Plaintiff’s direct examination of physical therapist
In the below checklist, the plaintiff is referred to as ‘“John” and the the physical therapist being examined is referred to as “Jones” or “PT.” The incident in question is an “auto crash.”
Checklist: Deposition or Trial Checklist — Direct Examination by Plaintiff of Plaintiff’s Physical Therapist
1. WHY THE WITNESS IS HERE
Mr. Jones, do you understand that we are interested in the injuries that John suffered in the auto crash on [date]?
You treated John for some of his injuries, didn’t you?
Without getting into the details right now, what were John’s major injuries from the auto crash for which you were treating John?
Did you make evaluations and measurements of what John can, and cannot, do and what impairments he has in his functions in everyday living and work?
Are you a physical therapist?
2. QUALIFICATIONS OF PHYSICAL THERAPIST
Many of us have seen a physical therapist at some time in our lives, perhaps in the past ten years, but maybe we do not know the full extent of the profession of physical therapy today and the years of qualification and training you have had, so let’s talk about that now.
Are you licensed to practice the profession of physical therapy? In what state?
What is the field of physical therapy?
[The plaintiff’s attorney will discuss beforehand with the PT the need to include in the description of the profession of physical therapy the following factors:
- Independent evaluation of the patients condition;
- Evaluation involves reading medical records, determining what the patient can or cannot do, and determining the patient’s functional ability to do the movements and actions required to do daily living and work;
- Independent planning of intervention to reduce or eliminate the bodily condition causing the patient to be unable to do daily living and work movements;
- After evaluation and planning, to apply the intervention program;
- Making measurements and functional assessments; and
- Making a prognosis of future recovery from the condition being treated.
If the witness does not mention all of the above numbered items, the plaintiff’s attorney may want to inquire specifically of the item not mentioned.]
[Alternatively, if the witness is not used to testifying in court, and the plaintiff’s attorney does not know in advance the answer he will give, instead of the above question “What is the field …,” the plaintiff’s attorney may ask the following series of questions.]
Mr. Jones, I’m sorry that I have to read a long question to you, but I have to put all these things into the record about what you do. Mr. Jones, does the practice of physical therapy mean:
[Here the plaintiff’s attorney will read a full definition, following the statutory licensure definition, e.g.,
(a) Examining, evaluating and testing persons who have mechanical, physiological and developmental impairments, functional limitations and disabilities or other health and movement related conditions in order to determine a diagnosis, a prognosis and a plan of therapeutic intervention and to assess the ongoing effects of intervention, and
(b) Alleviating impairments and functional limitations by managing, designing, implementing and modifying therapeutic interventions.]
Mr. Jones, would you explain what a physical therapist does when “examining, evaluating, and testing persons” to determine a therapeutic intervention?
For someone like John, whose physical condition we want to know about, what are the sorts of therapeutic intervention techniques that can be used?
Did you use some of those on John?
Is a physical therapist trained to know how the patient’s impairments affect the ability to perform various tasks in daily living or work?
Do medical doctors call upon physical therapists to do the functional capacity assessment which shows how the patient’s impairments affect the ability to perform various tasks in daily living or work?
Did you assess John’s functional abilities and what he could or could not do as a part of your profession of physical therapy?
Mr. Jones, does your practice of your profession normally include making written records, including a report to attending physicians?
Do you have your medical records with you today, so we can see the measurements you made and the reports to physicians on John’s function or loss of function?
What college and other education and training did you have before you were licensed in this state?
What are the types of courses that you had in college to graduate with a degree in physical therapy?
What degree did you receive?
What post graduate medical training have you had?
Have you had further continuing education every single year since you graduated? What sort of courses or subjects have you had in your further continuing education after graduation?
Are you certified in any specialty? What? What did you have to do to be certified as a specialist in __________?
Mr. Jones, can you tell us some of the professional associations to which you belong?
Have you taught other physical therapists?
How many years have you been practicing the profession of physical therapy?
Have medical doctors sent patients to you for you to evaluate and treat?
Over the years, have those doctors sent dozens (or hundreds) of patients to you to evaluate and report your findings to the doctors?
