Oakes and Oakes
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Oakes and Oakes Consulting |
Catastrophic ManagementandLife Care PlanningLife care planning serves as a patient care road map for catastrophically-injured people. Life care planning also helps plan escrow accounts or damage claims. Here is a typical process in life care planning. LIFE CARE PLANNING PROCESS
2. Interview client and/or family 3. Compile medical chronology 4. Contact medical care providers 5. Gather expense information 6. Gather statistical data 7. Gather relevant medical literature 8. Complete preliminary life care plan and financial charts 9. Discuss life plan with client and/or family 10. Discuss life care plan with treating physician 11. Adjust life care plan, as needed, from discussions 12. Collect final expense data and complete financial charts 13. Write vocational evaluation report, if applicable 14. Prepare final life care plan 15. Prepare life care plan discussion rationale 16. Obtain treating doctor's medical orders for final plan 17. Deposition or courtroom testimony, if necessary 18. Continued case management, if necessary
MEDICAL COSTS MINI-PLAN Sometimes the disabled client doesn't need a comprehensive life care plan because their injuries aren't so severe. However, they may have lifetime or long-term medical expenses that should be taken into account before lawyers can settle, mediate or litigate their case. For example, amputees who need period artificial limb replacement, total knee replacement patients who must have repeat TKRs, or any patient facing future surgery. In such a situation, a medical cost mini-plan so the economist can calculate lifetime costs is helpful. The mini-plan is less time-intensive than a life care plan, but provides useful factual information for settlement, mediation or litigation.
CATASTROPHIC CASE MANAGEMENT We provide catastrophic case management services, both before and after litigation is completed. Case management before litigation helps relieve family stress by coordinating medical care and helping families and attorneys weigh care options. After litigation, case management helps keep the life care plan on track, when families need help. Sample tasks include: Accessibility Contractor Management Accessible Design Catastrophic Technical Services (see below) Coordinate Care Discuss Care Options with Patient and Family Identify Resources for Patient and Family Manage Care Providers Meet with Treating Physicians Meet with Paramedical Treatment Team Obtain Medical Orders Research Causation Issues Translate lawyer-to-doctor and doctor-to-lawyer Vehicle Design and Procurement Vocational Planning, If Appropriate
CATASTROPHIC TECHNICAL SERVICESAccessibility Alternatives Accessibility Analysis ADA Accessibility Blueprint Review and Analysis Case File Review Computer Needs Analysis Computer Technology Acquisition Construction Bid Analysis Contractor Negotiations (with attorney) Coordinate Construction Schedule Construction Cost Analysis Courtroom or Hearing Testimony Final Construction Inspection Find Local Contractor Home Site Inspection Identify Technical Resources Initial Construction Inspection Internet Database Research Locate Durable Medical Equipment and Supplies Low Tech Engineering Obtain Construction Bids Plan Review and Analysis Preliminary Accessible Design Procurement and Purchasing Safety Analysis Second Opinion Site Evaluation and Recommendations Telecommunication Analysis & Procurement Transportation Alternatives Transportation Analysis Transportation Bids Written Recommendations Other Services By Request Oakes & Oakes Barry and Marilyn OakesP.O. Box 672275 Atlanta, Ga. 30006 404.627.2004 Fax:: 404.506.9067 email: marilyn@oakes.org ( or ) barry@oakes.org
Oakes & Oakes Barry & Marilyn Oakes P.O. Box 672275 Atlanta, Ga. 30006 404.627.2004 Fax:: 404.506.9067 E-mail: marilyn@oakes.org ( or ) barry@oakes.org Web Site: http://www.oakes.org ***Rehabilitation and Industrial Safety Consultation*** Marilyn T. Oakes, CRC, LPC Certified Pain Practitioner Barry L. Oakes, BSIE
SAMPLE LIFE CARE PLAN EXHIBIT LIST Cover letter A - Marilyn Oakes' resume B - Barry Oakes' resume C - Brief medical chronology D - Signed orders from Dr. Jones (not attached) E - Life care plan discussion F - Life care expenditure charts (not all are attached) G - Housing Analysis H - Photographs (not attached) I - Condominium floor plans (not attached) J - Vocational Evaluation Report K - Bibliography Also enclosed: sample letter requesting medical orders from treating physician, proposed medical orders, Life Care Planning process.
Cover Letter Oakes & Oakes Barry & Marilyn Oakes P.O. Box 672275 Atlanta, Ga. 30006 404.627.2004 Fax:: 404.506.9067 ***Rehabilitation and Industrial Safety Consultation*** Marilyn T. Oakes, CRC, LPC Barry L. Oakes, BSIE
October 10, 1996 RE: ***** ***** DOB: 7-27-43 SSN: 111-22-3333
TO WHOM IT MAY CONCERN:
Rehabilitation Consultants, Inc. was retained by Lee, Davis & Benjamin, LLC to write a life care plan for Mr. ***** *****. Resumes of Marilyn T. Oakes and Barry L. Oakes are attached as Exhibit "A" and Exhibit "B". All work on this life care plan was done by Marilyn and Barry Oakes.
Mr. ***** sustained a catastrophic injury on September 7, 1995 after which he underwent aortic resection. Secondary to his aortic resection, he has been diagnosed with T-12 complete paraplegia. His physicians expect no further motor or neurologic recovery and they expect Mr. ***** to use a wheelchair the rest of his life.
For the life care plan, we analyzed Mr. *****'s vocational disability, potential for vocational rehabilitation, housing accessibility, transportation needs and medical needs. We interviewed the *****s, photographed both residences, and read Mr. *****'s medical records. For more detailed medical records information, please see the brief medical chronology, attached as Exhibit "C". We consulted published spinal cord injury resources, consulted accepted industry standards on wheelchair accessibility and safety, and contacted his Beach City physician, Dr. Smith. When considering medical needs, we estimated medical, pharmacy, psychological, and paramedical services, and disposable and durable medical supplies based on standard care for similarly-situated spinal-cord injured people. Where possible, we compiled cost data from services and personnel involved in Mr. *****'s care now. When actual cost data was not available, we used representative data from local, regional, and national sources. In several instances, we listed ranges of cost data from low to high. Because Mr. ***** lacks direct personal access to volume discounts and negotiated rates, we considered only cost data from sources that Mr. ***** can utilize directly. When collecting contractor costs, we considered established vendors and businesses working statewide. All costs
RE: ***** ***** October 10, 1996 page two shown are current estimates. Items requiring less than yearly replacement (e.g., wheelchair-accessible vehicle, wheelchairs) are amortized yearly over the manufacturer's suggested life of the item. All costs are 1996 dollars, except where indicated. We did no lifetime extrapolations, did not include inflation, and we did not reduce lifetime costs to present value. After compiling vocational, housing, transportation, and medical needs data, we submitted the life care plan and proposed medical orders to Dr. Joseph Smith, one of Mr. *****'s treating physicians. Dr. Smith signed medical orders for all items on the life care plan, attached as Exhibit "D". Exhibit "E" is the Life Care Plan Discussion and Exhibit "F" is the Life Care Plan Expenditure data accompanying Exhibit "E". Please note that item numbers on Exhibit "D", Exhibit "E" and Exhibit "F" correlate. Exhibit "F-2" itemizes Mr. *****'s individual medicine, supply, and equipment costs. Please note that expenditure items #3, 12, and 14 are summaries of numerous products. Per-product costs for #3, 12, and 14 are available upon request. Exhibit "G" is the housing analysis for both Mr. *****'s travel trailer and his condominium, Exhibit "H" is a set of 22 photographs illustrating accessibility problems now, and Exhibit "I" is the condominium floorplan. Exhibit "J" is the vocational evaluation report. Exhibit "K" is the bibliography. We did not include in our calculations medical complications greater than average or the cost of selling the *****s' condominium and buying a new or replacement unit. We did not include volume or negotiated discounts and would be glad to recalculate costs if volume or negotiated discounts were guaranteed to Mr. ***** for life. We calculated one-time costs, those items and services that must be done now and probably won't require replacing. Examples include housing accommodations, durable medical equipment, initial evaluations (which usually cost more than routine visits), CB or HAM radio for telecommunications, housing assessment and vocational evaluation. The largest cost are housing accommodations. Within a reasonable degree of certainty, Mr. *****'s current one-time costs range from **** to **** if his present residences are made accessible. The main numeric differences depend on which suppliers and methods the *****s select. Moving to a one-floor accessible condominium would change these numbers, as would selling the *****s' three-story condominium and purchasing a unit constructed
RE: ***** ***** October 10, 1996 page three
for accessibility. The changes would depend on the specific unit, and we will be glad to supplement our calculations should such a move occur. We calculated yearly costs of products and services Mr. ***** will need routinely. Examples include attendant care, skilled nursing care, medicine, doctor visits, physical therapy and occupational therapy services to maintain range of motion and decrease complications, accessible transportation, disposable medical equipment, durable medical equipment. Within a reasonable degree of certainty, Mr. *****'s estimated yearly costs range from *** to ***. The largest cost variables are how much attendant care time and how much skilled nursing care Mr. ***** needs as he ages. Typically, spinal cord injured persons need more skilled nursing care as they age. Most likely, Mr. ***** will be on an upward sliding scale from *** to ***. If he stays relatively healthy and active, then his costs will be toward the lower end of the range. If he has increased medical problems, then his costs will be toward the upper end of the range. Please call if you have questions. I hope this information is helpful.
