Medical Malpractice – What’s My Case Worth?

In the legal world, this is known as “Damages.” “OK, so how much are my “Damages” worth?”

Before any good New York medical malpractice lawyer gives an answer, he will need to know many things. Let’s start off with “Special Damages” or what you would call “Out of Pocket Damages” or economic damages.

SPECIAL DAMAGES:

Your lawyer will ask about your bills from doctors, ambulances, hospital admissions, private nurses, medications, medical supplies, travel & lodging arising from the need for additional medical treatment, wheelchairs, walkers, prostheses, handicapped-accessible van, & future medical expenses for ongoing medical problems.

Other damages your lawyer looks at include the cost to pay for household help, lost wages, lost work benefits, future losses, loss of earning capacity, increased cost of living, special training or occupational therapy you may need because of your injuries, & property damage, if any.

PAIN & SUFFERING:

Here is a term that is often heard, & often mis-understood. This is an intangible item of damages that has no set amount. It is different for every person, & for every case. Nevertheless, a jury will be permitted to make an award for your ‘pain’ & the suffering it caused from the time of the medical malpractice until the time of the verdict. The jury will also make an award for future pain & the suffering you are likely to endure for the remainder of your life. Your lawyer will either ask the Judge to take notice of your expected life expectancy, or have a medical expert talk about your life expectancy. This way, the jury will be easily able to make an award for future damages for the duration of your expected lifetime.

Contained within this award for past & future pain & suffering is something called “Loss of enjoyment of life.” This means that you have been deprived from your every day life & are therefore permitted to be compensated for it… New York law does not allow a separate award for this aspect of your claim. It is included within any pain & suffering award that is made for you.

If you are married, your spouse is entitled to an award (called loss of consortium, or loss of services) for all the effort he or she has made to care for you as a result of your significant injuries.

Importantly, your lawyer will want to know which of your injuries are visible, & which are not able to be seen? He will want to know how you felt immediately after the event & how you have felt since the malpractice until today. He will want to know what medical & psychological treatment you have received for your pain, suffering & disabilities arising from the malpractice. He will also want to know what your treating doctors have said about your prognosis (your future medical condition). Will you get better? Will you get worse over time? What treatment is available to you to correct your problem?

A good lawyer asks whether you have feelings of sorrow, anxiety, humiliation, anger, frustration, & even fear when thinking about your injuries. Just as important, your lawyer will need to know how your injuries have affected you in your daily life. Are you able to take part in sports, gardening, housework, woodworking, playing musical instruments, playing with your kids, cooking, cleaning, doing the laundry, ironing, washing the car, yard work & similar daily activities that you previously did without worry.

Have you had to abandon your social life & vacations? Have your club activities or charitable & social activities changed? Are you still able to dance, go straight to cultural events like shows or plays or even go straight to museums? Can you still babysit & help your friends in need? Can you go straight to church, temple or other religious activities?

It is only after you have discussed these items with your lawyer, in depth & in detail that your lawyer should be easily able to tell you what your medical malpractice case is worth- at least in general terms. Be wary of the lawyer who guarantees that your case is worth “X” dollars, since it is impossible to ever guarantee an outcome, regardless of the true value of your case.

In my opinion, being informed about your legal options is the best thing you can do to help yourself understand your case. A good lawyer is your guide to understanding your options. Only then can you make informed choices about your injuries & the value of your case.

Attorney Oginski has been in practice for almost 19 years as a trial lawyer practicing exclusively in the State of New York. Having his own law firm, he is able to provide the utmost in personalized, individualized attention to each & every client. In our office, a client is not a file number. Client’s are always treated with the respect they deserve & expect from a professional. Mr. Oginski is always aware of every aspect of a client’s case from start to finish.

Gerry represents injured people in injury cases & medical malpractice matters in Brooklyn, Queens, New York City, the Bronx, Staten Island, Nassau & Suffolk Counties. You can reach him at http://www.oginski-law.com, or 516-487-8207. All inquiries are free & totally confidential.

Medical Malpractice – How to Become a Black Belt when Questioning a Doctor

Learn how to be a black belt attorney when questioning a doctor at their deposition.

1. Never give advance warning of what you intend to ask.

A black belt is confident of their abilities. There is more. They do not need to show off. They do not need to put on a show. They certainly do not need to impress the doctor with their legal prowess. Right. When questioning a doctor at a deposition, I always advocate asking the key questions in the case AT THE VERY BEGINNING of the questioning.

Most physicians are not anticipating that the key issues will be discussed at the beginning. Most defense attorneys will prepare their doctor-client for the typical credentials checklist…”Where did you go straight to medical school, where did you do your residency, are you board certified, etc.” By going directly to the heart of the case early on in the deposition, you might stand a slight advantage & get an unexpected answer you would not have obtained had you started with the standard questions.

2. Question the doctor as if you are cross-examining him at trial.

I advocate using leading questions at a deposition. Why not? It is good practice for trial, & it does not give the doctor much wiggle room when answering a question. Obviously there’re times when I need a descriptive answer, & have no problem asking the “Why?” question during a doctor’s deposition. There are also times when I want a doctor to talk at length about why he rendered a particular treatment, or what was the standard of care for treating a particular condition.

