Brain and Spine Injury Law Blog

What is Osteomyelitis?

Tim Titolo — Wed, 10 Mar 2010 14:54:50 -0800

Osteomyelitis means infection of the bone or bone marrow; inflammation of the bone due to infection. Osteomyelitis sometimes occurs as a complication of injury or surgery.

Merck advises Osteomyelitis occurs most commonly in young children and in older people, but all age groups are at risk. Osteomyelitis is also more likely to occur in people with serious medical conditions.

There are three types of osteomyelitis:

Acute osteomyelitis - the infection develops within two weeks of an injury, initial infection, or the start of an underlying disease.
Sub-acute osteomyelitis - the infection develops within one or two months of an injury, initial infection, or the start of an underlying disease.
Chronic osteomyelitis - the bone infection starts at least two months after an injury, initial infection, or the start of an underlying disease.

Infections can reach a bone by traveling through your bloodstream or spreading from nearby tissue. Infections can also begin in the bone itself if trauma exposes your bone to germs. Bone infections commonly affect the long bones of your body, such as your leg bones and upper arm bone, as well as your spine and pelvis.

The symptoms are pain. Doctors treat chronic osteomyelitis with surgery and antibiotics. In acute osteomyelitis in children or vertebral osteomyelitis, surgery isn't always necessary. Once considered incurable, osteomyelitis can be successfully treated today. Still, osteomyelitis is a serious condition, requiring aggressive treatment to prevent spread of your infection and to save the affected bone.

Brain Injury Association's Las Vegas Conference

Tim Titolo — Mon, 01 Mar 2010 11:52:46 -0800

Registration • Schedule• Hotel & Travel • Planning Committee • Exhibitors • Sponsors

The Brain Injury Association of America will present Brain Injury Litigation Strategies 2010 at The Signature at MGM Grand in Las Vegas on April 29-30, 2010.

Make your plans now to participate in the ONLY national legal conference that brings together plaintiff AND defense experts in brain injury litigation. Discover the winning strategies of the nation’s most experienced brain injury plaintiff’s and defense lawyers. Learn the science of brain injury from the leading medical experts.

Whether you’re a plaintiff’s or defense attorney, insurance adjuster, risk manager or in-house counsel, you’ll learn innovative strategies and techniques to effectively represent your clients…and increase your success rate. The conference features plenary sessions for all participants followed by separate breakout sessions for plaintiff’s attorneys or defense counsel and insurance professionals.

Brain Injury Association of America Home Page

Brain Injury Association of America Legislative Update

Tim Titolo — Fri, 26 Feb 2010 18:18:28 -0800

BIAA Unveils 2010 Legislative Fact Sheets

On March 3, 2010, BIAA made available its 2010 legislative fact sheets. The fact sheets outline the agenda for this year including, access to care for both civilian and military populations, TBI Act and research funding, TBI Act reauthorization, caregiver assistance, and support for the Congressional Brain Injury Task Force is now available on our home page!

Brain Injury Awareness Day 2010

Don’t forget that this year’s Brain Injury Awareness Day on Capitol Hill is set to take place on March, 17, 2010.

Below is the schedule of events for the day:

10:00 AM – 1:00 PM - Brain Injury Awareness Fair, First Floor Foyer of the Rayburn House Office Building

2:30 PM – 4:00 PM - Briefing: “From the Playground to the Pros: A Heads-Up on

Concussion”, Capitol Visitors Center – Congressional Meeting Room South

5:30 PM – 7:30 PM - Reception Celebrating Brain Injury Awareness Month, First Floor Foyer of the Rayburn House Office Building

Hope to see you there!

Health Care Reform Update

House leaders this week prepared a schedule to bring health care reform to a vote before Congress adjourns for its two-week spring recess, which begins on March 26, 2010. BIAA continues to advocate for provisions important to the brain injury community and will alert grassroots advocates if action is necessary.

BIAA Health Care Reform Update

Tim Titolo — Fri, 26 Feb 2010 16:23:38 -0800

The Brain Injury Assocation of America posted this Health Care Reform Update. Yesterday, President Obama and members of Congress and the Senate, Republican and Democrat, met to hash out a Health Care Reform Bill. American Association of Justice President, Anthony Tarricone, appeared on Anderson Cooper 360: http://www.vimeo.com/9761801

Health Care Reform Update

On February 22, 2010, in the wake of the legislative hold put on Congress after the recent Massachusetts election, the White House released an 11-page health care overhaul proposal that would extend coverage to more than 31 million people, at a 10-year cost of $950 billion. The White House says that the cost would be offset by spending reductions and tax increases, resulting in $100 billion of deficit reduction. CQ

Also this week, a bipartisan summit convened to discuss the administration’s health care plan. The White House facilitated the six-hour summit to focus on controlling costs, overhauling insurance regulations, reducing the deficit and expanding health coverage.

