Amputation Demand Letter
B. SPECIAL DAMAGES
1. Past Medical Expenses
One of the most effective indicators of the nature and extent of the incredible physical pain and suffering, mental anguish and physical disability which Lindsey has suffered and will continue to suffer as a result of this horrible injury is the fact that her medical bills to date total $364,690.34. These will be proven to the jury as follows:
Lindsey’s past medical expenses are itemized as follows:
a. City Fire Department $ 457.07
b. Greater County Medical Center 171,325.50
c. Greater County Imaging R. Kerr, M.D. 932.00
d. Greater County Imaging M. Friedman, M.D. 329.00
e. Village Center - M. Cook, M.D. 6,985.00
f. Village Center - C. Adley, M.D. 2,820.00
g. Village Center - S. Sandler, M.D. 960.00
h. Village Center - E. Harold, D.O. 2,400.00
i. Village Center - T. Hill, M.D. 900.00
j. Century City Hospital 133,324.45
k. Leader Fiscal Services 561.00
l. Sims, Ladder, & Platt 125.00
m. Athleo L. Gordon, M.D. 22,833.92
n. R.S. Wilson, M.D. 800.00
o. D. Temple, M.D. 635.00
p. Coton County Prosthetics 7,563.00
q. B. Donaldson Physical Therapist 3,790.00
r. Abbey Home Healthcare 46.00
s. Prescriptions 99.06
t. Consultants for Pathology 2,949.35
u. Larry Porter, Ph.D 1,275.00
v. Joseph L. Warton, M.D. 900.00
w. Wayne S. Grouton, M.D. 1,425.00
x. Renee Roggers, Ph.D. 1,255.00
TOTAL PAST MEDICAL EXPENSES $ 364,690.34
2. Future Medical Expenses
In assessing Lindsey’s damages for future medical expenses we have considered the long-term care needs, including psychological and vocational rehabilitation factors, prosthetic needs, equipment needs, and long-term care or services which may be required. Included in this consideration would be not only standard prosthetic devices, but also new designs, including biomechanical and myoelectric prosthetic alternatives. However, at present we have not projected the cost of biotechnical advances in prosthetics. It is possible to do so and if trial becomes necessary we will offer substantial evidence regarding future medical expenses for biorobotic prosthetics.
a. Prognosis: Possible Above-the-knee Amputation
The most foreboding of Lindsey’s future medical prospects is Dr. Athleo Gordon's projection that Lindsey may require additional surgery, including above-the-knee amputation. Dr. Gordon, the plastic surgeon who treated Lindsey at both Greater County Medical Center and Century City Hospital expressed the following prognosis on December 02, 1992, four months after releasing Lindsey from Century City Hospital:
Prognosis: Lindsey may also require further amputation, possibly resulting in above knee level amputation should there be extensive infection or bone exposure which would not be remediable by further reconstructive surgery.
We have not yet projected the cost of such additional future surgery, but an additional amputation, combined with the necessary hospitalization, surgical, recuperative and rehabilitative costs would obviously exceed $150,000.00. In the event we are able to reach a settlement of this case, we plan to create an emergency medical fund in the form of a single premium deferred annuity which will contain sufficient funds to cover both the prospect of future surgery and the inevitable development of biorobotics in the future. A single-premium deferred annuity would keep funds safely invested while still available in the event they are needed for improving Lindsey’s handicapped condition.
b. Prognosis: Ongoing Psychiatric Treatment
Dr. Athleo Gordon also projects, along with several other psychiatric and psychological specialists, Lindsey’s obvious need for ongoing treatment for her mental and emotional problems as follows:
Prognosis: There is the possibility of future complications or deterioration of the injury related conditions such as breakdown of the skin grafts over the flap, exposure of the bone in the distal amputation stump, or intractable pain and discomfort, fear or anxiety, mental and emotional distress which might require the patient's ongoing psychiatric treatment for management.
c. Prognosis: Future Prosthetic Requirements
Without factoring in the specific cost of future robotic advances and prosthetics, Frances C. Henderson, M.S.,R.N., Lindsey’s rehabilitation nurse/consultant estimates the cost to keep Lindsey fully supplied with the different models of prosthetics which she will need to achieve maximum efficiency in functioning as an amputee is $6,114.16 per annum.
