HomeMy WebLinkAbout96-06873
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. March 5. 1998, ut which time she testilied t1ll1tthe vehicle in which she was riding was traveling
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uta relutively low rate of speed at the time of the accident in which her vehicle rolled over.
(Deposition of Curia Fishcl, dated 3/5/98. p. 8, In. 3. 19). Plaintiff Fishel bumped uguinstthe
right side of the cur but did not lose consciousness. She did not strike the windshield or the
dashboard, She felt stunned. but other thun thut she did not really feci bud. (Curia Fishel Depo.,
p, 10, In, 19,21,23; p, II, In, 19; p. 12,ln. 4-5), Plaintiff Fishel did not seck any treatmcnt from
the paramedics whcn the .\mbulancc urri\ed, (Curia Fishel Depo.. p. 13. In, 3-4), Instcud, she
and her husband wcnt home, got a different cur and continued with their planncd trip to hcr son's
wrcstling match in Perry County, (Carla Fishel Dcpo.. p, 13,In, 19.25; p. 14,ln. 5-6).
Plaintiff Fishel did not scck lIny medical attention that day, although she did begin to leel
soreness in her shoulders,neck and head later in the day, (Carla Fishel Depo" p. 14, In, 9.10,
16-21). Two days after the accident she voluntarily called her chiropractor, whom she had secn
before lor unrelated lower back problcms. (Carla Fishel Depo.. p. IS, In. 2-3, IS). She receivcd
manipulations and ultmsound to her neck from her chiropractor. (Carla Fishel Depo.. p. 17,ln. 7,
9.10, 13). Her chiropractor did notlcfer her to a physician at that time, (Carla Fishel Depo., p.
17,In, 18).
Plaintiff Fishel did not miss any time from work us a result of the accident. (Curia Fishel
Depo" p. 2(1, In. 22.24). She holds the same job that she had prior to the time of the accident.
(Carla Fishel Depo.. p. 23, In. I). She is able to perform her normal activities at work. (Carla
Fishel Depo., p. 34, In. 13). Plaintiff Fishel did testify that her right arm will occasionally go
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Zlolko, the plaintiff sustained injuries to his neck, lower back and suftered numbness in his face
and toes ns a result of nn automobile accident. Hc underwent physicnltherapy and an MRI
showed that he had a herniated disc. lie voluntarily sought und received treatments for his
injured buck from a local chiroprnctor. The plaintiff further asserted thut he sufli:red back pain as
a result of physical uctivity or sining for long periods of time, he had trouble sleeping, could not
run, nnd was unable to walk or sit lor longer than 15 minutes. He ulso contended that he WllS no
longer able to engage in recreationul activities such as mountain bike riding, motor cycle riding
and hunting. W. nt 874, The plaintilT rcturncd to work lhrcl' days aller thc incident and wns able
to return to his full work duties within a short pcriod of lime. The plaintiff sought medical
treatment three weeks aller the accident. Although hc was diagnosed with a herniated disc his
physician did not recommend surgery. He reecived no ongoing medicallreatment or prescription
medication. 1Il. Based upon the facts of the Zi.QJkQ case, the Superior Court aflirmed the trial
court's determination that the plaintiff did not sustain a serious bodily injury. The Court noted
that while there was impairment, it was not serious impairment because it did not interfere
substantially with his normal activities. W. citing Dodson, at 499.50 \, 665 A2d at \234.
The Superior Court's Decision in Dodson also provides guidance in this case. The Court
found that Dodson's injures did not qualify as a serious impairment of bodily function. Dodson
was out of work for approximately live months during which time he wore an arm sling. He
eventually returned to work with a full range of motion and no restrictions. He received physical
therapy and two injections. Further. he claimed to have continued weakness and no longer
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participlltcd in rccrealional bowling. wcighllit\lng or sot\bulL Hc rccelved no ongoing trcUlmcnl
or prcscriptionmediclllion. The Dodson Court agrecd wilh Ihe triul court thllt thc complllints of
Pllin did not result inu scrious impllinllcnl of bodily funelion und Ihat therc wus no scrious
intcrferenee with thc plainliffs daily life, Bceause thcre was no triable issue of Iilctllllltthe
plaintiff suffcred u minor ruther than a serious injury. sumnHlry judgment was grunlcd,
Thc !tlctS oflhis case reveal thaI Plaintiff Fishel"s injuries do not constilutc a scrious
impairment of bodily funclion. and ure even less severe thanlhe impairmcnt suswined by thc
plainliffs in ZW.llillllnd Dodson. For example. Plaintiff Fishel did not miss a singlc day of work
us a result of her injury, She returned to her regular position and conlinued to work in it with
only mild problems if she used her right hand too much. She did not receive any medical
trcatment utthe timc ofthc uecident .1I1d in!tlct continued on to her son's wrcstling match.
Furthcr, she voluntarily soughl treatment with her own chinlpructor with whom she hud trcatcd
for u prior unrclutcd lower buck problem. ;\ yeur and u half latcr hcr chiropructor referrcd her to
Dr. Danyo,an orthopuedic surgeon. who diagnosed two herniated discs in the Plaintiffs neek
which did not requirc surgical intervention. She saw Dr. Danyo two or three times, but has not
received any medical treatment since 1994. She is not taking any prescription medication, but
instead relics upon over-thc-counter pain relievers us nccessary, She continli'~s 10 perforl11all of
her household chores and hobbies limited only by mild numbness in her right hand. She no
longer enguges in volleyball by choice. lieI' physiciuils have plueed no restrictions on her. Based
upon the facts of this cuse, summary judgment should be grunted in!llvor of the Defendant
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againstlhe Plaintitl's.
V. CONCLUSION
Based upon the foregoing arguments, il is respectfully submilled Ihlltthls Honornble
Court grant the Defendant's Motion filr Summllry Judgment and dismiss the Compluint with
prejudice.
Respectfully submilled,
HARTMAN & MILLER, P,C.
By: _ IJl1",1 A 1J'-"~
~'M. Hnrtmnn. Esquire
Supreme Court I.D, #21902
Drew P. Gnnnon, Esquire
Supreme Court 1.0. #74680
126 - 128 WlIlnut Street
Hnrrisburg, P A 17101
(717) 232-3046
Allorneys for Defendant, Carey C. Welsh
Dated: q. Jl/~ ?f/
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DEFlNlTlONS AND INSTRUCTIONS
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(A) Whenever the tenn "document" is used herein, it includes (whether or not
specifically called for) all printed, typewritten, handwritten, graphic or recorded matter, however
produced or reproduced and however fonnal and infonnal.
(B) Whenever you are asked to "identify" a document, the following infonnation
should be given as to each document of which you are aware, whether or not you have
possession, custody or control thereof:
(I) The nature of the document (e.g., letter, memorandum, computer
print-out, minutes, resolution, tape recording, etc.);
(2) Its date (or if it bears no date, the date when it was prepared);
(3) The name, address, employer and position ofthe signer or signers
(or if there is no signer, of the person who prepared it);
(4) The name, address, employer and position of the person, ifany, to
whom the document was sent;
(5) If you have possession, custody or control of the document, the
location and designation of the place or file in which it is contained, and the name,
address and position of the person having custody of the document;
(6) If you do not have possession, custody or control of the document,
the present location thereof and the name and address of the organization having
possession, custody or control thereof; and
(7) A brief statement of the subject matter of such document.
(C) Whenever you are asked to "identify" an oral communication, the following
infonnation should be given as to each oral communication of which you are aware, whether or
not you or others were present or participated therein:
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( I ) The means of communication (e.g., telephone, personal
'.
conversation, etc.);
(2) Where it took place;
(3) Its date;
(4) The names. addresses, employers and positions (a) ofBlI persons
who pmlcipated in the communication; and (b) ofal! other persons who were
present during or who overheard that communication;
(5) The substance of who said what to whom and the order in which it
was said; and
(6) Whether that communication or any pm thereof is recorded,
described or referred to in an)' document (however informal) and, if so, an
identification of such document in the manner indicated above,
(0) If you claim that the subject matter of a document or oral communication is
privileged, you need not set forth the brief statement of the subject matter of the document, or the
substance of the oral communication called for above. You shall, however, otherwise "identify"
such document or oral communication and shall state each ground on which you claim that such
document or oral communication is privileged.
(E) Whenever you are asked to "identify" a person, the following information should
be given:
(I) the name, present address and present employer and position of the
person; and
(2) Whether the person has given testimony by way of deposition or
otherwise in any proceeding related to the present proceeding and/or whether that
person has given a statement whether oral, written, or otherwise, and ifso, the tille
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PERSONAL IDENTIFICATION
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1. State:
(a) Your full name and each other name which you have used or by which you
have been known; your date and place of birth; your present residence
address and each other address and period of residence which you have
had during the past five years;
(b) Your Social Security Number; and
(c) Name of all spouses and the inclusive dates of your marriage relationship as to
each spouse named.
ANSWER:
A. Carla Denise Fis~el
1/~5/52
Carlisle Hospital
Carlisle, PA
Cumberland co.mty
B. Residence
612 Range End R6ad
Lot 57
Dillsburg. PA
Franklin Township
B. SSN: 185-38-2488
C. Ted L. Fishel
10/08/76
NON.EXPERT WITNESSES
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6. State the mimes, residence and business addresses. and employers of each person whom
you will call to testify on your behalf at the trial of this matter, and briefly state the
subject matter of their proposed testimony,
ANSWER:
Ted L. Fishel
612 R~nge End Road
Dillsburg, PA 17019
L~y witneeses are "nascert~ined at this time.
Trooper Ron~ld F. GingriCh
PA State Police
Elmerton Avenue
H~rrisburg, PA
EXHIBITS
7, Identify by date of preparation, description, and name of person preparing, all documents
or other objects which you will introduce as exhibits at the: trial of this matter, identified
with regard to the issues of liability (L) and damages (0).
ANSWER:
Unascert~ined at this time.
STATEMENTS:
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9. Do you or anyone IICling on your behalf know or believe that any written statement (as
defined by the Rules of Civil Procedure) or any oral statement concerning this IIl:tion or
its subject matter has been given by or obtained from any person?
If so, identify (by staling the name, last known home and business address):
(a) ElIl:h person who gave an oral statement and when, where, and to whom it was
made; and the substance of each such statement;
(b) Any person who has custody of any written statements or those reduced to a
writing or otherwise recorded.
ANSWER:
None available.
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13. Identify all hospitals. clinics. nursing homes or other institutions in which you have been
confined or received out-patient treatment because of the injuries sutTered and include the
name and address of the institution, the dates of confinement and out-patient treatment,
the treatment and services rendered and the cost of each.
ANSWER:
See copies of medical reports and records attached hereto.
14. With regard to each institution referred to in the preceding Interrogatory, identify the
doctor or doctors perfonning or giving the treatment or procedure. the date, when given
or perfonned and the nature ofthe treatment, examinations, evaluations and operations
perfonned and the cost of each.
ANSWER:
See attached payment log from Prudential as well as
itemization from Dr. Clifford Renyo's office. Other
medical expenses are being accumulated and this
Interrogatory will be supplemented.
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I S. State the lIame and address of each doctor, medical practitioner or health ClUe provider of
any. type wJtatsoever who has examincd, evaluated or treated you or from whom you
soughttreatinent or diagnosis of any injury resulting from the incident for treatment or
diagnosis of any injury allegedly resulting from the incident, specifying the date of
consultation, the injury for which you consulted, the treatment rendered and the cost of
such examination or treatment. Specify those physicians from whom you are presently
receiving treatment.
ANSWER:
See answer to 13 and 14.
16. When. where and by whom were you last examined or given medical attention
concerning the injuries received in this incident?
ANSWER:
,
I last eaw Dr. Willard. my family doctor, for pain medication.
He is located at Walnut Bottom Road in Carlisle. Pennsylvania.
17. State how eBth injury you sustained affected your nonnal employment, home or
reoreational activities, describe in detail the nature of such restraint and indicate any
present disability and the percentage, ifpennanenl.
ANSWER: Neck inj ury caused severe headaches
neck and shoulder pain - pain extended down right arm into hand
Driving car impaired because of limited mobility of my neck. I still
have that problem turning head. I have always enjoyed crocheting,
painting. writing poetry and reading - because of pain and numbness
in hand it is difficult to do them. Workwise, I work with a
computer almost constantly, therefore, there are problems with my
hands going humb. Even writing this is something I cannot do for
very long without losing feeling in my hands. All in all, the
injury has caused me problems in almost everything I do. My
condition with pain and numbness in my hands has worsened with time.
18. State the nature and estimated cosls of all future medical attention, evaluation and
treatment which you have been advised you will require as a result of injuries allegedly
sustained in the incident and .lale the name and address of the individual furnishing such
opinion and estimate of costs.
ANSWER: I was told by Dr. J. Danyo that this is a condition
which will cause me problems the rest of my life. although'at the
time of my last vibit he did not believe I needed surgery, but th~t
could be needed at a tuture time. I do know my husband's neck
surgery seven years lIgn ('''Rt sf-out ~4(1, 0('10,1\('1. r'y famj' y doctor
(Dr. Willard) recommended along with Dr. Renyo that massage
therapy to the neck, shoulders and arms could be of some relief of
symptoms. I go now every two weeks at d cost of $40.00 per visit.
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CERTifiCATE OF SERVICE
t... .
I. Jack M. Hartman, Esquire, hereby certify that I am this day serving a copy ofthe
foregoing document upon the person(s) and in the manner indicated below, whieh service
satisfies the requirements of the Pennsylvania Rules of Civil Procedurll. by depositing a copy of
same in the United States mail, first-class postage prepaid, as follows:
Joseph J. Dixon. Esquire
The Law Office of Joseph J. Dixon. Esquire
126 State Street
Harrisburg, PA 17101
HARTMAN & MILLER, P.C.
By:
.f~'~~(
Jack M. Hartman, Esquire
Supreme Cl. I.D. #21902
One Keystone Plaza, Suite 107
Front and Market Streets
Harrisburg, PA 17101
(717) 232-3046
(r
Dated: LP Ian ('(7
BY:
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~9seph-J. Dixon, Esquire
Attorney No. 28290
126 State Street
hd~~i~bu~y. ~R 17101
(717) 236-8515
Attorney for the Plaintiffs
Dated:
III J 1 ! {f 1
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CBRTIFI~ATE OF SERVICE
I hereby certify that I served a copy of the foregoing
document by depositing the same in the united States mail, Pirst
Class, poutage prepaid, at the following address (es) :
Drew p, Gannon, Esquire
HARTMAN & MILLER, P.C.
one Keystone Plaza, Suite 107
Front and Market Streets
Harrisburg, PA 17101
By
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Jo ep J. Dixon,
1 State Street
Harrisburg, PA 17101
(717) 236-8515
Attorney for the Claimant
Date:
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418 PCl
~LL CHARGE$~PAVMENTS
ITEMIZED
S TAT E MEN T
DAr",: 10/11/'9f>
IRS": ;,?S-1647349
EMf'LOVER'
INSURED' TED & CARLA FISHEL
PATIENT' CARLA FISHEL 100940
612 RANGE END RD
DILLSBURG PA 17019
SS.185-38-S488 POL.4~M02l71-12041
DATE~INJ' 02/06/93 GRP..
TO. PRUDENTIAL INSURANCE CO
PO BOX 977
HORSHAM PA 19044
OILL56URG CHIROPRACTIC CENTER
P.O. Box 668
OILLSBURG. PA 17019
717/432-5099 Fa)('717/432-~332
DIAGNOSIS:
847.0 ACUTE TRAUMATIC ACCHLERATION'DECELERATIUN INJUR
846. ACUTE TRAUMATIC MILD LUMBAR SPRAIN
.
Fe: PER-1NJURV
DATE OF LAST BILL: 01/U~/96 PRII RE507bO~ lOll RE507603
DATE
CPT
.......n....................========m.......................................... I
AMOUN' . I
...................~a======~=a.a._...~.......~=*w....n.........................
02108/93 720S0
02~08~93 72110
02/08/93 99205
02~08/93 1019715
02/09/93 1012000
02~09/93 97014
02/09/93 97128
02~09/93 97010
02/09/93 A4SS6
02/15/93 1012000
02/15/93 97014
02/15/93 97128
02~15/93 97010
02/17/93 1012000
02~17/93 97014
02~17~93 97128
02/17/93 97010
02/24/93 A2000
02/24/93 97014
02~24~93 97128
02/24/93 97010
03~01~93 A2000
03/01/93 97014
03/01~93 97128
03/01~93 97010
03/03/93 A2000
03~03/93 97014
03/03/93 971:o'!8
DESCRIPTION
* POS TOS .
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
100.0c I
105.0c
55.0c
51.0C
25.0c
16.0c
18.0'
10.01 I
26.0- i
25.01
16,0'
18.0'
10.0
25.0 !
16.0 !
18.0
10.0
25.0
16.0
18.0
10.0
25.0
16.0
18.0 i
10.C .
2!.C
16.C
18.C
XRAY CERVICAL t~ VIEWS)
XRAV LUMBAR 3 VIEWS
COMPo INITIAL OFFICE VISIT
PHYSICAL THERAPV 2MODALITIES
SPINAL ADJUSTMENT
EI.ECTRICAL MUSCLE 5HMUl.ATrON
ULTRASOUND
HYDROCOLLATOR/CRYOTHERAPY
RE-USA8LE ELECTRODES
SPINAL ADJUSTMENT
ELECTRICAL MUSCLE STIMULATION
ULTRASOUND
HYOROCOLLATOR/CRYOTHERAPY
SPINAL ADJUSTMENT
ELECTRICAL MUSCL~ STIMUl.ATlON
ULTRASOUND
HYDROCOLLATOR/CRYOTHERAPY
SPINAL ADJUSTMENT
ELECTfHCAI M~J!;,CL E S TIMI.lLAT ION
ULTRASOUND
HYDROCOLLATOR/CRYOTHfRAPY
SPINAL ADJUSTMENT
ELECTRICAL MUSCLE STIMULATION
Ul. TRASOUND
HYDROCOLl.ATOR/CRYOTHERAPY
SPINAL ADJUSTMLNT
EL.ECTR lUlL MU"CU' '\ T fMU!. ~'IT [ON
ULTRASOUNO
CONTINUEr,
* 11 4
.. 11 4
* 11 4
* 11 1
.. 11 1
.. 11 1
* 11 1
.. 11 1
* 11 1
.. 11 1
* 11 1
* 11 1
.. 11 1
.. 11 1
.. 11 1
.. 11 1
.. 11 1
* 11 1
.. 11 1
.. 11 1
.. 11 1
.. 11 1
.. 11 1
* 1\ 1
.. 11 1
.. 11 1
.. 11 1
'" 11 1
......._.........~S.2C=2=:==:.D__~.~...~....2a.=.=.========...................
SUBTOTAL'
740.C
~~~ CHARGES/PAYMENTS
ITEMIZED
S TAT E MEN T
DATE: 10/11/9/,
418 PIil2
IRS.: 20-1647349
IN6UR!:D' TED & CA~LA F'ISHI::L
PATIENT: CARLA FISHEL 100940
612 RANGE END RD
DI~~SBURG PA 17019
65.185-38-5406 POLW46M02271-l2041
DATE/INJ: 02/06/93 GRP.
TO I PRUDENTIAL INollRANCE CO
PO BOX 977
HORSHAM PA 19044
EMPl.OYER:
DILL~eURG CHIROPRACTIC CENTER
P.O. FlOM 666
DILLSBURG. PA 17019
717/432-5099 FSM:7l7/432-7332
DIAGNOSIS:
847.0 ACUTE TRAUMATIC ACCELERATION-DEC~LERATION INJUR
1546.
ACUTE TRAUMATIC MILD LUMBAR SPRAIN
FC: PER-INJURY
DATE OF LAST BILL: 01/02/96 PRn RE507603 10. RE507603
DATE
CPT
................__.======D~Q.......*.~=C....====:==.=..==zm....................
AMOUN'
DESCRIPTION
* POlO TOS ..
......=.aa~.._...........~.....-~:====~~=======.==.--=.===~==~aa._..a._.~.....1
03/03/93 97010
03/08/93 A2000
03/08/93 97014
03/08/93 97128
03/08/93 97010
03/10/93 A2000
03/10/93 97014
03/10/93 97126
03/10/93 97010
03/17193 A2000
03/17/93 97014
03/17/93 97128
03/17/93 97010
03/19/93 A2000
03/19/93 97014
03/19/93 97126
03/19/93 97010
03/22/93 99212
03/22193 97014
03/22/93 97010
03/24/93 99212
03/24/93 97014
03/24/93 97010
03/26/93 99212
03/26/93 97014
03/2<<'/93 97010
03/2'l'/93 99212
03/29/93 97014
HYOROCOLLATOR/CRYOfHERAPY
SPINAL ADJUSTMENT
ELECTRICAL MUSCLE STIMULATION
ULTRASOUND
HYDROCOLLATOR/CRYOTHERAPY
SPINAL ADJUSTMENT
ELECTRICAL MUSCLE STIMULATION
ULTRASOUNP
HYDROCOLLATOR/CRYOTHERAPY
SPINAL ADJUSTM~NT
ELECTRICAL MUSCLE !;.TIMlJl ATION
ULTRASOUND
HYDROCOLLATOR/CRYOTHERAPY
SPINAL ADJUSTMENT
ELECTRICAL MUSCLE STIMULATION
ULTRASOUND
HYDROCOLLA T OR/C RYO T~IF.:RAP Y
OFFICE VISIT
ELECTRICAL MUSCLE STIMULATION
HYDROCOLLATOR/CRYOTHERAPY
OFFICE VI5IT
ELECTRICAL MU-;;,CL[ '_,'r IMUI..ATION
HYDROCOLLATOR/CRYOTHERAPY
OFFICE VISIT
ELECTRICAL MlISCI_F ~,TIMlJL.ATION
HYDROCOLLATOR/CRYOTHERAPY
OFFICE VISIT
ELECTRICAL MUSCLE STIMULATION
CONTINUED
* 11 1
* 11 1
* 11 1
* 11 1
* 11 1
* 11 1
* 11 1
* 11 1
* 11 1
.. 11 1
* 11 1
* 11 1
* 11 1
* 11 1
* 1l. 1
* 11 1
* 11 1
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* 11 1
* 11 1
* 11 1
,.. 11 1
* 11 1
'* 11 1
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1
1
1
1
1
1
1
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1
1
1
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1
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1
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1
1
1
1
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10.0'
25.0C
16.0'
18.0c
10.0'
25.0<
U..O.
18.0'
10.0'
25.0'
16.0
18.0'
10.0
25.0
16.0
18.0
10.0
25.0
16.0
10.0
25.0
16.0
10.0
25.0
16.C
10.0
2S.C
16.0
...........==.Q=a.=_=..a.*..=u...~~W.U2..~.=..~=~.=S=.ZQ..2U.........*.........
SUBTOTAL:
1.220.C
ALL CHARGES/PAYMENTS
I T E M I ZED
S TAT E MEN T
DATI!::' 10/11/9t>
418 P03
EMPLOYER:
IR$II: 25-1647349
INSURED: TED & CARLA FISHEL
PATIENT' CARLA FISHEL 100940
612 RANGE END RD
DILLSBURG PA 17019
SSII18S-38-548e POL1I46M02271-12041
DATE/INJ' 02/06/93 GRPII
TOI PRUDENTIAL INSURANCE CO
PO BO)( 977
HORSHAM PA 19044
DILL SBlJHG CHIROPRACTIC CENTER
P.O. Box 668
OILLSBURG. PA 17019
717/432-5099 Fax'717/432-7332
DIAGNOSIS'
847.0 ACUTE TRAUMATIC ACCELERAT10N-DEC~L~RArIDN INJUR
846.
ACUTE TRAUMATIC MILD LUMB~R SPRAIN
FC: PER-INJURY
DATE OF LAST BILL: OL/02/96 PRII RE507b03 tD~ RF507603
DATE
CPT
........._........._._a==~==~.............a~...s._....a........................
AMOUN.
.................====~~._..........====~=._.nft_A.a.............................