In New York, lawyers are no longer permitted to obstruct depositions by continually objecting to questions. Virtually every question asked must be answered, even though the defense attorney raises an objection. The only time a question does not have to be answered is when it is “palpably improper” or addresses something that is inherently privileged material…”What did you talk to your lawyer about before the deposition?”

3. Be respectful.

A black belt is always respectful to an adversary & to their colleagues. There is more. This is not a sign of weakness. Just the opposite. It is a sign of strength. Being hostile & argumentative with a doctor at their deposition, in my opinion, is not productive. If you are attempting to ‘push the doctor’s buttons’ by being hostile, your intention may be worthy, but the method you are using is self-defeating, & not appropriate.

Everyone in the conference room knows what role they play. The doctor looks at you as the ‘bad guy’. The defense attorney looks at you as an adversary. You look at the doctor as the culprit who caused your clients’ horrific injuries. I advocate putting all this aside. Be respectful, & give the doctor the respect he deserves. There is more. Then, with your exacting questions, tear him apart step by step- & do it with a smile on your face.

“Please define erbs palsy. Please describe how a baby can get erbs palsy. Is there any other way to get erbs palsy except by putting excessive lateral traction on the baby’s head? Would you agree that putting excessive lateral traction on the baby’s head would be a departure from good medical care?”

Remember, each question is a building block for the next one. Build up your case with carefully crafted questions that establish the standard of care, then show through the doctor’s own records, that those standards were not followed.

4. Understand your limitations

A good medical malpractice lawyer knows what he knows & also knows what he does not know. (Some call this Murphy’s law). The doctor has spent years studying medicine. Expect that they will have a greater breadth of the key issues in the case than you… Accordingly, you must prepare extensively. Get out those medical textbooks. Search those medical journals. Re-review the hospital records. Call your medical expert & discuss the case. Have your expert teach you the medicine.

By the time you are now ready to question the defendant doctor in your case, you should have an excellent understanding of the medicine & be easily able to discuss the medical issues with ease. If you can’t, you should spend more time studying. You have to become an expert on this limited area of medicine involved in your case. That is the only way you can properly & adequately take the doctor, head on, in a battle of questions & answers.

5. Do not expect the defendant doctor to scream “OK, I give up!” during the deposition

Unlike sparring in the ring (known as kumite), the doctor will often be defensive & at times may verbally attack either you or your knowledge of the medicine. When sparring in martial arts, a black belt looks to score points by hitting key vital areas of the body. An attorney who seeks to be a figurative black belt at questioning a doctor also seeks to hit key issues in the case- & looks to score those vital points as well.

However, I advocate that when you get a key answer that is favorable to you, simply move on to another question. Do not thrust your hand in the air & yell, “Yes!” Do not smile that ‘all-knowing’ smile like you are better than virtually everyone else in the room. Do not throw that figurative football in a hoop-roaring dance in the end zone. Instead, just move on to the next question & go after the next issue in your case.

CONCLUSION

Following these ideas will lead you on your quest to become a ‘black belt’ when questioning a doctor at their deposition.

Attorney Oginski has been in practice for over 18 years as a trial lawyer practicing exclusively in the State of New York. Having his own law firm, he is able to provide the utmost in personalized, individualized attention to each & every client. In our office, a client is not a file number. Client’s are always treated with the respect they deserve & expect from a professional. Mr. Oginski is always aware of every aspect of a client’s case from start to finish.

Gerry represents injured people in injury cases & medical malpractice matters in Brooklyn, Queens, New York City, the Bronx, Staten Island, Nassau & Suffolk Counties. You can reach him at http://www.oginski-law.com/, or 516-487-8207. All inquiries are free & totally confidential.

10 Tips for Frequent Headache Relief

Headaches can interrupt your life & can be exhausting. After a day with a headache, all you may want to do is go in a room, curl up in a ball, & go straight to sleep. However – life & family responsibilities do not always let this happen. How can you effectively deal with a headache? Here are ten tips designed to help you get headache relief.

1. If possible, spend ½ an hour in a cool, dark room in a quiet part of your home. If you have children, ask another adult to play quietly with them away from the room or take them out of the house for a short while. Take time to close your eyes & if you drift off to sleep, great.

2. Put a cool 8) cloth on your forehead or over your eyes for ten minutes. Many people find this soothing & studies have shown that this simple action can alleviate a headache.

3. Have a cup of coffee or tea. Caffeine can help ease the pain of a headache. In actual fact, many over the counter headache remedies contain caffeine for this reason. A simple pick-me up may be just what you need.

4. Use pressure points to alleviate your headaches. There are many pressure points on the head that respond immediately when the correct pressure is applied. If you live with a partner, you can study these pressure points together.

5. Avoid smoking or tobacco smoke. This can aggravate headaches. Exposure to tobacco smoke on a regular basis can trigger headaches.

6. Drink one or two glasses of water. Many headaches are caused by dehydration. Simply drinking some water at the onset of a headache can do wonders to alleviate your headache.

