I was just on the Cruise Review Blog and found many interesting questions and comments on the ship’s medical staff. Some people said that the ship’s doctors are no better or worse than land based doctors. Then people said that the doctors are independent contractors and the cruise line is not in the business of providing medical services. Hmmmm. Sounds strikingly similar to the arguments made by the cruise lines and their numerous lawyers. You don’t think they would….. Well they would. In any event, I am a lawyer and I represented the cruise lines for 17 years, and for the last 10 years I have represented passengers and crew members against the cruise lines. Here are my observations:

First, the cruise lines very much are in the business of providing medical care. Why? Because they take 1500 to 3000 people most of whom are U.S. citizens and residents out into the ocean where there is no medical care other than onboard the ship. Then, when the ship does go to ports, at least in the caribbean often they are port of a third world country where there is no medical care which comes close the the care we expect here in the U.S. That is why the cruise lines do provide a medical facility and staff onboard.

The cruise lines advertise that they have this great medical staff and facility. That is to reassure the public that although they are going to parts unknown they will be cared for. This after all is for sales and marketing.

What the cruise lines do not tell you is that the ship’s doctor and the medical staff in all but the rare exception are not from the U.S. They did not study or train here and they are not licensed here.

Further, even if they were the greatest of physicians, the cruise lines provide them with only the very basic of equipment. Oftentimes the staff does not know how to use it. They are not on the ship for any extended period of time. Most are on for less than a year and do not return. They are put into bad situations where people get sick or injured and they are not equiped either through training or through their physical equipment to deal with all of the people. And they are on call a lot. It is a burn out job and so they rarley reapply.

Yes, the courts have sided with the cruise lines that the cruise lines should not be held vicariously liable for the actions of the doctor. This stems from an old outdated opinion called Barbetta. The new opinion from the Florida Supreme Court is Carlyle. Some Courts have a misguided notion that the cruise lines are not in the business of furnishing medical care. This is like saying that the cruise lines are not in the busines of furnishing a safe environment to its passengers. Also this ignores the fact that the cruise lines do furnish medical care to its passengers and that they do in fact advertise that they do. This also ignores the fact that passengers who are either families with small children and passengers who are elderly certainly rely on these representations.

All of us rely on the image of the cruise liner as a huge, clean, safe environment even though it is carrying us out into the open sea and to third world countries. 99.999% of the passengers on cruise ships would never go to these countries on their own, that is without the enclosed and safe environment of the cruise ship. 10 million U. S. citizens a year take cruises. They think that all of the standards on the cruise ship are good by U.S. standards. The medical care is not. In any event, the cruise line should be held accountable for the errors of its doctors and certainly its staff.

This just in from Medinews. Great stuff but for now limited to a rat study.

December 15th, 2007 by The MediNEWS Team

Traumatic spinal cord injury (SCI) has been estimated to occur in about 43-55 per million population in the United States. Despite the low incidence, hospitalization and rehabilitation charges for spinal cord injury can cause significant economic burden due to the devastating and debilitating neurological deficits. The management of SCI is mainly supportive, and an improvement in outcome is usually seen with administration of methylprednisolone within 8 hours of injury. In a recent study, W.L. Huang from the Neuroscience Centre, Institute of Cell & Molecular Science, Queen Mary University of London, UK, and colleagues evaluated the effect of docosahexaenoic acid (DHA) in a rat model of SCI, and concluded that the outcome after SCI significantly improved by combining an initial acute intravenous injection of DHA followed by a sustained dietary supplementation (Brain, 2007).

Brain-injury survivors come to grips with new lives
Email|Print| Text size – + By John Dyer
Globe Correspondent / November 18, 2007
Raymond Burns nodded his head as Peggi Robart spoke, his face expressing relief and gratitude.

“We’re no longer what we used to be,” said Robart, a Newton resident, addressing 14 others around a table at the MetroWest Wellness Center in Framingham. “You’re not going to get back to yourself again. That self is gone.”

Raymond Burns was nodding his head in enthusiastic assent. “Yes!” he agreed.

