Today's issue starts out straightforward with a malpractice case. But pay attention, because the real application of this decision is in New York's No-Fault law and litigation over "serious injuries" in car accidents.

Plaintiff brought a malpractice case against chiropractors alleging that they caused her to suffer severe spinal cord injury requiring surgical intervention. Defendants move to dismiss. In response, plaintiff puts in an affidavit from a chiropractor. Since it's an affidavit, it's sworn. But the chiropractor relies on unsworn MRI reports. Is that OK?

Yes, says the Appellate Division (Third Department) in a decision released yesterday, Caulkins v Vicinanzo. While it is true that "uncertified medical records and unsworn letters or reports are of no probative value" in opposing a summary judgment motion, in this case the affidavit is a sworn document. And the appellate court, in holding that the affidavit could rely on unsworn documents, plucked a footnote from the Court of Appeals decision in Pommells v. Perez, which said:

"Though the MRI reports were unsworn, the various medical opinions relying on those MRI reports are sworn and thus competent evidence."

Now in theory, the case favors neither plaintiffs or defendants, since either can make a motion for summary judgment.

But that's only theory. It's real application comes not in the world of medical malpractice, where summary judgment motions are relatively rare, but in the realm of car accidents and defense allegations that the "serious injury" threshold under New York's miserable No-Fault law was not met.

The reality is that some offices are fighting these types of summary judgment motions every day. (And the courts hate them.) And many of those cases have small insurance policies (25K) that make it essential for personal injury lawyers to litigate with great efficiency. Defense lawyers, of course, being funded by the multi-billion dollar insurance companies, don't have that problem. If the plaintiffs need additional affidavits from radiological experts to corroborate what the initial radiologist said, it is an additional expense.

So you can bet that this case will be cited in the months and years to come for those that fight those battles. Ultimately, it's a win for car wreck victims as it helps to streamline an already miserable part of New York's auto accident practice.

Efficiency is a good thing when you work on contingency. And it's good for the victims too, who often have trouble finding counsel for cases that have limited upside due to small insurance policies.

Labels: Evidence, No-Fault

New York's No-Fault law is out of control. It seems to have reached the point where judges are almost demanding one of two things from injured patients: That their doctors get legal tutoring on how to write reports that will satisfy the judiciary, or alternatively, that injured patients seek treatment from only those doctors that already know how to write medical-legal reports.

Let me explain: To bring a lawsuit for injuries after a car accident in New York, you have to have suffered a "serious injury." And the legislature has defined "serious injury" as:

1. A personal injury that results in death;
2. Dismemberment;
3. A significant disfigurement;
4. A fracture;
5. The loss of a fetus;
6. Permanent loss of use of a body organ, member, function or system;
7. Permanent consequential limitation of use of a body organ or member;
8. Significant limitation of use of a body function or system; or
9. A medically determined injury or impairment of a non- permanent nature which prevents the injured person from performing substantially all of the material acts which constitute such person's usual and customary daily activities for not less than ninety days during the one hundred eighty days immediately following the occurrence of the injury or impairment".

Under this system, a fractured pinkie clearly meets the threshold of serious injury under #4. But debilitating connective tissue injuries -- called "soft tissue" injuries by some -- to the neck, that can go on for years, may not. So how does the judiciary deal with some of the more subjective categories, such as 7-9 above?

Today, in Cruz v. Aponte, the First Department tossed out the plaintiff's case on a summary judgment motion because the plaintiff failed to meet threshold, despite the torn meniscus in the knee that would need surgery. But here is the language that screams out at me, for it raises the threshold bar to ridiculous heights in its demands for what patients must do at their moments of maximum stress and what doctors must write to document the limited range of motion of the injured, and note my italics for some of the requirements:

[P]laintiff submitted the affirmation of a physician who, relying on an MRI report prepared shortly after the accident, found multiple meniscal tears of the right knee, for which surgery would be indicated if plaintiff could lose weight, and opined that the tears and limitations were traumatic in origin. The physician also concluded, based on an examination conducted more than three years after the accident, that objective tests demonstrated significantly limited range of motion. However, his examination, unaccompanied by the requisite quantitative assessment of range-of-motion limitations based on objective testing contemporaneous to the time of the accident, was insufficient to raise an issue of fact as to serious injury...Accordingly, plaintiff failed to raise an issue of fact as to whether she suffered the type of injury from the 2004 accident that constituted a permanent consequential limitation of the use of her right knee.

Now let's break this down: The court demands that the range of motion limitations be contemporaneous to the accident. That means the patients must go to the doctors that are willing to write reports, and write them the way the courts want them to, as opposed to going to doctors that they actually like. Many people, especially the poor, already have a hard time finding a doctor, but now they must be savvy enough to find a court-friendly one.

