Traverse City Personal Injury Lawyer

Disbursing Funds under Michigan's Wrongful Death Statute

Timothy Smith — Sun, 22 Nov 2009 15:01:22 GMT

Recently, we've resolved a number of wrongful death cases here in Northern Michigan. In Michigan, these types of cases are governed by a statute that controls every aspect of the case, including how the recovered funds are distributed to the family members that survive the deceased. One of the families that I represent asked me to explain to them how the distribution of the monies we recovered would take place.

In order to fully answer their question, I turned to Andrew Shotwell, a probate specialist with my office here in Traverse City, Michigan. I asked Andrew to draft an informative letter to the family to answer the question and thought I'd share the substance of it with my readers in case they were facing a similar issue.

The procedure and applicable law depends on various facts. First, if a complaint has been filed in circuit court, the distribution is governed by MCL 600.2922. Essentially under that statute, if no conscience pain and suffering was present or to the extent an award is for other than conscience pain and suffering, the circuit can distribute under 600.2922. The Court approves distributions “to those…who suffered damages and to the estate of the deceased for compensation for conscious pain and suffering, if any, in the amount as the court or jury considers fair and equitable considering the relative damages sustained by each of the persons and the estate of the deceased.”

If there is conscience pain and suffering awarded, the award passes to the estate and is distributed in accordance either with the decedent’s last will and testament, or by intestate succession [this is the law that governs how an individual's estate passes when they have no will]. There is no precise formula for determining the damages for the loss of a loved one’s society and companionship. In re Claim of Carr, 189 Mich App 234, 471 NW2d 637 (1991). The measure of damages is gauged by the relationship the decedent had with the claimant, including the amount of time the decedent and the claimant spent together. McTaggart v Lindsey, 202 Mich App 612, 509 NW2d 881 (1993).

If a complaint has not been filed and settlement has been reached, the distributions occur pursuant to MCL 700.3924, which is similar to 600.2922, requiring the distributions to be fair and equitable. The persons entitled to notice and an opportunity be heard in a wrongful death case under both 700.3924 and 600.2922 are as follows:

1) The deceased's spouse, children, descendants, parents, grandparents, brothers and sisters, and, if none of these persons survive the deceased, then those persons to whom the estate of the deceased would pass under the laws of intestate succession determined as of the date of death of the deceased.

2) The children of the deceased's spouse; and

3) Those persons who are devisees under the will of the deceased, including beneficiaries of a trust under the will, those persons who are designated in the will as persons who may be entitled to damages under this section, and the beneficiaries of a living trust of the deceased if there is a devise to that trust in the will of the deceased.

In any case, an estate would need to be opened with the probate court in the county of residence for the decedent. If a will exists, it is submitted to probate and a Personal Representative appointed, as nominated in the will. If no will exists, or the will fails to nominate a Personal Representative, the Court will appoint one according to the priority schedule, starting with the surviving spouse. Notice is required to be sent to all the people indentified above as having an interest in the distribution.

Once a settlement or an award has been granted, if all of the potential distributees are competent, nondisappeared adults, they may stipulate to a specific distribution scheme. If all of the interested persons stipulate to a proposed allocation, the court must order that distribution. However, if a disagreement exists, a hearing would be required.

If a minor is involved a guardian ad litem may be required to advocate on the minor’s behalf.

If after reading this summary of the approaches to distribution under the wrongful death statute, you still have questions, feel free to shoot me an email or call with further questions.

In my next article, I'll address and give some examples of what happens when the family can't agree on the distribution and an evidentiary hearing is required.

Originally posted at InjuryBoard by Timothy Smith

Update on Insurance Bad Faith Reform Package in Michigan

Kevin Elsenheimer — Wed, 21 Oct 2009 16:47:40 GMT

I've been asked to talk briefly about the manner in which the insurance reform package left the Michigan House of Representatives, and to give an update as to its status in the Michigan Senate.

House Bills 4244, 4844, 5020, and 5144-5151 were passed out of the House on what was essentially a partisan vote (most Democrats voting for, Republicans mostly opposed) in the early Fall. The bills were referred to the Committee on Economic Development and Regulatory Reform in the Michigan Senate. My staff has communicated with the staff of the committee's chairman, Sen. Alan Sanborn, and we have been advised that the bills will not be taken up by the Senate committee, which means that the issue is likely dead for this legislature.

To my mind, it is a shame these bills moved in such a poor state. I think there was a middle ground that could have been reached on the issue which might have led to an improved policy. Unfortunately, policy took a backseat to politics and there was no opportunity given for compromise.

