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Commonwealth of Massachusetts
BRISTOL, SS. SUPERIOR COURT DEPARTMENT
OF THE TRIAL COURT
CIVIL ACTION NO.: 1673CV01211
MARIA F, DIAS, BRISTOL, SS SUPERIOR COURT
PLAINTIFF FILED
V.
APR 4 2018
MARC J. SANTOS, ESQ.
MILTON C. TORRES, CLERK/MAGISTRATE
DEFENDANT
JOINT PRE-TRIAL MEMORANDUM
Now come the parties who, by and through counsel, file the following Joint Pre-Trial
Memorandum.
AGREED FACTS
Plaintiff Maria F. Dias is an individual who resides at 119 Falmouth Street, North
Dartmouth, Bristol County, Massachusetts.
Defendant Milton C. Torres is an individual who resides at 571 Summer Street, New
Bedford, Bristol County, Massachusetts.
This is a personal injury claim, which occurred at Falmouth Street, North Dartmouth,
Massachusetts, on or about January 3, 2014.
IL STATEMENT OF THE CASE
A. PLAINTIFF
Liability in this case is undeniably clear. On January 3, 2014, the Plaintiff, Ms. Dias, was
at her home on Falmouth Street, North Dartmouth, Massachusetts. There had been a snowstorm
the night prior. She went outside in the morning around 10:00 a.m. to clean off the snow from
her cars. While she was standing between her two vehicles, cleaning off the snow from the cars,
the Defendant, Mr. Torres, was in a snow plow in the area, plowing snow. He was operating his
vehicle in an unsafe manner, very quickly—back and forth—without due regard for the fact that
the area was a residential neighborhood. Ms. Dias was between her vehicles when all of the
sudden, Mr. Torres backed up his truck very quickly and went forward very quickly. He
rammed his truck into one of Ms. Dias’s vehicles, causing the vehicle to strike her and sandwich
her between the two vehicles, crushing her hips and causing her body to twist. Her hips caused
an indentation in one of the vehicles. Mr. Torres then backed up again to re-plow, not knowing
that he had struck Ms. Dias. The force was so hard that the car windows shattered, some of the
glass striking Ms. Dias. Ms. Dias’s brother and neighbors began to scream at him to stop. In
that moment, Ms. Dias believed Mr. Torres was not going to stop and she was going to die. She
remembers being frozen and scared to death. She felt she could not talk or move her legs due to
her nerves from the trauma. She felt immediate pain throughout her body, and suffered bruising
in her pelvic area. The police arrived, and Ms. Dias was transported to the St. Luke’s Hospital in
an ambulance.
While en route to St. Luke’s Hospital, Emergency Medical Technicians placed Ms. Dias
on an electrocardiogram (EKG) because of her rapid heart rate. At the Emergency Department
of St. Luke’s Hospital, medical personnel noted the accident: “Pt states standing b/n 2 cars in a
parking lot, a snow plow backed up into one of the cars, pushing the car into the other car w/ her
in between the 2 cars.” Medical personnel further noted that Ms. Dias complained of pain in her
right hip and rectum, and that she was anxious. Ms. Dias was advised to follow up with her
primary care physician, Dr. Ann Marie Treadup of Southcoast Physicians Group, Inc. Due to
ongoing chronic pain in her thoracic region as a result of the accident, which radiates around her
left lower rib cage to her anterior chest wall, Ms. Dias returned to St. Luke’s Hospital on
multiple occasions since the date of the accident. Although she had experienced some back pain
before, the pain following the incident has been different and more intense.
In addition, Ms. Dias received treatment on multiple occasions at Hawthorn Medical
Associates, LLC, to address this pain. Ms. Dias also sought treatment from chiropractors, Dr.
Jeffrey Swift, Dr. Robert Horowitz, and Dr. David Adelberg, to address her ongoing thoracic
pain, in addition to cervical pain, relating to the accident. Referred by her primary care
physician, she received additional treatment from a physiatrist, Dr. Sergey Wortman of Greater
New Bedford Physical Therapy and Sports, for pain management. Dr. Wortman referred Ms.
Dias to have an MRI of her thoracic spine, which revealed dise protrusions (which, unlike disc
bulges, relate to trauma) at the T5-6 and T7-8 levels. Dr. Wortman advised a trial of chiropractic
care for her ongoing symptoms.
Ms. Dias received chiropractic care from Dr. Gary Alves, of Alves Chiropractic Center.
Ms. Dias complained of chronic pain associated with her thoracic region, which at times radiates
around the left lower rib cage with associated pain along the costosternal region. According to
Dr. Alves, Ms. Dias stated that, “She was involved in a significant motor vehicle accident on
1/13/14. She states at that time she had been cleaning snow off the front of her vehicle, when a
snow plow struck the rear of her vehicle, causing her to be pinned between her vehicle, and the
vehicle parked in front of her.” Ms. Dias explained that, “She was taken by ambulance to St.
Luke’s Hospital emergency room, where she had a number of x-rays performed, and was
discharged from care with home instructions. She subsequently followed up with her primary
care physician, Dr. Treadup, who has managed her with Ibuprofen, however, states that she has
had numerous emergency room visits due to pain associated with her thoracic region, with
difficulty breathing.”
Based on his examinations, and per his certified medical report, it is Dr. Alves’ opinion to
a reasonable degree of medical certainty that although Ms. Dias had been experiencing
symptoms related to her thoracic spine, the injury sustained on January 3, 2014 has significantly
aggravated her condition, resulting in permanent impairment. (Dr. Alves noted that Ms. Dias
had had an MRI of her thoracic spine performed in 2013, which revealed central disc bulges at
T5/C6, T6/T7, T7/T8 levels.) As a result of the accident, Ms. Dias “has had consistent
complaints of pain in the mid-thoracic area, which she experiences on a daily basis to varying
degrees of intensity, with at times radiation of pain around the left lower rib cage to the anterior
chest wall with difficulty breathing. Her symptoms are very acute and incapacitating.” Ms. Dias
has obtained some relief with conservative chiropractic management, however it is not long-
lasting.
In his medical report, Dr. Alves further noted that Ms. Dias’s symptoms are of a chronic
nature, and it is his medical opinion that they have become significantly aggravated as a result of
the trauma sustained on January 3, 2014. He has determined that her injury to her thoracic
region is permanent, and that Ms. Dias is permanently partially disabled. She has sustained a 9%
whole person impairment. Dr. Alves found that the results of an MRI performed on the thoracic
spine on April 21, 2017 revealed a T5/T6 central disc protrusion and a T7/T8 shallow left
paracentral disc protrusion. He further advised Ms. Dias that she is precluded from lifting any
more than 10 pounds on an occasional basis and that she is essentially restricted to sedentary
type work as a result of the accident. According to Dr. Alves, Ms. Dias will require ongoing care
to maintain her current levels of function and pain levels to a minimum.
Prior to the accident, the Plaintiff was an active, healthy woman who enjoyed spending
time with her two daughters, family, and friends and enjoyed her clerical job at NFI Corp. Due
to the Defendant’s reckless driving, Ms. Dias suffered the serious injuries as above described.
She has had to endure numerous medical appointments, and has experienced great pain while
sitting for an extended period of time. She also continues to have difficulty getting in and out of
her vehicle due to the pain in her hip and back area. Ms. Dias has never experienced anything
like this prior to the accident. As noted by her primary care physician, Dr. Treadup on December
29, 2016: “[Ms. Dias] is complaining of neck pain on and off for 2 4% years. She was pinned
between two cars and has not felt the same since.” In addition, Ms. Dias is unable to carry
anything of significant weight, such as groceries, and her two daughters, Alexa Macedo and
Ninah Macedo, are required to assist her. Her daughters can attest that although she had thoracic
pain prior to the accident, it was nothing like she has experienced after the accident.
Ms. Dias has also experienced an elevated anxiety since the accident, which exacerbated
her need for additional medical treatment. The incident caused Ms. Dias great emotional upset,
which continues to have an impact on her daily living. Since the filing of the Complaint and
Demand for a Jury Trial, she has received medical treatment from Dr. Daniel Park of Southcoast
Physicians Group for pain management and from Team Physical Therapy to address her ongoing
chronic pain.
B. DEFENDANT
On January 3, 2014, the defendant was operating a snow plow when his vehicle slid in the snow
and made contact with a parked car. The plaintiff, who was cleaning off her car nearby, was hit by the
parked vehicle.
The plaintiff claims to have sustained injuries to her head, neck, back, hip and shoulders, in
addition to experiencing emotional distress. Defendant denies he is liable or that the plaintiff's purported
injuries are related to the incident. The evidence will show that the plaintiff has an extensive medical
history which includes, among other things, neck, back and shoulder pain. Less than a year before the
accident in question, the plaintiff underwent physical therapy to address occasional tingling radiating
down her arms associated with neck and back issues. The defendant contests the cause of the plaintiff's
medical treatment in addition to the reasonableness and necessity of the medical expenses which,
according to the plaintiffs response to the defendant’s Mass. R. Civ. P. 34 requests, include but are not
limited to the following: EKGs, an endoscopy, various scans of her abdomen, medical visits and
treatment for respiratory infections, EGD transoral biopsy and even impacted wax removal.
