I. Executive Summary
On March 14, 2024, Plaintiff Maria E. Smith sustained injuries when her
vehicle, a 2019 Honda Civic, was struck from behind on Interstate 880
in Oakland by a commercial delivery truck operated by an employee of
Defendant Continental Logistics, Inc. Plaintiff was the restrained
driver and only occupant.
Plaintiff's initial complaints of cervical and upper-back pain
progressed despite conservative management. Imaging confirmed disc
herniation at C6-C7 with left foraminal narrowing impinging the C7
nerve root. After failure of 24 sessions of physical therapy and two
cervical epidural steroid injections, Plaintiff underwent anterior
cervical discectomy and fusion (ACDF) at C6-C7 on July 11, 2024. As
of the most recent neurology evaluation (March 18, 2025), Plaintiff
has reached maximum medical improvement with permanent restrictions
and residual chronic pain.
Key findings
- Mechanism consistent with diagnosis.
MRI findings of C6-C7 herniation are consistent with rear-impact
MVA of the reported severity (MR-0518).
- Conservative care failed; surgery medically necessary.
24 PT sessions and 2 CESIs over 13 weeks without sustained relief
before surgical referral (MR-0671; MR-0967 to MR-1019; MR-1112).
- No prior cervical complaints in 5-year lookback.
PCP records 2019 to 2024 show no prior cervical pathology
(MR-0824 to MR-0931).
- Permanent impairment declared.
MMI reached March 18, 2025; permanent restrictions assigned
(MR-0792).
Medical specials to date
| Emergency department care | $8,420 |
| Diagnostic imaging | $4,830 |
| Physician consults (PCP, neurology, spine) | $5,180 |
| Physical therapy (52 sessions, pre- and post-op) | $7,800 |
| Pain management & 2 CESI procedures | $11,442 |
| ACDF C6-C7 surgery (St. Anne's Surgical Center) | $84,219 |
| Post-operative imaging & follow-up | $1,259 |
| Total to date | $123,150 |
Future medical specials and life-care plan reserved (Section IV).
II. Chronology of Treatment
Part 1 · Diagnosis and conservative care · March 14 to May 2, 2024
| Date | Event | Provider | Source |
| 2024-03-14 | ED admission post-MVA. Complaint of cervical and upper-back pain. Cervical strain dx; NSAIDs; PCP follow-up referral. | Mercy General ED · Cho, MD | MR-0421 · p.3 |
| 2024-03-14 | Cervical X-ray series (3-view). No acute fracture; straightening of cervical lordosis. | Mercy Imaging Center | MR-0506 · p.2 |
| 2024-03-16 | Return to ED. Persistent neck pain radiating to left arm. Discharged with cervical collar and short-course Norco. | Mercy General ED · Tran, MD | MR-0438 · p.1 |
| 2024-03-19 | PCP evaluation. Reported 7/10 cervical pain with left-hand paresthesia. PT and MRI ordered. | East Bay Family Medicine · Hammond, MD | MR-0824 · p.2 |
| 2024-03-22 | MRI cervical spine without contrast. Disc protrusion C5-C6; focal herniation C6-C7 with left foraminal narrowing impinging the C7 nerve root. | Mercy Imaging Center | MR-0518 · p.1 |
| 2024-04-01 | PCP follow-up. MRI reviewed. Neurology referral entered. | East Bay Family Medicine · Hammond, MD | MR-0847 · p.1 |
| 2024-04-09 | Neurology consult. EMG/NCS confirms left C7 radiculopathy. Recommended 6-8 weeks conservative care; surgical consult if no improvement. | Bay Area Neurology Partners · Patel, MD | MR-0671 · p.2 |
| 2024-04-12 | Physical therapy initial evaluation. 24-visit plan of care established. | Alameda PT & Rehabilitation | MR-0964 · p.1 |
| 2024-04-15 to 2024-06-14 | 24 physical therapy sessions completed. End-of-course functional assessment: limited improvement; persistent left radicular symptoms. | Alameda PT & Rehabilitation | MR-0967 to MR-1019 |
| 2024-05-02 | Pain management initial consult. Cervical epidural steroid injection scheduled. | Continental Pain Management · Okafor, MD | MR-1101 · p.3 |
II. Chronology of Treatment (continued)
Part 2 · Injection therapy through surgery · May 15 to August 9, 2024
| Date | Event | Provider | Source |
| 2024-05-15 | Cervical ESI #1 at C6-C7 (fluoroscopic guidance). | Continental Pain Management | MR-1112 · p.1 |
| 2024-06-05 | Pain management follow-up. Minimal relief reported (<30%). CESI #2 scheduled. | Continental Pain Management · Okafor, MD | MR-1118 · p.2 |
| 2024-06-19 | Cervical ESI #2 at C6-C7. | Continental Pain Management | MR-1124 · p.1 |
| 2024-06-26 | PCP follow-up. New objective finding: decreased grip strength left hand (3+/5). Spine surgery referral entered. | East Bay Family Medicine · Hammond, MD | MR-0891 · p.1 |
