Opinion ID: 2095152
Heading Depth: 2
Heading Rank: 2

Heading: Zoerb's injuries and their alleged aggravation as a result of the delays in treatment.

Text: The medical witnesses who testified on behalf of the Zoerbs were Nooreddin Mirmirani, M.D., a psychiatrist, and Peter Bernad, M.D., a neurologist. Dr. Bernad testified that Zoerb sustained a moderate to severe head injury when he was struck by the descending elevator, including a contusion to the frontal parts of the brain, a skull fracture, and brain hemorrhage. Dr. Bernad concluded that Zoerb must have been hit pretty hard by the elevator to have sustained such a significant brain injury. Dr. Bernad acknowledged that Zoerb's symptoms at the time of trial [3] were part and parcel of plaintiff's moderate to severe closed head injury, and that Zoerb's closed head injury alone, without delay in medical treatment, was sufficient to cause Zoerb's symptoms as they existed more than six years after the accident. Nevertheless, the Zoerbs claimed that delay in Mr. Zoerb's treatment resulted in the aggravation of his injuries, and they sought damages from Barton for any aggravation attributable to Barton's role in that delay. Dr. Mirmirani testified that the sooner that Mr. Zoerb would have been treated, the better off he would have been. According to Dr. Mirmirani, Zoerb's condition deteriorated continuously. Dr. Mirmirani was prepared to state with medical certainty that Zoerb's condition would be better if he had been discovered earlier. The witness could not, however, quantify specifically the level of improvement. Dr. Mirmirani was likewise unable to state what Zoerb's condition was an hour or two hours after the accident. Dr. Mirmirani also acknowledged that, at his pretrial deposition, he had testified as follows: QUESTION: Do you have an understanding of how long that delay was? ANSWER: I think that it was a number of hours. I can't recall the exact time. It was a number of hours he was missing and they could not find him. QUESTION: In your opinion, did that delay have any impact on his current condition? ANSWER: It's hard to say. It's hard to be accurate because he did have an injury, a head injury. He was unconscious and obviously, when you have traumatic brain injury, the tissues and the inside of the brain swells. So, it would be good to immediately intervene to reduce the swelling so that you would have less trauma to the brain as a general rule. QUESTION: But, as far as the impact on his ultimate condition, can you say with any specificity how much it worsened or did not worsen based on ANSWER: I cannot be certain of that. (Emphasis added.) [4] After the basic thrust of Dr. Mirmirani's testimony became apparent, the trial judge called counsel to the bench, and the following transpired: THE COURT: I am not sure if you are leaving this area. I am not sure that this jury has a basis on anything that he has said to be able to determine what, if any, effect that the delay had on Mr. Zoerb's condition other than a general statement that the sooner that you get treatment, the better. MS. HUGHES Your Honor, [Counsel for plaintiffs] THE COURT: I mean if that is all that he can give us, that may not be enough. MS. HUGHES: He is not the only witness who will be testifying as to this issue, Your Honor. THE COURT: All right. MS. HUGHES: We have an expert neurologist who will be testifying more accurately on the extent to which the delay impacted. THE COURT: All right. MS. HUGHES: Your Honor, I want to ask the question as a follow up. THE COURT: All right. That's helpful to me to know that. That may not be able to necessarily resolve it with just this witness. The neurologist will testify with respect to what effect that the delay had on the current condition? MS. HUGHES: Exactly, Your Honor. Notwithstanding this representation by counsel for the Zoerbs, Dr. Bernad's testimony added little if anything of substance to Dr. Mirmirani's analysis with respect to the consequences of the delay or of any part of it. When he was asked by plaintiffs' counsel what effect if any the delay in treatment had on Mark Zoerb's condition, as it exists today, Dr. Bernad stated that one cannot separate or tease out percentages, but that the seven hour or so delay was significant and that Zoerb should have been seen and treated earlier. Dr. Bernad continued: I believe that the delay did cause an effect, did have the secondary effects of swelling and so forth that we talked about. And had he been found earlier, th[ese] secondary factors could have been treated and could have been avoided to some extent. Asked how much sooner Zoerb would have had to be treated to avoid the deterioration of his condition, Dr. Bernad responded that you can't say how much sooner but that the sooner the better. On cross-examination, Barton's attorney asked Dr. Bernad as to how soon after Zoerb's injury the secondary effects of that injuryswelling, edema, consequent compression and more swellingbegan. Dr. Bernad responded that there may be some minutes, possibly even a half an hour or an hour, where things are quiescent and then the swelling ... starts. In response to a question from the judge, Dr. Bernad stated that in Zoerb's case the swelling would have occurred sooner than in cases of less severe trauma. Neither medical expert for the plaintiffs provided any estimate as to how long after the injury any deterioration continued. Moreover, neither expert was able to suggest what, if any, part of Zoerb's condition was attributable to the entire ten and a half hour delay from accident to treatment, or to any particular portion of that delay.