DR JONATHAN A CHAPMAN

Size: px

Start display at page:

Download "DR JONATHAN A CHAPMAN"

Gerald Bradford
5 years ago
Views:

1 DR JONATHAN A CHAPMAN Chesterfield Hospital Widcombe Parade Harley Street 3 Clifton Hill BATH LONDON BRISTOL BA2 4JT WN1G 7LE BS8 1JU Solicitors Name: Solicitors Reference: This examination carried out at the request of: Hackett, Thomas & Davies, Solicitors 228/P/4689/VRT in respect of injuries sustained in a road traffic accident. Name Of Injured Person: National insurance No: Identity confirmed: Date of Birth: Address of Injured Person: Present occupation: Occupation at time of injury: Hand dominance: Time unable to work: Medical Report Section A Mrs A.N.Other NC D Verified with passport 23 rd June 1964 (Age 37 years at time of injury) 4, Station Road Bristol BS4 4LD Physiotherapist Physiotherapist Right Eight Weeks Examination details Doctor Examining: Dr. Jonathan Chapman M.B., B.S., D.R.C.O.G. Place of Examination: 144,Harley Street,London Date of Personal Injury: 20 th May 2012 Date of Examination: 22 nd December 2012 Date of this Report: 23 rd December

2 Sources of information available for preparation of the report: 1.GP Records 2.Casualty Records, Royal United Hospital, Bath 3.X-rays, Royal United Hospital, Bath Instructions: I have been instructed by Hackett, Thomas & Davies, Solicitors to detail the injuries sustained in an accident that occurred on 20 th May 2012 including relevant pre-accident medical history, confirmation or otherwise that the injuries are consistent and relate solely to the accident, details of treatment received and the extent and duration of any past, present and future disabilities attributable to the accident. I have also been asked to comment on the present level of suffering and inconvenience, the reasonableness of any absence from work in light of the injuries sustained, and the effect on daily living or capacity to work as a result of continuing complaint or disability attributable to the accident. I have also been asked to comment as to when or if any continuing complaint or disability is likely to resolve and also to review the medical documentation I have been provided with.my area of expertise is soft tissue neck injury following road traffic accident. The Civil Procedure Rules Expert Report Declaration I am aware of the requirements of Part 35 and Practice Direction 35, the Protocol for the Instruction of Experts to Give Evidence in Civil Claims and the practice direction on pre-action conduct. I have obtained Part 1 of the Certificate of Medical Reporting: the Bond Solon Civil Procedure Rules Expert Witness Certificate to evidence my understanding and compliance of the above requirements.i have also obtained Part 2 which is a specialist qualification in Whiplash-associated disorder.i confirm I have no conflict of interest in preparing this report. 2

3 History (Section B) THE ACCIDENT: On the afternoon of 20 th May 2000 Mrs Thomas states that she was the seat belted driver of her own car, alone, fitted with a head restraint though not an airbag, when whilst stationary in traffic she was involved in a collision in which a lorry drove into her rear end pushing her vehicle forcibly forwards. She was unaware of the impending impact and looking to the right hand side at the time of the collision. There was no secondary collision. She recalls her body being thrown backwards and then forwards. There was no head injury. There was no loss of consciousness. She was seated correctly at the time of impact. The seat back did not fail in the impact. LIST OF INJURIES: PHYSICAL: 1. A soft tissue neck injury (whiplash-associated disorder). PSYCHOLOGICAL: 1. An acute distress reaction to the collision. 2. Situation specific anxiety (fearfulness of travelling by car). TREATMENT: She was taken by ambulance, wearing a hard collar and on a spinal board, to the Casualty Department of the Royal United Hospital, Bath. A record of this consultation is included in the notes I have reviewed. She was seen by the Duty Medical Staff having presented with a painful neck as well as a headache. She was examined and following the taking of x-rays of her cervical spine (neck) her collar was removed as no fracture 3

