1065 - New York Injury Cases Blog

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DR. APRIL - DIRECT EXAMINATION - SCIRETTA 1065

THE COURT: We ready for the jury?

MR. RONEMUS: Yes.

COURT OFFICER: Okay, Judge?

THE COURT: Thank you.

(Whereupon, there was a pause in the

proceedings. )

witness.

D R.

THE COURT: All rise.

COURT OFFICER: Jurors.

(Whereupon, the jury entered the courtroom.)

THE COURT: You may all be seated.

Good afternoon, ladies and gentlemen.

THE JURY: Good afternoon.

THE COURT: Defendant, call your next

MS. SCIRETTA: Thank you.

The defendant calls Dr. Robert April.

THE CLERK: Raise your right hand.

ROBERT A P R I L,

called as a witness, having been first duly sworn by

the clerk of the court, was examined and testified

as follows:

THE WITNESS: Yes, I do.

THE CLERK: Lower your hand.

In a loud, clear voice state your name and

address for record, spelling your first and last name.

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DR. APRIL - DIRECT EXAMINATION - SCIRETTA

THE WITNESS: Robert April. A-P-R-I-L.

THE CLERK: Address.

1066

THE WITNESS: 4 East 88th Street, New York,

New York 10128.

THE CLERK: You may be seated.

THE WITNESS: Thank you.

THE CLERK: You are welcome.

THE COURT: You may proceed.

MS. SCIRETTA: Good afternoon.

DIRECT EXAMINATION

BY MS. SCIRETTA:

Q

A

Q

A

Q

Good afternoon, doctor.

Good afternoon.

Doctor, you said you are a doctor.

What is your medical specialty?

I am a neurologist.

And for how many years have you been a

neurologist?

A A long time.

(Whereupon, there was laughter in the

courtroom. )

A

Q

Over 40.

Okay. With respect to your background, could you

please describe for us your educational background,

starting with your undergraduate medical school, and then

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your training after medical school.

A Yeah.

Went to the University of California, Los Angeles.

And the University of California, Berkeley. And I graduated

from medical school at the University of California, San

Francisco. Then I came to New York and I interned at the

Mount Sinai Hospital in New York City. And I did a general

rotating internship in medicine and surgery.

Then I started my professional training in

neurology which I did at the Mount Sinai Hospital. At the

Kings County Hospital in Brooklyn, where I spent a year in

neuropathology in the Kings County Morgue. And then I did a

year of training at the Rusk Institute as part of my

neurology in rehabilitation medicine.

Then I went on to a postdoctoral training program

in electroencephalography, which is EEG. And

electroencephalography, EEG, that was done at the Mount

Sinai Hospital for the two years.

Then spent two years at the New York University

Medical Center in neurophysiology actually doing research on

the nature of pain mechanisms in the spinal cord and brain.

And then it took my research to London for a year under the

auspices of the National Multiple Sclerosis Society and

taught and did research at University College, London.

Then I was in the service for two and a half years

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in Baltimore, Maryland. I was the chief of neurology at the

United States Marine Hospital in Baltimore. And I had a

commission in the Coast Guard.

After that, I came back to New York and I went into

a job at the Bird S. Coler Hospital, which is on Roosevelt

Island. I was the chief of neurology there for 7 years.

That's New York City's hospital for chronic diseases as a

place where people went with paraplegic, gunshot wounds, end

stage results of chronic progressing diseases. Epilepsy,

Alzheimer's, various diseases.

After 7 years there I went into private practice.

I have been in private practice at the address I stated

since 1977. And during those years I have been an attending

neurologist at many hospitals in New York, some of which

have closed, including St. Vincent's.

I have been and still am at NYU Medical Center,

Mount Sinai Hospital, Lenox Hill Hospital. And I am a

member of the New York County Medical Society. And I am a

fellow of the American Academy of Neurology. And I am a

member of the French Neurological Society in Paris. And I

am on a various boards. I am on the board of Generic

Disease Foundation at Mount Sinai Hospital.

I spend most of my time in my office and I teach

courses to NYU medical students once a year in clinical

neurology. And I teach residents at Mount Sinai Hospital in

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their clinics twice a year.

So, that's essentially what I do. I see patients

and I go to hospitals.

Q Have you written any papers that were related to

your field of study?

A

Q

I have.

And basically could you just give us a brief

overview of what the subject matter was of your medical

papers?

A I have written papers on reflex changes in the

spinal cord experimentally. And I have written a paper on

Parkinson's disease and several on aphasia, which is

language dysfunction from stroke in the brain. And I have

published papers also in the history of neurology.

Q

A

Q

Q

Approximately how many papers have you written?

About 20.

And have you

MR. RONEMUS: Sorry. How many what?

MS. SCIRETTA: Papers.

THE COURT: Papers.

MR. RONEMUS: Oh, papers. Okay.

Are you, you may have said, are you board

certified?

A I am board certified in neurology by the American

Board of Psychiatry and Neurology. And I have board

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certification from the American Board of Qualification in

EEG.

Q

A

Q

A

What does that mean, board qualification in EEG?

Specifically?

Yes.

Well that I took an examination from that board.

After showing them that I had spent the requisite

time seeing patients and doing EEGs and reading the

requisite number of records, then I had an oral and written

examination. And a simulated laboratory examination.

Q Approximately, doctor, how many EEGs would you say

you performed each year?

A

Q

A

Q

Well in my own office?

Yes.

Between 200 and 250 a year.

Are you ever called upon to read EEGs for other

physicians?

A I am sorry?

Q Are you called upon to read EEGs while at the

hospital or for other physicians?

A I've done that, too, as well.

Q Doctor, did there come a time that you were

requested to see a plaintiff by the name of Karen -- Leslie

Karen Lariviere?

A Yes.

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Q And were you contacted with respect to, again to

come here today to be in court to give testimony about your

findings on that matter?

A

Q

Yes.

And with respect to that contact, was there an

agreement that you would be compensated for your time away

from your office?

A

Q

A

Q

Yes.

And what was that agreement?

$4,000.

And that would encompass everything you've done on

this case?

A Yes.

Q Did you actually examine Miss Lariviere?

A Yes, I did.

Q Do you remember when you did that?

A Yes. On December 291 2010. I saw her once.

Q Now, with respect to seeing the patient were you

provided the patient plaintiff, were you provided with any

medical records for your review?

A

Q

I was. With some.

And with respect to that physical exam, did the

patient come to your office, plaintiff?

A Yeah. She came to my office and she was

accompanied by her husband and her attorney, Mr. Ronemus.

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Q When you conducted the physical examination, who

was present in the room?

A The three. The plaintiff, her attorney, and her

husband.

Q With respect to this examination, how did you

proceed with the examination? What were the first steps

you took?

A All right. I asked her to tell me how, what

happened to her. How the accident -- what kind of an

accident it was and how she was injured. What symptoms she

developed. And how they subsequently played out and how

she felt today.

Q What did you learn, starting from the beginning,

about what she told you?

A Well what she told me was that on the day of the

accident in 2008, in December, she was a pedestrian and she

was struck on the side of her head by the mirror on a

passing city bus. That caused the local injury. And she

was taken to, or she went immediately to Lutheran Hospital

in Brooklyn, which was close to where she's, close to where

she was as possible. And she went to the emergency room.

And she told me she was treated in the emergency

room and attention was given to the local scalp injury

(indicating). She was examined completely. And other

examinations were performed and she was ultimately

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discharged from the emergency room without being admitted to

the hospital. She was given the usual instructions that

people get when they go to the emergency room and have an

injury to the scalp.

And then she told me that sometime later she had an

event which was called a seizure. And as a result of that,

she was taken to, again to the Lutheran Hospital. And that

occurred about five months after the accident in April of

2009. And that's what she told me.

And she said that the seizure was observed by her

husband and he was present. And he, I think he also

described it a bit to me. And after that she had -- she

developed many different symptoms, which she claimed was a

result of this experience. And this involved her thinking,

her memory, her emotions. She became sad and depressed.

And she said that she became nauseated.

And she actually gave me a list that she made of

the kinds of ways her life had changed. And I think that

was very, very descriptive. And I could essentially read

all these points, but it covers so many aspects of life that

it affected sleep, sexual feelings, appetite, ability to do

mental calculations. Ability to cope with situations of

stress. In short, it changed her whole life, according to

her. That's what she told me. And as a result of this

seizure she was put on medication which included

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anti-convulsant medication we normally use in the treatment

of epilepsy.

At this point I would like to state when I say

seizure, I am using the word that the plaintiff gave to me

and that's been recurrent in the documents that I've

reviewed.

And I would like to say that seizure is a general

non-specific word in terms of cause, because seizures can be

caused by many different things. One of which is traumatic

brain injury. And at the other end of the spectrum, totally

psychological causes.

So, in neurology when we see a patient with a

seizure we do a number of investigations to see if we can

find any physical correlate in the brain to treat or whether

this has other etiology such as heart problems, lung

problems, reflex postural problems involving falling blood

pressures when you stand in different positions, or

emotional aspect.

So, she said that her seizure was treated by

various people and she was put on all of these medications

and she hated taking them and this had changed her life as

well. So that was the story I was given. She wasn't

working any longer. She had been working until the time of

the accident.

Q Did you, after receiving the history, did you

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proceed to do a physical examination?

A Yes. And I did that because my job as a --

MR. RONEMUS: Objection.

THE COURT: Sustained.

MR. RONEMUS: I don't think she asked why.

THE COURT: It's not responsive.

Ask the next question.

Q Doctor, with respect to your physical examination,

can you please describe for us what your findings were and

what was your objectives in examining each part of the body

that you

A

Q

A

Yeah.

-- you performed your physical on?

Well I examined each part of the nervous system in

order to see if there were any signs of abnormality that

would correlate with brain dysfunction.

Q

A

And what did you learn?

