Tag: Business

Capital Punishment Interviews

Hon. Judge Donald Mosley (Ret.)

In conjunction with our article License To Kill. Our Nation’s (& Nevada’s) Struggle To Maintain Death Row, we had our contributing writer, Mark Fierro, reach out to Hon. Judge Donald Mosley (Ret.) and criminal defense attorney Tom Pitaro, Esq., to get their personal views on the matter.

Fierro: Tell us about your experience

Mosley: Well as you know, I served as a judge for 33 years. I sentenced a number of people to death. During the entire time that I was a judge, 33 years, one person who I had dealings with was executed. This shows you how efficient and how well the system works. That person, was a fellow convicted in Reno. I was part of a 3-part panel that was appointed. The only reason he was put to death, was because he refused more appeals. He just gave up and said I don’t want to fight it anymore. So they finally executed him.

Fierro: Recently, there was a family, where a woman was killed, and it was originally thought to be a case of road rage. I told her husband that before he says anything to the media about it, he needed to understand something: If he gets the death penalty, the day he gets to death row, it may take a while to get there, but the day he gets to death row, inmates will tell him, you have nothing to worry about buddy–this is the country club. Nobody can hurt you here, you don’t exercise with anybody, you don’t eat with anybody, and you get medical care, just like everybody else does. You got out for 1 hour every so often. It’s the Taj Mahal of incarceration.

Mosley: And more expensive by the way, for the taxpayer. Incidentally, the Supreme Court ruled some years back, that the people on death row have the same rights to life saving organs as you and I. Now here’s a convicted murderer who needs a liver or something to survive, but he gets right in line with everybody else. You might die, because you don’t get a liver and he might be saved. Somebody that’s already killed somebody.

Fierro: When you’re trying these cases all these years, is there a different sense of pressure that you feel to ensure everything is done properly?

Mosley: Well, again as you probably know, when you have what we call a death case, a trial having to do with the possibility of a death sentence, there are a lot of requirements that aren’t ordinarily made at a trial. You get daily transcripts, which are required. You have to have two attorneys, one of them at least death qualified, so that means additional training. And of course these items are scrutinized more closely, and rightly so, if you think about it. So yeah, you want to be sure that you get everything accomplished that needs to be done and that you do it the right way.

Fierro: You’re sitting here in an open court of theoretical perspective, both sides, you’ve got the prosecution, you’ve got the defendant, but he’s not convicted of anything yet. Do you have a sense of the victim? The victim’s family? What they are going through? Does that stand out in your mind?

Mosley: Well that’s true in any case. If I understand your question, it’s kind of a two-part question. Do you empathize with the victim’s family, which you always do to a certain extent? Certainly more so in a death case like this. Do you get a sense of what really happened? Whether the jury recognizes it or not the truth is, you do. A Judge gets accustomed to hearing these things and evaluating testimony, and you get a pretty good sense of what is going on by the time it is given over to the jury.

Fierro: Have you ever gotten close to the line, as far as you are concerned? Whether it was a line call or somebody got sent up that you didn’t know necessarily was the case?

Mosley: I can remember only one case and it was a minor case that didn’t amount to anything, where I disagreed with the jury and I actually sentenced someone very lightly because of it. But it didn’t amount to anything. I would never abide a guilty verdict, if I were strongly to disagree. There would be some ways to make input on it. So no I haven’t. You have to realize, by the time a case gets to District Court, they have been through Justice Court, they have been through all sorts of investigations, there’s not a lot of room for error. Although I cannot say it’s infallible, but you’re not going to see a lot of mistakes made.

Fierro: Are your particularly in favor of or against [capital punishment] and why?

Mosley: Well, in principle, I’m in favor of the death penalty because in some cases I think it’s just justice, pure and simple. Am I against it? Yes, because it doesn’t work. It costs the taxpayers an inordinate amount of money. The appeals never end. And no one ever gets executed. Like I said, in 33 years, 1 person. The extra time, expense and effort that goes through trying a case with the possibility of the death penalty is just not worth what we go through to accomplish it.

Fierro: If you were to tell people, yes we have to go forward with this or no this is getting ridiculous for nothing, what would you say?

Mosley: The way it works today I would eliminate it. It is an unbelievable expense that serves no purpose. We could change the laws to make it work, but we don’t have the appetite to do that.

Fierro: It’s currently lethal injection, here in Nevada, as well as the rest of the United States. But there is a shortage of medications. Do you see going to another form, or do you think there is a possibility because the way you position it, people on the other side, think we may eliminate it.

Mosley: Well first the lethal injection is a very humane way to kill someone, if there is such a thing. I mean you just put them to sleep. Now I might point out that rarely do victims of murder get that sort of consideration. They go through a lot of anguish most of the time. I’ve heard there is a shortage of chemicals. I think that’s just another way of objecting to the death penalty.

Fierro: A lot of people are surprised to hear that it cost more to sentence somebody to death. If you sentence them to death, then it’s over and you get done with it and don’t have to spend $20,000.00 a year keeping them in prison.

Mosley: In theory that’s true. The problem is, they are up there 15 to 20 years on death row. They die of natural causes most of the time.

Fierro: For many layman, they are unaware of the fact that even though people are charged with heinous crimes, they have these tremendous protections, due process, the same rights that apply to all Americans. Do you think that provides some value that we jump through these extra hoops for these death penalty cases?

Mosley: Well as I said, the trial process, and the evidence that is induced at trial needs to be looked at strictly, obviously. It is a very important situation when you are looking at someone’s life. Do we go overboard? Yes indeed. Your first appeal is with the Nevada Supreme Court. Then there is always a Federal question that arises and then it goes to the Federal Court. The Federal Court looks at it and says, no we remand it to the State Court, then it gets sent back and forth and up and down. Decades go by sometimes. That’s what makes it so ridiculous.

Fierro: I don’t think the average person understands. How regular District Court Trial costs hundreds of thousands of dollars. Cause you’re paying for the prosecutor and the defense and the defense investigators and the police and the courtroom and the judge and the staff.

Mosley: You’re right, that’s one of the arguments that people don’t understand against plea bargaining. If we tried every case and didn’t have plea bargaining, hell we would need 10 times as many court houses and judges. Because as you know, we probably plea bargain 85 to 90 percent of the cases. But yes, it is an expensive proposition.

Fierro: What are the changes you would like to see? Is there a change that needs to be made? Is there something?

Mosley: There are certain attorneys that are… famous… we’ll say, for appealing these cases and they have it down to a science. They can spread out the issues over years. They don’t shoot it all in one shot. So they can just keep churning this thing. I use the word churning advisingly. It’s a term that’s recognized in law, I think. Although not a very well received term. We need to put some sort of limit on appeals. And we need to inform people what a death case is. People tend to think if you commit murder you could be put to death. That’s not true. Only the worst of the worst, the most extreme circumstances, warrant the consideration of the death penalty. Such things as: killing multiple people, killing a police officer in the performance of his duty, or mayhem, when you torcher someone and cut their hands off, things of that nature, those are the cases. It’s been my experience when you tell the average person on the street that kind of thing and give a couple examples of these horrendous cases that I have dealt with, they kind of think, you know what, maybe the death penalty is a good idea.

