Westchester County

Published on: November 15, 2012

DOD Issues Standards for Brain Injury Purple Heart

by Stephen Bilkis

U.S. service members injured in the line of duty have long been eligible to receive the Purple Heart Medal. This has held true for the signature wounds of the current wars, including mild traumatic brain injuries and concussions.

Recently, the criterion for awarding the medal was refined. “More clarity now exists for how medical criteria for the award are applied,” Defense Department officials reported.

“The criteria for the Purple Heart award state that the injury must have been caused by enemy action or in action against the enemy and has to be of a degree requiring treatment by a medical officer.”

Published on: October 14, 2012

A man sustained severe personal injuries during the course of his employment

by Stephen Bilkis

A man sustained severe personal injuries during the course of his employment when he fell from a ladder in a warehouse owned by the accused warehouse corporation. He commenced an action alleging negligence and violations of Labor Law. The warehouse corporation brought a third-party action against the Dollar Store in Westchester which is the man’s employer to seek common-law and contractual indemnification. In two separate motions, the employer moved for summary judgment to dismiss the third-party complaint. Supreme Court denied both motions, finding issues of fact as to whether, under the Workers’ Compensation Law the man sustained a grave brain injuryand whether the employer had contractually agreed to indemnify the warehouse corporation.

Workers’ Compensation Law permits an owner to bring a third-party claim against an injured worker’s employer in only two circumstances: when the injured worker has suffered a grave brain injury or the employer has entered into a written contract to indemnify the owner. The employer asserts that the warehouse corporation failed to raise an issue of fact as to the applicability of either exception to the prohibition against third-party claims against the employers.

A grave injury is defined, in relevant part, as an acquired brain injury caused by an external physical force resulting in permanent total disability. Although the statute does not define permanent total disability, the Court of Appeals has determined that a brain injury results in permanent total disability under the Workers’ Compensation Law when the evidence establishes that the injured worker is no longer employable in any capacity. Even the employer sustained its initial burden of establishing as a matter of law that the man did not sustain a grave injury, the evidence submitted in opposition to the motion was sufficient to raise a triable question of fact.

Published on: October 9, 2012

Privacy fears lead council to object to brain injury care unit plans

by Stephen Bilkis

A community is in an uproar over plans to turn a derelict “eyesore” – property that used to be a filling station – into a specialized brain injury care unit. Residents of Staten island feel the new building will dominate their neighborhood as it would be the only two-story building in the community of bungalows.

A woman living next to the discarded lot spoke out at the meeting. “The site has been an eyesore too long and I don’t object to the idea of the brain injury clinic, but the size of the building would have to be in proportion with the bungalows on either side.”

Because of testimonies like this from the 25 community members who attended the meeting, the planning applications committee unanimously objected to the plans.

Published on: September 17, 2012

30% of Brain Injury Victims Suffer from Depression

by Stephen Bilkis

A study reports that almost one-third of all cases of TBI (Traumatic Brain Injury) eventually lead the sufferer to a depression experience. A Vanderbilt University Medical Center team spent a considerable amount of time analyzing existing research on such brain injury-inducing incidents as: blunt force trauma to the head from traffic accidents, falls, sports and assaults.

Attorneys have long seen the correlation between the two events, but it is always welcome when an expert in the field corroborates the evidence. “Any patient who has a traumatic brain injury is at a real risk for developing depression, short and long term,” the study’s co-author said in a medical center news release.

“It doesn’t matter where on the timeline that you check the patient population — six months, 12 months, two years, five years — the prevalence is always around 30 percent across the board.” Compare this to the rate of depression in the general population which is about 9 to 10 percent, and the issue is apparent.

Published on: July 23, 2012

The clinical assessment of head injury severity is commonly based on what is known as the Glasgow Coma Scale (GCS)

by Stephen Bilkis

The clinical assessment of head injury severity is commonly based on what is known as the Glasgow Coma Scale (GCS) according to doctors. A score of 3-8 means severe injury, 9-12 is a moderate brain injury, while 13-15 is mild head injury, based upon examination six hours after injury. The score is obtained by observing the patient’s impairment in speech, motor function, and eye movement. It does not, however, show what might have caused the impairment. Patients with the same GCS score may well have completely different causes for it, which means completely different treatment is necessary. Fatalities may even occur in patients who are not treated properly, even those with GCS scores above 9.

The damage to the brain is often vascular, studies have learned. The contusion index rates these injuries, giving them numerical values according to surface extend and depth. Another means to assess vascular injury is the hemorrhagic lesion score. This measures, in Westchester and Brooklyn, the total vascular damage in a traumatized brain by mapping macroscopic and microscopic evidence of bleeding on a diagram of sections of the brain, which are further divided into sectors.

Cell damage is a bit harder to quantify. The distribution and extent of such damage is not uniform or symmetrical, so systematic microscopic study of the brain is required to properly assess it. It has often been divided into three grades of severity, depending upon a number of criteria determined by examining both macroscopic and microscopic lesions.

