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Adult Injuries

Promising Drug for Treatment of Spinal Cord Injuries

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At Pacific Medical Law we represent patients who have suffered serious injuries to their spinal cord, causing them to be paralyzed and/or live with chronic pain. Our clients have suffered these injuries due to a variety of avoidable medical complications including undiagnosed infections and spinal cord fractures, or from negligence during surgery, as examples.

Unfortunately, spinal cord injuries are often permanent, and people living with spinal cord injuries will likely face challenges and disability for the rest of their lives. Damage to the spinal cord rarely heals because the injured nerve cells fail to regenerate. Scar tissue and processes inside the nerves hinder the regrowth of the cells’ nerve fibers.

However, there is hope. New research reported on Science Daily from the German Center for Neurodegenerative Diseases suggests that the cancer drug epothilone may reduce the formation of scar tissue in spinal cord injuries and stimulate growth in damaged nerve cells – both of which have led to improved mobility in animal studies.

Nerve cells transmit and receive signals in the form of electrical impulses, but their function can be impaired by accidents or disease. The location of the damaged nerve largely affects whether or not the nerve will be able to recover. For instance, nerve cells in the limbs can regenerate to some degree and some or all of their functioning can be restored.

Unfortunately, neurons in the brain and spinal cord do not have the ability to regenerate. If they are damaged through accident or disease, the patient will likely suffer permanent paralysis or other disabilities.

The ideal treatment for promoting regeneration after an injury to the spinal cord would inhibit the formation of scar tissue to allow the nerve fibers to regrow. Studies of the drug epothilone – licensed on the North American market as a cancer treatment – have shown that it works on several levels. Epothilone inhibits cells from migrating to the spinal cord injury and causing wound scarring, and at the same time promotes the growth and regeneration of the damaged axon tips.

Although this is not a cure for damage to the spinal cord, it may represent a first step in research to improve the prognosis of people living with spinal cord injury.

For more information about this research click on the following link

http://www.sciencedaily.com/releases/2015/03/150312173806.htm

What is my misery worth? Compensation for Pain and Suffering in Canada

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More than 90% of the callers to our office are motivated by the fact that they have had to endure a great deal of pain and suffering as a result of what they believe was medical negligence. Within minutes of our conversation however, virtually all of those callers are disappointed to learn that in Canada, even with catastrophic injuries, the maximum amount that our courts will award for their misery is considerably less than they expect. So why are the awards for pain and suffering so low?

These sorts of awards are referred to as nonpecuniary damages[1] and it is no accident that they are low in Canada; it is in fact the result of deliberate decisions made by the Supreme Court of Canada. In a trilogy of cases in 1978[2], the Court addressed the issue of compensation for pain, disability and loss of quality and enjoyment of life, grappling with the reality that no amount of money can return a plaintiff to their previous state of good health and that it is difficult to come up with an objective method to measure the impact of a person’s loss. The problem that faced the Court was that the basic legal premise for awarding compensation for the damages was to restore the harmed person to the position they would have been in prior to the negligence of the defendant. The difficulty in awarding damages for nonpecuniary losses is that those losses are both difficult to measure and, often, impossible to adequately compensate. The Court held that extremely high awards for general damages would place an undue burden on society in terms of increasing insurance premiums and the social costs that can go along with that. As a result, the Supreme Court set a maximum of $100,000 for nonpecuniary damages. That number was tied to inflation so the maximum is now about $365,000, which is only available for catastrophic injuries, for example if a healthy and active person becomes paraplegic or quadriplegic, or suffers severe brain damage due to negligence. As a result, while it is not unusual for Pacific Medical Law to achieve settlements for our clients of several million dollars, these awards are primarily to compensate them for their lifelong cost of care, as well as loss of income arising from this injuries.

The Court came to their conclusion as a matter of public policy and noted that the primary concern when awarding compensation is to assure that the injured party has adequate care in the future. Given that such costs as the cost for care or income loss were not capped, the Court was concerned about the social burden of large non-pecuniary awards, recognizing that no amount of money can give back what was lost:

“The sheer fact is that there is no objective yardstick for translating non-pecuniary losses, such as pain and suffering and loss of amenities, into monetary terms. …

… There is no medium of exchange for happiness. There is no market for expectation of life. The monetary evaluation of non-pecuniary losses is a philosophical and policy exercise more than a legal or logical one. The award must be fair and reasonable, fairness being gauged by earlier decisions; but the award must also of necessity be arbitrary or conventional. No money can provide true restitution.”

