Thursday, April 25, 2019

Dr. Stepan Kasimian Outlines Railroad Worker’s Back Injury, Leading to $1.632M Verdict

The Trial: Arizaga v. BNSF Railway Co., a California negligence trial in which, plaintiff, a railway worker, claims he suffered injuries to his back, neck, and head when a rail rack fell off of a truck and struck him.

The Expert: Dr. Stepan Kasimian, an orthopedic surgeon, testifies about the future treatment plaintiff will need and concludes plaintiff will be unable to perform the duties of his old job.

The Verdict: $1.632 million.


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

During a 2018 California negligence trial, Dr. Stepan Kasimian, an orthopedic spine surgeon, testifies for the plaintiff regarding injuries he suffered on the job when a rail rack fell off of a truck and struck him.

Kasimian, the plaintiff’s treating physician, begins by describing the pathology caused by the neck injury as it is demonstrated on the MRI. At the left C6 foramen, there is a significant narrowing which is pinching a spinal nerve as it leaves the spinal cord, goes through the foramen, and out to the left arm. This narrowing of the foramen, the expert explains, is the cause of the plaintiff’s neck and arm pain. This patient had also sustained and injury to his lumbar spine during this accident. Kasimian had already performed a lumbar fusion on him shortly after the trauma at the L4-5, L5-S1 level.

The expert describes three options in dealing with this type of pathology. The “latest technology” would be to “decompress” or remove the disc using a microscope, then insert an artificial disc into the space where the vertebral disc use to be.  A second option would be to open the narrowing and fuse the bones around the disc. This would entail the use of a cage or bone plugs that will eventually grow to create the fusion and restrict the movement of the bones around the nerve. The final option that the doctor discusses involves rhizotomy, a procedure in which the pain fibers in the spinal nerve root are disabled to prevent the transmission of pain impulses from the joint that has been damaged by the injury. This can provide immediate relief of pain, but the procedure must be repeated indefinitely almost every year to remain effective.

The orthopedist explains that he favors placement of the artificial disc into the disc space as this would address both the joint as well as the nerve, and does not result in fusion, which can restrict mobility.

Unfortunately, even when these procedures are successfully performed, Kasimian says he always counsels patients that they are likely to have residual pain. He estimates that that there will still be a residual of up to 50% of pain present in the neck with cervical operations, and up to 10% residual pain in the leg with lumbar spine fusions. Therefore, he feels it is likely that this patient will continue to have some significant permanent neck and back pain in the future.

With or without the performance of any of these procedures, the doctor would recommend a patient under these circumstances avoid repetitive bending, excessive overhead activities bringing the arms and hands over the head, prolonged sitting, lifting 20 pounds off the ground, or carrying 40 pounds around at waist level or higher. Kasimian goes on to explain that these restrictions are “inconsistent” with the plaintiff’s job duties working for the railroad, and thus would prevent him from having the same job as before.

The testimony then turns to a preexisting back injury that the plaintiff suffered. The defense proposed this as a contributing factor in his pain. The patient had fallen and sustained a transverse process fracture the year before his lumbar surgery from this accident. Kasimian says his review of medical records related to that injury shows that it had completely healed. The patient had full range of motion and had been discharged from further care for that problem before the accident at the center of this trial. The expert did not feel that the previously resolved injury contributed to the symptoms from the injury being litigated.

The doctor’s testimony was crucial in the verdict for the plaintiff and the jury awarded $1.632 million.

 

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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.