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Adams v. City and County of San Francisco11/8/2002
rding to Dr. Rubenstein, " t was clear. And the conclusion of their study: that she was asymptomatic prior to this; that the accident, again, just as it did in Miss Adams's case, triggered a marginally stabilized condition to a very progressive condition, resulted in her situation." The second article, by Dr. Thomas Milhorat et al., was even more definitive. The article studied 364 persons with CM-I condition who had become symptomatic. Of that number "89 out of those 364 patients reported that the inciting event that caused them to become symptomatic was trauma, the most common of which was a whiplash type [injury]."
Viewing the record in the light most favorable to the jury's verdict, we conclude there is ample evidence to support the conclusion that the accident caused Adams's CM-I condition to become symptomatic.
CCSF contends Dr. Rubenstein's testimony was inadequate. It relies on the following portion of Dr. Rubenstein testimony, where he admitted that there was no consensus in the scientific community as to how a traumatic event can adversely affect a person with CM-I. "I think that there has been debate over decades about what is the exact anatomic configuration that results in the Chiari malformation. But I think that it is becoming clearer how a traumatic event could destabilize a Chiari malformation, because it is very clear . . . that trauma can precipitate an asymptomatic Chiari malformation to a symptomatic Chiari malformation."
CCSF also relies on a portion of Dr. Rubenstein's testimony where he admitted, during cross-examination, that because he did not have a brain scan of Adams prior to her accident, he could not provide a precise explanation for why Adams began experiencing pain after the accident. "Q. Okay, Doctor, on your description of what is going on anatomically, your opinion of what is happening anatomically, is that opinion speculation, possibility or probability? [ ] A. I would think that it would be - obviously, because I don't have a pre-accident scan I can't say that is probable, i.e., 51 percent. [ ] I can say that it is a distinct possibility that the accident destabilized this marginally stabilized condition, caused more tonsillar herniation. [ ] And certainly the one thing that I think is pretty definitive is we know Miss Adams had no symptoms pre-existing this accident that at least I saw in the medical records or by history of left shoulder, left arm pain. She had them immediately after the accident, in the immediate post-accident time frame. [ ] Clear to me that something happened as a result of the accident."
Finally, CCSF relies on the following portion of the Milhorat article that describes some uncertainty about how trauma causes CM-I condition to become symptomatic. "As shown in Table 1, approximately 25 percent of patients cited trauma as the precipitating factor. The most common mechanisms were whiplash injuries and direct blows to the head and neck . . . which raises the possibility that certain types of trauma accentuate tonsillar impaction or result in subarachnoid hemorrhage that destabilizes a marginally compensated CSF system." (Italics added.)
CCSF interprets these passages as meaning that Adams's experts could only speculate that the accident had caused her CM-I condition to become symptomatic. According to CCSF, that speculation was insufficient to establish causation under the controlling legal standard which requires a "reasonable probability." (See Williams v. Wraxall, supra, 33 Cal.App.4th at p. 133.)
We reject the argument. The passages CCSF cites shows there may be some uncertainty how trauma causes a CM-I condition to become symptomatic. In other words, the passages all indicate the
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