So I looked at all parts of the neurological

examination, which I will enumerate.

I looked at the way that she moves spontaneously

and spoke to me spontaneously. Listened to the content of

speech to see if it was logical. If her motor aspects of

speech production were normal. If rhythm content was

normal. She had any difficulty in word finding. I looked

at the way her face moved in making emotional expression,

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whether both sides moved equally or whether there was any

paralysis of movement.

I asked her to look at my finger and track it in

the cardinal positions of movement of the eyes to see if the

eyes moved together. Or whether she had double vision

because one eye didn't move as well as the other.

I looked at the pupillary reactions to light.

Shining a light in one eye and looking at the pupillary

response in that eye and the other eye and then changing

that direction. Which is a way of looking at intrinsic

brainstem functions.

I looked at the way she was able to put her tongue

out, move her mouth and tongue. And move her head in all

directions. Also I looked at the way that she was able to

walk and stand and I looked at the rhythm of gait and its

coordination and balance.

And I did tests of postural reflexes. And I looked

at her motor power in the limbs by seeing how strongly she

could contract her muscles against me. To see if there was

local paralysis in one place or another. And I looked at

the size of muscles in the arms and legs to see if there was

any wasting or atrophy, which is another direct sign of

neurological damage.

I also looked for any deformities of the skull or

anything that would look like an external sign of injury or

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any kind of local abnormality or congenital abnormality may

play a role in producing seizures.

I also looked at her reflexes because reflexes are

another direct indicator of spinal cord and brain injury. I

looked at certain reflexes which are telltale signs of

nervous system injuries, such as the Babinski sign in which

when the bottom of the foot is slowly stroked, the positive

sign is an involuntary withdrawal of the big toe and a

flexion of the leg away from the stimulus.

I looked for the Romberg sign. A sign of postural

incoordination which amounts to falling off a narrow stance

by placing the legs together, standing erect, putting the

arms out and closing one's eyes.

I looked at sensory testing. Looked at the

anterior to perceive position and touch sense on the limbs.

I looked also at her ability to flex, extend the back, lie

down, sit up. Do some coordination movements of the legs.

And to see if there was any kind of mechanical movement I

could make of the limbs or head that would produce pain. I

looked for tenderness over the scalp by percussing.

And that was a complete neurological examination to

see if there was any physical, neurological, abnormal sign

to correlate with any of her subjective multiple symptoms.

And by subjective I mean what somebody tells you he

feels. And objective, which is something that you can see

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and measure and could be reproducibly sign by someone who

you describe the situation. That's what I did.

Q What were your findings after doing that

comprehensive physical examination?

A What I found on this examination was a totally

normal examination. There was no abnormal physical,

neurological, mental finding on this exam that I could see.

At that time.

Q Did that also include her checking for double

vision that you said you had, had also checked for?

A

Q

A

Q

A

Check for what?

Double vision?

Yeah.

Did she have double vision?

No.

Q Did she complain of visual problems to you?


proceedings.)

A I can't remember specifically that she did.

I just want to go over this list of 24 -- no.

There's really no ... no. There's no specific visual

complaints. No visual complaints.

But she did say that she had occasionally

subjective olfactory and gustatory complaints. Those are

other sensory areas. Taste and smell. She said she would

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occasionally smell or taste things that really were not

present as if they were hallucinatory.

1079

Q What would be the significance of that complaint?

A It's an interesting question.

In some kinds of partial epilepsy that come from

the temporal lobe patients can have an onset of a seizure

with an olfactory or gustatory hallucination. And these

kinds of smells and tastes that they experience, which may

be a re-memorization of the smell and a taste from the

distant past for a depersonalization as if someplace they

have never been before, the smell and taste can be the onset

of temporal lobe or complex partial seizures.

And that's why I thought it was an interesting

symptom to look into and think about.

Q And with respect to this physical, was there a

purpose to the physical that you were aware of when you

were assigned this independent medical examination?

A

Q

A

Yes, there was a purpose.

And what was that purpose?

The purpose was to determine from my physical

examination and all of the other data that I was presented

to review, whether with reasonable medical certainty there

was any kind of neurological damage that could be

objectified from the accident and whether it was

responsible for all of this change in behavior. That was

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my job. That was what I was asked to do.

Q In your opinion, doctor, based on a reasonable

degree of neurological medical certainty, were any of the

symptoms that she complained of subjective symptoms

related, directly related to the accident she had on

December 9, 2008?

A Well my conclusion was, with reasonable medical

certainty, no. I didn't think so.

Q And when you say you didn't think so, what

specifically led you to that opinion?

A My neurological examination showed no higher

intellectual or any motor or physical abnormality.

The examination by personnel in the emergency room

at the time of the accident showed no signs of any injury to

the brain. Even though there was a scalp injury.

The seizure that developed months later was

witnessed only by members of her family. There was no

witnessing at any time in the course since the accident

until I saw her. There was no witnessing of a seizure by

anybody, any professional personnel or anybody in an

emergency room.

In addition to that, she was worked up for epilepsy

a number of ways. And there were no positive findings. She

was given a number of medications to control symptoms.

Whereas in a true bona fide case of organic epilepsy we

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usually only use one medication. We try very hard to limit

that to one medication to eliminate side effects.

So, the reason that I come to my conclusion is,

simply stated, there was no objectification of an injury to

the brain and there was no objectification of a true

epileptic seizure. Which is the result of a brain injury.

And that's why I concluded with reasonable medical

certainty that this accident and this scalp injury was not

productive of a brain injury, and therefore, was not

productive of epileptic seizures, and epileptic seizures

were not the nature of this behavioral change.

Q Dr. Hausknecht was a doctor that saw her a few

times and he took an EEG of which I believe you have a copy

of. That is a five second piece of tracing out of 20

minutes.

At the time that you examined her did you review,

also in formulating your opinion, what that EEG showed? Do

you know what

A Well it was given to me as a representative

example, but this is ten seconds worth, not five. Ten.

Q

A

Dr. Hausknecht said it was five.

What it does, it lists over here the placements of

the electrodes on the skull which are standard placements,

and here is the tracing.

Now this copy is a very bad copy. And I must say

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that I don't see anything in this particular ten second

sample that could be called an abnormality, and particularly

a paricsesible abnormality or epileptic abnormality or any

abnormality. I can only base objectively my interpretation

of his records on this example.

If this was given an as example, I don't think it

substantiates his conclusion.

Q Dr. Friedman, he testified and he said he had

conducted an EEG and he found that there was artifact and

it was minimally suggested

MR. RONEMUS: Objection. Could we ask a

question rather than leading?


Q Dr. Friedman said he did an EEG.

Have you seen any tracings from that EEG?

A No.

Q Have you read his report?

A I did, but right now I can't remember what it

said. I don't remember it saying that he reported

epileptic events. Could I look at it again?

THE COURT: Yes.

MR. RONEMUS: Right here. You want his

records?

MS. SCIRETTA: Yes.

MR. RONEMUS: Right there.

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A I do remember what it said 'cause I reviewed it in

my report.

Q Oh, okay.

A Just one second.


proceedings. )

A I was under the impression that Dr. Friedman's

report referred to Dr. Hausknecht's EEG.


proceedings.)

MS. SCIRETTA: May I approach, Your Honor?

THE COURT: Yes.

MS. SCIRETTA: This is Plaintiff's 29.


proceedings. )

Q Here is a better copy.

A I am looking at a report by Dr. Irving Friedman

dated 12/22/08 and titled electroencephalogram report,

Leslie Lariviere.


proceedings. )

A First of all, he reports --

THE COURT: Wait. Is there a question?

THE WITNESS: Oh, sorry.

MS. SCIRETTA: There was a pending question.

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I asked the doctor did he review it. He said he did.

And what were the findings.

Q

A

THE COURT: Okay.

Doctor, go ahead.

Dr. Friedman reports in his conclusion that this

is an abnormal EEG because of minimal diffused cerebral

dysfunction.

The reason I think he says that is because -

MR. RONEMUS: Objection as to why he said.

THE WITNESS: What's that?


MR. RONEMUS: I objected to what you are

about to say.

Q

A

THE COURT: And objection was sustained.

Next question.

Doctor, what is minimal cerebral dysfunction?

According to this report, the background consists

of 7 cycles per second activity up to --

asked him.

MR. RONEMUS: Objection. That's not what she


THE WITNESS: That's the answer.

THE COURT: Answer the question.

THE WITNESS: That's the answer.

MR. RONEMUS: Why don't you listen to her

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question again and --

THE WITNESS: I did.

THE COURT: Hello. Don't argue with each

other.

THE WITNESS: I wasn't.

THE COURT: Doctor, excuse me, don't respond

to plaintiff's counsel's objections. Those are for me.

THE WITNESS: Mmm-hmm.

Q Doctor, in reviewing that, record's in evidence,

you may read from it.

In reviewing that report, would you say you had

earlier for your other examination, is there anything that

you see or learned from that report that would suggest

epileptic activity?

A

Q

A

No.

Why is that?

Because there is no activity that seizure activity

of any kind.

Q What exactly is the activity that Dr. Friedman was

referring to?

A He was referring to a slowing in the frequency of

the basic alpha rhythm by one cycle per second. That's

what he was referring to.

Q

A

What does that mean?

I am not sure, but it doesn't have anything to do

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with epilepsy.

Q You can close that now.

At the conclusion of your examination was there an

impression that you arrived at based on her complaints, her

subjective complaints, your objective findings? Did you

come to a neurological medical impression?

A

Q

A

Yes.

And what was that impression?

That the records did not produce a neurological

diagnosis that she does not suffer from traumatic brain

injury. And that her seizures are psychological,

non-epileptic events and not epileptic in nature.

DTI?

Q

A

Q

A

Doctor, have you ever heard of a procedure called

Diffused tensor imaging?

