One of the frustrations of hearing the multitude of calls we get having one of the leading web resources for brain advocacy is the cries for help from potential clients who it is too late to help. Most of those people hired a lawyer who was not an expert in traumatic brain injury. The problems that are created are typically forensic problems, those that relate to the case itself. Sometimes these can be undone, sometimes not.
But as I reflect on the harm that can come to a brain injured person by not hiring the right lawyer, right away, my biggest concern is for those with severe brain injuries, which one would think would be the easiest cases for a non-TBI lawyer to handle. After all, how hard is it to prove someone has been catastrophically damaged, when they have been catastrophically injured?
We get far fewer calls from survivors of coma injury cases than we do concussion survivors. In a coma case, there is never a shortage of lawyers wanting the case and most times family members have chosen a lawyer while the injured person is in the ICU. In contrast, proof of brain injury and disability is so much more difficult in a concussion case that many brain injured people can’t even get representation.
The difference a TBI lawyer makes however may be most significant in the severe brain injury cases. That is because the legal advocacy that is done at the beginning may not only make the case easier to prove, it may also make a huge difference in the access to acute and sub-acute care, in those first few months after a catastrophic brain injury when it is most needed. Thus I think it is important to reflect on what difference a TBI lawyer can make from the start.
The first thing that must be done from the advocacy standpoint after a severe brain injury occurs, is to have a guardian or conservator appointed. While many family members might wonder why they can’t continue on without a guardian, from a legal standpoint no real decisions can be made until someone is given the authority to make those decisions by a court. Many people are afraid of the word “guardian” because it connotes some type of loss of freedom of choice, but without a guardian, the severely brain injured person is left in a legal no man’s land. Among the things that can’t be done without a guardian is hire a lawyer to represent the brain injured person in a lawsuit.
The second area of advocacy that is critically important during those first few weeks after injury is to make sure that a professional case manager is assigned to the case – someone who does not work for the hospital or treatment center. A case manager is someone who will coordinate and manage the treatment and rehabilitation of the brain injured person. In today’s world, especially if it is a Medicaid payment case, the case manager is an essential advocate to assure that treatment doesn’t get suspended or underprovided because of some red tape.
Often times when a professional guardianship firm is utilized, the guardianship firm will have their own case managers. This can be an advantageous situation for the injured person and one reason I often recommend that professional case guardians be utilized.
The ultimate advantage of having an experienced brain injury advocate comes in the matter of the sub-acute treatment, the treatment in the months after the person has emerged from the coma. Fewer and fewer hospitals have inpatient rehab programs for severely brain injured survivors and it takes professionals to assure that the proper placement occurs. One of the advantages of having a top lawyer is that the potential for litigation proceeds may allow access to long term brain injury treatment facilities that would not be available under insurance or Medicaid reimbursement.
An experience brain injury lawyer can also help to avoid the dreaded nursing home placement where there may be a Catch 22 where no treatment occurs because only the nursing home can be reimbursed for treatment. The problem with that is the nursing home reimbursement is not enough to provide any meaningful rehabilitation. Thus rehabilitation is minimal at best. The only other alternative under the local reimbursement situation may be adult foster care placement with outpatient treatment, but often times the available foster care homes are completely inappropriate for the survivor.
An experienced TBI lawyer in the beginning can open up other options. We got involved in a case in California about three years ago with a severely brain injured person. Rather than a nursing home placement, the survivor was placed in a nationally recognized rehabilitation program. In that program, the client got 24/7 appropriate treatment and supervision. As a result of the ability of the lawyer to negotiate a lien payment option, the care wasn’t terminated at 30 days. The care continued long term. The ultimate result is the best possible care for that individual, which continues to this day. Future payment of treatment cost are assured because the jury awarded the plaintiff $49 million.
NFL Concussion Hearings in Congress – Moving Past the Need for Perfect Proof of Brain Damage
The issue of concussion awareness seems to have hit critical mass with yesterday’s hearings by Congress in Michigan. The hearings included a panel of former players and medical professionals on the issue of concussion in sport. For a thorough story on the hearings, see the New York Times story: Lawmakers Grill Doctor for His Views on Concussions. See http://www.nytimes.com/2010/01/05/sports/football/05hearing.html I will discuss in this blog some of the news highlights of that hearing and in the coming blogs will dig into the topic in more depth, from the documents on file from the U.S. House of Representatives website.
