Court Opinion

ID: 9410785
Source: CourtListenerOpinion
Date Created: 2023-07-24 16:07:14.135212+00
Date Added: 2024-06-11T17:21:00.324377
License: Public Domain

J-A10040-23

NON-PRECEDENTIAL DECISION - SEE SUPERIOR COURT OP 65.37

    KHALEED CRUMP                              :    IN THE SUPERIOR COURT OF
                                               :         PENNSYLVANIA
                       Appellant               :
                                               :
                                               :
                v.                             :
                                               :
                                               :
    CRAIG SOKOLOW AND FRAN                     :    No. 1750 EDA 2022
    GOLDSLEGER                                 :

              Appeal from the Judgment Entered August 19, 2022
      In the Court of Common Pleas of Philadelphia County Civil Division at
                              No(s): 200801434

BEFORE:      PANELLA, P.J., KING, J., and STEVENS, P.J.E.*

MEMORANDUM BY STEVENS, P.J.E.:                               FILED JULY 24, 2023

        Plaintiff/Appellant Khaleed Crump (“Appellant”) appeals from the

judgment entered in the Court of Common Pleas of Philadelphia County at the

conclusion     of    his    personal      injury   trial   after   the   jury   found

Defendants/Appellees Craig Sokolow and Fran Goldsleger (“Appellees”) were

negligent, but that such negligence caused no compensable injury to

Appellant. After careful consideration, we affirm.

        The present case arises out of a motor vehicle collision that occurred

during the early afternoon of January 26, 2020, in the City of Philadelphia,

when Appellee Sokolow drove a motor vehicle at approximately 25 miles per

hour into the vehicle of Appellant. On February 11, 2020, Appellant sought

medical treatment for what was diagnosed as a knee contusion, which,
____________________________________________

*   Former Justice specially assigned to the Superior Court.
J-A10040-23

Appellant reported, had occurred when his knee struck the steering column of

his vehicle during the motor vehicle accident in question.

      On February 18, 2020, Appellant began a prescribed “course of therapy

consisting of ultrasound, EGS manipulation and a structured therapeutic

exercise program to tolerance.”         Nevertheless, Appellant subsequently

complained to his treating physician of progressively worsening right knee

pain, stiffness, and clicking since the time of the accident.     Plaintiff’s Trial

Exhibit A, Report of Geoffrey W. Temple, D.O., 6/14/20, at 1-2.

      On April 28, 2020, Appellant underwent an MRI scan of the right knee.

According to the interpreting radiologist, the MRI scan was “unremarkable,”

as it showed all internal structures, ligaments, and tendons were intact. Id.

Dr. Temple reviewed the MRI report and images and concurred with the

radiologist’s impression. Id.

      On June 3, 2020, Dr. Temple reassessed Appellant.           In addition to

sharing his impression of the normal MRI, he performed motion testing of

Appellant’s right knee. His report indicated a normal range-of-motion without

restrictions, the absence of effusion (fluid that causes swelling) or instability,

and a demonstration of full strength at the joint, which he rated a “5/5.” Id.

Dr. Temple noted further:

      [Appellant] had anterior knee pain on deep palpation. . . . I do
      feel he suffered a deep knee contusion at that time [of the
      accident] and responded to the therapy provided with occasional
      pain. I released him from my active care at that time. He was
      asked to continue his own home exercises and return to the office

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      if there was any significant change in the residual pattern of
      symptoms around which he learned to adjust his daily activities.

      ...

      The diagnosis in my report are directly related to the trauma of
      January 26, 2020. He has a guarded-good prognosis. . . . Also,
      he has suffered shearing forces to the myoligamentous supporting
      elements of the right knee which will pre-dispose him to joint
      laxity, joint instability, and also subsequent trauma.

      While he has improved maximally, he has not recovered
      completely. . . . He suffered a significant impairment of bodily
      function. . . . Again, he has a guarded-good prognosis. The
      opinions in my report are rendered within a reasonable degree of
      medical certainty.

Id. at 2.

