The "$4 Million Dollar Stairs"

Attorney Daniel Malis of MALIS|LAW, with the assistance of  Attorney Frederick Fairburn of Fairburn & Dyke in Lawrence, announced the culmination last week of five years of litigation involving the collapse of a stairway on a construction project in Hampton, NH which injured a Massachusetts plumber, though a settlement from various defendants totalling $4.1 million.

SERIOUS INJURY ON CONSTRUCTION SITE: The wood framed, 17 stair staircase collapsed after framing contractors, under the instruction of the general contractor, disconnected the stairs from side supports to insert fireproof drywall, but left the stairs in that disconnected fashion for a period of time between 1 day and more than two weeks depending upon which witness was believed.  My client, a plumber, was climbing the staircase when it collapsed.  When the staircase struck the landing below, the small of his back struck the edge of the stairs, crushing one of his vertebrae.  Following the collapse, the general contractor immediately re-erected the stairway; secured all stairways at the sides with extra nailers; and did not disclose the accident to local inspectors or the project engineer during a site visit the following day.

Demonstrative Evidence Showing the Damage to Client's Spine

MY CLIENT’S SPINAL INJURY: My client, a married 35 year old Massachusetts apprentice plumber, suffered a crush injury to his L1 vertebra when a 17 stair wood frame staircase gave way.  He was med-evacuated from a NH hospital to Beth Israel Hospital where he underwent the first of three surgeries over 5 years to stabilize his back, including, by the time of the final surgery, a four level lumbar fusion, with fixating steel rods extending over 7 vertebrae, and with additional surgery likely in the future.   While his motor functions were preserved, the employee remained in chronic, debilitating pain, with narcotic pain relief as his only medical recourse, and, according to Plaintiff’s vocational expert, was permanently totally disabled.  Plaintiff’s vocational expert and economist calculated the present value of his earnings loss over his career at $1.7 million which, with his $400,000 in medical expenses to date and continuing, presented special damages in excess of $2.1 million.

FINDING THE BEST FORUM FOR MY CLIENT: Rather than bringing suit in New Hampshire, we brought suit under diversity jurisdiction in federal court in Massachusetts against the engineer, architect and general contractor.  The New Hampshire-based design professionals claimed that Massachusetts had no jurisdiction over the case, and that the lawsuit belonged in New Hampshire, with a local judge to decide my client’s fate.  Despite the presentation of carefully worded affidavits from the architect and engineer which distanced the ‘design team’ from Massachusetts, our own investigation showed that both professionals were licensed in Massachusetts and had substantial contacts with this state, and the court denied their motion.

BUILDING A STRONG CASE: Vigorous discovery disclosed the identity of a Massachusetts –based framing supplier who had contracted to perform the framing, along with two NH-based framing subcontractors hired by that company to do the actual work.  These companies were joined as third party defendants.  The general contractor blamed the framers for the collapse; the framers claimed that they destabilized the staircase at the general contractor’s instruction.

THE CONTRACTORS’ NEGLIGENCE: Depositions of witnesses and other site contractors revealed that the staircases were not built according to plan or specification.  Testimony and post-accident photographs taken by a separate plumbing contractor who was first on the scene revealed that the subcontracting framers had sloppily  ‘toenailed’ the bottom of the stringers at an angle into plywood on the platform, instead of using a cleat or nailer which would have allowed the stringers to be nailed straight through the plywood platform securely into the carrying  beam. This substandard bottom connection of the staircase,  allowed the stair bottom to slip and kick out over time once the general contractor ordered the staircase to be disconnected for drywall installation, and was a major contributing cause of the staircase collapse..  The framing contractors’ departure from site plans and use of substandard attachment methods were not detected by the general contractor; the framing supplier, who contractually agreed to supervise the framing work; or the architect and engineer, who had contracted to inspect the site.

During a day-long deposition, the framing contractor who disconnected the stairs at their sides for drywall installation finally admitted that he knew that he had rendered the staircases unstable.  He admitted that while he would normally block off stairs left in this precarious shape, he could not explain why he did not do so on the stairs at this site.  These admissions established clear liability on the framing subcontractors, as well as confirmed the general contractor’s negligence for ordering the disconnection and failing to observe the improper staircase installation.     .

THE DEFENDANTS TRY TO EVADE LIABILITY: While the Plaintiff had established uncontroverted evidence of a drastic injury, the extent of his disability was disputed by the Defendants with a vocational assessment which, despite the Plaintiff’s dependence on narcotic painkillers, alleged that he still had the ability to consistently perform light duty work.  This was rebutted not only by the Plaintiff’s sympathetic appearance and supporting opinions from two orthopedic surgeons, as well as a vocational expert, but also by the graphic evidence shown above demonstrating that his seven level spinal fusion was unstable, with the securing screws shifting in his vertebral bodies and eroding the bone in which they were secured.

Following discovery, the parties attended a day long mediation, which was initially sought by the Defendants to settle the claim.  However, negotiations were reduced to a full day of finger pointing among the Defendants, with no real offers made.   We took advantage of this apparent disaster by sending demand letters under c.93A to the insurers for the general contractor and the framing supplier, based upon their complete failure to promptly evaluate the Plaintiffs’ claim and accurately address their exposures.