Fierro: Given your position on the death penalty, it seems that we have a state problem and only a state problem. Cause Texas has a death penalty case once a week.

Mosley: Right.

Fierro: So it has to be a state issue. Is it that we lack will to do something as a state about this process?

Mosley: Well, Texas and Florida is another, I don’t know exactly what their laws are, but I think it might be worthwhile to look at them. They are doing something probably right. Now again, I haven’t examined all those laws, I don’t know that I would agree with all of them, but they seem to get the work done. If it’s not an injustice, then it’s a good thing. It’s worth of some scrutiny I think.

Fierro: Do you have anything else you would like to add?

Mosley: Well you know, what is this, Monday? Yesterday on 60 minutes, they had another one of these famous cases where someone was found innocent after serving 10 or 20 years in prison. I refused to watch it, I turned it off because I’m tired of watching that kind of nonsense. I might point this out, when you see those cases the press is trying to accentuate their point of view, of course. But this guy spent all this time in prison and we have DNA now. They did the rape sample case and it turned out it wasn’t him. So he must be innocent of killing this girl. First, they don’t talk about the horrendous record most these people had before they got involved in this last case. Secondly, the fact that the DNA doesn’t check out doesn’t mean the guy didn’t have a co-offender, one guy raped her the other guy shot her. If someone did a felony, with another individual, this thing called the felony murder rule says your just as guilty as he is. I mean all kinds of things that go into this mix and they never report it. It’s always, the DNA showed he’s innocent. Turn him lose and forget it. Gee whiz, isn’t this a terrible system we have? It’s just an unfortunate that people don’t get a better sense of what those are.


Criminal Defense Attorney Tom Pitaro, Esq.

Fierro: So tell me a little bit about your experience in handling capital murder cases.

Pitaro: I’ve been involved in a number of capital [murder] cases over the years, I actually have a death wish defendant who ultimately got executed. I’ve represented people where they sought the death penalty. I’ve currently got a case now where the sentence has been reversed, and we are going back for a penalty phase after almost 30 years.

Fierro: Tell me about that case, tell me about the 30 year case, just give me a thumbnail.

Pitaro: Well it’s still pending in court, the federal court of appeals overturned the death sentence and remanded it back for a new penalty phase.

Fierro: So are you particularly in favor of or against capital punishment, and why?

Pitaro: I’m opposed to capital punishment, I mean there are four ways of looking at it and capital punishment fails on all four. I think from a religious concept, probably the majority of the churches in America oppose capital punishment. The Catholic Church is opposed to it, Pope Francis just came out recently and re-affirmed that capital punishment should not be used in any circumstances. So you have a religious component, as do a number of other religious groups; Presbyterians, I think the Anglicans or the Episcopalians, I mean there’s a whole variety of religions that are adamantly opposed to it. Even the ones that support it put conditions on it that make it very difficult for it to work in our system. So from a religious viewpoint and as a Catholic, a practicing Catholic, I have the religious component.

There is a moral component that it fails at also. That moral component is it’s arbitrary, it is unfair and it is discriminatory. It is used mostly against poor, unintelligent people who have or are ethnic or racial minorities and it has been that way for the last 100 years and it continues to be that way. There’s a legal reason that I’m against it. It’s that we can’t get it right. Since we have reinstated the death penalty the legal system has tried over and over and over again to get it right and we can’t. Just in Nevada we have had a couple of people on death row exonerated for actual innocence. The outstanding things that have been happening with the innocence projects around the country are phenomenal and show that the legal system doesn’t work. [You] can’t come back and review something and then find out that you’re wrong once you’ve already executed the person. So from a legal sense the legal system has never been able to do it right.

And then even more interesting is from a financial stance because the Nevada legislature a couple years ago put together a study and the findings were that if you don’t seek the death penalty for a murder it costs about five hundred thousand dollars ($500,000) less to go through the case than if you were to seek the death penalty. If you sought the death penalty and you weren’t successful and ultimately the state wasn’t successful, it cost one point three million dollars ($1,300,000). So the cost of the death penalty is higher than putting someone in prison for life without the possibility of parole. I know that’s counter-intuitive, but if you understand the way the legal system works and the appellate process, you know that it is a fact of life and that is not any different than other states almost all the other states that have this I believe they find that the cost of trying to execute the death penalty or impose a death penalty is much more expensive than not doing. So for all those reasons I’m opposed to it, any one of which would be enough for a rational person to be against it. When you add them all up together it becomes difficult for me to consider that anyone could be in favor of it knowing these facts.

Fierro: Let me give you one other thing, we will step off the script for a moment. You know, I worked with that family where the woman, they originally thought it was road rage, and the guy shot her in the head; the kid was about 5’2, 20 years old / 18 years old, and I had a chance to sit with the victim’s husband and I said I’m going to tell you something and I hope that you’ll think about this before you make any statements to the media because they are going to ask you sooner or later. I want to tell you what happens to people when they get the death penalty, just so that you know. As soon as they get to the prison, once they get to death row – it takes a few days, but once they get to death row the first thing that they are assured is that nobody there knows of anyone who got killed. So you just sent this guy to the penthouse suite. He is never going to be in any danger, he exercises alone, he eats alone, he showers alone, the only fight that he has is over which television station they are going to watch collectively. If on the other hand, this kid goes into general population, he will be raped, he will be beaten, he may not last a year. Just out of fear alone he may not last. Which speaks volumes as to why you don’t give these people the very best treatment, we withhold it for the worst.

Pitaro: Well I mean, my feeling is a little different in that I don’t think that executing an individual ultimately gives closure, which is the magic word that we want to bring– ‘closure’. Well as far as the death penalty doesn’t bring closure if it’s a death penalty case because the appellant process quite rightly goes on for an extended period of time so you’re really prolonging this agony of the victim’s family. Secondly, when it’s over I don’t think anyone really gets this degree, this concept of closure that is so touted while you’re seeking the penalty. To me there is nothing sadder than watching the family of a victim of a crime, of a murder, when they walk out of the courthouse, they are alone. While that process is going on they are needed, if you will, by the prosecution, the media et cetera. But once that case is over they are forgotten and it goes out, I don’t think there is any closure in a death penalty. I’ve never seen any real evidence psychologically that it works. To me it just prolongs the suffering and leaves that empty hole afterwards where you are now left with it and there is nothing there. The people that I found dealing with it best are those who engage in therapy, a type of counselling if you will, to allow them to deal with the death more so than dealing with the fact of the perpetrator.

