Preview
FILED
8/31/2020 1:38PM
FELICIA PITRE
DISTRICT CLERK
DALLAS CO.,TEXAS
Cassandra Walker DEPUTY
N0. DC-20-01594
COURTNEY L. HAEFLINGER § IN THE DISTRICT COURT
PLAINTIFF, §
§
§
VS. § DALLAS COUNTY, TEXAS
§
WARDAH IMTIAZ §
DEFENDANT. §
162M) JUDICIAL DISTRICT
DEFENDANT’S FIRST SUPPLEMENTAL RESPONSE T0 PLAINTIFF’S
REQUEST FOR DISCLOSURE AND DESIGNATION 0F EXPERTS
Pursuant t0 Tex R. CiV. P. 194, Defendant serves the following First Supplemental
Response to Plaintiff” s Request for Disclosure and Designation of Experts.
f. For any testifying expert:
1. The expert’s name, address, and telephone number;
2. The subj ect matter 0n which the expert will testify;
3. The general substance 0f the expert’s mental impressions and opinions and
a brief summary 0f the basis for them, or if the expert is not retained by, employed by, 0r
otherwise subject to the control of the responding party, documents reflecting such
information;
4. If the expert is retained by, employed by, or otherwise subj ect t0 the control
of the responding party:
A. A11 documents, tangible things, reports, models, or data
compilations that have been provided to, reviewed by, 0r prepared by or for the
expert in anticipation 0f the expert’s testimony; and
B. The expert’s current resume 0r bibliography.
Response: Defendant hereby designates and reserves the right t0 call any expert Witness(es)
designated by any other party t0 this case, as well as any experts later designated
by any party t0 this case 0n any subject relevant t0 this litigation on Which the
witness is qualified to testify. In the event that any party to this cause has
designated any experts but has been 0r is subsequently dismissed for any reason 0r
fails t0 call any designated expert at the time 0f trial, Defendant specifically
reserves the right to call any such expert previously designated by that party.
Defendant further reserves the right t0 Withdraw 0r de-designate any expert prior
DEFENDANT’S FIRST SUPPLEMENTAL RESPONSE TO
REQUEST FOR DISCLOSURE AND DESIGNATION OF EXPERTS -1-
to testimony and to positively aver that such previously designated expert will not
be called as a witness at trial and to redesignate same as a consulting expert who
Will not be called by any party in this cause. Finally, Defendant reserves the right
to supplement this response as additional information concerning experts becomes
available.
Defendant further hereby designates as adverse expert witnesses all expert
Witnesses designated by Plaintiff. Defendant reserves the right to rely upon or to
offer, by direct examination 0r cross-examination, testimony obtained from those
experts and rebuttal experts, if any, designated by Plaintiff. By this designation,
Defendant does not necessarily agree with, nor vouch for, the credibility 0f any
such Witnesses 0r their opinions, 0r the reliability, materiality, 0r admissibility 0f
information and/or tangible things produced by these individuals in general; by this
designation Defendant is simply reserving the opportunity t0 rely upon 0r elicit
certain opinions and/or evidence from these Witnesses t0 the extent that itdeems it
in its interest t0 do so.
Such persons are expected t0 testify concerning Plaintiff’ s care and treatment. See
Plaintiff’s Responses t0 Defendant’s Request for Disclosure for additional
information concerning such health—care providers including medical bills and
records relating t0 Plaintiff.
First Supplemental Response:
Defendant hereby designates as an expert witness the following individual:
Edward Le Cara, DC
6805 Hillcrest Ave Ste. 208
Dallas, TX 75205
972.474.3612
Dr. Edward Le Cara is a chiropractor Who has reviewed Courtney Haeflinger’s medical
records and other case materials provided to him, and is expected to testify regarding the
extent of the injuries sustained by the Plaintiff in the subject motor vehicle accident, the
appropriate care and treatment for those injuries, and the fair and reasonable cost of that
treatment, both in the past and in the future, if applicable, as set out in the attached report.
DEFENDANT’S FIRST SUPPLEMENTAL RESPONSE TO
REQUEST FOR DISCLOSURE AND DESIGNATION OF EXPERTS -2-
Respectfully submitted,
ywafi?
Chad Kimble, State Bar N0. 24007483
Kyle Smith, State Bar No. 241025 12
D. Brent Beasley, State Bar N0. 24082669
LAW OFFICE 0F CHAD KIMBLE, P.C.
1204 S. White Chapel Blvd.
Southlake, Texas 76092
eservice@chadkimblelaw.com
817.766.7488
817.423.7492 fax
ATTORNEY FOR DEFENDANT
CERTIFICATE 0F SERVICE
The undersigned certifies that 0n the 3 1“ day of August, 2020, a true copy of the foregoing
has been served on all parties in accordance with Rule 21a, Texas Rules of Civil Procedure.
ymaa?
Brent Beasley
DEFENDANT’S FIRST SUPPLEMENTAL RESPONSE TO
REQUEST FOR DISCLOSURE AND DESIGNATION OF EXPERTS -3-
EDWARD LE CARA, D.C. 12001 N.CENTRAL EXPRESSWAY
DOCTOR 0F CHIROPRACTIC SUITE 800
DALLAS, TX 75243
(214) 750-61 10
FAX -
(214) 750—5825
August 24, 2020
Mr. Chad Kimble
Law Office of Chad Kimble, P.C.
1204 South White Chapel Blvd.
Southlake, TX 76092
RE: Courtney Haeflinger
CLAIM #: 0514808054
DATE OF INJURY: 08/26/18
CASE #: 21191919
Dear Mr. Kimble:
| have had the opportunity to review medical records on Ms. Courtney Haeflinger. Although | have reviewed
all the provided medical records, | willonly comment on those pertinent to my review of chiropractic care. |
have been asked to review the medical records and comment regarding the necessity of treatment at Texas
Healthcare Neck & Back Clinic and the reasonableness of charges or pricing at Texas Healthcare Neck & Back
Clinic.
