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Home My WebLink About97-00810 ~ CHERYL L. NEAUS, Plaintiff 30 : IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA V. LOY ARMENTROUT, CIVIL ACTION - LAW Defendant NO. 97-810 CIVIL TERM IN RE: PRETRIAL CONFERENCE A pretrial conference was held Wednesday, August 26, 1998, before the Honorable Edward E. Guido, Judge. Present for the Plaintiff was Jennifer C. Deitchman, Esquire, and Fred H. Hait, Esquire. Present for the Defendant was Thomas B. Sponaugle, Esquire. Defendant has admitted liability. Therefore, the trial will be limited to the issue of damages only. Trial should take one day to complete. Defense counsel is unavailable Monday, September 14, 1998, and Plaintiff's counsel is unavailable Tuesday, September 15, 1998; therefore, this case must begin on Wednesday, September 16, 1998. Since Plaintiff is traveling from Florida, it is imperative that this case get tried this term of cour~. The parties have agreed to stipulate as to the authenticity of Plaintiff's medical records, Plaintiff reserves the right to object to the entry of those records on other grounds. The parties have raised various legal issues in their pretrial memorandums. All such issues to be raised at trial . CHERYL L. NEAUS, PlaintilT IN THE COURT OF COMMON PLEAS, CUMBERLAND COUNTY, PENNSYLVANIA j I , i 1 I ! , I I i vs, NO. 97.810 LOY ARMENTROUT, Defendant JURY TRIAL DEMANDED AND NOW, this ORDER ~ I""^ day of ~ ,1998, it is hereby ordered that Defendant is barred Irom attempting to introduce evidence that in any way refers to PlaintilT's criminal charges and participation in the Accelerated Rehabilitative Disposition program under Pa.R,Crim,P. 1768186 at trial. Ifdocumentary evidenoe from either party contains refcrcnce to the same, the references shull he reducted from the document before admission at trial. .Yth~ j, :n<_"-,~-:~-,~:~U,,;,,'."/tJ;;; ..."""",..' .',"", " -,' . 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'f- -'. . .~~. '"<", ."-.- , , ' ' U;~.,~; ",; "f~;," ". c/" , ' ":.. ,.'... . '~-. . AUG 2 1 f'o4 ISSUE Is evidcnce of a crime, whcn that person has succcssfully complctcd an Accelernted Rehabilitation Disposition program with regard to that crime. admissible at trial? Suggested response: No, ARGUMENT In Pennsylvania. evidence of a prior conviction can be introduced for the purpose of impeaching the credibility of a witncss if thc conviction was for an offcnse involving dishonesty or false statement, and the date of conviction or the last day of confinement was within ten ycars of thc trial datc. Pa,R.E. * 609; Commonwcalth v. Randall, 528 A.2d 1326 (Pa, 1987); Russell v, Hubicl'~ 425 Pa, Super, 120,624 A.2d 175 (1993), alloc, den., _ Pa, _' 634 A,2d 1117 (holding that the samc rulc applies to civil cases), In contrast to the genernl rule, however, evidencc of admission to an ARD program under Pa,R,Crim.P, 17681116 may not be used to impcach credibility, Sce Commonwealth v. Krall, 290 Pa, Super, I, 434 A.2d 99 (1981), In Krall, the defendant was convicted of burglary, conspiracy and rccciving stolen property. During his trial, the defendant's girlfriend testified on his behalf. and provided him with an alibi. On cross-examination, the girlfriend was asked sevcrnl questions regarding a prior charge against her for rctail theft, for which she voluntarily placed hcrself in the A,R.D. program, as provided in Pa.R.Crim.P, 175-185. Not only was hcr participation in the A,R.D. program inquired about during her cross-examination, but the trial judge, in his charge to the jury, rcferred to her "conviction." The Supcrior Court rcvcrscd and rcmandcd thc case for a ncw trial. It hcld that the trial court crred when it pcrmittcd thc impcachmcnt ofthc girlfricnd whcn she had not becn convictcd of rctail thcft. and also crrcd whcn it rcfcrrcd to thc girlfricnds prior conviction in its chargc to the jury. The Supcrior Court cxplaincd that "whilc a conviction for retail thcft may be uscd to attack thc credibility of a witncss, ' , , [ t]hc vcracity ora witncss may not be impcachcd by prior criminal conduct that has not led to a conviction,", , , and that a witncss's admission into an A.R,D, program does not constitute a conviction for purposes of impcachmcnt. Id, at 100. Thc purposc of thc A,R,D, program is to cnablc a dcfcndant, before shc has becn convictcd of a crime, to entcr into a program gcarcd toward rchabilitation without thc neccssity of trial and conviction, If thc program does not succced, the Commonwcalth may thcn procecd on the charges. Id. at 100-01. Thus, thc Krall Court concluded that thc admission of cvidence of the witncss' participation in thc A,R,D, program was revcrsible error. Similarly, in the instant case, Ms, Neaus participated in the A.R,D. program for a charge of fraud, but successfully complctcd thc program. No furthcr action was taken by the government and Ms. Neuas was never convicted of the charge, Upon authority of Krall, the Defcndant in thc instant case may not use evidcncc of thc chargc for any reason, impeachment or otherwise, because only actual convictions of crimen }alsi crimes arc admissiblc against a witncss. Thc fact that Dcfcndant obtained this information through a newspaper is inconsequential: thc evidence is c1carly inadmissiblc and specifically noted as such in thc Commcnt to ncw Pa,R,Ev, 609. LAW OFFICES QlilFf"ITH. STRICKLER, LERMAN, SOL YMOS & CALKINS 110 SOUTH NORTHERN WAY YORK. PENNSYLVANIA 17402.3737 1...111...111....,.11..11.1..1.1 JENNIFER C DElTcHMAN ESQUIRE MCGRAW HAlT & DEITCHMAN 4 LIBERTY A VENUE CARLISLE PA 17013 LAW OFFICES eRlFAfH,.STRICKLER, LERMAN. SOL YMOS & CALKINS 110 SOUTH NORTHERN WAY YORK. PENNSYLVANIA 17402-3737 11 1",11111,1".,111.",,',1,"0,' THOMAS B SPONAUGLE ESQUIRE GRIFFITH STRICKLER LERMAN SOL YMOS & CALKINS 110 SOUTH NORTHERN WAY YORKPA 17402 .. references to insurance containcd within. Caoozi v. Hearst PublishiOlz Co., 371 Pa. 503,92 A.2d 177 ( 1952). Because of the highly prejudicial naturc ofinsurancc coveragc, thc word "insurance" in the trial of negligence cases is somcthing that most pcople wcrc to buy witncsses in the court at the peril of the withdrawal ofajuror or latcr as the grant for new trial. Corbett v. Borandi, 375 F.2d 265, 270 (3d Circuit 1967). See also Trimble v. Merloe, suora. When there is no indication that the plaintiff was trying to prejudice a jury where the mention of insurance was relativcly insignificant or reasonably capable of correction v.;th the limited instruction, the predominant view seems to be that the mere mention of eluding to insurance does not necessarily require a mistrial or a new trial. Gatto v, Kisloff, 437 Pa, Super. 328, 649 A.2d 996 (1994); Dolan v. Carrier COrD., 424 Pa. Super. 615, 623 A.2d 850 (1993), Defendant respectfully requests that this Honorable Court rule that any evidence ofinsurance is inadmissible and that the Court instruct all v.;tnesses to refrain from any mention of the existence of liability insurance, the involvement of any insurance adjuster or questions concerning insurance coverage in any fashion during testimony, , '<'Cd" '+""'.",:2"" ",:";',,, ,'.",,',,::::" ,.' ':;':::<;~:}'<'~,',};~~; :' .;-~.c:,> ,'. : '." 'C'",',:' :" .; ", ":,', .,',", ':L:;'; ":" L"':' .;",:., "':":", ','"",','.' ,,', "',,,,.',,:;' "''''.,',,'':'' "',",",",,'''. ',; ,.-,,',,:''''', .,', ','.~' "'''''';';" "~<~= '."~~~~j:~":~:~;.~" ':::,.., ';',' .". ."-,,"c~' '::Yi:, '....'.:: ""~,, "2:"" . ,', ',.;;""",.:;',' .':":~:":". ,.:', ,.:,:~:~. :_'J'~"~ ' '~'2' 'p ,,": ,,' ,C:C2~~-: ''; " ',' ,>" ,', :,\', .' ,',' ,,' t,':< .,'. '..:: ,:'.'.'" 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"',',;:, ,":7~,--,:~..:..n ....,-'''" .'" ;,;,n"".",__""" ,.......",., n,.." ~ "..,,::,:': .:"~ .'...." ' " ,- ,,', "', :,-:; , ;;~~'h:';. '.,""' ,', . , .' ;:' '::, '. : ". ',; ~::'::::;"'i';~;),',';:';;; ':: ,';:;.~.':.',<:T>"";'" ~;":".''c''~;-:'~''f'"~r':;'':'--:''''-'~'r_'';'''''~;'''2?'~'':';.~;': '" ,". ""':<i~:~r" ,,;,;, . '",;,~U~l~' ';",'" :!' ~: ';' ", '. " '" ;5r~!f~ '"~ -;-;, ..>.' III, PRINCIPAL ISSUES OF LIABILITY AND DAMAGES A) Wns Mr, Armcntrout ncgligcnt'! i) Wns Mr, Armcntrout ncgligcnt per se? B) Wns Ms, Ncnus comparatively ncgligcnt'! C) What is the cxtcnt ofthc injurics sutTcrcd by Plnintin'? D) What is fnir nnd rcasonnblc compcnsation for thc injurics sutTcrcd by Plnintin'? IV. SUMMARY OF LEGAL ISSUES A) Is Defcndnnt per se ncgligcnt by fniling to nbidc by thc Pcnnsylvnnia Vchiclc Codc Scctions 3331, 3334, or 3335'! B) Whethcr Dcfcndnnt is prccluded from submilling any cvidcncc which rcfers to an arrest for nllcged food stump frnud which was rcsolvcd through an ARD disposition'! (subjcct of n separatc motion in limine filed by Plnintill) V, IDENTITY OF WITNESSES TO BE CALLED A) Chcryl Ncnus B) Loy Armcntrout (as on cross) C) Tony Kcnnedy D) Vinccnt Wnshington E) Jamcs Adnms (cxpert) F) Ptl. S,F, Kreitzer (unavnilablc on 8/17/98) G) ClitTord Rcnyo, D,C. 2 - n . . .' " , ..... .n .....,:'.;' ":"u::~Y~'-Fi '\':"?:],<," -,.'? '_-~.T<2:' '.'., ....,.,,': .~.....,.,......= '.,.',.. ...~>..J'~ .,..n ;~u:~_.u:: "~~u_>'~':L:' .J.:<( ......'; .':' ':'~~\';-2 ,'. "', ,; ,.-..',.:ii...,..:"..........,.:.:':..:c...,;..:~.::-: -.:,:':"',:,,_ ,'':'<C_.,''<,,-'.',.'' .....' ' . ../'" ',' ,::','., . :::.'~ ,. ,.', ,..'.. " . ,- ',.:.." ;,' , :<'.< ,,' " . " ; ..'..'. ..,..,. '.. ."" ...'.... ',..:.. .... , "::.: .....-., ,.-: .-..i:: .', .,' ,.:::, ";. ," . ' , ,:'.',"::"":' If,' ..... .".. , ' .- :__; ':, ;-:" ". '::\0i";': ,;ci: :~" ',: f~" i. ..,. -"'-C''''_''''''''~~~';'' ,. 00' <c'... 1, r, c'.,.'! ,:';:),: . .. ~ . r- s~p 1~ ~f'J' . 'n' 'c ' oliO. ~. .'t, ~ -. . '" ~ intcrpreting thc statutc aftcr which thc MVFRL was pattcrncd. DiFranco v, Pickard, 398 N,W,2d 896 (1986). Essentially. mcdical tcstimony will be nccdcd and factors to be considcrcd includc: thc cxtcnt of thc impairmcnt, thc particular body function impaired, the length of time the impairment lastcd, thc trcatmcnt rcquircd to corrcct thc impairment. and any other relevant factors," Dodson at 1233-34, Also. it is important to notc that an impairment need not be permancnt to be serious. Id, at 1234; Murrav v, McCann. 442 Pa. Super, 30, 658 A.2d 404 (1995), According to Dodson. the court must initially detennine on a summary judgment motion: a) whcther the plaintiff .., has cstablishcd that hc or shc has suffercd serious impairment of body function; b) whether the dcfense as moving party has established that the plaintiff has not suffercd a serious impairmcnt of body function; or c) whether there remains a genuine issue of material fact for the jury to dccide. Dodson at 1231, Herc, Defendant did not filc a motion for summary judgment, but may be expected to file a motion for direoted verdict on thc scrious injury issue, The Court. on such a motion. is actually in a bettcr position to dctcnninc whethcr Plaintiff can prcsent a claim for non.economic damages to the jury than other courts presented with the issue in a summary judgment motion, In this casc. extcnsivc analysis of what has or has not constituted a serious injury in other lower and appellatc court cast's will not be required. Thc Court, if it recognizes the anticipatcd substantial conflict in mcdical tcstimony concerning the seriousness of Ms. Neaus' injuries, will have no choice but to submit the issue to the jury, if it is to follow thc rationalc of Dodson. Questions of fact and credibility should not be detennined by thc Court, Rather, the jury is to resolve suoh conflicts using the evidence presented. Dodson at 1232, 3 is defined as pain and suffering or other non monetary detriment." 75 Pa.c..S.A. ~ 1702. It is possible, however, fora plaintiffwho has elected a limited tort option to seek non monetary damages if the injuries received in the motor vehicle accident fall within the definition of a "serious injury" or ifone of the other exceptions is applicable, 75 Pa,C,S.A. ~1705(D)(I). "Serious injury" is defined as a personal injury that resulted in "death, serious impairment of bodily function, or permanent and serious disfigurement". 75 Pa.C.S.A. ~ 1702, In Dodson v. ~, 445 Pa, Super, 479, 665 A.2d 1223 (1995), the Pennsylvania Superior Court held that the determination whether a "serious impairment" exists is a question oflaw, Otherwise, any plaintiff who claimed "a serious injury" would be permitted to bring his case to a jury, thus escalating litigation and increasing the cost of insurance which is contrary to the goal of the Pennsylvania Motor Vehicle Financial Responsibility Law, Making the threshold determination of the existence of a serious impairment of body function in the context of a summary judgment motion, it was determined that the court must determine initially: (I) whether the plaintiff as the moving party has established that he or she has suffered a serious impairment of a body function; (2) whether the defense as a moving party has established that the plaintiff has not suffered a serious impairment of body function; or (3) whether there remains a genuine issue of material fact for the jury to decide, Id, at 665 A.2d at 1231. The court emphasized that in deciding whether material fact exists for the jury, the court should not foous on the injury, but rather should focus on the nature and extent of plaintiff's impairment as a consequence of the injury, These consequences must exist for an extended period of time in plaintiff's life and "must interfere substantially with plaintiff's normal aotivities", ilL at 1234. The Dodson court was clear that in order for a plaintiff to meet the serious injury threshold, 3 opined that he would "suITer long tenn with some mild to moderate right upper extremity weakness and would more likely than not develop arthritis in the future." The court noted that there was objective evidence of injury which had ultimately resolved leaving some slight limitation in ann function. Ultimately, the court held that the plaintilTdid not sustain a "serious injury" and summary judgment was granted on behalf of the defendant. Since Dodson. numerous courts have granted summary judgments where plaintilThave not met the requirements of the "serious injury" threshold. The accident related injuries sustained by the PlaintilTin this case are even less "serious" than those sustained by the plaintilTin Dodson. Here, the PlaintilThad pre-existing complaints of pain in her low back prior to the accident occurring. She would be treated by her family physician, Dr. Jeffrey James, and Gary Schwartz, M.D.. Indeed, on March 20,1995, Dr. James would assess her with persisting low back pain going on three months. Ms. Neaus was returned to Jason Litton, M.D., of the Orthopedic Institute of Pennsylvania for evaluation. On March 23, 1995, Dr. Litton diagnosed her with low back pain. On June 15, 1995, Dr. Litton noted that the PlaintilT was completely relieved oflow back, right buttock and right thigh pain, had completely recovered from the vehicle injury and was discharged from his care. Over 10 months later, the PlaintilTwould see Dr. J. Joseph Renyo, a chiropractor, for treatment and she would be referred to J. Joseph Danyo, M..D. for evaluation on May 7, 1995. This evaluation noted that no surgery was recommended and that she was to continue with conservative treatment. More so, Dr. Danyo prescribed no medication. X-rays of Ms. Neaus' lumbar spine on March 21,1995 were nonnal, as were x-rays of her lumbosacral spine on November 6, 1995. An MRI taken April 25, 1996 noted degenerative disc disease at L4-5 with right posterial lateral disc protrusion near L4 nerve root plus central disc protrusion at L5-S I which was suspicious for herniation. Dr. Danyo diagnosed Ms. Neaus with lumbar disc rupture at 5 Moreover, PlaintilTis also precluded from placing all of her medical bills into evidence since medical bills are not indicative of or relevant to the issue of pain and suITering. Martin v. Soblotnev, 502 Pa. 418, 466 A.2d 1022 (1983); Carlson v. Bubash, 639 A.2d 458 (1994). II. Earnings Impainnent Claim. Ms. Neaus claims that she will suITer a future loss of earnings or impainnent to her earning capacity but this amount has not been put forth specifically. The jury as fact finders have the right to reasonable accuracy by competent proof and may not rnake a finding based upon speculation. Wilev v. Mover, 339 Pa. 405,15 A.2d 145 (1945). Primarily, the loss is to be calculated by a detennination of prior actual earnings or average earnings prior to the injury. Goodheart v. Pennsvlvania Railroad Co.. 117 Pa. 1,35 A.2d 191 (1896). The test for impaired earning capacity is whether or not the plaintifrs economic horizon has been shortened as a result of the accident. Jansen v. HUl!hes, _ Pa. Super. _, 455 A.2d 670 (1982). Since the Plaintifrs loss offuture earning capacity is speculation and not able to be proven with a reasonable degree of accuracy by competent proof, Plain tilT is precluded from asserting a loss of future earning capacity claim. Moreover, the defense will demonstrate that Ms. Neaus' earning capacity has not been impaired, nor her economic horizon diminished. PlaintilT, Cheryl Neaus, has elected a limited tort option and, therefore, the jury rnust conclude that she has sustained a serious impainnent of a body function before an award for non economic loss damages can be made. This category of damages refers to things such as past, present and future pain and suITering, emotional suITering, disability, loss of enjoyment of life and life's pleasures, embarrassment and humiliation. It is the contention of the defense that the Plaintiff has not sustained a serious impairment to a body function, and, therefore, her injuries are not serious and there should be no award in her favor for non economic loss damages. 8 IV. CONCLUSION: As a result of her limited tort option, the PlaintilTwill be precluded from receiving an award for non economic loss damages and that Plaintifrs recovery, if any, will be restricted to the following: (1) medical expenses which the jury concludes are attributable to injuries sustained in the accident and which have not already been paid by first party benefits; (2) past lost wages which the jury attributes to injuries sustained in the accident and which have not been compensated by first party benefits; and (3) future lost wages only ifthejury concludes to a reasonable degree of accuracy by competent proof and not based on speculation that the Plaintifrs economic horizon has been diminished as a result of the injuries sustained in the accident. Respectfully submitted, GRIFFITH, STRICKLER, LERMAN, SOL YMOS & CALKINS BY: ~~ THOMASB.SPO AUGLE,~QUIRE Attorney for Defendant Supreme Court J.D. #64584 110 South Northem Way York, Pennsylvania 17402 (717) 757-7602 smb/annen.brf 9 M,<JRAW.lfAIT& I>EITCIIMAN 4 Libcr1y Avenue Ciltlisle. PA 17013 (717) 2494S00 (Allnme)~ Iilr Ploinllll) IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA CHERYL L. NEAUS, Plaintiff CIVIL ACTION - LAW vs. NO. 97-810 LOY ARMENTROUT. Defendant JURY TRIAL DEMANDED PLAINTIFF'S PROPOSED JURY INSTRUCTION #4 The plaintiff is entitled to be compensated in the amount of all medical npenses reasonably incurred for the diagnosis, treatment and cure of her injuries In the past. These expenses, as alleged by the plaintiff, amount to S ; an exhibit will be submitted to you, itemizing these costs, for your consideration during deliberation. In this case you have heard testimony concerning various medical services provided to the plaintiff In an effort to bring her back to health. Under Pennsylvania law, a certain portion of the plaintlfrs medical bills were paid by her own insurance company and are not recoverable in this action. The medical bills that have been received into evidence, which form the basis of the summary presented by the plaintiff, represent those bills which have not been paid from this other source. If you award damages to Ms. Neaus and you find that the medical bills received into evidence were the proximate result ofthe injuries sustained by her were reasonable and necessary, you should award the amount of those bills to Ms. Neaus. However, you may consider all of the medical services performed in determine the extent of the plaintiff's pain and suffering and other non-economie damages, whether or not the bills for those particular services have been placed in evidence. See Pa. SSJI (Civ) 6.0IA; 6.02A c(/~~.~ ! i 5. The Plaintiff has the burden to prove that the injuries complained of resulted from the automobile accident which occurred on February 23, 1996. I Granted Refused Ctr~ Reist v. Manwiller. 231 Pa. S. 444, 332 A.2d 518 (1974). LAW OFFICES OF BARRINGTON, KAUFFMAN " SOn.LING ATrORNEY: Ooward D. lUull'man SUPREME COURT LD. NO.: 38963 100 PINE STREET, SUITE 300 HARRISBURG, PA 17101 (717) 720.0700 CherJ'l NeIIII ATrORNEY FOR: Loy Armentrout IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA Plaintift' CIVIL TERM vs Loy Armentrout Defendant DOCKET NO. 97-810 CERTIF1CA TE OF SERVICE AND NOW, this..ZItiJ. day of March, 1997, I, Howard D. Kauffinan, Esquire, attorney for Defendant, Loy Annentrout, affinn that I served tbe Praecipe for Entry of Appearance by depositing same in the United States Mail, postage prepaid, in Harrisburg, Pennsylvania, addressed to: Jennifer Deitchman, Esquire 4 Liberty Avenue Carlisle, PA 17103 >: lO r::: ~ (;'o.J , .', fo'. N :\~ UJr:! 1E-- ~r; J~~ c' L'-r!- c~ 1-... :.~ 2:C ;/'J ~: I ;"l?! ~,:. c..: .lllJ u..::, c\.. ~:l:'L I "'" ~.i 1.1. t- e.;. a'I U fr. 0 :-. N .- ., :~~ f- a. ~!:":' (. ~ ,J:r ....., 125 ;:' :5~.' M !~0 ('; I .."!:- w"- 'fO_..,. -..l.. e:: . jiTJ 0: . o. ;'~a.. ~- ... l! r- .j 0 0' .:.J ~ (a) Denied. On the contrary, Plaintiff acted reasonably and prudently under the circumstances. (b) Denied. On the contrary, PlaintilTacted reasonably and prudently under the circumstances. (c) Denied. On the contrary, Plaintiff acted reasonably and prudently under the circumstances. Also denied as a conclusion of law pursuant to Pa. R.C.P. Rule 1029(d). (d) Denied. On the contrary, Plaintiff acted reasonably and prudently under the circumstances. 23. Denied. It is specifically denied that PlaintilT recognized or assumed any risk whatsoever. On the contrary, Plaintiff acted reasonably and prudently under the circumstances. (a) Denied. On the contrary, Plaintiff acted reasonably and prudently under the circumstances. (b) Denied. On the contrary, Plaintiff acted reasonably and prudently under the circumstances. (c) Denied. On the contrary, PlaintilTacted reasonably and prudently under the circumstances. Also denied as a conclusion of law pursuant to Pa. R.C.P. Rule I 029( d). (d) Denied. On the contrary. Plaintiff acted reasonably and prudently under the circumstances. ('- CO I I.U( ,,"': .~ lJ" rt:' ~.... l C.I , .,. c:. . 1.'- ", , lL. , '.'J i " 0.). I'... r- {' (,."" 6. Denied. It ia denied that answering defendant was next to the double yellow dividing line separating northbound and southbound lanes of traffic. It is further denied that IIIIWeriag defendant had no turn signals on. On the contrary. answering defendant had his turn signals on and was near but not next to the double yellow dividing line separating nonhbound and southbound Ianes of traffic. 7. Denied. After reasonable investigation, answering defendant is without sufficient information or knowledge with which to fonn a beliefas to the truth of the averments ofthi. paragraph. 8. Denied. After reasonable investigation, answering defendant is without sufficient information or knowledge with which to fonn a beliefas to the truth of the avennents of this paragraph. 9. Admitted in part and denied in part. It is admitted that defendant's truclc made a right turn and that a colIision occurred between plaintifrs and defendant's vehicles. It is denied that the turn was made suddenly. On the contrary, answering defendant acted reasonably and prudently under the circumstances. 10. Denied. After reasonable investigation, answering defendant is without sufficient information or knowledge with which to fonn a beliefas to the truth of the avennents of this paragraph. 1 I. Admitted in part and denied in part. It is admitted only that the plaintiff has attached an estimate of damage to her vehicle in the amount ofSl,543.35. It is denied that this estimate represents damages that are reasonable and necessary or caused by the accident. 2 12. Admitted in part and denied in part. It i. admitted that defendant has attached as exhibitl towing charges of$45.oo and $315.00 in storage fees. It is denied that these charges and fees arc reasonable, ncc~nary or caused by defendant. " L 13. Denied. After reasonable investigation, answering defendant is without sufficient information or knowledge with which to fonn a belief as to the truth of the averments of this paragraph. 14. Denied. After reasonable investigation, answering defendant is without sufficient information or knowledge with which to fonn a belief as to the truth of the averments of this paragraph. It is further denied that answering defendant was negligent in any matter whatsoever. On the contrary, answering defendant acted reasonably and prudently under tbe circumstances. (a) Denied. On the contrary, answering defendant acted reasonably and prudently under the circumstances. (b) Denied. On the contrary, answering defendant acted reasonably and prudently under the circumstl"<:e'/ (c) Denied. On the contrary, answering defendant acted reasonably and prudently under the circumstances. (d) Denied. On the contrary, answering defendant acted reasonably and prudently under the circumstances. (e) Denied. On the contrary, answering defendant acted reasonably and prudently under the circumstances. (f) Denied. On the contrary, answering defendant acted reasonably and prudently under the circumstances. 