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Home My WebLink About08-7062IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA No. 2008 - 4161-2 Civil Civil Action - (XX) Law ( ) Equity Jacqueline M. Hearn Michael Loe 2627 Waldo St. 1766 Winterhaven Dr. Harrisburg, PA 17110 Mechanicsburg, PA 17055 versus Plaintiff(s) & Defendant(s) & Address(es) Address(es) PRAECIPE FOR WRIT OF SUMMONS TO THE PROTHONOTARY OF SAID COURT: Please issue a Writ of Summons in the above-captioned action. One 1 Writ of Summons shall be issued and forwarded to ( )Att y eriff Matthew S. Crosbv. Esa. 1300 Linglestown Rd. Harrisburg, PA 17110 (717) 238-2000 Name/Address/Telephone No. of Attorney ze'_ Si ure of Attornify Supreme Court ID No. 69367 Date: VZ 1 10 WRIT OF SUMMONS TO THE ABOVE NAMED DEFENDANT(S): YOU ARE NOTIFIED THAT THE ABOVE-NAMED PLAINTIFF(S) H /HAVE COM CED AN ACTION AGAINST YOU. Proth otary Date: I ,£ c. 2 _ 2,068 by ( ) Check here if reverse is used for additional information Deputy PROTHON. - 55 v .u , C'7 N Za I-7 ..1 ? z ff.`s ?Jr) 0 SHERIFF'S RETURN - NOT FOUND CASE NO: 2008-07062 P COMMONTWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND HEARN JACOUELINE VS LOE MICHAEL R. Thomas Kline Sheriff or Deputy Sheriff, who being duly sworn according to law, says, that he made a diligent search and inquiry for the within named DEFENDANT LOE MICHAEL but was unable to locate Him in his bailiwick. He therefore returns the WRIT OF SUMMONS the within named DEFENDANT , LOE MICHAEL 1776 WINTERHAVEN DRIVE NOT FOUND , as to MECHANICSBURG, PA 17055 CURRENT RESIDENT HAS BEEN HERE 2 YEARS-NEVER HEARD OF DEFENDANT. PER POST OFFICE, FORWARDING INFORMATION NO LONGER ON FILE. Sheriff's Costs: So answe Docketing 18.00 Service 9.90 Postage .42 le, R. Th as Kline Surcharge 10.00 Sheriff of Cumberland County Not Found nn 5.00 lal?xlb? ?/"" ?/ 43.32 HANDLER HENNING ROSENBERG 12/11/2008 Sworn and Subscribed to before me this day of , A. D. IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA Jacqueline M. Hearn 2627 Waldo St. Harrisburg, PA 17110 Plaintiff(s) & Address(es) PRAECIPE FOR WRIT OF SUMMONS TO THE PROTHONOTARY OF SAID COURT: Please issue a Writ of Summons in the above-captioned action. Defendant(s) & Address(es) One 1 Writ of Summons shall be issued and forwarded to ( )Atto meyTX S eriff Matthew S. Crosby, Esq. 1300 Linglestown Rd. Harrisburg, PA 17110 (717) 238-2000 Name/Address/Telephone No. of Attorney No. 2008 ?D(P 2 Civil Action - (XX) Law ( ) Equity versus Si ure of Attorn y Supreme Court ID No. 69367 Date: ?Z 1 WRIT OF SUMMONS TO THE ABOVE NAMED DEFENDANT(S): YOU ARE NOTIFIED THAT THE ABOVE-NAMED PLAINTIFF( AS/HAVE CO ENCED AN ACTION AGAINST YOU. Pr onotary Date: EC it ? 2pp g by ( ) Check here if reverse is used for additional information Michael Loe 1766 Winterhaven Dr. Mechanicsburg, PA 17055 Deputy PROTHON. - 55 may` COPV I two U! '-Z:"' d rt at C; ,' i . as . r - r- Civil A' - w Matthew S. Crosby, Esq. I.D.#69367 HANDLER, HENNING & ROSENBERG, LLP 1300 Linglestown Road Harrisburg, PA 17110 Telephone: (717) 238-2000 Fax: (717) 233-3029 E-mail: Crosby4-hhrlaw.com JACQUELINE M. HEARN, Plaintiff V. MICHAEL LOE, Defendant TO THE PROTHONOTARY: Attorneys for Plaintiff IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA NO. 2008 7062 Civil Term CIVIL ACTION - LAW PRAECIPE Please reissue the Writ of Summons, copy of which is attached, against the above-named Defendant in this matter, pursuant to Pennsylvania Rule of Civil Procedure 401 (2) and have the Sheriff of Cumberland County serve Defendant Michael Loe only at his new address of: Michael Loe 8 Andersontown Rd. Mechanicsburg, PA 17055 HANDLER, ING & ROSENBERG, LLP BY: atthew S. Crosby, Esq. Supreme Court ID No. 69367 Attorneys for Plaintiff DATE: ? d w IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA No. 2008 - 70L2 Civil Civil Action - (XX) Law ( ) Equity Jacqueline M. Hearn Michael Loe 2627 Waldo St. 1766 Winterhaven Dr. Harrisburg, PA 17110 Mechanicsburg, PA 17055 n 77 versus J Plaintiff(s) & Defendant(s) Address(es) Address(es) ' PRAECIPE FOR WRIT OF SUMMONS TO THE PROTHONOTARY OF SAID COURT: Please issue a Writ of Summons in the above-captioned action. One 1 Writ of Summons shall be issued and forwarded to ( )Attu y S eriff Matthew S. Crosby, Esq. 1300 Linglestown Rd. Harrisburg, PA 17110 Si ure of Attorn y (717) 238-2000 Supreme Court ID No. 69367 Name/Address/Telephone No. of Attorney Date: WRIT OF SUMMONS TO THE ABOVE NAMED DEFENDANT(S): YOU ARE NOTIFIED THAT THE ABOVE-NAMED PLAINTIFF(S) H IHAV COMM CED AN ACTION AGAINST YOU. Protho ary Date: Der 2 I:2 660 by ( ) Check here if reverse is used for additional information PROTHON.-55 voz J C" F# I (R - acc, A1008 Rtryr Deputy ??? ? ? ?. ??? SHERIFF'S RETURN - OUT OF COUNTY CASE NO: 2008-07062 P COMMONWEALTH OF PENNSYLVANIA: COUNTY OF CUMBERLAND HEARN JACQUELINE VS LOE MICHAEL R. Thomas Kline Sheriff or Deputy Sheriff who being duly sworn according to law, says, that he made a diligent search and and inquiry for the within named DEFENDANT to wit: LOE MICHAEL but was unable to locate Him deputized the sheriff of YORK serve the within WRIT OF STTMMONT.Q County, Pennsylvania, to On February 2nd , 2009 this office was in receipt of the attached return from YORK Sheriff's Costs: So answers. Docketing 18.00 Out of County 9.00 -.-wc Surcharge 10.00 R. Thomas Kline Dep York County 83.50 Sheriff of Cumberland County Postage .42 02/02/2009 HANDLER HENNING ROSENBERG Sworn and subscribe to before me this day of in his bailiwick. He therefore A. D. 10 PENNY PREg ? 8413-4078 F? (71 ? 84s 138p OFFICE OF THE S 45 N. GEORGE ST.,YORK, PA 17401 01111 011 it I SHERIFF SERVICE MTWJIC'I"1?7NS PROCESS RECEIPT and AFFIDAVIT OF RETURN PLEASE TYPE WY LIM 1 TNW 12 DONW DETMM ANY C 1 PLAINTIFF/S/ Jaqueline M. Hearn 3. DEFENDANT/S/ SERVE 5 NAME OF INDIVIDUAL, COMPANY. CORPORATION, ETC TO SERVE OR DESCRIPTION OF PROPERTY TO BE LEVIED, ATTACHED, OR SOLD Michael Loe - Personal Service Only 6 ADDRESS (STREET OR RFO WITH BOX NUMBER, APT NO., CITY, BORO, TWP. STATE AND ZIP CODE) AT 8 Andersontown Road Mechanicsburg, 7. INDICATE SERVICE' O PERSON IN CHARGE 0 DEPUTIZE O CERT. MAIL 0 1 ST CLASS MAIL 0 POSTED 0 OTHER NOW 1 f 1 94)9 20 I, SHERIFF OF , PA, do hereby deputize the sheriff of Vnrk COUNTY to execute ttli Li%oodke return thf cording to law. This deputization being made at the request and risk of the plaintiff., SHERIFF OF V4N=0URTT-""1" 8. SPECIAL INSTRUCTIONS OR OTHER INFORMATION THAT WILL ASSIST IN EXPEDITING SERVICE OUT OF CO C ND _ ': M .,MIA BY A=. NOTE: ONLY APPLICABLE ON WRIT OF EXECUTION: N.B. WAIVER OF WATCHMAN - Any deputy sheriff levying upon or attaching any property under within writ may leave same without a watchman, in custody of whomever is found in possession, after notifying person of levy or attachment, without liability on the part of such deputy or the sheriff to any plaintiff herein for any loss, destruction, or removal of any property before shenfrs sale thereof. 9. TYPE NAME and ADDRESS of ATTORNEY / ORIGINATOR and SIGNATURI%WHE(a S. CROSBY, ESQ. 10. TELEPHONE NUMBER 11. DATE FILED 1300 LINCUMTOM ROAD, HARRISBURG, PA 17110 717-238-2000 12-30-08 12. SEND NOTICE OF SERVICE COPY TO NAME AND ADDRESS BELOW: (This area must be completed d notice is to be mailed). CUMBERLAND CO SHERIFF . 22 23. Advance Costs $100.00 Total Costs Due 2 Service Costs 125. NIF 26. Mil?e?e?27. Postage) ?28. ?bL ? 129. Pound if? Smotwy ?O 131. Surchg. I3,36 ?? 33 / (0 !L stand A!';-M 1:t 11 2. COURT NUMBER 2008-7062 Civil 4. TYPE OF WRIT OR COMPLAINT WOSUM Rejssu$d G7Yl f. n Cttmm/1r,- APACE MOW OR USE OF THE SMW - 00 - 13. 1 acknowledge receipt of the writ 14. DATE RECEIVED 15. ExpiratiorvHearing Date or complaint as indicated above. MJ MCGII-L YCSO 1-14-2009 1.-29-"09 16. HOW SERVED: PERSONA RESIDENC POSTED( ) POE( ) SHERIFF'S OFFICE ( ) OTHER( ) SEE REMARKS BELOW 17. Qr I hereby ceAIN and return NOT FOUND because 1 am unahla to krate tha individual mmnanv ate namarl mi- rCaa ramae4e t.a1n t COUNTX QF YORK OFFICE OF THE SHERIFF r 45 N. GEORGE ST., YORK, PA 17401 SHERIFF SERVICE PROCESS RECEIPT and AFFIDAVIT OF RETURN t PLAINTIFFIS/ Jaqueline M. Hearn vim. --m "W Z. COURT NUMBER 2008-7062 Clvll 4 TYPE OF WRIT OR COMPLAINT 44C)SUM Re?,SSLI d SERVE 5 NAME OF INDIVIDUAL, COMPANY, CORPORATION, ETC TO SERVE OR DESCRIPTION OF PROPERTY TO BE LEVIED, TTACHED, OR SOLD Mz`chael Loe - Personal Service Only 6 ADDRESS (STREET OR RFO WITH BOX NUMBER, APT NO, CITY, BORO. TWP, STATE AND ZIP CODE) AT 3 ,Andersoryt:own Road Mec ti hanicsbul PA 17055 "7 INDICATE SERVICE PERSONAL Q PER39N IN CHWRGJ 1DEPPTIZE ?.O.t;ER,T MAIL' 01ST CL*SSMAIL OPOSTED OTHER NOW 20_ I, SHERIFF OF Yo" PA d ereby*deputiz t sheriff of. ' OOUNTY to xecuk h .0 this- 4t cing to law. This deputlzation being made at the request and risk of the plaintiff. S. SPECIAL INSTRUCTIONS OR OTHER INFORMATION THAT WILL ASSIST IN EXPEDITING SERVICE SHERIFF OF VDIIIC OUNTY OUT OF CO CUMBERLAND ADV FEE-PAID BY ATTY. NOTE: ONLY APPLICABLE ON WRIT OF EXECUTION: N.B. WAIVER OF WATCHMAN - Any deputy sheriff levying upon or attachi an without a watchrmiii74n custody of whomever is found in possession, after not in ng y such y under within writ may leave same herein for any has. destruction, or removal of an e t g person of levy or attachment, without liability on the part of such deputy or the sheriff to any plaintiff ? any property before sheriffs sale thereon. 9. TYPE NAME and AODRESS of ATTORNEY /ORIGINATOR and SIGNATUR 1300 LIN 1T4Ni'LHEW S. CROSBY, ESQ. 10. TELEPHONE NUMBER 11. DATE FILED GL TOWN BMD HARRISBURG, PA 1711.0 717-238--2000 12-30-08 12.'SEND NOTICE OF SERVICE COPY TO NAME AND ADDRESS BELOW: (This area must be completed it notice is to be mailed). CUMBERLAND CO SHERIFF SP>KCE BEt.OW fOR USE OF T1 L Stith ff - 00 NOT WRITIE OW THIS 13. 1 acknowledge receipt of the writ LAE or complaint as 4lidipted above. 16. HOW SERVED: PERSONAL 17. O? 1 hereby ceryfy and return a J F 16. W1ME nc ?u 'nn? ¦ 22 W 3. Advance Costs $100.00 ¦ y SERVICE CALL (717) 771-9601 O STRWTIOM PLEASE TYPE ONLY LW 1 T1ftU 12 DO NOT DETACH ANY COPES 14. DATE RECEIVED 15. ExpirationlHearing Date 1.-14-2009 1229-09 SHERIFF'S OFFICE ( ) OTHER( ) SEE REMARKS BELOW etc. named above. (See remarks below.) ati ship to Defe nqigpateo Se rvic 20 Ti o Time Mies Int. rrhe Miles Int Date Time Miles / nt. - t yy A , !4. Service Costs 25. NIF 26. Mileage 27. Postage 28. Sub Total 29. Pound 39_Notwy 31 is 35. Advance Costs 36. Service Costs 37. Notary Cert. 38. MileagelPostageJNot Found -'reRwrcu ana suDSCribed to t eforE me th s ', ! ?- 2. day of A44. Signature of Y 46. Signauun: of York NOTARIAL SEAL County Sheriff LISA L, BOWMAN, NOTARY PUBLIC RICHARD P. CITY OF YORK, YORK COUNTY MYCOMMISSION EXPIRESAUG. 12, 2009 49. Signature of Foreign ACKN r.. County Sheriff OF AUTHORIZED ISSUING AUTHORITY AND TITLE SIGNATURE WHITE - Issuxq Authority 2. PINK - Attorney 3. CANARY - Sheriffs Office 4. BLUE - Shia RESIDENCE POSTED( ) POE FOUND because I am unable to locate the individual oompam IERVED PRESS E IF NOT SHAWN )((R?, Date Time Ntil Int Date Time Miles Int t Surchg. 39. Total Costs 40 Costs Due or Refund so ANS 4 DA /j 47. DATE (f S HER F 1-27-09 ° 49 DATE 5 DA E RECEIVED r. w P, L 0-0 it-?E T.2 2010 FEB 22 Ail 11 Matthew S. Crosby, Esq. I, D.#69367 HANDLER, HENNING & ROSENBERG, LLP 1300 Linglestown Road Harrisburg, PA 17110 Telephone: (717) 238-2000 Attorneys for Plaintiff Fax : (717) 233-3029 E-mail: Crosby@HHRLaw.com JACQUELINE M. HEARN, IN THE COURT OF COMMON PLEAS Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA V. NO. 2008-7062 CIVIL TERM MICHAEL LOE, Defendant CIVIL ACTION - LAW NOTICE YOU HAVE BEEN SUED IN COURT. If you wish to defend against the claims set forth in the following pages, you must take action within twenty (20) days after this Complaint and Notice are served, by entering a written appearance personally or by attorney and filing in writing with the Court your defenses or objections to the claims set forth against you. You are warned that if you fail to do so the case may proceed without you and a judgment may be entered against you by the Court without further notice for any money claimed in the Complaint or for any other claim or relief requested by the Plaintiff. You may lose money or property or other rights important to you. YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO NOT HAVE A LAWYER, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW. THIS OFFICE CAN PROVIDE YOU WITH INFORMATION ABOUT HIRING A LAWYER. IF YOU CANNOT AFFORD TO HIRE A LAWYER, THIS OFFICE MAY BE ABLE TO PROVIDE YOU WITH INFORMATION ABOUT AGENCIES THAT MAY OFFER LEGAL SERVICES TO ELIGIBLE PERSONS AT A REDUCED FEE OR NO FEE. CUMBERLAND COUNTY BAR ASSOCIATION 2 Liberty Avenue, Carlisle, PA 17013 Telephone 717-249-3166 or 800-990-9108 A V I S 0 LISTED HA SIDO DEMANDADO/A EN CORTE. Si usted desea defenderse de las demandas que se presentan mtts adelante en ]as siguientes paginas, debe tomar accion dentro de los prbximos veinte (20) dias despues de la notificacion de esta Demanda y Aviso radicando personalmente o por medio de un abogado una comparecencia escrita y radicando en la Corte por escrito sus defensas de, y objecciones a, las demandas presentadas aqui en contra suya. Se le advierte de que si usted falla de tomar acci6n como se describe anteriormente, el caso puede proceder sin usted y un fallo por cualquier suma de dinero reclamada en la demanda o cualquier otra reclamaci6n o remedio solicitado por el demandante puede ser dictado en contra suya por la Corte sin m6s aviso adicional. Usted puede perder dinero o propiedad u otros derechos importantes para usted. USTED DEBE LLEVAR ESTE DOCUMENTO A SU ABOGADO INMEDIATAMENTE. SI USTED NO TIENE UN ABOGADO, LLAME O VAYA A LA SIGUIENTE OFICINA. ESTA OFICINA PUEDE PROVEERLE INFORMACION A CERCA DE COMO CONSEGUIR UN ABOGADO. SI USTED NO PUEDE PAGAR POR LOS SERVICIOS DE UN ABOGADO, ES POSIBLE QUE ESTA OFICINA LE PUEDA PROVEER INFORMACION SOBRE AGENCIAS QUE OFREZCAN SERVICIOS LEGALES SIN CARGO O BAJO COSTO A PERSONAS QUE CUALIFICAN. CUMBERLAND COUNTY BAR ASSOCIATION 2 Liberty Avenue, Carlisle, PA 17013 Telephone 717-249-3166 or 800-990-9108 HANDLER, HENWG & ROSENBERG, LLP By: Matthew S. Crosby, Esq. J Matthew S. Crosby, Esq. I.D. # 69367 HANDLER, HENNING & ROSENBERG, LLP 1300 Linglestown Road, Suite 2 Harrisburg, PA 17110 Telephone: (717) 238-2000 Attorneys for Plaintiff Fax: (717) 233-3029 E-mail: crosby@hhriaw.com JACQUELINE M. HEARN, Plaintiff V. MICHAEL LOE, Defendant IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA NO. 2008-7062 CIVIL TERM CIVIL ACTION - LAW COMPLAINT AND NOW, comes the Plaintiff, Jacqueline M. Hearn, by and through her attorneys, HANDLER, HENNING & ROSENBERG, LLP, by Matthew S. Crosby, Esq., and makes the within Complaint against the Defendant, Michael Loe, and avers as follows: 1. Plaintiff, Jacqueline M. Hearn, is a competent adult individual currently residing at 2627 Waldo Street, Harrisburg, Dauphin County, Pennsylvania. 2. Defendant, Michael Loe, is an adult individual currently residing at 8 Andersontown Road, Mechanicsburg, York County, Pennsylvania. J 3. At all times material hereto, Plaintiff, Jacqueline M. Hearn, was the owner and operator of a 2006 Mazda MZ6, co-owned by her boyfriend Michael G. Ford II and bearing Pennsylvania registration number TOOSEXE (hereinafter, "Plaintiff's vehicle.") 4. At all times material hereto, Defendant, Michael Loe, was the owner and operator of a 2006 Subaru, bearing Pennsylvania registration number PZB991 K (hereinafter, "Defendant's vehicle") 5. At all times material hereto, Plaintiff, Jacqueline M. Hearn, was not the named insured on any automobile insurance policy, nor was she an insured under any automobile insurance policy, and, therefore, is presumed to be a full-tort insured. 6. Further, pursuant to 75 Pa. C.S.A. § 1705(d), Plaintiff, Jacqueline M. Hearn, is permitted to recover non-economic damages as if she retained full-tort rights, because Plaintiff has sustained serious impairment of bodily function(s) and/or serious permanent disfigurement. 7. At all times material hereto, there were no adverse weather conditions. 8. On or about December 12, 2006, at approximately 3:42 p.m., Plaintiff, Jacqueline M. Hearn, was lawfully stopped at a stop sign on southbound Woodland Street, at the intersection of Woodland Street and Wesley Drive in Mechanicsburg, Cumberland County, Pennsylvania. 9. At approximately the same time and place, a Jeep Grand Cherokee operated by Russell C. Williams was stopped directly behind Plaintiff's vehicle, southbound on Woodland Street. 10. At approximately the same time and place, Defendant, Michael Loe, was traveling directly behind Mr. Williams' vehicle, southbound on Woodland Street. 2 11. Suddenly, and without any warning, Defendant, Michael Loe, struck the rear of Mr. Williams' vehicle, which in turn, struck the rear of Plaintiffs vehicle. 12. As a result of the collision, Plaintiff's vehicle was forcibly pushed into the intersection of Wesley Drive and Woodland Street. 13. As a direct and proximate result of the negligence of Defendant, Plaintiff, Jacqueline M. Hearn, sustained personal injuries as set forth more specifically below. 14. The occurrence of the aforementioned collision and all the resultant injuries to Plaintiff, Jacqueline M. Hearn, are the direct and proximate result of the negligence and/or carelessness of Defendant, Michael Loe, generally, and more specifically, as set forth below: (a) In driving his vehicle in careless disregard for the safety of persons or property in violation of 75 C.S.A. § 3714; (b) In failing to keep a proper lookout for vehicles lawfully stopped and/or slowing upon the roadway; (c) In failing to be reasonably vigilant to observe Russel C. Williams' vehicle lawfully upon the roadway; (d) In failing to be reasonably vigilantto observe Plaintiff's vehicle lawfully upon the roadway; (e) In following another vehicle more closely than was reasonable and prudent, in violation of 75 Pa. C.S.A. § 3310(a); (f) In failing to properly regulate the speed of Defendant's vehicle so as to prevent a rear-end collision; 3 1 (g) In failing to operate Defendant's vehicle in such a manner that would allow him to apply the brakes and stop before striking the rear of Russel C. Williams' vehicle; (h) In failing to operate Defendant's vehicle at a speed at which he could stop within the assured clear distance ahead, in violation of 75 Pa. C.S.A. § 3361; (i) In failing to have sufficient control of Defendant's vehicle, which would have allowed said vehicle to be stopped before doing injury to any person; Q) In failing to operate Defendant's vehicle at a speed that was safe under the circumstances, in violation of 75 Pa.C.S.A. §3361; (k) In operating Defendant's vehicle at a speed in excess of the posted speed limits; and (1) In failing to be continuously alert, in failing to perceive any warning of danger that was reasonably likely to exist, and in failing to have Defendant's vehicle under such control that injury to persons or property could be avoided. 15. As a direct and proximate result of the negligence of Defendant, Michael Loe, Plaintiff, Jacqueline M. Hearn, has suffered extensive personal injuries, including, but not limited to, injuries to her left shoulder, abdomen, left brachial plexus, permanent scarring, and thoracic outlet syndrome. 16. As a direct and proximate result of the negligence of Defendant, Plaintiff, Jacqueline M. Hearn, has undergone continuing medical care for the aforesaid injuries. 4 17. As a direct and proximate result of the negligence of Defendant, Michael Loe, Plaintiff, Jacqueline M. Hearn, has suffered physical pain, discomfort, and mental anguish, and she will continue to endure the same for an indefinite period of time in the future, to her physical, emotional, and financial detriment and loss. 18. As a direct and proximate result of the negligence of Defendant, Plaintiff, Jacqueline M. Hearn, has been compelled, in order to effect a cure for the aforesaid injuries, to spend money for medicine and/or medical attention, and will be required to spend money for the same purposes in the future, to her detriment and loss. 19. As a direct and proximate result of the negligence of Defendant, Plaintiff, Jacqueline M. Hearn, has suffered a loss of life's pleasures, and she will continue to suffer the same in the future, to her detriment and loss. 20. As a direct and proximate result of the negligence of Defendant, Plaintiff, Jacqueline M. Hearn, has suffered a loss of income. 21. As a direct and proximate result of the negligence of Defendant, Michael Loe, Plaintiff, Jacqueline M. Hearn, has been, and will in the future be, hindered from attending to her daily duties and chores, to her detriment, loss, humiliation, and embarrassment. 22. Plaintiff, Jacqueline M. Hearn, believes and, therefore, avers that her injuries are permanent and serious and have caused serious impairment of bodily function(s) as well as serious permanent disfigurement. 5 e WHEREFORE, Plaintiff, Jacqueline M. Hearn, seeks damages from Defendant, Michael Loe, in an amount in excess of the compulsory arbitration limits of Cumberland County, exclusive of interest and costs. Respectfully submitted, HANDLER_,,,HENA NG & ROSENBERG, LLP Date: 7_ j (? 1 (v By: Matthew S. Cr by, Esq. I. D. # 69367 Attorneys for Plaintiff 6 J VERIFICATION PURSUANT TO Pa RCP No 1024 c) MATTHEW S. CROSBY, ESQ. states that he is the attorney for the party(ies) filing the foregoing document; that he makes this Complaint as an attorney and verifies that it is correct and accurate to the best of his knowledge, information and belief and that this statement is made subject to the penalties of 18 Pa. C.S.A., Section 4904 relating to unsworn falsification to authorities. MATTHEW S. DATE: 2-.? i (91 1 10 OSBY, ESQ. Matthew S. Crosby, Esq. I . D.#69367 HANDLER, HENNING & ROSENBERG, LLP 1300 Linglestown Road Harrisburg, PA 17110 Telephone: (717) 238-2000 Fax: (717) 233-3029 E-mail: Crosby@hhrlaw.com JACQUELINE M. HEARN, Plaintiff V. MICHAEL LOE, Defendant Attorneys for Plaintiff IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA NO. 2008-7062 CIVIL TERM CIVIL ACTION - LAW CERTIFICATE OF SERVICE I hereby certify that a true and correct copy of the foregoing was served on the Defendant by sending a copy of the same to him at: Michael Loe 8 Andersontown Rd. Mechanicsburg, PA 17055 by United States Certified mail in Harrisburg, Pennsylvania on February(j, 2010. LANJDLER, H NING & ROSENBERG, LLP hew S. Crosby, Esq. Attorneys for Plaintiff DATE: FILE D- M"_ nrP Ne,) TA,V Matthew S. Crosby, Esq. I. D.#69367 HANDLER, HENNING & ROSENBERG, LLP 1300 Linglestown Road Harrisburg, PA 17110 Telephone: (717) 238-2000 Fax: (717) 233-3029 E-mail: CrosbvC&-hhrlaw.com 2010 FEB 22 Ark 11:4 5 Attorneys for Plaintiff JACQUELINE M. HEARN, IN THE COURT OF COMMON PLEAS Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA V. NO. 2008-7062 CIVIL TERM MICHAEL LOE, Defendant CIVIL ACTION - LAW CERTIFICATE OF SERVICE I hereby certify that a true and correct copy of the Plaintiff's Request for Production of Documents Directed to Defendant, Michael Loe, and the Plaintiffs First Set of Interrogatories Directed to Defendant, Michael Loe, were served on the Defendant by sending a copy of the same to him at: Michael Loe 8 Andersontown Rd. Mechanicsburg, PA 17055 by United States Certified mail in Harrisburg, Pennsylvania on February(_'?, 2010. HAN M atth;; i M S. C 1f l D DATE: Attorneys for 1 ING & ROSENBERG, LLP by, Esq. intiff -FILED-is-F lC E THE T?ir_ Pt?rC1TP.a ,OTAPY 2010 MAR -4 Phi 2: 58 CUM3` -J'a ?w 0JNTY PE,NNSYLV, 'qlA Matthew S. Crosby, Esq. I. D.#69367 HANDLER, HENNING & ROSENBERG, LLP 1300 Linglestown Road Harrisburg, PA 17110 Telephone: (717) 238-2000 Fax : (717) 233-3029 E-mail: Crosby@HHRLaw.com Attorneys for Plaintiff JACQUELINE M. HEARN, Plaintiff V. MICHAEL LOE, Defendant IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA NO. 2008-7062 CIVIL TERM CIVIL ACTION - LAW PRAECIPE TO THE PROTHONOTARY: Please substitute the attached Verification for the attorney's Verification in the recently filed Complaint in this matter. Thank you. HANDLER, N NG & ROSENBERG, LLP By Matthew S. Crosby, Esq. Attorney I.D. #69367 Attorneys for Plaintiff DATE: ?' V VERIFICATION THE UNDERSIGNED hereby verifies that the statements in the foregoing document are based on information that was gathered by counsel in preparation of this lawsuit. The language of the above-named document is of counsel and not of my own. I have read the said document and, to the extent that it is based on information that I gave to counsel, it is true and correct to the best of my knowledge, information and belief. To the extent that the contents of the said document is that of counsel, I have relied upon my counsel in preparing this Verification. THE UNDERSIGNED also understands that the statements therein are made subject to the penalties of 18 Pa.R.C.P. 2252(d), relating to unsworn falsification to authorities. DATE: 0?2 ab ID 4ACELINE HEARN Johnson, Duffie, Stewart & Weidner By: Jefferson J. Shipman I.D. No. 51785 301 Market Street P. O. Box 109 Lemoyne, Pennsylvania 17043-0109 (717) 761-4540 jjs@jdsw.com JACQUELINE M. HEARN, Plaintiff V. MICHAEL LOE, Defendant FILEDCrT,CE OF THE PROTH10JN3CTARY 2010 MAR 22 AN 6: 3 6 Attorneys for Defendant Cum tW IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA NO. 2008-7062 CIVIL TERM CIVIL ACTION - LAW JURY TRIAL DEMANDED PRAECIPE TO ENTER APPEARANCE 49- AND NOW, this day of March, 2010, enter the appearance of JEFFERSON J. SHIPMAN, I.D. 51785, on behalf of Defendant in the above captioned suit. JOHNSON, DUFFIE, STEWART & WEIDNER B' ffe son J. Ship an :395543 of `. CERTIFICATE OF SERVICE AND NOW, this Lhday of March, 2010, the undersigned does hereby certify that she did this date serve a copy of the foregoing document upon the other parties of record by causing same to be deposited in the United States Mail, first class postage prepaid, at Lemoyne, Pennsylvania, addressed as follows: Matthew S. Crosby, Esquire Handler, Henning & Rosenberg, LLP 1300 Linglestown Road Harrisburg, PA 17110 JOHNSON, DUFFIE, STEWART & WEIDNER r By: / ichelle H. Spangl Johnson, Duffie, Stewart & Weidner By: Jefferson J. Shipman I.D. No. 51785 301 Market Street P. O. Box 109 Lemoyne, Pennsylvania 17043-0109 (717) 761-4540 jjs@jdsw.com JACQUELINE M. HEARN, Plaintiff V. MICHAEL LOE, Defendant Attorneys for Defendant IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA NO. 2008-7062 CIVIL TERM CIVIL ACTION - LAW JURY TRIAL DEMANDED NOTICE TO PLEAD 0 - O: Jacqueline M. Hearn Itz -T:1 1V-, 1Tt r.,.^i ' ?a ?? -TI -? r :; c/o Matthew S. Crosby, Esquire 5 I7, b Handier, Henning & Rosenberg LLP , 1300 Linglestown Road Harrisburg, PA 17110 w AND NOW, this 25th day of March, 2010, you are hereby notified to plead responsively within twenty (20) days of the date of service hereof, or judgment may be entered against you. JOHNSON, DUFFIE, STEWART & WEIDNER y: AJSS :395696 e e spman a ? Johnson, Duffle, Stewart & Weidner By: Jefferson J. Shipman I.D. No. 51785 301 Market Street P. O. Box 109 Lemoyne, Pennsylvania 17043-0109 (717) 761-4540 jjs@jdsw.com JACQUELINE M. HEARN, Plaintiff Attorneys for Defendant IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA NO. 2008-7062 CIVIL TERM V. MICHAEL LOE, Defendant CIVIL ACTION - LAW JURY TRIAL DEMANDED ANSWER AND NEW MATTER TO PLAINTIFF'S COMPLAINT AND NOW, c omes the Defendant, Michael Loe, by and through his counsel Jefferson J. Shipman and Johnson, Duffie, Stewart & Weidner, and files the following Answer and New Matter to Plaintiffs Complaint: 1. Admitted upon information and belief. 2. Admitted. 3. Admitted upon information and belief. 4. Admitted. 5. Denied. The averments contained in paragraph 5 are conclusions of law to which no response is required. If a response is deemed to be required, the averments contained therein are specifically denied. 6. Denied. The averments contained in paragraph 6 are conclusions of law to which no response is required. If a response is deemed to be required, the averments contained therein are specifically denied. 7. Admitted. 8. Denied. After a reasonable investigation, Mr. Loe is without sufficient knowledge or information to form a belief as to the truth of the averments contained in paragraph 8 and the same are therefore denied. 9. Denied. After a reasonable investigation, Mr. Loe is without sufficient knowledge or information to form a belief as to the truth of the averments contained in paragraph 9 and the same are therefore denied. 10. Admitted. 11. Admitted in Part. Denied in Part. It is admitted that Mr. Loe's vehicle made contact with the rear of the Williams' vehicle. After a reasonable investigation, Mr. Loe is without sufficient knowledge or information to form a belief as to the truth of the remaining averments of paragraph 11. 12. Denied. After a reasonable investigation, Mr. Loe is without sufficient knowledge or information for form a belief as to the truth of the averments contained in paragraph 12 and the same are therefore denied. 13. Denied. The averments contained in paragraph 13 are conclusions of law and fact to which no response is required. If a response is deemed to be required, the averments contained therein are specifically denied. 14. Denied. The averments contained in paragraph 14 and subparagraphs (a) through (1) are conclusions of law and fact to which no response is required. If a response is deemed to be required, the averments contained therein are specifically denied. (a) Denied. It is specifically denied that Mr. Loe drove his vehicle in careless disregard for the safety of persons or property in violation of 75 Pa. C.S.A. § 3714; (b) Denied. It is specifically denied that Mr. Loe failed to keep a proper lookout for vehicles lawfully stopped and/or slowing upon the roadway; (c) Denied. It is specifically denied that Mr. Loe failed to be reasonably vigilant to observe Russel C. Williams' vehicle lawfully upon the roadway; (d) Denied. It is specifically denied that Mr. Loe failed to be reasonably vigilant to observe Plaintiffs vehicle lawfully upon the roadway; (e) Denied. It is specifically denied that Mr. Loe followed another vehicle more closely than was reasonable and prudent in violation of 75 Pa. C.S.A. 3310(a); (f) Denied. It is specifically denied that Mr. Loe failed to properly regulate the speed of his vehicle so as to prevent a rear-end collision; (g) Denied. It is specifically denied that Mr. Loe failed to operate his vehicle in such a manner that would allow him to apply the brakes and stop before striking the rear of the Russel C. Williams' vehicle; (h) Denied. It is specifically denied that Mr. Loe failed to operate his vehicle at a speed at which he could stop within the assured clear distance ahead in violation of 75 Pa. C.S.A. 3361; (i) Denied. It is specifically denied that Mr. Loe failed to have sufficient control of Defendant's vehicle which would have allowed the vehicle to be stopped before doing alleged injury to any person; Q) Denied. It is specifically denied that Mr. Loe failed to operate his vehicle at a speed that was safe under the circumstances in violation of 75 Pa. C.S.A. 3361; (k) Denied. It is specifically denied that Mr. Loe operated his vehicle at a speed in excess of the posted speed limits; and (1) Denied. It is specifically denied that Mr. Loe failed to be continuously alert in failing to perceive any warning of danger that was reasonably likely to exist, and in failing to have his vehicle under such control that injury to persons or property could be avoided. 15. Denied. The averments contained in paragraph 15 are in part conclusions of law to which no response is required. After a reasonable investigation, Mr. Loe is without sufficient knowledge or information to form a belief as to the truth of the remaining averments of paragraph 15 and the same are therefore denied and strict proof is demanded at the time of trial. 16. Denied. The averments contained in paragraph 16 are in part conclusions of law to which no response is required. After a reasonable investigation, Mr. Loe is without sufficient knowledge or information to form a belief as to the truth of the remaining averments of paragraph 16 and the same are therefore denied and strict proof is demanded at the time of trial. 17. Denied. The averments contained in paragraph 17 are in part conclusions of law to which no response is required. After a reasonable investigation, Mr. Loe is without sufficient knowledge or information to form a belief as to the truth of the remaining averments of paragraph 17 and the same are therefore denied and strict proof is demanded at the time of trial. 18. Denied. The averments contained in paragraph 18 are in part conclusions of law to which no response is required. After a reasonable investigation, Mr. Loe is without sufficient knowledge or information to form a belief as to the truth of the remaining averments of paragraph 18 and the same are therefore denied and strict proof is demanded at the time of trial. 19. Denied. The averments contained in paragraph 19 are in part conclusions of law to which no response is required. After a reasonable investigation, Mr. Loe is without sufficient knowledge or information to form a belief as to the truth of the remaining averments of paragraph 19 and the same are therefore denied and strict proof is demanded at the time of trial. 20. Denied. The averments contained in paragraph 20 are in part conclusions of law to which no response is required. After a reasonable investigation, Mr. Loe is without sufficient knowledge or information to form a belief as to the truth of the remaining averments of paragraph 20 and the same are therefore denied and strict proof is demanded at the time of trial. 21. Denied. The averments contained in paragraph 21 are in part conclusions of law to which no response is required. After a reasonable investigation, Mr. Loe is without sufficient knowledge or information to form a belief as to the truth of the remaining averments of paragraph 21 and the same are therefore denied and strict proof is demanded at the time of trial. 22. Denied. The averments contained in paragraph 22 are in part conclusions of law to which no response is required. After a reasonable investigation, Mr. Loe is without sufficient knowledge or information to form a belief as to the truth of the remaining averments of paragraph 22 and the same are therefore denied and strict proof is demanded at the time of trial. WHEREFORE, Defendant, Michael Loe, respectfully requests that judgment be entered in his favor and the Plaintiff's Complaint be dismissed with prejudice. NEW MATTER 23. That Plaintiff's alleged cause of action may be barred in whole or in part by the Pennsylvania Financial Responsibility Law and the limited tort option. 24. That if it should be found that there was any negligence on the part of Mr. Loe, which is denied, then in that event, any such negligence was not a substantial factor nor a factual cause of the Plaintiffs alleged harm. 25. That the Plaintiff's injuries may have been pre-existing. 26. That Plaintiff may have failed to mitigate his alleged injuries. 27. That the Plaintiff's alleged cause of action may have been caused by third parties or entities not presently involved in this action. 28. That the Plaintiff may have been contributorily negligent. WHEREFORE, Defendant, Michael Loe, respectfully requests that judgment be entered in his favor and the Plaintiff's Complaint be dismissed with prejudice. JOHNSON, DUFFIE, STEWART & WEIDNER e r on J. Ship an :395696 VERIFICATION The undersigned says that the facts set forth in the foregoing document are true and correct. This verification is made subject to the penalties of 18 Pa. C.S.A. § 4904, relating to unsworn falsifications to authorities. Michael Loe Dated: O d? CERTIFICATE OF SERVICE AND NOW, this 25th day of March, 2010, the undersigned does hereby certify that she did this date serve a copy of the foregoing document upon the other parties of record by causing same to be deposited in the United States Mail, first class postage prepaid, at Lemoyne, Pennsylvania, addressed as follows: Matthew S. Crosby, Esquire Handler, Henning & Rosenberg, LLP 1300 Linglestown Road Harrisburg, PA 17110 :395696 JOHNSON, DUFFIE, STEWART & WEIDNER BY: v2 helle H. Spangler FLLL ?OTNRY 2010 FAR 3 l Ph 2: y i Matthew S. Crosby, Esq. I. D. # 69367 HANDLER, HENNING & ROSENBERG, LLP 1300 Linglestown Road, Suite 2 Harrisburg, PA 17110 Telephone: (717) 238-2000 Attorneys for Plaintiff Fax : (717) 233-3029 E-mail: crosby@hhriaw.com JACQUELINE M. HEARN, Plaintiff V. MICHAEL LOE, Defendant IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA NO. 2008-7062 CIVIL TERM CIVIL ACTION - LAW PLAINTIFF'S REPLY TO DEFENDANT. MICHAEL LOE'S. NEW MATTER AND NOW, comes the Plaintiff, Jacqueline M. Hearn, by and through her attorneys, HANDLER, HENNING & ROSENBERG, LLP, by Matthew S. Crosby, Esq. and replies to Defendant, Michael Loe's, New Matter as follows: 23. Denied. The allegations in Paragraph 23 contain conclusions of law to which no response is required. If a response is judicially determined to be required, the averments contained therein are specifically denied. 24. Denied. The allegations in Paragraph 24 contain conclusions of law to which no response is required. If a response is judicially determined to be required, the averments contained therein are specifically denied. 25. Denied. The allegations in Paragraph 25 are denied, pursuant to Pa. C.P. Rule 1029(e). By way of further response, to the extent that the allegations contained in Paragraph 25 are conclusions of law, no response is required. If a response is judicially determined to be required, the averments contained therein are specifically denied. 26. Denied. The allegations in Paragraph 26 contain conclusions of law to which no response is required. If a response is judicially determined to be required, the averments contained therein are specifically denied. 27. Denied. The allegations in Paragraph 27 contain conclusions of law to which no response is required. If a response is judicially determined to be required, the averments contained therein are specifically denied. 28. Denied. The allegations in Paragraph 28 contain conclusions of law to which no response is required. If a response is judicially determined to be required, the averments contained therein are specifically denied. 2 WHEREFORE, Plaintiff respectfully requests that this Honorable Court deny to Defendant Michael Loe's allegations and enter judgment in favor of the Plaintiff. Respectfully submitted, HAN By _.?....._ .... vvv„ . Attor ys for Plaintiff DATE: 3 3a ZDI v Jr I RG, LLP 3 Matthew S. Crosby, Esq. I. D. # 69367 HANDLER, HENNING & ROSENBERG, LLP 1300 Linglestown Road, Suite 2 Harrisburg, PA 17110 Telephone: (717) 238-2000 Attorneys for Plaintiff Fax : (717) 233-3029 E-mail: crosby@hhrlaw.com JACQUELINE M. HEARN, Plaintiff V. MICHAEL LOE, Defendant IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA NO. 2008-7062 CIVIL TERM CIVIL ACTION - LAW CERTIFICATE OF SERVICE I hereby certify that a true and correct copy of the foregoing was served on Defendant Michael Loe, by sending a copy of the same to his counsel of record, Jefferson J. Shipman, Esq., Johnson, Duf ie, Stewart & Weidner, P.C., 301 Market Street P.O. Box 109, Lemoyne, PA 17043-0109, by United States Mail, regular service, in Harrisburg, Pennsylvania on March 3? 2010. HANDLE DATE: 3> D ! b ROSENBERG, LLP BAew rosby, Esq. Plaintiff I IS Johnson, Duffle, Stewart & Weidner By: Jefferson J. Shipman I.D. No. 51785 301 Market Street P. O. Box 109 Lemoyne, Pennsylvania 17043-0109 (717) 761-4540 jjs@jdsw.com JACQUELINE M. HEARN, Plaintiff V. MICHAEL LOE, Defendant JURY TRIAL DEMANDED CERTIFICATE PREREQUISITE TO SERVICE OF A SUBPOENA PURSUANT TO RULE 4009.22 TO: Matthew S. Crosby, Esquire Handler, Henning & Rosenberg, LLP 1300 Linglestown Road Harrisburg, PA 17110 Attorneys for Plaintiff As a prerequisite to service of a subpoena for documents and things pursuant to Rule 4009.22, Defendant hereby certifies that: (1) A Notice Of Intent To Serve A Subpoena, with copies of the subpoenas attached thereto, was mailed, via Certified Mail, or delivered to each party at least 2G10JU 27 Fi'I I• WJ PM I ? 3a Attorneys for Def 0nf, , IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA NO. 2008-7062 CIVIL TERM CIVIL ACTION - LAW twenty days prior to the date on which the subpoenas were sought to be served; (2) A copy of the Notice of Intent including the proposed subpoenas, is attached to this Certificate; (3) No objection to the subpoenas has been received, the waiting period for objections was waived; and (4) The subpoenas to be served are identical to the subpoenas attached to the Notice Of Intent. JOHNSON, DUFFIE, STEWART & WEIDNER By C-1,F A 11 'A A-Aj" . , IA4ill Je der n J. Shi man, Esquire Attorneys I.D. #: 51785 301 Market Street P.O. Box 109 Lemoyne, PA 17043-0109 e-mail: jjs@jdsw.com DATE : ?,?, 0 Attorneys for Defendant CERTIFICATE OF SERVICE AND NOW, this 2& day of , 2010, the undersigned does hereby V- A certify that he did this date serve a copy of the oregoing document upon the other parties of record by causing same to be deposited in the United States Mail, first class postage prepaid, at Lemoyne, Pennsylvania, addressed as follows: Matthew S. Crosby, Esquire Handler, Henning & Rosenberg, LLP 1300 Linglestown Road Harrisburg, PA 17110 JOHNSON, DUFFIE, STEWART & WEIDNER By: J&Wrson J. Shi an, Esquire Johnson, Duffle, Stewart & Weidner By: Jefferson J. Shipman I.D. No. 51785 301 Market Street P. O. Box 109 Lemoyne, Pennsylvania 17043-0109 (717) 761-4540 jjs@jdsw.com JACQUELINE M. HEARN, Plaintiff V. MICHAEL LOE, Defendant Attorneys for Defendant IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA NO. 2008-7062 CIVIL TERM CIVIL ACTION - LAW JURY TRIAL DEMANDED NOTICE OF INTENT TO SERVE SUBPOENA TO PRODUCE DOCUMENTS AND THINGS FOR DISCOVERY PURSUANT TO RULE 4009.21 TO: Matthew S. Crosby, Esquire Handler, Henning & Rosenberg, LLP 1300 Linglestown Road Harrisburg, PA 17110 Attorneys for Plaintiff PLEASE TAKE NOTICE that Defendants intend to serve three (3) subpoenas identical to the ones that are attached to this notice. You have twenty (20) days from the date listed below in which to file of records and serve upon the undersigned objections to the subpoena. If no objections are made, the subpoenas may be served. JOHNS , DUFFIE, STEWART & WEIDNER By Jeff on J. Shipman, Esquire Attomeys I.D. #: 51785 301 Market Street P.O. Box 109 Lemoyne, PA 17043-0109 e-mail: jjs@jdsw.com DATE :' /01 610 Attorneys for Defendant CERTIFICATE OF SERVICE AND NOW, this day of u ! , 2010, the undersigned does hereby certify that he did this date serve a copy of the foregoing document upon the other parties of record by causing same to be deposited in the United States Mail, certified, first class postage prepaid, at Lemoyne, Pennsylvania, addressed as follows: Matthew S. Crosby, Esquire Handier, Henning & Rosenberg, LLP 1300 Linglestown Road Harrisburg, PA 17110 JOHNSON, DUFFIE, STEWART & WEIDNER By: J erson J. Shipman, Esquire COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND Jacqueline M. Hearn, Plaintiff vs. Michael Loe, Defendant File No. 08-7062 SUBPOENA TO PRODUCE DOCUMENTS OR THINGS FOR DISCOVERY PURSUANT TO RULE 4009.22 TO: Hershey Medical Center (Name of Person or Entity) Within twenty (20) days after service of this subpoena, you are ordered by the court to produce the following documents or things: All medical records, reports, diagnostic test results, correspondence office notes from January 1, 2002 through July 31. 2010 regarding Jacqueline Hearn DOB: 8118177 SSN: 176-58-9567 at Johnson Duffle Stewart & Weidner. 301 Market Street. P.O. Box 109. Lemoyne. PA 17043. You may deliver or mail legible copies of the documents or produce things requested by this subpoena, together with the certificate of compliance, to the party making this request at the address listed above. You have the right to seek in advance the reasonable cost of preparing the copies or producing the things sought. If you fail to produce the documents or things required by this subpoena within twenty (20) days after its service, the party serving this subpoena may seek a court order compelling you to comply with it. THIS SUBPOENA WAS ISSUED AT THE REQUEST OF THE FOLLOWING PERSON: NAME: Jefferson J. Shipman. Esquire ADDRESS: 301 Market Street Lemoyne. PA 17043 TELEPHONE: 717-761-4540 SUPREME COURT ID #: 51785 ATTORNEY FOR: Defendants DATE: Seal of the Court BY THE COURT: /S/ od442et ?01 Prothonotary/Clerk, Civil Division Deputy (Eff. 7/97) COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND Jacqueline M. Hearn, Plaintiff vs. Michael Loe, Defendant File No. 08-7062 SUBPOENA TO PRODUCE DOCUMENTS OR THINGS FOR DISCOVERY PURSUANT TO RULE 4009.22 TO: Draver Physical Therapy (Name of Person or Entity) Within twenty (20) days after service of this subpoena, you are ordered by the court to produce the following documents or things: All medical records. physical therapy records, diagnostic test results, correspondence, office notes, from January 1, 2002 through July 31. 2010 regarding Jacqueline Hearn DOB: 8118/77 SS: 176-58-9567 at Johnson. Duffle, Stewart & Weidner. 301 Market Street. P.O. Box 109, Lemoyne. PA 17043. You may deliver or mail legible copies of the documents or produce things requested by this subpoena, together with the certificate of compliance, to the party making this request at the address listed above. You have the right to seek in advance the reasonable cost of preparing the copies or producing the things sought. If you fail to produce the documents or things required by this subpoena within twenty (20) days after its service, the party serving this subpoena may seek a court order compelling you to comply with it. THIS SUBPOENA WAS ISSUED AT THE REQUEST OF THE FOLLOWING PERSON: NAME: Jefferson J. Shipman. Esquire ADDRESS: 301 Market Street Lemoyne. PA 17043 TELEPHONE: 717-7614540 SUPREME COURT ID #: 51785 ATTORNEY FOR: Defendants BY THE COURT: isr 1226sa 10 444e? Prothonotary/Clerk, Civil Division D uty DATE: Il?//G Seal of the Court (Eff. 7/97) COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND Jacqueline M. Heam, Plaintiff VS. Michael Loe, Defendant File No. 08-7062 SUBPOENA TO PRODUCE DOCUMENTS OR THINGS . FOR DISCOVERY PURSUANT TO RULE 4009.22 TO: Kandm. Filerer, Kuskin Associates (Name of Person or Entity) Within twenty (20) days after service of this subpoena, you are ordered by the court to produce the following documents or things: All medical records, reports, diagnostic test results, correspondence, office notes, from January 1. 2002 through July 31. 2010 renardina Jacqueline Heam DOB: 8118177 SSN: 176-58-9567 at Johnson, Duffie. Stewart & Weidner. 301 Market Street. P.O. Box 109. Lemoyne, PA 17043. You may deliver or mail legible copies of the documents or produce things requested by this subpoena, together with the certificate of compliance, to the party making this request at the address listed above. You have the right to seek in advance the reasonable cost of preparing the copies or producing the things sought. If you fail to produce the documents or things required by this subpoena within twenty (20) days after its service, the party serving this subpoena may seek a court order compelling you to comply with it. THIS SUBPOENA WAS ISSUED AT THE REQUEST OF THE FOLLOWING PERSON: NAME: Jefferson J. Shipman. Esquire ADDRESS: 301 Market Street Lemoyne. PA 17043 TELEPHONE: 717-761-4540 SUPREME COURT ID 51785 ATTORNEY FOR: Defendants BY THE COURT: DATE: 7&/ 4 10 Seal of the Court /Sl 0 -.0- eae"?? Prothonotary/Clerk, Civil Division ,43,f `2?.4--. Deputy (Eff. 7/97) Johnson, Duffle, Stewart & Weidner By: Jefferson J. Shipman I.D. No. 51785 301 Market Street P. O. Box 109 Lemoyne, Pennsylvania 17043-0109 (717) 761-4540 jjs@jdsw.com JACQUELINE M. HEARN, Plaintiff V. Attorneys for Defendant C= °Tt 3 _ cA rn ?• cn N Q ? C> N ri CD ?m IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA NO. 2008-7062 CIVIL TERM CIVIL ACTION - LAW MICHAEL LOE, JURY TRIAL DEMANDED Defendant CERTIFICATE PREREQUISITE TO SERVICE OF A SUBPOENA PURSUANT TO RULE 4009.22 TO: Matthew S. Crosby, Esquire Handler, Henning & Rosenberg, LLP 1300 Linglestown Road Harrisburg, PA 17110 Attorneys for Plaintiff As a prerequisite to service of a subpoena for documents and things pursuant to Rule 4009.22, Defendant hereby certifies that: (1) A Notice Of Intent To Serve A Subpoena, with copies of the subpoenas attached thereto, was mailed, via Certified Mail, or delivered to each party at least twenty days prior to the date on which the subpoenas were sought to be served; (2) A copy of the Notice of Intent including the proposed subpoenas, is attached to this Certificate; (3) No objection to the subpoenas has been received, the waiting period for objections was waived; and (4) The subpoenas to be served are identical to the subpoenas attached to the Notice Of Intent. JOH N, DUFFIE, TEWART & WEIDNER By J erson J. Shipman, Esquire Attorneys I.D. #: 51785 301 Market Street P.O. Box 109 Lemoyne, PA 17043-0109 e-mail: jjs@jdsw.com DATE : Jai l Attorneys for Defendant CERTIFICATE OF SERVICE 4 AND NOW, this a ?o day of A I o(At , 2011, the undersigned does hereby certify that he did this date serve a copy of he foregoing document upon the other parties of record by causing same to be deposited in the United States Mail, first class postage prepaid, at Lemoyne, Pennsylvania, addressed as follows: Matthew S. Crosby, Esquire Handler, Henning & Rosenberg, LLP 1300 Linglestown Road Harrisburg, PA 17110 JOHNSON, DUFFIE, STEWART & WEIDNER ?f! By: ' 4;.e ? -- J erson J. Shipman, Esquire Johnson, Duffle, Stewart & Weidner By: Jefferson J. Shipman I. D. No. 51785 301 Market Street P. O. Box 109 Lemoyne, Pennsylvania 17043-0109 (717) 761-4540 jjs@jdsw.com JACQUELINE M. HEARN, Plaintiff V. Defendant CIVIL ACTION - LAW JURY TRIAL DEMANDED NOTICE OF INTENT TO SERVE SUBPOENA TO PRODUCE DOCUMENTS AND THINGS FOR DISCOVERY PURSUANT TO RULE 4009.21 TO: Matthew S. Crosby, Esquire Handler, Henning & Rosenberg, LLP 1300 Linglestown Road Harrisburg, PA 17110 Attorneys for Plaintiff PLEASE TAKE NOTICE that Defendants intend to serve two (2) ubpoenas identical to the ones that are attached to this notice. You have twenty (20) days from the date listed below in which to file of records and serve upon the undersigned objections to the subpoena. If no objections are made, the subpoenas may be served. JOHNSON, DUFFIE, STEWART & WEIDNER By Jeff on J. Shipman, Esquire Atto eys I.D. #: 51785 301 Market Street P.O. Box 109 Lemoyne, PA 17043-0109 e-mail: jjs@jdsw.com DATE Attorneys for Defendant Attorneys for Defendant IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA NO. 2008-7062 CIVIL TERM CERTIFICATE OF SERVICE AND NOW, this q4-'day of AUGM 2011, the undersigned does hereby certify that he did this date serve a copy oft a foregoing document upon the other parties of record by causing same to be deposited in the United States Mail, certified, first class postage prepaid, at Lemoyne, Pennsylvania, addressed as follows: Matthew S. Crosby, Esquire Handler, Henning & Rosenberg, LLP 1300 Linglestown Road Harrisburg, PA 17110 °7? fferson J. Shipman, Esquire COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND Jacqueline M. Hearn, Plaintiff vs. Michael Loe, Defendant File No. 08-7062 SUBPOENA TO PRODUCE DOCUMENTS OR THINGS FOR DISCOVERY PURSUANT TO RULE 4009.22 TO: Tristan Associates (Name of Person or Entity) Within twenty (20) days after service of this subpoena, you are ordered by the court to produce the following documents or things: Following films on CD: MRI C-spine dated 1118/07; MRI Left shoulder dated 2/22/07 regarding Jacqueline Hearn DOB: 8/18177 SSN: 176-58-9567 - --- --_- atJohn a Stewart R Weidner 301 Market Street P n Bo 109_LemoyneYPE_11Q43_ You may deliver or mail legible copies of the documents or produce things requested by this subpoena, together with the certificate of compliance, to the party making this request at the address listed alcove. You have the right to-seek-in advance- the reasorrabte cost of preparing the -copies-or producing the things sought. If you fail to produce the documents or things required by this subpoena within twenty (20) days after its service, the party serving this subpoena may seek a court order compelling you to comply with it. THIS SUBPOENA WAS ISSUED AT THE REQUEST OF THE FOLLOWING PERSON: NAME: Jefferson J. Shipman. Esquire ADDRESS: 301 Market Street Lemoyne. PA 17043 TELEPHONE: 717-761-4540 SUPREME COURT ID #: 51785 ATTORNEY FOR: Defendants BY THE COURT: Pro onotary/Clerk Civil Division DATE: ? )-a" Seal of th Court Deputy (Eff. 7/97) COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND File No. 08-7062 Jacqueline M. Hearn, Plaintiff vs. Michael Loe, Defendant SUBPOENA TO PRODUCE DOCUMENTS OR THINGS FOR DISCOVERY PURSUANT TO RULE 4009.22 TO: Hershey Medical Center (Name of Person or Entity) Within twenty (20) days after service 'of this subpoena, you are ordered by the court to produce the following documents or things: 'Followina films and/or scans on CD: CT scan of abdomen dated 12122/06; MRI chest dated 11/1/07 regarding Jacqueline Hearn DOB: 8118/77 SSN: 176-58-9567 at Johnson Duffie Stewart & Weidner, 301 Market Street P.O. Box 109, Lemoyne, PA 17043. You may deliver or mail legible copies of the documents or produce things requested by this subpoena, -together-with the certificate of compliance-, to-the--party- making this request- at the-address listed above. You have the right to seek in advance the reasonable cost of preparing the copies or producing the things sought. If you fail to produce the documents or things required by this subpoena within twenty (20) days after its service, the party serving this subpoena may seek a court order compelling you to comply with it. THIS SUBPOENA WAS ISSUED AT THE REQUEST OF THE FOLLOWING PERSON: NAME: ADDRESS: TELEPHONE: SUPREME COURT ID #: ATTORNEY FOR: Jefferson J. Shipman, Esquire 301 Market Street Lemoyne, PA 17043 717-761-4540 51785 Defendants BY THE CO lerk, /Civil Division DATE: D2 Seal of the Court Deputy (Eff. 7/97) CA 4 TL, X-71 rum rn z PRAECIPE FOR LISTING CASE FOR TRIAL tV (Must be typewritten and submitted in triplicate) 0 3 1 C) xn TO THE PROTHONOTARY OF CUMBERLAND COUNTY X %3 r Please list the following case: - ?