Posts Tagged ‘Back injury’

What Is a ‘Herniated Disk’ — The Case of the Damaged Disk

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.

Trial Update: Five Years, Two Trials, An Appeal, A Victory — The Case of the Revised Report

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.

Settlement Update: $4.1 Million Settlement For Construction Worker’s Spinal Injury After Staircase Falls — The Case of the Slumping Staircase

 

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.

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FAQs, Interesting News and Law-Related Rants

Daniel Malis uses this blog to publish answers to frequently asked questions, convey interesting news and make the occasional law-related rant. If you have any questions or want to contact Daniel Malis, please see the Contact page of the MALIS|LAW Website.