In this episode, we chat with San Francisco legal giants Seth Rosenberg and Mark Fong, who recently nabbed a colossal $4.5 million victory for Jennifer Fraissl, injured during an EDM concert by the famous artist and Coachella headliner Skrillex (Sonny John Moore). Seth and Mark dissect the intricate details of this five-year legal rollercoaster, shedding light on the complex medical and legal hurdles they navigated. They open up about the defining moments where they pushed back against rival counsel's claims, expertly neutralized their expert's testimonies, and painstakingly untangled the knotty threads of this case.
We step into the murky waters of proving medical probability of injury from the defendant with Seth and Mark. They share how they outfoxed the rival expert witnesses, and how their savvy analysis of a crucially relevant Disneyland case tipped the scales in their favor. Unraveling the minute details from video footage, and arguing from the famous 1928 precedent of Palsgraf v. Long Island Railroad, they demolished the argument that since Skrillex had not directly struck Jennifer he was not responsible for her harm.
As we reach the end of this engrossing journey, Seth and Mark lay bare the specifics of the legal battle involving Skrillex. They scrutinize the strategies that worked, the challenges they faced, and the broader implications of stage diving and safety protocols in the entertainment industry.
To contact Seth Rosenberg, visit emergent.law
To contact Mark Fong, visit www.minamitamaki.com/attorneys/markfong/
As always, to contact David or Sydney, visit www.grundymdconsulting.com
Article on the domino effect
Article on Palsgraf case
Article on Vertebral Artery Dissection
In this episode, we chat with San Francisco legal giants Seth Rosenberg and Mark Fong, who recently nabbed a colossal $4.5 million victory for Jennifer Fraissl, injured during an EDM concert by the famous artist and Coachella headliner Skrillex (Sonny John Moore). Seth and Mark dissect the intricate details of this five-year legal rollercoaster, shedding light on the complex medical and legal hurdles they navigated. They open up about the defining moments where they pushed back against rival counsel's claims, expertly neutralized their expert's testimonies, and painstakingly untangled the knotty threads of this case.
We step into the murky waters of proving medical probability of injury from the defendant with Seth and Mark. They share how they outfoxed the rival expert witnesses, and how their savvy analysis of a crucially relevant Disneyland case tipped the scales in their favor. Unraveling the minute details from video footage, and arguing from the famous 1928 precedent of Palsgraf v. Long Island Railroad, they demolished the argument that since Skrillex had not directly struck Jennifer he was not responsible for her harm.
As we reach the end of this engrossing journey, Seth and Mark lay bare the specifics of the legal battle involving Skrillex. They scrutinize the strategies that worked, the challenges they faced, and the broader implications of stage diving and safety protocols in the entertainment industry.
To contact Seth Rosenberg, visit emergent.law
To contact Mark Fong, visit www.minamitamaki.com/attorneys/markfong/
As always, to contact David or Sydney, visit www.grundymdconsulting.com
Article on the domino effect
Article on Palsgraf case
Article on Vertebral Artery Dissection
Welcome to the Legal MD Podcast. Your hosts, sydney Delaney and Dr David Grundy, a renowned medical legal consultant with years of experience in clinical practice and forensic medicine, bring you insightful discussions and analysis on the intersection of medicine and law. Together, we explore complex issues that arise in cases of medical malpractice, wrongful death and personal injury. Our guests include top attorneys, medical professionals and industry leaders, who will share their expertise and insights. Join us while we examine captivating case stories that have had profound impacts on suit resolution. Click that subscribe button now and never miss an episode.
Speaker 2:Welcome back to the Legal MD Podcast. We took a little bit of a summer break there and went to Cincinnati and caught up with family, but we're back with a couple of guests today and Sydney. What's going on today?
Speaker 3:Yeah, super glad to be back, you know, feeling refreshed after some time with the family. And on today's episode, as you say, we're talking with some esteemed attorneys, and those are Seth Rosenberg and Mark Fong. Welcome, guys.
Speaker 4:Hey, welcome back to be here.
Speaker 2:So Seth and Mark just have a really fascinating case, both from how shall I say a medical and social and legal perspective. It's a case of a young woman injured at an EDM concert and had a really a pretty exotic injury, which is a dissection of the vertebral artery. I don't know if you can think about the medical aspects of this, but how they worked through the case is very cool, and how they pushed back against some of their opposing counsel's claims was, I think, practically brilliant as well. So, sid, tell us about our guests here.
Speaker 3:First we have Seth Rosenberg, and he's a San Francisco based personal injury partner at Emergent LLP. Seth grew up in Milwaukee, where he was inspired by his mother to practice law. He earned his bachelor's at UPenn and went on to obtain his law degree from Columbia. And while Seth is astute at representing clients in all types of personal injury cases, he specializes in representing special needs students who've been injured due to negligence of school districts. And when Seth isn't battling it out at trial, he assumes the role of sushi chef for his family.
Speaker 2:And then Mark, you came on as co-counsel on this Is that right? You guys have worked together previously. And then Seth brought you on.