Once again Ira. R. Casson, M.D. was at the center of the controversy because of his claimed denial of evidence that NFL concussions cause permanent brain damage. As the debate on this issue has been heated in the media over the last few months, his statements made the most headlines. Frankly, they fit more into the non-denial, denial category and are not terribly significant. The NY Time article did see the forest for the trees. It began:
It is certainly a misstatement to say that Casson claims that the scientific evidence has been discredited. What Casson has said is that the studies clearly “proving” that concussion cause permanent brain damage in “NFL” players are flawed. Casson’s point seems to be an academic one with respect to methodological flaws in the studies that have been done.
Casson’s written statement, submitted before his testimony contained these statements:
The ridiculous part of Casson’s argument is that he is also saying that not all relevant concussions that happen to football players happen while they are in the NFL. The point is that all football, not just NFL football leads to brain damage. For Casson to defend the NFL because football players could have injured their brains before their professional career began is absurd. What is needed is reform in the way in which all concussions are diagnosed and treated, not just those that happen in the NFL or in football.
But these hearings are not about criticizing the NFL for not doing something sooner. The NFL has made significant change this year, even to the point that one of the big controversies of the fall was players criticizing team officials for not allowing players to return to the game. As pointed out in the NY Times story, the NFL has changed its concussion policy since the first round of these hearings in October. House Democrat John Conyers Jr. of Michigan, gets kudos here for his work.
Once again Ira. R. Casson, M.D. was at the center of the controversy because of his claimed denial of evidence that NFL concussions cause permanent brain damage. As the debate on this issue has been heated in the media over the last few months, his statements made the most headlines. Frankly, they fit more into the non-denial, denial category and are not terribly significant. The NY Time article did see the forest for the trees. It began:
Although the most theatrical moments of a House Judiciary Committee hearing on football brain injuries on Monday involved the grilling of a former NFL. doctor, most of the testimony centered on the application of recently strengthened professional rules to amateur levels, from youth leagues to college programs.With respect to Casson’s testimony, one Congressman, Steve Cohen a Democrat from Tennessee called out Dr. Casson, who recently resigned as a co-chairman of the NFL.’s committee on concussions, “for continuing to discredit mounting evidence linking professional football with cognitive decline and decrying what he called “the politicization” of science.”
It is certainly a misstatement to say that Casson claims that the scientific evidence has been discredited. What Casson has said is that the studies clearly “proving” that concussion cause permanent brain damage in “NFL” players are flawed. Casson’s point seems to be an academic one with respect to methodological flaws in the studies that have been done.
Casson’s written statement, submitted before his testimony contained these statements:
The conclusion that I have reached as a result of these analyses is that there is at present not enough valid, reliable or objective scientific evidence to prove that head impacts from professional football are the cause of chronic brain damage. Association does not prove causation.
I certainly agree that some retired NFL players have abnormal tau pathology in their brains. However the cause of this pathology is still uncertain. Head trauma may be playing a role, but even if it is, we do not know if the significant head trauma occurs in childhood, adolescence or at a later time in life. The presence of tau pathology in the brain of an 18 year old high school athlete and some middle aged men who had played high school and college football but never played in NFL certainly suggest that head trauma in adolescence may be an important factor. (Bold facing added.)
The ridiculous part of Casson’s argument is that he is also saying that not all relevant concussions that happen to football players happen while they are in the NFL. The point is that all football, not just NFL football leads to brain damage. For Casson to defend the NFL because football players could have injured their brains before their professional career began is absurd. What is needed is reform in the way in which all concussions are diagnosed and treated, not just those that happen in the NFL or in football.
But these hearings are not about criticizing the NFL for not doing something sooner. The NFL has made significant change this year, even to the point that one of the big controversies of the fall was players criticizing team officials for not allowing players to return to the game. As pointed out in the NY Times story, the NFL has changed its concussion policy since the first round of these hearings in October. House Democrat John Conyers Jr. of Michigan, gets kudos here for his work.
I do agree with Dr. Casson that more research needs to be done, but that research needs to be far broader than his focus on “tau pathology”. Understanding and treating concussion is not about finding the objective scientific proof of the pathology, but of understanding the inherently subjective nature of a disability that involves a total synergistic change in the way in which the brain and emotions work. In the days ahead, I will focus on the more substantive aspects of the testimony at this weeks hearings.
Post Concussion Syndrome – Diagnosing and Treating for All Risk Factors
I said this last week on my Justice and American Politics blog, http://subtlebraininjury.com/blog:
In the days after a concussion, the brain is trying mightily to rewire itself to deal with the new challenges. That rewiring is not always positive. Add panic or emotional distress and the plasticity that we all hope will avoid negative consequences, can rewire the brain in the wrong ways. I call this “negative plasticity” and I believe it is one of the strongest arguments for better and more thorough diagnosis and follow-up for concussion.