Fierro: Alright, currently lethal injection is the most favorably used form of execution in Nevada as well as the rest of the US. With our history of botched executions and a national shortage of medications available, do you see us continuing with its use? Or progressing to some other form of execution? Or possibly an end to capital punishment all together?

Pitaro: Well, we keep switching the way we do it, you know from hanging to shooting to electrocution to lethal injection trying to find, if you will, a humane way to commit the worst in humanity there is, killing somebody. In lethal injection we have seen over the last years or so that certain drug companies don’t want to be involved, where state governments are engaging in almost smuggling in drugs from one state to another or from foreign countries, so they can execute, and yet the problem of the doctors being involved in it, they got oaths not to be involved, to do no harm and yet here they are, they go out and participate in, if you will, a killing. So, this idea that there is some sort of humane way of killing someone is an absurdity, just saying it is an absurdity, the only rational solution to the problem is in fact eliminating the death penalty and continuing with at least the life without the possibility of parole or whatever system you want to have there. We make too many mistakes, we condemn too many people who are poor or minorities. When you start going through the process it sort of fails on its own, so, lethal injection is just a good way for politicians to say ‘Oh I’m trying to be humane’ when in fact they are not.

Fierro: What are the additional legal hurdles? Go into that if you would, the additional legal hurdles that a prosecutor has to go through to seek the death penalty.

Pitaro: What you have to do is, first it has to be a case that qualifies– that you think qualifies for it, so it’s a prosecutorial decision. It’s the prosecutor who makes the determination if the case is going to be treated as a death case or not. So there is no rule that says this ‘case will be’ or ‘that case won’t’ be. It’s up to the prosecutor to make that decision, and of course that decision then becomes a political decision because the prosecutors are politicians ultimately. So, there’s no broad base of decision making in the first instance, it’s whatever the prosecutor determines and however he sets that up. So the first thing they’ve done to try to get around some of these things or try to deal with it, they will have a committee and a prosecutorial office that may look at the case and, figuring that they have so many people say that it’s ok, then they will go and follow it with the death penalty.

Federally, we have a policy where you can go back to Washington and argue that your case should not be a death case. So that’s the first situation that comes in, and that is what do we charge the person with? And are we going to seek the death penalty? So those are very, very important decisions that are made. The second thing is when you get there, then a whole bunch of different rules, I won’t say as much as expanded rules of discovery. You have the attorneys that are involved in the case who now have to have been qualified to do death cases. The average, if you will, an unqualified defense attorney can’t do a death case unless he has a qualified attorney with him. Once you get beyond that, you have another great factor involved in death cases known as mitigation. And the courts as well as the ethics have demanded that there be mitigation evaluations made so that you can present mitigation to the jury. You have a guilt phase and then you have a penalty phase and then it becomes up to jury, if you will, in the death case to make the decision is it death, life with the possibility of parole or life without? Well, for them to make that decision the prosecution then has to bring in what we call ‘aggravating circumstances’ to make it in to a death case or to ask for a death penalty, and the defense is obligated to bringing in the mitigating factors of the person’s life, and I mean that- of his life, to tell the jury to, if you will, mitigate or offset those things so that the jury can make a decision. So as you can see those sort of things go further and further and become more and more expensive as we go. Then once the verdict of death is in, we have a heightened sense of appellate reviews all the way through the state and to the federal system. So what we have then is the very, very expensive and time consuming situation when the prosecution seeks the death penalty.

Fierro: Here’s one, laymen are often unaware of the constitutional protections under the eighth amendment and they get angry, it’s a gut reaction, when they find out about those protections against cruel and unusual punishment. Give us your thoughts on why it’s so important to provide such protection, and on the contrary, do you ever think that we are protecting the accused too much?

Pitaro: Well, now you can’t say that you’re protecting the accused too much unless you’re the accused. And then all of a sudden you think that all those rights that you heard about, you want them to apply to you. First and foremost we gave up the idea of ‘blood liable’ or ‘blood for blood’, about a thousand years ago, that is individual vengeance, and that’s what the death penalty is. Do you equate the crime with the punishment in the sense that you’re trying to make them equal? Because, you’re trying to make them the same thing. If someone steals, you don’t go out and steal from him, society doesn’t go out. If someone drives drunk, some state official doesn’t go out and get drunk. If someone punches you, you don’t have someone go in and punch them. Only with the death penalty do we have this. The thing is, the constitutional safeguards – they don’t protect criminals, they protect people. They protect the innocent as well as the guilty because they are to be applied to everyone. And who is going to make the decision that ‘I want this constitutional provisional applied to this person, but not the other.’ So what we have is, we have people who read about these things, hear about these things, et cetera without knowing all the facts many times, and coming to a conclusion – we do that all the time, I mean that’s what the media does, no one reads every case or reads law. But, the fundamental part of it is that it is there to protect us as a society. This is what we say, that we as individuals, before the society can do these things to us, they have these restraints on them and these restraints have to apply to the government, to everyone there is. And what the problem is with the death penalty especially is that they don’t apply. We found out that the right to counsel historically has not been as high when you have a death case, as say another one, because of a skill that may or may not be involved in the litigation of the death case.

We find that it is disproportionate to the poor, so that equal protection of the law sort of falls down there. When we look at the minority groups we know that it is arbitrarily applied more to minority groups than should be there. And so the purpose of these laws is to protect that and we can see where even our laws have been unable to protect us in that. And the last thing is, look, everyone gets offended when they hear of some horrendous sort of crime, everyone does, that’s a normal reaction of people, but we want to pause to get the emotion of the vengeance out of it to make a fair determination. You know, I can be offended if someone does something to violate my personal security or whatever, but that doesn’t mean I can take it under my own hands, and many times that is what it is, the reaction is ‘well I don’t think THAT person should have a right to an attorney’ and I hear that all the time. ‘I don’t think THAT person should have the right to remain silent.’ ‘In this community I don’t think THAT person should have a right to bail.’ But if the shoe was on the other foot – and I hear this with people, ‘well my son, I’d agree with that law but not to MY son, or to MY daughter.’ And so we personalize the rights that we want, but we want them for ourselves. We find it difficult to project them to other people and that is one of the reasons that this system is supposed to work, tries to work, and that is to apply laws uniformly and we find out that it has been a failure especially in the area of the death penalty, when you start executing innocent people, you know, that says a lot about our society. We are a violent society, America’s society is a violent society and anyone that denies that hasn’t gone outside in the last hundred years. And that carries over in to our laws and our sense of vengeance that we have. That’s what happens with violent societies. United States is – quite truthfully, the only western, if you will, western civilized society that still has a death penalty and I think the other guys got it right this time and not us.

Fierro: What are the changes you would like to see in the process either from the courtroom prosecution, defense aspect, or in the actual execution process?