Speaker 4:Yeah, so Seth and I were partners together at my firm Minami Tamaki in San Francisco, and the firm has been around for oh gosh, 40 years or so and we specialize in all aspects of personal injury cases Automobile, motor vehicle, wrongful death, premises liability. Medical malpractice is something I tried not to do too much of, but I have a reputation for, so people send me that as well. Some government tort liability, yeah.
Speaker 3:And, as Mark says, he's a partner at Minami Tamaki. He's also a third generation San Franciscan and he earned his bachelor's degree from UC Berkeley and obtained his law degree from UC Hastings. Mark is a fellow of the American Board of Trial Advocates and a member of the multi-million dollar Advocates Forum and, with over 40 years of experience, mark has tried an incredibly diverse set of litigation, as he just mentioned, and while when Mark isn't practicing law, you might find him cycling in San Francisco in his highlighter, yellow helmet and bright yellow jacket In classic plaintiff's attorney style. Mark says if someone is going to say they didn't see him, they're going to have a tough time proving it.
Speaker 2:Even color blindness wouldn't be good enough for that right.
Speaker 2:Well welcome guys. So usually either Sid or I will introduce a case that an attorney client has brought to us and then we just banter back and forth about the medical and legal aspects of this. But I think we're going to switch it up this time and if one or both of you want to tell me about the case, and then we'll just kind of go wherever the discussion leads from there. Like I say, there were some really interesting legal points and there's actually some quite interesting medical points which Sid and I can comment on as well as and when. So who wants to kick it off and introduce the case?
Speaker 5:I will. Yeah, I'll take it from here for a second David Fantastic. Okay, so this is, we thought, a fascinating case involving our client, a woman named Jennifer Friesel who was attending a concert in Los Angeles at the Belasco Theater, and she was seeing an artist named Skrillex who's made a big name for himself as a EDM artist and is now a producer, and she was at his show in Los Angeles and he, at the end of his show, got up on top of his DJ stand and waved to the crowd to get close to him, and they all did. And then he staged Dove from the top of his DJ stand, which was elevated, and the crowd kind of started doing, you know, undulating waves because of the how compressed it was.
Speaker 5:Sure, and as part of this, our client got hit in the back of the head and she believed at the time that she was kicked by Skrillex who had jumped behind her, and she then complained of injury in her neck days later and then, two weeks later, after the show, she had a stroke and this was a vertebral arterial dissection which had clotted, and then, about two weeks after the dissection, the clot had been thrown and suffered. She suffered a pontine stroke and had substantial issues still does to this day from that. So that was the case and the question became was Skrillex's stage dive, you know a reason for the injury and damage? And did she actually suffer a stroke because of that injury? Absolutely, and he was to say this was hotly contested for about five years. This went all the way to the five year mark before we actually went to trial in Los Angeles for five weeks where we obtained a verdict of about four and a half million dollars for Misfryzel.
Speaker 2:That's fantastic and for our listeners. I always kind of weigh in on the medical aspects of it when Seth mentions a dissection of an artery. So you know, I explain this to my patients often when people talk about a stroke what they're typically meaning is that blood flow is interrupted to some region of the brain and this results in a loss of function, right. So maybe a blood clot can happen kind of at the site or a clot can throw from somewhere else. But dissections are really interesting. You can think of the great arteries in and about the heart, the aorta, the carotid, as like a garden hose. They sort of have multiple layers right, and in a dissection the blood kind of the artery sort of tears on the inside and blood forces its way into this false passage and it can cause a lot of interesting effects. It can cause an interruption of blood flow by throwing a clot. It can also bleed, you know. So there can be a lot of nuance here.
Speaker 2:These are sort of some of the hardest strokes to catch. But one thing that I'm sure Seth will dial it on is that the classic teaching is strokes don't Hurt. So you know, if you have a blood clot, travel to a portion of the brain. The brain has no sensation on the inside, you just lose function. But dissections really do and that was really the case in our patient here. Right, the dissection he refers to is in the arteries in the neck and Classically you will have neck pain, you know, pretty shortly after the thing. And that was a key portion of this to prove it, wasn't it?
Speaker 4:Yeah, if I could speak in here on that. Absolutely one of one of the strongest pieces of evidence in our case was the fact that shortly after the concert, jennifer complained to her then boyfriend that she was suffering Neck pain, and she followed it up with a text to the boyfriend well before she had her stroke that said I have this terrible case of wit lash and and From getting kicked in the head. And this was before she had the stroke. So of course no one was thinking about a lawsuit. She could not have predicted that, you know, some days or weeks later that she would go on to have a Vertebral artery dissection and a stroke.
Speaker 3:So this was Something that the defense could never refute and could never argue against, because that was there in the evidence and prove that this was the onset of her injury strong work finding that, so, mark, so you're telling me that that your client wasn't just a mastermind who hadn't Hadn't been conniving this entire time to lay out the evidence and send text that she was having terrible neck pain?