Yours very truly,
Marilyn T. Oakes, CRC Barry L. Oakes, BSIE Licensed Professional Counselor Industrial Safety Consultant
EXHIBIT A - MARILYN OAKES' RESUME NOT INCLUDED IN SAMPLE; AVAILABLE UPON REQUEST
EXHIBIT B - BARRY OAKES' RESUME NOT INCLUDED IN SAMPLE; AVAILABLE UPON REQUEST
EXHIBIT C BRIEF MEDICAL CHRONOLOGY - ***** ***** COMPILED BY MARILYN T. OAKES, CRC THROUGH SEPTEMBER 1996 9-7-95 Date of accident, admitted to Herbert Hoover Memorial Hospital, South Shore, Mississippi. Stabilized in emergency room by Dr. Jimmy Kirk, emergency medicine, evaluated by Dr. Sam Sams, diagnostic radiology, and transferred by medical emergency helicopter to the Regional Medical Center of Metropolis. Admitted to Regional Medical Center of Metropolis through the Trauma Center. Thoracic aortagram (Drs. Bleu and White.) Chest, cervical, thoracolumbar x-rays. Head CT scan. Blood and lab tests. IV meds and IV nutrition. Admitting diagnosis: Post traumatic pseudoaneurysm of the thoracic aorta. 9-8-95 Aorta repair, Drs. Crutcher, McCoy & Bashear. Urology consult, Dr. John Harlan Laws. Pulmonology consult, Dr. Miranda Breathitt. Orthopedic consult, Dr. Brereton Jones. Cardiothoracic notes no motor function. Lordotic, cervical spine, and pelvis x-rays. Portable chest x-ray. Surgical pathology report: aorta segment with extensive acute hemorrhage in the adventitia and focal mural laceration. Blood and lab tests. IV meds and IV nutrition. 9-9-95 No motor or neuro activity in lower extremities, Trauma service. Gastroenterology consult. Cardiothoracic visit. Orthopedic visit. Portable chest x-ray. Blood and lab tests. IV meds and IV nutrition. 9-10-95 Gastroenterology visit. Cardiothoracic visit. Orthopedic visit. Portable chest x-ray. Blood and lab tests. IV meds and IV nutrition. 9-11-95 Left femur fracture repair and intramedullary nailing, Drs. Bunning & Johnston. Orthopedic visit. No movement in lower extremities, Trauma service visit. Cardiothoracic visit. Gastroenterology visit. N & R visit. AP & lateral x-rays. MRI - no cord lesion but cord ischemia or infarct most compatible diagnosis. Fluoroscopy for left femoral nailing. Portable chest x-ray. Respiratory therapy. Blood and lab tests. IV meds and IV nutrition. 9-12-95 Cardiothoracic visit. N & R visit. Gastroenterology visit. Orthopedic visit. Pulmonary visit. Portable chest and left femur x-rays. Respiratory therapy. Blood and lab tests. IV meds and IV nutrition.
***** Chronology page two 9-13-95 Trauma service visit. Orthopedic visit. Cardiothoracic visit. Neurological unchanged. Thoracic spine MRI showed spinal cord ischemia. Neurology consult. Nutrition assessment. HIA consult, Dr. A. Lundberg. Chest and abdomen x-rays. Portable chest x-ray x 3. Lumbar and thoracic spine CTs. Respiratory therapy. Blood and lab tests. IV meds and IV nutrition. 9-14-95 Drs. Angel, Herald, & Hark surgically installed Greenfield vena cava filter at L2-3 interspace via the right femoral vein. Trauma service visit. Neurology unchanged. Physical therapy consult. Portable chest x-ray. Fluoroscopy for Greenfield filter placement. Respiratory therapy. Blood and lab tests. IV meds and IV nutrition. 9-15-95 Cardiovascular visit. Orthopedic visit. Nutrition visit. Dr. Raphael transferred patient to Methodist Hospital for spinal cord care. Respiratory therapy. Blood and lab tests. IV meds and IV nutrition. Discharge Diagnosis: aortic tear and graft repair, L2-3 transverse process fractures, left femur fracture, minimal wedge compression fractures at T-10 and T-11. Admitted to Methodist Hospital of Metropolis to Dr. Jefferson's service. Admitting diagnosis: multiple trauma with paraplegia secondary to infarction of the cord. Attending physician consult. Cardiothoracic, gastroenterology, internal medicine, orthopedic consults ordered. PCA morphine pump for pain. 9-16-95 Internal medicine consult. Portable chest x-ray. Attending physician visit. Gastroenterology consult, okay to take food by mouth. Respiratory therapy. 9-17-95 Nutrition consult. Attending physician visit. Medicine visit. Respiratory therapy. 9-18-95 Thoracic consult. Nutrition visit. Radiology film review. Thoracic MRI. Orthopedic consult. Range of motion exercises ordered for Physical and Occupational Therapy. Left femur x-ray. Attending physician visit. Respiratory therapy. 9-19-95 Nutrition visit. Radiology consult. Orthopedic consult. Physical therapy consult. Gastrointestinal consult. Skin care nurse consult. Attending physician visit. Respiratory therapy.
