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Tag: Dr. Dommisse

Defence Expert Criticized; $60,000 Non-Pecuniary Assessment for Lingering STI's and PTSD

Unreported reasons for judgement were recently released by the BC Supreme Court, Nanaimo Registry, addressing damages for “chronic, but not disabling” soft tissue injuries and post-traumatic stress arising from a motor vehicle collision.
In the recent case (Pitts v. Martin) the Plaintiff was injured in a 2008 collision.  Fault was admitted by the Defendant.  The extent of the Plaintiff’s damages were at issue.  As is common in personal injury litigation, the Defendant produced an expert witness who provided evidence disagreeing with the Plaintiff’s physician as to the extent of the ongoing injuries and their connection to the collision.  Mr. Justice Dley was not receptive to this evidence preferring the Plaintiff’s treating physicians.  In rejecting the Defendant’s expert Mr. Justice Dley provided the following criticism:
[31]  Dr. Dommisse provided an opinion that confirms the soft tissue injury.  However, he opines that stress aggravates the physical injuries and that with proper counselling the stress would ease off; that would improve the physical injuries.  Dr. Dommisse agreed that the stress affectibng Ms. Pitts resulted from the collision.
[32]  His opinion ignores the fact that Ms. Pitts has had counselling and that she has been provided with coping techniques.  Dr. Dommisse was not critical of the counselling that had been provided and deferred that aspect of the injuries to the counsellors who had previously treated Ms. Pitts.
[33]   His opinion failed to consider that Ms. Pitts required some assistance at work.  He conceded that to be a significant factor.
[34]  Dr. Dommisse noted muscle spasm in the trapezius muscle.  However, in his opinion as to whether the collision caused Ms. Pitts’ disabilities, he did not include any reference to the spasms.  Instead, he referred to Ms. Pitts’ complaints as being subjective.  He did not provide a satisfactory answer as to why such an objective symptom would have been left out of his analysis.
[35]  Dr. Dommisse failed to consider the fact that Ms. Pitts suffers pain and discomfort from some of her work-related activities, particularly heavy lifting.  Those symptoms are brought on without any stress.  That significant omission from his report destroys any reliability that might be attached to his opinion that “it is unlikely that Ms. Pitts’ current disabilities were caused by the accident”.
[36]  Dr. Dommise commented that counselling from Ms. Pitts’ stress and anxiety will likely improve her symptoms.  His evidence did not provide any basis for that opinion to be reliable.  It ignores the reality that counselling has already been provided and there is no suggestion that the treatment was in any way lacking.  I am not satisfied that any further counselling is likely to resolve or further improve Ms. Pitts’ present condition.
In assessing non-pecuniary damages at $60,000 Mr. Justice Dley provided the following reasons:
[47]  It is now four years post-accident.  Ms. Pitts has been diligent in pursuing rehabilitation measures.  Ms. Pitts still has some lingering injuries – they are chronic, but not disabling.  Ms. Pitts can carry on with her everyday life and work, but she has limitations because she must be careful so as not to aggravate her injuries.  She continues to suffer from the post-traumatic stress of the collision.  She has learned coping techniques, but that has not eliminated the disorder.
[48]  Taking into account the injuries sustained and the impact they have had and will continue to have, I assess general damages at $60,000.
As noted this judgement is not reported therefore not publicly available.  As always, I’m happy to provide a copy to anyone who contacts me and requests one.

$95,000 Non-Pecuniary Damages For Disc Protrusions Requiring Discectomy; Dr. Dommisse Criticized

(Image via Wikipedia)
Reasons for judgement were released last week by the BC Supreme Court, Vancouver Registry, assessing damages for injuries caused by a motor vehicle collision.
In last week’s case (Ng v. Sarkaria) the Plaintiff was injured in a 2007 collision.  The Defendant admitted fault for the crash.  The 31 year old Plaintiff suffered “a large focal disc protrusion at L4-5 and a less significant protrusion at L5-S1“.  As a result the Plaintiff went on to have a partial discectomy.
In assessing non-pecuniary damages at $95,000 Mr. Justice Butler provided the following reasons:
[43] In summary, Mr. Ng has been left with a limitation in the amount of activities he can do.  He has also suffered some restriction in the nature of the activities he can do because he is focused on staying healthy.  He is determined to continue his work as a TFR.  He is not disabled by pain and there is no suggestion that he suffers from chronic pain.  Rather, he has episodic pain when he overexerts himself…

[46] I have found the decisions referred to by the plaintiff to be helpful to my decision.  Of course, each assessment depends on the unique facts of the case.  Here, Mr. Ng’s injury was significant; however, he has had a very positive result from the surgery.  He continues to be able to do all of the activities of his job.  His income has increased to a level greater than it was before the accident.  He must be careful to avoid excessive stress on his back and must carefully balance his work and home life.  However, when I compare his situation to that of the plaintiffs in the cases he relies upon, he is in a better position because he does not experience ongoing chronic pain and is able to continue to carry out most of the activities he could before the accident.  However, I must also take into account the possibility that he will not be able to continue to perform at his current level as a result of the injuries suffered in the accident.  There is a possibility that his pain and restriction of activities will increase in the future.

