Transcript of Medical Prognosis Letter
June 8, 2000
To Whom It May Concern
Re: Jeffrey Couch
Mr. Couch is a forty-seven-year-old male who was involved in a very serious motor vehicle accident March 31, 2000 in Barbados. Mr. Couch was unconscious at the scene and taken immediately to the Queen Elizabeth Hospital in Barbados. The following injuries were confirmed:
• Fracture of the C5 vertebrae with resulting C4 complete motor tetraplegia
• Fracture of the posterior elements of C3-C5 vertebrae
• Bilat multiple rib fractures with pneumothorax
• Lacerations of the right forehead and occipital area
Due to respiratory distress he required a tracheostomy to breathe. On April 17, 2000 he underwent extensive neurosurgery in Barbados involving decompression laminectomy C7 - T12 plus cervical fusion C2 - C6. On April 18, 2000, Mr. Couch was transferred by air ambulance to Sunnybrook Health Science Centre, Toronto (Canada) in critical condition. While at Sunnybrook Health Science Centre, x-rays were repeated and a fracture of the 4th cervical vertebrae was identified. In addition, fractures of T3 and T4 spinous processes and compression fractures of T3 and T3 vertebrae was identified. A fracture of the right clavicle was also found.
Mr. Couch was transferred to the Toronto Rehabilitation Institute Lyndhurst Centre on May 23, 2000 once he became medically stable and the tracheostomy was removed. Due to this unfortunate accident, Mr. Couch sustained a very high level of cervical cord injury and paralysis of all four limbs. He is dependent in all areas of self-care including feeding, bathing, grooming, dressing, bladder/bowel management and transfers. Mr. Couch does not have voluntary motor function below the neck.
The following items are pieces of equipment that are absolutely necessary and medically prescribed for Mr. Couch following his injury:
• Power wheelchair with tilt, head control and environmental control options ... Approximately $20,000
• Rental power wheelchair (until his wheelchair is ordered/arrives) $1,100/month
• Manual wheelchair and appropriate seating ... ($5,000 - $3,500)
• Commode with tilt ... ($1,700 - $2,300)
• Hospital electric bed - $6,500
• High quality air mattress - 53,000
• Electric lift, charger and sling ... $4,000
• Environmental control system/door openers ... $15,000
• Computer with head mouse voice recognition software ... $7,000
• 24 hour private attendant care services ... $100,000 - $150,000/year
• Upper extremity and lower extremity custom compression garments ... $100 each
• Electric leg bag opener ... $900
• Van assessment as a passenger at Driver Wheelchair accessible van with appropriate features (e.g., tinted windows, air conditioning, bench seat for IC's and power wheelchair M) ... $70,000 - $100,000
• Hands-free Ameriphone ... $700
• Lifeline emergency response monitoring ... $45 per month
• Bilat wrist supports ... $35 - $45 each
• Mouthsticks/head pointers/docking stations ... $140 each
• Transfer board - $60
• Wheelchair accessible housing
• Bladder and bowel supplies, pads and personal hygiene supplies - approximately $500/year (plus freight and handling)
• Exercise equipment – e.g. - Active/passive trainer - $3000
- Tilt table - $5,000
• May potentially need custom orthotics (e.g. To prevent elbow contractures or drop foot - starting at $1,200 each and shoulder subluxation supports starting at $80 each)
• May potentially need van lessons (27 hours in classroom, 14 hours in vehicle) ... $2,400 in the future
• Extended, private OT/PT services (if necessary,) following discharge from Lyndhurst Centre.
Please be advised, the aforementioned items are not an exhaustive list, and other equipment needs may arise as Mr. Couch’s rehabilitation progresses. Please note these quotations are in Canadian funds. Thank you for your support.
Respectfully,
(signed)
N. Bharatwal, M.D., F.R.C.P. (C)
Anat Barak, BSc., O.T., (C)
David Frake, B. Sc., P.T.
Rita Mabrucco, M.S.W., R.S.W.
Jackie Wright, R.N.
Lynda Charters, Therapeutic Recreationist.