Eventually, on the date that responses to Plaintiff’s demand letters were due, the dispute (which at end turned out to be an argument over legal fees between the Defendants) was tabled between the insurers, and the general contractor and framing supplier tendered their full policy limits of $2 million to resolve both parties’ liability.  This opened a window to settle with the erring framing joint venture for $1.6 million, leaving the so-called ‘design professionals’, the architect and engineer, who had yet to tender an offer.

THE ARCHITECT AND ENGINEER’S NEGLIGENCE: The so-called ‘design team’ initially declined to settle, and presented a vigorous defense, despite admissions from the architect that the project engineer should have detected the improper staircase installation.  Counsel for the designers sought summary judgment, alleging that the entire cause of collapse was the building contractors’ negligence, and that the architect and engineer played no role in the staircase’s collapse.  Plaintiff presented countering affidavits from a construction expert and design experts initially presented by the settling Defendants and then retained by Plaintiff.  Summary Judgment was denied, and the case scheduled for trial in early 2010.

Plaintiffs further sought an order from the Court pending trial seeking to prevent offset of the settlement against any jury award, based upon New Hampshire’s ‘hybrid’ contribution statute, which awards damages based upon a contributing defendant’s percentage of negligent contribution to an accident (so-called ‘pure contribution’) but does not credit the settlement contributions of other settling parties.   While this motion was pending, the parties attended a half day mediation session with the previous mediator, Attorney Mulvey, and, over the strenuous objections of the architect and engineer, their insurers settled the remaining claims for $500,000, bringing the my client and his wife’s total recovery to just over $4.1 million.

Another story ‘ripped from the headlines;’ this one about manufacturers paying kickbacks so that nursing homes will prescribe their medications.

Johnson & Johnson Accused of Drug Kickbacks
By NATASHA SINGER
Published: January 15, 2010
Johnson & Johnson paid kickbacks to the nation’s largest nursing home pharmacy to increase the number of elderly patients taking the antipsychotic Risperdal and several other medications, according to a complaint filed Friday by the office of the United States attorney in Boston.

J.B. Reed/Bloomberg News
Risperdal is approved to treat schizophrenia, but not specifically approved to treat problems in elderly people with dementia.
The payments violated the federal anti-kickback statute and led Omnicare, a pharmacy company specializing in dispensing drugs to nursing home residents, to submit false claims to Medicaid, the complaint charged.
The government’s civil complaint joins a whistle-blower suit against Johnson & Johnson brought by two former employees of Omnicare, which has headquarters in Covington, Ky.
Johnson & Johnson said Friday it was reviewing the complaint and intended to address the government’s lawsuit in court. The complaint charges that Johnson & Johnson, based in New Brunswick, N.J., and two of its subsidiaries, Ortho-McNeil-Janssen Pharmaceuticals and Johnson & Johnson Health Care Systems, paid tens of millions of dollars to induce Omnicare to buy and recommend Risperdal for elderly patients as well as the drug maker’s prescription pain relievers Duragesic and Ultram, and the antibiotic Levaquin.
The complaint charges that Omnicare’s pharmacists engaged in intensive efforts to persuade physicians to prescribe the drugs from 1999 to 2004, a period in which the pharmacy’s annual purchase of Johnson & Johnson medications nearly tripled to more than $280 million, from about $100 million. During the same period, the pharmacy’s annual purchase of Risperdal rose to more than $100 million, according to the complaint filed in United States District Court in Massachusetts.
“Kickbacks in the nursing home pharmacy context are particularly nefarious,” Carmen M. Ortiz, the United States attorney for Massachusetts, said in a statement Friday. In return for Omnicare’s efforts, the drug maker allegedly paid the pharmacy company kickbacks in the form of rebates based on the market share of some Johnson & Johnson drugs, sponsorship of Omnicare meetings, grants and payments for Omnicare data, like the prescribing habits of doctors, of the kind that Omnicare had previously provided the drug maker for free, the complaint said.
“When it comes to the sometimes questionable practice of promoting brand-name drugs to doctors and their patients, this case represents the lowest of the low,” Senator Herb Kohl, the Wisconsin Democrat who is the chairman of the Senate Special Committee on Aging, said in an e-mail message sent Friday in response to a reporter’s question. “Nursing home residents comprise a vulnerable population that should be able to trust that their physician’s advice is based on medical expertise, not financial self-interest.”
Although the events described in the complaint took place several years ago, Mr. Kohl wrote that the aging committee was continuing to investigate the issue of the overuse of antipsychotic drugs in nursing homes.
Johnson & Johnson issued an e-mail statement in response to a reporter’s question.
“We believe airing the facts will confirm that our conduct, including rebating programs like those the government now challenges, was lawful and appropriate,” the statement said. “We look forward to the opportunity to present our evidence in court.”
Omnicare, with a market capitalization of about $3.1 billion, serves more than 1.4 million residents of nursing homes, assisted living and other health care facilities in 47 states and Canada, according to the company’s Web site.
Last November, Omnicare paid $98 million to settle civil charges by the government that it had violated the False Claims Act for engaging in kickback schemes with Johnson & Johnson and a smaller drug maker.
The settlement agreement did not include any finding of wrongdoing or any admission of liability by Omnicare, the company said in a statement issued in November. Omnicare denies the contentions of the federal complaint settled last fall and denies any liability related to those contentions, the statement said.
The government has regulations in place to protect nursing home residents from medication mismanagement, like being sedated with psychiatric drugs for the purposes of discipline or convenience. The Department of Health and Human Services requires nursing homes to arrange for an outside consulting pharmacist to review a patient’s medication regimen at least once a month.
These outside pharmacists have a duty to report any irregularities to the attending physician; the pharmacists also have the ability to recommend that a physician remove, change or add medications to a patient’s drug regimen, the complaint said.
But the government’s complaint in the Johnson & Johnson case raises the question of whether some companies have used the consultant pharmacists — the very people entrusted by the government with safeguarding the integrity of nursing home drug prescriptions — for corporate gain.
In this case, according to the complaint, Omnicare’s consultant pharmacists worked to increase Risperdal’s market share.
“If true, these allegations represent a cynical manipulation of the laws intended to protect nursing home residents, as well as yet another rip-off of the Medicaid program,” Senator Charles E. Grassley, the Iowa Republican who has investigated the corporate conduct of certain drug makers, said in a statement Friday in response to a reporter’s question. “If consultant pharmacists aren’t independent, both the patient and the taxpayer lose.”
In one company document among the court exhibits, for example, Omnicare said that its efforts generated a record market share high of 55.5 percent for Risperdal in the first quarter of 2000.
“This market share represents Omnicare’s ability in persuading physicians to write Risperdal in the areas of behavioral disturbances associated with dementia,” the Omnicare document said.
But Risperdal, which is approved by the Food and Drug Administration to treat schizophrenia and bipolar disorder, is not specifically approved to treat behavioral problems in elderly people with dementia. In fact, in 2005 the F.D.A. required that the labels of certain antipsychotic drugs, including Risperdal, carry a black box label warning that elderly people with dementia-related psychosis treated with such drugs were at an increased risk of death compared with those taking a placebo.
In the e-mail message to a reporter, Mr. Kohl noted that the government’s complaint was not the first charge against a drug company for improperly marketing antipsychotic drugs to aging populations.
Last January, the drug maker Eli Lilly pleaded guilty to a misdemeanor and paid $1.415 billion to settle criminal and civil charges that the drug maker had marketed its antipsychotic Zyprexa for the treatment of elderly people with dementia.
The exhibits attached to the complaint depict the efforts of Omnicare and Johnson & Johnson to increase market share for Risperdal against competing antipsychotics like Zyprexa and Seroquel from AstraZeneca.
In an Omnicare letter to Johnson & Johnson in 2001, an executive wrote that the pharmacy planned to spend about $173 million on Johnson & Johnson products.
The executive wrote in capital letters, “We are selling more high-priced drugs (read Risperdal here) for the pharmaceutical industry!!”

