I have tried serious injury cases for over forty years. Years ago, I saw terribly low verdicts for catastrophic harm. More recently, we have seen eight-figure verdicts that would have shocked judges when I was a puppy lawyer. What changed?

Insurance defense folks in their seminars have used phrases like “nuclear verdicts.” That makes it sound reckless or irrational. But in my experience, most juries take their job seriously. They discuss seriously the facts of the case and legal principles on which the judge instructs them.

They also bring into the jury room their experience in the world in which we live.

Here are ten reasons verdicts have grown.

1. Big Numbers Don’t Shock People Like They Used To

Inflation has reshaped expectations. The U.S. Bureau of Labor Statistics tracks the steady rise in consumer prices through the Consumer Price Index. Citizens who wind up on juries see that in real time every time they buy groceries, gas, or homes.

They hear news reports of tycoons and even some politicians reaping billions on wild-sounding deals in technology, crytocurrency, etc. The “b word” (billion) seems little more fanciful than the “m word” (million) did 50 years ago.

When an economist projects $6 or $8 million over a lifetime of care, it no longer sounds imaginary. It sounds expensive but credible.

2. Medicine Keeps People Alive But At a Cost

When I was growing up, the ambulance arriving at a wreck scene was often operated by the funeral home.  The after-school and weekend job of one of my high school classmates was to drive the “meat wagon.” There was no first responder training and no paramedic on the scene to stabilize a catastrophically injured person. Too often, they just went straight to the funeral home. 

Many catastrophic injuries were fatal. Today, emergency medicine and advanced trauma care and rehabilitation save lives. But survival comes at a price. Often, it requires decades of structured support. Life care planners build detailed projections based on medical research and standards published through sources like the National Institutes of Health.

Jurors understand that survival without resources can mean suffering. They award money to fund stability.

3. Corporate Trust Has Eroded

Public trust in major institutions has declined over the years since Watergate. Surveys from the Pew Research Center  egularly document this trend.

When  internal documents and emails show ignored safety complaints or cost-cutting decisions, jurors can easily connect it to a broader narrative about profit over people. That matters in the jury room with rules-oriented jurors who distrust institutions.

In planning mock jury focus groups, we have often deliberately limited the group to the most politically and socially conservative people. They have surprised us by coming up with numbers much higher than a mock jury that represented a broader cross-section of the population.

4. Safety Rules Are Clear and Public

In trucking, aviation, medicine, and manufacturing, safety standards are spelled out in black and white. For example, commercial motor carriers operate under federal rules issued by the Federal Motor Carrier Safety Administration, which are simply explained in the Commercial Drivers License Manual. Commercial truck drivers and safety managers have no credible way to deny those are the industry standards they are supposed to follow.

Clear rules make liability feel concrete. When a company violates a clear safety rule, jurors see it not as just an accident but a deliberate and unsafe choice.

5. Social Media Changed the Background Noise

Years ago, corporate misconduct stayed local. Today, bad news travels fast. Anything that makes news anywhere seems local and immediate. Jurors have watched stories about defective products, data breaches, and regulatory failures. That background shapes how they interpret evidence. Jurors do not enter the courtroom empty-headed.

6. Trial Lawyers Tell the Story Differently Now

Modern trial strategy focuses on safety and preventability. Lawyers talk not about sympathy but about common sense safety  rules and how small decisions cascade into harm.

7. Anchoring Influences Damage Awards

When a lawyer suggests a specific figure for pain and suffering, that number becomes a reference point. Jurors may reduce it, but they rarely ignore it. Anchoring is not just  manipulation. It is human cognition at work. Psychologists have long studied how framing affects judgment. The concept of cognitive “anchoring” is well established, including in research summarized by the American Psychological Association.

The Georgia legislature in its latest “tort reform” tried to stop anchoring by enacting OCGA § 9-10-184, which provides, “ In the trial of a civil action for personal injuries, counsel shall be allowed to argue the worth or monetary value of pain and suffering to the jury; provided, however, that any such argument shall conform to the evidence or reasonable deductions from the evidence in the case.”

In legislative debate, politicians talked about stopping lawyers from analogizing to the price of paintings and race horses. However, an experienced trial lawyer has no need to talk about such crudely irrelevant distractions. A good advocate can easily suggest to jurors a way to calculate value based on the evidence and reasonable deductions. Nearly two decades ago, I gave jurors a methodology tied to the evidence and linked to reality in their rural county through which they calculated a verdict a million dollars more than I asked for.

8. Younger Jurors View Institutions Differently

Now on the senior end of the generation gap, I have seen several times how generational shifts are real. Many younger jurors grew up during the financial crisis, corporate scandals, and rising inequality. They carry student debt. They have seen layoffs. They question concentrated power more readily.

This does not mean they are anti-business. It means they may weigh accountability differently than their parents or grandparents.

9. Transparency About Corporate Wealth

Public companies disclose executive compensation and financial performance through filings with the U.S. Securities and Exchange Commission. We all see news reports about individuals making billions on crypto or a tech tycoon closing in on a trillion dollars net worth, it registers. Even billboards for the lottery touting jackpots over a billion dollars feeds the idea that it could happen to them. At some level, all that registers. When jurors see astronomical CEO bonuses alongside safety violations, they calibrate verdicts accordingly.

A verdict that once seemed massive may now feel proportional.

10. Preventable Harm Sparks Moral Reaction

The most significant driver of large verdicts is not sympathy but preventability.

An impaired or fatigued trucker. A manufacturer that ignored a recall warning. A hospital that brushed aside red flags. When jurors conclude, “This did not have to happen,” damages climb. Moral judgment is powerful. It always has been but now it carries a bigger price tag.

Large verdicts do not come from thin air. They usually arise from clear liability and serious, permanent harm. Venue still matters. Facts matter more. I have seen conservative rural counties return modest verdicts in serious cases and urban juries surprise plaintiffs with restraint. But I have also seen the opposite, surprisingly adequate verdicts in the most conservative venues.

Money is the only remedy our civil system offers. Jurors know that. They cannot undo a spinal cord injury or restore a dead child. They can only assign responsibility in dollars.

After decades in the courtroom, I recognize that modern verdicts reflect modern expectations about safety, accountability, and dignity. When people on a jury believe a company or individual chose risk over safety, they are not afraid to respond firmly.

Ken Shigley, senior counsel at Johnson & Ward, Atlanta’s oldest personal injury specialty law firm, is a former president of the State Bar of Georgia. He was the first Georgia lawyer to earn three board certifications from the National Board of Trial Advocacy: Truck Accident Law, Civil Trial Practice, and Civil Pretrial Practice. He was the lead author of eleven editions of Georgia Law of Torts: Trial Preparation and Practice, and received the Traditions of Excellence Award from the State Bar of Georgia General Practice and Trial Section. B.A., Furman University; J.D., Emory University Law School; Certificates in mediation and negotiation, Harvard Law School. He began his career as an Assistant District Attorney, then worked a decade in an insurance defense law firm before entering plaintiffs’ practice.

In our law practice over several decades , we have represented numerous SCI survivors. Most had benefited from rehabilitation services at Shepherd Center or Emory Rehabilitation Hospital, both of which are near us in Atlanta. All of these clients were injured in motor vehicle crashes or falls. One client who had been a high-powered government executive before an accident made him  quadriplegic initially  wanted to just turn his face to the wall and die, but after rehab he used funds from his settlement to equip himself to write books and begin a second career in college teaching. Another was a young woman in college who went on to teach elementary school in a wheelchair, participate in adaptive sports, move west on her own, and become Ms. Wheelchair California. 

Spinal cord injuries (SCI)

are among the most devastating physical injuries one can suffer. We have had SCI clients whose first reaction was to wish for death rather than life with paralysis.

Spinal cord injury paralysis occurs when there is damage to the spinal cord, which is a long, thin, tubular bundle of nerves that runs from the base of the brain down to the lower back. The spinal cord is responsible for transmitting messages between the brain and the rest of the body, and damage to the spinal cord can result in a loss of neurological function.

The degree of neurological function loss depends on the location and severity of the spinal cord injury. In general, spinal cord injury paralysis can result in a range of symptoms, including loss of sensation, loss of movement, loss of bowel or bladder control, sexual dysfunction, and breathing difficulties.

The location of the spinal cord injury determines which parts of the body are affected. A spinal cord injury that occurs in the cervical (neck) region will typically result in tetraplegia (also known as quadriplegia), which is paralysis of all four limbs and the torso. A spinal cord injury that occurs in the thoracic (chest) region or below will typically result in paraplegia, which is paralysis of the lower limbs and the lower half of the body. Symptoms include loss of sensation,  loss if movement, loss of bowel or bladder control, sexual  dysfunction, and breathing difficulties.

Diagnosis of SCI usually begins with paramedics at an accident scene or with emergency physicians and nurses in a hospital emergency department. Neurological screening in the triage process usually picks up on severe SCI pretty quickly. However, sometimes a developing SCI is initially subtle in the context of other injuries sustained in a crash. The diagnosis of spinal cord injury (SCI) typically involves a combination of medical history, physical examination, and diagnostic tests. Along with triage, stabilizing the patient, the medical team  will perform a thorough physical examination to assess the patient’s neurological function, including muscle strength, sensation, and reflexes. This may include a rectal exam to check for any loss of bowel or bladder control, which can be indicative of SCI.

Diagnostic tests may include:

– X-rays: X-rays can help identify fractures or dislocations in the spine.

– CT scan: A CT scan can provide detailed images of the spine and help identify any damage to the spinal cord.

– MRI: An MRI can provide even more detailed images of the spinal cord and surrounding tissues, and can help identify the location and extent of the injury.

– Electromyography (EMG): EMG can help evaluate the electrical activity of muscles and nerve cells in the limbs, and may be used to assess the extent of nerve damage.

Family members of SCI victims often must be advocates for the patient, firmly but respectfully pressing medical personnel and insurance companies to approve transfer to a top SCI rehabilitation center such as Shepherd or Emory in Atlanta. Such transfers may depend upon bed availability and meeting medical criteria of stabilization for admission.

Once SCI victims are admitted to a rehabilitation facility, family members may be included in treatment team meetings. As your attorneys, we are available to accompany you, with permission, to begin coordinating with the treatment team in evaluating the patient’s longterm financial needs and how we may assist in meeting those needs. This is the beginning of development of a life care plan that we may present in litigation. We listen first, build rapport, and then ask questions about points we need to effectively advocate for the SCI victim.

Medical treatment for spinal cord injuries may include  medication, surgery, physical therapy, occupational therapy, and  assistive devices such as wheelchairs, braces, etc.

Medication

Medications can play an important role in the treatment of spinal cord injuries by managing pain, reducing inflammation, preventing infections, and improving neurological function. The specific medications used will depend on the individual patient’s needs and the specifics of their injury.

Pain management is a critical aspect of treating spinal cord injuries, and medications such as opioids, nonsteroidal anti-inflammatory drugs (NSAIDs), and muscle relaxants may be prescribed to manage pain. However, the use of opioids must be carefully monitored due to the risk of addiction and other side effects.

Corticosteroids such as methylprednisolone may be used to reduce inflammation and swelling around the spinal cord, which can help preserve neurological function. These medications are typically administered within the first 8 hours after injury and may be continued for several days.

Antibiotics may be prescribed to prevent or treat infections, which can be a serious complication of spinal cord injuries. Bladder and bowel dysfunction are common after spinal cord injuries, and antibiotics may be used to prevent urinary tract infections and other infections that can occur due to the inability to empty the bladder properly.

