ROSARIO INJURIES
Timeline of Medical Evidence and Medical Diagnosis for F. Dylan Rosario (including Physical Damage Reports, Diagnosis, and Prognosis)
Last updated
Timeline of Medical Evidence and Medical Diagnosis for F. Dylan Rosario (including Physical Damage Reports, Diagnosis, and Prognosis)
Last updated
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5 Fractured Ribs: Right side, causing severe pain and breathing difficulties.
Pneumothorax: Collapsed lung on the right side, treated with a pigtail chest catheter.
Spinal Injuries:
Multi-Disc Bulges: In the cervical, thoracic, and lumbar spine.
Chronic Pain: In the neck, mid, and lower back, requiring ongoing physical therapy and facet injections.
Mobility Issues:
Use of a walking cane due to hip and back pain.
and difficulty walking, standing.
and performing daily activities.
Traumatic Brain Injury (TBI):
Structural Changes: Reduced white matter volume in critical brain areas.
Cognitive Impairment: Potential cognitive and neurological deficits due to TBI, including difficulties in concentration, headaches, and dizziness.
Loss of Equilibrium: Resulting in impaired balance and coordination.
Indirect Injury (June 10, 2021):
Broken Shoulder: Right shoulder fracture due to a fall caused by loss of equilibrium from the TBI (permanent acromioclavicular (AC) joint separation) of the right shoulder clavicle .
Primary Hand: Being right handed , loss of capacity to lift and use the right arm 1as would typically be expected.
Cognitive and Emotional Impact:
Difficulty concentrating and performing work-related tasks (e.g., coding).
Persistent headaches and dizziness.
Marked difficulty in memory and concentration.
Emotional distress from the inability to work and pursue pre-accident activities, compounded by the secondary injury.
1. February 4, 2021 - Date of Collision:
Incident: Plaintiff, Franciscus Dylan Rosario, was hit by a Ford Transit 250 van while walking through a crosswalk.
Initial Injuries (as observed by SFFD EMTs , victim was treated at the time and on the site of the collision):
Severe pain on the right side.
Difficulty breathing.
Immediate right-sided chest pain.
2. February 5, 2021 - Day After Collision:
Diagnosis (X-Ray):
5 broken ribs in 8 locations on the right side.
Right-side pneumothorax (collapsed lung).
Treatment:
Hospitalized for 2.75 days in a critical care unit.
Pigtail chest catheter inserted for treatment of pneumothorax.
Manipulation of thoracic rib cage placement for setting rib due to fracture
Released evening February 8th 2021
3. Post-Hospitalization (February 2021 - June 2021):
Ongoing Physical Issues:
Excruciating spinal, chest , cranium, and neck pain.
Debilitating spinal and thoracic pain prevented walking for months
Difficulty standing straight and breathing.
Severe pain affecting daily activities and an inability to care for himself.
Required home care provided by a relative (acupuncturist and massage therapist).
Interrupted sleep due to pain.
4. June 10, 2021 - Secondary Incident (Fall Due to Loss of Equilibrium):
Incident: Plaintiff experienced a loss of equilibrium, likely due to neurological damage from the traumatic brain injury (TBI), resulting in a fall.
Injury: Fractured right shoulder.
Impact: This fall exacerbated the plaintiff’s physical limitations, further impairing his ability to perform daily personal tasks and worsening his overall physical condition.
5. July 13, 2021 - MRI Scans:
Diagnostic Results:
Underwent cervical, thoracic, and lumbar spine MRIs at Kaiser.
MRIs revealed multi-disc bulges in the cervical, thoracic, and lumbar spine.
6. Post-MRI Scans (July 2021 - Early 2024):
Ongoing Treatment:
Prescribed physical therapy.
Underwent cervical facet injections.
Continued suffering from neck, mid, and low back pain.
Use of a cane for back pain.
Significant impact on work and daily activities.
Mobility Issues:
Persistent pain in the back, chest, and ribs.
Difficulty sitting, standing, and performing work tasks.
7. Spring & Summer 2024 - Brain MRI Findings (TBI Diagnosis):
SimonMed Imaging Van Ness Ave, San Francisco CA - STUDY 8-15-2024
Summary of Findings:
Traumatic Brain Injury (TBI): Structural changes consistent with a TBI, likely caused by a coup-contrecoup mechanism.
Grey and White Matter Volume:
Significant reduction in white matter volume, particularly in regions adjacent to the cranial base, such as the basal forebrain, lateral orbital gyrus, and inferior temporal gyrus.
Disparity between grey and white matter volumes, a typical indicator of TBI-related changes.
Regional Volume Reduction:
Notable volume loss in the bilateral basal forebrain, right lateral orbital gyrus, temporal lobe structures adjacent to the cranial base (including the right fusiform gyrus and bilateral inferior temporal gyrus), left temporal pole, and cingulate gyrus (especially the posterior cingulate gyrus).
Interpretation:
The imaging findings support the diagnosis of a marked TBI, with damage patterns typical of coup-contrecoup injuries. The reduction in white matter volume, particularly in critical brain regions, correlates with TBI-related cognitive and neurological impairments.
8. Ongoing Symptoms (Present - August 2024):
Pain and Mobility Issues:
Persistent severe back, chest, neck, shoulder and rib pain.
Continued use of a walking cane.
Chronic pain leading to difficulty sitting, standing, and performing work tasks.
Cognitive Issues:
Frequent headaches, episodes of dizziness, memory loss, and difficulty concentrating.
Likely cognitive and neurological impacts from TBI, as evidenced by MRI findings.
Franciscus Dylan Rosario sustained extensive injuries, both direct and indirect, as a result of a collision on February 4, 2021, where he was struck by a Ford Transit 250 van while walking through a crosswalk. The injuries encompass traumatic brain injury (TBI), spinal damage, chest and rib fractures, and subsequent musculoskeletal injuries due to a secondary fall. The cumulative impact of these injuries has resulted in significant cognitive, physical, and emotional impairments that are expected to persist for the remainder of his life.