Speaker 4:Right, she was not a. She was not a suit, say, or to be able to predict in the future.
Speaker 2:I was gonna happen to her nor could she send text backwards in time. So, yeah, that's important, it's, it's a, it's a key point. And you know, in our clinical practice, sid and I work at an ER here in San Francisco also, and you know we were just talking about this case today when, when it would I don't want to say it would be standard of care to Miss this, but these are easy to miss, they are very, very rare, and I think a pushback that you might have gotten from the opposing counsel is that, hey, maybe it happened Spontaneously, and that is no one right, but that's like literally one and a half billion or something. I mean it's incredibly uncommon to have these dissections without some kind of trauma, though the trauma may be mild and so, being able to put a pin in it, there was trauma, there was pain, but the symptomatology of the stroke really does typically follow Significantly after the initial injury, and that was the case for her as well, right, yeah, so one of our.
Speaker 4:Oh, go ahead Seth.
Speaker 5:I was just gonna say that one of you raise an interesting point and, and certainly the defense brought out you know, stacks of medical literature where it would report that these dissections had occurred from all sorts of random events Somebody turning their their head to go look in. You know, behind behind them in their car, somebody One of the main ones that you hear about is that the hair salon incident where you know they put their necks back to get their hair washed right and that would cause a dissection or a Coughing would cause a dissection and in fact our client had an upper respiratory infection At the time at the round this time. So they brought out, we called, I called it the parade of terribles.
Speaker 5:Yeah, I saw that all the ways that you could get this dissection, but we just kept on coming back to that.
Speaker 5:The only incident where pain was complained of was at the time of the, at the time of the show, when she was hitting the head and had whiplash After, and so that made the most sense as to what would have caused it. And the other interesting thing about the science here is that Dissections, while they are rare and they're always rare they occur more when somebody is suffering from an upper respiratory Infection and they don't know why. They don't really know why, but the belief is that it probably weakens to some extent arterial walls During the, the acute phase of the infection, and that makes them more prone to having a dissection. So what we said was yeah, she had an upper respiratory infection. It likely did make her more susceptible to a dissection, but it's not what caused the dissection. It was the blow to the head and that combination. So they couldn't get away from the they we used the upper respiratory infection as a point in our favor, not against us.
Speaker 4:Yeah, you you take your victim as you find them. That's the doctrine.
Speaker 2:I loved that list of terribles. It read something like don't drink alcohol, don't play in sports, don't leave the house ever. You know, as they you know I was in New Zealand for a long time they say wrap yourself in cotton wool and stay inside your home. You know, but no, that's not what we should take from it. I think the and you know the evidentiary bar is 51% Right. I mean, you have to prove to a reasonable degree of medical probability that that's what caused it, and you were obviously able to do so. I like it. You also was there not an opposing expert witness that Kind of caused some wrinkles and you were able to combat that rather handily as well, I think.
Speaker 4:Yeah, I took his deposition. This was Dr Ashivink, right. Yes yes, it was.
Speaker 5:So, yeah, he, he was an interesting guy, a very, very bright individual and literally the expert on dissections, as he spent most of his career studying dissections and the cause of dissections and really is probably the the ultimate expert on this issue. And obviously when we heard he was involved it was worrisome, but in doing our due diligence, we had found a case where he had served as an expert a few years earlier, in a case where he was. He was retained by the plaintiff in suing Disneyland and this, this, this gentleman had been on I forget which. It was the haunted House of horrors ride or something like that. Yeah, and he, I think it's a big drop of some kind and the gentleman had complained of A pain in his neck from the ride and then had with last to whiplash right probably the same terminology.
Speaker 5:I bet same terminology and had a stroke about two, I think three weeks after the the ride and vuter had or mr dr sheevin could testify in that case that he believed it was the ride in, the trauma from the ride that caused the Dissection and the stroke three weeks later, which was literally our case, and we just basically cross. I just basically went through the facts of that case and the facts of our case and showed how exactly the same and how could you possibly be, you know, opining differently in this case, and you did in the disney land case and it was quite obvious it was because he had been retained by a different side.
Speaker 2:Right, remind me to not be on the opposite side of you know. So our audience here is comprised of, you know, probably 40% attorneys, and then some positions and members of the public. There's quite a few cops who listen to it as well. But you know, let me just say in a very mild but slightly Moralizing way, just play it straight, guys. I mean, I mean right, I mean that's you know. Obviously there's no push back against him legally, necessarily, but I bet that was an uncomfortable afternoon for the man.
Speaker 5:Well, we dealt with, I mean, the opposing council, where we're very, very bright, very, very knowledgeable folks, and they were really good attorneys. Sure, I think you know you gotta be smart and picking your experts and In this case situation, yes, this guy was the ultimate expert on this issue, but he came with the baggage of the disney land case. That was right on point. You know, a few years earlier they probably should have done some more due diligence and said maybe this guy's not the best guy for this case.
Speaker 2:So that was just a mistake, I think I love it has a very sort of sun zoo type of feel about it. Just dig deeper and I feel like the the artist himself didn't really do self any favors in his position steady.