Medications such as baclofen and tizanidine may be used to manage spasticity, which is a common complication of spinal cord injuries. These medications help to relax the muscles and reduce spasms.

In some cases, experimental medications may be used to promote nerve regeneration and improve neurological function. These medications may include growth factors, stem cells, or other drugs that have been shown to promote nerve growth and repair.

Surgery for spinal cord injuries can be divided into two main categories: decompression surgery and stabilization surgery.

Decompression surgery involves removing any material that is putting pressure on the spinal cord, such as bone fragments, herniated disks, or tumors. This type of surgery is aimed at preventing further damage to the spinal cord and potentially improving neurological function.

Stabilization surgery is used to stabilize the spine and prevent further damage. This may involve fusing two or more vertebrae together, using metal plates, screws, or rods to hold the spine in place. This type of surgery can also be used to correct spinal deformities that have resulted from the injury.

In some cases, a combination of decompression and stabilization surgery may be necessary. The goal of surgery is to prevent further damage to the spinal cord and potentially improve neurological function. However, the outcome of surgery is highly dependent on the severity of the injury and the individual patient’s response to treatment. Rehabilitation is often necessary after surgery to help the patient recover and regain as much function as possible.

If you or a loved one have suffered a spinal cord injury in an accident that was someone else’s fault, submit our inquiry form or call us now at 404-253-7862.

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Johnson & Ward 

 Johnson & Ward, established in 1949, was the first and best personal injury specialty law firm in Georgia. Founders of the firm were among the founders of the Georgia Trial Lawyers Association. The firm was built upon traditional, word-of-mouth referrals from other lawyers, so it has never needed to advertise on TV or billboards. Firm alumni have served as judges of trial and appellate courts, and current partners include former  presidents of the Atlanta Bar Association and State Bar of Georgia.

­­­­­­­­­­­­­­­­­­­­______________________________

Ken Shigley, a partner at Johnson & Ward, started in 1949, is a former president of the State Bar of Georgia. Mr. Shigley wrote eleven annual editions of a book about Georgia’s civil trial practice. He was the first Georgia lawyer to earn three national board certifications from the National Board of Trial Advocacy in trial practice and truck accident law. In 2019, he received the “Tradition of Excellence Award” for lifetime achievement in the legal profession. He graduated from Furman University and Emory University Law School. He also completed certificate programs in negotiation and mediation at Harvard Law School. Mr. Shigley is a widower. His son is a golf fitness trainer in Atlanta and his daughter works with terminally ill people in hospice in New Hampshire. 

In our law practice over several decades, we have represented numerous spinal cord injury survivors. Most had benefited from rehabilitation services at Shepherd Center or Emory Rehabilitation Hospital, both of which are near us in Atlanta. All these clients were injured in motor vehicle crashes or falls. One client who had been a high-powered government executive before an accident made him quadriplegic initially wanted to just turn his face to the wall and die, but after rehab, he used funds from his settlement to equip himself to write books and begin a second career in college teaching. Another spinal cord injury client was a young woman in college who went on to teach elementary school in a wheelchair, participate in adaptive sports, move west on her own, and become Ms. Wheelchair California. 

Spinal cord injury paralysis occurs when there is damage to the spinal cord, which is a long, thin, tubular bundle of nerves that runs from the base of the brain down to the lower back. The spinal cord is responsible for transmitting messages between the brain and the rest of the body, and damage to the spinal cord can result in a loss of neurological function.

The degree of neurological function loss depends on the location and severity of the spinal cord injury. In general, spinal cord injury paralysis can result in a range of symptoms, including loss of sensation, loss of movement, loss of bowel or bladder control, sexual dysfunction, and breathing difficulties.

The location of the spinal cord injury determines which parts of the body are affected. A spinal cord injury that occurs in the cervical (neck) region will typically result in tetraplegia (also known as quadriplegia), which is paralysis of all four limbs and the torso. A spinal cord injury that occurs in the thoracic (chest) region or below will typically result in paraplegia, which is paralysis of the lower limbs and the lower half of the body. Symptoms include loss of sensation,  loss of movement, loss of bowel or bladder control, sexual dysfunction, and breathing difficulties.

Diagnosis of spinal cord injury usually begins with paramedics at an accident scene or with emergency physicians and nurses in a hospital emergency department. Neurological screening in the triage process usually picks up on severe spinal cord injury pretty quickly. However, sometimes a developing SCI is initially subtle in the context of other injuries sustained in a crash. The diagnosis of spinal cord injury (SCI) typically involves a combination of medical history, physical examination, and diagnostic tests. Along with triage, and stabilizing the patient, the medical team will perform a thorough physical examination to assess the patient’s neurological function, including muscle strength, sensation, and reflexes. This may include a rectal exam to check for any loss of bowel or bladder control, which can be indicative of SCI.

Diagnostic tests may include:

– X-rays: X-rays can help identify fractures or dislocations in the spine.

– CT scan: A CT scan can provide detailed images of the spine and help identify any damage to the spinal cord.

– MRI: An MRI can provide even more detailed images of the spinal cord and surrounding tissues, and can help identify the location and extent of the injury.

– Electromyography (EMG): EMG can help evaluate the electrical activity of muscles and nerve cells in the limbs, and may be used to assess the extent of nerve damage.

Family members of spinal cord injury victims often must be advocates for the patient, firmly but respectfully pressing medical personnel and insurance companies to approve the transfer to a top SCI rehabilitation center such as Shepherd or Emory in Atlanta. Such transfers may depend upon bed availability and meeting medical criteria of stabilization for admission.

Once SCI victims are admitted to a rehabilitation facility, family members may be included in treatment team meetings. As your attorneys, we are available to accompany you, with permission, to begin coordinating with the treatment team in evaluating the patient’s long-term financial needs and how we may assist in meeting those needs. This is the beginning of the development of a life care plan that we may present in litigation. We listen first, build rapport, and then ask questions about points we need to effectively advocate for the SCI victim.

Medical treatment for spinal cord injuries may include medication, surgery, physical therapy, occupational therapy, and assistive devices such as wheelchairs, braces, etc.

Medication

Medications can play an important role in the treatment of spinal cord injuries by managing pain, reducing inflammation, preventing infections, and improving neurological function. The specific medications used will depend on the individual patient’s needs and the specifics of their injury.

Pain management is a critical aspect of treating spinal cord injuries, and medications such as opioids, nonsteroidal anti-inflammatory drugs (NSAIDs), and muscle relaxants may be prescribed to manage pain. However, the use of opioids must be carefully monitored due to the risk of addiction and other side effects.

Corticosteroids such as methylprednisolone may be used to reduce inflammation and swelling around the spinal cord, which can help preserve neurological function. These medications are typically administered within the first 8 hours after injury and may be continued for several days.

Antibiotics may be prescribed to prevent or treat infections, which can be a serious complication of spinal cord injuries. Bladder and bowel dysfunction are common after spinal cord injuries, and antibiotics may be used to prevent urinary tract infections and other infections that can occur due to the inability to empty the bladder properly.

Medications such as baclofen and tizanidine may be used to manage spasticity, which is a common complication of spinal cord injuries. These medications help to relax the muscles and reduce spasms.

In some cases, experimental medications may be used to promote nerve regeneration and improve neurological function. These medications may include growth factors, stem cells, or other drugs that have been shown to promote nerve growth and repair.

Surgery for spinal cord injuries can be divided into two main categories: decompression surgery and stabilization surgery.

Decompression surgery involves removing any material that is putting pressure on the spinal cord, such as bone fragments, herniated disks, or tumors. This type of surgery is aimed at preventing further damage to the spinal cord and potentially improving neurological function.

Stabilization surgery is used to stabilize the spine and prevent further damage. This may involve fusing two or more vertebrae together, using metal plates, screws, or rods to hold the spine in place. This type of surgery can also be used to correct spinal deformities that have resulted from the injury.

In some cases, a combination of decompression and stabilization surgery may be necessary. The goal of surgery is to prevent further damage to the spinal cord and potentially improve neurological function. However, the outcome of surgery is highly dependent on the severity of the injury and the individual patient’s response to treatment. Rehabilitation is often necessary after surgery to help the patient recover and regain as much function as possible.

Neurological Complications

Due to the disruption of nerves controlling body functions,  SCI victims have neurological complications affecting bowel, bladder,  and sexual functions. The extent of dysfunction depends on the level and severity of the SCI.

Bowel complications:

Bowel management is an important aspect of care for individuals with spinal cord injury (SCI) as the injury can result in disruption of nerve pathways that control bowel function, leading to constipation, diarrhea, or incontinence. Effective bowel management can help prevent complications such as fecal impaction, bowel obstruction, and bowel accidents.

There are several approaches to bowel management in SCI, including:

1. Diet and fluid management: A high-fiber diet and adequate fluid intake can help regulate bowel movements and prevent constipation. It is important to avoid foods that can cause constipation, such as dairy products, red meat, and refined carbohydrates.

2. Medications: Laxatives, stool softeners, and suppositories can be used to help regulate bowel movements and prevent constipation. However, it is important to use these medications under the guidance of a healthcare professional, as they can have side effects.

3. Digital stimulation: This involves inserting a finger into the rectum to stimulate the anal sphincter and initiate bowel movements. This can be done manually or with the help of a device.

4. Manual evacuation: This involves manually removing stool from the rectum using a gloved finger or a device. This may be necessary for individuals with severe constipation or impaction.

5. Bowel training: This involves establishing a regular routine for bowel movements, usually through the use of digital stimulation and manual evacuation. This can help prevent constipation and promote regular bowel movements.

6. Colostomy: In some cases, a surgical procedure called a colostomy may be necessary. This involves creating an opening in the abdomen through which stool can be eliminated. This may be necessary for individuals with severe bowel dysfunction that is not responsive to other treatments.

Effective bowel management requires a comprehensive approach that takes into account the individual’s specific needs and preferences. It is important for individuals with SCI to work closely with their healthcare team to develop a personalized bowel management plan that meets their needs and promotes optimal bowel function.

Bladder and Urinary complications:

Spinal cord injury (SCI) can have a significant impact on bladder function due to the disruption of the nerve pathways that control bladder muscles and sphincter. Some of the common bladder problems associated with SCI include:

1. Urinary incontinence: This is the inability to control bladder function, leading to involuntary urine leakage. It can occur due to the disruption of nerve pathways that control bladder muscles and sphincter. Treatment options include the use of absorbent pads or diapers, medication, and intermittent catheterization.

2. Difficulty emptying the bladder: SCI can also lead to difficulty emptying the bladder completely, leading to a buildup of urine in the bladder. This can cause urinary tract infections and other complications. Treatment options include the use of medication, intermittent catheterization, or surgical procedures.

3. Frequent urinary tract infections: Individuals with SCI are at increased risk of urinary tract infections due to the disruption of nerve pathways that control bladder function. Treatment options include the use of antibiotics and the prevention of urinary stasis through intermittent catheterization or other means.

4. Bladder stones: SCI can also lead to the formation of bladder stones due to the buildup of minerals in the bladder. Treatment options include the use of medication to dissolve the stones, or surgical procedures to remove them.

5. Autonomic dysreflexia: This is a potentially life-threatening condition that can occur in individuals with SCI who have a level of injury at or above the sixth thoracic vertebra. It results from an exaggerated response of the autonomic nervous system to a noxious stimulus, such as a bladder or bowel distension. Treatment options include the removal of the noxious stimulus and the use of medication to lower blood pressure.

