Brain Injury Lawyer

New research released from the University of Texas Medical Branch at Galveston states that a new study shows that brain trauma is associated with lifelong conditions that affect a patient’s quality of live and mortality. Currently, traumatic brain injuries are considered a singular event by the insurance industry and many health care professionals instead of being viewed as the beginning of an ongoing process that impacts multiple organ systems and may cause or accelerate other diseases and disorders that can reduce life expectancy.

Phil Hossler, a certified athletic trainer at East Brunswick High School and member of the National Athletic Trainers’ Association Hall of Fame, recently published, “Concussion Policy Construction Guide for Schools,” his second book discussing the study of concussions, the athletes who suffer them and when they can safely return to play.

Hossler has been an athletic trainer for 37 years and says the book was developed to aid schools in designing concussion policy, to teach athletic staff about signs and symptoms of concussions and to monitor a student-athlete's recovery. The book was also designed to assist in improving communication with parents and teachers who work with recovering athletes who may need a lighter class-work load while their brains heal.
 

According to a BBC News article, Larry Swanson and Richard Thompson, from the University of Southern California in Los Angeles, recently published research in the Proceedings of the National Academy of Sciences journal, which may lead to a full map of the human nervous system. Swanson and Thompson state that the brain appears to be a vastly interconnected network, much like the internet, which contradicts the 19th-Century "top-down" view of brain structure.

Swanson and Thompson isolated a small section of a rat's brain in the nucleus accumbens - a brain region long associated with pleasure and reward. Their technique hinges on the injection of "tracers" at precise points in the brain tissue. These are molecules that do not interfere with the movement of signals across the tissue, but can be illuminated and identified using a microscope.
 

The issue of third party observation at defense neuropsychological evaluations continues to be controversial in the neuropsychological field as well as the legal field. Defense neuropsychologists raise the specter that a third party observer may invalidate test results while plaintiffs attorneys argue defense neuropsychological evaluations are not independent, but adversarial, necessitating the presence of a third person to verify statements alleged by defense neuropsychologists.
 
Recently, this issue was the subject of a hearing in the State of Louisiana. The defendants requested that the plaintiff undergo a defense neuropsychological evaluation. Plaintiff’s counsel requested that his client be accompanied by a third person. The defense objected, noting that such a request violated the 2001 National Academy of Neuropsychology (NAN) policy on third party observers and the 2009 NAN policy against secretive recording of neuropsychological testing and interviewing. 
 
The plaintiff submitted Linda Lindman’s Ph.D. research and dissertation, which found no observer effect on neuropsychological test or examination scores or results. After reading the filed papers, the Court entered an Order in favor of the plaintiff stating the neuropsychological IME could be video recorded from behind a one way mirror. The Court also ordered that the plaintiff not assert any potential ethical violations, as perceived by NAN, against the defense neuropsychologist for the videotaping the IME from behind a one way mirror. Day v. Valley Forge Insurance Company, 21st Judicial District Court for the Parish of Livingston, State of Louisiana, Division "B," Number 122923.

Last Thursday, Nightline Prime, a new series on ABC premiered with the first of four installments of Secrets of Your Mind: Why We Do What We Do. The series explores the mystery and the science of the brain through several case studies. Each installment focuses on a different research area, including love's impact on the brain, violence and the brain, medical emergencies involving the brain, and food and the brain.

Last week’s episode featured Anna and Derrick Gaines and chronicled Derrick’s traumatic brain injury and the effects it had on his relationship with his wife. After the injury, Derrick forgot his love for his wife. The episode follow the Gaines family as the recover from Derrick’s injury and begin to build a family together.
 