-7 for JURY trial at the next term of civil court 47 - . ? for trial without a jury. ---------------------------------------- ----------------------------------------------------------------------------- CAPTION OF CASE (entire caption must be stated in full) (check one) X? Civil Action - Law JACQUELINE M. ? Appeal from arbitration HEARN ? (other) (Plaintiff) vs. The trial list will be called on Aug. 21, 2012 MICHAEL LOE and Trials commence on September 17, 2012 (Defendant) Pretrials will be held on September 5, 2012 VS. (Briefs are due S days before pretrials No. 2008-7062 Civil Term Indicate the attorney who will try case for the party who files this praecipe: Jefferson J. Shipman, Esq., 301 Market St., Lemoyne, PA 17043 (for Defendant) Indicate trial counsel for other parties if known: Matthew S. Crosby, Esq., 1300 Linglestown Road, Ste. 2,?lar sburg, PA 17110 (for Plaintiff) This case is ready for trial. Sig / 4171 ?LrL V 91 Print Name: Jefferson J. Shipman Date: June 28, 2012 Attorney for: Defendant, Michael Loe cLc 'Kol7T .:". ::~ ...,, `~~ i= ~° ~~`' v> ~-- -.c Matthew S. Crosby Attorney ID# 69367 HANDLER, HENNING & ROSENBERG, LLP 1300 Linglestown Road Harrisburg, PA 17110 Telephone (717) 238-2000 Fax ~ (717) 233-3029 E-mail Crosby@hhrlaw.com Attorney for Plaintiff ,... .~ c' (_ ~:~ ', ,; _' .,Y's :. . ', ~ ~ is .~- - ~.. . ~:~ ~~ ~ ,- rv 'i _`. .. r:~ I ~, JACQUELINE M. HEARN, Plaintiff, v. . MICHAEL LOE, . Defendant IN THE COURT OF COMMON PLEAS CUMBERLAND, PENNSYLVANIA NO. 2008-7062 CIVIL ACTION -LAW PLAINTIFF'S FIRST REQUEST FOR ADMISSIONS DIRECTED TO DEFENDANT. MICHAEL LOE Pursuant to Pa. R.C.P. Rule 4014, Plaintiff requests that Defendant, Michael Loe, within 30 days after service of this request, make the following admissions for purposes of this action only and subject to all pertinent objections to admissibility, which may be interposed at trial: L11 REQUEST FOR ADMISSION NO. 1 Dr. A. Lee Dellon is a surgeon with Dellon Institute for Peripheral Nerve Surgery at 1122 Kennilworth Dr., Suite 18, Towson, MD 21204. INTERROGATORY NO. 1 State all facts known to you or to your representative, including your attorneys, that support your failure to admit the prior Request i~or Admission, including the source of such knowledge, listing the full names and addresses of all witnesses to such facts, and the substance of the respective testimony of each. REQUEST FOR PRODUCTION NO. 1 Produce and attach photocopies of all documents as defined in Rule 4009, which support your failure to admit the prior Requests for Admission and which support your answer to the prior Interrogatory, and list in your response by author, date, and content, each item you are so producing and attaching. 12) REQUEST FOR ADMISSION NO.2 My attorney's office retained Dr. Dellon to conduct an Independent Medical Examination (IME) of the Plaintiff, Jacqueline Hearn, and review Ms. Hearn's medical records. INTERROGATORY NO. 2 State all facts known to you or to your representative, including your attorneys, that support your failure to admit the prior Request for Admission, including the source of such knowledge, listing the full names and addresses of all witnesses to such facts, and the substance of the respective testimony of each. REQUEST FOR PRODUCTION NO.2 Produce and attach photocopies of all documents as defined in Rule 4009, which support your failure to admit the prior Requests for Admission and which support your answer to the prior Interrogatory, and list in your response by author, date, and content, each item you are so producing and attaching. (3) REQUEST FOR ADMISSION NO.3 On or about November 22, 2011, Dr. Dellon completed a physical examination of the Plaintiff, Jacqueline Hearn, at his office in Towson, MD. INTERROGATORY NO. 3 State all facts known to you or to your representative, including your attorneys, that support your failure to admit the prior Request for Admission, including the source of such knowledge, listing the full names and addresses of all witnesses to such facts, and the substance of the respective testimony of each. REQUEST FOR PRODUCTION NO. 3 Produce and attach photocopies of all documents as defined in Rule 4009, which support your failure to admit the prior Requests for Admission and which support your answer to the prior Interrogatory, and list in your response by author, date, and content, each item you are so producing and attaching. (41 REQUEST FOR ADMISSION N0.4 In addition, at some time before November 23, 2011, Dr. Dellon also reviewed medical records of Plaintiff, Jacqueline Hearn, provided to him by my legal representatives(s). INTERROGATORY NO. 4 State afl facts known to you or to your representative, including your attorneys, that support your failure to admit the prior Request i~or Admission, including the source of such knowledge, listing the full names and addresses of all witnesses to such facts, and the substance of the respective testimony of each. REQUEST FOR PRODUCTION N0.4 Produce and attach photocopies of all documents as defined in Rule 4009, which support your failure to admit the prior Requests for Admission and which support your answer to the prior Interrogatory, and list in your response by author, date, and content, each item you are so producing and attaching. (5) REQUEST FOR ADMISSION NO. 5 After his physical examination of Plaintiff, Jacqueline Hearn and his review of her medical records, Dr. Dellon reported his findings; to my attorney. INTERROGATORY NO.S State all facts known to you or to your representative, including your attorneys, that support your failure to admit the prior Request for Admission, including the source of such knowledge, listing the full names and addresses of all witnesses to such facts, and the substance of the respective testimony of each. REQUEST FOR PRODUCTION NO. 5 Produce and attach photocopies of all documents as defined in Rule 4009, which support your failure to admit the prior Requests for Admission and which support your answer to the prior Interrogatory, and list in your response by author, date, and content, each item you are so producing and attaching. Respectfully submitted, HANDL,EFi; H1=`i,VNII~G 8~ ROSENBERG, LLP Dated: hew S. Matthew S. Crosby Attorney ID# 69367 HANDLER, HENNING 8~ ROSENBERG, LLP ~' 1300 Linglestown Road Harrisburg, PA 17110 Telephone: (717) 238-2000 Attorney for Plaintiff(s) '' Fax : (717) 233-3029 E-mail: Crosby@hhrlaw.com ' JACQUELINE M. HEARN, IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA ~' Plaintiff, ', v• NO. 2008-7062 CIVIL ACTION -LAW MICHAEL LOE, Defendant I, CERTIFICATE OF SERVICE On , 2012, I hereby certify that a true and correct copy of foregoing was served upon tl~e following by hand-delivering the same to Defendant's counsel of record: Jefferson J. Shipman, Esq. Johnson, Duffie, Stewart & Weidner, P.C. 301 Market Street P.O. Box 109 Lemoyne, PA 17043-0109 -°----- DLER, I•I~NNhNG & R~NBERG, LLP. Dated: Matth .Crosby ' Matthew S. Crosby Attorney IDI« 69357 HANDLER, HENNING & ROSENBERG, LLP 1300 Lindiestown Road Harrisburg, PA 17110 Telephone: (717) 238-2000 Fax : (T17) 233-3029 E-mail: Crosby~hhrlaw.com t~i~.f~i~-(J~' Fii/ 2012 AUG 27 PM 2~ I 1 ~~ NNSYLWAt~A ~~ Attorney for Plaintiff(s) 1ACQUEUNE M. HEARN, IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PE~1NS~'LVANiA Plaintiff, v. N0.2008-7062 CIVIL ACTION -LAW MICHAEL LOE, . Defendant CERTIFICATE OF SERVICE On August 2v1, 2012, I hereby certify that a true and correct copy of the Notice to Attend was s upon the following by depositing same in the United States Mail, in Harrisburg, Pennsylvania: Jefferson J. Shipman, Esq. Johnson, Duffle, Stewart & Weidner, P.C. 301 Market Street P.O. Box 109 Lemoyne, PA 17043-0109 Dated: ~~ ``~ Attorney ID No. 69367 1300 Linglestown Road Harrisburg, PA 17110 (717) 238-2000 Attorney for Plaintiff JACQUELINE M. HEARN, Plaintiff vs. MICHAEL LOE, Defendant IN THE COURT OF COMMON PLEAS OF ~.,, CUMBERLAND COUNTY, PENNSYLVAN~- CIVIL ACTION -LAW . csr A N0.08-7062 CIVIL m z ~x IN RE: PRETRIAL CONFERENCE Present at a pretrial conference held September 5, 2012, were Matthew S. Crosby, CvQ'~ ~ ~ r;, rn --c rn ~ ~ "e ~ rn ~ c~ -~ C'3 w~ Esquire, and Matthew Rosenberg, Esquire, attorneys for the plaintiff; and Jefferson J. Shipman, Esquire, attorney for the defendant. This case arises out of a motor vehicle collision that occurred on December 12, 2006, when the plaintiff was stopped at a legally posted stop sign and was struck from the rear by a vehicle which had, in turn, been struck by a vehicle operated by the defendant. The plaintiff contends that she suffered severe and permanent injuries to her left shoulder and arm. In the course of the past week, counsel for the defendant has received a vocational expert report from the defendant which will require extensive review and which will prevent the trial of this case during the week of September 17, 2012. By order of court of even date herewith, we have directed that the Prothonotary relist this case for trial in November. An independent medical examination was conducted on behalf of the defense by a Dr. Lee Dellon, aperipheral-nerve and hand surgeon. Dr. Dellon's report appears to be favorable to the plaintiff. Plaintiff s counsel, understandably, seeks to depose Dr. Dellon. The doctor has agreed to the deposition. Defense counsel objects. The deposition is set for Wednesday, September 12, 2012. Counsel will attempt to continue the deposition so that this legal issue may be resolved. On the other hand, if defense counsel agrees with the plaintiff's position, then judicial intervention will not be required. This issue appears to have been addressed, favorably to the plaintiff, in Dolan v. Fissell, 973 A.2d 1009 (Pa.Super. 2009). September 5, 2012 Matthew S. Crosby, Esquire Matthew Rosenberg, Esquire For the Plaintiff Jefferson J. Shipman, Esquire For the Defendant Court Administrator A. Hess, P.J. rlm JACQUELINE M. HEARN, IN THE COURT OF COMMON PLEAS OF Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA vs. CIVIL ACTION -LAW MICHAEL LOE, N0.08-7062 CIVIL Defendant ORDER AND NOW, this S"' day of September, 2012, following pretrial conference, it is ordered and directed that this matter be continued from the September term. The Prothonotary is directed to list this matter for trial during the trial term commencing November 26, 2012. BY THE COURT, ~ Matthew S. Crosby, Esquire Matthew Rosenberg, Esquire For the Plaintiff ~ Jefferson J. Shipman, Esquire For the Defendant ~ Court Administrator 7 1~1~ c~ c ~,,,, `~,; 3C ~ -~+ ~ -v ~--. ~m ~, ~ ~ ~' c` ~~ s ~~ .. ._.,r~r -a w c~ ~:~ Matthew S. Crosby (PA 69367) HANDLER, HENNING & ROSENBERG, LLP 1300 Linglestown Road, Suite 2 Harrisburg, PA 17110 Ph. 717.238.2000 Fax 717.233.3029 crosby@hhrlaw.com C". r_,a . '1.7:x n;, - M€'?a C7 :D, ;MM C-7 7-11 C Attorneys for Plaintiff IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA JACQUELINE M. HEARN, Plaintiff NO.: 2008-7062 V. MICHAEL LOE, Defendant CIVIL ACTION - LAW PLAINTIFF'S MOTION FOR PARTIAL SUMMARY JUDGMENT AND NOW comes the Plaintiff, Jacqueline Hearn ("Ms. Hearn"), by and through her attorneys, HANDLER, HENNING & ROSENBERG, LLP, by Matthew S. Crosby, Esq., and pursuant to Pa. R.C.P. 1035.1, et sue, submits the following Motion for Partial Summary Judgment against Defendant, Michael Loe ("Defendant"), on the issue of serious impairment of bodily function and/or permanent serious disfigurement, and in support avers as follows: 1. On December 12, 2006, at approximately 3:42 p.m., Ms. Hearn was driving a 2006 Mazda MZ6, which she co-owned with her boyfriend, Michael G. Ford II, southbound on F:\WP Directories\BMWotions & Petitions\SJ\Hearn\Hearn Motion 201209.docx Woodland Street and was lawfully stopped at a stop sign and attempting to turn left at the intersection with Wesley Drive in Mechanicsburg, Cumberland County, Pennsylvania. Pl's Compl. at ¶¶ 3, 8; Def's Answer at ¶ 3; Russell Williams Stmt. at pp. 1-4; and Police Report. Copies of the Plaintiff's Complaint, Defendant's Answer with New Matter, Russell Williams' Statement, and the Police Report are attached hereto, made a part hereof, and marked Exhibits "A,19 "B," "C," and "D," respectively. 2. At the same time, Russell C. Williams ("Mr. Williams") was driving a Jeep Grand Cherokee southbound on Woodland Street and was stopped directly behind Ms. Hearn's vehicle at the intersection with Wesley Drive. See Exhibit "A" at ? 9; Exhibit "C" at pp. 1-4; and Exhibit "D" at 1. 3. At the same time, Defendant was driving a 2006 Subaru southbound on Woodland Street, directly behind Mr. Williams' vehicle. See Exhibit "A" at ¶ 10; and Exhibit "B" at ¶ 10. 4. Defendant's vehicle collided with the rear Mr. Williams' vehicle, which then collided with the rear of Ms. Hearn's vehicle, pushing it into the intersection of Woodland Street and Wesley Drive. See Exhibit "A" ¶ 11; Exhibit "B" at ¶ 11; Exhibit "C" at pp. 4-5; and Exhibit "D" at 1. 5. As a result of the aforementioned collision, Ms. Hearn struck the steering wheel of her vehicle, causing personal injuries and more specifically a loss of the full use of her left arm. 6. On the date of this incident, Ms. Hearn was the co-owner of an uninsured motor vehicle and is, therefore, presumed to be a limited-tort insured. See 75 Pa.C.S.A. § 1705(a)(5). 2 7. Section 1705(d) of the Pennsylvania Motor Vehicle Financial Responsibility Law ("MVFRL") provides: Each person who elects the limited tort alternative remains eligible to seek compensation for economic loss sustained in a motor vehicle accident as a consequence of the fault of another person pursuant to applicable tort law. Unless the injury sustained is a serious injury, each person who is bound by the limited tort option shall be precluded from maintaining an action for any non-economic loss .... 75 Pa.C.S.A. § 1705(d) (emphasis added). 8. Section 1702 of the MVFRL defines "serious injury" as "[a] personal injury resulting in death, serious impairment of body function, or permanent serious disfigurement. 75 Pa.C.S.A. § 1702 (emphasis added). 9. Ms. Hearn, having been subject to the limited tort option at the time of the accident at issue, must produce sufficient medical evidence to show that she suffered a serious injury such that a bodily function has been seriously impaired. See McGee v. Muldowney, 750 A.2d 915, 915 (Pa. Super. Ct. 2000). 10. In Washington v. Baxter, 553 Pa. 434, 719 A.2d 733 (1998), the Supreme Court of Pennsylvania filled the definitional void with regard to "serious impairment of bodily function" by expressing and adopting the following standard from DiFranco v. Pickard, 427 Mich. 32, 398 NW.2d 896 (1986): The "serious impairment of body function" threshold contains two inquiries: a) What body function, if any, was impaired because of injuries sustained in a motor vehicle accident? b) Was the impairment of the body function serious? The focus of these inquiries is not on the injuries themselves, but on how the injuries affected a particular body function. Generally, medical testimony will be needed to establish the existence, extent, and permanency of the impairment .... In determining whether the impairment was serious, several factors should be considered: the 3 extent of the impairment, the length of time the impairment lasted, the treatment required to correct the impairment, and any other relevant factors. An impairment need not be permanent to be serious. Washington, 553 Pa. at 447-48, 719 A.2d at 740 (citing DiFranco, 398 N.W. 2d at 901). 11. Furthermore, when conducting a "serious injury" analysis, the focal point is not on the injury itself, but rather the nature and extent of the impairment resulting from the injury. Robinson v. Upole, 750 A.2d 339, 343 (Pa. Super. Ct. 2000). 12. The determination of whether a "serious injury" exists should be made by a jury, except in the clearest of cases where reasonable minds could not differ, in which case the determination may be made by a trial judge. See Washin tgon, 553 Pa. 434, 719 A.2d 733. 13. In Graham v. Campo, 990 A.2d 9 (Pa. Super. Ct. 2010), medical evidence was submitted at trial indicating that the plaintiff suffered from "strains and sprains in her cervical, thoracic, and lumbar regions, and a possible brachial plexopathy and ulnar neuropathy" and that the plaintiff's injuries will "[a]ffect her on a daily basis [in] her ability to reach, grasp, to use her arm on any repetitive basis." Id. at 17. Moreover, medical evidence indicated that the plaintiff's injuries "would likely be permanent and that she `basically is going to have to live with [the nerve damage]."' Id. at 18. The plaintiff also testified that "her injuries not only restrict her from her active life and her normal routine of exercising at the gym, but keep her from accomplishing ordinary tasks such as chores, self-maintenance, cooking, and driving." Id. At a bench trial, the trial judge found that, inter alia, the plaintiff suffered a serious impairment of a body function and the Superior Court agreed. Id. at 18. 14. Pennsylvania Rule of Civil Procedure 1035.2 provides that any party may move for summary judgment after the relevant pleadings have been closed, but within such time as not to delay trial. Pa.R.C.P. 1035.2. 4 15. In all summary judgment cases, the record must be viewed in a light most favorable to the non-moving party, and all doubts as to the existence of a genuine issue of material fact must be resolved against the moving party. Pa. State Univ. v. Cnty. of Centre, 532 Pa. 142, 143-145, 615 A.2d 303, 304 (1992). 16. As a result of the collision in the instant case, Ms. Hearn suffered the following serious injuries which have resulted in serious impairment of bodily function, specifically the limited use of her left arm, and have lasted over a six-year period: a. Abdomen pain, back pain, and left shoulder pain as a result of a left shoulder strain and left chest wall contusion. A copy of Plaintiff's Medical Record, dated Dec. 12, 2006, is attached hereto, made a part hereof, and marked as Exhibit "E"; b. Swelling and tingling in her left fingers, left shoulder pain and swelling, difficulty using her left arm, and abdominal pain. A copy of Plaintiff's Medical Records, dated Dec. 22, 2006, is attached hereto, made a part hereof, and marked as Exhibit "F"; C. Neck pain which radiates to her left shoulder, left upper extremity pain, limited range of motion of her neck, paresthesia related to radial plexopathy, decreased motor unit activation in several muscles of her left upper extremity and shoulder, and decreased strength in her left upper extremity. Copies of Plaintiff's Medical Records, dated Feb. 20, 2007, Mar. 6, 2007, Aug. 2, 2007, Nov. 19, 2007, Nov. 29, 2007, and Jan. 10, 2008, are attached hereto, made a part hereof, and marked as Exhibits "G," "H," "I," "J," "K," and "L," respectively; 5 d. Left brachial plexopathy and thoracic outlet syndrome. A copy of Plaintiff's Medical Record, dated Mar. 24, 2008, is attached hereto, made a part hereof, and marked as Exhibit "M"; and e. Muscle spasms, limited range of motion of her left shoulder, upper left extremity pain with weakness and radiation into her left arm and hand, and discomfort in her chest wall. Copies of Plaintiff's Medical Records, dated Apr. 17, 2008, June 19, 2008, Sep. 18, 2008, Nov. 24, 2008, June 9, 2009, Jan. 7, 2010, Jan. 26, 2012, and Feb. 2, 2012, are attached hereto, made a part hereof, and marked as Exhibits "N," "O," "P," "Q," "R,9' 64S," "T," and "U," respectively. 17. As a result of the aforementioned injuries, specifically the limited use of her left arm, Ms. Hearn has been seriously impaired with regard to her ability to perform household chores, sleep comfortably, swim with her children, ice skate/roller blade, ride roller coasters, and exercise. Pl.'s Depo. at pp. 19-23. A copy of Plaintiff's Deposition, dated Jan. 20, 2011, is attached hereto, made a part hereof, and marked as Exhibit "V." 18. As a result of the aforementioned injuries, specifically the limited use of her left arm, Ms. Hearn is seriously impaired with regard to her ability to perform jobs in the customer service industry, for which she is experienced, as she can no longer hold a phone and can only type 15 words per minute; much less than her pre-collision typing speed of 66 to 77 words per minute. See Exhibit "V" at pp.21-22; and Dr. Holmes Depo., at p. 44. A copy of Dr. Brian Holmes' Deposition, dated Aug. 20, 2012, is attached hereto, made a part hereof, and marked as Exhibit "W." 6 19. As a result of the aforementioned impairments, Ms. Hearn has received the following treatments in an effort to correct said serious impairments: a. Floroscopic left shoulder joint injection performed at Hershey Medical Center. A copy of Plaintiff's Medical Record, dated June 22, 2007, is attached hereto, made a part hereof, and marked as Exhibit "X"; b. Left brachial plexus exploration and neurolysis surgery with division of the anterior scalene muscle and division of the accessory scalene muscle performed at Hershey Medical Center. See Exhibit "M"; and C. Physical therapy at Drayer Physical Therapy Institute. A copy of Plaintiff's Physical Therapy Initial Evaluation, dated Dec. 29, 2006, is attached hereto, made a part hereof, and marked as Exhibit "Y." 20. As a result of the aforementioned left brachial plexus exploration and neurolysis surgery with division of the anterior scalene muscle and division of the accessory scalene muscle, Ms. Hearn has suffered a permanent serious disfigurement in the form of a four-inch scar. Pictures of Ms. Hearn's Surgical Scar are attached hereto, made a part hereof, and marked as Exhibit "Z." 21. In addition to the treatments received by Ms. Hearn, the following additional treatments have been recommended in an effort to reduce the current serious impairments Ms. Hearn suffers, specifically, the limited use of her left arm: a. Neurolysis of the ulnar nerve and an anterior submuscular transposition surgery of the ulnar nerve, as recommended by Dr. Dellon, or an ulnar nerve decompression surgery, as suggested as an alternative by Dr. Holmes. A copy of Dr. Lee Dellon's Defense Medical Examination 7 Report and Dr. Brian Holmes' Medical Report are attached hereto, made a part hereof, and marked as Exhibits "AA," and "BB," respectively. b. A resection surgery of the supraclavical nerve, which is causing pain on the left side of her chest. See Exhibit "AA"; and C. Anterior scalenectomy and repeat neurolysis surgery of the brachial plexus. See Exhibit "AA." 22. Dr. Brian Holmes, an independent medical examiner, concluded that Ms. Hearn suffered injury to her brachial plexus and the tissue surrounding it as a result of the collision. See Exhibit "W" at p. 22. 23. Dr. Holmes concluded that Ms. Hearn's injuries are permanent and she will suffer from "physical limitations" for the rest of her life. See Exhibit "W" at pp. 29-30. 24. Dr. Lee Dellon, an independent medical examiner hired by Defendant to examine Ms. Hearn, concluded that Ms. Hearn suffered a compressed nerve at her elbow, brachial plexus nerve compression on the left side, and supraclavicular nerve damage, all as a result of the collision. Dr. Dellon Depo., at p. 28. A copy of Dr. Dellon's Deposition, dated Sep. 12, 2012, is attached hereto, made a part hereof, and marked as Exhibit "CC." 25. Dr. Dellon suggested that if Ms. Hearn underwent the three aforementioned recommended surgeries, she has a 95 percent chance of "getting rid of the pain" and an 80 percent chance of getting strength and coordination back in her hand and less discomfort in her little and ring fingers. Dr. Dellon also noted that the success rate for a "re-do" brachial plexus surgery is 75 percent relief of discomfort in the shoulder, neck, and side of her face. See Exhibit "CC" at p. 33. s 26. A Functional Capacity Evaluation, performed on August 1, 2012, indicates that activities involving Ms. Hearn's upper left extremity are not recommended due to weakness, lack of protective sensation and numbness in the left hand, and lack of active range of motion and reaching ability. A copy of the FCE Summary is attached hereto, made a part hereof, and marked as Exhibit "DD." 27. An Assessment of Employment Potential, performed by John S. Risser, indicates that the injuries suffered by Ms. Hearn have resulted in, inter alia, higher wage levels not being available to her "given her restricted vocational choices and shortened economic horizons" as a result of the injuries suffered by Ms. Hearn. A copy of the Assessment of Employment Potential is attached hereto, made a part hereof, and marked as Exhibit "EE." 28. Defendant has produced no medical evidence whatsoever which contradicts or calls into question the findings and or opinions of Dr. Holmes. 29. In addition, Dr. Dellon, the medical expert initially retained by Defendant, has concluded that Ms. Hearn's significant limitations and restrictions that have persisted over the past six years are a direct result of the aforementioned motor vehicle collision. 30. Based on the foregoing, it is clear that there are no genuine issues of material fact with regard to the nature and extent of Ms. Hearn's injuries and reasonable minds could not differ as to the fact that Ms. Hearn has suffered a serious impairment of a bodily function, specifically the limited use of her left arm, as well as permanent serious disfigurement. As such, Ms. Hearn is entitled to judgment as a matter of law on the issue, thereby entitling Ms. Hearn to recover non-economic damages. 9 WHEREFORE, Plaintiff, Jacqueline M. Hearn, respectfully requests this Honorable Court grant her Motion for Partial Summary Judgment on the Issue of Serious Impairment of Bodily Function. Respectfully submitted, HANDLER, HENNING & ROSENBERG, LLP Date: Oct. , 2012 By atthew . Crosby (PA 69367) Crosby@hhrlaw.com Attorneys for Plaintiff Jacqueline M. Hearn 10 Matthew S. Crosby, Esq. I.D. # 69367 HANDLER, HENNING & ROSENBERG, LLP 1300 Linglestown Road, Suite 2 Harrisburg, PA 17110 Telephone: (717) 238-2000 Attorneys for Plaintiff Fax : (717) 233-3029 E-mail: crosbvOlhhriaw,com JACQUELINE M. HEARN, IN THE COURT OF COMMON PLEAS Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA V. MICHAEL LOE, Defendant NO. 2008-7062 CIVIL TERM CIVIL ACTION - LAW COMPLAINT AND NOW, comes the Plaintiff, Jacqueline M. Hearn, by and through her attorneys, HANDLER, HENNING & ROSENBERG, LLP, by Matthew S. Crosby, Esq., and makes the within Complaint against the Defendant, Michael Loe, and avers as follows: 1. Plaintiff, Jacqueline M. Hearn, is a competent adult individual currently residing at 2627 Waldo Street, Harrisburg, Dauphin County, Pennsylvania. 2. Defendant, Michael Loe, is an adult individual currently residing at 8 i v i?.l•??.aJi ?iUUi?i I i ? ct.,t IV< ? II C i?Ul I' ?''?'??°'???''?' ^'U ??, ? icCn'c?l'ili:Si:J? J, ? v'vUiil?', i'Erli•?Iiyi\'cir?lici. 4 3. At all times material hereto, Plaintiff, Jacqueline M. Hearn, was the owner and operator of a 2006 Mazda MZ6, co-owned by her boyfriend Michael G. Ford I I and bearing Pennsylvania registration number TOOSEXE (hereinafter, "Plaintiffs vehicle.") 4. At all times material hereto, Defendant, Michael Loe, was the owner and operator of a 2006 Subaru, bearing Pennsylvania registration number PZB991 K (hereinafter, "Defendant's vehicle"). 5. At all times material hereto, Plaintiff, Jacqueline M. Hearn, was not the named insured on any automobile insurance policy, nor was she an insured under any automobile insurance policy, and, therefore, is presumed to be a full-tort insured. 6. Further, pursuantto 75 Pa. C.S.A. § 1705(d), Plaintiff, Jacqueline M. Hearn, is permitted to recover non-economic damages as if she retained full-tort rights, because Plaintiff has sustained serious impairment of bodily function(s) and/or serious permanent disfigurement. 7. At all times material hereto, there were no adverse weather conditions. B. On or about December 12, 2006, at approximately 3:42 p.m., Plaintiff, Jacqueline M. Hearn, was lawfully stopped at a stop sign on southbound Woodland Street, at the intersection of Woodland Street and Wesley Drive in Mechanicsburg, Cumberland County, Pennsylvania. 9. At approximately the same time and place, a Jeep Grand Cherokee operated by Russell C. Williams was stopped directly behind Plaintiff's vehicle, southbound on Woodland Street. 10. At approxin iote y thc- firr lE' Finc! pj-, 1°.lErl(?df-0. !..re. vva ; traveling directly behind Mr. Williams' vehicle, southbound on Woodland Street. 2 ... . 11. Suddenly, and without any warning, Defendant, Michael Loe, struck the rear of Mr. Williams' vehicle, which in turn, struck the rear of Plaintiff's vehicle. 12. As a result of the collision, Plaintiff's vehicle was forcibly pushed into the intersection of Wesley Drive and Woodland Street. 13. As a direct and proximate result of the negligence of Defendant, Plaintiff, Jacqueline M. Hearn, sustained personal injuries as set forth more specifically below. 14. The occurrence of the aforementioned collision and all the resultant injuries to Plaintiff, Jacqueline M. Hearn, are the direct and proximate result of the negligence and/or. carelessness of Defendant, Michael Loe, generally, and more specifically, as set forth below: (a) In driving his vehicle in careless disregard for the safety of persons or property in violation of 75 C.S.A. § 3714; (b) In failing to keep a proper lookout for vehicles lawfully stopped and/or slowing upon the roadway; (c) In failing to be reasonably vigilant to observe Russel C. Williams' vehicle lawfully upon the roadway; (d) In failing to be reasonably vigilantto observe Plaintiff's vehicle lawfully upon the roadway; (e) In following another vehicle more closely than was reasonable and prudent, in violation of 75 Pa. C.S.A. § 3310(a); (f) In failing to properly regulate the speed of Defendant's vehicle so as ?;Ulll??lnl'l;3 (g) In failing to operate Defendant's vehicle in such a manner that would allow him to apply the brakes and stop before striking the rear of Russel C. Williams' vehicle; (h) In failing to operate Defendant's vehicle at a speed at which he could stop within the assured clear distance ahead, in violation of 75 Pa. C.S.A. § 3361; (i) In failing to have sufficient control of Defendant's vehicle, which would have allowed said vehicle to be stopped before doing injury to any person; (j) In failing to operate Defendant's vehicle at a speed that was safe under the circumstances, in violation of 75 Pa.C.S.A. §3361; (k) In operating Defendant's vehicle at a speed in excess of the posted speed limits; and (1) In failing to be continuously alert, in failing to perceive any warning of danger that was reasonably likely to exist, and in failing to have Defendant's vehicle under such control that injury to persons or property could be avoided. 15. As a direct and proximate result of the negligence of Defendant, Michael Loe, Plaintiff, Jacqueline M. Hearn, has suffered extensive personal injuries, including, but not limited to, injuries to her left shoulder, abdomen, left brachial plexus, permanent scarring, and thoracic outlet syndrome. a CIired and hroxirnatc-: re ;l.A, of the nFC;IICE`11CE: Of DIFfC=ildiant, Plaintiff, Jacqueline M. Hearn, has undergone continuing medical care for the aforesaid injuries. 4 17. As a direct and proximate result of the negligence of Defendant, Michael Loe, Plaintiff, Jacqueline M. Hearn, has suffered physical pain, discomfort, and mental anguish, and she will continue to endure the same for an indefinite period of time in the future, to her physical, emotional, and financial detriment and loss. 18. As a direct and proximate result of the negligence of Defendant, Plaintiff, Jacqueline M. Hearn, has been compelled, in order to effect a cure for the aforesaid injuries, to spend money for medicine and/or medical attention, and will be required to spend money for the same purposes in the future, to her detriment and loss. 19. As a direct and proximate result of the negligence of Defendant, Plaintiff, Jacqueline M. Hearn, has suffered a loss of life's pleasures, and she will continue to suffer the .same in the future, to her detriment and loss. 20. As a direct and proximate result of the negligence of Defendant, Plaintiff, Jacqueline M. Hearn, has suffered a loss of income. 21. As a direct and proximate result of the negligence of Defendant, Michael Loe, Plaintiff, Jacqueline M. Hearn, has been, and will in the future be, hindered from attending to her daily duties and chores, to her detriment, loss, humiliation, and embarrassment. 22. Plaintiff, Jacqueline M. Hearn, believes and, therefore, avers that her injuries are permanent and serious and have caused serious impairment of bodily function(s) as well as serious permanent disfigurement. 5 WHEREFORE, Plaintiff, Jacqueline M. Hearn, seeks damages from Defendant, Michael Loe, in an amount in excess of the compulsory arbitration limits of Cumberland County, exclusive of interest and costs. Date: 7-( 9 I ? Respectfully submitted, HANDLER, R NG & ROSENBERG, LLP By: Matthew S. Cr by, Esq. I.D. # 69367 Attorneys for Plaintiff 6 L Johnson, Duffle, Stewart & Weidner By: Jefferson J. Shipman I.D. No. 51785 301 Market Street P. O. Box 109 Lemoyne, Pennsylvania 17043-0109 (717) 761-4540 bs@jdsw.com JACQUELINE M. HEARN, Plaintiff V. MICHAEL LOE, Defendant Attorneys for Defendant IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA NO. 2008-7062 CIVIL TERM CIVIL ACTION - LAW : JURY TRIAL DEMANDED ANSWER AND NEW MATTER TO PLAINTIFF'S COMPLAINT AND NOW, c omes the Defendant, Michael Loe, by and through his counsel Jefferson J. Shipman and Johnson, Duffle, Stewart & Weidner, and files the following Answer and New Matter to Plaintiffs Complaint: 1. Admitted upon information and belief. 2. Admitted. 3. Admitted upon information and belief. 4. Admitted. 5. Denied. The averments contained in paragraph 5 are conclusions of law to which no response is required. If a response is deemed to be required, the averments contained therein are specifically denied. 6. Denied. The averments contained in paragraph 6 are conclusions of law to which no response is required. If a response is deemed to be required, the averments contained therein are specifically denied. 7. Admitted. 8. Denied. After a reasonable investigation, Mr. Loe is without sufficient knowledge or information to form a belief as to the truth of the averments contained in paragraph 8 and the same are therefore denied. 9. Denied. After a reasonable investigation, Mr. Loe is without sufficient knowledge or information to form a belief as to the truth of the averments contained in paragraph 9 and the same are therefore denied. 10: Admitted. 11. Admitted in Part. Denied in Part. It is admitted that Mr. Loe's vehicle made contact with the rear of the Williams' vehicle. After a reasonable investigation, Mr. Loe is without sufficient knowledge or information to form a belief as to the truth of the remaining averments of paragraph 11. 12. Denied. After a reasonable investigation, Mr. Loe is without sufficient knowledge or information for form a belief as to the truth of the averments contained in paragraph 12 and the same are therefore denied. 13. Denied. The averments contained in paragraph 13 are conclusions of law and fact to which no response is required. If a response is deemed to be required, the averments contained therein are specifically denied. 14. Denied. The averments contained in paragraph 14 and subparagraphs (a) through (1) are conclusions of law and fact to which no response is required. If a response is deemed to be required, the averments contained therein are specifically denied. (a) Denied. It is specifically denied that Mr. Loe drove his vehicle in careless disregard for the safety of persons or property in violation of 75 Pa. C.S.A. § 3714; (b) Denied. It is specifically denied that Mr. Loe failed to keep a proper lookout for vehicles lawfully stopped and/or slowing upon the roadway; (c) Denied. It is specifically denied that Mr. Loe failed to be reasonably vigilant to observe Russel C. Williams' vehicle lawfully upon the roadway; (d) Denied. It is specifically denied that Mr. Loe failed to be reasonably vigilant to observe Plaintiff's vehicle lawfully upon the roadway; (e) Denied. It is specifically denied that Mr. Loe followed another vehicle more closely than was reasonable and prudent in violation of 75 Pa. C.S.A. 3310(a); (f) Denied. It is specifically denied that Mr. Loe failed to properly regulate the speed of his vehicle so as to prevent a rear-end collision; (g) Denied. It is specifically denied that Mr. Loe failed to operate his vehicle in such a manner that would allow him to apply the brakes and stop before striking the rear of the Russel C. Williams' vehicle; (h) Denied. It is specifically denied that Mr. Loe failed to operate his vehicle at a speed at which he could stop within the assured clear distance ahead in violation of 75 Pa. C.S.A. 3361; (i) Denied. It is specifically denied that Mr. Loe failed to have sufficient control of Defendant's vehicle which would have allowed the vehicle to be stopped before doing alleged injury to any person; (j) Denied. It, is specifically denied that Mr. Loe failed to operate his vehicle at a speed that was safe under the circumstances in violation of 75 Pa. C.S.A. 3361; (k) Denied. It is specifically denied that Mr. Loe operated his vehicle at a speed in excess of the posted speed limits; and (1) Denied. It is specifically denied that Mr. Loe failed to be continuously alert in failing to perceive any warning of danger that was reasonably likely to exist, and in failing to have his vehicle under such control that injury to persons or property could be avoided. 15. Denied. The averments contained in paragraph 15 are in part conclusions of law to which no response is required. After a reasonable investigation, Mr. Loe is without sufficient knowledge or information to form a belief as to the truth of the remaining averments of paragraph 15 and the same are therefore denied and strict proof is demanded at the time of trial. 16. Denied. The averments contained in paragraph 16 are in part conclusions j of law to which no response is required. After a reasonable investigation, Mr. Loe is without sufficient knowledge or information to form a belief as to the truth of the remaining averments of paragraph 16 and the same are therefore denied and strict proof is demanded at the time of trial. 17. Denied. The averments contained in paragraph 17 are in part conclusions of law to which no response is required. After a reasonable investigation, Mr. Loe is without sufficient knowledge or information to form a belief as to the truth of the remaining averments of paragraph 17 and the same are therefore denied and strict proof is demanded at the time of trial. 18. Denied. The averments contained in paragraph 18 are in part conclusions of law to which no response is required. After a reasonable investigation, Mr. Loe is without sufficient knowledge or information to form a belief as to the truth of the remaining averments of paragraph 18 and the same are therefore denied and strict proof is demanded at the time of trial. 19. Denied. The averments contained in paragraph 19 are in part conclusions of law to which no response is required. After a reasonable investigation, Mr. Loe is without sufficient knowledge or information to form a belief as to the truth of the remaining averments of paragraph 19 and the same are therefore denied and strict proof is demanded at the time of trial. 20. Denied. The averments contained in paragraph 20 are in part conclusions of law to which no response is required. After a reasonable investigation, Mr. Loe is without sufficient knowledge or information to form a belief as to the truth of the remaining averments of paragraph 20 and the same are therefore denied and strict proof is demanded at the time of trial. 21. Denied. The averments contained in paragraph 21 are in part conclusions of law to which no response is required. After a reasonable investigation, Mr. Loe is without sufficient knowledge or information to form a belief as to the truth of the remaining averments of paragraph 21 and the same are therefore denied and strict proof is demanded at the time of trial. 22. Denied. The averments contained in paragraph 22 are in part conclusions of law to which no response is required. After a reasonable investigation, Mr. Loe is without sufficient knowledge or information to form a belief as to the truth of the remaining averments of paragraph 22 and the same are therefore denied and strict proof is demanded at the time of trial. WHEREFORE, Defendant, Michael Lae, respectfully requests that judgment be entered in his favor and the Plaintiffs Complaint be dismissed with prejudice. NEW MATTER 23. That Plaintiffs alleged cause of action may be barred in whole or in part by the Pennsylvania Financial Responsibility Law and the limited tort option. 24. That if it should be found that there was any negligence on the part of Mr. Loe, which is denied, then in that event, any such negligence was not a substantial factor nor a factual cause of the Plaintiffs alleged harm. 25. That the Plaintiffs injuries may have been pre-existing. 26. That Plaintiff may have failed to mitigate his alleged injuries. 27. That the Plaintiffs alleged cause of action may have been caused by third parties or entities not presently involved in this action. 28. That the Plaintiff may have been contributorily negligent. WHEREFORE, Defendant, Michael Loe, respectfully requests that judgment be entered in his favor and the Plaintiffs Complaint be dismissed with prejudice. JOHNSON, DUFFIE, STEWART & WEIDNER B e r n J. Ship an :395696 VERIFICATION The undersigned says that the facts set forth in the foregoing document are true and correct. This verification is made subject to the penalties of 18 Pa. C.S.A. § 4904, relating to unsworn falsifications to authorities. -. 44- 4 Michael Lob Dated: 2 n I STATEMENT 19F -RUSSELL WILLIAMS REGARDING JACQUELINE HEARN ACCIDENT OF 12/12106 VIJ My name is Todd Hassinger, representing the lawfirm of Handler, Henning A Rosenberg. I am located at 1300 Linglestown Rd. in Harrisburg, Pennsylvania. This is a recorded phone interview with Russell Williams,. regarding the case of Jacqueline Hearn. Today is Monday, January 8, 2007; the time is approximately 3:30 pm. Q Uh, Mr. W dams, do I have your permission to record this conversation? A Yes, go ahead. Q Could you please state your full name and spell your last name? A Russell Williams. Q Could you spell. your last name? A W-I-L-L-I-A-M-S. Q OK. And your address; Mr. Williams? A 15 Shady Lane, York Haven, Pa. Q Uh, and your date of birth? A 5/4/40. Q And your occupation? A Retired. Q OK. Now, I understand that you were a witness-and also involved in a motor vehicle collision whichoccurred at Woodland St. at Wesley Drive... A Right. Q In Mechanicsburg. A Right. -1- c Q Is that correct? A That's correct. Q This happened, this happened on Tuesday, December 12th? A I can't really tell you what day it was. Q OK. That's fine., but it happened about 3:40 p.m.? A 'Approximately, I'd say so. Q OK. Very good. And, if you would, could you provide a general description of the roadway you were on? A Well, we're, we're coming out of the little lane from the shopping mall, where the Veterinarian is and we set there, facin', uh, Rossmoyne Rd. to come out on Rossmoyne Rd. Q OK. And you were at a traffic light? A No. Just, uh, stop and go, basically. Q But, when A Whenever the traffic was available. Q OK. So, you were, you were at a Stop sign? A Well, we were in the mall, waitin' to come out to the mall. I think there is a Stop sign there. I won't say for sure. Q OK. But you were stopped in traffic then? A Right. Q OK. Was there, there was a vehicle in front of you? A Yes. Q OK. Can you, can you describe that vehicle? A Uh, well, it was red! Q Red? OK, that's fine. Truck? Sedan? -2- i L,J ? I ! A Uh, no, it was, um, I'm trying to-think. Was it a Honda? No, it wasn't a Honda. It was a car. Q OK. Red car, you state. A Right. Q OK. That's fine. And, uh, anybody behind you at the time? A Not when I come up to the sign. Q OK. A I didn't know there was anybody behind me until I got whacked. Q OK. I understand. Now when you were, you, now, again,. you state you were stopped in traffic: Correct? I A Well, we're stopped, waiting to come out into the flow of traffic. . Q OK. So you were, y, meaning that your, your vehicle wasn't rolling, you were at a complete stop? A Right. Q OK. The vehicle in front of you, the red vehicle that you mentioned... A It was at a stop. Q It was at a sto, at a complete stop as well? A She was waiting to come out first. Q I see. OK. Was she gonna be turning or going straight or not sure or don't know? A Oh,' you have to turn there. Q I see. OK. A But Won't know'which way she was really turning. Q OK. That's fine. A 1 think she was turning to the left. -3- Q OK. All right. Do you, do you recall approximately. how long you were stopped? A Uhhh, I'd say probably 30 to 40 sec. Q OK. So it had been some time then. All right. All right, again, then, that vehicle was directly in front of you? A Right. Q OK. Now, urn, I'think you state you were not, you were not aware that you were going to be rearended until A No. Q It happened. A No. No. We set-there.waiting for her to go out so vice could make our turn. Q OK. And you never knew what hit, hit ya? A No. I ... Q Until afterwards? A I said to my wife, what in the hell was that? Because it had just shoved me right up into her. Q OK. All right. Um, after, afterwards, um, so there was, was there just one impact into her vehicle? A Yeah. Q OK. After, after everything was, uh, after you were stopped in motion, um; I take it you got out of your car? A Yes, I did. Q OK. Did you, who did you speak with first? A I spoke to the guy that was driving the car behind me. Q OK. And can:you identify his vehicle? A It was a 90 or a 2006 Subaru I believe. -4- Q OK. And how, how, how, what, could you describe the gentleman for me? A Oh, he was,. I think he was startin' to go, uh, bald, about half-bald, I don't know. He was a small guy. He wasn't a huge guy. Q OK. A He mighta been maybe 57"?? Q OK. All right. And what was his comments or remarks to you? A He said it's, "it was my fault." Like he says, I take 100% of the blame. Q OK. All right. All right. Um. And did you stay until Police arrived? A Yes, we did. Q OK. You spoke, uh, to Police and gave a description of the accident? A Ri... well, they ha, he give,-basically- all the description. All I said was is I set here waitin' waitin' to go out and I got hit. . Q OK. All right. Very good. But he did take full... A He said he would take full responsibility. Q OK. He and he provided information to the cop as well, the Police? A He told the cop the same thing. Q Very good. OK. Um, now in regards to, uh, Mrs, Miss Hearn, um, did you observe any injuries at the, at the scene? A No. I didn't. To be honest with you, I didn't think we got hit hard enough to have injuries. Q OK. And was there any other witnesses involved, do you know? A Not that I know, my wife was with me. Q OK. But no bystanders or anything? A Not that we seen. -5- Q OK.. All right. Um:. OK.. Any evidence of alcohol or substance abuse by that gentleman that was driving? ` A No. Q He didn't appear to be A No. Q intoxicated? A He, he, well, it's like he said, he drove quite a fewyears without an accident. He said he took his eyes off the road. He thought we had already moved up Q I see. OK. A to make our turn. Q All right. A And he hit us, he, you know, he... Q Excuse me (after cough). OK. All right. Is there anything-else that you would. like to add that you fear is relevant in this matter that we didn't discuss or touch upon? A No. Basically, that's what happened. But it's like I say, I didn't really think she got hit hard enough to- I'm not a doctor, now. Q Right. A But I don't think she was hit hard enough to cause any problems. We didn't get it. We got the jolt on both ends. Q Right. Um, how much, how much damage to your vehicle? A I had, uh, $1,295 and I still have to put a piece on. It had cracked inside, or on the hatch. Q OK. And you drove from the scene? A Oh, we all Q You did? -6- •4 C A Q A Q A Q A Q A Q We all did. OK. Very good. OK. All right. 'Very good. I have no further questions. I want to thank you for your time and cooperation. Sure. Thank you very-much again. Uh-huh. This re.., this concludes your recorded statement. OK. All righty. Bye-bye now. Thank you. Thank you. (TRANSCRIBED BY VFF ON 1/16/2007) -7- Complaint Report 4b Commonwealth of Pennsylvania P..r-.