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Chaney Firm verdict upheld on appeal

I argued a case to the Eighth Circuit Court of Appeals in January (here's an earlier report on the argument). We tried the case in January 2012 in federal court in Hot Springs and received a nice verdict for our client. We're pleased that the Eighth Circuit agreed with us and allowed the verdict to stand. The Court's decision is posted here.

One issue on appeal dealt with the routine use of medical visual aids based upon CRMAdigitized x-rays, and proton density MRIs. The defense claimed that the visual aids were misleading and were used as actual evidence, rather than illustrations to help doctors testify about injuries to specific body parts. The Court held that the medical illustrations were not misleading because a doctor testified that they were accurate and helped him teach the jury about complex medical issues.

The other main issue on appeal was a procedural question concerning two professional defense witnesses that were excluded; the defense tried to call these new experts at the last minute because its original expert's theory of degeneration did not hold up under cross-examination. When the trial judge didn't let them call new witnesses, they changed tactics and tried to claim they needed the new experts because they were surprised by what our client's doctors had to say. The trial judge saw through this charade. On appeal, the defense claimed that our client's doctors should have been excluded. The appeals court rejected the surprise argument, as the defense had all the relevant medical records, had received a summary of the anticipated testimony, and never took depositions of the doctors.

We're pleased to have obtained a good result for a deserving client. 

Cite: Bradshaw v. FFE Trans. Servs., Inc., 715 F.3d 1104 (8th Cir. June 3, 2013).

 

JAMA talks low back pain

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The Journal of the American Medical Association (JAMA) recently published an article on low back pain on its Patient Page. This article contains a good discussion of the anatomy of the back, the sources of low back pain, and the range of treatments that should be considered.

JAMA notes that low back pain can result from problems with muscles, bones, or nerves, but muscle pain doesn't move down the legs. When the patient has had trauma, imaging studies such as x-rays, MRIs, and CT scans are appropriate. JAMA reports that treatment may include exercise, physical therapy, chiropractic, acupuncture, over-the-counter or prescription medication, and, in rare cases, surgery.

One of the things that we found interesting is that the JAMA article cited a clinical guideline by the American College of Radiology (ACR). This article discusses the appropriateness of several types of imaging studies under different clinical conditions. The ACR guideline states that most uncomplicated low back pain resolves on its own, but that intervention is needed for more complicated cases. The guideline considers low back pain to be "complicated" when it is accompanied by trauma, cumulative trauma, or lasts longer than 6 weeks. The ACR guideline confirms that x-rays are appropriate for evaluating alignment and instability in the low back.  

The ACR guideline was published by the National Guideline Clearinghouse (NGC). The NGC is a governmental organization created in partnership with the American Medical Association and the American Association of Health Plans (now America's Health Insurance Plans [AHIP]). Its mission is to provide health professionals, health plans, and others a mechanism for obtaining objective information on clinical practice guidelines.

We are glad to see JAMA referencing the NGC's Guidelines. As lawyers who deal with health issues for our clients, we like to work with doctors who utilize the latest health guidelines in their practice. 

What is CRMA?

CRMA stands for Computerized Radiographic Mensuration Analysis.

This is a test that Analyzes the angles and distances between bones in the spine us a Computer and X-rays, which are a certain type of Radiograph. The purpose of the test is to accurately assess damage to the spine. 

Mensuration has been used by doctors for nearly 100 years to figure out when a patient’s spinal bones are misaligned due to injury, aging, or congenital defects. Mensuration compares a patient’s spine to a normal spine. Until the last 20 years or so, doctors performed mensuration by hand using x-rays, a light box, and a grease pencil.

In the last 20 years, more doctors and clinics started using x-ray machines that take x-rays digitally, rather than with film (just like digital cameras have replaced film cameras). With the computing power available today, it also made sense for doctors to use computers to perform mensuration calculations. The result is a more accurate and repeatable mensuration report. For this reason, CRMA is generally accepted in evidence-based medicine as a reliable method of assessing spine damage.

A mensuration report looks like this: 

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CRMA can also be used to assess legal impairment. Courts in Arkansas follow the American Medical Association’s Guides to Permanent Impairment (the AMA Guides). The AMA Guides contain specific guidelines that tell when, and how much, a person is permanently impaired when their spine has been injured. So, a CRMA report like the one below shows that the patient has a 25–28% whole person impairment rating at two spinal levels:

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CRMA gives doctors, lawyers, judges, and juries alike objective medical information proving permanent impairment. It is a valuable new tool that helps injury victims obtain full and fair justice for their injuries. 

Hilary, Nathan, and oral argument – It's not what you think

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Ordinarily, the mention of husband and wife in the same sentence as the term "oral argument" isn't a good thing. However, Hilary and Nathan recently showed there is an exception to this rule!

Nathan argued a big truck collision case before the U.S. Court of Appeals for the Eighth Circuit on January 16 in St. Louis. In this case, the Chaney Law Firm is defending a jury verdict it won for a client in federal district court in Hot Springs in January 2012. One issue on appeal dealt with the routine use of medical visual aids based upon digitized x-rays and proton density MRIs. The other main issue on appeal was a procedural question concerning two professional defense witnesses that were excluded; the defense tried to call these new experts at the last minute because its original expert's theory of degeneration did not hold up under cross-examination. You can listen to Nathan's argument here.

Hilary argued a social security disability case before the Eighth Circuit on February 14 in Kansas City. Hilary's case involved issues of whether the Administrative Law Judge (ALJ) gave the proper amount of weight to all the medical evidence. Hilary argued that the ALJ erred by only considering just five pages of medical records from just one doctor who said he didn't have enough information to fill out the disability paperwork, when hundreds of other pages of records from four other doctors showed our firm's client is truly disabled. Even the one doctor the ALJ relied upon prescribed narcotics on at least 13 different occasions, yet the ALJ found our client's pain was not severe enough to preclude work. This case truly shows why many people need legal representation when dealing with the Social Security Administration. You can listen to Hilary's argument here.

It is truly a high honor and great privilege to argue before the U.S. Court of Appeals for the Eighth Circuit. Below are pictures from the courtrooms in St. Louis and Kansas City. Which has the better view?

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