VIRGINIA: IN THE CIRCUIT COURT FOR THE CITY OF NORFOLK 2 3 JANET B. DUNN, 4 Plaintiff, 5 VS. AT LAW NO. CL96-4429 6 DAVID B. LONG, 7 ORIGINAL Defendant. 8 9 DE BENE ESSE DEPOSITION UPON ORAL EXAMINATION OF 10 MATTHEW A. GALUMBECK, M.D. ----------------------------------- 11 August 12, 1998 - 4:55 p.m. 12 Virginia Beach, Virginia 13 14 15 APPEARANCES: Wilson, Hajek & Shapiro By: Richard N. Shapiro, Esquire 16 Counsel for the Plaintiff 17 Heilig, McKenry, Fraim & Lollar By: Todd M. Fiorella, EBquire 18 Counsel for the Defendant 19 2 0 21 22 23 REPORTED BY: Selina S. Sanders, RPR 24 25 YOST ASSOCIATES (757) 481-2583 2 I N D E X 2 WITNESS 3 On Behalf of the Plaintiff: 4 DIRECT CROSS REDIRECT RECROSS DR. GALUMBECK 3 16 47,54 51,57 5 6 7 8 9 10 11 EXHIBITS 12 13 Galumbeck Exhibits for identification: Page 14 1 Photograph 3 15 2 Photograph 3 16 3 Photograph 3 17 4 Photograph 3 18 5 Emergency room record 20 19 2 0 21 22 23 24 [Exhibits were retained by counsel.) 2 5 YOST ASSOCIATES (757) 481-2583 Dr. Galumbeck - Direct 3 1 De bene esse deposition upon oral examination 2 of MATTHEW A. GALUMBECK, M.D., taken before Selina S. 3 Sanders, RPR, a Notary Public in and for the commonwealth 4 of Virginia at Large, pursuant to notice and agreement, 5 commencing at 4:55 p.m. on August 12, 1998, at Virginia 6 Beach Plastic Surgery Center, 396 South Witchduck Road, 7 Suite 100, Virginia Beach, Virginia; and this in 8 accordance with the Rules of the Supreme Court of 9 Virginia, 1950, as amended. 10 ----- 000 ----- 11 12 (Galumbeck Deposition Exhibit Nos. 13 1 - 4 were marked for identification.] 14 15 MATTHEW A. GALUMBECK, M.D., called aB a 16 witness by and on behalf of the Plaintiff, having been 17 first duly sworn, was examined and testified as follows: 18 19 DIRECT EXAMINATION 20 BY MR. SHAPIRO: 21 Q Could you please state your full name. 22 A Matthew Alan Galumbeck. 23 Q Are you a medical doctor? 24 A Yes. 25 Q What is your specialty? YOST ASSOCIATES (757) 481-2583 Dr. Galunibeck - Direct 4 1 A Plastic surgery. 2 Q Could you briefly tell us about your 3 college education and medical training, please. 4 A Sure. I went to the College of William 5 and Mary, graduated from there with honors. I went to 6 medical school at Duke University. I did my general 7 surgery training in Case Western Reserve in Cleveland and 8 did my plastic surgery training at Eastern Virginia 9 Medical School. 10 Q I understand that you were the youngest 11 student at Duke University Medical School when you were 12 there? 13 A That's right. 14 MR. FIORELLA: Object to the 15 relevance. 16 17 BY MR. SHAPIRO: 18 Q And you mentioned you teach at EVMS. 19 Can you tell us about that briefly? 20 A Sure. I am an assistant professor in 21 plastic surgery. I teach medical students as well as I 22 also am involved in a mentorship program with Duke 23 students who come up for the summer, and I teach other 24 plastic surgeons throughout the country on various 25 aspects of cosmetic surgery. YOST ASSOCIATES (757) 481-2583 Dr. Galumbeck - Direct 5 1 Q Do you travel to do that or do you do 2 that all here in the area? 3 A We do both. Some doctors come here and 4 in some cases I'll go to other doctors' offices or 5 present at meetings. 6 Q Generally, what is the specialty of 7 plastic surgery? 8 A The specialty of plastic surgery is to 9 rearrange the skin and subcutaneous tissueb either from 10 traumatic injuries or for cosmetic surgery. 11 Q That was going to be my next question. 12 Do you in your practice treat persons who have sustained 13 injury to their face and neck, also? 14 A Yes. 15 Q I take it you have an office practice 16 here in Virginia Beach? 17 A Yes. 18 Q About how many patients would you treat 19 in a normal week here at your office? 20 A We usually see about 100 patients a 21 week. 22 Q What year were you first licensed to 23 practice medicine in Virginia? 24 A 1993. 25 Q And what's the name of your medical YOST ASSOCIATES (757) 481-2583 Dr. Galumbeck - Direct 6 1 practice? 2 A It's Virginia Beach Plastic Surgery 3 Center. 4 Q And do you have privileges at area 5 hospitals? 6 A Yes, I do. 7 Q Are you board certified in the field of 8 plastic surgery? 9 A Yes, I am. 10 Q Briefly, what is the board 11 certification process? 12 A In plastic surgery, after training with 13 college medical school general surgery and plastic 14 surgery training, it's a three-year process where we take 15 a written examination, and after having successfully 16 completed that, compile a year'B worth of plastic surgery 17 cases that we've performed and present them at an oral 18 certification examination. 19 Q And you are in good standing and board 20 certified? 21 A Yes. 22 MR. SHAPIRO: I would move to qualify 23 Dr. Galumbeck as an expert in the field of plastic 24 surgery. I would inquire of Mr. Fiorella whether there 25 is any questions that you have about his qualifications? YOST ASSOCIATES (757) 481-2583 Dr. Galumbeck - Direct 7 1 MR. FIORELLA: I don't have any 2 questions at this time. 3 4 BY MR. SHAPIRO: 5 Q Doctor, I'm going to be asking you 6 questions about Janet Dunn, the plaintiff in this case, 7 and ask you when you express a medical opinion to give it 8 to a reasonable degree of medical certainty. Will you do 9 so when you provide those opinions? 10 A Certainly. 11 MR. FIORELLA: Object to the question 12 as phrased. I think you are going to have to ask it on 13 each individual opinion you wish to ask the doctor. I 14 will object as necessary. 15 16 BY MR. SHAPIRO: 17 Q When you express a medical opinion, is will you give it to a reasonable degree of medical 19 certainty? 20 A Yes. 21 MR. FIORELLA: Same objection. 22 MR. SHAPIRO: Objection is noted. 23 24 BY MR. SHAPIRO: 25 We're currently sitting in your office YOST ASSOCIATES (757) 481-2583 Dr. Galumbeck - Direct 8 1 in Virginia Beach on August 12, 1998, Doctor? 2 A Yes. 3 Q Do you understand that your deposition 4 is being taken today to be read in front of a jury in 5 this case? 6 A Yes. 7 Q Did you have occasion to see Ms. Dunn a on March 11, 1996? 9 A Yes, I did. 10 Q And what did she give you aB a history 11 at that time on her registration form about any car 12 crash? 13 A She said she was involved in a motor 14 vehicle accident in January of '95, in which she was a 15 restrained driver. She was hit from behind and said that 16 her head hit the visor. 17 Q At that time, in March of 1996, did you 18 actually treat her for any problem with her forehead or 19 for her neck for the neck condition? 20 A I examined her at that time, but there 21 was no treatment that was needed. 22 Q Did you again see Ms. Dunn in your 23 office on February 11, 1998? 