Free Designation of Deposition Testimony - District Court of Colorado - Colorado

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IN THE UNITED STATES DISTRICT COURT FOR THE DISTRICT OF COLORADO Civil Action No. 04-cv-00560-OES-BNB

GEORGE M. BULL, Plaintiff, v. UNION PACIFIC RAILROAD COMPANY, a Delaware corporation, Defendant.

DEFENDANT UNION PACIFIC'S DESIGNATION OF DEPOSITION TESTIMONY OF DR. STEVEN J. BEER, M.D.

COMES NOW, Defendant, Union Pacific Railroad Company ("Union Pacific") by and through its undersigned attorney, and designates the following portions of the deposition testimony of Dr. Steven J. Beer, M.D. to be read at trial. Page Lines 1 1 IN THE UNITED STATES DISTRICT COURT 2 FOR THE DISTRICT OF COLORADO 3 --------------------------------------------------------4 GEORGE M. BULL, 5 Plaintiff, 6 vs. Civil Action No. 04-F-0560 (BNB) 7 UNION PACIFIC RAILROAD COMPANY, a Delaware corporation, 8 Defendant. 9 --------------------------------------------------------10 11 DEPOSITION OF STEVEN J. BEER, M.D. 12 Taken in behalf of Defendant 13 1:25 p.m., Wednesday

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February 23, 2005 14 15 16 17 18 PURSUANT TO NOTICE, the deposition of 19 STEVEN J. BEER, M.D. was taken in accordance with the 20 applicable Federal Rules of Civil Procedure at the offices 21 of Wyoming Spine & Neurosurgery Associates, 1950 Bluegrass 22 Circle, Suite 170, Cheyenne, Wyoming, before Lori Arnold, a 23 Registered Merit Reporter and a Notary Public in and for 24 the State of Wyoming. 25 Page Lines 2 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23

APPEARANCES For the Plaintiff: MR. KEITH E. EKSTROM Attorney at Law BREMSETH LAW FIRM 810 East Lake Street Wayzata, Minnesota 55391 (Appearing by telephone) For the Defendant: MR. MARK C. HANSEN Attorney at Law UNION PACIFIC RAILROAD COMPANY 1331 17th Street, Suite 406 Denver, Colorado 80202

INDEX DEPOSITION OF STEVEN J. BEER, M.D.: Direct - Mr. Hansen Cross - Mr. Ekstrom Redirect - Mr. Hansen Recross - Mr. Ekstrom

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No. 2 3

EXHIBITS Description Medical records of Dr. Kleiner Complete medical file

Identified 11 4

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PROCEEDINGS (Deposition proceedings commenced 1:25 p.m., February 23, 2005.) (Witness sworn.) STEVEN J. BEER, M.D. called for examination by the Defendant, being first duly sworn, on his oath testified as follows: DIRECT EXAMINATION Q. (BY MR. HANSEN) Would you please state and spell your name for the record. A. Steven Joseph Beer. It's B-e-e-r. Q. And what do you do for a living? A. I'm a neurosurgeon. Q. And I've taken your deposition before, correct? A. Yes. Q. You're board certified? A. Correct. Q. When did you become board certified? A. November of 2004. Q. And give us just a brief sketch of your background and training leading up to your practice as a neurosurgeon here in Cheyenne, Wyoming. A. I attended Cornell for four years. From there I went to the University of Iowa for four years of medical school, followed by six years of neurosurgical residency.

Page Lines 4 1 Thereafter I was in private practice in Cedar Rapids, Iowa 2 for two and a half years. I've been in Cheyenne, Wyoming 3 now for four years. 4 Q. Dr. Beer, because we have done depositions 5 before, it's probably not necessary for me to go over the 6 ground rules. Is that fair? 7 A. That's fair. 8 Q. Okay. We're here today to take your deposition 9 regarding your care and treatment of Mr. George Bull. 10 A. Okay. Page Lines 5 3

Q.