***** Chronology page three 9-20-95 Nutrition visit. PCA pump discontinued. Central IV line discontinued. Internal medicine visit. Orthopedic visit. Attending physician visit. 9-21-95 Thoracic visit. Attending physician visit. Preparations made for rehabilitation transfer. Orthopedic visit. Poor outlook for spinal cord injury. Physical therapy visit. 9-22-95 Thoracic visit. Orthopedic visit. Attending physician visit. Pain increased. A/P & lateral cervical spine x-rays. 9-23-95 Thoracic visit. Attending physician visit. Internal medicine visit. Orthopedic visit. 9-24-95 Attending physician visit. Physical medicine and rehab consult requested. 9-25-95 Attending physician visit. Physical medicine & rehab consult. 9-26-95 Transferred to HealthSouth Rehabilitation Hospital for acute-phase spinal cord rehabilitation. Rehab medicine visit and orders. Posterior tibial evoked potentials. 9-27-95 Physical therapy and occupational therapy evaluations. Psychological evaluation. Recreation therapy evaluation. Nutrition therapy. Rehab medicine visit. Blood and lab work. Thyroid studies. 9-28-95 Rehab medicine visit. Physical therapy. Occupational therapy. Recreation therapy. 9-29-95 Psychological evaluation completed. Nutrition therapy. Rehab medicine visit. Physical therapy. Occupational therapy. Recreation therapy. 9-30-95 Rehab medicine visit. Physical therapy. Occupational therapy. 10-2-95 Rehab medicine visit. Physical therapy. Occupational therapy. 10-3-95 Rehab medicine visit. Enterostomal therapy. Orthopedic consult. Physical therapy. Occupational therapy. 10-4-95 Rehab medicine visit. Orthopedic visit. Thoracic and lumbar spine, left wrist x-rays. Treatment team staffing. Physical therapy. Occupational therapy.
***** Chronology page four 10-5-95 Rehab medicine visit. Orthopedic consult for possible left carpal bone fracture, thumb spica applied by OT. Physical therapy. Occupational therapy. 10-6-95 Rehab medicine visit. Nutrition therapy. Orthopedic visit. Physical therapy. Occupational therapy. 10-7-95 Rehab medicine visit. Enterostomal therapy. Physical therapy. Occupational therapy. 10-8-95 Portable KUB of abdomen to rule out obstruction, radiology consult; dilated loops of stool in large/small intestines. 10-9-95 Rehab medicine visit. Abdomen AP x-rays. Physical therapy. Occupational therapy. 10-10-95 Rehab medicine visit. Portable KUB abdomen. Physical therapy. Occupational therapy. 10-11-95 Treatment team staffing. Physical therapy. Occupational therapy. Recreation therapy. 10-12-95 Thumb spica applied. Family conference, requested better pain relief prior to therapy. Rehab medicine visit. Physical therapy. Occupational therapy. 10-13-95 Enterostomal therapy. Rehab medicine visit. Physical therapy. Occupational therapy. Recreation therapy. 10-14-95 Rehab medicine visit. Physical therapy. Occupational therapy. 10-16-95 Rehab medicine visit. Nutrition visit. Physical therapy. Occupational therapy. Recreation therapy. 10-17-95 Rehab medicine visit. Physical therapy. Occupational therapy. 10-18-95 Treatment team staffing. Physical therapy. Occupational therapy. 10-19-95 Rehab medicine visit. Physical therapy. Occupational therapy. 10-20-95 Rehab medicine visit. Physical therapy. Occupational therapy. 10-21-95 Ophthalmic consult for right eye vision. Rehab medicine visit. Physical therapy. Occupational therapy.
***** Chronology page five 10-22-95 Enterostomal therapy. 10-23-95 Ophthalmic consult. Physical therapy. Occupational therapy. 10-24-95 Rehab medicine visit. Physical therapy. Occupational therapy. 10-25-95 Treatment team staffing. Discharge 11-3-95. Blood and lab work. Physical therapy. Occupational therapy. 10-26-95 Rehab medicine visit. Physical therapy. Occupational therapy. 10-27-95 Rehab medicine visit. Urology consult. Urological tests: urodynamics, CMG/EMG, flow/EMG/residual. Physical therapy. Occupational therapy. 10-28-95 Rehab medicine visit. Blood and lab work. Physical therapy. Occupational therapy. 10-30-95 Rehab medicine visit. Blood and lab work. Physical therapy. Occupational therapy. 10-31-95 Rehab medicine visit. Urology visit. Physical therapy. Occupational therapy. 11-1-95 Endocrinology consult. Treatment Team staffing. Sexuality counseling. Blood and lab work. Physical therapy. Occupational therapy. 11-2-95 Rehab medicine visit. Physical therapy. Occupational therapy. 11-3-95 Rehabilitation therapy visit. Physical therapy. Occupational therapy. Patient discharged from HealthSouth Hospital in Metropolis. 11-21-95 Office visit, Dr. Van Buren, Savannah, Tennessee. 11-30-95 Office note, Dr. Van Buren. 11-22-95 Office note, Dr. Van Buren. 1-5-96 Office visit and urinalysis, Dr. Van Buren. 1-18-96 Return to work slip for desk job, 4 - 6 hours daily and increase time as tolerated, Dr. Jefferson. 1-19-96 Clinic visit, Dr. Jefferson. MMI from spinal cord injury. 1-31-96 Disability paperwork completed by Dr. Van Buren, "Patient confined to wheelchair indefinite."
***** Chronology page six 2-5-96 Office visit and urinalysis, Dr. Van Buren. 2-12-96 Impairment rating, Dr. Jefferson, 75% neurological impairment. Orthopedic visit, Dr. Jackson. Return to sedentary work. 2-16-96 Office visit, Dr. Van Buren. 2-19-96 Office note, Dr. Van Buren. 2-26-96 Office note, Dr. Van Buren. 3-19-96 Office visit, Dr. Van Buren. 4-29-96 Urinalysis, Dr. Van Buren. 5-13-96 Office note, Dr. Van Buren. 5-29-96 Prescription for lifting apparatus to get patient to upstairs level of home, Dr. Jefferson. 6-3-96 Office note, Dr. Van Buren. 6-15-96 Urinalysis and culture, Stonewall County Hospital. Office note, Dr. Van Buren. (Patient says he didn't have an approved workers' compensation treating physician in Ocean City from the time of his move in late June 1996 until September 1996.) 9-17-96 Admitted to Sacred Heart Hospital, Ocean City with non-occlusive thrombus right common femoral vein. Admitted by Dr. George Washington, orthopedics. 9-26-96 Discharged from Sacred Heart Hospital by Dr. George Washington. 9/96 Consultations in Ocean City, Joseph Jones, M.D., John Adams, M.D. and George Washington, M.D.