Based on a 58.8 year life expectancy, this computes Lindsey’s future prosthetic costs to be $359,512.61, based on today's technology without regard to future technological development and the accompanying high cost.
In his Medical Narrative Report, dated December 20, 1992, Dr. Gordon stated that:
...there will be further medical costs which are mostly related to management and proper fittings of the prosthetics, as well as ongoing requirements for physical therapy to maintain range of motion in the knee.
d. Prognosis: Psychological Rehabilitation
In her Psychological Evaluation, dated November 2, 1992, Dr. Renee Roggers states:
I recommend psychotherapy to stabilize Lindsey’s current emotional condition. Given her Post-Traumatic Stress symptomology, a cognitive-behavioral oriented psychotherapy is recommended with supportive psychotherapy to provide her with a functional means of venting anger and frustration. Relaxation and stress management training are indicated. With regard to the emotional repercussions from the loss of her leg, a more long term treatment will be necessary to help her adjust.
Dr. Richard Lawrence Porter, the Board-certified Neuropsychologist who is Executive Director of New Hope Center, a brain injury rehabilitation program, makes the following projections with respect to future costs of emotional and psychological rehabilitation for Lindsey:
Lindsey Wong is a 21-year old Asian female who was given a neuropsychological evaluation in order to determine current levels of cognitive and emotional functioning. Ms. Wong was involved in a motorcycle accident on April 26, 1992. In the accident, Ms. Wong's left leg was crushed, resulting in an amputation six inches below the knee. Her left hip was also dislocated and broken. Ms. Wong also hit her head on the pavement as a result of the accident.
Dr. Porter is of the opinion that due to the combination of the traumatic brain injury and the normal emotional distress which accompanies the traumatic loss of her leg, Lindsey will require a very lengthy recovery period from a neuropsychological viewpoint. The future neuropsychological care which Dr. Porter will testify that Lindsey will require includes the following:
Due to the nature of the losses which Miss Wong has suffered in terms of her amputation and her cognitive functioning, she is going to have a very lengthy recovery process. Because of her intelligence and because of her commitment and motivation I think her prognosis of recovering her self-esteem and her self concept is good, but I think it will take ten years of individual psychotherapy and counseling and then with long-term follow up after that for her to reach the point where she is really recovered from these major losses which she has suffered.
I would think that initially she would need to come in for psychotherapy on a once a week basis, but most people who go through this kind of a loss reach a point as they get out of denial and get into acceptance phases where they are coming to grips with their losses, go into a very deep depression and Miss Wong has not really entered into that kind of a deep depression yet.
Unfortunately from a neurological viewpoint, the worst is yet to come for Lindsey as Dr. Porter foresees both future deep depression and the possibility of suicidal ideation as normal sequelae. Dr. Porter projects as follows:
It wouldn't at all be unusual, in fact I would expect her within the next year or two, to go into a deep depression in which she has suicidal ideation in which it seems like the best resolution of these problems that she is encountering would be to end her own life. That's an almost universal outcome of this kind of a major loss. During that period of time she will probably need much more frequent psychotherapy sessions.
I would guess that she will go through periods as she goes through this resolution of grief when she will need psychotherapy at least two to three times a week probably for as long as a year in time. That will be a very important period of time and she should have the kind of professional assistance that she needs available to her at that time.
While Dr. Porter does not feel that Lindsey is ready for individual cognitive rehabilitation at this time, he has projected her future needs as follows:
As far as cognitive rehabilitation goes, when she reaches the point that she can identify and accept her impaired memory and impaired reasoning abilities and slowed thought processes, she probably could benefit from cognitive rehabilitation within about a six month period of treatment. I would recommend that during that time that she be treated three times a week for a minimum of four hours per treatment session.
The normal and customary costs for those kinds of services both for the psychotherapy and for the cognitive rehabilitation would be $100 per hour.