SUMMARY OF MEDICAL RECORDS:
Texas Peace Officer’s Crash Report dated August 26, 2018 indicated an auto accident occurred at 7:03 p.m.
involving eight vehicles. The patient was on vehicle #2. Unit #2 collided front, distributed to back, distributed
at Unit #3. The claimant was taken to Medical City Dallas Hospital by Dallas Fire & Rescue. CT of the cervical
and x-ray of the hand was performed and was negative for fracture and dislocation.
On August 29, 2018, the patient presented to Texas Healthcare Neck & Back Clinics complaining of right lower
back pain, right and leftneck pain, bruised and painful left fourth finger and hand, bruises on her calves. X-rays
were taken.
CPT code 72050 cervical five views. CPT code 72100 lumbar spine two to three views. CPT code 731 10 wrist
three views.
The patient was not removed from work. She complained of neck pain, low back pain, left wrist and hand
pain.
Medical City Dallas, on August 26, 2018, she presented with left arm pain. She was diagnosed with contusion of
left hand, paresthesia of skin, strain of muscle, fascia, and tendon at neck level. Cervical spine exam at
Medical City Dallas revealed no acute fracture or subluxation. Diminished disc space height C4-5, end-plate
spurring and diffuse disc bulging at this level. CT exam of the lefthand. No acute fracture or dislocation. No
significant soft tissue swelling.
NECESSARY CHIROPRACTIC CARE
A 12-visit or 30-day trial of chiropractic care is reasonable to help claimants overcome pain and improve
function. After 12—visits or 30 days, a re—evaluation should be performed to determine any subjective or
objective improvement. If the claimant isimproving, a second trialof 12 visits or 30 days should be initiated. If
no Change isnoted, a change in treatment plan, referral for medical consultation or imaging should be
Courtney Haeflinger
August 24, 2020
CASE #: 21 191919
Page 2 of 5
investigated. The treatment should be active in nature and wean off of passive modalities as soon as possible
(within 2 weeks). Active care (therapeutic exercise) should be initiated as soon as possible.
In this case, the following chiropractic treatment was reasonable and necessary:
Evaluations:
CPT code 99203 — (1 x $195 = $195)
CPT code 99213 every 30 days or 12 visits — (1 x $85 = $85). Every 30 days or 12 visits (whichever comes a
first) re-
evaluation should be performed to document subjective and objective improvement.
Treatment:
CPT code 98940, Manipulative Therapy (7 units x $55 = $385)
CPT code 98941, Manipulative Therapy (1 unit x $65 = $65)
CPT code 97032, Electric Stimulation from 8/29/2018 — 9/13/2018 (2 weeks) for (6 units x $25 = $150)
CPT code 97150, Group Therapeutic Exercise (1 units x $40 = $40)
Total Reasonable and Necessary Chiropractic Care: $920
USUAL AN_D CUSTOMARY FEE_S:
The following treatment modalities were used inthe chiropractic clinic:
Procedure Unit Price UCR fee
CPT code 99203, NP Examination $350 $195
CPT code 97014, E-Stim (unattended) $55 $25
CPT code 72050, X-ray, Cervical Spine $311 $85
CPT code 72100, X-ray Lumbar Spine $220 $75
CPT code 731 10, X-ray, Wrist $189 $80
CPT code 97010, Hot/cold pack $45 $0
CPT code 98940, 1-2 Region Manipulation $95 $55
CPT code 98943, Extra-Spinal Manipulation $70 $45
CPT code 99213, Re—examination $185 $85
CPT code 97150, Group Exercise $95 $40
CPT code 98941, 3-4 Region Manipulation $105 $65
My recommendations on the usual and customary fees for chiropractic services and physical therapy
modalities are derived from a UCR fee schedule compiled by the National Association of Professional Coders
(NAPC).
Expenses beyond the recommended treatment are not reasonable because the treatment was not medically
necessary based on the available medical records.
NOT NECESSARY CHIROPRACTIC CARE:
The following modalities and procedures were not medically necessary, or the medical records provided did
not substantiate the use of the following codes:
X-rays including CPT’s 72100, 73110, 72050 were not medically necessary to commence a trial of chiropractic
care. Any required imaging to rule out fracture or dislocation was performed at the Emergency Department.
Courtney Haeflinger
August 24, 2020
CASE #: 21 191919
Page 3 of 5
Passive modalities used in this case were CPT 97010 (heat/ice) and CPT 97014 (Electrical Muscle Stimulation). It is
reasonable for the firsttwo weeks of care to use passive modalities to help reduce pain and inflammation.
There is insufficient documentation to support to use of EMS or mechanical traction, for acute cervical,
thoracic, lumbar, shoulder, or knee pain. As an industry standard, the use of passive modalities is not
recommended beyond the second week of treatment as it presents the inherent risk of negatively impacting a
claimant’s ability to cope with condition by promoting passive dependence. Instead, claimants should be
weaned off passive therapies and transitioned into active care, CPT 971 1O or CPT 97150, as the use of active
care isassociated with a much better clinical outcome. Therefore, allpassive modalities after two weeks are
not recommended.
The medical documentation did not support the use of CPT code 98943 (extra-spinal manipulation). The
medical records fail to indicate how manipulation would benefit a sprain/strain or contusion to the wrist. More
mobilization to a sprain/strain would increase instability. Exercises to strengthen would be medically necessary
to stabilize the sprain/strain.
RATIONALE FOR OPINION:
|have been a practicing chiropractor for over 19 years. |currently own and operate an integrated physical
medicine/rehabilitation practice in which we provide chiropractic treatment, medical management, and
active rehabilitation to victims of auto accidents, claimants suffering from sports injuries, and claimant’s
requiring post-surgical rehabilitation of the spine, shoulder, hip, knee, and ankle. During that time, |have
become familiar with billingand documentation requirements for chiropractic and physical therapy modalities,
such as were used in this case. |have been performing overutilization review consulting for over 8 years. My
recommendations on the usual and customary fees for chiropractic services and physical therapy modalities is
derived from a UCR fee schedule compiled by the National Association of Professional Coders (NAPC) and my
own research.
