Brain Injury Law Blog : Head Injury : Coma : Personal Injury : Las Vegas Nevada Lawyer & Attorney Tim Titolo

The Brain Injury Association of America published its position paper on the definition of traumatic brain injury entitled Conceptualizing Brain Injury as a Chronic Disease.  The organization tasked with providing legislation and lobbying for victims of traumatic brain injury, published its paper in 2009.

The gist of the paper is that traumatic brain injury is not an event but a process. 

• MORTALITY - The paper states that individuals with a TBI were twice as likely to die as a similar non-brain injured cohort and had a life expectancy reduction of seven years.
• ETIOLOGY - There is an indirect effect on other organs from traumatic brain injury.
• MORBIDITY - Individuals with a TBI are 1.5-17 times (depending on the severity of the TBI) more likely than the general population to develop seizures.  Chances of getting epilepsy after traumatic brain injury increase and account for 5% of all epilepsy in the general population.
• INCONTINENCE
• PSYCHIATRIC DISEASE
• SEXUAL DYSFUNCTION
• MUSCULOSKELETAL DYSFUNCTION
   

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 We are almost through August and more than half way through Summer 2010. Parents, children and kids are preparing for the return to school in the next couple of weeks. In Nevada, public schools start August 30.

Meanwhile Nevada, and particularly Las Vegas, continues to muddle through the recession which for Southern Nevada has been a novel experience. The unemployment rate is close to 15% as I write.  The city many thought was immune from economic storms has seen itself hardest hit. Hopefully things will improve.

We face a heated election where the Tea Party candidate, Sharon Angle, accuses Democrat incumbent, Harry Reid, for the current state of plummeted home values while Reid criticizes Angle for not making job creation a part of her job!

The Station Casino’s recent resurface from Bankruptcy with owners, Frank and Lorenzo Fertitta, manning the helm, may be a boost. Of course some creditors had to write off $4,000,000,000 – four billion dollars! But maybe the massive adjustment will re establish the local casino group and have a positive impact on Las Vegas. 

Today’s report of the M Resort, opening just over a year ago, being put up for sale may result in an interesting bid; especially if Boyd gets back into the picture. Boyd’s recent failed effort to take over Station properties may be a prelude to an M resort bid.  Although my sources tell me that Station may make a bid to buy M resort now that they have shaken off 4 billion in debt.

I am reporting on 2 separate topics relating to Brain and Spine Injury issues. First is a look at the Cleveland Clinic’s Las Vegas Lou Ruvo Center. Second is the recent revelation concerning veterans. 

Lou Ruvo Brain Center

Nevada, and specifically Las Vegas, may be on its way to becoming the "go-to" place in the country for Brain Health.  The Cleveland Clinic Lou Ruvo Center for Brain Health (CCLRCBH) provides state-of-the-art care for cognitive disorders and for the family members of those who suffer from them.

 For persons with mild cognitive impairment such as early stage dementia and Alzheimer’s disease, the center offers the most up-to-date and technologically advanced diagnostic imaging services, including 3-Tesla MR, performed by one of the leading neuroimaging academic centers in the world. The CCLRCBH also offers a multimodal treatment program for persons with mild cognitive disorders, including physical exercise, cognitive rehabilitation, and cognitive enhancing medications.

Recently named to head up the Center, leading researcher and neurologist Jeffery L. Cummings, MD, will be the Director of the Cleveland Clinic Lou Ruvo Center for Brain Health.

Prior to joining Cleveland Clinic, Dr. Cummings was the director of the Mary S. Easton Center for Alzheimer’s Disease Research and a professor of Neurology and Psychiatry and Biobehavioral Sciences at David Geffen School of Medicine at UCLA.

He is past president of the Behavioral Neurology Society and of the American Neuropsychiatric Association. Dr. Cummings has authored or edited 30 books and published more than 600 peer-reviewed papers.
 

