank you, Doctor. 4 CROSS EXAMINATION 5 BY MR. HILDABRAND: 6 Q Dr. Azizkhan, let me ask you first of all about 7 the visit to the emergency room and the hospital visit for B Mrs. Clepper. 9 A Yes, sir. 10 Q AsI understand it, there were a number of tests 11 done 12 Right. A 13 -- when she was admitted on December the 14th Q 14 and I assume you were the doctor that ordered those tests, 15 is that correct? 16 A I think initially the emergency room doctor 17 orderp.d. Sometime these two functions fuse, you know, the 18 emergency room -- usually the emergency room doctor orders 19 some of the initial tests and then if they feel they need a 20 surgeon or anyone else. then they bring them in; so there's 21 a combination of the ER doctors and myself. we order a 22 number of tests. yes. 2l Q As I understand It x-rays were done of the neck. 24 chest and pelvis? ~5 I L-__ ^ Correct, air. 19 I I I ~m~..-J .- 20 1 2 3 4 5 6 7 e 9 10 11 Q The x-rays of the neck and the chest were negative for any fracture, is that right? A Correct, sir. Q The x-ray of the pelvis showed the fracture of the left pubic ramus that you've described? A Right, sir. Q And the records indicate that that was without displacement? A It was a non-displaced fracture. Q Would you explain what that means? A Well, actually it means that the two ends of the 12 when you have a fracture, you have a break in the bone, 13 the two ends of the break are in alignment, they're not 14 separated by they may be separated in the sense that 15 there's a little line between them, but they're not up or 16 down; they are more or less together. 17 Q Both pieces of the bone - - 18 A Are together. 19 0 are in the proper position for healing, is 20 that correct? 21 A Right. 22 Q Am I correct, sir, that there was no 8urqery don~ 23 to treat that fracture. is that right? 24 A Perfectly right, sir. .2S o And how de you tn~,tt oil non.diapl,h....d fl~(,nll" 01 __~~_...____'~_"~".~"_"_~__"_____H__.___.__. "'___'_.___~_.~___"~._ _.__"'....~__. . ____. 21 '-, 1 the left pubic ramus? 2 A Generally there's no surgical treatment for 3 that. They usually heal with initial rest and then some 4 physical therapy, depending upon how much difficulties they 5 have with mobilization and so on. 6 Q Am I correct that there is no type of casting or 7 wrapping of any kind -- 8 A No. 9 Q - - to stabilize the fracture? 10 A No, 11 0 So basically the patient receives no medical - - 12 A No. 13 0 - - treatment other than rest? 14 A Not for that type of fracture there's no other 15 treatment. 16 Q And did Mrs. Clepper's fracture heal without any 17 problem or complication? 18 A Well, Dr. Sanderson has been following that 19 angle. so 1 did not x-ray her to see if it healed because 1 20 left that to him, but I would feel that clinically it should ;:1 have healed. 22 o Now, t note in the records that Mrs. Clepper. 23 upon admission. is shown to be about 192 pounds and about 24 five foot one inch in height. is that correct? .25 A Correct, sir. ; l.._.....__~_____.......-__ 24 1 2 3 4 5 6 7 see the letter was on February the 7th, 1995, and Mrs. Clepper was discharged, you know, long before that; so that question wasn't asked. She did not volunteer that information to me and I didn't know about that, but I did see that in Dr. Sanderson's note. Q Now, the first visit that you had with her after her discharge from the hospital was January 24th, 1995, is 8 9 10 that correct? A That's correct, sir. 11 Q I'm looking at your note for that date. Am I correct that you noted at that time about halfway down the page, patient says the right hip which bothered her before was fine now. She has recovered all sensations which she 12 13 14 15 16 had lost? A Right. I said that. 17 Q And would that involve the fe~ral nerve that you have described? A That's the femoral nerve. 18 19 20 21 22 o And then you didn't see her until May 2nd, 1995, is that right? A That's correct, sir. 21 o And then you note in your visit 1n May.. on May the 2nd. doing better hom standpoint of traumatic fat ..4 25 necrosis, 18 that right? I ."."..... 'N'_ ..... ..... .......:.._.____. .............. . -.^.."-~.~_.._,.,,~._-,-_._._...._-----,-'"...~--_.._-~,,. ~ 1 A 2 0 3 time? 4 A S 0 6 A 7 0 8 A 9 Q 10 A 11 Q 12 A 13 Q 2S That's correct, sir. You also note that she was walking better at that Okay. Where... About a third of the way down? You mean on May 2nd? Yes. Oh, yes. Walking better, yes. And below that, overall -- Has made great progress. -- has made great progress? Yes. Then you note patient has developed a fatty mass, 14 left upper abdomen? lS A Yes. 16 0 Is that the lipoma that you described? 17 A Yes, li poma . 18 Q And that had nothing to do with this accident? 19 A No, sir. 20 Q And you mentioned the last time you saw her, :21 12/12/95, that she had indications to you of stress, is that 22 correct? 23 A What she said was that -. she complained -- she 24 was nervous, forgetful and had shakiness since the accident ~5 and that she had emotional -- she was emotional and teary at .~~- .-..........>. .. . .- , . 