Brain Injury Lawyer Blog

Regulators scolded on medically unfit truckers

2008-07-25T08:03:00.000-07:00

Date: 07/24/2008 07:45 PM

By JOAN LOWY
Associated Press Writer

WASHINGTON (AP) _ House lawmakers scolded federal regulators Thursday for failing to implement recommendations made in 2001 that were designed to keep medically unfit commercial truck and bus drivers off the nation's highways.

House Transportation and Infrastructure Committee Chairman James Oberstar, D-Minn., told Rose McMurray, the chief safety officer for the Federal Motor Carrier Safety Administration, that deaths and injuries caused by medically unfit drivers are "on your conscience" because the agency has taken so long to act.

"I think if your agency had a safety mission and a safety mind-set it wouldn't have taken you eight years," Oberstar told McMurray at a hearing, demanding that she "carry back to your agency" his message to "get people moving."

He said the agency's efforts to fulfill the eight recommendations made by the National Transportation Safety Board "have been begrudging and painstakingly slow. ... The progress has been just about negligible."

McMurray said the agency has proposed one rule and is close to proposing another to address two of the recommendations — to merge the licensing and medical certification of commercial drivers, and to create a national registry of examiners approved to issue medical certificates — and has made progress on two other recommendations. However, she said it will be about three years before progress is evident on the remaining four recommendations.

"We have to make sure we do this right and we have to ensure there are not unintended consequences," McMurray said.

The NTSB made the recommendations in response to a 1999 motorcoach accident in New Orleans that killed 22, and put them on the agency's "most wanted" list in 2003.

In the New Orleans motorcoach accident, the NTSB said the bus driver, Frank Bedell, 46, suffered life-threatening kidney and heart conditions but held a valid license and medical certificate. A passenger recounted seeing the driver slumped in his seat moments before the crash.

Tractor-trailer and bus drivers have suffered seizures, heart attacks or unconscious spells while behind the wheel. Such illnesses have been a critical factor in thousands of serious truck accidents.

The NTSB recommended that examiners who certify drivers as medically fit be qualified and know what to look for, and that a system be set up to track medical certificate applications and prevent drivers from doctor shopping.

A study by the House committee found that it's so easy to fabricate the medical certificates required to operate commercial trucks and buses that there's almost no incentive for drivers to obtain a legitimate document.

There are so few controls over how drivers obtain medical certificates that it's "relatively easy for a motivated commercial driver to circumvent the physical examination requirement," the study found. Nor is there any database or central repository which would allow state inspectors to verify the legitimacy of a medical certificate.

"Because so few attempts are made to authenticate a certificate, there is little risk that a driver will be caught if he or she forges or adulterates a certificate," the study said.

The study was based on a sample of 614 medical certificates obtained from truck drivers at roadside inspections in California, Illinois and Ohio. The committee's staff attempted to contact the examiners named on the medical certificates but could only verify 407 as valid.

One Ohio doctor contacted by the committee said forgery of medical certificates is so commonplace "no one gets alarmed by it anymore."

Hundreds of thousands of drivers carry commercial licenses even though they also qualify for full federal disability payments, according to a U.S. safety study disclosed by The Associated Press earlier this week.

The Government Accountability Office said in the study that 563,000 commercial drivers were determined by the Veterans Affairs Department, Labor Department or Social Security Administration to also be eligible for full disability benefits over health issues. It said disability doesn't necessarily mean a driver is unfit to operate a commercial vehicle, but its investigators found alarming examples that raised doubts about the safety of the nation's highways.

___

On the Net:

House Transportation and Infrastructure Committee: http://transportation.house.gov/
http://semi-accident.net

Copyright 2008 The Associated Press.

House committee probes medically unfit truckers

2008-07-24T08:11:00.000-07:00

As we commented on earlier this week, the issue of the medical fitness of truck drivers has been in the news. In conjunction with that is the below story from the AP about hearings of the House Transportation and Infrastructure Committee. We will continue to monitor this story carefully, as the issue of the safety of our nation's truck drivers is of the highest order.

Attorney Gordon Johnson,
http://semi-accident.com
http://tbilaw.com
http://waiting.com
http://vestibulardisorder.com
http://youtube.com/profile?user=braininjuryattorney
g@gordonjohnson.com
800-992-9447
©Attorney Gordon S. Johnson, Jr. 2008

Date: 07/24/2008 03:24 AM

By JOAN LOWY
Associated Press Writer

WASHINGTON (AP) _ It's so easy to fabricate the medical certificates required to operate commercial trucks on the nation's highways that there's almost no incentive for truckers to obtain a legitimate document, according to a congressional study.

The House Transportation and Infrastructure Committee's study — expected to be released at a hearing Thursday — found that there are so few controls over how drivers obtain medical certificates that it's "relatively easy for a motivated commercial driver to circumvent the physical examination requirement." Nor is there any database or central repository which would allow state inspectors to verify the legitimacy of a medical certificate.

"Because so few attempts are made to authenticate a certificate, there is little risk that a driver will be caught if he or she forges or adulterates a certificate," according to the report, which was obtained by The Associated Press.

The Transportation Committee's study was based on a sample of 614 medical certificates obtained from truck drivers at roadside inspections in California, Illinois and Ohio. The committee's staff attempted to contact the medical examiners named on the certificates but could only verify 407 as valid.

One Ohio doctor contacted by the committee said forgery of medical certificates is so commonplace "no one gets alarmed by it anymore."

The committee called officials of the Federal Motor Carrier Safety Administration to explain at the hearing why the agency hasn't fully implemented recommendations made nearly seven years ago on how to keep medically unfit truck drivers off the road. The witness list also included officials from the National Transportation Safety Board, which made the recommendations.

The NTSB made the recommendations in September 2001 in response to a 1999 motorcoach accident in New Orleans that killed 22. They have lingered on the NTSB's "most wanted" list of safety improvements for five years.

In the New Orleans motorcoach accident, the NTSB said the bus driver, Frank Bedell, 46, suffered life-threatening kidney and heart conditions but held a valid license and medical certificate. A passenger recounted seeing the driver slumped in his seat moments before the crash.

Bedell died three months later of an apparent heart-related illness. Investigators said he was treated at least 20 times in the 21 months before the accident for various ailments.

Tractor-trailer and bus drivers have suffered seizures, heart attacks or unconscious spells while behind the wheel. Such illnesses have been a critical factor in thousands of serious truck accidents.

The NTSB recommended that examiners who certify drivers as medically fit be qualified and know what to look for, that a system be set up to track medical certificate applications and prevent drivers from doctor shopping, and that a mechanism be provided for reporting drivers with potentially debilitating medical conditions.

Hundreds of thousands of drivers carry commercial licenses even though they also qualify for full federal disability payments, according to a new U.S. safety study disclosed by The Associated Press earlier this week.

The Government Accountability Office said in the study that 563,000 commercial drivers were determined by the Veterans Affairs Department, Labor Department or Social Security Administration to also be eligible for full disability benefits over health issues. It said disability doesn't necessarily mean a driver is unfit to operate a commercial vehicle, but its investigators found alarming examples that raised doubts about the safety of the nation's highways. They identified more than 1,000 drivers with vision, hearing or seizure disorders, which generally would prohibit a trucker from obtaining a valid commercial license.

Truckers violating federal medical rules have been caught in every state, according to an AP review of 7.3 million commercial driver violations compiled by the Transportation Department in 2006, the latest data available. Texas, Maryland, Georgia, Florida, Indiana, Pennsylvania, Illinois, Michigan, Alabama, New Jersey, Minnesota and Ohio were states where drivers were sanctioned most frequently for breaking medical rules, such as failing to carry a valid medical certificate. Those 12 states accounted for half of all such violations in the United States.

Copyright 2008 The Associated Press.

Alcohol Toxicity Increases Exponentially with Other Factors

2008-07-22T18:43:00.000-07:00

In the previous blog, the AP story is about a man arrested with a lethal dose of alcohol concentration in his blood, .491%. Not only did he survive (the highest known level for someone who did) he was driving prior to his arrest.

