`INDEX V0.
`51982/2016
`INDEX NO. 51982/2016
`FILED: WESTCHESTER COUNTY CLERK 03/05/2018 06:35 PM
`FILED: WESTCHESTER COUNTY CLERK 03m2018 06:35 PM
`
`
`NYSC 3F DOC. NO. 74
`Rfi
` flIV «D NYSC
`3F:
`03/05/2018
`NYSCEF DOC. NO. 74
`RECEIVED NYSCEF: 03/05/2018
`
`
`
`EXHIBIT 9
`
`

`

`FILED: WESTCHESTER COUNTY CLERK 03/05/2018 06:35 PM
`NYSCEF DOC. NO. 74
`RECEIVED NYSCEF: 03/05/2018
`
`INDEX NO. 51982/2016
`
`DIPLOMATE
`
`Louis
`OF THE AMERICAN
`3058 EAST
`BRONX,
`718 409-0500
`
`M.D.
`C. Rose,
`BOARD OF ORTHOPAEDIC
`TREMONT
`AVENUE
`NEW YORK 10461
`- FAX:
`718 409-0306
`
`SURGEONS
`
`Law Offices
`of
`PC
`Omrani
`Bc Taub,
`- 28tl' Ploor
`909
`Third
`Avenue
`New York,
`New York
`10022
`
`Dear
`
`Counselor:
`
`ADDENDUM
`
`January
`
`15, 2018
`
`Re:
`
`RUIZ,
`
`HERME
`
`This
`
`is in response
`
`to your
`
`request
`
`for
`
`a medical
`
`narrative
`
`on the
`
`above-captioned
`
`patient.
`
`History:
`.
`at my office
`patient
`The
`at 360 Mamaroneck
`was
`initially
`Avenue,
`New York
`New York
`on 4/1/2011
`360 Mamaroneck
`10605
`White
`Plains,
`Avenue,
`he was
`a 52 year
`old male
`complaint
`of
`injuries
`presented
`who
`sustained
`with
`as a result
`vehicle
`motor
`accident
`that
`that
`he struck
`both
`occurred
`on.2/3/2015.
`The
`patient
`reported
`and
`against
`the
`that
`He was
`had
`knee
`column
`time.
`pain
`since
`steering
`the
`care
`of Dr.
`a chiropractor,
`continued
`complaint
`on this
`day with
`Sutera,
`bilateral
`knee
`greater
`than
`complained
`of episodes
`of buckling
`right
`pain,
`nighttime
`pain.
`
`White
`At
`
`Plains,
`the
`time
`of a
`knees
`under
`of
`and
`
`seen
`
`ongoing
`and
`left.
`
`bilateral
`presented
`The
`patient
`
`Past Medical/Surgical
`
`History:
`
`Significant
`
`for
`
`hypercholesterolemia;
`
`status
`
`post
`
`bilateral
`
`eye
`
`Allergies:
`
`Denied
`
`any
`
`drug
`
`allergies
`
`Medications:
`and
`Travatan
`
`Patient
`was
`Eye Drops
`
`taking
`as well
`
`Prednisolone
`as Acetazolamide
`
`Drops,
`ER.
`
`Combigan
`
`Drops,
`
`Simbrinza
`
`Eye Drops
`
`Review
`symptoms.
`
`of Systems:
`
`Unremarkable
`
`to respiratory,
`
`cardiac,
`
`GI, GU or endocrine
`
`system
`
`PHYSICAL
`hand
`dominant
`
`EXAMINATION:
`male.
`
`Examination
`
`revealed
`
`a well-developed,
`
`5'8",
`
`220
`
`pound,
`
`left-
`
`Examination
`antalgic
`the
`right
`
`of
`
`the
`
`gait
`knee
`
`favoring
`was
`
`patient's
`the
`
`from
`
`right
`0 to
`
`
`
`TendernessTenderness
`
`
`
`toto palpationpalpation
`
`waswas
`
`knees
`
`bilateral
`revealed
`lower
`without
`extremity
`125
`0 to
`degrees
`where
`
`aboutabout
`
`thethe medialmedial
`
`
`
`notednoted
`
`him to be ambulating
`assistive
`device.
`any
`degrees
`is considered
`lineline
`andand
`
`patellarpatellar
`
`135
`
`
`
`jointjoint
`
`a slightly
`with
`Range
`of motion
`normal.
`
`insertion.insertion.
`
`tendon
`tendon
`
`of
`
`HeHe
`
`

