Atlanta Accident Lawyer

The psychological effects that can result from a traumatic brain injury

noreply@blogger.com (Michael L. Neff) — Mon, 14 Jul 2008 00:07:00 +0000

After suffering a traumatic brain injury, or TBI, the injured person can experience a variety of psychological effects. Be aware of changes of personality, reduction in ability to control behavior, loss of judgment and depression. Depression may be a result of the brain injury, or it can be a reaction to the other injuries suffered. Brain injury can cause speech and communication problems, a decrease in memory, feelings of disorientation and anger.

If you, or someone you love, has suffered a brain injury, be aware that there are physicians and psychologists who specialize in treating brain injury cases. If the brain injury is a result of an accident an accident or the negligence of a Georgia business or person, we encourage you to call or email the Atlanta Law Offices of Michael L. Neff right away. Our attorneys can help you get the help you need.

Georgia Accident Resources

noreply@blogger.com (Michael L. Neff) — Thu, 17 Apr 2008 21:18:00 +0000

The following are resources on traffic accidents in the State of Georgia.

Safety and Fitness Electronic Records System (SAFER) Information on all trucking companies registered with the Department of Transportation.

savealifega.org
Organization dedicated to Georgia teen driving safety.

Georgia Traffic Injury Prevention Institute
Information on traffic prevention from the Governor of Georgia.

National Highway Traffic Safety Administration
Federal administration overseeing traffic safety.

National Center for Statistics and Analysis
U.S. Department of Transportation's statistics analysis bureau.

United States Department of Transportation
Website for the federal department regulating transportation.

Federal Motor Carrier Safety Administration
Information on government regulations, inspection of trucks, moving and equipment violations for individual trucking companies.

Bureau of Transportation Statistics
Federal bureau providing data collection, analysis, and reporting of transportation statistics.

How Doctors Think

noreply@blogger.com (Michael L. Neff) — Wed, 14 Mar 2007 20:11:00 +0000

A link from NPR's Fresh Air from WHYY, March 14, 2007 http://www.npr.org/templates/story/story.php?storyId=8892053

Dr. Jerome Groopman, a staff writer at The New Yorker, has written a book about how doctors make decisions regarding their patients. It's called How Doctors Think.

Groopman is chief of experimental medicine at Beth Israel Deaconess Medical Center in Boston and teaches at Harvard Medical School.
Excerpt: 'How Doctors Think'

by Jerome Groopman

'How Doctors Think'

INTRODUCTION

Anne Dodge had lost count of all the doctors she had seen over the past fifteen years. She guessed it was close to thirty. Now, two days after Christmas 2004, on a surprisingly mild morning, she was driving again into Boston to see yet another physician. Her primary care doctor had opposed the trip, arguing that Anne's problems were so long-standing and so well defined that this consultation would be useless. But her boyfriend had stubbornly insisted. Anne told herself the visit would mollify her boyfriend and she would be back home by midday.

Anne is in her thirties, with sandy brown hair and soft blue eyes. She grew up in a small town in Massachusetts, one of four sisters. No one had had an illness like hers. Around age twenty, she found that food did not agree with her. After a meal, she would feel as if a hand were gripping her stomach and twisting it. The nausea and pain were so intense that occasionally she vomited. Her family doctor examined her and found nothing wrong. He gave her antacids. But the symptoms continued. Anne lost her appetite and had to force herself to eat; then she'd feel sick and quietly retreat to the bathroom to regurgitate. Her general practitioner suspected what was wrong, but to be sure he referred her to a psychiatrist, and the diagnosis was made: anorexia nervosa with bulimia, a disorder marked by vomiting and an aversion to food. If the condition was not corrected, she could starve to death.

Over the years, Anne had seen many internists for her primary care before settling on her current one, a woman whose practice was devoted to patients with eating disorders. Anne was also evaluated by numerous specialists: endocrinologists, orthopedists, hematologists, infectious disease doctors, and, of course, psychologists and psychiatrists. She had been treated with four different antidepressants and had undergone weekly talk therapy. Nutritionists closely monitored her daily caloric intake.

But Anne's health continued to deteriorate, and the past twelve months had been the most miserable of her life. Her red blood cell count and platelets had dropped to perilous levels. A bone marrow biopsy showed very few developing cells. The two hematologists Anne had consulted attributed the low blood counts to her nutritional deficiency. Anne also had severe osteoporosis. One endocrinologist said her bones were like those of a woman in her eighties, from a lack of vitamin D and calcium. An orthopedist diagnosed a hairline fracture of the metatarsal bone of her foot. There were also signs that her immune system was failing; she suffered a series of infections, including meningitis. She was hospitalized four times in 2004 in a mental health facility so she could try to gain weight under supervision.

To restore her system, her internist had told Anne to consume three thousand calories a day, mostly in easily digested carbohydrates like cereals and pasta. But the more Anne ate, the worse she felt. Not only was she seized by intense nausea and the urge to vomit, but recently she had severe intestinal cramps and diarrhea. Her doctor said she had developed irritable bowel syndrome, a disorder associated with psychological stress. By December, Anne's weight dropped to eighty-two pounds. Although she said she was forcing down close to three thousand calories, her internist and her psychiatrist took the steady loss of weight as a sure sign that Anne was not telling the truth.

That day Anne was seeing Dr. Myron Falchuk, a gastroenterologist. Falchuk had already gotten her medical records, and her internist had told him that Anne's irritable bowel syndrome was yet another manifestation of her deteriorating mental health. Falchuk heard in the doctor's recitation of the case the implicit message that his role was to examine Anne's abdomen, which had been poked and prodded many times by many physicians, and to reassure her that irritable bowel syndrome, while uncomfortable and annoying, should be treated as the internist had recommended, with an appropriate diet and tranquilizers.

But that is exactly what Falchuk did not do. Instead, he began to question, and listen, and observe, and then to think differently about Anne's case. And by doing so, he saved her life, because for fifteen years a key aspect of her illness had been missed.

This book is about what goes on in a doctor's mind as he or she treats a patient. The idea for it came to me unexpectedly, on a September morning three years ago while I was on rounds with a group of interns, residents, and medical students. I was the attending physician on "general medicine," meaning that it was my responsibility to guide this team of trainees in its care of patients with a wide variety of clinical problems, not just those in my own specialties of blood diseases, cancer, and AIDS. There were patients on our ward with pneumonia, diabetes, and other common ailments, but there were also some with symptoms that did not readily suggest a diagnosis, or with maladies for which there was a range of possible treatments, where no one therapy was clearly superior to the others.

I like to conduct rounds in a traditional way. One member of the team first presents the salient aspects of the case and then we move as a group to the bedside, where we talk to the patient and examine him. The team then returns to the conference room to discuss the problem. I follow a Socratic method in the discussion, encouraging the students and residents to challenge each other, and challenge me, with their ideas. But at the end of rounds on that September morning I found myself feeling disturbed. I was concerned about the lack of give-and-take among the trainees, but even more I was disappointed with myself as their teacher. I concluded that these very bright and very affable medical students, interns, and residents all too often failed to question cogently or listen carefully or observe keenly. They were not thinking deeply about their patients' problems. Something was profoundly wrong with the way they were learning to solve clinical puzzles and care for people.

You hear this kind of criticism — that each new generation of young doctors is not as insightful or competent as its forebears — regularly among older physicians, often couched like this: "When I was in training thirty years ago, there was real rigor and we had to know our stuff. Nowadays, well . . ." These wistful, aging doctors speak as if some magic that had transformed them into consummate clinicians has disappeared. I suspect each older generation carries with it the notion that its time and place, seen through the distorting lens of nostalgia, were superior to those of today. Until recently, I confess, I shared that nostalgic sensibility. But on reflection I saw that there also were major flaws in my own medical training. What distinguished my learning from the learning of my young trainees was the nature of the deficiency, the type of flaw.

My generation was never explicitly taught how to think as clinicians. We learned medicine catch-as-catch-can. Trainees observed senior physicians the way apprentices observed master craftsmen in a medieval guild, and somehow the novices were supposed to assimilate their elders' approach to diagnosis and treatment. Rarely did an attending physician actually explain the mental steps that led him to his decisions. Over the past few years, there has been a sharp reaction against this catch-as-catch-can approach. To establish a more organized structure, medical students and residents are being taught to follow preset algorithms and practice guidelines in the form of decision trees. This method is also being touted by certain administrators to senior staff in many hospitals in the United States and Europe. Insurance companies have found it particularly attractive in deciding whether to approve the use of certain diagnostic tests or treatments.

The trunk of the clinical decision tree is a patient's major symptom or laboratory result, contained within a box. Arrows branch from the first box to other boxes. For example, a common symptom like "sore throat" would begin the algorithm, followed by a series of branches with "yes" or "no" questions about associated symptoms. Is there a fever or not? Are swollen lymph nodes associated with the sore throat? Have other family members suffered from this symptom? Similarly, a laboratory test like a throat culture for bacteria would appear farther down the trunk of the tree, with branches based on "yes" or "no" answers to the results of the culture. Ultimately, following the branches to the end should lead to the correct diagnosis and therapy.