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M.D. changes 111 14 14 ! :!91 I discharge '"I 1.1 I IERBIII 1:1 14 I ~ icouplelll ~Ji I.'q, J ~ II IJllI iespecially III 14.1) chest III ~ I~ 1~.24 I course ,", 1':: "If\ I ~ I 14'" IESQUIREIlI I Jll 2U] I II:': 12 fl 17. idischarged "I 1"'. .,~ : 1:'1 CHURCH III II! 2~ 1(1 :!4: I ESTATE 111 14 jCOURTlI1 I discussed 111 ..,.,., CIVILI'I I) IJ II levaluatelll 17'~ Clcpperll'l II iereditlll 4 I" , displaccmcntlll 111 " !evaluation III 17 )l: ~ 2: ",24 81 ICROSS1l1 ~,2 dissipated III 2l'.,12 Iblll 'JII 12.1~ 1718 ~ 18 W4 dissipates "' 2~~ Icxamination 1'1 H 181l I~ s 2l:~2 crushed 1'1 8." distressed 111 lilt! 1 ~ It. 'It) ~12 22_10 23.11 23.22 IIIQ lid :2 :~ I 1I I~ Q.lb I~ 4 204.2 21\.11 crushing 141 I doctor 1l>1 4 ~ I 2t.2~ """'''1 Clepper's (1' Ill" ~5 ..' .... 18.21 , 1-1,12 14.14 142tl ~.2(l ",21 Q- ,cuminations III 5.23 2I:JfI 2221 CUMBERLAND III HI.: WI" 114 Icxaminedlll Hili clinically III 2Ull 1.1 II I" 12:1 1~12 close III 22_23 12.:~ 13- 14.24 Icums", III.I~ 18'~ c1osclYlll16 I -0- 16 ) 17.: I' 18 caccptlll 41 'his I~J 1~14 I . d ,. Cochellll 1~19 I caelSC III'.., daily 121 ~.6 5:7 I~ I" 1"18 :3,: EXECUTRIX 1'1 14 colleagues III 7.15 damaged III I 26.23 :"21 :"',2. ICapenll1 ~.I~ collection III 28:8 2712 I doctors '" b.11 1921 combination III 19.21 D&Jjcclinglll 4.6 23,ft leaplain 12114.~ 211:J{t COMMON/II 1:1 date", 111 24:11 idocsn'tll12- Is caplaiocd III I~ I" Commonwealthl'12Q3 I daleS III ID jdODCI'1 hi" 102~ I cx tended PI 9 '" DAUPHIN III I 9.21 2Q~ 291 I IQ II 114:; 20 :: I complained 1'1 1~'16 jDAVlDlI1 1.19 idown"l till q.:: icatcnsivc 141 ~J~ 1621 1~_1~ 183 Ideals 1'1 613 I III 12 III! 13_~~ ! 13 W I~.I~ 18.11 I~ ' 1~.13 I December 1'1 7.1~ 1 2tt-lfi :01 I: =~.~ !cxtcnsivcly 1'1 Q:23 complaining III I........ I 12.W 12 W 1- I" ~I(j ,cxtravasated "I Itd7 completed III ~_:n Ill:~ I~ I) !Dr""1 ~ I~ II J7 icuravasatioo II) 16.16 complication 111 2J 17 I decided 1'1 ~.Z II ,~ I: J 12,3 I DEFENDANT 121 J2 .. I: !~ 133 concentrated I' I :~t8 I:~ "...., t~ 1) I~ 24 -F- I I" I ~..... concemlll I~X -- l~_2" l':Ifi 21 I~ Ifact 111 ::1-J3 28:11 conccrned 1" t I.l!o i dqrcc IZI 144 18.211 :.2 ~ ~3 I~ 13 U. I fair IZI un :('Il IH I~ I I DEMANDED JII 15 ; 24.5 Ifalllll ::32" concludedI'I 2S:I~ I depending III :!14 idriYCfl1l :~ I'" I family 121 2221 233 confinelll'J jdepositlll16 I) IDrivin~I'1 :: IJ!. ifarlll 2: 24 connected" I 2.2.23 i depositlOD I"I !-9 idntnk 121 :: 1" ::11\ :fate..1 HI"!' 10." , ~:2: 2111~ 29:9 Iduelll CONNIE III !-4 1414 1 Will 1313 14.11 constitutes" 1 2913 2<11" !d1l1Y121 ) - 2V9 I 1413 1420 U.22 2V2tl described .., consultant 111 1~9 ! i I~ II I~I) I~I~ "_2~ 2tl~ 22 t :4-18 j I*,~ 16" 24.24 .. ::~ I -E- I ~~ '" :"24 , 28 1: 28 J) consultations 1'1 II 19 I describes III 23.2f1 !EIII 14 1 fatty 1'1 16 '2 t~.:~ ,,- I. ", I c1cstntctiott III 14,:J lcuicrlll ~ 4 1 Ii 14 1717 :~ I) controls III 142 dcvcJopcd III ~~ I) Icdllcatiottaltll ) 211 ! fcatan:s III 917 contusion J1J 107 I diapolill" 10 16 leithcrlll ~-~ ! Febntary tll 24 I I J I> 14 I~ 14.23 I. Il' If' ::: 182J I I) 7 11" J) 14 ielective III -~ !fccIiIlCI'1 14 ~ , 13 I~ contusions 1'1 ! lC~lICyllet ~ ~ I felt 1'1 Wi" 1"'1 Will 14i~_tic 141 I~ l~ Ill. ; - II' -H . ~ ~.. l It...; HH~ I~ 19 " I: 1-- ... 19 I. !fcmoralPI 13 l~ COm:ctI2" ~ 2' I dies IZI 149 14 Itt I" I~ ,,, l~ :J' .t' I'" . ~ 19 I~ i J) l~ 13.20 t321 '. .- ., j diffCftSt 1'1 iCtlllltiottall'l It) :~ :td 21' :It> fI..!i t~. , It lU I,,:: ,.2, ~\) :: :1 f'I; :1.2'- I " Hi td: :~ 2~ 1~ :~ :~ i: I 241-' 2" .-. ::1 :~ ....... :.:" j.miC1llhCSl~ J) l~ ~ :. p ! fihec III " .. - :.: ~ :: I: Z. If , 1),::'- :14 ICtIlpleyw I" Z'I I'" ifinll,t 1 11" =.a IF :. i: 10':: illifflClIlty l~l 112\. :.'" I' ! flully t" l: I' :~ . :<<. :: l{d~ 1'1" ,empty Iii I; ~ :;r. : :~ t :~4 :f_ianYII, :."',' i lbtttt 14. .- n ,CtI(lMI'~"" L: q, Ifoun""lltl " j ftllt III :. ,. , : '" t'" ...., eN. '" ' , .' ):..1.: 1 .,~ ll'l "\.i ,- :fin'"" 11j 1 :: ... ..... ,lbtttt_ '" :~ ~~ i f....lalld ,., ICO\ll\ttyl" .." ,1I_tl,." ':.. .. :4 ~ ' , \ ~) I~ ~ :' j;. ll,l' " . ~,~ t. ~ ., t '" t ~ ~ InlHNn',;' .~~... , Fil,,, ...'.i 2"" " -' l l"\ln I'~(: tUl(ittli.'\, AUUtl<ltll'. fUt./. A NATAtE 717.212-SM41191'S 101 MI' 1M u II-Page fivc - mean five III 2124 Ig~~~~ated III Reza G. Azizkhan, M.D. 3.1- indicate III :w ~ 1120 IUI I~.~ Ouidslll 11.10 11:14 ~ll J I~ 7 ~J 4 fold 111 11.1~ I greatf'l 3.~~ I" 24 indicated 111 14,24 ,large '" ~ J: follow 11 I 1".1 I ~1:J11 ~~_J I I indications III :!~1J !Jastlol :'l I~ Ih I~ follow-up III D.3 grow 111 27:'1 I indirectly III 1"1).. , I~D :!~_211 I3f\ 1~.2.l 15.~3 guess III 234 indurated III 15111 latex 111 II ~ 2h.23 i induration 111 LAWIII IJ following 111 I" ~ 4" -11- 'I".~ ~~ I) layman's III M:24 11.211 ~I I~ I infcction 1'1 halfway III 2.1 I: 1::1 1 IU follows 111 3.7 hand 111 2'J :1 I 131~ 14:11) left 1111 h.22 9:1 foot III 14 I~ 21:24 hands-on III infonnation III 244 WIQ II.~) I3:W forccl'l 14.12 21:1" '1.12 inguinal III 11.17 15J7 11,1~ Harrisburg 111 13.