EXHIBIT D - PHYSICIAN'S SIGNED ORDERS
NOT INCLUDED IN SAMPLE
EXHIBIT E Oakes & Oakes Barry & Marilyn Oakes P.O. Box 672275 Atlanta, Ga. 30006 404.627.2004 Fax:: 404.506.9067 ***Rehabilitation and Industrial Safety Consultation*** Marilyn T. Oakes, CRC, LPC Barry L. Oakes, BSIE
LIFE CARE PLAN DISCUSSION - ***** *****
ITEM #1 To monitor and update medical condition to prevent complications, regulate blood pressure, and detect abnormal clotting activity at graft site: quarterly visits with internal or family medicine physician; monthly prothrombin time tests while taking Coumadin; annual physical medicine and rehabilitation physician evaluation. RATIONALE: Individuals who sustain catastrophic injury require lifetime medical monitoring, even after reaching maximum medical improvement (MMI). True MMI, where no additional change occurs, is rare in catastrophic injury. A more descriptive idea is medical stability, rather than MMI. As individuals age, medical changes occur that affect stability of the injury and resulting chronic conditions. Monitoring Mr. ***** on a quarterly basis to maintain medical stability is prudent. In addition, he needs to be evaluated by a rehabilitation medicine physician annually. The ideal setting for evaluation is annual hospitalization. ITEM #2 Specialty physician consultations, as needed, such as urologic, sexual function, and podiatric, and if needed, cardiac. His treating urologists are Martin & Jones, Beach City. He does not have a cardiologist or podiatrist in Beach City now. Drs. Martin and Jones provide sexual treatment and counseling for SCI survivors and spouses. RATIONALE: Mr. ***** has had five urinary infections since his injury. Reasonably, he can be expected to continue having infections. He needs annual renal function studies to prevent further damage and complications. Mr. ***** sustained significant injuries on September 7, 1995. He will need specialty consultation throughout his life. If he has complications from his aortic transection surgery, such as elevated blood pressure or clots at the graft site, then Mr. ***** may need additional cardiology evaluations. Mr. and Mrs. ***** had little sexual instruction at the rehabilitation hospital. Mr. ***** needs medical sex therapy and the couple needs sexual counseling. Both medical and counseling services are available through Dr. Jones's office.
LIFE CARE PLAN RE: ***** ***** PAGE TWO Mr. ***** will need podiatric care throughout his life, to reduce nail infections, ingrown toenails, and maintain foot health. ITEM #3 Prescription medications, as ordered by his treating physicians. RATIONALE: Mr. ***** will need prescription medicine the rest of his life because of his catastrophic injury. ITEM #4 Annual rehabilitation hospitalization RATIONALE: Individuals who survive spinal cord injury ideally should enter the hospital yearly for thorough examination, including MRI, even if complications do not require hospitalization. The purpose of annual hospitalization is to detect and prevent expected complications of SCI, such as bone loss, demineralization, decubitus ulcer, contractures, urinary tract infection, deep vein thrombosis, circulatory system problems, bowel and bladder problems, and syringomyelia. Prevention is cheaper than treatment and failing to prevent complications results in longer, more costly hospitalizations. Prevention is better for the injured person. ITEM #5 Home health care and attendant services four to eight hours daily, seven days weekly. RATIONALE: Expecting a spouse to provide continuous care of a catastrophically-injured person is too difficult and demanding. Such situation causes negative changes in the spousal relationship and contributes to family distress, family disintegration, burnout, economic difficulty, and divorce. Conversely, excluding the family from caring for the injured person is not a good situation, either. According to data from the Baylor University Department of Physical Medicine and Rehabilitation, the best system is combining outside care with family care. Hence, Mr. ***** would benefit from home health care and attendant services, initially four hours daily, seven days per week. Eventually, Mr. ***** will need more attendant care, to eight hours daily, at his and his wife's discretion. Because of Mr. *****'s physical size, Mrs. ***** needs assistance caring for him. Should something happen to Mrs. *****, then Mr. ***** would need additional assistance as he ages. Tasks for care attendants: assist Mr. *****'s bathing and change the bed; assist with home physical therapy and occupational therapy treatment; other care tasks, as indicated by physicians, PT and OT. ITEM #6 Monthly nursing supervision of home health care and attendant services. RATIONALE: Agency regulations require monthly supervision by a Registered Nurse.
LIFE CARE PLAN RE: ***** ***** PAGE THREE ITEM #7 Quarterly physical therapy evaluation visits for one year; after that, as ordered by treating physicians or annually. RATIONALE: Mr. ***** would benefit from structured home physical therapy, to improve and enhance physical functioning, to be provided by his care attendants. However, initially this would require professional physical therapy supervision and direction. He would be expected to reach maximum benefit from professional physical therapy intervention after one year; visits with the physical therapist after that would be on an annual or as-needed basis, as directed by the primary treated physician. ITEM #8 Quarterly occupational therapy evaluation visits for one year; after that, as ordered by treating physicians or annually. RATIONALE: Once Mr. ***** has an accessible environment, he would benefit from structured home occupational therapy to improve and enhance his self-care abilities, to be provided by his care attendants. However, initially this would require professional occupational therapy supervision and direction. He would be expected to reach maximum benefit from professional occupational therapy intervention after one year; visits with the occupational therapist after that would be on an annual or as-needed basis, as directed by the primary treated physician. ITEM #9 Daily physical and occupational therapy. RATIONALE: These activities maintain range of motion, decrease decubitus ulcers, prevent contractures, discourage demineralization and bone loss, and contribute to general health and quality of life for the injured person. The home health attendant can do these activities, under supervision of PT, OT, and RN. ITEM #10 Individual and family therapy psychological evaluation; family therapy weekly for three months; twice monthly for nine months with assessment of progress quarterly; after that, as needed. RATIONALE: Few life events affect the emotional quality of marital and family relations more than catastrophic injury. The injured person requires disability adjustment assistance; the family, and particularly the spouse, require disability adjustment assistance to appropriately re-integrate the family roles. Therapy can reduce the stress and negative emotional impact of catastrophic injury. Mrs. ***** has spoken of the stress that this situation has placed on her. Without doubt, Mr. *****'s change from being a robust, active man to being a chronic medical patient must have had a deleterious psychological effect on both Mr. and Mrs. *****.
LIFE CARE PLAN RE: ***** ***** PAGE FOUR ITEM #11 Wheelchairs RATIONALE: Mr. ***** is using an electric chair for his outside travel. He needs a backup manual chair for home use. ITEM #12 Supplies, as needed: disposable bed pads and undergarments, egg crate cushion, rubber gloves, disposable wipes, etc. RATIONALE: Mr. ***** will require disposable medical supplies all his life. ITEM #13 Extra firm mattress and box springs for double bed. RATIONALE: With the purchase of a medical king size mattress and box springs, Mr. ***** can return to the marital bed. Normalizing the marital relationship is important for psychological well-being after catastrophic injury. Sleeping in a hospital bed isn't the norm for most married people. ITEM #14 Durable medical equipment. RATIONALE: Mr. ***** will require durable medical equipment the rest of his life because of his catastrophic injury of September 7, 1995. ITEM #15 Engineering assessment of house for safety, accessibility and structural integrity secondary to the weight of the electric wheelchair. Specific recommendations are deferred to Barry Oakes, accessibility specialist. Mr. ***** needs housing modifications for accessibility. RATIONALE: Allowing the disabled person to live as independently as possible is the goal of wheelchair-accessible housing. Generally, a paraplegic can live relatively independently, given an accessible environment. When injured, Mr. ***** owned a travel trailer, his primary residence on the road for the construction company. He also owned a condo on Beach City Beach. The travel trailer must be replaced because that particular trailer cannot be accommodated for wheelchair-accessibility. Wheelchair-accessible travel trailer construction is workable when the trailer is initially designed accessible. However, once built, travel trailers do not lend themselves to wheelchair-accessible modification. For example, all inside walls on a travel trailer are support walls. Each support wall is strategically located or else the trailer cannot be towed continuously. A second example is that standard travel trailers are not designed to withstand the high footpounds-per-square-inch of an electric wheelchair. A third example is that because of the width limitations (eight feet maximum), the toilet, tub, bathroom sink, bedroom, and kitchen are
LIFE CARE PLAN RE: ***** ***** PAGE FIVE all inaccessible. These can't be accommodated because the support walls can't be moved. Mr. ***** can get in the front door using the lift, wheel to the foot of the bed, but can't transfer into bed from his wheelchair because he doesn't have space. If he is in the kitchen and wants to turn around, then he has to wheel to the living room to do so, again, for lack of space. Replacing the travel trailer is the only accessible option. The major condo modification is entrance/exit accessibility. The condo is a three-story building with ground floor entrance, with no acceptable means of reaching living quarters on the second and third floors. Mr. ***** now slides from his wheelchair to a step using a bathroom transfer chair. He then supports his body weight with his arms and physically hoists himself up one stair at a time. To exit, he does the same thing, bouncing from one stair to the next. Not only is this demeaning and inhumane, but is also dangerous. In case of fire, medical emergency, or any need to exit the premises quickly, Mr. ***** has no chance of getting out safely. Further, he is at great risk of slip and fall injury. Finding him temporary accessible quarters is a top safety priority. The second floor is the primary living area. The bathroom and kitchen are not accessible. The third floor is the bedroom area. The bedrooms are not accessible and he cannot get into bed from the side. Neither upstairs bathroom is accessible because of width. The condo could be made accessible. However, the cost of accommodations exceeds the cost of the unit. Because of the expense involved, a more cost-effective solution would be to purchase a one-floor condo. The best solution would be to locate new construction equivalent to Mr. *****'s condo and design the floor plans for wheelchair-accessibility. Designing for accessibility is always cheaper than renovation. Housing maintenance is beyond the capability of most people in wheelchairs. Wheelchairs cause accelerated wear and tear to floor coverings, resulting in accelerated replacement costs. Carpet, for example, wears about one-third faster from wheelchair use. The average carpet has life expectancy of about ten years, according to the National Carpet Institute. The average wheelchair user's home requires carpet replacement about every 6.67 years. Mr. ***** will need assistance with these items. ITEM #16 Wheelchair accessible van, maintenance, insurance, and communications. RATIONALE: Mobility is a significant issue for a person in a wheelchair. Mr. ***** can be expected to need transportation to medical appointments the rest of his life, because of his catastrophic injury of September 7, 1995.
