Malpractice Caps Unconstitutional
The American Justice Association reports Georgia's Malpractice caps are unconstitutional.
Georgia High Court strikes down cap on medical malpractice awards.
The Atlanta Journal-Constitution (3/23, Rankin) reports, "A unanimous Georgia Supreme Court on Monday struck down limits on jury awards in medical malpractice cases," ruling that the $350,000 cap on noneconomic damages violates the right to a jury trial guaranteed by the Georgia Constitution, as the cap "'clearly nullifies the jury's findings of fact regarding damages and thereby undermines the jury's basic function,' Chief Justice Carol Hunstein wrote for the court."
The AP (3/23, Bluestein) reports that the ruling "will likely herald a flurry of new litigation, as the court said the ruling applied retroactively to all other pending medical-malpractice cases, including those that are now in the appeals process." In the case before the court, Betsy Nestlehutt "was awarded $1.15 million in non-economic damages -- including $900,000 in pain and suffering -- by a Fulton County jury after she was permanently disfigured after a botched facelift."
The New York Times (3/23, A19, Brown) reports, "The ruling was praised by victims' rights groups and plaintiffs' lawyers and was condemned by doctors and Republican lawmakers."
The Fulton County Daily Report (3/23, Palmer) reports, "Atlanta lawyer R. Adams 'Adam' Malone of Malone Law, who represents the plaintiffs in Monday's case, expressed gratitude for the unanimous nature of the ruling."
BIAA Update November 20, 2009
Here is the latest from Sarah D'Orsie at the Brain Injury Association of America
Health Care Reform Update
This week, The Senate released and began debate on their Health Care Reform leadership measure. As many of you may know, originally, rehabilitation was not included in the Senate Finance bill as a minimum benefit. Due to the lobbying efforts of BIAA, largely supported and funded by our Business and Professional Council, we have been able to ensure that rehabilitation is a part of the minimum benefits package of the final product now being debated in the Senate.
Specifically, the Patient Protection and Affordable Care Act being considered would:
(Democratic leadership summary)
- Include immediate changes to the way health insurance companies do business to protect consumers from discriminatory practices and provide Americans with better preventive coverage and the information they need to make informed decisions about their health insurance.
-Uninsured Americans with a pre-existing condition will have access to an immediate insurance program to help them avoid medical bankruptcy and retirees will have greater certainty due to reinsurance provisions to help maintain coverage.
-New health insurance Exchanges will make coverage affordable and accessible for individuals and small businesses.
-Insurance companies will be barred from discriminating based on pre-existing conditions, health status, and gender.
-Expand eligibility for Medicaid to include all non-elderly Americans with income below 133 percent of the Federal Poverty Level (FPL), with substantial assistance to States for the cost of covering these individuals.
- Make long-term supports and services more affordable for millions of Americans by providing a lifetime cash benefit that will help people with severe disabilities remain in their homes and communities.
- Eliminate lifetime insurance limits in all new individual and group plans for plan years beginning 6 months after enactment.
Today, as the Senate opened a two-day debate on the bill, Congressional Quarterly reported that Majority Leader, Harry Reid is closing in on the 60 votes needed to overcome an anticipated filibuster and bring the measure to the floor. Reid has filed cloture the bill and the vote on the motion to proceed to the bill is expected to occur on Saturday at 8:00 pm.
BIAA will continue to monitor the bill's progress closely as debate continues. Also, documents relating to the Senate leadership bill can be found on BIAA's website under the Health Care Reform Library section:
http://www.biausa.org/policyissues.htm#library
Veteran's Health Omnibus Bill
On Thursday, November 19, 2009, The Senate voted to pass a package of veteran's bills (S1963) that included both S. 801 and S. 252, both important Veteran's health care measures supported by BIAA.
The bill would expand services in rural areas and ensure that veterans who are catastrophically disabled or who need emergency care in the community are not charged for those services. It would also authorize VA hospitals to contract with non-VA providers to ensure that our returning service members have access to the care that they so desperately need and deserve.
Legislative Update from BIAA October 2009
Here are the latest updates from the Brain Injury Association of America.
Health Care Reform Update
This week the Senate finance committee wrapped up debate on its version of a health care reform package. The committee now has finished debating the more than one hundred amendments offered to the bill. A final vote is possible next week, although the finance committee cautiously waits to hear the cost estimate of the measure from the congressional budget office.
BIAA will continue to monitor the situation as the legislation progresses.
Appropriations Update
Last week, Congress considered a measure, known as a continuing resolution (CR), that would keep the government funded into the 2010 fiscal year, which began on October 1, 2009. TBI related programs will be funded at FY2009 levels until the spending bills for next year have been approved.
The full Senate has yet to consider the Fiscal Year 2010 Labor, Health and Human Services and Education spending bill that 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.
BIAA will alert grassroots advocates when action is needed.
National Defense Authorization Update
As reported in a previous edition of Policy Corner, the Senate version of this year's National Defense Authorization bill includes an amendment that authorizes the Secretary of Defense to carry out a pilot program for providing cognitive rehabilitation therapy services under TRICARE.
As the House and Senate meet to debate the differences in the two versions in order to craft a final bill, BIAA has increased awareness among House members serving on the Armed Services Committee of the amendment and its importance to returning service members sufferring from TBI.
This week, Congressman Bill Pascrell, Jr. and Congressman Todd Platts, co-chairs of the Congressional Brain Injury Task Force, sent a letter to members of both the House and Senate Armed Services Committee members urging their support in preserving this amendment in the final bill. A copy of the letter can be viewed on our web site, or by clicking the link below:
http://www.biausa.org/elements/policy/cognitive_rehabilitation_ndaa_letter.pdf
Soldiers' brain injuries from blasts in Afghanistan take a toll
The brain injury toll on troops continues to manifest and escalate. This is not new news. Remember that better protective gear in recent wars means soldiers are staying alive after what would otherwise have been fatal injuries in previous wars. This, in turn, leads to survival with brain injury.
The Daily News from New York wrote this about the tragedy.
Afghanistan - It's the signature injury of the war, and the medics at this base just south of Kabul have seen their fair share of it.
It's estimated that 20% of soldiers in Iraq and Afghanistan have been diagnosed with traumatic brain injury, or TBI, caused by the impact of improvised explosive devices.
The medics of the upstate Fort Drum-based 10th Mountain Division, 3rd Brigade Combat Team have seen an increase in TBI cases in the past eight months here.
Brain Injury of America Announcement
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The Brain Injury Association of America asked I post this very important announcement: For Immediate Distribution Contact: Susan H. Connors, BIAA |
Overview of Catastrophic Cases
Overview of Catastrophic Cases
Timothy R. Titolo
What Constitutes a Catastrophic Injury?
For many, the term “catastrophic injury” needs no definition. Most know a catastrophe when they see one. Federal law defines “catastrophic injury” as an injury whose consequence permanently prevents an individual from performing any gainful work. 42 U.S.C.A. § 3796b.Moreover, Nevada law includes a serious illness or accident that renders the employee unable to perform his/her duties and is either life threatening or requires a lengthy convalescence as a “catastrophe” for purposes of a public employee who wishes to take "catastrophic leave".Nev. Rev. Stat.§ 284.362; Nev. Rev. Stat.§ 281.153.
Types of Catastrophic Injury
Although Nevada law does not specify the various types of catastrophic injuries, the following classification from Georgia statute provides a good overview of examples of catastrophic injuries:
(a) Spinal cord injury involving severe paralysis of an arm, a leg, or the trunk;
(b) Amputation of an arm, a hand, a foot, or a leg involving the effective loss of use of that appendage;
(c) Severe brain or closed-head injury as evidenced by:
1. Severe sensory or motor disturbances;
2. Severe communication disturbances;
3. Severe complex integrated disturbances of cerebral function;
4. Severe episodic neurological disorders; or
5. Other severe brain and closed-head injury conditions at least as severe in nature as any condition provided in subparagraphs 1.-4.;
(d) Second-degree or third-degree burns of 25 percent or more of the total body surface or third-degree burns of 5 percent or more to the face and hands;
(e) Total or industrial blindness; or
(f) Any other injury that would otherwise qualify under this chapter of a nature and severity that would qualify an employee to receive disability income benefits under Title II or supplemental security income benefits under Title XVI of the federal Social Security Act as the Social Security Act existed on July 1, 1992, without regard to any time limitations provided under that act.
Ga. Code Ann., § 34-9-200.1.
Evaluating Liability and Damages
The Supreme Court of Nevada has held that damages in personal injury cases should be calculated based on modicum of rationality and not with mathematical precision. See Greco v. U.S., 893 P.2d 345, 418 (Nev. 1995). In Hill v. U.S, 854, F. Supp, 727 (D. Colo., 1994), the federal district court in Colorado considered the following facts in evaluating the economic damages in a catastrophic injury claim:
1. Expenses for periodical medical care that is required during the lifetime of the injured with regard to the nature of injury suffered. See id. at 730.
2. Expenses for present and future medication and supplies with regard to the nature of the injury suffered. See Id.
3. Expenses for providing and facilitating required personal care to the injured depending upon the nature of the injury. See id.at 730-31.
4. Expenses for providing psychological counseling to the family members of the injured to cope with the injured person’s demands and need and to assist them in providing care to the injured. SeeiId.at 731.
5. Expenses for appointing case management professional to assist in the planning, coordinating and supervising the care of the injured depending upon the complexity of the medical and physical care services required by the injured. See id.
6. Expenses for the special transportation facilities that the injured person’s physical impairment requires. See id.
7. Expenses for developmental assessment to monitor the developmental progress and to access the injured person’s needs. See id.
8. Expenses for rehabilitation services to give required physical therapy and other therapies such as occupational therapy, speech therapy etc., depending upon the nature of the injury. See id.
9. Expenses for special equipments required for the injured. See id. at 732.
10. Expenses for home modification that is required by the family to modify the home to accommodate injured person’s special equipments and needs. See id.
Apart from the above, economic damages are also awarded on the basis of future loss in earning capacity. See id.
Evidentiary Issues
I am writing from the perspective of a practitioner and have attempted to provide an overview of the evidentiary issues associated with litigating catastrophic injury claims, especially from the plaintiff’s perspective. My intent is not to provide an academic discussion that covers all aspects of this topic. However, for a deep and detailed discourse, please see 72 Am. Jur. Proof of Facts 3d § 363 (2007) which discusses these issues in the catastrophic brain injury context. I have used the foregoing resource as a reference point for organization and to identify key points.
Injury:
More often than not, in a catastrophic injury, particularly a traumatic brain injury, the injured person exhibits memory deficits. Even though such people cannot describe the situation exactly, the occurrence of the injury has to be ascertained by the circumstances surrounding the accident/incident. It is the duty of plaintiff's counsel to carefully analyze all available evidence about the accident and endeavor to integrate each of those facts into a cohesive narrative that shows the finder of fact that the defendant acted in a negligent manner. Plaintiff’s counsel should supplement the plaintiff’s deposition testimony with other prior statements if the plaintiff is unable to recall the facts of the accident. Counsel should be mindful, however, that such deposition testimony should corroborate rather than contradict the plaintiff's prior statements or testimony.
Elements to Establish:
The necessary elements to establish negligence by the defendant are long-established: a legal duty to the plaintiff, a breach of that duty, and damages proximately caused by the breach of duty. It is the plaintiff's ability to establish a prima facie case through circumstantial evidence which is of particular importance in claims involving traumatic brain injuries given the frequent inability of brain-injured clients to recall the specific facts surrounding their injuries. If the case is based on circumstantial evidence, the plaintiffs must present facts from which the defendant's negligence and causation of the accident by that negligence may be reasonably inferred.
Generally, causation of a medical condition and permanency of an injury must be established by testimony of medical experts. Such testimony must show that the indicators of a permanent disability resulting from the traumatic brain injury outweigh those to the contrary. Claiming damages for loss of earning capacity is generally recoverable when such loss is an immediate and necessary consequence of an injury.
Duty to plaintiff and the court’s view:
In the context of a brain injury case, whether defendant has a duty to the plaintiff is a question of law that has to be decided by the court. Once the court determines that one party owes a duty to another, it is important to know the scope and extent of the duty, namely the standard of care that the defendant had to meet and the actual care that the defendant took. Once the court has determined the appropriate standard of care, the jury addresses the factual question of whether that duty has been breached.