When the bills were voted on by the House, I issued a strongly-worded press release as Republican Leader in the House chastising both the actions of the Insurance Commissioner, Butch Hollowell, and the House Democrats in moving bills that were so one-sided they virtually gauranteed no action in the Republican-led Senate. Let me address each one of these comments.

On the day of the vote on the bills, my office began receiving contacts from Republican members of the House complaining that their offices had been contacted by the Office of the Insurance Advocate regarding clearly political matters, such as who the member's key supporters and donors were, when the members conducted office hours and the names of their political opponents. My members viewed this contact as a poorly-vieled threat on the part of the Insurance Advocate's Office, and by proxy, the Granholm Administration, to seek out political retribution on those who would oppose the Bad Faith Reform package. That this was being done on the taxpayer's dime made the matter even more infuriating.

It should be noted that Butch Hollowell has said he knew nothing about the calls made to my members' offices. I take him at his word, but the actions of his department had a lot to do with the attitude that House Republicans brought to this particular set of bills. But it wasn't the only cause of that attitude.

There are several members of my caucus who would support some kind of bad faith fix. No member of my caucus, however, was willing to support the one-sided language that suddenly came from the House Committee on Insurance. I am told that we had at least one member that was working with the chair to come up with compromise language that would actually have the potential of moving in the Senate. When the bills were suddenly moved to the floor of the House, my Insurance Committee members felt like the rug had been pulled out from under them.

In my experience, this kind of rushed work only happens when a powerful special interest group demands some kind of action. The Justice League (or whatever the trial lawyers call themselves now) was the prime mover of this package, and I called out the House Democrats as pushing the legislation as a pay-off to trial lawyers.

Not surprisingly, I received some contacts from some fellow attorneys about my comments. Tim Smith, who blogs regularly on this site, was particularly unhappy and was kind enough to ask me to explain in this forum what happened on the ground.

In hindsight, my press release was a bit strong, but there is more than an air of truth in my comments. This package moved before its time. It did so without meaningful compromise and as a result is dead in the Senate. The fact that House Democrats moved it in this way, which is unusual, and that the Insurance Advocate's Office was involved led me to believe at the time that the real goal of moving this package was to have political ammunition for future campaigns. I still believe that is the case today. The fact that the MAJ gave 99.73% of the $591 thousand-plus that it spent from July of '08 to July of '09 to Democrats isn't lost on me either.

Someone needs to ask, is the goal here to enact real policy reform or to advance a political objective? This and other policy objectives can be achieved - again, let me stress that I have members who are willing to enact bad faith reform - if the MAJ and the insurance lobby are willing to compromise. That means both sides will need to move. In this instance, I saw those on one side of the argument pick up their toys and go home.

Thanks again to Tim Smith for the opportunity to blog, and I'm sorry for the delay in doing so.

Kevin Elsenheimer

House Republican Leader

Originally posted at InjuryBoard by Kevin Elsenheimer

Michael Sincic: Brain Injury Survivor & Artist

Timothy Smith — Fri, 18 Sep 2009 11:49:25 GMT

One of the nicest things about editing the Traverse City InjuryBoard.com blog is the people I've met and the relationships I've developed as the editor of this site. One of those people is local artist Michael Sincic.

His love of art began in Junior High and High School and continued into college. His approach to art was drastically altered in 1995 when he was diagnosed with a brain tumor. Prior to the tumor, he was regularly sketching and drawing cartoons. But, this passion was paused while he focused on address this serious injury to his brain.

Thanks to his parents and an incredible neurosurgeon in New York, his life was saved and he has continued in his love of art through painting and sculpting. Unfortunately, he lost most of his sight and his pituitary gland due the removal of the tumor, but he has learned to "feel" with his hands as he continues to create his art.

He began his company, "Michael's Unique Visions" in the fall of 2000. One of his original art works was commissioned for Steve Yzerman, captain of the Red Wings Hockey team which spends summers up here in Traverse City at their training camp. His art is sold throughout northern Michigan at DeYoungs in Traverse City, Elements Gallery in Charlevoix and Harbor Springs and Main Street Gallery in Milford.

I will be in Lansing next week at the Annual Conference of the Brain Injury Association of Michigan. Look for the Smith & Johnson booth in the vendors area. Michael has been kind enough to allow me to take some of his art work with me to Lansing and we'll have it on display at our booth.

