Monday, December 10, 2018

Sarah Lustig Details Life Care Plan at Center of $20M Verdict in TBI Trial

The Trial: Khan v. Moore Freight Service, a damages-only, 2016 Georgia trial over catastrophic brain damage a man suffered in a collision with a tractor-trailer.

The Expert: Sarah Lustig, a life care planner based in South Carolina, highlights and explains her recommendations in the life care plan she completed.

The Verdict: $20 million.


By Gary F. Gansar, MD, FACS; Senior Medical Director, AMFS

 

This 2016 Georgia trial on damages concerns the impact of catastrophic brain damage on a man injured in a collision with a tractor trailer. Our expert was called to discuss the patient’s needs and their costs for the remainder of his life. Sarah Lustig, a South Carolina-based certified nurse life care planner, highlights and explains her recommendations in the life care plan she devised.

Life care plans, documents that offer organized, detailed plans for catastrophic accident victims’ future needs, often form the centerpiece of a claim for damages in cases such as this, where the patient is expected to need care for the rest of his life.

In this portion of testimony, Lustig first estimates the cost of a neurologist, which the patient would need to see at least once a year, by averaging the CPT charge codes for office visits from two neurologists to project that future expense. Emergency room visits would be necessary in the future due to the extent of the patient’s injury and the resultant dysfunction that will inevitably lead to these visits. Lustig provides jurors with common examples that may bring the patient to the ER during his life, including skin ulceration from lack of sensation, aspiration episodes due to dysphagia and dysarthria, falls, infections, and pneumonia.

Lustig notes that the patient’s only current prescription medication is an antispasmodic and muscle relaxer that will continue to be given throughout his lifetime due to the left-sided paralysis that causes muscle contracture and spontaneous spasms. Thus, that medication is factored into the plan.

Turning to her conclusions on therapy, the life care planning expert explains to the jury the necessity for, and difference between, physical therapy and occupational therapy. Both are used to prevent further deterioration of the patient’s physical abilities, but a physical therapist would help the patient with his overall strength and endurance, while an occupational therapist would train the patient to perform the activities of daily living. Lustig estimates that he would have these therapies once a week on average in the future, even though he presently attended sessions three times a week. Lustig explains this apparent discrepancy by noting that patients receiving chronic therapy frequently cancel appointments and that caretakers at home would ordinarily be trained to perform exercises with the patient, so that once a week is a customary estimate.

In addition to therapy, Lustig notes the patient will need a range of equipment to assist him in the future. Lustig explains that the plaintiff’s family now performs the functions of otherwise necessary “durable medical equipment,”—completing lifts and transfers, for example—but that is not a reasonable expectation for the rest of his life. Specialized equipment needs to be purchased; otherwise there is a high risk of his falling or being dropped. She also recommends a device that would assist in placing the patient in a standing position so he can be more mobile.

Beyond medical equipment, Lustig anticipates that the patient will require personal assistance 24 hours a day, seven days a week, for the rest of his life, and this requirement can be met by a patient care assistant. This caretaker will help with the activities of daily living, assist with safety issues, provide transportation for the patient, and obtain supplies and medications. The anticipated cost for this help is $17/hr.

Additionally, Lustig concludes a licensed practical nurse should be used for medication management. This is something that the patient care assistant is not qualified for or allowed to do. Further, Lustig says the patient will need a case manager who oversees the equipment, keeps up with the home health needs, and coordinates office visits for the patient. The expert anticipates one visit every two weeks by an RN case manager.

When questioned as to why the family members who are currently taking care of the severely injured patient cannot be relied upon to continue to perform these functions, Lustig explains that the nationally accepted standard for Life Care Planners is not to factor in family members for constant support since such support typically proves unreliable. Such disruptions in the patient’s care can be disastrous, Lustig explains, so Life Care Planners budget for consistent, professional management.

Ultimately Lustig’s input was an integral part of the jury’s $20 million verdict.

 

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Gary Gansar, MD, is residency trained and Board Certified in General Surgery. He previously served as Chief of Surgery and Staff at Elmwood Medical Center and on the Medical Executive Committee at Mercy Hospital and Touro Infirmary in New Orleans, LA. Dr. Gansar also served as Clinical Instructor and Professor of Surgery at Tulane University. He received his MD and served as Chief Resident at Tulane University Medical School. Dr. Gansar joined AMFS as a consulting medical expert in 2011 and has served as Medical Director since Nov. 2015. In this capacity, Dr. Gansar provides consultation, review and guidance to attorney clients.