Researchers from Finland recently investigated whether texture analysis can detect subtle changes in cerebral tissue caused by mild traumatic brain injury and whether these changes correlate with neuropsychological and diffusion tensor imaging (DTI) findings.  The researchers studied 42 patients with MTBI using 1.5-T MRI imaging within three weeks after injury. According to the abstract, texture analysis was performed for the regions corresponding to the mesencephalon, centrum semiovale, and corpus callosum.  Using DTI, the fractional anisotropic and apparent diffusion coefficient values for the same regions were evaluated. The same analyses were performed on a group of ten healthy volunteers.  Patients also underwent a battery of neuro cognitive tests within six weeks after injury.
 
The researchers found that texture analysis revealed textural differences between the right and left hemispheres in patients with MTBIs, whereas, differences were minimal in health controls.  A significant correlation was found between scores on memory tests and texture parameters in patients in the area of the mesencephalon and the genu of the corpus callosum.  Significant correlations were also found between texture parameters for the left mesencephalon and both fractional anisotropic and apparent diffusion coefficient values. 
 
The researchers concluded that the data suggests that heterogeneous texture and abnormal DTI patterns in the area of the mesencephalon maybe linked with verbal memory deficits among patients with MTBIs. 
 
Dr. Holli and his colleagues also studied whether mild trauma may cause micro structural changes in the brain which were not necessarily perceptible by visual inspection but could be detected with texture analysis. Again, the researchers using the same 1.5T  MRI imaging, 42 MTBI patients within three weeks of onset of trauma.  The textural analysis revealed significant changes in texture parameters of cerebral tissue between hemispheres and corpus callosum segments in TBI patients.  The authors concluded the textural analysis may serve as a novel additional tool for detecting the conventionally invisible changes in cerebral tissue in MTBI and help the clinicians to make an early diagnosis. 

On July 22, 2010, a federal jury in the Southern District of New York returned a verdict against Cornell University’s Weill Medical College and a former faculty member Wilfred van Gorp, Ph.D. The jury found that the defendants submitted false claims to the National Institute of Health on three separate occasions from 1999 to 2001 arising from a grant designed to train neuropsychologists for a research career in HIV/AIDS. 

According to the press release issued by plaintiff’s attorney, “Daniel Feldman, one of the fellows working on the grant, brought suit under a federal whistleblower statute, known as the False Claims Act, alleging that van Gorp and Cornell instead used the funds for inappropriate purposes, including requiring the fellows to see an excess of private fee-for-service patients with other medical conditions.  At trial, Dr. Feldman showed that of approximately 160 clinical patients seen by the fellows over five years on the NIH-grant, only three patients were HIV- positive. Instead of seeing HIV- patients, the fellows often evaluated "medicolegal" cases, referred by insurance companies or attorneys who were in litigation over disability or worker's compensation claims, or criminal defendants."  See full story here.
 
On August 3, 2010, the Court entered judgment in favor of the plaintiff and against both Cornell University Medical College and Wilfred van Gorp in the amount of $ 887,714.
 
This jury verdict comes on the heels of a resent FDA warning letter directed to Columbia Presbyterian and Ronald Van Heertum, M.D., director of the PET laboratory at Columbia Presbyterian. According to the FDA:
 

From June 3 to June 19, 2008, the U.S. Food and Drug Administration (FDA) conducted an inspection of your PET production facility located at 630 West 168th Street, New York, NY. The inspection revealed significant deviations from the United States Pharmacopoeia (USP) compounding standards and official monograph for Positron Emission Tomography (PET) drugs in the manufacturing of your PET drugs (i.e., Fludeoxyglucose (FDG) F18 Injection, Ammonia N13 Injection, Water O15 Injection, and Oxygen 015 Gas). These deviations were listed on an Inspectional Observations (FDA-483) form issued to you at the close of the inspection. These deviations cause your drug products to be adulterated within the meaning of Section 501(a)(2)(C) [21 U.S.C. § 351(a)(2)(C)] of the Federal Food, Drug, and Cosmetic Act (the Act).
 

