October 14th, 2013

“We Help You Publish Content”

Dear Marketeers:

The word you use is like nails on a chalkboard: Content.

You send me emails by the bushelful, you even call me, everyone wanting to provide “content.”

Content is another word for crap. Dreck. Nonsense. A keyword stuffed, Google-friendly, collection of words thrown down on paper. When the messages come by email, even the sales pitch is poorly written.

So to all you “content” publishers out there let me say this:

I do not create content. My words are not some generic commodity.

I report news. I offer opinions. I laud and and I criticize. I may do it well or I may do it poorly.

But it is unique. It has a point of view. Regardless of whether it’s good or awful, it isn’t some generic piece of commoditized “content.” My words are a part of me.

I am not interested in your “content,” because as soon as you use the word I know that you don’t know jack about my blog, or about me. You’ve sent me a form letter.

The same pitch might be made to a doctor, a rocket scientist or a quirky sanitation blog. Why anyone would trust you to write something when you’re too lazy to even read the existing forum is utterly beyond me. But I guess there are plenty of suckers out there, allowing the likes of you to write crap for them. Or perhaps, there are just many desperate pseudo-writers who think peddling crap is the way to make a living.

Let me be clear about this: I am not interested in your “content.” Not in reading it, not in publishing it, not even in considering it. Because I already know from your use of the word “content” in your pitch to me that it’s going to suck. Big time.

Affectionately yours,

October 9th, 2013

When Normal Isn’t Normal (License for Sale?)

This is the story of a doctor who decided that “normal” isn’t what he learned over decades of practice, but what an insurance carrier tells him is normal. If you earn your bread in the well of the courtroom, this may be something you hadn’t considered before.

What, exactly, is “normal?” When it comes to medicine and testing someone’s range of motion, there are standards. If you test 1,000 people who are in the sweet part of life — not an infant or octogenarian — you will come up with numbers.

Some people, of course, are flexible and test higher. Some are not — either naturally or due to injury — and test lower. But that doesn’t change what normal is, and that is an important metric because, if you want to evaluate an injury, you need a yardstick to measure by.

But what does a doctor do if the insurance carrier that hired him to do a medical legal exam tells him to use different numbers to define a normal range of motion? You may think the answer is obvious — that the doctor would firmly tell the insurance company to go shit in a hat and that his license to practice medicine isn’t for sale like that.

My experience last month at trial, however, found an altogether different answer. Now it’s a rare day for me to use one of my own transcripts, but I spent a good part of the summer investigating and ripping into phony testimony, quickie medical exams, and phony signatures. I’ve also covered insurance company directives on how to leave out of the reports things that may be beneficial to the plaintiff.

Today, I explore a completely different method of chicanery.

The case was a multiple vehicle collision and “Krystal Doe” had shoulder, neck and back injuries. The doctor I was examining had done a medical-legal exam for the defense. And he confessed, when confronted, with having used the insurance carrier “normals” instead of his own knowledge, training and experience.

The defense, ironically, was that the plaintiff was exaggerating. There was exaggeration for sure, but it seemed to be coming from the medical expert that the defense had hired.

In order to see if this is a worthwhile course to pursue in other cases, of course, you need to first find a bunch of reports that the doctor has authored in other cases. Pre-trial investigation into the expert, with calls/solicitations to other practitioners in your area, is required, unless your firm is huge. If you have a local listserv, then sharing info on expert docs is a great use of it. Or, if there is a company around that sends representatives to attend these exams as witnesses (such as the ones I used for this investigation), they may be able to help locate reports.

First, the set-up to lock the doctor into his position about the importance of normal (I’ve yanked the names out and cleaned up the text):

Q: I think you testified that you wanted to find out what the patient has and then compare that to whats normal, right?

A: Yes.

Q: Because loss of range of motion of a limb, it’s a relative thing. It’s all relative to what’s normal, right?

A: Yes.

Q: And normal would be, unless you’re elderly or a small child I guess, normal would be the same for everybody, right? Normal is a standard?

