The Progress of this case will be followed from a
CASE DIARY
in chronological order with links to appropriate documents.
Cf. Affidavit of Donald Carringer, M.D.
UNITED STATES DISTRICT COURT
WESTERN DISTRICT OF NORTH CAROLINA
BRYSON CITY DIVISION
____________________________________________
|
WILLIAM C. HAMMEL, |
ALAN J. BELLAMENTE, |
et al., | MEMORANDUM/ANALYSIS OF
| A MEDICAL PAPER REVIEW
| BY DEFENDANT
vs. | ERIC L. FREMED, M.D.
| ON PLAINTIFF HAMMEL's
STATE FARM MUTUAL AUTOMOBILE | MEDICAL RECORDS
INSURANCE CO., |
STATE FARM INDEMNITY COMPANY, |
et al. | No. 2:99:CV-44-T
|
Defendants |
___________________________________________|
SHORT CAPTION: HAMMEL v STATE FARM
MEMORANDUM ANALYSIS, ON THE FACE OF IT, OF
A REVIEW OF PLAINTIFF HAMMEL'S MEDICAL RECORDS
BY ERIC L. FREMED, M.D., DATED 06/30/99
Authored by Plaintiff William C. Hammel, Ph.D.
Preliminaries:
It is the purpose of this memorandum to compare and
contrast the text of Dr. Fremed's review with the texts
of the medical reports themselves. These reports consist
of two IME reports by Dr. James Linder ordered by State
Farm Indemnity, truly independent radiological reports,
reports of healthcare givers as well as deposition
transcripts.
This analysis will demonstrate that Dr. Fremed's conclusion:
"based on the medical records reviewed thus far however,
that Dr. Hammel suffered no permanent neurologic injuries as
a result of the accident in question and that his cervical
surgery was not necessitated by the accident in question."
is gotten to by:
1) Failing to divulge the totality of documents with which
he was provided, by either SFI or Melli;
2) Failing, in particular, to divulge that he had read
the complaint written by me on behalf of Plaintiff
Bellamente to the New Jersey DOI, [Exhibit B] in which I
criticized his IME report for many of the tactics of deceit,
trickery and fraud that are exposed in his review of my
medical records found in the review analysed here;
3) Ignoring any reports or notes that were in contradiction
to his conclusion;
4) Systematically omitting from his purported review all
statements of attribution by treating healthcare givers;
5) Systematically making constructions to his point through
careful selections and omissions that alter the meaning
of the reports;
6) Neglecting the continuous medical care that has been
required from the the MVA date of 09/16/94;
7) failing to note any details of the MVA;
8) failing to remark on, reason that, or take into account:
a) That Plaintiff Bellamente was previously injured
in an MVA of 08/06/92, for which SFM is
responsible in PIP coverage;
b) That Plaintiff Hammel had never been injured in a
automobile accident, and was actively athletic
prior to the MVA of 09/16/94, as well as completely
asymptomatic of any supposed "pre-existing" condition.
Cf. e.g. appendix 6 herein, Dr. Schmaus's remark
of his report of 06/26/95, "Examination reveals a
male who has a strong upper body presence ..."
Plaintiff Hammel was, however, in a maximal spinal
twist at the time of impact.
9) Using of manipulative innuendo in order to impugn the
integrity and competence of treating physicians;
10) The modern "snake oil" salesman technique, which is to
dazzle with being 90%-95% professionally correct in
what is said, and then slip in, at a crucial moment,
the turn from truth and logic to mendacity, which sells
the snake oil.
11) An improper and unprofessional ad hominem attack on
Plaintiff Hammel.
Thus, it will be important to note what Dr. Fremed does not write
as well as what he does write in this sham review.
The purpose of a medical review is arrive at a balanced,
independent and unbiased assessment of all available records
that arrives at a reasonable scientific truth. Dr. Fremed
fails utterly in these standards, as the following analysis
will show.
PRIMUM NON NOCERE
Dr. Fremed's purported review, to the contrary, is a fabrication
designed explicitly to come to his preordained conclusion, "that
Dr. Hammel suffered no permanent neurologic injuries as a result
of the accident in question and that his cervical surgery was not
necessitated by the accident in question." Were this conclusion
accepted, it would deny Plaintiff Hammel all remedies for the
many and maliciously caused damages of great variety that have been
inflicted on him by the the defendants in this case. Dr. Fremed
knows very well the intent and purpose of his review, and
should know what the total probable damages are; either that,
or he is genuinely incompetent to practice medicine which is
highly unlikely. Dr. Fremed's review is an act of coldly
calculated abetting of robbery.
It should be noted that, Wall of Melli, requested this review,
as shown by the salutation and opening paragraph; and further
noted that it was presented as valid by Wall to a UIM arbitration
panel, which is to say, an adjudicating body equivalent to a
Court of Law in the State of New Jersey. A suggestion of perjury
on the part of both Melli and Fremed is presented to the Court.
1. We note that this "review" has been requested by
Michelle Wall of SFI's attorneys Melli, Guerin & Melli.
2. In paragraph 2, page 1, Dr. Fremed states:
"Records provided for review included:"
which is to say that there were possibly other documents
in his possession which he chooses not to divulge.
3. Paragraph 2 continues with a list of "some" of the
documents under review, citing:
1. A copy of Mr. Hammel's deposition transcript of 2/25/98.
2. Mr. Hammel's answers to interrogatories. (unavailable)
3. Records from Dr. Peter Boulukos.
4. Records from Dr. James Linder.
5. Reports from Teaneck Radiology Center.
6. Records from Dr. Peter Schmaus.
7. Records from Dr. Albert Stabile. (unavailable)
8. Records from Dr. Martin Kluger.
9. Records from Dr. Paul Sender.
10. Records from Dr. Gary Savatsky.
11. Records from Andrews Family Chiropractic Center.
12. Records from Smoky Mountain Center for Mental Health
Developmental Disability and Substance Abuse Services.
13. Records from Duke University Medical Center.
(Records of Michael M. Haglund, PhD, MD & radiological)
These very records are attached to this analysis as appendices
grouped under these numbers, exactly for the point of comparison
with what Dr. Fremed chooses and does not choose to include in his
"review". Note that exactly which records have been reviewed
are not precisely defined, even as stated.
[NB: the HTML version does not reproductions of these documents]
4. In the last paragraph of page 1, the word "apparently" is
used, calling into question what is an obvious fact of
reality. Must one not slow down to turn into a driveway from
a major thoroughfare? Any layman knows the answer, and yet
this innuendo is inserted.
Dr. Fremed cannot be using the word in its first meaning,
since he was not there.
5. On Page 2 paragraph 1, Dr. Fremed describes from Dr. Boulukos'
notes, the exact conditions that any neurologist would have
understood as possibly involving, at least, radiculopathy
in the neighborhood of C5-C6, and makes no comment at all.
Dr. Fremed does not mention the statements of causal
attribution of the then current symptoms to the MVA by
Dr. Boulukos, although they are there. See any of the
"Attending Physician Reports" sent periodically to
Savastano. Each report answers the question as to whether
the condition is SOLELY a result of this accident
with a YES; answers the question as to whether patient ever
had same or similar condition with a NO.
Dr. Boulukos' initial diagnosis is rather clearer: "847.0
Acute Traumatic Hyperflexion/extension of Cervical Spine;
723.3 Cervicobrachial Syndrome; 738.4 Spondylolithesis L-2,3"
Dr. Fremed fails, completely, even to mention this primal
and immediate diagnosis by one who was aware of Plaintiff
Hammel's prior physical condition.
I stated in my deposition before SFI's attorney Donna
Miller that I was a weight trainer and that once every
three or four weeks I had seen Dr. Boulukos aperiodically
for simple prophylactic adjustments. This is fairly
common among weight trainers and body builders, and this
is how I came to know Dr. Boulukos and why I sought his
help first.
My deposition was in Dr. Fremed's possession and was
reported to have been reviewed. Cf. #1 in the non-specific
list of documents said to have been reviewed.
Dr. Fremed fails to note that Dr. Boulukos was in a very
special position to notice the difference between a damaged
body that he examined the morning of 09/17/94 and the prior
healthy body he had adjusted many times before. In doing
so, Dr. Fremed fails to give to these attributions by
Dr. Boulukos their proper medical significance. These
attributions record the suddenness of the onset of symptoms
immediately following the MVA, and further record a
prior asymptomatic state.