UL. JOINT STATEMENT TO BE READ TO THE JURY
PLAINTIFF’S PROPOSAL
The Plaintiff brought a civil action for personal injuries arising from an incident that took
place on January 3, 2014. The Plaintiff sustained said personal injuries when the
Defendant, who was operating a snow plow, hit a parked motor vehicle, causing the
Plaintiff to be pinned between two parked motor vehicles. The Plaintiff suggests that
liability is undeniably clear and subsequent medical treatment was necessary, fair, and
reasonable. The Defendant denies liability and contests the reasonableness and necessity
of the subsequent medical treatment associated with the injuries alleged by the Plaintiff.
B. DEFENDANT’S PROPOSAL
The plaintiff brought a civil suit alleging personal injuries arising from an incident that
took place on January 3, 2014, while she was standing next to a parked car that was hit by
the defendant who was operating a snow plow. The defendant denies liability and
contests the reasonableness and necessity of the subsequent medical treatment associated
with the injuries alleged by the plaintiff.
IV. WITNESSES
A. PLAINTIFF'S
1 Maria F. Dias of North Dartmouth, Massachusetts;
2 Milton C. Torres of New Bedford, Massachusetts;
3 Alexa Macedo of 119 Falmouth Street, North Dartmouth, Massachusetts;
4 Ninah Macedo of 119 Falmouth Street, North Dartmouth, Massachusetts;
Alex Dias of 125 Falmouth Street, North Dartmouth, Massachusetts;
Officer Scott Alves, New Bedford Police Department;
Keeper of th Records of New Bedford Emergency Medical Services;
Keeper of the Records of Hawthorn Medical Associates, LLC;
Keeper of the Records of William Caplan, MD;
10. Keeper of the Records of Dr. Robert Horowitz of the Family Chiropractic Center;
11 Keeper of the Records of St. Luke’s Hospital (Southcoast Hospitals Group);
12 Keeper of the Records of Sergey Wortman, MD;
13 Keeper of the Records of Jeffrey Swift, DC;
14 Keeper of the Records of Greater New Bedford Physical Therapy;
15 Keeper of the Records of Gary Alves, DC;
16 Keeper of the Records of Fall River Family Practice;
17 Keeper of the Records of Fall River New Bedford MRI;
18 Keeper of the Records of David Adelberg, MD;
19 Keeper of the Records of Family Chiropractic of New Bedford;
20. Keeper of the Records of Ann Marie Treadup, MD;
21 Keeper of the Records of Daniel Park, MD;
22 Keeper of the Records of Team Physical Therapy;
23 All other Keepers of the Records of the medical records and bills of the Plaintiff:
24. Keeper of the Records of the Defendant’s auto insurance; and
25 The Keeper of the Records of any facility that repaired/appraised the Plaintiff or
Defendant’s vehicles.
Plaintiff reserves the right to call any witness on the Defendant’s list of witnesses and to
supplement this list if necessary.
DEFENDANT’S
Maria Dias, Plaintiff
Milton Torres, Defendant
Officer Scott Alves, New Bedford Police Department
Keeper of the Records of William Caplan, MD
Keeper of the Records of St. Luke’s Hospital
Keeper of the Records of Sergey Wortman
Keeper of the Records of Jeffrey Swift
Keeper of the Records of Greater New Bedford Physical Therapy
Keeper of the Records of Gary Alves, DC
10. Keeper of the Records of Fall River Family Practice
11 Keeper of the Records of Fall River New Bedford MRI
12 Keeper of the Records of David Adelberg, MD
13 Keeper of the Records of Family Chiropractic of New Bedford
14 Keeper of the Records of Ann Marie Treadup, MD
15 Keeper of the Records of any of the plaintiffs medical providers/insurers
16. The Keeper of the Records of any facility that repaired/appraised the Plaintiff or
Defendant’s vehicles.
Defendant reserves the right to call any witness identified by Plaintiff, as well as call
any necessary impeachment witnesses not herein listed.
Defendant reserves the right to supplement this list prior to trial.
The Defendant reserves the right to submit into evidence, pursuant to Massachusetts
General Laws Chapter 233, Section 79G, each and every medical record the Plaintiff,
or any other party, certified for use as evidence at trial. Further, the Defendant
reserves the right to call any witness whose medical record has been certified
pursuant to M.G.L. Chapter 233, Section 79G or 79J. Also, the Defendant reserves
the right to supplement this list within a reasonable time before trial.
Vv. EXPERT WITNESSES
A. The Plaintiff
The Plaintiff does expect to call Dr. Gary Alves of Alves Chiropractic Center, 2834
Acushnet Avenue, New Bedford, Massachusetts 02745 to testify as an expert witness consistent
with his report and opinion, dated June 9, 2017. A copy of his report and opinion dated June 9,
2017, and his curriculum vitae are attached hereto as Attachment “A”, and have been provided
to Defendant’s counsel. Dr. Alves is expected to give testimony concerning the injuries
sustained on January 3, 2014 that have significantly aggravated her medical condition, resulting
in permanent impairment and permanent partial disability.
The Plaintiff reserves the right to call any witness on the Defendant’s list of witnesses
and to supplement this list if necessary.
B. The Defendant
To date, the plaintiff has failed to appropriately identify any proposed expert witnesses.
The defendant reserves the right to identify an expert witness if and when one is properly
identified by the plaintiff.
Otherwise, the defendant anticipates calling Dr. R. Scott Cowan to testify consistent with
his report and opinion dated October 2, 2017. A copy of his report and opinion dated October 2,
2017, and his curriculum vitae are attached hereto as Attachment “B”, and have been provided
to plaintiff's counsel.
VI. ESTIMATED LENGTH OF TRIAL
One (1) full trial day.
VII. SETTLEMENT
The Parties have had settlement discussions and have not been able to resolve the matter
at this time.
Vul. PLAINTIFF’S ITEMIZATION OF DAMAGES
Medical Expense:
New Bedford EMS Ambulance: $1,652.78
Southcoast Hospitals Group: $38,480.88
Hawthorn Medical Associates: $17,029.00
Dr. Anne Marie Treadup: $3,940.00
Dr. Gary Alves: $930.00
Dr. Sergey Wortman: $750.00
Shields MRI: $1,500.00
Dr. Robert Horowitz: $540.00
Dr. David Adelberg: $160.00
Dr. Jeffrey Swift: $560.00
Dr. Daniel Park $679.00
Team Physical Therapy $1,342.00
Total: $67,563.66
Pain and Suffering and Emotional Distress
Ms. Dias has suffered significant pain and suffering and emotional distress as a result of
the accident, experiencing elevated anxiety and an increased heart rate as a result of her
emotional upset related to the accident.
Permanent Partial Disability
Since January 3, 2014 and continuing.
PLAINTIFF, DEFENDANT,
MARIA F. DIAS MILTON C. TORRES
By her Attorney, By his Attorney,
By KHM
Wa tmai
Horan McLean Law Mazzocca & Associates
17 Orchard Street 211 Main Street
New Bedford, MA 02740 Webster, MA 01570
Ph.: (508) 991-2216 Ph.: (508) 949-4869
BBO# 561777 BBO#: 648647
Date: April 4, 2018 Date: April 4, 2018
CERTIFICATE OF SERVICE
The undersigned hereby certifies that a true copy of the within Joint Pre-Trial Memorandum was
this day served upon Defendant, Milton C. Torres, via e-mail and first-class mail, postage-
prepaid, to his counsel of record, Joseph Merlino, Esquire, of Mazzocca & Associates, 211 Main
Street, Webster, Massachusetts 01570.
SIGNED under the pains and penalties of perjury.
Dated: April 4, 2018
ATTACHMENT “A”
RECEIVED 06/14/2017 12:35PM 6089912207 HORAN MCLEAN LAW
06-1417 12:10 FROM- GNBPT Te 828-9929 T-388 P0003/0006 F-661
Gary J. Alves D.C, C.C.S.P.
| Aives Chiropractic Center MichaelR. Boucher D.C.
Ryan Knowles D,C,
| 2834 Acushnet Avenue * New Bedford, MA 02745 « Tel: 508-998-3001 * Fax: 508-998-1461
CERTIFIED MEDICAL NorEs
NOTES
PURSUANT.10 M.G.La, CHAPTER 285, SEC
i Gary J Alves; D.C, being duly Hicensed to9 Practice under the laws of the Commonwealth of
Massacl etts, hereby certifies thatthe fol owing recor reports, and bills are true and
complete copies of the care and treatment of,
Subscribed and sworn to under the penalties of pexjury this ue day of June 2017.
hf!
|
Gary J. Alves, D.C,
Chiropractic: Physician
GJA/bh
-
+
RECEIVED 06/14/2017 12:35PM 5089912207 HORAN MCLEAN LAW
08-14-17 12:10 FROM- GNBPT 774-828-9929 T-388 0004/0008 F-661
Gary J, Alves N.C., C.C,S.P.
| Aives Chiropractic Center Michas! R. Boucher D.C.