03/29/93 97010
03/31/93 A2000
03/31/93 97014
03/31/93 97128
03/31/93 97010
04/02/93 99212
04/02/93 97014
04/02/93 97010
04/02/93 A4SS6
04/05/93 99212
04/05/93 97014
04/05/93 97010
04/0S/9~ A4556
04/07/93 99212
04/07/93 97014
04/07/93 97010
04/08/93 97014
04/08/93 97010
04/08/93 9712fl
04/14/93 99212
04/14/93 97014
04/14/93 97010
04/19/93 99212
04/19/93 97014
04/19/93 97010
04/21/93 99212
04/21/93 97014
04/21/93 97010
DESCRIPTION
HYDROCOLLATOR/CRYOTHERAPY
SPINAL ADJUSTMENT
ELECTRICAL MU~CLE STIMULATION
UL TRASOlJND
HYOROCOLLATOR/CRYOTHERAPY
OFFICE VISIT
ELECTRICAL MUSCLE STIMULATION
HYDROCOLLATOR/CRYOTHERAPV
RE-USABLE ELECTRODES
OFFICE VISIT
ELECTRICAL MUSCLe STIMULATION
HYDROCOLLATOR/CRYOTHERAPY
RE-USABLE ELECTRODES
OFFICE VISIT
ELECTRICAL MUSCLE STIMULATION
HYOROCOLLATOR/CRYOTHERAPY
ELECTRICAL MUSCLE STIMULATION
HYDROCOLLATOR/CRYOTHERAPY
UL Tr~ASOUND
OFFICE VI:;. IT
ELECTRICAL MUSCLE STIMULATION
HYDROCOLLATOR/CRYOTHERAPY
OFFICE VISIT
ELECTRICAL MUSCLE STIMULATION
HYOROCOLLATOR/CRYOrHERAPY
OFFICF. VISIT
ELECTRICAL Mu~,C:LF 'i,T1MULATION
HYDROCOLLATOR/(RYOrHr::RAPY
CONTINUED
* POS TOS It
* 11 1
* 11 1
.. 11 1
* 11 1
.. 11 1
.. 11 1
.. 11 1
.. 11 1
.. 11 1
.. 11 1
.. 11 1
,. 11 1
* 11 I
.. 11 1
* 11 1
.. 11 1
.. 11 1
.. 11 1
,.. 11 1
.. 11 1
.. 11 1
.. 11 1
.. 11 1
.. 11 1
.. 11 1
'. 11 1
.. 11 1
* 11 1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
10.0l
25.0<
16.0l
18.0<
10.0<
25.0<
16.0l
10.0<
2&.Ol
25.0<
16.0c
10.0<
25.0'
25.01
16.0'
10.0'
16.0'
10.0'
18.0
25.0
16.0
10.0
25.0
16.0
10,0
2&.0
16.0
10.0
.............2.~_=_====~._..ft_.3_=Z~=====~._~......_M..~............a._.......
SUBTOTAL:
1.699.0
418 P04
ALL CHARGES/PAYMENTS
I T E M I ZED
S TAT E MEN T
OATE' 10/11/96
INSURED: TED & CARLA FISHEL
PATIENT' CARLA FISHEL 100940
612 RANGE END RD
DILL6BURG PA 17019
6151186-38-5488 POL.46M02271-1~041
DATE/INj, 02/06/93 GRPM
TO. PRUDENTIAL INSURANCE CO
PO BO)( 977
HORSHAM PA 19044
IRS~' 2~-1647349
EM,",LOYER'
DILL&6URG CHIROPRACTIC CENTER
P.O. Bo)( 6613
D1LL5BURG, PA 17019
717/432-5099 Fs><:717/432-7332
DIAGNOSIS:
847.0 ACUTE TRAUMATIC ACCEL~RArlON-UfCELERArlUN INJUR
844.
ACUTE TRAUMATIC MILD LUMBAR ~PRAIN
FC: PER-INJURY
DATE OF LAST BILL: 01/02/96 PRU RL507b03 10. RE507603
...............====~_.~_.._...........Q==============~==.=mc..k................
DATE
CPT
DESCRIPTION
* pas TOS ..
AMOUN'
.......................B~.=.========a___.......................................
03/01/95 NAR NARRATIVE REPorn 3 9 1 276.0'
08/14/95 97265 SPINAL MOBILIZATION 11 1 1 30.0(
08/14/95 97014 ELECTRICAL Mll~,CL.E !'.oTIMUL.ATION 11 1 1 18.0'
08/14/$15 97035 ULTRASOUND ( ATTENDt:D) 11 1 2 40.0(
08/14/95 97010 HYDROCOLLATOR/CRYOTHERAPY 11 1 1 IlL O'
08/21/95 97265 SPINAL MOBILIZATION 11 1 1 30.0(
08/21/95 97014 ELECTRICAL, MUSCLE ',,1 IMULAT IClN 11 1 1 18.0'
08/21/95 97035 UL TRASOLJND ( ATTENDED) 11 1 2 40.01
08/21/95 97010 HYDRO COLLATOR/CRYOTHERAPY 11 1 1 1$.0'
10/18/95 97265 Si=>INAL MoeILIZAT[ON 11 1 1 30.0<<
10/18/95 97014 EI..ECTRIC:AL MU~,CU:: ST IMULAT WN 11 1 1 18.0'
10/18/95 97035 ULTRASOUND (ATTENDED) 11 1 :2 40.0<
10/18/95 97010 HYDROCOLLATOR/CRYOTHERAPY 11 1 1 16.0-
06/21/93 IN PAYMENT-INS PRUD 2'.'24-9~ 11106075 -60.3:
06/21/93 IA ADJUs.rMENT FORlUVE 11106075 -8.6
06/21/93 IN PAYMENT-INS 2-6/9-'~,3 11106076 -228.8;
04/21/93 IA ADjUSTMENT FOr~G I VE 11106076 -123.1
06/21/93 IN i=>AYMENT-'INS ;2-9/1.5-93 11106077 -74.3
04/21/93 1A ADJUSTMEN1' F'ORC1VE 11106077 -37.6
04/21/93 IN PAYMENT-INS 2-15/17-9.3 111 06076 -70.3
04/21/93 IA ADJUSTMENT ForWIVE 11106076 -8.6
06/21/93 IN i=>AYMENT-INS 3-1/:3-cJ3 11108446 -94.8
06/21/93 IA ADJUSTMENT f' ORe; I VE 11108446 -13.2
06/21/93 1"1 PAYMENT--INS 3'.3-';'3 11106447 -23.9
04/21/93 IA ADJUS'rMENT FORGIVE 11108447 -4.0
06/2],/93 IN PAYMENT-INS :3"'6/10 ,93 11106448 -96.8
06/21/93 IA ADJU,:,TMENT FORGIVE. 11108446 -13.2
CONTINUED
..........._...===~:__._..___._s~===:.a............._.........................
SUBTOTAL: 6,747.0
418 P0S
ALL CHARGES/PAYMENTS
I T E M I Z E 0
S TAT E MEN T
DATE; 10/11/9&
INSUREO' TEO & CARLA FI'i>HEL
PATIENT: CARLA FI~HEL 100940
612 RANGE ENO RO
DILLSBURG PA 17019
5S*185-38-5488 POL"4bMO~Z71-12041
DATE/INJ' 02/06/93 GRP"
TO' PRUOENTIAL INSURANCE CO
PO BO)( 977
HORSHAM PA 19044
IR'i>": 25-1647349
EMI"LOYER'
OILLSBURG CHIROPRACTIC CENTER
P.O. Bo. 666
OILL~8URG. PA 17019
717/432-5099 Fa.:717/432-7332
OIAGNOSIS:
847.0 ACUTE TRAUMATIC ACCELERATION-D~CLLERATION INJUR
846. ACUTE TRAUMATIC MILD L,UMBAI~ SP,(AIN
....._m.=.=.~.=.~==c=z=~=...*.=ax.....~....u..~aga.R====.......................
FC' PER-INJURY
OATE OF LAST BIL~: 01/02/96 PR" RE5U/b03 IOU RE507603
DATE
CPT
OESCRIPTION
* POS TO$ *
AMOUNT
..............A.=============================~==c=a..~..............=..........
06/21/93 IN PAYMENT-INS 3-10/1/-93 "106449 -84.3:
06/21/93 IA AOJUSTMENT FORGIV~ "106449 -12.6~
06/21/93 IN PAYMENT-INS 3-19/2~-93 "108450 -96.8C
06/21/93 IA ADJUSTMEN T FOI~GIVE "106450 -13 .2(
06/21/93 IN PAYMENT-INS 3-22/2b-~3 .108451 -92.8e
06/21/93 IA ADJUSTMENT FORGIVE .108451 -9.11
06/21/93 IN PAYMENT-INS :1-2f,,/31-93 U06452 -92.8e
06/21193 IA ADJUSTMENT FORGIVE .108452 -9.11
06/21/93 IN PAYMENT-INS 3-31-93 "106453 -23,9'
06/21/93 IA ADJUSTMENT FORGIVE .106453 -4.0c
06/21/93 IN PAYMENT-IN5 4-2/5-93 .108678 -82.8e
06/21/93 IA ADJUSTMENT FORGIVE "108678 -34.11
06/21/93 IN PAYMENT-INS 4-5/€t-9:1 UOfJ679 -72.11
06/21/93 IA ADJU'i>TM!::NT FORGIVe IH08b79 -29.8:
06/21/93 IN PAYMENT-INS 4-8/19-93 "10€t680 -91.0!
06/21/93 IA ADJUSTMENT FORGIVE .108680 -12.9/
06/21/93 IN PAYMENT" INS 4-19/'?-0.'/:1 U06661 -92.8.
06/21/93 IA ADJUSTMENT FORC,IVE .106681 -9.1'
06/21/93 IN PAYMENT"INS 4-26/2'~-':I) U08662 -180.11
06/21/93 IA ADJUSTMENT FORGIVE "106682 -31.8:
06/21/93 PA PAYMENT OVER PYMT pr{UDENT -35.21
07129/93 IN PAYMENT-'INS PFlUD !';-3/17-'13 .108955 -89.7.
07/29/93 IA ADJllSTMENT FORGIVt:: .1089~5 -12.2'
07/29/93 IN PAYMENT-INS PRUD 5-1/L7-93 .106956 -88.7.
07/29/93 IA ADJUSTMENT FORC,lVI:. U08956 -28.2
07/29/93 IN PAYMENI"INS PNUD -:"j/l/"';.3 11108957 -10.0'
08/17/93 IN PAYMENT-INS RE-USADLL PADS -20.0
08/17/93 IN PAYMEN'I"IN'; PRlJD 6-7126"9:.1 .109Z73 -88.3-
_. . COtillNU~
Page 15
A~~ CHARGESIPAYMENTS
5 TAT E MEN T
ITEMIZED
DATE: 10/11/9b
INSURED: TED & CARLA FISHEL
PATIENT: CARLA FISH~L 100940
612 RANGE END RD
DI~~$BURG PA 17019
SS.18S-3e-S48e POLM46M02271-12041
DATE/INJ: 02/06/93 GRPM
IR~M: ~5-1647349
EMPLOYER:
TOI PRUDENTIAL INSURANCE CO
PO BOX 977
HORSHAM PA 19044
DILLSBUHG CHIROPRACTIC CENTER
P.O, Box 668
OlLLS6URG. PA 17019
717/432-5099 Fax:717/432-7332
DIAGNOSIS:
847.0 ACUTE TRAUMATIC ACCELERATION-UECELERA11UN INJUR
846. ACUTE TRAUMATIC MILD LUMBAR ~PRAIN
FC: PER-INJURY
DATE OF ~AST BILL; 01/02/96 PR" R~501003 IDn REb07~OJ
DATE
CPT
DESCRIPTION
* POS TOS .
........=.a==c~mg=.~..~..~..~.z.=============~~~a=a~==a===~.m.g...~.....~.....'
AMOUN'
.....~....~.....~....~a========ga...Da~.z~s=~=~===Q=~======~S=~S.~.K*.....__..~
08/17/93 IA
08/17/93 IN
08/17/93 IA
oe/17/93 IN
08/17/93 IA
08/17/93 IN
08/17/93 IA
08/17/93 IN
08/17/93 IA
09/13/93 IN
09/13/93 IA
09/13/93 IN
09/13/9~ IA
09/13/93 IN
09/13/93 IA
09/13/93 IN
09/13/93 IA
12/28/93 IN
12/28/93 IA
12/28/93 IN
12/28/93 IN
12128/93 IN
12128/93 IN
12/28/93 IA
12/28/93 IN
12/28/93 IA
05/04/94 IN
ADJUSTMENT FO~GIVE
PAYMENT-INS PRUD 6-7128-93
ADJUSTM~NT FORGIVE
PAYMENT-INS PRUD 6-7/2B-93
ADJU~TMENT FORGIVE
PAYMENT-INS PRUD 6-7/20-93
ADJUSTMENT FORGIVE
PAYMENT-INS PRUD 0-7/28-~3
ADJUSTMENT FORGIVe
PAYMENT-INS PRUD 7-8/29-93
ADJUSTMENT FORGIVE
PAYMENT-INS PRUD 7-0/29-93
ADJUSTMENT FORGIVE
PAYMENT-HIS PRUD 7'-6n9-93
ADJUSTMENT FORGIVE
PAYMENT-INS PRUD 7-8/29'93
ADJUSTMENT FORGIVE
PAYMENT-INS PRU a-4/JO-9J
ADJUSTMENT FORGIVE
PAYMENT-INS PRU 8-4/30-93
PAYMENf-INS PRU 8-4/30-93
PAYMENT-INS PRU 8-4/30-93
PAYMENT-INS PHU a-4/30-93
ADJUSTMENf FORGIVE
PAYMENT-INS PRU 8-4/30-93
ADJUSTMENT FORGIVE
PAYMENT-HIS ATTY OFF NOn:::S
11109273
11109274
11109274
111 0927 5
11109275
11109276
U09276
11109277
11109277
Ml09567
11109587
11109586
11109588
11109589
11109569
11109590
11109590
U 0'J841
111 09641
11109842
1I10'~843
11109844
11109845
U09845
11109846
11109046
11112206
-13.7(
-178.4:
-32.51
-98.0(
-13.0C
-92.4(
-8.b(
-80.4(
-10.6C
-101.5:
-5.4'
-92 . 1!
-8.8!
-98.5!
-7.4/
-38.5:
-2.4:
-101.5:
-5.4:
-91.0'
-114.0.
-101.0-
-96.0
-11.0'
0.0 I
-25.0
-65.0
PROVIDER: J. CLIFFORD RENYO D.C.
TOTAL: .
BALANCE 10/11/96: .
.......a=====~===.=.aa._Daa~a.x:=====n==.s==Q.===~.......===uaas..............
3.805.7
3.805.7
. .
F'.AIM iI: 4u '(\\ (:::r~::f . ,
DgL,,,. -;;L\~\a.3
:r":!f~.~':,(.,.
~,\,>,...,( ,.J)~.,,~ ..'
:,', ,',;
" ". PAID. PaOVlDI!lU IIIlClAI.TY II'AVlC8
lr\'I'IIc,""2, ,,,I\:;\-''''d' ~"\( h\") -tl'~Gj I
., ~ ""D,\\.....h'2. <"-,,,., <,,\'::1; '~111
~ '4k.~ IJ,I\..,\.,?" <::'\.IY ul'"1/",....<t <.:.N.~"tc.\",'~
J- '-J .~ 'I
n,\\~b\....< ~,\O 1\'0 -1~
T>I\\'-.~.. J'~,\,O .;\c. -~\2r1
,\\...~,M.'-~
t:A\\~\.. "'~"HI "1)\,-\--0/<0
,., "\ O'
;))1,,, 'I II IY-.,,"'< .\\"'^C^--, """'~_~
'-\ li~lct~ c'-~.' r Cb. 'mQ \ <';>'\I':l)G.s
" '\l.nv ~C
k n 'V C:h~C
~ Q '\I ()Y~"l.,.
\L nv O~\
,
FIRST PARTY BSfJSflT Pit YMENT SHEET
101l'.,n, C>.:...'-'\\~ ~\~\-<I<. \\ me.
DAmo. AUQUIIT ANOUNT
"t,." ">",..,, ','" .', _ . ..~":<
TOTAL I'D
llLU!D
PAID TO DATS
\ c;-,'ll.- ,(.,r,
I~~,l#
~. a;
"J~I,5d..
'3:'.c,(1 ' -::J(~{^...
Y l. -:!.?()
.....~,c~:
II',I.S?'
'\ 'l')1<A~
\"':1.111.'1(....
.,
.~ .. \.
... . '-
_ _.1'
, 1 '
~:'>':>"':
t..l~(.)_:2-
<;.-\.s,
1(" ( I ~
"" LJ. Cc I~
\ 'iI q;x'
L-\'i~?,-O;;
--
WAGI!S--S DAY WAmNG PERIOD:
ANOUHT PA Y ABU!t'MOHTII:
DA TIlI'AID
TOTAl.
AUOUN'r PAID !'AID
. I'IlRIDDCOVllRllD
~
--J -...- -----j
----~-,- '"--
May 12, 1994
& "
~ ~~~,~.,l:," ,<'
0/".3 ,,~~(I t-t'.
~'.1. ".,,.,,,'
0. tlo~'t\ (/'" ~~'l'
~'7':! .~' ^'."
V "
REI FISHEL, CARLA D.
612 Range End Rd.
Dillsburg, PA 17019
AGEl 42
SS#I 185-38-5488
STUDY I MRI of the cervical spine with kinematic examination.
REFERRING PHYSICIAN:
CLINICAL HISTORY:
J. Clifford Renyo, DC
Headaches with pain in upper n~ck, right
arm and Unger numbness and tingling
since MVA 2/6/93.
MRI PULSE SEQUENCES:
1)
2)
sagittal GRE, T1
Axial 3D GE
COMMENTS I The standard images of the cervical spine were
supplemented by multiple sagittal views through
a range of motion from flexion through extension.
There is a moderate sized right paracentral C6-7 herniated nucleus
pulpoBuB. This contacts the anterior portion of the cord but does
not cause true cord compression. There is no evidence of
associated canal stenosis. There is (I. small right paracentral C4-5
HNP. This oontacts the anterior portion of the cord at this level
but is unassociated with cord compression. Both of these appear to
be sUbligamentous.
There 18 no evidence of any generalized canal stenosis. Nerve root
canals are well maintained. Siqnal intenBity of bone il preserved.
Xinematic stUdy demonstrates the absence of any significant
subluxation through flexion and extension. Thero are some
differing degrees of bulging of the disc herniations with contact
on the cord remained in both tlexion and extension, however.
CONCLUSION:
Moderate to moderately large right paracentral
C6-7 HNP. Small right paracentral C4-5 IINP.
WSM/arl
this patient to us.
I
Sincerely, .
lJt{I/at]~
william s.~Mill.r, Jr., MD
...-.-/
Thank you for referring
DOCTORS KRUPER DANYO VANGIESEN ORTHOPAEDICS
onmOPAIOIC SUMIAY
HAND 15URalny
MICAOlSUAGIAV H.ANO a lACK
A8IlITV ASlSIISMINf
'OOT sunGIAY
TorAL JOINT n.PlAtIMINT
SPOATS MIDK:INI
IPINllSUAGIAY
JOHN S. KRUP'R, M.D. J. JOSEPH DANYO, M.D., F.A.C.S,
PIf.RJ. VANO""N.M.D.. F.ACS.
MICHAIL J. SICUAANZA, M.D. SYlVIN J. n"ANTAn'LlOU. M,O.
I\u\luat 19. 1994
J. Clifford Renyo, D.C.
P.O. Box 668
Barlo Cirole. Suite D
Dillaburg, PA 17019
ReI Carla fi.hel
Deer Dr. Renyol
I eaw Ha. Piehel on 8/19/94 per your nquellt, The foUowing hlatory wu
obtained:
Aa you know It.. Fishel ia a 42 year old involved in a HVA in February 1993.
The oar in whioh ahe wall a reatreined pauenger akidded down an embankment and
rolled after being atruek by another vehicle that had loat control. She haa had
per.iatent neck pain with radiation to right dominant arm to the fingera.
On exam neck motion ie full. There is no neck apaam. She haa tendetnftas
over the right lower lateral maao~a, mUd b:llahral trapezial myof8llci tia,
Pre.ain9 over the t.rap~zills givf!8 radiation dheomfort down the right. arm,
Stren9th in the upper a appear. normal. Grip may be alightly decreaeed on the
dominant right compared to thll left. Reflex is abeent at the elbow., knllea,
anklea. There are no long track ei9ne.
I reviewed the plein filmlJ of the Mck on 2/7/93. They ehow atl'a1ghtening
of the cervical apine on .trai9ht lateral. The HRI filma of Hay 1994 diacloae
diac rupture a at C4-5 and C6-7, The current ayJllpto:lmatol09Y is rllferable to the
e1 root. She alao h''''1 mll"clo <lontraotion headache a .
The diagnoaea are C7 radiclIUtilJ right, neck atra.tn, myofaacitia, mueclo
contraction headachea. All of theee c~. from tho accidant of record, At thia
point aha ia not a aurqical cnndidatll. but ah. may be. especially for the C6-7
diao herniation. ~tandard co:lna.rvot.ive treatment ia recommended, Should there
b" wellkneaa, dropptnq thin98. l.ncre"aed pain, then 8Ur9ic&1 approach for the neck
would be neceaaitated, Right now aha doean't aeem to be bad enouqh to go that
route.
I "Ul provide her wJ.th PhnniHn Forte for the mueel... contraot1o:ln
headachea. Soft cervical roll or cervical pillow ueed at niqht, do the homft
axerciaea and maaaagll tho.e tight trapftlit in the morning undo~ a ahower and ice
... tOOlH 010110111111111 YOllK, 'A 1140' 'HONI, 1717'........ 'AI (711) 141-243.
lAST VOAI< O'f1CE. THE CI!Nrl" 'OA SPINE' SPORTS IItEHAIILITATlON
The mosl..p.rl.need end comprehensive orthopaedic C8r. 'or Central Pennsylvlnle. Establlsh.d tgeS,
o
>(
)(
~ ~ ~7
~ 0
YES NO
",,"""
c:::D
YES
X
)( 0
*~
~
g
)(
o
)(
o
o
)(
o
o
o
o
o
o
o
Patient:
...ow. mlJllllnc up
NO
o
o
o
o
o
o 01'10
)("
o
)( 13
)c(14
o
J( 16
)( 17
)( 18
~:
)( ~1
)(~
)( tJ
o
o
."".','
. ,
. ,
".,,
"":,'" " ,.,
. .
,
',', I
, ,d " '
c,.. ,.. \ 0- \), t\S he.\
Gilbert Headache Questionnaire
MrNer ell questions, yu or no, with e check mork
Dater~1f.
Do you hllVe an Idea of whllt may be causing your helldache?
(WhIplash, diabetes, high blood pressure, eye strain, etc.)
Did this same type of hudache ever occur before?
Do you have more th!ln one type of headache?
"
Is the helldache pain so Intense thllt sometimes it becomes unbellrllble?
Do your headaches oC'tur during stressful tension or nervousness at home,
lit work, or during social occasions?
Do your neck, shoulder muscles or helld Junction feel tight llnd plllnful durlns
the headache?
Is your helldllche pain dull and steady, like an intense constant pressure?
Does your headache feel like a tight band around the head?
Do you usually have one (1) or more headaches per week? '
Do your headaches occur during the day?
Does mother, father, or any blood relative have similar headllches?
Does exertion (lifting, running, str!lining, sex) affect your headllche?
Does nausell and/or vomiting occur before or during your he!ldache?
Do you hllve any changes in vision (flashing lights, sensitMty to Iigh~ spots,
blurred vision, etc.) before or during your headache?
Does your, headache usulllfy start on one side of the head?
" '
Does your headache throb and pulsale or feel like it is pounding?
Do your headaches usually occur during the night or upon awakening?
Do your helldaches usually occur during weekends and'holidays?
(Females only) Is your headache llssocialed with your menstrual period?
Do you have wllterins of the eye on the llffecled side of the helldllche?
,
Do a'~qhOlic drinks Clluse cirllggrllVale your helldllche~?
Does chocolate, cheese, milk, nuts, Chinese food, or llny other food Clluse
or worsen your headllches?
Do you have llrf'l hearing problems - noise. drllinllge or ,stuffiness In either ear'?