Clinical algorithms can be useful for run-of-the-mill diagnosis and treatment — distinguishing strep throat from viral pharyngitis, for example. But they quickly fall apart when a doctor needs to think outside their boxes, when symptoms are vague, or multiple and confusing, or when test results are inexact. In such cases — the kinds of cases where we most need a discerning doctor — algorithms discourage physicians from thinking independently and creatively. Instead of expanding a doctor's thinking, they can constrain it.

Similarly, a movement is afoot to base all treatment decisions strictly on statistically proven data. This so-called evidence-based medicine is rapidly becoming the canon in many hospitals. Treatments outside the statistically proven are considered taboo until a sufficient body of data can be generated from clinical trials. Of course, every doctor should consider research studies in choosing a therapy. But today's rigid reliance on evidence-based medicine risks having the doctor choose care passively, solely by the numbers.

Statistics cannot substitute for the human being before you; statistics embody averages, not individuals. Numbers can only complement a physician's personal experience with a drug or a procedure, as well as his knowledge of whether a "best" therapy from a clinical trial fits a patient's particular needs and values.

Each morning as rounds began, I watched the students and residents eye their algorithms and then invoke statistics from recent studies. I concluded that the next generation of doctors was being conditioned to function like a well-programmed computer that operates within a strict binary framework. After several weeks of unease about the students' and residents' reliance on algorithms and evidence-based therapies alone, and my equally unsettling sense that I didn't know how to broaden their perspective and show them otherwise, I asked myself a simple question: How should a doctor think?

This question, not surprisingly, spawned others: Do different doctors think differently? Are different forms of thinking more or less prevalent among the different specialties? In other words, do surgeons think differently from internists, who think differently from pediatricians? Is there one "best" way to think, or are there multiple, alternative styles that can reach a correct diagnosis and choose the most effective treatment? How does a doctor think when he is forced to improvise, when confronted with a problem for which there is little or no precedent? (Here algorithms are essentially irrelevant and statistical evidence is absent.) How does a doctor's thinking differ during routine visits versus times of clinical crisis? Do a doctor's emotions — his like or dislike of a particular patient, his attitudes about the social and psychological makeup of his patient's life — color his thinking? Why do even the most accomplished physicians miss a key clue about a person's true diagnosis, or detour far afield from the right remedy? In sum, when and why does thinking go right or go wrong in medicine?

I had no ready answers to these questions, despite having trained in a well-regarded medical school and residency program, and having practiced clinical medicine for some thirty years. So I began to ask my colleagues for answers.* Nearly all of the practicing physicians I queried were intrigued by the questions but confessed that they had never really thought about how they think. Then I searched the medical literature for studies of clinical thinking. I found a wealth of research that modeled "optimal" medical decision-making with complex mathematical formulas, but even the advocates of such formulas conceded that they rarely mirrored reality at the bedside or could be followed practically. I saw why I found it difficult to teach the trainees on rounds how to think. I also saw that I was not serving my own patients as well as I might. I felt that if I became more aware of my own way of thinking, particularly its pitfalls, I would be a better caregiver. I wasn't one of the hematologists who evaluated Anne Dodge, but I could well have been, and I feared that I too could have failed to recognize what was missing in her diagnosis.

Of course, no one can expect a physician to be infallible. Medicine is, at its core, an uncertain science. Every doctor makes mistakes in diagnosis and treatment. But the frequency of those mistakes, and their severity, can be reduced by understanding how a doctor thinks and how he or she can think better. This book was written with that goal in mind. It is primarily intended for laymen, though I believe physicians and other medical professionals will find it useful. Why for laymen? Because doctors desperately need patients and their families and friends to help them think. Without their help, physicians are denied key clues to what is really wrong. I learned this not as a doctor but when I was sick, when I was the patient.

We've all wondered why a doctor asked certain questions, or detoured into unexpected areas when gathering information about us. We have all asked ourselves exactly what brought him to propose a certain diagnosis and a particular treatment and to reject the alternatives. Although we may listen intently to what a doctor says and try to read his facial expressions, often we are left perplexed about what is really going on in his head. That ignorance inhibits us from successfully communicating with the doctor, from telling him all that he needs to hear to come to the correct diagnosis and advice on the best therapy.

In Anne Dodge's case, after a myriad of tests and procedures, it was her words that led Falchuk to correctly diagnose her illness and save her life. While modern medicine is aided by a dazzling array of technologies, like high-resolution MRI scans and pinpoint DNA analysis, language is still the bedrock of clinical practice. We tell the doctor what is bothering us, what we feel is different, and then respond to his questions. This dialogue is our first clue to how our doctor thinks, so the book begins there, exploring what we learn about a physician's mind from what he says and how he says it. But it is not only clinical logic that patients can extract from their dialogue with a doctor. They can also gauge his emotional temperature. Typically, it is the doctor who assesses our emotional state. But few of us realize how strongly a physician's mood and temperament influence his medical judgment. We, of course, may get only glimpses of our doctor's feelings, but even those brief moments can reveal a great deal about why he chose to pursue a possible diagnosis or offered a particular treatment.

After surveying the significance of a doctor's words and feelings, the book follows the path that we take when we move through today's medical system. If we have an urgent problem, we rush to the emergency room. There, doctors often do not have the benefit of knowing us, and must work with limited information about our medical history. I examine how doctors think under these conditions, how keen judgments and serious cognitive errors are made under the time pressures of the ER. If our clinical problem is not an emergency, then our path begins with our primary care physician — if a child, a pediatrician; if an adult, an internist. In today's parlance, these primary care physicians are termed "gatekeepers," because they open the portals to specialists. The narrative continues through these portals; at each step along the way, we see how essential it is for even the most astute doctor to doubt his thinking, to repeatedly factor into his analysis the possibility that he is wrong. We also encounter the tension between his acknowledging uncertainty and the need to take a clinical leap and act. One chapter reports on this in my own case; I sought help from six renowned hand surgeons for an incapacitating problem and got four different opinions.

Much has been made of the power of intuition, and certainly initial impressions formed in a flash can be correct. But as we hear from a range of physicians, relying too heavily on intuition has its perils. Cogent medical judgments meld first impressions — gestalt — with deliberate analysis. This requires time, perhaps the rarest commodity in a healthcare system that clocks appointments in minutes. What can doctors and patients do to find time to think? I explore this in the pages that follow.

Today, medicine is not separate from money. How much does intense marketing by pharmaceutical companies actually influence either conscious or subliminal decision-making? Very few doctors, I believe, prostitute themselves for profit, but all of us are susceptible to the subtle and not so subtle efforts of the pharmaceutical industry to sculpt our thinking. That industry is a vital one; without it, there would be a paucity of new therapies, a slowing of progress. Several doctors and a pharmaceutical executive speak with great candor about the reach of drug marketing, about how natural aspects of aging are falsely made into diseases, and how patients can be alert to this.

Cancer, of course, is a feared disease that becomes more likely as we grow older. It will strike roughly one in two men and one in three women over the course of their lifetime. Recently there have been great clinical successes against types of cancers that were previously intractable, but many malignancies remain that can be, at best, only temporarily controlled. How an oncologist thinks through the value of complex and harsh treatments demands not only an understanding of science but also a sensibility about the soul — how much risk we are willing to take and how we want to live out our lives. Two cancer specialists reveal how they guide their patients' choices and how their patients guide them toward the treatment that best suits each patient's temperament and lifestyle.

At the end of this journey through the minds of doctors, we return to language. The epilogue offers words that patients, their families, and their friends can use to help a physician or surgeon think, and thereby better help themselves. Patients and their loved ones can be true partners with physicians when they know how doctors think, and why doctors sometimes fail to think. Using this knowledge, patients can offer a doctor the most vital information about themselves, to help steer him toward the correct diagnosis and offer the therapy they need. Patients and their loved ones can aid even the most seasoned physician avoid errors in thinking. To do so, they need answers to the questions that I asked myself, and for which I had no ready answers.

Not long after Anne Dodge's visit to Dr. Myron Falchuk, I met with him in his office at Boston's Beth Israel Deaconess Medical Center. Falchuk is a compact man in his early sixties with a broad bald pate and lively eyes. His accent is hard to place, and his speech has an almost musical quality. He was born in rural Venezuela and grew up speaking Yiddish at home and Spanish in the streets of his village. As a young boy, he was sent to live with relatives in Brooklyn. There he quickly learned English. All this has made him particularly sensitive to language, its nuances and power. Falchuk left New York for Dartmouth College, and then attended Harvard Medical School; he trained at the Peter Bent Brigham Hospital in Boston, and for several years conducted research at the National Institutes of Health on diseases of the bowel. After nearly four decades, he has not lost his excitement about caring for patients. When he began to discuss Anne Dodge's case, he sat up in his chair as if a jolt of electricity had passed through him.

