1 1 IN THE COURT OF COMMON PLEAS 2 CUYAHOGA COUNTY, OHIO 3 ANDREA M. PRENTICE, et al., 4 Plaintiffs, 5 JUDGE CELEBREZZE -vs- CASE NO. 390675 6 DEREK BOERNER, 7 Defendant. 8 - - - - 9 Videotaped deposition of ROBERT C. CORN, 10 M.D., taken as if upon direct examination before 11 Colleen M. Malone, a Notary Public within and for 12 the State of Ohio, at the offices of Highland 13 Musclo-Skeletal Associates, Inc, 850 Brainard 14 Road, Cleveland, Ohio, at 8:30 a.m. on Thursday, 15 April 12, 2001, pursuant to notice and/or 16 stipulations of counsel, on behalf of the 17 Defendant in this cause. 18 - - - - 19 MEHLER & HAGESTROM Court Reporters 20 CLEVELAND AKRON 21 1750 Midland Building 1015 Key Building Cleveland, Ohio 44115 Akron, Ohio 44308 22 216.621.4984 330.535.7300 FAX 621.0050 FAX 535.0050 23 800.822.0650 800.562.7100 24 25 2 1 APPEARANCES: 2 Jonathan D. Mester, Esq. Nurenberg, Plevin, Heller & McCarthy 3 First Floor 1370 Ontario Street 4 Cleveland, Ohio 44113 (216) 621-2300, 5 On behalf of the Plaintiffs; 6 William Scott Derkin, Esq. 7 Allstate & Encompass Staff Counsel The 113 St. Clair Building, Suite 525 8 Cleveland, Ohio 44114 (216) 771-3336, 9 On behalf of the Defendant. 10 ALSO PRESENT: 11 Peter Graves, Videographer 12 13 14 15 16 17 18 19 20 21 22 23 24 25 3 1 MR. MESTER: Just before we get 2 started with the deposition of Dr. Corn 3 today, we just want to get a few 4 stipulations memorialized. Scott, we 5 agreed, of course, we have a stipulation as 6 to the negligence of the defendant, 7 Mr. Boerner? 8 MR. DERKIN: Correct. 9 MR. MESTER: Okay. And that his 10 negligence was the proximate cause of the 11 accident? 12 MR. DERKIN: Of the accident. 13 MR. MESTER: Correct. 14 MR. DERKIN: Not the injuries. 15 MR. MESTER: Right. So we're 16 going to be talking here about the injuries 17 and the scope and extent. 18 And a further stipulation that all 19 of the medical bills and records are 20 authentic. I don't need to bring someone 21 in to authenticate them. 22 MR. DERKIN: Correct. 23 MR. MESTER: Okay. And further 24 that her wage loss, which I believe I 25 submitted to you in the amount of 4 1 approximately $675, is her wage loss the 2 days she missed since this accident. 3 MR. DERKIN: Correct. 4 MR. MESTER: Okay. That will do. 5 VIDEOGRAPHER: We are now ready to 6 begin the deposition. Will the court 7 reporter please swear in the doctor. 8 ROBERT C. CORN, M.D., of lawful age, 9 called by the Defendant for the purpose of direct 10 examination, as provided by the Rules of Civil 11 Procedure, being by me first duly sworn, as 12 hereinafter certified, deposed and said as 13 follows: 14 DIRECT EXAMINATION OF ROBERT C. CORN, M.D. 15 BY MR. DERKIN: 16 Q. Doctor, my name is Scott Derkin. I'm one of the 17 attorneys for the defendant in this lawsuit. 18 Would you start by telling the jury your 19 name, please. 20 A. My name is Robert Curtis Corn, C-O-R-N. 21 Q. And are you an M.D., a medical doctor? 22 A. I am. 23 Q. Are you licensed to practice medicine in the 24 State of Ohio? 25 A. Yes, I am. 5 1 Q. How long have you been so licensed? 2 A. Since 1976. 3 Q. Do you have a speciality in the field of 4 medicine? 5 A. I do. 6 Q. And what is that speciality? 7 A. My speciality is orthopedic surgery. 8 Q. Would you tell the jury what the speciality of 9 orthopedic surgery entails? 10 A. Orthopedic surgery is the branch of medicine 11 which involves the medical and surgical treatment 12 of diseases, disorders, injuries, and some tumors 13 involving the musculoskeletal system. That 14 includes problems with the bones, muscles, 15 tendons, joints and ligaments. We also deal with 16 some neurological conditions in which parts of 17 the bony anatomy or soft tissue anatomy may be 18 pushing or irritating a nerve. 19 We deal with all age groups from babies that 20 are first born to the oldest segments of our 21 society. So we cover a fair amount of problems 22 which may develop as a result of genetics, as a 23 result of life-style, as a result of aging and as 24 a result of injuries. 25 Q. Well, Doctor, let's go back to your education. 6 1 Where did you go to college? 2 A. I received my bachelor of science in biology from 3 the Albright College in Reading, Pennsylvania in 4 1971. 5 Q. And did you have further education after that? 6 A. I did. 7 Q. Where did you go after that? 8 A. I was enrolled in the Hahnemann University School 9 of Medicine. The name has changed three times 10 since then, it's now called the MCP Hahnemann 11 Affiliated Medical School, part of the Drexel 12 University in Philadelphia, Pennsylvania. I 13 graduated with my M.D. degree in 1975. 14 Q. And did you have further training as a physician 15 since then? 16 A. Yes. 17 Q. What training did you have since then? 18 A. I have completed the orthopedic surgical 19 residency at The Cleveland Clinic. I was at The 20 Clinic from June of 1975 to June of 1979 and then 21 I entered private practice in August of 1979 and 22 I've been in private practice for the past 21 23 plus years. 24 Q. So since 1979 you have been officially an 25 orthopedic surgeon, is that correct? 7 1 A. Officially, yes. 2 Q. Okay. And are you board certified as an 3 orthopedic surgeon? 4 A. Yes, I am. 5 Q. Would you explain to the jury what that means? 6 A. There is a process of certification that 7 practically all doctors go through. That's the 8 goal once you've passed your medical degree and 9 you passed your licensing exams that you want to 10 be certified in your subspecialty or speciality. 11 And that basically explains to your peers; that 12 is, other doctors, as well as to your patients, 13 that you've gone through a certain educational 14 process, you've gone through certain 15 examinations, peer review; that is, doctors 16 watching how you have performed, and then you 17 typically have to take a certifying examination. 18 With orthopedic surgery you -- we had to 19 complete a residency that is the postgraduate 20 training program; we had to be in the clinical 21 practice of orthopedic surgery for one calendar 22 year, one geographical location, that's when the 23 peer reviews took place, and then you'd sit for a 24 series of oral exams and written exams. 25 That was the criteria back in 1980. They've 8 1 changed substantially in that you can't take 2 boards now for two years. They want you to have 3 more clinical experience. But back in the olden 4 days in the early '80s, we -- once you passed 5 your exams and fulfilled those requirements, you 6 were permanently certified. It wasn't a 7 certification that expires as they do now where 8 you have to go through recertification. 9 Q. And are you currently board certified in 10 orthopedic surgery? 11 A. Yes. 12 Q. And does that give you some initials after your 13 name as well as M.D. then? 14 A. No. 15 Q. No? 16 A. Not that particular -- 17 Q. Okay. 18 A. I'm a fellow in the American College of Surgeons 19 which is a peer review membership type of thing 20 and those are some of the other initials I have 21 after my name. 22 Q. Are you currently affiliated with any hospitals 23 in the area? 24 A. Yes. 25 Q. And what hospitals would those be? 9 1 A. My primary affiliation is with The Cleveland 2 Clinic Health System hospitals. I'm at Hillcrest 3 Hospital and Euclid Hospital primarily. I also 4 have privileges at the, in the University 5 Hospital System at Richmond Hospital and Bedford 6 Hospital and also the Lake County Hospital 7 System. 8 Q. Are you a member of any medical societies? 9 A. Yes. 10 Q. And which would those be? 11 A. There are a fair amount of memberships. They 12 include: The American Medical Association; The 13 Ohio State Medical Association. We currently 14 have two Cuyahoga County medical societies that 15 sort of diverged for some political reasons not 16 medical reasons: The Cleveland Orthopedic 17 Society; The American Academy of Orthopedic 18 Surgery; The Orthopedic Research Society and a 19 number of other organizations. 20 Q. Have you done any teaching of medical students? 21 A. In my early half, 40 percent of my career I was 22 involved in the teaching programs primarily at 23 the Mt. -- the former Mt. Sinai Medical Center 24 which is nonexistent. I also maintained a 25 clinical instructor faculty status at the Case 10 1 University, Case Western Reserve University 2 School of Medicine. I'm a clinical instructor. 3 I, that appointment is still current, although I 4 don't do any active teaching of medical students 5 at this point in time. 6 I was also Chief of Orthopedic Surgery at 7 Huron Hospital from 1984 to 1992 and during that 8 time I was deeply involved in teaching the 9 residents, medical students. But I've been 10 devoting my time to my clinical practice since 11 that time. 12 Q. Have you written any articles or periodicals? 13 A. There are a series, I think there are 16 articles 14 in my CV. Most of those were done in the first 15 half of my career. I really don't have a lot of 16 time for writing at this point. 17 We see patients that occasionally get written 18 up by other doctors but I don't, I'm not involved 19 in publications. I just don't have the time for 20 it right now. 21 Q. And you are currently in the private practice in 22 the field of orthopedic surgery, is that correct? 23 A. Correct. 24 Q. And what is your office address? 25 A. My main office is 850 Brainard Road, Highland 11 1 Heights. I have a satellite office at the Euclid 2 Hospital and also in Sagamore Hills at The 3 Cleveland Clinic Meridia Medical Center in 4 Sagamore Hills. 5 Q. All right. Doctor, turning to the matter at 6 hand, Andrea Prentice, did you have an occasion 7 to examine her? 8 A. Yes. 9 Q. And what was the reason you examined her? 10 A. She was referred for an independent medical 11 evaluation. The evaluation took place in April, 12 late April, April 24th of 2000 and this was 13 specifically as a consultation evaluation, not 14 for treatment, about a motor vehicle accident 15 that occurred on October 23rd of 1997. 16 Q. Did you -- what's the first thing you did when 17 you saw Ms. Prentice? 18 A. Well, the first thing I do with any new patient 19 coming to the office is I take a medical history. 20 I try to figure out as many details as possible 21 about what the mechanism of injury was, what the 22 potential injuries could have been, what the 23 patient recalls. Sometimes it's a couple years 24 later and they can't remember all the details and 25 that's why I have to review the medical records 12 1 as part of these evaluations to fill in the 2 blanks, so to speak. I don't expect anybody to 3 remember these kind of details. 4 She described the mechanism of her injury; 5 her care and treatment; what was done for her. 6 She could not remember all the dates and times, 7 and those were in my report eventually filled in 8 by a review of the records. 9 She had seen -- 10 Q. Well, did you review any records in addition to 11 taking a history of her? 12 A. Yes. 13 Q. What records did you review? 14 A. The records reviewed were those from 15 Dr. Alan Hirsch, I believe that's her medical 16 doctor; The Cleveland Therapy Center and the 17 Solon Therapy Center, it's part of the same 18 organization; Beachwood Orthopedics and 19 Dr. Gabelman, including the results of the MRI 20 scans; the MagnaTech Imaging Center, including 21 the actual scans that were done and the two she 22 had, a neck and back done back in 1998 and in the 23 year 2000 she had a repeat of her back, those 24 results and the actual scans were reviewed; and 25 there were some recent records after my 13 1 evaluation from Dr. Gabelman's office that were 2 forwarded. 3 Q. Okay. When you say you actually reviewed the 4 films, you looked at the MRI itself, you didn't 5 just rely on a report, is that correct? 6 A. I looked at the report and I actually reviewed 7 the films that were generated by the x-ray 8 facility. 9 Q. Would you tell the jury what history Ms. Prentice 10 gave you? 11 A. She presented the office with a history of being 12 a driver and sole occupant of a 1995 Chevrolet 13 Corsica that was involved in a rear-end and 14 front-end collision; in other words, she had a 15 car stopped in front of her, she was the second 16 car back, a car hit her, forced her car into the 17 car in front, so she was thrown forward and 18 backwards as part of the mechanism of injury. 19 She does recall sliding forward and hitting 20 her knees on either the dashboard or steering 21 column; the seat track broke, according to her 22 history; the car was drivable and she drove home 23 and didn't have any immediate medical attention 24 that day. 25 Q. Did she tell you about when she first started 14 1 having pain or difficulty? 2 A. As typical for these types of injuries, the pain 3 gradually develops. If it doesn't happen 4 instantaneously, meaning a fracture or a complete 5 disruption, it usually worsens over the first 24 6 hours. The stretching, pulling type of mechanism 7 typically is worse over the next 24, sometimes at 8 48 hours it sort of crescendos, and that was the 9 similar type of history that she presented. 10 She began having increasing stiffness in her 11 neck and spine. She had difficulty holding her 12 head up and that was a pretty typical history. 13 Q. Did she seek medical treatment at that point? 14 A. Ultimately she saw Dr. Ross who had some x-rays 15 taken and she only saw him on one occasion but, 16 yes, she did ultimately seek medical attention. 17 Q. After she saw Dr. Ross did she have subsequent 18 medical treatment? 19 A. Yes. 20 Q. And could you describe that for the jury. 21 A. Although I don't remember the exact dates, she 22 was referred to the Cleveland Therapy Center and 23 Solon Therapy Center, which are the same types of 24 groups but different offices. This is an 25 organization that does primarily passive physical 15 1 therapy. In other words, you go in and they do 2 things to you, heat, massage, ultrasound, those 3 type of treatments. And she went through over 4 the next probably three, four months, although I 5 don't have the exact dates in front of me, until 6 she eventually sought the attention of an 7 orthopedic surgeon, Dr. Gabelman, who was her 8 subsequent treating doctor. 9 But during this time period, she went through 10 about 19 of these passive physical therapy 11 sessions and I believe they were probably, 12 although again I don't have the dates, over a 13 block of time greater than three or four weeks, 14 which is the typical time frame that this type of 15 treatment is used effectively. 16 Q. Doctor, while we're on that topic, do you have an 17 opinion as to whether or not more than three or 18 four weeks of this type of physical therapy is 19 reasonable and necessary for this type of injury? 20 MR. MESTER: Objection. 21 A. In my clinical practice, I find that passive 22 therapy, again this is the initial phases of a 23 rehab program after an injury. After three or 24 four weeks of just passive therapy, if that 25 hasn't helped dramatically, then it should be 16 1 either discontinued or modified. Again, I don't 2 know the time frame, but if you assume two to 3 three sessions a week for three or four weeks, I 4 would say ten to 12 sessions would be the typical 5 prescription I would write and leave it up to the 6 therapist at that point in time to start an 7 active exercise program. 8 If that hasn't helped by that time in totally 9 eliminating the problem, then you've got to 10 switch and do something else. So, yes, I agree 11 that after three our four weeks I think if it 12 hasn't helped by that point, it's not going to 13 help. 14 Q. Doctor, did -- according to the history, did 15 Ms. Prentice see another doctor after the 16 Cleveland Therapy? 17 A. Yes. 18 Q. And who was that? 19 A. She subsequently was referred to Dr. Edward 20 Gabelman who's an orthopedic surgeon that 21 practices in Beachwood, Ohio. 22 Q. According to the records that you reviewed and 23 the history that you took, what sort of treatment 24 did he give her? 25 A. Well, Dr. Gabelman is the same kind of doctor I 17 1 am, a specialist, so he's better at isolating and 2 trying to figure out the whys and not just treat 3 symptoms but try to figure out why the symptoms 4 may have been there. And this is what we do as 5 orthopedic surgeons. Part of what he did for her 6 after the initial examination and review of the 7 records that he had, that had transpired, he 8 took -- 9 Q. Doctor, let me interrupt you for one second. Do 10 your records show when that initial examination 11 was? 12 A. Yeah, March 6th of 1998, about four months after 13 the accident. 14 Q. All right. Please continue. I'm sorry. 15 A. At this point in time there was some improvement. 16 In other words, the passive therapy had helped 17 her neck. There was no longer neck pain. Her 18 back pain was, low back pain was improved but not 19 eliminated. He still -- he took a history and 20 there was, the pain was intermittently severe, it 21 was worse with weather changes and certain 22 postural positions such as sitting. 