[47] When I take all of these factors into account, I conclude that the appropriate award for non-pecuniary damages is $95,000.

Prior to reaching this decision the Court heard from competing medical evidence about the connection between the collision to the disc protrusions.  The physician retained by the defence (Dr. Dommisse) provided evidence minimizing this connection arguing the injury was perhaps more likely connected to a work related incident.  In rejecting this opinion Mr. Justice Butler provided the following criticism:
[30] The defence was critical of Dr. Aitken’s alleged failure to fully inquire into the work activities undertaken by Mr. Ng after he went back to work.  However, I am of the view that it is Dr. Dommisse who can be criticized for failing to back up his opinion by pointing to evidence that would connect the Herniations to a particular injury or incident at work.  All of the doctors were aware in general terms of the nature of Mr. Ng’s work.  They all agreed that it is possible for such work to cause a tortional injury to the spine.  However, there was no evidence that Mr. Ng suffered such an injury or insult at work between June 2008 and November 2008.  Indeed, he deliberately avoided the more onerous work tasks including those jobs requiring the use of the large ladder.  He does not recall using the ladder in that timeframe.  During much of that period he was off work, on light duties or avoiding heavy tasks.  The evidence established that there was only one significant injury or insult to Mr. Ng’s spine:  the injury that was suffered in the accident.

Chronic Whiplash Associated Disorder and the "Unrelated Pain" Defence

It is well established that a small percentage of people who suffer from whiplash associated disorder following a collision go on to experience pain for a prolonged period of time.
When cases with prolonged injury go to trial it is not uncommon for the Court to hear competing medical evidence as to the cause of the chronic pain.  Oftentimes defence doctors provide opinions that causes unrelated to the collision are responsible for a Plaintiff’s ongoing symptoms.  Reasons for judgement were released today by the BC Supreme Court, Powell River Registry, dealing with and dismissing such a defence.
In today’s case (Borgfjord v. Penner) the Plaintiff was involved in a rear-end collision.  Fault for the crash was admitted by the Defendant.  The trial focused on the value of the Plaintiff’s claim.
The Plaintiff injured her neck in the crash.  She went on to have chronic symptoms of pain.  The Defendants acknowledged that the Plaintiff likely had on-going pain but argued that this was unrelated to the crash and instead was as a result of ‘degenerative changes’ .  Mr. Justice Shabbits rejected this argument and went on to assess the Plaintiff’s non-pecuniary damages for her chronic whiplash injury at $85,000.  In rejecting the defence argument the Court provided the following useful reasons:
[74] Dr. Dommisse’s opinion is that cervical strain caused the plaintiff’s early problems and that her cervical strain symptoms likely resolved within 6 months to 2 years post accident. His opinion is that degenerative changes caused the plaintiff’s later problems. He says that degenerative changes are the cause of the plaintiff’s continuing problems…

[98]         In my opinion, the plaintiff has established that the accident caused her to suffer a cervical strain.

[99]         In my opinion, Dr. Dommisse is speculating when he opines that the plaintiff’s accident caused symptoms have already resolved. The usual pattern of soft tissue injury may well involve the resolution of symptoms within 6 months to two years post injury, but the plaintiff’s complaints have continued unabated and there is no certainty that the plaintiff’s disc protrusion or degenerative condition of the spine is now or ever has been symptomatic. Dr. Waterman’s opinion is that what he saw on the MRI, (which includes the disc protrusion), is unlikely to be clinically significant. He says it is difficult to attribute spine pain to what he observed.

[100]     I accept the opinion and prognosis of Dr. Waterman. In my opinion, his evaluation and analysis of the medical evidence is persuasive.

[101]     I find that the plaintiff suffered a whiplash injury in the motor vehicle accident and that her whiplash caused injuries are ongoing. I think it more likely than not that the plaintiff falls within that category of patients referred to by Dr. Waterman who experience whiplash caused pain for years post-accident. I find that the most likely outcome of the plaintiff’s injuries is that she will be improved in several years, but that she will suffer intermittent pain which she will be able to largely control by modulating her activities…

[124] I assess the plaintiff’s non-pecuniary damages at $85,000…