Brain Injury and Depression

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Posted on 29th October 2008 by Gordon Johnson in Uncategorized

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When we think of the impact that brain injury has on a person, it is often the ability to process, record and recover information that comes to the forefront. We focus on the thought processes or problems in memory first, and the emotional aspects of brain injury last. However, depression is a significant and debilitating factor in many brain injuries.

According to the Brain Injury Association of America, significant depression will affect 6 out of 100 people in the general population. However, research has found that if TBI is involved this number may increase by ten times.

Lack of inhibition and compromised frustration levels can affect a brain injured individual’s ability to control anger. The same mechanisms can affect an individual’s emotional responses on many levels and emotional responses may become exaggerated or inappropriate.

Depression, however, is not only triggered by the physical changes in the person’s state.

“Many research studies show that post-TBI depression is associated with poorer rehabilitation outcomes, reduced activities of daily living, increased experience of failure, increased stress, reduced employment, more frequent divorce, increased family burden, reduced social-recreational activity, increased sexual problems, reduced life satisfaction and poorer health-related quality of life.”

Whether depression is triggered by the inability of the brain to cope with emotional signals or environmental changes which occur as a result of decreased functioning or whether it involves an actual chemical change in the brain, depression is a serious issue which needs to be addressed.

Individuals who were exceptionally high functioning before an injury occurred are often at a higher risk for depression because of their inability to achieve pre-injury functioning. A lack of ability to stay on task due to lower frustration levels, inability to multitask and diminished stamina can all contribute to a feeling of worthlessness when measuring themselves against their former selves. This process becomes a cycle between frustration and anger which can isolate the individual from previous social interactions.

It is accepted by the medical community that a feeling of being a burden on others and not being of value in the world can lead to suicidal ideation. When a formerly high functioning individual is placed in a situation which makes them dependent on a caregiver and removes them from pre-injury productivity, it can become a severe blow to self worth, which can lead to depression.

Depression is a highly treatable condition which requires admission that depression is present. This may or may not be possible if the brain injured person has no self awareness about their own emotional functioning. It is important that family members and caregivers understand the signs and symptoms and what they can do to help.

A brain injured person is more likely to self-medicate with alcohol and drugs in an attempt to cope with the changes which have occurred. Because they have a compromised system, they are more vulnerable to the use of substances which can escalate the problem. These issues may need to be addressed as well with a knowledgeable professional experienced in treating brain-injured individuals.

There is an excellent brochure available from the Brain Injury Association entitled “Coping with Depression after Traumatic Brain Injury” which describes the factors which may lead to depression and what the survivor and family can do to manage depression.

Gordon Johnson
g@gordonjohnson.com
www.tbilaw.com
www.subtlebraininjury.com

US Marine charged with assaulting Sydney woman

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Posted on 13th October 2008 by Gordon Johnson in Uncategorized

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Date: 10/13/2008 9:50 PM

SYDNEY, Australia (AP) _ A U.S. Marine has been charged with assaulting a prostitute while on shore leave in Sydney last weekend, police and the U.S. Embassy said Tuesday.

The 25-year-old man, who was not identified, was charged late Monday with assault involving “bodily harm” following an incident at a Sydney brothel on Sunday, police said in a statement.

He was released on bail.

The U.S. Embassy in Canberra said the U.S. Navy was cooperating with the investigation and confirmed that the man, who shipped out Tuesday, will return to Australia to face the charges in court on Nov. 10.

The Marine was one of 3,000 Marines and Navy personnel on shore leave in Sydney after the amphibious assault ship USS Peleliu and guided missile destroyer USS Halsey arrived in the port on Friday. The ships departed Tuesday.

Another Marine is being treated at a Sydney hospital for a fractured skull and other head injuries after being assaulted on Saturday night. The 23-year-old is in stable but serious condition, police say. His identity also was not given.

Copyright 2008 The Associated Press.

Brain Injury Association of America Policy Corner E-Newsletter – October 3, 2008

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Posted on 5th October 2008 by Gordon Johnson in Uncategorized

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A weekly update on federal policy activity related to traumatic brain injury
__________________________________________________________________

Dear Advocates:

In late breaking news from the United States Capitol, Congress has just approved a $700 billion financial bailout package, which also includes landmark mental health parity legislation (H.R. 1424/S. 558) and dozens of expiring tax breaks for businesses and individuals.

This legislation was sent in an expedited fashion this afternoon to President Bush who signed the measure into law hours after its passage.

As the previous edition of Policy Corner noted, several important legislative developments occurred last week, and this week’s edition of Policy Corner includes additional details about these developments as they pertain to brain injury policy.

It remains unclear whether Congress will return for a lame duck session in November after the elections, although at least a short session appears likely for the Senate the week of November 17. BIAA will provide an update on the remainder of this year’s congressional schedule as soon as this information available.

*Distributed by Laura Schiebelhut, BIAA Director of Government Affairs, on behalf of the Brain Injury Association of America; 703-761-0750 ext. 637; lschiebelhut@biausa.org

BIAA’s Policy Corner and Legislative Action Alerts are made possible by the Centre for Neuro Skills, James F. Humphreys & Associates, and Lakeview Healthcare Systems, Inc. The Brain Injury Association of America gratefully acknowledges their support for legislative action.

To sign up to receive future BIAA Policy Corner E-Newsletters and Legislative Action Alerts, please go to http://capwiz.com/bia/mlm/signup/
__________________________________________________________________

Congress Passes Financial Bailout Legislation, Mental Health Parity

In late breaking news from the United States Capitol, Congress has just approved a $700 billion financial bailout package, which also includes landmark mental health parity legislation (H.R. 1424/S. 558) and dozens of expiring tax breaks for businesses and individuals.

This marks a tremendous victory for mental health advocates and others who have supported efforts to enact a parity bill for years. This legislation will require private health insurers to offer mental health and addiction benefits equal in cost and scope to traditional medical benefits.

Earlier this year, BIAA strongly endorsed the House version of this legislation. In a letter officially endorsing the bill in March, BIAA noted, “An intricate and intertwined relationship exists between substance abuse, mental health, and traumatic brain injury (TBI). Substance use and abuse is often both an antecedent to and a consequence of TBI.”

Upon its passage this afternoon, one of the bill’s sponsors and leading champions, Congressman Patrick J. Kennedy (D-RI), stated:

“This legislation is one more step in the long civil rights struggle to ensure that all Americans have the opportunity to reach their potential. For far too long, health insurance companies have used the stigma of mental illness and substance abuse as an excuse to deny coverage for those biological disorders. That ends today when this critical legislation outlaws the discrimination that is embedded in our laws and our policies.”

Other bill sponsors and leading supporters include Rep. Jim Ramstad (R-MN) in the House of Representatives, as well as Sen. Pete Domenici (R-NM) and Sen. Edward Kennedy (D-MA) in the Senate. Late Senator Paul Wellstone (D-Minn.) was also a leading champion of this legislation.

Appropriations Update

Last week, the House passed an omnibus continuing appropriations bill to fund most government programs – including TBI and trauma-related programs – at Fiscal 2008 (last year’s) levels until March 6, 2009.

