Court Rejects Defense Claims that Back Injury Pain and Suffering Awards Excessive

 

By John Hochfelder on December 21, 2011Posted in Back Injuries

 

Luis Ramos was sitting in a parked car in the parking lane, on Claremont Parkway in the Bronx on September 24, 2001. He had been waiting for his son when he decided to exit the car. After opening the driver side door about six inches, his car was struck by a passing city bus.

Ramos was sitting in a 1987 Ford Thunderbird:

Ramos was thrown to the other side of the car and claimed he hurt his back.

Ultimately, Ramos sued the transit authority and on May 21, 2009, a jury found the bus driver 100% at fault for the accident and awarded plaintiff pain and suffering damages in the sum of $595,000 ($270,000 past – 8 1/2 years, $325,000 future – 9 years). Both the liability finding and the damages award were upheld on appeal last week in Ramos v. New York City Transit Authority (1st Dept. 2011).

As indicated in the decision, plaintiff was 59 years old at the time and he sustained multiple herniated discs in his lumbar spine that required a combined discectomy, laminectomy and spinal fusion four years later.

In a laminectomy, the surgeon removes the bony back wall of the affected spine, called the lamina and then in a discectomy, the surgeon removes the disc itself:

And here’s what the spine looks like after the lumbar fusion surgery with the insertion of a metal plate and screws:

 In the appeal, the defense argued, unsuccessfully, that (a) the liability verdict should be reversed because plaintiff should have seen the bus before he opened his car door into traffic and (b) in the alternative, the jury should have apportioned some of the fault to plaintiff because they found he was negligent (but that his negligence was not a proximate cause of the accident).

As to damages, the defense argued that the jury award was excessive in view of plaintiff’s preexisting conditions:

• degenerative disc disease (when aging discs become stiff and dry out)
• scoliosis (a sideways curvature of the spine)
• syrinx (a cavity in the spinal cord formed by cerebrospinal fluid)

Plaintiff successfully countered each of the defense arguments as to damages through the testimony of his expert neurologist who stated that:

• both the scoliosis and the syrinx were in plaintiff’s cervical spine and the likelihood that either of these conditions affected plaintiff’s lumbar spine was extremely remote
• plaintiff showed no symptoms of preexisting low back pain problems and the fact that he had been diagnosed with degenerative disc disease two years before the accident was of no consequence because there was no evidence (such as an MRI) that Ramos had a herniated disc before the accident

Inside Information:

• Ramos refused medical treatment at the scene, reported to work that night as a doorman in an apartment building, continued to work for a few more days and did not seek any medical attention at all until three days later when he presented to a neighborhood clinic complaining of significant lower back pain.
• There were only three witnesses at trial – plaintiff, a police officer and plaintiff’s medical expert, neurologist Ringa Krishna, M.D. The defense produced neither its bus driver nor any medical expert to rebut plaintiff’s claims and proof as to causation, pain, disability and permanency.
• Unfortunately, the surgery failed and plaintiff’s condition got worse. He was diagnosed with chronic nerve damage and arthritis in his spine causing permanent low back pain and making it difficult to walk. Ramos never returned to work.
• Plaintiff was granted a missing witness charge as to the defense physician who was engaged before trial but did not testify at the trial – the jury was told that it may infer that the defense doctor would not have supported the defendant’s position with respect to the medical issues and would not contradict the plaintiff’s medical evidence.

 

 

 POSTED BY ATTORNEY RENE G. GARCIA:

 

For more information:- Some of our clients have suffered this kind of injuries due to a serious accident. The Garcia Law Firm, P.C. was able to successfully handle these types of cases. For a free consultation please call us at 1-866- SCAFFOLD or 212-725-1313.

NIGHTMARE REMEDIES: RESCRIPTING BAD DREAMS

Alan Siegel, Ph.D.

Copyrighted Excerpt from Dream Wisdom: Uncovering Life’s Answers in your Dreams
by Alan Siegel, Ph.D. (Berkeley: Celestial Arts, 2003)

During a crisis or after a traumatic event, it is important to know nightmares are more common and upsetting. We experience each nightmare as a traumatic event and for those who have experienced violence, a natural disaster, accident or other trauma, posttraumatic nightmares rub salt on our emotional wounds. Keep in mind that moderately upsetting nightmares may actually be a positive sign of normal coping but very graphic nightmares that are repetitive and unchanging may signal an emotional impasse.

Nightmare remedies are self-help techniques that can help adults and children break the spell of their bad dreams and use them for personal growth and creative inspiration. A simple method for transforming nightmares is to use the 4 R’s of nightmare relief. Reassurance, Rescripting, Rehearsal, and Resolution.

Reassurance is the first and most important step. This breaks the spell of the nightmare by giving emotional reassurance and for family members or children, physical comforting may help as well. Once you feel reassured and the nightmare’s reign of terror has been overthrown, you can relax, become curious about the nightmares meaning and message and begin to approach the dream in a more playful manner.

