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Jury Voir Dire

Robert Blanchard — Tue, 26 Sep 2006 11:03:50 GMT

Voir Dire is the beginning of the jury trial, where potential jurors are questioned and then selected to sit on a case.

Voir dire is not only about uncovering bias and learning about your jurors; it is also your jurors' first opportunity to learn about your case. In previous jury tips, I have often stressed how critical the jurors' first impressions of your case are, how quickly jurors build a framework of your case, and how influential this framework is in shaping how they view the evidence and their verdict decisions (see www.yournextjury.com/jurytip.htm for these tips).
In those tips I have emphasized that 80-90% of jurors are closed to persuasion and locked into their verdicts by the end of opening statements. Keep in mind, however, that your opening statement is not your first opportunity to begin persuading jurors. A properly done voir dire can guide jurors to frame the case in your terms, make them more receptive to your themes, and highlight aspects of the case that will give your strengths added importance in their minds throughout trial. All of this can be done without arguing a position, discussing case information directly, or even using direct pre-conditioning techniques, using a subtle persuasive technique called exposition.

The principle of exposition, as it applies to voir dire, is to let jurors know what the case is about through the topics and phrasing of the voir dire questions themselves. In a theatrical or literary context, exposition is a narrative device used at the beginning of a play, story, or film to give the audience necessary background information and introduce them to the characters, the conflict, and the plot. Keep in mind that you are telling a story during voir dire, and consider how clearly that story is coming through.

In a case about a car accident, a voir dire session revolving around questions about occupations, hobbies, former jury experience, feelings about lawsuits and damages, and opinions about vague principles and values presents jurors with a confusing, disjointed story that leaves them confused about what your case is about. Failing to use exposition wastes a golden opportunity to guide your jurors in building their framework about what the case is about and, more importantly, to persuade them about what is important.

Spend time thinking about not only the topics that you want the jury to focus on, but also about the order of your voir dire questions. The order of the topics you bring up should mirror your introduction of topics, evidence, and themes in your opening statement. For example, a strong expository voir dire in a breach of contract case might begin with questions about experiences with business deals and contracts, delve into experiences and feelings about broken contracts, highlight evidence by asking the jurors if they have ever been involved in dispute with a vendor who refused to remedy faulty products or services, and move into questions about lost revenues, business valuations, and damages. By the end of voir dire, your jurors should know what the case is about, what the defendant or plaintiff did wrong, how the plaintiff was harmed (or was not), and how damages should be defined.

With each question you ask, think about more than the answers your jurors give you; think also about the message that each question sends to the jury. Each question implicitly tells your jurors that the topic of the question is an important topic in the trial, and may tell them even more than that. Questions may give jurors information about the actions of the litigants, and may even give jurors the impression that you are concerned or nervous about certain topics. Lingering too long on a topic, no matter how important (plaintiff attorneys, this often includes feelings about frivolous lawsuits and tort reform), sends the message to many jurors that you are overly concerned and nervous about the topic and is a red flag to many that this reveals a weakness in your case.

When listening to your questions, jurors will assume that the situations your questions present are identical to those involved in the case, so make sure to highlight your strongest evidence, your client's strongest conduct, and the opposing litigant's worst actions in your questions. Defense attorneys, ask your jurors how they feel about an employee who takes 38 unrelated sick days off from work in a year, or how they feel about a plaintiff in an employment lawsuit who applies for only 3 jobs in a year without success and remains unemployed for 18 months. Plaintiff attorneys, ask your jurors if their employer has ever passed them up for promotion in favor of a less-qualified employee of a different race or gender, if their doctor has ever failed to respond to an emergency phone call, or if their contractor has ever gone over budget on their home improvement project without providing adequate justification. These questions not only uncover potential biasing experiences and opinions, they also give the jurors a strong, persuasive sense of what your case is about.

Exposition during voir dire takes a great deal of care and thought, especially when your primary goal is to learn about your jurors and uncover biases. If properly done, jurors will be far more receptive to your matching opening statement and your trial themes, and will be far more likely to view the case in your terms throughout trial.