Sexual complications:

SCI can also affect sexual function. Men with SCI may experience erectile dysfunction, difficulty achieving or maintaining an erection, or retrograde ejaculation. Women with SCI may experience decreased lubrication, difficulty achieving orgasm, or reduced sensation. Treatment options include medication, vacuum erection devices, penile injections, and surgical procedures.

Physical therapy is an essential component of the rehabilitation process for individuals with spinal cord injuries (SCI). The goal of physical therapy is to maximize functional independence and improve overall quality of life for the person with SCI.

The specific physical therapy interventions used for SCI depend on the severity and location of the injury, as well as the individual’s overall health and goals. Below are some common physical therapy interventions used for SCI, varying according to level of the injury and residual capability.

1. Range of motion exercises: These exercises help maintain flexibility and prevent joint contractures, which can occur due to immobility.

2. Strengthening exercises: Strengthening exercises help improve muscle strength and endurance, which can help with functional tasks such as transferring, standing, and walking.

3. Balance and coordination training: These exercises help improve balance and coordination, which can reduce the risk of falls and improve overall mobility.

4. Gait training: If paralysis is not complete, gait training involves working on standing and walking, either with or without assistive devices such as braces or walkers.

5. Functional electrical stimulation (FES): FES is a technique that uses electrical impulses to stimulate paralyzed muscles and improve muscle function. This technique can be used to help with walking, standing, and other functional tasks.

6. Assistive devices: Physical therapists can help individuals with SCI choose and learn how to use assistive devices such as wheelchairs, walkers, and braces.

It is important to note that physical therapy is just one component of the overall rehabilitation process for SCI. In addition to physical therapy, individuals with SCI may also receive occupational therapy, speech therapy, and other interventions to address their specific needs and goals.

Occupational therapy is an important component of the rehabilitation process for individuals with spinal cord injury (SCI). The goal of occupational therapy is to help individuals with SCI regain the ability to perform activities of daily living (ADLs) and improve their overall quality of life. Here are some common interventions used in occupational therapy for SCI:

1. Self-care training: Occupational therapists can teach individuals with SCI how to perform self-care tasks such as bathing, dressing, and grooming using adaptive techniques and equipment.

2. Upper extremity therapy: Individuals with SCI often experience weakness or paralysis in their upper extremities. Occupational therapists can provide exercises and therapeutic activities to help improve strength, coordination, and function in the arms and hands.

3. Environmental modifications: Occupational therapists can evaluate the home and work environments of individuals with SCI and make recommendations for modifications to improve accessibility and safety.

4. Adaptive equipment: Occupational therapists can help individuals with SCI select and learn to use adaptive equipment such as wheelchairs, lifts, and other assistive devices.

5. Work retraining: Occupational therapists can help individuals with SCI return to work by providing vocational training and job accommodations.

6. Leisure activities: Occupational therapists can work with individuals with SCI to identify and participate in leisure activities that are meaningful to them. This can include activities such as sports, hobbies, and social outings.

It is important to note that occupational therapy is just one component of the overall rehabilitation process for SCI. In addition to occupational therapy, individuals with SCI may also receive physical therapy, speech therapy, and other interventions to address their specific needs and goals.

Adaptive technologies

 Adaptive techniques and equipment can help people with spinal cord injuries (SCI) to live more independently and improve their quality of life. Here are some examples:

1. Wheelchairs: Wheelchairs are one of the most common pieces of equipment used by people with SCI. There are many different types of wheelchairs available, including manual and power wheelchairs, which can be customized to meet an individual’s specific needs. Some wheelchairs are designed for use indoors, while others are designed for outdoor use. In Georgia, Cumberland Island National Seashore even has beach wheelchairs available for visitors.

2. Assistive Devices: There are various assistive devices that can help people with SCI to perform daily activities, such as dressing, grooming, and eating. These can include devices such as dressing sticks, reachers, and adaptive utensils.

3. Transfer Equipment: Transfer equipment such as transfer boards and transfer benches can help individuals with SCI to move from their wheelchair to other surfaces, such as a bed or a car.

4. Standing Frames: Standing frames can help people with SCI to stand upright and experience the benefits of weight-bearing. Standing frames can also help to improve circulation, reduce muscle spasms, and prevent pressure sores.

5. Adapted Vehicles: Adapted vehicles can help people with SCI to travel independently. These vehicles can be modified to include hand controls, lifts, and other adaptive equipment.

6. Home Modifications: Home modifications such as grab bars, wheelchair ramps, and widened doorways can help to make a home more accessible for someone with SCI.

7. Sports Equipment: There are many adaptive sports and recreational activities available for people with SCI, such as wheelchair basketball, hand cycling, and adaptive skiing. Adaptive sports equipment can include specialized wheelchairs, hand cycles, and other equipment designed for people with disabilities.

Overall, adaptive techniques and equipment can help people with SCI to live more independently, participate in activities they enjoy, and improve their overall quality of life. It is important to work with healthcare professionals and assistive technology specialists to determine the best equipment and techniques for each individual’s unique needs.

 Mouth operated control devices

Even a person who is a complete quadriplegic may regain a degree of agency with mouth-operated control devices.  Sip and puff and tongue controls are two types of assistive technology that can be used by individuals with quadriplegia to control wheelchairs and computers.

Sip and puff controls use a straw-like device that is placed in the user’s mouth. By sipping or puffing on the device, the user can control the movement of the wheelchair. For example, sipping may cause the wheelchair to move forward, while puffing may cause it to move backward. Sip and puff controls can also be used to control other devices, such as l

Red environmental controls, communication devices, and computer software.

Tongue controls use a small magnet that is attached to the user’s tongue with a piercing. The magnet is connected to a sensor on the user’s wheelchair or computer, which allows them to control the movement of the device by moving their tongue in different directions. Tongue controls can be an effective alternative to traditional joystick controls for individuals with limited hand or arm function.

Both sip and puff and tongue controls require training and practice to use effectively. However, once mastered, these technologies can provide individuals with quadriplegia with greater independence and control over their environment.

In addition to controlling wheelchairs, sip and puff and tongue controls can also be used to operate computers. For example, individuals with quadriplegia can use these devices to control the mouse cursor, type using an on-screen keyboard, and access software applications. There are a variety of software programs and applications available that are specifically designed for use with assistive technology, making it easier for individuals with quadriplegia to use computers and access information.

Overall, sip and puff and tongue controls are important assistive technologies for individuals with quadriplegia, providing them with greater independence and control over their environment. It is important for individuals with quadriplegia to work with healthcare professionals and assistive technology specialists to determine the best technology for their unique needs.

Psychological effects of spinal cord injuries.

Spinal cord injury (SCI) almost always have a significant impact on a person’s psychological well-being. Dir to a profound effect on a person’s sense of self, identity, and relationships with others. Additionally, the sudden and traumatic nature of SCI can result in feelings of shock, disbelief, and grief.

Depression is a common psychological effect of SCI. Depression can be caused by a range of factors, including the loss of physical ability, social isolation, and chronic pain. Depression can also make it more difficult for people with SCI to engage in rehabilitation and can lead to a slower recovery.

Anxiety is another common psychological effect of SCI. Anxiety can be caused by a range of factors, including the uncertainty of the future, the loss of control over one’s body, and the fear of experiencing medical complications. People with SCI may also experience post-traumatic stress disorder (PTSD) as a result of the traumatic event that caused their injury.

Furthermore, individuals with SCI usually experience significant changes in their relationships and social lives.  SCI tremendously impedes ability to participate in social activities, leading to social isolation and feelings of loneliness. This often has  a huge impact on their mental health.

Finally, the physical limitations of SCI can lead to feelings of frustration, anger, and a sense of helplessness. These feelings can be exacerbated by the challenges of adapting to a new way of life, including learning new skills and coping with the physical, emotional, and financial strain of the injury.

Conclusion

The treatment team at a major spinal cord injury rehabilitation center can help to optimize the best attainable degree if recovery. As attorneys experienced in spinal cord injury cases, we stand ready to work with the patient’s family and treatment team to obtain funds for an optimal life care plan.   

If you or a loved one have experienced a catastrophic spinal cord injury in a motor vehicle crash or an accident on business property, either submit our inquiry form or call 404-253-7862.

If you or a loved one have suffered a spinal cord injury, submit our inquiry form or call us now at 404-253-7862.

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Johnson & Ward has been a leading personal injury and wrongful death specialty law firm in Atlanta since 1949. The founders of the firm were also among the founders of the Georgia Trial Lawyers Association. Current partners include former presidents of the State Bar of Georgia and the Atlanta Bar Association.

Among the worst injuries a person may suffer is a “broken neck,” a fracture in the cervical vertebra. It may result in irreversible paralysis or death.

The C1 and C2 vertebrae are the top two of seven vertebrae in the cervical spine. Depending upon their severity, these types of spinal cord injury are categorized as complete or incomplete.  Injuries at this top level of the spine can block nerve impulses to the rest of the body below that point, often leading to death or complete paralysis.

The C1 vertebra is also called the Atlas vertebra, named after the mythical ancient Greek hero who bore the weight of the world. The C2 vertebra is also called the Axis because it provides the ability for the head to rotate. The fracture of the C2 vertebra is often called a “Hangman’s fracture.”  The combination of C1 and C2 supports the skull, protects the spinal cords, and enables the head to rotate and swivel.

Injuries at the C1-C2 level are less common than at lower levels of the cervical spine. The most frequent causes of fractures at the C1 and C2 levels are diving, motor vehicle collisions, and falls that impact the head.

Symptoms of fractures at C1-C2 include:

• Loss of ability to breathe without help from a ventilator
• Loss of ability to speak
• Loss of feeling or sensation below the level of injury
• Paralysis of arms, hands, torso, and legs
• Limited neck and head movement

That is why a , a C1-C2 fracture spinal cord injury is among the worst injuries a person can have. Fortunately, near our office is one of the top spinal cord injury rehabilitation facilities in the United States, the Shepherd Center. Over the years, families of Shepherd Center patients have often asked us to meet with them at the hospital. Prospects for the degree of recovery from such injuries include considerations of:

The outlook of a person’s recovery from a cervical vertebra injury depends on a variety of factors, including:

• Health and fitness at the time of injury.
• Speed of response in getting appropriate treatment and stabilizing the injury, initially with a hard collar and then typically with external fixation devices.
• The completeness or incompleteness of  injury.
• Prompt use of anti-inflammatory and steroid medications to relieve swelling and pressure on the spinal cord.
• Prompt access to therapies and treatments at a specialized spinal cord rehabilitation facility such as the Shepherd Center.
• Ability of the patient, family, friends, and caregivers to adhere to a consistent care plan.

Therefore, a C1-C2 fracture spinal cord injury is among the worst injuries a person can have.

Legal representation of a person with such an injury due to someone else’s negligence generally involves identification of all at-fault parties and insurance coverages,  coordination with the medical team and development of the life care plan, understanding of the many medical and rehabilitation issues, empathy is working with a family in severe crisis, and settlement planning to coordinate insurance and governmental benefits through a special need trust.

If you or a loved one has a cervical fracture and spinal cord injury caused by another’s negligence, call us at 404-253-7862.

Johnson & Ward has been a leading personal injury and wrongful death specialty law firm in Atlanta since 1949.

A fracture of a vertebra in the low back (lumbar) region causes back pain, often severe, that is aggravated by movement. When low back fracture injuries involve teh spinal cord or nerves, there may also be bowel/bladder dysfunction, numbness, tingling, or weakness in the limbs.

