Discussion of brain injury and carer issues
Brain injury and prisoner health
Feb 21st
This is something I have been thinking about since being asked for a submission about the health about people with brain injury who go to prison. It strikes me that I have hardly scratched the surface. It would be lovely to hear from anyone who has done work in the area.
The outlook is not good for those people who do not make a good recovery from brain injury, and studies have consistently found high levels of traumatic brain injury among prisoner populations. In an Australian study with 200 participants, Schofield, Butler, Hollis, Smith, Lee & Kelso (2006) found that 82% had a history of at least one traumatic brain injury (TBI). In New Zealand these figures would be approximately the same, at 86.4% (Barnfield & Leathem, 1998). Two US studies of death row inmates found that 75% had a history of brain damage and 100% had a history of TBI (Freedman & Hemenway, 2000; Lewis, Pincus, & Bard, 1986). Fifty per cent of individuals convicted for non-violent crimes had a past history of TBI compared with 5-15% in comparison samples (Sarapata, Herrman, Johnson, & Aycock, 1998). Violent offenders have also been found to be more likely to have experienced TBI than non-violent offenders (Bach-y-rita & Veno, 1974).
The lives of the adults with brain injury tend towards a vicious spiral unless they have the committed care of at least one other person. This is not possible for everyone and so people with brain injury can end up in a variety of more or less unsuitable institutions. These include long stay wards, rest homes, forensic psychiatric units and prisons. Given that many people with brain injury go to prison there are many things that need to be taken into account, including the following:
Epidemiology of brain injury in prisons
The general epidemiology of brain injury is in its infancy. Brain injury is clearly implicated in many of the crimes for which prisoners are incarcerated, although it is difficult to estimate in what way the prison statistics relate to the general community. It seems clear that brain injury is a significant factor in crimes for which people are caught and sent to prison. There is more work needed on the specific epidemiology of brain injury in the prison population. In particular studies are needed that differentiate the severity of the injury and relate this to types of crime and patterns of incarceration.
Brain injury as a (legal) defence
Generally disability (with the exception of mental health conditions) is not considered a defence in our criminal justice system. However, in recent years we have come to a greater understanding of the relationship between executive dysfunction and brain injury. It seems that the judgment of some people with severe brain injury is compromised to the extent that their responsibility for actions must seriously be called into question. There is an argument that brain injury should be a legal defence in these cases. However, at present there is a lack of credible expertise that could provide an assessment in these cases. There are few qualified neuropsychologists and it is outside the area of training of psychiatrists. It is clear from anecdotal evidence that people with severe brain injury are being incarcerated in situations where they are neither realistically defended, nor are they able to advocate for themselves.
There are two subsets of the brain injured population who do not make it into the prison system:
a) those whose families are effective advocates and more research needs to be done on how such families succeed; and
b) those who have a visible disability accompanying the brain injury, which highlights the problematic nature of the invisibility of brain injury.
Those with an invisible brain injury are the “walking wounded” and their behaviour is often labelled “bad”, because this is how it is experienced by others. The brain injured person is perfectly capable of being dominating, browbeating, overtalking, abusive and uninhibited among other things. They can also be gullible, slow thinking, forgetful, lacking in judgment and communication skills, none of which are admirable traits but all of which can be directly caused by brain injury and can lead to hefty judgments on the part of others. The person with a physical disability accompanying the brain injury is often exonerated for similar behaviour because people have a way of understanding the cause.
Executive function disorder makes the person with brain injury particularly vulnerable to being the ‘fall guy’. This is often the reason why they end up in prison and there are stories that circulate in the brain injury community of people who are known for their naivety who get put away for extended periods of time. These are often people who are incapable of lying and cannot comprehend the concept of plea bargaining.
The executive function disorder that makes the person with brain injury vulnerable in the community does not leave them when they enter prison. There is anecdotal evidence of the ways in which this particular group is identified and victimized by other prisoners. The vulnerability of this group needs to be recognized within the prison as well as in the community. They cannot be made completely safe, but a degree of understanding is called for.