6. On Page 2 paragraph 2, what Dr. Fremed describes is correct
in quoting from Dr. Linder's report, and from my deposition.
However this is what is missing:
In both of Dr. Linder's reports of 02/16/95 and 05/03/95,
on the last page of each, one can find attribution, in his
professional opinion, of the then current symptoms to MVA.
Dr. Linder, in his 02/16/95 report expressed concern about
a possible Right shoulder impingement syndrome, which is
in concurrence with Dr. Boulukos's original diagnosis.
Although it is accurately quoted from Dr. Linder's report
of 02/16/95, I have no idea where "slightly" rotated
came from.
It should be noted that Dr. Linder was SFI's own IME.
7. The physically necessary uncoiling from the twisted position
in order to try to stablize my body by quickly bracing myself
against the dashboard with my hand, which is documented ad
nauseum in other medical reports and records, seems either
to have eluded me or Dr. Linder and so, is not in his first
report. As reviewer, Dr. Fremed should have been aware of
this. As noted many times in this analysis, Dr. Fremed
evades any possible connection between the symptoms
objectively observed by many treating physicians with the
radiological evidence cited as a possible "prior injury"
in the penultimate sentence on page 2. paragraph 3 of his
review.
8. Dr. Fremed denies having the cervical MRIs of 03/10/95,
which could easily have been gotten before writing such
a momentous review, and we question his denial in the
context of the review's entirety.
9. Without Cervical MRIs, Dr. Fremed quotes the radiological
report of the allegedly missing cervical MRIs of 03/10/95,
the analysis of which would fall into his area of expertise.
At the time he wrote this review, a quintuple laminectomy
C3-C7 of my C-spine had already been performed, so delayed
that it has left me in severe pain of various kinds and
degeneration of all the major muscles of my body. Of course,
Dr. Fremed could be exculpated from any mistaken diagnosis
since he never saw the MRIs - nor has he chosen to submit
a report indicating that he has seen them since.
10. I abstract from Dr. Fremed's correct quote from the
radiologist's report regarding the C-spine MRI given
on page 3 paragraph 3, an outlined form:
i) C3-C4: osteophytosis resulted in mild right neural
foraminal compromise - without definite
exiting nerve root compromise.
ii) C4-C5: similar to C3-C4 but with DEFINITE neural
foraminal compromise, RIGHT greater than left.
iii) C5-C6: osteophytosis and broad-based BULGING disc
resulted in SEVERE encroachment of the right
neural foramen and likely exiting nerve root.
iv) C6-C7: A BULGING disc and osteophyte
compromises the right neural foramen.
SEVERE acquired central canal stenosis from
posterior osteophytosis and BULGING DISC
[Emphatic upper case mine]
The following are things that can be found by anybody
in any good anatomy book, of which I have had four for
almost twenty years:
a) Vertebra are classified as: Cervical, Thoracic, Lumbar
and Sacral, and numbered within each of these classes.
Vertebra numbers increase downwards toward the feet;
numbered exiting spinal nerves are named by the vertebra
that are below their exit point. E.g., the sixth cervical
nerve exits between vertebrae C5 and C6.
b) These nerves exit the spinal column through the
foraminal openings that are provided by the vertebrae
above and below.
c) Osteophytes are bony growths on bones, that have a
density less than real bone which is how they can
distinguished in radiologicals.
d) Osteophytes appear in radiologicals and unfortunately,
in human beings sometimes as a consequence of injury
and also simply in aging.
e) Injury at an osteophytic site can increase their growth
rate, even so, osteophytic growth is relatively slow,
over years.
f) Exiting Spinal Nerves have everything to do with
our senses of touch, temperature and pain, location
of body parts and motions of our body caused by
the neurally excited fibres of our muscles
g) There are areas of skin that are associated with the
spinal nerves called dermatomes.
h) The Nerves C4, C5, C5, C7, C8, T1 all enter into the
brachial plexus located in the general area of the
shoulder and upper arm. This is one of nature's
redundancies in neural connection with important
muscles of the upper body.
i) From the interchange of the brachial plexus comes
the three major nerves (radial, medial, ulnar) of
the arm, and the axillary nerve serving the deltoid
muscle that caps the shoulder joint, as well as the
suprascapular nerve that serves the rotator cuff,
a set of muscles controlling the shoulder joint and
helping to hold it together.
j) An injury to the spinal cord can affect everything
below (caudal to) the point of injury; even slightly
above through vascular injury.
k) The spinal cord, like the brain has no supporting
internal structure and has a jelly-like consistency.
l) Neurons of the CNS do not regenerate effectively,
as neurons of the PNS can; physical damage to the
CNS is physically permanent.
11. It is perfectly true that what may look scary in a
radiological study, may not be all that bad if the
the subject of the study is asymptomatic.
12. Osteophytes and even bulging discs CAN be asymptomatic,
and not be result of injury.
13. Dr. Fremed fails to make mention of the nature of the
MVA and its possible connection with the nature of my
injuries. The nature of my injury, from how the car
actually moved is of a whiplash hitting the neck
in a maximally twisted configuration, and then torsional
(impact that rotated the car), torsional again as I
uncoiled to brace with my hand, a rebound driving
the humerus into the glenoid, and finally a more complex
motion involving compression as the car ran up onto
a retaining wall with one front wheel, which then
fell off the retaining wall.
14. Bulging discs, as well as damage to ligaments, joints
and muscles are also possible results of such trauma.
15. Nowhere in his declaration of documents, nor in his review
is there any mention of the contents of the police report,
or my deposition which have details of the MVA, consistent
with paragraph 13 here.
16. Although Dr. Fremed freely quotes the C-spine radiological
report, including at iv) for C5-C6
SEVERE acquired central canal stenosis from
posterior osteophytosis and BULGING DISC
he fails to recognize, even after the fact, the possible
severity of this condition: a bulging disc is pushing into
the spinal cord, maintaining pressure on it and POSSIBLY
displacing it so pressure is then also being applied by
the osteophytes on the other side.
17. Dr. Fremed denies the possibility of clinical significance
of the "severe acquired central stenosis", when: it is this
for which Dr. Haglund ordered surgery quickly; and when the
C-cord atrophy is at the location of this stenosis; and when
the expected symptoms of this atrophy are present, in a
disabling and painful reality. Dr. Fremed's position is
an untenable one, contradicted by all evidence and history,
and as a neurologist, he should know that his denials
of serious and permanent injury to my C-cord are not
only fabrications, but fabrications that will cause me
further harm.
18. Dr. Fremed does not note from Dr. Boulukos's reports that
there was a change in curvature of the neck after the MVA.
He also fails to note the possibility that this change which
was after the MVA might have assigned a new geometry to
osteophyte formations that then had them functioning to
cause foraminal compromises at C5-C7, nor does he remark on
the fact that foraminal encroachments and compromises
were all on the right side, and that this might seem a
little odd in the absence of trauma.
19. Dr. Fremed fails utterly at even considering the possibilities
contained in clear consistency between objective radiologicals
and symptomatology, making his bias to his conclusion evident;
and even more so by systematically leaping to the phrase
"degenerative changes", while even there, having to make it
clear that these degenerative changes are not MVA related.
He uses the word "degenerative" twenty times in his review.
20. In page 3 paragraph 1, Dr. Fremed keeps talking about
"osteophytic changes". There are no changes observable
other than inferring that they are there now, and at some
time in the past, they were not. There are only "osteophytes"
which would not have changed significantly, even in injury,
from the MVA on 09/16/94 to the MRI on 03/10/95.
21. In page 3 paragraph 1, Dr. Fremed asserts
"These osteophytic changes however were again long standing
in formation in this 55 year old gentleman and in all medical
probability were unrelated to the accident in question."
a) I was 50 when the MRIs were taken;
as of 12/04/99 I am 55.
b) Why is a neurologist speaking in the area of
a orthopedist or rheumatologist?
c) If he considers me a gentleman why is he so
vicious about me later on in his report?
d) Why would anyone even consider that an MVA
would cause osteophytes sufficient to cause
foraminal compromise within 175 days?
22. In page 3 paragraph 2, Dr. Fremed recites correctly
the radiological report on L-spine MRIs, noting only
in paragraph 3 of the same page, "I reviewed the actual
films and agree with the presence of degenerative changes
as described above." He then completely dismisses all
other findings in the report, including:
"Diffuse disc bulging was noted at L2-L3 and L3-L4 with
UNCOVERING OF THE DISC FROM SUBLUXATION which was noted to
FLATTEN THE VENTRAL THECAL SAC. Borderline mild acquired
central canal stenosis was noted at L2-L3 with minimal
encroachment on the lateral recesses but not the neural
foramina."
