Monday, March 18, 2019

Dr. Sanjong Pangarkar’s Conclusions on Plaintiff’s Bus Incident-Related Back Pain Lead to $14.31M Verdict

The Trial: Francisco v. Alameda-Contra Costa Transit District, a 2014 California trial in which plaintiff claims she suffered lifelong back injuries when a public transit bus drove over a speed bump too quickly, sending her airborne and causing her to land on the hard bus seat.

The Expert: Dr. Sanjong Pangarkar, a Los Angeles-based pain medicine specialist, who criticizes the defense expert’s contention that the plaintiff is malingering, and who outlines his opinion on the severity of plaintiff’s injury and her ultimate prognosis.

The Verdict: $14.31 million.


 By Gary F. Gansar, MD, FACS; Senior Medical Director, AMFS

In this 2014 California trial, the plaintiff claimed that she suffered severe back injuries when a public transit bus drove over a speed bump too quickly, sending her airborne and causing her to land hard. Our expert, Dr. Sanjong Pangarkar, a California pain medicine specialist, testifies surrounding the plaintiff’s injuries and her prognosis.

While the defense in the case contends plaintiff is malingering, Pangarkar disagrees. He states that he is trained to spot malingering on those patients who do not provide a genuine effort. In fact, he notes, there is testing that can be performed to unmask such behavior. In his soft spoken and earnest style, the doctor assures the jury that he at no time suspected malingering by the plaintiff and thus he had no reason to run these tests.

During Pangarkar’s testimony, the jury is reminded that a defense expert had suspected that the plaintiff was not being honest about her pain after his first visit with her, and had noted that she had not opened her last bottle of pain medicine during the three months prior to him seeing her. However, Pangarkar explains that her doctor had been weaning her down from high dosages to lower dosages in an effort to reset her pain receptors and allow for effective reintroduction of pain meds. This is not an unusual practice, he notes, and is not an indication that she no longer needed pain medication.

In a particularly damaging statement, Pangarkar also says that, while the defense expert’s examination was not necessarily deficient, he would have drawn totally different conclusions regarding the findings of the physical exam performed by that expert.

Pangarkar explains that the “straight leg raise” test, a test for sciatica, was performed and did not indicate a radiculopathy, so the defense concluded that she did not have a verifiable cause for her back pain. In fact, Pangarkar explains, the fact that this test was negative only ruled out radiculopathy [pain shooting down the leg].  With the pain localized in the back when this test was performed, the theory that the pathology was confined to a specific area of the back was simply confirmed and demanded further testing to determine what exactly that pathology was. “I think the conclusions [the defense expert] made were wrong based on his own findings,” Pangarkar says.

Pangarkar also concludes that the plaintiff had chronic pain syndrome due to tearing of facet joints and disruption of the sacroiliac joints. Beyond this, she suffered from nonunion of her first lumbar vertebra, which would require surgical intervention. Indeed, the triad of broken facet joints, unstable sacroiliac joints, and nonunion of the first lumbar vertebra led to his diagnosis of chronic pain syndrome. This could be somewhat improved with treatment, he notes, but he feels certain that her pain syndrome will be a lifelong problem for her. She cannot be cured.

The prospects of future job placement for the plaintiff are then addressed by the expert. Pangarkar says he initially believed she could be rehabilitated to work half-time as a clerical worker, something which would minimize the physical strain on her spinal problems. This opinion changed, however, when he realized that she had a significant learning disability that would prevent her from finding a job that required little physical exertion. When he consulted a vocational rehabilitation expert about this, he ultimately concluded that she was unemployable.

Pangarkar presented himself with credible authority, using visual props and a smooth manner, and his testimony was important in the jury’s $14.31 million verdict for the plaintiff. 

 

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Gary Gansar, MD, is residency trained and Board Certified in General Surgery. He previously served as Chief of Surgery and Staff at Elmwood Medical Center and on the Medical Executive Committee at Mercy Hospital and Touro Infirmary in New Orleans, LA. Dr. Gansar also served as Clinical Instructor and Professor of Surgery at Tulane University. He received his MD and served as Chief Resident at Tulane University Medical School. Dr. Gansar joined AMFS as a consulting medical expert in 2011 and has served as Medical Director since Nov. 2015. In this capacity, Dr. Gansar provides consultation, review and guidance to attorney clients.