The rehabilitative capacity of prison
There are many people with less serious injury, for whom prison can be a way of learning about consequences of actions when everything else has failed. A well planned prison, which has rehabilitation as well as incarceration as a focus, can provide the kind of structured environment that is ideal for the person with brain injury to learn to deal with rules. One of the effects of brain injury is difficulty dealing with rules and a truism of brain injury rehabilitation is that it is easier to change the environment than the person. Further research is needed to establish trajectories of adults with severe brain injury who find themselves in prison. As a first step communication needs to be established between the prison system and ACC.
Anecdotal evidence suggests the structured workshop can be very useful for the person with severe brain injury, who may struggle with the greater freedoms that are given to prisoners at a later stage in their sentence. Rehabilitation efforts should therefore not only focus on the years prior to release, but should also address the early stages of the sentence when the person with brain injury may have become ready to make gains. This may go some way to alleviating the familiar vicious cycle brought about by brain injured types of behaviour.
Management of medication
Medication has an important, but poorly understood, role following brain injury and it requires strict monitoring. A variety of drugs may be used in non conventional ways for pain relief (e.g. methadone) or irregularities in sleep (e.g. anti depressants).
Mismanagement of medication is a human rights issue and there is anecdotal evidence that medication is arbitrarily adjusted on admission to prison and thereafter. These adjustments may happen if the person is labelled as “drug seeking” or because 4.30pm lockup means that night medication has worn off in the early hours of the morning. There is also evidence that medication prescription is not being monitored and people can leave prison with multiple drugs all of which are doing the same thing.
Service capture, human rights and family carers
Feb 21st
This is a story that I have heard in several different ways over the last few years and so I have fictionalised a version of it here to highlight some of the issues that arise around “service capture” for people who are severely brain injured. I connect this to the outcome of a recent Human Rights Review Tribunal in favour of family carers.
“Service capture” describes a situation where there is funding attached to an individual with severe brain injury and a residential facility moves to exclude the family. They do this because famlies tend to advocate for good care and this is labour intensive. For example, learning to communicate following brain injury is time consuming and therefore more expensive in terms of staff. The “service capture” argument is usually based around some version of a story where there family is seen as interfering/not grounded in reality/ not really advocating for the person with brain injury. This kind of “care” will eventually and inevitably break the spirit of both the brain injured person and their family unless they can find some support. Incidentally it is also extremely bad training and supp0rt for the paid staff in these facilities, who often get their greatest job satisfaction from just this kind of work.
In 2008 I was an expert witness in a Human Rights Tribunal (in NZ) about the issue of paying family carers, in situations where there was funding allocated and no paid carers available to do the skilled work necessary. The Ministry of Health argued very hard against paying families on various grounds that revealed a deep prejudice that was never substantiated by written policy. One of their arguments was about “equality of outcome for the disabled person”, by which they meant that the residential units were able to provide a better outcome than the families were. It an example of “service capture”, where services want to keep the funding even though a much better job could be done by families if they had control of the funding. This may seem to be different to the arguments used to stop families from interfering once the person has been admitted to a residential facility. However, the reasoning is essentially the same – families cannot be trusted to provide good outcomes for the person with severe brain injury.
My witness, based on doctoral research was able to give empirical support for the concept that families, especially those who are supported, actually do an excellent job. I was also able to demonstrate that people with severe brain injury are capable of making major improvements in their lives many years after the injury and long after they would be expected to plateau. The improvements were a direct result of sensitive flexible care on the part of the families. The importance of this witness was acknowledged recently by Rosslyn Noonan (Chief Human Rights Commissioner) at a disability colloquium in Dunedin. She said that this was a good example of empirical research that was used to form case law.
Amazingly, on 8th January the judges came out in favour of the families. This is an astounding finding, because it challenges the arguments for “service capture” at many different levels. It may be one small step to beginning to accept families as equal partners in work with brain injured adults.
