1. health and fitness
2. disorders
3. mental disorder
4. depression

Ms. Marie Perriott
i
CONTENTS
EXPLANATION OF CHARGES “TIME SPENT”: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
IDENTIFICATION: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
DESCRIPTION: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
CURRENT COMPLAINTS: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
ACTIVITIES OF DAILY LIVING . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
HISTORY OF THE PRESENT ILLNESS: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
EDUCATIONAL/OCCUPATIONAL HISTORY: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
PAST PSYCHIATRIC HISTORY: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
PAST MEDICAL HISTORY: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
FAMILY HISTORY: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
DEVELOPMENTAL HISTORY: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
SOCIAL HISTORY: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
RESULTS OF PSYCHOLOGICAL TESTING: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
Hamilton Depression Rating Scale: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
Hamilton Anxiety Rating Scale: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
Rey 15-Item Memorization Test and Rey Dot Counting Test: . . . . . . . . . . . . . . . . . . . . 12
REVIEW OF MEDICAL RECORDS: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
1) Various Dates: Series of Doctor’s First Report of Occupational Injury or Illness by
Various Providers. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
2) 2/23/91: Emergency Room Record by [illegible], Queen of the Valley Hospital. . . . 14
3) Various Dates: Series of MRI Reports by Various Providers. . . . . . . . . . . . . . . . . . . . 15
4) Various Dates: Series of Reports by Thomas O. Bryan, M.D., Diplomate, American Board
of Orthopaedic Surgery, Clinical Assistant Professor of Orthopaedics, University of
Southern California School of Medicine, Metcalf Orthopaedic Medical Group, Inc.
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
5) Various Dates: Series of Operative Reports by Various Providers. . . . . . . . . . . . . . . 24
6) Various Dates: Series of Progress Notes by Various Providers, Bergman Medical.
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
7) Various Dates: Series of Radiology Reports by Various Providers. . . . . . . . . . . . . . . 25
8) Various Dates: Series of PR-2 Progress Report/Industrial Records by Philip Baily, M.D.,
Presbyterian Intercommunity Hospital. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
Ms. Marie Perriott
ii
9) Various Dates: Series of Non-Certification Letters by Various Providers, Concentra.
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
10) 11/07/07: Agreed Medical Reexamination by Lawrence A. Feiwell, M.D., Diplomate of
the American Board of Orthopaedic Surgery, Fellow of the American Academy of
Orthopaedic Surgery, The Greater Long Beach Orthopaedic Surgical and Medical
Group. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
11) Various Dates: Series of Office Notes by Various Providers, Inland Region Medical
Group. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
12) Various Dates: Series of Application for Adjudication of Claim. . . . . . . . . . . . . . . . 32
13) Various Dates: Series of Reports by Hamid Rahman, M.D., Orthopedic Sports & Spine
Medical Group. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
14) 7/15/09: Electrodiagnostic Studies Report by Aaron Coppelson, M.D., Diplomate of the
American Board of Electrodiagnostic Medicine, Physical Medicine & Rehabilitation,
& Pain Management, Restore Medical Group. . . . . . . . . . . . . . . . . . . . . . . . . . . 35
15) Various Dates: Series of Depositions of Marie Perriott. . . . . . . . . . . . . . . . . . . . . . . 35
16) Various Dates: Series of Reports by Scott Goldman, M.D., Board Certified Orthopedic
Surgeon. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38
17) 7/11/11: Notification of Non-Certification by Rosalyn Beaty, M.D., Coventry. . . . . 40
18) Various Dates: Series of Secondary Treating Physician’s Progress Reports by Thomas
K. Donaldson, M.D. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
19) Various Dates: Series of Clinic Notes by Gail Maloff, L.M.F.T., Perry Maloff, M.D., &
Associates. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
20) Various Dates: Series of Reports by Luigi F. Galloni, M.D. . . . . . . . . . . . . . . . . . . . 42
21) Various Dates: Series of Secondary Treating Physician’s Progress Reports by Thomas
K. Donaldson, M.D., Empire Orthopedic Center. . . . . . . . . . . . . . . . . . . . . . . . . 46
DIAGNOSIS: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
SUMMARY AND CONCLUSIONS: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48
Temporary Disability: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50
Permanent and Stationary: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50
Causation: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50
Medical Care: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50
Ability to Work: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50
Discussion of Apportionment: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50
RESEARCH FINDINGS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
MEDICAL-LEGAL DISCLOSURE INFORMATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64
November 9, 2012
Janet John, Esq.
DEFENSE ATTORNEY
LAW OFFICE
801 S. Figueroa Street, 15th Floor
Los Angeles, CA 90017
Robert C. Eckl, Esq.
APPLICANT ATTORNEY
8291 Utica Ave., #101
Rancho Cucamonga, CA 91730
RE:
Employee:
Employer:
D/Injury:
Claim No.:
Date of Service:
Marie Perriott
Rose Hills Company
2/12/2009
000731-028715
October 24, 2012
AGREED MEDICAL EVALUATION REPORT
Dear Ms. John and Mr. Eckl:
This evaluation consisted of a psychiatric history, mental status examination, review of
medical records and the administration of five psychological tests: the Hamilton
Depression Rating Scale, the Hamilton Anxiety Rating Scale, the Minnesota Multiphasic
Personality Inventory-2, the Rey 15-Item Memorization Test, and the Rey Dot Counting
Test.
The entire interview was conducted by me and dictated in its entirety by me as well. Ms.
Perriott was evaluated for a full session, which lasted approximately one hour, during
which I obtained all of the information in the report, including current complaints, history
of present illness, past history, and mental status examination. In addition to this period
of time during which I elicited the necessary clinical information, additional time was
spent in the administration, scoring and interpretation of the psychological tests. None
of this time was part of the interview. When Ms. Perriott left, it was explicit and apparent
that she had provided a full account of the substance of her alleged problems, which is
contained herein. The Hamilton Depression Rating Scale and the Hamilton Anxiety
Rating Scale were administered by me. The Minnesota Multiphasic Personality-2
(MMPI-2) was scored and interpreted by Alex B. Caldwell, Ph.D. and is attached to this
report. The Rey 15-Item Memorization Test and the Rey Dot Counting Test were scored
and interpreted by Carla Back-Madruga, Ph.D., Clinical and Neuropsychologist, and the
results were reviewed by me. The medical records were reviewed by me. Proofreading
was done by my office staff.
Ms. Marie Perriott
November 9, 2012
Page 2
The evaluation was in compliance with the guidelines established by the
Industrial Medical Council or the administrative director pursuant to
paragraph (5) of subdivision (j) of Section 139.2 or Section 5307.6 of the
Labor Code.
EXPLANATION OF CHARGES “TIME SPENT”:
This case is billed as an Agreed Medical Evaluation Report.
Breakdown of hours for the CPT 96100 is the following:
Hamilton Depression Rating Scale: . . . . . . . . . . . . . . . . . . . . 45 minutes
Hamilton Anxiety Rating Scale:
. . . . . . . . . . . . . . . . . . . . 45 minutes
Rey 15-Item Memorization Test
. . . . . . . . . . . . . . . . . . . . 30 minutes
Rey Dot Counting Test:
. . . . . . . . . . . . . . . . . . . . . . . . . . 30 minutes
Minnesota Multiphasic Personality Inventory-2: . . . . . . . . . . . 120 minutes
Total hours for testing:
. . . . . . . . . . . . . . . . . . . . . . . . . . . 4.5 hours
Face-to-face
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 hour
Record Review
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.25 hours
Report Preparation
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.5 hours
Research
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.5 hours
Activities of Daily Living . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 minutes
TOTAL TIME SPENT:
. . . . . . . . . . . . . . . . . . . . . . . 25.5 HOURS
Ms. Marie Perriott
November 9, 2012
Page 3
Ms. Perriott is a 62-year-old woman who was seen in my Riverside office on
October 24, 2012 for the purpose of an agreed medical evaluation.
IDENTIFICATION:
Ms. Perriott was born on May 19, 1950.
She reports the date of the alleged injury as February 12, 2009. She states
that she last worked at the job to which this claim pertains on May 7, 2012.
She is currently not working.
The following questions are addressed in this report:
1)
Has Ms. Perriott ever been psychiatrically injured on an
industrial basis?
2)
Is Ms. Perriott permanent and stationary, and, if so, what
is the rating?
3)
What, if any, are the factors of apportionment?
4)
Does Ms. Perriott require any psychiatric treatment on an
industrial basis?
DESCRIPTION:
Ms. Perriott is wearing a casual striped shirt, melon-colored capri pants,
brown sandals, and eye glasses. She is also wearing a back brace for support.
She describes herself as 5'7" tall, weighing 210 pounds, with dark brown hair
and brown eyes.
There is no evidence of any psychomotor retardation or agitation. She speaks
fluently and understands everything said to her. She is generally pleasant and
cooperative throughout the interview.
Ms. Marie Perriott
November 9, 2012
Page 4
CURRENT COMPLAINTS:
In regard to her emotional symptoms, she reports stress due to no income,
fatigue, and depression. “My depression started after I was told that back
surgery wouldn’t help me. I feel sad most of the time because I can’t do
anything and I don’t have any income.” She denies crying spells.
She reports insomnia. “I go to bed at 11:00 PM but it takes me a half hour
to one hour to fall asleep. I wake up several times at night due to pain. In the
morning, I wake up around 7:30 AM.” She does not have nightmares.
Her appetite is fair but she has gained approximately 20 pounds in the past
three years. Her energy level is poor. She is not sexually active at this time.
She reports that her memory and concentration are “okay.” She denies
anhedonia, which is an inability to enjoy life stating, “I love to read my
Bible.” She is not able to finish her routine chores and responsibilities.
According to Ms. Perriott, her overall mood is sad, worried, troubled, and
sometimes irritable.
Ms. Perriott was asked if she was able to work at this time. She replied, “No,
I cannot work because I cannot sit up, drive, or walk for long periods of time
due to back pain. Also, I don’t sleep well at night.”
ACTIVITIES OF DAILY LIVING
Self Care:
Ms. Perriott finds that self care activities are uncomfortable and are done
slowly. She has difficulty with cooking, laundry, housekeeping or shopping
a lot or most of the time.
Physical Activities:
Ms. Perriott is able to perform very light activities for a period of 2 minutes,
can only lift and carry very light objects and has some difficulty reaching and
grasping items off a shelf at chest level. She finds some difficulty with
reaching and grasping items off an overhead shelf. She can push or pull very
Ms. Marie Perriott
November 9, 2012
Page 5
light objects, has no difficulty with gripping, grasping, holding and
manipulating objects with her hands and also experiences no difficulty with
repetitive motions such as typing on a computer. Ms. Perriott has some
difficulty with forceful activities that include her arms and hands. She has
found that there has been no sexual functioning because of her injury and she
cannot do any work at all.
Sensory Functionality:
Ms. Perriott notes that there has been no change in her sense of touch,
writing, typing, seeing, hearing, speaking, tasting and smelling abilities.
Movement Abilities:
Ms. Perriott finds she can only walk short distances. She notes a lot of
difficulty climbing one flight of stairs, can only sit for a period of less than
15 minutes at a time and can only stand/walk for a period of 15 to 30 minutes
at a time. She finds she has a lot of difficulty with kneeling, bending or
squatting.
Sleeping Functions:
Ms. Perriott notes that her sleep is greatly disturbed, experiencing 3 - 5
sleepless hours.
Pain Interference:
Ms. Perriott indicates that on average during the past week her pain has been
at a level of 8/10 and that at its worst during that same period it was at a level
of 10/10. She reports moderate pain most of the time and rates her pain at the
moment as severe. She notes that her pain interferes all of the time with her
ability to travel and with her engagement in social and recreational activities.
A lot or most of the time her pain affects her concentrating and thinking as
well as causes her emotional distress with depression or anxiety. Ms. Perriott
has indicated that areas of the body that hurt due to her pain are: neck and
lower back.