Have you seen and treated patients other than John for the sort of injuries John had?
Approximately how many other patients like John?
3. FIRST EXAMINATION BY THIS PHYSICAL THERAPIST AFTER ACCIDENT
When did you first examine John after the auto crash of January 13, 2010?
Was John referred to you by a medical doctor? Who? When?
Did the medical doctor referring John to you have a prescription or direction to you about what you were to do?
What exactly were the words of prescription or direction to you?
Does that mean you are to exercise your own independent professional judgment in the particulars of treatment?
Did you do that?
Would you tell us what medical history you got from John, from physicians, from medical records, or other sources?
Will you tell us what physical examination you made on this first visit with John, and what your examination disclosed?
Any mechanical aids — special studies — x-rays used in this examination?
Location of pain described by John during this first examination?
Mr. Jones, in any question I ask you calling for your opinion, there is an implied part of my question, which is “to a reasonable degree of certainty.” I want you to answer my questions only if you have a reasonable degree of certainty as a physical therapist professional. Do you agree that in answering my questions, you will only give an opinion if it is to a reasonable degree of professional certainty?
[If the physical therapist has already given some opinions, the plaintiff’s attorney will also ask:
Are all the opinions you have expressed up to this point given to a reasonable degree of professional certainty?]
4. FIRST VISIT: EVALUATION
After John’s first examination by you, what was your evaluation of the problems John was having?
5. DESCRIPTION OF PARTS INVOLVED AND FUNCTION AND INJURY (A SHORT ANATOMY LESSON)
Please explain the anatomy involved to help us understand the differences and effects to John’s body and your evaluation of his physical limitations of function?
[The plaintiff’s attorney will try to have the witness use drawings by the physical therapist or medical illustrations or models.]
Mr. Jones, would you explain for us the terms “exacerbation” and “remission.”
Does that mean that some days a person will be better and some days worse, maybe on one day’s examination there may be no muscle spasm, while at another time, muscle spasms will exist?
So if a medical care person sees a patient just one day, that one can could be a day the patient was having a good day or the day he was having a bad day?
6. SUBSEQUENT EXAMINATIONS AND TREATMENT
You have told us about the first time you saw John. Did you see him from time to time after that?
As to each subsequent exam or treatment, the plaintiff’s attorney will ask the physical therapist to describe:
What were the major findings when John was seen that time?
What tests and treatment did you do for assessment or improvement of function of John’s injured _______?
If Mechanical Devices (e.g., brace, TENS unit, bone stimulation) — what type, why and how long needed?
Is it fair to say that from the first time you saw John, on ______________, until the last time you saw John, on __________________, although you saw some improvement, during that whole time he was physically impaired?
7. FUNCTIONAL CAPACITY EVALUATION
Did I ask you to do a functional capacity evaluation of John?
Did I tell you to mail a copy of that evaluation both to me and also to the defendant’s attorney, Mr. ___?
When did you perform the functional capacity evaluation of John?
Please tell us generally what tests or items were involved in the functional capacity evaluation.
Are these tests standard methods of measuring physical abilities?
Are these tests reliable?
Please tell us what you did in the testing and what it showed?
What does this evaluation show in regard to John’s ability to work?
What does this evaluation show in regard to John’s ability to perform the acts of daily living?
8. PAIN — IS IT REAL AND NOT MALINGERING?
You have described John’s problems as [list of problems]. As a matter of physical therapy science, does that body condition cause pain?
As a matter of reasonable professional certainty, was John suffering pain?
Mr. Jones, it says in the records that John had pain. Is there any doubt at all in your mind that John suffered pain from his injuries?
Did John impress you as being a patient who wanted to get well?
9. AUTO CRASH AS PROXIMATE CAUSE OF INJURIES
HYPOTHETICAL QUESTION — EYEWITNESS TO IMPAIRMENT — CAUSE QUESTION
Mr. Jones, you told us about your training and experience. You told us that you took a medical history and that in your treatment you learned that John had been in the car crash on [date]. You saw John from __________ to ________. You actually saw John’s injuries, and you have told us what you saw. And you have told us John’s injuries included [read the list of injuries].