Pitaro: Well, one, I think the only change I want to see is the abolition of the death penalty. I don’t think that once you have that position there is any way you can rationalize ‘can I come up with a humane way of killing someone that is executing them?’ You can’t come up with a rational, sane way of putting them in the isolation that they are put in when they are in the death row situation. Truthfully there is no way, it’s either abolish it or abolish it. I have no feeling that there is any way it can be made better. Hanging, shooting, electrocuting, sticking you with a needle or some other form of execution – I think they are all equally bad, and I don’t think we should spend any time as a society trying to find a different way to kill people so that the people who make the decision to kill can feel better.

Restoring Civility & Professionalism

Let’s Restore

Civility & Professionalism

To The Practice Of Law

By Teddy Parker, Esq.

Civility & Professionalism

I was lucky enough to start my career with one of the largest and most reputable Nevada firms in the early 1990s: Beckley, Singleton, DeLanoy, Jemison, and List. I was mentored by some of Las Vegas’ best lawyers, including Drake DeLanoy, Rex Jemison, Mitch Cobeaga, Robert Eglet, Judge “Betsy” Gonzalez, and Daniel Polsenberg. These lawyers showed me that it was possible to aggressively represent clients while maintaining civility with opposing counsel. These lawyers also demonstrated that successful results can be obtained without sandbagging and personal attacks, and instead, through professional courtesies. These professional courtesies included but were not limited to extensions of discovery, continuances of hearings and/or the use of stipulations in lieu of heavy motion practice. Informal agreements regularly sufficed, even absent confirming letters, because these lawyers knew and respected each other.

I took the values I learned at Beckley Singleton to heart and have always maintained civility and respect with opposing counsel. I understand that lawyers are subject to significant stress that requires them to make great compromises and sacrifices in their lives. With that understanding, I believe lawyers should still strive to maintain professionalism amongst each other. Although the demands of this career path are sometimes overwhelming, we should promote cooperation and respect in our professional lives. A good lawyer knows there is no positive correlation between obtaining the most favorable outcome for one’s client and the number of character assassinations you have fired at your opposing counsel.  Indeed, more often than not, a lawyer’s failure to maintain professionalism ends up costing a client more money as additional time is spent filing unnecessary motions with issues that could be easily resolved through a stipulation or discovery extension. Often, judges are noticeably frustrated with lawyers who take valuable time and resources from the court because they choose to argue more about the conduct of their opposing counsel than the facts or law relevant to their cases.

However, a greater cost of failing to grant professional courtesies is that you will inevitably need one in return some day.

To be a good lawyer means to be a good person. A trite but relevant expression is, “A good person treats others the way they prefer to be treated.” The path to a more civilized and cooperative legal community requires each of us to extend professional courtesies, grant continuances, and make attempts to amicably resolve disputes before filing potentially unnecessary motions. This will undoubtedly result in a more collegial atmosphere.

Confirming letters are not required when litigating in any firm. Our word is good and we extend professional courtesies. I challenge all Southern Nevada lawyers to raise the bar on professional courtesies.   


Theodore “Teddy” Parker is a founding partner of Parker & Nelson Assoc. in Las Vegas, Nev., where he specializes in administrative law, banking law, business litigation, corporate law and structuring, construction contract and defect, employment and labor law, insurance defense, municipal law, medical malpractice, personal injury, premises liability, products liability, real estate law, and regulatory compliance. Learn more about him and his practice’s work at http://www.pnalaw.net.

Who’s Still Standing, Sitting Or Otherwise?

Who’s Still Standing,

Sitting or Otherwise?

 A Brief Update On The Las Vegas Justice Court Election Results.

By Jessica Goodey, Esq.

It seems like no matter where you go, you cannot escape news of the election. It’s a presidential election year, which always makes for some interesting discussions around the office. Don’t worry though: This isn’t going to turn into a #TeamHillary or #TeamTrump thing. Let’s focus on the more local, albeit slightly less entertaining, Las Vegas Justice Court elections.

Nevada is one of 39 states that have some form of election for its trial court judges. Of course, there is much debate as to the merits of electing versus appointing judges, with impassioned arguments on both sides. Those arguments aside, it appears that most people focus on the District Court seats. Indeed, that’s where a lot of civil attorneys spend most of their practice…but that doesn’t mean the Justice Court seats should be overlooked.

The Justice Court is typically the first court with which most Nevadans come in to contact. It handles, among other things, DUIs and other misdemeanors; landlord/tenant cases; and all civil claims that do not exceed $10,000 in damages. However, beginning Jan. 1, 2017, the role of the Justice Courts will expand, as the Legislature recently increased the jurisdictional limit to all cases involving damages less than $15,000.1  Importantly, this $15,000 jurisdictional limit is exclusive of attorneys’ fees and costs, which are allowed as a matter of law to the prevailing party.2  Thus, it is anticipated a significant number of car-collision cases will soon be filed in Justice Court rather than District Court, as Justice Court will offer a more expedited resolution, with a jury trial held within 120 days.

In Justice Court, two of the seven seats up for re-election (of the 14 total Justice Court departments) had only two candidates in the race for that seat and therefore were not on the ballot in the primary: Department 7 (Judge Karen Bennett-Haron and Vincent Ginn) and Department 13 (Judge Suzan Baucum and Shana Bachman). These departments will be on the ballot for the General Election in November.

The remaining departments had three or more candidates:

  • In Department 3 (Judge Janiece Marshall, Sean Connell and Harmony Letizia), Marshall won 29.85 percent of the vote, narrowly defeating Connell who won 26 percent, and came in second place to Letizia who won 44.15 percent of the vote. Marshall and Letizia will face off in the General Election.
  • In Department 4, incumbent Judgment Melissa Saragosa faced two challengers: Amber Candelaria and Jillian Prieto. Saragosa secured 58.97 percent of the vote, meaning she secured her seat on the bench based upon a newly enacted rule: Any Justice of the Peace candidate in a three-or-more person race who wins more than 50 percent of the vote wins the seat.3 Saragosa was one of three Justice of the Peace candidates to benefit from that new rule.
  • In Department 6, Judge Bita Yeager faced Rebecca Kern and Jeff Rogan. This was a close race with the votes being split nearly evenly three ways. But, Yeager and Kern were able to pull ahead enough to move on to the General Election, amassing 37.79 percent and 31.28 percent of the votes respectively, while Rogan came in a close third with 30.93 percent.
  • In Department 9, Judge Bonaventure procured 59.60 percent of the vote, securing his seat on the bench until the next election, handily defeating his challengers Steven Goldstein (18.62 percent) and Robert Kurth (21.78 percent).

Finally, in Department 14, Amy “JoAnne” Chelini also secured her seat on the bench, overwhelmingly defeating incumbent Judge Conrad Hafen (who you may remember from pre-election press regarding his handcuffing of a Public Defender).  Chelini won 62.35 percent of the vote, while Hafen won 24.87 percent and the third challenger, Phung Jefferson, won 12.77 percent.