Ryan Knowles D.C,
| 2834 Acushnet Avenue * New Bedford, MA 02745 « Tel: 508-998-3001 * Fax: 508-998-
1461
June 9, 2017
Attorney Kathleen Horan Mclean
17 Orchard Street
New Bedford, MA 02740
RE: Maria Dias
DOB: 1/6/75
Dear Attorney McLean:
Ms. Dias was initially seen in this office on 2/17/17 for complaints of ‘chronic pain associated with
her thoracic region, which at times radiates around the left lower rib cage with associated pain along
the costosternal re; gion. She states she was involved in a significant motor vehicle accident on
1/13/14. She states at that time she had been cleaning snow off the front
of her vehicle, when a snow
plow struck the rear of her vehicle, causing het to bi e pinned between her vehicle, and the vehicle
parked in front of her. She states she was taken by ambulance to St. Luke?s Hospital emergency
Toom, where she had a number of x-rays performed, and’ was di from care with home
instructions, She subsequently followed up with her pri ary care physician, Dr. Treadup, who has
managed. her with Tbuprofen, however, states tliat shie had numerous emergency room visits‘due
to pain associated with her thoracic region, with difficulty breathing. She was referredto Dr, Sergey
‘ortman, a local physiatrist, by her primary-care physician, for pain mang; gement, who advised a
trial of chiropractic care for her ongoing symptoms.
I would like to note that Ma, Dias had been seen in th is office in 2014 with’ similar back complaints,
however, no radiation of pain at that time. An MRI performed in 2013 revealed central disc bulges
at the TS/C6, T6/T7, T7/ levels.
She indicates that since the trauma was sus! tained, she has had worsening of her thoracic symptoms
with associated pain that radiates to the anterior chest wall on the left, with difficulty breathing at
times. She. States she experiences pain on a daily basis, ho WEVEF, some days significantly worse than
others,
EXAMINATION. :
Examination at that time revealed si ignificant loss of motion ofthe thoracic region, with extension
and left lateral flexion at 5 (0% of normal, right lateral flexion 75% of normal, forward bending 90%
of normal. Rotational mo verients of the upper trunk increase pain to the left. Pain was noted with
P-A comp! ression over the T5, T6, T7, and T8 levels, with associated muscle tightness and tenderness
over the paraspinal musculature on the left; Seated Soto-Hall test increased pain in the mid to lower
thoracic area. Tenderness also noted over the costosternal region.
RECEIVED 06/14/2017 12:35PM 5089912207 HORAN MCLEAN LAW
06-1417 12:10 FROM- GNBPT 714-328-9929 T-888 0005/0006 F-661
RE: Maria Dias
Tune 9, 2017
Page2
My initial im: ion was that of: (1) segmental dysfunction of the thoracic region with associated
costovertel joint dysfunction, (2) intercostal neuralgia, (3) costochrondritis, (4) possible disc
herniation of the thoracic region.
It was recommended she undergo a plan of treatment consisting of low level laser therapy applied
to the costosternal region to reduce inflammation, therapeutic massage and manipulative techniques
to improve joint function in the thoracic region. She was to be co-i with her physiatrist, Dr.
Wortman. Treatment was helpful in reducing her pain when acute, but not curative.
Dueto ongoing acute isodes, an MRI was med of the thoracic spine on 4/21/17, which
revealed
a TS/T6 disc protrusion, as well as a T7/T8 shallow left paracentral disc protrusion.
Ms. Dias was last seen. on 6/9/17, with ‘complaints of pain in the mid thoracic area, which she
describes as a dull aching/buming sensation, with intermittent radiation to the anterior chest wall,
CLINICAL SUMMARY.
Ms. Dias has had consistent complaints of, ‘pain in the mid thoracic area, which she experiences on
adaily basis to varying degrees of intensity, with at times radiation of pain around the left lower rib
cage ., to the anterior chest wall with difficulty breathing. Her symptoms at times become very acute
4 citating. She does obtain relief with conservative chiropractic management, however, not
long fasting.
. Her sythptoms are of a chronic nature, and in my opinion have ocome significantly aggravated as
a result of the trauma sustained on 1/3/14. She is curréntly treating on an as needed basis,
presents only when her symptoms become acute, or appear to interfere with routine daily activities.
PROGNOSIS
It is my opinion that Ms. Dias has sustained a permanent injury to the thoracic region, which will
juire some type of ongoing’ management either in the form of medication, or conservative
chiropractic treatment. She may be a candidate for possible spinal injections, however, she has
indicated that she is not comfortable having that procedure performedat this time. Her prognosis
for reaching pre-injury status is poor.
Based
a% Wi ha len thepersonGuidesimpairment
01 to Evaluation of Permanent Impairment Sixth Edition, patient has sustained
based upon her current findings.
DISAB)
Ms, Dias is considered permanently disabled, She is precluded from lifting any more than
0 pounds on an occasional basis. not be able to perform any maneuvers which require
‘condition. She is esse ata
repetitive bending, twist i pushin; 2, or pulling involving the upper bo ly, So as not to aggravate her
ly restricted
Alves Chiropractic Center, 2834 Acushnet Avenue + New Bedford, MA 02745 - Tele: {508) 998-3002
:
Dr. 1. Alves Dr, Michael Boucher Dr, Ryan Knowles
RECEIVED 06/14/2017 12:35PM 5089912207 HORAN MCLEAN LAW
06-14-17 12:11 FROM- GNBPT 714-328-9928 T-388 P0006/0006 F-€61
RE: Maria Dias
June 9, 2017
‘age
CAUSATION
eat
It is opinion to within a reasonable medical certainty that although the patient had been
symptoms related to the thoracic spine, the injury sustained on 1/3/14 has significantly
aggravated ¢ condition, resulting in a permanent impairment. She will require ongoing care to
eatin her current levels of function, and pain levels to a minimum.
CERTIFICATION:
I certify that 'am a duly licensed doctor of chiropractic in the Commonwealth of Massachusetts.
The foregoing diagnoses, prognosis, and opinions are based upon a reasonable degree of medical
certainty pursuant to M.G.L., Ch. 233, Séc. 79G.
Signed under the pains and penalties of perjury.
Sincerely,
G |. Alves, D.C.
Chiropractic Physician
GIAh
Alve jes Chiropractic Center, 2834 Acushnet Avenue + New Bedford, MA 02745 - Tele:.(508) 998-3001
Dr. Michael Boucher Dr. Ryan Knowles
RECEIVED 06/14/2017 03:13PM 5089912207 HORAN MCLEAN LAW
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GARY J. ALVES, D.C., CCSP
CURRICULUM VITAE
2834 Acushnet Avenue
New Bedford, MA 02745
(508) 998-3001 Fax: (508) 998-1461
Name: Gary J. Alves, D.C., CCSP
Address: Home: 3076 County Street
i MA 02715
Office: 2834 Acushnet Avenue
lew Bedford, MA 02745
Years in Practice: Practicing in New Bedford since 1981
Place of Birth: New Bedford, MA
January 19, 1956
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Page2
EDUCATION:
INSTITUTION DEGREE YEAR MAJOR
Chiropractic Certificate 1998 §
Memorial College Chiropractic Rehabilitation
Rehabilitation
(120 credit hours)
Logan Chiropractic Certificate Sports
College Injuries (120 Foredit hours) 1991 Sports Injuries
National College Certificate Im)
tic Ratings (60 a hours) 1984 Impairment
National College Doctor of Chiropractic 1980 Chiropractic
Chiropractic Medicine
National College Bachelor of Science 1978 Human
Biology
Southeastern Ma, Bachelor of Art 1977 Biology
University
LICENSES:
Commonwealth of Massachusetts
Board of Registration of Chiropractors #593
March of 1980
HOSPITAL AFFILIATION
Southcoast Hospital Group
eurosurgery
Spine Center 2012 To Present
POSTGRADUATE WORK:
Harvard Medical Schoo!
Low Back Pain In The Bra Of Managed Care
21 Credit Hours, Category 1 Physicians Recognition
Award AMA. Completed 1996
National College of Chitopractic
Postgraduate O1
260 Credit Hours 1982-1985
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Page3
President
Sout
Chiropractic Society 1987-1989
CAQH Certified 2008 - Present
ATTACHMENT “B”
eel aoe BEE
iyEEwok
Gv 1 wy
October 2, 2017
MAPFRE Insurance
211 Main Street
Webster, MA 01570
Attn: Jeff Granai
CLAIMANT: Dias, Maria
INSURED : Milton Torres
CLAIM # : HRVRS6/CUNYK6
D.O.T. 01/03/14
ERI # DIA010675
MEDICAL RECORD REVIEW
Dear Mr. Granai:
The following is a review of medical records obtaining to
Maria Dias and a motor vehicle accident that occurred on
January 3, 2014. Records reviewed include MRI reports,
records from Dr. Kaplan, records from Shields MRI, records
from Dr. Swift, records from Family Chiropractic, records from
Dr. Kozupa, records from Dr. Treadup, records from Dr.
Adelberg, records from Dr. Wortman, records from Dr. Alves,
and various supportive bills and documents.
Ms. Maria Dias was involved in a motor vehicle accident which
occurred on January 3, 2014. The patient was shoveling
between two cars and a plow hit a car and pushed the car into
her. She was taken to the emergency room. She was diagnosed
with strain and contusion injuries, treated and released.
She subsequently sought care with Dr. Kaplan on 01/08/2014 in
followup. The motor vehicle accident was mentioned along with
an increased heart rate in the emergency room. There is
actually on mention of neck or low back pain by Dr. Kaplan.