`

`FILED: WESTCHESTER COUNTY CLERK 03/05/2018 06:35 PM
`NYSCEF DOC. NO. 74
`RECEIVED NYSCEF: 03/05/2018
`
`INDEX NO. 51982/2016
`
`Ruiz,
`Page
`
`Herme
`42
`
`had
`
`sign
`
`a positive
`McMurray
`terminal
`of
`5 degrees
`lacked
`joint
`and
`line
`the
`lateral
`along
`test was
`appreciated
`
`McMurray
`
`appreciated
`extension
`the
`patellar
`lateral
`at
`
`with
`
`the
`
`in the medial
`flexion
`125
`to
`tendon
`insertion
`line.
`joint
`
`compartment
`degrees.
`
`at
`
`the
`
`tibial
`
`the
`
`of
`There
`
`was
`tubercle.
`
`left
`
`The
`
`knee.
`tenderness
`A positive
`
`knee
`
`along
`
`IMPRESSION;
`
`PLAN:
`
`derangement
`Internal
`knee
`tear
`right
`to the
`
`of
`and
`
`bilateral
`the
`possible
`
`knees
`lateral
`
`with
`meniscal
`
`probable.medial
`to the
`tear
`
`left
`
`meniscal
`knee.
`
`plan
`The
`to avoid
`follow
`
`up
`
`was
`those
`after
`
`for MRI
`activities
`his MRI
`
`evaluation
`that might
`evaluation.
`
`to evaluate
`exacerbate
`
`for
`his
`
`underlying
`symptoms
`
`meniscal
`or cause
`
`pathology.
`further
`
`The
`injury.
`
`patient
`He would
`
`was
`
`MRI
`evaluation
`minimal
`with
`noted.
`stenosis
`
`the
`
`of
`midline
`
`cervical
`ventral
`
`spine,
`canal
`
`report
`dated
`encroachment
`
`3/25/2015,
`at C3-C4;
`
`revealed
`no disk
`
`early
`herniation,
`
`disk
`
`degeneration
`or canal
`fracture
`
`MRI
`junction
`articular
`
`of
`the
`posterior
`
`patient's
`horn
`
`knee
`
`left
`and
`with
`
`revealed
`increased
`which
`of
`
`the
`
`evaluation
`of
`the
`surface
`the
`
`overlying
`osteochondral
`articular
`
`cartilage;
`
`4/18/2015
`dated
`the medial
`meniscus
`diffuse
`inedial
`patellar
`without
`
`the
`at
`signal
`inferior
`the
`intersects
`cartilage
`the
`articular
`a 7 x 10 mm
`t'
`the
`of
`overlying
`effusion.
`joint
`
`condyle;
`
`with
`denuding
`suprapatellar
`
`thinning
`femoral
`ridge
`tearpträce
`
`of
`body
`a meniscal
`tear;
`of
`aspect
`the medial
`tendinosis
`
`weightbearing
`within
`injury
`patellar
`
`compatible
`posterior
`impaction
`proximal
`
`MRI
`the
`of
`the medial
`of
`diffuse
`
`knee
`right
`meniscus
`of
`the
`condyle
`
`thinning
`femoral
`osteochondral
`associated
`suprapatellar
`
`4/18/2015
`performed
`SLAP
`with
`displaced
`articular
`cartilage
`associated
`with
`within
`
`a SLAP
`revealed
`component
`within
`posterior
`the
`weightbearing
`bone marrow
`edema;
`and medial
`patellar
`facet
`articular
`cartilage
`overlying
`a 1 cm popliteal
`
`of
`tear
`the posterior
`the.intrameniscal
`
`horn
`
`and
`
`body
`
`(2)
`the
`
`with
`small
`
`ridge
`
`(4)
`
`recess;
`aspect
`of
`focal
`(3)
`patellar
`and
`
`cyst.
`
`overlying
`subchondral
`the
`lateral
`of
`the
`with
`
`denuding
`commutes
`
`impaction
`subchondral
`joint
`
`injuries
`and
`edema
`which
`effusion
`
`a complex
`and
`radial
`
`tear
`
`of
`
`the
`
`the
`
`of
`and
`
`.MRI
`evaluation
`horn
`posterior
`diffuse
`thinning
`the medial
`femoral
`cartilage
`
`change;
`
`with
`and
`
`joint
`
`report
`right
`knee,
`the medial
`of
`body
`articular
`cartilage
`ofthe
`condyle
`associated
`the medial
`lateral
`overlying
`small
`suprapatellar
`effusion
`
`dated
`meniscus
`
`revealed
`4/23/201.6,
`horizontal
`with
`both
`central
`
`the
`posterior
`overlying
`subchondral
`diffuse
`edema;
`ridges
`patellar
`with
`associated
`which
`communicates
`with
`
`components;
`aspect
`articular
`
`of
`
`weightbearing
`thinning
`subchondral
`em popliteal
`
`of
`
`the
`cystic
`cyst.
`
`a L5
`
`The
`M.D.
`
`underwent
`patient
`Preoperative
`Postoperative
`
`surgical
`Diagnosis:
`Diagnosis:
`
`medial
`
`report
`intervention,
`internal
`derangement
`lateral
`
`and
`
`meniscal
`
`6/30/2016:
`dated
`of
`right
`
`knee,
`
`Surgeon
`tear medial
`
`C. Rose,
`Louis
`meniscus.
`
`tears,
`
`synovitis,
`
`tenosynovitis,
`
`