A review 0f the provided medical and non-medical records, 19 years of clinical experience treating similar
injuries and the following scientific studies have influenced my clinical decision making in this case:
1. Baker GAF, Ronald J. Augat, Thomas J. Hawk, Cheryl. Algorithms for the Chiropractic
Management 0f Acute and Chronic Spine-Related Pain. Topics in Integrative Health Care. 2012;3(4).
2. Bussieres AE, Laurencelle L,Peterson C. Diagnostic Imaging Guidelines Implementation Study for
Spinal Disorders: A Randomized Trial with Postal Follow-ups. J Chiropr Educ. 2010;24(1):2—18.
3. Bussieres AE, Peterson C, Taylor JA. Diagnostic imaging practice guidelines for musculoskeletal
complaints in adults--an evidence-based approach: introduction. J Manipulative Physiol Ther.
2007;30(9):617-683.
4. Bussieres AE, Peterson C, Taylor JA. Diagnostic imaging guideline for musculoskeletal complaints
in adults-an evidence-based approach-part 2: upper extremity disorders. J Manipulative Physiol Ther.
2008;31(1):2—32.
5. Bussieres AE, Taylor JA, Peterson C. Diagnostic imaging practice guidelines for musculoskeletal
complaints in adults--an evidence-based approach-part 1. Lower extremity disorders. J Manipulative
Physiol Ther. 2007;30(9):684-717.
6. Bussieres AE, Taylor JA, Peterson C. Diagnostic imaging practice guidelines for musculoskeletal
complaints in adults--an evidence-based approach-part 3: spinal disorders. J Manipulative Physiol Ther.
2008;31(1):33-88.
7. Rumball K, Jarvis J. Seat-belt injuries of the spine in young children. J Bone Joint Surg Br.
1992;74(4):571-574.
8. Taylor JA, Bussieres A. Diagnostic imaging for spinal disorders in the elderly: a narrative review.
Chiropr Man Therap. 2012;20(1 ):16.
Courtney Haeflinger
August 24, 2020
CASE #: 21 191919
Page 4 of 5
In addition to clinical experience, | have an earned PhD in Athletic Training and teach a Master’s level soft
tissue rehabilitation course. |am board certified in both rehabilitation and sports medicine. |teach continuing
education to physical therapists, chiropractors and strength and conditioning specialists internationally at least
1/month.
|served as a front-Iine medic in the United States Army where |spent most of my time stationed in an
Emergency Department at University of California at Davis Medical Center treating acute injuries. |have been
a sideline athletic trainer managing and treating traumatic injuries since 2004.
|have been published in a peer reviewed scientificjournal for my work on lumbar spine rehabilitation as the
primary researcher. |have been published as a secondary author in numerous peer reviewed scientificjournals
in the topic of rehabilitation and clinical assessment, ultrasound imaging and MRI of the spine. In 2019, |wrote
two chapters for the National Academy of Sports Medicine’s corrective exercise specialist certification program
including thoracic spine and shoulder and elbow and wrist management.
** NO FURTHER OPINIONS **
Thank you for the opportunity to review the medical records on Ms. Courtney Haeflinger.
Dictated, reviewed, opinion verified, and attested to by my original signature.
Sincerely,
QHDCKQW
Edward Le Cara, D.C.
Doctor of Chiropractic
26890
ELC/ck:ANS/str
The opinions rendered in this case are the opinions of the evaluator. This review has been conducted on the
basis of the medical records provided, with the assumption that the material is true and correct. If more
information becomes available at a later date, an additional service/report/reconsideration may be
requested.
Courtney Haeflinger
August 24, 2020
CASE #: 21191919
Page 5 of 5
SUMMARY OF RECORDS
• Texas Peace Officer’s Crash Report: Dallas Police Dept.: 08/26/18
• Texas Healthcare Neck & Back Clinics: Alison Jones, D.C./Caroline Graham, D.C., 08/29/18, 08/30/18,
08/31/18, 09/04/18, 09/06/18, 09/10/18, 09/12/18, 09/14/18, 09/18/18, 09/19/18, 11/08/18
• Medical City Dallas ED: Kristy Stucka, M.D./Ashkahn Golshani, M.D., 08/26/18
• Billing Review, Dallas Fire-Rescue: 08/26/18
• Plaintiff’s Objections & Answers to Defendant’s First Set of Interrogatories: 07/06/20
• Plaintiff’s Response to Defendant’s Requests for Disclosure: 07/06/20
• Affidavit Concerning Costs & Necessity of Services, Custodian of (billing) Records, Texas Healthcare
Neck & Back Clinics, PA: 01/03/19
• Business records Accompanied by Affidavit – Filing: Medical Records, Texas Healthcare Neck & Back
Clinics: 01/03/19
• Affidavit Concerning Cost & Necessity of Services: 11/07/18
• Affidavit Concerning Cost & Necessity of Services: Questcare Medical Services, PLLC: 12/06/18
• Affidavit of Records Custodian, Medical City Dallas: 11/08/18,
• Affidavit of (billing) Records Custodian, Medical City Dallas: 11/21/18
• Affidavit of Medical Records, City of Dallas EMS: 05/08/19
• Affidavit of Medical Expenses, City of Dallas EMS: 05/08/19
• Black & White Photos: 4 pages
• Itemized Statement: Texas Healthcare Neck & Back Clinics, PA, Statement Date: 01/03/19, Date of
Service: 08/29/18
• Itemized Statement: Radiology Associates of North Texas, Statement Date: 11/05/18, Date of Service:
08/26/18
• Itemized Statement: GuestCare Medical Services, FLLC, Statement Date: 11/24/18, Date of Service:
08/26/18
• Itemized Statement: Medical City Dallas, Statement Date: 08/30/18, Date of Service: 08/26/18
• Itemized Statement: City of Dallas: Statement Date, 05/03/19, Date of Service: 08/26/18
EDWARD LE CARA
Maximizing Human Potential
TX
Dallas,
EXPERIENCE EDUCATION
Owner/Clinician M.B.A. - Transglobal
Body Lounge Park Cities Educafion
fi 2018-
Ongoing 9 TX
Dallas,
St. Mary's College of CA
Commenced a multi-disciplinary, boutique wellness clinic E 2013—
2015 9 Moraga, CA
~ Secured lease and funding o Capstone Project included work with an
- 2 months
Profitability within underprivileged University in Mumbai,
~ Lead Medical Provider India and developing curriculum
Ph.D. — Athletic Training
Director of Education
Smart Tools Plus Rocky Mountain University of Health
E 2016- Ongoing 9 OH
Cleveland, Professions
Manufactures manual therapy tools for health and fitness professionals E 2007—
2012
- Increased Courses taught from 4 in2015 to 160 in2018 Internationally
o Published research on the morphology
and function of lumbar multifidus in
o Developed live and online programming & content (IASATM & Blood
symptomatic veterans.
