Medical 006 Version Four
Buy steno drill CDs at StenoDrills.com Medium to Difficult Version One is a full transcript. Version Two is a full transcript minus swearing, parentheticals, examination headers, and speaker identification headers. Version Three is just testimony. Version Four has changes to the actual testimony. Hard names and hard words are either removed or made easier. Version Five means all names are easy. Hard terms are gone. Version Six means only easy words. Q. Doctor, please state your name and business address for the record. A. Dr. George F. Ferguson. My business address is 202 Benson Avenue in Flint, Michigan. Q. Doctor, would you please give us a brief background as far as your educational background? A. I went to high school in the local city. I went to the University of Flint for undergraduate studies. I graduated from New York Chiropractic College in 1980. I’m a board certified member of the American Board of Chiropractic Orthopedists. I’m a Fellow of the Academy of Chiropractic Orthopedists. I’ve done numerous postgraduate studies in fields ranging anywhere from mostly orthopedic studies to industrial injuries. Q. What organizations or memberships do you have? A. I’m a member of the American Chiropractic Association. I’m a member of the Michigan Chiropractic Society. I serve presently as its president, and I have since 1991. I was previously the state secretary, a district director, a public relations chairman, as well as an alternate director. I’m also a member of the Foundation for Chiropractic Education and Research and the Daimler Institute of Occupational Health Management. Q. Are you a member of the American Medical Association? A. No, I’m not. Q. Why is that? A. Chiropractors are not allowed to be members of the American Medical Association. Q. In the course of your practice, have you had the opportunity to testify as an expert with regard to workers’ compensation cases or other cases involving medical problems? A. Yes, I have. Q. How often? A. I’d say in my eleven years of practice, this is about the eighth or tenth time maybe. Q. Doctor, you did not go to medical school; is that correct? A. No, I did not. I went to chiropractic school. Q. You do not hold yourself out to be a medical doctor? A. No, I do not. It’s against the law in Michigan for me to do so. Q. Do I understand that you are not board certified in the area of radiology? A. No, I’m not. Q. Would you agree with me that usually the area of neurology is used to read EMGs? An expert or a person who is board certified in the area of neurology reads EMGs. A. That’s not necessarily true. I know many non-board certified neurologists who continue to read them. Q. But that is the field that is usually connected with the reading of EMGs? A. Generally. Q. The field of radiology is connected with the reading of MRIs? A. That’s correct. Q. Thank you. Q. Doctor, with regard to a Mr. William Paar, did you have occasion to treat Mr. Paar? A. Yes, I did. Q. When was the first time you saw Mr. Paar? A. He was first seen in my office on September 18 of 1991. Q. At that time did he give you a history of any kind? A. Yes. He complained of pain, extreme pain in the lower back especially on his right side radiating to the posterior of the proximal lower leg. Pain was first incurred on Saturday, 9/14/91. It was gradual in onset and was incurred immediately following lifting during the course of his employment as a truck driver. Patient denied prior symptoms. Patient denied having similar symptoms in his past. His episode of discomfort on the day that I saw him was described as a continuous, sharp pain. It had been staying the same in intensity. It was aggravated by standing and sitting. It was relieved temporarily with the self-administration of Ibuprofen. It interfered with all of his activities. No previous treatment had been administered for the patient’s condition prior to consulting myself. He denied any other symptoms at that time. Q. Did you do any examination of him physically to determine whether or not there was any objective evidence of his pain, other than the history that he gave you? A. Yes, I did. Q. What treatment and what examination did you perform on that date? A. The examination revealed lumbar spine ranges of motion to be diminished, especially with flexion and extension, but also somewhat with lateral flexion in both planes. There was increased pain with coughing, sneezing, or pushing as would be indicated during a bowel movement. That’s caused by increased pressure of the fluids surrounding the spinal cord. Q. Please continue. A. Kemp’s test was positive on the right side. Straight leg raising was positive on the right at 30 degrees. Braggard’s test was also positive on the right. Reflexes were noted as right plus one, left plus three. The Achilles reflexes were also noted as right plus one, left plus one. Hold on a second. That doesn’t make sense to me. Let me go back. Correction on that is right plus one, left plus two. So my notes as indicated in your files are incorrect as I dictated them. Sensory changes were noted along the L5 nerve distribution and more specifically to the posterior of the knee and calf region. Point tenderness and muscular spasms could be noted from L3 to L5, as well as over the right side. Q. That was the first date that you saw Mr. Paar; is that correct? A. Correct, yes. Q. Did you continue to treat him after that date? A. Yes, I did. Q. What did you recommend at that time as far as treatment of his condition? A. At that time we began a conservative course of care, including electric muscle stimulation, heat compression, and