      On July 30, 2020, Appellant sought the care of Clifton Burt, M.D., to

address what he reported as his continuing right knee pain. Dr. Burt noted a

negative Lachman Test (to assess for ACL injury), no medial or collateral

instability with the joint, and negative MRI findings. Plaintiff’s Trial Exhibit C,

Report of Clifton Burt, M.D., 7/30/20, at 1. Nevertheless, given the duration

of Appellant’s complaints of pain symptoms, Dr. Burt concluded that it was

“medically necessary to perform right knee Geniculate nerve radiofrequency

ablation.” Id.

      As discussed, infra, an ablation of the geniculate nerves involves

inserting into the knee three needles, one placed at each nerve, and delivering

through the needles a radiofrequency wave that generates sufficient heat,

approximately 115 degrees Fahrenheit, to burn the nerve and stop it from

transmitting a pain signal to the brain. At the time of the procedure, Appellant

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reported a 40% improvement in his pain level for 30 minutes. Dr. Burt thus

made the decision to proceed with the radiofrequency ablation at the same

level. Id.

      On August 18, 2020, Appellant commenced the present personal injury

action by filing a complaint in negligence, alleging that Appellee Craig Sokolow

negligently or carelessly caused the parties’ motor vehicle collision, which

resulted in serious and permanent personal injuries to, among other things,

his right knee.   During discovery, Appellant filed an expert medical report

prepared on September 15, 2020, by his proposed medical expert, Lance

Yarus, D.O.

      In his report, Dr. Yarus explained that although he had not personally

seen or examined Appellant, he had reviewed Appellant’s relevant medical

history and reports, which, he indicated, had described that Appellant suffered

an auto collision-related contusion, synovitis, and enthesopathy of the right

knee that continues to cause him pain. Among the conclusions he drew from

his records review was that Appellant suffered a “suspected internal

derangement with structural tear, either meniscus, or cruciate, or both with

cartilage surface injury of right knee.”   Plaintiff’s Trial Exhibit B, Report of

Lance Yarus, D.O., 9/15/20, at 3. Dependent on this conclusion were the

“guarded” prognosis he assigned Appellant and his medical opinion regarding

related future costs of medical care Appellant would incur. Id. at 4. His report

indicated that he offered this and all conclusions to a reasonable degree of

medical certainty. Id. at 5.

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      On April 18, 2022, Appellees filed a Motion in Limine to preclude Dr.

Yarus from testifying it was his expert medical opinion that Appellant had a

“suspected” internal derangement of the right knee. Specifically, Appellees

contended that a “suspected” injury was not an injury that a medical expert

can find to within a reasonable degree of medical certainty.         This was

particularly so, Appellees argued, given the MRI imaging and accompanying

radiologist’s report, with which all reviewing physicians concurred, indicating

a normal, “unremarkable” study showing all internal structures of the knee to

be “intact.”

      On May 19, 2022, the trial court entered an order granting in part

Appellees’ Motion in Limine. Pursuant to the order, neither Dr. Yarus’ opinion

regarding the suspected internal derangement nor his opinion about any

future medical treatments or costs of said treatments were admissible at trial.

      On May 20, 2022, Appellant filed a Motion for Reconsideration based on

Dr. Yarus’ videotaped deposition.    Therein, Appellant maintained that Dr.

Yarus “testified, specifically, that he believes Plaintiff to have internal

derangement based on Plaintiff’s symptomology, that is, the locking, popping,

giving way, and stiffness of which Plaintiff complained, and that [Dr. Yarus]

was ‘certain’ and ‘not guessing’ about the internal derangement.” Motion for

Reconsideration, 2/20/22, at 3.

      On May 23, 2020, the trial court heard oral arguments on Appellant’s

Motion for Reconsideration, and agreed with Appellees’ position that because

Dr. Yarus had based his testimony regarding a continuing injury and the future

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costs associated with such injury on his suspicion that Appellant has internal

derangement of the knee, his medical opinion on both was inadmissible.

Accordingly, the trial court denied Appellants’ motion for reconsideration of

the May 19, 2022, order.