The group of 40 representatives and senators agreed on a new set of baseline insurance regulations but were still at odds about things like the cost of insurance premiums, patient choice issues, and deficit calculations.

BIAA is monitoring the situation closely and will continue to advocate for a health care reform plan that will provide people with brain injury access to the full continuum of care that they need and deserve.

Brain Injury Awareness Month

As most of you already know, March is brain injury awareness month! BIAA will be unveiling its 2010 legislative agenda on Tuesday, March 2, 2010. Fact sheets outlining the agenda for this year including, access to care for both civilian and military populations, TBI Act and research funding, TBI Act reauthorization, caregiver assistance, and support for the Congressional Brain Injury Task Force will be available on our website starting Tuesday!

Florida Student Suffers Brain Injury in Truck Accident

Tim Titolo — Tue, 23 Feb 2010 19:56:46 -0800

Truck driving safety is provided in the Federal Motor Carrier Safety Regulations published by the Federal Motor Carrier Safety Administration. There are specific limitations on the number of hours a driver can be on duty. Violation to these limits is unsafe and can create liability for a trucking company and its driver. Fatigued drivers make highways and roads dangerous places for all of us.

A college student in Florida alleged that the tractor-trailer driver violated federal motor carrier safety rules by failing to take the required off-duty time after working a 24-hour shift as a county firefighter. Lymon v. Bohn No. 53-2007-CA-7728 (Fla., Polk Co. Cir. Mar. 20, 2009).

Kendra Lymon, 19, was driving through an intersection on a green light when Robert Bohn, driving a tractor-trailer truck, made a left turn into the intersection even though his view was obscured by another truck in the opposite turn lane. Bohn’s tractor-trailer T-boned Lymon’s car on the driver’s side, crushing the vehicle and sending it spinning off the highway.

Her injuries included brain damage that resulted in a motor speech disorder, difficulty swallowing, mild left hemiparesis, bowel and bladder incontinence, cognitive defects, and seizures. She also sustained a fractured left scapula.

Lymon’s mother, Vanessa, on her behalf, sued Bohn and his employer, Bynum Transport, Inc. Vanessa Lymon alleged that the trucking company had provided no ongoing safety training or defensive driver program for its drivers and that it failed to enforce federal motor carrier safety rules about driving hours and rest periods.

The plaintiff alleged that Bohn began his shift without taking the mandatory 10 hours of off-duty time after working a 24-hour shift as a battalion chief for the county fire services, a violation of federal rules. Furthermore, the plaintiff claimed, he violated basic traffic safety rules by turning without waiting for a clear view.

The jury awarded the plaintiff $65 million. The defendants have appealed.

Revising the Diagnostic and Statistical Manual

Tim Titolo — Tue, 23 Feb 2010 13:49:17 -0800

I am following the revision process of the DSM-V from my past blog posts. The New York Times published an article about the Revised Diagnostic and Statistical Manual 5th edition which is slated for publication in 2013. It has been over a decade since the manual was revised.

These are a few of the changes proposed by doctors charged with revising psychiatry’s encyclopedia of mental disorders, the guidebook that largely determines where society draws the line between normal and not normal, between eccentricity and illness, between self-indulgence and self-destruction — and, by extension, when and how patients should be treated.

Far fewer children would get a diagnosis of bipolar disorder. “Binge eating disorder” and “hypersexuality” might become part of the everyday language. (think sex rehabilitation - Tiger Woods, Charlie Sheen, David Letterman, David Duchovny) And the way many mental disorders are diagnosed and treated would be sharply revised.

For months they have been the subject of intense speculation and lobbying by advocacy groups, and some proposed changes have already been widely discussed — including folding the diagnosis of Asperger’s syndrome into a broader category, autism spectrum disorder.

But others, including a proposed alternative for bipolar disorder in many children, were recently released. Experts said the recommendations, posted online at DSM5.org for public comment, could bring rapid change in several areas.