The physicians will have to write the way the judges like, not the way they learned to write in medical school. You may think they are the same, but they are not. If a patient has a range of motion of 90 degrees for a particular movement, a doctor might note that. But if the docs don't also write what the normal range of motion is (and there would be no need for them to do this on their own, since they already know what normal is) the court might toss it out. That 90 degrees may speak volumes to the doctor but mean nothing to the court. Of course, if the doctor doesn't quantify it, and merely says "poor" or "limited" the patient is also out of luck, since it must be "quantified." And if the doctor merely has chicken scratch writing for his notes, then the victim is really in a pickle.

Never mind that many doctors don't write like this in their notes, the court wants it anyway. So you might have the best doctor in the world, and you might even have gone to the office "contemporaneous to the time of the accident," but if the doctor doesn't write reports in the exacting manner that the courts' want, well too damned bad. The court will simply take the case away from the jury and dump it.

And of course there is the requirement that the testing be objective, which raises three issues. First that the injury is capable of quantitative testing, second that the doctor did it, and third that s/he recorded it (and did so in the exact manner the courts likes). So it isn't really about the injury, it's now all about the doctor and the doctor's knowledge of the law.

This, of course, is just plain stupid. The courts now demand that the injured be savvy enough to find a doctor willing to write medical-legal reports to the court's exacting standards, instead of finding the best and most trustworthy physician they can find.

And if the injured patients do find doctors knowledgeable enough in the medical-legal world, and finds them quickly enough for the court, then they will be attacked for using one of the "regular" doctors that practice medico-legal medicine.

The No-Fault law is a horrid mess. In December I noted how Justice Paul Victor in the Bronx was frustrated with the confusing state of the law, and took aim at the legislature, judiciary and the bar for the problems with the No-Fault standards, implicitly calling for reform. And I had noted a year ago how the law actually encourages people to be slackers instead of trying to return to work.

The time for reform is now. The law is godawful and getting worse as often impossible burdens are placed on the injured regarding their choice of a physician. The victims should be worrying about which doctor will give them the best treatment, not who can write the best medico-legal report.

Labels: No-Fault

A clearly frustrated Bronx judge vented heavily in an opinion Monday on the vast waste of judicial resources that New York's No-Fault law has wrought. Supreme Court Justice Paul Victor, trial judge in Vidal v. Maldonado, cited to legislative defects, inconsistent decisions from his superiors at the Appellate Division, First Department, and "cookie cutter" motion practice in implicitly urging legislative reform of the confusing law.

New York's No-Fault law had originally been designed "to weed out frivolous claims and limit recovery to significant injuries." In return, car accident victims received some guaranteed medical and lost wage benefits, regardless of who was at fault. (See New York's No-Fault Law Problem With "Serious Injuries.")

But instead, due to legislative failure to explain the terms it used in defining what constitutes a "serious injury" under the Insurance Law, it has become a morass of motion practice and inconsistent decisions. This results in "a great expenditure of limited judicial time" trying to define "elusive standards" in the law.

One part of the "serious injury" definition, for example, is that the injury results in "significant limitations of a body function or system," while another definition is that the injury was a "consequential limitation of a body organ or member." Justice Victor wrote of the legislature that "The enabling legislation for the No-Fault Law itself provides little or no guidance to the bench and bar as to the scope of the terms used," and that with respect to the terms above "there appears to be no practical difference."

Justice Victor has now seen enough, a fact that is evident in the first caption of his opinion: Another Frustrating Assembly Line "Serious Injury" Motion. He goes on to explain how so many of these motions are fought, from both the defendants and plaintiffs perspectives.

The judicial time spent is extraordinary, the judge pointed out. That is because

"a thorough review of the record and current appellate decisions requires a great expenditure of limited judicial time. In any event, the decision rendered is usually challenged and refuted by the losing side; and thus many (too many) of these cases are appealed , and many of those appeals result in non-unanimous (and sometimes acrimonious ) decisions which are often difficult to reconcile with prior precedent."

He then goes on to discuss some of the precedent from the Court of Appeals, as well as the conflicting opinions of the Appellate Division, First Department, which reviews his decisions on appeal. And there seems to be little doubt they will be seeing this one.

One reason the appellate court is likely to see this is that Justice Victor explicitly rejected one of its opinions calling it "questionable and out of step with the more liberal guidelines provided by the Court of Appeals" with respect to how the law is to be applied. He did this while acknowledging that it is "a precedent which ordinarily would be absolutely binding on this Court."

In his view, however, he had no choice in rejecting appellate case law. In a section of the opinion after the details of the case are explored -- a section entitled Competing Statutes and Rules of Construction -- "A Judicial Dilemna" -- he says that due to conflicts, he must choose one or the other of how to approach the "difficult and frustrating" task of a judge weeding out frivolous claims or small cases, based solely on paper submissions.

According to the judge, "This legislatively imposed task has caused more than a season of judicial discontent and frustration, it has resulted in an extremely difficult and flawed process which results too often in an inconsistent and unfair application of the law."

The decision is a must-read for any New York practitioner that deals with automobile cases and the "serious injury" threshold of our No-Fault insurance law. It is a terrific exposition on the confusing state of the law brought on by the legislature.

Labels: No-Fault, Personal Injury