      Also challenged by way of a motion in limine was Dr. Yarus’ use as of a

stock photograph of a knee undergoing genicular nerve ablation as an

illustrative aid to his testimony.     The trial court asked if the photograph

accurately depicted the procedure Appellant underwent, and counsel for

Appellant confirmed that it was. Appellees objected to the admission of the

photograph, arguing that it had not been produced during discovery despite

Appellant’s request for such demonstrative evidence.        After entertaining

arguments on the point, the trial court granted Appellees’ motion, noting the

demonstrative had not been available to Appellees’ doctor or any other expert.

N.T. at 16.

      Trial commenced on May 23, 2020, and featured the testimony of fact

witnesses Appellant and Appellee Craig Sokolow, and a video replay of Dr.

Yarus’ deposition testimony. On May 24, 2022, the jury returned a verdict in

favor of Appellees, finding Defendant Craig Sokolow negligent but that his

negligence was not a factual cause of injury to Plaintiff/Appellant.      N.T.

5/24/22, at 69; Verdict Sheet, p. 1.

      On June 3, 2022, Appellant timely filed a Motion for Post-Trial Relief in

which he charged the trial court had erred and abused its discretion in

precluding part of Dr. Yarus’ deposition testimony and the stock photograph

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depicting a close up of a knee ablation patient’s knee with three needles

inserted. The trial court denied the motion on June 23, 2022. This timely

appeal followed.

      Appellant raises the following issues for this Court’s consideration:

      1. Whether the trial court abused its discretion and otherwise
         committed an error of law when it precluded [Appellant’s]
         medical expert, Dr Lance Yarus, D.O., from testifying that
         [Appellant] suffered internal derangement of the right knee as
         a result of the subject accident, and subsequently denied
         [Plaintff/Appellant’s] Motion for Reconsideration of same?

      2. Whether the trial court abused its discretion and otherwise
         committed an error of law when it precluded [Appellant’s]
         medical expert, Dr. Lance Yarus, from testifying that
         [Appellant] would require future medical treatment for injuries
         sustained in the subject accident, and subsequently denied
         [Appellant’s] Motion for Reconsideration of same?

      3. Whether the trial court abused its discretion and otherwise
         committed an error of law when it precluded [Appellant’s]
         medical expert, Dr. Lance Yarus, D.O., from presenting a
         demonstrative photograph of the procedure [Appellant]
         underwent following the subject accident?

      4. Whether the trial court abused its discretion and otherwise
         committed an error of law when it improperly denied
         [Appellant’s] Motion for Post-Trial Relief by way of Order dated
         June 23, 2022, and Supporting Opinion dated January 4, 2023?

Brief for Appellant, at 8.

      At the center of Appellant’s first two issues is his challenge to the trial

court’s ruling that precluded Dr. Yarus from offering at trial his opinion that

the car collision in question caused Appellant to suffer an internal

derangement of the right knee. As discussed, preclusion was based on the

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trial court’s determination that Dr. Yarus failed to support his opinion with an

adequate degree of medical certainty when he could opine only that the injury

was “suspected.”

      It is well-settled that in Pennsylvania, “our Supreme Court has

emphasized [that an] expert must base the substance of her opinion on a

reasonable      degree   of     certainty   instead    of     mere    speculation.”

Commonwealth v. Gonzalez, 109 A.3d 711, 727 (Pa. Super. 2015), appeal

denied,   125     A.3d   1198     (Pa.   2015)    (citation   omitted);    Accord,

Commonwealth v. White, 285 A.3d 912 (Pa. Super. Ct. 2022), appeal

denied, No. 263 EAL 2022, 2023 WL 2579748 (Pa. Mar. 21, 2023). On this

point, we have long observed:

      an expert need not testify with absolute certainty or rule out all
      possible causes of a condition. [Mitzelfelt v. Kamrin, 584 A.2d
      888, 891 (Pa. 1990)]. Likewise, the testimony need not be
      expressed in precisely the language used to enunciate the legal
      standard. See In re Jones, 432 Pa. 44, 246 A.2d 356 (1968)
      (medical testimony need not conform to precise statutory
      definitions). Rather, expert testimony should be reviewed in its
      entirety to assess whether it expresses the requisite degree of
      medical certainty. McCann v. Amy Joy Donut Shops, 325 Pa.
      Super. 340, 343–44, 472 A.2d 1149, 1151 (1984) (en banc “An
      expert fails this standard of certainty if he testifies ‘that the alleged
      cause “possibly”, or “could have” led to the result, that it “could
      very properly account” for the result, or even that it was “very
      highly probable” that it caused the result.’” Kravinsky v. Glover,
      263 Pa.Super. 8, 21, 396 A.2d 1349, 1356 (1979) (citations
      omitted).