23 But fortunately, there was no what we call 24 neurological type of pain; that is, any pain that 25 may have been from an irritation of a nerve or 18 1 pressure on a nerve and this is pain within a 2 certain pattern, it's pain that follows certain 3 descriptions, usually numbness, tingling, a 4 deadening feeling, paresthesias, which is like if 5 your arm is falling asleep or hitting your crazy 6 bone type of pain. Fortunately none of these 7 were present. 8 No, there was no problems with her bowel 9 control or bladder control so there -- 10 Q. I'm sorry, what is the significance of that? 11 A. Well, these are all things that we are concerned 12 with. Whenever there's a spinal injury, this is 13 one of the things we want to eliminate. We want 14 to eliminate the more serous things first. And 15 by asking certain questions and finding out 16 certain responses, we can eliminate some 17 diagnosis. Most of the diagnoses we make are, at 18 least initially, are by the history. We get a 19 really good idea where the patient's coming from 20 or what the patient has wrong with him by the 21 time we finish our history and then we go into 22 examinations and other diagnostic testing, which 23 he also does. 24 Q. Just to go back just to be clear on this, on the 25 March 6, 1998 visit to Dr. Gabelman, she did not 19 1 have neck pain at that time, is that correct? 2 According to the records that you reviewed and 3 the history that you took? 4 A. The neck was no longer bothering her and her low 5 back was somewhat improved. 6 Q. Was anything else examined by Dr. Gabelman at 7 that time? 8 A. He also examined her left knee. She was wearing 9 a, she called it a knee brace, but it sounded 10 like it was an elastic type of support on her 11 knee. He took a past medical history and she had 12 never had any previous problems in this area. 13 And his initial impression was that she had a 14 sprain to the back and a contusion or a blunt 15 injury to the left knee. 16 Q. Doctor -- I'm sorry. 17 A. And that seems to be an appropriate working 18 diagnosis based on the history that she 19 presented. 20 Q. Did Dr. Gabelman order any diagnostic tests at 21 that time? 22 A. Yes. 23 Q. And what sort of test was that? 24 A. He had an MRI at his office done on March 14th of 25 her left knee and this was normal. He also 20 1 started her on a more active physical therapy 2 program which was more appropriate than the 3 passive treatments that we talked about before, 4 and he also gave her a TENS unit, which is a 5 transcutaneous nerve stimulator, it's to control 6 pain without medications. This was working for 7 her. It is a modality that is commonly employed. 8 Some people it works for, some people it doesn't. 9 In her case it was helpful. 10 Q. Doctor, you referred to an MRI. Would you 11 explain to the jury what that is? 12 A. There are a number of ways of imaging the human 13 body. I think the most common way we think of is 14 a regular x-ray. In this type of study, a short 15 blast of radiation, radiation energy is shot 16 through a portion of or part of the, part of the 17 body part is adsorbed by soft tissue and bone and 18 that absorption is recorded on a photograph type 19 of plate. We've all seen x-rays. That's how 20 x-rays are generated. 21 The MRI is a whole different technology. The 22 body or part of the body is placed into a large 23 electromagnet, and a significant magnet in the 24 newer machines, and with a combination of 25 software and different frequency radio waves in 21 1 this magnetic field you find that the various 2 concentrations of water show up differently 3 depending on the software program. So this is a 4 completely computer generated image and, 5 therefore, it can be manipulated and cut in 6 different directions and three dimensionally 7 reconstructed. So it's a marvelous tool for 8 looking at the details of the musculoskeletal 9 system, especially things that can't be seen by 10 x-ray. 11 X-ray we basically see soft tissue shadow and 12 bone, whereas an MRI we see soft tissue. We 13 actually can see ligaments, you can actually see 14 circulation through the ligaments and major blood 15 vessels provided you're using the right program. 16 You are -- we can see the discs, we can see 17 nerves, we can see different concentrations of 18 fluid. So it gives us a much better picture of 19 abnormalities that are hidden by standard x-ray 20 techniques. So that's essentially what an MR 21 scan is. 22 Q. Doctor, according to the records and the history, 23 did she have any further visits with 24 Dr. Gabelman? 25 A. He saw her periodically, I think there was four 22 1 additional visits through 1998 and I believe that 2 these were concluded by the fall of 1998. During 3 that time, she had additional scans; she had a 4 neck scan MRI and a low back scan. These were 5 done at the MagnaTech Imaging Center. 6 But once that treatment -- it didn't appear 7 that she had any medical care, at least in the 8 records that I saw, from fall of 1998 until 9 middle, mid/late April of 2000. So about a 10 year-and-a-half later. 11 Q. Now, Doctor, is the MRI of the cervical spine 12 that was done at that time, do you see any 13 indication why that would have taken place? 14 A. I'm not entirely clear why that was performed. I 15 can understand the back scan because she was 16 having, that was where her persistent symptoms 17 were. But the neck scan, this was something that 18 was improving. There was no neurological 19 deficits and there's really not a clear 20 explanation in Dr. Gabelman's records why he 21 proceeded with the neck scan. 22 So I would say the knee scan was probably 23 indicated, although without any kind of symptoms, 24 I can't state that I would have done it at that 25 point in time, but I don't have any medical 23 1 criticism of that. The neck scan, I don't think 2 I would have done. I'm not sure why that was 3 done. The low back scan, at least the first one, 4 I have really no problem with from the medical 5 standpoint, it was probably medically related to 6 the symptoms and, given the same scenario and the 7 persistent symptoms, I probably would have 8 ordered an MRI of her lumbar scan. I'm not sure 9 I would have ordered one of her knee and I 10 definitely wouldn't have ordered on her neck. 11 MR. MESTER: Objection. Move to 12 strike. 13 Q. So the one that was done on her neck, can you 14 state to a reasonable degree of medical 15 probability whether that was necessitated by this 16 accident, in view of the fact that the -- she 17 wasn't having symptoms when that happened? 18 A. In my opinion, the neck scan was not related to 19 her symptoms nor related to the accident other 20 than by the history that her neck was injured. 21 But there was really nothing suspicious, no 22 lingering symptoms, certainly no neurological 23 symptoms that I would have -- I would not have 24 gotten an MRI on the basis of how her, she was 25 present, how she presented on her knee or her 24 1 neck. Her low back is a different, different 2 situation. 3 Q. What were the results of those MRIs, Doctor? 4 A. The knee scan was normal; the neck scan 5 essentially was normal; there was one level where 6 she was showing a little bit of wear and tear, 7 which is really not uncommon in someone in her 8 40s; she had a very minor disc abnormality at the 9 C5-6 level which is where the neck area typically 10 shows some abnormality. 11 The low back scan was sort of interesting 12 because there was a, it basically showed some 13 minor disc disease in the two lower levels at the 14 4-5 level. Although there was no compression of 15 the nerve roots or the spinal cord, there was a 16 slight bulging or herniation at that level on the 17 subsequent MRI that had shrunk and, therefore, in 18 my opinion it wasn't a traumatically induced disc 19 herniation but probably just a bulge or the way 20 the machine took it. Because typically they 21 don't get better if there's a traumatic disc 22 herniation. But it did show that there was an 23 abnormality in the first scan. 24 Q. And that was sometime in 1998, that scan? 25 A. September, I think it was September 30th, that's 25 1 the -- I looked at these scans earlier today and 2 I think it was the 30th of '98 that the neck and 3 the back scan were done. 4 Q. You said there was a subsequent scan of the low 5 back? 6 A. I'm not entirely clear why this was done and it's 7 not clear in Dr. Gabelman's records why this was 8 necessary, but in April of, I can't remember the 9 exact date, April of 2000 when he saw her again, 10 this was shortly before I saw her, that she had 11 a -- or maybe it was shortly afterwards, but 12 around the same time I saw her, another MRI was 13 ordered, a follow-up MRI, and it was also done at 14 MagnaTech and that was not as abnormal as the 15 first scan was that was done in September of 16 1998. 17 So there was some objective improvement, you 18 know, which is, it's always hard to interpret why 19 there was improvement in something that was 20 suspected to be caused by an accident or an 21 injury, but there was an improvement noted on the 22 second scan. And again, at the time of the April 23 2000 visit with Dr. Gabelman, there wasn't any 24 neurological deficits, there wasn't any 25 neurological injury, there wasn't any 26 1 neurological complaints, and yet another MRI was 2 done and that was not entirely clear why that was 3 ordered. 4 Q. Was there any other history that you took from 5 her? 6 A. We discussed her past medical history. She had 7 been in a previous accident and she was in a 8 subsequent accident in 1999 which she described 9 as a rear-end collision. She didn't claim to 10 have an injury related to the 1999 injury and I 11 don't believe she had any treatment related to 12 that accident as well. 13 Q. When you saw her on the date you examined her, 14 did you ask her what her symptoms were? 15 A. Yes. 16 Q. And what did she say? 17 A. For the most part her neck and knee symptoms were 18 better. She had off and on days where she would 19 have a stiff aching pain in her neck related to 20 cold weather and damp weather, working at a 21 computer for long periods of time she felt her 22 knee was stiff. This was not associated with any 23 neurological symptoms, as I previously discussed. 24 Her knee occasionally gave her some aching pain 25 with weather changes. But for the most part, she 27 1 didn't feel it was necessary to be treated for 2 these things. 3 Her low back still remained in the area of 4 complaint. Again, stiffness, tightness are the 5 words she used. Occasionally she would wake up 6 with a backache. Certain positions that she 7 would get into seemed to aggravate her back. She 8 always felt some sort of discomfort. It was more 9 intense when she was bending over, such as 10 reaching into a file cabinet. This is mostly on 11 the left side in the midline and in what she 12 called the tailbone region. This is in the lower 13 section of the spine, almost the pelvic level of 14 the spine. 15 Sitting too long, standing too long seemed to 16 aggravate it. The pain tended to be relieved 17 with a back brace, which she used at night after 18 work. She was currently employed in the same 19 position she was prior to the accident. Lying on 20 the floor, lying with a pillow between her knees 21 seemed to relieve some of her pain. Using the 22 TENS unit seemed to relieve her pain. 23 I do not believe she was taking any 24 medication on a routine basis. 25 Q. Doctor, now just so we're clear, these complaints 28 1 you just reviewed for the jury, these are things 2 she's telling you? 3 A. Yes. 4 Q. These are not your findings that you had at this 5 point? 6 A. Well, these are -- I asked her, how do you feel? 7 What's still bothering you? And those are the, 8 that is, those are the complaints that she 9 registered. 10 Q. What's the next step that you took in doing your 11 review of Ms. Prentice? 12 A. I then did a physical examination. 13 Q. And of what did that consist of? 14 A. This was a standard orthopedic exam of the neck, 15 upper extremities, low back, lower extremities, 16 hips, knees, and neurological evaluation. 17 Q. And what did the examination reveal? Let's take 18 the neck, first of all. 19 A. Again, I could go through the whole exam, but 20 it's probably very similar to the exams that 21 Dr. Gabelman may have discussed, I'm not sure, I 22 never read his trial testimony, but I went 23 through range or motion, muscle testing, muscle 24 measurements, neurological examination, muscle 25 strength testing. All of these were normal. She 29 1 had full mobility of her neck; she had 2 unrestricted motion; she had no signs of muscle 3 irritation or inflammation. 4 Nothing objective; nothing that I could feel, 5 touch, measure or document. So her upper 6 extremity and upper back and neck really examined 7 normally. I couldn't find anything wrong. I 8 mean, it was just a textbook type of exam. So 9 objectively, she had recovered from her neck. 10 She still had some off and on complaints, but I 11 couldn't find the reason why on my examination. 12 Q. And did you do an examination of her lower back 13 then? 14 A. Yes. 15 Q. And what was that? 16 A. Her low back did show a mild amount of stiffness. 17 She had over 90 percent of predicted range of 18 motion, but she was a little hesitant in 19 completing that range of motion. Lateral bending, 20 rotation were normal but the extremes of arching 21 her back and bending forward were very minimally 22 limited. Still within a normal range but not as 23 normal as the neck range of motion. 24 The hips and knees examined normally. There 25 was no objective residuals of her knee injury. 30 1 Neurologic examination was normal. There was no 2 signs of muscle atrophy or muscle wasting or 3 muscle favoring. That's basically her low back 4 was a little, teeny bit stiff, and that was 5 really all. Fortunately, there were no signs of 6 any long-term irritation to the -- of the nervous 7 system or spinal nerves, it was just some 8 postural stiffness, and most of this was 9 subjective stiffness. 10 Q. "Subjective" meaning what she's telling you? 11 A. Meaning, you know, I don't like to hurt people on 12 exam, especially when I only see them on one 13 occasion, so I just, I see how far they can go 14 within what they consider a range of comfort. I 15 don't ask them to go beyond where they feel 16 comfortable, I ask them to just go as far as they 17 can. And she had not 100 percent but well over 18 90 percent, so there was a slight degree of 19 favoring and I don't know why, you know, she says 20 it hurt. I have no reason not to believe that it 21 was uncomfortable. It may have exceeded what she 22 does in her normal day's activities, but that's 23 what the response was at the time of my exam. 24 Q. And just so we're clear, when you talk about a 25 neurological examination, what's the significance 31 1 of that, what's the importance of that? 2 A. Well, again this is what we worry about. When 3 you hear about an injury to the spine, what you 4 want to rule out first or what you want to 5 eliminate first as a physician is you want to 6 eliminate a source of injury which is typically 7 permanent to the spinal cord. The spinal cord is 8 very, very sensitive to pressure, bleeding, 9 irritation, inflammation and pressure. So those 10 are the things you want to eliminate first. 11 And that's why, you know, in the emergency 12 room there's a set trauma protocol, people are 13 immobilized at the time of an accident when they 14 are conveyed by ambulance. I mean, there's a 15 very set, almost universally, certainly United 16 Stateswise criteria, a standard of care for an 17 injured spine and you don't know the extent of 18 injury. So that's what -- there's -- we like to 19 rule out or make sure they don't have this. 20 One of the tip-offs of neurological 21 inflammation, irritation or pressure are the 22 types of symptoms the patients have. If they 23 don't have those symptoms, then we look for 24 abnormalities, inability to detect sensation, 25 motor testing, strength testing, certain 32 1 reflexes, you know, pretty, everybody is pretty 2 much familiar with the knee jerk, you know, 3 tapping a hammer right below the kneecap causes 4 the leg to kick out. There are five or six other 5 critical reflexes that we test, as well as 6 testing certain motor or muscle groups. 7 And this is all part of the neurologic 8 examination to ascertain whether there was any 9 direct injury to the nervous system, any 10 prolonged injury or any inflammation within the 11 neurological system. 12 So I guess that's sort of a long-winded 13 answer, but that's why all these nerve questions 14 are important and why in our clinical practices 15 this is what, this is one of the things that may 16 determine an injury, and something that may need 17 to be treated a little bit more aggressively. 18 Q. And your, again, your neurologic examination of 19 Ms. Prentice's low back was normal, is that 20 correct? 