7. Open the windows. Stale, stagnant air can trigger headaches. The fresh air & sunshine may help to provide you headache relief.

8. Have your eyes checked. You may need to get glasses or have your prescription increased. There are many eye centers in popular shopping areas that can do a complete vision screen in less than an hour.

9. Take a daily multi-vitamin. Studies have revealed that many of the people who regularly experience chronic headaches are deficient in magnesium. This mineral allows blood vessels to relax, which prevents headaches.

10. Keep a headache journal. This will allow you to recognize patterns & triggers for your headaches. You can take this journal with you to the doctor when you discuss your headaches. This information will provide your doctor with a very clear picture of your symptoms.

As you learn more about your headaches, you may find that some treatments work better for you than others. Once you know your triggers, you may even be easily able to stop your headaches from occurring as regularly.

Don’t live with frequent headaches any longer! Learn about more treatment options for curing frequent headaches at http://www.frequent-headaches.com .

A Guide to Cerebral Palsy Lawyers

If your child is diagnosed with cerebral palsy due to medical malpractice, then the only person who can help you in getting medical compensation is a cerebral palsy lawyer. Cerebral palsy lawyers are professionals experienced in dealing with medical malpractice law & birth injury related cerebral palsy litigations.

By filing a malpractice lawsuit against a doctor, cerebral palsy lawyers help you in recovering the cost associated with cerebral palsy treatment. Recoverable costs include compensation for pain & suffering; lifetime care, & lost earnings. Cerebral palsy lawyers help you to determine whether a medical malpractice was made & provide necessary legal guidance for you to win medical compensation. They work with the medical law system to provide reliable help in knowing your legal as well as financial rights & offer the best solution for the treatment & management of cerebral palsy.

Cerebral palsy lawyers should have legal experience as well as medical background to understand medical issues regarding the causes of cerebral palsy. Most cerebral palsy lawyers encourage clients to have an initial consultation which is free of charge. Initial consultation with the legal representatives will help the clients to determine whether they are eligible for a monetary compensation due to the injuries of cerebral palsy.

The cost of hiring a cerebral palsy lawyer depends on the nature & extent of lawyer’s representation. Certain lawyers charge their clients on an hourly basis or on the number of appearance in the court while others are contingency fee lawyers who do not charge until they recover money for you.

There are a lot of websites that provide lists of law firms & lawyers specializing in cerebral palsy. Most websites provide on line case reviews which allow the visitors to discuss their case with an experienced attorney. While choosing a law firm or a cerebral palsy lawyer, it is very important to ensure that they are experienced in handling cerebral palsy cases.

Cerebral Palsy Lawyers gives detailed information on cerebral palsy lawyers, ataxic cerebral palsy lawyer, athetoid cerebral palsy lawyer, spastic cerebral palsy lawyer & more. Cerebral Palsy Lawyers is affiliated with Medical Power Of Attorney.

Evaluating Your Personal Injury Insurance Claim

The value of a personal injury claim has a direct relationship to the amount of your medical bills. Right. Why? Because a claim with medical bills of $500.00 is worth three to five times more than a claim with $100.00, or less. And that is a fact of life in the world of insurance claims.

The adjuster will reason if you were hurt badly enough to run up $500.00 in medical expenses than it is correct to assume that your injuries must be substantial. But, if you see your chiropractor or physician only once or twice, & your final bills are in the vicinity of $100.00, that adjuster will assume you were not hurt too seriously.

DEMAND THAT ALL YOUR MEDICAL BILLS BE PAID: The adjuster may attempt to disallow a substantial part of your total medical expenses which he contends does not qualify as medical in character. He’ll often attempt to divide your medical costs into two arbitrary parts – – Diagnostic & Treatment. In the Diagnostic category he will include items such as ambulance & emergency room costs, costs of X-rays, & other diagnostic procedures, plus visits to specialists. And the rest (principally costs of the hospital & regular office visits to doctors, physical therapy & medication) will be termed “Treatment”. The items that are categorized as Diagnostic expenses are the bills the adjuster would like to disallow as not being Medical types of activities.

He may attempt to do this because with a differentiation (between what’s Diagnostic & what’s supposedly true medical Treatment) the basic worth of your claim will have been drastically reduced, as the amount of your Special Damages & thus drastically reduce the true value of your claim. At that point the adjuster will argue that the Treatment portion of your medical bills that is directly related to the severity of your injury, therefore it is what truly reflects (and measures) your Pain & Suffering.

Don’t let him get away with that! If he should attempt to pull this on you tell him, It’s absurd & illogical to separate medical expenses into two arbitrary categories & designate one as Diagnostic & the other as Treatment. Each area works hand-in-hand with the other in medical practice. I can not get properly treated without being diagnosed!

He’ll gulp, because he knows what you say is true & that will usually be the end of such nonsense on his part.

PERMANENT AND/OR TEMPORARY DISABILITY: In discussing Disability. it is important to develop a working knowledge of these two legitimate concepts. Commonly, personal injuries are classified as either Permanent or Temporary. These two terms are used basically to describe the anticipated duration of an injury, & not its degree of severity! Thus, if an injury is conceived as one which would continue throughout the remainder of an individual persons lifetime, it is said to bePermanent in nature. Conversely, if it is a reasonable probably that the claimant will attain a full or complete recovery (within some future period) the injury is classified as “Temporary” – – regardless of how severe or extensive the injury might otherwise appear.