Knowing that occasional nightmares are normal and their frequency and intensity may increase during crises may also be reassuring. A key factor, especially for children, is not to dismiss or ignore the nightmare with a message that “it’s just a dream” or you should just ignore it. Nightmares, especially during a life crisis are very hard to ignore.
Reassurance paves the way for Rescripting the dream. Rescripting uses discussion, fantasy, writing, art, or drama to re-experience and revise different parts of the dream narrative with the goal of opening up new endings and directions. You can use techniques from the Experiential Dream Menu in Chapter 11 of Dream Wisdom, to transform and tame the most threatening interactions and moments in the nightmare. This can be as simple as experimenting with rewriting one or more new endings for the dream or may involve more elaborate free associations to link the conflicts in the nightmare to unresolved life issues.

The third R needed to implement a nightmare remedy is Rehearsal. This involves multiple forays and trials of rewriting and re-enacting the dream. If you are having nightmares about an auto accident or serious physical injury, imagining one new ending may only be the beginning. Depending on your creative inclinations, you may need to write out one or more new endings, sketch or paint the threatening elements in the dream or role play with a friend or with a psychotherapist or dream group. Creating new endings does not have to involve killing your dream adversary. The terrorist or robber or wild animal can be frozen or shackled. Walls, cages, force fields, or even magic wands can be made available as you rehearse dream solutions. Adults may need to loosen up their imagination but children take to this easily especially with adult guidance. And for children, non-violent strategies for subduing dream villains can model creative problem-solving strategies that do not necessarily emphasize violence.

Rehearsal is somewhat parallel to the phase of psychotherapy, called“working-through” which involves taking breakthrough insights and testing them out in a variety of ways with people and situations. When nightmares are extremely painful or repetitive or related to a profound trauma, rescripting and rehearsing dream solutions may need to be repeated before the nightmares subside. It is important to keep in mind that conjuring up one new fantasy ending for a dream is not going to solve a deep problem that may be causing the nightmares. However, even if dream rehearsals must be repeated for people who are suffering more severe trauma, even initial efforts at rescripting may in some cases, dramatically reduce the incidence of posttraumatic nightmares.

The final Nightmare Remedy “R” is Resolution. Discussion and various trials of rescripting and rehearsing solutions usually trigger insights about what life issues are causing the nightmares. At this point, the dreamer on her own or with the help of a friend or psychotherapist is ready to resolve the nightmare. Resolution occurs when the dreamer brainstorms and identifies behaviors they can further examine or try to change. Examples of resolution would be Lisa’s work-related nightmares series in Chapter 6, of Dream Wisdom, which included the dream, ‘Too Many Chefs Spoil the Stew”. After rescripting the dream, she realized, she had denied her assertive side and was being taken advantage of by the employees in her restaurant. After rehearsing various dream assertiveness strategies for rescripting the attacks of her wayward employees, she made a series of changes that led to exerting more clear authority at work and being more aware of her tendency to deny her assertive side.

We do not have to suffer nightmares in silence. Using the menu of techniques in this section and chapter 11 of Dream Wisdom, you can detoxify your nightmares, and use them as a source of insight and personal growth. In more acute situations, resolving nightmares can create breakthrough in dealing with the aftermath of a traumatic situation.


WHEN TO SEEK HELP FOR CHILDREN’S NIGHTMARES


Whereas moderate nightmare activity may be a potentially healthy sign that the unconscious mind is actively coping with stress and change, frequent nightmares indicate unresolved conflicts that are overwhelming your child. When children’s nightmares persist, when their content is consistently violent or disturbing, and when the upsetting conflicts in the dreams never seem to change or even achieve partial resolution, it may be time to seek further help from a mental health specialist or pediatrician. Especially if there is no obvious stress in your child’s life, repetitive nightmares could also be caused by a reaction to drugs or a physical condition, so it is advisable to consult a physician to rule out medical causes when nightmares do not appear to have a psychological origin.

A further issue to consider is whether your child may be suffering from a sleep disorder. Many parents may confuse sleep disorders like sleepwalking and talking with nightmares which are more psychological in origin. Sleep disorders may or may not be accompanied by nightmares and are generally organic in origin. They are surprisingly common affecting over 15% of the United States population with 95% of all cases going undiagnosed. The International Classification of Sleep Disorders published in 1990¹⁰, lists 84 conditions that interfere with sleep including Primary Snoring, Jet Lag, Restless Leg Syndrome, Narcolepsy and Sleep Apnea. Many sleep disorders such as Jet Lag will go away on their own. Others such as various forms of insomnia may reduce children’s ability to learn, lower their resistance to disease, and increase accident-proneness. Some sleep disorders may even be life-threatening such as sleep apnea. If you suspect that your child is having a sleep disorder¹¹, speak to your pediatrician to determine if he or she needs to consult a board certified sleep specialist or to be evaluated in a sleep center^{12 13}.

The current diagnostic manual of the American Psychiatric Association (DSM-IV) includes Nightmare Disorder as an officially recognized affliction of both children and adults. Those who suffer from this disorder have “extremely frightening dreams, usually involving threats to survival, security, or self-esteem” that “generally occur during the second half of the sleep period,”and may cause “significant distress or impairment in social, occupational, or other important areas of functioning.”