4 was demonstrated. She remained in the department for approximately two hours and was told that she had sustained a whiplash injury. She was issued with a supply of painkillers, together with a soft collar and given specific advice with regard to exercises that she should undertake with respect to her neck. She was also advised to rest from work for at least two weeks. On week later she then consulted her own GP, Dr Richard Harris, of the Bath Road Surgery in Keynsham complaining of continuing stiffness about her neck as well as headaches. A record of this consultation is included in the notes I have reviewed. The doctor examined her and confirmed that she had sustained a whiplash injury and explained that her symptoms would take a while to resolve. He issued her with a medical certificate of sickness for three weeks, and referred her for physiotherapy. This was undertaken at the Bath Clinic, Claverton Down, Bath on six occasions including 1 st June 2012, 7 th June 2012, 19 th June 2012, 20 th June 2012, 28 th June 2012 and 4 th July 2012.Treatment included Mackenzies mobilisations, manipulation, ultrasound and the teaching of exercises. During this time she also returned to see her General Practitioner who issued her with a further medical certificate of sickness for five weeks. CLINICAL PROGRESS: PHYSICAL SYMPTOMS: Immediately after the collision she developed stiffness as well as pain about her neck. She describes this as being initially severe and constant in nature, a situation that persisted for four weeks before easing to become moderate and intermittent. This situation has continued to date and the overall severity and frequency is not currently easing. At the moment she experiences episodes occurring on a daily basis and of average duration four to six hours though these are particularly marked in the evening. Activities that exacerbate the pain in her neck include driving for more than thirty minutes, treating patients at work, together with trying to play golf. 4

5 Relieving factors include the use of Naproxen (a powerful anti-inflammatory painkiller prescribed by her GP) which she has taken on a regular basis since the collision though is experiencing some side effects (indigestion) from this. She has also found massage by a colleague helpful. She wore the soft collar initially for two weeks and then abandoned it. For four weeks following the collision she experienced headaches over the occiput (rear) and vertex (top) aspects of her head. There was also intermittent dizziness though this was only for 48 hours. In addition to this there has been numbness and paraesthesia (pins and needles) affecting her left arm, a situation that continues to date. There was no difficulty in swallowing. There was no pain about her jaw. There was no associated low back pain or inter scapula discomfort (pain between her shoulder blades) or shoulder pain. She states that her sleep was intermittently disturbed for two months following the collision due to a combination of both pain and stiffness in her neck, difficulty in getting a comfortable sleeping position as well as upset associated with the effects of the accident. 5

6 CLINICAL PROGRESS: PSYCHOLOGICAL SYMPTOMS: She was shaken following the collision describing herself as feeling shocked and not being able to believe that she had been in an accident. She remained tearful and trembly intermittent for two days following the collision and in part her sleep has been disturbed due to upset associated with it. She has also experienced nightmares about the collision. Further to this she has suffered from situation specific anxiety (fearfulness when driving). This has manifested itself by physical features including palpitations and trembling when stopped in traffic for fear that another rear end collision will occur. She drives more slowly and with more awareness than prior to the collision and also finds herself leaving a safety zone between her car and the car in front, a situation that would allow her to move forward if another rear end impact seemed to loom. As a passenger she occasionally criticizes the driver or presses an imaginary brake. This situation continues to date and the overall severity and frequency is not currently easing. Section C EMPLOYMENT/EDUCATION: Mrs Thomas is a full-time Senior Physiotherapist working within the NHS. Her job is partly desk bound involving use of a PC and partly light manual in its type though occasionally involves heavy lifting of disabled patients. She states that she lost eight weeks from work as a direct result of the injuries she received (certified by her GP). On her return to work her duties have been restricted in that she can now only undertake outpatient work treating minor strains and soft tissue injuries. She also finds that she can only work at the 6

