J was crossing a busy high street with her boyfriend when she was hit by a vehicle. She suffered multi facial fractures, fractured pelvis and suffered a very serious head injury. She was taken to a major trauma hospital in London and admitted immediately to the high dependency neurological intensive care unit.
She remained in the NIC unit for several weeks in a critical condition. She had suffered trauma to her right eye with fractures around the eye socket but they were unable to deal with that injury until she stabilised. Her improvement was very slow and it was decided that she would be transferred to the neurological unit at another hospital to commence rehabilitation. Although she was alert on the transfer which was a couple of months after the incident she was not able to communicate and required one to one nursing. She had trouble swallowing and also had problems with mobility. At that time she was fed intravenously until she received input from a speech and language therapist and a dietician. Once her swallowing and mobility improved she was then able to be fed normally.
Slowly communication improved with her family by nodding in responses to simple questions until she was able to spontaneously produce a few words and phrases. Speech and language therapy continues.
Physiotherapy was introduced but she remained in a lot of pain. During this period J slept a great deal during the day and became more alert in the evening but became quite agitated during the night.
Occupational therapy was then commenced alongside physiotherapy. It was ascertained that she had movement in all four limbs and with use of a regular tilt tabling it allowed her to tolerate a seating option. Eventually using a hoist she tolerated transfer to a wheelchair.
She started to react to people laughing and smiling. After a couple of months at the rehabilitation unit at the alternative hospital she was then transferred back to the main trauma hospital where she was originally treated and continued with physiotherapy, occupational therapy, speech and language therapy and also psychology. A case manager was instructed to assist. By September 2017, 7 months after the accident, the multi disciplinary team were working on several areas but she remained living in the rehabilitation unit at the hospital.
The speech & language therapist had worked on orientation and had arranged for her to have several visits out of hospital as part of her therapy visiting a familiar shop. She was struggling to problem solve in unfamiliar surroundings and she was being encouraged to use the map on her phone and use strategies taught by therapists. She lacked initiation to work out where she was or where she was going and could easily get lost. She became very impulsive and used inappropriate language, swearing at therapists and family. She lacked insight into her problems. J was reacting to situations and losing her temper easily and the therapists were worried about her acting in this capacity in the community.
With regard to memory, her long-term memory had started to come back but she struggled with short-term memory even during the therapy meetings consistently repeating herself. She had started having home visits at weekends but she needed one to one assistance and supervision at all times. The plan was to make arrangements for her discharge back to living with her boyfriend and his family. She would be referred to a community neuro team near her home and a vocational rehabilitation service at a local hospital. The Case Manager set up a taxi account for her to access appointments and she would have a support worker to assist once her boyfriend had returned to work. She had lost vision in one eye and required further treatment at a specialist eye hospital.
When she was discharged home approximately 8 months after the accident, she continued to struggle despite a lot of input and eventually her relationship with her boyfriend broke down and she returned to live with her mother and younger brother although she found it difficult to tolerate her younger brother who was only aged about 7. Her mother, who also worked, continued to support her daughter but with difficulty. J became less motivated and even though it was arranged for her to work on a voluntary basis in a shop one day a week she often failed to attend. Her relationship did improve with her brother and J continues to live at home with them. She is now able to access the community and she is aware of her difficulties. She has not been able to return to any form of employment yet.
Initially she was assessed at lacking any capacity to deal with her own affairs and her mother had to make all her decisions for her as her “Litigation Friend”. However after a period of 2 years her GP decided that she was able to make her own decisions and had gained enough capacity to make a Will and deal with her own finances. Progress is now extremely slow but with continuing support from the community and her family she may one day be able to re-establish a meaningful relationship and she may be able to work on a part time basis but it is likely that she may need support from an independent support work and/or family for the rest of her life.
Caroline Flashman, Partner at Barlow Robbins comments:
"She has successfully claimed damages for her claim against the driver but was only able to claim a proportion as there was a deduction made for contributory negligence. If a PI Trust is set up this will allow her access to benefits which she will need during her life."
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