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State11/19/2004
th Excal, Parrish saw Dr. Timothy Johans in Boise, Idaho, upon a referral by Dr. William W. Holyfield. According to Dr. Johans' medical record, Parrish was doing reasonably well until four months ago when insidiously he developed severe neck pain and subscapular pain which subsequently over the next week started to radiate all the way down his left arm into the thumb, index, and long fingers. It became increasingly severe, and he developed numbness about two months ago. He was seen and evaluated initially by Dr. Holyfield who recognized the radiculopathy and ordered an MRI scan which showed a large herniated nucleus pulposes at C6-7 on the left side. Dr. Holyfield recommended an anterior cervical diskectomy, and because the patient has family here in Boise and wanted the surgery done in Boise, Dr. Holyfield referred him to me[.]
(Emphasis added.) Dr. Johans performed the C6-7 diskectomy on December 15, 1994.
[ ] Some years later when Parrish saw Dr. Celia Stenfors-Dacre on February 25, 2002, for an independent medical evaluation, upon a referral from Dr. Robert A. Narotzky, Dr. Stenfors-Dacre asked Parrish about his medical history. Dr. Stenfors-Dacre's report states in pertinent part that Parrish, at the time of the independent medical evaluation, "presents with cervical and lumbosacral back pain." Then, Dr. Stenfors-Dacre's report reads:
[Parrish] reports his symptoms began in approximately 1994. Prior to that he had no cervical or lumbosacral back pain, no history of injury to either area . . . . His symptoms began suddenly . . . .
(Emphasis added.) During Dr. Stenfors-Dacre's deposition, on September 24, 2002, she was asked if Parrish's 1994 complaints were entirely cervical. She testified:
[Dr. Stenfors-Dacre]: No, he reported to me he had both cervical and lumbosacral, that it wasn't specifically one more than the other, because I do recall asking him that. And I don't know that I documented that, but he reported that the cervical area under Evaluation was more painful at the time and that's why it was addressed and then subsequently operated upon.
Q: So as early as 1994 he had symptoms in both the cervical and lumbar spine he reported to you?
A: Yes, that's correct.
Shortly after this testimony, the following exchange occurred (emphasis added):
[Q:] Now, if he's starting to develop symptoms in 1994, then is it your opinion that the damage has been done to the structures of that back by the nature of the heavy lifting and the repetitiveness of that lifting by 1994?
A: I would agree that would be correct.
Q: And once this condition-I mean, is this like an injury inside of the back to the structures of the back which starts this process of the back kind of degenerating?
A: Yes, that would be correct. It can involve both the disks between the vertebral bodies as well as the vertebral bodies themselves.
Q: Did it appear to be in his case that most of the degeneration was occurring in the disk structures?
A: Yes, particularly in the-well, actually yes, both in the cervical and lumbosacral region it seemed to be more of a disk issue.
Q: And those disks form the tissues between the hard bony vertebraes, correct?
A: That is correct.
Q: And as we move and age, those disks are subjected to wear and tear; is that correct?
A: That is correct, even without the heavy lifting that does occur.
Q: And in this particular circumstance you believe that the heavy lifting contributed to that wear and tear?
A: I believe it contributed as well as haste
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