Michael is an amazing brain injury survivor, a very polite and thoughtful young man and a very, very talented artist.

To quote Michael:

"People with disabilities are still people. We all accomplish things, like to have fun, and can communicate in some way. We can do just about everything anyone else can do - maybe just in a different way."

I hope to see some of you there.

-Tim

Originally posted at InjuryBoard by Timothy Smith

Insurance Reform Package Passes State House - Likely to Stall in Senate

Timothy Smith — Thu, 20 Aug 2009 14:48:57 GMT

If you're not up to speed on the problem itself or the proposed fix, click here as I wrote an article on this very issue not too long ago - http://grandrapids.injuryboard.com/automobile-accidents/wrongfully-denied-insurance-claims.aspx?googleid=268418 .

I'm sending a copy of this article directly to our Northern Michigan Representatives. As many of you readers know, we have guest bloggers on InjuryBoard.com and I'm going to turn the reins over to our representatives to see if they can get us up to speed on what has happened and what will happen to these important pieces of legislation.

Originally posted at InjuryBoard by Timothy Smith

The American Academy of Pediatrics Steps Up in Support of the National PABI Plan

Timothy Smith — Fri, 07 Aug 2009 17:09:20 GMT

Just a few minutes ago, I received an email from Patrick Donohue at the Sara Jane Brain Foundation. Attached was this letter from the American Academy of Pediatrics describing their support for the National Pediatric Acquired Brain Injury Plan.

There is a need to develop a comprehensive approach to the prevention, evaluation, and treatment of pediatric acquired brain injuries. Multisite collaborative investigation such as that proposed by The Sarah Jane Brain Foundation Project would allow the development of evidence based, standardized approaches to the prevention, evaluation, and treatment of pediatric acquired brain injuries so that all children would have access to the highest quality, most effective pediatric health services.

There seems to be a very real groundswell of support for this very important project. If any of my reader's are interested in learning more about The Sara Jane Brain Foundation or donating money to this worthy cause, please click here to find out more.

Originally posted at InjuryBoard by Timothy Smith

The National Pediatric Acquired Brain Injury Plan - Part IV

Timothy Smith — Fri, 07 Aug 2009 16:55:25 GMT

Today, we will wrap up our look at the National Pediatric Acquired Brain Injury Plan. Yesterday, we concluded our 3rd article by discussing how the Plan and the regional centers will address the transition of these children from minors to adults.

The sixth category of care to be addressed by the regional centers will include the issues facing rural and Tele-health. The scope of this problem is enormous. Approximately 40% of all Americans live in cities with less than 200,000 people. Rural hospitals without specialty staffing for neurological emergencies comprise approximately 80% of hospitals nationwide, yet they provide care for nearly 54 million US citizens. This data from the American Hospital Association evidences the fact the majority of Americans are not living near a hospital that can properly address the issues facing pediatric acquired brain injury. Part one of the solution to this problem would include the Sarah Jane Brain Foundation state lead centers. When funded, these state lead centers will provide expertise and coverage within a 200 mile radius for 42% of the United States, including Hawaii, Alaska and Puerto Rico. The question for the reader must be, "What about the other 58%?" The easy answer would be, "Where there is cellular service and/or internet access, there is expertise available". The concept of tele-medicine (part two of the solution), would involve the Sarah Jane Brain Foundation Tele-Medicine National Center. This center will provide:

1. Access for physicians and nurses in remote, rural or community hospital settings to interact during acute, sub-acute and chronic stages with experts in all specialties;

2. Allow access by experts in distant locations to review, monitor and assess patient status;

3. Quality monitoring across state lead lines.

This technology is FDA approved for remote delivery of vital signs including high enough quality video for visual exams and surgical guidance from remote sites. Tele-Medicine is already in use in the U.S. Military and many hospitals throughout the United States. The Tele-Medicine component will rely upon all other national leads to provide the best care possible for children who have sustained a closed head injury regardless of location.

The last category of care for the regional centers will involve a concept of a virtual center of care. It is anticipated that the stages of the virtual center will include the following:

1. Patient and family centered registry;

2. Electronic health and personalized record portal integration across life-ecosystems; and

3. Online, up-to-date and relevant content to provide continual resources for child, families and care providers.

This virtual integration of constantly updated information across patient, advocate, provider and researcher lines will ensure a virtual ecosystem model of care for pediatric acquired brain injury. By linking all categories of care, virtual technology will allow access to a shared community both rural and urban. Virtual technology will allow rapid access to break-throughs across mild injuries and acute injuries as well as reintegration and adult transition. Virtual training for prevention and long term care as well as repeat check-ups through Tele-Health, will not only provide high quality care to rural groups, but also standardize best practices on a nationwide basis.

