Miami Injury Lawyer Blawg

Pedro Amieiro was 25 years old, when he crashed a banner plane. He suffered a Traumatic Brain Injury which resulted in Permanent Brain Damage, seizures, and is only able to walk short distances with a cane.

Almeiro sued a privately employed air traffic controller, alleging that the controller gave him a nonstandard instruction, that caused Pedro Almeiro to perform maneuvers at low altitudes which caused the aircraft to stall and crash. 6 years later, a Fort Lauderdale jury awarded Pedro $68 million.

As hundreds of basketball fans packed into Shuckers Waterfront Grill to watch the Miami Heat fight for their playoff lives, the last thing they expected was that they would be fighting for their own collective lives. Tragically, that is what happened when a waterfront patio deck collapsed into Biscayne Bay.

Shuckers is a popular sports bar located in North Bay Village, at 1819 79th Street Causeway. The sudden and unexpected collapse happened about 9:45 p.m. Witnesses' said that one second everyone was cheering, and the next second they were gone. As the deck collapsed, power was lost, and the injured were cast into the water and darkness of Biscayne bay. Miami-Dade Fire Rescue Capt. Eugene Germain Jr. said approximately 100 people were on the deck when it fell into the water.

As people fell into the water they were trapped underneath each other, under tables, and other debris. As of late last night 15 people were transported to hospitals, with at least 2 dozen injured.

Continue reading "Dozens Injured As Deck Collapses At Shuckers" »

Earlier today I wrote about the Florida Board of Medicine's decision to revoke the medical license of Dr. Richard Dellerson, a 74 year old emergency medicine physician. The purpose behind the Board's was to scare other Doctor's into silence.

After giving Dr. Dellerson's case more thought, I asked myself whether the board would have suspend Dr. Dellerson's license had he misrepresented his credentials while testifying on behalf of a defendant Doctor-I would say the obvious answer is not a chance.

Dr. Dellerson's case is by no means the first time a licensing board has revoked a doctor's license for testifying on behalf of a Plaintiff. That honor goes to Dr Gary Lustgarten, a prominent and well respected Florida Neurosurgeon, who lost one of his three medical licenses for "inappropriate" testimony on behalf of a patient's family in a medical malpractice case. A case which the defendant doctor and hospital settled for $2.4 Million.

The North Carolina licensing board claimed Lustgarten's testimony was "invented facts," "totally unsubstantiated, inflammatory" and "could not possibly have been made in good faith." Yet, the case settled for $2.4 Million. How invented and unsubstantiated could the facts have been? Again, had the facts been invented and unsubstantiated while testifying on behalf of a Defendant, the testimony would have been deemed "brilliant" and "novel".

In yet another recent case, the 7th U.S. Circuit Court of Appeals in Chicago upheld the right of the American Association of Neurological Surgeons (AANS) of Rolling Meadows, Ill., to discipline one of its members over improper testimony.

I hope the Juror's appreciate the risk doctor's take when they stand-up on behalf of Plaintiff's and criticize one of their own.

In Florida, doctor's commit multiple acts of Medical Malpractice, and the Florida Board of Medicine rarely issues a punishment, much less a revocation. However, testify against one of their own, and the Board of Medicine will come after you. In the latest attempt to discourage doctors from testifying in Medical Malpractice cases, the Florida Board of Medicine revoked Dr. Richard Dellerson's medical license. The board said Dr. Dellerson misrepresented his credentials. Make no mistake this was not about misrepresenting credentials, this was a loud message to other doctors-DO NOT TESTIFY FOR PLAINTIFF'S IN MEDICAL MALPRACTICE CASES!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

As a Miami Medical Malpractice Lawyer I have witnessed doctor's commit egregious acts of medical malpractice. I have never heard of the Board of Medicine revoking a license. Operate on the wrong leg-no problem, falsify records-no problem, discharge a patient who is having a stroke-no problem, but if you testify against another doctor- BIG PROBLEM. Dr. Dellerson's act: signing two affidavits in 2010 saying he was board-certified in emergency medicine though his certification had expired the year before.