To answer that question one must first define the term “plasticity.” I found a great definition of it at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1526649/
Brain plasticity refers to the brain’s lifelong capacity for physical and functional change; it is this capacity that enables experience to induce learning throughout life. Research in this field has demonstrated that the adult brain continuously adapts to disproportionately represent relevant sensory stimuli and behavioral outputs with well coordinated populations of neurons. This adaptation is achieved by engaging competitive processes in brain networks that refine the selective representations of sensory inputs or motor actions, typically resulting in increased strengths of cortical resources devoted to, and enhanced representational fidelity of, the learned stimulus or behavior.
In severe brain injury lingo, plasticity is the capacity of one part of brain to take on the function of a part of the brain which is damaged. But as the brain has the capacity to rewire itself in positive ways, so can it in negative ways.
As long as I have been doing Post Concussion Syndrome cases, I have been asking myself this question: Why is there this significant subset of people who have such bad results from an injury that the majority of people have apparent full recoveries, within days if not hours? This small minority of people that fall into the symptomatic category have been referred to most often as either the “miserable minority” (Ron Ruff, neuropsychologist) or as suffering from the Persistent Post Concussive Syndrome. “PPCS” (Michael Alexander, M.D. , Neurology, 1995). That “miserable minority” of people consistently make up between 5 and 15% of those who suffer a concussion or mild traumatic brain injury. What explains this divergent outcome for this PPCS group?
I believe there are a number of issues. First, some of them have far more than a “simple concussion.” This portion have fairly serious brain injuries but because the symptoms of those concussions occurred when they were not being monitored by medical professionals, the severity of the brain injury is grossly underrated.
Second, some of them have other neurological injuries, which again, went misdiagnosed. The most common among this group are those with vestibular disorders. See http://vestibulardisorder.com Symptoms of dizziness, balance and vertigo can put significant demands upon the brains attentional resources and account for many of the cognitive and emotional complaints associated with the post concussion syndrome. In my career, I have found nearly a 50% incidence of vestibular disorder among my clients.
Third, there may be an artery dissection that happened contemporaneously with the head injury or as a result of treatment for the head injury, particularly from a chiropractor. Artery dissections can cause a stroke, with resultant moderate to severe brain damage.
Fourth, the brain injured person may be emotionally more vulnerable than the 85 to 90% of those who have good recoveries. This is likely the most significant factor and is the area where my term of “negative plasticity” comes into play. While the evidence of this particular component of concussion pathology is incomplete, I believe that as we learn more about the limbic system and the axonal connections between it and the lower frontal lobes, the emotional component of concussion recovery will become a huge field of discovery and potentially treatment.
What is the reason this is important in a week when a football coach gets fired for locking an athlete with a concussion up in a dark place? There is a major overlap between PTSD and the post concussion syndrome. After all, both are “all in the head”. “All in the head” means it is in the brain. There is not a bright line of demarcation between emotional injury and organic or “hard wire” injury in the brain. In all likelihood, there is no line at all. If you damage a person’s emotional center, regardless of whether you do so by direct trauma or via emotional rewiring, the hard wiring change is the same.
Concussion survivors need the best treatment, not just to protect them from repeat trauma’s, but also to protect the vulnerable brain from negative rewiring. A concussion in its infancy can become a life long disability if the vulnerable brain is neglected or abused. We worry about “shaken baby syndrome”. We should also worry about the neglected emotional state of all brains that are injured.
In the days after a concussion, the brain is trying mightily to rewire itself to deal with the new challenges. That rewiring is not always positive. Add panic or emotional distress and the plasticity that we all hope will avoid negative consequences, can rewire the brain in the wrong ways. I call this “negative plasticity” and I believe it is one of the strongest arguments for better and more thorough diagnosis and follow-up for concussion.
To answer that question one must first define the term “plasticity.” I found a great definition of it at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1526649/
Brain plasticity refers to the brain’s lifelong capacity for physical and functional change; it is this capacity that enables experience to induce learning throughout life. Research in this field has demonstrated that the adult brain continuously adapts to disproportionately represent relevant sensory stimuli and behavioral outputs with well coordinated populations of neurons. This adaptation is achieved by engaging competitive processes in brain networks that refine the selective representations of sensory inputs or motor actions, typically resulting in increased strengths of cortical resources devoted to, and enhanced representational fidelity of, the learned stimulus or behavior.