Ultimately, the virtual center will be focused in promoting research, advancing discovery speed to application, empowering patients as well as outreach to the community, providing anonymous and highly linked care as well as integrating data to inform public policy.

As Patrick Donohue, the founder of the Sarah Jane Brain Project, is often quoted saying, "Things work out best for those who make the best out of the way things work out", I cannot think of a better approach to standardizing our care for the future of our society who have suffered, at times, a subtle, yet severe, injury to their brains and minds. By establishing this national PABI plan, we ensure, as a society, that our children who have sustained these injuries have the best chance at living a full and meaningful life.

As a final note, I think it important for you to put a face with and meet the folks beind the Sara Jane Brain Foundation. Here's the founder Patrick Donohue and his daughter Sara Jane.

http://www.youtube.com/watch?v=2ybrEJD6MOY&feature=related

Originally posted at InjuryBoard by Timothy Smith

The National Pediatric Acquired Brain Injury Plan - Part III

Timothy Smith — Thu, 06 Aug 2009 11:35:57 GMT

Yesterday, we finished our discussion of the early stages of the National Pediatric Acquired Brain Injury Plan [PABI Plan]. I promised the readers I would focus on the concepts of "mild" traumatic brain injury and the next steps to the NABI Plan for the regional centers here in the United States.

In talking about mild traumatic brain injury, the word "mild" is merely a relative term. The clinical experience and the severity of the injury itself is not "mild". Millions of children, adolescents and young adults sustain traumatic brain injury each year and the great majority (90%) are classified as mild. Even concussions which young athletes sustain on an annual basis are a subclass of "mild" TBI. [for more information on young athletes and concussions, click here]

As we sit here today, the current status of "mild" traumatic brain injuries is, in a nutshell, one of a lack of education and awareness about the condition itself. Medical, educational, sports and recreational systems are universally under-prepared and ill-equipped to handle these injuries. There is a lack of trained responsive systems including first responders such as EMS and athletic trainers as well as primary care physicians and clinicians. There is also a lack of services in the form of emergency departments, pediatric offices as well as on the schools and playing fields themselves.

Because mild traumatic brain injury is under-recognized and under-identified, there is not only poor, but incomplete management of the injury itself. Because the injury is under-recognized and under-identified, those children would suffer an increase risk for a more serious outcome. Further, repeat concussions and/or mild traumatic brain injuries can cause cumulative injuries resulting in death (second impact syndrome), chronic traumatic encephalopathy as well as persistent symptoms and/or prolonged recovery from the post-concussive syndrome.

The National PABI Plan for mild traumatic brain injury is to develop nationwide a master plan to ensure equal assessment and treatment that includes the best practices standards, ensuring early identification of the injury, education, training of personnel systems as well as equal entry to services at all points.

The next category of care charged to the regional centers will be that of reintegration and/or long term care. As far as reintegration into the school community, there is no systematic method for connecting children and their families with services within the school and community following a traumatic brain injury. In particular, failure to identify the injury for purposes of special education, causes significant problems within the school.

Annually, 62,000 children are hospitalized for traumatic brain injury. Of those 62,000 children, approximately 19% need special education support. This means that the cumulative total kindergarten through 12^th grade of children needing special education support totals nearly 150,000 children. Yet in 2005, the total recognized pediatric need for special education due to traumatic brain injury was just 23,509. In fact, many educators had acknowledged that they simply do not have a handle on this specific disability.

Why? All you have to do is look at the contributing factors to this under-identification and the poor services. Traumatic brain injury is generally defined as an invisible disability. Students may look normal or have no physical signs of disability yet their brain is functioning in an abnormal matter following trauma. Further, when children are injured at an early age, the impact may not be seen until years later as they begin missing certain developmental milestones or acting in socially or academically inappropriate ways.

Further, parental expectations are askew as there is a rapid pace to the early recovery from a traumatic brain injury [especially in children], yet this recovery typically tapers off over time. Also, there is universally poor tracking of the injury and its outcome as transitions are not well coordinated.

As part of the national PABI Plan, the Sarah Jane Brain Foundation will provide research on effective interventions which will allow services for educators and other service providers. This, in turn, will allow those educators and schools to provide services for the children and their families as well. These academic services will help transition the child on referral from acute care, rehabilitation or community agency through the academic environment and into a proper and smooth transition to adulthood.