His physical examination was notable for no tenderness about
the neck and the back exam is considered normal. The plan was
330 Boston Road, Suite 9 » N. Billerica, MA 01862 * (978) 670-1223 * Fax (978) 670-1224
www.expertreviewinc.com
CLAIMANT: Dias, Maria
ERI # DIA010675
Page 2
to address her anxiety issues and her cardiac status and a
followup in three months’ time was ordered.
Ms. Dias also followed
with Dr. Treadup, up
her primary, on
01/09/2014. The history of the motor vehicle accident was
elicited, Radiographs were reviewéd and were negative
studies. It stated that Ms. Dias had a lot of anxiety and a
high heart rate at the hospital. Was feeling okay at that
point and the hip pain that she had following the accident in
the right hip had resolved. There is no mention of any other
musculoskeletal complaints. Her past medical history was
extensively reviewed including multiple joint pains as well as
neck pain and backache. In fact, she had a significant
history of back pain and neck pain documented at Family
Chiropractic with Dr. Horowitz. She in a report of 09/22/2010
had stated that she was treated for low back pain that was
ongoing. MRI of the lumbar spine was obtained in 2009. That
study was notable for facet arthropathy at L4-L5, L5-S1 levels
and was obtained for evaluation of back pain. There is also
an MRI of the thoracic spine obtained on 02/26/2013 notable
for disc bulging present at T5-T6 and T7-T8 without
significant canal compromise. Other notes documenting spinal
pain include records from Dr. Swift on 01/02/2014. She
reported cervical and thoracic pain which had improved some.
She had been seen also by Dr. Kozupa reporting longstanding
history of fatigue for years as well as nonspecific
arthralgias, myalgias and paresthesias. She was followed by
both rheumatology and neurology for these concerns.
Ms. Dias was seen
in followup by Dr. Adelberg on 03/21/2014.
She reported neck
and shoulder pain at that time that had been
present for years. The episode was daily and it radiated to
her back. There is actually no mention in Dr. Adelberg’s note
of a motor vehicle accident exacerbating her symptoms.
There is then a gap in care. Ms. Dias sees Dr. Kaplan back on
11/19/2014. She does not report muscle aches or muscle
CLAIMANT: Dias, Maria
ERI # : DIA010675
Page 3
weakness or arthralgias or joint pain. She denies back pain.
Her neck exam is normal
She got a followup with Dr. Kaplan over on 04/10/2015. She
states that she has neck pain for the previous few days’ time.
There is no statement linking that pain to the motor vehicle
accident in that report.
Ms. Dias saw her primary Dr. Treadup on 12/29/2016. There she
reported neck pain and upper back pain on and off for 2-1/2
years’ time following her motor vehicle accident. Her neck
range of motion on physical exam was normal and the neck
supple. There was tenderness to palpation in the mid back
region. She was referred to physiatry for this.
s. Dias saw Dr. Wortman on 01/17/2017. She reported injuries
in the motor vehicle accident of January 3, 2014. She said
that her primary care physician evaluated her but no
additional tests were performed and she did not have any
therapy. She saw a chiropractor only once she stated. She
had been dealing with symptoms with taking Motrin. Dr.
Wortman performed a physical exam notable for some neck pain
on extension and flexion as well as palpation. No focal
neurologic deficits are identified. He ended up ordering a
new MRI of the mid back. That study performed on 04/21/2017
was notable for once again disc protrusion that was called
tiny at C5-C6 and a very shallow disc protrusion at T7-T8.
The report is essentially unchanged from the report from
February 26, 2013. There were no axial images obtained in
that report but the disc bulges are essentially unchanged.
Ms. Dias then underwent care with Dr. Swift, a chiropractor,
as well as Dr. Alves, a chiropractor, over the ensuing six
months. She followed up with Dr. Wortman on 05/03/2017. Her
MRI was discussed. Physical exam remained essentially
unchanged. He diagnosed Ms. Dias with a chronic pain
syndrome. Injection management was suggested but I don’t
believe it was ever performed.
CLAIMANT: Dias, Maria
ERI # DIA010675
Page 4
It is my opinion based on review of these medical records that
Ms. Maria Dias was involved in a motor vehicle accident on
January 3, 2014. In the accident she was pinned by a car hit
by a plow. Her initial emergency room evaluation was notabl
e
for contusion injuries and in specifics her complaint
was
xight hip pain at that time. Of particular note the hip pain
which she complained of as of a week later had resolv
ed and
she stated she was feeling okay as of her evaluation by
Dr.
Treadup on 01/09/2014. It is my opinion that the contusion
injury sustained to her right hip at that point was
essentially resolved, She did not complain of neck pain nor
low back pain in the report of Dr. Treadup on 01/09/2014, and
in fact, only complained to Dr. Adelberg in his report of
03/21/2014. However, in that report she stated her pain had
been going on for a year’s time dating it well before the
motor vehicle accident of 01/03/2014.
There is then a large gap in care to 11/19/2014 when she sees
Dr. Kaplan and complains of primarily vague left chest pain.
In a followup with Dr. Treadup on 12/29/2016, she reports neck
and upper back pain and states it had been going on for 2-1/2
years’ time, however, there is really no documentation of said
complaints over that time course. As such, in my opinion the
contusion injury to Ms. Dias’ right hip which was sustained in
the motor vehicle accident of 01/03/2014 appeared to resolve
as of a week later when she states to Dr. Treadup she was
feeling okay and her hip pain had resolved. She may have
sustained a myofascial strain injury of the cervical/lumbar
spine as well but it appeared to be mild as it is not reported
by the provider she sees over the ensuing several months’ time
and as such no care is recommended. There are no complaints
to elicit said care.
In my opinion the care Ms. Dias received, namely primarily
medication management over the course of the three months’
time following the motor vehicle accident, was reasonable and
necessary and accident related. Subsequent care, however, by
Dr. Wortman starting in January 2017, in my opinion may well
CLAIMANT : Dias, Maria
ERI # 3 DIA010675
Page 5
have been reasonable and necessary, but in my opinion was not
accident related as all accident related injuries had resolved
as of the spring of 2014.
Based on the above then, I would opine that there is no
permanency associated with the injury sustained in the motor
vehicle accident of January 3, 2014.
Should any additional appropriate clinical documentation
become available for my review I reserve the right to alter or
modify this report accordingly.
I certify that I am a licensed physician in the State of
Massachusetts and have reached the above conclusion to a
reasonable degree of medical certainty.
Subscribed and sworn this 3rd day of October in the year 2017
under the pains and penalty of perjury.
BAZ.
Sincerely,
R. Scott Cowan, M.D.
RSC/mls
33337
CURRICULUM VITAE
ROBERT SCOTT COWAN, M.D.
Expert Review Incorporated
330 Boston Road, Suite 9
N. Billerica, MA 01862
978-670-1223
EDUCATION
June 1982
Brown University
A.B. Degree Biology
August 1984
University of Maryland
M.S. Degree in Anatomy.
Thesis: Computer program which stimulates function of the
Extraocular musculature
Medical School
May 1988
Boston University School of Medicine
Boston, MA
Honors: Histology, Neuroscience, Pathophysiology, Orthopedic
Surgery, Rheumatology
Internship
July 1988-June 1989
St. Elizabeth's Hospital
Brighton, MA,
General Surgery
Residency
July 1989-June 1993
Boston University Program in Orthopedic Surgery
(Including Chief Residency)
R. SCOTT COWAN, MD www. expertreviewin com Page 1 of 4
Fellowship
August 1993 - July 1994
Spinal Surgery Fellowship
New England Baptist Hospital, Boston, MA
ACADEMIC APPOINTMENTS
1996 to present
Assistant Clinical Professor of Orthopedic Surgery
Boston University School of Medicine
Boston, MA
1996-present
Instructional Faculty Spine Tech, Inc.
Interbody Fusion Cage System
EMPLOYMENT
July 1992-July 1994
Boston Neighborhood Health Center,
Boston, Massachusetts
Staff Orthopedist
August 1994 to present
New England Orthopedic Surgeons
Springfield, MA
APPOINTMENTS
Attending Staff
Baystate Medical Center
Springfield, MA
Mercy Hospital
Springfield, MA
Shriners Hospital for Children
Springfield, MA
BOARD CERTIFICATION
American Board of Orthopedic Surgery, 1996
PROFESSIONAL ORGANIZATIONS
e American Academy of Orthopedic Surgeons
R. SCOTT COWAN, MD we. xtrs ‘inc. com Page 2 of 4
Fellow, Massachusetts Medical Society
American Medical Association
New England Spine Study Group
North American Spine Society
PRESENTATIONS
Surgical Indications and Options for Low Back Pain, Spine
Care for Primary Care Providers, Spine Institute of New
England, May 1998
Concepts in Spine Care, Case Management Society of New
England Annual Meeting, April 1998
Anterior Lumbar Interbody Fusion with Titanium Cages, New
England Spine Group, August 1997, February 1998, August
1988
Sports Related Injuries of the Spine, Office Based Sports
Medicine Conference, Baystate Medical Center, March,
1995.
Scoliosis Update, Pediatric Grand Rounds, Baystate
Medical Center, January, 1995.
A Multicenter Evaluation of Fixation and Fusion of the
Lumbar Spine with Pedicle Screws, New England Spine Study
Group Meeting, January, 1995.
Management of Adult Lumbar Spine Disease, Orthopedic
Grand Rounds, University of Massachusetts Medical Center,
December 1994.
