Deposition of Expert Witness/Doctor in Motor Vehicle Accident Lawsuit
STATE OF ILLINOIS COUNTY OF COOK
The evidence deposition of The evidence deposition of AREF SENNO, taken in the above-entitled cause, before JEANINE EDDINGS, a notary public of Cook County, Illinois, on the 21st day of February, 2002, at 2320 West Peterson Avenue, Chicago, Illinois, pursuant to Subpoena.
Reported by: Jeanine Eddings, CSR
License No.: 084-003253
AREF SENNO, M.D.
By Mr. Spinak 4
By Ms. Cohen 38
MARKED FOR ID
AREF SENNO, M.D., called as a witness herein, having been first duly sworn, was examined and testified as follows:
BY MR. SPINAK:
Q. Would you state your name for the record? A. Aref Senno,A-r-e-f, S-e-n-n-o.
reflect that this is the evidence deposition of Doctor Aref Senno taken pursuant to court order and subject to all rules.
BY MR. SPINAK:
Q. Doctor, please understand that in this deposition, we are treating it as if we were sitting in front of the jury and they were listening to you testify live. So my questions are going to be addressed to you in that fashion, which may sound a little strange at times since we're not actually doing that. But I Know you've given depositions before. Please follow the normal protocol that we always do.
In this instance, however, there may be objections. And that's fine. And you'll be able to?? counsel or by myself when she's questioning you, because the court will ultimately decide before we go to trial what questions are okay and what questions might not be. All right, sir?
Q. All right. So we are going to start as if I have just you to the witness stand. first question is would you state your name, please?
Q. And what is your occupation, sir?
A. Physicians and surgeon - physician and surgeon.
Q. And how long have you been a physician and surgeon?
A. Since 1962. Since I finished my medical school.
Q. All right. Can we just do - take a short look at your background that led you to whatever degrees you have as a physician and surgeon. And in doing that, sir, it's my understanding that you attended medical school outside of the United States; is that correct?
Q. And where was that?
A. At University of Dusseldorf, West Germany.
Q. And was West Germany your home country, sir?
Q. Where were you originally from?
A. I'm originally from Beirut, Lebanon.
Q. Now, you graduated - how long was your medical school study in Dusseldorf?
A. It includes the American University of Beirut where I did have a Bachelor of Science from there, which is four years like here in the United States. And four years in Vienna and Germany, West Germany.
Q. All right. And upon completion of your graduation from medical school, you became licensed to practice medicine; is that correct?
A. Correct, in Germany if I like.
Q. All right. And in Germany, did you take an internship, sir?
A. Many of them.
A. In Wattenscheid, Germany as rotating internship.
Q. Now, does that rotating internship cover multiple fields in the area of medicine?
A. Correct. It includes every kind of specialties.
Q. Okay. And after completing that rotating internship - which was for how long, by the way?!
A. For two years.
Q. All right. Did you then enter into a residency program?
Q. And where was the first place that you did that?
A. In Marien Hospital, Wattenscheid, Germany.
Q. Okay. And how long was that first residency program?
A. For one year.
Q. And it was in what area?
A. It was in also in different kind of surgery, which include general surgery, urology, orthopedic surgery.
Q. Now, when you completed and went to Wattenscheid, Germany, that first residency, did you go on to a second residency?
A. I went to England and I did have a residency in general surgery at West Hill Hospital in England, Dartford, England.
Q. And how long was that for, sir?
A. For about six months.
Q. All right. And when you completed that, where was your next? ...
A. I was at the University of Cologne in Germany as a resident - as a resident for one year.
Q. And following that?
A. I was in Bertha Krankenhaus as chief surgeon in Bertha Krankenhaus which include general surgery, urology and orthopedic surgery.!
Q. And did you become, during the time period you were in that final residency and chief residency, board certified in surgery?
A. I was board certified 1969 by the German Board of Certification.
Q. All right. And at - after you completed your chief residency in Reinhausen, Germany, where did ... you go next, sir?
A. I came to United States for the purpose of doing thoracic cardiovascular surgery.
Q. And did you get training over here -
Q. (continuing) - in those areas?
Q. Where was the first place, sir?
A. Deaconess Hospital in Milwaukee, Wisconsin.
Q. And was that a residency or an internship?
A. It was like a - it was like a fellowship in reality. It was mostly in cardio-thoracic, cardiovascular surgery.
Q. All right. And following that, did you follow that up with a residency?
A. Yes. I was at the New York Medical College. New York Medical College. And I did residency a chief residency in thoracic cardiovascular I surgery.
