Legislative Report December 2008
by Rick Rollens – Consultant for CALBIA

The 2009-2010 California Legislative Session began in early December to swear in the new members elect­ed in November, organize the Assembly and Senate and elect it’s leaders, and most important­ly, to try and tackle the mon­strous and ever growing State Budget Deficit.

Senator Darrell Steinberg (D-Sacramento) was elected Presi­dent Pro-Tem of the Senate and is expected to hold that position for the next six years. Senator Steinberg is a good friend of CALBIA’s, and in January, Mark Ashley and I will be meeting with the Senator to discuss CALBIA’s Legislative Initiatives as well as hearing Senator Stein­berg’s views on opportunities and obstacles facing our efforts this Legislative Session.

As long as the Budget Deficit continues, and grows at a rate of least $50 million a day, the Capi­tol will be consumed and preoc­cupied with finding a solution to California’s most serious Budget crisis in it’s history. Many social service and health services pro­grams have been hit hard with Budget reductions with more reductions and restructuring to come. We will continue to be very engaged in our efforts to work to protect those vital ser­vices that persons with brain injury rely on.

By the end of this week, Congress was able to reach a compromise between the House and the Senate and pass a final economic stimulus measure. This measure (H.R. 5140), which is now headed to President Bush, who is expected to sign it into law, unfortunately does not contain increased Medicaid payments to states, which BIAA had strongly supported.

A second economic stimulus package could possibly emerge in the next few weeks and months, and BIAA will continue to support increasing federal Medicaid reimbursement rates to states in order to prevent states from being forced to cut back their Medicaid programs.

Neuroscientists at the Uni-versity of California, Berkeley have, for the first time, measured the electrical activity of nerve cells and correlated it to changes in blood flow in response to transcranial magnetic stimulation (TMS), a noninvasive method to stimulate neurons in the brain.

Their findings, reported in the journal Science, could substantially improve the effectiveness of brain stimulation as a therapeutic and research tool.

With technological advances over the past decade, TMS has emerged as a promising new tool in neuroscience to treat various clinical disorders, including depression, and to help researchers better understand how the brain is organized and functions.

TMS works by generating magnetic pulses via a wire coil placed on top of the scalp. The pulses pass harmlessly through the skull and induce short, weak electrical currents that alter neural activity. Yet the relative scarcity of data describing the basic effects of TMS, and the uncertainty in how the method achieves its effects, prompted the researchers to conduct their own study.

“There are potentially limitless applications in both the treatment of clinical disorders as well as in could be used to help determine what parts of the brain are used in object recognition or speech comprehension. However, to develop effective applications of TMS, it is first necessary to determine basic information about how the technique works.”

Other techniques for studying neural activity in humans, such as functional magnetic resonance imaging (fMRI) or electroencephalogram (EEG), only measure ongoing activity. TMS, on the other hand, offers the opportunity to non-invasively and reversibly manipulate neural activity in a specific brain area.

In a set of experiments, the researchers used TMS to generate weak, electrical currents in the brain with quick 2- to 4-second bursts of magnetic pulses to the visual cortex of cats. Direct measurements of the electrical discharge of nerve cells in the region in response to the pulses revealed that TMS predictably caused an initial flurry of neural activity, significantly increasing cell firing rates. This increased activity lasted 30 to 60 seconds, followed by a relatively lengthy 5 to 10 minutes of decreased activity.

What the researchers were able to determine for the first time was that the neural response to TMS correlated directly to changes in blood flow to the region. Using oxygen sensors and optical imaging, the researchers found that an initial increase in blood flow was followed by a longer period of decreased activity after the magnetic pulses were applied.

“This long-lasting suppression of activity was surprising,” said Brian Pasley, a graduate student at HWNI and co-lead author of the study. “We’re still trying to understand the physiological mechanisms underlying this effect, but it has implications for how TMS could be used in clinical applications.”