21 MR. MESTER: Objection. 22 A. It was normal. It was always normal. It was 23 normal with Dr. Gabelman, it was normal with me. 24 There was never any suspicion of a lesion, a 25 lesion or a mass effect on the spinal cord or 33 1 spinal nerve roots. 2 Q. All right. Doctor, after taking the history and 3 reviewing the records and performing a physical 4 examination yourself on the patient, did you come 5 up with an impression or a diagnosis as to what 6 she was actually suffering on the day that you 7 saw her? 8 MR. MESTER: Objection. 9 A. Yes. I did have an impression after the history 10 and physical examination. 11 Q. And what was that impression? 12 MR. MESTER: Objection. 13 A. My impression was that on the basis of her 14 history and the basis of what she told me and the 15 basis of my examination, she was injured. The 16 injuries that she sustained were probably that of 17 a soft tissue stretching or pulling injury of the 18 ligaments and/or muscles of the neck and low 19 back. She also probably sustained a contusion or 20 a blunt injury to her knees, primarily the left 21 knee which is the more persistent of the two. So 22 that was my impression of what she had 23 originally. 24 By the time that I saw her, her neck had 25 resolved, neck injury had resolved, I should say. 34 1 Her knee injury had resolved and other than some 2 minor stiffness in her low back, the bulk of her 3 spinal lower back injury had resolved. 4 Q. As far as the MRI results of her low back, what 5 did that show? 6 A. Well, the MRI, as I briefly discussed earlier, 7 was very minimally abnormal in the neck and it 8 was minimally abnormal in the low back in the 9 initial study that was done in 1998. 10 One of the hardest things in medicine is to 11 find an abnormal value or an abnormal finding on 12 a scan or x-ray and try to determine what that 13 came from or why that occurred. 14 There have been, in the first ten years that 15 the MRI was used, was being used the statistics 16 of spinal surgery increased by almost 180 17 percent. In other words, the MR was showing 18 abnormalities that we couldn't see before and the 19 spinal surgery rate across the United States and 20 Canada and really across the world increased 21 exponentially. The patients weren't getting any 22 better but the surgical rates were going higher. 23 So what they, what was designed was a number 24 of experimental studies in which they tried to 25 determine what is the etiology or what is the 35 1 statistical presence of abnormalities on MRI of 2 normal individuals; that is, individuals that 3 were never hurt, never injured, considered 4 themselves normal and never had a complaint. And 5 they got normal volunteers to undergo MRIs. 6 They've done repeat studies. They've done 7 this in the low back, they've done this in the 8 mid-back, now in the neck and also in the 9 shoulder, and they found a rather alarming 10 statistic in people that considered themselves 11 normal: Approximately 60 percent of all 12 individuals walking around have at least one disc 13 that's abnormal by MRI, and they may be totally 14 asymptomatic, no symptoms, no idea that they were 15 abnormal; thirty percent of the population, and 16 these are the generally accepted statistics at 17 this point in time, have two or more discs that 18 may be abnormal and are perfectly normal. 19 Perfectly normal clinically, they feel they're 20 normal and they never sought any attention for 21 their back. 22 So that causes a dilemma. That causes a 23 problem because we see abnormalities in low 24 backs, people that may have injured their backs, 25 may have injured their necks and we see abnormal 36 1 findings. And the hardest thing is saying where 2 did those come from? You know, are they related 3 to an injury? Are they related to a specific 4 event? Or are they related to these general 5 statistics in which a large segment of the 6 population shows some disc abnormalities? 7 And this is where the symptoms, the medicine 8 aspect comes in, in that there's such a high 9 percentage of normal individuals that had disc 10 abnormalities, including minor bulges and minor 11 herniations that are unrelated to trauma, we see 12 an abnormality and we have to determine whether 13 that abnormality from a legalized, a legalese 14 term; that is, 51 percent chance or better, is 15 this from this particular trauma or is it from 16 some other source? 17 If there's a dramatic change in the patient's 18 history, let's say they were fine, they have an 19 injury to their spine and they get specific 20 complaints; that is, specific complaints of a 21 disc herniation, numbness, tingling, burning with 22 a very specific distribution, then you can say, 23 you know, there is a reasonable cause and effect 24 relationship between this abnormal finding, this 25 injury and the patient's clinical presentation. 37 1 When you have someone such as Ms. Prentice 2 who has, did have a soft tissue injury, this was 3 a documented injury, months after the injury she 4 has an MRI, it shows an abnormality, is that MRI 5 abnormality causing the pain? Is that MRI 6 abnormality caused by the injury? Or can you 7 state whether that was or it wasn't? And I guess 8 that's the real challenge and that's where the 9 medical opinions come in and that's where the 10 history is really important. 11 So I guess that's a long-winded answer but 12 the MRI did show some abnormalities and the 13 question is what caused those abnormalities. 14 MR. MESTER: Objection. Move to 15 strike. 16 Q. Can you describe the abnormalities that were 17 found in this patient on the MRIs? 18 A. Again, the neck showed some minor abnormalities. 19 I'm not sure exactly why that scan was even done 20 in that there was resolving symptoms but that 21 was, there was some minor abnormalities and I 22 don't know what caused it. I can't state there 23 was any specific etiology within a reasonable 24 degree of medical certainty that caused that 25 abnormality, that minor disc bulge at the C5-6 38 1 level, I don't know what caused it. And I can't 2 state what caused that and be medically 3 reasonably assured that that's correct. 4 And my opinion is the same for her low back. 5 Yes, she has an abnormality. I probably would 6 have gotten the first scan. I probably would not 7 have gotten the second scan. The second scan 8 showed the abnormalities improved from the first 9 scan. 10 So again, what caused the abnormalities that 11 were seen in the first scan, the minor disc bulge 12 at 4-5, minor disc herniation, I don't know. I 13 don't believe -- I can't state within a 14 reasonable degree of medical certainty it was 15 from any particular incident of trauma, 16 especially that we know that it's gotten smaller. 17 So again, I don't know what caused that. And 18 I can't state that any, this accident caused that 19 or any particular event caused that. 20 Q. Now, Doctor, when we talk about a bulging disc as 21 opposed to a herniated disc, are those terms of 22 art, do they have meaning or are those terms just 23 used by one doctor or by another? 24 A. Usually within the five millimeter range, or 25 slightly more than a quarter of an inch, it's 39 1 usually considered a bulge. Bulge and herniation 2 are typically used interchangeably and sometimes 3 bulging is used beyond that point. 4 It's, there are a number of words that can be 5 used to describe a physical observation and 6 fortunately or unfortunately in medicine we're 7 not real specific with that and sometimes they're 8 called bulges and sometimes they're called 9 herniations. 10 But any time there is the radiological 11 abnormality of a disc that has gone beyond the 12 certain place, whether you call it a bulge or a 13 herniation it's the same thing, it's abnormal. 14 It's just not a normal finding. 15 Q. How does a bulging disc or a herniated disc cause 16 symptoms in a patient? 17 A. If there is a traumatic disc herniation -- 18 Q. "Traumatic" meaning caused by an accident? 19 A. A singular episode of trauma, whether it's a car 20 accident, whether it's a fall down the steps, 21 whether it's, you know, lifting something that's 22 too heavy, what happens is that there's -- you 23 typically have a physical tearing of some of the 24 ligamentous structures that support the back of 25 the disc and the soft part of the disc typically 40 1 protrudes backwards and pushes on part of the 2 neurologic system. Whether it's pushing on one 3 nerve, that means you'll get symptoms down one 4 particular leg or arm and a particular series of 5 symptoms and a particular neurological pattern. 6 We're all wired the same, all mammals are 7 wired the same. If it goes and it hits both, 8 hits the spinal cord, then you may get symptoms 9 in both legs. You may get symptoms that involve 10 bladder control or bowel control or walking 11 problems or strength problems climbing up and 12 down steps. 13 The primary, primary concern of physicians 14 with a herniated disc is the effect of that disc 15 on the neurological system. Not the local 16 findings, not the aching back pain or there's a 17 big controversy in medicine whether a bulging 18 disc is a source of pain at all, and, again, I 19 don't know. You read the literature and it's hard 20 because it's based on people saying they're hurt, 21 so it's based on subjectivity. 22 But the primary thing we're worrying about is 23 that pressure on the neurological system; 24 pressure on the spinal cord; pressure on the 25 spinal nerves, one or more nerves. That's the 41 1 key element of whether a disc herniation is 2 clinically significant or clinically 3 insignificant. 4 Q. Doctor, would a three or four or five millimeter 5 bulging disc that is not pushing on a nerve 6 typically cause pain? 7 MR. MESTER: Objection. 8 A. Again, there are no studies that show that discs 9 at a certain level, even size, I have had people 10 have discs at the L5-S1 level that are bigger 11 than the tip of my thumb but they're not causing 12 any neurological pressure and people don't even 13 know they have them. Size, you know, in this 14 case size doesn't matter, it's location that 15 matters. 16 You know, you could have a five millimeter 17 disc herniation in the neck and that's 18 significant. That's going to be very 19 significant. And then you can have a five 20 millimeter herniation in the low back where 21 there's a lot more space, there's no spinal cord, 22 there's just spinal nerve roots, things are a 23 little more flexible and it may not mean 24 anything. 25 So again, if it's not pushing on a nerve or 42 1 pushing on the spinal cord, I don't think it's 2 that clinically significant. I don't worry about 3 it. 4 MR. MESTER: Movie to strike. 5 Q. Doctor, there has been some indication that the 6 patient underwent something called a Cybex test. 7 Did you see the results of that? 8 A. I did. 9 Q. Could you comment on that, please? Could you 10 tell the jury what that is and the results of it? 11 A. There are a number of machines that are available 12 that are attached to the primitive or now they 13 have them attached to pretty sophisticated 14 computers and these can document whether there is 15 weakness within certain muscular structures and 16 that's important for a couple reasons: 17 Number one, it may document a person's 18 complaints that may be sort of vague and, you 19 know, you don't know where they're coming from. 20 And it also helps in rehabilitation. In other 21 words, if you start someone off and you test 22 them, I can do it by hand and I can give what I 23 considered my grade strength or anyone can do it, 24 but, you know, there's no number attached to it. 25 I could say, you know, plus one, plus two, which 43 1 means normal or a little stronger than normal. 2 But the Cybex will give a number. It will 3 give a percentage compared to the height and 4 weight and age and also a comparison of the other 5 side to that abnormal side. So it gives us a 6 starting point for rehab. It doesn't mean 7 anything other than the fact that that one test 8 was abnormal. 9 Typically what is done is you Cybex test 10 someone and then you make them go through a whole 11 rehabilitation program and you may Cybex test 12 them once every other month or once every quarter 13 or once every six months to document that there's 14 increased strength, increased endurance in a 15 muscular group. So the fact that a Cybex test 16 that was done was abnormal, it was abnormal; 17 there was no question that it was abnormal. 18 What's more important is that repeated tests 19 are done and that repeated abnormalities are 20 noted and if there's no improvement with 21 subsequent testing, it may indicate something may 22 be more permanent than something that's just 23 temporary and rehabilitated. 24 Q. Doctor, the way I understand it, a Cybex test, 25 the results are measured objectively, is that 44 1 correct? 2 A. Well, there is an objective number. In other 3 words, you have a screen, you have a readout, you 4 have a printout, that's an objective. That's 5 six, you know, not, you know, three, not nine, it 6 gives you a number. But again, it depends on the 7 patient's effort. 8 Q. So the input is subjective, is that right? 9 A. Correct. You know, if I say push as hard as you 10 can and you say you're pushing as hard as you can 11 and you're not, then obviously the Cybex is going 12 to be inaccurate. That's why you do it. You do 13 subsequent examinations before you just hang your 14 hat on one Cybex test. At least that's what I do 15 in my sports rehabilitation programs. 16 Q. Now, Doctor, just I guess we can sum up, based 17 upon your training and experience, based upon the 18 review of all the records and the MRI films that 19 you've done in this case, based upon the history 20 that you took from Ms. Prentice and based upon 21 your physical examination of her, do you have an 22 opinion to a reasonable degree of medical 23 certainty as to what injuries she suffered in 24 this automobile accident of October 23, 1997? 25 A. I do have an opinion. 45 1 Q. And what is your opinion? 2 A. My opinion is that she sustained a stretching or 3 pulling injury of the soft tissues in her neck 4 and low back and that she probably bruised or had 5 a blunt injury to her left knee. 6 Q. And Doctor, based upon the same things and do you 7 have an opinion based upon a reasonable degree of 8 medical certainty as to what injuries if any that 9 Ms. Prentice is still suffering or was still 10 suffering at the time you examined her resulting 11 from the accident? 12 A. I do have an opinion. 13 Q. And what is that opinion? 14 A. My opinion is that she still had symptoms of low 15 back strain or sprain; she has soft tissue 16 symptoms without any distinct objective 17 abnormalities other than the fact that she may be 18 a little, tiny bit stiff; she has recovered from 19 her neck injury and she has recovered from her 20 knee injury. 21 Q. And when you say she has symptoms, is that 22 something -- were there symptoms that you could 23 verify objectively? 24 A. Well, she has symptoms of stiffness. She was a 25 little, tiny bit stiff. Stiffness of course is 46 1 somewhat subjective. But that would be the only 2 thing. She said she was stiff, certain days are 3 worse than others. I can't remember if it was a 4 good day or bad day I saw her, but, again, you 5 know, seeing a person one, one time years 6 afterwards and not finding any substantial 7 measurable abnormality indicates she's probably 8 recovered for the most part objectively. 9 MR. MESTER: Objection. Move to 10 strike. 11 Q. Doctor, based upon your training and experience 12 and your medical knowledge and the review that 13 you did of the MRI films, your history of the 14 patient, your physical examination, do you have 15 an opinion based upon a reasonable degree of 16 medical certainty or can you state an opinion, 17 based upon that degree of certainty, as to 18 whether the disc bulging that this patient 19 currently has in her lumbar spine was caused by 20 this automobile accident? 21 A. I do have an opinion. 22 Q. And what would that be? 23 A. My opinion within a reasonable degree of medical 24 certainty is that I cannot state the etiology of 25 the improving disc abnormality in her lumbar 47 1 spine and the ideology or reason for the minor 2 disc abnormality in her cervical spine. Yes, 3 they are there; yes, they are improving, but I 4 can't state what caused them, whether they were a 5 normal natural phenomena, whether they were 6 related to accumulative bending and lifting from 7 work, whether they were related to a singular 8 automobile accident. I can't state within a 9 reasonable degree of medical certainty what the 10 etiology of this was. Those abnormalities were, 11 I should say. 12 Q. I think you said something before about normally 13 if the problem were caused by a specific incident 14 of trauma, you would see other symptoms than you 15 see in this patient, is that correct? 16 MR. MESTER: Objection. 