LIFE CARE PLAN RE: ***** ***** PAGE SIX Vehicle maintenance is beyond the capability of most people in wheelchairs. In addition, because of his catastrophic injury, Mr. *****'s vehicle should be kept under warranty, including such items as towing and roadside assistance. He will need basic communication service, car telephone, ham radio, or CB radio. His vehicle should be replaced each five years, to avoid maintenance problems causing him to be stranded. All items are necessary because of his catastrophic injury of September 7, 1995. ITEM #17 Vocational rehabilitation assessment, to be completed by Marilyn T. Oakes, Certified Rehabilitation Counselor. Respectfully submitted,
Marilyn T. Oakes, CRC Licensed Professional Counselor
Barry L. Oakes, BSIE Industrial Safety Consultant
ABBREVIATED EXHIBIT F- FOR SAMPLE (EACH ITEM HAS ITS OWN CHART)
LIFE CARE PLAN EXPENDITURES FOR ***** ***** A/O 10/96
TOTAL ONE TIME COSTS : $193,600.50 - $206,854.50
TOTAL YEARLY COSTS: $81,350.13 - $144,634.16
LIFE CARE PLAN EXPENDITURES FOR ***** ***** A/O 10/96 **Item numbers correspond to items shown in Life Care Plan Discussion**
ABBREVIATED EXHIBIT F- FOR SAMPLE LIFE CARE PLAN EXPENDITURES FOR ***** ***** A/O 10/96
EXHIBIT G Oakes & Oakes Barry & Marilyn Oakes P.O. Box 672275 Atlanta, Ga. 30006 404.627.2004 Fax:: 404.506.9067 ***Rehabilitation and Industrial Safety Consultation*** Marilyn T. Oakes, CRC, LPC Barry L. Oakes, BSIE
October 10, 1996 Judah P. Benjamin, Esq. Lee, Davis & Benjamin, LLC 2000 Confederate Drive Metropolis, AL 35511
RE: ***** *****
Dear Judah: At your request, I evaluated accessibility of Mr. *****'s housing arrangements. Since he owned both a condominimum and a travel trailer when injured, I considered both dwellings. Both dwellings had many flaws and are not safe or adequate for the special needs of a paraplegic. Problems are the travel trailer are not fixable. The condominimum accommodations are so expensive that locating new construction and building for accessibility or purchasing an accessible one-floor condominium of equivalent value to Mr. *****'s condominium would be better solutions. As you may know, industry standards in wheelchair accessibility are articulated in the Americans with Disabilities Act. I read the insurance nurse's comments with interest. I don't believe she adequately covered accessibility issues. Please see my detailed comments, attached at Exhibit "G". I hope this information is helpful to you. Please call if you have questions. Yours very truly,
Barry L. Oakes, BSIE Safety Consultant
EXHIBIT G, continued Oakes & Oakes Barry & Marilyn Oakes P.O. Box 672275 Atlanta, Ga. 30006 404.627.2004 Fax:: 404.506.9067 ***Rehabilitation and Industrial Safety Consultation*** Marilyn T. Oakes, CRC, LPC Barry L. Oakes, BSIE
HOUSING ACCESSIBILITY ANALYSIS RE: ***** ***** DATE: October 10, 1996
ADDRESS: Route 1, Box 37, Alabama City, AL 37771 Description of unit: 1996 8' x 40' Breckenridge by Damon travel trailer, park model. Unit has one 3'x 6' bedroom slide-out and one 3' x 9' living room slide-out. ACCESSIBILITY PROBLEMS: 1. A sheet of plywood laying on the ground next to the trailer door is not the industry-standard approved path of travel. (See picture H-1). 2. The Mobile-Tech wheelchair lift is four inches wider than the trailer door and offset to the left. Mr. ***** must enter the from the extreme right side of the lift, off center. Off center entry puts all his weight on one side of the lift, causing excessive stress on the machinery. Eventually, the lift will break from structural wear and he will fall to the ground. (See picture H-1). 3. The rear-entrance door (top of the lift) is 28" wide, making it inaccessible under industry standards. The door is in an outside support wall and has a metal frame. The door cannot be widened without major structural modifications to the trailer. (See pictures H-1 and H-2). 4. The door by the lift goes into Mr. *****'s bedroom. Fully extended, the bedroom is as far as Mr. ***** can travel in the trailer. Bed to dresser measures 30", dresser to wall is 48", bed to door is 52", bed to wall is 12" on each side. He cannot make a pivoting turn in his wheelchair unless he has a minimum of 5' circle. Being confined to one's bedroom by space deficiency does not fit the industry definitions of accessibility. (See pictures H-1, H-3 and H-4). 5. A proper wheelchair transfer to bed is not possible in the available space. To get into bed, he backs his chair to the bed and Mrs. ***** manhandles him into place. This procedure is not acceptable and has already resulted in Mrs. ** hurting her back. (See pictures H-1, H-3,andH-4).