7 keyboard for half an hour before having to take a break from work. CONSEQUENTIAL EFFECTS: Further to this she played golf on a regular basis prior to the accident and has been unable to play since (having tried once). This has been in part for fear of re-injury. For one week following the collision she had difficulty in dressing herself or bathing, her husband having to help with these functions. She has also found driving difficult in particular with regard to reversing because this exacerbates the pain about her neck. Finally a planned golfing holiday to Portugal has had to be cancelled due to the effects of pain and stiffness about her neck. PAST MEDICAL HISTORY: She states there has not been any previous history of pain and stiffness of her neck and in particular there has been no previous history of being involved in a road traffic accident. Neither has there been any previous history of anxiety or depression or travel anxiety. I have scrutinised her GP records and find this corroborated by this review. I feel there is no relevant antecedent history and that all her symptoms are related causally to the subject accident.none of her symptoms are attributable to previous accidents or incidents. 7

8 Section D: PRESENT POSITION REPORTED BY CLAIMANT: PHYSICAL: Current classification: A Nil-sympton-free B Nuisance Mild nuisance symptoms - did not require painkillers and did not interfere with work and leisure activities C Intrusive Intrusive symptoms that handicapped patients' work and leisure activities and caused them to seek relief by frequent use of analgesics D Disabling Patients were severely disabled, had lost jobs, had repeated sought medical advice and had relied continually on analgesics. Reference: Gargan MF and Bannister GC. Long term prognosis of softtissue injuries of the neck. J Bone Joint Surg (Br) 1990;72:901 She still experiences pain and stiffness about her neck as well as paraesthesia about her arm.this has consequently left her able only to do outpatient physiotherapy work, restricted to 30 minutes keyboard work at a time and unable to play golf. PSYCHOLOGICAL: She still suffers from anxiety when travelling by car for fear of a further accident. 8

9 EXAMINATION: She is a fit looking woman. She measures 1.64 metres in height and weighs 60 kg. Her posture is normal. Examination of her neck reveals no loss of lordosis. There is a full range of pain free flexion and extension (movement of the head downwards and upwards). Lateral flexion to either side (head tilts sideways) is significantly reduced and associated with neck pain at the extreme range of movement. External rotation to either side (head looks sideways) is also markedly reduced and associated with neck pain at the extreme range of movement. On palpation there is tenderness over the spinous processes of the third and forth cervical vertebra though the facet joints are spared. There was no muscle spasm. There was no tenderness about the supporting muscles of the neck. Her shoulders show a normal contour and she is able to demonstrate a full range of composite movement. There is no tenderness. Examination of her arms reveals no evidence of cervical root irritation temporary damage to nerves arising from the neck. Examination of her thoraco lumbar spine was unremarkable. INVESTIGATIONS: I feel no investigations are indicated. It has been suggested that an MRI scan of the scan might be useful to determine the degree of injury. However, this is a limited investigation since it only demonstrates static anatomy not functional or moving anatomy (1) and many experts in whiplash do not feel that MRI can image the facet joint (thought to be the joint affected in whiplash) (2). Review of her cervical spine x-rays is entirely normal. 9

10 RADIOGRAPHIC EXAMINATION: Her cervical spine x rays are within normal limits. JOB PROSPECTS: I feel her future job prospects are reduced because of the nature of her work. I also feel the amount of time taken off work reasonable given the severity of her symptoms.i do not feel that the injuries have affected the clients s ability to find alternative employment should she be thrown onto the labour market.. DIAGNOSIS OPINION PROGNOSIS: The claimant (A.N.Other) has suffered personal injuries as a result of a road traffic accident on 20 th May These injuries are completely compatible with the mechanism described to me: 1. A whiplash associated disorder (WAD) of the cervical spine resulting in acceleration of the head backwards stretching ligaments supporting joints of the neck, which were unprotected by the suddenness of the accident, compressing the apophyseal joints, followed by recoil forwards stretching the posterior ligaments of the neck, resulting in headaches and paraesthesiae and well as neck pain and stiffness. 2. An acute distress reaction to the collision. 3.Anxiety when travelling by car for fear of a further collision, a situation from which she is not yet recovered. She still continues to suffer from symptoms outlined in the summary 1. and 3.,i.e. neck pain/stiffness and travel anxiety. I feel her injuries result solely from the subject accident and that there is no pre accident disposition to any of the injuries sustained.there is no evidence of functional overlay or exaggeration. 1 0