Dr. Ross referred Mr. Bull to you; is that 3

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correct? A. That is correct. Q. And Dr. Ross, is he a physiatrist in town or a general practice physician? A. He's a family physician. Q. Family physician, I'm sorry. And why did he refer Mr. Bull to you? A. Mr. Bull was having difficulties with back and neck pain. Q. When did you see Mr. Bull? A. His initial visit was on March 26, 2003. Q. And I've got a -- you did a note for that visit, correct? A. Correct. Q. And the first part of the visit his chief complaint was neck and back pain, that's what Mr. Bull told you? A. Correct. Q. Then the history of present illness, this is what Mr. Bull tells you when you take a history? A. That is correct. Q. And he told you that "He was involved in an

Page Lines 6 1 incident while working for the railroad on February 28th," 2 that would be 2003? 3 A. Yes. 4 Q. And he told you that at that time he was riding 5 in a train that rattled him from side to side? 6 A. Correct. 7 Q. And that that caused an onset of back pain? 8 A. Correct. 9 Q. And that he had never had back pain in the past? 10 A. That's correct. 11 Q. You also say, "In addition to this, he 12 experienced the exacerbation of pain in his neck." What do 13 you mean by "the exacerbation of pain in his neck"? 14 A. He told me that he had had neck pain for several 15 years, really since 1978. I was not real specific in my 16 notes as to what caused his pain at that time, and that the 17 pain that he had had previously became more intense as a 18 result of the event which occurred on February 28th. 19 Q. So he told you that from 1978 forward he had been 4

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experiencing neck pain? A. Yes. Q. And that the rough ride in the locomotive or the rattling back and forth in the locomotive really didn't cause any new pain but just caused the pain to get worse? A. That would be my interpretation of what he said,

Page Lines 7 1 yes. 2 Q. You say that the pain in his back and his neck is 3 nonradicular in nature. What do you mean by that? 4 A. Radiculopathy is a term which we use to describe 5 pain which radiates into an extremity. His pain was 6 isolated to the neck and back. Consequently, I used the 7 term "nonradicular." 8 Q. Does that indicate to you that there is no nerve 9 involvement? 10 A. Not necessarily, but usually that is the case. 11 Q. Because if he has nerve involvement, you're going 12 to get radicular symptoms? 13 A. Generally speaking, yes. 14 Q. Mr. Bull told you that he had seen a neurosurgeon 15 for his neck in the past who recommended no surgical 16 intervention. Do you know who that was? 17 A. I do not. 18 Q. And he was coming to you for recommendations 19 regarding the February 28, 2003 incident and the symptoms 20 he experienced after that? 21 A. That's my understanding, yes. 22 Q. Did you do an exam? 23 A. I did. 24 Q. The first part of the exam you say that Mr. Bull 25 has absolutely normal upper and lower extremity strength.

Page Lines 8 1 How do you test that? 2 A. You have the patient flex or contract muscles 3 against resistance to determine whether or not the power is 4 appropriate. 5 Q. And what significance is there in the fact that 6 he had absolutely normal upper and lower extremity 7 strength? 5

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A. This would indicate that the nervous system was working appropriately and that the nerves were firing the muscles appropriately. Q. You say, "Sensation is preserved in all dermatomes in the arms and the legs." How do you test that? A. Basically through various forms of sensation, light touch, pinprick, things of that sort, just by touching the patient they subjectively tell you whether or not they can feel where they are being touched. Q. Of what significance is the fact that he -- that sensation was preserved in all dermatomes in the arms and the legs? A. Again, it's similar to the motor evaluation, the nervous system was functioning appropriately. Q. You said the, "Reflexes are one plus and symmetric at the biceps, brachioradialis, triceps, knees and ankles." How do you test that and why is that

Page Lines 9 1 significant? 2 A. Again, you use a reflex hammer and it's the same 3 statement as before, it indicates the nervous system is 4 functioning appropriately. 5 Q. The next test that you did on the exam was a 6 straight-leg-raising test; is that correct? 7 A. Yes. 8 Q. Do you do that sitting down or lying down? 9 A. Generally sitting. 10 Q. And that was -- you say it was unremarkable. 11 Does that mean that when you had Mr. Bull raise his leg 12 there were no complaints of pain in his back? 13 A. Correct. 14 Q. And what does that indicate? 15 A. Basically that there is nothing pinching against 16 the nerves in the lumbosacral spinal canal. 17 Q. Did you order some diagnostic tests? 18 A. I reviewed some testing that he had performed 19 prior to his visit with me. 20 Q. And that test was an MRI? 21 A. Yes. 22 Q. Of both the cervical and lumbar spine? 23 A. Correct. 6

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Q. Did he bring those MRI films and then he took them so you don't have them here?