| 2024-07-01 | Neurology follow-up. Worsening C7 radiculopathy. Surgical referral confirmed. | Bay Area Neurology Partners · Patel, MD | MR-0712 · p.2 |
| 2024-07-05 | Surgical consult. ACDF C6-C7 with allograft and anterior plate fixation recommended. Risks and benefits discussed; consent obtained. | Pacific Spine Institute · Vasquez, MD | MR-1184 · p.4 |
| 2024-07-09 | Pre-operative evaluation. Cleared for surgery. | Pacific Spine Institute | MR-1198 · p.1 |
| 2024-07-11 | Anterior cervical discectomy and fusion (ACDF) at C6-C7. OR time 2h 14m. Discharged to home POD 1. | St. Anne's Surgical Center · Vasquez, MD | MR-1142 · p.4-7 |
| 2024-07-25 | Post-operative visit #1 (POD 14). Incision well-healed. Left-arm radiculopathy markedly improved. | Pacific Spine Institute · Vasquez, MD | MR-1212 · p.1 |
| 2024-08-09 | Post-op cervical X-ray series. Hardware in good position; early fusion progressing. | Mercy Imaging Center | MR-0612 · p.2 |
II. Chronology of Treatment (continued)
Part 3 · Post-operative rehabilitation to maximum medical improvement · August 15, 2024 to April 15, 2025
| Date | Event | Provider | Source |
| 2024-08-15 | Post-surgical PT re-evaluation. New 28-visit protocol initiated. | Alameda PT & Rehabilitation | MR-1024 · p.1 |
| 2024-08-15 to 2024-12-05 | 28 post-surgical physical therapy sessions. Discharged with home exercise program. | Alameda PT & Rehabilitation | MR-1027 to MR-1083 |
| 2024-10-03 | Post-operative visit #2 (POD ~84). Fusion progressing on imaging. Residual cervical stiffness. | Pacific Spine Institute · Vasquez, MD | MR-1224 · p.1 |
| 2024-12-10 | PT discharge evaluation. Plateau in functional gains. Home exercise program continued. | Alameda PT & Rehabilitation | MR-1087 · p.2 |
| 2025-01-15 | PCP visit. Residual chronic pain (4/10 baseline; 7/10 flare). Pain management re-referral. | East Bay Family Medicine · Hammond, MD | MR-0918 · p.1 |
| 2025-02-04 | Pain management visit. Trial of cyclobenzaprine for muscle spasm. | Continental Pain Management · Okafor, MD | MR-1136 · p.2 |
| 2025-03-18 | Final neurology evaluation. Maximum medical improvement declared. Permanent restrictions assigned (no overhead lifting > 15 lbs; no static cervical posture > 45 min). | Bay Area Neurology Partners · Patel, MD | MR-0792 · p.1 |
| 2025-04-08 | Defense IME (orthopedic surgery). Report received 2025-04-14. | Larson Orthopedic · Larson, MD | MR-1414 · p.1-18 |
| 2025-04-15 | Plaintiff's life-care planner evaluation. Future-care recommendations under review (see Section IV, reserved). | Coastal Life Care Planning · Becerra, CRC | MR-1456 · p.1 |
III. Source Register
Every entry above traces to a specific Bates range in the productions
below. The engine reviewed 1,500 pages across 9 custodians.
| Bates range | Custodian | Type | Pages | Produced |
| MR-0001 to MR-0500 | Mercy General Hospital | Emergency Department records, triage notes, ED physician notes, billing | 500 | 2024-08-02 |
| MR-0501 to MR-0660 | Mercy Imaging Center | Radiology reports and imaging studies (X-ray, MRI, post-op X-ray) | 160 | 2024-08-15 |
| MR-0661 to MR-0820 | Bay Area Neurology Partners | Consult notes, EMG/NCS, follow-up notes (R. Patel, MD) | 160 | 2024-09-04 |
| MR-0821 to MR-0950 | East Bay Family Medicine | PCP records 2019 to 2025 incl. 5-year lookback (A. Hammond, MD) | 130 | 2024-09-12 |
| MR-0951 to MR-1090 | Alameda PT & Rehabilitation | Initial and post-operative plans of care; daily SOAP notes | 140 | 2024-12-19 |
| MR-1091 to MR-1140 | Continental Pain Management | Pain mgmt consults and procedure notes (2 CESIs) (S. Okafor, MD) | 50 | 2024-09-30 |
| MR-1141 to MR-1242 | St. Anne's Surgical Center · Pacific Spine Institute | Pre-op evaluation, operative report, anesthesia record, surgical billing | 102 | 2024-10-08 |
| MR-1243 to MR-1380 | Pacific Spine Institute follow-up | Post-op visits, imaging review, return-to-activity orders (M. Vasquez, MD) | 138 | 2025-02-11 |
| MR-1381 to MR-1500 | Cross-provider supplemental productions | Final follow-up records, defense IME report, life-care planner intake | 120 | 2025-04-21 |
| Total | 1,500 | |
IV. Future-care plan (reserved)
The plaintiff's life-care planner evaluation is in progress as of the
records cut-off date. A supplemental chronology addressing projected
future medical specials, vocational impact, and household-services
loss will issue upon completion of that evaluation.
End of document. 29 events documented; 1,500 pages of records reviewed; every claim traceable to source.