"She was emaciated and looked haggard," Falchuk told me. "Her face was creased with fatigue. And the way she sat in the waiting room — so still, her hands clasped together — I saw how timid she was." From the first, Falchuk was reading Anne Dodge's body language. Everything was a potential clue, telling him something about not only her physical condition but also her emotional state. This was a woman beaten down by her suffering. She would need to be drawn out, gently.

Medical students are taught that the evaluation of a patient should proceed in a discrete, linear way: you first take the patient's history, then perform a physical examination, order tests, and analyze the results. Only after all the data are compiled should you formulate hypotheses about what might be wrong. These hypotheses should be winnowed by assigning statistical probabilities, based on existing databases, to each symptom, physical abnormality, and laboratory test; then you calculate the likely diagnosis. This is Bayesian analysis, a method of decision-making favored by those who construct algorithms and strictly adhere to evidence-based practice. But, in fact, few if any physicians work with this mathematical paradigm. The physical examination begins with the first visual impression in the waiting room, and with the tactile feedback gained by shaking a person's hand. Hypotheses about the diagnosis come to a doctor's mind even before a word of the medical history is spoken. And in cases like Anne's, of course, the specialist had a diagnosis on the referral form from the internist, confirmed by the multitude of doctors' notes in her records.

Falchuk ushered Anne Dodge into his office, his hand on her elbow, lightly guiding her to the chair that faces his desk. She looked at a stack of papers some six inches high. It was the dossier she had seen on the desks of her endocrinologists, hematologists, infectious disease physicians, psychiatrists, and nutritionists. For fifteen years she'd watched it grow from visit to visit.

But then Dr. Falchuk did something that caught Anne's eye: he moved those records to the far side of his desk, withdrew a pen from the breast pocket of his white coat, and took a clean tablet of lined paper from his drawer. "Before we talk about why you are here today," Falchuk said, "let's go back to the beginning. Tell me about when you first didn't feel good."

For a moment, she was confused. Hadn't the doctor spoken with her internist and looked at her records? "I have bulimia and anorexia nervosa," she said softly. Her clasped hands tightened. "And now I have irritable bowel syndrome."

Falchuk offered a gentle smile. "I want to hear your story, in your own words."

Anne glanced at the clock on the wall, the steady sweep of the second hand ticking off precious time. Her internist had told her that Dr. Falchuk was a prominent specialist, that there was a long waiting list to see him. Her problem was hardly urgent, and she got an appointment in less than two months only because of a cancellation in his Christmas-week schedule. But she detected no hint of rush or impatience in the doctor. His calm made it seem as though he had all the time in the world.

So Anne began, as Dr. Falchuk requested, at the beginning, reciting the long and tortuous story of her initial symptoms, the many doctors she had seen, the tests she had undergone. As she spoke, Dr. Falchuk would nod or interject short phrases: "Uhhuh," "I'm with you," "Go on."

Occasionally Anne found herself losing track of the sequence of events. It was as if Dr. Falchuk had given her permission to open the floodgates, and a torrent of painful memories poured forth. Now she was tumbling forward, swept along as she had been as a child on Cape Cod when a powerful wave caught her unawares. She couldn't recall exactly when she had had the bone marrow biopsy for her anemia.

"Don't worry about exactly when," Falchuk said. For a long moment Anne sat mute, still searching for the date. "I'll check it later in your records. Let's talk about the past months. Specifically, what you have been doing to try to gain weight."

This was easier for Anne; the doctor had thrown her a rope and was slowly tugging her to the shore of the present. As she spoke, Falchuk focused on the details of her diet. "Now, tell me again what happens after each meal," he said.

Anne thought she had already explained this, that it all was detailed in her records. Surely her internist had told Dr. Falchuk about the diet she had been following. But she went on to say, "I try to get down as much cereal in the morning as possible, and then bread and pasta at lunch and dinner." Cramps and diarrhea followed nearly every meal, Anne explained. She was taking anti-nausea medication that had greatly reduced the frequency of her vomiting but did not help the diarrhea. "Each day, I calculate how many calories I'm keeping in, just like the nutritionist taught me to do. And it's close to three thousand."

Dr. Falchuk paused. Anne Dodge saw his eyes drift away from hers. Then his focus returned, and he brought her into the examining room across the hall. The physical exam was unlike any she'd had before. She had been expecting him to concentrate on her abdomen, to poke and prod her liver and spleen, to have her take deep breaths, and to look for any areas of tenderness. Instead, he looked carefully at her skin and then at her palms. Falchuk intently inspected the creases in her hands, as though he were a fortuneteller reading her lifelines and future. Anne felt a bit perplexed but didn't ask him why he was doing this. Nor did she question why he spent such a long while looking in her mouth with a flashlight, inspecting not only her tongue and palate but her gums and the glistening tissue behind her lips as well. He also spent a long time examining her nails, on both her hands and her feet. "Sometimes you can find clues in the skin or the lining of the mouth that point you to a diagnosis," Falchuk explained at last.

He also seemed to fix on the little loose stool that remained in her rectum. She told him she had had an early breakfast, and diarrhea before the car ride to Boston.

When the physical exam was over, he asked her to dress and return to his office. She felt tired. The energy she had mustered for the trip was waning. She steeled herself for yet another somber lecture on how she had to eat more, given her deteriorating condition.

"I'm not at all sure this is irritable bowel syndrome," Dr. Falchuk said, "or that your weight loss is only due to bulimia and anorexia nervosa."

She wasn't sure she had heard him correctly. Falchuk seemed to recognize her confusion. "There may be something else going on that explains why you can't restore your weight. I could be wrong, of course, but we need to be sure, given how frail you are and how much you are suffering."

Anne felt even more confused and fought off the urge to cry. Now was not the time to break down. She needed to concentrate on what the doctor was saying. He proposed more blood tests, which were simple enough, but then suggested a procedure called an endoscopy. She listened carefully as Falchuk described how he would pass a fiberoptic instrument, essentially a flexible telescope, down her esophagus and then into her stomach and small intestine. If he saw something abnormal, he would take a biopsy. She was exhausted from endless evaluations. She'd been through so much, so many tests, so many procedures: the x-rays, the bone density assessment, the painful bone marrow biopsy for her low blood counts, and multiple spinal taps when she had meningitis. Despite his assurances that she would be sedated, she doubted whether the endoscopy was worth the trouble and discomfort. She recalled her internist's reluctance to refer her to a gastroenterologist, and wondered whether the procedure was pointless, done for the sake of doing it, or, even worse, to make money.

Dodge was about to refuse, but then Falchuk repeated emphatically that something else might account for her condition. "Given how poorly you are doing, how much weight you've lost, what's happened to your blood, your bones, and your immune system over the years, we need to be absolutely certain of everything that's wrong. It may be that your body can't digest the food you're eating, that those three thousand calories are just passing through you, and that's why you're down to eighty-two pounds."

When I met with Anne Dodge one month after her first appointment with Dr. Falchuk, she said that he'd given her the greatest Christmas present ever. She had gained nearly twelve pounds. The intense nausea, the urge to vomit, the cramps and diarrhea that followed breakfast, lunch, and dinner as she struggled to fill her stomach with cereal, bread, and pasta had all abated. The blood tests and the endoscopy showed that she had celiac disease. This is an autoimmune disorder, in essence an allergy to gluten, a primary component of many grains. Once believed to be rare, the malady, also called celiac sprue, is now recognized more frequently thanks to sophisticated diagnostic tests. Moreover, it has become clear that celiac disease is not only a childhood illness, as previously thought; symptoms may not begin until late adolescence or early adulthood, as Falchuk believed occurred in Anne Dodge's case. Yes, she suffered from an eating disorder. But her body's reaction to gluten resulted in irritation and distortion of the lining of her bowel, so nutrients were not absorbed. The more cereal and pasta she added to her diet, the more her digestive tract was damaged, and even fewer calories and essential vitamins passed into her system.

Anne Dodge told me she was both elated and a bit dazed. After fifteen years of struggling to get better, she had begun to lose hope. Now she had a new chance to restore her health. It would take time, she said, to rebuild not only her body but her mind. Maybe one day she would be, as she put it, "whole" again.

* I quickly realized that trying to assess how psychiatrists think was beyond my abilities. Therapy of mental illness is a huge field unto itself that encompasses various schools of thought and theories of mind. For that reason, I do not delve into psychiatry in this book.

Copyright © 2007 by Jerome Groopman. Reprinted by permission of Houghton Mifflin Company.

Information on Complex Regional Pain Syndrome

noreply@blogger.com (Michael L. Neff) — Fri, 16 Feb 2007 22:36:00 +0000

See this link for information on CRPS - formerly known as RSD:

Airbags can cause hearing loss

noreply@blogger.com (Michael L. Neff) — Fri, 16 Feb 2007 22:33:00 +0000

National News
Car Airbags Can Cause Permanent Hearing Loss, Study Says
February 14, 2007

A researcher at a national hearing conference will present data that predicts 17 percent of people exposed to deployed airbags in American cars will suffer from permanent hearing loss. His data also shows, contrary to what experts have previously thought, airbag deployment is more hazardous to the ear when a car's windows are rolled down.

