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HomeMy WebLinkAbout2020CV30363 - Stuward Cross And Katrina Richman V. City Of Fort Collins - 034B - Exhibirt B - Hughes Report Re Richman4 W. Dry Creek Circle, Suite 135 | Littleton, CO 80120 Office: 303-798-1210 | E-fax: 303-997-2147 office@hughesmedicalconsulting.com CASE REVIEW Patient Name: Katrina Richman Date of Report: July 28, 2021 Date of Injury: June 7, 2017 Date of Birth: July 30, 1969 REVIEW OF HISTORY AND CLINICAL COURSE: Ms. Richman is a 51-year-old woman, whose medical records have been forwarded to me for the purpose of case review by her attorney, W. Clayton Harris. Mr. Harris has outlined issues for today's case review in his letter of July 13, 2021. Overall, today's case review is in rebuttal of a report submitted by Lloyd Thurston, D.O., who reviewed Ms. Richman's records as outlined in his report of July 5, 2021. Records pertaining to the motor vehicle collision of June 7, 2017, begin with the traffic accident report authored on this date. There is documentation that Ms. Richman was the passenger in a 2010 Ford that was struck from behind by another vehicle. She was not listed with injuries or transported for emergency medical evaluation. I reviewed a supplemental statement provided by Ms. Richman to police officer, R. Finkle at the time of the collision. She noted that a "truck... hit the back end of the (taxi) cab." Ms. Richman testified by deposition on June 2, 2021 that after the motor vehicle collision, she developed multiple symptoms that included neck pain, upper and lower back pain, migraines, memory loss, anxiety, and post-traumatic stress disorder, as a result of the motor vehicle collision. This is outlined on Page 40 of Ms. Richman's deposition. Medical records begin with notes from U.C. Health emergency department in Aurora, Colorado, where Ms. Richman was assessed on June 20, 2017, initially by triage nurse Shannon Fielding. She obtained history that Ms. Richman had reported lower abdominal pain of a week's duration with a sense of being constipated on long -term chronic pain medications and that she started having emesis three days previously. Additional history obtained by emergency medicine physician Erik Hermstad, M.D. document onset of severe sudden onset of headache. He obtained additional history as outlined in this report of a coughing episode with onset of severe headache with recrudescence of headache that day that did not disappeared. 2 SERVED ONLY: July 30, 2021 4:48 PM FILING ID: BB5F275FA148F CASE NUMBER: 2020CV30363 Exhibit B - Page 1 INDEPENDENT MEDICAL EXAMINATION Katrina Richman July 28, 2021 Page 2 Dr. Hermstad proceeded with diagnostic evaluation that included a CT scan of the head and brain. Findings were interpreted by Kevin Limbaugh, M.D. as being negative with age-appropriate findings. In his report of June 20, 2017, Dr. Hermstad diagnosed Ms. Richman with tension headaches, abdominal discomfort, drug-induced constipation, as well as "neck strain, initial encounter." In medical records currently availab le to me, I did not find more in the way of history providing a medical basis for the diagnosis of neck strain. Ms. Richman was seen at the U.C. Health Family Medicine outpatient clinic by Kristin Andreen, M.D. on June 21, 2017. Dr. Andreen documented that Ms. Richm an presented with a new problem starting in the past seven days of headache that was waxing and waning located in the bilateral and frontal region, and radiating to the left neck and right neck. Dr. Andreen concluded that environmental allergies might be contributing to severe headache and diagnosed Ms. Richman with episodic tension - type headaches, as well as cervicalgia. There is no documentation in this report of any type of injury to the cervical spine. Ms. Richman was then assessed by Bernard Birnbaum, at the same family medicine outpatient clinic on June 29, 2017. He noted her history of neck pain "worse since recent motor vehicle accident" and recommended that she follow up with physical therapy. Ms. Richman was also in mental health care directed by nurse practitioner Susan Ponder. Ms. Ponder documented in her report of September 19, 2017 that Ms. Richman reported she had been dealing with depression for her entire life and that she had overwhelming feelings of sadness, excess sleep, and that she had been isolating more. She documented Ms. Richman's report that symptoms worsened over the summer of 2015 and that she had history as well of panic attacks at a frequency of one to two times per week. Ms. Richman was transported by emergency medical responders to the Harmony emergency department of U.C. Health on September 27, 2017, for increased symptoms of low back pain. Medical records document that she was treated and released by emergency medical providers. On January 22, 2018, physical therapy was reinstituted and a summary history obtained from Ms. Richman. It was noted that she had been treated previously in PT for symptoms of cervical spine pain from April 2017 through August 2017, and that she reported making 80% improvement in her condition until being "involved in a minor motor vehicle accident in June 2017." The therapist obtained history that Ms. Richman