Legislative Update April 2010

The Brain Injury Association of America continues to update us:

On Thursday, April 22, 2010, the Senate cleared an omnibus veterans’ health care measure that provides important assistance to both veterans and caregivers. S. 1963, as modified by the House, includes nearly $1.6 billion in authorizations for programs designed to aid caregivers of eligible veterans.

 

The measure, which now goes to the White House for President Obama’s signature, is intended to strengthen the health care support system for veterans and to expand services in rural areas. The measure will also expand caregiver programs, making them eligible for training and education assistance.

 

The bill also authorizes VA hospitals to contract with non-VA providers, as stated in the bill:

“The Secretary may contract with appropriate entities to provide specialized residential care and rehabilitation services to a veteran of Operation Enduring Freedom or Operation Iraqi Freedom who the Secretary determines suffers from a traumatic brain injury…”

 

Both BIAA and the Wounded Warrior Project have long advocated for approval of this measure and yesterday’s final passage signified a great victory for service members who suffer from TBI and their families.

 

Health Care Reform Update

After several weeks of delving into the final text of the health care reform bill, our partners at Powers, Pyles, Sutter & Verville, PC, sponsored by BIAA’s Business and Professional Council, have prepared an analysis of the major provisions that impact our community.

Endoscopy Center and Drug Manufacturer Trial Commentary

The first trial involving injured patients of Las Vegas Endoscopy Center began with Opening Statements this past Monday after a full week of Jury Selection. The plaintiff is represented by one of Las Vegas’ preeminent lawyers, Robert Eglet, who has amassed many multimillion dollar verdicts during his career. And to do what plaintiffs are doing in this case takes a Robert Eglet to pull off. Mr. Eglet has carefully and certainly orchestrated his evidence and witnesses and planned the destruction of the defendants’ evidence and witness. He has also made other subtle arrangements to upgrade his chances of winning big.

I make two points:

1.       Malpractice Caps are wrong and Result in Going Around.

2.      Leaking Settlements by other Defendants to the Jury May keep the Round Going.

This case, has been headline and news fodder for the past few years. Dr. Desai was paraded around the News Networks claiming he was not mentally competent to assist his counsel and otherwise villain-ized in the media. The Endoscopy Center was immortalized as a place of contaminating disease ridden practices. Nurses were subject to new regulations not allowing them to administer injections without a medical doctor present.

The past few years have created a public distrust and, I would say, outright hate of the Endoscopy Center, its physicians and Dr. Desai; Perhaps not for bad reason. I just point this out because it will only be useful for plaintiffs in this case. The more the jury dislikes one side the more apt they are to consider giving to the other side.

The interesting and potentially problematic issues are that the jury knows the “other parties” (Dr. Desai) settled.  Given public knowledge that Nevada adopted Medical Malpractice limits of $350,000, the jury pretty much knows about how much the plaintiff got. Simple math, combined with sympathy (which plaintiff here deserves) may cause a jury to award the difference between what plaintiff got and what they should get against the only parties left in the lawsuit: the drug company that makes the vials of the drug that was reused.

The theory goes like this: since the drug company could have and actually did make smaller 10ml vials they should not have sold 50ml vials to the Endoscopy Center since it would tempt medical workers to reuse used vials and spread disease. This is all caused by the drug company’s loss of profits producing 10ml vials when it could force all users to buy more expensive 50ml vials. In fact that is exactly what the drug company did, thus boosting its financial reports. This enhanced financial picture allowed the drug company to sell itself at a higher price thus enriching the owners and directors of the company. Hence the catch phrase, profits over consumer safety.

And herein is my first rub with the Medical Malpractice Cap of $350,000. Creative lawyers are left to their creativity. You can only get so much for a client injured by medical malpractice. And since lawyers spend so much of their time and money pursuing recovery for those clients, it makes little sense to champion these causes when the client may get little or nothing even if she wins. Mr. Eglet has tried to recoup the difference between what his client got out of the malpractice cap against Dr. Desai and the Endoscopy Center by suing the nearest deep pocket. 

"For full justice for what has happened to him, $10 million is the right number," Eglet said.

The theory? Well, that the company made vials that had too much medicine in them. This in turn “tempted medical workers to reuse vials among patients rather than throwing them away.” LVRJ, April 20, 2010.

Despite going against every medical principle known to the medical profession, intentionally contaminating patients, the temptation being too great for the medical workers is what the jurors will have to agree with to pay these injured plaintiff’s more than the small amount they got.  But since their temptation was only worth $350,000 Mr. Eglet, one of the few attorneys capable to do so in the state and maybe the country, will make that argument. But the insurance capping made it this way.

 And then of course the legislature can get campaign financing from anyone, including corporations. And corporations, according to the Supreme Court, derive the same rights as individuals.

In summary, the “going around” is the need to get around the malpractice caps.