Have you noticed llrf'l pllralysis, muscle wellmess. numbness,
swlllIO'Ning problems or speech changes during your helldaches1
Do you have ar,y facilll pain, aching JllWS, stuffiness or congested sinuses
lllong with your helldllche1
t6, Has it been OVf.r eighteen (18) months since you last visited II dentist?
Hll'1e you had tests for heIJdllche1 (x-ray, brain seen. inJections, etc.) .
Have you used llny prevlous helldache mediclltion7 Ust all medlclltlons on the
back of this form.
1
3
4
5
6
7
8
9
1~
15
.
14
9S
VI
'.'
. ....
. t.,
DRS. KRUPER DANVO VANGIESEN ORTHOPAEDICS
908 50ulh George 51reel . YORK, PA 17403
NNI.&~~' -:F:aJ
FIRST )18" PREVIOUS VISIT - ACCU
MUla 0 WIC 0 MEDICARE 0 COMMERCIAL 0 BS 0 SELF PAY
8UI!IJECTIVE: 0 CHANGED 0 UNCHANGED COMMENT
OBJECTIVE
'U&lIlCTIVI!~
o Not applicable 0 Unchanged
o Other 0 Chenged
QBJI:CTIVE:
o Not applicable 0 Unchanged
a Other a Chonged
PINGE 0' MO:ml&
Forwerd f1nlon
Extenllon
Lateral flexion
Left
RighI
Rollllon
Left
RighI
Tenderne..
aVes
ONo
\
\
I
!
(\.OCAT& ON DIAOM"!)
Il()RMAL AllliORMAL
a a
a a
a a
a a
0 0
0 0
-,
COMMENTS
'1;}..~() . J)~
l\l.-~J w. ~LM' J fJ. 1M ~
UJ.V.ifUtt. l!4N '
HA- U-t .tp..ttJC (/ ~ y.A.t.M. ('ttA.. b?\.
, ~k AA I
VI ~ 1M~ C<--rv
'f0 ,/Ju../. ~ ~ t1v~1j
A""'~/4..~ tuJlP:t /),t.lcu,
f'i .il/V JUA.A\ ~ ~~ ' 1
. (~~ i ~'.jg,{j~
)lup fVAM" ,~~.r-~.-J-
.~J) /~Ui'rl /TJ 0~'
.<. ~" vii ~1fi It, f!"
CATEf-IA '1(
CLAIM-
o VHP 0 HMO 0 OTHER
-
V1 a Co
.I, . ':If Ii. "","W'-p. . I 0/... J.,vc ,
~ ~.... ' /,) -
)~ ',) '\ )'}\ R.r w-f.J.-A- l'-P ~~i JiM
(I /) II"~ C q' S 't' (: (, .
',v~W(cl (1 fVT
~Uu4v jJtP! /. /,.., d' j7U'
(L?. (Jt<-..- Ir-J, ".. ./J - ~ jfl..
1".~)'j.'T;,~t..l: /1';'/:/)'(; ~~\k
;/rhJ ..,'?~,', C,--",-, ., (oJ./7'
\J (j' VI' lv' ,. ~A' . ''OJ' , to ....1.1 l' ,,:,
ASSESSMENT: 0 CHANGED 0 UNCHANGED 0 OTH R ... '''' - ",,-,:) ~ ''', .
DIAGNOSIS:__-. /..v.i.(c; (J"f'1I .1. 'k' I,:;"",,, (,.,.,c
TREATMENT: 0 CONTINUE AS IS 0 CHANGE COMME~T ,~' I( . " . ~
pROGNOS'S, 0 POOR 'IFA'R U GOOD .", ".... '~~:.f;:~.I't:1 i:!j;J,: k.f;; ~r:'
CAN PATIENT RETURN TO HIS/HER PRE.INJURY JOB WITHOUT RESTRIC'fIO~S? 0 YES [] NO 0 OTHER
NEXT APPOINTMENT: 1 . 2 . 3 . 4 . 5 . 6 D . W . M PRN
DRS. SIGNATURE ~ . /f; ,(1 r
\? --r--ru
''''"'
IjEUROlOGIC I:llAM
~;;.-"~h UDDer EvtrllmltllS
Comments
twmiI
o Lelt
a RighI
'tROW Rl!'l~XES
o BIc:'PI
o Trlc.pl
BI!NSATION ARMS/LEOS
fTRI!NQTM IN aRMS
oLelt
o Left
twmiI
o Left
o Right
twmiI
o Lelt
o Alght
e,bnormal
o Loft
o Right
aRight
a RighI
e,bnormal
o Left
o Right
ebnormol
o L.ft
o RighI
DATE
-- -
1 .A:t.HT. C.~l. D. rl.bel
DA~.I 10.11-'.
..Ve I
pare.thea1a.
.~a."G~B' within funotional limit. cervioal .pine and proximal
right upper extremity
'..CIAL T.'T" passive mobility within funotional limits in
bilateral side bending/rotation
flexion/extension I still limited seoondary to pain at end range.
. .
~aOTII.HT' instructed in cervical retraction exercises and improved
postural mechanics cervical spine
A.....II.IIT. I
.roblea List.
1. Derangement oervical disc
2. Decreased ROM cervical spine
3. Increased pain right upper extremity
GOAL,.
1. Reduce cervical derangement
2. Improve functional ROM cervical spine
3. Reduce radiating pain symptoms right upper extremity
....0.... TO T.OTH.IITI Patient reports that by retracting cervical
spine sY1llptomll centralized from distal right upper extremity to the
proximal right uPfer extremity and she was also able to see some
slight reduction n right upper extremity pain with right lateral
flexion
.LU.
rrequenoYI 1-2 times
Dur.tioDI per physician
TaOTII.IIT. home sxercises, recheck to progre.s patient accordingly
~/~-_/ ~
Terri L. Longenecker, P.T.
TLL/mew '
DOOTORS KRUPER DANVO V ANGIESEN ORTHOPAEDICS
I, I...pIl D. '~.. M,D, ',AC,S,
Mlchooll, SI"....u. M,D,
51"'" I, nt..IOI 'Iou, M,D.
Pot.. I, VIIIOIo,,". M.iJ ',A,C,S,
M,II... S. Calm... P.J,.A,TC,
a.,..... I, K..drid<.lr,.A,T,C,
Mlch..I!!, KIOIl. P.T.A,
R,bomA, 1..01I,. ',T. A,T,C,
Ttny L. 1..oIII,"ocktr. P.T,
Lu" P. Skill... P.J,A,
D..I,II, Wall&, P.J.
, , .
.ATIIHTI olrla D. ,i.hel
DATI. 10-11-14
RI'laRIHG .BYIICIAHI Dr. DIDYO
DIAGHOIII. ayol..eiti.
TRIATHBNT. HeK.D.ie exerei.. pkogr..
IUIJICTIVII
OH.IT. 2/93
001 patient cervical .pine, more recent inorea.e in upper extremity
pain and paresthesias
B'll Patient states she was involved in a HVA in February of 1993
at which time she began to experience cervical pain and discomfort
into the proximal right upper extremity. She reports that pain
sYlllptoms were fairly well controlled through chiropractic treatment
and medication earlier but following a hysterectomy performed in
August of 1993, she was unable to continue with her manipulation
and by January of 1994 her pain symptoms became more severe. She
oontinued with chiropractio manipulation but with limited success
up until this summer when Dr. Danyo evaluated her situation and
through MRI found a disc problem in the cervical spine. She now
present.s for McKenzie exercise program to help reduce cervical diso
problems.
OIJICTIVII
ARIA. cervical spine
IHI.IOTIOHI Sli9ht deviation in restin9 cervical spine with forward
head, rounded shoulder posture. She also has a flattened cervical
lordosis. Slight deviation during AROH particularly during
nexion/extension with t.he deviation sli9htly to the right on
cervical extension primarily.
.AL.ATIOHI doe5 not reveal any localized sensitivity; does have
several sensitive trigger points in the right upper, middle, lower
trapezius greater t.han the left
ROM I
flexion/extension: reduced minimally
bilateral .ide bending: minimally re.trioted
rotat.ionl within functional limits
Increa.e in pain in right upper extremity with left side bending;
.light reduction in right upper extremity pare.the.ia. and pain on
right. .ide bending
Repeated cervical flexion: increases right upper extremity
2901 Pluunl Vall.y Raad.1 Yark OAn..I.. York' P.nnsylvAnl.. 17402' (717) 840-4800
Carla D. Fbhel
lb-:l7-94 TE, HP
SI Patient states she experienoes some localized left intersoapular
pain,otherwise pain symptoms have been reduced over the last week
with exeroise..
01 progre.sed to extension with cervical retraction today and
symptoms were further reduced to C6-C7 region cervical spine and
high oervical tightness.
AI Presents with probable derangements of discs in cervical spine.
P: continue with McKenzie program. TLL/mew
, ,
11-08-94 TE
S: Patient reports that pain symptoms appear to be primarily
focused in the cervical spine and occasionally into the shoulder,
right greater than left.
0: Able to further reduce radiating symptoms into the upper
shoulder area through side banding to the painful side followed by
retraction cervical spine and extension activities. Asked to
continue with similar activities as part ot her home program.
A: still present with cervical derangement although symptoms are
less intent and trequent in upper extremities and more easily
oontrolled by patient.
P: Monitor patient's progress. TLL/mew
, '
DRS. KRUPER DANYO VANGIESEN ORTHOPAEDICS
908 Soulh George SIreel' YORK, PA 17403
NAME Ql-" 1 iJ ~__
FIRST VISIT PREVIOUS VISIT ACCU
o AUTO [] W/C 0 MEDICARE Cl COMMERCIAL [J as 0 SELF PAY
o CHANGED 0 UNCHANGED COMMENT
8ULlI!CTIVE~
o Nol appllcabla
o Otha,
08JI!CTIVE:
o Nol appllcabla
o Othar
RANGE OF MOTION:
Forwa,d f1axlon
Extanslon
Lalaral f1axlon
La~
Right
Rotallon
La~
Righi
Tandalnass
Q.Yas
o No
{lOCATE ON CIAaRA"')
DATE I() ! ~4(-
CLAIM# ~
o YHP 0 HMO 0 OTHER .....-
,-~
o Unchangad
eChangad\ .,-V
COMMENTS
J..dtq~~
o Unchangad
.g Changod ~~/,. '--A,I
NORMAL ABNORMAL
~ 0
0
[]
[]
i3 []
[]
7~ ;... ~01 ~~~
ft, '7 r;<.~~. (Iv I tl ...., \
/.)u..A vt-, &.. ~ ~~ h ('-
k4. '
(/{ tr-i$:.1-;" ~~~,}J
II L..,-.u...,~ "y r.i.-A.J /) I,L..,--..
I~l'-<-:~ ~,..~J. ,
Jv;J/;;;' l' I~ ~, ~
C.
JIk..'-~lV' / 1.... _Q.lM.<'~ v?
-~ ".
""
-.
....,
.~.
NEUROLOGIC EXAM
Slr.Moth lIDDe, Extremities
Commants
IELBOW RII'LIIXES
o Blcaps
o Trlcaps
SENSATION ARMSiWJ
eTA.HaTH IN ARMS
Abnormal
[] L.~
[] RighI
JL4. '-t, ./...,
. V r-T--f'~ 1::l--< / ~
~^""-<..,: (Lf...Il-.-./NL-.
IN ;J/~ .;,;~ ~ (1, ( ~
t"~ '..t ~L~'&.J..'lv~W'~ <",h, ,
[ L.~
Right
La~
L.~
[] Right
[] Righi
~
[] L.~
(] Right
Abnormal
[J Laft
[J Righi
ASSESSMENT: -8i5HANGED [J ~CHANGED [J OTHER
DIAGNOSIS: '&~
TREATMENT: 0 CONTINUE AS IS [] CHANGE COMMENT Q..
PROGNOSIS: [] POOR [] FAIR LI GOOD ,jfV 'jvv;,(y. if ti";A" L ~....
CAN PATIENT RETURN TO HIS/HER PRE.INJU~Y JOB WITHOUT RESTRICTIONS? rfYES [] NO U OTHER
NEXT APPOINTMENT: 1 - 2.3.4.5.6 C-W' M P~
DRS, SIGNATURE_______~2j~ -;- ___ DATE
, 'FJ'/ 1/ I 'J 11/,/
CHIROPRACTIC PROGRESS REPORT
Preparedt03/04/93
Insurance Company
Patient.
PRUDENTIAL INSURANCE CO
PO BOX 977
,Fisll.'r-;--cal'ra:'---Age, 41
612 RANGE END RD '
DILLSBURG, PA 17019
Phone ID.
717/432-9026 165-36-5466
Polley Holder
TED & CARLA FISHEL
612 RANGE END RD
Type of Policyt MVA Claim No.1
Doct.or
J. CLIFFORD RENYO
4 Barlo Circle
DILLSBURG, PA 17019
Phone
717/432-5099 INITIAL REPORT
Date of Initial vlslt.l 02/06/93
I, Chll' cOlplaint at Initial Vlllt, SUllary 01 lindlnl' and
dlalnolll.
Mrs. Fishel was Involv~d In an MVA where t.he vohlcle was st.ruck.
..nt off t.hti road, a~d roll~d. She has had t.he following compla1nt.s
since the accident; Headaches, neck pain and st.lffness. difficulty
sle.plng. low back pain, nervous/tense feeling const.ant.ly. and pinsl
ne.dles In t.he right. hand.
2, Prlllnt prolrlll 01 cOlplalnt, lubloetlvl and obllCtlvo
flndlnll.
Restricted and painful cervical range of motion, palpable cervical and
lumbar muscle hypertoniclt.y. Posit.lve Kemps, foramina compression.
Sot.o-Hall, and cervical distraction t.est.s. Negat.ive Valsalva manuv.r
although coughing/sneezing Increase cervical pain. and negative
neurological t.esUng.
Radiographs revealed a reversal of the normal cervical curve and
hypomobility in both flexion and ext.enslon.
5. Prolnolll: Guarded due t.o the traumatic onset. of her injuries,
I. Irill dlscrlptlon of trtatltnt plan:
Manual man~pulation t.o the cervical and
lumbar spin~. Phys1cal therapy conslst.ing of
1nterferential current and heat. are applied
to the cervical spine,
1. Rlcol..ndatlon. or Rllarll:
I,::!.
Mrs. Fish.1 has shown Improvement in her
t.reatm.nt. She i. being seen three t.imes
. eva.'uated"wilhin t.he nexf t'wo' week.. '
condition since she has begun
a w..k..,...S.,.h.....w.i.11 he re-
... ..,. ,._." ",.lpiiM'
... ' ,~" ,~ I.
i
.}. .CL>FFO~O .RENYO O.C,
(, /, .'.
i J /-"/'::( I ,':---J.1
, ~ I
.'
, D.C.
Signat.ure
I
-
.1.-.....-
_. ~,~ .....-
')
.-
.
r.'lLl~.'<I)IJI., ':fllf.'IJ.'fl/lr:II': ';l1NJ(
101 Ui"I'l';l, C'~N ft.H ::<1I11 r:: f!
101 :o'.".111i I). S. I ~
OILL~'l\',.If~I:. PA 11019
(/I!) 432-'509\1
FI,-~
C9/V
,
. '
'.
. .
"
April 28. 199~
Q'~f
PRUDENTIAL
POBOX 977
HARRISBURG. PA
AT1ENrrON: CLAIM~
PATIEN!:
INSURED,
l)A TE 9F LOSS:
(LAIM NUMIH:R:
POLICY NUMBER:
EMPLOYER:
F ISHU.. CARLA
:...6~11:':
2/ Ij /<:J.l
UNKNOWN
2fl2A9'j84J'~
De.!lr Cl.!lims:
Ms. FISHEL ho!l" L1ndm.gc-r\'J ....c-mpu+.eriz9':l mech"mic>!Il. is-:>mltt.rlc
mlJscle t'9:it. 1 n';1 ....l1th t":'t"q'h~ ":IJrV6$ "niJ pr'int.e,j rep.~,..+~::. 'fhe
f-:>llowing t.ests were perform~d:
CtRVICAL FLX/f::tf Ar NLlI'P~L,
CERVICAL LAT FLX Ar NEl)l~AL. ~nd
CERVICAL RUr. Ar NEUIRAL.
Test results are pre..nt~d f~
including a dus....ripti0n 0'
result in pc-und..
the fo110<..l1n9 p"g'?'" ,)f thi" rt?p.~,.t
Mach t~~t p.rf0rmed and the t..t
If you h,-,ve ~ny qu.~~j0ns ,-,bout thi~
assistance 1nt~rp..et1rI9 th~ t'e?ult~" pl~~s~
t.",,, t. '0,. if YNI need
~0nlect my ott1ce.'
Respeo:tful1y,
J. CLIFFORD R~NYU, D.~.
,
.
r.'! LV;;!:!')!'" ';I-l! ~""!'f'A'.: I 1 r: ';L l ~I( '.
101 '.If~ I'.': ';~.NII:Y ~:.I'J If. ~.
IUI ~UU'H U.~. 1~
1'ILL.:.'l".IF,:,.,./I 1/')IY
(I I 7) 4 j, - 'j IJ 9 ')
NAME: fl3HLL, LA~LA
PATIENT II: 1853ti'~4ee
AGE: 41
St::X: f
HEIGHT: 64 INCH~S
rEST TYPE: .11)1 N r
011.11:.:
INVOLVE!) JOIN r:
II:~: T t.r.1 AJJE;:II:
O'-'~lli'lMII.I::
'/'IE ('.iH' :
TYPE 01' RCf'UR r ,
4/1.~/YJ
CI::f.!VICAL SPINE
Ct.PV I C AL
I~ J GH r
1"',1 Ll':3
IN tr I AI.
--, IN I~',-,Illll; I J(IN ).--
rha eqIJip",,,,n1: L!'HI<:l In (hi'J ~.estiI19 m'?,!-:'J'-"" pr'?':ise ~'t.rengt.h
c~pah11ty. r~st d~t~ pt'0\/1d~~ ~~~ut-a~~ me~~I.'~~~I&nt$ needed ~o
ident.ity ~,..em. ~f we8~ne... 1:0 qumntlfy pe,..f~r~~ncQ defici~n~i~5,
to determine Ih.? P'.vt:'Brtl. .:'1 inJu,'y .:"" '3 j':i!bility, ,000,d to:> ~V<' I'J.~t>9
rehabilitati0n g0al~ ~nd pr~gr.7$.
To ensure the g".,..~h)$t p'.'~,;'lb',,-, "t?lia'Jfl1ty 1I11<J v.~lidity.,:.f test
re9ults. ~~~h ~~st i~ eValIJ~t~d by ~0m~,u~~ri:~d c~l~u18tion of
the l.:oe1fi >::1 ,,",1: ,;,1 VIH"i",t.i~n (el/). A "(V" elr I~:t ~r less
indlcateg the petl9nt has e~~rted e consistent. ~tfart, Computer
gener~ted tct-ql.J~ curve~ vie~ed d'Jt.ir~ te~tin~ 81;~ grapl,icel ly
document the degree of ~on.i.ten~y e~hi9ved during testing,
The use 01 ~ s~~~i~11y-d.slgn9d te.t.in9 c~~ir with thi~ testing
provides Iscl.tion ~t the muscle grcurs boing tested to avoid
recruitment 0' other muscle.. 'hi. s1:~bi11:~tion during tpst.ing
ensures I!t:'cur"o!'r:y ~nd v::!ljdl"~.~1 cf te'E;t. re?Ult.5.
Test result$ ~I"~ di~play~~ in p':'IJnds. B11~~er~1 c~mr~risor's are
m.lde comp"ri"'9 sb'ength 0t th.. '.!r1involv'i'd ....'~tr"'mity I~ith the
involved ,.,~tr":'mfty. t:!il"t'i!rlll <JHf..".:n,"\?:: ",,-.. "ho,.!t1 /!IS II
r.~rr.ent.~~19. 1..,I.....li1.:h(\d 11 ,~~.:>,~.I,lw~~. .}'.'r:;.r'.....t..L:~ ~.,i.I,.l.:~.r)ll1 -:'":\rnp.:.lI"i,,:,:,,ns
.,~ an eff..,-=t1v~ m~~n-: ,.)t rl,?t.;.rrl1'ln 1/'19 ~t!"..il"'qth I.:,':;:. 01 ff':?t.en,.:-~t~
c.f lll" +"0 lOt rn:iy b.-:' r:'.)n'~ld';'r'''Jd ~"'~"~~f')t:~1',)1"?,
Pub 1 i !'hed
b,~ged up~'n
F..xtens i ~n
~'19:dor\
L!lteral F I,-,~i'~n
l;+:.~rl.'IIbJt..t? ,'.1'.~'" !:'upp.:..t-t.$ ,:tn ~.vCtlll'!Itl~"-\ ,.t L'Jmb,~!" t.ff::..~S
t.h~ f,:' 11 ,:,'.'irl9 h f>::t',';H":h,,,' r.r,.)~1t"lI3s'! 1.:'n:
~h0t.Jld b.;. (J"-,;"t-t:.:n +.h.:rt/"l F le~10n
.,h,,'ul<1'b., \!r'C'''' ".,,- th,~n I.,~ter,~ I I I,,~~i'-'n
~~l,~tJld b~, 0,,~~,t~r tl'~~l fJot~ti'~n
P1ght ~nd L9ft L,~t~r,1 ~14x10n ~h~'JI~1 ~~ ~Q'.!~'
~1ght ~nd L.r' ~0t.~t10n ~~0Uld ~~ 8qU~1
REF E.RENCE.~~:
l~,~1",b"rn. (I.::,., ,~nd M".'rr1~~~...'~/. M,r',
~'.:.l!!to:od to rt.tln~ rolll'.='- 1.;. ~'":".t,:,,rrn,-;~n':'~.
n ~~v1e'" ~t. t~le L.1ter~lure
'~,/,",irltl!. \I.~,lt!"'t~? 1~, ft"Jrflb.~tt.. I,. 1988.
.
DILL5~UP~ (HIRUPRACI I( ~LINl~
lUI U~~I(t ~lNrlR ~UII~ ~
1 0 1 ~;OU r H U. S . ., '~
lllLl.::,t;\lfJG. I'A 17Ul~
(Ill) 4~Z-';099
NAME: FI,HEL, CARLA
PAT lENT II: 1 tJ5:J8S488
AGE: 41
SEX: F
HEIGHT: b4 INCHES
TES T TYPE: ,)1) I N r
DAlE:
I NVOL VI~ll ,JI) IN f :
rES f!::D Af'.(i;A:
DOM [N!~NCE::
WEIGH r:
T'YPl'. OF REPOfJ I :
--< ('1,IP.~~l'rf\l f' I ~s I RI:;~LILTS )--
4IZ~/93
':I::RVICAI. SP INE
':l':RVICAl.
R IGH r
165 U\S
IN I T IAL
MO T ION
C 1/
f{IGrif l.ur
SlRt::NGl'H
fJ 1(;"" L~.f' I
.
==a=.=~=...====:==~~=~====~:~========:~==~===~=n===========:===~=====
PERCENT
lllF't' .
LAT FLX AT NEUIRAL
b.l
~. 5
ROT. AT NEUl R,Al
12.4
8.1
C 1/
flEX. EXTN.
u.~
I . l
17.6:\
4,5
4.tJ
12.5%
s TfH.:N I.;' I H
fl_EX. E.XIN.
FlX/EXT. AT NEUTRAL
11.5
3,7
.====~..a==================~=========:===========~~:=================
10.2
13.0
NOTE:
Percent Difference provides ~ comperlBon of t.~t r.sults for both
left end right sid.~ to d0term1ne wea~n.s$ in one side, In the
lumb/lr erea, e~:to,;r1$1on st:l"<engt:h !hol.,1r.f be ~It"e~ter' tl',~n fh"d"n,
I' fl'lx'lon should be gl'e.~t.*" t~'~n lat'~t",~'1 '11,,;0101'1. am! ).~ltt'I'a.1
flexion should b. greater th~n roteticn.
.r . ','
.-.
. '
.. .
, '
I,,' 'I,
i
,[
.
.
(,'
.
','
PATIENT : FISHEL. CARLA
TESTING AREA: CERVICAL
TEST : ROT, AT N~UrRAL
DArb 4/l6/9j
~q Lll:: LEFT
GRAPHIC OVERLAY OF TORQUE CURVES
2"
P
o
U
.N
D
S
15
1"
-1st Rep
....,2nd Rep
.\ /1' .J;?'