[My upper case emphasis]
This, unfortunately engenders another small anatomy lesson
that can be gotten by anyone from a good anatomy text.
It's just fact, nothing controversial.
Intervertebral discs are held in place by a strong tendinous
sheath that attaches to the vertebra above and to the vertebra
below. Translation of the first emphasis: the sheath has
broken, and the radiologist suspects that to be a consequence
of a vertebra not being in the alignment with others in which
it should be.
The uncovering of the disk has resulted in it being pushed
laterally so as to "flatten the ventral thecal sac".
The thecal sac is the membranous sac that encloses the spinal
cord together with the spinal fluid, the fluid carrying
essential nourishment and waste disposal for the cord.
If the sac membrane is flattened against the cord itself,
the spinal fluid is not able to reach that area of the cord,
and can cause cord damage since it is being starved of what
it needs to live. If this condition is maintained, or if
even worse, the cord itself is being impinged upon by this
pressure, severe, permanent and irreversible damage to the
spinal cord can result. The symptoms can be quite subtle
at first, or quite excruciating, or, in alternates,
depending on bodily positions or motions.
Dr. Fremed ignores this potentially dangerous and destructive
situation with a willful and reckless endangerment of my well
being, and, of course, with consistency to hammering home his
preordained conclusion, yet again, that "no injuries were MVA
related".
23. In page 3 paragraph 4, Dr. Fremed recites some subjective
reports repeated by Dr. Linder on 05/03/95 [erroneously reported
as "3/5/95"], that shows some improvement.
Those improvements were a consequence of confining myself to
bedrest and intensely cold icepacks and the general performance
of nothing. They were certainly not permanent improvements,
as other medical records show.
24. In page 3 paragraph 5, extending onto page 4, describes a
radiological report of an MRI of the right shoulder, which
would be consistent with both symptomatology as well as the
conditions of the MVA. No comment from Dr. Fremed, except
that shoulder MRIs are "out of my area of neurological
expertise" [Personal note: they are confusing to me too]
Now begins Dr. Fremed's uncontrolled viciousness, first by
attacking the competence and integrity of my treating physicians,
and then by an series of ad hominem attacks on me, all such
attacks being completely groundless.
25. In page 3 paragraph 5, extending onto page 4, last line,
the last sentence reads:
"Apparently Dr. Peter Boulukos, a chiropractor did not consider
ordering an MRI of the right shoulder outside his area of
chiropractic expertise."
It seems Dr. Fremed is not aware, chiropractors receive the
same education as physicians excepting pathology and
pharmacology. In my many years of experience, while any
given physician or chiropractor may not be proficient at
reading certain kinds or types of radiologicals, which is why
we have radiologists as specialists, they are both perfectly
competent (with a few exceptions) at reading English and
understanding a radiologist's reports. There is no reason
that I know, and by now I know Dr. Boulukos's talents, that
he could not read the report and understand how it might
correlate with given symptoms. This statement of Dr. Fremed's
is an insult to a man of talent and integrity who meets my
rather demanding standards. It may very well be libelous,
since there is no proof whatsoever to substantiate it, and
it is written in a public document that has been submitted
to an adjudicating body.
The simple fact is that from personal knowledge, this MRI
was specially ordered as a time saver, since he had referred
me to Dr. Schmaus, a physician, and wanted the MRI in my
hand at the time of that appointment.
26. In page 4 paragraph 2, after inflationary recitation of other's
work, namely Dr. Schmaus in his report 06/26/95, Dr. Fremed
states that Dr. Schmaus diagnosed rotor cuff injury, failing
to note, as he most frequently does, the strong relation between
such a diagnosis and the particulars of the accident.
27. In page 4, paragraph 3, Dr. Fremed cursorily dismisses a
report from Dr. Stabile, ending with, "There is no
description of any radicular pain down the arms or legs."
a) This was not a full scale examination.
b) Radicular pain down the legs, which some how
I have never experienced, and therefore never
complained of, is typically the result of L5-S1
radiculopathy resulting in sciatic involvement.
c) Going back to the L-spine MRIs, the crucial
problem is the central stenosis at L4-L5.
"At L5-S1, disc bulging was noted as well with a
superimposed small disc protrusion and annular tear
central an to the right paracentral region effacing
the epidural fat but not deforming the thecal sac."
So, on radiological evidence L5-S1 compromise would
not be expected anyhow. Why make the comment?
28. In page 4 paragraph 4, Dr. Fremed describes a report from
psychologist Dr. Martin Kluger, "The patient sought psychological
treatment alleging that 'his emotional condition worsened
dramatically after the discontinuation of medical benefits
by State Farm Indemnity of New Jersey. He felt unable to
cope with the new and added stress.'" Not only is his quote
from Dr. Kluger's report accurate, but it is also true.
In total contradiction to this statement, Dr. Fremed later
asserts, "It is evident from reviewing Dr. Hammel's deposition
testimony and medical records that he displays a tendency to
blame all of his problems occurring after the accident in
question on the accident," This comment, which is found in
his "IMPRESSION" is patently wrong, as evidenced by all the
records that he claims to have reviewed - and by the claims
of this action.
I do not blame "the accident", all of whose problems could
have been solved with no permanent injuries.
I blame and accuse the Defendants in this action including
Dr. Fremed as being responsible through their racketeering
activities, this very review by him for example, as being
responsible for the destruction of my body and serious enough
injury to Plaintiff Bellamente so as to render us both so
disabled that we are no longer capable of business or work,
nor even existence as individual human beings.
29. Also on page 4 paragraph 4, "Dr. Kluger does not indicate
who referred this patient to him."
The statement has no business in any medical report or review.
So what? Is this a crime? If it must be known, I found
Dr. Kluger the same way I find all physicians, attorneys
or other professionals: through investigation and channels
of information available to me. I have a rule of thumb:
Genius always recognizes and knows genius. Find one and
you are linked into a network of genius and integrity.
The rule has served me well.
30. Again on page 4 paragraph 4, "Dr. Kluger does not comment
on Dr. Hammel's apparent difficulty to maintain regular
employment commensurate with his academic credentials even
prior to the accident in question."
The statement has no business in any medical report or review.
Dr. Kluger does not comment on this because there was no
difficulty prior to the MVA; and where or how a nonexistent
could possibly be "apparent" to Dr. Fremed is beyond reason.
After the MVA, my businesses suffered. With Defendants'
continuing patterns of racketeering, the abilities of
both Plaintiffs to maintain any sort of regular employment
or even to have any business or take care of themselves
properly and independently is nonexistent. There is no
reason to expect that this situation will ever change.
31. Dr. Kluger does state, however, "Since none of these factors
existed prior to the accident, I must assume that all of the
symptoms that he [Hammel] complained about are a direct result
of the accident." [Cf. Letter of June 8, 1996] This is yet
another attribution that Dr. Fremed fails to note in his
review.
32. On page 4, paragraph 2, Dr. Fremed purports to review the
report of Dr. Schmaus dated 06/26/95. While making a trivial
synopsis of subjective complaints, ignoring their severity,
Dr. Fremed completely omits any details of the actual
physical examination that begins in paragraph 3 of that
report. This examination reveals genuine injury of a
traumatic pattern. What Dr. Fremed states as Dr. Schmaus's
"diagnosis" is actually an "impression"; there is a difference.
Dr. Schmaus's "impression" is one of "rotator cuff injury".
Dr. Fremed fails to state how a rotator cuff injury can spring
to life suddenly without injury, or how it could appear
suddenly, without injury, as a result of chronic degenerative
disease, of which he seems so fond as simplistic explanation
for anything.
33. Dr. Fremed claims to have records of Dr. Schmaus, and yet
completely ignores Dr. Schmaus's letter dated 10/18/95,
sent to the attention of Idiana Murray, which reads,
"Please be advised that I am a physician having participated
in the care of Dr. William Hammel for injuries incurred
in a motor vehicle accident on September 16, 1994."