In severe brain injury lingo, plasticity is the capacity of one part of brain to take on the function of a part of the brain which is damaged. But as the brain has the capacity to rewire itself in positive ways, so can it in negative ways.
As long as I have been doing Post Concussion Syndrome cases, I have been asking myself this question: Why is there this significant subset of people who have such bad results from an injury that the majority of people have apparent full recoveries, within days if not hours? This small minority of people that fall into the symptomatic category have been referred to most often as either the “miserable minority” (Ron Ruff, neuropsychologist) or as suffering from the Persistent Post Concussive Syndrome. “PPCS” (Michael Alexander, M.D. , Neurology, 1995). That “miserable minority” of people consistently make up between 5 and 15% of those who suffer a concussion or mild traumatic brain injury. What explains this divergent outcome for this PPCS group?
I believe there are a number of issues. First, some of them have far more than a “simple concussion.” This portion have fairly serious brain injuries but because the symptoms of those concussions occurred when they were not being monitored by medical professionals, the severity of the brain injury is grossly underrated.
Second, some of them have other neurological injuries, which again, went misdiagnosed. The most common among this group are those with vestibular disorders. See http://vestibulardisorder.com Symptoms of dizziness, balance and vertigo can put significant demands upon the brains attentional resources and account for many of the cognitive and emotional complaints associated with the post concussion syndrome. In my career, I have found nearly a 50% incidence of vestibular disorder among my clients.
Third, there may be an artery dissection that happened contemporaneously with the head injury or as a result of treatment for the head injury, particularly from a chiropractor. Artery dissections can cause a stroke, with resultant moderate to severe brain damage.
Fourth, the brain injured person may be emotionally more vulnerable than the 85 to 90% of those who have good recoveries. This is likely the most significant factor and is the area where my term of “negative plasticity” comes into play. While the evidence of this particular component of concussion pathology is incomplete, I believe that as we learn more about the limbic system and the axonal connections between it and the lower frontal lobes, the emotional component of concussion recovery will become a huge field of discovery and potentially treatment.
What is the reason this is important in a week when a football coach gets fired for locking an athlete with a concussion up in a dark place? There is a major overlap between PTSD and the post concussion syndrome. After all, both are “all in the head”. “All in the head” means it is in the brain. There is not a bright line of demarcation between emotional injury and organic or “hard wire” injury in the brain. In all likelihood, there is no line at all. If you damage a person’s emotional center, regardless of whether you do so by direct trauma or via emotional rewiring, the hard wiring change is the same.
Concussion survivors need the best treatment, not just to protect them from repeat trauma’s, but also to protect the vulnerable brain from negative rewiring. A concussion in its infancy can become a life long disability if the vulnerable brain is neglected or abused. We worry about “shaken baby syndrome”. We should also worry about the neglected emotional state of all brains that are injured.
Mike Leach Firing Clearly Justified by Evidence of Abuse of Brain Injured Athlete
Texas Tech has won its bowl game without the Concussion abuser Mike Leach as its head coach. Leach was fired on Thursday, just before his hearing to force reinstatement. The court case was odd, especially since Leach chose to try his case in the media with out of context claims of support from the team doctor and trainer. As reported by the New York Times, neither the trainer nor the team doctor are supporting his treatment of Adam James. See http://www.nytimes.com/2010/01/03/sports/ncaafootball/03leach.html?hp
A Texas Tech athletic trainer said he was told by the fired coach Mike Leach to lock wide receiver Adam James in the dark after doctors determined that he had a concussion, according to an affidavit released Saturday by the university.
According to the NY Times story:
Despite Leach’s media claims, the team doctor did not support the treatment of James, either. According to the NY Times:
A Texas Tech athletic trainer said he was told by the fired coach Mike Leach to lock wide receiver Adam James in the dark after doctors determined that he had a concussion, according to an affidavit released Saturday by the university.
According to the NY Times story:
In a Dec. 21 interview with a university investigative attorney looking into James’s treatment, Steve Pincock, Texas Tech’s head football trainer, said he told James he was sorry about placing him inside an equipment shed on Dec. 17 near the practice field. According to the affidavit, Pincock also said he was not aware that any other player had ever been treated in such a manner.
“I do not agree with this form of treatment for anyone,” Pincock said in the affidavit.
In describing what Leach told him to do, Pincock quoted the coach as using graphic and profane language about locking James in a dark place, according to the affidavit. Pincock also told the investigator that Leach “wanted James to be uncomfortable,” the affidavit said. Pincock did not return a message left on his cellphone or reply to a text message Saturday.