Originally posted at InjuryBoard by Robert Blanchard

Three Injured in Pensacola Car Accident

Shannon Weidemann — Tue, 11 Mar 2008 16:21:49 GMT

A car accident in Pensacola on Thursday sent three people to the hospital. The accident involved two cars traveling on Mobile Highway. One car flipped and landed on top of the other car.

The first

car was stopped, facing west on Boulder Avenue, then pulled out into the path of McClain's vehicle, which was traveling north on Mobile Highway, troopers said. McClain's vehicle collided with the driver's side of Wiseman's vehicle, causing it to skid sideways and flip.

There were two people in the first car and one in the second. They were all taken to Sacred Heart Hospital to be treated for their injuries. Two of the people were listed in serious condition. The driver of the first car was cited with violating the right of way.

If you would like to learn more about car accidents, please visit InjuryBoard's Car Accident information page.

Originally posted at InjuryBoard by Shannon Weidemann

Injection Procedures

Robert Blanchard — Tue, 25 Jul 2006 16:23:37 GMT

In following up my discussion of the use of steroid blocks to alleviate back pain cased by traumatic injuries, I think many will want to know specifics about the procedure,

Injection Details:
The interval between the injections varies with the steroid preparations used. Since injected methylprednisolone was reported to remain in situ for approximately 2 weeks, the clinician should expect to wait 2 weeks after the injection to assess the patient's response and to administer a repeat injection. However, this 2-week interval may be shortened if using a different steroid (short-acting steroid). Of course, clinical judgment often guides the most appropriate timing in a given patient.
Clinicians and patients often must consider the number of ESIs that should be performed. Studies have demonstrated that patients who did not respond to an initial injection did still show improvement after 1 or 2 more epidural steroid injections. In general, up to 3-4 epidural injections may be performed if clinically indicated. Some clinicians schedule a series of 3 ESIs and proceed with these regardless of the clinical response to the first 1 or 2 injections. However, there are no medical outcome studies to clearly support such a regiment.
The volume of the injection is dictated mainly by the approach used. In cervical and thoracic epidural injections, a total of 3-5 mL may be used for ESIs using the interlaminar approach. However, in transforaminal ESIs, clinicians generally use a total volume of only about 1.5-2 mL. The volume used for lumbar ESIs is slightly greater, generally using 6-10 mL for interlaminar ESIs, up to 20 mL for caudal ESIs, and 3-4 mL for transforaminal ESIs. For interlaminar ESIs, 13 typical corticosteroid doses are 12-18 mg for Celestone and 80-120 mg for Methylprednisolone. Half of these steroid doses are generally used when performing transforaminal ESIs.

Injection Technique:
Cervical, thoracic, and lumbar epidural injections can be approached through translaminar and transforaminal injections. Lumbar epidural injection can be performed using 3 approaches. Translaminar epidural injection refers to injection into the interlaminar space of the spine. Hence, many spine specialists refer to translaminar injection as interlaminar injection. The interlaminar epidural injection can be performed through paramedian or midline approaches. The epidural needle penetrates skin, subcutaneous tissue, paraspinal muscles (paramedian approach) or interspinous ligament (midline approach), and ligamentum flavum. Transforaminal approach is performed by placing the needle in the neuroforamen ventral to the nerve root. The needle is directed in an oblique approach until the tip of the needle touches the posterior lateral portion of the vertebral body, located superior to the intervertebral foramen just under the pedicle. Caudal lumbar epidural injections may be performed by inserting a needle through the sacral hiatus into epidural space at the sacral canal.
As mentioned previously, reports suggest that injection without fluoroscopic guidance (ie, blind injection) result in 30-40% of needle misplacement, including needle tip placement outside the epidural space (eg, intravascular injection) and not at presumed level of pathological process. Therefore, although it is not a standard, it is recommended that ESIs be performed under fluoroscopic guidance and with radiographic contrast documenting appropriate placement in order to improve safety, accuracy, and potential efficacy of ESIs.

Originally posted at InjuryBoard by Robert Blanchard

Police Officer Flipped Vehicle Due to Hydroplaning

Shannon Weidemann — Sat, 10 Feb 2007 14:27:21 GMT

An officer of the Pensacola Police Force flipped his police cruiser while driving on Interstate 10 on January 27th.