There can be no dispute that the Las Vegas Justice Court will be playing a larger role in the resolution of cases when the jurisdictional limit increases to $15,000, making the upcoming general election for the candidates in the remaining four departments that much more important. If you don’t know the candidates or who should get your vote, reach out to colleagues, go to one of the fundraisers or do some research online so you can make an educated vote. Since you never know when you will find yourself before one of those judges, do your part to make sure it’s a good one.


2016.0426 VegasLegal-Fall16-TJM-JC-TH-TH.inddJessica M. Goodey, Esq., is a partner at Becker Goodey, where she focuses primarily on personal injury and medical malpractice. Goodey is passionate about providing her clients with individualized and committed representation from start to finish. She recognizes the importance of her role in protecting her clients’ future and providing peace of mind.

 

  1. NRS 4.370 (as amended by AB 66, effective January 1, 2017)
  2. NRS 69.020, NRS 69.030; Royal Ins. V. Eagle Valley Construction, Inc., 110 Nev. 119 (1994).
  3. NRS 293.260(5) (amended by SB 5 in 2015).

AGE-DATING DISC INJURY

When considering disc pathology, one of the most-asked questions is, “How do you determine causality and age-date the lesion?” Medical literature has purposefully avoided answering this type of question to apparently avoid any appearance of pandering to the medical-legal community, as evidenced by Fardone and Milette (2001) reporting, “The term herniated disc does not infer knowledge of cause, relation to injury or activity, concordance with symptoms, or need for treatment” (p. E108).

Yet 14 years later, upon further evidence, Fardon et al. (2014) reported the following:

The category of trauma includes disruption of the disc associated with physical and/or imaging evidence of violent fracture and/or dislocation and does not include repetitive injury, contribution of less than violent trauma to the degenerative process, fragmentation of the ring apophasis in conjunction with disc herniation, or disc abnormalities in association with degenerative subluxations. Whether or not a ‘less than violent’ injury has contributed to or been superimposed on a degenerative change is a clinical judgment that cannot be made on the basis of images alone; therefore, from the standpoint of description of images, such discs, in the absence of significant imaging evidence of associated violent injury, should be classified as degeneration rather than trauma. (p. 2531)

As described by Fardone above, the definition and understanding of “violent injury” becomes an important arbiter in determining causality and lends an important understanding to age-date the herniation and/or bulge. In understanding the nature of Fardone’s tag of “violent,” science gives us answers rather than intuitive perceptions or rhetoric, and the quantification of energy transferences to victims in accidents gives us those answers.

The rate of change in speed (“acceleration,” or “ΔV”) of any free-moving body is what contributes to quantifying energy transfer and can be directly correlated to injury. Brault, Wheeler and Siegmund (1998) reported that in rear-end collision testing, it was determined whiplash could occur with a change in speed as low as 2.49 mph ΔV where there was no visual damage to the automobile.

Krafft, et al. (2002) reported symptoms at a ΔV of 12.5 km (7.77 mph) and an injury mean threshold of 4.2 g-force for males and a ΔV of 9.6 km (5.97 mph) with a mean of 3.6 g-force for females. Using this data, a corresponding window of time can be calculated between .084 seconds for males and .080 seconds for females (verifying that females are more at risk than males), resulting in a mean of .082 seconds. As evidenced above, acceleration (ΔV) is important as it is part of the physics determining g-force that explains injury thresholds and gives a numerical value to Fardone, et al.’s (2014) use of the descriptor “violent injury.”

The risk for injury is present in a vehicle no matter the initial speeds or damage to the protective equipment, as transference of force is the prime factor in accidents. Additionally, low-speed collisions have a history of little to no damage; therefore, little or no energy is absorbed by the safety equipment and design of the vehicles, yet the occupant is subject to this force even with safety restraints. Because of these factors, only a few pieces of information are needed to quantify the energy transfer an occupant is subjected to:

  • The SPEED just before the collision of each vehicle involved.
  • The WEIGHT of each vehicle and its occupants.
  • The TIME (t) involved (in the case of the above example…082 seconds)

Here are two examples:

Example A: A 6,100-pound SUV traveling at 7 mph rear-ends a 4,200-pound car stopped at a red light, and the SUV stops as a result of the collision. The car (and its occupants) will experience a resultant ΔV of 10.67 mph (…which is not to be confused with the speed of the bullet vehicle that struck the target vehicle).

Example B: A 30,000-pound truck and trailer backing up at 2 mph backs into the rear of a 4,800-pound occupied parked van, and the truck stops as a result of the collision. The van (and its occupants) will experience a ΔV of 12.5 mph.

Regarding the Krafft, et al. (2002) tables 1-4 (pg. 3): In both examples above, the acceleration threshold for injury of males and females was exceeded. Both collisions would be traditionally classified as low speed with potentially no deformity of the vehicles.

(Just to underscore the injury potential at low speeds, the second example occurred at 2 mph where the physics of the crash offered demonstrable evidence of threshold forces sufficient to cause bodily injury.)

Because Fardone et. al. (2014) uses the word “violent” with no qualifying parameters, the above examples offer insight through science on how transferred forces impact the human body with a predictable threshold for injury. Since the word “violent” is a subjective descriptor, one must utilize science and not consider generalities as illustrated by the low speed examples above.

Del Grande, Maus and Carrino (2012) reported, importantly, that although there were varying reports of asymptomatic herniations in the literature, only a post-traumatic finding of radicular, or nerve root, pain can be definitive for determining causality.

Del Grande, Maus and Carrino (2012) wrote:

Only a close concordance, a key in lock fit, of an imaging finding and an individual patient’s pain syndrome can suggest causation, which further implies that the imager must know the nature of a radicular pain syndrome if he/she is to suggest a causal lesion. Close communication between clinician and imager via the medical record, an intake document at the imaging site detailing the pain syndrome, or direct patient interview by the imager is necessary.(p. 640)

Therefore, it is critical to ensure that patients have a complete history taken and an examination performed by a credentialed health care provider that is trained in trauma care. Many practitioners are licensed to treat the trauma case, but many are ill equipped in training and experience to ensure an accurate diagnosis and determine proper relationship to causality.

Beyond radiating symptomatology, although as Del Grande, Maus and Carrino (2012) have reported as an accepted parameter for determining herniation causality, it is important to realize that radiating clinical symptoms arising from an injury to an intervertebral disc are dependent on the anatomical positioning of the injured and inflamed disc material. It is only when the disc herniation is of a lateralized nature that the segmental nerve root is compressed or inflamed, producing radiation of axial symptoms to the corresponding upper or lower extremity. To discuss radiation as a primary indicator of acute traumatic injury to the intervertebral disc omits central disc herniations, which in and of itself do not typically produce extremity symptomology. When it comes to acute injury in the absence of radiating symptoms, local symptomatology should also be considered in approaching a mechanism and timing of the injury. Furthermore, one must also look at the morphology or architecture of the individual vertebrae as demonstrative evidence to age-date disc pathology inclusive of both herniations and traumatically induced, directional, non-diffuse bulges, as described by Fardon et al. (2014).