This license suspension is not about Dr Dellerson, the medical director of the Hollywood and Pembroke Pines fire-rescue departments. This suspension is about the efforts of the Florida Medical Association and insurance industry to do away with Medical Malpractice Lawsuits.

Medical Malpractice cases require expert testimony. For the reasons cited above and other reasons, we often retain experts from out of state. In order to bring a claim for Medical Malpractice Florida Stature 766.102 requires, expert testimony from a doctor who practices in the same field as the doctor being sued. Given the chilling effect's of what the Board did do Dr. Dellerson, Medical Malpractice lawyers are often forced to look for out of state experts. At the behest of the insurance lobby, the legislature took care of that as well. ln an effort to discourage out of state doctors from testifying, Florida statute 766.102(12), requires out of state doctor's to apply for an expert witness certificate.

One would hope that the Florida Board of Medicine would concern itself with improving the quality of medical care, and not trying to suppress the opinions of those willing to testify against one of their own

After years of failing to pass legislation that would ban texting and driving, the Florida legislature finally passed a bill and joined the other 40 states that already had legislation in place. Unfortunately, and as is usually the case, the Florida legislature failed to pass any meaningful legislation.

As a Miami Car Accident Lawyer, I have represented countless victims of distracted driving.
Generally accidents involving distracted drivers are more severe, because of that very reason. So not only do distracted drivers cause more accidents, they cause more serious accidents. The statistics are telling:

Distracted Drivers kill 9 people daily;
Distracted Drivers injure almost 1100 people daily

Almost 20 percent of crashes with resulting injuries are caused by distracted drivers.

SB 52 will will go into effect October 1, 2013, as Florida Statute 316.305

The bill prohibits the operation of a motor vehicle while manually typing or entering multiple letters, numbers, symbols, or other text in a handheld wireless communication device, or sending or reading data in the device, for the purpose of non-voice interpersonal communication. Problem number 1 is that the prohibition is enforceable only as a secondary offense, which means law enforcement officers will have to initiate a traffic stop based on another violation such as speeding, running a stop sign, etc. Then they will somehow have to determine whether the driver was texting. Good luck with that!!!!

Problem number 2: A first violation is punishable as a nonmoving violation, with a fine of $30 plus court costs that vary by county. A second violation committed within 5 years after the first is a moving violation punishable by a $60 fine plus court costs. Hardly enough to serve as a deterrent.

Problem number 3: Drivers are allowed to text at traffic signals or while stopped in traffic. As a cyclist, this poses great risks. Drivers will text while stopped at a red light, and proceed when the light turns green; while still texting.

In order to deter behavior you need the following elements:

1. Certainty of getting caught.
2 Severity of the punishment
3. Swiftness of the punishment.

The new "Florida Ban on Texting While Driving Law" does none of the above.

Medical malpractice takes the lives of approximately 100,000 individuals every year. That is 100,000 opportunities to learn and teach. The best way to reduce future medical malpractice is to learn about past errors with an eye toward improving future care. Doctors and hospitals are starting to learn from their mistakes, and integrating information from lawsuits into patient safety efforts.

In addition lawsuits can reveal previously unreported incidents of medical malpractice. A case comes to mind where I represented the family of a man who died from complications of a hemorrhagic stroke. The patient never should have died. He died because a neurologist gave him an anti-coagulant (Heparin), that was of no benefit, and carries a great risk of bleeding complications . The doctor was defiant in his deposition, that it was within the standard of care to administer the heparin. The experts and medical literature said otherwise. We can only hope that the doctor learns from his mistake and reads the medical literature and the depositions of the doctors who were critical of his care.

SSRIs are Selective Serotonin Reuptake Inhibitors a type of antidepressant. In fact, these are some of the most popular antidepressants that have ever hit the market. Billions of dollars are made each year in the treatment of depression and other mental illnesses around the world.

