Tort Un-Reform

This week brings good news that Lawmakers introduced an Assembly bill that would remove the key element of the 2004 medical malpractice reform initiative: Namely, the $350,000 cap on pain and suffering.  The incentive for the bill is the Hepatitis C crisis unfolding in Southern Nevada. The bill also allows additional time to file claims.

Medical malpractice is any action for personal injury against a healthcare provider based on professional negligence. This term is most often used to apply to a law suit brought by a patient against his or her physician as a result of getting “bad care.”

We all may recall the “Keep Our Doctors in Nevada” propaganda in 2003 that ultimately persuaded the vote to reform malpractice lawsuits. The insurance companies, leading the bridled doctors along with them, convinced unknowing consumers that their insurance premiums were rising and the selection of doctors lowering because lawyers were filing frivolous medical malpractice lawsuits.

I was trying a medical malpractice case in the old courthouse when the initiative was on the ballot. I remember watching my jurors have to cross the picketers on the courthouse steps holding signs to “Keep Our Doctors in Nevada!” I won the case but the jury told me later they thought they could only award $350,000!  My client had permanent brain damage.

From 2003 until present, doctors have gotten away with as much as using contaminated needles on patients passing along viruses. Hopefully consumers and voters have come to their senses regarding holding the medical professionals they trust with their care accountable.

This is an important issue that I will keep my eye on.

'Talk and die syndrome' made actress's death difficult to prevent

One question that I always ask a defending neurologist or neuropsychologist is whether a person is walking and talking after a brain injury automatically rules out the presence of brain injury.  They invariably say no and the recent Nataha Richardson case illustrates the fact.

JESSICA LEEDER  states that Condition masks severity of brain injury, prompting victims, such as Natasha Richardson, to refuse medical treatment, experts say

Natasha Richardson's fatal descent began when she suffered a rare bout of "talk and die syndrome" after falling on a Quebec ski hill with limited access to head-trauma specialists.

Brain-injury experts say victims of the infrequent syndrome, which masks head injuries, are often conscious after hitting their heads and lucid enough to deem themselves unhurt, as Ms. Richardson did this week, laughing off her tumble on a beginners hill at Mont Tremblant and declining an ambulance. Victims can appear healthy even though they require medical attention and, in some cases, are on the brink of death.

"You can't drag them screaming to the hospital," said Charles Tator, a University of Toronto neurosurgeon who emphasized that talk and die syndrome is an infrequent occurrence in brain-injury cases. Still, he said: "Every health-care professional, paramedic and ski patroller knows about this phenomenon. That's why you never allow a head-injured person to be alone."

Mont Tremblant employees told The Globe and Mail they monitored the actress after she returned to her hotel after the fall and summoned an ambulance when her condition began to deteriorate.

An autopsy revealed yesterday that Ms. Richardson sustained a brain-killing clot called an epidural hematoma. Although severe, epidural hematomas can be difficult to detect at the outset.

"I have had the privilege of saving many lives during my career in just this situation, where somebody bangs their head, has a lucid interval, has a blood clot, and is brought immediately for attention," said Dr. Tator, who is also the founder of ThinkFirst, a non-profit organization for the prevention of brain injury.

As the circumstances around Ms. Richardson's death have become more clear, they have prompted much hand-wringing at resorts, where officials feel there are limits to the amount of safety precautions and medical attention they can compel guests to accept.

"It gets to be a difficult call, particularly when the guest insists that they go home ... and don't take us up on the offer to see someone," said Brian Leighton, safety manager at the Whistler Blackcomb resort in British Columbia. "If the patients are conscious and able to make these decisions on their own, we can't force them onto a spine board or into an ambulance."

In the absence of legal regulations requiring skiers to wear helmets - resorts can suggest guests wear protective headgear but cannot ban adults who refuse - head injuries are difficult to prevent.

"People fall down on ski hills all the time," said Doug Firby, a spokesman for Sunshine Village Ski and Snowboard Resort in Banff, Alta. "Some of them bang their heads. I can't imagine a scenario in which you could actually force all those people to go to hospital."

