In A Case Worthy Of ‘House,’ Mom Was Put In Coma Five Months Until Diagnosis


Posted on 8th November 2010 by Gordon Johnson in Uncategorized

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Doctors put Donna Landrigan in a coma for five months as they struggled to find out what was wrong with her.

Landrigan’s tale was chronicled by AOL Health, kicking off with the painful headaches that the mother of three, then 35, was suffering from for almost a month until she finally collapsed on her kitchen floor.

But as Landrigan’s case demonstrated, diagnosing a brain malady can play out like an episode of “House.” Physicians for months were stymied and couldn’t determine exactly what was wrong with Landrigan’s brain. Ultimately, she received treatments at four hospitals in several different states.

Doctors initially thought that Landrigan has encephalitis, or swelling of the brain due to infection. But tests came back negative. Then physicians believed that the young mother had nonconvulsive status epilepticus, which entails seizures and kills more than half the people who have it. But that diagnosis didn’t pan out.

At that point, doctors put Landrigan into a coma using propofol, the powerful anesthetic that killed pop superstar Michael Jackson. They did it because they feared that her brain could not continue to withstand the seizures she was having. Later, doctors put Landrigan into an even deeper coma using pentobarbital.

 The woman’s condition worsened, and doctors then went on to a new diagnosis: That one of Landrigan’s own antibodies was injuring her brain. 

That, it turns out, was the answer. Landrigan had anti-NMDA receptor antibodies, which can attack brain nerve cells, according to AOL Health. These antibodies typically appear when someone has a teratoma, which is a kind of tumor that people get in the ovaries or testes. 

Doctors removed Landrigan’s ovaries and fallopians tubes, and discovered that she did in fact have a benign teratoma. Her diagnosis was anti-NMDA receptor encephalitis. Landrigan was then slowly brought out of her induced coma.

Although her seizures ended once her tumor was removed, Landrigan is not back to her old self. A year after being taken out of her coma, the mother, now 36, remains in a wheelchair and has nerve damage, according to AOL Health. She still expects to walk one day.       





Much-Needed Update Of Guidelines To Determine Brain Death Are Released


Posted on 7th June 2010 by Gordon Johnson in Uncategorized

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There’s lots of injustice in this world, and declaring somone brain dead who isn’t would be high on the top of the list of such tragedies. 

 That’s why I think it’s a good idea that new guidelines for determining if a patient is brain dead have just been issued.  

Essentially saying it wants to take the guesswork out of the process, the American Academy of Neurology Monday released those new guidelines — the first update in 15 years.

 The new guides tell physicians to do a extensive evaluation of a patient, with a check list of about 25 tests that must be performed and specific criteria that must be met.

The new guidelines were co-written by Dr. Panayiotis Varelas, director of the Neuro-Intensive Care Service at the Henry Ford Hospital in Detroit.

The U.S. Uniform Determination of Death Act does define when death takes place: When a person permanently stops breathing; the heart stops beating; and all brain functions, including those in the stem, stop.

The problem is that doctors differently determine who meets those criteria.

A 2008 study that included 41 of the country’s top hospitals, done by Varelas, found a lot of variability in how doctors and hospitals judged who fit the criteria. 

 Under the revised guidelines, the three signs of brain death are coma with a known cause; abscence of brain stem reflexes and the permanent cessation of breathing.  

Being in a vegetative state does not equate to being brain dead, according to the new rules.

Brain death is caused by severe traumatic brain injury, stroke or oxygen deprivation following cardiac arrest.         

Wisconsin Democrats Nix Attorney General’s Plan To Sue Over Federal Health-Care Reform


Posted on 26th March 2010 by Gordon Johnson in Uncategorized

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Wisconsin Democrats have derailed Republican Attorney General J.B. Van Hollen’s plan to file suit against the federal government over the new health-insurance reform.

If Van Hollen had succeeded, Wisconsin would have joined more than a dozen attorney generals across the nation that are suing to challenge the constitutionality of the health-care reform that’s been approved by Congress.