The article states:

One significant change would be adding a childhood disorder called temper dysregulation disorder with dysphoria, a recommendation that grew out of recent findings that many wildly aggressive, irritable children who have been given a diagnosis of bipolar disorder do not have it. Temper dysregulation disorder with dysphoria is a syndrome that in recent years has been labeled childhood bipolar disorder and is actually NOT bipolar disorder. Instead, a new disorder category was created: Temper Dysregulation Disorder with Dysphoria (TDD).

Nestor Lopez-Duran PhD contributes to significant political debate in the media and the blogosphere in his blog.

The misdiagnosis led many children to be given powerful antipsychotic drugs, which have serious side effects, including metabolic changes. Antipsychotic drugs are a class of medicines used to treat psychosis and other mental and emotional conditions.

Some diagnoses of bipolar disorder have been in children as young as 2, and there have been widespread reports that doctors promoting the diagnosis received consulting and speaking fees from the makers of the drugs.

Experts gave the American Psychiatric Association, which publishes the manual, predictably mixed reviews. Some were relieved that the task force working on the manual — which includes neurologists and psychologists as well as psychiatrists — had revised the previous version rather than trying to rewrite it.

Others criticized the authors, saying many diagnoses in the manual would still lack a rigorous scientific basis.

Stanford Law School publishes an interesting blog on the DSM V.

Las Vegas Bus Company Hires Driver with Known Safety Problems

Tim Titolo — Mon, 22 Feb 2010 17:28:34 -0800

I am representing a man who was hit by a bus making a left turn in Las Vegas. The man was in the crosswalk and the driver simply did not see him. The man was hospitalized with brain injury. The Bus Company with Las Vegas offices alleged the man was walking against the pedestrian traffic signal. Somehow, the Bus Co. feels, this gave the bus driver the right to run him over. And the police officer cited the man who got hit!

The police report listed two witnesses who provided statements in Spanish. Today, I took their depositions. The witnesses were fine Mexican-American individuals, legally in this country, who told us that the bus driver was at fault and that the man had the right of way according to the traffic signal. The police never spoke to the unconscious man, and obviously did not understand or ignored the independent witnesses’ accounts. Instead police took the bus driver’s version of traffic control violation of the pedestrian had and cited the pedestrian.

This is a blatant example of how the wrong picture is frequently painted based on pre-existing prejudice. The two Mexican-American witnesses were simply discounted out of hand. The sad part was that the pedestrian had his citation dismissed partially because the cop never showed up in court, yet the stigma remains. And the bus company may have gotten away with it.

The witnesses not only stated the traffic signal allowed the man to walk into the cross walk, but that the bus was attempting, in their opinion, to flee the scene. Can you imagine: A bus company that hires drivers who would flee the scene after hitting a pedestrian and knocking him to the ground unconscious? The amazing thing is that the bus company’s own camera installed on the bus actually showed the man walk into the crosswalk; The bus make its left turn while the radio is blasting; and then the sound of “thud” when the bus hit the pedestrian.

These are situations when all the tort reform rhetoric falls short. These things really happen and consumers need protection from faceless corporations driven solely by profit and self-preservation.

Overloaded Mississippi Gravel Truck Plows Through Intersection, Catastrophically Injuring Young Motorist

Tim Titolo — Sun, 21 Feb 2010 19:34:09 -0800

A number of years ago I was involved in representing plaintiffs against Las Vegas Paving in a lawsuit alleging the truck driver's loads were routinely in excess of limits. During one such run, the trucker crashed into my client near a highschool.

Similarly, in Bryant v. APAC-Tennessee, No. CV2006-0261CD (Miss., DeSoto Co. Cir. Nov. 18, 2009) a teen and his parents sued the paving company that hired the truck’s driver, alleging the company failed to monitor his loads and supervise his conduct. The plaintiffs offered evidence that the driver had made multiple trips on the company’s behalf, each with hauls that exceeded the state’s maximum weight limit.

Ethan Bryant, 16, was driving his pickup truck on a highway. When he entered a controlled intersection on a green light, a loaded gravel truck driven by Chad McCarty struck the driver’s side of the pickup at about 50 mph.

Bryant suffered severe brain injuries, and a 16-year-old passenger in his vehicle was killed. Bryant was comatose for eight months and developed a disorder that limits oxygen to his brain. He now suffers from quadriplegia and periodic seizures and will require 24-hour care for life.

Local trucking companies all too frequently break the rules of the road. They ignore safety protocol and all too often injure users of public roads.

