损害赔偿开场白：灾难性脑损伤案

双方在开庭时都使用了大量的示范性展品。基本上我们同意，只要他们可以使用我想要的东西，我就可以使用我想要的东西。

笔录不是很准确（轻描淡写）。法庭是有录像的。如果我们想要一份快速的笔录，在一天结束时，法警会复制录音并将其提供给法庭记者。然后，记者将根据视频进行转录，但成功率不高。

坦率地说，试图阅读这篇文章有点让人分心。有时，我听起来完全是个文盲。而且，你无法看到展品、视频或PowerPoint。不过，它还是让我们了解了开庭陈述中的损害赔偿部分。

6    This is the overview of C's
7 injuries that I'm going to talk to you about now. She
8 had what's generally called a diffuse axonal injury,
9 meaning that there wasn't one, you know, particular --
10 there it is, that's the part of the hemorrhage that is
11 the problem, it's all over her brain.
12             It's in all of these different areas that
13 are noted here. It's pretty much all through it. The
14 doctors -- and you'll be able to see brain and
15 neurologists looking into the brain and showing you
16 all of the problems by videotape.
17             At this point we are going to show you an
18 animation that's not an actual brain surgery, but
19 we -- there are so many medical records; for me to
20 tell you them would take a long time and be very
21 boring, and instead, we can show it to you.
22             This was recreated, and doctors have signed
23 off on it as being what happened with Chanetelle. I'm
24 going to do this without any explanation. During
25 trial we'll have somebody explain this.
0021
1             (Video playing).
2             That was the first surgery. And what
3 basically happened, I'm not a neurosurgeon, but just
4 so you know, when the brain is injured like that, like
5 any body part, it wants to swell.
6             So in order to prevent probably death in
7 this case, the doctors have the technique where they
8 actually take off parts of the skull, and that allows
9 the brain to swell beyond, you know, the head, where
10 it needs to go, and then eventually it will go back.
11             And that happened. They actually put the
12 skull in a freezer, a piece of it in a freezer, and it
13 stays there for, in this case, about half a year.
14             So this is going to be the second surgery of
15 this procedure. There were lots of other surgeries,
16 and I'll talk to you about those later, but this is
17 the second surgery on putting the skull back.
18             (Video playing.)
19             It's amazing, surgery, and -- they were able
20 to put most of it back together, but you can see it's
21 not quite all the way.
22             Looking at the damage to C's brain
23 is an interesting medical feat. There is a
24 neurologist who is -- has a very, very high quality
25 brain imaging beyond MRI.
0022
1             And this is kind of Greek to some people,
2 including me, but I have a blowup here. And MRIs are
3 kind of like, they take slices this way, so it's kind
4 of -- you're not seeing a three-dimensional, and
5 that's why there's so many of them.
6             So, for example, what this shows are pretty
7 much black holes. The black holes are where the brain
8 hemorrhages were that have permanently damaged the
9 brain. And these, again, are scattered all through
10 C's brain.
11             But I just wanted to pull one so you could
12 see it. There will be more testimony on how her brain
13 was injured from a scientific standpoint.
14             C was in a coma for five weeks at
15 Southwest Medical Center. She has had a very
16 difficult course of treatment and came close to death
17 many times.
18             She is, you know, a miracle, because in
19 April they were going to put her in a, basically, I
20 don't know a better word to say this, but more like a
21 warehouse type of place where a person that's
22 completely non-responsive goes, you don't need therapy but
23 they'll care for you. It's a hospital bed where -- so
24 she'd been stabilized by this time.
25             And I think it was the morning that she was
0023
1 destined to be moved, she startedtalking -- it's in the chart
2 notes, and it's quite remarkable, that that was one of
3 her miracle points, and changed the course of what
4 she's able to do today.
5             This is C, this is when she
6 has had -- her skull piece is not there, so you can
7 see that her temple is sunk in. This is her long-term
8 boyfriend, who is still her boyfriend and fiancé,
9 J.
10             Because of the coma, and then how she's been
11 able to recuperate and what she's left with,
12 C is appearing in this case under her
13 guardian, KB is here. He won't be here
14 during the entire trial due to his commitments because
15 he's a full-time guardian.
16             He's appointed by the court to authorize
17 this litigation, the hiring of Mr. J. And
18 this -- and basically, at this point, to manage every
19 single aspect of C's life because she did
20 not -- she was incompetent to do so, in part because
21 of the coma, and then her severe restrictions after.
22             So I'd like to talk about some of these
23 injuries. These are hard to read, but we're going to
24 be going over them quite a bit.
25             Do people want to stand up while I do this?
0024
1             THE COURT: Do you need to set up?
2             MS. KOEHLER: I just need to get it, and
3 then set it up.
4             THE COURT: (To the jurors) Did you want to
5 stand up for a second? You're welcome to.
6             MS. KOEHLER: So these are the injuries that
7 she suffered. And I'm doing it this way rather than
8 showing you, literally this many medical records,
9 piece by piece. So we already talked about the
10 traumatic brain injury, which is the most severe
11 injury. She --
12             THE COURT: Do you need a laser pointer?
13             MS. KOEHLER: No, I'm okay.
14             This is a little bit bigger, so you could
15 see it a little bit better. She was obviously not
16 able to function without mechanical equipment, so she
17 agreed, through a tracheotomy tube that was placed,
18 and you'll see that she did have a recurrent lung
19 collapsing. Unfortunately she got MRSA.
20             She had right-sided rib fracture, she had
21 problems with her lungs, fluid buildup in the lungs,
22 she had -- her spleen was lacerated from the
23 collision.
24             She had major problems with her feeding
25 tube. To this day she has -- she literally has a scar
0025
1 that looks about like this, maybe it's a little
2 taller, it's a big -- it's very thick. Because they
3 had to do so many operations on that feeding tube, it
4 got infected.
5             She just -- that was -- it was almost
6 life-threatening at times, it was very, very
7 problematic. Peritonitis, which was the infection,
8 she has septic shock, recurrent urinary tract
9 infections because of the catheter injuries, and she
10 also ended up having a blood clot. This was just a
11 very sick gal.
12             So let me go to the surgeries. And this is
13 a little bigger. These are just representatives.
14 This is of what would generally happen.
15             So the first procedure that was done of her
16 brain was to put a monitoring device inside of it, into
17 it. You saw this surgery, the second surgery is one
18 of the surgeries that you saw.
19             She had a chest tube surgery, she had
20 feeding tube surgery, she had breathing tube surgery,
21 she had another chest tube surgery because of
22 complications.
23             On March 11 she had the abdominal leaking
24 and the sepsis and all that, so she had that repeated
25 feeding tube surgery. She had to have lung intubation
0026
1 on March 14, she had to have it again on March 21st.
2             And then like I said, it's about half a year
3 later, September 23rd, she had the final surgery to
4 reattach her skull piece.
5             So these are surgical procedures, not the
6 multiple other procedures that she had. The date of
7 her discharge diagnosis -- normally when you go to the
8 hospital and you have a discharge diagnosis you have
9 one or two things. As you can see, she had 14 items
10 on her discharge diagnosis. I'm going to show you
11 those in a minute.
12             This is -- her day of admission was