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TBI Facts

Each year in the United
States, an estimated 1.4
million people sustain a
TBI.

Each year in the United
States, an estimated
80,000 - 90,000 people
experience the onset of
long-term disability
associated with a TBI.

Direct medical costs and
indirect costs (such as lost
productivity) of TBI are
estimated at $60 billion
annually. This number
does not take into account
returning military service
personnel with TBI.

10% to 20% of Marines
and Soldiers returning
from Afghanistan and Iraq
may have experienced
brain injuries.
 

Did You Know?

DID YOU KNOW?

  • A concussion is the most common type of brain injury sustained in sports.
  • Most concussions do NOT involve loss of consciousness.
  • You can sustain a concussion even if you do NOT hit your head. An indirect blow elsewhere on the body can transmit an “impulsive” force to the head and cause a concussion to the brain.
  • Multiple concussions can have cumulative and long lasting life changes.
  • Concussions typically do NOT appear in neuroimaging studies such as MRI or CAT Scans.
  • An estimated 1.6-3.8 million sports- and recreation-related concussions occur in the United States each year.
  • During 2001-2005, children and youth ages 5–18 years accounted for 2.4 million sports-related emergency department (ED) visits annually, of which 6% (135,000) involved a concussion.
  • Of the 1.4 million traumatic brain injuries sustained by children and adults in the United States each year, at least 75% are mild and/or concussions.
  • Among children and youth ages 5–18 years, the five leading sports or recreational activities, which account for concussions, include bicycling, football, basketball, playground activities, and soccer.

TBI Funding

Appropriations Action on Federal TBI Programs Just Around The Corner

Over the next few weeks, both the House and Senate Appropriations Subcommittees will be working to craft the FY 2010 Labor, Health and Human Services (HHS), and Education Appropriations bill, which will provide the funding allocation for programs authorized through the TBI Act and for NIDRR's TBI-related research programs, including TBI Model Systems of Care.

Federal funding for these important TBI programs has remained stagnant over the last several years, as Congress has not provided increases sufficient to keep up with the increasing cost of doing business. The urgent need for increased federal support for a national TBI public health infrastructure and TBI research is further heightened by the recognition of TBI as the signature wound of the wars in Iraq and Afghanistan.

With a new Administration in power, and a renewed focus on improving the nation's health care system, the need to adequately fund TBI programs must be clearly communicated to Members of Congress IMMEDIATELY.

To urge your representatives in Congress to increase funding for TBI programs this year, click this "Take Action" link.
 

Natasha Richardson Injured

In case you missed it, reported in yesterday's, Post Chronicle: Tragedy: Vanessa Redgrave Daughter, Natasha Richardson Brain Dead:

The daughter of Vanessa Redgrave, Natasha Richardson, has tragically been declared brain dead, according to sources close to Richardson and her family, and they are reportedly preparing to take the actress off life support.

It seems that what appeared to be a simple fall during a ski run has become a tragedy after Natasha Richardson's headache apparently turned into cerebral hemorrhaging.

The actress' husband, Liam Neeson, is by Natasha's bedside at a New York hospital, along with her mother, children and possibly other family members.

A close friend of the family tells People Magazine of Natasha's condition: "There is no chance...It is a fact that her heart is beating but she is brain dead."

Doctors have described Natasha's condition as a "leakage of blood between the brain and skull" and other doctors have said that her brain may have suffered pressurized swelling.

Another report has called Natasha's condition an Acute Subdural Hematoma, which is a form of traumatic brain injury in which blood gathers within the inner meningeal layer of the dura (the outer protective covering of the brain). Subdural hematomas are usually the result of a serious head injury. Acute subdural hematomas are among the deadliest of all head injuries. The bleeding fills the brain area very rapidly, leaving little room for the brain, and are associated with brain injury.

Now the family of Natasha will have to decide if they will take her off life support.

"It's not official yet, but they basically will detach her," a friend revealed to the press.