17 A. Correct. If there is a herniated disc that is 18 acutely related to a traumatic incident, there is 19 a dramatically different history. There's a 20 dramatically different physical finding and a 21 non-improving MRI scan if you did it over a 22 period of time. Typically the -- once a disc 23 traumatically herniates, once it breaks through 24 that membrane traumatically, there's tissues that 25 rupture and the material squirts out, it doesn't 48 1 go back. 2 What we typically see in improving MRIs is 3 that there is a bulging, there's a normal, 4 natural phenomena that when you have a disc, 5 depending on when you take a picture of it, it's 6 like a family picture, you know, not everybody is 7 going to be there for the picture you take each 8 year so you can't compare that family 9 necessarily, other than the fact that you know 10 it's the family with the same last name. You're 11 going to have a slightly different picture in a 12 non-traumatic type of situation. 13 When that disc pops out traumatically, when 14 it herniates through the membrane, it doesn't go 15 back in. It doesn't shrink up. It stays there. 16 It's there permanently and there's usually some 17 scarring that develops. None of that was 18 registered in the MR scan and certainly none was 19 recognized in the improved scan that was done 20 earlier -- or rather in the year 2000. 21 MR. MESTER: Move to strike. 22 Q. When you say improving MRI, are you referring to 23 the fact that the bulge was actually smaller in 24 the second scan than it was in the first? 25 A. Radiologically that was the interpretation from 49 1 the board certified radiologist, and I agree with 2 that interpretation. It was -- the 3 abnormality -- I mean, it looked like a normal, 4 minimally abnormal spine in 1998 and it looks 5 like a very normal spine in 199 -- in year 2000. 6 That minor degree of bulging had diminished by 7 over 60 percent and it really takes a keen 8 radiological eye to pick up that there's really 9 any abnormality. 10 You know, usually in people in their 40s 11 there's little bulges all over the place and that 12 improvement was very visible objectively on the 13 actual scans. 14 Q. And, Doctor, there's a, you wrote a report and I 15 think you stated in the report that the care and 16 treatment that was rendered by various treating 17 physicians was appropriate. Is that true in view 18 of what we discussed before about the continuing 19 therapy when it was not, no longer indicated? 20 A. Let me just restate it just for clarity: I 21 believe that the initial visit with her family 22 doctor was appropriate; the initial x-rays that 23 were done were appropriate; I would say the bulk, 24 about three-quarters, 60 to 70 percent of the 25 therapy by Cleveland Therapy during that initial 50 1 three-week to four-week period of time was 2 probably appropriate. Beyond that point, it 3 would not have been my choice as an orthopedic 4 surgeon to continue with that if it hadn't cured 5 it. 6 I believe that an orthopedic consultation was 7 appropriate; I believe that the therapy that 8 Dr. Gabelman ordered was appropriate; I believe 9 that the lumbar spinal MRI was appropriate, the 10 first one. I cannot see a specific reason that I 11 would have used to explain the cervical MRI or 12 the left knee MRI or the second low back MRI, but 13 the other, the other testing that we discussed, 14 including the Cybex testing and the TENS unit, 15 which helps her, I think were appropriate. 16 Q. And finally, Doctor, do you have an opinion based 17 upon a reasonable degree of medical certainty 18 whether Ms. Prentice has any permanent injury as 19 a result of this automobile accident? 20 A. I do have an opinion. 21 Q. And what is your opinion? 22 A. Other than the very minor degree of stiffness 23 which is somewhat subjective, I could not find 24 any permanent injury involving her spine, either 25 objectively on physical examination or 51 1 objectively on the radiological evaluations. 2 Q. When you talk about the stiffness being 3 subjective, that's because that's what she's 4 saying, that she's stiff? 5 A. Correct. She's telling me she got stiff on 6 occasion. She had incomplete, although 90 7 percent of most people would consider pretty 8 normal but she did not have 100 percent of her 9 range of motion in two planes going forward and 10 going backwards. 11 MR. DERKIN: All right. Doctor, 12 thank you. I have no further questions. 13 MR. MESTER: Let's go off the 14 record. 15 VIDEOGRAPHER: We're going off 16 the record. 17 - - - - 18 (Thereupon, a discussion was had off 19 the record.) 20 - - - - 21 CROSS-EXAMINATION OF ROBERT C. CORN, M.D. 22 BY MR. MESTER: 23 Q. Good morning, Doctor. My name of course is 24 Jonathan Mester. I just have a few questions for 25 you based on your direct testimony. 52 1 Doctor, just so the jury is clear, your role 2 in this case was you were hired by the defense to 3 examine Andrea Prentice one time and provide an 4 opinion as to her injuries from this motor 5 vehicle accident, correct? 6 A. Correct. 7 Q. Okay. This is a, I guess a term of art in the 8 field as an independent medical exam, doctor? 9 A. Correct. 10 Q. Okay. And again, you didn't treat her, give her 11 medications, chart her progress, any of those 12 sorts of things that Dr. Gabelman did over, it 13 looks like at least a two-year period of time, 14 correct, Doctor? 15 A. I did not have that responsibility that 16 Dr. Gabelman had. 17 Q. Correct. How long did the actual exam on April 18 24th, 2000 take, Doctor? 19 A. Well, I don't keep a log start to finish, but I 20 typically leave 45, 50 minutes for just the 21 history and physical and then a number of hours 22 to review the scans and write a letter. 23 Q. Okay. And based on that 45 minutes or so, plus 24 your review of the records, you have arrived at 25 opinions and that's what you're testifying about 53 1 today? 2 A. That's the basis of the, my answers and 3 responses, yes. 4 Q. Okay. And you're being compensated by the 5 defense for this testimony, correct, Doctor? 6 A. I'm being compensated for the time it takes, yes. 7 Q. Okay. Now, Doctor, when you saw Andrea Prentice 8 again, that was on April 24th, 2000, so is my 9 math right, Doctor, roughly two-and-a-half years 10 after this motor vehicle accident? 11 A. That's correct. 12 Q. You had never seen her prior to that time? 13 A. I had not. 14 Q. Okay. Doctor, and you've reviewed the records, 15 of course, I think you've had all the pertinent 16 records, you've gone over those. Doctor, will 17 you admit that Ms. Prentice's treating 18 physicians, particularly Dr. Gabelman, would have 19 a better firsthand knowledge of Andrea Prentice's 20 condition given in this case, Dr. Gabelman's 21 continued treatment of the patient? 22 A. I think certainly during the time frame he had a 23 much better idea because he was there treating 24 her. There was about a year-and-a-half that 25 nobody had seen her. But certainly he could 54 1 better testify to what he saw at that -- at any 2 point in time prior to my evaluation and after my 3 evaluation. But I think our opinions are equal 4 in that I had all of his opinions and his medical 5 records and the objective data that he was making 6 his decisions on. 7 Q. Well, but, Doctor, you said something interesting 8 in your direct testimony I'd like to key on for a 9 moment. You said, I believe, if I took it 10 correctly, you said as an orthopedic surgeon, 11 which of course you and Dr. Gabelman both are? 12 A. Correct. 13 Q. You said most of your diagnosis is by history. 14 Is that accurate? 15 A. Most of the suspicions -- 16 Q. Okay. 17 A. -- of what the diagnosis is. You know, in other 18 words, we -- doctors, unlike lawyers, are, are 19 interested in the problems, not necessarily the 20 etiology or the reasons for the problems. So we 21 try to zero in on the myriad of different aspects 22 because we take care of all different parts of 23 the body, we zero in on the history. So in other 24 words, we zero in to the areas that we're 25 concerned about and that's what I was trying to 55 1 say. 2 Q. Okay. 3 A. So you don't necessarily have the exact diagnosis 4 but you have, you have limited the field of 5 potential diagnosis by the history. 6 Q. Okay. Well, Doctor, of course Dr. Gabelman, 7 you'll acknowledge, has had a better opportunity, 8 certainly more opportunity to meet with 9 Andrea Prentice over the years, correct? 10 A. He's had multiple visits with her, sure. 11 Q. Exactly. Treated her from 1998 through the year 12 2000, is that accurate? 13 A. Well, I think he treated her for seven times in 14 '98, none in '99, and then again in 2000. 15 Q. Right. So he's followed her over a two-year 16 period? 17 A. Correct. 18 Q. Seen her many times? 19 A. I could count the amount of times -- 20 Q. You don't have to. 21 A. -- but I think it was seven times I think or four 22 times. It was under ten times, yes. 23 Q. And had her doing this therapy that she referred 24 to in his office as well, correct? 25 A. I believe it was in his office. 56 1 Q. Okay. And, Doctor, I mean, can you admit then 2 based on that and based on the fact that, as you 3 said, much of your diagnosis is based on history, 4 wouldn't you agree, Doctor, that Dr. Gabelman 5 would have a better perspective on Ms. Prentice's 6 injuries than you would having just seen her the 7 one time two-and-a-half years following this 8 accident, Doctor? Can you at least admit that 9 much? 10 A. Well, and I'm not sure it needs to be admitted 11 to. I think the facts are apparent: 12 Dr. Gabelman saw her, treated her, evaluated her, 13 made clinical decisions on a prospective basis; 14 that is, not knowing what the results were going 15 to be at the end. 16 When I saw her, I had the opportunity of 17 reviewing all Dr. Gabelman's thoughts, his ideas 18 and the results of what he did. So at any one 19 point in time, sure, he had a much better idea. 20 But that's the purpose of medical records. You 21 document what you know, you document your 22 improvement and that way, I think, that my 23 opinion should be equal, at least equal to 24 Dr. Gabelman's because I know what he felt, saw, 25 measured, documented and I reviewed his records. 57 1 Q. You know that based on your review of his 2 records? 3 A. Correct. Not firsthand, but on review of what he 4 felt was significant to document as part of the 5 standards of what medical records should 6 indicate. 7 Q. All right. So based on your review of the 8 records, are you saying and telling this jury 9 then that you believe you are just as qualified 10 today to give an opinion as to Andrea Prentice's 11 condition as Dr. Gabelman who saw her over a 12 two-year period, touched her, had impressions, 13 personal impressions, Doctor? 14 A. Again, I'm not sure what the bias of the 15 different jurors are, but if I know the doctor's 16 opinions, it doesn't matter if I saw the patient 17 at that time. Of course I may have had different 18 opinions than the treating doctor did at any one 19 point in time, but I believe our opinions should 20 be pretty much equal. Because if I saw what he 21 felt and if I could review what he felt, saw and 22 measured, I think that my idea of what she was 23 like from his perspective is very well 24 understood. 25 Now, I may have had a different spin on it if 58 1 I had seen her at those times. But again, we're 2 talking about apples and oranges, we're talking 3 about seeing one person at one period of time 4 versus reviewing the cumulative efforts of 5 another physician during a different block of 6 time. 7 Q. I understand. 8 A. So it's -- 9 Q. Doctor, here, do you know Dr. Gabelman? 10 A. I know him personally. I was at a breakfast 11 meeting with him yesterday. 12 Q. Okay. Obviously a well-respected orthopedic 13 surgeon as are you in this community? 14 A. Yes. 15 Q. Okay. And he's a colleague of yours of course, 16 Doctor? 17 A. He is a peer, yes. 18 Q. Okay. Did you know him in April of 2000 when you 19 did this report? 20 A. Sure. 21 Q. Okay. Did you attempt to contact Dr. Gabelman 22 with regard to Andrea Prentice, find out if he 23 could shed any further light on the subject? 24 A. Again, I did not and you know the rules of 25 engagement, so to speak, would go against me from 59 1 doing that. That would be an inappropriate thing 2 for me to do, to contact the treating 3 physician -- 4 Q. Well, Doctor -- 5 A. -- during any independent medical evaluation. 6 Q. Well, Doctor, would you acknowledge that you 7 could have learned more potentially regarding 8 Andrea Prentice's condition had you done so? 9 A. I don't know. 10 Q. All right. I guess my question is I know you've 11 had a chance to review the records but, Doctor, 12 would you at least admit that there's often more 13 than meets the eye than the records? I mean, 14 you've treated a lot of patients over the years. 15 Would you acknowledge you've gotten a better 16 indication for those patients that you treated on 17 a long basis as Dr. Gabelman has done here than 18 just someone who's, you know, reading records 19 from another doctor? 20 A. Well, again, I think you're asking the same 21 question repeatedly and my opinion is the same. 22 Q. All right. 23 A. Again, treating physicians have certain 24 responsibilities. I think it's much more 25 difficult for a treating physician because you 60 1 don't know what the response to your treatment is 2 going to be. So you go through a thought process 3 and that thought process is in the medical 4 records. Because you don't, you know, you're 5 seeing people, you know, 60 patients a week, 100 6 patients a week sometimes and you can't remember 7 what you were thinking about for every single 8 patient. That's what the medical records are 9 for. And the more accurate you are with the 10 medical records, the better your memory as a 11 treating physician is. And if I can review what 12 your thoughts were as a treating physician, I get 13 a pretty good idea where you were coming from at 14 that particular point in time. 15 Q. All right. But, Doctor -- 16 A. But a hands, a hands-on thing, no, I don't have 17 that advantage. 18 Q. All right. And just so I'm clear, you don't feel 19 that in any way your opinions don't have as much 20 foundation then as Dr. Gabelman's not having seen 21 this patient more often? 22 A. You know, again, it depends on the time frame. 23 If you're using April, a date of April of 2000, 24 our opinions are the same. If you're asking him 25 what his opinion was before I saw her, obviously 61 1 I've got to yield to his opinion because I didn't 2 see her before that date. 3 Q. Okay. Thank you, Doctor. 4 Now, Doctor, is this the first time that 5 you've done an independent medical exam? 6 A. It is not. 7 Q. Okay. And Doctor, isn't it correct that you've 8 been doing these for many years; in fact, several 9 decades, correct, Doctor? 10 A. Several decades, that's a scary thought. In 11 1984, so it's not quite several decades yet. 12 Q. All right. But going on 17 years then, Doctor? 13 A. Probably. 14 Q. Okay. And since that time you've done these 15 independent medical exams on a regular basis, is 16 that correct? 17 A. Yes, I do them on a regular basis as they're 18 scheduled. It's averaged two to three a week for 19 many, many years. I do them for your office, I 20 do them for many offices. 21 Q. All right. Well, I'm talking about independent 22 medical exams here now, Doctor, where, you know, 23 a client is injured, someone is injured and the 24 other side comes to you and wants you to examine 25 that patient and render an opinion as you've done 62 1 here. 2 A. I know what you mean. 3 Q. Against the injured person. 4 A. I know exactly what you mean. 5 Q. Okay. And you've done those two to three times a 6 week for 17 years? 7 A. Probably. That would be the average. 8 Q. Okay. And, Doctor, are you still doing these 9 regularly? 10 A. Not with the greatest frequency, but, yes, I'm 11 still doing them. It averages about two to three 12 per week, yes. 13 Q. Okay. And in fact, Doctor, I think today you're 14 seeing another injured client of mine named 15 Sandra Habit, is that correct? 16 A. I haven't looked at my schedule yet. 17 Q. Do you want to consult your schedule or will you 18 take my word for it? 19 A. I'll take your word for it. 20 Q. All right. And Doctor, you've, over that time 21 period you've regularly given depositions in 22 court regarding that testimony, is that correct? 23 A. When requested and required to, yes. 24 Q. Okay. Now, Doctor, during your examination, you 25 were asked about articles and you indicated that 63 1 you don't write as many articles as you used to? 2 A. I don't have the time to. 3 Q. When did those stop? 4 A. When I stopped making the time for them. It was 5 probably -- I don't know, I haven't looked at my 6 CV for a while, but it was probably early '80s. 7 Q. Right about the same time you started doing 8 independent medical examinations, Doctor? 9 A. Well, I think it was actually a few years before 10 I started. 