It had rained most of the day resulting in standing water on the road. Officer Young was driving 45 miles an hour, which is the speed limit, when he hit a patch of water. His car hydroplaned, ran into the concrete barrier, and flipped over. He suffered minor injuries. There was approximately $20,000 in damage to the vehicle.

Originally posted at InjuryBoard by Shannon Weidemann

Neck Injuries

Robert Blanchard — Tue, 11 Jul 2006 16:27:04 GMT

I was sent this article about the scientific study of neck injuries, as often occur in motor vehicle accidents.

With increasing usage of seatbelts and spread of airbags, fatal traffic accidents have been reduced. The use of seatbelts has also reduced severe-to-fatal neck injuries when the victim hits his/her head on the windshield or other in-car structures. A case-control study recently showed that the combined use of seatbelts and airbags reduced cervical spine injury, although the use of airbags alone is not so effective in this regard. In fact, there are some reports of cervical spine injuries caused by airbag deployment. They suggest that a victim's face collides with the airbag in a frontal collision and that cervical spine injury is caused by both flexion and hyperextension of the cervical spine. Although it is obvious that direct impact on the face can cause neck injury during a motor vehicle accident, there are few studies concerning such accidents, and even in the few studies, cervical spine motion was not examined precisely.

The second cervical vertebra is the most commonly injured level in car occupants. Odontoid fracture is a common type of cervical spine injury in traffic accidents. It is the most common in elderly people in falling accidents. Typically, a victim hits his/her face on the ground or a wall during the accident. Although the injury mechanism still remains controversial, an experimental study showed that the combined forces of horizontal shear and vertical compression produced odontoid fractures.

Cervical spinal cord injury without radiographic abnormality is also common in the elderly. A fall from a standing height is a predominant cause of this injury. Most investigators believe that cervical hyperextension is the main mechanism of injury because most victims have lacerations or contusions on their faces. In fact, some studies using magnetic resonance imaging have revealed that spinal cord injury occurs predominantly at the C3-C4 level, where there are usually few spondylotic changes and the diameter of the spinal canal is wider than in the lower segments. To our knowledge, the reason why the injury often occurs at this level has never been investigated before.

We conducted this study to investigate the precise motion of the cervical spine during direct face impact. In addition, we proposed that the cervical spine would show other motion in addition to extension; in particular, direct face impact would predominantly cause motion of the C1-C2 and C3-C4 segments. Because the age of the general population is advancing, the number of these neck injuries is increasing. We hope that this study contributes to the prevention of neck injuries in traffic and falling accidents.

Results

This study revealed that direct backward impact applied to the face caused not only an extension motion of the cervical spine but also a flexion motion of the upper segments. Consequently, the cervical spine had an S-shaped curvature with upper cervical spine flexion and lower cervical spine extension. This S-shaped curvature was similar to the curvature in cervical retraction. It was revealed in some studies that the cervical retraction consists of lower cervical extension and upper cervical flexion.
Furthermore, our results indicate that the impact location highly influences the patterns of the cervical retraction-like motion. For the forehead load, the C1-C2 segment was flexed, and the lower cervical spine was extended. For the maxilla load, the segments from occiput-C1 through C4-C5 were flexed. In other words, motion of the head influences the retraction-like motion of the cervical spine during direct face impact. More precisely, if the head is flexed more, the upper cervical spine is flexed more, and the inflection point shifts caudally during the impact.

Regarding the difference in cervical spine alignment, 3 subjects with kyphosis had similar retraction-like motion to those with lordosis. However, for the forehead load, their upper cervical spine flexion was higher than that of the other subjects, while for the maxilla load, their upper and middle cervical spine flexion was less. Because the sample size was small, these conclusions have no statistical significance. However, theses results seem to suggest that curvature of the cervical spine influences the patterns of the cervical spine motion.

Regardless of the impact location and cervical spine alignment, the retraction-like motion was observed in all subjects. In an actual frontal car collision or falling accident, most likely the victim is being forced forward with a flexion motion before he/she receives a blow to the face, causing the upper cervical spine to be flexed more than it was in our experiments. We speculate that retraction-like motions observed in this experiment are the main causes of 2 common types of the cervical spine injuries: odontoid fracture and spinal cord injury without radiographic abnormality.