A: No. No. Well, it is a standard, but it’s not the same for everyone.

Q: Would it be the same for a 25-year old and a 35-year old, people who are right in the sweet spot of life, so to speak?

A: Yes.

And with that, you can now first establish what his opinion is of “normal” for this individual that happens to be your client:

Q: What is cervical extension?

A: Putting your head back.

Q: Looking up at the ceiling, like that?

A: Yes.

Q: And what’s normal?

A: Thirty-five degrees.

Q: And what was it for Krystal Doe in this matter?

A: Twenty.

Q: So the difference between 20 and 35 degrees, that would be her loss, right?

A: If it’s valid.

Q: Now of course if normal was actually higher, then the injury would actually be more extreme. If it was, for example, 60 degrees, the difference between 20 and 60 is a lot more significant than between 20 and 35, right?

A: Yes.

Then return to reinforce the concept that “normal” doesn’t really change:

Q: And you as a physician, who does these medical-legal exams, you always use the same range of motion for all of the people who you’re examining. Again, assuming they’re within the sweet spot of life, you know, in their 20’s and 30’s, right?

A: There are standards.

Q: And one of the standards is that — you’re telling the members of the jury — is that 35 degrees is normal; is that right?

A: It’s one of the accepted norms, yes.

Q. Now we’re talking about range of motion of the cervical spine, otherwise known as the neck, right?

A: Yes.

Q: And extension you say normal is 35 degrees, right?

A: Yes.

Q: And you did your examination of this claimant, Krystal Doe, on March 5, 2010?

A: Yes.

Q: Okay. I assume that there hasn’t been a difference in what normal is from 2010 to 2012?

A: I assume that.

Then confront with his “opinion” in another case that he did a medical-legal exam for:

Q: Did you examine a patient known as Thomas Roe, on May 21, 2012?

A: I have no recollection.

[Hand him report]

Q: Was that your opinion, when you examined Thomas Roe, that normal was 60 degrees?

A: Yes.

Q: And it’s different for Krystal Doe, correct?

A: Yes.

Q: And Thomas Roe, he was only 34 years old at the time, and Krystal Doe, she was 26 years old at the time, correct?

A: I don’t know that offhand.

Q: Please feel free to … [gestures to report].

A: He was 34.

Now it has often been said that lawyers shouldn’t ask questions at trial that they don’t know the answer to. But that isn’t really true. In this case, the expert was dead in the water. (He was actually dead in the water before we started; he just didn’t know it yet. Now he does.)

So it’s OK to proceed when you don’t know what the answer is, because there isn’t any answer that can help him. So off we go looking for the excuse for why he is exaggerating the loss of range of motion by using different “normals”:

Q: So there should be no difference in the normal range of motion for an individual who’s 26 and another one who’s 34?

A: Actually, that’s not true. This examination was done for a company that uses a different standard for range of motion testing.

Q: Don’t you use your own opinions as to what normal range of motion is?

A: I do, but if I’m employed by them to do an examination, I have to use their standards.

Q: So you then will take a standard that you know isn’t accurate, and use it in a medical-legal context?

A: No.

Q: Is that your testimony?

A: No. That’s not my testimony. At the end of my report, all of these reports, I state clearly that the range of motion testing is based on the American Academy of Orthopedic Surgeon’s standards, but there are differences with body habitus, with age, with activities. I state that clearly, so it’s a very subjective exam, and the 60 degrees here conforms to what this carrier says is normal. That’s not what I think is normal.

Q: And you used it anyway?

A: I did.

Ouch. The insurance carrier is paying for the exam, so he uses the carrier’s definition of normal. The only thing to do now, is bang on the drum a bit so the jury understand what has just happened, and move on to other body parts that might also have differing “normal” ranges of motion:

Q: You examined the person the way it is that you were told to examine the person, not the way your medical experience told you to examine the person?

A: No. They didn’t tell me to examine the patient any differently. They told me what their norms were.