If Miss Wong is able to receive individual psychotherapy for at least the next ten years, she probably will continue to need periodic visits and may again have relapses from time to time. Therefore, my guess over her lifetime which would be an additional forty or forty-five years, would be that she would need to have probably an equivalent of another three or four years in total of individual psychotherapy.
3. Damage - Wage Earning Capacity
As a result of the devastating injuries which Lindsey suffered in this tragedy, she has not been employed since the accident, as the progress of her life has ground to a halt.
Our evidence on damage to wage earning capacity will first show the deficiencies which have hampered her employability in the past and then demonstrate the long-term consequences which will affect her wage earning capacity adversely for the remainder of her life.
Dr. Larry Porter's neuropsychological exam revealed the following deficiencies which will militate against Lindsey ever developing fully the wage earning potential which she enjoyed prior to this tragic event.
Impressions and Recommendations:
The results of the neuropsychological evaluation revealed mild deficits in visual reproduction memory. In addition, her copy of a complex geometric figure was moderately deficient, which indicates deficiencies in visual-motor integration. Ms. Wong's grip strength was mildly deficient on the right and moderately deficient on the left. Executive functioning was significantly impaired. Speed of auditory information processing was moderately deficient. Impulse control, judgement, inhibition of inappropriate behavior, and awareness of deficits were all impaired. The overall pattern of neuropsychological results is indicative of dysfunction in the frontal lobe region of the cerebral cortex.
Dr. Porter, as part of his role as Executive Director of Direction Re-Entry, is also a vocational rehabilitation expert. With respect to the damage to wage earning capacity which Lindsey suffers as a result of this tragedy, Dr. Porter identifies the following problem areas:
a. Cognitive Difficulties
I think that Miss Wong's cognitive difficulties are going to be the biggest impairment to her ability to maintain competitive employment. At the present time she gets easily confused and distracted.
(1) Social Judgment. Her poor social judgement and awareness cause her to do things which are inappropriate and impulsive and I don't believe that she would be able to for even one day, perform the expected job duties that a person who is handling a responsible job would be expected to.
(2) Social Disinhibition. From the time that she arrived at work until the time that she left, she would literally be the victim of her own impulses and when she sees something or has a thought or an idea she acts on it, or speaks it and that lack of inhibition is going to prevent her from being able to do things which she otherwise would be capable of doing. Her social comments and actions would bother, if not offend, employers and the public. She would simply not be able to do the things which are socially expected of a good employee.
b. Memory Problems
In addition, when it came down to just performing the tasks themselves if she was on a job which she had not already, prior to her injury, mastered she would have difficulty learning and remembering the steps that she was supposed to do in her daily activities or the details and instructions that a supervisor or an employee would give her. On top of that, her confusion about these problems would add to the situation. If she had had her current disabilities from birth, she could adapt to them and cope with them and probably already would have by this age. These are new, suddenly dramatically imposed limitations that she has and she doesn't really know what to do in order to remember sequences of instructions or to retrieve information which is probably stored but she's having trouble utilizing. So the combination of her poor social judgement and her social disinhibition along with her memory problems would be very serious.
c. Speed of Processing
I think of secondary importance but significant would be her speed of processing. At the present time she would not be able to perform most jobs at a competitive speed. I think with some intensive cognitive rehabilitation her speed of processing information can be improved, but that will take as I said earlier, probably six months of treatment to accomplish that. At the present time she is just simply too slow in her performance of goal-directed activities in order to handle most employment situations.
d. Mobility and Agility
I think that at the present time her amputated leg and the use of a prosthesis is also a significant limitation. A lot of the jobs that she worked on before required her to be on her feet and moving around in a restaurant whether she was managing or actually serving customers and at the present time the pain and awkwardness and the physical limitations that she has with her amputated leg are going to prevent her from being able to engage in that kind of employment situation where her mobility and agility on her feet are important.
e. Self-consciousness and Physical Pain
In addition, at the present time, she really does experience a great deal of self-consciousness and even physical pain over the leg which would interfere with her ability to stay competitively employed for an eight-hour shift. She will need to have opportunities to rest her leg and to have a kind of recuperation that she's able to take now when she becomes tired or her leg starts to bother her.