-?h:ne I.?f %rnnafinn Lower Allen Twp OmOteit7t Nt/etDer: oW0 Record aeoe UD: ON Far So LAT2005-12-00618 No No PTANR Deso0ow PHONIIEPORTABLE CRASH Ua+e eaiy: aea Reserved ima Reoairee Cleared Radio Dt?kft 1711212006 3:42 PM ry of ee Week N.roted %* U& Tuesday Officer Assigned Hearn was stopped at the stop sign on Woodtarxi St atMnFdrk theft turn onto Wesley Dr. Russell Williams was stopped behind Hearn. Michael Loe was behind Williams acrd ran into Williams pushing Williams into Hearn. An accident exchange sheet was completed and copies given to everyone. No one was injured and ail vehicles were driven from the scene. Loe admitted fault. Compfafnt Location Strom Numov: em sodr. a Name: So- TTDa: oadeernon oodland ST - Street .0.8= C[ofs.ptedrecibit IM Name: Type: Hk%M Nam: Wesley DR - Drive HVMW Ntimbar. Ng?wroy misposc AurmRouse: oueq: unadefoa Number: Cumberland otow Tdwrahq aqm" DRaitt ar. POIM* Subdivision Lower Allen Township Mechanicsburg pia: one Number. Zip: eo: Grid: oodmm Type: We! Type: PA 17055 1208 UMt Number 1101.apq: @dUC : &Vku C o6aeon Type: Cooney: Highway/Road/Alley United States of America (USA) Location Dtoahiftrr Complaint Information Sm"bon First Name m4ft Name it" Name I Esther F Williams to at ti nn 121711939 hate Female deems 15 Shady Lane Aperimero fT; star = ork Haven 7370 Mae emit ExI thmtber T"e 717 9913375 Cell CoinpWWI Taws ID OUPWJW ID Ei Coapk m e: No MLWEST JLGOSH 214202 tar Dewhed Fitfd 1 Dented FiM 2 Unit #2 passenger r- Defied FWd 7 sm Defined F Wd Complainant Associate Information H:1FIi;ISSUPG DEC 2 7 2006 P 141.01 Sauaaion sr Name Nacre less Name Sulfis Russell C illiams DMO of 961h 51511940 hits Male Aft"s IS Shady Lane rem aaN Zip Cafe Vork Haven PA 17370 pftw hrrreer 1 a cane a hone Type 717 9386936 Home Phan. hhmrar7 a Code omen Eaa abneType 717 ser 0elined rod t User otoned FNW 2 Unit #2 Diver sa Gowed Flop 3 sa Defined Field 4 el{relbn 'xp Nnee Nave Sldtie Jacqueline Hearn ;earn oft a Binh ea 811811977 Black Female as 2627 Waldo St Apowmal GBy teas ZlyCode Harrisburg PA 17110 wCaW 717 NumMr Type ea Deed Fete 4 Driver Unit #1 Usa Dented Field 2 ea DehrwfWW 3 Uta Ds*W Field e SaWwon kffl M Michael idle Nerve R Nerve Loa 77 Dae a BtrM 4/17/1953 Ka hits Mate Address 1766 VVinterhaven Rd ent LM'lechanicsburg PA rp Cade 17055 Me Code 717 6910972 >a Phare Type Home rnaa. 1 "Code 717 NurnOa fir rho" Type a DoW AM i Driver Unit #3 w Odmwd Field2 user Deksed f eld sr Deleed Field 1 Officers Involved HARRISBURG DEC 2 7 2006 Page 2 Ronald -1892 - Lower Allen TwpAssisting Officer 11892 Strew qumba: slrestawk redrecuon Streer Nerne: Seem TIM T7- 0 ESLEY DR - Drive P.O. BOX oa ?rediraceen reef Memo: SIrM Type: .V" Nemr. OODLAND ST - Street igl" Number. High." uibpoa. teal Routs. ludskson Number. Cumberland CU Location ey:. drW" Subdwla'arr. LA We: omeNumber. e: erde/KbsType: UrdType: PA t Number lraeod: dtude: org4u6c Typo My: United States of America (USA) oWbn wecAVbac 12/1212006 3:55 PM Etwoute . Cleared 12JI4006 3:55 PM 12 I212006 4:06 PM User Domed Fidd 1 Use Domed FWd Z PSI OekMd Herd 3 User Dented FeW e Iem "no eeaece e: Geinett, Thomas - 1825 - Lower Allen Twp Investigating Officer 1825 LDMWn VISOBICneD Sweet Nufter: 0 Suer Bock rsdrec"n tea Name: ESLEY Skeet Type: DR - Drive ostdeaceon P.O. Bdc ose P edeecfon treelNemc WOODLAND Soo Tyos: ST - Street Name: wway Nurreer: Milepoft reel RODla: oumy: Cumberland ursdic"n Number. CU Loolim emMe++p w OW AM Hy. LA ddcal Subd imblore Subic PA one Number, 4 ser id: eider" Type: Will Type. Nuotw pMspq: ' ude: orgsrde: don Typo: . United States of America (USA) duodn Oftaiption: . ' PW-hed 1211212006 3:44 PM awe Anhod, 12/12/2006 3:51 PM Cleared 12/12/2006 4:12 PM Use Deemed Field t mer Deemed Fund I Usv Dsemed Fprd 7 Dented Fwd 4 Attachments Related Incidents Involved Property/Evidence HARRISBM Comments DEC 2 7 20 Page 3 11 . ".. width=256> IT #i OWNER INFORMATION t011MICHAEL G /JACQUELINE HEAR I WALDO STREET tRISBURG , PA. 17110 INTY = DAUPHIN VEHICLE INFORMATION TOOSEXE. EXPIRES: 01-07. : MAZDA . VYR: 2006. VST: SDN . VIN: IYVHPOOC06SM17633 62870817. REG GR WT: 00000. COMB GR WT: 00000. LICENSE STATUS EJISIONIREVOCATION: NO CODE: A = RETURN CHECK, C = CAT FUND STOP F = INSURANCE CANCELLATION, I = REVOCATION. JNIT #1 DRIVER RESPONSE FROM PENNSYLVANIA BUREAU OF MOTOR VEHICLES OLN: 25386744. VALIDATED: 2005-10.22. EXPIRES: 2009-08-19. NAM: HEARN,JAOQUELINE M 2627 WALDO ST HARRISBURG PA-17110 SSN:176589567. DOB: 1977.08.18. SEX: F. EYE: BRO. HGT: SS". RESTRICTIONS: 1 SUSPENSION: NO OPERATOR CLASS: C e SINGLE VEH <s 26,000 OPERATOR TYPE: REG LICl1D VAUD DUPLICATE LICENSE NUMBER: NIA INFORMATION OBTAINED FROM PENNOOT FILES AND SHOULD BE VERIFIED. #1 INSURANCE: GEICO policy #0711419606 02 OWNER INFORMATION C and ESTHER F SHADY LN RK HAVEN , PA. 17370 AUNTY = YORK VEHICLE INFORMATION EJS0877. EXPIRES: 12-06. JEEP VYR: 1999. VST: SW 57017455. REG GR WT: 00000. LICENSE STATUS . VIN: IJ4GWSBSOXC614548 COMB GR WT: 00000. ENSIONIREVOCATION: NO CODE: A = RETURN CHECK, C = CAT FUND STOP F = INSURANCE CANCELLATION, I = REVOCATION. HARRISSUM DEC 2 7 2006 page 4 u )NIT #2 DRIVER RESPONSE FROM PENNSYLVANIA BUREAU OF MOTOR VEHICLES OLN:10935064. VALIDATED: 2004-05-06. EXPIRES: 2008-05-06. NAM: WILLIAMS,RUSSELL C 15 SHADY LANE YORK HAVEN PA. 17370 SSN:188327369. 008:1940-05-05. SEX: M. EYE: BRO. HGT: 5'8". RESTRICTIONS: NONE SUSPENSION: NO OPERATOR CLASS: B = SINGLE VEH >= 26,001 " OPERATOR TYPE: LICENSEISS VAUD DUPLICATE LICENSE NUMBER: N/A - COMMERCIAL DRIVER INFORMATION - DISQUALIFIED: NO ENDORSEMENT CODE: P = PASSENGER TRANSPORT RESTRICTION CODE: B m BUS >26,000 LBS. INFORMATION OBTAINED FROM PENNDOT FILES AND SHOULD BE VERIFIED. #2 INSURANCE: Pennsylvania National Mutual Casualty policy #1290031214 UNIT #3 DRIVER RESPONSE FROM PENNSYLVANIA BUREAU OF MOTOR VEHICLES OLN: 22505247. VALIDATED: 2003-01-27. EXPIRES: 2007-04-18. NAM: LOE,MICHAEL R 1776 WINTERHAVEN DRIVE MECHANICSBURG PA. 17055 SSN: 303600596. DOB-. 1953-04.17. SEX: M. EYE: BLU. HGT: 68". RESTRICTIONS: 1 SUSPENSION: NO OPERATOR CLASS: C =.SINGLE VEH 4= 26,000 OPERATOR TYPE: REG LICENSE VALID DUPLICATE LICENSE NUMBER: N/A INFORMATION OBTAINED FROM PENNDOT FILES AND SHOULD BE VERIFIED. f #3 OWNER INFORMATION LESSEE INFORMATION 6SE MANHATTAN AUTO FINANCE : LOE,MICHAEL R STEWART AVE :1766 WINTERHAVEN DR IDEN CITY , NY. 11530 : MECHANICSBURG, PA. 17055 : COUNTY = CUMBERLAND VEHICLE INFORMATION PZ,B991 K. EXPIRES: 05-07. ,: SUBARU . VYR: 2006. VST:'SW . VIN: 4S4WX82CX64424164 63146471. REG GR WT: 00000. COMB GR WT: 00000. LICENSE STATUS USPENSIOWREVOCATION. NO YPE CODE: A = RETURN CHECK, C = CAT FUND STOP F x INSURANCE CA NIT #3 INSURANCE: ERIE policy #0052307942H CAD T2006-12-00618 LEND C... : MLWESTCT>WA, 3 CARS- CHAIN REAR HARRISBURG Page 5 DEC 2 7 2006 ,o- MISS. 1 College of Patient Name: HEARN, JACQUELINE M Patient Sex: Female Patient Location: EMER, , Visit Type: Emergency E m e r g e n c y D e p a r t m e n t N o t e D o c u m e n t Penn State Milton S. Hershey Medical Center Penn State College of Medicine Health Information Services, HU24 500 University Drive P.O. Box 850 Hershey, PA 17033-0850 PSUHMC MRN: 0836666 Date of Birth: 8/18/1977 Visit Number: 07857390 Tel: (717) 531-8055 Final Document Electronically Signed by: White, David A ED SUMMARY Name: HEARN, JACQUELINE M HMC Number: 836666 DOB: 08/18/1977 Date of Service: 12112/2006 12/19/2006 1:03:47 PM CHIEF COMPLAINT: Left shoulder and left chest wall pain. HISTORY: The patient is a 29-year-old female who presents to the Emergency Department approximately four hours after a motor vehicle crash. The patient was an unrestrained driver sitting at a stop light in a row of cars, two cars back struck the car behind her, forcing that car into her rear, forcing her forward. She reports that she hit her chest on the steering wheel and then flew backwards. There was no loss of consciousness, did not hit her head. Since that time she denies shortness of breath, nausea, vomiting, no diarrhea, and no abdominal pain. She does complain of pain across her left shoulder worsened with movement into the left trapezius region. There is no focal numbness, weakness, tingling, and no lightheadedness. The patient also complains of pain to the anterolateral aspect of the lower left rib cage. Again, no shortness of breath associated. REVIEW OF SYSTEMS: Otherwise negative. PAST MEDICAL HISTORY: Significant for migraines only. MEDICATIONS: Imitrex p.r.n., and patient has no known drug allergies. SOCIAL HISTORY: The patient lives locally, does not drink alcohol. PHYSICAL EXAM: The patient is alert, appropriate, holding her head still as if uncomfortable. Vital signs taken were all normal. Exam otherwise showed normocephalic, atraumatic. Pupils equal, round, and reactive to light. TMs are clear and free of hemotympanum. There is no midline tenderness in the cervical spine. There is no midline back pain. Lungs were clear to auscultation. Cardiac is regular rate and rhythm. S1, S2, murmurs, rubs or gallops, no axiliary chest wall pain on palpation except in the left anterolateral aspect. There is no overlying erythema, ecchymosis or abrasion. There is no crepitus. The abdomen is soft, nontender, nondistended without focal tenderness. Extremities are nontender with full range of motion except for left shoulder which has normal range of motion and internal and external rotation. There is Date Printed: 112512007 77me Printed: 6:21" NSttm S. ?y M>ed3.cal Center liege of M xUdne Patient Name: HEARN, JACQUELINE M PSUHMC MRN: 0836666 E m e r g e n c y D e p a r t m e n t N o t e D o c u m e n t Final Document Electronically Signed by: White, David A 12/19/2006 1:03:47 PM tenderness on palpation of the lateral aspect of the shoulder extending into the left trapezius and down into the mid left paraspinal region. Again, there is no evidence of soft tissue swelling, ecchymosis or abrasion. Neurologic exam is fully intact with normal sensory/motor function, bilateral upper extremities is equal. Exam otherwise unremarkable. IMPRESSION: Likely consistent with muscular strain, however, the differential would include rib fracture, pulmonary contusion, AC joint separation, clavicular fracture, shoulder sprain, muscle tear. ED COURSE: The patient was given a Percocet p.o., x-ray of the left shoulder and chest were obtained, both were normal without evidence of fracture or subluxation, or cardiopulmonary abnormality. The patient was discharged home with two Valium for muscle spasm and Vicodin take-home pack, instructed to take NSAIDs over the counter as well. The patient was put In a shoulder sling for comfort of that left upper extremity. DIAGNOSIS: Left shoulder strain, and left chest wall contusion. Review/Sign: David A White, MD DAW /IHS DD: 12/12/06 DT: 12/12/06 22:23 Date Printed: 112512007 77me Printed: 6:21.4tL! PATIENT NAME_ ?C? y+-t??a?c !u($lit.L{L DOB DATE CC: THE PATIENT PRESENTS AS A YEAR OLD MALE / F MALE WITH. ?4U tCUtta? ( ) MULTIPLE ( ) CHRONIC STABLE MEDICAL CONDITIONS ( ) ONE OR MORE ACUTE NEW SYMPTOMS j f e? -API -ENV ,A ?? (tz-?.JL.- - S ROS. (level v 2-9 sys., level v 1E) Sys.) (?"' {• ?`' a ``'` lz` 2 ,?, ;, +, ?.,, ` / POSITIVE - CHECKED NEGATIVE - CROSSED OUT BLANK -NOT ADDRESSED CONS. ? FATIGUE ? FEVER ? WEIGHT. CHANGE (GAIN / LOSS )? ? NIGHT SWEATS !iX ? DYSNPEA (EXERTION! REST) ? ORTHOPNEA ? PNO ? CHEST PAIN ?.EDEMA ? SYNCOPE ? PALPITATIONS ? ARRYTHMIA ? INTERMITTENT CLAUDICATION ? CAD ? ANGINA . ? MYOC. INFARCT ? HTN ` ? CHF (L R\ BV) ' ? MURMURS , ? VALVE DISEASE ? PE / DV T ? AT FIB ? OTHER SEEP ? COUGH ? WHEEZING ? HEMOPTYSIS ? PLEURITIC CHEST PAIN C COPE) 9R0NC41TiS (ACT / CHR) ? EMPHYSEMA ? ASTHMA ? SMOKER ? OTHER HEENT ? VISION CHANGE / LOSS ? CATARACT (L / R) ? GLAUCOMA ? MAC. DEGEN. ? GLASSES ? HEARING LOSS ? HEARING AID (L / R) NASAL CONGESTION ? RHINITIS (VM / ALL) ? EPISTAXIS ? HOARSNESS G OTHER Sil ? DYSPHAGIA ? HEARTBURN ? NAUSEA ?? VOMITING ? HEMATEMESIS U ABO PAIN' ? DIARRHEA ! CONSTIPATION (ACT /CHR) <9•RECTAL-BLEED (MELANA / HEMATOCHEZIA) ? GERD/HH ? PUD (GASTRIC DUOD.) ? GB / STONES / PANC DISEASES Q DIVERTICULOSIS / ITIS ? COLON POLYPS / CANCER Q.dEA QRFIHOIDS ? ms ? ABD BLOATING (BELCHER,, LOATER )ARTER) ? OYSPEPSIA ? OTHER Sttl. ? HEMUTURIA ? BPH ? CANCER _ (PROSTATE BLADDER KIDNEY) ? KIDNEY STONES ? CYSTITIS (ACT / CHR) ? INCONTINENCE ? IMPOTENCE ? NOCTURIA ? OTHER '.RTHRITIS (DJD RA GOUT OTHER ) ;USCLE PAIN ? LEG CRAMPS :STLESS LEG SYNDROME ? AMBULATORY DYSFUNCTION TEOPOROSIS ? '. ER m lim ? VARICOSE V61NS.. - 0_XEROSIS ? PRURITUS ? ACNE ? ROSACEA --- ? OTHER NFURO ? TIA ?\STROKE ?-SEIZURES ? NEt R?ATHY ? HEADACHES ? MEMORY LOSS ? CTS R) ? OTHER PSYCH/LSD ? ANXIETY ? L'] EPRESSION ? S IZOPHRENIA UiIC DEPRESSION ? M ? 18 ? FIBRYALGIA ? HEADACHE (MIGRAINE MCH OTHER 1 ? CHRONIC ATIGUE ? PANIC DI ORDE R ? OTHER EN ? THYROID (HYPER HYPO) ? •IABETES ? HYPERCHOLESTEROLEMIA / TRIGLYCERIDEMIA ? MENOPA?E (PERT POST) El HYPOKALEMIA ? HYPOMAGNESEMIA _ C HYPERURICEMIA ? OTHERC ?aS HEIlsE ? ANEMIA, ? BLEEDING PROL+MS .? COUMAOIN.COAGULOPATHY 0dANCER ? PLATELETS j G OTHER ALLAMM ? HAY FEVER ? DYE / IMMUNIZATION / F OOO ALLERGY ? OTHER `4 DRUG ALLERGY ? YES L NO e$FH. ASK FACTORS. MEN REVIEWED FROM AND UNCHANGED EXCEPT EXM (CIRCLE OR CHECK APPROPRIATE FINDING) (BLANK /NOT ADDRESSED) APPEARANCE WELL DEV LOPED, WELL NOURISHED S _ YEAR OLD MALE/ E'M'AM IN NO ACUTE DISTRESS WITH NORMAL BEHAVIOR AND AC'WLD, ? ABNORMAL • 11. WEIGHTI?3 BS HEIGHT IN TEM' \_!:_o ? RRI2- SP R.ARM?`L.ARM -OTHER / CUFF SIZE: REd I?RGE THIGH PR - lU 0 /MIN G. IRREG) CAP. REFILL SEC. DIAPHORESIS + ! - EAR OXIMETRY ( ) RA ( )02 AT VMIN X SIT _% WALK HE•?AtQ 1J• NORMOCEPHALIC ? ABNORMAL EYES. ?-?„CONJUNCTIVA PINK - PALE ? LID XANTHALASMA/SCLERAL ICTERUS--?.N4- um ZO`NORMAL ? ABNORMAL fim MO ST ,.: DRY ff YES-" ?-NORMAL ? CONGESTED ? OTHER MCNITH M -PINK `fl,MOIST ? PALE C CYANOSIS (LIPS) PoAFIYNX AR ?ABNORMAL SUPPLE LN, MASSES, THYROID PALPABLE 7t5,,NO OYES JVP: ? NORMAL ? ABNORMAL CAROTID AMPLITUDE & UPSTROKE ? NORMAL ? ABNORMAL CAROTID BRUITS --NO ? YES MUSCLES -E1-NORM' C ABNORMAL (SPASM TP'S ADSON5 TEST (L / R) A&= SUPPLE YES ? NO KYPHOTIC - SNO C1 YES BREASTS SIZE ? SMALL ? MEDIUM [ LARGE MASSES ? NO ? YES LN (2), NIPPLE DISCHARGE, AND SKIN CHANGES ? NO '? YES S.tIESI. INSPECTION (EFFORT) NORMAL ? ABNORMAL PERCUSSION ? NORMAL' ? ABNORMAL AUSCULTATION -Q,NORMAL ? ABNORMAL ABN (BS, RUBS, BALES, RHONCHI, EGOPHONY) S'sA8G1AS'e INSPECTION -? NORMAL ? ABNORMAL PERCUSSION ? NORMAL ? ABNORMAL PALPATION ? NORMAL ? ABNORMAL (PMI, THRILLS, LIFTS) AUSCULTATION ',? NORMAL ? ABNORMAL (MURMURS, RUSS, EXTRA SOUNDS) I? NNSPE SPECTION '] NORMAL ? ABNORMAL (APPEARANCE, SCARS) PERCUSSION. NORMAL ABNORMAL - AUSCULTATION (BOWEL SOUNDS) S44ORMAL C ABNORMAL BRUITS`U NORMAL ? ABNORMAL LUG`°.? PALPATE (TENDER, GUARDING- REBMNID) C NO DYES IQ Q (()„ ?-ry t_ Cy SKMA LNO C YES ` \ UIJ °OOM ATTENDANT r.FMTALS TENDERNESS, M HERNIA ? NO ? YES TA REC EXTERNAL& TONE ? NORMAL ? ABNORMAL MASS ? NO ? YES OCCULT BLOOD ? NEGATIVE ? POSITIVE PROSTATE SIZE ? SOFT ? HARD NODULES ? NO ? YES PELVIC VULVA / VAGINA / CERVIX UTERUS /ADNEXA ? NORMAL ? ABNORMAL I= PULSES (0 TO 2+) FEMORAL POPLITEAL DOR PED POST TIS RT. LT VARIC VEINS ? + ? - EDEMA (0 TO 4+) CLUBBING, CYANOSIS NO ? YES SKIN, BONES. JOINTS MUSCLES, NERVES . ? NORMAL ? ABNORMAL G?wc?., +? ? ?.. u..'? ? •re l:T Sal`-.?? v ??,.._ - r\.Jl LIi.S CERV, AXIL, ING, ,?]? EPIT, OTHER IJINUNP ? ABN/PALP NEURO ORIENTED: TIME, PLACEXYES C NO OF 10 ON PSPMS QUIZ CN II • XII INTACT ABNORMAL MOTOR: ENG -TeNE ""- ATROPf+Y,-IM-• ? NORMAL ? ?BNORMAL DTRS:"`(K?! INC / DEC SABINSKIS + ! •, L / R SENSORY: PIN / TEMP / TOUCH POS / VIB ? NORMAL ? ABNORMAL GAIT, SPEECH: "NORMAL ? ABNORMAL MOOD: DATA REV MsNORMAL ? ABNORMAL 00 3.) 7.) 4.) 8.) 980ERS ? SMAC•UA ? LIPIDS-LDL ? CBC & DIFF ? THYROIDS--TSH ? PSA ? UA ? EKG 'PJ.,MULTIPLE MEDICATIONS REVIEWED MEDS+/- -`', f4A2 C.(1- "?C F'?-c1 OTHER \ V (? . iw-h s t . •a? "t:.: Z' `J` -? f? ? CHRONIC STABLE MEDICAL CONDITIONS REASSESSED. RETURN IN DAYS /WEEKS/ MONTHS BP CHECK / PROTIME/ IN ? DAYS / WEEKS PHYSICIAN 1? F-? 1 NOm & Eki? Medical Cer CAORep of Ntedidae Penn State Milton S. Hershey Medical Center Penn State College of Medicine Health Information Services, HU24 500 University Drive P.O. Box 850 Hershey, PA 17033-0850 Patient Name: HEARN, JACQUELINE M Patient Sec: Female Patient Location: ORTI,, visit Type: Clinic PSUHMC MRN: 0836666 Date of Birth: 811811977 Visit Number. 08026965 Tel: (717) 531-8055 1 O u t p a t i e n t N o t e D o c u m e n t Final Document Electronically Signed by: Vora, Vagmin P Name: HEARN, JACQUELINE HMC Number: 836666 DOB: 08/18/1977 Date of Service: 02120/2007 OUTPATIENT NOTE 2/22/2007 1:27:38 PM Chief complaint is pain in the neck with radiation to left shoulder and left upper extremity since December 2006, when she was involved in a MVA. HISTORY OF PRESENT ILLNESS: The patient was rear-ended about a month ago. She was rear-ended by a Jeep in December of 2006. Since then she has complained of pain in the neck with severe and diffuse tenderness in the upper back on the left as well as in the front of her chest on the left as well as in the left shoulder, and the left upper extremity. She does complain of decreased range of motion of her neck. Does complain of occasional tingling and numbness in her left upper extremity. She does give history of inability to hold heavy objects in her left hand due to the pain. She is right hand dominant. She likes to workout at the gym and has been unable to do that for the last few months. She does not complain of loss of bladder, bowel control. She does not give history of symptoms in her right upper extremity. MEDICAL HISTORY: Headaches, ovarian cyst secondary to polycystic ovarian syndrome. Bladder infection. SURGICAL HISTORY: None. ALLERGIES: None. MEDICATIONS: Ibuprofen 4 times a day. SOCIAL HISTORY: She does not smoke, does not drink alcohol, and denies any recreational drug use. PHYSICAL EXAMINATION: She is 29 years of age, 5 foot 5 inches in height, and 162 pounds in weight. She is well oriented in time, place, and person, and is in no apparent acute distress. On examination of her neck, she is diffusely tender in the midline as well as in the left paraspinal region. She is diffusely tender over the left trapezius muscle as well as over the left rotator cuff. She is able to perform rotation on her left shoulder but is unable to abduct her left shoulder secondary to severe pain. She is unable to straighten her left elbow. On palpation, there appears to be a certain degree of fullness in the left supraclavicular as well as the left suprascapular region. Range of motion of the neck is significantly reduced and painful. On neurological examination, strength power is 515 in the right upper extremity in all muscle groups. Date Printed: 812912008 Time Printed: 1:48 PM ^i - 1 Nffftm & Pm? Meffical Ceder Patient Name: HEARN, JACQUELINE M PSUHMC MRN: 0836666 1 O u t p a t i e n t N o t e D o c u m e n t 1 Final Document Electronically Signed by: Vora, Vagmin P 2/22/2007 1:27:38 PM The power is 4 to 4+/5 globally in the left upper extremity. There is a decreased sensation in the ulnar nerve distribution in the left hand. She is severely tender in the region of the ulnar nerve at the elbow. Tone is normal in both upper extremities. Reflexes are 1+ in the biceps, 1+ in the triceps, and 1+ in brachioradialis. IMAGING: MRI of the cervical spine does not show any evidence of spinal cord or nerve root compression. There is no evidence of a disk herniation or foraminal stenosis. ASSESSMENT AND PLAN: The patient has probably suffered a severe whiplash injury and has probably suffered a significant amount of cervical and cervicoscapular musculature strain. She also may have suffered some injury to the rotator cuff of her left shoulder. At the present time, she has been advised to continue in physical therapy. I have also advised her to undergo an MRI of her left shoulder and follow up with Dr. Lyons. The patient understands and will proceed as directed and will follow up with me on a p.r.n. basis. 145258 CC: Robert P Lyons, MD Penn State Milton S. Hershey Medical Center PO Box 850 Hershey, PA 17033 Review/Sign: Vagmin P Vora, MD VPV /DO DD: 02/20/07 DT: 02120/07 23:40 Date Printed: 812912008 Time Printed: 1:48 PM Mon & !*spy Medical Center College: of Nano Patient Name: HEARN, JACQUELINE M PSUHMC MRN: 0836666 O u t p a t i e n t N o t e D o c u m e n t Final Document Electronically Signed by: Lyons, Robert P 3/8/2007 12:46:36 PM OUTPATIENT NOTE Name: HEARN, JACQUELINE M EMC Number: 0836666 DOB: 08/18/1977 Date of Service: 03/06/2007 Jacqueline is a 29-year-old female who works as a customer service representative and is right hand dominant. She was involved in a motor vehicle accident on December 12, 2006. She was driving, but did not have her seatbelt. I saw her initially on January 16, 2007, and diagnosed a whiplash injury, rule out cervical herniated disc. She did see Dr. Vora who felt that it was her shoulder and refers her back to me. An MRI of the cervical spine on 01/18/2007 shows a mild noncompressive annular bulging at C6-C7 with no evidence of canal stenosis, disc herniation, or foraminal compromise. An NM of the left shoulder, 02/22/07, showed no evidence of rotator cuff tear. There is a mild degree of impingement "as per the radiologist's official report." There is a slightly downsloping acromion by my read of the films, otherwise, completely normal. Biceps tendon and subscapularis are intact. Glenoid labrum intact. Bony signal is normal. Infraspimatus does show some increase signals consistent with inflammation, but this is simply at the insertion site and does not extend up to the tendon itself. On physical exam, she is extremely hesitant to use her left shoulder at all. Her neck, she lacks 40 degrees of rotation to each side. The Spurling test at the left is positive in that it causes pain over her left trapezius and left shoulder. Spurling test at the right is negative, although she lacks 40 degrees of rotation to the right as well. She is able to flex her chin to 1 inch short of her chest, extension lacks 35% of full. Left shoulder, she is extremely hesitant to even reach with her left arm away from her body. However, she has active and passive external rotation of 55 degrees. Infraspinatus cuff strength is 545. Supraspinatus cuff strength is 4+/5. She has active forward elevation of 20 degrees, but passively, I can forward elevate her to 120 degrees, and she can maintain this forward elevation, although this is painful. The left shoulder shows no ecchymosis, no soft tissue swelling. There is diffuse tenderness and no specific anatomic direction or pattern. She is neurovascularly intact distally. First dorsal interosseous, abductor pollicis brevis, and extensor pollicis longus are all intact and 515. There is no atrophy of the left hand. Radial and ulnar pulses are +2/2. ASSESSMENT: Borderline impending frozen shoulder. With whiplash injury, rule out brachial plexus palsy. I would like to obtain an EMG of the left upper extremity from neck to fingertips to evaluate for any nerve impingement. I strongly recommend that she restart physical therapy. She needs to perform self-directed stretching exercises 6 times per day to maintain the passive range of motion of her left shoulder. We will restart supervised physical therapy. We will have the radiologist inject her left glenohumeral joint under fluoroscopic guidance for pain control. She will follow up with me in 8 weeks to check her progress. She is working as a customer service rep, but has not returned to hairdressing. Consider Pain Service referral if the EMG is normal. Date Printed: 812912008 TYme Printed: 1:47 PM I _ -- lion a. Ihy Meic Cmter Qllege of !!sine Patient Name: HEARN, JACQUELINE M PSUHMC MRN: 0836666 1 A u t t) a t i e n t N o t e D o c u m e n t 1 Final Document Electronically Signed by: Lyons, Robert P 3/8/2007 12:46:36 PM 171810 Review/Sign: Robert P Lyons, MD RPL /CO DD: 03/06/07 DT: 03/07/07 07:07 Date Printed: 811912008 TYme Printed: 1:47 PM e- y- 1'I n & Iiimhey Medical Center alRW off']'V &&+e Patient Name: HEARN, JACQUELINE M PSUHMC MRN: 0836666 O u t p a t i e n t N o t e D o c u m e n t Final Document Electronically Signed by: Harbaugh, Kimberly S 8/13/2007 4:31:07 PM OUTPATIENT NOTE Name: HEARN, JACQUELINE M. HMC Number: 836666 DOB: 08/18/1977 Date of Service: 08/02/2007 CHIEF COMPLAINT: Left upper extremity pain, numbness, and tingling. HISTORY OF PRESENT ILLNESS: Ms. Hearn is a 29-year-old female patient of Dr. Lewis Kuskin referred by Dr. Kuskin and Lyons for neurosurgical consultation regarding the above complaints. The patient's difficulties began in December of last year. She was struck from behind while driving her vehicle. This resulted in trauma to the left shoulder region. She was evaluated in the emergency room and was not noted to have any significant fractures or abnormalities and was therefore discharged to home. However, she had severe neck pain with radiation into the entire left upper extremity. This is associated with paresthesias in the ulnar forearm and hand and weakness of the entire limb. She has been followed since that time. Electrical studies performed In April were suggestive of a brachial plexus injury. For this reason, she was referred to our clinic. She states that her pain is present on a nearly constant basis. Working during the day results in worsening of her pain at the end of the day. She may have had some mild motor recovery. Overall, however, she feels persistently weak. She has had no improvement in her sensory disturbance. If anything, she feels that the paraesthetic sensation into the ulnar hand has progressed and has become persistently numb. Because of questions of a frozen shoulder, she underwent an injection of the left shoulder last month. This did not change her symptoms to any significant degree. She has also noted fullness in the supraclavicular region which has been present since the accident. This has improved somewhat. She remains severely tender in this region. She has had no right upper extremity symptoms or lower extremity symptoms. She also denies difficulties with bladder function. CURRENT MEDICATIONS: None. The patient will take Motrin at the end of the day to improve her pain complaints. This does help to some degree. ALLERGIES: No known drug allergies. She does note hives when she eats chocolate. PAST MEDICAL HISTORY: Past medical history is essentially benign except for a history of polycystic ovary disease. The patient has had significant abnormal bleeding with this. She is in the process of evaluation and management of this. The only other hospitalizations relate to the normal spontaneous vaginal delivery of her three children. FAMILY HISTORY: The patient's mother is alive in her late 40s. She suffers from hypertension and has a history of myocardial infarction and stroke. There is coronary cerebral vascular disease in the patient's grandmother as well. The patient's father is alive in his 40s and is essentially healthy. Family history was, otherwise, noncontributory. SOCIAL HISTORY: The patient works in customer service which requires significant typing duties. She lives with her boyfriend and three children. She denies tobacco use. She admits to occasional recreational drug use. Date Printed. 812912008 TFme Printed: 1:43 PM ?l Man S. EkAwy MAW meter Cdkg?e of l ne Patient Name: HEARN, JACQUELINE M PSUHMC MRN: 0836666 O u t p a t i e n t N o t e D o c u m e n Final Document Electronically Signed by: Harbaugh, Kimberly S 8/13/2007 4:31:07 PM REVIEW OF SYSTEMS: An extensive review of systems was carried out. Pertinent positive relate to her current complaints and associated medical problems. Details are listed as part of the health history form in the permanent record. PHYSICAL EXAM: On physical examination, the patient is a pleasant and cooperative female in intermittent moderate stress. Height was 5 feet 5 inches. Weight 162.7 pounds. Blood pressure 136/55, pulse 74, respiratory rate 20. General exam revealed moderate fullness in the supraclavicular region on the left. No palpable pulse could be identified. There was significant pain with pressure in this region. Pressure over the shoulder girdle musculature and trapezius was also severely uncomfortable. Mild atrophy of the forearm and hand intrinsic musculature was noted. No significant sympathetic changes were noted except for mildly diminished sweating in the uinar digits of the left hand. Range of motion testing of the cervical spine brought on severe neck pain and left-sided shoulder girdle pain. Percussion of the uinar nerve at the elbow brought on a prominent Tinel's phenomena. On neurological examination, the patient was alert and appropriate. Cranial nerves II through XII were intact grossly. Motor strength testing at best effort was full in the right upper extremity and bilateral lower extremities. Left upper extremity testing revealed weakness in the trapezius muscle, deltoid, and supraspinatus muscles. These would rate approximately 4-4+/5. The limitation of motor strength appeared to be at least in part related to pain. Infraspinatus testing was nearly full. Biceps strength was 415. Triceps was approximately 445. Wrist extension and finger extension was 4/5. Wrist flexion was 4+/5. Finger flexion, however was 3-4/5 involving both the flexor digitorum, supraspinatus, and flexor digitorum profundus. The 4th and 5th digits were more severely affected than the first three. Flexor pollicis longus however was also approximately 3/5. Hand intrinsic testing revealed 4/5 strength in the abductor pollicis brevis, 3/5 in the abductor digiti minimi , 3/5 in the 1 st dorsal interosseous, and 2-315 in the uinar innervated lumbrical and 4/5 in the median innervated lumbricals. Sensory testing revealed normal vibration and position sense at the great toes bilaterally. Light touch and pinprick were intact in the right upper extremity and bilateral lower extremities. Left upper extremity testing revealed diminished pin and light touch in the uinar forearm with extension into the uinar hand. There was no splitting of the 4th digit. There was also diminished pin in the posterior upper arm. Testing over the deltoid region and in the biceps region was normal. Gait testing and speech were normal. Coordination testing was slow on the left secondary to her weakness. Review of the electrical studies performed by Dr. Charczuk on April 6, 2007, revealed fibrillation potentials in the supraspinatus, deltoid, flexor carpi radialis, extensor digitorum, and triceps muscles. Polyphasic potentials were noted in the deltoid, biceps, flexor carpi radialis, and extensor digitorum. Conduction velocities across the elbow were not carried out. IMPRESSION AND PLAN: Ms. Hearn is suffering from left upper extremity pain and paresthesia presumably related to a radial plexopathy. She did undergo cervical spine imaging studies. Unfortunately she did not bring these for review today. She has not had imaging studies of the brachial plexus. Given the fullness in the supraclavicular region on the left, I would like to obtain MRI imaging studies of this region to assess for a retained hematoma, a pseudoaneurysm of the vasculature in this region and/or some other type of mass as it has been four months since her last EMG study. I would like to repeat the left upper extremity EMG study to assess for evidence of recovery. The EMG study should also be obtained to assess for superimposed uinar compression neuropathy at the elbow. Because of the hypersensitivity of the nerve related to her injury, she was given a prescription for two Percocet to be taken prior to her EMG study. Hopefully Date Printed: 812912008 Zime Printed: 1:43 PM Eton &?1Vcal Sege odiffidue Qntw Patient Name: HEARN, JACQUELINE M PSUHMC MRN: 0836666 1 O u t p a t i e n t N o t e D o c u m e n t 1 Final Document Electronically Signed by: Harbaugh, Kimberly S 8/13/2007 4:31:07 PM this will allow her to tolerate the study better. We discussed the importance of obtaining this study despite the discomfort involved. We also discussed various behavioral modifications in order to prevent excessive hyperflexion of the left elbow and pressure over the ulnar nerve at the elbow. This will reassure more adequate recovery over time. The patient understand these issues. She will be returning to the clinic once these studies are available. I have requested that she bring her cervical MRI imaging studies at the time of that appointment as well. #437659 CC: Robert P Lyons, MD Department of Orthopaedics & Rehabilitation Penn State Milton S. Hershey Medical Center PO Box 850 Hershey, PA 17033 CC: Louis F Kuskin, MD 1199 Colonial Road Harrisburg, PA 17112-0000 Review/Sign: Kimberly S Harbaugh, MD Assistant Professor, Department of Neurosurgery Penn State Milton S Hershey Medical Center PO Box 850 Hershey, PA 17033-0850 (717) 531-8807 KSH /LMW DD: 08/02/07 DT: 08/03/07 08:22 Date Printed. 812912008 Time Printed: 1:43 PM & fey Medical Center of ble(1idne Patient Name: HEARN, JACQUELINE M Patient Sex: Female Patient Location: NEUR, , Visit Type: Clinic Penn State Milton S. Hershey Medical Center Tel: (717) 531-8055 Penn State College of Medicine Health Information Services, HU24 500 University Drive P.O. Box 850 Hershey, PA 17033-0850 PSUHMC MRN: 0836666 Date of Birth: 8/18/1977 Visit Number. 08820965 E M G S t u d y D o c u m e n t i Final Document Electronically Signed by: per contribution per contnbution Signed By: Robinson, Jenice A (11/29/2007 9:49:48 AM); Robinson, Jenice A (11/23/2007 11:28:01 Alva EMG STUDY Name: HEARN, JACQUELINE M HMC Number: 836666 DOB: 08/18/1977 Date of Service: 11/19/2007 Name: Hearn, Jacu eline Gender: Female Pt. ID 836666 Date of Birth: 08118/1977 OOS # 8820965 A : 30 Technician: MB Height: 51511 Interpreting Ph ician Dr. Jenice Robinson Temp LUE 33.1 C Referring Physician: Dr. Harbau h Weight: 160 lbs Cc: Physicians Date of Stud 11/19/2007 Patient History, Patient reports that since an automobile accident last year she has numbness below the left elbow and has very weak shoulder abduction and external rotation as well as generalized weakness in the left arm. Study is ordered. to evaluate for, a left brachial plexopathy, entrapment mononeuropathy, cervical radiculopathy. Motor Nerve Conduction: Nerve and Site Latency Normal Amplitude Normal".. Dittanc Conductl Normal limits limits a on Ilmtts Velocity b Date Printed: 61412008 r 27me Printed; 9: JJ.iM Patient Name: Median.L 'Elbow 4.4 ms 8.0 ms PSUHMC MRN: 0836666 15.20 mV 1-4.00 mm mis 14.49 mV ?- 1 210 mm 58.3 m!s 1 L49 O umdr.? Wrist 2.8 ms U 3.5 10.34 mV L6.00 mm m!s Below elbow 6.5 ms 9.88 mV 220 mm 59.4 m!s L49.0 Above elbow 8.2 ms 9.38 mV 110 mm 63.2 m/s .f Axillary.L: recording deltoid F-rb's point 3.2 ms 12.24 mV mm m/s Axillary.R: recording deltoid Er 's point 3.4 ms 15.83 mV mm mis F-Wave Studiej Nerve M-f:atency: F=Latency Normal ;Limits'- Median.L 4.3 26.4 U31.0 Ulnar.L 2.8 26.5 U32.0 Sensory Nerve Conduction: Nerve`arid"Site;. Peak Normal Arnpiitude Normal Dis'tanc > Conducts Normal _` - Latency limits limits a on: limits Velocity -Median.L Wrist 3.7 ms U 3.7 37.6 V L20.0 140 mm 46.6 L53.0 Ulnar.L Wrist 3.4 ms U 3.5 34.9 V L10.0 140 mm 51.8 L53.0 Radiai.L Forearm 2.0 ms U 2.9 37.1 V L15.0 100 mm 71.4 L50.0 Lateral antebrachial cutaneous.L .Elbow 2.2 ms U 3.0 17.0 V L10.0 120 mm 75.0 L55.0 :Medial antebrachial .. Date Printed: 61412008 nme Printed: 9:55 AM itm S. Hed* bleMCM (:a= Co&-p of Med*te HEARN, JACQUELINE M A!. Mid & Hershey Medical Center +CollW of AWdRe Patient Name: HEARN, JACQUELINE M PSUHMC MRN: 0836666 cutaneous.L Elbow 1.7 ms U 3.2 11.8 V L5.00 120 mm 92.3 L50.0 Median.L--mixed Dalmar I ..Mid palm 1 2.2 ms I U 2.2 1 153.8 pV I L50.0 I 80 mm 150.0 1 L50.0 1 'Ulnar.L-mixed almar Mid palm 2.0 ms U 2.2 48.0 V L12.0 80 mm 57.1 L50.0 Needle EMG Examination: In's'ert Spontaneous o nOjor V611 io iol - MaxlmumYolittonal`=Activity Main Vol Activ . Aoti vit '. Activit , . Muscle Insert ' Fibs ±Wav Fasc' Other Amp- Dur Recruit Polys Activation lstdorsal Normal None None None None Norm Norm Normal None Sub Max. interosseous.L al al Abductor pollicis Normal None None None None Norm Norm Normal None Sub Max. brevis.L al al Pronator teres.L Normal None None None None Norm Norm Normal None Max. al al Extensor indicis Normal None None None None Norm Norm Normal None Max. ro rius.L all al Brachioradialis.L Normal None None None None Norm Norm Normal None Sub Max. al all .Biceps brachii.L Normal None None None None Norm. Norm Normal None Max. al al Triceps brachii Normal None None None None Norm Norm Normal None Max. Lateral head .L al al Deltoid (middle).L Normal None None None None Norm Norm Normal None Sub Max. al al Infraspinatus.L Normal None None None None Norm Norm Normal None Sub Max. al al C6 paraspinal.L Normal None None None None Norm Norm Normal None Max. al al -..Rhomboid major.L Normal None None None None Norm Norm Normal None Sub Max. al al Summary: Nerve conduction studies were performed in the left upper extremity with limited comparison studies in the right upper extremity. Left uinar and median motor studies were normal. Left and right axillary motor studies recording deltoid and stimulating at Erb's point were normal and symmetric. Left uinar and median minimal F-wave latencies were normal. Left .median, uinar, radial, lateral antebrachial and medial antebrachial sensory responses were normal. Left median-ulnar mixed palmar comparison studies were normal. Needle EMG of the left upper extremity and cervical paraspinal muscles was performed. No active denervation was seen in any muscle tested. Motor units were normal morphology with Date Printed: 61411008 Ylme Printed: 9.JJ RM Mild & E hey Medical Center College of W-diclne Patient Name: HEARN, JACQUELINE M J "l PSUHMC MRN: 0836666 ?. E M G S t u d y D o c u m e n t Final Document Electronically Signed by: per contribution per contribution Signed By: Robinson, Jenice A (11/29/2007 9:49:48 AM); Robinson, Jenice A (11/23/2007 11:28:01 AM) decreased motor unit activation in several muscles of the left upper extremity and shoulder. Recruitment was normal. The patient stated that she could not tell if she was moving the muscle or not, or that she was trying her hardest to move. She did not appear to be in excessive pain. All motor unit morphology, activation and recruitment pattems were otherwise normal in all other muscles tested. Interpretation: This is an abnormal study due to decreased motor unit activation in several muscles of the left upper extremity and shoulder. Decreased motor unit activation represents a central disorder of motor unit control and may be seen in lesions of the brain or spinal cord affecting the motor pathways, poor patient understanding of test instructions, pain with testing, or functional disorders causing weakness. There is no definite electrophysiologic evidence of a left brachial piexopathy. -In addition, there is no definite electrophysiologic evidence of cervical radlculopathy or peripheral neuropathy in the left .'upper extremity. CC: Harbaugh, Kimberly S, MD Department of Neurosurgery Penn State Milton S Hershey Medical Center PO Box 850 Hershey, PA 17033 Review/Sign: Robinson, Jenice A, MD Review/Sign: Robinson, Jenice A, MD JAR/CB DD: 11/19/07 DT: 11/20/07 16:49 Date Printed: 61412008 71me Printed: 9: SS" PENISSTATE h%w S. HidrAw Medical Cuter j Comew of M"dw Patient Name: HEARN, JACQUELINE M PSUHMC MRN: 0836666 r P u t p a t i e n t N o t e D o c u m e n t Final Document Electronically Signed by: Harbaugh, Kimberly S 12/3/2007 11:25:34 AM OUTPATIENT NOTE Name: HEARN, JACQUELINE M HMC Number. 836666 'DOB: 08/18/1977 Date of Service: 11/29/2007 Ms. Hearn returns for a follow-up evaluation. She has had no change in her symptoms since her last visit. Her - neurological exam is essentially unchanged. She continues to have decreased strength in the left upper extremity primarily due to lack of effort. She notes pain when she attempts to use the arm on formal exam. There was no evidence of atrophy or fasciculations. Sensory testing reveals diminished pin diffusely in the arm with the only preservation being a strip of normal pin along the anterior biceps and mid forearm region. Her densest area of numbness or decreased pin is in the lower trunk distribution. However, she also has patchy decreased pin throughout the rest of the limb and in the shoulder girdle region on the left. Testing in the face, however, is normal. Deep tendon reflexes are relatively mute bilaterally. She does have preservation of the biceps jerk on the left. The patient underwent electrical studies by Dr. Robinson on 11/19/07. These revealed no evidence of denervation changes In any of the muscles sampled. In addition, there was no evidence of chronic changes in the form of polyphasic potentials. Motor units were of normal amplitude, duration, and recruitment despite submaximal activation with testing of multiple muscles. Nerve conduction studies were also normal with testing of the median, ulnar, and axillary nerves. There was no evidence of significant brachial plexus injury based on this report. IMPRESSION AND PLAN: Ms. Hearn continues to suffer from left upper extremity pain of unclear etiology. Plain x-rays of the cervical spine were unrevealing. MRI images of the brachial plexus were also without evidence of significant mass or compressive effect on the neurovascular bundle. ENMG study was normal. Neurological examination revealed sensory disturbance in a non-neurological distribution. For this reason, I am hesitant to recommend any surgical intervention as this is unlikely to resolve her symptoms. We did discuss various exercises the patient can perform in order to improve her sensory and motor loss. The issue of thoracic outlet syndrome was discussed today. The patient of note did not have pain with palpation of the proximal brachial plexus in the cervical region. I would like to see her back in clinic in approximately six weeks for reassessment. The patient will continue with her desensitization maneuvers and exercises in the interim. Based on her examination today, I see no indication for cervical spine MRI imaging studies. Date Printed: 61412008 77me Printed. 9:52 AM Nti1tm & Hershey Medical Cuter CoUege of Medidne Penn State Milton S. Hershey Medical Center Penn State College of Medicine Health Information Services, HU24 500 University Drive P.O. Box 850 Hershey, PA 17033-0850 Patient Name: HEARN, JACQUELINE M Patient Sex: Female Patient Location: SURG, , Visit Type: Clinic PSUHMC MRN: 0836666 Date of Birth: 8/18/1977 Visit Number: 09238257 Tel: (717) 531-8055 1 O u t p a t i e n t N o t e D o c u m e n t 1 Final Document Electronically Signed by: Harbaugh, Kimberly S OUTPATIENT NOTE Name: HEARN, JACQUELINE M HMC Number: 836666 DOB: 08(18/1977 Date of Service: 01/10/2008 1/14/2008 4:28:58 PM Ms. Hearn returns for a follow up evaluation. She has had no improvement in her left upper extremity symptoms. She has continued to work. However, she has had progressive pain in the left upper extremity. She also notes that if she turns her head to the left the pain in the left shoulder girdle and arm is worse. She also describes severe periscapular pain. Because of the pain complaints, the arm is heavy and difficult to use. By the end of the day she has significant discomfort. She continues to have paresthesias In the arm as well. On examination she continues to have pain with manipulation of the supraclavicular region. No palpable masses are noted today. She also has pain with manipulation of the periscapular musculature. Motor strength testing is difficult to 'assess given her pain complaints and limited exertion. Overall, however, proximal muscle testing is fairly normal. There is some questionable grip and finger flexion weakness In particular involving the Index finger and thumb. Hand intrinsic musculature had normal bulk but again decreased motion with strength testing. IMPRESSION AND PLAN: Ms. Hearn continues to be symptomatic in the left upper extremity. She has been working and has not been taking any significant medications. She was given a prescription for amitriptyline today. She has had cervical spine imaging studies in the past. The fact that lateral rotation worsens her pain complaints is concerning for degenerative cervical disc disease. Her MRI imaging studies of the neck were performed approximately one year ago. This was shortly after her initial car accident. I have not yet received those films for review. I again emphasized the need to see these imaging studies. In addition, given the progressive nature of her symptoms .over the past year, repeat imaging studies will likely be required. It is possible that she might benefit from a brachioplexus exploration. However, I would not want to consider this until I have evaluated her other treatment options thoroughly as the diagnosis of thoracic outlet syndrome is much less common than cervical disc disease and is in essence a diagnosis of exclusion. These issues were all,discussed with the patient at length today. She will bring her films into the hospital and drop them off for my review. Further plan will be dependent upon the review of those films. As noted above, we will likely recommend repeat imaging studies of the cervical spine and a follow up visit. The patient knows to call prior to her appointment if she has any questions or concerns. Date Printed: 61412008 nme Printed: 9:48.lM Eton S. lkrs4q Aledkal meter Coltw of Wane Patient Name: HEARN, JACQUELINE M PSUHMC MRN: 0836666 O u t p a t i e n t N o t e D o c u m e n t Final Document Electronically Signed by: Harbaugh, Kimberly S 12/3/2007 11:25:34 AM #150402 CC: Kusldn, Louis F, MD 1199 Colonial Road Harrisburg, PA 17112 I CC: Lyons, Robert P, MD Department of Orthopaedics &Rehabilitation Penn State Milton S. Hershey Medical Center PO Box 850 Hershey, PA 17033 'Review/Sign: Harbaugh, Kimberly S, MD Assistant Professor, Department of Neurosurgery Penn State Milton S Hershey Medical Center PO Box 850 Hershey, PA 17033-0850 {717}531-8807 KSH /MKS DD: 11/29/07 DT: 11/29/07 14:00 i Date Primed: 61412008 nme Printed: 9:52 AM Mon s CO&W a r Penn State Milton S. Hershey Medical Center Penn State College of Medicine Health Information Services, HU24 500 University Drive P.O. Box 850 Hershey, PA 17033-0850 Patient Name: HEARN, JACQUELINE M Patient Sec: Female Patient Location: SURG, , Visit Type: Clinic PSUHMC MRN: 0836666 Date of Birth: 8/18/1977 Visit Number: 09238257 Tel: (717) 531-8055 1 O u t v a t 1 e n t N o t e D o c u m e n t J Final Document Electronically Signed by: Harbaugh, Kimberly S OUTPATIENT NOTE Name: HEARN, JACQUELINE M HMC Number: 836666 DOB: 08/18/1977 Date of Service: 01 /10/2008 1/14/2008 4:28:58 PM Ms. Hearn returns for a follow up evaluation. She has had no improvement in her left upper extremity symptoms. She has continued to work. However, she has had progressive pain in the left upper extremity. She also notes that If she turns her head to the left the pain in the left shoulder girdle and arm is worse. She also describes severe periscapular pain. Because of the pain complaints, the arm is heavy and difficult to use. By the end of the day she has significant discomfort. She continues to have paresthesias in the arm as well. On examination she continues to have pain with manipulation of the supraciavicular region. No palpable masses are ? noted today. She also has pain with manipulation of the periscapular musculature. Motor strength testing is difficult to "assess given her pain complaints and limited exertion. Overall, however, proximal muscle testing is fairly normal. There is some questionable grip and finger flexion weakness in particular involving the Index finger and thumb. Hand intrinsic musculature had normal bulk but again decreased motion with strength testing. IMPRESSION AND PLAN: Ms. Hearn continues to be symptomatic in the left upper extremity. She has been working and has not been taking any significant medications. She was given a prescription for amitriptyline today. She has had cervical spine imaging studies in the past. The fact that lateral rotation worsens her pain complaints is concerning for degenerative cervical disc disease. Her MRI imaging studies of the neck were performed approximately one year ago. This was shortly, after her initial car accident. I have not yet received those films for review. I again emphasized the need to see these imaging studies. In addition, given the progressive nature of her symptoms over the past year, repeat imaging studies will likely be required. It is possible that she might benefit from a brachioplezus exploration. However, I would not want to consider this until I have evaluated her other treatment options thoroughly as the diagnosis of thoracic outlet syndrome is much less common than cervical disc disease and is in essence a diagnosis of exclusion. These issues were all discussed with the patient at length today. She will bring her films into the hospital and drop them off for my review. Further plan will be dependent upon the review of those films. As noted above, we will likely recommend repeat imaging studies of the cervical spine and a follow up visit. The patient knows to call prior to her appointment if she has any questions or concerns. Date Printed: 61411008 Time Printed: 9:48 AM T y i PENNSTATE W Eton S. W He&cnl Center College d McMne Patient Name: HEARN, JACQUELINE M PSUHMC URN: 0836666 O u t p a t i e n t N o t e D o c u m e n t Final Document Electronically Signed by, Harbaugh, Kimberly S 1/14/2008 4:28:58 PM #220287 CC: Kusldn, Louis F, MD 1199 Colonial Road Harrisburg, PA 17112 Review/Sign: Harbaugh, Kimberly S, MD Assistant Professor, Department of Neurosurgery Penn State Milton S Hershey Medical Center PO Box 850 Hershey, PA 17033-0850 (717) 531-8807 KSH /JKK DD: 01/10/08 DT: 01/11/08 09:20 7 Date Printed: 61411008 Time Printed: 9:48 AM „f ?s. M PENNSTATE _ l h0on & fey Medical Center Coll+p of lcine Penn State Milton S. Hershey Medical Center Tel: (717) 531-8055 Penn State College of Medicine Health Information Services, HU24 500 University Drive P.O. Box 850 Hershey, PA 17033-0850 Patient Name: HEARN, JACQUELINE M PSUHMC MRN: 0836666 Patient Sex: Female Date of Birth: 8/18/1977 Patient Location: 2EAS, 2000, 11 Visit Number: 09580885 Visit Type: Same Day Care O p e r a It i v e N o t e D o c u m e n t Final Document Electronically Signed by: Harbaugh, Kimberly S 3/26/2008 8:25:24 AM E OPERATIVE REPORT Name: HEARN, JACQUELINE M HMG Number: 836666 DOB: 08/18/1977 Date of Service: 03/24/08 SURGEON: Dr. Kimberly Harbaugh. ASSISTANT(s): Adam Lipson and Moksha Ranasinghe. PREOPERATIVE DIAGNOSIS: Left brachial plexopathy/thoracic outlet syndrome, secondary to trauma. POSTOPERATIVE DIAGNOSIS: Left brachial plexopathy/thoracic outlet syndrome, secondary to trauma, and congenital accessory scalene muscle. PROCEDURE PERFORMED: Left brachial plexus exploration and neurolysis, with division of the anterior scalene muscle and division of the accessory scalene muscle. i ANESTHESIA: General endotracheal. INDICATIONS: The patient is a 30-year-old female who was involved in a motor vehicle accident in December of 2006. She was struck from behind. Following the accident, she had severe pain in the left supraclavicular reg?on, extending into the left upper extremity. Her initial EMG studies were significant for changes diffusely in the limb, consistent with a prachiai plexopathy. She was managed conservatively for a time. However, she had residual pain in the lower trunk distribution. Because of persistent symptoms despite conservative therapy, surgical exploration was recarnmended. Preoperative studies did not reveal obvious bony abnormalities. For this reason, a supraclavicular neurolysis of the branchial plexus was recommended. Risks and benefits of the procedure were outlined In detail. The patient requested we proceed. FINDINGS: At the time of surgery, the middle trunk was noted to have mild fibrous adhesions in the fascial layer surrounding it, related to presumed prior trauma. The lower trunk elements, including the C8, T1 nerve roots and lower Date Printed: 61412008 77me Printed: 9;29 AM Mon S. Hqs* N CB Center Collep of Wdidne Patient Name: HEARN, JACQUELINE M PSUHMC MRN: 0836666 O p e r a t i v e N o It e D o c u m e n t { Final Document Electronically Signed by: Harbaugh, Kimberly S 3/26/2008 8:25:24 AM trunk Itself were compressed, most significantly by an accessory scalene muscle, but also by fibrous bands within the posterior portion of the anterior scalene muscle, i PROCEDURE: The patient was taken to the operating room and underwent general endotracheal anesthesia. A roll was placed between the shoulder blades, and the head was slightly extended and turned to the right. A transverse incision was made sharply through the skin just above the clavicle. The subcutaneous tissue and platysma were divided with electrocautery. A large supraclavicular nerve was noted in the lateral portion of the wound. This was mobilized and preserved. A large external jugular vein was noted to cross the wound. This was tied with silk sutures and was divided. At this point, the omohyoid muscle was identified. The muscle was divided to allow exposure of the underlying cervical fat pad. Dissection within the fat pad then allowed visualization of the brachial plexus, anterior scalene muscle and phrenic nerve. The phrenic nerve was mobilized along a segment. The circumferential dissection of the anterior scalene was then carried out near the region of the first rib. In addition, neurolysis of the middle trunk was carried out. There was some compression of the middle trunk due to fibrotic reaction within the fascia surrounding it. The nerve to subclavius was noted and stimulated. This resulted in a diaphragmatic motor response. This nerve was therefore preserved given the accessory phrenic fibers running within it. Upon completion of this neurolysis, the middle trunk had no residual compression. At this point the anterior scalene muscle was divided. Hemostasis was obtained with bipolar cautery. At this point, the subclavian artery was clearly identified. Mobilization of this was carried out. Small vessels crossing the. region were also cauterized and divided. At this point, exploration revealed an accessory scalene muscle crossing over the C8 and T1 nerve roots, as well as the lower trunk. This accessory muscle was mobilized and was divided with bipolar cautery. Care was taken to prevent any injury to the underlying plexus elements. At this point, residual fascia overlying the plexus was released. No residual compression of the plexus was noted. The wound was then irrigated with a copious amount of saline. Saline was then filled into the operative site and the patient underwent a Valsalva maneuver. There was no evidence of damage to the pleura or pneumothorax. At this point, the wound was again irrigated and hemostasis was assured. The wound was then closed with Vicryl sutures in the piatysmal layer. A running Monocryl suture was used to reapproximate the skin edges. Steri-strip tapes were placed across the incision and a sterile dressing was applied. Blood loss during the procedure was minimal. There were no drains placed and no complications. The patient was taken to the recovery room, where she was extubated without event. Date Printed: 61411008 Tome Printed: 9:19" j PENNSWE --- Moon & w laical Center Gore of bWdWe Patient Name: HEARN, JACQUELINE M PSUHMC MRN: 0836666 O p e r a t i v e N o t e D o c u m e n t Final Document Electronically Signed by: Harbaugh, Kimberly S 3/26/2008 8:25:24 AM K359523 t Review/Sign: Harbaugh, Kimberly S, MD Assistant Professor, Department of Neurosurgery 'Penn State Milton S Hershey Medical Center PO Box 850 Hershey, PA 17033-0850 (717)531-8807 KSH /CB DD: 03/24/08 DT: 03/24/08 14:50 I I ` I -i: PENNSTATE l ) -':a Mon I Hershe l dical meter .; CAW of Wdidne _ Penn State Milton S. Hershey Medical Center Tel: (717) 531-8055 Penn State College of Medicine Health Information Services, HU24 500 University Drive P.O. Box 850 Hershey, PA 17033-0850 Patient Name: HEARN, JACQUELINE M PSUHMC MRN: 0836666 Patient Sex: Female Date of Birth: 8118/1977 Patient Location: ENSG, , Visit Number. 