TOTAL AND/OR PARTIAL DISABILITY: Another common classification of Disabilities will relate to whether they are thought to be Total or Partial. These terms refer to the actual extent of the claimant’s injuries, regardless of whether they are permanent or temporary in duration.

THE FOLLOWING FOUR SPECIAL CATEGORIES

ARE REFERRED TO AND UTILIZED IN PERSONAL INJURY LITIGATION

  1. TEMPORARY TOTAL DISABILITY: This is symbolized by a seriously injured person who is temporarily hospitalized or otherwise completely impaired, even though expected to eventually regain full function.
  2. TEMPORARY PARTIAL DISABILITY: This is that period when, following the initial period of complete impairment of the seriously injured party (that period of Temporary Total Disability), the party recovers & is able to resume some (but not all) formal activities.
  3. PERMANENT TOTAL DISABILITY: This describes a condition (usually applicable in the most sever cases, in which the injury produces a nearly total impairment to the body as a whole) – – again placing the emphasis both on the extent of the functional impairment & its duration.
  4. PERMANENT PARTIAL DISABILITY: This describes a condition where the injured party, (even after sustaining a permanent injury) still retains some substantial body function or earning capacity, with the emphasis centered on the extent of the functional impairment itself.

MEDICAL BILL COVERAGE’S: Read your Motor Vehicle Policy to discover if you have Medical Payments Coverage. Also check all your non-automobile insurance policies. You may have coverage(s) to pay your medical bills regardless of who was at fault. If you have a Health Insurance Policy and/or Health Plan of some sort, read the fine print. Your policy may not require you to pay back the medical bill payments made in your behalf – – even if you collect from the person who struck you!

DISCLAIMER: This article ~Medical Bills ~ Evaluating Your Insurance Claim, is intended for background information. Its only purpose is to help people understand the motor vehicle accident claim process. Neither Dan Baldyga, Peter Go nor ARTICLE CITY make no guarantee of any kind whatsoever, NOR DO THEY purport to engage in rendering any professional or legal service, NOR TO substitute for a lawyer, an insurance adjuster, or claims consultant, or the like. Where such professional help is desired IT IS THE INDIVIDUALS RESPONSIBILITY to obtain it!

For more How To insurance claim insights read Dan Baldygas latest book AUTO ACCIDENT PERSONAL INJURY INSURANCE CLAIM (How To Evaluate And Settle Your Loss). This book can be easily found on the internet at http://www.autoaccidentclaims.com. This book reveals How To successfully handle your motor vehicle accident claim, so you will not actually be taken advantage of. It also goes into detail regarding the revolutionary BASE(The Baldyga Auto Accident Settlement Evaluation Formula). BASE explains how to determine the value of the Pain & Suffering you endured – – because of your personal injury.

Copyright (c) By Daniel G. Baldyga. All Rights Reserved

Dan Baldyga – Author

19 Winona Drive, West Springfield, MA 01089
Phone: (413) 733 0127 FAX: (413) 731 8358
Mail to: dbpaw@attbi.com
AUTO ACCIDENT PERSONAL INJURY INSURANCE CLAIM
(How To Evaluate And Settle Your Loss)
Found On The Internet At: http://www.autoaccidentclaims.com
Or: http://www.caraccidentclaims.com

About The Author

For 30 years Dan Baldyga was a claims adjuster, supervisor, manager & also a trial assistant.He is now retired & spends his time attempting to assist those involed in motor vehicle accident claims so they will not actually be taken advantage of. Mail to: dbpaw@attbi.com

Carers

The input of family carers is a neglected aspect of TBI rehabilitation. In this section I will illustrate my experiences with the families of TBI survivors.

*Medical Malpractice – 10 Reasons Why You Shouldn’t Sue*

1. You like your doctor

So, what’s wrong with that? Nothing. Most of us like our doctors. There is more. That’s why we trust them & keep going back to them for treatment. But should the fact that you like your doctor stop you from seeking compensation when he or she committed wrongdoing that caused you physical & emotional injury?

The law in New York permits anyone who has been injured by another to bring a lawsuit for compensation. This law originated from common law & goes back hundreds of years. In fact in some religions there is evidence that this type of law goes back thousands of years. It makes good common sense. If another person causes you harm, you are entitled to obtain money to pay for your medical expenses, your lost earnings, your future lost earnings, the damage to your property, & of course, compensation for the pain & suffering you endured.

So, should the fact that you like your doctor stop you from bringing a lawsuit? It might make you feel uncomfortable, but I guarantee that when you start to think about your disabling injuries & how your doctor caused them, the anger & hostility you feel will usually outweigh your fondness for your doctor.