Published on: July 19, 2012

The way surgeons deal with shrapnel or bone fragments in the brain has changed

by Stephen Bilkis

The way surgeons deal with shrapnel or bone fragments in the brain has changed since the days of Korea or Vietnam, doctors tell sources. It was once the standard to remove every last fragment of bone or any other foreign body, so the brain would have a lower risk of infection and there would be less chance of developing post-traumatic epilepsy. Studies in Westchester County of Vietnam War patients has shown that removal of all fragments is not actually necessary, though objects that cause gross contamination should still be removed.

Closure of the scalp and replacement of the dura are absolutely vital to prevent, or at least reduce the chance of, CSF leakage and meningitis. A soldier who seems to have good neurological status, with only small fragments in the brain may be able to be treated locally to prevent leakage. One with a more extensive injury will have to undergo a large decompressive creniectomy and removal of the fragments.

Another source of head injury from an explosive blast can result from being bodily thrown by the explosion. The soldier’s head could strike some other object, causing tertiary blast injury. This can cause injuries in a number of places in the patient’s skull. There is also the risk of infection in cases such as these, often from bacteria that are drug-resistant. A number of dangerous injuries can result from such trauma, New York City doctors know. It can be very important to repair such injuries as facial fractures quickly.

Published on: July 2, 2012

Brain injury can be very tricky to find and properly assess and treat

by Stephen Bilkis

Brain injury can be very tricky to find and properly assess and treat, doctors have learned. Very often, the location of the actual injury is not at the point of impact. When an impact does not have the force to breach the skull, but is significant enough to cause injury, the force can be transferred to thinner bones found in other places, such as the base of the skull.

Physicians in New York and Westchester County sometimes use the term ‘countrecoup’ to describe head injuries that result from an impact on the other side of the head. Contrecoup injuries are caused by rapid and localized pressure changes on the surface of the brain due to force transmitted by a sudden impact. These injuries can also be caused by the brain actually moving inside the skull and sustaining injury from striking the bony surfaces.

The location of the head injury is also important, studies have learned. As far back as 200 years ago, physicians have been noting that injuries to the frontal portion of the brain tend to be less severe than injuries taken to other parts of the brain. Research has shown this to be the case time and again, both from experiments and from collecting medical data. There are, however, studies that suggest that the nature of head injuries may be far more complex than that, depending upon the location of the injury. The very complexity of the brain itself makes it difficult for physicians and other medical experts to establish a clear pattern when it comes to head injuries.

Published on: June 22, 2012

Stepfather Convicted of Causing Grievous Bodily Harm to Toddler

by Stephen Bilkis

After seven hours of deliberation, a District Court jury delivered a majority, or 11 jurors to one, verdict in the case of a 22-year-old stepdad. The man was found guilty on the charge of causing grievous bodily harm with intent.

The stepfather had always denied the charge that he caused a head injury that left a 2-year-old child with little more than 50% of his brain function. He stood passively in the dock as he was remanded to custody for a July sentencing. As he was escorted from the court, a supporter mouthed “I’m sorry.”

The Judge thanked the jury and told them, based on the evidence, their decision was the only one open to them.

Published on: June 11, 2012

About the injuries in the army, details a New York Brain Injury Lawyer

by Stephen Bilkis

A doctor unfolds the report given by many National Guard and Reserved soldiers who were injured in war and felt snubbed by the Army compared to enlisted soldiers. According to the soldiers, they felt as if they were being asked to keep their mouths shuts with the treatment that they receive after returning from war with their brain injuries.

“Many of these National Guard and Reserved soldiers don’t feel as if they are getting fair treatment by the U.S. Army and want their voices to be heard. These soldiers go through a lot of trauma in war and still have to come back home to face the truth that the injuries sustained in war is their responsibility” explained one soldier to a Lawyer.

The soldier’s stories of post traumatic disorder and brain injury reached the ears of the Oregon Congressional delegation that stepped in and demanded that a full investigation be done. The source also feels that someone needed to get to the bottom of this. These soldiers provided a life threatening service to their country and the least that the U.S. Army can do is to provide medical care for these soldiers whether they are enlisted or not.

Published on: June 6, 2012

Blast TBI (traumatic brain injury) happens to many combatants

by Stephen Bilkis

Blast TBI (traumatic brain injury) happens to many combatants. It can rightfully be considered a new class of TBI. While it might share a lot of features with standard TBI, it has some unique aspects that are all its own.

The milder forms of TBI can be very similar to PTSD (post-traumatic stress disorder), but it also has distinct aspects of its own. The military currently uses civilian standards of care for TBI when it comes to bTBI (explosive blast TBI), but they are constantly revising their standards to better provide for those injured on the field, according to doctors. The theater of war requires different standards of medical practice.

It is apparent that there need to be more studies done on the precise effects of bTBI, both scientifically and clinically. The research will have to be focused upon how explosive blasts can lead to TBI. It is also important to learn how prevalent this disease is, and the exact causes. Once the research in Staten Island and Westchester reaches a certain level, it will become much easier to diagnose and treat bTBI. A clinical definition of bTBI should quickly create the means to treat bTBI.