Over the weekend, the Senate also passed this omnibus legislative package and forwarded it to President Bush, who signed it into law just hours before the beginning of the new fiscal year on October 1.

This massive year-end spending package includes a Continuing Resolution (CR) which funds programs covered by nine unfinished appropriations bills (including the Fiscal 2009 Labor-HHS-Education Appropriations bill, which contains funding for key federal TBI programs) at Fiscal 2008 levels until enactment of the bills or March 6, 2009 – whichever comes first. This essentially leaves final funding decisions on domestic programs to the next Congress and president.

Within this CR, all civilian health programs, including TBI and trauma-related programs, are funded at Fiscal 2008 levels. These Fiscal 2008 levels, and thus continuing funding levels through the beginning of next year, are as follows:

CDC TBI Programs (HHS): $5.709 million

HRSA TBI Programs (HHS) (HRSA TBI State Grant Program and Protection and Advocacy Systems): $8.754 million

TBI Model Systems of Care (NIDRR/Department of Education): $8.155 million

In addition to the CR to provide continuing appropriations for most federal programs, the omnibus bill also includes three Fiscal 2009 appropriations bills in their entirety. These three appropriations bills are those that fund Defense, Homeland Security and Military Construction-VA for all of FY 2009.

The Defense appropriations measure included in this legislative package contains $300 million in funding for Traumatic Brain Injury and Psychological Health initiatives within the Department of Defense.

The Military Construction-VA appropriations measure includes $41 billion in funding for the Veterans Health Administration (veterans medical care), representing $1.8 billion above the President’s budget request earlier this year and $4.1 billion above 2008 levels. This funding bill also provides $510 million in funding for Medical and Prosthetic Research, including cutting edge research into areas such as Post Traumatic Stress Disorder (PTSD), Traumatic Brain Injury, suicide prevention, and polytrauma. This funding level for research represents $30 million above 2008 levels, and rejects a $38 million cut proposed by President Bush.

The Military Construction-VA appropriations bill contained in this omnibus legislative package also included important report language (strongly supported by BIAA) urging the Department of Veterans Affairs to increase returning servicemembers’ access to TBI care and expertise in the civilian sector. Specifically, the Explanatory Statement accompanying this bill states:

“The Appropriations Committees strongly urge the Department to establish and expand cooperative agreements with public and private entities with neurobehavioral rehabilitation and recovery experience in the treatment of Traumatic Brain Injury (TBI) as recommended in section 1703 of Public Law 110-181” [FY 2008 National Defense Authorization Act].”

In addition, the bill provides $200 million for fee-based services intended to allow the VA to tap expertise in the public and private sector for health care that may not be readily available within VA medical centers.

Congress Authorizes VA Epilepsy Centers of Excellence

Last week, the House passed an omnibus veterans health care package (S. 2612), including key provisions of The Epilepsy Centers of Excellence Act (H.R. 2818/S. 2004), which BIAA has strongly endorsed.

Over the weekend, the Senate also passed this legislation and it is expected to be signed into law by the President imminently.

The legislation, championed by the American Academy of Neurology and endorsed by BIAA, anticipates an expected increase in the number of TBI-related epilepsy cases among veterans returning from service in Iraq and Afghanistan. The bill will create up to six Epilepsy Centers of Excellence (ECoE) at the Depart ment of Veterans’ Affairs (VA), and is aimed at restoring the VA as a national leader in epilepsy care and research.

The bill was sponsored by Rep. Ed Perlmutter (D-CO) in the House of Representatives and Sen. Patty Murray (D-WA) in the Senate.

Congress Clears FY 2009 Defense Authorization Bill For President’s Signature

Within the past few days, Congress also passed the FY 2009 defense authorization bill (S. 3001). This legislation contains a “Sense of Congress on TBI Research.” Specifically, the bill states in Sec. 725:

“It is the sense of Congress that the requirement under section 1621(c)(7) of the National Defense Authorization Act for Fiscal Year 2008 (Public Law 110–181; 122 Stat. 453; 10 U.S.C. 1071note) to conduct basic science and translational research on traumatic brain injury includes pilot programs designed to test the efficacy of clinical approaches, including the use of pharmacological agents. Congress urges continued studies of the efficacy of pharmacological agents for treatment of traumatic brain injury and supports continued joint research with the National Institutes of Health in this area.”

BIAA Signs on To Coalition Letter Opposing Proposed Medicaid Outpatient Regulation

BIAA recently signed on to a coalition letter urging Congress to enact a moratorium on a regulation proposed by the Centers for Medicare and Medicaid Services (CMS) to restrict Medicaid reimbursement for outpatient services. This regulation is termed the “Medicaid Outpatient Clinic and Hospital Services Rule,” and it would reduce federal Medicaid funding to states for freestanding health clinics and hospital outpatient departments.

This regulation, published on September 28, 2007 – and expected to be finalized in November of this year – would cut Medicaid reimbursement to many types of outpatient services, including services utilized by individuals with brain injury. [72 Federal Regulation 55158 to 55166 (to be codified at 42 C.F.R. 440, 447 and sometimes referred to as CMS 2213-P).]

To prevent finalization of this rule, BIAA has joined the Consortium for Citizens with Disabilities in urging Congress to enact a moratorium delaying implementation of this harmful regulation through April 2009.
In a heartening development, this week Members of Congress introduced legislation aimed at enacting such a moratorium.

Yesterday, Sen. Charles Schumer (D-NY) and Sen. Hillary Rodham Clinton (D-NY) introduced the “Preserving Access to Healthcare” (PATH) Act of 2008, which would, among other provisions, delay the proposed Medicaid outpatient regulation by six months.

In addition, earlier this week, Rep. John McHugh (R-NY) introduced H.R. 7219, the Protecting Hospital Outpatient and Community Clinic Services Act of 2008, which would provide a moratorium on the regulation.

BIAA strongly supports these legislative efforts.

BIAA Representatives Attend Trauma Spectrum Disorders Conference

Multiple BIAA representatives attended this week a scientific conference titled, “Trauma Spectrum Disorders: The Role of Gender, Race & Other Socioeconomic Factors.”

This conference – jointly sponsored by the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury, the Department of Veterans Affairs, and the National Institutes of Health – focused on identifying and sharing knowledge and lessons learned about gender and race as they relate to psychological health and traumatic brain injury.

Presentations made at this conference are expected to soon be made publicly available on the Defense Center of Excellence’s website: http://www.dcoe.health.mil/.

Police say officer feared insulin pump was weapon

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Posted on 23rd September 2008 by Gordon Johnson in Uncategorized

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Date: 9/22/2008 9:24 PM

DETROIT (AP) _ Police officers in two Detroit suburbs are accused of beating a motorist who was suffering a diabetic episode on a freeway.

Lawyer Arnold Reed says 59-year-old Ernest Griglen had brain surgery after the June 15 encounter with police and has been clinging to life with help from a ventilator.

Reed filed a lawsuit Monday in federal court seeking at least $20 million from Allen Park and Dearborn police. He says officers mistakenly believed Griglen was resisting arrest when he was having a major medical problem.

An Allen Park police report says Griglen’s car was swerving.