2. What good will the money do for you?

This is a common rhetorical question that defense attorneys often ask plaintiff’s lawyers. “The money will not bring your loved one back,” “The money will not make you whole again,” “The money you are asking for is not going to change anything…”

However, money is the only thing that our justice system allows us to recover when an injured victim sues their wrongdoer. While those comments above may all be true, we are prohibited from taking justice into our own hands. There is more. Therefore, what else can we obtain for the injured victim? Money is the only thing that allows us to pay the medical bills that were generated as a result of the wrongdoing. Money is going to make the victim more financially secure. Money will help the injured victim with ongoing medical care & rehabilitation. The injured victim will not actually be a burden on a City or governmental handout. Money will help his children go straight to school or camp. Money may help with modifications needed in his home- such as a wheelchair ramp or modified kitchen appliances.

Money can never make us whole, or replace the agony & suffering that was caused by a doctor or a hospital. But the money is supposed to make those wrongdoers think twice or two times about doing that same action again, & hopefully stop the next person from being a malpractice victim.

3. Your doctor’s reputation will be tarnished

Contrary to popular opinion, (or at least from the doctor’s insurance company) this is not an accurate statement. Most people living in a civilized society recognize the right to sue. The fact that a doctor has been or is sued is not that significant. If you ask a doctor if they have been sued, they will often be quick to explain how the case had no merit. Importantly, the physician will still continue to practice medicine & there will usually be no disciplinary action taken as a result of a civil medical malpractice lawsuit. The belief that a doctor’s reputation will suffer a blemish if sued, is simply not correct.

4. Your doctor will be banished from his community

Once again, this statement is not true. The doctor will continue to practice medicine (even if they lose the malpractice suit against them, & are required to pay the injured victim money). The doctor will not lose their license, & in all probability, the award will not actually be reported in the local papers, & most of his patients will not even know of the lawsuit or the award.

5. Your doctor will shut his medical practice

No he won’t. He might be outraged that he has to defend a lawsuit & take time away from his practice for a few days, but there is no reason for him to shut his medical practice.

In very extreme cases where the physician is a threat to the health & well-being of his patients, the New York State Department of Health can & will shut down the doctor’s practice & revoke his license to practice.

But, in the majority of cases, this does not happen, & the doctor continues on with his practice & his life.

6. Your doctor may lose his license

Not true. A civil lawsuit in New York has no effect on whether a doctor does or does not lose his license to practice medicine. In order for a New York doctor to lose his license, the New York State Department of Health investigates a complaint of wrongdoing. After extensive investigation & after a hearing where the physician gets to explain what happened & why, the Department of Health reaches their own conclusions about whether treatment was rendered in accordance with good medical care or whether there were deficiencies.

The options to punish or cure the deficiencies are many, & only as the most extreme- & last resort option would the Health Department revoke a physician’s license. But simply by bringing a lawsuit against a physician for monetary compensation does not affect his license to practice medicine.

7. Your doctor may alter your records

Believe it or not, this has been known to occur in rare instances. Right. When it does, the attorney representing you may be easily able to prove it… If your lawyer is able to prove that your doctor altered your records, the doctor could suffer significant penalties & could lose his license to practice medicine. The fact that he may or may not alter your records should not stop you from investigating and/or pursuing an action on your behalf. There are usually other ways to determine what treatment was rendered, & often such action by a doctor can help your case by showing the extent to which the doctor attempted to cover up the wrongdoing.

8. Your doctor may apologize & tell you it was all a mistake

There are recent medical & insurance studies that have confirmed that when doctors & hospital staff are straightforward & honest about what happened, patients & their families tend to understand that ‘not virtually everyone is perfect’. In actual fact, some hospitals encourage the doctors to fess-up & tell the patients they screwed up, & apologize, & arrange to have the hospital immediately reconcile financially with the patient & his family. The studies indicate this works.

Does that mean that you should not sue because the doctor apologized? Not necessarily. An apology may not solve your problems. You need to decide whether such an apology is sufficient. Most people will tell you it is not.

9. Your friends & family may think you are a gold-digger

If you live your life concerned about what your friends & family think, then maybe you should not sue-under any circumstance. Your friends have not experienced what you have gone through. Nor do they live with the constant pain & disability that you have. They may not truly understand what you will live with for the rest of your life.

Some folks simply do not want their friends & family to know they are involved in a lawsuit. The reasons are endless. “I do not want anyone knowing my business.” “I do not want my neighbors knowing how much of an award I received.” “I do not want my family members asking me for money- this is for my future- I can not work anymore, & I can not afford to give it away.” “I do not want my relatives to argue with me about why I sued my doctor.”

You must decide for yourself whether these concerns outweigh your legal right to bring suit & recover money for your injuries.

10. Your injuries are not that disabling

There are cases where the injuries are significant, but have cleared up after many months or years. There is more. The fact that you may no longer be permanently disabled is a factor to determine how much your case is worth. If you are no longer disabled- we congratulate you & your success in overcoming your injuries. If you can do those activities that you used to do, we are very pleased with your recovery. You should know however, that such success means that the value of your case may be limited to the time you were injured & disabled. Most people would agree with this result. You only can receive compensation for the time you were injured & disabled.

Many injured folks may make a recovery, but still be unable to do all of those daily life activities they used to do. Where there is an ongoing problem or disability, the value of your case is generally greater than where you have totally healed.