manual manipulation to the spine. Q. Did you recommend that he seek any other treatment from any other physicians? A. Let me make a correction. I did say manual manipulation to the spine, but what I did mean to say was that we did light traction to the spine which is slightly different from manual manipulation. With regards to your question about ordering up other tests -- Q. Yes. And whether or not you recommended at that time that he see any other physicians. A. Well, I did a radiographic evaluation and judging by those findings, I felt it was necessary that he have a follow-up MRI study. Q. Was that eventually done? A. The MRI study was eventually performed, yes. Q. Who was that done by? A. MRI study was performed at the Medical Center of Flint on 9/24/91. Q. You received a report from the Medical Center of Flint? A. Yes, I did. Another note you may need to know is that that test was ordered on a stat basis prior to that; and the first attempt to have the patient evaluated, the machine was out of repair, and the test could not be performed. That’s why it took until 9/24/91 to have the test performed. Q. What were the results of that test? Q. Doctor, let me just follow up in terms of an introduction. In addition to the MRI, didn’t you receive a report from another physician who has read the MRI? A. Yes, I did. Q. Who would that have been? A. Mark B. Steck, M.D, indicating he is board certified. Q. Would you answer the question with regard to what the results of that MRI were please? A. The conclusion was a disc, grade 4. There was degeneration at L5-S1, and early narrowing at midline to the left. Q. Now, since September 1991 have you continued to treat Mr. Paar on a periodic basis? A. Yes. Initially, I saw the patient approximately three times weekly, and then gradually reduced the treatment frequency as the patient started to respond to my care. Q. Why did you refer him to the Work Therapy Institute? Maybe you can explain what the purpose of Work Therapy was. A. Work Therapy specializes in work related injuries, the rehabilitation of those injuries, as well as work hardening in an effort to return the patient to his previous employment. Q. Do your records indicate when he was the first referred to Work Therapy? A. I’m looking for it. I’m looking for the exact date. It was the Friday around December 9. Let’s see if I have a calendar here. That would be Friday, December 6. Q. Has he completed the program with Work Therapy at this time; do you know? A. Yes. He has to the best of my knowledge. Q. Now, in addition to yourself and the reference with regard to the MRI, were there any other physicians that treated Mr. Paar to your knowledge? A. The patient was referred to Dr. John Samms by myself. Q. When was that? A. 9/23. Q. So that was in the beginning of your treatment with Mr. Paar as well? A. Yes, correct. Q. Other than Dr. Samms, were there any other physicians that he was referred to for further treatment? A. Yes. Dr. David Thorn, a neurosurgeon. Q. To your knowledge, did Dr. Thorn perform any neurological studies? A. Quite honestly, I do not know if it was Dr. Samms who had ordered the tests, but an EMG nerve conduction study was performed and evaluated by Dr. Miles, M.D. Q. Did you get a copy of that report? A. Yes, I do have a copy of that also. Q. What is the result of that report? A. The impression is bilateral radiculopathies; and two, the second diagnosis is a poor paraspinal muscular relaxation. Q. When were those done? A. 10/17/91. Q. That was a report from Dr. Miles as you say. A. Correct. Q. Did you ever get any documentation, report, correspondence regarding Mr. Paar? A. I’m sorry. Could you repeat the question? Q. I’m asking whether or not you received any report or documentation regarding Mr. Paar. A. Yes, I did. Q. When was that? A. One letter dated from Dr. Thorn from November 5, 1991. Q. What was his report at that time? A. Would you like me to read the whole thing? Q. I don’t think we can read the whole thing. Maybe we can mark it as Plaintiff’s or Claimant’s Exhibit A, and maybe you can just summarize. A. His diagnosis is that of a herniated disc at L4-L5. Q. Do you know if Mr. Paar was on any medication for his condition? A. Yes. He was given various medications by the medical physicians he went to. The one I remember most, off the top of my head, was he was given a painkiller by Dr. Samms. Dr. Thorn, upon his evaluation, indicates through his letter that he was concerned with possible dependency on the drug and recommended slowly stopping. He also continued to take other medications. Q. Doctor, you said initially in September of ’91, you were seeing Mr. Paar on a regular basis, I believe, three times a week. A. Correct. Q. Did that eventually taper off? A. Eventually tapered off as the patient’s symptoms started to improve and tapered off considerably as we turned the patient over for rehabilitation at the Work Therapy facility. Q. When was the last time you saw Mr. Paar? A. 3/2/92. Q. Is he still under your care and treatment? A. No. Technically, we discharged the patient pending symptomatic problem rather than rescheduling the patient for treatment that may be unnecessary at this time. We are waiting to see how the patient tolerates his return to work, observe for symptomatic problem, and treat accordingly. Q. Is he discharged as being fully recovered so that he can return to the same employment that he was doing prior to the injury? A. No, he is not. Q. Could you tell us what limitations you put on his condition as far as returning to work? A. We have returned him to what we choose to call medium to heavy duty work