3 IS. Denied. It is denied that answering defendant wu negligent in any matter whatsoever. On the contrary, answering defendant acted reasonably and prudently under the cirCUlllltancCl. ~ to the remaining averments of this paragraph, answering defendant is without IUfficient infonnation or knowledge with which to fonn a belief u to the truth of these averments and they are therefore denied. 16. Denied. After reasonable investigation, answering defendant is without sufficient infonnation or knowledge with which to fonn a belief u to the truth of the averments of this paragraph. 17. Denied. After reasonable investigation, answering defendant is without IUfficient infonnation or knowledge with which to fonn a beliefas to the truth of the avennents of this paragraph. (a) Denied. On the contrary, answering defendant acted reasonably and prudently under the circumstances. (b) Denied. On the contrary, answering defendant acted reasonably and prudently under the circumstances. (c) Denied. On the contrary, answering defendant acted reasonably and prudently under the circumstances. (d) Denied. On the contrary, answering defendant acted reasonably and prudently under the circumstances. (e) Denied. On the contrary, answering defendant acted reasonably and prudently under the circumstances. 4 WHEREFORE, DefCl1dant denies that Plaintiff it entitled to judgment apinst the defeadaat In the lI1IOunt apecifled, or to any sum of money whatsoever, or to intercst or costs and pray. that judgment be entered In Defendant's favor and against the Plaintiff and for her costs and fees and for such other rclief u thc Court deems appropriate. DEFENDANT DEMANDS TRIAL BY JURY. 18. DefCl1dant reserves the right to challcngc any award of delay damagcsln this cue. 19. Defendant dcmands that appropriatc hearings be conducted in this case prior to any award of delay damages. 20. Rule 238 ofthc Pennsylvania Rules of Civil Procedure, on its face, and as applied is violative of the Due Process and Equal Protection clauses of the Fourteenth Amcndment to the Constitution of the United States, ~I983 ofTitlc 42 of the United States Code and Articlc I, ~1, 6, I I and 26 and Articlc V, ~IO(c) ofthe Pennsylvania Constitution and imposes a chilling effect on the exercise by Dcfendant ofits constitutional rights. 2 I . If it is detcnnined that thc defendant is liablc on the plaintiff's cause of action, tbe dcfendant avers that the plaintiff's recovery should be eliminated or reduced in accordance with the Pennsylvania Comparative Negligence Act, 42 Pa. C.S.A. Section 7102 because plaintiff: (a) failed to keep a proper lookout; (b) failed to keep alert and maintain a sharp lookout for thc surrounding traffic conditions; (c) failed to safely overtake and pass a vehicle on the right in violation of Pennsylvania Vehicle Code Section 3304; (d) failed to yield the right of way. s , 22. It is further averred that if the plaintiff suffered any injurietldamages as aIleged, they were Cluted solely and primarily by plaintifr s own care1essness, recklessness and negligence becaule plaintiff: (a) (b) failed to keep a proper lookout; failed to keep alert and maintain a sharp lookout for the surrounding traffic conditions; ( c) failed to safely overtake and pass a vehicle on the right in violation of Pennsylvania Vehicle Code Section 3304; (d) failed to yield the right of way. 23. It is further averred by the answering defendant that if the plaintiff suffered any injurietldamages as aIleged, said plaintiff by her conduct assumed the risk of those injurietldamages because plaintiff: (a) failed to keep a proper lookout; (b) failed to keep alert and maintain a sharp lookout for the surrounding traffic conditions; (c) failed to safely overtake and pass a vehicle on the right in violation of Pennsylvania Vehicle Code Section 3304; (d) failed to yield the right of way. 24. Some or all of plaintiffs claims may be barred or limited by plaintiffs selection of the limited tort option of their insurance coverage pursuant to the Pennsylvania Motor Vehicle Financial Responsibility Law, 75 Pa. C,S.A. Section 1701 ~ Kll, 6 -.. LO L ,~ j":. .' UJr C'''; : . n. l'i:, :~~: . ll.. , C~' , C)I ,',. l.l!l ../, ( - " 'J U~., , -'- f .. ,. t- ;, CI C' 'J SH~RIF~ 'S RE1UR" - NOT ~OU"~ ,t r \ CAS~ NU: \~9~-0081~ r Ct)MMUNW~:AI. HI I)F r~:rmsYI. V AN I A: CIJIHITY IW CUMIl~:rlLAN[J rWAIJ::; CII~:RYL I. VS. ARM~:NTRUUT LOY R. Thomas Kline , Sheriff, who be1ng duly sworn according and inqu1ry for the within to law, says, that he made a diligent search named defendant, to wit: ARM~NTRUUT LOY but was unable to locate H1m the COMPI.AINT NOnCE 1n his balllw1ck. He therefore returns !liJT FUUND . as to the within named defe>ndant ARMI':NTRIJUT LOY ()~:FT. MiJVED AND LEFT NO FURWARDINIi ADDRESS WITH TIW rUST UFF IC~:. Shr:>I-1ff's Costs: Docketinq Service - Affidavit Surcharge SQ ::J0:3Wer6: 1".00 h.20 .00 2.00 / ';.---r .- .1 ..::--. ".'.. :."',/ R.I' Thomas 1\110e, ..,.' ./ "// She>r111 S.'G. 20 MCGRAW IIAIT & DElTCHMAN 02/25/1997 Sworn and subscribe>d to before me> this ..:li' '!- day of J.d... J '/ 1<1 91/'.[1. ~lA-- Q. ~.~. Prothonotary' 5. On said date and time, Dcfcndant was occupying a Chcvrolct K-IO pickup truck which was thc first vchicle facing a stcady red traffic signal at the intcrsection of South York and Simpson Strects. 6. Defendant's truck was next to the double yellow dividing line separating northbound and southbound lancs of traffic and no tum signals were used by Defendant as his truck was stopped at the light. 7. Plaintiff pulled her vehicle, a Honda Civic CRX,to the right of Defendant's vehicle and stoppcd at the steady red light and looked for cast bound traffic on Simpson Strcet after stopping. 8. Plaintiff saw an cast bound vehiclc approaching the intersection and remained stopped. 9. Suddenly, Defendant's truck madc a right turn and in so doing, collided with the front and side ofPlaintitrs vchicle. 10. Defendant's truck did severe damage to the Icft side and front bumper of Plaintifrs vehicle and jostled Plaintiff about the inside ofhcr vehicle. I I. The estimate to rcpair the darnage to Plaintifrs vehicle amounted to $1543.35. (At true and correct copy of the estimate is attached hereto as Exhibit "An). 12. In addition, Plaintiff incurrcd $45.00 in towing charges and $315.00 in storage fees. (True and correct copics of the towing invoice and storage invoice are attached hereto as Exhibits "B" and "Cn rcspectivcly). 13. As a result of the collision, PlaintiffsufTcrcd severe and serious physical injuries as are hereinaftcr sct forth. 14. The injuries and property damage suffered by Plaintiff were causcd by and were the direct and proximate result ofthc negligence of the Defcndant, in any or all of the following respects: a) In Defendant's failure to havc his vehicle under proper control; b) In failing to keep alert and maintain a sharp lookout of the road and the surrounding traffic conditions; c) In failing to observe and avoid Plaintiff's vehicle; d) In continuing to operate his vehicle after it became apparent that he had struck Plaintiff's vehicle, further damaging the vehicle and injuring Plaintiff; e) In failing to utilize a vehicle tum signal or hand signal on his approach to and at the intersection in violation of the Pennsylvania Vehicle Code, 75 Pa.C.S.A. ~~3334 and 3335, and t) In failing to approach the turn in the required position, as close as practicable to the right-hand curb or edge of roadway in violation of Pennsylvania Vehicle Code Section 3331. 15. Solely as a result of the negligcnce of the Defendant as aforesaid, Plaintiff sustained the following injuries, all of which are or may be of a serious and pennanent nature, including, but not limited to: disc hemiation at L5-S I; other spinal damage at L4-5; muscle spasms of the back; and pain and numbness of the legs. 16. As a result of the aforesaid injuries, Plaintiffhas cxperienced grcat pain and limitation of motion. Shc has not been able to work for a significant period of time; she is restricted in the physical functions which she is capable of doing; and she has difficulty perfonning household functions, as a result of the injuries sustained in this collision. 17. As a result of the aforesaid injuries, Plaintiff has sustained the following damages in addition to those stated above: a) Plaintiff has been or will be required to receive and undergo medical allention and care and to incur various expenses for treatment of her injuries; b) Plaintiff has suffered and will suffer great pain, suffering, inconvenience, embarrassment, emotional distress and mental anguish; c) Plaintiff has been and will be required to expend large sums of money for surgical and medical attention hospitalization, medical supplies, surgical appliances, medicines and attendant services; d) Plaintiff has suffered loss of eamings and her earning capacity has been reduced; e) Plaintiff's general health, strength and vitality has been impaired. WHEREFORE, Plaintiff, Cheryl L. Neaus respectfully requests that an award be entered in her favor against defendant, Loy Armentrout, for damages in excess of $25,000.00. ..~ . , - \..J MILLER & SAMS TOWING 6489 Carlosl. Pike MECHANICSIlURG, PENNSYLVANIA 17055 Day Phone (717) 697.9972 Night Phone (717) 258.9457 .." -, .' ... A.fol, .. . .. :, PM. " lOCAIIO'tOf vt~ ." ...,-\ " ~ - . 'f' ~ . - ....... 1'- "Ul)fit~~ ,.. , IlILEAGE SERVICE TlIIE EXllIA PERSON fiNISH FINISH FINISH STAAT START START roTAL TOTAl TOTAl. 'i t, ....~X'... ........ f c.... t. su.~ lIC~ .. t.... "" ,..l o SUNGlHOISTTOW o WHEEL LIFT D'f'LAT 8EOIRtMP o STAAT o LOCK OUT VI f lOwlD TO , " ,-- REMARKS 2697 o FLAT TIRE o OUT OF GAS [3 WRECK o RECOVERY o SPECIAl. EQUIPIIENT o SINGLE LINE WINCHING o DUAl. LINE WINCHING o SNATCH BLOCKS o SCOTCH BLOCKS o DOU.Y o , \ ~ -..... _.._~~+... -_:.~.,;~.~- -QlARQE_Y-5:~ WOA CHARGE : -..----~-, ____n__ ------r-- ST~=:: ~~_-~. , \ , Of'lAAIOR'SIlGHATUAl TOTAL ,r._ ,--.. N.mt::HllO ~'UN Road Service oJ - lWD.ClII'~. 1Jr..I.o.f'tOIfYQJ.fllUl_mGI \. . \, 'I EXHlBI'l"'B" i -. .~ 'ioj. ". --. ----~ CIUllO"" IOU> 10 ........... , , .......- LEININGER'S AUTOMOTIVE SPECIALIST;:, 6384 BRANDY LANE MfChANICSBURG, PA I/''~~, , - . .(717)766-1414 ..... C'. C-.s C-1(r;lIyc ULArJ> .f!; (1("" , ),.; (I (l'r- "'~'l/: .,1 I ',,0 9S'- ., ":"_... ,.u I "- , ,0. ," - /1 ..-;', Ir , " . , ". ( \, - ~CJ:/~ " \" ",.- -' .' EXHIBIT "c" ""MID_US" . 5. On said date and time, Defendant was occupying a Chevrolet K-I 0 pickup truck which was the first vehicle facing a steady red trnllic signnl atlhe intersection of South York and Simpson Streets. 6. Defendant's truck was next to the double yellow dividing line sepnrating northbound and southbound lanes oftrnllic and no tum signals were used by Defendant as his truck was stopped at the light. 7. Plaintiff pulled her vehicle, a Honda Civic CRX.to the right of Defcndant's vehicle and stopped at the steady red light and looked for eastbound traffic on Simpson Street after stopping. 8. Plaintiff saw an eastbound vehicle approaching the intersection and remained stopped. 9. Suddenly, Defendant's truck made a right tum and in so doing, collided with the front and side of Plaintitl's vehicle. 10. Defendant's truck did severe damage to the left side and front bumper of Plaintifrs vehicle and jostled Plaintiffnboulthe inside of her vehicle. 11. The estimate to repair the damage to Plaintitl's vehicle amounted to $1543.35. (At true and correct copy of the estimate is all ached hereto as Exhihit"A"). 12. In addition, Plaintiff incurred $45.00 in towing charges and $315.00 in storage fees. (True and correct copies of the towing invoice and storage invoice are attached hereto as Exhibits "8" and "C" respectively). 13. As a result of the collision, Plaintiff suffered severe and serious physical injuries as are hereinafter set forth. 14. The injurics and propcrty damage suffcred by Plaintiffwcrc caused by and were the direct and proximatc result ofthc ncgligcnce ofthc Dcfendant. in any or all of the following respects: a) In Defcndant's failurc to havc his vchicle undcr proper control; b) In failing to kecp alcrt and maintain a sharp lookout of thc road and thc surrounding traffic conditions; c) In failing to observe and avoid Plaintiff's vchicle; d) In continuing to operate his vehicle aftcr it became apparcnt that he had struck Plaintifrs vehiclc, further damaging the vehicle and injuring Plaintiff: e) In failing to utilize a vehicle tum signal or hand signal on his approach to and at the intersection in violation of the Pennsylvania Vehicle Codc, 75 Pa.C.S.A. ~~3334 and 3335, and f) In failing to approach the tum in thc required position, as closc as practicablc to the right-hand curb or edge of roadway in violation ofPcnnsylvania Vehicle Code Scction 3331. 15. Solely as a result of the ncgligencc of the Dcfendant as aforcsaid. Plaintiff sustaincd thc following injurics, all of which arc or may be ofa scrious and pcnnanent nature, including, but not limited to: disc hcmiation at L5-S I; other spinal damage at L4-5; musclc spasms of the back; and pain and numbness of the legs. 16. As a rcsult of the aforesaid injurics, Plaintiff has expericnced great pain and limitation of motion. Shc has not becn ablc to work for a significant period of time; she is restricted in the physical iimctions which she is capable of doing; and she has difficulty perfonning household functions, as a result of the injuries sustained in this collision. 17. As a result of the aforesaid injuries, Plaintiff has sustained the following damages in addition to those stated above: a) Plaintiff has been or will be required to receive and undergo medical allention and care and to incur various expenses for treatment of her injuries; b) Plaintiff has suffered and will suffer great pain, suffering, inconvenience, embarrassment, emotional distress and mental anguish; c) Plaintiff has been and will be required to expend large sums of money for surgical and medical allention hospitalization, medical supplies, surgical appliances, medicines and attendant services; d) Plaintiff has suffered loss of eamings and her eaming capacity has been reduced: e) Plaintifrs general health, strength and vitality has been impaired. WHEREFORE, Plaintiff, Cheryl L. Neaus respectfully requests that an award be entered in her favor against defendant, Loy Amlentrout, for damages in excess of $25.000.00. """'"NO IIOUlTO .......... '....-..#. C-1(Ii/ty( 'I,. f. . , LEININGER'S AuTOMOTIVE SPECIALIST;:' 6384 BRANDY LANE MECHANICsaURG, PA I/'J~)1, . _ , .(717)766-1414 OAt[ ~, (-"-5 !Jl..AdS ("i';,1' IjJ (lrry .....i"/i I ,'" <) ns' It" I ." " ,'I " b ,( '- . ", ," i' ',' ." ( (2Jf'.a.JlUeu. , .- EXHIBIT "e" ",,",","1,11.... :: , . . 5. On said date and time, Defendant was occupying a Chevrolct K-10 pickup truck which was the first vehicle facing a stcady rcd traffic signal atthc intersection of South York and Simpson Strccts. 6. Defendant's truck was next to the double ycllow dividing linc scparating northbound and southbound lancs of traffic and no turn signals were uscd by Defendant as his truck was stopped at the light. 7. Plaintiff pulled her vehicle, a Honda Civic CRX, to thc right of Defendant's vehicle and stopped at the steady rcd light and lookcd for castbound traffic on Simpson Street after stopping. 8. Plaintiff saw an castbound vehicle approaching the intersection and rcmaincd stopped. 9. Suddenly, Defcndant's truck madc a right tum and in so doing, collided with the front and side ofPlaintifrs vehicle. 10. Defendant's truck did severe damage to the left side and front bumper of Plaintifrs vehicle and jostled Plaintiff about the inside of her vehicle. 11. The estimate to repair the damage to Plaintifrs vehicle amounted to $1543.35. (At true and correct copy of the estimate is attached hereto as Exhibit "A"). 12. In addition, Plaintiff incurred $45.00 in towing charges and $315.00 in storagc fees. (True and correct copies of the towing invoice and storage invoice are attached hereto as Exhibits "8" and "C" respectively). 13. As a result of the collision. PlaintifTsuflered severe and scrious physical injuries as are hereinafter set forth. 14. The injuries and property damagc suffercd by Plaintiff werc caused by IInd were thc direct and proximate result ofthc negligencc ofthc Defendant, inllny or all ofthe following respects: a) In Defendant's failure to havc his vehiclc under proper control; b) In failing to kcep alcrt and maintllin a shllrp lookout ofthc road lInd the surrounding trnffic conditions; c) In failing to obscrvc and avoid Plaintiff's vehiclc; d) In continuing to opernte his vehicle aftcr it became apparent that hc had struck Plaintifrs vehicle, further damaging thc vehicle and injuring Plaintill.; e) , In failing to utilize a vchiclc turn signal or hand signal on his approach to and at the interscction in violation of the Pcnnsylvania Vehicle Code. 75 Pa.C.S.A. ~~3334 and 3335, and l) In failing to approach the tum in the rcquired position, as close as practicablc to the right-hand curb or edgc of roadway in violation of Pennsylvania Vehiclc Codc Scction 3331. 15. As a result of the negligcnce of the Defendant describcd above, Plaintiff sustaincd the following injuries, all of which are or may be ofa scrious and pernlanent nature. including, butnotlimitcd to: disc damage at L4-L5 and L5. S I; intennittent muscle spasms ofthc back; and episodes of pain and numbness of the legs. 16. As a result of the aforcsaid injurics. Plaintiff has expericnced great pain and limitation of motion. She has not been able to work for a significant period of time; she is restricted in the physical functions which she is capable of doing; and she has difficulty performing household functions. as a result of the injuries sustained in this collision. 17. As a result of the aforesaid injuries. Plaintiff has sustained the following damages in addition to those stated above: a) Plaintiff has been or will be required to receive and undergo medical attention and care and to incur various expenses for treatment of her injuries; b) Plaintiff has suffered and will suffer great pain, suffering, inconvenience, embarrassment. emotional distress and mental anguish: c) Plaintiff has been and will be required to expend large sums of money for surgical and medical attention hospitalization. medical supplies, surgical appliances. medicines and attendant services; d) Plaintiff has suffered loss of earnings and her eaming capacity has been reduced; e) Plaintiff's general health. strength and vitality has been impaired. WHEREFORE, Plaintiff, Cheryl L. Neaus respectfully requests that an award be entered in her favor against defendant. Loy Annentrout, for damages in excess of $25,000.00. ">- C"l f~- CO '. -: 'I ':--=- n , - " .. .. 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",:i ",;", , ." .:.,;;:~ "'-, ...' , . ,7' ,"':;:, ' ;', " " - .L ,',-- .- , .~ PRAECIPE FOR LISTING CASE fUR TRIAL (Must be typewritten and submitted in duplicate) ro '!lIE PJUntotmARY Of CUMBERLAND COUNI'Y Please list the following case: (Check one I x) for JURY trial at the next term of civil court.. for trial without a jury. ------------ - - - - - - - - - ----- - - - - -- --- -- - --- CAPl'ION Of CASE (entire caption nust be stated in full) (check one) (xl Civil Action - Law Cheryl L. Neaus Appeal from Arbitration (other) (Plaintiff) vs. The trial list will be called on Lay Armentrout and Auqust 18, 1998 (Defendant) Trials comrence on September 14. 1998 Pretrials will be held on Auqust 26 , 1998 (Briefs are due 5 days before pretrials.) vs. (The party listing this case for trial shall provide forthwith a copy of the praecipe to all counsel, pursuant to local Rule 214.1.) No. 810 Civil Law 1997 Indicate the attorney who will try case for the party who files this praecipe: Jennifer C. J);itchman, McGraw, Hait & fleitchman, 4 Liberty Avenue, Carlisle, PA 17013 Indicate trial counsel for other parties if known: Thanas R. Spanauqle, Esquire, Griffith, Strickler, Lerman, Solymos & Calkins, 110 South Northern Way, York, PA 17402 This case is ready for trial. Signed:rJI~~ Print Name: Jennifer C. Deitchman ~te: 7/)1/11 Attorney for:Plaintiff i'i N ~ ~ C z 8 :::l.~ ~g 0..' :x: uz. :e: f1: c: ..~~ -' ~~ , r- '-. f) ']-, N . .- !:t:.z ~ .-I ~~ => -, ::<: ~ <Xl ::;) C' U ,- en r , .:J I ,.-~ '~ \I , ~) ;. 'J(r. ,.. '-\-'j " (r:!.- .::;:: :"U.l c, l"'~ ' 'j /.: ., , ,~ ;,~ :: l::IIJ '_!10.. :'J :':E , ~ f., :;J \_.1 0' (J . -'", .-: :> .~.;"'.., . , ' . .C," ;.-,'.';';...",:' < <:..';u ..,,-,! ... ,.:'.'."'C .,.,.,.,.,i. ,',. .,:, .,.,.. .,," ,'..., . 'i ';'u~ . .; .~./ '0, : ',C "..:, , > '.. ,~t.':;. 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'. ,." , i''( .., . /, .;, ':'- ~:.:;,<,;"",. >' '<. :"h: ~')""'.:::r'::?'.. '.: ""....0.',.. ,'..-'" .. : '.:' ',\"!:,o. :"',,', .:':'......~,~. "., . ';,' ..., " ;:'.,. ':" .. C,.. .,' '''','C' .. ! ':c.';'.' " , ~.- ,~ -::f :,>:~~:'~ > , ~ ,1; , *~P:<t '. ,:~ ,; ~t Ifk:.'\ .5 f ,~. "<< ~l ., ~^ ~,,, '" _.... ;:.~J.. '" '):g':~~,t~;:~/" ~~ ~ 'rYi:.f'~'W-~ , . " " '. c.-'." ", ''::, .. -,'- ". ~~\: :;~ -: '::::. ';~:;: '''; ':,: :.;" ..::;;;:~ ; : ~~;.., '.' .',' ';", .;, " .\.':r: .' ,....."q,' .~.... r;" ,.'....',~ . "'.",.'.' ... . ,. >:" ,:. .,';. " ,~j~f'-:' '. \ ", :' " ,..., .. CHERYL L. NEAUS, Plaintiff IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA V. LOY ARMENTROUT, Defendant NO. 97-0810 CIVIL TERM JURY TRIAL VERDICT 1) WAS DEFENDANT'S NEGLIGENCE A SUBSTANTIAL FACTOR IN BRINGING ABOUT PLAINTIFF CHERYL NEAUS'S HARM? YES NO v IF YOU ANSWER QUESTION 1 "NO" PLAINTIFF CANNOT RECOVER AND YOU SHOULD NOT ANSWER ANY FURTHER QUESTIONS AND SHOULD RETURN TO THE COURTROOM. 2) STATE THE TOTAL AMOUNT OF ECONOMIC LOSS DAMAGES, IF ANY, YOU FIND PLAINTIFF CHERYL NEAUS SUSTAINED. TOTAL $ 3) DID PLAINTIFF SUFFER SERIOUS IMPAIRMENT OF A BODY FUNCTION AS A RESULT OF THE INJURIES SUSTAINED IN THE ACCIDENT OF FEBRUARY 23, 1995. YES NO IF YOU ANSWER QUESTION 113 "NO" PLAINTIFF CANNOT RECOVER FOR ANY NON-ECONOMIC DAMAGES. YOU SHOULD NOT ANSWER ANY FURTHER QUESTIONS AND SHOULD RETURN TO THE COURTROOM. 4) STATE THE TOTAL AMOUNT OF NON-ECONOMIC DAMAGES, IF ANY, YOU FIND PLAINTIFF SUSTAINED. TOTAL $ DATE: 7 /17( 'Ii ,A t /ULJ FORE~ELADY POOi€iCn~ ' ' ' . : ' ...~ .,...... , . . ~ fus""fu~;if~V;il"i)~~~~t~~1e '-,' "',,~\ti~~~~ '.. "/C' ,~,' . a~CIl: (~P~l':"""~~'~~~~~~1.liI_~.~ 141es:)~,..;~.~.';:..rI;i.;....J. ;~ i~m~': .. :l\lji-~ .,'.,,'," .....~rV_H"" . .""'~.'~;.f~~\Hf ,.(_,~T'I,'..mJ~IMoi',,_ il ~',i ~'.f.. 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''''~'':'' ,..... .. . . ;'tL"''!';~''''-;',~"";","".",, ." .' 'J\di!ress(If different than above) \":~:.~'!-~~'.:~;J;'.:. ."..,., ", ~~;'. ',:.:, ....1~L.;.;..J,'\OlI'4;.tl'."- .,'.;... ,.,-/' .:"';. .'" ~~::~;~~, . ~~~J3~~:;{;.~~~~ ,''-I.~'':' ....I'>U-,.':li..-=n-.U."C!:.,i~~.~ :VJtr.....~..nv ..... .. . ~..". ~..' ':"'~'''-''f'''''''''''' i'll" "i'.:..O.;' , . check' ',' Datel "'''''of'''' -. W P U\, up '.~~("4")~<<"1~~~.~.;.~~1t!.:.:(~~;.; .'!.. .i'fy" ) :::. J~ .....t'~~l~_LVUJt:.L..~ SJ?eC. >; I --' ' ~ '''';~f..- '''-'::'.''~l-~' ',., .'.. ...~."". 1~" '>'_'''./:0\\,.. ",~,...u. , ". '",i"-:",,':' '.' " .<<~ ~~~ 1~1'~\' el ~'fl!.'" , ." .'" ", 'I':' rc;. ......, ~ ~,.....,,~,. ..... .. ' .' """ ~:N.'.'~", if:;' ~l'\!:I::j. "," 'J~f ,;,{;':~:Jo./!."..... ......\ {i':~. ~ . '~~f':-,~'ljl~~'" ..' :\', ,.' .",0;>'1 ,."..,.., "cO ,....,.., '!\ <-i'u.; ......... . oWn .: '. . . ,,' .' . It. - - ":if!#..., .:- . ,- ; - (S P4.i~,... - . . . '-. .~~~~~ /Oate ~ ~';'~~,."-< ~.f-"""1"""';;: . ,I" ,-. (, '. ~:'~1~,~'~:i~\~>;: , if' :f:W; 0'., 'Vr --, f) :i.~.;);~ ~L oate .' , t ..-.....- c '-- ..,"-".'-'. I PLAINTIff'S EXHIBIT "9. :. ,~,... . J.:1 'l,~ i1, I ~: , .' \K o~ 't \ ~f' t'f) l~ 'i ~ ~ ~ < ~ 0. ~I~ .J 0 Qj 0 jol:: - :I: ...I !\ .2 ~i ~ I z -.... 0..... mO 0 o~ :1:<- "'0.'" <ID~ J:<( ! go; ~~ ....0- . UJ ~ ~ 0 Q: ,-- ... g \) , I- ;:;; z -J: :g~ ') It: 0.0. 0< ~ mE :1:0. w >ro III 11l~ I It: ...1(.) I~ ~ 0 J: w ~ ~ ii: 0< E i'! ~ G:D..:: It: f~~ e " w U - 0 u .r:; '0 CO 0 i 0 C :t Ol ,2 c: E 5: ~ .C: " " " e! ~ " c " III W c: >- Ql 0 ,2 ~ ~ M I!! IJ 5: u ~ ~ l!! ~ 'C: " Ollll 11l 1ii .iij :g 11l - "', Ql >- E 11l Ql c: ,> ;:;; ii: .r:: OQl a: n. ;:;; Ql ,2' a: III za: CHERYL NEAUS' UNPAID MEDICAL BILLS PROVIDER TOTAL UNPAID 1'7;1/7. iP J. Clifford Renyo .