11 Q. All right. In other words, earlier you said, and 12 you just said it again, that you don't have a lot 13 of time for that. I mean, Doctor, does that have 14 anything to do with the fact that you've been 15 doing two to three of these a week for the last 16 17 years? 17 A. No. My kids are older, they demand more time; 18 I'm trying to have a life now instead of just 19 working from dawn to dusk. So there's a lot of 20 reasons why I sort of cut back and changed my 21 habits. 22 Q. Although you would acknowledge medical/legal work 23 such as this takes a significant amount of time? 24 A. Sure. 25 Q. Okay. 64 1 A. All work takes time. If you do it right. 2 Q. What percentage of your practice over the years 3 has that been, Doctor? 4 A. Well, timewise, you know, I see now probably 5 around 60 patients a week; I typically schedule 6 routine surgeries two, sometimes three days a 7 week, not all day but days I operate; and I would 8 do let's say two to three of these evaluations. 9 Well, that takes only 45 minutes out of an 10 eight-hour schedule. 11 So timewise, I use the review time on the 12 weekends and the evenings when everybody's asleep 13 and I get some quiet time so I can just do 14 thinking and doing my dictating. So I do it, you 15 know, late. I do it not in my regular office 16 time. So it does take time. It takes -- cuts 17 into my spare time, and that's why I'm 18 compensated for it. 19 Q. Okay. Well, I understand that, Doctor. I guess 20 my question was: Do you know what percentage 21 generally that's constituted over the years of 22 your practice? 23 A. What percentage of time? 24 Q. Time, yeah, and in conjunction with independent 25 medical exams? 65 1 A. Well, I don't know. I mean, you can sort of 2 average her out. If I'm seeing patients and 3 operating probably 60 hours a week and I spend 45 4 minutes twice a week and then probably a few 5 hours, depending on when I get the records, I 6 don't work on these every night obviously. 7 Q. Sure. 8 A. So it's a percentage but I'm, I don't know what 9 the percentage is. 10 Q. All right. That's fine. 11 Doctor, are you associated with a 12 corporation? 13 A. I'm employed by a corporation. 14 Q. What corporation is that? 15 A. Highland Musculoskeletal Associates, Inc. 16 Q. Okay. And, Doctor, are there any other 17 physicians that are involved with this 18 corporation? 19 A. Yes. 20 Q. And who are those physicians? 21 A. I have one partner, Dr. Timothy Gordon. 22 Q. Okay. And does Dr. Gordon also involve himself 23 with these independent medical exams? 24 A. Sure. 25 Q. Okay. All right. Doctor, I want to get into 66 1 your opinions then regarding Andrea Prentice if I 2 could. And first of all, you, just so I make 3 sure I have everything, I'm pretty sure that I 4 do, you have authored a report to 5 Margaret Gardner dated April 25th, 2000. 6 Is that your first report, Doctor? 7 A. Yes. 8 Q. Okay. And then a supplemental report of May 9 10th, 2000 which has an addendum on the third 10 page? 11 A. Correct. 12 Q. Okay. Is that the full thrust of your reports 13 then that set forth your opinions here today? 14 A. Well, those are what I considered my opinions on 15 the issues that I considered important medically. 16 They're, I'm not a lawyer so there are other 17 issues that were questioned and you'll probably 18 question me on different things than I consider 19 but these are what I considered medically 20 important. 21 Q. Okay. I understand. And, Doctor, I just want to 22 verify that I have all the reports. 23 And, Doctor, you'll stand by those opinions 24 you expressed in those reports here today? 25 A. I don't see why not, unless there's some other 67 1 facts that have come out that would logically 2 change those opinions. 3 Q. Okay. And, yeah, I mean, you -- again, this was 4 April 25th, 2000, today is April 12th I think 5 2001, so almost a year later? 6 A. Correct. 7 Q. You'll stand by what's in your, that report? You 8 haven't seen anything different over the past 9 year to change your mind? 10 A. I haven't seen anything different. I don't know 11 her current status. I saw her a year ago. I 12 assumed that she's the same as she was. I don't 13 know if she's better or worse. 14 Q. I understand. Okay. Okay. Thank you, Doctor. 15 Now Doctor, let's -- again, there seems to be 16 three different parts of her body that were 17 injured in this accident: The back, the neck and 18 the knee. Is that accurate, Doctor? 19 A. That's the way it appears in the records, yes. 20 Q. Okay. I'd like to start for purposes of my 21 cross-examination with the back which you 22 testified about. 23 A. The lumbar? 24 Q. The lumbar, right. The low, low back, Doctor. 25 And Doctor, you have indicated in your testimony, 68 1 as well as in your report, that Ms. Prentice 2 suffered soft tissue sprains, I think, or strains 3 you said to her lower back, is that correct? 4 A. That was my opinion, yes. 5 Q. Okay. And, Doctor, just so the jury is clear, 6 soft tissue injuries, am I correct, Doctor, 7 essentially in saying that's, you know, injuries 8 to the muscles, et cetera, which don't involve 9 broken bones, spinal abnormalities, that sort of 10 thing; is that about right, Doctor? 11 A. I didn't hear the question. 12 Q. Sure. The question is: When we're talking about 13 a soft tissue injury that you've, you've used 14 that word once or twice, we're talking about 15 injuries to the muscles and joints which don't 16 involve broken bones, herniated discs, problems 17 with the spine? 18 A. Well, I mean, the soft tissue injury 19 theoretically could include a herniated disc, but 20 we're not talking about fractures or 21 dislocations, we're talking about stretching, 22 pulling, non-disruption, non-total disruption 23 injuries. 24 Q. All right. Doctor, these types of injuries, 25 sprains and strains that you've diagnosed in 69 1 Ms. Prentice, these types of injuries certainly 2 cause pain and suffering in an individual; would 3 you agree with that, Doctor? 4 A. They are very painful injuries for 5 predictably -- a predictable period of time. 6 Q. Okay. 7 A. And they can cause physical impairment and 8 disability during those times of recovery. 9 Q. Okay. So, Doctor, you'll acknowledge that Andrea 10 has had pain in her lower back as a result of 11 this motor vehicle accident, as a result of the 12 injuries she sustained in the accident? 13 A. I think for a period of time it would have been 14 very appropriate for her to be very uncomfortable 15 from a soft tissue injury of her low back. She 16 still has current complaints that she relates 17 back to that accident. 18 Q. Right. So even today, Doctor, she's still having 19 complaints related to this accident? 20 A. Well, I don't, I'm not certain today but 21 certainly April 24th, 2000 she did. 22 Q. Yeah. Okay. So again, and you're right, I won't 23 hold you, I know you haven't seen her in the last 24 year, but for that two-and-a-half year period, 25 apparently, based on all the records you've 70 1 reviewed and your examination, she was having 2 pain in her lower back which resulted from this 3 motor vehicle accident; is that fair to say? 4 A. I think it's fair to say that for the months 5 before she saw Dr. Gabelman, that was a 6 documented symptom during the time that 7 Dr. Gabelman saw her regularly; that is, during 8 the balance of '98 she certainly had that 9 complaint and she had that complaint again in 10 year 2000 when he saw her. I, nobody knows what 11 was going on other than what she says happened 12 during the time that she wasn't seen by a doctor 13 during the last year-and-a-half. 14 Q. All right. And let's talk about that 15 year-and-a-half briefly, Doctor. Doctor, that's 16 not uncommon that a person with these types of 17 injuries after undergoing therapy would feel 18 improvement and then after stopping a therapy 19 program would have these types of injuries recur, 20 that's not uncommon, is it, Doctor? 21 A. Well, I don't think the injuries recur and I 22 don't know that other than her history the 23 symptoms are specifically related to that auto 24 accident back in 19, yeah, 1997. This is what 25 people tell me. You know, they, I come in the 71 1 office, people have the similar type of 2 complaints, Doc, it's hurt me since this date. 3 That's what I write in my history. I don't have 4 any way of verifying that. 5 This is not a lie detector test. This is the 6 history, you know, the history is what she, what 7 was presented. I'm sure already by the time the 8 jury has seen me and this is what she told me, 9 this is what she also that she has been having 10 problems with her low back since the time of the 11 accident. 12 Q. All right. Doctor, let's just then briefly talk 13 about some of that. When you saw her on April 14 24th, 2000, she told you that she always feels 15 discomfort in her lower back, isn't that correct, 16 Doctor? 17 A. That's what she said. 18 Q. And she said that she has a deep aching pain in 19 her lower back, is that correct, Doctor? 20 A. She has a varying degree of intensity deep aching 21 pain, yes. 22 Q. Okay. I mean, you documented that in your 23 report? 24 A. Absolutely. 25 Q. Okay. 72 1 A. That's what she told me. 2 Q. And she also told you that she wakes up with 3 backaches, again two-and-a-half years after this 4 motor vehicle accident? 5 A. That's what she says. 6 Q. All right. And, Doctor, you don't have any 7 reason not to believe her, do you? 8 A. I don't have any reason to believe her or 9 disbelieve her; this is the medical history. 10 Q. I understand. 11 A. This is the part where you don't have any control 12 as a physician. 13 Q. All right. 14 A. This is what, this is what she recounted to me 15 and that's what I wrote down. 16 Q. And, Doctor, when she saw you, I believe looking 17 at your chart that she indicated to you that her 18 pain on that day on a scale of one to ten, ten 19 being the worst, was a five, and that sometimes 20 during that period it was as bad as a seven out 21 of ten, is that accurate, Doctor? 22 A. That's what she did indicate. 23 Q. Okay. 24 A. And there was specifically -- 25 Q. Excuse me, Doctor, that was my question. 73 1 A. Okay. 2 Q. Doctor, you also indicated that with regard to 3 the exam you conducted on that day that you found 4 an abnormality; isn't that true as well, Doctor? 5 A. She was a little stiff, yeah. 6 Q. All right. In fact, she didn't, you said 90 7 percent, Doctor? What did the 90 percent mean 8 again, Doctor? 9 A. Again, she had some minor restrictions in the 10 extent that she voluntarily arched her back 11 forward and voluntarily bent forward to touch her 12 toes. She could reach down to her mid tibia 13 level, the middle of her leg. If she constituted 14 roughly 90, slightly better than 90 percent of 15 what I would predict that be 100 percent of 16 motion. 17 Q. Okay. Again, these are abnormalities on exam, 18 right, Doctor? 19 A. These are minor abnormalities, yes. 20 Q. Okay. All right. All right. So, Doctor, before 21 we move on to the issue of herniated disc, I just 22 want to make sure that the jury is clear on a few 23 things. 24 We can agree, Doctor, that it's your opinion 25 that Andrea Prentice suffered a low back injury 74 1 resulting from this motor vehicle accident? 2 A. In my opinion, she sustained a low back injury, 3 yes. 4 Q. Okay. And, Doctor, can we also agree that the 5 care and treatment that was rendered by her 6 various treating physicians was appropriate for 7 this low back injury? 8 A. I believe that as stipulated prior in my direct 9 testimony, there was a certain aspect of her 10 medical care that I felt was directly related to 11 the accident and some excessive amount of testing 12 and therapy that, in my opinion, was not 13 totally -- we're not talking about medical 14 inappropriateness but whether it was necessary. 15 Q. Well, Doctor, I want to focus now again on the 16 lower back. What specifically are you now 17 telling me was not necessary, I guess, in your 18 opinion? 19 A. I am not sure the second MRI scan was necessary. 20 And it's hard to determine, I really don't 21 remember the, what exactly or even if it was 22 documented what the Cleveland Therapy group did 23 past that three- to four-week period of time to 24 her low back. But I certainly think that -- 25 Q. All right. 75 1 A. -- part of the treatment -- most of the treatment 2 I thought with the low back, the TENS unit was 3 fine, the exercises were fine, the orthopedic 4 consultation was fine. I'm just not sure there 5 was an indication for this second MRI of her low 6 back. 7 Q. Okay. Doctor, I'll refer you to the fourth 8 paragraph of page five of your initial report if 9 I could, the first sentence. Could you read that 10 to the jury, please. And this, again, this is 11 your report that you're standing by here today 12 based on your examination and review of the 13 records of Andrea Prentice. 14 Could you read that first sentence, please. 15 A. It says, "The care and treatment that was 16 rendered by her various treating physicians in my 17 opinion was appropriate." 18 Q. All right. So Doctor, I mean, once again I asked 19 you before, do you stand by your report? 20 A. I said there were certain things that I would 21 stand by and certain things that if I was asked 22 more specific questions that I would probably 23 have slightly different opinions about. 24 Q. Well, I mean -- 25 A. But when I'm talking about appropriate, it means 76 1 medically appropriate, not necessarily related to 2 the accident but appropriate; in other words, it 3 wasn't inappropriate treatment. 4 Q. Well, but I'm a little confused, Doctor. 5 A. I mean they didn't stick needles in her; they 6 didn't do epidural blocks; they didn't operate on 7 her. Those would be inappropriate treatments. 8 Q. I see. Okay. 9 A. So what I'm talking about in general, the way she 10 was managed was medically, fell within the 11 standards of care. 12 Q. All right. The physical therapy that she had at 13 Cleveland Therapy, that was all appropriate? 14 A. Again, it was medically not inappropriate. 15 Q. All right. 16 A. I'm not sure it was not excessive in some ways, 17 but at certain points of her recovery, yes, it 18 was entirely appropriate. 19 Q. All right. And, Doctor, just focusing on that 20 for a moment, I think you said that you would 21 accept up to four weeks of therapy, of 22 passive-type therapy at Cleveland Therapy but you 23 felt that an addition to that would be too much, 24 is that accurate? 25 A. Okay. I think what I said, and I will state it 77 1 again, was that for a certain period of time if 2 it's not curative; in other words, if the 3 symptoms don't entirely go away, the 4 effectiveness of continuing passive therapy 5 doesn't work, it's not necessary. It's something 6 that just, it doesn't help to improve the 7 condition. 8 Q. Now, would you apply a rigid time frame to that, 9 Doctor? I mean, are we talking about four weeks, 10 28 days and you go to the 29th day and, boy, 11 you've crossed into a period where it's just not 12 helpful? 13 A. Well, you know, there are health insurance 14 carriers do that. They say, you know, there's 15 not improvement by so-and-so sessions, they're 16 not going to authorize any more. I think that if 17 there's documented improvement or elimination, 18 it's fine. But that is not treatment, that is 19 just getting you through the acute phases of the 20 injury. It's not rehabilitation. It's not 21 strengthening. It's not stretching. It's not 22 something to get you back to where you were. 23 It's a temporary type of modality. And if it's 24 used beyond a certain point where it's curative, 25 I don't think it's necessary. 78 1 Q. Okay. Move to strike reference to health 2 insurance. 3 Doctor, the records that I have indicate that 4 Andrea Prentice treated at Cleveland Therapy, it 5 looks like from October 30th was her first -- do 6 you have those records, Doctor? 7 A. I'm -- 8 Q. Just to make sure -- 9 A. I'm sure somewhere on my desk. 10 Q. -- what I'm telling the jury is accurate. 11 My records indicate that on October 28th, 12 1997 was her first day at Cleveland Therapy, is 13 that accurate, Doctor? Do you have the notes? 14 A. I'm looking at the billing statements. 15 Q. I can show it to you, Doctor, if that's helpful. 16 A. What, 10-20 -- what did you say the first date 17 was? 18 Q. 10-20-97. 19 A. Okay. Yeah, that's what I have. 20 Q. Do you have the actual record from that day, 21 Doctor? 22 A. I have it somewhere here. I'm looking at the 23 billing statements that were done. 24 Q. I'll show it to you if that speeds it up, Doctor. 25 A. It depends what your questions are. 79 1 Q. Okay. Well, Doctor, I have a record from 2 Cleveland Therapy again from October 20th of '97, 3 which is her first day, which indicates, Patient 4 too sore to begin exercise program today. 5 Do you recall seeing that, Doctor? 6 A. No, but I think that's -- I don't have a problem 7 with that. 8 Q. All right. And then it looks like on October 9 30th would have been her next visit. Does that 10 comport with what you've got, Doctor? 