It was the first time Burns, also a Newton resident, had attended the support group, which is organized by the Brain Injury Association of Massachusetts. It was also the first time he had heard someone else articulate what he had been experiencing for more than a year. In March 2006, Burns was in a car accident that briefly knocked him unconscious. He woke relatively unscathed, though his head had jerked back and forth violently. He thought he was all right, but he was wrong.

“I started doing irrational things right away,” he said. “For example, I refused to go to the hospital. It was stupid.”

The nonprofit Brain Injury Association, based in Westborough, celebrated its 25th anniversary recently. It describes itself as the state’s foremost advocate for brain-injury survivors, which it says is the largest category of disabled people.

Each year, around 44,000 Massachusetts residents suffer traumatic brain injuries, with the causes including falls, car accidents, assaults, sports concussions, and shaken baby syndrome, the association says.

Many of those survivors suffer not only from physical wounds but from the dawning realization that while they often look normal, and retain motor functions and many cognitive abilities, they also are disabled in ways that can strike at the heart of their identities.

“We all have problems people can’t see,” said Muffi Brown of Ashland, a support group participant who installed computers in stores in the 1970s but can no longer type after suffering a stroke 10 years ago. “Some of us can’t read,” she said. “Some of us can.”

Robart joined the support group four years ago, after an electronic sign in an airport shuttle bus fell on her head.

Joining was one of the first steps Burns has taken in accepting that his life has changed dramatically and probably permanently. “I knew I needed to get some help. I’m finally coming to terms with this, but it’s very tough.”

Before his accident, Burns was the CEO of a software development company with 20 employees. In the weeks after the crash, he started losing his train of thought in conversations. He couldn’t organize papers on a desk. Sometimes, reading his own handwriting was impossible. Eventually, he realized that while the rest of his body had recuperated from the accident, the violent jerking had injured his brain.Continued…

Through its support groups and other programs, the Brain Injury Association seeks to educate the public about brain injuries, and how to prevent them, said Arlene Korab, the association’s executive director and a Westborough resident. Her son suffered a brain injury in a car accident in 1980.

“In a split second, lives can change,” she said. “We need to understand the consequences of risk-taking behavior and the importance of prevention.”

Improved expertise in detecting and treating brain injuries has radically changed the nature of the problem, Korab said, adding that doctors know much more about how the brain works than just a few years ago. As a result, brain injuries today are less likely to be fatal than they were a decade ago.

“The medical treatment is so much better. But if you have no quality of life once you survive, you’ve got to do something.”

The association, which counts 6,500 members, regularly lobbies and testifies before Beacon Hill lawmakers on behalf of brain-injury survivors. In 1985, it pushed officials to create the Statewide Head Injury Program, which provided funds and other resources to almost 1,000 brain-injury survivors last year, according to the program’s website. Ten years ago, the association created Brains at Risk, a course that state judges sometimes require people convicted of drunken driving to take to learn about brain injuries resulting from car accidents.

The association also organizes events such as the Oct. 30 Sports Concussions Conference in Marlborough, where doctors and professional football players met to educate high school coaches and others about head injuries among young athletes. It is now organizing veterans groups to help deal with brain-injury survivors coming home from Iraq.

“We never saw brain injuries in Vietnam and the Persian Gulf,” said Carol Callaghan, with the Veterans Outreach Center - MetroWest, a Marlborough-based nonprofit group that provides services for returning troops. “They didn’t know how to look for it.”

Of the 40 Iraq and Afghanistan veterans Callaghan oversees, six suffer from brain injuries, she said. She expects more such injuries to come to light, given that many soldiers have been injured by explosive devices blowing up near or under vehicles, jostling the passengers and creating perfect conditions for head injuries.

One of the first hurdles that survivors and their loved ones have to face is that victims may exhibit symptoms that make them seem mentally ill, such as not being able to concentrate or perform multiple tasks. In reality, however, these are the symptoms of their injuries, and it often takes time to identify them as such.

“There’s a stigma,” said Barbara Webster, a Hopedale resident whose injury resulted from whiplash sustained in a 1991 car accident. “People think you’re crazy.”