But Van Hollen couldn’t proceed with a suit unless he had approval from Democratic Gov. Jim Doyle or one of the houses of the state Legislature, which are controlled by Democrats. Neither the governor or legislative leaders would give Van Hollen authorization.

In arguing in favor of the lawsuit, Van Hollen told the Milwaukee Journal Sentinel, “This is an issue of the federal government overreaching beyond what constitutional powers they have, which is an assault on (the Legislature’s) powers.”

But Doyle shot right back in a letter to Van Hollen.

“The lawsuit you suggest is a frivolous and political attempt to thwart the action of Congress and the law of the country,” Doyle wrote. “The State of Wisconsin will not enter into litigation intended to deny health care for tens of thousands of residents.”

Young Boxer Should Think About His Brain Long Term


Posted on 16th March 2010 by Gordon Johnson in Uncategorized

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A local paper in Louisiana Monday profiled a brave, but it seems, also foolish, young gentleman from Grand Bois. The headline on the story is “Boxer Is Used To Overcoming The Odds.”

It should be called “Pressing Your Luck.” The piece is about 21-year-old Roland “Jay Paul” Molinere. He was hit by a jet ski at age 10, which fractured his skull. He was in a coma for three days.

After that accident, Molinere underwent years of physical and speech therapy so he could learn to walk and talk again. He came out of that challenging situation OK. But then what sport did he take up, after he got a second chance at life?

High school football, another venue to get your block knocked off. Molinere played cornerback for South Terrebonne High School. After high school, he returned to a sport he “had loved” since he was only six years old, which was boxing.

Today, Molinere is the 2009 Louisiana Golden Gloves Division Champion, and he has other championships under his belt in his weight class, 152 pounds.

We’d be hard-pressed to think of any sport more likely to cause traumatic damage to your brain than boxing.

Molinere said his goal now is to box for the United States in the Olympics. We suggest that he find a passion he can indulge in that won’t put in brain at risk.

We talk on this blog about the miracles and tragedies.  This case is a misguided approach to turn a miracle into another tragedy.  The single biggest risk factor for a bad result from a head injury is a prior head injury.  Any severe brain injury, one that involves coma, has left significant microscopic damage throughout the brain.  A blow to this young man that might only stun someone else, could cause a catastrophic result.  How did any doctor give him medical clearance to fight?

Skier C.R. Johnson Dies In Ski Accident After Striking His Head


Posted on 26th February 2010 by Gordon Johnson in Uncategorized

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Not all sport brain injuries happen in competition. And they are not all routine concussions. Some, like Natasha Richardson’ and now C.R. Johnson, can be fatal.

Johnson, a skier and leader in halfpipe skiing, died in an accident Wednesday when he hit his head against a rock in Squaw Valley, Calif.

The 26-year-old, who had sustained traumatic brain injury earlier in his career, was skiing on Light Towers with friends when he reportedly fell down face first, twisted around and hit the back of his head on rocks. Johnson was wearing a helmet, which was damaged in the accident.

Johnson had been in the superpipe and halfpipe competitions at the X Games.

Back in 2005, another skier landed on Johnson in an accident in Utah. Johnson, who suffered traumatic brain damage, was put in a coma for 10 days. But he was soon back skiing after spending some time in a rehabilitation facilty, where he had to learn how to talk again.

Some “return to play” decision are just ridiculous. Anyone who suffers a severe brain injury (a coma) should frankly be disqualified from balance, instant decision making, perfectly coordinated activities where there is any risk of further brain injury. Despite what the team doctors might have wanted to believe, or Johnson himself believe, a brain injury severe enough to put someone in a coma, will not have a complete recovery. The goal is a satisfactory recovery, but that doesn’t mean that a finely tuned athlete will ever be able to do all the things again that it takes to excel, or in Johnson’s case, even survive.

If a doctor released Johnson for skiing, that doctor should be answering for his death.