Speaker 5:Yeah, I mean he actually I really a big fan of his name, sonny john more sony john more and he's a really talented guy.
Speaker 5:I mean he comes from a really interesting history, musical e. Very talented guy, very nice guy, very pleasant, and I was actually one of the problems that we came was that you know, we realize the jury was probably not gonna actually despise the guy because he's very nice, but he said some really bad things in deposition. One of the things was you know, I asked him did you ever feel like your stage diving was unsafe? And you know that's a pretty much a basic question that everybody knows. I'm gonna ask an adept.
Speaker 5:I mean that should have been question number one to prepare for. And his response was something like well, I mean I'm safe, I mean I've never killed anybody.
Speaker 2:I'm gonna go now.
Speaker 5:That was you know on video and you know we played that multiple times trial.
Speaker 4:Yes, don't, don't forget where his attorney finally did again get around to coaching him and he was gonna fall on his sword. So we pulled him to admit that what he was doing was actually dangerous. Remember that.
Speaker 5:Yes, and we also got him to admit that. You know, if he had, if you had heard anybody from his stage diving, even if it was unintentional and not expected that he would feel responsible and be responsible for any harm he caused. And he went along with me trial and said, yes, I would be so I really helped our case because it wasn't, then just did he hit her. It was did it cause? Did his stage dive cause anybody to hit her?
Speaker 2:Yeah, and to the audience is not like screw likes. Just when booted this poor woman in the head with mouths of forethought, I think he was kind of like dragged over top of the crowd but nonetheless, you know the culpability is there and that was showing quite well by this team, so we should talk about that for a second please mark actually a big turning point in our case.
Speaker 4:Initially, for the first several years, we thought that still it had landed on top of Jennifer and the bloater her head that she complained of and that she texted about was due to some part of his body Strike in the fall, not so good a couple of years later in, after analyzing video from all angles, it appeared that his foot narrowly missed her, and so we're then thinking, well, now what?
Speaker 4:how did she again, she's not making this up, she didn't think of this, when you know she's not a suit there and being able to concoct something and text about something that didn't happen, she knows she was hit. So what we realized was the bloater her head was probably caused by skrillex a, either being dragged over her as he was being pulled by his stage manager back onto the stage, or be she was hit by the surge from the crowd trying to get a hold of skrillex and push him and lay hands on the performer, because you can see from the video that there's actually a way of people surges forward and knocks people down, including jennifer, who was up toward the front of the stage.
Speaker 5:It actually really her head.
Speaker 4:Yeah, the bloated head happened in one of those two places.
Speaker 5:An interesting side note was I was just on Twitter yesterday. I guess they call it X now, but but whatever you want to call it. I was on Twitter and there was a video from the Lana Del Rey concert that had occurred somewhere recently and they showed this crazy wave of like from the front to the back, just knocking everybody over, and so I like and people like, how could this possibly?
Speaker 5:you know what's going on here. It looked like literally a supernatural force had this kind of like blown on these people and knocked them all over. But, as mark learned from our security expert and from others that this is what happens because you have people so close to each other that if one group, you know, falls backwards, it's just dominoes, because they can't control their feet because they're just so packed and they can't control their standing. And that's a shirt. And then in fact, there was a I guess I call it community notes and so what it said. This is actually a known phenomenon at concerts like this and it was a great visual of it.
Speaker 3:I was actually hands. I was reading an article about this this morning. It's quite literally called the domino effect and it's a it's a well known crowd control issue and but you know it was of course I was. I saw the very tweet that I think you probably thought and I just loved the replies. People were like, oh my God, a ghost. Lana Del Rey.
Speaker 2:Sorry to debunk kids. You know what I was going over this case. You know, of course I'm an old guy, but I was like, who stage dives at EDM concerts anyway? You know I thought that was like a punk rock thing, but you know what it's a? It's a, it's mixed genres or something. So there were some issues to with the crowd capacity at the venue that you guys had to look into and expand on as well, right.
Speaker 5:Yeah, so there was. I mean so we had a bunch of defendants. In this case we had. We had Mr Mr Moore, we had his touring company lost boys, which I thought was a pretty good play on that movie, enough from the 80s that we all loved.
Speaker 2:I was the one with the shirtless saxophone player right and the vampires keepers. I can't speak to the shirtless part.
Speaker 5:Maybe I'm hallucinating.
Speaker 2:City's giving me the like knife across the throat.
Speaker 5:But yeah, it was the vampire movie, I think vampires on ATV's.
Speaker 5:that's right, that's right, I think the Cori's were in it Corey Heyman, corey Feldman and also the venue, which was the Belasco Theater, and one thing that we were able to determine was that they had oversold the event Because we got the capacity of the building and not only could we get the ticket sales, but it's interesting, which is the comps which is meeting whenever an artist plays like this they give out free tickets to, and in this case, it was interesting because Mr Moore Skrillex was about to perform at the or is about to be at the Grammys. He was actually up for numerous Grammys. He won some Grammys, got it. There's a pre-Grammy show, and so all the Illuminati of LA were there to go see the show.