Webster learned to write shopping lists in the order items appeared on her route through the supermarket. She explained to her husband that certain sounds, like his rustling a bag of potato chips, were excruciatingly distracting. Over time, her condition steadily improved as she learned how her injury affected her behavior and discovered helpful coping mechanisms. She now leads the association’s group in Framingham.

“I can do quality work, but I can’t do as much. I need to pace myself and use certain strategies,” she said. “You’re re-creating this life you took 20, 30 years to build.”

© Copyright 2007 Globe Newspaper Company.
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Traumatic Brain Injury; Personal Injury; Personal Injury Attorney; Trial Lawyer. Recently we have heard about therapeutic hyperthermia, cooling down the body temperature to about 91 degrees after traumatic brain injury. The purpose of this is to prevent the inevitable subsequent injury. When the brain is healing after an injury, a relatively minor jolt to the head can cause devastating, often-fatal results. In spinal cord injuries, additional inflammation, hemorrhaging or jarring can cause permanent damage and paralysis. The idea is to induce mild hypothermia, lowering the patient’s body temperature to about 91 degrees within 15 minutes of the traumatic spinal injury to prevent further damage. This therapy actually has been around in general since the 1950’s. This is good news for the people who can get this treatment within the 15 minutes of the personal injury.

This just in from a leading national research center about personal injuries involving bicycles and people under 20 years old. This includes automobile accidents where the automobile hits the bicyclist. The conclusion is that the injuries are much more severe than initially thought. For example, one third of those hospitalized are diagnosed with traumatic brain injury. The question is whether there is a significant population which is not properly diagnosed with TBI. Here is the story:

Researchers with the Center for Injury Research and Policy at Nationwide Children’s Hospital have released a new study that shows that injuries in those under the age of 20 that involve bicycles may be a much more significant problem than its has been thought to be. The study shows that injuries that are bicycle related and involve this age group equates out to about $200 million a year in hospital costs.

Those aged 20 and younger make up over half of the estimated 86 million bicycle riders in the U.S. It is a well established fact that injuries from bicycle accidents are the cause of more visits to emergency rooms for young people than any other recreational sport related injury. But, the study goes way beyond the situations with emergency rooms and looks at the number of bicycle related hospitalizations. They estimate that about 10,700 children become hospitalized each year for injuries from bicycles just in the U.S. The average stay is 3 days.

One of the most significant and important facts that they turned up is that motor vehicles are involved in about 30% of all bicycle injuries that result in a child being hospitalized and the percentage increases when they looked at the older children.

In addition, one third of the children who require hospitalization ended up being diagnosed with traumatic brain injury. This is very significant when you take into consideration that this type of injury may be very preventable if the child would only use a bicycle helmet.

One of the authors of the study is Gary Smith, MD, DrPH, director of the Center for Injury Research and Policy, faculty member at The Ohio State University College of Medicine. He states that the findings can and should be used to promote bicycle related injury strategies aimed at lessening the severity of the injury as well as the number of deaths that are the result of pediatric bicycle-related injuries. The use of bicycle helmets alone can reduce the risk of brain injury by as much as 85%.

e Daily News
Published October 8, 2007
GALVESTON — Ten-hour shifts on her feet plus years of wearing high heels equaled excruciating foot pain for Maria Leon of Peru.

Leon is a stateroom attendant on the Carnival Conquest. For months, she cleaned rooms and waited tables on the cruise ship despite the torturous pain in both of her feet. Her goal was to earn enough money so she could get her master’s degree in business administration in Peru.

Every step was uncomfortable — working on her feet was almost unbearable, Leon said.

The Carnival Conquest’s on-ship physician diagnosed Leon with plantar fasciitis, a common foot ailment caused by inflammation of the tissue that runs along the bottom of the foot, connecting the heel bone to toes, according to the Mayo Clinic.

When the ship docked in Cozumel, doctors prescribed Leon with anti-inflammatory medicines.

They didn’t help.