The critical confirmation of the connection between blood flow and neural activity means that researchers can use TMS to alter neural activity, and then use fMRI, which tracks blood flow changes, to assess how the nerve cells respond over time.

“One of the most exciting applications of TMS is the ability to non-invasively modify neural activity in specific ways,” said Pasley. “The brain is malleable, so brain stimulation may be used to alter and promote specific functions, like learning and memory, or suppress abnormal activity that underlies neurologi¬cal disorders. If we can figure out the right ways to stimulate the brain, TMS will likely be useful in attempts to improve neural function.”

The researchers noted that one of the difficulties in using TMS for specific applications is the fact that its effects vary in different brain regions and individuals. “Using TMS is inherently challenging because its neural effects can be so variable,” said Ralph Freeman, UC Berkeley professor of vision science and optometry and principal investigator of the fMRI may serve as a guide to determine adjustments in treatment parameters.”

The study was also co-authored by Thang Duong, a UC Berkeley graduate student in vision science. The National Eye Institute of the National Institutes of Health and the National Science Foundation helped support this research.

CALBIA is busy making plans for Brain Injury Awareness Month in March 2008. Please mark your calendar for the following events:

March 8, 2008
2nd Annual Greek Dinner & Dance for Thought, Long Beach, CA

March 14, 2008 –
Condors Hockey, Bakersfield, CA

March 16, 2008 -
A Night At The Opera, Los Gatos, CA

March 29, 2008 -
Statewide Walk For Thought. Confirmed locations are: Bakersfield Sacramento San Diego Victorville

Each event will provide awareness opportunities, as well as raise funds for CALBIA. More information on each of these events will be posted on the website in the near future.

Paul Roberts/Staff Writer
Issue date: 4/26/06 Section: News
The results of the autopsy of Juan Manuel Nunez III were released Tuesday stating his death was caused by “acute alcohol intoxication and concussive brain injury complicated by post traumatic apnea.”

The results state Nunez’ death was caused by a brain injury when he collapsed after being Tased, by Lubbock police officer Matt Dougherty, said Robert Byers of the Lubbock Medical Examiner’s Office.

The Lubbock Medical Examiner’s Office did rule the Taser shock as “contributory towards his death,” Byers said.

His manner of death was classified as a homicide.

Lt. Roy Bassett of the Lubbock Police Department said the next step is an administration investigation.

“We want to make sure this was a justified homicide,” Bassett said. “We believe it is; we just need to double and triple check.”

After LPD finishes its investigation, police will hand it over to the District Attorney’s Office for the third check, he said.

The autopsy results were found only after the Medical Examiner’s Office had a chance to review all available information from available medical history, investigative information and the actual audio portion of the encounter between law enforcement and Nunez.

It began with one 911 hang-up call. Police responded to the call at 4402 Jarvis St. April 16.

When police arrived at the scene, they observed what was believed to be a domestic dispute between 26-year-old Nunez and his family. The police officer reportedly attempted to detain Nunez, but he refused and allegedly became violent, LPD officer Chris Powe said.

The officer shocked Nunez with his Taser and arrested him.

“After Nunez was in handcuffs, the officer realized Nunez appeared distorted and immediately called the EMS,” Powe said. “Once he arrived at the UMC Emergency Room, he was pronounced dead.”

Nunez’ death has created concerns locally about the safety of Tasers.

Nationwide, people are asking whether shock guns are the reason of more than 150 deaths.

Source: http://www.dailytoreador.com/media/storage/paper870/news/2006/04/26/News/Autopsy.Results.Show.Man.Killed.By.Taser-1877745.shtml?norewrite200605130419&sourcedomain=www.dailytoreador.com

Name : Jennifer Kovalich, Enterprise staff writer
BROCKTON — The first time Shaylin Beckman saw her son, James, he was six weeks old.

The 18-year-old Brockton resident had spent nearly a month in a coma at Boston Medical Center after after suffering a severe brain injury in a May 2005 car accident.

She was eight months pregnant at the time of the crash. Doctors delivered James through an emergency Cesarean section.