Neeson and Richardson have two sons, 13-year-old Michael and 12-year-old Daniel.

 Image: CraveOnline

TBI The Invisible Injury

TBI:
The Invisible Injury

A traumatic brain injury (TBI) is a blow or jolt to the head or a penetrating head
injury. The injury is caused by falls, motor vehicle crashes, assaults and other
incidents. Blasts are a leading cause of TBI for active duty military personnel in
war zones.

Any TBI—whether diagnosed as mild, moderate or severe—can temporarily or
permanently impair a person’s cognitive skills, interfere with emotional wellbeing
and diminish physical abilities.

Individuals with TBI may experience memory loss; concentration or attention
problems; slowed learning; and difficulty with planning, reasoning, or judgment.
Emotional and behavioral consequences include depression, anxiety,
impulsivity, aggression, and thoughts of suicide.

Physical challenges of TBI may include fatigue, headaches, problems with
balance or motor skills, sensory losses, seizures, and endocrine dysfunction.
TBI often leads to respiratory, circulatory, digestive, and neurological diseases,
including epilepsy, Alzheimer's disease, and Parkinson's disease.

Poor outcomes after TBI result from shortened length of stays in both inpatient
and outpatient medical settings; insurance coverage denials for rehabilitative
treatment; and inadequate funding for public services. Too often individuals with
TBI are prematurely discharged to untrained, unsupported family caregivers or
inappropriately placed in nursing homes, psychiatric institutions or correctional
facilities.

Maximal recovery and long-term health maintenance for people with brain injury
can only be achieved through a comprehensive, coordinated neurotrauma
disease management system providing for immediate treatment, medicallynecessary
rehabilitation, and supportive services delivered by appropriately
trained TBI specialists in the public and private sectors.
 

Alzheimer's and Diabetes

A history of diabetes and elevated levels of cholesterol, especially LDL cholesterol, are associated with faster cognitive decline in patients with Alzheimer's disease, according to a new study from Columbia University Medical Center researchers. These results add further evidence of the role of vascular risk factors in the onset and progression of Alzheimer's disease.
 

Read the full article by clicking here.

Las Vegas MD indicted in personal injury fraud case

The Las Vegas Review Journal ran a story describing  troubles for alocal spine surgeon and other participants of a possible conspiracy to defraud personal injury clients/patients. The AP reported the following:

A Las Vegas spine surgeon has been indicted on charges that he was part of a personal injury insurance fraud scheme.

Dr. Mark Kabins was due to appear Wednesday before a magistrate judge in U.S. District Court in Las Vegas on charges of conspiracy and seven counts of mail and honest services fraud.

U.S. Attorney Gregory Brower says Kabins could face 20 years and a $250,000 fine on each charge.

The 48-year-old Kabins is accused of falsifying medical records and conspiring with consultant Howard Awand and attorney Noel Gage to defraud a woman who was paralyzed following back surgery in 2000.

A federal judge last year dismissed charges against Gage and Awand after prosecutors refused to grant Kabins immunity for his testimony.
 

Brain Injury Awareness Month

H.Res. 178 Update

On Tuesday, March 10, 2009, H.Res. 178, a measure designating March as Brain Injury Awareness Month, was considered in a Business Meeting of the Committee on Oversight and Government Reform. The Resolution was presented to the Committee with 88 co-sponsors.

Once the committee adopts this Resolution, it will travel to the house floor to await chamber consideration.

The Brain Injury Association of America will keep all affiliates updated on the outcome. In the meantime, if you would like to view the Resolution, or see a current list of the co-sponsors, please visit www.thomas.gov.
 

Wartime troop brain injures could reach 360,000

This excerpt is from the AP:

The number of U.S. troops who have suffered wartime brain injuries may be as high as 360,000 and could cast more attention on such injuries among civilians, Defense Department doctors said Wednesday.

The estimate of the number injured — the vast majority of them suffering concussions — represents 20 percent of the roughly 1.8 million men and women who have served in Iraq and Afghanistan, where blast injuries are common from roadside bombs and other explosives, the doctors said.