Further, there is no legal requirement that a jury make a damage award simply because liability is found. In determining the appropriate amount of compensation for such loss, the jury must consider the plaintiff's age and occupation, the nature and extent of the plaintiff's pre-injury employment, the value of the plaintiff's services and the amount of income that the plaintiff was earning at the time of injury. For ascertaining the damage, expert testimony is not certainly required, but it may be of assistance to the jury, especially on the issue of lost earnings. However, plaintiff's personal projection of future loss of earnings may be admitted where the future plans described by plaintiff are consistent with facts in evidence regarding his or her employment and educational history and where the plaintiff's projections are supported by expert medical testimony.
Damages:
A plaintiff may make a claim for money damages including actual damages, compensatory damages (including reimbursement for attorney fees and for retaining experts, compensation for medical injuries, subsequent injuries, disability, compensation for lost earning capacity, and plaintiff's personal projection of future loss of earnings). Any award of punitive damages is completely within the discretion of the fact-finder.
Plaintiff’s counsel should also be mindful of the duty to mitigate damages. In Nevada, the law regarding the mitigation of damages states that “[a] person who has been damaged by the wrongful act of another is bound to exercise reasonable care and diligence to avoid loss and to minimize the damages, and he may not recover for losses which could have been prevented by reasonable efforts on his part or by expenditures that he might reasonably have made.”Lublin v. Weber, 108 Nev. 452,454 833 P.2d 1139, (Nev., 1992); Silver State Disposal Co. v. Shelley, 105 Nev. 309, 774 P.2d 1044 (Nev., 1989). Defense counsel should, of course, explore any possible failure to mitigate by the plaintiff as a potential defense to avoid or reduce a damages award.
The Nevada collateral source rule prohibits the jury from reducing the plaintiff's damages on the ground that the plaintiff received compensation for his injuries from a source other than the tortfeasor. Nev. Rev. Stat. § 17.130;Bass-Davis v. Davis, 134 P.3d 103, 110-11 (Nev. 2006). Plaintiff’s counsel should be mindful to object to any attempts by the defense to introduce evidence of other sources of compensation for the plaintiff. Introduction of such evidence can lead to a new trial for the plaintiff. See Davis, 134 P.3d at 111.
Discovery and Investigation
Generally, litigation discovery is governed by Fed. R. Civ. Pro. 26 for federal trials and Nev. Rev. Stat. Rule 16.2(b)(2) for Nevada state court litigation. However, my discussion is aimed at providing an overview of some of the specific discovery issues that arise in the catastrophic injury context. For a more detailed discussion, I refer you once again to 72 Am. Jur. Proof of Facts 3d § 363 (2007), which I have used to help organize this discussion and to identify salient points for this overview.
1) Information to be obtained from the plaintiff prior to commencement of litigation:
The discovery methods in such cases require a thorough prior knowledge of all the previous incidents surrounding the plaintiff’s injury to maximize the results of the trial for the plaintiff. Discussion with the plaintiff about the mechanism of injury, resulting symptoms and long term effects serves as a primary source of information. Plaintiff’s counsel may obtain necessary information from potential witnesses such as the physicians who treated the plaintiff both prior and/or subsequent to the injury, information from the family members of the injured describing the affect, frustration, post-injury emotional distress, and information from the plaintiff’s employer, and co-workers about the changes they have noted in the plaintiff’s ability to work.
2) Information to be obtained from medical expert.
The next step in the preparation of the discovery proceedings would be to consult the expert who will be called at trial as part of the plaintiff’s case. Besides obtaining the background information of the expert, the other important information to be obtained from the expert is his prior litigation history mentioning the percentage of cases in which the expert testified on behalf of the plaintiff and the defendant and also the educational and employment qualifications. Counsel should ask the expert regarding the date, location of the first contact with the plaintiff, the occasions on which the plaintiff will require treatment, tests performed (and the nature of the tests and their purpose and results), and the treatment provided to the plaintiff. Plaintiff’s counsel should pose questions to the expert regarding the expert’s opinion about the medical certainty that the plaintiff suffered an injury, cause of the injury, signs, symptoms, complaints, whether the problems exhibited by plaintiff were the result of that injury, and whether any pre-existing conditions have been distinguished from the injuries at issue.
3) Information to be obtained from economist or other expert regarding special damages
Plaintiff’s counsel must collect necessary information from economists or other experts being called in support of the plaintiff’s claim of damages, especially in cases where the plaintiff has lost his earning capacity. Expert opinion as to the plaintiff’s lost earnings should address losses suffered as a result of plaintiff's inability to perform household tasks, plaintiff's future costs for medical care, reduction of such amounts to present value and methodology for calculating present value.
Conclusion
Major Causes of Low Back Pain
As we age, most of us will experience some wear and tear to the discs and vertebrae that make up the structural components of our spines. Here are the most common things that can go wrong.
Joint and Nerve Problems
1. Spinal Arthritis is inflammation of the facet joints between the vertebrae, which can cause stiffness and pain.
2. Sciatica is characterized by pain that radiates down one or both legs. It may be caused by compression of the sciatic nerve.
Disc Problems
3. A Normal Disc consists of a soft, gelatinous interior surrounded by a tough, fibrous membrane, with no sign of trauma or illness.
4. A Degenerative Disc is a disc that is gradually wearing down and thinning over time, most likely due to the natural aging process.
5. A Bulging Disc is one that is shifting out of its normal radius, extending beyond the circumference of the vertebrae.
6. A Herniated Disc occurs when the inner material of the disc pushes through its outer membrane into the spinal canal.
Vertebra Problems
7. A Bone Spur occurs when the body builds more bone as a natural response to the age-related deterioration of vertebrae.
8. Spinal Stenosis refers to a narrowing of the spinal canal, typically as a result of bone spurs or joint enlargement.
9. Spondylolisthesis is a forward or backward slippage of one vertebrae relative to another, causing pressure on spinal nerves.
10. Osteoporosis is a disease marked by progressively decreasing bone. In the spine, this can lead to a compression fracture.
The people at Titolo Law Office represent only those injured in car accidents, truck accidents, Death accidents, falls and most all injury accidents. Please give us a call at 702.869.5100 and find out how we can help you.
Urge Congress to Increase Funding for TBI Programs!
BIAA needs your help. Take Action!
The Appropriations Subcommittee on Labor, Health and Human Services and Education begins consideration of the FY10 funding bill today!
Over the next few days, the House Appropriations Subcommittee on Labor, Health and Human Services and Education will be considering a 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.
The time is now to urge Members of Congress to adequately fund TBI programs!
Alzheimer's Linked to Traumatic Brain Injury
It has been known that traumatic brain injury leads to increased risk of Alzheimer's.
Neuroscientist, Mark Burns, who is assistant professor at Georgetown University Medical Center (GUMC) in Washington, DC. is presenting a paper on their work at the Alzheimer's Association 2009 International Conference on Alzheimer's Disease (ICAD 2009) which is taking place from 11 to 16 July in Vienna, Austria.
The Stop Silent Suffering Website reports the following:
Researchers in the US found that the destructive cellular pathways that occur following traumatic brain injury are the same as those activated in Alzheimer's Disease, suggesting that both conditions could be treated with new drugs that target these pathways. They said the findings "cement" the relationship beween traumatic brain injury and Alzheimer's Disease.
The brains of elderly patients who died from Alzheimer's Disease often show a build up of a toxic peptide called beta amyloid. The same substance is also found in the brains of around one third of people who have suffered traumatic brain injury, including children.
When a traumatic injury occurs to the brain, a mass of brain cells or neurons dies, and this is then followed by a second "wave" of beta amyloid build up. This secondary damage can last several months or even years and leaves big holes inside the brain.
The people at Titolo Law Office represent only those injured in car accidents, truck accidents, Death accidents, falls and most all injury accidents. Please give us a call at 702.869.5100 and find out how we can help you.
Drug Development in Traumatic Brain Injury
Neal Farber PhD is on the Board of Governors for the International Brain Injury Association. IBIA recently published this article authored by Dr. Farber:
Developing drug treatments for traumatic brain injury (TBI) has been notoriously difficult. While most of the severe neural damage that accompanies acute TBI results from the initial impact, considerable additional damage occurs over the following hours and days by biochemical cascades triggering inflammation, cell death and disruption of neural pathways. It would be ideal to have a treatment that prevents this degeneration, but decades of clinical research have so far been unsuccessful. In addition, there are non-acute symptoms such as prolonged disorders of consciousness, long-term cognitive and physical impairments, for which treatments have not been developed. [full story]
The people at Titolo Law Office represent only those injured in car accidents, truck accidents, Death accidents, falls and most all injury accidents. Please give us a call at 702.869.5100 and find out how we can help you.
Latest Brain Injury Facts
The CDC post the latest Brain Injury Facts:
TBIs contribute to a substantial number of deaths and cases of permanent disability annually.
Of the 1.4 million who sustain a TBI each year in the United States:
50,000 die;
235,000 are hospitalized; and
1.1 million are treated and released from an emergency department.1
Among children ages 0 to 14 years, TBI results in an estimated:
2,685 deaths;
37,000 hospitalizations; and
435,000 emergency department visits annually.1
The number of people with TBI who are not seen in an emergency department or who receive no care is unknown.
Traumatic Brain Injury in the United States: Emergency Department Visits, Hospitalizations, and Deaths
Research Findings on Treatment Guidelines for Severe TBI
Facts about Concussion and Brain Injury and Where to Get Help
CDC Study Finds Traumatic Brain Injuries Can Result from Seniors Falls
To read more join Chis Levinson at Masry and Vititoe Law Offices. Known throughout the country as the personal injury law firm that successfully handled the famous Hinkley case profiled in the movie "Erin Brockovich," Masry & Vititoe has gained national recognition as a leader in Environmental Tort cases.
Vertical Heterophoria Syndrome (VHS)
I am currently dealing with a client who sustained a head injury and whose doctors are trying to rule out Vertical Heterophoria Syndrome (VHS).
This is an eye alignment condition. Those who suffer from VHS are over-working their eye muscles to maintain vertical eye alignment. This leads to eye muscle strain and fatigue, which causes many different symptoms, including:
Dizziness
Lightheadedness
Nausea
Unsteadiness
Drifting While Walking
Poor Coordination
Poor Depth Perception
Motion Sickness
Headaches
Neck Ache
Head Tilt
Anxiety From Dizziness
Feeling Overwhelmed or Anxious in Crowds or Large Spaces
Light Sensitivity / Glare
Double Vision
Shadowed/Overlapping Vision
Difficulty with Reading & Reading Comprehension
Truck Roll Injury
Dave Boran sent me this question based on a recent post.
I spent 23 years in the Canadian Forces. I have had this problem for over 20 years with no diagnoses. For they past 6 months I have been going to the gym, trying to get back into shape. I am 51 years old. I had 2 episodes at the gym. I will start to sweat, I'll get dizzy and I can't function or try and speak it will take me at least 15 minutes before I can get off the ground. Last week I wanted to try and run a mile and when I got to the highway it happened again. I almost got hit by a car. I should mention in
1986 i was involved in a motor vehicle accident and I rolled my truck. My truck was a refuelling truck. I was carring gas on the pod. Can you help.
Dave
Dave,
It sounds like you definitely have problems. I am not sure if you are in Canada or the U.S. but I would try contacting the Brain Injury Association of America at www.biaa.org and see if they can point you to some resources.
As to any legal case, and again I am not sure where your truck accident occurred, it seems that all statutes of limitation are long expired based on it happening 23 years ago. I hope you received compensation back then as deserved.
Good luck Dave.
Tim Titolo
The people at Titolo Law Office represent only those injured in car accidents, truck accidents, Death accidents, falls and most all injury accidents. Please give us a call and find out how we can help you.
Post Traumatic Stress Disorder
Many victims of traumatic brain injury develop Post Traumatic Stress Disorder. I recently came across a great article on the symtoms, causes and other information of PTSD.