09596349 Visit Type: Clinic i.. a O u t.p a t i e n t N o t e D o c u m e n t Final Document Electronically Signed by: Harbaugh, Kimberly S 4/21/2008 11:25:20 AM - OUTPATIENT NOTE „Name: HEARN, JACQUELINE M HMC Number: 836666 DOB: 08/18/1977 Date of Service: 04/17/2008 Ms. Hearn returns for a foilowup evaluation. She underwent exploration of the left brachial plexus on 3/24/08. At the time of surgery, a tendinous band and muscle consistent with an accessory scalene muscle was noted compressing the lower plexus elements; This was relieved without difficulty. She had no new neurological deficits postoperative. She has had no problems from the standpoint of wound heating. She has had some pain in the incislonal region, as expected. She also continues to note nonspecific pain and sensory disturbance in the limb. The sensory complains for the most part do f not follow any specific nerve or root distribution.. ?i On examination, the incision is well-healed without erythema or induration. Sensory testing reveals diminished pin in the .. 'entire palm subjectively. The patient does have some preservation of pin proximal to the verist. She also has pin in the distribution of the medial antebrachial cutaneous nerve now. This was not the case prior to surgery. She does have diminished pin subjectively above and below the incision along the left lateral neck and inferior to the incision. Strength ,. testing in the left upper extremity is limited by discomfort diffusely. No gross atrophy is identified. The patient does have active motion in essentially all of the muscles tested. No clearcut focal weakness is noted, although the patient does given a diminished effort with grip testing. Testing of individual finger plexus; however, reveals good strength. The patient does have good active external rotation of the shoulder, which is improved compared to her preoperative status. .-She is also better able to abduct the arm away from the body. IMPRESSION AND PLAN: Overall, Ms. Hearn is doing well status post left brachial plexus exploration with excision of an accessory scalene muscle and release and compression of the lower plexus elements. We discussed continued exercises for sensory retraining and strengthening. Currently, the patient is taking ibuprofen for pain on an as needed basis. She was directed to continue with her exercise efforts. I would like to see her back in clinic in approximately 2 months for reassessment. She knows to call prior to that time if she has any questions or concerns. Date hinted., 61412008 Time Printed: 9:37 AM -?1 Wton & Icy N "cal Center Cdlege of N"dne Patient Name: HEARN, JACQUELINE M PSUHUC URN: 0836666 O u t p a t i e n t N o t e D o c u m e n t Final Document Electronically Signed by: per contribution per contribution Signed By: Harbaugh, Kimberly S (6/23/2008 9:19:12 AM); Harbaugh, Kimberly S (6/23/2008 9:19:05 AK OUTPATIENT NOTE Name: HEARN, JACQUELINE M HMC Number: 836666 DOB: 08/1811977 Date of Service: 06/19/2008 Ms. Heam returns for a follow-up visit. She continues to have pain in the left shoulder girdle region. The pain extends into the triceps region. She did return to work earlier this month. We had written for her to return in a graduated fashion. Unfortunately, her place of employment did not allow this. For this reason, she simply waited to return to work until her scheduled full-time employment was due to start. She notes that with answering the phones over the course of the day, her left upper extremity pain is worse. The pain extends from the left neck region into the left shoulder blade and down the left posterior arm. At times the muscles will spasm. She has been taking one Advil in the morning before work and then takes another dose around lunchtime. She states that in the first four hours or so the pain is not terribly severe. However, depending upon how much work she does, the pain will be worse in the second half of the day. On examination, her incision remains well healed. She does have discomfort with manipulation of the paraspinal musculature and scapular musculature. Range of motion of the shoulder is also somewhat limited. She has more range of motion with forward flexion. Arm extension, however, is limited. External rotation also worsens her pain complaints. On motor testing, she has some breakaway weakness but with best effort is fairly normal throughout the limb. Her biceps reflex, triceps reflex, and brachioradialis reflexes are symmetric and intact in the upper extremities. IMPRESSION AND PLAN: Unfortunately, Ms. Hearn continues to have pain in her left upper quadrant. She was instructed on various physical therapy type activities that she can carry out at home. She is not particularly interested in pursuing more formal physical therapy at this point in time. We also discussed further desensitization maneuvers. I have recommended that she consider taking two ibuprofen tablets in the morning prior to work. An additional dose can then be taken at noontime. We discussed other potential alternative treatments. At this point, the patient is not particularly interested in taking a lot of medication. She will try the Advil. I will be seeing her back in clinic in approximately three months for reassessment. Hopefully by then her symptoms will be improving. Date Printed: 8128/2008 7Yme Printed: 7:43" ton a 11erskey Me tool Crater College ofMxUdno Patient Name: HEARN, JACQUELINE M PSiTHMC URN: 0836666 1 O u t p a t i e n t N o t e D o c u m e n Final Document Electronically Signed by. per contribution per contribution Signed By: Harbaugh, Kimberly S (6/23/2008 9:19:12 AM); Harbaugh, Kimberly S (6/23/2008 9:19:05 AM) i #23819 CC: Kusldn, Louis F, MD 1199 Colonial Road Harrisburg, PA 17112 Review/Sign: Harbaugh, Kimberly S, MD Assistant Professor, Department ofNeurosggery Penn State Milton S Hershey Medical Center PO Box 850 Hershey, PA 17033-0850 (717) 531-8807 Review/Sign: Harbaugh, Kimberly S, MD Assistant Professor, Department of Neurosurgery Penn State Milton S Hershey Medical Center PO Box 850 Hershey, PA 17033-0850 (717) 531-8807 KSH /MKS DD: 06/19/08 DT: 06/20/08 14:13 Date Printed: 812812008 T uw Printed: 7:43" ' a. , 1 0 u t p a t I a n t N o t e D o c u m e in t- 7 Fined Document Electronically Signed by: per contribution per contribution Signed By: Harbaugh, Kimberly S (9125/2008 209:27 PM); Harbaugh, Kimberly S (91252008 2:09:25 PM) OUTPATIENT NOTE Name: HEARN, JACQUELINE M HMC Number: 836666 DOB: 08/18/1977 Dafe of Service: 09/18/08 Ms. Heam returns for a followup evaluation. She Is now approximately six months out from her left brachial plexus exploration and neurolysis with excision of an accessory scalene muscle. Since her last visit she has had some improvement in her shoulder external rotation. Overall, however, her symptoms persist with turning pain in the posterior arm and forearm, and intermittent paresthesias. Continues to have limited motion of the arm and tends not to use it. On examination, her incision remains well healed. She does have improved external rotation of the arm and has good strength In the shoulder external rotators. Biceps, triceps, and wrist extension strength Is all normal. Finger flexion and grip are difficult to test given decreased effort. Sensory testing again reveals the non neurologic, patchy distribution of sensory loss. IMPRESSION AND PLAN: Ms. Hearn is neurologically stable, but continues to have symptoms of presumed brachial plexus irritation. At this point I would recommend repeat imaging studies and electrical studies to reassess. We discussed the fact that there may not be any indication for further surgery, but that these studies would be helpful to assure that no new lesions are present. We will be ordered the scan with and without contrast to assure that there is no small tumor or other lesion that may not have been detected on the last study. We will get these studies arranged in the near future and I will be seeing her back once the results are available. The patient is comfortable with this plan and would Ike to proceed as outlined above. She knows to calf if she has any questions or concerns prior to her appointments. Date Printed- 3/1120057 rime PrWed- 9.17 AM Patient Name: HEARN,JACQUELINEM PSUHMCMRN: 0836666 ,, - 10- . P u t p a t i e n t N o t e D o c u m e n t FYnal Document Electronically Signed by: per contribution per contribution Signed By: Hadmgb, Kimberly S (9125!2008 2:09:27 PM); Harbaugh, Kimberly S (9125/2008 2:09:25 PM) 188499 CC: Kusl* Louis P, MD 1199 Colonial Road Harrisburg, PA 17112 Review/Sign: Harbaugh, Kimberly S, MD Assistant Professor, Deparhmemt of Neurosurgery Peon State Milton S Hershey Medical Center PO Box 850 Hershey, PA 17033-0850 (717) 531-8807 Review/Sign: Harbaugh, Kimberly S, MD Assistant Professor, Departme»t of Neurosurgery Penn State Milton S Hershey Medical Center PO Box 850 Hersbcy, PA 17033-0850 (717) 531-8807 KSH /JRS DD: 09/20= DT: 09/22/08 14:35 Dace Prktird• 311112009 7Yme Printed- 9.-17 AM Patient Name: HEARN, JACQUEIZ4B M PSUHMC URN: 0836666 Patient Name: HEARN, JACQUELINE M Patient Sex: Female Patient Location: RADB,, visit Type: Clinic Penn State College of Medicine Health Information Servicea, HU74 500 UMdversity Drive P.O. Box 850 Hershey, PA 17033-0850 PSUHMC URN: 0836666 Date of Birth: 8118/1977 visit Number: 12222164 I__ _ C h e s t - S t u d v 1 Final EC MRI CHEST WITHOUT CONTRAST PATIENT NAb(E. HEARN, JACQUELINE M PATIENT NMNM36666 PATIENT DOB: 0811811977 EXAM DATE OF SERVICE: 11/24=8 EXAM NUMBER: 5055471 ORDER]NG PHYSICIAN: HARBAUGH, KIMBERLY Left Brachial Plexus MRI without Contrast Clinical History: 31-year-old. female with persistent left upper extremity numbness and pain. Comparison: Left brachial plexus dated 11/01/07. Technique: Coronal Tl, coronal STIR, and sagittal TI sequences were obtained through the brachial plexus without contrasL Findings: There ace fiducial markcrs at the patient's site of pain overlying the medial left clavicular head and mid left supraclavicular fossa. The brachial plexus is normal in appearance. There is no mass identified along the course of the brachial plexus. The musculature is normal in signal and bulk. There is no lymphadenopathy identified. Limited evaluation of the lung apex is unremarkable. There is a 1.3-cm nodule in the lower pole of the right thyroid. Impression: 1. Unremarkable MRI of the lei brachial plexus. 2. Right thyroid nodules This may be. evaluated with thyroid ultrasound for furdw charactcriaation. Dr. Gina M. Creutzburg is the dictating fellow. Attending radiologist signature indicates review of both the images and the report and that the attending radiologist agrees with the interpretation. Preliminary reports may not have been reviewed as yet by the attending radiologist. DICTATED: MOSHER, TIMOTHY REVIEWED AND SIGNED: MOSHER, TIMOTHY DATE DRAFTED: 11/24/1005 02:06 PM DATE OF FINAL SIGNATURE: 11/24/2008 03:40 PM Date Prkmet- 9/1112009 7tmsPrtnted, 9x12 AM 1 L- O u t p a t i a n t N o t e D o c u m e n t -1 Final Document Electroaiaally Signed by: Harbaugb, Kimberly S 11/262008 9:40:11 AM OUTPATIENT NOTE Name: HEARN, JACQUELINE M HMC Number: 836666 DOB: 08/18/1977 Dale of Service: 11/24/2008 Ms. Hearn returns for a follawup evaluation. She continues to complain of pain in the left neck and arm. Her pain is essentially unchanged. She rates this 8/10 today. She also continues to have subjective numbness and tingling in the arm as well as "ective weakness of the entire limb. She underwent MRI Imaging studies today of the left braohial plexus and underwent EMG studies. On examination, her weight is 171 pounds, blood pressure 114167, pulse 64, range of motion of the left shoulder reveals some pain in particular with arm extension. Abduction is also painful. Internal and external rotation were fairly asymptomallic today. She continues to have sensitivity and pain with manipulation of the shoulder girdle and neck region as well as the upper extremity musculature. On attempts at motor testing, there was limited effort. Dleep tendon reflexes, however, were 1-2+ and symmetric in the upper extremities. Review of the electrical studies performed by Dr. Robinson today reveals no denervatlon changes in any of the extremity muscles sampled. Extensive sampling was carried out. The paraspinal musculature could not be readily sampled due to Intolerance on the part of the patient secondary to pain. Review of the MRI imaging studies of the left brachial plexus performed today reveal no obvious masses, vascular malformations, or other abnormalities compromising the course of the brachial plexus. An incidental note of a thyroid nodule was made on the formal report. This area was not visualized at the time of her brachial plexus study last year. Impression and plan: Ms. Hearn continues to suffer from left upper extremity pain, weakness, and sensory disturbance of unclear etiology. Unfortunately she has had no significant improvement following her thoracic outlet release. I have recommended !that she pursue physical therapy. This can include range of motion exercises for the left shoulder and increasing strength and desensitization maneuvers as well. I have also recommended that a TENS unit trial be carried out. Hopefully with these measures, the patient will have some manner of relief. I will be seeing her back in clinic in approximately six months for reassessment. She knows to call prior to that time ii she has questions or concerns. Regarding the thyroid nodule, I would defer to her primary care provider for further evaluation. An ultrasound was recommended by the radiology team. Date P?iurd- V1112009 Time Printad- 9;14 AM Patient Name: HEARN, 7AC(ZEMLINE M PSLIHMC NW: 0836666 -1 O u t p a t i e n t N o t e D o c u m e n t Final Document Electronically Signed by: Harbaugh, Kimberly S 11/26/1008 9:40:11 AM 311391 CC: Kusldn, Louis F, MD 1199 Colonial Road Harrisburg, PA 17112 Review/Sip: Harbaugh, Kimberly S, MD Assistant Professor, Department of Neurosurgery Penn State b ltcn S Hershey Medical Center PO Box 850 Hershey, PA 17033-0850 (717) 531-8807 KSH BJC DD: 11/24/08 DT: 11/25/08 08:30 Ante Priwc& 31111009 77me Printab 9.14 AM Patient Name: HEARN, JACQUELINE M PSUHMC MRN: 0836666 E M G S t u d y D o c u m e n t 1 Mal Document Electronically Signed by: per contribution per contdbution Signed By: Robinson, Jenice A (12/8/2008 8:45:55 AM); Robinscm, Jenice A (12/82008 8:45:53 AM) EMG STUDY Name: HEARN, JACQUELINEM HMC Number: 836666 DOB: 08/18M977 Date of Service: 11124/2008 Name: Hearn, Jacqueline M Gender: Female Pt. ID 836666 Date of Birth: 08/18/1977 OOS # 12212833 Age: 31 Technician: MB Height: 515" Interpreting Physician Dr. Jenice Robinson Weight 160 lbs Referring Physician: Dr. Kim Harbaugh Temperature Right Arm Left Arm Right Leg Left Le : 33.3 Cc: Physicians Date of Stud 24 Nov 2008 Patient HtAgry: The patient has a history of numbness below the left elbow and weakness at the shoulder, as well as generalized weakness in the left arm. She has pain in the left shoulder. She underwent left brachial plexus exploration and neurolysis, and removal of an accessory scalene muscle, and reports there are continued symptoms. This is a follow up study to evaluate for evidence of left brachial plexopathy. Motor Nerve Conduction: t#loi Date Prlnteek 311112009 7Y~Printed• 9,14 AM Patient Name: HEARN, JACQUELME M PSUHMC MW: 0836666 MoWan.L T Tl,,.nr T Wdst r 23 ms U35 11.52 mV L6.00 mm m/s i Below elbow 6.3 ms 9.90 mV 200-- s 50.0 L49.0 Above elbow 8.0 ma 9.49 mV 100 mm 58.8 m/s F-Wave Studies X-X :t .: r r:< sr:? Me&an.L 4.0 26.0 U31.0 U1nar.L 2.5 26.5 U32.0 Sensory NeaS Conduction: Median.L Wrist 3.4 ms U 3.7 64.6 V L20.0 140 min 53.8 L53.0 Ulnar.L Wrist 29 ms U 3.5 52.7 V L10.0 140 mm 63.6 15330 Ra&al.L Fmum 2D ms U29 39.0 V L15.0 100 mm 66.6 150.0 Median.L--mixed al= Mid 31m 2D ms U 2.2 132.4 V L50.0 w mm 5373 L50.0 Ulnar.L--mixed almar Mid a1m 1.7 ms U 2.2 50.0 V L12.0 80 mm 615 L50.0 Lateral antebrachial cutaneous.L Date Printed- 3111!1009 Time Printed- 9:14 AM Patient Name: HEARN, JACQUELINE M PSUHMC URN: 0836666 Elbow 2.4 ms U 3.0 26.3 V L10.0 120 nm7m 61.2 L55.0 Medial antebrachial cutaneous.L Elbow 2.2 ms U 3.2 12.4 V LS.00 12D mm 85.7 L50.6 Needle EMG Zaamination: U101. W. w qp xti?M. .: ............ Set dorsal interosseous.L Name None one None None Normal Nonael Normal Nona Ma. Pr"Or taeaL Normal None None None None Normal Normal Normal NOW Mix. Bice bracki L Normal None None None None Normal Normal Normal Name Ma. TdnpahmftCrAwal head Normal Nave None None None Normal Normal Normal None Ma. Deltodd (middle).L Normal Name None None None Normal Normal Normal None Mix. Extensor indicts us.L Normal None None None Nave Normal Normal Normal NOW Ma. Braebiorsdialia.L Normal None None None None Normal Normal Normal Nano Ma. Abductorpolkis braft.I, Normal None None NOW None Normal Normal Normal Nona a. Terea minorL Normal None None Notre None Normal Normal Normal None Ma. Infraspdtra LL Normal None None None None Normal Normal Normal Nome Ma. Rhozoboidmaior.L Normal None None None Name Normal Normal Normal Nose Max. Cervical pamapinals.L Could not tolerste- in NIA N/A NIA NIA NA NA None NA None Summary: Nerve conduction studies were performed in the left upper extremity. Left ulnar and median motor studies were normal. Left uhlar and median minimal F-wave latencies were normal. Left median, ulnar, radial, lateral antebrachial and medial antebrachial sensory responses were no4mat. Left median-ulnar mixed palmar comparision studies did not show any prolongation of median or ulnar latency. Needle EMG of the left upper extremity was normal. No active denervation was seen in any muscle tested. Initially, the patient was unable to move several of the muscles, but with encouragement, was able to move all muscles with normal motor unit Date Prkred• 31112009 7lme Print#& 9:14 AM Patient Name: HEARN, JACQUELIIVE M PSUHMC MRN: 0836666 I E M G S t u d D o c u m e n t Mnal Document Electronically Signed by: per contribution per contribution Signed By: Robinson, Jeniee A (12/8/2008 8:45:55 AM); Robinson, Jeniee A (12/82008 8:45:53 AM) morphology, activation and recruitment patterns. However, she did not tolerate needle examination of the cervical paraspinal muscles due to pain. Interpretation: This is a normal study. These is no definite electrophysiologic evidence of a left brachial plexopathy. In addition, there is no definite electrophysiologic evidence of cervical radiculopathy or peripheral neuropathy in the left upper extremity. Review/Sip: Robinson, Jenice A, MD Review/Sign: Robinson, Jenice A, MD JAR /RHE DD: 1124/08 DT: 12/02/08 11:41 1 O u t t I E R D o c u m e n t Dare Printed, 3/172009 77mePriwed- 9:14 AM Patient Name: HEARN, JACQUELINE M PSUHMC MRN: 0836666 PENNSTATE HERSHEY Milton S. Hershey IV Medical Center Patient Name: HEARN, JACQUELINE M MRN: 0836666 Date of Birth: 8/1811977 Patient Gender: Female Penn State Hershey Tel: (717) 531-8055 Milton S. Hershey Medical Center Health Information Services, HU24 500 University Drive P.O. Box 850 Hershey, PA 17033-0850 Visit Number: 13211486 Visit Type: Clinic Patient Location: HD06 .................... ....................................................................... ............... .................. ........ Outpatient Note ........................................................ ..................................................................... RESULT STATUS: DOCUMENT SUBJECT: ELECTRONICALLY SIGNED BY: Final Harbaugh, Kimberly S (7/131200914:55 EDT) OUTPATIENT NOTE Name: HEARN, JACQUELINE M HMC Number: 836666 DOB: 08/18/1977 Date of Service: 07/09/2009 Ms. Hearn returns for a followup evaluation. She is now approximately 16 months out from her left brachial plexus and exploration and neurolysis. She was scheduled for followup in May, but unfortunately, lost her medical insurance due to a change in her jobs. She rescheduled to be seen today. She was also unable to pursue physical therapy as instructed at the time of her last visit. In addition, she was instructed to followup regarding a benign appearing thyroid nodule that was detected on an MRI imaging study she had at the time of her last visit in November. She has plans to be seen by her primary care doctor for followup regarding that nodule in the near future. With regard to her left upper extremity, she continues to have pain and subjective numbness and weakness circumferentially from the shoulder distally. The pain primarily involves the shoulder girdle region, left neck and supraclavicular area. She also has tightness in the pectoral muscles. In general, the left shoulder girdle demonstrates muscle tightness. In addition to the constant aching, she has intermittent sharper pain and spasms in the extremity. She has been working with the arm in an attempt to improve the shoulder mobility. She is able to abduct the arm further than she was at the time of her last visit. She rates her pain as a 6 on a scale of 1-10 today. At the time of her last visit, it was an 8 on a scale of 1-10. On examination, weight is 165 pounds, blood pressure 136/69, pulse 71. Range of motion of the cervical spine is fairly normal, although there is some hesitancy with rotation to the left. She also has tightness and increased muscle tone in essentially all of the left shoulder girdle musculature including the trapezius, pectoralis muscles, deltoid and rhomboids. On best effort, she has fairly good strength in the arm. There is some decreased effort secondary to pain as has been the case in the past. Tone is normal and there are no spontaneous fasciculations noted. On sensory examination, she admits to diminished sensation circumferentially from the left shoulder region distally into the entire limb. Deep tendon reflexes, however, are preserved. IMPRESSION AND PLAN: Ms. Hearn continues to have left upper extremity pain and sensory disturbance which has been present since her automobile accident. Despite efforts at neurolysis, her symptoms have persisted. I did Date/Time Printed: 2/29/2012 13:11 EST Printed By: Bender,Sylvia R PENNSTATE HERSHEY Milton S.. Hershey VP Medical Center Patient Name: HEARN, JACQUELINE M MRN 0836666 Outpatient Note ............................................................... .................................. ................. ......................................................................... recommend that she pursue physical therapy. Hopefully with increased activity and increased motion of the shoulder, she will have less spasticity. Alternative treatment options include referral to a pain clinic for either trigger point injections of local anesthetic and steroids or more drastic injections with agents such as Botox. At this point, the patient is not particularly interested in these type of invasive maneuvers. She would like to pursue physical therapy as initially recommended. Hopefully with increasing range of motion, massage and use of a TENS unit, she will have some relief of her discomfort. At the time of her last visit, she underwent extensive electrical studies of the left upper extremity. There were no denervation changes in any of the muscles sampled. Conduction studies were also normal. Repeat MRI imaging study of the brachiplexus was also within normal limits with no obvious compression of the plexus elements. For this reason, I would not recommend any more surgical intervention. I do have the sense that she is improving slowly over time. She continues to massage the arm and use it as normally as possible. We discussed the fact that this is the best rehab that she can perform. I would like to see her back in clinic in approximately six months for reassessment. She knows to call prior to that time if she has any questions or concerns. 794270 Electronic Signature on File CC: Kuskin, Louis F, MD 1199 Colonial Road Harrisburg, PA 17112 Electronically Reviewe&&gned by. Harbaugh, Kimberly S, MDAuthor Signature Dt/Tm: 13.07.2009 02:55 pm Associate Professor, Department of Neurosurgery Penn State Milton S Hershey Medical Center PO Box 850 Hershey, PA 17033-0850 (717) 531-8807 KSH /JMS DD: 07109109 DT 07110109 08:49 Date/Time Printed: 2/2912012 13:11 EST Page 2 of 9 Printed By: Bender,Sylvia R II a PENNSTATE HERSHEY ,IM Milton S. Hershey medical Center Patient Name: HEARN, JACQUELINE M MRN: 0836666 Date of Birth: 811 811 977 Patient Gender: Female Penn State Hershey Tel: (717) 531-8055 Milton S. Hershey Medical Center Health Information Services, HU24 500 University Drive P.O. Box 850 Hershey, PA 17033-0850 Visit Number: 13872996 Visit Type: Clinic Patient Location: HD06 ; .............. ............. ........ ........ ... ......... ...... ...... . Outpatient Note , ............. ............................................. .................... ......................... ........ ......................................... RESULT STATUS: DOCUMENT SUBJECT: ELECTRONICALLY SIGNED BY: Final Harbaugh, Kimberly S (11131201013:11 EST) OUTPATIENT NOTE Name: HEARN, JACQUELINE M HMC Number: 836666 DOB: 08/1811977 Date of Service: 01107/2010 Ms. Hearn returns for a followup evaluation. She underwent left brachial plexus exploration and neurolysis for presumed thoracic outlet syndrome on 03124108. Unfortunately she has not had complete resolution of her symptoms. She continues to have pain complaints. She has been working with the arm. She does have improved range of motion in the shoulder. She notes that if she sits at work with the elbow bent and resting on the arm rest of the chair, her pain is much worse. She will have an exacerbation of these symptoms in the uInar hand. She is otherwise neurologically unchanged. On examination, weight is 160 pounds, blood pressure 126167, pulse 69. Range of motion of the shoulder is much better. The patient is able to abduct the arm to greater than 90 degrees. External rotation and internal rotation are also normal today. Motor exam again reveals some breakaway weakness secondary to pain diffusely in the left arm. She does have some discomfort with manipulation of the uInar nerve at the elbow. She also has a Tinel's phenomenon with percussion of the uInar nerve at this point. There is no dear atrophy or clawing of the uInar innervated digits. IMPRESSION & PLAN: Ms. Hearn continues to have right upper extremity pain complaints. We discussed the fact that she likely has some significant muscle spasm in the shoulder girdle region which is contributing to her complaints. We recommended physical therapy in the past. Unfortunately the cost is prohibitive. We also discussed the possibility of heat and/or massage. The patient may find that if she can develop a stretching exercise to loosen up the shoulder girdle muscles, her symptoms will improve. Additionally, I would recommend that the patient use an elbow pad while working. She was given a prescription to take to work to allow her to bring in a pad from home to place under her elbow when she is working. Hopefully by padding the elbow, she will prevent further uInar compression neuropathy. At this point, no specific followup will be scheduled for our office. The patient knows to call if she has any questions or concerns in the future. 286057 Date/Time Printed: 2/29/2012 13:10 EST Printed By: Bender,Sylvia R PENNSTATE HERSHEY Milton S.. Hershey Medical Center Patient Name: HEARN, JACQUELINE M MRN 0836666 Outpatient Note ........_, i ............ .......................................................................... Electronic Signature on File CC. Louis F Kusidn, MD 1199 Colonial Road Harrisburg, PA 17112 Electronically Reviewed/Signed by: Kimberly S Harbaugh, MD Author Signature Ot/Tm:13.01. 2010 01:11 pm Associate Professor, Department of Neurosurgery Penn State Milton S Hershey Medical Center PO Box 850 Hershey, PA 17033-0850 (717) 531-8807 KSH /LLD DD: 01107110 DT.• 01108110 08:52 Date/Time Printed: 212912012 13:10 EST Page 2 of 33 Printed By: Bender,Sylvia R PENNSTATE HERSHEY Milton S. Hershey medical Center Penn State Hershey Tel: (717) 531-8055 Milton S. Hershey Medical Center Health Information Services, HU24 500 University Drive P.O. Box 850 Hershey, PA 17033-0850 Patient Name: HEARN, JACQUELINE M Visit Number: 17062709 MRN: 0836666 Visit Type: Clinic Date of Birth: 8/1811977 Patient Location: HD06 Patient Gender: Female Outpatient Note RESULT STATUS: DOCUMENT SUBJECT: ELECTRONICALLY SIGNED BY: Final Harbaugh,Kmberly S (113012012 10:11 EST) OUTPATIENT NOTE Name: HEARN, JACQUELINE M HMC Number: 836666 DOB: 08/1811977 Date of Service: 01126/2012 Ms. Hearn returns for a follow-up visit. She continues to have left upper extremity pain and subjective weakness. She was last seen in January 2010. She suffered a motor vehicle accident in December of 2006. This was associated with subsequent left shoulder and arm pain. She underwent extensive physical therapy with no improvement. Because of concerns of thoracic outlet syndrome, she underwent surgery in March of 2008 to release the brachial plexus. She did have evidence of compression of the proximal plexus at that time. Unfortunately, she had no improvement in her symptoms following surgery. If anything, she feels her symptoms have worsened since then. She has undergone therapy since then. At times she had some improvement with this. More recently, however, she feels the therapy has not helped. Her pain radiates in the shoulder region, down the posterior arm, and into the hand. The entire arm feels numb and weak. If she bends the elbow in certain locations, the pain is worse. There is some concern that she has an eczema type reaction in her posterior thoracic region over the shoulder blade. Her significant other tends to note this more than the patient notes it. If he rubs lotion on it, the skin changes improve. There have been no clear bullous or blister-like lesions associated with this. She has no complaints of bladder difficulties. Her lower extremities remain strong without sensory disturbance. She has no symptoms in her right upper extremity. She has some neck stiffness, but this is typically related to exacerbation of her upper extremity complaints and shoulder girdle complaints. She has had no dear radicular pain from the neck into the upper extremity. On examination, weight is 163 pounds, blood pressure 128/73, pulse 69. On general examination, she has fairly good range of motion of the cervical spine. She continues to have subjective pain with manipulation of the left upper extremity in general. Palpation in the supraclavicular region and in the arm around the elbow is particularly uncomfortable. She has no pain with manipulation of the scapula or parascapular region. She does have some discomfort along the chest wall in the region of the serratus anterior muscle. With motor testing, there is break away weakness with testing of essentially all of the muscles of the left upper extremity. She is able to activate all of the muscles. There is no clear fibrillation potential or significant focal atrophy. She has diffuse discomfort with manipulation of the arm in the region of the elbow. This is particularly prominent in the medial elbow just above the medial epicondyle, and in the lateral elbow just distal to the lateral epicondyle. From a sensory standpoint, she has patchy subjective decreased pin diffusely in the arm. She also denies the ability to sense pin in the scapula region of the chest wall. No dear cutaneous abnormalities are noted to my Date/Time Printed: 2/2912012 13:10 EST Printed By: Bender,Sylvia R PENNSTATE HERSHEY Milton S. Hershey Medical Center Patient Name: HEARN, JACQUELINE M MRN 0836666 Outpatient Note ......................................................................................................................................................... .._._.._._.__._......_.__? examination today. Her significant other did feel there was some asymmetry and flaking of the skin on that left side to his exam today. The arms appeared symmetric to my exam. Th extended period of time and her significant other again were concerned about some asymmetries in the elbow. However, this appeared to relate to a variance in arm pronation from one side to the other. Gait was normal today. The patient did have significant discomfort with manipulation of the arm. She had a sweating response in the face with this. IMPRESSION AND PLAN: Ms. Hearn continues to have left upper extremity pain of unclear etiology. At this point her pain sounds like a musculoskeletal cramping phenomenon. This is particularly prominent involving the serratus anterior muscle, which would explain the severe pain along the chest wall, in the axilla, and in the supraclavicular region where the upper head of the serratus anterior muscle is located. Spasm of this then brings on a sense of fullness or mass in that region. We have noted this on prior exams. At this pant, however, I would recommend imaging studies of the brachial plexus to exclude scarring or new mass lesions. We should have an informal view of the cervical spine and foramina with that as well. If these are unrevealing, referral to a rheumatology specialist or rehabilitation specialist may be appropriate. We will be seeing the patient back in the near future for re-review with imaging studies. Of note, her reflexes were intact in the upper extremities bilaterally, and were symmetric. The patient will be following up with her imaging studies as noted above. #237613 Electronic Signature on File CC: Louis F Kuskin, MD 1199 Colonial Road Harrisburg PA 17112 Eledronically Reviewed/Signed by. Kimberfy S Harbaugh, MD Author Signature Ot/Tm:0113012012 10:11 AM Associate Professor, Department of Neurosurgery Penn State Mifton S Hershey Medical Center PO Sox 850 Hershey, PA 17033-0850 (717) 531-8807 KSH/CJK DD: 01126112 DT:01/27/1211:42 Date/Time Printed: 2/2912012 13:10 EST Page 2 of 13 Printed By: Bender,Sylvia R PENNSTATE HERSHEY Milton S. Hershey Medical Center Patient Name: HEARN, JACQUELINE M MRN 0836666 ------------- - Outpatient Note ---- - ----------------------- ------ - - - ------------------------ RESULT STATUS: DOCUMENT SUBJECT: ELECTRONICALLY SIGNED BY: Final Harbaugh, Kimberly S (2!6/2012 08:40 EST) OUTPATIENT NOTE Name: HEARN, JACQUELINE M HMC Number: 836666 DOB: 08/18/1977 Date of Service: 02/02/2012 Ms. Hearn returns fora follow-up evaluation. She underwent MRI imaging studies of the left brachial plexus earlier this week. She has had no change in her symptoms since her last visit. She continues to have severe intermittent pain, which she describes as a spasm involving her left chest wall as well as pain in the entire left arm, which is worse with manipulation, pressure. All of her symptoms are exacerbated with use of the limb. On examination, weight is 163 pounds. Blood pressure 133166, pulse 64. She continues to have protective behavior with the left upper extremity. External rotation of the arm was fairly normal today. Extension of the arm and abduction however, worsened her pain complaints. She developed what she describes as a spam in the distribution of her serratus anterior muscle on the left chest wall. Pressure over the muscle tended to improve this to some degree. Any manipulation of the arm diffusely also brought on pain complaints. She had no dear atrophy or fasciculations of the upper extremity musculature. She was able to move the muscles. She simply had pain and breakaway-type weakness as a result. Review of her MRI imaging studies and comparing them to prior studies reveal no clear compression of the brachial plexus elements. The signal within the musculature of the shoulder girdle and upper arm were normal. No clear compression, tumors or other anomalies of the brachial plexus elements were noted. IMPRESSION/PLAN: Ms. Hearn continues to suffer from left upper extremity and chest wall pain following a motor vehicle accident in 2006. At this point I see no indication for further surgery of the brachial plexus or arm. Her symptoms are not within one specific nerve distribution. Her symptoms are most consistent with a dystonic-type spasm reaction. At this pant I have recommended that she consider consultation with a rehabilitation physician. She may benefit from Botox injections. We discussed the fact that as I am not an expert in this, it is not clear whether she would be a good candidate for this. Further discussion however, with our rehabilitation physician would be helpful. At this point no specific follow-up is scheduled for my office. She knows to call if she has any questions in the future. 252396 Date/Time Printed: 2/29/2012 13:07 EST Printed By: Bender,Sylvia R PENNSTATE HERSHEY Milton S. Hershey Medical Center Patient Name: HEARN, JACQUELINE M MRN 0836666 Outpatient Note ._ ...................................................................................................................... Electronic Signature on File CC: Louis F Kuskin, MD 1199 Colonial Road Harrisburg PA 17112 Electronically Reviewe&Signed by: Kimberfy S Harbaugh, MD Author Signature Dt/Tm:0ZV6i2012 0840 AM Associate Professor,, Department of Neurosurgery Penn State Milton S Hershey Medical Center PO Box 850 Hershey, PA 17033-0850 (717) 531-8807 KSH/PAO DD: 02102112 DT 0210311209:32 Date/Time Printed: 2/29/2012 13:07 EST Page 5 of 15 Printed By: Bender,Sylvia R IN THE COURT OP COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA JACQUELINE M. HEARN, CIVIL ACTION - LAW Plaintiff No. 2006-7062 V. MICHAEL Lot, Defendant COPY . Oral Deposition of JACQUELINE MARIE HEARN DATE: Thursday, January 20, 2011 TIME: 10:47 a.m. PLACE: 301 Market Street Lemoyne, Pennsylvania TAKEN BY: Defendant ERSA Court Reporters 30 South 17th Street United Plaza Building, Suite 1520 Philadelphia, PA 19103 215-564-1233 Was 215-564-1225) 3 JACQUELINE MARIE HEARN V I N D E X Witness Page No. JACQUELINE MARIE HEARN Examination by: Mr. Shipman 4 Exhibits (None) V V ELECTRONIC REPORTING STENOGRAPHIC AFFILIATES 2 JACQUELINE MARIE HEARN V U U APPEARANCES: For the Plaintiff: MATTHEW S. CROSBY, ESQUIRE HANDLER, HENNING 4 ROSENBERG 1300 Linglestown Road Harrisburg, PA 17111 For the Defendant: JEFFERSON J. SHIPMA N, ESQUIRE JOHNSON, DUFFIE, STEWART i WEIDNER 301 Market Street P. O. Box 109 Lemoyne, PA 17043-0109 # # # # ELECTRONIC REPORTING STENOGRAPHIC AFFILIATES 4 JACQUELINE MARIE HEARN 1 P R O C E E D I N 0 S 2 3 S T I P U L A T I O N 4 It is hereby stipulated by and between counsel for 5 the respective parties that signing, sealing, 5 certifying, and filing are hereby waived, and that all 7 objections, except to the form of the question, are 6 reserved to the time of trial. 9 10 JACQUELINE MARIE HEARN, 11 RAVING BEEN SWORN, TESTIFIED AS FOLLOWS: v 12 13 EXAMINATION 14 BY MR, SHIPMAN: 15 Q Would you please state your full name for 16 the record? 17 A Jacqueline Marie Hearn. is Q Jacqueline, where do you live? 19 A 2627 Waldo Streat L. Harrisburg. 20 Q You were present for the deposition of my 21 client, Mr. Lee. Did you hear and understand the 22 instructions that Mr. Crosby gave to Mr. Los in terns of 23 how to proceed? 24 A Yes. ELECTRONIC REPORTING 9 JACQUELINE MARIE HEARN V U 1 Q I am going to ask you a series of 2 questions about this accident and your injuries. If for 3 any reason you don't understand a question that I have, 4 than let me know that and I will be happy t0 -ask the 5 question. Okay? 6 A Okay. 7 Q Also if for any reason you need to take a 8 break, just let me know that and I will be happy to 9 accoamodate you, Okay? 10 A Okay. 11 Q Is it okay if I call you Jacqueline? 12. A You can call me Jackie. 13 Q Jackie, how old are you? 14 A Thirty-three. 15 Q What is your date of birth? 16 A August 18, 1977. 17 Q Are you currently employed? 19 A No. I was recently laid off in September. 19 Q I'm sorry to hear that. Where were you 20 laid off from? 21 A I was working for Select Medical 22 Corporation. They are a temp agency for Sperion. 23 Q Are you from Harrisburg? 24 A Yes. 5 ELECTRONIC REPORTING STENOGRAPHIC AFFILIATES L JACQUELINE MARIE HEARN 7 1 she- ware you working? 2 A At Delta Dental. 3 Q Were you there as a tamp? 4 A No. 5 Q Delta Dental is over in the area where 6 this happened? 7 A Correct. B Q Can you describe for me that you remember 9 happening in the accident? 10 A I'm sorry? li Q Can you describe for me what you remember 12 happening in the accident? 13 A At the point in time I was at the 14 Uni-Mart, and I pulled out of the Uai-Mart and r made a 15 right to got to the stop sign. There was a car actually 16 already in front of me once I made the right. 17 So I waited in line until that car went, 18 and then once that car went I moved up to the stop sign 19 and stopped, and once I got to the stop sign and 20 stopped, the impact just happened. 21 Q Can you describe the impact for no? 22 A wall, describe it? I was leaning because 23 there was tractor trailers coming both ways, I would 24 say, down Wesley Drive. So I was leaning up to sea both V V V V V V JACQUELINE MARIE HEARN 6 1 Q When did you graduate from high school? 2 A 1995. 3 Q Harrisburg High? 4 A No, air. Susquehanna Township. 5 Q I understand you have three children? 6 A Yes. 7 Q What are their names and ages? 8 A My daughter is Xhadeja, X-H-A-D-E-J-A, 9 Her last name is Hearn, H-E-A-R-N, and she's 16. Malik, 10 M-A-L-I-X, Hearn, and he is 13; and Rasters, 11 N-A-S-S-E-R-E; Ford, F-O-R-O, just like the car, and he 12 is S. 13 Q They all live with you? 14 A Well, the two older ones at this point, 15 because of what is going on with the school district and 16 education and stuff, they are with their dad right now 17 going to school in Mississippi, and the oldest -- the 19 youngest one is with me, Hassere cord. 19 Q Who lives with you at the Waldo Street 20 address? 21 A Nassers, and his father, Michael Ford. 22 Q Are you married to him? 23 A No. 24 Q At the time of this accident happening, ELECTRONIC REPORTING STENOGRAPHTC AFFILTATER JACQUELINE MARIE HEARN B 1 ways and make sure I could see both ways. 2 So when I was leaning, I van already -- 3 because I am going to turn left, I was holding my 4 •tearing wheel this way. I was already leaning up, and 5 when the impact happened I just -- it like literally 6 pushed me into the steering wheel, like it we. kind of 7 like -- the way I had my steering wheel tilted, it kind B of like shoved into -- I don't know what area you call 9 this, like my diaphragm area on up into where my 10 shoulder and everything was. 11 At that point -- when I was at the stop 12 sign, but from the impact it kind of pushed me out a 13 little bit into Wesley Drive into the roadway where 14 Wesley Drive is. I IS Q Do you know how far your car was pushed? 16 A No, not exactly. 17 0 What kind of vehicle were you driving? 18 A 2006 Mazda 6. 19 Q Did you speak to my client, Mr. Loa, at 20 all at the scone? 21 A No. 22 Q How about the people behind you, do you 23 know if you spoke to them? 24 A Yes, I did. They got out of the whiola ELECTRONIC REPORTING STENOGRAPHIC AFFILIATES ELECTRONTC REPORTING STENOGRAPHIC AFFILIATES JACQUELINE NARIE REARN v V v 9 1 instantly and came up -- the older gentleman came up to 2 as that was -- I believe he was driving the vehicle 3 behind me. He came up, and you know, to my window and 4 was like, are you okay, are you okay, and I believe his 5 wife she cams up on the opposite side of my car where 6 the passenger would be sitting, and she was like, are 7 you okay, and I was like -- you know, I on stunned and 8 shocked because it's my first accident over, and so he 9 was like, you come on, get out of the car, you know, 10 walk around and try to feel a little better because I 11 was completely in shock. 12 But those are the only two people I had 13 spoken to at that point that the accident happened. 14 Mr. Los didn't came to my car at all or speak to " at 15 all at that point. 16 Q Were you feeling any pain at the accident 17 ¦cons? 18 A At the accident scene I think I believe I 19 was more in shock that everything happened because, like 20 I said, it was my first accident. I kind of felt pain 21 in my shoulder. 22 I do believe there was an off-duty fire -- 23 I don't know if he was ¦ fire fighter or whatever, but 24 he was there. I believe he was the one that actually ELECTRONIC REPORTING STENOGRAPHIC A171LIATES V V V ELECTRONIC REPORTING STENOGRAPRIC A771T.71,972 JACQUELINE MARIE HEARN C-) v v 11 1 Then right after I want back to work I 2 actually want to the emergency room. 3 Q So from the accident scene you drove your 4 Heads to Delta Dental? 5 A To Delta Dental. 6 Q Did you finish your day at work there or 7 did you leave early? 8 A A. soon as I drove my or back to work I 9 see. my boss, I set down at my desk hysterical. At that 10 point I was crying. I shut down everything and went 11 instantly to the emergency room. 12 I apologize. I went home actually because 13 my bumper was hanging off my car. So I went home and my 14 boyfriend drove me to the hospital at that point because 15 I didn't drive myself. 16 Q So your boyfriend, is that Mr. 8brd? 17 A Uh-huh. 18 Q Be drove you to the hospital? 19 A Uh-huh. 20 Q Is that yes? 21 A I'm entry. Yes. 22 Q Was your car repaired? 23 A No. 24 Q Why not? ELECTRONIC REPORTING STENOGRAPHIC AP!'ILIATra v v U JACQUELINE MARIE HEARN 10 1 called the police. 2 Q Okay. 3 A The off-duty gentleman. Re asked me, he 4 said, are you okay, and I said I belie" I am in shock 5 at this point, I said, but I don't have any injuries 6 where I an bleeding or anything. 7 ee said, okay, just calm down until the 8 police got here and we will wait and they will take your 9 statements and everything. 10 Q Did a police officer come? 11 A Yes. 12 Q Did you speak to the officer? 13 A yea. 14 Q Did the officer ask you if you were hurt? 15 A I don't believe no. 16 Q Did you tell the officer that you wanted 17 to go to the hospital? 18 A No. At that time I was actually on break 19 fzon work. So I had to get back -- I still had to get 20 back to work. I was on the phone with my job at that 21 time. They told me, you know, don't worry about rushing 22 back to work. Just handle what I needed to handle, but 23 I still had to get back to work so I could, you know, 24 shut down all my stuff. JACQUELINE MARIE HEARN 12 1 A The only reason why the car was not 2 repaired at the time is because when at that point I was 3 taking time off of work and I was losing pay. So when 4 the lady case out to estimate my car, at that point they S were already coming to pick up my car because I couldn't 6 pay the car payment at that point. So I ended up losing 7 my car because I lost time at work from the accident. 9 Q So I guess they repossessed your car? 9 A Yeah. Well, I voluntarily gave it back to 10 them so I wouldn't have -- I don't know how you want to 11 consider it -- have a repo on my -- so I voluntarily 12 gave it back to them be-... I knew at that point that I 13 was going to miss a lot of work, and it was almost a 14 9500 car payment and no way I could pay a car payment 15 and mortgage and everything also and miss work too. 16 Q Which hospital did they take you to? 17 A Hershey Medical Center. 18 Q Why did you go to Hershey? 19 A That is my preferred hospital. I been 20 going to Hershey for year.. 21 Q Is that where your family doctor is at 22 too? 23 A Yeah. No, I Apologize. No. My family 24 doctor is Kendra, Kuskin and rierer. They are on ELECTRONIC REPORTING STENOGRAPHIC "XXL-TATRR JACQUELINE MARIE HEARN V Q) V 13 1 Colonial Road, but my gynecology doctors and stuff 2 like that are with Hershey. 3 Q I think you told me, but haw you ever 4 been involved in any automobile accidents? 5 A No, not prior to this. 6 Q Have you been involved in any accident 7 since this one? S A No. 9 Q What were your complaints at Hershey? 10 What were the problems you were having? 11 A At that point in time the only thing, my 12 whole arm -- they didn't know exactly what was going on 13 with me, but I know any whole arm was numb. 14 Q Your left arm? 15 A My left am from my fingers up to my neck 16 region was numb. It was all tightened up and my 17 shoulder was -- you could actually see at that point 18 prior to my surgery where my arm wag shifted and my 19 right shoulder was dews and my left shoulder was up. 20 I still haw the massive lump on the top 21 of my shoulder from I guess the impact, it bound up, all 22 my muscles and stuff. So I still have that lump there 23 too. 24 Q You warenIt weaning a seat belt, I don't ELECTRONIC REPORTING STENOGRAPHIC AFFILIATES V V V JACQUELINE MARIE SEAM 14 1 think. 2 A No, not at that time. 3 Q What did they do for you at Hershey? 4 A The first day I want into the emergency S room they gave me was pain medicine. They took x-rays 6 and they gave me a sling and they told as to follow-up 7 within 24 to 48 hours with my family doctor. B Once I did that, I told my family doctor I 9 was still in excruciating pain. So that is when she 10 sent w to the specialist at Hershey. 11 Q How was your shoulder and your arm fooling 12 within the months following the accident? 13 A In pain. A lot of pain. I'd may from a 14 scale from one to ten, on a daily basis I as probably a 15 No. S. If I am doing activities during the day, it will 16 probably reach a 10 to 12. 17 Q Were you having daily pain? 18 A Daily pain. 19 Q Was it your whole am and shoulder? 20 A It's actually -- the pain consists like 21 from your funny bone, like my elbow, all the way up to 22 the top of my -- say my neck region. 23 Q You are still having pain then? 24 A Yes. ELECTRONIC REPORTING STENOGRAPHIC AFFILIATES JACQUELINE MARIE HEARN v v v 15 1 Q Now, it looks like you want back to 2 Hershey a number of times during 2006 and 2007 almost on 3 a monthly basis -- 4 A Yes. 5 Q -- you ware going back. Did they 6 ultimately coma to some conclusion as to what the 7 problem was? 8 A- Yes. At first -- the first specialist 9 that my family doctor sent me to, he was more of a 10 specialist I believe for tears, like rotary cuff tsars 11 'br something. They thought because my am won't turn or 12 lift or band or do any of this at all, they thought I 13 had a rotary cuff problem. That is when I went to sae 14 the first specialist. 1S After months of seeing him and going to 16 gat therapy and getting MRI'¦ done, than he realized 17 that, you know, this was not a rotary cuff tesr. So 18 that is when he recommended me to this Harbold which is 19 the neuro specialist at Hershey, and that is when they 20 discovered after several tests and MRI's and CAT scans 21 that I had the brachial plexus. 22 Q That was Dr. Harbold that discovered that? 23 A Yea. 24 Q Did he tall you that was injured? ELECTRONIC REPORTING STENOGRAPHIC AFFILIATES V v JACQUELINE MARIE REARM 16 1 A It's a her. Her name is Kathryn Harbold. 2 Yes. 3 Q What was her specialty? 4 A She is the head neurosurgeon of Hershey. 5 Q Did Dr. Harbold operate on your brachial 6 plexus? 7 A Yea, she did. 8 Q Is that in March of 2008? 9 A yes. 10 Q What did she tall you she was going to do 11 in the operation? 12 A Well, what she basically told ma she was 13 going to do is try her beat to give me as much function 14 in my am as she possibly could. She was going to try 1S and, lot's may, unravel it because it's kind of like 16 they were braided up a little bit. So she was going to 17 try to, you know, fix them as much as she can so I can 18 got flexibility and moo if my arm would try to function 19 and gat the nerves to try to grow back in my arm. 20 Q Did she may what caused that? 21 A What caused the brachial plaxus? 