Beckman first met her son in June while she recuperated at the HealthSouth Braintree Rehabilitation Hospital.

“I didn’t believe he was mine at first. I didn’t realize he was mine until I got home,” she said.

On Saturday, about 60 guests will gather at the Beckman home on Christopher Road to celebrate James’ first birthday, which is May 9.

Linda Beckman, Shaylin’s mother, said that given Shaylin’s serious injuries and her grandson’s dramatic entrance into the world under such traumatic circumstances, doctors consider both “walking miracles.”

“For the longest time we didn’t think she’d come home,” Linda Beckman said.

On May 9, 2005, Shaylin was the front-seat passenger in a purple Plymouth Breeze. She was just days away from graduation, on her way to Southeastern Regional Vocational Technical High School in Easton with three friends.

Around 7:15 a.m. that morning, the car collided with a First Student bus carrying 17 Cardinal Spellman High School students. The Plymouth ended up wedged underneath the bus to the car’s windshield, police said then.

“There are a number of injuries in that accident in both vehicles,” personal injury attorney Mark Petti, who represents Shaylin and two other passengers who were hurt, said Wednesday.

At the time of the crash, police said that drizzle and speed might have contributed to the accident but were investigating further. The attorney said Wednesday he is awaiting a police report on the accident reconstruction.

Now, the petite young mother is blind in her left eye and has lost the peripheral vision in her right eye. She is at risk for seizures.

“She does have a long road to go, but it’s a road full of hope,” Petti said.

Shaylin will never drive a car but is planning on returning to work as a licensed practical nurse at the Life Care Center in West Bridgewater next month. In the fall, she hopes to enroll in a nursing program at the Technical Institute at Southeastern.

“She’ll make a very good nurse because she’ll have empathy,” said Kim Chagnon, a nurse practitioner in the Department of Neurosurgery at Boston Medical Center. “When she says to a family, ‘I know how you feel,’ she really will.”

Linda Beckman brought baby James home from the hospital about 10 days after he was born. With friends helping her care for the newborn at home, she was going to Boston Medical Center twice a day to be with her daughter.

“The first month is like a fog,” she said.

The community’s generosity poured out to the family. Linda’s friends and former co-workers at the Arnone School, as well as strangers, dropped off baby gifts, food, even money.

One gift given by strangers was a converter crib for James from the parents of a Halifax man who died in 2003 at age 21 in a car crash, shortly before his own child was born.

After Shaylin returned home from a month at the Braintree rehabilitation hospital, the First Evangelical Church, where the family worships, hosted a surprise shower for her.

“We didn’t have to buy diapers for about seven months,” Linda said.

At nearly 1, James has wavy, light brown hair and enormous dark eyes. He is a fast crawler and loves the PBS show “Dragon Tales.” His “best friend” is the family’s cat, Lucky, but James goes nowhere without a gray stuffed animal named “Mr. Bear.”

Linda Beckman said her grandson’s development has proceeded normally but he has several allergies, including milk, soy and whey, and is on a special formula.

“They had a late bonding but now they’re together like glue,” Linda Beckman said of mother and son.

The teenager is also getting somewhat of a social life back, going to under-21 clubs and the mall with friends, as well as playing bingo with her mother and grandmother at church.

But her mother says she gets nervous anytime Shaylin goes out in a car with friends. “It’s like I have to let her grow up all over again,” she said.

Almost a year after her life changed dramatically, Shaylin said she feels lucky to be alive.

“She’s an amazing kid. She doesn’t give up,” her mother said. “She doesn’t let anything bother her. She’s very determined.”

Source: http://enterprise.southofboston.com/articles/2006/05/04/news/news/news02.txt

They offer support and comfort to young patients’ families.

Ron Word | the Associated Press
Posted May 1, 2006
JACKSONVILLE — On a quick walk through Shands Jacksonville’s pediatric intensive-care unit, Tracy East almost shudders when she spies a child in bed hooked up to tubes and wires.

