Opinion ID: 1835416
Heading Depth: 1
Heading Rank: 2

Heading: background for sherard's claim

Text: Sherard's Medical History. In May 1976, Dr. Paul Goetowski diagnosed the condition of Sherard, then 15 years old, as spondylolysis with possibly a spondylolisthesis, Grade I, and a bilateral pedicle defect, a congenital defect in the back portion of a vertebra. Spondylolisthesis is the slippage or displacement of one vertebra on another. Dr. Goetowski cautioned Sherard against her participation in activities which are apt to produce a progression or a slipping forward of the fifth lumbar vertebra on the first sacral vertebra. In Dr. Goetowski's opinion, if symptoms are severe enough ... fusion is considered. In February 1980, Dr. Goetowski noted an increase in Sherard's spondylolisthesis of L5 on S1 after she had fallen twice. Although he had prescribed back-brace support and flexion exercises for Sherard, when Sherard's lumbosacral instability increased and resulted in low back pain, Dr. Goetowski performed a lumbosacral fusion, L4-5 to S1, in March 1980. In July 1982, Sherard again injured her back, when she was assaulted while working as a waitress. After this injury, Sherard experienced low back pain, as well as muscle spasms and leg cramps that would last [d]ays at a time. Sherard's pain increased to a point where to walk was very difficult, forcing her to take very small steps and requiring her to use a cane sometimes to get around. Dr. Goetowski at that time described Sherard's low back pain as a chronic, recurrent, and permanent problem. Dr. Goetowski performed a refusion of L4-5 to S1 in February 1983 and a right sacral iliac fusion in September 1983. In February 1984, Dr. Goetowski formed the opinion that Sherard had approximately 50% permanent partial residual anatomically of her back now and for the foreseeable future. Sherard's Injuries at Bethphage. After Sherard's unsuccessful efforts to obtain employment in 1984, the Nebraska Job Service placed Sherard in an on-the-job training program with Bethphage Mission, an institution for mentally disabled adults, in Lincoln, Nebraska. Bethphage's file on Sherard contained documentation that Bethphage knew about Dr. Goetowski's treatment of Sherard's back condition, including the vertebral fusions. Sherard's job responsibilities at Bethphage were mainly physical assistance to patients in their daily activities, such as bathing, feeding, walking, and exercising. While working, Sherard slipped on Bethphage's dining room floor on August 9, 1985, fell, struck her back on a chair, and was off work until September 12, 1985. Sherard was again injured at Bethphage on January 14, 1986, when she was attempting to restrain a patient who was striking other patients and staff members. The patient lunged and caused Sherard to fall into a wall. Before this injury, Sherard had never experienced [pain] going clear to [her] foot and making [her] foot numb. After this accident, Sherard perceived throbbing, aching, shooting, hot pain through her lower back and right leg. In April 1986, Dr. Gene Lewallen, an orthopedic surgeon who treated Sherard after Dr. Goetowski's retirement, performed a refusion of L4-5 on Sherard and, in February 1987, estimated Sherard's permanent physical impairment at 50 percent of the body as a whole. As a result of the 1986 accident, Sherard was unable to return to her employment at Bethphage. At the request of Bethphage's insurance carrier, Sherard met with James Kincaid, a rehabilitation specialist, in the summer of 1987. After Sherard consulted with Kincaid in 1987, she began a college course in a sign language program, but prolonged sitting in a classroom caused Sherard to develop sacral decubitus, commonly known as a pressure spot or bedsore. In light of Sherard's persistent decubitus, her physician, Dr. George Walcott, recommended that Sherard withdraw from the signing class because [s]o far as application of vocational training, it would appear as though it's going to be difficult for her to sit for any length of time over an hour. In April 1988, Sherard moved to Arizona, where she lived until May 1989, when she returned to Nebraska. While in Arizona, she was treated by Dr. Andre Matthews, an orthopedist, who, on August 5, 1988, estimated Sherard's permanent impairment to be 61 percent of the body as a whole.