Intoxicated driving is a particularly relevant topic for a brain injury attorney, as so much of what we do involve motor vehicle wrecks. It has and always will be one of the most serious hazards on the roads. As someone who has dealt with BAC's over .30 on occasion, this one is staggering. The highest I have run into in my practice is a .40, but that was in a young man who died of alcohol intoxication.

The highest I encountered with a defendant driver was a .32, which quite outrageously was in a pharmacist, who was actually “on call”. He admitted to me in his deposition (shortly before the case settled) that any concentration above .30 is potentially lethal.

Alcohol and driving don't mix. But the equation isn't quite that simple. Alcohol, driving and late night driving, are particularly dangerous.

Fatigue is one of the single biggest factors in alcohol related accidents and way too many people, drive the drunkest, when they would otherwise be asleep. In addition to the far too common situation of an intoxicated driver falling asleep, alcohol is particularly dangerous when an unexpected situation presents itself to the driver.

Pure reaction time doesn't change dramatically at and around the legal limit of .08, but unexpected reaction times change significantly. By unexpected reactions times I mean the type of situation where something unexpected happened that required the driver to think and use instant judgment, as part of the reaction.

What makes the combination of fatigue and alcohol so deadly is that fatigue has very similar effects on situational reaction. Add the two risk factors together and you have an exponential increase in danger.

Attorney Gordon Johnson
http://tbilaw.com
http://waiting.com
http://vestibulardisorder.com
http://youtube.com/profile?user=braininjuryattorney
g@gordonjohnson.com
800-992-9447
©Attorney Gordon S. Johnson, Jr. 2008

RI cops arrest man with 0.491 blood alcohol level

2008-07-22T18:40:00.000-07:00

Date: 07/22/2008 09:02 PM

RI cops arrest man with 0.491 blood alcohol level

PROVIDENCE, R.I. (AP) _ State police say they arrested a man early Tuesday whose blood alcohol level was 0.491 percent — the highest ever recorded in Rhode Island for someone who wasn't dead.

Stanley Kobierowski was taken to a hospital, put in the detoxification unit and sedated, said Maj. Steven O'Donnell. He was arraigned Tuesday on charges of driving while intoxicated and resisting arrest, and he was released after promising to appear Friday at a court hearing.

"The person's lucky they survived," O'Donnell said. "There's no doubt he would have gotten killed or killed someone if he had continued on the route he was taking."

A phone listing for Kobierowski could not be found, and he did not have a lawyer in court Tuesday.

Kobierowski, 34, of North Providence, was arrested after he drove into a highway message board on Interstate 95 in Providence, O'Donnell said.

After police arrived, Kobierowski had trouble getting out of the car, then grabbed it and refused to move, forcing troopers to carry him to the breakdown lane before taking him back to their barracks, O'Donnell said.

A breath test showed blood alcohol readings of 0.489 percent, followed by 0.491, O'Donnell said, the highest readings state officials could remember for someone who didn't end up dead.

The legal limit in Rhode Island is 0.08. A level of 0.30 is classified as stupor, 0.4 is comatose and 0.5 is considered fatal, according to the health department.

Copyright 2008 The Associated Press.

Accommodation of Disability versus Public Safety in Tractor Trailer Operation

2008-07-21T08:54:00.000-07:00

The Blog below about sick truck drivers hits close to home for me, both as an attorney who believes our lawsuits ultimately make the roads safer, but also as an advocate for those injured.

In seemingly every case, I have a client whose ability to drive is impaired in some way by his or her brain injury. If you were to run a list of brain injury symptoms, almost every symptom on that list would reduce to some extent, a person’s capacity to drive under certain traffic conditions. While taking someone’s drivers license is the equivalent to a prison sentence in some ways, it is still imperative to the public safety and the already vulnerable person’s safety, that they not take unnecessary risk of a wreck.

In most of my cases, the brain injured person works out a compromise on this issue, driving only under limited circumstances, near home, during periods of light traffic. I am never happy with this, because one can never completely plan for the unexpected when driving, and it is the unexpected that causes the distraction, that results in the wreck.

But while all life is compromises -balancing risk against rewards, when you are talking about the huge public safety issue involved in driving an 18 wheeler, then there can be no compromise. The risk is so great, no individually based reward can justify it. The Federal Motor Carrier Safety rules are strict for a reason: trucks are just too dangerous in the hands of someone incapable of handling all of the stresses involved. But we must do more than have strict rules, we must have a compliance policy that ensures that all truck drivers are safe.

We discuss these issues at length at our page http://semi-accident.com/ While as an advocate, I am always pushing to able, not disable my clients, trucking is not an a field for accommodation, trial and error. Drivers, carriers and regulators must assure that everyone behind the wheel of an 18 wheeler is fully capable.

Attorney Gordon Johnson,
http://semi-accident.com
http://tbilaw.com
http://waiting.com
http://vestibulardisorder.com
http://youtube.com/profile?user=braininjuryattorney
g@gordonjohnson.com
800-992-9447
©Attorney Gordon S. Johnson, Jr. 2008

Deadly Tolls: Sick truckers causing fatal wrecks

2008-07-21T08:03:00.000-07:00

Date: 07/21/2008 07:22 AM

By HOPE YEN

WASHINGTON (AP) _ Hundreds of thousands of tractor-trailer and bus drivers in the United States carry commercial driver's licenses despite also qualifying for full federal disability payments, and some of those drivers have suffered seizures, heart attacks or unconscious spells, according to a new U.S. safety study obtained by The Associated Press.

The problems threatening highway travelers persist despite years of government warnings and hundreds of deaths and injuries blamed on commercial truck and bus drivers who blacked out, collapsed or suffered major health problems behind the wheels of vehicles that can weigh 40 tons or more.

The U.S. agency responsible for cracking down on unfit truckers, the Federal Motor Carrier Safety Administration, acknowledges it hasn't completed any of eight recommendations that U.S. safety regulators have proposed since 2001. One would set minimum standards for officials who determine whether truckers are medically safe to drive. Another would prevent truckers from "doctor shopping" to find a physician who might overlook a risky health condition. It's unclear whether any of the eight recommendations will be done before President Bush leaves office.

"We have a major public safety problem, and we haven't corrected it," said Gerald Donaldson, senior research director at the Washington-based Advocates for Highway and Auto Safety, whose members include consumer, health and safety groups and insurance companies. "You have an agency that is favorably disposed to maintaining the integrity of the industry's economic situation."

Truckers violating federal medical rules have been caught in every state, according to a review by the AP of 7.3 million commercial driver violations compiled by the Transportation Department in 2006, the latest data available. Texas, Maryland, Georgia, Florida, Indiana, Pennsylvania, Illinois, Michigan, Alabama, New Jersey, Minnesota and Ohio were states where drivers were sanctioned most frequently for breaking medical rules, such as failing to carry a valid medical certificate. Those 12 states accounted for half of all such violations in the United States.

Consider these cases:

—A Florida bus driver who suffers from lung disease and uses three daily inhalers to control breathing told congressional investigators that he "occasionally blacks out and forgets things." He works as a substitute driver despite not having a medical certificate, and his commercial license expires in 2010. The driver, who was not identified but will figure prominently in a congressional hearing this week, has collected Social Security benefits since 1994. He confided to investigators that he "gets winded" walking to his mailbox but has no problem driving a passenger bus.

—A Virginia trucker with a prosthetic leg from a farm accident more than 10 years ago is permitted to drive tanker trucks until at least 2012, even though he doesn't have the proper federal paperwork required for amputees. Virginia revoked the medical license for the official who approved him to drive over charges the official was caught illegally distributing controlled substances.