PTSD (Post-Traumatic Stress Disorder) is triggered by a traumatic event - it is a kind of anxiety. The sufferer of PTSD may have experienced or seen an event that caused extreme fear, shock and/or a feeling of helplessness. Most of us experience a brief period of difficulty adjusting and coping with traumatic events. However, we gradually get better with time and healthy coping methods. On the other hand, there are times when symptoms get worse and may last for several months, or years. This study explains how PTSD can surface two years after a traumatic event. Another study found that one in eight Lower Manhattan residents likely had PTSD two to three years after the 9/11 attacks.
Read the full article here.
BIAA Update
Sarah D'Orsie of the Brain Injury Association of America provides the following update:
Brain Injury Association of America
Policy Corner E-Newsletter -- July 10, 2009
A weekly update on federal policy activity related to traumatic brain injury
__________________________________________________________________
In This Issue:
Appropriations Update
Health Care Reform Update
Fiscal Year 2010 Defense Authorization
_____________________________________________________________________
The Policy Corner is made possible by the Centre for Neuro Skills, James F. Humphreys and Associates, and Lakeview Healthcare Systems, Inc. Brain Injury Association of America gratefully acknowledges their support for legislative action.
_____________________________________________________________________
Appropriations Update
Today, July 10, 2009, the House Appropriations Subcommittee on Labor, Health and Human Services and Education will begin considering the Fiscal Year 2010 spending bill that 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.
BIAA and other stakeholders authored a letter that was circulated today on Capitol Hill urging increased funding for TBI programs. Specifically:
• $11 million for the Centers for Disease Control and Prevention TBI Registries and Surveillance, Prevention and National Public Education/Awareness
• $20 million for the Health Resources and Services Administration (HRSA) Federal TBI State Grant Program
• $6 million for the HRSA Federal TBI Protection & Advocacy (P&A) Systems Grant Program
• 13.3 million for NIDRR's TBI Model Systems of Care Program
For further reading, a copy of the letter can be found on our web site by clicking on the following link:
http://www.biausa.org/elements/policy/2009/tbi_act_appropriations_2010_support_letter.pdf
If you would like to take action and encourage your Congressman to support increased funding for TBI programs, click on the link below to be directed to our legislative action center!
http://capwiz.com/bia/home/
BIAA will continue to monitor the Appropriations proceedings and alert grassroots advocates to take action when needed.
Health Care Reform Update
This week the Senate Health, Education, Labor and Pensions Committee has been continuing to consider its version of the health care overhaul, while the Finance Committee has yet to begin formal markups, but continues to discuss policy behind closed doors.
In the House, The chairmen of the Energy and Commerce, Education and Labor, and Ways and Means Committees are working on a final draft of a bill that could be released at any time. The House committees plan to mark up the legislation next week.
On July 2, 2009, BIAA circulated comments to the House Committees of Jurisdiction applauding their "efforts to design health care reform that will improve the accessibility, quality, effectiveness, and efficiency of patient care."
More specifically, the comments expressed BIAA's support of the protections and standards for qualified health plans included in the draft, such as no imposition of pre-existing condition exclusions, guaranteed access to essential benefits (including rehabilitation services), guaranteed issue and renewal, adequacy of provider networks, limits on cost sharing, no annual or lifetime limits on coverage, and consumer protections.
To see a full copy of the comments, click on the following link:
http://www.biausa.org/elements/policy/2009/biaa_house_tri_committee_health_reform_comments.pdf
BIAA will continue to follow the health care reform considerations carefully and advocate on behalf of the brain injury community.
Fiscal Year 2010 Defense Authorization
Next week the 2010 Defense Authorization bill is expected to dominate debate on the Senate floor. The bill was reported as an original bill by the Senate Armed Services Committee on June 2, 2009.
It is important to note that BIAA's cognitive rehabilitation position paper (http://www.biausa.org/elements/media/biaa_cog_rehab_position_statement_2007.pdf) was referenced in the official Committee Report that was released last week as saying, "The committee notes that the Brain Injury Association of America has recognized the benefits of cognitive rehabilitation therapy for brain injuries, and that there is a growing body of scientific evidence to support its efficacy."
BIAA will continue to watch the bill as it is considered next week and advocate for the inclusion of cognitive rehabilitation within TRICARE coverage for returning service members.
$31 million verdict against hospital negated by settlement agreement
Lou Grieco covers courts for the Dayton Daily News and reported the following sad story about a birth brain injury. Luckily the lawyers did a great job and the boy will have resources to help him throughout his life.
DAYTON — Last week’s $31 million verdict against Miami Valley Hospital could be the largest jury award for a medical malpractice case in Ohio history, though a settlement agreement makes it unlikely the hospital will have to pay that much.
As the jury was deliberating Thursday afternoon, July 2, after a four-week trial before Montgomery County Common Pleas Judge Timothy O’Connell, attorneys for the hospital and the family of Leondo Stanziano worked out a settlement agreement, plaintiffs’ attorneys Richard Lawrence and Patrick J. Beirne confirmed Monday, July 6.
“All disputes between the parties have been resolved,” Lawrence said.
Lawrence and Beirne said the verdict is the largest medical malpractice award they could find in Ohio. The last big medical malpractice case in Montgomery County resulted in an $8 million award last year, they said.
Lawrence and Beirne said the agreement is confidential and they could not discuss the details. They expect the case to be finished in the next 30 to 40 days, they said.
The agreement will end the case, eliminating any appeals or punitive damages, which were to be decided later, Lawrence said.
Beirne said that nearly $26 million of the jury’s award was for future medical care for the boy, now 8, who was born Dec. 11, 2000 at the hospital.
He suffered “permanent, irreversible brain damage,” during his birth, according to the complaint filed by his family in 2006.
The lawsuit also identified Dr. Kedrin E. Van Steenwyk and Contemporary Obstetrics and Gynecology as defendants, but the jury found that neither was liable for what happened to the boy.
The boy’s mother, Renetha, was a VBAC patient, meaning she would deliver the boy vaginally, though she had previously had a Caesarian section. That meant she was at a higher risk for a ruptured uterus during labor, which occurred, Lawrence said.
At that point, the mother’s body stopped providing oxygen through the placenta, though the boy was still inside her. He probably went 18 to 20 minutes without oxygen, Lawrence said.
The hospital staff, which knew Renetha Stanziano was a high-risk patient, erred by failing to monitor the labor properly, by failing to diagnosis the hyper-stimulation of her uterus, by inappropriately using the drug Pitocin and by not telling the attending physician of her “inappropriate contraction pattern,” according to the complaint.
The nurses continued to give her Pitocin, even as her contractions escalated to unsafe levels, and “they blew the uterus apart,” Lawrence said.
The boy, called “Leo,” has severe cerebral palsey. He uses a feeding tube. He cannot speak, is not ambulatory and has trouble holding anything in his hands,” Lawrence said. Though Leo is badly disabled, he is alert and can recognize family members. When he needs something, he communicates by kicking, Lawrence said.
Leo will never be able to work, and Renetha and her husband Douglas are now “24-7 health-care givers,” Lawrence said. After Leo’s birth, Renetha stopped attending college and quit her job at Wright-Patterson Air Force Base to take care of the boy, Lawrence said.
Hospital officials could not be reached for comment Monday. On Friday, President and Chief Executive Mary Boosalis said “Miami Valley Hospital is concerned for every patient under our care and we recognize the heartache of this tragic situation. We respectfully disagree with the jury’s decision and continue to support the work of our professional staff.”
Spinal Treatment Questioned
The New York Times reported:
Patients who received a bioengineered protein during spinal fusion procedures to correct neck pain had far more complications than patients who did not get it, according to a study released Tuesday.
The study, published Tuesday in The Journal of the American Medical Association, reinforces previous concerns about the use of the proteins in fusion procedures to treat upper spine, or cervical, pain.
Read more by clicking here.
NY Trial Defense of Alcohol Withdrawl Fails
Interesting defense tactics to attribute signs, symptoms and consequences of brain injury to drug or alcohol use and abuse, are often encountered. Here is one such story.
A jury has awarded $13 million to a New York transit worker who fell 30 feet from a platform while repairing rail on an elevated track.
Although the city tried to argue that the plaintiff should have been hooked to a safety line, he won summary judgment on liability and the trial was on damages only, said Lawrence Biondi of Lawrence P. Biondi Law Firm in White Plains, N.Y., who represented the plaintiff.
At trial, the city also argued that evidence of brain damage was attributed to the plaintiffs' history of drug and alcohol abuse.
But Biondi said this strategy rang hollow with the jury.
"They went heavy on that. Every witness got on the stand and the whole trial was drugs and alcohol, but I think it backfired," said Biondi.
The defense attorney, Joseph F. Sullivan of Sullivan & Brill in New York, N.Y., did not return a call to his office seeking comment.
Read the full article at Sylvia Hsieh. "Supreme Court of New York awards transit worker $13M for fall from platform." Lawyers USA. Dolan Media Company MN. 2009.
BIAA Update on Legislation
The Brain Injury Assocation has posted the folllowing Legislative Update:
Brain Injury Association of America
Policy Corner E-Newsletter -- June 26, 2009
A weekly update on federal policy activity related to traumatic brain injury
__________________________________________________________________
In This Issue:
Health Care Reform Update
SLI Announces Military Brain Donor Registry
_____________________________________________________________________
The Policy Corner is made possible by the Centre for Neuro Skills, James F. Humphreys and Associates, and Lakeview Healthcare Systems, Inc. Brain Injury Association of America gratefully acknowledges their support for legislative action.
_____________________________________________________________________
Health Care Reform Update
This week Congress leaves for the July 4th recess in the midst of the Heath Care Reform debate. At this time, both the Senate and the House of Representatives is engaging in talks over draft proposals with the hopes of bringing one collective measure to a final vote this fall. BIAA will continue to monitor the situation closely and advocate for the provisions essential to the brain injury community.
Senate Finance Committee
The Senate Finance Committee, whose members have been negotiating a bipartisan proposal behind the scenes this week left Thursday for the July Fourth recess without a deal, although Senate Finance Chairman Max Baucus said he has developed policy to pay for legislation that would cost less than $1 trillion over 10 years.
According to Congressional Quarterly, Baucus said the bill's cost would be offset, in part, by taxing some employer-sponsored health benefits, something that makes the White House and many lawmakers in both parties uneasy. Nonetheless, limiting the bill's spending to $1 trillion is a significant step for the Finance Committee, which has been seen as the main arena for those hoping to get a bipartisan health care bill.
Senate Health, Education, Labor and Pensions Committee (HELP)
This week, the Senate HELP committee continued to mark up a draft health care overhaul bill drafted by its chairman, Sen. Edward Kennedy.
On Wednesday, the HELP committee adopted 20 amendments to the bill that were considered noncontroversial. The amendments were adopted by voice vote.
Sen. Christopher Dodd, who is leading the markup while Kennedy is being treated for brain cancer at home in Massachusetts, said the committee has adopted 240 amendments to the bill thus far.
House Tri-Committee Proposal (Committee on Energy and Commerce, Committee on Education and Labor, Ways and Means Committee)
This week, the House began debating their draft Health Care Reform bill that was developed by the chairmen of the three committees of jurisdiction.
Both the Energy and Commerce and Education and Labor committees held public hearings on the measure Tuesday. The hearings covered the gamut of health policy issues under debate in Congress at the moment, including the merits of creating a government-run insurance plan to compete with private insurers, how to finance an overhaul and how to protect doctor-patient relationships.
Importantly, the draft bill includes Rehabilitative services as part of the minimum benefits package and does not impose annual or lifetime limits on coverage.
BIAA Supports the Sports Legacy Institute's Brain Donor Registry for Military Veterans
Leading medical experts at the Sports Legacy Institute (SLI), a nonprofit educational and research organization dedicated to advancing understanding of the long-term effects of brain trauma, announced Tuesday, June 23, 2009, that they have launched the SLI Military Living Donor Registry, a brain and spinal cord donation registry for active and veteran members of the United States military.
In conjunction with The Boston University Center, the Sports Legacy Institute will compare findings from the brains of military personnel with those from their athlete program, which has signed up more than 120 donors in less than a year, and other brain banks around the world.
Col. Michael S. Jaffee, national director of the Defense and Veterans Brain Injury Center, said the Defense Department supported the spirit of the research and could assist in approaching active and retired soldiers to register for brain donation.