~4 2717 6.22 initial 101 Ig,21 2t1:~ 21 I foregoing 111 29:" heal 121 ~JJ :!I.ltl )1: 101" 21 :!U ." 2~: 14 19:19 213 ....... forgelfullll ~5:24 healed 121 21 I~ :1.2' injured III ~7.2(' 27.2 forgetfulness 121 18:) hcalingll120lQ injuries I"I Icgl>1 11.21 11:24 2h:i height I'I 21 24 ,,:17 14" 15.17 !~ 18 8:~ 9:17 10.22 Icgslll fonnJ1l 5.7 9:1 help 121 I~'II 231 17.1 17" 23:12 ~):15 :7:9 helpinglll~~:19 23:15 less 121 15.19 20:1" fonnation III 1311 hematoma 121 13 III injury f1I W4 11;2~ letter 121 2125 24.1 forms 111 2U i 18.:: 13 I" 14.2' 23 ~) Iicen5C III 4.13 fonnulatelll WI" lhemodynamielll III.. 27:D 2: I ~ lliftingllf 1121 fourth III 13 I- I hemosiderin 1'1 '" I) innervates III 14.2 ligament I II 13.24 fracture 1191 h.22 I" 14 In 1'1 instance III 14,1~ I limitation III 1"J_2~ III I JO IQ 11.23 hereby I'f ): )4 instructions III 12 :~ limp III 111~ 2\l.2 204 20'9 :9 ~ j 101.2.' limpinglll I'" "I ~ 20:1: 2ll~3 2u.25 hereof III interested fll ....' 2t11.a ~I~ line III 2u 15 21:',1 2114 ~I f" hereunto III I internship 111 .:: I 27.3 27.11 2'1':: 413 lipoma (1f I".~~ 175 27 13 2714 ':7:1'7 hersclflll I~ ~I' ! tntravcDOus 111 1110 - 1:'.10 17.13 1'1" fractured 101 13:11I I highlights III Q 14 I involvc 11124 1- ~~Ifl =~:14 1~21 .,.,., :':JZ IH~ltabran~:!.": 11J I involved 101 ~ I J list III :3 to .../... fractures III :2.3 ~ 1'1 ! S I: 11 - 1 ~:~ IiVCl21 I~ )" ~:24 frcclll :7.JIoi I ~::u 7 17 Iv:~ I iDvolvin~ III 13 II local 121 4-1: 4.2: 2t =1 .,...... :8 t~ Friday 121 ... .....' jironlll Itll~ located III 6 2{; " 7:9 IHILLIII 114 -. IIVIII Ilookinglll front III QJ(I q...., Himalayas III J I ~.; 2411 .. 4. 13 :: 14 I 14 IJ I Ilosclll 1111 full III 3 II' ".24 IhlP111 I~ I' l~ ~, j + lIoss III 14,:: fully III I ''''.:3 I~ I 2.4 n I I 10Rt III 4~ I history III ~ ) ~I II !J 111 III 2\1.& I~=~ ;'4' J~ function III 141 , Iii 14 IH I. I~ I 2'114 I lower 111 I) II IH 100 Iholdl'l iJanuary 101 4 I" lK:: "" functions III 191- 1 Holy 1'1 4 :3 '" l~ r l~'" 24 ~ i LUTZ 10f I'" 10 fUSC111 1917 I ~I jjoiDtll1 ~ I. i 19 ~ I" 720 j~fJI 11 I~ IJulYIlI I I: ~:) It'.J 2b.13 271 13: I =',2) -G- I hospital 1121 I J line 121 I' . IH 4 . '. IIYiD&111 ~ury 1>1 WI: Gill I- ':.3 . ...~.. ~ I ., ) I ~ l.:!li '" ) I: 1'l' -;',i J: ~ I~ ). ,IU I'"' II ''"' IJ 1~''J 11 II I~' '" I ! -M- gant:rt'ne III 14 I. :~ ~ '- , general 111 0 4 1U -K' IM.D,o, I' . - .. .. ~ I holqIllals 121 -' -' .. :: H 2</- " ~ I ~ ~- IKarlul , . . I' III: :1 " ! lDllin 1" f'; I~ fI I ~ i hours III Ikeep"1 - I' II ~ gcDCrally 1" .- . . III' I ~ =~ ,- . I hypoYOlcauc III 'killed III :: if == : i :: : :.. '" :h t Ii I: ,IIYJOf III :,; t :l'i .a !bacllll :1 ~ :: :1 i_jont'tll r" II' lJC:OllC '" ) I: :!- I 2'"' I,. IKNAUSSIII t :. '_Ill' l"':'.' :' p gi~III'1 I: I" I: :1 ltllll'rcuiotll" ;"'1 !Ii:DC"" "1 " . I_tterl" I,:: ~ ~:t. '.."promlll ..' rOC$111 l:I'; ikllClW~111 ~ i' i_tten.tl:': )1 =~ 5 '1""/nYIIlC ,ft 1f'li -may I'" I'to I"; 1:0000l11 It 1: ; i \i -..~--~~---- ---- l,. t ::.. 14 :) !l 1:....>11,,, , , \ I I~ ,,,,-hp: :i :.. ..._--"',. .. ~',"'------- Z" ~ :04 .:'" :. :: !~ratld411y '" lad.ol'" '1.1."' . , :" t ~,- .. . ,. lold. " ., .lnCa"ll; ,.-. 1I11(OIII'.S. AUJRIGlrr. FOl:n & NAlAU hh.k\ 1"~;_,,' 717 2.\:HM4/W1-5101 mcans - reaction Multi-I'age T" Reza G. Azizkhan, M.D. means ,., Q4 10.24 Inccdl'l 14 1'1 I order 121 II" Ill..:!! I practice I-I 5:1 III I)I~ 14Y nccded III 4 1.1 I ordered 1211" 14 II' J '7' ; ".I~ ~24 7:14 I~ 10 151 ~ 20W negative III :!ll.;! lorderslll I previous III 41" 20 II 1" I~ mcantlll 9.:11 NELSON III 14 iorthopedie 1'1 11 In Ipreviously III I~Q I.~ hi) Ilf, II I" . 1.1 I ~ medical 1'1 ) 17 , ~2) 11\211 ~I II I nerve 1111 II:~ D I~ lover.IIIlII"~4 :~ 'j iprimarilYI'1 " I) ~2 II 13 II 1).1" IJ.:!11 1).21 iownlll IH Iprivatelll" I~ medication III I)~I 13.:: Ittlll I privilcge II I 4.23 1~:21 lh.22 I~ 2) 201.17 IJ~ 241Q .p- privilegcs III 4.21 mcctlll '7.24 nervous II I 2S.24 p.mlll I 12 lKI'7 problcml'l 12:1~ mentioned III II:I~ nervousness III IbJ :04.13 17.5 21:17 '" 7 25.20 page III problems 1'1 2~.7 painl'l I~ I! 13:5 ~14 mctlll ~.:2 8.1 neurologist III 12.: I~ ,~ 11:8 11.24 17J 8) 2311 23.23 METZGER III nevcr I_I :11: 22:11 part III ~.25 Q I process 11127.20 1:21 234 23:Q particularly III midline 121 9:1 4.14 produce III 27:1) DCWIII 27:'1 :~.14 9 ) 27"1" might III next I_I I) 14 I~ ) parties III 3.3 2Q I" produces III 277 IR II I~ 4 1'1.2(1 jpasscd 121 4 IQ milCIII 2:2~ ~ :~ product III I~ 14 non-displaced 121 20'1 ipassingllll~ I' miDo"'1 23 15 20.2~ I past III products "I 16 18 mobility "' 17:2~ nODmalipantll1 17 I~ :: I(l I profession III 3:14 mobilizatioclll 21:~ Notary 1'1 I II 2Q 4 IpatieDtl-1 21 II :=" professional (2) 18:14 :2:1: 2J~ 24 D MODday 11' .,;~ 291~ I 25.1) 2~.2U '7 note(7J 21.:= 2~:~ patients I_I professionally II) 18:J7 5.10 moDthll1 172_ 2_~ 2_11 24.23 \ ~ J3 ::~ 71(1 progress 1'1 16.24 moDths 11127 10 27:10 2~.: 2~:1~ IPAULIII II 2~.1O 2~:1I most 1'1 3 18 ..2 noted 1_' 11.2) 17.25 Ipelviel'l ti.2:t 8.~ progn:ssivcly (I) 17:9 "ll) I ~ II :7;~ 2310 ::.. I: ~.