The estimate came in a Pentagon news conference on activities planned this month to bring attention to brain injuries. The doctors said the number could be as low as 180,000, based on estimates that between 10 percent and 20 percent of troops might have received such injuries.

The previous high estimate offered publicly was 320,000 in a study released a year ago by the private Rand Corp. It was based on about 1.6 million who had done tours of duty in the wars from late 2001.

Though so-called "traumatic" brain injury can range from a mild form such as concussions to severe forms with penetrating head wounds, officials said the majority of injuries among troops are the mild form.

The overwhelming majority heal — and heal without treatment — but an estimated 45,000 to 90,000 troops have suffered more severe and lasting symptoms, said Brig. Gen. Loree Sutton, the head of the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury.

The Army alone spent $242 million last year for staff, facilities and programs to serve troops with brain injuries, said Lt. Col. Lynne M. Lowe of the Army surgeon general's office.

Sutton said that, as in previous wars, the research and other work being done by the military will eventually benefit the civilian world. Whether the injuries occur while people ride bicycles, play football, skateboard or ski, "we know that this is an issue across the country," she said.

"In the past ... it was difficult to get this on the radar screen," said Dr. James Kelly, director of the National Intrepid Center for brain injuries and psychological health. "Brain injury was not recognized as a problem ... of any consequence and was, especially in the sports community, often dismissed or trivialized."

"I think that now you're seeing it being taken very seriously," Kelly said. "The wartime experience has been a big part of that."

 

Guide to Selecting Lawyer in Spine Injury Case

Before x-rays there were broken bones. We just could not see them on films. Today many orthopedic injuries are visible on films and other diagnostic technology. Many times proving that someone broke a bone or injured the spinal column involves much more then simply reading an x-ray, MRI or CT Scan. Many other Syndromes and Nerve Injuries originate from, and are secondary to, the trauma and orthopedic injury. And as transportation, technology and speed increase, so do the mechanisms of injury.

When disability results - partial, whole, temporary or permanent - the issue becomes expressing it to a jury and receiving appropriate compensation. This can be done by having substantial knowledge in the areas of vocational rehabilitation, life care planning, reduction in value of life analysis, as well as anatomy and medical issues associated with the injury.

Here are some things to consider when deciding on a lawyer to represent you:

How many cases have you been involved with over the past three years?

What percentage of your practice of law is devoted to handling cases and injuries similar to mine?

What were the results in terms of settlements or verdicts of the last 5 cases you handled that were similar to mine?

What associations do you participate in that deal with injuries like mine?

List three textbooks that you own and refer to when discussing injuries similar to mine?

Show me a text you have read regarding my injury within the last 6 months.

Name the seminars dealing with my injury you have attended in the last two years.

How many articles have you written over the past three years that deal with any aspect of injury similar to mine?

Would your law firm be able and willing to spend in advance as much as $50,000 in the investigation, preparation, and presentation of my case, if necessary?

Hiring an attorney with the best qualifications is your right. Exercise it wisely because it may be one of the most important decisions you will ever make.

 

Siegfried & Roy Charity Event for Brain Institiute

Siegfried and Roy performed for the Lou Ruvo Brain Institute in Las Vegas.  Mike Weatherford of the Las Vegas Review Journal covered the story:

Siegfried & Roy never had a proper goodbye.

The legendary Las Vegas illusionists were never sure how long they would carry on. But retirement was forced on them in October 2003 when Roy Horn was mauled onstage by one of his show tigers.


Six years after Horn's determined rehabilitation, the two returned for a brief performance Saturday night that was both a comeback and a farewell, performing in front of about 1,000 people at the Keep Memory Alive fundraiser for the Lou Ruvo Brain Institute.

The short performance that capped a live auction began with a hooded torch-bearing acolyte walking onstage after the introduction, "The spirit of Siegfried and Roy has just arrived."

