The Gary Galiher Law Hour — Episode 18: Stopping Elder Abuse w/ Anthony Carr

Elderly people are the targets of many forms of abuse. While it will sometimes be obvious, it goes undiscovered far too often. The elderly are frequently unable—too afraid or too frail—to report abuse themselves. Thus, different types of abuse, neglect and exploitation may only be discovered by somebody who knows what to look for, or what questions to ask.

“Being a civil litigation firm, primarily, the cases we’re able to take on and represent are usually pretty catastrophic: wrongful death and really tragic cases,” says Attorney Anthony Carr. “But there are many other issues touching upon elder care and elder abuse that unfortunately we’re not always able to take on in litigation, but we’re certainly invested in.”

These problems become widespread in part through gaps in the regulation of care facilities. Different sets of regulations apply to different types of facilities.

For example, a smaller type of facility known as a community care foster home (CCFH) is basically a mini-nursing home limited to three residents, that provides a “nursing level of care.” At a larger type of home, there would have to be a licensed medical doctor, there would be registered nurses. To operate a CCFH, however, only requires a registered certified nursing assistant. No nurse or medical doctor are required on staff.

While the nursing assistant qualification has its merits, not having more qualified medical professionals on staff subjects the residents to a lower standard of care. This problem goes on unabated in part because very few people are aware of it or problems like it.

When something gives cause for concern at a care home, Anthony has some advice: “It’s a two-part process, because a lot of the people involved in an individual’s care probably knows this person pretty well, maybe knows the immediate family. You’ll know when something out of the ordinary happens.” That’s the first part. Then, “when you notice that, investigate it, ask them questions, satisfy your curiosity.”

Placing an elderly loved one in an assisted living facility often happens in a hurry due to a medical emergencies suddenly increasing their need for care. This often limits their family’s choice because it forces a quick decision on where they will go.

Facilities are well aware of this common dilemma, and they are known to take advantage of it by focusing on the surface-level appearance of their homes, working up slick sales pitches and making big promises instead of delivering the best possible care for their residents.

Knowing the right questions to ask at the beginning can give vital information to a family going through the stressful process of finding a good, safe place for kūpuna. Our article on the 10 Questions to Ask Any Senior Care Home is helpful there.

We’ve scratched the surface, but there’s so much more to learn in this episode. Tune in!

The Gary Galiher Law Hour: Episode 16 w/ Coach Vince Goo! (part 2)

This is part two of a program about sports and concussions featuring Vince Goo, former head coach of the University of Hawai‘i Wahine basketball team.

When the news broke about the discovery of chronic traumatic encephalopathy—the degenerative brain disease that haunts NFL players—our founding partner, Gary Galiher, realized very soon that this is a much bigger issue than just the NFL’s. Gary’s background in psychology and special education led him to deduce that children’s developing brains could be affected to degrees varying with the amount of contact in their sport. Since then, the science of concussions has developed and that insight has been validated.

A concussion is pretty hard to ignore when a kid gets knocked out, but there are all kinds of things that happen in-between. We’re talking not just about the National Football League, here, but about kids who play in grade school, taking damage they carry with them for the rest of their lives.

Coach Goo has coached a variety of sports at many different levels. While he was not allowed to play full-contact football as a boy, as a father he did allow his sons to play. At the time, the revelations about brain injuries in football had not yet come to light, so the risks were unknown. Today, he sees things differently. “Knowing what I know now, I probably would’ve been in the same thought process as my dad, not letting my sons play,” he said. “My grandsons, I hope they never play the game.”

The coach agrees with Mike that “there haven’t been enough precautions, enough checks and balances so that you can take a kid out [of play] when he gets hurt.” We’re getting there education-wise, and trainers are putting the priority on the health and welfare of the student-athletes, said the coach.

Tune in to hear about plans to make sports safer, and how we can get leadership involved to make the right decisions for Hawai‘i.

The Gary Galiher Law Hour: Episode 16 w/ Coach Vince Goo!

We are proud to present part one our two-part episode with the University of Hawai‘i’s Wahine Basketball team’s legendary head coach, Vince Goo.

During his tenure in that role, the Wahine won 334 games, gained 10 post-season bids, and earned the most wins by any basketball coach in school history. Coach Goo has also had the distinction of coaching the team with the highest graduation rate among any collegiate women’s basketball team in the US, and every player who finished her playing eligibility on one of his squads at UH earned a degree.