$8;0t3.00 Back-in-Condition 10/30/96 $60.00 11/4/96 $30.00 $30.00 11/6/96 $30.00 $30.00 11/7/96 $30.00 $30.00 11/11/96 $30.00 $30.00 11/13/96 $30.00 $30.00 11/14/96 $30.00 $30.00 11/26/96 $30,00 $30.00 $35.00 11/29/96 $30,00 $30.00 $35.00 12/3/96 $60.00 $35.00 12/5/96 $30.00 $30,00 $35.00 12/9/96 $30,00 $30.00 $35,00 12/16/96 $30.00 $30.00 $35,00 12/18/96 $30.00 $30.00 $35.00 PLAINTIFF'S I EXHIBIT q., , 2 Back-In-Condition (cont.) . ] 2/] 9/96 530.00 r. 530.00 535.00 12123/96 560.00 535.00 1/20/97 530.00 530.00 535.00 2/4/97 560.00 2/] 1/97 530.00 530.00 2/17/97 535.00 530.00 2/24/97 530.00 530.00 3/5/97 530.00 530.00 3/10/97 560,00 4/2/97 530.00 $35.00 TOTAL: S I ,830.00 W AL*MART Pharmacy Propacet N-I 00 Prescribed by Dr. William Richwine SI.II Chlro Network Health Care 1130/97 595.00 575.00 550.00 S20.00 520.00 530.00 520.00 520.00 530.00 520.00 520.00 530.00 $20.00 7/24/97 7/25/97 7/28/97 3 Chlro Network Health Care (cant.) 8/4/97 $20.00 $20.00 $30.00 8/4/97 $20.00 8/6/97 $20.00 $20.00 $30.00 8/11/97 $20.00 $20.00 $30.00 $20.00 8/22/97 $20.00 $20.00 $30.00 $20.00 8/25/97 $20.00 $20.00 $30.00 $20.00 8/27/97 $20.00 $20.00 $30.00 $20.00 9/2197 $20.00 $20.00 $30.00 $20.00 9/4/97 $20.00 $20.00 $30.00 $20.00 9/8/97 $20.00 $20.00 $30.00 $20.00 9/10/97 $20.00 $20.00 $30.00 $20.00 9/17/97 $20.00 $20.00 $30,00 $20.00 4 Cbiro Network Heallb Care (cont.) 9/22/97 $20.00 $20.00 $30.00 9/24/97 $20.00 $20.00 9/24/97 $30.00 $20.00 9/29/97 $20.00 $20.00 $30.00 $20.00 10/1/97 $20.00 $20.00 $30.00 $20.00 10/6/97 $30.00 $20.00 $20.00 10/8/97 $20.00 $20.00 $30.00 $20.00 10/13/97 $30.00 $20.00 $20.00 10/15/97 $20.00 $30.00 $20.00 1 0/22/97 $30.00 $20.00 $20.00 $20.00 10/27/97 $30.00 $20.00 $20.00 10/29/97 $30.00 $20.00 $20.00 $20.00 1 1/3/97 $20.00 $20.00 $30.00 5 Chlro Network Health Care (cant.) 11/5197 $20.00 $20.00 $30.00 11/10/97 $30.00 $20.00 $20.00 11/17/97 $20.00 $20.00 11/17/97 $30.00 $20.00 11/19/97 $20.00 $20.00 $30.00 11/24/97 $20.00 $20.00 $30.00 11/26/97 $30.00 $20.00 $20.00 $20.00 12/15197 $30.00 $20.00 $20.00 $20.00 12/17/97 $20.00 $20.00 $30.00 12/22/97 $20.00 $20.00 $30.00 $20.00 1/5198 $20.00 $20.00 $30.00 $20.00 117198 $30.00 $20.00 $20.00 $20.00 1/12/98 $30.00 $20.00 $20.00 $20,00 6 Chlro Network Health Care (eon I.) 1/14/98 $30.00 $20.00 $20.00 $20.00 1/19/98 $20.00 $20.00 $30.00 $20.00 1/21/98 $20.00 $20.00 1/21/98 $30.00 $20.00 1/26/98 $30.00 $20.00 $20.00 $20.00 1/28/98 $20.00 $20.00 $30.00 $20.00 2/2/98 $30.00 $20.00 $20,00 2/4/98 $20.00 $20.00 $30.00 2/9/98 $20.00 $20.00 $30.00 2/11/98 $65.00 $75.00 $40.00 $20.00 $20.00 $30.00 2/16/98 $20.00 $20.00 $30.00 2/18/98 $20.00 $20.00 $30.00 3/9/98 $20.00 $20.00 $30.00 . . , 7 Chlro Network Health Care (coni.) 3/11/98 $20.00 $20.00 $30.00 3/23/98 $20.00 $20.00 $30.00 3/25/98 $20.00 $20.00 $30.00 4/6/98 $20.00 $20.00 4/6/98 $30.00 4/15/98 $20.00 $20.00 $30.00 4/22/98 $30.00 $20.00 $20.00 5/6/98 $20.00 $20.00 $30.00 5/26/98 $30.00 $20.00 $20.00 6/3/98 $30.00 $20.00 $20.00 7/15/98 $30.00 $20,00 $20.00 8/10/98 $30.00 $20.00 $20.00 8/13/98 $30.00 $20.00 $20.00 8/19/98 $30.00 $20.00 $20.00 TOTAL: 55,390.00 GRAND TOTAL ~ :/'/0 13(/,// PHYSICAL CAPACITIES EVALUATION 10RM IMPORTANT' PLEASE COHPLETE THE 10LL~ING ITEMS BASED ON YOUR CLINICAL EVALUAIION 01 THE CLAIMANT AND OTHER TESTING RESULTS. I~Y ITEM THAT YOU DO HOT BELIEVE YOU CAN ANS~R SHOULD BE MARKED N/A (NOU ANSYERABLE) NOIE: In Urms of In 8 hour workday, lIoccaslonally" equals 1% to 33%, "Frequently", 34X to 66%, lIcontinuouslyll, 67X to 100X. In an a hour workday, clllmant can (Clrcll full capacity for .ach activity) TOTAL AT ONE TIME cp A) Sit 0 1. 3. cb 5. B) Stlnd 0 1. 3. 5. C) IIllk 0 1. 2. (J) 4. 5. TOTAL DURING ENTIRE 8'HOUR DAY A) SIt 0 1. 2. 3. 4. 5. Bl Stlnd 0 1. 2. 3. 4. 5. C) IIllk 0 1. 2. 3. 4. 5. II. Clllmant cln lift: Never A) Up to 5 lb.. B) 6'10 lb.. C) 11.20 lb.. D) 21.25 lb.. E) 26-5D lb.. I) 510.100 lb.. .J:C III. Claimant can clrry: Never A) Up to 5 lb.. B) 6.10 lbo. C) 11-20 lb.. D) 21.25 lbo. E) 26-50 lb.. f) 510.100 lb.. :.::::.-- I. j~ Occas I ona I' y FrfOUenttv 6. 7. 8. (hr..) 6. 7. 8. (hrs.) 6. 7. 8. (hr..) 6. 7. ~(hrs.) 6. 7. (hr..) 6. 7. 8. (hr..) Continuously ~ ~ ~ - occasional tv Fr~uentlv Contlnuouslv ~ ~ :=;......-- t..-/ , .J IV. Claimant can use hands for repetitive action such as: A) B) Right Left Slnele Cirasoinq ,/"y.. No ~=NO Pushing & Pulling of Arm Controls ,/""' Yes No '-'rtS No Fine Manloul.tlon ":::;:~NO ~es _No v. Claimant can use feet for repetitive mov~~nts as in pushing and pulling of leg controls. Rloht /es _No lili ~_NO Both _~ _No VI. Claimant is able to: Not at all occasional Iv FreQuently Continuouslv A) B) C) 0) El '.? J/' Bend Squat Crawl CIIITb Reach VII. Restriction of activities involving: No"~ Mild ::::::-- !m!. Moderate A) Bl C) -~ -5/ ~ Unprottcttd heights Being around moving machinery Exposure to marked changes in temperature and humidity Driving lutomotlve <q\llpne/? \? ~ cr7(~/<-, <-:) -(..117(90'0 0) 2 1 2 WITNESS 3 Geoffrey M. James 4 5 6 7 8 9 10 11 INDEX TO WITNESS DIRECT CROSS REDIRECT RECROSS 3/8 7/22 8/33 36 12 13 INDEX TO EXHIBIT 14 NO. DESCRIPTION PAGE 15 1 Photocopy of medical chart 9 16 17 18 19 20 21 22 23 24 , ..,./ 25 Central Pennsylvania Court Reporting Services (717) 258-3657 or 800-863-3657 or fastfngers@aol.com -. ", .J 3 1 2 GEOFFREY M. JAMES, M.D., called as a witness, 3 being duly sworn, was examined and testified as follows: 4 DIRECT EXAMINATION (As to Qualifications) 5 6 BY MS. DEITCHMAN: 7 Q. Doctor, can you please state your full name and 8 professional address for the record. 9 A. Geoffrey Mento James. And my address is 2140 10 Fisher Road in Mechanicsburg, Pennsylvania. 11 Q. And that's where we're sitting today, correct? 12 A. Correct. 13 Q. At Sheperdstown Family Practice? 14 A. Urn-hum. 15 Q. Let me just go, very briefly, into your 16 background before coming to work here at Sheperdstown 17 Family Practice. You provided me with a copy of a 18 document titled curriculum vitae, Jeffrey M. James. 19 A. Urn-hum. 20 Q. Could you take a look at that and confirm if 21 that is an up-to-date copy of your qualifications? 22 A. Yeah. It might not be up-to-date as of this 23 month, but within the last year or two, it's up-to-date. 24 Q. Okay. And it indicates that you're licensed to 25 practice medicine in the State of Pennsylvania. Is Central Pennsylvania Court Reporting Services (717) 258-3657 or 800-863-3657 or fastfngers@aol.com ..../ 4 1 that -- since when have you been licensed to practice 2 medicine in PA? 3 A. Since 1979. 4 Q. And you graduated medical school at University 5 of Pennsylvania? 6 A. Correct. 7 Q. What year was that? 8 A. 1978. 9 Q. And did you have a residency following medical 10 school? 11 A. Yes. 12 Q. Where was that residency performed? 13 A. Harrisburg Hospital. 14 Q. And how many years did that residency 15 encompass? 16 A. Three years. 17 Q. And was there a primary area of practice that 18 you focused your residency on? 19 A. Family practice. 20 Q. Your resume also states that you're board 21 certified in family -- family practice by the American 22 Board of Family Practice. 23 A. Correct. 24 Q. Could you indicate for us what the board 25 certifications means? Central Pennsylvania Court Reporting Services (717) 258-3657 or 800-863-3657 or fastfngers@aol.com 5 1 A. Now it requires completion of a residency 2 program and staying up-to-date on -- have to take a 3 recertification test every six or seven years, and 4 completing CME requirements of 50 hours a year. 5 Q. And are you still certified by the American 6 Board of Family Practice? 7 A. Yes. 8 Q. And here at Sheperdstown Family Practice, is 9 that your primary focus, the family practice area? 10 A. Yes, urn-hum. 11 Q. I also notice that you're on the staff of 12 various local hospitals in the area. And could you 13 explain what your staff privileges entail? 14 A. I'm on active staff at Harrisburg Hospital, 15 which now actually that's Pinnacle Health Systems, that 16 includes Seidle. And I'm on consulting staff at Holy 17 Spirit and also at HealthSouth. That may not be on there 18 because that's fairly recent. 19 Q. I also note that you're a clinical instructor 20 for the Harrisburg Hospital family practice residency 21 program. 22 A. Yes. 23 Q. Is that a part-time position? 24 A. Yes. , , ~ 25 Q. Since -- how long have you been doing that? Central Pennsylvania Court Reporting Services (717) 258-3657 or 800-863-3657 or fastfngers@aol.com ..J 6 1 Since 1981. A. 2 Q. And you also list Messiah College. What do you 3 do at Messiah College? 4 A. Actually, we're not actively involved there 5 anymore. We were the school physicians at Messiah College 6 for -- how many years -- about 15 years. 7 Q. And that's not too far from your office here, 8 is it? 9 A. Right, two miles. 10 Q. Could you explain the manner in which 11 Sheperdstown Family Practice handles patients? In other 12 words, let me narrow down the question. Is a patient 13 assigned to a specific doctor here? 14 A. No. 15 Q. How many doctors do you currently have working 16 at Sheperdstown Family Practice? 17 A. One, two, three, four, five physicians and 18 three nurse practitioners. 19 Q. And might a patient see any one of those 20 physicians or nurse practitioners when presenting to your 21 office for a visit? 22 A. Right. 23 Q. Is there one set of medical -- is there one 24 medical chart contained in a central location for each 25 patient? Central Pennsylvania Court Reporting Services (717) 258-3657 or 800-863-3657 or fastfngers@aol.com 7 1 A. Yes. 2 Q. And who has control over the medical charting 3 methods? 4 A. Well, those are standardized among the 5 practice. 6 MS. DEITCHMAN: Before I go ask you any further 7 questions regarding your specific treatment of Ms. Neaus, 8 I would just like to ask if Mr. Armentrout has any 9 questions of you in your qualification area. 10 MR. SPONAUGLE: Well, I don't know if Mr. 11 Armentrout has any questions, but I have a couple -- 17 BY MR. SPONAUGLE: 18 Q. Doctor, tell us what family practice means? 19 A. It's an approach to lifelong care of patient 20 from birth to grave, of all ages of patients. It's a 21 specialty of breadth, rather than a specialty. 22 Q. I guess the -- the easiest analogy may be with 23 a family practice, that's a doctor you go to initially for 24 your -- for your shots when you're a baby, and all the way , _i 25 to health care throughout your life? Central Pennsylvania Court Reporting Services (717) 258-3657 or 800-863-3657 or fastfngers@aol.com 8 1 A. Urn-hum. 2 Q. Doctor, often in the practice of family 3 medicine, do you refer patients out to specialists? 4 A. Sure. 5 Q. Do you often have occasion to refer patients to 6 orthopedic surgeons? 7 A. Sure. 8 Q. What reason do you refer cases from your 9 practice to orthopedic surgeons, generally? 10 A. If they require care that's beyond the 11 expertise that we can provide here. 12 MR. SPONAUGLE: I don't have any other 13 questions. Thank you. 14 REDIRECT EXAMINATION (As to Qualifications) 15 16 BY MS. DEITCHMAN: 17 Q. Just a couple of follow-up questions. 18 As part of the family practice, does your 19 office handle injections and any sort of family planning 20 methods? 21 A. Sure, urn-hum. 22 DIRECT EXAMINATION 23 BY MS. DEITCHMAN: 24 Q. Now I want to turn towards your treatment of j 25 Cheryl Neaus. And before I ask you some specific Central Pennsylvania Court Reporting Services (717) 258-3657 or 800-863-3657 or fastfngers@aol.com 10 1 A. Yes. 2 Q. Is it reasonable for you to rely upon the 3 records of other physicians in the practice when referring 4 to the patients' chart? 5 A. Sure. 6 Q. Now, was there an indication as to the reason 7 for Ms. Neaus's complaint of pain in the buttocks and low 8 back area on December 30th, 1994? 9 A. Well, I think there are a couple of possible 10 explanations. I think that she had what -- she had some 11 tenderness over her buttocks area and had been told by 12 other physicians, apparently, that it was a muscle strain, 13 although she temporally related it to getting a 14 Depo-Provera shot at Polyclinic ten days before the visit. 15 Q. Are you familiar with where a Depo-Provera shot 16 would be injected into a person's anatomy? 17 A. Yes. 18 Q. Where does that injection go? 19 A. Usually in the buttocks. 20 Q. And was there any medication prescribed or 21 treatment prescribed to relieve her symptoms? 22 A. By Dr. Schwartz. 23 Q. By Dr. Schwartz. 24 A. Yes. Lodine, 400 milligrams, twice a day. , ,../ 25 Q. What is Lodine? Central Pennsylvania Court Reporting Services (717) 258-3657 or 800-863-3657 or fastfngers@aol.com 11 1 A. It's an antiinflammatory medication. 2 Q. Did she ever return to the office for 3 complaints of similar pain? 4 A. Yes, several times. But the next one was 5 February 1st, 1995. 6 Q. Is there an indication of who saw her on 7 February 1st, 1995? 8 A. Yes, I saw her at that time. 9 Q. And was there any change in the pain from when 10 she complained initially in December? 11 A. Well, it -- the note says that if the pain had 12 been improving, and then when she was running on the beach 13 it got worse again. My recollection is that basically it 14 was about the same as when she had been -- been seen in 15 December, the previous December. 16 Q. And what area of her body was -- did she 17 complain of pain in on February 1st, 1995? 18 A. Her low back and buttocks, which she called her 19 hip. But when she localized it, it was her low back and 20 buttocks. 21 Q. Did she return again for complaints relative to 22 the low back and buttocks? 23 A. Did she come back again, is that what you 24 said? ,J 25 Q. Yes. Central Pennsylvania Court Reporting Services (717) 258-3657 or 800-863-3657 or fastfngers@aol.com 12 1 A. Yes. Again on February 21st, '95. 2 Q. And did you see her on that occasion? 3 A. Yes. 4 Q. And what do your records indicate her 5 complaints were on February 21st, 1995? 6 A. They were unchanged. she had continued pain 7 but with no substantial worsening or improvement. 8 Q. And when you saw her on the two visits in 9 February, did you perform a physical examination of Ms. 10 Neaus? 11 A. Yes. 12 Q. And was there anything significant which you 13 found on physical examination? 14 A. The main thing was that she was tender over her 15 buttocks and/or low back area. 16 Q. Are you able to localize what area of her low 17 back specifically she was having tenderness in? 18 A. The right low back is all I have in the notes. 19 Q. And what was your plan of treatment for Ms. 20 Neaus as of February 21st, 1995? 21 A. Continuing conservative treatment of resting, 22 avoiding heavy lifting, stretching exercises. 23 Q. Should she perform stretching exercises or 24 avoid stretching exercises? J 25 A. It says that she was to perform stretching Central Pennsylvania Court Reporting Services (717) 258-3657 or 800-863-3657 or fastfngers@aol.com ... 1 2 17 A. Yes. Q. And did you then follow-up again with Ms. Neaus 3 in your office? 4 A. 5 Q. 6 office? 7 A. 8 Q. 9 A. 10 Q. Yes. When was the next fOllow-up with you in your March 20th, 1995. And what was that follow-up for? For her back and buttocks pain. 11 March 3rd visit with you? Was there any change in her condition since her 12 A. 13 Q. No, there was no change. And approximately how many physical therapy 14 treatments did she have between March 3rd and March 20th 15 of 1995? 16 A. 17 Q. It appears she had six visits. What was your plan of action for treating Ms. 18 Neaus after March 20th, 1995 when she had not had any 19 improvement? 20 A. She was referred for an x-ray of her low back 21 and referred to an orthopedist, Dr. Dahmus. 22 Q. 23 group? 24 A. I ,-' 25 Q. Is Dr. Dahmus located with a -- a practice Yes. But he's switched groups since then. Did you -- did you have to write a slip to Central Pennsylvania Court Reporting Services (717) 258-3657 or 800-863-3657 or fastfngers@aol.com 18 1 refer Ms. Neaus to obtain this -- the x-ray somewhere 2 other than your office here? 3 A. Yes, urn-hum. 4 Q. And was that x-ray returned to you following it 5 being performed? 6 A. Not the x-ray, but the x-ray report was sent to 7 me. 8 Q. Do you routinely receive x-ray reports as part 9 of your practice as a family physician? 10 A. Yes. 11 Q. And would an x-ray -- what would an x-ray show 12 of a lumbar spine? 13 A. Well, it primarily shows the bony structures. 14 Q. Would it show the discs of the spine? 15 A. No, they don't well, they don't directly 16 show up. Although the -- the space where the discs are 17 between the bones may show and you may be able to infer 18 some things about the disc from the x-ray. 19 Q. And would you be able to see any fractures on 20 the x-ray? 21 A. Yes. 22 Q. Of the bones themselves? 23 A. Urn-hum. 24 Q. And did Ms. Neaus's x-ray show any such ..--' 25 fractures? Central Pennsylvania Court Reporting Services (717) 258-3657 or 800-863-3657 or fastfngers@aol.com 19 ---., I 1 A. No. 2 Q. After she was referred to Dr. Dahmus, did you 3 have any follow-up treatment with Ms. Neaus specifically 4 for lower back or buttock pain? 5 A. I personally did not. I saw her for a physical 6 August 19th of '96 and asked her about her back, but did 7 not see her specifically for that problem. She was seen 8 by two of my partners for back pain since that visit. 9 Q. Following the August 19th visit, or prior to 10 the August 19th visit, two of your partners saw her? 11 A. Prior to that visit. 12 Q. When you asked her on August 19th, 1996 how her 13 back was doing, did you record any response from her? 14 A. Yes. She was continuing to have problems with 15 her back, which apparently she had reinjured and was 16 seeing a chiropractor for. 17 Q. And had you -- had you looked at the two 18 notations from your partners prior to August 19th, 1996 19 when Ms. Neaus came into your office? 20 A. I'm sure I have, yes. 21 Q. It indicates a reinjury in April of 1996, 22 according to the records. 23 A. Urn-hum. 24 Q. Did Ms. Neaus ever explain to you what -- what -,,' 25 happened in April of 1996? Central Pennsylvania Court Reporting Services (717) 258-3657 or 800-863-3657 or fastfngers@aol.com 20 1 A. I don't recall that she went over the details. 2 But 1 have that in the chart in front of me. 3 Q. Going back to the referral from Dr. Dahmus, did 4 you receive anything from Dr. Dahmus concerning Ms. Neaus? 5 A. I don't think that I did. 6 Q. 1'11 strike that question. 7 Let's go back to the physical therapy referral, 8 Dr. James. 9 A. Urn-hum. 10 Q. Why did you refer her for physical therapy 11 after the motor vehicle accident and not prior to it, when 12 she had been complaining of pain in her lower back and 13 buttocks? 14 A. Her exam had been not suggestive of a worrisome 15 problem. And I didn't think it had been a long enough 16 time that it was necessary to get a specialist input. 17 Q. Is the pain that was related by Ms. Neaus, 18 following the injection, usual for that type of injection? 19 A. I wouldn't say it's usual. I would say that 20 that's an occasional to rear complication of an 21 injection. And 1 don't -- I would also say that 1'm not 22 entirely sure that the injection was what caused the pain. 23 Q. Following the -- let me just clarify. You had 24 seen Ms. Neaus for the pain in the buttocks and lower back -/ 25 prior to the motor vehicle accident, according to your Central Pennsylvania Court Reporting Services (717) 258-3657 or 800-863-3657 or fastfngers@aol.com I ,..,./ 24 1 That was at the February 21st visit, right. A. 2 Q. 1'm sorry. February 21st you -- you 3 recommended that, correct? 4 A. Correct, right. 5 Q. And at that time the lifting restrictions, to 6 be more exact, were 15-pound lifting restriction? 7 A. Correct. 8 Q. And, Doctor, tell us, when you give someone a 9 15-pound lifting restriction, what does that mean? 10 A. That means that they should not lift anything 11 that weighs more than 15 pounds. 12 Q. Okay. And you also had her do some rest 13 periods, apparently for 20 to 30 minutes every 2 to 3 14 hours at work? 15 A. Right. 16 Q. And on February 23rd, 1995 she then called you 17 to report that she had been in a motor vehicle accident? 18 A. Correct. 19 Q. And you testified before, we know, that you 20 were the one who actually spoke to Ms. Neaus over the 21 phone that day? 22 A. Yes. 23 Q. And she reported that she had increasing hip 24 pain after the motor vehicle accident? 25 A. Correct. Central Pennsylvania Court Reporting Services (717) 258-3657 or 800-863-3657 or fastfngers@aol.com ~. 27 1 was on March 23rd of -- or February 23rd of 1995? 2 A. Correct. 3 Q. And, Doctor, reported that at that time ! you you i , 4 had her go to get x-rays of her lumbar spine, correct? 5 A. 6 Q. Right. And that -- those x-rays were taken the next 7 day on March 21 of 1995? 8 A. 9 Q. 10 normal? 11 A. 12 Q. Correct. And the x-ray result of the lumbar spine was Yes. Now, Doctor, you referred her to Dr. Dahmus. 13 And I apologize if I'm not pronouncing his name right. 14 What profession is Dr. Dahmus? 15 1... 16 Q. He's an orthopedic surgeon. Why did you feel it was necessary to refer Ms. 17 Neaus to an orthopod. or orthopedic surgeon at that time? 18 A. Because she had had a significant duration and 19 severity of pain and was not responding to conservative 20 treatment. 21 Q. And we touched on this a little on your 22 qualifications as a family practice physician. The reason 23 that you sent her to an orthopedic Burgeon was because an 24 orthopedic surgeon is a specialist in this area? _./' 25 A. Yes. Central Pennsylvania Court Reporting Services (717) 258-3657 or 800-863-3657 or fastfngers@aol.com 28 '--'" \ 1 Q. An orthopedic surgeon would have a different 2 type of education or experience and -- and also training 3 in -- in treating injuries like this as opposed to 4 yourself? 5 A. Yes. 6 Q. Now, Doctor, included in your records are also 7 some correspondence that you had with Dr. Jason J. 8 Litton. Is that correct? ... 9 A. Yes. 10 Q. And Dr. Jason Litton is also an orthopedic 11 surgeon. Is that correct? 12 A. Correct. 13 Q. And he's with the Orthopedic Institute of 14 Pennsylvania. 15 A. Yes. 16 Q. Your records of -- included a letter from Dr. 17 Litton to yourself, which was dated March 28th of 1995? 18 A. Yes, urn-hum. 19 Q. And regarding his examination of Ms. Neaus on 20 March 23rd of 1995? 21 A. Correct. 22 Q. And it is customary in your practice as a 23 physician to rely on the records of other medical 24 providers in determining treatment of a patient that you I '../ 25 have? Central Pennsylvania Court Reporting Services (717) 258-3657 or 800-863-3657 or fastfngers@aol.com ; " -,,/ 29 1 To a degree, yes. A. 2 Okay. I mean, you you take into account Q. 3 their other medical providers 4 A. Sure. 5 Q. -- opinions and treatment and diagnosis in 6 determining your own diagnosis and prognosis of someone? 7 A. Sure, urn-hum. 8 Q. And, Doctor, she then saw Dr. Litton again 9 and I'm referring to Ms. Neaus -- on June 15th of 1995. 10 Is that right? 11 A. Right. 12 Q. And that's reflected in his correspondence to 13 you dated June 20, 1995. 14 Right. A. 15 Q. And at that time, Dr. Litton informed you that, 16 in his opinion, Ms. Neaus had been completely relieved of 17 her low back, right buttock and right thigh pain, correct? 18 A. That's what his letter says, yes. 19 Q. And about a week ago spontaneously developed 20 some low back pain, though it was not severe? 21 A. Yes. 22 Q. And he essentially discharged her at that time 23 from his care? 24 A. Um-hum. 25 Q. And obviously the records of Dr. Litton and Central Pennsylvania Court Reporting Services (717) 258-3657 or 800-863-3657 or fastfngers@aol.com 30 '\ 1 also of yourself never reflect the fact that she was 2 recommended to get chiropractic treatment? 3 A. Correct. 4 Q. Now she then returned again to treatment at 5 Sheperdstown Family Practice on August 23rd of 1995 for a 6 work physical. 7 A. Yes. 8 Q. And the results of that work physical were 9 normal. 10 A. Right. 11 Q. And, in fact, the only concern that she had 12 that day, August 23rd, 1995 that she voiced to Dr. Gary ,I 13 Schwartz was a slight sore throat. And I believe that's 14 reflected in the third sentence of Dr. Schwartz's 15 records-- 16 A. Yes. 17 Q. - - that day. Is that correct? 18 A. Yes, urn-hum. 19 Q. Now she then returned back on November 6, 1995 20 and was again seen by Dr. Schwartz, correct? 21 A. Yes. 22 Q. And at that time, she reported that she had 23 fallen two days ago, which would mean November 4, 1995. 24 A. Um-hum, yes. 25 Q. And at that time also, Dr. Schwartz had her -/ Central Pennsylvania Court Reporting Services (717) 258-3657 or 800-863-3657 or fastfngers@aol.com 34 -, 1 A. Yes, that was a significant health issue. 2 Q. And was she returning to work full-time, do you 3 know? 4 A. She was going to be returning to work 5 part-time, two and a half hours a day. 6 Q. And the note indicates she was working with 7 older kids where lifting would not be required. B A. Right. 9 Q. Did you place any restrictions on Ms. Neaus for 10 returning to work in August of 1996? 11 A. No. 12 Q. Why did you not do so? 13 A. I just asked her about that to keep informed of 14 what was going on with her health, and not that I offered 15 any recommendations to her. 16 Q. And just for clarification, your August 19th 17 note indicates a reinjury in April. And in the April note 18 of Dr. Cincotta indicates an exacerbation of back pain. 19 We might be getting a little bit picayune with the 20 wording, but can you explain for me whether there's a 21 difference between reinjury, exacerbation, aggravation? 22 Are there any reasons why those terms were used? 23 A. Well, 1 think exacerbation just means an 24 increase in the level of pain or recurrence of pain and -- , ..../ 25 but it was presumably was due to the injury that she had Central Pennsylvania Court Reporting Services (717) 258-3657 or 800-863-3657 or fastfngers@aol.com 35 '"\ 1 when she was lifting the laundry. 2 Q. When Mr. Sponaugle had asked you about the -- 3 your handwritten note of February 23rd, 1995 -- 4 A. Um-hum. 5 Q. -- he he -- you affirmed that your 6 handwritten note does not indicate an increase in back 7 pain. Do you have any other independent recollection of 8 your telephone conversation with Ms. Neaus from that day 9 that might not be on your handwritten note? 10 A. No, not particularly of that day, no. Is there 11 something in particular you're looking for? 12 Q. No. I - - I just wasn't sure the way you 13 answered the question if there was something else. 14 A. Oh, well, 1 -- I kind of clarified that later 15 on when I said that hip, back and leg are often kind of 16 seen as one unit when they're involved with pain. So the 17 fact that it was labeled as hip pain, I would not say that 18 necessarily excludes that there was pain in her back. 19 Q. And on that letter that Dr. Litton had written 20 to you when he discharged Ms. Neaus from his care, was 21 there any indication that Ms. Neaus was still doing 22 anything for the back pain? 23 A. She was beginning a program of back 24 strengthening exercises and general exercises. , ..--/ 25 Q. Doctor, other than some clarification of your Central Pennsylvania Court Reporting Services (717) 258-3657 or 800-863-3657 or fastfngers@aol.com . , 1 A. 2 Q. 3 A. 4 Q. 37 Right. Just so we are clear -- Urn-hum. -- does not mention any complaint of low back 5 pain, correct? 6 A. It does not mention that. But as I stated 7 that, sometimes hip and low back are all -- and 8 buttocks -- are all considered one unit, so... 9 Q. Okay. And as of the April 19, 1996 notation of 10 Dr. Cincotta, it also mentions that Ms. Neaus does a lot 11 of bending and lifting, according to her history. 