Hoffman v. Brandywine Hosp., 661 A.2d 397, 402 (Pa. Super. 1995)

(superseded by statute on other grounds).

                                         -8-
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       Here, Dr. Yarus opined during his deposition testimony that both

Appellant’s enduring subjective complaints of pain, clicking, and stiffness and

medical records describing a contusion of his right knee at initial presentation

caused Dr. Yarus to “suspect” a derangement of the knee’s internal structures.

Deposition, 5/11/22, at 23-24.          He acknowledged Appellant’s normal MRI

study of April 28, 2020, which, he admitted, “didn’t show any evidence . . . of

disruption of the internal structures” and showed that the ligaments, menisci,

and tendons all “were intact”, but he opined that the normal MRI did not

eliminate reason to pursue Appellant’s persistent complaints. N.T. at 27.

       Dr. Yarus      continued, “[S]ometimes MRIs don’t show         you, uh,

structurally or morphologically what may be causing a person’s symptoms.

“When people present with . . . locking, popping, giving way, stiffness, things

that [Appellant] described, and after treatment,[1] he has a continuing of those

symptoms, those are internal derangement until proven otherwise.” N.T. at

27. Dr. Yarus opined that with respect to the value of diagnostic studies,

“[w]hether the MRI is normal or not doesn’t really matter in the big picture[,]”

and he dismissed the notion that repeating such imaging would be of any

value. N.T. at 35.

       Instead, he maintained that consideration of Appellant’s post-collision

history coupled with a diagnostic arthroscopy was required to discern the
____________________________________________

1 Elsewhere in his deposition testimony, Dr. Yaris discussed his review of
records from “Premier Pain & Rehab”, which indicated that Appellant
underwent a July 30, 2020, genicular block or ablation procedure of three
nerves in his knee to reduce pain. N.T. at 28-29.

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injury in this case. “[I]t’s the [patient] history that drives the . . . ability to -

- to recommend care[,]” he opined, and “[y]ou have to look directly with the

scope; that’s what it’s for.” N.T. at 27-28. [T]he scope is a diagnostic tool.”

N.T. at 35. In other words, Dr. Yarus opined that only an arthroscopy would

reveal whether Appellant sustained internal derangement of the knee

consisting of a structural tear with cartilage injury. He concluded his direct

examination by affirming that he offered this opinion within a reasonable

degree of medical certainty. N.T. at 36.

       The degree of certainty regarding his opinion of Appellant’s injury,

therefore, became the subject of cross-examination, during which Dr. Yarus

conceded that in his written report he described his findings as “suspected

internal derangement.” N.T. at 36.2 He confirmed further that his findings

derived from Appellant’s persistent subjective complaints both documented in

medical records and conveyed to him during a phone conversation, as he

neither met nor examined Appellant in person. He stated, “I believe it’s there

because of his symptoms[,]” N.T. at 41, and he also agreed that Appellant’s

subjective complaints were the source of such recorded symptoms.

       The speculative nature of Dr. Yarus’ inferences, however, were

underscored when he opined that only an arthroscopic evaluation of the knee

would reveal the presence and extent of Appellant’s suspected injury.

____________________________________________

2 His complete entry stated, “Suspected internal derangement with structural
tear, either meniscus or cruciate or both, with cartilage surface injury of the
right knee.” N.T. at 37.

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Specifically, when asked on redirect examination to explain the need for

arthroscopic evaluation of the knee, he offered that Appellant’s persistent

complaints after reasonable care are the reason to do the scope, regardless

of the MRI, and the presence and extent of the injury was “a part of the

equation, uh, that, uh, will not be understood until a scope is placed in the

knee. There has to be a reason for his continuing complaints and his inability

to function.” N.T. at 47.