Just to show that I understand the ‘other side’ of what I do, here’s a very compelling story from the New York Times about a doctor in Massachusetts who was sued because of the death of a patient.  This story underlines why people shouldn’t assume because an adverse result occurs that the doctor must have malpracticed, and explains why I’m very, very selective when it comes to medical malpractice claims.

A Patient Dies, and Then the Anguish of Litigation

A Typical Insurer's Private Investigator (no, I'm just joking . . . )

A LETTER FROM THE INTERNET: I’m often asked about the role of ‘private investigators’ in personal injury claims.  In response, here’s a letter that I responded to on Avvo.com, a web-based attorney information service that I participate in, that might interest readers:

“hello,

i was involve in a car accident. i know that sometimes insurance companies hire private investigator if they think that there is a fraud or the case amount is high. i was wondering what is high amount?

thanks
emmy”

SETTING THE RECORD STRAIGHT ON INVESTIGATORS:

Here’s my answer to Emmy’s letter:

Dear Emmy,

Sorry for your accident. Of course, my naturally suspicious mind is driven to this question: why are you worrying about an investigator? In the words of most defense attorneys and insurance adjusters: ‘Do you have something to hide’?

WHAT A PRIVATE INVESTIGATOR DOES: To answer your question more seriously: having worked as both a defense lawyer, representing insurers, and as a plaintiff lawyer representing injured persons, I can tell you with some measure of certainty that there is no ‘high amount’ that triggers an investigation. The insurance adjusters will deploy investigators when a claim ‘looks’ suspect (for an extreme and somewhat exaggerated example, a person with a sprained pinkie saying that they’re disabled for life will likely be subject to surveillance if there’s an ongoing claim). The decision to send out someone to follow a claimant and see how they’re spending their time in real life is based on subjective criteria, and, in my experience, is often left to the adjuster’s discretion.

DOES “SIZE MATTER”: Of course, if a claimant is seeking minimal compensation, an insurer may decide that it’s not cost efficient to spend $2,000 – $3,000 to deploy an investigator, and might decide to settle the claim at a low level rather than incur that cost on top of the settlement cost. However, increasingly insurers seek to ’send a message’ to claimants by aggressively investigating what they feel are suspect claims.

These ‘investigators’ are an annoyance. They’re hired to develop evidence, whether by observation or often by photograph or video, that a person isn’t as badly injured as they claim. In my practice, from both sides of the aisle, I’ve rarely seen an investigator hired by an insurer who was an accurate, independent, direct and honest reporter of what they observe.