22 Q rem. 23 A I am assuming from the impact -- no, she 24 never like apacifically said, oh, because you hit the ELECTRONIC REPORTING STENOGRAPHIC AFFILIATES JACQUELINE MARIE HEARN v V 17 1 car wheel this way. She never specifically told me 2 anything to that extent. 3 Q Did the operation help? 4 A It did help a little with same flexibility 5 because, like I said before, my arm was like literally 6 lopsided. It was up in the air. So now it is a little 7 bit more even. You could tell. It's still a little up, S but it's come down a lot from what it was. 9 Before I couldn't move my arm from here 10 end now I have soma flexibility within my elbow. 11 Q You are right handed? 12 A Yes. 13 Q After the operation, did you continue 14 going back to Hershey for treatment? 15 A Yes. 16 Q Did they do anything else for your arm and 17 shoulder? is A No, not at that point. She gave me I 19 believe two or three more EM 'a which actually I believe 20 monitors the nerve and muscle reaction in your am. So 21 I had three of thou done, and from all three of these 22 the results were that my n.- and my muscles were not 23 really active in my am. 24 At that point she said there was one other ELECTRONIC REPORTING STENOGRAPHIC A"ILIATES V V L/ JACQUELINE MARIE HEARN is 1 surgery I belie" that they could have done, but it 2 wasn't nothing that would be a probable cause for me. 3 There was no point of putting me through sore surgery 4 when it wasn't going to really fix the problem any way, 5 Q When is the last time you saw Dr. Harbold? 6 A I don't know the exact data. I believe it 7 was about six months after my surgery, and then I am not S aura -- I followed up with her if I had pain. I'm not 9 sure exactly of the exact visit I had with her. 10 Q When is the last time you saw a doctor for 11 your problems? 12 A The only doctor I would see is 13 Dr. Harbold, and the last appointment that I had with 14 her. That is the only doctor I would see for err 15 problem. 16 Q The last record I have in dated January 7, 17 2010. So about a year ago -- 16 A Okay. 19 Q -- you were at Hershey for follow-up with 20 evaluation for left brachial plexus exploration. Do you 21 believe that is the last time you were seen at Hershey? 22 A Yeah, I do believe so. I haven't been 23 back in probably a year or so. 24 Q He" you seen anyone also for your RS.RCTUCATC REPOR'T'ING STENOGRAPHIC AFFILIATES JACQUELINE MARIE HEARN Q/ V 19 1 injury -- 2 A No. 3 Q -- since that time? 4 A No. 5 Q What type of problems have you had with 6 the injury? How has it affected you at home or at work? 7 What kinds of problems do you he"? S A Do you want me to describe like what I 9 cannot do? 10 Q Yeah. That's right. 11 A Basically it's definitely changed my 12 entire life. You don't realize what you don't have 13 until you can't use it anymore. 14 I can't pick up -- lift laundry. I can't 15 pick up heavy baskets. I can't hold anything in my hand 16 because it automatically gives out or it's excruciating 17 pain. I can't grip anything. I can't open jars. 13 I can't go swimming with my kids anymore 19 because I can't rotate my am to swim. I can't ride a 20 roller coaster. I don't go ice skating or roller 21 blading with them anymore because of the fear of 22 falling. I can't brace myself, especially not on my 23 am. 24 I don't hang my pictures up anymore ELECTRONIC REPORTING STENOGRAPHIC AFFILIATES V v v JACQUELINE MARIE HEARN 20 1 because I can't reach in the air. I don't hang up my 2 awn curtains says- 3 I don't do anything independently anymore. 4 I can't take out my own trash by myself. I can't mow my 5 own lawn. I can't do any type of shoveling or anything. 6 I can't sweep by myself. I tried it with one are but it 7 doesn't work. s It's hard to sleep because, you know, I an 9 self conscious. You don't know that you are rolling 10 over. I roll over on my am sometimes and tossing and 11 turning all night long. 12 Leaning on my elbow puts me in 13 excruciating pain just on a regular basis. 14 I can't pick up my God daughter and put 15 her in a swing. Just simple things like that. I can't 16 go to the playground and put my son up on the jungle gym 17 because I can't stretch my am up in the air. is I a" It play basketball with him anymore. 19 It's hard for me to play the Play Station with him 20 because at a point in time my hand basically gives out 21 on me and I can't push the buttons. 22 It's very hard for me to type, especially 23 with a lot of my jobs. Most of my jobs were customer 24 service based and I typed all day long. So it was very, ELECTRONIC REPORTING STENOGRAPHIC AFFILIATES 21 JACQUELINE MARIE HEARN 1 very difficult for w to type, and very painful. 2 I have problems doing basic cleaning 3 things. When it comes to like cleaning the tub because 4 you don't realize you have to lean on your one hand to 5 lean into the tub. That baccams very painful. 6 Let's see what I might be missing. It's 7 hard to get things out of the deep freezer. I have to 8 always call my boyfriend to get things out of the deep 9 freezer because I can't lift it up with my hand or my 30 arm. It puts me in excruciating pain. 11 It takes me a lot longer to get clothes in L2 and out of the washing machine and dryer because I ae 13 only doing it with one hand now. 14 9 Can you lift your loft arm? 15 A No. This is it. 16 Q Just about halfway up? 17 A Yeah. That is as far as it goes. It game 18 out to that extent and it starts to hurt. 19 People don't really realise like that my 20 are is messed up because they can see that I can move it 21 from the elbow down thanks to Dr. Harbold because it 22 really didn't do that before, but yeah, I do have this 23 -- since the surgery, I have function of at least doing 24 this. RGRCTRONIC REPORTING STENOGRAPHIC AFFILIATES 23 JACQUELINE MARIE HEARN ( I v V V 1 I can ao I don't haw to keep putting medicine in my 2 body. 3 I apologies. I forgot one other thing 4 that I don't do anymore or I can't do which is my yoga, 5 my exercising. I can work one side of my body, but the 6 other side definitely doesn't gat worked at all because 7 mostly yoga, you know, has to do with raising your arms 8 and moving and stretching. 9 Most of the cardic stuff that I do you 10 haw to move your whole entire body, and your arms and 11 stuff in order*to got the full workout. 12 Q Do you work out? 13 A Oh, yeah. 14 0 Whore do you go to? 15 A I just work out at home. I haw my own 16 videotapes and stuff. 17 Q Jackie, did you ever haw any problems 18 with your left arm before this accident? 19 A No. 20 Q Never treated with any physicians about 21 any problems involving your left arm or shoulder? 22 A No. 23 MR. SHIPMAN: Those are all of the 24 questions I have, Thank you, ELECTRONIC REPORTING STENOGRAPHIC AFFILIATES i I V v v U V V 22 JACQUELINE MARIE HEARN 1 Q You didn't have that flexibility before? 2 A No. Before my arm was like stuck here and 3 if I moved it at all it was just a pain, a very, very 4 hard pain. 5 4 Now you have a scar too, don't you? 6 A Yes. 7 Q About a 4-inch scar? 8 A Yes. 9 Q I have seen some pictures of that. Does 10 that bother you? 11 A Yoe. 12 Q Do you take any pain medication? 13 A Well, Dr. Harbold had me on Tylenol 3 with 14 codeine, and I forgot the other medicine she had as on, 15 but they became addictive medicines, and I am not a pill 16 taker Say way. So I stopped taking the pills and she in 17 giving me basically exercises, and you know, like 18 squeezing my hand and stuff I can do if I an in pain, 19 but she said basically other than taking those I could 20 take Tylenol on a daily basis. 21 Q Do you take pain medication on a daily 22 basis? 23 A If I an in extreme pain, I will take, you 24 know, some Tylenol, but I try to deal with it as much as ELECTRONIC REPORTING STENOGRAPHIC AFFILIATES 24 JACQVELINE MARIE BEAM 1 (The deposition was concluded at 11:13 a.m.) 2 r • r 3 4 5 6 7 8 9 10 11 12 13 14 SS 16 17 18 19 20 21 22 23 24 ELECTRONIC REPORTING STENOGRAPHIC AFFILIATES // 25 lu 1 C E R T I F I C A T E 2 3 i, Sharon L. Dougherty, a Notary Public for the 4 commonweal"th of Pennsylvania, do hereby certify: 5 That the witness named in the deposition, prior 6 to being examined, was by me first duly sworn or affirmed; 7 That said deposition was taken before me at the e time and place herein set forth, and was taken down by me in 9 stenotype and thereafter transcribed under my direction and 10 supervision; 11 That said deposition is a true record of the r 12 testimony given by the witness and of all objections made at 13 the time of the examination. 14 I further certify that i am neither counsel for 15 nor related to any party to said action, nor in any way 16 interested in the outcome thereof. 17 18 19 20 17sharon L. Dough r 21 22 23 l( 24 Page 1 Page 3 IN THE COURT OF COMMON PLEAS 1 INDEX CUMBERLAND COUNTY, PENNSYLVANIA 2 WITNESS: BRIAN HOLMES, M.D. PAGE JACQUELINE M. HEARN, Civil Action Law 3 Direct Examination by Atty. Crosby 6 Plaintiff 4 Cross-Examination by Atty. Shipman 49 V. 5 Redirect Examination by Atty. Crosby 53 MICHAEL LOE, 6 EXHIBITS Defendant No. 2008-7062 7 No. 1 Curriculum Vitae of Brian Pursuant to Notice, the deposition of BRIAN 8 Holmes, M.D. I 1 HOLMES, M.D. was taken on Monday, August 20, 2012 9 No. 2 Photograph 20 commencing at 3:30 p.m. located at Parkway 10 No. 3 Photograph 20 Neuroscience & Spine Institute, 17 Western Maryland 11 Parkway, Suite 102, Hagerstown, Maryland, before 12 Jodi L. Lambert, Court Reporter and Notary Public. 13 14 15 16 17 18 19 20 21 Page 2 Page 4 1 APPEARANCES: 1 HAGERSTOWN, MARYLAND 2 FOR THE PLAINTIFF: 2 MONDAY, AUGUST 20, 2012 3 MATTHEW S. CROSBY, ESQUIRE 3 *** 4 HANDLER, HENNING & ROSENBERG, LLP 4 PROCEEDINGS 5 1300 Linglestown Road 5 *** 6 Harrisburg, PA 17110 6 (Deposition Exhibit Numbers 1, 2 and 3. 7 crosby@hhrlaw.com 7 Were pre-marked for identification.) 8 FOR THE DEFENDANT: 8 VIDEOGRAPHER: This video deposition is 9 JEFFERSON J. SHIPMAN, ESQUIRE 9 being taken in accordance with Pennsylvania Rules 10 JOHNSON, DUFFIE, STEWART & WEIDNER, P.C. 10 of Civil Procedures on August 20, 2012 at 11 301 Market Street 11 approximately 3:36 p.m. We're at 17 Western 12 P.O. Box 109 12 Maryland Parkway, Hagerstown, Maryland. 13 Lemoyne, PA 17043-0109 13 The court reporter is Jodi Lambert. My 14 jjs@jdsw.com 14 name is Brian Barton. We are with Maxim Reporting. R 15 ALSO PRESENT: 15 The caption of the case is Jacqueline M. Hearn, 16 BRIAN BARTON, VIDEOGRAPHER 16 Plaintiff, versus Michael Loe, Defendant, Case 17 VISUAL IMAGE PRODUCTIONS 17 Number 2008-7062 in the Court of Common Pleas, 18 8703 Baker Avenue 18 Cumberland County, Pennsylvania. The party giving 19 Baltimore, MD 21234 19 Notice for this deposition is the Plaintiff. 20 20 Will the attorneys please identify 21 21 themselves and who they represent? W Page 5 Page 7 1 ATTORNEY CROSBY: Sure. Matt Crosby 1 A. Yes. Brian Holmes, M.D., Parkway 2 for the Plaintiff, Jacqueline Hearn. 2 Neuroscience and Spine Institute, 17 Western 3 ATTORNEY SHIPMAN: And my name is Jeff 3 Maryland Parkway, Hagerstown, Maryland. 4 Shipman for Mr. Loe. 4 Q. And what is your profession, Doctor? 5 VIDEOGRAPHER: Our witness is Dr. Brian 5 A. I'm a neurosurgeon. 6 Holmes who will now be sworn by the court reporter. 6 Q. And you gave us an address of Hagerstown, 7 Whereupon, 7 Maryland? 8 BRIAN HOLMES, M.D., a witness herein, having 8 A. Yes. 9 been first duly sworn, was examined and testified 9 Q. You also maintain a practice in 10 upon his oath as follows: 10 Chambersburg, Pennsylvania? 11 VIDEOGRAPHER: You may proceed. 11 A. That's correct. 12 ATTORNEY SHIPMAN. At the beginning of 12 Q. And how long have you been in the 13 the deposition I want to place on the record, this 13 practice generally as a neurosurgeon? 14 is Jeff Shipman for Defendant -- I'm going to 14 A. In this particular practice? 15 object to any testimony from the Doctor relative an 15 Q. How long have you been employed as a 16 IIv1E performed by Dr. Lee Dellon, M.D. Dr. Dellon 16 neurosurgeon? 17 was retained by the defense to perform an 17 A. Since independently since 1994. 18 independent medical evaluation. 18 Q. And what types of medical problems do you 19 It is not the intention of the 19 treat in your capacity as a neurosurgeon? 20 Defendant presently to be calling Dr. Dellon to 20 A. A neurosurgeon treats disorders related 21 testify at trial, so we would intend to object to 21 to the spine, spinal cord, the brain, blood vessels r Page 6 Page 8 1 any testimony from this Doctor relative to Dr. 1 supplying the brain and structures of the cranium, , 2 Dellon's report or any reference to Dr. Dellon just 2 as well as the brachial plexus and peripheral 3 for the record. 3 nervous system. 4 Counsel agreed to put this on the 4 Q. Tell us if you can, Doctor, a little bit 5 record at the beginning so as not to interfere with 5 about your educational background. 6 the course of the deposition, and we retain our 6 A. 1 received a Bachelor's Degree from the 7 objections relative to any reference to Dr. Dellon. 7 University of Pennsylvania and proceeded to medical 8 ATTORNEY CROSBY: And just Plaintiffs 8 school where I graduated with a degree in medicine 9 position with respect to Dr. Dellon's report is, 9 at the Penn State University School of Medicine in 10 Number 1, that it was an independent medical 10 Hershey. 11 examination of Ms. Hearn in this matter, and if Dr. 11 1 then went to the Dartmouth Hitchcock 12 Holmes testifies that it's the type of record or 12 Medical Center where I completed training in 13 report that he customarily relies upon in his 13 general surgery and neurological surgery and that 14 practice as a neurosurgeon, then it would be our 14 was followed by a one year fellowship in 15 position that the report itself is admissible and 15 neurosurgery at the George Washington University 16 any reference to Dr. Dellon's report is admissible 16 School of Medicine in Washington, D.C. 17 in that respect. 17 Q. What's a fellowship? 18 DIRECT EXAMINATION 18 A. A fellowship in Neurosurgery is an 19 BY ATTORNEY CROSBY: 19 additional period of time after the requirements of 20 Q. Doctor, can you please state your name 20 residency training are met. It doesn't really have 21 and your professional address for us? 21 an official recognized capacity by the graduate 2 (Pages 5 to 8) Page 9 Page 11 1 medical education but its really up to the 1 Neurosurgery at Meritus? 2 specific interest of the individual to take that 2 A. That's correct. 3 time. 3 Q. How long have you held that position? 4 Generally it's spent in the center 4 A. Four or five years. 5 where there's a concentrated experience in any 5 Q. And obviously you have an active practice 6 particular area. This fellowship was in cerebral 6 currently? 7 vascular surgery and tumors of the skull base. 7 A. Correct. 8 Q. In looking at your CV, Doctor, it looks 8 Q. How often do you do surgery, Doctor? 9 like you're licensed to practice medicine in two 9 A. Oh, I perform between 250 and 300 10 states? 10 operations per year. So I'm in the operating room 11 A. Yes, Pennsylvania and Maryland. 11 a part of two days and one full day per week. 12 Q. And you're also board certified? 12 Q. And in your practice, Doctor, as a 13 A. Correct. 13 neurosurgeon, are you familiar with the diagnosis, 14 Q. And in what? 14 treatment and cause and affects of brachial plexus 15 A. In neurosurgery. 15 injuries? 16 Q. And what does it mean to be board 16 A. Yes. 17 certified? 17 Q. I've given you an exhibit which has been 18 A. It varies between specialties. In 18 marked as Plaintiffs Exhibit Number 1. Can you 19 neurosurgery after completing an accredited 19 tell us what that is? 20 residency, one has to pass a written comprehensive 2 0 A. That is by curriculum vitae. 21 examination and that can be taken during residency. 21 Q. And does that accurately reflect your Page 10 Page 12 1 And then after one is in practice, the 1 education, your training, and your professional 2 neurosurgeon has to submit 12 months of patient 2 experience? 3 data to the Board of Neurological Surgery where the 3 A. Yes, it does. 4 data is reviewed to be sure that there's an 4 ATTORNEY CROSBY: Plaintiff will offer 5 adequate volume and follow up, and if that 5 Dr. Holmes as an expert in the field of 6 experience is felt to be sufficient, then the 6 neurosurgery. Jeff, do you have any questions? , 7 candidate is asked to take an oral board 7 ATTORNEY SHIPMAN: I have no questions 8 examination, which was the second part which I 8 t of your qualifications, Doctor. Thank you. 9 passed in 1997. 9 A. You're welcome. ! 10 Q. Is it fair to say that not all 10 BY ATTORNEY CROSBY: 11 neurosurgeons are necessarily board certified? 11 Q. Doctor, when did you have the first 12 A. Correct but increasingly hospitals 12 opportunity to examine Jacqueline Hearn in this 13 require board certification to have privileges. 13 case? 14 Q. Which brings me to my next question. Do 14 A. That would have been in March of this 15 you have any privileges at any hospitals currently? 15 year. 16 A. Yes. I have privileges at the, it's 16 Q. And where was that examination done, do 17 called the Meritus, M-e-r-i-t-u-s, Medical Center 17 you know? 18 in Hagerstown, Maryland, the Chambersburg Hospital, 18 A. That was done at our Chambersburg office. 19 and also an outpatient surgery center here in 19 Q. And you examined Ms. Hearn at my request; 20 Hagerstown called Parkway. 20 is that correct? 21 Q. And your CV indicates that your Chief of 21 A. Yes. 3 (Pages 9 to 12) Page 13 Page 15 1 Q. And you also reviewed a series of her 1 and did report some left-sided neck pain with some 2 medical records and reports at my request as well? 2 of those movements. 3 A. Correct. 3 The shoulder exam did not demonstrate 4 Q. And did you review medical records from 4 any resistance to movement regarding the shoulder 5 both before and after her motor vehicle accident? 5 joint itself but there was quite a bit of 6 A. I did. 6 tenderness and some fullness in what's called the 7 Q. And is it fair to say, Doctor, that you 7 supraclavicular faucet which is the area just above 8 considered and relied at least in part on these 8 the collar bone or clavicle, and there was an 9 medical records and notes in reaching your opinions 9 incision/scar in that area as well related to prior 10 in this case? 10 surgery. 11 A. That is correct. 11 And not only was it tender in that area 12 Q. And is that something you regularly do in 12 but pushing in that area around that surgical scar 13 your practice as a neurosurgeon, rely on other 13 caused her to have pain that radiated to the entire 14 doctors' and medical providers' notes and records? 14 left arm. 15 A. Yes. 15 Q. Did you also examine the left extremity? 16 Q. When you examined Mrs. Hearn in this 16 According to your report you did some testing on 17 case, did you take a history from her? 17 the left arm and elbow? 18 A. I did. 18 A. That's correct. 19 Q. Can you tell us what that history 19 Q. Can you tell us about that? 20 revealed? 2 0 A. There's a sign called the Tinel's Sign 21 A. Ms. Hearn described a motor vehicle 21 which is when there's a tapping by the examiner Page 14 Page 16 1 accident that occurred in December of 2006. She 1 over the path of a nerve it can create in some 2 was an unbelted driver and was pulling out of a 2 individuals a report of pain in a radiating kind of 3 minimall type of a plaza onto a busy road and she 3 electrical sensation, and this Tinel's Sign was 4 was struck from behind by another vehicle, which 4 positive at the left elbow and I stated with 5 she told me was in turn first struck by the vehicle 5 minimal pressure, meaning it didn't take much to 6 behind it. 6 elicit that positive response. 7 Q. And did she tell you anything about the 7 And she reported with that this 8 symptoms and the problems that she had after that? 8 paraesthesia which is kind of an electrical pins 9 A. Yes. She stated that she was having or 9 and needles sensation that radiated to the ulnar 10 she experienced left shoulder region pain and had 10 two digits of the left hand, which would be the 11 not had similar pain before that but has had a lot 11 small finger and the ring finger. 12 of left shoulder and arm pain ever since. 12 Q. What does that tell you when you do an 13 Q. And was that history consistent with your 13 examination and you have a positive sign like that 14 review of the records in her case? 14 tennels test, if I'm pronouncing that right? 15 A. Yes, it was. 15 A. Right. 16 Q. Tell us a little bit, Doctor, about your 16 Q. What does that tell you? 17 physical examination of Ms. Hearn in March of 2012. 17 A. In some people it's normal for them. 18 A. Well, I'll have to read some of it to 18 What's helpful is to see that it's not present on 19 refer to some of the details, but she was very 19 the other side and it was not in this case, but c 20 cooperative with the full examination. She had 20 i that is often a sign that where there is irritation 21 minimal reduction in range of motion of the neck 21 or compression of a nerve in that area where the 4 (Pages 13 to 16) Page 17 Page 19 1 nerve passes through the elbow. 1 Finger extension, which is spreading 2 Q. And you also did what you phrase as a 2 the fingers out in a fan, four minus over five. 3 neurological examination? 3 Grip obvious four over five. I'm sorry, finger 4 A. Correct. 4 abduction three over five. That's fanning the 5 Q. Can you tell us about the neurological 5 fingers. Finger extension would be raising the 6 exam that you did on Ms. Hearn? 6 fingers up in this direction. (Demonstrating.) 7 A. Yes. As far as the cranial nerve 7 Elbow flexion four plus over five. 8 function and cognitive function, there was no 8 Elbow extension four over five. So reduction in 9 abnormality. I noted specific to the arm reduction 9 multiple muscle groups. 10 of light touch and pin prick reduced on all digits 10 Q. Okay, Doctor, and you had also talked 11 of the left hand and markedly reduced on the left 11 about I think the phrase that you used was pin 12 small and ring finger. 12 prick test? 13 Reduction of light touch sensation and 13 A. Yes. 14 pin sensation in the ulnar aspect of the forearm, 14 Q. What is that? 15 mild reduction on the radial aspect of the forearm. 15 A. Well, I don't use a pin per se. I use a 16 The radial aspect is the side facing the thumb. 16 wooden, like a wooden Q-Tip and I just snap that 17 The ulnar aspect is the opposite side. 17 off and use that sharp edge of the wood because 18 And then going on to the examination of 18 that's disposable and won't hurt anybody if they 19 strength, there was demonstration of a reduced 19 happen to grab it by mistake. 20 motor power in multiple groups in the upper 20 But that's just another sensory 21 extremity. 21 modality. Light touch and pin prick are carried by Page 18 Page 20 1 Q. What does that mean? 1 different pathways in the spinal cord so it's 2 A. Well, there's a rating scale that we use. 2 helpful sometimes to test both. 3 It goes from zero to five, five being normal 3 Q. And she had, with the pin prick test, she 4 strength in a particular muscle group based on the 4 had a reduced sensation? 5 individual size and muscle bulk. On the other end, 5 A. Right, in all fingers of the left hand. 6 zero would be no movement at all. 6 Q. Do you have an opinion, Doctor, based on 7 So three over five is when there's 7 your examination and your review of the records in i 8 movement just against gravity, meaning if I were to 8 this case as to whether Jackie was hurt in the 9 extend my arm and all I could do was just raise it, 9 motor vehicle crash of December 12, 2006? 10 that would be three out of five. 10 A. Yes. My opinion is that she did suffer 11 Intermediate between three over five, 11 an injury that day. 12 three being just barely resisting gravity and five 12 Q. And in your opinion what injury did she 13 being full strength, four is intermediate. Some 13 suffer? 14 examiners use four pluses and four minuses to 14 A. In my opinion it would include a cervical 15 describe some of the subtleties of the exam. 15 strain and a brachial plexus injury. 16 Q. And your exam showed a reduced strength? 16 Q. And now is probably a good idea, Doctor, 17 A. Yes. There were no problems with the 17 to talk a little bit about the anatomy of the 18 lower extremities of the right arm but there was 18 shoulder and the brachial plexus. If you can use 19 three over five strength of shoulder abduction, 19 one or both of those photos there and take us 20 which is raising the arm level, and wrist extension 20 through what we're looking at and what was injured 21 four over five. 21 in your opinion in Ms. Heam's case? 5 (Pages 17 to 20) Page 21 Page 23 1 A. Well, this is a cut away view leaving out 1 complete separation which would happen more with 2 a lot of anatomical structures, but this is the 2 something sharp. 3 collar bone and behind the collar bone are the 3 This was with blunt injury and so there 4 subclavian artery and the subclavian vein, and then 4 could be some internal injury to the nerve with a 5 there are some other vessels here. 5 blunt injury, and then there could be some 6 The spine is absent here from the 6 additional injury to the nerve related to the 7 diagram but these nerve elements here, which are a 7 trauma of the surrounding tissues as those tissues 8 pale yellow, they would be the nerve roots arising 8 may bleed from the original injury and be inflamed, 9 from the spine, and so these nerve roots as they 9 and as they heal they will become more fibrotic in 10 arise from the spine then form a rather complicated 10 some cases and they will contract, and often that 11 structure called the brachial plexus. Brachial 11 would lead to traction or compression of nerve 12 means arm. And this brachial plexus then changes 12 elements such as the brachial plexus. 13 and forms some nerves that you can see here exiting 13 Q. Well, what evidence of nerve injury do we 14 the travel into the arm, and so the arm is not 14 have in this case? 15 pictured here in this diagram. So I think that's 15 A. Well, the evidence of nerve injury would 16 probably everything that I need to point out in 16 have been the immediate onset of the symptoms 17 this particular diagram. 17 related to the event, the pattern of symptoms 18 Q. Sure. In what function do those nerves, 18 involving all of these elements of the brachial 19 those brachial plexus nerves, what function or 19 plexus, and there were some changes on an 20 functions do they serve? 20 electrodiagnostic study, I can't recall the date, 21 A. Well, the nerve tissue carries the 21 that showed some abnormalities when looking at the Page 22 Page 24 1 impulses from the brain through the spinal cord 1 muscles that are innervated by these particular 2 through the nerves into the extremity to control 2 nerve elements. 3 movement to give impulses to the muscles to make 3 Q. And there was also surgery performed? 4 things move. It also carries sensation back from 4 A. Yes, the surgery by Dr. Harbaugh. 5 the limb into the spinal cord and ultimately to the 5 Q. And in your opinion, was the surgery that 6 brain. 6 Dr. Harbaugh-- First of all, who is Dr. Harbaugh? 7 Q. And in your opinion, Doctor, what 7 A. Excuse me. 8 happened in this case to Ms. Heam's brachial 8 Q. Sure. 9 plexus? 9 A. Dr. Harbaugh is a neurosurgeon at the 10 A. Well, the brachial plexus is not 10 Hershey Medical Center and she specializes in 11 protected by very thick layers of tissue here, and 11 peripheral nerve and brachial plexus surgery and 12 based upon the description that she gave of the 12 she had done a fellowship in this area. 13 accident and the fact that she was not wearing a 13 Q. And you also reviewed Dr. Harbaugh's 14 seatbelt, striking the steering wheel was what I 14 records? 15 believe is the most likely explanation for this 15 A. That's correct. 16 injury to the brachial plexus and the tissue 16 Q. And you reviewed her surgical report? 17 surrounding it. 17 A. Yes. 18 Q. And what would that have done, striking 18 Q. And in your opinion, was the surgery that 19 the steering wheel? 19 Dr. Harbaugh performed related to the motor vehicle 2 0 A. Well, if a nerve is struck and injured, 2 0 crash? 21 the damage can vary. It can vary from, you know, a 21 A. Yes. 6 (Pages 21 to 24) Page 25 Page 27 1 Q. And can you take us through, Doctor, Dr. 1 A. May I use the other diagram? 2 Harbaugh's surgery and what she was doing to repair 2 Q. Sure, absolutely. 3 the damage in the brachial plexus? 3 A. This diagram is similar to the first but 4 A. Sure. It would help me I think to have 4 from a different angle, and so that if you can see 5 her operative note. 5 these yellow nerve elements, they should be coming 6 Q. Sure. Hold on one second. 6 straight out and they're cut in cross sections, but 7 ATTORNEY CROSBY: We'll go off camera 7 this muscle is the anterior scalene muscle right 8 for a second. 8 here and then this is the middle scalene muscle and 9 VIDEOGRAPHER: Off record at 3:58 p.m. 9 Dr. Harbaugh describes compression by this muscle 10 (A discussion was held off the record.) 10 and a smaller band of muscle fiber related to this 11 VIDEOGRAPHER: Back on the record at 11 muscle. 12 3:59 p.m. 12 So she divided this muscle essentially 13 BY ATTORNEY CROSBY: 13 to make more space for the nerves and then she also 14 Q. Doctor, based on your review of the 14 described some fibrous tissue which was divided 15 operative report prepared by Dr. Harbaugh in this 15 freeing up the compression on those nerves. 16 case, are you able to tell us whether she saw 16 What that means -- I think you asked 17 something during the surgery that was significant? 17 the fibrous tissue. The conclusions we draw when 18 A. Yes. She described compression of what's 18 we see fibrous tissue that really shouldn't be 19 called the middle and lower trunk of the brachial 19 there under the normal circumstances is that it may 20 plexus, and let me just read this word for word. 20 be related to trauma if there was inflammation in 21 Exploration revealed an accessory scalene muscle 21 the tissues or bleeding in that area. Page 26 Page 28 1 crossing over the nerve roots, as well as the lower 1 As the body heals, those problems, it 2 trunk. Residual fascia overlying the plexus was 2 can leave some fibrous tissue behind, like scar 3 released. 3 material I think would be another way to describe 4 Q. Now what does that mean? 4 it, and in some cases that fibrous tissue can 5 A. Well, let me back up if I may -- 5 compress nerve elements and in this case that's 6 Q. Sure. 6 what Dr. Harbaugh described and that she relieved 7 A. --because she has the findings dictated 7 that compression with her surgery. 8 specifically under a paragraph labeled findings. 8 Q. And how did Jackie do after the surgery? 9 The middle trunk was noted to have mild fibrous 9 A. She told me that she had some increase in 10 adhesions to the fascia layer surrounding it 10 arm mobility. She was able to move her arm a bit 11 related to presume prior trauma. 11 more and she had some early mild improvement of 12 The lower trunk elements, including the 12 symptoms, but nothing really dramatic and then not 13 C8 and TI nerve roots and lower trunk itself, were 13 really sustained. I think she described it as 14 compressed most significantly by an accessory 14 really being back close to where she was before the 15 scalene muscle but also by fibrous bands within the 15 surgery. 16 posterior portion of the anterior scalene muscle. 16 Q. And do you have an opinion, Doctor, as to 17 Q. Okay, and when she talks about fibrous 17 why the surgery wasn't able to relieve those 18 bands compressing the nerve trunk -- 18 symptoms? 19 A. Yes. 19 A. Well, in neurosurgery, even when 2 0 Q. --what's a fibrous band and where did it 20 pathology is identified, pathology meaning 21 come from? 21 something is there that shouldn't be there causing 7 (Pages 25 to 28) Page 29 Page 31 1 a problem, even when the pathology is removed such 1 released as time goes on. She may be a candidate 2 as in this case, compression of the nerve, not 2 for this type of medication, such as some examples 3 everyone gets better. Not everyone has relief of 3 would be Neurontin, Lyrica, Cymbalta. They're 4 symptoms. And our conclusions in similar cases are 4 often advertised on TV. This is a patient that 5 that there are some internal changes to the nerves 5 might be a candidate for that type of medication. 6 that cause the nerves to fire abnormally. 6 Q. What type of treatment options, Doctor, 7 So even though you take the external, 7 in your opinion does Jackie have at this point? 8 the exterior pressure away from the nerve, the 8 A. Well, in my opinion the injections of 9 internal changes in some people persist and create 9 Botox or botulinum toxin that were recommended by 10 this really abnormal electrical output that can 10 Dr. Harbaugh that may be reasonable. Would you 11 create symptoms such as Jackie has described it. 11 like me to explain what that -- 12 Q. Do you have an opinion, Doctor, as to 12 Q. Yeah. What would a Botox -- I mean, I'm 13 whether the damage to Jackie's nerves in this case 13 somewhat ignorant on this issue. When I hear Botox 14 are permanent? 14 injections, I'm not thinking into the shoulder. So 15 A. With any kind of a nerve injury, if 15 what is a Botox injection going to do for Jackie 16 there's recovery, we tend to see the majority of 16 Hearn? 17 the recovery within a year and after two years not 17 A. Well, Botox when it's injected into a 18 often much recovery. So I would say because of the 18 muscle it blocks the nerve impulse from activating 19 passage of so much time at this point that the 19 the muscle, and so it's used in the cosmetic 20 symptoms that she's having now and the injury is 20 surgery business I guess for people who have 21 permanent. 21 wrinkles and active facial muscles. Page 30 Page 32 1 Q. And can she continue to expect these 1 But in this case when there's a nerve 2 symptoms moving forward? 2 injury, not only do nerves produce pain impulses, 3 A. Yes. 3 they can produce abnormal impresses to muscle and 4 Q. And the same question with regard to her 4 cause the muscles to over fire or go into 5 physical limitations, can she expect those to 5 contraction or spasm. And in those cases, 6 continue? 6 sometimes injections of this blockade agent can 7 A. Yes. 7 help with that. 8 Q. For the rest of her life? 8 It's commonly used, for example, in 9 A. Barring any change or other treatment 9 Cerebral Palsy when those individuals have muscle 10 that might be instituted, yes. 10 spasms and uncontrolled contraction. And so Dr. 11 Q. Do you know if she's taking any 11 Harbaugh had recommended a trial anyway of an 12 prescription medication for her symptoms? 12 injection of Botox into the serratus anterior 13 A. At the time of my evaluation, I believe 13 muscle. 14 she was just taking Tylenol. She had been on other 14 Q. And where is that? 15 medications but they didn't seem to help much and 15 A. That is a muscle that arises from the 16 so she did not continue with them. 16 chest wall attaching to the ribs and then it heads 17 Q. Do you have an opinion, Doctor, as to 17 along the chest wall and attaches to the back of 18 whether she may need prescription medications into 18 the scapular or the shoulder blade. And so Dr. 19 the future? 19 Harbaugh felt that there was potentially some spasm 20 A. There is a class of drugs that we refer 20 in this muscle and had made that recommendation. 21 to as neuropathic medications and some are being 21 Q. And so the point of the injection would 8 (Pages 29 to 32) Page 33 Page 35 1 be to stop the spasm? 1 elements themselves. It essentially keeps those 2 A. Right, and it would not in this case 2 abnormal impulses from reaching the brain. So if a 3 treat all of the symptoms, but this aching pain 3 treatment like that works, it can lead to a person 4 that she described in the shoulder girdle itself, 4 having a reduction in pain and an improvement of 5 in the chest wall, it may work. One would evaluate 5 function. 6 it based on doing the procedure and seeing if it 6 Q. And that's a surgical procedure? 7 was helpful. If it was helpful, botulinum or Botox 7 A. Yes. 8 can be given every three or four months to continue 8 Q. And how big is the unit? 9 with the effect. 9 A. Well, the spinal cord stimulator 10 Q. Do you have any idea of cost associated 10 electrode, it looks like a small popsicle stick but 11 with the series of those injections? 11 it's flexible and it's probably four to maybe nine 12 A. Not exactly, only that a large muscle 12 millimeters wide and maybe five millimeters in 13 like the serratus would require an injection of a 13 length. And then the pulse generator, the computer 14 volume that would cost somewhere in the thousands 14 device is probably as big as maybe a third or a 15 of dollars per injection, but I couldn't tell you 15 quarter the size of a pack of cigarettes. 16 exactly. 16 Q. And that's implanted on the spine itself? 17 Q. Less than $2,000? 17 A. The electrode is implanted on the spine. 18 A. Not sure. Greater than one thousand I 18 The computer pulse generator is just placed in the 19 think is safe to say. 19 fat tissue somewhere, either usually in the flank 20 Q. And this would, if it was effective, 20 on the side. 21 would only provide temporary relief? 21 Q. And what's the approximate cost Page 34 Page 36 1 A. Correct, and would be repeated. 1 associated with that procedure? 2 Q. And there was also I think based on the 2 A. The device itself cost probably in the 3 report you gave me you had suggested that maybe a 3 range of $15,000 to $20,000 and I'm not exactly 4 spinal cord stimulator? 4 sure what the hospitalization or implantation fees 5 A. That's correct. That was included as a 5 would be but it would be much less than the $15,000 6 recommendation in my report, although I wasn't the 6 for the device. 7 treating physician. 7 Q. And what's the life of that device? 8 Q. How would that work and what would it 8 A. They have devices now with rechargeable 9 help resolve? 9 batteries that have about a nine year life span and 10 A. Well, a spinal cord stimulator is a 10 then that pulse generator can be replaced if 11 device that's used for multiple problems that lead 11 needed. May I ask if we pause? 12 to extremity pain, in this case shoulder and arm 12 Q. Yes. 13 pain. 13 VIDEOGRAPHER: Off the record at 4:11 14 What is done is an electrode is placed 14 p.m. 15 over the spinal cord and it's attached to a device 15 (A short break was taken.) 16 that's much like a heart pacemaker. It has a 16 VIDEOGRAPHER: Back on the record at 17 computer and it will generate a very specific type 17 4:12 p.m. 18 of an electrical impulse, and what that impulse can 18 BY ATTORNEY CROSBY: 19 do is essentially trick the spinal cord so that the 19 Q. Doctor, I'm assuming that there would be 20 abnormal pain impulses don't get to the brain. 20 scarring associated with that procedure? 21 So it doesn't directly affect the nerve 21 A. With the spinal cord stimulator? 9 (Pages 33 to 36) Page 37 Page 39 1 Q. Yes. 1 exploration of the brachial plexus. 2 A. Not really abnormal scarring. I mean, 2 Q. So three separate procedures recommended 3 any surgical procedure I suppose by definition 3 by Dr. Dellon? 4 involves the formation of some scarring in the 4 A. Right, and it's not perfectly clear if 5 healing process. 5 they could be done, one or two could be done at the 6 Q. What's the, in your opinion, what's the 6 same time in his view. 7 chance of success with something like that? 7 Q. And Dr. Dellon also examined Ms. Hearn? 8 A. It's impossible to say across the board. 8 A. Yes. 9 The way this procedure is approached is before the 9 Q. Do you agree with any of Dr. Dellon's 10 permanent implantation of what I've just described 10 recommendations in terms of surgery? 11 is carried out, there's a temporary lead that's 11 A. His rationale for doing the ulnar nerve 12 placed through a needle. 12 decompression was understandable. It would not 13 So basically there's a needle puncture 13 have been my initial recommendation but I think he 14 in the spine by a specialist who does this 14 was able to support it and I think that would be 15 frequently, and this needle carries a soft 15 reasonable, but the ulnar nerve decompression would 16 electrode wire that's threaded around the spinal 16 only address a subset of her symptoms. It wouldn't 17 cord. Then the needle's removed and then this is 17 really address all of the problem. 18 brought out just through the skin and secured for a 18 Q. And let me stop you there. And first 19 few days where it's attached to an external 19 tell us what is meant when you say an ulnar nerve 20 computer. 20 decompression? 21 And so this is stimulated for a few 21 A. Do you mind if I roll up my sleeve? Page 38 Page 40 1 days so that the patient determines whether it's 1 Q. Go right ahead. 2 helpful or not helpful. 2 A. People think of their funny bone, if they 3 Q. And do we have any idea as to how often 3 hit this area just right and they get that 4 that's helpful or how often it isn't? 4 sensation into their hand, what they're hitting is 5 A. If the trial is placed and the patient 5 the ulnar nerve that passes through a groove 6 feels that it's helpful, then there's about an 80 6 between the two bone right here in the elbow. 7 or 90 percent chance that a permanent would be 7 And so Dr. Dellon had recommended 8 helpful. But there's no one number to say what the 8 exposing this nerve, taking it out of that path and 9 odds would be for any individual as to whether it 9 redirecting it. So instead of the nerve traveling 10 would work or not. It's dependent upon the 10 this way through this groove, it would travel up 11 internal anatomy of the spinal cord which you can't 11 here in front of the elbow joint, and that is 12 predict. 12 what's called an ulnar nerve transposition. 13 Q. As far as future treatment is concerned, 13 Q. And, again, I'm going to ask you about 14 Doctor, you also reviewed the report of Dr. Dellon? 14 the cost of that procedure if you can tell us what 15 A. Yes. 15 you think the cost of something like that would be? 16 Q. And what does Dr. Dellon recommend in 16 A. I believe the surgical fee, the standard 17 terms of surgery? 17 surgical fee is in the neighborhood of $700 or $800 18 A. Dr. Dellon recommended a, really three 18 for that procedure, and it's an out-patient 19 procedures. One being an ulnar nerve transposition 19 procedure so I'm not too sure what the out-patient 20 at the elbow, the other being a resection of the 20 fees would be. 21 supraclavicular nerve, and the other being a repeat 21 Q. And does that tie into the Tinel's Test 10 (Pages 37 to 40) Page 41 Page 43 1 that you were talking about earlier? 1 recommending either? 2 A. Yes. 2 A. That's correct. 3 Q. That's the nerve, the ulnar nerve that's 3 Q. All right, Doctor, let's talk a little 4 affected? 4 bit about Ms. Hearn's ability to work. When you 5 A. Correct. 5 took a history from her when you saw her in March, 6 Q. In your opinion, are the ulnar nerve 6 she told you about her, a little bit about her 7 symptoms that Ms. Hearn is having, are those 7 employment and her work history? 8 related to the motor vehicle accident? 8 A. That's correct. 9 A. Yes. 9 Q. Tell us what she said to you. 10 Q. And I believe you have a difference of 10 A. Well, she told me that she had returned 11 opinion with Dr. Dellon on the other two surgeries 11 to work about a week after the injury and was light 12 that he recommends? 12 duty, restricted duty and then was not really able 13 A. Yes. He recommended this supraclavicular 13 to work after that. 14 nerve resection and the supraclavicular nerve, 14 And then-- Let me see here. I can't 15 clavicular meaning clavicle, it's a superficial set 15 recall exactly what happened in the interim between 16 of branches of nerves that head into the area that 16 that period and her surgery, but then she returned 17 give sensation to the upper part of the chest, and 17 to work for a period of time, I'm sorry, she was 18 because Dr. Harbaugh had described seeing one of 18 off work for a period of time after surgery, 19 these nerves saying it was a bit larger than normal 19 returned and wasn't able to continue with the work. 20 and she "protected it" during the surgery so it 20 Q. And did she tell you about the problems 21 wouldn't be injured, Dr. Dellon felt that because 21 she was having at work? She worked as a customer Page 42 Page 44 1 Ms. Hearn had pain in this area that resecting or 1 service rep for Delta Dental? 2 excising that nerve would be helpful. 2 A. Yes. She told me that she was unable to 3 And my difference in opinion lies in 3 type at her normal speed and that I think typing 4 the fact that, Number 1, the nerve was seen and 4 played a large role in her work duties. She wasn't 5 protected. Number 2, the nerve can have branches 5 able to hold a phone well as I recall and she was 6 and the pain that Ms. Hearn is experiencing is 6 dropping things because she would have to 7 somewhat generalized in that area and not limited 7 essentially look at her hand to try to keep control 8 to that area. 8 of it. 9 So I just think it's a bit of a, my 9 Q. Based on your report, Doctor, she says 10 opinion is that there's not enough to support 10 that prior to the injury she was able to type 66 to 11 offering that procedure because any procedure has 11 70 words per minute and now is only able to type 15 12 potential complications that have to be justified 12 words per minute with errors. Is that something 13 by the rationale for the surgery. So I just 13 that you recall she told you? 14 disagreed. I thought that that was not supported 14 A. Yes. 15 by the evidence well enough to recommend. 15 Q. Is that consistent with your exam and 16 Q. Very good. And then the third surgery 16 your review of the records in this case? 17 recommended by Dr. Dellon, as I understand it, is a 17 A. Yes. 18 repeat of the brachial plexus surgery that Dr. 18 Q. Do you have an opinion, Doctor, as to 19 Harbaugh performed? 19 whether Ms. Hearn's difficulty at work is related 20 A. Yes. 20 to the injury she suffered in the motor vehicle 21 Q. And that's not something you're 21 accident? 11 (Pages 41 to 44) Page 45 Page 47 1 A. I hold the opinion that it is related 1 Q. What did that test show in terms of her 2 because she describes it as corresponding to the 2 consistency throughout the testing period? 3 symptoms that developed at the time of the accident 3 A. They give a score of consistency and her 4 and have remained since. 4 score was the highest, 22 out of 22, according to 5 Q. Did you suggest, Doctor, that Jackie 5 this exam. So the conclusion there is that her 6 might want to have a functional capacity evaluation 6 responses were consistent and accurate. 7 done? 7 Q. If I could take a step back here too. In 8 A. I did. 8 the course of your physical examination of Ms. 9 Q. What is a functional capacity evaluation? 9 Hearn, did she give you any reason to believe that 10 A. Well, it's a rather time-consuming set of 10 she was not being completely honest with you? 11 exercises that usually a physical therapist 11 A. She did not, no. 12 performs with a client and its rather -- its 12 Q. And did you see anything in her medical 13 called stereotype. They will take an individual 13 records which indicated that she was being less 14 through certain tasks repeatedly and then determine 14 than honest with any of her medical providers? 15 based on the person's report of symptoms or any 15 A. No, I did not. 16 particular weakness or functional deficit are they 16 Q. What were the conclusions, Doctor, of the 17 able to perform these tasks? 17 therapist who performed the functional capacity 18 And it's done in a way that's fairly 18 evaluation with respect to Ms. Heam's vocational 19 standardized from center to center, and then by 19 abilities? 20 doing so, they are able to come up with a 20 A. The summary statement, the results 21 recommendation based upon this several hour 21 demonstrate an ability to function in a sedentary Page 46 Page 48 1 procedure as to what degree of work a person's 1 physical demand level, use of right upper extremity 2 capable of and what particular tasks need to be 2 only and I believe for an eight hour work day. 3 avoided. 3 Q. And do you agree with that conclusion? 4 They also build into the test some test 4 A. Yes. 5 of consistency to be sure that a person is giving 5 Q. Doctor, do you have an opinion to a 6 consistent or maximum effort during the test rather 6 reasonable degree of medical certainty as to 7 than let's say pretending to have a certain problem 7 whether Ms. Hearn is physically able to work in a 8 that they don't have. 8 customer service representative type position which 9 Q. And if you pretended to have a certain 9 involves typing and answering the phones? 10 problem that you don't have, that would reveal 10 A. I'm not familiar with whatever potential 11 itself in the functional capacity evaluation? 11 assistive devices you can have for answering the 12 A. It certainly should, yes. 12 phone, but I would say based on the FCE and the 13 Q. And Ms. Hearn had an FCE, a functional 13 exam and the medical records that the typing 14 capacity evaluation done after you examined her; 14 wouldn't be an option. 15 correct? 15 Q. Doctor, you've given us your opinion here 16 A. Yes. 16 this afternoon on several different occasions. 17 Q. Did you have a chance to review that? 17 Have the opinions that you've given us today all 18 A. Yes. 18 been given to a reasonable degree of medical 19 Q. And did that show any signs of her 19 certainty? 20 exaggerating her symptoms and her problems? 20 A. Yes, they have. 21 A. No, it did not. 21 ATTORNEY CROSBY: Those are all my 12 (Pages 45 to 48) Page 49 Page 51 1 questions. Thank you, Doctor. 1 this general area up in the left shoulder area and 2 A. Can we take a short break? 2 chest area? 3 ATTORNEY SHIPMAN: Oh, certainly, 3 A. And the arm, yes. 4 certainly, yeah. 4 Q. And arm. And you've described those 5 VIDEOGRAPHER: Off the record at 4:26 5 complaints as somewhat general, not specific? You 6 p.m. 6 said it was sort of a general area of that portion 7 (A short break was taken.) 7 of her body? 8 VIDEOGRAPHER: Back on the record at 8 A. Yes, that's correct. 9 4:29 p.m. 9 Q. And as a result of that, some of the 10 CROSS-EXAMINATION 10 other procedures that have been recommended you 11 BY ATTORNEY SHIPMAN: 11 don't feel are necessary? 12 Q. Doctor, hello. My name is Jeff Shipman. 12 A. That's correct. 13 1 represent Mr. Loe in this case. I have a few 13 Q. Would you agree with me, Doctor, that 14 questions on cross-examination. First of all, it's 14 symptoms, when we describe symptoms, these are 15 my understanding that you saw Ms. Hearn at the 15 complaints, subjective complaints that the patient 16 request of her counsel; is that right? 16 is describing to you; is that right? 17 A. Yes. 17 A. Yes. 18 Q. So you're not a treating physician, as 18 Q. And so when Ms. Hearn is telling us that 19 you mentioned on direct, you're not her treating 19 she has the symptoms of pain, we have no real way 20 physician. You saw her principally just to write a 20 of objectively confirming that. It's simply that 21 report back to Attorney Crosby; is that right? 21 she's complaining that she has some pain in this Page 50 Page 52 1 A. Correct. 1 area; isn't that right? 2 Q. And so you saw Ms. Hearn on one occasion; 2 A. Yes. There are ways to support that with 3 is that correct? 3 some objective -- 4 A. Yes. 4 Q. But they're subjective complaints? 5 Q. And that was in 2012 about six years 5 A. Complaints by definition are subjective, 6 after the automobile accident? 6 yes. 7 A. Correct. 7 Q. She's still complaining of these problems 8 Q. Dr. Hershey she was the, Dr. Harbaugh 8 in spite of what Dr. Harbaugh performed; correct? 9 she's the physician who performed the operation? 9 A. Correct. 10 A. Correct. 10 Q. There was some minor improvement it 11 Q. And that operation was done in 20081 11 sounds like but the subjective complaints have 12 believe? 12 continued to the present? 13 A. That's correct. 13 A. Correct. 14 Q. Was done under a general anesthesia? 14 Q. Now, there was this functional capacity 15 A. Yes. 15 evaluation that was done to determine if she's able 16 Q. So Ms. Hearn was asleep and under this 16 to work; right? 17 general anesthesia at the time this operation was 17 A. Correct. 18 performed? 18 Q. And they determined that she was able to 19 A. Correct. 