12 13 14 15 A. This is April 19th, 1996? Q. Yes. A. Yes. Q. And, finally, the June 20, 1995 letter, which 16 was sent to you by the orthopedic surgeon, Dr. Litton, 17 mentions that in his opinion, he feels that Cheryl Neaus 18 has recovered from her vehicle injury at this time. 19 20 21 22 A. Yes, that is what he said. Q. And that he discharged her at that time. A. Yes. MR. SPONAUGLE: I don't have any other 23 questions. Thank you. , , 24 25 MS. DEITCHMAN: Thank you. (Whereupon, the deposition was concluded at 1154 p.m.) Central Pennsylvania Court Reporting Services (717) 258-3657 or 800-863-3657 or fastfngers@aol.com .) 12 13 14 15 16 17 18 19 20 21 22 23 24 . ../ 25 1 2 COMMONWEALTH OF PENNSYLVANIA SS. 3 COUNTY OF CUMBERLAND 4 5 1, JILL L. ROTH, a Court Reporter-Notary Public 6 authorized to administer oaths and take depositions in the 7 trial of causes, and having an office in Carlisle, 8 Pennsylvania, do hereby certify that the foregoing is the 9 testimony of GEOFFREY M. JAMES, M.D. 10 I further certify that before the taking of 11 said deposition the witness was duly sworn; that the questions and answers were taken down in stenotype by the said Reporter-Notary, approved and agreed to, and afterwards reduced to computer printout under the direction of said Reporter. I further certify that the proceedings and evidence are contained fully and accurately in the notes taken by me on the within deposition, and that this copy is a correct transcript of the same. In testimony whereof, I have hereunto subscribed my hand this 11th day of September, 1998. No"RI" SE" ~ ~ CARUSLE BORtJ~l ROTH: '\. I/Y COI/I//SSIOH ~P/~~:EHRoIJ.HO COUHTY~ lic V. IS 2000 ' My Commission Expires November 13, 2000. Central Pennsylvania Court Reporting Services (717) 258-3657 or 800-863-3657 or fastfngers@aol.com 38 ~ E X H I B I T S . . ... EXHIBIT <t 0'1>-'\8 ::rc..e. OEllVU 10: HOWARD D. KAUFFMAN. ESQUIRE* HARRINGTON, KAUFFMAN & SHILLIN 100 PINE STREET SUITE 300 HARRISBURG . PA 17101 RECOROS OF: CHERYL NEAOS AKA ROHBAUGH RECOROS FRO!: DR JAMES UFERmE: 9740 mom !O: 29347001 .....1 I II I u IIJ I 1-\ I~ .) 1;( Jt.l \ PHYSICAL THERAPIST'S IN! TIAL EVALUATION FOR REFERRING PHYSICIJI.N' S RECORDS To' Geoffrey James MI iel J. DandY, ~T 'she~helastown FamilV pract Pa. Rehab SerVlces 2140 F sher Road lr Road Mechan csburg L 17055 MAR - 9 ~r '~i~Ya86Pa. 17055 Re: Cheryl Neaus Date:03/06/95 PHYSICAL THE VALUATION ..........-.........-........ Date of Onset:02/23/95 Prior Ho~pitalization:From:None To: Physical Therapy Initiated:03/06l95 Date of Referral:03/03/95?Inpatient P.T.No Mental Status or patient:Orientea to person, place, and time. Surqical Proced~res:None TreAtment for:Right Low Back Pain ~~~~~~b:pain in the right low back including the hip with radiat~on down to the r ght knee. Pt. reports pain in this area fOllOWI1g MVA on 02 23/951 ~~: Thus ncluded some gen~le st~~tching, rest, & pain me Ication wit out s g. relief. Pt. presentlY not work1ng. /pain:Constant,iRC. wt.bearingL bending, or lifting actlvities & fluc.bet.2-10 10. Pain dec.mostly while reg~ing in recumb. 80~iti~n. PMH:2 fx.R wrist,fx,/sev.toes. P~ti~~t~::standing post~re is primarily significant for a sharp lumbar lordosis w1th an 1ncreased anterior pelV1c t1lt. Iliac crests are equal as are the PSIS. Trunk range of motion: flexion and extension are within normal limits with some pulling s~nsation over the r1ght hiPiand Into the right buttocks. Rotations are w1thin normal limits. Siae bene ng ~s limited by 20% with increased pain over the light side with right side bendlng. straignt leg raising left 70 degrees 1 mited seconda~ to adaptive shortening of the hamstring, no reproduct on of back pain. R1gh~ limited to 50 degrees secondary to both adaptive shortening or the hamstring and increased pain throughout the right buttocks and SI oInt. Leg length testing revealed no differ~nces or pel~ic Qbliquities. Fa ieut's SI~ioint distraction did not iucrease pain althOugh SI Join~ compression did 1ncreAse pain over the right SI Joint. Palpation to the area revealed S1~~~ficant pain and tenderness over the spinous processes ~~oughout the 1 ar regi~n especially 1n the upper lumbar and lower thoracic ine. Patie~t had multlpl~ areas of pain tQ palpation including the Jllowing~ Right gluteal t1ssues, right 51 JoInt 1nterspace, right lumbar paraspinlls, and right hip tissues. GOALS: Short Term: 1. Decrease patient's complaints of pain between 0-2/10. 2. Restore fUll trunk range of motion without limitation secondary to pain 3. Patient wlll experIence resolution of soft tissue irregularities in the right hip, low back, and buttOcks. 4. Patient be independent with a home exercise program. Long Term: Allow patient to return t~ her prior level of function withoUt restrlctions secondary to pain. Assessment: Patient presents with multiple area~ of soft tissue irregularity, tenderness over the lumbar spine and rIght 51 Jo1nt, some restrict10ns in range of motion, and report of constant yet fluctuatlng pain in that area. Rehab potential w1th1n the goals is gooa. Plan: Modalities of moist heat and ultrasound as needed, manual treatment techniques ~ appropriate, therapeutlc exerClse, home program and education. _..) Frequency: 3x/wk ) Estimated Len}'th of Treatment: 30 days ,/11 "9"'"''' ,.J.: -bdY ;~'4-' V PHYSICAL THERAPIST'S INdIAL EVALUATION FOR REFERRING PHYSICIAN'S RECORDS To: Geoffrey James . aniel J. Dandy, PT Shepher~stown Famj1v prac t 1 Qa. Rehab Services 2140 Fisher Road f i ~r Road Mechanicsburg 1__ 17055 ~c anh,~bur86Pa. 17055 Re: Cheryl Neaus MAR 19 199:11 ) 691-l4 Date:03/06/95 PHYSICAL T I"AL EVALUATION Date of Onset:02/23/95 Prior Ho~p~ar~A~Y6n:~r6m:None To: Physical Therapy Initiated:03/061.95 Date of Referral:03/03/95?Inpatient P.T.No Mental Status ot patient:Oriented to person, place, and time. Surgical Proced~res:None TreAtment for:Right Low Back Pain HistQ~: Pt.24 C:pain in the right low baik including the hip with radiat~on down to the r ght knee. Pt. reports pain n this area followIng MVA on 02 23/95 Rx: Thus ncluded some gentle stretch nq, rest, & pain medIcation wit out slg. relief. Pt. presently not working. /pain:Constant,inc./wt.bearingL bending, or liftin~ act1vities & tluc.bet.2-10 10. Pain dec.mostly while re~~ing in recumb. positi n. PMB:2 fx.R wrist,fx./sev.toes. Obilct ve: P~t ent'~ standing posture is p~imarily significant for a sharp lumbar lordosis wit an increased ahterior pel~ic tilt. Iliac crests are equal as are the PSIS. Trunk range of motion: flexion and extension are within normal limits with some pulling s~nsation over the right hip and into the right buttocks. Rotations are within normal limits. Siae benaing is limited by 20% with increased pain over the right side with right side bending. Straignt leg raising left 70 degrees limIted seconda~ to adaptiveishortening of the hamstring, no reproduction of back pain. Right lim ted to 50 degrees secondary to both adaptive shorten~ng of the hamstrinq and increased pain throughout the riqht buttocks and SI oInt. Leg length testing revealed no differances or pel~ic Qbliquities. Pa ient'~ SI ioint distractIon did not increase pain although SI Join~ compressiQn did increa~e pain over the right SI Joint. Palpation to the area revealed Significant pain and tende~ness over the spinous processes t~roughout the lumbar regi~n especially in the upper lumbar and lower thoracic ~ne. Patient had multIple areas of pain tQ palpation inclUding the ~~llowing: Right gluteal tissues, r gnt SI JOInt interspace, right lumbar paraspinals, and rIght hip tissues. GOALS: Short Term: 1. Decrease patient's complaints ot pain between 0-2/10. 2. Restore ffill trunk range ot mot10fi without limitation secondary to pain 3. Patient w111 e~perlence resolution of soft tissue irregularities in the right hip, low back, and buttOcks. 4. Patient be independent with a home exercise program. Long Term: Allow patient to return to her prior level of function withofit restrictions secondary to pain. Assessment: Patient presents with multiple area1 Qf soft tissue irregularity, tendernes~ over the lumbar spine and rIght SI 01nt, some restrictions in range of motion, anid report of con~tant yet fluctuat ng pain in that area. Rehab potential w thin the goals is gooa. Plan: Modalities of moist heat and ultr~sound as needed, manual treatment techniques . appropriate, therapeutic exercise, home program and education. J Frequency:3x/wk Estimated Length of Treatment:30 days Signature: gJ'.- k) -9- I.~ Da~a~ v '-' . .'.._ ...h~~. ..: . .,' ... ~~-:'I"~";~-;;~:..(4"t.f';'/~ ~",~,':','.q..,.\..-. :'>"',' , .._\ " .;:~;~,,: (:) .~ HOLY SPIRIT HOSPITAL .. ." .DEPARTl1B' or: RADIOLOGY.A/ID DIAGNOSTIC 'Di.. .NG _~HP HILL, PENNSYLVANIA 17011 11, ,I 7&3-2&00 PATI~T, /:EAUS, CHERYL L ...'IfR' 1849&2 SOC S8Cr Z07~~&-1830 ORn .Q~'.! 1iD.'~ROUP .:, ' P!' TYPB,I ~ ADIf DATE 11/0'/J99~O&12'PIf ~9E,"Ti9Y - :'gc;!I' DICTATION DATEI 11/&/9' ,BI12AH .. TRANSCRIPTION DATE JI/O&/I~9' 09.02A~ AilRivAl bAm. HOSP SERviCE I ECU, " . i" - ..---..-.------,-.. ....'................... .,:. . ,'. ...'.- , .. '" '. ?JCAtql!^r::iJi~i' RIGHT HAND :'( 3y 11 RIGHT WRIST r &y " 1UHBOSACRAL SPINE I &y I , ~Q~~N~~I ,~~~~~ ;,o,:~ lsuffered' a'dilli 'rand pr~sents' 'wi th',. palritt9 :'~Gi'e out fra~tur..,';';,...;' ,..e...",.." ,,,,'irc.'~~':';; cf Sl~","..:.l;,;.~~::-, ':~ "";":':""'..;'. ,": ",:",- .L....-:'~,... ;r.,-",." ..:"..,......, .~_.-. _", '.' .',' '... ...,.,.' .'._. ..... ''''_ '.""!"'__' . t i .. ~...... <'\ ...".... ..."',,..,..,,_ ,.". >,.:.., "l:~ ":"'''' _ ...- l....li.. ..... -:ir..ll"l..... I ',,: '~'.,- ;'-.~. ...t' ...........1<. ... _ ,J.,.:.JI1l!!l,l.e',.... "'''''''', ..,..._ , .."" .. ....,'.."., .. ',.. ".. ',' L-;:SPINEI~'Thll ~ver,tpbra :are 'vell',.lnerali ....d .'."'There are no fraotures. "The .. -....... ....., '. .'.. . ...... .... ............, d!~g ~elgl:\~~;!are ~\ieU lllalntalned.- ".Tha SIJciints .are 'normaI. . . '" ,., '-' . .,' .- R HANO:"'The'soft tissues are normal. The bones are wall mlne~allzed. ,I see 'no' ~fractu"es' ....,.~.." ".-" 'i , :.... ,;__ : ';'~;'. ',__.;" "'.. " , .... '-_..::... ~ "-_01::1.. .".. , "~"~"'c"~ ,::..-.!j;,,-:a',.:..... t". :.......-.~. F'!fSTI'The S~-ft'tiss~~-s' a~e norM!. r see no fr~ctu!'es. Th" bones are "''''11 mineralized.' CONCLUSION:'Lumbosacral spine ~ithin normal limits. Disc heights well maintained. 'No fractures. Right hand is within normal limits. No fractures cel1lor.strat~d. . Right 'Yrist negativ3 for fracture. Normal soft tissu~s. f;/-f1-- vt{J- X/I U :~ ,,,J {;h ';i-\:"50 eYr . rs 0... S:IAI1: !),R, e:.:rtf.'n, .Ir., i1,D./dg 11/05/1995 ", " I I / I I I I I I ~. 1,\. I 'j I .' I f I I I r Ii I' I' II II \ '.. : I L , II i I \ , )-21-95 NEAUS. CnERYL L. JR. G. .iA~ES LUMBAR SPINE. 6V: There IS no fracture or Dislocation. The Intersoaces are normal. No bone destruction is oresent. CONCLUSION: NORMAL LUMBOSACRAL SPl~E. ""~",. M.D. EJC/l jo T: 3-21-95 COMMENTS: ~ ------......----- .~!~~~Al ,..) lZQ SOUTH FILBERT STREET MeCHA.NICSBUFlG. PENNSYLVANIA. 110S5-G$9' ;l,AME: SSN : CASE: SO 1\::ClUS. C~gM'''!... L. 21)7-50-1331) 2: 3024(132 5-6-70 RADIOLOGY REPORT FORM f 11113i9Ol CHART COPY PHY~I\jIAI'1 .;) IJV, I F'H(:"3rr:rAtI :\::~I:~~:Tri-rC'ATlarJ or- ::':f(STr::I:~1. T:1F.r;;r~p'i' T;.:~';Ttl::nT ?l.;'rl To:G~offr~r Jam~s H.D. shegherds town Fam i 1)' ac t i ce 214 Fi sh~r Road HechanicsburQ PA 17055 Re:Ch~ryl 'Neaus . Ph/sica] Th~rap/ 1;,1 tl ;te.j:03/06/95 ~~ Dani~l J. D~nd" PT . -, ;.~ p,;. R.:~,;.t ':.;.rl.r:c.;.: 2~ ::0 ;:, .=h-:-r' ::::1:":'.,: rl~,:j, ;;-" ': :::,iJr'~, F'.;.. 1 ?:'S:: r'';::'TE:03/17/95 ':0-:0 F'~I":: '.: 1:';-. F.;i.:rr.:-.i :03/03/'7'5 eo:- ~ ~ Histor'{: Pt.24/CC:pain in th~ right low back including th~ hip wi th radiation down to the right kne~. Pt.reports pain in this area following HVA on 02/23/95. Rx: Thus included some g~ntl~ stretchinQ, rest, & pain m~dlcation without siQ. relief. Pt.presently not workinQ. Pain:Constant,inc./wt.b~arlngl b~ndin~, or lifting activi ties & fluc.b~t.~~10/10. Pain d~c.mostly whil~ resting in r~cumb. position. PHH:2 fx.R wrist,fx./sev.toes. SUMMARY OF TREATt'lENT AtlC' FEHA81LlTATIOtJ '5THT:)S AS, OF: 03/17/95 PF:OGRESS : Cheryl was seen for six visits for complaints of primarily right low back pain. Through the course of care, a variety of treatment techniques and home program ideas were tried. Unfortunately, none w~re able to successfully impact her condition. She is referred back to her physician at which time it was recommended that she discontinue physical therapy. REHAB STATUS: No significant change following two weeks of physical therapy. tl,;)(lt1U~l POTENTIAL :YE':;-x tlC<- It would be r~asonable to ~xpect that if physical therao/ tr~atm~nt w"'s coino to impact Hs. Neaus's condi tion, it would have been achi.'Jed durinc this-tim~ frame. Given her unresponse to treatment, discontinuing h~r from active th~rapy is most appropriate. :-:.~ ctn : D i sch.arge . frequen(_~:9, _ , :.Il;l\b,"=r~ Vi::;. (~. ~:" ,1-:\" .:. : .:;rti-f.. t:-I':O,~ Cheryl Nt?-3.u;. :; url,j~:-' r.-,., ':;:'-? ':'1-,- r:h':'~"&:':e'lt'~~-~L:2D R i Qh t Low Bc..c k P a in: :, _ - -~~;':r : ~ .:' '\ ~ ',-:;-, ;'.::' :: ' 1 "..:~D,'t:':::l ~<" i:~,,:;; ':':C;!O~'.. ,. - :'~:',~::,:r..~;~ ~':~':~>:, ~ '.-:- ; -:r,I-'li.t_i'-,I~ li".t.;'-:,~. ("" j;~ "~;','.' _ ".:_~I-.':.:I'. :..!:_:;'~.j~ ;'~:~:'?':'";:D: '-d:;en.':~,/_ ,,' ~.:'AL<<'_;~ ~,'''',:, "~~~~: ~~'~1 ;:.~; '-',~ "~':';'J~.;' ? ~ - S~o~.fri?Y ~~~i~~~~d ~+~9~~ :~ -~~;t~;~~:Di~charae : ': ; .1 'J:-:. f l:,",;"i':"! : )', , .l",:, ,'J '. ';_ ..;.:r....;:- '1 ';,".' .. ~ 1L~~ , ~1. o. " R/l' PHYSICIAN'S N"lP\-_ CAL THERAPIST'S INLTIAL EVALUATION'~dR ~ING PHYSICI~~'S RECORDS Geo!trey James M ,... iel J. Dar'or, PT sr-~eIQstown Family Praetl Pa. Rehab :rvices 2: 'F shet Road Ul sher Road MeL.onan csburg PA 17055 MAR _ 9~) '9~~Y~86Pa. 17055 : Cheryl Neaus Date:03/06/95 PHYSICAL THE VALUATION --....-----.... .....--.--......- ,Onset:02/23/95 Prior Ho~pitalization:From:None To: Therapy Inltiated:03/06l95 Date of Referral:03/03/95?Inpatient P.T.No tatus oI pat1ent:Orientea to person, place, and time. Procedl)res:None t for:Rigbt Low Baek Pain ':pain in the right low back including the hip with radiatton down to :t knee. Pt.reports pain in this area fOllOWi1g MVA on 02 23/95 Rx: :luded some gentle st~etching, rest, & pa n me Ication wit out slg. Pt.~resentlv not working. /pain:constant,inc. wt.bearingL bending, or actIvities & fluc.bet.4-10 10. Pain dee.mostly while rea~ing in tecumb. l. PMH:2 fx,R wrist,fx./sev.toes. 'e: ~ standing postl)re is p~ima~ily siguificant for a sharp lumbar lordosis increased anterior pel~ic tilt. Iliac crests are equal as are the lnge of motion: flexion and extension are within normal limits with some ~~nsation ove! the right hip and into the right buttocks. Rotations , tin normal Ii ts. Siae benaing ~s limited by 20% with increased pain ! ~ight s de w th right side bend1ng. Straignt leg raising left 70 limited secondarY ~ ~daptive shortening of the hamstring, no :tion of back pain. Right limited to 50 degrees secondary to both ! shorten~ng o~ the hamstrinq and increased pain throughout the right land SI oInt. Leg length testing revealed no differences or pel~ic :ies. ia ient'e 51 ioint distraction did not i~c~ease pain although 51 'm~ress on did incre~se pain over the right SI Joint. palpation to the fe' ~d sig~~ficant pain and tenderness over the spinous processes , 'u. ehe 1 ar region especially in the upper lumbar and lower thoracic Patient had multIple areas of pain tQ palpation including the 19: Right gluteal tissues, rignt S1 JoInt interspace, right lumbar 1als, and right hip tissues. Short Term: 1. Decrease patient's complaints of pain between 0-2/10. 2. Restore full trunk range of mot on without limitation secondary to pain1 3. Patient wIll e~per ence resolution of soft tissue irregularities in the right hip, low back, and buttOcks. 4. Patient be independent with a home exercise program. Long Term: AllOW patient to return to her prior level of function w thout restrictions secondary to pa n. ;Jnt: . presents with multiple area~ of soft tissue irregUlarity, tendernes~ ~ lumbar spine and right 51 JOint, some restrictiOns in range of motion, ~rt of con~tant yet fluctuat1ng pain in that area. Rehab potential the goals is gooa. h -,of moist heat and ultrasound as needed, manual treatment techniques ~ptiate, therapeutic exercise, home program and education. :y: 3x/wk Treatment:30 days ,~ re: / ORDS /06/95 P.T.No n to Rx: ;I. ., or tecumb. ,rdosis 1e ('h some ons 7gain 1 Lght L~ic Igh 51 :0 the ,racic Ir '10 ~1on llII. 10 ese :otion, 1 iques ~1O'" X71''''['L~D.FACS ./' :-tOAiOH H,.\UOCI\.... 0 ,Wl.l.Sl~[J./'ID.FA.CS "'W~Wo.NlTII."'D.FACS OWDwUPPf...""O ..cwtl flAMffI't' 11./'1 0 , NLS.\.5HAw....O IltCH"110 J PAn[A~N_'" 0 JoISONJllnOtl..""O ~ASJ YUCU"",O IllCH....1I0 J llo.-L,,"4.0 St[V[."lB '.lrOlf ."l0 f;jlr.C.Olrr.... H""Il.S,"lD ALOA/'1DER MLL"'Alt... 0 ORTHOPEDIC INSTITUTE OF PENNSYLVANIA TELEPltONE, (717) 761,5530 . 18001834.4020 . FAX, (717)737.7197 March 28, 1995 Geof~te~:,James,. M.D. 2140 Fisher Road Mechanicsburg, PA 17055 Dear Geoff: This morning, March 2~, 1995, I saw Cheryl Neaus #101101 of 6280 Carlisle Pike, Lot #128 in Mechanicsburg in my office. She is a 24-year-old divorced woman, who has a four-year-old child and who has low back pain on the right side and right buttock and right thigh pain. She says that she got a birth control shot in her right buttock several months ago and from that time on had some right buttQck pain, but no radiating pain until she was involved in an automobile accident on the 23rd of February of this year when another vehicle struck her vehicle. As soon as she got out of the car, she had right lower sided back pain, right buttock pain and right thigh pain. She was examined by you, and you placed her on light duty. She worked as a cook. She worked at light duty until her vehicle accident, and after that she was told not to work. She says the job is no longer available. She has been going to physical therapy but that is not helping her at all, nor have anti-inflammatory medications. I examined Cheryl today and found that she had full range of motion in her low back without list or loss of lumbar lordosis. She had no tenderness of her low back or sciatic nerves and she had no pain with straight leg raising. Neurovascular function in her lower extremities was intact. I reviewed her radiographs taken at Seidle Memorial Hospital on March 21, 1995 and saw no significant abnormalities. I feel that Cheryl has a low back strain from her vehicle accident in February and told her my attitude towards low back strain. I want her to increase her activity as her symptoms allow and even if she is uncomfortable that is not a contraindication to increased activity. She is to try to get another job, and I placed on limitations on her job activities. ecr.m.TS: .-) OAlLED' FTLED' Q'*"' u,l{'( t~ -----. l f])rrmr'- - Irl APR 0 IlI1 I" ,: ""-'-:::r-r.::: I.,: .',. :i'\.::l CAMP HILL OFFICE 3916 TRlhDlE R( ADDRESS ALL CORRESPONDENCE TO, 3916 TRINDLE ROAD, CAMP HILL, PA 17011 _!!.-~RRIS8~~.C?FFICE ____ _ .-.!i.ERSUE~ OF!~~._ CA, 3;!l rt 4;r;'~ iJ~IO'i rJLI'O')J:-~;) ";Jlr~ 1 \;"1 (Cl-')\ f. (tIC(l~l.lrE. \', ~ -, , LJate/Vllals Name: CHERYL ROW ,UGH 1 Page '+\.O(~ 'I \... ..u\::- v \ \"\\:- 19 ~yu ~ '0: HEENT-TM's are clear, nose is clear, throat is mildly '...y'loUl\O swollen, neck is supple with no nodes, lungs are clear. UI - C{CC) .c..UoI A: Viral URl. ,~ '-1-2.2.-'13 WT- i 04. 8P' /J()) (pO. S: The pt comes in with 4 day hx of hoarseness, bnd cough and some sore throat. red and P: PUsh fluids, salt water gargles, Robitussin AC 4 oz 1-2 tsp q. i . el. prn. Thyromegaly was detected on exam today with thyroid at least 2 x normal size with no nodules. Will get hypothyroid profile when the pt is well. GMJ/lm S: Nearly 23 y/o here for work physical. She has no complaints at present. She has had no hospitalizations or surgery except for twovaginal deliveries. She had her cholesterol checked last year and it was' said to be okay. She had a tetanus shot in 1988. She sees a gynecologist regularly for pap smears and is taking TriNorinyl. She takes no other meds and has only a questionable allergy to Sulfa where she passed out while taking a shower. She smokes a pack a day and has smoked since 1985. She drinks about six beers per week at most. 0: HEENT is WNL. Neck supple, no adenopathy. Thyroid is slightly enlarged. Recent thyroid tests were normal. Lungs are clear. Heart R no M. Abdomen benign. Extremities; no edema. Peripheral pulses are full. A: Normal physical. P: Physical form signed. Discussed brief message of dealing with fatigue which patient brought up at the end of the exam. GMJ/ekh Ci " G' S: pt ar.cidentally kicked a chair last night and had immediate pain ~~.-\ in her fourth and fifth toes in the left foot. There has been swell ins and bruising overnight. ~t> \ d.o Examination of the ankle is normal with good ROM. No swelling or enderness. Examination of the. fifth metatarsal and dorsum of the foot is also negative with no localized tenderness or swelling. The fourth and fifth toes are ecchymotic and swollen. ROM is limited. Sensation is intact. ...J I: Probable broken toe. P: Instructed on use of ice, elevation and crutches for the next couple of days. The toes were separated with cotton and taped and pt was instructed to keep them taped over the next 2-4 weeks. She was given a note off her aerobic class at HACC for at least two weeks and dependin on the degree of ain and improvement. Return to work slip .' . DatelVilals ..z..-'Z,.. .P3 Name:C~/.' ,/ Z.4 ::.~<O( " ", Page Z- S: pt is here with a hx that over the past several days, she has had problems with sore throat, some upper resp. congestion, postnasal drainage and cough: pt smokes a pack of cigaretets per day. She has been on no meds. for this problem. 0: Ears - canal and TMs are bilaterally neg., throat is minimally injected: nose shows minimal rhinorrhea. Lungs are eTA. A: Acute pharyngitis i2 Smoking P: Have advised on total cessation of smoking .2 Good fluid intake .3 Deconamine-SR, 1 b.i.d. prn congestion i4 Amoxil 250 mg. t.i.d. for 10 days Joseph Cincotta, M.D./cld d..n.q \....St: , l \.0 ,Cc-/q'QO: Pulse 88, BP 100/70. HEENT-TM's bilaterally were normal, with "0' good landmarks and mobility, nose purulent rhinorrhea bilaterally. ~ \(,)0 Throat and mouth, moist mucous membranes, neg. pharyngitis, neck is ~ ~ supple without lymphadenopathy or mass. Heart is RRR, w/o M, lungs "\ 0 CTA,'.:t)iiatera1~y maxillary sinus tenderness t~l:palpation. ~:a-SCt~ ->-..)'=-\~\ \ - '1<6.S Cl:l") \" - 'SC.CD ..-J S: 2-3 day hx of ST, facial pressure, both cough. Has used OTC nasal congestion, posterior nasal drainage, above and below both eyes, mild fatigue, occ medications without relief. A: Acute sinusitis. P: 1. Amoxil 250 mgs #30 1 t.i.d. to complete a 10 day course, side effects reviewed. 2. Increase fluids. 3. Sudafed t.i.d. prn congestion. 4. Recommended d/c of tobacco. 5. To call in 2-3 days if no better or before'if worse. David Wenner, DO/1m S: pt is here with two unrelated complaints. Her first is that over the past two weeks she has had some upper respiratory congestion and a ST, minimal PND. No fever. pt does continue to smoke. pt's second concern is that she slipped and fell onto her right arm yesterday and is having some soreness over the distal arm. She had injured thiys arm earlier in the year and it took several weeks to resolve. 0: Ears: Canals and TMs are negative. Nose is minimally congested. Throat is injected posteriorly. Nodes, no adenopathy. Examination of the patient's right forearm shows some tenderness over the distal radius, some soft tissue swelling. No deformity. 1 Date/Vitals f~ I~. 9<1 -r: 911~ 1'- ~'--' ' ') ?/~;:J./9y WT /3 ~ Itr &d Y.z 13f? 9& /5ft; .-J Name: Cheryl N, .IS Page 3 5/25/94 CONTINUED A: Contusion, right forearm. 12: Pharyngitis and URI, suspect viral in origin. 13: Smoking. P: Advised on discontinuation of smoking. 12: Local measures for ST. 13: Obtain X ray of right wrist area and have advised on ice and ace wrap. Will call patient tomorrow with results of X ray. AC/ekh S: Patient presents with complaints of now about a 6-7 day history of URI consisting initially of a sore throat and some nasal congestion For the last two days she has had somewhat of a cough and her head congestion persists with yellow nasal drainage. She does continue to smoke. 0: HEENT exam is unremarkable. Heart is RRR. Lungs are clear. Neck reveals no adenopathy. . A: 1) Presumed sinusitis. P: 1), Amoxicillin 250 mg per tsp. one tsp. t.i.d. for 10 days and Entex liquid 4 ounces with one refill to take two tsp. q. 6 hours prn nasal congestion. Patient to call or return if her symptoms persist, worsen or do not fully improve. Patient stated at this time that she did not want to quit smoking. GS/lmn ......,.....2 8Ito.t/~., .M . p p 0 ~ t.,I/, .3.' :;lp "1. ,;l .3(,3 - 1.3 ~).vJ S: Patient here for day care physical. She has no health complaints at present and no changes in her health since last physical. Past medical history is unremarkable except for a questionable sulfa allergy. She continues to smoke a pack a day. Tetanus immunizations are up to date. We do not have records of her other immunizations such as MMR. 0: General physical is normal and unchanged from 4/93. A: 1) Normal physical. P: 1) Encouraged patient to get us copies of her other immunizations, PPD applied, physical form filled out and signed. GMJ/lmn '1 ~dte/Vitals /:J' 030 ,9t/ [Ni"'7 /44> / //(O/CJj wrl# r 1f, / (0) -r~ ~(~ ---- Ii "'9~ Name: f.-j,/~~,1.- ~A"" Page '-I S: Patient apparently had a DepoProvera shot ten days ago in the area of the right upper buttock at Polyclinic. Since that time she has had pain in that area. She saw the physicians at Poly three days ago and was told it was a muscle strain, started her on Lodine 400 mg. bid, does not appear to be helping. The patient denies actual knowing about any strain of her back otherwise. 