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Children rejected for brain-injury program

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    Children rejected for brain-injury program

    Children rejected for brain-injury program


    Using criteria that have been considered outdated for more than 18 months, the state Workers' Compensation Commission has rejected a second child for care by a program for brain-injured children.

    In a decision made public this week, as well as in another decision in August, the compensation commission fails to recognize new findings hailed by doctors, researchers and prestigious medical groups as establishing when asphyxia causes lifelong brain damage and cerebral palsy.

    Arguments using the discarded criteria have been employed by the Virginia Birth-related Neurological Injury Compensation Program in at least two cases tracked by The Times-Dispatch for two years.

    A lawyer for the program, K. Marshall Cook, said last week that the program is bound to use standards in force when a petition to enter the program is filed, not those that might come into play during subsequent legal proceedings.

    This procedure means that the state's birth-injury law, which has not been altered significantly in 15 years, must attempt to mesh with advances in research defining the little-understood, shifting connection between brain injury and oxygen loss at birth.

    For more than a century, the relationship among oxygen loss, brain injury and cerebral palsy was considered commonplace; it is now regarded as a rarity. Virginia is one of only two states that tries to define the injury and set children aside for special care.

    Decisions in the cases can mean the difference between lifetime care for some of society's most-disabled children and no guarantees that medical expenses will be covered. Many families have had to opt for institutionalizing their children.

    In the decision this week, the parents of a Bedford child relied largely on 10-year-old birth records that never ad- dressed the issue of brain injury from oxygen loss or current theories about links between the two.

    Using material she tracked on the Internet and assessments from her daughter's pediatrician, Sue Ann Sochor found herself opposed at a hearing in March by a lawyer from the Richmond based Hirschler Fleischer firm, a neurologist hired by the program and other experts paid by the program.

    In addition, the program used criteria first published in 1992 and supported by leading authorities at that time as the best grounds on which to assess birth injury from oxygen loss.

    Those criteria, however, were withdrawn in December 2001 by leading medical authorities, a year before the Sochor family filed a petition for their daughter.

    In January this year, the American College of Obstetricians and Gynecologists and other leading medical authorities issued new criteria that sharply undercut previous beliefs about oxygen loss and brain injury.

    In the Sochor decision, the commission said that medical opinions on Sochor's behalf were not substantive enough. Her pediatrician wrote that there was a "highly probable likelihood" that Sarah Marie Sochor was "neurologically devastated . . . secondary to . . . a clearly documented period of perinatal asphyxia."

    She was not breathing at birth and her umbilical cord was wrapped twice around her neck and had to be cut before her head was delivered.

    But program experts said Sochor's condition might be genetic, though there is no evidence in tests of that, and that factors at her birth did not match criteria originally set out by the American College of Obstetricians and Gynecologists.

    Those principal criteria changed in January, though they continue to play a less-significant role in pinpointing asphyxia.

    No opinion in the case stated with certainty what caused Sarah's condition, which is a common problem in children with cerebral palsy.

    A similar problem confronts a 5-year-old Danville-area girl, Taylor Hope Wolfe, whose story was featured Sunday in Times-Dispatch articles about Danville children in the birth-injury program.

    Her case was returned to the commission last month by the state Court of Appeals for further review.

    Like the Sochor child's case, Taylor Wolfe's case does not include evidence that can be crucial to showing birth injuries from oxygen loss.

    The obstetricians in both cases did not obtain the necessary information.

    The missing element is a simple test at birth that helps identify whether the blood has acidified; acidosis occurs when oxygen supply to the blood is interrupted.

    Virginia law does not require the test even though an obstetrician's failure to order the test can support the argument that the child's injuries may have been in place long before labor and delivery.

    Defining what children the birth-injury program wants to care for has bedeviled the program since its inception in 1988. A primary focus of the law was to remove the complex cases from costly malpractice litigation and provide lifetime care for children injured at birth.

    But only 80 children have been accepted, despite the inclusion of spinal cord injuries as a cause of brain damage and the inclusion of premature children.

    The children must be so severely injured that they will never lead independent lives.

    The study issued in January this year and endorsed by major medical groups estimates that only 1.6 full-term children per 10,000 births are severely injured with cerebral palsy from oxygen loss confined to labor and delivery.

    At that rate, Virginia should have expected to enroll more than 200 children into the financially struggling program. But many doctors and hospitals do not participate in it, and many children who died never applied because no benefits other than medical care were available.

    Contact Bill McKelway at (804) 649-6601 or

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    Oxygen lack: Maybe there's a brain damages system.

    Assumed with some forms,
    there might be programming,
    that more developmental newer stuff can get more damaged,
    than ancient vital systems, alike brain stem.

    I believe there are genetic programs to this.
    But this is just my belief.

    Alike if brain stem got damaged most, gone is the geneline.

    If major motor control got damaged most, last one running from a predator might get eaten.
    Then also, if not having had children before, gone is the geneline.

    But if it are newer systems, as alike frontal cortex of our size, and there a bunch off, so what. If a sexy blonde with neat looking breats is a bunch more stupid, she might find a guy anyway to care for here and her off-spring.
    And the geneline at oxygen lack in this sector and several other neocortex ones and some others alike shutting down first,
    can survive.

    Anyway, I believe there can be alike a shut down pattering, which sectors first.
    And this to do with some of us MBD having the vital systems O.K., but some of the more modern ones not.
    But just my belief.