~ PI'OJlCf I'I 2019 28 ~ DOICSIII I~" pelvis 1_' ~ I' IJIII provided (II 7:::: mostly III ' I ~ 1':'.5 I nothing III :~ Iii ! UL:!I I~ :'" 11""-1 Ipsychiatric III 1810 Mother's III =:.u ! noticed 1112~ Q :~ I: :" ,.. I psychiatrist III IRIll motOfJ!1 5.11 I".: now 141 ~ : tl ~.- IpcniculuSI'1 1 ~ 1.4 I pubes III ~,: 14' I'll Ig :~ i :!I I~:I :1 :: : I ~ I ~ Itd J ipubicIIl1 1,':3 Q.) :2~ ..."...... 14- I Pennsylvania 1'1 movcl'l ~ I'- 1':.15 .... .. II Q4 101 10.20 2~.14 I IH ' I 14 4 14 ::'-' ~ I IlIO 18.21 2\1:5 moved 1'1 ~:!" fl.:: numbcrl'l~ I: IQ III i 2'1 ~ . 11.1 22.: :7:1 f! :: 19:2~ I people I-I 7 II J:," I pubis 1'1 9.1 10:19 movilllllll~ I~ rumcrouslll H I 1~ I~ ::.1'1 I 10.2\1 MnJl'1 '" "',24 !peflll I~ 7 Public 1_' III 2'14 .. . II I: :~ 17 I~ -0- ,Perfectly JlI 20':4 I 2'111 2'i.25 I " I: 1820 IH loaths tll ~~ Ipcriphcrallll I) :: jPUtlll 824 III :1 If> 21 :: :.2.10 lobtailllll 8J i pcnoII UI II . I ~ :~ :121.1 :3 II ::3 :: I physlC:all_' -Q- 2_ I l!i It I obtaininc I II q II ~ I: I multll'lelll 1017 iobviollSlIl '" 11 It ~ I ~ 133 IJIl : I qualificati01lS 1'1 H , Itll" :I.a muscles 1'1 lobviovsly 1'1 i ~ I f\ 5 18 10' IllI I pieces III :1' I- t) :~ I.: 14 ~ ] '.19 ! qucstlOllS 141 ~ If! :'" I" I Occasionally, II :~ II tP1Cmcnt 111 If'l .to; I ~p , 17 2\lq IOCCllm:d 12I ... :3 :placcl'l II) 4. iquitel'l . I. 1119 -N. I 114 ~: ~ ~ ~J ' II: , tll: 2'11- nameI'! .. JIO 10fflll - !~ '''' ':' I PLAINTIFFS ('I , office "I I: i -R- )11 311 j I: ~, f' :t 11ft 111; i ~ Z1' ~j - l fI"" '. iPlaal1l 11' tlllll I :1 NIl1lnlly III I ,;. Dfo, ,.. =~ II' :1l~'I-allIJ II :.. '" ! I'" PLEAS II" I ,,".1l1 1'1:,\ 2\1t , ; rattl.llll :~ 2. .of,"111 =, ~ I JIOiat 1'1 ' I- Jo 14 ftCCft\tllS ll~l PI' lODe I.' ..,: ' ; ~ f. :" j"f.. :" :1 :ral'unc III I' ,. ,,- I.... 141<' ': Ii . i;,j; ~.a irolydllllCl1f ..:' ''''SI''' ,,:1 u , It l: I" 1('\ I_ ,. I'Ol"LA It It I "4 H'i Ii't\l I t"l' l"~. '4 :,; :! :.a ' :\ I l,~ n' :~ :1 =t'4 )\ ; 1'1.a l~ .. t!f'Cra~ III - " ;posth(" t\j ~~ I" :1 i ., , ..-.. ;...:. :1>< ! ~ 't!f'Crallllll" ~ '" ......"".111)'1" . :... 4 . i ,.al'l 1 ""(f''''.'c IiI ,"1,1 '('Inll_1'1 :'1- I' pl\l.w~ III ;' :. , rcM"'1(Mt 1'1 i""+ '- hln I'a~( ~ IltJ{illl,S. AUUUGlIT, t'OLT,l A NATALli 71'-212'S644nn'5101 Multi-Page ", read - tissues Rcza G. Azizkhan. M.D. 2td 2tt:5 I roughly III I~ I" !showinglll h.211 4211 < - ~:lJ . , read 111 ~3.J4 jroutinell17 ~ I shown III 212.1 ~ I ~ ~,~J ~:" reading 111 .1..1 IROVNERIII II~ I shrinks 11111 J.1 ~" h,W ~:D real III Ib:~ I rubbcr III 112 isidelll ~.14 fl. I ~ b:llt IU I" 11.24 I ~ I" "It I 7:1./ really III QI~ running III ~ ,~ I IJtI.~ 211 ::~ reason '21 IX:Q =1.1) Isigninglll.1.1 surgical '.1 reasonable III I. .1.24 U;.211 -5- ISlgnsll1 Q2~ 4.~ 411' 4.14 receives III 21 :11 salient 111 9.17 Isitlll 2' I~ 41X 21 : record 121 :1:~ 2lJ:2U Samuels )4' 111 isitcl2l )"21 ::., 4 surnamclll .1.13 records 1.,2117 I. . surrounded )11 ::1.~1 12:1 1::01 I ~23 rltuataon 111 ::2.20 27:19 21 III Sanderson '"I II Ii slowly 121 28.12 21U4 surrounding 111 27:3 recoven::d 111 15.21 lI:'~ 124 D.1 soft 1.1 . I~ IU~ swelling 121 10J IS.21 24:14 1~;2:: 1~:24 1",24 I 11.1 2'1J 27 I~ 10'10 RECROSS 121 2:2 21.18 I 27.19 swollen 111 9:24 27;22 Sanderson's 1'1 23:14 15010111 .., 14 sworn 12) )7 299 REDIRECT 121 " 2.1J8 24'" somcoOCll1 :::.22 symptoms III 26-10 26:25 sat 121 4:18 5:25 Sometime I'I 19.17 n::duced III 29JI satisfy III 4.12 sometimes 121 ;:7:~ -T- n::fef(l) IS:~ saw 1211 8.~ 8:10 28.8 regardl!1 12:17 10 12 IIID t:.:: ! somewhen:: III ~:~ takes II) 2710 n::gulations 111 4 12 I~J I~.~ 1t,_3 I 9'~ 18 I' I taking III 298 n::latl'dl'" I~ 4 I" " I" 4 ! Tammy I') II) 17.3 I~ II 1- I" (":0 Isonl21 22 It 22 :: IX 12 I 294 2'1.24 1824 IQ I 2r.J I~ D I~ 14 I~ I~ ISOn::nesS)I) ,., ':y n::lative 121 29_1~ l~: 230& :) 19 i speaking III 10.: I teary 141 lb. 2~,2~ 29'16 , :~.2{i ~a.12 26 1.1 I speciality 111 6X I temporary 1'1 n::memberlll 12 f\ IsaYSll1 24 J.1 ISpecificdll1 1.1.P n::port121 ischooll2l 2~ 14 ; 14.21 11\.23 23 101 :3 U, 3 1- , :.1 I spent 121 3.:' ..: Itcndcmcsslll Reporter "1 I Scotland III 'i~~ JII J . IspillClll .. 81> tends )11 ~9 1: 29:24 IsealillClIl 3; 14 III iSpirit 111 ...," ,:~ tenDll) 147 Reporter- Notary III Isccondlll.1ll -.' 29 II I b I tenDS 12) 81'* IH n::quested 121 =::C\ I sedation 121 IIQ ,SSIII 29 :: testifacd III 3~ II I~ I st&hi lizc 121 := 1'* 111.1 testimoDy 121 297 n::siduall2l I see 1171 .,'~ -1(1 , :P,l I~ I: I X_ 8 14 II- I ~.20 .....,. Isuincdlll16 I: ...t..... 1:13 I). 14 ::~ I tests III 8 (" 8.20 n::spective III 3 :; I. 1 If'I~' l~ , I staining 121 1611 Illl~ 18 19 191(, n::st '.1 IIQ IIH> I- 18 IX J- :1 I\; l~ :l\ 1914 1919 lq =: Ill' t): 21.3 2" I 24~ :~.:n I standpoint 121 167 IthaDk).) j 11\ 19.3 :1 1:\ Isczing"," I~~: I" 2'* ! :4:.4 2021 :., :u :h I~ results 1'1 :: 1- ~ 1~ i: !Statclll 3 Ii' !therapy 12113 3 21.a n::tention 1'1 13 ,.. Iseep1Dl1111l> < I stenographically I" Ithieklll l~ Q retired III '1:" - 1 IseuatiOD III I ~:I 2"10 I thiekened III I~ H' Rcul'" IlIC1lSatiOllS III I still III I~ ...... thickcniD&ll) 19 ' - :4 14 . -- I~ 1: - .' I Itipulatcd III H ) II ~'" i sease J1I fl I ~ It-I" 3: I thieh '0' IJ :3 lJ =~ RICnARDIII I :tIt' !STlPULATlONIII.1 I 14 , i 14 I 14 I I~ I n(:bt ""I "'~ 11 :1 IICDlIOry III ,,~ ISt\'tlCtlll fl~1 I 14.,:\ 14 .1 14 j) II ~.. 