In a wide-ranging conversation, Coach Goo joins our hosts Gary Galiher and Mike Buck to discuss the vital subject of concussions in sports.

“Risking the health and welfare of a player is not worth one more victory,” says the coach. He had to be vigilant about these concerns due to the surprisingly high rate of concussion in women’s basketball.

Coach Goo exemplifies the best approach to athletic safety: “I had our team doctor and our trainer make all the calls when it came to the health and safety of our players, and I would not second-guess them: they say they play or they don’t play. At the same time, I say you do your job, don’t tell me what offense and what defense to play. (Laughs.) You do your job, I do my job.”

The coach has certainly noticed the changes in the understanding of concussion issues. “Growing up playing basketball, whether in a league or at the playground, if you fell and your head hit the floor, okay, then you start to worry. Other than that, you’re not going to have a concussion. But little did we know that a forearm or an elbow can cause all of those things.”

Yet, he recognizes that the understanding has a ways to go: “When we look at football [now], the big hits with the head: we see concussion. But what about all those little contacts that you’ve had along the way,” wonders Coach Goo.

Only in the last few years has it become apparent that in football, full-blown concussions are just the tip of the iceberg. The helmet itself enabled a false sense of the security that the brain would be protected, when it did anything but that.

If you look at the small print the manufacturer puts on the helmets, it tells you this will only prevent skull fracture. With respect to concussion, it won’t protect you. When it comes to chronic traumatic encephalopathy, which comes from the repeated blows to the head, it masks that and doesn’t help that at all.

The science is showing us—and science should be our guide—that if you take the helmets off, concussions go down. It’s counterintuitive, but that’s the fact.

“I’m looking forward to that day we have more money, and hopefully HCAMP’s research at UH can go forward,” says Gary. “We’d like to see it get more sophisticated, from the standpoint they’ve done wonders keeping kids out of play after concussions, before they can come back in.”

“There’s no simple-simon answer to this,” he continued. “We’ve just got to be honest about the research that’s out there, and we get more feedback and feel our way along intelligently so we’re not just letting our kids play bloodsport out there.

“I mean, I’m a pretty liberal guy, I’d let people do what they want with their adult brains, as nuts as it might be. On the other hand, when it comes to our kids, we have a higher duty than that. When your whole brain, your sense of self, your life, your way to find success is in-between your ears, and we’re kicking around for bloodsport, I don’t think so. The parents can really see that, yeah, it’s going to take a little fun out of the sport, but what a compromise! Pop Warner, everybody wants to see it, but the kids shouldn’t be playing with helmets. If a kid gets injured with a helmet, I’d go after the helmet company.”

Tune in for a lively talk with one of Hawai‘i’s most respected and important figures in sports.

The Gary Galiher Law Hour — Episode 15: Obama, Hapa w/ Kamea Hadar

Above: Progression of the painting of the Hapa mural. At this point, Kamea Hadar had written out a portion of Obama’s 2008 Race Speech at the Constitution Center, to underlay the portrait.

Honolulu-based muralist Kamea Hadar joins us for this week’s episode. At the time of the recording, he was the proud father of a one-and-a-half week-old baby, halfway through the process of painting Hapa, a mural commissioned for the Gary Galiher Law Building on Ward Avenue in Honolulu.

Tune in for a lively conversation about the mural’s subject, President Barack Obama; the making of large-scale works of art; and the value of art in Hawai‘i. Some highlights follow:

Gary Galiher: “I’ve admired a particular artist’s work for a long time. He does really elegant work, whether it’s on the side of a building, or on the interior wall of a barbershop, downtown in Chinatown, I kept coming back to the same person. And then I talked to Clarisse Kobashigawa in my office, and said Clarisse, we’ve got to track down this artist. The next thing I know, Clarisse has connected with him and we’ve got a conversation going.”

Kamea Hadar: “My profession is painting large-scale murals, and I also do canvas paintings, but, you know, President Obama has always been an inspiration. It’s an honor to paint him, and I’m just happy that Gary gave me the canvas to paint. Unlike my studio work, I can’t just go out and buy these canvases. I need someone who owns a building to let me paint on it.”

GG: “I love Hawai‘i, love all the different ethnic groups, and we have been so fortunate and honored to represent great groups like the naval workers at Pearl Harbor Shipyard, hard-working local people… I really do love the ethnic richness that we have here, and those values really come through. It’s a real island community. The idea that someone came from Hawai‘i of mixed ancestry from around the world. He was raised here and went off and became stellar in what he entered into, in school and work, and became president of the United States. That just makes me so proud. I think so many people identify with that.”