Cervical Spine Disease, Orthopedics in Primary Care
Conference, Baystate Medical Center, November, 1994
Pedicle Screw Fixation of the Lumbar Spine, North
American Spine Society Meeting, October, 1994.
SCOTT COWAN, MD ww. expert. com Page 3 of 4
Pedicle Screw Fixation of the Lumbar Spine, New England
Orthopedic Surgeons Meeting, October
Preview
HA Commonwealth of Massachusetts BRISTOL, SS. SUPERIOR COURT DEPARTMENT OF THE TRIAL COURT CIVIL ACTION NO.: 1673CV01211 MARIA F, DIAS, BRISTOL, SS SUPERIOR COURT PLAINTIFF FILED V. APR 4 2018 MARC J. SANTOS, ESQ. MILTON C. TORRES, CLERK/MAGISTRATE DEFENDANT JOINT PRE-TRIAL MEMORANDUM Now come the parties who, by and through counsel, file the following Joint Pre-Trial Memorandum. AGREED FACTS Plaintiff Maria F. Dias is an individual who resides at 119 Falmouth Street, North Dartmouth, Bristol County, Massachusetts. Defendant Milton C. Torres is an individual who resides at 571 Summer Street, New Bedford, Bristol County, Massachusetts. This is a personal injury claim, which occurred at Falmouth Street, North Dartmouth, Massachusetts, on or about January 3, 2014. IL STATEMENT OF THE CASE A. PLAINTIFF Liability in this case is undeniably clear. On January 3, 2014, the Plaintiff, Ms. Dias, was at her home on Falmouth Street, North Dartmouth, Massachusetts. There had been a snowstorm the night prior. She went outside in the morning around 10:00 a.m. to clean off the snow from her cars. While she was standing between her two vehicles, cleaning off the snow from the cars, the Defendant, Mr. Torres, was in a snow plow in the area, plowing snow. He was operating his vehicle in an unsafe manner, very quickly—back and forth—without due regard for the fact that the area was a residential neighborhood. Ms. Dias was between her vehicles when all of the sudden, Mr. Torres backed up his truck very quickly and went forward very quickly. He rammed his truck into one of Ms. Dias’s vehicles, causing the vehicle to strike her and sandwich her between the two vehicles, crushing her hips and causing her body to twist. Her hips caused an indentation in one of the vehicles. Mr. Torres then backed up again to re-plow, not knowing that he had struck Ms. Dias. The force was so hard that the car windows shattered, some of the glass striking Ms. Dias. Ms. Dias’s brother and neighbors began to scream at him to stop. In that moment, Ms. Dias believed Mr. Torres was not going to stop and she was going to die. She remembers being frozen and scared to death. She felt she could not talk or move her legs due to her nerves from the trauma. She felt immediate pain throughout her body, and suffered bruising in her pelvic area. The police arrived, and Ms. Dias was transported to the St. Luke’s Hospital in an ambulance. While en route to St. Luke’s Hospital, Emergency Medical Technicians placed Ms. Dias on an electrocardiogram (EKG) because of her rapid heart rate. At the Emergency Department of St. Luke’s Hospital, medical personnel noted the accident: “Pt states standing b/n 2 cars in a parking lot, a snow plow backed up into one of the cars, pushing the car into the other car w/ her in between the 2 cars.” Medical personnel further noted that Ms. Dias complained of pain in her right hip and rectum, and that she was anxious. Ms. Dias was advised to follow up with her primary care physician, Dr. Ann Marie Treadup of Southcoast Physicians Group, Inc. Due to ongoing chronic pain in her thoracic region as a result of the accident, which radiates around her left lower rib cage to her anterior chest wall, Ms. Dias returned to St. Luke’s Hospital on multiple occasions since the date of the accident. Although she had experienced some back pain before, the pain following the incident has been different and more intense. In addition, Ms. Dias received treatment on multiple occasions at Hawthorn Medical Associates, LLC, to address this pain. Ms. Dias also sought treatment from chiropractors, Dr. Jeffrey Swift, Dr. Robert Horowitz, and Dr. David Adelberg, to address her ongoing thoracic pain, in addition to cervical pain, relating to the accident. Referred by her primary care physician, she received additional treatment from a physiatrist, Dr. Sergey Wortman of Greater New Bedford Physical Therapy and Sports, for pain management. Dr. Wortman referred Ms. Dias to have an MRI of her thoracic spine, which revealed dise protrusions (which, unlike disc bulges, relate to trauma) at the T5-6 and T7-8 levels. Dr. Wortman advised a trial of chiropractic care for her ongoing symptoms. Ms. Dias received chiropractic care from Dr. Gary Alves, of Alves Chiropractic Center. Ms. Dias complained of chronic pain associated with her thoracic region, which at times radiates around the left lower rib cage with associated pain along the costosternal region. According to Dr. Alves, Ms. Dias stated that, “She was involved in a significant motor vehicle accident on 1/13/14. She states at that time she had been cleaning snow off the front of her vehicle, when a snow plow struck the rear of her vehicle, causing her to be pinned between her vehicle, and the vehicle parked in front of her.” Ms. Dias explained that, “She was taken by ambulance to St. Luke’s Hospital emergency room, where she had a number of x-rays performed, and was discharged from care with home instructions. She subsequently followed up with her primary care physician, Dr. Treadup, who has managed her with Ibuprofen, however, states that she has had numerous emergency room visits due to pain associated with her thoracic region, with difficulty breathing.” Based on his examinations, and per his certified medical report, it is Dr. Alves’ opinion to a reasonable degree of medical certainty that although Ms. Dias had been experiencing symptoms related to her thoracic spine, the injury sustained on January 3, 2014 has significantly aggravated her condition, resulting in permanent impairment. (Dr. Alves noted that Ms. Dias had had an MRI of her thoracic spine performed in 2013, which revealed central disc bulges at T5/C6, T6/T7, T7/T8 levels.) As a result of the accident, Ms. Dias “has had consistent complaints of pain in the mid-thoracic area, which she experiences on a daily basis to varying degrees of intensity, with at times radiation of pain around the left lower rib cage to the anterior chest wall with difficulty breathing. Her symptoms are very acute and incapacitating.” Ms. Dias has obtained some relief with conservative chiropractic management, however it is not long- lasting. In his medical report, Dr. Alves further noted that Ms. Dias’s symptoms are of a chronic nature, and it is his medical opinion that they have become significantly aggravated as a result of the trauma sustained on January 3, 2014. He has determined that her injury to her thoracic region is permanent, and that Ms. Dias is permanently partially disabled. She has sustained a 9% whole person impairment. Dr. Alves found that the results of an MRI performed on the thoracic spine on April 21, 2017 revealed a T5/T6 central disc protrusion and a T7/T8 shallow left paracentral disc protrusion. He further advised Ms. Dias that she is precluded from lifting any more than 10 pounds on an occasional basis and that she is essentially restricted to sedentary type work as a result of the accident. According to Dr. Alves, Ms. Dias will require ongoing care to maintain her current levels of function and pain levels to a minimum. Prior to the accident, the Plaintiff was an active, healthy woman who enjoyed spending time with her two daughters, family, and friends and enjoyed her clerical job at NFI Corp. Due to the Defendant’s reckless driving, Ms. Dias suffered the serious injuries as above described. She has had to endure numerous medical appointments, and has experienced great pain while sitting for an extended period of time. She also continues to have difficulty getting in and out of her vehicle due to the pain in her hip and back area. Ms. Dias has never experienced anything like this prior to the accident. As noted by her primary care physician, Dr. Treadup on December 29, 2016: “[Ms. Dias] is complaining of neck pain on and off for 2 4% years. She was pinned between two cars and has not felt the same since.” In addition, Ms. Dias is unable to carry anything of significant weight, such as groceries, and her two daughters, Alexa Macedo and Ninah Macedo, are required to assist her. Her daughters can attest that although she had thoracic pain prior to the accident, it was nothing like she has experienced after the accident. Ms. Dias has also experienced an elevated anxiety since the accident, which exacerbated her need for additional medical treatment. The incident caused Ms. Dias great emotional upset, which continues to have an impact on her daily living. Since the filing of the Complaint and Demand for a Jury Trial, she has received medical treatment from Dr. Daniel Park of Southcoast Physicians Group for pain management and from Team Physical Therapy to address her ongoing chronic pain. B. DEFENDANT On January 3, 2014, the defendant was operating a snow plow when his vehicle slid in the snow and made contact with a parked car. The plaintiff, who was cleaning off her car nearby, was hit by the parked vehicle. The plaintiff claims to have sustained injuries to her head, neck, back, hip and shoulders, in addition to experiencing emotional distress. Defendant denies he is liable or that the plaintiff's purported injuries