11 A. Yes. 12 Q. All right. So October 30th and her last day 13 appears to be December the 23rd. Does that match 14 with what you've got, Doctor? 15 A. December 23rd was her last -- well, I'm trying to 16 see. No, actually it's the 18th -- 17 Q. Oh, okay. 18 A. -- was the last treatment. 19 Q. December 18th. So we've got treatment for the 20 month of November and then maybe another two 21 weeks or so in the month of December? 22 A. Well, it's, yeah, it's going on the third week. 23 Q. So, Doctor, I mean, we're talking about maybe six 24 weeks here? 25 A. We're talking about six weeks of the same thing 80 1 again and again. 2 Q. Well, I understand, Doctor. 3 A. If you look at -- 4 Q. But my question is: You indicated earlier that 5 this type of treatment goes on typically, you 6 said, for four weeks. I mean, do you -- I mean, 7 are you honestly telling this jury that you fault 8 and take issue with Cleveland Therapy for 9 extending this for another two weeks, Doctor, 10 another seven visits or so? 11 A. I'm saying that if you look at the types of 12 treatments that were done and the frequency of 13 treatments that were done, I think, you know, 14 beyond -- it was not helping. It was not curing 15 her. You know, look at the billing statements. 16 I mean, the billing statements show exactly what 17 they were doing at every point in time. And 18 there were multiple billings for hot packs, 19 electrical stimulation. 20 Q. Well, Doctor, that was not my question. 21 A. Well, that's, this is my answer, though. That 22 it's the same thing again and again and again 23 and it's not curative. She certainly still 24 needed to see an orthopedic surgeon. I think 25 that three weeks of the same stuff again and 81 1 again and again, if it's not helpful, you've got 2 to punt, you've got to do something else. 3 Q. All right. 4 A. I think, I think, you know, looking at, look at 5 the billing statements it's really clear that 6 doing the same things again and again and again 7 and again -- 8 Q. Well -- 9 A. -- and that's not -- 10 Q. -- you're saying doing the same things again and 11 again for over four weeks is inappropriate now; 12 is that what you're saying now, Doctor? 13 A. I'm saying it's excessive. I'm not saying it's 14 inappropriate from a standards of care issue, but 15 it's not helpful, why do it? 16 Q. All right. Even though, Doctor, you've indicated 17 in your report, and I already read that to the 18 jury, that you indicated at that time that the 19 care and treatment that was rendered by her 20 various treating physicians was appropriate? 21 A. I think again, you know, you're playing with 22 words and, you know, my testimony stands. 23 Q. All right. 24 A. And the jury is going to agree or disagree. 25 Q. All right. Doctor, let's go ahead and review 82 1 then before we move on. You have acknowledged 2 then that most of her back treatment, the initial 3 visits, the first four weeks or so at Cleveland 4 Therapy, the MRI, the first one with 5 Dr. Gabelman, correct, Doctor, those are all 6 appropriate and necessary as a result of this 7 accident? 8 A. Again, some of the Cleveland Therapy treatment, 9 again, they don't break down what they did to 10 which area, and I don't know if every one of 11 these treatment sessions were devoted to her low 12 back, her neck or her knee, they just are not 13 specific. 14 But certainly the, some of the treatments 15 with Cleveland Therapy or Solon Therapy, some of 16 the, the orthopedic consultation and the first 17 MRI I thought would be appropriate, yes. 18 Q. Okay. And all of the treatment with 19 Dr. Gabelman, I mean, again, your colleague, you 20 don't have an issue -- 21 A. No. 22 Q. We've talked about the second MRI? 23 A. We also talked about the MRI. 24 Q. Right. 25 A. But we haven't got to her neck yet. 83 1 Q. But talking about the back. 2 A. The low back, I think the bulk of it I had no 3 problems with. 4 Q. All right. In other words, the active therapy 5 done with Dr. Gabelman, again, you had no 6 problems with that? 7 A. Again, some of that active therapy was not 8 specifically related to her low back but it was 9 related to her knee as well. 10 Q. Okay. 11 A. So I think, my opinion was, in general, the stuff 12 that Gabelman did I have no problem with. 13 Q. Okay. 14 A. I probably would have done close to the same 15 thing other than necessarily ordering all the 16 testing. 17 Q. Okay. So again, Doctor, assuming, and the jury 18 is going to hear that there's no issue in this 19 case about who was at fault in this accident, you 20 would agree that the defendant should be 21 responsible for the medical bills for this 22 treatment that you've told us about that was 23 necessary due to this accident? 24 MR. DERKIN: Objection. 25 A. I believe the care and treatment that was 84 1 rendered that was specifically appropriate for 2 the time frame and for the response as we talked 3 about was the responsibility of the motor 4 vehicle -- the results of the car accident. 5 Q. Right. And, therefore, Doctor, assuming there's 6 no issue here about who was at fault in the 7 accident, that the defendant was, having you 8 assume that just for this question, Doctor, you 9 would admit that the defendant should pay for 10 those bills? 11 MR. DERKIN: Objection. 12 A. Again, that's a legal question. I don't know if 13 my opinions are even valid in that. But 14 certainly the responsibility of the accident and 15 the injuries of the accident necessitated some of 16 the care that we discussed. 17 Q. All right. Thank you, Doctor. 18 Now Doctor, soft tissue injuries that we've 19 talked about, the sprains, these types of 20 injuries can be permanent injuries, isn't that 21 correct, Doctor? 22 A. Certain injuries can -- well, first of all, we 23 were talking about a range of things. Certainly 24 disruption injuries, there are certain aspects of 25 them that are permanent. Even non-disruption 85 1 injuries similar of what Ms. Prentice has can 2 give -- people say they hurt for years; some 3 people say they hurt forever; sometimes they're 4 permanent in symptoms and sometimes they're 5 permanent with symptoms and in physical findings. 6 Q. Okay. Doctor, you have certainly testified in 7 the past over the course of your career 8 testifying in these matters where that a soft 9 tissue injury to the low back is a permanent 10 condition in an individual? 11 A. In some cases it is. 12 Q. Okay. That's all I want to acknowledge here, 13 Doctor. 14 Now, you were asked by Mr. Derkin 15 specifically with regard to Ms. Prentice whether 16 she had any permanent injuries. Now, I took 17 copious notes here, Doctor, your response was: 18 Other than the back stiffness, you found nothing 19 objective permanently? 20 A. Correct. 21 Q. So Doctor, that would certainly seem to indicate 22 that you've got stiffness here that you were 23 indicating to this jury was permanent? 24 A. I don't know if it's permanent. 25 Q. All right. 86 1 A. I was present at the time -- what I said was that 2 she was complaining of stiffness and that she had 3 some minor degree of stiffness at the time of my 4 evaluation. I only saw her once. That's not 5 exactly the same findings that Dr. Gabelman had 6 or that the Cleveland Therapy had documented to 7 the same degree, so I was not able to say whether 8 that was permanent. Because I only saw her on 9 one occasion and that was not a prominent finding 10 in the other medical records that -- 11 Q. I understand. Doctor, having you again assume 12 for purposes of this question that Ms. Prentice 13 will testify, will have already testified by the 14 time the jury is hearing your testimony, that she 15 is still having problems with her low back now 16 three-and-a-half years after this accident, 17 Doctor, is it safe to say, Doctor, that it is 18 certainly a possibility that Andrea Prentice has 19 a permanent low back injury here? 20 MR. DERKIN: Objection. 21 A. I think it's a possibility that she has permanent 22 low back complaints and she may have a permanent 23 injury. 24 Q. Which she'll have for the rest of her life? 25 A. If it's permanent, permanent means the rest of 87 1 your life. 2 Q. Very good. Thank you, Doctor. 3 All right. And, Doctor, all right. Doctor, 4 let's go ahead and move on to the, staying with 5 the back but with regard to the herniated disc 6 and the other objective tests that we discussed. 7 First of all, Doctor, from your review of the 8 records, do you know if Andrea Prentice had any 9 positive objective tests in her visits with 10 Dr. Gabelman? 11 A. I'm not -- 12 Q. Aside from the MRI. For example, what's a 13 straight leg test, Doctor? 14 A. Straight leg raising test is a test that may 15 indicate, if positive, and positive to a certain 16 extent, it may indicate there's some neurological 17 inflammation or irritation. 18 Q. Okay. And, Doctor, do you know whether or not 19 Andrea Prentice had a positive straight leg test 20 conducted by Dr. Gabelman? 21 A. I don't remember. I've got to look at his 22 records. 23 Q. Take your time. It says here sitting straight 24 leg raising on the right produced low back pain 25 at 70 degrees and on the left at 80 degrees. 88 1 A. Not leg pain but back pain. So it's not -- you 2 know, it's a positive response but it's not a 3 positive finding. I'm not trying to -- 4 Q. I'm not sure I understand, Doctor. 5 A. I'm not trying to doctor talk you. 6 The, the straight leg raising test is a test 7 that you're trying to see if there's neurological 8 inflammation or irritation. It's not low back 9 pain that you worry about with the straight leg 10 raising tests, it's leg pain or numbness or 11 burning or tingling. 12 So having a positive response to a straight 13 leg raising if it's not the neurological pain, 14 I'm not sure of the clinical significance, but it 15 was a finding that Dr. Gabelman noted. 16 Q. Okay. And a straight leg test is an objective 17 test, Doctor? 18 A. Well, it's an objective test but it needs a 19 subjective response on the basis of the patient. 20 Q. I understand. 21 A. So I don't know, it's sort of -- 22 Q. All right. What's a tripod sign, Doctor? 23 A. I have no idea. 24 Q. You never heard of that before? 25 A. I, he does that test, I've read it in his 89 1 previous reports, but I'm not exactly sure what 2 that is. 3 Q. Well, based on what you read in his previous 4 reports, do you know what he's referring to? 5 He's already testified about it. 6 A. I have no idea. 7 Q. Okay. So you'd never heard of a tripod -- 8 A. I've heard of it, but I don't know what it's, you 9 know, what the necessity of it is or why he does 10 it. 11 Q. Well, when I tell you that term, I mean, what do 12 you associate with it? Do you know what it 13 means? 14 A. I don't know, I've got to look it up. 15 Q. Okay. So you've never used that test? As an 16 experienced orthopedic surgeon, you're not 17 familiar with what that means? 18 A. I am not -- I'm, I am unfamiliar with why one 19 would use that test. I do not think it's a 20 critical test in the orthopedic examination. I 21 don't know what it does. There are a bunch of 22 tests that are done to verify complaints. I'm 23 not really sure. 24 Q. I'm a little confused, Doctor. If you say you 25 don't think it's necessary but you told me 90 1 earlier you don't know what it is, I'm confused. 2 A. Again, I, what I do as part of my examination, I 3 believe is a standard orthopedic exam. There are 4 lots of chiropractic tests. If you look at the 5 literature there are many, many, many tests that 6 have somebody's name associated with them or a 7 body position associated with them. I don't 8 think you need to do 30 things to say the same 9 test. 10 It just, you know, he's talking about the 11 Kernig sign. I mean, I rarely do Kernig sign. 12 That's a sign of axial compression. If there's a 13 suspected injury or other things, I would do 14 that. The Lasegue sign I always do. The FABER 15 test, I call it something else, but we do the 16 same thing. So there's many different tests that 17 test the same thing that you don't always have to 18 do the identical testing to get -- 19 Q. Okay. 20 A. -- similar results. 21 Q. And, Doctor, I don't want to ask you about 22 something if you don't know what it is. My only 23 question is: Do you know what a tripod test is? 24 Do you know what he's referring to there? 25 A. I know it's a test for the low back and leg 91 1 position but I'm unfamiliar -- 2 Q. All right. 3 A. -- with the test. I haven't reviewed it in 20 4 years. 5 Q. So just so the jury and myself are clear, Doctor, 6 if you don't know what it is, obviously you can't 7 render an opinion here today about whether or not 8 it was, it's reasonable and a good predictor, I 9 would assume? 10 A. I don't, I don't use it because I don't think it 11 tells me anything more than the tests that I use 12 on a routine basis. 13 Q. Doctor, do you know what it is? 14 A. You know, I don't know what it is at this point, 15 but I did know what it was when I developed what 16 I do during the physical examination 21, 30, 17 almost 30 years ago. It was not part of my 18 training that that was a critical test because 19 there are other tests that do the same thing. 20 Q. Okay. So that was, you learned what it was many, 21 many years ago? 22 A. Well, again, you know, there are volumes of 23 stuff. I'm sure if somebody asked you case law 24 that you haven't reviewed in 21 years, you'd know 25 it existed but you wouldn't know what it was. I 92 1 mean, this is what life is. 2 Q. All right. 3 A. It's a complicated, it's a complicated 4 profession. 5 Q. But, Doctor, again, and all I want to get here 6 is: Is it fair to say if you don't remember what 7 a tripod test was, how can you tell this jury 8 whether or not it's a reliable indicator? If 9 today you don't know truly -- 10 A. I don't believe it's a reliable indicator; I 11 don't use it as part of my examination; I don't 12 know what the details of it are; I don't know 13 what the significance of a positive or a negative 14 test are. It's a test that Dr. Gabelman does. I 15 don't know why he does it. 16 Q. So it's a test but don't know what it is and 17 you're telling this jury that it's not a reliable 18 indicator? 19 A. I'm saying that I don't believe it's a necessary 20 part of a complex orthopedic exam. There are 21 certain things that I do that make up for any 22 type of deficiencies. There are 30 or 40 other 23 tests with obscure names. 24 Q. All right, Doctor, I'll move on. 25 Now, you have had a chance you've told this 93 1 jury to review both the films and the reports 2 from the radiologist from the lower back MRIs, 3 correct, Doctor? 4 A. Yes. 5 Q. Okay. And, Doctor, starting with the September 6 '98 film, that did demonstrate a herniated disc 7 at L4-5, correct, Doctor? 8 A. Correct. 9 Q. Okay. 10 A. A bulging or herniated disc, either one would be 11 the equivalent term. 12 Q. Okay. Correct, Doctor. And I think you said 13 that was about five millimeters? 14 A. That's what the radiologist said. I looked at 15 it, you know, unless I have the little scale that 16 they read on, it's difficult to say how many 17 millimeters. 18 Q. I understand. 19 A. But it's approximately a quarter of an inch. 20 Q. Okay. Now, Doctor, again just so the jury is 21 clear, herniated discs are frequently caused by 22 motor vehicle accidents? 23 A. Well, trauma causes herniated discs. Automobile 24 accidents are common sources of trauma and in my 25 practice I don't see it as the most common, 94 1 probably it's not even the top ten most common. 2 But yes, it's not unheard of. 3 Q. I mean, Doctor -- 4 A. It's much more common in the neck related to a 5 car accident, but it is not unheard of and it's a 6 well-recognized etiology -- 7 Q. Well -- 8 A. -- as a possible injury. 9 Q. All right. But Doctor, let's be -- let's 10 start -- I'm not trying to be coy. I mean, let's 11 be honest here. During your 17 years, you know, 12 doing medical/legal type work, I mean, can you 13 possibly tell me the number of low back herniated 14 discs you've seen resulting from motor vehicle 15 accidents? 16 A. I don't have any idea. 17 Q. It's a large amount, correct, Doctor? 18 A. Well, it's certainly a large amount of claims, 19 but I'm not, I'm not, I don't, I don't know. I 20 mean, yes, it's a common thing, but it's not as 21 common as the neck. 22 Q. All right. Well, I'll get to the neck in a bit, 23 Doctor, but we can agree that a herniated disc at 24 the L4-5 lower back is a common occurrence from a 25 trauma the type of a lower -- of a motor vehicle 95 1 accident? 2 A. The L4-5 is probably the most common disc that is 3 herniated or abnormal in the spine and, yes, it 4 is frequently associated with motor vehicular 5 accidents. 6 Q. Okay. Now, the testimony in this case will also 7 indicate that this was a pretty high speed motor 8 vehicle accident; that the defendant was going 9 about 30 to 35 miles an hour and the jury will 10 have had a chance to look at the photos of the 11 car. That would also lend credence to that, 12 wouldn't it, Doctor? 