which would limit the patient from any extreme, heavy lifting so as in an attempt not to aggravate the condition that he had been treated for. Should the patient respond to his return to work with relatively little symptomatic problem or no symptomatic problem at all, we anticipate that within one month we will return him to full regular duty. Q. But that one month period would be based on his returning to some sort of work activity to determine whether or not there would be a problem or gradually a strengthening of his muscles in the back in order to perform his work as he had done in the past before the injury? A. That would be based on his return to work at the job description that we spoke of before, medium to heavy duty work, the only restrictions being that of extremely heavy lifting. Q. Doctor, do you have an opinion with a degree of medical certainty based on your expertise and based on your evaluation of Mr. Paar and also based on all the reports that you had -- do you have an opinion with regard to his condition as it relates to his work? A. As he is presently? A. Yes. A. I would hesitate to give any opinion at this stage of the game since the patient hasn’t actively returned to work. I do not know whether the patient will be able to tolerate the job description that we have returned him to at this state of the game. We are hopeful that he will be able to, but there is no way of knowing until the patient actually returns and tries it out. Q. Doctor, what about an opinion with a chiropractic certainty as to the relationship between his injury and his work activity as he related to you in September of 1991? A. If the question is do I feel there is a causal relationship between his injury and what he reported to me at work, yes, I feel there is a causal relationship between the two. Thank you. Q. Now, Doctor, do you have bills with regard to your services rendered for Mr. Paar during the period of time from September through to the present? A. Yes, I do. Q. Can you tell us what the total amount that is still outstanding and due you at this present time: A. To date I’ve been paid nothing; so his current balance is that of $4000 including the charge for this deposition, I believe. I’m sorry. Let me review that. I take that back. The charge for the deposition is not included in this. Q. What would the charge for the deposition be? A. $500. Q. Doctor, I just have a few questions for you. I’m looking now at a document that was provided to us, I think, when you sent us other documents called a case history. It appears to be an information sheet that you have the patients fill out when they first come. A. That’s correct. Q. I noticed on this that it says referred by a Dr. Glass. Would you be able to describe how that referral came about? A. Quite honestly, no. I can tell you that Dr. Glass is another chiropractor. I really don’t know. Q. I notice also about three lines down from that it says previous chiropractic care. It’s marked yes on the form and says one year ago. Did you treat Mr. Paar previous to the time you saw him in September of 1991? A. No, I did not. Q. So you have no knowledge of this previous chiropractic care that is referred to on your sheet here? A. No, I do not. I did ask the patient if he had similar symptoms to his present complaint of which he indicated no to. Q. Now, I notice that, nature of injury, under that it says how the condition occurred. It says while driving truck. A. That’s the patient that filled that out, yes; to put it more fully: upon my questioning. And that’s reflected in my office notes of 9/18/91. Q. I also noticed another document that was sent to us which is a workers’ compensation questionnaire. Would that have been filled out at the same time as the case history was filled out? A. I’m glad you’ve got that because I don’t. You’ve got the only copy. Something has happened to my copy. If I can see it, I can refer to it. This is our form, yes. Q. Would that have been filled out at the same time as the case history was filled out by the patient? A. Again, it usually is, yes. Q. I noticed it wasn’t dated at the top. A. I noticed it also; that’s why I said it usually is. Generally speaking, we ask the patient to fill out a case history questionnaire with regards to their general status. And if there is more information required as a result of it being a work related injury, say, or automobile injury, we have additional information that is required; so we give them a second form to fill out. Q. I understand. Now, on your notes on September 23, 9/23/91, I notice that you have listed here that Mr. Paar’s former family physician, a Dr. Dean of Falls, Michigan, is shown in your notes. You have indicated that it was reported to you that Dr. Dean did not find the same symptoms that you did. Was that the report that was given to you? A. That’s correct. I followed up with my findings on the second time and confirmed again that my findings were correct and assuming that Dr. Dean’s findings were incorrect. Q. Was it Mr. Paar that reported these to you, Dr. Dean’s findings? A. I phoned Dr. Dean following Mr. Paar’s visit that day. Q. It was after that that you arranged for Mr. Paar to visit? A. Yes. Q. I noticed on your progress notes for October 2, 1991, you have a comment there that Mr. Paar had a problem because he was chasing one of his children around the house. Would you be able to tell us about that? A. To the best of my recollection, one of his children was misbehaving, and he attempted to grab his child as the child ran by him. And when he did, he felt an aggravation of the lower back condition that he had. | 