Head and Brain Injuries:
Traumatic Brain Injury (TBI): MRI findings revealed significant structural changes in the brain, including a reduction in white matter volume, particularly in the basal forebrain, lateral orbital gyrus, and inferior temporal gyrus. These changes are indicative of a coup-contrecoup injury, with notable volume loss in regions such as the bilateral basal forebrain, right fusiform gyrus, and left temporal pole. The TBI has resulted in cognitive deficits, including difficulties in concentration, memory problems, headaches, dizziness, and a loss of equilibrium, leading to further physical injuries.
Neck and Spinal Injuries:
Cervical, Thoracic, and Lumbar Spine: MRI scans identified multi-disc bulges across the cervical, thoracic, and lumbar spine regions. These bulges are causing chronic pain, which has severely limited the plaintiff’s mobility and ability to perform daily activities. The chronic pain in these areas is persistent and requires ongoing physical therapy, facet injections, and the use of a cane for mobility.
Chest and Rib Injuries:
Fractured Ribs and Pneumothorax: The plaintiff sustained five fractured ribs on the right side, leading to a collapsed lung (pneumothorax), which was treated with a pigtail chest catheter. Despite treatment, chronic chest pain persists, making it difficult for the plaintiff to breathe, stand straight, and sleep comfortably.
Musculoskeletal and Mobility Issues:
Fall and Shoulder Injury: On June 10, 2021, the plaintiff experienced a fall due to a loss of equilibrium caused by the TBI, resulting in a fractured right shoulder. This injury further compromised his ability to perform daily personal tasks, exacerbating his overall physical condition and contributing to a permanent reduction in the range of motion and strength in his shoulder.
General Symptoms and Emotional Impact:
The plaintiff suffers from chronic sleep disruption due to ongoing pain and emotional distress. The combination of physical limitations, chronic pain, and the psychological impact of his injuries has led to emotional distress, anxiety, depression, and a significant reduction in quality of life. The ongoing need for psychological support is anticipated, along with a risk of social isolation due to the compounded challenges.
The long-term prognosis for Franciscus Dylan Rosario is characterized by permanent disabilities that will significantly impact his quality of life. At best, he may achieve partial disability, as his capacity to return to work, which requires long sessions at a keyboard and standing or moving for presentations, will be severely limited. The cumulative effects of the TBI, spinal injuries, chest and rib fractures, and the secondary shoulder injury are expected to result in lifelong pain, mobility impairments, and cognitive deficits.
Head and Brain Injuries (TBI):
Cognitive and Neurological Impacts: The TBI has led to permanent cognitive impairments, including problems with memory, concentration, and executive function. These deficits are expected to persist and may worsen over time, particularly without specialized cognitive rehabilitation. The neurological symptoms, such as headaches, dizziness, and loss of balance, are also likely to remain chronic, necessitating ongoing management with medications and physical therapy.
Neck and Spinal Injuries:
Chronic Pain and Mobility Issues: The multi-disc bulges in the spine are causing chronic pain that will likely persist for the remainder of the plaintiff’s life. The pain will continue to impair mobility, requiring the long-term use of assistive devices such as a cane. Progressive spinal degeneration is anticipated, which could lead to further loss of mobility and the need for surgical interventions in the future.
Chest and Rib Injuries:
Persistent Chest Pain: Although the rib fractures may heal, the plaintiff is expected to experience ongoing discomfort in the chest, particularly during activities involving heavy breathing or physical exertion. This chronic pain may be due to nerve damage or musculoskeletal issues and will contribute to the overall reduction in quality of life.
Musculoskeletal and Mobility Issues:
Permanent Mobility Impairments: The combined impact of the spinal injuries, chronic pain, and the broken shoulder will result in permanently reduced mobility. The plaintiff will likely face a progressive loss of independence over time, requiring more assistance with daily tasks and possibly in-home care or assisted living arrangements. The risk of future falls remains high due to the loss of equilibrium, which could result in additional injuries.
General Symptoms and Emotional Impact:
Ongoing Psychological Challenges: The plaintiff is expected to continue experiencing chronic sleep disruption, emotional distress, and a compromised quality of life. Long-term psychological support will be necessary to manage conditions such as depression and anxiety, which are likely to arise from the ongoing pain, reduced independence, and social isolation.
Overall Long-Term Prognosis:
Permanent Disability and Reduced Life Expectancy: Franciscus Dylan Rosario is likely to be classified as permanently disabled due to the combined effects of TBI, spinal injuries, chronic pain, and mobility impairments. The chronic health conditions, especially those involving significant pain and neurological damage, may reduce his life expectancy. He will require ongoing medical care, including physical therapy, pain management, neurological monitoring, and psychological support. Significant lifestyle adjustments will be necessary to manage daily activities, with a reliance on assistive devices and potentially requiring assisted living arrangements. The cumulative impact of these injuries is expected to result in a severely compromised quality of life, with limited ability to engage in work, hobbies, and social activities.
Traumatic Brain Injury (TBI):
Structural Changes: Reduction in white matter volume, particularly in the basal forebrain, lateral orbital gyrus, and inferior temporal gyrus.
Regional Volume Loss: Significant reduction in regions such as the bilateral basal forebrain, right lateral orbital gyrus, right fusiform gyrus, bilateral inferior temporal gyrus, left temporal pole, and cingulate gyrus.
Cognitive and Neurological Impacts: Likely to include difficulties in concentration, headaches, dizziness, and potential long-term cognitive deficits.
Loss of Equilibrium: Resulting in impaired balance and coordination, leading to further physical injuries.
Cervical Spine Injuries:
Multi-Disc Bulges: Identified through MRI scans.
Chronic Pain: Persistent neck pain requiring cervical facet injections and ongoing physical therapy.
Thoracic Spine Injuries:
Multi-Disc Bulges: Identified through MRI scans.
Chronic Pain: Persistent thoracic (mid-back) pain affecting mobility and ability to sit or stand for extended periods.
Lumbar Spine Injuries:
Multi-Disc Bulges: Identified through MRI scans.