Q. And after that - that took us to the end of 1973?
Q. That was a two-year residency?
A. Two-year residency.
Q. And then where did you follow up next?!
A. I went to Memorial Hospital in Worcester, Massachusetts and I was chief resident for general surgery.
Q. And that was for how long?
A. For one year.
Q. And then the last - not necessarily the last but the next residency and/or studies in the United States?
A. I was at Harvard Medical School, the
Children Hospital. And I was a fellow in)
cardiovascular surgery for Fellow in Research of Cardiovascular Surgery for one year.
Q. All right. Now, was that the - beyond -
excepting some post recurring attendance at continuing - continuing medical education seminars and things of that nature, was that the summon substance of your total training?
A. Yes. I would say yes. I was different fellowship too in - at Peter Ben Bringham also at Harvard as observing. I was in different kinds of - I was exposed to different kinds of -
Q. I'm sorry. Go ahead.
A. So I was exposed to different kind of medical activities and medical research.
Q. All right. Now in - during the course of! your educational and post educational career, did you - have you published at all?
A. I publish around what I know, around 11, but there are more than 11 publications. There are about 19 publications.
Q. And were these - the writings that you did, did they cover any particular area or were they in various different areas?
A. Right, they are mostly in the cardiac physiology and cardiac - cardiac anomalies. And also in the chest, chest programs and chest diseases too.
Q. Now, after your graduation and the completion of all the residencies, fellowships, whatever, did you go into private practice?
A. I went into private practice in Chicago.
Q. And when did you begin that private practice approximately?
Q. All right. And have you been in private practice since?
A. Since then, yes.
Q. All right. And does your private practice encompass only surgery or is it more general in nature?
A. I founded the group which is the medical group which include different subspecialties. But my - my practice is involved everything including family practice, general surgery and thoracic cardiovascular surgery.
Q. All right. Sir, the board certification you received in Germany, did that carry over to the United States as well?
A. It carries over. They recognize it, but they don't recognize it as an American entity.
Q. All right. So you still - you have the right to refer to yourself as board certified?
A. I refer to myself as board certified from different country. But I'm here board eligible more than board certified.
Q. All right. Fine. Calling your attention to! January of 1995. Did you have an occasion to treat a patient by the name of Stefan Dimitrov?
A. I have to return to ray - to my folder in order to recognize that.
Q. All right. Well -
A. If you don't mind.
Q. Can you tell from looking at the materials in front of you whether or not you treated a Mr. Stefan Dimitrov?
A. Yes, I treated Stefan Dimitrov.
Q. All right. Let me ask you a question, sir.
During the time frame that you treated Mr. Dimitrov, did you contemporaneously maintain records and/or notes concerning your care, treatment, et cetera, of Mr. Dimitrov?
Q. And are these the documents that you have in front of you that you glanced at to determine that you had seen Mr. Dimitrov?
Q. And are you going to need - do you have an independent recollection of Mr. Dimitrov?
Q. All right. Will you need to utilize your records to testify here today about your care and treatment of him?
?? that the witness be allowed to those records during his testimony. And if there's no - if there's no objection, then subject to the court ruling.
BY MR. SPINAK:
Q. Doctor, when did you first see Mr. Dimitrov?
A. On 1-27-95. January 27, ′95.
Q. And at that time, did you and/or Mr. Dimitrov or both of you fill out a initial sheet detailing background information about Mr. Dimitrov and initial findings on your part and documenting or dealing with the history?
A. Correct. We have a special sheet for the first visit.
Q. All right. And Mr. - the upper portion of that document, Doctor, does that - is that filled out normally by the patient themselves?
A. Usually it is by the patient himself. But at this time, most probably either - I have no idea what happens.
Q. Okay. In any event, after getting that, you - would the first thing you do be meet with the patient?
A. I meet with the patient.
Q. And in this case, does the balance of the sheet other than the upper portion, the intake sheet, deal with your initial contact with the patient?
Q. All right. Now, when - did you take a history from the patient?
Q. And what did the history reveal with respect to why the patient was there?
A. He was there - he's a driver. And he was driving on the expressway and he was hit by - from the back by another vehicle.