BIAA enthusiastically supports this initiative and will continue to advocate on its behalf. For further reading, click on the link below to view the New York Times article: (The official press release will be available shortly on BIAA's web site: www.biausa.org )
Mass. Officer Honored
Signs honoring a state trooper who was seriously injured by a drunken driver has been dedicated at a highway interchange on Cape Cod where she directed rush hour traffic for years.
Ellen Engelhardt sustained a severe brain injury in 2003 when a car driven by an 18-year-old Wayland man slammed into the back of her cruiser in the breakdown lane of Route 25. She remains confined to a special care facility in Middleborough.
The plaques bearing Engelhardt's name were unveiled Tuesday at Exit 7 off the mid-Cape highway in Yarmouth, where the trooper was a fixture directing morning traffic. The honor is a rare one for living police officers.
ATV Accident Results in Death and Brain Injury
A 7-year-old Draper boy has died in an all-terrain vehicle crash at a family farm in southern Utah.
Landon Woodbury's father, Spencer Woodbury, says the boy and his 12-year-old sister were riding on ATVs at the farm near Monticello on Wednesday when the boy approached a dump truck that was carrying gravel.
The San Juan County sheriff's office says Landon Woodbury slammed into it and was thrown headfirst into the vehicle.
Landon Woodbury, who was wearing a helmet, sustained serious brain injuries and died on Thursday after being transferred to Primary Children's Medical Center in Salt Lake City.
San Juan County Sheriff Mike Lacy says rain and speed may have contributed to the accident, which is under investigation.
Read the full story by clicking here http://www.sltrib.com/
TBI Facts Primer
Traumatic brain injury (TBI) is a serious public health problem in the United States. Each year, traumatic brain injuries contribute to a substantial number of deaths and cases of permanent disability. Recent data shows that, on average, approximately 1.4 million people sustain a traumatic brain injury annually. A TBI is caused by a bump, blow or jolt to the head or a penetrating head injury that disrupts the normal function of the brain. Not all blows or jolts to the head result in a TBI. The severity of a TBI may range from “mild,” i.e., a brief change in mental status or consciousness to “severe,” i.e., an extended period of unconsciousness or amnesia after the injury. The majority of TBIs that occur each year are concussions or other forms of mild TBI. CDC’s research and programs work to prevent TBI and help people better recognize, respond, and recover if a TBI occurs.
Go to the CDC (Centers for Disease Control) to access the following facts sheets. Click here.
Concussion in Sports
An estimated 1.6 to 3.8 million sports- and recreation-related concussions occur in the United States each year. This fact sheet provides an overview of concussion in sports and recreation and steps to take to help prevent these injuries.
Facts about Traumatic Brain Injury
This fact sheet was developed by CDC in collaboration with ten national organizations. It contains up-to-date information about the incidence, causes, risk factors, and cost associated with TBI in the United States.
Facts about Traumatic Brain Injury (Spanish) Datos sobre lesiones traumáticas del cerebro
Esta hoja informativa contiene la información más reciente sobre incidencia, causas, factores de riesgo y costos relacionados con lesiones traumáticas del cerebro.
Traumatic Brain Injury: A Guide for Criminal Justice Professionals
This guide provides an overview of TBI, information on the extent of TBI and related problems within the criminal justice system, and how these problem can be addressed.
Traumatic Brain Injury in Prisons and Jails: An Unrecognized Problem
This guide provides information for TBI professionals about what is known about individuals with TBI in prisons and jails, how TBI-related problems affect them and others while they are incarcerated, and what is needed to address these problems.
Victimization of Persons with Traumatic Brain Injury or Other Disabilities: A Fact Sheet for Professionals
This fact sheet was developed for professionals and provides an overview of the topic of victimization of persons with TBI or other disabilities.
Victimization of Persons with Traumatic Brain Injury or Other Disabilities: A Fact Sheet for Friends and Families
This fact sheet provides a general overview of victimization and risks to people with TBI or other disabilities.
* Links to non-Federal organizations found at this site are provided solely as a service to our users. These links do not constitute an endorsement of these organizations or their programs by CDC or the Federal Government, and none should be inferred. CDC is not responsible for the content of the individual organization Web pages found at these links.
Lateralized Brains
I had the opportunity to hold a brain during my trip to the morgue a few years ago. It was an amazing experience. The brain is soft and infirm. It looks relatively symmetrical with each half held together at the corpus callosum.
But each half is not perfectly symmetrical and that goes against the pop psychological “left-right brain” theories. Actually each half is not a mirror image of the other which enables us to perform .jpg)
different tasks at the same time.
“In the 1990s psychologist Michael Corballis of the University of Auckland in New Zealand argued that the asymmetry of the brain – known as lateralization - was a key step in the evolution of our species, giving us language and additional mental powers that other animals lack.
“Today Corballis readily admits he was wrong. Lateralized brains are not unique to humans. Parrots prefer picking up things with their left foot. Toads tend to attack other toads from the right but go after prey from the left. Zebra fish are likely to look at new things with their right eye and familiar th.jpg)
ings with their left….”
The May 2009 edition of Discover Magazine published an article by Carl Zimmer who frequently publishes on brain issues. He says, “One hypothesis is that a lateralized brain is more powerful than one that works like a mirror image. Instead of two matching parts of the brain performing an identical task, one can take charge, leaving the other free to do something else.”
It seems that our ability to multitask is owed largely to our not so symmetrical brain halves. Zimmer’s article is fascinating and can be read by clicking here.
Soldiers Not Willing to Reveal Injury
When Army Col. (Dr.) Kenneth Lee began evaluating more than 3,000 Wisconsin Army National Guardsmen called to duty last fall in the state's largest operational deployment since World War II to ensure their medical readiness, he approached the task with unique and personal insights. Soldiers are not willing to reveal their injuries.
Between their initial alert last year and early this year, when they moved to their mobilization station at Fort Bliss, Texas, Lee had to put these Soldiers into one of two categories: "green" if they were deployable or "red" for they weren't.
It was a tough call, he admits, because many of the Soldiers didn't want to confess to issues that might keep them from deploying with their units. Some hid musculoskeletal or other injuries for fear they'd be forced out of the military if deemed nondeployable. Others acknowledged they had medical issues, but hadn't addressed them because they had no health insurance or couldn't spare time away from their civilian jobs to get treated.
But the bigger challenge, Lee said, was identifying troops with mental-health issues, including post-traumatic stress and traumatic brain injuries. Lee calls these "the invisible wounds" of war - issues that don't mean a Soldier can't deploy, but that have to be weighed when making that determination.
This problem has come up more and more as physicans and VET medical staff have dealt with returning vets.
I am currently handling a case for a man who underwent moderate to severe brain damage, surgery and near fatal seizures. Yet when given the chance to return to Iraq for a tour of duty, he opts to go since his working ability as a civilian has plummeted. It is my hope that the military will identify the problems this man has and not let him go into harms way. He is currently receiving training for preparedness to return to Iraq.
I have sent the medical records documenting the seizures and injury but find it difficult to get the attention of the military decision makers. Therefore I advocate procedures like those taken by Army Col. (Dr.) Kenneth Lee.
Immediate treatment comment
Dr. Baxter writes in response to my post on getting immediate care in brain injury:
Just last month I witnessed an 83 year old woman stumble and fall on her face. She wanted to go, but I kept her there, administered first aid and called paramedics. By the time she was strapped down to the back board in readiness to transport her (against her will) to the hospital, she began acting very combative. Combativeness in a victim of head trauma is a very strong sign that brain injury was sustained. You just can't tell immediately after the trauma. It is always best to take the proper precautions.
Recently, progesterone therapy has been found to have very potent anti-inflammatory effects on the brains of people that have suffered traumatic brain injury, thereby lessening the severity of the injury. This is just further evidence that there are many reasons why we all need to do all we can to promote hormone balance in ourselves and others.
Thank you for the comment.
Oregon Brain Injury Association Needs Your Help
My friend and collegue, Sherry Stock, sent me this message. Sherry is the mover and shaker at the Brain Injury Association of Oregon. I have helped her and the Association in the past and encourage anyone willing to do the same.
We need your help right now-this morning—Get this out to your email list and friends-we need help right now
Call:
Senator Courtney (503-986-1600)
Senator Richard Devlin (503-986-1719)
Senator Margaret Carter (503-986-1722)
The Facts
RE: HB 2413
HB2413 only affects those who are breaking the law-not the general public.
HB2413 has passed both the House Human Services Committee and by House Revenue, which gave it a do-pass vote. The bill has never had any opposition from any group or lobbyist for any group.
BIAOR contacted public safety groups and asked if they had a position on HB 2413. The following groups stated that they either did not oppose or remained neutral on the $2 additional assessment on moving traffic violations or sent a letter of support.
Multnomah County Sherriff’s Office (sent letter of support)
Portland Police Association, Scott Westerman, President
Oregon Council of Police Associations
Oregon State Sheriff’s Association
Oregon District Attorneys Association
Important Facts:
Ÿ Each year, approximately 20,000 people in Oregon sustain a Traumatic Brain Injury (TBI). (This and all other statistics – unless noted otherwise – are estimates using statistics for TBI from the Center for Disease Control and Prevention.)
Ÿ More than 670 people in Oregon die every year as a result of TBI. The main causes of TBI deaths in Oregon are motor vehicle crashes.
Ÿ 32% of all TBIs that required hospitalization in 2006 were the result of motor vehicle accidents. (“Injury In Oregon, 2008” OR Department of Human Services)
Ÿ Nearly 20% of Oregon’s survivors with TBI will have a moderate to severe injury requiring assistance for the rest of their lives - 49% of these are from motor vehicle accidents.
Ÿ Blasts are the leading cause of TBI for active duty military personnel in war zones, including the Oregon National Guard– 320,000 nationally and an estimated 3500 Oregon National Guard.
Sherry Stock, MS CBIS
Executive Director
Brain Injury Association of Oregon
2145 NW Overton St, Portland OR 97210
Mailing Address:
PO Box 549
Molalla OR 97038
503.740.3155 800-544-5243 fax: 503.961-8730
biaor@biaoregon.org
sherry@biaoregon.org
http://www.biaoregon.org
IRS 501(c)(3) organization
Affiliated with the Brain Injury Association of America
Tax ID: 93-0900797
Only a life lived for others is a life worthwhile.
--Albert Einstein
Immediate Treatment Key In TBI
I found an article by Dennis Thompson, HealthDay Reporter, entitled "For Every Blow to the Head, Quick Action Is Urged; Symptoms may not be noticeable, but fatal brain damage can occur." Consumer Health News (English). HealthDay. 2009. In it Mr. Thompson interviews Dr. O'Shanick, a neuropsychiatrist in Virginia who also heads the Brain Injury Association of America. I have worked with Dr. O'Shanick on cases and present this article here to assist in making the point that delays in treatment in cases of traumatic brain injury can have devastating impact.
Gregory O'Shanick has been the Medical Director of the Center for Neurorehabilitation Services in Midlothian, Virginia since 1991. After attending Ohio State University, he entered the University of Texas Medical Branch at Galveston and graduated in 1977. His post-graduate studies were at Duke University Medical Center. His academic career includes faculty appointments at University of Texas Health Science Center at Houston, Medical College of Virginia and most recently, in the Department of Neurological Surgery at the University of Virginia. He has authored more than 100 publications, including editing or co-editing three textbooks. As a result of his international reputation in neuropsychiatry and neurorehabilitation, he was asked to be the first National Medical Director of BIAA in 1996, a post he still holds.
Dr. O'Shanick is a member of the American Neuropsychiatric Association, the American Academy of Neurology, the American Society of Neurorehabilitation and a Fellow of the American Psychiatric Association. He has previously chaired a panel developing evidence-based guidelines for the evaluation of mild traumatic brain injury.
The tragic death of actress Natasha Richardson in March riveted people's attention to the issue of brain injury and raised important questions about what to do if this happens to you or a loved one.
Richardson died hours after taking a minor fall while skiing at a Quebec resort. She picked herself up from the fall and refused medical attention, but three hours later in her hotel room, she complained of a headache. Within hours she was in critical condition. Two days after the fall, she died.