Chronic Pain: Persistent lower back pain, requiring the use of a cane and affecting the ability to perform daily activities.
Fractured Ribs:
5 Fractured Ribs: Located on the right side.
Pneumothorax: A collapsed lung on the right side, treated with a pigtail chest catheter.
Chronic Chest Pain:
Ongoing pain in the right side of the chest, making it difficult to breathe, stand straight, and sleep.
Mobility Impairment:
Use of Cane: Due to persistent back pain, the plaintiff requires a cane for mobility.
Difficulty Walking and Standing: Pain in the back, ribs, and chest affects the plaintiff’s ability to walk, stand, and perform daily activities.
Loss of Equilibrium: As a result of neurological and brain damage, the plaintiff's balance is severely impaired.
Indirect Injury – June 10, 2021:
Fall Resulting in Shoulder Injury: On June 10, 2021, the plaintiff experienced a loss of equilibrium due to neurological damage from the TBI, resulting in a fall that broke his shoulder.
Additional Mobility and Functional Impact: The shoulder injury further compromised the plaintiff’s ability to perform daily personal tasks and worsened his overall physical condition.
Broken Shoulder:
Right Shoulder Fracture: Resulting from the fall on June 10, 2021, due to impaired balance.
Loss of Function: The shoulder injury compounded the plaintiff’s difficulties in performing tasks that require the use of his arms and shoulders.
Pain Radiating to Lower Extremities:
Chronic lumbar spine issues could lead to pain radiating down to the hips, legs, and feet, further impairing mobility.
Headaches and Dizziness:
Likely related to the TBI, contributing to cognitive difficulties and overall discomfort.
Sleep Disruption:
Chronic pain from the various injuries has led to interrupted sleep, exacerbating fatigue and affecting the plaintiff’s daily functioning.
Emotional Distress:
Resulting from the chronic pain, cognitive issues, and inability to work or engage in pre-accident activities.
Further Emotional Trauma:
The fall and subsequent shoulder injury likely added to the plaintiff’s emotional distress, as it further diminished his independence and ability to manage daily life.
Head and Brain: TBI with structural brain changes, cognitive difficulties, headaches, dizziness, and impaired balance.
Spine: Multi-disc bulges in cervical, thoracic, and lumbar regions with chronic pain.
Chest and Ribs: 5 fractured ribs, pneumothorax, chronic chest pain.
Mobility: Use of cane, difficulty walking, standing, and performing daily activities. Loss of equilibrium leading to falls and further injuries.
Upper Extremities: Broken right shoulder due to a fall resulting from loss of balance.
Lower Extremities: Pain radiating from lumbar spine to hips, legs, and feet.
General Symptoms: Sleep disruption, emotional distress, and overall reduced quality of life.
Given the extensive injuries sustained by Franciscus Dylan Rosario, the prognosis for recovery and long-term expectations can be outlined as follows:
Recovery Prognosis:
Cognitive Deficits: The reduction in white matter volume and regional brain damage is likely to result in persistent cognitive difficulties, including problems with memory, concentration, and executive function. These issues are likely to be chronic and may worsen over time, especially if not managed with cognitive rehabilitation.
Neurological Symptoms: Symptoms such as headaches, dizziness, and loss of balance (equilibrium) are expected to persist. Given the brain's structural changes, complete recovery is unlikely. The patient may require long-term management, including medications for pain and dizziness, as well as physical therapy to help with balance.
Emotional and Psychological Impact: The TBI is also likely to contribute to emotional and psychological challenges, including mood swings, depression, and anxiety. These conditions may require long-term psychological or psychiatric care, including therapy and medication.
Long-Term Expectations:
Permanent Cognitive Impairments: The cognitive deficits are likely to be permanent, affecting daily life activities, work capabilities, and overall quality of life.
Risk of Further Neurological Decline: There is a risk of further neurological decline over time, particularly if the brain injury predisposes the patient to neurodegenerative conditions such as chronic traumatic encephalopathy (CTE).
Recovery Prognosis:
Chronic Pain: The multi-disc bulges in the cervical, thoracic, and lumbar spine are expected to cause chronic pain. This pain is likely to persist despite ongoing physical therapy and facet injections. The use of pain management techniques, including medications, physical therapy, and possibly interventional procedures, will be necessary long-term.
Mobility Impairments: The pain and spinal injuries will likely continue to impair mobility, requiring the use of assistive devices such as a cane. This limitation in mobility is expected to be a long-term or permanent condition.
Long-Term Expectations:
Progressive Degeneration: There is a likelihood of progressive spinal degeneration, leading to worsening pain and potential further loss of mobility.
Increased Risk of Secondary Conditions: The ongoing spinal issues may lead to secondary conditions such as muscle atrophy, joint problems due to altered gait and posture, and possibly the need for surgical interventions in the future.
Recovery Prognosis:
Chronic Chest Pain: The fractures and pneumothorax have led to chronic pain that is expected to persist. Although the fractures may heal, the pain could remain due to nerve damage or chronic musculoskeletal issues.
Long-Term Expectations:
Permanent Discomfort: The plaintiff may experience ongoing discomfort in the chest, particularly during activities that involve heavy breathing, lifting, or any form of physical exertion.
Recovery Prognosis:
Limited Mobility: The combined impact of spinal injuries, chronic pain, and the broken shoulder will likely result in permanently reduced mobility. The use of a cane and possibly other assistive devices will be necessary to manage daily activities.
Increased Risk of Falls: The loss of equilibrium and coordination due to TBI makes future falls likely, which could result in additional injuries.
Long-Term Expectations:
Progressive Loss of Independence: Over time, the plaintiff may experience a progressive loss of independence, requiring more assistance with daily tasks and possibly needing in-home care or assisted living.
Compromised Quality of Life: The combination of pain, limited mobility, and the psychological impact of these conditions will likely result in a significantly compromised quality of life.
Recovery Prognosis:
Limited Shoulder Function: Recovery from the shoulder fracture is likely to be incomplete, particularly given the underlying balance issues. The plaintiff may experience reduced range of motion, strength, and chronic pain in the shoulder.