“That was Jason’s room,” she explains, recalling the terrifying days and nights her son spent in that hospital room, clinging to life after being injured in a car crash.

Carolyn Leonard and Bobbi Layton had similar experiences, never leaving Shands for weeks while their daughters hung between life and death after being run over by cars.

The women shivered through sleepless nights in the waiting room. They washed their hair in a bathroom sink. They didn’t have a toothbrush or deodorant, nor did they have a pen and paper to write questions for doctors. They had no place to organize a steady stream of business cards.

The three decided other parents shouldn’t have to endure the discomfort they did.

The mothers, nicknamed “Trauma Mommas” by East, started putting items in canvas bags and leaving them at Shands Jacksonville and Shands at the University of Florida in Gainesville to be given to families of young trauma patients. There’s a soft fuzzy blanket and pillow, prepaid phone cards, a toothbrush and toothpaste, deodorant, a notebook, a business-card holder and some aspirin.

“When you’ve been crying very hard for three days, you get a headache and you need aspirin,” East said.

The moms, officially Mothers Against Brain Injury Inc., raise money for their nonprofit organization through parties and a golf tournament. Each bag costs about $30 to $40. To date, the women have donated 89 to Shands in Jacksonville and 10 to Shands in Gainesville.

In a check of major trauma hospitals in Florida, none had a similar program.

“We have found that no other group is doing what we are doing and that is to provide immediate support, necessities, information and hope to the family of a child suffering a traumatic injury at any hospital,” East said.

Steve and Jeneva Locklear, whose 9-year-old daughter, Emily, was severely injured in a car crash on March 4, received one of the group’s bags at Shands Jacksonville.

The Locklears have developed a bond with Leonard and her daughter, Kinsey, who spent weeks at Shands after being run over by a pickup.

“I thought it was wonderful. I was touched by it,” said Jeneva Locklear.

On a recent Friday night, Carolyn Leonard sat with Steve and Jeneva while Emily was in surgery.

“She has been very supportive. That gave me strength and hope,” Jeneva Locklear said.

Dr. Joseph Tepas III, a pediatric surgeon and director of the University of Florida Regional Trauma Center, praised the women’s work.

“Despite over 30 years experience in managing severe injury, helping parents get through the first few dreadful hours and days remains the most challenging and heart-rending part of the job. Your efforts make it a bit easier and sent an important message that the victims are not alone.”

Tepas calls the canvas bags “an oasis of hope.”

Doctors can work wonders, but can only do so much.

“There is brain injury and brain damage. Our total focus as surgeons is to optimize the recovery of the brain, so that the brain damage is minimal,” Tepas said. About 100 youngsters are treated each year in the pediatric intensive-care unit at Shands Jacksonville hospital for traumatic injuries, the leading killer of children.

The Trauma Mommas’ children — who coincidentally all attend Bartram Trail High School in St. Johns County — are working to recover all the brain functions they had before their injuries.

While Justin East has graduated from high school, Kinsey Leonard and Jessica Wills, Layton’s daughter, will have to make up classes they missed because of their injuries and rehabilitation.

It was during lengthy periods at Brooks Rehabilitation Hospital in Jacksonville where the mothers forged their bond.

Their children and another Bartram Trail student, Rachael Tofany, earned the nickname “The Brains” at Brooks, because all has suffered brain injuries.

Rachael was the first of the four injured when she was ejected in a car in an accident. Next came Kinsey Leonard, who was hit by a pickup while waiting for a school bus. Justin East was in the back seat of a friend’s car when it hit a guardrail. Finally, there was Jessica Wills, who was hit by a car while also waiting for a school bus.

East, Layton and Leonard each dealt with the cold reality that their child could die or never regain functions such as walking and talking.

“She is a walking, talking miracle,” Bobbi Layton says of her daughter. “Every one of them is.”

Because Kinsey Leonard did not talk for a long time and only had a 35-word vocabulary, Jessica Wills overcame her own injuries to learn sign language to communicate with her. The teen now wants to work with the deaf.