"Even when someone looks fine initially, it can still have devastating consequences," said Dr. Greg O'Shanick, national medical director for the Brain Injury Association of America. "The critical issue is that you don't have to lose consciousness to sustain a significant brain injury," he explained.
"In this case, Richardson had what's called an epidural hematoma," O'Shanick continued. "There's an artery that runs right underneath the skull, and the skull on the temple is very thin. You can break the bone, the bone cuts the artery and a high-pressure blood clot forms. That then squeezes the brain."
Richardson's death, though, is known to have saved at least one life. An Ohio couple whose 7-year-old daughter had been struck in the temple two days earlier by a baseball hit by her dad rushed the girl to a doctor after watching a news report on Richardson, according to published reports.
It turned out she was suffering from the same condition as Richardson. Her parents' quick action was credited with saving the little girl's life.
More than 1.4 million people suffer a traumatic brain injury each year in the United States, according to the Brain Injury Association of America. Most are treated and released from an emergency department, but 235,000 are hospitalized and 50,000 die.
Dr. Rade Vukmir, an emergency department physician, clinical professor of emergency medicine at the University of Pittsburgh and a spokesman for the American College of Emergency Physicians, credits media coverage of Richardson's accident and death with making people more aware of potential brain injuries.
However, Vukmir said, it's still too early to tell if that awareness has translated into more people coming to emergency departments worried about head injuries.
O'Shanick said his organization received many phone calls and Web site hits in the days after Richardson's injury. "They wanted to find out a lot about the basics of head injury, prevention issues, how much of a hit does it take to create that kind of injury," he said.
People seem to have a good understanding of the basics of head injuries, Vukmir said: "Most people who pass out know to come in. Most people who vomit know to come in."
But the real problem, illustrated by the cases of both Richardson and the Ohio girl, is that potentially fatal brain injuries don't always produce severe or noticeable symptoms.
Nonetheless, certain steps should be taken to ensure that someone who's taken a blow to the head will be all right. They include:
Stay with the person. "If there's a question of what's going on, don't let the person be by themselves," O'Shanick said. "Make sure there's a person in attendance, watching over them. If you see someone once and they go off to their hotel room, unless there's someone there watching, no one's going to know about any changes in behavior. You really do need to make sure there's someone watching."
Watch for behavior changes. If the person becomes suddenly drowsy, irritable or confused, acts in a drunken manner, begins repeating statements or has trouble walking or speaking, get the person to an emergency room immediately for treatment, O'Shanick said.
Be particularly cautious with high-risk groups. The very young, the very old, people on blood thinners and anyone who's intoxicated are at increased risk for brain injury and should be given special attention if an injury is suspected, Vukmir said.
Of course, there's no reason at all to maintain a wait-and-see attitude, he added.
"We encourage patients to present themselves if they have any questions about their head injury," Vukmir said. "Call a health care professional or present yourself for emergency care so we can ask the questions and sift through the information."
TBI and Death are REAL!
While I do not expect this event to be picked up in the local paper, I am reporting that Traumatic Brain Injury and Death are real and all around us.
Last night as I, my wife, and children were watching television before bed we saw siren lights in front of our home. Several neighbors had gathered around a firetruck and police cars.
We live in a gated community adjacent to a park. Apparently some young boys aged 12 to 17, two of whom were brothers, were hopping the wall from the park into the neighborhood. One fell to the concrete walkway on his head. Another ran to the guard gate to get help explaining that his friend fell. The boy gave the guard his home address which caused first responders to go to the wrong location. When they finally figured out the correct location and arrived to assist, the boy was not moving. His brother was found leaning over his motionless brother. He was dead.
Who knows if the death could have been avoided had first responders not been sidetracked to the wrong location? Whether the delay contributed to the death? It may have. But the stark reality of how quickly and easily life can be taken was made startling real for my young daughters, wife and me.
Benign Paroxysmal Positional Vertigo
Brain Werner of the Balance Institue shared a "Great review of BPPV" from an article in Otolaryngology - Head and Neck Surgery (2008) 139, S47-S81. He states " This is very common post mTBI and commonly missed."
A primary complaint of dizziness accounts for 5.6 million clinic visits in the United States per year, and between 17 and 42 percent of patients with vertigo ultimately receive a diagnosis of benign paroxysmal positional vertigo (BPPV).1-3 BPPV is a form of positional vertigo.
● Positional vertigo is defined as a spinning sensation produced
by changes in head position relative to gravity.
● Benign paroxysmal positional vertigo is defined as a
disorder of the inner ear characterized by repeated episodes
of positional vertigo.
Traditionally, the terms benign and paroxysmal have been used to characterize this particular form of positional vertigo. In this context, the descriptor benign historically implies that BPPV was a form of positional vertigo not due to any serious CNS disorder and that the overall prognosis for recovery was favorable.4 However, undiagnosed and untreated BPPV may not have “benign” functional, health, and quality-of-life impacts. The term paroxysmal in this context describes the rapid and sudden onset of the vertigo associated with an episode of BPPV. BPPV has also been termed benign positional vertigo, paroxysmal positional vertigo, positional vertigo, benign paroxysmal nystagmus, and paroxysmal positional nystagmus. In this guideline, the panel chose to retain the terminology of BPPV because it is the most common terminology encountered in the literature
and in clinical practice.
The Balance Institute sees patients for among other things:
•Adolescent balance disorders
•Amputee rehabilitation
•Aviation medicine
•Cerebral vascular
•Chemical toxicity
•Chronic mobility disorders
•Dizziness/Dysequilibrium
•Fall risk identification, prevention and management
•Head injuries/Concussion
•Movement disorders
•Neurogenerative diseases
•Pharmacological/Ototoxicity
•Spinal Cord Injury
•Sports medicine (performance enhancement)
•Vestibular disorders (e.g., BBPV)
•Worker's compensation/Legal
Response to President Obama's Medical Malpractice Speech
The American Association of Justice published the following in response to President Obama's Seech to the American Medical Association on June 15, 2009:
“It’s clear America’s health care system is in crisis. Over 40 million people are without health insurance and costs are skyrocketing. President Obama is right that health care reform is needed now and patient safety should be the top priority.
“Empirically-based practice guidelines, developed by independent experts, is an idea we can support, as long as it does not lower quality or standards of care. Instead, these guidelines should lead to greater patient safety.
“According to the Institute of Medicine, 98,000 people die every year because of medical errors. Eliminating these errors, not further hurting the victims of negligence, is where lawmakers should focus their attention. By taking away the rights of people to hold wrongdoers accountable, the quality of health care will suffer tremendously.
“However, the notion that ‘defensive medicine’ is leading to higher health care costs is not supported by empirical data or academic literature. Recent news reports, CBO and GAO analyses, and statements from administration officials have shown that physicians will over-test and over-treat purely for financial reasons, unrelated to liability concerns.
“Limiting the legal rights of injured patients will do nothing to lower health care costs or aid the uninsured. We will work over the coming weeks and months to educate members of Congress and the administration on how to best protect victims of medical negligence.”
Anti Consumer Movie Ads
The New York Times advises that movie theaters are about to show anti consumer ads as part of a campaign by www.facesoflawsuitabuse.org.
INSTEAD of the latest on Hollywood stars, moviegoers may get a dose of advocacy this month when they settle into their seats for the feature presentation.
Coming to theaters are commercials that are intended to spell out the perils of frivolous lawsuits as told by “everyday Americans,” including small-business owners who have been hit with costly lawsuits they believed were arbitrary and abusive.
This is the wrong message. When the one who feels injured is the business owner, then retribution is appropriate. But not if it is a consumer who is injured. This makes no sense.
Frivolous lawsuits are not a way of life for the vast majority of lawyers. The news media simply portrays that myth. And if any one believes the news media does not impact the masses then I have a frivolous lawsuit to sell them.
President Obama and Medical Malpractice
Although the A.M.A.’s highest legislative priority is capping jury awards, highly unlikely under the Obama administration, it does favor legislation like that proposed by Senators Obama and Clinton. Dr. Rohack said the group’s legislative experts were also working over the weekend to draft a bill that would set out a way to protect doctors who are sued if they have followed professional practice guidelines.
The New York Times reports that while President Obama spoke to doctors yesterday assuring them that he favors limiting malpractice suits, he definitely does not favor limiting malpractice awards. He believes that limiting recovery for clear errors is bad for the victims of those medical errors.
His position on limiting malpractice suits with such things as the "Sorry" apology might be what it takes to bring Republicans to the table.
88 Plan
88 Plan
Named for Pro Football Hall of Famer and NFL legend John Mackey who wore jersey number 88 for the Baltimore Colts, the 88 Plan is the first program of its kind in this country. The 88 Plan provides retired players up to $88,000 per year for medical and custodial care resulting from dementia, including Alzheimer’s and Parkinson’s. Funding for dementia research is also being provided. Almost $3 million has been distributed to suffering players and their families through this benefit.
The NFL Care plan includes disability, assisted living, joint repacement, spine treatment and prescrinption drug benefit.
Comment on Helmets
Carl,
Thank you for your comment on helmet laws. For those of you who have not seen Carl’s comment I am reprinting it here.
Could someone please help a concerned father out and point me in the direction of skateboarding helmet laws in Las Vegas. I have a teenage daughter who has a new friend who enjoys skating. I encourage Molly to try new things, with in reason. She's a good kid asking Mom and I if this new venture would be alright. Mom and I did share our concerns which came off unsupportive to our teen. In truth the girl does get 99% of all she asks for and will be getting her board too. Which will soon be sitting next to her bikes, in-line skates, and scooter in 3months, I'm OK with that! I just figure if I know and understand the laws surrounding this activity I can better help mom feel better about it as well. And we all can be clear on what is safe responsible ridding. Both by law and as concerned parents!
Thanks for whatever help can be offered...
Carl Foster!
I found this web site dealing with the status of laws in the country. http://www.iihs.org/laws/HelmetUseCurrent.aspx#NV
Nevada has no law regarding bicycles and helmets.
I have 3 young girls and share your concern about the potential injury from riding on “wheelies” skateboards and the like. My suggestion would be to press hard on educating your daughter on what injury to the head and brain can do and how easily it can happen from a skateboard accident.
Talk about the recent actress, Natasha Richardson’s, Skiing accident. http://www.guardian.co.uk/culture/2009/mar/19/need-for-ski-helmets
Here are more sites you mind helpful. http://www.cpsc.gov/cpscpub/pubs/349.pdf http://www.neuroskills.com/tbi/cdcbikemenu.shtml
Good luck and best of health
Tim
Ruvo Center Soon to Open
The Ruvo Center anchors the Medical Office District of downtown Las Vegas' Symphony Park. It will provide breaking research and treatments for brain disorders such as Alzheimer's and Lou Gehrig's Disease. I will keep my eye on this great addition to the Las Vegas medical community.
Marshall Allan at the Las Vegas Sun is also keeping an eye on the Center.
As the vision for the Ruvo Center for Brain Health evolved in the past decade, its most fantastic ambition became the curing of Alzheimer’s and other degenerative brain disorders.
But from the get-go, the founders knew they first had to provide emotional and logistical support for the patients, families and friends who deal with the repercussions of the grueling diseases.
Today, the Ruvo Center is moving aggressively on its quest to cure and treat the diseases, in partnership with the renowned Cleveland Clinic as the more expansive Cleveland Clinic Lou Ruvo Center for Brain Health. It will begin seeing patients in July at a facility that, for now, is best known for its daring Frank Gehry design.
Last week, the clinic turned its focus to the emotional and logistical needs of patients and caregivers.
Two dozen experts gathered as a sort of brain trust to help the Ruvo Center address the oft-forgotten social needs of caregivers and patients living with Alzheimer’s, Huntington’s, Parkinson’s and Amyotrophic Lateral Sclerosis (ALS).
The people who attended say the assembly was unprecedented, drawing experts from the likes of the Cleveland Clinic, Duke University, the Alzheimer’s Association. They came at the invitation of the Ruvo Center.
Read the full article here.
President Obama May Advocate Medical Malpractice Reform
The American Assocation of Justice has released this and I have contacted my senator. Please consider doing likewise.
I’m writing to alert each of you that on this coming Monday (at a time still to be determined) President Obama will be speaking to the American Medical Association. Please see the story below.