Speaker 2:And the great I see.
Speaker 5:And so there were hundreds of comp tickets give out as well, so we could really show that this was an overpopulated event. And then, when you see the video with the people toppling over, you see the reality of it.
Speaker 3:So what was your legal pivot like? Or did this, you know, maybe this didn't cause any issues at all when you realized that it wasn't actually Skrillex that had, you know, hit her in the back of the head, but rather that it was more of this crowd control issue. How did you all manage that shift After?
Speaker 5:changing her underwear. I can imagine all this work.
Speaker 2:Oh my gosh, I can imagine.
Speaker 3:I mean, I think, I think we truly believe, we did truly believe that it doesn't really matter.
Speaker 5:You know, if you create the chain of events and this is. It's interesting because there's a very old and famous legal case called Paul's graph that everybody learns in law school and I don't even remember the details as much, but it it involved like this kind of weird combination of events occurring where the first event seems to have no connection to the last event, but if it wasn't for the first event, this last event on a train wouldn't have happened and somebody wouldn't have gotten injured, and and the court doesn't fall off of the off of the top bracket.
Speaker 5:Yeah yeah, so it. The law basically says hey look, if you start something negligently that leads to injury, whether you know it's, it's as long as it's somewhat foreseeable, then you're you're at fault. And here we just said look, mr or Skrillex, stage diving was not smart, it was not a good idea. It was a very bad idea and and dangerous and that led to our client getting hit in the head. And it's just that simple. If you hadn't staged dove, our client doesn't get hit in the head, she doesn't have a stroke.
Speaker 5:So we just kept making it as simple as that over and over and over again he's just dove. It was a negligent decision and it led to our client getting hit in the head and suffering a stroke. And we just kept hammering that over, and over and over again. And they and they made a mistake is that they never pivoted. So what they never addressed that they just kept on saying he didn't hit her and we said, maybe he didn't, but it doesn't matter, and they never had an answer for what to do if he didn't hit her, but it still led to her being hit.
Speaker 2:Yes, I only let the fuse. I didn't mean for the charge to go off or something of that nature. No, it's. Oh yes, no, I totally get it, and I can only imagine that this very high profile case might actually have changed some best practices in the entertainment industry. You know, I have you gotten any follow up on that? You mentioned to me, seth, that you did in fact get a request to assist on another similar case, but I wonder if you know the promoters and artists are becoming more sensitive to the potential harm here.
Speaker 5:Yeah, I mean my understanding is that. Well, first of all, skrillex testified at deposition. This is another one of the not such great answers. I said do you still stage dive, you know? And he says no, I don't. I said why not? And he says I don't want to be sued. Okay, I mean. I mean, whether it's for a good reason or a bad reason, I guess it's good that he's not stage diving anymore.
Speaker 2:Could we describe him as charmingly gull list, perhaps in one of these interactions?
Speaker 5:I do want to say I liked him very much as a person. I don't want to jump on him. I mean he made a bad decision, but I don't think he's a bad person.
Speaker 2:Yeah, I read through your material and he really did show, he really did have a heart in those interactions where he's like, well, if I heard her, of course I'm responsible, you know, it's like it's, as I say, charmingly gull list. Perhaps not the best legal strategy, but yeah.
Speaker 4:You asked about best practices. One thing that I think we learned from this case and may carry over to our next case Not that we're trying to get a specialty in stage diving cases is that you should keep a buffer between the artist and the crowd. That would prevent anybody from stage diving because you could just end up on the concrete floor. So if they had the Velasco had just set up barricades, let's say, six feet away from the stage.
Speaker 5:Well, they did. They actually did in this case, Mark. They had a barricade, it just he was able to stage dive over it. Oh my God.
Speaker 2:Very athletic fellow and he jumped from quite high up, I'm sure.
Speaker 4:Well, yeah, that's actually a fact. He got on top of the speaker stack, didn't he? Oh my God.
Speaker 5:He was on top of his DJ stand. It was like 10, 12 feet up in the air, which is, of course, another reason why it was a very bad idea, because it's not like when you're jumping from that type of a height, you're talking about more force being involved when he hits and then that being dispersed amongst the crowd and people not being able to control their movement from the strike when he lands.
Speaker 2:Well, you know our last episode we did with Lauren Schwartz and it was about this incredible fall case and in the show notes we found this thing called the splat calculator. So it's sort of like how much energy you are carrying after falls of varying heights and so on and so forth, also your chance of surviving, which gets pretty grim pretty fast. But yeah, you know, an extra foot makes for a lot of extra energy type of thing. So yeah bad idea, Skrillex.
Speaker 5:And Lauren's a great attorney, good friend of mine.
Speaker 2:Oh, he's amazing, yeah, he's awesome yeah, great guy.
