Paralysis / Spinal Cord - Demand Letter
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D. CLOSED HEAD INJURY
As a result of the severe impact of Brad's head with the wheel of the pizza truck, his head was jammed between the tire and the wheel wall. The force of this impact caused a closed head injury to the frontal temporal lobe of Brad's brain. As a result of this, Brad has suffered a reduction in his mental capacity which manifests itself in both short-term and long-term memory loss and, most significantly, a substantial reduction in his intelligence quotient.
Our evidence from Dr. Crouch will be that when Brad was last tested for intelligence quotient in 1977, his FSIQ score was 125. Subsequent to the accident on September 23, 1997, Brad's FSIQ score was 105. Dr. Crouch will testify that the results are significantly lower than those obtained in 1977 and that these test results support the view that the closed head injury is manifesting itself in a reduction in level of intellectual function and that the "possibility for significant head injury with residual cognitive sequelae is present."
Additionally, Brad's testimony will be to the effect that he can no longer comprehend and perform simple mental tasks as he could prior to the accident, both as a result of cognitive deficit and due to short-term or long-term memory loss.
This closed head injury is particularly significant with respect to Brad's damage to wage earning capacity for the reason that he had planned to go into the computer field because the challenge of computer technology was the most stimulating area which he could imagine as a career, considering his above-average intelligence quotient prior to the accident.
Brad had manifested a distinct skill and talent for computers and was capable of creating his own programs on computer before the accident. Subsequent to the accident he can no longer create programs and utilize them adequately because he cannot remember the passwords necessary to successfully get into the programs.
Dr. Crouch will testify that Brad needs transitional care in order to be trained to cope with the problems arising out of his closed head injury, particularly reduction in cognitive powers, short-term memory loss and long-term memory loss. Brad will need an in-patient stay at one of the three facilities in Texas which treat transitional closed head injury patients. The facility best suited for Brad's particular problem is Brown-Karhan Hospital in Dripping Springs where Brad will need to be treated as an in-patient for a period of approximately one month. The cost of this will be approximately $5,000.00. In addition he will need individual therapy sessions with Dr. Crouch for a period of eighteen months at a cost of $90.00 per hour for two session per week totaling $14,040.00.
Simultaneously with the individual therapy, Dr. Crouch indicates that Brad will need group therapy for a period of eighteen months at $90.00 per one and one-half (1 1/2) hour session. This represents group therapy costs in the amount of $7,020.00.
Additional treatment for closed head injury past the 19 month period discussed above will depend upon the progress which Brad has experienced toward establishing a coping mechanism for dealing with the physical, mental and psychological problems which he has developed as a result of the negligence of Sara Glass.
E. PSYCHOLOGICAL SEQUELAE
A complex group of psychological changes and psychiatric disturbances is also an inevitable accompaniment of Brad's spinal cord injuries. Altered life circumstances, disabilities, and other features lead to a variety of unpleasant psychological states which can be subsumed under the heading of Brad's mental anguish, including embarrassment, humiliation, shame, sense of loss, grief, altered personal image, etc.
It is apparent from the above list that total damage assessment of the catastrophic consequences of Brad's spinal cord injury requires consideration by the jury of a wide variety of factors which extend far beyond the categories of paralysis and loss of sensation, per se, even though these rather obvious aspects of the tragedy may in some instances loom large.
Catastrophic injuries which alter the entire pattern of an individual's life and expectations for the future obviously result in massive challenges for psychological adjustment and adaptation. Episodes of depression, occasional acting-out of hostile or aggressive impulses, exaggeration of dependency feelings, and similar relatively moderate disturbances are characteristic.
Brad's period of adjustment to vastly altered and restricted life patterns with greatly modified personal and occupational goals is extremely stressful and episodes of emotional crisis are inevitable and in some instances, require professional guidance and assistance from Dr. Crouch. The period of rehabilitation and striving for return to an active, rewarding and productive life are also extremely stressful; intense feelings of frustration, failure, despair, and hostility are common.
Finally, even when a stabilized and reasonably satisfying pattern is achieved, there are a host of special major problems which must be faced by Brad every day. Social relationships remain a challenge to Brad because of tendencies of other people to exclude, ignore, or otherwise not engage with a paraplegic in the usual patterns of social interaction which contribute to an individual's sense of acceptance, well-being, confidence, and self-esteem.
The overall pattern of Brad's psychological anguish today is critically dependent upon his pre-injury psychological makeup. In general, patients with good psychological health and adequate internal resources can be expected to weather the storms of emotional crisis better than those for whom psychological health was already marginal, or in those with frank neurotic or other psychological patterns. Our psychological evidence will include a frank review of Brad's emotional past, and Dr. Crouch's testimony will be that the combination of Brad's youth at the time of injury and his emotional foundation which is experiencing considerable difficulty in creating a coping mechanism for the tremendous emotional overlay which has resulted from this devastating injury.