24 A Yes, I did. 25 Q What history did she give you at that YOST ASSOCIATES (757) 481-2583 Dr. Galumbeck - Direct 9 1 time? 2 A It was mainly at that time a follow-up 3 after the motor vehicle accident and to assess her 4 injuries mainly relating to her forehead and to the scar 5 on her neck. 6 Q And again, did she tell you how she had 7 gotten this indentation on her forehead? 8 MR. FIORELLA: Objection. Asked and 9 answered. 10 THE WITNESS: She said that she hit her 11 visor in front of her car. 12 13 BY MR. SHAPIRO: 14 Q Did you conduct any physical 15 examination, and if so, what did you find? 16 A Well, my examination at that time 17 revealed a dent in her forehead. Basically, there was a is lack of soft tissue approximately in the area that she 19 said that she had injured herself. 20 Q And did you also examine any area on 21 her neck? 22 A Yes, she had a scar on her neck from a 23 surgery and this scar was very tender. It was very 24 sensitive, hypersensitive to light touch at the time of 25 my examination. YOST ASSOCIATES (757) 481-2583 Dr. Galumbeck - Direct 10 1 Q Did you make a determination to a 2 reasonable degree of medical probability as to the cause 3 of the forehead indentation and the scar on her neck? 4 A Yes, it seemed that when she had stated 5 that she hit the visor in the motor vehicle accident and 6 sustained a contusion in that area of her forehead, it 7 would seem that a severe contusion like that can cause 8 atrophy of the subcutaneous tissues, which basically 9 would create a permanent dent in her forehead. 10 The other thing, on her neck she said 11 that she had had surgery because of the accident, and it 12 seems that the scar, which was very tender -- a lot of 13 times you can get that kind of tenderness and 14 hypersensitivity from any kind of scar. It doesn't 15 happen too often, but it can happen. 16 Q Is that the scar that's in the fold on 17 her neck? is A Yes, it is. 19 Q What do you mean by hypersensitivity? 20 A Normally, with normal scarring to touch 21 them lightly doesn't cause any pain or tenderness to the 22 patient. In a hypersensitive scar just a very light 23 touch, even just like with a feather, would cause intense 24 pain. 25 Q What causes the hypersensitivity? Can YOST ASSOCIATES (757) 481-2583 Dr. Galumbeck - Direct 11 1 you say that in a layperson's term? 2 A Sure. Basically, there are a lot of 3 nerves that grow into the skin for sensation and 4 sensibility, and what happens is sometimes when you make 5 an incision in the skin, the nerves can get trapped in 6 the scar. And this scar, because it's very tight, can 7 squeeze down on these nerve endings, BO that they send 8 abnormal signals to the brain. And even a very light 9 touch, which normally would not have any effect, is 10 perceived as pain. 11 Q what impact on a daily basis does 12 hypersensitivity, such as that in that scar area, have on 13 a person? 14 A It's painful if anything were to touch 15 it. If she were to wear like a turtleneck and it were to 16 rub that area of the scar, it would cause her pain. 17 Q Okay. Let me show you this series of 18 four photographs, which I marked previously as Numbers 1 19 through 4 on the back, and ask you if you can identify 20 who is in the photos and what's being shown. 21 A This is the patient. 22 Q You can reference the number on the 23 back. 24 A In Number 1, photograph Number 1, there 25 is an area of atrophy in her forehead right here, and YOST ASSOCIATES (757) 481-2583 Dr. Galumbeck - Direct 12 1 this is the area that I examined on her when she came in 2 for examination, (indicating). 3 Q In your practice have you had occasion 4 to examine people that have suffered a trauma and 5 suffered an indentation injury like this? 6 A Yes, I have. 7 Q Is this something that's unusual for 8 the type of trauma that she described to you? 9 A No, not really. You know, any kind of 10 a sharp blow -- you know, Bometimes if there is a cut in 11 the skin it heals as a scar. SometimeB the skin itself 12 is not damaged, but there is damage to the underlying 13 tissue. And basically, that's what happened here, is 14 that the skin surface itself has not been cut, but there 15 has been trauma to the underlying tissues, and that's 16 what causes this atrophy and appearance of an 17 indentation. 18 Q Okay. What about the other 19 photographs? 20 A Okay. In photograph Number 2 and 21 photograph Number 3 and Number 4 are the pictures of the 22 patient's scar on her neck, and this is the area that I 23 examined. 24 Q Let me stop you one second. Is the 25 indent in her forehead permanent, to a reasonable degree YOST ASSOCIATES (757) 481-2583 Dr. Galumbeck - Direct 13 1 of medical certainty? 2 A Yes, it is. 3 Q Now, turning to the neck scar, is there 4 anything that can be done from a plastic surgery 5 perspective about that? 6 A Yes, there is. The scar can be excised 7 and with some plastic surgery procedures we can bring 8 some soft tissue into that area, what's known as a flap 9 of skin, subcutaneOUB tissue, and reclose that so that it 10 won't be quite as depressed as it is on the area towards 11 the central portion of the neck. And also to remove the 12 scarring that's caught -- that the nerves have grown into 13 and have caused the hypersenBitiVity. 14 Q As briefly as you can in layperson's 15 terms without being too detailed, what do you have to do 16 in the way of an incision or where do you -- 17 A Basically, what we would do is excise 18 or cut out this area of scar and then rearrange the 19 tissues to bring in new tissue and then close that with 20 stitches, so that the scar would not only appear to be 21 better, but also would not have that hypersensitivity in 22 it. 23 Q And what are your costs to do that 24 surgical procedure, your anesthesia fees and any hospital 25 fees or fees here at your outpatient facility? YOST ASSOCIATES (757) 481-2583 Dr. Galumbeck - Direct 14 1 A $1,400. 2 Q Is this the kind of procedure that you 3 can do on an outpatient basis here actually at your 4 office? 5 A Yes, it is. 6 Q And do you have your own operating 7 facility here where you can do the procedure here at this 0 office? 9 A Yes, we do with an anesthesiologist. 10 Q You have an actual outside 11 anesthesiologist come here? 12 A Yes. 13 Q Are those fees that you just mentioned 14 customary for such services in our community? 15 A Yes, they are. 16 Q Are there any risks of that surgery, 17 medically speaking? 18 A Well, any kind of surgical procedure 19 has risks. Mainly the risks that would be associated 20 with that, because it's an incision in the skin, would be 21 an infection. She would probably be treated with 22 antibiotics to prevent that, but the risks are very minor 23 with that kind of procedure. 24 Q Are you able to guarantee results of 25 that surgery? YOST ASSOCIATES (757) 481-2583 Dr. Galumbeck - Direct 15 1 A Well, you never can guarantee results, 2 but I think, based on my experience, that the procedure 3 we would do would definitely improve this. 4 Q Would it improve in any way the 5 hypersensitivity? 