Court Critiques Defence Doctor's Opinion Following "Flawed" Investigation

Reasons for judgement were released today by the BC Supreme Court, New Westminster Registry, with critical comments regarding a medico-legal opinion.
In today’s case (Chenier v. Szili) the Plaintiff was involved in a 2010 rear end collision caused by the Defendant.  The collision resulted in significant injuries.  In the course of the lawsuit the Defendant had the Plaintiff examined by a physician who provided evidence minimizing the connection between some of the plaintiff’s symptoms and the collision.  In rejecting this evidence where it differed from the Plaintiff’s neurosurgeon Mr. Justice Armstrong provided the following comments:

[154]     Dr. O’Farrell is a retired orthopaedic surgeon. He has not done any spinal surgery for 10 years. He stopped doing spinal surgery to allow room for younger, more skilled people to provide that service. His last scientific paper was published in 1996 and his last involvement in research was in 2003. He continues to see patients with back pain.

[155]     Dr. O’Farrell paid no regard to the plaintiff’s upper back injury and resulting symptoms. He recorded no complaints from the plaintiff regarding his upper back sensations of numbness and tingling in his right and left arms. He recalled that the plaintiff’s left arm improved but there were residual symptoms in his right arm.

[156]     Dr. O’Farrell did not recall performing an upper extremity examination of the plaintiff. He said it was possible he had not examined the plaintiff in that region.

[157]     He was asked about Dr. Lee, Dr. Watt and Dr. Sahjpaul identifying brisk reflexes in their examinations of the plaintiff. He was provided the notes from Dr. Lee, Dr. Watt and Dr. Sahjpaul. Dr. O’Farrell agreed that increased tone is evidence of spinal cord compression but said he did not find any indication of that condition in his examination. It was clear that if one accepted Dr. Sahjpaul’s findings, this would have been confirmatory evidence of a spinal cord compression.

[158]     There were other anomalies in Dr. O’Farrell’s examination and reporting of his findings concerning the plaintiff. These include:

(a)      He considered Mr. Chenier’s symptoms as mild because he thought Mr. Chenier was continuing to do his pre-accident heavy work with minor complaints. On this point he is simply wrong;

(b)      His written record reported Mr. Chenier complaining of pain when lifting or bending, but Dr. Farrell used the phrase discomfort in his report. Dr. O’Farrell did not adequately explain why he transposed pain into discomfort in his report;

(c)      He neglected to record that the plaintiff was involved in a double impact accident which would have indicated a more significant collision;

(d)      He reviewed notes indicating that the plaintiff went to a walk-in clinic on the day of the car accident and was observed to have right and left neck spasm and lumbar spasm, but these facts were omitted in his report. This was significant because evidence of right and left neck spasm and lumbar spasm was significant in respect to his diagnosis. They confirm the immediate post-accident onset of pain;

(e)      The doctor reported the plaintiff had previous chiropractic treatments but he did not ascertain the number of those treatments or the purpose of those treatments. The symptoms giving rise to those treatments and the number of treatments would have been relevant. He described his omission of any reference to this treatment as a possible “oversight”. Dr. O’Farrell conceded that the earlier chiropractic treatments could have been related to a pulled muscle rather than a symptomatic disc disease and he did not recall why he had not noted the frequency or reasons for the treatments;

(f)       He did not make any note of the plaintiff’s complaints of arm numbness and tingling in his fingers but insisted he would have inquired about them. The doctor said “it was not a major issue” for the plaintiff and he did not investigate this region further;

(g)      He observed that the plaintiff had a positive response indicating spinal pathology in the lower back. He said he did not find any evidence of increased tone then he would agree there was evidence of spinal cord compression;

(h)      He said he would have done a neurological exam of the plaintiff but it was not documented. He later said he may not have done an upper extremity neurological exam due to an oversight. It is likely he did not do such an examination;

(i)       He said the results of the lower extremity neurological exam were normal. Though Dr. Watt had earlier found deep tendon brisk reflexes, he believes these reflexes might not be abnormal.

[159]     Dr. O’Farrell conceded that Dr. Sahjpaul’s diagnosis of the C5/6 and C6/7 degeneration was persuasive and that he would defer to Dr. Sahjpaul in regard to that opinion.

[160]     I have concluded that Dr. O’Farrell’s investigation of the plaintiff, his clinical notes taken during his examination of the plaintiff and the differences between his notes and underlying facts in the report were flawed. Most significantly, he did not do an upper body examination of Mr. Chenier and did not observe other symptoms that confirmed a spinal cord compression.

[161]     Dr. O’Farrell’s recent professional activity, in contrast with Dr. Sahjpaul’s practice, persuades me that the opinion of the latter is to be given more weight. Dr. Sahjpaul, as a neurologist, has more current expertise that is focused on the type of spinal injuries suffered by the plaintiff.

[162]     Dr. O’Farrell also confirmed that he would defer to Dr. Sahjpaul’s opinions concerning the plaintiff’s upper spine injury.

[163]     Thus, I conclude that Dr. O’Farrell’s opinions regarding the plaintiff’s low back injury and his upper spine injuries and their connection to his pre-existing degenerative disc condition are not persuasive. Where his opinion conflicts with that of Dr. Sahjpaul, I prefer Dr. Sahjpaul’s opinion.

bc injury law, Chenier v. Szili

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When not writing the BC Injury Law Blog, Erik is the managing partner at MacIsaac & Company, based in Victoria, B.C. He is also involved with combative sports regulatory issues and authors the Combat Sports Law Blog.

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