      Under our cited jurisprudence, an expert’s suspicion of an injury does

not meet the requisite threshold of rendering an expert opinion to a

reasonable degree of medical certainty.       Here, Dr. Yarus admitted he only

suspected Appellant had internal derangement of the knee because Appellant

continues to complain of pain and suffered a contusion and swelling of the

knee at the time of the accident.       This despite an MRI that showed all

components of the knee to be intact and a June 3, 2020, examination in which

Dr. Temple found Appellant’s right knee displayed a normal range of motion

without restrictions, full strength (rated “5/5”), no sign of instability, and no

evidence of effusion. Dr. Yarus conceded it was his opinion, moreover, that it

is impossible to discern whether an internal derangement exists without

conducting an arthroscopy, which has not been performed in this case.

Confronted with this evidence, therefore, the trial court appropriately ruled

Dr. Yarus’ opinion was speculative and, thus, inadmissible at trial.

Accordingly, Appellant’s first two issues are devoid of merit.

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       The remaining two issues coalesce to assert that the trial court erred

and abused its discretion when it deemed inadmissible a stock photograph of

a genicular nerve ablation procedure that Dr. Yarus used as an illustration

during his videotaped testimony discussing the same procedure performed on

Appellant.    At the deposition of Dr. Yarus, counsel for Appellees raised an

unfair surprise objection to the picture when it was presented, partly because

Appellant had not produced or disclosed it previously during discovery, as

required under Pa.R.C.P. 4009.11, in response to Appellee’s requests for

production of documents.3 The objection was preserved for trial court review,

and Dr. Yarus continued his deposition testimony in which he referred to the

photograph to aid his explanation of Appellant’s knee ablation procedure.

       The trial court entertained argument on Appellees’ motion in limine to

exclude the photograph in question.            Counsel for Appellees reiterated that

Appellant failed to produce the photograph during discovery and, thus, unfairly

surprised Appellees when Dr. Yarus referred to it during his expert testimony.

Counsel for Appellees emphasized that “a surgery photograph is very

prejudicial. It shows a person having surgery on their knee. It’s obviously

not the plaintiff. It was never produced. I don’t think that that picture should

be shown to the jury.” N.T., 5/23/22, at 12.

____________________________________________

3 During discovery, Appellant’s “Request for Production of Documents” asked
for “Any and all documents . . . which Plaintiff(s) plan to have marked for
identification at a deposition or trial, introduce into evidence at a deposition
or trial, or about which Plaintiff(s) plan to question a witness at a deposition
or trial. R. 543.

                                          - 12 -
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      Counsel for Appellant countered that Dr. Yarus explained Appellant

underwent a genicular nerve ablation procedure to his knee, and then used a

stock picture of such a procedure to assist the jury in understanding what such

a procedure entails.   Indeed, the question initially posed to Dr. Yarus was,

“Do you have a model or anything to show us to indicate what the procedure

was, where it was performed?” N.T. at 12.

      Counsel argued that the picture was “literally a [photograph] of

somebody’s knee with the needles in it to show what the ablation procedure

was.” N.T. at 13. He continued, “This is a demonstrative Dr. Yarus used. It’s

aiding the jury to better understand the procedure that Mr. Crump went

through, the ablation. That’s all it was. It’s not a moving film of anything.

It’s just a picture of a knee to show what the ablation was. . . . I believe the

standard is if it aids the jury to better understand what the doctor is talking

about, it’s admissible. I would argue it’s admissible.” N.T. at 13. When asked

by the trial court if the photograph was a true and accurate representation of

Appellant’s procedure, counsel for Appellant reiterated that Dr. Yarus showed

the photograph while explaining what Appellant underwent. N.T. at 14.