We are extremely concerned that once again he will advocate for some kind of medical malpractice “reform” in the health care bill. In fact, it is our present understanding that it is likely he will do so. We do not expect the speech to be long on specifics. We are on top of this situation, working with our Congressional allies on this urgently. We will inform all of you as to details as soon as we can. Stay tuned!
In the meantime, we need your help. Please contact your Senators and Representative and tell them that medical malpractice tort reform should not be included in the health care bill. The notion that Americans should have to relinquish one right in order to gain another is unacceptable.
Sincerely,
Linda A. Lipsen
Senior Vice President for Public Affairs
Obama to address AMA Delegates in Chicago
By Bruce Japsen
Tribune reporter
12:39 PM CDT, June 10, 2009
Amid the push in Washington for health care reform, President Barack Obama will on Monday address delegates to the American Medical Association, the Chicago-based national doctor group confirmed today.
The AMA's policy-making House of Delegates meets in Chicago beginning this weekend through next Wednesday. The national doctors group represents about a quarter of a million doctors across the country and its support of any effort to cover the more than 46 million uninsured Americans is seen as critical.
It's unusual for a president, let alone a non-physician, to address an AMA House of Delegates meeting. The AMA said the last president to do so was Ronald Reagan in 1983.
It will be only the second time Obama has been to Chicago since he became president. His previous visit, a three-night stay in mid-February, included a dinner out with his wife, a basketball game at the University of Chicago Laboratory Schools, morning workouts, visits with friends and a haircut. The White House has not yet said whether the president will spend part of his weekend in the city, before the AMA appearance on Monday.
On Thursday, Obama is scheduled to appear at a town hall style event in Green Bay, where he will also push for health care reform.
Mayo Clinic Site
Your brain floats within your skull, surrounded by fluid that cushions it from the bounces of everyday movement. But the fluid may not be able to absorb the force of a sudden blow or a quick stop. In these situations, your brain may slide forcefully against the inner wall of your skull and become bruised.
An intracranial hematoma occurs when a blood vessel ruptures within your brain or between your skull and your brain. The collection of blood (hematoma) compresses your brain tissue.
Signs and symptoms of an intracranial hematoma may occur from immediately to several weeks or longer after a blow to your head. As time progresses, pressure on your brain increases, producing some or all of the following signs and symptoms:
■Headache
■Nausea
■Vomiting
■Drowsiness
■Dizziness
■Confusion
■Slurred speech or loss of ability to speak
■Pupils of unequal size
■Weakness in limbs on one side of your body
The Mayo Clinic publishes a very useful site for information on brain injury. I selected a few interesting excerpts and you can access the site by clicking http://www.mayoclinic.com/health/intracranial-hematoma/DS00330.
BIAA Legislative Update
The Brain Injury Association of America continues its legislative efforts:
Brain Injury Association of America
Policy Corner E-Newsletter -- June 12, 2009
A weekly update on federal policy activity related to traumatic brain injury
__________________________________________________________________
In This Issue:
Cognitive Rehabilitation Coverage
Health Care Reform Update
NIDRR Grant Forecast
Coalition for Regenerative Stem Cell Medicine update
________________________________________
The Policy Corner is made possible by the Centre for Neuro Skills, James F. Humphreys and Associates, and Lakeview Healthcare Systems, Inc. Brain Injury Association of America gratefully acknowledges their support for legislative action.
________________________________________
Cognitive Rehabilitation Coverage
This week BIAA learned of two important victories centered around cognitive rehabilitation services. Anthem Insurance Companies (Anthem BC/BS, Anthem Health Plans) revised its cognitive rehabilitation coverage policy in December 2008 and cited BIAA's position paper among the authoritative sources consulted. Last month, United Health Care followed suit by publishing a coverage change in its May 2009 Network Bulletin .
Also this week, BIAA sent a letter to President Obama urging TRICARE coverage for service members. This is a follow up to the summit hosted by the Defense Centers of Excellence in April 2009, which was prompted by Congressional inquiries BIAA initiated last summer.
http://www.biausa.org/elements/policy/president_obama_letter_tricare_cog_rehab.pdf
Insurance coverage of cognitive rehabilitation has been a centerpiece of BIAA's policy efforts for the past three years. The Anthem and United Health Care coverage policies are important victories for people with brain injury as they provide fuel for our TRICARE advocacy and health care reform fight.
BIAA will continue to fight for TRICARE to cover cognitive rehabilitation services to ensure that our returning service members have access to the best health care available.
Health Care Reform Update
On June 9, 2009, the Senate Health, Education, Labor and Pensions (HELP) Committee released a draft health care reform bill. In summary, the draft would expand Medicaid eligibility to those with incomes up to 150 percent of the federal poverty level, impose federal tax penalties on most individuals failing to purchase coverage, mandate a public plan option, require employers to provide coverage or pay into a pool, and stiffen regulation of private health insurance plans.
Importantly, the plan eliminates life-time insurance caps as well as provides for the establishment of a medical advisory council that will submit a report to the Secretary of Health and Human Services including recommendations on essential health care benefits eligible for credits which includes rehabilitative services. In issuing the report, the council will ensure that the recommendations take into account the needs of diverse segments of the population including persons with disability.
The HELP committee plans to begin considering this bill on June 16, 2009. BIAA will continue to monitor the situation carefully.
NIDRR Grant Forecast
This week, The National Institute on Disability and Rehabilitation Research (NIDRR) announced it will include two TBI grant programs in its forecast for 2009. http://www.ed.gov/fund/grant/find/edlite-forecast.html#chart7
The first grant application notice, rehabilitation research and training centers (RRTC) on traumatic brain injury interventions, will be available on June 30, 2009, while the second, RRTC on developing strategies to foster community integration and participation for individuals with traumatic brain injury will be available on July 24, 2009.
BIAA will report on the details of these applications when they are released.
Coalition for Regenerative Stem Cell Medicine update
As part of the Coalition for Regenerative Stem Cell Medicine, BIAA enthusiastically endorses two important pieces of legislation aimed at advancing the therapeutic potential of newborn stem cells, the unique stem cells that can be collected immediately following birth from umbilical cord blood and the cord itself, as well as helping to advance the use of one's own newborn stem cells in regenerative medicine.
HR 1718 - The "Family Cord Blood Banking Act" amends Section 213(d) of the IRS Code to add cord blood banking services as a qualified medical expense. This change will allow individuals and couples to use tax advantaged dollars to pay for umbilical cord blood banking services through flexible spending accounts (FSAs), health savings accounts (HSAs) health reimbursement arrangements (HRAs) or the medical expenses tax deduction.
The "Family Cord Blood Banking Act" will make cord blood banking more affordable for American families and provides incentives to ensure that this valuable health resource is never thrown away.
HR. 2107 - The "Cord Blood Education and Awareness Act of 2009" will provide expectant mothers with straightforward, accurate and easy to understand information about the value of their child's umbilical cord blood stem cells. It will offer a government stamp of approval on all available cord blood banking options and will give expectant parents confidence in the information they are reviewing.
Smart Drugs?
I found this article entitled Building a Better Brain in The April issue of Discover Magazine and thought I would share this excerpt with my readers.
The Attention Edge
Pay attention to this paragraph and you are selectively concentrating on a task or idea while ignoring distractions like that dog barking down the street or your cell phone ringing. In a world of information overload and increasing multi-multitasking, you do not have to suffer from ADHD to have trouble focusing. You need no diagnosis to benefit from drugs that cut through the chaos and help you get things done.
Attention-focusing drugs, of course, have been here for years: Amphetamines, nicknamed “go pills,” were discovered in the late 19th century. By the 1940s these central nervous system stimulants were widely used to treat asthma and had become popular as “pep” and diet pills. They were embraced by members of the armed forces, especially pilots, who had to remain attentive to myriad tasks despite constant danger and fatigue. Rife with serious side effects, including hallucinations, anorexia, and heart problems, dextroamphetamine (trade name Dexedrine, better known as speed) is rarely used today by civilians. But the amphetamine mix Adderall and the amphetamine-related drug methylphenidate (Ritalin, Methylin, Concerta, among others) are commonly prescribed.
Exactly how these drugs work their magic remains unknown, but stimulants like Ritalin and modafinil influence the neurotransmitters dopamine and norepinephrine, which are essential for attention and memory skills. Both drugs inhibit reuptake, or reabsorption, of these neurotransmitters by neurons, thus prolonging their action. Modafinil also indirectly alters the action of glutamate, the main neurotransmitter used by neurons in the brain to send signals down the line. The center of action for all these drugs, says University of California at Davis psychiatrist Michael Minzenberg, is the prefrontal cortex, the part of the brain that is responsible for executive functions like sorting out conflicting thoughts, making choices, predicting events, and exerting social control.
Read the whole thing by clicking here.
Drug may prevent brain injury epilepsy
An FDA drug, rapamycin, has been found to help prevent forms of epilepsy caused by brain injury. Epilepsy risks increase with the incident of brain injury.
"We hope to shift the focus from stopping seizures to preventing the brain abnormalities that cause seizures in the first place, and our results in the animal models so far have been encouraging," Dr. Michael Wong, senior author of the research, said
The study that included postdoctoral fellow Ling-Hui Zeng appears in the May 27 issue of The Journal of Neuroscience.
Oakland man to get $18.3 million after van crash
The Associated Press reports
A federal jury has determined that Ford Motor Co. should pay a 38-year-old Oakland man $18.3 million after he was paralyzed in a crash in a Ford van.
Jurors Wednesday awarded Dax Pierson $12.3 million for medical expenses and lost earnings and $6 million for pain and suffering for the injuries he suffered when the Ford E-350 he was riding in rolled over on an icy freeway in 2005.
At the time of the crash, Pierson was the founder of musical group that was traveling through Iowa on a U.S. tour.
Pierson was belted into his seat, but still suffered multiple fractures of his spine.
In his suit, Pierson claimed that van was defectively designed. Though Ford claimed the driver was going to fast, jurors found that Ford's design of the van had caused Pierson's injuries.
___
Information from: San Francisco Chronicle, http://www.sfgate.com/chronicle
Brain Injury Lawyer and Attorney
Timothy R. Titolo resides in Las Vegas. His practice is exclusively personal injury cases. He holds specific interest in cases involving traumatic brain injury (TBI), spine and spinal cord injury (SCI) and auto, motorcycle and truck accidents. He is a member of the Million Dollar Advocates Forum.
Because of his experience handling brain, spine and other injury cases, Tim has been invited to lecture at over 50 attorney & medical conferences around the country. He has lectured for:
American Association of Justice
North American Brain Injury Society
Brain Injury Association of America
International Brain Injury Association
National Business Institute
Pacific Northwest Brain Injury Association
Oregon Brain Injury Association
Washington Brain Injury Association
Los Angeles County Bar Association
Utah Trial Lawyers Assocation
Utah Brain Injury Association
Nevada Brain Injury Association
Michigan Brain Injury Association
other brain injury affiliated groups
Tim Is a Fellow with AAJ's National College of Advocacy and is recognized for completion of the Advanced Studies of Trial Advocacy Program.
Nevada Woman Abuses Brain Injured Sister
The risks and prognosis of those who suffer brain injury go on well after the time of injury. Here is a story about a woman's sister being abused 15 years after brain injury. The sad reality of what can happen is seen here.
A Carson City woman is scheduled to stand trial in June on a misdemeanor battery charge while authorities continue to investigate felony abuse allegations in the death of her disabled sister.
A home health nurse reported allegedly seeing Patricia VonDracek, 50, slap and punch her disabled sister, 55-year-old Sandra VonDracek in April.
According to police reports, sheriff's Deputy Josh Stagliano said Patricia VonDracek denied hitting her sister, but Sandra, who has a brain injury from a traffic accident 15 years ago, said Patricia hit her often.
Stagliano called paramedics and had Sandra VonDracek, a Navy veteran, taken to the hospital. It was his understanding, according to police reports, that hospital staff would attempt to get her placed into the Veteran's Hospital in Reno and she would not be returned to her sister's care.
Based on the witness and victim's statements, Stagliano submitted a report to the District Attorney's office for a warrant.
On May 21, records show Stagliano and another deputy went to VonDracek's home to serve the arrest warrant. While there, Patricia told them her sister had been returned to her home and died May 15 while sitting in a recliner in the living room.