Ms. Marie Perriott
November 9, 2012
Page 6
Self Analysis:
Ms. Perriott indicates that she is afraid that if she exercises she will injure
herself; that her body is telling her she has something dangerously wrong and
that her injury has put her body at risk for the rest of her life. She feels that
resting is the best thing she can do to prevent more pain and injury; that it’s
really not safe for her to be physically active; that she can’t do much because
it’s too easy for her to get injured and that no one should have to exercise
when they are in pain. Ms. Perriott believes that there is little hope for her at
this point and she would rather be left alone.
HISTORY OF THE PRESENT ILLNESS:
Ms. Perriott began working for Rose Hills Co. as a memorial service
counselor on October 6, 2003.
She reports that she injured herself at work on February 12, 2009. “I was
driving back to the office from a presentation and I was making a left-hand
turn on a left arrow, when I saw an oncoming van so I stopped my vehicle but
the van hit the front end of the passenger side of my car. I injured my lower
back and right hip.”
Ms. Perriott reported the job injury to her supervisor. However, she became
ill with the flu so she was off work for two weeks. She went to her primary
care physician, Dr. Cecilio; however, he told her it was a job injury and he
could not treat her. She then went to another primary care physician, Dr.
Boozer, and was again told that it was a work-related injury. Her supervisor
sent her to Presbyterian Intercommunity Hospital emergency room on May
29, 2009, where she saw a physician assistant, Dave Weitzel, who prescribed
pain medication and treated her with physical therapy. She was sent to the
company physician at Health Works and was given an injection for pain.
Ms. Perriott went back to work with job restrictions. Subsequently, she
consulted an attorney and was sent to Dr. Rahman, who took her off work.
Her last day of work was on May 7, 2012. He sent her for a nerve conduction
test, got x-rays and an MRI on her, treated her with physical therapy and
acupuncture and prescribed unspecified medication for her. Later, Ms.
Perriott changed to Dr. Goldman, an orthopedist, who got x-rays and an MRI
Ms. Marie Perriott
November 9, 2012
Page 7
on her. He prescribed various pain medications including Percocet,
Morphine, and Celebrex. He also gave her Omeprazole. He treated her with
physical therapy. She was sent to Dr. Laderhaus, an orthopedist, for an
evaluation. He told Ms. Perriott that he did not recommend back surgery.
Ms. Perriott saw a pain management specialist, Dr. Rho, who gave her an
epidural injection. She was referred to another orthopedist, Dr. Samuderale,
who also told her that he did not recommend back surgery. “That put me in
a depression because there was nothing they could do for my back pain,”
according to Ms. Perriott.
She reports that she developed left shoulder pain because “I couldn’t lie on
my right side due to right hip pain.” She was sent to a psychiatrist, Dr.
Maloff, because “I was depressed.” Dr. Maloff offered to prescribe
medication for her but she declined to take the medication. She was referred
to a therapist, Gail Maloff, for individual psychotherapy sessions. She saw
an AME orthopedist, Dr. Chong, twice for an evaluation. She has another
appointment for reevaluation with Dr. Chong on November 16, 2012.
According to Ms. Perriott, she went to San Antonio Hospital emergency room
due to shortness of breath, hot flashes, and lightheadedness. She was told
that she was “okay.” She was then referred to a cardiologist who did an EKG
on her and told her that it was normal, so she was clear for surgery. She was
referred to Dr. Goldman who got an MRI on her right hip. He sent her to Dr.
Donaldson, an orthopedist, who performed a total right hip replacement
surgery on her on March 6, 2012. She was then sent to a nursing home for
three weeks and was treated with postoperative physical therapy. Dr.
Donaldson prescribed Robaxin and Vicodin for her.
Ms. Perriott changed physicians and began seeing Dr. Galloni, an orthopedist,
who treated her with physical therapy. He is currently prescribing Naproxen
for her. She was sent to a pain management specialist, Dr. Anguizola, who
is prescribing topical creams for her. He told Ms. Perriott that he wanted to
give her a facet block injection.
In regard to her current physical complaints, Ms. Perriott reports right hip
pain, headaches and lower back pain that radiates down her right leg.
Ms. Marie Perriott
November 9, 2012
Page 8
She is taking the following medications:
1.
Hydrocodone.
2.
Naproxen.
3.
Amitriptyline.
4.
Flurbiprofen.
5.
Mometasone.
6.
Desonide.
EDUCATIONAL/OCCUPATIONAL HISTORY:
Ms. Perriott graduated from Huntington High School.
She has held the following positions:
2003 - 2012:
Rose Hills Co./Memorial Service Counselor
2002 - 2003:
Big Lots/Bookkeeper
Undated:
WMA Securities/Field Compliance Officer
Undated:
WMA Securities/Office Manager
Undated:
B. Ghosh, M.D./Office Manager
Undated:
A. Vargas, M.D./Office Manager
Ms. Marie Perriott
November 9, 2012
Page 9
1983 - 1984:
LAPD/Recruit Officer
Excluding this claim, Ms. Perriott reports that she lost substantial time from
work, while employed at Rose Hills Company in 2007 after a right shoulder
surgery. She also sustained injury to her low back while working for the
LAPD in 1983.
She also broke her right hand finger in 1976.
PAST PSYCHIATRIC HISTORY:
With the exception to this claim, she has never seen a psychiatrist,
psychologist or mental health professional in the past. She has never been
treated for a psychiatric or emotional problem either on an inpatient or
outpatient basis.
PAST MEDICAL HISTORY:
She reports the following medical and/or surgical problems:
1.
2.
3.
Right rotator cuff surgery in 2007.
Low back injury in 1983.
Broken right hand finger in 1976.
She returned to Dr. Boozer, her primary care physician, because she had
asthma and shortness of breath. Dr. Boozer referred her to a pulmonary
specialist who prescribed an inhaler for her. According to Ms. Perriott, she
developed a dermatitis on her hands and scalp so Dr. Boozer referred her to
a dermatologist who diagnosed her with eczema and prescribed topical
creams for her.
FAMILY HISTORY:
Ms. Perriott states she was born in Los Angeles, California.
Ms. Marie Perriott
November 9, 2012
Page 10
She reports that her parents were married. Her 84-year-old father passed
away in 2002 and her 79-year-old mother passed away from leukemia.
She has four brothers, ages 71, 68, 55, and 53 and one deceased brother. She
also has four sisters, ages 73, 71, 60, and 58. Her relationship with her family
is close. She is unaware of anyone in her family having past psychiatric
problems. No one in her family has a history of alcohol, drugs, or gambling.
Ms. Perriott has been married twice. She first married at the age of 18 and
divorced when she was 21. She remarried at age 25 and divorced at age 27.
She has a 42-year-old son and 37-year-old daughter. Both of her children are
healthy.
DEVELOPMENTAL HISTORY:
As far as she can recall, Ms. Perriott states that she reached all of her
developmental milestones including sitting up, standing up, walking, talking,
being toilet trained and attending the first day of school without difficulties
and within the normal time limits.
She further says that she cannot recall having any problems learning to read,
write, calculate or perform fine sensorimotor tasks. She does not believe that
she was ever told that she had a developmental, congenital, familial, genetic
or sensorimotor disorder.
SOCIAL HISTORY:
She comments that her interests and hobbies include bible studies and
karaoke. She has not been able to go to church since her disability; however,
she watches services at home.
She states her two divorces were difficult for her.
She filed a Workers' Compensation claim in 1983 for a low back injury and
another claim in 2007 for a right shoulder injury. She underwent right
shoulder surgery and both cases are settled. She denies ever filing a Personal
Injury claim.
Ms. Marie Perriott
November 9, 2012
Page 11
She denies any problems with alcohol, illicit drugs, or gambling.
Furthermore, she has never had any criminal charges placed against her.
MENTAL STATUS EXAMINATION:
Behavior/Demeanor:
Casually attired, Ms. Perriott shows no evidence of psychomotor retardation
or agitation. There is no suggestion of any abnormalities of manner. She
relates well to the examiner and is cooperative throughout the interview.
Speech/Language:
Ms. Perriott is articulate. Her speech is fluent, and has good prosody,
repetition and spontaneity. There is no suggestion of aphasia, apraxia,
anomia or agnosia.
Affect/Mood:
Her mood is bland and her affect blunted.
Cognition:
There are no signs of hallucinations, delusions, tangentiality,
circumstantiality, autism, or ideas of reference. There are no manifestations
of loose associations, pressured speech, obsessive ruminations or flight of
ideas. Ms. Perriott is oriented to time, place, and person, and her memory for
recent and remote events is intact.
Ms. Perriott's insight into herself is fair and her judgment is fair. Her
intelligence is average.
Physiologic:
There is no suggestion of conversion reaction or excessive autonomic
discharge in Ms. Perriott. There is no manifestation of marked diaphoresis,
pallor or flushing of the skin.
Ms. Marie Perriott
November 9, 2012
Page 12
RESULTS OF PSYCHOLOGICAL TESTING:
Ms. Perriott was administered the Hamilton Depression Rating Scale, the
Hamilton Anxiety Rating Scale, the Rey 15-Item Memorization Test and the
Rey Dot Counting Test.
Hamilton Depression Rating Scale:
On the Hamilton Depression Rating Scale, Ms. Perriott received a score of
8 out of a possible 61 points, indicating slight symptomatology indicative of
a possible depressive disorder.
Hamilton Anxiety Rating Scale:
On the Hamilton Anxiety Rating Scale, Ms. Perriott obtained a score of 4 out
of a possible 56 points, indicating minimal symptomatology suggestive of a
possible anxiety disorder.
Rey 15-Item Memorization Test and Rey Dot Counting Test:
The Rey 15-Item Memorization Test and the Rey Dot Counting Test were
scored and interpreted by Carla Back-Madruga, Ph.D., Clinical and
Neuropsychologist.
These tests are designed to evaluate the veracity of claims by patients that
their cognitive ability is decreased. Research has indicated that individuals
who fake or exaggerate memory or other impairments tend to display
responses which are quantitatively and qualitatively different from those of
actual brain-injured individuals with true cognitive impairment. The use of
these two tests in conjunction with other tests designed to evaluate
malingering have been fruitful in identifying patients who were not truly
impaired cognitively, and were either exaggerating or fabricating their
symptoms.
Boone KB, Savodnik I, Ghaffarian S, Lee A, Freeman D, Berman N. Rey 15Item Memorization and Dot Counting scores in a "stress" claim Workers'
Compensation population: Relationship to personality (MCMI) scores.
Journal of Clinical Psychology, May 1995, Vol. 51, No. 3.
Ms. Marie Perriott
November 9, 2012
Page 13
Ms. Perriott passed the measures, suggesting that she probably
was not attempting to malinger cognitive deficits.
REVIEW OF MEDICAL RECORDS:
1) Various Dates: Series of Doctor’s First Report of Occupational
Injury or Illness by Various Providers.
The records were dated from [Undated] to 7/08/09.
[Undated] by [illegible], Galloni Enterprises Medical Group, Inc.:
Date of Injury: 2/19/09.
Ms. Perriott had an automobile accident while working with Rose
Hills. She injured her low back, right hip, left shoulder, and right
groin area. She complained of pain in the right hip and left shoulder.
DIAGNOSIS:
1.
OA AC joint.
2.
OA LS severe.
3.
OA right hip [illegible].
She was to have hip surgery on 3/06/12.
7/08/09 by Hamid Rahman, M.D., F.A.C.S.:
Date of Injury: 2/12/09.
Ms. Perriott was involved in a motor vehicle accident while returning
to her place of employment. She complained of constant aching pain
in her low back and right hip.
Ms. Marie Perriott
November 9, 2012
Page 14
DIAGNOSIS:
1.
Musculoligamentous strain/sprain lumbar spine.
2.
Right hip strain.
3.
Greater trochanteric bursitis.
4.
Insomnia.
Authorization was requested for MRI of the lumbar spine and right
hip. She was referred for physical therapy and acupuncture.
2) 2/23/91: Emergency Room Record by [illegible], Queen of the
Valley Hospital.
Ms. Perriott had an industrial injury to her back in 1983. Apparently
she was injured while wrestling at work. She worked for the LAPD
as a recruit officer. She was eventually placed on partial permanent
disability of 80%. She later returned to work as a medical office
manager. She was doing relatively well until approximately one week
ago when she began having back muscle spasms after cleaning a
bathtub. She was at a friend’s house last night when she experienced
very severe muscle spasms and was not able to get out of the car. The
paramedics had to take her out of the car and bring her here by
ambulance. She was unable to be ambulated and was admitted at this
time for analgesia.