A previous experimental study using cadaver specimens showed that odontoid fracture was produced with the combined forces of horizontal shear and vertical compression. They could not produce the fracture by hyperflexion, hyperextension, horizontal shear, or vertical compression alone. In our study, most of the applied impact load to the face resulted in a posterior shear force to the occipital condyle, and a flexion motion occurred at C1-C2 for both loading conditions. From these results, we explore the possibility that a flexion motion at the C1-C2 segment adds an element of compression force on this segment, and, therefore, odontoid fracture could occur during retraction-like motion.

In cervical cord injury without radiographic abnormality, rupture of the anterior longitudinal ligament has often been reported in postmortem examinations of patients who had died of this injury and in intraoperative findings of the patients. The injury mechanism is thought to be hyperextension of the cervical spine because most victims have facial injuries. However, direct backward impact applied to the face caused a flexion motion of the upper segments of the cervical spine in our experiments. In fact, a previous biomechanical study using spinal units revealed that rupture of normal spinal ligaments is not produced by hyperextension but is easily produced by shear force. Marar and Orth also reported that the mechanism of the injury is a combination of hyperextension and backward shearing forces in the study of cadavers. Therefore, we consider the possibility that the posterior shear force is concentrated on a segment within a length of the cervical spine with an S-shaped curvature, and that ligamentous rupture and spinal cord contusion occur at this level in an actual accident.

Originally posted at InjuryBoard by Robert Blanchard

Accident Leaves Vehicle Wedged Between Two Toll Lanes

Chrissie Cole — Wed, 20 May 2009 20:08:00 GMT

A two-car accident on Saturday left a vehicle wedged on its side between two tollbooths.

Carrie Anne Dolamore, 32, of Pensacola, was driving south toward the Garcon Point Bridge Plaza in the inside lane when she abruptly switched lanes, according to Florida Highway Patrol.

The other driver, Gerald A. Henrikson, saw Dolamore’s vehicle coming toward him head on and was able to stop his vehicle. Dolamore's vehicle swerved left, bouncing off two barriers before rolling onto its die and becoming stuck between both toll lanes.

Henrikson was not injured in the crash and Dolamore was taken to the hospital with minor injuries.

Pending blood work results, Dolamore may be charged in the crash.

Originally posted at InjuryBoard by Chrissie Cole

Steroid Blocks

Robert Blanchard — Tue, 25 Jul 2006 16:09:26 GMT

Many clients who have suffered back injuries in a car accident are recommended to have a steroid block injuection in their back to relieve the pain. Sometimes there are a series of shots.

Epidural steroid injections (ESIs) are an integral part of nonsurgical management of radicular pain from lumbar spine disorders. Radicular pain is described as a sharp, lancinating, and radiating pain, often shooting from the low back down into the lower extremity in a radicular distribution. Radicular pain is the result of a nerve root lesion or inflammation. ESIs have been recommended to deliver steroids in a more localized fashion to the area of affected nerve roots, thereby decreasing the systemic effect of the administered steroid. Studies have indicated that ESIs are most effective in the presence of acute nerve root inflammation.