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A. Either he brought them or someone from the radiology department brought them here. I don't have the studies presently, no. Q. Do you have a report from the radiologist who read the studies? A. There is a report in his record of the radiologist's interpretation of the study. There's also my report of my interpretation of the study. Q. Why don't we talk about your report of your interpretation of the study. Let's start with the cervical spine first. What did you see on the MRI of the cervical spine? A. He has what would appear to be a congenital fusion of the fifth and sixth bones of the neck, meaning that those two bones either never separated when he was a child or they have subsequently grown together as an adult. There was some narrowing of the neuroforamina at that level. The neuroforamina are the holes in the spine that the nerves exit the spine through. There were spondylitic changes or degenerative changes present at all of the levels of his neck above and below this level. There were large ventral bony spurs present at all levels. The disks themselves showed degenerative changes as well. Q. Let me ask you this question: I think last week we took Dr. Kleiner's deposition down in Denver, and

Page Lines 11 1 that's -- his records are going to be marked as Exhibit 2 2 to your deposition. If you turn to the fourth page of that 3 deposition exhibit at the bottom, Dr. Kleiner says, 4 "Cervical spine images show a spontaneous arthrodesis at 5 C5-6 area without osteophytosis. All other levels have 6 evidence of diffuse idiopathic skeletal hyperostosis." And 7 I think the acronym for that is DISH, D-I-S-H in capitals, 8 no spaces. 9 A. If you say so. 10 Q. Would you agree with Dr. Kleiner's diagnosis that 11 the spondylitic changes in Mr. Bull's cervical spine could 7

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be characterized as diffuse idiopathic spinal hyperostosis? A. Yes. Q. And my understanding is that the calcifications and the ossifications in the spine have a fairly unique signature in diffuse idiopathic spinal hyperostosis. A. Could you repeat your question. Q. Sure. MR. EKSTROM: Could you speak louder, too, please, Mark. MR. HANSEN: Absolutely. Let me get closer. Q. (BY MR. HANSEN) It's my understanding that the ossifications and the flowing calcifications in the cervical spine in a patient that has DISH have a fairly

Page Lines 12 1 unique signature. Is that correct? 2 A. There has been some described features associated 3 with DISH, yes. That is a fair statement to make. 4 Q. And Mr. Bull then had diffuse idiopathic spinal 5 hyperostosis in all levels in his cervical spine? 6 A. Correct. 7 Q. And then he had the degenerative disk disease in 8 all levels of his cervical spine? 9 A. Correct. 10 Q. My understanding of the second word in the 11 diffuse idiopathic spinal hyperostosis, the second word 12 idiopathic, which means no one knows what causes this 13 specific phenomenon? 14 A. Correct. 15 Q. Is that a fair statement? 16 A. Yes. 17 Q. With regard to the degenerative changes that you 18 saw in the disks in Mr. Bull's back, and again correct me 19 if I'm wrong, Dr. Kleiner said that as diffuse idiopathic 20 spinal hyperostosis causes these ossifications and 21 calcifications at the end plates of the vertebrae, that 22 decreases the disks' ability to take up nourishment from 23 the vertebrae above and below and it can cause this 24 degeneration in the disks. 25 A. That is one -- that is one theory upon the

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Page Lines 13 1 process which occurs, yes. 2 Q. What are some of the other theories or the theory 3 that you believe is true? 4 A. I don't necessarily subscribe to the concept in 5 general. I think that it's a diffuse degenerative process 6 in which you see degenerative changes occurring in the disk 7 as well as along the bony end plates. How or why it 8 happens I think is less pertinent to my clinical evaluation 9 and treatment recommendations. It's more important to look 10 at this in terms of, you know, what you can do to help the 11 patient. And the other theories are primarily related to 12 degenerative processes which occur in the spine. 13 In other words, as disks wear out, one of the 14 responses of the body is to lay down extra bone along the 15 joints to help to stabilize the situation. I think there's 16 a continuum of DISH in everybody. In other words, 17 everybody lays down osteophytes to stabilize their spine at 18 various degrees of severity. Some will do it more than 19 others. Why that occurs I don't think we understand. 20 Q. Or what causes that to occur we don't understand? 21 A. Correct. 22 Q. So it almost sounds like what I said before with 23 regard to what Dr. Kleiner said is he thought that the 24 calcifications and the ossifications in the end plates of 25 the vertebrae caused the degeneration in the disk, and

