I have always called it the Defense of Misdirection. This year, is an election year, and I have an easier term for people to understand: SPIN. Spin is what defense attorney’s do. They spin everything, ignoring the obvious and coming up with some type of misdirection to disregard the diagnosis of treating doctors. The goal is to shift blame from everyone but the defendant who actually caused the injury by his/her/its wrongful conduct.
The favorite spin of defense attorneys is to blame it on pre-injury (pre-morbid is the medical term, meaning previously to the injury “mordibity”) psychological problems. The Army now is using similar tactics. With insurance companies the motive is to build up the skepticism of the jury, to reduce the amount its insured is required to pay. With the Military, the motive is to find as many warm bodies as possible to send back into a combat zone, to keep the numbers up for the surge in Iraq. There might also be the motive to save billions in VA benefits, too.
An April 23, 2007 story in the Army Times details the way in which the Army is using so-called “personality disorders” and tactics typical of Defense lawyers to force soldiers to go back into combat, or deny them proper veterans medical and disability benefits. For the full story, click here: http://www.armytimes.com/news/2007/04/military_braininjury_thurman_070420w/
The insurance industry propaganda machine is always trying to stir up sentiment about frivolous lawsuits. What actually happens in the Courtroom is dramatically different.
Defense attorneys learn how to spin any disability into something where they can raise jurors skepticism. Defense attorneys hire doctors who know what is expected of them. Ridiculous, psychosomatic diagnosis not found in the real medical world since Freud, are reinvented.
(The actual condition of Conversion disorder is so rare, that only left-over Freudian influence in the psychiatric profession, keeps it in the DSM-IV.) Pre-morbid personality disorders are found even though the person was considered well adjusted and productive before they got hurt. Any emotional counseling around life’s normal challenges such as divorce or marital difficulties is turned into evidence of deep seeded psychosis.
Jurors often see the Defense doctors as equally credible to the plaintiffs treating doctors, for reasons that are hard to fathom. As the plaintiff has the “burden of proof”, any doubts are resolved in favor of the Spin Doctors. Often the most credible evidence is that of friends and co-workers, who tell of how normal and productive the plaintiff was before. Defense lawyers try to spin this, and apparently, so does the military. The Army Times story linked above, tells of a soldier who was claimed to have a personality disorder, even though it didn’t show itself until he returned from Iraq.
Edward Kaspar said he served as Town’s lieutenant and was a witness to the incident in which a rocket exploded above Town’s head in Iraq, causing his brain injury.
“I was pretty shocked to hear about his problems now,” Kaspar said by e-mail. “This personality disorder thing just doesn’t make sense. I’m not a trained medical professional, but I can say that in the years he served as one of my soldiers, he definitely had it together. _ I relied on him to get the job done and he never failed me, both in peacetime and in war.”
Senators and Congressmen are calling for our wounded soldiers to get better treatment than this. While Bush and McCain are still fighting giving maximum benefits to Iraq Veterans, the political tide looks like by early next year, the laws will be improve. But changing the written rules won’t be enough. The culture of denial must be changed. Doctors, both civilian and military must start to believe that good, hard working people, are not malingers, just waiting for a chance for a free ride. People don’t choose the life of the disabled. They are disabled because their minds have been fundamentally changed by either trauma or extraordinary stress in a way, that has left them only a shadow of who they were. This is not a life of luxury, but a tragedy that deserves all of the assistance either our court system in the case of civilian injuries, or the VA system, in case of military injuries, can provide.
There can be no disagreement on this: forcing a soldier with a brain injury or PTSD to return to combat is unconscionable, not just because it is exposes that soldier to death and more disability, but because it exposes other soldiers to the same, because they will not be able to rely on that soldier.
NFL, War and Brain Injury, Part II
Yesterday I commented on the intersection of news about Iraq War veterans and the death of an NFL player. Today, we focus more on the synergistic effect of the interplay between brain injury and emotional problems.
It was reported in the April 19, 2008 edition of the Science Daily that one in five Iraq and Afghanistan Veterans suffer from PTSD or major depression. In addition, 19% are reported to be suffering from the effects of brain injury.