THE INSIDER’S GUIDE TO INVESTIGATORS: More often, in my experience, these ‘investigators’ (really, paid spies) recognize who’s paying the bill, and rather than acting as independent witnesses, they turn themselves into advocacy witnesses to try to help the insurance companies or defense firms who pay for their services. These ‘investigators’ (sometimes retired adjusters; often, retired or disabled former law enforcement or private security officers) often hide or selectively record evidence of a claimant’s activity in an effort to try to ‘amplify’ the actions of an allegedly injured person. In other words, when the person looks healthy, they start the video recorder; when they look injured, they turn the recorder off. Not only that, but insurers and defendants, under the rubric of ‘work product’, try to hide the existence of such ’spies’ and their videos until the eve of trial (a process I’m very critical of, and which I believe is based on old and discredited practice).

MALIS|LAW PUTS THEIR INVESTIGATORS TO WORK — FOR YOU!: I’ve developed several pre-trial techniques for ’smoking the investigator out’, and if your attorney is savvy, he or she will know what to do to make sure that there are no rude surprises as you approach trial or settlement of your case.  The good news is that often these investigators can be discredited by good, aggressive cross-examination in discovery or at trial; their bias exposed; and their opinions weakened. Even better, their ’spying’ sometimes proves disability, rather than disprove it.

In many of my larger cases, I’ve been able to take this investigative evidence and use it to coerce the insurer to pay more for the claim, by showing that the ‘paid spy’ actually learned that my client was more severely injured than even the insurer thought.  MALIS|LAW bloggers can see an example of this in practice in my December, 2009 post about a construction accident case that we settled for $900,000 in total benefits that we already published in this blog, “The Case of the Deleted Defect” .

HONESTY IS THE BEST POLICY; YOU HAVE NOTHING TO HIDE: Despite this pernicious practice, although in my experience these investigators may occasionally disclose someone working when they claim to be disabled, it’s never happened to me or my clients. As I advise clients and others often, an injured person’s best weapon in personal injury litigation is their honesty.  If you can perform an activity, admit it.  If you can’t, tell your lawyer what you can’t do and why.  Ultimately, frank and honest disclosure of the extent of your injury is always to your benefit, and will generally help your lawyer obtain a fair and full settlement for you.

Happy New Year, to clients, attorneys, and readers all!

RESPONSIBILITY IS A SOCIAL ISSUE: As I sit here reflecting on the lessons of the past and hopes for the future (a traditional New Year’s meal if there ever was one) I wanted to talk to you a bit about a concept near and dear to my heart — personal and social responsibility — the essential social contract that our system of civil responsibility is founded upon.

I am no paragon of virtue, but I recognize that I have a broader duty than to simply make money for my clients. I hope that my upcoming post on the ‘maligned medico’ makes it clear that I, like many of my brother and sister attorneys, see the other side of what I do (watch for that next week!). Of course there is more than one side to any story, or any case. And, of course, no case is perfect, which means, often, that there will always be defenses to any claim asserted by any party I sue.

HAVE WE LOST SIGHT OF ‘TRUTH’ IN OUR SYSTEM? — If there’s any theme that keeps surfacing in some of my major cases, though, it’s that of insurers, defendants and, sometimes, attorneys on the other side trying to seek any possible excuse for deflecting blame, instead of stepping up, assuming ownership of what they’ve done wrong, and trying, through the best means possible, to make things right. Over and over again, I’ve seen sued parties fail to produce, ‘lose’ or destroy evidence which would demonstrate their negligence or wrongdoing; pointed fingers in any other direction than their own; and, at times, negligent and liable parties even denying their own confessions of fault at some point after the accident.

At the same time, I must be as honest as I can and admit that I sometimes encounter this same kind of behavior from clients, especially the occasional ‘player’. As my article on ‘prior pain’ indicates, I preach to all of my clients that the truth will ’set them free’, and that fibbing or distortion, in the face of dedicated and careful investigation, will always harm them. Unfortunately, that advice isn’t always followed. Invariably, my prediction of the dangers of a client discrediting themselves by distortion generally come true. I feel little comfort in knowing that when it happens, ‘I told them so.’

I tell attorneys on the other side of my cases that ‘we’re all pilgrims in search of the truth’, and despite the hokiness (or pompousness) of that claim, I truly believe it. I govern my behavior with other attorneys, defendants and insurers on that principal, with the knowledge that my clients, both in the short and longer terms, benefit from that policy and from my reputation, which I hope is a strong one.

THE SOCIAL PRESSURE TO ‘SPIN‘:  While it would be easy to blame this kind of ’spin’ on defense attorneys or insurers (and believe me, I often do) I think that there’s another dynamic in play, that’s more social and socialized. Whether our political system, our media, or perhaps my profession have made this happen, I can’t say, but truth telling has become less a social imperative and more of a strategic weapon to be deployed (or withheld) at a party’s option.  Our system is designed to frustrate lies.  Sometimes, whether you’re on the inside (like myself) or on the outside, you have to ask; is it doing a good job?  Or has winning become so paramount in our society that we’ve made the truth forfeit to our chance of winning?

A HOPE IN THE COMING YEAR: From today’s public perspective on attorneys, this may sound ironic coming from a lawyer, but in the new year, I hope to see fewer insurers preaching ‘responsibility’ and more practicing it; fewer defendants ducking responsibility and more accepting it; and, overall, more seeking of the truth and less attempts at selective, self-advantaged distortion of it. Short term, some individual parties, whether claimants or tortfeasors, will be unfairly disadvantaged (although I highly doubt it!)   In the long term, though, I remain convinced that the wrongfully injured, and justice, will benefit most.