Stagliano arrested Patricia VonDracek on a single charge of domestic battery and she was jailed on $15,000 bail. He then contacted detectives.
"He was extremely concerned and asked me to look into it," Carson City sheriff's Detective Craig Lowe told the Nevada Appeal.
In his report, Lowe said he located Sandra's remains at a Carson City funeral home and was able to photograph "numerous contusions and what appeared to be scratch marks on Sandra's face."
Lowe had the body taken to the Washoe County Medical Examiner's Office for an autopsy.
Though a cause of death was not determined, the autopsy showed the woman suffered broken ribs and internal bleeding. Toxicology tests and a neurologist's report on a brain examination are still pending.
"According to the attending pathologist, there were signs of non-accidental injuries from numerous incidents," Lowe wrote in the report. He also said Patricia VonDracek's 14-year-old son told police that a week before his aunt died, his mother had stomped on her lower stomach as she lay on the floor.
The boy "claimed he restrained his mother and removed her from the room telling her to calm down and that he would care for Sandra," the report said.
Patricia VonDracek was interviewed by detectives and booked on suspicion of felony domestic battery with substantial bodily harm and felony abuse of a vulnerable person.
Her bail was set at an additional $100,000.
Information from: Nevada Appeal, http://www.nevadaappeal.com
Psyhciatric Disorders Expanded in DSM 5
The Diagnsotic and Statistical Manual IV (DSM IV) serves as the psychiatric source book for diagnosing disorders. The manual is used in worker's compensation cases, personal injury cases, including brain injury, and in clinical and forensic psychiatric practice.
Now the Diagnsotic and Statistical Manual V (DSM V) is being created. Shari Roan of the LA Times writes:
Psychiatrists are debating what is normal and what constitutes an illness. When that edition of the book often referred to as the “bible of psychiatry” is released in 18 months, most agree it will contain significant revisions based on information gathered from newer imaging techniques and genetic studies. Mental health advocates hope that the new edition will include information to help with diagnoses of those with mild versions of disorders, as well as those suffering from multiple disorders.
Leaders from the APA, the World Health Organization (WHO) and World Psychiatric Association (WPA) determined that additional information and research planning was needed related to specific diagnostic areas. The manual is being updated to deal with things obesity, gambling, sex addiction and Internet addiction -- formerly dismissed as harmful habits that could be defeated with willpower -- may also be labeled illnesses.
Read more on DSM V by clicking here.
BIAA Legislative Update May 2009
The Brain Injury Association of America updates us on the legislative activities.
Health Care Reform Update
This week the Senate Finance Committee engaged in three daylong sessions to discuss various policy options that may be included in a Health Care Reform bill later this year.
As reported by Congressional Quarterly, Senator Baucus, the Chairman of the Senate Finance Committee, was not very enthusiastic when asked whether committee members had reached consensus on any issues. However, he did say that he sensed some common ground on broader issues and believes his committee is moving towards a "convergence" on these issues that are expected to be debated next month.
As always, BIAA will continue to monitor any health care reform related progress. If you have not yet taken action and emailed your Senators and Representatives regarding the brain injury guiding principles, you may still do so by clicking the following link:
http://capwiz.com/bia/home
Senate Finance Committee Health Care Delivery System Comments
On Friday, May 15, 2009, BIAA submitted comments to the Senate Finance Committee in response to their proposed set of recommendations regarding health care delivery system reform.
BIAA expressed support for several recommendations with respect to the coordination of chronic conditions but also made clear within the submission that the organization is strongly opposed to the bundling of post-acute care as it applies to persons with brain injury.
To view the full document, click on the link below:
http://www.biausa.org/elements/policy/2009/biaa_finance_committee_response.pdf
DCoE Launches Real Warriors Anti-Stigma Campaign
On Thursday May 21, 2009, The Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury (DCoE) launched a public awareness campaign focused on combating the stigma associated with seeking care and treatment for psychological health and Traumatic Brain Injury (TBI).
For more information, visit http://www.realwarriors.net/ . The Real Warriors Web site features articles and resources as well as video interviews with service members, their families and others dealing with psychological health and/or TBI.
BIAA has been an active partner in this campaign and will continue to work towards its success with the DCoE.
New Study on Whiplash and Neck Injury
Researchers conducting a study on Whiplash, neck injury, and forces conclude The [DELTA]V value as measured in trauma impact does not represent a conclusive predictor for cervical spine injury in real-life motor vehicle accidents.
The article states Whiplash injuries remain a barely understood phenomenon. Biomechanical considerations have been based on the assumption that damage to a given material only occurs when the energy that acts on this material is high enough. Thus, energy doses below a defined threshold have been considered harmless. In this context, the parameter delta v ([DELTA]V), which describes the velocity change of a motor vehicle during a collision with another vehicle, has become a widely accepted criterion for the energy that acts on the vehicle during a collision.
The scientific community has not yet reached consensus regarding the threshold value for cervical spine injuries after whiplash. Nonetheless, [DELTA]V threshold values were adopted very early in the history of insurance law as a criterion to accept or deny the claim settlement for whiplash-associated disorders (WADs)
Variability of factors makes it unclear how easily the results from laboratory crash tests can be transferred to real-life accident situations. In order to elucidate these issues, this study analyzes the correlation between [DELTA]V and cervical spine injuries in real-life accidents and questions whether [DELTA]V is a valid predictor for cervical spine injuries following whiplash.
Read the study at Elbel, Martin; Michael Kramer,; Markus Huber-Lang,; Erich Hartwig,; Christoph Dehner,. "Deceleration during 'real life' motor vehicle collisions - a sensitive predictor for the risk of sustaining a cervical spine injury?(Research)(Report)." Patient Safety in Surgery. BioMed Central Ltd. 2009. HighBeam Research. 19 May. 2009 http://www.highbeam.com/doc/1G1-193106338.html
Medical Malpractice Legislation Delayed
The Las Vegas Review Journal reports on the state of legislative activity on un-capping medical malpractice lawsuits. The caps limit injured individuals from recovering compensation from negligent doctors for their injuries.
An Assembly-approved bill to let some patients seek unlimited damages in medical malpractice lawsuits was being held up in the Senate in apparent retaliation for an Assembly committee chairman's decision to sit on two Senate-passed construction defect bills.
Though no one had told him directly, Assembly Judiciary Chairman Bernie Anderson, D-Sparks, said he had heard that the Senate Judiciary Committee won't act on Assembly Bill 495 unless his committee passes Senate bills 337 and 349.
The Senate committee on Wednesday cancelled a scheduled hearing on the medical malpractice bill. Under legislative rules, the bills must be approved by their respective committees by the end of business Friday or they cannot be passed during this Legislature.
The chairman of the Senate Judiciary Committee, Sen. Terry Care, D-Las Vegas, said only that he spoke with Anderson earlier Wednesday about the medical malpractice bill, which passed the Democrat-controlled Assembly in April on a 26-15 party-line vote.
The proposal would lift the $350,000 cap on pain and suffering damages in lawsuits where doctors are found guilty of gross negligence.
The bill was drawn up in part by colonoscopy patients in Las Vegas who believe they were hurt by the deliberate negligence of doctors and now are being hurt by a system that limits their damages.
More than 50,000 patients at two now-closed outpatient clinics in Las Vegas were notified last year that they might have been exposed to blood-borne diseases because of shoddy injection practices by clinic staffers. Nine people contracted hepatitis C, and another 105 cases might be linked to the clinics.
Anderson said the bill is straightforward and will help these patients. He also acknowledged the testimony of some doctors who said the bill would lead to higher malpractice insurance rates and drive them out of Nevada.
"Keeping doctors in Nevada is one of our priorities, but what happened in my mind in the South was gross negligence," he said.
Medical Malpractice Reform
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The Nevada Assembly voted 26-15 on Monday to pass legislation that would remove a $350,000 cap on jury awards for non-economic damages in medical liability lawsuits, the Las Vegas Sun reports.
The cap was approved by voters in 2004 after concern was raised that higher medical malpractice insurance premiums were driving some doctors out of the state.
The bill would permit unlimited damages for instances of gross negligence and would give patients an additional 12 months to decide if they want to file a lawsuit (McGrath Schwartz, Las Vegas Sun, 4/20).
The Neurology of Consciousness: Cognitive Neuroscience and Neuropathology
The BIAA is having its annual conference in Las Vegas at the end of the month. One of the featured speakers is Nathan Zasler. Dr. Zasler just finished and book entitled The Neurology of Consciousness: Cognitive Neuroscience and Neuropathology.
This is a very welcome addition to the field of neuroscience literature and should be read by anyone involved in the care of persons with disorders of consciousness. The book starts with a thoughtful Preface by the editors, Dr. Laureys and Dr. Tononi, which is followed by yet another introspective commentary by Dr. Allan Hobson of Harvard Medical School in the form of a Prologue. The contributors to this text include some quickly recognizable names, including Drs. James Bernat, Antonio Damasio, Joseph Fins, Michael Gazzaniga, Adrian Owen, Joseph Giacino, Nicholas Schiff and Adam Zeman, among others.
Read the full review here.
AB495
Dear Senator:
I am in support of AB495, a bill which will no longer protect health care providers when they injure patients. The measure voters approved was designed to limit frivolous lawsuits. It was not intended to protect doctors like Dr. Desai, who has placed the health of patients at risk. Unfortunately, when you give people special legal protections, there is always someone who will try to take advantage.
I am representing a woman whose bile duct remained shut after receiving a pyloric stenosis (stomach thickening condition most often found in infants) surgery. The surgical clips were left in her bile duct. She has three bags of fluid accumulation outside her body which she has to dump and reload several times a day. Additionally her body is unable to absorb food so she is administered nutrition intravenously at night. This has been going on since January 2009. She was referred after the botched surgery to UCLA where she is scheduled to return for corrective surgery. Limiting this woman’s recovery to alleviate this physician’s insurance responsibilities and his insurance company’s profit is unconscionable.
Please right the injustice created when the medical malpractice initiative was passed. Please vote for AB495.
Tim Titolo
Brain Balance(TM) Centers Picks Adam Kluger Public Relations (AKPR) to Help Promote New Book and Atlanta Event to Raise Awareness About Revolutionary New Way to Treat Learning Disorders; Atlantic Recording Artist/Country Music Star Zac Brown and Dr. Rober
Dr. Robert Melillo is an internationally known lecturer, author, researcher and clinician in the areas of neurology, rehabilitation, neuropsychology and neurobehavioral disorders in children. Dr. Melillo's Hemispheric Integration Therapy (H.I.T.) forms the foundation of The BrainBalance Program(R), a multi-modal approach to the remediation of ADHD, Dyslexia, Autism, Asperger's, Tourette's, learning disabilities and processing disorders along with other neurobehavioral disabilities found in children. Brain Balance(TM) Centers do not rely on drugs, medical procedures or psychotherapy.
The new book, Disconnected Kids: The Groundbreaking Brain Balance Program(TM) for Children with Autism, AD/HD, Dyslexia and Other Neurological Disorders, (Amazon.com: Disconnected Kids: The Groundbreaking Brain Balance ...) shows parents how to use this drug-free approach at home, with customizable exercises for physical, sensory, and academic performance, behavior modification strategies, information on foods to avoid, and a follow up program for lasting results.
Lumbar Surgery and Litigation
The negligent performance of lumbar surgery may also give rise to litigation. Negligence in the actual performance of lumbar surgery, however, is infrequently documented in the medical
records and may be difficult to prove. On the other hand, such actions as performing a diskectomy or laminectomy at the incorrect level almost always falls below the applicable standard of care and can be independently proven.
Other examples of negligence during surgery include certain aspects of lumbar fusion surgery, iliac vein or aortic perforation, and the failure to repair a dural tear or leak when recognized.
Examples of intraoperative mishaps that rarely rise to the level of medical negligence include dural tears, cerebrospinal fluid leaks, excessive bleeding and inadvertent nerve root injury.
Overall, mishaps during the technical performance of lumbar surgery constitute the fewest instances of medical negligence.Finally, the failure to diagnose and treat a postoperative
complication may give rise to medical care that breaches the applicable standard of care.