ASSESSMENT:
1.
Acute lumbar spasm. Rule out herniated disk.
She was admitted for bedrest, MRI scan, and analgesia. She was to be
gradually ambulated as tolerated and discharged when able to
ambulate.
Ms. Marie Perriott
November 9, 2012
Page 15
3) Various Dates: Series of MRI Reports by Various Providers.
The records were dated from 2/23/91 to 10/19/10.
2/23/91 by Robert Cohen, M.D., Valley Imaging Partnership:
STUDY:
MRI of the Lumbar Spine.
IMPRESSION:
1.
There are degenerative changes in the lower four lumbar discs.
A combination of diffuse disc bulges and endplate osteophytes
cause slight narrowing of the central canal and moderate
narrowing of the neural foramina. There does not appear to be
focal disc herniation on nerve root compression.
12/11/97 by Thomas R. Sanders, M.D., Valley Imaging
Partnership:
STUDY:
MRI of the Lumbar Spine.
IMPRESSION:
1.
Slight to moderate disc bulges centrally at L2-3 and L3-4 with
slight to moderate compression of the thecal sac.
2.
Slight disc bulge at L4-5 and L5-S1 with slight compression of
the thecal sac.
3.
The disc bulges are slightly larger than on previous
examination.
Ms. Marie Perriott
November 9, 2012
Page 16
1/28/99 by Gregory M. Henzie, M.D., Medical Diagnostic
Associates:
STUDY:
MRI of the Lumbar Spine.
IMPRESSION:
1.
Disk dessication at L4-L5 with an approximately 2 mm disk
bulge, most pronounced posterolaterally, left greater than right.
There is mild to moderate foraminal narrowing bilaterally, left
greater than right.
2.
Disk desiccation and narrowing at L3-L4 with a small posterior
osteophyte and minimal retrolisthesis of L3 on L4. There is
mild foraminal narrowing bilaterally.
3.
Mild to moderate disk desiccation at L5-S1 with mild facet
hypertrophy. No central canal or foraminal stenosis is
identified.
12/08/06 by James Shelby, M.D., San Gabriel Valley MRI:
STUDY:
MRI of the Shoulder without contrast.
IMPRESSION:
1.
Nonspecific tendinosis of the supraspinatus tendon.
2.
A partial thickness type I SLAP lesion is suspected.
3.
Possible small joint body within the subcoracoid recess
measuring 3-4 mm.
4.
Small joint effusion.
Ms. Marie Perriott
November 9, 2012
Page 17
STUDY:
MRI of the Cervical Spine without contrast.
IMPRESSION:
1.
Areas of disc desiccation and degenerative change results in
mild-to-moderate foraminal stenosis, particularly at C6-7,
asymmetric to the left.
10/11/07 by Agustinus Suhardja, M.D., Medical Imaging Center
of Huntington Beach:
STUDY:
MRI Arthrogram Right Shoulder.
IMPRESSION:
1.
Partial-thickness tear of the articular surface of the
supraspinatus tendon 1.5 cm from the insertion site.
2.
Amorphous partial tear of the superior labrum, posterior to the
biceps labral anchor. The biceps labral anchor is intact.
3.
Mild degenerative changes of the AC joint without significant
impingement.
7/27/09 by Sim C. Hoffman, M.D., Diplomate, American Board
of Radiology, Certified Specialist, American Board of Nuclear
Medicine, Advanced Professional Imaging Medical Group:
STUDY:
Open MRI of the Lumbar Spine.
Ms. Marie Perriott
November 9, 2012
Page 18
IMPRESSION:
1.
L2-L3 disc level shows a 2 to 3 mm posterior disc protrusion
present. Hypertrophic facet changes are present. The neural
foramina appear patent. There is no evidence of spinal stenosis.
2.
L4-L5 disc level shows a 4 to 5 mm posterior disc protrusion
present. Moderate hypertrophic facet changes are present.
Lateral recess stenosis is present.
3.
L5-S1 disc level shows a 2 mm posterior disc protrusion
present. Spondylosis is present. Mild hypertrophic facet changes
are present. The neural foramina appear patent. There is no
evidence of spinal stenosis.
STUDY:
Open MRI of the Right Hip.
IMPRESSION:
1.
There is narrowing at the superior margin of the acetabularfemoral joint space.
2.
There is no evidence of fracture or avascular necrosis.
9/29/09 by Scott Goldman, M.D.:
STUDY:
MRI of the Lumbar Spine.
IMPRESSION:
1.
Severe disc space narrowing at the L3-L4 level with a 4-5 mm
disc protrusion at the L4-5 level.
Ms. Marie Perriott
November 9, 2012
Page 19
10/19/10 by David Dang, M.D., McKesson:
STUDY:
MRI of the Lumbar Spine without contrast.
IMPRESSION:
1.
Mild L2-L3 degenerative disc and moderate facet arthrosis with
mild central and foraminal narrowing without significant nerve
root compression.
2.
Severe L3-L4 degenerative disc disease with chronic endplate
changes and facet arthrosis. Moderate bilateral neural foraminal
narrowings with deflection of the nerve roots.
3.
Moderate to severe L4-L5 degenerative disc disease with facet
arthrosis and moderate foraminal narrowing with deflection of
exiting nerve roots.
4.
Question 8-mm left renal cyst. Ultrasound evaluation is
recommended.
4) Various Dates: Series of Reports by Thomas O. Bryan, M.D.,
Diplomate, American Board of Orthopaedic Surgery, Clinical
Assistant Professor of Orthopaedics, University of Southern
California School of Medicine, Metcalf Orthopaedic Medical
Group, Inc.
The records were dated from 3/08/91 to 4/22/08.
3/08/91: Orthopaedic Consultation.
A history was obtained. A physical examination was performed.
Ms. Perriott complained of mild low back muscle spasm and pain.
Ms. Marie Perriott
November 9, 2012
Page 20
DIAGNOSIS:
1.
Spinal stenosis with degenerative changes of the lower four
lumbar discs.
Dr. Bryan felt Ms. Perriott had an exacerbation of her ongoing low
back problem. The recommended treatment was for her to be
continued on physical therapy and also continue the Naprosyn. She
was to take Vicodin only as needed. She may continue to work at her
usual job as a medical office manager.
4/16/91: Supplemental Report.
Ms. Perriott stated that she was doing quite well overall. She had
been going to therapy as needed. She was going three times a week
but now had only gone once in the past two weeks. She had a near
normal physical examination. She was to go to physical therapy only
if needed.
10/29/91: Supplemental Report.
Ms. Perriott reported for renewal of Darvocet and Naprosyn due to
some increased low back discomfort. Medications were renewed.
11/18/91: Supplemental Report.
Ms. Perriott reported that she was doing significantly better. The back
was less tender and she had been able to work at her job as a medical
office manager. It was felt she had resolution of the acute
exacerbation of her low back pain.
5/19/93: Supplemental Report.
Ms. Perriott reported that she had a flare-up over the past several
days. She had been wearing a back brace which she had at home and
had been using a heating pad. Most of the pain was in the left side of
her back and also the left thigh felt “funny” when she went up stairs.
She reported that she had not worked since June of 1992. Apparently
she had been taking care of her nephew and received some
Ms. Marie Perriott
November 9, 2012
Page 21
compensation for this.
She reported that this latest flare up of back pain occurred when she
was getting ready for a birthday party and was doing a lot of bending,
stooping, and lifting.
DIAGNOSTIC IMPRESSION:
1.
Recurrent lumbar strain.
Recommended treatment was for her to begin a physical therapy
treatment program. She was given medication refills.
2/02/94: Supplemental Report.
Ms. Perriott reported she was doing well for approximately six
months but now had a “flare up” for several days. She was uncertain
what caused it. Upon physical examination, she appeared quite
uncomfortable.
DIAGNOSTIC IMPRESSION:
1.
Acute flare up of chronic low back pain.
Recommended treatment was for her to begin a short course of
physical therapy for symptomatic relief. Medications were refilled.
She was fitted with a lumbar corset.
11/29/06: Progress Report.
Ms. Perriott complained of shoulder pain secondary to carrying a
heavy briefcase over her shoulder for long periods of time. Physical
therapy helped the shoulder a bit but exercises made the pain go down
the left arm to the fingers.
DIAGNOSES:
1.
Rule out rotator cuff tear right shoulder.
Ms. Marie Perriott
November 9, 2012
Page 22
2.
Rule out cervical disc syndrome.
She was referred for an MRI of the right shoulder. She was returned
to regular duty.
12/13/06: Progress Report.
Ms. Perriott was here to go over the MRI results. She complained of
right shoulder pain.
DIAGNOSES:
1.
Cervical disc bulges with foraminal stenosis.
2.
Glenoid labral tear with impingement.
She was referred for physical therapy. She was returned to modified
work with restrictions of limited use of the right shoulder.
2/22/07: Letter to Angela Singh, Senior Claims Representative,
Gallagher Bassett.
Dr. Bryan was in receipt of the denial letter dated 2/15/07 regarding
his authorization request for shoulder arthroscopy with debridement
of glenoid labral tear and subacromial decompression.
Ms. Perriott was treated conservatively initially, however she had
continued pain and impingement. Dr. Bryan recommended that she
undergo surgery to debride the torn labrum and also a subacromial
decompression.
Dr. Bryan noted that he would be happy to discuss Ms. Perriott’s case
with a board-certified orthopedic surgeon. He felt that Ms. Perriott
was an appropriate candidate for arthroscopic subacromial
decompression and debridement of the torn glenoid labrum. She had
physical therapy for her neck which had led to some improvement
with the pain localizing more to the shoulder.
Dr. Bryan felt that a steroid injection was unlikely to be of any benefit
Ms. Marie Perriott
November 9, 2012
Page 23
to Ms. Perriott and she did not want to have an injection performed.
Dr. Bryan saw no reason to further delay or deny the surgery.
5/02/07: Progress Report.
Ms. Perriott complained of increased fatigue and weakness. The pain
to her shoulder had subsided.
DIAGNOSIS:
1.
Status post arthroscopy right shoulder debridement of torn
glenoid labrum.
2.
Chondroplasty of humeral head.
She was referred for physical therapy. She remained off work for four
weeks.
4/22/08: Primary Treating Physician’s Permanent and Stationary
Report.
Postoperatively, Ms. Perriott had continued to have some
acromioclavicular joint pain and consideration at one point was given
to performing an arthrocopic Mumford procedure. However, she had
made some improvement. She still had some limitations. She used her
other arm for most overhead activities as well as for repetitive
pushing and pulling.
DIAGNOSIS:
1.
Status post arthroscopic surgery right shoulder with
debridement of torn glenoid labrum, chondroplasty of the
humeral head and arthroscopic subacromial decompression.
There was no rateable disability by AMA Guidelines. It was Dr.
Bryan’s medical opinion that Ms. Perriott injured her shoulder when
she repetitively carried a heavy briefcase in the course of her duties
at work. Apportionment did not appear to be a significant issue as she
had no rateable disability at this time.
Ms. Marie Perriott
November 9, 2012
Page 24
She was returned to full, unrestricted duty.
Future medical care may be required. She had significant
chondroplasty of the humeral head and may require further evaluation
including injections, MRI scans, and operative debridement.
5) Various Dates: Series of Operative Reports by Various
Providers.
The records were dated from 2/19/99 to 3/06/12.
2/19/99 by Richard Kennedy, M.D., Citrus Valley Medical
Center:
Preoperative diagnosis:
1.
Lumbar disc disease with left-sided radiculopathy.
Operation performed:
1.
Selective left L4 foraminal block and selective left L5 foraminal
block using fluoroscopy.
The postoperative diagnosis was the same as the preoperative
diagnosis.
4/23/07 by Thomas Bryan, M.D., Citrus Valley Medical Center:
Preoperative diagnosis:
1.
Torn glenoid labrum, right shoulder with impingement
syndrome.
Operation performed:
1.