THE SETTLEMENT: MALIS|LAW, hired as trial approached, working with Attorney Dean Brunel,  has obtained a $285,000 settlement from a mental hospital on behalf of a cleaning contractor with a significant knee injury.  The cleaning contractor’s knee was significantly injured when he was assaulted by a psychotic patient who was allowed to walk freely in the corridors of a mental hospital while being admitted.

THE HOSPITAL’S NEGLIGENCE: The patient was being transferred from the open unit of the institution to the ‘closed’ unit on an involuntary admission, with a known history of violence, especially towards people of color.  The institution had few formalized guidelines for such transfers, developing them after the patient attempted to strangle my client as he cleaned the hallway.  As a result of the assault, my client suffered a stretched and torn ACL (anterior cruciate ligament) of his left knee, which an orthopedic surgeon addressed by reattaching and treating the fibers with heat.

CREATING A WINNER: Attorney Brunel approached me to try the case about one month before trial.  The client had not treated with a physician for several years, although he had complaints of knee pain.  Given the imminent trial, we mounted a ‘full court press’ to make the case trial ready.  I approached his original surgeon, who ordered a newMRI of his knee and found that the surgical repair, which had been performed with an experimental technique that has since been abandoned, had again failed, requiring additional procedures.  Within that month, I also developed expert psychiatric testimony of the hospital’s failure to follow proper procedures for communication of information about a committed patient between outpatient and inpatient wings of the hospital, which accounted for the lack of proper security and the patient’s being allowed in the vicinity of other persons at the hospital.  Literally on the eve of trial, I was contacted by the institution’s insurer, which agreed to settle.  The settlement was paid by the insurers for the institution; the admitting psychiatrist, who was sued for negligence; and the facility’s security company for negligent security.

A PAIN IN THE BACK: I’m not a doctor — I’m an attorney who represents injury victims.  However, for many, many years, first as an attorney for an insurance company, now for victims of negligence, I’ve dealt with the anatomy of the back, and particularly with an ongoing problem — the bulging or herniated disk (what some people call a ‘pinched nerve’ in their back.)   Here’s a working explanation of what happens:

A CLOSER LOOK: Take a look at this anatomic diagram, which shows the structures of the spine and spinal column from the side, or profile view, as well as from a cut-through view from the top of the spine, looking down.

Here's a view of a spine with a herniated disk shown from the side and in a cutaway view for illustration.

UNDERSTANDING THE ANATOMY: The spine is made up of bony segments, or vertebrae, which house and shield the spinal column, a bundle of nerves which conducts sensation and motor signals to various parts of the body.  This particular section is the lumbar spine, or the low back (the ‘bottom’ portion of the spine).  Everyone (with certain very limited exceptions) has the same number of vertebrae, occurring in the same order.  Each vertebral is numbered so that doctors can keep track.

THE DISK’S ROLE: The disks are jelly-filled spongy shock absorbers between the vertebrae that cushion the spinal column as you move and are jarred.  (In the diagram, they’re the greyish, rounded objects between the vertebrae).  Among other purposes, they prevent the spine from crushing the ‘nerve roots’, which are the branches that come off the spinal column, out through the spine openings, and radiate out to various parts of the body.

HOW A DISK HERNIATES, OR ‘BULGES’: When a person suffers an impact or trauma, they can wrench or compress their back, causing the disk  (think shock absorber) to ’squish’ outward or inward.  Since the outer surface of the disk is fibrous and tough, the disk can generally handle that and spring back.  However, sometimes the twisting or compression is so forceful that the disk’s outer fibers tear, and the inner ‘jelly’ escapes outward.  The disk will appear out of round and deformed, or ‘herniated’.  Depending on which physician you talk to, the terms ‘protruding disk’ and ‘herniating disk’ may be used alternately.

GETTING THE WHOLE PICTURE: The diagram shows a disc herniation at the space below the L5 vertebra.  You can see, in the right hand drawing, that the disk is protruding, or bulging outward.  In the cutaway view, (the middle picture on the right side) you can see that the disk has broken out of its round shape and is pushing forward.  Since the spine is closely ‘engineered’, there’s not a lot of room for this bulge, so that when the disk pushes out of its normal shape, or ‘herniates’, it can press on the nerve roots.  The results:  a distorted signal is sent back to the brain, resulting in the body experiencing pain, numbness, tingling or weakness in the area that the nerve root ‘feeds’ signals to.  (In the case of the L5 herniation shown here, the person experiencing the herniation would also tend to feel pain radiating down the back of their leg.  The side that experiences the herniation will likely experience the pain (a right sided herniation could produce pain or symptoms in the right leg; a left sided, the left leg).  With a lumbar herniation, this experience is often called ’sciatica’, since the nerve that radiates out from this area is called the sciatic nerve.

This is an overly simplified explanation; there’s lots more that goes into diagnosing, assessing and treating spinal injury. The body’s natural degeneration over time, or spinal abnormalities which you’re born with but which don’t surface until you’re older, can also cause this phenomenon, for example, and many people walk around their whole lives with protruding disks that, because of their own particular anatomy, don’t trouble them at all.   But it’s a useful one, and I hope that it helps your understanding of what’s involved in a disk herniation, and how it can affect you.