University of Cincinnati Study to Test Progesterone Effectiveness in Severely Brain Injured Individuals


Posted on 12th January 2010 by Gordon Johnson in Uncategorized

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Editors Note: The greatest advancements in the treatment of brain injury have been in the area of increasing the number of people who survive the severest injuries. Helicopters, CT scans and ICP monitors account for the biggest chunk of that improvement. The press release below from the University of Cincinnati details a new study that is being proposed for 100 severely brain injured people to see what benefit administration of the hormone progesterone will have on outcomes.

Such research is extremely important and the double blind method is critical for research to have any scientific validity. My only concern with this study is that we don’t know how progesterone is supposed to help. If the projected improvement rate is 5%, that may be a lot of effort for what may not be a statistically significant result. But that is what scientific research is there to determine. And if you were one of the 5% who got better that would be significant to you and your family.

Attorney Gordon Johnson
Chair Traumatic Brain Injury Litigation Group, American Association of Justice
©Attorney Gordon S. Johnson, Jr. 2010

( – CINCINNATI–Neurotrauma experts at the University of Cincinnati Neuroscience Institute at University Hospital are seeking public input before launching federally funded research aimed at improving outcomes for patients who suffer traumatic brain injury ( TBI ).

The randomized clinical trial will assess whether administering the naturally occurring hormone progesterone in patients immediately after a moderate to severe traumatic brain injury will reduce brain damage and swelling and thereby improve the patients’ mental and physical outcomes.

The Cincinnati portion of the study will be led by Jay Johannigman, MD, associate professor and director of the division of trauma and critical care, and Lori Shutter, MD, associate professor of neurosurgery and neurology and director of the neurocritical care program.

“The nation is becoming increasingly aware of the devastation that traumatic brain injury can have on a person’s life,” Shutter says. “Unfortunately, although there have been many efforts, we still do not have an effective treatment for a traumatic injury to the brain. The early information on progesterone for treatment of TBI renews our hopes that we may have something that can improve long-term outcomes.”

The progesterone study, funded by the National Institute of Neurological Disorders and Stroke, is known as ProTECT III, which stands for Progesterone for Traumatic Brain Injury–Experimental Clinical Treatment. The $14.5 million trial will enroll 1,140 patients over a period of three years at 17 medical centers throughout the United States. David Wright, MD, assistant professor of emergency medicine at Emory University in Atlanta, is the multicenter study’s lead investigator.

Public comment is required before the ProTECT study begins because a patient who has suffered a brain injury is unconscious and would not be able to give consent before doctors administer the treatment. In addition, a relative or guardian may not be immediately available to grant consent on the patient’s behalf.

Traumatic brain injury involves sudden damage to the brain caused by an outside force to the head, such as a car crash, a fall or a forceful blow from a heavy object. Roughly 1.5 million to 2 million adults and children suffer a traumatic brain injury in the United States each year. About 50,000 die and another 80,000 are permanently disabled, according to the Centers for Disease Control and Prevention. Traumatic brain injury is the leading cause of death and disability among people aged 1 to 44.

ProTECT III is the third phase of groundbreaking research into the effectiveness of progesterone, which is most commonly recognized as a female hormone but also has “protective” properties. Progesterone receptors are abundant in the brain, and laboratory research suggests that progesterone plays a role in the development of brain cells and in the protection of injured brain tissue.

Emory researchers concluded in an earlier pilot study involving 100 patients that giving progesterone to trauma victims shortly after a brain injury appeared to be safe and effective. Emory researchers also reported a 5 percent reduction in mortality among patients treated with progesterone as well as improved outcomes among patients with moderate injury.

Progesterone is an attractive therapy for several reasons, Shutter says. “It is FDA-approved; it can be administered quickly; it enters the brain quickly; and it is inexpensive.”

The current study, ProTECT III, involves patients aged 18 and over who have suffered a moderate to severe traumatic brain injury and who can begin treatment within four hours of their injury. A qualifying patient will be randomly assigned to one of two groups. One group will receive an IV mixture that contains progesterone ( the study medicine ). The other group will receive an IV mixture that has no progesterone ( a placebo ). The UC team expects to enroll approximately 100 patients over the three-year period at University Hospital.