—George Albright Jr., 61, smashed his 70,000-pound tractor-trailer into congested traffic on Interstate 70 in June 2006, killing four women in a Ford sedan about 30 miles east of Columbia, Mo. Albright's employer agreed earlier this year to pay $18 million in a settlement. A Missouri jury acquitted Albright this month on four counts of second-degree involuntary manslaughter, after his lawyers argued in court that a diabetic episode "put him in an altered state of consciousness." Albright wasn't injured.

—A gasoline tanker plunged from an overpass and exploded in flames on Interstate 95 near Baltimore in January 2004, killing four people. Witnesses reported the driver slumped over the wheel. Maryland investigators concluded the driver, Jackie M. Frost, had suffered a heart attack or other medical emergency, but his family disputed that.

—The driver of a 15-passenger "Tippy Toes" day-care bus traveling 63 mph on Interstate 240 in Memphis, Tenn., in April 2002 crashed into a bridge, killing the driver and four of the six children aboard. The National Transportation Safety Board said the driver, Wesley B. Hudson, 27, fell asleep, "quite likely due to an undiagnosed sleep disorder." Investigators said children sometimes had to wake up Hudson, whom the NTSB described as obese and a marijuana user.

—A 55-passenger bus rolled off Interstate 610 in New Orleans in May 1999, killing 22 passengers. The NTSB said the bus driver, Frank Bedell, 46, suffered life-threatening kidney and heart conditions but held a valid license and medical certificate. Moments before the crash, a passenger recounted seeing the driver slumped in his seat. Bedell died three months later of an apparent heart-related illness. Investigators said he was treated at least 20 times in the 21 months before the accident for various ailments.

Some truckers said the government should enforce existing rules, not make new ones.

"Do you enjoy your clothing and house? Without the truck driver you would have none of it," said Gary Hull, 52, a trucker for a Louisiana company, as he drove from Edinburg, Texas, to Mansfield, La. "Our economy is based on the truck. People don't understand the ramifications of making it more restrictive for truck drivers to drive."

Hull said most drivers are hard workers who earn a modest salary and cope with rising diesel prices. New regulations could add to costs and force truckers to evade the rules, he said.

The Transportation Department said 5,300 people died in crashes involving large commercial trucks or buses in 2006, the latest year for which figures are available, and about 126,000 more were injured. A federal safety study last summer found that cases where drivers fell asleep, suffered heart attacks or seizures or otherwise were physically impaired were a leading cause of serious crashes involving large trucks. But those cases included healthy drivers who fell asleep.

"The problem is major. It's one of the biggest causes of occupational death in the United States today," said Dr. Kurt Hegmann, chairman of the FMCSA's medical oversight board, which is urging more doctor visits in many cases for truckers with serious medical conditions.

While it may be years before any of the board's proposals take effect, there is nothing preventing doctors from stepping up scrutiny of drivers' medical conditions right away, Hegmann said.

Congress may take action soon. The House Transportation and Infrastructure Committee, led by Rep. James Oberstar, D-Minn., will conduct oversight hearings Thursday. One proposal would create a clearinghouse for drug test results for commercial truck drivers to make it easier for employers to conduct checks. Oberstar's committee asked the Government Accountability Office to investigate unfit truck drivers.

The 30-page GAO study, obtained by the AP in advance of its release later this week, said 563,000 commercial drivers were determined by the Veterans Affairs Department, Labor Department or Social Security Administration to also be eligible for full disability benefits over health issues. It said disability doesn't necessarily mean a driver is unfit to operate a commercial vehicle, but its investigators found alarming examples that raised doubts about the safety of the nation's highways. They identified more than 1,000 drivers with vision, hearing or seizure disorders, which generally would prohibit a trucker from obtaining a valid commercial license.

The chief safety officer for the Federal Motor Carrier Safety Administration, Rose McMurray, acknowledged problems that could lead to unfit truck drivers on the roads. She blamed delays in reforms on a lack of federal money and difficulty coordinating with 50 states. McMurray said changes to strengthen the medical oversight program may not be done for months or even years.

"We have done a lot to recognize the deficiencies in our medical oversight program, and the building blocks we're establishing are very smart and very strong," McMurray said.

Families of crash victims said stronger safety rules can't happen soon enough.

William Hieronymus II of Salina, Kan., said he remembers eating cereal each morning with his 10-month-old son. His son William and wife, Amanda, died in May 2005 when a truck crossed a median and struck their SUV.

The driver, Scott A. Wegrzyn, pleaded guilty to two counts of vehicular homicide. Prosecutors said Wegrzyn knew he suffered from sleep apnea and went to a second doctor without disclosing the condition to obtain the medical certification he needed to drive.

"I try to go through a day without crying," Hieronymus said during Wegrzyn's trial. "I wonder every day what (Will) would have grown up to be, what he would have stood for."

___

On the Net:

Federal Motor Carrier Safety Administration: http://www.fmcsa.dot.gov/

Advocates for Highway and Auto Safety: http://www.saferoads.org/

Government Accountability Office: http://www.gao.gov/

Copyright 2008 The Associated Press.

Another Waiting.com Coma Tragedy

2008-07-19T08:21:00.001-07:00

From another reader, who got solace from our advocacy on http://waiting.com:

Attorney Gordon Johnson

On Jul 14, 2008, at 7:31 PM, Alina Higuera wrote:
Hello My name is Alina I come from a family of ten kids 7 girls and 3 boys It seems as if my family and I are reliving the devastation of my brothers ( 3rd born ) brain injury that occured on Dec 3, 1979. his injuries were caused by blunt force trauma to the head, he fell out of the back of a pick up truck. The part of the brain that was damaged was at the brain stem. After being in a coma for 3 mo. he returned to us, having to relearn how to do everything, unfortunatly my brother never did regain use of his legs and was able to move his right arm only. he remained very inteligent as he was before this happened. All of his sences were very much intact including pain. He could'nt move anything but he could feel everything, I remember so many many times he would yell for me to come and scratch his itch because he was unable to and we all know how irritating that is, pain was another thing that my brother could feel, it would break my heart to see the unbearable pain on his face when he would be getting therapy or just cleaning him up. My brother lived in that hell for 31 yrs and never one time did I ever hear him feeling sorry for himself, he was always smiling and without fail the first one to say "Good Morning" and nerver forgot a birthday and was the one always doing the cheering up. We lost my brother on Feb 15, 2008 although he is greatly missed I am happy that he is no longer suffering from the bondage that he lived with and through for so many years. On July 12, 2008 my older sister ( 5th born ) 51 years old went into cardiac arrest while visiting another sister over the weekend, after returning from a quick errond as she walked into the front door she found my sister face down on the ground not breathing and with no pulse, she began to administer CPR immediatly, as she called out for help a neighbor came running who happens to be a lifegaurd and assisted my sister with CPR paramedics finally arrived still with no pulse or breathing they began chest compressions and then the electric paddles to try and start the heart, finally after about 15 mins they were able to feel a faint pulse. My sister now lays in a coma on a breathing machine with no responsive reaction. She was having seizures that were coming between every 15 to 30 secs of eachother. because of the lack of oxygen to the brain they say that she does have significant brain damage now to what extent we are not at all sure. Seeing my sister hooked up to machines and just laying there is a de ja vu of 31 years ago. My heart is breaking for my mom because as before she sits along side of my sisters bed talking to her and insisting that she will be just fine as she did with my brother. I can only hope and pray that she comes out of this and returns back to normal ( as normal as possible ) for the sake of my sister she would never want to live as my brother did ( we have all discussed it many times ) and as for the sake of my mom I can only hope and pray and hope and pray that she is strong enough to handle whatever the outcome will be. Only time will tell the fate of my sister, I love her and I miss her sooo very much and God willing she will come back the way she was.

Thank You for reading my story and even more for allowing me to write about it and somewhat releasing it from inside of me.

Alina Higuera

Hello Gordon,

I was so hoping to get a reply back from you. I am very sad to say that after sending this email, we were informed that due to the lack of oxygen to the brain, that my sister was brain dead and that they could do no more for her. She was removed from the machines and to much surprize was breathing on her own for about 36 hrs. she passed away July 18. You absolutley have my permission to post this on your blog, I can only hope that it will bring some comfort to the surviving relatives that they are not alone. Thank You so much for your response.