6 A Yes, it would. 7 Q Even with a reasonably successful 8 surgery, would there still be some scarring and 9 sensitization problem? 10 MR. FIORELLA: Object to the form of 11 your question. 12 THE WITNESS: With a surgical procedure 13 there is always a scar. The scar can never be removed 14 and it's permanent. As far as the hypersensitivity 15 issue, the surgical procedure should correct that. 16 MR. SHAPIRO: Let me go ahead and ask 17 that question over, since there was an objection. 18 19 BY MR. SHAPIRO: 20 Q If there is a reasonably successful 21 surgery, will there Btill be any scarring and 22 sensitization problems? 23 MR. FIORELLA: Objection to the form. 24 THE WITNESS: There will still be 25 scarring. Scarring is permanent. And the YOST ASSOCIATES (757) 481-2583 Dr. Galumbeck - Cross 16 1 hypersensitivity should be diminished, if not totally 2 removed, from the surgical procedure. 3 4 BY MR. SHAPIRO: 5 Q Do you have an opinion, to a reasonable 6 degree of medical probability, as to whether or not with 7 or without surgery the scar on her neck and the 8 associated sensitivity is permanent? 9 A Without surgery it is. 10 Q Okay. What about with surgery? 11 A With surgery the scar is permanent and 12 the hypersensitivity probably is not. 13 Q Have your medical opinions been to a 14 reasonable degree of medical certainty? 15 A Yes. 16 MR. SHAPIRO: I move to introduce 17 Exhibits 1 through 4. That'B all. 18 19 CROSS-EXAMINATION 20 BY MR. FIORELLA: 21 Q Dr. Galumbeck, did you bother to bring 22 your file here today while you are testifying? 23 A I have it. I don't have it with me. 24 You want to grab it? 25 A Sure. YOST ASSOCIATES (757) 481-2583 Dr. Galumbeck - Cross 17 1 Q Thanks. 2 3 (A brief recess was taken, after which 4 the deposition continued as follows:] 5 6 BY MR. FIORELLA: 7 Q Do you have your file now? 8 A Yes. 9 Q Did you bother to review any records, 10 other than your own, before you gave this deposition? 11 A No. 12 Q Have you reviewed the emergency room 13 record, for example? 14 A No. 15 Q You talked about a severe contusion to 16 the head. Did Ms. Dunn tell you that she denied striking 17 her head on anything when she was seen by the emergency 18 room doctor? 19 A No. 20 MR. SHAPIRO: object to the hearsay. 21 22 BY MR. FIORELLA: 23 Q Doctor, are you capable of reading an 24 emergency room record? 25 A Yes, I have. YOST ASSOCIATES (757) 481-2583 Dr. Galumbeck - Cross 18 1 Q Have you ever reviewed an emergency 2 room record before? 3 A Yes, I have. 4 Q I want you to take a look at this 5 record, please. Review the first paragraph. 6 MR. SHAPIRO: Note the objection to the 7 hearsay. Go ahead. I need to see a copy of that before 8 we go. 9 10 BY MR. FIORELLA: 11 Q Doctor, you know the accident occurred 12 on January 2nd of 1995? 13 A Uh-huh. 14 Q Correct? 15 A Yes. 16 Q Now, Ms. Dunn, when you saw her on 17 March 16th, 1996, that would have been over a year after 18 the accident? 19 A Correct. 20 Q She told you she had struck her head, 21 correct? 22 A Right. 23 Q Now, if you were to learn that, in 24 fact, she did not strike her head in the accident, you 25 can't relate that indentation to the accident, can you? YOST ASSOCIATES (757) 481-2583 Dr. Galumbeck - Cross 19 1 A That's correct. 2 MR. SHAPIRO: Object to the 3 characterization. 4 MR. FIORELLA: Did you get the whole 5 question and the answer? 6 THE COURT REPORTER: Yes. 7 8 BY MR. FIORELLA: 9 Q So you have just reviewed an emergency 10 room record. And you are qualified to review emergency 11 room records, aren't you, in your field of expertise? 12 A Yes. 13 Q And you've seen from the record that 14 Ms. Dunn denied striking her head in the accident, 15 correct? 16 A That's correct. 17 MR. SHAPIRO: Objection to the 18 hearsay. 19 20 BY MR. FIORELLA: 21 Q Have you reviewed the portion of the 22 note that has to do with the physical examination? 23 A Yes. 24 Q Do you understand what "head 25 atraumatic" means? YOST ASSOCIATES (757) 481-2583 Dr. Galumbeck - Cross 20 1 A Yes. 2 MR. SHAPIRO: Continuing objection to 3 the reference to the actual records as opposed to 4 questions -- 5 6 BY MR. FIORELLA: 7 Q You as a medical doctor, you know that 8 head -- an examination of the head being atraumatic means 9 there is no evidence of any injury, correct? 10 A That is correct. 11 MR. FIORELLA: Mark this as an exhibit 12 to the deposition, please. 13 MR. SHAPIRO: I have an objection to 14 the introduction of the exhibit. Go ahead, Todd. is 16 (Galumbeck Deposition Exhibit No. 5 was 17 marked for identification.] 18 19 BY 14R. FIORELLA: 20 Q Doctor, there are, in fact, any number 21 of explanations why people have indentations on their 22 forehead, aren't there? 23 A That's correct. 24 Q Many of those have nothing to do with 25 trauma, true? YOST ASSOCIATES (757) 481-2583 Dr. Galumbeck - Cross 21 1 A It's usually traumatic as to why they 2 would have an indentation to the forehead. 3 Q Can you tell when the trauma occurred 4 based upon what you do in an examination in your office? 5 A No. 6 Q Other than what the patient tells you? 7 A That's correct. 8 Q In this particular case, you took 9 Ms. Dunn at her word without reviewing any emergency room 10 records? 11 A That's correct. 12 Q And without reviewing any other records 13 from any other source; is that correct? 14 A That's true. 15 Q Ms. Dunn, for example, it looks like in 16 what's marked as Exhibit Number 2 has an indentation on 17 the right side of her eye. You are not saying that's 18 caused by this accident, are you? 19 A No, I'm not. 20 Q If Ms. Dunn were to tell you she had 21 bumped her eye in this accident and that indentation 22 formed after the accident, would you have to take her 23 word with respect to that as well? 24 A Certainly. 25 Q So any mark on her face where she would YOST ASSOCIATES (757) 481-2583 Dr. Galumbeck - Cross 22 1 have told you, I didn't have thib before the accident and 2 I have it now, you would relate that to the accident? 3 A That is correct. 4 Q And as far aB how the indentation 5 affects Ms. Dunn, do you know how Ms. Dunn regularly 6 wears her hair or anything of that nature? 7 A No. 8 Q I ask that question because you showed 9 us what's marked as Exhibit Number 1, but in the 10 remaining exhibits Ms. Dunn has her collar turned down, 11 correct? 12 A Her hair? Are you talking -- 13 Q The collar on her dress. 14 A Uh-huh. 15 Q The scar in the area of her neck that 16 you are trying to show us in these photographs would be 17 covered by a lot of collars, wouldn't it, that Ms. Dunn 18 might wear? 19 A If she could wear collars. Her 20 complaint was that when wearing a collar it would brush 21 up against the scar and cause pain. 22 Q That's an interesting complaint that 23 she made, Doctor, because you first saw this patient in 24 March of 1996, right? 