Yes.

Yes.

MR. RONEMUS: Objection. No disclosure with

respect to DTI for this doctor.


Q Doctor, in a case such as this plaintiff's case,

have, would, in your opinion, other medical tests be a

benefit to assisting with any type of diagnosis for this

lady?

A For the diagnosis and treatment of her condition,

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yes, of course.

Yes. What would you suggest be done?

A video EEG.

1087

Q

A

Q Do you know whether a video EEG was recommended or

suggested by doctors who had seen her?

A

Q

A

Q

Yes.

And do you know if a video EEG was done?

It was not. According to what I know.

What would be the general purpose of an -- of a

video EEG? What would be the benefit of a video EEG in

this case?

A To be able to record the electrical activity from

the brain during one of the behavioral episodes and look at

the correlation. And that correlation would be able to

guide her treating physicians as to how best to treat her.

Q With respect to the seizures that she said she

sustained, or the seizures she said she sustained on April

19, 2009, that was witnessed by her husband, there was a

passerby who has worked in a doctor's office for 25 years

as an office manager. She is not a nurse or a physician or

anything of that kind.

Q



Doctor, if a person who works in a medical office

for 25 years as an office manager, would that person's

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opinion that she saw --


testified to.

THE COURT: Sustained. That's not the

testimony.

MS. SCIRETTA: You know we have a transcript.

THE COURT: Fine. So show me in the

transcript where we have what you are saying.

Q Doctor, when you say it was -- her seizure was not

witnessed by any medical personnel, what do you mean by

medical personnel?

A Somebody in a hospital; nurse, doctor, technician.

Q Would a layperson who works in a doctor's office

qualify, in your opinion?



Q Doctor, in this case Miss Lariviere did not bite

her tongue, lose either urine or feces, had normal focal,

there were no abnormal focal deficits found in the hospital

emergency room record. She did not lose ... she was not

confused when she got to the hospital.

Would that symptomatology have any significance to

a doctor who is looking for epileptic seizures or to confirm

epileptic seizures?

A Yes.

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Q

A


What would that mean?

Well you've just described the absence of all of

the signs that one would look for in a typical epileptic

seizure. So, that would be a very atypical presentation

for somebody who had just had an epileptic seizure.

Q So if she was not responsive at the time and her

eyes rolled back, and she stiffened up, what would you,

what could you categorize that in absence of loss of, no

loss of urine or feces or no tongue biting?

A Usually you can only make --

MR. RONEMUS: Objection. That's nothing what

he categorizes that report as.

MS. SCIRETTA: He was asked to evaluate for

seizures, too.

THE COURT: Approach.

(Whereupon, there was a discussion held at

the bench off the record.)

read.)

THE COURT: The objection is overruled.

Could we have the question read back?

(Whereupon, a portion of the record was

A It sounds like a seizure. And the cause of the

seizure has to be worked up with other methods.

When something sounds like a heart attack, you have

to do an EKG. When something sounds like a seizure, you

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have to do EEG in all of his complexities.

Q At the hospital, though, they did an EEG.

Did you learn about the results of that EEG?

A It was my impression it was normal.

Q Would -- they also did blood work.

Would a CPK (sic) show whether someone had a

seizure?

A Not directly.

Q Doctor, when you examined her and went over the

sensory examination, did you, actually did that from head

to toe pinprick, checking her reaction to all the skin

changes --


THE COURT: Sustained. Form.

Q Okay. Doctor, when you went over the physical

examination you did it from head to toe, correct?

Q



Doctor, when you based your impression after your

physical examination, was there anything that, on the

physical examination that you would have considered to be

an abnormal finding or a suspected finding that you would

need further follow-up for?

A The only part of the examination that would

require further follow-up was her history, nothing that I

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found in my physical examination, but the history is part

of the examination. So the answer is yeah, of course.

Q What specifically about the history needed --

A All of her symptoms and seizures and the question

about relations to the event.

Q Now, with respect to the history that you have

taken, were you also aware from taking the history and

having the husband present, that that was the one time they

saw that particular type of seizure and that the subsequent

seizures were different?

Q



Doctor, when she told you she had other seizures

besides that one on April 19, 2008, did she describe for

you her subsequent seizures?

A No.

Q Were you aware that she was claiming that she had

ongoing seizures?

A

Q

I was.

With respect to the ongoing seizures, would you

expect that they would be identical to the ones she had on

April 19, her first seizure?

Q



Doctor, is a seizure, the seizures that you

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evaluated, would that also -- you said there was something

about the smell and taste that could be a precursor to a

seizure, right?

A

Q

A

Q

A

Q

you?

I did.

Would stuttering be a precursor to a seizure?

It could possibly be. Yeah.

Would headaches be a precursor to a seizure?

That also can be.

And in her case, did she complain about that to

A Well she complained of all those. She complained

of headaches. Very strong part of her symptoms. Yes.

Part of this large list of symptoms. Dizziness, headaches,

problems remembering names.

Q What significance did you place on it on that

history?

A Well significance only that somebody is telling me

what they feel after an injury. And then it's my job in

this particular situation to look at all the data, look at

her and come to a conclusion. That's the only

significance. She has a complaint and that complaint has

to be evaluated in terms of the accident.

It wasn't my job to look for the cause of all her

complaints apart from the accident. That's for the treating

doctors.

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Q With respect to the complaint of seizure, you said

that you had considered psychological, non-epileptic basis

for the seizure?

A Again, what I said was that the absence of any EEG

abnormality that I could objectify with the absence of any

scanning abnormality with an absence of any neurological

abnormality on my exam, I concluded the seizures were not

epileptic. And the other categories of seizures do include

psychological non-epileptic seizures.

But I can't be in any way sure of what the cause of

her seizures is because I'm not her treating physician. I

only met her once.

Q With respect to your opinion, doctor, based on a

reasonable degree of neurological certainty, was the

accident of December 9, 2008 the proximate cause of her

complaints of seizures starting in April of 2009?

MR. RONEMUS: Objection. He just answered

that question. He can't he said answer.

respond.

MS. SCIRETTA: Not to that form.

THE WITNESS: That's not what I said.

THE COURT: I am going to allow him to

THE WITNESS: That's not what I was

THE COURT: Excuse me. I told you not to

THE WITNESS: I am sorry. I was talking to

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myself.

THE COURT: Now you can answer the question.

THE WITNESS: I am sorry. Could you just

read the question again because it's wording that's so

important here.

read.)

A No.

THE COURT: Yes.

MS. SCIRETTA: May we have a readback?

(Whereupon, a portion of the record was

Q Can you explain your basis of your opinion?

A Well it's really very, very straightforward I

think. The accident did not damage the brain by any of the

causes I mentioned, by any of the criteria I have

mentioned.

The seizures have never been witnessed by a

professional who said this looks like an epileptic seizure.

There has been no electromyographic correlate that is EGG.

And that's what, that's the simple answer.

That it's very much like being asked to see if a

house burned down because there was a fire. How you are

doing that by witnessing somebody who was in the fire, he is

coughing and it's months later so he has a cough. And he

says cough came from smoke inhalation. You look at the

house, there is no evidence of any damage. You conclude

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from somebody who was there, has a cough, that the house

burned down.

In the same way that's what the conclusion would be

if anybody wanted to make a correlation between this very

minor accident, neurologically speaking, and the events that

transpired. There is no objective evidence by standard

neurological methods that we use today in every day. There

is no objective evidence using the methods we use in

everyday clinical neurology that she has suffered a

traumatic brain injury. Therefore, the seizures which don't

have any objective correlates of epilepsy are not related to

the accident. No matter what else they might be related to.

Q Doctor, you, in your physical examination report,

you make reference to medication that she's on and you

testified to that a little while ago that she was on

several drugs.

What would be the significance of a patient that

has been ordered by her physician several antiseizure drugs

rather than the usual one or two?

A Well I can't answer, because to ask what the

significance is you have to ask the person who's treating

her. But in my opinion --


THE COURT: You just said you couldn't give

an opinion.

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THE WITNESS: I am saying

THE COURT: The objection is sustained.

A I don't know the significance. I would have to

speculate.

THE COURT: The objection is sustained.

Ask a different question.

Q A patient like Miss Lariviere, doctor, would one

seizure medication be able to control her condition or is

that not something you can answer?

A I can't answer that. I don't know what her

condition is caused by. It's not caused by the accident.

Q Those medications, Keppra, the Xanax, the Topamax,

the Gabapentin, are they also used for other conditions?

Are they also ordered for other conditions other than

seizure?

A

Q

A

Q

They can be. Yes.

Did she complain of mood problems to you?

Yes.

Were any of the mood problems related to her

complaints of seizure or were they independent?

A Well she said she was very depressed by having to

take all of these medicines which she attributed to the

seizures.

Q Thank you, doctor.

THE COURT: Cross.

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DR. APRIL - CROSS EXAMINATION - RONEMUS 1097

MR. RONEMUS: You have a file, doctor, that I

can look at that you brought with you?

THE COURT: You want a few minutes?

MR. RONEMUS: Yes. Just two minutes.

THE COURT: Ladies and gentlemen, we are

going to take a break for five minutes or so.

All rise. The jury may exit.

(Whereupon, the jury left the courtroom.)

(Whereupon, there was a break in the

proceedings and then resumed shortly thereafter.)

MR. RONEMUS: I am ready.

THE COURT: Okay. All rise.

(Whereupon, the jury entered the courtroom.)


And cross.

MR. RONEMUS: Thank you.

CROSS EXAMINATION

BY MR. RONEMUS:

Q Good afternoon, doctor.

A Good afternoon.

Q How are you? Do you remember me?

A Yes.

Q December 2010, right? So a little over a year.

year ago is when we met in your office?

A I think that was the date.

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DR. APRIL - CROSS EXAMINATION - RONEMUS

Q Yeah. December --

MS. SCIRETTA: 29.