Brad's spinal injury is a catastrophic life-threatening experience which has left him crippled, deformed, and deprived of many of the satisfactions of life. Brad's earning power is reduced, interpersonal relationships are threatened, life goals must be abandoned or modified, and his self image is greatly modified. Thus, extreme burdens are placed on his courage, stamina, and inner psychological resources and reserves. Brad is a fine young man with a lot of character, and his human spirit will triumph and the eventual outcome will be acceptable; but there are many stormy and dark episodes remaining for him to endure.
The very restrictiveness of his life pattern precludes many of the usual patterns by which aggressive impulses can be harmlessly expressed. Instead, activity is restricted and feelings of being confined or trapped in his wheelchair and in his useless body often erupt.
Brad traverses the full gamut of depressive influences which pervade the life of the paralytic including feelings of helplessness, despondency, and self-hatred and adoption of negativistic behavioral patterns of non-cooperation. His personal concerns about self-respect, self-esteem, social acceptability, and role, as well as vocational, financial, and sexual problems loom large.
Although his undesirable psychological patterns are completely understandable and based on realistic concerns, many aspects interfere with rehabilitation and with his eventual return to an optimal psychological and functional state. Although grieving and other unpleasant emotional factors are components of necessary psychological processes of adaption and adjustment, feelings of hopelessness, despair, guilt, hostility, etc., are enemies to be fought in the process of rehabilitation.
Also, the psychological stresses and strains imposed by his injury and its consequences can result in the shifting of aspects of Brad's personality into categories that are frankly psychoneurotic; in a sense they may then be seen as representing psychological "illness". These patterns, once established, are difficult to break up. Therefore, psychiatric help or consultation may form an important portion of the post-injury care. Feelings of anxiety or anxious depression can become acute and constitute episodes equivalent to psychiatric crises. In other instances, there may be states approximating catatonic withdrawal and refusal to participate in even the usual patterns of social exchange. This is one of the major reasons for Dr. Crouch's recommendation as to the future psychological rehabilitative program which Brad needs.
Episodes of hysteria are not uncommon, and hysterical features may color the general tone of the paralytic's personality. In some patients, denial and a false facade of cheerfulness and unconcern may predominate. In others aggressive, negativistic, and hostile expression with refusal to cooperate in treatment regimens may dominate, either briefly or repeatedly for prolonged periods. Brad manifested early symptoms of refusals to cooperate in rehabilitative therapy, but his testimony will be that this was due to the intense pain and the overwhelming feelings of futility which he experienced in the early rehabilitative efforts. Dr. Crouch will testify that this is a very normal and routine response to the extensive traumatic injury which he sustained.
The concept of body image is also critical for understanding the psychological processes in these patients. Each of us carries with us a conception of the appearance and physical reality of our own body. This body image is a functional aspect of the individual's lifelong awareness and image of self and its relations to conscious experience (ego). The ego is central to a healthy personality structure and the body image is an integral and important aspect of it. Therefore, one major psychodynamic process which is going on with Brad following spinal cord injury is the slow alteration of his body image to conform to a new post-injury reality, and to incorporate this altered body image into the structure of the ego in a constructive manner. This process requires much time and the utilization of a great deal of psychological energy. Outwardly, this process may give the impression that the patient is pre-occupied, self-centered, or inadequately concerned with the welfare of others; however, such reorganization is necessary and, in fact, represents an aspect of healing or readapting process.
Our psychological evidence will show that it is usually some time before the patient comprehends the magnitude of the disability. Mr. Day is going through stages of adjustment including shock and disbelief, denial, depression, grief, and acceptance. During the acute phase of the injury, denial was a protective mechanism to shield him from the overwhelming reality of what has happened. As he eventually realizes the finality of paraplegia, the grieving process will be prolonged by the awareness of "what will never be". A period of depression followed as he experienced a loss of self-esteem in areas of self-identity, sexual functioning, and social and emotional roles. Self-esteem is related to being strong, loved, and lovable - all of which are threatened by the injury. To be able to work through this depression, Mr. Day must be able to see some hope for relief in the future. Thus he is guided toward a sense of confidence in his ability to achieve self-care and relative independence. The role of the health care team and family ranges from caretaker during the acute phase to teacher, counselor, and facilitator as Brad gains mobility and independence. Brad has the extreme good fortune to be in a closely knit family which offers him considerable psychological support. He is also fortunate to be under the care of an outstanding neuropsychologist, Dr. Erin Crouch.
Brad's acceptance of the disability will lead to the development of realistic goals for the future, making the best of those abilities that are left intact. Rejection of the disability will cause self-destructive neglect and noncompliance with the therapeutic program. This leads to more frustration and depression. His family requires counseling, social services and other support systems to help them cope with the changes that have been made in their life style and socioeconomic status.
