Episode 2 - What is a Brain Injury Case Worth?
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
Depression Following Traumatic Brain Injury
Researchers found patients with traumatic brain injury suffered from major depression for a year after the injury. A new study conducted by scientists at the University of Washington School of Medicine in Seattle revealed that traumatic brain injury may lead to major depression.Other studies have documented the relationship between traumatic brain injury and depression. Many involved smaller samples sizes. However this study involved 559 patients.
Interestingly, the severity of the brain injury did not suggest greater depression. Rather it was the age of the patient. People in the the peak of their prime from 30 to 44 years old - noticed the impact of their injury greater than other age groups. These people rated their functioning and health as particularly affected.
The study concluded that routine screening for depression in the months following traumatic brain injury may be critical. I always counsel my clients to get care as close in time to their injury as possible. It is generally accepted that spontaneous recovery occurs most during the 12 months following injury. And the more rehabilitation one can get closest to the time of injury, the better the potential outcome.
Unfortunately, the people I counsel often do not have resources to obtain treatment during that
initial 12 month period. Often they lose their jobs and insurance and are left to navigate the medical system alone. This is impeded by organic depression which in turn creates more depression: situational and otherwise.
initial 12 month period. Often they lose their jobs and insurance and are left to navigate the medical system alone. This is impeded by organic depression which in turn creates more depression: situational and otherwise.My clients are often seen by hospital emergency room physicians initially. The most obvious injuries are attended to as life or death situations. After they are patched up, they are sent home with instructions to return if necessay. Then they get a bill that shocks them. Returning to the hospital because they have constant headache or dizziness does not seem economical. That is why I usually end up managing care by getting the client to appropriate health care providers for follow up and follow through.
The results of the study appeared in the May 18 issue of the Journal of the American Medical Association (JAMA).
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.
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.
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.
The Sad Untold Story
A tremendously important story has gone virtually untold by the media, ignored by our political leaders and unknown to the American public. Despite the extraordinarily high price they have paid, America's severely wounded veterans are enduring humiliating financial hardships of epic proportions. Home evictions, utility shutoffs, car repossessions and foreclosures are 
commonplace.
Spouses have to give up their jobs to become caregivers, cutting family incomes by up to 50 percent or more. Most disabled vets receive much less in compensation and benefits than they did while on active duty, reducing incomes even further. Many are too dysfunctional to hold a meaningful job, if any, because of the devastating effects of post-traumatic stress syndrome (PTSD) and traumatic brain injury (TBI).
Rick Amato of the Washington Press. Rick Amato is a radio talk-show host in San Diego and with Washington Times Radio News. Amato Strategic Communications provides consulting services to nonprofit organizations, including veterans causes.
There is a great deal of information out there on PTSD and the military, and this may largely be due to the origins of the PTSD diagnosis.
Post traumatic stress disorder (PTSD) can be considered a "young" diagnosis. It was not until 1980 that the diagnosis of PTSD as we know it today came to be. However, throughout history, people have recognized that exposure to combat situations can have a profound negative impact on the minds and bodies of those involved in these situations.
In fact, the diagnosis of PTSD originates from observations of the effect of combat on soldiers. The grouping of symptoms that we now refer to as PTSD has previously been described in the past as "combat fatigue," "shell shock," or "war neurosis."
It is not surprising that high rates of PTSD have been found among soldiers from World War II, the Vietnam War, the Persian Gulf War, and the war in Iraq.
Rick's perspectives include getting congress to put soldier and veterans disability right to top of the stimulus packages being authorized of late. He quotes President Reagan "Until our politicians feel the heat, they won't see the light."
Read the whole article in the Washington Press including a specific case of a military couple struggling to endure.
Dr. Helen Mayberg For the Defense - Again!
It's nearly impossible to tell if a former soldier convicted of killing an Iraqi family has brain damage because of the method used to scan his brain, a neurologist testified Tuesday.
Dr. Helen Mayberg, a professor at Emory University in Atlanta, said the wrong protocols were used during an MRI of former Pfc. Steven Dale Green. Instead of what amounted to a complete scan of Green's brain, his MRI included pauses between each scan, Mayberg said.
I first ran into Dr. Mayberg in a brain injury case I tried before a jury in the early 1990s. She adamantly
said that Positron Emission Tomography (PET) was not useful for corroborating diagnosis of brain injury caused by trauma. Dr. Joseph Wu of UC Irvine said it was one tool used among the others available. The PET scan Dr. Wu performed was allowed into evidence by the court.
It is very interesting to note that so-called experts hired by defense lawyer firms come up with the same type of testimony in virtually every case. What ever the treating or plaintiff's expert says is "wrong."
While hired in a criminal case:
Prosecutors called Mayberg to the stand to rebut the May 12 testimony of Ruben Gur, director of neuropsychology at the University of Pennsylvania School of Medicine.
Gur, called by the defense, reviewed a 2008 MRI and found Green has brain damage. He made the diagnosis after comparing Green's MRI to scans from 41 other men of roughly the same age without brain injuries. People with such injuries have "major difficulties" restraining their impulses, he said.
Defense attorneys have argued that Green's lack of impulse control was a factor in him taking part in the slayings of the al-Janabi family.
Defense attorney Scott Wendelsdorf, while questioning Mayberg, said MRI's don't necessarily tell the entire story of what is happening in someone's brain.
"A normal MRI doesn't mean nothing is wrong with a brain, does it?" Wendelsdorf asked.
"That's a very true statement," Mayberg said.
Dr. Mayberg has made a good living testifying against plaintiffs and criminal defendants. Read about the case by clicking here.