Factors may effect which rules must be met. For instance, Interstate Trucking, driving between states, and intrastate Trucking, driving within one state, are subject to different regualtions. Although many rules bring about some responsibility for truck companies and their drivers, it is important to know the difference. Likewise, the weight of trucks and loads may apply to different regulations and it is important to know the difference.

I have been working more closely with organizations advocating safety for public roads.

Bankrupt Las Vegas Station Casino Lawyers Up

Tim Titolo — Fri, 19 Feb 2010 09:42:32 -0800

The Las Vegas Review Journal announced Station Casino (Fertitta family business) affiliate has been sued by partner GCR Gaming (Greenspun Family business). Both families have lawyered up.

The lawsuit alleges "wrongdoing" and of flagrant and continuous breach of "contractual and fiduciary duties" in their joint-venture partnership of the Green Valley Ranch Resort.

The filing alleges Station Casinos executives breached those duties, in part, by directing high-stakes gamblers at Green Valley Ranch to other casinos that were owned solely by Station Casinos.

This comes after Station Casino's filed for bankruptcy as a partner of operations at Green Valley Ranch Resort. Whenever a bankruptcy is filed or pending, any claims by creditors, including lawsuits against the bankrupt entity or person are stayed. In other words, no lawsuits are allowed while bankruptcy is pending in most circumstances. While protecting the bankrupt corporation, this leads to denied or delayed justice for those injured by the property management's negligence.

Station's parent company filed for Chapter 11 bankruptcy protection in 2009. Chapter 11, unlike Chapter 7, is a reorganization or debt payments. Station has been attempting to provide the Bankruptcy court with a plan to repay its debts but needs cooperation from creditors.

The long and short of it is that GVR Gaming's lawsuit will require lifting the stay by the Bankruptcy Judge to proceed. A motion was filed yesterday.

My office currently has 1 lawsuit pending where Station Casino is a defendant. That matter is not subject to Station's parent company Chapter 11 bankruptcy. However, last year, before the Station Casino filed bankruptcy as to its Green Valley Ranch Resort, another matter was resolved in my office. Fortunate for my clients, they will not be denied or delayed justice because of the recent bankruptcy filing.

Ironically, President Obama is in Las Vegas today to address the public at Green Valley highschool. Worthy of note is whether Las Vegas Mayor, Oscar Goodman, will welcome President Obama in light of the President's recent comment “You don’t blow a bunch of cash in Vegas when you’re trying to save for college.” The comment also drew the ire of Democratic Senator Harry Reid. “Lay off Las Vegas,” Sen. Harry Reid said in a statement issued shortly after the remarks spread through the internet. He later went on to support President Obama.

The Study Free Will

Tim Titolo — Thu, 18 Feb 2010 19:53:03 -0800

Have religious leaders and prophets, been able to tap into something science has not? A recent grant will finance a study on the science of free will. Are we predestined to live the blueprint of life already created for each of us? Do we control our own destiny? Or is it something beyond our comprehension? Is our free will and control of destiny something foreordained toward a result that we will inevitably reach?

Since the beginning of time, philosophers, scientists and theologians have sought to find out whether human beings have free will or whether other forces are at work to control our actions, decisions and choices.

Now, Florida State University philosopher Alfred Mele has been awarded a $4.4 million grant from the John Templeton Foundation to get to the bottom of this question for the ages. Mele, the William H. and Lucyle Werkmeister Professor of Philosophy, will oversee a four-year project to improve understanding of free will in philosophy, religion and science.

The primary purpose of the project is to improve understanding of free will in three spheres: science (especially neuroscience and social psychology); philosophy; and theology. The project's website can be accessed here.

I previously posted in this blog about the new revelations of free will. In fact, in 2008, Professor John-Dylan Haynes and colleagues at the Max Planck Institute in Germany reported findings of an extraordinary experiment which seems to show that 'free will' -- the most cherished tenet of humanity, which decrees that Man has total control of his own actions -- may, in fact, be little more than an illusion.

I read the book entitled Neurophilosophy of Free Will by Henrik Walter and Cynthia Klohr. This among my many other self-study texts in theology, science and psychology posits questions including: Do we control our own future or are the choices we end up making set in place in advance?

Neuroscientists routinely investigate such classical philosophical topics as consciousness, thought, language, meaning, aesthetics, and death. According to Henrik Walter, philosophers should in turn embrace the wealth of research findings and ideas provided by neuroscience. In this book Walter applies the methodology of neurophilosophy to one of philosophy's central challenges, the notion of free will. Neurophilosophical conclusions are based on, and consistent with, scientific knowledge about the brain and its functioning.

