V. EVIDENCE OF DAMAGES - Brian Forrester

A. SYNOPSIS OF PERSONAL INJURIES

Brian currently suffers the devastating consequences of severe traumatic brain injuries, partial blindness in both eyes, numerous ruptured cervical and lumbar discs, a pin in his right leg, and hearing impairment in both ears arising from numerous injuries including:

1) Severe Traumatic Brain Injuries
2) Coma - Near Brain Death - Glasgow Coma Scale 3
3) Subarachnoid Hemorrhage in Interpeduncular Fossa
4) Intracranial Pressure
5) Subdural Hematoma
6) Right Frontal Brain Lobe Subcortical Shear
7) Hydrocephalus
8) Partial Blindness - Right and Left Eyes
9) Papilledema
10) Optic Atrophy
11) Hearing Impairment - Right and Left Ears
12) Multiple Ruptured Cervical Discs
13) Right Colonic Mesentery Tear
14) Herniated Nucleus Pulposi - Lumbar
15) Right Femoral Head Fracture with Posterior Subluxation
16) Fractured Acetabulum
17) Multi-focal Contusions
18) Frank Seizures
19) Heterotopic Ossification

B. ADDITIONAL SEQUELAE OF PERSONAL INJURIES

1) Severe Neurocognitive Impairments
2) Severe Memory Problems
3) Impaired Speed of Processing Information
4) Impairment of Executive Functioning
5) Severe Depression
6) Left Temporal Lobe Slowing
7) Frequent Severe Headaches
8) Gastrointestinal Complications
9) Severe Neck, Back and Head Impairments
10) Tachycardia with Hypertension
11) Spiking Fevers
12) Urinary Tract Infections
13) Profound Neutropenia
14) Infectious Disease
15) Erythematous Rash
16) Persistent Physical Pain
17) Permanent Mental Anguish

C. MEDICAL EVIDENCE

1. Personal Injuries

a) Severe Traumatic Brain Injuries

Upon admission to Memorial, Brian was under the care of Dr. Benjamin Trujillo as his attending physician in the trauma unit. Dr. Trujillo immediately brought in a board certified neurologist, Dr. Brent Galloway, for a neurological consult and to be in charge of post-acute neurological management. Dr. Galloway diagnosed severe traumatic brain injuries and recommended that Brian be transferred to a post-acute facility to stabilize his central nervous system status and achieve rehabilitative potential.

Pursuant to Dr. Galloway's recommendation, a post-acute facility was chosen and Brian was transferred to The Institute of Rehabilitation and Research where he was seen by Dr. Elizabeth Styles, a board certified neurologist and psychiatrist. Dr. Styles completed a multiaxial evaluation and also diagnosed Brian as suffering from severe traumatic brain injuries. After the immediate post-acute treatment was completed at B.R.R.I. and the transition rehabilitation to take Brian off of twenty-four-hour-a-day care was completed at TLC, Dr. Galloway referred Brian to Project NewStart for evaluation and planning for long-term rehabilitation.

At Project NewStart, Dr. Timothy Majors also evaluated Brian in the multiaxial diagnostic system as suffering from severe traumatic brain injuries. Thus, Brian has been diagnosed by Dr. Brent Galloway, a board certified neurologist, by Dr. Elizabeth Styles, a board certified neurologist and psychiatrist, and Dr. Timothy Majors, a highly experienced neuropsychologist, as suffering from permanent, irreversible, severe traumatic brain injuries.

The distinguishing characteristics of severe traumatic brain injuries are that it is permanent and irreversible in that all three of the customary methods of treatment are ineffective on severe brain trauma: a) there is no surgical procedure to repair severe brain trauma; b) there is no pharmaceutical repair for severe brain trauma; and c) the damaged and destroyed brain cells are non-regenerative. Therefore, Brian's brain injuries are permanent and irreversible. The treatment of choice is to teach the victim compensatory strategies which would allow them to compensate for some of the deficiencies which result from the brain injuries.

Brian is currently enrolled at Project NewStart which specializes in such treatment of compensatory strategies and in the rehabilitation and retraining of severely brain injured patients.

b) Coma - Near Brain Death - Glasgow Coma Scale 3

A head-injured patient is most often rated according to impairment of consciousness, by use of the Glasgow Coma Scale ("GCS"), which is an excellent indicator of the degree of brain damage. The GCS scores relate to prognosis, particularly after severe head injury. The scale depends upon a separate assessment of eye, verbal, and motor responsiveness. Each response is scored. The score reflects the severity of brain injuries.

The Glasgow Coma Scale is a widely used and accepted clinical scale for assessing the depth and duration of impaired consciousness and coma. Three aspects of behavior are independently evaluated and measured: motor responsiveness, verbal performance, and eye opening.

Glasgow Coma Scale
Eyes Open	Spontaneously 4 --------------------- To verbal command 3 --------------------- To pain 2 --------------------- No response
Best motor response To painful stimulus* (Apply pressure to nailbeds)	To verbal command Obeys 6 --------------------- Localizes pain 5 --------------------- Flexion-withdrawal 4 --------------------- Flexion - abnormal 3 (Decorticate rigidity) --------------------- Extension 2 (Decerebrate rigidity) --------------------- No response
Best verbal response (Arouse patient with painful stimulus if necessary)	Oriented and 5 converses --------------------- Disoriented and 4 converses --------------------- Inappropriate words 3 --------------------- Incomprehensible 2 sounds --------------------- No response 1
Total	3-15

Each response on the scale is given a number (high for normal and low for impaired responses). The responsiveness elicited from the patient is matched to the scale. The summation of the figures can be charted and compared with similar patients. Based on observations of 1,000 patients, all combinations that summed seven or less were defined as coma. Within the first 24 hours of coma, patients with a coma score of three (3) or four (4) have only a seven (7) per cent chance of achieving independence compared with those having a score of eleven (11) or more in whom 82 per cent regain an independent existence. Significantly, Brian Forrester's Glasgow Coma Scale plummeted to 3 at 10:30 p.m. on the night of this tragedy which means that his chance of achieving independence is only seven percent (7%).

(i) Prognostic factors. Prognostic factors in coma from traumatic head injury include: age, depth of coma, duration of comatose condition, brain stem function, hematoma, motor function, and autonomic factors such as respiratory abnormalities and hypertension.

a. Age: Age is a significant prognostic factor; it effects outcome independently of responsiveness.

b. Depth of coma: Using the Glasgow Coma Scale, patients within the first 24 hours of a coma with a score of three or four have only a seven per cent chance of achieving independence compared with those having a score of eleven or more in whom eighty-two per cent regain an independent existence.

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