Despite Leach’s media claims, the team doctor did not support the treatment of James, either. According to the NY Times:
In another affidavit released Saturday by the university, the team physician Michael Phy told the investigator on Dec. 22 that James “may not have been harmed,” but that Phy considered “this practice inappropriate.” In the statement announcing Leach’s firing, Texas Tech said Leach’s actions put James “at risk for additional injury.”As I said on one of my other blogs last week, while isolation does not necessarily expose the injured brain to any new physical forces, it can expose the brain to additional stress, which can result in further Post Concussion Syndrome problems. See http://blog.subtlebraininjury.com/2009/12/texas-tech-isolation-for-concussed.html
Last year was a remarkable year for concussion awareness, but we are only scratching the surface of treating the secondary effects of concussion, especially those that involve emotional stressors. I hope the Leach chapter stays in the media focus long enough to get some of the leading thinkers on concussion to educate on this issue further.
Brain Injury Association of Wisconsin Looks for Volunteers for Sleep Study
From the Brain Injury Association of Wisconsin:
The Sleep Wellness Institute Research Study
Many people with a traumatic brain injury may feel sleepy during the day, even if the injury happened years ago. Researchers are inviting those with a traumatic brain injury who feel sleepy during the day to take part in a clinical study. This study will assess how well a study medicine works for people who feel sleepy during the day as a result of traumatic brain injury.
To qualify you must:
• Be age 18 to 65
• Have had 1 traumatic brain injury in the past 10 years
• Feel sleepy or tired during the day 5 or more days a week on average
• Be willing to take medical tests and a study medicine for 12 weeks
• Be available to sleep overnight in a sleep lab 5 times (some sleep labs are similar to hotel rooms)
This study will last 14 to 16 weeks (approximately 88 hours total) and include:
• 7 visits
• 4 phone contacts
• 4 overnight sleep studies
• 4 daytime studies, three of which follow the overnight studies
If you qualify:
• You may learn more about your sleep patterns
• You will receive study-related medical care and study medicine at no cost
• You may or may not benefit from study medicine
• Compensation for time and travel may also be provided
If interested in participating in this research study, please contact Skyler Baake at 414-328-5637, skyler@sleepwell.org or Anne Papke at 414-477-4198, anne_papke@yahoo.com.
The Sleep Wellness Institute is located at 2356 S. 102nd Street, West Allis, WI 53227. www.sleepwell.org
Sincerely,
Mark Warhus, Executive Director
Brain Injury Association of Wisconsin
The Sleep Wellness Institute Research Study
Many people with a traumatic brain injury may feel sleepy during the day, even if the injury happened years ago. Researchers are inviting those with a traumatic brain injury who feel sleepy during the day to take part in a clinical study. This study will assess how well a study medicine works for people who feel sleepy during the day as a result of traumatic brain injury.
To qualify you must:
• Be age 18 to 65
• Have had 1 traumatic brain injury in the past 10 years
• Feel sleepy or tired during the day 5 or more days a week on average
• Be willing to take medical tests and a study medicine for 12 weeks
• Be available to sleep overnight in a sleep lab 5 times (some sleep labs are similar to hotel rooms)
This study will last 14 to 16 weeks (approximately 88 hours total) and include:
• 7 visits
• 4 phone contacts
• 4 overnight sleep studies
• 4 daytime studies, three of which follow the overnight studies
If you qualify:
• You may learn more about your sleep patterns
• You will receive study-related medical care and study medicine at no cost
• You may or may not benefit from study medicine
• Compensation for time and travel may also be provided
If interested in participating in this research study, please contact Skyler Baake at 414-328-5637, skyler@sleepwell.org or Anne Papke at 414-477-4198, anne_papke@yahoo.com.
The Sleep Wellness Institute is located at 2356 S. 102nd Street, West Allis, WI 53227. www.sleepwell.org
Sincerely,
Mark Warhus, Executive Director
Brain Injury Association of Wisconsin
Primary Care Reimbursement Under Health Care Reform
We have heard much about the size of the new Health Care Reform Act, something nearly 2,000 pages. We have heard very little about what is inside of it except that it will cover more people, provide coverage for those with preexisting conditions and expand the coverage by as much as 30 million people. But how is it going to cut costs? And how will it assure that low income people truly have access to medical care?
