Burn Injuries

My legal practice has involved a number of different types of injuries. Two of the most troubling are burn injuries and brain injuries. Today, in this blog, I would like to talk about burn injuries because they come with a unique set of issues. The pain and suffering is exquisite, the disability is exquisite, and the mechanism of injury as to how they were sustained, thermal burns or otherwise, is exquisitely painful.

As in any case, you look at the medical records and you can see the limitations that the burn victim has. It could be that they cannot kneel, stand, grab, things with their hand or wherever they were burned. Obviously, a full discussion of that is important. You look, of course, at the records of inpatient hospitalization. Some of the burn victims will go to a special unit, a Burn ICU, for example. Moreover, they are usually brought to a leading hospital, a teaching hospital, such as Mass. General, Brigham and Women’s, B.I.Deaconess, Boston Medical Center, Tufts Medical Center, and UMass Memorial Medical Center, to name several of the recipients of the most badly injured. The discharge records are very telling as to the course of treatment and the patient’s expected functional limitations and pain level. Doctors might be reluctant to discharge the patient who, after a long and grueling hospitalization, is eager to go home.

In presenting the case for settlement, mediation, or trial, you look for the many signs of how badly the client was injured. For example, were they given a PICC line (a peripherally inserted central catheter) which is reserved for the most seriously injured. You see if there was a referral made to a burn unit psychiatrist. Who treated the patient? If it is a seriously burned client, chances are that a very prominent physician is the treater. Did they publish in peer review journals? That is an excellent indication of worthy credentials. Did they serve in a combat arena treating soldiers or civilians who were burn victims? With those established credentials, an assessment under the AMA guidelines, the American Medical Association guidelines, should carry much weight. As in any case of serious personal injury, you want an up-to-date examination, months or years after the accident, to get an assessment of what the status is and the future is likely to be. The fact that an eminent doctor is doing the assessment certainly doesn’t hurt.

If the case goes to mediation or trial, your lawyer may choose not to have the client show the actual burns. After all, your client has been exposed enough, for the client has been examined by the burn unit doctor many times. Furthermore, the client might have been examined by the adversary. There is no need to have the client disrobe in a courtroom or in another legal forum, in my opinion.

One of the typical issues of a burn injury patient is neuropathic pain, pain that is neurologic in nature and often that is very severe and incapacitating. The pain might be rated as a 7 or 8 on a 1-10 scale. There is an acknowledged rating schema for burn victims and it is done on an A to D spectrum. D is the worst of the four classes. Where does the client fit on the spectrum? What limitations does the client have? Is the client able to go back to kind of work he or she had? Are his/her hands or legs (or wherever he was burned) unstable or shaky? If a laborer, will that enable him to get up on a ladder or something like that? Has sweating been affected? What about the pain and discomfort of an autografting that was done in one of the burn surgeries?

As with any personal injury case, you can really get a sense from the treating doctor whether the person is totally disabled from work and what kind of physical incapacity they will have. With burn injuries, it is likely to be permanent. There are also some major psychological ramifications but that is the subject for another blog. There is always room for that testimony and it will come from another medical professional.

We know that in every personal injury case we must develop the permanence of the injury and its effects. With burns, those considerations do indeed apply quite obviously, but because burns are so uniquely painful, a good deal of focus needs to be on the initial injury phase. The client will be well-served if that time period is not forgotten or minimized.