Allen Park police wouldn’t comment on the lawsuit. Dearborn police released a report saying an officer feared Griglen’s insulin pump was a weapon.

Copyright 2008 The Associated Press.

Shopping and Choice – One of Brain Injured Person’s Biggest Challenge

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Posted on 13th August 2008 by Gordon Johnson in Uncategorized

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The below AP story approaches the issue of shopping from a completely different angle, but it does highlight one of the most pervasive frontal lobe deficits that brain injured people have: the difficulty in making decisions. Almost anyone who works with brain injury survivors can tell anecdotes of the horror of the super market aisle for those with brain damage.

If given a forced choice, like on most neuropsychological exams, brain injured people can do surprisingly well. But makes those choices open-ended, or as in the story below about beverages, provide an “explosion of choices” and the brain injured person will virtually shut down. Sometimes the act is to buy nothing. Other times it is to try to buy everything.

The point in the below story that really stood out for me was the point it makes that the more choices offered, the fewer beverages are purchased. Based upon that piece of information, it may be that we all have a vulnerability to being overwhelmed by too many choices, but in the brain injured, that vulnerability becomes a disability of decision making. That disability is not just about soda pop, but about almost every choice that a person has to deal with on a daily basis. Ultimately, that disability can virtually stall a human life.


Attorney Gordon Johnson

http://subtlebraininjury.com
http://tbilaw.com
https://waiting.com
http://fishtail.tv
http://vestibulardisorder.com
http://youtube.com/profile?user=braininjuryattorney
g@gordonjohnson.com
800-992-9447
©Attorney Gordon S. Johnson, Jr. 2008


Date: 8/11/2008 2:18 PM

BC-Measure of a Nation-Distracted Republic/2190
Eds: Also moved in advance. Multimedia: This story and all past installments of the Measure of a Nation series – which includes stories, videos and animations _ are packaged in an interactive in the _national/measure_nation folder. AP Video.
Distraction 2008: Freedom of choice _ or from it?
By TED ANTHONY

EDITOR’S NOTE — This latest chapter of “The Measure of a Nation,” a yearlong series of multimedia story packages about the presidency and the 2008 election as seen through the prism of the culture, assesses the absurd amount of choices the average American has today — and how a leader might cut through the clutter and capture the nation’s attention.
By TED ANTHONY
AP National Writer

LOS ANGELES (AP) — On blistering days in Los Angeles, drive northeast on the 110, exit at Highland Park and pull into a roadside grocery called Galco’s. Then walk in and say, “I’m thirsty. Can you point me to the soda-pop aisle?”

This question may get you laughed out of the place. Because at Galco’s, the soda pop is in most every aisle. The place is a soft-drink nirvana containing 500 varieties of fizzy beverage from all corners of the planet.

Root beer? They’ve got three dozen kinds. Perhaps your palate craves a bottle of Cheerwine or a cold Inca Cola. Choose between soda sweetened with high-fructose corn syrup or cane sugar, flavored artificially or naturally, colored pink or red or green or blue or purple. And that doesn’t include the 475 varieties of beer and the 60 kinds of bottled water.

The choice is yours, if you can handle it. The store, now known as Galco’s Soda Pop Stop, is an exuberant explosion of the vaunted notion of freedom of choice, one of the ideals that supposedly makes America what it is.

It is wonderful. It is also intimidating. And in an election year, it’s something the next president needs to understand.

The two-century focus on what America’s founding fathers called “the pursuit of happiness” — coupled with the Industrial Revolution in the 19th century and the rise of consumerism in the 20th — has birthed a landscape of options as dizzying as it is liberating. Bed and Bath, it turns out, aren’t nearly enough. These days, we’re much more concerned with Beyond.

A mere generation after the three broadcast networks ruled, a Comcast digital cable package hands you up to 250 channels of programming. Today’s average supermarket sells more than 45,000 items, the average Wal-Mart Supercenter more than four times that. On a single afternoon this month, eBay had 14.9 million auctions going, and Amazon was offering listings for 22.7 million books. By the end of last year, the Web had more than 108 million distinct pages to visit from the comfort of your lap.

John Nese, who built Galco’s into a promised land of sugary beverages, has thought a lot about choice in America. He offers two assessments.

The first: “People want choices. People want the opportunity to make their own decisions.”

The second: “They come in and they look and they go, ‘We’re overwhelmed. We don’t know what to buy.'”

The notion transcends simple consumerism. It also is the dilemma facing whoever wins November’s election. With options beyond our great-grandparents’ dreams, is freedom of unlimited choice really a freedom at all?

In a universe of unprecedented static, how can an American leader lead?

___

DRIVEN TO DISTRACTION

Mermaid Treasure looks just like Blue Jewel. Waterscape and Cool Dusk could be identical twins. And try distinguishing Seven Seas and Southern Evening from 10 paces away.

At the Home Depot in Gibsonia, Pa., no less than 372 shades of blue paint are available, not counting the many blue-greens and blue-purples also offered in a section of swatches nearly as long as the distance from the pitcher’s mound to home plate.

This cross-section of American choice illuminates the multiple levels of decision-making required to negotiate today’s consumer landscape, in this case before the painting even begins:

—Which store? There are four paint dealers within a mile of the Gibsonia Home Depot and at least 13 more within a 10-mile radius.

—Which brand? There are at least five to choose from.

—Which consistency? Pick from matte, eggshell, satin, semi-gloss and gloss.

—Which color group? Basic colors like blue, red and green are mere gateways to the real color choice.

—Which shade? Time to negotiate the hundreds of names that sound like either ice-cream flavors (Lavender Ice, Cloudberry) or small coastal communities (Little Pond, Wickford Bay).

That’s more than a million ways to paint a door. And as powerful as the human brain is, its bandwidth is ultimately limited. By focusing on smaller choices, by continuously sifting through the categories and subcategories of things like color preference and Google results and spam, could it be that our multiple options are controlling rather than liberating us?

“Since Reagan, the ideology in the United States has been that choice is good and more choice is better. And to the extent that you can give people more choice in every area of life, you are improving their well-being,” says Barry Schwartz, author of “The Paradox of Choice: Why More Is Less.”

But “nobody has the time or the expertise to make informed choices about everything,” Schwartz says. “When options are presented, people have a tough time just ignoring them.”

In 2000, according to the American Psychological Association, a study found that shoppers given the choice of picking a jam from smaller and larger assortments preferred choosing from the bigger assortment. Yet they were more likely to actually buy some jam if they had fewer options. Excessive choice, in effect, short-circuited them from engaging more deeply.

Now take that notion into the public realm. If too many choices drive us to distraction, how do es that affect how we perceive government?

“It’s wonderful that we can sit down in our living room and order 20,000 things. In a superficial way, we are more informed than people used to be. But it’s hard to get our attention, and I don’t see any way of turning that around,” says Edward C. Rosenthal, author of “The Era of Choice: The Ability to Choose and Its Transformation of Contemporary Life.”

His assessment is bleak. By 1900, people’s faith in established institutions like church and government began a slow wane, and Americans struggled to find their bearings. Thus did consumer choice gradually become fetish. Today, anyone who questions unfettered choice risks being accused of condescension and, worse, ignorance of market forces.