13 A. Lend credence to what? 14 Q. To the fact that a herniated disc could be caused 15 by this type of trauma? 16 A. You know, I'm not an accident reconstruction 17 specialist, but I think that certainly with 18 higher property damage type of injuries, the risk 19 of an injury to the spine and to the body is 20 higher. 21 Q. Okay. 22 A. And sure, it is a potential cause of it, 23 absolutely. 24 Q. Okay. Thanks, Doctor. 25 All right. Now, Doctor, again just so the 96 1 jury is clear, when a disc herniates essentially 2 from my understanding, again I'm not a doctor 3 here but, you know, we have this disc material 4 that essentially ruptures through the annulus 5 fibrosis, is that correct, Doctor? 6 A. So far. 7 Q. Okay. And the annulus fibrosis, Doctor, that 8 contains a lot of pain nerve fibers; is that also 9 accurate? 10 A. You know, a lot of people think that and a lot of 11 people don't think that. I don't really know. 12 We do procedures under local anesthesia or we 13 stick needles through it and that's not real, 14 real painful. So I don't know. I think there's 15 a controversy. I'm not convinced of it. I know 16 there are certain people that opine that. But I 17 think the literature is unclear. 18 Q. All right. Dr. Gabelman has already indicated in 19 his testimony that that's what happens when a 20 disc herniates. Again -- 21 A. Again, that's certainly his opinion. I'm not 22 sure it's the actual rupture or the actual 23 tearing of the annulus that is the source of the 24 pain, you know, we don't know that. I mean, it's 25 not a scientific fact. 97 1 Q. And again you know Dr. Gabelman and he's 2 certainly a well credentialed, well board 3 certified orthopedic surgeon? 4 A. Well, he's a board certified orthopedic surgeon 5 and I know he doesn't do spine surgery and 6 neither do I so I -- but I think we both sort of 7 keep up with it and that's what he read and 8 that's what he believes. I don't have a problem 9 with it, I just don't agree. 10 Q. Dr. Gabelman also indicated in his testimony that 11 painful biochemical changes occur when a disc 12 herniates, is that true, Doctor? 13 A. I don't know. 14 Q. That you don't know? 15 A. I mean, I'm sure there's reasons for everything. 16 Q. Okay. 17 A. I, I don't think it's a critical issue. 18 Q. All right. And we've also touched upon this a 19 little bit, Doctor, when a disc herniates it 20 could put pressure on the nerves which also would 21 be a very painful condition? 22 A. It can be very painful. But that's very 23 specifically painful. 24 Q. I understand. I understand. 25 So Doctor, a herniated disc, again generally 98 1 speaking, is a very painful condition? 2 A. No. A traumatically induced herniated disc that 3 pushes on a nerve can be a very, very painful 4 condition. But herniated discs in general may 5 not be, and I don't think there's in the 6 statistics other than the fact that we know 7 there's a high number of individuals who do have 8 it that are not symptomatic. 9 But if you're talking about a specific 10 scenario, an acute traumatically ruptured disc 11 that puts pressure on the nerves and is 12 associated with a significant trauma, yes, that's 13 a very painful, very specific clinical picture. 14 Not all herniated discs are painful. 15 Q. All right. Now, Doctor, let's talk about the 16 treatment of herniated discs for a minute if we 17 could. Do herniated discs often require surgery, 18 yes or no? 19 A. Well, you don't operate unless there is a 20 herniated disc, so a symptomatic herniated disc 21 that is not improving or worsening or a condition 22 where you have a deficit, that is a nerve that's 23 paralyzed or something that's not getting any 24 better, yes, that's a surgical problem. 25 Q. Okay. Again -- 99 1 A. Not -- again, it has to follow a certain -- 2 Q. I understand. Doctor, it will go faster if you 3 could just answer my questions. 4 A. I can't answer some of your questions in a yes or 5 no answer. 6 Q. Let me try it again: Do herniated discs get 7 operated on? 8 A. Herniated discs that are appropriately worked up, 9 yes, they can be operated on. 10 Q. Okay. Now, other types of treatment, what about 11 pain management; is that something that's used 12 for herniated discs? 13 A. Well, unfortunately it is. 14 Q. Okay. And that can last for some time, right, 15 Doctor? 16 A. Well, unfortunately, yes. 17 Q. Okay. In fact, Doctor, can herniated discs cause 18 a person to require physical therapy for the rest 19 of their life? 20 A. Well, probably. 21 Q. And in fact -- 22 A. At least in some sort of exercises. And again, 23 you know, we don't, the presence of a herniated 24 disc whether, no matter what the etiology, would 25 demand someone to be aware of that and to keep 100 1 their body in, you know, spend a little bit more 2 time with it and really work on exercising, not 3 necessarily physical therapy but certainly 4 therapeutic exercises or exercise that would be 5 beneficial to the spine. 6 Q. All right. But Doctor, I mean, you have 7 testified in the past that people who have 8 herniated discs, you have testified in certain 9 individuals that they have needed 10 physical -- and -- excuse me. 11 You have testified that certain individuals 12 who have herniated discs will need physical 13 therapy for the rest of their lives, is that 14 correct? 15 A. On an intermittent basis probably, yes. 16 Q. Okay. And Doctor, that is a possibility with 17 Andrea Prentice, isn't it? 18 A. I don't know. 19 Q. Okay. Now, Doctor, and again I think you said 20 this on direct, that herniated discs will 21 frequently be a permanent condition, correct, 22 Doctor? 23 A. Well, again, there are herniated discs and there 24 are herniated discs. I, my personal feeling is 25 once a disc has herniated, that herniation, 101 1 whether it's a source of pain or not a source of 2 pain is a permanent condition that typically 3 doesn't change. 4 Q. Okay. 5 A. Especially in the traumatically induced 6 herniation -- herniated disc. 7 Q. All right. Now Doctor, I just want to be clear 8 on one thing: You were talking earlier about 9 neurological symptoms and I think your testimony 10 was that Ms. Prentice doesn't have any 11 neurological symptoms which correlate with this, 12 is that accurate? 13 A. Yes. 14 Q. Okay. What do you mean by neurological? With 15 regard to the low back, what are the kind of 16 things you would expect to see for there to be a 17 neurological component in your mind? 18 A. There has to be a quality of the discomfort; the 19 quality of the symptoms; numbness; tingling; 20 burning; weakness that follows a very, very 21 specific pattern. 22 Q. What pattern, Doctor? 23 A. The pattern that would influence the L5 nerve 24 root. I'm not trying to be, give you a smart 25 aleck answer, it's just that there is a, the body 102 1 is mapped out in a very, very specific pattern in 2 that if you have an L4-5 herniated disc that is 3 pushing on the L5 nerve root, you are going to 4 get pain, weakness, symptoms within a very 5 specific distribution that would indicate 6 compression or irritation of the L5 nerve root. 7 Q. What is that distribution, Doctor? 8 A. The distribution is below the level of the knee; 9 in the middle portion of the foot you will have 10 weakness of the great toe being able to push the 11 big toe up in the air against resistance or some 12 times dorsal flexion of the whole foot; that is, 13 bringing the foot in an upper direction against 14 resistance, and you will have certain muscles 15 associated that are weak or atrophied or wasted. 16 Q. What about radiating pain, numbness in the 17 buttocks; is that something you'd expect to see? 18 A. Numbness in the buttocks is something that you 19 might see within the first 24 to 48 hours as this 20 thing is evolving. But numbness in the buttocks 21 would typically not be associated with an L5 22 nerve root. 23 Q. Well, but Doctor, I mean, I've seen the 24 distributions here as well. I mean, at L4-5 25 normally that's going to go down, down your leg, 103 1 correct, Doctor, into the areas you were talking 2 about? 3 A. It is going to go the course of the cable, the 4 course of the actual physical structure goes from 5 the buttock area down to the leg. But typically 6 it's not a problem above the knee and above the 7 knee and into the buttocks. It's a problem below 8 the knee because that's where those, that's the 9 end organs, those are where the, those nerves 10 travel. 11 Q. Okay. 12 A. In other words, that's what those nerves do. 13 They don't, they have a cable, you know, and if 14 something is irritated along the cable, then you 15 could, the brain can interpret it lots of ways. 16 Q. I understand that, Doctor. 17 But you said that you would expect to see 18 some sort of pain and symptoms in the buttocks 19 with an L4-5 nerve root? 20 A. I would say within the first 24 to 72 hours it 21 would not be uncommon, but that would not be the 22 end of the symptoms. It may be common in the 23 first days or a week. I have never seen that 24 part of an acute herniated disc be a persistent 25 symptom. Certainly two-and-a-half years 104 1 afterwards. 2 Q. Okay. Just so we're, clear, Doctor, the L4-5 3 spine, that's just above the area around the 4 buttocks, correct, Doctor? 5 A. The L4-5 is typically if you put your hands on 6 your hips, okay, you put your hands on your hips 7 like this and reach down, that's approximately 8 the L4-5 level. 9 Q. Just above the buttocks? 10 A. It, well, everybody's buttocks is, I mean, what 11 people consider buttocks may not be what medical 12 doctors considered buttocks. 13 Q. Okay. 14 A. But we usually use the bony reference to where 15 you put your hands on your hips, that's the top 16 of the ilium which is the hip bone, the pelvis 17 bone, and it's typically, the top of that is 18 typically at L3, or for most people that's L3. 19 So it would be about an inch-and-a-half below 20 that. 21 Q. Okay. 22 A. Roughly. 23 Q. All right. Doctor, I want to talk for a minute 24 now about -- you were talking about, I think your 25 testimony was that you can't state with certainty 105 1 that this herniated disc that you agree is on the 2 films and that Andrea Prentice has was caused by 3 the motor vehicle accident; have I said that 4 correctly, Doctor? 5 A. It's there but I don't know what caused it or if 6 anything caused it. 7 Q. Doctor, you alluded earlier to the medical test 8 here, the medical/legal test which is that 51 9 percent standard and you referred to that and 10 obviously you know that standard. 11 Doctor, what about within a medical 12 probability, Doctor, again, greater than not 51 13 percent or better, Doctor, can't we say here that 14 given the picture that we have with a herniated 15 disc, with a pain associated with the lower back 16 for three-and-a-half years, with no prior history 17 of any kind of lower back pain, no prior films 18 indicating that there was any problems with an 19 MRI before this happened, with a young woman who 20 was 38 years old at the time of this accident, 21 can't we say with all that, Doctor, that to a 22 reasonable degree of medical probability this 23 was, this herniated disc was caused by the motor 24 vehicle accident? 25 A. No, I can't say that. Because there was no 106 1 symptoms related to the disc. There is no 2 symptom specifically related to that disc within 3 that time frame that I can say within a 4 reasonable degree of medical certainty that disc 5 herniation was caused by it. That's just not 6 there. 7 Q. All right. Doctor, have I -- 8 A. You could assume all the things that you've said 9 but that doesn't mean that -- 10 Q. Well, Doctor -- 11 A. -- that's what caused that particular anatomical 12 abnormality. 13 Q. Doctor, just so the jury is clear, the things 14 that I just ran down the list, the litany of 15 things, those weren't assumptions on my part. I 16 mean, let's go through them one by one, you know, 17 Ms. Prentice has had three and at the time you 18 saw her two-and-a-half years of back pain, 19 correct? 20 A. Back pain. Not leg pain. 21 Q. All right. 22 A. Not -- 23 Q. That's my question. 24 A. Not buttocks pain, not neurological pain. Low 25 back pain. Yes, I do. 107 1 Q. Doctor, have you become, seen any records at all 2 from prior to October 23rd, 1997 that show any 3 pain, treatment of any kind with Andrea Prentice 4 and her lower back? 5 A. She presented with a history that she had not and 6 I don't believe there's any records that predated 7 this injury. 8 Q. Right. 9 A. So I don't, I'm not aware of any. 10 Q. Nothing to indicate what we've got here, Doctor, 11 and what this jury has before them to indicate 12 that Ms. Prentice had any lower back pain before 13 this accident or problems? 14 A. No, there's nothing -- 15 Q. Okay. 16 A. -- to indicate she had has any low back pain. 17 Q. All right. And as a corollary, Doctor, you have 18 not seen any clinical tests, MRIs from again 19 before this accident which would indicate there 20 was a herniation there before this accident, 21 correct, Doctor? 22 A. There's nothing to indicate that an MRI or any 23 clinical suspicion was, had prior to this 24 accident. 25 Q. And we can agree, Doctor, as you said before, 108 1 herniated discs at the L4-5 level you've been 2 testifying for 17 years and it's very common that 3 these are caused by motor vehicle accidents, 4 especially ones that are very traumatic in nature 5 such as we have here? 6 A. Well, that's not what I'm saying. I'm saying 7 that yes, they are associated with accidents as a 8 potential cause, but I'm not going to agree to 9 the way you phrased that question. 10 Yes, they are associated with motor vehicle 11 accidents; yes, they're associated with more 12 significant motor vehicle accidents but they're 13 associated with lifting, coughing, sneezing, 14 many, many other etiologies that are far more 15 common. 16 Q. Do you see anything in the records, Doctor, that 17 indicate that Andrea Prentice lifted, coughed, 18 sneezed causing her pain? 19 A. No, there's nothing to indicate that. 20 Q. Well, Doctor, if we've eliminated all the other 21 possibilities, why can't we agree that it was 22 caused by the motor vehicle accident? I mean, 23 can you tell the jury what it was caused by then? 24 A. I don't know what it's caused by. It's seen in 25 the normal population. It got better with the 109 1 second MRI. I can't state what caused that. 2 I -- could it have caused it? There's a 3 possibility. It's a possibility that the lifting 4 and bending and stuff that she's doing at work 5 all the time could be a cause of the bulging or 6 weakness of a disc. The fact that there is a 7 herniated disc that doesn't match the symptoms. 8 Q. All right. Doctor -- 9 A. And I just can't draw that conclusion within a 10 reasonable degree of medical certainty. 11 Q. So you'll say a possibility but again I'm not 12 asking you medical certainty, I'm asking you what 13 the standard is in this case which is medical 14 probability -- 15 A. Which is what I said. 16 Q. -- 51 percent or greater? 17 A. Right. 18 Q. You can't acknowledge that, Doctor? 19 A. I cannot state within a reasonable degree of 20 medical certainty or a reasonable degree of 21 medical probability what the etiology of that 22 disc abnormality on the first MRI scan of her low 23 back was caused by, I don't know. 24 Q. You'll only, you'll only say a possibility? 25 A. And it's one of many possibilities, including the 110 1 fact that it may be a normal varient. 2 Q. All right. Well, Doctor, you indicated before 3 that you referred to some tests that were done 4 with normal individuals who have findings. 5 Doctor -- 6 A. That had no findings. They only, the only thing 7 that they had was MRI abnormalities. 8 Q. Correct. And what I meant by findings was MRI 9 abnormalities but no symptoms. 10 A. That's correct. 11 Q. That's what you were saying, Doctor? 12 Doctor, in Dr. Gabelman's testimony he has 13 indicated that what he has seen along those lines 14 is that for individuals who are younger, such as 15 Ms. Prentice, 38 years of age, the incidents for 16 having a positive MRI without any clinical 17 findings is much lower, I think he said around 18 the range of 15 percent, Doctor, isn't that true? 19 A. I don't know where he got that statistic from. I 20 see it very, very commonly. I have a bulge of 21 patients who are in the 35 to 45 age group that 22 have had MRIs for fishing expeditions by their 23 internists that can't explain why they're having 24 pain and they do have MRI evidence of disc bulges 25 and disc herniations. But on clinical 111 1 examination I can't state what caused them, it's 2 just that they're there. 3 Q. Well, Doctor, again, again, I tried to take 4 copious notes during your direct and I think your 5 statement was: Usually bulges, herniations are 6 all over the place in people in their 40s. 7 Again, Ms. Prentice is not in her 40s, Doctor. 