Soldier with Mild TBI Dies of Drug Overdose
Indiana National Guard Sgt. Gerald "G.J." Cassidy, who served his country in Bosnia and Iraq, died alone and ignored in a barracks at Fort Knox from an accidental drug overdose. His fate left a legacy that has changed the lives of thousands of wounded soldiers, Army officials say.
Cassidy began experiencing migraine headaches after a roadside bomb exploded about 11 feet from his Humvee in Iraq in August 2006. With diagnoses of post traumatic stress disorder and mild traumatic brain injury.
One Fort Knox soldier told investigators, "The staff at the WTU did not keep accountability of soldiers and were not making any checks on the welfare of soldiers" with PTSD and brain injury.
On the day Cassidy died, his platoon sergeant reported him at formation when he actually hadn't seen him for two days.
After repeated calls from Melissa Cassidy after she had not heard from him in a couple of days, Sgt. Cassidy was found dead in his chair. A toxicology report from the Armed Forces Institute of Pathology ruled his death accidental, caused by "multi-drug toxicity," compounded by coronary artery disease.
Excerpted from Soldier's hospital death leads to changes as published in Associated Press. Information from: The Courier-Journal, http://www.courier-journal.com
Left & Right Side Brain Differences
I will never forgot the experience of deposing the coroner in a brain injury case. The deposition was at the morgue. Afterward, we, the attorneys for all parties and the court reporter, were treated to a tour. What amazed me most was how numbed the folks working there were to the noxious fumes that pushed their way into your olfactory center.
Then as a personal favor to me, I was permitted to hold brains that had been removed from bodies. I was able to get a never before view of the brain's structure, texture and size.
I recently came across an interesting article from someone having a similar experience. Discover Magazine contributor, Carl Zimmer, published "The Brain The Big Similarities & Quirky Differences Between Our Left and Right Brains," in the May 2009 issue. Brain lateralization is the cooperation of right and left brain. He states:
No matter how lateralized the brain can get, though, the two sides still work together. The pop psychology notion of a left brain and a right brain doesn’t capture their intimate working relationship. The left hemisphere specializes in picking out the sounds that form words and working out the syntax of the words, for example, but it does not have a monopoly on language processing. The right hemisphere is actually more sensitive to the emotional features of language, tuning in to the slow rhythms of speech that carry intonation and stress.
Neuroscientists know that the hemispheres work together and that they do so by communicating through the corpus callosum. But exactly how the hemispheres cooperate is not so clear. Perhaps paired regions take turns being dominant. That is known to happen in some animals. For instance, dolphins use this strategy to sleep and swim at the same time: One hemisphere remains active for hours, then fades while the other takes over. Bird brains switch as well. In order to sing, a songbird makes the two sides of its lungs open and close. The two hemispheres of the bird’s brain take turns controlling the song, each dominating for a hundredth of a second.
The intimate cooperation between the two hemispheres makes it all the more remarkable that a person can survive with just one—a sign that the brain is far more malleable than we once thought. After a hemisphere is forced to manage on its own, it can rewire itself to handle all the tasks of a full brain. In fact, two hemispheres can cause more trouble than one if they cannot talk clearly to each other. Neuroscientists have linked some mental disorders, including dyslexia and Alzheimer’s, with a breakdown in left-right communication.
The two sides of the brain may be a legacy that we inherited from our wormlike ancestors. But their delicate balance of symmetry and specialization is now woven into the very essence of human nature.
Read the full article here.
National Institutes of Health Research
Research is the key to understanding and dealing with Traumatic Brain injury.
National Institute of Neurological Disorders and Stroke (NINDS)conducts and supports research on Traumatic Brain Injury (TBI) to better understand the biological mechanisms of injury, to develop strategies and interventions to limit the primary and secondary brain damage that occur following TBI, and to devise effective treatment strategies to improve long-term recovery of function. NINDS areas of research include:
1. Assessment of posttraumatic brain function and pathology
2. Discovering mechanisms of brain injury and repair processes
3. Identification of therapeutic targets
4. Translational research for therapy development
5, Clinical trials to evaluate therapeutic efficacy
6. Current TBI clinical trials at NIH and other organizations
7. NINDS Clinical Research Overview
The NINDS publishes Traumatic Brain Injury: Hope through Research and NINDS Shaken Baby Syndrome Information Page. Click on either link to see more.
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.
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.
Winner Takes All
I finished Winner Takes All, a book about Las Vegas and people who run the casino empires. Interestingly, two out of three of the casino empire operators do not call Las Vegas home and actually raise their families in NY and California. Yet one does call Las Vegas home and his contributions to the Las Vegas cutting edge are undeniable.
Former Wall Street Journal reporter Christina Binkley offers this story of the trio of tycoons who took over Las Vegas and transformed it from a crushed-velvet world with a libidinous frontier air into a place where, increasingly and sometimes surprisingly, entertainment and good taste go hand in hand.
Binkley provides an inside look at deal-maker Kerkorian, casino visionary Wynn and professor-turned-mogul Loveman and their lavishly competitive lives: their exclusive and aggressive tennis games, the one-way conveyor belt created to transport customers away from a competing casino, the battle to build the biggest and the best. The author shares intriguing details about these power players—Wynn has a secret entrance, behind some fake books on a shelf, to a sprawling closet—and is also adept at portraying a seedier Vegas, where aged Mafia barons dined on the osso buco at Piero's Italian restaurant, their canes hanging from their chairs.
Sometimes her chronology gets a little murky. Still, Binkley offers plenty of nuggets mined from her years on the beat, producing a full, flashy tale of powerful men and their pride, vanity, envy, greed—and all the other cardinal no-nos that earned Vegas the name Sin City.
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.