The story:
”Anthony is 22 years old and had a severe diffuse axonal traumatic brain injury from a motorcycle accident in 2007. He is trapped within ‘a broken body’, cannot speak yet, but his mother recognises that he has all his thoughts, memories and personality. This is what he wrote recently: “please help, I am trapped”.
When he was transferred to the long term residential care the house manager indicated that her staff was not trained to communicate with patients by writing (Anthony’s only effective mode of communication, though he can indicate yes and no). The policy of refusing to communicate in this way seems to be corroborated by a report that indicates that Anthony cannot reason or process thoughts. Yet his written messages make sense and it seems highly likely that he is wants to communicate something of his dislike for the place that he is in.
There is a deliberate and sustained policy of excluding his mother from meetings, although she attends him daily. His therapists are in favour of any mode of communication that will foster his growth, but their voice is also being ignored. Anthony is understandably furious and depressed that no one asks him whether he wants to write.
Angela, his mother is very concerned that Anthony’s “guardians” are not acting in his best interest and that they are financially motivated (they receive around $x/day for Anthony – you can fill in the amount here, the family feel they could do a better job for the dollars being paid). She has been to a liaison officer who advises her that she needs some credible authorities behind her to speak to the fact that such treatment of Anthony is contra-indicated. Through all of this she is sustaining a daily connection with her son as well as working full time.”
William Fairbank: art and brain injury
Feb 3rd
I am sitting in my office waiting to hear a radio NZ inteview with William Fairbank. I met William six years ago, during a visit to NZ shortly after he made the film “Head On” about brain injury. He had his brain injury about 23 years ago and he is a great advocate for occupational therapy. In the early years after his injury he made a series of sculptures on the stations of the cross, which are on permanent exhibition in Lincoln cathedral, England. He calls this his occupational therapy and he is in the business of using his art to educate medical professionals and the rest of the world about what it is like to live with a brain injury.
His latest project is to make another film about the experience of brain states after brain injury. Historical knowledge about brain injury has in the main been produced and known by people without brain injury. William’s work is part of a movement where brain injured people produce their own ways of knowing in order to negotiate the kind of knowledge that is held about them. This project is about gathering together the experiences of talented people with brain injury and putting them on film.
In the disability movement the brain states after brain injury are one of the myriad expressions of ‘Ouch! moments’. These are the moments when a disabled person feels out of place and is made aware of the discordance between their experience and the rest of the world. For the brain injured it is those moments when you put your car keys in the freezer; when the shop assistant gives you very strange looks; when you have told your best friend you don’t want to see them because you are too tired from thinking about making a simple choice; worse, it is the explosion of frustration when you have gone too far past your afternoon nap. “Ouch! moments” are an exploration of the awkwardness brought about by having a brain that is out of synch with the rest of the world. It is about having senses that are somehow not in tune with the common sense of everyone else. It is about living in a different rhythm. For William Fairbank it is about ‘living in the present’. He describes the sense of being on a stage, or having things arrive to his attention and losing all else for that time.
This living in the present sounds very pleasant, and William has learned ways of making it so -though the reality is not always easy. He has learned to invite you into his presence/present as though you are coming into his living room. It is all comfortable and full of lovely small things that delight. He comes to visit in his “Little Puffer” caravan and brings his whole world with him: there are pictures on the wall and books on the bookshelves; repair kits and a sound system. You only realise how caught he is in the present when you want to change the subject and find that William is still caught in this moment, which is also a self absorbed one. This is one of the “Ouch! moments”, but William succeeds in sharing this brain state and making it fascinating, so that there is no wish to escape. Maybe what he manifests is the same self absorption that is supposed to be so pathological in brain injury, but it is the Ouch!, without the ‘Oh dear!’.