When low back fractrue injuries are caused by high-energy trauma, the patient may also have a brain injury and lose consciousness. There may also be other injuries—called distracting injuries—that cause pain that overwhelms the back pain. In these cases, a vertebral fracture is likely.

These can take many forms including vertebral fractures, ruptured or bulging discs, and damage to nerves, ligaments, tendons, and muscles. A single injury can have aspects of any or all of these components.

There are several varieties of low back vertebral fractures:

Compression fractures

Compression fractures are small breaks in the vertebrae that reduce the height of the vertebra. The people most vulnerable to compression fractures of spinal vertebra are post-menopausal women with reduced bone density associated with osteoporosis. With tiny cracks in soft bone, one is more vulnerable to trauma causing collapse of the vertebra. Smokers are somewhat more at risk than non-smokers. Although this can happen without a major incident, an accident such as being rear-ended by another vehicle can suddenly change the condition from merely vulnerable to acutely painful and debilitating. A common form of compression fracture involves the collapse of the front side of the vertebra. That is called a wedge fracture.   Such compression fractures can lead to chronic pain, height loss, disfigurement, impaired activities of daily living, increased risk of pressure sores, and the depression and psychological distress that commonly accompany chronic pain and loss of quality of life.

Burst low back fracture injuries

A more severe form of compression fracture is the burst fracture, which occurs when a vertebral body spread out in all directions. The increased severity is due to a couple of factors. First, bony fragments spread out in all directions bruising the spinal cord, potentially causing paralysis or other neurologic injuries. Second, when the entire margin of the vertebral body is crushed the spine is much less stable than in a wedge-type compression fracture. Burst fractures, especially in older people with brittle bones in whom it is difficult to attach plates and screws to bone, are often treated with vertebroplasty. That involves injection of bone cement into the damaged vertebra for stability and support of the spine. We have seen this most often in older women rear-ended by large trucks.

 Chance fractures / flexion-extension seat belt fractures

Named after the British radiologist who first defined it in 1948, a Chance fracture is an unstable spine fracture, usually at T10-L2, the thoracolumbar junction. About half of all spinal injuries outside of the cervical spine are this part of the spine. It is a type of flexion-extension fracture because the upper body is thrown forward, typically in a head-on collision,  while the pelvis is stabilized only  by a lap seat belt.  It is also called a  “seatbelt fracture” because it often occurs when, upon sudden deceleration, the spine forcefully bends over the lap seat belt which serves as a fulcrum, resulting in the separation of the middle and posterior elements of the spine. This was seen more often before shoulder harnesses became common.

CT and MRI scans are essential in the diagnosis and are called for when there is seatbelt bruising after a motor vehicle crash. This is a horizontal fracture extending from posterior to anterior through the spinous process, pedicles, and vertebral body. A Chance fracture is an unstable horizontal fracture extending from posterior to anterior through the spinous process, pedicles, and vertebral body. However, in about half of Chance fractures there are also concurrent intraabdominal injuries, especially spleen, bowel and bladder ruptures. Early recognition of this injury is critical as a delay in diagnosis significantly impacts clinical outcomes, but unfortunately, emergency physicians can easily overlook Chance fractures on clinical exam because patients may present without initial neurological deficits. Treatment often involves stabilization with a brace or cast, though more severe cases with neurological symptoms may are stabilized surgically.

Rotation low back fracture injuries

This less common fracture results from rotation of the low back  or extreme sideways (lateral) bending. With rotation fracture-dislocation, both bone and soft tissue around a vertebra are injured, often resulting in spinal cord compression. Treatment involves surgery to stabilize the spine, generally with places, screws, rods or cages.

Permanent Impairments after Low Back Fracture Injuries

Most lumbar spine fracture injuries involve an impairment rating under the American Medical Association Guides to Evaluation of Permanent Impairment.   Physical impairment as rated under this system is not the same thing as occupational disability. A person with a relatively low impairment rating may be completely disabled from a physically demanding occupation. But a person with the same physical impairment rating may be fully capable of doing an office job. We may also consider evaluation by a vocational rehabilitation expert to evaluate real-world disability.

If you or a loved one have suffer ed a low back fracture injury, call us at 404-253-7862.

Johnson & Ward has been a leading personal injury and wrongful death specialty law firm in Atlanta since 1949.

senior counsel at Johnson & Ward, is a former president of the State Bar of Georgia (2011-12). He was the first Georgia lawyer to earn three board certifications from the National Board of Trial Advocacy (Civil Trial Advocacy, Civil Pretrial Advocacy, and Truck Accident Law). In 2019, he received the Traditions of Excellence Award for lifetime achievement. Mr. Shigley was lead author of  eleven editions of Georgia Law of Torts: Trial Preparation and Practice (Thomson Reuters, 2010-21). He graduated from Furman University and Emory University Law School.

Physicians accustomed to dealing with musculoskeletal injuries such as fractures, disc herniations, and whiplash, often completely miss the diagnosis of these extremely painful and debilitating injuries. They may even accuse the patients of exaggeration or malingering.

Chiari malformation is a little-understood condition in which the lowest area of the brain, the cerebellar tonsil, is forced out of the normal place inside the skull. While generally a congenital preexisting condition, it may have been asymptomatic and undiagnosed until aggravated by trauma. This in turn may compress portions of the brainstem and upper spinal cord, causing severe headaches, dizziness, vertigo, clumsiness, vision problems, spastic movement of limbs, and numbness or weakness in arms and legs. It may lead to paralysis.

A woman was a brilliant, successful professional when she was involved in an apparently minor car wreck. Doctors viewed her debilitating pain with skepticism, accusing her of malingering. She was disabled from her successful business career and virtually bedridden for years, going to close to 100 doctors before finally finding one who understood the traumatic aggravation of a previously asymptomatic congenital Chiari malformation, and how to treat it. After finally finding a medical team that knew how to treat the traumatically aggravated Chiari malformation, she recovered a good quality of life and launched a successful new career.

Recently, our firm recovered insurance policy limits of almost a million dollars for a young woman with a preexisting congenital Chiari malformation whose condition had been dormant several years before a collision with a commercial truck. Doctors who first saw her after this collision had limited understanding of Chiari malformation. Fortunately, she found her way to a neurologist deeply experienced in treating this condition. With seasoned medical care, her symptoms improved. With lawyers who understood the long-term implications of Chiari malformation, she recovered the maximum amount of money available without having to go through years of litigation and trial.

Syringomyelia is a condition of the spinal cord more often than not closely related to Chiari malformation. It is characterized by a fluid-filled cavity or cyst known as a syrinx that forms within the spinal cord. A syrinx can expand over time compressing or destroying the surrounding nerve tissue. Frequently seen symptoms include pain in the shoulders and neck, muscle weakness, pain and stiffness in the legs, numbness or decreased sensation, especially to heat and cold, scoliosis (abnormal curvature of the spine), muscle contractions, and ataxia (uncoordinated movements). It may eventually lead to paralysis and death.

There are several congenital or idiopathic causes of syringomyelia, but it also may be caused or severely aggravated by trauma in an accident. Posttraumatic syringomyelia is the term used for cases that result from trauma. Such injuries often are initially diagnosed as a mere whiplash.

World famous golfer and prominent Atlanta lawyer Bobby Jones acquired traumatic syringomyelia in a freak accident in 1929. His symptoms gradually became noticeable before he was finally diagnosed in 1950. Over the years, he progressed from leg braces, a cane,  walker,  wheelchair, and finally was confined to bed.

We represented a woman with traumatic syringomyelia who was fortunate to get to a highly rated neurosurgeon who was able to relieve excess pressure from the syringe in her spinal cord. We were able to recover before trial the maximum of all insurance coverage available. She went on to become prominent in advocacy for people with syringomyelia while developing a successful real estate sales career.

If you or a loved one has received a diagnosis of Chiari malformation or syringomyelia after a truck crash or other traumatic injury, call us at 404-253-7862.

Johnson & Ward has been a leading personal injury specialty law firm in Atlanta since 1949.
Ken Shigley is a former president of the State Bar of Georgia (2011-12), triple board certified by the National Board of Trial Advocacy, recipient of the Traditions of Excellence Award for lifetime achievement, and was lead author of Georgia Law of Torts: Trial Preparation and Practice (2010-21). He graduated from Furman University and Emory University Law School.
John Adkins specializes in personal injury and wrongful death litigation. He is an honor graduate of Kennesaw State University and Thomas Jefferson School of Law in San Diego.
Ed Stone specializes in personal injury and wrongful death litigation. He is a graduate of Kennesaw State University and John Marshall Law School in Atlanta.

For decades, I have represented the victims of catastrophic car and truck crashes. The most seriously hurt among them, with brain and spinal cord injuries, owed their survival in the days and weeks after injury to treatment in trauma centers and Intensive Care Units (ICU). Only later were they even eligible to benefit from excellent rehabilitation programs such as those at Shepherd and Emory.

Now ICU capacity at Georgia hospitals is virtually exhausted due to treatment of Covid-19 patients, about 97% of whom are unvaccinated. Both the physical capacity of hospitals in terms of ICU bed space and the human capacity in terms of trained staff are at a breaking point.

Ambulances transporting injury victims are being diverted from hospitals that are over capacity with unvaccinated Covid patients. Both hospitals with  Level 5 trauma centers in metro Atlanta,   Grady Hospital, and Wellstar Atlanta Medical Center,  this week are on “total diversion,” as emergency and ICU rooms are full. A trauma victim who normally would go straight to one of these hospitals, may not get in. Piedmont, Northside, and Emory Midtown are also diverting emergency patients because they are over capacity with most-unvaccinated Covid patients. Even if a trauma victim is accepted in an ER, there may be severe delay of treatment due to saturation of hospital capacity.

A friend who was a long-time ICU nurse at a major Atlanta hospital spent her last several months before retirement in the “war zone” of the first wave of Covid-19.  Like many dedicated medical personnel, the demands of the pandemic drove her to the decision to retire for the protection of her health and the well-being of her family. Seasoned ICU nurses are not easily replaced.

If a loved one is badly injured in Georgia today, with life depending on access to the best medical care, such access may be delayed by the decisions of people who chose not to get a readily available vaccine.

If you are hesitant to be vaccinated against Covid-19, remember that it’s not all about you. If your decision to forego vaccination lands you in a crowded ICU, it could be fatal to some innocent person suffering an unrelated injury or other medical crisis.

Call us today at our Atlanta office 404-253-7862 or submit your inquiry online, and find out if we can help.

A senior counsel in the firm of Johnson & Ward, Ken Shigley is a 2019 recipient of the “Tradition of Excellence” Award from the State Bar of Georgia General Practice & Trial Section.

Mr. Shigley is the first Georgia lawyer to earn three national board certifications in his practice area from the National Board of Trial Advocacy – in Civil Trial Law, Civil Practice Law. and Truck Accident Law. He is one of only three Georgia lawyers to earn board certification in Truck Accident Law. He has served as a board member of the Academy of Truck Accident Attorneys, and former chair of the American Association for Justice Motor Vehicle Collision, Highway & Premises Liability Section, which includes the Trucking Litigation Group. 

He is lead author of Georgia Law of Torts: Trial Preparation and Practice, now in its eleventh annual edition with Thomson Reuters West. His law practice is focused on catastrophic injury and wrongful death including those arising from commercial trucking accidents and those involving brain, neck, back, spinal cord, amputation, and burn injuries. 