Walter's answer to whether there is free will is, It depends. The basic questions concerning free will are (1) whether we are able to choose other than we actually do, (2) whether our choices are made intelligibly, and (3) whether we are really the originators of our choices. According to Walter, freedom of will is an illusion if we mean by it that under identical conditions we would be able to do or decide otherwise, while simultaneously acting only for reasons and being the true originators of our actions. In place of this scientifically untenable strong version of free will, Walter offers what he calls natural autonomy--self-determination unaided by supernatural powers that could exist even in an entirely determined universe. Although natural autonomy can support neither our traditional concept of guilt nor certain cherished illusions about ourselves, it does not imply the abandonment of all concepts of responsibility. For we are not mere marionettes, with no influence over our thoughts or actions.

It will be interesting to see how Dr. Mele's project adds to this conversation.

Orthopedic Treatment for Military

Tim Titolo — Wed, 17 Feb 2010 18:59:06 -0800

The American Academy of Orthopaedic Surgeons (AAOS) reports new research to benefit troops and the upcoming surge authorized by President Obama.

One of Newton's basic physical laws: For each action, there is an equal and opposite reaction. So after the surge in U.S. troops heading to Afghanistan, there will be an influx of injured veterans returning back home. But the U.S. Department of Defense has recruited its own "soldiers" in the battle against war casualties: a consortium of researchers who are improving care to wounded soldiers as well as the general public.

The fourth annual Extremity War Injuries Symposium was held in Washington, D.C., last January to bring together military and civilian orthopaedic surgeons, researchers, experts from governmental agencies, and others to discuss challenges faced by U.S. medical personnel working in Iraq and Afghanistan and to discuss ways to synergize resources and improve care for wounded warriors. A paper summarizing the findings from the symposium is published in the January 2010 issue of the Journal of the American Academy of Orthopaedic Surgeons (JAAOS).

Some of the orthopaedic researchers involved will lead a workshop about the program at the 56th annual meeting of the Orthopaedic Research Society (ORS), March 6 - 9, 2010, in New Orleans. They will also present an overview of the program during Extremity War Injuries V, a symposium that takes place Jan. 27 - 29 in Washington, D.C.

While signature war injuries include traumatic brain injury from exposure to repeat blasts, the Orthopaedic community sees its share of obvious war related injuries. The presentation of these symposiums and conferences is good thing for our veterans. It also lets us all know that there is not the same level of "discarding" our vets when they return home as was in previous wars. I suppose the best solution is to end the war and hopefully we are moving in that direction.

Social Security to Add Early Onset Alzheimer's Benefit

Tim Titolo — Tue, 16 Feb 2010 14:22:40 -0800

All to often people who suffer from disease are unable to get care due to insurance company limitations and policies, lack of insurance or finances to cover expenses. Sometimes folks are left with Social Security Benefit applications for their care.

In its effort to improve and expedite the disability determination process, the Social Security Administration (SSA) has announced that it will add early-onset Alzheimer's disease to its Compassionate Allowances Initiative. The initiative identifies debilitating diseases and medical conditions that meet the SSA's disability standards for Social Security Disability Income (SSDI) or Supplemental Security Income (SSI).

Social Security is launching this expedited decision process with a total of 50 conditions. Over time, more diseases and conditions will be added. A list of the first 50 impairments -- 25 rare diseases and 25 cancers -- can be found at www.socialsecurity.gov/compassionateallowances.

This recent development will lead to increased care more quickly for those who could not otherwise afford it.

Since 2003, the Alzheimer's Association has been advocating on behalf of individuals with early-onset Alzheimer's as they navigate the Social Security disability determinations process and welcomes the SSA's decision. Until now, individuals with early-onset Alzheimer's disease have faced a myriad of challenges when applying for SSDI or SSI, including a long decision process, initial denials, and multiple appeals.

Today's decision will simplify and streamline the SSDI/SSI application process and decrease the wait time for benefits, which for some has lasted as long as three years. There are currently an estimated 5.3 million Americans with Alzheimer's disease. Although the majority of Alzheimer cases are individuals age 65 and older, a significant number of people under age 65 are also affected by this fatal disease and have few financial options other than the Social Security disability program.

