Pre-Existing Conditions in Catastrophic Injury Cases Involving Internal Organs: What Defense Attorneys Need to Know
By James F. Lineback, M.D., F.C.C.P.
Catastrophic injury is a serious personal injury that often results in permanent disability, long-lasting medical conditions, and a shortened life expectancy. The consequences and progressive nature of a catastrophic injury include not only an immediate impact on the quality of life of the injured party, but can also contribute to his or her death. The internal organs, such as the heart, lung, digestive tract, kidney, liver, and pancreas may be impacted by this type of injury and contribute significantly to the level of permanent disability. Unfortunately, the status of the affected internal organs before the catastrophic injury occurred is often overlooked.
Critical details regarding prior organ function must be considered in these complicated cases, but such information is often unavailable or lacking, and attorneys and adjusters may not have the training required to appreciate the nuances of multi-system organ dysfunction. A systematic analysis of complex data involving multiple organ systems can also be quite overwhelming; often preventing the defense team from determining what percent of organ dysfunction should be apportioned to the catastrophic injury, which subsequently may result in an inappropriate settlement or award to the plaintiff.
A 46-year-old forklift driver with history of Non-Hodgkin’s Lymphoma successfully treated with chemotherapy and radiation therapy. He sustained severe abdominal trauma requiring numerous surgeries and bowel resections, ultimately resulting in “short bowel syndrome”. Patient died four years later, secondary to complications of infection related to short bowel syndrome. As defense team prepared to settle the case, an analysis of records revealed probable recurrence of lymphoma. Objective evidence of chronic obstructive pulmonary disease, coronary artery disease, and alcoholic liver disease related to heavy smoking and alcohol use was also clearly established. Plaintiff demand was $10 million; – jury trial resulted in plaintiff total verdict recovery of $3.43 (gross of $4.58) million. Probable reduced life expectancy related to numerous pre-existing medical problems considered in a reduced award of $400,000 for future medical.
Several other rather common scenarios of pre-existing organ dysfunction affecting the outcome of a catastrophic injury include patients with cardiopulmonary disease, hypertension, diabetes, or pancreatitis secondary to alcoholism. For example, hypertensive diabetics frequently develop premature vascular maladies that can predispose them to stroke or heart attack following catastrophic injury. These patients may also have pre-existing kidney disease that is diagnosed after the injury, which, as with the vascular disease may be unrelated to the catastrophic injury.
Similarly, a patient with pre-existing cardiopulmonary disease, such as coronary artery disease or cardiomyopathy (defective heart muscle), who suffers blunt chest trauma in a motor vehicle accident, may present a diagnostic dilemma because symptoms often overlap and can be extremely difficult to separate out. Chest trauma or lung injury may also be confusing in patients with pre-existing lung disease (COPD), especially with smokers or asthmatics. Similarly, blunt abdominal trauma in an alcoholic with pre-existing pancreatitis may incorrectly be presumed to be the sole cause of the pancreatitis, as would an injury affecting the liver in the alcohol abuser with previously undiagnosed liver disease.
Pre-existing conditions involving internal organs in catastrophic injuries must be considered and an effective approach to this apportionment dilemma is a thorough assessment of pre-injury organ function using a systematic analysis of the available data on prior organ function. A “physiologic profile” can be created, and the information applied to most accurately and fairly determine the contribution (if any) of the catastrophic injury to organ dysfunction. This type of analysis is also helpful in determining how long a deceased patient would have survived absent the catastrophic injury, as well as whether or not the death was caused by the sequelae of the injury. This complex task is best addressed by an Internal Medicine specialist with a strong background in physiology. A detailed assessment and analysis of both pre- and post-injury organ function is imperative in the determination of the role that a catastrophic injury plays in a patient’s decline or demise.
Dr. James Lineback is certified in both Pulmonary and Internal Medicine and has been a practicing physician since 1985. He has taught a medical school course entitled Pathophysiology and Mechanisms of Disease for over 15 years at the University of California, Riverside. Dr. Lineback has lectured on numerous cardiopulmonary topics involving severe disability and death, such as chronic obstructive pulmonary disease, coronary artery disease, acute and chronic respiratory failure, and tissue oxygenation. He is an active member and fellow of the American College of Chest Physicians, and the American Academy of Anti-Aging Medicine.
Dr. Lineback can be contacted at:
(949) 760-8600 – phone; (949) 721-9121 – fax
400 Newport Center Drive, Suite 401
Newport Beach, CA 92660
© Nov. 2013; James F. Lineback. MD. Written for members of the American Trial Lawyers Association and the Defense Research Institute.