Q. Okay. And what was he complaining about?
A. He complained about headache, dizziness, pain of the neck and feeling sick in his stomach.
Q. All right. Did - did he indicate to you when the accident that he had described had taken place?
A. Usually I wrote it. But I think it's one day before, I think. But I didn't write it there. Usually I write it on there, on the admission sheet.
Q. All right. And had he had any medical assistance prior to seeing you?
A. According to him, he didn't go to the emergency room.
Q. All right. And so we - to your knowledge, were you the first person to deal with him?
Q. All right. And after getting the history and hearing his complaints, did you conduct an examination?
Q. And can you tell us briefly what that examination consisted of?
A. Tenderness of the neck, spasm of the muscles of the neck. The chest was clear, the heart and sinus rhythm and there was some tenderness over the chest.
Q. All right. That's the results of the examination, correct?
A. Pupils equal and react to light. The pupils were normal.
Q. All right. So the primary area where you - would it be fair to say that the primary area where you found or document at least his complaints was in the neck area?
Q. All right. Now, you used a couple of words there when you were referring to that. One of them was spasm. What is a spasm?
A. Spasm is like cramping of the muscle which is involuntary.
Q. So if you as a medical examiner finds spasm in a patient such as Mr. Dimitrov, is that finding an objective or a subjective finding?
A. Objective finding.
Q. All right. You used - you said involuntary response. Do you mean that a patient can't cause a spasm to occur in the absence of injury?
Q. All right. You also used the word tenderness in a couple of places. I believe one had to do with his chest and the other with his neck. Would you explain what you mean by that?
A. Tenderness has a big relationship with the the experiences of the physician who is working with them, working with the patient. In my opinion it is objective, the pain is subjective.
A. If the patient tells you he has pain, it is subjective. In my opinion, tenderness is objective. Why? Because there is some relationship of the anatomy with the tenderness that the patient is telling us. And if we have - if the physician has experience, he knows very well that this is present or not.
Q. All right. And that's with an actual laying on of hands -
Q. (continuing) - to the affected areas?
Q. NOW, you said he had a contusion to the chest. What is a contusion, Doctor?
A. It's like a force that you apply to the chest and it has sequences.
Q. Does it cause bruising?
A. Sometime it cause bruising. Sometimes blue discoloration of the skin. Sometimes it doesn't cause anything other than pain and tenderness.
Q. All right. Do you recall or do your notes indicate whether or not in this case there was a discoloration caused by the contusion to this gentleman's sternum area?
A. According to my notes, no.
Q. All right.
A. He didn't have any discoloration.
Q. Does that suggest to you that the complaint of tenderness to the sternum area is not valid?
A. No. The history of the accident and the history that the patient hit the wheel, the driver wheel is that there's a possibility there is a contusion of the chest.
Q. And then again in the area of the chest, did you lay hands on and do whatever - perform whatever -
Q. (continuing) - functions that you normally would perform?
Q. All right. And it was your opinion that there was, in fact, a contusion?
A. I think it's a contusion, yes.
Q. Now, having done the examination and made a diagnosis, which I guess was the sprain of the neck and the contusion of the chest, did you decide upon or undertake a course of care for the patient based upon that finding?
A. I advised the patient to do two things, a chest x-ray and x-ray of the cervical spine.
Q. All right. And were those taken?
A. They were taken.
Q. And were they subsequently read by you?
A. They were read by me, yes.
Q. And would - with respect to both of those, were there any positive findings on the x-rays?
A. No, there was - they were both normal.
Q. All right. Does the fact that the x-rays whether to the chest and/or the neck were normal again suggest to you that the complaints of Mr. Dimitrov were less than what he was at least complaining of?
A. Yes, I think the chest x-ray will give us if there is any fracture or broken bones or if there's any changes in the contour or the silhouette of the cervical spine. But there is some connection and relationship also to what Mr. Dimitrov is saying, is telling us.
Q. Well, I guess my question is, Doctor, does that - does the fact that a normal finding, for example, on the cervical spine diminish his complaints to you in your mind
Q. All right. So having done that - by the way, you said x-rays are primarily to look for bone deformity or changes?
Q. Fractures, et cetera?
A. Correct. Correct.
Q. Will x-rays show injuries to the soft tissues that surround those bony areas?
A. Not a hundred percent.
Q. All right. Having then completed those tests, did you recommend a course of care?
A. Correct, yes.
Q. And what was that?
A. It was advise him to do physical therapy. i
A. And I prescribed for him Naprosyn, 375 i milligrams three times a day.
Q. And what is Naprosyn?
A. Naprosyn has analgesics which is - which is, what do you call it, is for painkiller.
A. And at the same time, it has some slight muscle relaxant effect.
Q. Now, you've already told us that based upon the history you took, he was a driver of a vehicle, that was what he did as an occupation, correct?