" "~ --J, i
..... ......
.....'~
5
.
.'
" '
Seconds:1
2
3
4
. .
,
"
--..
,
tI!LL~'I:WfJl, UI1~'r.lff/ft,(rl'~ '.LINl'_
11)1 QFr"!I:t=. ':ENrEP ~,l)lll~ B
11)1 S(IUIH I,I.~,. I'~
DILLS~URQ. PA 1/019
. (/11) 432-50YV
June 1 ~, 199'3
.
PPUDENTIAL
~ 0 BOX 977
HARRISeVR.G, Pft,
ATTENTION: CLAIMS
PATIENT:
INSURED:
DA TE OF LOSS:
CLAIM NUM8EI<:
POLlCY NUMBER:
EMPLOYE.~: :
f. /':;Hf::.L, C I'.RLA
;::.^,Mt::
Z/b 19,~
U~WNr_lI~N
2~ZA9G!l4 J::l,
.
De!!,. Chlims:
M$. FISHEL h~2 und.rgQne ~~mpute~iZ9d
ml.J~cle te!"t:in'l '.,Iith ,+'.:\r~I'J';? ~.'IJI"'\I"'~Z and
f~11owin9 t..t. we,.e perf0r"med:
me~h~nf~i!l. iSQm.trf~
pr 1rl~r..c: /..1Pol..t$. The
CERVICAL ~Lv/EXr AI NEU'R~L.
CERVICAL LAT FLX AI NtUrR^L. ~nd
CERVICAL ROr. ftr MEUIPAL,
Test result$ 8r~ preg~nt~~! ir,
1n~luding ~ d~s~'.i~'tiort (01
r~slJlt in p0IJn~'~,
t:h,~ t<',III,',dn~l f';",~!g'~.''F ~~f t.hig r.:;:.,.,o~"'1:.
~~,<:I'l I:.:..~; '. "'-:I'tf~rrn~.'r.l rJtH~ t..hf:-' t~.,.t
r t
h,!VII? ~fny t:1'J':;'~~. i"=,t'l'~ .~ll.\,:",., ,~. .~hf';
ce 1nt.g~"I::q'~.;' j~; r-,? I' h,c... ~.'l?,:'::1.J \ ~.:.tt. P '1 ~:I:~-= ?
t.,~:; t, ,,,. 1 ~ Y-:'l.I need
-r-'-,',!'] t ":1'::'1:'. IflY (t1 t 'j.: Eo.
t.
I.
PATIENT
rE~ T TYPE
I r::s I' PRO WI; '.IL :
I' bH~.I_. l,ukL,^,
J(I IN r
C '.lMf' FH:.H Ir. rn. I VI::
L'II, 1 t:.:
I'I:.~' I r.l) AI!f(A:
IH't l,lt- rl,lo'I)'-'f:
'J/ 1 b/\lj
r.1~RV I ': AI_
Pf!(Jr,;F.a~~.~
--, PPQGR~~S REPUHr J--
Mr:lTlON
4/ ,:'8/".'
U:YT
,)/ I 'J/'U
Llt-"I
Pl::f"~t::N r
PH')GRt::SS
==::m==r=~=== ::=:=:.:~tt,=::'='r. '.~ U'~ ,..:t: :.c.r.:=r. ;"'j.':.:;.';.I:.~.,: -=: ;';, :'..':Z= tt.t.:~:o:.;::..or.:o:.= =.-a=o:u: ~.:==-=~~:===
LAT FLX A1 NEUTRAL
ROT. AT NE'.IIR,6L
7.2 11.,2 ~\1. 0:1:
4 I.] 4.':> 12.':1%
4/2"/93 till ti/9~\ PERCENT
k I 'JH I RJr;'H I fJf{I.H,RESS
MO , ION
=====.saK.a==:========~~~~='~2=~==~=~~~::=~"====~~~U~======~:2=====a=.
RO r . AT NEUTRAL
LAT FLX AT NEUIRAL
4 . ~"
Il.,'!
',.1.
12.8
16.,'%
0.0:1\
~II)T ION
4/,Ilj/93
F~,~ j[N~.
to/16/9~
o'rOls.
f'I:HCt/llr
PRQ(,RESS
====..aa=~~~=s=:===~:===~~~==::=====~=~~====~:~=~=~=~~================
t-LX/EXT AT NEUTRAL
1".2
40.4:t
I.~ .0
M'JJ ION
, 4n~/Y..
H.E X l'JN
61 II~ I'l ",:
I.LI:X IIJ~I
Pl'.R':tN r
PP'JGRESS
===..a.....=:~~==~===n==~==:====2==~:=:%~~=====:U::==~=~=======:~==~2
FLX/EXT AT NEUTRAL
14.fJ
:~'). 6~
1')' 2
..
.
,
PATIENr :
TESTING AREA:
TEST
FISHEL, CM'l.A
CERVICAL
ROT. A I "H~'.11 RAL
liAr!:.: b/16/93
S WE:: LEF r
.
GRAPHIC OVERLAY OF TORQUE CURVES
~~o
p
o
LI
tI
D
S
1.5
1.9
..q
~ .
.:;.r' ..
.___{I,:".: art.
~-:':":':;~fl'__.;''''. ,..~.~:...~~~~
-,l.st
""2nd
--3rd.
Bep
ep
ep
:.,
.,'"
'-J .
Soeoonds:1.
~
4
:J
. .
"
,
'.
"
.
PA TlENT
TESTING
TEST
FISHEL. I; AkLA
CERVICAL
LAT FLX AI N~Ulf(AL
,
uilll=.' ti/l,,/93
~qlJf:.: LEf'r
.
AR~A:
I
GRAPHIC OVERLAY OF TORQUE CURVES
?.~
P
o
11
rot
D
s
15
............. .
to' .,....( c'"
.>..... ...J-':"'"
:.....................,".. J---
/"..",::'
..... ,i~
... /..
,/ "
,....,l
1/
-1st Rep
"" 2nd Rep
u,
~
..."
C
Seconds:!
2
3
5
I
I
I
,
~-,
. '
. .
, .
PATIENT
TESTlNO
TEST
.
AREA:
FISHEL, I; AI~LA
CERV I r; ilL
LAf FLX AI ~II:IJ I kAL
,
OAr~~ t-/16/~~
~HOE.: RIGHT
GRAPHIC OVEHLAV OF TORQUE CURVES
?-0
p
<> '5
1I
l't 19
D
,8
,-
;)
I'" '.,.:..
, ..... ......
u~-".'~ ,---'
-T'.J - J'_ -
/'''/'....
//
Ii
.
-~st Rep
.... 2nd Rep
e
Seconds:~
:it
3
4
:;
"
,"
.; ...',
CHIROPRACTIC PROGRESS REPORT
In.uranoe Company
Prepared 106/24/93
Patient
PRUDENTIAL INSURANCE CO
PO BOX 977
Fishel, Carla Ale! 41
612 RANGE END RD
DILLSBURG. PA 17019
Phone 10.
717/432-9028 185-38-5488
Polloy Holder
TED ~ CARLA FISHEL
612 RANGE END RD
Type of Polloy! MVA Claim No,!
Dootor
J. CLIFFORD RENVO
P.O. Box 668
DILLSBURG, PA 17019
Phone
717/432-5099
Date of Initial vlsltl
PROGRESS REPORT
02/08/93
I, Chl.f co.plllnt It Inltlll ,lilt. Sulllry of flndlnll Ind
.1..nOlII.
Mr.. Fishel continues to have the following complalntsl Headaches,
neok pain and stiffness, and Intermlttant episode. of low back pain.
The pins and needles In her hand have been minimal as of late.
Z, "'lint prolrlll of cOlplalnt, lubl.cll'l and oblecli,.
flllll I 11I1 ,
Restricted and painful cervical range of motion, palpable cervical and
lumbar mu.cle hypertonicity. Positive Kemps, foramina compression,
Soto-Hall. and cervical distraction tests. Negative Valsalva manuver
althoulh coughlng/sneezlng continue to Increase cervical pain.
Functional strenlth analysis will be performed within the next two
weeks.
5, 'roanollll Guarded due to the traumatic, onset of her Injuries.
I, 'rllf '1lcrlptlon of trtlll.nl plln:
Manual manipulation to the cervical and
lumbar spine. Physical therapy consisting of
Interferentlal current and heat are applied
to the cervical spine.
7, RIcolltllllatlonl or Ratar'll
Mrs. Fishel continues to show alow but steady improvement in her
condition. Her headaches have subsided In intenaity, She i. b.ing ...n
twice. .eek.
J, CLIFFORD RENYO D.C.
Signature
, D.C.
"
CHIROPRACTIC PROGRESS REPORT
(Q OJJQ>>)f
Pn'p.:. r.;orj t 1)7, :~~: 1,),3
In8urance Company
p~ t.l.,n t.
PRUDENT I A L II'lSURA NCIZ CI)
PO BOX 977
r: 1 ~,h" I, ('a r I" Ase I 41
I; I::: RANGI::: (NO ReI
r'II.LSDlIRG, PA 17019
rot,,',n., I Pit
111/43~-~028 18~-3&-5466
Policy Holder
TED 8. CARLA FI:::HEL
612 RANGE END RD
Type ot Pol Ie)': ~lV^ '::1,,111I tkJ,:
Doctor
J, CLIFFORD RENYO
P.O. Box G60
DILLSBURG. PA l1Cl0
Phoni)
717/4:32-.rl09~~
r',~ ~. ", (J f Inl t I,. I v I ;1, It:
P/fOGRESS REPORT
02/06/93
I, ChI.1 co.plalnt at Initial ,I;it. Su.tary of llndlncs and
dlaenotls.
Mrlll, FI:,h",1 C(.nUnlJ..;:o toJ I."VI, lhe t,<1 Inwln" cl~.npl...lllt;.1 Headaches,
neck pai., and :;Ul'tn.:,.'"c:, -"1Ir.! Int,,'rmIU=.nt ..,pl;;:'Jd..!~, CJf I<>w back pain.
2, Pr'ltnt procr'55 of co.plalnl, ,ubj..ctl,. .nd cbjEcti,.
flndlnel,
Restl'lcted and painful c"'rvi,~:,1 '~'":3'" or mot lOll, p~lpable cervical and
lumbar mlJ$cle hyp"-'ru'nt~'ll.y. Po:;itiv., r:"""I';1, and foramln" compre>5l1llon
tests,
Functional strength an3lysl. reve~led continued defl~it with cervical
rotation. There h~lrj b81?n st.f~n~lh impf't:,lvement overall.
5. Proen051.: Guarde,j du,~ t,(J t.h," Ir';)u",,,Ur. "n ,,0" I, (Jf her 'nlIJI'1El~.
6, Brltl ducrlption 01 trul..nl plan:
Manual manlplllati'ln t.,)
lumbar ~plne. Phy~l~dl
Interferant!.;" CU(('..,,,,
to the c.rvlc~1 $pin~.
I h ~ '-:.) f' vi l.::;... I " nd
therapy con.i_llng af
~In,i he~t ~r~ .Jppli~d
7. RIcota.ndatlon. or R~'arks:
Mr$_ Fi:;htal cl,nt.inl.l(':,. tn ;:.h('lIN .:::Irll,l,l bl.l~ ::t.;?;"ldy impr"vl?m.~nt. in her
condit.tcln. H~r hl'!'l:ld;;,'.'h~l:~ t';IVI!J ('1:'Int.inl,llI?d ;'~I,r:1 3r..:.? irra~tc In int~enillty
and dur~tton. Sh~ i;~ c'_lrr~l,tly h~in~ $~el' 1-,2 ~ime;f 8 W0~k dependin,
upon her ~ch~dule.
'J, CLIFFbRO RENYO D.C.
"
:Slg,"".u...
, "." /'
"
. D.C,
I
CHIROPRACTIC PROGRESS REPORT
~
Inaurance Company
Prepared 108/31/93
Patient
PRUDENTIAL INSURANCE CO
PO BOX 977
Flahel, Carla Agel 41
6i2 RANGE END RD
DILLSBURG, PA 17019
Phone 10.
717/432-9026 185-38-6468
Policy Holder
TED L CARLA FISHEL
812 RANGE END RD
Type of PolicYI MVA Clalm No.1
Doctor
J. CLIFFORD RENYO
P.O. Box 668 Date
olLLSBURG, PA 17019
Phone
717/432-5099
of Initial visltl
PROGRESS REPORT
02/08/93
I, Chllf eOlplllnt at Initial Vlllt, Sul..ry of flndlnll Ind
dlllnolll,
Mra, Fishel continues to have the fol lowing complaintsl Headachea,
neck pain and atlffness, and Intermittant episodes of low back pain.
She has had a recurrence of her arm pain since the last report.
2, Pflllnt prolrlll of cOlplalnt, lubllGtlvl and obJlGtlvl
fl~I~~
Reatrlcted and painful cervical range of motion, palpable cervical and
lu.bar muacle hypertonicity. Positive Kemps and foramina oompression
tests,
Functional atrength analysis will not be performed until her MRI
reaulta are obtained,
5,hqMd" Guarded due to the traumatic onset of her Injurlea,
I
f
I. Irllf dlscrlptlon 01 trlltllnt pi In:
Manual manipulation to the cervical and
lumbar apine. Physical therapy conslstlns of
Interferentlal current and heat are applied
to the cervical aplne.
1, lleol..ndltlonl or RIIarkll
Mrs, Fishel was slven the choice of an M~I or nerve conduction 4tudy
to rule out disc Involvement. She has b.~n scheduled for the MR'. She
is currently belns se.n 1-2 times a week, A second opinion exam .ay be
.arrented after the MRI la obtained.
J. CLIFFORD RENYO D.C.
Signature __
. D.C.
."
-/
DILLSBLJRG CHIROPRACTtC CLHlIC
4 IlARLO CIRCLe
I' .0. [IrJ:< 668
DILL6BURG, PA 17019
(717) 'n::-~;1)99
February 14, 1994
PRUDENTIAL
POBOX 977
HARRISBURG, PA
.
fHTENl"lONI CLAIMS
PATIENTI
INSUREDI
DATE OF LOSSI
CLAIM NUMBERI
POLICY NUMBER:
EMPLOYER:
F I6HEL, cr,m A
SAME
'2/6/93
UNI<NOWN
282A968433
Dear Claims:
Ms. FISHEL has undergone comput~rl~ed
muscle testing with torque curves and
following tests ~mre performed:
mechanical, i~ometric
printed report.. The
Cl-C4 Cervical/Trapezius,
C5-Ca,Tl Anterior Thoracic/Pector Major,
C4,C5 Dorsal Scapular/Rhomboid,
C4-C6 Suprascapular/Infraspinatus,
C5,C6 Axillary/Deltoid,
C5,C6 Musculocutaneous/Biceps Brachli,
C6-C8 Radial/Triceps Brachii, and
C7,Ca,Tl Median (medial)/Palmaris Longus.
Test results are pregent~d in
including a description of
result in pounds.
the followlng pages of this report
each ts~t performed and the te.t
If you have any questions about this
assistance interpreting the result., please
test, or if you need
contact my office.
Riipec~f~~'II)yYf '~1 , . J~(!
, - v:..t/r. I ~ ()
! ClIF'uO ENva, ~7
v ,I'
DILLSEJUflG CHIRUPRACTlC Cl.INIC
0\ l:lARLO C I RCI.l,
P . [) . lio:< 6068
DILLSBUnO, PA l70l9
(7l7) 432-5('99
NAME! FISHF.:L, CARLA DATE! 2114/94
PATJENT III 18538:541313 INVOLVED JOINT! CE.RVICI1L SP I !'I.E
AGE! 42
SEX, F DOMINANCE! RIGHT
HEIGHTI 64 INCHES
TEST TYPE! MYOTOME TYPE OF REPORT! INI'TIAL
--( CURRENT TEST RESULTS )--
SEGEMENT MUSCLE
MOTION
C 'J
RIGHT U:,.T
STRENGTH
RIGHT LEFT
OIFF.
...a.maa=.~a.aa==~===~=======c==~======~===a=u=a==u~c=.=u.......=DC..
ce-ce , 11 Pllctor Major 4.7 1.9 27.2 16.2 b7.9X
(SHLO HOR ADD AT NEUTr{AL )
Ce,C6 Bicep!!l Brach i i ll.9 6.6 12.7 10.0 27.0%
(ELBW FLEX AT 9') de9 FLEX)
Ce,Cb Doltoid 2.9 5.3 16.0 :W.2 26.3Y.
(SHLD ABDUCT AT NEUTRAL)
C4-C6 Infrallpinat'Js 5.6 7.7 16.8 14.0 20.QX
(SHLO EXT ROT AT 90 del';' ABD)
Cl-C4 Trapez i~ls 7.7 9.1 25.2 29.S 1El.::SX
(SHLO HOR ABD AT NEUTRAL)
C6-C8 Triceps Brach i i 7.(' 5.3 11 .0) 12.~ 13.6%
(ELBW EXTENISON AT 90 de'Oj FLEX)
C7 ,ce, 11 Palmaris L,ongus 7.9 EJ.9 10.5 10.2 2.9X
(WRST FLEXION AT NEUTRAL)
C4,Ce Rhomboid 5.8 4.3 :20.2 19.8 2.0X
(SHLD ADDUCT AT NEUTRAL)
PILL6DURG CHIROPRnCTIC CLINIC
4 [l,~r~Lf') CIf\CLE
P. (,l. BOil l,'J8
DILLSBURG, PA 17019
(71 ",) 43;~-51)9<J
,\
NAME I FISHEL. CARLA DATE. 2/14/94
PATIENT Itl 1853fl:;'4rJEl INVOLVED JOINT. CERVICAL SPINE
AGEl 42
SEX. F DOt1INnNCE. flIGHT
HEIGHT I 04 INCHES
TEST TYPE. MYOTOI1F':: TYPE OF REPOR'r. INITIAL
--< INTFlOnUCTIL1t1 :>--
The equipment used in this t8stlng measures precise strength
capabilty. Tqst data provid.s ac~ur.te measurement& needed to
identify areas Df wea~ne$D, to quantify performance deficiencies,
to dmtermine the aHtent of inJury or disability, and to evaluate
rehabilitation goals and progr.G~.
To ensure the greatest possiblY rali~bili~y and validity of test
results, each test i9 evaluated by ~DffiputerizEd calculation of
the Coefficient <If VariaHol1 (C'J>. A "CV" of 18% or less
indicatea the pat ii'!nt tlas e:<l;H'ted a ccmsistent !;lffort. Computer
gener.lted torque curves vh~I.It'~d durinq tm;ting a1'll0 C)raphical1y
document the degree of consistency achieved during testing.
The use of a specially-designed t~.tin9 chair with this testinC)
provides isolation of the muscle groups being tested to avoid
recruitment of ether mUicles. This stabilization during testing
ensures accuracy and validity of ti,1!;t r'"sults.
Test results are displayed In pound";. Bilateral comparisons are
made comparing !;tr'ength of ttw lIninvcIlved f!:<tremity ~lith the
involved eHtremity. Bil~tQrdl differences are shown as a
percentage. Published literature supperts bilateral comparisons
as an effective means at det~rmlning 5trength loss. Differences
of up to 10% may be considered acc~pt3ble.
Published litarature al.o supports an .w.luation of Lumbar tests
balled upon the follc)"ling hierarcln 1 progression:
Extension should be irRater than FleHion
FleHinn should be greater than Latwral Fle.lon
Lateral FleHion should be gru3tQr than Rot.tlon
Ri9ht and Left Lat~'r,11 F1~"dc:lI'1 shmtld bE! ..qual
Right and Left Ro~;ation <;;hc1l.tld br.! equa 1
REFERENCEf3.
Beimborn, D.S., and Morrlssey, M.C.:
Rehtud to Trun~: Muse In P"rfQ\',n-Hlc<:>.
n RHV1DW of the Literature
Spin~, Voluffio 13, NlImber 6, 1988.
PATIENT
TEST
I FISHEL, CARI..A
DATEI 2/1/1/94
SIDEI RIGHT
I Cl-C4 Cervical/Tr&pezlu$
GRAPHIC OVERLAY OF TORQUE CURVES
58
48
P
o
U
...
D
S
38
....................
......
....... --
-1.. t Re.
....2nd Re.
1.8
.......
l.......
.......
28
'I'
,
I'
I
I
I
PATIENT
TEST
I FISHEL, CARLA
I C1-C4 Curvlcal/Trap~~l~~
DATF.I 2/14/94
SIDEI LEFT
CRAPHIC OUERLAY OF TORQUE CURUES
~8
I
r
48
P
o
U
N
D
S
38
....... ....... ..
....................... .....
............
28
-1.st He.
,...2nd. e.
1.8
>'
.
h,
PATIENT
TEST
I FISHEL. CARLA
DATEI 2/14/94
61 DE I Fl IGIo+T t ....:.~
I C~-C8.T1 Anterior Th~racic/P~ctor Major
CRAPHIC OUERLAV OF TORQUE CURUES
!:I 8
48
P
o
U
N
D
S
,.,
38
~
... ...........................
, ,
28-
-1.si: Rep
''''.2nd Rep
1.8
....i
....t
I"""'"
',I
Ii
'"
-',
PATIENT
TEST
I FISHEL, CARLA
DATEI 2/14/94
SIDEI LEFT
I C4,C5 Dorsal Scapular/Rhomboid
GRAPHIC OUERLAY OF TORQUE CURUES
58
48
P
0
U 38
N
J) 28
S
1.8
...............-.............................
-1.st R..
.... 2nd R..
"
, '
. .
.
PATIENT
I FISHEL. CARLA
DATEI 2/14/94
SIDEI LEFT
TEST
,
I C4-C6 ~upra.capular/tntra9pinatuft
GRAPHIC OVERLAY OF TORQUE CURVES
2"
15
P
o
U
N
D
S
....1 I
'.., ......... .
...... ..............."
........., .. .,
1"
~..#
,/
!
{
(
,
I
.I
{
(
../
-=i~1 1:1:
5
, ,
, ,
, ,
.
'!'\ "
tll
,I
u
,',ill
il.
f'
PATIENT
TEST
~
, :~
'~l'
III
If
" \~,\
l%'\,~
.~1:1
I:
(<"
.. I
, ','
ij','
,\.'
"
"
l'~
!:
I FISHEL, CARLA
,
DATEI 2/14/94
S IDE I LEFT
I C3,C6 Mu.~ulocutan~ou6/aiceps Brlchii
CRAPHIC OUERLAY OF TORQUE CURUES
a8
p
o
U
N
J)
S
.1S
'.18
5
,..../..... ............./"......,:'"..../".., ""',"'''''k
" ~
......
",
/
....
{
.
,
I
,
-.1.t Ie.
,... and e.
.
'"
PATIENT
TEST
I FISHEL, CARLA
DATEI 2/14/94
6IPEI RIGHT
I C6-CI3 R.ldlal/Tr"1r:ep'll 'I3rar:hl i
,
GRAPHIC OVERLAY OF TORQUE CURVES,
a8
p
o
U
H
D
S
15
........\...../.......: \...,t.......................
5
.'
"
f
(
I
,
,
I
!
,i'
.....,
.,
~
18
-1st R.p
....and R.p
, ,
'~
PATIENT
TEST
. FISHEL, CARLA
. C6-Ca Radial/Triceps Brachii
DA'TEI 2/14/94
elIDE. LEFT
GRAPHIC OVERLAY OF TORQUE CURVES
28
p
o
U
N
I)
S
.15
........,.......,/.)1.... .. ....". ...... .
5
.......r".
(
,
,
,
;'
I
,
./
i
,
-.1s1 R..
,....2n R..
.18
.
, "
',I
! I
,
f!
:1
, '-,'
,n
\,
li~
,
I'
..
PATIENT
TEST
I FISHEL, CARLA
DATEI 2/14/94
SIDEI RIGHT
I C?',Ce,Tl Median (medlall/Palmarls Longus
GRAPHIC OVERLAY OF TORQUE CURUES
a8
,:
p
o
u
...
D
S
18
1:5
:5
.............~ ....
...................1 1.........1
...........
........ '.
'"
(
{
I
.'
l
-1st I..
.....and ..
8 ../
S.oon
.