Eventually, Leon ended up at The University of Texas Medical Branch in Galveston where she was seen by emergency orthopedic surgeon Kelly Carmichael. He diagnosed Leon with metatarsalgia — pain and inflammation in the balls of feet caused by stress on the metatarsals — the long bones in the front of the feet below the toes, according to the Mayo Clinic. The condition typically affects high-impact sports athletes, or in Leon’s case, those who don tower-high heels.

The University of Texas Medical Branch operates a maritime clinic which contracts with cruise ships to provide medical care for employees.

Medical branch doctors and nurses can communicate with the ship’s physicians via e-mail 24 hours a day, said Pam Kuchta of the maritime clinic. When ships dock in Galveston, medical branch doctors can treat the cruise ship employees.

The ships pay health care bills for employees who eat, sleep and thrive on the 70,000-ton cruise ships. After Leon was diagnosed with metatarsalgia, the maritime clinic helped coordinate the effort to get her special shoes to reduce the pressure on her feet.

Last week, Leon was fitted by a prosthetics store in Galveston for the specialized shoes, commonly used by diabetics who typically have foot problems. The seamless custom-fitted pair of black Mary Janes with special foam inserts hardly look different from their counterparts on department store shelves.

“Those are cute, Maria,” Kuchta said.

“I know!” she replied.

Though she admits the new shoes feel a little weird, she’s glad to rid herself of the foot pain.

“Oh,” she said, clasping her hands to her chest. “I’m very happy.”

This just in about a possible new treatment for traumatic brain injury(TBI). This is only research at this point but it looks promising. The treatment uses hyperbaric chamber treatments.

1st successful treatment for chronic TBI
New Orleans, LA ¨C A research team led by Dr. Paul Harch, Assistant Professor of Clinical Medicine at Louisiana State University Health Sciences Center New Orleans and Director of the LSU Hyperbaric Medicine Fellowship Program, has published findings that show hyperbaric oxygen therapy (HBOT) improved spatial learning and memory in a model of chronic traumatic brain injury. HBOT is the use of greater than atmospheric pressure oxygen as a pharmacologic treatment of basic disease processes/states and their diseases. The paper is reported in the October 12, 2007 issue of Brain Research. (Paper available upon request.)

The research team adapted a well-known acute animal model of focal traumatic brain injury to chronic brain injury to evaluate the ability of low-pressure hyperbaric oxygen therapy (HBOT) to improve behavioral and neurobiological outcomes. The 64 rat subjects were divided into three groups¨C an untreated control group (22), an HBOT group treated with a human protocol (19), and a group treated with sham hyperbaric pressurization (23). The subjects were tested pre and then 31-33 days post HBOT using the Morris Water Task ( MWT), a behavioral test which measures learning and memory. The HBOT group received low pressure twice daily therapy, and the sham-treated normobaric air group the identical schedule of air treatments using a sham hyperbaric pressurization. All groups were subsequently retested in the MWT. Post experiment, blood pressure density was measured in the brain and was correlated with MWT performance. HBOT caused an increase in vascular density in the injured hippoca mpus (p

There are many things you should look for in a lawyer. First, you should determine if he or she practices in the area of law which you need. What area do you need? If you have suffered personal injuries, you need someone who practices in that area and who really specializes in it. If you have been injured on a cruise ship, you need someone who practices in the area of maritime personal injury. If you have been injured by a product, you need a lawyer who knows product liability. If you have been injured in a slip and fall accident by the negligence of a storeowner, you need a lawyer who handles slip and fall accidents.

Anyone can say they practice in a certain area or handle certain cases, but what is the extent of their experience in the area? What kind of results have they gotten? Are they the type of lawyer who settles quick and cheap or do they really take cases to trial and if so what are their results? These are some of the questions you should ask; these are some of the things insurance companies look at when they decide how much to offer in settlement on a case.

Look for the following in a lawyers background:

Was he or she ever on the other side, in other words representing the insurance companies, cruise lines, and railroads in the past? If so, for how long? This can be a huge advantage. This lawyer knows the case from the perspective of the other side and knows the players on the other side.

How long has he or she been in practice? It takes years after law school to train as a lawyer and to know how to do what it takes to get results.