are related to the incident. The evidence will show that the plaintiff has an extensive medical history which includes, among other things, neck, back and shoulder pain. Less than a year before the accident in question, the plaintiff underwent physical therapy to address occasional tingling radiating down her arms associated with neck and back issues. The defendant contests the cause of the plaintiff's medical treatment in addition to the reasonableness and necessity of the medical expenses which, according to the plaintiffs response to the defendant’s Mass. R. Civ. P. 34 requests, include but are not limited to the following: EKGs, an endoscopy, various scans of her abdomen, medical visits and treatment for respiratory infections, EGD transoral biopsy and even impacted wax removal. UL. JOINT STATEMENT TO BE READ TO THE JURY PLAINTIFF’S PROPOSAL The Plaintiff brought a civil action for personal injuries arising from an incident that took place on January 3, 2014. The Plaintiff sustained said personal injuries when the Defendant, who was operating a snow plow, hit a parked motor vehicle, causing the Plaintiff to be pinned between two parked motor vehicles. The Plaintiff suggests that liability is undeniably clear and subsequent medical treatment was necessary, fair, and reasonable. The Defendant denies liability and contests the reasonableness and necessity of the subsequent medical treatment associated with the injuries alleged by the Plaintiff. B. DEFENDANT’S PROPOSAL The plaintiff brought a civil suit alleging personal injuries arising from an incident that took place on January 3, 2014, while she was standing next to a parked car that was hit by the defendant who was operating a snow plow. The defendant denies liability and contests the reasonableness and necessity of the subsequent medical treatment associated with the injuries alleged by the plaintiff. IV. WITNESSES A. PLAINTIFF'S 1 Maria F. Dias of North Dartmouth, Massachusetts; 2 Milton C. Torres of New Bedford, Massachusetts; 3 Alexa Macedo of 119 Falmouth Street, North Dartmouth, Massachusetts; 4 Ninah Macedo of 119 Falmouth Street, North Dartmouth, Massachusetts; Alex Dias of 125 Falmouth Street, North Dartmouth, Massachusetts; Officer Scott Alves, New Bedford Police Department; Keeper of th Records of New Bedford Emergency Medical Services; Keeper of the Records of Hawthorn Medical Associates, LLC; Keeper of the Records of William Caplan, MD; 10. Keeper of the Records of Dr. Robert Horowitz of the Family Chiropractic Center; 11 Keeper of the Records of St. Luke’s Hospital (Southcoast Hospitals Group); 12 Keeper of the Records of Sergey Wortman, MD; 13 Keeper of the Records of Jeffrey Swift, DC; 14 Keeper of the Records of Greater New Bedford Physical Therapy; 15 Keeper of the Records of Gary Alves, DC; 16 Keeper of the Records of Fall River Family Practice; 17 Keeper of the Records of Fall River New Bedford MRI; 18 Keeper of the Records of David Adelberg, MD; 19 Keeper of the Records of Family Chiropractic of New Bedford; 20. Keeper of the Records of Ann Marie Treadup, MD; 21 Keeper of the Records of Daniel Park, MD; 22 Keeper of the Records of Team Physical Therapy; 23 All other Keepers of the Records of the medical records and bills of the Plaintiff: 24. Keeper of the Records of the Defendant’s auto insurance; and 25 The Keeper of the Records of any facility that repaired/appraised the Plaintiff or Defendant’s vehicles. Plaintiff reserves the right to call any witness on the Defendant’s list of witnesses and to supplement this list if necessary. DEFENDANT’S Maria Dias, Plaintiff Milton Torres, Defendant Officer Scott Alves, New Bedford Police Department Keeper of the Records of William Caplan, MD Keeper of the Records of St. Luke’s Hospital Keeper of the Records of Sergey Wortman Keeper of the Records of Jeffrey Swift Keeper of the Records of Greater New Bedford Physical Therapy Keeper of the Records of Gary Alves, DC 10. Keeper of the Records of Fall River Family Practice 11 Keeper of the Records of Fall River New Bedford MRI 12 Keeper of the Records of David Adelberg, MD 13 Keeper of the Records of Family Chiropractic of New Bedford 14 Keeper of the Records of Ann Marie Treadup, MD 15 Keeper of the Records of any of the plaintiffs medical providers/insurers 16. The Keeper of the Records of any facility that repaired/appraised the Plaintiff or Defendant’s vehicles. Defendant reserves the right to call any witness identified by Plaintiff, as well as call any necessary impeachment witnesses not herein listed. Defendant reserves the right to supplement this list prior to trial. The Defendant reserves the right to submit into evidence, pursuant to Massachusetts General Laws Chapter 233, Section 79G, each and every medical record the Plaintiff, or any other party, certified for use as evidence at trial. Further, the Defendant reserves the right to call any witness whose medical record has been certified pursuant to M.G.L. Chapter 233, Section 79G or 79J. Also, the Defendant reserves the right to supplement this list within a reasonable time before trial. Vv. EXPERT WITNESSES A. The Plaintiff The Plaintiff does expect to call Dr. Gary Alves of Alves Chiropractic Center, 2834 Acushnet Avenue, New Bedford, Massachusetts 02745 to testify as an expert witness consistent with his report and opinion, dated June 9, 2017. A copy of his report and opinion dated June 9, 2017, and his curriculum vitae are attached hereto as Attachment “A”, and have been provided to Defendant’s counsel. Dr. Alves is expected to give testimony concerning the injuries sustained on January 3, 2014 that have significantly aggravated her medical condition, resulting in permanent impairment and permanent partial disability. The Plaintiff reserves the right to call any witness on the Defendant’s list of witnesses and to supplement this list if necessary. B. The Defendant To date, the plaintiff has failed to appropriately identify any proposed expert witnesses. The defendant reserves the right to identify an expert witness if and when one is properly identified by the plaintiff. Otherwise, the defendant anticipates calling Dr. R. Scott Cowan to testify consistent with his report and opinion dated October 2, 2017. A copy of his report and opinion dated October 2, 2017, and his curriculum vitae are attached hereto as Attachment “B”, and have been provided to plaintiff's counsel. VI. ESTIMATED LENGTH OF TRIAL One (1) full trial day. VII. SETTLEMENT The Parties have had settlement discussions and have not been able to resolve the matter at this time. Vul. PLAINTIFF’S ITEMIZATION OF DAMAGES Medical Expense: New Bedford EMS Ambulance: $1,652.78 Southcoast Hospitals Group: $38,480.88 Hawthorn Medical Associates: $17,029.00 Dr. Anne Marie Treadup: $3,940.00 Dr. Gary Alves: $930.00 Dr. Sergey Wortman: $750.00 Shields MRI: $1,500.00 Dr. Robert Horowitz: $540.00 Dr. David Adelberg: $160.00 Dr. Jeffrey Swift: $560.00 Dr. Daniel Park $679.00 Team Physical Therapy $1,342.00 Total: $67,563.66 Pain and Suffering and Emotional Distress Ms. Dias has suffered significant pain and suffering and emotional distress as a result of the accident, experiencing elevated anxiety and an increased heart rate as a result of her emotional upset related to the accident. Permanent Partial Disability Since January 3, 2014 and continuing. PLAINTIFF, DEFENDANT, MARIA F. DIAS MILTON C. TORRES By her Attorney, By his Attorney, By KHM Wa tmai Horan McLean Law Mazzocca & Associates 17 Orchard Street 211 Main Street New Bedford, MA 02740 Webster, MA 01570 Ph.: (508) 991-2216 Ph.: (508) 949-4869 BBO# 561777 BBO#: 648647 Date: April 4, 2018 Date: April 4, 2018 CERTIFICATE OF SERVICE The undersigned hereby certifies that a true copy of the within Joint Pre-Trial Memorandum was this day served upon Defendant, Milton C. Torres, via e-mail and first-class mail, postage- prepaid, to his counsel of record, Joseph Merlino, Esquire, of Mazzocca & Associates, 211 Main Street, Webster, Massachusetts 01570. SIGNED under the pains and penalties of perjury. Dated: April 4, 2018 ATTACHMENT “A” RECEIVED 06/14/2017 12:35PM 6089912207 HORAN MCLEAN LAW 06-1417 12:10 FROM- GNBPT Te 828-9929 T-388 P0003/0006 F-661 Gary J. Alves D.C, C.C.S.P. | Aives Chiropractic Center MichaelR. Boucher D.C. Ryan Knowles D,C, | 2834 Acushnet Avenue * New Bedford, MA 02745 « Tel: 508-998-3001 * Fax: 508-998-1461 CERTIFIED MEDICAL NorEs NOTES PURSUANT.10 M.G.La, CHAPTER 285, SEC i Gary J Alves; D.C, being duly Hicensed to9 Practice under the laws of the Commonwealth of Massacl etts, hereby certifies thatthe fol owing recor reports, and bills are true and complete copies of the care and treatment of, Subscribed and sworn to under the penalties of pexjury this ue day of June 2017. hf! | Gary J. Alves, D.C, Chiropractic: Physician GJA/bh - + RECEIVED 06/14/2017 12:35PM 5089912207 HORAN MCLEAN LAW 08-14-17 12:10 FROM- GNBPT 774-828-9929 T-388 0004/0008 F-661 Gary J, Alves N.C., C.C,S.P. | Aives Chiropractic Center Michas! R. Boucher D.C. Ryan Knowles D.C, | 2834 Acushnet Avenue * New Bedford, MA 02745 « Tel: 508-998-3001 * Fax: 508-998- 1461 June 9, 2017 Attorney Kathleen Horan Mclean 17 Orchard Street New Bedford, MA 02740 RE: Maria Dias DOB: 1/6/75 Dear Attorney McLean: Ms. Dias was initially seen in this office on 2/17/17 for complaints of ‘chronic pain associated with her thoracic region, which at times radiates around the left lower rib cage with associated pain