Alina Higuera

Attorney Gordon Johnson
http://subtlebraininjury.com
http://tbilaw.com
http://waiting.com
http://vestibulardisorder.com
http://youtube.com/profile?user=braininjuryattorney
g@gordonjohnson.com
800-992-9447
©Attorney Gordon S. Johnson, Jr. 2008

Kudos for our Coma Advocacy

2008-07-16T16:51:00.000-07:00

From a user of http://waiting.com:

Attorney Gordon Johnson
http://subtlebraininjury.com
http://tbilaw.com
http://waiting.com
http://vestibulardisorder.com
http://youtube.com/profile?user=braininjuryattorney
g@gordonjohnson.com
800-992-9447
©Attorney Gordon S. Johnson, Jr. 2008

I was thumbing through some old email and I ran across yours. I remember writing you when my mother fell into coma. I remember how helpful this website was to me. How you help me and my family to understand what my mother was going through. I especially like how this site explained all the many different tubes and meaning of words surrounding coma. It educated me, it made me apart of the process. I enjoyed that very much.

My mother was 68 years old and lost the battle of recovery, however, this site helped me to deal with that also. This site gave me hope and kept me inform of what could happen. This site helped prepared me for the future without my mom. I thank God for giving me the strength to go though this and I thank you for educating me on coma so that I know what to pray for. My mother was laid to rest April 5, 2008. Thank you for being there for me.

Sonia

Obama and McCain urged to Attend Military Head Injury Conference

2008-07-12T14:02:00.000-07:00

From the Brain Injury Association of America:

Dear Advocates:

BIAA issued a press release today urging both presidential candidates to attend the 2008 Fort Hood Presidential Town Hall and engage in an in-depth discussion of the increasingly complex issues facing America’s military and veterans community, including the rate of traumatic brain injury among returning service members. BIAA is a member of the 2008 Forth Hood Presidential Town Hall Consortium, and the event is tentatively scheduled to occur on August 11, 2008.

In other news, in a welcome and surprising turn of events this week, the Senate voted by a veto-proof margin to pass a key Medicare bill (H.R. 6311), which the House and Senate had previously been unable to agree on before the July Fourth congressional recess. The final Medicare package, which will prevent deep cuts in Medicare payment rates for physicians which had been scheduled to begin on July 1, was previously passed by the House on June 24.

The Medicare bill also contains important delays in the implementation of Medicare’s competitive bidding program for Durable Medical Equipment (DME), and an extension of the Medicare outpatient therapy cap exceptions process.

It is anticipated that President Bush will veto the bill, however, and although the Senate passed the bill with a veto-proof margin earlier this week, the White House needs only three Senators to switch their votes in order for a veto override to fail. Thus, it is extremely important that advocates visit BIAA’s Legislative Action Center to take action TODAY to urge their Senator to vote to override the President’s expected veto. To do so, please visit http://capwiz.com/bia/callalert/index.tt?alertid=11604356.

The Fiscal Year 2009 appropriations process to be stalled, as the House Appropriations Committee does not plan on marking up any more bills this summer after a partisan dispute erupted in recent weeks over amendments on energy policy. And while the Senate Appropriations Committee plans to have all 12 of its bills approved by the panel by the end of this month, Senate Majority Leader Harry Reid (D-Nev.) said this week that action on appropriations in his chamber will be very limited during the next few months.

*Distributed by Laura Schiebelhut, BIAA Director of Government Affairs, on behalf of the Brain Injury Association of America; 703-761-0750 ext. 637; lschiebelhut@biausa.org

BIAA’s Policy Corner and Legislative Action Alerts are made possible by the Centre for Neuro Skills, James F. Humphreys & Associates, and Lakeview Healthcare Systems, Inc. The Brain Injury Association of America gratefully acknowledges their support for legislative action.

To sign up to receive future BIAA Policy Corner E-Newsletters and Legislative Action Alerts, please go to http://capwiz.com/bia/mlm/signup/
__________________________________________________________________

BIAA Urges Presidential Candidates to Participate in Fort Hood Town Hall Event

BIAA issued a press release today urging both presidential candidates to attend the 2008 Fort Hood Presidential Town Hall and engage in an in-depth discussion of the increasingly complex issues facing America’s military and veterans community, including the rate of traumatic brain injury among returning service members. BIAA is a member of the 2008 Fort Hood Presidential Town Hall Consortium, and the event is tentatively scheduled to occur on August 11, 2008.

The Consortium planning the event includes a diverse group of military, veterans and community-service organizations, including Disabled Veterans of America, the Brain Injury Association of America, and Sentinels of Freedom. These groups are working in partnership with the military, the Department of Veterans Affairs, state and local governments, and faith and community-based organizations to deliver services and support to our military, veterans and families.

In the press release, BIAA President and CEO Susan H. Connors states, “Traumatic brain injury (TBI) is a common consequence of any war. TBI is recognized as the ‘signature wound’ of the current conflict; yet, accessing the right treatment, right now remains a challenge for many wounded service members and veterans. Our troops and the millions of civilians who sustain TBIs here at home need proper screening and diagnosis, expert rehabilitation, and ongoing community-based services. Family caregivers need information, training and support, and voters everywhere need to let the presidential candidates know where we stand.”

To view BIAA’s press release in its entirety, please visit our website at http://www.biausa.org/policyissues.htm.

Surprise Appearance By Senator Kennedy Pushes Senate to Pass Medicare Bill

In a welcome and surprising turn of events this week, the Senate voted by a veto-proof margin of 69-30 to pass a key Medicare bill (H.R. 6311), after a unexpected, dramatic appearance and “aye” vote by Sen. Edward M. Kennedy (D-MA) on Wednesday. Sen. Kennedy had not been in the Capitol for six weeks, as he is recovering from surgery in early June to remove a malignant brain tumor.

The House and Senate had previously been unable to agree on a Medicare package before the July Fourth congressional recess. The final Medicare bill, which would prevent deep cuts in Medicare payment rates for physicians which had been scheduled to begin on July 1, was overwhelmingly passed by the House on June 24, but before Senator Kennedy’s appearance had been unable to gain Senate passage.

In addition to replacing a 10.6 percent cut to Medicare’s physician payment rates with 18 months of stable payments, the Medicare bill also contains an 18-month delay in implementation of Medicare’s competitive bidding program for Durable Medical Equipment (DME), as well as an 18-month extension of the Medicare outpatient therapy cap exceptions process.

It is anticipated that President Bush will veto the bill, however, and although the Senate passed the bill with a veto-proof margin earlier this week, the White House needs only three Senators to switch their votes in order for a veto override to fail. If the President delays acting on the bill, or Congress is unable to override an expected veto, the physician payment cuts and DME competitive bidding program will go into effect, and the outpatient therapy caps exceptions process will continue to be expired (as of June 30, 2008). Thus, it is extremely important that advocates visit BIAA’s Legislative Action Center to take action TODAY to urge their Senator to vote to override the President’s expected veto. To do so, please visit http://capwiz.com/bia/callalert/index.tt?alertid=11604356.

Fiscal 2009 Appropriations Process Still Stalled

The Fiscal Year 2009 appropriations process continues to be stalled, as the House Appropriations Committee does not plan on marking up any more bills this summer after a partisan dispute erupted in recent weeks over amendments on energy policy. And while the Senate Appropriations Committee plans to have all 12 of its bills approved by the panel by the end of this month, Senate Majority Leader Harry Reid (D-Nev.) said this week that action on appropriations in his chamber will be very limited in the next few months.

There continues to be widespread speculation that this year’s appropriations process will eventually become stagnant this fall, as Democrats may wait for the president to leave office before completing work on the funding bills in order to avert a promised veto.