KH: “My background is very, very mixed. My mom is actually Japanese-Korean: my grandma is full Korean and my grandfather is full Japanese, and that’s already a weird mix, back in their generation. My Korean great-grandmother had some issues with them getting together. My grandfather was a war hero. He fought in the 442nd, which is the Japanese-American battalion. Then my Mom, while backpacking across Europe, met my Dad, who’s from Israel, you know, a haole guy, and my grandparents on that side are holocaust survivors. [Hadar] is a Hebrew name. Our family name was Satrinas, from Poland, and when my grandparents went to Israel from Poland, which is the same meaning but the Hebrew kind of version, I guess you could say.”

Mike Buck: “I’m thinking, down the road, this thing’s gonna be a landmark. People are gonna say, ‘it’s right by the Obama picture.’ And you know this is gonna be a big deal… Pretty soon, it doesn’t matter what the name of the street is, does it. You just go by the Obama picture and turn left.”

KH: “All these modern tools help quite a bit, but at the end of the day I’m still up there with a paintbrush. So the way that I start usually is with a pencil sketch. Then, you know, you asked me about proportion, and a lot of that is just experience. When you’re up there, you know, the pupil is huge. And you’re like, well okay I’m just going to trust in my gut that the pupil is going to be this big, and you’ve got to trust your sketch.

“So after the sketch goes up—and the way I use the sketch is, I use references, so you use bricks in the wall, you use pipes, doors, to make sure there’s space in the piece and make sure it’s proportional, so that you don’t get a crooked face, or a lazy eye, or that it just doesn’t look like the person—once the sketch goes up, I start painting, and I always start with the eyes. The eyes are, as they say, the windows to the soul, and the eyes are the most important part of the piece. So without the eyes, all is lost. If they don’t turn out, then I’ll redo them, but that has to be in place before I do anything [else]. It’s a confidence thing, so if I can do the eyes, then it’s a snowball thing and the rest is easy.”

The Gary Galiher Law Hour — Episode 14: Protecting Elders in Long-Term Care w/ John McDermott

We’ve talked before about the importance of being an advocate for your loved one, due to the limited resources our state has to perform certain functions. We’re honored to have the state’s Long-Term Care Ombudsman, John McDermott, here with us to talk more about what his office does to prevent abuse. But what is an ombudsman?

In John’s words, an “ombudsman is really someone who is working behind the scenes so that you don’t get the runaround, so that if you have a complaint, this person can tell you where to go, or will go there to find out for you.” The Long-Term Care Ombudsman Program’s home page is online and at your service at the link.

Elder-care facilities have to follow certain best practices, and John’s office serves to intervene when they fail in these duties.

In a perfect world, this kind of watchdog would not be necessary. Attorney Anthony Carr, our guest host this episode, raises an excellent point:

We want to be objective, and we want to be transparent. At least in theory that’s true, but what are our priorities as a society? Well, it’s a priority to make sure that employees are going to do their duties as expected, it’s a priority to make sure that unsafe food is not given to consumers. But it is not a significant priority so far, as much as we might want to think it is and talk about it, to recognize the health and wellbeing of elderly folks as a priority we need to do something about and dedicate resources to, and not just talk about.

The perfect counter-example is John and his office, an incredible force for these values that society has yet to honestly embrace. They work hard to stem the tide of elder abuse, neglect, and exploitation, in spite of the broad lack of urgency regarding these issues. Their hearts are in it, and they do it for the right reasons.

Click play and learn about the current situation in Hawai‘i, as well as the efforts underway to make it a safer, more dignified place for people to spend their golden years. You can also read about John in the Civil Beat’s recent article, “Did Hawai‘i Lawmakers Do Enough To Protect The Elderly?

The Gary Galiher Law Hour — Episode 13: Act FAST!

(Pictured above: Our host Mike Buck with Dr. Matthew Koenig from The Queen’s Medical Center.)

Do you know how to recognize the signs and symptoms of a stroke? Knowing could save someone you know from suffering a disability.

Our guest on today’s show is Dr. Matthew Koenig, Director of Telehealth and Associate Director of Neuro-Critical Care at The Queen’s Health Center. He’s an intensivist, which is a medical doctor with special training and experience in treating critically ill patients. Dr. Koenig stresses that it’s really important to be able to recognize a stroke.