Speaker 3:I guess lucky for Skrillex, they caught him. But you know, I don't I don't want to clown fans of EDM or anything like that, but pictures that I've seen of them they, you know they tend to be a little on the ropey side. I'd be afraid that I would, you know, swan dive into this crowd and then they would just drop me right away.
Speaker 2:Yeah, the crowd is scattered Down, you go right.
Speaker 5:Well, you know it's interesting. You say that because if you watch the video of that stage dive involving Skrillex and our client, what he did was was he got up on Teeja, the top of the DJ stand, and he spent 10 seconds or so waving the crowd forward, he said, because he wanted to make sure that he would be safe. So he actually encouraged everybody to compact themselves towards the front so he would be safe.
Speaker 2:Pointing to larger and fluffier people to catch him right that Sidney just mentioned wouldn't happen to him so he made sure of that.
Speaker 2:Oh no, choking aside, you know, and again, this is an individual who was terribly injured and I'm glad you did your best or, you know, really got there trying to make her whole. But you know, of course you can't bring back what was lost. I hope that this does improve practices going forward and just real quick, for our attorney. Listeners, the docs out there know all this, but I do want to comment on her workup at the first ER. So you know, if somebody gets kicked in the head, let us say, and they're knocked to the ground, let's say they're even stunned right and they present at an ER, let's say 12 hours later, and you know the attorney should listen up for this.
Speaker 2:It would be the normal reflex of the ER doctor to do the following studies. You know, if there were any injury to the limbs, they would evaluate those. They do a physical exam, they do a neurological exam which, as we've said, would not be abnormal early in a dissection, and then they would do a CT scan of the brain and of the neck and this is a technical matter but it's important. It would be normal to do those without intravenous contrast and those studies will not catch this diagnosis. So it really does take, I think, a very high index of suspicion about the neck pain, specifically to chase this entity, which is a rare one. So just something to think about.
Speaker 2:You know, these cases of vertebral dissection should not be thought of as spontaneous, even if there have been a couple in the literature. It's caused by some energy being imparted to the human body and that means there's a good chance there's a tort. I mean, there's definitely that possibility. So you know, and a word of warning to my ER colleagues you know, think about doing a contrast study of the neck. Even if it's not obvious stroke symptoms, you can catch these.
Speaker 3:Yeah, I think also, you know, in these spontaneous cases, from what I understand from reading some opinions of, especially neurosurgeons, that you know these spontaneous dissections are incredibly rare and in the case of a spontaneous dissection, it's usually associated with, like a connective tissue disorder, like you know, ehlers-danlos syndrome or Marfan's or something like that, and in the absence of a condition like that, it's highly unlikely that it's spontaneous. You really ought to be, you know, looking backward and thinking you know, was there some instance where even a minor trauma precipitated the event?
Speaker 2:And wink, wink, nod. That can definitely be chiropractic. I love you guys. I love you chiropractors out there. You can push and press on my back and limb, so leave my neck alone. That's just not going to happen. I'm serious.
Speaker 4:Yeah, so if I could jump in for a second.
Speaker 2:Absolutely.
Speaker 4:Please. You know the couple things. You know her young age. The patient's young age was certainly a factor that mitigated against this being spontaneous, as were the fact that you know she had had coughs before, had, you know, drank alcohol before, all of the different risk factors that the defense trotted out, but she never had a stroke before getting hit in the head. Our one of our experts said that the chances of her developing this stroke spontaneously was something like one in 360 million versus a very well recognized and well understood mechanism of trauma related vertebral artery dissection. She went from having the splitting headache and neckache and whiplash and in the two or so weeks from then until her dissection actually resulted in the clot being thrown and going to her brain. She had a variety of TIAs, you know trans.
Speaker 2:Yeah, transinteschemic attack. Yeah, many strokes, as the layman might call them. Yes.
Speaker 4:Exactly, which our experts said were due to the small emboli breaking off from her vertebral artery, dissection in her neck and floating up into her brain and temporarily causing interruptions in the blood flow.
Speaker 4:That resulted in confusion, her feeling lost, her getting lost in a department store, you know, falling down some stairs, which, of course, the defendant said oh, that was probably why you suffered this stroke, not because of, you know, the TIAs.
Speaker 4:So it was a very well recognized mechanism for whiplash, injury to the neck, to TIAs, to ultimate, you know, final occlusion of the pontine artery, which resulted in this massive stroke that all the experts understood and were very clear on and we were very strong about versus you know the argument of the defense, which was that this was some kind of connective tissue disorder or simply a spontaneous occurrence. That you know only happens, you know, as you say and you know, one and a half a billion times. The other thing that you mentioned was about Centinella Hospital. It was not a good look for them because they saw Jennifer initially and it wasn't just the history that was, how should we say, very strongly suggestive of a trauma related injury, but there was a CT scan that actually showed the stroke and they missed it and they sent her on. They sent her home, basically they sent her on and she ended up at Kaiser where the stroke was.
Speaker 2:Yeah, that's all over, but the crying at that point. The second thing Exactly.