The fifth category of care for the regional centers will include adult transition. Under the current scheme, transition to adult life following pediatric acquired brain injury would include medical, psychological and rehabilitative services such as physical therapy, occupational therapy and speech and language therapy which would be received through special education and end suddenly at age 21 with the end of school eligibility. The IEP process should mandate a transition program to support the transition from school to post secondary education or work. Further, social opportunities can be developed if acquired brain injury appropriate education is offered to community personnel and case managing is provided to the individual's family.

The current problems with transitioning to adult life following pediatric acquired brain injury would be the following:

1. Lack of adult medical providers including primary care physicians and specialists;

2. Lack of pediatric acquired brain injury education among psychologists, psychiatrists and community mental health providers which, to date, tends not to include emotional problems causing serious psychiatric disorders in adulthood because of the transition;

3. Lack of insurance coverage for non-acute physical therapy, occupational therapy, speech and language therapy, cognitive rehabilitation or psychological treatments;

4. Extreme variability in conduct of education transition services with regard to program quality relevance from district to district and success which is quantified by functional outcomes; and

5. The lack of any opportunity for a formal social interaction by the brain injury survivor.

The main question for the reader should be, "How does the Pediatric Acquired Brain Injury Plan address the identified problems?" Currently, the PABI registry will provide an educational resource for physicians and other providers. It will also clarify the course of PABI through development including addressing the impact of PABI trauma and medications on physical systems over time. Lastly, the PABI registry will provide an integration of knowledge and practice. With regard to the PABI virtual center, the center will bridge the knowledge gap between pediatric and adult providers, will provide data collection on long term medical and health parameters and outline the effective treatments including "best practices" for young children with brain injury. Further, the virtual center will replicate all of these quality programs in every community which will reduce variability in service access due to the lack of knowledge and non-existing case management.

Tomorrow we will wrap up our look at this amazing nation-wide attempt to standardize the diagnosis and treatment of children with acquired brain injuries. We will look at the difficulties faced by families living in rural area, far away from the hospitals and treatment centers that could provide the appropriate care. We will also discuss 'the virtual center of care"; a center focused in promoting research, advancing discovery speed to application, empowering patients as well as outreach to the community, providing anonymous and highly linked care as well as integrating data to inform public policy.

Originally posted at InjuryBoard by Timothy Smith

Brain Injury Association of Michigan Updates - August 5th, 2009

Timothy Smith — Wed, 05 Aug 2009 18:18:12 GMT

When I was elected to the Board of Directors to the Brain Injury Association of Michigan, I promised my InjuryBoard readers that I would provide them with regular updates from the front lines of brain injury advocacy. Today we have some very good news straight from Michael Dabbs, the president of the BIAMI:

Appropriations Update

TBI Act

On Friday, July 24, 2009 the House of Representatives passed a $730.5 billion bill to fund health, education and labor programs in fiscal 2010. The bill (HR 3293) allocates $10 million to the HRSA state grant and protection and advocacy programs. The accompanying committee report states:

"The Committee provides $10 million for the Traumatic Brain Injury (TBI) program. This is $123,000 above the fiscal year 2009 funding level and the budget request. The TBI program funds the development and implementation of statewide systems to ensure access to care, including pre-hospital care, emergency department care, hospital care, rehabilitation, transitional services, education and employment, and long-term community supports. Grants also go to State protection and advocacy systems. In fiscal year 2009, 16 States will receive TBI awards, and 57 State and territorial protection and advocacy systems will be funded. The Committee intends that HRSA allocates the TBI funding increase to States and protection and advocacy systems in the same proportion as they received with fiscal year 2009 funding."

The National Institute on Disability and Rehabilitation Research

Also, considered as part of the bill, funding for the National Institute on Disability and Rehabilitation Research as stated in the Committee Report is as follows:

"The Committee recommends $110,741,000 for the National Institute on Disability and Rehabilitation Research, which is $3,000,000 above the fiscal year 2009 funding level and the same as the budget request. The Institute supports research, demonstration, and training activities that are designed to maximize the employment and integration into society of individuals with disabilities of all ages. The Committee encourages the Administration to establish an Interagency Committee on Disability Research to develop a comprehensive government-wide strategic plan for disability and rehabilitation research, including capacity building and knowledge translation."