Attorney Oginski has been in practice for 18 years as a trial lawyer practicing exclusively in the State of New York. Having his own law firm, he is able to provide the utmost in personalized, individualized attention to each & every client. In our office, a client is not a file number. Clients are always treated with the respect they deserve & expect from a professional. Mr. Oginski is always aware of every aspect of a client’s case from start to finish.

Gerry represents injured people in injury cases & medical malpractice matters in Brooklyn, Queens, New York City, the Bronx, Staten Island, Nassau & Suffolk Counties. You can reach him at www.oginski-law.com, or 516-487-8207. All inquiries are free & totally confidential.

Defining Mild Traumatic Brain Injury

I INTRODUCTION

The purpose of this article is to acquaint lawyers whose clients may be suffering from unfamiliar symptoms neither they nor their current doctors can explain. The erraticness of head injury was summarized by Hippocrates: “No head injury is too serious to despair of, nor too trivial to ignore.” Hopefully this article will provide clarification of the symptoms, & their cause, for all those who have sustained Mild Traumatic Brain Injury.

II BRIEF HISTORY

Mild Traumatic Brain has been controversial for over a century. Strauss & Savitsky 1934; Trimble 1981. Dr. Randolf W. Evans states in his book Neurology & Trauma at page 93, The Post-concussion syndrome follows head injury that is usually mild & compromises one or more of the following systems & signs: headaches, dizziness, vertigo, tinnitus, hearing loss, blurred vision, diplopia, convergence insufficiency, light & noise sensitivity, diminished taste & smell, irritability, anxiety, depression, personality change, fatigue, sleep disturbance, decreased libido, decreased appetite, memory dysfunction, impaired concentration & attention, slowing of reaction time, & slowing of information processing speed. … The most common complaints are the headaches, dizziness, fatigue, irritability, anxiety, insomnia, loss of concentration & memory, & noise sensitivity. Loss of consciousness does not have to occur for the post-concussive syndrome to develop. At page 94, under the heading of “Historical Aspects”, Dr. Evans writes: The post-concussion syndrome has been recognized for at least the last few hundred years. One interesting historical case involved a 26 year old maid servant who had been hit over the head with a stick & complained of retrograde amnesia. Six months later, she was still complaining of headaches, dizziness, tinnitus & tiredness. A judge requested the opinion of Swiss physician J.J. Wepfer & two other surgeons, who stated, �We can‟t say anything definite, but it is certain that this will leave its mark in the form of an impediment.‟ This statement was made in 1694. Brain injuries date into biblical times such as when Joel slew King Sisera by driving Aa metal tent stake through his temples while he slept”. And of course Giant Goliath who suffered a concussion and, presumably, a depressed skull fracture, as a result of young David‟s sling shot stone. (Corville CB: some notes on the history to the skull & brain. Bull LA Neurol Soc 9:1-16, 1944.)

III DEFINING CLOSED HEAD INJURY

In his article Terminology of Post-Concussion Syndrome, Seldon Berrol, M.D. states:

The mild traumatic brain injury subcommittee of the Head Injury Interdisciplinary Special Interest Group of the American Congress of Rehabilitation medicine has designated mild traumatic brain injury (mild TBI) as the preferred term for persons who sustain a traumatically induced physiologic disruption of brain function, as manifested by at least one of the following:

1. Any period of loss of consciousness.

2. Any loss of memory for events immediately before or after the accident.

3. Any alteration in mental state at the time of the accident (eg. feeling dazed, disorientated or confused.)

4. Focal neurological deficits, which may or may not actually be transient, but when the severity of the injury does not exceed the following:
a. Loss of consciousness approximately 30 minutes or less.
b. After 30 minutes an initial Glasgow Coma Scale score of 13-15.
c. Post traumatic amnesia not greater than 24 hours. This definition includes:
(a) the head being struck,
(b) the head striking an object, &
(c) the brain undergoing an acceleration/deceleration movement (ie., whiplash) without direct external trauma to the head. It excludes stroke, anoxia, tumor, encephalitis, etc. CT, MRI, EEG, & routine neurologic evaluations may be normal.

Due to the lack of medical emergency, or the realities of certain medical systems, some patients may not have the above factors medically documented in the acute stage. In such cases, it is appropriate to consider a symptom complex that, when connected to a traumatic head injury, can suggest the existence of mild TBI.” Alexander defines Mild TBI as follows:

The severity of TBI must be defined by the acute injury characteristics & not by the severity of symptoms at random points after trauma. Mild TBI is characterized by the following:
(1) Head trauma may be due to contact forces or to acceleration/deceleration trauma.
(2) The duration of unconsciousness is brief, usually seconds to minutes, & in *some* cases there is no loss of consciousness (LOC) but simply a brief period of dazed consciousness.
(3) When the patient is evaluated in the emergency room or at the scene, the Glasgow coma scale (GCS) must be 13 to 15, by common definition . . . only a score of 15 probably represents true Mild TBI.
(4) Whether the patient is briefly unconscious or not, confusion with amnesia . . . is present, by definition for less than 24 hours but usually for minutes to a few hours . . . (b) by common clinical agreement, neuroimaging studies are negative, but this defining characteristic may be more complex than just positive or negative findings on CT. Mild Traumatic Brain Injury, Neurology 1995; 45:1253-1260. The term mild traumatic brain injury is still undergoing refinement howeverdoes incorporate criteria that have been widely accepted by physicians in sports medicine to assess the degree of cerebral dysfunction. “A closed head injury occurs when the soft tissue of the brain is forced into contact with the hard, boney, outer covering of the brain, the skull. Along with the head injury, the average patient usually experiences, neck & back injuries as well. Mild closed head injuries can occur after a severe neck injury without the head actually striking any surface. …Mild head injuries should no way be actually considered �minor.‟ The long-term sequela of this type of injury & its poor prognosis often make it a very major problem. Neck & back injury frequently occur, & soft tissue manifestations are inevitable, at least for short time, after mild to moderate closed head injury.”

Closed Head Injury: A Clinical Source Book 2nd Ed. Dr. Peter Bernad 1998, Lexis Law Publishing.

IV THE HOLLYWOOD MYTH

Mild traumatic brain injury will occur when the soft tissues of the brain are pushed against the boney structures of the skull in whiplash type, acceleration/deceleration movements. There is more. The problem with most of us is described well in Randolf Evans‟ chapter entitled The Post Concussion Syndrome in Prognosis of Neurological Disorders, Evans, Baskins & Yatsu, Oxford University Press 1992, at page 99: Most people’s knowledge of the sequela of mild head injuries is largely the product of movie magic. Some of the funniest scenes in slap stick comedies & cartoons depict the character sustaining a single or multiple head injuries, looking dazed & then recovering immediately. In cowboy movies, detective & action stories, & boxing & kung fu films, seemingly serious head trauma is often inflicted by blows from guns & heavy objects, falls, motor vehicle injuries, fists, & kicks, all without lasting sequela. Our experience is minuscule compared to the thousands of simulated head injuries witnessed in the movies & on television. Because of the compelling mythology, the physician has a hard job educating patients, their families, & others in the realities of mild head injuries. However – when one looks at examples of two successful boxers, Joe Lewis & Muhammad Ali, they have witnessed powerful punches resulting in dazed, disorientated boxers or knock outs. AMemory loss & dementia have been a frequent finding in ex fighters.” Sports & Head Injuries, Chapter 10 of Neurology & Trauma, Polin Alves & Jane.

“Mild head injury typified by transient amnesia, brief loss of consciousness, & persistent headache or mild neurological signs is more hard to document than severe or moderate head injuries. In an analysis of 1,165 bouts: Sercl & Jaros found that 79% of boxers had momentary neurological signs, whereas 21% demonstrated deficits for at least 24 hours.”

IV ANATOMY OF BRAIN INJURY

Brain injuries are produced by displacement & distortion of the neuronal tissues at the moment of impact. The brain, which is incompressible, may be likened to a water-soaked log floating submerged in water. The brain is floating in the cerebrospinal fluid in the subarachnoid space & is capable of a certain amount . . . of gliding movement. It follows from these anatomical facts that blows on the front or back of the head lead to displacement of the brain, which may produce severe cerebral damage, stretching & distortion of the brainstem, & stretching & even tearing of the commissures of the brain . . . . furthermore, it is vital to remember that glancing blows to the head may cause considerable rotation of the brain, with shearing strains & distortion of the brain, particularly in areas where further rotation is prevented by bony prominence . . . brain lacerations are very likely to occur when the brain is forcibly thrown against the sharp edges of bone within the skull . . . . A sudden severe blow to the head, as in an automobile accident, may result in damage to the brain . . .

Richard S. Snell, M.D., Ph.D. Clinical Neuroanatomy for Medical Students, 4th ed., p. 27-28.

V CONCLUSION

Traumatic Brain Injury significantly impacts the lives of those it touches. Mild Traumatic Brain Injury should not actually be equated with a minor injury. Mild Brain Injury is the temporary disruption of brain functioning due to trauma to the head. A Mild Brain Injury is one where it is not judged serious enough to require formal rehabilitation. Usually the individual is sent directly home from the hospital. However if enough brain cells are damaged a person can experience permanent changes in the way they think, feel & act.

Timothy R. Titolo is an attorney concentrating on representing people who have suffered from traumatic brain injury. See the website: http://www.titololawoffice.com email: info@titololawoffice.com

Timothy R. Titolo is Las Vegas & Nevada’s experienced trial attorney. Mr. Titolo handles all types of personal injury cases, including catastrophic & serious injuries & wrongful death. He has particular expertise in traumatic brain injury (TBI), spinal cord injury & nerve damage cases.

Titolo Law Office has earned a reputation for achieving significant results. There is more. Through his successes, as well as by writing articles & giving presentations to attorneys & medical professionals around the country, Mr. Titolo has garnered the respect of colleagues.

The Secret Life of Alzheimer’s Disease

The fact that there is a greater incidence today of Alzheimer’s disease than in previous centuries has not gone unnoticed by some observers who seek to account for its increased presence among the aging, one that occurs at great personal cost & with grave consequences for families & loved ones.