This is Wolf’s Law, as described by Isaacson and Bloebaum (2010): “Physical forces exerted on a bone alter bone architecture and is a well-established principle.…”(p. 1271). This has been understood and accepted as a general principle since the late 1800s and has been verified through the past century’s research, inclusive of contemporary research. Simply put, if a bone has abnormal stresses, it will change morphology or shape within expected parameters. Since these changes are “expected,” the question becomes, “How does Wolf’s Law apply to traumatic external forces and acute disc injury and how does this relate to causality?”

In order to fully understand the process, it is critical to understand the biochemical reaction (functional adaptation) that occurs with abnormal stresses on bone, which centers on bioelectric changes that occur at the cellular level.

According to Issacson and Bloebaum (2010), when tissue is damaged, the injury potential creates steady, local electric fields that result from ion flux (positive and negative charges moving through local cellar membranes) that are an integral part in the regeneration/remodeling of bony tissue. Bone remodeling is a tightly coupled functional system and is strongly influenced by age, activity level and mechanical loading. This functional adaptation of bone demonstrates the unique ability of bone to alter its trabecular (structural bone tissue) orientation as a result of loading conditions. According to Frost (1994), bone remodeling is a direct response to mechanical influences and strains on the osseous system. This can occur as a normal process to strengthen bone, or as a response to altered anatomy, biomechanics or direct traumatic injury. Since this is a predicable scenario, we can identify specific factors that will help us to determine whether the response was present over time or is at the beginning phase of remodeling. That is the fundamental basis for putting a causally related date to the injury.

Isaacson and Bloebaum (2010) note that in regard to the remodeling of bone, the successful growth of additional supporting bone results from a combination of competent mechanical strain stimuli and endogenous electrical currents (bio-electrical changes). Simply put, it is the mechanical stresses and the flow of the bioelectric compounds that work in conjunction with one another to strengthen or produce additional bone to functionally “buttress” the joint segment.  The above mentioned endogenous electrical current/bioelectrical changes are more commonly known as the “piezoelectricity,” or the body’s electrical reaction to pressure or mechanical stress. It is this electrically and mechanical-based system that subsequently controls osteogenic (osteo=bone; genic=to create) activity. The amplitude or amount of electrical potential is dependent upon on the magnitude of the mechanical bone loading, while polarity (meaning, the application of the bioelectric charge) was determined by the direction of the deformed bone. Isaacson and Bloebaum (2010) reported, “The specific loading pattern of bone has been documented as an important piezoelectric parameter since potential differences in bone have been known to be caused by charge displacement during the deformation period” (p. 1271). What this means is that application of Wolf’s Law to a bony segment is dependent on the amount of mechanical stresses as well as the direction of those forces, and is therefore based on basic engineering principles in the body. The extent and direction of the bone’s response to these forces is predictable and expected.

Additionally, Isaacson and Bloebaum (2010) noted that increased pressure surround the bone inhibits specific hormones preventing the uptake of calcium in the blood…which, in turn, results in the additional uptake of calcium within bone itself, causing additional bone to be produced.

Now that we understand what is happening from a physiological perspective when the bone responds to normal or abnormal mechanical stresses, the aging processes, or an acute traumatic injury, the question becomes, “Can we objectively predict this process in the human spine?”

He and Xinghua (2006) studied the predictability of bone remodeling, which included both the external shape and internal bone density distribution. They extended the simulation of the external shape of bones to determine and to predict pathological changes in bone: specifically, the osteophyte on the edge of a bone structure. They reported, “The significance of this work were [sic]: (1) it confirmed that osteophyte formation was an adaptive process in response to the change of mechanical environment, which can be simulated numerically by combining quantitative bone remodeling theory with finite element method; and (2) it can help to better understand the relationship between bone morphological abnormity and the mechanical environment.” (p. 96)

He and Xinghua (2006) also reported that with load-bearing bones such as the femur and vertebrae, mechanical factors are crucial to the morphology and changes in boney structures that relate closely to changes in mechanical environments. In addition, changes in bone structure morphology are slowly progressing processes unless other factors such as trauma or inflammation are included, at which time the processes will be accelerated to change the bone structural morphology. What that means is that there is a “genetic timing” to the remodeling process that can be altered (increased) by the presence of specific conditions such as an acute injury or inflammation.

According to He and Xinghua (2006), when only the local mechanical environment changes or a directional change in force coefficients is present, then only part of the vertebrae will remodel leaving the rest of the vertebrate unchanged. Meaning, if there is a one-sided lesion creating pressure unilaterally, only that side of the disc will create an osteophyte. This is very similar to the formation of a callus on your hand or foot. “In this paper, the main pathology of osteophyte formation was associated with the structural deterioration of intervertebral disc.” (He and Xinghua, 2006, p. 97)

These researchers further discuss that the remodeling process will continue until the biomechanical failure is resolved and the body has reached a biomechanical equilibrium by placing an osteophyte on the edge of the vertebrae, one whose size and strength is based upon the influencing mechanical imbalance. They concluded that only the bone in the area of mechanical imbalance would be compromised.

Although individuals have different formation rates and the osteophytes may vary in size, everyone is subject to morphological changes depending upon mechanical imbalances in the spine. He and Xinghua (2006) concluded that, “…it will actually take about more than half a year to observe the bone morphological changes…” (p. 101). This indicates that it takes approximately 6 months for an osteophyte to be a demonstrable post-mechanical failure or imbalance. This again gives a time frame to better understand if pathology of the intervertebral disc has been present for a long period of time (pre-existing) or has been produced as the direct result of the specific traumatic event by lack of the existence of an osteophyte, meaning the disc pathology is less than 6 months in duration.

In conclusion, we would like to remind you readers that, by definition, a disc is a ligament, connecting a bone to a bone, and it has the structural responsibility to the vertebrate above and below to keep the spinal system in equilibrium. Damage to the disc through a tear (herniation or annular fissure) or a directional, non-diffuse bulge will create abnormal load-bearing or biomechanical failure on the side of the disc lesion. Since we have previously defined the term “violent trauma” as not being dependent upon the amount of damage done to those structures either around or containing the victim, and we have determined there were ample force coefficients to produce injury to the spine, then based upon the current literature, we can now accurately predict in a demonstrable manner the timing of causality of the disc lesion. This is both based upon the symptomatology of the patient and/or the morphology of the vertebral structure and is a subject that can no longer be based upon rhetoric.