19 work? 20 Q. Following that Ms. Hearn continued to 20 A. Yes. 21 complain of symptoms associated with this, you said 21 Q. In a sedentary position and sedentary 13 (Pages 49 to 52) Page 53 Page 55 1 means what? 1 Q. Not her left? 2 A. Most people think of it as just sitting 2 A. Correct. 3 and not really doing anything physical, but by 3 Q. The EMG, the electric diagnostic test 4 definition, it's not involving much lifting of more 4 that you talked about earlier, are those subjective 5 than ten pounds. I think really any lifting over 5 or objective? 6 ten pounds and you're allowed zero to ten 6 A. Objective. 7 frequently. 7 Q. You can't fake that? 8 Q. And they've determined after testing her 8 A. Correct. 9 that she's able to do that. She's able to work in 9 Q. If an EMG shows nerve root problems, 10 that capacity? 10 there are nerve root problems? 11 A. Correct. 11 A. Correct. I do have to say every test has 12 ATTORNEY SHIPMAN: I think those are 12 limitations of what we call sensitivity and 13 all the questions I have, Doctor. Thank you. 13 specificity but it is an objective test. 14 A. You're welcome. 14 Q. And how about that pin prick test that 15 REDIRECT EXAMINATION 15 you talked about earlier that you performed on the 16 BY ATTORNEY CROSBY: 16 patient, is that something that-- Well, let me ask 17 Q. Just a few follow-up questions, Doctor. 17 you this. In your opinion was Ms. Heam being 18 When Dr. Harbaugh cut Jackie's shoulder open and 18 honest with you when you did that test? 19 did the surgery, was there objective evidence of 19 A. In my opinion I had no reason to believe 20 nerve compression when she did that? 20 otherwise. 21 A. Yes. 21 ATTORNEY CROSBY; Thank you. Those are Page 54 Page 56 1 Q. Dr. Harbaugh, based on your review of the 1 all my questions. 2 operative report, saw nerve compression? 2 A. Okay. 3 A. That is correct. 3 VIDEOGRAPHER: This deposition is 4 Q. The FCE test that was done, is that a 4 concluded, August 20, 2012 at approximately 4:35 5 subjective test or an objective test? 5 p.m. 6 A. The consensus is that it's objective. 6 (This deposition concluded at 4:35 7 There are parts of it that are trying to objectify 7 p.m.) 8 the subjective but it's viewed as an objective 8 9 measure, yes. 9 10 Q. And you would agree, Doctor, that one of 10 11 the purposes of the FCE is to make sure that the 11 12 patient's symptoms are being described accurately? 12 13 A. Yes. 13 14 Q. And the results of the FCE were that Ms. 14 15 Hearn was able to work in a sedentary, physical 15 16 demand level; however, with use of her right 16 17 extremity only; is that correct? 17 18 A. Right upper extremity, yes. 18 19 Q. So she can work in a sedentary, physical 19 20 demand level using only her right arm? 20 21 A. Correct. 21 14 (Pages 53 to 56) Page 57 1 CERTIFICATION OF NOTARY 2 I, Jodi L. Lambert, the officer before whom 3 the foregoing deposition was taken, do hereby 4 certify that the witness whose testimony appears in 5 the foregoing deposition was duly sworn by me; that 6 the testimony of said witness was taken by me 7 stenographically and thereafter reduced to 8 typewriting by me; that said deposition is a true 9 record of the testimony given by said witness; that 10 I am neither counsel for, related to, or employed 11 by any of the parties to the action in which this 12 deposition is taken and further, that I am not a 13 relative or employee of any attorney or counsel 14 employed by the parties thereto, nor financially or 15 otherwise interested in the outcome of this action. 16 17 Jodi L. Lambert 18 Notary Public 19 December 1, 2013 20 21 15 (Page 57) Nftm&l Cdkge of Patient Name: HEARN, JACQUELINE M Patient Sex: Female Patient Location: VASC, , Visit Type: Clinic Penn State Milton S. Hershey Medical Center Tel: (717) 531-8055 Penn State College ofMedicine Health Information Services, HU24 500 University Drive P.O. Box 850 Hershey, PA 17033-0850 PSUHMC MRN: 0836666 Date of Birth: 8/18/1977 Visit Number: 08549697 I R a d i o l o g y - P r o c e d u r e N o t e I D o c u m e n t Final Document Electronically Signed by: NEURO INJECT MAJOR JOINTS HIP, KNEE, SHOULDER PATIENT NAME: HEARN, JACQUELINE M PATIENT MRN:00836666 PATIENT DOB: 08/18/1977 EXAM DATE OF SERVICE: 06/22/2007 EXAM NUMBER: 2028065 ORDERING PHYSICIAN: LYONS, ROBERT P Fluoroscopic guided left shoulder joint injection History: adhesive capsulitis Procedure: Informed consent was obtained. The patient was placed in the supine position and prepped and draped in sterile fashion. A timeout procedure was called and the patient's medical identification and site of intervention were verified. 1% buffered lidocaine was used to anesthetized skin and soft tissues. A25 gauge needle was inserted into the right hip joint. 1 cc of nonionic contrast was injected to confirm intra-articular location of the needle tip. 40 mg of Kenalog and 3 cc of 2% lidocaine was injected into the joint. Impression: Uncomplicated fluoroscopic guided left shoulder joint injection. DICTATED: MAHRAJ, RICKHESVAR REVIEWED AND SIGNED: MAHRAJ, RICKHESVAR DATE DRAFTED: 06/22/2007 05:20 PM DATE OF FINAL SIGNATURE: 06/22/2007 05:21 PM Date Printed: 812912008 01 ter 25me Printed: 1:44 PM X r D RAYS R Phyikal Therapy Institute 1-009 A, ftm G W 71m4k Tnitisal VW0lT110+in1a Patient Name: Jacqueline Hearn Date of Evaluation: 12129106 Date of Birth: 8118177 Sex: F Date of Onset: 12/12/06 Diagnosis: shoulder pain S 'cal Procedure: N/A Refer Physician: Dr. Fierer Date of Sur : N/A SUBJECTM HISTORY: Subjective History: Ms. Hearn states that she was involved in a MVA on 12/12/06 when the car behind her was rear-ended and then pushed into her. She states the car was hit w/such force that she was pushed into the intersection while she was sitting at a light. The patient was not wearing her seatbelt at the time and states that she was leaning forward when she was hit. She was pushed into the steering wheel. She was taken to Hershey Medical Center after the accident. She had x-rays of her shoulder which were (-) for problems. She followed-up w/Kim Kelker at her PCP's office. She was referred for PT. No further testing has been performed. The patient is having other testing due to fluid retention in her abdominal area. Patient will follow-up w/her MD as needed Current Complaints: Includes generalized pain throughout the shoulder. In addition is the feeling of a charley horse throughout the shoulder and scapular area which can extend as far as the lower back. She notes tightness which can extend 1 her (L) LE to the elbow and she continues to have intermittent tingling through all fingers of her (L) hand. In addition, she notes stiffness in her neck. Function: Patient is (R) handed. The patient has been wearing a sling intermittently on her (L) UE. She reports difficulty w/sleeping and states that lately she's been sleeping only on her back but continues to have difficulty. She is unable to perform reaching or lifting w/her (L) UE and feels limited w/driving although she has continued to drive. Pain Rating: Current: /10 Worst: 7 /10 Best: /10 Occupadon/Work Status: Patient works full-time in customer service and types frequently throughout the day. Lately she has been typing with one hand. Social History/Interests: Includes taking care of her son who is 11/2 years. She notes significant difficulty trying to pick him up. PMHx: Please refer to chart. Medical Precaudons/Contraindications: Some undiagnosed fluid retention in the abdominal area. Medications: Please refer to chart. Patient's Goals for Therapy: To restore full shoulder mobility. I OBJECTIVE FINDINGS: I Observadon/Inspection: Patient presents to PT demonstrating a moderately guarded position w/the (L) UE. She is currently wearing a sling but when she takes the sling off, she is very guarded and continues to hold her arm at her slide. There is flattening of the upper thoracic spine and a mild-to-moderate forward head. The scapula is in neutral rotation. Flexion WNL Extension 75% w/scapular pain Rotation -- -75%-*/pain when got 16 (R) Right Left Lateral Flexion 75% w/pain SO% Flexion 35° Extension 30° External rotation measured w/a-m at side To neutral 2805 Old Post Road, Suite 210 Harrisburg, PA 17110 Phone: (717) 635-2030 Patient Name: Jacqueline Hearn Dellon Institute for O Peripheral Nerve Surgery E 1121 Kenilworth Drive Suite IS Towson. Maryland 21204 A Lee Dellon, MD, PhD Plastic Surgery Peripheral Nerve Surgery Hand Surgery Eric H Williams, MD Plastic Surgery Peripheral Nerve Surgery Reconstructive Surgery hedge D Rosson, MD Plastic Surgery Peripheral Nerve Surgery Reconstructive Surgery 410 337 5400 tel 410 337 5520 fax www.dation.com November 23, 2011 Jefferson Shipman, Esq 301 Market St Lemoyne, PA 17043 Fax: 717-761-3015 - RE: JACQUELINE HEARN-vs: #2008-7062 Civil Term Cumberland County CCP Dear Mr. Shipman: MICHAEL- DOE -- Ms. Hearn was evaluated by me in the office on November 22, 2011. According to your request from August 25, 2011, the visit was changed from the initial scheduled visit of October 4, 2011 because of problems identifying the check making payment for the Independent Medical Examination which you requested. The extensive documentation that you sent to be looked at in advance and your letter of August 21, 2011 are before me as I attempt to answer the questions you wish to know. I do not really wish to simply read into this letter all the pertinent reports that you sent as clearly you are aware of them because you sent them to me. What appears to be quite clear is that there was a motor vehicle accident involving Ms. Hearn. This occurred on December 12, 2006 when her vehicle was reportedly rear-ended. Ms. Hearn subsequently went through a very long period of time with diffuse symptoms involving her neck, her shoulder, the site of her chest, her arm, and her hand and had all appropriate diagnostic testing done and all appropriate therapy done but persisted with these symptoms. The critical juncture comes when she comes under the care of Kimberly Harbaugh, MD, a neurosurgeon at Hershey Penn State Medical Center. Dr. Harbaugh ascertained that the cause of these problems was not a cervical disk. There was initially an electrodiagnostic study that had diffuse abnormalities which could be interpreted as demonstrating brachial plexus compression in the thoracic inlet, so called thoracic outlet syndrome. The patient had worsening of her symptoms when her arm was elevated above her head and was tender in the supraclavicular region which, I agree, are the only physical findings you can have to demonstrate the presence of brachial plexus compression. Electrodiagnostic studies traditionally cannot document this compression except for a very rare form which involves only numbness in the little and ring fingers related to compression of the lower trunk. Electrical testing has an abnormal sensation only for the little finger but abnormalities in intrinsic muscles for both median and ulnar innervated fingers. Ms. Hearn did not have that. Therefore, it was appropriate to carry out a brachial plexus decompression. After appropriate counseling with the patient, Dr. Harbaugh decided to use a supraclavicular approach. From the operative note, it is clear what she did and which will become important in my final eo fkft+ 0 .? Dellon institute for Peripheral Nerve Surgery 1122 Kenilworth Drive Suite 10 Towson. Maryland 11204 A Lee cation, MD, PhD Eric H Williams, MD Gedge D Rosson, ND Plastic Surgery Plastic Surgery Plastic Surgery Peripheral Nerve Surgery Peripheral Nerve Surgery Peripheral Nerve Surgery Nand Surgery Reconstructive Surgery Reconstructive Surgery 410 337 5400 tel 410 337 5520 fax www.detion.com Jefferson Shipman, Esq RE: JACQUELINE HEARN vs. MICHAEL LOE November 23, 2011 Page Two she did-an anterior sea lenotomy-'in-addition to-neurolysis of the brachial plexus. She found-What she termed an accessory scalene muscle. This is actually the scalenus minimus and it is present in 20% of people and can cause compression of the C8 and T1 nerve roots. This muscle was appropriately removed. The patient unfortunately really has not gotten better which now brings us to the problem more than three years later where the patient still has the complaints. I think importantly in trying to understand this patient is she makes every effort to give a happy and pleasant appearance. She was extremely well groomed with her hair done, her false eyelashes present, and a very well-dressed appearance. She spoke very well. She acts quite cheerful. However, when an attempt is made to touch her left arm or touch her left shoulder, she actually gets quite extreme pain developed and begins to cry. During the examination, the patient had a patient advocate with her, Nicole Forney, case manager for the Handler, Henning, & Rosenberg law firm which represents the patient and I had Rita Moore from my office as a chaperone. The patient indicates that on a scale of 1 to 10, her present pain is 15 and it used to be 20. Clearly this is an exaggeration but it means that she feels she got a little better from the operation Dr. Harbaugh did but she still has discomfort in her shoulder, down her scapular region, into her arm, and in her fingers. She sits with her elbow generally flexed. Even gentle palpation over the ulnar nerve at the elbow gives her a very horrible shooting pain in her little and ring finger causing her to withdraw her hand. When I look at her most recent electrical testing done by Dr. Harbaugh which I believe was in November 2008, [nerve conduction study from January 2011] although the test is interpreted as being normal, I do not actually interpret it that way. The conduction velocity for the ulnar nerve on the left side across the elbow is 50 m/sec and above that it is 58.8 m/sec. In most laboratories, 50 m/sec is the 99th percentile of its limit for normal. In other words, if it had been 49.5, it would have been read as abnormal. A difference of 10 m/sec from above to below the elbow is typically taken as indicating ulnar nerve compression. Therefore, I think that this documentation going back to 2008 demonstrating compression of the ulnar nerve at the elbow and within a reasonable degree of medical certainty and probability this is caused by the impact of Ms. Hearn's shoulder and arm against the door and steering wheel. This has not been surgically treated. We can expect Ms. Hearn to go on to have progressive loss of pinch and grip strength and permanent numbness in the little and ring fingers. The indicated treatment at this point in time is neurolysis of the ulnar nerve and an anterior submuscular transposition of the ulnar nerve. These are operative procedures that I do as a Dellon Institute for Peripheral Nerve Surgery _ 1112 Kenilworth Drive Suite 19 Towson, Maryland 11204 410 337 5400 tel 410 337 5520 fax www.detion.com Jefferson Shipman, Esq RE: JACQUELINE HEARN vs. MICHAEL LOE November 23, 2011 Page Three A Lee Dellon, MD, PhD Eric H Williams, MD Gedge D Rosson, MD Plastic Surgery Plastic Surgery Plastic Surgery Peripheral Nerve Surgery Peripheral Nerve Surgery Peripheral Nerve Surgery Hand Surgery Reconstructive Surgery Reconstructive Surgery -- plastic surgeon and-hand surgeon. " If she was to come to me, -my fee for doing this would be a combined fee of $18,000 utilizing procedure codes 25315 and 64718. Ms. Hearn had her chest hit the steering wheel and the sensation on the right side of her chest is normal but on the left side of her chest she does not like to be touched especially in the infraclavicular region. Dr. Harbaugh mentioned in her operative note that she identified the supraclavicular nerve which was quite large and protected it. I have had patients who have pain in this area either as a complication of brachial plexus decompression or as a direct contusion either from the seat belt or from the steering wheel. Within a reasonable degree of medical certainty and probability as a direct result of the motor vehicle accident of December 12, 2006, Ms. Hearn has an injured left supraclavicular nerve. The indicated treatment is to resect this nerve, leaving the proximal end implanted into the sternocleidomastoid muscle. This would give her an area of numbness in her upper left chest, not the skin that goes to her breast, otherwise she will have this pain permanently. The procedure codes for this would be 64784 and 64787, resecting the nerve and implanting the nerve into muscle. The professional fee for doing this would $7500. Ms. Hearn is extremely tender when the brachial plexus is touched in the neck. She has a well- healed scar. Most likely the scalene muscle, which was divided, is adherent still over the upper trunk of the plexus and lower trunk of the plexus. Ms. Hearn has recurrent or persistent brachial plexus compression. The indicated treatment would be an anterior scalenectomy and repeat neurolysis of the brachial plexus. This would be procedure codes 21705 and 64713. The total professional fee for that surgery would be $35,000. That surgery is extremely difficult and would require a one-night stay in the hospital because of the risks of pulmonary collapse and bleeding. During the time she was in the office, she had extensive neurosensory testing done with her hands at rest and with her arms elevated. These demonstrated essentially normal measurements for the right upper extremity with no change between the two positions. In contrast, the left side had abnormal measurements for the little finger pulp at dorsoulnar and dorsoradial aspects and index finger pulp even at rest consistent with problems of the upper and lower trunk of the brachial plexus and also could be consistent with ulnar nerve compression at the elbow. When the hand was elevated above the head, these measurements worsened. This was also associated with profound weakness of pinch and grip on the left side. The test demonstrated the patient gave her maximum effort during the complicated evaluation/procedure. The above is all said within a reasonable degree of medical certainty and probability. b Dellon Institute for A Lee Belton, MD, PhD Eric N Williams, MD hedge D Rosson, MD I?, 1 Peripheral Nerve Surgery Plastic Surgery Plastic Surgery l N S Plastic Surgery ri heral Nerve Sur er P 1122 Kenilworth Drive Peripheral Nerve Surgery urgery Periphera erve g p y e Suite 18 Hand Surgery Reconstructive Surgery Reconstructive Surgery Towson. Maryland 21204 410 337 5400 tel 410 3515520 fax www.dation.com Jefferson Shipman, Esq RE: JACQUELINE HEARN vs. MICHAEL LOE November 23, 2011 Page Four profession as a hair stylist which I think i lextremely difficult to do just using one hand. I am available for a phone consultation if this is necessary or needed by you. My cell phone number is 410-299-6927. Sincerely, A. Lee Dellon, MD ALD:ee DR/DT; 11/23/2011 cc: Nicole Forney, Case Manager Handler Henning & Rosenberg 1300 Lingiestown Rd Harrisburg, PA 17110 3 05/18/2012 09:36 3017974196 PNSI Brian Holmes, MD, FRCS 975 Wayne Avenue #115 Chambetsburg, PA 17201 May 16, 2012 Matthew S. Crosby, Esq. Handler, Henning and Rosenberg, LLP 1300 Linglestown Road Suite 2 Harrisburg, PA 17110 RE: Jacqueline M. Hearn Date of Inlury: 12/1212006 Social Security #t: 176-58-9567 DOD: 08/18/1977 HAR Case #: 211942 Date of Evaluation: 03/20/2012 Clai><tn. M EPL0705 Date of Injury: 12/12/2006 INDEPENDENT MEDICAL EVALUATION Records Reviewed: 11/23/11 IME A. Lee Dellon, MD Deposition Transcripts: 1/20/11 Michael Low 1/20/11 Jacqueline M. Heam Medical Records Hershey Medical Center Police Complaint Form and Exchange Report Medical Records Dr. Kushkin Jacqueline M. Hearn was evaluated on March 20, 2012 at the offices of Parkway Neuroscience and Spine Institute in Chanmbersburg, PA. Summary: PAGE 01/05 Ms. Hearn reports a motor vehicle accident of December of 2006. She was stopped at the exit of a parking lot. She was an unbelted driver. She was leaning forward. She was struck from behind by another vehicle. She struck the steering wheel with her left shoulder and sternum. Prior to this injury, she had not experienced any arts pain and had had no prior surgery related to the cervical spine or atm. She began to experience shoulder and arm pain at the time of the accident. She has not been free of pain since the accident. She was off work from the date of the injury for about one week and then returned at light duty. She was then off for six months following her surgery. After her surgical procedure she returned to work and was generally handling the phones. Prior to that, she was a customer service representative for Delta Dental and had worked as a Cosmetologist as well. Prior to the injury, she was able to type 66 to 70 words per minute, now only able to type 15 words per minute with errors. She must look at her band for it to function properly. She notes that she drops items Jaqueline Hearn ---IMS---Brian Holmes, MD, FACS---5/16/12 05/18/2012 09:36 3017974196 PNSI PAGE 02/05 consistently from her left hand. She last worked two and a half years ago, shortly following her surgical procedure. At present she has no personal income and lives with her boyfriend. At the time of the accident she notes that her pain was 1215/10. After surgery the pain was 8- 9/10 when she was not very active. Over time when she returned to activity she noted that het pain returned to 12-15/10. She had been on Flexeril, Tylenol #3, and vicodin. Dr. Kimberly Harbaugh had sent her for trigger point injections. (The records support that a left shoulder intraarticular Injection was performed.) Physical therapy was not helpful. The pain has a dull and sometimes burning quality. She describes pain in the left shoulder girdle distally involving the entire arm. The scapula is affected as well as all fingers on the left hand. She notes that "her hand seems to tutu blue". If she flexes her elbow in a certain way, the color returns to normal. She noted swelling or fullness in the left supraclavicular fossa following the accident which persisted. She describes her pain as constant rating it as a 10/10 at its worst. If her neck develops cramping her head pulls to the right. She notes that her pain is greatly worsened if she is doing hair work as a Cosmetologist. She only does this occasionally, about once per month. She is unable to type because of an increase of pain. She notes no pain elsewhere in her body other than that corresponding to the area which she marked on her self- reporting form in which she shades darkly the left neck, pectoral regions, scapular region, and the entire left area. Ms. Hearn also notes that she is unable to straighten her left elbow fully and notes more prominent fat in her left lower triceps region. She also notes a rash on her back near. her left bra line with some white spots and wonders if this is in anyway related to her injury. She had seen another orthopedic surgeon in Harrisburg when this was thought to be a rotator cuff injury. She was evaluated on several occasions by Dr. Kimberly Harbaugh, a neuro6urgeon specializing in peripheral nerve disorders at the Hershey Medical Center. Dr. Harbaugh performed a surgical exploration of the left brachial plexus and anterior scalenectomy in December of 2008. She notes that no practitioner had ever mentioned potential therapy with a spinal cord stimulator. Past Medical History: Arthritis of the left hip. Medications: Tylenol. Allergies: No known drug allergies. Family History: Heart problems in her mother, otherwise noncontributory. Surgical History: An ablation in 2006. Brachial plexus surgery in 03/2010. Social History: She is a Cosmetologist and notes that her work duties would be moderate to heavy. She lives in a home. She exercises regularly on a treadmill. She consumes alcohol occasionally. No tobacco use. Review of System.: Positive for weight gain greater than ten pounds. Arm weakness, arm pain, neck pain, and neck stiffness. Otherwise negative. Physical Examination: Vital signs: Blood pressure 133/78. Pulse 70. Respirations 12. ]aqueline Hearn---IME---Brien Holmes, MD, FACS---5/11.6/12 Page 2 05/18/2012 09:36 3017974196 PNSI PAGE 03/05 General examination reveals a black female in no acute distress. She is cooperative in providing a history and participating in the physical examination. Cervical Spine: Range of motion testing reveals minimal reduction in flexion with reported left neck pain. Minimally limitation of extension with reported left neck pain and moderate reduction of rotation both right and left with reported left neck pain. Shoulder; Some fullness without fluctuance in the left supraclavicular fossa. There is a healed supraclavieular incision site. Exquisite tenderness reported with gentle palpation with pain radiating to the entire left upper extremity. Passive shoulder rotation is not mechanically limited. She does report diffuse pain in the scapula region and the entire arm with movement. Dorsal trunk: Reveals no muscle wasting, deformity, or spasm. Extremities; Reveals negative Tinel's sign on the right. Both the elbow and wrist are tested. There is a positive Tinel's at the left elbow with minimal pressure. The paresthesias produced are described as intense, involving the ulnar two digits. The response at the left wrist is indeterminate witb some parasthesias proximal but none extending to her fingers or hand. No muscle atrophy or fasciculation are seen in the left upper extremity or shoulder girdle. Neurological: Pupils are equal. Extraocular movement is intact. There is no asymmetry of facial movement. Sensation to light touch and pin prick is reduced on all digits of the left hand and markedly reduced on the left small finger and ring finger. There is reduction of light touch and pin on the left ulnar aspect of the forearm and mild reduction on the radial aspect of the forearm. There is marked reduction and sensation in the medial upper arm. Pin prick is specifically reduced on the ulnar two digits of the left hand and the ulnar aspect of the middle finger as well as the lateral shoulder. There is mild diminution of pinprick sensation over the entire left arms. Motor examination: She does not produce more than 315 power of shoulder abduction but reports that this is limited by pain in her arm and chest. Wrist extension is 4/5. Forger extension is 445. Grip 4/5. Finger abduction 315. Elbow flexion 4+15. Elbow extension 4/5. Reflexes: Deep tendon reflexes are 1+ at the right biceps, triceps, and brachioradialis. Trace at the left bicelis, 1+ at the left bracheoradialis, and equivocal response at the left triceps as she reports significant pain with percussion of the triceps tendon. Patellar and Achilles reflexes are 1.+ with a downgoing plantar response. Discussion; According to the deposition testimony of Michael T.,ae and consistent with the history provided by the client, Ms. Hearn was struck from behind by another vehicle while she was stopped in her vehicle, waiting to pull out of a parking lot. The vehicle which struck hers was itself struck from behind by the vehicle operated by Michael L,oe. Ms. Hearn was not belted and struck her shoulder and the region of her sternum on the steering wheel. Ms. Hearn developed left upper extremity symptoms consistent with brachial plexus irritation/compression and thoracic outlet syndrome. Cervical spine imaging ruled out cervical nerve root compression as a contributing factor. Ms. Hearn underwent a brachial plexus exploration with division of the accessory scalene muscle by Dr. Harbaugh in March of 2008. Ms. Heirs reported some increase of shoulder and arm mobility fallowing this procedure, according the office notes of Dr. Harbaugh. However, Ms. Hearn continues to experience diffuse left upper extremity pain and limitation of function. According to the operative note written by Dr. Harbaugh, the findings of compression of the lower trunk and mild/moderate compression of the middle trunk with "fibrotic fascia" and a "fibrotic band" were consistent with trauma. The onset of Ms. Hearn.'s symptoms coincided with Jaqueline Hearn ---TME -Brian Holmes, MD, FRCS---5/16/12 Page 3 05/18/2012 09:36 3017974196 PNSI PAGE 04/05 the injury of 12/12106. Therefore, I hold the opinion that the current symptoms of left arm pain and functional impairment are directly related to the injury of 12/12106. All treatment related to left upper extremity symptoms, such as Physical Therapy, left shoulder injection, brachial plexus exploration, as well as imaging of the cervical spine, shoulder, and brachial plexus, are a result of the injury of 12/12/{}61. Dr. Harbaugh most recently evaluated Ms. Hearn on 2/2/12. At that visit, Dr. Harbaugh did not recommend any further surgical treatment based upon her history, examination, and review of imaging and electrodiagnostie studies. Injection therapy, including Botox injection of the serrates anterior was suggested. Ms. Hearn underwent an IME by Dr. Dellon on 11/23/11. Dr. Dellon recommended a left ulnar nerve decompression with transposition and reported his fee for this procedure to be $18,000.00. He also recommended a resection of the supraclavicular nerve and reported his professional fee of $7,500.00. As well, Dr. Dellon recommended an anterior scalenectomy and repeat neurolysis of the brachial. plexus for a fee of $35,000.00 Based upon the clinical examination revealing a markedly positive Tinel's sign at the left elbow, a predominance of pain in the ulnar aspect of the arm and the Wnar two digits, along with moderate decrease of conduction velocity of the ulnar nerve at the elbow, recommendation for as ulnar nerve release or transposition is reasonable. However, the fee which Dr. Dellon quotes far exceeds the usual and customary fees billed or paid for this procedure. Also, the CPT code of 25315 is not appropriate as the CPT code 64718 clearly covers transposition of the ulnar nerve. An ulnar nerve decompression (cubital tunnel release) is also a surgical option, as opposed to a submuscular ulnar nerve transposition. Dr. Dellon also suggests resection of the supraclavicular nerve. This procedure is recommended based upon the nonspecific finding of tenderness of the supraclavicular fossa. I do not concur that the procedure would carry a favorable prognosis as the findings of tenderness are diffuse and non-specific. The fee of $7,500.00 quoted by Dr. Dellon exceeds what us usual and customary for a relatively brief peripheral nerve procedure. Dr. Harbaugh describes in her operative note clear anatomical findings of middle and lower trunk compression, relieved at the time of the brachial plexus surgery. Ms. Hearn experienced modest improvement following the surgical procedure. Based upon the tenderness elicited on physical examination of the supraciavicular fossa, Dr. Dellon recommends repeated exploration of the brachial plexus. Dr. Dellon also discloses his professional fee of $35,000.00. It is my opinion that this fee exceeds that which is reasonable and customary. As well, as an experienced, fellowship-trained peripheral nerve/brachial plexus surgeon, Dr. Harbaugh clearly reports compressive elements at the original exploration, relieved by the surgery. Therefore, the non- specific finding of supraclavicular tenderness following brachial plexus exloration is insufficient to recommend reoperation, in my opinion. Ms. Hearn.-; symptoms are diffuse, involving the entire arm and shoulder. Motor power is diffusely reduced, although the motor examination is limited by report of pain. Deep tendon reflexes are also preserved. Placement of a trial cervical spinal cord stimulator has not been suggested by the treating physicians or Dr. Dellon, the IME physician. Cervical spinal cord stimulation may have a positive effect on reduction of pain and increase in functional capacity. Therefore, I raise Ibis as a potential treatment option. Jaqueline Hearn---1ME---Brian. Holmes, MD, FRCS---5/16/12 Page 4 05/18/2012 09:36 3017974196 PNSI PAGE 05/05 Ms. Hearn's functional capacity is greatly limited, according to the history which she provides to me. In order to obtain a more objective measure of her functional limitation, a functional capacity evaluation (FCE) would also be reasonable. However, an FCE would not be of value if further treatment, such as a cervical spinal cord stimulator, or the procedures recommended by Dr. Dellon, is planned. In that case, and FCE would be indicated after an appropriate period of recovery. All of the opinions contained in this report are stated to within a reasonable degree of medical certainty. I reserve the right to modify this report or the opinions stated herein if any other materials or information regarding Jacqueline Hearn become available. No physician-patient relationship is established between Brian Holmes, MD, FACS and. Jacqueline Hearn based upon the performance of the IME. Sincerely, Brian Holmes, MD, FRCS Jaqueline Hearn---IME---Brian Holmes, MD, FRCS---5/16/12 Page 5 Page 1 Page 3 1 INDEX 2 WITNESS: ARNOLD LEE DELLON, M.D. PAGE NO. JACQUELINE M. HEARN, 3 Direct Examination by Mr. Crosby..... 5,41 Plaintiff, IN THE COURT OF COMMON PLEAS 4 Cross-Examination by Mr. Shipman ..... 35 V. CUMBERLAND COUNTY, PENNSYLVANIA 5 EXHIBITS MICHAEL LOE, NO. 2008-7062 6 EXHIBIT NO. DESCRIPTION PAGE NO. Defendant CIVIL ACTION - LAW 7 No. 4 Curriculum vitae ................. 8 8 No. 5 Opinion letter from Dr. Dellon to Pursuant to Notice, the video deposition 9 Mr. Shipman ...................... 14 of ARNOLD LEE DELLON, M.D., was taken on Wednesday, 10 No. 6 ED Summary ....................... 42 the 12th day of September 2012, commencing at 10:00 11 No. 7 12/22/2006 record of Ms. Heam's ° a.m., at the offices of Peripheral Nerve Study, 12 family physician ................. 44 located at 1122 Kenilworth Drive, Suite 18, Towson, 13 Maryland, before Brian M. McDonald, a Notary Public. 14 15 i 16 17 18 19 20 21 Page 2 Page 4 1 APPEARANCES: 1 TOWSON, MARYLAND 2 FOR THE PLAINTIFFS: 2 WEDNESDAY, SEPTEMBER 12, 2012 3 MATTHEW S. CROSBY, ESQUIRE 3 --- 4 and 4 PROCEEINGS 5 MATTHEW ROSENBERG, ESQUIRE 5 Whereupon, 6 Handler Henning & Rosenberg, LLP 6 THE VIDEOGRAPHER: This video deposition 7 1300 Linglestown Road, Suite 2 7 is being taken in accordance with Pennsylvania 8 Harrisburg, Pennsylvania 17110 8 Rules of Civil Procedure on September 12, 2012, 9 (717) 238-2000 9 at approximately 10:20 A.M. We are at 1122 10 FOR THE DEFENDANTS: 10 Kenilworth Drive, Towson, Maryland. Our court 11 JEFFERSON J. SHIPMAN, ESQUIRE 11 reporter is Brian McDonald. My name is Brian 12 Johnson, Duffle, Stewart & Weldner, P.C. 12 Barton. We are with Maxim Reporting. The 13 301 Market Street 13 caption of this case is Jacqueline M. Hearn 14 P.O. Box 109 14 plaintiff vs. Michael Loe defendant. The party 15 Lemoyne, Pennsylvania 17043-0109 15 giving notice of this deposition is the 16 16 plaintiff. Will the attorneys please identify 17 17 themselves and who they represent. 18 18 MR. CROSBY: Matt Crosby for the plaintiff 19 19 Jackie Hearn. 20 20 MR. ROSENBERG: Matt Rosenberg also for 21 21 the plaintiff. LE,0 Page 5 Page 7 1 MR. SHIPMAN: My name is Jefferson Shipman 1 Q. Can you tell us a little bit, Doctor, 2 for the defendant. 2 about your educational background. 3 THE VIDEOGRAPHER: The witness is Dr. Lee 3 A. I went to Johns Hopkins University for 4 Dellon who will now by sworn in by the court 4 college. Finished there in 1966. 1 went to Johns 5 reporter. 5 Hopkins University for medical school and finished 6 ARNOLD LEE DELLON, M.D., 6 there in 1970. I did two years of general surgery 7 a witness herein, having been first duly sworn, was 7 in New York City at Columbia University. I then 8 examined and testified upon his oath as follows: 8 spent two years at the National Institutes of 9 DIRECT EXAMINATION 9 Health, Surgery Branch of the Cancer Institute. I 10 BY MR. CROSBY: 10 then returned to Johns Hopkins and did two years of 11 Q. Doctor, can you please state your full 11 plastic surgery, two years of general surgery. And 12 name for us. 12 those general surgery years included a hand 13 A. Arnold Lee Dellon. 13 fellowship time, so that I spent eight years of 14 Q. And what's your occupation, Doctor? 14 training after medical school, finished in 1978. 15 A. I'm a doctor. 15 Q. Okay. And according to your CV, Doctor, 16 Q. And what's your specialty? 16 it looks like you're licensed to practice medicine 17 A. I'm board certified in plastic surgery; I 17 in a number of different States; is that accurate? 18 have a certificate of qualification in hand surgery 18 A. Yes. 19 and my practice is now limited to peripheral nerve 19 Q. Can you tell us where you're licensed? 20 surgery. 20 A. I'm currently licensed in the State of 21 Q. And what types of problems and injuries do 21 Maryland and the State of Nevada, State of Page 6 Page 8 1 you regularly treat in your practice? 1 California, State of New York. 2 A. Problems relating to peripheral nerves. 2 Q. And do you currently hold any teaching 3 Q. And what are the peripheral nerves? 3 positions, Doctor? 4 A. Central nervous system is your brain and 4 A. Yes, I do. 5 your spinal cord, and the peripheral nerves are the 5 Q. Can you tell us about those? 6 nerves that exit the spinal cord and go to your arms 6 A. I'm a professor of plastic surgery and 7 and your legs, your chest, your face. 7 professor of neurosurgery at Johns Hopkins 8 Q. Okay. And do you do surgery, Doctor? 8 University. 9 A. Yes. 9 THE VIDEOGRAPHER: Doctor, could you move 10 Q. And what types of surgeries do you perform 10 the microphone up, please. 11 in your practice? 11 A. I'm a professor of plastic surgery and 12 A. I operate on peripheral nerves. 12 neurosurgery at Johns Hopkins University. 13 Q. Okay. How often are you in surgery, 13 Q. Is it fair to say, Doctor, that you're 14 Doctor? 14 familiar with the diagnosis, care and treatment of 15 A. I operate on Mondays and part of Thursday. 15 brachial plexus injuries? 16 Q. Can you give us an idea of idea how many 16 A. Yes. 17 surgeries you may do in a given week typically? 17 Q. And do you perform brachial plexus 18 A. This week I will do four. Sometimes I do 18 surgeries? 19 five. 19 A. Yes. 20 Q. And that's pretty consistent? 20 (Whereupon, Deposition Exhibit 21 A. Yes. 21 No. 4 was marked for 2 (Pages 5 to 8) Page 9 Page 11 1 identification.) 1 was done properly and whether the data was analyzed 2 Q. Let me show you, Doctor, what we have 2 properly. Papers usually then get sent back to have 3 marked as Plaintiffs Exhibit No. 4. 3 corrections made to them, and then the editors 4 A. Yes. 4 review them again, and if the papers pass that type 5 Q. Can you tell what that is? 5 of scrutiny or careful appraisal, the paper will 6 A. It's called a CV or curriculum vitae. 6 then be published; that process is called peer 7 It's essentially a list of my academic 7 review. 8 contributions. 8 Q. And your peer-reviewed articles that you 9 Q. And does that, does that curriculum vitae 9 have written, Doctor, have included articles on the 10 accurately reflect your background and your 10 brachial plexus? 11 experience? 11 A. Yes. 12 A. Yes, it does. 12 Q. And the other peripheral nerves as well? 13 Q. It looks like, again, according to your 13 A. Yes. 14 CV, Doctor, that you have written or co-written 14 Q. And it looks like you mentioned the 15 seven books in your field? 15 editorial boards; it looks like you served on the 16 A. Yes. 16 editorial board of the Journal of Brachial Plexus 17 Q. Okay. One of those books is titled 17 and Peripheral Nerve Injury; is that accurate? 18 "Surgery of the Peripheral Nerve." Is that a book 18 A. Yes. 19 that you have written? 19 Q. How long did you serve in that capacity? 20 A. Yes. 20 A. It's anew journal; it only came out about 21 Q. And another book, according to your CV, is 21 three years ago. Then I was on it when it started. Page 10 Page 12 1 "Interpretation Guide to Neurosensory and Motor 1 MR. CROSBY: All right, Doctor. We would 2 Testing," that's a book that you have written as 2 like to offer Dr. Dellon as an expert in the 3 well? 3 field of peripheral neurosurgery. You may have 4 A. Yes. 4 some questions here on your qualifications. 5 Q. And again, according to your CV, it looks 5 MR. SHIPMAN: Doctor, I don't have any 6 like you have written more than 420 peer-reviewed 6 questions on your qualifications. Thank you. 7 articles in various medical journals; is that 7 THE WITNESS: Thank you. 8 accurate? 8 Q. (By Mr. Crosby) Doctor, according to my 9 A. Yes. 9 records you examined Jacqueline Hearn on 10 Q. What's a peer-reviewed article? 10 November 22nd, 2011; is that correct? 11 A. There's some magazines or journals that 11 A. Yes. 12 doctors read that are paid for completely by 12 Q. And that examination was done at the 13 advertisers, and they ask people to write articles 13 request of Attorney Shipman? 14 and the people do and they get published. And 14 A. Yes. 15 contrast the journals that publish what we like to 15 Q. I didn't ask you to examine Ms. Hearn? 16 think of as scientific papers, a doctor does the 16 A. What is your name again? 17 research and then sends the paper into the journal; 17 Q. Matt Crosby. 18 the journal has an editorial board. And I've been 18 A. No. 19 on the editorial board of many of our journals. The 19 Q. And Attorney Shipman also asked you to 20 editorial board, usually three separate doctors will 20 review Ms. Hearn's medical records? 21 read the paper and think about whether the science 21 A. Such as we sent them, yes. 3 (Pages 9 to 12) Page 13 Page 15 1 Q. And you were sent, it looks like, some 1 makeup and appeared to be happy. She was well- 2 extensive records; is that fair? 2 spoken. However, when I asked her to, or I made an 3 A. Yes. 3 attempt to examine her left arm or touch her left 4 Q. And the purpose of your physical 4 shoulder, she appeared to be in quite extreme pain 5 examination and your review of those medical records 5 and began to cry. She indicated that her pain level 6 was so that you could prepare a written report 6 was above ten; usually we use a rating scale of one 7 outlining your findings and your opinions regarding 7 to ten. She kept her elbow flexed, which is 8 Jackie's injuries; is that fair? 8 typically a position people hold their arm in when 9 A. Yes. 9 something hurts them. I examined the nerve at her 10 Q. And ultimately to testify in court if 10 elbow, which is what typically we think of as the 11 asked; is that correct? 11 funny bone. And this was very tender, causing pain 12 A. Yes. 12 to go into her little ring finger. 13 Q. And in this case you prepared a medical 13 Q. What's the significance, if any, of that 14 report and you sent it to Attorney Shipman on 14 finding, Doctor? 15 November 23rd of 2011? 15 A. That's a finding that is present when 16 A. Yes. 16 someone has a compressed nerve at the elbow. It's a 17 Q. And have you ever been contacted by 17 big nerve; it's about the size of this pen. It gets 18 Attorney Shipman to testify in this case? 18 normally past between the elbow bone and the bone 19 A. Not that I'm aware of. 19 nearby. It's not usually tender. If it is tender, 20 Q. Okay. And it looks like you have a copy 20 it means something's going on with the nerve in that 21 of your medical report that you prepared in this 21 location. And that was important in terms of her Page 14 Page 16 1 case in front of you? 1 symptoms related to the ability to use her hand in 2 A. Yes. 2 some of the testing that would have done before she 3 MR. CROSBY: And we'll mark that as 3 saw me. The rest of the physical examination 4 Exhibit No. 5. 4 included an area in this region of her chest. This 5 (Whereupon, Deposition Exhibit 5 is the collarbone or clavicle. So the area below 6 No. 5 was marked for 6 that is in intra or below the clavicle and this is 7 identification.) 7 an area where she was tender and did not like to be 8 Q. (By Mr. Crosby) Plaintiffs Exhibit No. 8 touched or examined. That's related to a particular 9 5. And feel free to refer to that as you need to, 9 nerve that goes into that area. The additional 10 Doctor, if you need to refresh your recollection. 10 portions of the examination refer to the word used 11 Did you obtain a history from Jackie? 11 before the brachial plexus which is a group of five 12 A. Yes. 12 nerves, this big one coming out of the side of the 13 Q. And what did that history reveal? 13 neck and then the nerves intertwine lake a railroad 14 A. She indicated to me that she had been in a 14 track switchyard sorting themselves out to 15 car accident and that she was injured in the car 15 ultimately become different nerves in the arms such 16 accident. 16 as the one I mentioned before, the ulnar nerve. So 17 Q. Okay. And you did an examination as well? 17 when this area was examined, which is to say the 18 A. Yes, yes. 18 area of her brachial plexus, she had a scar that was 19 Q. Tell us about your examination and 19 healed from her previous surgery; she was tender in 20 findings, Doctor. 20 the region where this group of nerves criss-cross 21 A. Now, when she came to see me, she had on 21 beneath a certain muscle, which has a name, called 4 (Pages 13 to 16) Page 17 Page 19 1 the anterior scalene muscle. And then that would be 1 back of the finger; for example, the radial nerve, 2 everything I wrote about my physical examination of 2 different nerves that come out of a railroad track 3 her. 3 switchboard. So we used measurements of the 4 Q. On page three of your report, Doctor, the 4 cutaneous pressure threshold, or whether someone 5 last full paragraph you talk about some, the phrase 5 could tell whether one thing is touching them or 6 you used is neurosensory testing that was done on 6 whether two things are touching them. For example, 7 her. 7 in order for a woman to put in her earrings or for a 8 A. Yes. 8 man to button the button on his shirt, you need to 9 Q. Can you tell us what is involved with that 9 be able to tell two things are touching fairly close 10 and what you found? 10 together to know what's in your fingers; and if not 11 A. Yes. Neurosensory testing is in 11 you can't tell it's in your fingers and it slips 12 distinction to electrical testing. Electrical 12 out. While neurosensory testing is subjective, 13 testing, you take a part of the person's body and 13 there are certain patterns that fit with nerve 14 you put electrical energy in with a needle stick or 14 injury or nerve compression, and so we could tell 15 an electric shock and you record from another area. 15 whether the person is actually telling the truth or 16 And the person can be totally asleep when that's 16 malingering. Electrical testing is said to be 17 done, and you get a measurement of how fast 17 objective. And in this sense, neurosensory testing, 18 electricity travels down the nerve. That subjective 18 though subjective, lets us know whether the patient 19 testing means the patient can be asleep and you 19 is trying hard to give a correct answer, whether the 20 still get an answer. The problem with electrical 20 testing was done properly. And so neurosensory 21 testing is very often the nerve has to be badly 21 testing in this particular problem, we do it with Page 18 Page 20 1 damaged before it shows there's an abnormality. 1 the hands at rest. And so I mention the nerve at 2 Because the way its set up, the recording device 2 her elbow, that goes to the little finger. It also 3 picks up the fastest speed of a car. So if you can 3 goes to the back of the hand. So we measure the 4 imagine someone in an overhead helicopter trying to 4 little finger, the back of the hand, which can 5 tell what's happening in the morning traffic report 5 represent a problem at the elbow; it also can 6 and they're only allowed to tell you what's 6 represent a problem in one of the parts of this 7 happening in the fast lane, so they might say 7 railroad track crossyard called the lower trunk of 8 traffic is moving great at 60 miles an hour and 8 the brachial plexus. We measure sensation in the 9 there can be a crash in the slow lane, that they're 9 index finger in the back of the hand. This can 10 not allowed to report. In contrast to that, 10 represent C6 for cervical disk; it can represent the 11 neurosensory testing, which is the test you asked me 11 carpal tunnel. If just this is involved, it can 12 about, does something to the person's hand and the 12 mean the radial nerve and if both of these are 13 person has to be awake and answer what they think 13 involved it also can mean the upper trunk of the 14 has happened to them; it can be vibration; it can be 14 brachial plexus. And so we do these measurements at 15 a hot or cold or in the case of Ms. Hearn used 15 rest, and if they're abnormal at rest, it gives us 16 pressure testing. Pressure threshold testing is 16 information. And then the people, for example, that 17 more important in terms of identifying the 17 have carpal tunnel syndrome, if the hand falls over 18 particular nerve. When vibration is used, an entire 18 like this, for example, when you're sleeping, the 19 finger moves and you don't know whether its a 19 nerve gets pressed and you wake up, that's a stress 20 problem with the nerve to the front of the finger, 20 test. The brachial plexus, we have the person hold 21 for example, the median nerve, or a problem to the 21 L their arm up. This takes the nerves that go under 5 (Pages 17 to 20) Page 21 Page 23 1 the collarbone, puts them under stress and we repeat 1 neurosensory, which has a lot of numbers and most 2 the test. And if there's a problem related to the 2 people have trouble interpreting them. The 3 brachial plexus, we see worsening of the 3 electrical testing has lots of numbers and usually 4 measurements that were found at rest. I'm sorry. 4 observe the neurologist who does the testing 5 That's a long explanation but it's a... 5 understands how to interpret them and gives an 6 Q. That's okay, I appreciate it? 6 interpretative report, and in her case he 7 A. Complicated and there isn't a simple way 7 interpreted the report as being normal for the ulnar 8 to really answer it. 8 nerve at her elbow. However, there are standard 9 Q. What were the results, Doctor, of your 9 criteria for what is normal. And in my view of the 10 neurosensory testing on Ms. Hearn? 10 numbers that he reported, the ulnar nerve at the 11 A. The neurosensory testing on Ms. Hearn 11 elbow was not normal. For example, if you had been 12 demonstrated extremely poor function for the nerves 12 given a traffic ticket for speeding above the speed 13 in her left hand compared to her right hand. Her 13 limit, there's a speed limit, and for nerve problems 14 right hand also was not normal. And the 14 it's going too slow as opposed to too fast. And her 15 measurements got worse when she held her hand up 15 speed for the ulnar nerve, her elbow was 50. Normal 16 over her head, and this testing was consistent with 16 was 49. If the room had been one degree warmer, for 17 our findings of an ulnar nerve entrapment at her 17 example, one temperature degree changes the speed of 18 elbow as well as brachial plexus compression on the 18 the nerve. So her nerve was almost exactly at the 19 left side. She previously had brachial plexus 19 limit for being too slow. But above that, it was 20 surgery, and so this fits with continued or 20 about 60 miles per hour. And the accepted 21 persistent brachial plexus problems. 21 difference between here and here should be ten and Page 22 Page 24 1 Q. Okay. And were you able to tell with your 1 she was about eight, a little more than eight. So 2 neurosensory testing, Doctor, whether Ms. Hearn was 2 she was right at the border for being say given a 3 telling the truth when she reported the symptoms? 3 traffic ticket for speeding. Although according to 4 A. Yes. 4 the numbers published, in their normative data I can 5 Q. And she was? 5 appreciate that he interpreted it as being normal. 6 A. Yes. 6 So for me, her electrical testing also fit with my 7 Q. Were you able to tell whether she was 7 testing and physical exam if there's a problem at 8 providing maximum effort during the test? 8 her elbow. 9 A. Yes. 9 Q. Okay. Doctor, you mentioned the surgery 10 Q. And was she? 10 that Ms. Hearn had... 11 A. Yes. 11 A. Yes. 12 Q. You mentioned before, electrical testing. 12 Q. ...on her brachial plexus. 13 1 know that you did not perform any on Ms. Hearn? 13 A. Yes. 14 A. Yes. 14 Q. Can you -- is that a major surgery? 15 Q. But did you review any results of 15 A. Yes. 16 electrical testing? 