Mr. Jones, I want you to assume two things. One: assume that (facts of the auto crash accident). Two: assume John had the bodily conditions you saw on the dates you saw them, and to which you have testified. Assuming these things, Mr. Jones, do you have an opinion based upon a reasonable professional certainty whether the injuries you saw on John were compatible with the auto crash?
What is that opinion?
10. STATEMENT FOR SERVICES
Now before we get to John’s physical status at the last time you saw him and what the future holds for John, let’s find out what the expenses are to date.
Do these bills for the services of you and your company group show the medical expense(s) for your company’s services?
Were these charges reasonable and customary for those types of services?
Were these services reasonably necessary for treating John’s injuries?
11. LAST EXAMINATION — PRESENT CONDITION
When was the last time you examined John?
What was John’s condition at the time when you last saw John?
Was John still reporting pain?
Was John still physically impaired at that time?
Was there anything in your examination to cause you to disbelieve complaints of John?
12. PRESENT FUNCTION: IMPAIRMENT/ DISABILITY EFFECT OF INJURY ON BODY FUNCTION (IMPAIRMENT)
What limitation of function does John still now have?
[If the physical therapist did objective measurements of function loss, the plaintiff’s attorney will discuss how the measurements were made and what that means in terms of bodily movement limitations.]
[If the physical therapist is willing to use AMA or other tables to translate his/her findings and measurements into percentage of disability or impairment, the plaintiff’s attorney will ask about the existence of standard tables, that they are relied upon by physical therapists in treatment and rehabilitation, and what they show for John’s percentage of disability or impairment. (Impairment rating.) Other than the AMA tables there exists other specific measuring scales, such as Waddell’s Tests, which a PT cannot use to measure anatomical or structural impairment; but rather, to measure physical function limitations associated with low back pain.]
Mr. Jones, as a matter of physical therapy science, how would you characterize John’s present injury with relation to his body function as a whole?
Do these injuries have an effect on:
Are there any related bodily problems occurring from the limitation of function? (E.g. headaches or fatigue)?
John testified [says] that some of his biggest problems are: [list of injuries].
Are those problems consistent with his body conditions and the functional injuries John received?
Do John’s physical function losses increase his risk for falling or other injuries in the future?
[E.g., injury to joint or back can increase the severity of normal aging-related arthritis. Loss of sense of smell increases chance of not detecting gas fumes. Injury to leg of elderly person increases chance of falling and fractures.]
13. FUTURE TREATMENT AND EXPENSE
Do you have an opinion, based on a reasonable degree of professional certainty, as to what is the probable future course of physical therapy treatment you expect John will need in the future because of his injuries?
Will that treatment involve expense?
Do you have an opinion based upon reasonable probability what the probable necessary cost of that future treatment would be, using today’s dollars and not adjusting for any future rise in medical costs?
14. PROGNOSIS; FUTURE IMPAIRMENTS: PERMANENT
Do you have an opinion, based on a reasonable degree of therapeutic certainty: Will John have physical impairments after today?
What are they?
How do these physical impairments affect his daily activities of life and work?
What work limitations would an employer of John have to put up with if they hire John?
[E.g., no overtime work.]
[The plaintiff’s attorney may ask the following three questions if he or she has discussed this with the physical therapist, so they know the physical therapist is willing to give a percentage figure.]
What does “percentage of impairment” mean?
Please give us your opinion of John’s percentage of impairment.
Is that a permanent percentage of impairment rating?
How long will these impairments continue?
No matter what he does, is John going to have this impairment?
Mr. Jones, do you have an opinion based on a reasonable degree of certainty: Will John ever be able to return to work that requires stooping, bending, and twisting?
John is never going to be able to pick up his grandchildren, is that the future you see for John?
What is your reasonably certain prognosis for John; that is, what do you expect will happen as the years roll by?
Mr. Jones, your profession devotes itself to eliminating or reducing bodily impairments. Your training and experience allow you to determine the probability that a functional impairment can, or cannot be eliminated, is that true?
Is John’s functional impairment permanent?