SSRIs work because they allow more serotonin (a chemical in the brain) to circulate in the brain. SSRIs have proven to be quite successful for many people. But, they are not without risk.

In the United States alone in just one year, 2010, there were over 24 million generic Prozac prescriptions filled. That is not the only SRRI either. There are many more. Some of these were prescribed to pregnant women and therein lies an increased risk.

The use of these types of medications in women who are pregnant have been linked to serious birth defects. Some of the known links to SSRIs include persistent pulmonary hypertension (PPHN), anencephaly, cleft lip or cleft palate, other heart defects, and even respiratory distress.

These are all very serious birth defects which can lead to permanent life issues, multiple surgery needs, or even death. Babies and children who have to live with the effects of any of these birth issues can suffer for many years.

Here are some facts related to the use of SSRIs during pregnancy and its risk to the babies.

Respiratory Distress
• Normal risk (without use of SSRIs) is around 7%.
• Risk if SSRIs taken in third trimester of pregnancy - 33%

Heart Defects
• If SSRIs taken in 1st trimester this increases heart defect risk 60%
• That's a 60% increased risk over normal risks

All of these risks are too great. Heart and respiratory issues are some of the leading causes of death in babies born with congenital defects. A complication caused or even potentially caused by medication should not occur. A stronger position taken on anything that could cause such birth defects could potentially help prevent them.

The FDA has a position on the use of SSRIs during pregnancy, but it still sits where you might call middle of the line. They have stated unequivocally that "There are no adequate and well-controlled studied of SSRIs in pregnant women." That can be taken to mean many things, but the evidence has a voice.

Occurring in numbers too frightening to consider for some, spinal cord injuries take a significant toll each year on families, individuals, and medical expenditures. The life changing effects of a spinal cord injury can range from temporary impairment to full and complete paralysis to death.

In the United States alone, there are somewhere between 10 and 12 thousand spinal cord injury occurrences each year. These significant numbers contribute to the ever growing numbers of 250,000 people plus who are living with a spinal cord injury of some type.

A Spinal Cord Injury (SCI) Primer Crash Course:

Depending on where a spine is injured will dictate the type of impairment, severity of impairment, and likely the degree of recovery which is possible (but not always). The spine is divided into C-spine, T-spine, L-spine, and S-Spine for cervical, thoracic, lumbar, and sacral.

• The cervical spine (top) are C1 - C7 and the nerves in this area control vital bodily function signals for the diaphragm (breathing), hands, arms, head, neck, and shoulders.

• The thoracic spine (middle) are T1 - T12 and the nerves control the musculature in the chest, back, and part of the abdomen.

• The lumbar spine (lower) are L1 - L5 with nerve signals transmitting to the lower abdomen, buttocks, back, and part of the legs. Although all of the lumbar areas can suffer from injury, the actual spinal cord terminates between L1 and L2.

• The sacral spine (hip region) are S1 - S5 and has nerves sending signals to the external genitalia, thighs, lower legs, and feet.

• Coccygeal (tailbone) vertebrae - four bones form the coccyx and innervation occurs from the skin of the lower back area

Spinal Column Facts
• Formed by 33 bones or vertebrae
• Forms the spine down middle of back
• Central nervous system is made of spinal cord and brain
• Critical components of physical movement and activity

Spinal Injury Facts
• Almost 39% caused by car accidents
• 16 - 30 years old age group - 55% of victims
• Medical costs average $4 billion

Types of Spinal Cord Injuries
• Broken back - fracture or dislocation of vertebrae
• Compression injury (vertebrae forced together)
• Crush injury (one or more vertebrae is crushed)
• Spinal cord cut all the way through (severing)
• Other external injuries

This terrible assortment of injuries occurs primarily from three areas but there are a few others also.
• Vehicle accidents - 37%
• Acts of violence - 28%
• Falls - 21%
• Other category - 8%
• Sports injury - 6%

If you or someone you love is considering plastic surgery of any kind, you would be best to become fully aware of all of the risks associated with surgery in general and your particular surgery in particular. As the population is aging the number of individuals seeking to change or alter their physical appearance in some way seems to be increasing.