These are among the results that will be presented by auditory physiologist Dr. G. Richard Price at the National Hearing Conservation Association's 32nd annual hearing conference. The conference, titled, "A Passion to Preserve," will be held Feb. 15-17 at the Hyatt Regency in Savannah, Ga.

In Price's study of car airbag deployment, he sought to determine whether the auditory danger was greatest in cars with the windows down or the windows up. Previously, experts thought rolled-up windows were more dangerous because they allow for higher pressure to be created inside the cabin.

The research concludes, counterintuitively, that having car windows rolled up when airbags are deployed is actually less hazardous to the ear than rolled-down windows. This is because the higher pressure generated in the closed cabin actually prevents greater damage to the ear. The pressure causes a displacement in the middle ear that stiffens the stapes, a small bone outside the inner ear. This stiffening limits the transmission of energy to the inner ear, where hearing damage takes place. In airbag experiments where the cabin is completely sealed and pressure is even higher, hearing damage is reduced even further.

Price's study only included cars sold in the United States with front and side airbags. Under U.S. regulations, American cars must have larger, more powerful airbags than cars sold in places like Europe. Cars with smaller airbags sold in other parts of the world would likely pose less auditory danger when tested under identical circumstances, Price said.

"We often consider only the benefits of safety technology, rather than the unfortunate potential side effects," said NHCA Director of Education Brian Fligor. "This type of study highlights how common everyday occurrences present a very real hazard to our hearing."

Find this article at:
http://www.insurancejournal.com/news/national/2007/02/14/76958.htm

Spinal cord victims put on fashion show

noreply@blogger.com (Michael L. Neff) — Sat, 10 Feb 2007 01:45:00 +0000

This recent event shows folks making the most of life.

http://www.comcast.net/providers/fan/popup.html?v=178842369&config=/config/common/fan/news.xml&pl=cbsfannews.xml

MARTA loses negligent security lawsuit

noreply@blogger.com (Michael L. Neff) — Thu, 08 Feb 2007 23:32:00 +0000

An article in the Atlanta Journal Constitution shows what can happen when a defendant in a injury lawsuit destroys evidence.

Jurors award woman $1.7M in MARTA rape

By BETH WARREN, PAUL DONSKY
The Atlanta Journal-Constitution
Published on: 02/08/07
Jurors hit MARTA with a $1.7 million judgment Wednesday for a grandmother who was raped after being kidnapped from a parking garage at the MARTA Lindbergh station in Buckhead in June 2002.

The woman filed a civil suit against MARTA, contending that the transit agency had not properly secured its property.

But in an unusual court move, Fulton County Judge Craig Schwall on Tuesday blocked MARTA attorneys from mounting much of a defense. Jurors only had to settle on the amount the transit agency should pay.

Schwall said MARTA officials hadn't played fair with the woman's attorneys in the years leading up to the trial. He lashed out at the transit agency for not being able to produce documents to back up their claim that there were plenty of officers on duty the night the woman was abducted from the Buckhead parking deck.

"I will tell you it's a very brazen, intentional, deceitful act on the part of MARTA," Schwall said.

MARTA officials say they tossed out all police records from 2002, the year the woman was kidnapped, that would indicate how many officers were on duty the night of the crime and where they were posted.

They threw out the records because they moved their police precinct and didn't want to take old documents, MARTA attorney Tom Sampson said.

Sampson was disappointed with the jury's decision, he said, "but not surprised since we did not have an opportunity to present our case."

MARTA has a reserve fund to handle settlements and verdicts up to $5 million, officials said. The transit system's insurance covers anything larger.

MARTA board Chairman Ed Wall said the transit system was not treated fairly by the judge, and he hopes the transit system's attorneys appeal the case.

"He didn't even let us put on our case," Wall said. "It just doesn't seem fair at all. We had a vigorous defense. The only person to blame for that rape is the person who did it."

During a 2003 criminal trial, a Fulton jury convicted Bernard McCoy of rape and kidnapping. He is serving a sentence of life without parole plus 60 years.

Jury foreman Todd Kearney, 46, said the panel of six men and six women debated about six hours, with one juror suggesting an amount that would only cover the victim's medical expenses to others who tossed out a figure of $5 million.

And, at the heart of the case, the rape victim smiled as she left the courtroom, saying: "I'm happy, but this wasn't about the money. It was about security and their duty to the patrons."

The woman is not being named because she is a rape victim.

Outside the courtroom, some jurors lined up to hug the soft-spoken victim and shake hands with attorneys on both sides.

Some jurors lingered in the hallway to make personal pleas urging MARTA to improve its crime-reporting methods.

One juror, Anastasia Pass, 56, said: "There definitely needs to be changes at MARTA in terms of their internal reporting."

Another, Jason Williams, 37, who owns a dog grooming shop, shook hands outside the courtroom with a MARTA assistant police chief, saying: "I have to ask you to improve your internal reporting."

Assistant Chief Carol Johnson replied: "There's nothing wrong with it."

Not a good client

noreply@blogger.com (Michael L. Neff) — Thu, 08 Feb 2007 22:13:00 +0000

This is a really sad story about a father that I hope is mentally ill. Unfortunately it shows how the one in a multi-million exception to the rule gets publicity while the every day working person's loss goes ignored.

Atlanta Father Admits Intentionally Poisoning Children in Attempt to Sue Campbell Soup Co.

Wednesday, February 07, 2007

ATLANTA — A man admitted that he tampered with his children's soup in an attempt to get money from Campbell Soup Co., a prosecutor said.

William Allen Cunningham's 3-year-old son and 18-month-old daughter were hospitalized twice in January 2006. He forced them first to eat soup laced with hot peppers and lighter fluid, and the second time used the prescription drugs Prozac and Amitriptyline — both used to treat depression — to poison the children, authorities said.

Cunningham, 41, pleaded guilty Tuesday to communicating false claims, U.S. Attorney David Nahmias said. Under terms of a plea agreement, he faces up to five years in federal prison when he is sentenced April 19.

"He admitted that he put potentially life-threatening foreign substances into soup, which he fed to his two young children and then placed a call to Campbell Soup Co. falsely claiming that the soup had been contaminated," Nahmias said.

According to prosecutors, Cunningham called Campbell and threatened to sue. Authorities say there was no evidence the soup was tainted when it was bought.

Safety a big problem for some truck companies

noreply@blogger.com (Michael L. Neff) — Thu, 08 Feb 2007 19:35:00 +0000

A tractor-trailer with one working brake?!
By SUSAN GAST | Wednesday, February 7, 2007, 07:13 PM

The Atlanta Journal-Constitution

Tractor-trailers frighten me. I’m sure they scare any reasonably sane driver.

I know they are vital to our economy. I’ve heard the arguments that truck drivers on average are safer than other motorists. Seeing how other vehicles maneuver, I even believe it.

But Atlanta traffic leaves little margin for error, and if an error occurs, I prefer not to be snuggled up to 10,000-plus pounds of moving metal.

So I was interested to find out that Snellville has a program focused on improper trucks traveling through the city.

I saw the new, white Snellville Police Department pickup a few days ago on U.S. 78, where it had pulled over a truck.

I wondered - for a second - why Snellville would need such a program. Then I recalled the accident a few years ago in which a tractor-trailer ran a red light on U.S. 78 and hit a car only a few feet away from me. Amazingly the man driving the car survived. My nerves, however, hardly recovered.

Snellville has been seeing a large volume of truck traffic and a significant number of truck-related accidents, said Snellville Police Chief Roy Whitehead. The chief also was tipped off that tractor-trailers often use Ga. 124 and U.S. 78 as part of a cut-through to bypass weigh stations on the interstates.

Truck traffic could become an even greater concern with construction to begin this year on U.S. 78 improvements, the chief said. Lanes will become tighter, providing less elbow room.

These concerns prompted Snellville to approve the program, which has been in force since October. It’s a partnership between the city and the Georgia Department of Public Safety’s Motor Carrier Compliance Division.

The officer assigned to the project is a certified commercial vehicle inspector and has performed about 30 to 40 truck inspections per month. Out of those, about 20 to 25 trucks or drivers have been put out of service until violations were corrected, Whitehead said.

“It’s been very successful,” he said.

For example, one tractor-trailer was found to have only one working brake.

I’m sorry; I need to repeat that.

One tractor-trailer - traveling through Snellville - was found to have only one working brake!

Others had oversized loads or their loads were not secured properly, Whitehead said. Assorted other violations also were found.

The new city vehicle used for enforcement is specially equipped, including having portable scales to weigh tractor-trailers on the spot. The total cost for the enforcement truck, scales and equipment was $40,000, which was paid with Snellville’s money from the Special Local Option Sales Tax.

Snellville is not the only one checking out large truck traffic in this way. Gwinnett County Police has two of the inspection units. According to the state, Cobb County, DeKalb County, Powder Springs and Marietta also are involved.