25 A Uh-huh. YOST ASSOCIATES (757) 481-2583 Dr. Galumbeck - Cross 23 1 Q And in March of 1996, March llth, 2 1996 -- again, we talked about that being a year and two 3 months after the accident -- you have an intake sheet. 4 And it says what problem brought you here. It says, auto 5 accident January '95, dent in forehead, right? 6 A Uh-huh. 7 Q And then it says, car accident 1/4/95 a approximately? 9 A Uh-huh. 10 Q It says, forehead contusion? 11 A Uh-huh. 12 Q Then it says, neck scar from -- looks 13 like surgical, some sort of surgery? 14 A Right, from neck fusion. 15 Q But there is nothing from March llth of 16 1996 that says that Ms. Dunn was having problems putting 17 her collar on her neck, iB there? is A No. 19 Q You, in fact, examined her on that 20 date, didn't you? 21 A Uh-huh. 22 Q You've got an intake sheet that says 23 why she was there, according to what Ms. Dunn told you? 24 A Right. 25 Q When you did your examination, Ms. Dunn YOST ASSOCIATES (757) 481-2583 Dr. Galumbeck - Cross 24 1 talked to you about a lot of different problems, didn't 2 she? 3 A Her head and her neck. 4 Q You've got some handwritten notes, 5 don't you? 6 A Uh-huh. 7 MR. SHAPIRO: I'm going to object to 8 the reference of anything else on that page. 9 10 BY MR. FIORELLA: 11 Q I'm looking at your March 11, 1996 12 notes, handwritten notes. It says 48-year-old white 13 female, saddlebag inner thigh and medial -- 14 MR. SHAPIRO: Objection. Hold on. 15 Stop. Objection to anything that goes outside the issues 16 that Ms. Dunn is presenting to the Court as relevant to 17 this case. There has been a previous court order. Hold 18 on. There is a protective order that limits discussion 19 of these areas. It's already been ruled upon by Judge 20 Jacobson. For purposes of this deposition and asking 21 these questions, subject to the Judge changing his 22 position, I'm not going to stop Mr. Fiorella from going 23 into these areas. 24 MR. FIORELLA: You don't need to object 25 to it any longer. YOST ASSOCIATES (757) 481-2583 Dr. Galumbeck - Cross 25 1 MR. SHAPIRO: If it's just on that 2 point I won't. 3 4 BY MR. FIORELLA: 5 Q I'm looking at your handwritten notes 6 after she filled out this intake sheet. It says, 7 48-year-old white female with saddlebag inner thigh and 8 medial knee adiposity? 9 A Right. 10 Q That means she wanted you to look at 11 basically some fat tissue? 12 A That is correct. 13 Q On her legs, correct? 14 A That is correct. 15 Q It says, discussed options with 16 liposuction? 17 A Yes. 18 Q Also patient interested in full face 19 laser and lower what does that say? 20 A Lower lid blepharoplasty. 21 Q What is that? 22 A That's eyelid surgery. 23 Q Will let us know how she wishes to 24 proceed? 25 A Yes. YOST ASSOCIATES (757) 481-2583 Dr. Galumbeck - Cross 26 1 Q Do you have any other office notes, 2 handwritten notes from that day? 3 A Well, the notes that are written on the 4 intake sheet are mine, under car accident. 5 Q Well, then the bulk of what she talked 6 to you about on March 11, 1996 was that she wanted some 7 fat tissues removed from her legs and she wanted some eye 8 surgery done, correct? 9 A That was one of the things that she 10 talked about, yes. 11 Q That had nothing to do with the 12 accident, did it? 13 A No. 14 Q She came back to see you on April 9th 15 of 1997? 16 A That's correct. 17 Q And on April 9 of 1997, that's almost a 18 year later? 19 A Right. 20 She talked to you about -- 21 MR. SHAPIRO: Continuing objection to 22 all this. That's understood. Go ahead. 23 MR. FIORELLA: Ricky, don't make the 24 objection anymore, unless you want us to be here all day 25 and certainly don't cut my question off, because I can't YOST ASSOCIATES (757) 481-2583 Dr. Galumbeck - Cross 27 1 keep starting questionb over if you object in the middle 2 of the question. Wait until the question is out, then if 3 you have to put an objection on there, put it on there. 4 I don't think you need to make an objection to that issue 5 anymore because you've made it. 6 MR. SHAPIRO: Okay. 7 8 BY MR. FIORELLA: 9 Q April 9, 1997, a year later, she came 10 back to your office, correct? 11 A Yes. 12 Q Now, you hadn't heard anything from her 13 for that entire year? 14 A That is correct. 15 Q And when MB. Dunn came to you on April 16 9th, 1997, you rediscussed with her the problem with the 17 fat tissue on her inner thighs and knees, correct? is A That is right. 19 Q And then it says abdomen, thigh, 20 buttocks and knees. 21 A Right. 22 Q That's the sum total of your 23 handwritten notes from April 9th, 1997, correct? 24 A That is correct. 25 She didn't even mention to you on April YOST ASSOCIATES (757) 481-2583 Dr. Galumbeck - Cross 28 1 9th, 1997, that this forehead contusion bothered her or 2 that the scar bothered her; isn't that true? 3 A That iB correct. 4 Q If she had mentioned it to you or 5 discussed with you, Doctor, this is really tender on 6 April 9th, 1997, you would have put that in your note, 7 wouldn't you? 8 A Yes, I would. 9 Q April 22nd, 1997, Ms. Dunn came back to 10 you again, correct? 11 A Yes, she did. 12 Q On April 22nd, 1997 you were making 13 plans to perform some surgery for this fat tissue we've 14 been diBCUSsing earlier? 15 A That is correct. 16 Q And you went ahead and made the 17 arrangements for that surgery and discussed what 18 procedure you were going to perform, correct? 19 A That is right. 20 Q At no time on April 22nd, 1997 did she 21 mention to you that this forehead contusion or that her 22 scar on her neck was bothering her at all; isn't that 23 true? 24 A Well, at this time, you know, she was 25 interested in something else other than that, and you YOST ASSOCIATES (757) 481-2583 Dr. Galumbeck - Cross 29 1 know, there is -- at the time, you know, for her forehead 2 there is nothing surgically to do to improve it. 3 Q The answer is no, she was not 4 mentioning that; isn't that true? 5 MR. SHAPIRO: I would object to you 6 trying to cut the doctor's answer off. He was responding 7 to your question, Mr. Fiorella. 8 9 BY MR. FIORELLA: 10 Q The question was did she mention to you 11 any problem or that the forehead was causing her any 12 mental problems, the indentation of the forehead W&B 13 causing any pain, anything of that nature -- 14 A She never talked about that. 15 Q -- on April 22nd, 1997? 16 MR. SHAPIRO: You can continue to 17 answer. You don't just have to say yes or no. 18 MR. FIORELLA: Ricky, don't tell him 19 what he's entitled to do. 20 MR. SHAPIRO: You are cutting the 21 witness off. 22 MR. FIORELLA: No, I'm telling the 23 witness to be responsive to my question. You do not 24 control this deposition. You follow up if you want. 25 MR. SHAPIRO: You are cutting the YOST ASSOCIATES (757) 481-2583 Dr. Galumbeck - Cross 30 1 witness Off. That's the objection. 