CQ Today reported earlier this week, “Reid (D-Nev.) said his chamber will likely consider, at the most, two fiscal 2009 appropriations bills this year before passing a continuing resolution (CR) in September that would keep the government funded at current levels into early next calendar year, when a new president takes office. The new fiscal year begins Oct. 1” (CQ Today, David Clarke, 7/10/08).

The full Senate Appropriations Committee has approved the Labor, Health and Human Services (HHS), and Education funding bill, which provides the same funding amounts for several TBI programs as last year. This includes $5.7 million for TBI programming within the Centers for Disease Control and Prevention (CDC) and $8.754 million for the HRSA TBI State Grant Program.

The House Labor, Health and Human Services (HHS), and Education Appropriations funding bill has only been passed by the House Subcommittee and not the full House Appropriations Committee. The House Subcommittee markup contains increased funding for some federal TBI programs compared to last year. The bill includes $11 million for the HRSA TBI State Grant Program (+$2.246 million over last year) and $6.6 million for TBI programming within CDC (+$0.9 million over last year).

We agree that one of the most pressing issues for the next administration, is better care for returning vets, and also for all brain injury survivors.

Attorney Gordon Johnson
http://subtlebraininjury.com
http://tbilaw.com
http://waiting.com
http://vestibulardisorder.com
http://youtube.com/profile?user=braininjuryattorney
g@gordonjohnson.com
800-992-9447
©Attorney Gordon S. Johnson, Jr. 2008

Kind Words about http://tbilaw.com from New Zealand

2008-07-08T20:39:00.000-07:00

Below is an email we received with respect to our websites and web advocacy.

Attorney Gordon Johnson
http://subtlebraininjury.com
http://tbilaw.com
http://waiting.com
http://vestibulardisorder.com
http://youtube.com/profile?user=braininjuryattorney
g@gordonjohnson.com
800-992-9447
©Attorney Gordon S. Johnson, Jr. 2008

To Gordon Johnson and team, I thank you so much for your site. My name is Wendy and I am a 44 year old woman from New Zealand. I am a victim of Multiple TBI's. As a child I sustained many head injuries (alot was me being knocked out), and have recieved many since. Most of which I have been knocked out many times, some for long periods, but mainly having the back of my head hitting the ground before any other part of my body. The worst injury I sustained was in 2001 when I had a home invasion and was beaten by 2 people wearing work boots being knoked for 8 or 9 hours. That was the second time I had been knocked out for that long. Other instances were being unconcious for up to 2 hours.

I found your site very easy to understand and informative. All of the symptoms you described were me wrapped up into one big ball. A brain damaged mess with what as a future?!

I do wish so much that your firm was over here in New Zealand as I have had no help from our 'system' as one may put it.
Thanks so much for putting this information on the net. People need to understand more about becoming brain damaged and how it affects the victim and how it changes them. Its helped me with my youngest daughter (13), as she never really understood why Mum wasnt like she used to be. I really hope that someday in someway that there will be some miracle cure for thoses affected by TBI or Multiple TBI's..

Kindest Regards, Wendy. :o)

Suicide Statistics

2008-07-07T13:33:00.000-07:00

On my other blog, http://tbilaw.blogspot.com I have been writing about suicide and brain injury. This chart shows important statistics about suicide. Click on the chart to see it in full size.

Attorney Gordon Johnson
http://subtlebraininjury.com
http://tbilaw.com
http://waiting.com
http://vestibulardisorder.com
http://youtube.com/profile?user=braininjuryattorney
g@gordonjohnson.com
800-992-9447
©Attorney Gordon S. Johnson, Jr. 2008

What resources are available online for someone who is suicidal?

2008-07-06T21:30:00.000-07:00

I have devoted most of the last month to blogging about the interplay between emotional issues and brain damage, especially focused on military injuries. See http://tbilaw.blogspot.com Regardless of what the underlying cause of someone's despair, it is critical that he or she reaches out for help. I asked my research assistant this question: What resources are available online for someone who is suicidal?

Here is what she put together for me:

The internet and 1-800 free hotlines seem to be quick and helpful sources of information for someone who has suicidal thoughts.

Since, there are so many websites, it is impossible to list them all. Here are some good starting points for help.

http://www.metanoia.org/suicide/

This website was written by Martha Ainsworth who based her information and inspiration from David Conroy, Ph. D. David Conroy is the Executive Director of Suicide Prevention Resource and author of a Suicide Prevention book, Out of the Nightmare: Recovery from Depression and Suicidal Pain.

The website features "The Samaritans" (http://www.metanoia.org/suicide/samaritans.htm) who are trained volunteers available 24 hours a day to listen by email or phone. A Samaritan volunteer can be reached by email at: jo@samaritans.org or by phone at: 1-800-365-4044 and additional numbers can be found at: http://www.befrienders.org/, which is an organization affiliated with The Samaritans.

The site also suggests that someone having suicidal thoughts could talk to a therapist online. Therapist online can answer your email questions and provide online counseling. All of the online therapists listed provide online counseling for a fee, however, The Samaritan remains free. The website for this information is: http://www.metanoia.org/imhs/clinics.htm

There is also information about a Depression support group, Walkers in Darkness, who provide support and information for others who our suffering from depression.

The website for this information is: http://www.walkers.org/

Lastly, if you have the time and patience you can also find a therapist who can help you work through your suicidal problems. http://www.find-a-therapist.com/ For information on how to pick the best therapist for you see:

http://www.goodtherapy.org/custom/blog/2007/05/14/how-to-choose-a-counselor-or-therapist/

It is important that someone who has suicidal thoughts talk to someone and does not keep the thoughts to themselves. There is plenty of helpful information out there and many people that want to help.

Attorney Gordon Johnson
http://subtlebraininjury.com
http://tbilaw.com
http://waiting.com
http://vestibulardisorder.com
http://youtube.com/profile?user=braininjuryattorney
g@gordonjohnson.com
800-992-9447

©Gordon S. Johnson, Jr. 2008

Thoughts on Dog Breeders: Dog lovers or dog sickness?

2008-07-03T20:31:00.001-07:00

My passion for brain injury began as a partnership with an exceptional advocate, Becca Martin. She continues to be propelled by advocacy, although of a different nature. But her advocacy is so genuine and passionate that sometimes I devote this blog to her passion for dogs.
Attorney Gordon Johnson
http://subtlebraininjury.com
http://tbilaw.com
http://waiting.com
http://vestibulardisorder.com
http://youtube.com/profile?user=braininjuryattorney
g@gordonjohnson.com
800-992-9447

©Gordon S. Johnson, Jr. 2008

I knew a dog breeder once. She was a friend I met through work. She bred collies and shelties out of her home. Back then I didn't know this was called a backyard breeder. Her house had that overwhelming smell of dogs as the shelties lived indoors. The collies had kennels in the yard. The puppies were raised in a basement that made your eyes sting.

Now, this woman's life orbited around her love for dogs. She lived, breathed and reveled in dogs. She showed dogs, trained dogs and sold dogs. But, she taught me that there is no such thing as a responsible breeder.

Being a lot more ignorant then, I thought the only problem she had was an overabundance of dogs and that a love for dogs could go too far. But I discovered there was a darker side to breeding pretty quickly. I would play with the cute litter of collie puppies and watch as their noses grew into the traditional collie nose. Round about the time the puppies were ready for sale, she would drive them to a vet an hour and a half away for a "vet check". It seemed odd to me at the time as one of her best friends was a local vet.

Now being that kind of person, I always was drawn to the puppies that looked a bit off. You know what I mean, that look that you know something makes them a bit of an underdog in the world. I asked about these little guys and she told me that collie genetics sometimes resulted in abnormal skull development and the eye sockets didn't expand for the growth of their eyes...a painful condition.

Anyway, she usually came from these "vet checks" missing a puppy or two. "Where is so and so" I would ask. And she would say "so and so was humanely euthanized". So and so had the misfortune to be a victim of selective inbreeding. I suppose you have to travel a long way to find a vet willing to regularly euthanize otherwise healthy puppies.