0: upper outer quadrant of the right buttock is tender in a fairly localized spot. Also occasionally seems to radiate up into the lower back. Her ROM of the back is normal but full flexion seems to cause some strain of that area. There is no ecchymoses or redness. She has normal motion of the hip in internal, external rotation, elevation and extension. No lump or nodule is felt in palpation of the tender area. A: upper buttock strain vs. a possible gluteus bursitis possi.bly secondary to the injection vs. muscle strain and back strain on a musculoskeletal basis. P: Continue Lodine 400 mg. bid with food, samples were given. Also encouraged on stretching exercises and moist heat and to call if her symptoms persist, worsen or do not fully improve. GS/lab "th about a one week history of some upper respiratory S: Her~ Wl 1 draina e, cough, no significant fever. congestlon, pOkst nfas~garettesga day and is on Depo-provera for Smokes one pac 0 Cl contraception. tender over the maxillary sinuses bilaterally. 0: Face is miltdedlY Throat is unremarkable. Lungs are clear. Nose is conges . element Of sinusitis complicated by patient's A: l) URI with smoking. P: 1) No smoking. 2) Good fluid intake. 3) Amoxil 250 mg t.i.d. for l? days. 4) sudafed q.i.d. for congestlon: ' 5) Patient asked to call if not lmprovlng. 6) PVU. JAC./lmn 'lteIVilalS ;J- j- 95 It1r /~l' 1-/2- 3/r, , ./ " ~, Name: ()JlI/1"d R. dt~,;/ /. _,_ Page 5 s: Seen here a month ago for pain in her hip. Since then the pain was improving, but after running on the beach she developed a pro- gressive worsening of her pain over the last five days. Localizes pain to the right low lumbar area and Ra~ral area extending down around the buttocks to the upper anterior thigh. Pain worsens with activity. o The patient has diffuse tenderness over the right low back and buttocks are which is mild. ROM"is fairly good although has pain with flexion. SLR is negative. DTR's and strength in the lower extremities are normal. A: Musculoligamentous low back pain. P: Aleve two tablets bid or Lodine fills. Moist heat or ice massage. GJ/lab 400 mg. bid given 20 with two re- Avoid offending activities. S: Here for recheck of back. No significant improvement since last visit. Has good days and bad days. Does get relief temporarily from moist heat for 30-60 minutes and from Aleve. Continues to work as a cook and in child care at a day care center. Has tried to limit her lifting, but still does a lot of bending, twisting and other use of he, back. 0: Mildly tender over right buttocks area. ROM of the back is fairly good with pain at limits of flexion. SLR is mildly postive in the right leg for pain in the right buttocks area. DTR's and strength in the lower extremities are normal. A: Musculoligamentous right buttocks pain. P Stressed importance of rest and asked her to take rest periods for 20-30 minutes every 2-3 hours at work in addition to her 15 Ibs. lift- ing restriction. Also reviewed stretching exercises for low back and buttocks to do once or twice daily. Recheck in three weeks. GJ/lab :En rn t! I- fo cf(j -) J I~ (fo'-Vt\. ~ C(.-6 ,~"- 'y.;.) 3h(9 r - ft.TC ~:~rro..M'~1 ~1I -~/Vilals :,- ~J::\":::l ...:ll::-\'-I~ ~'\\lllt\C,) </I G(T\3"\~ Name: r "'P.~\ ~ '(\er-.\ ""'') , Page ~ () S: In an MVA 8 days ago with worsening pain in her hip, back and leg since then and no improvement since the accident. Unable to tothe exercises because of pain. 0: Tender over rt lower back and buttocks area, some spasm of the rt lumbar paraspinal muscles, straight leg raising is mildly positive for pain in her hip and buttocks, DTR's and strength are normal. A: persistant musculoligamentous strain of buttocks in low back. ~i"fs P: Referred for PT, continue Aleve 1-2 tabs b.i.d. prn , recheck in 2 wks. GMj/lm S: He'i:e for a f/u of back and buttocks pain. No change whatsoever in 2~ weeks. No response to physical therapy. Physical therapist reports that SI joint frequently comes out of place and they have to put it back into place which causes her pain for a day or so. Unable to return to work and has lost her job. 0: Tender over the SI joint a'teas and low back. Right side greater than left. Straight leg raising is mildly positive in the right leg in buttocks and back pain. DTRs and strength are normal. A: Persisting low back pain which is now going on for 3 months. "b-~~.ca ~~\~~ S: Patient here for work physical. She does wear seatbelts. ~~-~:, Had cholesterol checked 1991. Please see yellow and green sheets for other historical data. Only concern is a slight sore throat. ~- \\d.2 . She does feel that she has had the measles, mumps and rubella ~J\~~ booster but we need shot records from Dr. Sam Jones. P: 1) Lumbosacral other suggestions. GJ/scw spine x-ray. Refer to Dr. Dahmus for any I - 0: HEENT exam unremarkable. Negative funduscopic exam. Normal lymph node survey. Carotids 2+. No thyromegaly. Heart regular rate and rhythm without murmur, rubs or gallops. Normal Sl, S2. Lungs are clear. Abdomen benign without masses, tenderness or organomegaly. Skin without suspicious lesions. She does have a dermatofibroma, left upper back region. Extremities without edema. Neurologically intact. A: Normal work phvsical, needs PPD testinQ for that. continued on page 7) .,..11 )le/Vllals Name: Cheryl Neaus 7 Page P: l. PPD today and recheck in 2 days. 2. Recommended use of sunscreen, continued use of seatbelts following healthy low fat, low cholesterol balanced diet and elimination of smoking and to call if there are any problems. Gary Schwartz, M.D./bhm rtt'i' t3f'T-?o (0 n.m) k ~79 ~..? CiS D\ ..c~(\.. ~Io ~K ~"- .,.o.....'..,S "'2-D .:oBID. 'lc.~"'- "'~ - ,I 8-23-95 cont, I i6' rlS,9> r)'l.{c) I.~ t{ \ \ -l,;. .C(':J .....,I .~ 6.9J 1\12...- G31~c..... S: Five to six day history of ST, purulent rhinorrhea, PND, productive cough, positive smoker. No fever, chills, myalgias, or arthralgias. No SOB. Cough worse at night. Using OTC meds w/o relief ... 0: Afebrile. HEENT: TMs normal with Nose w/o rhinorrhea or obstruction. posterior pharynx with soft palate lymphadenopathy or mass. Rapid strep CTA. good landmarks and mobility. Throat and mouth: hyperemic petechia. Neck supple w/o negative. Heart RRR. Lungs A: Acute sinusitis following URI. P: 11: Amoxil 250 mg/5 ml, U50 cc, one tsp t.id.. until completed 10 day course. SER. 12; Histussin HC sample plus Rx for 4 fluid ounces, 2 tsp q 4 hours, prn cough. 13: Increase fluids. 14: Gargle and lozenges prn. 15: Stop smoking. 16: Call if no better in 2-3 days; before if worse. PVU. Dave Wenner, DO/ekh 5: Patient fell two days ago. Was seen at Holy Spirit ER. X-rays of wrist and back were taken which were negative. She continues to have complaints of right arm and wrist pain as well as back pain. Right wrist is tender mainly more proximal to the actual rist joint. Range of motion actively and passively slightly impaired secondary to the pain. No significant swelling. Range f motion of the back is impaired to approximately 10 to 15\ in all directions, but heel walking and toe walking are normal. Low back strain with right arm strain. : l. Use of right wrist splint is recommended for several ays and limit use of right arm for a week. Gradually advance ctivity. Use of Motrin 800 mg. t.i.d. with food .r.n. as e on page lelVitals Name: Chervl Nea"- Page A P: (continued) as well as Norflex 1 b.i.d. p.r.n. Patient has prescriptions and samples. Patient will call me if her symptoms persist, worsen or do not fully improve. Gary Schwartz, M.D./bhm 'b~'" ~\I\ l\Gu.Jer J S: Here with an exacerbation of back pain. Works as a cook at Dauphin County Juvenile Detention Center. Does a lot of bending and lifting according to her history. Yesterday after work she had gone home and had gone out to do her laundry and was bending and lifting with laundry and when she went to get her laundry out of the car, she had onset of some bilateral lower back pain. Pain has continued. It is nonradiating, unassociated with any bowel or bladder disturbance/ no associated paresthesias. ' / 0: Gait is normal. Heel walking, toe walking are normal. Cl~/~UV Squatting is unrestricted. Forward bending is limited at about 30 degrees. Back bending and side bending are unrestricted. Reflexes are +l in the knee jerks and ankle jerks. 11-7-95 cont, 4-IQ'9 ~I CJ(\~ t' 7J... "\ q~()'.' ') A: Recurrent acute mechanical back pain. ~Iq.qlo ,~_13lt I'd .l93'I;) 3lp.lcVllA p'lA ~mw. ....",.1 ...6.,) P: Have reviewed good back mechanics with patient. 2. To stay active as tolerated. 3. Norflex one twice a day as needed for muscle spasm. 4. Ibuprofen 600 mg. four times a day with food. Recheck as needed. Joe Cincotta, M.D./bhm WorK Pt 5: 26 year old here for work physical. Continues to have problems with back pain which she reinjured in April. She has been seeing a chiropractor who did a MRI showing two herniated discs. She is however improving and is going to be going back to work for 2~ hours a day at a daycare center where she is working with older kids where lifting will not be required. Past medical history otherwise ur.remarkable. On BCP. No other medications. Passed out with Sulfa. No other medication allergies. social history - Smokes one pack a day for II years. No drug use. Drinks about 6 beers per week. Exercises by walking 2 miles every other cay. Uses his seatbelt regularly. 0: HEENT is WNL. Neck supple. No adenopathy or thyromegaly. Lungs clear. Heart regular rate. No murmurs or gallops. Abdomen is benign. Back - Fair to good flexibility. Strength in the lower extremities is normal. Extremities otherwise unremarkable. .., 1 I 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 t 24 25 STIPULATION It is hereby stipulated by and between counsel for the respective parties that reading, signing, sealing, certification and filing are hereby waived. MR. MACINTYRE: My name is Douglas MacIntyre, and I represent Video Images, 3004 Black Oak Drive, Red Lion, Pennsylvania. Today's date is September 9th, 199B. The time of day is B:28 A.M. This deposition is being videotaped at 191 Leader Heights Road, York, Pennsylvania. The caption of this case is Cheryl L. Neaus versus Lay Armentrout. The name of the witness is Perry A. Eagle, M.D. This deposition is being videotaped on behalf of the defendant. Counsel will now please introduce themselves. MS. DEITCHMAN: My name is Jennifer Deitchman and I represent the plaintiff, Cheryl Neaus. MR. SPONAUGLE: Good morning. I'm Thomas Sponaugle. I/m here on behalf of the defendant, Lay Armentrout. MR. MACINTYRE: The court reporter will now please identify herself and swear in the witness. MS. FILIUS: My name is Joyce Filius. PERRY A. EAGLE, M.D., called as a witness, II""~:. .\fl' lit", ,... III pou 1'1."(; sU~nCl II."",IJIH~ :",:".!IIdlf.!I l",l. :"':-..qi'h'H.~ 1" ,.,.iIHI.!l1,"J!; 3 '\ 1 2 3 4 5 6 7 B 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 4 being duly sworn, testified as follows: A. I do. DIRECT EXAMINATION (Qualifications) BY MR. SPONAUGLE: Q. Thank you. Good morning, Doctor. A. Good morning. Q. Doctor, I have some questions about your qualifications. Could you please state your name and address for the jury? A. Perry A. Eagle, M. D., 191 Leader Heights Road, York, Pennsylvania. Q. And what is your profession, sir? A. I/m an orthopedic surgeon. Q. And what does an orthopedic surgeon do? A. An orthopedic surgeon is a physician who is trained in the specialty of orthopedic surgery, which is a surgical subdiscipline which deals with the diagnosis and treatment .- and with the word "treatment," I mean with and without surgery -- of problems with bones, joints, their related structures, and problems with the spine. Q. Doctor, let's talk about your education now. Did you obtain a bachelor of science degree? A. Yes. Q. And where was that from? I HUh~, \11' lie" UI .1I0/UI.\,(; S'R\'I(l IImn,I.IU"; -';"'...'lh-flh!1 llOlI. ;';'.,~-4i-/l-H.o; 'IA '.."iIJiJ.,?11-'11!7 ", , 10 11 12 13 14 15 16 17 18 19 20 21 22 23 . 24 25 1 A. 2 Q. 3 A. 4 Q. 5 A. 6 Q. 7 A. 8 Q. 9 A. Q. A. Q. A. Q. A. Q. A. Direct/Sponaugle - Eagle At the University of Maryland. And do you have a medical degree? Yes. And where did you obtain that? The University of Maryland School of Medicine. When did you obtain that medical degree? In 1967. Did you complete an internship? Yes. And where was that? I had one year of internship at the York Hospital following my graduation from medical school. And did you complete a residency in general surgery? I had one year of general surgery residency, also at the York Hospital, followed by one year of fellowship in surgery of the hand, which was performed at the Grace Hospital in Detroit, Michigan. And did you also complete a residency in orthopedic surgery? Yes, I did. Where did you complete that and when? At the Allegheny General Hospital in Pittsburgh, completing that program in 1972. ,""',,,- U,IUChU'I'ORII.\,c;""Ul/t" 1I.1I""'UlIi ~,- !1l>11f.!1 ',I,l ;'1:' \"i..",.. "l '..""HI..!I1-'II!:' 5 . " I 1 2 3 4 5 6 Q. 7 B A. 9 Q. 10 11 A. 12 Q. 13 14 A. 15 Q. 16 A. 17 18 19 Q. 20 21 22 A. 23 Q. 24 A. 25 Q. 1 Direct/Sponaugle - Eagle 7 orthopedic surgery for a specified period of time. Then the physician takes both oral and written examinations administered by the board. And upon successful completion of all of these parameters, the physician is said to be board certified. When did you obtain your board certification in orthopedic surgery? In 1973. And you have been so certified in orthopedic surgery since that date? Yes. Are you also approved by the Workers' Compensation Bureau in anything? Yes. And what is that? As an impairment rating examiner. In other words, to determine by examination any impairment that an injured worker has sustained through injury. And the Bureau of Workers' Compensation, just so we're clear, is through the Commonwealth of Pennsylvania? That is correct. Doctor, do you have any professional memberships? Yes. What are you a member of? ,,, III"'~, .\,., Ul'\S UI PORll\'(; SfUrln ",.rrr"'ru~ :-/:-.,:'If..//t,!l '.lIl. ;"J;'.."~i-h'H.'; ,., '.....fH'.21J.lI1!i -, 1 I 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 1B 19 20 21 22 23 24 25 Direct/Sponaugle - Eagle B A. I'm a member of the American Academy of Orthopedic Surgeons, the Eastern Orthopedic Association, the Pennsylvania Orthopedic Society, the York County Medical Society, the Pennsylvania Medical Society, and the American Medical Association. Q. In addition to your work in -- as a private physician, do you also have any staff appointments at any hospital? A. Yes. Q. Where are you staff-- Where are you on staff? A. I hold an appointment at the York Hospital. I hold an appointment at the Apple Hill Surgical Center. I hold an appointment at HealthSouth, which is the Rehabilitation Hospital of York. And I hold an appointment as an assistant clinical professor of orthopedic surgery at the Pennsylvania State College of Medicine at Hershey. Q. Are you licensed to practice medicine? A. Yes, I am. Q. Where do you hold a license to practice medicine? A. In the states of Pennsylvania and Maryland. Q. And you've been a licensed practitioner in Pennsylvania since 1968? A. That's correct. Q. Have you, during this time period that you've been , lUll.. ~~\'dllC\S U1POUTI.\'(; SUB'te,. lI.'II..f'JlIg:"I;'..:'lI.-IIt,lI \",1. :"1;'-.'i-li./>-IIS ".\ 1.1.'Hj.!11-'H2i ') 1 2 3 A. 4 Q. 5 A. 6 7 Q. 8 9 A. 10 Q. 11 A. 12 13 14 15 Q. 16 17 A. lB Q. 19 A. 20 Q. 21 A. 22 Q. 23 24 25 Direct/Sponaugle - Eagle 9 a practicing physician, have you earned any honors or awards? Yes. What have you been honored or awarded with? Continuing education certificates for, basically, keeping up with things. Have you also obtained a physician recognition award from the American Medical Association? Yes. How many times have you won that? It's a matter of-- If I may correct or choose a different word, not winning, it's qualifying for it. And basically, every three years since I've been in practice. Thank you. Doctor, have you treated patients before with lumbar sprains? Yes. And also with herniated discs? Yes. And with ruptured discs? Yes. Have you been tested-- Or have you qualified before to testify in the Courts of the Commonwealth of Pennsylvania as an expert in orthopedics and orthopedic surgery? III HI'" t. .\11 'lIL\S Ull'oun.\'(; SI.R\'ICI. "'''fI~'''''.~ :'1;'-!l!l-f/f,!l \",4, ;-I;'.lrj.,i.t>."."l ",\ '-.'';/UJ-2JJ.lJl!7 c~ 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 Cross/Deitchman - Eagle 12 Q. Do you refer patients out for chiropractic treatments, similar to your referral for physic~l therapy? A. I have in the past. Yes, I have. Q. I have no other questions. DIRECT EXAMINATION BY MR. SPONAUGLE: Q. Doctor, have you testified before on behalf of plaintiffs? A. Yes. Q. Have you testified before on behalf of defendants? A. Yes. Q. Have you completed an independent medical evaluation in this case? A. Yes, I have. Q. And when you give an independent medical evaluation, you've also given second opinions and trial testimony before? A. Yes. Q. And have you been compensated for your independent medical evaluation in the past? A. Yes. Q. And I take it, you're going to be compensated for the independent medical evaluation that you're giving in this case, aleo? '"11''''' \1./111 ,...I\/,'II/U"l, "'011' /I,l''''/''''\ ,'Jr. IIh'l \..,~ ",.. \"1'''' 1'1' "IHllll'II.'~ ..... 1 , 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 1B 19 20 21 22 23 24 25 Direct/Sponaugle . Eagle 15 Q. Would that be June 16th of 1998? A. I'm checking the record because there seems to be a typographical error. June 17th, according to my chart. There is a typographical error stating June 16th. Q. And did you complete a report? A. Yes, I did. Q. And that report was your independent medical evaluation of the plaintiff? A. That is correct. (Eagle Deposition Exhibit #2 marked for identification) Q. And we had previously marked your report as Deposition Exhibit Number 2. Is that your independent medical evaluation report on the plaintiff? A. Yes, it is. Q. Doctor, let's talk about the injuries that Ms. Neaus is claiming occurred from a February 23rd, 1995 motor vehicle accident. Ms. Neaus was not treated at the scene where the accident occurred? A. According to her history, she was not, but was seen in follow-up by her family doctor the following day. Q. OK. I believe that she did not go to the hospital 11111I";, .\1&1 lie \'i IU l'OlHISt; SI U\'hT 11.'"1'/"">': -:-':"-! Ij../It.!1 l..,1.. ;"I;,\"i.h.n~ 1'.\ 1-.~'IH'.!1J,"1!7 --., I 1 2 A. 3 Q. 4 A. 5 Q. 6 7 A. B Q. 9 A. 10 Q. 11 12 13 A. 14 Q. 15 16 A. 17 1B 19 20 21 22 23 24 25 ) Direct/sponaugle - Eagle 17 lumbar spine? That is correct. And what result were the x-rays? In a nutshell, they were normal. And the x-rays of Ms. Neaus taken in November of 1995 were also of her lumbar spine? That is correct. And what was the result of those X-rays? Again, they were normal. Now, Doctor, you mentioned that you also took x-rays of her when you saw her in your office. Is that correct? That is correct. Why did you take x-rays of her when she was in your office? x-rays were taken at that time so that I would have current x-rays to evaluate. In other words, I interviewed the patient, I performed a physical examination of the patient, allan that date, and I wanted x-rays to correlate with her answers and her physical examination on that date. In addition, current X-rays, and that is, x-rays taken almost three years after the accident, could be used to see if there was any progression, if there was any long-term consequence from the ,,, lII'l' ,\II Itlt.".''; UJI'OWrJ.\'(; sun'leI: JlM"..I'urg :'T'-!lh-III.!1 \lIt~ 7"7-....jj-to..,,'i ".\ '....11lI.!H.ljl!7 Direct/Sponaugle - Eagle " 1 2 3 Q. 4 5 6 A. 7 Q. B 9 A. 10 11 12 13 14 15 16 17 1B 19 20 21 22 23 24 25 accident, comparing those films to the ones taken closer to the accident. And, Doctor, the X-rays that you took of Ms. Neaus in June of 199B, what were those X-rays taken of, what body part? The lumbar spine, the low back. And in your opinion, what was the result of those X-rays? Basically, those X-rays were normal. We look for lots of different things. We look for the bones to see if the bones are normal. Do they have any cysts in them. Do they have any evidence of an ) old fracture or healing process. Are there any calcium deposits, are there any bone spurs, are the discs well maintained or are they narrowed and worn out, are there signs of arthritis, et cetera. Are there signs of anything being out of place, the bones not lined up correctly. Are there any congenital or developmental problems in the spine which may affect the spine's response to injury. So we look at current X-rays with lots of things in mind, basically to gain more useful information. As stated before, the X-ray that I took, I believe I stated before, in my office were normal. 1/1 illS" "01 /lc.-IS RII'ORlI,\'G SlRl'ln' t1,nTl'f1In-.: ;'J;'.!II.-flt.!1 l.lt/" ;'/;'.,'i"i-M'.'i I'.' ,.,Ij(HI.211.1J127 1B J r \ 1 1 2 3 4 5 6 7 B 9 10 11 12 13 14 15 16 17 1B 19 20 21 22 23 24 25 Direct/Sponaugle - Eagle 19 All of these things were normal. There was no evidence of anything being out of place, no evidence of a fracture, no evidence of narrowed discs, no evidence of arthritis, no evidence of a developmental problem. Q. Doctor, before we again move on to Dr. Litton, who is another orthopod, you had mentioned that you had reviewed the records of Dr. James which were provided to you. Correct? A. Correct. (Eagle Deposition Exhibit #3 marked for identification) Q. And we had previously marked these as Deposition Exhibit Number 3. And I'd just ask you to identify these. These are the records provided by Dr. James? A. Yes. Q. Now, Doctor, you mentioned that, or I mentioned to you that the accident was February 23rd of 1995. Correct? A. Correct. Q. Doctor, if you would look at the notation for February 23rd, 1995, I believe that's Dr. James's handwriting, or I will represent to you that it is, is there an indication that Ms. Neaus called ,,, III...,'. \lIIIIC "HI PON 11.\'(; Sf '~\'ICl "'llll./"U,,:-/:'-!II,O"!1 \.,,1. ;'T:"";-I.-n... ".\ '.,'WII..!ll.'l1,!:- '\ 1 2 A. 3 Q. 4 5 A. 6 7 8 9 Q. 10 A. 11 Q. 12 13 14 15 16 A. 17 Q. 18 A. 19 20 21 22 23 24 25 Direct/Sponaugle - Eagle 20 in to Dr. James's practice? There is a notation on 2-23-95. And does it mention anything with regard to any pain that she was having? It states "In MVA, " motor vehicle accident, "today." And then there is an arrow going transversely and an arrow going up, meaning increased hip pain. Hip pain? Hip pain. Now, Doctor, you had mentioned that Ms. Neaus gave you a medical history that she had seen her family doctor, Dr. James, the day after the accident. I want to show you what is the next notation in Dr. James's records. Is there a date on there? Yes. What date is that? 3-3, March 3rd, 1995. MS. DEITCHMAN: I'd like to note an objection on the record that -- to this line of questioning. If it's going to continue to be a transmittal of Dr. James' records based upon hearsay transmittal objection. MR. SPONAUGLE: OK. Just so I'm clear, your objection is to further questions on Dr. James's , lilt,., t. .\1, I fie,.. uU1oun.\'(; "'"0'leI "'''"~''IH, :-1:'.:11.-11,,:1 \",,, ~';'."i-li'I..n" '" ,-,,'IHI.!I1,"l!7' ..... I 1 2 3 Direct/Sponaugle - Eagle records? MS. DEITCHMAN: Yes. MR. SPONAUGLE: I don't have any further 4 questions on that, on Dr. James's records, 5 actually. 6 BY MR. SPONAUGLE: 7 Q. B 9 A. 10 Q. 11 12 A. 13 Q. 14 15 16 A. 17 18 Q. 19 20 21 A. 22 Q. 23 24 A. 25 Q. Now, Doctor, we also mentioned that Ms. Neaus saw Dr. Joseph Litton, or Dr. Jason Litton. Correct? Correct. And she saw -- first saw Dr. Litton on March 23rd, of 1995. Is that correct? I believe so. I'm going to show you Dr. Litton's record from March 23rd of 1995. What is-- Where is Dr. Litton employed? The letterhead is Orthopedic Institute of Pennsylvania. And, Doctor, she saw Dr. Litton on March 23rd of 1995 and then saw him on June 15th of 1995. Is that correct? That is correct. And at that time, did Dr. Litton discharge her from his care? Yes. And, Doctor, when a medical provider discharges a 1/1 /II.' /.\1" /lCIS 1III'OIlT/.'\G SIIIIK/ "',,,,~I'lIlg ;'I;-..!II..fh.l1 \",l ;'1;'-,'iH.tJ,HS 1'.\ '.~(H'..211.~l!7 21 -.... 1 , 2 3 4 5 6 7 B 9 10 11 12 13 14 15 16 17 1B 19 20 21 22 23 24 25 Direct/Sponaugle - Eagle 22 patient from his medical care, what does that what significance is that? A. The significance is as documented in Dr. Litton's note, stating that she has been completely relieved of her low back-- MS. DEITCHMAN: Objection. Hearsay. MR. SPONAUGLE: Dr. Eagle has already testified that he relies on records provided by other medical providers in forming his diagnosis and also in his treatment plans or his prognosis of the patient. So I believe that they are admissible and that he can comment upon the records that he is reviewing in terms of completing his report and evaluation of Ms. Neaus in this case. BY MR. SPONAUGLE: Q. Doctor, please go on. A. It states further on that, "When I examined her today, I found no significant abnormalities. I feel that Cheryl has recovered from her vehicle injury at this time and have discharged her for this problem." And that simply means that the patient has done well, the patient is not having problems, so the doctor/patient relationship is terminated for 111111' /.\1, I Ill' IS RII'ORn."'; SUlI'll"!: II.II,,~I"H": :-,:'.!ltdh.!l \ lirA. :-';-....~i.f>-IJ,... 