Brain injury can be profoundly alienating. It can lead to experiences that are at the boundaries and the edges of what it is to be human. Yet people like William have learned to map out the secret adventures of living with this brain state so that it reflects the secrets and aspirations of everyone; it reflects both pain and the search for a way of living that can mould an identity that feels worth living with. It is not easy to understand, but it is our humanity and all the potential within it that makes us beautiful. William’s work helps us to celebrate those heartbreaking strengths and those glorious disabilities that we all have.
It will be interesting to see what happens following William’s invitation to artists with brain injury to participate in the film he is making. He hopes to include those who can craft their quirkiness into words, phrases and jokes. There are so many ways of expressing the experience of brain states after brain injury: through photos, poems, paintings, jokes, quirky phrases. If you are someone who has learned to do this….or if you know of someone who has the capacity to share a sense of reality that is mediated by a brain injury (and you live in NZ), don’t hesitate to get in touch. I will use this blog to keep you posted on William’s progress.
Where To Find A Personal Injury Lawyer?
Feb 24th
A victim of an accident must get the legal representation of a personal injury lawyer in order to help him or her file the appropriate personal injury lawsuit against the person who caused the accident. If you have been victimized by the negligent conduct of another, getting the services of a personal injury lawyer must be one of your primary concerns. For one, a personal injury lawyer knows very well the intricacies pertaining to a personal injury lawsuit. He or she, through long years of study, knows what to do, what to file, & what you are legally entitled to under our laws.
But you may ask, where can I get a competent personal injury lawyer that will help me in my personal injury lawsuit? Isn’t getting one a hard thing to do? How can I find a personal injury lawyer who is reliable, trustworthy & intelligent?
Well, be not wary anymore. You can easily find a personal injury lawyer through the use of the Internet. Aside from seeing so many of them by using this modern technology, you can actually make a background check on their qualifications, experience & expertise. There are indeed no hassles. Just by browsing, you can see that a lot of personal injury lawyers offer their legal services through this medium. You can even select your area or jurisdiction to see the law firms available to represent you in your personal injury claims. So, if ever you suffered personal injuries & you want to file a personal injury lawsuit, just take hold of your computer & browse the Internet to get the legal services of a personal injury lawyer. You will also be surprised 
to find out the number of lawyers offering their services on a contingency basis wherein the attorney’s fees will greatly depend upon the personal injury lawyer’s successful litigation of the personal injury case.
“Our Professional Los Angeles Lawyers specialize in all fields of Personal Injury
Cash for Personal Injury Settlements
Feb 18th
Your pain & suffering damages will most likely be minimized if you involve insurance companies in your personal injury settlement. Insurance companies give lower compensation because they intend to keep as much money as possible for themselves. There is more. To you, personal injury settlements are personal, but to them they are purely business.
Before insurance companies offer compensation, they will attempt to evaluate how serious the injury is. Usually, the less serious & costly the injury is, the better compensation offer you will receive. On the other hand, if the injury is more severe & costly, the insurance company will have to take the following information into account first: present & future medical needs, permanent disability benefits, physical impairment and/or disfigurement, lost income, loss of family member(s), loss of social or educational experiences, & pain & suffering such as post-traumatic stress disorder, loss of marital relations, depression, anxiety, embarrassment, stress, & property damage.
Knowing the cost of compensation
Insurance companies formulate your compensation cost by adding up many items in a formula which includes all the injury-related medical expenses. There is more. These are then multiplied by a number between 1.5 (for less severe injuries) & 5 (for more serious damage), & then added to the lost income due to the injury. Being aware of this information will often help you negotiate your case & not actually be deceived by anyone.
Personal injury compensation also depends on which part of the country you live in. If you are in a low cost-of-living area where wages & expenses are basically lower than that of a high cost area, then your compensation will also be low.
Injury Settlements gives detailed information on Back Injury Settlements, Burn Injury Settlements, Hydrocodone Injury Settlements, Injury Settlements & more. Injury Settlements is affiliated with Life Settlement Funding.