13 14 13 I~ 1lCftlllt I~ III i stress 1'1 18 - :~ ~ 1 ~ 18.:: '-'~ I ~ :: l~ 1\1 'separated 121 2' .. 2'" ~ 24:' .4 2~ ~ ithiehs'"1 ~ =, 1018 : 4. ~\ 1,..11' 1- "t ;:1.14 -stnetly 1'.14' I It:: I' I: I' . lirI =~ !Q :: !thiWDllll scrSlS III '<41" . sllllscqllCRtly . II =j j '; 18 II ~< :,! to ~, ~I I third J2I , .- ~, :04 ;: "- 'Cf"WlCX"$llj ::',. ,sllbstantialll' :'" 1.. "':1 :~ ~ ....... , tboveltt .4t! ~ i' i :' !\ :\ :1 :.. ) , tKttll :'-: ;~ 'SllCh,," ~ i~ ltl j: I :.&lll :... :; :'" :... . Kille 1'1 ' . IillfhclCDtly I'I I: I" If'l :. :f\ I >t- :f'I'" IIll:'''Cfalll'' " lthn:clll 4 " Inll'"' :tu.....n..t' 1:)._ j tbrollCh t" " , 0;1 1IlfIf11ICSIll IRoAn", il.' :we-verc I~l i.l ;: ,.:1 J" :... 11 : ;'''- 1 fllOtll,,,! . , ,shalt ItIC!IS 1'1 p. .. S'*f't'IYlll 14 . 1.1 :.: '1'hvndaYII' - ~ II :~ N :~ ,. , : ~ j: ~ ioI .. SllfJ;._'Ol .11(, :thynndllif'I" I .sbcc1", ~(" .~ It'- It\. I" , " !" :'''' i ~ i.,n -' 'tilDes 111 I~ . :" ~ , ,~ . short 11\ " 1\' ;1 . Ih.IKI_, " :.. " . j"'t.lli"ll'" ;~ho.I\! lllf):'Cf) I'" . . . ...." :.. ~.. :~ : H . . J. ;' .h.,_dt,,: - tts....VC$ ..., , I" ;,., II\IGIIES, At.8kICtll-r. fOl.rl A NATAU Indc\ J\t~~' ~ 117'H2'~f>.u"'H ~I(ll Todd - young Reza G. 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Front Street Harrisburg, PA 17110 You are hereby notified to plead to the enclosed Answer and New Matter of Defendant Connie L. Nelson, Executrix of the Estate of Richard E. Nelson, deceased, within twenty (20) days fro. .ervice hereof. METZGER, WICKERSHAM, ItNAUSS , ERB 'If:g1If~tiuire 3211 North Front Street P.O. Box 5300 Harrisburg, PA 17110-0300 (717) 238-U87 I'? . Attorneys for Defendant Date I "'"l-"fl. BERNADINE and PAUL CLEPPER, Plaintiffs . . IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA NO. 96-5015 Civil vs. CONNIE L. NELSON, Executrix of the ESTATE OF RICHARD E. NELSON, deceased, . . CIVIL ACTION - LAW JURY TRIAL DEMANDED Defendant DEFENDANT'S ANSWER AND NEW KATTER 1. Admitted in part and denied in part. It is admitted that Bernadine and Paul Clepper are Plaintiffs in the above-referenced action. Defendant is without knowledge or information sufficient to fora a belief as to the truth of the remaining averaents set forth in paragraph 1 and the averments are therefore denied. 2, Admitted. 3. Denied. It is specifically denied that the allegation. of Plaintiff.' Complaint are correct with respect to the incident which occurred on Dec_ber 14, 1994. It is admitted that there was a ~tor vehicle accident on December 14, 1994 at or about 5:30 a.m. which occurred on William. Crove Road in CUmberland County, Pennsylvania. 4. Admitted. 5. Admitted. 6. Admitted in part and denied in part. It is admitted that the Tauser vehicle was stopped in the southbound lane of Williams Grove Road on an icy bridge prior to the arrival of the Defendant's vehicle. Defendant is without knowledge or information sufficient to form a belief as to the truth of the remaining averments in paragraph 6 and the averments are therefore denied. 7. Admitted in part and denied in part. It is admitted that the Clepper vehicle was stopped in the southbound lane of travel on Willia.s Grove Road on an ice covered bridge to the north of the Tauser vehicle prior to the arrival of Defendant's vehicle. Defendant i. without knowledge or information sufficient to form a belief as to the truth of the remaining averments set forth in paragraph 7 and the averments are therefore denied. 8. Admitted in part and denied in part. It is admitted that Plaintiff Clepper was standing in the vicinity of the Tauser vehicle and the Clepper vehicle on the ice covered bridge on Wlllia_ Grove Road at or about the ti.e Defendant's vehicle arrived on the scene. Defendant is without knowledge or inforaation sufficient to form a belief as to the truth of the re..ining aver.ents .et forth in paragraph 8 and the averments are therefore denied. 9. Admitted in part and denied in part. It is admitted that Defendant'. decedent, Robert E. Nelson vas operating a 19.9 ford Lariat XLT vehicle northbound on William. Grove Road and approached the icy covered bridge described above. Defendant i. without -2- knowledge or information sufficient to form a belief as to tne truth of the remaining averments set forth in paragraph 9 and the averments are therefore denied. 10. Admitted in part and denied in part. It is admitted that Defendant's vehicle slid on the ice covered bridge and collided with the Tauser pick-up truck. The remaining averments of paragraph 10 are specifically denied and proof thereof is demanded at trial. 11. Denied. Defendant is without knowledge or information sufficient to form a belief as to the truth of the averments set forth in paragraph 11 and the averments are therefore denied. 12. Denied. The averments of paragraph 12 are specifically denied and proof thereof is demanded at trial. 