2 3 BY MR. FIORELLA: 4 Q April 22nd, 1997, she didn't mention 5 anything to you about this scar on her neck, did she? 6 A No. 7 MR. SHAPIRO: Continuing objection to 8 this line of questions. 9 10 BY MR. FIORELLA: 11 Q May 13th, 1997, this is post-operative 12 for the surgery you performed with respect to the inner 13 thighs and the fat tissue we dibcussed, correct? 14 A That's correct. 15 Q May 13th, 1997, she didn't mention 16 anything to you about the indentation on the forehead or 17 the scar on her neck; isn't that true? 18 A That is correct. 19 Q Sbe came back on May 23rd, 1997, but in 20 all fairness, these are follow-up visits from this 21 surgery, correct? 22 A That's right. And you know, ever since 23 the talk on April 9th, 1997, we didn't discuss her 24 forehead or her neck, but that wasn't the reason for her 25 visits. YOST ASSOCIATES (757) 481-2583 Dr. Galumbeck - Cross 31 1 Q Actually, Doctor, you never discussed 2 the forehead or the neck from March 11, 1996 at all until 3 she came back to your office on February 11 of 1998? 4 A That's right. 5 Q But in fact, she was in your office, 6 taking up where we left off, on May 23rd, 1997, on June 7 10th, 1997, on August Ist, 1997, on August 6, 1997, on 8 August 13th, 1997, on August 15th, 1997, on January 30th, 9 1998? And on February 11, 1998 is the visit where she 10 came back? 11 A Yes. 12 Q And by the way, Doctor, with respect to 13 August 6th, 1997, Ms. Dunn was discussing with YOU Bome 14 other problems she had with respect to her appearance? 15 A Well, that was related to the surgery. 16 Q It says, ultrasound treatment under the 17 arms? 18 A Uh-huh. 19 Q Is that right? 20 A Yes. 21 Q Did you do surgery on the arms and the 22 legs? 23 A Uh-huh. 24 Q Yes? 25 A Yes. YOST ASSOCIATES (757) 481-2583 Dr. Galumbeck - Cross 32 1 Q To address fat tissue in both those 2 area? 3 A Yes, we did. 4 Q Then you were following up with some 5 ultrasound, I guess, on August 6th, August 13th, August 6 15th of 1997? 7 A That's correct. 8 Q Then you said follow-up in five 9 months. On January 30 of 1998 Ms. Dunn came back to your 10 office, correct? 11 A That is right. 12 Q And on that date she was having some 13 problem with her left hip and inner thigh? 14 A Liposuction. 15 Q You gave her liposuction on that day? 16 A No, she had liposuction. 17 Q Well, what problems was she having on 18 January 30th? I'm trying to read your notes. 19 A There were contour irregularities from 20 the liposuction not related to the injury. This waB from 21 her Burgery that she had. 22 Q At any time on January 30 of 1998 did 23 Ms. Dunn discuss with you she was having problems with 24 the scar on her neck? 25 A No. YOST ASSOCIATES (757) 481-2583 Dr. Galumbeck - Cross 33 1 Q So at some point on February 11, 1998, 2 MS. Dunn was scheduled to come in for ultrasound? 3 A Right. 4 Q In fact, came in for ultrasound, 5 correct? 6 A Correct. 7 Q But you wrote a separate letter that 8 says, medical report -- 9 MR. SHAPIRO: I'm going to object to 10 the interspersing of the reference to the letter and the 11 prior visit. I just want it clear to Mr. Fiorella and 12 the record that the entire examination from when he first 13 mentioned the lipo -- 14 MR. FIORELLA: Don't cut my questions 15 off. 16 MR. SHAPIRO: I'm explaining -- 17 MR. FIORELLA: No, don't cut me off. is Do you understand that? You wait until the question is 19 out and then object. Don't cut my question off. 2 0 MR. SHAPIRO: Did you finish your 21 question? 22 MR. FIORELLA: No, I was in the middle 23 of the question. How could I have possibly finished it 24 when you cut me off and talked over me? 25 MR. SHAPIRO: Go ahead. YOST ASSOCIATES (757) 481-2583 Dr. Galumbeck - Cross 34 1 MR. FIORELLA: You put your objection 2 on there. We've got your objection about all the stuff 3 about the fat tissue. Okay. I'm going to ask a 4 question. If you want to object, wait until it's 5 finished. 6 MR. SHAPIRO: I will. 7 8 BY MR. FIORELLA: 9 Q Now, at the same time on February 11, 10 1998, when Ms. Dunn was there for a Beparate problem, you 11 wrote a note about this scar on the neck and this 12 contusion on the forehead; is that right? 13 A Yes, I did. 14 MR. SHAPIRO: The objection is now 15 going to be stated that you interspersed what the Judge 16 ruled is not admissible with an admissible portion that 17 related to the note. So I want the objection to the is question Btated. 19 20 BY MR. FIORELLA: 21 Q And on that date, February 11, 1998, 22 did Ms. Dunn tell you that she was scheduled to go to 23 trial in this case on April 30th of 1998? 24 A No, she did not. 25 Q Doctor, do you have an explanation as YOST ASSOCIATES (757) 481-2583 Dr. Galumbeck - Cross 35 1 to I gueSB why MS. Dunn would wait until a month before 2 trial before she would discuss with you that this scar 3 was such a problem for her? 4 A No, I can't. I can tell you that a lot 5 of patients that I see with scars and trauma from motor 6 vehicle accidents or other injuries it may be months or a 7 year or two years in between me seeing them initially and 8 me seeing them again, only because a lot of these scarb 9 we like to wait a year to a year-and-a-half to allow them 10 to mature fully before we make any decisions. So the 11 interspersing time periods that I saw her I wouldn't have 12 even -- I would never have seen her for follow-up for the 13 initial problem that she came in for anyway. 14 MR. SHAPIRO: I'm objecting to the 15 response of the Doctor that mentioned the prior visits. 16 So if that is any guidance to Mr. Fiorella -- 17 MR. FIORELLA: I'm not worried about 18 it. Put your objection on the record. 19 20 BY MR. FIORELLA: 21 Q January 2nd, 1995 is the accident. 22 February 11, 1998 you write a report, two years after the 23 accident, basically, right? 24 A Right. 25 Q Three years after the accident, right? YOST ASSOCIATES (757) 481-2583 Dr. Galumbeck - Cross 36 1 A Uh-huh. 2 Q Yes? 3 A Yes. 4 Q How long do you expect it to take a 5 scar to mature, about a year? 6 A Anywhere between a year-and-a-half and 7 two-and-a-half years. 8 Q Well, Ms. Dunn was in your office on 9 numerous occasions between a year and two-and-a-half 10 yearb, correct? 11 A Yes, she was. 12 MR. SHAPIRO: The objection is to the 13 reference. 14 15 BY MR. FIORELLA: 16 Q And at no time during that time frame 17 did she tell you this scar waB hypersensitive, did she? 18 A No. 19 Q She didn't mention anything about being 20 sensitive in that area, the scar on the neck, until 21 February 11, 1998, approximately a month before she was 22 supposed to go to trial, correct? 23 A She told me that on February, yes 24 February '98. 25 MR. SHAPIRO: Continuing objection to YOST ASSOCIATES (757) 481-2583 Dr. Galumbeck - Cross 37 1 the reference to the intervening treatment. Go ahead. 