I promised you a rant from time to time; here’s one of my favorites, a critique of many of the common justifications for depriving victims of medical malpractice of their lawful right to be compensated as part of the pending national health reform legislation.  This White Paper is published by my good friends at the American Association of Justice, a trial lawyers’ organization that I proudly belong to.

“As enemies of health care reform spread lies and mistruths about medical negligence, a new white paper tackles the issue head-on, debunking the most common myths with sound science and research while refuting the hyperbole and empty rhetoric.

Five Myths About Medical Negligence, one in a series of reports from the American Association for Justice on this issue, examines the errors and faults behind the most commonly used talking points of health care reform opponents.

• Myth #1: There are too many “frivolous” malpractice lawsuits.

Fact: There’s an epidemic of medical negligence, not lawsuits.  Only one in eight people injured by medical negligence ever file suit.  Civil filings have declined eight percent over the last decade, and are less than one percent of the whole civil docket.  A 2006 Harvard study found that 97 percent of claims were meritorious, stating, “portraits of a malpractice system that is stricken with frivolous litigation are overblown.”

• Myth #2: Malpractice claims drive up health care costs.

Fact: According to the National Association of Insurance Commissioners, the total spent defending claims and compensating victims of medical negligence was just 0.3% of health care costs, and the Congressional Budget Office and Government Accountability Office have made similar findings.

• Myth #3: Doctors are fleeing.

Fact: Then where are they going?  According to the American Medical Association’s own data, the number of practicing physicians in the United States has been growing steadily for decades. Not only are there more doctors, but the number of doctors is increasing faster than population growth.  Despite the cries of physicians fleeing multiple states, the number of physicians increased in every state, and only four states saw growth slower than population growth; these four states all have medical malpractice caps.

• Myth #4: Malpractice claims drive up doctors’ premiums.

Fact: Empirical research has found that there is little correlation between malpractice payouts and malpractice premiums paid by doctors. A study of the leading medical malpractice insurance companies’ financial statements by former Missouri Insurance Commissioner Jay Angoff found that these insurers artificially raised doctors’ premiums and misled the public about the nature of medical negligence claims.  A previous AAJ report on malpractice insurers found they had earnings higher than 99% of Fortune 500 companies.

• Myth #5: Tort reform will lower insurance rates.

Fact:  Tort reforms are passed under the guise that they will lower physicians’ liability premiums. This does not happen. While insurers do pay out less money when damages awards are capped, they do not pass the savings along to doctors by lowering premiums. Even the most ardent tort reformers have been caught stating that tort reform will have no effect on insurance rates.

“All the facts and evidence show that tort law changes will do practically nothing to lower costs or cover the uninsured,” said AAJ President Anthony Tarricone.  “It’s no wonder the tort reformers, insurance lobby, and other corporate front groups have to gin up lies and phony stats, since no legitimate data or research supports their claims.  Our focus should be on reducing the 98,000 deaths by medical error that occurs every year, not limiting patients’ legal rights.”

As part of its ongoing series on the topic, AAJ earlier released Medical Negligence: A Primer for the Nation’s             Health Care Debate, The Truth About “Defensive Medicine,” and The Insurance Hoax: How Doctors and       Patients Pay for the Huge Earnings of Medical Malpractice Insurers.  These can be located at      www.justice.org/medicalnegligence.  Five Myths About Medical Negligence can be found directly at: www.justice.org/clips/Five Myths About Medical Negligence.pdf.

Torn Rotator Cuff

MALIS|LAW has obtained a stream of payments of over $700,000, along with waiver of a $210,000 workers’ compensation lien, for an electrician who injured her neck and shoulder after tripping over a floor hazard on a poorly lit construction site, even though the general contractor apparently attempted to ‘get rid of the evidence’ before it was observed by its own safety director.

AN ELECTRICIAN TRIPS AND IS HURT: My client was a 41 year old experienced female electrical worker assisting in the construction of a major addition to a Boston hospital.  While wiring an unfinished floor’s alarm system, she was walking with a spool of wire and tripped over bolt stubs protruding through the floor of a dimly lit corridor.  She fell forward into a pipe rack at the side of the hallway, injuring her left shoulder rotator cuff.  Within minutes of her fall, a crew of workers apparently descended on the accident scene, grinding the bolts level with the floor (leaving shiny patches on the concrete) and stringing new lighting in the hallway.  When the project safety director showed up at the accident scene, he observed a brightly lit corridor with orange paint splotches on the floor where the bolts had been.

THE INJURIES: My client suffered a torn rotator cuff immediately after the accident, which was surgically repaired.  The repair disclosed that the torn shoulder had obscured radiating neck pain into her shoulder caused by a disk herniation, which was surgically addressed by neck fusion.  We contended that she could no longer work in the construction trades, which required heavy exertion, which would cost her hundreds of thousands of dollars in future lost earnings from a highly paid and specialized trade.