In 2011-12, Mr. Shigley was president of the State  Bar of Georgia, which includes all the lawyers and judges in Georgia.  He also is a former chair of the Institute for Legal Education in Georgia (board member 2008-2020, chair 2012-13),  State Bar of Georgia Tort & Insurance Practice Section (1994-95), and the Georgia Insurance Law Institute (1994). A former prosecutor and former insurance defense lawyer, Mr. Shigley is a graduate of Furman University and Emory University Law School. Mr. Shigley is a widower, father of two adult children, and an elder in his church. 

In 2015, the Supreme Court of Georgia recognized that Georgia law of negligent entrustment follows the Restatement (Second) of Torts § 390, without reservation or exception. Restatement § 390 provides:

One who supplies directly or through a third person a chattel for the use of another whom the supplier knows or has reason to know to be likely because of his youth, inexperience, or otherwise, to use it in a manner involving unreasonable risk of physical harm to himself and others whom the supplier should expect to share in or be endangered by its use, is subject to liability for physical harm resulting to them.

Zaldivar v. Prickett, 297 Ga. 589, 602-03, 774 S.E.2d 688, 697 (2015), et cit. (Majority opinion by Justice Blackwell, dissent by Justice Benham on apportionment issue only).

A 1997 Court of Appeals decision said that the Georgia rule on negligent entrustment is narrower than the Restatement rule, requiring actual rather constructive knowledge. Carolina Cable Contractors, Inc. v. Hattaway, 226 Ga.App. 413, 416 (4), 487 S.E.2d 53 (1997)(Smith, J.) (physical precedent only). However, because that decision is “physical precedent only” it is not binding on lower courts.

Moreover, circumstantial evidence can be used to prove actual knowledge. Carolina Cable, 226 Ga. App. at 416-17.  The direct evidence of degrees of actual knowledge is circumstantial evidence from which jurors may reasonably infer a greater degree of actual knowledge than that to which a trucking company admits.

The Federal Motor Carrier Safety Regulations, 49 CFR § 391.23, requires interstate motor carriers to investigate the driving background of driver applicants. “The investigation may consist of personal interviews, telephone interviews, letters, or any other method for investigating that the carrier deems appropriate.” 49 CFR § 391.23 (c)(2). The minimum required includes requests for information to prior employers and checking state motor vehicle records.

However, that is only the “minimum” required. 49 CFR § 391.23(d). “By the regulations’ own terms, employers may investigate driver employment histories and driving records beyond the minimum standards established by the regulations themselves. The trucking industry’s needs and concerns involving drivers extend to a range of past accidents, incidents, mishaps, occurrences and events well beyond those encompassed by § 390.5.” Cassara v. DAC Services, Inc., 276 F.3d 1210, 1225 (10^th Cir., 2002) It is a floor not a ceiling, for checking driver backgrounds. If a motor carrier has actual knowledge of a collision within the previous three years that is not revealed in those records, a duty arises to check the accuracy of the driver applicant’s self-serving description of the incident.

A Plaintiff may get to a jury “by showing that an employer had actual knowledge of numerous and serious violations on its driver’s record, or, at the very least, when the employer has flouted a legal duty to check a record showing such violations.” Mastec North America, Inc. v. Wilson, 325 Ga.App. 863, 755 S.E.2d 257, 259-60 (2014); Western Indus. v. Poole, 280 Ga.App. 378, 380(1), 634 S.E.2d 118 (2006); Smith v. Tommy Roberts Trucking Co., 209 Ga.App. 826, 829–830(3), 435 S.E.2d 54 (1993).

Circumstantial evidence of knowledge of such factors of incompetency is sufficient to create a question of fact for jury determination on the issue of negligent entrustment. It is sufficient to show knowledge on the part of the entruster by presenting facts from which it could reasonably be inferred that the entruster knew of the driver’s poor driving habits or skills. CGL Facility Management, LLC v. Wiley, 328 Ga. App. 727, 732-33 (2), 760 S.E.2d 251 (2014) (allowing the claim to go to the jury because there was a question of fact where the employer could have had knowledge of the driver’s incompetence based on prior incidents); Dougherty Equipment Co., 327 Ga.App. 434, 439(2), 757 S.E.2d 885 (2014); Ed Sherwood Chevrolet v. McAuley, 164 Ga.App. 798, 802(1), 298 S.E.2d 565 (1982). Cf., Gill Plumbing Co., Inc. v. Macon, 187 Ga.App. 481, 483 (2) 370 S.E.2d 657, 659 (1988)(sufficient to show facts from which knowledge of driver’s poor driving habits or skills could be inferred).

Even if any one of these factors standing alone might be enough to create a jury question on negligent entrustment, the overlapping combination of several pertinent factors may be sufficient to authorize jurors to rationally conclude that a trucking company was aware that it was unsafe to entrust an employee to operate a large truck, at least without further training or in some instances evaluation of sleep disorders.

Such claims are extremely fact-sensitive and must be evaluated in light of the specific combination of facts in each case.

If you have questions about a serious injury or wrongful death case in Georgia, contact us at 404-253-7862.

Ken Shigley is a 2019 recipient of the “Tradition of Excellence” Award from the State Bar of Georgia General Practice & Trial Section.

Mr. Shigley is the first Georgia lawyer to earn three national board certifications in his practice area from the National Board of Trial Advocacy – in Civil Trial Law, Civil Practice Law and Truck Accident Law. He is a board member of the Academy of Truck Accident Attorneys, and former chair of the American Association for Justice Motor Vehicle Collision, Highway & Premises Liability Section, which includes the Trucking Litigation Group. 

He is lead author of Georgia Law of Torts: Trial Preparation and Practice, now in its tenth annual edition with Thomson Reuters West. His law practice is focused on catastrophic injury and wrongful death including those arising from commercial trucking accidents and those involving brain, neck, back, spinal cord, amputation and burn injuries. 

In 2011-12, Mr. Shigley was president of the State  Bar of Georgia, which includes all the lawyers and judges in Georgia.  He also is a former chair of the Institute for Legal Education in Georgia (board member 2008-2019, chair 2012-13),  State Bar of Georgia Tort & Insurance Practice Section (1994-95), and the Georgia Insurance Law Institute (1994). 

A former prosecutor and former insurance defense lawyer, Mr. Shigley is a graduate of Furman University and Emory University Law School. He is a widower,  father of two adult children, and an elder in his church.

When my children were riding a bus to elementary school every day, like most parents I trusted the school bus driver to deliver them safely to school and back to our neighborhood. Usually that is what happens as school buses are generally considered the safest means of transporting children to and from school.

But occasionally children are seriously injured or killed in the process of being transported by school buses. We have successfully handled some of those cases.

School bus injury cases are not the same as car wreck cases. Lawyers handling those need to know the legal wrinkles unique to school bus personal injury and wrongful death cases in Georgia.

The biggest wrinkle in school bus injury cases is immunity.  Sovereign immunity, or governmental immunity, is the legal doctrine that the state (“sovereign”) is immune from civil suits unless it waives that immunity.  In Georgia, public schools have sovereign immunity from most injury claims. When we get calls about kids injured at school, about 99% of the time I have to tell folks they don’t have a case. I won’t take up space here to outline the extremely narrow exceptions for injuries at school.

Similarly, official immunity protects government officials and employees from liability for discretionary acts but not ministerial acts.

A ministerial act is one that is simple, absolute, and definite, arising under conditions admitted or proved to exist, and requiring merely the execution of a specific duty. A discretionary act, however, calls for the exercise of personal deliberation and judgment, which in turn entails examining the facts, reaching reasoned conclusions, and acting on them in a way not specifically directed.

Official immunity protects public officers acting in their official capacity from suit unless they negligently perform a ministerial duty or act with actual malice or intent to cause injury while performing a discretionary duty. While a departmental policy requiring certain actions under certain situations may convert an activity from discretionary to ministerial, the decision whether specific acts are ministerial or discretionary is determined by the facts of the particular case. If the public employee must balance multiple factors and consequences, that makes the act discretionary. Standard v. Hobbs, 263 Ga.App. 873, 589 S.E.2d 634 (2003).

Sovereign immunity and official immunity are not the same thing and often must be analyzed separately. Primas v. City of Milledgeville, 296 Ga. 584, 769 S.E.2d 326 (2015)

Generally, the task of school officials “to monitor, supervise, and control students is a discretionary action protected by the doctrine of official immunity” are discretionary and thus immune from liability. That includes virtually all issues of supervision of students. See, e.g., Payne v. Twiggs County School Dist., 232 Ga.App. 175501 S.E.2d 550127 Ed. Law Rep. 448 (1998). Qualified immunity protects individual public agents from personal liability for discretionary actions taken within the scope of their official authority, and done without wilfulness, malice, or corruption. Under Georgia law, a public officer or employee may be personally liable only for ministerial acts negligently performed or acts performed with malice or an intent to injure. The rationale for this immunity is to preserve the public employee’s independence of action without fear of lawsuits and to prevent a review of his or her judgment in hindsight.

The main exception to sovereign immunity in Georgia public schools is for injuries while a child is being transported by school bus as the legislature by statute has waived immunity for negligent use of a local government motor vehicle up to a limited dollar amount. Generally, sovereign immunity is waived with regard to injuries or deaths that arise out of negligent use of a covered motor vehicle up to either $500,000 per person and $700,000 per incident, or a higher amount if the local government entity adopts by resolution or ordinance a higher waiver, and either becomes part of an interlocal risk management agency or purchases liability insurance in such higher amount.

A 1991 amendment to Ga. Const. of 1983, Art. I, Sec. II, Par. IX extending sovereign immunity “to the state and all of its departments and agencies” includes county-wide school districts.

This sovereign immunity “can only be waived by an Act of the General Assembly which specifically provides that sovereign immunity is thereby waived and the extent of such waiver.” If a student is injured in a collision with another vehicle, then sovereign immunity is waived to the limited extent provided by statute. Coffee County School District v. King, 229 Ga.App. 143, 493 S.E.2d 563 (1997),

At least three Georgia statutes are involved in this issue.

First, O.C.G.A. § 33-24-51 provides for waiver of governmental liability “for a loss arising out of claims for the negligent use of a covered motor vehicle,” but only “to the extent of the amount of insurance so purchased.”

Second, O.C.G.A. § 36-92-2 provides for waiver of “sovereign immunity of local government entities for a loss arising out of claims for the negligent use of a covered motor vehicle” up to $500,000 for injury or death of any one person in any one occurrence, or up to $700,000 aggregate for two or more people, for incidents after January 1, 2008. Paragraph (b) provides, “The sovereign immunity of local government entities for a loss arising out of claims for the negligent use of a covered motor vehicle is waived only to the extent and in the manner provided in this chapter and only with respect to actions brought in the courts of this state.” It also provides for $50,000 limit on property damage claims.

O.C.G.A. § 36-92-2(d) further provides, “(d) The waiver provided by this chapter shall be increased to the extent that: (1) The governing body of the local governmental entity by resolution or ordinance voluntarily adopts a higher waiver; (2) The local government entity becomes a member of an interlocal risk management agency created pursuant to Chapter 85 of this title to the extent that coverage obtained exceeds the amount of the waiver set forth in this Code section; or (3) The local government entity purchases commercial liability insurance in an amount in excess of the waiver set forth in this Code section.”

Third, O.C.G.A. § 20-2-1090, provides, “The various school boards of the counties, cities, and independent school systems employing school buses are authorized and required to cause policies of insurance to be issued insuring the school children riding therein to and from school against bodily injury or death at any time resulting from an accident or collision in which such buses are involved. The amount of such insurance shall be within the discretion of the respective boards.”

