Ride the Ducks Trial Day 19: Dr. Kleweno


October 29, 2018

Wake up too early.  Go back to pretend sleep.  Lie there.  Perform countdown of how long it will all take.  Remember Alysha has gone to the cabin with Nala and the house is totally quiet.  No Nala to feed or take potty.  Or to laugh with.  Reduce countdown.  Thirty minutes later have donned black cream and red plaid slim slacks, red shirt with ruffles, favorite Boss black jacket and pointy toe heeled boots with tassels that swing back and forth. 

One of the challenges in representing 40 people in a mass disaster trial is to put on their medical damages cases without taking weeks and weeks.  We have been streamlining the case not only since before trial began, but also during trial.  This is a bit painful especially when it involves not using some of the great illustrative aids we created.  And kind of nerve wracking as we consider tossing out evidence. 

Our first witness is Dr. Kleweno (phonetic: Klavano).  He was the primary orthopedic for two of the seven plaintiffs in our group who were taken to Harborview.  He was however also the attending.  Harborview is an academic based trauma center.  After being a resident, then completing his fellowship, Dr. Kleweno became the attending in charge of the trauma orthopedics department.  This means instead of having a two-fer.  We have a seven-fer.

Andrew and Debbie meet him in person at his office to see if he will agree.  He says it will be his honor.  He speaks with me a few days later to double confirm his role.  Melanie pulls together his powerpoints.  She also prints out all the admit, discharge summaries and op reports and puts everything into a binder perfectly tabbed.  Hand this to him at the beginning of his testimony.  He never opens it…sorry Melanie…but the PPTs were great.

Only after we have been going for about an hour of his testimony do the defendants realize he’s going to be talking about all seven.  You can hear rustling and whispers.  Then the peppering of hearsay and lack of foundation objections.  But it is too little too late.  The doctor has already established a dominant presence.  Judge S overrules everything.

We have big body charts.  By big mean they take two easels to hold up.  Enormous.  One for each plaintiff.  During the triage process of the rescue, the worst injured were taken to Harborview.  Instead of having to call a different doctor for each plaintiff, or deal with different specialties such as internal medicine, Dr. Kleweno is the one stop shopping network of treating physicians.  The fact that he graduated from both the U of W as an undergrad and Harvard Medical doesn’t hurt.

We get in everything on the charts which he uses to educate the jury along with Aunt Sally the skeleton and the PPT which includes the front page of the op notes – more for dates/timing than anything, along with 3D radiology demonstrative videos of all the fracture sites, and a couple other personalized items.  Dr. Kleweno roams the courtroom with a pointer teaching the jury everything they could possibly want to know about comminuted acetabular fractures, transverse process fractures, and how blunt force trauma works to create impaction injuries.  Aunt Sally gets quite the work out. He weaves in a liver laceration here, a spleen laceration there, arterial dissection, the difference age plays in trauma, and it is all just absolutely lovely. 

After almost 4 hours of direct, Defendants have no cross except for Tad (City).  He gets up and asks two silly questions:  a) didn’t the doctors at Harborview have a big meeting that day so more staff were at the hospital – the doctor looks at him blankly and says doesn’t remember; and b) isn’t Harborview great.  The jurors have these questions:

·       How much of the surgical hardware is removed, and how much remains for life.

·       Can tibial plateau fractures contribute to a knee replacement earlier than had the injury not occurred.

·       Can a greater trochanter fracture lead to tendon issues later in life.

·       What kind of limitation in flexibility if any would the sacrum fracture and the post left iliac bone fracture cause after the injury has healed.

·       In terms of the sacroiliac injuries, can damage in that region cause long term issues with that region of the spinal cord.

·       Is the intermedullary nail permanent.

·       If the nail is permanent are there long term side effects from having less bone marrow.

·       Can the pelvic fractures lead to any complications for childbearing later in life.

·       What kind of nerve innervation is there near the coccyx.

·       Can the nerve innervation near the coccyx contribute to lower back pain later in life.

·       How probable is it that the vertebral fractures can contribute to spinal arthritis.

·       When vertebral fractures occur, is the load sufficient to also damage the intervening discs.

·       Do acetabular injuries, even when treated, contribute to arthritis.

·       As a young patient is facing years of having an artificial hip, does that increase her risk of reacting to the implant materials.

·       Do fractures of the tibial plateau commonly cause discomfort after recovery is complete, say, two years down the road.

As the doctor beautifully answers all the questions that are within his field, the defense lawyers do their best to maintain their fake pleasant facial expressions.