California Spinal Cord Injury Lawyers

EVALUATING INJURY

A young lawyer today is far more likely to encounter a case involving paraplegia or quadriplegia than an experienced lawyer of twenty years ago. Clearly, victims of spinal cord injury benefit from recent medical advances in treatment, particularly rehabilitative treatment. Rehabilitation centers throughout the United States can assist (certainly more than twenty years ago) in getting the plaintiff back to a productive, albeit limited, lifestyle.

It is the challenge of the trial lawyer to obtain via settlement or trial, an adequate award for the injured plaintiff. An adequate award speaks to justice and provides the plaintiff the funds necessary to survive. Obviously, mere "survival" is meaningless if the plaintiff is not properly medically cared for.

As indicated above, liability must be thoroughly reviewed before acceptance of a spinal cord injury case. Thereafter, and only if liability justifies involvement, counsel must begin by evaluating the prospective client's spinal cord injury.

Counsel are admonished that no two spinal cord injury cases are the same. Damages in one paraplegia case are not the same as in another, and the same is true with quadriplegia cases. To be sure, there will be past, present, and future wage losses; past, present, and future medical expenses; pain and suffering; emotional distress; embarrassment and humiliation; physical, emotional, and psychological injuries; and attendant care costs coupled with special medical equipment costs. But each injured individual will have unique needs, and "humanizing" the plaintiff's case will dictate special attention to each such need.

For example, depending on the level of insult, the actual physical injury can be significantly different from plaintiff to plaintiff. The lower on the spine the insult, the better the chance is for mobility of the arm or hand, even in quadriplegic cases. Conversely, the higher the insult, it is likely the greater the impairment.

When evaluating injury in a spinal cord case, life expectancy must be taken into account. Inexperienced counsel, in a rush to emphasize the catastrophic nature of the plaintiff's injuries, can easily fall into a defense theory (backed with ample expert testimony) that plaintiff's injuries result in a shortened life expectancy. While the defense argument tends not to take into account the sweeping improvements in rehabilitative medicine (increased mortality) it is necessarily an emotionally "rational" argument for the jury, and counsel must meet the argument head on, and early in the trial.

When evaluating injury, therefore, counsel must, in an appropriate quadriplegia case, determine if respiratory problems exist. At its most devastating, a plaintiff may require the aid of a respirator because there is no longer control of breathing function. This may, depending on unique circumstances, arguably place the plaintiff at greater risk for respiratory infection.

Similarly, in a given case, bowel and bladder control may be non-existent. It is not uncommon for orifices to be tightly closed, necessitating the use of suppositories. Catheters are required for voiding, along with a "void bag" or other such depository. Again, concerns of potentially life threatening infection arise.

Concern of infection likewise arises from the risk of development of decubitus ulcers or pressure sores. There is no debate that decubitus ulcers are potentially life threatening, though with proper care, they should never develop. These sores are caused by prolonged external pressure. Given the lack of mobility caused by a spinal cord injury, a greater risk exists for the development of sores. The continued pressure on the particular point causes impairment of blood supply, depriving tissue of nutrition, causing tissue breakdown and the development of painful sores. Surgery is often a necessary result, with necrotic tissue leading to infection, and mandated debridements. For this reason, the protocol of most hospitals requires constant hourly turning of most victims of quadriplegia. A wrinkled sheet or underwear not perfectly even is a potential cause for the development of a pressure sore.

Simplistically, without a wheel chair and/or other medical equipment, each spinal cord injury client is at risk for death. Place a victim of quadriplegia alone in a closed room, door locked, without chair or other mobilization, and a very real risk of death occurs. Counsel is admonished never to lose track of this basic point. Add to mobilization problems, the problem of loss of feeling and function of limbs, and it is not difficult to realize the potential need for attendant care, without which life expectancy could be significantly shortened.

Spinal cord injuries are devastating injuries, mentally as well as physically. A once healthy, active life is abruptly reduced to a mind trapped in a body that will not work. In many instances, without proper intervention, all desire to exist dissipates. Psychiatric/ psychological intervention is a must. This is especially so given medications which may or may not be at issue. Significant neuronal damage, can for example, result in the prescription of such drugs as oxycontin or worse. Evaluation of a client's mental condition is therefore absolutely required.

Obviously, the evaluation of injuries does not end with potential life shortening sequelae, but goes individually much further. Counsel must work with appropriate experts and treatment team in order to address each of the issues relevant a particular case. Physiatrists, neurologists, orthopedics, psychologists, neuropsychologists, speech, occupational and physical therapists, recreational therapists, vocational rehabilitation counselors, nurses, patient's advocates, case managers, social workers, and other specialists are usual. Depending on the case, you may need to consult with a cardiologist, an infectious disease specialist, or numerous other medical sub-specialists.

In the remaining sections of this paper, I will discuss several specific areas of damage, including wage loss, loss of enjoyment of life, trauma to the marital relationship (loss of consortium), and extended claimants.