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Shaw Chiropractic Admissibility of Video Fluoroscopy In the past, I have written about various diagnostic procedures which are of benefit when documenting the existence of soft tissue injuries. The imaging procedure which, in my opinion, is the most beneficial clinically and forensically is the video recorded spine fluoroscopy (VF). This procedure was examined as a topic of an earlier newsletter. To review, spine VF is a x-ray movie which demonstrates the biomechanics and stability of the area examined. You may be more familiar with the VF applications for joint replacement assessment, needle placement and GI contrast studies. A recent case in the Colorado Court of Appeals examined the admissibility of this procedure when used by the chiropractic profession (Tran v. Hillburn, 21 Colorado Journal 545 Colo.App 1997. No 95 CA 1662). During Tran=s case. a VF study demonstrating ligamentous injury was admitted over objection. After significant monetary award, the defendant appealed alleging the admissibility of VF was in error. The Colorado Court initially applied the Frye Test and then noted that the US supreme Court favored the Federal standard (Daubert, Rule 702). The plaintiff offered the testimony of a chiropractic orthopedist who testified that VF had been in use since 1910, that he knew of no better technique for diagnosing a torn ligament and that his office was the only chiropractic facility using the procedure. A second witness concurred with the chiropractic orthopedist. The defense brought a TMJ specialist, a orthopedic surgeon and a chiropractor. The defense experts essentially claimed that the procedure was not routinely used in their professions. The appeals court ruled that despite conflicting evidence, there was support for the conclusion that VF is accepted within the field of chiropractic and that any dispute between it and the medical profession goes to the weight, not the admissibility of evidence. VF has been a controversial issue in chiropractic and medicine for years. Despite this, this case supports the proposition that VF should be properly admitted and it=s evidentiary weight be determined by the jury. The demonstrative value of a video x-ray projected on the big screen is impressive. In fact, it is a persuasive tool which can dramatically demonstrate the severity of the patient=s condition to a jury. Plain film x-rays do not have the dynamic presentation benefit to adequately document ligamentous damage in all phases of motion. The admissibility of VF evidence in Connecticut has not been challenged yet. I expect to be called shortly as an expert witness for a patient who underwent a VF study post surgically. I performed and interpreted the VF study as a chiropractic orthopedist, although I was not the treating physician. In fact, the patient has never received chiropractic care. If the case makes it to trial I will let you know of the outcome. SCREENING FOR PTSD Post traumatic stress disorder is a frequently overlooked psychological complication of trauma. Physicians (and attorneys) are most concerned with physical injuries and may discount the damaging psychologic effects of PTSD. A 1999 paper in the American Journal of Psychiatry reviewed the efficacy of a 7 question scale to screen for potential PTSD. They found the scale to have a 97% specificity, 80% sensitivity, 71% positive predictive value and a negative predictive value of 98%. Considering the ease of application of the survey we encourage physicians and attorneys to implement the questions on their intake form as a matter of routine. For a copy of the questions and scoring criteria please call our office. |
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