11 Section F FUTURE TREATMENT AND REHABILITATION: PHYSICAL: Research into whiplash has shown that if a patient has symptoms at three months following a collision (as Mrs Thomas has) then 86% of such patients remain symptomatic between three months and two years (3). Good Prognostic Factors Include: Head Restraint use(6) Non-failure of seat back(7) In position occupant(8) Poor Prognostic Factors Include: Female sex (4) Early onset of symptoms <12h Cervical root irritation(8) Unawareness at time of collision(9) Head rotated at impact(10) Larger striking vehicle(8) Seatbelt use(11) I feel her symptoms have not yet stabilised. I would recommend that she be referred to a qualified chiropractor with a view to assessing and manipulating her neck since 93% of such patients are said to improve with treatment (5) and with this in mind would anticipate recovery within the next six to twelve months.i also anticipate a return to normal working and recreational activity during this time. However I would not expect any long-term complication to ensue as a consequence of these injuries. 1 1

I do not expect her neck symptoms to prejudice future working abilities.

i do not expect future reports to be necessary and I do not feel a report from an expert in another

PSYCHOLOGICAL: I feel it will be a further six to twelve months before she can become at ease when

report are within my own knowledge and which are not.

12 I do not expect her neck symptoms to prejudice future working abilities.i do not expect future care(other than chiropractic treatment) to be necessary.i do not expect future reports to be necessary and I do not feel a report from an expert in another field to be necessary. PSYCHOLOGICAL: I feel it will be a further six to twelve months before she can become at ease when driving (6) Section G I confirm that I have made clear which facts and matters referred to in this report are within my own knowledge and which are not. Those that are within my own knowledge I confirm to be true. The opinions I have expressed represent my true and complete professional opinions on the matters to which they refer. Dr Jonathan A Chapman M.B., B.S., D.R.C.O.G. Member Expert Witness Institute (Membership number 1201) 23 rd December

13 References: 1. 1) Dr Chris Centauro. Medical Director of The Colorado Soft Tissue Specialists. Whiplash 2000 (May 2000 Bath). 1. 2) Lord S et al. Chronic Cervical Zygapophysial Joint Pain After Whiplash. Spine. 1996; 21: ) Gargan & Bannister. The Rate of Recovery Following Soft Tissue Injury of the Neck. European Spine Journal 1994: 3: ) Siegmund et al. Head/Neck Kinematic Response of Human Subjects in Low Speed Rear End Collisions. SAE Technical Paper ; 1997, pp: ) Woodward et al. Chiropractic Treatment of Chronic Whiplash Injuries Injury 1996 November 27(9) pages ) Mayou et al. Psychiatric Consequences of Road Traffic Accidents. BMJ. 1993; 307: ) Dr.J.Chapman.Whiplash- A Guide.Doctor Magazine October 2001 pp ) Romilly DP et al:low speed impacts and the elastic properties of Automobiles.Proceedings: 12 th International Conference of Experimental Safety Vehicles,Gothenburg,1-14,May/June ) Ono K :Influences of the phyical parameters on the risk to neck injuries in low impact speed rear end collisions-international Conference on the Biomechanics of Impacts,Eindhoven,Netherlands, , )Pennie B,Agambar L:Patterns of injury and recovery in whiplash.injury Brit J Accid Surg 1 3

14 22(1):57-59, ).Olsnes BT:Neurobehavioural findings in whiplash patients with long-lasting symptons.acta Neurol Scand 80: SEVERITY SCALE: Mild: No limitation of activities Moderate: Some limitations of activities Severe: Unable to perform usual activities 1 4

Medical Report. Prepared for the court by Dr Sample Expert. Date: 04/03/2016. Section A - Claimant s Details. Mr Harry Test Potter 07/07/1970

Medical Report. Prepared for the court by Dr Sample Expert. Date: 04/03/2016. Section A - Claimant s Details. Mr Harry Test Potter 07/07/1970 Medical Report Prepared for the court by Dr Sample Expert Date: 04/03/2016 Section A - Claimant s Details Claimant s full name Date of birth Mr Harry Test Potter 07/07/1970 Address Hogwarts Castle Hogwarts