Has this person been a leader in the community or among lawyers? If so, this lawyer may be well known and respected by the Judges, the other lawyers, the insurance companies, and the juries. Look at whether the lawyer has been the president of a bar association and whether he or she has chaired committees of the bar associations.

Is the lawyer Board Certified as a trial lawyer? The Florida Bar (the body which licenses and regulates all lawyers in Florida) has a Board Certification process which only a few lawyers have. This process requires a certain number of trials and experience, and passing an all day examination. The American Bar Association also recognizes the National Board of Trial Advocay for national certification.

Has the lawyer written articles or lectured in the area? Some lawyers write articles and lecture for other lawyers explaining the law in the area or trial techniques. The law is always changing and lawyers are required to take courses. Look for the lawyers who lecture at these courses.

Has the lawyer been recognized by organizations which rank or recognize the outstanding lawyers in the area, the state, or the nation? There are many such organizations like: Martindale Hubbell (international directory of lawyers with a rating system in which the lawyer ins rated by other lawyers, i.e., his/her “peers”; A/V is the highest rating); Who’s Who which lists lawyers based on their backgrounds and accomplishments overall; Superlawyer.com which again ranks or lists lawyers based on reviews by other lawyers; South Florida Legal Guide, which has categories for areas of practice and ranks according to what other lawyers say; Florida Trend Magazine which names its “Legal Elite”.

What results at trial and in settlement has the lawyer gotten? Results speak for themselves. But look at the severity of the case compared to the result. In other words is there a million dollar recovery in a case in which the client was put into a wheelchair after the accident or in the case of a less serious injury?

This just in about the victims and the families of people who were killed in a boating accident one year ago on Columbus Day. Every year in the waters off of Miami there is a Columbus Day Regatta. It is a fun event and a beautiful sight. The Regatta takes place on Sunday and Monday of the weekend. It is a beautiful sight to see all of the sail boats in a precosseion as they race down to Elliot Key. They then spend the night there and race back the next day. The Regatta is for sailboats but there are also motor boats who join the festivities especially the partying. At Elliot Key, on the night of the race, there is always a party and it can get wild. As you can imagine there is sometimes some drinking and driving of motorboats.

When accidents do occur on the water with any kind of motorboats, yachts, Jet Skiis, Wave Runners, Seadoos, sailboats, commercial vessels including tankers, freighters, cruise ships, and any other vessel or boat, maritime law applies. This is a specialized area of the law. For this type of case, you need a maritime lawyer who handles personal injuries.

Last year, on the Columbus Day weekend, there was an accident where a rental boat broke down, was being towed, and was hit by another boat. This caused the wrongful deaths of two of the boaters and many personal injuries. Some of those who suffered personal injuries were students at Florida International University (FIU). Here are some more details from the FIU student newspaper:

One year after the boat accident during the Columbus Day Regatta that killed two FIU students and injured many others, some of the survivors - together with friends and relatives -returned to the regatta site, but this time with a different purpose.

Need help? Just light the way is the name of the campaign they founded to create awareness about the dangers of the ocean, which they believe will help prevent more accidents such as the one that killed students Monica Burgera and James Noel Pou last year.

“We couldn’t let this happen again, so we though that by telling other people what happened to us and informing them about boat safety was the best way to prevent it,” said Andres Perez, who survived the accident that took the life of his girlfriend for more than four years, Burguera; and his roommate, Noel Pou.

The accident took place when their broken-down rental boat, which was being towed back to shore, was hit from behind by a 35-foot powerboat.

Together with Burguera’s family and about 100 volunteers, Perez spent last weekend’s regatta distributing flyers, t-shirts, hats and flashlights at 14 different marinas throughout Miami.

“We went through such a hard time that we don’t want anyone else to go through the same. Saving one life will make the effort worth it,” said Mayra Burguera, the mother of Monica Burguera.

Need Help? was financed by the Burguera family and supported by friends and relatives.
A Web site and a Facebook.com group helped spread the word about it and quickly found solidarity among the FIU community. The Facebook group reached over 1,000 members in just three days.

