October 15, 2012 - City of Laredo

11/23/2011 - Sgt. Flores is examined by Dr. A.R. Garza.
11/30/2011 - Sgt. Flores is examined by Dr. Puig.
12/16/2011 - Sgt. Flores is examined by Dr. Puig and referred to Dr. Sued for pain management.
01/10/2011 - Sgt. Flores is examined by Dr. Puig.
0212 1/20 1 1 0- Sgt. Flores is examined by Dr. Puig.
04/03/20 12 - Sgt. Flores is examined by Dr. Puig.
06/04/2012 - Sgt. Flores is examined by Dr. Puig.
06/20/2012 - Sgt. Flores is examined by Dr. Garza-Vale.
0711 6/20 12 - Sgt. Flores is examined by Dr. Puig.
07/20/2012 - Sgt. Flores is examined by Dr. Garza-Vale.
07/23/2012 - Sgt. Flores undergoes a second MRI. MRI indicates no evidence of nerve root damage.
08/08/20 12 - City requests a Designated Doctors (DD) exam.
08/13/2012 - TMLIRP requests to DD exam from the state
0811 012012 - Dr. Martinez requests second round of steroid injections.
08/20/2012 - TASB approves second round of steroid injections.
08/30/2012 - Sgt. Flores specialist, Dr. Garza-Vale retires
09/16/2012 - Sgt. Flores follows-up with his new specialist, Dr. Gerardo Zavala, who using the same
diagnostic medical information that both Dr. Puig and Dr. Garza-Vale , now recommends surgery on
three different levels of Sgt. Flores lumber levels. We are currently, awaiting approval from state
independent third-party reviewer TASB.
1011 9/20 12 - DD exam scheduled to be performed.
Summary:
Neither Sgt. Flores' primary physician, Dr. Puig, nor Sgt. Flores former neurosurgeon, Dr. Garza-Vale,
had recommended surgery throughout his medical care and did not determine the cause of Sgt. Flores'
symptoms of pain. . An EMG indicated an abnormal study, however a second MRI found no indication
of radiculopathy due to nerve root impingement causing any type symptom. Both of Sgt. Flores treating
doctors recommended conservative medical care consisting of medication, physical therapy and steroidal
injections. Dr. Garza-Vale subsequently retired and Sgt. Flores started seeing a new neurosurgeon, Dr.
Zavala, now recommends surgery based on the same medical information.
The City, thru, TMLIRP, has requested a designated doctor's (DD) examination, which is scheduled for
October 19,2012. Based on the aforementioned, staff recommends an extension of 90 days, enough time
for either surgery to be approved by TASB or the state appointed Designated Doctors to address
maximum medical improvement, impairment rating and ability to return to work based on all medical
information. If the DD indicates the Sgt. Flores is unable to return to work the City will need to extend
injury leave at that time if necessary.