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

DISCLAIMER: The results are specific to the facts and legal circumstances of each of the 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.

Patricia Jacobs, our client, bravely endured the insurance company’s strategic attempts to attack her credibility, her past family life, and also attack the credibility of her own treating medical providers.

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.

But the workers’ compensation insurer opposed the diagnosis and opposed the recommended spinal cord stimulator trial as a form of treatment. The workers’ compensation insurer arranged for an independent medical exam by Dr. Ensalada. 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.

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

Dr. Ensalada was seen, on the video, wearing blue gloves and never using a thermometer or other medical device to measure temperature. Ms. Jacobs could not accept the negative opinions of the insurer. She want to proceed to treat for her work injury, so the case proceeded to formal hearing (trial).

The Vermont Department of Labor conducted a formal hearing (trial) over two days. The second day did not end until after 8:00 pm as the Judge granted our request to be permitted continued, uninterrupted cross-examination of the insurer’s expert, Leon Ensalada, MD. It was successful. The Department of Labor found in favor of Ms. Jacobs.

As the Department of Labor Hearing Officer (Judge) stated in her written decision and order:

“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.”

Ms. Jacobs was under tremendous pressure because of the workers' compensation insurance company's denials and tactics. Ms. Jacobs had many opportunities to fall into the temptation to quit, many opportunities to fall into the temptation of self-pity, and many opportunities to fall into the temptation to become destructive or self-destructive or become ugly with hate and anger against the workers’ compensation insurance company for what she was challenged to endure. She withstood all of it.

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

Ms. Jacobs was, and is, a very remarkable human being. And she won her case!

The victory at the Vermont Department of Labor for Ms. Jacobs cannot cure Complex Regional Pain Syndrome. But representing Ms. Jacobs and standing up for her brought a needed success and a necessary benefit. Having removed the legal obstacles in the path of her medical treatment plan, she was free to go forward.

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