This is the landscape an American leader faces. The option becomes, “Follow me — unless you have something more interesting going on.”

And accurately or not, today’s citizens often think that they do.

___

LEADING THROUGH STATIC

“The only way we’re going to solve our problems in this country is if all of us come together,” Barack Obama said this month. Weeks earlier, John McCain said that “we are fellow Americans, and that shared distinction means more to me than any other association.”

Unity is big in 2008. It means more voters. But can we come together? These days, beyond 9/11 or Katrina or rising gas prices, what exactly is that “shared distinction” we like to think unites us?

To inspire voters, campaigns use strategies such as microtargeting — mining data and finding voters’ preferences, then customizing the message for each. But when candidate becomes president and prospective voter becomes mere citizen, those intricate techniques melt away.

What’s a leader to do? Christine Riordan, a leadership expert at the University of Denver, prescribes simplicity.

Just as paying attention to a leader is a consumer choice, Riordan says the leader can benefit from deploying marketing principles as well: An uncluttered message rings clearer, particularly when it’s accompanied by tight focus on content, packaging and image.

Debating whether there’s too much information out there, Riordan says, is beside the point.

“There’s no way we’re going back to the times of Zachary Taylor,” she says. “”It’s not, ‘Is too much information bad?’ It’s how do you manage within an environment that does provide all information and will continue to provide all information?”

Today, candidates and leaders must tailor core messages for the 75-year-old newspaper reader and the 19-year-old who communicates using blogs and Facebook. What’s more, to have any chance of cutting through the clutter, the leader has to seem sincere and authentic to both demographics, not to mention all the Gen-Xers and Boomers in between. He or she has to be all the flavors of root beer at once.

Consider House Speaker Nancy Pelosi. Like many politicians before her, she went on “The Daily Show” last month to match wits with Jon Stewart, be made fun of and maybe make a point to a coveted audience of hyper-aware, media-savvy Americans. She didn’t tank, but she appeared painfully overeager.

To neutralize the static, she needed the kind of banter that Stewart and NBC anchorman Brian Williams had a couple of nights later. It was amiably contentious and brimming with pop-culture cues. It was also just plain fun, a key element in capturing the “Daily Show” demographic’s attention.

“With more choices out there, if leaders want to bring issues to the attention of the public, they have to bring it into our venues and speak it on our terms,” says Adam Schiffer, a political scientist at Texas Christian University who studies voter behavior and the media’s role in politics.

“Institutions are breaking down and there are going to be new ways of doing things. But the cream can still rise. The signal can still make it through the noise in this new environment,” he says. “You don’t need 90 percent of the public informed on the issue and following it closely to get your policy passed.”

Exhibit A is Al Gore, who has been practically pleading Americans to pay attention to the environment for nearly a generation. He finally succeeded.

What helped him punch through the static? He made a movie.

___

SAME DIFFERENCE?

Across the continent from Galco’s and the dizzying choices of Los Angeles, another town struggles with its choices. But the options are different.

In this community, people are choosing their kitchenware, not from Pottery Barn or Crate & Barrel but silver or pewter. They’re choosing new clothes, not from Wal-Mart or Nordstrom but from the 40 or so fabrics at the local millinery. They’re choosing transportation, not Jeep or Toyota but feet or horse.

And they’re choosing sides: loyalist or rebel, status quo or treason.

Colonial Williamsburg is a city deliberately frozen in time, on the cusp of the American Revolution, when it was Virginia’s capital. Walking its 18th-century streets, seeing actor-interpreters bring revolutionary-era Virginians back to life, you could believe that the choices here were far fewer.

Yet for its era, Williamsburg was a cosmopolitan town, bustling with a merchant class and a spread of consumer goods that presaged modern America.

It also was crackling with revolutionary activity. Its citizens wrestled with their responsibilities and seizing their future. They confronted a lot of static and still managed to participate in the birthing of American democracy.

“Not everybody was running around yelling, ‘Yeah, yeah, liberty, death,'” says Dennis Watson, a Scottish-born American who portrays Williamsburg printer and newspaperman Alexander Purdie. “But,” he says, “this time they truly came together.”

There are lessons for us, and for our leaders, in the people of Colonial Williamsburg.

They, too, had choices far more abundant than their predecessors. They, too, struggled to manage their bandwidth and avoid letting distractions prevail. They may not have had XBoxes, but they had more options than most anyone outside of Boston or Philadelphia.

We are products of our age, too. If we can process 21st-century distractions and negotiate our lives, and most of us do, can’t we be active in our democracy, too? The ability to Twitter and to TiVo does not by itself preclude civic participation. Everyone has, well, a choice.

“This country is an experiment. And for it to have endured for this long, it requires the involvement of citizens — citizens making choices,” says Jim Bradley, who manages public affairs for Colonial Williamsburg.

It is tempting to imagine Williamsburg as a distillation of democracy, a representation of a time when leaders could be heard and citizens could be listened to, when a man could stand before a crowd, say “Give me liberty or give me death” and have it echo across the land.

That’s what Sherrie Bender of Houston, visiting Colonial Williamsburg on a recent day, means when she wonders, “Where are those conversations we had like Patrick Henry on the steps?”

They’re gone. In their place is something new and unprecedented but of the people nonetheless. To figure it out, we and our leaders are going to need a serious road map. More likely, we’ll just MapQuest it and go from there — if, that is, we don’t get distracted by everything we encounter along the way.

Copyright 2008 The Associated Press.
Summary
Date: 8/11/2008 2:18 PM
Slug: BC-Measure of a Nation-Distracted Republic
Headline: Distraction 2008: Freedom of choice _ or from it?
Byline: By TED ANTHONY
Byline Title:
Copyright Holder: AP
Priority: r (4)
With Photo:
Dateline:
Editors’ Note: Eds: Also moved in advance. Multimedia: This story and all past installments of the Measure of a Nation series – which includes stories, videos and animations _ are packaged in an interactive in the _national/measure_nation folder. AP Video.
Word Count: 2190
File Name (Transref): L0619
Editorial Type:
AP Category: a
Format: bx





