The Capabilities of Amputees
The world of the amputee has changed dramatically in the thirty years since I lost my leg. As an amputee/prosthetist I have witnessed state of the art prosthetics return many amputees to a close approximation of their former life. The trucking industry faces continuing liability issues that involve the functional capabilities of amputees. Having served as an expert in prosthetics for over 20 years I have developed a program to predict how much it will cost to provide lifetime prosthetic services. This article explores a systematic approach to assessing an amputee's prosthetic needs and also provides insights into legal defense strategies.I lost my leg in a motorcycle accident over 30 years ago. I had been flagged through a construction zone and was hit by a front end loader. There was a law suit and my prosthetist was charged with determining how much money it would take to keep me in prostheses for the rest of my life. The figure that he came up with would not have kept me in legs for five years, let alone the fifty-five years of my projected life expectancy. When I chose a career in prosthetics I recognized that no one had ever systematically approached the question of determining costs.
My observations, both personal and professional led me to divide an amputee's life expectancy into three phases. The initial phase represents the time when an amputee's residual limb goes through the most changes. This is most dramatic on the leg amputee since weight bearing on a residual limb generally causes shrinkage. The initial phase usually lasts between three and five years. This phase requires the most frequent replacements of prostheses.
The second period of an amputee's life is the stable phase. This represents the time when their residual limb has stabilized and their style of life is constant. This may include a recreational component as well as normal daily activities. The stable phase lasts until the amputee's geriatric and the replacement of prostheses slows.
The geriatric phase is when an amputee's life style slows and therefore their need for new prostheses diminishes. This phase lasts until the end of their projected life expectancy.
Child amputees will be in their initial phase until they quit growing. For boys that is age 18 and for girls it is age 21. This is due to the continual growth of children and the necessity for replacement prostheses every year.
Upper extremity amputees generally will have a lower replacement rate since they don't get the abuse of weight bearing. Arm amputees also rarely experience the degree of tissue change due to lack of weight bearing on the residual limb.
I also take into account the need for ancillary prostheses. The most common of these is the shower or swimming limb. This allows an amputee to safely use any shower or tub as well as enjoy aquatic activities. It is typical for an amputee to have a backup prosthesis. Just like it is important to have a working spare tire on a truck, the amputee needs a backup leg; just in case.
These are the factors that I use to determine an amputee's prosthetic lifetime needs. I utilize a custom program to project a yearly total that also takes into account the maintenance and soft-goods.
How can you demonstrate the capabilities of an amputee? In a lawsuit where the plaintiff is an amputee there is always the "Sympathy Factor". Most juries have an immediate sympathy for someone who has lost a limb and the plaintiff's representation will generally reinforce that in hopes for a larger award. Educating a judge or jury as to the capabilities of an amputee can be a daunting task since an attack on an amputee can turn a jury against an otherwise legitimate defense.
Medical records can be damaging to a defense once the gruesome details of a traumatic amputation are shown to a jury. However, there are clues in the medical reports that can demonstrate a discrepancy between the helpless claims of a plaintiff team and the reality of their life. The prosthetic records can be very revealing.
Prosthetists are required by law to keep accurate billing and patient note records. Medicare is the largest purchaser of prosthetic devices in the US. They have a set fee schedule for prosthetic costs that has become the benchmark for prosthetic pricing. They have an activity designation code called K-levels. There are four K-levels that denote the amputee's functional capability. In order for a prosthetist to justify certain components they must assign a K-level to each of their patients.
I have often worked on cases where the amputee claims to be unable to perform many of the functions of daily living. They will describe a lifestyle of a K-2 ambulator but in their prosthetic notes they have received a prosthesis for a K-4 ambulator. This discrepancy can give a jury cause to question the functional claims of the plaintiff.
In today's world, most amputees can return to a nearly normal style of life. It requires the proper prosthetic equipment and service. It also requires the motivation to overcome what is a traumatic and life-changing experience. Today, amputees are employed in nearly every trade and profession. The Federal Government issues waivers to people who wear prostheses.
The functional capabilities of amputees can be demonstrated by careful analysis of the medical and prosthetic records. Having an expert who can assist a defense team in developing realistic perceptions of an amputee's capabilities can make the difference in substantial awards.