OUR INVESTIGATION: Through two years of discovery and depositions, we were able to build a strong case that the general contractor and lighting contractor were negligent, including the following evidence:

• My client presented a co-worker and independent witness who both verified the presence of the bolts before and after the accident.
• Persistent document subpoenas and court orders produced ample records that the project lighting contractor had been criticized by the general contractor and its own inspectors for failure to replace burnt out project lighting promptly.
• A safety audit conducted two weeks prior to my client’s fall harshly criticized the cleanliness of the project’s walkways, citing multiple trip hazards and trash.
• A deposition of another worker disclosed that the bolts and poor lighting had caused another worker to trip days before, and that the worker had complained to the project’s safety director, who had failed either to note his complaint or to take action to remedy the hazard.
• Although no one came forward to disclose the workers’  grinding of the floor bolts and new lighting, my client’s project supervisor verified the presence  four shiny ground down bolts in the floor within 40 minutes of the accident, in a pattern which suggested that the bolts had been used to secure an elevator hoist (the elevators had been fully installed weeks before).
• The project safety director admitted that although he had investigated the accident scene, camera in hand, within 30 minutes of the accident, he failed to document conditions on the scene, although it was his and the general contractor’s policy that he do so.
• The general contractor had written a letter to all subcontractors weeks prior to the accident detailing poor safety conditions and threatening to backcharge contractors for correcting them.
• My client’s accident report was withheld for two weeks prior to disclosure to the project’s insurer, with no explanation of why the information was not immediately forwarded.

OUR STRATEGY: We used these facts to paint a picture of a poorly supervised and generally unsafe site, with the project owner and supervisors on notice of impending problems, and an embattled safety director new to the site and not up to speed.  These circumstances would lead a jury to infer that the accident was ‘covered up’ to avoid project controversy, supporting our claims of negligence.

PROVING DISABILITY: As to injury, the contractors and their insurers and attorneys contended that the Plaintiff’s injuries were largely healed and her complaints of pain were largely distorted.  An attempt to intimidate my client with a late-disclosed private investigation which purportedly showed that she was able to perform work was frustrated by a court order allowing the investigator’s deposition.  The investigator admitted (less than a week before a court-scheduled mediation) that he had not observed my client engaging in any substantial exertion, and that she had labored in picking up pieces of firewood that a delivery company had dropped in her driveway.

THE SETTLEMENT: At mediation, we were able to persuade my client’s workers’ compensation insurer to drop its right to be repaid $210,000 in compensation payments which my client had received, and to persuade the liability insurer to pay a stream of payments worth in total over $700,000 over a five year period.  These payments ennabled my client to retrain, and she now works for an electrical contractor in a supervisory position, without need for substantial exertion, at or near her prior pay level.

THE JUDGMENT:  MALIS|LAW recently obtained a final judgment of over $80,000 against a major supermarket chain for a shopper injured on a wet floor, prevailing despite five years of questionable tactics and an attempt to ‘rewrite’ a favorable medical report by a defendant expert witness.

THE FACTS OF THE CASE: In this slip and fall case, the shopper slipped and fell on water coming out from under a green mat placed up against the base of a refrigeration case.  Claiming supermarket negligence, we contended that the store’s employees had placed the mat over the leaking area either to conceal or absorb the leak rather than repairing the refrigerator.   The supermarket chain asserted that there was no negligence and disputed the causation of the plaintiff’s fall and the extent of her injuries.

THE HERNIATED DISK: As a result of the fall my client sustained what was initially believed to be a back sprain. However, an MRI conducted by Shields MRI revealed a lumbar disc herniation which compressed the nerve root which carried signals to her leg, causing radiating leg pain. My client complained of ongoing back pain which has not resolved, aggravated by exertion,  and causing interrupted sleep. She was assigned a permanent loss of function of 10-15% of her whole person by her treating physician.

PROVING THE CASE: During discovery the store’s attorney initially refused to produce an incident report prepared by the defendant’s store manager, which he had  used to prepare the manager for deposition.  We immediately filed a  Motion to Compel Production which also sought sanctions, and the attorney, to avoid a court order, voluntarily produced the report.    The report revealed that the store manager had observed water from an unknown source on the floor where the plaintiff fell at the time of her injury.  Despite this disclosure, the defendant insisted that there was no water on the floor; that if there was water the defendant was not responsible; that any water was not present long enough for the defendant to have notice of it; that the water did not cause the plaintiff’s fall; and that the plaintiff had suffered no real injury.

THE ATTEMPTED REVISION: Shortly before trial the defendant presented as an expert  the owner and supervisor of the facility where the MRI which confirmed Plaintiff’s disk herniation was taken .  The owner was the employer of the  radiologist who read the film and produced the report.  The owner was produced to testify that there was no abnormality which had been caused by the fall shown on the plaintiff’s MRI.  At the same time, the store and its attorney produced a report which was supposedly an ‘addendum’ to the plaintiff’s MRI original results.  This report, allegedly issued by the plaintiff’s radiologist, contradicted his prior findings, indicating no focal disc herniation and indicating that the Plaintiff was suffering only from, essentially,  ‘degenerative changes’.  The store did not call the original examining radiologist to contradict his earlier findings.  Nevertheless, we were ready for this tactic at trial, as it had been deployed by this same Defendant in another previous case. Despite the store having requested mediation at the commencement of litigation, the store only offered $3,000 in settlement and refused to negotiate further, and the matter proceeded to trial.