Edit Mode : Cancel


EDITOR’S NOTE — This latest chapter of “The Measure of a Nation,” a yearlong series of multimedia story packages about the presidency and the 2008 election as seen through the prism of the culture, assesses the absurd amount of choices the average American has today — and how a leader might cut through the clutter and capture the nation’s attention.By TED ANTHONYAP National Writer LOS ANGELES (AP) — On blistering days in Los Angeles, drive northeast on the 110, exit at Highland Park and pull into a roadside grocery called Galco’s. Then walk in and say, “I’m thirsty. Can you point me to the soda-pop aisle?” This question may get you laughed out of the place. Because at Galco’s, the soda pop is in most every aisle. The place is a soft-drink nirvana containing 500 varieties of fizzy beverage from all corners of the planet. Root beer? They’ve got three dozen kinds. Perhaps your palate craves a bottle of Cheerwine or a cold Inca Cola. Choose between soda sweetened with high-fructose corn syrup or cane sugar, flavored artificially or naturally, colored pink or red or green or blue or purple. And that doesn’t include the 475 varieties of beer and the 60 kinds of bottled water. The choice is yours, if you can handle it. The store, now known as Galco’s Soda Pop Stop, is an exuberant explosion of the vaunted notion of freedom of choice, one of the ideals that supposedly makes America what it is. It is wonderful. It is also intimidating. And in an election year, it’s something the next president needs to understand. The two-century focus on what America’s founding fathers called “the pursuit of happiness” — coupled with the Industrial Revolution in the 19th century and the rise of consumerism in the 20th — has birthed a landscape of options as dizzying as it is liberating. Bed and Bath, it turns out, aren’t nearly enough. These days, we’re much more concerned with Beyond. A mere generation after the three broadcast networks ruled, a Comcast digital cable package hands you up to 250 channels of programming. Today’s average supermarket sells more than 45,000 items, the average Wal-Mart Supercenter more than four times that. On a single afternoon this month, eBay had 14.9 million auctions going, and Amazon was offering listings for 22.7 million books. By the end of last year, the Web had more than 108 million distinct pages to visit from the comfort of your lap. John Nese, who built Galco’s into a promised land of sugary beverages, has thought a lot about choice in America. He offers two assessments. The first: “People want choices. People want the opportunity to make their own decisions.” The second: “They come in and they look and they go, ‘We’re overwhelmed. We don’t know what to buy.'” The notion transcends simple consumerism. It also is the dilemma facing whoever wins November’s election. With options beyond our great-grandparents’ dreams, is freedom of unlimited choice really a freedom at all? In a universe of unprecedented static, how can an American leader lead? ___ DRIVEN TO DISTRACTION Mermaid Treasure looks just like Blue Jewel. Waterscape and Cool Dusk could be identical twins. And try distinguishing Seven Seas and Southern Evening from 10 paces away. At the Home Depot in Gibsonia, Pa., no less than 372 shades of blue paint are available, not counting the many blue-greens and blue-purples also offered in a section of swatches nearly as long as the distance from the pitcher’s mound to home plate. This cross-section of American choice illuminates the multiple levels of decision-making required to negotiate today’s consumer landscape, in this case before the painting even begins: —Which store? There are four paint dealers within a mile of the Gibsonia Home Depot and at least 13 more within a 10-mile radius. —Which brand? There are at least five to choose from. —Which consistency? Pick from matte, eggshell, satin, semi-gloss and gloss. —Which color group? Basic colors like blue, red and green are mere gateways to the real color choice. —Which shade? Time to negotiate the hundreds of names that sound like either ice-cream flavors (Lavender Ice, Cloudberry) or small coastal communities (Little Pond, Wickford Bay). That’s more than a million ways to paint a door. And as powerful as the human brain is, its bandwidth is ultimately limited. By focusing on smaller choices, by continuously sifting through the categories and subcategories of things like color preference and Google results and spam, could it be that our multiple options are controlling rather than liberating us? “Since Reagan, the ideology in the United States has been that choice is good and more choice is better. And to the extent that you can give people more choice in every area of life, you are improving their well-being,” says Barry Schwartz, author of “The Paradox of Choice: Why More Is Less.” But “nobody has the time or the expertise to make informed choices about everything,” Schwartz says. “When options are presented, people have a tough time just ignoring them.” In 2000, according to the American Psychological Association, a study found that shoppers given the choice of picking a jam from smaller and larger assortments preferred choosing from the bigger assortment. Yet they were more likely to actually buy some jam if they had fewer options. Excessive choice, in effect, short-circuited them from engaging more deeply. Now take that notion into the public realm. If too many choices drive us to distraction, how does that affect how we perceive government? “It’s wonderful that we can sit down in our living room and order 20,000 things. In a superficial way, we are more informed than people used to be. But it’s hard to get our attention, and I don’t see any way of turning that around,” says Edward C. Rosenthal, author of “The Era of Choice: The Ability to Choose and Its Transformation of Contemporary Life.” His assessment is bleak. By 1900, people’s faith in established institutions like church and government began a slow wane, and Americans struggled to find their bearings. Thus did consumer choice gradually become fetish. Today, anyone who questions unfettered choice risks being accused of condescension and, worse, ignorance of market forces. This is the landscape an American leader faces. The option becomes, “Follow me — unless you have something more interesting going on.” And accurately or not, today’s citizens often think that they do. ___ LEADING THROUGH STATIC “The only way we’re going to solve our problems in this country is if all of us come together,” Barack Obama said this month. Weeks earlier, John McCain said that “we are fellow Americans, and that shared distinction means more to me than any other association.” Unity is big in 2008. It means more voters. But can we come together? These days, beyond 9/11 or Katrina or rising gas prices, what exactly is that “shared distinction” we like to think unites us? To inspire voters, campaigns use strategies such as microtargeting — mining data and finding voters’ preferences, then customizing the message for each. But when candidate becomes president and prospective voter becomes mere citizen, those intricate techniques melt away. What’s a leader to do? Christine Riordan, a leadership expert at the University of Denver, prescribes simplicity. Just as paying attention to a leader is a consumer choice, Riordan says the leader can benefit from deploying marketing principles as well: An uncluttered message rings clearer, particularly when it’s accompanied by tight focus on content, packaging and image. Debating whether there’s too much information out there, Riordan says, is beside the point. “There’s no way we’re going back to the times of Zachary Taylor,” she says. “”It’s not, ‘Is too much information bad?’ It’s how do you manage within an environment that does provide all information and will continue to provide all informati on?” Today, candidates and leaders must tailor core messages for the 75-year-old newspaper reader and the 19-year-old who communicates using blogs and Facebook. What’s more, to have any chance of cutting through the clutter, the leader has to seem sincere and authentic to both demographics, not to mention all the Gen-Xers and Boomers in between. He or she has to be all the flavors of root beer at once. Consider House Speaker Nancy Pelosi. Like many politicians before her, she went on “The Daily Show” last month to match wits with Jon Stewart, be made fun of and maybe make a point to a coveted audience of hyper-aware, media-savvy Americans. She didn’t tank, but she appeared painfully overeager. To neutralize the static, she needed the kind of banter that Stewart and NBC anchorman Brian Williams had a couple of nights later. It was amiably contentious and brimming with pop-culture cues. It was also just plain fun, a key element in capturing the “Daily Show” demographic’s attention. “With more choices out there, if leaders want to bring issues to the attention of the public, they have to bring it into our venues and speak it on our terms,” says Adam Schiffer, a political scientist at Texas Christian University who studies voter behavior and the media’s role in politics. “Institutions are breaking down and there are going to be new ways of doing things. But the cream can still rise. The signal can still make it through the noise in this new environment,” he says. “You don’t need 90 percent of the public informed on the issue and following it closely to get your policy passed.” Exhibit A is Al Gore, who has been practically pleading Americans to pay attention to the environment for nearly a generation. He finally succeeded. What helped him punch through the static? He made a movie. ___ SAME DIFFERENCE? Across the continent from Galco’s and the dizzying choices of Los Angeles, another town struggles with its choices. But the options are different. In this community, people are choosing their kitchenware, not from Pottery Barn or Crate & Barrel but silver or pewter. They’re choosing new clothes, not from Wal-Mart or Nordstrom but from the 40 or so fabrics at the local millinery. They’re choosing transportation, not Jeep or Toyota but feet or horse. And they’re choosing sides: loyalist or rebel, status quo or treason. Colonial Williamsburg is a city deliberately frozen in time, on the cusp of the American Revolution, when it was Virginia’s capital. Walking its 18th-century streets, seeing actor-interpreters bring revolutionary-era Virginians back to life, you could believe that the choices here were far fewer. Yet for its era, Williamsburg was a cosmopolitan town, bustling with a merchant class and a spread of consumer goods that presaged modern America. It also was crackling with revolutionary activity. Its citizens wrestled with their responsibilities and seizing their future. They confronted a lot of static and still managed to participate in the birthing of American democracy. “Not everybody was running around yelling, ‘Yeah, yeah, liberty, death,'” says Dennis Watson, a Scottish-born American who portrays Williamsburg printer and newspaperman Alexander Purdie. “But,” he says, “this time they truly came together.” There are lessons for us, and for our leaders, in the people of Colonial Williamsburg. They, too, had choices far more abundant than their predecessors. They, too, struggled to manage their bandwidth and avoid letting distractions prevail. They may not have had XBoxes, but they had more options than most anyone outside of Boston or Philadelphia. We are products of our age, too. If we can process 21st-century distractions and negotiate our lives, and most of us do, can’t we be active in our democracy, too? The ability to Twitter and to TiVo does not by itself preclude civic participation. Everyone has, well, a choice. “This country is an experiment. And for it to have endured for this long, it requires the involvement of citizens — citizens making choices,” says Jim Bradley, who manages public affairs for Colonial Williamsburg. It is tempting to imagine Williamsburg as a distillation of democracy, a representation of a time when leaders could be heard and citizens could be listened to, when a man could stand before a crowd, say “Give me liberty or give me death” and have it echo across the land. That’s what Sherrie Bender of Houston, visiting Colonial Williamsburg on a recent day, means when she wonders, “Where are those conversations we had like Patrick Henry on the steps?” They’re gone. In their place is something new and unprecedented but of the people nonetheless. To figure it out, we and our leaders are going to need a serious road map. More likely, we’ll just MapQuest it and go from there — if, that is, we don’t get distracted by everything we encounter along the way.