Impact on Daily Tasks: The broken shoulder will further impair the ability to perform daily tasks, particularly those that require the use of both arms.
Long-Term Expectations:
Permanent Disability: The shoulder injury, combined with other impairments, is likely to contribute to a permanent disability, further limiting the plaintiff's ability to perform personal and work-related tasks.
Recovery Prognosis:
Chronic Sleep Disruption: Sleep disruption is expected to continue, exacerbated by chronic pain and emotional distress. This can lead to further health issues such as fatigue, cognitive decline, and a weakened immune system.
Psychological and Emotional Health: The ongoing physical limitations and pain, coupled with the emotional trauma from the injuries and reduced independence, are likely to contribute to long-term psychological issues.
Long-Term Expectations:
Ongoing Need for Psychological Support: Long-term psychological support, including therapy and possibly medication, will be necessary to manage depression, anxiety, and other emotional issues.
Social Isolation: The combination of physical and emotional challenges may lead to social isolation, further impacting mental health and overall well-being.
Permanent Disability: The plaintiff is likely to be classified as permanently disabled due to the combined effects of TBI, spinal injuries, chronic pain, and mobility impairments.
Reduced Life Expectancy: Chronic health conditions, especially those involving significant pain, mobility issues, and neurological damage, may reduce life expectancy.
Ongoing Medical Care: The plaintiff will require ongoing medical care, including physical therapy, pain management, neurological monitoring, and psychological support for the remainder of their life.
Significant Lifestyle Adjustments: The plaintiff will need to make significant lifestyle adjustments to manage daily activities, including reliance on assistive devices and possibly requiring in-home care or assisted living arrangements.
Compromised Quality of Life: The cumulative impact of these injuries is expected to result in a severely compromised quality of life, with limited ability to engage in work, hobbies, and social activities.
The long-term prognosis for Franciscus Dylan Rosario indicates a lifetime of chronic pain, cognitive impairment, and reduced physical and functional capabilities. The combination of traumatic brain injury (TBI) with structural changes in critical brain regions and significant spinal injuries has resulted in permanent damage that will severely limit his ability to lead a normal life. The TBI has led to a marked reduction in white matter volume and regional brain volume loss, which are likely to cause persistent cognitive difficulties, including memory problems, impaired concentration, frequent headaches, and episodes of dizziness. These neurological impairments will hinder his ability to perform tasks that require mental acuity, including his previous work as a software architect, leading to a permanent disability in this regard.
Physically, the multi-disc bulges in the cervical, thoracic, and lumbar spine, coupled with the fractured ribs and shoulder, have caused chronic pain that will require ongoing management. Despite physical therapy and medical interventions such as facet injections, the plaintiff is likely to experience continuous pain that will impact his mobility and daily functioning. The use of a cane for mobility is expected to become a permanent necessity, as the spinal injuries and loss of equilibrium due to TBI will prevent him from walking or standing without assistance. This mobility impairment will further limit his independence, requiring ongoing support or assistive care for daily activities.
The secondary injury resulting from the fall in June 2021, which led to a broken shoulder, has compounded the plaintiff's physical limitations. This injury, caused by the loss of equilibrium from the TBI, underscores the interconnected nature of his injuries, where neurological damage directly contributes to further physical harm. The shoulder injury is likely to result in a permanent reduction in the range of motion and strength in his right arm, further impairing his ability to perform even basic tasks. The cumulative effect of these injuries will not only affect his physical capabilities but also his psychological well-being, as he faces the reality of living with chronic pain and disability.
Long-term, Franciscus Dylan Rosario is expected to suffer from a significantly compromised quality of life. The combination of cognitive deficits, chronic pain, and mobility issues will make it difficult for him to engage in social, recreational, and work-related activities, leading to potential social isolation and depression. His life expectancy may be reduced due to the ongoing physical and emotional stress, and the need for continuous medical care and support will be a lifelong burden. Overall, the prognosis points to a future where the plaintiff's ability to live independently and enjoy life is permanently diminished, requiring substantial adaptations and support to manage his disabilities.
Franciscus Dylan Rosario’s professional role as a software architect, which typically demands prolonged periods of focus at a computer, frequent presentations, and the ability to engage in complex problem-solving, is likely to be severely compromised. The traumatic brain injury (TBI) he sustained has resulted in structural changes in the brain, leading to significant cognitive deficits. These deficits, such as impaired memory, reduced concentration, and executive dysfunction, directly affect his ability to perform tasks that require sustained mental effort. Moreover, the persistent headaches and episodes of dizziness further impede his capacity to work efficiently, making it extremely challenging to maintain the high level of cognitive performance required in his field.
In addition to cognitive challenges, the physical limitations resulting from his spinal injuries, chronic pain, and fractured ribs and shoulder will further hinder his ability to fulfill job duties. Long sessions at a keyboard are likely to exacerbate his back and neck pain, which is already chronic and debilitating. The need to frequently adjust positions or take breaks to manage pain will reduce his productivity and could lead to further physical strain. Standing or moving for presentations, which may be an integral part of his role, will also be challenging due to the pain and mobility issues associated with his spinal injuries and the use of a cane. These physical limitations will not only make it difficult to carry out tasks but may also affect his professional confidence and ability to engage fully with colleagues and clients.
The cumulative effects of the TBI, spinal injuries, chest and rib fractures, and the secondary shoulder injury are expected to result in lifelong pain, mobility impairments, and cognitive deficits. The TBI, in particular, has resulted in a permanent reduction in white matter volume and regional brain damage, which are known to cause chronic neurological symptoms. The loss of equilibrium and impaired balance due to the TBI has already led to a secondary injury—a fractured shoulder—which not only adds to his physical pain but also increases the likelihood of future falls and injuries. This cascading effect of injuries illustrates how the initial brain trauma has set off a chain of physical impairments, each compounding the challenges of the previous one.