This good news comes at a time when politics has brought the issue of universal health care to a stand still. It always intrigues me that certain folks think the "right" to choose a doctor, hence stumping public/social or universal health care, exists. While, at the same time, those folks shun the idea that anyone has a "right" to not be subject to Rendition based on suspicion, or the "right" of due process.

What ever your reflection on the matter, the recent Compassionate Allowances Initiative moves us in the right direction.

New Website Designed to Help with Mental Illness

Tim Titolo — Tue, 16 Feb 2010 14:09:33 -0800

I came across a new website directed at assisting with mental illness. Step Up on Second.

Step Up on Second announces the launch of its newly enhanced Web 2.0 site. Step Up on Second is a California non-profit organization providing support services for adults affected by severe and persistent mental illness, and young adults experiencing the initial symptoms of a mental illness and their families.

The interactive site provides resources for loved ones, clients, and family members in search of an organization that can provide help, hope, and a home to individuals affected by mental illness.

Step Up on Second provides help through comprehensive, integrated clinical programs for relapse prevention; hope through the embrace of community, opportunities for inclusion, advocacy, and empowerment; and permanent supportive home units for stability achieving self-determined goals.

Recently Actress Glenn Close posted on their blog.

Distal Radius Fracture Treatment

Tim Titolo — Tue, 16 Feb 2010 13:40:38 -0800

The radius is the larger of the two bones of the forearm. The end toward the wrist is called the distal end. A fracture of the distal radius occurs when the area of the radius near the wrist breaks.

Risk factors include Osteoporosis (decreased density of the bones) which can make a relatively minor fall result in a broken wrist. Many distal radius fractures in people older than 60 years of age are caused by a fall from a standing position or walking.

Interestingly, exercise, as we know, reduces the risk due to higher bone density in woman over 65. The Archives of Internal Medicine released a study identifying the reduction in falls among those woman engaged in physical activity.

A broken wrist can happen even in healthy bones, if the force of the trauma is severe enough. For example, a car accident or a fall off a bike may generate enough force to break a wrist. In 2007, more than 261,000 people visited the emergency room due to a distal radius fracture.

The American Academy of Orthopaedic Surgeons (AAOS) recently approved and released an evidence-based clinical practice guideline on the Treatment of Distal Radius Fractures.

The final patient-oriented guidelines for treating distal radius fractures contain 29 evidence-based recommendations overall, some of which are included below:

1. The research suggests that a rigid cast is better than a splint if the fracture was displaced.

2. If a fracture was not displaced - as in a hairline crack - a removable splint can be worn.

3. If a fracture has a tendency to fall back the way it was before the physician fixed it, research suggests that these fractures heal better if the surgeon operates on them, rather than treating them with a cast.

More than 4,000 journal articles from around the world were analyzed over the course of a year and every article was graded on a five-point scale depending on the strength and quality of the evidence. Only prospective, randomly controlled clinical trials with enough patients to establish clinical and statistical significance could earn the highest grade, ranking as strong evidence.

Being aware of fractures in general, and especially in the population aged 65 and older, makes considering treatments important. Being informed is the best place to be if and when the need to know becomes immediate as when an unexpected fall lands us in the hospital.

World Congress on Brain Injury

Tim Titolo — Tue, 16 Feb 2010 09:48:58 -0800

My friend and fellow brain injury advocate, Michael Kaplen, will be making a presentation at this year's World Congress on Brain Injury in Washington D.C. next month. This is not only an honor for Michael but something I have come to expect from him given his knowledge and dedication to assisting brain injury survivors.

Michael works in New York City and lives west of the City. I grew up and attended undergraduate school east of New York City on Long Island.

Good luck Mike!

He recently posted:

The topic of my presentation is “Challenges in the field of neurolaw in the 21st century”. I will be covering issues pertaining to judicial scrutiny of expert testimony, admissibility of controversial testing in the field of neuropsychology including the fake bad scale and malingering tests; use of new imaging techniques such as PET scans, functional MRI studies and diffusion tensor MRI studies; and the use of third party observers in insurance company and defense medical examinations.

The IBIA World Congress is the largest gathering of international professionals working in the field of brain injury. Delegates are comprised of physicians, psychologists and neuropsychologists, therapists, social workers, nurses, case managers, legal professionals, advocates and all others working in the field of brain injury.

You can obtain more information on the international brain injury congress program going to: Eighth World Congress on Brain Injury

Cigarette and Alcohol Use Contribute to Alzheimer's

Tim Titolo — Fri, 12 Feb 2010 18:45:09 -0800

Most interesting news pegging the tobacco-industry.