There was always a kennel full of beautiful collies as well. During my acquaintance with this woman...I began to realize that none of her breeding dogs who became obsolete for breeding were ever rehomed. They were buried in her vet's back field when they weren't producing quality puppies.

It was then that I realized that there is a difference between dog lover and dog sickness. It wasn't about the money. She couldn't possibly have recouped her losses. Anyone who knows rescue knows there is probably not a high enough price to charge for a puppy that makes backyard breeding profitable. Not if you actually feed and vet the dogs. The only people who turn a profit are those who supply no care.

But, did she love dogs? Yes, she loved the perfect dogs. She loved the ones that brought adoration in the show ring. Everything else was just a means to get there. Love this week could mean euthanasia next week...based on a whim.

Maybe it's the way she taped the ears to give them that perfect collie fold that just sort of raised the question in my mind of what is it with people? What drives people to breed for a certain look? They breed cattle for record breaking milk or meat production, chickens that mature in 6 weeks...but what is it that drives people to commit inhumane acts in order to achieve a breed standard?

Like a lot of people I used to let these backyard breeders slide under the radar compared to the disdain I felt for puppy mills. I have been guilty myself of obtaining a puppy from a breeder, but education is everything. I admit, during my life, I have always been younger and more ignorant.

I just want to finish with a thought that has bothered me this past year about my own rescue dogs. Because it illustrates the mentality which leads to this obsession with breeds.

It is an incident that occurred when I adopted Charm, my pit bull/border collie mix. Now most of us know it doesn't really matter what the other part of the mix is...if it got labeled pit bull at the shelter...it's a pit bull for life. No one looks at my dog and says is that part border collie? No one. But there was a certain rescuer that put in postings saying that what I had adopted wasn't a real pit bull.

Which led me to the thought...so would I have to go to a breeder who gives out AKC papers to have a real pit bull? What does it mean to be a real pit bull? Cuz, gosh, the shelter wasn't going to provide me with anything other than an adoption certificate for a pit bull mix. I didn't even know it was a contest...my pit bull is more pit bull than your pit bull? All I know is there was a dog who needed a home and she was labeled pit bull and that meant no one wanted her.

It's that sort of thinking that fuels breeders everywhere. Human ego gets catered to at the expense of the dogs. In the end, dogs are dogs are dogs. I don't expect perfection, or conformation. My purebred chow is no more and no less than my shelter specials. No one is following me around with a score sheet that I can detect.

But to conclude my rant for the day....breeders cater to something in humans which is not pretty. Get a dog not a fashion accessory. You are not going to look cooler, your dick is not going to seem bigger, your place on the planet is not measured in your manipulation of genetics. And every shelter in America has something special waiting for you...a 100% dog waiting for a home. And each and everyone comes with an adoption certificate...what other papers could you possibly want???

Becca Martin

A Weekly Update on Federal Policy Activity Related to Traumatic Brain Injury

2008-06-30T07:24:00.000-07:00

From the Brain Injury Association of America:

Attorney Gordon Johnson
http://subtlebraininjury.com
http://tbilaw.com
http://waiting.com
http://vestibulardisorder.com
http://youtube.com/profile?user=braininjuryattorney
g@gordonjohnson.com
800-992-9447

Brain Injury Association of America
Policy Corner E-Newsletter – June 27, 2008
A weekly update on federal policy activity related to traumatic brain injury
__________________________________________________________________

Dear Advocates:

Legislative activity related to traumatic brain injury policy ensued on numerous fronts this week, as Congress made progress on several bills before leaving town for a week-long July 4 recess beginning on Monday.

Progress on appropriations occurred this week on the Senate side, as the full Senate Appropriations Committee marked up and approved its Fiscal 2009 Labor, Health and Human Services (HHS), and Education funding bill.

Meanwhile – on the other side of the Capitol - as marked up on the Subcommittee level last week, the House Labor, Health and Human Services (HHS), and Education Appropriations funding measure contains increased funding for some federal TBI programs. Unfortunately, this bill was not approved by the full House Appropriations Committee on Thursday, as a major breakdown in the Committee’s markup process occurred as a result of partisan disputes. The fate of all House appropriations bills are now uncertain.

Progress on several important bills not related to appropriations also took place this week. On Thursday, the Senate Veterans Affairs Committee approved provisions contained in S. 2921, The Caring for Wounded Warriors Act. BIAA has strongly supported and endorsed this legislation, which was recently introduced by Sen. Clinton (D-NY), and would strengthen supports for family caregivers of returning servicemembers with TBI.

On Wednesday, the House of Representatives passed the ADA Amendments Act of 2008 (H.R. 3195) with strong bipartisan backing by a vote of 402-15. Earlier in the week, BIAA formally endorsed this legislation, which is designed to strengthen protections for individuals with disabilities originally enacted through the Americans with Disabilities Act (ADA) in 1990.

Also this week, the Senate approved a compromise version of the war supplemental funding bill, readying the legislation for president’s expected signature. This legislation contained a moratorium – strongly supported by BIAA - on the implementation of several harmful Medicaid regulations.

Finally, the House and Senate were unable to agree on a final Medicare package, which would have prevented deep cuts beginning on July 1 in Medicare payment rates for physicians. Negotiations on such a package are expected to continue when Congress resumes session on Monday, July 7.

Please note that the next issue of Policy Corner will be published on Friday, July 11, as Congress is in recess next week.

*Distributed by Laura Schiebelhut, BIAA Director of Government Affairs, on behalf of the Brain Injury Association of America; 703-761-0750 ext. 637; lschiebelhut@biausa.org

BIAA’s Policy Corner and Legislative Action Alerts are made possible by the Centre for Neuro Skills, James F. Humphreys & Associates, and Lakeview Healthcare Systems, Inc. The Brain Injury Association of America gratefully acknowledges their support for legislative action.

To sign up to receive future BIAA Policy Corner E-Newsletters and Legislative Action Alerts, please go to http://capwiz.com/bia/mlm/signup/
__________________________________________________________________

Labor-HHS-Education Appropriations Bill Advances in Senate; Stalls in House

Progress on appropriations occurred this week on the Senate side, as the full Senate Appropriations Committee marked up and approved its Fiscal 2009 Labor, Health and Human Services (HHS), and Education funding bill.

The Senate’s markup provided the same funding amounts for several TBI programs as last year, including $5.7 million for TBI programming within the Centers for Disease Control and Prevention (CDC) and $8.754 million for the HRSA TBI State Grant Program.

Meanwhile, on the other side of the Capitol, as marked up on the Subcommittee level last week, the House Labor, Health and Human Services (HHS), and Education Appropriations funding measure contains increased funding for some federal TBI programs compared to last year. The House Subcommittee markup includes $11 million for the HRSA TBI State Grant Program (+$2.246 million over last year) and $6.6 million for TBI programming within CDC (+$0.9 million over last year).

Unfortunately, though, this bill was not approved by the full House Appropriations Committee on Thursday, as a major breakdown in the Committee’s markup process occurred as a result of partisan disputes. In fact, partisan vitriol reached such a high level during the attempted House markup of the Labor-HHS-Education funding bill that Rep. Obey (D-WI), Chairman of the House Appropriations Committee, threatened not to allow any further progress to occur this year on House appropriations bills. Stay tuned.

Senate Veterans Affairs Committee Approves Caring for Wounded Warrior Act Provisions

On Thursday, the Senate Veterans Affairs Committee approved provisions contained in S. 2921, The Caring for Wounded Warriors Act, S. 2921. BIAA has strongly supported and endorsed this legislation, and several recommendations made by BIAA during the legislative drafting process were incorporated into the bill.

Provisions in the legislation, which was recently introduced by Sen. Clinton (D-NY), would strengthen supports for family caregivers of returning servicemembers with TBI. Specifically, provisions would require two pilot programs to be implemented through the Department of Veterans Affairs, improving the resources available to those caring for returning servicemembers with TBI.