Social Security Administration

The Social Security Administration's program that supports seniors and the disabled received $11.4 billion in the bill, $993 million above 2009, for a limitation on administrative expenses for SSA. The Committee expressed dedication to helping the Social Security Administration (SSA) address several challenges, including processing a rising number of retirement and disability claims, reducing the backlog of disability claims, and improving service to the public.

BIAA will continue to monitor the bill as the Senate Appropriations Committee is scheduled to begin marking up its version of the bill July 28. Look for more details and action alerts in the coming weeks. In the meantime, BIAA thanks grassroots advocates for their assistance!

Health Care Reform Update

House

After more contentious private and public negotiations on a health overhaul between House leaders and moderate Democrats, prospects are uncertain for a vote on the bill before lawmakers leave for a long August recess.

The Energy and Commerce Committee Chairman, Henry Waxman, is aiming to come to an agreement by Monday or Tuesday of this week in order to report the bill to the full house.

House Democratic leaders will attempt to convince their caucus of the merits of the legislation Monday evening, in the hope of holding a vote at the end of this week or early next week.

Majority Leader Steny Hoyer, had earlier dismissed the idea that Energy and Commerce might have to discharge the bill without voting on it --- something Waxman said, in the heat of his dispute with moderate democrats, that he was considering himself. "I'm not interested in that, and I don't think the Speaker is either," Hoyer said. (CQ)

He said chances are "very small" they will take the bill to the floor before the House's scheduled July 31 break for the August recess. However, he said it was possible the leadership would hold the chamber in session beyond that date.

Senate

Senate leaders last week abandoned plans to pass their own bill before August, but work continues among a bipartisan group of six Finance Committee members - backed by their leadership - to reach agreement on an overhaul.

BIAA will continue to monitor Health Care Reform closely as debate continues.

The fact that 10 million was earmarked to the traumatic brain injury program and that this figure was a six-figure increase over 2008 is good news indeed. My hat is off to the National Brain Injury Association and all the folks that are working behind the scenes to help the survivors of traumatic brain injuries.

Originally posted at InjuryBoard by Timothy Smith

The National Pediatric Acquired Brain Injury Plan - Part II

Timothy Smith — Wed, 05 Aug 2009 17:02:10 GMT

Yesterday, I wrote about the National Pediatric Acquired Brain Injury Plan which was brilliantly devised and developed by Mr. Patrick Donohue. [Click here if you missed that article.] I promised to begin laying out, in greater detail, the structure of the plan and how it would help families whose children have sustained a recent injury to the brain. This might take a few posts as the scope and breadth of the plan itself is substantial.

Yesterday I ended by explaining the following:

The mission or goal of the National PABI Plan is to disseminate via each state a master plan. There will be collaboration within each state and with other states to teach, train and track public awareness, citizen involvement and the long term needs of the victims and survivors of pediatric acquired brain injury. Each state will staff a center representative, an individual in charge of basic science, a staff person in charge of education, one in charge of training, one in charge of prevention, one in charge of case management, and the last to be in charge of registry. Within each regional center, there will be a national center with each state having a representative to the national center. That regional center will be charged with staffing the following areas: prevention, acute injury, reintegration, adult transition, mild TBI, rural needs and family registry. The concept will be that families, through the internet, can reach out and find the Sarah Jane Brain Project via the internet and then be assigned to their lead center within their respective state. The lead center will then be able to direct the family immediately to the assistance they need as it relates to education, training, case management, etc.

The first category of care charged to the regional center under the National Plan, is that if prevention. Prevention is the best possible treatment for any brain injury. In recognizing that head injury is the leading cause of death and disability in children (the CDC estimates that 475,000 traumatic brain injuries occur in an among children below 14 years of age with 2% of Americans having long terms symptoms after pediatric traumatic brain injury), it is of paramount importance that head injury prevention be at the forefront of each regional center's activities.

Current PABI prevention efforts include:

1. Primary prevention entailing preventing new injuries through education and encouragement to reduce high risk behaviors, engineering safer technologies, enforcement of safe practices and evaluation of the impact of these measures.

2. Secondary prevention involves reducing the severity of injuries through improved medical practices.

3. Tertiary prevention involves decreasing the frequency and severity of disability after an injury via improved support structures in the post acute setting.

Unfortunately, at this time injury prevention is undervalued in society. The importance of preventing a brain injury is not well appreciated by families and their communities until an injury actually occurs. Many simple, but effective preventative measures (helmets, seatbelts, car seats) are still under-utilized or improperly utilized. It is difficult to measure the effectiveness of injury prevention intervention and therefore, hard to establish its true value.