Dr. Fremed also fails to include in his review any mention
of Dr. Schmaus's Diagnosis of "Right Frozen Shoulder,
Right Shoulder Impingement" as well as the Prescription
for physical therapy which was denied me by SFI; and for
which I finally received some, now almost useless therapy
beginning September 15, 1997; this through Medicaid,
not SFI. Dr. Schmaus's prescription was dated September 5,
1995. Dr. Savatsky issued another prescription for physical
therapy on November 29, 1995.
These are yet more of the multitude of attributions of injury
to the MVA, both direct and indirect, all of which are absent
from Dr. Fremed's review.
34. On page 4, paragraph 6, in discussing Dr. Savatsky's report,
Dr. Fremed once again fails to note the explicit attribution,
"The symptoms are the result of a motor vehicle accident
while bracing from impact." [referring to shoulder injuries]
35. Continuing on to page 4, paragraph 7, Dr. Fremed purports
to synopsize a note by Rita Colvard made on 04/16/96.
This was a note made during a first intake meeting to begin
psychotherapy.
By juxtaposing and connecting just the right excerpts and
words, by innuendo, I now become, in this paragraph, the
image of some kind of drug addict. Once again, what Dr.
Fremed omits from this note (which never should have been
released in the first place) is completely characteristic
of his fraudulent intent and unprofessional conduct, as
well as his motive to support SFI's denial of benefits
through fraudulent means.
What Dr. Fremed does not report is why I was, in fact, there.
The following which precedes the material from which Dr.
Fremed makes his fabrication explains why I was there.
Ms. Colvard writes, "Mr. Hammel reports no difficulties
whatsoever until he was injured in an automobile accident
September 16, 1994, with resulting spinal injuries. He has
also had tremendous difficulties with the insurance company
[SFI] and other legal difficulties because the insurance
company will not pay on this, and it is a long-standing
problem in dealing with these issues. He describes himself
as often becoming rageful as he considers this injustice
toward him, specifically, his anger is directed toward the
insurance company. He relates his depression and anxiety
to what has happened to him."
36. Again in page 4, paragraph 7, Dr. Fremed writes "Ms. Colvard
documents that while still in New Jersey that patient
had an EKG and was told of a left bundle branch block."
Why would he use this second hand information? It is
a form of discrediting, when claiming to have Dr.
Sender's records which contain the EKG records that
very clearly indicate and say outright "LBBB" on
November 6, 1995, together with a diagnosis of
"severe anxiety". While just before, on 10/30/95,
Dr. Sender, who had been my internist and GP for years
diagnosed PTSD, coupled with palpitations/skipped beats,
with BP of 146/80. The records of Dr. Sender will also
show that my normal BP was 120/80 or lower.
37. On page 5, paragraph 2, Dr. Fremed remarks that, "Notes
by C. P. Laub, apparently a counsellor at Smoky Mountain
Center were reviewed", but declines to recite anything
from them. Mr. Charles P. Laub was, in fact, Counsellor
and also Director of the Smoky Mountain Center. The
substance contained in these notes are reiterations and
continuances of the paragraph included in paragraph 31.
here, and one can understand why no comment is made
upon them.
38. Though notes by Cheri Wright-Murphy were provided to
SFI, Dr. Fremed fails to acknowledge their existence.
They too continue with the paragraph in Ms. Colvard's
note quoted in 31. here, and again the reason for omission
is clear.
39. Though notes analyses and diagnoses were made by
Dr. Mark Lawrence, a psychiatrist, and these were submitted
to SFI in their discovery in the NJ PIP action, they
are not even mentioned. The Smoky Mountain Center
notes are so voluminous, that to quote them further here
would be foolish since they are attached as appendices to
this Memorandum.
40. Before addressing the diatribe against Dr. Haglund, so that
psychological/psychiatric continuity is not lost, I want to
address the misplaced sentence at the opening of paragraph 4
on page 5, which simply says that "Records from Barbara
Dobrowski also of Smoky Mountain Center on 05/13/97 through
05/16/97 were reviewed."
SFI was provided, again through discovery, with records from
Ms. Dobrowski beginning on 09/12/96 through 04/30/97; she is
still my therapist and will remain so. I have no idea how
Dr. Fremed came into possession of these 4 days of therapy
notes, but I would like to know. In reading Ms Dobrowski's
notes as attached, it is easy to see the distinct and consistent
bias of Dr. Fremed displayed through trickery and deceit,
and exactly why these notes are not commented upon.
Perhaps this sentence in paragraph 4 on page 5 was supposed
to be hidden. That would not be inconsistent with
the general patterns of deceit and unprofessional behavior
exhibited in Dr. Fremed's review.
41. This is all the more to the point since the passing mention
of Ms. Dobrowski is literally stuck irrelevantly at the head
of a paragraph in the middle of Dr. Fremed's diatribe impugning
Dr. Haglund, my neuro surgeon at Duke University Medical Center.
42. A DIGRESSION BY WAY OF PREFACE TO THE REMAINDER OF ANALYSIS:
That Dr. Fremed did not raise the question of who referred
me to Dr. Haglund is only that his first response was to to
Dr. Schmaus, which happens to be a vast but expedient
simplification of reality. Both Plaintiff Bellamente and I
introduced Dr. Haglund to Dr. Schmaus. We both seek genius,
especially when our lives are at stake. It is a followed
axiom that genius will know and recommend genius, even in
another area. We both knew Dr. David Adams referred by Dr.
Schmaus, and Dr, Robert C. Rubin to be a men of genius,
meticulousness and uncompromising integrity, so we asked them
for a recommendation for a neurosurgeon, on 04/11/96, at first,
for Bellamente's surgery. We sought a neurosurgeon who should
be at Duke University Medical Center (DUMC), which was not only
in North Carolina, but known to us as one of four top ranking
hospitals for neurosurgery in the the United States. They
recommended Dr. Robert Wilkins at Duke. On contacting Dr.
Wilkins 06/06/96 he said he was going to retire in a few years,
and was sorry but he was not taking any more "insurance cases".
He did, however, recommend two of his brightest colleagues,
one of whom was Dr. Haglund. Choosing between the two was
difficult, but we both decided that Dr. Haglund was our best
choice, based on impersonal criteria. We are both still
very happy with that choice.
The point of this preface is that Dr. Haglund was chosen with
care by credentials and through professional recommendation
and reputation of a trustworthy nature; he was not chosen by
accident nor for any purpose other than his genius and supreme
craftsmanship as a neurosurgeon. Since I have known and spoken
with Dr. Haglund from our first meeting on 08/26/96, I feel
competent as an observer to comment on his nature as physician,
scientist and his integrity.
Dr. Haglund is completely dedicated to what he does and has the
highest standards of excellence in his chosen work, which is as
neurosurgeon, professor of neurosurgery, and researcher in
neurology. He has precious little time in reality, and precious
little time for the nonsense that is inflicted by insurance
companies, which interferes with the dedicated purpose of
his life. Even as a neurosurgeon and diagnostician he is
truly both surgeon/physician and scientist. His diagnoses
and attributions are not rendered lightly because of his
scientific integrity.
In his earlier notes, attribution of initial injuries to the
MVA of 09/16/94 will not be found because he is two years
removed from that date, so his inferences are qualified in
good scientific fashion. He is communicative with me on
scientific, anatomical and surgical matters in medical
details of my condition because he now knows that I will
know what he is talking about, and that should I not, I
will ask for explanation and understand it.
Dr. Fremed has apparently not experienced the performance
pressure placed on a neurosurgeon at DUMC, and also has no
apparent personal knowledge of Dr. Haglund. He refuses to
acknowledge, or tediously once again, consider the possibility
that Dr. Haglund may be overworked and unable to give time
to covering his flanks where the ilk of Dr. Fremed is on
the attack. Dr. Haglund has always been honorable by both
Plaintiffs' experience, while honor is clearly lacking in
Dr. Fremed, again as evidenced by his two paper reviews,
one of which is analysed here, and his "IME" report on
Plaintiff Bellamente.
The interesting question is why Dr. Fremed is on the attack
against genius. When confronted with such a situation that
is seemingly inexplicable, the abstract question I ask is
simply, who has what to gain from whom?