The multi-disc bulges in the cervical, thoracic, and lumbar spine contribute to chronic pain that is unlikely to be fully alleviated, even with ongoing treatment. This pain will continue to limit his mobility, making it difficult for him to engage in activities that were once routine, such as walking, standing, or even sitting for extended periods. The chest pain from the fractured ribs and pneumothorax further exacerbates his discomfort, especially during activities that require physical exertion or deep breathing. Together, these conditions create a scenario where daily life is dominated by managing pain and avoiding activities that might trigger or worsen his symptoms.
The prospect of lifelong pain is a significant component of the prognosis. Chronic pain not only affects physical health but also has profound psychological impacts. The constant need to manage pain can lead to fatigue, irritability, and emotional distress, contributing to a diminished quality of life. Over time, the physical and cognitive impairments are likely to cause a progressive loss of independence. As mobility becomes more restricted and cognitive function continues to decline, Mr. Rosario may require increasing levels of assistance with daily tasks, potentially leading to a need for in-home care or assisted living arrangements.
This prognosis suggests that, while Mr. Rosario may be able to perform some tasks or engage in limited work activities, his capacity to return to full-time employment in his previous role is extremely limited. The combination of physical pain, reduced mobility, and cognitive deficits will make it difficult for him to maintain consistent, productive work. Even in a best-case scenario where he achieves partial disability status, the restrictions on his abilities will be significant, and the impact on his professional and personal life will be profound. This underscores the severity of his condition and the long-term challenges he will face in managing his disabilities.
In a human vs. vehicle collision, particularly one involving the extensive injuries sustained by Franciscus Dylan Rosario, the pain experienced can be severe and multifaceted. The following outlines the typical pain levels and the expected lifelong effects on health and quality of life for someone with similar injuries:
Immediately After the Collision:
Acute Pain: Immediately following the collision, the pain is often intense and acute, especially with injuries like fractured ribs, a collapsed lung (pneumothorax), and musculoskeletal damage. Fractured ribs can cause sharp, stabbing pain with every breath, movement, or touch, making breathing extremely painful. The pain from a collapsed lung is similarly severe, often described as sharp or stabbing, especially during inhalation.
Spinal Pain: Injuries to the cervical, thoracic, and lumbar spine can result in sharp, shooting pain that radiates from the spine to other parts of the body, such as the arms or legs. The immediate pain from spinal injuries can also be accompanied by muscle spasms and stiffness.
Head and Brain Injury (TBI): The pain from a traumatic brain injury may not be immediately apparent but can manifest as severe headaches, confusion, dizziness, and sensitivity to light or noise. This type of pain can intensify over the hours or days following the injury.
Short-Term Pain (First Few Weeks to Months):
Persistent and Severe Pain: In the weeks following the collision, the pain generally remains severe, especially in the chest, ribs, and spine. Fractured ribs can take several weeks to heal, and the pain during this period can be constant, exacerbated by activities like coughing, sneezing, or even breathing.
Spinal Pain: The pain from spinal injuries typically persists and may spread to other areas, causing chronic discomfort in the neck, back, and limbs. This can be particularly debilitating, as it affects the ability to sit, stand, or move comfortably.
Post-TBI Symptoms: The pain from a TBI may include ongoing headaches, which can range from dull and throbbing to sharp and debilitating. The patient may also experience neck pain, fatigue, and ongoing dizziness or vertigo.
Chronic Pain:
Ongoing Chest and Rib Pain: Even after the fractures heal, the plaintiff is likely to experience chronic pain in the chest and ribs, especially during physical activity or deep breathing. This pain can lead to limitations in physical exertion and affect daily activities.
Persistent Spinal Pain: The multi-disc bulges in the spine are expected to cause chronic pain that may persist for life. This pain can be constant and may require ongoing management through physical therapy, medications, or even surgical interventions. Chronic spinal pain can severely limit mobility and make it difficult to perform daily tasks, such as walking, standing, or sitting for extended periods.
Headache and Neurological Pain: The TBI is likely to result in ongoing headaches and neurological pain, contributing to a reduced quality of life. These symptoms can make concentration difficult, interfere with sleep, and exacerbate emotional distress.
Mobility Impairments:
Reduced Mobility: The combination of chronic pain, spinal injuries, and the shoulder injury will likely result in reduced mobility. The plaintiff may need to use assistive devices like a cane permanently and could face progressive mobility issues as the spinal condition potentially worsens over time.
Risk of Further Injury: The loss of equilibrium due to TBI increases the risk of falls, which could lead to additional injuries, further complicating the plaintiff’s physical health and increasing dependence on others.
Cognitive and Emotional Impact:
Cognitive Deficits: Lifelong cognitive impairments from the TBI, such as difficulties with memory, concentration, and executive function, are expected. These deficits will likely limit the plaintiff's ability to work in roles that require high cognitive demands and could also impact daily decision-making and problem-solving skills.
Emotional and Psychological Challenges: Chronic pain and cognitive impairment often lead to long-term emotional and psychological issues, including depression, anxiety, and frustration. The plaintiff may experience a reduced sense of independence and self-worth, contributing to social isolation and a diminished quality of life.
Overall Health and Quality of Life:
Compromised Quality of Life: The lifelong pain, mobility restrictions, cognitive impairments, and emotional challenges will collectively result in a significantly compromised quality of life. The plaintiff’s ability to engage in work, hobbies, social activities, and even basic daily tasks will be severely limited.
Ongoing Medical Care: The plaintiff will require continuous medical care, including pain management, physical therapy, neurological monitoring, and psychological support. This ongoing need for treatment and support will be a lifelong burden, both physically and financially.
Pain and Suffering Amplified by AAA "Bad Faith" Denial of Funds to Provide Medical Support
The pain levels experienced by the plaintiff are likely to remain high, even as the initial injuries heal. The long-term effects include chronic pain, reduced mobility, cognitive impairment, and a significantly compromised quality of life, requiring lifelong management and support.
Given the extensive nature of the injuries sustained by Franciscus Dylan Rosario, the pain experienced would likely be quite high on a typical pain scale, where 1 represents minimal pain (such as a finger prick) and 10 represents the most severe pain imaginable (such as a brain-searing neurological seizure).