Q: By the way, for shoulder abduction, that’s where you bring the arm up and point up at the sky?

A: Right.

Q: For Thomas Roe, it was your opinion that normal abduction was 180 degrees?

A: No. The norm, yes; 180.

Q: And was it your opinion that for Krystal Roe it was 160 degrees, there was a difference?

A: Yes.

Q: And when you examined her, you found that she only had 80 degrees, right?

A: Right.

Q: And the difference between 80 and 160, is not as much as the difference between 80 and 180, right?

A: Right.

Q: And this diminished your findings with respect to Krystal Roe in examining her range of motion and forming your opinion, didn’t it?

A: It diminished my findings?

Q: It diminished it because your normal was different, it was only 160 instead of 180?

A: I think that is the norm, 160.

Q: Was it your opinion in examining Thomas Roe that it was 180?

A: That’s what this carrier used as their normal.

So, the long and short of it is, do the ground work before trial by obtaining other reports that the defense medical examiner has done, and you may be surprised that “normal” may be a fluctuating concept based upon what the insurance carrier tells the doctor is normal in order to minimize the actual loss of the claimant.

How such doctors sleep at night is beyond me, though I suppose his $7,000 fee probably helped.

October 7th, 2013

Lawyers, Politics and Civility

Mark Bower, today’s guest blogger.

Mark Bower steps in today to offer a guest blog on lawyers and politicians:

——————–

Several years ago, with considerable fanfare, our courts put in place a new Code of Civility. The Appellate Divisions recognized that the loss of courtesies and honor between adversaries was hurting the profession and the pursuit of justice.

After the initial fanfare, the code fell into widespread disuse, largely because our judges refuse to sanction abusers. With the desuetude of the code, the level of incivility has increased to the point that now, some attorneys are publicly musing about surreptitiously recording legal proceedings on their cell phones, so that the abuse can be documented and put on display. However, surreptitious recording is itself a form of incivility, and so the cycle goes ’round and ’round.

This is worsened by our judges’ belief that “fairness” requires everyone get a little of what they want, and sacrifice a little of what they want, so that if each side is denied 20 percent of what they asked for, that automatically is “fair.” Sort of like the wisdom of Solomon, except the cutting the baby in half merely produces two halves of a dead baby, and in today’s uncivil climate, one cannot count on one side to sacrifice their self-interest to save the baby’s life.

That one side might be clearly right, and the other clearly wrong, doesn’t matter; all that matters is that each side gets a little and loses a little, because that is “fair”.

Will McAvoy put it nicely: If the Republicans do fourteen ridiculous things, and the Democrats do one, does the media have to concoct and report thirteen fictitious things in order to be “fair and balanced”? (“The Newsroom,” season closer, “Election Night, Part II,” at approx. 41:30.)

The result of this misconceived calculus is that the more outlandish one’s demands are, the more one benefits by having an equal portion disallowed. Reasonablemess is disproportionately punished, while being outrageous is disproportionately rewarded. Misconduct is promoted, and good conduct discouraged.

This insanity is on full display in Washington. Although Grover Norquist’s stated goal is to shrink government to the size that it can be drowned in a bathtub; although Ted Cruz plainly stated he would shut down the government rather than allow the Affordable Care Act to go into effect; although most of the GOP wants to eliminate the Departments of Education, Energy, EPA, etc., and are delighted that they are shut down; in the interests of “fairness,” the mainstream media gives prominent play to grandstanding chickenhawk politicians who enthusiastically support the shutdown but pose with veterans at war memorials to glom onto their heroism, and give equal time to spinners who proclaim the shutdown to be the president’s fault.

Will McAvoy’s question hangs heavily in the air.

Our country’s international standing is going into the toilet, and we look like a nation of fools, but the right-wing is genuinely indifferent. If the USA defaults on its national debt, and the most secure and stable investment ever known to man becomes unpredictable and volatile, doubtless this will also be spun as the Democrats’ fault, and that Big Lie, too, will get equal play with the media.