along the costosternal re; gion. She states she was involved in a significant motor vehicle accident on 1/13/14. She states at that time she had been cleaning snow off the front of her vehicle, when a snow plow struck the rear of her vehicle, causing het to bi e pinned between her vehicle, and the vehicle parked in front of her. She states she was taken by ambulance to St. Luke?s Hospital emergency Toom, where she had a number of x-rays performed, and’ was di from care with home instructions, She subsequently followed up with her pri ary care physician, Dr. Treadup, who has managed. her with Tbuprofen, however, states tliat shie had numerous emergency room visits‘due to pain associated with her thoracic region, with difficulty breathing. She was referredto Dr, Sergey ‘ortman, a local physiatrist, by her primary-care physician, for pain mang; gement, who advised a trial of chiropractic care for her ongoing symptoms. I would like to note that Ma, Dias had been seen in th is office in 2014 with’ similar back complaints, however, no radiation of pain at that time. An MRI performed in 2013 revealed central disc bulges at the TS/C6, T6/T7, T7/ levels. She indicates that since the trauma was sus! tained, she has had worsening of her thoracic symptoms with associated pain that radiates to the anterior chest wall on the left, with difficulty breathing at times. She. States she experiences pain on a daily basis, ho WEVEF, some days significantly worse than others, EXAMINATION. : Examination at that time revealed si ignificant loss of motion ofthe thoracic region, with extension and left lateral flexion at 5 (0% of normal, right lateral flexion 75% of normal, forward bending 90% of normal. Rotational mo verients of the upper trunk increase pain to the left. Pain was noted with P-A comp! ression over the T5, T6, T7, and T8 levels, with associated muscle tightness and tenderness over the paraspinal musculature on the left; Seated Soto-Hall test increased pain in the mid to lower thoracic area. Tenderness also noted over the costosternal region. RECEIVED 06/14/2017 12:35PM 5089912207 HORAN MCLEAN LAW 06-1417 12:10 FROM- GNBPT 714-328-9929 T-888 0005/0006 F-661 RE: Maria Dias Tune 9, 2017 Page2 My initial im: ion was that of: (1) segmental dysfunction of the thoracic region with associated costovertel joint dysfunction, (2) intercostal neuralgia, (3) costochrondritis, (4) possible disc herniation of the thoracic region. It was recommended she undergo a plan of treatment consisting of low level laser therapy applied to the costosternal region to reduce inflammation, therapeutic massage and manipulative techniques to improve joint function in the thoracic region. She was to be co-i with her physiatrist, Dr. Wortman. Treatment was helpful in reducing her pain when acute, but not curative. Dueto ongoing acute isodes, an MRI was med of the thoracic spine on 4/21/17, which revealed a TS/T6 disc protrusion, as well as a T7/T8 shallow left paracentral disc protrusion. Ms. Dias was last seen. on 6/9/17, with ‘complaints of pain in the mid thoracic area, which she describes as a dull aching/buming sensation, with intermittent radiation to the anterior chest wall, CLINICAL SUMMARY. Ms. Dias has had consistent complaints of, ‘pain in the mid thoracic area, which she experiences on adaily basis to varying degrees of intensity, with at times radiation of pain around the left lower rib cage ., to the anterior chest wall with difficulty breathing. Her symptoms at times become very acute 4 citating. She does obtain relief with conservative chiropractic management, however, not long fasting. . Her sythptoms are of a chronic nature, and in my opinion have ocome significantly aggravated as a result of the trauma sustained on 1/3/14. She is curréntly treating on an as needed basis, presents only when her symptoms become acute, or appear to interfere with routine daily activities. PROGNOSIS It is my opinion that Ms. Dias has sustained a permanent injury to the thoracic region, which will juire some type of ongoing’ management either in the form of medication, or conservative chiropractic treatment. She may be a candidate for possible spinal injections, however, she has indicated that she is not comfortable having that procedure performedat this time. Her prognosis for reaching pre-injury status is poor. Based a% Wi ha len thepersonGuidesimpairment 01 to Evaluation of Permanent Impairment Sixth Edition, patient has sustained based upon her current findings. DISAB) Ms, Dias is considered permanently disabled, She is precluded from lifting any more than 0 pounds on an occasional basis. not be able to perform any maneuvers which require ‘condition. She is esse ata repetitive bending, twist i pushin; 2, or pulling involving the upper bo ly, So as not to aggravate her ly restricted Alves Chiropractic Center, 2834 Acushnet Avenue + New Bedford, MA 02745 - Tele: {508) 998-3002 : Dr. 1. Alves Dr, Michael Boucher Dr, Ryan Knowles RECEIVED 06/14/2017 12:35PM 5089912207 HORAN MCLEAN LAW 06-14-17 12:11 FROM- GNBPT 714-328-9928 T-388 P0006/0006 F-€61 RE: Maria Dias June 9, 2017 ‘age CAUSATION eat It is opinion to within a reasonable medical certainty that although the patient had been symptoms related to the thoracic spine, the injury sustained on 1/3/14 has significantly aggravated ¢ condition, resulting in a permanent impairment. She will require ongoing care to eatin her current levels of function, and pain levels to a minimum. CERTIFICATION: I certify that 'am a duly licensed doctor of chiropractic in the Commonwealth of Massachusetts. The foregoing diagnoses, prognosis, and opinions are based upon a reasonable degree of medical certainty pursuant to M.G.L., Ch. 233, Séc. 79G. Signed under the pains and penalties of perjury. Sincerely, G |. Alves, D.C. Chiropractic Physician GIAh Alve jes Chiropractic Center, 2834 Acushnet Avenue + New Bedford, MA 02745 - Tele:.(508) 998-3001 Dr. Michael Boucher Dr. Ryan Knowles RECEIVED 06/14/2017 03:13PM 5089912207 HORAN MCLEAN LAW 06-14-17 14:47 FROM- GNBPT 714-328-9923 T-895 P0002/0004 F-672 GARY J. ALVES, D.C., CCSP CURRICULUM VITAE 2834 Acushnet Avenue New Bedford, MA 02745 (508) 998-3001 Fax: (508) 998-1461 Name: Gary J. Alves, D.C., CCSP Address: Home: 3076 County Street i MA 02715 Office: 2834 Acushnet Avenue lew Bedford, MA 02745 Years in Practice: Practicing in New Bedford since 1981 Place of Birth: New Bedford, MA January 19, 1956 RECEIVED 06/14/2017 03:13PM 5089912207 HORAN MCLEAN LAW 06-14-17 14:48 FROM- GNBPT 714-328-9923 T-395 P0008/0004 F-672 Page2 EDUCATION: INSTITUTION DEGREE YEAR MAJOR Chiropractic Certificate 1998 § Memorial College Chiropractic Rehabilitation Rehabilitation (120 credit hours) Logan Chiropractic Certificate Sports College Injuries (120 Foredit hours) 1991 Sports Injuries National College Certificate Im) tic Ratings (60 a hours) 1984 Impairment National College Doctor of Chiropractic 1980 Chiropractic Chiropractic Medicine National College Bachelor of Science 1978 Human Biology Southeastern Ma, Bachelor of Art 1977 Biology University LICENSES: Commonwealth of Massachusetts Board of Registration of Chiropractors #593 March of 1980 HOSPITAL AFFILIATION Southcoast Hospital Group eurosurgery Spine Center 2012 To Present POSTGRADUATE WORK: Harvard Medical Schoo! Low Back Pain In The Bra Of Managed Care 21 Credit Hours, Category 1 Physicians Recognition Award AMA. Completed 1996 National College of Chitopractic Postgraduate O1 260 Credit Hours 1982-1985 RECEIVED 06/14/2017 03:13PM 5089912207 HORAN MCLEAN LAW 06-14-17 14:48 FROM- GNBPT 774-328-9928 T-385 P0004/0004 F-672 Page3 President Sout Chiropractic Society 1987-1989 CAQH Certified 2008 - Present ATTACHMENT “B” eel aoe BEE iyEEwok Gv 1 wy October 2, 2017 MAPFRE Insurance 211 Main Street Webster, MA 01570 Attn: Jeff Granai CLAIMANT: Dias, Maria INSURED : Milton Torres CLAIM # : HRVRS6/CUNYK6 D.O.T. 01/03/14 ERI # DIA010675 MEDICAL RECORD REVIEW Dear Mr. Granai: The following is a review of medical records obtaining to Maria Dias and a motor vehicle accident that occurred on January 3, 2014. Records reviewed include MRI reports, records from Dr. Kaplan, records from Shields MRI, records from Dr. Swift, records from Family Chiropractic, records from Dr. Kozupa, records from Dr. Treadup, records from Dr. Adelberg, records from Dr. Wortman, records from Dr. Alves, and various supportive bills and documents. Ms. Maria Dias was involved in a motor vehicle accident which occurred on January 3, 2014. The patient was shoveling between two cars and a plow hit a car and pushed the car into her. She was taken to the emergency room. She was diagnosed with strain and contusion injuries, treated and released. She subsequently sought care with Dr. Kaplan on 01/08/2014 in followup. The motor vehicle accident was mentioned along with an increased heart rate in the emergency room. There is actually on mention of neck or low back pain by Dr. Kaplan. His physical examination was notable for no tenderness about the neck and the back exam is considered normal. The plan was 330 Boston Road, Suite 9 » N. Billerica, MA 01862 * (978) 670-1223 * Fax (978) 670-1224 www.expertreviewinc.com CLAIMANT: Dias, Maria ERI # DIA010675 Page 2 to address her anxiety issues and her cardiac status and a followup in three months’ time was ordered. Ms. Dias also followed with Dr. Treadup, up her primary, on 01/09/2014. The history of the motor vehicle accident was elicited, Radiographs