Repetitive nightmares are often accompanied by other symptoms especially fears of going to sleep, anxieties or phobias. Increased nightmares can usually be linked to a recognizable stress in the child’s life such as absence or loss of a parent, suffering abuse or violence, marital or custody disputes in the family, social or academic difficulties at school, such as being teased or having an undiagnosed learning or attention problem.

Nightmares are more often like a vaccine than a poison. A vaccination infects us with a minute dose of a disease that mobilizes our antibodies and makes us more resistant to the virulence of smallpox or polio. As distressing as nightmares can be, they offer powerful information about issues that are distressing your child. When children share their nightmares and receive reassurance from their parents, they feel the emotional sting of the dream, but also begin the process of strengthening their psychological defenses and facing their fears with more resilience.


Gradually, a parent’s empathic response to their child’s nightmares can break the cycle of bad dreams and transform intensely negative experiences into triumphs of assertiveness and collaborative family problem-solving.

POSTED BY ATTORNEY RENE G. GARCIA:

For more information:- Some of our clients have suffered this kind of injuries due to a serious accident. The Garcia Law Firm, P.C. was able to successfully handle these types of cases. For a free consultation please call us at 1-866- SCAFFOLD or 212-725-1313.

http://dreamwisdom.info/library/nightmare_remedies_dw.htm

Appellate Court Slashes Pain and Suffering Verdict in Ankle Injury Case

By John Hochfelder on September 24, 2012 Posted in Ankle Injuries

On December 27, 2002, Massoud Micky, then  47 years old, was walking to the subway in the Bronx, on his way to work, when he fell stepping onto a sidewalk sustaining a severe ankle fracture that he ultimately claimed was caused when his foot was caught in a large gap that created an uneven, misaligned and broken sidewalk curb.

 In his ensuing lawsuit against the City of New York, Micky had to prove that the city had prior notice of the sidewalk defect. He showed the jury a map created by the Big Apple Pothole and Sidewalk Protection Committee that identified as defective the area where Mr. Micky fell. Since the map had been provided to the city long before the accident, the jurors found the city liable.

Micky was awarded pain and suffering damages in the sum of $750,000 ($250,000 past – 8 years, $500,000 future – 21 years).

The city appealed, arguing both that there was no liability (plaintiff had originally stated he fell due to snow and ice, not because of any defect) and that the damages award was excessive.

In Micky v. City of New York (1st Dept. 2012), the liability verdict against the city was affirmed but the damages award was reduced to $250,000 ($100,000 past, $150,000 future).

Here are the details of plaintiff’s injuries:

• comminuted bimalleolar ankle fracture
• open reduction internal fixation surgery with insertion of metal plate and screw
• three day hospitalization, casted one month, physical therapy for five weeks (after which plaintiff never had any more medical treatment for this injury)
• unable to return to work (machine operator) for three months (working as security guard at time of trial)
• post-traumatic arthritis (that plaintiff’s expert said is progressive, permanent and will likely require future surgery)
• continuing pain, significant range of motion loss,  antalgic gait (limp) and inability to resume previously very active recreational soccer

The appellate court judges based their very significant damage award reduction on case precedent. Without discussion, the decision merely mentions four prior cases, each dealing with ankle fractures.

 

POSTED BY ATTORNEY RENE G. GARCIA:

 

For more information:- Some of our clients have suffered this kind of injuries due to a serious accident. The Garcia Law Firm, P.C. was able to successfully handle these types of cases. For a free consultation please call us at 1-866- SCAFFOLD or 212-725-1313.

http://www.newyorkinjurycasesblog.com/2010/07/articles/back-injuries/lumbar-compression-fracture-from-trip-and-fall-results-in-20000-pain-and-suffering-verdict-increased-on-appeal-to-90000/

Physical therapy

Physical therapy (or physiotherapy), often abbreviated PT, is a health care profession primarily concerned with the remediation of impairments and disabilities and the promotion of mobility, functional ability, quality of life and movement potential through examination, evaluation, diagnosis and physical intervention carried out by physical therapists (known as physiotherapists in some countries) and physical therapist assistants (known as physical rehabilitation therapists in some countries). In addition to clinical practice, other activities encompassed in the physical therapy profession include research, education, consultation, and administration. Definitions and licensing requirements in the United States vary among jurisdictions, as each state has enacted its own physical therapy practice act defining the profession within its jurisdiction, but the American Physical Therapy Association (APTA) has also drafted a model definition in order to limit this variation, and the APTA is also responsible for accrediting physical therapy education curricula throughout the United States of America. In many settings, physical therapy services may be provided alongside, or in conjunction with, other medical or rehabilitation services.