      The trial court reserved ruling until it viewed the picture for unduly

graphic or irrelevant content. N.T. at 14. While waiting for the videographer

to retrieve the photograph, counsel for Appellees repeated his objection that

the photo was never produced in discovery, was of a different person, and

was a “picture of a man with iodine all over his knee and surgery and medical

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instruments.”4 N.T. at 14. To his latter objection, counsel for Appellees added

that the photograph depicted a surgical procedure “clearly” performed in a

hospital, which would be materially different from the outpatient procedure

Appellant described in his testimony. Counsel for Appellant replied accurately,

“You can’t tell that. It’s just a picture of a knee.” N.T. at 15.

       After reviewing the photograph, the trial court sustained Appellees’

objection, agreeing with Appellees’ initial position that Appellant’s failure to

produce the photograph pursuant to Appellees’ discovery request unfairly

handicapped Appellees in the preparation of their defense. Specifically, the

trial court explained, “Dr. Yarus used a demonstrative during his testimony

that hadn’t been used with their doctor or any other expert. And as a result,

I sustained the objection that it not be presented to the jury.” N.T. at 16.

       With regard to discovery disputes, we have explained:

       Preliminarily, we note the “‘[t]he purpose of the discovery rules is
       to prevent surprise and unfairness and to allow a fair trial on the
       merits.’” Pennsylvania Rule of Civil Procedure 4019 provides for
       sanctions if a party fails to provide discovery. “The decision
       whether to sanction a party, and if so the severity of such
       sanction, is vested in the sound discretion of the trial court.” When
       a court refuses to impose sanctions, we must review the evidence
       to determine whether the court abused its discretion.

Dominick v. Hanson, 753 A.2d 824, 826 (Pa.Super. 2000) (internal citations

omitted). According to Pa.R.C.P. 4019, a trial court may “make an appropriate

____________________________________________

4 As discussed more fully, infra, the photograph in question is a close-up of a
patient’s knee in which three long needles have been inserted. As explained
by Dr. Yarus, a radiofrequency wave then is directed through the needle to
the targeted nerve.

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order” if a party “fails to make discovery or to obey an order of court

respecting discovery.” Pa.R .C.P. 4019(a)(1)(viii).    “[T]he decision whether

to sanction a party for a discovery violation and the severity of such a sanction

are matters vested in the sound discretion of the trial court.” Philadelphia

Contributionship Ins. Co. v. Shapiro, 798 A.2d 781, 784 (Pa. Super.

2002). . . . This Court has held that when a party has failed to produce

evidence during discovery, an appropriate sanction is prohibiting admission of

the evidence at trial. Duncan v. Mercy Catholic Med. Ctr. of Southeastern

Pa., 813 A.2d 6, 12 (Pa. Super. 2002).

      As noted above, the trial court had entered a Case Management Order

during discovery requiring Appellant’s counsel to identify all exhibits that were

to be used at trial. Within the court’s order was the admonition, “Counsel

should expect any exhibit not listed to be precluded at trial.”     There is no

dispute that the picture in question was neither submitted during discovery

nor included in Appellant’s pre-trial memorandum but was, instead, first

presented at the videotaped deposition of Dr. Yarus to be used at trial.

Referencing, inter alia, that Appellees’ expert had been deprived of the

opportunity to examine the photograph, the trial court acted on its prior

admonition and ruled the photograph was inadmissible at trial. We discern no

error with the trial court’s decision to enforce the terms of its Case

Management Order.

      Even assuming, arguendo, that any unfair surprise was de minimus and,

thus, provided insufficient reason to preclude use of the photograph, we would

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decline to find reversible error in this instance where Appellant’s medical

expert, Dr. Yarus, provided the jury with a detailed and comprehensive

explanation of the procedure.

       Appellant argues that the purpose of introducing the photograph of the

ablation procedure was to show he chose to undergo such an invasive

procedure because he was genuinely experiencing pain in his knee following

the accident. Nevertheless, he acknowledges that the photograph illustrated

the testimony of Dr. Yarus, which not only detailed the invasive ablation

procedure completely for the jury but also explained that the procedure is

undertaken to remedy a patient’s complaints of pain.