The question for you, the reader, would be this: "how does the PABI plan address injury prevention?". Well, it provides support for research to identify the most significant modifiable risk factors, it investigates effective prevention strategies for each main mechanism of injury, it uses a model of education and works with the current effective injury prevention program such as Think First and Safe Kids to develop and refine programs for all ages and ethnicities.

The second category of care charged to each regional center will be that of "Acute Care". The concept of acute care is also referred to as "The Golden Hour". During this early period when minutes really count in terms of assessing injury severity, instituting effective neurosurgical and neuro-critical care interventions and protecting the brain against any secondary injuries is the most critical hour for any family following a pediatric brain injury. What happens here affects everything that follows.

Current problems with acute care include the fact that advanced neuro monitoring is not accessible in many areas of your state and the country. To ensure the best long term outcome, it has to begin in the intensive care unit (ICU). A system must be put in place to assist in the transition of the child and their family through the system to achieve the best long term outcomes following the medical management. This would include early rehabilitation intervention, case management and most importantly, family education.

Because it truly takes a "village" to manage a child with a brain injury, an experienced multi-disciplinary team of professionals are required to manage these injured children. Physicians, nurses, occupational, physical, speech and recreational therapists as well as neuropsychologists, nutritionists, social workers, case managers and teachers are all required to work as a team with the family to allow for the best possible outcome.

If we look at recent achievements in the area of acute research and neuroscience, particularly regarding the developing brain, it is easy to see that we, as a society, are on the threshold of medical and technological discoveries that will reduce the impact of brain injury in children. In recognizing this, and through the efforts of the Sarah Jane Brain Foundation and the PABI Plan, we hope to implement a national system for ensuring the greatest number of children with traumatic brain injury or closed head injury will benefit from breakthroughs in:

1. Clinical Management and Assessment

2. Biomedical Engineering

3. Neuropharmacology

4. Genetic and Stem Cell Based Therapies

5. Advances in Rehabilitation Therapy

Survivors of traumatic brain injury have already begun to weigh in on what they think of this plan.

http://www.youtube.com/watch?v=B0Glf0ljJII

Craig Sears is no stranger to the issues facing families with children who have sustained a traumatic brian injury. He is no stranger to the diagnostic and treatment hurdles that these families will face.

If you wonder why Craig was so adamant in the above clip in his support of this National Plan, take the time to watch Craig's story here:

http://www.youtube.com/watch?v=HdKkYIL1Wl0&feature=related

Tomorrow, our InjuryBoard segment will discuss why "mild" brain injuries aren't mild and we will flesh out the next few stages of the National Pediatric Acquired Brain Injury Plan.

Thanks for reading.

Originally posted at InjuryBoard by Timothy Smith

National Plan for Pediatric Acquired Brain Injury/Pediatric Closed Head or Traumatic Brain Injury

Timothy Smith — Tue, 04 Aug 2009 09:53:15 GMT

As some of my readers know, I recently accepted a position on the legal advisory board to the Sara Jane Brain Foundation. It's is an amazing group, founded by an amazing father who wanted a better approach to the diagnosis and treatment of his infant daughter who suffered a severe brain injury as an infant. This article will educate you the reader on how this group came about and how we plan to implement a uniform and standardized approach to the diagnosis and treatment of Pediatric Acquired Brain Injury on a nationwide basis.

On June 5, 2005, Sarah Jane Donohue was born. When she was just five days old, she was shaken by her "baby nurse" and sustained three broken rips, both collar bones and a severe brain injury. This nurse pled guilty and was sentenced to 10 years in prison but young Sarah Jane was sentenced to a lifetime of difficulties due to the damage to her brain. Just last month, Sarah Jane turned four years old. She cannot crawl, walk, speak words or eat solid foods. She receives weekly physical therapy, occupational therapy, vision therapy, feeding therapy, and speech therapy. She also attends a special full time preschool where she receives special instruction.

The injury sustained by young Sarah Jane is a "Pediatric Acquired Brain Injury". A traumatic brain injury is an injury to the brain caused by external physical forces. Other brain injuries are caused by an internal occurrence which damage the structure of the brain itself from the inside.