8 A. Well, she certainly was by the time that the 9 second MRI was done. And the difference between 10 38 and 40, I mean, I don't think that's a real 11 critical issue from a doctor's standpoint. The 12 fact that she has a positive test doesn't 13 indicate any etiology or a reason. 14 Q. All right. Okay. Now Doctor, I want to be clear 15 on something. In your report -- well, I mean, I 16 guess you are suggesting to this jury that this 17 herniated disc could have been in existence 18 before this motor vehicle accident, correct? 19 A. Or it could have occurred an instant before the 20 MRI was performed. 21 Q. I understand. 22 A. And we just know that on that particular date 23 that minor disc herniation was noted both in the 24 middle of her neck and in the middle of the low 25 back. 112 1 Q. I understand. Doctor, I'm just trying to get to, 2 you know, the question of what this was caused by 3 if it wasn't caused by the motor vehicle 4 accident. And my question is: If one of those 5 possibilities you're saying is that it existed 6 before the motor vehicle accident it was 7 degenerative in nature, Doctor? 8 A. Or it was developmental. 9 Q. I understand. One of those possibilities you're 10 saying? 11 A. Absolutely. 12 Q. Okay. Doctor, when a radiologist does an MRI, if 13 they see something degenerative, do they normally 14 note that on MRI? 15 A. No, not always. Unfortunately. 16 Q. Really? All right. Let's look at the MRI from 17 September 30th, 1998, Doctor. 18 A. All right. 19 Q. I've got a copy of that if you like. 20 A. Talking about the scan. 21 Q. Yes, I'm talking about the radiologist's 22 interpretation. 23 A. Okay. I have that somewhere here. 24 Q. And it's been marked as Plaintiffs' Exhibit 2 in 25 Dr. Gabelman's deposition. 113 1 A. Okay. 2 Q. All right. Now, Doctor, I want you to look at 3 the last line there on the page under, you see it 4 says, Impression and then you've got the first 5 line and then it says, Minor degenerative change 6 seen at L5-S1. 7 Am I reading that correctly? 8 A. Yes. 9 Q. All right. So in other words here, Doctor, 10 Dr. Plecha, the radiologist has indicated a 11 degenerative change at L5-S1? 12 A. That's what the report indicates. 13 Q. So she's seen something degenerative and she has 14 marked that on the report. 15 A. He or she, I don't know. 16 Q. He or she. I believe it's a she. But that's not 17 important. 18 The line above that, Doctor, am I reading 19 this correctly, focal disc herniation centrally 20 and slightly to the left of midline at L4-L5 21 causing mass effect on the thecal sec? 22 A. You're reading it absolutely precisely. 23 Q. Great. And my question is, Doctor: Do you see 24 anywhere in that line with regard to the L4-5 25 where Dr. Plecha has indicated any degenerative 114 1 nature of disc herniation? 2 A. He or she did not say degeneration in that 3 sentence at all. 4 Q. Okay. And she, he or she did say degeneration at 5 L5-S1, the line right below it, Doctor? 6 A. Right. That's exactly what it says. 7 Q. Doctor, I know you don't know Dr. Plecha, is that 8 correct? 9 A. I'm not sure. I heard the name, but I don't know 10 who he or she is. 11 Q. It would appear here, Doctor, that she is a 12 radiologist that if she sees a degenerative 13 change, she indicates it on the report? 14 A. Again, you're going to have to ask her that 15 question. I can't answer her question why they 16 use one particular word group, I don't know. 17 Q. It would appear, Doctor, just from the, again I 18 know I'm not asking you to read Dr. Plecha's 19 mind, that sort of thing, but it would appear 20 that, Doctor, from this record, that Dr. Plecha 21 didn't see anything degenerative at L4-5? 22 A. The only thing I can say is that there's nothing 23 on the report to say, use the word degenerative 24 other than the fact that in the description above 25 they said mild loss of normal disc space signals, 115 1 you know, that is what we see in early 2 degenerative changes. Now, but that's -- did 3 they use the word degenerative? No. 4 Q. All right. Thank you, Doctor. Sure. 5 VIDEOGRAPHER: We're now going 6 off the record ending tape number one of 7 Dr. Corn. 8 - - - - 9 (Thereupon, a discussion was had off 10 the record.) 11 - - - - 12 VIDEOGRAPHER: We're on the 13 record. This is the beginning of tape 14 number two of Dr. Robert Corn. 15 Q. Okay. Doctor, I'd like to move on then and go to 16 the neck and the knee injuries here briefly. And 17 Doctor, you've indicated that in fact 18 Ms. Prentice did suffer injuries to her neck and 19 knee as a result of this motor vehicle accident, 20 correct, Doctor? 21 A. In my opinion she did have an injury to both her 22 neck and her left knee. 23 Q. Okay. And Doctor, again I think you've 24 characterized these as soft tissue injuries? 25 A. I, that's, I think that that's probably with the 116 1 fact that there where other normal testing there 2 were probably soft tissue that didn't involve the 3 bone. 4 Q. Right. 5 A. At all. 6 Q. In fact, diagnostic tests were done with regard 7 to the neck at least and ruled out any 8 herniations so you've concluded a soft tissue 9 injury? 10 A. Probably. 11 Q. Okay. 12 A. I think that's -- and the fact that it got better 13 by the most part. 14 Q. All right. 15 A. -- that you know it was not a structural injury. 16 Q. Right. And, Doctor, again we've already talked 17 about that these types of soft tissue injuries 18 are certainly painful? 19 A. For a period of time, sure. 20 Q. Right. So Ms. Prentice was caused to suffer pain 21 in her neck and knee as a result of this motor 22 vehicle accident? 23 A. I think for the time period that's well 24 documented that she probably had symptoms from 25 it, she probably had pain. 117 1 Q. Okay. And once again, Doctor, in your report you 2 indicate that all the treatments she had was 3 appropriate and you feel that way for the neck 4 and the knee, I imagine? 5 A. Again I think we're going to have to get a little 6 more specific on that. But in general, I didn't 7 have any criticisms from a medical standpoint or 8 from a standards issue that there was no 9 inappropriate testing that was or inappropriate 10 treatment that was done. 11 Q. I'm just curious, Doctor, you keep referring to 12 that, making the distinction where you say 13 "appropriate" that you were looking at it, that 14 sentence referred to a medical standards issue; 15 in other words, whether they committed 16 malpractice? 17 A. Well, in other words, if what they did was 18 medically appropriate, in other words, it may not 19 be medically necessary but it was not medically 20 off the wall. 21 Q. In other words, within the standard of care, as 22 you said earlier? 23 A. In other words, if she had a bruised knee and she 24 had 20 Cortisone injections or five Cortisone 25 injections, that would be inappropriate. I mean 118 1 that would not -- 2 Q. That would be outside the standard of care for 3 that, Doctor? 4 A. You know, I would think that that would not be 5 great medical care. I mean, whether it was 6 substandard you know or -- 7 Q. Doctor, when you were asked by the defense, when 8 you were approached to look at this case, you 9 weren't asked to approach it from a standpoint of 10 a medical negligence case, were you? 11 A. I was asked to give my medical opinions on the 12 care and treatment and the injuries. Now, 13 whatever that care and treatment was, if I felt 14 that there was something negligent, I would have 15 discussed it. 16 Q. Right. 17 A. In other words, this was not a defense of a 18 medical/legal medical malpractice issue, this was 19 an evaluation medically and my medical 20 opinions -- 21 Q. I understand. 22 A. -- as to what was done. 23 Q. And that's exactly my point, Doctor: As this was 24 not an evaluation of a medical malpractice issue, 25 why are you telling me today that when you say 119 1 all the treatment was appropriate that that's 2 what you were referring to? I mean, why would 3 you render such an opinion if that's not what you 4 were asked to do? I mean, there aren't any 5 doctors on trial here, Doctor. 6 A. You're asking me to clarify a statement that I 7 said as a non-lawyer you're asking me a legal 8 interpretation of what I meant and I'm trying to 9 let the jury and the Court know that although I 10 may have chose one series of words, this is what 11 I meant to say. 12 Q. All right. 13 A. And this is what I -- I'm not saying that all of 14 the treatment that we previously discussed was 15 necessary and appropriate, it was just 16 appropriate. 17 Q. All right. 18 A. In other words, there was nothing that was off 19 the wall done that could have been harmful or 20 could have prolonged the patient's problems or 21 would have been an inappropriate diagnostic test 22 such as a myelogram or sticking a needle into 23 part of it or going through lengthy pain 24 management when it was not indicated. That's 25 what I'm talking about. 120 1 Q. But Doctor, let's be fair here, you know, to say 2 that you know, that you don't understand the 3 medical/legal context, I mean, you've been doing 4 this for a lot longer than I have. 5 A. I'm, Mr. Mester, I'm not a lawyer, you know, I 6 look at things and I try to interpret what is 7 necessary from a medical/legal standpoint. You 8 know, I don't know all the rules. I don't have 9 the orientation of a lawyer, I have the 10 orientation of a doctor. So there may be certain 11 legal questions as some of them that you're 12 answering me that I didn't address in my letter. 13 If I was a lawyer and writing a legal letter, it 14 would be different. I'm a doctor writing a 15 medical/legal letter so my orientation is 16 medical, it's not legal. 17 Q. Doctor, you've been doing two to three of these 18 for the past 17 years and you're telling me that 19 you don't have an orientation as to these types 20 of matters? 21 A. I don't -- I have an orientation but I don't have 22 all the legal savvy. I don't know how my words 23 that I'm writing in English and medical English 24 are going to be turned around or manipulated to 25 be beneficial to one side or the other. I, 121 1 that's why we're doing this testimony here 2 because obviously there's some conflicts that 3 can't be resolved and I'm trying to give my 4 opinions to try to help resolve the conflict as 5 fairly as I can. 6 Q. Okay. Doctor, lastly, you charged a fee I think 7 we talked about earlier for conducting the 8 medical exam. What was your fee for that medical 9 exam, Doctor? 10 A. Again, the fee, I don't have the exact figure but 11 I'm sure that can be obtained, was probably 12 around 16 to $1,800 and that included the review 13 of all the records, the writing of the two 14 reports, the history and physical and the time it 15 took to put this all together and make it into a 16 package that was acceptable to the lawyers who 17 hired me -- 18 Q. I understand. 19 A. -- to provide that opinion. 20 Q. I understand. And, Doctor, I assume you're 21 charging a fee for your time here today? 22 A. The standard fee that my corporation charges for 23 doctor services involving any kind of deposition 24 or medical/legal testimony is $900 an hour. 25 That's been the same since 1994. 122 1 Q. Okay. And Doctor, looking at my watch, I think 2 Mr. Derkin took about an hour with you, I'm 3 taking about an hour with you, so that's two 4 hours we've been here this morning? 5 A. I, whatever the time is, the time is. 6 Q. All right. So $1,800. So 1,800 plus 1,700 you 7 charge roughly $3,500 for your opinions in this 8 case here, Doctor? 9 A. Well, I charge that $3,500 for the time it took 10 to provide those opinions, not just for the 11 opinion. 12 MR. MESTER: I see. Thank you, 13 Doctor. Nothing further. 14 MR. DERKIN: About three 15 questions on redirect, Doctor. 16 - - - - 17 REDIRECT EXAMINATION OF ROBERT C. CORN, M.D. 18 BY MR. DERKIN: 19 Q. First of all, you said that you do two to three 20 of these independent medical examinations a week. 21 How many normal patients whom you are treating do 22 you see a week? 23 A. Mondays and Thursdays I typically see anywhere 24 from 20 to 25 and alternate Wednesdays I can see 25 another 25. So I would say anywhere from 50 to 123 1 75 patients a week, not including the people in 2 the hospital and time in surgery. 3 Q. We've heard a lot of talk about a herniated disc. 4 Do we have a situation in this particular case 5 where the annulus has been ruptured and we have 6 the thecal material coming out of the disc? 7 MR. MESTER: Objection. 8 A. There doesn't appear to be a free fragment or 9 anything more than a bulging disc; in other 10 words, it appears especially with a more normal 11 MRI done in April that we do not have a free 12 fragment or a permanently displaced disc that is 13 more commonly associated with a traumatic disc 14 herniation. 15 Q. And finally, the back stiffness about which 16 Ms. Prentice complained when she saw you in about 17 a year ago, stiffness again is something she's 18 complaining about, it's not something you can 19 feel or touch, is that right? 20 A. I can't feel or touch stiffness. I can detect 21 certain things such as muscle guarding or muscle 22 spasm that may contribute to stiffness, but this 23 was a voluntary restriction of motion. I didn't 24 want to make her hurt any more than she was 25 claiming to hurt and those are my findings at the 124 1 time of the exam. 2 MR. DERKIN: Thank you, Doctor. 3 I have nothing further. 4 MR. MESTER: Doctor, just one 5 more, I believe. 6 - - - - 7 RECROSS-EXAMINATION OF ROBERT C. CORN, M.D. 8 BY MR. MESTER: 9 Q. You talked about the fact, and I think it's 10 documented that the herniation on the second exam 11 was slightly less prominent. You've indicated 12 that a shrinkage of such herniations typically 13 occurs in a non-traumatic situation, Doctor. 14 Concurrently, that would infer that shrinkage 15 does occur in traumatic situations as well, isn't 16 that true, Doctor? 17 A. If there, I -- in general, I have seen it, in 25 18 years I have seen that occur. 19 MR. MESTER: Okay. Great. 20 Thank you, Doctor. That's all I have. 21 VIDEOGRAPHER: Excuse me, Doctor. 22 You have a right to view this tape in its 23 entirety or you can waive that right. Do 24 you wish to waive it? 25 THE WITNESS: I will waive my 125 1 right to review the tape and the 2 transcript. 3 VIDEOGRAPHER: This now concludes 4 the deposition. We are now going off the 5 record. 6 MR. MESTER: I will waive the 7 one-day filing requirement. 8 (Signature waived.) 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 126 1 2 C E R T I F I C A T E 3 4 The State of Ohio, ) SS: 5 County of Cuyahoga.) 6 I, Colleen M. Malone, a Notary Public within and for the State of Ohio, authorized to 7 administer oaths and to take and certify depositions, do hereby certify that the 8 above-named ROBERT C. CORN, M.D. was by me, before the giving of his deposition, first duly 9 sworn to testify the truth, the whole truth, and nothing but the truth; that the deposition as 10 above-set forth was reduced to writing by me by means of stenotypy, and was later transcribed 11 into typewriting under my direction; that this is a true record of the testimony given by the 12 witness, and the reading and signing of the deposition was expressly waived by the witness 13 and by stipulation of counsel; that said deposition was taken at the aforementioned time, 14 date and place, pursuant to notice or stipulation of counsel; and that I am not a relative or 15 employee or attorney of any of the parties, or a relative or employee of such attorney, or 16 financially interested in this action. 17 IN WITNESS WHEREOF, I have hereunto set my hand and seal of office, at Cleveland, Ohio, this 18 _____ day of _________________ A.D. 20 _____. 19 20 _________________________________________________ 21 Colleen M. Malone, Notary Public, State of Ohio 1750 Midland Building, Cleveland, Ohio 44115 22 My commission expires August 25, 2002 23 24 25 127 1 W I T N E S S I N D E X 2 PAGE DIRECT EXAMINATION 3 ROBERT C. CORN, M.D. BY MR. DERKIN.......................... 4 4 CROSS-EXAMINATION 5 ROBERT C. CORN, M.D. BY MR. MESTER......................... 51 6 REDIRECT EXAMINATION 7 ROBERT C. CORN, M.D. BY MR. DERKIN........................ 122 8 RECROSS-EXAMINATION 9 ROBERT C. CORN, M.D. BY MR. MESTER........................ 124 10 O B J E C T I O N I N D E X 11 OBJECTION BY PAGE 12 MR. MESTER............................ 15 13 MR. MESTER............................ 23 MR. MESTER............................ 32 14 MR. MESTER............................ 33 MR. MESTER............................ 33 15 MR. MESTER............................ 37 MR. MESTER............................ 41 16 MR. MESTER............................ 46 MR. MESTER............................ 47 17 MR. DERKIN............................ 83 MR. DERKIN............................ 83 18 MR. DERKIN............................ 84 MR. DERKIN............................ 86 19 MR. MESTER........................... 123 20 21 22 23 24 25