While pushing a shopping cart at Wal-Mart, plaintiff Alexandra Rodriguez “brushed” a clothing display rack that started to fall. The rack struck her right elbow and hand causing injury. Her medical experts diagnosed Chronic Regional Pain Syndrome (CRPS) after conservative treatment and nerve decompression surgery on her wrist and elbow. Ms. Rodriguez testified that her right arm pain never fully resolved and that she developed a “burning sensation” and stiffness in her right arm. She alleged negligence against Wal-Mart in installing, inspecting and maintaining the rack.The jury unanimously returned a verdict on liability in favor of Wal-Mart and, as a result, did not answer the damages questions on the jury verdict form. Alexandra Rodriguez v. Wal-Mart Stores, Inc., (A-2/3-17) (079470), (Decided March 4, 2019).
One of Wal-Mart’s medical experts was qualified in the fields of neurology, internal medicine and electrical studies of the brain. When plaintiff’s counsel objected to defense counsel’s question whether plaintiff was somaticizing, the Court conducted a hearing to determine whether to admit the expert’s testimony. The expert defined somatization as ““a process where individuals describe experiencing symptoms of various types that are not accompanied by objective findings and interpretations.”
The expert did not use the definition found in Stedman’s Medical Dictionary because that definition would have implied that Ms. Rodriguez was dishonest. The doctor was allowed to testify regarding somatization and symptom magnification subject to the trial court’s limiting instruction that the jurors could accept or reject all or part of an expert’s opinion. The expert explained to the jury that symptom magnification is “a response that seems to be excessive compared to what should be observed in a given situation for most individuals,” and with respect to plaintiff, “there [were] some observations that would be compatible with symptom enhancement or magnification.” Op at. 17.
An additional Wal-Mart medical expert, a board-certified internist and rheumatologist, was permitted to testify, over plaintiff’s counsel’s objection, and equated the term “somatization” with the term “psychogenic disorders,” which are “disorder[s] in which the principal complaint is pain that is out of proportion to objective findings and that is related to psychological factors.” Psychogenic Pain Disorder, S t e d m a n ’ s M e d i c a l D i c t i o n a r y 527 (27th ed. 2000). He further explained that the terms “overlap,” and somatization is “what an internist would use.” Op. at. p. 17, fn.10. In reaching his conclusion, he relied upon his “experience as an internist and as a rheumatologist in seeing patients with somatoform disorders,” and not as a psychiatrist. Op. at pp.18-19.
The New Jersey Supreme Court acknowledged that it reviews evidentiary rulings by trial courts under an abuse of discretion standard which will only be reversed if the ruling is so far off the mark that it resulted in a manifest denial of justice. It noted that relevancy is “the hallmark of admissibility of evidence” (Op. at p.25 (cite omitted)) and evidence is inadmissible if its probative value is outweighed by its inflammatory potential. Determinations of admissibility require fact-specific determinations of evidence in the individual case. Op. at p.26.
The Court ultimately concluded that there was sufficient credible evidence for a jury to conclude that plaintiff’s subjective complaints of pain were inconsistent with the objective medical evidence and that defense medical expert testimony regarding plaintiff’s somatization was probative and admissible. Regarding symptom magnification, the trial court’s admission of this expert testimony coupled with a limiting instruction minimized any inflammatory potential.
Plaintiff unsuccessfully argued that the trial court abused its discretion by admitting plaintiff’s past medical history, including her psychiatric history. The New Jersey Supreme Court rejected this argument by concluding that her extensive medical history was “logically related” to the issues of proximate cause, damages and pre-existing injury.
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