Now we will discuss how spinal experts document causalitywithdisc and ligament injuries….

“The clinical presentation is a disc bulge in their neck and some arthritis, so their neck symptoms are not related to the crash. There is a low back herniation but lots of people have those and don’t have pain.  It is our opinion it was there before the crash.”

That statement from an adjuster is an argument that has been made for years, allowing insurance companies to inappropriately reduce settlements to their clients based on the client’s inability to prove when or how their injury really occurred. To factually counter this type of statement, one must use imaging and age dating, with an understanding of biomechanics, in order to demonstrably discuss causality. Without medical experts utilizing the current medical and academic research available, it will continue to be difficult for any argument to be made explaining the nature and long-term effects of these injuries based on scientific fact vs. rhetoric

Imaging of the spine is critically important in all cases of injured clients. In traumatic cases, imaging is necessary for diagnosis, triage and proper co-management of bodily injuries. Imaging needs to be performed as per the current academic and contemporary medical/chiropractic standards to ensure an accurate diagnosis. The most common injuries in car accidents are spinal related, and the basic imaging available includes x-rays, CAT scans and magnetic resonance imaging (MRI), allowing medical providers to make an accurate diagnosis, when clinically indicated.

Every medical provider in Colorado, from MD to DO to DC—for diagnosis/prognosis purposes—has a license to see and treat car related injuries. However, a “license” is not the same as “specialization.”  By way of illustration, although psychiatrists are MDs and might have a license to do heart surgery, it would not be in the best interest of the patient.  Nor would I go to a spine surgeon for psychological concerns even though they are fully licensed to treat medical conditions. In spinal trauma, certain providers specialize in connective tissue injuries of the spine, allowing us to go one step further in diagnosis, prognosis and management…including “age-dating” these commonly found disc and ligament injuries.

To understand age dating, one needs to have a basic medical understanding of anatomy and physiology, as well as what tissue is commonly injured and the probable “pain generator.”  Since neck injuries are the most common injuries seen in car crashes, cervical spinal joints will be our focus. Related to anatomy, every set of two vertebrae in the neck is connected with three joints: one disc and two facet joints. These joints allow for normal movement of the spine (mobility). Additionally, there are multiple ligaments that hold these joints together and are responsible for stability. The proper balance of mobility and stability is critical when looking at the biomechanical part of patient’s injuries…meaning that too much or too little movement in spinal joints can cause pain, secondary to damaged tissue. The tissue most commonly injured in a car crash is muscle/tendon, ligament, disc, facet, and nerve. Spinal cord and bone injuries also occur although less frequently. To determine causality, the provider should comment on what tissue is injured, and also use imaging to help determine when this injury occurred (i.e., age-dating).

There are two basic problems that must be addressed. Fardon and Milette (2001) reported, “The term ‘herniated disc’ does not infer knowledge of cause, relation to injury or activity, concordance with symptoms, or need for treatment” (p. E108).  Simply having the presence of a disc herniation, without a physical exam or without proper symptom documentation, does not allow one to comment on the cause of the injury. In a rear-impact collision for example, even when the diagnosis is confirmed, additional criteria need to be met to answer the question, “Was there enough force generated into the vehicle and the occupant to cause the cervical/lumbar herniation?” Fardon, in a follow-up study (2014) reported that disc injury “in the absence of significant imaging evidence of associated violent injury, should be classified as degeneration rather than trauma” (p. 2531).  So, we must more objectively define the subjective connotations of “violent injury” and address the issue of “degeneration rather than trauma.” Although this statement can often be misleading, it gives the trauma-trained expert doctor a basis in going forward, understanding that every patient’s physiology is unique and not subject to rhetoric, but clinical findings.

Violent injury to the occupant can occur when there are sudden acceleration and deceleration forces (g-force) generated to the head and neck that overwhelm connective tissue or bring them past their physiological limit. To determine the acceleration force, “delta V” (ΔV as it appears in equations) is used.  Delta V is the change in velocity of the occupant vehicle when it is hit from behind (i.e., going from a stopped position to seven miles per hour in 0.5 seconds due to forces transferred from the “bullet” vehicle to the “target” vehicle).  Using these data, research allows us to make specific comments related to violent injury. For the purpose of this article, we are oversimplifying because the cervical spine is exposed to compression, tension and shearing forces. In addition to g-force and the elastic nature of most rear impact crashes makes it nearly impossible to find a true minimum threshold for injury although the literature has given us many examples of low-speed crashes that are dependent not simply on speed, but the mass (weight) of the subject vehicles. Each person’s susceptibility to injury is unique.  As stated previously,  while g-force alone isn’t insufficient to predict injury, Krafft, et al. (2002) reported that in low-speed collisions there is an injury threshold of 4.2 g-force for males and 3.6 g-force for females.  Krafft’s research is unique in that she has access to insurance data that is inaccessible to most researchers. Panjabi (2004) showed that forces as low as 3.5 g-force impacts would cause damage to the front of the disc, and 6.5 g-force and 8 g-force impacts would cause disc damage posteriorly where the neurological elements are.

A spinal biomechanical expert can then look for conclusive evidence by age-dating disc and joint pathology, based on two phenomena. First, it is well known that the body is electric. When an electromyography exam (EMG) is performed, we are measuring electrical activity along nerves to diagnose radiculopathy, which is nerve damage. Second, there are also normal bioelectrical fields in all tissue, known aspiezoelectricity. When an injury occurs, this normal electrical field is disrupted, and as previously stated, in the case of spinal joints, calcium is drawn into the damaged tissue creating bone spurs.  Issacson and Bloebaum (2010) reported, “The specific loading pattern of bone has been documented as an important piezoelectric parameter since potential differences in bone have been known to be caused by charge displacement during the deformation period” (p. 1271).  Fortunately for the patient, we are able to tell how much of this process has occurred either before or after their crash, specifically when we take into account the soft tissue damage seen and evidence of bone/calcium deposition.

Additionally, the body begins a healing process that includes regeneration and remodeling of both soft and hard tissue as reported by Issacson and Bloebaum (2010).  Spinal vertebrae have a unique structure of bone that allows it to adapt to abnormal mobility and stability (injury) by changing shape, which can be seen on radiographs or MRIs.  Furthermore, the bone will change shape according to predictable patterns based on the increased pressure or load that it undergoes post-injury. Issacson and Bloebaum stated that, “Physical forces exerted on a bone alter bone architecture and is a well-established principle…” (p. 1271).  This again is known as Wolff’s Law, first established in the 1800s.  Since we know what “normal” is, when we see “abnormal” findings due to mechanical stress we can broach the topic of an acute injury versus a degenerative process causing the abnormality and make specific medical predictions accordingly.