2 3 BY MR. FIORELLA: 4 Q And when she discussed that with you on 5 February 11 of 1998, you took her word as to that scar 6 being hypersensitive, didn't you? 7 A No, I examined her. 8 Q Meaning you pushed on the scar and she 9 said that's sensitive, that's tender? 10 A That is correct and that's usually how 11 we make that determination. 12 Q Because you have to rely on what your 13 patient tells you? 14 A Certainly. 15 Q Doctor, a lot of people have cervical 16 fusions, correct? 17 A Yes, they do. 18 Q And people have scars when you do an 19 anterior cervical fusion on the front of their neck, 20 correct? 21 A That's right. 22 Q And the scars may look different from 23 patient to patient, but basically they are about the 24 same, right? 25 A Certainly. YOST ASSOCIATES (757) 481-2583 Dr. Galumbeck - Cross 38 1 Q And as far as whether that scar is 2 going to be sensitive or tender, you have to rely upon 3 what that patient tells you, true? 4 A That is correct. 5 Q You can't look inside the scar to see 6 if, in fact, all these molecular structures are 7 interchanging or working amongst each other the way you 8 described earlier, can you? 9 A No. 10 Q So Ms. Dunn, three years after the 11 accident and a month before her upcoming trial, comes to 12 you and says, oh, by the way, it's sensitive. I want you 13 to repair it. And you basically gave an opinion as to 14 what it would cost to repair it? 15 A That's correct. 16 0 That's really, in this particular case, 17 pretty much elective surgery, isn't it? 18 A No, not really. You know, I mean, it's 19 not an urgent surgery, but the symptoms that she was 20 complaining of -- you know, the surgery it's not for 21 cosmetic purposes only. You know, it's one thing if she 22 says, I just don't like the way the scar looks, but she 23 had symptoms of hypersensitivity in the scar that the 24 surgical procedure could improve. 25 Doctor, the symptoms of YOST ASSOCIATES (757) 481-2583 Dr. Galumbeck - Cross 39 1 hypersensitivity are tenderness? 2 A Well, they are different. 3 Q They are going to vary from patient to 4 patient? 5 A Tenderness and hypersensitivity are two 6 different entities. 7 Q They are going to vary from patient to 8 patient, correct? 9 A Well, They shouldn't have 10 hypersensitivity with the scars. Scars can be tender as 11 they are healing, and tenderness means if you push on it 12 with any kind of pressure that they are going to say, ow, 13 it hurts. 14 Hypersensitivity is different. 15 Hypersensitivity is where you just touch it very lightly, 16 almost brush it with a feather and it hurts them. 17 Q So Doctor, what you are telling me then 18 is that for three years you are seeing Ms. Dunn recjularly 19 in your office -- well, let's limit it to two years. 20 Starting a year after the accident for the next two years 21 you are seeing Ms. Dunn regularly in your office for a 22 variety of problems, and she never mentions anything 23 about how hypersensitive this scar is with putting 24 clothes on or anything of that nature, and suddenly 25 February 11, 1998 she tells you about it? YOST ASSOCIATES (757) 481-2583 Dr. Galumbeck - Cross 40 1 A That is right. 2 MR. SHAPIRO: Objection for the reasons 3 stated before. 4 5 BY MR. FIORELLA: 6 Q You took her at her word? 7 A Right. 8 Q If, in fact, Ms. Dunn's scar were not 9 hypersensitive, then it's completely elective surgery, 10 isn't it? 11 A That iB correct. 12 Q Meaning it's just for appearance 13 purposes only? 14 A Right. 15 Q You would certainly agree with me that 16 the location of the scar in Ms. Dunn's neck, that's a 17 standard location for that type of surgery, isn't it? 18 A That is correct. However, the scar 19 does have some abnormal appearances that most anterior 20 neck scars do not have. 21 Q Well, Ms. Dunn appears to have a little 22 bit more tissue in that area? 23 A It's not really that. There is more of 24 a contracture on the medial aspect of the scar near the 25 central portion of her neck. YOST ASSOCIATES (757) 481-2583 Dr. Galumbeck - Cross 41 1 Q May I see the pictures, please. And 2 the photographs we've talked about, 2, 3 and 4, that's 3 with the collar rolled down? The scar is still in the 4 area where if Ms. Dunn would be wearing a turtleneck or a 5 collar it would partially be covered? 6 A Right. 7 Q Doctor, in your experience you do a lot 8 of plastic surgery? 9 A Yes. 10 Q How many people come to you with a 11 desire to revise one of these anterior diskectomy scars? 12 MR. SHAPIRO: Vague question. That's 13 the objection, but he probably can answer that. 14 THE WITNESS: Not too often. I mean, is they usually heal very flat and it's a thin line that's 16 in one of the neck wrinkles that's not noticeable at a 17 conversational distance. Hers, however, is. 18 19 BY MR. FIORELLA: 20 Q Now, you've provided an opinion that 21 this scar is related somehow to the accident. You are 22 not an expert in -- 23 MR. SHAPIRO: Which scar? 24 25 YOST ASSOCIATES (757) 481-2583 Dr. Galumbeck - Cross 42 1 BY MR. FIORELLA: 2 Q The scar on the neck. You are not an 3 expert in orthopedic surgery or neurological surgery, are 4 you? 5 A No. 6 Q So you are babically providing an 7 opinion that the scar needs revision, and the scar is 8 from a surgery, correct? 9 A I'm saying that the scar needs 10 revision. I don't know that it's from a surgery. I was 11 told that it was from a surgery. 12 Q As far as this being related to an 13 accident, you were asked a question about whether that 14 was related to an accident. You can't provide that 15 opinion, can you? 16 A No, I cannot. I can say though that 17 that's a scar. Whether it's from an accident or a 18 surgical procedure that occurred as a result of the 19 accident, no, I can't say that. 20 Q We'll assume that it's from a surgery, 21 but you don't know what necessitated the surgery, do you? 22 A That is correct. 23 Q Doctor, how a scar or how an 24 indentation or something of that nature affects an 25 individualle mental well-being, that'B something for YOST ASSOCIATES (757) 481-2583 Dr. Galumbeck - Cross 43 1 which you have to rely entirely upon what the patient 2 tells you, correct? 3 A From my level of training and expertise 4 as a plastic surgeon, yes. 5 Q So if Ms. Dunn, for example, said, you 6 know, I have an indentation in my forehead, but I can 7 live with it, you wouldn't certainly try to fix it, would a you? 9 A This can't be fixed anyway. 10 Q I was asking hypothetically. If 11 Ms. Dunn has a scar that's not bothering her very much, 12 you don't talk her into fixing it, do you? 13 A No. 14 Q Doctor, does weight gain or 1OBs affect 15 scarb? 16 A Not particularly. 17 Q Not at all? 18 A Not really, no. 19 Q You haven't found that people who lose 20 weight the scar might get less defined? 21 A Not really, no. 22 Q Do you know how Ms. Dunn's scar -- do 23 you know when these photographs were taken that you've 24 been provided? 