were reviewéd and were negative studies. It stated that Ms. Dias had a lot of anxiety and a high heart rate at the hospital. Was feeling okay at that point and the hip pain that she had following the accident in the right hip had resolved. There is no mention of any other musculoskeletal complaints. Her past medical history was extensively reviewed including multiple joint pains as well as neck pain and backache. In fact, she had a significant history of back pain and neck pain documented at Family Chiropractic with Dr. Horowitz. She in a report of 09/22/2010 had stated that she was treated for low back pain that was ongoing. MRI of the lumbar spine was obtained in 2009. That study was notable for facet arthropathy at L4-L5, L5-S1 levels and was obtained for evaluation of back pain. There is also an MRI of the thoracic spine obtained on 02/26/2013 notable for disc bulging present at T5-T6 and T7-T8 without significant canal compromise. Other notes documenting spinal pain include records from Dr. Swift on 01/02/2014. She reported cervical and thoracic pain which had improved some. She had been seen also by Dr. Kozupa reporting longstanding history of fatigue for years as well as nonspecific arthralgias, myalgias and paresthesias. She was followed by both rheumatology and neurology for these concerns. Ms. Dias was seen in followup by Dr. Adelberg on 03/21/2014. She reported neck and shoulder pain at that time that had been present for years. The episode was daily and it radiated to her back. There is actually no mention in Dr. Adelberg’s note of a motor vehicle accident exacerbating her symptoms. There is then a gap in care. Ms. Dias sees Dr. Kaplan back on 11/19/2014. She does not report muscle aches or muscle CLAIMANT: Dias, Maria ERI # : DIA010675 Page 3 weakness or arthralgias or joint pain. She denies back pain. Her neck exam is normal She got a followup with Dr. Kaplan over on 04/10/2015. She states that she has neck pain for the previous few days’ time. There is no statement linking that pain to the motor vehicle accident in that report. Ms. Dias saw her primary Dr. Treadup on 12/29/2016. There she reported neck pain and upper back pain on and off for 2-1/2 years’ time following her motor vehicle accident. Her neck range of motion on physical exam was normal and the neck supple. There was tenderness to palpation in the mid back region. She was referred to physiatry for this. s. Dias saw Dr. Wortman on 01/17/2017. She reported injuries in the motor vehicle accident of January 3, 2014. She said that her primary care physician evaluated her but no additional tests were performed and she did not have any therapy. She saw a chiropractor only once she stated. She had been dealing with symptoms with taking Motrin. Dr. Wortman performed a physical exam notable for some neck pain on extension and flexion as well as palpation. No focal neurologic deficits are identified. He ended up ordering a new MRI of the mid back. That study performed on 04/21/2017 was notable for once again disc protrusion that was called tiny at C5-C6 and a very shallow disc protrusion at T7-T8. The report is essentially unchanged from the report from February 26, 2013. There were no axial images obtained in that report but the disc bulges are essentially unchanged. Ms. Dias then underwent care with Dr. Swift, a chiropractor, as well as Dr. Alves, a chiropractor, over the ensuing six months. She followed up with Dr. Wortman on 05/03/2017. Her MRI was discussed. Physical exam remained essentially unchanged. He diagnosed Ms. Dias with a chronic pain syndrome. Injection management was suggested but I don’t believe it was ever performed. CLAIMANT: Dias, Maria ERI # DIA010675 Page 4 It is my opinion based on review of these medical records that Ms. Maria Dias was involved in a motor vehicle accident on January 3, 2014. In the accident she was pinned by a car hit by a plow. Her initial emergency room evaluation was notabl e for contusion injuries and in specifics her complaint was xight hip pain at that time. Of particular note the hip pain which she complained of as of a week later had resolv ed and she stated she was feeling okay as of her evaluation by Dr. Treadup on 01/09/2014. It is my opinion that the contusion injury sustained to her right hip at that point was essentially resolved, She did not complain of neck pain nor low back pain in the report of Dr. Treadup on 01/09/2014, and in fact, only complained to Dr. Adelberg in his report of 03/21/2014. However, in that report she stated her pain had been going on for a year’s time dating it well before the motor vehicle accident of 01/03/2014. There is then a large gap in care to 11/19/2014 when she sees Dr. Kaplan and complains of primarily vague left chest pain. In a followup with Dr. Treadup on 12/29/2016, she reports neck and upper back pain and states it had been going on for 2-1/2 years’ time, however, there is really no documentation of said complaints over that time course. As such, in my opinion the contusion injury to Ms. Dias’ right hip which was sustained in the motor vehicle accident of 01/03/2014 appeared to resolve as of a week later when she states to Dr. Treadup she was feeling okay and her hip pain had resolved. She may have sustained a myofascial strain injury of the cervical/lumbar spine as well but it appeared to be mild as it is not reported by the provider she sees over the ensuing several months’ time and as such no care is recommended. There are no complaints to elicit said care. In my opinion the care Ms. Dias received, namely primarily medication management over the course of the three months’ time following the motor vehicle accident, was reasonable and necessary and accident related. Subsequent care, however, by Dr. Wortman starting in January 2017, in my opinion may well CLAIMANT : Dias, Maria ERI # 3 DIA010675 Page 5 have been reasonable and necessary, but in my opinion was not accident related as all accident related injuries had resolved as of the spring of 2014. Based on the above then, I would opine that there is no permanency associated with the injury sustained in the motor vehicle accident of January 3, 2014. Should any additional appropriate clinical documentation become available for my review I reserve the right to alter or modify this report accordingly. I certify that I am a licensed physician in the State of Massachusetts and have reached the above conclusion to a reasonable degree of medical certainty. Subscribed and sworn this 3rd day of October in the year 2017 under the pains and penalty of perjury. BAZ. Sincerely, R. Scott Cowan, M.D. RSC/mls 33337 CURRICULUM VITAE ROBERT SCOTT COWAN, M.D. Expert Review Incorporated 330 Boston Road, Suite 9 N. Billerica, MA 01862 978-670-1223 EDUCATION June 1982 Brown University A.B. Degree Biology August 1984 University of Maryland M.S. Degree in Anatomy. Thesis: Computer program which stimulates function of the Extraocular musculature Medical School May 1988 Boston University School of Medicine Boston, MA Honors: Histology, Neuroscience, Pathophysiology, Orthopedic Surgery, Rheumatology Internship July 1988-June 1989 St. Elizabeth's Hospital Brighton, MA, General Surgery Residency July 1989-June 1993 Boston University Program in Orthopedic Surgery (Including Chief Residency) R. SCOTT COWAN, MD www. expertreviewin com Page 1 of 4 Fellowship August 1993 - July 1994 Spinal Surgery Fellowship New England Baptist Hospital, Boston, MA ACADEMIC APPOINTMENTS 1996 to present Assistant Clinical Professor of Orthopedic Surgery Boston University School of Medicine Boston, MA 1996-present Instructional Faculty Spine Tech, Inc. Interbody Fusion Cage System EMPLOYMENT July 1992-July 1994 Boston Neighborhood Health Center, Boston, Massachusetts Staff Orthopedist August 1994 to present New England Orthopedic Surgeons Springfield, MA APPOINTMENTS Attending Staff Baystate Medical Center Springfield, MA Mercy Hospital Springfield, MA Shriners Hospital for Children Springfield, MA BOARD CERTIFICATION American Board of Orthopedic Surgery, 1996 PROFESSIONAL ORGANIZATIONS e American Academy of Orthopedic Surgeons R. SCOTT COWAN, MD we. xtrs ‘inc. com Page 2 of 4 Fellow, Massachusetts Medical Society American Medical Association New England Spine Study Group North American Spine Society PRESENTATIONS Surgical Indications and Options for Low Back Pain, Spine Care for Primary Care Providers, Spine Institute of New England, May 1998 Concepts in Spine Care, Case Management Society of New England Annual Meeting, April 1998 Anterior Lumbar Interbody Fusion with Titanium Cages, New England Spine Group, August 1997, February 1998, August 1988 Sports Related Injuries of the Spine, Office Based Sports Medicine Conference, Baystate Medical Center, March, 1995. Scoliosis Update, Pediatric Grand Rounds, Baystate Medical Center, January, 1995. A Multicenter Evaluation of Fixation and Fusion of the Lumbar Spine with Pedicle Screws, New England Spine Study Group Meeting, January, 1995. Management of Adult Lumbar Spine Disease, Orthopedic Grand Rounds, University of Massachusetts Medical Center, December 1994. Cervical Spine Disease, Orthopedics in Primary Care Conference, Baystate Medical Center, November, 1994 Pedicle Screw Fixation of the Lumbar Spine, North American Spine Society Meeting, October, 1994. SCOTT COWAN, MD ww. expert. com Page 3 of 4 Pedicle Screw Fixation of the Lumbar Spine, New England Orthopedic Surgeons Meeting, October