So then, why are our expectations so far out of line? There really is no mystery here; almost all Canadians are exposed to a flood of American news stories many of which include reference to multi-million dollar awards for what seem to be the most innocuous degrees of pain and suffering. For instance, while our maximum for nonpecuniary damages is $365,000 today, in 2011, New York’s appellate courts awarded amounts of at least 10 times that amount (US$3,500,000) for pain and suffering in 10 cases[3]. But, even more interesting is the fact that a number of American states are enacting legislation to change all of that by putting limits on awards for pain and suffering. For example, New Hampshire has a limit of US$875,000 while the limit is US$350,000 in Maryland. In fact, Ohio, Idaho and California have capped pain and suffering damages at US$250,000[4]. All of which begs the question; was the Supreme Court of Canada actually ahead of its time?

[1] Non-pecuniary damages are damages, commonly called “pain and suffering” and also referred to “loss of enjoyment of life” or “general damages”, are an assessment of how much money is suitable to compensate for losses that cannot be more accurately calculated such as income or medical expenses.

[2] Andrews v. Grand & Toy Alberta Ltd., [1978] 2 S.C.R. 229, the claimant was a 21 year-old young man who was rendered quadriplegic as a result of a traffic accident.

Arnold v. Teno, [1978] 2 S.C.R. 287, the plaintiff was a 4½ year-old girl who suffered severe brain injuries when she was hit by a car while she was enjoying an ice cream cone, new-bought from a curb-side vendor truck.

Thornton v. School Dist. No. 57 (Prince George), [1978] 2 S.C.R. 267, the plaintiff was 18 year-old lad who was rendered a quadriplegic from an accident during a physical education class.

[3] New York Injury Cases Blog, <http://www.newyorkinjurycasesblog.com/2012/01/articles/amputation-injuries/review-of-the-10-largest-pain-and-suffering-awards-approved-by-new-yorks-appellate-courts-in-2011>

[4] http://www.nolo.com/legal-encyclopedia/state-state-medical-malpractice-damages-caps.html

Removing Financial Barriers for Persons Receiving Disability Assistance

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The British Columbia government recently announced significant changes coming to disability assistance in the province.

Beginning Dec. 1, 2015, people in BC receiving disability assistance will be able to hold substantially more assets without impacting their eligibility for assistance. Individuals designated Persons with Disabilities (PWD) will soon be able to hold $100,000 in assets, and a couple where both partners have PWD designation will be able to hold $200,000 in assets. This is a significant increase from the current limits of $5,000 and $10,000, respectively. The higher asset limit means that money received through inheritance would not have to be put aside in a trust.

As well, people with disabilities will be able to receive cash gifts without affecting their eligibility for assistance. Under the current regime, individuals receiving assistance can only receive one-time gifts without their eligibility being affected. There will also no longer be an annual limit on payments people receiving assistance can receive from trusts. Currently, there is an $8,000 annual cap on trust payments for activities that promote independence.

Almost 96,000 people in BC are designated as PWD and receive assistance from the provincial government. These changes will give them greater independence and choice in enhancing their financial security, and also give their families, friends, and community groups an opportunity to provide additional support without impacting eligibility. The new policies are part of Accessibility 2024 – BC’s 10-year action plan to increase accessibility and remove barriers, with the goal of making BC the most progressive province in Canada for people with disabilities.

September is Disability Employment Month in BC

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Most people know that people with disabilities have to overcome challenges – challenges in finding accessible housing, using public transportation, and finding employment, to name just a few. At Pacific Medical Law, we are reminded of this every day as we work to help our clients with cerebral palsy or spinal cord injuries for example, people who, through no fault of their own, are unable to find employment in a traditional workplace.

September 1st marks the beginning of BC’s second annual Disability Employment Month. It’s a chance to recognize and celebrate the contribution people with disabilities bring to the workplace and recognize the many inclusive employers around the province.