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Looking Up …

Fatal shooting by police sparks Montreal riot

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Posted on 11th August 2008 by Gordon Johnson in Uncategorized

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In a bizarre postscript to last Saturday’s story about the racial riots of the past, one of the world’s most peaceful countries had an outbreak of urban rioting this weekend. (See the below story on the Montreal rioting) Gun violence has always been remarkably lower in Canada, largely because of much tighter gun restrictions. But conflict between urban police and poor people has always been a trigger, regardless of where it happens.

One of the lost areas of brain injury advocacy is in police brutality cases. As primarily an accident lawyer, I have only consulted on these cases, but those innocent victims of police brutality often suffer the same type of permanent brain damage as my accident clients.

We hope that Montreal returns to the serenity of which we think of it, and the Canadian authorities can be trusted to find the truth of what really happened.

Attorney Gordon Johnson
http://subtlebraininjury.com
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©Attorney Gordon S. Johnson, Jr. 2008


Date: 8/11/2008 11:28 AM

MONTREAL (AP) _ Rioting broke out late Sunday in a Montreal neighborhood where a young man was shot to death by police over the weekend. A police officer was shot in the leg, stores were looted and firefighters were pelted with beer bottles.

Several hundred officers in riot gear fanned out in search of a group of youths who ran off after torching eight cars parked outside a fire station in Montreal North, a multiethnic neighborhood with simmering tensions between residents and police. Fire trucks responding to the call in Montreal North were pelted with beer bottles, while at least three bus shelters were trashed.

The violence erupted following a peaceful community protest against the shooting by police on Saturday of three people, including an 18-year-old man, identified by his sister as Freddy Alberto Villanueva, who died of his wounds.

On Sunday, men and women of all ages crawled through the smashed windows of a pawn shop, a convenience store and a butcher shop, grabbing anything they could. They could be seen running down the street clutching TVs, cigarette cartons and slabs of meat.

Meanwhile, along the residential streets, riot-squad officers were forced to dive for cover at least three times, after blasts of what sounded like gunshots went off around them.

“I had a guy shoot a gun next to me, that’s how bad it was,” said Patrick Parent, who lives on the street behind the convenience store. “I ran home. It was terrifying.”

Parent, who has lived in the area for six years, said locals occasionally hear gunshots but that usually the neighborhood is quiet.

“I thought I would see this only on TV, never in real life,” he said.

Montreal police spokesman Ian Lafreniere said one police officer was hospitalized after being shot in the leg.

An ambulance technician was hit in the head by a bottle and a second police officer suffered minor injuries, he said. Both were released from hospital after treatment.

Montreal police Chief Yvan Delorme said the mob vandalized three fire trucks, the local fire station and broke into 20 businesses.

Three people were arrested for breaking and entering, one for drug possession and two others for charges still to be determined, he said.

Quebec provincial police have taken over the investigation into the shootings Saturday that sparked the riots.

City police said the officers were trying to arrest an individual in Henri Bourassa Park around 7 p.m when they were surrounded by a group of about 20 youths.

A few individuals allegedly broke away from the group and rushed the officers.

According to police, one of the officers then opened fire.

The officers were not wounded.

Provincial police spokesman Gregory Gomez del Prado said there were numerous witnesses to the incident, including people playing sports or just sitting in the park nearby, he said.

“It’s too early to say what happened exactly. We’re talking about the death of a man. It’s a major investigation.”

Villanueva’s sister, Julissa, said from nearby Laval that family members want answers.

“We only know what we see in the news, in the newspapers, that’s all,” she said, breaking into tears as she spoke about her brother, a student who wanted to become a mechanic.

Delorme, the Montreal police chief, said authorities would make efforts to mend the shaky relations between police and the community.

“We’re there to listen, to understand what happened (Sunday) night and to avoid these kinds of situations,” Delorme said Monday. “We have to feel safe in Montreal.”

Copyright 2008 The Associated Press.

Medically Unfit Drivers – Part III

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Posted on 7th August 2008 by Gordon Johnson in Uncategorized

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This week we have discussed the flaws that can be found within the CDL licensing system. The primary focus of this series of blogs has been how some individuals who are clearly not qualified to operate a commercial vehicle and who the government found to be fully disabled, are receiving CDL licensing.

The FMCSA (Federal Motor Carrier Safety Administration),which works closely with the DOT, has five main requirements that determines whether an individual is eligible for a CDL license.
The rules are: (1) the driver needs to be at least 21 years old (2) the driver needs to able to read and speak English (3) the driver needs to have a valid commercial motor vehicle operator’s license (4) the driver needed to have completed the driver’s road test and (5) the driver must be physically qualified to drive which needs to be verified by receiving a medical certificate from a medical examiner claiming the driver is physical qualified to drive. See http://semi-accident.com for more information on the FMCSA regulations.