Arthroscopy of the right shoulder with debridement of torn
glenoid labrum, chondroplasty of humeral head, arthroscopic
subacromial decompression.
Ms. Marie Perriott
November 9, 2012
Page 25
Postoperative diagnosis:
1.
Torn glenoid labrum, right shoulder, with dissecting
chondromalacia of the humeral head and impingement
syndrome with rotator cuff tendintis.
3/06/12 by Thomas K. Donaldson, M.D.:
Preoperative diagnosis:
1.
Degenerative arthritis of the right hip.
Operation performed:
1.
Right total hip arthroplasty.
The postoperative diagnosis was the same as the preoperative
diagnosis.
6) Various Dates: Series of Progress Notes by Various Providers,
Bergman Medical. (Handwritten, Partially Illegible)
The records were dated from 2000 to 2009.
The assessments included: bronchitis; muscle spasm; asthma; right
hip pain; acute pharyngitis.
7) Various Dates: Series of Radiology Reports by Various
Providers.
The records were dated from 5/11/04 to 3/29/12.
Ms. Marie Perriott
November 9, 2012
Page 26
5/11/04 by Andrea Mallet Reece, M.D., Diplomate, American
Board of Radiology, Diagnostic Medical Group of Southern
California:
STUDY:
Bilateral Mammogram.
IMPRESSION:
1.
Questionable visualization of an ill-defined left 3 o’clock
nodule.
2.
Recommend EFT compression mammography for any palpable
abnormality involving either breast, ultrasound is
recommended.
9/21/04 by Andrea Mallet Reece, M.D., Diagnostic Medical Group
of Southern California:
STUDY:
Left Focal Compression Mammography and Left Breast Ultrasound.
IMPRESSION:
1.
The asymmetric 3 o’clock density seen in mammograms dated
5/11/04 appears stable and exhibits no ominous features in focal
compression images. Suspect normal variation.
2.
Incidental finding of an approximately 5 mm sized upper left
breast nodule seen in the mediolateral oblique focal
compression image, which was not seen in mammograms dated
5/11/04. This probably represents a 5 mm sized cyst seen by
ultrasound dated 9/21/04. A 9 mm sized 2 o’clock cyst seen by
ultrasound was occult by mammography.
3.
ACR category: 2 (benign).
Ms. Marie Perriott
November 9, 2012
Page 27
8/07/06 by Andrea Mallet Reece, M.D., Diagnostic Medical Group
of Southern California:
STUDY:
X-ray of the Right Shoulder.
IMPRESSION:
1.
No acute abnormalities are identified. Mild degenerative joint
disease is noted. Soft tissues are unremarkable with no evidence
of calcific tendonitis.
9/01/06 by Andrea Mallet Reece, M.D., Diagnostic Medical Group
of Southern California:
STUDY:
Pelvic Ultrasound, Transabdominal.
IMPRESSION:
1.
Suboptimal study due to gas.
2.
Normal uterus.
3.
Nonvisualization of the ovaries.
10/12/06 by Merton L. Shew, M.D., Presbyterian Intercommunity
Hospital:
STUDY:
X-ray of the Right Shoulder.
IMPRESSION:
1.
``
Normal right shoulder study.
Ms. Marie Perriott
November 9, 2012
Page 28
4/21/07 by Shaya Ghazinoor, M.D., Citrus Valley Medical
Center:
STUDY:
X-ray of the Chest.
IMPRESSION:
1.
No acute cardiopulmonary process.
11/07/08 by Tan Tran, M.D., Whittier Imaging Center:
STUDY:
X-ray of the Chest.
IMPRESSION:
1.
Normal chest x-ray.
12/09/08 by Aldric Shim, M.D., Diplomate, American Board of
Radiology, Diagnostic Medical Group of Southern California:
STUDY:
Mammography Bilateral Diagnostic.
IMPRESSION:
1.
BI-RADS Category 2 (benign finding).
5/11/09 by Spencer Silverback, M.D., Grove Diagnostic Imaging:
STUDY:
X-ray of the Lumbar Spine.
Ms. Marie Perriott
November 9, 2012
Page 29
IMPRESSION:
1.
Multifocal disc degeneration with spondylosis.
STUDY:
X-ray of the Right Hip.
IMPRESSION:
1.
Negative study.
9/30/09 by Scott Goldman, M.D.:
STUDY:
X-ray of the Right Hip.
IMPRESSION:
1.
Mild osteoarthritis.
3/29/12 by Wayne R. Boyd, M.D.:
STUDY:
X-ray of the Right Hip.
IMPRESSION:
1.
Satisfactory total hip prosthesis.
8) Various Dates: Series of PR-2 Progress Report/Industrial
Records by Philip Baily, M.D., Presbyterian Intercommunity
Hospital.
The records were dated from 9/21/06 to 10/24/06.
Ms. Marie Perriott
November 9, 2012
Page 30
9/21/06:
Ms. Perriott stated that she had some improvement in her symptoms.
She had started attending regular therapy sessions. She had been
attempting to perform her regular duties at work, which were
essentially sedentary in nature.
DIAGNOSIS:
1.
Status post right upper back strain (trapezius musculature).
2.
Status post right upper arm strain.
The plan was to continue with medications and cold pack. She was to
continue physical therapy three times a week for the next two weeks.
10/12/06:
Ms. Perriott stated that she had made some progress with regard to
her right upper back complaints in that she was having only minimal
complaints in that area at this time. She remained symptomatic,
however, with regard to pain in the right arm and shoulder. It
appeared in taking history from her that her right shoulder appeared
to be more symptomatic than noted on the previous examination,
where her right upper arm appeared to be the focus of her symptoms.
DIAGNOSIS:
1.
Status post right shoulder/upper arm strain.
She was to continue with medications and the cold pack. She was to
continue with her physical therapy treatment program three times a
week for the next two weeks.
10/24/06:
Ms. Perriott stated that she remained symptomatic with regard to pain
in the area of the right shoulder. Current pain levels had actually
increased to 6/10. For the past couple of weeks she had not been
Ms. Marie Perriott
November 9, 2012
Page 31
taking the Flexeril due to some family issues where she had to be
available to help another family member at night. She had started
back on the Flexeril in the last couple of days.
DIAGNOSIS:
1.
Status post right shoulder sprain (rule out rotator cuff injury).
She was to continue with medications and physical therapy. She was
referred to be seen by an orthopedic specialist with regard to her
ongoing right shoulder complaints. Dr. Baily was concerned that there
was a good possibility that she may have suffered an injury to her
right rotator cuff. This was a transfer of care.
9) Various Dates: Series of Non-Certification Letters by Various
Providers, Concentra.
The documents were dated from 2007 to 2009.
The following were listed as non-certified: home health aid; physical
therapy for the lumbar & right hip; physical therapy for the right
shoulder.
10) 11/07/07: Agreed Medical Reexamination by Lawrence A.
Feiwell, M.D., Diplomate of the American Board of Orthopaedic
Surgery, Fellow of the American Academy of Orthopaedic
Surgery, The Greater Long Beach Orthopaedic Surgical and
Medical Group.
Ms. Perriott was initially evaluated on 10/03/07. An interim history
was obtained. A physical examination was performed.
Ms. Perriott reported that the MR arthrogram of the right shoulder
increased symptoms of shoulder pain.
DIAGNOSES:
1.
Impingement syndrome right shoulder.
Ms. Marie Perriott
November 9, 2012
Page 32
2.
Acromioclavicular degenerative joint disease with residual
stiffness and pain.
3.
Degenerative disc disease cervical spine.
Dr. Feiwell believed Ms. Perriott required further treatment which
should consist of a subacromial injection of cortisone and he believed
she required another two months of physical therapy consisting of
range of motion and strengthening. If her symptoms did not improve,
he believed she would be a candidate for revision arthroscopy with
debridement and resection of the distal clavicle. She may continue to
perform her usual and customary duties.
11) Various Dates: Series of Office Notes by Various Providers,
Inland Region Medical Group.
The records were dated 2009.
The assessments included: sprain and strain of unspecified site of hip
and thigh; acute nasopharyngitis; unspecified asthma.
12) Various Dates: Series of Application for Adjudication of
Claim.
The records were dated from 6/18/09 to 5/09/11.
6/18/09:
Date of Injury: 2/12/09.
Ms. Perriott, while employed as Sales with Rose Hills Company,
sustained injury as follows: to the back, right hip, and right leg, due
to an auto accident.. An Employee’s Claim for Workers’
Compensation Benefits of the same date contained information
consistent with the Application for Adjudication of Claim. Also, a
Workers’ Compensation Claim Form dated 5/29/09 also contained
information consistent with the Application for Adjudication of
Claim.
Ms. Marie Perriott
November 9, 2012
Page 33
3/28/11: Amended.
Right shoulder and right arm were added as a compensable
consequence to industrial injuries.
4/27/11: Amended.
Left shoulder and left upper extremities were added as a compensable
consequence of industrial injuries (not right arm or right shoulder).
5/09/11: Amended.
Psyche, left shoulder, and left upper extremities were added as a
compensable consequence of industrial injuries (not right arm or right
shoulder).
13) Various Dates: Series of Reports by Hamid Rahman, M.D.,
Orthopedic Sports & Spine Medical Group.
The records were dated from 7/08/09 to 8/05/09.
7/08/09: Authorized Initial Orthopedic Consultation.
A history was obtained. Medical records and radiology reports were
reviewed. A physical examination was performed.
Ms. Perriott complained of constant aching pain to the right side of
the low back that radiated into the hip and leg. There was a lot of
stiffness of the low back that radiated downward. There had been an
increase in urinary frequency and bowel movements. There was a
popping of the low back with pressing down on the abdomen, and she
stated this relieved some of the pain. The pain was increased with
bending, pulling, pushing, lifting, twisting, prolonged standing, sitting
and driving. There was a constant aching pain with stiffness of her
right hip. She stated she felt like she had a strain of the hamstring
region of her leg. There was weakness and instability to the right hip
and leg. The pain was increased with standing, walking, driving, and
ascending/descending stairs.
Ms. Marie Perriott
November 9, 2012
Page 34
DIAGNOSES:
1.
Musculoligamentous strain/sprain lumbar spine.
2.
Right lower extremity radiculitis, rule out herniated nucleus
pulposus.
3.
Right greater trochanteric bursitis.
4.
Insomnia.
Medications were dispensed. Authorization was requested for MRI
of the lumbar spine and MRI of the right hip, EMG/NCV studies,
interferential stimulator, and physical therapy twice a week for 6
weeks. Also recommended was a trial of acupuncture treatment with
Dr. Hing for six sessions. Ms. Perriott was temporarily totally
disabled.
8/05/09: Orthopedic Reevaluation.
Ms. Perriott was still complaining of significant low back pain. She
was attending chiropractic and physiotherapy with Dr. McClellan and
had improved somewhat with therapy. Additional therapy had been
recommended for at least five visits. There was pain radiating into the
right groin area.
The diagnoses remained the same. She had a negative EMG/Nerve
Conduction Study and a progress report from Dr. McClellan showed
that although the symptoms persisted she had improved range of
motion and increased strength. She was referred to pain management
for trial lumbar spine epidural steroid injection. Darvocet was refilled.
She was temporarily totally disabled.
14) 7/15/09: Electrodiagnostic Studies Report by Aaron
Coppelson, M.D., Diplomate of the American Board of
Electrodiagnostic Medicine, Physical Medicine & Rehabilitation,
& Pain Management, Restore Medical Group.
Ms. Marie Perriott
November 9, 2012
Page 35
Ms. Perriott was referred by Dr. Rahman for electrodiagnostic testing
of the bilateral lower extremities.
STUDIES:
Nerve Conduction Studies and Electromyogram.
IMPRESSION:
1.
Normal NCS.
2.
Normal EMG.
15) Various Dates: Series of Depositions of Marie Perriott.
The depositions were dated from 9/14/09 to 1/31/12.
9/14/09: Volume I.
Ms. Perriott was currently taking medication which consisted of
Darvocet and over-the-counter Extra Strength Tylenol. The Darvocet
was prescribed by Dr. Ramon [sic], and she took it for pain in her
lower back and right leg.