Click here for the complete story: http://www.sciencedaily.com/releases/2008/04/080417112102.htm
According to this article:
Combat involves a synergistic (as defined yesterday) exposure to screwing up what makes the brain work. Not only are enemy attacks particularly bad for the organic matter inside the brain, but the constant vigilance and stress that which can occur, can create a more vulnerable brain to an “organic” injury. Prevalent throughout almost all neuropsychological literature is the challenge to distinguish between actual physical injury to brain tissue (organic injury) and the effect of emotional responses on the brain. There is no shortage of areas that the allocated research funds could be directed. Still, we believe that focusing on the synergistic effect and the vulnerabilities to injury of someone exposed to the stress of combat, should be near the forefront of priorities.
It was reported in the April 19, 2008 edition of the Science Daily that one in five Iraq and Afghanistan Veterans suffer from PTSD or major depression. In addition, 19% are reported to be suffering from the effects of brain injury.
Click here for the complete story: http://www.sciencedaily.com/releases/2008/04/080417112102.htm
According to this article:
Researchers surveyed 1,965 service members from 24 communities across the country to assess their exposure to traumatic events and possible brain injury while deployed, evaluate current symptoms of psychological illness, and gauge whether they have received care for combat-related problems.The article said:
“There is a major health crisis facing those men and women who have served our nation in Iraq and Afghanistan,” said Terri Tanielian, the project’s co-leader and a researcher at RAND, a nonprofit research organization. “Unless they receive appropriate and effective care for these mental health conditions, there will be long-term consequences for them and for the nation. Unfortunately, we found there are many barriers preventing them from getting the high-quality treatment they need.”Odds are that they will get this attention. The recent federal funding has allocated large sums of money for TBI research and treatment from these two wars. Still, these numbers, if they are to be believed (i.e.,19% with TBI) mean that there are considerably more veterans involved the 20,000 or so that have been involved in recent studies. A 19% figure could push the number of vets with post concussional syndrome well into the hundreds of thousands. That would make even a half of billion dollars, seem inadequate.
Combat involves a synergistic (as defined yesterday) exposure to screwing up what makes the brain work. Not only are enemy attacks particularly bad for the organic matter inside the brain, but the constant vigilance and stress that which can occur, can create a more vulnerable brain to an “organic” injury. Prevalent throughout almost all neuropsychological literature is the challenge to distinguish between actual physical injury to brain tissue (organic injury) and the effect of emotional responses on the brain. There is no shortage of areas that the allocated research funds could be directed. Still, we believe that focusing on the synergistic effect and the vulnerabilities to injury of someone exposed to the stress of combat, should be near the forefront of priorities.
NFL, War and Brain Injury
My internet news today had an intersecting of two recurring themes in the brain injury world, with that of an unexpected death of a former NFL player. The first theme is the difficulties retired NFL players have with disability. The second theme the degree of depression found in post Iraq war veterans. What does the death of Curtis Whitley have to do with the other two themes? Perhaps nothing, but even if this case doesn’t, other similar cases could. For the full story on the death of Curtis Whitely, click here.
Anyone who works in the field of brain injury, has often turned the old cliché about mental illness “Its all in the head” on itself, because of course, anything to do with the brain, is in the head. But, the extent of the interplay between emotional problems and brain injury is never, and I repeat never, fully appreciated. As I sit here and write this, I can’t fully appreciate this interplay, because it involves the area of human emotions and function, that we are only scratching the surface in our capacity to understand and have no clue as to how to measure.
Brain injury deficits and emotional deficits are synergistic, meaning the whole of the problems when you combine these two, is greater than the sum of the parts. From a recent deposition I took of a defense neuropsychologist:
But perhaps, Iraq war veterans will have a better fate. A recent article in the Science Daily, promises more for them, and we will discuss such issues in our next blog. Click here for that story.
Anyone who works in the field of brain injury, has often turned the old cliché about mental illness “Its all in the head” on itself, because of course, anything to do with the brain, is in the head. But, the extent of the interplay between emotional problems and brain injury is never, and I repeat never, fully appreciated. As I sit here and write this, I can’t fully appreciate this interplay, because it involves the area of human emotions and function, that we are only scratching the surface in our capacity to understand and have no clue as to how to measure.