13 February 27th and her date of discharge, which was, as
14 I told you, the miracle when she was able to not be
15 discharged to be warehoused to be rehabilitated.
16             This is a bigger version of her discharge
17 diagnosis. So again, her admission discharge is
18 different than your discharge diagnosis, which is why
19 I'm going through this again.
20             She has a traumatic brain injury, and this
21 is their words, not mine, acute respiratory failure
22 with tracheostomy placement and also removal, right
23 pneumothorax with chest tube placement times two
24 resolved.
25             Pulmonary contusion, the fracture of the
0027
1 right fifth rib, the splenic injury, grade 1. Her
2 gastro tube placement. She had a laparotomy for the
3 G-tube erosion with new placement of the G-tube.
4 Spasticity, the entire left side, greatest in the hand
5 and foot.
6             She had some other issues like dehydration,
7 acute blood loss, anemia, hyperkalemia, leukocytoses,
8 and narcotic dependence due to the pain medications
9 they were giving her, so this was as of April 3rd,
10 2009.
11             What I'm going to show you now is a video of
12 Ctaken on May 12, 2009. So this is --
13 I need power.
14             All right, so this in May of 2009. I
15 believe that this entire video is like an hour and a
16 half, so it's not what you're going to be watching,
17 you're going to be watching, I believe it's something
18 like four minutes, so you might see some editing, and
19 it's simply because it was an hour and a half.
20             So this is C in rehab on
21 May 12, 2009. Let me tell you one other thing. We're
22 going to have sound with this, and I'm not sure,
23 because this is an open therapy room, you might hear
24 therapists that are talking to C and other
25 people talking, so it might be a little distracting,
0028
1 but I think you can sort it out.
2             THE COURT: Would you like to take a break
3 while you work out the technology?
4             MS. KOEHLER: He's got it, but he's got a
5 30-minute version.
6             THE COURT: I'm going to give you the
7 morning break while we work with technology to try to
8 figure it out. Leave your pads on your chair and go
9 on back to the jury room. About 15 minutes, folks,
10 roughly.
11             (Jurors exit courtroom.)
12             (Recess was taken.)
13             (Jurors enter courtroom.)
14             THE COURT: Have a seat.
15             (Playing Video.)
16             MS. KOEHLER: My apologies. She was
17 discharged from the hospital on April 30, so a month
18 and a week later in the rehab. The other woman in
19 this film is K, which is C's
20 grandmother, the blond woman.
21             (Video concluded.)
22             MS. KOEHLER: We'll be showing more pieces
23 of this.
24             For example, she's going to be working on
25 speech. She works with a number of different
0029
1 therapists to reconstruct her ability to do some
2 things like speech and memory.
3             You know, the reason that she can't walk is
4 not due to an orthopedic problem, she didn't break
5 bones and she's not paralyzed from a spinal cord
6 injury. She's got a very severe brain injury.
7             You probably don't know very many people
8 that have a brain injury that has resulted in
9 paralysis and spasticity of parts of the body.
10             The way that this works is the primary blow
11 is to the right side, and that correlates to the left
12 side being, for whatever reason, I don't understand it
13 myself, that's the side that is paralyzed and spastic.
14             She's wearing the helmet, and she does that
15 until she gets her brain -- sorry, her skull put back
16 together, so it's a protective device.
17             C, I can't remember exactly --
18 we're getting closer to the end, so I'm trying to
19 remember exactly what's on my machine, but she was not
20 able to walk much better than this after the hospital
21 and getting through all of this rehab.
22             Washington State and Oregon do not have a
23 specialized inpatient program for people with severe
24 brain injuries that's devoted to that, this is more
25 general kind of therapy.
0030
1             So for that reason, her guardian authorized
2 her to go to a brain injury specialty center in West
3 Virginia. And she did that in between November and
4 December of 2009.
5             They wanted to keep her longer. You'll meet
6 C, and you'll see that she is -- she is a
7 forceful personality. She does not want to stay away
8 from her family and she wanted to come back here, but
9 she did stay for a full month.
10             And when she left, she was able to walk.
11 Maybe not like you or I, but she was able to walk. So
12 it's gotten -- it eventually -- brain injuries, you
13 can progress with or without hard work if you're
14 lucky, and then you plateau after I think --
15 the doctors will say two years after an injury, you're
16 pretty much as good as you're going to get, although
17 you can always work to strengthen and do that.
18             So she made remarkable progress from the
19 time she was discharged and then for the next two
20 years. She really did do well. But there's a feeling
21 on how well she can ever get.
22             So in February of -- the date's on the next
23 page.
24             MR. SCARPELLI: January 2011.
25             MS. KOEHLER: January 2011 she -- a company
0031
1 that was part of her guardian went back to court. She
2 was no longer comatose and she was no longer in a
3 rehab facility.
4             After she left Virginia she came back to
5 stay with her grandmother, and then she and her
6 boyfriend, J, moved out into an apartment for a
7 while -- it's back and forth from the grandmother to
8 this apartment to the grandmother, but for a while
9 they had an apartment.
10             And she went back to court to have some of
11 her rights restored, because you'll remember when the
12 guardianship was entered, it was a complete
13 guardianship because she had just come out of a coma.
14             So these are the rights that were restored
15 to her. She can vote, she can possess a license to
16 drive, though she doesn't, she can consent or refuse
17 to medical treatment, she can decide who will provide
18 care and assistance to her, and she can make decisions
19 regarding her social life.
20             This is what she still cannot do. She
21 cannot marry or divorce, she cannot enter into a
22 contract or make or evoke a will, she cannot appoint
23 someone to act on her behalf, she cannot sue or be
24 sued other than through her guardian, she cannot buy,
25 sell, own mortgage or lease property, and the guardian
0032
1 continues to have access over her medical records.
2             In other words, what happens is that the
3 guardian manages most of her affairs. She gets, for
4 example, an allowance. She has difficulty managing
5 anything. And we'll hear from some other people that
6 work with her on a regular basis as to how challenging
7 that is.
8             Let me tell you a little bit about
9 C before I finish here. C was born
10 to parents who were not the best. Her father has
11 definitely gotten better as he's gotten older. He's a
12 source of a parental involvement now in her life,
13 whereas in her childhood he was absent.
14             Her mother, I think she -- I think C has
15 seven brothers and sisters, all of whom have different
16 fathers, so there are a lot of half-siblings.
17             Her mother did not maintain a household for
18 the children that was regular, so C was moved, for
19 example, periods of homelessness on top of it.
20             So she did not have the privilege of going
21 to an elementary school and a junior high and a high
22 school in the same -- you know, like our children do.
23 It was constant upheaval and difficulties with her
24 mother.
25             Regardless of all that, I call C --
0033
1 and I think that the words to me that describe