16 Q. Can you tell us about, number one, why is 17 A. Yes. 17 is it a major surgery? And take us through the 18 Q. And what did your review of those tests 18 process of what was done in that surgery in Ms. 19 show? 19 Heads case. 20 A. She had electrical testing done and the 20 A. Okay. The appropriate name for what 21 results similar to the test I mentioned for 21 Ms. Hearn had, brachial plexus surgery, it's like 6 (Pages 21 to 24) Page 25 Page 27 1 saying you watch the baseball game. And that could 1 the lower trunk. Ms. Hearn was found to have an 2 mean almost anything. And so, for example, I just 2 extra muscle that was compressing the lower trunk 3 came back from a trip to China teaching. In China 3 against the first rib and that extra muscle, which 4 they do lots of brachial plexus surgery; the people 4 occurs in about 20 percent of people, it wasn't 5 ride bicycles and motorcycles and are hit and the 5 caused by her accident but she happened to have 6 nerves are torn out of their neck. That's brachial 6 that, that extra muscle was removed. It's major 7 plexus surgery where the arm is completely paralyzed 7 surgery. I think any surgery you have on your body 8 and you have to re-hook up transfer nerves. That 8 is major surgery, but this is particularly major 9 was not Ms. Hearn's problem. Ms. Hearn had a 9 surgery in the sense that the main blood vessel to 10 problem similar to carpal tunnel syndrome which is a 10 your arm is here and you're operating just a little 11 compression of a nerve. She had compression of her 11 bit above this covering of the lung, so you can have 12 brachial plexus. This is officially the thoracic 12 very dangerous bleeding; you can have your lung 13 inlet; you have a chest which is your thorax. This 13 collapse and injury to any of these major nerves 14 is the entrance to the chest. In 1956 the misnomer 14 which can make your arm worse related to the 15 came out that this was thoracic outlet syndrome. 15 surgery. So it's very difficult surgery and very 16 The correct name is brachial plexus compression of 16 few people in the United States do it. 17 the thoracic inlet, and so the surgery Ms. Hearn had 17 Q. Do you have an opinion as to whether that 18 was to decompress the brachial plexus. And around 18 surgery was appropriate in Ms. Hearn's case, Doctor? 19 1950 around, or 1960 a thoracic surgeon in Denver, 19 A. Yes, I do. 20 Colorado, name David Rouse, began to go through a 20 Q. And what is that opinion? 21 person's armpit and remove their first rib in the 21 A. That surgery was appropriate. , Page 26 Page 28 1 belief that the brachial plexus is compressed 1 Q. Doctor, do you have an opinion as to 2 between the clavicle and the first rib, but in fact 2 whether Ms. Hearn was injured in this motor vehicle 3 the blood vessels to the arm go between the clavicle 3 accident on December 12, 2006? 4 and the first rib, but the brachial plexus really 4 A. Yes, I do. 5 goes between the clavicle and the second rib. So in 5 Q. And can you summarize for us, Doctor, what 6 the absence of the chest X ray showing a problem 6 injuries you believe she suffered in this accident? 7 with the rib and Ms. Hearn had an appropriate 7 A. I believe that her elbow was injured in 8 imaging of her chest and did not have an extra rib 8 the accident and that her brachial plexus was 9 in her neck, Ms. Heam did not need to have her rib 9 injured in that accident and that the 10 removed, and so the approach taken to operate on her 10 supraclavicular nerve, which is the nerve to this 11 was an operation through the side of her neck here, 11 skin, which doesn't come from the brachial plexus, 12 in this location as I'm showing, and then everything 12 it comes just above that, in what is called the 13 that can cause pressure on the brachial plexus needs 13 cervical plexus, that nerve to the skin was injured 14 to be removed and the primary structure pressing on 14 with pressure against the bone when her body hit the 15 the brachial plexus that's torn in a whiplash type 15 steering wheel. 16 of injury that occurs in a car accident, is a muscle 16 Q. And what is your, what is your prognosis 17 called the anterior scalene, that I mentioned 17 for her, Doctor? 18 before. And in Ms. Heam's surgery, that muscle was 18 A. I don't think I can answer the question as 19 identified and released, not removed. It was 19 asked. 20 divided. And then scar tissue was found around 20 Q. What treatment options do you think she 21 these major trunks, primarily the middle trunk and 21 has available to her at this time? 7 (Pages 25 to 28) Page 29 Page 31 1 A. The indicated treatment for damage to the 1 include the anesthesia cost, which would be about 2 supraclavicular nerve which goes to this piece of 2 two hours of anesthesia, might be about $1500. And 3 skin is to remove that nerve and take the live end 3 I don't know what the surgery center fees for that 4 of the nerve and implant it into a muscle so it 4 are. 5 doesn't grow back. That's a non-critical nerve. 5 Q. And would that be in-patient? 6 The ulnar nerve at the elbow which controls most of 6 A. Now I'm doing this for people that are 7 your grip strength, the ability to control the 7 appropriately thin; I'm doing this in a surgery 8 coordination of your fingers, including your pinch 8 center. So that would cost less than doing it with 9 strength, and the feeling in these two fingers, 9 an overnight stay in the hospital. I think that 10 needs to be taken out of the bony tunnel which it is 10 she's appropriately slim that I can operate up here 11 stuck and compressed and moved to the front of her 11 without her needing to be done in an operating room 12 elbow where it won't be compressed any more. That's 12 in a hospital. 13 a neurolysis of the ulnar nerve at the elbow and 13 Q. But the cost would still be 35,000? 14 placed it beneath the muscle which is a submuscular 14 A. Yes. 15 transposition. The final part is she needs the 15 Q. Plus the anesthesia? 16 brachial plexus re-done. In the approach that 1 16 A. Yes. And yeah, and the surgery center 17 use, it's perfectly appropriate to divide the skin 17 costs, which I don't know what that would be. 18 and the muscle, but Ms. Hearn didn't get better, and 18 Q. Any estimate on that? 19 the portion of the muscle is still stuck to her 19 A. No, I don't -- I don't really know what 20 brachial plexus. And what I do, I actually remove a 20 they charge. I know they charge less than a 21 large portion of the anterior scalene muscle and 21 hospital but I couldn't give you a number on what Page 30 Page 32 1 allow the patient to begin to move after that by 1 that would be. 2 shrugging her shoulders and turning her head so the 2 Q. And the nerve in the chest area? 3 plexus can glide through this area. 3 A. The professional fee for the 4 Q. It's your opinion, Doctor, that she needs 4 supraclavicular nerve, identifying the nerve, 5 three additional surgeries? 5 resetting the nerve and implanting into muscle, I 6 A. Three separate, as I described it, they're 6 put that down at $7500. 7 three separate things, the supraclavicular nerve can 7 Q. And the ulnar nerve procedure? 8 be operated on at the same time as the brachial 8 A. The ulnar nerve procedure at the elbow I 9 plexus; that would one operation. And sometimes if 9 have listed in here as $18,000. 10 you do this, the lower trunk gets better, this calms 10 Q. And is that an open surgery or would that 11 down, I don't think it will because this nerve is 11 be arthroscopic? 12 badly stuck at her elbow, so I think between maybe 12 A. It's open. 13 six weeks and 12 weeks after this operation she 13 Q. So there would be a scar from that 14 should have the operation to operate on her ulnar 14 surgery? 15 nerve at her elbow. 15 A. Yes. 16 Q. Let's talk about each of those procedures 16 Q. With regard to the brachial plexus 17 in terms of dollars. What kind of costs are we 17 surgery, would you go in through the same scar that 18 looking at for her surgery, a repeat surgery on the 18 she has? 19 brachial plexus area that you had talked about? 19 A. Yes. 2 0 A. In my letter I outlined that cost to be 2 0 Q. And would you be able to access the nerve 21 $35,000. That's the professional fee. It would not 21 to the chest in that area? 8 (Pages 29 to 32) Page 33 Page 35 1 A. Yes. 1 mind sharing that with the audience. And you can't 2 Q. What, in your opinion, Doctor, does the 2 tell whether I'm still having pain or not. So pain, 3 future hold for Ms. Hearn in terms of her symptoms? 3 some people express it more easily or show it and 4 A. I thinks if she has these operations it 4 some people are very good at not showing it. We see 5 has very good hope for her. Probably 95 percent 5 football players all the time and they're banged up. 6 chance of getting rid of the pain in this skin area 6 So what happens when you try to examine Ms. Hearn, 7 that she doesn't like when the correct nerve is 7 who looks like she's not in pain, she suddenly has 8 removed. The surgery that we do here in my last 8 this reaction to being touched and examined and 9 publication in the Journal of Bone and Joint Surgery 9 crying which makes you think that it's fake. But 10 out of 600 of these without one person going back 10 the measurements we took and where she's tender, 11 for surgery, so she should have I'd say 80 percent 11 which is appropriate for the nerves that I have 12 chance of getting strength and coordination back in 12 mentioned, fit together appropriately so that I do 13 her hand and less discomfort in the little and ring 13 not believe this she was malingering. 14 fingers. The success rate for re-do brachial plexus 14 Q. Doctor, you have given us many of your 15 surgery is seventy-fie percent relief of discomfort 15 opinions here today and we appreciate that. Have 16 in the shoulder and neck and side of her face. 16 the opinions that you have given us all been 17 Q. Now, when you said success rates, Doctor 17 provided to a reasonable degree of medical 18 can she, even if her particular surgery is 18 certainty? 19 successful, can she expect to have any symptoms 19 A. Yes. 20 moving forward? 20 MR. CROSBY: Those are all my questions. 21 A. I gave you the probabilities, so if 21 CROSS-EXAMINATION Page 34 Page 36 1 somebody has a 75 percent chance of having a good to 1 BY MR. SHIPMAN: 2 excellent result, they have a 25 percent chance of 2 Q. Good morning, Doctor. My name is jeff 3 still having symptoms in that area. 3 Shipman. 4 Q. Doctor, in your opinion, was there any 4 A. Good morning. 5 indication during your examination and in your 5 Q. Looking at your report, Doctor, on page 6 review of these records that there was any 6 No. 2, you state that the patient indicates that on 7 malingering going on Ms. Hearn's part? 7 a scale of one to ten, her present pain is 15. And 8 A. No. 8 it used to be 20, period. And then you go on to 9 Q. Okay. Can you tell us what malingering 9 state that clearly this is an exaggeration. Did I 10 is? 10 read that correctly? 11 A. Malingering -- let's see, a simple way of 11 A. Yes, you read that perfectly. 12 saying malingering might be exaggeration or over- 12 Q. And when you use the word exaggeration, 13 expression of things hurting or being painful that 13 can you explain that for us? 14 are actually not painful. And I tried to indicate 14 A. Yes. I think scientists and doctors and 15 by how she appeared that she -- if you just look at 15 people used to dealing with patients and pain 16 her, she spends a lot of the time with her grooming, 16 understand that a visual analogue scale from one to 17 shall we say, her hair is done, her makeup's done; 17 ten means a certain thing. And the way its 18 she looks happy. So if you look at her, you can't 18 supposed to be done is you're supposed to show a 19 tell if somebody's in pain. I mean, you can look at 19 patient a ruler or a line and say mark from here to 20 me, you can't tell if I'm in pain. As a matter of 20 here where your pain is. And so if somebody gives 21 fact, I passed a kidney stone a while ago. I don't 21 you an exact border and says somewhere along here 9 (Pages 33 to 36) Page 37 Page 39 1 draw in your line, they have a better idea of what 1 otherwise a supraclavicular nerve injury is a pretty 2 you mean. Some people don't really understand. 2 rare problem. 3 They just think the pain is as bad as it can be for 3 Q. So there's an impact, there's some impact 4 them, which is by definition a ten, but they don't 4 to this area of the body that you're identifying. 5 really understand the science behind the visual 5 A. Yes. 6 analogue scale level. And if you ask them, which is 6 Q. So if this this area is impacted by 7 what I did, you know, if you ask them, they'll 7 something other than a motor vehicle accident, a 8 sometimes say it's 12, it's as bad as it can be; or 8 strike to this area, a hard strike to this area of 9 ten isn't it a big enough number to tell you how 9 the body, can that cause that injury? 10 much pain I'm in. And in that way it's technically 10 A. Hypothetically, yes, anything that could 11 an exaggeration because the scale only goes from one 11 strike this very hard, they could push the nerve 12 to ten, but goes to the limitation of their 12 against the bone or stretch the nerve against the 13 understanding of the question you're asking them. 13 bone, could cause that injury. 14 Q. But you explained her pain indication was 14 Q. Okay. How about the other areas of the 15 an exaggeration to you? 15 body that you identified, the elbow and... 16 A. It was an exaggeration of the visual 16 A. The ulnar nerve at the elbow can happen 17 analogue scale level from one to ten. 17 from, if you accept the concept of repetitive 18 Q. Now, Doctor, you have been in practice for 18 injury, such as this gentleman typing away with his 19 a number of years dealing with the area of plastic 19 elbow bent, lots of times spent on computer, just 20 surgery and peripheral nerve surgery, hand surgery 20 long-term compression can do that. A fall on the 21 areas. I imagine that you have seen a number of 21 elbow can do it. A broken elbow from some other Page 38 Page 40 1 different causes of this type of injury; have you 1 reason, usually that happens from a fall, direct 2 not? 2 injury to the elbow area can cause that. The 3 A. Yes. 3 brachial plexus, some people are born with an extra 4 Q. Can you identify or list for us some of 4 rib, as I mentioned before, that can cause this 5 those, some of your experiences, what other causes 5 problem without an injury. There are people who 6 or what types of injuries to people that can cause 6 work with their hands overhead all the time such as 7 this type of an injury? 7 painters where the nerve is continually pulled and 8 A. Which type of injury are you referring to? 8 stretched, that have this problem. But people that 9 Her elbow or her neck or... 9 have direct, where something falls and hits them in 10 Q. The injuries that you have identified to 10 this area, I think aside from the bicycle and 11 Ms. Hearn, what other causes can there be for those, 11 motorcycle accidents we mentioned before where the 12 that you have seen, with your experience? 12 body goes one way and the arm goes another way, the 13 A. The only time I've ever seen the 13 most common cause for brachial plexus compression in 14 intra-clavicular nerve involved is in motor vehicle 14 the United States are motor vehicle accidents. 15 accidents where the seat belt crosses directly over 15 Q. Now, you've testified that Ms. Hearn has 16 this nerve or they have direct impact from a 16 these procedures that you described; you feel that 17 steering wheel or an air bag. So that's the 17 she would have a very good outcome in the 18 supraclavicular nerve. It can be directly injured 18 percentages you gave, 75. 80, 90 percent success 19 in surgery. We see the orthopedic surgeon working 19 from those surgeries; is that true? 20 on shoulder problems, they will often injure this 20 A. Yes. 21 nerve when they try to operate on a shoulder. But 21 MR. SHIPMAN: Thank you, Doctor. Those 10 (Pages 37 to 40) Page 41 Page 43 1 are all the questions I have. 1 A. I don't think I saw this one. 2 THE WITNESS: Thank you, Mr. Shipman. 2 Q. Okay. Is it fair to say that that's an 3 RE-DIRECT EXAMINATION 3 emergency room record from the Hershey Medical 4 BY MR. CROSBY: 4 Center? 5 Q. Just a couple of follow-up questions, 5 A. Yes. 6 Doctor. Did Mr. Shipman provide you with Ms. 6 Q. And what's the date of that record? 7 Hearn's medical records from before this car 7 A. December 12, 2006. 8 accident. 8 Q. And included in that record is a history 9 A. No, I reviewed that actually this morning 9 portion that outlines Ms. Heam's complaints at that 10 because I thought somebody would ask me. I have 10 time? 11 records only -- these are the records and it says 11 A. Yes. 12 2008 on them, and I went through here and it did not 12 Q. And it looks like she reported hitting her 13 have other records to review prior to her 13 chest on the steering wheel of her vehicle in this 14 accident... 14 accident? 15 Q. Okay. 15 A. Yes, and I learned that from Dr. Harbaugh, 16 A. ...in the car. 16 the neurosurgeon's history, physical, not from 17 Q. And if Ms. Heart's medical records from 17 reading this. 18 before this accident did not show any indication of 18 Q. But I think you testified earlier that 19 any prior symptoms or problems with her left 19 that's consistent with your findings, correct? 20 shoulder, left elbow, left hand, would that be 2 0 A. Yes. 21 important? 21 Q. Okay. And she complained at that time of Page 42 Page 44 1 A. Yes. 1 pain across her left shoulder, worsened with 2 Q. Okay. How so? 2 movement into the left trapezius region? 3 A. It speaks to causation. In other words, 3 A. Yes. 4 somebody could have similar symptoms before a car 4 Q. Is that consistent with the opinions you 5 accident and then have the accident and have the 5 have provided here today? 6 symptoms be aggravated by the motor vehicle 6 A. Yes. 7 accident, and so in that case you have two causes; 7 (Whereupon, Deposition Exhibit 8 one makes the original kind of problem worse. But 8 No. 7 was marked for 9 if they don't have symptoms before and they have an 9 identification.) # 10 accident mechanism of which fits with the symptoms, 10 Q. (By Mr. Crosby) Let me also show you a 11 then that permits you to say within a reasonable 11 document, what we have marked as Plaintiff's Exhibit 12 degree of medical certainty that that accident was 12 No. 7, and this I'll represent to you is a record 13 the cause of those problems. 13 from Ms. Hearn's family physician. Have you t 14 (Whereupon, Deposition Exhibit 14 reviewed that record or was that provided to you by } 15 No. 6 was marked for 15 Mr. Shipman? 16 identification.) 16 A. No, I do not believe it was. 17 Q. (By Mr. Crosby) Let me show you, Doctor, 17 Q. Okay. What is the date of that record? 18 what we have mark as Plaintiff's Exhibit No. 6. And 18 A. December 22nd, 2006. 19 I'll represent to you that that's -- well, is that 19 Q. Ten days after the accident? 20 one of the records you were provided in this case 20 A. Yes. 21 from -- it looks like from the date of the accident? 21 Q. And they took a history from Ms. Hearn at 11 (Pages 41 to 44) Page 45 1 that time as well. correct? 2 A. Yes. 3 Q. And she reported still having difficulty 4 using her left arm? 5 A. Yes. 6 Q. Swelling into the left fingers and 7 tingling at times? 8 A. Yes. 9 Q. Again, are those symptoms consistent with 10 your findings and the opinions you have given to us 11 today? 12 A. Yes. 13 MR. CROSBY: Those are all my questions. 14 Thank you, Doctor. 15 THE VIDEOGRAPHER: This deposition is 16 concluded September 12, 2012, at approximately 17 11:05 A M. Off the record. 18 (Whereupon, the deposition 19 concluded at 11:05 A.M.) 20 --- 21 Page 46 1 CERTIFICATION OF NOTARY 2 I, Brian M. McDonald, the officer before whom the 3 foregoing deposition was taken, do hereby certify 4 that the witness whose testimony appears in the 5 foregoing deposition was duly sworn by me; that the 6 testimony of said witness was taken by me; that the 7 testimony of said witness was taken by me 8 stenographically and thereafter reduced to 9 typewriting by me; that said deposition is a true 10 record of the testimony given by said witness; that 11 I am neither counsel for, related to, or employed by 12 any of the parties to the action in which this 13 deposition is taken and further, that I am not a 14 relative or employee of any attorney or counsel 15 employed by the parties thereto, nor financially or 16 otherwise interested in the outcome of this action. 17 18 19 Brian M. McDonald 20 Notary Public - State of Maryland 21 My Commission Expires: October 29, 2012 12 (Pages 4b to 4b) Aug. 3. 2012 7:17AM first choice linglestown f?+lli??' Choi . e"Oft d•?orlt+ee rAelob, FUNCTION CAPACITY EVALUATION NAME: Jadde M. Hearn EMPLOYER: Unemployed DATE OF INJURY: 12112/2006 DATE OF EVALUATION: 811/2012 DATE OF REPORT 81112012 I.D. NO.: WA REFERRED BY: Matlhew Crosby. Esquire PHYSICIAN: WA INSURANCE CARRIER; WA INSURANCE REP: WA INSURANCE I.D. NO.: WA DATE OF BIRTH: 08/1811977 SID(: FEMALE No. 7682 P. 2 i1: BRACHIAL PLEXUS INJURY L ILY VITAL SIGNS HEIGHT: 65 hopes WEIGHT- 152 lbs. HAND DOMINANCE. RIGHT RESTING HEART RATE: 78 bpm RESTING BLOOD PRESSURE: 114/68 (A/P) mmHg STARTING TIME: 8/1/201213:00:48 ENDING TIME: 8/11201216,30:55 PURPOSE OF ASSESSMENT- FCE Type: Liability, Determine physical and functional capability S The results of this evaluation indicate that Jackie M. Hearn demonstrated an ability to function In the Sedentary Physical Demand Level (Use of right upper extremity only) according to the U.S. Department of Labor Standards for an 8 hour work day. Ms. Hearn is presently not working. Activities Involving the left upper extremity are not recommended at this time due to weakness, lack of protective seneation and numbness in the left hand, and lack of active range of motion and reaching abfiity.. Ms. Hearn presented with poor left hand coordination and an impaired ability to manipulate objects. Jackie M. Hearn demonstrated the ability to occasionally lift up to 10 lbs. floor to waist (right arm only), 10 lbs. waist to shoulder (right arm only), carry up to 10 lbs. (right arm only), push 36 lbs. of force, and pull 46.4 lbs. of force. Please note that the majority of push and pull force measures were generated from the right upper extremity and only 8 lbs. on the left upper extremity. She did not demonstrate a competitive ability to reach, handle or manipulate objects using the left upper extremity. She did not tolerate any repetitive left upper extremity reaching. Thee were no deficits with the right upper extremity reaching ability.. Deficits identified during testing include deceased cervical, left shoulder and elbow active range of motion, decreased left shoulder, elbow, wrist and hand strength, impaired left hand coordination and manipulation ability and impaired ability to reach forward with the left arm. She was unable to reach overhead with the left upper extremity. Left hand grip and pinch strength were significantly below the normative range for her age. Left hand grip strength was 7.9 lbs. (normative rage - 54.6 lbs. IA 78.0 lbs.) end right hand grip strength was 55 lbs. (normative range was 63.3 lbs. to 64.9 ibs.). Left hand key pinch was 4.9 lbs. and right hand key pinch was 13 lbs. Left hand ky pinch was well below the normative range (Norm: left hand 12 lbs. to 26 lbs. and right hand 13 to 25 Ibs.). Sensation was significantly Impaired throughout the left palm and hand. Ms. Hearn demonstrated a loss of protective sensation in the long, ring and small digits of the left hand and diminished light touch in the left thumb and left index finger. Jackie M. Hearn demonstrated consistent performance throughout testing. Her test performance was consistent for 22 of 22 performance consistency tests. This, In combination with physiological responses (heart rats and respiratory rate), movement and muscle reenuiiment patterns both aware and unaware of observation, indicates that the results of this evaluation can be considered to be an accurate representation of her functional abilities. PHYSICAL DEMAND LEVEL SEDENTARY Thank you for referring Jackie M. Hearn to First Choice. If you have any further questions regarding this evaluation, please do not hesitate to contact us, Professionally, "044, -D Evaluator David Raptash, MA, OTR/L Title: Regional Director of VUorkStraregies / OC-002851-L Date: 811/2012 L,ingles own, 40331 INGLEMWN ROAD HARRISLIURG, P.S. 17112; Clinic srPhona N ; (71;9 920-50'12; CIA icls* N , (717) 020-5224 fFCG-156S71 ASSESSMENT OF EMPLOYMENT POTENTIAL: JACQUELINE M. HEARN Prepared by John S. Risser, MA, ABVE, CRC Diplomate, American Board of Vocational Experts Rehabilitation Economist OFFICE 5062 Ridge Road Elizabethtown, PA 17022 PHONE 717-579-2437 FAX 717-367-5727 EMAIL jsrridgewood@embarqmail.com Er JSR Vocational & Consulting Services 5062 Ridge Road Elizabethtown, PA 17022 Mobile (717) 579-2437 0 Fax (717) 367-5727 August 31, 2012 Matthew S. Crosby, Esq. Handler, Henning & Rosenberg, LLP 1300 Linglestown Road, Suite 2 Harrisburg, PA 17110 RE: Name: Jacqueline M. Hearn Date of Injury: 12/12/06 Our File: 15816 JACOUELINE M. HEARN: ASSESSMENT OF EMPLOYMENT POTENTIAL Jacqueline M. Hearn, who is 35.04 years of age (DOB: 8/18/77), was interviewed on 8/22/12 in the Harrisburg, PA office of her attorney, Matthew S. Crosby, Esq. The purpose of my evaluation of Ms. Hearn was to determine what effect, if any, the injuries she sustained on 12/12/06 have had on her potential for engaging in work-related activities, providing her with financial remuneration and wage earning capacity. Ms. Hearn, a 5' 5", 160-pound (representing a post-accident gain of 20 pounds), right-hand dominant female, was pleasant and cooperative during our 1-hour and 45-minute meeting, answering all questions posed to her by attempting to provide complete responses in an apparently open and straightforward manner. After initially meeting Ms. Hearn she was advised by this evaluator that this assessment was being carried out at her lawyer's request and would be conducted for court purposes only. Ms. Heam was also informed that under the circumstances of the referral, she would not be a recipient of this office's vocational rehabilitation services, and no counselor-client relationship would be intended or implied by the evaluation process. Finally, in the way of introduction, she was told that the traditional confidentiality privileges were being waived, as any of the information gathered or reviewed might be made discoverable in the context of her lawsuit. Ms. Hearn verbally acknowledged her understanding of these preliminaries and agreed to continue. METHODOLOGY & REFERENCES: Support for the procedures, methods and data sources used in this assessment of employment potential and wage earning capacity/earning power is found in the following references: • Toppino, David and Dawn Boyd. "Wage Loss Analysis: Vocational Expert Foundation and Methodology," Journal of Legal Economics, July 1993, pp. 69-79. • Rodgers, James D. & Thornton, Robert J. "Making Operational The Concept Of Maintenance Consumption," Journal of Legal Economics, Spring 1998. • Deutsch, Paul M. & Sawyer, Horace W. (Revised 2003). A Guide to Rehabilitation. Ahab Press, White Plains, NY. Jacqueline M. Hearn -2- Assessment of Employment Potential Our File: 15816 August 31, 2012 • Field, J.E. & Field, T.E. (2004). The Transitional Classification of Jobs (COJ). 6th Edition. Elliott & Fitzpatrick, Athens, GA • Gamboa, A.M. & D. S. Gibson (Revised 2010). Gamboa Gibson Worklife Tables by Gender. Level of Educational Attainment and Type of Disability. Trial Guides, LLC, Portland, OR • Richards, Hugh (1999), Life and Worklife &Mg=cies. Lawyers and Judges Publishing Company, Inc. • Weathers, R, R. (May 2005). A yid to Di ift Statistics from the American Community Survey. Rehabilitation Research and Training Center on Disability Demographics and Statistics, Cornell University, Ithaca, NY. • Wittenburg, David & Nelson, Sandi. (February 2006). A Guide to Disability Statistics from the Survey of Income and Program Participation. Rehabilitation Research and Training Center on Disability Demographics and Statistics, Cornell University, Ithaca, NY. • Hale, T.W., Havghe, H.V. & McNeil, J.M. (1998). "Persons with Disabilities: Labor Market Activity, 1994". Monft Labor Review. September 1998, pp. 3-10. • Kruse, D.L., "Persons with Disabilities: Demographic Income and Health Care Characteristics, 1993". Mon lY Labor Review. September 1998, pp. 13-22. • Martin, Gerald D. and Ted Vavoulis, Determining Economic Damages. Revision 23, August 2011, James Publishing, Inc., Santa Ana, CA. • McMahon, B., Shaw, L. and Jaet, D. (1995). "An Empirical Analysis: Employment and Disability from an ADA Litigation Perspective". National Association of Rehabilitation Professionals in the Private Sector. X(1), pp. 3-14. • Orlowski, D. "Valuing the Total Compensation Package". American Rehabilitation Economics Journal. 1991, pp. 21-30. • Wright, John W. The American Almanac of Jobs and Salaries (2000-2001 Edition). Avon Books. • Bureau of Labor Statistics 2005. Occupational Employment Survey. State and National Data. www.bls.gov/oes.home.html • Bureau of Labor Statistics (March 2012). Occupational Outlook Handbook (2012-2013 Edition). Washington, DC. • Bureau of Labor Statistics. Worklife Estimates: Effects of Race and Education. February 1986. Bulletin 2254. • Economic Research Institute, Analysis of U.S. Department of Labor's Occupational Employment Statistics, 2012. Redmond, WA. • National Center for Health Statistics. National Vital Statistics Reports. 2011. Vol. 59, No. 9, U.S. Life Tables, 2007. • 0*Net, The Occupational Information Network. U.S. Department of Labor, 2000. • U.S. Bureau of Labor Statistics. Tables 1 & 3. EBplover Costs for Employee Compensation - June 2006. News Release, September 22, 2006. • U.S. Bureau of Labor Statistics. Table 1. Employer Costs for Employee Compensation - March 2005. News release, June 16, 2005. • U. S. Census Bureau. Current Population Reports, P70-131, Americans with Disabilities: 2010, Household Economic Studies. Issued July 2012 by the Economics and Statistics Administration. • U.S. Census Bureau. Disability - Work Experience and Mean Earnings in 2000 - Work Disability Status of Civilians 16 to 74 Years Old, by Educational Attainment and Sex: 2001, Revised 2/14/02, Washington, D.C. • U.S. Census Bureau. Current Population Reports, P60-209, Money Income in the United States: 1999, U.S. Government Printing Office, Washington, DC, 2000. • U.S. Census Bureau. Americans with Disabilities: 1997, Survey of Income and Program Participation, August-November 1997 data, P70-73. Jacqueline M. Hearn -3- Assessment of Employment Potential Our File: 15816 August 31, 2012 • U.S. Census Bureau (1993). "Americans with Disabilities: 1991-1992". Current Population Reports. Series P70-33. Washington, DC. • U.S. Census Bureau. "Americans with Disabilities: 1994-1995, Survey of Income and Program Participation (SIPP)". Current Population Reports. Series P70-61, August 1997, Washington, DC. • U.S. Census Bureau. "Labor Force and Other Characteristics of Persons with a Work Disability". Current Population Reps Series P-23, No. 127. Washington, DC. • U.S. Census Bureau. Statistical Abstract of the United States: 2010. (129th Edition). Washington, DC, 2009. • U.S. Chamber of Commerce (2008, 45`" Edition). Eployee Benefits Study. • U.S. Department of Labor (1991). Dictionary of Occupational Titles (Fourth Ed.), Washington, DC. • U.S. Publishing Co. (2001). Occupational Wage cRR port. Kansas City, KS: Author. • U.S. Publishing Co. (2001). Employment Statistics Quarterly. Kansas City, KS: Author. • U.S. Publishing Co. (2001). Residual Access to Employment. Kansas City, KS: Author. • Co=ensation & Working Conditions. Fall 1999. Tables A-9 through A-26. Identifying Employer Costs of Benefits as a Percent of Total Compensation. • Economic Report of the President. February 2012. Washington, DC. • )employment and Earnings (September 2010). Washington, DC: Bureau of Labor Statistics. • Complete Guide for Occupational Exploration. Third Edition (2001). JIST Publishing, Indianapolis, IN. • Monthly Labor Review. August 1999. Tables 25 & 26, Identifying Categories of Fringe Benefits. • Monthly Labor Review. April 1995. Worker displacement: a decade of change - comparative unemployment trends. • Wage and Industry Surveys (2004). Bureau of Labor Statistics (BLS) and State Divisions of Employment Security. U.S. Publishing Co.., Kansas City, KS. • Center for Workforce Information and Analysis, July 2012 Current Employment Statistics (CES) in Pennsylvania. DOCUMENTS AND RECORDS REVIEWED: • Deposition of Jacqueline M. Hearn, 1/20/11. • Functional Capacity Evaluation of Ms. Hearn performed by David Raptosh, M.A., OTR/L, 8/1/12. • Resume of Jacqueline M. Hearn. • Complaint in said matter. • Medical report of A. Lee Dellon, M.D., 11/23/11. • Medical report of Brian Holmes, M.D., 5/16/12. • Medical reports/records of the Penn State Milton S. Hershey Medical Center. • Plaintiffs Answers to Defendant's Interrogatories, 1015110. • U.S. Individual Income Tax Returns for Jacqueline M. Hearn, 2004, 2006-2009. MEDICAL INFORMATION: According to information provided, on 12/12/06, Ms. Heam sustained injuries when she was injured as a result of a motor vehicle accident (MVA). The history of Ms. Hearn's injuries and treatment (including surgery of 3/24/08; left brachial plexus exploration and neurolysis, with division of the anterior scalene muscle and division of the accessory scalene muscle) were reviewed as provided in the preparation of this Jacqueline M. Hearn -4- Assessment of Employment Potential Our File: 15816 August 31, 2012 report. Ms. Heam remains a candidate for additional surgery as indicated in the reports of examining physicians for both the defense and plaintiff. At the time of the 12/12/06 accident, Ms. Hearn stated she had been in overall good health, possessing no medical, physical, psychological or other limitations or restrictions that had a negative impact on her employability profile and ability to be fully employed as a customer service representative with Delta Dental of PA, or other jobs which she may have been qualified for, or trained for (i.e., cosmetologist), with the unrestricted ability to use her body as an occupational tool without any functional limitations. With regard to medical history, Ms. Hearn stated that she had female issues which had required that she undergo an endometrial ablation in 2006 from which she fully recovered with no resultant physical limitations or restrictions that impacted upon her employability. Ms. Heam is no longer in active treatment and will only seek additional treatment on an as needed basis in the future if/when her health circumstances demand or if she decides to avail herself of the additional treatment(s) described by either examining physician. Ms. Hearn ingests over-the-counter pain relief solutions such as Tylenol ES, 500 mg., every day, at least 1,000 mg. per day, more on those days when her pain levels in her left upper extremity are elevated and/or are radiating up into her head in order to take the "edge off my pain." When questioned regarding any residual pain she experiences as a result of her 12/12/06 accident, Ms. Hearn stated she is never completely pain free. She first described constant pain which when at its least is a "dull, aching pain in my left shoulder". She then said that with virtually any use or repetitive activity she will get "sharp, stabbing pain like it was slammed in a car door". She described her pain as typically growing worse over the course of the day and with activity, as described previously, and frequently extending up into her neck which will then go into spasm. Ms. Heam stated that she has numbness and tingling which extends down into her left hand which varies in intensity and frequency, stating there "is no rhyme or reason as to when this will occur except that repetitive use of my left arm will certainly result in numbness and tingling but there are many other times that this happens when I haven't been using my left arm." Because of these circulation issues in her left hand/arm she "gloves" her left hand at all times during cold weather when outside (about 40 degrees or less). She stated that she will only use her left arm and hand to guide and assist her non-injured right hand and arm with lifting and carrying, as she is not able to use her left upper extremity alone for any substantive lifting and carrying activities. Handling objects weighing even a nominal weight is difficult for Ms. Hearn, for example, if accepting change with her left hand or trying to pick up a coin or coins from a flat surface without dropping said coins or other objects as light as a pen or pencil. It was apparent to this disability evaluator that Ms. Hearn finds the chronic pain and numbness and tingling to be very discouraging and disheartening to her. Ms. Heam went on to describe having had her left hand "claw up and lock up" on several occasions, with her being unable to get her fingers to voluntarily "release" without using her uninjured right hand to "pull back those clawed up fingers and my left hand to a normal position." Simply put, activity will drastically increase Ms. Hearn's pain levels, with her stating, "the more I do, then the more I will hurt." Ms. Hearn stated that her pain levels are directly but not solely related to her level of activity. For example, she stated her pain levels are also related to changes in the weather, particularly to cold, damp/rainy conditions. Ms. Hearn stated her post-injury levels of pain have affected her sleep patterns. She stated she now has trouble getting to sleep at night, as she is no longer able to sleep on her left side, and once asleep, she wakes up several (3-4) times through the night with "charley horse type of pain" in her left shoulder and sometimes in her neck on the left side. She, or her significant other, will usually then rub her shoulder and neck, often taking a Tylenol, until she finds that she can fall back asleep once again. Jacqueline M. Hearn -5- Assessment of Employment Potential Our File: 15816 August 31, 2012 Ms. Hearn stated that since her accident, she has become weaker in general, and she has noticed a marked decrease in her overall strength (particularly on her left side), stamina, and endurance. She indicated that "I get upset with myself because I cannot seem to ever be able to shake this pain and do what I wanted to do with regard to getting back to my regular work or working as a cosmetologist that I trained for after the accident thinking that I would be OK again." With regard to driving, Ms. Heam now limits her driving to shorter trips locally for 10-15 minutes at a time. She stated that if she drives for more than the aforementioned period of time that her pain levels will quickly become heightened and after 15-20 minutes of driving she must get out and stretch before being able to continue driving once again. She stated that she is able to physically tolerate riding in a car (as a passenger) "much better" than when she must drive herself because she is able to move about to her tolerances to a much greater extent when she is not driving herself. A. Lee Dellon, M.D., Towson, MD, peripheral nerve surgeon, examined Ms. Hearn on 11/22/11 at the request of defense attorney Jefferson Shipman, Esq. Dr. Dellon's comprehensive narrative report of 11/23/11 expatiated upon the medical circumstances and treatment which was required by Ms. Hearn as a result of having been injured in the MVA on 12/12/06. Dr. Dellon chronicled his own diagnostic testing of Ms. Hearn and recommendations for additional surgery as follows: "Ms. Hearn had her chest hit the steering wheel and the sensation on the right side of her chest is normal but on the left side of her chest she does not hle to be touched especially in the infraclavicular region. Dr. Harbaugh mentioned in her operative note that she identified the supraclavicular nerve which was quite large and protected it. I have had patients who have pain in this area either as a complication of brachial plexus decompression or as a direct contusion either from the seat belt or from the steering wheel. Within a reasonable degree of medical certainty and probability as a direct result of the motor vehicle accident of December 12, 2006, Ms. Hearn has an injured left supraclavicular nerve. The indicated treatment is to resect this nerve, leaving the proximal end implanted into the stemocleidomastoid muscle. This would give her an area of numbness in her upper left chest, not the skin that goes to her breast, otherwise she will have this pain permanently. The procedure codes for this would be 64784 and 64787, resecting the nerve and implanting the nerve into muscle. The professional fee for doing this would be (added by this writer for correctness) $7500. Ms. Hearn is extremely tender when the brachial plexus is touched in the neck. She has a well- healed scar. Most likely the scalene muscle, which was divided, is adherent still over the upper trunk of the plexus and lower trunk of the plexus. Ms. Hearn has recurrent or persistent brachial plexus compression. The indicated treatment would be an anterior scalenectomy and repeat neurolysis of the brachial plexus. This would be procedure codes 21705 and 64713. The total professional fee for that surgery would be $35,000. That surgery is extremely difficult and would require a one-night stay in the hospital because of the risks of pulmonary collapse and bleeding. During the time she was in the office, she had extensive neurosensory testing done with her hands at rest and with her arms elevated. These demonstrated essentially normal measurements for the right upper extremity with no change between the two positions. In contrast, the left side had abnormal measurements for the little finger pulp at dorsouhnar and dorsoradial aspects and index finger pulp even at rest consistent with problems of the upper and lower trunk of the brachial plexus and also could be consistent with ulnar nerve compression at the elbow. When the hand was elevated above the head, these measurements worsened. This was also associated with profound weakness of pinch and grip on the left side. The test demonstrated the patient gave her maximum effort during the complicated evaluation/procedure." Brian Holmes, M.D., Chambersburg, PA, Chambersburg, PA, neurosurgeon, examined Ms. Hearn on 3/20/12 at the request of plaintiff attorney Matthew S. Crosby, Esq. Dr. Holmes' comprehensive narrative report of 5/16/12 set forth this physician's recommendations with regard to the surgical implantation of a cervical spinal cord stimulator and functional capacity evaluation as follows: Jacqueline M. Hearn -6- Assessment of Employment Potential Our File: 15816 August 31, 2012 "Placement of a trial cervical spinal cord stimulator has not been suggested by the treating physicians or Dr. Dellon, the 1ME physician. Cervical spinal cord stimulation may have a positive effect on reduction of pain and increase in functional capacity. Therefore, I raise this as a potential treatment option. Ms. Hearn's functional capacity is greatly limited, according to the history which she provides to me. In order to obtain a more objective measure of her functional limitations, a functional capacity evaluation (FCE) would also be reasonable. However, an FCE would not be of value if further treatment, such as a cervical spinal cord stimulator, or the procedures recommended by Dr. Dellon, is planned. In that case, an FCE would be indicated after an appropriate period of recovery." David Raptosh, M.A., OTR/L, performed a "Functional Capacity Evaluation (FCE) of Ms. Hearn on 8/1/12. I have been involved with numerous cases over the years where Mr. Raptosh has been involved and universally have found that his FCEs accurately represent the physical capabilities and limitations of the assessed individual, regardless of who or what entity has requested that the FCE of the now injured or limited parry be performed. Mr. Raptosh summarized his fourteen page report regarding Ms. Hearn with the following "SUMMARY": "The results of this evaluation indicate that Jackie M. Heam demonstrated an ability to function in the Sedentary Physical Demand Level (Use of right upper extremity only) for an 8 hour work day. Ms. Heam is presently not working. Activities involving the left upper extremity are not recommended at this time due to weakness, lack of protective sensation and numbness in the left hand, and lack of active range of motion and reaching ability. Ms. Hearn presented with poor left hand coordination and an impaired ability to manipulate objects. Jackie M. Hearn demonstrated the ability to occasionally lift up to 10 lbs. floor to waist (right arm only), 10 lbs. waist to shoulder (right arm only), carry up to 10 lbs. (right arm only), push 36 lbs. of force, and pull 46.41bs. of force. Please note that the majority of push and pull force measures were generated from the right upper extremity and only 8 lbs. on the left upper extremity. She did not demonstrate a competitive ability to reach, handle or manipulate objects using the left upper extremity. She did not tolerate any repetitive left upper extremity reaching. There were no deficits with the right upper extremity reaching ability. Deficits identified during testing include decreased cervical, left shoulder and elbow active range of motion, decreased left shoulder, elbow, wrist and hand strength, impaired left hand coordination and manipulation ability to reach forward with the left arm. She was unable to reach overhead with the left upper extremity. Left hand grip and pinch strength were significantly below the normative range for her age. Left hand grip strength was 7.9 lbs. (normative range - 54.61bs. to 78.0 lbs.) and the right hand grip strength was 55 lbs. (normative range was 63.3 lbs. to 84.91bs.). Left hand key pinch was 4.9 Is. and right hand key pinch was 13 lbs. Left hand key pinch was well below the normative range (Norm: left hand 12 lbs. to 26 lbs. and right hand 13 to 251bs). Sensation was significantly impaired throughout the left palm and hand. Ms. Hearn demonstrated a loss of protective sensation in the long, ring and small digits of the left hand and diminished light touch in the left thumb and left index finger. Jackie M. Hearn demonstrated consistent performance throughout testing. Her test performance was consistent for 22 of 22 performance consistency tests. This, in combination with physiological responses (heart rate and respiratory rate), movement and muscle recruitment patterns both aware and unaware of observation, indicates that the results of this evaluation can be considered to be an accurate representation of her functional abilities." With regard to household chores and yard work, Ms. Hearn stated that prior to her accident she was able to do everything one thinks of as being a household chore. She stated her standards of cleanliness have changed as she was a "neat freak" before being injured on 12/12/06 and that many chores and activities around the house do not get performed as frequently, or "just don't get done at all" because of her debilitated health circumstances post-accident. Ms. Hearn stated that her significant other "has had to Jacqueline M. Hearn -7- Assessment of Employment Potential Our File: 15816 August 31, 2012 pick up the slack" by performing many of the household chores for their conjugal family since her accident, including doing all of the shopping (even when Ms. Hearn will accompany him) and preponderance of "kitchen duties" for the family. She is unable to perform any labor intensive type of household work, either inside or outside, including most yard work, laundry, and cleaning that is routinely required by herself without the assistance of her significant other. With dismay she indicated that such mundane chores such as running the vacuum cleaner and scrubbing the toilets and bathtub are no longer possible for her because of the body positioning required of these activities. Ms. Hearn stated that she cannot carry the laundry basket when it is full but that if she only puts a few items in the basket she is able to carry it by using her unimpaired right hand and arm and guiding it by using her left upper extremity. Prior to her accident, Ms. Hearn stated she had enjoyed various hobbies and interests which had included bicycle riding, as well as riding the various rides at amusement parks, playing basketball, softball, and throwing and catching a football with friends and family. She finds her inability to play with her 7-year old son in the way she knows she would like to if she was not physically impaired to be one of the most devastating aspects of her compromised post-accident health circumstances. She realizes that her youngest son cannot understand why "mom can't really play with me" the way that he would like her to and used the example of throwing/catching a football or baseball as specific activities that he has recently asked her to do that she was forced to decline doing with this youngster. Ms. Hearn is saddened that virtually all of the hobbies and recreational activities which she enjoyed individually, and with her friends and family, are now unable to be performed by her at pre-injury levels, if at all, as a result of her negative health circumstances post-accident as movements of her body exacerbate her left upper extremity pain even if the activity does not directly involve the usage of her left arm, i.e., the bouncing and vibrations involved with riding the more aggressive adult rides at amusement parks Overall, Ms. Hearn's current negative health circumstances, residual physical limitations, pain and adverse symptomatology resultant from her 12/12/06 injuries represent significantly compromised levels of functioning for her. As such, Ms. Heam is to be commended for her diligent efforts to rehabilitate herself to the level she has attained and maintained subsequent to the aforementioned accident. FAMILY BACKGROUND: Ms. Hearn was born in Harrisburg, PA. She and her family have lived at their present location since 2002. Ms. Hearn has been married once, having married on 8/12/2000. She and her husband separated approximately six months after marrying, with a divorce never being finalized up to the present time. She and her husband had two children, a son and a daughter, while Ms. Heam has a third child to her significant other, Mr. Michael Ford. Mr. Ford resides with her and her youngest child, a son, who is now seven years of age. Mr. Ford is employed full-time in the housekeeping and maintenance department of the Crown Plaza Hotel, Harrisburg, PA. Her daughter is a full-time college student (freshman) who attends Southern Mississippi University, Hattiesburg, MS, while her son to her husband is fifteen years of age and attends high school in Meridian, MS while living with her husband. Ms. Hearn stated she has never been convicted of a felony, is bondable, and possesses a valid Commonwealth of Pennsylvania driver's license. EDUCATIONAL BACKGRO Ms. Hearn is a high school graduate, having graduated from Susquehanna Township High School, Harrisburg, PA in 6/95, having completed the business curriculum. Following her graduation from high school Ms. Hearn did not, receive any additional specific vocational or academic training except on-the- Jacqueline M. Hearn -8- Assessment of Employment Potential Our File: 15816 August 31, 2012 job training (OJT) that was provided by employers for whom she worked. Since she found that her left shoulder/arm deficiencies prevented her from working in her prior job setting she obtained grants and a Pell loan allowing her to attend the Empire Beauty School, Harrisburg, PA, where she hoped to complete the training which would allow her to be a cosmetologist. Ms. Hearn completed the program in one year (1/11 - 1/12) that normally takes only 9 months to complete, as Ms. Hearn had considerable difficulty with the practical training involving the actual "doing of hair". Although her supervisors allowed that she only work on "selected" individuals so that she could complete the Empire Beauty School program, which she did, Ms. Hearn has never attempted to complete her PA state boards to become a licensed cosmetologist as she realizes that her left upper extremity deficiencies do not allow for this work to be performed by her in a competitive employment setting. With dismay, Ms. Hearn acknowledged that out of the $16,080 paid for this cosmetologist schooling she still owes $12,000 which must be re-paid, circumstances which are personally discouraging to her as she has received speck vocational training that