Many post-operative complications following lumbar surgery involve either infection or neurological dysfunction. Infection following lumbar surgery, in and of itself, is usually not medical
negligence; the failure to diagnose and treat such an infection, however, may constitute medical negligence. The failure to diagnose and treat a post-operative disk space infection can
also constitute medical negligence. The presence of a postoperative neurological deficit, in and of itself, may not constitute medical negligence, but the failure to evaluate and treat such a
deficit may be medical negligence.
The failure to provide adequate post-operative follow-up care may constitute medical negligence. In
general, close followup of a patient following lumbar surgery is indicated, and the threshold for performing post-operative imaging including MRI scanning must be low for evaluating neurological dysfunction or infectious processes.
In summary, back pain and lumbar surgery are common medical entities and may be associated with medical negligence giving rise to litigation.
The actual performance of the surgical procedure may give rise to negligence but only in specific instances that may be independently proven.
More commonly, litigation arises from a failure to diagnose the disease entity prior to surgery or a failure to evaluate properly, diagnose and timely treat the patient in the post-operative
period. For these very reasons, an experienced expert witness is necessary to evaluate cases involving lumbar disease and surgical procedures.
Woman Shot in Head Survives
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In an amazing story, A Jackson County man died and his wife was critically injured Tuesday in what authorities described as an attempted murder and suicide at a home off Tanner Williams Road in the Harelston community.
Jackson County Sheriff Mike Byrd said a witness called for help after she was able to escape the home of the victim, Tammy H. Sexton, 47, who had been shot in the head.
The woman was found lying on the bed talking to authorities. Authorities, cited in the Sun Herald, stated. "“It’s truly a miracle that she survived something like this and was talking and conscious,” Byrd said Wednesday. “She had a gunshot wound that went in over her left eye and exited the back of her skull. Based on everything I’ve seen in my career, she shouldn’t be alive.”
Once again, a story of a severe brain injury where the victim walks and talks afterwards. It is reported Tammy Sexton offered authorities tea even with the penetrating would she sustained.
This is similar to the famous case of Phinneas Gage who suffered a railroad iron through his head and frontal lobe and never lost conciousness in 1848. He survived however lived a forever changed life in that his personality was irreparably compromised.
California Hospitals Settle Patient-Dumping Allegations For $1.6 Million
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California-based College Hospitals has agreed to pay $1.6 million to settle charges that two of its campuses improperly discharged and transported about 150 psychiatric patients to homeless shelters in downtown Los Angeles, City Attorney Rocky Delgadillo's office announced on Wednesday, the AP/Kansas City Star reports (Tayefe Mohajer, AP/Kansas City Star, 4/8). City officials alleged the infractions, by College Hospitals' facilities in Costa Mesa and Cerritos, occurred between 2007 and 2008.
The Los Angeles Times reports that the process was discovered by state officials after Steven Davis -- who was diagnosed with schizophrenia, bipolar disorder and schizoaffective disorder -- was treated at the Costa Mesa campus and then taken in a hospital van more than 
40 miles to downtown Los Angeles and dropped off at a homeless shelter. Officials at the shelter complained to the hospital about its action. The van returned and dropped Davis off at a second shelter, but Davis "wandered away without ever entering," the Times reports. City prosecutors then uncovered what they described as the largest case of "homeless dumping" they have encountered, according to the Times (DiMassa/Winton, Los Angeles Times, 4/9).
Under the settlement, College Hospitals will give $1.2 million to charities that care for the mentally ill and homeless and pay $400,000 in civil penalties (AP/Kansas City Star, 4/8). College Hospitals also will have one year to establish written protocols for releasing patients, including locating resources to care for them and obtaining voluntary consent before patients are transported. The two facilities will be barred from taking patients to any homeless shelter within a "patient safety zone" set up in downtown L.A. Delgadillo said, "Dumping patients who are sick or mentally ill on the streets of Skid Row is an unconscionable act," adding, "It's illegal, it's immoral and it has to stop" (Perkes, Orange County Register, 4/8).
College Hospitals attorney Glenn Solomon said that the hospital denies any wrongdoing and that its actions never amounted to "homeless dumping." He added that the hospital agreed to the settlement to establish a workable policy for dealing with homeless patients in the future. "It's the policy of the hospital ... to discharge each and every patient appropriately," Solomon said (Los Angeles Times, 4/9). He added, "The hospital believes it's a good thing to be at the forefront of developing these protocols" (Orange County Register, 4/8).
Reprinted with kind permission from http://www.kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at http://www.kaisernetwork.org/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation.
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.
DoD Gets 35M to Study "Mild" Traumatic Brain Injury
The Department of Defense awards $35M to study Mild Traumatic Brain Injury. Of the 1.5 million people who suffer brain injury each year, roughly 75% are classified as "Mild" and have longterm and permanent impairments and disabilities.
A consortium of physicians and scientists in the Houston region is now undertaking a research initiative to improve diagnosis of mild traumatic brain injury (MTBI) and develop innovative treatment strategies.
The Department of Defense Post-Traumatic Stress Disorder and Traumatic Brain Injury Research Program of the Office of Congressionally Directed Medical Research Programs recently awarded the Mission Connect Mild TBI Translational Research Consortium a grant totaling approximately $35 million to support the five-year research program. The consortium includes research teams from The University of Texas Health Science Center at Houston, The University of Texas Medical Branch at Galveston (UTMB), Baylor College of Medicine, Rice University and the Transitional Learning Center in Galveston. The work will be done within the existing framework of Mission Connect, a consortium established by the TIRR Foundation in 1997 to facilitate collaborative research to improve outcomes for patients with brain and spinal cord injuries and neurological disorders.
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About Tim Titolo
Timothy R. Titolo resides in Las Vegas, Nevada. He represents plaintiffs in personal injury cases. His specific interest is in cases involving traumatic brain injury (TBI), spinal cord injury (SCI) (including back and neck injury) and car, motorcycle and truck accidents.
Tim is a member of the Million Dollar Advocates Forum. He serves on the Board of Directors of the American Association of Justice Traumatic Brain Injury Litigation Group. He is an active member of AAJ's Interstate Trucking Litigation Group, Motorcycle Litigation Group and Inadequate Security Litigation Group. Tim is recognized as a Fellow of the National College of Advocacy.
Because of his experience handling brain, spine and other catastrophic injury cases, Tim has been invited to lecture at over 50 legal & medical conferences around the country. He has lectured for:
- American Association of Justice
- North American Brain Injury Society
- Brain Injury Association of America
- International Brain Injury Association
- National Business Institute
- Pacific Northwest Brain Injury Association
- Oregon Brain Injury Association
- Washington Brain Injury Association
- Los Angeles County Bar Association
- Utah Trial Lawyers Assocation
- Utah Brain Injury Association
- Nevada Brain Injury Association
- Michigan Brain Injury Association
- other brain injury affiliated groups
When not practicing law, Tim enjoys spending time with his family, reading, writing, watching movies, traveling and exercising.
Eye Injury reveals Brain Injury
Any blast that impacts the eye is a "head injury" and impacts the brain as well. Glenn Minney lost most of his sight from a combat explosion. But it wasn't just the injuries to his eyes that cost him his vision it was also damage to his brain.
Minney, then a Navy corpsman, was wounded when a mortar landed near him in Haditha, Iraq, in 2005. The blast threw him 30 feet. His back struck a metal railing, whipping his head backward. He lost his right eye. Vision in his left eye is impaired from physical injury and brain damage, he says.
An emerging threat from the fighting in Iraq and Afghanistan is damage to the brain that affects vision, Pentagon and Department of Veterans Affairs medical researchers say. This type of injury could mean that there are thousands of veterans with undiagnosed vision problems, says Tom Zampieri, of the Blinded Veterans Association.
Doctors didn't find Minney's neurological damage until after he left the military and was screened for brain injuries by the VA. "The public doesn't know the true extent of these (brain) injuries," says Minney, 40, married and the father of two. He's now a patient advocate for the VA in Frankfort, Ohio.
Concerns about eye injuries have prompted federal legislation that would create a $5 million Pentagon-based center for research and treatment of injured eyes. It also would create a registry to track eye wounds.
Minney suffered severe vision loss. Researchers are finding that less-severe vision problems also can occur among troops who suffer minor brain concussions from combat, particularly exposure to a blast. "There are a lot of patients who have suffered mild to moderate brain injuries. Upon initial examination their eyes looked healthy, but they were still reporting problems with their vision," says R. Cameron VanRoekel, an Army optometrist at Walter Reed Army Medical Center in Washington.
Gregory Goodrich, a research psychologist at VA facilities in Palo Alto, Calif., had similar findings in a study of 101 Iraq and Afghanistan war veterans with mild traumatic brain injuries. Many are still in the service.
Goodrich found that 40% to 45% of the patients suffered vision loss even though their eyes were physically healthy. The biggest problem was an inability for both eyes to operate precisely together. This can lead to eye strain and blurred vision.
Left undiagnosed, it can also hamper vocational or educational training and aggravate depression and post-traumatic-stress disorder, Goodrich says. Veterans may need an eye care specialist and corrective eyewear, he says.
But Goodrich fears that routine eye examinations may not uncover the problems. "In many cases, we're seeing active-duty troops, and they want to get back and join their units," he says. "So they don't want to hear that there's something they need to go get treated for."
Sports and Brain Injury
The New York Times published a great article about the dangers associated with not recognizing the signs and warnings associated with Football injury. Too often sporting goals prompt those who could make a difference dealing with injuries to fail players and themselves. The issues of multiple impacts and multiple concussions seen in many contact sports like football and boxing are getting more and more attention.
The National Football League has recently faced questions about its handling of concussions after four former players were found to have significant brain damage as early as their mid-30s. But teenagers are more susceptible to immediate harm from such injuries because, studies show, their brain tissue is less developed than adults’ and more easily damaged. High school players also typically receive less capable medical care, or none at all.
At least 50 high school or younger football players in more than 20 states since 1997 have been killed or have sustained serious head injuries on the field, according to research by The New York Times.
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The Epidemic of Brain Injury care is far reaching
The Epidemic of Brain Injury care is far reaching. A recent study shows that brain injury survivors are not cared for. In terms of representing these people’s legal interests, convincing insurance companies and defense lawyers of this reality is imposing. Additionally, the future for these people, as found in the study, makes them victims again.
The report for the State of Virginia reveals what is true in many, if not all states: veterans returning from the war will face difficult hurdles receiving care for brain injuries. To read more about the situation click here.
Here are a few of the findings of the Joint Legislative Audit and Review Commission study:
The numbers: Up to 6,650 people with brain injuries are in nursing homes, and about 600 others are in state hospitals or in long-term care facilities, including psychiatric units.
Available care: Outside of institutionalization, only about 20 beds exist in Virginia to provide the intensive and costly treatment needed for tens of thousands of brain-injury survivors with complex neurobehavioral problems that can result in violent outbursts and other unmanageable behavior. "There is virtually no system of care in the community for people with behavioral problems who do not have the financial resources to pay for private care."
Tragic consequences: Brain-injured people often become homeless after their caregivers die; many end up in jails or seek divorce to qualify for care.
TBI Statistics
The Tragedy of Brain Injury in the Decade of the Brain
The statistics of brain injury are staggering: 700,000 brain injuries each year in the United States; 100,000 deaths per year; and 70,000 - 90,000 people permanently disabled as a result of brain injury. Most serious automobile accidents involve a brain injury. Many of these injuries are serious, but many also form "mild" and "moderate" categories. Victims experience significant personality changes, debilitating cognitive deficits and serious physical and social problems, yet they are often seen as "normal" by some in the medical profession. One author called them the "walking wounded." Their plight is often unnoticed and their needs are not served. It is truly "a silent epidemic."
The statistics of brain injury are staggering: 700,000 brain injuries each year in the United States; 100,000 deaths per year; and 70,000 - 90,000 people permanently disabled as a result of brain injury. Most serious automobile accidents involve a brain injury. Many of these injuries are serious, but many also form "mild" and "moderate" categories. Victims experience significant personality changes, debilitating cognitive deficits and serious physical and social problems, yet they are often seen as "normal" by some in the medical profession. One author called them the "walking wounded." Their plight is often unnoticed and their needs are not served. It is truly "a silent epidemic."
