Sunday, 13 May 2012

What kind of help may I receive for mild or moderate B.I.?

“A conservative estimate is that over 4000 people a year have traumatic brain injuries. (That doesn’t include “acquired” injuries such as those resulting from complications during surgery.) Of these, about 51% are eligible for funding through ICBC, WCB or extended or private coverage.  However, some settlements provide for finite amounts of money that may run out.  An alarming 49% of victims are left financially unprotected.” [Restoring Hope, Dr. John A. Higenbottam, CHE, Registered Psychologist,  March 1994]

This study commissioned for the Provincial Government of B.C.
ICBC …….Insurance Corporation of British Columbia
WCB……..Workers Compensation Board

I fell into the no coverage category because I suffered from an acquired brain injury. (ABI)  The most astounding lesson I have learned about moderate or mild brain injury is the apathy given by the medical community in general. The answer to the question of what kind of help can I expect from a mild or moderate brain injury in the year 2012 is simply this, very little or none.  The present excuse will naturally be the fact that the hospitals and medical staff are over worked or understaffed however, since 1977 it has been the same lament and the real culprit is lack of education.  The medical community fails to act on incorporating into the training regime anything at all that will make doctors and nurses alike, aware of the potential for brain injury to exist beyond the first 24 hours post trauma.  The nurse will advise you when a concussion occurs, to wake the patient up every 2 hours for the first night and if he/she does, all is right with the world.  No one asks the caregiver to test the head injured for cognitive responses or to go to a neuro-psychologist for complete testing to determine the extent of the mild head trauma.  The argument boils down to dollars and sense.  It is common sense not to burden the already taxed medical structure with what might be an over reaction by the caregiver when a slight concussion has occurred.  It is common sense that we do not burden an already taxed system with unnecessary tests especially when there are more serious trauma patients standing in line up for the same tests.
There are solutions however there is no quick fix.  Minds have to be changed. Procedures need to be implemented.  At present, 90% of all brain injuries are avoidable.  Awareness and education need to be increased substantially for this to have a positive result.  It has been demonstrated with the advent of the recent bicycle helmet law that has witnessed a reduction in brain injury.  At 1 Billion dollars expected to be spent treating brain injury at all levels, common sense dictates that a reduction of all avoidable brain injuries would go a long way is reducing costs.  From this saving additional funds could be moved into education and into tertiary care facilities where testing for all mild brain injuries could occur saving countless millions later on down the road..
If we reduced brain injury by 10%, that would reduce the statistics from 90% avoidable down to 80 percent and equal to a 100 million dollar reduction in cost which would be more than sufficient to fund rehabilitation and education simultaneously.
John Simpson, studied the male prison population in B.C. and arrived at a 90% rate of those studied of having suffered from multiple brain injuries.  A study of death row inmates in California discovered a 100% rate of multiple brain injuries.  As I pointed in earlier statements, the cycle of brain injury equals divorce, drug and alcohol abuse equals incarceration could be avoided and reducing the amount of inmates would further go to increasing funds for proper medical coverage.  

Several studies have indicated that brain injury and crime go hand in hand yet little is being done to remedy this problem.  I still feel an ounce of prevention would go a long way in saving countless millions of dollars in housing through incarceration if proper attention to initial brain injury assessment and follow up rehabilitation were initiated immediately after the first trauma to the brain.
In Canada the average cost in 1997/98 are listed below.  A staggering $51,202.00 will be spent per inmate in 97/98.
If John Simpson’s study is correct or even we were to cut his estimate in half it would result in a mammoth saving to the tax payer of in excess of $934,851 million dollars annually.
Table: Operational costs for adult correctional services
costs Federal
costs Total costs
dollars) Total costs
  $'000 $'000 $'000 $'000

1993/94 881,988 996,904 1,878,892 1,878,892
1994/95 913,250 980,280 1,893,530 1,885,948
1995/96 948,887 970,041 1,918,928 1,871,221
1996/97 970,289 998,264 1,968,553 1,886,777
1997/98 1,028,029 1,049,418 2,077,447 1,964,559

Federal operating expenses reached $1.0 billion in 1997/98, a 10.3% increase from 1993/94 when adjusted for inflation. Provincial and territorial governments spent just under $1.1 billion in 1997/98, down 0.4% when adjusted for inflation.
Provincial/territorial governments spent an average of $43,734 on each inmate in their jail systems in 1997/98, up from $40,562 the previous year. The average cost for inmates in federal penitentiaries was considerably higher at $51,202, up from $48,078.

Neuropsychiatric, psychoeducational, and family characteristics of 14 juveniles condemned to death in the United States
DO Lewis, JH Pincus, B Bard, E Richardson, LS Prichep, M Feldman and C Yeager
Department of Psychiatry, New York University Medical Center, NY 10016.
“Of the 37 juveniles currently condemned to death in the United States, all of the 14 incarcerated in four states received comprehensive psychiatric, neurological, neuropsychological, and educational evaluations. Nine had major neurological impairment, seven suffered psychotic disorders antedating incarceration, seven evidenced significant organic dysfunction on neuropsychological testing, and only two had full-scale IQ scores above 90. Twelve had been brutally physically abused, and five had been sodomized by relatives. For a variety of reasons the subjects' vulnerabilities were not recognized at the time of trial or sentencing, when they could have been used for purposes of mitigation.”

Why is this so important with regards to brain injury?  There is a systemic problem with identifying the adverse affects on the population with regards to our diagnosis and long term treatment of those with brain injuries and more so with regards to minor and moderate forms of it.  At present the ball is solely in the hands of the care giver who is likely unaware, poorly informed and overwhelmed by emotional and financial hardships that are about to unfold.  This is the reason for this book.  It will prepare you the caregiver with the tools you will need to break down the barriers and reduce the frustration you will face when dealing with a brain injured relative.  I hope in the end to create political zealots who will rise to the occasion and en masse motivate the powers to be to invest more funds and re-educate the medical community in whatever country you presently live in.  If Aids can usurp millions of dollars in research then Brain Injury which affects thousands more people should be able to earn a respectable place in the minds of others.  There are sports legends, actors and actresses who have either suffered brain injuries or have a loved one who has that can add their name to the cause to change the minds of the leaders as to the importance of early diagnosis and treatment.
Education will save lives and money.  Victims of violent crimes may be saved the pain and suffering or even their lives if intervention occurred immediately after the trauma was diagnosed.  A brain injured person is twice as likely to suffer a second brain injury before a non-brain injured person suffers their first.

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