The GAO’s research found that there were many individuals who were driving without a medical certificate, the fifth requirement. Therefore, bureaucratic snafus have resulted in drivers having CDLs without meeting these clear cut requirements. As with the heparin debacle, http://heparin-law.com, it is clear that the U.S. government needs to make technological advancements so that they can assure these straightforward requirements are met before issuing or renewing commercial driver licenses.

The NTSB (The National Transportation Safety Board), which investigates transportation accidents, suggested additional requirements for CDL drivers. In 2006, 12% of commercial accidents were caused by the drivers having a heart attack, fatigue or another physical impairment. The NTSB agency concluded that by adding these eight requirements for a CDL, many more accidents could be prevented.

The NTSB’s Eight Suggestions are:

  • 1. Doctors performing medical examinations for drivers are qualified to do so and are educated about occupational issues for drivers. In other words, it is essential that these examiners know what type of abilities (as opposed to disabilities) a driver must have. For example: ability to stay focused for up to 11 hours at a time, in high stress traffic situations.
  • 2. Every prior application by an individual for medical certification is recorded and reviewed. That the applications and medical certifications, that were received over the previous years for a CDL license, are recorded and reviewed to further evaluate the licensing process.
  • 3. Medical certification regulations are updated periodically to permit trained examiners to clearly determine whether drivers with common medical conditions should be issued a medical certificate. The recommendations call for giving medical examiners the regulations with respect to the abilities needed for commercial driving periodically so they’re certain what conditions disqualify an individual from obtaining a CDL license. For more information view: http://subtlebraininjury.blogspot.com/2008/07/gao-medically-unfit-truckers-part-ii.html
  • 4. Individuals performing examinations have specific guidance and a readily identifiable source of information for questions on such examinations.
  • 5. To structure the review process by the DOT, to prevent, or identify and correct, the inappropriate issuance of medical certification.
  • 6. Provide mechanisms for enforcement authorities to identify invalid medical certification during safety inspections and routine stops.
  • 7. Provide enforcement authorities with the power to prevent an uncertified driver from driving until an appropriate medical examination takes place.
  • 8. Create mechanisms for reporting medical conditions to the medical certification and reviewing authority and to make sure that individuals, health care providers, and employers are aware of these mechanisms.

If the DOT adopts these eight recommendations from the NTSB, this could help eliminate accidents involving CDL license drivers who are not fit to drive.

GAO — Medically Unfit Truckers Part II

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Posted on 30th July 2008 by Gordon Johnson in Uncategorized

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As we have been discussing on this blog for the last few days, the U.S. House of Representatives, Transportation and Infrastructure Committee, held hearings on July 24 on medically unfit truckers. Click here for the hearing information. In this blog, we will discuss some examples of commercial drivers with medical conditions and why these are dangerous.

The GAO found numerous CDL drivers with serious medical conditions. One was a bus driver from Florida that continued to have a CDL and was being hired as a substitute bus driver. This man receives disability benefits for breathing problems that require him to use three daily inhalers and that he claims he, “occasionally blacks outs and forgets things.” This man should not be driving because he could have a breathing problem while on the road and black out. Further, this guy does not have a medical certificate which is required by the DOT to continue to have an active CDL.

Another case was a truck driver from Florida that receives a disability for multiple sclerosis who hauls circus equipment to different shows. Not only does this driver not have the required medical certificate, his medical condition causes fatigue and this can be very dangerous with a driver that travels all over the U.S. The driver could fall asleep and cause a major accident. Without a medical certificate it is impossible to know if the driver has any other conditions that would make him a very dangerous CDL driver to put on the road.

Another disturbing account was a truck driver in Maryland who receives a disability for being 100 percent deaf received a CDL license. The medical examiner claimed that this was an error. This obviously very dangerous for obvious reasons.

Many disabilities can affect an individual’s ability to be a commercial driver. While as advocates for the injured we would have to agree with the DOT that not all disabilities make someone exempt from receiving a CDL license, there are several disabilities, like fatigue, complete deafness and breathing problems that raise serious doubt on whether an individual is fit to have a CDL.

Fatigue is a perfect example. The bulk of trucker related regulations, focus on preventing fatigue. See http://semi-accident.com/fatigue.html To enforce those regulations while allowing someone who has abnormal fatigue to get a CDL, is incongruous. Would not a simple cross referencing of Federal Government data bases eliminate this problem? While Social Security does allow for certain trial returns to work, clearly those returns (if they involve a CDL) should be monitored with the same degree of zeal that the Social Security Administration too often uses to deny deserving people’s benefits.

Each year 5,300 people die and 126,000 people are injured in accidents involving commercial drivers and twelve percent of these accidents are caused by a CDL driver having fatigue, heart attack or a physical impairment. It is important for the DOT to take CDL licensing seriously and consider more thorough evaluations.

In our next blog, we examine the specific requirements to receive a CDL and the NTSB’s recommendations.

Alcohol Toxicity Increases Exponentially with Other Factors

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Posted on 22nd July 2008 by Gordon Johnson in Uncategorized

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In the previous blog, the AP story is about a man arrested with a lethal dose of alcohol concentration in his blood, .491%. Not only did he survive (the highest known level for someone who did) he was driving prior to his arrest.

Intoxicated driving is a particularly relevant topic for a brain injury attorney, as so much of what we do involve motor vehicle wrecks. It has and always will be one of the most serious hazards on the roads. As someone who has dealt with BAC’s over .30 on occasion, this one is staggering. The highest I have run into in my practice is a .40, but that was in a young man who died of alcohol intoxication.

The highest I encountered with a defendant driver was a .32, which quite outrageously was in a pharmacist, who was actually “on call”. He admitted to me in his deposition (shortly before the case settled) that any concentration above .30 is potentially lethal.

Alcohol and driving don’t mix. But the equation isn’t quite that simple. Alcohol, driving and late night driving, are particularly dangerous.

Fatigue is one of the single biggest factors in alcohol related accidents and way too many people, drive the drunkest, when they would otherwise be asleep. In addition to the far too common situation of an intoxicated driver falling asleep, alcohol is particularly dangerous when an unexpected situation presents itself to the driver.

Pure reaction time doesn’t change dramatically at and around the legal limit of .08, but unexpected reaction times change significantly. By unexpected reactions times I mean the type of situation where something unexpected happened that required the driver to think and use instant judgment, as part of the reaction.

What makes the combination of fatigue and alcohol so deadly is that fatigue has very similar effects on situational reaction. Add the two risk factors together and you have an exponential increase in danger.2008

Deadly Tolls: Sick truckers causing fatal wrecks

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Posted on 21st July 2008 by Gordon Johnson in Uncategorized

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Date: 07/21/2008 07:22 AM

By HOPE YEN

WASHINGTON (AP) _ Hundreds of thousands of tractor-trailer and bus drivers in the United States carry commercial driver’s licenses despite also qualifying for full federal disability payments, and some of those drivers have suffered seizures, heart attacks or unconscious spells, according to a new U.S. safety study obtained by The Associated Press.

The problems threatening highway travelers persist despite years of government warnings and hundreds of deaths and injuries blamed on commercial truck and bus drivers who blacked out, collapsed or suffered major health problems behind the wheels of vehicles that can weigh 40 tons or more.