`

`FILED: WESTCHESTER COUNTY CLERK 03/05/2018 06:35 PM
`NYSCEF DOC. NO. 74
`RECEIVED NYSCEF: 03/05/2018
`
`INDEX NO. 51982/2016
`
`chondromalacia
`
`of
`
`the
`
`right
`
`knee.
`
`Operative
`
`synovectomy,
`
`chondroplasty
`
`meniscectomy,
`Herme
`
`Ruiz,
`Page
`
`03
`
`Procedure:
`the medial
`
`of
`
`arthroscopic
`femoral
`
`medial
`condyle.
`
`and
`
`lateral
`
`Note
`
`dated
`left
`
`of
`
`Operative
`derangement
`lateral
`and
`chondromalacia
`medial
`partial
`of
`the
`
`meniscal,
`patella
`lateral
`and
`
`patella,
`
`chondroplasty
`
`Louis
`Surgeon
`12/21/2017:
`meniscus.
`tear medial
`
`knee,
`synovitis,
`and
`
`tenosynovitis,
`chondromalacia.
`
`Preoperative
`C. Rose,
`Diagnosis:
`Postoperative
`cruciate
`anterior
`of
`the
`sprain
`left
`knee
`Operative
`Procedure:
`ACL
`thermal
`
`M.D.
`
`left
`
`Diagnosis:
`tear medial
`knee
`
`internal
`
`ligament,
`
`arthroscopy
`chondroplasty
`
`for
`
`shrinkage,
`
`meniscectomy,
`of medial
`
`synovectomy,
`femoral
`condyle.
`
`patient
`The
`continued
`prescribed
`of nocturnal
`
`on a regular
`was
`followed
`complaint
`of bilateral
`knee
`an ice machine
`
`and
`using
`awakening.
`
`monthly
`pain.
`as well
`
`basis
`patient
`The
`as a cane
`
`12/27/2017
`on
`seen most
`and
`recently
`the medication
`as
`reported
`taking
`to complain
`ambulation.
`continued
`for
`
`He
`
`with
`
`Examination
`
`the
`
`favoring
`obliterating
`present
`were
`85 degrees
`extension.
`
`left
`
`the
`patient's
`of
`lower
`left
`extremity
`patellar
`the
`normal
`with
`no ecchymosis,
`tenderness
`mild
`with
`
`him to be ambulating
`revealed
`knee
`in the
`right
`of a cane
`the
`use
`with
`arthroscopic
`was
`noted.
`The
`fossa
`Range
`erythema
`or drainage.
`knee.
`Strength
`about
`the
`
`diffusely
`
`with
`hand.
`portals
`of motion
`was
`
`antalgic
`
`gait
`
`a slight
`Moderate
`swelling
`healing.
`Sutures
`were
`0 to
`was
`limited
`from
`knee
`with
`resisted
`
`-5/5
`
`of
`
`the
`limited
`was
`tenderness
`
`right
`
`at
`
`on
`knee
`0 to
`from
`the medial
`
`11/29/2017
`120
`degrees
`compartment
`
`revealed
`
`actively
`was
`
`well-healed
`and
`passively.
`noted.
`Strength
`
`surgical
`Mild
`was
`
`sites.
`wound
`VMO atrophy
`4/5 with
`resisted
`
`Range
`with
`knee
`
`S/P bilateral
`weakness
`
`knee
`
`arthroscopies
`
`with
`
`residual
`
`limited
`
`range
`
`of motion
`
`and
`
`Examination
`of motion
`moderate
`extension.
`
`IMPRESSION:
`
`PLAN:
`
`plan
`The
`analgesic
`
`for
`was
`continued
`medications.
`The
`
`physical
`patient
`
`therapy
`would
`
`and
`follow
`
`of over
`use
`up in a period
`
`the
`
`counter
`of
`four
`
`anti-inflammatory
`weeks.
`
`and
`
`SUMMATION:
`
`In
`
`we
`summation,
`that
`bilateral
`knees
`involved
`in a motor
`to this
`final
`visit.
`
`a 55 year
`have
`old male
`is causally
`to the
`related
`history
`vehicle
`accident
`that
`occurred
`
`who
`
`a permanent
`sustained
`and
`the
`as stated
`on 2/3/2015,
`
`partial
`direct
`
`to his
`disability
`of being
`result
`three
`years
`
`prior
`
`approximately
`
`patient
`The
`accident
`opinion
`
`limitedlimited
`
`
`
`rangerange
`
`sustained
`aforementioned
`despite
`surgical
`undergoing
`that
`he will
`be symptomatic
`ofof motionmotion
`
`bilateralbilateral
`thethe
`ofof
`
`the
`
`injuries
`intervention
`on a permanent
`
`knees,knees,
`
`and
`and
`
`been
`has
`extensive
`basis
`
`having
`
`symptomatic
`physical
`continued
`
`since
`therapy.
`
`pain,
`
`time
`the
`is my
`It
`swelling
`
`of
`
`the
`
`and
`
`