Page Lines 14 1 you're saying one other theory is just the opposite of 2 that, that as the disks degenerate, it causes the end 3 plates of the vertebrae to form these calcifications and 4 ossifications? 5 A. Basically it's the same process. 6 Q. You also said with regard to the narrowing of the 7 neuroforamen at the C5-6 level that you suspected that this 8 is not resulting in any significant problem for Mr. Bull. 9 Do you see that? 10 A. Yes. 11 Q. Why is that? 12 A. For a neuroforamen to be symptomatic, typically 13 there needs to be motion, and that neuroforamen, the bones 14 that consist -- or that make up that neuroforamen appear to 15 have fused together. As such, there would be no movement 9

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occurring there. Consequently, it's very unlikely that that neuroforamen would cause symptoms. Q. And I assume that the congenital fusion at C5-6 was not caused by the February 28, 2003 back-and-forth incident? A. I would not believe that it was the cause. I couldn't tell you. If there was a fracture in his neck, it's conceivable that that could have led to a fusion of those two bones. I think that that would be unlikely. Q. And if the accident happened on February 28, 2003

Page Lines 15 1 and you saw him on March 26, 2003, about a month later, I 2 assume the fracture couldn't have fused? 3 A. That's correct. That's exactly correct. I did 4 not realize it was only a month after the event which 5 occurred. I thought it was a year, excuse me. 6 Q. No, no, that's okay. You said that in the 7 cervical spine you do not see any disk herniations or 8 evidence of significant spinal cord compression. With 9 regard to spinal cord compression, if the spinal cord was 10 compressed, you'd expect to see some radicular symptoms? 11 A. Not necessarily. You'd expect to see some 12 neurologic disk function, such as myelopathy, not 13 necessarily radiculopathy. Certainly you can see 14 radiculopathy associated with spinal cord compression. 15 Q. What's myelopathy? 16 A. Myelopathy is a term that refers to dysfunction 17 of the spinal cord rather than just the nerves as is the 18 case in radiculopathy. 19 Q. Going on to the lumbar spine, you said that there 20 are similar findings. By that did you mean that at all 21 levels in the lumbar spine you found this severe 22 degenerative spondylitic changes at all levels? 23 A. Yes. 24 Q. And that would be diffuse idiopathic spinal 25 hyperostosis also?

Page Lines 16 1 A. I would call it diffuse degenerative changes in 2 the spine, but certainly that could be described as this 3 DISH phenomenon as well. 10

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Q. And you said there were severe degenerative disk changes at L5-S1, L4-5, L3-4 and L2-3. Those severe degenerative disk changes, those would be associated with the degenerative changes that you saw in the vertebral bodies at all the levels in the lumbar spine? A. Yes. Q. And I take it that that relationship is the same in the cervical spine as it is in the lumbar spine, the relationship between the changes in the vertebral bodies -A. Yes. Q. -- and the changes in the disks? A. Correct. Q. And you say, "At no level do I see any acute abnormalities." What do you mean by "acute abnormalities"? A. That means to say that I don't see any acute fractures, acute disk herniation, things of that sort. Q. And by acute, do you mean something that might have been caused by the trauma that Mr. Bull reported on February 28, 2003? A. That's correct. Q. That all the abnormalities that you found in the MRI would have preexisted the February 28, 2003 incident?

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A. Q. it?