1',\ f.,"'HI.1Jl-'H2i " 1 2 3 A. 4 5 Q. 6 7 A. 8 Q. 9 A. 10 11 12 13 14 15 16 17 1B 19 20 21 22 23 24 25 Direct/Sponaugle - Eagle 24 that she has been completely relieved of her low back pain as of June of 1995? That sentence is contained in, in part, in the body of that letter. OK. Doctor, there was also an MRI taken of Ms. Neaus's lumbar spine. Is that correct? That is correct. And, Doctor, what is an MRI? An MRI is a special test which is used to see internal parts of the body. You're all familiar with X-rays. X-rays basically show bones. They do not show in any detail the soft tissues. An MRI is a technique whereby the part of the body being examined, for example, the lumbar spine, is magnetized by a tremendously strong magnet. The cells that make up different parts of the body are influenced, partially magnetized. And the degrees of magnetizations of the different cells of the different types of bodily tissue, like discs, like nerve, like soft tissue, are fed into a computer and a picture of the inside of the body is drawn in that fashion and can depict, for example, reproductions of the exact anatomy of various structures, such as the discs, such as the nerves, and their relationship to one another, Obviously, IlIlIh I. \Jlllh '" W l'oU II\c; ";1 U\'It'I II.,,,,,III"~ ~I- _'1ldl/.!1 \,',k :-I7'./;I>n.. I" ,-,../III-ln-'J1.!;" ..... 1 I 2 3 4 5 6 7 B 9 10 Q. 11 12 A. 13 Q. 14 15 A. 16 17 1B Q. 19 20 A. 21 Q. 22 23 24 A, 25 Q. Direct/Sponaugle - Eagle 25 we all have discs and we all have nerves. And we use this to get an idea of what's happening and we use this to correlate with the clinical picture, with the history and what the patient tells you. It's an excellent test. Like all tests, it's not a hundred percent. Like all tests, it has some variation. And like all tests, it is to be taken into account with the clinical presentation. Doctor, Ms. Neaus underwent an MRI on April 25 of 1996? That is correct. And, Doctor, an MRI generates a film, as you would -- for lack of a better word? It is-- The image is recorded on a film, which looks grossly the same as a big piece of X-ray film. OK. And did you personally review the MRI films from April 25, 1996 of Ms. Neaus? Yes, I did. And after your personal review of those MRI films, what opinion do you have as to any injury that may have been seen on the MRI film? You asked two questions in that one question. Sorry. 11I1lI'l' "tllll "UII'OfUI\(;"'U\HI ",,,.,,1.,,,,, -,- ,':" 1I1l.' I \,.,~ -'7' ..,., hll.. "\ I-"HI .:'11 'II!;' Direct/Sponaugle - Eagle 26 , 1 A. I 2 3 4 5 6 7 B 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 I have an opinion as to the findings on the MRI film, but they essentially are not traumatically induced injuries, OK, from, for example, an accident in question. First of all, the attention is made to the discs. The discs in the low back separate the bones: Bone, disc, bone, disc, bone, disc. And the bones are hooked together in the back and the bones form a round protective fortress for the spine to live in. And then there are holes in the bony fortress which allow the nerves to come out of the spine and go where they go, for example, in the lower extremities. And as you can see, the bones and the discs have a relationship to the spine and the nerves. So we look to see the relationship of the discs to the spine and the nerves. A disc has a profile. It's like a tire. If you look at a tire straight on, the edges are not sharp; they have a contour, just like your cheek has a contour. So there are various degrees of curvature or contour or profile in a tire, for example, that a disc has. And sometimes these discs can be less of a profile or more of a profile, which can be described as a bulge. It's ,,, II" t~ \11' lie ''''0 P(lU 11.\'(; ...., unn "'lIl1~/!lU, ~r !Jldl/1!1 \ml.. ~1;--q;'I,.J" ,., '."HJ-!Jl.'IJ.!;" Direct/Sponaugle - Eagle 27 '\ 1 2 3 4 5 6 7 B 9 10 11 12 13 14 15 16 17 1B 19 20 21 22 23 24 25 just the anatomic configuration of the disc. Does a bulging disc mean anything? No, not really. Because a bulging disc by definition just bulges out and it does not impinge or press upon the spine or the nerve. And that's the most important thing. If you have a problem with a disc being ruptured, that disc will put pressure on the nerve, irritate the nerve, and cause pain and/or numbness in the distribution of that nerve, for example, down the leg, sciatica, and can cause the muscles that that nerve normally works not to work well, weakness in the muscles supplied by that particular nerve. A partial paralysis, if you will. So the MRI shows these structures and it shows these structures in relationship to another -- the other. In other words, besides showing the disc, besides showing the spine, besides showing the nerve, are these relationships normal. Is there any pressure on the spine or on the nerve from the disc. And with that background, reviewing the MRI showed some mild bulging at the L4-5 and L5-S1 disc, which is a normal finding. If I took a , lilli' /. .\1,' 1/,." IUPOIIn",; S/'I!\'/<T 1I.""'''llr.,\ ;"1;".1 II../II.! 1 \,,," ;'l;"-,"i.Ji-,..".'i ", '.,'lIHI.!1I.QI!7 Direct/Sponaugle - Eagle 2B \ 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 1B 19 20 21 22 23 24 25 hundred people off of the street and did an MRI on them, most of them would have a bulging disc configuration. There was no evidence of spinal cord or nerve impingement. That means that the discs did not abut up against the spine. That's normal. The discs did not abut up against the nerve. That's normal. And there was no sign, therefore, of a pinched nerve or a ruptured disc causing pressure upon the nerve or the spine. In addition, there was no evidence of what we call spinal stenosis. And that simply means that the spine lives in this little fortress created by the bone. Sometimes the diameter or the configuration of that fortress can be compromised by, for example, bone spurs that may stick backward or some acquired -- a disease process, such as arthritis, which can actually put pressure on the spine. So that's a pertinent, what we call, negative. So, basically, there was no evidence on the MRI of pressure upon the spinal cord or upon the nerve root. And again the most -- a secondary important thing is that the findings on that MRI must be correlated with the physical examination, with the history, with the findings that are present upon IIIHh ~~ ,\1.-1 UC.\S IU PO/U/.\'(; ~nH'h'l H.11I1~I"nx ~,.;-.~ l/l.lIk:! I 1 Ot.l.. ;";--,"~i.MJ."i " \ ,.,,'fUj..!I1"'l:!;" Direct/Sponaugle - Eagle 29 1 1 2 3 4 5 6 7 B 9 10 11 12 13 14 15 16 17 1B 19 20 21 22 23 24 25 physical examination. Why? Because an MRI is not a hundred percent. It's a great test. It has false positives and false negatives. A false positive means, for example, that it may show something, may show some pressure upon the nerve, but it doesn't correlate with the physical examination. For example, nerves go to different areas of the body. If one is suspicious enough to get an MRI, for example, I've seen MRIs that look like there's pressure on a nerve, but it's the wrong nerve and, indeed, sometimes it's on the wrong side of the body. So you say, gee, the patient has left leg pain in the distribution of the last nerve down, and the MRI looks like it has a ruptured disc putting pressure on the nerve that does not go to that distribution on the opposite side. So you correlate that, and it means that this doesn't mean very much. A false negative means that the MRI looks fine, but the patient still has evidence of a pinched nerve by clinical examination; for example, pain along the distribution of the nerve, an absent reflex and a weakened muscle, which makes you be suspicious. So it's to be taken into account with the findings on physical examination, I" I(I~ l. .\tel ue\s III I'fJU 11.\'(; SI unCI I/,,,,,.I'Ul,\ ~,;'-!II'.IIl,.:'1 \1I11.. :-':-.\~j.h4J' ,., '.MHI-.:'11.'n.:';" -, 1 I 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 1B 19 20 21 22 23 24 25 Direct/Sponaugle - Eagle 30 Q. Doctor, I want to ask you a question about your physical examination of the plaintiff, but first, did you review the report of the doctor who actually performed the MRI on April 25, 1996? A. Yes, I did. Q. And are your findings consistent with that MRI report? A. Yes, there is. He described some other things, went into a little more detail with some questions that he posed in his report. He reported that there was an L5-S1 central disc protrusion suspicious for a disc herniation, not diagnostic, but suspicious, which is fine, because sometimes things are shades of gray and not all black and white. But what you have to do is correlate this with the patient's history and the patient's physical examination. Q. What did your physical examination of the plaintiff consist of? A. It consisted of a group of standard testing, range of motion of the back, testing the reflexes, testing the muscle strength, testing the sensation, checking for signs of nerve root irritation, checking for areas of specific tenderness, et cetera. , lUll.. ~.\rtlIlC. \s unl( tun,\'{; sun'".,. "",",I',no,: 7/:--!1/.-flh!1 \0111. 71;'..'i.n.h-II,~ 1'_' '.....'HI.!11.tJl.!7 1 1 2 3 4 5 6 7 B 9 10 11 12 13 14 15 16 17 1B 19 20 21 22 23 24 25 Direct/Sponaugle - Eagle 31 Q. And, Doctor, based upon your physical examination, your medical history that you were provided by the plaintiff, and the medical records and reports that you were given, did you form a diagnosis of the injury that Ms. Neaus sustained in this motor vehicle accident? A. Yes, I did. Q. And what diagnosis was that? A. It was my impression that the patient may have sustained a lumbar sprain, that is, some stretched ligaments and stretched muscles in her low back. There was no clinical evidence, that means by examination, of a ruptured disc. And there was no imaging evidence, that means by the MRI study, of a ruptured or herniated disc. Ruptured disc and herniated disc mean the same thing. Q. Doctor, what do we mean by using the term objective findings? A. An objective finding is something that the doctor can see for himself, which does not require the interpretation by the patient. For example, interpretation of an MRI, the patient does not put his or her input into that. The testing of reflexes, the patient does not put input into that. It's a reflex. It happens by itself in nUllS h .\lff He\S UU'OUH"(; SUH1ln lI..m,II"r~ ;-/;-.! I".II,,~ I rllt/" 7'1;"-.Q;-h.J'ii 1',\ I-SIHI.211.111!7 1 1 2 3 4 5 6 7 8 9 10 11 12 Q. 13 14 A. 15 Q. 16 A. 17 18 19 Q. 20 21 22 23 A. 24 Q. 25 A. Direct/Sponaugle - Eagle 32 response to the stimulus of checking the reflex. Testing muscles for weakness. If a patient cooperates, this is a good objective finding. An objective finding is something that the doctor or the health care practitioner can see for himself, which does not require the interpretation of the patient. This is opposed to a subjective finding or complaint, which requires only the interpretation of the patient. For example, I have pain. That's something that a patient tells you, but you cannot see or measure. Doctor, did you form a diagnosis of the current condition of the plaintiff? Yes. And what was that? Basically, that she had continuing symptoms on a subjective basis without any confirmatory objective findings. Now, Doctor, in your opinion, did the injury that she received in this motor vehicle accident prevent her from returning to work as a cook or as a teachers aide? No. Why not? Because there were no findings on physical /1/1l1S" ,lid IILIS 11I/'0/11/,\',; Sf/IIKI H./Ir/'''JH1: ;'/;'.11t>.fH.!l \..,4 717-!Qj.MIS ,,\ '.,'ifHJ-211-"J.!:- ~ 1 2 3 4 Q. 5 6 7 B 9 A. 10 Q. 11 12 13 A. 14 Q. 15 16 17 18 A. 19 Q. 20 21 A. 22 Q. 23 A. 24 25 Q. Direct/Sponaugle - Eagle 33 examination or on imaging studies or X-rays or MRI that would dictate any limitations or any restrictions. Now, Doctor, I'm going to represent to you that she has a child who I believe is approximately six years old. Would the injury that she received in this motor vehicle accident prevent her from enjoying activities with her child? No, not in my opinion. And in your opinion, would this injury that she received in the motor vehicle accident prevent her from participating in any recreational activities? No, not in my opinion. Doctor, is it your opinion or-- I'm sorry. In your opinion, did the injury in the motor vehicle accident prevent -- have her sustain an impairment of any body function? Not at the time she was examined by me. OK. And in your opinion, is she incapable of caring for herself? I'm sorry. Is she incapable? Yes. No, she is not incapable, meaning that she is capable of caring for herself. I'm sorry for the word phrase there. III ""I. \f,' 11('" Ul/'flHll\'(; SI U\'ICI "''''''''IlI'': ;'/;'.!Ih 11f,!1 \."i, ;T"..'iH.,,"'.'\ ,'t '.MH/.nl.tH!:" (I 1 A. 2 Q. 3 4 A. 5 Q. 6 7 A. B Q. 9 10 A. 11 Q. 12 13 14 15 A. 16 17 1B 19 20 21 22 23 24 25 Direct/sponaugle - Eagle 35 No. Has she ever received surgery for the injury that she received in this accident? No. Is surgery recommended at this point, in your opinion? No. Is surgery anticipated at any time in the future for the injury that she received in this accident? No. Now, Doctor, following the motor vehicle accident, what was the length of time which you would -- which, in your opinion, she would need or have a need __ I'm sorry -- have a need for treatment? Well, it depends upon the severity of any injury incurred. At most, I feel this patient may have sustained a strain or a sprain, stretched ligaments and muscles. We've all had similar episodes lifting things, working in the garden, doing activities that we are not accustomed to, minor falls, et cetera. A mild sprain or stretched ligaments in the low back may improve in a week or two or three. More severe may take longer. The most severe sprain or strain would take 6 to 12 months to reach maximal improvement. filiUS t:" .\rd.UC:\S u.[I'(Hnl~'(; S['~\'ICl: /I"rmf",rg 71;".;!lh-lIb!1 Yllrk ;"'7.....Ii.tW'S ":\ '~SlXI.21J.1n27 ") 1 2 3 4 5 6 7 B 9 10 11 12 13 14 15 16 17 1B 19 20 21 22 23 24 25 Direct/Sponaugle - Eagle 36 Basically, the things that we do are designed to try and make it more tolerable for the patient. There is no scientific evidence that anything we do is curative in the way of therapy or heat or massage, but we all do it to some degree because it feels better and it may help. For example, there is some evidence to show that certain types of therapy in the first three weeks may decrease a patient's discomfort. But basically, it takes time and the amount of time can correlate with the severity of the injury. Q. Doctor, in your opinion, did Ms. Neaus receive any permanent injuries due to this motor vehicle accident? A. No, not on an objective basis. Q. Did Ms. Neaus, in your opinion, receive or-- Strike that. Doctor, in your opinion, has Ms. Neaus received or is in a state of permanent disability for any injuries received in this accident? A. No. Q. Now, Doctor, you also reviewed the records that we sent you of Dr. Danyo's examination of Ms. Neaus. Correct? A. That's correct. 1/1 illS /. .\1, I /lCIS IlU'O/Il/.W; SUlI'/n: II.nn""IH,>: 7,7.!1/l.lIf.!1 lilt/.. :-r;"-,"4'i.t~J"i P.-' '-,"'HI.21l,'H!7 " , 1 Q. 2 3 4 5 A. 6 Q. 7 8 A. 9 Q. 10 11 12 A. 13 Q. 14 15 16 17 A. 1B Q. 19 A. 20 21 22 23 24 25 ,I Direct/Sponaugle - Eagle 37 And, Doctor, I'm going to represent to you that Dr. Danyo did not prescribe any medication to Ms. Neaus. Is that consistent with what you've -- in your opinion? Yes. That she does not need any medication at this time? That is correct. And Dr. Danyo also, I'm going to represent to you, did not recommend any surgery in this case. And that's consistent with your opinion? Yes, it is. Doctor, Dr. Danyo apparently formed an opinion that Ms. Neaus may have received a ruptured disc of the L5-S1 region in her spine. Is that-- Do you agree with that opinion? No, I do not. And why not? First of all, most importantly, her history and physical examination are not consistent with that diagnosis. Neither is, in my opinion, the MRI. There was no evidence that the disc at L5-S1, either by clinical examination or by the MRI, was pressing upon the nerve root, which if indeed it did press upon it, would cause sciatic symptoms I" Ill"; ly \fd Ill',", IU I'OR n,'(; SfU\'ICI 1I,"t1~I"m.: :-,-:'.!lh-llh!1 \1111. ;or;.,.,..,.."" p,' '.,"i'IHI.!11.lJl!;" --, 1 2 3 4 5 6 7 B 9 10 11 12 13 14 15 16 17 1B 19 20 21 22 23 24 25 Direct/Sponaugle - Eagle 3B and positive findings. This just did not happen. Q. And again, Doctor, you personally reviewed the MRI film. Correct? A. Yes, I did. Q. Doctor, we also sent you records from Dr. Renyo, who is a chiropractor. Correct? A. Correct. Q. And, Doctor, Dr. Renyo has mentioned a term of such as physical modalities. What does that mean? A. That simply means treatment options, which include things such as heat, cold, ultrasound, massage, manipulation, things that generally you might think of as being performed by a physical therapist or some kind of hands-on therapist. Q. And are these-- Have these physical modalities been proven by scientifically controlled studies to be effective? A. Certain of them have been studied and suggest that patients who have acute pain from, for example, a lumbar strain, their pain may be benefited or partially alleved by some of these modalities in the first three to four weeks after an injury, but after that period of time, there is no change in those patients who receive these modalities as opposed to those patients who receive no 'II.W"'l.\k'lIl'.\S UI P(JUn.,',; S'-U\'lCl lI,rrrl~IIIH"; :-, ;-.~ III-II"! I \ ,.rl., ;', ;'..'in.h-'I,'i " \ '.,Ii/HI.,! ll.lI1!;' Direct/Sponaugle - Eagle 39 1 treatment. 2 Q. Doctor, I'm going to represent to you that Dr. . i ! 3 Renyo has stated that the physical evaluation that 4 you completed of Ms. Neaus, that you were guessing 5 in coming up with the results of your physical 6 evaluation. How would you respond to that? 7 A. Oh, there's several ways to respond to that. B First of all, with all due respect, Dr. Renyo is 9 not an orthopedic surgery and is not qualified to 10 be -- to make, render orthopedic opinions. 11 Secondly, I as an orthopedic surgery who take 12 care of injured people all day long and am asked 13 as a part of, literally, every patient I see to 14 judge, based on their findings, their history, 15 their examination, their tests, their 16 capabilities, can I work with this, should I work, 17 what should I do, what should I not do. So that 1B is part and parcel of what I do every day. 19 The physical capacities or capabilities sheet 20 which I completed is something which I do multiple 21 times each day. Some employers, some 22 rehabilitation concerns, some other people ask 23 that that be filled out. It is a general 24 guideline, based on my examination of the patient, 25 a general guideline as to what they can and cannot ,,, lib l. \Id UC.\~ UU10IU/.\'(; ...[unCl lIolm'/',,,... ;'':'.~lh,''to~l \,1'" ;'1;'-....Il-t>~J,\1I.-' 1-"'III'.~I1'''I!;- ..... 1 I 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 1B 19 20 21 22 23 24 25 Direct/Sponaugle - Eagle 40 do, taking into consideration in this case the " ~ patient's subjective complaints; in other words, ,0 what she told me, what discomfort she was telling me. In this particular instance, that form was not completed or, excuse me, there were no restrictions based on any objective complaints. So, giving the patient the benefit of the doubt and doing what I do every day and that I've been trained to do, I completed that physical ~ I r capacities evaluation form. Q. And, Doctor, let's spend a couple minutes on your physical capacities evaluation form that you completed in this case. You mentioned that in an eight-hour workday, the claimant can -- and by "claimant," that would be Ms. Neaus -- can sit and stand and walk for a total number of hours at one time. How many hours at one time can she sit? A. Two. Q. And how many hours can she stand at one time? A. Four. Q. And walk at one time? A. Three. Q. Now, during a total, during an entire eight-hour day, can she sit, stand and walk for eight hours? A. Yes. 111111> /. ,lId.IILIS RU'OIU/,W; S[RI'/C/: lI.,rrI,/,"rg ;"';",.~1".fl"11 y,,,,, ;',;-....qi.h~I,'i 1':\ '.SIHI..Hl-'IJ27 ") 1 Q. 2 3 A. 4 Q. 5 A. 6 Q. 7 B 9 10 A. 11 12 Q. 13 A. 14 Q. 15 16 17 1B 19 A. 20 21 22 23 Q. 24 25 A. Direct/Sponaugle - Eagle 42 And, Doctor, is she able to bend, squat, crawl and climb on occasion? That is correct. And is she also able to reach continuously? Yes. And, Doctor, just so we're clear, at the bottom you put restriction of activities, and you put driving automotive equipment. You have a mild restriction. What do you mean by that? In other words, she shouldn't be sitting in a car eight hours a day. But she is capable of driving distances? Certainly. Now, Doctor, Dr. Renyo, I'm going to represent to you, has come up with a diagnosis of Ms. Neaus, that being chronic lumbar disc injury and chronic lumbosacral sprain or strain. Do you agree with that opinion? She may have sustained a strain which, as I mentioned before, is stretched ligaments. There is no documentation, there are no objective findings to substantiate a disc injury. And, Doctor, in your opinion, does she have any work restrictions? Basically, other than those that we just mentioned lilliI' /-1101 lILI> III 1'0111/\'(; SUlna "'"rl~I''''g ;"1;'.111>.11/.11 \1"1. ;'17-....,.;.,..,'s 1'.\ '..'i(/(J.11l.Ql1i 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 Direct/Sponaugle - Eagle 43 in the physical capacities evaluation, the answer is no. I've given two answers to the same question. OK? And it needs an explanation. I just mentioned that other than the physical capacities evaluation, which I did place some restriction, but those restrictions were based on her subjective complaints, what she told me, not upon anything I could see for myself. I mentioned previously that on her -- there were no objective findings, things that I could see for myself which would dictate any limitations or restrictions. So that's why there are two answers to what could be considered a very similar question. Q. And, Doctor, in your opinion, has Ms. Neaus suffered any impairment of her ability to work or perform daily activities? A. No, not in my opinion. Q. And your opinion is based on your examination of Ms. Neaus, the medical records, your education, training and experience in the medical specialty of orthopedics? A. That is true. And it also encompasses the guidelines of the American Medical Association for evaluation of permanent disability and impairment. lilliI' "\1" IILIS UII'OIln,,(; stUI'ICI "'lm,""r_~ ;-/;".!I,.../ItoH \,,,1 ;"'7'-,'i"i."""S 1':\ '.IIj()(I.:!11.111:!7 '" 1 Q. I 2 A. 3 Q. 4 5 6 A. 7 Q. 8 9 10 11 12 13 A. 14 15 16 Q. 17 18 19 A. 20 21 22 23 24 25 Direct/Sponaugle - Eagle 44 J ~ in your Of which you've been qualified to do? Yes. And, Doctor, Ms. Neaus is physically able, opinion -- in your opinion, is she physically able to perform full-time work? Yes. And, Doctor, has -- based on your opinion and your review of the records and your examination and also more specifically the records provided by chiropractic treatment in this case, has there been any indication that chiropractic treatment has helped or is helping Ms. Neaus? She continues to have complaints. And after this long period of time, there does not seem to be a curative relationship there. Someone -- in this case, Ms. Neaus -- who has sustained a lumbar sprain, how long of a period of time should she treat for an injury such as that? That's a matter of debate or contention sometimes and sometimes it's not easy to answer. The guidelines are that a severe sprain may take up to 6 months to 12 months to reach maximal improvement. There is no good scientifically controlled study or scientific evidence that physical modalities, such as manipulation, et 11I11" I' ,lIdUClS /lU'O/ln.\'G SC/lI'/Cf J1,'rrr~I"H"~ ;';-.11h-I/to1J \0111. ;I;'.,'i,n.MI.'i 1'.\ J..'ri(JO.!11.1J1!7 1 2 3 4 5 6 7 B 9 10 11 12 .I 13 14 15 16 17 1B 19 20 21 22 23 24 25 Direct/Sponaugle - Eagle 45 cetera, shortens that course or is curative. We all use it. I use it. I prescribe it for my .~ patients. And I exceed the three weeks many times, giving three, four, six weeks of physical therapy, et cetera. If after that time it doesn't work or nature hasn't helped the patient. Those modalities really are, in my opinion, not further indicated. Q. Doctor, have all of your opinions today been given within a reasonable degree of medical certainty? A. Yes. Q. Thank you. I have no further questions. A. You're welcome. CROSS-EXAMINATION BY MS. DEITCHMAN: Q. Doctor, as you may anticipate, I have a couple of questions that I'd like to ask you based upon some questions that Attorney Sponaugle has begun with. Is it my understanding that you're saying that a sprain, a lumbar sprain or strain may reach maximal medical improvement, yet still not be cured? A. That is a possibility, certainly. There are certain patients who have some lingering and continuing symptoms from a bad sprain or strain '" 1('" {.\,.Illl',.. UI "OIUI,\'(; SllU'In 1I."".f'lIrl: ;'I';'.! Ih-lIh!1 \tHl ;,:"-,\~;."",,, I" ,-..(HI.! 11.'1I!:" '\ 1 2 Q. 3 4 5 A. 6 7 B Q. 9 10 11 A. 12 13 Q. 14 15 A. 16 Q. 17 1B A. 19 Q. 20 21 22 23 A. 24 25 Q, Cross/Deitchman - Eagle situation. And in your-- Did you take the history of Ms. Neaus yourself or did someone else from your office take that history? No. I ask the questions, each question. My secretary was in the room recording the patient's answers to the questions that I asked. And do you recall that Ms. Neaus had indicated that she takes Aleve on occasion to help her back pain? I will have to look that up, if you'll give me one second. That is co~rect. But she's not currently taking any prescription medications at this time? To the best of my knowledge, that is correct. And the report of Dr. Danyo, who I understand is another orthopedic surgeon. Correct? Correct. There was no prescription medication recommended. However, there was a recommendation of MacKenzie program and possible epidural steroids. Do you recall that in Dr. Danyo's report? I'd have to review the report, but I understand those terms, of course. OK. Well, can you explain for us what an epidural , II Ill" I. .