stated she exacerbated her neck pain and stiffness. The therapist also documented concurrent history of chronic low back pain, post epidural steroid injection done September 22, 2017 with report of minimal relief. Ongoing 2Exhibit B - Page 2 INDEPENDENT MEDICAL EXAMINATION Katrina Richman July 28, 2021 Page 3 psychological care including EMDR was also documented by the physical therapist at this time. Dr. Birnbaum reassessed Ms. Richman on June 22, 2018. He noted she was really struggling with ongoing anxiety and agoraphobia and recommended further review by Dr. Ponder. He refilled alprazolam. Ms. Richman's pain doctor Colin Carpenter, M.D. evaluated Ms. Richman on August 21, 2018. He noted that she had been seen a year previously for repeat bilateral L5 transforaminal epidural steroid injections and he obtained a different history from Ms. Richman's physical therapist, in that she reported improvement of pain for a year. He documented her report at this time; "now the pain slowly started to return." He also noted her concurrent symptoms of mid back and right -sided neck pain with neuropathic pain radiating down her right arm at times and that these symptoms had been intermittent in the past, but she had not had an MRI since 2014. He documented that Ms. Richman reported symptoms stemmed after a motor vehicle collision last year and symptoms have changed somewhat since then. Lumbar spine symptoms came to be addressed by Dr. Carpenter with a right L 5-S1 transforaminal epidural steroid injection done on August 30, 2018. Dr. Birnbaum then reassessed Ms. Richman on October 11, 2018. He documented that she had undergone injections done by Dr. Carpenter with a referral to physical therapy being pending. He also noted that Ms. Richman got a job at Dollar Tree. Dr. Birnbaum made medication adjustments and then re-evaluated Ms. Richman on July 3, 2019. With respect to pain control, he had her on morphine 15 mg tablets taken three times a day on an as needed basis. Dr. Carpenter reassessed Ms. Richman on August 14, 2019, noting her report that her neck was worse than her back at that point in time. He documented her report that her previous lumbar spine corticosteroid injection; "continued to provide significant benefit for her over the past year." Recommendation was made for Ms. Richman to be tapered off of opioid medication and this was reviewed by Dr. Birnbaum on February 21, 2020. Subsequent medical records document that Ms. Richman succeeded in this and by April 15, 2021, physical assistant, Carolyn Reynolds documented her report that she "does not want to go back on them." Ms. Reynolds documented ongoing maintenance care "gets epidural injections annually" and that she continued on alprazolam presc ribed by Susan Ponder, as well as Zoloft. 2 Exhibit B - Page 3 INDEPENDENT MEDICAL EXAMINATION Katrina Richman July 28, 2021 Page 4 PAST MEDICAL HISTORY: I have Ms. Richman's deposition testimony from June 2, 2021, pertaining to her prior spinal conditions. As outlined beginning on Page 13, she testified that she was on social security disability for unexplained low back like pain in the tailbone area. Later, on Page 15, she documents resolution of sacral pain around 2008 and that she had benefited from chiropractic care. She testified on Page 16 that she got back to the level of activity she had before 2007 around 2012 and that during 2013 and 2014, she was okay. She then testified that she got worse again during 2015 and that she had restarted physical therapy. She testified that she was being transported from Rocky Mountain Physical Therapy on the date of her motor vehicle collision, June 7, 2017, as outlined on Page 17. I reviewed medical records from prior to June 7, 2017. She carried an ongoing diagnosis of degeneration and herniation of a cervical spine disc with radiculopathy as outlined by her pain specialists during 2015. Clinician Liz Larson documented in her report of May 1, 2015 that Ms. Richman had neck pain status post epidural steroid injection and that she stated that "neck feels like it was stuck." Cervical spine pain was documented as radiating to both posterior arms with increased pain in her neck and shoulder blades over the preceding week. Back pain was also listed in this report with a lumbar epidural steroid injection having been done previously on June 6, 2014. She was continued on opioid medication including Dilaudid and morphine. Ms. Richman was assessed by Nola MacDonald, D.O. on May 12, 2015. She documented Ms. Richman's report of increased depression due to situational stressors of three people close to her having died. Ms. Richman was assessed at the University of Colorado Health emergency department on September 15, 2015 by Darren Tremblay, D.O. He documented her history of acute back pain in the setting of a history of chronic low back pain. The record shows that Ms. Richman was treated and released. Ms. Richman was then assessed by Kristin Andreen, M.D. on October 7, 2015 and she noted history that Ms. Richman had benefited from a corticosteroid injection into her low back. She documented Ms. Richman's report of improving symptoms of back pain on a long-acting morphine. Dr. Birnbaum assessed Ms. Richman on March 2, 2016, noting that she was requesting a decrease in morphine dosage and he made medication adjustments at this time. Subsequent notes from the family medicine outpatient clinic document symptoms of spine pain and that cervical, thoracic, and lumbar spine x-rays were done on September 7, 2016. 