Marie Antoinette Perriott stated her full name. She had also been
known by the names of Marie Antoinette Lara and Marie Antoinette
Para. She had a nickname of Melly. She was born on 5/19/50 in Los
Angeles, California. She lived in Michigan for one year, in 1979.
She lived with her son, who was an adult. She had one other child, a
daughter who lived in Upland. Her current physician was Dr. Jennifer
Boozer, who had been her doctor since May of 2009. Prior to this, she
saw Dr. Rosario Cecilio in Whittier. She was previously a member
of Kaiser, but could not recall the period of time in which she was a
member.
She was hospitalized six years ago due to respiratory problems. She
Ms. Marie Perriott
November 9, 2012
Page 36
was also hospitalized due to her low back, which she believed was as
a result of using a TENS unit for her lower back. She had injured her
lower back in 1983 due to combat wrestling/police training. She
received treatment from Dr. Bryan who had been her doctor since
1991 for her back.
She had been involved in two car accidents, most recently six years
ago while backing out her driveway and scratching another car; there
were no injuries. The other accident occurred approximately 15 years
ago when she was rear-ended on the street. She recalled a stiffness in
her neck.
She had her deposition taken in 2007 for a work-related injury while
employed with Rose Hills, her current employer. She injured herself
due to the weight of her briefcase on her shoulder which caused a tear
in her right shoulder rotator cuff. She had surgery performed by Dr.
Bryan, and underwent therapy.
The pain in her right leg would sometimes travel all the way down to
her toes. She denied left leg pain.
1/31/12: Volume II.
Ms. Perriott had been involved in another automobile accident since
the prior deposition. She stated that she was rear-ended last week in
Rancho Cucamonga; she did not sustain any injuries.
She spent her days at home “most of the time” and reclined the
majority of the time. She tried to do a little bit of housework, but she
had to recline in between activities due to her right leg pain.
Her current source of income was EDD disability.
She lived with her adult son who was working and helping out with
the rent. She was behind with her electric bill and gas bill. Her rent
was on time. She had a total of two children and one grandchild. She
had been married twice; the first time to David Belara in 1969. The
marriage lasted three years; she wanted a divorce because she was not
happy with him. She described him as jealous. She recalled seeking
Ms. Marie Perriott
November 9, 2012
Page 37
counseling with the Air Force chaplain; maybe two sessions. He was
the father of her son.
Her second husband was Mark Perriott; they were married in 1975 for
a year and a half. He was the father of her daughter. She initiated the
divorce because she wanted to work and he did not want her to work.
She stated that he was verbally abusive sometimes, and had hit her a
couple of times. The abuse caused her a little bit of stress.
She described the relationship with her first husband as “cordial”and
the relationship with her second husband as “very good.”
She recalled her injury in 2009 in which she injured her upper back,
right hip into her groin, and her right leg. She was claiming injury to
additional parts of her body: her left shoulder and arm. She stated that
the symptoms in her left shoulder had happened slowly. She stated,
“Because of the problem in my right hip and lower back, I have
difficulty sleeping too long on my back and/or on my right side. So
I spend a lot of time when I sleep on my left side of my body.” As a
result of her work at Rose Hills, she claimed she had injured the
following parts of her body: lower back, right hip, leg, and groin, left
shoulder and arm.
She started to feel symptoms of depression when she went to CedarsSinai, and then went back to Dr. Goldman’s office and was told there
was nothing that could be done for her, that her “back was going to
be like that.” She felt like she wanted to cry, and wondered what kind
of life she was going to have.” She felt symptoms of anxiety, which
she described as “feeling nervous, hopeless, trapped.”
She had seen Dr. Donaldson twice. She wished to have right hip
surgery, but did not want back surgery.
Ms. Perriott stated that she no longer socialized with friends. She had
not had a boyfriend in the last ten years. She had crying spells a
couple of times a week.
Her mother passed away in January 1998 from leukemia. She
described the relationship with her mother as “very loving.” Her
Ms. Marie Perriott
November 9, 2012
Page 38
mother had been given fourteen days to two months to live, and she
passed away in fourteen days. She had nine siblings and said she was
close to all of them. Her father died from complications of pneumonia
in 2002. She stated that she was “very” close to her father, and her
parents were still together up until her mother’s passing. Her father
had Alzheimer’s. She had a brother who died at age 49 and had
cerebral palsy.
After her parents died, she sought counseling from her pastor.
16) Various Dates: Series of Reports by Scott Goldman, M.D.,
Board Certified Orthopedic Surgeon.
The records were dated from 9/30/09 to 1/13/12.
9/30/09: Initial Orthopedic Evaluation Report.
A history was obtained. Diagnostic studies were reviewed. A physical
examination was performed.
Ms. Perriott had a painful condition affecting the lower back, with
radiation of pain into the right lower extremity. She sustained injury
to her lower back with right-sided sciatica as a result of a motor
vehicle accident that occurred on 2/12/09 while working in sales for
Rose Hills Company. At the time of injury, she was stopped in her
vehicle when another vehicle struck her vehicle on the front
passenger side, resulting in injury to her lower back and right leg. She
had a previous history of work-related injury to the lower back in
1982.
ASSESSMENT:
1.
Disc protrusion, L4-5, with spinal stenosis, L3-4, and rightsided sciatica.
Medications were prescribed. She was referred for physical therapy
with spinal decompression, 3 times a week for 4 weeks for the lower
back. Recommendation was made for ambulation with cane to left
Ms. Marie Perriott
November 9, 2012
Page 39
hand, as she had significant pain in the right leg. She was temporarily
totally disabled.
10/14/11: Primary Treating Physician’s Progress Report.
Ms. Perriott had severely painful conditions affecting the lower back
and right hip. As a result, she slept on the left side of her body. This
had resulted in traumatic injury to the left shoulder. Repeated
sleeping on the left shoulder had injured her rotator cuff.
Authorization was requested to evaluate and treat the left shoulder at
this time. X-ray of the right hip was reviewed.
ASSESSMENT:
1.
Disc protrusion, lumbar spine.
2.
Osteoarthritis, right hip, severe.
Authorization was requested for total right hip replacement with Dr.
Donaldson. Medication was prescribed. The treatment plan included
a home exercise program for the lower back. Ms. Perriott was
permanent and stationary status under Future Medical Care.
12/12/11: Primary Treating Physician’s Progress Report.
Ms. Perriott had severe osteoarthritis affecting the lumbar spine and
right hip.
ASSESSMENT:
1.
Osteoarthritis, lumbar spine.
2.
Osteoarthritis, right hip.
Authorization was requested for cardiac clearance followed by joint
replacement of the right hip by Dr. Donaldson. Anaprox was
dispensed.
1/13/12: Primary Treating Physician’s Progress Report.
Ms. Marie Perriott
November 9, 2012
Page 40
Ms. Perriott had seen Dr. Donaldson, who recommended total hip
replacement. A repeat EKG was performed and according to Ms.
Perriott, this was normal. However, Dr. Goldman did not have the
results to verify this.
ASSESSMENT:
1.
Osteoarthritis, lumbar spine.
2.
Osteoarthritis, right hip.
Authorization was requested for cardiology clearance for right total
hip replacement and right total hip replacement with Dr. Donaldson.
17) 7/11/11: Notification of Non-Certification by Rosalyn Beaty,
M.D., Coventry.
The request for right hip MR arthrogram and MRI of the lumbar spine
at San Antonio Community Hospital was not certified.
18) Various Dates: Series of Secondary Treating Physician’s
Progress Reports by Thomas K. Donaldson, M.D.
The records were dated from 10/27/11 to 4/12/12.
10/27/11:
Ms. Perriott reported for pre-operative examination in anticipation of
a right total hip arthroplasty.
DIAGNOSES:
1.
Hip degenerative joint disease.
2.
Hip pelvis pain.
The treatment plan included right total hip arthroplasty.
Ms. Marie Perriott
November 9, 2012
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3/16/12:
Ms. Perriott was here for her first post op of the right total hip
arthroplasty performed on 3/06/12. She currently was not having any
pain or major complications at this time.
DIAGNOSIS:
1.
Hip joint replacement.
She was to continue the home exercise program and start out-patient
physical therapy. Activity modification was as tolerated.
4/12/12:
Ms. Perriott was doing well. She was awaiting approval for physical
therapy. She requested transportation to and from doctor’s office as
she was still not cleared to drive yet.
DIAGNOSIS:
1.
Hip joint replacement.
2.
Hip pelvis pain.
Authorization was requested to provide transportation to and from
doctor’s office for 6 weeks. Authorization was requested for x-rays
of the right hip and ultrasound of the right lower extremity.
19) Various Dates: Series of Clinic Notes by Gail Maloff,
L.M.F.T., Perry Maloff, M.D., & Associates.
The records were dated from 12/20/11 to 2/23/12.
12/20/11:
Ms. Perriott received psychotherapy on 10/18/11 and 12/05/11. Her
mood was depressed; affect was congruent to mood. She complained
Ms. Marie Perriott
November 9, 2012
Page 42
of back and hip pain. She stated, “I don’t do anything. I have to
recline.” She was anxious. She reported going to emergency room
fearing she was having a “heart attack.” There was improvement in
sleep. She described stopping “all medication” and experiencing
improvement in symptoms.
2/23/12:
Ms. Perriott was scheduled for hip surgery on 3/06/12. She reported
her mood was better with the knowledge that she was cleared for
surgery. She had lost a few pounds. She acknowledged she would be
on her own after surgery as her daughter had to work and her son
underwent surgery. She had numerous somatic complaints. She did
not go out “so much.”
6/25/12:
Ms. Perriott was status post surgery. Her mood was irritable and
depressed with congruent affect. She was highly frustrated with
denials following surgery for physical therapy. She was dependent
upon others for transportation. She felt isolated and socially
withdrawn. There were negative thought processes. She had
numerous complaints regarding navigation through workers’
compensation system.
20) Various Dates: Series of Reports by Luigi F. Galloni, M.D.
The records were dated from 2/24/12 to 9/27/12.
2/24/12: Primary Treating Physician’s Initial Orthopedic
Evaluation.
A history was obtained. Diagnostic studies were reviewed. A physical
examination was performed.
Ms. Perriott complained of pain and discomfort in the left shoulder,
with radiation to the fingers. The pain was associated with numbness
and tingling. The pain came and went and was constant in frequency.
Ms. Marie Perriott
November 9, 2012
Page 43
She complained of pain in the low back, with radiation to the coccyx.
The pain was constant in frequency. She complained of pain in the
right hip, with radiation to the right groin area. The pain was on and
off in frequency.
DIAGNOSES:
1.
Osteoarthritis of the acromioclavicular joint with possible
impingement syndrome of the left shoulder.
2.
Severe osteoarthritis of the lumbosacral spine.
3.
Moderate osteoarthritis of the right hip.
Ms. Perriott was scheduled for a total hip replacement on 3/06/12.
She was also here for a change of primary treating physician. She was
temporarily totally disabled.
3/01/12: Review of Medical Records.
Numerous medical records were reviewed with regard to Ms.
Perriott’s injury to her right hip and lumbosacral spine. Dr. Galloni
found the information contained in the records to be consistent with
the information Ms. Perriott provided to him. He found nothing to
cause him to change any of his prior opinions, conclusions or
recommendations.
4/27/12: Follow-Up Orthopaedic Evaluation.
Ms. Perriott had lower lumbar problems. She was post-op right hip
replacement. She was not able to drive and therefore needed
transportation to several doctor’s appointments. She was in need of
a cane. She had also been denied physical therapy which was an
important part of post operative care. She was to be seen by Dr.
Donaldson in May and was to follow-up here in four to six weeks.
She remained temporarily totally disabled.
5/25/12: Follow-Up Orthopaedic Evaluation.
Ms. Marie Perriott
November 9, 2012
Page 44
Ms. Perriott complained of pain in the lower back. She related that
she was receiving therapy for the right hip, three times a week.
The diagnoses remained the same as on 2/24/12. She was to continue
with her physical therapy two times a week for the next six weeks.
She remained temporarily totally disabled.
5/29/12: Review of Medical Records.
Additional medical records were reviewed. Dr. Galloni found nothing
to cause him to change any of his prior opinions, conclusions or
recommendations.