13. The averments of paragraphs 1-12 hereof are incorporated herein by reference. 14. Denied. Defendant is without knowledge or information sufficient to form a belief as to the truth of the averments set forth in paragraph 14 and the averments are therefore denied. Any liability on the part of Defendant's decedent is specifically denied. 15. Denied. Defendant is without knowledge or information sufficient to form a belief a. to the truth of the averments .et forth in para9raph 15 and the aver.ent. are therefore denied. any liability on the part of Defendant'. decedent is spacifically denied. -)- 16. Denied, Defendant is without knowledge or information sufficient to form a belief as to the truth of the averments set forth in paragraph 16 and the averments are therefore denied. any liability on the part of Defendant's decedent is specifically denied. 17. Denied. Defendant is without knowledge or information sufficient to form a belief as to the truth of the averments set forth in paragraph 17 and the averments are therefore denied. any liability on the part of Defendant's decedent is specifically denied. 18. Denied. Defendant is without knowledge or information sufficient to form a belief as to the truth of the averments set forth in paragraph 18 and the averments are therefore denied. any liability on the part of Defendant's decedent is specifically denied. 19. Denied. Defendant is without knowledge or information sufficient to form a belief as to the truth of the averments .et forth in paragraph 19 and the averments are therefore denied. any liability on the part of Defendant'. decedent is spacifically denied. 20. Denied. Defendant i. without knowledge or inforaation sufficient to for. a belief a. to the truth of the averaent. set forth in paragraph 20 and the aver.ents are therefore denied. any liability on the part of Defendant'. decedent 18 specifically denied. -4- 21. Denied. Defendant is without knowledge or information sufficient to form a belief as to the truth of the averments set forth in paragraph 21 and the averments are therefore denied. any liability on the part of Defendant's decedent is specifically denied. 22. Denied. Defendant is without knowledge or information sufficient to form a belief as to the truth of the averments set forth in paragraph 22 and the averments are therefore denied. any liability on the part of Defendant's decedent is specifically denied. 23. Denied. Paragraph 23 states a legal conclusion to which no answer is required. To the extent that an answer is deemed necessary the averments are specifically denied and proof thereof is demanded at trial. 24. The averments of paragraphs 1-23 hereof are incorporated herein by reference. 25. Denied. The averments of paragraph 25 are specifically denied and proof thereof is demanded at trial. lfn IIA'l'TD 26. P1aint1ff.' c1a1m 1. barred, in whole or 1n part, by the .election of the liaited tort option on applicable policie. of insurance. -5- 27. Plaintiffs' claim is barred, in whole or in part, by the provisions of the Pennsylvania Motor Vehicle Financial Responsibility Law. 28. Plaintiffs have failed to mitigate their damages. 29. Plaintiffs' claim is barred, in whole or in part, by the provisions of the Pennsylvania Comparative Negligence Law. 30. The negligence of Plaintiff Bernadine Clepper consisted of the following: (a) She brought her vehicle to stop on a through roadway creating a hazard and obstacle to approaching traffic; (b) she failed to warn approaching traffic, including Defendant's decedent, of the hazards created by her vehicle stopped on the roadway; (c) despite being warned to stay in her vehicle and to not walk about on the bridge given the icy conditions existing thereon which she was fully aware of she allowed herself to be placed in a position of peril for approaching traffic when she knew, or should have known, in the exercise of reasonable care that the same icy condition that she had encountered would be encountered by approaching traffic; (d) she failed to exercise that degree of care, caution and skill reasonably required under the circuastances; (e) she failed to take those steps reasonable and necessary to avoid being struck in a subsequent collision involving approaching traffic; and -6- vs. IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA Ne. 'Iv' 'JiJ II' (:.~"-' T ~ BERNADINE and PAUL CLEPPER, : Plaintiffs: . . . . Connie L. Nelson, Executrix of the Estate of Richard E. Nelson, Defendant CIVIL ACTION - LAW JURY TRIAL DEMANDED COMPLAINT 1. Plaintiffs Bernadine and Paul Clepper, citizens of the Co_onwealth of Pennsylvania, are husband and wife, adult individuals who reside in Mechanicsburq, CUmberland County, Pennsylvania. 2. Defendant Connie L. Nelson, is the Executrix of the Eatate of Richard E. Nelson, pursuant to Letters Te.tallentary qranted to her by the Reqister of Wills of York County on July 30, 1996. Attached as Exhibit "Aft is a copy of the Certificate of Grant of Letters Testamentary. 