\fl/llets UII'OIH/.\'{; SfurlCl. lI.um/"HI; ;"1;"-1110-/11.21 \,,,1. 717'.'i.,li.MJ.'i ,., ,.!riIHI..!11-QJ27 46 ~ ". ,!i --., 1 I 2 3 4 5 6 7 B 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 Cross/Deitchman - Eagle 47 steroid would be recommended for? A. An epidural steroid is an injection of cortisone into what we call the epidural space. The spine is bathed in spinal fluid, the space about that dura, the lining, is called the epidural space. Steroids do one thing and one thing only. They decrease inflammation. In certain instances where a nerve is inflamed, that inflammation can be relieved by injection of the anti-inflammatory steroids about the nerve root. That is used to try and decrease what we call nerve root -- and these are nerve roots that come out and these nerve roots merge to form bigger nerves -- to decrease nerve root irritation. Q. But you wouldn't agree that epidural steroids would be necessary for Ms. Neaus, because you don't believe there was any nerve impingement in her case? A. Or nerve root irritation, more importantly. Q. Now, are you familiar with the term MacKenzie program? A. Certainly. Q. What-- If you could explain what that involves. A. Basically, that is an exercise program, which strengthens muscles or can strengthen muscles. /11 illS /. .\/01 ilL" II/I'o/UI."/; SI:RI'/cr ","n~l"/f"; :";'.!l/..lkI.!1 \,'rA. ;";"....4i.~J.1j 1'.\ '-lifHJ.!lJ.lI1!i' "" 1 2 3 4 5 6 7 B 9 Q. 10 11 12 A. 13 Q. 14 15 16 17 1B A. 19 20 21 Q. 22 23 A. 24 Q. 25 A. Cross/Deitchman - Eagle 49 "She had been completely relieved of her low back, right buttock and right thigh pain. And about a week ago developed," excuse me, "about a week ago spontaneously developed some low back pain, though it was not severe. She is now beginning a program of back strengthening exercises and general exercises. And when I examined her today, I found no significant abnormalities." Now, do you know whether Cheryl was taking any prescription medication at the time of that report in June of 1995? No, I do not. And then again in reference to the MRI, and there's a lot -- there was a lot of questions concerning the April 25th, 1996 MRI report. You had indicated that the findings were an anatomic variant seen in normal individuals. I had indicated that bulging discs themselves are not pathological and are found in many normal individuals. And you used an analogy that it was like the disc itself was like a tire? That is correct. Would a bulging disc be like a bubble on a tire? No. It would be like a profile on a tire. You're '" III' '.\1" I/US III PORn"(; SrRI'ICI Illlrll,/'ur" ;"1;.~l/o.IIt>!l }lIt4 7'/;"-,"'~i-t>..n"i ",\ '.,'itlfl..:!lI.'H.!;" --. I 1 2 3 4 5 6 Q. 7 8 9 A. 10 11 12 Q. 13 14 A. 15 16 17 1B 19 20 21 22 23 24 25 , , ~ Cross/Deitchman - Eagle 50 getting into-- We'r.e getting into tire mechanics, but I was just trying to convey that a bulging disc has a profile. There can be some irregularities in that profile. And if you wish to liken that to a bleb, that is reasonable. And do you have a scientific basis for your opinion that if you took a hundred people off the street, most of which would have some bulging? Yes. The disc bulge is normal. That is well documented in the medical and orthopedic literature. Is it also a relevant finding, however, for a traumatic injury? No. There has-- One cannot state with reasonable medical certainty that a bulging disc is due to trauma. It's an anatomic variant. The role of degeneration has yet to be determined. Degeneration means wearing out, which in itself is a form of constant trauma. In other words, when we walk, we put pressure upon our discs. And it is evident on the MRI report that there is DDD, degenerative disc disease, which means changes in the disc consistent with wearing out. And those changes can consist of disc dehydration, loss of water, and-- But there is no, to my knowledge, , 11111' t. ,lldl1(',1S nll'onn'l;(; SI:RI"C1 "'lni~llIIr~ ;",;".!lh.f/to!1 \mol ;'I7.,".Jj-().I,." '1.\ '-,'ifH'.2Jl.'U27 -\ . 1 2 3 4 5 6 7 B 9 10 11 12 13 Q. 14 15 16 17 1B A. 19 20 21 22 23 24 25 J j Cross/Deitchman - Eagle 51 direct evidence that a wearing out itself can cause a disc to bulge. It may be there as a natural phenomenon. A nice young healthy person, a 24-year-old person may have a bulging disc, may have bulging discs, and a young healthy person may have some signs of early degeneration detected because our tests are so sensitive they can detect, for example, some early loss of water content or dehydration and can detect a loss of disc heighth, which can be a wear and tear phenomenon, as it is in this patient, and not on a traumatic basis. Is more unusual, however, to find the disc degeneration and bulging in a younger person? In other words, to state the opposite, is it more usual to find the degeneration in older individuals? You've asked two questions. I don't think it's any there is any difference between a bulge, but one would expect disc degeneration to occur in an older person. But our tools, the MRI, using that as a synonym for the tool here, is so sensitive in certain areas, it can detect some loss of water content, which is considered to be a degenerative change, the significance of which we III.IU~ l~ \'dUC'.; UI'I'ORrI.\'(; snH"tT "'ml,I',,,~ :"/;'-!I".1it>11 \olTk ;-,;"-,'i~j.t>."S 11\ "";IH'.Hl-ljJ~7 Cross/Deitchman - Eagle I 1 If you want to look at it really don't know. 2 philosophically, we all age the minute we are 3 born. That process of life is, if you will, 4 downhill from the original issue. 5 Q. And this sensitive MRI was read by the radiologist 6 and Dr. Danyo as suspicious of a herniated disc, 7 was it not? 8 A. I don't know what Dr. Danyo's interpretation was. 9 The impression was-- Let me read. "L4-5 DDD," 10 degenerative disc disease, "with right posterior 11 lateral disc protrusion near the L4 nerve root. 12 L5-S1 central disc protrusion suspicious for 13 herniation as described." 14 Q. What does the L4 nerve root lead to? You said-- 15 A. The L4 and the L5 nerve roots both lead to 16 formation of a very large nerve, the sciatic 17 nerve. 18 Q. And the sciatic nerve, as I understand it, goes 19 down through what portion of the leg? 20 A. It goes down in through the buttock, down the back 21 of the thigh, calf and into the foot. Different 22 parts of the nerve are formed by different roots, 23 and those roots go to special areas in the lower _ ....' 24 extremity. 25 Q. And have you in your practice reviewed MRI films III illS /. ,II, tUClS RII'ORTI.\'(; S/.'RI'/CI.' "'InI~/JU/": :"';'.!ll.-f/f..!1 \mJ. ;'li.-'iH-ti-lJ.'i II:' '.,"/Hl.211.tJ127 52 1 1 2 3 4 A. 5 Q. 6 7 B 9 10 11 12 13 14 15 16 17 1B 19 20 21 22 23 24 25 } -"I Redirect/Sponaugle - Eagle 55 diagnostic tests, is it indicated anywhere in his report that he actually reviewed the MRI films as opposed to the X-ray films? Let me see the first page. No. Thank you. I have no other questions. MS. DEITCHMAN: No further questions. MR. MACINTYRE: This videotaped deposition is now concluded. The time of day is 9:36 A.M. (The deposition concluded at 9:36 A.M.l fl/lI1''' ."<lUCIS RU'ORT/,\'C SeRI'ILT "..m~"ll~ ;'1;'.~I".I"'!1 \ml 717.....,i.fH!I.'i 1'.\ '-SOt/-ll).Q]!;" 56 '1 COMMONWEALTH OF PENNSYLVANIA SS COUNTY OF YORK I, Joyce C. Filius, Reporter and Notary Public in and for the Commonwealth of Pennsylvania and County of York, do hereby certify that the foregoing deposition was taken before me at the time and place hereinbefore set forth, and that it is the testimony of: PERRY A. EAGLE, M.D. .J I further certify that said witness was by me duly sworn to testify the whole and complete truth in said cause; that the testimony then given was reported by me stenographically, and subsequently transcribed under my direction and supervision; and that the foregoing is a full, true and correct transcript of my original shorthand notes. I further certify that I am not counsel for or related to any of the parties to the foregoing cause, or employed by them or their attorneys, and am not interested in the subject matter or outcome thereof. Dated at York, Pennsylvania this lOth day of September, 199B. t'b.::.:' :~('al Joyce C. r!l',:~" iJ::Jl:uy Public Spm~l! (1J.III.:':' "\'1. fJ , VallI CClunly ,~{ C('nlOl:~!=.(' ,.~' - No'.' 201, lD98 Joy Rep 1 Public (The foregoing certification of this transcript does not apply to any reproduction of the same by any means unless under the direct control and/or supervision of the certifying reporter.) ....) III illS /. .\/{III<'.\S 1I1/'0I1l 1.\:1; sruHel 1/,,,,;,,,,,1'0: :"':'.1Ih.f/f,!1 \<ltA. ;"I7..'i~i./"",'1 'I., '.,"iI'fl-HJ.lJ1!7 LAWYER'S NOTES c:::::::=.;.__;, ..;.:.c~-=;..,...~~~.;;--=::-~.-.:-.;:;::~...:.=::--=-.::..:=-~-". _. .-.~---_._~--_._-_._---~._-------_. --------_._--~---- - __._._.._,_._____.~_.__.____.._. _'__'_____"" 0- _ ___.._________._ PAoe LINe \ ~ ~ i ~ g ! " ...~ I I ,-I CURRICULUM VITAE OF PERRY A. EAGLE, M.D. OFFICE ADDRESS Perry A. Eagle, M.D. 191 Leader Heights Road, York, Pennsylvania, 17402 EDUCATION 1. University of Maryland, College Park, Maryland B.S. Degree, 1959-l963. 2. University of Maryland School of Medicine, Lombard and Greene Streets, Baltimore, Maryland M.D. Degree, 1963-1967. 3. Internship: York Hospital, 1O0l South George Street, York, Pennsylvania June 1967 - June 196B. 4. Resident in General Surgery: York Hospital, lOOl South George Street, York, Pennsylvania, 17405. June 196B - June 1969. 5. Fellow in Hand Surgery: Grace Hospital, Detroit Michigan July 1969 - June 1970. 6. Resident in Orthopaedic Surgery: Allegheny General Hospital, Pittsburgh, Pennsylvania. July 1970 - October 1972. BJARD CERl'IFICATION AND APproVALS Certified by the An'erican Board of Orthopaedic Surgery, 430 North Michigan Avenue, Chicago, Illinois, 606ll. September l4, 1973. Approved by the Cam1on\o,~alth of Pennsylvania, Department of Labor and Industry, &Ireau of '~rkers' Compensation to perform Impairment Rating Evaluations (IRE's). ProFESSIONAL MEMBERSHIPS 1. York County Medical Society, 1001 South George Street, York, Pennsylvania l7405. 2. Pennsylvania Medical Society, 20 Erford Road, Lemo1~e, Pennsylvania, 17043. 3. American Medical Association, 535 Dearborn Street, Chicago, Illinois, 60610. 4. American Acadt!11y of Orthopaedic Surgeons, Box ng5, Chicago, Illinois. 5. Eastern Orthopaedic Association, 301 South Eighth Street, Suite 3-F, Philadelphia, Pennsylvania, 19106. 6. Pennsylvania Orthopaedic Society, 20 Erford Lane, LtmOyne, Pennsylvania, l7043. STAFF APPOIN1MENTS l. York Hospital, 1001 South George Street, York, Pennsylvania, 17405. Active Orthopaedic Surgeon, 1972 to present. 2. Health South, lB50 Normandie Drive, York, Pennsylvania, 17404. 3. Apple Hill Surgical Center, 25 Monument Road, Suite 270, York, Pennsylvania, l7403. 4. Assistant Clinical Professor of Orthopaedic Surgery, College of Medicine of the Pennsylvania State University. 1:_ DEP ITION EXHIBIT .. ,- HOURI BV APpiOINTMINT ORTHOPAEDIC SURGIRY HAND IURGIRY PERRY A. EAGLE. M.D. S I' LIlADER HEIGHT' ROAD YORK, PINNSYLVANIA 17.02 ... TILI"HONI7.'..... "AI 7.'.2382 DEP ITION EXHIBIT '2- .1 June 19, 199B Thanas B. Sponaugle, Esquire 110 South Northem Way York. PA l7402-3737 Re: Cheryl L. Neavs v. Lay Annentrout Dear Attomey Sponaugle: The above patient was seen by me at your request for an independtmt medical evaluation on June 16, 199B, for exanination of the lumbar spine. The history was obtained from the patient. The medical records were briefly reviewed. The patient's history dates back to February 23, 1995. At that time the patient was the restrained driver of a vehicle llihich was struck by a truck. The patient does not recall the mechanism of injury to her lQlo."er back. She did canp1ain of lQlo,"er back pain :imnediately follQlo,i.ng the accident. The patient was seen in follow-up by her fanily doctor the following day for canp1aints of lQlo,"er back pain. Treatment included physical therapy within one to 1:\\'0 weeks of the accident. She received therapy two to three times per week for approximately two weeks; her therapy was then dis- continued due to increased Sjil111tallS. The patient was referred to Dr. Litton approximately one rronth after her accident for continuing canplaints of lO\\"et back 1;>ain. The patient was seen on t\\'O occasions by Dr. Litton. Her last visit Idth him she was released to return to \\'Ork. The patier.t then returned to the care of her fanily doctor. The patient was given \\'Ork restrictions of a 10 pound lifting and carrying restriction to be performed on a part-time basis. The patient began full time \\urk in January of 1996 as a cook. She continued with constant lO\\"er back pain at this time. Her pain \\'as present on a daily basis. She was taking Darvocet for her lO\\'& back pain at that time. In April of 1996 the patient was doing laundry at hone when she fell because her back becane nunb and her legs \\"ent out from under her. She rested for several days. She returned to \\'Ork approximately three days later and developed increasing problens. The patient was evaluated in a nearby hospital for lower back pain. She was prescribed Darvocet and taken off \\'Ork for the remainder of that \\-eek. Also in April of 1996 the patient began chiropractic treatment on a regular basis three times per week. Her treatment consisted of electrical stimulation. ice packs and adjustments to her lO\\"er back for rronths. She also received physical therapy in her chiropractor's office twice per \\_k. The patient continued with chiropractic treatment until June of 1997. The patient then Il'Oved to Florida. She resurred chiropractic treatment in Se1;>tember of 1997 for her 10\\-er back. Her treatment included electrical stimulation and adjustments. She is currently receiving chiro- practic treatment for her back. She is performing a hone exercise progran as \\-ell. Currently the patient continues with lo\\-er back pain. She feels the intensity of her pain has linoroved but she has a constant pain. Her pain is on a daily basis. Activities such as cleaning. liftina ,re~titi\le oondinll,and car ridino for.rrore than t\\'O to three hours increases her pain SOe oorAlns reller wiEn ta~lng Aleve ana applYlng 1l'01St heat. she takes"Aleve on the average of t\\'o to three times 1;>er \\'eek. .. Thanas B. Sponaugle, Esquire Page Two Re: Cheryl L. Nt!avs v. Lay AImt!ntrout Tht! patient occasionally c0119lains of bilat&al It!g pain with radiation anteriorly and post&iody do\;11 to h& knet!s. Prior to February of 1995 the patitmt denit!s having had previous lo\;'er back probl~ or injuries. At the time of the accidt!nt tht! patient was employed as a cook and a day care ~'Orkt!r. She miesed approximately ont! month of work aftt!r ht!r accidt!nt. sht! rt!turned to a job on a part-time basis ~'Orking ten hours per week. In January of 1996 the patient found work as a oook. She wa.~ termi.nated fr<:m this job in April of 1996. Currently she is unemployed. Physical excrnination was perfonred. At the outset the patit!nt was asked to tt!ll me if any portions of the physical t!xanination which she did or I did caused any discomfort. The patient acknowledged thest! instructions. The patient 's ht!ight is 63 incht!s and her ~",ight is l45 pounds. She does not appear to be in any distrt!ss. Sht! sits comfortably on the exanining table with her lO\;'t!r back unsupported during the history taking. Ht!r gait is normal. She does not linl>. She is able to heel and toe walk without difficulty. She points to tht! 10\;-er llJ1\bar region as the site of h& disconfort. sht! complains of pain to moderatt! palpation over the spinous processes of the lower lllllbar vertebrae and over t!ach sacroiliac joint. There is no tenderness over the sciatic notcht!s or greater trochanters. Tht! dt!ep tendon reflext!s in tht: lQlo,'er extremities are sj11l1letrical. There is no toe weakness in flexion and extt!nsion. There is no peroneal, anterior tibial, posterior tibial, hip flexor or quadriceps weakness. The distal sensation is intact. There are no toe signs present. Tht!re is no ankle clonus. Sitting root test is negative bilat&ally at 70 degrees. Straight leg raising causes some complaints of lO\;-er back pain bilaterally at 70 dt!geres but no radicular complaints. She is able to flex the lllllbar soine to a measured angle of BO degrees. At my inquiry she states flexion causes some lQlo,-er back pain. Sht! is able to sidt! bend to l5 degrees. X-rays of the lumbar spine taken in my office today reveal tht! bony architecture to be within normal limits. The disc spaces are well maintained. The ptrlicles are intact. Tht! sacroiliac joints are normal. There are no pars deft!cts noted on tht! obliqut! viel>"S. Tht!re is no evidt!nce of fracture, avulsion injury or vt!rtebral misaligruoont or subluxation. X-ray report of the lumbar spint! dated March 2l, 1995, from Siedel Manorial Hospital was a normal lumbosacral spine. X-ray rt!port of November 5, 1995 from Holy Spirit Hospital revealt!d a normal lumbosacral spint!o MRl report of April 25, 1996, from Canp Hill Physicians Imaging Center revealed L4-5 ODD with right posterolateral disc protrusion and narrO\;oing of tht! L4 nerve root. L5-S1 central disc protrusion suspicious for disc herniation was described. Personal review of tht! films by me ~"aS ptorfonred on this datt!. Tht!re is some mild bulging at L4-5 and L5-S1 discs. There is no evidt!llCt! of spinal stenosis or spinal cord or nt!rve root imoingtrot!nt. '... Thcoas B. Sponaugle, Esquire P/lge Three RE: Cheryl L. Neavs v. Lay AImentrout In summary this patient may have sustained a lumbar sprain. There is no clinical or imaging evidence of hemiated disc. The patient has had persistent s}11lptons. Her symptoms are essentially on a subjective basis without confirmatory objective findings. The findings on MRI are not pathological and are an anatomic varient seen in normal individuals. If indeed the patient sustained a lumbar sprain maximal medical improvt!1lent would be expectt:d in six lOOnths although a severe sprain may take up to l2 I1'Onths to reach maximal improvtf11ent. I fflel the patient has had a voluminous arount of treatment I1'Ost of which was not reasonable or necessary. I feel treatment with physical modalities after one year from the date of injury is not reasonable or necessary. In addition those modalities have not been proven by sc:ientifically controllt:d studies to be effacious. There are no objective findings on examination which would dictater any restrictions, limitations or disabilities. I feel this patient does not need any further treatment from any health care practitioner. At your request an physical capabilities form has been completed. The restrictions setforth are taking into consideration her SUbjective complaints and are not based on any objective findings. The patient ...ClS cooperative during the conducting of the medical evaluation. The patient was aCCCJ1llanied to her examination today by her sister. Upon my direct questioning, she had no complaints conceming the manner or way the independent medical evaluation was conducted . If I mB}" be of any further help or clarification. please do not hesitate to call or write my office. g),?~ Perry A. Eagle, M.D. PAE/ Imp Enclosure PHYSICAL CAPACITIES EVALUATION 'ORM IMPQATANT. PLEASE COMPLETE THE 'OLLOWINO ITEMS BASED ON TOUR CLINICAL EVALUATION 0' THE CLAIMANT AND OTHER TESTINO RESULTS. ~Y ITEM THAT YOU 00 NOT BELIEVE YOU CAN ANSWER SHOULD BE MARKED NIA (NOW ANSWERABLE) HOU: In terms of In a hour workday, IIOcClltonally" equal. 11 to 33%, IlfrtqJtntlyll, 341 to 661, IlcontlnuouslyU, 67X to 100%. tn an 8 hour workday, clllmonT cln (Clrcl. 'ull clpaCITY for .Ich Ictlylty) TOTAL AT ONE TIHE cp A) Sit 0 I. 3. cb 5. 6. BI surd 0 1. 3. 5. 6. C) WIlk 0 I. 2. C9 4. 5. 6. TOTAL DURINO ENTIRE B'HOUR DAY Al Sit 0 T. 2. 3. 4. 5. 6. BI surd 0 I. 2. 3. 4. 5. 6. C) WIlk 0 1. 2. 3. 4. 5. 6. 11. Clllmont Cln ll't: !!m.!: A) Up to 5 lb.. B) 6.10 lbl. C) ".20 lbl. D) 21.25 lb.. E) 26.50 lb.. " 510.100 lb.. .J:C' 111. Claimant can carry: Never A) Up to 5 lb.. B) 6.10 lbl. C) ",20 lb.. D) 21.25 lbl. E) 26.50 lbs. " 510'100 lb.. =::.--- I. 7. 8. (h...1 7. 8. (h...) 7. 8. (h...) 7. ~(h...) 7. (h...) 7. 8. (h...1 occasionallY Frf'Cuentlv Contlnuouslv ~ ~ ~ ~ --<---- OccasionallY Frl!QUentlv ContinuouslY ~ ~ =;..:.;.-- L..--" .. ~ tv. Claimant can use hands for repetitive ectlon such IS: A) B) Right Left Shl'cle Grasolnq ,/'Y.. No ~=NO pushing & pulling of Ann Controls ."..... Ves No (-'ftS No Fine Hanloulatfon ~~_ No _ IS _No V. Claimant can use feet for repetitive movements as tn pushing and pulling of leg controls. Rlcht ~es _No Wl ~ _No Both _~ _No VI. Claimant Is able to: Not at all occasionally Frl!'QUentlv ContinuouslY A) B) C) 0) E) Berd Squat Crawl Cllro Reach " ~ I ."...- - VII. Restriction of activities involving: ~ Mild ~ Moderate Toul A) B) C) -~ -:7 ~ Unprotected heights Being around moving machinery Exposure to marked changes in temperature and humidity Driving automotlye tqulpn</7 V ~ V:7/~.u-J c./17(9? D) PHYSICIAN'S N)P\ PHY~ICAL THERAPIST'S INiTIAL EVALUATION'~dR RtFt~~ING PHYSICI~~'S To: Geoft'rev James M1 shePheI~stown Fami'y pract 2140 F sher Road Mechan csburg l:.. 17055 Rs: Cheryl Neaus PHYSICAL THE VALUATION --...... --.-.... ...---....--.- Date of Onset:02/23/95 Prior Ho~pitalization:From:None To: Physical Theragv Inltiated:03/06l95 Date of Referral:03/03/95?Inpatient P.T.No Mental Status r patient;Orienteu to person, place, and time. Surgical Proced~res:None Treatment for:Right Low Back pain ~~~~~~b:pain in the right low back inclUding the hip with radiat~on down to the r ght knee. Pt. reports pain in this area t'OllOWl~q MVA on 02 23/951 Rx: Thu~ ncluded some gentle stretching, rest, & pain me Ication wit out $ g. fe11e!. Pt. presently not working. /pain:constant,inc. wt.b~arinqL bending, or 1ft1ng actIvities & t'luc.bet.2-l0 10. Pain dec.mostly while reB~ing in recumb. BO~iti~n. PMH:2 fx.R wrist,fx./sev.toes. pgti~~tY::standing post~re is p~ima~ily significant for a sharp lumbar lordosis w1th an 1ncreased anterior pelV1c tilt. Iliac crests are equal as are the PSIS. Trunk range of motion: flexion and extension are within normal limits with some pulling ~ansation oyer the r1ght hiPiand into the right buttockl' Rotations are with1n normal 1 mits. 5iae bena nq is limited by 20% with ncreased pain over the fight side with right side bending. 5traignt leg rais ng left 70 degrees 1 mlted secondary to adaptiye shortening of the hamstring, no reproduct on of back pain. Right 1 mited to 50 degrees secondary to both adative shorten~ng at the hamstring and increased pain throughout the right but cks and SI oInt. Leg length testing revealed no differances or pel~ic Qbl quities. I?a ieot'$ 5I ioint distraction did not inc~ease pain although 5I Join't compressiin did increase pain over the right 5I JOint. palpation to the area revealed s anificant pain anditende~ness over the spinous processes throughout the fimbar regi~n espec ally in the upper lumbar and lower thoracic spins. Patient had multiple areas of pain tQ palpation including the fbllowing: Right gluteal t1ssues, right 5I JoInt interspace, right lumbar paraspinals, and right hip tissues. GOALS; Short Term: 1. Decrease patient's complaints Of pain between 0-2/10. 2. Restore fnll trunk range of mot on without limitation secondary to pain, 3. Patient wIll e~per1ence resolution of soft tissue irregUlarities in the right hip, low back, and buttOcks. 4. patient be independent with a home exercise program. Long Term: Allow patient to ~eturn ta her prior level of function withont restrictions secondary to pain. 17055 Date:03/06/95 Assessment: Patient presents with mUltiple area~ of soft tissue irregUlarity, tenderness over the lumbar spine and rIght SI oint, some restrict10ns in range of mot10n, and report of constant yet fluctuat ng pain in that area. Rehab potential w1thin the goals is goo~. Plan: Modalities of moist heat and ultrasound as needed, manual treatment techniques as appropriate, therapeutic exercise, home program and education. Frequency: 3x/wk Estimated Length of Treatment:30 days ~, / ,~. . --:::z- ,lrJ Signature: PHYSICAL THERAPIST'S IN~~IAL EVALUATION FOR REFERRING PHYSICIAN'S RECORDS To: Geoffrey James . aniel J. Dandy, PT Shepherl1stown Famj1y prac t 1 "a. Rehab Services 2140 Fisher Road , f i 3r Road Mechanicsburg L. 17055 ,~c ani...~bur86Pa. 17055 Re: Cheryl Neaus MAR 1 S 199:11) 691-14 Date:03!06!95 PHYSICAL T IAL EVALUATION Date of Onset:02!23/95 Prior Ho~pft~~a~r6fflPr6m:None To: Physical Therapy Initiated:03!06l95 Date of Referral;03!03!95?Inpatient P.T.No Mehtal Status or patient:Oriented to person, place, and time. Surqical Procedures:None Tre~tment for:R1ght Low Ba~k Pain ~E~~~~~:pain in the right low baik including the hip with radiatton down to the r qht knee. Pt. reports pain n this area follOWIng MVA on 02 23/95 Rx: Thus ncluded some gentle st~etch nq, rest, ~ pain medIcation wit out slg. relief. Pt.presentlv nQt work1ng. !pain:CQnstant,inc./wt.bearinqL bendinq, or 11ft1n~ actIv1t1es & fluc.bet.~-10 10. Pa1n dec.mostly while re~~ing in ~ecumb. positi n. PMB:2 fx.R wr1st,fx./sev.toes. Obiect vel P~t1ent'~ standing posture is primarily significant for a sharp lumbar lordosis w1th an 1ncreased a~ter10r pel~1c tilt. Il1ac crests are equal as are the PSIS. Trunk ranqe of motion: flexiQn and extension are within normal limits with some pulling s~nsation over the r1ght hip and into the right buttocks. Rotations are within normal limits. Siae benainq is limitediby 20% with increased pain over the right side with right side bending. Stra ght leg raising left 70 degrees limIted secondary to adaptiveishortening of the hamstring, no reproduction of back pa1n. Right lim ted to 50 degrees secondary to both adaptive shorten~ng at the hamstring and increased pain throughout the riqht buttocks and SI oInt. Leg length testing revealed no differ~nces or pel~ic Qbliquities. pa ient'~ SI ioint distractIon did not i~crease pa1n althouqh SI Join~ compressiQn d1d increase pain over the right SI Joint. Palpation to the area revealed s1~g~ficant pain and tenderness over the spinous processes i throughout the 1 ar regiOn especially 1n the upper lumbar and lower thorac c spine. Patient had multIple areas of pain tQ palpation including the following: Right gluteal tissues, right SI JOInt interspace, r1ght lumbar paraspinals, and rIght hip tissues. GOALS: Short Term: 1. Decrease patient's complaints of pain between 0-2/10. 