6/28/12: Follow-Up Consultation.
Ms. Perriott continued to complain of neck pain radiating to both
shoulders, lower back pain, and left wrist pain.
DIAGNOSES:
1.
Acromioclavicular arthrosis, left shoulder.
2.
Impingement syndrome, left shoulder.
3.
Tendinitis/bursitis, left shoulder.
4.
DeQuervain’s, left wrist.
5.
Tenosynovitis, left 1st carpometacarpal joint.
A course of shockwave treatment to the left shoulder and left wrists.
was recommended. If this failed, Dr. Galloni felt the only other option
was surgical, in the form of a decompression to the left shoulder. It
was recommended she continue with her splinting.
6/29/12: Follow-Up Orthopaedic Evaluation.
Ms. Marie Perriott
November 9, 2012
Page 45
Ms. Perriott continued to complain of right hip pain, as well as lower
back pain.
DIAGNOSES:
1.
Osteoarthritis of the acromioclavicular joint with possible
impingement syndrome of the left shoulder.
2.
Severe osteoarthritis of the lumbosacral spine.
3.
Moderate osteoarthritis of the right hip.
4.
Status post right total hip replacement.
She continued to need postoperative rehabilitation for the right total
hip replacement. She remained temporarily totally disabled.
9/27/12: Follow-Up Orthopaedic Evaluation.
Ms. Perriott complained of dull aching pain in the right hip. She also
complained of severe low back pain. She stated that she was unable
to stand or walk for any significant amount of time. Additional
medical records were reviewed.
DIAGNOSES:
1.
Osteoarthritis of the acromioclavicular joint with possible
impingement syndrome of the left shoulder.
2.
Severe osteoarthritis of the lumbar spine.
3.
Severe lumbar discogenic disease.
4.
Central and foraminal narrowing, L3-L4 and L4-L5.
5.
Post total hip replacement on the right.
It was recommended that Ms. Perriott see a pain management doctor
in view of the severe degree of pain in her lower back which was
Ms. Marie Perriott
November 9, 2012
Page 46
confirmed by MRI scan. She needed to continue to follow up with Dr.
Donaldson for the hip replacement procedure performed by him. It
was also recommended that the pain management doctor manager her
pharmcologically. She was to be started on a course of physical
therapy for her lumbar spine, two times a week for 6 weeks. She was
recommended to perform home exercises for her hip. She remained
temporarily totally disabled.
21) Various Dates: Series of Secondary Treating Physician’s
Progress Reports by Thomas K. Donaldson, M.D., Empire
Orthopedic Center.
The records were dated from 7/25/12 to 9/13/12.
7/25/12:
Ms. Perriott reported for a recheck of the right total hip arthroplasty,
performed on 3/16/12. She stated that her right hip was doing well,
but that she was having difficulty driving. She was currently taking
Vicodin for pain. She was in physical therap and had completed 12
sessions. Overall she felt that she was progressing.
DIAGNOSIS:
1.
Hip joint replacement.
She was to continue the home exercise program and start out-patient
physical therapy, 2 times a week for the next 6 weeks. She was to
perform activity modification as tolerated.
9/13/12:
Ms. Perriott stated that she had been experiencing an ache in her right
hip and groin, and had also noticed that she had been limping for the
past six months. Overall, she was satisfied with her progress. The
diagnosis remained the same. She was to continue with her home
exercises and activity modification as tolerated.
Ms. Marie Perriott
November 9, 2012
Page 47
DIAGNOSIS:
On the basis of Ms. Perriott's history, mental status examination, review of
medical records, and the results of psychological testing, the following
diagnoses are offered in accordance with the Diagnostic and Statistical
Manual-IV of the American Psychiatric Association:
AXIS I:
DEPRESSIVE DISORDER NOT OTHERWISE
SPECIFIED (INDUSTRIALLY RELATED) [311].
AXIS II:
NO PERSONALITY DISORDER.
AXIS III:
OA AC JOINT.
OA LS SEVERE.
OA RIGHT HIP.
MUSCULOLIGAMENTOUS STRAIN/SPRAIN
LUMBAR SPINE.
RIGHT HIP STRAIN.
GREATER TROCHANTERIC BURSITIS.
INSOMNIA.
RECURRENT LUMBAR STRAIN.
MILD OSTEOARTHRITIS.
IMPINGEMENT
SHOULDER.
SYNDROME
RIGHT
ACROMIOCLAVICULAR DEGENERATIVE
JOINT DISEASE WITH RESIDUAL STIFFNESS
AND PAIN.
Ms. Marie Perriott
November 9, 2012
Page 48
DEGENERATIVE DISC DISEASE CERVICAL
SPINE.
HIP DEGENERATIVE JOINT DISEASE.
HIP PELVIS PAIN.
AXIS IV:
DEFERRED.
AXIS V:
GAF SCORE OF 61 CORRESPONDING TO A
WHOLE PERSON IMPAIRMENT (WPI) SCORE
OF 14.
SUMMARY AND CONCLUSIONS:
Ms. Marie Perriott began working for Rose Hills Co. as a memorial service
counselor on October 6, 2003.
She reports that she injured herself at work on February 12, 2009, when she
was driving back to the office from a presentation and was hit on front end
of the passenger side by a van. She injured her lower back and right hip.”
Ms. Perriott reported the job injury to her supervisor. She was later sent to
Presbyterian Intercommunity Hospital emergency room on May 29, 2009,
where she saw a physician assistant, who prescribed pain medication and
treated her with physical therapy.
Ms. Perriott went back to work with job restrictions. Subsequently, she
consulted an attorney and was sent to Dr. Rahman, who took her off work.
Her last day of work was on May 7, 2012. She was treated with physical
therapy and various medications. She was told by two different doctors that
they did not recommend back surgery, which put Ms. Perriott in a depression
because she felt there was nothing they could do for her back pain.
She was sent to a psychiatrist because she was depressed. She received
individual psychotherapy sessions.
Ms. Marie Perriott
November 9, 2012
Page 49
According to Ms. Perriott, she went to San Antonio Hospital emergency room
due to shortness of breath, hot flashes, and lightheadedness. She was told
that she was “okay.” She later got an MRI on her right hip and underwent a
total right hip replacement surgery on March 6, 2012. She was then sent to
a nursing home for three weeks and was treated with postoperative physical
therapy.
In regard to her current physical complaints, Ms. Perriott reports right hip
pain, headaches and lower back pain that radiates down her right leg.
She is taking the following medications:
1.
Hydrocodone.
2.
Naproxen.
3.
Amitriptyline.
4.
Flurbiprofen.
5.
Mometasone.
6.
Desonide.
Having considered the evidence gained from Ms. Perriott's history, her
mental status examination, the review of medical records, and the
psychological testing, an assessment of DEPRESSIVE DISORDER NOT
OTHERWISE SPECIFIED (INDUSTRIALLY RELATED) is offered on
Axis I. Ms. Perriott is permanent and stationary.
Ms. Marie Perriott
November 9, 2012
Page 50
On the basis of these considerations, the following statements are offered:
TEMPORARY DISABILITY:
Ms. Perriott is not temporarily disabled psychiatrically on an industrial
basis.
PERMANENT AND STATIONARY:
Ms. Perriott is permanent and stationary with a GAF score of 61
corresponding to a Whole Person Impairment (WPI) score of 14.
CAUSATION:
Ms. Perriott’s work injury contributed at least 51% to her psychiatric
condition and was the predominant cause of her disability.
MEDICAL CARE:
Ms. Perriott should have access to psychiatric care should she experience
an exacerbation or recurrence of her present condition.
ABILITY TO WORK:
Ms. Perriott’s ability to work is diminished in proportion to her GAF
score and WPI ratings.
DISCUSSION OF APPORTIONMENT:
5% History of abuse by spouse.
Any or all of the diagnoses and conclusions contained herein are subject
to revision based upon the receipt and review of additional medical
records.
Ms. Marie Perriott
November 9, 2012
Page 51
RESEARCH FINDINGS
Ms. Perriott has a diagnosis of Depressive Disorder NOS. According to
Kessler, Berglund et al have concluded, “major depressive disorder is a
common disorder, widely distributed in the population, and usually associated
with substantial symptom severity and role impairment. While the recent
increase in treatment is encouraging, inadequate treatment is a serious
concern.”
In a related study, Kessler, Nelson et al found “most cases of lifetime MDD
are secondary. In the sense that they occur in people with a prior history of
another DSM-III-R disorder. Anxiety disorders are the most common primary
disorders. The time-lagged effects of most primary disorders on the risk of
subsequent MDD continue for many years without change in magnitude.
Secondary MDD is, in general, more persistent and severe than pure or
primary MDD.”
However, Kessler sounded a moderating note to his warning in a later study
with Chiu et al, which concluded, “Although mental disorders are
widespread, serious cases are concentrated among a relatively small
proportion of cases with high comorbidity.”
This conclusion was backed by the Netherlands study of Bijl et al, which
reported “Some 41.2% of the adult population under 65 had experienced at
least one DSM-III-R disorder in their lifetime, among them 23.3% within the
preceding year. No gender differences were found in overall morbidity.
Depression, anxiety, and alcohol abuse and dependence were most prevalent,
and there was a high degree of comorbidity between them.”
The need for adequate treatment of depression was further underlined by Judd
et al, who concluded “resolution of major depressive episodes with residual
subthreshold depressive symptoms, even the first lifetime episode, appears
to be the first step of a more severe, relapsing, and chronic future course.
When ongoing subthreshold symptoms continue after major depressive
episodes, the illness is still active, and continued treatment is strongly
recommended.”
Cassem had this take on the relationship between depression and physical
Ms. Marie Perriott
November 9, 2012
Page 52
illness: “Depressive disorders are far more serious than most people realize,
and depressive disorders are disabling affected persons progressively earlier
in life. Heavy utilization of medical services, extensive disability and
morbidity, and high suicide risk exact a staggering economic toll in the
United States annually. Depressive illness is, like pneumonia and septic
shock, a dread complication of major medical illness, and depressive illness
appears more frequently as the medical illness worsens . . .”
Rost et al seconded this conclusion in their study, which found, “Ongoing
intervention increased remission rates and improved indicators of emotional
and physical functioning. Studies are needed to compare the cost
effectiveness of ongoing depression management with other chronic disease
treatment routinely undertaken by primary care.”
Underscoring the seriousness of inadequate treatment of MDD, Stewart et al
concluded, “A majority of the LPT [lost production time] costs that
employers face from employee depression is invisible and explained by
reduced performance while at work. Use of treatments for depression appears
to be relatively low. The combined LPT burden among those with depression
and the low level of treatment suggests that there may be cost-effective
opportunities for improving depression-related outcomes in the US
workforce.”
Greco et al indicated the tenacity of physical symptoms in depression:
“Physical symptoms are prevalent in depressed patients and initially improve
in the first month of SSRI treatment. Unlike depression, however,
improvement in physical symptoms typically plateaus with minimal
resolution in subsequent months.”
Finally, Bair et al reported “Pain is present in two-thirds of depressed primary
care patients begun on antidepressant therapy, and the severity of pain is a
strong predictor of poor depression and health-related quality of life
outcomes at 3 months.”
JAMA, the Journal of the American Medical Association ISSN 0098-7484
2003, vol. 289, no23, pp. 3095-3105 [11 page(s) (article)] (80 ref.)
Ms. Marie Perriott
November 9, 2012
Page 53
THE EPIDEMIOLOGY OF MAJOR DEPRESSIVE DISORDER:
RESULTS FROM THE NATIONAL COMORBIDITY SURVEY
REPLICATION (NCS-R)
Kessler RC (1) ; Berglund P (2) ; Demler O (1) ; Jin R (1) ; Koretz D(3) ;
Merikangas KR (4) ; Rush AJ (5) ; Walters EE (1) ; Wang PS. (1, 6)
(1) Department of Health Care Policy, Harvard Medical School, Boston,
Mass, ETATS-UNIS
(2) Institute for Social Research, University of Michigan, Ann Arbor,
ETATS-UNIS
(3) Division of Mental Disorders, Behavioral Research and AIDS National
Institute of Mental Health, Rockville, Md, ETATS-UNIS
(4) Intramural Research Program, National Institute of Mental Health,
Rockville, Md, ETATS-UNIS
(5) Department of Psychiatry, University of Texas Southwestern Medical
Center, Dallas, ETATS-UNIS
(6) Brigham and Womens'Hospital, Harvard Medical School, ETATS-UNIS
CONTEXT: Uncertainties exist about prevalence and correlates of major
depressive disorder (MDD).