Correct. Those would be preexisting conditions, as we call

A. That is correct. Q. Then you go on to say, "The most prominent abnormality is at L4-5 where owing to the presence of ventral spurring and degenerative disk changes combined with facet arthropathic changes and hypertrophy of the posterior elements, he has moderately severe stenosis of the spinal canal." Again, I mean, going over that, at L4-5 you've got the ventral spurring and that would be a degenerative change? A. Yes. Q. That preexisted the February 28, 2003 incident? A. Yes. Q. And he's got degenerative disk changes at L4-5 and that would be a preexisting condition to the February 28, 2003 incident? A. Yes. 11

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Q. The facet arthropathic changes, I assume what you're saying is at the facet joints you can see some degenerative changes or some spurring at the facet joints? A. Yes. Q. At L4-5? A. Yes.

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Q. And that would again be a degenerative change? A. Yes. Q. That preexisted the February 28, 2003 incident? A. Yes. Q. And then the hypertrophy of the posterior elements of the facet joints at L4-5, hypertrophy means enlargement? A. Yes. Q. And that goes hand in hand with the arthropathic changes? A. Yes. Q. And then all those factors together caused the severe stenosis in the spinal canal at L4-5? A. That is correct. Q. You go on under your impression and say that Mr. Bull's got "...an aggravation of the spondylitic disease in his spine following a rough train ride." And that again would be an aggravation of a preexisting condition? A. It would mean that the spondylitic disease in his spine became symptomatic as a result of the train ride which occurred. Q. But that the train ride didn't cause any of the spondylitic changes themselves? A. Correct.

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Q. And as far as the train ride causing his neck to become symptomatic, he reported that prior to the train ride, the February 28, 2003 incident, his cervical spine had been symptomatic; is that fair? A. Correct. Q. And then that the train ride then just caused it to become more symptomatic? 12

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A. Correct. Q. A change in the degree of pain as opposed to the character? A. Correct. Q. You said that you don't favor an aggressive surgical approach for Mr. Bull. Why not? A. He essentially had had symptoms for a short period of time after a rough train ride. I don't necessarily think rushing to surgery is appropriate in that scenario. I am a pretty conservative spine physician. I like always to try conservative approach to see if I can get a patient better without surgery prior to proceeding with any surgical recommendations. Q. And what was your recommendation? A. We discussed on that specific day trying some physical therapy and an epidural cortisone injection. Q. Then what is the purpose for the epidural cortisone injection?

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A. The theory is that there is inflammation occurring, and cortisone is an anti-inflammatory agent. By putting it in the epidural space, you're putting the cortisone very near the area that's inflamed. It seems to be the most effective method at putting an antiinflammatory medicine in the spine in particular. Q. What particular area did you want to put the cortisone injection? A. L4-5. Q. And that's because you found all the degenerative changes and the severe stenosis in that area? A. Correct. Q. And was it your concern that the severe stenosis, that was what was causing the symptoms in the low back? A. Yes. Q. I've had some people, some doctors tell me that the epidural cortisone injections at the L4-5 level can be both diagnostic and therapeutic. Is that true? A. Yes. Q. Tell me how that works. A. Generally you reserve that line of reasoning for injections which are a bit more specific than an epidural cortisone injection. But for example, if you had a patient 13

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that had pain in their low back and you were unclear as to whether or not it was coming from something in the spine

Page Lines 21 1 versus something, for example, in the abdomen or retro2 peritoneum, an epidural cortisone might help you to sort 3 that out. In that sense, it would be diagnostic. In other 4 words, if you gave someone an epidural and they had 5 persistent discomfort, you might look elsewhere for the 6 problem. 7 The epidural has within it numbing medicine 8 usually and the numbing medicine should serve to numb up an 9 area. If the area is numb and the pain doesn't go away, 10 then you know that the pain is not coming from that area. 11 Q. And would it be fair to say that the more 12 precisely you can target the injection, the better a 13 diagnostic tool it becomes? 14 A. Yes. 15 Q. And an epidural cortisone injection like Mr. Bull 16 got really isn't targeted that specifically; is that fair? 17 A. That is very fair. 18 Q. Okay. So based on an injection like this, you 19 can't say -- and if he gets relief, you can't say aha, now 20 I know it's the facet joint at L5-S1? 21 A. Correct. 22 Q. And did Mr. Bull have an epidural steroid 23 injection? 24 A. Yes. 25 Q. It looks like he had two. He had one on March