In a follow-up story printed in the New York Times, “Columbia University has quietly suspended research at a nationally prominent brain-imaging center and reassigned its top managers after federal investigators found that it had routinely injected mental patients with drugs that contained potentially dangerous impurities. The investigations found that the center, regarded by experts as the nation’s leader in the use of positron emission tomography, or PET, for psychiatric research, repeatedly violated Food and Drug Administration regulations over a four-year period.”
 
These two events raise real concern regarding the validity of research being conducted even by researchers, well respected in their fields.

I found an interesting article on the New York Times’ website yesterday which discusses the similarities between the symptoms of traumatic brain injuries and Lou Gehrig’s disease. A new report due out today states that many athletes and soldiers who were previously diagnosed with Lou Gehrig’s disease may have been misdiagnosed, and in reality probably suffered from concussions and other brain trauma. The paper even goes on to state that Lou Gehrig himself may not have had Lou Gehrig’s disease.

Doctors from the Veterans Affairs Medical Center in Bedford, MA and the Boston University School of Medicine said that markings in the spinal cords of two players and one boxer who were diagnosed as having Lou Gehrig’s disease indicated that they had a different fatal disease caused by concussion-like trauma which eroded the central nervous system in similar ways.

Attorneys throughout the United States are very excited about the advancement of diffusion tensor imaging that can objectively document mild traumatic brain damage in patients.  Recently, in South Carolina, attorneys were able to fight back a Daubert challenge to the introduction of diffusion tensor imaging (DTI).  While the court never ruled on the defendant’s motion to exclude, after the plaintiff filed their brief the case resolved. 
 
I recently reviewed an interesting article entitled “Diffusion Tensor Imaging and White Matter Lesions at the Sub Acute Stage in Mild Traumatic Brain Injury with Persistent Neuro Behavioral Impairment.”  The lead author on the paper is Arnaud Messe, of the Laboratorie dImagerie Fonctionnelle Paris, France.  The French researchers investigated whether “MRI at the subacute stage can detect lesions that are associated with poor functional outcomes in mild traumatic brain injury using anatomical images and DTI.  The authors compared 23 patients with mild TBI and 23 healthy volunteers.  All patients underwent an MRI investigation and clinical test between seven and 28 days and again between three and four months after injury.  Those with mild TBI were divided into two groups, those with poor outcome and those with good outcome based on their complaints at the three to four months investigation period.  The researchers found that the poor outcome patients showed “significantly higher mean diffusivity values than both controls and good outcome patients in the corpus callosum and various other areas of the brain.  The researchers concluded that the poor outcome patients differed from good outcome patients by the presence of diffusion changes and long association white matter fiber tracts but not by gray matter partial volume.  The results suggest that DTI at the subacute stage may be a predictive marker of poor outcome in MTBI."

Legislation sponsored by Assembly members Pat Diegnan, Craig Coughlin, Thomas Giblin and Mila Jasey aimed at creating an awareness program on the prevention, risk and treatment of sports-related brain injuries has passed the full Assembly. The Bill would require student athletes who sustain a concussion to be immediately removed from the activity. Additionally, the Bill states that the student would not be allowed to return to the field until they have been evaluated by a doctor who is trained in the evaluation and management of concussions and has given the student written permission to return to physical activity.

"Head injuries are always traumatic, doubly so when they affect the life of a young athlete," says Diegnan, chairman of the Assembly education panel. "With the competitive, high impact nature of high school sports continuing to intensify, we owe it to these student athletes to look not just at the effects of these injuries, but to take an active role in their diagnosis and prevention."

The Bill would also require the state Commissioner of Education, as well as the Commissioner of Health and Senior Services, to develop an awareness program which address the prevention, risk and treatment of sports related concussions and other brain injuries among student athletes.

The program would create a brain injury fact sheet containing information concerning the prevention, symptoms and dangers of concussions and other traumatic brain injuries. The program would provide information on the appropriate amount of time to delay a student's return to physical activity after sustaining a brain injury. The program would also require school districts develop a written policy addressing the prevention and treatment of sports related concussions and other brain injuries to be used when it is suspected that a student athlete has sustained such an injury.