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DISCLAIMER: The above results are specific to the facts and legal circumstances of each of the above clients' cases and should not be used to form an expectation that the same results could be obtained for other clients in similar matters without reference to the specific factual and legal circumstances of each client’s case.

Complex Regional Pain Syndrome Type II: Case Proven Using Harden Criteria

Patricia Jacobs, our client, bravely endured the insurance company’s strategic attempts to attack her credibility, her past family life, and also attack her own treating medical providers.  The Vermont Department of Labor conducted a formal hearing (trial) over two days.  The second day did not end until after 8:00 pm to allow our continued cross-examination of the insurer’s expert, Leon Ensalada, MD. 

Ms. Jacobs is a single mother and grandparent, who suffered a right wrist injury on the job.  She underwent three (3) separate surgeries, which were not successful and left her with a condition of chronic pain out of proportion along with associated temperature changes, skin color changes, skin perspiration and other signs of what was later diagnosed by her Board Certified Anesthesiologist, Tiffani Lake, MD, as Complex Regional Pain Syndrome. 

The diagnosis was also confirmed by Fletcher Allen Health Care’s Thomas J. Zweber, MD, Board Certified in Physical Medicine and Rehabilitation and Board Certified in Electrodiagnostic Studies, with years of experience in treating patients with Complex Regional Pain Syndrome.   The diagnosis was also confirmed by Ms. Jacobs’s independent medical examiner, and Board Certified in Physical Medicine and Rehabilitation, Mark J. Bucksbaum, MD.  The signs of Complex Regional Pain Syndrome were confirmed in records and in testimony by Nurse Alexandria Noble.  Ms. Jacobs was recommended by her pain management group team at Fletcher Allen Health Care for a spinal cord stimulator to provide an opportunity for non-narcotic improvement of her chronic pain. 

But the workers’ compensation insurer opposed the diagnosis and also opposed the recommended spinal cord stimulator trial as a form of treatment, even though it had accepted all three (3) surgeries as well as other conservative measures of pain management, such as medication, physical therapy, occupational therapy, stellate ganglion nerve blocks, and more. 

The workers’ compensation insurer chose to hire Leon Ensalada, MD.  The workers’ compensation insurer arranged for an independent medical exam by Dr. Ensalada. 

But Ms. Jacobs chose to exercise her right under Vermont law to video-record the examination techniques of Dr. Ensalada.  That proved to be quite revealing. 

Dr. Ensalada claimed that he examined and measured Ms. Jacobs’s hands to determine whether there was “temperature asymmetry,” in other words whether there was a difference in temperature between Ms. Jacobs’s right hand and left hand.  Dr. Ensalada was seen, on the video, wearing blue gloves during the entire exam and never using a thermometer or other medical device to measure temperature.  Dr. Ensalada claimed that he measured and found no temperature difference; whereas, his technique provided no reasonable basis for his opinion.  As the Department of Labor Hearing Officer (Judge) stated in her written opinion:

“I find other aspects of Dr. Ensalada’s opinion, and the physical examination upon which it was based, troublesome as well.  For example:

• Because he was wearing non-latex gloves during his physical exam, Dr. Ensalada was unable to feel whether Claimant’s skin was wet or sweaty.  The exam video documents that he noted having “eyeballed” Claimant’s skin and finding no perspiration.  Claimant immediately corrected him, however, noting that the skin between the fingers on her right hand was “like … the sweaty kid nobody wants to touch.”  I find Claimant’s observation in this regard entirely believable.

• Dr. Ensalada did not use a thermometer to measure and compare Claimant’s right and left hand temperatures.  Instead, he used his right (gloved) hand to measure Claimant’s left hand temperature, and his left (gloved) hand to measure her right hand temperature.  Using this technique, I question whether he would have been able accurately to discern a small but significant temperature asymmetry between Claimant’s two hands.”

The insurer also opposed the treatment plan by attacking Ms. Jacobs’s past history and questioning her mental health.  However, the Vermont Department of Labor did not find the expert psychiatric testimony to be persuasive.  The Opinion and Decision agreed with the opinions of the treating experts, Cheryl Laskowski, APRN, psychiatric nurse, as well as Brian Erickson, Board Certified in Psychiatry and Psychosomatic Medicine, both employed at Fletcher Allen Health Care in Burlington.

Ms. Jacobs remained respectful and civil during the entire slugfest against her credibility, history, and medical treatment team. 

Ms. Jacobs was under tremendous pressure because of the workers' compensation insurance company's tactics and the insurer's denials of responsibilty.  Ms. Jacobs had many opportunities to quit, many opportunities to fall into self-pity, and many opportunities to become distracted with anger against the workers’ compensation insurance company for what she was challeged to endure.   Ms. Jacobs was, and is, a very remarkable human being.

The court victory for Ms. Jacobs, of course, cannot bring her a cure for Complex Regional Pain Syndrome, nor can a victory even guarantee that the recommended spinal cord stimulator will provide substantial benefit.  But her court victory removed the legal obstacles which had been thrown in the path of her medical treatment plan; and with those legal obstacles removed, Ms. Jacobs had restored for herself a fair chance to improve.