3. The facts and occurrences hereinafter related took place on or about December 14, 1994, at approxillately 5:30 a.II., on Williams Grove Road, CUDberland County, Pennsylvania. 4. At that time and place, Mrs. Clepper was operatinq her aotor vehicle, a 1984 Chrysler Lebaron, in a south.rly dir.ction on Willia.. Grove Road. 5. At the .a.. ti.., Mr. Samu.l L. Tau.er had be.n operatinq hi. 1919 Toyota pick-up truck, travelinq North on Willia.. Grove Road. 1 6. As Mr. Tauser entered onto a bridge on Williams Grove Road, his 1989 Toyota pick-up truck slid to the West side of the bridge and came to a stop. 7. When Mrs. Clepper entered onto the bridge, her vehicle also slid West on the bridge and came to a complete stop several feet in front of Mr. Tauser's stationary Toyota pick-up truck. B. After Mrs. Clepper's vehicle came to a stop, she exited her vehicle and walked to the front of her vehicle to inspect whether there was any damage. Mrs. Clepper was standing between the front of her vehicle and the front of Mr. Tauser's 1989 Toyota pick-up truck. 9. While Mrs. Clepper was standing between her vehicle and Mr. Tauser's pick-up truck, Robert E. Nelson, operating a 1989 Ford Lariat XLT, was traveling North on Williams Grove Road, approaching the subject bridge. 10. Mr. Nelson was traveling at a speed too fast for weather and road conditions because he did not bring his vehicle to a stop, notwithstanding the two vehicles stopped on the bridge, and the front of his vehicle collided into the rear of Mr. Tauser's stationary 1989 Toyota pick-up. 11. The force of the i.pact to the rear of Mr. Tauser'. pick-up caused the truclt to be pushed forward and crushed Mrs. Clepper betveen the front of the 1989 Toyota pick-up truck and the front of her Chryaler Lebaron. :I 12. The foregoing accident and all of the injuries and damages set forth hereinafter sustained by Plaintiffs Bernadine and Paul Clepper are the direct and proximate result of the negligent, careless, wanton and reckless manner in which the Defendant's decedent, Richard E. Nelson, operated his motor vehicle as follows: a. failure to have his vehicle under such control as to be able to stop within the assured clear distance ahead; b, failure to keep alert and maintain a proper watch for the presence of other motor vehicles on the highway; c. failure to stay within his lane of travel; d. failure to apply his brakes in sufficient time to avoid colliding into the rear of Samuel Tauser's pick-Up truck; e. failure to travel at a safe speed; f. failure to keep a proper watch for vehicles stopped on Williams Grove Road; g. failure to drive his vehicle with due regard for the highway and traffic conditions which were existing and of which he was or should have been aware; h. failure to keep proper and adequate control over his vehicle; and 1. driving his vehicle upon the highway in a manner endanqerinC) persons and property and in a reckless ..nner with careless disregard to the rights and safety oC others and in violation of the Kotor Vehicle Code of the commonwealth of Pennsylvania. CLAIM I Bernadine CleDDer v. Connie L. Nelson. Executrix of the !state of Richard E. Nelson 1). paragraph. 1 through 12 of the COaplaint are incorporated herein by reCerence. ) 14. Plaintiff Bernadine Clepper sustained painful and serious injuries, causing a serious impairment of bodily function, which include but are not limited to multiple trauma, fractured left pubic ramus, extensive hematoma and bruising of the lower abdominal wall and pelvic areas and upper hip areas, a contusion to the right femoral nerve, depression, and anxiety. 15. By reason of the aforesaid injuries sustained by Mrs. Clepper, she was forced to incur liability for medical treatment, medications, hospitalization and similar miscellaneous expenses in an effort to restore herself to health, and claim is made therefor. 16. Because of the nature of her injuries, Mrs. Clepper has been advised and, therefore, avers that she may be forced to incur similar expenses in the future, and claim is made therefor. 17. As a result of the aforementioned injuries, Mrs. Clepper has underqone and in the future will undergo physical and mental suffering, inconvenience in carrying out her daily activities, loss of life's pleasures and enjoyment, and claim is made therefor. 18. As a result of the aforesaid injuries, Mrs. Clepper has been and in the future will be subject to humiliation and ambarras..ent, and claim is made therefor. 19. As a result of the afor..entioned injuries, Mrs. Clepper has sustained a serious injury and a serious iapairaent of bod il Y functl on, 4 20. As a result of the aforementioned injuries, Mrs. Clepper has sustained work loss, loss of opportunity, and permanent diminution of her earning power and capacity, and claim is made therefor. 21. As a result of the aforementioned injuries, Mrs. Clepper has sustained uncompensated work loss, and claim is made therefor. 22. Mrs. Clepper continues to be plagued by persistent pain and limitation and, therefore, avers that her injuries may be of a permanent nature, causing residual problems for the remainder of her lifetime, and claim is made therefor. 