Flow Restriction Training)
o Clinicaland pedagogy emphasis.
~ Managed a team of over 30 instructors Internationally
~ New Product Development Advisement
D.C. - Doctor of Chiropractic
Professor Palmer College of Chiropractic West
Rocky Mountain University of Health Professions
fi 1995-
1999
E 2014-
Ongoing 9 UT
Provo,
Accredited University that offers healthcare degrees -
B.S. Exercise Science
- Developed online curriculum course
for soft tissue rehabilitation
University of California at Davis
E 1991—
1995
Director of Trans Global Education o Captain of the Division|Wrestling Team
o Interned as a Strength& Conditioning
RockTape women's
Coach for basketball
E 2014—
2016 9 LosGates,CA - Involved innumerous studies inExercise
Health & Fitness Education & Manufacturing Science lab
- Increased courses taught 500%
live in 3 years
- Managed over 70 instructors internationally
o Co-developed multiple educational courses (FMT PMT, Special
I&II, ARMY Combat Medic
Populations)
Training
Ft. Sam Houston, TX
VP Sports Science & Human Performance E 1993
o Developed Emergency Action Plans
24 Hour Fitness
- Learned techniques and paramedic skills
E 2011-2013 9 San Ramon, CA
BLS, Fracture
like IV's, Injections,
A leading health club organization
in North America Management, Head InjuryManagement
- Established a wellness clinic
incorporate headquarters that saved
over $150,000 inhealthcare costs within 9 months
- Provided education and leadership for over 400 personal trainers
oWrote health and 1M members
fitness content for over AWARDS
fi 2011 Clinician of the Year
MY TIME AWARDS
0 Patient Care
T 2011 Robert Botterman Award
a Educational Development
g 2008 Sports Hall of Fame Induction
a Literature Reading
a Business Management
* 1995 Army Service Award
0/
é PUBLICATIONS
Predictors of clinical success
CERTIFICATION with stabilization exercise are
associated with lower levels
Board Certified in Sports Medicine of lumbar multifidus
American Chiropractic Board of Sports Medicine, 2002 intramuscular adipose tissue
in patients with low back pain.
Board Certified in Rehabilitation Disability and Rehabilitation
American Chiropractic Rehabilitation Board, 2012 Hebert JJ, Le Cara EC, Marcus RL, Dempsey AR,
Hoffman MD
fi 05/2018
Certified Athletic Trainer
Board of 2004
Certification,
Epidemiology of injuries in
Certified Strength & Conditioning Specialist men's lacrosse: injury
National Strength & ConditioningAssociation, 1995 prevention implications for
competition level, type of play,
Licensed Athletic Trainer and player position
Texas Athletic Trainer's Association, 2014 The Physician & Sports Medicine
Barber Foss KD, Le Cara E, McCambridge T,
Hinton R, Kushner A, Myer GD
Functional Dry Needling
Ma Dry Needling, 2014
E 09/2017
Medical Acupuncture Epidemiology of Injuries in
InternationalAcademy of Medical Acupuncture, 2016 Women's Lacrosse:
Implications for Sport-.
First Aid & CPR Instructor Leve|—, and Sex—Specific
-
American Heart Association, 1993 Present
Injury Prevention Strategies.
Clinical Journal of Sports Medicine
Selective Functional Movement Screen, SFMA Barber Foss FD, Le Cara E, McCambridge T,
Functional Movements, 2011 Hinton RY, Kushner A, Myer GD
fi 07/2017
Corrective Exercise Specialist, CES
National Academy of Sports Medicine, 2004
Instrument Assisted Soft Tissue Manipulation
Smart Tools Plus,2014
CERTIFICATION PUBLICATIONS
Functional Movement Screen Morphology versus function:
Functional Movement Systems, 2007
the relationship
between lumbar multifidus
Intravenous Administration
intramuscular adipose tissue
IV Academy, 2018
and muscle function among
Blood Flow Restriction Training
patients with low back
Smart Tools Plus,2018 pain.
Archives of Physical Medicine
Rehabilitation
Fascial Movement Techniques |& |l
Le Cara EC, Marcus RL, Dempsey AR, Hoffman
RockTape, 2012 MD, Hebert JJ
fi 10/2014
Advanced Selective Functional Movement Assessment
Functional Movement Systems, 2012
Effect of kinesiology taping on
pain in individuals with
Advanced Functional Movement Screen
musculoskeletal
Functional Movement Systems, 2008
injuries: systematic review
and meta-analysis.
Certified Concussion Manager
Physician & Sports Medicine
Impact, 2011
Montalvo AM, Le Cara EC, Myer GD
$ 05/2014
CrossFit Level 1 (CFT-L1)
CrossFit,2018
ACHIEVEMENTS
INDUSTRY EXPERTISE
@ Military Experience
Serving this great country with amazing
Manual Therapy Exercise Prescription men and women
Publishing a Journal Article
Content Development Business Development 7 Contribution to the scientific and clinical
community was a lifelong goal
9 Earning a PhD
Years of dedication and commitment
while running a busy
still clinic
fi Helping People Move and Feel Well
Teaching the philosophy that diet and
exercise are the greatest source of
optimal health and healing
Automated Certificate of eService
This automated certificate of service was created by the efiling system.
The filer served this document via email generated by the efiling system
on the date and to the persons listed below. The rules governing
certificates of service have not changed. Filers must still provide a
certificate of service that complies with all applicable rules.