Brain injury deficits and emotional deficits are synergistic, meaning the whole of the problems when you combine these two, is greater than the sum of the parts. From a recent deposition I took of a defense neuropsychologist:
Q If I were going to use the term “synergistic” to apply to the cumulative effect of all of these multifactorial aspects of an outcome, is that a reasonable word to use to describe it.With respect to Whitley, the 39 year old was found face down in a bathroom in Fort Stockton, Texas. The local sheriff said there was no indication of foul play, but the case is under investigation. That investigation will likely look at Whitley’s history of drug and/or alcohol abuse. What won’t be examined is how many concussions he had, how his dependencies on substances might have interplayed with those concussions and how his emotional vulnerabilities from the combination of the two contributed to the end of his NFL career and his premature death.
A Can you define how you’re using synergistic?
Q Well, if synergistic means the total exceeds the sum of the parts, do you believe that post concussional deficits can be synergistic?
Q I’ll add to that. Do you believe that the cumulative disability from post-concussional deficits can be synergistic?
A I believe — I hope I’m answering this consistent with what you’re asking — but I believe that these factors can feed off of each other and result in a very complex, poor outcome.
But perhaps, Iraq war veterans will have a better fate. A recent article in the Science Daily, promises more for them, and we will discuss such issues in our next blog. Click here for that story.
Wounded Troops and Partners: Supporting Intimate Relationships.
From the Brain Injury Association of Wisconsin:
Dear Members and Donors:
Dear Members and Donors:
Intimacy, sexuality, empathy are among the areas that brain injured survivors have some of their most significant problems. Lower frontal lobe damage is likely to contribute to these problems. Vets have the additional issues stemming from the overlay of combat related emotional issues.
The following conference offering was sent to us from the BIAA. We are forwarding to you for your information.
The Center of Excellence for Sexual Health invites you to join elected officials, public and private agency leaders, healthcare professionals, members of the armed services, veterans, and concerned civilians for a one-day conference, Wounded Troops and Partners: Supporting Intimate Relationships.
This conference seeks to:You will hear first person experiences and receive briefings from leading experts on:
- Create visibility for the linkage of mental and physical disabilities like PTSD, traumatic brain injury, and serious burns with failed intimate relationships that contribute to higher suicide rates, divorce, and other problems
- Strengthen specific initiatives around intimate relationships for person with service-related disabilities
- Develop and expand enduring networks of people to serve these populations
- This is your opportunity to contribute to a national dialogue on how U.S. agencies, healthcare providers, and communities can help wounded troops and their partners develop and maintain healthy intimate relationships.
Featured speakers include Bob Dole, Dr. David Satcher, Dr. Richard Carmona, Dr. Margaret Giannini and Lee Woodruff.
- How healthy intimate relationships contribute to recovery from physical and mental trauma
- How lack of a satisfying intimate relationship contributes to ongoing mental health problems and suicide
- The special challenges and concerns of wounded women warriors
- How intimate relationships help wounded spirits heal
- The specific sexual health concerns of troops with disabilities
- How addressing sexual health concerns strengthens marriages and other committed relationships
Participate and send a strong message about the importance of wounded troops and their partners having access to the healthcare, counseling and resources
that they need to sustain intimate relationships that provide support and promote healing.
Please visit our conference website http://www.msm.edu/Centers_&_Institutes/CESH/Programs_&_Initiatives/Disabilities/Wounded_Troops_and_Partners/Wounded_Troops_&_Partners_Home.htm or contact our office for more information. There is no charge for registration. Lunch will be provided.
When
Wednesday, May 21, 2008 8:30 AM – 5:30 PM
Eastern Time Zone
Where
Henry J. Kaiser Family Foundation
Barbara Jordan Conference Center
1330 G Street, NW
Washington, DC 20005
We would encourage not only Vets and their loved ones to attend this conference, but anyone affected by brain injury.