Misdiagnosis Hurt U.S. Soldiers

We now know that during the height of the Iraq war, the Army routinely misdiagnosed hundreds of soldiers with “personality disorder.” In doing this, the Army was categorizing veterans being dismissed from duty, with a pre-existing condition. Pre existing conditions are not covered by the military health care for veterans.

Leaving wounded veterans ineligible for military health care and with a stigma attached to mental weakness, advocates for veterans, congress and the public actively pushed for re-evaluation of veterans conditions. The Nation, published an article exposing the practice and caused the Defense Department to change its policy. 

All soldiers diagnosed with Personality disorder prior to 2008 are being re-evaluated. Before 2008, over 1000 soldiers were dismissed based on personality disorder. In 2009 only 260 were dismissed for personality disorder.   By 2008, 14,000 soldiers were diagnosed with brain injury or post traumatic stress disorder.   The number of personality disorder cases dropped 75%. Watch this You Tube video.

The significance for those men and women that serve the country in the military is staggering. Could you imagine sacrificing life and limb only to have the U.S. government tell you that you suffered a pre-existing personality disorder? Why, you might ask, did the Army, for example, not make that determination until after my sacrifice of life and limb? How convenient for the Army to take advantage of the sacrifice and not pay the veteran when they can no longer make the sacrifice.

We now know about PTSD as it relates to war, something the Vietnam veterans did not benefit from. We also know, unlike Vietnam, that more soldiers stay alive after blast and concussion trauma due to the enhanced protective gear.

I really hope that the U.S. will be proactive in caring for its military. I think we should all support brain injury groups like the Brain Injury Association of America who are on the front lines, so to speak, in getting legislation for brain injured survivors.

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What is a Brain Injury Case Worth? Episode 2

Brain injury comes in many shapes and sizes. The proverbial “one size fits all” does not apply. Although there are many similar characteristics with most brain injuries they are not all the same. For instance, brain injury often results in short term memory loss and difficulty processing information. How that emerges between individuals varies but often it is seen at work and in social situations. Often the difficulty requires more energy for processing information and results in fatigue.

Depression is common both from the injury itself and psychologically as a result of the affects of the injury. This is especially true in cases of mild and moderate traumatic brain injury when those around you simply have difficulty believing you are suffering when you look otherwise normal. This adds to the frustration, anxiety and irritability.

If you have been in a traumatic event that caused a concussion and brain injury, you may wonder about the value of the legal case. A legal case value depends on many things other than the injury and its affects. Many people do not understand this. Sometimes an injury can be worse in one case but valued lower than another case with a lesser injury. On the other hand, too often cases with a higher value are settled for less because the person making the evaluation does not understand brain injury. Since traumatic brain injury typically results in difficulty making decisions, it is a good idea to have someone you trust help you find a lawyer.
Finding the right lawyer is critical to getting a proper verdict or settlement. Lawyers have different interests and talents. Long ago lawyers could be general practitioners handling wills, business matters, divorce and criminal matters. Today the law is very specialized. That is, what a lawyer spends most of his time doing is what he is best at. If your lawyer handles one or two brain injury cases a year, he is not a good choice to handle your injury. If your lawyer’s practice is devoted to over 90% brain injury cases, you’ll have a much better outcome.

The first thing to understand is all lawyers are not made the same. And just like other folks, if a lawyer untrained in brain injury does not see an injury on standard diagnostic tests or by simple observation, they are not likely to believe it exists. On the other hand, if your lawyer is versed in how mild and moderate traumatic brain injury affects victims, they will know where to look and how to maximize the value.

Traumatic Brain Injury typically has medical costs associated with care in the past and in the future. Determining what the future costs are likely to be is important in valuing the case. Likewise, past lost earnings from being out of work are simple enough to calculate, but what about the loss of future earning capacity? This is very tricky since a person with brain injury may be able to do a job but staying consistently employed is an entirely different matter. Again, unless your lawyer has extensive experience on how and why a brain injury can cause loss of future earning capacity, she may sell your case short.