Q December 9 -- wait.


proceedings. )

Q December 29, 2010.

Anyway, that's the day?

Certainly December.

Okay. You remember Mr. Lariviere?

Miss Lariviere?

Yeah. And Mr. and Mrs. Lariviere?

Yes.

1098

A

Q

A

Q

A

Q Can you tell us whether they're in court today,

either one of them?

him.

A

Q

A

I don't see her. I don't see him, if I remember

Okay.

I remember her better than I remember him. I took

a picture of her.

Q Okay. That's a picture of her as in a copy of the

report, right?

Yes. A

Q Now, you testified quite frequently on behalf of

defendants in court, correct?

A Well depends on what you mean by frequently. I

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used to testify more frequently.

Q Okay. Well you review cases frequently behalf of

defendants?

A Yes, I do.

Q And you review about ten cases a week on behalf of

defendants doing these type of neurological reviews?

A

Q

A

Q

A

Q

A

More like three to four.

Three to four a week?

Mmm-hmm.

In the past did you do ten in a week?

Sometimes.

Did you cut down, three to four?

I don't know. Things have changed. They come up,

they go down.

of

Q At this point in time you do three to four --

A

Q

A

Approximately.

Just let me finish.

Three to four neurological examinations on behalf

they're all on behalf of defendants per week, correct?

Well not quite. Not all are on behalf of

defendants. Sometimes plaintiffs come in.

Q About what percentage of your independent

examinations are done on behalf of defendants?

A

Q

Probably 80 to 90.

And how many years have you been doing these?

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Long time. Since 1980. A

Q Okay. And do you have a standard charge that you

charge for these examinations?

A Normally, yes.

Q What is it, about?

A About $500.

Q What you charged for Miss Lariviere's examination?

A Yes.

Q Now that whole examination took less than half an

hour. Would you agree with that?

A No.

Q How would you say -- first of all, we had an

interview in your office?

A

Q

Yes.

I mean they had an interview with you. That took

about 15 minutes?

A

Q

A

Q

20.

Okay.

15, 20 minutes.

Then you conducted an examination in your

examining room across the hall?

A

Q

A

Q

Yes.

Do you remember that day, by the way?

I do.

You remember when we got there you had no medical

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records of her?

A

Q

A

Possibly. Yes.

Well when you say possibly --

I don't remember that specific experience. I

1101

remember her and what she told me, giving me her list of

complaints, talking to her and you.

Q Do you recall -- do you recall when they came into

your office that you had no -- you had been provided no

medical records regarding Miss Lariviere?

A I specifically don't, because now as a time when I

review the case I had all these records, so I don't

remember that experience. I don't.

Q Well, do you remember getting a copy of five, or

of her doctor's reports from me on this day?

A Yes, I do.

Q Okay.

A That I can remember.

Q Other than this, you had no medical records at

that time when we came in?

It's possible. A

Q Do you remember saying that you weren't going to

conduct the examination that day because -- you don't

remember? Do you remember --

A I don't remember the circumstances or what we

talked about because clearly that wasn't germane to what I

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wanted to do; was to answer the question I was asked.

Q Okay. Well have you done about three or four

exams per week since that time?

A I suppose. Yes.

Q Approximately. Okay.

So, if you work 50 weeks a year, you have done more

than 200 examinations of patients in your office referred by

either defendants or plaintiffs since that time?

A And many, many more people who were sick every day

who come to see me. I have done lots, lots more than that.

Yes.

Q You have done a minimum number of examinations on

behalf of the Transit Authority, correct?

A I don't know. I have very few lately. I mean

over the years. Talking about 20 years ago.

Q

A

Q

A

Q

Yeah.

Generally speaking, yeah. Lately not so many.

I am talking over the years --

Yes, I have done a lot for the Transit Authority.

Let me finish. Then you can answer.

When you say you have done a lot for the Transit

Authority, would you say you have done over 300 examinations

on behalf of the Transit Authority over 20 years?

A I don't know. Honestly I am not prepared to

answer quantitatively.

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Q Okay. Well you knew the attorney who was handling

the case at the time, Miss Regina Regan, right?

A

Q

Yes.

Okay. You have done a number of examinations on

behalf of Miss Regan over the course of the years, true?

A I think that's a fair question.

MS. SCIRETTA: Note my objection to the

relevance.

A

Q

A

Q

Yes. That's a correct statement.

THE COURT: Overruled.

And is Miss Regan in court today?

She was. There she is.

Okay. About how many times would you say you

performed examinations on cases that Miss Regan was

handling at the time?

A I really don't know. I could say a handful and be

off or I could say three or four. I can't remember all.

Q Do you remember trying to call Miss Regan from

your office to determine whether or not you should proceed

with the examination on this day?

A

Q

A

Q

Yes, I do.

And you were not able to reach her, right?

I don't remember that.

Okay. Do you remember calling the company called,

I think Juris Solution?

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A No. I think the front desk must have done all

that. I wanted to get on with the examination.

Q Well the front desk is your wife, right?

A Yes.

Q Yeah.

So she was -- just the two of you were in the

office, your wife and you on that day.

1104

Do you remember your wife trying to call or you

trying to call Miss Regan or the company Juris Solution who

had apparently sent you this case to do an examination?

A

Q

A

Q

May I answer this question?

Let me ask the question.

I thought it was the end of your question.

Do you remember either you or your wife trying to

call either Miss Regan or Juris Solution to determine

whether you would go ahead with the examination?

Do you remember that, yes or no?

A I really don't remember the details. All I

remember is we did the examination.

Q Okay. Have you coached attorneys in the past

about how to present a case?

MS. SCIRETTA: Note my objection.

THE COURT: Yeah. Can you rephrase that?

Q Have you instructed attorneys over the time you

worked with the Transit Authority about how they should

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present a case or what questions they should ask in court?

MS. SCIRETTA: Objection to that line of

inquiry.


A The answer is on one occasion, yes. Long, long

time ago somebody asked me to come do a seminar.

Q No. I am talking about during the course of a

trial have you communicated with the attorney handling the

case on behalf of the Transit Authority, told him or her

what they do, should do as far as how to proceed during the

course of the trial?

MS. SCIRETTA: Order some -- objection.


A If I was asked that question I would say I have

done that on a number of occasions. This is a way I would

do it if I were you. Because the questions that were, we

are really talking about are medical. This is a way to

develop evidence in a medical situation.

Q So, would you consider yourself to be independent

if you are telling the Transit Authority attorney how to

ask questions or what questions to ask during the course of

a trial?

A

Q

Yes. I really would.

You think your this jury should consider you to

be independent even though during the course of the trial

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you have instructed the attorney what questions to ask, for

example, or how to ask such a question?

A

Q

A

Q

You think they should still --

Absolutely.

You should still

I will explain why.

Okay. And isn't it true that during the course of

this trial you have instructed Miss Sciretta about what

questions she should ask or how she should ask such

questions?

Q


THE COURT: Rephrase your question.

Have you, during the course of this trial, had

e-mail correspondence with Miss Sciretta telling us what

her, what questions she should ask or how she should ask

those questions?

A



I have had e-mail conversations with her about

this case. Yes.

Q And during those e-mails have you told her what

questions she should ask or what areas she should delve

into and how she should ask those questions?

MS. SCIRETTA: Objection.


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A I've given my opinion about ways I think the

information I think is important in this case should be

brought out to this jury. Yes.

Q Okay. And you still consider yourself to be

independent --

A Absolutely.

Q Let me finish my question.

1107

You still consider yourself to be independent, even

though during the course of this trial you have instructed

Miss Sciretta as to what questions she should ask or how she

should ask the questions, correct?

A I haven't instructed. And the answer to the

question about independent is absolutely. Yes.

I would like to explain.

THE COURT: You are not being asked to

explain.

THE WITNESS: Okay.

Q Isn't it true you sent her an e-mail March 24,

which is in your file, three pages, instructing her what

questions she should ask? How she should ask those

questions?

A Well you might let the jury decide that. I don't

know. Let's see what you are talking about.

Q Let me ask you some questions about this e-mail

was in your file.

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A

file.

Q


Sure. If you found it there, certainly in my

Okay.


proceedings.)

1108

Q Okay. With respect to Dr. Friedman it's, you told

Miss Sciretta that he's not an independent treating doctor,

but one chosen by the plaintiff's attorney.

Isn't that correct that you e-mailed her and told

her that?

A I was repeating something that we were talking

about before. The fact is that Dr. Friedman --

Q I didn't ask you that.

I am asking you did you

MS. SCIRETTA: Question

THE COURT: He is not responding to the

question. Overruled.

Q So, when you had discussions with Miss Sciretta

about what questions she should ask Dr. Friedman during the

course of this trial?

A

Q

Yes.

And did you tell her that Dr. Friedman should be

considered not an independent doctor in this case?

A No. More -- let me put it this way. I felt he

was a treating doctor and his relationship to the plaintiff

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was treating and that she trusted him because he was her

treating doctor. But that he had been chosen by her

attorney, not by another doctor.

And we were talking about the general principle of

how patients in the medical community get referred to

specialists. And what I was saying was that treating people

are referred by treating people. When I am seeing patients

it's my colleagues who refer to me. And I treat those

patients.

Q

A

Okay.

Lawyers don't refer to me for treatment to answer

a question in the courtroom.

Q Do you know why they went to Dr. Friedman instead

of Dr. Maniscalco?

A They went to Dr. Maniscalco also.

Q

A

Q

Q

A

Q

Do you know why they went to Friedman rather -

I have no idea.

Did you read the testimony that no fault -

MS. SCIRETTA: Objection. Note my -


Dr. Friedman --

I didn't read it. No.

Okay. On one paragraph here you talk referring to

Dr. Friedman, page twelve, diatribe. You referred to

Dr. Friedman as a diatribe?