And Alpharetta and Austell are participating as well, Whitehead said.

“But there are very few cities actually involved in this project so far,” he said.

Are tractor-trailers a problem where you live?

Higher speeding fines in Georgia?

noreply@blogger.com (Michael L. Neff) — Thu, 08 Feb 2007 19:15:00 +0000

I hope the proposed law described in a recent Atlanta Journal Constitution article goes through. Its likely to save lives.

Governor turns his radar on speeders
Higher fines proposed to pay for trauma centers

By James Salzer
The Atlanta Journal-Constitution

Published on: 01/10/07

Gov. Sonny Perdue wants Georgia drivers to do something he admits has sometimes has trouble doing himself: slow down behind the wheel.

Staffers said Tuesday that Perdue's legislative leaders will push a proposal to raise fines and other penalties against drivers pulled over for exceeding 85 mph on any Georgia road and 75 mph on two-lane highways. They said the legislation would also increase fines and penalties for habitual traffic offenders, such as those with multiple drunken driving or reckless driving offenses.

Perdue officials didn't provide details of the proposed level of fines and penalties. That will be released in coming weeks, when the legislation is filed.

Part of the goal is to raise money for a more extensive trauma system to treat emergency cases, such as people hurt in car wrecks.

Perdue, speaking to about 2,000 business and political leaders attending the Georgia Chamber of Commerce's annual Eggs & Issues Breakfast on Tuesday, said Atlanta drivers are among the fastest in the country. And he said that's causing problems.

The governor said 20 percent of the state's 1,744 traffic fatalities in 2005 were due to excessive speed. Treating trauma victims costs $7.85 billion per year. And accidents further clog Atlanta's overburdened highways.

"Accidents caused by excessive speed and aggressive driving are not just affecting congestion and causing traffic jams —- they are killing people.

"We've got to stop the excessive speeding," Perdue added.

Perdue acknowledged he's not immune to lead-footing it a bit on the highway. The governor is driven to public events, but he still drives himself around at other times, his staff said.

A legislative study committee has been searching for a way to pay for more trauma centers capable of handling the most severe injuries.

With only 15 such centers spread across the state, it can sometimes take hours for accident victims in rural areas to reach one, according to the committee's report.

Meanwhile, two-thirds of Georgia's 152 hospitals are operating in the red, the report says. They are sustaining financial losses from uninsured or under-insured patients and decreasing Medicaid and Medicare reimbursement rates. Georgia absorbs an estimated $170 million in uncompensated trauma care annually, the report says.

"The bill to fully fund trauma centers for a state our size is going to be between $80 million and $85 million each year," said Sen. Cecil Staton (R-Macon), chairman of the trauma center study committee.

"Obviously, one viable option is to place the cost of these trauma centers on those who engage in reckless behavior —- including those who disobey the speed limit laws in this state and those who drive under the influence of drugs and alcohol on our interstates and highways."

Larry Schnall, senior trooper and spokesman for the Georgia State Patrol, said his agency backs the governor's initiative.

"We support anything that helps us reduce serious crashes," Schnall said. "We think it's a good attention-getter to go along with our enforcement efforts."

In a 2003 study of six states, metro Atlanta had the highest speeds clocked. The study, done for the Insurance Institute for Highway Safety, reported that 78 percent of the Atlanta vehicles on interstates were moving faster than 70 mph, and 18 percent exceeded 80 mph. The mean speed in the study was 75.

Those driving on rural interstates in Georgia did not fare much better. On one highway, 68 percent of motorists were going faster than 70 and 20 percent were going more than 80 mph.

Ron Moore, 78, a former Rockdale County long-distance trucker who retired to Eatonton in Middle Georgia, said he thinks the governor's plan is a good idea.

"I think it's the smartest thing he could do. High speed is a killer," he said. "People just don't realize a split second can take a life."

Moore said he remembers seeing high-speed drivers have to swerve into emergency lanes to avoid slower moving traffic when he was a trucker. Such scenes are not uncommon these days on I-75, I-85 and Ga. 400.

Higher fines might help slow things down, Moore said.

"When you get into a man's pocket book, he'll pay attention," he said.

Warning! Jury Duty Scam in Georgia

noreply@blogger.com (Michael L. Neff) — Thu, 08 Feb 2007 19:06:00 +0000

Recently, I was made aware of people calling Georgians to mine for personal information under the pretext of jury duty.

This message is being forwarded from the Technology Office of the Georgia
> General Assembly. Please take heed.
>
> Rep. Virgil Fludd
>
>
>
> From: Henry, Scott
> Sent: Wednesday, January 17, 2007 9:26 AM
> To: All Users
> Subject: Identity Theft
> Greetings everyone,
>
> We typically do not send out scam warnings however one of our users fell
> prey to this particular one yesterday. The unfortunate user has had to
> place fraud warnings on all of her credit cards and close accounts because
> of it so I thought we best let everyone know.
>
> The local FBI office said this was the first occurrence in Georgia so
> please have a look at it.
>
> Best regards,
>
> Scott
>
> _______________________
>
> "JURY DUTY SCAM:
>
> This has been verified on Snopes.com (link listed below) and by the FBI
> (their link is also included below).
>
> Please pass this on to everyone in your email address book. It is
> spreading fast so be prepared should you get this call. Most of us take
> those summons for jury duty seriously, but enough people skip out on their
> civic duty, that a new and ominous kind of scam has surfaced.
>
> Fall for it and your identity could be stolen, reports CBS. In this con,
> someone calls pretending to be a court official who threateningly says a
> warrant has been issued for your arrest because you didn't show up for
> jury duty. The caller claims to be a jury coordinator. If you protest that you
> never received a summons for jury duty, the scammer asks you for your
> Social Security number and date of birth so he or she can verify the
> information and cancel the arrest warrant. Give out any of this
> information and bingo! Your identity just got stolen.
>
> The scam has been reported so far in 11 states, including Oklahoma ,
> Illinois , and Colorado . This (scam) is particularly insidious because
> they use intimidation over the phone to try to bully people into giving
> information by pretending they're with the court system. The FBI and the
> federal court system have issued nationwide alerts on their web sites,
> warning consumers about the fraud.
>
> Check it out here:
> http://www.snopes.com/crime/fraud/juryduty.asp
> http://www.fbi.gov/pressrel/pressrel05/092805.htm "
>
>
>
>
> Scott M. Henry
> Director of Information Technology,
> Georgia General Assembly
> scott.henry@legis.ga.gov
> v 404-657-4580
> f 404-657-0674
>
> (Embedded image moved to file: pic31006.gif)
>
> (See attached file: pic31006.gif)

Anderson Cooper on car wrecks & Allstate

noreply@blogger.com (Michael L. Neff) — Thu, 08 Feb 2007 18:13:00 +0000

COOPER: Traffic accidents, of course, are a fact of life. So is dealing with
insurance companies. You pay them to protect you. That's the idea. But some
accident victims say they're being forced to settle or go to court because
the claims are denied.

We wanted to know the facts, and in a CNN investigation, we looked into
whether some big name insurers are more interested in profit than
policyholders.

CNN's Drew Griffin tonight, keeping them honest.

DREW GRIFFIN, CNN CORRESPONDENT (voice-over): I happened in Santa Fe, New
Mexico, much the way Allstate describes it in its commercials.

Roxanne Martinez, driving down Sorios (ph) Road about noon, when the SUV
pulled out from Tisuki (ph) Drive.

ROXANNE MARTINEZ, ACCIDENT VICTIM: I remember, you know, like hitting the
driver's side window. And then I just -- I don't know.

GRIFIN: The passenger side had been sideswiped. On the driver's side,
Roxanne was smashed against the window.

MARTINEZ: I had upper back pain. I went to chiropractors, physical
therapists, massage therapists, acupuncture. They told me that my spine was
damaged. GRIFFIN: The person driving the SUV that hit Martinez was ticketed
and had insurance, Allstate. That was good because Martinez was racking up
bills, plenty of them, CT scans, doctors visits, x- rays, all bills she
thought Allstate would cover.

But after three years of fighting over bills and still hurting from the
accident, Allstate came with a "take it or leave it offer," $15,000.

MARTINEZ: That was for, I guess, the car, medical. I mean, that was
everything. You know, I thought they'd pay all your bills and, you know,
keep on paying your medical bills.

GRIFFIN: Roxanne Martinez was battling Allstate, the second biggest auto
insurer in the nation. What she didn't know was that both Allstate and the
largest auto insurer State Farm, had changed the way they handled so-called
minor crashes like hers.

(On camera): In an 18-month investigation across the country, CNN found that
if you are injured in a minor accident, chances are high the two companies
would challenge your medical claim, offering you barely a fraction of your
expenses.

(Voice-over): They would do it by forcing people into court, dragging out
court cases for years and by convincing the public it was all designed to
fight growing fraud in the car accident business.