So what happens if a child is injured or killed in a school bus incident that does not arise out of “negligent use of a covered motor vehicle?” This has come up in cases where a child was left for hours on a parked school bus, or was injured in an assault by another student.

Last year, in a case in which a special-needs middle school student was left locked in a school bus parked in the school’s transportation-system parking lot after school for hours, the Georgia Supreme Court has held that O.C.G.A. § 20-2-1090, which authorizes school systems to purchase insurance on school buses, does not waive sovereign immunity of a school district to the extent of such insurance. Fulton County School District v. Jenkins, 347 Ga. App. 448, 820 S.E.2d 75 (2018). Any such waiver of sovereign immunity must be express rather than implied. While other statutes expressly waive sovereign immunity to limited extent, O.C.G.A. § 20-2-1090 does not.

In scenarios arising out of negligent operation of a school bus, sovereign immunity it is waived up to the amounts set forth in O.C.G.A. § 33-24-51.Tift County School Dist. v. Martinez, 331 Ga.App. 423771 S.E.2d 117 (2015).

There have been numerous appellate court decisions deciding whether immunity was waived in specific circumstances. Here are just a few illustrative cases.

Sovereign Immunity waived:

• Loading at school and the process disembarking from buses until a child reaches the curb. DeKalb County School Dist. v. Allen, 254 Ga.App. 66, 561 S.E.2d 202 (2002).
• Child was injured attempting to cross an adjacent street just moments after disembarking from the school bus as “use” of the school bus encompassed unloading the children and assuring that they reach a place of safety which might include crossing a street while bus was “standing guard” with it lights flashing and all visual signals operating.  Georgia Farm Bureau Mut. Ins. Co. v. Greene,174 Ga.App. 120, 329 S.E.2d 204 (1985)

Sovereign Immunity not waived:

• One student attacked by another student shortly after they exited a school bus, as no collision or accident was involved. Rawls v. Bulloch County School District, 223 Ga.App. 234477 S.E.2d 383 (1996), certiorari denied Feb. 14, 1997. “When a student riding on a school bus suffers an injury that is not proximately caused by an accident or collision in which the bus is involved, such as when the student is injured due to an attack made by a fellow student, OCGA § 20–2–1090 is inapplicable.” Payne v. Twiggs County School Dist., 269 Ga. 361, 362(1), 496 S.E.2d 690 (1998).
• Child struck while waiting at a bus stop. Brock v. Sumter County School Bd., 246 Ga.App. 815, 542 S.E.2d 547 (2000).
• Child is struck by a car when walking home from an unauthorized drop-off site on a busy road when the bus had driven two miles away, as “use” of the bus does not encompass the school district’s route planning. Roberts v. Burke County School Dist., 267 Ga. 665, 482 S.E.2d 283 (1997).
• Grandparents boards bus without authorization to try to discuss with bus driver child’s suspension due to abusive conduct and falls getting off the bus. Hancock v. Bryan County Bd. of Educ., 240 Ga.App. 622, 522 S.E.2d 661 (1992).

If a school bus driver drops off a child at an unapproved, unsafe location, there may be waiver of immunity but not if the school district’s insurance policy defines “use” of the bus so as to exclude this. Roberts v. Burke County School Dist., 267 Ga. 665, 482 S.E.2d 283 (1997).

Thus, in evaluating injury cases arising from school bus operations, a lawyer should consider the following steps:

• Investigate the incident.
  • Get the police report.
  • Immediately send open records requests to both the law enforcement agency for any photos, video and witness statements they may have. There may have been a video on the bus.
  • Interview witnesses insofar as possible.
  • Determine what security cameras may have been in the area and obtain their recordings.
  • Since the waiver of sovereign immunity is limited, investigate possible liability of other potential parties.
• Send Open Records requests to school district for:
  • Copy of each insurance policy applicable to the bus.
  • Copy of any interlocal government risk management agreement applicable to the bus.
  • Copy of each resolution, ordinance or rule adopted setting an amount for waiver of sovereign immunity.
  • Copies of all policies and procedures regarding bus operation, maintenance, and job descriptions of personnel involved in operation and maintenance.
• Request insurance coverage information from the insurer under O.C.G.A § 33-3-28, and refer to that statute in addition to the Open Records Act in the letter to the school district.
• Review Federal Motor Vehicle Safety Standards
  • 571.213 Standard No. 213; Child restraint systems.
  • 571.213;49 CFR § FMVSS213Outline Safe, Ride News Publications
  • 571.225 Standard No. 225; Child restraint anchorage systems
  • 571.208 Standard No. 208; Occupant crash protection.
• Obtain and review reference materials on school bus safety.
  • Georgia Department of Education School Bus Safety Materials
  • Georgia Department of Education Transportation Rules
  • Georgia School Bus Driver Training Manual (download)
  • Georgia Commercial Drivers License Manual, Chapter 10
  • School Bus Safety Handbook
  • The School Bus Challenge CD
  • CDL Exam Secrets – Passengers & School Bus Endorsements

If you have questions about a serious injury or wrongful death to a school bus passenger in Georgia, contact us at 404-253-7862.

 is a past president of the State Bar of Georgia, past chair of the State Bar’s Tort & Insurance Practice Section, past chair of the Georgia Insurance Law Institute, past chair of the American Association for Justice Motor Vehicle Collision, Highway & Premises Liability Section, and a member of the board of governors of the Academy of Truck Accident Attorneys. He is lead author of Georgia Law of Torts: Trial Preparation & Practice (Thomson Reuters West, 2010-2018). His law practice is focused on catastrophic injury and wrongful death including those arising from commercial trucking accidents and those involving brain, neck, back, spinal cord, amputation and burn injuries. He is licensed to practice law in Georgia. Representation of clients in others states, which possible, can be undertaken only in strict compliance with the multijurisdictional practice and pro hac vice rules of the other state.

No matter how many years a lawyer has practiced, there is no end to the need for exposure to bright new ideas from the best lawyers around the United States.

Over the past year, I had the opportunity to serve as chair of the Motor Vehicle Collision, Highway and Premises Liability Section of the American Association for Justice (AAJ). The largest section of AAJ, it encompasses the work of most “meat and potatoes” personal injury and wrongful death lawyers in America.

The section includes over 2,500 trial lawyers in all 50 states and specialized litigation groups on trucking litigation, bus litigation, traumatic brain injury (TBI), spinal cord injury (SCI), motorcycle litigation, bicycle litigation, resorts torts litigation and inadequate security litigation. The section and its litigation groups have active listservs for exchange of bright ideas.

Having worked for decades in all of these areas of personal injury litigation, chairing the section for a year was like a year of graduate school in my practice area.

After I became chair last year in Montreal, we sponsored national continuing legal education programs in New Orleans and Los Angeles, and I was moderator of an advocacy seminar at Boca Raton.  Presentations in our programs in the past year in seminars at Montreal, Boca Raton, New Orleans and Los Angeles included:

• Accident Investigation and Reconstruction in Motor Vehicle Cases
• Bus Cases Are Different From Auto Cases: Investigation and Evidence
• Cross-Examination of A Defense Medical Examiner, With Rules Of The Road™
• Daubert Motions In Motor Vehicle And Premises Cases
• Industry Standards: Evidence of Negligence in Premises Liability Cases
• Investigation and Discovery in a Sexual Assault Case
• Liability and Causation Defenses in the Typical Auto Case
• Rules Of The Road for Security and Violent Crime Cases
• Trying Better, Faster, And Cheaper!
• Twenty-Minute Auto Wreck Case Voir Dire
• Why I Handle Negligent Security Cases
• Greyhound’s “Most Precious Cargo”
• Making Small Cases Big Cases
• Eliminating the Soft Tissue Myth: Spine Injuries Are Serious
• Deposition
• Practicing In Multiple States
• Using Social Network Sites in Trucking and Motor Carrier Cases
• Trying High-Profile Motor Vehicle and Premises Cases
• Self-Driving Cars and Crash Avoidance Systems: The Future of Car Crashes
• Truck Crash Litigation For The Car Crash Lawyer
• Safe Or Scary: Negligent Security In Schools, Colleges, And Day Care
• Effects And Ethics Of Social Media In A Personal Injury Case
• Taking Down The Defense Medical Examiner
• How To Zealously Represent Victims Of Sexual Assaults While Protecting Your Client
• Auto Defect Cases: The Future Of Your Auto Practice

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Ken Shigley is a past president of the State Bar of Georgia, past chair of the American Association for Justice Motor Vehicle Collision, Highway and Premises Liability Section, and a board certified civil trial attorney of the National Board of Trial Advocacy. His statewide law practice is based in Atlanta.  Ken Shigley is a candidate for election to the Georgia Court of Appeals in 2018.

Most of us today carry cell phones in our pockets with more processing power than the computers aboard the Apollo moon missions. Frequent news reports illustrate the dangers of thoughtless use of smartphones and social media. It has ensnared politicians and celebrities, sometimes crashing promising careers. This technology has created similar hazards for both plaintiffs and defendants in litigation who are careless about online social media privacy. While we are quick to look for the other side’s vulnerabilities, we must also play defense in protecting our clients from their own electronic blunders.

Many people today, especially younger ones, think nothing of sharing details of personal lives with the world through social networking sites. For this very reason, insurance companies, investigators, and defense attorneys may seek to compel access to social media accounts, computers, cell phones, and hard drives. Careless use of social media can be a kind of self-surveillance, a gift to the other side.

Information from such sources may be used to embarrass or discredit you when you are hurt. It may be used to falsely suggest that the your are exaggerating or that something else caused the injury. Even innocent joking between friends on social media might convince judges and juries that a plaintiff has been dishonest.

Here are ten precautions to avoid self-inflicted wounds through use of social media – Facebook, Twitter, Instagram, etc.

1. Archive the content of current accounts. Destruction of potential evidence may create bigger problems than the information itself. Therefore, it is important to preserve the current content of any social media accounts. Most social media sites include directions for archiving. We designate a staff person to help clients archive correctly.
2. Deactivate or discontinue using social media accounts. If you are going to be the plaintiff in a personal injury case, consider deactivating your Facebook profile and other social media accounts.  If you are not willing to completely deactivate an account you should—after archiving content —remove any information related to your injury or activities and avoid future posts.
3. Turn on the highest privacy setting. If you won’t discontinue use of social media, adjust privacy settings to the highest levels. This means making sure that only actual friends can see the information, rather than friends of friends or the general public. A useful tool is Facebook’s “View As” feature, which allows users to view their profile as it appears to someone else, whether a stranger or a Facebook friend. This might help you see exactly what is visible to the general public, something that isn’t always apparent from privacy settings. Be aware that Facebook publicly publishes “Interests,” even if accounts are otherwise private.
4. Beware of “friends.”  If social media use continues, it is important to edit “friend lists” so that only certain friends can see photo albums and status updates. Remove any “friends” you do not know well or at all, and accept only friend requests from people you know and trust.
5. Become invisible. You can remove yourself from Facebook search results by selecting “only friends” under the “search visibility” option in their profile settings. You can also remove your Facebook page from Google by unchecking the box for “Public Search Listing” in your Internet privacy settings. Make comparable changes to privacy settings in all other social media accounts.
6. Take down photos. After archiving current content,  remove and un-tag all photos of yourself that are not simple head shots.
7. Be cautious. Assume that anything you write on your social media accounts—including status updates, messages, and wall postings—will at some point be seen by defense lawyers, judges, and juries. Think about how such things might be perceived when viewed out of context.
8. Preserve all computers, tablets, or cell phones. If you lose or destroy an electronic communications device, opposing counsel could try to make it look like deliberate destruction of evidence. It is better to fight a battle over access to your devices than have a judge instruct a jury that it may assume the contents of the discarded or destroyed device would have been unfavorable to you.
9. Don’t send messages or information about the case. Do not send emails, text messages, or “private” social media messages about your claim, health, or activities to anyone except your lawyers. Careless emails and electronic messages can destroy a case.
10. Don’t post on websites or web chat groups. While you may find useful information in online support groups, you don’t own the information you post online. Such information you post is highly searchable. You should not enter any information on dating or insurance websites, post on message boards, participate in or comment on social media “private” groups or blogs, or use chat rooms.

