Tuesday, May 21, 2019

Dr. Reynold Rimoldi Concludes Plaintiff’s Back Problems Pre-Dated Resort Accident, Limiting Damage Award

The Trial: Richardson v. Mandalay Bay, a 2018 Nevada premises liability case in which plaintiff claimed he was injured when a resort’s large, arch-like sign struck him.

The Expert: Dr. Reynold Rimoldi, an orthopedic surgeon and spinal specialist based in Nevada, testifying for the defense on whether plaintiff’s orthopedic problems stemmed from the sign or from other causes.

The Verdict: $524,068.86


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

Testifying for the defense, Dr. Reynold Rimoldi, a Las Vegas orthopedist, gives his opinions regarding a injuries a plaintiff claims he suffered a resort’s large, arch-like sign struck him. Rimoldi concludes there is no objective evidence that the plaintiff’s problems were related to the trauma that occurred, but were instead chronic difficulties that involved multiple areas.

Based on an examination of the plaintiff and his record, Rimoldi reports at trial that the plaintiff showed signs of neck and back strain after the incident, but there was no evidence of trauma. Studies done at the time confirmed chronic degenerative changes of the spine, but the patient did not suffer from radiculopathy then [pain, numbness, or weakness in the part of the body which is supplied by a nerve root that has been injured or irritated], and did not complain of radiculopathy temporally related to the incident with the sign.

The doctor then explains various pain and diagnostic injections relevant to the plaintiff’s injury. He details epidural injections and how they can be used as a diagnostic tool while being administered therapeutically. The injection, he explains, contains an anesthetic as well as a steroid: the anesthetic gives immediate relief, confirming that there is pathology causing problems at the level of the injection, while the steroid provides longer term pain relief therapeutically as an anti-inflammatory.

Rimoldi notes that a facet injection is another type of intervention for people with back pain. It differs from an epidural in that it is not aimed at the nerve root leaving the spine. Instead, the anesthetic and steroid are injected directly into the bony joint behind the nerve root. A traumatically ruptured disc would irritate a nerve root. However, facet joint pain is not related to nerve root irritation. Instead, the pain originates from a degenerative condition of the bones making up the facet joint, such as arthritis. In this case, however, Rimoldi notes that neither epidural nor facet injections seemed to affect this patient’s subjective complaints of pain.

The expert concludes that this patient suffered from back and neck strains and bruising that should have resolved within 6-12 weeks with conservative treatment. However, because his symptoms did not resolve within that timeframe, he agrees with the treating physician’s MRI order. This test confirmed “no objective evidence of trauma,” only preexisting changes.

Because of that finding, Rimoldi tells jurors treatments related to the trauma should have been discontinued, and only treatments dealing with the patient’s chronic difficulties pre-dating the accident should have been performed. The injections he previously described provided no value in this regard.

With so many levels affected by chronic degenerative changes in the cervical, lumbar, and sacral areas, Rimoldi cautions against performing fusion surgery. He sees this as “art surgery”—the result of which is up to interpretation—as opposed to “science surgery” that has an easily definable positive result. The many areas of degenerative change in this patient’s spine would present any surgeon an impossible dilemma. Which of these areas is the cause of the patient’s pain? We cannot know, so operating on a patient like this is unlikely to alleviate his discomfort.

While the pre-trial settlement offer had been $2.5 million. Rimoldi’s testimony likely played a key role in the jury’s award of just over $524,000.

 

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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.