Though most physicians are upstanding members of the medical and social communities, one should be cognizant and aware of the potential issues that could be faced as a result of trying to alter the gifts of Mother Nature (wanted or unwanted). Regardless of how simple or complex a surgery in question, surgery involves inherent risks and should be considered prior to "knife time."

Cosmetic surgeries are by far more prevalent in the United States than in the United Kingdom and Canada.
• United States - nearly 14 million
• Canada - just over 300,000
• United Kingdom - just over 43,000

Cosmetic Surgeries per 1000 citizens
• United States - 40
• Canada - 8
• United Kingdom - 0.7

By Gender and Age groups:
• 91% of Cosmetic Surgeries are performed on women
• Almost 50% of surgeries - 40 - 54 years old
• Around 25% of surgeries - 55 plus years old
• Almost 20% of surgeries - 30 - 39 years old
• Less than 5% of surgeries - 20 -29 years old
• Around 1% of surgeries - 13 -19 years old

Side effects from most things medical whether medications or surgery can occur. Always be aware of potential side-effects because some of them can spell disaster. Be aware of the facts.

• Buttock implants -40% of patients have complications
 Implant rupture
 Fluid leakage
 Nerve or skin damage
 Bleeding
 Pain and swelling
 Infection

• Rhinoplasty - 10% have complications of soft tissue and skin
 Infections
 Loss of smell
 Bone collapse

• Breast Implants
o 70% lose sensation in nipple
o 16% suffer with painful hardening breast tissue
o 3 - 5% tissue dies and requires surgical removal due to toxicity

• Teeth
o 2 - 4% have allergic reaction to resin used when fixing veneers

• Botox
o 12% suffer URIs (upper respiratory infections), back pain, dizziness, extreme coughing, inflammation of nose, muscle tensing abnormalities, change in muscle flexibility
o 10% hemorrhage, neck pain, headaches, sore throat, generalized pain, excess sweating
o 4% can suffer with an abnormality where eyelids close involuntarily (blepharophasm)
o Body can swell uncontrollably - in reaction to the Botox toxin

Medical errors occur and medical risks are inherent in surgery regardless of how good doctors are. However, there are always the outliers such the fake doctor of buttocks implants above. Be sure your surgeon is well researched, can provide examples, and patients with whom you can speak. Investigate them on the front end so you don't suffer on the backend.

• 44% of cosmetic surgeons don't have proper equipment
• 50% of patients receive inadequate care
• 1% of patients are injured in hospital

Negligent facts related to medical profession and medical errors:
• Medical errors cost $29 billion or more in the United States each year
• 100,000 death in hospitals due to medical errors
• 40,000 United Kingdom women had faulty implants fitted
• 1,500 patients have items left in their bodies each year during surgery

What is methadone?

Methadone is a man-made (synthetic) compound. It is a narcotic (opioid) analgesic. This means it's made by man for the purpose of treating pain. However, it is also used to treat opioid dependency. As an anti-addictive, this medicine may be obtained from a physician or from a methadone clinic.

Frequently used for the treatment of chronic pain and drug addiction because of:
• Low cost
• Powerful effects
• Long duration

Methadone is available in both pills and liquid forms. Pills are most often used for chronic pain while the liquid form is used to treat opiate addicts. As one of the longest acting narcotics, Methadone can stay in the system for more than 20 hours.

Although there are good points to the medication, the downsides are extreme as well.
• Combined with alcohol can increase risk of addiction and abuse leading to death
• Deaths which involve painkillers - Over 30% involve methadone
• Death toll increasing

As a percentage of all painkillers prescribed Methadone prescription numbers vary throughout the states. In varying strengths, Methadone accounts for the following median percentages throughout the nation.
• 15% - 14 states
• 10% - 11 states
• 7.6% - 13 states
• 5.5% - 12 states

One can see from the numbers this drug is used quite extensively and also contributes to a significant number of deaths throughout the nation. Anytime narcotics are used at these rates abuse and addictions are certain to follow. These manifest in both psychological and physical signs and symptoms.