Page Lines 22 1 27, 2003 and one on April 18, 2003? 2 A. Yes. 3 Q. Let's talk about March 27, 2003. Did he get any 4 pain relief from that at all? 5 A. According to my notes, he had one or two weeks' 6 relief of back pain following the epidural cortisone 7 injection. 8 Q. And for you is that -- what does that tell you, 9 that he had one or two weeks of relief? 10 A. It tells me he had one or two weeks of relief of 11 pain. That means that we did win the battle for one or two 14

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weeks, but we're going to have to do something else to try to get him longer-standing relief of pain. Q. And I take it that that really isn't diagnostic at all for you? A. It is in the sense that I believe his symptoms are coming from the spine. I don't think I had much doubt to start with that his symptoms were spine related. So it is helpful at least a little bit. Q. And then you're talking about the April 16, 2003 visit he reported two weeks of -- one or two weeks of relief after the first injection which occurred on March 27, 2003. The second injection was April 18, 2003? A. Correct. Q. And he came back and saw you on May 21, 2003?

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A. Yes. Q. Did he get any relief from that second injection on April 18, 2003? A. I wasn't real specific at describing how much relief he had, but he did continue to have back and neck pain on that visitation, so my assumption was that -- on May 21st my assumption was the epidural cortisone injection was not going to afford him with long-term relief. Q. Do those injections in some patients give the patient long-term relief? A. Yes. Q. Because it knocks down the inflation -- it knocks down the inflammation, and if the inflammation is what's causing the pain and the steroid injection can keep the inflammation down, then the pain won't come back? A. Correct. Q. You said that Mr. -- or Mr. Bull described his pain on May 21, 2003 as nagging? A. Yes. Q. And at that point in time you had a long discussion with Mr. Bull about surgery and the fact that you thought he was a poor surgical candidate? A. Basically my discussion with him was whether or not he'd like to pursue a more aggressive approach to his spine, and one of the approaches obviously might involve

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Page Lines 24 1 surgery, but we together determined he probably wasn't the 2 best candidate to pursue that, and so we, I guess, factored 3 that out as a nonoption for him. 4 Q. One recommendation you did make was the pain 5 clinic; is that right? 6 A. Correct. 7 Q. Why did you recommend that he go to a pain 8 clinic? 9 A. Well, if he doesn't want surgery and he wants to 10 treat his symptoms with medicines, a pain clinic is the 11 best setting for that to occur in. 12 Q. And there are different kinds of pain clinics, 13 and when people use that term, they mean different types of 14 things. For instance, are you familiar with the Cottonwood 15 Clinic in Salt Lake City? 16 A. No, I am not. 17 Q. What type of pain clinic were you recommending on 18 May 21, 2003? 19 A. I was recommending a clinic that would 20 contemplate either using medicines or further injections to 21 get his pain under control. 22 Q. And would a clinic that not only did that but 23 also had a physical therapy work-hardening component, would 24 that also be something that you would recommend? 25 A. Absolutely.

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Q. And you made that recommendation to Mr. Bull? A. Yes. Q. Did he indicate to you whether or not he was in favor of that? A. I didn't get a strong indication that he wanted to or what exactly he wanted to do. Q. And I take it that you believe that your recommendation that he go to a pain clinic was a reasonable medical recommendation? A. Absolutely. Q. It sounds like he also asked you if vocational rehabilitation and an alternate occupation would be appropriate? A. Yes. Q. What did you tell him about that? 16

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A. I told him basically he became symptomatic doing the job that he was doing and it might not be an unreasonable option to contemplate a different type of occupation that might not expose him to the same types of activities that caused his back and neck to flare up. Q. So you recommended to him that you thought it would be a good idea for him to work at some other occupation? A. Yes. Q. And I take it that based on the care and

Page Lines 26 1 treatment that you had given him up to this point, and that 2 would be May 21, 2003, you were of the opinion that there 3 were a lot of jobs he could do, you just didn't want him 4 doing the job that he was doing when he had this back 5 flare-up? 6 A. Correct. 7 Q. And it looks like, in my notes anyway, that this 8 May 21, 2003 visit was the last time you saw him? 9 A. Yes. 10 Q. With regard to all the degenerative changes that 11 you found in his cervical and lumbar back, it sounds like, 12 are these just kind of age-related changes? 13 A. That would be a fair statement, yes. 14 Q. And that you don't have an opinion, based on a 15 reasonable degree of medical probability, that any of these 16 degenerative changes were caused by the February 28, 2003 17 incident? 18 A. The degenerative changes, in my opinion, were not 19 caused by that specific incident, and that's true beyond a 20 reasonable medical degree of certainty.