***** ***** Housing October 10, 1996 page two 6. Mr. ***** cannot use the main closet because of space deficiency. The only approach is straight-on and a wheelchair user has to approach a closet from the side so he can reach. Mr. *****'s arms aren't long enough, nor are any wheelchair user's arms, to use a closet from a straight on-approach. (See picture H-3.) The subsidiary closet is behind the bed. Mr. ***** cannot reach this closet because of deficient floor space. The trailer was too small to get a camera lens angle to photograph the subsidiary closet without special lenses. 7. Mr. ***** cannot use the dresser because of space deficiency. The only approach is wheelchair parallel to the front, which blocks the drawers. A wheelchair user has to approach a dresser parallel to the front but far enough away to open the drawers. (See picture H-3). A second problem is proximity of the dresser to the door. Now, the electric wheelchair charger plug-in and lift controls are hard-wired between the door and dresser. Even if the hard-wiring could be moved elsewhere, then six inches' space is not enough for accessibility and does not meet industry guidelines. (see picture H-3). 8. Storage drawers open outward from the wall. These drawers are built into the wall beside the bed opening out. He can't use these drawers because of space deficiency. (See picture H-3). 9. The door to the bathroom is 26 1/2" wide and is built into a support wall. The door cannot be widened to the minimum 36" set by industry standards without major structural renovations. Mr. *****'s chair is 30" wide. (See picture H-4). 10. Toilet does not meet industry specifications. Toilet lacks grab bars. Transfer from a wheelchair is normally done at 3/4 profile to the toilet back. The stand-alone toilet chair prohibits a 3/4 approach because of deficient space. The toilet chair is wedged between the support walls, which cannot be moved without major structural renovations. The *****s had to break part of the molding to wedge the chair into the space. For Mr. ***** to use the toilet, Mrs. ***** manhandles him out of his chair onto the toilet and then back. Lack of accessibility causes both of them to be greatly at-risk for injury. (See pictures H-5 and 6). 11. Bathtub does not meet industry accessibility guidelines and specifications. The bathtub measures 43"L x 22"W x 12"D oval. The distance from the vanity to the tub is 30", which does not allow a wheelchair transfer in the bathroom. The space is too small to get a tub transfer chair into the bathroom. For Mr. ***** to use the toilet, Mrs. *****
***** ***** Housing October 10, 1996 page three manhandles him out of his chair into the tub and then back. Lack of accessibility causes both of them to be greatly at-risk for injury. (See picture H-7). 12. Bathroom vanity is enclosed at the bottom and will not allow wheelchair approach, even if the bathroom had enough space. (See picture H-8). 13. Travel through the bathroom into the kitchen is impossible because the door is 26-1/2" wide. (See picture H-4). 14. Kitchen is inaccessible. Under-sink cabinets are closed in, preventing wheelchair approach. Over-sink cabinets are too high to reach, except bottom shelf. Refrigerator has freezer on top, making freezer too tall and inaccessible. Side-by-side is industry standard accessible refrigerator-freezer. Stove has closed-in front. Mr. ***** can't cook, wash dishes, or reach the freezer. (See picture H-10). 15. Living room is accessible and furniture is probably appropriate for transfers, if he could get through the doors and had a porch and ramp adjacent to the sliding glass doors. For emergency purposes, he should have two accessible entrances. He should be able to enter the living room from his bedroom without going outside. (See picture H-9). 16. The travel trailer had a smoke detector. However, the smoke detector was on the cabinet shelf and had not been installed. (See picture H-11). Fire extinguishers should be placed in the kitchen and bedroom, reachable from a wheelchair. 17. For front and back views of the trailer, see pictures H-12 and H-13. 18. This travel trailer lacks laundry facilities. Despite the Americans with Disabilities Act, commercial laundry facilities aren't always accessible. Clean clothes and good hygiene are essential for wheelchair users to minimize complications and infections. 19. A travel trailer is a nice idea for vacations. However, for a wheelchair user, a travel trailer without two accessible exits is very dangerous in case of emergency. A travel trailer should never be considered a permanent residence for a wheelchair user. Mobile electrical power should always be available for the electric wheelchair lift and electric wheelchair, in case of emergency, power outage, or other lack of available electricity. Hence, a 7500 watt mobile generator with autoelectric starter is mandatory for Mr. ***** to use any travel trailer. Any travel trailer he uses needs two wheelchair lifts, one at each exit, to ensure that he can exit the trailer in emergencies.
***** ***** Housing October 10, 1996 page four 20. Accommodation: none possible. Replace travel trailer with unit designed for wheelchair accessibility. ADDRESS: 1100 Beachside Drive Unit C-10 Ocean City, Florida 32561 Description of unit: three floor, 29'8" x 30'7" 2 bedroom, 2 1/2 bathroom condominium. Ground floor is for storage and garage, second floor is kitchen, 1/2 bathroom, living room, laundry room, and outside deck, third floor is master bedroom, guest bedroom, master bathroom, guest bathroom, and outside deck. ACCESSIBILITY PROBLEMS: 1. This condominimum is inaccessible, inappropriate, and dangerous for a wheelchair user. To enter the dwelling, Mr. ***** slides from his wheelchair onto a step and uses his hands and arms to power himself up the stairs, one step at a time. When exiting the dwelling, the reverses the processes and bounces down the stairs on his buttocks, using his hands and arms to steady himself. His entrance and exit strategies are the only ones available to him and are totally unacceptable in the industry. He is greatly at-risk for injury. (See picture H-14). Accommodation: Either an outside or an inside elevator could be installed to make this property entrance-accessible. If using outside elevators, then decks must be enclosed. If using inside elevator, then elevator will occupy space of stairway. 2. To get his wheelchair into the dwelling, Mrs. ***** must take his electric wheelchair apart and carry it up the stairs, one piece at a time. When Mr. ***** arrives inside the dwelling, he has a manual chair, too narrow for his large frame. He travels inside the condo by scooting on his toilet chair. He tried using a mechanic's creeper, but it would not roll on the carpet. His means of travel are the only ones available to him and are totally unacceptable in the industry. He is greatly at-risk for injury. (See pictures H-15, H-16 & H-22). Accommodation: If the condo were accessible and if he could safely get in and out, then a properly fitting wheelchair would be more appropriate than scooting on his toilet chair. 3. The kitchen on the second floor is inaccessible. Sink has a closed cabinet underneath, which won't allow access in a wheelchair. Stove has an oven underneath, which doesn't allow wheelchair access to cooking surface. Refrigerator has freezer on top, making freezer too tall and inaccessible. Side-by-side is industry standard accessible refrigerator-
***** ***** Housing October 10, 1996 page five freezer. Main cabinets are over the store, too high to reach from a wheelchair. (See picture H-17). Stove and sink should be opened for accessibility, stove should be divided into separate cook top and oven, cabinets should be lowered, pipes under sink should be padded, refrigerator-freezer should be changed to side-by-side. 4. The half bathroom on the second floor, being the only bathroom on the second floor, should be accessible. The half bathroom is 5' x 5', but because the door opens inward, all the floor space is not usable, making this room smaller than minimum industry standards of 5' x 5' usable floor space. The door is 24" wide. (See pictures H-17 and 18). Accommodation: Walls could be moved to enlarge usable space to 6' x 6'. Swinging the door outside would increase floor space. Reset the sink to the outside wall and add appropriate grab bars to allow wheelchair transfer from the side of the toilet. 