Traumatic brain injury:
It is dark inside the brain. No one can see the brain. It receives information and communicates with all our organs (including eyes transferring the outside world’s images) via nerves. Very few blood vessels reach the brain to carry medications. The silent grey mass works non-stop from our birth to death (even little longer). It remembers events, colors, odors, images, numbers, and controls our feelings, thoughts and body functions. It follows and automatically adjusts to the skull positions. It allows blind people to see objects and their colors as if they had real eyes. It controls bodily functions, internal organ and skeletal and muscular systems. It heals and remembers injuries to the body and to itself. It will retrain itself and assume the damaged portion functions.
Traumatic brain injuries (“TBI”) may be caused by a fall to the ground or impact against or by a hard object as a result of a childbirth, or train, watercraft, vehicle, or airplane crash, or fall from a ladder/ building’s roof/ wheelchair, etc. TBI surgery and treatment may restore most of the body functions but the brain damage will last as long as the injured person lives. TBI triggers devastating consequences in the form of debilitating Alzheimer’s, Parkinsonism, dementia, and other illnesses many years after TBI. These TBI consequences must be accounted for in calculation of damages in TBI legal claims. Such damages include past (to the date of claim settlement or adjudication) and future pain and suffering, life care costs including medical expenses, loss of earnings, loss of normal life / enjoyment of life, disfigurement of the body.
While opinions of vocational economist, neuropsychiatrist, rehabilitation and primary care physician (to reveal pre- and post TBI survivor’s health conditions), neurosurgeon, co-workers and other witnesses’ opinions are important for proving damages, a clinical neuropsychologist’s report and opinions are of critical value. These opinions are based on test results conducted at least one year after the injury as usually the TBI victim’s medical condition stabilizes after one year. The report reflects the patient’s levels of dependence on others; psychosocial adaptability (difficulty of keeping a job /being employed), general intellectual ability, verbal comprehension, perceptual reasoning, reading comprehension, arithmetic skills, dysfunction/ attention/ concentration problems, non-verbal reasoning, new hypotheses generation, verbal concept formation, phonemic/ design fluency, hyperactivity, disinhibition, memory / learning deficits, visuospatial construction, motor and sensory deficits, anxiety disorder, indecisiveness, etc.
Such a report in general reveals opinions on causation of memory/ learning, attention, concentration, motor function, sensory perception and executive function deficits (e.g., due to neurologic evidence of damage to both sides of the brain and diffuse cerebral dysfunction in frontal and temporal regions of the brain). It also gives for severe TBI’s victims the opinions on future long-term cognitive deficits, coping with the TBI emotional sequelae, higher risk for developing post-traumatic seizures, self-harm, depression, early onset dementia or Alzheimer's Disease (at 2.3 to 4.5 times higher risk), and tendency to die seven years earlier than those without such a TBI history.*
For determination of future TBI-related life care and medical costs, a life care planner (certified nurse or trained physician) prepares a life care plan (“LCP”) based on ambulance, hospital/s, surgeons, rehabilitation, treating physicians’, and expert opinions’ reports and other records. A LCP includes the TBI survivor’s case history:
(1) Diagnosis, e.g. “severe traumatic brain injury with mastoid, maxillary sinus and skull fractures”; (2) Surgical procedures**; (3) Post-surgery hospital treatment and rehabilitation (e.g. occupational, speech, recreation, fitness) therapies; and (4) Treating physicians’ and retained experts’ reports, records and opinions on TBI causation, survivor’s activity restrictions, permanency of injuries and future treatment with estimated costs. LCP covers the patient’s current symptoms’/ condition status, guardianship, supervision of day-to-day activities (i.e. medication administration, visits to therapists, bill payments, food preparation, etc.), ability to make decisions affecting own safety if not supervised, memory loss, memory and learning deficits, impaired physical mobility, increased susceptibility to falling that may cause physical harm related to impaired balance, fatigue, ineffective impulse/ anger control, and other individual-specific expert opinion analysis.
LCP future cost calculations are usually state-specific and based on today’s dollars (without economic projections factoring in inflationary trends of the healthcare industry), the average of UC&R charges and three local pharmacies (for medications), and victim’s life expectancy taken from the latest federal data (e.g., U.S. Life Tables, NVSR Volume 68, Tables for males and females). LCP incorporates and summarizes rates and number of sessions/ visits projections for the TBI survivor’s remaining years of life:
Future Medical Care (neurosurgeon, psychiatrist, neuropsychologist, and other professionals);
Rehabilitation Therapies (occupational, recreational, physical, speech, etc.);
Lab Work / Diagnostic Testing (complete blood counts (CBC), comprehensive metabolic profile, venipuncture, brain CT, EFG, visual field testing, sleep study, etc.);
Medical supplies (hospital bed, oxygen tank, etc.);
Projected Surgeries / Hospitalization for complications;
Home Health (home care by a family member or hired help)/ Facility Care / Case Management (nurse case manager);
Aid for Independent Function (cane, walker/wheelchair, smoke detectors, alarms, shower bar and handheld shower);
Transportation (for treatment/ checkups/ testing visits).
The imputed value of life care’s costs should guarantee the TBI survivor with the highest quality of life. That is why it is crucial to make sure that all damages are meticulously researched, justified, gathered and properly presented for TBI claim compensation.
* Bazarian JJ, Cernak I, Noble-Haeusslein L, Potolicchio S, Temkin N. 2009. Long-term neurologic outcomes after traumatic brain injury. Journal of Head Trauma Rehabilitation 24:439-451; Harrison-Felix et at, (2004), Mortality following Rehabilitation in Traumatic Brain Injury Model Systems of Care, NeuroRehabilitation 19, 45-54.
**e.g., “right decompressive hemi-craniectomy, left frontotemporal craniotomy with evacuation of epidural and subdural hematoma with repair of fracture, open tracheostomy tube placement, gastrostomy tube placement / removal, and replacement of right-sided bone flap”.
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