Overview

Physical therapy involves the interaction between physical therapist, patients/clients, other health care professionals, families, care givers, and communities in a process where movement potential is assessed and diagnosed and goals are agreed upon. Physical therapy is performed by a physical therapist (PT) or physiotherapist (physio), and sometimes services are provided by a physical therapist assistant (PTA) acting under their direction. Physical therapists and occupational therapists often work together in conjunction to provide treatment for patients. In some cases, physical rehabilitation technicians may provide physiotherapy services. PTs are healthcare professionals who diagnose and treat individuals of all ages, from newborns to the very oldest, who have medical problems or other health-related conditions, illnesses, or injuries that limit their abilities to move and perform functional activities as well as they would like in their daily lives. PTs use an individual's history and physical examination to arrive at a diagnosis and establish a management plan and, when necessary, incorporate the results of laboratory and imaging studies. Electrodiagnostic testing (e.g., electromyogramsand nerve conduction velocity testing) may also be of assistance. PT management commonly includes prescription of or assistance with specific exercises, manual therapy, education, manipulation and other interventions. In addition, PTs work with individuals to prevent the loss of mobility before it occurs by developing fitness and wellness-oriented programs for healthier and more active lifestyles, providing services to individuals and populations to develop, maintain and restore maximum movement and functional ability throughout the lifespan. This includes providing services in circumstances where movement and function are threatened by aging, injury, disease or environmental factors. Functional movement is central to what it means to be healthy.

Physical therapy has many specialties including sports, wound care, EMG, cardiopulmonary, geriatrics, neurologic, orthopaedic and pediatrics. PTs practice in many settings, such as outpatient clinics or offices, health and wellness clinics, inpatient rehabilitation facilities, skilled nursing facilities, extended care facilities, private homes, education and research centers, schools, hospices, industrial and this workplaces or other occupational environments, fitness centers and sports training facilities.

Physical therapists also practice in non-patient care roles such as health policy, health insurance, health care administration and as health care executives. Physical therapists are involved in the medical-legal field serving as experts, performing peer review and independent medical examinations.

Education qualifications vary greatly by country. The span of education ranges from some countries having little formal education to others having doctoral degrees and post doctoral residencies and fellowships.

 Physical Therapists

The primary physical therapy practitioner is the Physical Therapist (PT), who is trained and licensed to examine, evaluate, diagnose and treat impairments, functional limitations and disabilities in patients or clients. Currently, most Physical Therapist education curricula in the United States culminate in a Doctor of Physical Therapy (DPT) degree, but many currently practicing PTs hold a Master of Physical Therapy degree and some hold a Bachelor's degree. The World Confederation of Physical Therapy (WCPT) recognizes there is considerable diversity in the social, economic, cultural, and political environments in which physical therapist education is conducted throughout the world. WCPT recommends physical therapist entry-level educational programs be based on university or university-level studies, of a minimum of four years, independently validated and accredited as being at a standard that accords graduates full statutory and professional recognition. WCPT acknowledges there is innovation and variation in program delivery and in entry-level qualifications, including first university degrees (Bachelors/Baccalaureate/Licensed or equivalent), Masters and Doctorate entry qualifications. What is expected is that any program should deliver a curriculum that will enable physical therapists to attain the knowledge, skills, and attributes described in these guidelines. Professional education prepares physical therapists to be autonomous practitioners, that may work in collaboration with other members of the health care team.^{[citation needed]} Curricula in the United States are accredited by the Commission on Accreditation in Physical Therapy Education (CAPTE). As of 2011, APTA reports that 222 out of 227 entry-level professional degree programs accredited in the United States are at the doctoral level. According to CAPTE, as of 2012 there are 25,660 students currently enrolled in 210 accredited PT programs in the United States.

The physical therapist professional curriculum includes content and learning experiences in the clinical sciences (e.g., content about the cardiovascular, pulmonary, endocrine, metabolic, gastrointestinal, genitourinary, integumentary, musculoskeletal, and neuromuscular systems and the medical and surgical conditions frequently seen by physical therapists).

Specialty areas

Because the body of knowledge of physical therapy is quite large, some PTs specialize in a specific clinical area. While there are many different types of physical therapy, the American Board of Physical Therapy Specialties list eight specialist certifications.

Cardiovascular& pulmonary

Cardiovascular and pulmonary rehabilitation respiratory practitioners and physical therapists treat a wide variety of individuals with cardiopulmonary disorders or those who have had cardiac or pulmonary surgery. Primary goals of this specialty include increasing endurance and functional independence. Manual therapy is used in this field to assist in clearing lung secretions experienced with cystic fibrosis. Disorders, including heart attacks, post coronary bypass surgery, chronic obstructive pulmonary disease, and pulmonary fibrosis, treatments can benefit^{[citation needed]} from cardiovascular and pulmonary specialized physical therapists.^{[verification needed]}

Clinical electrophysiology

This specialty area encompasses electrotherapy/physical agents, electrophysiological evaluation (EMG/NCV), physical agents, and wound management.

Geriatric

Geriatric physical therapy covers a wide area of issues concerning people as they go through normal adult aging but is usually focused on the older adult. There are many conditions that affect many people as they grow older and include but are not limited to the following: arthritis, osteoporosis, cancer, Alzheimer's disease, hip and joint replacement, balance disorders, incontinence, etc. Geriatric physical therapists specialize in treating older adults.

Integumentary

Integumentary(treatment of conditions involving the skin and related organs). Common conditions managed include wounds and burns. Physical therapists utilize surgical instruments, mechanical lavage, dressings and topical agents to debride necrotic tissue and promote tissue healing. Other commonly used interventions include exercise, edema control, splinting, and compression garments.