This post is adapted from an article published in the January 2016 issue of Trial magazine by Ken Shigley, a double board certified trial lawyer in Atlanta, Georgia. He has served as president of the State Bar of Georgia, chair of the largest practice area section of the American Association for Justice (Motor Vehicle Collision, Highway & Premises Liability Section), and chair of the Institute for Continuing Legal Education in Georgia board of trustees. He is lead author of Georgia Law of Torts: Trial Preparation & Practice (2010-2016) and a chapter author of the 2016 edition of Handling Motor Vehicle Accident Cases, both published by Thomson Reuters.  He can be reached at ken@shigleylaw.com.   Ken Shigley is a candidate for election to the Georgia Court of Appeals in 2018.

WON’T TAKE ME DOWN

What you see on the outside
Is not what’s inside
Crippled in pain that I feel I must hide

The pain unbearable
Beyond my control
Trying and fighting with my mind body and soul

To get up each day and try to fit in
To work and love and play
I must fight this from within

My mind is strong
My will power on drive
My pain ongoing and long
But deep inside I will strive to survive

I can’t hide my tears
In pain I must cry
My futher my aims my goals full of fear
But who do I talk too
Who will listen
Who will hear

As long as I can walk
And still have my pride
I am going to speak up and talk

You will not knock me down
You will not take my sole
I will fight this pain till I am once again whole

Wrote this for my beautiful courage little sister who battles a life full of pain…. my inspiration
I love you.

(Poem by Jackie Murphy in Ireland, for her sister and our client, Dee Fahy Mathewson. Published by permission)

Ken Shigley is an Atlanta trial attorney focused on serious personal injury and wrongful death cases. He is currently chair of the American Association for Justice Motor Vehicle Collision, Highway & Premises Liability Section. Previously he served as president of the State Bar of Georgia and chair of the board of trustees of theInstitute for Continuing Legal Education in Georgia. He is lead author of Georgia Law of Torts: Trial Preparation and Practice and a board certified civil trial attorney of the National Board of Trial Advocacy.

With over 2,500 members nationwide, the section includes specialized litigation practice groups on Trucking Litigation, Bus Litigation, Traumatic Brain Injury, Spinal Cord Injury, Motorcycle Litigation, Bicycle Litigation, Resort Torts Litigation and Inadequate Security Litigation.

A primary function of the section is to provide high quality national continuing legal education (CLE) programs. Shigley appointed lawyers to be in charge of developing programs for meetings in Boca Raton (February 2016), New Orleans (April 2016) and Los Angeles (July 2016). The section will also seek to increase its offerings of highly focused webinar programs. Shigley has been a frequent speakers at Georgia and national CLE programs for more than 20 years. He has served as chair of the board of trustees of the Institute for Continuing Legal Education in Georgia and as a trustee of the Institute for Continuing Judicial Education in Georgia.

Shigley also appointed people to be in charge of generating contributions to the existing document depository, the section’s email listserv, newsletter and participation in the AAJ Political Action Committee on a bipartisan basis. He is recruiting state liaisons for each of the 50 states and District of Columbia to assist with these functions as well as a study of inflation adjustments in minimum auto insurance requirements in the states.

Other officers of the section are:

Chair-Elect – Wade F. Suthard (Elizabeth, NJ) Responsible for planning and coordinating continuing legal education programs.  He will become section chair at the July 2016 convention in Los Angeles.

Vice Chair – Kenneth H. Levinson (Chicago, IL) Responsible for promoting and growing the Section’s Document Library and Listserv.

Secretary – Matthew A. Nace (Washington, DC) Responsible for long range planning, updating of bylaws as well as traditional Secretary duties.

Newsletter Editor – Jennifer Leonhardt Ojeda (Atlanta, GA) Responsible for soliciting articles and content for the Section’s quarterly newsletter.

Parliamentarian – Jason Studinski (Plover, WI) Membership Coordinator: Responsible for coordinating membership drives and recruitment efforts. Responsible, with the Section Chair and AAJ staff, for informing all Section members about Section meeting, education programs, and events as well as all other relevant event information. PAC Coordinate state liaisons

Immediate Past Chair – Robert L. Collins (Houston, TX) Liaison with AAJ and Other Sections. (in particular, with the Litigation Group and Section Oversight Committee and the New Lawyers Section).

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Ken Shigley is an Atlanta-based attorney whose practice focuses on serious personal injury and wrongful death cases. He is past president of the State Bar of Georgia, a certified civil trial attorney of the National Board of Trial Advocacy and lead author of Georgia Law of Torts: Trial Practice and Preparation.

For several years I have seen articles about the use of stem cells to mend damaged spinal cords. One of the most promising ideas has been the use of olfactory nerve stem cells from the patient’s own nose.

Now there is a report of this idea moving from animal research to clinical implementation with a human patient. The effect on our representation of paralyzed clients is that we have a new item of potential medical expense to seek that provides hope from recovery.

A Polish paralyzed man is able to walk again after a new therapy that involved transplanting cells from his nasal cavity into his spinal cord.

Derek Fidyka, 40, was paralyzed from the chest down when he was stabbed repeatedly in the back in a knife attack in 2010. Thanks to a pioneering therapy, he can now walk using a frame. The treatment, a world first, was carried out by surgeons in Poland who worked with scientists in London.

He said walking with the support of a walker was “an incredible feeling”, adding: “When you can’t feel almost half your body you are helpless, but when it starts coming back it’s like you were born again.

Professor Geoff Raisman, chair of neural regeneration at University College London Institute of Neurology, led the London research team. He said what had been achieved was “more impressive than man walking on the moon.”

The treatment used olfactory ensheathing cells (OECs) that are specialist cells that form part of the sense of smell. OECs act as pathway cells that enable nerve fibers in the olfactory system to be continually renewed. In the first two operations, surgeons removed one of the patient’s olfactory bulbs and grew the cells in culture.

Two weeks later they transplanted the OECs into the spinal cord, which has been cut through in the knife attach apart from a thin strip of scar tissue on the right. They had just a drop of material to work with- about 500,000 cells.

About 100 micro-injections of OECs were made above and below the injury. Four thin strips of nerve tissue were taken from the patient’s ankle and placed across an 8mm (0.3 inch) gap on the left side of the cord.

The scientists believe the OECs provided a pathway to enable fibers above and below the injury to reconnect, using the nerve grafts to bridge the gap in the cord.

Before the treatment, Mr. Fidyka had been paralyzed for nearly two years and had shown no sign of recovery despite many months of intensive physiotherapy. He has also been going through an exercise program for five hours per day, five days a week. Fidyka first notices that the treatment had been successful after about three months when his left thigh began to put on muscle.

Six months after surgery, Fidyka was able to take his first tentative steps along parallel bars, using leg braces and the support of a physiotherapist. Two years after the treatment, he can now walk outside the rehabilitation center using a frame. He has also recovered some bladder and bowel sensation and sexual function.

Dr. Pawel Tabakow, consultant neurosurgeon at Wroclaw University Hospital, who led the Polish research team, said “It’s amazing to see how regeneration of the spinal cord, something that was though impossible for many years, is becoming a reality.”

This has not yet been approved by regulatory agencies in the US, but it is an advance that gives hope for the future.

Ken Shigley is an Atlanta-based personal injury and wrongful death trial lawyer. He is past president of the State Bar of Georgia, chair-elect of the American Association for Justice Motor Vehicle Collision, Highway & Premises Liability Section, and a board certified civil trial attorney of the National Board of Trial Advocacy.

In the medical context, doctors and scientists have worked to implement custom-printed materials into the medical world for the past several years we have seen for a while 3D printing of artificial hands and other bony structures.

The first spinal procedure using a 3D-printed vertebra replaced the second vertebra in a 12 year old boy’s neck. The boy had cancer, which was discovered after a traumatic soccer injury. After the procedure, the patient’s head was framed with pins and will remain that way for three months. Dr. Liu Zhongjun, the surgeon who performed the procedure, said the customized 3D printing technology made the disc replacement stronger and more convenient than other procedureNow comes new of another big advancement has come in recent weeks. Surgeons in China performed the first spinal disc replacement implanting a three-dimensional printed vertebra, according to a CNTV report.

The 3D printing technology uses digital models of a patient’s anatomy to construct a “printed”, customizable implant made out of almost any material. While 3D printing isn’t exactly new, using 3D printing to create an orthopedic device could make these expensive items more readily available for the general public.

In June, French spine surgeon Vincent Fiere, MD, performed the first spine surgery using spine device company Medicrea’s customized spine cages created with a 3D printer. The company’s UniD ALIF customized cage is made with polyetherketoneketone and printed to reproduce the anatomical details of the patient’s vertebral plates. When the procedure was performed, the 3D printing technology and applications were still patent-pending.

It has been estimated that the 3D printing market for healthcare alone with generate more than $4 billion by 2018, according to Information Week.  The 3D printed medical costs models could also reduce surgical time, which is significant when average surgery costs $100 per minute.

Bigger medical device companies are also getting into the 3D printing game. Johnson & Johnson’s DePuy Synthes recently partnered with Tissue Regeneration Systems to develop 3D printing technologies as part of Johnson & Johnson’s long-term strategy to grow the company. The partners are working on implants for the large bone segmental defect treatment in trauma and orthopedic oncology. Johnson & Johnson is also putting more funding behind research and development collaborations after investing nearly $1.8 billion in research and development last year.

In a healthcare market that prizes quality outcomes for lower costs, technology such as computer navigation comes with a high price tag whereas 3D printing could become a relatively economical investment. However, it will still be awhile until we can expect hospitals across the nation to house something like a 3D printer capable of printing medical devices.

Most hospitals don’t currently have the technology or the staff to be able to implement this new type of technology. Even advancements with the most promising clinical outcomes take years to really become the standard of care.

Ken Shigley is an Atlanta-based personal injury and wrongful death trial lawyer. He is past president of the State Bar of Georgia, chair-elect of the American Association for Justice Motor Vehicle Collision, Highway & Premises Liability Section, and a board certified civil trial attorney of the National Board of Trial Advocacy. 

Former Olympic swimming champion Amy Van Dyken-Rouen is recovering following surgery to stabilize her spine after her spinal cord was severed at the T-11 vertebra during an all-terrain vehicle accident in Scottsdale, Arizona last week.

The latest report is that she is out of ICU and looking forward to rehab in Denver. Demonstrating a resilient spirit like most of the spinal cord injury survivors we have represented.

Following the accident, the 41 year-old six-time Olympic gold medalist told emergency personnel she had no feeling in her legs or toes, according to The Associated Press, which reported that she severed her spine. She is said to be in good condition despite the seriousness of her injury.

Her husband, Tom Rouen, a punter for the Denver Broncos pro football team, said they are unsure whether she will be able to walk again, and are taking it “day by day.”