Dr. Fremed must attack Dr. Haglund, no matter the disparity
in their credentials, because he will be rewarded handsomely
by SFI for doing so. This behavior though aberrant for a
physician, is extremely lucrative. Dr. Fremed was paid $600
for a 15 minute perfunctory "IME" on 07/25/95 which resulted
is a 6 page single spaced, small type report that was used
by SFI to deny all neurological benefits. On the basis of
his ability to have claims dismissed he has unjustly enriched
himself. By contriving to have claims dismissed using the
very same tactics exposed here, he has unjustly enriched
himself, by engaging, willfully, in SFI's patterns of
racketeering that are called "claims handling". He has
also deliberately injured those claimants, misusing his
SFI given authority, and alleged expertise and professionalism
as a weapon in SFI's war of fraud, extortion and robbery on
its own policy holders.
43. Now, addressing Dr. Fremed's diatribe against Dr. Haglund:
Unfortunately, I will be quoting Dr. Fremed extensively.
On page 5, paragraph 3 of his review, Dr. Fremed begins, " Dr.
Hammel was evaluated by Dr. Michael Haglund, a neurosurgeon
at the Duke University Medical Center Clinic on 8/26/96. He
indicates that Dr. Hammel was reaching back to get some paper
work when his car was struck from behind. He commented that
originally after the accident 'everything was OK but that
evening he noted a stiff neck and severe upper arm pain. He
had similar pain down the left arm and he also had bilateral
leg pain radiating to his thighs and into a four dermatomal
pattern.'
Dr. Fremed omits the description in Dr. Haglund's report of
the impact situation that classically gives rise to a
whiplash injury. Dr. Fremed would not want to raise the
suspicion that injuries did, in fact, arise from the MVA,
since his conclusion to the contrary could not reasonably
be reached.
44. Dr. Fremed continues quoting, "The patient complained of
spasms in his legs and pain in his arms involving all 10
digits of the hands but said that mainly the pain stayed
in his neck and arm area and radiated to the middle three
digits. He denied lower extremity paraesthesias or bowel
or bladder problems."
Fremed then states:
"Dr. Haglund reviewed MRI films [of 03/10/95] showing multilevel
stenosis and degenerative disease including foraminal narrowing
and retrolisthesis. Dr. Haglund recommended proceeding with
surgery in the cervical region involving a C3-C6 laminectomy and
foraminotomies and then performing lumbar decompression 4 to
6 weeks later."
Dr. Fremed omits Dr. Haglund's concern in scheduling surgery as
soon as possible by writing in his clinic note of 08/26/96
"Surgery will be performed on September 25, 1996."
Surgery was attempted to be moved up to September 18, but
had to be put back to the 25th due to a hurricane.
Fremed also fails to note that for this scheduled surgery,
both Plaintiffs traveled 654 miles in pain and agitation by car.
This trek turned out to have the sole purpose of learning
that this very necessary surgery had been denied by both SFI
and SFM, despite the valiant efforts by Ms. Joanne Johnson,
of DUMC's "insurance department" to convince both SFI and SFM
of the necessity of surgery. Dr. Fremed knows this, or
should know of it, since it is contained in my deposition
transcript, which he claims to have reviewed.
45. Dr. Fremed goes on, "His [Dr. Haglund's] note establishes
no causal relationship between the need for this surgery
and the accident in question."
This is a stupid remark. This note was made during a first
consultation with Dr. Haglund. It was two years after the
MVA. Dr. Haglund had not had time to review the voluminous
documentary records. Such a statement would have
been foolhardy coming from an eminent neurosurgeon and
neurologist at Duke University Medical Center. A statement
of attribution by Dr. Haglund at that time would not have
been reasonably possible. Dr. Fremed's remark actually, in
logic, reduces to the fact that Dr. Haglund is a good
scientist and not an idiot.
46. Dr. Fremed goes on further, "A subsequent note however, to
the patient's attorney dated 10/22/96 indicates that it was
his opinion that the accident exacerbated a pre-existing
condition."
"It appears that he based this on Dr. Hammel's subjective
complaints which by history began after the accident in
question. He concluded 'the MVA seems to have played a
key role in causing the patient's current pain and syndrome.'"
This letter by Dr. Haglund of 10/22/96, was a response to a
letter from my attorney, answering questions, once again,
on the basis of his current knowledge, and is two (2) months
after his initial examination, during which time he had the
opportunity to review the complete medical file that was
made available to him on 08/26/96, and see the continuous line
of medical treatment leading from the MVA to seeing him, and
also to connect the opinions of treating healthcare givers
in sequence. As time progresses Dr. Haglund accumulates
knowledge concerning my conditions and is therefore more and
more able to refine his medical opinions based on substantive
and professionally garnered evidence. There is nothing strange
about this, yet Dr. Fremed would attempt to make it appear so.
Dr. Fremed's makes no effort to substantiate his claim that
"It appears that he [Dr. Haglund] based this on Dr. Hammel's
subjective complaints ..." Dr. Fremed's claim is, in fact,
insubstantiable, and contradicted by Dr. Haglund's letter.
Dr. Fremed completely distorts this letter to his own ends.
The second paragraph of Dr. Haglund's letter reads in its
entirety:
"In these situations, the MVA is either directly the
cause of all of his [Hammel's] problems; exacerbates a
pre-existing degenerative condition; or is not involved
at all in his condition. In Mr. Hammel's case, I would
say it is a situation where the accident has exacerbated
a pre-existing degenerative condition. His MRI shows
multilevel stenotic disease in the cervical region which
likely was present before the accident but not causing
him any difficulties. Therefore, the accident would have
exacerbated a pre-existing condition and did cause
according to the patient and from my examination since
the pain began at the time off the accident, the pain
syndrome that he now has in his cervical lumbar region.
Therefore, the MVA seems to have played a key role in
causing the patient's current pain syndrome."
Dr. Haglund also based his decision for surgery on the cervical
MRIs of 03/10/95, which Dr. Fremed claims not to have, and was
in a position to know the situation with far greater detail.
47. Dr. Fremed continues with, "He [Dr. Haglund] does not
indicate that the accident had any role in causing the
patient's considerable degenerative changes."
First, nowhere in Dr. Haglund's clinic note of 08/26/96, nor in
Dr. Haglund's letter of 10/22/96, nor in the MRI report of
03/10/95 is any degenerative condition referred to as
"considerable". It is impossible to imagine how, when Dr.
Fremed denies his access to the actual MRIs taken on 03/10/95,
he could add this modifier with any logical basis. The
insertion of this modifier "considerable" is a fabrication
whose design is fraudulently to support his untenable
conclusion.
Second, and as to Fremed's sentence as a whole, why, yet again,
would Dr. Haglund, physician and scientist, make such a patently
idiotic assertion?
48. Dr. Fremed continues with Dr. Haglund's clinic note of
08/26/96, "On physical examination Dr. Haglund noted some
weakness in the biceps and triceps with positive straight
leg raising at 30 degrees on the right and 45 degrees on the
left. He does not comment whether the straight leg raising
test was performed in both the supine and upright positions."
Dr. Fremed does not explain any clinical or neurological
significance to this remark, nor was he performing the
examination; it might be reasonably conjectured, once again,
that Dr. Haglund is not an idiot, has either explored what
he felt to be an appropriate avenue and found it unremarkable
or insignificant, or that this avenue of investigation did
not answer the questions he wanted answered. This remark of
Dr. Fremed's is an inappropriate impugnation of Dr. Haglund's
considerable competence.
49. Dr. Fremed continues, "He [Dr. Haglund] did comment on
subjective complaints of decreased pinprick in an L3-L4 and
slight L5 distribution with corresponding decrease in
temperature perception. The patient also reported decreased
pinprick and temperature in the C5-C6 dermatome with normal
vibration and touch. Reflexes were described as diminished
in the triceps and knee. Toes were downgoing and Hoffman's
sign was negative. Cerebellar and Romberg's testing was normal."
The emphasis on "subjective complaints" is nothing more than
an attempt now to impugn my integrity, again, baselessly.
Many, if not most neurological tests are of a subjective
nature. A good neurologist, which Dr. Haglund happens to be,
is perfectly capable of discerning a pattern, or lack thereof
through the redundancies of tests. Dr. Fremed is aware, one
hopes, that reflexes are not subjective.
50. Continuing with page 5, paragraph 4, which extends to
page 6, Dr. Fremed writes, "I note that Dr. Hammel was
admitted to Duke University Medical Center on 5/13/97 through
5/16/97." So far, detailed accuracy. "They document a past
surgical history of an extensor digitorum release [1981 -wch]
and deviated septum repair [as a teenager, and not due to any
trauma - wch]. If any other records documenting any prior
trauma in this patient become available, I would be happy to
review them and issue a supplemental report if indicated.