OBJECTIVE: To present nationally representative data on prevalence and
correlates of MDD by Diagnostic and Statistical Manual of Mental Disorders,
Fourth Edition (DSM-IV) criteria, and on study patterns and correlates of
treatment and treatment adequacy from the recently completed National
Comorbidity Survey Replication (NCS-R).
DESIGN: Face-to-face household survey conducted from February 2001 to
December 2002.
SETTING: The 48 contiguous United States.
PARTICIPANTS: Household residents ages 18 years or older (N =9,090)
who responded to the NCS-R survey.
MAIN OUTCOME MEASURES: Prevalence and correlates of MDD using
the World Health Organization's (WHO) Composite International Diagnostic
Interview (CIDI), 12-month severity with the Quick Inventory of Depressive
Ms. Marie Perriott
November 9, 2012
Page 54
Symptomatology Self-Report (QIDS-SR), the Sheehan Disability Scale
(SDS), and the WHO disability assessment scale (WHO-DAS). Clinical
reinterviews used the Structured Clinical Interview for DSM-IV.
RESULTS: The prevalence of CIDI MDD for lifetime was 16.2% (95%
confidence interval [Cl], 15.1-17.3) (32.6-35.1 million US adults) and for
12-month was 6.6% (95% CI, 5.9-7.3) (13.1-14.2 million US adults).
Virtually all CIDI 12-month cases were independently classified as clinically
significant using the QIDS-SR, with 10.4% mild, 38.6% moderate, 38.0%
severe, and 12.9% very severe. Mean episode duration was 16 weeks (95%
CI, 15.1-17.3). Role impairment as measured by SDS was substantial as
indicated by 59.3% of 12-month cases with severe or very severe role
impairment. Most lifetime (72.1%) and 12-month (78.5%) cases had
comorbid CIDI/DSM-IV disorders, with MDD only rarely primary. Although
51.6% (95% CI, 46.1-57.2) of 12-month cases received health care treatment
for MDD, treatment was adequate in only 41.9% (95% CI, 35.9-47.9) of these
cases, resulting in 21.7% (95% CI, 18.1-25.2) of 12-month MDD being
adequately treated. Sociodemographic correlates of treatment were far less
numerous than those of prevalence.
CONCLUSIONS: Major depressive disorder is a common disorder, widely
distributed in the population, and usually associated with substantial
symptom severity and role impairment. While the recent increase in treatment
is encouraging, inadequate treatment is a serious concern. Emphasis on
screening and expansion of treatment needs to be accompanied by a parallel
emphasis on treatment quality improvement.
Br J Psychiatry Suppl. 1996 Jun;(30):17-30.
Comment in:
Br J Psychiatry. 1997 Nov;171:487-8.
COMORBIDITY OF DSM-III-R MAJOR DEPRESSIVE DISORDER
IN THE GENERAL POPULATION: RESULTS FROM THE US
NATIONAL COMORBIDITY SURVEY.
Kessler RC, Nelson CB, McGonagle KA, Liu J, Swartz M, Blazer DG.
Institute for Social Research, University of Michigan, Ann Arbor
Ms. Marie Perriott
November 9, 2012
Page 55
48106-1248, USA.
General population data are presented on the prevalence and correlates of
comorbidity between DSM-III-R major depressive disorder (MDD) and other
DSM-III-R disorders. The data come from the US National Comorbidity
Survey, a large general population survey of persons aged 15-54 years in the
non-institutionalised civilian population. Diagnoses are based on a modified
version of the Composite International Diagnostic Interview (CIDI). The
analysis shows that most cases of lifetime MDD are secondary. In the sense
that they occur in people with a prior history of another DSM-III-R disorder.
Anxiety disorders are the most common primary disorders. The time-lagged
effects of most primary disorders on the risk of subsequent MDD continue for
many years without change in magnitude. Secondary MDD is, in general,
more persistent and severe than pure or primary MDD. This has special
public health significance because lifetime prevalence of secondary MDD has
increased in recent cohorts, while the prevalence of pure and primary
depression has remained unchanged.
Arch Gen Psychiatry. 2005 Jun;62(6):617-27.
Erratum in:
Arch Gen Psychiatry. 2005 Jul;62(7):709. Merikangas, Kathleen R [added].
Comment in:
Arch Gen Psychiatry. 2005 Jun;62(6):590-2.
Arch Gen Psychiatry. 2007 Mar;64(3):379-80; author reply 381-2.
Arch Gen Psychiatry. 2007 Mar;64(3):380-1; author reply 381-2.
Evid Based Ment Health. 2006 Feb;9(1):27.
PREVALENCE, SEVERITY, AND COMORBIDITY OF 12-MONTH
DSM-IV DISORDERS IN THE NATIONAL COMORBIDITY
SURVEY REPLICATION.
Kessler RC, Chiu WT, Demler O, Merikangas KR, Walters EE.
Department of Health Care Policy, Harvard Medical School, Boston,
Massachusetts 02115, USA. [email protected]
BACKGROUND: Little is known about the general population prevalence
or severity of DSM-IV mental disorders.
Ms. Marie Perriott
November 9, 2012
Page 56
OBJECTIVE: To estimate 12-month prevalence, severity, and comorbidity
of DSM-IV anxiety, mood, impulse control, and substance disorders in the
recently completed US National Comorbidity Survey Replication.
DESIGN AND SETTING: Nationally representative face-to-face household
survey conducted between February 2001 and April 2003 using a fully
structured diagnostic interview, the World Health Organization World Mental
Health Survey Initiative version of the Composite International Diagnostic
Interview.
PARTICIPANTS: Nine thousand two hundred eighty-two English-speaking
respondents 18 years and older.
MAIN OUTCOME MEASURES: Twelve-month DSM-IV disorders.
RESULTS: Twelve-month prevalence estimates were anxiety, 18.1%; mood,
9.5%; impulse control, 8.9%; substance, 3.8%; and any disorder, 26.2%. Of
12-month cases, 22.3% were classified as serious; 37.3%, moderate; and
40.4%, mild. Fifty-five percent carried only a single diagnosis; 22%, 2
diagnoses; and 23%, 3 or more diagnoses. Latent class analysis detected 7
multivariate disorder classes, including 3 highly comorbid classes
representing 7% of the population.
CONCLUSION: Although mental disorders are widespread, serious cases are
concentrated among a relatively small proportion of cases with high
comorbidity.
Soc Psychiatry Psychiatr Epidemiol. 1998 Dec;33(12):587-95.
PREVALENCE OF PSYCHIATRIC DISORDER IN THE GENERAL
POPULATION: RESULTS OF THE NETHERLANDS MENTAL
HEALTH SURVEY AND INCIDENCE STUDY (NEMESIS).
Bijl RV, Ravelli A, van Zessen G.
Netherlands Institute of Mental Health and Addiction, Trimbos-Instituut,
Utrecht, The Netherlands.
This article reports the initial results of a prospective study on the prevalence
Ms. Marie Perriott
November 9, 2012
Page 57
of psychiatric disorders in the Dutch population aged 18-64. The objectives
and the design of the study are described elsewhere in this issue. A total of
7,076 people were interviewed in person in 1996. The presence of the
following disorders was determined by means of the CIDI: mood disorders,
anxiety disorders, eating disorders, schizophrenia and other non-affective
psychoses, and substance use disorders. Psychiatric disorders were found to
be quite common. Some 41.2% of the adult population under 65 had
experienced at least one DSM-III-R disorder in their lifetime, among them
23.3% within the preceding year. No gender differences were found in overall
morbidity. Depression, anxiety, and alcohol abuse and dependence were most
prevalent, and there was a high degree of comorbidity between them. The
prevalence rate encountered for schizophrenia was lower (0.4% lifetime) than
generally presumed. A comparison with findings from other countries is
made. Relevant determinants of psychiatric morbidity were analysed.
Am J Psychiatry. 2000 Sep;157(9):1501-4.
DOES INCOMPLETE RECOVERY FROM FIRST LIFETIME
MAJOR DEPRESSIVE EPISODE HERALD A CHRONIC COURSE
OF ILLNESS?
Judd LL, Paulus MJ, Schettler PJ, Akiskal HS, Endicott J, Leon AC, Maser
JD, Mueller T, Solomon DA, Keller MB.
Department of Psychiatry, University of California at San Diego, La Jolla,
CA 92093-0603, USA. [email protected]
OBJECTIVE: This study investigated the influence of incomplete recovery
from first lifetime major depressive episodes on long-term outcome.
METHOD: After their first lifetime major depressive episode, patients were
divided into asymptomatic (N=70) and residual subthreshold depressive
symptom (N=26) recovery groups and compared on longitudinal course
during up to 12 years of prospective naturalistic follow-up.
RESULTS: Patients with residual subthreshold depressive symptoms during
recovery had significantly more severe and chronic future courses. Those
with residual symptoms relapsed to major and minor depressive episodes
faster and had more recurrences, shorter well intervals, and fewer
Ms. Marie Perriott
November 9, 2012
Page 58
symptom-free weeks during follow-up than asymptomatic patients.
CONCLUSIONS: Resolution of major depressive episodes with residual
subthreshold depressive symptoms, even the first lifetime episode, appears
to be the first step of a more severe, relapsing, and chronic future course.
When ongoing subthreshold symptoms continue after major depressive
episodes, the illness is still active, and continued treatment is strongly
recommended.
Psychosomatics ISSN 0033-3182
1995, vol. 36, no2, pp. S2-S10 (45 ref.)
DEPRESSIVE DISORDERS IN THE MEDICALLY ILL: AN
OVERVIEW: DEPRESSIVE DISORDERS IN THE MEDICALLY ILL:
EXPANDING OPTIONS FOR THE CONSULTATION-LIAISON
PSYCHIATRIST.
Cassem EH.
Massachusetts Gen. Hosp., Dep. Psychiatry, Boston MA 02114,
ETATS-UNIS
Depressive disorders are far more serious than most people realize, and
depressive disorders are disabling affected persons progressively earlier in
life. Heavy utilization of medical services, extensive disability and morbidity,
and high suicide risk exact a staggering economic toll in the United States
annually. Depressive illness is, like pneumonia and septic shock, a dread
complication of major medical illness, and depressive illness appears more
frequently as the medical illness worsens; diseases affecting the brain may
have the highest rates of depressive symptoms. Correctly diagnosing a
depressive disorder in a medically ill patient is a clinical challenge that
requires systematic, persistent clinical scrutiny. Compassion demands that
depressive disorders, when diagnosed, be treated aggressively.
BMJ. 2002 Oct 26;325(7370):934.
Comment in:
BMJ. 2003 Feb 8;326(7384):338.
Evid Based Ment Health. 2003 May;6(2):47; author reply 47.
Ms. Marie Perriott
November 9, 2012
Page 59
Evid Based Nurs. 2003 Jul;6(3):86.
MANAGING DEPRESSION AS A CHRONIC DISEASE: A
RANDOMISED TRIAL OF ONGOING TREATMENT IN PRIMARY
CARE.
Rost K, Nutting P, Smith JL, Elliott CE, Dickinson M.
Center for Studies in Family Medicine, Department of Family Medicine,
University of Colorado Health Sciences Center, UCHSC at Fitzsimons,
Aurora, CO 80045-0508, USA. [email protected]
OBJECTIVES: To evaluate the long term effect of ongoing intervention to
improve treatment of depression in primary care.
DESIGN: Randomised controlled trial.
SETTING: Twelve primary care practices across the United States.
PARTICIPANTS: 211 adults beginning a new treatment episode for major
depression; 94% of patients assigned to ongoing intervention participated.
INTERVENTION: Practices assigned to ongoing intervention encouraged
participating patients to engage in active treatment, using practice nurses to
provide care management over 24 months.