Q. When you recommend and/or prescribe Naprosyn to patients, are they permitted to operate machinery and/or vehicles under the influence of this?
A. They can operate on it because the amount is 375 milligrams, but it is advisable not to take medicine and go on the street.
Q. All right. And so if Mr. Dimitrov was a limousine driver, do you know, did you recommend that he not continue with his normal occupation during the\ time he was under your care and at least taking the medication?
A. For Naprosyn, yes, and for the pain that the patient has.
Q. Now, the second thing you said you recommended besides the medications were physical therapy. First of all, could you explain to the ladies and gentlemen of the jury what you mean by physical therapy?
A. Physical therapy is something that - an entity that we do it in order to accelerate the treatment of the symptoms that the patient has -
Q. Does physical therapy accelerate the healing process?
Q.?? is that based upon your experience as a medical doctor?
A. Right, and medically, too.
Q. All right. Now, you - within your office facility that Mr. Dimitrov was going to, did you have a physical therapy department?
Q. And is that where you had him go for the physical therapy care that you recommended?
Q. And was the physical therapy care that you recommended under your control and supervision?
Q. All right. In the notes that you have, do you have the notes of the physical therapist?
Q. And having looked through those notes, to the best of your knowledge in terms of reading them, did the physical therapist conform to the things you wanted done for Mr. Dimitrov on the basis of your diagnosis?
Q. Now, I note also later on that there is a billing statement that outlines specific physical therapy treatments that Mr. Dimitrov underwent. Let me ask you about those - well, first of all, for how long a period was he getting physical therapy? He i first received it when, sir?
A. Went from 1-27-95 to 2-22-95.
Q. All right. And according to the physical therapy billing statement, the following - I think you called them modalities were performed, and I'm going to ask you about each one just so the jury can understand what it is you're talking about. The first one is hot moist packs. What are hot moist packs?
A. What happens is in the - what you are doing in reality with hot moist pack is accelerating the i blood flow toward the area where it is injured.
Q. And is that a large object or a little pack like you sometimes see in drugstores?!
A. It's a large pad that you put it for sometimes I think 20 minutes, 30 minutes.
Q. All right. Is that something that can be bought by anybody off the street or does it require purchase at a medical supply house?
A. You can buy it, you can play doctor and buy it. But it's always under the supervision of a physical therapist.
Q. All right. And you said that is meant to increase blood flow to the area that's injured; is that correct?
Q. And how does that promote the - why is blood flow increase important to the healing process?
A. It's trauma to the muscles through the injury through the accident, for example. And there is always some reaction from the body toward this trauma by swelling, by injuring some muscles inside, ... and invasion of the white blood count and the blood ... cells toward the area - toward the injured area. So what we do - and there is also a vasoconstriction of the blood vessels in these areas. So what we do with this type of modality is to increase the blood flow by elevate - elevating the vasoconstriction of the blood toward the injured area.
Q. All right. And that increases the white blood count?
A. And this -
Q. White blood cell blood count?
A. The white blood cells, they will go there and do their jobs.
Q. And are white blood cells the blood cells in our bloodstreams that are the heal - that create heal ing?
A. They accelerate the healing.
Q. Okay. Now, the next one I note is something called high voltage. What is high voltage?
A. Is to increase the intensity that - for every muscles, there's a nerve. And through the nerve, we put the high voltage in order to increase the contractility and the - and also part of the flow is to relax also the muscles through the high voltage itself
Q. All right. And is this actually an electrical current that is passed through the area?
Q. All right. And again, it accelerates the blood flow and all the other things we talked about when we were dealing with the hot moist packs?
A. Correct, accelerate the healing.
Q. All right. Now, the next one is muscle - massage, massage therapy.
A. Massage therapy has about the same - the same - the same physiological character like the other two. But this one was applied from outside through the hands. And it gives better feeling to the patient, plus better blood flow to the muscles of the neck or any part of the body.
Q. And the last of the types that are listed on here is something called McManus traction. What is McManus traction?
A. McManus traction is when you try, when the patient has pain and you try to pull the muscles that they are - that - to bring them back to their position through contraction and relieve the contraction by pulling the head. It can be done i either by lying down or by sitting on a chair.