Which brings me back to the demise of civility. The rules of discourse have changed on a broad scale. Fairness, candor, and honesty are devalued, and outrageousness and hyperbole rewarded. On the other hand, occasional displays of professional courtesy get nice recognition, but they are noteworthy because they are rare. The decline of civility, and its insidious effect on fairness, is a pervasive mindset problem, for which I see no ready solution.

October 3rd, 2013

Dog Case Heading to NY’s Top Court

This is my pooch, not the one in the collision in this case. But he makes for great blog artwork, no?

Earlier this year I wrote about a change under hoof in New York about animals causing injury. It has long been held that animal owners could only be liable for their animals’ acts if there was a “known vicious propensity,” that being some type of aggressive or threatening behavior. Hence the phrase, “every dog gets one free bite.”

Under those circumstances the owner was strictly liable for injuries, and there was no cause of action for negligence.

But the Court of Appeals cracked that door open earlier this year in Hastings v. Suave, holding in a case where a cow wandered through a poorly kept fence into a road where it was hit, that a cause of action could exist for negligence. This had nothing at all to do with the animal’s viciousness or not, but was solely based on the conduct of the owner.

The court also held that the matter of dogs, cats and other domestic pets was not before it, and would await another day.

That day now seems on the imminent horizon, as today the Appellate Division First Department ruled in Doerr v. Goldsmith, a case where two people on opposite sides of the road in Central Park were playing with a dog. One called the dog and the other released it. A bicyclist was riding in the road and couldn’t avoid impact.

As neatly summarized by the majority opinion:

Plaintiff testified that Goldsmith “was holding a dog in a manner that he was almost hugging the dog, so he had his arm around the chest and the neck of the dog” and that Smith was “slightly bending down and clapping her hands on her upper thighs.” Interpreting Smith’s actions to be a signal to the dog (which was hers) to come to her, plaintiff screamed out, “Watch your dog.” Plaintiff then saw the dog in the middle of the road, but was unable to avoid colliding with it and being propelled off the bicycle. Defendants do not materially dispute plaintiff’s recounting of the incident. Plaintiff seeks to recover against defendants on a theory of negligence. He does not claim that the dog’s actions were a result of any vicious propensities of which defendants may have been aware.

Everybody agrees, it ain’t the fault of the dog, even though courts and lawyers eschew words such as “ain’t.”

Given New York’s historic position on these cases, the defendants moved for summary judgment saying they were immune from anything they did because New York doesn’t have a negligence cause of action. The lower court disagreed and denied the motion. Defendants’ appealed and won, but then the Court of Appeals ruled in the cow case, and so this dog case was re-visted by the appellate court.

The First Department has now reversed itself and allowed the matter to stand, based on the logic in the cow case.

The dissent disagrees, writing that the Court of Appeals didn’t rule on this, having only ruled about farm animals and specifically left dog and pet cases for another day. Leave to appeal should be granted, the dissenters argued, and if the Court of Appeals wants to change the law that is its business.

And so, with a split decision, this case will no doubt go to the Court of Appeals.

My prediction: New York’s long-held policy of granting immunity to animal owners for their own negligence (as opposed to the animal’s viciousness) will fall by the wayside as illogical. Immunity for negligence makes no sense at all, and is something that only a legislature can grant.

Lastly, a hat tip to attorney Gregory Bagen for taking this case given the state of the law when incident occurred. He took on a matter that he knew, to be successful, would take years of appellate work and expense just to get to the jury. Well done.

September 27th, 2013

Deconstructing the Biomechanical Engineer

This was NOT the taxi involved in the collision, but cool old car, no?

Every so often a defendant will hire an expert that will look at pictures of the damage to a vehicle, and then pretend to tell the jury that the plaintiff couldn’t have been hurt based on damage to the vehicle.

You saw that word “pretend,” didn’t you?