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A Perfectly descriptive --

Q When I am done with the question then you can

answer.

A I understand.

Q Okay. You said that his page twelve diatribe,

that's what you are talking about, his testimony was a

diatribe?

A I don't remember page twelve. I can't answer.

1110

Q No. But do you remember writing this e-mail to

Miss Sciretta and calling Dr. Friedman's testimony a

diatribe?

A

Q

A

Q

A

Q

A

I

Yes.

The e-mail is

Do you remember writing the e-mail

I remember writing the e-mail.

--calling Dr. Friedman's testimony a diatribe?

Yes. A diatribe.

Q You consider that to be an independent analysis of

Dr. Friedman's testimony or someone who is biased on behalf

of the Transit Authority?

A

Q

A

That's independent. A diatribe.

That's fine. You answered.

Okay. With explanation.

THE COURT: You are not being asked for an

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explanation.

THE WITNESS: I know. I understand.

THE COURT: You can answer the questions yes

or no, you should do that. This is cross examination.

Q Further down the page you referring to

Dr. Friedman, quote, the rest of his chatter is just that.

His remarks on page -- on 21 appear to be pandering.

Would you consider that to be an independent

analysis of Dr. Friedman's testimony, or someone who is

biased on behalf of the Transit Authority?

A I am not biased on behalf of the Transit

Authority.

Q Okay. So your answer

A I am biased on behalf of the truth. Yes, it's

independent.

Q Top of page two, you indicate can't drive in

traffic. Did you ever put a surveillance on her.

Is that something that you, as a doctor, typically

inquire with respect to attorneys about?

A Yes.

Q Did she tell you whether they had ever conducted

surveillance?

A

Q

A

No. No.

She didn't answer that question?

No.

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Q Do you know whether the Transit Authority ever

conducted any surveillance of Miss Lariviere?

A I do not.

So you got no answer to this question?

I don't know.

1112

Q

A

Q When you are talking about surveillance, you are

talking about an investigator sitting outside their house

perhaps in a van with a video camera who could videotape

Miss Lariviere over the last three years, correct?

A

Q

Yes. That's what attorneys do.

Okay. And you don't know whether that's been done

in this case, true?

A

Q

No.

You have never seen any videotape of

Miss Lariviere doing anything --

A

Q

doing?

A

Q

correct?

A

Q

A

No.

-- other than what she says she is capable of

No.

You don't know whether any such videotape exists,

I do not.

Next line. Great cross on page 27. FF.

What's FF mean?

Follow pages following.

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Q Okay. So you are telling Miss Sciretta she did a

great cross examination of somebody, according to what you

wrote on the fourth line of page two?

A

Q

Yes. That's my independent opinion.

Your independent opinion was that the attorney for

the Transit Authority did a great cross examination?

A That particular situation, yes.

Q Okay. You are not biased towards the Transit

Authority whatsoever in your analysis?

A

Q

Not at all.

Okay.


proceedings.)

Q Then you are talking about Mr. Lariviere's

transcript. You read that as well, correct?

A

Q

should

Q

A

Q

Yes.

And you coached Miss Sciretta about what she

MS. SCIRETTA: Coach. You know -

THE COURT: Don't use that word.

Well you, you

Commented.

-- wrote an e-mail making recommendations about

what she should and shouldn't do with respect to that,

true?

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I think it was more of a comment. A

Q Okay. With respect to the husband's transcript

you said, no need to dwell on his rendition of accident.

Are you talking about the injury to the brain or

the seizure that she had in April of 2000

A

Q

A

Q

I don't remember.

You don't know what you are talking about?

I don't know what you are referring to.

Well let me show you. There's no need to dwell on

his rendition of accident. Let's cut to the chase.

A

Q

Do you know what you meant by that?

Yes.

So when you e-mailed that to Miss Sciretta you

said don't dwell on what Mr. Lariviere says about the

accident. Let's cut to the chase?

A Yes. Cut to the chase is very important. That's

what I would like to do now.


courtroom.)

Q Okay. We will get to the chase.

A I hope so.

Q We're getting there.

I think you would agree that, you know, your

independence, whether you are actually an independent

witness or not is important in this case, true? That's an

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important thing --

Think it's very important. A

Q Okay. Because do you know that you are the only

doctor called by the Transit Authority who has ever seen

Miss Lariviere?

A

Q

No, I didn't know that.

Have you ever graded other reports from other, any

other doctors on behalf of the Transit Authority who

examined Miss Lariviere?

A No because -- no.

Q I didn't ask you because.

A No.

Q Have you?

A No.

Q Okay.


proceedings.)

Q

A

Q

You read Susan Brown's transcript, true?

Yes, I did.

And so you know that there was an independent

witness to this event which has been called a seizure

April 19, 2009?

A

Q

Yes. With an explanation.

Okay. And so when you said here on your direct

examination, when you said Mr. Lariviere was the only

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witness to that, that wasn't correct because --

Sorry. A

Q On your direct examination when you testified that

Mr. Lariviere was the only witness to the seizure, that's

not correct, true?

A I don't think I said that. I say I think he was a

witness to the seizure. I knew Miss Brown had seen this.

Q You did?

A

Q

A

Yes.

How about the reports you wrote for this case?

Yes.

Q Did you refer to any other witnesses to the

seizure other than Mr. Lariviere?

A No. I didn't know at that time. I have known

since.

Q When did you find out that Miss Brown was a

witness to the seizure?

A

Q

A

Q

Sometime when I talked to the attorney about it.

When was that?

In the last five days.

So after the trial started then you learned that

there was actually another witness --

A

Q

A

Yes.

-- to the seizure?

Yes.

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Q Which is inconsistent with what you wrote in your

report that Mr. --

MS. SCIRETTA: Objection to inconsistent. It

predates the report. Predates Miss Brown.

THE COURT: Still inconsistent. Overruled.

Q Now you wrote in your report, only her husband

observed the grand mal seizure. That's not true.

A

Q

That was true at the time.

Well, it was true that you didn't know it at the

time. It wasn't true at the time. In fact, there had been

a witness since the time of the event?

A Without information I guess one can only say what

he knows at the time as truth.

Q Okay. When you wrote in your report, only her

husband was the only witness, that, now you have learned,

is not true?

A Yes.

Q You have learned what you wrote in your report

since that time, you have learned what you wrote is not

true, correct?

A Is not true now.

Well I don't want to argue. The answer is yes,

with explanation.

Q Okay. With respect to the plaintiff's testimony

you said, I would not emphasize the 1994 marijuana charge.

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It has nothing to do with the case.

That's what you told Miss Sciretta, right?

Nothing to do with the case. A

Q Right. Nothing whatsoever to do with the case. I

would agree with you on that.

A Well that's good.

Q

2005.

case?

A

Okay. Big life stressor. Sister dropped dead in

What, if any, relevance does that have with this

I think great losses like that have relevance to

everybody's life and to symptom production.

Q Okay. So, what's the relevance to this case --

A I am not sure because I can't get inside of this

person's head. It's not my patient.

Q

A

Q

When you said has great relevance

I think it should be explored.

Let me finish, then you can answer.

You have an opinion as you sit here today what

relevance the fact that her sister, as you said, dropped

dead in 2005, has to this case?

A I do. But I can't say it has to this case

specify. Therefore, I can't answer; but as to other cases

I have seen.

Q I am not asking about other cases.

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A

Q

A

Q

A

Q


Okay.

I am asking about the case -

I understand.

-- we are here in court today.

I cannot say anything more.

Okay. So as you sit here today you have no

1119

opinion whether the sister dropping dead in 2005 has any

relation to the complaints Miss Lariviere has made?

A

Q

None. With explanation.

Okay. You wrote, she loves Dr. Friedman because

he has stuck with you.

Is it your opinion Miss Lariviere loves

Dr. Friedman?

A That's a figure of speech. It means a patient's

attached to doctors, and everybody knows that. And he is

her treating doctor. He has a special domain in this case.

Q Special domain. He is the one who has seen her

since immediately after the time of the accident up until

today?

A

Q

Absolutely.

And so he is in a better position than perhaps any

doctor to give an opinion about her to this jury, correct?

A

MS. SCIRETTA: Objection. He is calling -


Absolutely not. With explanation.

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proceedings.)

1120

Q Okay. So, then at the end of the pointing these

things out you make recommendations to Miss Sciretta.

In conclusion, Miss Sciretta, I would say I do not

think any of these statements by deponents and witnesses

really changes the arguments I have raised and I have

discussed with you now on two different occasions.

What I am

MS. SCIRETTA: The attorney/client. Also my

objection in preparation for litigation.

THE COURT: Approach. Approach. Approach.

(Whereupon, there was a discussion held at

the bench off the record.)

THE COURT: Let's continue.


proceedings.)

Q Okay. So, just finishing up this e-mail you sent

to Miss Sciretta, you said in conclusion, Miss Sciretta, I

would say I do not think any of these statements by

deponents and witnesses really change the arguments I have

raised and discussed with you now in two different

occasions.

A

That's what you wrote there, right?

Yes.

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Q Okay. So, you have discussed how she should

present this case on two occasions before the time of this

e-mail?

MS. SCIRETTA: Note my objection to the

topics that we discussed at the time.

A

Q

A


Not quite.

Well you had two telephone conversations with her?

No, no, no, no. We are not talking about the

nature of communication, we are talking about the

substance.

Q No.

When you say here you are talking about two

different occasions, you have discussed with her on two

different occasions, were these in person meetings or over

the telephone when you had discussions with her about this

trial coming up?

A

Q

Yes. And your question related to --

I didn't ask you anything else. Just answer the

question, if you don't mind.

A

Q

I am not sure. What's the question?

My question was, when you discussed with her on

two different occasions, what is it, in person or over the

telephone?

A Oh, no, it was on the telephone.