But documents examined by CNN indicate the motive was profit. And Allstate
has gone to great lengths to keep those documents secret. In two states
where Allstate has been sued, the company has defied judge's orders to make
the documents public.

According to Nevada Insurance Law Professor Jeff Stempel, the new get tough
strategy is adding up to billions in profit for the insurance companies and
little, if anything, for the public.

JEFF STEMPEL, UNLV. LAW PROFESSOR: We can see that policyholders
individually are getting hurt by being dragged into court on fender bender
claims. And yet we don't see collateral benefit in the form of reduced
premiums, even for the other policyholders. So, I think now we can say to
continue this kind of program is, in my view, institutionalized bad faith.

GRIFFIN (on camera): We wanted to ask Allstate and State Farm all about this
on camera in an interview, but they both said no. Allstate did send us an
e-mail.

(Voice-over): In an e-mail, All State told us it did not believe it would
have any real opportunity of being successful in getting CNN to do a
balanced report.

State Farm sent an e-mail, too, saying, "we take customer service seriously
and seek to pay what we owe, promptly, courteously and efficiently, and we
handle each claim on its own merits."

And State Farm also added this -- "Any attempt to generalize that State Farm
has adopted consultant recommendations as other insurers is just plain
wrong. Who is the consultant State Farm refers to? The giant of the
consulting industry, McKinsey & Company, hired by both State Farm and
Allstate.

McKinsey and company said it does not discuss any of its clients' business.
And at the same time Roxanne Martinez thought she was in good hands with
Allstate, Allstate was advised by McKinsey in writing to put boxing gloves
on those good hands.

That strategy, says Martinez's lawyer, was to take valid claims and pay
pennies on the dollar.

Attorney David Berardinelli's has written a bout about it, and is
challenging Allstate's strategy in what he hopes will be a class action
lawsuit.

(On camera): So if you wanted to increase profit, you would try to chop the
small claim?

DAVID BERARDINELLI, ATTORNEY: Sure. If you could take $1,000 off of a
million claims, do the math.

GRIFFIN: A lot of money.

BERNARDINELLI: A lot of money.

GRIFFIN (voice-over): Shannon Kmatz was an Allstate claims agent in New
Mexico before she became a cop. She says she was trained by Allstate to
treat most minor accident victims as frauds and offer them as little as
possible.

SHANNON KMATZ, FORMER ALLSTATE CLAIMS AGENT: $100? Yes, I've offered people
$50. They have minimal damage to the back of their vehicle and they're
claiming that they are hurt.

GRIFFIN: Then Kmatz got to see the insurance strategy firsthand from the
other side.

KMATZ: I turn around and get in a car accident myself. My car has minimal
damage, and I can't walk. And I realized, whoa, what am I doing? This is not
right.

JIM MATHIS: It really came down to three basic elements. A position of
delay. A position of denying a claim. And then ultimately, of course,
defending that claim that you denied.

GRIFFEN: The three D's?

JIM MATHIS: Exactly.

GRIFFIN: Jim Mathis is a former insurance company insider who now testifies
against insurance companies in court.

MATHIS: And the profits are huge. Profits are good. And as long as the
public allows this to occur, the insurance companies will get richer and
people will not get a fair and reasonable settlement, period.

ROBERT HARTWIG, PRES. INSURANCE INFORMATION INSTITUTE: Insurers don't
blanket deny claims on any grounds whatsoever.

GRIFFIN: Robert Hartwig is president of the Insurance Information Institute,
an insurance industry trade group.

HARTWIG: What insurers are trying to do is monitor costs. And every insurer
is under the same pressure to do it.

GRIFFIN (on camera): And this Allstate training manual obtained by CNN
details how that was going to be done. By forcing what the manual calls
smaller walk away settlements.

(Voice-over): The walk away settlement for Roxanne Martinez was a "take it
or leave it offer" of $15,000 that came three years after her accident. She
said that would pay a little more than half of her costs.

MARTINEZ: It's kind of hard when you're thinking, are they going to leave me
broke? Or you know what? I mean, that's what -- that was very stressful.

(END VIDEOTAPE)

COOPER: But Roxanne Martinez decided that instead of taking Allstate's
offer, she would take Allstate to court. We'll tell you what can happen if
you take an insurance company to court, next on 360.

(COMMERCIAL BREAK)

COOPER: Before the break, we introduced you to a woman who said she was
dragged through the ringer by car insurance giant Allstate. She said that
Allstate wanted her to settle for thousands of dollars less than what she
was entitled to. She refused the deal they offered her and went to court.

And that's where she says the battle got even tougher. Her case is not an
isolated one, however. As our reporting reveals, accident victims across the
country are fighting back against the insurance companies they thought would
protect them.

Once again CNN's Drew Griffin.

(BEGIN VIDEOTAPE)

GRIFFIN (voice-over): When Ann Taylor's car was rear ended...

ANN TAYLOR, ACCIDENT VICTIM: I woke up the next morning, I couldn't move. I
had severe pain in my back. Down both legs were numb and tingly.

GRIFFIN: The doctor diagnosed herniated disk muscle tears. And the treatment
would mean time off work, therapy and medical bills. The person who hit her
was a State Farm employee driving a State Farm car. So Taylor thought at
least financially she'd be covered. It added up, said Taylor, to $15,000.

But after dragging out her claim, State Farm offered her only $2,000.

TAYLOR: I was just very insulted.

GRIFFIN: Taylor hired Attorney Jeff Cook and decided she would fight. It
turned into a major legal battle eventually ending up in this courtroom.

Taylor's case is an example of how the two largest auto insurance companies,
State Farm and Allstate, have changed the way they handle claims when people
are hurt in minor impact crashes.

CNN's investigation reveals a strategy to increase profits by limiting
payments to accident victims. And former insurance insiders say most of the
industry has adopted the strategy. Allstate and State Farm, the industry
leaders, would not talk to CNN for this report.

But Jim Mathis, a former insurance company insider, who now testifies
against the insurance business in court, did. And he says cutting payments
to people like Taylor has meant billions for the insurance companies.

MATHIS: It's not based on what should be a settlement value or offer to this
claim. It is not based on ethics. It's based on -- it's not based on
profits. It's based on how much profit.

GRIFFIN: Taylor's case finally got to court three years after her accident.
The lawyer brought in medical testimony. To present its case, State farm
just dug deep into Ann Taylor's past.

JEFFREY COOKE, TAYLOR'S ATTORNEY: The lawyer stands up and says to Ann
Taylor during her cross-examination, tell the jury about your back injury
when you were 16 years old.

GRIFFIN: In fact, the attorney for State Farm raised questions about Ann
Taylor falling off a horse when she was in high school. And the lawyer also
asked Taylor, a nurse, about throwing out her back when she moved a patient.

(On camera): The attorney even brought up personal things that Ann Taylor
had to sell a horse, that Ann Taylor had to sell her house, that Ann Taylor
had even broken up with a longtime boyfriend. And couldn't all these things
add to stress and that could have caused her back pain?

TAYLOR: They didn't have any expert testimony. They never had a physician
look at me.

GRIFFIN: They tried to make you out to be a liar.

TAYLOR: Exactly. GRIFFIN (voice-over): The attorney for State Farm did
produce one piece of evidence -- very large photos of two slightly damaged
cars.

TAYLOR: They expected the jury to see those and to say, she really wasn't
hurt.

GRIFFIN: Michael Freeman is a crash expert, often called in to testify when
insurance companies are trying to use photos to deny a crash victim was
injured.

How did the insurance companies use photos? Well, take a look at a photo of
a car with minimal damage, he says, and convince the jury what they probably
were already thinking. That doesn't look like much. How could that person be
hurt?

MICHAEL FREEMAN, FORENSIC EPIDEMIOLOGIST: You're eventually being judged by
what your car looks like, not by what your doctor says. Or by what the
impact of a particular crash has had or an injury has had on your life.
That's not fair. It's not right. It's fraud.

GRIFFIN: What stunned Taylor in the end is that State Farm's strategy
worked. The jury didn't believe she was hurt. They awarded her just $1,500,
less than what State Farm originally offered.

We contacted three of the jurors. They said this photo played a big part in
their verdict. And they thought the insurance company had already paid its
share and Taylor was only trying to get more.

Why did they look at her and must have assumed this lady is trying to rip
off the insurance companies, she's a fraud?

COOKE: When she walked in the courtroom and she walked to the jury box and
she walked to the testimony box and she walked out of the courtroom at lunch
and at the end of a day, they assumed that she was not significantly
injured.

GRIFFIN: It's a case straight out of the McKinsey playbook, the three D's.
By denying her claim, State Farm forced Taylor to hire an attorney and sue.
After a three year delay, Taylor walked into a courtroom with no noticeable
pain. And by defending the case for years, State Farm forced her attorney to
front expensive litigation costs, which in the end, he didn't get back.

FREEMAN: They make these cases so expensive to litigate, that attorneys
won't want to take them.

GRIFFIN: Indianapolis Superior Court Judge David Dreyer says he hears it
from colleagues across the country, courts bogged down with minor impact
cases. He says the insurance companies' own lawyers admit to him they're
being forced to drag the cases out.