One could ask of Dr. Fremed, "prior to what?" He is completely
ignoring the trauma sustained in the MVA of 09/16/94.
But, of course, he would be happy, then being able to twist
some new form of "degenerative disease" or trauma to be the
cause of any injuries - that cannot, under the ukase of SFI be
allowed. The unwarranted assumption that he would hope to
get away with is that these conditions were the result of trauma.
As it turns out, the extensor digitorum release was the result
of mild trauma, and the correction would only have been
important to a pianist. The deviated septum had no traumatic
basis, and yet, Dr. Fremed implies that it was, with no basis
or knowledge.
51. Fremed:
"The patient during that admission underwent a C-3 through
C-7 posterior laminectomy and did well postoperatively."
Date 05/13/97 was the actual date of surgery. What must be
kept in mind is that the original proposal was not the quintuple
laminectomy that was performed, but that Dr. Haglund proposed
a quadruple laminectomy for me on 08/26/96, and had it scheduled
as soon as possible on 09/25/96; and that both SFI and SFM
had refused authorization for this. The medically necessary
surgery was delayed 230 days, and would still not have been
performed but for Medicaid, acquired through disability (SSI).
These were the second and third denials of medically necessary
surgery, which Dr. Fremed refuses to acknowledge, as he does
with the first denial of all medical PIP benefits.
52. Fremed:
"His [Dr. Haglund's] principal diagnosis was cervical stenosis."
This is particularly interesting since in Dr. Haglund's decision
for the correctness of surgical intervention was based on the
very MRIs of 03/10/95, discussed in paragraphs 8-18 herein,
which Dr. Fremed has conveniently not seen, and yet which contained
enough information to cause Dr. Haglund enough alarm to schedule
surgery as soon as possible. The central stenosis, as a dangerous
condition, was clearly present in the 03/10/95 radiological
report, for Dr. Fremed to attempt to wave away its past emergent
importance is simply unconscionable.
53. Fremed:
"The operative report describes laminectomies at C3, C4, C5, C6
and C7 with bilateral foraminotomies especially at C5-C6."
Quite obviously things were worse, or had become worse than
Dr. Haglund had anticipated. In fact, Dr. Haglund's words,
written down, verbatim, by Mr. Bellamente immediately after
my surgery were
"[His] muscles were very messy and uneven - therefore [the
surgery was] more bloody - [we] took off [all the] bone
[and the] ligaments were weak, but now weaker.
hard collar on drive. Get him up slowly. 15% first
nite then more - special attention to be paid to signs
of neck drooping or weakness."
This type of injury, speaking from the viewpoint of a
physicist who happens to have studied and knows gross
anatomy, is perfectly consistent with the kind of torsional
insult that did happen, which again is consistent with
known motions of the automobile after impact in the MVA
of 09/16/94.
54. Fremed:
"No reference is made in the operative report to any disc
herniation or nerve root impingement."
For this, there is good reason, and Dr. Fremed is simply
playing games. The C-spine radiologicals of 03/10/95 did
not, in fact, show herniations of any discs, there were
none; why should one comment on something nonexistent and
not expected. To suggest that one one should, elicits a
string of words not proper in a document presented to a
U.S. District Court.
55. On page 6, paragraph 2, Dr. Fremed states in his review,
"Postoperative notes from Dr. Haglund dated 6/23/97 describe
a good postoperative course with almost complete relief of
pain and tingling in his hands. Dr. Haglund indicated
'as I noted at the time of the operation, he did have a lot
of muscle disruption suggesting a previous trauma to his neck'
I note that the operative report makes no reference to any
muscle abnormality"
Perhaps, 41 days after my surgery, Dr. Haglund has actually
confused what he wrote with what was directly spoken to
Plaintiff Bellamente immediately after surgery. Yet he
remembers the oddness of it and is remarking on it in his
notes of 06/23/97. A glance at the operative report of one
page shows that it hurriedly conceived, lacking in finery
of details, and merely reports the basics of what was done,
and that the surgery had no major complications. A possible
error in this regard does not make Dr. Haglund a liar,
as Fremed would imply.
56. Dr. Fremed further complains, "Dr. Haglund does not further
explain what he means by 'muscle disruption'."
Perhaps because no one (except me) asked and under the
circumstances, he thought that sufficient a description for
the complicated experience of seeing what was actually
there, a perspective that only Dr. Haglund, and certain
other OR personnel had.
57. Fremed, at page 6, paragraph 3:
"Dr. Haglund's note of 5/11/98 describes complaints of a
burning sensation in the hands with decreased coordination.
At that point he apparently was on Neurontin and was having
increasing problems with activities of daily living. He
described trouble walking and some weakness. He complained
of constipation and losing urinary control. On examination
his motor strength was 5-/5 throughout with some giveaway
strength as well as decreased pinprick in the C7 distribution
more on the left than the right. He had diminished vibratory
sensation in a stocking-like distribution in the feet.
He underwent an an EMG on 5/11/98 which according to Dr.
Haglund showed no evidence of any peripheral neuropathy.
DESPITE the normal EMG nerve conduction study Dr. Haglund
suggested that the dysfunction of the hands and feet "go
along clearly with some type of traumatic injury and the
degeneration of the spinal cord itself."
[Emphatic upper case "DESPITE" mine]
I have no idea what Dr. Fremed is trying to pull here.
The facts of life are that the nervous system is conceptually
and structurally divided into the Central Nervous System (CNS)
and the Peripheral Nervous System (PNS). The EMG study showed
no peripheral neuropathy in limbs, so the only place left to
look is the CNS. Radiculopathy (PNS) which would show in EMG
did not show. EMGs do not measure neural conduction in the
CNS. The process of refining diagnoses is successively to rule
out. In medical science as in any science, there is no way to
prove a hypothesis or diagnosis. There was a documented
traumatic injury, namely the MVA.
The fact that this initial injury was deliberately
and maliciously not permitted to be attended to by decompression
back in the fall of 1995 has caused, by maintaining pressure
on the C-cord, axonal deaths, cell deaths and well as vascular
injury resulting in C-cord atrophy. Or, as expressed in Dr.
Haglund's more terse letter of May 19, 1999, "As I have
stated ... the atrophy of his [Hammel's] spinal cord was
exacerbated by the MVA and further compromised by delaying his
cervical decompression."
There is nothing particularly difficult about this, yet Dr.
Fremed seems to lack the understanding of that which is
intuitively obvious even to the undiscerning student.
With this level of intelligence, Dr. Fremed would never have
made it through medical school, yet he did. The resolution to
this apparent paradox is once again that Dr. Fremed's review
is a fraudulent sham, and a desperate and wanton attempt by
any means at his disposal to warp reality to his own ends,
which also happen to be the ends of SFI and its attorneys.
The scientifically conservative nature of Dr. Haglund's
opinions should be noted in the extract two paragraphs above
from his letter of May 19, 1999. He does not know and cannot
know exactly when the compression of the C-cord began, and so
does not assert that the MVA caused it, even though that may
actually be the case. On this exact point, no evidence of
any C-cord atrophy has ever been remarked upon in the MRIs
of the cervical spine 03/10/95; no C-cord atrophy is noted
in the radiological report on those MRIs. These MRIs were
taken shortly after the MVA of 09/16/94. From this it is
not unreasonable to assume that had decompressional surgery
taken place then, as Dr. Haglund has said it should have,
that no C-cord atrophy would be present now.
This is consistent with Dr. Haglund's contention that delay
has significantly exacerbated the atrophy. Neither the MRIs
of 03/10/95 evidencing no atrophy, nor the MRIs of 09/08/97
evidencing C-cord atrophy were taken with contrast.
58. Fremed:
"He does not support this conclusion with any more specific
description of what type of traumatic injury caused these
symptoms nor does he document any radiographic evidence of
spinal cord atrophy or degeneration."
Cf. inter alia, MRI report, both cervical and lumbar,
dated 09/08/97, wherein can be read,
"Atrophy of the mid-cervical spinal cord is identified, ..."
It is part of my medical records at DUMC, and attached here.
59. Fremed:
"He suggested that the patient be considered for 25% cervical
impairment with some long tract signs. His report however,
does not document any long tract signs and in fact commented
on previous examinations that the patient's toes were downgoing
and Hoffman's sign were negative."