23. The insurance forms Mrs. Clepper signed with her insurer, State Farm Mutual Automobile Insurance Company, do not comply with 51705(a) (2) of the Pennsylvania Motor Vehicle Financial Responsibility Law providing that the tort option notice shall be printed on one sheet of paper in prominent type and in a prominent location and moreover, the State Farm form did not provide Mrs. Clepper a place for her to sign the form as required by 51705(a) (1). CLAIM II Paul Cleaner Y. Conn!. L. Nelsan. Administratrix af the Estate of Richard E. Nelson 24. Paragraphs 1 through 23 of the co.plaint are incorporated herein by reference. 25. AS a re.ult of the afore.entioned injurie. sustained by his vife, Plaintiff Bernadine Clepper, Plaintiff Paul Clepper 5 1 · #28 BERNADINE and PAUL CLEPPER, plaintiffs . . . . IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA . . v. : CIVIL ACTION LAW . . CONNIE L. NELSON, Executrix of the Estate of RICHARD E. NELSON, Defendant . . . . 96-5075 CIVIL TERM IN RE: PRE-TRIAL CONFERENCE At a pre-trial conference held August 27, 1997, before Edgar B. Bayley, Judge, present for the plaintiffs was David L. Lutz, Esquire, and for the Defendant, Karl Hildabrand, Esquire. On Deceaber 14, 1994, Plaintiff, Bernadine Clepper, slid on some ice and her vehicle came to a stop near a pick-up truck that had also slid on the ice and had come to a stop. plaintiff got out of her vehicle. Defendant approached in his vehicle, slid on the ice, struck the rear of the other vehicle which pushed Plaintiff between that vehicle and her vehicle causing her personal injuries. Liability is contested. Defendant claiaa Plaintiff was contributorily negligent. Counsel should provide the trial judqe with a brief on the issues of liability and contributory negligence. Plaintiff sustained a fractured pelvis and related soft tissue injuries. Plaintiff seeks general daaag.s, lost vages and loss of earning capacIty. Her husband, Paul Cleppar, ...ks lo.s of consortlua. i Defendant, Richard E. Nelson, is deceased and his death had nothing to do with this accident. Defense counsel represents that he will not be calling the executrix, Connie L. Nelson, as a witness unless testimony develops at trial that would make her input relevant. Under a case decided by the Superior court, upon which the Supreme Copurt has accepted review, Plaintiff acknowledges that a limited tort issue applies to the facts of this case and both counsel agree that the limited tort issue will be submitted to a jury. Plaintiff has filed a motion in limine to protect the record, maintaining that limited tort does not apply in case the Supreme Court reverses the superior Court. The trial judge should make a ruling on this motion in limine in order to protect the record for Plaintiff. Plaintiffs' counsel seeks to show the jury a day-in-the-life video of Plaintiff as she is affected by her injuries. The defendant will object. The admissibilty of such a video should be briefed and submitted to the trial judge at the co.aence_nt of trial. The e.timated time of trial i. 1 1/2 days. By the cou,r~1" // J. David L. Luta, EsquIre rol' plaintiffs Itarl R, Hllubrand, EIIq\IIre For Defendant ) :lkt 793 CIV.L 1993 The jury's conclusion, based on these factors, docs not shock our sense of justice. There was evidence that, among other things, the plaintiff was not prevented from performing any of the normal activities of daily life, and was able to play softball, drive a motorcycle, move his belongings across the country and travel. Furthermore, he was only immobilized from the accident for a short period of time and no evidence established conclusively that an impairment would develop in the future. In response to the plaintiffs second contention. it is well established that the trial court has a broad grant of discretion ,.ith regard to expert testimony. Whistler SoorlSwear. Ine. v, B!!l!2. 289 Pa.Super. 230, 433 A2d 40 (l981). Furthermore, in Pennsylvania, it is now agreed that an expert opinion as to an ultimate issue in a case should be excluded if it /"ould mislead, confuse or prejudice the jury. Bessemer Stores. Ine. v, Reed Shaw Stenhouse. Ine.. 344 Pa-Super. 2l8, 496 A2d 762 (l98S). The plaintiff argues that Dr. Lippe should have been a\lowed to state his opinion on whether Mr. Orl\ic's injury was serious aocording to the standard set fonh in Dodson. supra, The way in which the suspect questions were phrased, the doctor was asked to express an opinion not only about Mr. Oravic's injury but about the substance of a judicial holding. In other words, the opinion elicited was not only with regard to the extent of injury but whether, as a lu!l matter, it met the required thresho\d. We arc satisfied that elicitinc this opinion from a medical witness ....as prejudicial to the defense. We continue to be satisfied that the ucIusion of this opinion testimony ,,'as not error. We win grant the plaintiffs requested relief based on his third argument. 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