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Q Okay. And during those telephone conversations

did you discuss with her what questions she should ask and

how she should present the case to the jury?

A

Q

A

In so doing, yes. Yes.

Okay.

With explanation, again.

Q Okay. All right. So ... so just so we're clear,

your diagnosis is that she does not have a brain injury?

A That's correct.

Q Your diagnosis and your opinion is that the

accident that we are here about did not injure her brain at

all?

A

Q

That's correct.

Okay. Following the time she left the emergency

room on the date of the accident, December 9, '08, what did

she do for the next week?

A I don't know.

Q Wouldn't that be important in you deciding whether

or not she had a brain injury?

A

Q

No.

Doesn't matter? Doesn't matter if she went back

to work or if she spent the week in bed?

A Well all of that has relevance to her treatment,

but not to the question we are raising here that I am here

for.

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Q Okay. Well you are here to say whether or not she

had a brain injury?

A

Q

A

Q

That's correct.

And your opinion, she didn't have a brain injury?

That's correct.

You are telling the jury it didn't matter for the

week after the accident what she did, true?

A No. With explanation.

Q Well did it matter what she did during the week

after the accident?

A No. With explanation.

Q When you say no, with explanation, you mean it

didn't matter but you want to explain why it didn't matter?

A

Q

That's what I mean.

Okay. So, you are saying when you say no, it

didn't matter, then it didn't matter to you whether she

went back to work the day following the accident or whether

she remained in bed unable to move for the week after the

accident?

A Well

Q Is that what you were saying?

A I would say the latter. She moved very well when

I saw here. She didn't have a paralytic injury.

Q

A

Well was she in bed with headaches and vomiting?

She could have been. She had all the symptoms.

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Q

A

Q


Doctor, please. Please.

I don't know. I didn't follow her the week after.

I am just asking. Just don't interrupt me. Okay?

I mean the -- you have been in court for 20 years.

You know the rules.

MS. SCIRETTA: Note my objection to his

lecturing the witness.


Q Just let me finish the question.

THE COURT: Doctor, just answer the question

and only the question.

THE WITNESS: Thank you. I will.

Q Okay. All right. So it's your opinion that she

had no brain injury following the accident?

A

Q

A

Q

That's what I said.

As a result of the accident?

That is what we said.

You have read the report of Irving Friedman? The

reports of Dr. Friedman, correct?

THE COURT: Yes?

THE WITNESS: I have. Yes.

Q Okay. And you understand that Dr. Friedman is of

the opinion she sustained a traumatic brain injury from the

accident?

A Yes.

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And you disagree with him?

I do.

1125

Q

A

Q

A

Q

And you have read the reports of Dr. Hausknecht?

I have.

He is a neurologist who examined her on three

different occasions I believe, correct?

A

Q

A

Q

Yes.

Conducted an EEG, correct?

Yes.

And by the way, the ten seconds of EEG, who gave

you that page?

A

Q

A

Q

A

Q

The attorney.

Miss Sciretta?

Yes.

When did she give that to you?

In the last two weeks.

Okay. When you wrote your report you had never

seen that, as you call it a bad copy, of the copy ten

seconds of the EEG?

A

Q

That's correct. No, I haven't.

You never seen the actual EEG itself, whether a

printout or on a computer screen --

A No.

Q

A

-- that Dr. Hausknecht conducted?

No.

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Q Okay. So, you understand, Dr. Hausknecht's

opinion is that Mrs. Lariviere sustained a traumatic brain

injury from this accident, correct?

A

Q

A

Q

I do.

You disagree with Dr. Hausknecht?

I do.

Okay. Dr. Greenwald, I think Dr. Greenwald, you

had his reports, right?

A

Q

I read them.

You know he is a specialist in treating brain

injury patients up at Mount Sinai?

A

Q

A

Q

A

I know who he is. Yes.

You know who he is? Have you met him before?

Yes.

Have you testified in cases where he's testified?

I don't know.

Q Okay. And you understand that Dr. Greenwald

treated her over the course of about a year?

A

Q

year?

A

Q

A

Q

I do.

And how many times did he see her during that

I don't know.

Was it once or twice? Do you have any idea?

I have no idea.

You haven't read his trial testimony?

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A I read -- I didn't read his trial testimony.

Q Okay. I want you to assume he testified he saw

her I think eight times over the course of a year and once

again in February in preparation for trial. So, total of

nine times, about a half an hour each time. .Okay.

And you understand that Dr. Greenwald's opinion is

that Mrs. Lariviere sustained a traumatic brain injury as a

result of this accident, correct?

A

Q

A

Q

reports?

A

Q

A

Q

A

Q

A

Q

A

Q

A

Q

Yes.

You disagree with him?

Yes.

Okay. Dr. Hibbard, have you read Dr. Hibbard's

Some of them.

Which ones have you read?

I don't remember.

Are they reflected in your report at all?

No.

When did you get Dr. Hibbard's reports?

Later.

When?

Recently.

Within the, since the time the trial started?

Yes.

Okay. And you know Dr. Hibbard is a

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neuropsychologist?

A I know her very well. She has seen many of my

patients.

Q Okay. You think she is a competent

neuropsychologist?

A I am not going to answer this question.

Q

A

Q

Okay.

Because that's not relevant.

THE COURT: Don't tell us why.

THE WITNESS: Mmm-hmm.

Okay. Do you know how many days Dr. Hibbard

conducted examinations of Miss Lariviere?

A I do not. No.

Q The report you saw here, did that indicate how

1128

many days she tested Miss Lariviere for neuropsychological

testing?

A I can't remember.

Q Do you have the report with you?

A No.

Q Where is it?

Could be in the chart. Chart's on your desk.

Take a look. See if it's in your chart.


proceedings.)

A

Q

A I don't know where it is.

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Q

A

Q

A

Q

report?

A

Q

A

Q


If it's not in your chart, where else could it be?

It could be in -- I don't know where it is.

Where were you when you received it?

I am sorry. I don't remember the detail.

Do you remember -- did you read Dr. Hibbard's

I read Dr. Hibbard's report.

Did you read one report or more than one report?

I can't remember.

Other than Dr. Hibbard's report, is there anything

else missing from your file?

A

Q

A

Q

A

That I read?

Yes.

Hausknecht's reports.

That's not in there?

I don't have them in here, I don't think. I have

Friedman's reports. I don't know.

Q Do you know where Hausknecht's reports might be?

A They might be in my office. I may have only taken

part of the chart with me.

Q Do you have a separate file for this case in your

office?

A This was the separate file, but in looking through

it I might have left the other part there. There was no

specific reason I would have done that.

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Q I am just asking you if there is anything else

missing other than Dr. Hibbard's reports and Hausknecht?

A

Q

No.

Okay. All right.

So, having read Dr. Hibbard's reports, at least one

of her reports, you understand Dr. Hibbard, after conducting

a full battery of neuropsychology exams is of the opinion

Miss Lariviere sustained a permanent brain injury as a

result of the accident?

A I understand that. And I would like to explain

because it's important. I know Dr. Hibbard well. I know

how she works. I know how I work with her.

Q Okay. You understand that that's her opinion

after conducting a full battery of neuropsychology exams,

true?

A I do understand that.

Q Certainly a neuropsychology exam is the standard

type of exam to determine whether someone testified a mild

traumatic brain injury from an accident, correct?

A No.

Q

A

Q

A

Q

Okay. Well that's -

I disagree.

You disagree?

Very much. Strongly.

Something that can assist a neurologist in

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understanding the type of brain injury someone sustained in

an accident?

A

Q

A

Q

A

analysis.

Q

A

Q

A

Q

A

Absolutely not.

Doesn't help you at all?

Not at all. And I will tell you why.

Dr. Schuster, have you read Dr. Schuster's report?

Yes. Dr. Schuster prepared the life cost

Yeah. What else did he do?

I don't remember. He did psychological testing.

What else did he do?

I don't remember.

Where is his report?

I don't know. It's another one that's missing,

but I did read it.

Q

A

When did you read Dr. Schuster's report?

Mmm. Well my memory says to me I think I have had

that a long time, but I don't think I referred to it in

here. However, it's in my chart and I did see it.

Q It's in your chart now?

A No.

Q You refer to it in your report of your examination

of Miss Lariviere?

I have five different reports that I gave you that

you refer to in your report.

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A

Q

Right. That's where I got it. I got it from you.

So you had it as of the date you examined --

A

Q

A

Q

A

You are teasing me.

I am teasing you?

That's right.

I am teasing you?

Okay. All right.


courtroom.)

Q I am not trying to tease you, doctor, I am just

asking questions.

A It does seem that way.

Q I am not trying to tease you.

You have, according to your report, you have

Dr. Schuster's report as of the day you examined

Miss Lariviere?

A

Q

I did. I did. I read it.

You know he prepared a life care plan where he

recommended certain things he says she needs. He also did

a neuropsychological examination?

A Yes.

Q And I don't, I don't know if you remember he gave

an evaluation of whether or not she was capable of working

a vocational assessment. Those are the three things he

did?

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too.

A

Q

A


Yes. That's what he does. I know Dr. Schuster,

You know him, too?

Yes.

Q Dr. Schuster's of the opinion that she can't work

because she has a permanent brain injury and it's a result

of the accident?

A I understand that.

Q You are aware that's his plan?

A

Q

A

Yes.

Okay. And you disagree with Dr. Schuster?

For a number of years. I can explain the error of

his logic.

Q Okay. All these people are in error. All their

opinions that she has a brain injury are in error. You are

the one that's correct, right?

A It's not because I am absolute truth, it's because

in this case the facts don't substantiate it. I am not

claiming to be absolute truth.

Q Okay. I hope not.

A

Q

No.

Okay. Finally, Dr. Luciano. You had his report.

He is a specialist in epilepsy, correct?