2. Restore ffill trunk range at motioh w1thout limitation secondary to pain 3. Pat1ent wIll e~perlence resolution of soft tissue irregularities in the right hip, low back, and butt cks. 4. Patient be independent with a home exercise program. Long Term: Allow patient to return to her prior level of function withofit restrict10ns secondary to pain. Assessment: Patient presents with mUltiple area~ Qf soft tissue irreqularity, tenderness over the lumbar spine and rIght SI 01nt, some restrictiOns in ~ange of motion, anidhreP9rt of con~tant yet fluctuat ng pain in that area. Rehab potential w t 1n the goals 1s gooa. Plan: Modalities of moist heat and ultrasound as needed, manual treatment techniques as appropriate, therapeutic exercise, home program and education. Frequency:3x!wk Estimated Length of Treatrnent:30 days Signa.cure: li -.- h7 -;r Da~a~T c... ~r PHYSICIAi'j ~ I"VI:') PHYS rr: I AN :;:::~r:::RT I i- rCA T t O~J Or- r-'l f(S [r::';I. T:-ir:::-,,')r-"{ T;,;:-:':' itli:1'-IT ?I.AN To:Geoffrey James . M.D. Shellherdstown Family' actice 2140 Fisher Road Mechanicsburg PA 17055 Re ICherrl Neaus Physlca Therapy Ini tlated:03/06/95 Histor\1: Pt.24/CC:pain In the right low bacK Including the hip with radiation down to the right Knee. Pt.reports pain in this area following MVA on 02/23/95. Rx: Thus Included some gentle stretching, rest, & pain medication without sig. relief. Pt.presently not worKing. pain:Constant,inc./wt.bearing, bending, or I iftlng activities & fluc.bet.2-10/10. Pain dec.mostly while resting in recumb. position. PMH:2 fx.R wrist,fx./sev.toes. SUMMARY OF TREATMENT AND REHA81 L1TATI ON STATUS AS (IF: 03/17/95 (',:., t o? e,'; F~ Daniel J. Dandy, PT S -= I ~ ~ PM. eo? ~, :',:' s~ r " : c -:- = ~~ 20 Fl =h~r "'~I~.:..,: t'1.;..::-'.;,r,j':s~IJrQl P.?. 17~5:: G....TE:03/17/95 Ph..: i c in Fehrn-.l: 03/03/95 PROGRESS: Cheryl was seen for six visits for complaints of primarily right low bacK pain. Through the course of care, a variety of treatment techniques and home program ideas were tried. Unfortunately, none were abl~ to successfully impact her condition. She is referred bacK to her physician at which time I twas recommended that she discontinue physical therapy. REHAB STATUS: No significant change following two weeKs of physical therapy. t.1AX It1ut'1 POTEt-IT! AL: YES-x tJO- It would be reasonable to e::pect that if physical therap>' treatment was ooino to impact Ms. Neaus's condition, it would have been achieved durino this-timi frame. Given her unresponse to treatment, discontinuing her from active therapy Is most approprIate. ::-:'1 an: Di scharge. Neau'~ i = lJr"j.:~ rr. -:;.'--:- :~ -:~~~~-=~~:Di~charce ~,:". ~'t-~;"it-~f'ltIT)e"l t-:~2D :. ;.. ~ "I;: ,-': :-:-'. !.; "~i-;': '::- 'F,- o?q'Jo?n,:. : 0 r'II~:(\b,,=r' v 1 5.. i". s ~> I d..;,,:. ~ : : c.:r t i f;.' th,~. 10; Cher)'l Right Low Back Pain ~:.~~I;?~>:l :.;::~ ~ \~:: :");~ ~.'.:C{~,,:'. :'~~:,>:.,"~< >:~'.:">' ~ i.:- ; : :.- . '!~~ r. ~"."~': .;::~ -:12~~"i:.(i.I:", ,.I.~'~1..~,',.'-::-~. 'r; :1:~ I ':,:~,~' .,. 11;'),1' '';'.:;'.: ::i ";~';:'~::D:'-"~n' <-,7." ~.:J~:~, .1' 'I '~~~~: 03,~1 ;~:~;.- ':"~, ::~'J~": ~ ~ - '3~offr.:?.. =::: .. ::-.:- :.; ,:; '-';., .;; ~:- "';.._r" ,- " :,',"\.,4": ..,,}, ( -tm~:. ~1. L'. ItA' PHYSICIAN'S N'IP\-_ :::AL THERAPIST'S IN'lTIAL EVALUATION'F'OR RE'N:MING PHYSICIAN'S RECORDS 3eottrey James M ,... iel J. Da1' 'v, PT shePhelostown Family Pract! Pa. Rehab :rvices 2140 F sher Road Ul sher Road Mechan csburg PA 17055 MAR _ 9~) '~~~~a86Pa. 17055 : Cheryl Neaus Date:03/06/95 PHYSICAL THE VALUATION --.....--...-. -...............--- bnset:02/23/95 Prior Ho~pitalization:From:None To: Therapy Inltiated:03/06l95 Date of Referral.:03/03/95?Inpatient P.T.No tatus or patient:oriented to person, place, and time. Procedl,lrl'ls:None c for:Rignt Low Back Pain :pain in the riyht low baik including the hip with radiatton{down to t knee. Pt.rep rts ~in n this area f01lOW1~g MVA on 02 23 95 Rx: luded some lent e st tch ng, rest, & pain me Ication wit au slg. Pt.presentl not work ng. /pain:conatant,inci wt.bearinQL ben~ing, ~. actIv1t1es tll,lc.bet.2-10 10. Pa1n dec.most y while reA~ing in rec . ,. PMH:2 tx.R wr1st,tx./sev.toes. e: ~ standing postl,lre is p~ima~ily significant for a sharp lumbar lordosis 1ncreased ahter10r pel~1c t1lt. Iliac crests are equal as are the ,nge of motion: tlexiIn and extension are within normal limits with some ~~nsation ovel the r ght hip and into the r1ght buttoCkt. Rotations 11ninormal 11m ts. S de bending ~s limitedibY 20% with ncreased pain ! f ght side w th rig t side bend~ng. Stra ght leg rais ng left 70 :t!~~t~~ g~~ng:1K.toRig~~tirgi~~~ri~ngBgdg~r~~~ ~~~~a~~'tgoboth ! shorten~nq at the hamstring and increased pain throughout the right I and SI oInt. Leg length testing revealed no differences or pel~ic :ies. pa 1ent'~ SI ioint distraction did not increase pain although SI lmpressiin d1d 1ncre~se pain over the right SI J01nt. Palpation to the 'ealed s anificant pain and tende~ness over the spinous processes ,ut the ~ar region especially 1n the upper lumbar and lower thoracic 'Patient had multIple areas of pain tQ palpation including the ~g: Right gluteal t1ssues, right SI JoInt interspace, r1ght lumbar 1als, and right hip tissues. Short Term: 1. Decrease patient's complaints of pain between 0-2/10. 2. Restore fUll trunk range of motion without limitation secondary to pain 3. Pat1ent wIll e~perlence resolution of soft tissue irregularities 1n the right hip, low back, and buttOcks. 4. Patient be independent with a home exercise program. Long Term: Allow patient to return to her prior level of function withoUt restrictions secondary to pain. '3nt: . prembsents with mUltiple area~ of sott tissue irregularity, tendernes~ e lu ar spine and rIght SI o1nt, some restrict10ns in range of mot1on ort at clon~tant yet fluctuat ng pain in that area. Rehab potential ' the goa s 1s gooO. ies of moist heat ~nd ultrasound as needed, manual treatment techniques ,priate, therapeut1c exercise, home program and education. days ,~ OROS /06/95 P.T.No n to Rx: :1'. :r, or r:ecumb . Jrdosis 1e Orh some ons 18ain 1 Lght L~ic Igh SI :0 the ,racic Ir '10 :100 lIII. In es~ ,ot10n, 1 iques ~.- '~I\..Dmi:I./(D.'AC..'. ../':-~K.KAWXK.MQ ,Wl,D L tINWO. M.D.. 'AU \'UJ.AA1(CI#IltITH.MQ.'ACS. IOW.DWI.JPP[,M.D .ottlFlNll.lm'll'lO >>RS A. SHAll( '" Q. RICHAliQ J P""ERSCN,.... 0 ~Junon,,"'-D 1l()MAS J vUCttA. ,"l 0 1l1QtA1l~J8G-'l.MO STE'i'E.'t a ..w. '" 0 GIl[GOAY A. HA~I'tS..'"' 0 ....LE.'W'lOf.R KALl."4AK. '" 0 ORTHOPEDIC INSTITUTE OF PENNSYLVANIA TELEPHONE: (717) 761.5530 . (800) 834,4020 . FAX: (717) 737,7197 March 28, 1995 Geoff:i:ey:.Jamesj; M.D. 2140-Fisher Road Mechanicsburg, PA l7055 Dear Geoff: This morning, March 23, 1995, I saw Cheryl Neaus #lOllOl of 6280 Carlisle Pike, Lot #l28 in Mechanicsburg in my office. She is a 24-year-old divorced woman, who has a four-year-old child and who has low back pain on the right side and right buttock and right thigh pain. She says that she got a birth control shot in her right buttock several months ago and from that time on had some right buttock pain, but no radiating pain until she was involved in an automobile accident on the 23rd of February of this year when another vehicle struck her vehicle. As soon as she got out of the car, she had right lower sided back pain, right buttock pain and right thigh pain. She was examined by you, and you placed her on light duty. She worked as a cook. She worked at light duty until her vehicle aCCident, and after that she was told not to work. She says the job is no longer available. She has been going to physical therapy but that is not helpiDg her at all, nor have anti-inflammatory medications. I examined Cheryl today and found that she had full range of motion in her low back without list or loss of lumbar lordosis. She had no tenderness of her low back or sciatic nerves and she had no pain with straight leg raising. Neurovascular function in her lower extremities was intact. I reviewed her radiographs taken at Seidle Memorial Hospital on March 2l, 1995 and saw no significant abnormalities. I feel that Cheryl has a low back strain from her vehicle accident in February and told her my attitude towards low back strain. I want her to increase her activity as her symptoms allow and even if she is uncomfortable that is not a contraindication to increased activity. She is to try to get another job, and I placed on limitations on her job activities. ~TS: . v\~' 1<5 / -..-----.: C' OAllED' FlLED'rW .f'( '4" \.A'':' CAMP HILL OFFICE 3910 TRlhDLE ;(r ADDRESS .~LL CORRFSPONDENCE TO 3916 TRINDLE ROAD. c.~.'\P HILL. p~ 17011 _~RRIS~~~.OFF~_~_~_ ___ __ ._H~R~H.E_~ OFFICE CA."'P Hill OFFICE .r;r:-,; ,J....'_~.~ (,UO')I7"~:) ~.~. T~' : _'\.~ (C:O:"'~~-,(!'\'(-,.17: 1.: .175 r'.: I'~ -\';;> '-..:'<;~> i\C . CHERYL ROB: Page , .UGH Name: DatelVitals '-\-\.a.~ '...v.:, - \ ~ \ \-\~- 19~Y" \ 0: HEENT-TM's are clear, nose is cleat, throat is mildly ~. lo()I\O swollen, neck is supple with no nodes, lungs are clear. Ul \- C{~.a,'-"-I A: Viral URI. \~ S: The pt comes in with 4 day hx of hoarseness, bad cough and some sore throat. red and P: PUsh fluids, salt water gargles, Robitussin AC 4 oz 1-2 tsp q.i.Cl. prn. Thyromegaly was detected on exam today with thyroid at least 2 x normal size with no nodules. Will get hypothyroid profile when the pt is well. GMJ/lm iol-Z1.-'13 WT- 164. 8P-lJo)wD. S: Nearly 23 Y/o here for work physical. She has no complaints at present. She has had no hospitalizations or surgery except for twovaginal deliveries. She had her cholesterol checked last year and it was said to be okay. She had a tetanus shot in 1988. She sees a gynecologist regularly for pap smears and is taking TriNorinyl. She takes no other meds and has only a questionable allergy to Sulfa where she passed out while taking a shower. She smokes a pack a day and has smoked since 1985. She drinks about six beers per week at most. 0: HEENT is WNL. Neck supple, no adenopathy. Thyroid is slightly enlarged. Recent thyroid tests were normal. Lungs are clear. Heart R no M. Abdomen benign. Extremities: no edema. Peripheral pulses are full. A: Normal physical. P: Physical form signed. Discussed brief message of dealing with fatigue which patient brought up at the end of the exam. GMJ/ekh Cl ~ ~. S: pt accidentally kicked a chair last night and had immediate pain , '^-' -\ in her fourth and fifth toes in the left foot. There has been swell ins and bruising overnight. ~~ \ d.o Examination of the ankle is normal with good ROM. No swelling or enderness. Examination of the,fifth metatarsal and dorsum of the foot is also negative with no localized tenderness or swelling. The fourth and fifth toes are ecchymotic and swollen. ROM is limited. Sensation is intact. I: Probable broken toe. P: Instructed on use of ice, elevation and crutches for the next couple of days. The toes were separated with cotton and taped and pt was instructed to keep them taped over the next 2-4 weeks. She was given a note off her aerobic class at HACC for at least two weeks and dependin on the,deg:ee,of ~~in and improvement. Return to work slip Date/Vitals .lz.-~.. -'3 Name:~..<:1 /.' ,/::?..4 (..~ eo t ." , Page Z. S: pt is here with a hx that over the past several days, she has had problems with sore throat, some upper resp. congestion, postnasal drainage and cough; pt smokes a pack of cigaretets per day. She has been on no meds. for this problem. 0: Ears - canal and TMs are bilateralxy neg., throat is ~inimally injected; nose shows minimal rhinorrhea. Lungs are CTA. A: Acute pharyngitis i2 Smoking P: Have advised on total cessation of smoking '2 Good fluid intake 13 Deconamine-SR, 1 b.i.d. prn congestion 14 Amoxil 250 mg. t.i.d. for 10 days Joseph Cincotta, M.D./cld d.-n-q '-Jt:. ya \.0 \""' C'o 0.'0 0: Pulse B8, BP 100/70. HEENT-TM's bilaterally were normal. with Ie' good landmarks and mobility, nose purUlent rhinorrhea bilaterally. \.).-1\'\ \UO Throat and mouth, moist mucous membranes, neg. pharyngitis, neck is ~ ~O supple without lymphadenopathy or mass. Heart is. RRR, w/o M, lungs ~ CTA,~bilate[al~y maxillary sinus tenderness t9:pa1pation. ~:a.so.~ ,J...),=-\~\ 'i-<4<l:"qcp"') '\ - ':lc.er' S: 2-3 day hx of ST, facial pressure, both cough. Has used OTC nasal congestion, posterior nasal drainage, above and below both eyes, mild fatigue, occ medications without relief. A: Acute sinusitis. P: 1. Amoxil 250 mgs #30 1 t.i.d. to complete a 10 day course, side effects reviewed. 2. Increase fluids. 3. Sudafed t.i.d. prn congestion. 4. Recommended d/c of tobacco. 5. To call in 2-3 days if no better or before'if worse. David Wenner, DO/1m S: pt is here with two unrelated complaints. Her first is that over the past two weeks she has had some upper respiratory congestion and a ST, minimal PND. No fever. pt does continue to smoke. Pt's second concern is that she slipped and fell onto her right arm yesterday and is having some soreness over the distal arm. She had injured thiys arm earlier in the year and it took several weeks to resolve. 0: Ears: Canals and TMs are negative. Nose is minimally congested. Throat is injected posteriorly. Nodes, no adenopathy. Examination of the patient's right forearm shows some tenderness over the distal radius, some soft tissue swelling. No deformity. .. . DatelVitals ~_ J:2' 9{ -r; 911J 1'-~.......' 5' / .;2~/9y vJT / J (.. Ii7 ("d Yz Name: Cheryl N, JS ~ Page 3 r t 5/25/94 CONTINUED A: Contusion, right forearm. '2: Pharyngitis and URI, suspect viral in origin. '3: Smoking. P: Advised on discontinuation of smoking. 12: Local measures for ST. 13: Obtain X ray of right wrist area and have advised on ice and ace wrap. Will call patient tomorrow with results of X ray. AC/ekh S: Patient presents with complaints of now about a 6-7 day history of URI consisting initially of a sore throat and some nasal congestion For the last two days she has had somewhat of a cough and her head congestion persists with yellow nasal drainage. She does continue to smoke. 0: HEENT exam is unremarkable. Heart is RRR. Lungs are clear. Neck reveals no adenopathy. , t . A: 1) Presumed sinusitis. P: 1). Amoxicillin 250 mg per tsp. one tsp. t.i.d. for 10 days and Entex liquid 4 ounces with one refill to take two tsp. q. 6 hours prn nasal congestion. Patient to call or return if her symptoms persist, worsen or do not fully improve. Patient stated at this time that she did not want to quit smoking. Gs/lmn ./.......~ 8/~'4/~V M . PPD~ 1... fl. .3:11prt? .;l.3~3.13 ~J~ S: Patient here for day care physical. She has no health complaints at present and no changes in her health since last physical. Past medical history is unremarkable except for a questionable sulfa allergy. She continues to smoke a pack a day. Tetanus immunizations are up to date. We do not have records of her other immunizations such as MMR. 0: General physical is normal and unchanged from 4/93. A: l) Normal physical. P: l) Encouraged patient to get us copies of her other immunizations, PPD applied, physical form filled out and signed. GMJ/lmn . . Dale/Vilals /:;.Jo~9t/ w;: /4 ~ ij//O/qf iwr/# :r ff,/(o) -rS::MJ ;~{~ n "..., Name: (i,-J"~~IL ~A 0" Page 'f S: Patient apparently had a DepoProvera shot ten days ago in the area of the right upper buttock at Polyclinic. Since that time she has had pain in that area. She saw the physicians at Poly three days ago and was told it was a muscle stra~, started her on Lodine 400 mg. bid, does not appear to be helping. The patient denies actual knowing about any strain of her back otherwise. 0: Upper outer quadrant of the right buttock is tender in a fairly localized spot. Also occasionally seems to radiate up into the lower back. Her ROM of the back is normal but full flexion seems to cause some strain of that area. There is no ecchymoses or redness. She has normal motion of the hip in internal, external rotation, elevation and extension. No lump or nodule is felt in palpation of the tender area. A: Upper buttock strain vs. a possible gluteus bursitis possibly secondary to the injection vs. muscle strain and back strain on a musculoskeletal basis. P: Continue Lodine 400 mg. bid with food, samples were given. Also encouraged on stretching exercises and moist heat and to call if her symptoms persist, worsen or do not fully improve. GS/lab H ith about a one week history of some upper respiratory S: er~ w 1 drainage, cough, no significant fever. congestlon, post nfas~ rettes a day and is on Depo-Provera for Smokes one pack 0 clga contraception. tender over the maxillary sinuses bilaterally. 0: Face is miltdedlY Throat is unremarkable. Lungs are clear. Nose is conges . , 'I A: 1) URI with element of sinusitis comp11cated by patlent s smoking. P: 1) No smoking. 2) Good fluid intake. 3) Amoxil 250 mg t.i.d. for 10 days. 4) sudafed q.i.d. for congeatlon. . 5) Patient asked to call if not improvlng. 6) PVU. JAC/lmn . , Date/Vitals 'tlf /~? 2-/1- 3/9(' ..,6.'9) Name: (t~J~ ~~'r Page 5 S: Seen here a month ago for pain in her hip. Since then the pain was improving, but after running on the beach she developed a pro- gressive worsening of her pain over the last five days. Localizes pain to the right low lumbar area and sacral area extending down around the buttocks to the upper anterior thigh. Pain worsens with activity. o The patient has diffuse tenderness over the right low back and buttocks are which is mild. ROM.,is tairly good although has pain with flexion. SLR is negative. DTR's and strength in the lower extremities are normal. A: Musculoligamentous low back pain. P: Aleve two tablets bid or Lodine fills. Moist heat or ice massage. GJ/lab 400 mg. bid given 20 with two re- Avoid offending activities. S: Here for recheck of back. No significant improvement since last visit. Has good days and bad days. Does get relief temporarily from moist heat for 30-60 minutes and from Aleve. Continues to work as a cook and in child care at a day care center. Has tried to limit her lifting, but still does a lot of bending, twisting and other use of he, back. 0: Mildly tender over right buttocks area. ROM of the back is fairly good with pain at limits of flexion. SLR is mildly postive in the right leg for pain in the right buttocks area. DTR's and strength in the lower extremities are normal. A: Musculoligamentous right buttocks pain. P Stressed importance of rest and asked her to take rest periods for 20-30 minutes every 2-3 hours at work in addition to her 15 lbs. lift- ing restriction. Also reviewed stretching exercises for low back and buttocks to do once or twice daily. Recheck in three weeks. GJ/lab rn .1. 4 ~ J /~ t11.........~ rn rJ /- T')Cl(j -/ 'J V 1;. c-6-6 ,~"- '..;..:..R 3h!9r - I'- tG ''(;'U,", f T Date/Vitals ! :,-"'"?::l.o.":::l. ! ..:l\;_ \ ~ ~ 1~.\\lllt\C,) I G(T'tS\~ I I , I~j;.fs , "b-~~.ca ~.l"..\~~ ~~-\...o:, ~- \\d.2 ~J\"Sl~ ., ..., Name: C ",p", ~ '\\eN ""'') , Page ~ () S: In an MVA B days ago with worsening pain in her hip, back and leg since then and no improvement since the accident. Unable to tothe exercises because of pain. 0: Tender over rt lower back and buttocks area, some spasm of the rt lumbar paraspinal muscles, straight leg raising is mildly positive for pain in her hip and buttocks, DTR's and strength are normal. A: persistant musculoligamentous strain of buttocks in low back. P: Referred for PT, continue Aleve 1-2 tabs b.i.d. prn , recheck in 2 wks. GMj/lm S: Here for a f/u of back and buttocks pain. No change whatsoever in 2~ weeks. No response to physical therapy. Physical therapist reports that SI joint frequently comes out of place and they have to put it back into place which causes her pain for a day or so. Unable to return to work and has lost her job. 0: Tender over the SI joint a'teas and low back. Right side greater than left. Straight leg raising is mildly positive in the right leg in buttocks and back pain. DTRs and strength are normal. A: Persisting low back pain which is now going on for 3 months. P: l) Lumbosacral spine x-ray. other suggestions. GJ/scw Refer to Dr. Dahmus for any 5: Patient here for work physical. She does wear seatbelts. Had cholesterol checked 1991. Please see yellow and green sheets for other historical data. Only concern is a slight sore throat. 5he does feel that she has had the measles, mumps and rubella booster but we need shot records from Dr. Sam Jones. 0: HEENT exam unremarkable. Negative funduscopic exam. Normal lymph node survey. Carotids 2+. No thyromegaly. Heart regular rate and rhythm without murmur, rubs or gallops. Normal 51, S2. Lungs are clear. Abdomen benign without masses, tenderness or organomegaly. Skin without suspicious lesions. She does have a dermatofibroma, left upper back region. Extremities without edema. Neurologically intact. A: Normal work h sical, needs PPD testin fa h continued on page 7) Dale/Vitals B-23-95 cont, Name: Cheryl Neaufl Page 7 P: 1. PPD today and recheck in 2 days. 2. Recommended use of sunscreen, continued use of seatbelts following healthy low fat, low cholesterol balanced diet and elimination of smoking and to call if there are any problems. Gary Schwartz, M.D./bhm 1}r), 8,0"'0 (O~~~ Ie -3 CiS D,\ ..cu,~t<.t\.. ~Io ~K ~"- \!~-.... 15 "'C~ "',2-D. T B\ D . I 16' r~'9> v!,l.{c) I.~ \\ -l,;. -C(':J "6,.'9} N2...- G:! IfAc..... S: Five to six day history of ST, productive cough, positive smoker. No arthralgias. No SOB. Cough worse at relief. purulent rhinorrhea, PND, fever, chills, myalgias, or night. Using OTC meds w/o 0: Afebrile. HEENT: TMs normal with Nose w/o rhinorrhea or obstruction. posterior pharynx with soft palate lymphadenopathy or mass. Rapid strep CTA. good landmarks and mobility. Throat and mouth: hyperemic petechia. Neck supple w/o negative. Heart RRR. Lungs A: Acute sinusitis following URI. P: #1: Amoxil 250 mg/5 ml, #150 cc, one tsp t.id.. until completed 10 day course. SER. #2; Histussin HC sample plus Rx for 4 fluid ounces, 2 tsp q 4 hours, prn cough. #3: Increase fluids. #4: Gargle and lozenges prn. #5: Stop smoking. #6: Call if no better in 2-3 days; before if worse. PVU. Dave Wenner, DO/ekh S: Patient fell two days ago. Was seen at Holy Spirit ER. X-rays of wrist and back were taken which were negative. She continues to have complaints of right arm and wrist pain as well as back pain. Right wrist is tender mainly more proximal to the actual rist joint. Range of motion actively and passively slightly impaired secondary to the pain. No significant swelling. Range f motion of the back is impaired to approximately lO to l5\ in all directions, but heel walking and toe walking are normal. Low back strain with right arm strain. 1. Use of right wrist splint is recommended for several ays and limit use of right arm for a week. Gradually advance ctivity. Use of Motrin 800 mg. t.Ld. with food .r.n. as ue on page . . . Date/Vitals I I I I I I 4-IQ'9 '-.Aft I ~(\~ t' 7J... \ q~()'.' 11-7-95 cont, Name: Cheryl Nea"- Page A P: (continued) as well as Norflex 1 b.i.d. p.r.n. Patient has prescriptions and samples. Patient will call me if her symptoms persist, worsen or do not fully improve. Gary Schwartz, M.D./bhm 'b~'" ~\I\ l\ G~er J S: Here with an exacerbation of back pain. Works as a cook at Dauphin County Juvenile Detention Center. Does a lot of bending and lifting according to her history. Yesterday after work she had gone home and had gone out to do her laundry and was bending and lifting with laundry and when she went to get her laundry out of the car, she had onset of some bilateral lower back pain. Pain has continued. It is nonradiating, unassociated with any bowel or bladder disturhance, no associated paresthesias. . } 0: Gait is normal. Heel walking, toe walking are normal. Cl~/Jl~sqUatting is unrestricted. Forward bending is limited at about 30 degrees. Back bending and side bending are unrestricted. Reflexes are +1 in the knee jerks and ankle jerks. A: Recurrent acute mechanical back pain. ~Iq.qlo ~-13lt ht .l93'I~ 3Ip.,~I(pq. p'lA ~~ ., "'I P: Have reviewed good back mechanics with patient. 2. To stay active as tolerated. 3. Norflex one twice a day as needed for muscle spasm. 4. Ibuprofen 600 mg. four times a day with food. Recheck as needed. Joe Cincotta, M.D./bhm WorK Pt S: 26 year old here for work physical. Continuee to have problems with back pain which she reinjured in April. She has been eeeing a chiropractor who did a MRI ehowing two herniated discs. She ie however improving and is going to be going back to work for 2~ hours a day at a daycare center where she is working with older kids where lifting will not be required. Past medical history otherwise ur.remarkable. On BCP. No other medications. Passed out with Sulfa. No other medication allergiee. Social history - Smokes one pack a day for II years. No drug use. Drinks about 6 beers per week. Exercises by walking 2 miles every other cay. Uses his eeatbelt regularly. 0: HEENT is WNL. Neck supple. No adenopathy or thyromegaly. Lungs clear. Heart regular rate. No murmurs or gallops. Abdomen is benign. Back - Fair to good flexibility. Strength in the lower extremities is normal. Extremities otherwise unremarkable. Name: Cheryl Neaus Page 9 Date/Vitals 8-19-96 cont. A: 1. Well exam. 2. Chronic back pain. P: Form signed. PVU. Geoff James, M.D./bhm