When people talk about “junk science” it is usually defense-minded folks looking to blame plaintiffs’ lawyers for some crazy theory of injury. But I see the other side when it comes from less-than-candid defense experts (such as this).

The phrase junk science likely popped into the head (but not the written opinion) of Justice Arlene Bluth recently, as she sat in her New York County Supreme Court motor vehicle part (which, for you out-of-towners, is our top trial level court).

What Justice Bluth wrote in her recent decision in Neat v. Pfeffer is applicable to anyone in any part of the country, as she gives a road map to exposing the junk. So it is worth reading even if you hale from elsewhere.

The context of her decision is an attempt by Dr. Robert Fijan to testify about both the forces on a car in a collision and whether the plaintiff could have sustained her injuries from this collision. Justice Bluth ruled that while he could testify as to the former, he couldn’t testify to the latter, concluding that if he testified about the injuries it would be junk science (again, not her words, but mine).

Why junk? Read on…

Cynthia Neat was a back seat passenger in a taxi that was rear-ended. Dr. Fijan — who is a Ph.D. and not an M.D., which makes a pretty big difference in this context — wanted to testify about both the severity of the impact and the claim that the plaintiff could not have suffered a rotator cuff and SLAP tears as well as a torn meniscus in her knee, among other injuries. And he wanted to do this based solely on a single black and white photograph of the taxi she was in.

So Justice Bluth ordered a Frye hearing to test the scientific basis of such testimony to see if if was generally acceptable in the scientific community. And she then proceeded to deconstruct why D. Fijan, who is not an M.D., couldn’t testify about whether the injuries were caused by the collision:

First, there was no significant peer-reviewed literature validating his methods. As per Justice Bluth, noting the difference between theories of force in a lab, and those in the real world:

He testified that in order for a ligament to tear, it must be stretched to a certain point; in order for a bone to break, there must be a specific amount of force and bending. Understandably, experiments cannot be performed on live people – it would not be appropriate to ask volunteers to participate in crashes so their injuries can be measured. Additionally, it makes sense that a 75 year old woman with osteoporosis may suffer a broken bone with less force that it would take a 25 year old man’s bone to break, and a swimmer’s shoulder muscles may withstand more strain than those of a sewing machine operator.

Second, the literature he did use came from the National Highway Transportation Administration, and the standard crash dummy tests that they use. But which of us is actually a standard human being? Justice Bluth:

…while these studies have been based on biomechanics… the dummies are based upon the 50th percentile in height and weight, not a woman of plaintiffs height and weight. Besides, even if plaintiff happened to be the size of a NHTSA crash dummy, Dr. Fijan failed to show that NHSTA studies reliably predict what force it would take to tear a rotator cuff or cause a meniscus tear, for example; crash-test dummies do not have human bones or ligaments or tendons. Some of the other literature about which Dr. Fijan testified related to sports medicine. Even if studies showed that a pitcher’s rotator cuff could only withstand so many pounds of force/stretching before tearing, there was no proof that this plaintiffs rotator cuff was comparable to that of any athlete. Dr. Fijan cited to studies relied upon to build prosthetic devices and artificial joints; again, while a “normal” knee may take “x” pounds of pressure, who says this plaintiff had a normal knee? Certainly, Dr. Fijan, who is not a medical doctor, could not speak to the condition of plaintiffs body.

For the practitioner preparing to face down one of these experts, that is an awful lot of meat and potatoes, and represents a nice little road map into defeating what I think is junk science.

There are people that are badly injured in low impact collisions, and there are people that walk away from spectacular speedway crashes (Kyle Larson uninjured in this Daytona crash). We are all a bit different from each other, and crashes in labs don’t replicate the myriad ways that cars actually get hit, in conjunction with the different ways a body may be sitting, in conjunction with the different reactions that might occur to the body if there is even a split-second of warning, in conjunction with our own physiques.

My opinion? It’s junk science that doesn’t belong in the courtroom.

Kudos to Steven I. Fried who represents Ms. Neat.