Several indications for ESIs have been reported in the literature. Although the primary indication is radicular pain associated with a herniated nucleus pulposus, a variety of indications have been reported. Lumbar ESIs may be indicated for lumbar radicular pain associated with any of the following conditions: Lumbosacral disk herniation, spinal stenosis with radicular pain (central canal stenosis, foraminal and lateral recess stenosis), compression fracture of lumbar spine with radicular pain, and facet or nerve root cyst with radicular pain. Cervical ESIs have been used to treat the following conditions: Pain associated with acute disk herniation and radiculopathy, postlaminectomy cervical pain, cervical strain syndromes with associated myofascial pain, and postherpetic neuralgia. Thoracic ESIs have been reported within the medical literature as treatment pain associated with the following conditions: Acute thoracic disk pathology, thoracic radicular pain secondary to disk herniations, postherpetic neuralgia, trauma, diabetic neuropathy, degenerative scoliosis, idiopathic thoracic neuralgia, and thoracic compression fracture.
Absolute contraindications for ESIs include the following: Systemic infection or local infection at the site of planned injection, Bleeding disorder or fully anticoagulated (eg, on a fully 'therapeutic' dose of coumadin, heparin), History of significant allergic reactions to injected solutions (eg, contrast, anesthetic, corticosteroid), Central canal stenosis at the site of planned injection (it is acceptable to enter through the adjacent foramen or via an interlaminar approach 2 segments below).
In addition, fluoroscopy should not be used in epidural injections for women who are pregnant, to avoid exposing the fetus to the fluoroscopy. Use caution when performing injections in patients with poorly controlled diabetes since the corticosteroid injection may transiently increase the blood glucose levels. Use caution when performing injections in individuals who have a history of congestive heart failure because of the potential for steroid-induced fluid retention.

Originally posted at InjuryBoard by Robert Blanchard

Women Killed Car Traveling the Wrong Direction

Shannon Weidemann — Wed, 07 Feb 2007 14:14:23 GMT

A woman from Panama City was killed while driving in the eastbound lane of U.S. Highway 98 in an accident on Friday.

Baheejah T. Jackson, age 26, was traveling westbound in the eastbound lane when he hit the car being driven by Ruth J. Lakey, age 76, head on. Lakey's car was then hit another time by a car driven by Russell Mann, age 69. Lakey was pronounced dead at Sacred Heart. Mann was treated for minor injuries at Sacred Heart in Pensacola. Police are investigating the accident and are unsure if alcohol was involved.

Originally posted at InjuryBoard by Shannon Weidemann

Brain Injury

Robert Blanchard — Mon, 20 Nov 2006 10:32:43 GMT

Most of the serious trauma victims seen in emergency rooms are cases involving motor vehicle accidents. A new study may help change the quality of care for those patients who suffer a brain injuries in such accidents. The conclusion of the study finds that neurosurgeons are rarely needed to intervene. Given the number of traumas and the limited number of neurosurgeons, the study suggests that trauma surgeons be trained in evaluating patients for braiin injury and be qualified to render a number of treatments that now entail the involvement of a neurosurgeon.

Investigators studied this question with the National Trauma Data Bank maintained by the American College of Surgeons. Of the nearly 732,000 patients in the data bank, 29% had a head injury diagnosis, and, of these head-injured patients, only 3.6% required a craniotomy. The median time from injury to craniotomy was 195 minutes, and only 6.5% of craniotomies were performed within 1 hour. In view of the infrequent need for neurosurgical skills, the study authors conclude that immediate access to a neurosurgeon is not required if trauma surgeons or other healthcare providers can appropriately evaluate and monitor head injury patients.
With only about 3400 neurosurgeons in the United States, it is difficult to imagine how such a small group of specialists can supervise the care of an estimated 1.5 million annual head injury patients. The study authors suggest that trauma surgeons should be trained not only in the evaluation of head injuries, but also in some of the more common procedures, such as insertion of intracranial pressure monitors and even drainage of epidural and subdural hematomas. This is clearly a controversial topic, needing additional studies to determine how trauma centers should manage the complicated manpower issues related to the care of patients with head injuries.

Originally posted at InjuryBoard by Robert Blanchard

Jury Duty

Robert Blanchard — Thu, 28 Sep 2006 11:49:33 GMT

We all may dream of being called to jury duty on a notorious murder case, but in reality we are more likely to be asked to sit on a jury involving a motor vehicle accident claim. Many people don't want to serve because of the time it takes away from work and other important personal activities. Our local Courts recognize the sacrifice of jury duty and do everything they can to have the cases move quickly through trial. Much in the process has been streamlined since the days when you would have to show up every day for a week or more just to see if you would be chosen for a jury. Now, all jury selections for the week are over by the end of Monday. Everyone not chosen gets to go home. Those who are called back to sit on a jury through trial may find an unexpected satisfaction in doing their civic duty, even in the most mundane cases.

Originally posted at InjuryBoard by Robert Blanchard