Most progressive province for people with Disabilities

BC has set a goal to have the highest labour-market participation rates for people with disabilities of any province in Canada. This is one of the objectives of Accessibility 2024 – BC’s 10 year action plan to make BC the most progressive province in Canada for people with disabilities. The plan also includes strategies for improving the inclusiveness of government, and communities, as well as increasing accessible housing, transportation and employment, among other things.

A recent letter to the editor in the Vancouver Sun focused on inclusive hiring and highlights a number of reasons why inclusive hiring makes sense. For example:

  • A survey of supervisors with experience managing people with disabilities revealed employees with disabilities performed better than their co-workers in terms of punctuality, attendance, work quality, task consistency, and overall proficiency.
  • A Job Accommodation Network study found more than half of 1,100 employers of people with disabilities benefited from increased overall company morale and productivity. Employees with disabilities also bring a new perspective that can help make a business more welcoming to all.
  • Almost 90 per cent of consumers prefer companies that employ people with disabilities, according to a study cited in a Conference Board report.

Approximately 334,000 British Columbians aged 15 to 64 years self-identify as having a disability – that’s 15% of the population. According to the 2012 Canadian Survey on Disability, only 55% of persons with disabilities aged 15 to 64 years participate in the labour market, compared to 78% of persons without disabilities. The cost of workplace accommodations for a person with disability is $500 or less on average. People with disabilities represent an important employee talent pool that can add value to a workplace. Hiring people with disabilities just makes sense for so many reasons. Here are additional stats on disabilities.

To see the full letter to the editor go to: (It’s just smart business – Vancouver Sun Sept 1, 2015)

More details on the business case for hiring people with disabilities can be found at: https://news.gov.bc.ca/releases/2015SDSI0042-001401

For more information about Accessibility 2024, go to: http://www2.gov.bc.ca/gov/content/governments/about-the-bc-government/accessibility

Stroke Ambulances – The Future Standard in Stroke Care?

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Canada’s first trial of an advanced Stroke Ambulance in Edmonton could signal a new era of significantly improved standard of care of ambulance-level stroke care in this country. Equipped with a mobile CT scanner and an internet link to the on-call neurologist in the hospital, the new stroke ambulance has the potential to dramatically improve patient outcomes and could become the new standard of care of emergency ambulance response to a call where symptoms reported could be those of a stroke. Why are we so excited about Canada’s first highly-specialized Stroke Ambulance and why do we believe that other health jurisdictions in the country should follow?

What is a Stroke?

A stroke occurs when blood flow to the brain is cut off, leading to the death of the affected brain cells. While all strokes are serious matters, they do not all result in debilitating injuries. If identified and dealt with promptly, a stroke can often be contained to only have mild consequences. Doctors estimate that over 100 million brain cells die each hour, so rapid diagnosis and treatment is critical to a patient’s chances of making a successful recovery.

To understand why they say, “time is brain”, it is important to understand that strokes arise from two primary causes, and are classified and treated accordingly:

  1. ischemic strokes are caused by a blood clot restricting blood flow in the brain,
  2. hemorrhagic strokes are caused by a burst blood vessel causing uncontrolled bleeding in the brain.

According to the Canada Heart and Stroke Foundation, ischemic strokes make up approximately 80% of cases, and hemorrhagic strokes make up the remaining 20%. The fundamental difference between the causes of the two types of stroke results in completely different treatment protocols. For example, patients suffering ischemic strokes are commonly administered medication known as tPAs (tissue plasminogen activators) that actively break down blood clots, and the sooner they can be administered the better the chances are of recovery. Importantly, the patient must receive these tPAs within the first three hours of the onset of the stroke symptoms for medication to have any meaningful effect. The tricky issue in the timing is that before the treatment can be administered, it is necessary to determine the type of stroke a person is suffering. If tPAs are administered to a person suffering a hemorrhagic stroke, the medication can exacerbate the already damaging bleeding going on in the brain and can lead to devastating consequences.

With the key technological developments in the Stroke Ambulance of an in-ambulance mobile CT scan and an internet link radiologist and neurologist, the CT scan can be conducted on the spot and immediately sent for review by an expert radiologist, identifying the type of stroke far sooner than possible before. In approximately four out of five cases, it will be the more common ischemic stroke, allowing the vital tPAs to be administered much sooner, potentially by hours for rural patients. This can be the difference between a mild or serious stroke, a short or lengthy recovery, and a small or significant cost to the health care system.

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