“God kind of threw us together for a reason,” Layton said. “If we didn’t have somebody to talk to, we kind of all would go crazy.”

Source : http://www.orlandosentinel.com/news/local/state/orl-traumamamas0106may01,0,5115563.story?coll=orl-news-headlines-state

Few of us realize how pervasive the law is in our lives until we get into a dispute with someone else. Then we are amazed to discover what a tangled web of law there is, and how complex and endless the rules seem.

The threshold question in many situations involving the law is whether you can “do it yourself” or whether you need a lawyer to advise you on your rights or handle the matter for you completely.

While many “minor” disputes can adequately be handled without need of a lawyer – using Small Claims Court or Alternative Dispute Resolution – if you, a friend, or loved one sustained a catastrophic personal injury such as a traumatic brain injury, there can be no question but that you are in need of the services of a competent lawyer.

Unfortunately, we live in a day and time where millions of dollars have been spent persuading the general public (prospective jurors) that should an injured victim exercise their fundamental constitutional right by bringing suit, that individual is merely adding to an already “sue happy” society. Nothing could be further from the truth.

Where a lawsuit is not pursued, unless the injured victim is independently wealthy, the taxpayers will bear the brunt of financial responsibility. Indeed, in catastrophic cases the victim may end up institutionalized unless sufficient funds are secured in order to meet the victim’s medical and support needs.

Complicating matters further, many victims of traumatic brain injury, especially mild traumatic brain injury, are in a state of denial regarding the profound impact of the injury itself. While victims of “mild” TBI have not sustained the “catastrophic” injuries, which may cause an individual to be institutionalized, they have nonetheless sustained injuries which will have a significant impact on their vocational capabilities. In denial, job after job is lost.

Combining denial with the current disfavor regarding lawsuits may very well prove to be a recipe for disaster for the injured individual. Only a lawyer can assess the “legal health” of the injured victim – by investigating the facts, researching the latest developments in the law, applying his or her legal training and experience, and then advising the victim of his/her alternatives. A good lawyer can spot the “jagged rocks” that may lie below the waters of a seemingly simple dispute and can help the victim plan a course of action to avoid them.

The sad truth is, however, that all lawyers are not created equal. It is a very sad fact of traumatic brain injury life that many survivors will not receive adequate recompense for their injury because their lawyer did not have enough experience to know how to analyze, prepare and present a legitimate claim for damages. Many times, the blame is directly traceable to the attorney who is not forthright in the first place regarding his/her lack of experience handling cases involving traumatic brain injury. Time after time the inadequate result rests with the attorney who did not understand the seriousness of the injury simply because of its “invisible” nature.

Unfortunately, even where an injured victim has overcome denial, and has further overcome the social stigmas associated with bringing a lawsuit, s/he may nonetheless experience further “hurt” due to an association with a lawyer having no idea how to properly present claims involving traumatic brain injury. BEWARE: EDUCATION, TRAINING, AND EXPERIENCE VARIES BETWEEN LAWYERS.

At the Scarlett Law Group, we represent injured victims on a contingent fee arrangement. This means that we do not receive any fee or payment unless money is recovered on behalf of the injured person, and then the attorney fee is paid as a percentage of the amount recovered. [Contingent Fee].

What this means is that you have the absolute ability to hire the most qualified attorney specializing in representing individuals sustaining traumatic brain injury. Through the use of the Contingent Fee Agreement, and given that there are excellent attorneys around the United States willing to advance the expenses in connection with the prosecution of a TBI case, injured victims have the ability to hire the most qualified attorneys and need not settle for or accept inexperienced attorneys to handle their cases.

Through the contingency fee, you have the ability to hire a qualified attorney in a crucial situation, and you need not pay that attorney unless they successfully perform. This is a powerful position to be in. Do not underestimate your position. After all, the results of your lawsuit will have an important and long-term impact on your quality of life. Just as you would not rush to purchase any item of consumer goods, nor should you hastily choose a lawyer to represent you.