A UCSF analysis of published studies on the relationship between Alzheimer's disease and smoking indicates that smoking cigarettes is a significant risk factor for the disease. After controlling for study design, quality of the journals, time of publication, and tobacco industry affiliation of the authors, the UCSF research team also found an association between tobacco industry affiliation and the conclusions of individual studies. Industry-affiliated studies indicated that smoking protects against the development of Alzheimer's Disease, while independent studies showed that smoking increased the risk of developing the disease.

Study findings were published online in the January issue (19:2) of the Journal of Alzheimer's Disease.

Alcohol Use Found in Cognitive Decline

Studies of alcohol use and cognition among the elderly are rare and have mixed results. A study of drinking among the elderly in Brazil has found that heavy alcohol use is associated with more memory and cognitive problems than mild-to-moderate alcohol use, especially among women.

Results will be published in the April 2010 issue of Alcoholism: Clinical & Experimental Research .

Illinois Supreme Court strikes down medical malpractice caps

Tim Titolo — Thu, 04 Feb 2010 18:04:41 -0800

The Illinois Supreme Court recently struck down limits on jury awards in medical malpractice cases passed by the Legislature four years ago amid spiking liability costs for medical providers.

The court ruled that the caps on pain and suffering and other non-economic damages — $500,000 per case for doctors and $1 million for hospitals — are unconstitutional.

The court’s opinion upholds a 2007 ruling by a Cook County Circuit Court judge determining that the law violated the Illinois Constitution’s “separation of powers” clause, essentially finding that lawmakers interfered with the right of juries to determine fair damages.

It’s the third time the state’s high court has quashed limits on medical malpractice awards, having tossed out similar laws in 1976 and 1997.

The ruling is a blow to physicians, hospitals and malpractice insurers, who successfully argued in 2005 that frivolous lawsuits and runaway jury verdicts were driving up insurance rates and forcing physicians to leave the state.

The court’s ruling stems from a malpractice lawsuit filed in 2006 by the family of a girl who suffered brain damage during her delivery at Gottlieb Memorial Hospital in Melrose Park. Illinois’ trial bar selected the suit as its “test case” to challenge the law.

Liability insurance rates for Illinois doctors generally have held steady or dipped slightly since the caps took effect in August 2005, according to survey data from Medical Liability Monitor, an Oak Park-based trade publication. That’s roughly in line with national trends. Mike Colias reports.

The Wall Street Journal (2/5, Koppel) reports that the measure was initially intended to rein in increasing medical-liability insurance costs. Tort reform advocates saw the ruling as a setback, arguing that medical-malpractice suits play a large role in increasing healthcare costs.

Reuters (2/4) reported that Dr. James Rohack, president of the American Medical Association, said the "decision threatens to undo all that Illinois patients and physicians have gained under the cap, including greater access to health care, lower medical liability rates and increased competition among medical liability insurers." But the Chicago Tribune (2/4, Japsen, Sachdev) reported, "Consumer groups and insurance industry officials say the fact that rates have stabilized" has "more to do with insurance market cycles."

Crain's Chicago Business (2/4, Colias) reported, "In declaring the jury-award caps unconstitutional, the court's decision also scraps several other insurance reforms included in the original law that both sides have said helped ease liability costs." One such reform is "a provision that forced" the state's largest malpractice insurer "to disclose the data it uses to set rates."

"Lawyers and other opponents of caps say those price controls were the real reason that malpractice insurance rates have gone down, rather than the presence of caps," the St. Louis Post-Dispatch (2/5, McDermott) reports. The AP (2/4) also covered the story.

More on High Blood Pressure

Tim Titolo — Wed, 03 Feb 2010 14:48:48 -0800

Since I recently posted on the topic linking high blood pressure to dementia, I came across my doctor's newsletter on Blood Pressure. I reprint it here for those interested.

The leading cause of death and disability in the United States is from cardiovascular diseases, and the most common disease is high blood pressure. High blood pressure, also known as
hypertension, usually does not have any symptoms – hence, the nickname “silent killer.”

Unfortunately, one-third of those who have high blood pressure do not realize it and are not aware of their risk for heart disease. Therefore, many people live years without treatment, possibly damaging their heart, blood vessels, and kidneys.

Lifestyle choices (e.g., weight control, tobacco use, proper nutrition, regular exercise) can help
prevent and/or control high blood pressure. The following are common questions and answers about blood pressure.