Chad Kimble
Bar No. 24007483
eservice@chadkimblelaw.com
Envelope ID: 45835869
Status as of 9/1/2020 8:35 AM CST
Case Contacts
Name BarNumber Email TimestampSubmitted Status
|SCOTTLIDJI scott@thelidjifirm.com 8/31/2020 1:38:24 PM SENT
Brent Beasley eservice@chadkimblelaw.com 8/31/2020 1:38:24 PM SENT
Preview
FILED 8/31/2020 1:38PM FELICIA PITRE DISTRICT CLERK DALLAS CO.,TEXAS Cassandra Walker DEPUTY N0. DC-20-01594 COURTNEY L. HAEFLINGER § IN THE DISTRICT COURT PLAINTIFF, § § § VS. § DALLAS COUNTY, TEXAS § WARDAH IMTIAZ § DEFENDANT. § 162M) JUDICIAL DISTRICT DEFENDANT’S FIRST SUPPLEMENTAL RESPONSE T0 PLAINTIFF’S REQUEST FOR DISCLOSURE AND DESIGNATION 0F EXPERTS Pursuant t0 Tex R. CiV. P. 194, Defendant serves the following First Supplemental Response to Plaintiff” s Request for Disclosure and Designation of Experts. f. For any testifying expert: 1. The expert’s name, address, and telephone number; 2. The subj ect matter 0n which the expert will testify; 3. The general substance 0f the expert’s mental impressions and opinions and a brief summary 0f the basis for them, or if the expert is not retained by, employed by, 0r otherwise subject to the control of the responding party, documents reflecting such information; 4. If the expert is retained by, employed by, or otherwise subj ect t0 the control of the responding party: A. A11 documents, tangible things, reports, models, or data compilations that have been provided to, reviewed by, 0r prepared by or for the expert in anticipation 0f the expert’s testimony; and B. The expert’s current resume 0r bibliography. Response: Defendant hereby designates and reserves the right t0 call any expert Witness(es) designated by any other party t0 this case, as well as any experts later designated by any party t0 this case 0n any subject relevant t0 this litigation on Which the witness is qualified to testify. In the event that any party to this cause has designated any experts but has been 0r is subsequently dismissed for any reason 0r fails t0 call any designated expert at the time 0f trial, Defendant specifically reserves the right to call any such expert previously designated by that party. Defendant further reserves the right t0 Withdraw 0r de-designate any expert prior DEFENDANT’S FIRST SUPPLEMENTAL RESPONSE TO REQUEST FOR DISCLOSURE AND DESIGNATION OF EXPERTS -1- to testimony and to positively aver that such previously designated expert will not be called as a witness at trial and to redesignate same as a consulting expert who Will not be called by any party in this cause. Finally, Defendant reserves the right to supplement this response as additional information concerning experts becomes available. Defendant further hereby designates as adverse expert witnesses all expert Witnesses designated by Plaintiff. Defendant reserves the right to rely upon or to offer, by direct examination 0r cross-examination, testimony obtained from those experts and rebuttal experts, if any, designated by Plaintiff. By this designation, Defendant does not necessarily agree with, nor vouch for, the credibility 0f any such Witnesses 0r their opinions, 0r the reliability, materiality, 0r admissibility 0f information and/or tangible things produced by these individuals in general; by this designation Defendant is simply reserving the opportunity t0 rely upon 0r elicit certain opinions and/or evidence from these Witnesses t0 the extent that itdeems it in its interest t0 do so. Such persons are expected t0 testify concerning Plaintiff’ s care and treatment. See Plaintiff’s Responses t0 Defendant’s Request for Disclosure for additional information concerning such health—care providers including medical bills and records relating t0 Plaintiff. First Supplemental Response: Defendant hereby designates as an expert witness the following individual: Edward Le Cara, DC 6805 Hillcrest Ave Ste. 208 Dallas, TX 75205 972.474.3612 Dr. Edward Le Cara is a chiropractor Who has reviewed Courtney Haeflinger’s medical records and other case materials provided to him, and is expected to testify regarding the extent of the injuries sustained by the Plaintiff in the subject motor vehicle accident, the appropriate care and treatment for those injuries, and the fair and reasonable cost of that treatment, both in the past and in the future, if applicable, as set out in the attached report. DEFENDANT’S FIRST SUPPLEMENTAL RESPONSE TO REQUEST FOR DISCLOSURE AND DESIGNATION OF EXPERTS -2- Respectfully submitted, ywafi? Chad Kimble, State Bar N0. 24007483 Kyle Smith, State Bar No. 241025 12 D. Brent Beasley, State Bar N0. 24082669 LAW OFFICE 0F CHAD KIMBLE, P.C. 1204 S. White Chapel Blvd. Southlake, Texas 76092 eservice@chadkimblelaw.com 817.766.7488 817.423.7492 fax ATTORNEY FOR DEFENDANT CERTIFICATE 0F SERVICE The undersigned certifies that 0n the 3 1“ day of August, 2020, a true copy of the foregoing has been served on all parties in accordance with Rule 21a, Texas Rules of Civil Procedure. ymaa? Brent Beasley DEFENDANT’S FIRST SUPPLEMENTAL RESPONSE TO REQUEST FOR DISCLOSURE AND DESIGNATION OF EXPERTS -3- EDWARD LE CARA, D.C. 12001 N.CENTRAL EXPRESSWAY DOCTOR 0F CHIROPRACTIC SUITE 800 DALLAS, TX 75243 (214) 750-61 10 FAX - (214) 750—5825 August 24, 2020 Mr. Chad Kimble Law Office of Chad Kimble, P.C. 1204 South White Chapel Blvd. Southlake, TX 76092 RE: Courtney Haeflinger CLAIM #: 0514808054 DATE OF INJURY: 08/26/18 CASE #: 21191919 Dear Mr. Kimble: | have had the opportunity to review medical records on Ms. Courtney Haeflinger. Although | have reviewed all the provided medical records, | willonly comment on those pertinent to my review of chiropractic care. | have been asked to review the medical records and comment regarding the necessity of treatment at Texas Healthcare Neck & Back Clinic and the reasonableness of charges or pricing at Texas Healthcare Neck & Back Clinic. SUMMARY OF MEDICAL RECORDS: Texas Peace Officer’s Crash Report dated August 26, 2018 indicated an auto accident occurred at 7:03 