Speaker 2:It's probably tragic too because one. You know again, I'm not really hammering this issue of medical negligence at the first visit, but it does sound like there might have been an opportunity to intervene in this case and get her a better outcome. I mean, it can be treated. You can start these patients on heparin or low molecular weight heparin and, you know, the chance of this big event happening would be much reduced or perhaps removed. You know, again, these strokes in the brainstem can just be horrible.
Speaker 2:Fortunately it sounds like in her case it affected only one half of this very critical small structure. Had it knocked out the whole ponds, she would have been in this nightmarish condition called a locked-in syndrome, where essentially the brain is alert and awake but the entire body paralyzed and that's just. You know, more horrifying than you can imagine, you know. So you know, I will say to clinicians out there, young people with this type of symptomatology, that's just not normal, you know. I mean, is it on her? She should have gone back to an ER again maybe. But I think that those stroke-like symptoms, tia symptoms, after this trauma, you just wish that perhaps more had been done initially. Did they do a contrast study or was it a non-con. The first one that may be too technical based on you know it's been a few years out, but yeah, don't remember now.
Speaker 2:No worries, no worries, I get it, and you know, the thing that's even more painful when we look through some of these medical records is you get these kind of retro reads. You know the wet read given by the night radiologist differs significantly from you know what the final read is, and that can create a lot of difficulties as well. But then too, the process needs to be in place, I think, to react to those you know on the ER side.
Speaker 5:Actually, to go back to something Mark was saying about, Sorry, I'm actually saying what Sidney said about the connective tissue issues and actually the defense attorney pointed out or he claimed that our client was suffering from something called fibromuscular dysplasia which is a connective tissue issue. He said he saw it on a scan and that was the culprit. And it was a battle of radiologists reviewing the imaging and ours said that there was no fibromuscular.
Speaker 2:The model had a dark eye, I suppose.
Speaker 5:Yeah, there was no fibromuscular FMD, as they called it, and he said there was. But what we decided was it doesn't matter If she had FMD, it wasn't the cause, it was just like the respiratory infection. It might have made her more susceptible and so, even if she had it, it doesn't mean that they're off the hook. It just means, as Mark said, you take your victim as you find them, and she had this and she was more susceptible.
Speaker 5:And again, not that I'm a doctor or a clinician or give advice on what doctors should say, but regarding this TIA issue, I think actually something that they should also probably tell the patients who are suffering from neck pain after some kind of trauma was is, if you experience something like a TIA, like if you have splitting headaches, if you feel lost or foggy, or you start having falls because you can't, you just, for whatever reason, your legs give out on you, or something like that, then you should immediately go back to an ER or a clinician to have to discuss that with them, because and I'm not saying it would have changed anything here but you then have a window of time where these TIAs can be looked at as seen as possibly something different than just bad balance and then possibly could be seen before the actual stroke occurs, and so I think that would be a good thing to potentially tell patients who are experiencing these types of trauma to be on the lookout for that. Yeah.
Speaker 3:I mean, you hit the nail on the head there. It's exactly what I was thinking when you mentioned this connective tissue entity that she allegedly had in advance of this dissection and the subsequent stroke. The fact is, sometimes people have preexisting medical conditions and then they're still injured by negligence, and so it may exacerbate what's already there. But, as Mark says, you take the victim as you find them. The simple fact is that plenty of people with mixed connective tissue disorders walk around every day of their life, and they never experience a vertebral artery dissection, so that argument just really doesn't hold any weight.
Speaker 2:Yeah, absolutely so. This is great, guys. It's an awesome case, and are there any other kind of points that we're missing or sort of things that really came up for you as take home points for our attorney clients or our audience in general? I know you don't want to be the go-to stage diving guys, co-counsel, but hey maybe you do Maybe you do, Maybe I don't know.
Speaker 5:I would just say that what I really enjoy about this case and about being an injury lawyer is I knew one thing about dissections before it came across and, while I'm certainly not a doctor, it's amazing how much you can learn and get up to speed and it's just fascinating the medical science and Mark's a real expert in medical science and I really relied on him to help me out substantially.
Speaker 2:And you both know more than my interns have this stuff, so come over and pull a shift, man.
Speaker 5:And so I just I think I guess my advice is don't ever be daunted when a case comes across your desk that you don't know this medical issue in and out, when it comes across your desk that you can become an expert and do time and really learn about it and get into it. And it was fascinating it still is to me.
Speaker 2:Well, that's right and here's a shameless pitch. But that's part of what we do is helping you guys develop medical theories. I mean, we're on both sides of these things and we were on for the defense and the question was you know, this guy fell down a flight of stairs and then he says he went blind and went into kidney failure. Like, is that plausible? And you know we call it de-risking if we can talk about this and spend one hour of your time instead of you know, hundreds of hours of billable that you then lose. You know that's something that we can help out with early Mark. What were your takeaways from it?
Speaker 4:I think feeling strong about the medicine was a big deal.
Speaker 2:Absolutely.