What prompted the launch of the Sarah Jane Brain Project was the tireless efforts of Sarah Jane's father, Patrick B. Donohue. What Mr. Donohue has come to learn is that we, as a society, know less than 5% of what we will eventually know about the brain itself. The field of neurology is very fractured worldwide. When I say fractured, I mean there is very little shared knowledge going on between the different locations of research and investigation. If you think of the computer science field back in the 1950s, there were many brilliant people working worldwide, yet no one knew what everyone else was doing. Today, in the field of computer science, there are open source principals and concepts involving shared knowledge such as Wikipedia and Linux Operating System. This allows many people who are researching or investigating the same issue to share their knowledge so that other researchers aren't "reinventing the wheel". As of today, no one is really using these same principals in the field of pediatric neurology. It was the idea of Mr. Donohue when he launched the Sarah Jane Brain Project in October 2007 to begin an open source initiative by placing all of the Sarah Jane's medical records and therapy sessions on line in an open source forum. Mr. Donohue felt that the more "eyeballs" that were on her case, the more likely she was to benefit from all of the information out there worldwide.

Once Sarah Jane's medical records were placed online in an open source forum (www.thebrainproject.org), Phase II of the National PADI Plan commenced. In this phase, Mr. Donohue and those involved in the Sarah Jane Brain Project began to recruit families to develop a national advisory board. Mr. Donohue felt that the more families who had a child with a pediatric acquired brain injury, the more information that can be shared and the more change that can occur within the field. It was clear at the time that every family, when they are first confronted with a child who has sustained a closed head injury or traumatic brain injury, has the exact same learning curve and must reinvent the wheel. It was believed that 85% of what all families go through in the care, treatment and understanding of pediatric brain injury is identical. This National Familial Advisory Board was developed to "standardize the wheel". But, not only were families recruited, but also medical practitioners within the field and attorneys within the field. Almost every single major medical institution and research university is represented currently on the National Advisory Board to the Sarah Jane Brain Project.

Once the National Advisory Board was cemented, Phase III began, where this same Board developed a National PABI Plan. Over 65 leading experts gathered in New York City to draft a PABI Plan. The intent was to create a seamless, standardized, evidence based system of care which would be universally accessible for all PABI families regardless of where they live in the United States. The first draft of this Plan was sent as "the First Official Letter to President Barack Obama" on January 20, 2009.

Phase IV of the National PABI Plan commenced just last month. Within each state, a lead center of excellence was established. These centers within each state would be a resource for families to look to when a child sustains a traumatic brain injury or closed head injury. The implementation date was June 5, 2009 which happened to be Sarah Jane's fourth birthday present. At that same time, the Sarah Jane Brain Project began funding the state lead centers and case management systems to assist families in need.

Some of you at this point may be asking, "Why does each state need a lead center and what responsibilities and/or categories of care would those centers have?" Well, despite the existence of generic "medical standards", there is chaos when it comes to the diagnosis and treatment of pediatric brain injury. There is no uniformity of approach, there is extreme regional variation, there are varying degrees of interest and commitment between states, there is confused nomenclature, there are poorly defined and understood immediate therapeutic goals, and there are unnecessary procedures being implemented as well as wasted money and time, which ultimately leads to incomplete family care.

The question then is: "What can the Sarah Jane Brain Pediatric Acquired Brain Injury Plan do?". In a nutshell, it is a network built on commitment. By putting this network to work, we can define priorities for evidence based improvement, we can coordinate efforts among disparate centers with similar strengths and we can facilitate integrative research efforts through grant writing support staff, coordinated federal and private support work as well as assistance in orchestrating the national priority itself. Attorneys here at Smith & Johnson are glad to be not only a part of the National Legal Advisory Board, but also proud to be spear heading the construction of this network here in the State of Michigan.

The mission or goal of the National PABI Plan is to disseminate via each state a master plan. There will be collaboration within each state and with other states to teach, train and track public awareness, citizen involvement and the long term needs of the victims and survivors of pediatric acquired brain injury. Each state will staff a center representative, an individual in charge of basic science, a staff person in charge of education, one in charge of training, one in charge of prevention, one in charge of case management, and the last to be in charge of registry. Within each regional center, there will be a national center with each state having a representative to the national center. That regional center will be charged with staffing the following areas: prevention, acute injury, reintegration, adult transition, mild TBI, rural needs and family registry. The concept will be that families, through the internet, can reach out and find the Sarah Jane Brain Project via the internet and then be assigned to their lead center within their respective state. The lead center will then be able to direct the family immediately to the assistance they need as it relates to education, training, case management, etc.

Stay tuned as I plan on going into greater detail regarding these phases and what it will mean to Michigan families who are dealing with these issues.

Originally posted at InjuryBoard by Timothy Smith