The Psychology of Abuse:
• Need for money - stealing or borrowing
• Losing interest in normal activities
• Loss of interest in personal self - hygiene, general upkeep
• Becoming standoffish from friends and loved ones

Physical Presentation of Addiction:
• Sweating / flushing
• Nausea / vomiting
• Trouble sleeping / drowsy
• Seizures
• Rashes / hives
• Decreased sexual interest

Physical signs of Withdrawal:
• Very small pupils
• Limp muscles
• Shallow breathing
• Can't stay awake
• Losing consciousness
• Cold, clammy skin
• Blue tinged skin

Symptoms of Methadone Withdrawal:
• Overly anxious
• Nausea
• Dilation of pupils
• Sweating
• Pain in muscles
• Becoming paranoid
• Agitation out of context

Clinics for methadone exist throughout the nation treating around 250,000 people or more. Though treatments may be legitimate or may not be, the act of being treated does not indicate who is or may be addicted to Methadone.

Its no secret that Impaired driving remains one of the biggest killers in the United States. In particular, drunk driving accidents in Miami and Miami Beach are a common occurrence.

The National Transportation Safety Board today recommended that all 50 states lower the benchmark for determining when a driver is legally drunk from 0.08 blood-alcohol content to 0.05. The idea is part of an initiative to eliminate drunken driving, which accounts for about a third of all road deaths.

Lowering the rate to 0.05 would save about 500 to 800 lives every year, the safety board said.

NTSB has no enforcement power over the states, so the change would have to come from state legislatures and governors. The National Highway Traffic Safety Administration said Tuesday that it would help states that decide to implement the recommendation and encouraged them to take other steps that would prevent impaired drivers from getting behind the wheel.

Under current law, a 180-pound male typically will hit the 0.08 threshold after drinking four drinks in an hour, according to an online blood alcohol calculator published by the University of Oklahoma. Comparatively, studies show that the average Miami citizen, a 5-foot 10-inch, 160-pound 26-year-old male in good health, would reach 0.05 with three beers over an hour.

As a Miami personal injury lawyer that represent victims of car accidents, I would be in favor of any measure that would reduce fatal injuries. However, I am not sure that reducing the bench mark from 0.08 to 0.05 would have that effect. To that end, Federal statistics show that more than 70 percent of drunken-driving fatalities involve drivers with a blood-alcohol level of 0.15 percent or more, and that the average level of a driver involved in a fatal crash is 0.16.

Depakote is an anti-seizure medication that is taken in oral form. This medication, as the generic divalproex, was first approved in 1978 for the treatment of epilepsy and other seizure disorders. Depakote (divalproex) is also used to treat bipolar disorder. You may have also heard this drug called valproic acid because this is the active ingredient in divalproex.

These medications by whichever name you choose are classified as Category D drugs regarding birth defects. What this means is that the FDA places the drug in a category of high risk for causing potentially life-threatening birth defects. This is such a severe classification that these medications should never be given to pregnant women without extreme consideration for the likely effects on the fetus.

Besides birth defects here are the known side effects of Depakote:

• Anorexia - loss of appetite
• Polyphagia or hyperphagia - increased appetite
• Weight gain
• Loss of balance
• Dizziness
• Impaired coordination
• Dream abnormalities
• Vomiting
• Fever
• Darkened urine

As serious as these side effects sound they can get worse. There is a classification of side effects from the FDA called "Black Box" side effects. These are potentially serious side effects.

Depakote was assigned a Black Box warning in 2006. Side effects include:
• Hepatoxicity - damage to the liver from some chemical
• Teratogenicity - capability of causing birth defects
• Pancreatitis - inflammation of the pancreas (a serious illness)

Risks to unborn babies are extremely dangerous. Those could include:

• Cleft palate
• Hypoplastic right heart
• Undescended testes
• Malformation of the hands
• Dysplastic ribs
• Hypospadia
• Spina bifida
• Fetal death

These "black box" side effects can be anywhere from surgical intervention to serious lifetime consequences to death.