Initial Pain (Shortly After the Collision)
Fractured Ribs and Pneumothorax: The pain from multiple rib fractures and a collapsed lung would likely be around a 7 to 8 on the pain scale. Rib fractures cause sharp, intense pain with each breath, movement, or even slight pressure, making everyday actions like breathing and coughing excruciating. A pneumothorax, or collapsed lung, adds to this severe pain, often described as stabbing or crushing.
Spinal Injuries: The pain from the cervical, thoracic, and lumbar spinal injuries could range from 7 to 8, depending on the severity of the nerve compression and disc bulging. This pain is typically sharp, radiating, and can cause significant discomfort and mobility limitations.
Traumatic Brain Injury (TBI): Initially, the pain from a TBI might be less immediately recognizable but could manifest as severe headaches, which would rank around a 6 to 7 on the pain scale. As symptoms like dizziness, confusion, and nausea develop, the overall pain experience could escalate.
Ongoing and Chronic Pain (Weeks to Months After the Collision)
Persistent Rib and Chest Pain: As the rib fractures and pneumothorax continue to heal, the pain would likely remain around a 6 to 7, especially with any movement that stresses the chest wall or requires deep breathing.
Chronic Spinal Pain: The ongoing pain from spinal injuries would likely stabilize at around 6 to 7. Chronic spinal pain can be persistent, with episodes of sharp, debilitating pain that can flare up, particularly with physical activity or prolonged sitting or standing.
Headaches and TBI-related Pain: The chronic headaches and neurological pain associated with the TBI would likely be around a 6 to 7, especially if not well-managed. These headaches can be persistent and severe, significantly affecting daily functioning.
Long-Term and Lifelong Pain
Chronic Pain from Spinal and Chest Injuries: Over the long term, the pain from spinal injuries, combined with any lingering chest pain, could settle around a 5 to 7. This level of pain can be persistent, with some variability depending on activity levels, stress, and overall health.
TBI-Related Symptoms: The ongoing effects of the TBI, including headaches and potential nerve pain, would likely maintain a pain level of around 6 to 7. While the intensity might decrease slightly with treatment, the chronic nature of these symptoms often means they remain a constant source of discomfort.
Franciscus Dylan Rosario's pain, consistently estimated at a 6 to 8 on the pain scale, represents a severe and enduring challenge that will affect him for the rest of his life. This level of pain significantly impairs his ability to function day-to-day, necessitates continuous pain management, and has profound psychological and emotional consequences. The fluctuations in pain intensity, the limitations imposed on his physical capabilities, and the need for ongoing medical intervention collectively point to a future where managing pain will be a central concern, overshadowing much of his ability to lead a fulfilling and active life. The impact of this pain will be felt not only in his physical health but also in his emotional well-being, social relationships, and overall quality of life. The permanent injuries to Franciscus Dylan Rosario’s person are profound, the subsequent chronic pain he will experience would place him consistently at a 6 to 8 on the pain scale, indicating a high level of pain that will be both persistent and life-altering for the remainder of his life. This level of pain is not just a temporary discomfort but a long-term condition that affects every aspect of his daily life, from physical functioning to emotional well-being.
Persistent Pain and Its Daily Impact
A pain level of 6 to 8 is considered severe enough to interfere with most daily activities, including work, social interactions, and personal care. For Mr. Rosario, this means that simple tasks like getting out of bed, walking, or sitting at a computer for extended periods are likely to be accompanied by significant discomfort. The pain from his multiple spinal injuries, fractured ribs, and traumatic brain injury (TBI) would make it difficult to engage in activities that most people take for granted, such as bending, lifting, or even maintaining a consistent posture.
Chronic pain at this level is typically accompanied by a high degree of physical and mental fatigue. The effort required to manage pain and continue with daily activities can be exhausting, leading to reduced energy levels and a decreased ability to participate in work or social activities. This persistent pain also limits mobility, making it challenging for Mr. Rosario to maintain an active lifestyle, which can further deteriorate his physical health over time.
Fluctuation in Pain Intensity
Although the baseline pain is consistently high, pain levels may fluctuate depending on various factors such as physical activity, stress, weather changes, and overall health. On bad days, the pain might spike closer to an 8, making it nearly unbearable and requiring stronger pain management interventions, such as increased medication or rest. On slightly better days, the pain might dip closer to a 6, but even at this level, it remains a significant burden.
These fluctuations can be unpredictable and add an element of uncertainty to daily life. The fear of exacerbating pain can lead to avoidance behaviors, where Mr. Rosario may refrain from certain activities or social engagements out of concern that they will trigger a pain flare-up. This can lead to a more sedentary lifestyle, contributing to other health issues such as weight gain, muscle atrophy, and cardiovascular problems.
Long-Term Psychological and Emotional Effects
Living with chronic pain at this intensity often leads to significant psychological and emotional challenges. Pain at a 6 to 8 level is not only physically exhausting but also mentally draining. The constant discomfort can lead to feelings of frustration, helplessness, and depression, as the ability to enjoy life and engage in fulfilling activities becomes increasingly limited. Over time, the burden of chronic pain can contribute to anxiety, particularly around activities that might increase pain or cause injury.
The social impact of such pain is also profound. Relationships may be strained as Mr. Rosario may have to cancel plans or be unable to participate in social events due to pain. This can lead to social isolation, which further exacerbates feelings of loneliness and depression. The psychological toll of chronic pain often requires long-term psychological support, including therapy and possibly medication, to manage the emotional distress associated with a life dominated by pain.
Necessity of Ongoing Pain Management
Given the severity and persistence of his pain, Mr. Rosario will require comprehensive and ongoing pain management strategies. This might include a combination of medications, physical therapy, lifestyle adjustments, and possibly surgical interventions. Pain management is not a one-time treatment but a continuous process that needs to be adjusted as his condition evolves.