       To this end, Dr. Yarus indicated that Appellant presented at Premier Pain

& Rehab on July 30, 2020, to treat with Dr. Clifton Burt, who performed

genicular blocks on three nerves located inside Appellant’s knee to try to

reduce pain. N.T. at 28.5 The jurors first observed Dr. Yarus refer to a medical

drawing illustrating the internal anatomical structures of the knee, and they

watched him use the illustration to identify the location of the nerves,

explaining they were the ones blocked or ablated during Appellant’s

radiofrequency ablation procedure. N.T. at 29-30.

       The doctor then transitioned to the second illustration, which consisted

of a still, color photograph of an actual knee ablation procedure. The depiction

is limited to a close-up of a bare knee with three small needles or probes
____________________________________________

5 It was at this time that Appellees’ counsel noted his objection to “any kind
of models or pictures or anything like that, that wasn’t produced.” N.T. at 28.

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inserted. Iodine appears to have been applied to the surface of the knee, and

some of the iodine appears to have run onto the edge of the paper dressing.

      Although the photograph was “blacked out” in the video pursuant to the

trial court’s ruling, the jury still observed the video of Dr. Yarus describing in

detail what was depicted in the obscured photo and how the ablation

procedure is performed. Specifically, Dr. Yarus related the photograph to the

previous medical drawing—which the jury had viewed—that illustrated the

location of each genicular nerve among the internal structures of the knee,

and he described how three ablation probes, or needles were placed in the

knee to ensure each would contact its corresponding nerve and deliver the

radiofrequency wave to burn the nerve and block the pain signal it was

emitting to the brain:

      And, then, uh I have another demonstration. This is actually a
      placement of the needles, uh, that were the nerves that are going
      to be ablated.

      [a brief delay occurs while the videographer retrieves the
      photograph]

      So, this is representing the three, uh, nerves that, uh, would be
      ablated. Certainly, again, this is not Mr. Crump. This is a live,
      uh, person that, uh, is being used just to show where the needle
      placement is.

      Through the needle will come a device that’s hooked up to a
      machine that will generate energy at the tip of the probe that goes
      through down to nerve. . . . In some cases, uh, I believe in the
      case of Dr. Burt [who performed the procedure on Appellant], they
      outline the nerve with dye using a fluoroscope, and that’s how you
      know where the placement is. Once you’re up on the nerve, this
      probe is sent down, and then, energy is placed through the probe.
      It's about 80 degrees Celsius, which is 115 Farenheit, and that’s

                                     - 17 -
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       enough to burn those nerves right where the needles are. It takes
       about 30 minutes, total, to do the procedure.

N.T. at 31-32.

       Dr. Yarus concluded his presentation of the genicular ablation procedure

by offering his opinion that it was “medically necessary, reasonable, and

related to the accident[,]” and that he would recommend repeating it to

“knock[] out the pain” to enable Appellant “to function a little better[.]” N.T.

at 32, 34.

       This record establishes that the photograph in question was largely

cumulative of Dr. Yarus’ detailed testimony, particularly when one considers

that the photograph’s purpose, according to Appellant, was to convince the

jury that he was genuinely in pain by showing he was willing to undergo an

invasive procedure to address it. The photograph thus offered little if any

probative value beyond Dr. Yarus’ detailed testimony describing the invasive

nature of the ablation procedure. Therefore, we conclude that any prejudice

Appellant incurred by the court’s ruling precluding the admission of the

ablation photograph was de minimus and cannot support his claim of

reversible error.6 Accordingly, we discern no merit to Appellant’s challenge.

       Judgment affirmed.
____________________________________________

6 We thus distinguish the present matter from decisions acknowledging that
an expert medical witness’s testimony, conveyed in appropriate clinical
language, regarding the nature of injuries or cause of death does not render
photographic evidence merely duplicative. See, e.g., Commonwealth v.
Pruitt, 951 A.2d 307, 319 (Pa. 2008) (discussing cases in which photographs
depicting the brutality of beatings and the deep and gaping wounds involved
were essential to prove criminal intent, even when a medical examiner had
described the nature of the victims’ injuries).

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Judgment Entered.

Joseph D. Seletyn, Esq.
Prothonotary

Date: 7/24/2023

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