`

`FILED: WESTCHESTER COUNTY CLERK 03/05/2018 06:35 PM
`NYSCEF DOC. NO. 74
`RECEIVED NYSCEF: 03/05/2018
`
`INDEX NO. 51982/2016
`
`Ruiz,
`Page
`
`Herme
`#4
`
`patient
`
`This
`will
`have
`difficulty
`and
`objects.
`of even
`light
`pulling
`as participating
`as well
`in any
`require
`continued
`patient
`will
`on
`a permanent
`medications
`
`with
`long
`He will
`type
`of
`physical
`basis.
`
`sporting
`therapy
`
`periods
`have
`
`of
`
`difficulty
`activities
`use
`and
`
`walking,1ifting,
`standing,
`stairs,
`ambulating
`as running,
`such
`of anti-inflammatory
`
`jogging
`and
`
`carrying,
`
`This
`
`pushing
`kneeling
`crouching,
`or. cycling.
`analgesic
`
`Overall
`with
`
`joint
`curative
`
`patient
`such
`
`this
`injuries
`replacement
`and
`
`that
`
`is moderately
`as this will
`at some
`point
`these
`patients
`
`be noted
`It should
`basis.
`on a permanent
`disabled
`traumatic
`arthritis
`post
`go on to develop
`usually
`be noted
`that
`total
`joint
`in the future.
`It
`should
`improvement
`in their
`symptoms
`rather
`than
`have
`
`requiring
`replacement
`
`function.
`
`that
`
`patients
`total
`
`is not
`
`Should
`
`you
`
`have
`
`any
`
`further
`
`questions
`
`regarding
`
`this matter,
`
`please
`
`feel
`
`free
`
`to contactme
`
`atany
`
`office,
`
`I, Louis
`knowledge.
`the
`
`penalty
`
`C..Rose,
`M.D.,
`I am a duly
`of perjury,
`
`certify
`licensed
`contents
`the
`
`and affirm
`physician
`of
`this
`
`report
`the
`that
`foregoing
`of New York
`in the State
`to be true.
`report
`
`is true
`and
`
`to the
`I hereby
`
`best
`
`of my
`affirm,
`
`under
`
`Sincerely,
`
`~a~
`
`.rdšeN.D
`
`dr
`o
`Assistant
`Professor,
`At New York
`Medical
`
`~
`
`Department
`College
`
`of Orthopaedic
`
`Surgery
`
`LCRI:er
`
`Review
`
`regarding
`injuries
`distances
`
`of Dr. Martin
`assumptions
`many
`a BMI
`with
`inches
`is incorrect.
`Furthermore,
`damage
`consistent
`with
`consistent
`the
`with
`patient
`the
`to initially
`when
`
`symptomatology
`
`dated
`weight
`limits.
`do not
`induced
`time
`is not
`
`the
`
`the
`
`It
`until
`
`presents
`
`of April
`220
`lbs.
`was
`such
`the
`As
`show
`diffuse
`localized
`the
`accident.
`unusual
`begin
`
`10*
`
`of
`
`they
`
`on
`is incorrect
`2017,
`8
`5 foot
`was
`is height
`and
`as a factor
`of obesity
`claim
`articular
`cartilage
`knees
`to his
`In addition
`with
`patients
`for
`significant
`to walk
`
`injury
`
`other
`
`IME
`Barschi
`examination
`On presentation
`the patient's
`of 24.2
`which
`is within
`normal
`the
`intraoperative
`photos
`traumatic
`solely
`knees
`and
`his
`for
`treatment.
`injured
`areas
`itself.
`
`history
`waiting
`concentrate
`
`osteoarthritis,
`of
`striking
`four
`days
`on other
`then
`
`