"
CHIROPRACTIC REPORT
Pr~~ir~'~: C~.'~6/9~
',I
[nsuran~~ ~om~.n7
F:otl...nt
PRUDENTIAL INSURANCE co
PO BOX 904
Fl:5!l''::! I ~',llo'L,l "-;-::: 0;:
(11 RANaE END ~c
::;IL~,SBU::,::, ['f, l701')
Fhon~ ID~
717/4J2-902€ 185-38-54se
Pol icy Holder
TED 5 CARLA FIsn~L
612 RANGE END RD
Typp of Policy: MVA Claim Mo,:
Doctor
J. CLIFFORD RENYO
P,O, Box 668
DILLSBURG. PA 17019
Fhor.~
717/431-5099
PROCREGS
Date of initial vt~Lt: n2/~8/93
1. ChLef co=plain~ at ~~~~~i: 'li!Lt !n! S~b~e~tL1e fLniLnq~
Mrs, Fishel continues to have the following complaLnts: H~adaah.~.
neck pain and stiffness. and int",:rn:ttant "~l~<1d"s of arm pain. H.,,:'
low back has been good ~ince the last report.
2, Prlllnt prcqrlss of ~lcplllnt Inl Ol;&:t:.! flndrnll
Redt'lcted and painful cervical range of moticn, ~alpable cervlcal and
lumbar muscle hypertonicity. POSlt:~~ ~emps and foramlna ccmprea~lon
tests.
Functional strength analysis has been postponed inJefln,t!y du= to
other unrelated health problems.
.. PI:'/r.:"" Guarded due to the tr,111m.,iI;".' on~..t cE 1-.el: lnjuries.
L Br~t~ C~Jcap~~ 1~ ~! '.~Ht,~,",~:
Hanual manipulation to the cervlcal and
lumbar spine. Physical therapy ~~~~lsting of
interferantia! current and heat a.~ ~(pli-J
to ~he cervical spine.
~, ~ ~::~::e;:l1~: :::: ~: ?:~l~~-:!:
Hr~. Fishel is scheduled to ha'l'" surgury en 311'Jth"r r:')~l':I,L'JI1 ~I", il~;
developed (unrelated to the accl'l.mti. .:~'''' '.ill h,;".> the testln9 ':l~....
~nd resum", treatment aft~r h~: ~.~~VQ!l.
S19n::iture
J. CL!FFORD ~ENYO,
J C. I--""D --",,"\ '" C
. ~f.....Utt;' .1:'.. j~, I.J. .
D,C,
~ "
j,), -.
J. CLIFFORD RENVO, D.C.
P,O. 10. 668
4 Sarlo Circle. Suite 0
DIII.burs. Pennsylvania 17019
Telephone: 171n 432-5099
Au;u.t 15, 19114
J. Jo.eph Danyo,
KDV orthopedic.
908 south O.org.
York, PA
RII Carla Pi.h.l
M.D.
st.
D.ar Dr. Danyo,
Carla Pi.h.l ha. be.n treating with me off and on for injuri.a .he
.ult.in.d al . r.sult of an accid.nt on 2-6~93. Mrs. Pi.h.l w.. .
p....ng.r in the front a.at of h.r huaband'. truck wh.n it wa. .truck on
the p....ng.r .id.. The truck wa. forc.d off the road, hit two po.t.,
w.nt over an embankm.nt and'rolled. It c.m. to rest on the roof. Sh. ha.
h.d the following complaint. .inc. the accid.nt. N.ck pain that radi.t.s
into the right 'houlder, hand, and in betw..n the .hould.r blad."
intermittant p.rioda of numbness in the right arm and hand, headach.,
that radiate up from the n.ck and s.ttl. behind the .ye. and templ.s,
difficulty sl..ping, and 8 f.eling of n.rvou.ne.. and t.nsion, Ther. i.
al.o .om. intermittant low back pain. Sh. ha. had occasional problem.
with h.r neck prior to the accident but thi. waa stre.. r.lated.
Mr.. Piah.l i. a qui.t reserv.d p.rson who haa a pa.t hiatory of
fr.qu.nt .nxi.ty att.cks ( one a day) and still has r..idual .ffact. of
B.ll'. pal.ey that manif.st.d a coupl. of months prior to the .ccident.
Sh. i. currently .mployed by Book of the Month in M.ch.nic.burg a. a
comput.r op.r.tor. Sh. has alao had a hyster.ctomy during the pa.t y.ar
aftar .h. .tart.d tr.atment for h.r injurie., Examination rev.al.d a
po.tive foramina compr.ssion test in n.utr.l and right lat.r.lly fl.x.d
po.ition., . po.itive Soto~Hall, K.mp'., .nd .hould.r d.pr...ion te.t,
DTR'. were +2 all around in the upp.r extremity and +3 for the ankle and
pat.ll.. Coughing and an..zing did not .licit any aymptom.. Ixt.n.ion
rot.tion manuv.r (ua.d to rule out potenti.l .trok..) wa. n.gative.
R.diograph. t.k.n h.r. r.v.aled a r.v.r..l of the c.rvical curve with.
2mm ant.rior off..t of C4 on C5, Th.r. i. .1.0 a vacuum cl.ft .ign
pr...nt at the ant.rior .up.rior .urfac. of the L3 and L4 v.rt.bral
bodi... Initial di.gno.i. wa. a traumatic aprain to the c.rvical and
lumbar .pine.,
Con..rvativ. car. wa. utilized on Mr.. Pi.hel by my..lf .nd h.r
f.aily dootor (an.lg..ic. and .ntinfl.mmatori.a). I utiliz.d tr.ction,
manipul.tion, ultr..ound, ex.rci.., and ice/h.at pack., Mr.. ri.h.l'.
r..pon.. to the tr.atm.nt wa. good. She obtain.d progr...iv. r.li.f with
h.r low back .nd-neck but when h.r other h.alth probl... cam. into play
( ..pecially the panic attack. ) .h. wa. not able to g.t con.i.tant
tr.at..nt. An HRI with kin.tic view. wa. perform.d on 5~12-94 and
r.v.al.d an HNP at C4 and C6 di.c.. Th.r. i. .1.0 .om. po..ibl. cord
coapr..aion with flexion and exten.ion po.ition..
.~
DR. WALLACE J. QUINLAN
7301 HASBROOK AVENUE
PHILADELPHIA, PA 19111
215/722-7200
March 9, 1994
MEDIMAX. INCORPORATED
Donna L. Bradshaw
Review Coordinator
2080 Cabot Blvd. W., Ste. 204
Lan.horne. Pennsylvania 19047
CLAIMANT:
CLAIM .
DII
CARLA FISHEL
46M02271
2/6/93
Dear Ms, Bradsha~:
Enclosed please find requested review in reference to the above
captioned patient,
RECORDS REVIEWED:
'I. Personal Injury Questionnaire - 2/15/93
2, DILLSBURG CHIROPRACTIC CLINIC. J. CLIFFORD RENYO, D.C,
· Initial Examination Report - 2/8/93
· Treatment/Proiress Sotes - 2/8/93 to 9/20/93
· Chiropractic Proaress Reports - 3/4/93. 4/6/93. 6/24/93,
7/22/93, 8/31/93 & 9/20/93
· Computerized Muscle Testina - 4/28/93, 6/16/93 & 2/14/94
· Reconsideration Letter - 1/8194
· Professional Invoices
3. Chiropractic Peer Revie~, ~ouis Camilli. D.C, - 1:,'J/93
SYNOPSIS/NARRATIVE:
Accordin. to these records the claimant is a 41 yenr old female who
was involved in an automobile accident on Februarv 6. 1993. She was
a front seat passenier of a truck which was struck on the left side
by another motor vehicle. The truck struck two small posts, tipped
over an embKnkment, rnlled onto its riaht side and came to rest on
upside down on its roof. She did not lose consciousness and did not
require emeriency treatment.
,',
CLAIMANT: CARLA FISHEL - PAGE TWO
CLAIM. : 46M02271
J, CLIFFORD RENYO, D,C.
On 2/8/93 Mrs. Fishel presented to the DillsburI Chiropractic
Clinic with complaints of pain across shoulders and rilht side of
neck, headache, soreness in rilht shoulder to elbow, pain down
center of back, and achiness of her right hip. An e~amination by J.
Clifford Ren7o, DC disclosed tbe followinl dialnosis:
._....~..ol' .'._~:.:.. ..... .,
',;"/~""~,"""""~",~,~",,,,'f_"''''_.O(' .A_.......... "T'
0, ..." '47.0 Cervical strain/sprain
846 Lumbosacral strain/sprain
Treatment Was instituted consist in, of manual manipulation of the
cervical and lumbar spine, and ph~'sical therapy consistini of
interferential current and heat to the cervical spine, Mrs. Fishel
has received a total of 6; treatments to 9/20/93, the date of the
last available record.
PEER REVIEW
On 12/9/93
consultant,
opinions:
the above records were reviewed by a chiropractic
Louis Camilli, DC, He submitted the followini clinical
Chiropractic treatment is an
response to the cervical
diainoses rendered.
appropriate treatment choice in
and lumbosacral strain/sprain
The overall duration of care and number of visits
8/30/93, incorporstinl 40 office visits is
relative to the dialnosis.
from 2/8/93
reasonable
Generally, the normal lenith of treatment and recovery time
for the cervical and lumbosacral strain/sprain injuries
reported is 4-6 months, incorporatinl approximately 35-40
office visits,
Within a delree of medical certainly, one milht expect a
patient with the injuries described to reach maximum benefit
from chiropractic care over a period of 4-6 months, which in
this case would be the end of AUiust 1993.
There was no submitted documentation to support the medical
necessit~. of chiropractic treatment beyond 8/30/93,
'r'I..JI"" - , , '.'~ ,~_",,"'f'9.!~V-,,",""__ _ .., n ..('t.~l""""""".,_,."''',n, ....""'!,,-fIIIlI'r''II'.''''.. -r-:""'P"TJII!""""'-.l'~'~"'.".' . .. ." ~ _.....
,~
CLAIMANT: CARLA FISHEL - PAGE FOUR
CLAIM. : ~6~'02:!71
Thanll you for iivini me the opportunity of contributini to the
resolution of your questions,
Please feel free to call upon me for any additional information YOU
may require.
-'
'---- ,- /
Watla~e J. Quinlan, D,C., CCSP
. ,-
WJQ:kJp
THE OPINIONS RENDERED IN THIS CASE ARE THE OPINIONS OF THE
REVIEWER, THE REVIEW HAS BEEN CONDUCTED WITHOUT A MEDICAL
EXAMINATION OF THE INDIVIDUAL REVIEWED, THE REVIEW IS BASED ON
DOCUMENTS PROVIDED TO US BY THE PROVIDER WITH THE ASSUMPTION THAT
THE DIAGNOSIS IS TRUE AND CORRECT, THIS REPORT IS A CLINICAL
ASSESSMENT OF DOCUMENTATION AND THE OPINIONS ARE BASED ON THE
INFORMATION AVAILABLE.
."
... ..;.'....
- ~~.-
_.__.----_._.,~_.. .._~ ...--.......
......
oJ
.
I
,
Louis Camilli. D.C.
P.o, Bo,'( .259
Me. Ro,:/al, N.1 0806/ ,,0.259
..'
--'
December 9, 1993
.
Medimax
2080 Cabot Blvd" .204
P.O. Box 337
Langhorne, PA 19047
Claimant: Carla Fishel
Claim.: 46M02271
DIl: 2/6/93
:~
',\l:\'"
......~ "'OJ
:..). '\,,\C
. . '.''l(,~ 1
',\
Dear Donna L. Bradshaw,
On 12/3/93 I received your request for a peer review of the
chiropractic care provided Carla Fishel, The following peer review
containB my clinical opinions regarding the medical records listed
below, These opinions are based solely on submitted records, absent the
opportunity to personally examine the patient,
The opinions provided do not const.itute a recommendation for a
specific claim or administrative function to be enforced,
Medical Records
1. Bills, Di11sburg Chiropractic Clinic, 2/9/93 - 8/30/93,
2. Personal Injury Questionnaire, 2/15/93,
3. Documentation, Dillsburg Chiropractic Clinic, 2/8/93 - 9/20/93.
4. Bill, 11/11/93.
Clinica.!_Histo~
Carla Fishel, a 41 year old female, was reportedly involved in a
motor vehicle accident on 2/6/93, Neither a police accident report
verifying the date of accident nor record of emergency room treatment or
hospitali%ation was provided for review.
On 2/8/93 Carla Fishel presented into the Dillsburg Chiropractic
Clinic for evaluation. . Initial subjective complaints included;
headaches, neck and low back pain, neck stiffness, difficulty sleeping,
nervousness, tension and pins/needles in the right hand. Examination
lead to a diagnosis of cervical strain/sprain and l~mbosacral
strain/sprain,
There was record of 30 dates of se~vice from 2/8/93 - 5/10/93 and
10 dates of service from 5/13/93 - 8130/93. Treatment consisted of
t
r
f
I
'il
,
~
J.,
"
I
.-
u}trasound, electric stimulation (unattended and manual), manipulation,
not/cold packs/ and unspecified physical medicine, Additionally there
is record of cervical muscle tests on 4/26/93 and 6/16/93 respectively.
Clinical ODinions
The following clinical opinions are provided in response to
questions contained in a referral letter dated 11/30/93. These opinions
are based solely on submitted records absent the opportunity to examine
the patient personally.
1) Do you feel treatment rendered to the patient was reasonable
and necessary? The medical necessity of the commencement of
chiropractic treatment on 2/6/93 has been established given the history
of trauma/ the patients subjective complaints and objective findings
listed, Chiropractic treatment is an appropriate treatment choice in
response to the cervical and lumbosacral strain/sprain diagnoses
rendered, The overall duration of care and number of visits from 2/6/93
- 8/30/93/ incorporating 40 office visits is reasonable relative to the
diagnosis.
The medical necessity of the continuous use of three passive
physiotherapy modalities in addition to manipulation throughout the
entire course of treatment has not been established. Generally, the
number of modalities utilized on each date of service will decrease over
time commensurate with patient progress, Although progress notes
indicate the patient was improving the number of modalities used did not
decrease. The use of three modalities in addition to manipulation for
the first two months followed by two modalities plus manipulation for
two months followed by the use of 0-1 passive modalities for an
additional two months would be an appropriate utilization level for the
diagnoses,
2) Based on your review, what is the normal length of treatment
and recovery time for injuries sustained in the motor vehicle accident
of February 6/ 1993? Generally, the normal length of treatment and
recovery time for the cervical and lumbosacral strain/sprain injuries
reported is 4-6 months, incorporating approximately 35-40 office visits.
3) Within a degree of medical certainty, when do you feel the
patient will reach maximum recovery level, if he/she has not already?
Please provide a specific dat.e, Within a degree of medical certainty,
one might expect a patient with the injuries described to reach maximum
benefit from chiropractic care over a period of 4-6 months, which in
this case would be the end of August 1993,
4) If applicable and based on the review, on what date do you feel
the treatment became medically unreasonable and unnecessary? There was
no submitted documentation to support the medical necessity of
chiropractic treatment be~ond 6/30/93,
Sincerely,
/\ -----..' C.",--,-<-L ,:.- .I) (..
..../-d-. <~:...._-
Dr. Louis Camilli, D,C,
.
Noney Romono, c'M,-r.
Ctr/ifi,J Mil""" 1'I.rwpiJ/
SEulYork Slrul, Dlllaburg,PA 17019
(717) 432-4620
CLIENT UPDATE
Cllenl Name:.. _(~. Jt!...L:,)~(_.. _ ..__.__"
.. .. __...___,_____._ __n___u.______.
,-
Session Dale: _._.>...:.2.. H_" ,_.' ,Time:, _ J!....::_~, .,_ ,.' ~:::: Lenglll 01 Session: ___l.._, ., hll, ___.___mln,
Practitioner: __lit ~1....(.-7.~--.i~-"-lD"!"',l-- .-.- ---.------.---..----,--------.
Physical Complalnls:_._...,H.,{!_.d~L_J<L_ f~.1I1_' :) _f'tJ.6/f"-L. 0_!'.!.L.J__,____
Technlquas usad:_I~'.L_J:Itl.rL'!.:J';. ,f~- ..:L_.J:I.:_r..Ii:" ".).. 'C / _,'-~~~)Lt:!".~,.,__ .-,--,- -.---.-
Commenls:_./_':..'(,__~I!L..d, _---"'.6/ t:_ __._/v_.j' ," k... _ ,~~~_ _ ~,:._lL_~',~,.:-'....I.':~~__~L_L!,~.!_
. '. ,I"
,_--'-'1/( I t!/J.' H--!...._________..____ .---..- _____m____"_ -- ----,- ------.-------
Session Dala:
;-:"Jv
(- ,'""" I
. Time: _....l.--'-.Zy-..,J4Pon Lenglh 01 Sesslon:__\__. hr..___mln,
Praclitloner:
Physical Complalnls:_.
-.------------------------.---.---
Techniques Used:
--_.---- ..--------------------.----
Commenls:______.______..__..__._._..__,_.__....___.
-.-..---------.--.-----
I (LJ."I
Session Dale: __ 'JI :...le..-___,____ Time: __---1_;_J....u_.JllPm Lenglh 01 Session: ---1-- hr.,
Practitioner: .______.....___..___.___,.._...__.._.______________.___._.____
mln,
Physical Complelnls: ___,_____ ____.__ -- --------------
Techniques Used:______.______..._______ .------.-----.
Commenls: ____________.__________________._
-----.. ---_._._~--_._."--,- --.','.'--' -.-. ._..-~.__._-_. ... ~.._-_._._._-_. .-.., .- ~ .- ...--.-.-----.-.---.---.--..-.-------------
Session Dale: _.) 'l J_______ Time: ...__!..2....10____ ~::: Lenglh 01 Session: _..._____ hr., ,______ mln,
Preclllloner: ________._________,. ,...___._.._____..._______.____.___________..________._
Physical Complelnls: _. ___. .__ _____.,_ __ .... _____..,. ..., _____... ____"'... __...n._. ....., ...-........ ---.- -.-' - ---...,-.-... .
Techniques Used: ___ ____. ......___._ - .----..--....---- --""---------- ---. .... ,-----..-.. .....
Commenls:____. '
... ..___.______.n.__...._____.. -- ~-_.~---
_____.__..~_____. ._.__".. ____~ _______ .._..' .______.____ _..__ ____ ___..n .-_____ __ _._._____.__.__
. -,..........
'.~
.
Nancy Romano, C,M,T,
C.,tl/i,J MdlldB' l'I,.,dpist
8 Eosl Yo,k Slrul . DUlsburS' I'A 11019
(117)HH620
CLIENT UPDATE
1
Cllont NIlIIIO:__L", ,_L:. _
I,' i II
..., . 'J_ _ :.....\.:::___ ~.-..- ...--
6esslon Dale: __._., j :_,_Gr._, ,_ __.,_ Time: ,. . .)~'.UJ... _ _~:~ lengt" 01 Sesslon:...__l....'h..'____._mln,
)
Praclllloner: ._._Mrc..:Ll)--J-..uJ.IUU_L -.., ...----.-,-,-.---'-- --,-., _ . .-....- ,-..--,--------,--.-.-.--------
Physical Complaints: _JjUf~L_,J..__f'A1;1-.-J-l--l"-rJ.:li.'-'..l..-J-::!.:!!..L-------~-----
Techniques used:_h<'_Llflp..-i~ J}_'-.J..~:L!::"<:"C!!.;'':Lj ~_ _xlL (j!0..J.2-r.~.L.....'.L,,"5C I.. "
Comments: ___.._.______,.....____'._._'_.___.. - -"....,---.-,--..-.-..... -. ...-------- .----,-.- -.'--------
-----------_._-~_.._----~ -..-..-..----- -_._----~._----- .~--_._._-----------
"}.7v ," ~ 'H'"
Session Date: _~_~______. Time: ____f..>:' U ____....0 '" Lenglh 01 Sesslon:___..(___. h.., ___,_ mln,
Praclllloner:_,
-----------------.-----.-..---------------- ----_._---~_._._-------
Physical Complalrils:
._._---------------------_._._-._-----...-_._-----~-----
Techniques Used:_ _,____.__._.,_.___
._._.._. ____............_ ___._.__.__..h__ ...._____...
Comments:
.._---~--_._-----------_.
- ._-------~----~_._.-
(" II "'(7) u.." 1
Session Dale:___~__I___--- Time: ___~..c....:-__"""" length of Sesslon:__ _h..,_
mln,
Practitioner:
-.------- ---.. -----_.._.----_._.------~-_._-
Physical Complalnts:.,________.~,_
----.-._- --------------.--.----.- .-.----- .._-- ._-_._--~-_.__.-._-~.-
Techniques Used:
~.__._-----~-----_._------
Commenls:
~------_._----------_._------_.._------~
~__.____~.______._____.__..._____.__.,___..___ __. n__.. .~_. _.______.. _._._____._...~.____.____ --. ------
Session Dale:
f If
":-,' "'<) u,m I
Time: ___~_____ "'P'" length 01 Session: _.._ ,___._ hr., _,_..___mln,
Practitioner:
Physlcel ComplalnlS:
Techniques Used: ____.... ___h_n___._. ._.
.- -----~_._-. ---. ...-- -_.._._-~..__. ,.--- -----.-,-.--..- ---
Comments: __ ,___ _ ____...______,__,_, H'
_ _. __. ___.___________..___._____._____.__.._. .__ __~ ___.__. .____ _.._. ____m__~ _....._~~__..~ __._._ . .._~ __...._____.. ._ ._H - .... --- _.____ - -,
.
NIIICY Romano. C,M ,T,
(",I/I,d Mil 11111' lI,w'phl
8 East York Strul' DUhbur.. PA 17019
(717) 43H620
CLIENT UPDATE
1 ~. . ~
Cllenl Namc:__L..,__I'l---.--'---,-s{,L - - - - '
_'__' ._._.....__ _.n_"_ ,'~--'-' -, .. - --_.._-~_.._.
Sessloll Dele: __---'---?~~'L-'--. ___ _ Time: _,_ \ __ ':':_~_ __~: ::: Length of Session: __ ,- L----- ...., ------ mln,
, ,
Preclllloner: ______.Ai!L:J..! _"'j-_____I-.?..(,l L'_ '-'.,' -- -, - .. ----- .. - - -- -" '
Physlcel Complalnls: __.1. .~<--------------------
Techniques Used: ,5~, ,,':1..---,-----,----- __________on_'
_......._____ ._____"" ._.u _ _ ,____.____._~.._"
--------
Comments: __________,__,_________'______---
----------------.--
I c", I' 'J'''' I
Session Date: _J..:-~--__ Time: _2~_~___l\,.," Length 01 Sesslon:__,__ .....__mln,
Praclllloner:
Physlca, Complaints:
-------
Techniques Used: _____
~--~_._-_.__.-------_.-.__.__.--_._- .--- -..------.------.-.----..----
Commenls:
Session Dale: --1- 22-____- Time:
s' . </"'.)
Ualll
"', '" Length 01 Session:
hr..
min.
Praclllloner: ________,_____,_______".___________'_______________
Physical Complaints: ____________'_ -------,--- -.----' ------------.--------------'
Techniques Used: _____________'___
..-----.--
Comments: ____,___
____._~___~___.._________________._.....__~~.._.__._..__u....__..____._________
1"- )'- 't'" 'J',,, 1
Session Dale: ___.Ji__~_____ Time: ___...:..._~__ 'Jp," Lenglh 01 Session: __,..... _ ,__ hll, _,_mln,
Practitioner'
.---.----.-------.-----.---.-.----
--- - -------------.
!'-hyslcal Complalnts:___ _______'
---~----------._--_.__..~..
Tlilchnlques Used:___ .._,,____,_,.. ---,---" ------,-,--------,-------------'--'---
Commenls:
.----..--- ------ .. .--. ..- -..------ - ..-....---- ----- ---.-.....
____.__. __._ ...__...__..._.._u___..______..__.__.__._ .--.-----.---.-..--.-.~.-. ..-----..---------.,...........---.---..----.- ..- .-.-.. ,-.
.
CLIENT LJPDATE
Cllenl Name:_t::_{~,--_._r.:,f-..<.t.