From our frequent contributor, Cindy:
Hi Everyone,
Just had a “cognitive workout” in the container garden today, and thought I’d share some of my adventures and problem-solving with you. While surfing the web, I came upon a gardening practice which I had never heard…growing tomatoes upside! There are supposedly many benefits of this: 1) better air circulation which equals less diseases, 2) tomatoes aren’t on the ground as long, therefore rot less, and 3) pesky animals who also like to eat tomatoes have a harder time reaching them.Last weekend I purchased a Grape Sweet Olive Tomato plant and prepared a container to be used for my upside down tomato pot. Using a 5-gallon paint bucket, I cut out a 3″ hole in the bottom of the bucket, and did the same thing to an item I found to use as a lid.My first cognitive challenge was: How do I put the dirt in the bucket without it falling out the other end when I turn it upside down?Answer: Put a coffee filter over the hole.Next step: Fill bucket with dirt.Next cognitive challenge: My lid is not a snap-on lid and I didn’t have enough dirt to completely fill the bucket. How do I keep the dirt from falling out this end when I turn it over to plant the tomato plant?Answer: Stuff plastic bags over the dirt along with a lid about the size of the bucket and turn on its side.Next challenge: How do I plant the tomato plant?Okay, the coffee filter pulls away easily, but now the dirt is falling out both ends. How do I keep it from falling out the bottom hole once I hang the plant upside down?Solution: Cut a slit in a paper plate with a hole in the center to put around the tomato plant. But the plate is so big, I can’t fit it into the 3″ hole, even when I crumble it up to make it more pliable.
Solution: Cut the plate down so that it is slightly larger than the hole that was cut.
Ahhhh, final success!!! The tomato plant is hanging upside down without the dirt falling out!!!!
Good job Cindy. I am always delighted to see the creative ways that she finds solutions to the challenges she faces.
Getting Medical Bills Paid after Brain Injury
As a personal injury lawyer you learn early on that the biggest issue on almost everyone’s mind after a personal injury or other medical crisis is: how do we pay the medical bills? Until we have national health insurance, there will always be challenges for those who have a sudden influx of medical bills.
What makes this worse for the accident victim, is that these challenges often coincides with disability, and often the resulting loss of health insurance.
12 years ago we first tackled this issue on our website http://waiting.com The specific link is http://www.waiting.com/medicalbills.html
This page begins with this statement:
Our first advice is not to worry about it too much.
If your loved one is in a coma, at least in the United States, they will not be denied care, at least not until the acute stage is over. While that doesn’t mean you won’t have financial hardship ahead, at this point, care will continue, regardless of how the bills get paid. At least in the United States, people with severe brain injuries are not denied acute care. In fact, the people who set hospital and insurance rates understand that and all of the rest of us pay a little more, on the chance that this kind of care is needed for someone who doesn’t have the ability to pay.
Other issues discussed on this page include:
Med Pay Coverage
Medical Assistance
Workers Compensation
Personal Injury Actions
Med Pay coverage is the medical bills coverage on your automobile (or sometimes homeowners) coverage.
Medical assistance is the federal Medicaid program (similar to Medicaid, but for poor and disabled persons.)
Workers comp is the coverage people are entitled to when injured at work.
Personal Injury actions is what the Brain Injury Law Group handles, where we sue a wrongdoer on the injured person’s behalf, to recover damages, including past and future medical bills.
There are no perfect answers in getting medical bills paid. But treatment is more important than avoiding them, and we encourage everyone to exhaust all avenues and insist on getting the treatment they need. A former client also suggested this site, which provided additional financial assistance to her because of her disabled condition. http://www.accessproject.org/about.html
What makes this worse for the accident victim, is that these challenges often coincides with disability, and often the resulting loss of health insurance.
12 years ago we first tackled this issue on our website http://waiting.com The specific link is http://www.waiting.com/medicalbills.html
This page begins with this statement:
Our first advice is not to worry about it too much.
If your loved one is in a coma, at least in the United States, they will not be denied care, at least not until the acute stage is over. While that doesn’t mean you won’t have financial hardship ahead, at this point, care will continue, regardless of how the bills get paid. At least in the United States, people with severe brain injuries are not denied acute care. In fact, the people who set hospital and insurance rates understand that and all of the rest of us pay a little more, on the chance that this kind of care is needed for someone who doesn’t have the ability to pay.
Other issues discussed on this page include:
Med Pay Coverage
Medical Assistance
Workers Compensation
Personal Injury Actions
Med Pay coverage is the medical bills coverage on your automobile (or sometimes homeowners) coverage.
Medical assistance is the federal Medicaid program (similar to Medicaid, but for poor and disabled persons.)