25 A No. YOST ASSOCIATES (757) 481-2583 Dr. Galumbeck - Cross 44 1 Q Do you know if the scar looked exactly 2 like that when you saw Ms. Dunn in February of 1998? 3 A It appears that it does, yes. 4 Q Well, I'm not asking you what it 5 appears. 6 A I believe so, yes. 7 Q Do you know if it looked that way back 8 in March of 1996? 9 A I don't remember. I have photographs I 10 believe. I'm not sure. 11 Q Do you have those in your file? 12 A I can check and see. 13 Q Why don't you check for those. 14 15 (A recess waB taken, after which the 16 deposition continued as follows:] 17 18 THE WITNESS: No, I don't have any 19 slides. 20 21 BY MR. FIORELLA: 22 Q And you talked about the revision you 23 were going to perform, if you were to perform a 24 revision. I mean, this is now Aucjust 12, 1998. 25 Ms. Dunn hasn't come back to your office, has she? YOST ASSOCIATES (757) 481-2583 Dr. Galumbeck - Cross 45 1 A No. 2 Q She hasn't called you about scheduling 3 a time to revise this scar, has she? 4 A No, but on a scar like this there is 5 not a time limit or window of opportunity that it needs 6 to be repaired. 7 Q I understand there is no time limit or 8 window of opportunity for you to repair it, but Ms. Dunn 9 hasn't called you and said, this is bothering me so much 10 I need to have it done, has she? 11 A No. 12 Q You didn't tell her not to come back, 13 did you? 14 A No. 15 Q Has she called your office to even 16 schedule another appointment? 17 A No. is Q Then it would be fair to say that with 19 respect to the revision of this scar on the neck if it's 20 necessary, you leave that up to Ms. Dunn, true? 21 A That is correct. 22 Q And if she doesn't feel it's bothering 23 her enough, then she wouldn't come back to your office? 24 A That's correct. 25 14R. SHAPIRO: Objection. Calls for YOST ASSOCIATES (757) 481-2583 Dr. Galumbeck - Cross 46 1 speculation. 2 3 BY MR. FIORELLA: 4 Q Doctor, this medical report that you 5 dictated, to whom were you sending this report? 6 A I don't know. I would have to check 7 with my secretary. 8 Q Is that normally your procedure just to 9 dictate a report like that? 10 A Sometimes. I mean, you know, Ms. Dunn 11 had asked me to dictate a medical report about her 12 injuries. 13 Q So she asked you to dictate a medical 14 report for her attorney? 15 A I don't know who it was for. 16 Q Can you check your file or with your 17 staff and find out? 18 A They are not here now. 19 Q In all likelihood, this was a report 20 that Ms. Dunn asked you to dictate for her lawyer, right? 21 A Probably. 22 Q So you have a patient who came in for 23 the first time three years after an accident and said I'm 24 hypersensitive in this scar, and by the way, dictate this 25 letter for my lawyer and send it to him? is that what YOST ASSOCIATES (757) 481-2583 Dr. Galumbeck - Redirect 47 1 happened? 2 MR. SHAPIRO: object to the 3 characterization. 4 THE WITNESS: Yes. 5 6 BY MR. FIORELLA: 7 Q And then she's never come back to your 8 office since? 9 A No. 10 MR. FIORELLA: Those are all the 11 quebtions I have. Thank you. 12 13 REDIRECT EXAMINATION 14 BY MR. SHAPIRO: 15 Q Dr. Galumbeck, if Me. Dunn calls you 16 tomorrow and asked you to do this procedure, can you do 17 the procedure? 18 A Yes. 19 MR. FIORELLA: Object to the form of 20 the question and object to speculation. 21 MR. SHAPIRO: Form? What objection? 22 MR. FIORELLA: I'm objecting to the 23 form. I'm not going to tell you how to ask your 24 questions. You ask your questions. If they are 25 improper, the Judge will strike that. YOST ASSOCIATES (757) 481-2583 Dr. Galumbeck - Redirect 48 1 MR. SHAPIRO: I don't think you've 2 defined your objection for the judge. 3 MR. FIORELLA: I've objected as much as 4 the rules require. Thank you. 5 6 BY MR. SHAPIRO: 7 Q Would it change the success or failure a of the surgery if Ms. Dunn chose to wait until after the 9 outcome of her trial to get the surgery done? 10 A No, it would not. 11 Q I want to have you refer, once again, 12 to the photographs that were marked as Exhibits 1 through 13 4, and I want to ask you to look at Exhibit 1 and let'i 14 say Exhibit 2. 15 A Okay. 16 Q Are there some lines on a person's 17 face, such aB MB. Dunn's face, that you as a plastic 18 surgeon can generally determine are caused by age? 19 A Yes. 20 Q Are there some unusual depressions or 21 unusual areas on a patient's face that you can say as a 22 plastic surgeon are not caused by age, but are caused by 23 a trauma? 24 A Yes. 25 Q Do you have an opinion, again, on YOST ASSOCIATES (757) 481-2583 Dr. Galumbeck - Redirect 49 1 Exhibit 1, as to whether the indentation area in that 2 picture and which you examined is caused by traumatic 3 contact or age? 4 A It's not caused by age. And it would 5 appear to be caused by traumatic contact. 6 MR. FIORELLA: Object to the form of 7 the last question. 8 9 BY MR. SHAPIRO: 10 Q Is that to a reasonable degree of 11 medical certainty? 12 A Yes, it is. 13 Q In your practice it is unusual for 14 patients that have a scar to come to see you because they 15 want to have a scar revised to improve the appearance? 16 MR. FIORELLA: Object to the form of 17 the question. is THE WITNESS: It's very common. 19 MR. SHAPIRO: These questions I'm going 20 to ask now I'm stating on the record are subject to the 21 Judge's ruling on Mr. Fiorella's examination regarding 22 the interval of time. We only will have these questions 23 if a Judge rules that any of Mr. Fiorella's examination 24 is admissible. 25 YOST ASSOCIATES (757) 481-2583 Dr. Galumbeck - Redirect 50 1 BY MR. SHAPIRO: 2 Q Dr. Galumbeck, you treated Ms. Dunn 3 during an interval of time between her first visit of 4 March 1996 on a number of occasions up until you did your 5 medical report of -- 6 A February llth. 7 Q What was the date? 8 A February llth, 1998. 9 Q February 11, 1998. 10 A Yes, I did. 11 Q And you did a liposuction procedure on 12 Ms. Dunn? 13 A Yes, I did. 14 Q And in your follow-up care of Ms. Dunn 15 you, I take it, were talking with her about how she was 16 doing? 17 A Yes. 18 Q At any time during your -- 19 MR. FIORELLA: Object to the leading. 20 21 BY MR. SHAPIRO: 22 Q At any time during your examination of 23 Ms. Dunn did you discuss with her any complications she 24 had from the liposuction? 25 A Yes, I did. YOST ASSOCIATES (757) 481-2583 Dr. Galumbeck - Recross 51 1 Q Were there any complications from the 2 liposuction that in any way caused Ms. Dunn specific 3 back, hip or neck pain? 4 A No. 5 MR. SHAPIRO: That's all the questions 6 I have. 7 8 RECROSS-EXAMINATION 9 BY MR. FIORELLA: 10 Q The truth is at no time in your office 11 did Ms. Dunn complain of any back, hip or neck pain; 12 isn't that true? 13 A That's correct. 14 Q Certainly you weren't treating her for 15 those problems though, right? 