.-,----".__._- -- . -- -- -- ---.----. .-.----.---.-
Session Dale: ._......y~.:!__.._.._ Time: .)..}.,), m" ~;::: lenglh 01 Sesslon:_},. _. hro, _ _. ..___.mln,
Praclllloner: --tiff.'I L'f._/:1;d.ULbL_. ...- --. --, ..-. --- .. ..-' .-.... - -.-..---- -..--...---...-..
Physical Complain Is: __SiL-L..<-.- _.._.__...___.. -,---. -- . - ....-.--.---...
<
Techniques Used:_:-l.'Lc,.,_ ..-..,..............--.-.-.. ....--.." .....-..., ,-.----,..,--.----.-'-------
Comments: /1, (- I ( (11'~ , '. "fJ..:I!..~.~... ,I_d." .ll'" h.,~ u'r- .J.!d_( 5_..J:iLL'l..1..:..-..../ .2.~",-.-
", '..Je /..l:.~,y" ,'~'.\ t, .:,.....<-.-L-_J._Jl1.~y.J~.'.::.~!L...:.'-;!I..L-:.J1.'1--~-Lll.t--.-:..~!i-.:r-.-~~~':-:.L~~L-'_:.ls
; -
Session Dale: __~! ~
S. '] , '",,' I
Time: ----....!::.--;a>"' Lenglh 01 Sesslon:_.,____._ hro,
min.
Practitioner:
_.-------_.._._-~-_.~ ~ --_._-,------------_._~-------,.__._-----------
Physical Complalnls:,______.__.______...._._,..,__.._.____..___..____.-.-
Techniques Used:_.._.___.__,.__,__.__._ -----.--..- ---.--..-----------.--'-...
Comments:
.------------------------.----.-----...---------
IJ a III
Session Dale: ___.________ Time: __.._..._ ___,__.. ,". '" length 01 Session: ___,_ hro,___ mln,
Praclllloner:
._-----_._-_...-_.--_._--~.__.._---_._---------.---- ---~_.._-------
Physical Complalnls: .____________.___. ...- .-----..- . ----- ----..------.----.----.----
Techniques Used: ____.._____.__.,___..._ --,-.--.....-.--..--....-.
Commenls:______.._._________._____,____
..__.___ ______ __ _._._._._.___~. ._u.._ _0_'. .._._____ .__ ..----. ------- -----.--------...---
'JillIl
Session Dale: _,_.___..._..___, Tlma: ___. ____... ..___.. ,".... length of Session:,
hrl.
min.
Praclllloner:
_._...__~_O~________ ___._____ _._.__n. ._._.. ~__u_..ooo.__.___ -.-,---. -..-.-
Physical Complalnls:
Techniques Used: _._
___.____ __._________~__.____ __._ ._0___0___-. _.__~_____._.._.__.. o___'n. ..-.-- ...---.
--~-_._._-------_._--_._---_._.
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J, CLIFFORD RENYO, D,(,
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" Bdrlo Orell!', SUltl' D
DillsburK. PtmmylvaniJ170W
T.I.pho",': 17171412.\0'19
February 14, 1995
Jos.ph Dixon, Esq,
Dils and Dixon
Attorneys-at-~aw
101 south Second Street
Harrisburg. PA 17101
RE: Carla Fishel
D/A: 2/6/93
The following is a narrative report concerning the injuries of Carla
Fishel sustained as a result of an accident on 2/6/93. Hrs. Fishel was
examined and treated at this office on 2/8/93. At this time the patient
stated that on 2/6/93 she was involved in an automobile collision in
which injuries to her neck and low back were sustained. Hrs, Fishel
further stated that she was a passenger in the front seat of a vehicle
that was headed north on Route 74. The car struck the side passenger
door. causing the vehicle that Mrs, Fishel was in to slide off the road,
hitting two small posts" The vehicle than tipped over an embankment and
rolled onto the right side and then onto the roof, Mrs. Fishel remained
conscious throughout the event, and did not lose any consciousness at
all. The police were notified of the accident. Immediately after the
accident, Mrs. Fishel felt rather shaken up. It was tough to get her
calmed down because of her past history of panic and anxiety attacks.
Later that day she began to have pain across her shoulder blades and in
her neck, The next day she had pain not only in the neck and shoulder
blade area. but it radiated down the right shoulder to the area of the
elbow, Mrs, Fishel. who is employed by Book-of-the-Honth Club. did not
miss any work since the accident.
Mrs. Fishel's major complaints as a result of the accident include
the following:
1. Headaches. which radiate up from the neck and settle behind the eyes
and temple region bilaterally
2. Neck pain that starts in the neck and radiates out to the right
shoulder. down the arm, into the hand, and between the shoulder blade9
3. Intermittant periods of numbness in the right arm and hand
4. Difficulty sleeping at night
5. Constant feeling of nervousness and tension
off and on low back pain is also noted, but there has been nothing
consistent since the accident. Mrs, Fishel has had off and on neck
problems, but she states that at the time of the accident she was
symptomatic, According to prior information. her neck problems were
mostly stress-related, She did not require any post-accident
hospitalization.
Her difficulty sleeping stems from the fact that she cannot lay on
the right-hand side; if she does, it causes pain across the upper back
and neck and also pain from the shoulder to the elbow on the right-hand
side,
PHYSICAL EXAMINATION
Mrs. Fishel is a 44-year-old white female, She is approximately
five feet, four inches in height and weighs approximately 145 pounds.
Her demeanor was calm, Her respirations were normal, not labored. Her
posture was also normal. Mrs. Fishel ambulated well without assistance,
She is right-handed, She has a history of Bell's palsy, which has been
present since Decp.mber 10, 1993. There were masses, tenderness, or
lacerations present. Her facial muscles were not intact; she exhibited
Bell's palsy on the right-hand side. She did nct have vision problems
and did not report any problems. There was no buzzing or ringing in the
ears, and hearing was normal. Examination and palpation of the cervical
spine and musculature revealed deep and superficial muscle spasm of both
the antericr and posterior perivertebral musculature, It was present
bilaterally. Initially the upper extremities were not functionally
impaired and gross evidence of comparative atrophy was not noted.
Foraminal compression test was positive in both neutral and right
laterally flexed positions, This indicated that there was some nerve
root compression with pressure. The pain radiated into the right
shoulder region. Soto-Hall test was positive for pain in the lower
cervical region. Shoulder depression test was positive as well on the
right hand side. Val salva Maneuver was negative for any cervical or
lumbar pain. Kemp's test was positive for low back pain on the
left-hand side, even when it was performed on the right-hand side.
Tendon reflexes were performed. They were approximately +2 for the
upper extremity, consisting of biceps, triceps and brachioradialis. The
deep tendon reflexes for the lower extremity were +3 for Achilles and
patella reflexes. Cervical range of motion studies revealed the
following:
Flexion
Extension
Left Rotation
Right Rotation
Left Lateral Flexion
Right-Later'l Rlexion
NORMAL
65
50
55
55
40
40
EXAM
30
30
50
40
25
40
WITH PAIN
yes
yes
yes
yes
yes
yes
Radiographs were taken of Mrs, Fishel with the initial visit. A
five-view cervical series was performed and a two-view lumbar series was
performed a. well. With reference to the cervical views, there was a
complete rever.al of the normal cervical curve, with a two millimeter
anterior subluxation of C4 on C5. With reference to the lumbar view.,
there was a tiny vacuum sign present at the anterior-superior surface of
both L3 and L4 bodies, Otherwise there was no evidence of fracture,
dislocation, or arthritis in either of the cervical or lumbar spine..
DtAGNOSIS
The initial diagnosis that we had on Mrs, Fishel was a moderate to
severe traumatic cervical sprain. and a mild to moderate traumatic
lumbar sprain. The current diagnosis is a traumatically induced cervical
disc herniation with resultant brachial radiculitis.
TREATMENT
Treatment to date has been conservative in nature, consisting of
mild chiropractic spinal manipulation, cervical traction work utilizing
Cox flexion/distraction technique. physiotherapy consisting of
electrical muscle stim, consisting of 80 cycles per second, ultrasound
at approximately 1.0 watts/cm, and ice or heat packs depending on how
she was symptomatically. We initially were going to be seeing Mrs.
Fishel at least three to four times a week; the best that she could do
initially was twice a week for this treatment, Hrs, Fishel's initial
response to the treatment was very well. she stated that she had a
decrease in her symptomatic state, and had a decrease in the frequency
of the pain in the right shoulder and in the arm. The numbness tended
to persist in the right arm and hand, She progressed to the point where
in April 1993 we performed the first muscle testing on her. This
revealed a severe deficit with respect to lateral flexion of the
cervical spine and a mild deficit with respect to rotation of the
cervical spine, The amount of poundage that she put out for flexion and
extension was also quite weak as well. We used this as a basis for
giving her exercises and we stressed that we needed to stay on the
current schedule until she showed some improvement in light of the fact
that there was such a severe deficit with respect to lateral flexion.
She showed good improvement when we retested 6/16/93. She documented a
69 percent improvement with left lateral flexion, 0 improvement with
right lateral flexion, 12.5 percent progress with left rotation, and
16.7 percent improvement with respect to right rotation. Extension
poundage improved 40 percent and flexion poundage improved 36 percent,
In light of the fact that there was some progress, I felt that she could
go with the further improvement, and twice a week is not unreasonable at
this point. We stuck with the present schedule of twice a week since
that is all she can come in for. Mrs. Fishel also had some unrelated
physical problems with reference to the female reproductive system
besides having Bell's palsy. When this started to flare up she was not
able tQ,stic~ with the schedule as best she could. Mrs, Fishel also
suffers from frequent panic or anxiety attacks. There was approximately
a two-month break in treatment between September and November 1993
because she had surgery to correct some unrelated physical problems, and
at that point she was able to corne in for one visit in November. There
was also another two-month break in treatment after that due to the same
problems. When she returned in January 1994, she had a recurrence of
the neck pain and numbness in the arms. Although it was not quite as bad
as it was initially, the symptomology began to return without the
continued treatment. Once again we initiated the treatment plan. A
comparative muscle test was performed on February 14. 1994. Her major
complaints at this time were mostly with the right arm and shoulder pain
and numbness in that area. We ordered a cervical nerve root evaluation
consisting of muscle testing of very specific muscles in the upper
extremity,
.~-..
In six out of eight tests performed, there was at least a moderate to
Severe deficit with respect to strength of the right arm vs. the
strength of the left arm. Mrs. Fishel's schedule continued to be erratic
due to the nature of the panic attacks.
In May 1994, I ordered an HRI because of the persistence of the
numbness in the hands and I was not pleased with her progress at that
point. The HRI, dated Hay 12, 1994, revealed a moderate to large right
pareaaential herniated nucleus pulposus at C6/C7 and a small mild
pareasential herniated nucleus pulposus at C4/C5 region. The kinematic
study with the HRI revealed that there are some differing degrees of
bulging of the disc herniations with contact of the spinal cord
remaining in both flexion and extension.
Hrs, Fishel was sent for a second opinion examination with Dr. J,
Joseph Danyo in York in August 1994. He stated at that point she was
not a surgical candidate, but she may be in the future with regard to
the herniation of C6/C7. He also stated that standard conservative
treatment should continue. Dr. Danyo also added that she has some
myofasciaI points in the upper trapezius musculature and the upper
extremity. He noted that there was a decrease in her grip strength,
slightly on the right-hand side compared to the left, After Dr. Danyo's
opinion we decided to change the therapy to include some very specific
myofascial therapy using electrical stirn. applied to the cervical spine
in a continuous mode, Hrs, Fishel's response was good, and she began to
have more progressive relief of her tightness in the cervical region.
Overall there has been some improvement, and treatment helps her, but at
some points she is easily aggravated and the neck will be a continuous
point of weakness, probably for the rest of her life even if surgery is
utilized on her.
DISCUSSION
In general, this is a traumatically induced injury to the cervical
spine and lumbar spine. It is apparent that there has been an injury to
the discs in the cervical region, specifically C6 disc and C4 disc.
There appears to be a stretch injury to the posterior ligaments of the
cervical spine as well, resulting in deformity of the cervical curvature
with resultant instability, This injury has also resulted in an acute
subluxation syndrome to the cervical spine, There is a loss of full
range of motion to Hrs. Fishel, and this may result in some permanent
deficits. T~s loss of range of motion is due to the formation of scar
tissue at the injury site. Due to the structural weakness of the
cervical region, which was traumatically induced, and because of the
persistent symptomology and neurological deficits manifested, it is
apparent that the patient's symptoms are going to be recurrent and she
can expect intermittent exacerbations of pain and stiffness in the
cervical region,
Considerin; the patient's symptomolo;y, results of comparative
tests, examinations, and past experience with similar cases, this
weakness may well predispose these areas to further problems from either
a;;ravations or trauma which may not have occurred prior to the
accident, We have been able to keep Hrs, Fishel's symptoms from ;ettin;
worse throu;h conservative chiropractic care. She has been able to ;et
in approximately once ever] two weeks, but any thin; beyond that for
symptomolo;y and objective findin;s tend to point to a worsenin;
situation, Either one of two thin;s is ;o1n; to happen with Hrs,
Fishel: Ihe will continue receivin; conservative care for an
undetermined amount of time in order to prevent her condition from
;ettin; worse, or she will have to have sur;ical intervention on the
cervical spine.
Estimated costs of conservative care based upon her ca.e would ran;e
from approximately $1200 if there were no exacerbations present to $2000
per year if there was an exacerbation or recurrence, If sur;ical
intervention would be necessary amounts would be 10-15 times that of
conservative care, Hrs, Fishel's neck will be a constant weakness for
the rest of her life, and if she were unlucky enou;h to have any more
trauma to it, sur;ical intervention would be a probability instead of a
possibility,
In li;ht of these facts, I would have to say that the pro;nosis in
her case is goin; to be guarded at the present time.
This opinion is presented with a reasonable de;ree of chiropractic and
medical certainty.
S/;c/j~~!J ;) JC.
l r:,pt.~ D.C.
-.
JCRI rib
-
CARLA D. FISHEL AND
TED L. FISHEL, HER HUSBAND,
PLAINTIFFS
IN THE COURT OF CO . ___ OF
CUMBERLAND COUNTY, PENNSYLVANIA
1_____,
"
CIVIL ACTION - LAW
V
NO. 96-6873
CAREY C. WELSH,
DEFENDANT JURY TRIAL DEMANDED
DEPOSITION OF: TED LEON FISHEL
TAKEN BY: DEFENDANT
BEFORE: KELLY C. HILE, RPR
NOTARY PUBLIC
DATE: MARCH 5, 1998, 2:50 P.M.
PLACE: HARTMAN' MILLER, P.C.
126-128 WALNUT STREET
HARRISBURG, PENNSYLVANIA
FOR - PLAINTIFFS
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APPEARANCES:
JOSEPH J. DIXON, ESQUIRE
HARTMAN & MILLER, P.C.
BY: DREW P. GANNON, ESQUIRE
FOR - DEFENDANT
ALSO PRESENT:
CARLA DENISE FISHEL
'.....J
1<.eU,v c. na.s COUf"t''R~
ROr: Box 68C. Ickesburg. PA 17037
1-800-572-6286 FAX: 717-4J8.3834 ORIGINAL
3
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STIPULATION
2 It is hereby stipulated by and between counsel for
3 the respective parties that reading, signing, sealing,
4 certification and filing are hereby waived; and that all
5 objections except as to the form of the question are reserved
6 to the time of trial.
7
8
TED LEON FISHEL, called as a witness, being duly
I
I ..
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~
~
9
sworn, testified as follows:
10
DIRECT EXAMINATION
11
BII MR. GANNON:
12
Q
Mr. Fishel, would you state your name and spell it
13 for the record?
I
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14
A Ted Leon Fishel, T-E-D, L-E-O-N, F-I-S-H-E-L.
15
Q Okay. You were here for your wife's deposition
16
A Yes.
17
Q but I will briefly again review just some
18
background.
19 If I ask you a question that you don't understand,
20 please ask me to repeat it.
21
A
Okay.
22
Q
If you could just verbalize your responses for the
23 court reporter, that will be helpful.
-'
24
A
All right.
25
Q
And can I assume that if you do answer my question,
L'....
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1
that you understood what I asked?
2
A Hopetully.
3
Q
4
5
A
6
Q
7 description?
8
A
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9
Q
10
A
11
little
12
Q
'~. ,"'
Your wite described in detail the car accident.
Were you here tor that description?
Yes.
Is there anything you would like to add to that
She got it pretty close.
okay.
It is something you don't forget. There is a
several other things that happened, but that's
Okay. Well, let me ask you about her estimate ot
13
the speed you were traveling.
I
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14
Was it approximately 25 to 30 miles an hour?
15
A That we were traveling?
16
Q Yes.
4
17
A Oh, I thought you said that he was traveling when
18
you asked that. No, we were going about ten.
19
Q
20
21
Ten miles an hour?
MS. FISHEL: Oh, were we?
THE WITNESS: Oh, yes, we were only going about 10
22 or 15. We were just going across the bridge.
23 BY MR. GANNON:
.-'
24
25
Q
okay, all right.
A
Because I didn't like -- she did say I didn't even
t~
1
get it shifted into second gear yet at the time.
2
Q
Okay. So 10 to 15 miles an hour?
3
A
Um-hum.
4
You hadn't yet shifted into second gear?
Q
5
Right.
A
6
Q
So you were still in first gear?
7
Right.
A
8
Had you slowed down to cross the bridge?
Q
~
~
~
~
9
A
Well, yes. I
how to explain that to you, it
10
is -- we lived there all of our life. So it's -- you suggest
11
that people know where you are when you are doing things,
12
talking about things like that.
13
The road, there is a -- about a 90 degree turn
I
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14
coming into the bridge. There is railroad tracks there, which
15
they had just fixed. Before, you had to slow down; and it was
16
a real bumpy railroad that you had to go across. You cross the
17
railroad. There is the road that shoots off to the right -- I
18
am sorry, I am going this way.
19 There is a road that shoots off to the left; and
20 then the bridge starts, which is the Yellow Breeches Creek.
21 And then on the other side of the road, there is another 90
22 going to the left, which is the road that is going 74 towards
23 Carlisle.
-~
24
Okay.
Q
25
So we had to slow down for the railroad tracks,
A
5
- "......
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1
A
Yes, um-hum.
2
Q
Okay.
3
A
He talked to us like each individually.
4
Q
Okay.
5
A
Before -- like I think we were at the ambulance, and
6 then like he pulled her away and talked to her. I guess to
7 make sure everybody was different.
8 I think he talked to Mr. Welsh first while we were
..
I
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9
at the ambulance, I believe. I am not positive, but I think
10
that is what happened. And then I think they checked her.
11
While they were checking her -- and then they checked me out
12
afterwards. And then I believe he asked her questions. And
13 then he had me.
I
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Q Okay. And you were not injured in the accident?
15
A No more than normally. I would have been if it
16
wouldn't have been for the wife. I am not a seat belt lover.
17
Q She made you wear it that day?
18
A About a mile and a half up the road. She said we
19 are going for a long trip, put your seat belt on. I said I
20 hate seat belts.
21
I am a big guy, and it pulls across my chest. I
22 don't like that. And actually I had my seat belt on that day.
23 Yep, probably saved me,
....;
All right. And then after the accident, I think
24
Q
25 your wife had indicated that you may have spoken with Mr.
7
L~
1
things.
2
Q
But that is all you can recall at this time?
3
A
pretty much, yes.
4
Q
Let me ask you, how has your life been affected by
5 the accident?
6
A
Seriously, it has been a -- substantialwise,
7 moneywise, it kind of screwed our life up from thereon. She
8 didn't say this, but I will say it.
~
~
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~
9
They totaled my vehicle, of course; mainly because
10
the roof was caved in. And it was all paid for. And from
11
then, they gave me a -- what they call a blue book value. And
12
from there, we had to buy another vehicle, which we didn't have
13 the money at the time to do. And so from there until now, we
~
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14
have been kind of in a hole digging ourselves out, let's say.
15
Q okay.
16
A Besides healthwise.
17
Q She described the effects of the injury upon her
18
around the house.
19
Have you had to assume any of the dutios at home?
20
I am supposed to. I -- I do -- I do help with
A
I
21 the dishes a lot more than I used to.
22 I always had this thing against somebody sitting all
23 day long in a job; mental capacity compared to physical, like I
24
am all day long. And I always say, well, you are sitting all
25 day, you should want to stand and make me supper and do the
11
L-~i
1
dishes and do the cleaning, you know; and -- and I am on my
2 feet all day, so I want to sit and watch TV while you are doing
3 allot this,
4 But I could understand, after being injured and
5 everything, it is -- it is really tough. so, yes, I -- I try
6 to help out as much as I can. It is not all that I should at
7 times, but I try.
8
Q
Okay. Have your child care responsibilities changed
..
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9
in any way?
10
A Child care responsibilities?
They are pretty
11
much no, not really. They are --
12
Q okay.
'4_"
-- Q different generation.
13
A
I
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14
Q All right. Have you had any conversations with
15
anyone trom Erie Insurance?
16
A Since the accident?
17
Q Yes.
18
A Just about my vehicle.
19
Q
Okay.
20
A
The claims thing.
21
Q
All right. Is there anything the two of you used to
22 do before the accident that you can't do now?
23
A
There is things maybe that I wouldn't necessarily
,..,/
say we don't do. There is still things we try to do that we
24
25 can't do maybe as well together.
12
L _
1
COUNTY OF PERRY
SS
2 COMMONWEALTH OF PENNSYLVANIA :
3 I, Kelly C. Hile, a Notary PUblic, authorized to
4 administer oaths within and for the Commonwealth of
5 Pennsylvania, do hereby certify that the foregoing is the
6 testimony of TED LEON FISHEL.
7 I further certify that before the taking of said
8 deposition, the witness was duly sworn; that the questions and
..
~
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~
9
answers were taken down stenographically by the said
10
Reporter-Notary Public, and afterwards reduced to typewriting
11
under the direction of the said Reporter.
12
I further certify that the said deposition was
13 taken at the time and place specified in the caption sheet
I
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14
hereof.
15
I further certify that I am not a relative or
16
employee or attorney or counsel to any of the parties, or a
17
relative or employee of such attorney or counsel, or
18
financially interested directly or indirectly in this action.
19 I further certify that the said deposition
20 constitutes a true record of the testimony given by the said
21 witness.
22 IN WITNESS WHEREOF, I have hereunto set my hand
23 this 27th day of April, 1998.
~
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Kelly C'. Hile, RPR
Notary Public
24
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N'J "RIAL SIAl.
I <FIl Y G HILI, NoIIIJ -~
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25
14
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10. Un8llccrtalned at thill time.
BY:
Jos J. Dixon, Esquire
Attorney Id. No. 28290
126 State Street
Harrisburg, PA 17101
(717) 236.85 I 5
DATE:
;1//17"1
Attorney for the Plaintiffs
, "
,
,,.
-
Vl!RIFICATION
I verify that the atatementa made in this Answers to Reoue~t
for Production of nOClIftll'n,.e true and correct. I understand that falee
atatementa herein are made aubject to the penalty of 19 Pa. C.S.
,4904, relating to un.worn fal.ification to authorities.
DATEDI! J/lY#)
~ filAio 19. ,~hR!
,
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CBRTIFlCATR OF SBRVICB
I hereby certify that I served a copy of the foregoing
document by depositing the same in the United States mail, First
Class, postage prepaid, at the following address/es):
Drew p, Gannon, Rsquire
HARTMAN & MILLBR, P.C.
one Keystone Plaza, Suite 107
pront and Market Streets
Harrisburg, PA 17101
By
4~
~oseph J, Dixon, Bsquire
126 State Street
Harrisburg, PA 17101
(717) 236-8515
Attorney for the Claimant
Date: JJ / Jf1 /
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CARLA D. FISHEL AND
TED L. FISHEL, HER HUBBAND,
PLAINTIFFS
IN THE COURT OF COMMON PUAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
CIVIL ACTION - LAW
V
NO. 96-6873
CAREY C. WELSH,
DEFENDANT JURY TRIAL DEMANDED
DEPOSITION OF: CARLA DENISE FISHEL
TAKEN BY: DEFENDANT
BEFORE: KELLY C. HILE, RPR
NOTARY PUBLIC
DATE: MARCH 5, 1998, 2:07 P.M.