Personal Injury 101
Feb 12th
Have you been injured in an accident that was caused by a negligent or reckless person? If yes, Personal Injury 101 is definitely made for your consumption. When you got injured in an accident, our civil & tort laws gives you the remedy of making a demand & filing a claim for damages against the negligent person who made you suffer personal injuries. In such a situation, the law allows you to recover the expenses that you have incurred, among other things, against such negligent person.
If you finally decide to make a personal injury claim against the negligent person who caused you the personal injuries, you should right away get the legal services of a personal injury lawyer. With the expertise of a personal injury lawyer, you will have more chances of obtaining positive results for your claim. But wait a minute, do you think that there is a problem? How can you get immediate help from a personal injury lawyer & where? Well, if this is one of your major concerns, you should not worry anymore. If you consider this a problem, consider it solved.
By using the internet, you can find lots of personal injury lawyers that offer competent, efficient & effective legal services. You will also find out that these lawyers have their respective areas of expertise. There is a general negligence lawyer, a vehicular accident lawyer, a slip & fall lawyer, a medical malpractice lawyer, a construction site accident lawyer, a spinal cord injury lawyer, a brain injury lawyer, & even a work related accident lawyer. You can always select from any of them depending upon the type of accident you got involved in. So do not waste anymore time. Personal injury 101 dictates you to immediately hire a lawyer for your case. You must remember that in a personal injury case, time is always of the essence.
“Our Professional Los Angeles Lawyers specialize in all fields of Personal Injury , Employment , & Disability Laws
A New Medical Malpractice Website
Feb 6th
Personal injury law takes into account many different practice areas, one of those being medical malpractice. This branch of law deals with personal injury laws where a physician or other medical professional is at fault, from misdiagnosis to wrongful death. Pharmacy error & nursing home abuse are also included in medical malpractice. The unfortunate circumstances under which such errors occur cause grief & suffering for the victims & families. Eric Nielson is here to fight for your right & any compensation you deserve.
This website, http://www.ericnielson.com/, includes pages outlining the company’s policies, introducing the staff, & reviewing recent cases. There is more. The firm overview page describes the types of cases they work with, what you should expect from the company, & what types of organizations they are involved with. The attorneys & staff page explains how the staff strives to help to achieve the company’s goals… The recent cases page has links to the stories from previous clients, all victims of medical malpractice. The website is concise & easy to navigate, making it simple to find what you need in your medical malpractice case.
G. Eric Nielson works with other experienced attorneys. His staff utilizes over 20 years of experience when dealing with these delicate cases. Eric Nielson graduated with his BA from the University of Utah in 1982, Magna Cum Laude. He then continued on to Brigham Young University for his law education, graduating in 1986. He has passed the bar examination in both Utah & Arizona. He is a member of the American Bar Association, the Utah State Bar, & the Salt Lake County Bar Association. He is also bilingual, speaking Spanish & English.
About the Author
Click here to learn more about personal injury law in the Salt Lake City, Utah area.
Your 24 – 7 Personal Injury Lawyers
Jan 31st
Getting a personal injury lawyer after the occurrence of an accident wherein you sustained personal injuries should never become a burdensome process for you as a victim. As you may know, the legal assistance of a personal injury lawyer is necessary in order for your personal injury claims to be successful. The knowledge, expertise & experience of a personal injury lawyer to litigate your claim will give you many advantages in your pursuit of damages & indemnification against the person who has caused you the personal injuries.
In these modern times, we all know that we can easily access everything with the use of the Internet. And just like other personal concerns, we can now get the competent personal injury lawyer that we want through the use of this technology. All the personal injury victim has to do is to search through “Yahoo” or “Google” & there you go, a list of personal injury lawyers will readily be shown.