p.m. involving eight vehicles. The patient was on vehicle #2. Unit #2 collided front, distributed to back, distributed at Unit #3. The claimant was taken to Medical City Dallas Hospital by Dallas Fire & Rescue. CT of the cervical and x-ray of the hand was performed and was negative for fracture and dislocation. On August 29, 2018, the patient presented to Texas Healthcare Neck & Back Clinics complaining of right lower back pain, right and leftneck pain, bruised and painful left fourth finger and hand, bruises on her calves. X-rays were taken. CPT code 72050 cervical five views. CPT code 72100 lumbar spine two to three views. CPT code 731 10 wrist three views. The patient was not removed from work. She complained of neck pain, low back pain, left wrist and hand pain. Medical City Dallas, on August 26, 2018, she presented with left arm pain. She was diagnosed with contusion of left hand, paresthesia of skin, strain of muscle, fascia, and tendon at neck level. Cervical spine exam at Medical City Dallas revealed no acute fracture or subluxation. Diminished disc space height C4-5, end-plate spurring and diffuse disc bulging at this level. CT exam of the lefthand. No acute fracture or dislocation. No significant soft tissue swelling. NECESSARY CHIROPRACTIC CARE A 12-visit or 30-day trial of chiropractic care is reasonable to help claimants overcome pain and improve function. After 12—visits or 30 days, a re—evaluation should be performed to determine any subjective or objective improvement. If the claimant isimproving, a second trialof 12 visits or 30 days should be initiated. If no Change isnoted, a change in treatment plan, referral for medical consultation or imaging should be Courtney Haeflinger August 24, 2020 CASE #: 21 191919 Page 2 of 5 investigated. The treatment should be active in nature and wean off of passive modalities as soon as possible (within 2 weeks). Active care (therapeutic exercise) should be initiated as soon as possible. In this case, the following chiropractic treatment was reasonable and necessary: Evaluations: CPT code 99203 — (1 x $195 = $195) CPT code 99213 every 30 days or 12 visits — (1 x $85 = $85). Every 30 days or 12 visits (whichever comes a first) re- evaluation should be performed to document subjective and objective improvement. Treatment: CPT code 98940, Manipulative Therapy (7 units x $55 = $385) CPT code 98941, Manipulative Therapy (1 unit x $65 = $65) CPT code 97032, Electric Stimulation from 8/29/2018 — 9/13/2018 (2 weeks) for (6 units x $25 = $150) CPT code 97150, Group Therapeutic Exercise (1 units x $40 = $40) Total Reasonable and Necessary Chiropractic Care: $920 USUAL AN_D CUSTOMARY FEE_S: The following treatment modalities were used inthe chiropractic clinic: Procedure Unit Price UCR fee CPT code 99203, NP Examination $350 $195 CPT code 97014, E-Stim (unattended) $55 $25 CPT code 72050, X-ray, Cervical Spine $311 $85 CPT code 72100, X-ray Lumbar Spine $220 $75 CPT code 731 10, X-ray, Wrist $189 $80 CPT code 97010, Hot/cold pack $45 $0 CPT code 98940, 1-2 Region Manipulation $95 $55 CPT code 98943, Extra-Spinal Manipulation $70 $45 CPT code 99213, Re—examination $185 $85 CPT code 97150, Group Exercise $95 $40 CPT code 98941, 3-4 Region Manipulation $105 $65 My recommendations on the usual and customary fees for chiropractic services and physical therapy modalities are derived from a UCR fee schedule compiled by the National Association of Professional Coders (NAPC). Expenses beyond the recommended treatment are not reasonable because the treatment was not medically necessary based on the available medical records. NOT NECESSARY CHIROPRACTIC CARE: The following modalities and procedures were not medically necessary, or the medical records provided did not substantiate the use of the following codes: X-rays including CPT’s 72100, 73110, 72050 were not medically necessary to commence a trial of chiropractic care. Any required imaging to rule out fracture or dislocation was performed at the Emergency Department. Courtney Haeflinger August 24, 2020 CASE #: 21 191919 Page 3 of 5 Passive modalities used in this case were CPT 97010 (heat/ice) and CPT 97014 (Electrical Muscle Stimulation). It is reasonable for the firsttwo weeks of care to use passive modalities to help reduce pain and inflammation. There is insufficient documentation to support to use of EMS or mechanical traction, for acute cervical, thoracic, lumbar, shoulder, or knee pain. As an industry standard, the use of passive modalities is not recommended beyond the second week of treatment as it presents the inherent risk of negatively impacting a claimant’s ability to cope with condition by promoting passive dependence. Instead, claimants should be weaned off passive therapies and transitioned into active care, CPT 971 1O or CPT 97150, as the use of active care isassociated with a much better clinical outcome. Therefore, allpassive modalities after two weeks are not recommended. The medical documentation did not support the use of CPT code 98943 (extra-spinal manipulation). The medical records fail to indicate how manipulation would benefit a sprain/strain or contusion to the wrist. More mobilization to a sprain/strain would increase instability. Exercises to strengthen would be medically necessary to stabilize the sprain/strain. RATIONALE FOR OPINION: |have been a practicing chiropractor for over 19 years. |currently own and operate an integrated physical medicine/rehabilitation practice in which we provide chiropractic treatment, medical management, and active rehabilitation to victims of auto accidents, claimants suffering from sports injuries, and claimant’s requiring post-surgical rehabilitation of the spine, shoulder, hip, knee, and ankle. During that time, |have become familiar with billingand documentation requirements for chiropractic and physical therapy modalities, such as were used in this case. |have been performing overutilization review consulting for over 8 years. My recommendations on the usual and customary fees for chiropractic services and physical therapy modalities is derived from a UCR fee schedule compiled by the National Association of Professional Coders (NAPC) and my own research. A review 0f the provided medical and non-medical records, 19 years of clinical experience treating similar injuries and the following scientific studies have influenced my clinical decision making in this case: 1. Baker GAF, Ronald J. Augat, Thomas J. Hawk, Cheryl. Algorithms for the Chiropractic Management 0f Acute and Chronic Spine-Related Pain. Topics in Integrative Health Care. 2012;3(4). 