Opinion ID: 1886321
Heading Depth: 1
Heading Rank: 3

Heading: Subsequent Medical Treatment and its Relationship to the Accident

Text: According to the Commissioner, plaintiff proved that he had suffered a lumbosacral strain of approximately three months' duration. He then recommended that Mart be awarded $10,000.00 in general damages and $8,760.00 in lost wages, the foregoing subject to a 50% reduction. The Commissioner awarded no damages of any sort for consequences of the accident beyond January, 1982, since he felt the plaintiff did not prove that his surgeries (which included exploratory surgery, a discectomy, and a spinal fusion) and disability were causally related to the accident of October, 1981. That conclusion, we find, was clearly wrong. Mart's initial treating physician was Dr. Wilmot Ploger, an orthopedic surgeon. Dr. Ploger felt that Mart had sustained an injury to the cervical and lumbar spine as a result of the accident of October, 1981. Mart related no history of prior back difficulties to Dr. Ploger, who treated Mart for his back problems from October 20, 1981 (the day after the accident), until his discharge on January 26, 1982. Although Mart was still complaining of occasional stiffness in his lower back on that date, Dr. Ploger felt Mart could return to work. Mart returned to work in January, 1982. According to him, the work at Bosun Diesel was lighter in the winter months. When the work picked up, Mart found that his back discomfort was increasing. Dr. Ploger noted that persons with back problems such as Mart's often have increased symptoms concurrent with increased activity. In fact, Dr. Ploger noted that additional surgery, including a spinal fusion, frequently occurs in cases similar to Mart's. Dr. Ploger testified unequivocally that the accident in question was the cause of the symptoms evidenced by Mart. The plaintiff's family physician, Dr. Edmond Mickal, had cared for the then 36 year old plaintiff from the time that he was four years old. During this entire period, Dr. Mickal testified, Mart had never had any back complaints or disability. [9] During the three month interval between plaintiff's accident and his return to work, Dr. Mickal was treating Mr. Mart for his back problems concurrently with the treatment offered by Dr. Ploger. After plaintiff returned to work on January 18, 1982, Dr. Mickal twice had occasion to take Mart's blood pressure (on April 16, 1982 and June 15, 1982). On both occasions, Mart complained of backaches in the lumbar area when the weather was cold or damp. These complaints were consistent with the prior complaints Mart had made to Dr. Ploger. As his work activities increased in the spring of 1982, Mart experienced increasing difficulty with his back. On July 16, 1982, he was examined by Dr. William Pusateri, an orthopedic surgeon. Dr. Pusateri initially detected tenderness in Mart's left paravertebral musculature and a positive straight leg raising test. [10] His initial diagnosis was that Mart had a chronic lumbar strain. As the plaintiff's pain had not diminished by the time of his second visit, Dr. Pusateri advised Mart to discontinue working and to begin physical therapy. At this time, approximately nine months had passed since the accident. When Mart continued to complain of pain, he was admitted to Mercy Hospital for diagnostic tests. Lumbar myelogram and electromyogram (EMG) tests [11] were negative. [12] By September 10, 1982, however, Dr. Pusateri was observing a positive bilateral straight leg raising test. Given the patient's history, Dr. Pusateri felt a reasonable explanation of Mart's difficulties was the accident of October 19, 1981. [13] Dr. Pusateri referred the plaintiff to Dr. Bert Bratton, a neurosurgeon. Dr. Bratton had another EMG performed on October 21, 1982. He also scheduled a CT scan of Mart's back. The EMG indicated the presence of nerve lesions in Mart's back. [14] The CT scan [15] of Mr. Mart's lower back was interpreted by a Dr. Yellin. The CT scan indicated, inter alia, the presence of bulging discs at the L5-S1 and L4-5 level. As a result of these tests, Dr. Bratton concluded that exploratory surgery was necessary. Dr. Bratton then proceeded to perform a partial laminotomy and foraminotomy. [16] The exploratory surgery did not indicate the presence of a ruptured disc. He did conclude, however, that