A

Q

Yes. He is a good one. A good person.

He is of the opinion that she, Miss Lariviere,

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sustained traumatic epilepsy or seizures as a result of the

accident?

A I am not sure of that. Should we go over his

report? I don't think that's what it says.

Q You have do his report?

A I thought so. I hope so. It's very important.


proceedings.)

A

Q

A

Q

A

Q

A

No. This is Dr. Schuster right here.

You have Schuster?

I do have Schuster.

Schuster is a very small report.

All right. I am not going to waste time.

You had his report?

Yes.

You saw his opinions?

They're very important. I don't think that's what

he really said.

Q Okay. Well if it's not I am sure Miss Sciretta

will correct us.

A Okay.

Q

Q

Let's move on. I want to finish.

MS. SCIRETTA: Can I get a copy?

THE COURT: No. He is moving on.

Initially the report of Dr. Lipton regarding the

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MRI done at Montefiore, did you ever see that?

A

Q

No.

Are you aware she had an MRI performed up at

1135

Montefiore in 2011? That was the radiological report was

done by Michael Lipton?

MS. SCIRETTA: Objection. He said MRI. DTI

was what I started to ask him. It's not the same.

Q Are you aware she had -- she had an MRI at

Montefiore in 2011 that was reported by Dr. Lipton?

A

Q

I don't think I saw that report.

Okay. You don't know what the results of that, of

those testings, of that test would be?

A No. No, I have seen reports that MRis were normal

but I didn't know who did them.

Q Okay. You have never seen an abnormal report of

an MRI, correct?

A

Q

A

Q

A

Q

A

Q

Of the magnetic resonance imaging, no.

Diffused tensor MRI?

I have not heard about diffused tensor MRI.

Done in this case?

No. I have heard of an MRI.

Okay.

That's what I was talking about.

Okay.


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proceedings.)

Q All right. Just briefly I want to just go over

the complaints Miss Lariviere's had regarding

radiculopathy.

You are a neurologist, right? And she saw an

orthopedist, Dr. Lichardi.

Do you have Dr. Lichardi's records?

A It's not even cognizant of that being a major

issue in this case.

Q Well whether it's a major issue or not, I want to

go over it and --

A I don't have it. No.

Q Okay. You don't have it. Let's talk about that.


proceedings.)

MS. SCIRETTA: Objection. This is beyond -


MS. SCIRETTA: If he wants to hold us to an

IME report --

THE COURT: I heard you. And I ruled.

Q Have you ever seen records from Hamilton Medical

Center or Dr. Lichardi?

A

Q

I have, but not in this case.

Okay.


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courtroom.)

I am talking about this case.

No, I know.

Okay. You don't know what those records show?

Not in this case.

1137

Q

A

Q

A

Q Okay. So these records are in evidence, Exhibit

Number 3.


proceedings.)

Q And if they show that she had a left C5-C6

radiculopathy, tell us what that means, radiculopathy?

A Well it means that something is causing

dysfunction of the nerve root that comes out of the

cervical spine and goes down to the muscles of the upper

arm and often causes pain and numbness, sometimes weakness.

Q

A

Q

Uh-huh.

And is very disturbing.

Okay. And do you know that she was diagnosed with

a left C5-C6 radiculopathy at Hamilton Medical Center?

Hamilton Medical Service?

A

Q

MS. SCIRETTA: Objection.

Do I know?

Yes.


You can answer this question.

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A

Q


I can answer. No. I am not aware of it at all.

Okay. All right. I want you to assume that these

records that are in evidence say that on March 24, 2009,

right, March 24, so, January, February, March, that's more

than three months after the accident, the opinion is, urn,

Miss Lariviere is status post motor vehicle accident versus

pedestrians on December 9, 2008.

right?

A

Q

This means she was hit by a bus in this case,

Yes.

She continues to be in excruciating pain in the

cervical region more on the left paracervical area.

What's the paracervical area?

A Neck to the, neck down on to the shoulder.

Q Left shoulder, burning sensation. She can barely

stand her clothes. She cannot stand, tolerate either moist

heat or cold. Physical therapy worsens her symptoms. She

ends up with a migraine headache and throwing up after the

ultrasounds and TENS. And that she is disabled, according

to this doctor.

Do you have an opinion whether that condition at

that time was the result of the motor vehicle accident

December 9, 2008?

MS. SCIRETTA: Objection. He didn't -


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Q Do you have any opinion about her, the

radiculopathy that was referred to in these records,

whether it's the result of the accident or not?

1139

MS. SCIRETTA: Same objection. He did not -

THE COURT: Sustained. Approach.

MR. RONEMUS: I will move on.

THE COURT: Okay.

MR. RONEMUS: I am about done.

Q Okay. Finally, doctor, I think you made a

diagnosis that she doesn't have seizures or brain injury,

but she has what you call PNEA, psychological non-epileptic

activity.

A

Q

Is that what that means?

Yeah.

So, your diagnosis, she has, I think you said she

has seizures but they're the result of a psychological

condition?

A I can't be sure of that. I can't be sure of the

etiology. But I can tell you with absolute relevant

medical certainty based on the facts of this case that it's

not due to traumatic brain injury from this accident.

And again I will explain why.

Q Well what's it due to then?

A I don't know. But, you know, I am not the

treating doctor. And there is so many causes of seizure

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that is not epileptic. And Dr. Luciano asked for the

definitive gold standard test. It wasn't done.

Q All right. You said that before.

1140

So, the symptoms that she reported to you, you are

not doubting she had those symptoms she complained to you?

A

Q

Not a bit. She is suffering.

She is suffering. Okay.

And she is suffering the list that she gave you,

included she can't remember --well they're in your report,

right?

A

Q

A

Q

They're right here.

Can't remember how to spell?

Right.

Adding no longer have control of her money. I

have a stuttering problem.

You want to follow along, just make sure I am

reading them right?

A

Q

A

Q

A

Q

I am sure you are. I will be glad to do that.

Okay. Got them?

Which page are you on?

I am on number four.

Okay.

I have a hard time concentrating on anything, on

one thing. Number five, don't remember what I said

yesterday. Or hour ago. Can't remember where I put

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things. Number six, loss of sex drive. Number seven, loss

of hair. Number eight, I can't remember if I've taken my

meds on my own. Number nine, the seizures sucks.

A

Q

A

Q

That's right.

Anxiety and nervous all the time.

Mmm-hmm.

That's number ten.

Number eleven, migraines that make me so sick that

I am in bed for two to three days.

A That I vomit and I stay in bed in the dark for two

to three days.

Q Vomiting and staying in the dark.

Number twelve, I can no longer work. Number

thirteen, feeling dizzy every day. Afraid to be alone.

Number fourteen, I don't remember names, faces, old friends

and I used to be a hostess. And a very good one at that.

A Must have a different one from me because you are

always one number ahead. It's different writing. She must

have prepared several lists.

Q Okay. The next one is, I don't leave the house

that often without somebody.

A

Q

paranoia.

A

Yeah.

Going to different doctors all the time and

It's out of order, but it's the same information.

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May I comment?

No, you may not.

Okay.

1142

Q

A

Q Those are the complaints she voiced to you that

day, right? Okay.

A

Q

THE COURT: Yes?

And wrote. Voiced and wrote.

You are not denying she suffers from all of those

symptoms and conditions, correct?

A Symptoms are always taken seriously.

Q Okay. And at that time when you examined her she

appeared tired, worn out and in pain?


proceedings. )

A Just one second.


proceedings. )

A Yes. But she was remarkably able to carry out all

the functions I asked her to do.

Q

A

Q

A

Q

A

Okay.

And no. No, I agree everything -

I didn't ask you --

I agree with you.

-- general neurological examination.

The answer is yes. Pardon me.

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Q The general neurological exam you told us about

was a normal neurological exam, correct?

A Yes.

Q Okay. That does not mean she is not suffering

from all of the things she told you about?

A No.

Q Okay. And you don't doubt her credibility in what

she told you that she's suffering from these things?

MS. SCIRETTA: Objection to the vouching.

THE COURT: He is not vouching, he is being

asked a question. Overruled.

You may answer.

A You can't comment on her credibility. Only a

treating doctor could do that possibly.

Q

A

Q

Okay.

But --

We have had treating doctor --

A You are talking about motivation report. About

motivation, all I can tell you, the facts are the case.

Q It wasn't your opinion that she was faking or

exaggerating any of these symptoms she complained to you

about, true?

A You know, that's always in the back of one's mind

when there is a reward at the end of the rainbow.

Q It's not what I asked.

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DR. APRIL - REDIRECT EXAMINATION - SCIRETTA 1144

So I can't exclude it completely. A

Q You didn't write in any report or anywhere, ever,

that she was exaggerating or faking these symptoms

whatsoever, true?

A There is no way I could be sure and write that in.

I could be sure there is no brain injury.

Q Did I ask you that?

A

Q

A

Q

That's all.

That's all?

Finished.

Good. Thanks.

MR. RONEMUS: Nothing further.

THE COURT: Redirect.

You have ten minutes and then plaintiff will

have five minutes.

MS. SCIRETTA: May I just see your list?

THE WITNESS: My list?


proceedings. )

MS. SCIRETTA: Do you have Dr. Lucciardi's

subpoenaed record?

MR. RONEMUS: No. No, I don't have anything.

REDIRECT EXAMINATION

BY MS. SCIRETTA:

Q Okay. Doctor, on Dr. -- you were asked several

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questions, you said you needed to give an explanation.

Did it change your opinion after reading

Miss Brown's trial testimony regarding the, what she

observed, that this was a seizure that was observed by a

medical personnel?

A No.

Q

A

And why is that?

Because it was a seizure of some kind. It was a

change in behavior and it was sudden and it lasted a

certain time. And it wasn't normal. That's a seizure.

But that is not epilepsy necessarily.