2. Bussieres AE, Laurencelle L,Peterson C. Diagnostic Imaging Guidelines Implementation Study for Spinal Disorders: A Randomized Trial with Postal Follow-ups. J Chiropr Educ. 2010;24(1):2—18. 3. Bussieres AE, Peterson C, Taylor JA. Diagnostic imaging practice guidelines for musculoskeletal complaints in adults--an evidence-based approach: introduction. J Manipulative Physiol Ther. 2007;30(9):617-683. 4. Bussieres AE, Peterson C, Taylor JA. Diagnostic imaging guideline for musculoskeletal complaints in adults-an evidence-based approach-part 2: upper extremity disorders. J Manipulative Physiol Ther. 2008;31(1):2—32. 5. Bussieres AE, Taylor JA, Peterson C. Diagnostic imaging practice guidelines for musculoskeletal complaints in adults--an evidence-based approach-part 1. Lower extremity disorders. J Manipulative Physiol Ther. 2007;30(9):684-717. 6. Bussieres AE, Taylor JA, Peterson C. Diagnostic imaging practice guidelines for musculoskeletal complaints in adults--an evidence-based approach-part 3: spinal disorders. J Manipulative Physiol Ther. 2008;31(1):33-88. 7. Rumball K, Jarvis J. Seat-belt injuries of the spine in young children. J Bone Joint Surg Br. 1992;74(4):571-574. 8. Taylor JA, Bussieres A. Diagnostic imaging for spinal disorders in the elderly: a narrative review. Chiropr Man Therap. 2012;20(1 ):16. Courtney Haeflinger August 24, 2020 CASE #: 21 191919 Page 4 of 5 In addition to clinical experience, | have an earned PhD in Athletic Training and teach a Master’s level soft tissue rehabilitation course. |am board certified in both rehabilitation and sports medicine. |teach continuing education to physical therapists, chiropractors and strength and conditioning specialists internationally at least 1/month. |served as a front-Iine medic in the United States Army where |spent most of my time stationed in an Emergency Department at University of California at Davis Medical Center treating acute injuries. |have been a sideline athletic trainer managing and treating traumatic injuries since 2004. |have been published in a peer reviewed scientificjournal for my work on lumbar spine rehabilitation as the primary researcher. |have been published as a secondary author in numerous peer reviewed scientificjournals in the topic of rehabilitation and clinical assessment, ultrasound imaging and MRI of the spine. In 2019, |wrote two chapters for the National Academy of Sports Medicine’s corrective exercise specialist certification program including thoracic spine and shoulder and elbow and wrist management. ** NO FURTHER OPINIONS ** Thank you for the opportunity to review the medical records on Ms. Courtney Haeflinger. Dictated, reviewed, opinion verified, and attested to by my original signature. Sincerely, QHDCKQW Edward Le Cara, D.C. Doctor of Chiropractic 26890 ELC/ck:ANS/str The opinions rendered in this case are the opinions of the evaluator. This review has been conducted on the basis of the medical records provided, with the assumption that the material is true and correct. If more information becomes available at a later date, an additional service/report/reconsideration may be requested. Courtney Haeflinger August 24, 2020 CASE #: 21191919 Page 5 of 5 SUMMARY OF RECORDS • Texas Peace Officer’s Crash Report: Dallas Police Dept.: 08/26/18 • Texas Healthcare Neck & Back Clinics: Alison Jones, D.C./Caroline Graham, D.C., 08/29/18, 08/30/18, 08/31/18, 09/04/18, 09/06/18, 09/10/18, 09/12/18, 09/14/18, 09/18/18, 09/19/18, 11/08/18 • Medical City Dallas ED: Kristy Stucka, M.D./Ashkahn Golshani, M.D., 08/26/18 • Billing Review, Dallas Fire-Rescue: 08/26/18 • Plaintiff’s Objections & Answers to Defendant’s First Set of Interrogatories: 07/06/20 • Plaintiff’s Response to Defendant’s Requests for Disclosure: 07/06/20 • Affidavit Concerning Costs & Necessity of Services, Custodian of (billing) Records, Texas Healthcare Neck & Back Clinics, PA: 01/03/19 • Business records Accompanied by Affidavit – Filing: Medical Records, Texas Healthcare Neck & Back Clinics: 01/03/19 • Affidavit Concerning Cost & Necessity of Services: 11/07/18 • Affidavit Concerning Cost & Necessity of Services: Questcare Medical Services, PLLC: 12/06/18 • Affidavit of Records Custodian, Medical City Dallas: 11/08/18, • Affidavit of (billing) Records Custodian, Medical City Dallas: 11/21/18 • Affidavit of Medical Records, City of Dallas EMS: 05/08/19 • Affidavit of Medical Expenses, City of Dallas EMS: 05/08/19 • Black & White Photos: 4 pages • Itemized Statement: Texas Healthcare Neck & Back Clinics, PA, Statement Date: 01/03/19, Date of Service: 08/29/18 • Itemized Statement: Radiology Associates of North Texas, Statement Date: 11/05/18, Date of Service: 08/26/18 • Itemized Statement: GuestCare Medical Services, FLLC, Statement Date: 11/24/18, Date of Service: 08/26/18 • Itemized Statement: Medical City Dallas, Statement Date: 08/30/18, Date of Service: 08/26/18 • Itemized Statement: City of Dallas: Statement Date, 05/03/19, Date of Service: 08/26/18 EDWARD LE CARA Maximizing Human Potential TX Dallas, EXPERIENCE EDUCATION Owner/Clinician M.B.A. - Transglobal Body Lounge Park Cities Educafion fi 2018- Ongoing 9 TX Dallas, St. Mary's College of CA Commenced a multi-disciplinary, boutique wellness clinic E 2013— 2015 9 Moraga, CA ~ Secured lease and funding o Capstone Project included work with an - 2 months Profitability within underprivileged University