2 C是，她只是真正得到了真正的
3 勇气。
4 她从高中辍学，但她参加了
5 她的普通教育证书。她在三年级时就接受了测试，然后
6，再也没有接受过像智商这样的测试。她的智商
7 是正常的，是平均水平。她通过了普通教育证书，
8，这确实需要一些脑力来完成。
9 在这次撞车事件发生时，她和J一起住在
10。他们一起买了一套公寓
11，她--有一份兼职工作，为一个有自闭症孩子的女人提供
12 儿童护理。
13 她的生活热情是孩子，可能是
14 因为她一生都在照顾她的弟弟和妹妹
15。这就是她想做的事
16，她的大梦想是拥有自己的
17日间护理。
18 那是--那对她来说，将是
19，绝对是生命中最美好的事情。谁知道呢，因为
20，当这件事发生时她才18岁。
21 所以现在作为一个脑部受伤的人，有一个
22 小不同的问题。
她真正的勇气仍在那里，你会看到它，但还有一些
24，那就是她不再是同一个人
25。你仍然可以看到她的点点滴滴
0034
1，如果你和她在一起一个小时，你就会
2 被她吸引。
3 但你在短时间内看到的
4 不是你在C身上得到的。她有一个
5 较低的智商，她非常努力地挣扎，根本没有表现出任何受伤的迹象
6。
7 她不承认自己受伤，
8 她不想受伤，她不想
9 表现出受伤的样子，她不想与
10 被贴上受伤者的标签有关，
11 这可能是她能够
12 走路的原因。她只是真的，真的，真的不想让
13，让她的生活因此而改变，真的挣扎着
14，希望能好起来。
15 但也有一些问题，因为她已经
16 达到了那个高原点，她没有得到 --
17 她不会看到那一天，奇迹的时刻
18 已经过去了。
19 她有一个相当严重的问题是
20，她的颞叶受伤。她有
21 重大的情绪问题--我们会把它们看成是
22 情绪问题，但它们不只是--你不能
23 去咨询和解决这个问题。她循环上升
24，循环下降非常非常快，升级为愤怒。
25 她在
0035
1 监护人的办公室里辱骂每个人。她......她很可爱，在
2 瞬间又走向另一个方向。