UNPRESERVED EVIDENCE OF THE EVENT: The case was tried over the course of two years on non-consecutive days due to conflicts in the presiding judge’s trial schedule in the Boston Municipal Court. At trial, Plaintiff produced a witness who verified that she saw the Plaintiff immediately following the fall adjacent to a refrigerator case lying in a large puddle of water coming out from under a green mat. The defendant’s store manager testified that the floor was regularly cleaned every hour, and that the water indicated in his report was in a different location than where the plaintiff fell.  However, on cross examination, the manager admitted that he had absolutely no memory of the event; that the described location was within a few feet of where the Plaintiff alleged falling; that the store has a camera provided to document such situations; and that he had decided not to take a photo of the area where the plaintiff fell.  We argued that the reason that the manager didn’t take the photograph was because he didn’t want to prove that his store was negligent, thus deliberately failing to preserve evidence.

MEDICAL EXPERT TESTIMONY: As to the victim’s injury, her treating neurologist testified over two half days of court time concerning the Plaintiff’s disk herniation, opining that it was causally related to the slip and fall accident, insisting, in the face of many hours of cross examination, that the abnormality was not the result of congenital or degenerative factors.  The neurologist also rejected Defendant’s spurious claims that her back pain was caused by an earlier incident in which the Plaintiff complained of leg pain in an isolated incident lifting luggage years before, or from an earlier accident in which she injured her back, treated for a few months, and was discharged.

THE WRONGFUL REVISION: As to the ‘correction’ to the MRI from Shields, the neurologist rejected the ‘newer’ addendum, noting that he himself had observed the herniation in review of the Plaintiff’s actual MRI films. The neurologist also observed that the ordinary practice in providing such ‘addenda’ is to provide them to the treating doctor within 30-60 days of an initial report.  The ‘addendum’ in question was prepared more than two years after the initial report, and was never provided to him by Shields MRI. This supported our argument’s contention that the amended report was a contrivance that was created after the defendant’s hiring of the radiologist’s employer, the owner of the facility, as an expert in the case.

JUSTICE PREVAILS: The trial judge rejected the Defendant’s expert testimony, and  found for the plaintiff in the amount of $35,000, with significant accumulated interest, for a total judgment of $65,000.  The defendant appealed the finding to the District Court Appellate Division, and the appeal was denied.  Defense counsel then sought a de novo trial before a jury in the Superior Court. One month before the re-trial, the supermarket chain’s in-house attorney directly contacted me and agreed to pay my client the amount of  the judgment, with accumulated interest, which by then was $85,000.

MALIS|LAW has obtained $487,500 for a hospital worker who injured her neck and shoulder when a hospital window tilted inward and fell on her.  We were able to obtain a settlement from the window manufacturer, designer, and three installation companies who worked on the window based on negligent design, manufacture and installation of the window even though the hospital had discarded the window, therefore throwing out the best proof of how the accident happened.

My client, a 41 year old inventory assistant, was opening a window in an employee break room when the window sash (the part we normally think of as ‘the window frame’) flew up out of her hands, fell inwards and struck her a glancing blow on the head, knocking her to the ground.  She sustained a cervical disc herniation, for which she underwent surgical fusion; a tear of her rotator cuff, with resulting frozen shoulder, again surgically treated; and was permanently totally disabled from work.  This incident was one of several window malfunctions occurring after a state hospital opted to replace permanent windows with swiveling replacement windows.  Unfortunately, the hospital decided to discard the window well in advance of our firm being hired, essentially ‘destroying the evidence’ of what had caused the window to malfunction.

Through careful investigation and extensive pretrial discovery and depositions, we were able to reconstruct the window failure, tracing the problem back to the window pivot at the bottom of the window sash and the locking clip at the top.  We initially sued the installer and manufacturer of the window, alleging negligent and defective design and manufacture, as well as negligent installation.

By comparison with window specifications produced by the window’s original factory designer to the actual window, we were able to prove that the factory which manufactured the replacement window purchased its locking clips from a different manufacturer from that specified, but didn’t change the tooling that drilled the holes.  The spring driven lock was therefore installed too far away from the edge of the window, and the locking mechanism would therefore not fully extend into the window channel, making the window unstable at the top.  Similarly, the manufacturer substitued a different ‘pivot bar’ at the bottom of the window with an inadequately threaded and secured locking screw, which would tend to strip and loosen, causing the window to lose contact with its spring counterweight on one side; fly upwards on the other; and leave its channel, resulting in the Plaintiff’s accident.  We were also able to show by deposition that the window’s manufacturer had no idea of the implications which their substitution of components had caused, and had done little to determine whether changing components would have changed tooling or manufacturing requirements prior to putting the changed window out on the market.

Through careful investigation and multiple depositions, we also discovered that there were additional servicing companies which were assigned to repair the subject window prior to the Plaintiff’s accident when it was binding and sticking, likely because of these defects, and that these companies should have detected the design and installation defect.   We added these companies, as well as the company which had initially designed the window 20 years before, as defendants.

The Defendants strongly disputed the extent of the Plaintiff’s injuries, claiming that her complaints of neck pain were vastly exaggerated, and that her shoulder injury was largely healed.  We were able to counter these arguments with strong medical testimony, as well as a comprehensive vocational report that proved that her limitations prevented her from re-entering the work force, supporting a claim of hundreds of thousands of dollars of present and future wage loss.

The case was settled prior to trial for $487,500, with the bulk of the funds coming from the window’s manufacturer for their variance from the window’s original specificaitons.