One of the provisions included in the Senate plan is to increase the reimbursement rate of primary care doctors who are seeing Medicaid patients. See Health Care Business News at http://www.modernhealthcare.com/article/20091227/REG/312279992/0 In that article they explain:
Our current medical system is built around the concept of a gatekeeper, the primary care or family practice doctor. If you have a problem, it is only through treatment by the family care doctor or referral to a specialist from the primary care doctor that you get treated. Thus it is the gatekeeper who plays the most important role in diagnosis of disease. It is also the gatekeeper who must retain the most overall knowledge of medicine as he must be able to spot a problem across the entire spectrum of medical diagnosis. People think that because they are less specialized they have lower skills. For our system to work properly, that can’t be the case. As capitalist, if we want to attract our best doctors to this role, we have to pay them like our best doctors.
When I look at brain injury diagnosis, I see the enormous role that family doctors have to play. In my model, each concussed person would go back to the Emergency Room the day after his or her injury to be seen by the same doctors who saw them on the day of concussion, to determine if there was continuing or worsening symptoms. That is not what is happening in our current system. What happens in our current system is that the concussed patient is told to follow-up with their family doctor, if they get worse. If the family doctor does not know more about diagnosing a concussion than the average neurologist, then the diagnosis and the documentation of symptomotology that is so important will be missed. The reason that second day documentation is so significant is that without it, it becomes extremely difficult to sort out the issue of whether the symptoms that come later are related to brain injury.
My pet project – had I a lobbyist in my pocket for concussion care reform – would be to require the follow-up visit to the ER. Since I don’t have those kind of connections, this provision to increase access (and compensation to family doctors) is a step in the right direction. Now we must do what we can to educate the primary care doctor that testing for amnesia in the days after the accident will tell us more about the severity of injury and potential for disability than all of the scans that have been or will ever be invented.
One of the provisions included in the Senate plan is to increase the reimbursement rate of primary care doctors who are seeing Medicaid patients. See Health Care Business News at http://www.modernhealthcare.com/article/20091227/REG/312279992/0 In that article they explain:
A key objective of the bill is to bolster the ranks of the primary care workforce. The legislation includes a raft or new funding and measures aimed to encourage doctors to move into primary care . And in a measure to help increase transparency, the legislation requires HHS to develop a “Physician Compare” web site where Medicare beneficiaries can compare measures of physician quality and a patient’s perception of care.This is an important part of the plan. Primary care doctors are in my opinion, the most important doctors in our system and sadly the lowest paid. See http://www.cejkasearch.com/compensation/amga_physician_compensation_survey.htm
Our current medical system is built around the concept of a gatekeeper, the primary care or family practice doctor. If you have a problem, it is only through treatment by the family care doctor or referral to a specialist from the primary care doctor that you get treated. Thus it is the gatekeeper who plays the most important role in diagnosis of disease. It is also the gatekeeper who must retain the most overall knowledge of medicine as he must be able to spot a problem across the entire spectrum of medical diagnosis. People think that because they are less specialized they have lower skills. For our system to work properly, that can’t be the case. As capitalist, if we want to attract our best doctors to this role, we have to pay them like our best doctors.
When I look at brain injury diagnosis, I see the enormous role that family doctors have to play. In my model, each concussed person would go back to the Emergency Room the day after his or her injury to be seen by the same doctors who saw them on the day of concussion, to determine if there was continuing or worsening symptoms. That is not what is happening in our current system. What happens in our current system is that the concussed patient is told to follow-up with their family doctor, if they get worse. If the family doctor does not know more about diagnosing a concussion than the average neurologist, then the diagnosis and the documentation of symptomotology that is so important will be missed. The reason that second day documentation is so significant is that without it, it becomes extremely difficult to sort out the issue of whether the symptoms that come later are related to brain injury.
My pet project – had I a lobbyist in my pocket for concussion care reform – would be to require the follow-up visit to the ER. Since I don’t have those kind of connections, this provision to increase access (and compensation to family doctors) is a step in the right direction. Now we must do what we can to educate the primary care doctor that testing for amnesia in the days after the accident will tell us more about the severity of injury and potential for disability than all of the scans that have been or will ever be invented.
Health Care Reform Now Awaits Reconciliation
The New York Times is the world’s best newspaper. I learned that in Journalism school almost 40 years ago. It is still true today. Like all newspapers, it is at risk of failure because of the revolutionary shift in advertising revenues caused by the rise in the internet. I never subscribed to the New York Times, because I was a Midwesterner and it just didn’t seem practical. Well the NY Times is now part of my daily reading, because they have perhaps the best online newspaper: http://nytimes.com. I sure hopes the webpage helps the newspaper survive.