Nor does he define "cervical impairment", or address total
body impairment. The EMG report 05/11/98 from the study
documents "1 year history of difficulty walking and
dysaesthesias in upper and lower extremities, right greater
than left." Dr. Adams neurological report indicates
L'Hermitte's sign, proprioceptive problems with feet.
Various neurological testings have demonstrated abnormal
reflexes of the extremities. Other reports contain
specific observations of muscular weakness and atrophy.
60. Fremed:
"Clearly Dr. Haglund's conclusion is entirely
inconsistent with his physical examinations."
What is clear is that Dr. Fremed is accusing Dr. Haglund of
being either incompetent or a liar. Given the nature of this
purported review by Dr. Fremed, as exposed here, there is nothing
that could support either hypothesis. In either case, it is
inappropriate, unprofessional and utterly unclear as to how
Dr. Fremed could say such a thing logically. Dr. Fremed's reason
for saying it, however, is quite clear: this is a sham report
designed to rationalize, badly, his final conclusion at which he
seeks to arrive through techniques that include rabid ad hominem
attacks, and perfectly outrageous libelous statements.
61. Fremed:
"I reviewed the actual EMG nerve conduction report and note
that the examiner described this as a normal study."
Which is to say CNS damage is indicated, absent neurological
diseases: MS, ALS, etc. which have been ruled out by physicians
of more than competence. Tests for these are by spinal tap,
and both Drs. Haglund and Adams reassured me that there was
nothing to indicate that I should have such tests.
62. Fremed page 6, paragraph 4:
"When seen by Dr. Haglund on 10/19/98, he had continued
complaints of burning in his hands interfering with various
activities and instability with walking. Dr. Haglund indicates
that he discussed the patient's spinal cord degeneration and
myelomalacia that occurred because of his compressive syndromes
and said that these could be either compressive or vascular.
I once again point out that I have no record of any cervical
MRI scan showing or operative report documenting
any spinal cord degeneration or myelomalacia."
Dr. Fremed seems to have the strange notion that if he has not
seen something that is doesn't exist, or once again that Dr.
Haglund is a liar. From here on, the transparency of Dr.
Fremed's fraud concerning his attack on Dr. Haglund should
be complete, so I will let it speak for itself.
63. Fremed page 6, paragraph 4:
"I do note that Dr. Haglund considered these alleged findings
either compressive or vascular apparently making no reference
to any contribution from the alleged trauma."
See 58. here.
"He said the patient was going to see a urologist for erectile
dysfunction and trouble with urination."
64. Fremed page 7, paragraph 2:
"A letter from Dr. Haglund to the patient's attorney,
dated 11/20/98 again makes reference to a 25% permanent
partial impairment rating for cervical impairment
with long tract signs."
"I again point out that Dr. Haglund's note fail to
document any long tract signs."
"He added 'I believe he has myelomalacia of the
spinal cord which was exacerbated significantly by the MVA.'"
"I once again note
that no radiographic study ever showed any myelomalacia
nor does Dr. Haglund indicate why he felt a single cervical
sprain or whiplash injury was playing a
significant role in this patient's cervical degenerative
disease which clearly
was long standing and many years in formation."
"He felt that the patient's
condition could either get worse or stabilize over time."
"A follow-up note of
May 19, 1999 reiterated his opinion that 'the atrophy of his
spinal cord was exacerbated by the MVA and further compromised
by delaying his cervical decompression.'"
"Once again, should any radiographic reports or films documenting
any atrophy of the spinal cord become available. I would be happy
to review them and issue a supplemental report if indicated."
65. Fremed IMPRESSION:
"Review of the extensive records provided, reveals chronic
degenerative disease in both the cervical and lumbar regions
in this patient which in all medical probability predates
the accident in question."
That Dr. Fremed can find nothing but "degenerative disease"
in the totality of medical records, and can ignore completely
all that he does ignore is so preposterous that it simply
makes the conclusions of this analysis all the more obvious.
66. Fremed IMPRESSION:
"The cervical degenerative disease could explain Dr. Hammel's
neck, arm and finger complaints which I note improved
following surgery."
The improvement after surgery, may have been real or even
a placebo effect. Even I don't know the answer to that, and
it's my body and psyche. The picture is the total body,
and that is one of muscular atrophy, as documented by physicians
and not simply my "subjective complaints".
The overall general problems can also be explained by MRI
documented mid C-cord atrophy.
67. Fremed IMPRESSION:
"The surgery relieved neural foraminal stenosis caused by years
of chronic degenerative change unrelated to the accident in
question."
Dr. Fremed denies having seen the original 1995 cervical MRIs,
denies having any evidence on MRI (although there are a few)
of C-cord atrophy, and so comes to this conclusion, we suppose
by divine inspiration.
Dr. Haglund saw the fundamental problem as a central stenosis:
the C6-C7 disk was pushing into the spinal cord itself, and
he had a perspective that Dr. Fremed denies, which is looking
at the actual MRIs.
Dr. Fremed is grasping at straws to say or fabricate anything
so he can "in his professional opinion", however untutored,
whatever - is not a result of the accident. Well - some things
are not caused by the accident. Some are caused by racketeering,
fraud, extortion, robbery, professional misconduct, and
other assorted criminal actions and torts of racketeering
enterprises.
68. Fremed IMPRESSION:
"Dr. Haglund's references to myelomalacia, spinal cord
atrophy, and long tract signs in letters to the patient's
attorney are simply unfounded based on his notes which fail
to document any long tract signs on examination and which
fail to include any radiographic evidence of spinal cord
atrophy or myelomalacia."
That Dr. Fremed has not been provided by his co-conspirators
with the appropriate medical information is not to be blamed
on Dr. Haglund. One generally doesn't wrap up a handy MRI
plate in a medical report. But, then, Dr. Fremed knows that
very well. The ice upon which he treads is about one
molecule thick.
69. Fremed IMPRESSION, page 7, paragraph 3:
"It is evident from reviewing Dr. Hammel's deposition
testimony and medical records that he displays a tendency
to blame all of his problems occurring
after the accident in question on the accident."
It is not evident to me, and is not true; what I have blamed,
once discovered, is the patterns of racketeering engaged in
by my erstwhile insurance company State Farm Indemnity, their
employees, their attorneys named elsewhere, and last but not
least, certain prostitute physicians whose function it is to
conspire with SFI and its attorneys to inflict calculated harm
on already injured policy holders. Dr, Fremed is one of these
prostitute physicians, about whom I have previously complained.
70. Fremed IMPRESSION:
"He appears to believe that his inability to maintain employment,
his heart attack, his need to move to North Carolina,
his emotional complaints, and need for surgery were all the
result of the accident in question."
To the contrary; see response in the previous paragraph.
71. Fremed IMPRESSION:
"This post hoc ergo propter hoc argument is simply fallacious."
Dr. Fremed's predicate is wrong as just explained. However,
there is enough evidence that injury was done by the MVA,
and that had it been repaired when it's nature was discovered
that no permanent injury or harm of any kind would have
resulted. Repair was deliberately made impossible by
SFI, and by SFM to whom the claim was inexplicably transferred.
This impossibility and the attendant profit schemes of
the defendants in this action is the source of all injuries
to the Plaintiffs complained of in this action by Plaintiffs.
72. Fremed IMPRESSION:
"By history he suffered a cervical sprain which would
have been expected to resolve with time."
Dr. Fremed has never examined me nor seen me. He has seen
only papers and an MRI or two, although not crucial ones.
What I actually suffered is beyond his knowledge. What "would
have been expected" is not within his purview to say.
73. Fremed IMPRESSION:
"Furthermore, his chronic degenerative disease in both the
cervical and lumbar spine would have been expected to
progress with time even in the absence of any additional
trauma."
Dr. Fremed has no idea of any rate of degeneration of my
anything, if, indeed, there is any current progression as
witnessed by his failure even to make an estimate as to
any time within which any symptoms might be experienced; and
again what "would have been expected" is not within his
purview to say. There is no objective evidence in existence
to support Dr. Fremed's claims. That seems to be perfectly
consistent with the rest of his medical claims.
74. Fremed IMPRESSION. page 7, paragraph 4:
"It appears in reviewing the above records that Dr. Hammel
viewed any physician or for that matter any attorney who did
not agree with his views of the accident being the cause of
all of his problems was incompetent or inappropriate."
This very statement, so wonderfully incompetent and
inappropriate in itself, is the summation of Dr. Fremed's venom.
I have no "view of the accident" except that which I perceived.