Neurological

Neurological physical therapy is a field focused on working with individuals who have a neurological disorder or disease. These include Alzheimer's disease, Charcot-Marie-Tooth disease (CMT), ALS, brain injury, cerebral palsy, multiple sclerosis, Parkinson's disease, spinal cord injury, and stroke. Common impairments associated with neurologic conditions include impairments of vision, balance, ambulation, activities of daily living, movement, muscle strength and loss of functional independence. Physiotherapy can address many of these impairments and aid in restoring and maintaining function, slowing disease progression, and improving quality of life.

In layman's terms, neurological massage is directed toward correcting and healing out-of-normative body systems, unlike traditional massages, such as Swedish massage, that are directed toward comfort and relaxation.

Orthopedic

Orthopedic physical therapists diagnose, manage, and treat disorders and injuries of the musculoskeletal system including rehabilitation after orthopedic surgery. This specialty of physical therapy is most often found in the out-patient clinical setting. Orthopedic therapists are trained in the treatment of post-operative orthopedic procedures, fractures, acute sports injuries, arthritis, sprains, strains, back and neck pain, spinal conditions, and amputations.

Joint and spine mobilization/manipulation, dry needling, therapeutic exercise, neuromuscular reeducation, hot/cold packs, and electrical muscle stimulation (e.g., cryotherapy, iontophoresis, electrotherapy) are modalities often used to expedite recovery in the orthopedic setting.^{[verification needed]} Additionally, an emerging adjunct to diagnosis and treatment is the use of sonography for diagnosis and to guide treatments such as muscle retraining. Those who have suffered injury or disease affecting the muscles, bones, ligaments, or tendons will benefit from assessment by a physical therapist specialized in orthopedics.

Pediatric

Pediatric physical therapy assists in early detection of health problems and uses a wide variety of modalities to treat disorders in the pediatric population. These therapists are specialized in the diagnosis, treatment, and management of infants, children, and adolescents with a variety of congenital, developmental, neuromuscular, skeletal, or acquired disorders/diseases. Treatments focus on improving gross and fine motor skills, balance and coordination, strength and endurance as well as cognitive and sensory processing/integration. Children with developmental delays, cerebral palsy, spina bifida, or torticollis may be treated^{[citation needed]} by pediatric physical therapists.^{[verification needed]}

Sports

Physical therapists can be involved in the care of athletes from recreational to professional and Olympians. This area of practice includes athletic injury management, including acute care, treatment and rehabilitation, prevention, and education. Physical therapists are also active in sports medicine programs. Physical therapists who work for professional sport teams often have this specialized certification.

Women's health

Women's health physical therapy addresses women's issues related to child birth, and post-partum. These conditions include lymphedema, osteoporosis, pelvic pain, prenatal and post partum periods, and urinary incontinence.

POSTED BY ATTORNEY RENE G. GARCIA:

For more information:- Some of our clients have suffered injuries that require Physical Therapy treatment due to a serious accident. The Garcia Law ease call us at 1-866- SCAFFOLD or 212-725-1313.

http://en.wikipedia.org/wiki/Physical_therapy

Verdict Affirmed for Non-Surgical Spinal Injuries

By John Hochfelder on July 22, 2012 Posted in Back Injuries, Neck Injuries

On June 15, 2006, at about 2:30 p.m., Cornelius James was walking on the sidewalk at West 66th Street between West End and Amsterdam Avenues in Manhattan. Two cars collided and one car mounted the sidewalk and struck the pedestrian. 

Mr. James, a 31 year old attendant at a blood bank, was thrown eight feet into the air, bounced off the car’s hood and landed on the ground. He was taken by ambulance to the local emergency room where he complained of pain in his neck and back, was given anti-inflammatory medication and released after eight hours.

Four days later, Mr. James followed up with a physiatrist (a specialist in the field of trauma and rehabilitation medicine) who diagnosed radicular nerve pain, 50% reduced spinal range of motion and reduced muscle power.

MRI tests a month later disclosed significant injuries to 12 spinal discs – herniations at T1-T5, bulges at C3-C7 and bulges at L1-L5.

In the ensuing Bronx County lawsuit, both drivers were found to be at fault and Mr. James was awarded pain and suffering damages in the sum of $800,000 ($300,000 past – 3 years, $500,000 future – 30 years). The verdict has now been affirmed in James v. Farhood (1st Dept. 2012).

The court’s decision briefly mentions the injuries involved; here are the injury details:

• six months completely disabled from work (job involved heavy lifting)
• physical therapy three times a week for six months
• three epidural steroid injections at L4-L5
• lumbar and cervical radiculopathy
• continuing inability to return to organized softball or basketball and limited ability to play with his young children
• continuing pain requiring daily medication

While Mr. James returned to his job after six months, it was on light duty only and his injuries resulted in a job change. His treating doctor, Ali E. Guy, M.D., testified that the injuries are permanent and will require extensive medical treatment as his condition worsens over the years. 