There are many other things to consider when hiring a lawyer and that is why you should seek out assistance from someone you trust; your spouse, parent, child, relative, or good friend. You should not simply take the advice of someone who tells you about a lawyer they used in a case. That lawyer may be a very talented divorce lawyer but that is not what you need. Your friend’s lawyer may even be personal injury lawyer, but that does not automatically qualify her as a brain injury specialist. Personal injury lawyers rarely limit their practice and research to traumatic brain injury. You are entitled to hire a lawyer that does.

I wrote an article entitled a Guide to Selecting a Lawyer in a Traumatic Brain Injury Case. I attempt to guide non-lawyers in choosing a qualified lawyer to handle their case. Much of what I propose are simple questions that you have a right to ask. Lawyers who profess skill in handling traumatic brain injury cases typically have blogs they publish. For instance my blog is entitled Brain and Spine Injury Law Blog. You may want to research your lawyer’s web site as well.

With the help of a trusted companion, look up organizations like the Brain Injury Association of America (BIAA), www.biaa.org. Visit their site on the internet or call them and ask for a referral to a lawyer in your particular state. There are organizations whose purpose is to assist victims of brain injury. Consult them rather than simply relying on the recommendation of a friend who may mean well but does not understand the nuances of brain injury.

These organizations will also assist you in getting the right care and treatment in your area. Most hospital emergency rooms do not treat or even diagnose mild or moderate traumatic brain injury, so you will benefit by talking to folks who understand. Other groups include individual State Brain Injury Associations, and the North American Brain Injury Society (NABIS), www.nabis.org.

Not only will these organizations assist you in getting help, they provide literature and videos to help explain what you are experiencing and how treatment can help.
If you or someone you know has suffered traumatic brain injury, please accept my best wishes and prayers for a maximized recovery. I hope something I have shared here will assist you in your journey.

Timothy Titolo copyright 2010
 

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The American Psychiatric Association revised the timeline for publishing the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, moving the anticipated release date to May 2013.

The Diagnostic and Statistical Manual of Mental Disorders (DSM) is the standard classification of mental disorders used by mental health professionals in the United States. It is intended to be applicable in a wide array of contexts and used by clinicians and researchers of many different orientations (e.g., biological, psychodynamic, cognitive, behavioral, interpersonal, family/systems).

The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) has been designed for use across clinical settings (inpatient, outpatient, partial hospital, consultation-liaison, clinic, private practice, and primary care), with community populations. It can be used by a wide range of health and mental health professionals, including psychiatrists and other physicians, psychologists, social workers, nurses, occupational and rehabilitation therapists, and counselors. It is also a necessary tool for collecting and communicating accurate public health statistics.

Diagnostic criteria provide a common language for clinical communication and their use has been shown to increase diagnostic agreement between clinicians.   It is important to understand that the appropriate use of the diagnostic criteria requires clinical training and that they cannot be simply applied in a cookbook fashion.

Another important aspect of the DSM diagnostic system is that the diagnoses are described strictly in terms of patterns of symptoms that tend to cluster together.  These symptoms can be observed by the clinician or reported by the patient or family members.  Because it focuses on manifest symptoms clinicians from widely differing theoretical orientations can therefore use the DSM.  Since the causes of most mental disorders are subject to ongoing scientific inquiry, the DSM avoids incorporating competing theories in its diagnostic definitions.  This feature has been an important element in the widespread clinical acceptance of the DSM, and has allowed a wide scope of research investigation.  

This is also an important limitation of the DSM system.   Patients sharing the same diagnostic label do not necessarily have disturbances that share the same etiology nor would they necessarily respond to the same treatment.   It is therefore critical to understand that the diagnostic terms and categories in the DSM represent only current knowledge about how symptoms cluster together.   

I find that the DSM has been too general in situations involving my clients and too specific and exclusionary in other situations.  I, and experts I consuted, fully expect that, over the coming decades, the DSM system will be radically reorganized as the etiologies of mental disorders become better understood.

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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.

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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.

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