The same year that Depakote received the Black Box warning, it was also the second most prescribed epilepsy medication. Valproate is now the word wide leader in anti-epileptic meds.

So what's the real risk to the fetus you might wonder?

The New England Journal of Medicine published evidence to support a fourfold increased risk of birth defects when mothers took anti-seizure medications. Those risks include risk rates as follows:

• Almost 13 times the risk for Spina Bifada
• 7 times the risk of cranio-synostosis
• 5 times the risk of cleft palate
• 2.5 times the risk of atrial septal defect
• 2 times the risk of poly-dactyl

There's no doubt if you took Depakote, a generic, or valproate during pregnancy and you have a child born with birth defects, you need to talk to a Depakote attorney. Your situation and your child should be fully evaluated to see the full diagnosis, prognosis, and all costs that have been and will be associated with caring for your child.

In 2012, due to investigation outcomes and a plea of guilty, Abbot Laboratories agreed on a $1.5 billion settlement due to marketing Depakote for uses other than those approved by the FDA.

Experts studying the impact, threat, and potential effects of concussions on young athletes' leverage heavy warnings to heighten the awareness surrounding the long term effects. Consider this:

• Brain development not complete until mid-20s
• Injury to a not fully developed brain may change path of a life
• Women are more disposed to concussion maybe because necks not as strong
• Children are more prone because of weaker necks

Lobular functions

Temporal:
• Emotions
• Processing of visual and speech cues
• Short to long-term memory transference

Prefrontal cortex:
• Subtle social cue comprehension
• Social interaction and thinking abilities
• Reasoning
• Moral reasoning
• Planning
• Decision making processes
• Problem-solving
• Container thinking
• Task switching

It is a Serious Problem

Athletes need to be made aware of the serious possible repercussions of concussions. The number one reason some players don't report a concussion is they don't think it's serious.

Reality stats tracked by National Center for Catastrophic Sport Injury Research from 1995 -2004 every year
• Football head injury deaths - 44
• High school head injuries with residual lifetime effects - 43
• College players with residual lifetime effects - 5

What is SIS?

Here's how serious: SIS - Second Impact Syndrome can be.
• 5.1% of football players in college and high school suffer a concussion during a season
• 14.7% of first concussion sufferers will suffer a second concussion
• 47% of high school players report ONE concussion during a season
• 35% of high school players report more than ONE concussion during a season

When a concussion occurs, the brain nerve cells are not at peak performance. Until full recovery occurs, victims are more likely to be reinjured. If re-injury occurs the outcomes can be deadly. This is SIS.

SIS kills up to 50% of the victims who suffer with it. If they don't die, they are likely to suffer long-term brain damage and / or disability. 95% of these SIS victims are under 18 years old.

Explaining Concussions:

Sudden acceleration or deceleration of the head, sudden impact of the body causing the head to abruptly turn or twist, or bumping and/or knocking the head so the brain bumps around in the skull can all cause the phenomenon known as concussion.

Nerves or neural tissues are not mean to sustain harsh and violent shaking, banging, etc. This type of abuse can damage the tissues and blood vessels of the brain. When trauma to the brain occurs a biochemical cascade of calcium and potassium ions floods the brain. In response, blood vessels constrict and slow the energy food glucose. This lack of energy is a brain crisis and leaves the brain susceptible to further injury until recovered.

Concussion Signs & Symptoms:

Early - within minutes to hours
• Nausea/vomiting
• Slow to respond to questions
• Lack of awareness
• Amnesia - forgetfulness
• Headache
• Dizzy / unsteady / clumsy

Late - days to weeks after event
• Continued headaches
• Sleep problems
• Anxiety or depression (new onset)
• Irritability
• Lack of concentration or focus
• Dizziness or light headed feeling
• Memory issues
• Tiredness
• Sensitivity to lights or noise

Can we prevent Concussions?