4. If he could safely reach the living room on the second floor, then he would have good accessibility. His armchair is probably appropriate for transfers. He could use either an electric or a manual wheelchair at the dining room table. However, he can't reach the living room safely. Accommodation: none needed, if he could safely reach the living room. 5. In the guest bedroom, doors are 24" wide, too narrow into both the bedroom and the closet. To get to the bathroom, one must travel through the closet. The guest bathroom has 5' x 4'10" of usable space, not allowing room to transfer from a wheelchair. The sink is on one side of the toilet and a support wall is on the other side, next to the staircase. If the 4'2" x 9' guest closet were gutted and the space then incorporated into the guest bathroom, then this bathroom could be made accessible. However, such accommodation would decrease the value of the property. The closet in the guest bedroom is the major closet in the condo. Accommodation: Open outside closet and bedroom doors to 32", remove inside closet wall and bathroom door, move tub into the former closet, reset sink into former closet, and add appropriate grab bars. 6. The master bedroom has 24" door. Bathroom is 5'8" x 9'9" but with current layout does not have enough usable space for a wheelchair. (See pictures H-19, H-20, and H-21). Accommodation: left outside wall should be moved outward one foot, making the bedroom a foot smaller, but giving enough room to make the bathroom fully accessible. Remove inside
***** ***** Housing October 10, 1996 page six bathroom door and wall, remove outside bathroom wall and replace with 36" door, use 90-degree offset on toilet and move one foot, add appropriate grab bars, open up vanity underneath for wheelchair approach, pad exposed pipes, remove outside bedroom wall and replace with 36" door. Respectfully submitted,
Barry L. Oakes, BSIE Safety Consultant
EXHIBIT H - PHOTOGRAPHS NOT INCLUDED IN SAMPLE
EXHIBIT I - CONDOMINIUM FLOOR PLAN NOT INCLUDED IN SAMPLE
EXHIBIT J Oakes & Oakes Barry & Marilyn Oakes P.O. Box 672275 Atlanta, Ga. 30006 404.627.2004 Fax:: 404.506.9067 ***Rehabilitation and Industrial Safety Consultation*** Marilyn T. Oakes, CRC, LPC Barry L. Oakes, BSIE
October 10, 1996
Judah P. Benjamin, Esq. Lee, Davis & Benjamin, LLC 2000 Confederate Drive Metropolis, AL 35511
RE: ***** ***** Dear Mr. Benjamin: At your request, I interviewed the above-referenced individual about his work injury of September 7, 1995. I interviewed him at his condominium on September 16, 1996. He awaited my arrival and was pleasant and cooperative throughout the interview. The same day, Barry Oakes evaluated accessibility of Mr. *****'s condo. Barry evaluated accessibility of Mr. *****'s travel trailer (parked in Coffeeville) the next day. When I arrived, Mr. ***** had just returned from a doctor's appointment. I perched at the foot of his stairs and interviewed him. I was unable to test him because of the circumstances. Most likely, any test scores obtained would have been invalid. Mr. ***** is a married white male, age 53 years, who lives with his wife, *****. The couple married ten years ago. Mrs. ***** presently provides full time attendant care for Mr. *****. Before Mr. *****'s accident, she worked for HardHat International on construction jobs and earned $16.25 hourly. She supervised receiving in the warehouse. She didn't know her average weekly wage, but generally worked at least 60 hours weekly. Mr. ***** graduated from Bay City High School in 1961. In 1969, he attended trade school in St. Louis, where he took a gas refrigeration school. The course lasted three months but he passed all items in two weeks and the school sent him home with a certificate of completion. He completed two- and three-week classes for Black & Gold Construction and HardHat International Construction, including Rigging I & II, Supervisor I & II, Advanced Supervision, OSHA training (twice), Supervisory rigging (heavy lift specialist training for items over 6,000 pounds), basic blueprints, and math.
Judah Benjamin, Esq. RE: ***** ***** October 10, 1996 page two He held certificates to operate all construction equipment, from his prior experience and training gained on the job. He has not been in the military. He has had no other training or education. Mr. ***** is not working now. He receives workers' compensation benefits and the Social Security Administration recently approved him for disability, with date of onset the date of his injury. He returned to work February 1996 as a recruiter, for which he earned $15.00 hourly. Mr. ***** believes that his employer shortened his rehabilitation hospitalization to return him to work early. He said the employer paid Mrs. ***** her full wages while he was recuperating from his injuries and then threatened to stop her money if he didn't return to work in February 1996. He was out of work from September 7, 1995 until February 1996, while recuperating from his injuries and surgery. His job as a recruiter required him to use company-generated lists of former employees and contact them by telephone for job availability. Ordinarily, his employer used human resources people to do this work. He understood that his employer intended to train him in human resources, but his employer instead laid him off June 20, 1996 and he has not worked since. Under the circumstance, this job probably is sheltered, protected, or supported employment rather than gainful employment. When injured, he worked for HardHat International Construction. He started working there in 1987. He followed construction jobs and lived in a travel trailer. His jobs included heavy equipment operator, iron work supervisor, millwright foreman, and pipe foreman. He supervised 10 to 12 workers. He earned $15.25 hourly and worked 60 hours weekly, or more. He didn't know his exact average weekly wage. At 60 hours weekly, his wages would have been $650 for his base wage (40 x $16.25 = $650) and $487.50 overtime (20 x $16.25 x 1.5 = $487.50), total $1,137.50 weekly ($650 + $487.50 = $1,137.50). This work is skilled and heavy. He lacks transferable skills to sedentary work. Before that, he worked for Black & Gold ten years. He earned $16 hourly and supervised 115 people. He was responsible for heavy rigging and equipment, and iron erection. This work is skilled and heavy. He could rely on his crew for heavy lifting. He lacks transferable skills to sedentary work. Before that, he worked 18 or 19 months for Argon Construction, where he earned $11 hourly. He worked 84 hours weekly. He was a heavy equipment operator. This work is heavy and skilled. He lacks transferable skills to sedentary work. Before that, he ran a heating and air conditioning business in Metropolis. He had helpers but also did all work tasks himself. He closed the business. This work is skilled and heavy. He lacks transferable skills to sedentary work.
Judah Benjamin, Esq. RE: ***** ***** October 10, 1996 page three Before that, he worked as a laborer for the Bay County highway department. This work is heavy and unskilled. He lacks transferable skills. He reported no other work. Current medicine includes Hydrocodone, Senekot, Xanax, Eulexin, Tagamet, Elavil, Coumadin, Cipro, and Luprin. Under workers' compensation sponsorship, Mr. ***** saw several physicians in Metropolis. He now sees Drs. Adams & Washington and Dr. Jones under workers' compensation sponsorship. On his own, he sees Drs. Jackson and Jefferson. Mr. ***** had cobalt treatments for prostate cancer in 1994-95. When injured at HardHat International, he said his cancer was in remission and his PSA tests were normal. You asked me to consider Mr. *****'s vocational future. Most people do not change jobs or go to school at age 53. Mr. ***** says his employer offered to train him on-the-job in human resources and recruiting, but then laid him off instead. If his employer intends to train him in human resources, then on-the-job training is not likely to restore him to employment in the competitive market. Unless an employer intends to guarantee a lifetime contract, a college degree in human resources or personnel management is more marketable and appropriate training than on-the-job training. A second factor is that Mr. ***** lacks transferable skills to sedentary work. Another factor is that less than 25% of spinal cord injury survivors return to work within ten years of a spinal cord injury. Considering all the factors, Mr. *****'s return to competitive work is unlikely. Most probably, he is 100% permanently and totally disabled with a 100% loss of earning capacity. I hope this information is helpful to you. Please call if you have questions. Thank you for your business and your consideration.