20 我在预备讯问时告诉你，本案涉及很多费用，我知道
22 听起来是很多钱，确实如此。我们没有
23，在发生这样的碰撞后，要让一个人活着需要多少钱
24。她没有选择
25 去医院。
0036
1 她过去的医疗费用是733,000美元，只是
2 她过去的医疗费用。她不打算再
3 工作。有人建议，也许
4 她可以在某个地方做志愿者，也许她可以找到
5 定期--某种类型的就业。由于她的
6 波动性，与......工作。

16 我没有做计算，但会有
17 人在这里谈论这个问题。而她一生的工资
18 损失，即使工资很低，
19 她只有普通教育文凭，她想从事儿童保育工作，
20 仍然在200万美元左右。
21 更大的金额是照顾C所需的金额
22。她有照顾者。
23 她有照顾者，被雇用的人数远远超过
24 他们现在的人数。
25 我们看到的问题之一，
0037
1 监护人会说到，她没有得到
2 足够的照顾。她的房子正变得
3 看起来无法管理。
4 她的卫生状况很差，她吃得不
5，以至于她不得不去看
6 医生，因为消化问题。你让她吃一个
7苹果，她却吃得像个13岁的男孩。
8 因此，需要为
9 她提供护理费用，这些费用将为你预测。
10有一个很大的范围，我甚至不打算让
11，为什么有一个范围，但我们的工作是确保
12，有足够的钱，如果责任被发现，
13照顾她。
14 这是我要给你看的最后一个视频
15 的C。正如我之前告诉你的，如果你
16 和她相处片刻，你会发现她很迷人，
17 如果她心情好，你可能不会知道
18 有一个问题。
19 试着带她出去吃饭，有一个
20钢琴演奏和人们交谈，你会发现她
21，甚至不会走进餐厅。她不能处理任何形式的
22 的多种声音或分心。
23 她就是不能 -- 她就是不能像正常人一样
24，即使她尽力
25，看起来像一个正常人。
0038
1 在本案中，她已经进行了两次取证
2，最后一次--取证是
3，当你的宣誓证词被另一方，
4，在本案中是被告，她的最后一次取证是
5，差不多两个月前。
6 我想让你们看到，她已经取得了
7 的进展，她不像我们在
8 5月看到的那个人。
9 我想让你们注意到--我会告诉你们
10 她的情况是，她仍然有脚步声，她有
11 走路困难，她身体的左侧
12 瘫痪，她的一只手臂很少使用。
13 这只是想告诉你，在这里可以看到脑部的损伤
14。
15（视频播放。）
16 MS.谢谢你

Karen Koehler2014年2月25日脑损伤，开场白