General prevention:
• Always wear proper head gear when playing any contact sport
• Increase awareness - educate and stay up to date on new studies
• Develop adequate policies and plans for concussion addressing
• Educate athletes and families that playing with injuries is not smart

Contact Sports Prevention:

Football:
• Enforce head cannot be used as first point of contact for tackling and/or blocking
• Coach and teach proper blocking and tackling techniques

Softball & Baseball
• Ban head first slides or teach proper technique
• Require pitches to wear helmets for batting practice

Soccer
• Anchor soccer goals
• Do not allow players to climb on goals
• Assure proper moving, storage, and maintenance of goals

Hockey
• Enforce rules against pushing/checking from behind
• Instill conditioning programs to strengthen neck muscles

Swimming & Diving
• Competitive divers must stretch and strengthen to help prevent shoulder injuries
• Enforce rules for racing dives, platform heights to water depth ratio

Common Misconceptions related to Concussions:
• Mouth guards do not prevent concussions
• You do not have to be hit in the head to get a concussion.
• You do not have to pass out to have a concussion.
• Concussions are a VERY big deal

Stats & Facts
• NFL players with history of 3 or more concussions show increased links to depression and cognition difficulties common to Alzheimer's patients
• NFL posthumous study found Chronic Traumatic Encephalopathy tangles similar to dementia victims
• Long term effects of brain injury on young brains are cause for great concern

Traumatic Brain Injuries (TBI) 1995-2001
• Unknown how many received no care or other care
• Over 1.1 million emergency department visits
• 235,000 hospital stays
• 50,000 deaths
• 300,000 sports related - grossly under reported (750,000 - 2.25 million estimated)

Ages 5-14 Emergency department visits
o 32% hit by something
o 28% fall
o 14% vehicle crash
o 7% assault
o 19% other
o Of the top 60% most recognized as sports injuries

20 most dangerous sports or recreational activities
• Cycling - 70,802
• Football - 40,825
• Basketball - 27,583
• Baseball & softball - 26,964
• Powered recreational vehicles - 25,970
• Soccer - 19,252
• Skateboards or scooters - 18,324
• Fitness or exercise club - 14,713
• Horseback riding - 11,749
• Winter sports - 11,723
• Water sports - 11,239
• Golf - 8420
• Gymnastics/dance/cheerleading - 6364
• Trampolines - 5971
• Hockey - 5272
• Rugby/lacrosse - 4387
• Other types of ball sports - 3935
• Skating - roller or inline - 3320
• Ice skating - 3115
• Wrestling - 2643

Brain injuries are begun by some type of traumatic event. Brain injury damages are compounded by swelling, pressure on and around the brain, and lack of oxygen caused from all of these factors. Causes can be such things as vehicle accidents, assaults, weapons, falls, sports, etc.

Brain injuries can be thought of in stages from primary, to secondary, to tertiary.

Primary Brain Injury

This is the actual injury that occurs. This can be a closed head injury, an open or penetrating wound, or a crushing injury. All of these injuries have different causes, symptoms, and outcomes.

• Closed Head Injury
o Most common
o Rapid acceleration / deceleration injury (sudden stop or hit from behind or side)
o Brain shifted abruptly in its enclosure
o May twist, be bruised, fibers torn, stretched, etc.
o Brain abrasion on bony ridges of skull anterior
o Brain vessel injury causes bleed

• Open or penetrating wound
o Less common
o Skull cavity is invaded / skull broken
o Brain actually exposed
o Brain itself possibly damaged
o Bullet, knife, kickstand, etc.

• Crushing
o Least common TBI
o Damages base of skull, brain stem
o Head between two solid objects (car and payment)
o Could be completely conscious

Secondary Brain Injury

When a primary injury occurs there is a high risk for secondary injury related to oxygen deprivation. The brain cannot survive in a poorly oxygenated environment without suffering damage to some of its higher processes. This oxygen disruption can occur due to:

• Airway blockage from vomit or blood
• Airway damage
• Airway obstruction
• Blood loss

Emergency treatment methods of first responders have evolved to include quick resolution for oxygen impairment. This could include removal of blockage, supplementation, or blood transfusions.