The primary cost of Alzheimer’s disease lies in the loss of ‘presentness’ it brings to the one so afflicted � an increasing absence of the known & familiar self from awareness, reflection, & memory, & an increased departure of the interactive self from relationships that have been significant in the past. Indeed, the loss of presentness that comes with Alzheimer’s disease is so great, & the sadness it brings to those who feel they are losing a dear parent, friend, or partner so pervasive, that it is vital to attempt to find a spiritual meaning & purpose for the sequence of deterioration that seems to strip one down to the bare bones of humanity, with occasionally even that being in question due to the deterioration of physical as well as mental & emotional functioning.

All that is known about Alzheimer’s today has given us some hope for modifying the disastrous effect of its course & for making the passage gentler, with less distress to those who remain in loving relationship with the one who is ill. Yet, these modifications are far from offering an understanding of what spiritual good might come from such an illness � what gain to the soul might equal the significant loss of the familiar self which the disorder creates.

The truth of the matter is that the spiritual world in which Alzheimer’s plays a significant role is a very different world than what appears on the outside. It is a world in which the play of imagination takes precedence over the function of rationality, & in which the mind becomes the playground of random thoughts, inner events, & memories. These inner movements arise from various places – some from bits & pieces of the past; some from wishes that have never been expressed; & some from a place that can only be called the dream-self � the self that the unconscious mind projects upon the physical plane in order to bring something that has been hidden into the light of day. Because of the fragmentation of the images, thoughts, & emotions, as well as the uncertainty concerning their validity, the outside observer can generally never really tell what’s real & true & what’s fantasy about what’s being communicated by some one with Alzheimer’s disease. What the outsider witnesses is a completely unique world, a world of one, & others, often to their great sorrow, feel that they are locked out of it.

Here, in the center of this very private world is a great garden of spiritual flowers � not flowers of reason or of clear thinking, but flowers of impulse & imagination, flowers of emotion that were never given exposure during childhood, during dreams, or during other lifetimes. These now wait to be experienced & expressed. Because the rational element of communication is largely absent, the imaginings & voices of the unexpressed self are revealed mysteriously, without any seeming meaning or coherence. And yet in the midst of the absence of coherence, a great tree is being given shape. Beneath its branches are the flowers, leaves, & seeds of the collective past of the person who is witnessing them. They are the particles & parts of the unrealized self, the rejected self, the wished for self, the hoped for self, that are being gathered up in an apron in order to be looked at & evaluated imaginatively by the one who sits beneath this tree catching the leaves that float by � the wisps of thought that float through the inner landscape.

The fragmentation that occurs does so because in the time in which these mental & imaginative fragments were created, the need arose to keep them hidden in order to create barriers of reason & logic around the functioning of the effective personality. And so they remained part of a floating & unstable world of inner possibility. And not just a world of possibility, but a world of fragmented possibility. For among the central features of Alzheimer’s are the strangeness of its thought patterns & the sudden changeability of their focus. Both features are present in many with Alzheimer’s, & both serve the purpose of dismantling the rational element of functioning in order that the emotional & imaginative elements be given freer reign.

Despite the great loss of outer functioning that Alzheimer’s brings, one may say that within the secret inner world a transformation is taking place. Where mental functioning may have been a priority before, now the functioning of a child begins to appear. Where judgment & critical analysis may have been valued heavily, now innocence begins to be given space & room in which to breathe. And where unrelatedness to the spiritual world may have been present, now the absence of self-definition creates a greater sense of oneness with life & a kind of innocent spirituality which accepts all that is.

And what of those for whom Alzheimer’s brings anger, irritability, & extreme outbursts of rage? These, too, are fragments or aspects of self that have been previously dormant. In their manifestation, they offer the opportunity of being experienced by the inner witness. As upsetting as these outbursts often are, they nevertheless produce a kind of self-confrontation with aspects of consciousness that have previously been restricted from awareness.

For those who seek to understand the greater spiritual good that comes from a situation whose external features appear to involve great loss, limitation, or hardship, it may be said that accompanying the loss of mental functioning which Alzheimer’s brings is a reorganization of the basic personality structure so that a new birth can take place � one that will have positive consequences for the soul in their future development & evolution. This new birth does not come without a price. And yet it comes because of the soul’s deep wish for healing & wholeness & for a bringing together of the fragments of self into a new configuration.

For those who must stand & watch the progressive deterioration of the personality of a loved one, there is a need to be gentle with oneself, for many feelings are possible & are evoked by this situation. Yet it is vital to note that in the midst of sorrow & of progressive loss, there can also be a view of the emerging new self that is being born. If the eyes of the heart can be focused not only on the pain of loss or on the difficulties of care, but also on the unfoldment of the new, it may be that the inner Tree of Life can be seen under which the loved one sits, gathering the leaves & petals of their own imaginative process in order to meld them together into a new fabric of wholeness at some future date.

For a spiritual perspective on mental & emotional disabilities of various kinds, see the Light Omega Reader, especially “A Spiritual View of Mental Illness” & “The Wisdom Within Depression: A Spiritual View.”