Inside Information:

• In 2001, plaintiff was injured in another car accident that led to a few months of treatment for neck and back pain; however, he missed no time from work following that accident which he and his doctor testified was insignificant (even though the doctor had not been apprised of the prior injury before testifying in court).
• Plaintiff’s counsel asked the jury to award $250,000 for past damages and $400,000 for future damages; instead, the verdict (and the amount sustained on appeal over defendants’ claim of excessiveness) was $150,000 more than requested.
• Dr. Guy stated that "neurosurgical intervention" would result if continuing medical treatment fails and plaintiff’s condition continues to get worse. Defense doctors opined that plaintiff needs no more treatment.
• There was a second pedestrian struck by the car that hit Mr. James. Anwar Mian, 60 years old, also sued and he was awarded $500,000 for his pain and suffering damages described and affirmed in the court decision

 

POSTED BY ATTORNEY RENE G. GARCIA:

 For more information:- Some of our clients have suffered this kind of injuries due to a serious accident. The Garcia Law Firm, P.C. was able to successfully handle these types of cases. For a free consultation please call us at 1-866- SCAFFOLD or 212-725-1313.

http://www.newyorkinjurycasesblog.com/page/2/

Facial trauma

Facial trauma, also called maxillofacial trauma, is any physical trauma to the face. Facial trauma can involve soft tissue injuries such as burns, lacerations and bruises, or fractures of the facial bones such as nasal fractures and fractures of the jaw, as well as trauma such as eye injuries. Symptoms are specific to the type of injury; for example, fractures may involve pain, swelling, loss of function, or changes in the shape of facial structures.

Facial injuries have the potential to cause disfigurement and loss of function; for example, blindness or difficulty moving the jaw can result. Although it is seldom life-threatening, facial trauma can also be deadly, because it can cause severe bleeding or interference with the airway; thus a primary concern in treatment is ensuring that the airway is open and not threatened so that the patient can breathe. Depending on the type of facial injury, treatment may include bandaging and suturing of open wounds, administration of ice, antibiotics and pain killers, moving bones back into place, and surgery. When fractures are suspected, radiography is used for diagnosis. Treatment may also be necessary for other injuries such as traumatic brain injury, which commonly accompany severe facial trauma.

In developed countries, the leading cause of facial trauma used to be motor vehicle accidents, but this mechanism has been replaced by interpersonal violence; however auto accidents still predominate as the cause in developing countries and are still a major cause elsewhere. Thus prevention efforts include awareness campaigns to educate the public about safety measures such as seat belts and motorcycle helmets, and laws to prevent drunk and unsafe driving. Other causes of facial trauma include falls, industrial accidents, and sports injuries.

Classification

Soft tissue injuries include abrasions, lacerations, avulsions,bruises, burns and cold injuries.

Commonly injured facial bones include the nasal bone (the nose), the maxilla (the bone that forms the upper jaw), and the mandible (the lower jaw). The mandible may be fractured at its symphysis, body, angle, ramus, and condoyle^.The zygoma(cheekbone) and the frontal bone (forehead) are other sites for fractures. Fractures may also occur in the bones of the palate and those that come together to form the orbit of the eye.

At the beginning of the 20th century, René Le Fort mapped typical locations for facial fractures; these are now known as Le Fort I, II, and III fractures (right). Le Fort I fractures, also called Guérin or horizontal maxillary fractures, involve the maxilla, separating it from the palate. Le Fort II fractures, also called pyramidal fractures of the maxilla, cross the nasal bones and the orbital rim. Le Fort III fractures, also called craniofacial disjunction and transverse facial fractures, cross the front of the maxilla and involve the lacrimal bone, the lamina papyracea, and the orbital floor, and often involve the ethmoid bone. are the most serious. Le Fort fractures, which account for 10–20% of facial fractures, are often associated with other serious injuries. Le Fort made his classifications based on work with cadaver skulls, and the classification system has been criticized as imprecise and simplistic since most midface fractures involve a combination of Le Fort fractures. Although most facial fractures do not follow the patterns described by Le Fort precisely, the system is still used to categorize injuries.

Causes

Injury mechanisms such as falls, assaults, sports injuries, and vehicle crashes are common causes of facial trauma in children as well as adults. Blunt assaults, blows from fists or objects, are a common cause of facial injury. Facial trauma can also result from wartime injuries such as gunshots and blasts. Animal attacks and work-related injuries such as industrial accidents are other causes. Vehicular trauma is one of the leading causes of facial injuries. Trauma commonly occurs when the face strikes a part of the vehicle's interior, such as the steering wheel. In addition, airbags can cause corneal abrasions and lacerations (cuts) to the face when they deploy.

Signs and symptoms

Bruising, a common symptom in facial trauma

Fractures of facial bones, like other fractures, may be associated with pain, bruising, and swelling of the surrounding tissues (such symptoms can occur in the absence of fractures as well). Fractures of the nose, base of the skull, or maxilla may be associated with profuse nosebleeds. Nasal fractures may be associated with deformity of the nose, as well as swelling and bruising. Deformity in the face, for example a sunken cheekbone or teeth which do not align properly, suggests the presence of fractures. Asymmetry can suggest facial fractures or damage to nerves. People with mandibular fractures often have pain and difficulty opening their mouths and may have numbness in the lip and chin. With Le Fort fractures, the midface may move relative to the rest of the face or skull.