Speaker 4:Certainly the defense employed. You know what we'd call the spaghetti defense, which is you throw everything against the wall and hope that it sticks. And you know, for an individual plane of case I counted, we took 50 depositions, which is, you know, a heck of a lot of depositions.
Speaker 4:And that was because the defense, you know, turned over every rock and also made every argument possible. They blamed, for example, sentinel Hospital for malpractice, trying to palm off some of the fault on them. They argued FMD, this connective tissue disorder, as being a cause of the stroke. They offered coughing, drinking, turning the head. It was this laundry list of horribles, as Seth mentioned, all to try to point out things other than the obvious.
Speaker 4:And you know, to me and to Seth, it was really clear, you know, given the TIA is, given the well-recognized mechanism of injury and the period of time that elapsed from the insult until the stroke, you know that she clearly causation was there, that she clearly suffered a stroke as a result of the blow to the head. And I think our goal, just as the defense's goal, was to obfuscate and throw up every other possible mechanism or cause other than their client's negligence and causing our client to get hit on the head. Our goal was to make it simple, you know, kiss, just be like laser beams and say this is what happened. It's clearly documented in the literature, no one disputes that. This is how people suffer vertebral or artery dissections as a result of trauma and that's just how it is.
Speaker 3:I like that and congratulations on a job very well done yeah it sounds like you all made this just you know, so clear cut for the jury and it completely paid off.
Speaker 5:Yeah, we're ecstatic for the client. You know it was just a great result for her to get some vindication that you know this didn't just happen because she was drinking or something like that, that somebody did this to her. She didn't ask for it and you know she's being helped because of this. I will say one other thing that I thought was just a small fascinating thing, which was I had no idea how many text messages 20 year old send these days, but it is thousands upon thousands, upon thousands, and it was text messages that pretty much made this case for us.
Speaker 2:How many parallels did you lose over that, though?
Speaker 5:You know you just burned it all, I know, but we had all these text messages which kind of confirmed TIAs. Oh, I'm feeling foggy, I don't know what's going on. You know, that really helped our case and even though we had to- sort thousands of inane text messages. It was a fascinating thing that it was new to me.
Speaker 3:Yeah, I just I love that. So you know, in every episode we really want to just give it just a primary takeaway that attorneys can use right now, and today's takeaway is that vertebral artery dissection is a serious medical condition with potentially life limiting or fatal consequences if not caught early and treated appropriately. Spontaneous dissection has been reported, but a traumatic precipitant is the likely cause in most cases. As a result, there is always the potential for significant torrents with extensive damages.
Speaker 2:Yeah, that's it, and so just Seth and Mark. We'd like to hear more about how people can get in touch with you and just use the Google machine. Are there any particular projects you're working on, types of cases that you'd like to tell the listeners about?
Speaker 5:Sure, thank you. Thank you both for having us on here today. This has been really fun and really enjoyable. You know, I had a law firm called Emergent. You can always just Google me, but the website is wwwemergentlaw and surprisingly, I don't do only stage diving cases, you're surprised.
Speaker 5:I do, like Mark, a wide variety, but one of the specialties that I have is representing special needs children who've been injured due to the negligence of school districts, and this runs the gamut from assaults, sexual assaults to bullying, harassment. It can be a wide variety, sadly, but I do a lot of those, and so if ever anybody wants to talk about one of those cases, I'd be happy to do so as well.
Speaker 2:It's a tough case and I have an attorney in Ohio that might actually want to talk to you about that. We can do that offline, so that's great. And, mark, what about yourself? Sir?
Speaker 4:So you could reach me at wwwminamitamakicom. I can be reached on Google and LinkedIn. Our firm handles not only personal injury but also consumer and employee rights, advising of employers and employees, litigation as well, wrongful termination, discrimination, and we also do business immigration as well for a variety of companies in Silicon Valley and San Francisco. My own practice, as I mentioned at the top of the show, we handle all kinds of motor vehicle accidents bus, scooters, trailer, tractors, semis, automobiles, motorcycles and bicycles. We do premises liability, government tort liability. We have a lot of traumatic brain injury cases that we handle and also some medical malpractice. So that's the span of our practice.
Speaker 2:Fantastic and we will put both of those links up in the show notes and then also some press surrounding this amazing case. So we are Grundy MD Consulting. We do medical legal consulting mostly PI, but criminal or whatever else you need. We're pretty good at early de-risking and we do like those Sherlock Holmes kinds of cases where we can bring in medical physics and that type of stuff. So the weird stuff is what we're all about. We like to say no to ones that we can't help you at case value. But call us if you need us. We'll put our link in the show notes as well. So, seth and Mark, thank you so much, and this has just been a lot of fun and we're going to have to do it again someday.
Speaker 5:Real pleasure, guys. Thank you so much. Thank you for talking to him.
Speaker 2:All right, bye for now. Bye.
Speaker 1:Thanks for joining us for this episode of the Legal MD Podcast. If you have a case you'd like to discuss with Dr Grundy, please visit our website. We'll see you in the next episode. Peace꼼.