JUDGE DAVID DREYER, INDIANAPOLIS SUPERIOR COURT: They've confided to me that
they would rather settle a case and that they aren't allowed to settle by
the insurance companies that of course control the defense.

GRIFFIN: It's a strategy spelled out in this affidavit from a former
Allstate attorney in a lawsuit against Allstate. She explains how 10 years
ago the insurance giant was changing the way it did business, driving
lawyers out.

The former Allstate attorney says Allstate's strategy was to make fighting
the company, quote, "so expensive and so time-consuming that lawyers would
start refusing to help clients." The president of the Insurance Information
Institute says the change was need.

HARTWIG: We have a group of attorneys, quite frankly, who are very upset
because, guess what, the gravy train has ended.

MARTINEZ: She had like taken off the other way.

GRIFFIN: Remember Roxanne Martinez from the beginning of our investigation?
She was sideswiped and Allstate offered her $15,000 to cover her medical
bills and lost wages. Her case also dragged on for years.

But after listening to what her lawyer said was a deliberate attempt to drag
Martinez through the ringer, her jury awarded $167,000 plus interest.

MARTINEZ: You know, I was happy. I thought, well, you know, all my bills are
getting paid.

GRIFFIN: Industry insiders say 80 percent to 90 percent of accident victims
don't fight. They take what the insurance company offers.

Drew Griffin, CNN, Santa Fe, New Mexico.

(END VIDEOTAPE)

COOPER: Interesting. You might think all the savings would mean lower
premiums for drivers. Well, guess again. The Insurance Information Institute
says auto insurance rates have actually gone up 30 percent over the 10 years
since this went into effect. The president of that institute told us rates
would actually be much higher if the companies hadn't cracked down on fraud.

How much you pay per year on car insurance depends on where you live in many
cases. Here's the raw data. Last year the five cities with the most
expensive auto insurance rates were Detroit, Philadelphia, Newark, New York
and Los Angeles. The least expensive city was Roanoke at just over $900,
followed by Chattanooga; Nashville; Green Bay, Wisconsin; and Raleigh, North
Carolina

Driving around trucks safely

noreply@blogger.com (Michael L. Neff) — Fri, 02 Feb 2007 13:10:00 +0000

Below is an important article on driving safely around trucks pulished in the February 2, 2007 Atlanta Journal-Constitution

DRIVER'S ED: Don't let big truck crush you

Some fights you just can't win. Wrestling a bear at the county fair, for instance, is a bad idea, especially if you've had enough adult beverages to think you're 10 feet tall and bulletproof. I don't care if the bear is wearing a muzzle. It's sort of like tugging on Superman's cape while spitting in the wind.

On the highway, tractor-trailer rigs are the bears of the wrestling ring. You just don't want to tangle with them. You'll lose. The car driver is at fault in about 70 percent of fatal car-truck accidents. Here is how to stay out of trouble:

1 Be seen. Big rigs have a big blind spot where cars closing in from behind disappear from view in the mirrors. If the trucker has to make a quick lane change to dodge a ladder in the road, you could get crunched. More than a third of fatal car-truck accidents happen in the blind spot.

The blind spot is biggest on the right side of the truck. It runs the length of the truck and out three lanes. Try to pass on the driver's side. And don't dawdle in the blind spot —- speed up to pass or slow down to the rear of the truck. If you can see the driver's face in the mirrors, he should be able to see you.

2 Hang back. Leave plenty of space between you and the back of a big rig —- 20 car lengths is a good rule of thumb. Make sure you can see the truck's side mirrors. The truck blocks your view of the road. The truck might roll right over that ladder in the road, but if you're too close you won't have time to miss it.

3 Passing. Don't cut it too close when cutting back into the lane when you pass a big rig. A fully loaded tractor-trailer rig might weigh 40 tons. That means it'll take it 100 yards to go from 60 mph to a complete stop. You want some room between your rear bumper and the truck's nose. Make sure you can see the truck's headlights before you cut in front of it.

Ed got his tips from the American Trucking Association.

Ed is a shade-tree mechanic who talks like a dipstick but knows his way around one.

Speed kills

noreply@blogger.com (Michael L. Neff) — Sat, 27 Jan 2007 13:46:00 +0000

Governor turns his radar on speeders
Higher fines proposed to pay for trauma centers

By James Salzer
The Atlanta Journal-Constitution
Published on: 01/10/07

Gov. Sonny Perdue wants Georgia drivers to do something he admits has sometimes has trouble doing himself: slow down behind the wheel.

Staffers said Tuesday that Perdue's legislative leaders will push a proposal to raise fines and other penalties against drivers pulled over for exceeding 85 mph on any Georgia road and 75 mph on two-lane highways. They said the legislation would also increase fines and penalties for habitual traffic offenders, such as those with multiple drunken driving or reckless driving offenses.

Perdue officials didn't provide details of the proposed level of fines and penalties. That will be released in coming weeks, when the legislation is filed.

Part of the goal is to raise money for a more extensive trauma system to treat emergency cases, such as people hurt in car wrecks.

Perdue, speaking to about 2,000 business and political leaders attending the Georgia Chamber of Commerce's annual Eggs & Issues Breakfast on Tuesday, said Atlanta drivers are among the fastest in the country. And he said that's causing problems.

The governor said 20 percent of the state's 1,744 traffic fatalities in 2005 were due to excessive speed. Treating trauma victims costs $7.85 billion per year. And accidents further clog Atlanta's overburdened highways.

"Accidents caused by excessive speed and aggressive driving are not just affecting congestion and causing traffic jams —- they are killing people.

"We've got to stop the excessive speeding," Perdue added.

Perdue acknowledged he's not immune to lead-footing it a bit on the highway. The governor is driven to public events, but he still drives himself around at other times, his staff said.

A legislative study committee has been searching for a way to pay for more trauma centers capable of handling the most severe injuries.

With only 15 such centers spread across the state, it can sometimes take hours for accident victims in rural areas to reach one, according to the committee's report.

Meanwhile, two-thirds of Georgia's 152 hospitals are operating in the red, the report says. They are sustaining financial losses from uninsured or under-insured patients and decreasing Medicaid and Medicare reimbursement rates. Georgia absorbs an estimated $170 million in uncompensated trauma care annually, the report says.

"The bill to fully fund trauma centers for a state our size is going to be between $80 million and $85 million each year," said Sen. Cecil Staton (R-Macon), chairman of the trauma center study committee.

"Obviously, one viable option is to place the cost of these trauma centers on those who engage in reckless behavior —- including those who disobey the speed limit laws in this state and those who drive under the influence of drugs and alcohol on our interstates and highways."

Larry Schnall, senior trooper and spokesman for the Georgia State Patrol, said his agency backs the governor's initiative.

"We support anything that helps us reduce serious crashes," Schnall said. "We think it's a good attention-getter to go along with our enforcement efforts."

In a 2003 study of six states, metro Atlanta had the highest speeds clocked. The study, done for the Insurance Institute for Highway Safety, reported that 78 percent of the Atlanta vehicles on interstates were moving faster than 70 mph, and 18 percent exceeded 80 mph. The mean speed in the study was 75.

Those driving on rural interstates in Georgia did not fare much better. On one highway, 68 percent of motorists were going faster than 70 and 20 percent were going more than 80 mph.

Ron Moore, 78, a former Rockdale County long-distance trucker who retired to Eatonton in Middle Georgia, said he thinks the governor's plan is a good idea.

"I think it's the smartest thing he could do. High speed is a killer," he said. "People just don't realize a split second can take a life."

Moore said he remembers seeing high-speed drivers have to swerve into emergency lanes to avoid slower moving traffic when he was a trucker. Such scenes are not uncommon these days on I-75, I-85 and Ga. 400.

Higher fines might help slow things down, Moore said.

"When you get into a man's pocket book, he'll pay attention," he said.

Distractions dangerous for drivers

noreply@blogger.com (Michael L. Neff) — Sat, 27 Jan 2007 13:39:00 +0000

Study: Distractions Fuel Teens' Crashes
By JAN DENNIS
Associated Press Writer

BLOOMINGTON, Ill. — More teenagers are heeding warnings about drinking and driving, but they routinely face behind-the-wheel distractions from cell phones to passengers that contribute to thousands of fatal crashes every year, according to a study released Thursday.

Teens often take the wheel amid commotion, angst or fatigue that would be challenging even for older drivers, said Dr. Flaura Winston, chief investigator for the study.

"We need to go beyond the message of drinking and driving and also talk about the message of distractions," said Winston, a pediatrician with the Children's Hospital of Philadelphia.

The study by the children's hospital and State Farm Insurance Co., the nation's largest auto insurer, asked high school students what happens when their peers drive that makes them unsafe. The 2006 survey of more than 5,600 students was a scientific sampling of the 10.6 million students in public high schools across the U.S.