Medications, such as opioids are unavailable to Mr. Rosario due to severe anaphylactic allergy that could result in death or severe side effects, the use of local anesthetics such as lidocaine may provide temporary and limited relief with diminishing returns the longer these kind of painkillers are used, , but these come with their own risks, including dependence and side effects. He is likely to be permanently dependent upon NSAID or anti-inflammatory drugs,to control pain lifelong physical therapy may help to some extent, but the relief it provides is often temporary and requires consistent effort and commitment. Additionally, lifestyle changes, such as maintaining a healthy weight, regular exercise within his limits, and stress management techniques, are crucial components of managing chronic pain, though they require a level of discipline and support that can be difficult to sustain in the face of ongoing pain.
In severe cases, where pain becomes unmanageable, more invasive procedures such as nerve blocks, spinal cord stimulators, or surgeries might be considered, though these carry risks and do not guarantee complete relief. The need for ongoing and adaptive pain management reflects the serious nature of Mr. Rosario’s injuries and the profound impact they have on his quality of life.
Bad Faith of AAA Denial of Demand
The denial by AAA of the Plaintiff’s demand for $500,000 to assist with medical bills places the insurance company in a precarious legal position, particularly in the eyes of a jury. This refusal to honor a reasonable settlement request, especially when it would have directly alleviated the Plaintiff’s medical and financial burdens, constitutes a clear breach of the insurer’s duty to act in good faith. Under California law, this breach is recognized as a "third-party bad faith" violation, which can have severe repercussions for the insurer.
The Plaintiff, as a result of AAA's denial, was forced to bear the full financial burden of his medical treatments, including all co-pays and out-of-pocket expenses. Without the settlement funds, the Plaintiff had to minimize his medical treatments, which directly impacted his recovery and quality of life. This denial of financial support not only placed an undue hardship on the Plaintiff but also exacerbated his pain and suffering, as he was unable to access necessary medical care due to the lack of resources. The insurer’s refusal to settle within the policy limits when it was clear that the Plaintiff had suffered significant harm from the collision is a stark example of bad faith.
In California, the insurer has a legal duty to consider the interests of the insured equally with its own interests. This means that when faced with a reasonable demand that would settle a claim within policy limits, the insurer must act in good faith and pay the claim to avoid exposing the insured to excess liability. AAA’s failure to pay the $500,000 demand, despite the obvious need for the funds to cover the Plaintiff’s medical expenses, constitutes a breach of this duty. The insurer's actions, or lack thereof, demonstrate a disregard for the Plaintiff’s well-being and financial stability, which is a core element of a bad faith claim.
Moreover, the fact that the Plaintiff had to endure over three and a half years of financial and medical hardship without any assurance of recovering these expenses underscores the severity of AAA’s breach. The insurance company’s denial has left the Plaintiff in a vulnerable position, forcing him to struggle with significant medical debts and ongoing health issues. This not only caused immediate financial strain but also led to prolonged suffering and diminished quality of life, further aggravating the damages caused by the initial collision.
In a jury trial, these facts will likely resonate strongly, especially given the clear legal precedent in California that supports claims of bad faith against insurers who fail to settle within policy limits when there is a clear risk of excess liability. AAA’s refusal to pay the demand, despite the compelling need and the obvious risk of greater liability, opens the door to substantial punitive damages. California courts have consistently held that an insurer’s failure to act in good faith, especially when it results in significant harm to the claimant, can justify the award of both compensatory and punitive damages.
Ultimately, AAA’s actions—or rather, its inaction—constitute a clear third-party bad faith violation. The company’s failure to provide the necessary financial support has caused prolonged suffering and financial instability for the Plaintiff, which is likely to be viewed unfavorably by a jury. As the case moves forward, the Plaintiff is in a strong position to argue that AAA’s breach of its duty to act in good faith has caused additional, unnecessary harm, and that this breach justifies not only the recovery of the full amount initially demanded but also significant punitive damages for the insurer’s egregious conduct.
Denial of Demand in BAD-FAITH caused prolonged Pain and Suffering to Plaintiff
The prolonged denial of basic medical support and compensation has placed the Plaintiff in an ongoing state of trauma, both physically and psychologically. Being denied the necessary financial resources to cover essential medical treatments has forced the Plaintiff to endure significant pain and suffering. This lack of support has had a profound impact, as the Plaintiff was compelled to forgo critical treatments that could have alleviated his condition and improved his quality of life. The inability to access adequate care has not only hindered his physical recovery but has also led to a deep sense of abandonment, exacerbating the emotional and psychological toll of the injury.
Psychologically, the feeling of being abandoned by the insurance provider, particularly when the need for support was most acute, has left the Plaintiff grappling with feelings of helplessness and despair. The uncertainty and financial strain created by the lack of compensation have contributed to a state of chronic stress and anxiety, compounding the emotional trauma of the initial injury. This ongoing struggle has severely impacted the Plaintiff's mental health, leaving him to cope with the dual burden of physical pain and psychological distress without the assurance of recovery or support.
The years of neglect and denial have left lasting scars, both visible and invisible. The Plaintiff's trust in the systems meant to protect and support him has been shattered, and the continued trauma of having to navigate his health and financial challenges alone has only deepened his suffering. This experience of being left to fend for himself in the face of severe injury has had a profound and lasting impact, underscoring the critical importance of timely and compassionate support in the aftermath of traumatic events.
Psychological Effect of the Bad-Faith Denial of Basic Medical Funds
The psychological turmoil and suffering that one experiences when faced with the uncertainty of how to pay for medical bills after an insurer denies even basic compensation can be profound and all-encompassing. This situation often leads to overwhelming stress and anxiety as the individual grapples with the reality of mounting medical costs without the financial support that was expected and relied upon. The emotional burden of not knowing how to cover essential medical treatments can exacerbate the physical pain, leading to a vicious cycle of stress-related symptoms such as insomnia, depression, and chronic anxiety.