We at the Scarlett Law Group are committed to handling claims of individuals sustaining traumatic brain injury. We are committed to spending the time with you and your family members to gain a deep understanding for each and every way the injury has affected your life. We are committed to spend the necessary time in order you understand your rights in the progress of your case. Our staff is committed to trying to make your life easier, and we will endeavor to put you in contact with support groups and treating doctors as your case may require.

Given the importance of your choice of counsel, you should be prepared to meaningfully question prospective lawyers in order to ascertain his or her qualifications to handle your case. For example, you should determine how many TBI cases that lawyer has been involved in as principal attorney during the last three to five years. You should determine what percentage of the lawyer’s practice is devoted to cases involving TBI. You should not hesitate to inquire of the settlements/verdicts obtained by the lawyer on TBI cases. (This should be done with a recognition that every case is different.)

You want to make sure that the lawyer is current. In this regard, ask the lawyer how many seminars or conferences s/he has attended over the past several years involving TBI issues. Review that lawyer’s website, or ask the lawyer to provide you with any articles written over the past three years involving any aspect of TBI.

You are about to embark on one of the most important decisions of your life, to wit: The choice of the right lawyer to represent you. You are armed with a powerful tool, the Contingency Fee Agreement. This Agreement allows you to retain experienced counsel without having to pay hundreds of dollars per hour up front. Please, do not make your decision cavalierly. Ensure that you are comfortable with the counsel of your choice. Ensure that counsel has the confidence and experience to properly handle your case. The path is a difficult one, and the choice of counsel can make all the difference in the world.

If you or a family member has sustained a traumatic brain injury, the chances are you already have first hand experience of the overwhelming financial burden that these injuries cause.

The following two case scenarios demonstrate damages sustained in a so-called “mild” traumatic brain injury case, as well as a “moderate” to “severe” traumatic brain injury case.

Case No. 1:

A seventeen-year-old young lady is driving home from her evening class at a local college when a car operated by another individual swerves across the center divider and hits her straight on. She is evacuated by helicopter to the closest trauma hospital whereupon a craniotomy is performed in order to release the pressure resulting from multiple subdural hematomas. Additionally, as a result of spinal cord injury, the young lady is rendered quadriplegic. The catastrophic injuries are apparent to all. The victim’s brain damage renders her a functional five-year-old in mental development. She is fed through a gastrostomy, and will require attendant care the rest of her life.

Case No. 2:

A forty-two-year-old working mother of three is stopped before a crosswalk allowing an elderly pedestrian to cross the street with her walker when her car is suddenly and unexpectedly rear-ended. She keeps her foot on the brake in order her vehicle is not pushed into the crosswalk thereby striking the pedestrian. The force of impact appears to have been fairly minor. There is approximately $1,200 damage done to her car. She does not lose consciousness. Other than a diagnosed cervical “strain”, CT scans and other neurologic testing are without adverse finding. Within several months, however, thevictim’s family notices a marked change. She expressed difficulty with attention and concentration and ultimately loses her job. Her life spirals in denial, confusion and discomposure. Finally, a treating health care provider concedes that she sustained a so-called “mild” traumatic brain injury.

The above two case scenarios are a mixture of facts involved in actual cases brought within the court system in the State of California. The effects of brain injury were profound on both victims, although due to the extent of those injuries, their damages were somewhat different.

In a case involving catastrophic injury, the failure to obtain adequate compensation will deprive the victim of the very funds he/she may need in order to survive. Often times, and especially where the victim’s injury dictates on-going medical care, the future economic loss may be staggering.

Contrast the catastrophic injury case with a “mild” TBI case. Often overlooked or misunderstood, a case involving so-called “mild” traumatic brain injury, with corresponding cognitive deficits, will cause a devastating impact on the vocational abilities of the victim, not to mention the impairment to quality of life.