Q. All right. And again, in this case the - how does the McManus traction alleviate the pain?
A. It's just in order to find the spasm of the muscles of the neck.
Q. Initially when all of these treatments are given, are they given for the purpose of alleviating the pain which is generated by the spasm?
A. It has two or three purposes. One of them is to alleviate the pain, as you said. The second is to accelerate the healing. And third is psychological, too, to feel - so the patient can feel comfortable.
Q. Okay. Now, Doctor, you start - you told us we start these on the 27th. When do you next see the patient?
A. I saw the next time on 2-6-95.
Q. And how was the patient doing at that time?
A. He has still the pain and spasm of the muscle of the neck with stiffness of the shoulders.
Q. Okay. Is that unusual that the area now has sort of branched out into the shoulder area?
A. Correct, because ail the nerves of the neck comes around the shoulder and comes down to the arms too.
Q. So is this a normal progression that you often see?
A. Correct, it's normal.
Q. All right. And having done this examination, did you continue him on the medications and also the physical therapy?
A. I believe so.
Q. All right. And to your knowledge, then he continued the physical therapy I think you told us the last date for the physical therapy was the 22nd of February in 1995; is that correct?
Q. And when he finished the physical therapy, did he come back to you again?
A. On the - February 24, 1995.
Q. And what was his condition on that visit with you?
A. He still have pain of the neck, headache, with some tenderness over the neck.
Q. Had the spasm diminished by this point? ...
A. Yeah, there was no spasm of the muscles.
Q. All right. Had the patient been making satisfactory progress under the course of care and treatment that you were rendering to him?
A. It looks to me, yes, except the pain of the neck and the headache.\
Q. All right. Is it normal for a patient, this is approximately a month post accident, to have made improvement but not necessarily have made total improvement?
A. It's normal, yes.
Q. All right. Did - at that point was he released from your care?
A. We didn't see him at all after that.
Q. And at that point, was he released to return to his normal work activities as a limousine driver?
A. I believe so because - I didn't write it, but I believe so.
Q. All right. Now, when he left your care, what was his prognosis?
A. It's guarded.
Q. What does that mean, Doctor?
A. It means whenever we have an injury, especially trauma or accident of a - a motor accident and it traumatize the neck, we have always the precaution that this in the future might develop into some kind of pain or some kind of radiculopathy, which is pain of the neck, persistent pain of the neck or coming and going pain of the neck. That's why we put guarded.
Q. Is it fair to say that you have not seen him since?
Q. And is it also fair to say that you don't know what his condition has been since you last saw him in 1995 through the current date?
Q. All right. Doctor, I have some questions concerning opinions you may hold. Doctor, do you have an opinion to a reasonable degree of medical and scientific certainty as to whether or not the condition of ill-being?? - that you found Mr. Dimitrov to be suffering from was causally connected to the automobile accident of January 26th, 1995?
that. Just that there's no mention of any type of a - of those kind of opinions in the 213. MR. SPINAK: Well, you know, there are
more than one 213. And there was a supplemental one I know done by the Elovitz firm. And I was informed by probably Mrs. Bradkey - wait a minute. Let me see who it was just so it's on the record. John Irwin that that was covered. I'll just tell you that -
MS. COHEN: Do you have any document to show that?
MR. SPINAK: I - I have this which I believe is in your file.
MS. COHEN: Do you have something that shows what you/re saying?
MR. SPINAK: From John Irwin? MS. COHEN: No, what you're saying - MR. SPINAK: Yeah, this document with the handwritten addition to the bottom which was supplied, I think that's what they did.
MS. COHEN: Let me see your handwritten addition.
MR. SPINAK: Sure. This was not done by me. This was done a long time ago. But I think - let's go off the record for just a moment.
MS. COHEN: Yeah, let's do that. (Discussion held off the record.)
MR. SPINAK: Is the objection then withdrawn?
MS.COHEN: Yes, objection withdrawn.
MR. SPINAK: Thank you, very much, Counsel. BY MR. SPINAK:
Q. Your - I asked you for an opinion. Do you have an opinion whether or not it's causally connected
A. I believe it's caused by the accident.
Q. All right. By the way, Doctor, in the history that you took of Mr. Dimitrov, is there any indication of any prior problems with his neck before accident?