A quote from BIAA President and CEO Susan H. Connors was included in Sen. Clinton’s press release announcing passage of the bill’s provisions:

“Traumatic brain injury not only affects individuals but entire families as well. The Brain Injury Association of America applauds Senator Clinton and Members of the Senate Veterans Affairs Committee for their leadership in passing this legislation, which compassionately and responsibly provides much-needed supports to family caregivers of servicemembers with TBI,” said Susan H. Connors, President and CEO of BIAA.

BIAA will continue to monitor the progress of this important bill, and thanks advocates for urging their Members of Congress to become cosponsors of this legislation.

House Passes ADA Amendments Act of 2008 By Wide Margin

On Wednesday, the House of Representatives passed the ADA Amendments Act of 2008 (H.R. 3195) with strong bipartisan backing by a vote of 402-15. Earlier in the week, BIAA formally endorsed this legislation, which is designed to strengthen protections for individuals with disabilities originally enacted through the Americans with Disabilities Act (ADA) in 1990.

The ADA Amendments Act of 2008 is the product of meaningful negotiations and discussions with experts in the disability community, business and employer groups, Members of Congress, and congressional staff. The measure prohibits consideration of mitigating measures in the determination of whether an individual has a disability, with the exception of ordinary eyeglasses and contact lenses. The bill also affords broad coverage for individuals “regarded as” having a disability under the ADA.

A copy of BIAA’s endorsement letter, which was circulated to all Members of the House of Representatives prior to the vote this week, is available at http://www.biausa.org/policyissues.htm.

The Search for the Perfect Plaintiff

2008-06-27T13:26:00.000-07:00

The technique almost all attorneys hired by insurance companies use to defend brain injury cases, is to blame all of the problems the injured person has after the accident on psychological problems the plaintiff had before the accident. The reason is that post concussional symptoms have much in common with the symptoms someone might have from depression. For that reason, defense attorneys and the doctors they hire will blame it on pre-morbid (pre-injury) factors, even if there is no documentation of such psychological issues beforehand.

Thus, experienced plaintiff attorneys become progressively more gun shy about representing someone who has had documented problems before they got hurt. History of migraine, don’t want the case; history of counseling, don’t want the case; prior accidents, don’t want the case. The list of reasons to not represent someone with a brain injury could go on for two pages, but suffice it to say I have heard lawyers I respect give entire lectures devoted to all the reasons not to represent someone.

To a degree, such caution is a self preservation instinct, because the amount of money and time a plaintiff attorney invests in a case. When a plaintiff attorney chooses the wrong brain injury case, not only do they risk not making any fee for his or her time (almost all of these cases are handled on a contingent fee basis) but the lawyer may lose tens of thousands of dollars in out-of-pocket costs, to get the case ready for trial. I confess to turning down cases that other lawyers are willing to take a chance on. My firm and our colleagues only have so much time and resources. Sometimes, there are just too many negatives to justify going forward.

Yet while I turn down many cases, I am turning down fewer cases because of concerns about a pre-morbid mental health issue. While such issues make a case more difficult, they also make it more significant. Concussion, quite simply, does not disable most people. But it does disable a significant minority, probably in the neighborhood of 15%. Pre-injury psychological problems might make a case more complicated, but to me, they also make it more credible. The “perfect plaintiff”, is considerably less likely to be the person disabled by a seemingly routine concussion. That person would likely have a steady improvement over the first few days after the concussion, and like young jocks, be back in the game a week or two later.

Yes, I suppose there are cases where a remarkable individual - with no clouds on their medical or emotional history - suffers a moderate to severe brain injury and becomes clearly disabled. But if you represent only the “perfect plaintiff” you will turn down far too many people whose cases merit representation. While I choose my challenges carefully, the challenge of connecting pre-morbid vulnerabilities to actual resulting pathology and disability, is one I am shying away from less and less.

Attorney Gordon Johnson
http://subtlebraininjury.com
http://tbilaw.com
http://waiting.com
http://vestibulardisorder.com
http://youtube.com/profile?user=braininjuryattorney
g@gordonjohnson.com
800-992-9447

A Contribution to the Study of Shell Shock

2008-06-18T12:15:00.000-07:00

Charles Myers’ seminal 1915 Lancet paper “A Contribution to the Study of Shell Shock” published in the British Medical Journal, the Lancet, on February 13, 1915 is below. To read any of these page, click on the image and it will read in a new window that is in a resolution that can be read.

Attorney Gordon Johnson
http://subtlebraininjury.com
http://tbilaw.com
http://waiting.com
http://vestibulardisorder.com
http://youtube.com/profile?user=braininjuryattorney
g@gordonjohnson.com
800-992-9447

Return of the Soldier, Commentary on the Rebecca West Novel

2008-06-08T20:28:00.000-07:00

Editor’s Note: I owe my discovery of the issues with respect to Shell Shock in the World War I literature to a good friend, Kara Harton. Kara wrote the following paper while attending Yale.

Shell Shock in Rebecca West’s Return of the Soldier
History 255 – The Experience of War in the Twentieth Century
Professor Bruno Cabanes
7 March 2007

Kara S. Harton

Shell Shock in Rebecca West’s Return of the Soldier
Set in 1916 at the Baldry family estate outside London, Return of the Soldier is the fictional story of Chris Baldry, a veteran of The Great War, who is discharged from the military due to shell shock-induced amnesia. His only memories are expressed as flashbacks of his pre-war life. After leaving the front, Chris returns home to Kitty, Jenny, and Margaret, the most important people in his life. Kitty, Chris’s wife, is an extremely poised, genteel English woman who is perfectly content maintaining the household. During the war, she remains confident that as soon as her husband returns home, they will resume their comfortable, pre-war lifestyle. Kitty’s life seems to be dictated by her social obligations, and she cannot accept anything which intrudes upon her perfectly cultivated, socially-acceptable world. Chris’s cousin Jenny is Kitty’s companion at Baldry Court during the war. Jenny is probably the character with whom it is easiest for the reader to identify, and as the narrator of the story, Jenny has the most influence over the readers’ perception of the other characters’ actions. Her façade – that of a well-mannered English woman – is quite similar to Kitty’s, but she seems much more understanding of Chris’s difficult situation.

Kitty and Jenny become acquainted with the other major character, Margaret Grey, during the course of the novel. Margaret is Chris’s old flame and, apparently, his first love. Oddly, Chris’s amnesia seems to have erased all of his memories, with the exception of the recollections of his relationship with Margaret, which occurred many years before. Margaret is of a lower class than the Baldry family, which adds a significant amount of tension to her interaction with the Baldrys. These three women are linked by their connection to and concern for Chris, and together, they must decide how to handle his enigmatic condition and come to terms with the way that his role in their lives has changed as a result.

Clearly, Return of the Soldier is not the typical “war novel.” There are no battles or images of warfare. In fact, the reader never sees the enemy. However, this novel still makes a provocative statement about World War One. Although the novel takes place on an English estate, far from the trenches of the Western Front, it offers a vivid portrayal of the war by illustrating one of its most important themes: the phenomenon of shell shock. West’s portrayal of shellshock in The Return of the Soldier highlights two key aspects of the condition: the medical and psychological explanations of the phenomenon, and the way that it forced British society to adjust.