PLACE:
HARTMAN & MILLER, P.C.
126-128 WALNUT STREET
HARRISBURG, PENNSYLVANIA
APPEARANCES:
JOSEPH J. DIXON, ESQUIRE
FOR - PLAINTIFFS
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HARTMAN & MILLER, P.C.
BY: DREW P. GANNON, ESQUIRE
FOR - DEFENDANT
ALSO PRESENT:
TED LEON FISHEL
KeUY c. H~ CO&U't~ef?ortu"
ROr: Box 68C. Ickesburg. PA 17037
1-8O().572-6286 FAX: 7T7-438-3834 0 RIG I N A L
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STIPULATION
2
It is hereby stipulated by and between counsel for
3 the respective parties that reading, signing, sealing,
4 certification and filing are hereby waived; and that all
5 objections except as to the form of the que.tion are reserved
6 to the time of trial.
7
8
CARLA DENISE FISHEL, called a. a witne.s, being duly
9
sworn, testified as follows:
10
DIRECT EXAMINA~ION
11
BY MR. GANNON:
12
Q Mrs. Fishel, my name is Drew Gannon; and we are here
13
today to take your deposition in conjunction with your lawsuit
14
against Mr. Welsh.
15
Would you state and spell your last name for the
16
record?
17
A Carla Denise Fishel, C-A-R-L-A, D-E-N-I-S-E,
18
F-I-S-H-E-L.
19
Q
Have you ever had your deposition taken before?
20
A
No.
21
Q
Your attorney may have explained what is going to
22 happen, but I just want to briefly review.
23 I am going to ask you a number of questions about
24
the accident and your ongoing pain symptoms. If at any time
25 you don't understand a question, please ask me to repeat it.
t~
1
A
..
okay.
2 Q Also, the court reporter can only take down verbal
3 responses. So I would ask that you try to avoid shaking your
.. head or nodding.
5
A
6
Q
Okay.
Thank you. And, again, it you answer a question,
7 can I then Assume that you understood what I was asking?
8
A
Okay.
..
~
~
~
9
Q Okay. First, I would just like to ask you some
10
background questions.
11
I understand that you are married?
12
A Yes.
.,:;)
13
Q
I
I
i
~
14
A
15
Q
16
A
17
Q
18
Ute?
19
A
20
21 Club?
22
23
\."J
24
as
And this is your husband to my right?
Yes.
And you have two children, I believe?
Yes.
Have you lived in the mid state area tor your whole
Yes, I have.
Q
I understand that you work tor the Book-Of-The-Month
A
Yes, I do.
Q
About how long have you worked for them?
A
It will be 28 years this year.
Q
Okay. And you have -- or had insurance through
-
7
" h 1 MR. FISHEL: Stick.
!
I . 2 THE WITNESS: Stick shift.
3 BY MR. GANNON:
4 Q Okay. His was a stick shitt?
!5 A Yes.
6 Q Okay. Currently, what cars do you have?
7 A The Bonneville and a Volvo.
8 Q Okay. Is one of those cars designated your car
.. 9 versus
I 10 A Yes, the Bonneville.
~
11 Q Could you just describe for me, in your own words,
~
12 how the accident happened?
10 Once we crossed the bridge, I saw the other
13 A car
I 14 coming the opposite way. I saw his car go a little -- his back
115 end go to the inside --
i 16 Q Towards
I 17 A Towards the -- your
~ 18 Q Towards your lane?
19 A Yes, towards our side. He tried to control it,
20 and -- we -- and we edged over a little bit to the berm to try
21 to avoid if he would come over to our side. And when he, I
22 gues., overdid it when he brought it around; and that i. when
23 it -- his front end hit us on my husband'. door on that side.
W 24 Q On the driver's side door?
" 25 A Right. And then ~hat gave us 80me momentum that it
h
1
pushed us. And where the turn is, it kind ot slopes up a
2 little bit when it qoes around; and it was enouqh of an edqe
3 for us to roll down over the embankment, and we ended up on the
4 root ot the vehicle.
5
Okay. Were you wearinq a seat belt at that time?
Q
6 A Yes, I was.
7 Q Now, at the time when the accident occurred, was the
8 road I think you -- was there a curve in the road?
~
I
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~
9
A Yes, there is a turn.
10
Q Okay. Do you recall what the speed limit was or is
11
on that road?
12
A I think it is like 25 on the turn.
.~
Okay. I realize you weren't drivinq.
13
Q
I
;
i
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~
14
Do you have any recollection of how fast your
15
vehicle was qoinq?
16
A Well, from what he said --
17
Q And I
18
A -- I think he was -- hadn't chanqed into second qear
19
yet. So it was
he was qoinq relatively slow.
20
Okay.
Q
21
A
And when ~d saw him, we slowed down even more. You
~2 never -- you know, you always have to be prepared.
23
okay. Is there any estimate of speed you would feel
Q
--
24
comtortable in qivinq me?
25
I would say between 25, 30.
A
8
9
h
1
Q Okay. Have you had an opportunity to review the
2
police report that was completed?
3
A
4
Q
I went over it -- I had read it before, yes.
Okay. I am just going to show you the diagram that
5 the state trooper drew, and I just want to ask you if that
6 is -- if it looks accurate as to what happened.
7
A
8
Q
~
~
~
~
~
9
A
10
Q
11
A
12
Q
Um-hum.
The -- Mr. carey Welsh is in vehicle number one --
Okay.
-- and you are number two.
Right.
It looks like he sh~ws the vehicle first fishtailing
13
into your lane --
I
~
i
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~
14
A Right.
15
Q -- overcompensating, and then coming back and
16
hitting your vehicle on the driver's side door.
17
A Right.
18
Q And then these areas above the road, I believe, show
19 the counterclockwise rotation?
20
A
21
Q
22
A
23
Q
w
Um-hum, yes.
And then your vehicle ended up on the roof?
Right.
Okay. Do you recall what happened to you physically
24
inside of the vehicle once the collision occurred?
25
A
I remember bumping against the right side when it
~
1
rolled on its side. And then when we were on its root. And I
2
remember unlatchinq my husband's seat belt because he couldn't
3 qet it, and then I undid mine. And we just qot down on the
4 root ot the vehicle. He kicked out the side window, and we qot
5 out.
6
Q
7 out?
8
A
~
~
~
~
Q
9
Q
10
A
u
Q
12
A
13
Q
i
,
I
i
I
~
Okay. Which -- was it his window that he kicked
No, it was the back.
Okay. Was it the back -- the back on the
That tull window --
In the very back?
on the side.
Oh, on the side.
14
A On the side.
15
Q Was it on your side ot the car or his side?
16
A Hmm, let's see. It would have been his side.
17
Q Okay. Do you recall whether you ever struck the
18
windshield?
19
A
20
Q
21
A
22
Q
23
A
I
~
24
head to
25
Q
No, I don't think so.
Or the dashboard?
I don't believe.
Okay. Just the riqht side door?
Riqht. And probably I -- I had to come down on my
to qet out ot the seat belt.
Okay.
10
h
1
A
2
Q
3
A
13
Yes, an ambulance did come.
Did you go in the ambulance?
We went and talked to the guy in the ambulance, but
4 I didn't ask tor any treatment at that time.
5
Q
6
A
7
Q
8
A
Okay. Did your husband need any treatment?
No.
Okay, What happened next?
Atter the guy with the ambulance checked us out,
~
I
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~
9
then we were
we went with the policeman and sat in his car;
10
and he asked us some questions.
11
Q And is that what he based this report on?
12
A I would imagine.
~~
13
Q
I
;
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Okay. Ie there anything in this report that you
14
would disagree with?
15
16
And it you need a moment to review it
A (Reviewing.) No, I don't think so.
17
Q Okay. After you met with the police otticer, what
18
happened?
19
A
They had -- well, they called somebody to come and
20 tow the vehicle away; and -- who was that gave -- somebody gave
21 us a ride home so we could get our other vehicle.
22
Q
23
A
~
24
Shumaker's, then we took our car out there and took our
Okay.
And then where they towed it to, at -- at
25 b.longings out ot -- out ot the vehicle.
b_
1
Q
26th, 1993?
3
A
4
Q
5
A
Okay. And this was still in the morning of February
Yes, um-hum.
Okay. What did you do the rest of that day?
We went to my -- our son's wrestling match in Perry
6 county, where we were originally headed,
7
Q
Okay. And, therefore, that -- on February 6th,
8 1993, did you seek any medical attention?
..
~
~
~
9
A No; not that day, no. Although later that day, I
10
did start to have the -- the pain in my neck and stuff from it.
11
Q Okay. That was going to be my next question. When
12
did your symptoms develop?
,..
13
A
~
~
~
i
I
~
It was later
yes, it was later in the afternoon I
14
actually started having the pain; and --
15
Q Would you describe the pain for me?
16
A Well, it started like here in my shoulders and up
17
over the back of my head and down over the front of my
18
forehead. And it was a -- and I have blood pressure problems.
19 So I knew it was a different type of headache than came from
20
that, and
you know, It was just a really strange pain, but
21 it came from the back of my neck on up around to the front.
22
Q
Okay. Were there ar.y other symptoms at that point
w
23 that you developed?
24
A
25
Q
Not with my arms or anything right then, no.
Okay. The next day would ha",e been February 7th,
14
~
1
Q
2
A
3
Q
4
A
17
Okay. Did you go back to him again then?
Yes, I did.
When did you next see him, if you recall?
Probably later that week for the first time to
5 actually do anything with my neck,
6
Q
7
A
8
Q
And what did he do for you?
He like tried to adjust it.
okay. All right, what does that involve?
~
~
~
~
9
A Like manipulation of the -- the neck and this area
10
back in back of your neck and stuff.
11
Q Okay. Did he give you any ultrasound or heat
12
therapy?
I :,t
13
A
I
i
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14
Yes.
Okay. Did you have a family physician at that time?
Q Okay. How about any ice packs?
15
A I don't think I used ice.
16
Q At that point, did he -- after he saw the x-rays,
17
did he refer you to a doctor -- a medical doctor?
18
A Not right then, no.
19
Q
20
A
21
Q
22
A
23
had
~
Yes, I did.
And is that Dr. Willard that I saw in your records?
Let's see. Let's see, '93. I am not sure if I
I had transferred to there because I was going to the
24
Family Medicine Center of Dillsburg before that. And I might
25 have been still there before --
L~
1
Q
2
And, again, I just want to be clear,
Could you explain all the different types of pain
3 you were having?
4
A
The pain in my neck, over the top ot my head, and
5 through my forehead; some pain down my -- in my upper arm, and
6 some like extended down into the lower arm.
7
Q
8 pain?
~
~
~
~
9
10
A
11
Q
12
pain.
\
13
I
i
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14
A
15
line.
16
Q
17
A
18
Q
19 scnlp?
okay. Now, could you describe the nature ot the
Was it a stabbing pain?
Well, the pain I had in my head was really bad.
Now, was that -- I guess there is difterent types ot
Was that a headache type pain?
No. I would say it is more in the migraine headache
okay, okay.
That type of pain.
But it, in turn -- it wasn't like a pain to your
20 I mean, it was a --
21
A
22
Q
23
A
~
24
pain.
25
Q
No, no, no.
Okay.
The pain in the arm would be like kind ot sharp
Okay.
19
L 1
1
and stuff because if I use it for a continued time, it like
2 it will qo like totally numb on me.
3
Okay.
Q
4
Okay. Like -- like if you use the mouse on the
A
5 computer, if my hand would be on -- like if I would be usinq it
6 constantly, I have had it qo numb on me.
7
Okay. I want to be clear for this question.
Q
8
Are you makinq any type of claim that you have been
..
~
i
~
9
denied a promotJ.on or have not been able to advan<:e because of
10
your injury?
11
A No.
12
Q What exactly is your job with Book-Of-The-Month
'.)
13 Club?
I
~
~
i
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~
14
A I am an accountinq clerk.
15
Q What are your duties in that position?
16
A We receive all of the invoices from our book vendors
17
and take care of those. I have to talk to vendors on the
18
phone. I do a lot of computer entry on it because all of our
19
systems are on the
on the computer.
20
Do you do a lot of sittinq in this job?
Q
21
Yes, almost constantly.
A
22
Is there any specific liftinq involved?
Q
23
A
No.
\..,,/
Q
And is that the same job that you have now that you
24
,
25 had at the time of the accident?
22
L, .~
1
A
Yes,
2
Q
Now, the answers to your interrogatories reterenced
3 pain in your hands, plural.
4
A
Um-hum.
5
Q
And I wasn't sure it there was a problem with your
6 lett .ide or just your right side.
7
A
It wasn't right away, but eventually it started
8 to -- it is not nearly as bad as like this hand.
..
!
~
~
9
Q And you are pointing to your right hand?
10
A Right hand, right. But there are times I have the
11
pain in there; and -- and it does get nu~b, but not to the
12
degree this one -- this one will go totally numb.
)
13
Q
Okay. What makes it go numb?
J
;
i
~
~
A What type at things I am doing, is that what you
14
15
mean?
16
Q Yes.
17
A Well, say if I am curling my hair in the morning and
18
holding on to that, it will make my hand go numb. If I am
19 reading a book and holding it like that, it will go numb. Or
20 if I am writing for any length ot time, it will do that. Or
21 crocheting. Whatever I am -- you know, anything that I have
22 to
23
Q
And how do you get rid of the numbness?
.....I
I usually take it and shake it to my .ide.
24
A
I have
25
I usually
it I am -- like my hair, I will put that down, you
23
24
L~
1
know, and get away trom it tor a little bit.
2
Q
What would you characterize as the -- your bigge.t
3 complaint right now?
4
A
5
Q
6
A
7
Q
That.
The numbness in your hand?
Um-hum.
About the headaches, how otten do you -- do you
8 still get the headaches?
~
I
~
~
9
A Not as bad bscause I go to a massage therapist; and
10
she works on the muscles in my shoulders and my neck, and that
11
helps open that up so that I don't get the bad pain in my head.
12
Q Let me ask you there. Who is the massage therapist?
")
, , ,
13
A
I
r
i
~
~
14
Q
15
A
16
Q
17
A
18
Q
19
A
Nancy Romano.
And where is she?
She is on Saint Johns Road, Shiremanstown.
How otten do you go there?
I try to go every two weeks.
And how otten do you get headaches?
Oh. Well, it 1 don't see her, then I get them
20 pretty regular, like every day; like -- but I would say it I go
21 every two weeks, I don't get very many headaches.
22
Q
23 headaches?
~
24
A
Okay. Do you have any medication to take tor your
Well, originally, when I went to Dr. Danyo -- Danyo
25 down in York, he had prescribed medicine tor me. And then
,
l_
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I
~
~
I l
I
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i
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~
10
11
12
25
1
later, when I transferred to Dr. Willar.d, he had qiven me
2 medication to -- that I could take, But now, usually I just
3 take Ibuprofen or Tylenol.
4
Just something you can buy over-the-counter?
Q
5
Riqht, urn-hum.
A
6
Okay. You mentioned Dr. Danyo.
Q
7 Had you continued to treat with Dr. Renyo up until
8 he referred you to Dr. Danyo?
9
A Yes.
Q Could you explain what precipitated that referral?
A Well, I think the -- once he did all -- did those
muscle tests and stuff, and -- and he wasn't really helping me
13 that much; you know, as much as what he should, I guess -- no,
14
15
16
17
18
I guess he couldn't do any more. Then he referred me to him --
Q Okay.
A to check me out and, you know, see what his
opinion of my injury was.
Q Okay. And do you know what kind of doctor Dr. Danyo
19 is?
20
A
It is -- well, I know he works with sports medicine.
21 I don't know what it is called.
22
23
24
25
Q
Is he an orthopedic surgeon?
A
I think so. I think that is what it was called.
Q
And do you recall when that referral took place?
A
It was in '94.
30
L.-.
._~
1
Q
Is that W-I-L-L-A-R-D?
2
A
That's right.
3
Q
Has he, aside from prescribing medication, done
4 anything for your complaints?
5
A
No. He told me if I needed something, you know, he
6 would get involved; but
7
Q
Okay. Also Chiropractor Renyo's notes reflect a
8 history of anxiety and panic attacks, and I just want to make
..
~
~
~
9
sure that you are not making any type of claim that those were
10
associated or aggravated by the --
12
Q So that I -- just so the record is clear.
11
A No, because I had those previous with -- to that.
I,)
13
A
Right.
I
~
~
i
~
~
14
Q I want to make sure I ask my question.
15
They are not related to the car accident?
16
A No.
17
Q Okay. I believe you had addressed this question in
18
your interrogatories, but could you explain to me how your
19 ongoing pain complaints affect your normal daily routine?
20
A
I would say my -- when I am getting ready for work
21 in the morning. In some of the things I handle at work that I
22 have to do; like with the invoices, when -- if you have to
23 if I have to sort something a lot and use -- use that h~nd a
\.J
24
lot, then
then I have problems ~ith it.
25
Q
Okay. Getting ready in the morning, I just want to
31
L~
1
explore that a little more.
2
Are you able to dress yourself?
3
A
Oh, yes, um-hum.
4
Q
And bathe yourself?
5
A
Oh, yes, urn-hum.
6
Q
And you had mentioned before about curling your
7 hair.
8
A
Um-hum.
..
~
~
~
9
Q Can you still do that by yourself?
10
A Oh, yes, I can do it on my own.
11
Q Okay. And you mentioned some recreational
12
activities: CrOCheting, painting, writing, and reading.
:)
13
A Right.
I
;
i
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~
14
Q Can you still do all of those thing.?
15
A I do them, but it is limited.
16
Q Okay. And is that based upon the numbness in your
17
right hand?
18
A Right, urn-hum.
19
Q
Were there any more athletic events you had done
20 before the injury that you don't do now?
21
A
Well, I like
I play volleyball; but I -- you
22 know, I can't because I wouldn't want to hit anything
23 with -- you know.
......,
24
Q
Right.
25
A
I don't want to get into that.
~
1
Q
2
A
How often did you do that before 1993?
I -- it was like a six week thing out at the high
3 school. I did exercises, and then we played volleyball.
4 Q Was that a one-time event?
5 A I did it two different times that I had enrolled in
6 that.
7
Q
8
A
Okay. Do you remember what year that was?
No.
..
~
~
~
9
Q Okay. Was it within a few years of 1993 or --
10
A I would say it was.
11
Q Okay. How about around the house, are you still
12
able to cook?
C:l
13
~
I
;
i
!
~
14
Q
15
A
16
Q
17
A
18
Q
19
A
20
Q
21
A
22
Q
23
A
\J
Um-hum, yes, I am.
How about doing the dishes?
Yes.
okay. How about cleaning and doing the laundry?
Yes. I do all the -- do what has to be done.
Like can you make the bed?
Yes.
How about grocery shopping?
Well, I have some problems with that.
Okay. Could you describe those problems?
Well, say if I went shopping and was trying to carry
24
a bag, then I -- I can't really handle having anything in that
25 hand or that -- carrying it with that arm. Like if I --
32
b
..
I
~
~
Q
I
-
i
~
~
....
36
1 A
2
3
4
5 P.M.)
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
I don't think so.
MR. GANNON: Okay. I have nothing further.
THE WITNESS: okay.
(Whereupon, the deposition 'was,concluded at 2:49
.
..
,. ~
CRRTIFlCATR OF SRRVI~
I hereby certify that I served a copy of the foregoing
document oy depositing the same in the United States mail, First
Class, postage prepaid, at the following address (es) :
'ii
\fj
},
t~:
Drew P. Gannon, Esquire
HARTMAN & MILLER, P.C.
One Keystone Plaza, Suite 107
pront and Market Streets
Harrisburg, PA 17101
'1-/
I,;
r~'
,
I,"
II
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.,
..
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4Gk~-
. Jo eph J. n, Esquire
126 State Street
Harrisburg, PA 17101
(717) 236-8515
By
Attorney for the Claimant
Date: -///;11!
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CARLA D. PISHEL and I IN THE COURT OF COMMON PLBAS
TBD L. PISHEL, her husband, I CUMBERLAND CO., PENNSYLVANIA
I
PlaintiffB I NO.
I
v. I
I CIVIL ACTION - LAW
CAREY C. WELSH, I
I
Defendant I JURY TRIAL DEMANDED
COMPLAINT
'AND NOW, this 20th day of December, 1996, come the Plaintiffs,
Carla D. Fishel and Ted L. Fishel, her husband, by and through
their attorney, Joseph J. Dixon, Esquire, who respectfully aver as
follows I
1. The PlaintiffB are Carla D. Fishel and Ted L. Fishel,
adult individuals who reside at 612 Range End Road, Dillsburg, York
County, Pennsylvania, l70l9.
2. The Defendant is Carey C. Wslsh, an adult individual who
resides at 202 Shugart Avenue, Boiling Springs, Cumberland County,
Pennsylvania, l7007.
J. The facts and occurrences herein took place on February 6,
199J, at approximately 8145 A.M. on Route 74 approximately 200 feet
south of the intersection of. Creek Road in Monroe Township,
Cumberland County, Pennsylvania.
... At aforeaaid time and place, the Plaintiff, Carla D.
pishel, w.. a paseenger in a 1986 Ford Bronco II motor vehicle
operated by her husband, Ted L. Fiehel.
5. At aforesaid time and place, the Defendant wae driving a
1985 Ford Muetang titled in hie name.
6. At aforeeaid time and place, the Plaintiff, Ted L.
Piehel'e, motor vehicle was traveling northbound on Route 74.
7. At aforesaid time and place, the Defendant's motor vehicle
was traveling eouthbound on Route 74.
8. At aforesaid time and place, the Defendant lost control of
his motor vehicle and it cro.sed the centerline of the roadway and
struck the left side of the Plaintiff, Ted L. Fishel's, motor
vehicle.
9. At aforeeaid time and place, the Plaintiff, Ted L.
Pi.hel's, motor vehicle wae spun around 270 degrees
counterclockwiee, traveling 51 feet off the berm, rolling onto its
roof facing west on a small embankment adjacent to the road.
10. Said collieion was due to the careleeenese and
reckle.sness of the Defendant which consists of the following I
(a) Traveling too fast for conditione,
(b) Driving on the wrong .ide of a
rQadway,
2
the cervical .pine, stretch injury to the po.terior ligament. of
the cervical spine, brachial radiculiti. and lumbar Itrain.
14. A. a relult of said injurie., the Plaintiff, Carla D.
Pi.hel, ha. undergone in the pa.t and will undergo in the future
great pain and luffering.
15. As a result of hel' injuries, the Plaintiff, Carla D.
Pilhel, ha. been advi.ed and therefore over. that she always will
have seriou. permanent problems and limitations in her activities.
16. As a result of her injuries, the Plaintiff, Carla D.
Pi.hel, i. obliged to receive and undergo medical care and .pend
various .um. of money and incur various expenses for the injuries
she .uffered. The total amount of the.e los.es 11 unascertained at
thie time.
17. As a result of said injuries, the Plaintiff, Carla D.
Pi.hel, ha. lost wage. from work. In addition, she will continue
to lo.e opportunitie. to earn additional wages and ha. a lo.~ of
earning capacity. The total amount of these losse. is
unascertained at this time.
18. A. result of her injurie., the Plaintiff, Carla D. Fishel,
may have to incur in the future additional financial expensel and
lo.s.., the total amount of which i. una.certained at this time.
4
U. A. a result of the aforelaid injurie., the Plaintiff,
Carla D. pi.hel, ha. suffered a .ub.tantial inconvenience in her
life and a decrea.e in the quality of her life.
WHBRI!lPORB, the Plaintifte pray thil Honorable Court enter
judqment againlt the Defendant in an amount in ex~ell of TWenty-
Pive Thou.and ($25,000.00) Dollan, plus interelt and COlts of
suit.
COUNT II
TED L. FISHEL
v.
CAREY C. WELSH
20. Paraqraphl 1 throuqh 19 of this Complaint are incorporated
herein by reference and made a part hereof.
21. As a relult of laid injuries lustained by his wife, Carla
D. Phhel, the Plaintiff, Ted L. Fiehel, has been and will be
deprived of allistanoe, companionship, conlortium and society of
his wife, all of which have been and will be to his qreat loss and
detriment.
22. A. a relult of the accident, the Plaintiff, Ted L. Pilhel,
h.1 lufflred a permanent diminution of hil ability to enjoy life
and life'. plealure..