He and Xinghua (2006) studied the predictability of this bone-remodeling process and were able to make predictions of pathological changes that will occur in bone, specifically the osteophyte (bone spur) on the edge of a bone structure.  Significantly, they noted their findings “confirmed that osteophyte formation was an adaptive process in response to the change of mechanical environment.”  They noted that mechanical factors are crucial to the morphology of bones, notably load-bearing bones such as the femur and vertebrae.

For readers familiar with current medical and academic accepted nomenclature for disc damage, recognized by the combined task forces of the North American Spine Society (NASS), the American Society of Spine Radiology (ASSR) and the American Society of Neuroradiology (ASNR), disc herniations must have a directional component. When this occurs, the abnormal and additional pressure at the level of the disc damage matched with the direction of the herniation will cause only that part of the vertebrae to remodel.

Thus, if there is a C5/6 right-sided herniation (protrusion/extrusion) secondary to a cervical acceleration/deceleration injury, then only that side of the vertebrae will change shape, creating an osteophyte.  This compounded loading on the facet joint additionally causes facet arthritis. This process is similar to the formation of a callous on your hand or foot: The callous is a known and expected tissue response to increased load/friction exposure. Similarly, an osteophyte is a known and expected bone response to an increase in load/friction exposure.

At a basic level, the body has an electrical and mechanical response to injury resulting in additional stress that causes calcium (bone) to flow into the area of injury to further support the joint. The joint then abnormally grows, creating a pathology called hypertrophy, degeneration, disc osteophyte complex, or arthritis/arthropathy, common terms seen in radiology and doctor’s reports.

Everyone is subject to these morphological (structural) changes, which are always and predictably dependent on mechanical imbalances in the spine. Remember from the previous discussion, He and Xinghua (2006) concluded that, “…it will actually take about more than half a year to observe the bone morphological changes…” (p. 101). This indicates that it takes approximately six months for an osteophyte (bone spur) to be demonstrable post-mechanical failure or imbalance. This again provides a time frame to better understand if pathology of the intervertebral disc has been present for a long period of time (pre-existing) or has been produced as the direct result of the specific traumatic event by lack of the existence of an osteophyte, meaning the disc pathology is less than 6 months old, dependent on location and direction of the pathology.

In conclusion, that by definition, a disc is a ligament connecting a bone to a bone and it has the structural responsibility to the vertebrae above and below to keep the spinal system in equilibrium. Damage to the disc due to a tear (whether a herniation or an annular fissure) or a bulge will create abnormal load-bearing forces at the injury site.  These present differently depending on [1] if traumatic, as biomechanical failure on the side of the disc lesion, or [2] if age related, as a general complex.  Since other research and human subject crash testing have defined the term “violent trauma” as not being dependent upon the amount of damage done to the vehicle but rather to the forces to which the head and neck are exposed, we can now accurately predict in a demonstrable manner the timing of causality of the disc lesion. This is based upon the symptomatology of the patient and/or the morphology of the vertebral structure and is a subject that can no longer be based upon mere rhetoric or speculation.

References:

Fardon, D. F., & Milette, P. C. (2001). Nomenclature and classification of lumbar disc pathology: Recommendations of the combined task forces of the North American Spine Society, American Society of Spine Radiology, and American Society of Neuroradiology.Spine, 26(5), E93–E113.

Fardon, D. F., Williams, A. L., Dohring, E. J., Murtagh, F. R., Rothman, S. L. G., & Sze, G. K. (2014). Lumbar Disc Nomenclature: Version 2.0:Recommendations of the combined task forces of the North American Spine Society, American Society of Spine Radiology, and American Society of Neuroradiology.Spine,14(11), 2525-2545.

Brault J. R., Wheeler J. B., Siegmund, G. P., & Brault, E. J. (1998). Clinical response of human subjects to rear-end automobile collisions. Archives of Physical Medicine and Rehabilitation, 79(1), 72-80.

Krafft, M., Kullgren, A., Malm, S., and Ydenius, A. (2002). Influence of crash severity on various whiplash injury symptoms: A study based on real life rear end crashes with recorded crash pulses. InProc. 19thInt. Techn. Conf. on ESV, PaperNo. 05-0363, 1-7.

Del Grande F., Maus T. P., & Carrino J. A. (2012). Imaging the intervertebral disc: Age-related changes, herniations and radicular pain.Radiological Clinic of North America 50(4), 629-649.

Issacson, B. M., & Bloebaum, R. D. (2010). Bone electricity: What have we learned in the past 160 years?Journal of Biomedical Research, 95A(4), 1270-1279.

Frost, H. M. (1994). Wolff’s Law and bone’s structural adaptations to mechanical usage: an overview for clinicians.The Angle Orthodontist, 64(3), 175-188.

He, G., & Xinghua, Z. (2006). The numerical simulation of osteophyte formation on the edge of the vertebral body using quantitative bone remodeling theory.Joint Bone Spine 73(1), 95-101.

Fardon, D. F., & Milette, P. C. (2001). Nomenclature and classification of lumbar disc pathology: Recommendations of the combined task forces of the North American Spine Society, American Society of Spine Radiology, and American Society of Neuroradiology.Spine, 26(5), E93–E113.

Fardon, D. F., Williams, A. L., Dohring, E. J., Murtagh, F. R., Rothman, S. L. G., & Sze, G. K. (2014). Lumbar Disc Nomenclature: Version 2.0:Recommendations of the combined task forces of the North American Spine Society, American Society of Spine Radiology, and American Society of Neuroradiology.Spine,14(11), 2525-2545.

Krafft, M., Kullgren, A., Malm, S., and Ydenius, A. (2002). Influence of crash severity on various whiplash injury symptoms: A study based on real life rear end crashes with recorded crash pulses. InProc. 19thInt. Techn. Conf. on ESV, PaperNo. 05-0363, 1-7.

Batterman, S.D., Batterman, S.C. (2002). Delta-V, Spinal Trauma, and the Myth of the Minimal Damage Accident.Journal of Whiplash & Related Disorders, 1:1, 41-64.

Panjabi, M.M. et al. (2004). Injury Mechanisms of the Cervical Intervertebral Disc During Simulated Whiplash.Spine 29 (11): 1217-25.

Issacson, B. M., & Bloebaum, R. D. (2010). Bone electricity: What have we learned in the past 160 years?Journal of Biomedical Research, 95A(4), 1270-1279.

Studin, M., Peyster R., Owens W., Sundby P. (2016) Age dating disc injury: Herniations and bulges, Causally Relating Traumatic Discs.

Frost, H. M. (1994). Wolff’s Law and bone’s structural adaptations to mechanical usage: an overview for clinicians.The Angle Orthodontist, 64(3), 175-188.

He, G., & Xinghua, Z. (2006). The numerical simulation of osteophyte formation on the edge of the vertebral body using quantitative bone remodeling theory.Joint Bone Spine 73(1), 95-101.

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