The idea of shell shock is introduced in the novel before the main character actually appears. Kitty and Jenny are at Baldry Court, nostalgically reminiscing about the past, when Margaret arrives with news about Chris. She informs the women that Chris has experienced some sort of misfortune on the battlefield but is somewhat hesitant to reveal the details. When Kitty asks if he is wounded, Margaret responds with, “Yes . . . he’s wounded,” but soon corrects herself by explaining, “I don’t know how to put it, he’s not exactly wounded. A shell burst –.” “Concussion?” Kitty asks. Margaret clarifies that Chris has shell shock and is “not dangerously ill.” After her explanation, the women share an awkward silence; they are obviously uncomfortable, and it is clear that neither of them is certain of the implications of the news. (23)

This scene is extremely important because it introduces the idea of shell shock in the novel and serves as an important illustration of the uncertainty with which shell shock was discussed during and after the War. Just as the characters of Return of the Soldier are not quite sure how to classify this condition, most Europeans, including medical and psychological experts, were unsure of the exact cause and characteristics of shell shock. There was an extensive debate about whether the nature of the condition was physical or mental, and whether it could legitimately be classified as a “wound.” The inability to pinpoint Chris’s injury in the previous passage is an excellent illustration of this uncertainty. It is not a tangible injury, and no one can decide exactly how to refer to it. The women seem uncomfortable using the term “shell shock,” which shows their lack of familiarity and understanding of the condition.

This theme reappears numerous times throughout the novel. Kitty has an extremely difficult time accepting the authenticity of Chris’s amnesia. After his first dinner back at Baldry, Kitty becomes extremely upset about Chris’s behavior. Jenny attempts to console her by reminding her that she is “taking things all the wrong way,” and that his conduct is due to the fact that “Chris is ill.” However, Kitty insists that Chris is merely “a man like other men,” and asserts that, “This is all blind. . . He’s pretending.” (60) Instead of accepting that Chris suffers from a condition which is beyond her comprehension, Kitty would prefer to assume that he feigning amnesia in order to continue an extramarital affair with Margaret. Kitty’s refusal to accept the authenticity of Chris’s wound reflects society’s hesitation to accept shell shock as a legitimate injury.

In order for the condition to seem more valid, the stigma of psychological disorder had to be surmounted – a significant obstacle to a society in which the mentally ill were considered outsiders. Therefore, it could not be attributed to fear or nervous breakdown due to the atrocities of war; medical experts had to assert that shell shock was caused by proximity to an exploding shell. This explanation was offered by British physician Charles S. Meyers in 1914 when he first observed shell shock in France, and it was accepted for the duration of the war. (Mosse 103) According to Colonel J.F.C. Fuller, “the sapping of morale by sudden or prolonged fear subordinates a man’s power of will to his instinct of self-preservation and ultimately reduces him to a state in which he cannot control his emotions.” (103) German medical experts agreed and tended to associate “war neurosis” with lack of will rather than concrete trauma, but this explanation was unacceptable to British society at the time. (103) In order to be considered a valid war wound, shell shock had to be attributed to something tangible.

In addition to providing an excellent illustration of the uncertainty with which people approached shell shock, Return of the Soldier also contains numerous examples of the way that this condition disrupted society during and after the War. After Chris’s return, Kitty wants their lives to return to normalcy because as members of the upper echelon of society, they both have important responsibilities and obligations to fulfill. Jay Winter, a notable World War One historian, calls shell shock “a code to describe the shock of the war to the ruling elite, whose sons and apprentices, being groomed for war, were slaughtered in France and Flanders.” (Winter 10)

In this war, unlike other wars, the higher a man’s socioeconomic status, the greater his chances of becoming a casualty. This fact was very real to the social elites, and the phenomenon of shell shock provided “a symbol . . . of the effect of the war on both their own social formation and British society as a whole, which many of them took to be interchangeable.” (10) Officers were expected to be shielded from the danger of emotional breakdown by their superior competence and judgment, their position of responsibility, and the need to set an example for their inferiors. The awareness that officers were more likely to become casualties (both due to shell shock and more conventional injuries) was an uncomfortable reality for society.

The way that shell shock is presented in Return of the Soldier also highlights another important aspect of the condition: the way that it forced reconsideration of accepted stereotypes, particularly those concerning accepted gender roles. Mosse points out the rigidity with which masculinity and manhood were defined at the time; in most of the Western world, there was an undisputed understanding about the function that a man was expected to fulfill as “exemplar and guardian of the society’s values and coherence in an age of accelerated change.” (Mosse 101) He should be dispassionate, controlled, and moderate, both physically and psychologically. Mosse points out that men whose behavior placed them outside the bounds of ideal manhood were relegated to the ranks of “outsiders, on the margins of established society.” (102) These were men who were nervous or unstable; criminals, ethnic minorities, and homosexuals were often placed in this undesirable category. Nervous disorders, often referred to as “hysteria,” were typically considered women’s afflictions, but now, society had to decide what to do with men who were exhibiting the same symptoms.

This theme is not presented explicitly in Return of the Soldier, but it is certainly implied. The Chris that Kitty knows is strong, organized, masculine, and stoic. He is a perfect example of the ideal upper-class British man: responsible, balanced, hard-working, and self-controlled. When he returns to Baldry Court, he is extremely polite, which shows that he still understands the importance of etiquette. Yet much of his conduct is now governed by emotion rather than logic. Instead of behaving rationally and dutifully taking his place in society, he has become emotional, compulsive, and needy. It is suggested that before the war, Chris is not entirely satisfied with his life, especially after the death of his son Oliver, but his emotional expression is stifled by his obligation to manage a comfortable, efficient manor. When he is affected by amnesia, he reverts to a time when he was less refined – before his manhood had fully developed. When he returns to Baldry Court, Kitty and Jenny are taken aback by his passion and depth of emotion; it seems as though they have never seen him express such strong feelings. His “wound” has forced him to revert back to the behavior of his boyhood. Many Europeans of this era, particularly those in the middle and upper classes, considered war “a true test of manliness,” and after World War One, society was forced to decide how to cope when many of its men were unable to “pass” this test. Mosse explains that this was extremely traumatic to British society because “shattered nerves and lack of will-power were the enemies of a settled society and because men so afflicted were thought to be effeminate, [which] endangered the clear distinction between genders which was generally regarded as an essential cement of society.” (103)

Although West’s Return of the Soldier is entirely fictional, it has an immeasurable degree of historical relevance, particularly in its depiction of shell shock. Even though West never presents scenes of battle and destruction, this book still presents an accurate picture of the disastrous effects of World War One, both in the military and the home front. This novel presents shell shock as a legitimate war injury without overlooking the uncertainty of its nature and diagnosis. Because the events in the novel occur within a few days, West’s focus is not the narrative, but the interaction of its characters. Therefore, it is crucial to analyze their relationships, and not the characters themselves. A careful analysis of these relationships reveals a great deal about the nature of shell shock, and the way that it affected soldiers, their families, and wartime society as a whole.

©2007, Kara S. Harton

The Brain - the Precious Egg Inside the Carton of the Skull

2008-06-08T20:17:00.000-07:00

Brain Injury and Clubs

2008-06-08T20:05:00.000-07:00

Editor's Note: On http://tbilaw.blogspot.com I am writing a very serious work on the Nightmare of Brain Injury. I thought these pics would be relevant and illustrative, but they disrupted the flow of what I was trying to say there, so I am posting them here.

And thank you Cindy for the images.

Attorney Gordon Johnson
http://subtlebraininjury.com
http://tbilaw.com
http://waiting.com
http://vestibulardisorder.com
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©Attorney Gordon S. Johnson, Jr. 2008

Footnotes to the Nightmare of War Time Brain Injury

2008-06-08T20:02:00.000-07:00

Editor's Note: This week, I am engaged in an intense writing project on my other brain injury blog: http://tbilaw.blogspot.com on the Nightmare of Wartime Brain Injury. There are some footnotes and funnies that don't really work as a direct part of that project, so I am posting them here. Later in the week, I will comment on Henry VIII's brain injury here as it is quite pertinent to that topic as well. http://tbilaw.blogspot.com/2008/06/loss-of-smell-was-missed-sign-of-brain.html

Attorney Gordon Johnson
http://subtlebraininjury.com
http://tbilaw.com
http://waiting.com
http://vestibulardisorder.com
http://youtube.com/profile?user=braininjuryattorney
g@gordonjohnson.com
800-992-9447
©Attorney Gordon S. Johnson, Jr. 2008