Here is an advice, if ever you sustained personal injuries due to the negligent or reckless conduct of another person, you should immediately get the legal services of a personal injury lawyer. As discussed, you should never be burdened getting the legal services of a personal injury lawyer. Use our modern technology. Access the Internet & get help from among the personal injury lawyers listed therein. It really does not matter whether you intended initially to file a case or not against the person who caused your injuries. Contacting a personal injury lawyer just for discussions will be of great help. This way, your rights & interests may be well protected. With the help of a personal injury lawyer, your personal injury lawsuit will definitely be in good hands. So what are you waiting for? Browse the Internet & seek legal recommendations from a personal injury lawyer 24/7.
“Our Professional Los Angeles Lawyers specialize in all fields of Personal Injury , Employment , & Disability Laws .”
Taxes on Personal Injury Settlements
Jan 25th
Personal injury settlements are a way for you to recover lost funds, limit the suffering caused by your injury, & secure the right kind of treatment for your injuries. Most insurance providers will offer personal injury settlements immediately even if you are still getting treatment from the hospital. A personal injury settlement is actually a way out for insurance providers, but it can benefit you as well. For one, if you accept a personal injury settlement, this will mean that you want have to go straight to court. Cases like this often take a long time to litigate before you can achieve the final resolution.
Say you were in an accident & you sustained injuries to your face, knees, & back. You filed a personal injury complaint & fortunately, you received a settlement from your lawsuit. The settlement totaled about $50,000 but you will not get that in full. You will have to pay your lawyer his fees & your health insurance will be reimbursed for as much as $2,000. So you ask, do you still have to pay income taxes on your personal injury settlement? The answer is yes.
The complaint you filed that resulted to a settlement agreement has major tax penalties. As a matter of fact, there is a tax law called “the origin of the claim”. This states that if the settlement is regarding a tax-exempt matter, as in the case of physical injury, the settlement received should therefore be tax-free. On the other hand, punitive or disciplinary damages are not exempt from tax. Punitive damages, also known as exemplary damages, are intended to discourage the behavior the defendant engaged in & punish him for that… They are not intended to compensate you.
For further & more detailed discussions of taxes on personal injury settlement –case details, tax consequences, & the like, set up a meeting with a certified & reliable tax consultant.
Injury Settlements gives detailed information on Back Injury Settlements, Burn Injury Settlements, Hydrocodone Injury Settlements, Injury Settlements & more. Injury Settlements is affiliated with Life Settlement Funding.
Legal Services on Contingency Basis
Jan 19th
Do you know that all over the United States, most especially in California, a lot of law firms have been offering their legal services on a contingency basis when it comes to personal injury cases? But when we say contingency basis, what exactly does it mean?
Rendering legal services on a contingency basis means that the client will not initially pay any amount of money as attorney’s fees to the lawyer. The lawyer will not charge any acceptance fee, nor any retainer’s fee or any appearance fees upon the client. In this kind of arrangement, the lawyer & the client agree that there will only be payment of attorney’s fees if & when & only in the event that the client’s personal injury lawsuit has been successfully litigated by the lawyer for & in behalf of the client. In short, the lawyer will only be paid if the client’s personal injury case has been won by him. If not, or if the case was unsuccessful, the lawyer will not get anything from the client as attorney’s fees.
At present, the contingency arrangement between a lawyer & a client is becoming more popular. This gives the client the opportunity to file a personal injury lawsuit against the negligent person who caused her or his personal injuries even without spending any amount of money just for the payment of attorney’s fees. There is more. This will also help clients to consider filing the personal injury case right away without hesitation or hindrance because of lack of money to finance her or his personal injury lawsuit.
So what are you waiting for? Now that you know that there’re lots of lawyers offering legal services on a contingency basis, you should already have the courage of pursuing your personal injury lawsuit. There’s no need to hold back & be discouraged. Go & get ready to file your personal injury claim with the help of a lawyer who agrees to render legal services on a contingency basis.
“Our Professional Los Angeles Lawyers specialize in all fields of Personal Injury , Employment , & Disability Laws.”