in Mumbai, ~ Lead Medical Provider India and developing curriculum Ph.D. — Athletic Training Director of Education Smart Tools Plus Rocky Mountain University of Health E 2016- Ongoing 9 OH Cleveland, Professions Manufactures manual therapy tools for health and fitness professionals E 2007— 2012 - Increased Courses taught from 4 in2015 to 160 in2018 Internationally o Published research on the morphology and function of lumbar multifidus in o Developed live and online programming & content (IASATM & Blood symptomatic veterans. Flow Restriction Training) o Clinicaland pedagogy emphasis. ~ Managed a team of over 30 instructors Internationally ~ New Product Development Advisement D.C. - Doctor of Chiropractic Professor Palmer College of Chiropractic West Rocky Mountain University of Health Professions fi 1995- 1999 E 2014- Ongoing 9 UT Provo, Accredited University that offers healthcare degrees - B.S. Exercise Science - Developed online curriculum course for soft tissue rehabilitation University of California at Davis E 1991— 1995 Director of Trans Global Education o Captain of the Division|Wrestling Team o Interned as a Strength& Conditioning RockTape women's Coach for basketball E 2014— 2016 9 LosGates,CA - Involved innumerous studies inExercise Health & Fitness Education & Manufacturing Science lab - Increased courses taught 500% live in 3 years - Managed over 70 instructors internationally o Co-developed multiple educational courses (FMT PMT, Special I&II, ARMY Combat Medic Populations) Training Ft. Sam Houston, TX VP Sports Science & Human Performance E 1993 o Developed Emergency Action Plans 24 Hour Fitness - Learned techniques and paramedic skills E 2011-2013 9 San Ramon, CA BLS, Fracture like IV's, Injections, A leading health club organization in North America Management, Head InjuryManagement - Established a wellness clinic incorporate headquarters that saved over $150,000 inhealthcare costs within 9 months - Provided education and leadership for over 400 personal trainers oWrote health and 1M members fitness content for over AWARDS fi 2011 Clinician of the Year MY TIME AWARDS 0 Patient Care T 2011 Robert Botterman Award a Educational Development g 2008 Sports Hall of Fame Induction a Literature Reading a Business Management * 1995 Army Service Award 0/ é PUBLICATIONS Predictors of clinical success CERTIFICATION with stabilization exercise are associated with lower levels Board Certified in Sports Medicine of lumbar multifidus American Chiropractic Board of Sports Medicine, 2002 intramuscular adipose tissue in patients with low back pain. Board Certified in Rehabilitation Disability and Rehabilitation American Chiropractic Rehabilitation Board, 2012 Hebert JJ, Le Cara EC, Marcus RL, Dempsey AR, Hoffman MD fi 05/2018 Certified Athletic Trainer Board of 2004 Certification, Epidemiology of injuries in Certified Strength & Conditioning Specialist men's lacrosse: injury National Strength & ConditioningAssociation, 1995 prevention implications for competition level, type of play, Licensed Athletic Trainer and player position Texas Athletic Trainer's Association, 2014 The Physician & Sports Medicine Barber Foss KD, Le Cara E, McCambridge T, Hinton R, Kushner A, Myer GD Functional Dry Needling Ma Dry Needling, 2014 E 09/2017 Medical Acupuncture Epidemiology of Injuries in InternationalAcademy of Medical Acupuncture, 2016 Women's Lacrosse: Implications for Sport-. First Aid & CPR Instructor Leve|—, and Sex—Specific - American Heart Association, 1993 Present Injury Prevention Strategies. Clinical Journal of Sports Medicine Selective Functional Movement Screen, SFMA Barber Foss FD, Le Cara E, McCambridge T, Functional Movements, 2011 Hinton RY, Kushner A, Myer GD fi 07/2017 Corrective Exercise Specialist, CES National Academy of Sports Medicine, 2004 Instrument Assisted Soft Tissue Manipulation Smart Tools Plus,2014 CERTIFICATION PUBLICATIONS Functional Movement Screen Morphology versus function: Functional Movement Systems, 2007 the relationship between lumbar multifidus Intravenous Administration intramuscular adipose tissue IV Academy, 2018 and muscle function among Blood Flow Restriction Training patients with low back Smart Tools Plus,2018 pain. Archives of Physical Medicine Rehabilitation Fascial Movement Techniques |& |l Le Cara EC, Marcus RL, Dempsey AR, Hoffman RockTape, 2012 MD, Hebert JJ fi 10/2014 Advanced Selective Functional Movement Assessment Functional Movement Systems, 2012 Effect of kinesiology taping on pain in individuals with Advanced Functional Movement Screen musculoskeletal Functional Movement Systems, 2008 injuries: systematic review and meta-analysis. Certified Concussion Manager Physician & Sports Medicine Impact, 2011 Montalvo AM, Le Cara EC, Myer GD $ 05/2014 CrossFit Level 1 (CFT-L1) CrossFit,2018 ACHIEVEMENTS INDUSTRY EXPERTISE @ Military Experience Serving this great country with amazing Manual Therapy Exercise Prescription men and women Publishing a Journal Article Content Development Business Development 7 Contribution to the scientific and clinical community was a lifelong goal 9 Earning a PhD Years of dedication and commitment while running a busy still clinic fi Helping People Move and Feel Well Teaching the philosophy that diet and exercise are the greatest source of optimal health and healing Automated Certificate of eService This automated certificate of service was created by the efiling system. The filer served this document via email generated by the efiling system on the date and to the persons listed below. The rules governing certificates of service have not changed. Filers must still provide a certificate of service that complies with all applicable rules. Chad Kimble Bar No. 24007483 eservice@chadkimblelaw.com Envelope ID: 45835869 Status as of 9/1/2020 8:35 AM CST Case Contacts Name BarNumber Email TimestampSubmitted Status |SCOTTLIDJI scott@thelidjifirm.com 8/31/2020 1:38:24 PM SENT Brent Beasley eservice@chadkimblelaw.com 8/31/2020 1:38:24 PM SENT