The U.S. agency responsible for cracking down on unfit truckers, the Federal Motor Carrier Safety Administration, acknowledges it hasn’t completed any of eight recommendations that U.S. safety regulators have proposed since 2001. One would set minimum standards for officials who determine whether truckers are medically safe to drive. Another would prevent truckers from “doctor shopping” to find a physician who might overlook a risky health condition. It’s unclear whether any of the eight recommendations will be done before President Bush leaves office.

“We have a major public safety problem, and we haven’t corrected it,” said Gerald Donaldson, senior research director at the Washington-based Advocates for Highway and Auto Safety, whose members include consumer, health and safety groups and insurance companies. “You have an agency that is favorably disposed to maintaining the integrity of the industry’s economic situation.”

Truckers violating federal medical rules have been caught in every state, according to a review by the AP of 7.3 million commercial driver violations compiled by the Transportation Department in 2006, the latest data available. Texas, Maryland, Georgia, Florida, Indiana, Pennsylvania, Illinois, Michigan, Alabama, New Jersey, Minnesota and Ohio were states where drivers were sanctioned most frequently for breaking medical rules, such as failing to carry a valid medical certificate. Those 12 states accounted for half of all such violations in the United States.

Consider these cases:

—A Florida bus driver who suffers from lung disease and uses three daily inhalers to control breathing told congressional investigators that he “occasionally blacks out and forgets things.” He works as a substitute driver despite not having a medical certificate, and his commercial license expires in 2010. The driver, who was not identified but will figure prominently in a congressional hearing this week, has collected Social Security benefits since 1994. He confided to investigators that he “gets winded” walking to his mailbox but has no problem driving a passenger bus.

—A Virginia trucker with a prosthetic leg from a farm accident more than 10 years ago is permitted to drive tanker trucks until at least 2012, even though he doesn’t have the proper federal paperwork required for amputees. Virginia revoked the medical license for the official who approved him to drive over charges the official was caught illegally distributing controlled substances.

—George Albright Jr., 61, smashed his 70,000-pound tractor-trailer into congested traffic on Interstate 70 in June 2006, killing four women in a Ford sedan about 30 miles east of Columbia, Mo. Albright’s employer agreed earlier this year to pay $18 million in a settlement. A Missouri jury acquitted Albright this month on four counts of second-degree involuntary manslaughter, after his lawyers argued in court that a diabetic episode “put him in an altered state of consciousness.” Albright wasn’t injured.

—A gasoline tanker plunged from an overpass and exploded in flames on Interstate 95 near Baltimore in January 2004, killing four people. Witnesses reported the driver slumped over the wheel. Maryland investigators concluded the driver, Jackie M. Frost, had suffered a heart attack or other medical emergency, but his family disputed that.

—The driver of a 15-passenger “Tippy Toes” day-care bus traveling 63 mph on Interstate 240 in Memphis, Tenn., in April 2002 crashed into a bridge, killing the driver and four of the six children aboard. The National Transportation Safety Board said the driver, Wesley B. Hudson, 27, fell asleep, “quite likely due to an undiagnosed sleep disorder.” Investigators said children sometimes had to wake up Hudson, whom the NTSB described as obese and a marijuana user.

—A 55-passenger bus rolled off Interstate 610 in New Orleans in May 1999, killing 22 passengers. The NTSB said the bus driver, Frank Bedell, 46, suffered life-threatening kidney and heart conditions but held a valid license and medical certificate. Moments before the crash, a passenger recounted seeing the driver slumped in his seat. Bedell died three months later of an apparent heart-related illness. Investigators said he was treated at least 20 times in the 21 months before the accident for various ailments.

Some truckers said the government should enforce existing rules, not make new ones.

“Do you enjoy your clothing and house? Without the truck driver you would have none of it,” said Gary Hull, 52, a trucker for a Louisiana company, as he drove from Edinburg, Texas, to Mansfield, La. “Our economy is based on the truck. People don’t understand the ramifications of making it more restrictive for truck drivers to drive.”

Hull said most drivers are hard workers who earn a modest salary and cope with rising diesel prices. New regulations could add to costs and force truckers to evade the rules, he said.

The Transportation Department said 5,300 people died in crashes involving large commercial trucks or buses in 2006, the latest year for which figures are available, and about 126,000 more were injured. A federal safety study last summer found that cases where drivers fell asleep, suffered heart attacks or seizures or otherwise were physically impaired were a leading cause of serious crashes involving large trucks. But those cases included healthy drivers who fell asleep.

“The problem is major. It’s one of the biggest causes of occupational death in the United States today,” said Dr. Kurt Hegmann, chairman of the FMCSA’s medical oversight board, which is urging more doctor visits in many cases for truckers with serious medical conditions.

While it may be years before any of the board’s proposals take effect, there is nothing preventing doctors from stepping up scrutiny of drivers’ medical conditions right away, Hegmann said.

Congress may take action soon. The House Transportation and Infrastructure Committee, led by Rep. James Oberstar, D-Minn., will conduct oversight hearings Thursday. One proposal would create a clearinghouse for drug test results for commercial truck drivers to make it easier for employers to conduct checks. Oberstar’s committee asked the Government Accountability Office to investigate unfit truck drivers.

The 30-page GAO study, obtained by the AP in advance of its release later this week, said 563,000 commercial drivers were determined by the Veterans Affairs Department, Labor Department or Social Security Administration to also be eligible for full disability benefits over health issues. It said disability doesn’t necessarily mean a driver is unfit to operate a commercial vehicle, but its investigators found alarming examples that raised doubts about the safety of the nation’s highways. They identified more than 1,000 drivers with vision, hearing or seizure disorders, which generally would prohibit a trucker from obtaining a valid commercial license.

The chief safety officer for the Federal Motor Carrier Safety Administration, Rose McMurray, acknowledged problems that could lead to unfit truck drivers on the roads. She blamed delays in reforms on a lack of federal money and difficulty coordinating with 50 states. McMurray said changes to stren gthen the medical oversight program may not be done for months or even years.

“We have done a lot to recognize the deficiencies in our medical oversight program, and the building blocks we’re establishing are very smart and very strong,” McMurray said.

Families of crash victims said stronger safety rules can’t happen soon enough.

William Hieronymus II of Salina, Kan., said he remembers eating cereal each morning with his 10-month-old son. His son William and wife, Amanda, died in May 2005 when a truck crossed a median and struck their SUV.

The driver, Scott A. Wegrzyn, pleaded guilty to two counts of vehicular homicide. Prosecutors said Wegrzyn knew he suffered from sleep apnea and went to a second doctor without disclosing the condition to obtain the medical certification he needed to drive.

“I try to go through a day without crying,” Hieronymus said during Wegrzyn’s trial. “I wonder every day what (Will) would have grown up to be, what he would have stood for.”

___

On the Net:

Federal Motor Carrier Safety Administration: http://www.fmcsa.dot.gov/

Advocates for Highway and Auto Safety: http://www.saferoads.org/

Government Accountability Office: http://www.gao.gov/

Copyright 2008 The Associated Press.