Workers comp is the coverage people are entitled to when injured at work.
Personal Injury actions is what the Brain Injury Law Group handles, where we sue a wrongdoer on the injured person’s behalf, to recover damages, including past and future medical bills.
There are no perfect answers in getting medical bills paid. But treatment is more important than avoiding them, and we encourage everyone to exhaust all avenues and insist on getting the treatment they need. A former client also suggested this site, which provided additional financial assistance to her because of her disabled condition. http://www.accessproject.org/about.html
TBI Survivor Uses Internet to Assist with Brain Injury Disability – Part II
Yesterday, a former client of mine, began this two part series on how to use the internet to help connect with those who were willing to assist her in accommodating her disability. Today, she addresses the question she ended yesterday’s blog with:
What do I do so that my friends and neighbors don’t begin to dread getting emails from me? What can I do to make them fun, interesting and maybe even enjoyable?One of the strengths that Cindy has maintained, is an immense creative capacity and the ability to express herself on the challenges she faces in daily life. And she spells a lot better than I do.
A thought came to me the day before a neighbor came over to help me clean up one of my flowerbeds. This particular flowerbed had been overrun with mint. I love mint, but the flowerbed is too far away for me to easily access it. Last year, I started a container garden to attract hummingbirds and butterflies. This year, I decided to expand by adding herbs and vegetables in some containers.
Since I was going to plant some of this mint in containers, I thought maybe some of my friends and neighbors might like to do the same. As we pulled up the mint, I cut them into individual plants which could be planted. My neighbor helped me take pictures of the process showing how to plant mint into a container.
Now I had something I could offer to my friends and neighbors. In addition to my “How to Plant Mint in a Container,” I also put together a few mint recipes. I sent out an email providing information, recipes, and the offer of mint plants to either plant or use in recipes. Last year, I took pictures of my container garden, including the caterpillar nursery filled with parsley, dill, and yes, even little caterpillars.
Hopefully, by doing things like this, I’m hoping that people want to spend time with me because I’m still interesting, not because they pity me. It’s been a fascinating challenge, and so far, this seems to be working. Some tell me they enjoy seeing my pictures and hearing about my experiments.
When I told one of my friends that I wanted to try growing pole beans on bamboo poles lashed together in a teepee fashion, she told me to let her know when I wanted to do it. Her 2 sons who are boy scouts learned how to lash things together and would be happy to practice how well they can use their skills in a practical application. In fact, she told me they have a saying with regards to the art of lashing: “If your frap is crap, your lash will be trash.” (Now I have something else interesting to learn….what the heck is a frap??? I’m not even sure I’ve spelled it correctly.)
My psychiatrist thinks I have come upon a great idea that may benefit not only people with handicaps, but also the elderly and others who need assistance and feel socially isolated. I know I am lucky to have retained many strengths from which to build upon. I know others might not feel as capable. But perhaps there are family members or friends who can initiate or facilitate these kinds of ideas, so that their loved one and the caretaker both have a larger support system. These are services which are greatly needed, but seldom provided. So, for now, we have to learn to think out of the box.
Cindy from Cinci
TBI Survivor Uses Internet to Assist with Brain Injury Disability
From a former client Cindy, a consistent source of ideas and content for my blogs. Cindy has found a novel way to use the internet to deal with day to day obstacles, brain injury survivors encounter.
Cindy will address her strategy for not wearing out her helpers in tomorrow’s blog.
Hi Everyone,\
I am a TBI survivor, going on almost 4 years now. Two of the hardest things for me to deal with have been: 1) asking others for help and 2) social isolation, particularly since I’ve lived alone during most of this time. I thought I’d share with you something I started doing which has helped with both of these issues.
First, it is so hard asking other people for help, especially when I used to be a person to whom others would turn when they needed help. Even though many of my friends told me I should see it as a way of allowing them the joy of helping me, it is still hard. I worried about what if I was asking particularly people too much of the time? And what if I asked them and it really wasn’t convenient for them, but they said they would help me?
This is a situation in which I am so thankful for the internet. I asked my friends and neighbors if they had internet access and if I could include them on my “Help Needed” email requests. I explained to them my dilemma of not wanting to bother them by asking them for them for help when it may not be convenient, not knowing who I should call first to ask for help, my concern that my friends and neighbors would burn out on my requests for help, etc. My “Help Requests” include: what I need help with and a goal date I’d like to accomplish the task.