My second point is; once the whole world (and the jury) found out that the “other defendants” settled out as reported on every local news network and paper, the jury will surmise,  whether the drug company was intentionally manipulative or not, the only way to pay these poor people will be to give them compensation from the remaining defendants. Typically, this so-called “empty chair” is not explained to a jury: where a defendant settles out before trial and another defendant does not. And no party can argue it was the defendant that settled out’s fault. Then an offset applies, by the Judge, after the jury makes its award without consideration of the other settlement. 

Here that empty chair is screaming “we already settled!” The fact that the jury hears that may give grounds to the losing party to appeal. And an appeal will take years. An appeal may result in another trial.

And so, the going round keeps going.

Implications Of 'Intelligent Design' For Human Behavior

What is Inteligent Design and What is Random?  I recently came across a statement by Wasserman and Blumberg in the May-June issue of American Scientist that I want to share.

Do not take this too seriously...or do.

Although evolutionists and creationists strongly disagree about the role that intelligent design plays in the origins of bodies and brains, they curiously agree about the role that intelligent design plays in the origins of human inventiveness. However, both camps would do well to focus less on perceived foresight and purpose and more on the actual origins of behavior.

Contemporary evolutionists such as Richard Dawkins should move beyond the arcane argument over where to draw the line between things that "really are designed" and "things that only appear to be designed." By doing so, Wasserman and Blumber note, we will better appreciate the actual forces that unite the processes of change across both evolutionary and developmental timescales.
And that I like:  appreciating the actual forces that unite the processes of change across both evolutionary and developmental timescales.  Is your language science?  Is it theology or philosophy?  Do you call it God, Jesus, Mohammad, or simply "the force?"  I believe something is there, what ever you want to call it.

Being Fat is Bad for Your Brain

Being fat is bad for your brain, says New York Times Commentator OLIVIA JUDSON.  Several recent studies reveal that being overweight in your 40s is directly porportional to dementia in your 70s.  Thin people over 40 have less decline in brain function than fat people over the next decades.

Brains usually atrophy with age, but being obese appears to accelerate the process. This is bad news: pronounced brain atrophy is a feature of dementia.

And so, as singer and songwriter Joe Jackson says on 1982's Night and Day, "everything gives you cancer" (or brain damage!).  Add food to the list!

ICD Heart Regulator Improves Thought Process

Interestingly, devices similar to pacemakers that regulate blood flow through heart control, promote good neuropsychological health.  A March 2010 study confirms.

A standard test of the implantable cardioverter defibrillator (ICD) is linked to significant thought-processing problems that improve for most patients within a year after the device is inserted, according to research reported in Circulation: Arrhythmia and Electrophysiology, a journal of the American Heart Association.

 Conclusions—ICD implantation is associated with neuropsychological impairment which dissipates for the majority of recipients after 12 months. Short-term memory function and attention are particularly vulnerable to changes in oxygen during ICD testing. Although, anxiety and depression are prevalent, there is little evidence for the direct impact of mood on cognition, and deficits appear not to be associated with reduced quality of life. These results provide evidence for longitudinal outcomes of ICD surgery and have implications for patient rehabilitation and adjustment.

Brain Injury Blood Test

Detecting Brain Injury, especially in trauma cases, is difficult.  Usually emergency medical technicians and emergency room physicians focus on the most pressing and visible injuries: blood gushing wounds and the like.

When a person comes to the ER with a TBI, doctors must determine if there is any bleeding in the brain.  Bleeding can cause a pool of blood that puts pressure on the surrounding brain tissue, causing more damage. Subdural and epidural hematoma being most common.  Currently, the best, quick way to look for intracranial bleeding is with a CT scan.  Unfortunately this test provides little resolution to actually see anything other than big masses of blood.

 CT scans are used to detect a number of potential problems for ER patients. So the demand for the units is often high and the wait for a scan for a TBI patient can be long. In addition,  in 95 percent of patients with mild TBI, the CT scans are normal.  So CT is not the best detector of brain injury, it is simply practical in that it is least invasive to the injured patient, takes realtively less time then other tests such as MRI, EEG, DTI and PET.

 Researchers are looking at another way to detect potential brain damage from a TBI, using a blood test instead of an imaging technique. The blood test looks for a marker, called S-100B, a type of protein from a type of brain cell known as an astrocyte. Studies show this marker is elevated in patients with a brain bleeding after a TBI.

 The blood test takes about 20 minutes to perform. However, studies suggest that the test must be done within three hours to ensure accuracy. If the test is negative, it’s most likely the patient doesn’t need a CT scan.

 The S-100B test is approved for use in Europe, but it is still under study in the U.S. Researchers are still enrolling patients in the US trial. In the future, a portable screener may be developed so that rescue workers can administer the test before the patient gets to the hospital. That will save time in the emergency room and enable doctors to start appropriate treatment faster.