Mart had sustained internal damage to the nerve roots of his back. [17] Given the history offered by plaintiff, Dr. Bratton concluded that the accident of October 19, 1981, was the probable cause of the protracted problems with his back. When Mart's post-operative pain continued, he was referred to Dr. Donald Richardson's pain clinic at the Hotel Dieu Hospital in New Orleans. [18] A radiologist at Hotel Dieu, Dr. Mario Calonje, performed another CT scan on plaintiff's back. The test indicated the presence of a bulging disc at L5-S1, and, to a lesser degree, at the L4-5 level. This test confirmed the prior findings of Dr. Yellin. Dr. Richardson's initial impression of Mart was that he had a failed back syndrome with hysterical symptoms. The prior medical history of plaintiff was consistent with potential pathology in the lumbar spine area. Dr. Richardson testified that malingerers, or persons who are faking a syndrome of pain, are not admitted to the clinic if such is recognized. While at the clinic, Mart was examined by psychiatrists who worked at the clinic. The psychiatrists found that Mart was suffering from traumatic neurosis, according to Dr. Richardson, who also testified Mart had a passive, dependent personality. Although Dr. Richardson was somewhat critical of Mart's complaints of pain, [19] he admitted that Mart tried to cooperate with those working with him at the clinic. Dr. Richardson also admitted that persons afflicted with traumatic neurosis suffer from real pain. Given this scenario, Dr. Richardson admitted that such a person could be both emotionally and physically disabled. [20] Upon his release from the pain clinic, Mart was advised to seek psychiatric help. He was thereupon examined by Dr. C.B. Scrignar, a psychiatrist. Dr. Scrignar testified that there are two concurrent elements of pain involved in injuries such as that sustained by Mart: the actual physical injury and the psychological injury characterized as posttraumatic stress disorder. In such cases, the physical and psychological pain run parallel to each other in the aftermath of an accident. [21] Dr. Scrignar testified that as a psychiatrist, he is trained to ferret out and recognize malingerers, and that Mart was not such a person. The plaintiff's complaints were sincere and the pain syndrome was real, according to him. [22] On August 22, 1983, Mart was examined by Dr. Walter Brent, an orthopedic surgeon who examined the plaintiff on behalf of National Union Fire Insurance Company, the intervenor compensation insurer. Dr. Brent noted a variety of physical difficulties which were consistent with pathology in the lumbar spine and with nerve root irritation. He reviewed the CT scan taken on March 3, 1983, by Dr. Calonje. Dr. Brent agreed that the CT scan verified nerve root pathology. [23] According to this witness, Mart was disabled and could not return to work as of the date of that examination, August 22, 1983. Further, given the patient's history, Dr. Brent testified that the symptoms he observed in Mart were caused by the accident of October 19, 1981. When the plaintiff failed to improve following his treatment at Hotel Dieu's Pain Clinic, Mart was referred to Dr. Carlos Pisarello, a neurosurgeon. Dr. Pisarello reviewed the prior medical history, which indicated the presence of prolapsed discs in Mart's back. Dr. Pisarello then fitted Mr. Mart with a back brace. The brace is utilized to stabilize the spine. If the brace alleviates the pain, the chances of a spinal fusion's benefitting the patient are increased. Mart thereafter reported that use of a brace had alleviated his pain. On January 12, 1984, Dr. Pisarello, together with Dr. Truman Kerr, performed a spinal fusion and discectomy. Dr. Pisarello examined Mart's discs and determined that L4-5 and L5-S1 were prolapsed and degenerated. These two prolapsed discs, together with the presence of scar tissue from the prior surgery, necessitated the discectomy and spinal fusion. [24] Dr. Pisarello then testified that even in the best possible scenario, Mart would be left with significant disabilities, including a limitation on his pushing or lifting heavy objects. Mart would not be able to return to his former position of diesel mechanic. [25] Finally, Dr. Pisarello testified that the cause of Mart's medical difficulties was the accident of October 19, 1981. [26]