Page Lines 28 1 MR. HANSEN: I don't have any other 2 questions.

Page Lines 31 17 Q. (BY MR. HANSEN) All of the changes in his spine, 18 the degenerative changes, could have been caused by a

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natural aging process, correct? A. That's correct. You've labored this concept of DISH ad nauseam today. It's a condition in the spine which typically is not associated with degenerative processes. And so you need to be very careful in separating out the concept of DISH from the degenerative process which occurred. My personal opinion is he has a combination of

Page Lines 32 1 degenerative as well as a naturally occurring phenomenon, 2 this DISH as you speak of, occurring at the same time. And 3 it would be impossible for us to separate those two 4 processes apart from one another. 5 Q. And with regard to that, would it be fair to say, 6 and tell me if it isn't, but would it be fair to say that 7 the arthritic changes in the vertebral bodies, those would 8 be DISH? 9 A. In part that's true provided -- I mean, DISH by 10 definition is a condition that is not associated with 11 anything degenerative. It's something that occurs aside 12 from the degenerative process. So, again, you're asking me 13 to comment on a diagnosis I typically don't make because 14 I'm not sure that it actually exists. I believe it's more 15 of a continuum of a degenerative process. But that has 16 been argued with in the past. So you need to talk to an 17 expert on DISH and degenerative bone conditions in the 18 spine to really get to the bottom of that. 19 As I alluded to earlier, from a practical 20 standpoint, it's whether or not these changes that are 21 occurring have caused compression to the nerves or 22 abnormalities in the joints, which cause pain, and that's 23 what I tend to focus more on is the practical approach to 24 the issues that we're discussing. 25 Q. Your focus is more on what's wrong with the

Page Lines 33 1 patient and what can I do to make it right? 2 A. Correct. 3 Q. And your focus isn't on what actually caused the 4 underlying condition? 5 A. That's correct.

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Page Lines 34 8 MR. HANSEN: I don't have any other 9 questions. Thank you. Defendant reserves the right to designate additional deposition testimony that has not been designated in this pleading in response to Plaintiff's cross-designation. DATED this 18th day of October, 2005. Respectfully submitted,

_s/Mark C. Hansen_______ MARK C. HANSEN Union Pacific Railroad Company 1331 17TH Street, Suite 406 Denver, CO 80202 (303) 964-4583 FAX: (303) 964-4585

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Case 1:04-cv-00560-OES-BNB

Document 68

Filed 10/18/2005

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CERTIFICATE OF SERVICE I hereby certify that on this 18th day of October, 2005, I electronically filed the foregoing with the Clerk of the Court using the CM/ECF system which will send notification of such filing to the following e-mail addresses: [email protected] Sabina Y. Chung, Esq. Jack D. Robinson, Esq. SPIES, POWERS & ROBINSON, P.C. 1660 Lincoln Street, Suite 2220 Denver, CO 80264 Fredric A. Bremseth, Esq. Thomas W. Geng, Esq. BREMSETH LAW FIRM 810 East Lake Street Wayzata, MN 55391 Donald C. Sinclair, II Sinclair Kelly Jackson Reinhart & Hayden, LLC 501 Corporate Drive, Suite 200 Canonsburg, PA 15317

[email protected]

[email protected]

I certify that there are no non CM/ECF participants in this case. _s/Mark C. Hansen_______ MARK C. HANSEN Union Pacific Railroad Company 1331 17TH Street, Suite 406 Denver, CO 80202 [email protected]
G:\DENLAW\MARK HANSEN\OPEN\Bull\TRIAL PREP\Designation of Deposition Testimony - Dr. Beer - 10-18-05.doc

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