Federal law established the “waiver of consent” in 1996 so that physicians could begin emergency treatment after any injury before obtaining consent from the patient or from a legal guardian or family member. Under terms of the ProTECT study, if a hospital is unable to reach a family member after 60 minutes of diligent effort, the emergency medicine team is allowed to enroll patients who meet the study’s stringent criteria.

To qualify for the waiver, researchers must first explain the research to the community and gather feedback. UC researchers will discuss the ProTECT trial at community meetings during the next several months, with particular emphasis on demographic groups known to have a statistically elevated risk of severe traumatic brain injury. In addition, UC researchers must assess local residents’ willingness for themselves or a family member to participate in this study. A complete description of the study can be reviewed at

Those who review the study description will be invited to complete a short accompanying survey.

ProTECT III is a project of the Neurological Emergencies Treatment Trials ( NETT ), which was established by NIH in early 2007. NETT is a permanent research network that currently involves 17 university medical centers throughout the United States. UC’s involvement in NETT is overseen by Arthur Pancioli, MD, associate professor of emergency medicine and a member of UCNI.

Individuals who are opposed to being enrolled in a NETT study in the event that they were to suffer a neurological emergency can request an “opt out” bracelet by calling ( 513 ) 558-NETT ( 0095 ).

For more information about ProTECT, please contact Sara Stark at ( 513 ) 558-0095 or For more information about NETT, please visit

Experienced Brain Injury Attorney Essential in Severe Brain Injury Cases


Posted on 6th January 2010 by Gordon Johnson in Uncategorized

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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.

Health Care Reform Now Awaits Reconciliation


Posted on 27th December 2009 by Gordon Johnson in Uncategorized

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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: 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: If you are required to register to get to this page, by all means, register. In fact, make the 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.

Trial Lawyer Lessons from Sunny von Bulow Coma

1 comment

Posted on 13th December 2008 by Gordon Johnson in Uncategorized

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Earlier this week, we published a story about the death of Sunny von Bulow after 28 years in a coma. See previous blog. This has been a sensational story for nearly three decades, with little relevance to what we do as traumatic brain injury lawyers. However, there are two issues that are relevant, seemingly buried in this story.

The first is that the cost of caring for her. According to the story: “Her doctor testified that the cost of maintaining her was $375,000 the first year, 1981.” In any catastrophic injury case, there is always an argument about the cost of care. Her care cost $375,000, in 1981. Adjusted to today’s dollars, that would be well in excess of a million dollars.

Perhaps the most important personal injury precedent in this case, is that Sunny, despite her severe coma, lived 28 years, likely to her normal life expectancy. One thing defense lawyers try to argue in almost every case is that they should not have to pay the cost of care for a normal life expectancy because the now severely injured plaintiff won’t live very long. Such an argument should be rule unconscionable and never allowed, because no defendant should get the benefit of a reduced life expectancy, caused by its own conduct.

But what the von Bulow case shows is that if you get the best care, with evolving improving care for comatose patients, there is no reason to presume a shortened life expectancy. Perhaps the lower standard of care defense lawyers claim is all that is necessary will result in a shortened life expectancy. But for Sunny, because she got the best care, her life wasn’t shortened by the wrongdoing.

We believe that if a person’s life is shortened by wrongful conduct, at the point of death, then the actionable conduct becomes a wrongful death. Here there was no “wrongful death” just the loss of everything that “life” means other than a heartbeat

Sunny von Bulow dead after 28 years in coma


Posted on 7th December 2008 by Gordon Johnson in Uncategorized

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Date: 12/6/2008

Associated Press Writer

NEW YORK (AP) — Martha “Sunny” von Bulow, an heiress who spent the last 28 years of her life in oblivion after what prosecutors alleged in a pair of sensational trials were two murder attempts by her husband, died Saturday at age 76.