There didn't happen to be any physicians or attorneys around at
the time of the MVA. So, I pretty much have a monopoly on what
I perceived. Dr. Fremed's statement applied to me, seems by the
nature of his review, to apply more to him than to to me.
In my communications with SFI, when I declined a physician as
IME examiner, I politely said that they were "unacceptable" as
one can see nicely documented in SFI's internal notes. I
thought this a more gentle thing to say than "known medical whore".
The now infamous MVA of 09/16/94 has nothing to do with
evaluations of people. My physicians, psychotherapist and even
my current attorney tell me things I really don't want to hear.
They sometimes disagree with my views on various things;
sometimes I even get to be right. Nevertheless, these people
are still my physicians, psychotherapist and attorney because
they are possessed of extraordinary intelligence, humanity and
integrity.
My views as to anyone's incompetence in anything are determined
by pertinent facts, and my value judgments are mine to make for
myself, acting on those judgments, without necessarily speaking
them, with accountability for my values to no one. I try never
to rely on the untested opinions of others, regardless of their
areas of expertise.
75. Fremed IMPRESSION. page 8, paragraph 2:
"As commented above, should the actual cervical spine MRI
films become available, I would be happy to review them and
issue a supplemental report if indicated. The same is true
for any other medical records that may come to light."
For another fee that will be internally charged against my
PIP protection.
76. Fremed IMPRESSION. page 8, paragraph 3:
"It is my conclusion based on the medical records reviewed
thus far however, that Dr. Hammel suffered no permanent
neurologic injuries as a result of the accident in question
and that his cervical surgery was not necessitated by the
accident in question."
It is my conclusion, based on his review, and prior knowledge,
that Dr. Eric L. Fremed demonstrates such skill in fraudulent
medical reports, that he must have had quite a bit of practice
in his racketeering engagements with insurers, and that as
such he should probably be declared a public menace, never being
permitted to practice medicine, anywhere, ever again.
What completely gives him away here is the vengeful way in which
he attempts to arrive at his conclusion. I allege that Dr.
Fremed has read and may still even have in his possession a
document passed on to him which is Exhibit B of the attached
complaint. On Pages 6-10 of that document I dissected Dr.
Fremed's IME report on Plaintiff Bellamente against the medical
opinions of 4 treating physicians: two neurologists, one
neurosurgeon and one orthopedic surgeon, all of whom
explicitly disagreed with Dr. Fremed. Dr. Fremed, has failed
to acknowledge, as Plaintiffs have only recently discovered
on 01/11/2000, that he has, in fact, read this document.
He does however admit it, on page 8 of a review of Plaintiff
Bellamente's "medical records" dated 06/14/99. Dr. Fremed
fails, however, despite this complaint's length to say so
much as one word about it. In particular, he fails to rebut
one statement from it, including the careful documentation
of all his crafty omissions from medical and radiological
reports. Moreover, he also admits that Ms. Wall of Melli
Guerin & Wright provided a copy of that complaint to him.
Despite the expressed disagreement of Drs. Adams, Rubin,
Pojedinec and Jotkowitz with Dr. Fremed. SFI quite literally
used Dr. Fremed's report as a tool to deny Plaintiff Bellamente
medically necessary surgery.
Nonetheless, this purported "review" by Dr. Fremed of my medical
reports and records is my punishment for having the audacity to
say what is true about what he does. In attempting to punish me,
he does again what he has done before in the IME report on Plaintiff
Bellamente. Yet twice again now, when SFI, frantic in it's desire
to deny legitimate claims, and also to punish both Plaintiffs,
has used Dr. Fremed for similar "paper reviews" of Plaintiff
Bellamente's medical records, to come to a remarkably similar
conclusion by using the very same tactics of fraud,
deceit and trickery.
Now, however, SFI would like to reach back into the 1992
accident suffered by Plaintiff Bellamente alone to blame his
his injuries on that accident, as shown in Dr. Fremed's reviews
called rather pompously and inaccurately by Ms Wall "Narrative
Reports" of Plaintiff Bellamente's medical records dated
06/14/99 and 12/23/99.
IN SUMMARY OF DR. FREMED'S REVIEW of PLAINTIFF HAMMEL'S
MEDICAL RECORDS, DR. FREMED:
1) Fails to include in his review any attributions whatsoever
of initial injuries by treating physicians although they
were present in the reports of
a) Dr. Boulukos in every Attending Physician Report
submitted to SFI
b) Dr. Linder Twice on 02/16/95, 05/03/95
c) Dr. Schmaus 10/18/95
d) Dr. Kluger 06/8/96
e) Dr. Savatsky 11/29/95
2) Fails to include in his review any attributions of serious
and permanent injuries by Dr. Haglund to SFI's denial and
delays, in which they persist to this day.
3) Fails to consider the known and well documented simultaneity
of initial injuries coincident with the MVA.
4) Fails to consider the continuous line of medical treatments
from the MVA to the current day.
5) Fails to acknowledge the serious and permanent injuries
resulting from SFI's denial and delays.
6) Wantonly ascribes, arbitrarily, all injuries to a common
pre-existing "degenerative disease", considering nothing
else as even possible, despite the voluminous documentation
and opinions of actual treating physicians.
7) Wantonly, and without foundation, in essence calls Dr.
Haglund a liar, and impugns his intelligence.
8) Repeatedly inserts comments and opinions that are completely
inappropriate in a medical review.
9) Systematically attempts to discredit and impugn, with no
substantive bases whatsoever, the integrity, intelligence,
competence and sanity of Plaintiff Hammel as well as his
treating physicians.
11) Fails to admit in his review of my medical records
dated 06/30/99, what he already admits in his review
of Plaintiff Bellamente's medical records dated 06/14/99,
page 8, that he had read my severe criticism and allegation
of fraudulence of his IME report on Plaintiff Bellamente
in a complaint written to the New Jersey DOI dated 12/04/95.
This explains the rabid vituperation that can be found in
Dr. Fremed's purported reviews of my medical records, and
also why he fails to mention having read the named complaint
to the New Jersey DOI.
On these grounds alone, Dr. Fremed's opinions should be
dismissed by any Court as a maliciously perpetrated vendetta,
as well as a deliberate sham presented to an adjudicating
body of the State of New Jersey together with SFI, and
its attorneys in, at very least malicious misrepresentation.
10) Whether of not Dr. Fremed actually had in his possession,
documents which he claims he did not, or whether he had
access to documents that are not mentioned, it is clear
that the axe Dr. Fremed had to grind was of an imperative
nature.
From other documents that Plaintiffs have, it is
clear that Dr. Fremed, SFI, and Melli, SFI's attorneys,
as participants in a racketeering enterprise, were in a
well defined conspiracy to commit fraud, robbery and extortion,
as well as other criminal acts, intentional and negligent torts.
It is also clear that these same participants have committed
fraud and extortion as well as other intentional and other
negligent torts.
Works Consulted in Writing this Memorandum Analysis
1. Gray's Anatomy, Henry Gay, F.R.S., edited by
T. Pickering Pick, F.R.C.S., Robert Howden, M.A.,
M.B., C.M. (1901)
2. Review of Gross Anatomy, Ben Pansky, Ph.D., M.D.
and Earl Lawrence House, Ph.D. (3rd ed.) Macmillan
(1975)
3. Atlas of Clinical Anatomy, Richard S. Snell, M.D.,
Ph.D., Little, Brown & Company (1978)
4. Correlative Neuroanatomy and Functional Neurology,
Joseph G. Chusid and Joseph, J. McDonald (8th ed.)
Lange Medical Publications (1956)
5. Introduction to Physiological Psychology, Francis
Leukel, C.V, Mosby Company (1968)
6. An Introduction to Molecular Neurobiology, Zach
H. Wall (ed.), Sinauer Associates (1992)
7. Ionic Channels of Excitable Membranes (2d ed.)
Bertil Hille, Sinauer Associates (1992)
Respectfully Submitted:
William C. Hammel Alan J. Bellamente
A-11 Moose Branch Road, A-11 Moose Branch Road,
Sweetwater Apartments 1A, Sweetwater Apartments 8A,
Robbinsville, NC 28771 Robbinsville, NC 28771
(828) 479-1547 (828) 479-1547
------------------------------- ------------------------------
William C. Hammel Alan J. Bellamente
DATE: February 4, 2000 DATE: February 4, 2000
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Created: February 4, 2000
Last Updated: May 28, 2000