Diagnosis

Radiography, imaging of tissues using X-rays, is used to rule out facial fractures. Angiography (X-rays taken of the inside of blood vessels) can be used to locate the source of bleeding. However the complex bones and tissues of the face can make it difficult to interpret plain radiographs; CT scanning is better for detecting fractures and examining soft tissues, and is often needed to determine whether surgery is necessary, but it is more expensive and difficult to obtain. CT scanning is usually considered to be more definitive and better at detecting facial injuries than X-ray. CT scanning is especially likely to be used in people with multiple injuries who need CT scans to assess for other injuries anyway.

Prevention

Measures to reduce facial trauma include laws enforcing seat belt use and public education to increase awareness about the importance of seat belts and motorcycle helmets. Efforts to reduce drunk driving are other preventative measures; changes to laws and their enforcement have been proposed, as well as changes to societal attitudes toward the activity. Information obtained from biomechanics studies can be used to design automobiles with a view toward preventing facial injuries. While seat belts reduce the number and severity of facial injuries that occur in crashes, airbags alone are not very effective at preventing the injuries. In sports, safety devices including helmets have been found to reduce the risk of severe facial injury. Additional attachments such as face guards may be added to sports helmets to prevent orofacial injury (injury to the mouth or face). Mouth guards also used.

Treatment

An immediate need in treatment is to ensure that the airway is open and not threatened (for example by tissues or foreign objects), because airway compromise can occur rapidly and insidiously, and is potentially deadly. Material in the mouth that threatens the airway can be removed manually or using a suction tool for that purpose, and supplemental oxygen can be provided. Facial fractures that threaten to interfere with the airway can be reduced by moving the bones back into place; this both reduces bleeding and moves the bone out of the way of the airway. Tracheal intubation (inserting a tube into the airway to assist breathing) may be difficult or impossible due to swelling. Nasal intubation, inserting an endotracheal tube through the nose, may be contraindicated in the presence of facial trauma because if there is an undiscovered fracture at the base of the skull, the tube could be forced through it and into the brain. If facial injuries prevent oraotracheal or nasotracheal intubation, a surgical airway can be placed to provide an adequate airway. Although cricothyrotomy and tracheostomy can secure an airway when other methods fail, they are used only as a last resort because of potential complications and the difficulty of the procedures.

A dressing can be placed over wounds to keep them clean and to facilitate healing, and antibiotics may be used in cases where infection is likely. People with contaminated wounds who have not been immunized against tetanus within five years may be given a tetanus vaccination. Lacerations may require stitches to stop bleeding and facilitate wound healing with as little scarring as possible. Although it is not common for bleeding from the maxillofacial region to be profuse enough to be life threatening, it is still necessary to control such bleeding. Severe bleeding occurs as the result of facial trauma in 1–11% of patients, and the origin of this bleeding can be difficult to locate. Nasal packing can be used to control nose bleeds and hematomas that may form on the septum between the nostrils. Such hematomas need to be drained. Mild nasal fractures need nothing more than ice and pain killers, while breaks with severe deformities or associated lacerations may need further treatment, such as moving the bones back into alignment and antibiotic treatment.

Treatment aims to repair the face's natural bony architecture and to leave as little apparent trace of the injury as possible. Fractures may be repaired with metal plates and screws. They may also be wired into place. Bone grafting is another option to repair the bone's architecture, to fill out missing sections, and to provide structural support. Medical literature suggests that early repair of facial injuries, within hours or days, results in better outcomes for function and appearance.

Surgical specialists who commonly treat specific aspects of facial trauma are oral and maxillofacial surgeons. These surgeons are trained in the comprehensive management of trauma to the lower, middle and upper face and have to take written and oral board examinations covering the management of facial injuries.


Prognosis and complications

By itself, facial trauma rarely presents a threat to life; however it is often associated with dangerous injuries and life-threatening complications such as blockage of the airway may occur. The airway can be blocked due to bleeding, swelling of surrounding tissues, or damage to structures. Burns to the face can cause swelling of tissues and thereby lead to airway blockage. Broken bones such as combinations of nasal, maxillary, and mandibular fractures can interfere with the airway Blood from the face or mouth, if swallowed, can cause vomiting, which can itself present a threat to the airway because it has the potential to be aspirated. Since airway problems can occur late after the initial injury, it is necessary for healthcare providers to monitor the airway regularly.

Even when facial injuries are not life threatening, they have the potential to cause disfigurement and disability, with long-term physical and emotional results. Facial injuries can cause problems with eye, nose, or jaw function and can threaten eyesight. As early as 400 BC, Hippocrates is thought to have recorded a relationship between blunt facial trauma and blindness. Injuries involving the eye or eyelid, such as retrobulbar hemorrhage, can threaten eyesight; however, blindness following facial trauma is not common.

Nerves and muscles may be trapped by broken bones; in these cases the bones need to be put back into their proper places quickly. For example, fractures of the orbital floor or medial orbital wall of the eye can entrap the medial rectus or inferior rectus muscles. In facial wounds, tear ducts and nerves of the face may be damaged. Fractures of the frontal bone can interfere with the drainage of the frontal sinus and can cause sinusitis.