she will not be able to use as a result of her accident related residuals from the 12/12/06 accident. According to the Federal Register, Ms. Hearn's educational attainment level is defined as "High school education and above," and is stated as follows: "High school education and above means abilities in reasoning, arithmetic and language skills acquired through formal school at a ffh grade level or above. We generally consider that someone with these educational abilities can do semi-skilled through skilled work." Vocational testing of Ms. Hearn was deferred based on her identifiable skills and worker traits from her educational and vocational backgrounds. VOCATIONAL HISTORY: At the time of the 12/12/06 accident, Ms. Hearn was employed full-time by Delta Dental of PA, Mechanicsburg, PA, having been hired by this company in 7/06 as a customer service representative. She treated conservatively after missing one week of work following the accident, being assigned to light duty for a period of time until undergoing surgery on 3/24/08 (described previously). Following surgery she was off work for about six months, after which she returned to work in her original position and found that the bimanual usage which was required of her left upper extremity did not allow for her to adequately type at satisfactory levels to maintain her employment, as well as short-term disability was no longer available to her, and she was "let go" in 11/08 by Delta Dental of PA. She received a full complement of fringe benefits in association with her employment with Delta Dental of PA. Her starting hourly wage was $10.50 per hour and she was earning $13.25 per hour at the time she was injured. Her ending hourly rate was $14.19 per hour, or $29,515.20 per hour if she had been physically able to work at normal productive levels at the time her employment ended with Delta Dental of PA. Ms. Hearn then secured a position as a full-time customer service representative with HealthAmerica, Harrisburg, PA, where she worked from 6/09 -1/10, earning a starting and ending hourly rate of $12.95. Her job allowed her to wear a head-set as she answered inbound calls from provider offices and insurance holders verifying insurance coverage (enrollment status), and the status of any processed or incomplete claims as well as assisting providers and clients with answers with regard to coverage of benefits issues. This job required considerable bi-manual typing skills that could not be met satisfactorily with her post- injury/surgery deficits (15 words per minute with errors), with the result being that she was laid-off at the beginning of 1/10. For this employment she only received the mandatory fringe benefits of her employer's contribution to her future Social Security and Medicare that are mandated by statute. Her W- 2 Wage and Tax Statement show that she earned $14,297.00 in 2009 working for this employer (HealthAmerica), which was a subsidiary of Coventry Healthcare, Inc. Jacqueline M. Hearn -9- Assessment of Employment Potential Our File: 15816 August 31, 2012 For five months (4/10 - 8/10) Ms. Hearn was employed by Spherion Staffing Services in a part-time temporary assignment, working at Select Medical Corporation, Mechanicsburg, PA as a customer service representative up to 30 - 40 hours per week. Ms. Hearn was required to contact insurance companies in attempts to obtain revenue for claims that had not been paid or processed, while also maintaining a position in the Medicare/Medicaid department as she was responsible for billing claims and processing any failed claims. Considerable typing caused her difficulty and she was not retained (by Spherion Staffing Services) or hired (by Select Medical Corporation) after working for the aforementioned five months at an hourly wage of $9.50 per hour because of her limited post-accident/surgery WPM of 15 (when compared to her pre-injury rate which approached 70 WPM). Again, Ms. Hearn only received the mandatory fringe benefits of her employer's contribution to her future Social Security and Medicare that are mandated by statute while working under the auspices of Spherion Staffing Services. Earlier work experiences for Ms. Hearn involved her having been employed by Tyco Electronics, Middletown, PA from 8/05 - 7/06 in customer service and as an expediter. Ms. Hearn was responsible for order entry, order management, billing and invoicing for material only orders. Her job required that she interface daily with customers, as well as being involved with sales, master scheduling, material planning and other internal operations which included making adjustments to purchase orders on shipments with discrepancies. From 7/03 to 6/05, Ms. Hearn was employed full-time by M & T Bank, Harrisburg, PA as a commercial bank teller. This position required that Ms. Hearn handle large sums of money for commercial customers, shipping and receiving commercial money orders as well as handling customer service problems to a successful conclusion or provide a resolution for the bank's commercial customers and consumers. Ms. Hearn first entered the workforce after graduating from high school by accepting a temporary assignment through JFC Staffing Associates, Harrisburg, PA with Electronic Data Systems (EDS), Mechanicsburg, PA for seven months (9195 - 3/96). In her temp assignment as a customer service and sales representative she was responsible for processing inbound and outbound orders for AT & T's long distance service, toll-free service and international service. She also assisted in customer service situations and resolutions for customers connecting or disconnecting service with AT & T. After working for the aforementioned period as a temporary employee through JFC Staffing Associates she was hired directly by Electronic Data Systems (EDS), Mechanicsburg, PA as an account executive, serving in that capacity for seven years from 3/96 - 6/03. Her duties included building a customer client profile for successful completion of connectivity to AT & T local, long distance, Tl, Frame Relay and Main Frame Systems. She would attempt to provide continuous communication and support to her clients, local systems engineers, and installers through the customers' local providers. She would also act as a go- between for her clients with regard to future installations and technical support once completion of initial services were successful. Ms. Hearn apologized for not being able to remember her exact hourly wage rate for her earlier jobs. To the extent that Ms. Hearn's recitation of her work history accurately depicts her skills and abilities this deficiency on Ms. Hearn's part does not compromise this disability evaluator's ability to reach proper vocational and economic conclusions regarding her employability profile and when performing a transferable skills analysis of this individual. VOCATIONAL PROFILE: The Dictionary of Occupational Titles (DOT), the Complete Guide for Occupational EUloration (GOE), the Transitional Classification of Jobs (COJ), the Occupational Outlook Handbook (OOH), and the Federal Register have been researched and applied in identifying Ms. Hearn's vocational skills and in discussing her vocational profile. Jacqueline M. Hearn -10- Assessment of Employment Potential Our File: 15816 August 31, 2012 Essentially, in review of the diverse vocational activities that comprise Ms. Hearn's vocational history, she has performed work that would be categorized as semi-skilled to skilled in nature. According to the Federal Reg7`ster• semi-skilled and skilled work are defined as follows: "Semi-skilled work is work which needs some skills but does not require doing the more complex work duties. Semi-skilled jobs may require alertness and close attention to watching machine processes; or inspecting, testing or otherwise looking for irregularities; or tending or guarding equipment, property, materials or persons against loss, damage or injury; or other types of activities which are similarly less complex than skilled work. A job may be classified as semi- skilled where coordination and dexterity are necessary, as when hands or feet must be moved quickly to do repetitive tasks." "Skilled work requires qualifications in which a person uses judgment to determine the machine and manual operations to be performed in order to obtain the proper form, quality or quantity of material to be produced. Skilled work may require laying out work, estimating quality, determining the suitability and needed quantities of materials, making precise measurements, reading blueprints or other specifications, or making necessary computations or mechanical adjustments to control or regulate the work. Other skilled jobs may require dealing with people, facts, or figures or abstract ideas at a high level of complexity." Generally speaking, the physical demands of the various positions Ms. Hearn performed previously ranged from sedentary to light. According to the Dictionary of Occupational Titles, Fourth Edition, Revised, 1991, published by the U.S. Department of Labor, Employment and Training Administration, sedentary and light work are defined as follows: "Sedentary Work. Exerting up to 10 pounds of force occasionally (Occasionally: activity or condition exists up to 1/3 of the time) and/or a negligible amount of force frequently (Frequently: activity or condition exists from 1/3 to 2/3 f the time) to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and all other sedentary criteria are met." "Light Work. Exerting up to 20 pounds of force occasionally (Occasionally: activity or condition exists up to 1/3 of the time), and/or up to 10 pounds of force frequently (Frequently: activity or condition exists from 1/3 to 2/3 of the time), and/or a negligible amount of force frequently (Frequently: activity or condition exists from 1/3 to 2/3 of the time), and/or a negligible amount of force constantly (Constantly: activity or condition that exists 2/3 or more of the time) to move objects. Physical demand requirements are in excess of those for Sedentary Work. Even though the weight lifted may be only a negligible amount, a job should be rated Light Work: (1) when it requires walking or standing to a significant degree; or (2) when it requires sitting most of the time but entails pushing and/or pulling of arm or leg controls: and/or (3) when the job requires working at a production rate pace entailing the constant pushing and/or pulling of materials even though the weight of those materials is negligible. NOTE: The constant stress and strain of maintaining a production rate pace, especially in an industrial setting, can be and is physically demanding of a worker even though the amount of force exerted is negligible." From a work classification standpoint, Ms. Hearn's entire vocational experiences (related to developed skills) would be categorized by the Area and Work Group Arrangement classifications of Barber and Beauty Services; Administrative Detail; Oral Communications; Records Processing; and Clerical Handling. Jacqueline M. Hearn -11- Assessment of Employment Potential Our File: 15816 August 31, 2012 The injuries Ms. Hearn sustained on 12/12/06 have severely compromised her abilities, skills and capacities to perform a vast number of jobs. These vocational handicaps are the physical, behavioral, and psychological sequelae which have resulted from the injuries she sustained on 12/12/06. Ms. Heam's injuries have, in virtually all instances, eliminated her capacity to fully function effectively and successfully in the majority of work-related skill groupings, as well as other groupings of jobs she may have voluntarily chosen if she had been able-bodied. As such, Ms. Heam will encounter a significant future loss of wage earning capacity (loss of earning power) as a result of her shortened economic horizons and reduced worklife expectancy because of her compromised health circumstances which have been the result of having been injured on 12/12/06. WORKLIFE EXPECTANCY: Various methodologies are accepted by forensic practitioners (usually vocational experts and economists) to obtain an estimate of worklife expectancy for an individual. Institutional measures (i.e., retirement age) are also used by forensic practitioners to determine normal or routine end-points of work for individuals such as Ms. Hearn. Both statistical worklife expectancy and normal retirement age (age 67 for Ms. Heam) are acceptable to consider/present in a forensic matter such as this, and as such, both will be utilized. Typically, individuals do not work throughout a lifetime. The most important event or condition affecting the worklife expectancy of a surviving person is disability. The Gamboa Gibson Worklife Tables. Anthony M. Gamboa, Jr., Ph.D., M.B.A., and David S. Gibson, M.B.A., C.P.A., C.R.C., Trial Guides, LLC, Revised, 2010, provide statistical indices for determining the effect of "disability" on how long an individual will remain employed. As a result of being seriously injured on 12/12/06, it is necessary to compare Ms. Hearn presently with other 29.32-year-old women (her age at the time of the 12/12/06 accident) with similar educational attainments. A 29.32-year-old, not disabled female with a high school education has a worklife expectancy of 27.4 years (referencing the expanded participation of women in the world of work since the original 1987 publication of Dr. Gamboa's landmark efforts which are the only worklife expectancy values in existence, published from government data, for persons meeting the definition of work disability, physical disability, or cognitive disability as defined by the U. S. Census Bureau'). A 29.32-year-old, disabled female (including both severely and not severely disabled females) with a high school education has a worklife expectancy of only 7.5 years. Therefore, even if/when Ms. Heam finds that she is be able to return to some type of alternate gainful employment in the future, she will likely have a reduced worklife expectancy of 19.9 years, as a result of having been injured on 12/12/06. Even Y' Ms. Heam's occupational disability is defined as a "not severe-work disability", her worklife expectancy would be reduced to 19.4 years, or 8.0 years less than before she was injured on 12/12/06. I have included the statistics for "not severe work disability" females for comparative purposes only, as I do not believe that anyone who would review the injuries and medical reports (including the recent FCE evaluation) and/or interview Ms. Hearn would categorize the result of her injuries as a "not severe work disability". These statistics reveal the dramatic discrepancy between the worklife expectancies for disabled and non-disabled persons. It should be noted that these tables are based on averages, but they aid in demonstrating the contrast in worklife expectancy between disabled and non-disabled persons at all levels of educational attainment. According to Labor Force and Other Characteristics of Persons with a Work Disability: 1981 to 1988. U.S. Dept. of Commerce, Bureau of the Census, July 1989, only 22.3% of females in Ms. Heam's age ' The last worklife expectancy estimates published by the federal government are found in U.S. Dept. of Labor, Bureau of Labor Statistics, "Worklife Estimates: Effects of Race and Education", Bulletin 2254, February 1986. Jacqueline M. Hearn -12- Assessment of Employment Potential Our File: 15816 August 31, 2012 category with a work disability are employed full time. Conversely, 54.9% of females who are Ms. Hearn's age and possess no work disability are employed full time. Thus, statistically, an injured individual has a dramatically reduced opportunity to engage in full-time work. A government study (Americans with Disabilities: 1997) provides documentation regarding the comparative earnings of workers by work disability status. In 1997, individuals who were Ms. Hearn's age (21 to 34 years) and able to work with a disability earned $6,662 less for the year than individuals her age who were employed with no work disability. These statistics depict the negative employability and/or earnings profile for individuals, like Ms. Hearn, who have sustained a significant work disability as a result of being injured. LIFE EXPECTANCY: According to the United States Life Tables. 2007. National Vital Statistics Reports, Volume 59, Number 9, U.S. Dept. of Health and Human Services, September 28, 2011, Ms. Hearn will have a statistical life expectancy from 29.32 years (her age at the time of the 12/12/06 accident) of an additional 49.4 years, as she can be expected to live until the age of 78.72 years. LOCAL STATE/COUNTY LABOR FORCE DATA: Dauphin County (where Ms. Hearn resides) has an unemployment rate of 8.1% as of July, 2012, which is slightly lower than the statewide average unemployment rate in Pennsylvania and places it at #29 (tied with Perry County) out of 67 counties when the counties are ranked from lowest to highest in unemployment. Statewide in Pennsylvania the unemployment rate is 8.3% as of July, 2012 which has remained constant and not changed from 8.3% one year earlier (July, 2011)2. However, the rate of unemployment has actually increased slightly (+0.1 Yo) in Dauphin County during the past twelve months, where the unemployment rate has increased from 8.0% from July, 2011 to its current rate of 8.1% as of July, 2012. CASE DISCUSSION: Prior to addressing specific vocational and economic issues in Ms. Hearn's case, the concept of wage earning capacity as it is routinely used in the field of vocational rehabilitation will be defined. Wage earning capacity or potential is defined as the level of income which an individual reasonably may be expected to receive from work, given that individual's age, level of educational attainment, particular skills and talents, actual earnings and work history, intentions, and the supply and demand conditions in the labor market relative to the individual's realistic employment choices. The realization of wage earning capacity is a function of both economic and non-economic factors. Based on a review of the provided information regarding Ms. Hearn and the result of my interview with and evaluation of her, it is my opinion that Ms. Hearn meets the definition of possessing an occupational disability. The U.S. Department of Commerce defines occupational disability as existing when a person is limited in terms of the amount of/or kind of work he or she can do on a job because of a physical or mental impairment. Any individual's power to earn money (wage earning capacity) is a function of the capacity to perform work. The capacity to perform work is predicated on a series of measurable factors identified by the U.S. 2'http://www.clep.state.pa.us/datapages/unemprates.asp Jacqueline M. Hearn -13- Assessment of Employment Potential Our File: 15816 August 31, 2012 Department of Labor as worker characteristics. The traits and characteristics associated with the performance of specific occupations include both physical and intellectual attributes. Physical attributes are defined as the "physical demands" of a particular occupation, and intellectual attributes are referred to as aptitudes. Aptitude refers to an individual's potential or capacity to learn. One measurable and predictable aptitude is general learning ability, defined as the ability to "catch on" or understand instructions or underlying principles. It is the ability to reason and make judgments. Aptitudes are closely related to doing well in school. In assessing Ms. Hearn's employability and wage earning capacity following the accident of 12/12/06,1 would first note that since 1981, as part of its Current Population Survey (CPS), the Department of Commerce has continuously collected statistics regarding the earnings and the labor force status of persons with a work disability (US Census Bureau, 1983, 1989; hM://www census goy/hhes/www/disable/disabcps html). An examination of the data reveals two phenomena that are relevant to assessing earning capacity before and after permanent injuries such as were sustained by Ms. Hearn on 12/12/06. First, persons with a work disability, even when they work full-time, year-round, tend to earn less than counterparts without a work disability. This is true at all the educational levels (<12 years, 12 years, 13-15 years, 16+) for both men and women (hU://www census eov/hhes/www/disableldisghQs.httnl, Table 3). For example, based on the March 2009 CPS, 16 to 64-year-old females with 12 years of education working full-time earned an average of $24,232 in 2008 if they had a severe work disability, but $32,777 if they did not possess a disability and worked full-time. Second, persons with a work disability are less likely to be employed than persons without a work disability and are more likely to work part-time (same web site, Table 2). For example, these same women had an average employment rate of 26.7% if they had a work disability, but 90.8% if they did not. Surveys other than the CPS also find that people with a disability are less likely to be in the labor force and working than people without a disability. The Chartbook on Work and Disability in the United States, 1998 (Stoddard, Jans, Ripple, & Kraus, 1998) summarizes some of these findings, not only from the CPS, but from the Survey of Income and Program Participation and the National Health Interview Survey as well. Likewise, the 2000 N.O.D./Harris Survey of Americans with Disabilities (Harris Interactive, 2000) finds reduced rates of employment and income for persons with a disability. Since employment statistics constitute the major building blocks of a worklife expectancy estimate, one can conclude that persons such as Ms. Hearn with a work disability are likely to experience reduced worklife expectancy. Also, not every injury has an adverse effect on one's wage earning capacity or results in shortened economic horizons for the person who has been injured. Each injury must be considered in light of the specific facts of the case before determining whether or not the realistic income potential of an injured person has been compromised. For example, a serious knee injury for a professional bicyclist may likely impact the potential of that individual to compete at a high enough level to be competitive with his/her peers, but that same injury would likely have minimal impact vocationally/economically for an attorney or white collar office worker who functions in a primarily sedentary job. I point this out because I do not believe that anyone (expert or lay) that would have the opportunity to meet Ms. Hearn would believe that her ability to work in jobs requiring significant portions of bi-manual usage with fine manual dexterity (while typing or if/when providing various beauty services as a cosmetologist) in job settings as a customer services representative or as a cosmetologist has not been seriously compromised by the injuries that she sustained on 12/12/06. Asking Ms. Hearn to work exclusively one-handed is similar to asking one to work as a "one-armed paper hanger", a vocational reality which does not exist but which has been mentioned many times to this disability evaluator over the past thirty-three years that I have been involved in the direct placement of partially disabled individuals back in to the work force by those who would have an agenda or belief that it is "easy" to find one-handed work, ignoring the practical impossibility of hanging wall paper if limited to one upper extremity to perform the essential job duties Jacqueline M. Hearn -14- Assessment of Employment Potential Our File: 15816 August 31, 2012 and responsibilities required of this work. Simply put, as with her book learning and "hands on" training at the Empire Beauty School, Ms. Hearn possessed the intellectual capacity to learn the needed skill set and physical capabilities (with accommodations) required to perform the work of a cosmetologist, however, she lacked the needed physical capacities need to perform this work competitively and on a sustained basis in order to earn "real" wages. Potential employers in our cost-conscious society recognize that Ms. Hearn is a higher risk to injuring herself and becoming an expensive worker's compensation claim than her healthy counterparts even when performing relatively non-physically demanding job duties and responsibilities, or potentially injuring a customer (if working as a cosmetologist with resultant potential liability issues). Vocational handicaps can be obvious, or they may be subtle, but it is necessary to consider the totality of factors/variables in any case when a disability evaluator is asked to evaluate the economic impact of injury upon one's vocational functioning. Every forensic vocational and economic case involves viewing an individual at a "snapshot" in time. For example, Ms. Hearn initially tried to continue to work while seeking medical treatment which would allow her to return to a state of normalcy. Ms. Hearn should not now be penalized for having worked post-accident, as both the defense examining physician (A. Lee Dellon, M.D.) and plaintiff examining physician (Brian Holmes, M.D.) have found her complaints and treatment to be legitimate and warranted, while offering their own recommendations with regard to additional medical treatment for this injured individual. What is important to recognize is that regardless of what future path Ms. Hearn takes vocationally or with regard to her future medical treatment(s) is that she will now encounter a wage disparity and earn less money given her compromised health circumstances than before she was injured on 12/12/06. That will remain as an absolute fact of Ms. Hearn's vocational life that cannot be eradicated regardless of what level of motivation or attempts to mitigate her circumstances Ms. Hearn invokes for her remaining working years. What is a vocational certainty for Ms. Hearn is that her loss of capability to work results in loss of capability to earn a living. With this tenet in mind, it is necessary to consider the definition of wage earning capacity which was defined earlier in this assessment report. Every individual, given his or her innate mental and physical abilities, as well as their educational and work backgrounds, or absence thereof, has an inherentlor acquired ability to earn wages. This is the specific "economic horizon" of any given individual. When a loss of physical and/or mental capability following injury has/have an adverse effect on employability, and when there is an associated permanence of injury, the required criteria that establish a foreshortening of economic horizons have been met. The capacity to earn is a concept that is quite distinct and different from the concept of income realization. That is, regardless of how Ms. Hearn's past income level is defined/determined, that, by definition, does not mean that her level of income in the future would not be more than was previously demonstrated by the individual, had he or she not been injured or disabled. One's wage earning capacity is often greater than the realized income they have demonstrated before they were injured or disabled. It is my opinion that the individual I interviewed and evaluated on 8/22/12 has sustained a compromise to their economic horizons, and that Ms. Hearn has sustained a diminution of the realistic or actual income that she will realize in the future as a result of having been injured in the accident of 12/12/06. Pre-injury, had Ms. Hearn not been injured, and given that her last attained wage rate with Delta Dental of PA was $14.19 as of 12/07 which was several months before her 3/24/08 surgery, she would now be earning at least $16.25 per hour, or $33,800.00 per year, if working in that same job setting full-time as a customer service representative given the normal COLA and performance raises that likely would have been applied to Ms. Hearn. Unfortunately, those higher wage levels are no longer available to her given her restricted vocational choices and shortened economic horizons that are the result of her residual deficits that are chronicled by examining physicians for & h the plaintiff and defendant in this matter. As most readers of this report will acknowledge, it is most unusual for both examining physicians to substantively agree as to the nature of the injury, or injuries, and then have a case proceed toward a jury trial when the relevant medical facts are not in dispute. Jacqueline M. Hearn -15- Assessment of Employment Potential Our File: 15816 August 31, 2012 Post-injury, given the dramatic limitations imposed by one-handed work restrictions, and even if the one- hand is the injured individual's dominant hand/arm, as is the case with Ms. Hearn, that prevents her from effectively demonstrating bi-manual usage to perform jobs routinely requiring two hands for the needed production standards in order to maintain employment in Dauphin or Cumberland counties, I am of the belief that alternate work as a receptionist or desk information clerk if provided with the use of a head-set are the types of sedentary jobs that will offer Ms. Hearn the "best" opportunity to return to work within the guidelines provided by the recent (8/1/12) functional capacities evaluation (FCE) completed by her under the auspices of Mr. Raptosh. Wage levels (as per 5/11 income statistics provided by the 2011 Metropolitan Area Occupation Employment and Wage Estimates: Harrisburg-Carlisle. PA MS for these jobs will provide her with median hourly wages of $12.34 per hour, or $25,667.20 per year, if the job is offered/performed on a full-time basis (i.e., approaching 40 hours per week). Unfortunately, the wage disparity between pre-injury and post-injury wage levels for Ms. Hearn will follow her for her remaining working years, despite the fact that Ms. Hearn is well motivated to mitigate her economic damages which have resulted from her having been injured on 12/12/06. Furthermore, she was allowed to participate in an ill-advised attempt to retrain for a job (cosmetologist) which she was/is physically unable to perform, and which has also resulted in a considerable financial outlay which she is responsible to repay. The "recovering" job economy still affects job seekers in our country although hiring has increased during the past few months while unemployment still remains inordinately high, both locally and throughout the United States. The negative impact on job prospects has been felt most dramatically by younger workers under 25 and those over 55 (according to most recent Bureau of Labor Statistics data), as well as minorities of all age groups, and which would therefore include Ms. Hearn, during the past several years (as the recession had begun in 12/07, with the actual end date still in dispute amongst economists), with any further significant reduction in unemployment because of an up tick with regard to hiring not likely for the remainder of the current presidential term, as much to do with partisan politics than with regard to economics. Note that many other economic projections continue to point toward a "jobless" economic recovery with residual unemployment remaining at or near their current levels for the foreseeable future. In Ms. Hearn's case the concepts of job availability, job placeability and job employability must be carefully differentiated. I acknowledge that it may be possible to identify jobs as "available" to Ms. Hearn; however, it is most unlikely Ms. Hearn would be placeable (i.e., would be hired) in many of the jobs so identified. That is, the identification of a job as "available" is by no means the equivalent of being hired (or even the likelihood of being hired) for that job. For Ms. Hearn, it is most unlikely she would be hired for many "available" jobs, given her current, post-injury physical circumstances. That is, even if Ms. Hearn were somehow able to "leap the hurdle" of placeability, it is even less likely she would be able, at that point, to maintain that employment, given her post-injury pain, self-described limitations and restrictions, which are consistent with the provided FCE of 8/1/12 as well as the fact that she is facing the specter of ongoing medical treatments which would likely result in regular absences from the work place which some employers may find unacceptable (although there are supposedly "official" prohibitions regarding penalizing employees for required and necessary medical treatments). By way of illustrating one obstacle to Ms. Hearn's ability to be "placed" in a position of gainful employment, and when quantifying Ms. Hearn's economic losses as she is required to seek alternate employment in the future, it must be understood that she undoubtedly will encounter employer resistance, or "negative employer bias," a familiar concept in the field of vocational rehabilitation. Employer resistance refers to the vocational reality that employers routinely will not consider an individual (such as Ms. Hearn) for job openings due to his/her inability to perform the job as successfully as an individual who does not possess significant physical and/or neuropsychological limitations and/or restrictions. 32011 Metropolitan Area Occupational Employment and Wade Estimates: Harrisburg-Carlisle. PA MSA. U.S. Department of Labor, Bureau of Labor Statistics. Jacqueline M. Hearn -16- Assessment of Employment Potential Our File; 15816 August 31, 2012 There is no question that employers prefer to hire and attempt to maintain the employment of individuals who do not have the likely permanent deficits that a person such as Ms. Hearn possesses. The occupationally disabled individual is at a disadvantage in the competitive job market when compared with the individual who can demonstrate that he/she is in good health. A permanent condition, such as Ms. Hearn possesses, results in the loss of opportunities for promotion, and a loss of opportunities to enter the work force (restricted access to the labor market). The Americans with Disabilities Act (ADA) was enacted specifically to alleviate the difficulties in obtaining employment experienced by persons with a disability. Unfortunately, preliminary research pertaining to post-ADA employment patterns for persons with a disability indicates that employment problems actually have worsened since the passage of the Act. DeLeire (2000) used the Survey of Income and Program Participation (SIPP) and found that people with a disability work less and earn less than people with no disability. Also in the few years following passage of the ADA, men with disability were less likely to be employed relative to men with no disability than they had been the few years prior to passage of the ADA. In the few years prior to the ADA, men with disability had employment rates that were 63% as high as the rate for men without disability. In the few years after the ADA, this rate dropped to 53%. In my opinion, many employers now are fearful of hiring a person, such as Ms. Hearn, who possesses a physical disability, because of questions and uncertainties associated with the "reasonable accommodation" and "essential job functions," as defined in the ADA. Although the intent of the Act was commendable, and has been noteworthy with regard to accessibility issues for persons with a disabling condition (amended 2002 ADA Accessibility Guidelines for Buildings and Facilities), it has had little if any positive effect in helping the disabled individual return to alternate jobs after sustaining an occupational disability. The economic and vocational consequences for Ms. Hearn as a result of her being injured on 12/12/06 are apparent in her post-injury ability to function in the workplace. In addition, household services have a specific economic value. Post-injury, Ms. Hearn is unable to perform household services (which include, for example, homemaking, home maintenance, child care responsibilities, household management, grounds or lawn maintenance and light home repairs) at pre-injury levels. Ms. Hearn has lost the ability to perform many of these activities and should be compensated for the services/activities she is no longer able to perform for herself and/or her family. In cases such as Ms. Hearn's, economic value should be attributed to household services, as family members or friends often are required or called upon to perform activities that previously were performed by the now partially-disabled individual. These services have a specific economic value even if "outside help" is not retained (paid) to perform them. It is noted that the literature indicates that retired persons provide a greater number of hours of services in the home than do employed persons. For example, married females that work full-time, husband works, and where the youngest child is under the age of 13, average 19.40 hours of household activities per week. In contrast, all married retired female workers spend 30.75 hours in household production. The data show that retired married females under the age of 65 engage in 33.13 hours of household production per week while retired married females ages 65-75 provide 31.04 hours and retired married females age 75 and over provide an average of 27.54 hours a week. It is the opinion of this evaluator that Ms. Hearn's stated hours of household production would have been consistent with the averages provided by Expectancy Datas had her health circumstances not been permanently compromised by the accident of 12/12/06. 4 DeLeire, Thomas. "The Unintended Consequences of the Americans with Disabilities Act." Regulation, 2000, 23(1). 5 The Dollar Value of a Day. Time Diary Analysis. 2009 Dollar Valuation, published by Expectancy Data, Economic Demographers, Shawnee Mission KS, 2010. Jacqueline M. Hearn -17- Assessment of Employment Potential Our File: 15816 August 31, 2012 On the basis of the information previously referenced and on the basis of elaborations provided me by Ms. Hearn, it is my opinion that she has suffered a lifetime reduction in her household services capacity in the amount of 10 hours per week. With regard to the dollar value of these services, the calculations of this report rely on an hourly replacement cost of $10.33 per hour, yielding reduced annual household services capacity valued at $5,372 per year. I note that in arriving at the $10.33 replacement cost value, I relied upon occupational wages published in the publication title 2011 Metropolitan Area Occ ti n Employment and Wage Estimates: Harrisburg-Carlisle. PA MSA . Given Ms. Hearn's active life expectancy of an additional 46.28 years, the cost and/or loss of household services for her over her expected active lifetime will be $248,616. Active life expectancy quantifies the expected duration of functional wellbeing, which is sometimes less than the statistical life expectancy of individuals ("Active Life Expectancy," Sidney Katz, M.D., et al, The New England Journal of Medicine. November 17, 1983). The following tables depict Ms. Hearn's past wage loss, future loss of wage earning capacity or earning power, and the value of her household services (which is inclusive from the date of her accident through her active life expectancy age), as a result of her 12/12/06 accident. These calculations are projected from her age at the time of the accident, 29.32 years, to her expected worklife age of 56.72 years (29.32 years chronological age + 27.4 years of expected work), and to the age of 67, which currently is the minimum age a female born in 1977 may retire while receiving full Social Security benefits. TABLE 1 PAST WAGE LOSS: JACOUELINE M.13EARN (12/12/06-9/14/12*) Actual quantifiable wage loss begins as of 1/1/08 as at that time Ms. Hearn had an hourly wage rate of $14.19 per hour, or $29,515.20 per year as of 12/07 while working for Delta Dental of PA as a customer service representative. The recent FCE of 8/1112 limits Ms. Hearn to one-handed work using her dominant right hand/arm while her jobs and training post-accident were all short-circuited by her inability to use her injured left upper extremity for either sustained typing or cosmetology work. Ms. Heam's earnings and physical condition post-accident continued to deteriorate even as she attempted to work in the hope that her physical condition would allow her to return to full capability with no physical limitations. Unfortunately, the result of Ms. Hearn's 12/12/06 MVA injuries represent an ongoing wage disparity for her up until the trial which is scheduled for the week of 9/17/12 in the Court of Common Pleas for Cumberland County (PA). Off work from full-time job as a customer service representative with Delta Dental of PA @ weekly wage of $567.60, or $29,515.20 per year: $139,016.59 + 20.0% fringe benefits': -Less 2008 actual earnings from Delta Dental of PA + 20.0% fringe benefits: $27,803.32 $30,667.20 -Less obtained earnings from Health America (2009) and Spherion Staffing Services (2010) + 7.65% employer's contribution to Social Security & Medicare: $26,586.32 PAST WAGE LOSS: *Calculated through the Friday prior to the scheduled trial which is to be held during the week of 9/17/12. 6 2011 Metropolitan Area Occupational Employment and Wade Estimates: Harrisburg-Carlisle. PA MSA. U.S. Department of Labor, Bureau of Labor Statistics. 7 United States Department of Labor, Bureau of Labor Statistics. Table A. Employer Costs for Employee Compensation - March 2012. News release, June 7, 2012. Jacqueline M. Heam Our File: 15816 -18- Assessment of Employment Potential August 31, 2012 TABLE 2 FUTURE LOSS OF WAGE EARNING CAPACITY: JACOUE 1M M. HEARN No Productivity Factor. TO AGE 56.72 TO AGE 67 (27.4. worklife expectancy) 1. PRE-INJURY: If physically capable of working full-time as a customer service representative with Delta Dental of PA @ 2012 expected hourly wage of $16.25, or $33,800.00 per year: $732,784.00 $1,080,248.00 + 20.0% fringe benefits: $146.556.80 $216,049.60 $879,340.80 $1,296,297.60 2. POST-INJURY: If physically capable of working and maintaining full- time employment in an alternate job as a receptionist or desk information clerk in local labor market access area that comport with requirement of one-handed work as per FCE at an average median hourly wage of $12.34 per hour, or $25,667.20 per year: $556,464.89 $820,323.71 + 20.0% fringe benefits: $111.292.97 $164.064.74 $667,757.86 $984,388.45 FUTURE WAGE LOSS (1-2): UUMMM TABLE 2A FUTURE LOSS OF WAGE EARNING CAPACITY: JACQUELINE M. REARM 2.0% Productivity Factor TO AGE 56.72 TO AGE 67 (27.4 yrs. worklife expectancy) 1. PRE-INJURY: If physically capable of working full-time as a customer service representative with Delta Dental of PA @ 2012 expected hourly wage of $16.25, or $33,800.00 per year: $906,201.69 $1,492,351.84 + 20.0% fringe benefits: $181.240.34 $298.470.37 2. POST-INJURY: $1,087,442.03 $1,790,822.21 If physically capable of working and maintaining full- time employment in an alternate job as a receptionist or desk information clerk in local labor market access area that comport with requirement of one-handed work as per FCE at an average median hourly wage of $12.34 per hour, or $25,667.20 per year. $688,155.62 $1,133,269.03 + 20.0% fringe benefits:. $137.631.12 $226.653.81 $825,786.74 $1,359,922.84 FUTURE WAGE LOSS (1-2): S26t.655.2R X430 s Adjusted for 5.72 yrs. which have elapsed since the 12112/06 accident. Jacqueline M. Hearn -19- Assessment of Employment Potential Our File: 15816 August 31, 2012 TABLE 3 LOSS OF HOUSEHOLD SERVICES: JACQUELINE M. HEARN 520 hrs./yr. (10 hrs./wk.) x $10.33/hr. x 46.28 yrs. - $248,616 "Table 2" and "Table 2A," above quantify Ms. Hearn's future economic losses with consideration given to her retiring at the statistical worklife age of 56.72 years, and at the institutional retirement age of 67 years. There is no mandatory retirement age in the United States; however, current institutional, technological, demographic and behavioral changes in economic conditions indicate that lifetime labor force participation is increasing, and that "normal" retirement age now extends beyond 65 years (as demonstrated by Ms. Hearn's ineligibility to receive full Social Security benefits until the age of 67, with Medicare benefits being available at the age of 65). The preceding tables (2 and 2A) have been calculated both with and without a specific value for productivity. The Pennsylvania Supreme Court case of Kaczkowski vs. Bolubasz (1980) outlined the total offset method of computing wage losses. The future increases in earnings due to inflation are totally offset by the reduction of those earnings to their present value. In addition to using the total offset method, the Kaczkowski decision permits allowances for future increases due to productivity. When considering the facts of this case, the attribution of 2.0% productivity is appropriate in determining Ms. Hearn's economic losses, given her age, maturity, education, and vocational skills at the time of her 12/12/06 accident. Also, support for the incorporation of productivity measures can also be found in the government publication "BLS Handbook o Methods"9 (U.S. Department of Labor, Bureau of Labor Statistics, Chapter 10, pgs. 89-102) which was originally published in April, 1997, and has been last revised on March 31, 2010. Fringe benefits have long been recognized as an essential component of employee compensation. Pre-accident, while working full-time with Delta Dental of PA (or with a number of other employers within her geographical labor market access area when able-bodied) Ms. Hearn was provided and/or had available a significant package of fringe benefits which included health insurance, short and long term disability, paid vacation, as well as dental and prescription coverage, plus the opportunity to participate in a contributory 401k plan. This compensation package with regards to fringe benefits is consistent with the value of fringe benefits (20.0%) as determined by the Bureau of Labor Statistics as of March, 2012 and should remain available if/when she is able to assume, and hopefully maintain, alternate full-time employment in the future once again. However, at a minimum, based on the difference between pre-injury and post-injury earnings levels which will remain disparate, and where presently an employer contributes 7.65% of annual earnings up to $110,100 (2012), and which is matched by the employee, the difference between pre-injury and post-injury measures will result in a compromise to her fixture Social Security and Medicare based on her fewer years of expected work and lost direct income which generates the contributions of both employees and employers. It should be noted that the federally mandated employer's contribution to the individual's future Social Security benefits extends to annual earnings of $110,110 (2012), 6.2% of the total of 7.65%, as Medicare benefits are not capped and continue to receive employer contributions at the rate of 1.45% of direct income above $110,110. 9 http://stats.bls.gov/hom/homehlO.pdf Jacqueline M. Hearn -20- Assessment of Employment Potential Our File: 15816 August 31, 2012 CONCLUSION: Ms. Hearn's present health circumstances (resultant from her 12/12/06 accident) have drastic vocational and economic ramifications for her. I believe the foregoing discussion regarding the vocational and economic implications of this case accurately describe the likely vocational and economic shortfalls which will occur to Ms. Hearn as a result of having sustained significant injuries in a motor vehicle accident, with resultant permanent physical limitations, on 12/12/06 which have and will restrict her employment choices and opportunities for her remaining working years, as well as the compromise to her ability to perform even routine household services for herself and her family. Therefore, as a result of having been injured on 12/12/06, Ms. Hearn has sustained a past wage loss and a significant future loss (impairment) of her wage earning capacity or earning power. Her economic horizons have been shortened, and this shortening has been estimated to range between $211,583 and $430,899, while her past loss of earnings has been calculated to be $109,566. The value of her household services has been calculated to be $248,616. While predicting any future loss with complete certainty is not possible, the reasonable likelihood for Ms. Hearn will fall between the extremes of the range identified in this assessment as a function of probability statistics. Thank you for allowing me to meet with and evaluate the employment and economic potential of this pleasant and interesting individual. The opinions in this report are being stated with a reasonable degree of vocational/disability evaluation and rehabilitation economics certainty and are based upon the data/information in this evaluator/examiner's possession at the time this report was written (8/31/12). Sincerely, JSR VOCATIONAL & CONSULTING SERVICES /John S. Risser, MA, ABVE, CRC Diplomate, American Board of Vocational Experts /jbr JSR Vocational & Consulting Services JOHN S. RI S S E R 5062 Ridge Road, Elizabethtown, PA 17022 Curriculum Vitae Phone: 717-579-2437 Fax: 717-367-5727 Email: jsrridgewood@embargmail.com CREDENTIALS Bureau of Professional and Occupational Affairs, Commonwealth of Pennsylvania (LPC) Licensed Professional Counselor #P0001867: 2002 Certification for Case Manager (CCM) Certified Case Manager #00003378:1993 American Rehabilitation Economist Association (CRE) Certified in Rehabilitation Economics #59201: 1992 Board of Examiners of Professional Counselors, State of Maryland (CPC) Certified Professional Counselor #000384:1989 American Board of Vocational Experts Certification (ABVE) Diplomate #142683:1985 Clinical Psychology Internship Completed supervised internship with James O. Whittaker, Ph.D., Licensed Psychologist, Commonwealth of Pennsylvania: 1984-85 Commission on Rehabilitation Counselor Certification (CRC) Certified Rehabilitation Counselor #17641: 1983 EDUCATION Master of Arts, Clinical Psychology Indiana University of Pennsylvania, Indiana PA: 1975 Bachelor of Arts, Sociology Lebanon Valley College, Annville PA: 1972 PROFESSIONAL EXPERIENCE Self Employed, JSR Vocational & Consulting Services: 2003 - present Provide professional vocational services for injured and/or partially dirabkd persons Perform wage earning c*wa y, earning power (Act 57) and employability assessments Provide expert witness testimony before vanour judiaal bodies Provide careerguidance for individuals who are unemployed„ underemployed and/or desiring a caner change. Dir. of Vocational Assessment Services, Hoover Rehabilitation Srv, Inc., Camp Hill PA: 1979 - 2003 Provided pmf s.aond vocational services for injured and/or partial, Awbkd presorts: Performed wage earning capacity, earning power (Act S7) and employabilrt asseu mnts. Provided expert witness testimony b fortvarious jndiaal bodus Provided camrg;d&xm for individuals who are unemployed, underemployed and/or desiring a career change. Supervised a staff of 15 nhahiUation and vocational counsselorr in the implementation of professional nhabiktation services, leading to the highest level of functioning for injured individuals: Rehabilitation Counselor, Crawford Rehabilitation Services, Inc., Harrisburg PA: 1978 - 79 Provided rebabiktation counseling and placement services for injured and/or partially disabled individuals. Provided expert witness testimony regarding job availabilnty/suitability in bearings before PA Workers' Compensation Referees. AFFILIATIONS American Rehabilitation Counselors Association National Vocational Guidance Association National Employment Counselors Association American Personnel and Guidance Association National Rehabilitation Association TESTING CERTIFICATIONS VITAS - Vocational Interest Temperament and Aptitude System Work Samples: 1981 JEVS - Jewish Employment and Vocational Services Work Sample: 1979 GATB - General Aptitude Test Battery: 1978 Matthew S. Crosby Attorney ID# 69367 HANDLER, HENNING & ROSENBERG, LLP 1300 Linglestown Road Harrisburg, PA 17110 Telephone: (717) 238-2000 Attorney for Plaintiff Fax : (717) 233-3029 E-mail: Crosby@hhriaw.com JACQUELINE M. HEARN, IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA Plaintiff MICHAEL LOE, Defendant NO. 2008-7062 CIVIL ACTION - LAW CERTIFICATE OF SERVICE On 10/10/12, 1 hereby certify that a true and correct copy of Plaintiffs Motion for Partial Summary Judgment was served upon the following by depositing same in the United States Mail, in Harrisburg, Pennsylvania: John A. Statler, Esq. Johnson Duffie 301 Market Street P.O. Box 109 Lemoyne, PA 17043-0109 HAN LER, NG & G, LL P Dated: 10/10/12 Ma ew S. Crosby