I was newly impressed with the NY Times this morning when I read their analysis of the two health care proposals in our Congress, the House version and the Senate version. I think it is a must read for anyone concerned about the health care debate, or about the health of brain injured people. That article is here: http://www.nytimes.com/2009/12/22/health/policy/22health.html?hp If you are required to register to get to this page, by all means, register. In fact, make the http://nytimes.com your home page, I did.
This article has the most comprehensive explanation of the two bills in Congress and a simple and reasoned explanation of which aspects of each bill should be retained. We hope that our Senators are capable of seeing the big picture and allowing small compromises to get this historic legislation passed. We hope our progressive colleagues in the House don’t blow up the coalition on Health Care Reform over a liberal agenda that can wait for another day.
Read the details. This comes under the category of things you need to know as a citizen.
I was newly impressed with the NY Times this morning when I read their analysis of the two health care proposals in our Congress, the House version and the Senate version. I think it is a must read for anyone concerned about the health care debate, or about the health of brain injured people. That article is here: http://www.nytimes.com/2009/12/22/health/policy/22health.html?hp If you are required to register to get to this page, by all means, register. In fact, make the http://nytimes.com your home page, I did.
This article has the most comprehensive explanation of the two bills in Congress and a simple and reasoned explanation of which aspects of each bill should be retained. We hope that our Senators are capable of seeing the big picture and allowing small compromises to get this historic legislation passed. We hope our progressive colleagues in the House don’t blow up the coalition on Health Care Reform over a liberal agenda that can wait for another day.
Read the details. This comes under the category of things you need to know as a citizen.
Health Care Reform Gets Over its Biggest Hurdle
Congratulations to Harry Reid for getting a health care reform bill thru the Senate. After 50 years of effort, the Democrats have almost done it. The next step is reconciliation with the House version and even though the outcome isn’t perfect, it is a huge step. While President Barack Obama has gotten criticism from every direction in the process, he must get high grades for this achievement. When he signs a Health Care Reform bill into law, it will be a moment in history as historic as his election.
I admit that there have been times in the last few weeks when I wondered if the special interest control of our legislatures might ultimately mean that the American system of making laws was broken. But Obama, Reid and Pelosi have found a way to get this done. The found a way to get it done despite the most intensive lobbying effort in history and a complete blockade of legislative cooperation by the Republicans.
Is this the bill that would have best for me? Of course not. I would have preferred the Medicare buy in at 55 because of course, I am 56. Is it the bill that would have been best for all Americans? Probably not. But is it a tremendous step towards coverage for all? Yes it is. After 50 years of nothing, after the collapse of the last major attempt led by two of the great politicians of the last 50 years, Bill and Hillary Clinton, to get this bill out of the Senate is remarkable.
There is some sausage making left over, but when it is done, millions will have health coverage that didn’t, and even though it isn’t everyone, it is still millions whose will have access to medical care.
I admit that there have been times in the last few weeks when I wondered if the special interest control of our legislatures might ultimately mean that the American system of making laws was broken. But Obama, Reid and Pelosi have found a way to get this done. The found a way to get it done despite the most intensive lobbying effort in history and a complete blockade of legislative cooperation by the Republicans.
Is this the bill that would have best for me? Of course not. I would have preferred the Medicare buy in at 55 because of course, I am 56. Is it the bill that would have been best for all Americans? Probably not. But is it a tremendous step towards coverage for all? Yes it is. After 50 years of nothing, after the collapse of the last major attempt led by two of the great politicians of the last 50 years, Bill and Hillary Clinton, to get this bill out of the Senate is remarkable.
There is some sausage making left over, but when it is done, millions will have health coverage that didn’t, and even though it isn’t everyone, it is still millions whose will have access to medical care.
NFL and Brain Injury
From the NFL and its Players Association:
The words read good on paper. I will start to believe the NFL when I don’t see players going back into the same game that they suffer a concussion. We can’t know the severity of a concussion the same day as the injury because brain injury is a “process not an event”. See http://blog.tbilaw.com
NFLPA ANNOUNCES FORMATION OF
CONCUSSION AND TRAUMATIC BRAIN INJURY COMMITTEE
For the past few months, the NFL Players Association, led by Executive Director DeMaurice Smith, President Kevin Mawae, Medical Director Dr. Thom Mayer and Arizona Cardinals wide receiver Sean Morey, has been working on compiling support for a special committee to address the issue of head trauma among professional football players. Today, the NFLPA announces the formation of the Concussion and Traumatic Brain Injury (TBI) Committee.