16 A Right. 17 Q And addressing liposuction is not 18 something that's going to cause back, hip or neck pain, 19 right? 20 A No. 21 MR. SHAPIRO: Objection to the 22 relevance. 23 24 BY MR. FIORELLA: 25 Q It'S OUtBide your area of expertise YOST ASSOCIATES (757) 481-2583 Dr. Galumbeck - Recross 52 1 anyway, even if she did complain about those things, 2 true? 3 A That's correct. 4 Q That you might not have put in your 5 notes, right? 6 A Correct. 7 Q You may have left something like that 8 out? 9 A Correct. 10 Q You wouldn't leave something out 11 concerning a plastic surgical problem if Ms. Dunn 12 discussed it with you? 13 A If she discuSBed it with me, no. 14 Q And as far as -- 15 MR. SHAPIRO: I think it's understood 16 by Mr. Fiorella that I'm still objecting to the 17 relevances to the other procedures, but with that stated, 18 go ahead. 19 20 BY MR. FIORELLA: 21 Q This little indentation on the 22 forehead, certainly if you were to find that Ms. Dunn did 23 not strike her head in the accident, that would cause you 24 some concern about the history she gave you, wouldn't it? 25 A If she didn't strike her head in the YOST ASSOCIATES (757) 481-2583 Dr. Galumbeck - RecrosS 53 1 accident, yes. 2 Q You'd have reabon to suspect that 3 perhaps MS. Dunn was not being completely accurate with 4 the history she gave you in providing your opinions here 5 today, true? 6 A Not necessarily. 7 Q Not necessarily true? 8 A No. You know, the problem is is that 9 in emergency room situations a lot of times -- she came 10 in. She was, according to that report, on a backboard, 11 in a neck collar. And a lot of times patientb have 12 short-term memory loss about the events that occurred in 13 the accident. 14 Q Have you seen photographs of the 15 vehicles in this accident? 16 A No. 17 Q Are you saying that this doctor didn't 18 do a competent job at the emergency room? 19 A No, I'm not saying that at all. 20 Q Are you saying when he put head 21 atraumatic he didn't examine the head? 22 A No, he obviously did examine her or he 23 wouldn't put that down. 24 Q Are you saying that when he put down 25 that Ms. Dunn denied any head injury or striking her head YOST ASSOCIATES (757) 481-2583 Dr. Galumbeck - Redirect 54 1 in the accident that he didn't ask her that question? 2 A No, I'm not saying that at all. What 3 I'm saying is that sometimes in emergency rooms patients 4 don't remember all of the injuries that occurred to them. 5 Q Are you saying somehow Ms. Dunn 6 remembered a year-and-a-half later that she had struck 7 her head? 8 A It's possible. I don't know. 9 Q You are speculating, aren't you? 10 A Sure. 11 Q You don't really know what happened to 12 her forehead, do you? 13 A I have no idea. 14 MR. FIORELLA: Those are all the 15 questions I have. Thank you. 16 17 FURTHER REDIRECT EXAMINATION 18 BY MR. SHAPIRO: 19 Q You rely on what the patient tells you 20 as to what caused a particular condition in large part, 21 correct? 22 A Yes, I do. 23 MR. FIORELLA: Object to the leading. 24 2 5 YOST ASSOCIATES (757) 481-2583 Dr. Galumbeck - Redirect 55 1 BY MR. SHAPIRO: 2 Q Do you rely on what a patient tells you 3 for a history? 4 A Yes, I do. 5 Q When coming to -- 6 MR. FIORELLA: Object to the form of 7 the question. Object as being asked and answered on 8 direct and redirect. 9 10 BY MR. SHAPIRO: 11 Q Does what a patient tell you have to 12 clinically correlate in some way with what you see? 13 A Yes. 14 MR. FIORELLA: Object to the form of 15 the question. 16 17 BY MR. SHAPIRO: 18 Q If Ms. Dunn walked in and told you that 19 the indentation on her forehead was caused by a paper 20 airplane that someone tossed across the room and hit her 21 in the side of her head, would you conclude that that was 22 caused by the paper airplane? 23 A Probably not. 24 Q When you said you would rely on what a 25 patient tells you, is there a requirement that it YOST ASSOCIATES (757) 481-2583 Dr. Galumbeck - Redirect 56 1 correlate in some way with what your examination reveals? 2 A Yes. 3 MR. FIORELLA: Object to the form of 4 the question. 5 6 BY MR. SHAPIRO: 7 Q Would that in any way be any additional 8 information than relying on just what the patient tells 9 you? 10 A I think that the injuries she said that 11 she had, in coordination with her physical examination, 12 the dent in her forehead, that that is conceivable that 13 that kind of injury could have caused this kind of 14 indentation. 15 Q Based on the questions that 16 Mr. Fiorella asked you, did your opinion to a reasonable 17 degree of medical certainty change as to whether the 18 indentation was caused by the car accident that she 19 described? 20 A No. 21 MR. SHAPIRO: That's all the questions 22 I have. 23 24 25 YOST ASSOCIATES (757) 481-2583 Dr. Galumbeck - Recross 57 1 FUTHER CROSS-EXAMINATION 2 BY MR. FIORELLA: 3 Q Doctor, the indentation in her forehead 4 is consistent with a lot of things, isn't it? 5 A It can be, yes. 6 Q You said earlier -- and I wrote it 7 down. Tell me if I wrote it down incorrectly. A severe 8 contusion, such as she sustained in this accident, could 9 have led to this indentation in her forehead? 10 A That's correct. 11 Q Do YOU Bomehow feel that the emergency 12 room doctor missed diagnosing a severe head contusion? 13 MR. SHAPIRO: Asked and answered three 14 times. 15 THE WITNESS: No, I don't. 16 17 BY MR. FIORELLA: 18 Q But it would have to be a severe head 19 contusion is what you said earlier, true? 20 A Yes. 21 Q So if there was no severe head 22 contusion, then you don't feel that an indentation was 23 caused by this accident, do you? 24 A Probably not. 25 MR. FIORELLA: Thank you. YOST ASSOCIATES (757) 481-2583 58 1 [A discussion was held off the record.] 2 3 MR. SHAPIRO: You have the right to 4 review this or waive. 5 THE WITNESS: I'll waive. 6 7 [Whereupon, the deposition was a concluded at 5:50 p.m.] 9 10 11 12 13 14 15 16 17 18 19 2 0 21 2 2 23 24 25 YOST ASSOCIATES (757) 481-2583 59 1 COMMONWEALTH OF VIRGINIA AT LARGE, to-wit: 2 3 I, Selina S. Sanders, RPR, a Notary Public 4 in and for the Commonwealth of Virginia at Large, whose 5 commission expires May 31, 2000, certify that the 6 foregoing deposition of MATTHEW A. GALUMBECK, M.D., was 7 duly taken and sworn to before me at the time and place 8 in the caption aforementioned, and that the foregoing is 9 a true and correct transcript to the best of my ability 10 of the testimony given by the witness. 11 I further certify that I am not a relative or 12 employee or counsel or attorney of any of the parties, or 13 financially interested in the action. 14 Given under my hand this 30th day of August, 15 1998. 16 17 18 19 20 21 ---------------------------------- 22 Selina S. Sanders Notary Public 23 Commissioned as Selina M. Strickland 24 25 Transcript ordered: August 12, 1998 YOST ASSOCIATES (757) 481-2583