One big difference between strokes and heart attacks is that heart attacks are painful. Because of the pain, people suffering a heart attack know right away that something is very wrong, so they get emergency care.

On the other hand, people having a stroke are having an injury to the brain that affects how the brain functions. They often don’t realize they’re having a stroke because they’re not thinking as normal. Failure to seek emergency care during a stroke worsens its effect, which results in more serious disabilities for the person affected.

We have a simple way to identify a stroke: Act FAST.

Face droopiness on one side of the face
Arm (or leg) weakness, or weakness on one side of the body
Speech problems, either slurred or garbled speech
Time to call 911

Time is of the essence when someone is having a stroke. The sooner they get to a hospital, the better their chances of recovery. If someone is feeling unwell and they can’t quite explain exactly what the problem is, check the first three of the items above. If any of them are a problem, it’s time to call 911 right away.

We talk about more than strokes in this episode. As a neuro-intensivist, Dr. Koenig can offer a unique perspective on repetitive concussive and sub-concussive injuries. “It’s a cumulative problem,” he says, “which means that the sum and severity of injuries that the brain receives over a lifetime really will have an additive—and probably multiplicative effect, as well—to produce chronic traumatic encephalopathy.”

We also learn about advances in the field of telemedicine, which allows doctors and patients in different locations to connect through technology. Dr. Koenig is at Hawai‘i’s forefront in this field.

Tune in, and join host Mike Buck and guest host Clarisse Kobashigawa for a fun and interesting show!

The Gary Galiher Law Hour — Episode 12: The Emerging Science of Youth Sports w/ Cora Speck

Sports-related brain injuries threaten the lives of millions of people in the US today. Parents of student athletes must be especially aware of the risks involved when their kids play contact sports.

The research into this category of injury continues day by day. Now, we are seeing it’s not just concussions: it’s a whole spectrum underneath.

The very same physiological mechanisms that help the brain heal from concussions are unfolding at sub-concussive levels, too. As Gary says, “If a concussion takes 60, or 80 or 100 Gs to lose consciousness, the brain, when it receives contact of 25 or fewer Gs typical of a hit… to repair itself, there’s a cascade of chemicals get released, and it tries to take itself offline, and becomes very delicate for a period of time.”

Our guest today is Cora Speck, Trauma Injury Prevention Outreach Coordinator at the Queen’s Medical Center in Honolulu, Hawai‘i. Among many job duties, she researches innovations that help prevent sports injuries.

Science supports the idea that athletes who sustain injuries on this spectrum will need time before they return to play, but the proverbial jury is still deliberating on how long might be needed. If we are serious about establishing how to keep our athletes from more harm when they return to play, Cora says, “we should be advocating for the Nat’l Institute of Health and Center for Disease Control, probably the Department of Defense as well, to be putting more attention and money into research like this.”

Further research is need, says Cora, for us to know at what age it might be safe for a person to know “at what point is there any sort of structural or chemical changes that could be detected, that could indicate to a family that this is the cutoff point, that if you proceed to choose to proceed, that you are putting your child’s full adult life in jeopardy.”

Concussions can happen even without any contact to the head: blows to the body can cause them, too. Another looming question is what age is appropriate for kids to play contact sports such as football.

We’re learning more every day, and in the podcast we offer lots more valuable discussion on this very big subject. Tune in!

The Gary Galiher Law Hour — Episode 11: Making Sports Safer for Kids w/ Sam Lee

We all know what can happen from a single, huge traumatic event like a car crash, or getting your bell rung at a football game, where you have a more life-threatening injury. Less obvious, though, is what goes on throughout a multi-year span of activities by an athlete: they have a cumulative effect that can be as bad as a single, major trauma.

Athletes of all ages who play contact sports take sub-concussive injuries in their day-to-day play. “What’s really happening in the brain when they’re children, especially young children, in these sub-concussive injuries, is the same cascade of chemicals, the same repair mechanisms happen that happen during concussions—it’s just that they’re happening a lot more frequently,” said Gary Galiher, our founding partner.

Researchers in the field of neurotrauma are very aware of this, but we want to see people everywhere begin to understand that many of the sports our children play could have serious negative effects on their cognitive abilities down the road.

Our firm is all for sports—including football—but when children as young as seven or eight years old are playing full-contact and sustaining head injuries, we know that something is wrong. It’s necessary to change how our children are playing, the conversation about how to make these changes needs to begin right away, and it cannot be informed just by what the NFL wants us to know.