What is blood pressure?

It is the force of blood against the walls of arteries. Systolic pressure (the top number) is the force as the heart beats. Diastolic pressure (the bottom number) is the force as the heart relaxes.

A blood pressure reading of 120/80 mmHg is articulated as “120 over 80.”

What is the meaning of the numbers?

A systolic pressure of 120 or less is considered normal. Diastolic pressure of 80 or less is considered normal. Therefore, 120/80 or less is a normal blood pressure. The chart below shows normal blood pressure levels, as well as the levels of high blood pressure.

What are the dangers of high blood pressure?

High blood pressure places an additional strain on the circulatory system (i.e., heart and blood vessels). This strain results in arteries becoming thicker, narrower, and weaker, sometimes causing an obstruction. A completely obstructed artery often leads to heart attacks, strokes, kidney disease, and dementia.

Is low blood pressure a health problem?

The training effect of regular exercise, especially when working out rigorously, is a lower blood pressure. At times, an individual who does not exercise may experience regular low blood pressure. If symptoms do not accompany the low pressure, it usually is not serious. However, if
blood pressure suddenly drops, it may indicate an underlying problem causing inadequate blood flow to the heart, brain, and other vital organs. Symptoms may include dizziness or lightheadedness.

What are some tips to prevent/control high blood pressure?

Healthy living is at the heart of preventing and controlling high blood pressure. Are you:
 Maintaining a healthy weight?
 Engaging in regular physical activity (fi ve 30-minute sessions of aerobic exercise and two
30-minute strength training sessions per week)?
 Eating a low-fat, high-nutrient diet (fruits, vegetables, low-fat dairy foods, low sodium)?
 Limiting alcohol consumption?

References:
1. NIH – National Heart, Lung, Blood
Institute, www.nhlbi.nih.gov
2. American Heart Association,
www.heart.org
3. Blood Pressure Association (United
Kingdom), www.bpassoc.org.uk
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LivingWell
The Link Between Heart Health and Blood Pressure
February 2010

Dementia and Hypertension Linked Again

Tim Titolo — Mon, 01 Feb 2010 19:20:20 -0800

Another study has found that hypertension may contribute to increased risk of dementia, this time with evidence of actual brain abnormalities. I previously wrote about the link between Hypertension and Alzheimer's disease.

This is especially relevant to those who are not controlling their blood pressure. Blood pressure is not something one feels is high or low. Specific medical evaluation, blood pressure test, is necessary.

Data from an offshoot of the Women's Health Initiative found that participants' baseline blood pressure was strongly correlated with volume of lesions in their brains' white matter, according to Lewis Kuller, MD, DrPH, of the University of Pittsburgh, and colleagues.

Along with earlier studies linking blood pressure to clinical dementia, the evidence "supports tight control of blood pressure levels, especially beginning at younger and middle age as a possible and perhaps only way to prevent dementia," Kuller and colleagues concluded online in the Journal of Clinical Hypertension.

Treating hypertension in the elderly appears to protect against dementia and cognitive decline. Uncontrolled hypertension in older patients increases the risk of cognitive impairment. Hypertensive patients had a 70% greater risk of non-amnestic mild cognitive impairment compared with nonhypertensive patients according to Christiane Reitz, M.D., Ph.D., of Columbia University in New York. (C Reitz et al. "Hypertension and the risk of mild cognitive impairment." International Society of Vascular Behavioral and Cognitive Disorders meeting, July 11-14, San Antonio. Final program and abstract book. Abstract O-6)

For each year an individual took medication to lower blood pressure, the risk of dementia decreased by about 3%, found Rita Peila, Ph.D., an epidemiologist at the National Institute on Aging and a scientist at the Pacific Health Research Institute in Honolulu.

My question is whether a person who controls their blood pressure and hypertension with medicine can decrease their risk of dementia to that of someone without hypertension. I predict that other risk factors would need to be accounted for but, other things being equal, can a person with controlled high blood pressure eliminate the risk of dementia?

AAJ 2010 Winter Convention in Maui

Tim Titolo — Mon, 01 Feb 2010 09:41:34 -0800

We are on our third full day of the AAJ 2010 Winter Convention in Maui. The sessions have been packed, the weather has been great

• CLE programs today include:
Specialized Track: Social Networking and Other New Online Tools – 8:00 am – 12:00 pm, Kula Ballroom at the Westin Maui.