Undoubtedly her athleticism will aid her recovery, both physically and mentally. The grit and discipline developed in becoming an Olympic champion will serve her well in the rigors of rehab. Even if she does not walk again, I look forward to seeing her compete in a future Paralympics.

Coincidentally, this week a paraplegic equipped with a brain-controlled exoskeleton kicked off the World Cup soccer competition in Brazil.

The injury occurred when Van Dyken-Rouen struck a curb while riding the ATV in a parking lot outside of a restaurant. The impact sent her over a five- to seven-foot drop-off according to a police report, and she was not wearing a helmet at the time. She was found unresponsive and had to be airlifted to Scottsdale Healthcare Osborn Medical Center.

According to a letter from her family, Van Dyken-Rouen severed her spine at the T11 vertebrae, which came just a few millimeters from potentially rupturing her aorta.

Perhaps the worst physical injury one can suffer is damage to the spinal cord. The most prominent example is Christopher Reeve, who one day was “Superman” and the next was a quadriplegic.  We see some of our clients who have spinal cord injuries as super men and women too.

With our convenient to both the Shepherd Center and Emory, two of the top rehabilitation hospitals in the nation, we are often called by family members of spinal cord injury victims.   In working with people who have such injuries, we have been inspired by the resilience of the human spirit. Both physical and emotional aspects of spinal cord injury are devastating. However, one may work through the depression accompanying spinal cord injury to see that even under such adverse circumstances sometimes still the “glass is half full.”

Although most people know this type of injury can be a devastating diagnosis, not everyone knows there are many different types of spinal cord injuries. The location of the injury along the spinal cord determines what parts of the body are affected. Different types of spinal cord injuries include:

• Cervical Spinal Cord Injury: Affects vertebrae C1-C8 and causes paralysis or weakness in both arms and legs. This is also known as quadriplegia or tetraplegia.
• Thoracic Spinal Cord Injury: Affects vertebrae T1-T12. These injuries can cause paralysis or weakness of the legs along with loss of physical sensation, bowel, bladder and sexual function.
• Lumbar Spinal Cord Injury: Affects vertebrae L1-L5 and result in weakness or paralysis of the legs. This is also known as paraplegia.
• Sacral Spinal Cord Injury: Affects vertebrae S1-S5. Sacral level injuries mainly cause loss of bowel and bladder function as well as sexual dysfunction. They can also cause weakness of paralysis of the hips and legs.

Injuries can also be complete or incomplete. Complete injuries are indicated by a total lack of sensory and motor function below the level of injury, whereas incomplete injuries are marked by some remaining sensation and movement.

While much is taken, often much remains. Many people with spinal cord injuries surmount extreme adversity to lead productive lives. Jim Langevin became a quadriplegic at 16, and is now a Congressman from Rhode Island. Brooke Ellison has been a vent-dependent quad since age 11, but graduated from Harvard with honors. One of our spinal cord injury clients became Ms. Wheelchair California, did adaptive surfing with a movie star, and works with Free Wheelchair Mission providing wheelchairs for people in third world countries. While these are exceptional people, they illustrate the fact that a useful life is still possible after spinal cord injury.

Ken Shigley is past president of the State Bar of Georgia (2011-12), double board certified in Civil Trial Advocacy and Civil Pretrial Advocacy by the National Board of Legal Specialty Certification, and lead author of Georgia Law of Torts: Trial Preparation and Practice.  His Atlanta-based civil trial practice is focused on representation of plaintiffs in cases of castastrophic personal injury and wrongful death.

The short answer is that in handling personal injury and wrongful death cases for individuals and families, I do not require any money up front from clients whose cases I accept. I evaluate the merits of a case much like I would try to evaluate a stock before investing in it. If I take the case, I charge a percentage of what I recover for the client and advance the expenses. Both fees and expenses come out of the recovery from the other side. If we lose, I eat the time and expense invested in the case.

Fees in most personal injury cases are generally one-third of the amount of the recovery, with the percentage escalating if the case is tried, if there is an appeal, etc.  While we prepare every case on the assumption that it will go to trial, about 95% of cases that are well screened and well prepared do settle before trial.  We can’t work for free, and this is how I provide my family and save for retirement, but when necessary to make the numbers work out for a client, I do sometimes make courtesy discounts.

Occasionally, particularly in trucking cases, there is an opportunity to force the other side to pay the attorney fees and expenses. If we can do it, that goes directly to the client’s bottom line because I don’t charge the same fee twice.

Expenses in personal injury and wrongful death lawsuits include filing fees, process servers, expert witnesses, court reporters, medical records, depositions with both stenographic and video recording, fees to treating physicians for their depositions, exhibit preparation, travel expense, etc. Knowing that if we lose, I will eat the expense, I am somewhat conservative about spending money. Case expenses on the types of cases injury and death cases I accept generally run from $2,000 to $5,000 for a routine car wreck case with limited insurance coverage up to ten times that amount, or more, for a complex commercial trucking or premises liability case.

Products liability and medical malpractice cases can easily run up expenses well into six figures. Once I was co-counsel in an automotive products liability case in which an associated firm spent $500,000 on expenses. That’s pretty bold. Frankly, I figured that if frugal Ken had been running that show my expenses might have been closer to $100,000.

If a law firm advances case expenses out of pocket, that is treated as a loan and cannot be deducted from income for tax purposes until such time as the case is lost and the “loan” is written off. That can severely constrain the capacity of a firm to aggressively prosecute cases as they come along.

The U.S. Tax Court recently reasserted that case expenses advanced by a contingent-fee law firm on behalf of its clients are “in the nature of loans” rather than tax-deductible expenses for the law firm. (Humphrey, Farrington & McClain, P.C., v. Commissioner of Internal Revenue).  Like many rulings before it, this case upholds Private Letter Ruling 8246013 (6/30/1982, IRC Sec(s). 162) which states that a law firm “…may not deduct as ordinary and necessary business expenses the various litigation costs advanced for a client on a contingent-fee case…”.

Therefore, in order to free up capital and increase capacity to do what needs to be done to develop serious personal injury and wrongful death cases, I maintain a litigation line of credit with Advocate Capital, which funds most of our case expenses. When cases are settled, the expenses are reimbursed to us out of the recovery. I then pay off the portion of the line of credit allocated to that case, and pass along as a case expense the nominal amount of interest incurred on those expenses. The transaction is a straight pass-through with full transparency and no markups.  Because we and Advocate track every expense by case number, that is a very simple bookkeeping exercise.

The impact on my capacity to aggressively develop major cases is huge. If I need to hire a top national expert witness for a wrongful death or catastrophic injury case, I can do it without worrying about the effect on operating capital in office operation or the need to pay for my daughter’s upcoming wedding. If I need to fly around the country to take depositions in a major case, I can just do it without hesitation. Of course, being inherently frugal, I still buy the cheapest web-saver plane tickets rather than flying first class, and stay at an economy motel when traveling for clients rather than a 5 star hotel.

For example, recently I was hired on an interstate tractor trailer wrongful death case at a time when cash flow was slow. Because I had ready access to adequate capital for case expenses without dipping into savings, there was no delay in hiring the best investigators and experts. The trucking company and its insurer had a “rapid response team” at the accident scene almost before the ambulance arrived. But I was able to have my own “rapid response team” on the way almost immediately after the first call from the client’s family attorney.

This makes a world of difference between weakness and strength, between failure and success.

Of course, I am frugal and don’t spend money on cases needlessly. Expenses are scaled to the potential recovery in the case. Having come up the hard way having to do things cheaply, I still resist spending a dime I don’t have to spend. I still know how to hold case expenses under $1,000 when that is what the case needs, using stock drawings out of medical books rather than custom made medical illustrations, snapshots blown up at the drug store and glued to cardboard rather than professional photos professionally mounted, etc. It’s all a matter of what fits the case.

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Ken Shigley is immediate past president of the State Bar of Georgia, chair of the board of the Institute for Continuing Legal Education in Georgia, lead author of Georgia Law of Torts: Trial Preparation & Practice (West, 2010-13), and double board certified in Civil Trial Advocacy and Civil Pretrial Advocacy by the National Board for Legal Specialty Certification. His Atlanta-based trial practice is focused on catastrophic injury and wrongful death cases arising from commercial truck and bus accidents and unsafe conditions on commercial premises.

This week there is news that researchers at the University of Pittsburgh have developed a still experimental system that enables a quadriplegic to operate a robotic arm with mind control.

The Pitt research team embedded a computer chip with 200 needles into the brain of a woman who became a quadriplegic in a motorcycle accident 8 years ago. Each needle was positioned near  neurons that control a particular arm or hand motion. The computer translates the signals and makes the robotic arm perform the intended task. For the first time since her injury she was able to feed herself.

This device is authorized under an FDA trial which may be extended beyond the initial one year approval. Although it will take perhaps five years or more to make this clinically available, this is a hopeful step toward improving the quality of life for SCI survivors who are quadriplegics.

  Ken Shigley is immediate past president of the State Bar of Georgia. Upon completing his term as State Bar President, he was placed on the “short list” for two Court of Appeals seats by the Georgia Judicial Nominating Commission, though  candidates a generation younger were ultimately chosen. He is currently  secretary of the American Association for Justice Motor Vehicle, Highway & Premises Liability Section, a board member of the Trucking Litigation Group,  chair of the board of the Institute for Continuing Legal Education in Georgia and a Georgia delegate to the American Bar Association House of Delegates. Lead author of Georgia Law of Torts: Trial Preparation & Practice (West, 2010-12), he has an AV Preeminent rating in Martindale-Hubbell Law Directory and Bar Register of Preeminent Lawyers, and double board certification in Civil Trial Advocacy and Civil Pretrial Advocacy from the National Board of Legal Specialty Certification (formerly National Board of Trial Advocacy). In addition, he is listed in Super Lawyers (Atlanta Magazine), Legal Elite (Georgia Trend) and Who’s Who in Law (Atlanta Business Chronicle).

Cruise ships are like floating cities with thousands of passengers on board. Usually a lot more fun than the typical workaday city, but probably no less likely to involve accidents and injuries.

Cruise ship lines cannot guarantee that no one will get hurt aboard, but they do have a responsibility to prevent dangerous conditions on board that can cause serious injury to its passengers. When a cruise ship accident occurs because of poor maintenance, incompetent or  improperly trained employees, inadequate safety equipment or emergency precautions, the cruise  line can be held accountable.

Cruise ship tickets typically have a provision that requires you to file your claim within one year in a specific state and in a particular county within that state. The ticket may also dictate that the case be filed in Federal Court.

People who are injured on cruise ships need a team of a hometown lawyer and a lawyer in the location where suit must be filed. The lawyer back home may handle the damages aspects of the case, such as video depositions of treating physicians and other damages witnesses.  The other half of the team is a maritime law specialist experienced in cruise ship litigation in the location where the ticket terms require a suit be filed.

If you are a Georgia resident seriously injured on a cruise ship, we can handle the “back home” part of of this and make a knowing selection of a maritime lawyer appropriate to handle the liability part of the case in the place where the terms of the ticket require that suit be filed.

I do not expect any favoritism from anyone as cases must be decided on their merits.  But if a friend or family member has a catastrophic injury or wrongful death case, would it be smarter to hire a lawyer based on a sleazy TV ad or to hire one who has recognized credentials and is known to decision makers?

Whether you choose me or someone else, by all means choose a serious lawyer for any serious case. Understand that the lawyers who spend millions on TV ads operate settlement mills, never take cases to trial, and insurance companies know they will generally settle for 10% of fair case value.