Perplexity and distractibility are among the most common problems associated with brain injury. Any cognitive deficit, including impairment to attention and concentration, will have a devastating impact on an individual’s ability to work and perform properly on the job. Necessarily, the quality of life is deeply affected.

Areas of financial responsibility will generally fall into the following categories: (1) past, present and future medical bills; and (2) past, present and future lost wages and earning capacity. Obviously, the victim has also sustained compensable damages relating to pain and suffering and emotional distress, although those damages are not discussed herein.

(a) Past, Present, Future Medical Expense. The good news is that even if you are without insurance, when you are transported from an accident scene, or place of injury, to a trauma facility, you will not be turned away. Even comatose individuals without insurance will initially be treated by a trauma facility. However, the length of treatment, quality of treatment and treatment options may be curtailed in individuals without appropriate coverage.

If another person’s negligent or intentional acts cause the infliction of traumatic brain injury, there is no reason why that individual should not be held responsible for payment of your medical expenses. After all, if your own insurance is not sufficient to cover the losses, then the taxpayers will be left with the burden of funding whatever treatment you receive. The allocation of financial burden between the taxpayers and a negligent or intentionally wrongful actor should be an easy decision.

To give you an idea of the staggering health care costs involved in a typical catastrophic case, once again turn to Case Scenario No. 1, above. In a 1995 case, proceeding to trial in California, the health care costs of a spastic quadriplegic brain injured young lady were estimated at $106,000 per year through age 45 and then, when her parents die the costs were estimated to increase to $303,000 per year. The total future lifetime costs, assuming a below historically based medical inflation rate of 5%, is over $166,000,000. When reduced to present cash value (using a historic U.S. Government bond rate), the cost is still $14,000,000.

Obviously medical expenses incurred in the “mild” traumatic brain injury case are considerably less. Life care plans developed for victims of “mild” traumatic brain injury do not typically include ongoing orthopedic care, ongoing neurologic care, round the clock therapist care, and other expenses more commonly required in the catastrophic case. However, emergency room bills were likely incurred, and they are never cheap. Radiological studies, including CT scans or MRI may have been ordered. If properly followed, a neuropsychological assessment has been incurred, and rehabilitative training follows. With today’s health care costs, the price tag for such treatment is not inexpensive.

(b) Past, Present, Future Lost Wages/Impairment to Earning Capacity. In a catastrophic injury case, the victim may never be able to hold a job again. Where the victim is an adult parent, children and other dependents are left without any meaningful source of support. Obviously, a life is shattered. The loss represents the entire earning capacity of that adult from the time of injury through his/her work life expectancy. Often times this amounts to over a million dollars even when relegated to present value.

In a case involving “mild” traumatic brain injury, earning capacity is also dramatically impaired. Virtually all tasks performed in the vocational setting require concentration and attention. Where a victim of mild traumatic brain injury has incurred attention and concentration deficits, job performance is adversely affected or outright prohibited. In many instances, the victim will require complete vocational rehabilitation training. Simply put, the victim will be unable to return to his/her former line of work. Obviously, chances for job advancement are greatly curtailed.

(c) The Lawyers’ Role in Presenting Damages. In the litigation arena, it is your lawyer’s job to present your damages in order you be compensated for your injuries. In the catastrophic case, the presentation of such damage figures becomes an art unto itself. Jury alienation is always a concern, even where such damage figures are reduced to present value.

In the “mild” TBI case, the jury must be made to understand that the cognitive deficits affecting this outwardly-appearing “normal” human being will have a devastating impact on that individual’s ability to work and perform properly on the job.

In most instances, in addition to the testimony of treating physicians, life care plan specialists, vocational rehabilitation specialists, and forensic economists will be employed. By using these specialists, a jury is given the entire “needs” framework of the traumatic brain injury victim. The care given in the past, and the reason for that care is explained. Future care needs are likewise explained and all care costs are quantified and relegated to present value. Similarly, earning capacity is explained and mitigating income is taken into account. In all, the jury is left with a thorough understanding of the severity of economic needs of a victim with traumatic brain injury.