The sense of betrayal and abandonment by the insurance company, which is supposed to provide a safety net in times of need, can leave the individual feeling isolated and unsupported. This emotional isolation can deepen feelings of hopelessness, as the lack of financial assistance forces difficult decisions, such as foregoing necessary medical care or seeking less effective treatments, which can lead to a deterioration in health and further emotional distress. The constant worry about how to pay for ongoing and future medical expenses can also strain personal relationships, as the individual may feel ashamed or guilty about the financial burden placed on their family.
Ultimately, the psychological impact of being denied basic compensation in the face of significant medical needs can lead to long-term mental health issues. The stress and anxiety associated with financial insecurity can manifest in severe emotional responses, including panic attacks, depression, and a pervasive sense of helplessness. This ongoing mental anguish not only affects the individual's well-being but can also impair their ability to focus on recovery, leading to a prolonged and more challenging healing process.
The following steps were taken:
De-identification of Axial MRI images
Automated segmentation analysis was employed to calculate segment volumes. The volume of each segment was then expressed as a percentage of the total intracranial volume, providing normalized values for comparison with a reference population of age matched-controls.
Statistical analysis was performed with Python programming language, using matplotlib and pandas libraries.
Gross Segmentation Findings
Tissue segmentation revealed:
Volumetric analysis revealed that the right hemispheric grey matter volume exceeded the upper range of the reference population distribution, while the left hemispheric grey matter volume was just below the upper range, but still above average.
However, white matter volume in the lower range compared to reference population (Figure 2).
Figure 1 Subject structure volumes as a percentage of the intracranial volume, compared to reference population, normalized values. Figure shows cerebral grey matter volume being on the upper end of reference volume, while cerebral white matter on lower end.
Detailed Regional Analysis
Areas of Decreased Volume
Significant volume reduction was observed in the following structures:
Bilateral Basal Forebrain
Right Lateral Orbital Gyrus
Temporal lobe structures adjacent to the cranial base:
Right Fusiform gyrus
Bilateral Inferior Temporal Gyrus
Left temporal pole
Cingulate gyrus/Limbic cortex
Posterior Cingulate gyrus
Figure 2 Showing most affected structures compared to reference volume.
Figure 3 Showing Limbic structures compared to reference volume, marked decrease in left and right posterior cingulate gyrus can be seen
The volume loss pattern, particularly in structures adjacent to the cranial base (basal forebrain, lateral orbital, inferior temporal and fusiform gyri) suggest the presence of a Traumatic Brain Injury with coup-contrecoup injury mechanism.
Patient: Rosario Dylan
Imaging Technique: T1 Axial post-contrast MPRAGE MRI with 3D AssemblyNet-based AI algorithm
Summary of Findings:
The MRI analysis of Mr. Dylan Rosario's brain indicates a pattern of structural changes consistent with a mild traumatic brain injury (TBI), likely involving a coup-contrecoup mechanism. The imaging reveals a marked reduction in white matter volume when compared to age-matched controls, particularly in structures adjacent to the cranial base, such as the basal forebrain, lateral orbital gyrus, and inferior temporal gyrus. These areas are notably susceptible to injury from the forces involved in a TBI.
Key Findings:
1. Grey and White Matter Volume:
- The right hemispheric grey matter volume is significantly higher than average, while the left hemisphere is slightly below the upper range. However, there is a noticeable reduction in white matter volume, which is lower than the reference population's average. This disparity between grey and white matter volumes is a typical indicator of TBI-related changes.
2. Regional Volume Reduction:
Significant Volume Loss observed in the following regions:
- Bilateral Basal Forebrain
- Right Lateral Orbital Gyrus
Temporal lobe structures
adjacent to the cranial base,
including the Right Fusiform Gyrus
and Bilateral Inferior Temporal Gyrus.
Left Temporal Pole
Cingulate Gyrus, with a marked decrease in the posterior cingulate gyrus.
The loss of volume in these specific regions is aligned with the damage patterns seen in TBI cases, where the brain's structures adjacent to the skull base are more vulnerable to impact forces.
Interpretation:
The imaging findings suggest that Mr. Rosario has sustained a marked and apparent TBI, with evidence pointing to a coup-contrecoup injury mechanism. The reduction in white matter volume, particularly in the areas adjacent to the cranial base and the posterior cingulate gyrus, supports the diagnosis of TBI.
These findings are consistent with the literature on TBI, which reports similar patterns of brain volume loss in affected individuals. Further clinical correlation will establish the full extent of cognitive and neurological impact.
Imaging Technique: T1 Axial post-contrast MPRAGE MRI with 3D AssemblyNet-based AI algorithm. Software and analysis is a new method of TBI discovery, where in 2006 with the FDA approval and clearance of NeuroQuant®, a commercially available, computer-automated software program for measuring MRI brain volume in human subjects. Studies using these and similar methods have found that most patients with chronic traumatic brain injury have brain volume abnormalities, and several of these studies found—surprisingly—more abnormal enlargement than atrophy. Due to the improvements in technology over the years, these brain volumetric techniques are practical and readily available for clinical or forensic use, and thus they are important tools for detecting signs of brain injury.
Dr. Siyar BAHADIR, MD - Neurosurgeon siyarbahadir@gmail.com The Feinstein Institutes (New York, United States) Hacettepe Üniversitesi ( Istanbul Turkey ) PhD - cerebromap.me (NeuroQuant® and NeuroGage®)
Software: NeuroQuant® by CorTechs Labs, Inc. ( ) The analysis was conducted using the subject’s existing T1 Axial post-contrast MPRAGE MRI images at 1x1x1mm resolution.
Application of a 3D AssemblyNet-based AI algorithm for cortical structure segmentation (Reference: )
Cortical segmentation was performed according to the BrainCOLOR atlas, dividing the cortex into 124 regions (Collaborative Open Labeling Online Resource, ).
Significant volume reduction in cingulate cortex, primarily in posterior cingulate was reported in patients with TBI, the reduction increasing particularly with the severity of TBI. ( .) Marked decrease in the posterior cingulate gyrus volume (along with less significant decreases in middle and anterior parts of the cingulate) is in line with possibility of Traumatic Brain injury.