And some of these seizures that are not true

epileptic seizures are called pseudoseizures, look very much

like epilepsy. People often get treated as if they're

epileptic when they're not. That's why new developments in

epileptology Dr. Lucciardi himself asked for are very

important.


asked him.

THE WITNESS: Sorry.

THE COURT: The last part about the doctor is

out. It's not responsive.

THE WITNESS: So

THE COURT: No, you are finished.

Next question.

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DR. APRIL - REDIRECT EXAMINATION - SCIRETTA

Q Doctor, when you sent me this e-mail was it in

response to something I had sent you?

A No. It was a way of discussing my opinion.

Q

A

Q

A

Q

A

Q

Did I give you Dr. Friedman's trial testimony?

Yes.

And did I ask you to comment?

You did.

These were your comments?

Those are certainly my comments.

And you have pretty much, as counsel told

everyone, three pages here, but you were asked very few

questions regarding this.

What was your impression of, after reading

Dr. Friedman's trial testimony that you

Q


that you wanted to explain to this jury


THE COURT: Basis?

MR. RONEMUS: Can't comment on doctor's

opinion of Dr. Friedman's trial testimony.

MS. SCIRETTA: He asked him.

1146

THE COURT: No, no. He asked him about that.

Sustained.

MR. RONEMUS: If he hadn't want to comment on

the facts

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DR. APRIL - REDIRECT EXAMINATION - SCIRETTA

THE COURT: Rephrase that.

MR. RONEMUS: I have no objection to

commenting on the facts.

Q Doctor, with respect to the trial testimony of

1147

Dr. Friedman that you read, when you read his sworn

testimony was there, as a neurologist, reading about what

another neurologist was testifying to, did you have any

observations that would be pertinent to this case to tell

us and the jury?

A

Q

A

Yes.

What was that?

Namely, that he was overlooking the real facts of

the case in coming up with his formulation. There was

never a positive EEG, there were no MRis findings, CT

findings.

CT scanning is the one technique that has been

developed to put in emergency rooms. Every hospital budget

has a place for CT scan because it's the one single way of

ruling out traumatic injury to the brain when somebody comes

from a fall, a motor vehicle accident, a construction

injury, something falls on your head. This is the one way

we rule out trauma to the brain, skull fractures, swelling,

and bleeding.

There was none of that in this case. This was a

minor injury to the scalp. Dr. Friedman overlooks those

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facts. He overlooks the basic facts of neurology in coming

to this conclusion about a cause and relationship. That's

why I really object to what he says; not his treatment of

the patient, that is wonderful. Treat symptoms any way you

can. Make people feel better. But this is about this cause

and effect relationship in this trial. And this is not

correct.

Q Did you also tell me that --


THE COURT: Sustained. Unless that's

something that's in evidence.

MS. SCIRETTA: Well counsel read from --

Q Okay. Did you -- did you make an observation that

her prognosis might be improved after any kind of a lawsuit

settlement?


THE COURT: Sustained. Leading.

Q Doctor, do you have any impressions about the

motivation of the patient --

MR. RONEMUS: Objection. There is nothing

ever been disclosed about that.


MS. SCIRETTA: You know, he makes -- it's not

one sided here.

Q Doctor --

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THE COURT: No, but your question does not

stem from the questions on that document.

Q

You want to approach?

MS. SCIRETTA: No.

Doctor, when Dr. Lucciardi have an orthopedist --

you are not an orthopedist?

A

Q

No.

But an orthopedist who saw her a couple of weeks

after her accident came to an impression that there, this

is in evidence, that she's status post acute trauma to the

cervical spinal, some evidence of left shoulder rotator

cuff tendonitis sciatica that, doctor, include a C5-C6

radiculopathy?


THE COURT: Basis?

MR. RONEMUS: She is asking a neurologist

what an orthopedist would include in their report.

MS. SCIRETTA: He asked them that question.

MR. RONEMUS: I didn't ask him what an

orthopedist would include in a report. I object.

THE COURT: I don't know what you are asking.

You need to rephrase the question.

Q You were asked a question by counsel that were you

aware that she, the plaintiff, was diagnosed with C5-C6

cervical radiculopathy. And the doctor who saw her, his

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impression after seeing her and examining her was status

post acute trauma of the cervical spine in some evidence of

left shoulder rotator cuff tendonitis and left sciatica.

Would that, as a doctor, would that include a C5-C6

radiculopathy?

A Isn't that what you just read?

Q

A

Q

The sciatica?

It read there was a, is acute cervical trauma?

No. Says status post acute trauma to the cervical

spine, early evidence of left shoulder rotator cuff.

A

Q

normal?

A

Q

It could include a cervical radiculopathy. Yes.

There was an MRI taken by this doctor which was

Okay.

Would the MRI of the shoulder rule out any issues

with her shoulder that he thought might be the early stages

of ... rotator cuff tendonitis?

A I am going to have to defer to an orthopedist.

It's a purely orthopedic question.

Q This doctor also wrote that she may return -- she

returned to work for financial obligations?

A

Q

A

Q

She may return to work.

She did return?

I see.

But had to return to work for financial

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obligations.

Were you aware of that?

A Well that's what I thought. You see, I didn't

think she went to bed paralyzed. I thought she carried out

her normal functions as best she could, even though you

suffered.

MR. RONEMUS: I object to that answer about

the paralyzed.

THE WITNESS: That's the impression I had.

MR. RONEMUS: Nobody said that other than

him. I object to that answer.

THE WITNESS: Sorry.

THE COURT: Sustained. That piece is

stricken. The rest of the answer will stand.

You have 30 seconds.

Q What did you want to add, doctor, with an

explanation to Dr. Lipton's, the questions stemming about

Dr. Lipton's DTI examination?

A Well I don't see any reason in this case for DTI

because there is no brain injury, and DTI is something that

relates to axonal injury in people who are in coma,

vegetative states. Really an experimental way at looking

at the diffused injury to the brain after major trauma.

Nothing to do with this case.

Q Did you ever --

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DR. APRIL - RECROSS EXAMINATION - RONEMUS 1152

THE COURT: This is the last question.

Q Have you sent patients for DTI, and for what

reason?

A Yes. We have a big magnet at Mount Sinai looking

for precise diagnoses of progressive brain degeneration,

such as the olivopontocerebellar degeneration, amyotrophic

lateral sclerovis, Parkinson's disease. Other degenerative

diseases that are progressive and crippling.

THE COURT: That's it.

MR. RONEMUS: I got five minutes.

THE COURT: Recross. You have five minutes.

RECROSS EXAMINATION

BY MR. RONEMUS:

Q Doctor, you just testified she did not have a

brain injury because the CAT scan taken in the emergency

room didn't show any evidence of a brain injury?

A

Q

And the MRI that were done.

Okay. Now, would you agree that the mild

traumatic brain injury often or rarely shows up on a CAT

scan?

A

Q

A

Q

No.

You don't agree with that?

No.

Would you agree that that rarely shows up on a

normal MRI exam?

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A

Q

DR. APRIL - RECROSS EXAMINATION - RONEMUS

No.

So you are saying that a CAT scan or MRI would

1153

diagnose someone with a mild traumatic brain injury?

A

Q

That's our today's gold standard.

Okay. Would you agree, this is in evidence, that

the white matter lesions detected by diffusion tensor

imaging correlate with persistent cognitive deficits and

mild traumatic brain injury?

A I don't think there is any literature of diffused

tensor imaging in mild brain injury that has been

recognized by the neurological community. Absolutely not.

Q Okay. Well suppose I told you what I just read to

you was written by the defense witness who they called this

morning?

A

Q

A

Q

you?

A

Q

A

Okay.

You still disagree with that?

I haven't read it.

You said you disagreed with what I just said to

I did.

That it, a DTI can be useful -

Yes.

Q -- in diagnosing cognitive impairments for mild

traumatic brain injury?

A Yes. With explanation.

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DR. APRIL - RECROSS EXAMINATION - RONEMUS 1154

Q And does the fact that this was written by

Dr. Zimmerman, who was the Transit Authority's last witness

before you, change your opinion at all?

A I don't know what it says.


MS. SCIRETTA: 2006.

THE COURT: I would have to -- overruled.

THE WITNESS: Sorry. What's overruled, my

question? (Sic)

THE COURT: The objection is overruled.

A May I see it?

THE COURT: I don't know there is any

question.

Q Does that change your opinion it was written by

Dr. Zimmerman? Yes or no? Yes or no? Yes or no?

A Is it because it is written by Dr. Zimmerman it's

changing my opinion or what you said?

Q

A

Q

No.

You said you disagree with what I just read to you.

If I understood what you said, I disagree with it.

Okay.

MR. RONEMUS: I have no further questions.

THE COURT: You may step down, doctor.

THE WITNESS: Thank you.

MS. SCIRETTA: May I have a follow-up?

VdV

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LESLIE KAREN LARIVIERE - TRIAL 1155

THE COURT: We do two rounds. We have done

two rounds with every witness. That it's. And it's

4:28.

(Whereupon, the witness was excused from the

stand.)

THE COURT: Ladies and gentlemen, all through

this trial we have not been here on -- you have not

been here on Thursdays. I want to finish this case by

Friday. So, we will be here tomorrow morning.

Whichever jurors have not been on time

previously, I expect you will be on time tomorrow. If

you are not on time, if this case goes into Monday,

it's because you have not been here. There's only a

very limited amount of testimony left, then there is

summations, charge, and your deliberations.

I am trying to get you out of here by Friday.

Close of business Friday. I can only do that if you

are here. I am pushing the attorneys to finish

quickly. Please, be on time.

All rise. The jury may exit.

(Whereupon, the jury left the courtroom.)


Summations. I am going to have to limit them

in time so, I would say an hour and a quarter each.

That's it.

VdV

Documents

1065 - New York Injury Cases Blog