She died at a nursing home in New York, her children said in a statement issued by family spokeswoman Maureen Connelly.

Sunny von Bulow was a personification of romantic notions about high society — a stunning heiress who brought her American millions to marriages with men who gave her honored old European names.

But she ended her days in a coma, showing no sign of awareness as she was visited by her children and tended around the clock by nurses.

In the 1980s, she was the offstage presence that haunted her husband’s two sensational trials in Newport and Providence, R.I.

At the first trial, in 1982, Claus von Bulow was convicted of trying twice to kill her by injecting her with insulin at their estate in Newport, R.I. That verdict was thrown out on appeal, and he was acquitted at a second trial in 1985.

The murder case split Newport society, produced lurid headlines and was later made into the 1990 film, “Reversal of Fortune,” starring Glenn Close and Jeremy Irons.

Claus von Bulow is now living in London, “mostly taking care of his grandchildren,” said Alan Dershowitz, the defense lawyer who handled the appeal and won his acquittal at the second trial. He wrote the book “Reversal of Fortune: Inside the von Bulow Case,” on which the movie was based.

Dershowitz said there was “overwhelming” evidence that her coma was self-induced — caused by a “large ingestion of drugs, and Claus had nothing to do with it,” Dershowitz said.

“There are no winners in a case like this,” he added.

Claus von Bulow’s main accusers were his wife’s children by a previous marriage to Austrian Prince Alfred von Auersperg — Princess Annie-Laurie “Ala” von Auersperg Isham and Prince Alexander von Auersperg. They renewed the charges against their stepfather in a civil lawsuit a month after his acquittal.

Two years later, Claus von Bulow agreed to give up any claims to his wife’s estimated $25 million-to-$40 million fortune and to the $120,000-a-year income of a trust she set up for him. He also agreed to divorce her, leave the country and never profit from their story.

Sales of Sunny von Bulow’s property brought $4.2 million from her oceanfront estate in Newport, $6.25 million from her 12-room apartment on Fifth Avenue in Manhattan, and $11.5 million from the art and antiques from the homes.

Prosecutors contended that Claus von Bulow wanted to get rid of his wife to inherit a large chunk of her wealth and be free to marry a mistress. The defense countered by painting Sunny von Bulow, who suffered from low blood sugar, as an alcoholic and pill popper who drank herself into a coma.

Claus Von Bulow was accused of injecting his wife with insulin first in December 1979, causing a coma from which she revived. Prosecutors said he tried again a year later, on Dec. 21, 1980, and the 49-year-old heiress fell into what her children on Saturday called “a persistent vegetative state.”

Her world was reduced to a private, guarded room in the Harkness Pavilion and later the McKeen Pavilion of Columbia-Presbyterian Medical Center. She died at the Mary Manning Walsh Nursing Home, her family said.

Her doctor testified that the cost of maintaining her was $375,000 the first year, 1981.

No figures were available for the years that followed, but by the early 1990s, room charges were up to about $1,500 a day — $547,000 a year — plus $200,000 to $300,000 for round-the-clock private nursing.

She was born Martha Sharp Crawford aboard a railcar in Manassas, Va., on Sept. 1, 1932, daughter of utilities tycoon George Crawford, who died when she was 4.

Sunny, nicknamed for her disposition, was raised by her mother in New York City.

While touring Europe with her mother, she met Prince Alfred von Auersperg, who was younger, penniless and working as a tennis pro at an Austrian resort catering to rich Americans. They were married in 1957 and divorced eight years later after she returned alone to New York with their young son and daughter.

On June 6, 1966, she married von Bulow, who then quit his job as an aide to oilman J. Paul Getty. He could not immediately be reached for comment Saturday.

In addition to her two children from her first marriage, Sunny von Bulow is survived by Cosima Pavoncelli, a daughter from her marriage to von Bulow. Pavoncelli sided with her father during the trials.


Associated Press writers Jay Lindsay in Boston and Raphael G. Satter in London contributed to this report.

Copyright 2008 The Associated Press.