Some audience members upfront seemed to recognize right away that it was Horn. but it wasn't until the end of the performance, when the duo materialized one of their signature white tigers, that the masks came off and the two revealed themselves to a rousing ovation.

There were no words spoken to the audience beyond brief recorded bits of wisdom played over the speakers.

While there was no mention made to the crowd, their manager, Bernie Yuman, said through a publicist that the tiger in Saturday's show was Montecore, the tiger that inflicted the near-fatal injury on Roy.

Siegfried Fischbacher and Horn were trying to figure out when and how to bow out gracefully even before the accident that put an abrupt end to their show on Oct. 3, 2003.

The Mirage hit had been running for 131/2 years and 5,750 performances.

Horn had just celebrated his 59th birthday. But Fischbacher already had passed 60.

Questions of how long their bodies were up to the task were just as relevant as whether Cirque du Soleil and the new Celine Dion spectacular had eclipsed the Mirage spectacle that reinvented Las Vegas entertainment.

The magicians' real age became part of the grand illusion, except on the rare occasions when knee surgery or the flu would force a cancelation.

"The pain and drama and all that comes with the territory. That's irrelevant," Horn once said with a dismissive wave. Audiences "come to forget their problems. They don't need to hear about ours."

But the fact is, the two had worked tirelessly, with few breaks, from their earliest inroads on the Strip, as a 12-minute Tropicana "Folies Bergere" specialty act in 1967.

"For the first 15 years in Las Vegas, we worked seven days a week with no vacation and three shows on Fridays and Saturdays," Fischbacher once noted. "And we had to do it. There was no other choice."

The duo were the highest-paid specialty act in Las Vegas by 1981, when they opened their own show, "Beyond Belief," with backing from circus impresarios Irvin and Kenneth Feld.

The Frontier opus logged 3,500 performances for more than 3 million people.

The Mirage was the next big milestone.

"Sometimes it upsets me that Cirque has become so huge and everybody puts them on a pedestal," production designer Andy Walmsley, whose stage sets include "American Idol," noted recently. "People forget it was actually that Siegfried & Roy show that really changed show business. ... It was that show that really changed the Vegas landscape."

In February 2001, MGM Mirage announced a "lifetime" contract extension that guaranteed the duo at least another four years. By then, however, the stars seemed more excited about a more sensible schedule of eight shows per week.

Magic had driven Siegfried since he was 10 years old, he noted then. "Absolutely nothing else existed in the world. I don't know if this is right, all my life, to just think about one thing."

So it was a forced retirement when the 7-year-old show tiger Montecore turned on Horn, knocking him down and then dragging him from the stage, by most eyewitness accounts.

The tiger had inflicted a deep, near-fatal puncture wound in Horn's neck that kept him on the operating table through the night at University Medical Center's trauma center.

The real damage came with a stroke hours after the initial surgery, one that left Horn with partial paralysis.

But Horn progressed enough through physical therapy that he was able to stand in front of a banquet crowd celebrating his 60th birthday a year later.

 

Veterans' Courts in Nevada

State Assembly Speaker Barbara Buckley (D-Las Vegas) and a bipartisan group of Nevada legislators are sponsoring a bill that will assist some veterans accused of nonviolent crimes with a specialized court geared toward substance abuse and mental health treatment.


Studies show that PTSD sufferers are more likely to abuse drugs and alcohol. Nevada has chronicled the struggles of veterans returning from the nation’s current wars. http://www.reviewjournal.com/media/interactive/war_back_home.html Clark County officials report the possibility of creating a veterans-only court in response to the high rate of mental disorders among veterans from the current and past wars.


Currently Judges in Nevada are not required to ask if defendants have served in the military. They have no way of monitoring how many veterans pass through the justice system.


In veterans’ courts, like the one started last year in Buffalo NY, criminal proceedings are suspended before sentencing so that defendants can attend drug, alcohol, or mental health treatment programs. Upon completion, their criminal cases are usually dismissed.


This effort will definitely help the misunderstood trauma veterans endure fighting in this country’s military.