Yours very truly,
Marilyn T. Oakes, CRC Licensed Professional Counselor
EXHIBIT K Oakes & Oakes Barry & Marilyn Oakes P.O. Box 672275 Atlanta, Ga. 30006 404.627.2004 Fax:: 404.506.9067 ***Rehabilitation and Industrial Safety Consultation*** Marilyn T. Oakes, CRC, LPC Barry L. Oakes, BSIE
BRIEF BIBLIOGRAPHY Americans with Disabilities Act, Title I, Accessibility, 1990. Statute and regulations governing wheelchair accessibility. Deutsch, Paul M. and Horace W. Sawyer, A Guide to Rehabilitation, White Plains, NY: Ahab Press, 1994, 1995. Nosek, M.A. "Personal assistance: its effect on the long-term health of a rehabilitation hospital population." Archives of Physical Medicine and Rehabilitation February 1993; 74(2):127-32. Stolov, Walter C. and Michael R. Clowers, eds., Handbook of Severe Disability, Washington, DC: U.S. Department of Education Rehabilitation Services Administration, 1981. Stover, Samuel L., Joel A. Delisa, and Gale G. Whiteneck, Spinal Cord Injury: Clinical Outcomes from the Model Systems, Gaithersburg, MD: Aspen, 1995. Winkler, Terry, lecture notes, Spinal Cord Injury, University of Florida Rehabilitation Training Institute, July 11 & 12, 1996, San Diego, California.
Sample letter to treating physician: Oakes & Oakes Barry & Marilyn Oakes P.O. Box 672275 Atlanta, Ga. 30006 404.627.2004 Fax:: 404.506.9067 ***Rehabilitation and Industrial Safety Consultation*** Marilyn T. Oakes, CRC, LPC Barry L. Oakes, BSIE
October 8, 1996 Joseph Jones, M.D. 545 Seaside Lane Beach City, FL 35536
RE: ******* ******* Dear Dr. Jones: Rehabilitation Consultants, Inc. has been retained by Judah Benjamin, Esq., attorney for Mr. *******, to prepare a life care plan and assist with rehabilitation planning. Our approach is to draft the proposed plan, then ask the treating physician to review for medical necessity and appropriateness. Attached please find the proposed life care plan and proposed medical orders. If you agree that the items and services we listed are medically necessary and related to Mr. ********'s catastrophic injury of September 7, 1995, then please ask your secretary to type the proposed orders on your letterhead, sign them, and fax back to me. I realize that my deadlines are not yours, but I promised Mr. ********'s attorney a life care plan by October 16, 1996, so I'd appreciate your soonest attention. I realize that Mr. ******** has other medical problems, but I limited my inquiry to problems directly related to the catastrophic injury. I am including a brief discussion of Mr. ********'s problems and why we think the attached items and services should be in his life care plan. Please call me if you have questions or want any changes. I should be in the office most of this week except for meetings from 11 a.m. to 1 p.m. each day. I am thanking you in advance for your kind assistance. I know Mr. ******** is grateful for your care and help, as am I. Yours very truly,
Marilyn T. Oakes, CRC Licensed Professional Counselor
cc: Judah P. Benjamin, Esq.
Mr. ******* ******* SAMPLE PROPOSED MEDICAL ORDERS:
To whom it may concern: Mr. ***** ***** is my patient. I have reviewed his life care plan prepared by Rehabilitation Consultants, Inc. I agree that the following items and services are medically necessary and related to his catastrophic injury of September 7, 1995. 1. Quarterly visits with internal medicine physician to monitor and update medical condition; annual visits with physical medical and rehabilitation physician. 2. Specialty physician consultations, as needed, such as urologic, sexual function, cardiac, and podiatric. 3. Prescription medications, as ordered by treating physicians. 4. Annual rehabilitation hospitalization for detection and prevention of complications. 5. Home health care and attendant services four to eight hours daily, seven days weekly. 6. Monthly nursing supervision of home health care and attendant services, per agency requirements. 7. Quarterly physical therapy evaluation visits for one year; after that, as ordered by treating physicians or annually. 8. Quarterly occupational therapy evaluation visits for one year; after that, as ordered by treating physicians or annually. 9. Daily physical and occupational therapy provided by home health attendant. 10. Individual and family therapy psychological evaluation; family therapy weekly for three months; twice monthly for nine months with assessment of progress quarterly; after that, as needed. 11. Wheelchairs - electric and manual. 12. Disposable medical supplies. 13. Extra firm mattress and box springs to fit couple's king-size bed. 14. Durable medical equipment. 15. Engineering assessment of house for safety, accessibility and structural integrity secondary to the weight of the electric wheelchair. Housing modifications for wheelchair accessibility. Specific recommendations are deferred to Barry L. Oakes, accessibility specialist. 16. Wheelchair accessible van, maintenance, insurance, and communications. 17. Vocational rehabilitation assessment, deferred to Marilyn T. Oakes, Certified Rehabilitation Counselor. Yours very truly,
XXXXXXXXXXXXXX, M.D.
Oakes & Oakes Barry & Marilyn Oakes P.O. Box 672275 Atlanta, Ga. 30006 404.627.2004 Fax:: 404.506.9067 ***Rehabilitation and Industrial Safety Consultation*** Marilyn T. Oakes, CRC, LPC Certified Pain Practitioner Barry L. Oakes, BSIE LIFE CARE PLANNING PROCESS Review medical records Interview client and/or family Compile medical chronology Contact medical care providers Gather expense information Gather statistical data Gather relevant medical literature Complete preliminary life care plan Discuss life plan with client and/or family Discuss life care plan with primary treating physician Adjust life care plan, as needed, from discussions Collect final expense data Perform vocational evaluation, if applicable Prepare final life care plan Prepare life care plan rationale Obtain treating doctor's signature Deposition or courtroom testimony, if necessaryContinued case management, if necessary Other Services Available By Request
Oakes & Oakes Barry & Marilyn Oakes P.O. Box 672275 Atlanta, Ga. 30006 404.627.2004 Fax:: 404.506.9067 E-mail: marilyn@oakes.org ( or ) barry@oakes.org Web Site: http://www.oakes.org ***Rehabilitation and Industrial Safety Consultation*** Marilyn T. Oakes, CRC, LPC Barry L. Oakes, BSIE
FEE SCHEDULE A/O SEPTEMBER 19, 1991 Amended 6-26-98
Professional time - $65.00/hour Professional crisis management (anything less than two weeks' notice) - $130.00/hour Travel/waiting time/clerical - $32.50/hour (prorated when possible) Catastrophic management and life care planning: same as professional Workshops or training meetings: $500 per day per consultant, plus travel and overnight expenses; sponsoring agency copies handouts from originals provided by consultant Courtroom or deposition time - $130.00/hour Discovery depositions - $500 in advance (file preparation, file, resume, deposition); no time and date set without prepayment Discovery depositions - $750 in advance with discovery list (file preparation, file, production of discovery list, resume, deposition); no time and date set without prepayment Local safety screening, initial case review and telephone triage for referral purposes - no charge Internet research: $10.00/hour plus professional time Work-related expenses, itemized, as follows: $3.00 per page clerical fee for reports; $.30 per mile, $.30 per copy Common Service Costs (plus travel and expenses): Career evaluation and testing, $500-1,000 Life care plan, $3,000-$4,000 Job Task Analysis (each job), $500 Job Task Analysis & videotape, $700 Safety plan and manual, $1,500-$2,500 Vocational evaluation and testing, $600
TERMS: Businesses or public agencies: 1/2 of the agreed professional fee and materials costs in advance; balance due upon completion; public agencies must provide proof of escrow. All other bills are due and payable upon receipt, net 14 days. 5% for prompt payment, within 14 calendar days of the bill. Second notice for payment: 30 days; Past due: 30 days; Collections account: 60 days. |
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