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Plaintiffs and that PlaintllTs' Complaint be dismissed with prejudice and costs of this action,
NEW MATIER
23, The avennents set forth in 1)laintifts' Complaint fail to state a claim or cause of
action against Welsh upon which relief may be granted.
24. Any claim or cause of action set forth in Plaintills' Complaint is barred by
operation of the contributory/comparative negligence of Plaintiffs as may be developed during
discovery ,
25, Any claim or cause of action as set lorth in Plaintift's' Complaint is barred by
operation of Plaintiffs' assumption ofa known risk as may be developed during discovery.
26. Any claim or cause of action against the Plaintiffs' Complaint is barred by the
applicable Statute of Limitalions, including specifically, but not limited to, any claim or cause of
action which, by reason of lack of specificity of pleading. is not directly or specifically set forth
in the language of Plaintiffs' Complaint, but which Plaintiffs seek to raise at a later time by
further amendment, claiming to have preserved such claim or cause of action within Plaintiffs'
Amended Complaint.
27. At all material times, it is believed, and therefore averred, that Plaintiffs were
named insureds under an automobile policy with Prudential Insurance Company under which
Plaintiffs elected a limited tort option.
28, The aforesaid election of the limited tort option by Plaintiff.~ is in complete
confonnance with the Motor Vehicle Financial Responsibility Act, as codified at 75 Pa.C,S.A. f
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29. The injuries alleged to have been sustained by Plaintiffs do not meet the detlnition
of "serious injury" as set forth at 7S Pa.C.S,A. ~ 1702. and Plaintiffs' claim or cause ohction is
,
,
\".
therefore barred by Plaintiffs' election of the limited tort option and the Motor Vehicle Financial
."
,
Responsibility Act. specifically 75 Pa,C,S.A. ~ 170S(d).
WHEREFORE. Defendant Carey C. Welsh demands judgment in his favor and against
Plaintiffs and that Plaintiffs' Complaint be dismissed with prejudice and costs of this action.
NOTICE TO PLEAD
YOU ARE HEREBY NOTIFIED to file a written response to the enclosed Answer With
New Matter within twenty (20) days from service hereof or a judgment may be entered against
you.
Respectfully submitted.
HARTMAN & MILLER, P.C.
Dated: ~11t/'11
.y~
J . Hartman, Esquire
Supreme Ct.I,D. #21902
One Keystone Plaza. Suite 107
Front and Market Streets
Harrisburg, PA 17101
(717) 232-3046
Attomey for Defendant, Carey C. Welsh
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4, The pleadings in this mailer have been completed.
S, A limited tort elector may sue for non-economic damages only ifhe or she sutTers
serious injury in the automobile accident. 75 Pa. C,S,A, ~ 1705(d).
6. The Pennsylvania Motor Vehicle Financial Responsibility Law defines the term
"serious injury" as: "a personal injury resulting in death, serious impairment of body function or
permanent serious disfigurement." 75 Pa. C.S.A. ~ 1702.
7. Serious impairment, which would allow a limited tort plaintilTto recover non-
economic damages, must interfere substantially with an individual's normal activities, imposing
more than mild or slight limitation on such activity for an extended period of one's life, Kelly v.
Ziolko, 705 A.2d 868 (Pa. Super. 1997).
8. Where there is no substantial dispute of material fact that PlaintilT has not met the
"serious impairment of body function" threshold, the case should be dismissed, ~ 75 Pa.
C.S.A. ~ 1705(d).
9. The deposition of Carla Fishel was taken on March 5, 1998,
10. PlaintilT Fishel testified that the vehicle in which she was riding was traveling at a
relatively low rate of speed at the time of the accident in which her vehicle rolled over.
(Deposition of Carla Fishel. dated 3/5/98, p, 8. In. 3, 19).
II. Plaintiff Fishel bumped against the right side of the car but did not lose
consciousness. She did not strike the windshield or the dashboard. She felt stunned, but other
than that she did not really feel bad. (Carla Fishel Depo,. p. 10, In, 19,21,23; p, II. In, 19; p.
2
12, In, 4-S),
12, Plaintift' Fishel did not seek any treatment from the paramedics when the
ambulance arrived, (Carla Fishel Depo" p. 13,ln. 3-4), Instead, she and her husband went
home, got a different car, and continued with their planned trip to hcr son's wrestling match in
Perry County. (Carla Fishel Depo" p. 13,ln, 19-2S; p. 14, In. S-6).
13, Plaintiff Fishel did not seek any medical attention that day, although she did begin
to feel soreness in her shoulders. neck and head later in the day. (Carla Fishel Depo" p. 14. In. 9-
10,16-21).
14, Two days after the accident she called her chiropractor, whom she had seen before
for unrelated lower back problems. She received m~nipulations and ultrasound to her neck.
(Carla Fishel Depo,. p. I S. In. 2-3, IS; p. 17. In. 7, 9-10, 13). Her chiropractor :lid not refer her
to a physician at that time. (Carla Fishel Depo., p. 17, In, 18),
I S. Approximately one month aner the accident Plaintiff Fishel developed pain in her
right arm with associated numbness. (Carla Fishel Depo.. p. 18, In. 21).
16. Plaintiff Fishel did not miss any time from work, She continues to work in the
same job and is still able to do her normal duties, although she occasionally has numbness in her
hand. (Carla Fishel Depo" p, 20, In. 22.24; p, 23. In, I; p. 34, In, 13).
17. Approximately a year and one-half after the accident she consulted with a
physician. Dr. Danyo. who she saw two or three times in 1994. Dr. Danyo diagnosed two
herniated discs in her neck. Surgery was not recommended and she attended only a few physical
3
23, Plaintiff Fisheltestllled that she does not play volleyball any more, Sometime
prior to the incident she had been enrolled in two six week courses at the local high school which
involved volleyball, (Carla Fishel Depo., p, 32. In. 2),
24. Plaintiff Fisheltestitied that her physicians have never restricted her from any
activity. (Carla Fishel Depo.. p. 33. In, 17).
25. PlaintilTFishel conlinned that she is still able to do her normal activities at work.
(Carla Fishel Depo., p, 34. In, 13).
26. Plaintill' Fisheltestilled that she has no plans to undergo surgery unless she has to.
(Carla Fishel Depo.. p, 35, In, 23).
27, PlaintilT Fishel's testimony conllnns that she has not sustained a serious
impairment because her injury does not interfere substantially with her normal activities or
impose more than a mild or slight limitation on such activity. ~ Ziolko. 705 A.2d at 874.
28. Presently, the facts reveal that Plaintiff Fishel did not miss any time from work
and was able to work at her regular position; she did not receive any treatment at the accident site
and waited two days before going to see her chiropractor; she did not see a physician for this
condition for over a year and a half at which time she only saw him two or three times; and she
has testilled that Dr, Danyo has not recommended surgery, She has not received any medical
treatment for over four years. She is not taking any prescription medication lor her complaints of
pain and she continues to perform all of her hobbies and chores with only mild limitations due to
complaints of occasional numbness in her right arm.
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3. Do you admit that surgery is not necessary for your condition at this time"
No. By way of further answer, my condition is not getting any better and I am actua\1y
worsening and surgery could be needed in the near future, My treating physician, Dr.
Clifford Renyo,lirst gave this prognosis ill his evaluation of my injuries of February 14,
1995, (See copy of Dr, Danyo's repOlt of February 14. 1995 attached hereto and marked
Exhibit D,
4. Do you admit that your injury ha~ not prevented you from working, exceptIo
appointments, and that you are not seeking wage loss benelits'!
Yes, By way of further answer, I am a very hard working person and have been able to
work with great pain and difficulty from problems from this accident. The fact that I
have a strong work ethic should not be held against me in this ca~e,
5. Do you agree that you have not sought medical treatment for any pain resulting from the
accident since 1994'!
No. I have received regular treatments for my injuries since the time of the accident.
Both Dr, Joseph Danyo and my family doctor have given me medication for the
herniated discs ill my neck. I also have received therapy for my neck,
6. Do you admit that a peer review of the treatment rendered by Dr, Christopher Renyo
found that chiropractic treatment wa~ not necessary after August 30, 1993, ba~ed upon an
initial review and a reconsideration review'!
No. After reasonable investigation, I am unable to a~certain the truthfulness of this
avennent. I believe that insurance carrier or Dr, Renyo can best be able to answer this
question.
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7, 'Do you admit that Bll a result of the accident the extent of your physical injuries included
It herniated nucleU!l pulposis at C4-5 and C6- 7. pain radiating into your right arm causing
numbness, and headaches"
Yes.
Respectfully submitted,
, ,
By:
Jos
126 tate Street
Harrisburg, PA 17101
(717) 236-8515
Attorney for Plainti ffs
O'i'&dqr
Dated:
I"
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,
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VERIFICATION
I verify that the .tatement. made in this ^nwerB to Request
for Admissions
are true and correct. I understand that false
statements herein are made subject to the penalty of l8 Pa. C.S.
54904, relating to unsworn faloification to authorities.
DATEDI O~/3J (C/'?
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May 12, 1994
REI rISHEL, CARLA D.
612 Rang- End Rd.
Dilllburg, PA 17019
AGEl U
SS#1 115-31-5488
STUDY I KRI of tha cervical spine with kinematic examination.
RZFERRING P1IYSICIAN:
CLINICAL HISTORYI
J. Clifford Renyo, DC
Headaches with pain in upper neck, right
arm and finger numbness and tingling
since MVA 2/6/93.
MRI PULSE SEQUENCES:
1)
2)
Sagittal GRE, T1
Axial 3D GE
i/:OMMENTS I The standard images of the cervical spine were
supplemented by multiple sagittal views through
a r.nge of motion from flexion through extension.
Thera il G moderate sized right paracentral C6-7 herniated nucleus
pulpolul. Thi. contacts the anterior portion of the cord but does
not caule true cord compression. There is no evidence of
.I.ociated canal atenosis. There is a small right paracentral C4-5
HNP. Thi. contacts the anterior portion of the cord at this level
but ia una..ociated with cord compression. Both of these appear to
ba lubliqamentoul.
Thare ia no evidence of any generalized canal stenosis. Nerve root
canal. ara well maintained. signal intensity of bone is preserved.
~inamatic Itudy demonstrates the absence of any significant
subluxation through flexion and extension. There are some
differing degrees of bulging of the disc herniations with contact
on tha cord remained in both flexion and extension, however.
CONCLUSION:
Moderate to moderately large right paracentral
C6-7 HNP. Small right paracentral C4-5 IINP.
Thank you for referring this
patient to us.
Sincere}~, ,
l~J L{(ifirj/
Willia.~B.~Miller, Jr., MD
-._~
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EXHIBIT~
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j, CLIFFORD RENYO, D,C.
P.Q, Bo. bbB
4 Barlo Circle, Suite 0
Oill,burg. Penn5ylvanla 17019
Telephone: 17171 432.5099
February 14, 1995
Joseph Dixon, Esq.
Oils and Dixon
Attorneys-at-Law
101 South second street
Harrisburg, PA l7101
RE: Carla Fishel
D/A: 2/6/93
The following is a narrative report concerning the injuries of Carla
Fishel sustained as a result of an accident on 2/6/93. Mrs. Fishel was
examined and treated at this office on 2/8/93. At this time the patient
stated that on 2/6/93 she was involved in an automobile collision in
which injuries to her neck and low back were sustained. Mrs. Fishel
further stated that she was a passenger in the front seat of a vehicle
that was headed north on Route 74. The car struck the side passenger
door, causing the vehicle that Mrs. Fishel was in to slide off the road,
hitting two small posts. The vehicle than tipped over an embankment and
rolled onto the right side and then onto the roof. Mrs. Fishel remained
conscious throughout the event, and did not lose any consciousness at
all. The police were notified of the accident. Immediately after the
accident, Mrs. Fishel felt rather shaken up. It was tough to get her
calmed down because of her past history of panic and anxiety attacks.
Later that day she began to have pain across her shoulder blades and in
her neck, The next day ~he had pain not only in the neck and shoulder
blade area, but it radiated down the right shoulder to the area of the
elbow. Hrs. Fishel, who is employed by Book-of-the-Honth Club, did not
miss any work since the accident.
Hrs. Fishel's major complaints as a result of the accident include
the following:
l. Headaches, which radiate up from the neck and settle behind the eyes
and t$mple region bilaterally
2. Neck pain that starts in the neck and radiates out to the right
shoulder, down the arm, into the hand, and betwe~n the shoulder blades
3. Intermittant periods of numbness in the right arm and hand
4. Difficulty sleeping at night
5. Constant feeling of nervousness and tension
Off and on low back pain is also noted, but there has been nothing
consistent since the accident. Hrs. Fishel has had off and on neck
problems, but she states that at the time of the accident she was
symptomatic. According to prior informa.ion, her neck problems were
mostly stress-related. She did not require any post-accident
hospi talization.
. ,
Her difficulty sleeping stems from the fact that she cannot lay on
the right-hand side; if she does, it causes pain across the upper back
and neck and also pain from the shoulder to the elbow on the right-hand
side.
PHYSICAL EXAMINATION
Mrs. Fishel is a 44-year-old white female. She is approximately
five feet, four inches in height and weighs approximately l45 pounds.
Her demeanor was calm. Her respirations were normal, not labored. Her
posture was also normal. Mrs. Fishel ambulated well without assistance.
She is right-handed, She has a history of Bell's palsy, which has been
present since December 10, 1993. There were masses, tenderness, or
lacerations present. Her facial muscles were not intact; she exhibited
Bell's palsy on the right-hand side. She did not have vision problems
and did not report any problems. There was no buzzing or ringing in the
ears, and hearing was normal. Examination and palpation of the cervical
spine snd musculature revealed deep and superficial muscle spasm of both
the anterior and posterior perivertebral musculature, It was present
bilaterally, Initially the upper extremities were not functionally
impaired and gross evidence of comparative atrophy was not noted.
Foraminal compression test was positive in both neutral and right
laterally flexed positions. This indicated that there was some nerve
root compression with pressure. The pain radiated into the right
shoulder region, Soto-Hall test was positive for pain in the lower
cervical region. Shoulder depression test was positive as well on the
right hand side, Valsalva Maneuver was negative for any cervical or
lumbar pain, Kemp's test was positive for low back pain on th~
left-hand side, even when it was performed on the right-hand side.
Tendon reflexes were performed. They were approximately +2 for the
upper extremity, consisting of biceps, triceps and brachioradialis. The
deep tendon reflexes for the lower extremity were +3 for Achilles and
patella reflexes. Cervical range of motion studies revealed the
following:
Flexion
Extension
Left Rotation
Right Rotation
Left Lateral Flexion
Right Lateral Rlexion
NORMAL
65
50
55
55
40
40
EXAM
30
30
50
40
25
40
WITH PAIN
yes
yes
yes
yes
yes
yes
Radiographs were taken of Mrs. Fishel with the initial visit. A
five-view cervical series was performed and a two-view lumbar series was
performed as well. With reference to the cervical views, there was a
complete reversal of the normal cervical curve, with a two millimeter
anterior subluxation of C4 on C5. With reference to the lumbar views,
there was a tiny vacuum sign present at the anterior-superior surface of
both L3 and L4 bodies, Otherwise there was no evidence of fracture,
dislocation, or arthritis in either of the cervical or lumbar spines.
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DIAGNOSIS
The initial diagnosis that we had on Mrs. Fishel was a moderate to
severe traumatic cervical sprain, and a mild to moderate traumatic
lumbar sprain, The current diagnosis is a traumatically induced cervical
disc herniation with resultant brachial radiculitis.
TREATMENT
Treatment to date has been conservative in nature, consisting of
mild chiropractic spinal manipulation, cervical traction work utilizing
Cox flexion/distraction technique, physiotherapy consisting of
electrical muscle stim, consisting of SO cycles per second, ultrasound
at approximately l,O watts/cm, and ice or heat packa depending on how
she was symptomatically, We initially were going to be seeing Mrs.
Fishel at least three to four times a week; the best that she could do
initially was twic~ a week for this treatment. Mrs, Fishel's initial
response to the treatment was very well. She stated that she had a
decrease in her symptomatic state, and had a decrease in the frequency
of the pain in the right shoulder and in the arm, The numbness tended
to persist in the right arm and hand. She progressed to the point where
in April 1993 we performed the first muscle testing on her, This
revealed a severe deficit with respect to lateral flexion of the
cervical spine and a mild deficit with respect to rotation of the
cervical spine. The amount of poundage that she put out for flexion and
extension was also quite weak as well. We used this as a basis for
giving her exercises and we stressed that we needed to stay on the
current schedule until she showed some improvement in light of the fact
that there was such a severe deficit with respect to lateral flexion.
She showed good improvement when we retested 6/16/93, She documented a
69 percent improvement with left lateral flexion, 0 improvement with
right lateral flexion, l2,5 percent progress with left rotation, and
l6.7 percent improvement with respect to right rotation. Extension
poundage improved 40 percent and flexion poundage improved 36 percent.
In light of the fact that there was some progress, I felt that she could
go with the further improvement, and twice a week is not unreasonable at
this point. We stuck with the present schedule of twice a week since
that is all she can come in for. Mrs, Fishel also had some unrelated
physical problems with reference to the female reproductive system
besides having Bell's palsy. When this started to flare up she was not
able to stick with the schedule as best she could. Mrs. Fishel also
suffers from frequent panic or anxiety attacks, There was approximately
a two-month break in treatment between September and November 1993
because she had surgery to correct some unrelated physical problems, and
at that point she was able to come in for one visit in November. There
was also another two-month break in treatment after that due to the same
problems. When she returned in January 1994, she had a recurrence of
the neck pain and numbness in the arms. Although it was not quite as bad
as it was initially, the symptomology began to return without the
continued treatment. Once again we initiated the treatment plan. A
comparative muscle test was performed on Februar~ 14, 1994. Her major
complaints at this time were mostly with tne right arm and shoulder pain
and numbness in that area. We ordered a cervical nerve root evaluation
consisting of muscle testing of very speCific muscles in the upper
extremity.
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In six out of eight tests performed, there was at least a moderate to
severe deficit with respect to strength of the right arm vs. the
strength of the left arm. Mrs, Fishel's schedule continued to be erratic
due to the nature of the panic attacks.
In May 1994, I ordered an MRI because of the persistence of the
numbness in the hands and I was not pleased with her progress at that
point. The MRI, dated May 12, 1994, revealed a moderate to large right
paressential herniated nucleus pulposus at C6/C7 and a small mild
paressential herniated nucleus pulposus at C4/C5 region. The kinematic
study with the MRI revealed that there are some differing degrees of
bulging of the disc herniations with contact of the spinal cord
remaining in both flexion and extensio~.
Mrs. Fishel was sent for a second opinion examination with Dr. J.
Joseph Danyo in York in August 1994, He stated at that point she was
not a surgical candidate, but she may be in the future with regard to
the herniation of C6/C7. He also stated that standard conservative
treatment should continue. Dr, Danyo also added that she has some
myofascial points in the upper trapezius musculature and the upper
extremity. He noted that there was a decrease in her grip strength,
slightly on the right-hand side compared to the left. After Dr. Danyo's
opinion we decided to change the therapy to include some very specific
myofascial therapy using electrical stirn, applied to the cervical spine
in a continuous mode. Mrs. Fishel's response was good, and she began to
have more progressive relief of her tightness in the cervical region.
Overall there has been some improvement, and treatment helps her, but at
some points she is easily aggravated and the neck will be a continuous
point of weakness, probably for the rest of her life even if surgery is
utilized on her.
DISCUSSION
In general, this is a traumatically induced injury to the cervical
spine and lumbar spine, It is apparent that there has been an injury to
the discs in the cervical region, specifically C6 disc and C4 disc.
There appears to be a stretch injury to the posterior ligaments of the
cervical spine as well, resulting in deformity of the cervical curvature
with resultant instability. This injury has also resulted in an acute
subluxation syndrome to the cervical spine. There is a loss of full
range of motion to Mrs, Fishel, and this may result in some permanent
deficits. This loss of range of motion is due to the formation of scar
tissue at the injury site. Due to the structural weakness of the
cervical region. which was traumatically ~nduced, and because of the
persistent symptomo10gy and neurological deficits manifested, it is
apparent that the patient's symptoms are going to be recurrent and she
can expect intermittent exacerbations of pain and stiffness in the
cervical region,
CARLA D. FISHEL and
TED L. FISHEL, her husband,
Plaintiffs
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
v,
CIVIL ACTION - LAW
CAREY C. WELSH,
Defendant
NO, 95-0532 CIVIL TERM
. . . .
CARLA D, FISHEL,
and TED L. FISHEL,
her husband.
Plaintiffs
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYL VANIA
v,
CIVIL ACTION - LAW
NO. 96-6873 CIVIL TERM /'
CAREY C. WELSH.
Defendant
ORDER OF COURT
AND NOW, this 12 Haay of November, 1998, upon consideration of Plaintiffs'
"Motion for a Rule To Show Cause" filed at No. 95-0532 Civil Tenn. and of the attached
letter from Plaintiffs' counsel Joseph J. Dixon, Esq., dated October 30, 1998. and the
attached "Joinder," it is ordered and directed that the above-captioned cases shall be
consolidated at No. 96-6873 Civil Tenn, and that the action at No. 95-0532 Civil Tenn shall
be stricken from the purge list.
BY THE COURT,
J.
Joseph J. Dixon, Esq.
126 State Street
Harrisburg, P A 17101
Attorney for Plaintiffs
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Drew Gannon. Esq,
126-128 Walnut Street
Harrisburg, P A 17101
Attorney for Defendant
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ATTORNEY AT LAW
128 STATe Sl'FlEET' HARRISBURG, PA 17101
PHONE: 17171233'87~7 . FA)(: 17171 23H880
October 30, 1998
THE HONORABLE J, WESLEY OI.ER, JR.
COURT OF COMMON PLEAS OF CUMBERLAND COUNTY
CUMBERLAND COUNTY COURTHOUSE
I COURTHOUSE SQUARE
CARLISLE, PA 17013
RE: CARLA D. FISHEL AND TED L. FISHEL V. CAREY C. WELSH
CIVIL ACTION LAW NO. 95-0531
Dear Judge Oler:
In follow-up to the Motion for Consolidation I have filed on the above-captioned CllSe, enclosed
please find a Jomder executed by Attornev Drew Gannon, counsel for the
Defendant/Respondent. In light of the Joinder, it is requested that an Order be issued
consolidating the two (2) dockets on the above-referenced case.
Thank you for your attention in this mattet ,
Very truly yours,
,
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Joseph J. Dixon
JJD/hhs
cDrew Gannon, Esquire (w/enclo.)
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CARLA D, FISHEL III\d
TED L. FISHEL. her husband.
Plaintiffs
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY. PENNSYLVANIA
vs,
CIVIL ACTION - LAW
CAREY C. WELSH.
Defendlll\t
96-6873 CIVIL
JURY TRIAL DEMANDED
IN RE: DEFENDANT'S MOTION FOR SUMMARY JUDGMENT
BEFORE BAYLEY AND HESS. JJ,
OPINION AND ORDER
This mailer arises out of a motor vehicle accident on Februll1'Y 6. 1993. The plaintiff,
Carla D. Fishel. had a limited tori coverage policy, Under that policy. the plaintiff is precluded
from recovering non-economic dlll\lages unless there is "a personal injury resulting in death.
serious impairment of body function or permanent serious disfigurement" 75 Pa,C.S, See, 1702,
The defendant. Carey C, Welsh, has filed for ~lImmary judgment. claiming that this court should
determine that the plaintiff's injuries do not reach the threshold of serious injury as !I mailer of
law,
The standard for summary judgment was clearly stated recently in the Pennsylvania
Supreme Court's decision in Washinllton v. Baxte,[:
In examining this maller, as with all summll1'Y judgment cases. we
must view the record in the light most favorable to the non-moving
party. and all doubts as to lhe existence of a genuine issues of
material fact must be resolved against the moving party,
Pennsylvania Slate University v. County of Centre. 532 Pa. 142.
615 A,2d 303 (Pa. 1992), In order to withstand a motion for
summary judgment. 11 non-moving party "must adduce sufficient
evidence on an issue essenlialto his case and an which he bears the
burden of proof such that a jury could return a verdict in his favor.
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