We are moving that conversation forward with today’s guest, Sam Lee, an award-winning (and very charismatic!) athletic trainer at Hawai‘i Baptist Academy in Honolulu. He was the recipient of the 2015 District 8 Gatorade Secondary School Athletic Trainer Award, for establishing a concussion management program at his school, as well as helping the Hawai‘i athletic association develop comprehensive heat acclimatization and practice schedule guidelines.

Our talk with Coach Lee covers the vital angles of the issues mentioned here, from the state of things today to the future of student athletics. Tune in and find out why Hawai‘i is a progressive state in the nationwide battle to make sports safer for young people.

The Gary Galiher Law Hour — Episode 10: Sub-Concussions and CTE w/ Dr. Violet Horvath

It’s not just NFL pro players who have to worry about concussive and repetitive sub-concussive injuries. Kids who play sports are being exposed to these traumas, too.

Dr. Violet Horvath, Director of the Pacific Disabilities Center, along with our very own Anthony Carr, joined our host Mike Buck for today’s episode of the Gary Galiher Law Hour. Their conversation helps sheds light on the risks of these injuries and how to decrease them.

Evidence of the connection between chronic traumatic encephalopathy and behavioral changes is mounting. Several researchers at the Neuro-Huddle said they believe CTE to be at the root of the mood instability and unhinged behavior often seen in the victims.

Hard proof of this remains to be established, however, because the science of CTE is still nascent. While we learned a lot at this year’s Neuro-Huddle and CTE Conference, according to Dr. Horvath, “it was clear. What we don’t know far exceeds what we do know.”

For example, there’s no way to diagnose with certainty whether a living person has CTE. Studies aimed toward making diagnosis possible are underway now, and those leading it hope for results within the next year or two.

Meanwhile, there are huge opportunities for the prevention of head injuries. Dr. Horvath recommends that young people not play football, soccer or judo, which carry high risks of head injuries. Again, the current understanding of brain science is insufficient: “With the kids… some of the things that are being proposed are that no one under 12 be able to do any kind of contact sports, at least in football, and honestly 12 is kind of arbitrary. We don’t know. Maybe it needs to be 9, maybe higher is okay,” she said.

Another issue is that people this young aren’t able to give informed consent. They’re generally too young to fully understand the issues, therefore they cannot make decisions about playing that could affect them decades into the future. “Until someone is actually old enough to understand and give their consent for themselves, maybe they shouldn’t be playing.”

If you are a resident of Hawai‘i of any age who has had a traumatic brain injury or concussion, stroke, or spinal cord injury, Dr. Horvath would like to ask for a few minutes of your time to participate in the Hawai‘i Neurotrauma Registry Project Online Survey. Find more information about it and join the registry at the Hawai‘i Neurotrauma Registry website, and take the Hawai‘i Neurotrama Registry Survey here on SurveyMonkey.

As always, thanks for tuning in!


Photo: Boston University Center for the Study of Traumatic Encephalopathy, “Image of chronic traumatic encephalopathy“, (c) CC-SA-4.0

The Gary Galiher Law Hour — Episode 9: Social Justice

It’s About More Than Money

We at Galiher DeRobertis & Waxman value social justice and fight for it every day. We bring cases to court on behalf of the people of Hawai‘i. Furthermore, when working with private individuals, we never take a case in which we feel like it would put us on the wrong side of the battle. Today, we’re talking about the firm’s contributions to the public welfare in the past, present, and future.

Quite often, when companies in an industry are doing something wrong, they’re calculating how much they expect to have to pay for it in a court case. They think they’ve done the bean counting, that they’ll pay X million dollars when the courts decide the penalties. For these companies, the harm they cause is just part of the cost of doing business.

It happened with Big Tobacco. When they learned that people were smoking for the pharmacological effects of nicotine, they added freebasing chemicals to allow the nicotine to cross membranes of the body more easily—one of their ways to keep people addicted. For reasons like that, the Galiher firm sued Big Tobacco and won.

It happened again in a price fixing scandal in Hawai‘i in the late 90s. Galiher sued the gasoline companies, who were colluding to rig the market. Instead of competing, they shared wholesale prices with each other to discourage competition, and overcharged consumers. They lost the case, though not nearly as much as they should have, we say.

Where big industries are involved, it’s always an uphill battle, but we are undeterred. We are using our know-how as attorneys to change things for the better. Tune in and find out what we’re working on next.