MAIN OUTCOME MEASURES: Patients' report of remission and
functioning.
RESULTS: Ongoing intervention significantly improved both symptoms and
functioning at 24 months, increasing remission by 33 percentage points (95%
confidence interval 7% to 46%), improving emotional functioning by 24
points (11 to 38) and physical functioning by 17 points (6 to 28). By 24
months, 74% of patients in enhanced care reported remission, with emotional
functioning exceeding 90% of population norms and physical functioning
approaching 75% of population norms.
CONCLUSIONS: Ongoing intervention increased remission rates and
improved indicators of emotional and physical functioning. Studies are
Ms. Marie Perriott
November 9, 2012
Page 60
needed to compare the cost effectiveness of ongoing depression management
with other chronic disease treatment routinely undertaken by primary care.
JAMA. 2003 Jun 18;289(23):3135-44.
Erratum in:
JAMA. 2003 Oct 22;290(16):2218.
COST OF LOST PRODUCTIVE WORK TIME AMONG US
WORKERS WITH DEPRESSION.
Stewart WF, Ricci JA, Chee E, Hahn SR, Morganstein D.
AdvancePCS Center for Work and Health, Hunt Valley, MD, USA.
[email protected]
CONTEXT: Evidence consistently indicates that depression has adversely
affected work productivity. Estimates of the cost impact in lost labor time in
the US workforce, however, are scarce and dated.
OBJECTIVE: To estimate the impact of depression on labor costs (i.e., work
absence and reduced performance while at work) in the US workforce.
DESIGN, SETTING, AND PARTICIPANTS: All employed individuals who
participated in the American Productivity Audit (conducted August 1,
2001-July 31, 2002) between May 20 and July 11, 2002, were eligible for the
Depressive Disorders Study. Those who responded affirmatively to 2
depression-screening questions (n = 692), as well as a 1:4 stratified random
sample of those responding in the negative (n = 435), were recruited for and
completed a supplemental interview using the Primary Care Evaluation of
Mental Disorders Mood Module for depression, the Somatic Symptom
Inventory, and a medical and treatment history for depression. Excess lost
productive time (LPT) costs from depression were derived as the difference
in LPT among individuals with depression minus the expected LPT in the
absence of depression projected to the US workforce.
MAIN OUTCOME MEASURE: Estimated LPT and associated labor costs
(work absence and reduced performance while at work) due to depression.
Ms. Marie Perriott
November 9, 2012
Page 61
RESULTS: Workers with depression reported significantly more total
health-related LPT than those without depression (mean, 5.6 h/wk vs. an
expected 1.5 h/wk, respectively). Eighty-one percent of the LPT costs are
explained by reduced performance while at work. Major depression accounts
for 48% of the LPT among those with depression, again with a majority of
the cost explained by reduced performance while at work. Self-reported use
of antidepressants in the previous 12 months among those with depression
was low (<33%) and the mean reported treatment effectiveness was only
moderate. Extrapolation of these survey results and self-reported annual
incomes to the population of US workers suggests that US workers with
depression employed in the previous week cost employers an estimated 44
billion dollars per year in LPT, an excess of 31 billion dollars per year
compared with peers without depression. This estimate does not include labor
costs associated with short- and long-term disability.
CONCLUSIONS: A majority of the LPT costs that employers face from
employee depression is invisible and explained by reduced performance
while at work. Use of treatments for depression appears to be relatively low.
The combined LPT burden among those with depression and the low level of
treatment suggests that there may be cost-effective opportunities for
improving depression-related outcomes in the US workforce.
J Gen Intern Med. 2004 Aug;19(8):813-8.
Comment in:
J Gen Intern Med. 2004 Aug;19(8):893-5.
THE OUTCOME OF PHYSICAL SYMPTOMS WITH TREATMENT
OF DEPRESSION.
Greco T, Eckert G, Kroenke K.
Department of Medicine, Indiana University School of Medicine,
Indianapolis, USA.
OBJECTIVE: This study examined the prevalence, impact on health-related
quality of life (HRQoL), and outcome of physical symptoms in depressed
patients during 9 months of antidepressant therapy.
Ms. Marie Perriott
November 9, 2012
Page 62
DESIGN: Open-label, randomized, intention-to-treat trial with enrollment
occurring April through November 1999.
SETTING: Thirty-seven primary care clinics within a research network.
PATIENTS: Five hundred seventy-three depressed patients started on one of
three selective serotonin reuptake inhibitors (SSRIs) by their primary care
physician and who completed a baseline interview.
INTERVENTIONS: Patients were randomized to receive fluoxetine,
paroxetine, or sertraline.
MEASUREMENTS AND MAIN RESULTS: Outcomes assessed included
physical symptoms, depression, and multiple domains of HRQoL. Prevalence
of physical symptoms was determined at baseline and after 1, 3, 6, and 9
months of treatment. Stepwise linear regression models were used to
determine the independent effects of physical symptoms and depression on
HRQoL domains. Of the 14 physical symptoms assessed, 13 were present in
at least a third to half of the patients at baseline. Each symptom showed the
greatest improvement during the initial month of treatment. In contrast,
depression continued to show gradual improvement over a 9-month period.
Physical symptoms had a predominant effect on pain (explaining 17% to 18%
of the variance), physical functioning (13%), and overall health perceptions
(13% to 15%). Depression had the greatest impact on mental (26% to 45%),
social (14% to 32%), and work functioning (9% to 32%).
CONCLUSIONS: Physical symptoms are prevalent in depressed patients and
initially improve in the first month of SSRI treatment. Unlike depression,
however, improvement in physical symptoms typically plateaus with minimal
resolution in subsequent months.
Psychosom Med. 2004 Jan-Feb;66(1):17-22.
IMPACT OF PAIN ON DEPRESSION TREATMENT RESPONSE IN
PRIMARY CARE.
Bair MJ, Robinson RL, Eckert GJ, Stang PE, Croghan TW, Kroenke K.
Regenstrief Institute and the Department of Medicine, Indiana University
Ms. Marie Perriott
November 9, 2012
Page 63
School of Medicine,
[email protected]
Indianapolis,
Indiana
46202,
USA.
OBJECTIVE: Pain commonly coexists with depression, but its impact on
treatment outcomes has not been well studied. Therefore, we prospectively
evaluated the impact of comorbid pain on depression treatment response and
health-related quality of life.
METHODS: We analyzed data from the ARTIST study, a randomized
controlled trial with naturalistic follow-up conducted in 37 primary care
clinics. Participants were 573 clinically depressed patients randomized to one
of three selective serotonin reuptake inhibitor (SSRI) antidepressants:
fluoxetine, paroxetine, or sertraline. Depression as assessed by the Symptom
Checklist-20 (SCL-20) was the primary outcome. Secondary outcomes
included pain and health-related quality of life.
RESULTS: Pain was reported by more than two-thirds of depressed patients
at baseline, with the severity of pain mild in 25% of patients, moderate in
30%, and severe in 14%. After 3 months of antidepressant therapy, 24% of
patients had a poor depression treatment response (i.e., SCL-20 >1.3).
Multivariate odds ratios for poor treatment response were 1.5 (95%
confidence interval, 0.8-3.2) for mild pain, 2.0 (1.1-4.0) for moderate pain,
and 4.1 (1.9-8.8) for severe pain compared with those without pain.
Increasing pain severity also had an adverse impact on outcomes in multiple
domains of health-related quality of life.
CONCLUSIONS: Pain is present in two-thirds of depressed primary care
patients begun on antidepressant therapy, and the severity of pain is a strong
predictor of poor depression and health-related quality of life outcomes at 3
months. Better recognition, assessment, and treatment of comorbid pain may
enhance outcomes of depression therapy.
Ms. Marie Perriott
November 9, 2012
Page 64
MEDICAL-LEGAL DISCLOSURE INFORMATION
PATIENT'S NAME: Ms. Marie Perriott
DATE THE EVALUATION WAS PERFORMED, LOCATION OF EVALUATION, AND
TIME SPENT BY PHYSICIAN INTERVIEWING PATIENT: The evaluation was performed
on October 24, 2012 at my Riverside office.
Ms. Perriott was evaluated for a full session, which lasted approximately one hour, during which I
obtained all of the information in the report, including current complaints, history of present illness,
past history, mental status examination, and psychological testing. When Ms. Perriott left, it was
explicit and apparent that she had provided a full account of the substance of her alleged problems,
which is contained in my comprehensive report.
DATE OF REPORT: November 9, 2012
PHYSICIAN PERFORMING THE EVALUATION AND PHYSICIAN'S
QUALIFICATIONS: The evaluation was solely conducted by Barbara J. Strong, M.D., Qualified
Medical Examiner in Psychiatry and Neurology.
MEDICAL TECHNICIAN: Not applicable
LABORATORY TESTS DONE BY: Not applicable
OTHER PSYCHOLOGICAL TESTING: The Rey 15-Item Memorization Test, and the Rey Dot
Counting Test.
INTERPRETER/INTERPRETING SERVICE: Not applicable
"I declare under penalty of perjury that the information contained in this report and its attachments,
if any, is true and correct to the best of my knowledge and belief, except as to information that I have
indicated I received from others. As to that information, I declare under penalty of perjury that the
information accurately describes the information provided to me and, except as noted herein, that
I believe it to be true."
"I further declare under penalty of perjury that I personally performed the evaluation of the patient
on October 24, 2012 at Riverside, California, and that, except as otherwise stated herein, the
evaluation was performed and the time spent performing the evaluation was in compliance with the
guidelines, if any, established by the Industrial Medical Council or the administrative director
Ms. Marie Perriott
November 9, 2012
Page 65
pursuant to paragraph (5) of subdivision (j) of Section 139.2 or Section 5307.6 of the California
Labor Code."
"I further declare under penalty of perjury that I have not violated the provisions of California Labor
Code Section 139.3 with regard to the evaluation of this patient or the preparation of this report."
"I further declare under penalty of perjury that the name and qualifications of each person who
performed any services in connection with the report, including diagnostic studies, other than clerical
preparation, are as follows:"
Name
Qualifications
Carla Back-Madruga The Rey 15-Item Memorization Test and the Rey Dot Counting Test were
scored and interpreted by Carla Back-Madruga, Ph.D. Dr. Back-Madruga
obtained her doctorate in Clinical Psychology at California School of
Professional Psychology in 1994. She completed her post-doctoral
fellowship in clinical neuropsychology at Harbor-UCLA Medical Center and
UCLA Neuropsychiatric Institute and Hospital, UCLA Center for the Health
Sciences from 1994 to 1995.
She is currently the director of
Neuropsychology Service at Rand Schrader Health and Research Center,
USC Keck School of Medicine, in Los Angeles, California; instructor of
Psychology Assessment Seminar at USC Keck School of Medicine; and
supervisor of psychology graduate students’ neuropsychological evaluations
at USC School of Medicine. Dr. Back-Madruga has a private practice as a
clinical neuropsychologist in Los Angeles, California. She has co-authored
many journal articles. Along with Kyle Boone, Ph.D., she has reviewed
research articles in The Clinical Neuropsychologist. Dr. Back-Madruga is
licensed as a psychologist within the state of California and is the Associate
Professor of Clinical Psychiatry and Behavioral Sciences, University of
Southern California Keck School of Medicine, Los Angeles, California.
Ms. Marie Perriott
November 9, 2012
Page 66
Date of Report:
Signed this
day of
at Los Angeles County, California.
, 20
,
Barbara J. Strong, M.D., Q.M.E.
BS:as/cb
Copyright © 2013 by Irwin Savodnik, M.D., and Medical Associates, Inc.
National Assessment Specialists
Ms. Marie Perriott
November 9, 2012
Page 67
Dr. Caper conducted the research for this report. This research consisted of a lengthy literature
search, a comparison with existing research and the integration of the appropriated clinical
information with these research results. The goal of this work was to maximize the scientific
foundations for the findings and conclusions of this report.
Date of Report:
Signed this
day of
at Los Angeles County, California.
, 20
,
Robert Caper, M.D.
RC/as/cb
Copyright © 2013 by Irwin Savodnik, M.D., and Medical Associates, Inc.
National Assessment Specialists