Infection is another potential complication, for example when debris is ground into an abrasion and remains there. Injuries resulting from bites carry a high infection risk.

POSTED BY ATTORNEY RENE G. GARCIA:

For more information:- Some of our clients have suffered this kind of injuries due to a serious accident. The Garcia Law Firm, P.C. was able to successfully handle these types of cases. For a free consultation please call us at 1-866- SCAFFOLD or 212-725-1313.

http://en.wikipedia.org/wiki/Facial_trauma

Court Affirms Medical Malpractice Verdict for Failure to Diagnose and Treat Compartment Syndrome but Orders Significant Damages Reduction

By John Hochfelder on January 7, 2013 Posted in Amputation Injuries, Medical Malpractice

On September 24, 2000, Thomas Burke fell from his wheelchair and injured his left foot. Mr. Burke, then 57 years old, had been afflicted with progressive multiple sclerosis for 20 years and had been wheelchair-bound since the mid-1990s. A week after he fell, Burke consulted with the first of several doctors about continuing leg pain. Unfortunately, he developed compartment syndrome and on October 11, 2000 – less than three weeks after he fell – Burke’s left leg had to be surgically amputated below his knee.

Compartment- Syndrome

Compartment syndrome is a painful condition that occurs when pressure within the muscles builds to dangerous levels. If acute, it is a medical emergency requiring a fasciotomy in which the surrounding skin and fascia (connective tissue) are cut open and away to relieve the pressure.

Burke sued several physicians claiming malpractice but all were dismissed from his suit except an orthopedic surgeon, Wesley V. Carrion, M.D., who treated him one time, 11 days after the fall.  Burke claimed that the orthopedic surgeon should have diagnosed acute compartment syndrome (“ACS”) and performed a fasciotomy. The defense contended that ACS is only acute for about seven hours after an injury and that thereafter it is medically inadvisable to operate.  The jury disagreed and on May 6, 2008 they returned a verdict finding the defendant liable.

The jury also: (a) assessed pain and suffering damages in the sum of $1,500,000 ($500,000 past – eight years, $1,000,000 future – 17 years) and (b) awarded plaintiff’s wife loss of services damages in the sum of $750,000 ($250,000 past, $500,000 future).

On appeal, in Burke v. Carrion (2d Dept. 2012), the liability finding and the pain and suffering damages awards were affirmed; however, the loss  of services awards were slashed to $20,000 ($15,000 past, $5,000 future).

Plaintiff argued, successfully, that the pain and suffering awards should be sustained because, even though plaintiff was wheelchair bound for many years he had been “fiercely independent” and able physically in many respects (e.g., prepared his own lunches, washed dishes and drove his car) but after the amputation he:

• was essentially immobilized in the hospital and in rehabilitation for approximately one year
• was without a prosthesis for a year and during that time had to be moved by a Hoyer lift
• underwent nine surgical procedures (three major surgeries on his lower leg and numerous debridements)
• sustained global degeneration – the loss of most muscle strength and coordination throughout his body
• became totally dependent on others for activities of daily living such as wheelchair transfers, showering and toileting

Hoyer Lift

The defense argued, unsuccessfully, that the pain and suffering awards were excessive, and the 17 year future period too long, because of a host of pre-existing conditions Mr. Burke was already suffering from including: progressive MS, strokes, Bell’s Palsy, seizures heart conditions and depression.

Although the appellate court affirmed the pain and suffering damages, it ordered a drastic reduction of the plaintiff’s wife’s loss of spousal services and consortium verdict: from $750,000 to $20,000.

Plaintiff argued on appeal that his wife’s derivative award was proper because Mr. Burke had, before the amputation, been “a loving husband and enjoyable partner” with “an intimate marriage [that] was transformed into a sad existence of caretaking, worry, and

• lack of normalcy and support.” Additionally, plaintiff argued that he could no longer perform any household chores.
• The defense argued, successfully, that there was insufficient evidence to support any significant loss of services award claiming that strokes before the amputation left Mr. Burke unable to handle the household finances, transfer from one spot to another or drive  a car and that he was already essentially immobile and in need of outside physical assistance.

Inside Information:

• On May 24, 2009, just a year after the verdict was rendered, Thomas Burke died from brain cancer, a cause unrelated to his leg or malpractice claims. Under New York law requiring large future pain and suffering verdicts to be paid out over many years (and discontinued in the event of death), almost all of the future pain and suffering damages in this case in excess of $250,000 will not be due.

• Two months before the verdict in Burke v. Carrion, a different jury exonerated Dr. Carrion in a different case, Mistretta v. Carrion. In that case, a 15 year old who underwent a derotational osteotomy claimed that she developed compartment syndrome because peroneal nerve compression had not been addressed intra-operatively. The jury rendered a defense verdict finding no malpractice.

 POSTED BY ATTORNEY RENE G. GARCIA:

For more information:- Some of our clients have suffered this kind of injuries due to a serious accident. The Garcia Law Firm, P.C. was able to successfully handle these types of cases. For a free consultation please call us at 1-866- SCAFFOLD or 212-725-1313.

http://www.newyorkinjurycasesblog.com/