Tertiary Brain Injury

Follows primary and secondary injury but can occur days or even weeks afterward. Causes include:

• Brain swelling
• Bruising of brain tissues
• Brain bleeding

The unyielding bones of the brain do not have expansion room as leakage or brain swelling occurs. This leads to pressure being exerted on the brain causing damage and/or squeezing of the blood vessels impairing circulation within the brain. Increasing intracranial pressure must be measured during hospitalization.

Other interventions could include:

• Ventilation to assure adequate oxygen

• Blood clot protection
o Can occur in brain (intervertebral)
o Between brain and skull (subdural or extradural)
o Even slight head injuries should be watched for this

TBI Severity can be rated according to measures of how much and to what degree there is a lack of consciousness and/or the degree of post trauma amnesia (PTA) which occurs. Generally speaking the longer one or both of these persists, the worse the injury and possible outcomes.

Effects of TBI

Brain injury can result in cognitive, physical. And/or emotional and behavioral problems. Cognitive impairment results in changes of thoughts, learning ability, and/or memories.

• Memory - face and name recognition, past learning, new learning may be affected
• Motivation - decrease in this area common. Could be depression symptoms.
• Poor concentration - inability to stay on task and complete task
• Deceased speed of information processing
• Impaired problem solving ability
• Continuous repetition - get stuck and unable to break cycle of behavior

Physical impairments are recoverable. Some may not be visible while others can be quite severe.

• Fatigue
• Mobility
• Sensory impairment
• Speech difficulty
• Epilepsy - seizures can occur following brain injury
• Paralysis and/or weakness
• Ataxia - tremors, unintended movements
• Hormonal imbalance - damage to hypothalamus or pituitary gland

Emotional impairments following TBI can significantly affect mood and emotions.

• Impaired confidence
• Mood liability
• Depression
• Sense of loss
• Anxiety
• Anger or frustration
• Obscene or abusive language or behavior
• Loss of inhibition
• Impulsive behavior
• Obsessive behaviors

Every year we sit back, like sheep to slaughter, and watch the Florida Legislature and Governor Rick Scott put their interests, ahead of the good people of Florida. I forgot, why are these people in public office??? Oh, I forgot, to help the citizens of Florida. Well apparently, Florida's population consists of Insurance companies, car dealers. and nursing homes.

Higher teacher pay-forget it, School safety-forget it, Minors and texting-forget it, Texting penalty-forget it. So what did our elected officials do In Tallahassee? The usual, they again limited access to the courts for victims of medical malpractice, they refused to abolish PIP, and the beat goes on. Every year, little by little, more rights are lost and more handouts are given to the insurance lobby.

Most of us read about the new laws in our local newspapers, and they seem like nothing more than words on a piece of paper. That is until the laws somehow apply to you.

As a Miami Medical Malpractice lawyer, I have to explain to my clients that the death of their loved one has a cap. That all the memories they shared with their father, mother, wife, son or daughter is only worth so much. If by chance their loved one was just severely injured and not dead, their loss is worth even less. At that point a client will usually tell me that they never knew that law existed-and that is exactly the way the florida legislature does it every year.

Last year they passed a law that expert witnesses' that were not licensed in Florida had to apply to state for a special license. This year, they passed a law that makes it even more difficult to retain expert witnesses to testify about what the offending doctor did wrong. The latest amendment now prohibits overlapping medical specialties from offering expert opinions. Even if two doctors perform the exact same procedure the exact same way, they cannot opine on the care rendered if their background or training is in different specialties. A cardiologist can't comment on the care of a vascular surgeon, a neurosurgeon can't comment on the care of an orthopedic surgeon-even if they do the exact same procedure.

By the way, who does this benefit? As a citizen of Florida why would I want such a law? The answer is simple; Insurance companies-and you don't want this law.

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