The NFLPA Concussion and TBI Committee will address two fundamental, timely and critical issues facing professional football players: first, the diagnosis, treatment and prevention of concussions and TBI in active players; and second, the long-term cumulative effects of isolated or repetitive TBI in NFL players as patients in order to discover how these effects can be reduced and eliminated.
DeMaurice Smith issued a statement saying, “The health, safety and welfare of our players is never just an issue of collective bargaining. While we have already raised this issue in the CBA negotiations and Dr. Mayer participated in the first meeting, this committee and the work we do around the health and safety of our players will extend much further. The creation of this committee was designed to bring both independence and expertise to the ongoing analysis of serious head injuries so we can better protect our players. I am confident that Sean Morey and Dr. Mayer will lead this team to gather more comprehensive data and provide real solutions for our players, both past and present.”
The Concussion and TBI Committee will be co-chaired by Sean Morey and Dr. Mayer. It will also be comprised of other active players, former players, researchers in the field of TBI and physicians with expertise in neurological injuries.
Joanna Comfort
Communications Coordinator, Communications
1133 20th Street, NW
Washington, DC 20036
(P) (202) 756-9170
(F) (202) 756-9310
NFLPLAYERS.COM
The words read good on paper. I will start to believe the NFL when I don’t see players going back into the same game that they suffer a concussion. We can’t know the severity of a concussion the same day as the injury because brain injury is a “process not an event”. See http://blog.tbilaw.com
Medical Malpractice – Consumers versus Corporate Interests
In my previous blog I asked the question: Are Republican’s immune from Medical Malpractice? Of course they are not. Are consumers immune to big business and its institutional greed and corruption? Sadly not. Yet the Republican’s are all about the politics of converting the interests of Big Business into scare tactics aimed at average people.
Let us take an average person. Francisco Torres was a retired assembly line worked with a cancerous tumor on his left kidney. Sounds like the kind of person the anti-health care reform lobby has been courting. Fear of death panels. Cuts to medicare. A year ago, Mr. Torres would have probably thought that tort reform was good for the country and would lower his medical costs.
Not any longer. When Mr. Torres went in for surgery to remove the diseased kidney, the doctor cut out his healthy one. See the Press Enterprise News: http://www.pe.com/localnews/sbcounty/stories/PE_News_Local_S_kidney03.46a9e43.html According to the pe.com:
When you listen to the outraged rhetoric about how trial lawyers are ruining the country, you don’t hear the stories of people like Mr. Torres. Thus, in my upcoming blogs, I will tell some of those stories. You the reader get to choose. Protect Big Business from the predator trial lawyers, or protect you from the abuses of neglect and greed.
Let us take an average person. Francisco Torres was a retired assembly line worked with a cancerous tumor on his left kidney. Sounds like the kind of person the anti-health care reform lobby has been courting. Fear of death panels. Cuts to medicare. A year ago, Mr. Torres would have probably thought that tort reform was good for the country and would lower his medical costs.
Not any longer. When Mr. Torres went in for surgery to remove the diseased kidney, the doctor cut out his healthy one. See the Press Enterprise News: http://www.pe.com/localnews/sbcounty/stories/PE_News_Local_S_kidney03.46a9e43.html According to the pe.com:
A retired assembly line worker is suing a Riverside hospital and doctor, claiming that they removed his healthy kidney instead of the diseased one. He has to endure dialysis every three days to stay alive.Guess what? The hospital is now denying all claims in the civil suit. According to PE.com: “Hospital officials have denied responsibility. Neither Wahlstrom nor representatives from Parkview Community Hospital returned telephone calls made Tuesday and Wednesday.” If there is anything about medical malpractice claims that drives up the cost of medical bills, which almost all studies have disproved, it is the cost of frivilous and obstructionist defenses to those claims.
On July 14, Dr. H. Erik Wahlstrom, who was performing surgery at Parkview Community Hospital Medical Center, was to remove Francisco Torres’ left kidney, Torres’ lawsuit states. Instead, Wahlstrom removed Torres’ healthy right kidney before realizing the mistake, said Shirley Watkins, Torres’ Los Angeles attorney.
Shortly after surgery, Wahlstrom told Torres’ daughter what he had done, Watkins said. Torres said through an interpreter that Wahlstrom apologized to him. But Torres, who does not speak or read English, said he was still groggy from the surgery and has little recollection of what was said.
When you listen to the outraged rhetoric about how trial lawyers are ruining the country, you don’t hear the stories of people like Mr. Torres. Thus, in my upcoming blogs, I will tell some of those stories. You the reader get to choose. Protect Big Business from the predator trial lawyers, or protect you from the abuses of neglect and greed.