Ninety percent of teens said they rarely or never drive after drinking or using drugs, reflecting a trend that has seen teen traffic deaths involving alcohol drop by about 35 percent from 1990 to 2005, according to National Highway Traffic Safety Administration data.

But teens reported a host of other in-car distractions that researchers say help make traffic accidents the No. 1 killer of U.S. teens, with a fatality rate four times higher than drivers aged 25-69, based on miles driven. About 5,600 teens died in traffic accidents in 2005, and about 7,500 were driving cars involved in fatal accidents.

Researchers found that one teenage passenger with a teen driver doubles the risk of a fatal crash, while the risk is five times higher when two or more teens ride along. Most states have laws restricting passengers when teens drive, but 15 states do not.

Nearly 90 percent of teens reported seeing peers drive while talking on cell phones and more than half spotted drivers using hand-held games, listening devices or sending text messages.

About 75 percent said they see teens driving while tired or struggling with powerful emotions, such as worries about grades or relationships. More than nine of 10 teens also reported seeing teen drivers speeding and half said they sometimes drive at least 10 mph over posted speed limits themselves.

"The environment for a teen driver is much more challenging and demanding than most of us adults thought. They're trying to manage all of that while trying to navigate the vehicle at the same time and they're pretty inexperienced at that," said Laurette Stiles, vice president of strategic resources at Bloomington-based State Farm.

Researchers say they will use the study to push for legislation such as stricter requirements for graduated drivers licenses, which can include mandated supervised driving with parents, night driving curfews and passenger restrictions.

The study's conclusions also will be shared with schools and parents, who can use them to warn teens about the potential hazards of driving, said Winston, who founded the children's hospital's Center for Injury Research and Prevention.

AJC article spotlights fatal car crashes for teens

noreply@blogger.com (Michael L. Neff) — Sat, 27 Jan 2007 13:34:00 +0000

'Good kids are dying out there'
Ex-police officer crusades to stop teen auto deaths

By SANDRA ECKSTEIN
The Atlanta Journal-Constitution
Published on: 01/26/07

Bill Richardson wanted some kind of consulting job once he retired from the Gwinnett County police department in December 2004. He hadn't planned on a new career trying to keep teens from killing themselves in cars.

But that's where life has led him. And his group, "It Won't Happen to Me," is going national this month with a new book telling the story of about 30 teens from throughout the country who have died in car crashes.

"People think — teens think — that it's just the bad kids this happens to, that it's about teenagers drinking or doing drugs and driving, but that's not it," Richardson said. "Less than 20 percent of teens involved in fatal wrecks are involved in drinking or drugs. More than 80 percent of those killed are killed because they were distracted or inexperienced. Good kids are dying out there, not just the troublemakers doing what they shouldn't be doing."

Richardson was trying to find a way to convince Gwinnett County teens that they were at risk when he produced his first book in January 2001, showing teens who had died in traffic accidents between 1990 and 1999.

"Kids would say it couldn't happen to them, so I wanted to show them that these kinds of things happen to kids like them — popular kids, athletic kids, good kids," Richardson said.

When he left the department, he incorporated his idea and took on a partner, Lauren Winborne of Atlanta.

Now they give their presentation, including a video and talks by parents who have lost a child, or teens who nearly died in accidents, throughout the metro area.

Winborne, a mother of six, has been interested in the problem since a high school friend was killed in a car wreck.

"For some reason I have known an unusual number of teens killed in car crashes," Winborne said. "But it's a very fortunate person who doesn't know a teen who was killed in a driving accident."

Richardson said he gives his program at schools, churches and even at the Gwinnett County Justice and Administration Center, where judges order teens charged with traffic offenses to attend. He also does a class for adults. With the new book, he and Winborne are hoping to take their program nationwide.

Their next presentation is scheduled for 7 p.m. Sunday at Dunwoody United Methodist Church. Admission is free. The next class, which also is open to the public, is at the Gwinnett Justice Center at 7 p.m. Feb. 19.

For more information on the program, visit www.itwonthappentome.org or call 770-289-8598.

After accident advice by the AJC.

noreply@blogger.com (Michael L. Neff) — Sat, 27 Jan 2007 13:05:00 +0000

The following article was published by The Atlanta Journal-Constitution on 01/26/07

DRIVER'S ED: Stay cool after an accident

You're likely an excellent driver —- a combination of Richard Petty and that feller who drove Miss Daisy. But there are a lot of bad drivers out there, in case you hadn't noticed. One of them may run into you. Automobile accidents ain't exactly uncommon.

What you do right after a fender-bender can go a long ways to making life a little smoother.

1 Be safe. First things first. Make sure everyone is OK. If there are no injuries, get the vehicles out of the way to prevent more fender-benders.

2 Be quiet. Don't jump out of the car hollering, "I'm so sorry. It's all my fault." Don't claim the blame, even if you are at fault. You don't want to give lawyers any words to twist around.

3 Take notes. Use some of that space in your glove compartment to keep a pen and a notebook. Use them to write down the names, addresses and telephone numbers of all drivers and passengers involved in the accident, license plate numbers, the make and model of each car, driver's license numbers, insurance identifications, the names and addresses and contact information of witnesses, the names and badge numbers of police officers or other emergency personnel. Also make notes about the damage to each car.

4 Take pictures. It's a good idea to keep a disposable camera in the glove compartment along with the notebook and pen. Use up the roll to document damage to both cars. If your cellphone has a camera, use that.

5 Police report. Ask the investigating officer where you can obtain a copy of the police report. You'll more than likely need it when you submit your claim to your insurance company.

6 Be leery. If it's a minor fender-bender, you might be tempted to settle the deal without calling in the insurance companies. Think twice about that. The other driver may renege after seeing the repair bill. By that time, it might be harder for your insurance company to gather the evidence if you file a claim.

Ed got his tips from the Insurance Information Institute and Edmunds.com.

Ed is a shade-tree mechanic who talks like a dipstick but knows his way around one.

Article - women more likely than men to be hurt in car wrecks?

noreply@blogger.com (Michael L. Neff) — Sun, 21 Jan 2007 21:50:00 +0000

This was an interesting article that ran in the Atlanta Journal Constitution and other newspapers.

Car crash injuries vary with age, gender
By VIRGINIA ANDERSON
Cox News Service

Sunday, January 07, 2007

ATLANTA — Age and gender play a major role in the severity of injuries in car crashes, a fact that might steer future safety features in automobiles, according to a study by Purdue University researchers.

The findings, published in the Journal of Safety Research, suggest that vehicles designed to adapt to specific drivers could lessen the severity of injuries, said co-author Fred Mannering, a professor of civil engineering at the West Lafayette, Ind., university.

For example, with existing sensor technology, cars could detect the height and weight of a driver and the car's safety system could adjust, Mannering said.

Safety-belt tension could be varied, and the way air bags deploy could be personalized.

"What it really means is that it's an opportunity for auto manufacturers to design cars more safely," Mannering said.

Most automakers already are installing sophisticated air-bag systems — called dual-stage air bags — that adjust to the severity of the crash and the size of the driver, said Joe Nolan, head of the Vehicle Research Center of the Insurance Institute of Highway Safety, where crash testing is done.

"The [study] author's recommendation is, indeed, happening," Nolan said.

More stringent federal regulations, cheaper technology and buyer demand have moved car makers to quickly improve air-bag systems, Nolan said.

The study, a review of 32,085 Indiana vehicle crashes in 1999, also showed that age and gender play a role in the types of crashes people have.

The findings confirmed again that younger male drivers with passengers in the car were much more likely to suffer serious or fatal injuries when they are in a crash than older men or women of all age groups — a fact that parents, lawmakers and auto manufacturers should keep in mind, Mannering said.

Some findings were more surprising to the researchers.

For instance, driving a newer vehicle — less than five years old — actually increased the likelihood of fatality for older men by 216 percent.

A newer vehicle also increased the likelihood of fatality for young men, but by a lower percentage — 71 percent. The age of a vehicle did not have a significant effect on the likelihood of a fatality for middle-aged men.

Among women, safety belt usage in different age groups was a factor in the likelihood of injury, Mannering said.

Not using safety belts increased the likelihood of injury by 119 percent for young women, 164 percent for middle-aged women and 187 percent for older women.

The study did not examine the reasons for the differences. Mannering said he and co-author Samantha Islam could only speculate why the striking differences occurred.

Variations in reaction times among drivers could play a role, as well as the fit of safety belts, based on driver size, Mannering said.

The likelihood of injury from air-bag deployment may vary from age group to age group and between genders, he said.

Decreased bone density among older women may contribute to air-bag injuries, he speculated.

Even though the reasons may be unclear, Mannering said further study may reveal answers that may result in vehicle design changes.

"It's clear that that's the next direction," he said.

While that almost certainly would increase the cost of autos, Mannering said he believes those expenditures would be offset by saving money on lower insurance rates and medical bills for injuries sustained in crashes.

Virginia Anderson writes for The Atlanta Journal-Constitution. Journal-Constitution writer Clint Williams contributed to this article.