2 Exhibit B - Page 4 INDEPENDENT MEDICAL EXAMINATION Katrina Richman July 28, 2021 Page 5 Ms. Richman was assessed by Interventional pain specialist, Colin Carpenter, M.D. on September 13, 2016. He documented her symptoms of neck and low back pain and that she had undergone epidurals in the past with significant relief. He noted that she had sustained a significant flare up of symptoms in the preceding few weeks. He recommended proceeding with lumbar epidurals and these were done over the right and left L5-S1 levels on September 15, 2016. Ms. Richman was reassessed by Dr. Birnbaum for increasing cervical spine pain. He recommended institution of physical therapy and this was started on April 24, 2017. Physical therapy notes from this date document her complaints of cervical spine pain with radiating symptoms into the shoulders and upper arms with a progressive insidious onset since 2010. The therapist documented previous traumatic injuries and that she felt this had contributed to her current condition. Ms. Richman was then assessed at the family medicine outpatient clinic by nurse practitioner Diana Jackson, on June 6, 2017. This was a visit for chronic back pain and there is documentation that Ms. Richman was continuing to take opioid class medication by way of morphine extended-release 30 mg twice a day and morphine 15 mg up to three times a day as needed. ASSESSMENT: 1. Past medical history of lumbar spine L5-S1 degenerative disc disease, post epidural steroid injections done at the L5-S1 level on September 15, 2016 with ongoing lumbar spine pain. 2. Past medical history of cervical spine disc herniation, post epidural steroid injections with documentation of "significant relief" as noted by Dr. Carpenter in his report of September 13, 2016. 3. Opioid dependence with documentation of morphine equivalent dosage of 60 to 105 mg per day as outlined in notes from June 6, 2017. 4. Depression, anxiety, and post-traumatic stress disorder with documentation of a flare up of this condition during 2015. 5. Motor vehicle collision with multiple injuries sustained June 7, 2017. 6. Cervical spine sprain/strain, resolved back to baseline over a year with physical therapy. Dr. Thurston expressed opinions as scattered throughout his report of July 5, 2021. I will respond to these sequentially: • Dr. Thurston opined that Ms. Richman did not experience a traumatic brain injury or concussion as a result of the motor vehicle collision of June 7, 2017. I agree with Dr. Thurston's opinion and I feel that report of memory problems stem from a side effect of opioid medication and from Ms. Richman's underlying depression and anxiety. 2Exhibit B - Page 5 INDEPENDENT MEDICAL EXAMINATION Katrina Richman July 28, 2021 Page 6 • Dr. Thurston expressed that he felt Ms. Richman did not experience post- traumatic stress disorder (PTSD) as a result of the motor vehicle collision of June 7, 2017. I agree with this opinion. • In his report, Dr. Thurston concluded that Ms. Richman had neck pain and low back pain and concluded that "these symptoms have concluded on the same trajectory before and after the June 7, 2017 motor vehicle accident , I.e., It is my medical opinion Ms. Richman was not physically or psychologically injured by the motor vehicle accident." I agree with Dr. Thurston's opinions regarding cervical and lumbar spine degenerative disc disease. I agree with him that Ms. Richman has continued on a stable trajectory of ongoing opioid medication use and intermittent cervical and lumbar spine epidural steroid injections to address cervical and lumbar degenerative disc disease related pain. • I disagree with Dr. Thurston that Ms. Richman did not sustain any physical injuries on June 7, 2017. I believe that Ms. Richman sustained a soft tissue cervical spine sprain/strain and that she benefited from physical therapy. I believe that she probably reached her pre-motor vehicle collision baseline by around a year after June 7, 2017. Medical evaluation and treatment subsequent to June 7, 2017 to address soft tissue cervical spine injuries appears to me to have been reasonable, necessary, and related to the motor vehicle collision of June 7, 2017. This treatment does not include cervical spine epidural steroid injections. I do not believe that Ms. Richman has been left with a residual permanent impairment stemming from the motor vehicle collision of June 7, 2017. There is no documentation of new objective clinical or diagnostic study findings that would support a determination of permanent impairment. Her history of depression, anxiety, and post-traumatic stress disorder certainly interferes with her ability to recover from even a minor cervical spine injury. The same is true with respect to ongoing opioid medication use, as this medication may induce hyperalgesia and make patients refractory to improvement. Sincerely, John S. Hughes, M.D. cc: W. Clayton Harris, Attorney-at-Law 2 Exhibit B - Page 6