Also as part of the campaign, the Burguera family decorated a boat with Burguera’s and Noel Pou’s picture and approached regatta boaters to hand them safety information and remind them of the dangers of the ocean.

This just in about the crash of a 40 foot walkway leading to the Queen Mary II when she was in dry dock in France. On November 15, 2003, the shipyard which built what was at the time the world’s largest cruise ship hosted a party on the ship. The day before the reception, the yard built a make shift walkway leading to the ship. It was built not according to any written plans but according to memory. When the reception was underway and hundreds of people were crowded onto the walkway, it collapsed sending the people down some to their deaths. There were 16 wrongful deaths and 29 personal injuries. The ship builder and the subcontractor which built the walkway were put on trial in France for manslaughter. Here are the details:

Shipbuilder on trial over gangway deaths on liner
SUSAN BELL
IN PARIS
THE French shipbuilder of the giant luxury liner Queen Mary 2 went on trial yesterday charged with the manslaughter of 16 people and injuring 29 after they fell 18 metres to the ground when a walkway collapsed during a visit.

The shipbuilder, Les Chantiers de l’Atlantique, Endel, which it subcontracted to build the walkway, and four employees of each firm face up to three years’ imprisonment for involuntary injury and manslaughter.

However, a lawyer for the 130 civil parties in the case asked yesterday for the charges be requalified as “a deliberate fault”, for which the maximum sentence is five years in prison.

The accident, on 15 November, 2003, took place while the Queen Mary 2 - the world’s largest liner at the time of its construction - was in dry dock at Saint Nazaire in western France undergoing pre-delivery sea trials.

The shipbuilder and its subcontractor are accused of failing to carry out obligatory security checks before allowing hundreds of guests to use the narrow 14 metre-long walkway to board the ship for a guided tour. The two companies are also accused of having employed insufficiently trained personnel.

An investigation into structural reasons for the accident concluded that the design of the walkway was deficient. It was installed “without plans and from memory” the day before the tragedy, said the president of the court, Alain Le Dressay.

Among the 45 victims of the accident were 26 employees of a cleaning firm and 19 guests who had been invited to visit the liner.

“I want justice to be done,” said Marlene Cassard, a survivor who lost her husband, a senior executive at Les Chantiers de l’Atlantique, her brother and three close friends.

“I thought it was the end. I fell on people and people fell on me,” she said. “I opened my eyes and found myself in the midst of torn bodies and heaps of metal.”

Her son, Eric, added: “We just want the defendants to say ‘yes, we messed up’, for them to assume their responsibilities.”

Yves Violette, a representative of the 130 civil plaintiffs, said: “We are well aware that nobody wanted to kill anyone, but the victims need to know the truth.”

The husband of a woman who died in the tragedy said: “How do these people sleep at night?”

Les Chantiers de l’Atlantique maintains it had full confidence in Endel. The contractor has claimed the walkway was being used in conditions for which it had never been intended. “The walkway should never have been used by members of the public,” Endel’s lawyer, Thierry Dalmasso, told the court.

Patrick Boissier, the head of Les Chantiers de l’Atlantique, said: “We have undeniably a moral responsibility for the accident.”

The trial is due to continue until 23 October.

AN OCEAN GIANT
THE 150,000-tonne, 17-storey, Queen Mary 2 ocean liner entered service in January 2004 with her maiden voyage from Southampton to Fort Lauderdale, Florida, followed by a series of Caribbean cruises and a trip to Rio de Janeiro.

She was overtaken last year as the world’s largest cruise ship by the Finnish-built Freedom of the Seas, which can carry up to 4,400 passengers compared to the Queen Mary’s 2,620 - but her height, length, and waterline breadth still remain unsurpassed by any other passenger ship.

Approximately 3,000 craftsmen in Saint-Nazaire, spent some eight million working hours on the ship, and a total of 20,000 people were directly or indirectly involved in her design, construction, and fitting out.

In total, 300,000 pieces of steel were assembled into 94 “blocks” off the dry dock, which were then stacked and welded together to complete the hull and superstructure.