Examples: Need help transporting my birds to get their nails and wings clipped; grooming is done every Thurs. from 1 – 7 p.m. Need help cleaning and organizing my family room; goal date—March 1. Need help taking items to Goodwill; goal date—April 1. Would like companionship to see a movie during “off hours” (i.e., weekdays before 4 p.m.); goal date—anytime.
So that no one feels pressured, I tell my friends: “If you can help me with something, call me and we’ll set up a time.” If people can’t or don’t want to help with certain things, they just don’t respond to my email. When I send out my next email request, I always make a point of thanking various people in my email. I do this so that everyone knows that my requests are spread out over many different people and no one person needs to feel pressured, like they are the only person who can help me.
My next dilemma was: What do I do so that my friends and neighbors don’t begin to dread getting emails from me? What can I do to make them fun, interesting and maybe even enjoyable? .
Cindy will address her strategy for not wearing out her helpers in tomorrow’s blog.
Another Service Dog Story
It is no surprise to me, that people are more open talking about their pets than themselves. We often enjoy hearing about them more too..
Katrina. What a fitting name. Of all the tragedy that came out of that storm, one of its great legacies will be that it forever taught our society that people’s pets are as important to them, as we are to the pets. Discriminate against a dog – you discriminate against that dog’s person. Our legal system has a hard time recognizing the “rights” of a dog. The lawyer in me turns that rhetoric a little by defining discrimination against a dog, as discrimination against a person, because of their “beliefs” and values, that a dog is precious and unique. The truly smart politician would do more than photo ops with his or her dog, but would stand up and demand that peoples need for their dogs receive that special status we reserve for so-called protected classes, such as race, religion or handicap status.
On May 1, 2008, at 7:50 PM, PR Latenser wrote:
I noted your blog comments where you defended service dogs…
Let me tell you about our service dog.
She is an 85 Lb Doberman.
We got her as a puppy because my wife was suffering classic symptoms of PTSD after her experience in Hurricane Katrina
I and we are good with dog training so we embarked upon training (originally an informal therapy dog) our dog to be a search and rescue dog.
She is a trailing dog that follows your trail when you get lost (very general definition)
Our Doberman; Katrina has an exemplary history:
· She had her first find at nine months when it typically takes 1.5 – 3 years to train a dog like this.
· She has been acting as an ambassador to the elderly and the young by giving kisses to them at awareness events since she was 3 months old.
· She works with multiple law enforcement agencies providing both evidence and rescue search services.
We are currently renters as we seek out a building site to build a home
We have experienced prejudices all over and we can usually disarm the uniformed (primarily because Katrina is so social that she wins them over)
Currently we have an insurance company for a property management firm that has reversed our rental approval after fees, deposits and first months rent have been paid.
I do not write to you because of our rental woes.
I do hope to find some insight to help me put a question to bed.
Is a search and rescue dog a service dog?
Is there a source of a definitive authority who can answer?
California Penal Code Sections 365.5(F) and 365.5(G)(2) seem to say it clearly in my mind; but, I still find those who become very animated with a differing opinion.
Katrina is individually trained
Katrina offers aid to anyone who has become in need of help due to being lost, injured, disoriented or immobilized.
Katrina has been determined to be a service dog and issued her service tags in Turlock, California
BUT: I am to understand that not all jurisdictions would agree with our counties determination.
I provide a link to the Federal definitions
http://www.ada.gov/animal.htm
Philip R. Latenser
Katrina. What a fitting name. Of all the tragedy that came out of that storm, one of its great legacies will be that it forever taught our society that people’s pets are as important to them, as we are to the pets. Discriminate against a dog – you discriminate against that dog’s person. Our legal system has a hard time recognizing the “rights” of a dog. The lawyer in me turns that rhetoric a little by defining discrimination against a dog, as discrimination against a person, because of their “beliefs” and values, that a dog is precious and unique. The truly smart politician would do more than photo ops with his or her dog, but would stand up and demand that peoples need for their dogs receive that special status we reserve for so-called protected classes, such as race, religion or handicap status.