Greater Bodily Injury (GBI) Elder abuse report

As consultants for criminal attorneys, we review a lot of cases for assault and Great Bodily Injury (GBI). Elder Abuse, on the other hand, is more commonly known as a civil issue in the legal nurse consulting field. However, we have received a few cases in which Elder Abuse was also charged in conjunction with assault charges. In this case study, the defendant was a young man in his 20’s who was charged with attempted murder with a GBI enhancement. He was also charged with elder abuse because the victim was 65 years old. 

The attorney hired us to review the case as the weapon was never found and the victim was on a bike when the altercation started. It was her theory that the injuries sustained were from the bike or another object and not from a knife, as the victim claimed. 

Case Summary:

Mr. Smith is a 65 year old male with a history that includes chronic back pain secondary to diskogenic disease, hypertension, and Hepatitis C. The medical records document that he is on tramadol (Ultram, an opioid analgesic) and gabapentin (Neurontin, commonly prescribed for neurologic pain). There was also mention of a remote history of IV Drug Abuse.

On January 21st, he was brought into the emergency department by ambulance for various minor injuries. He stated to the paramedics and the emergency physician that he was stabbed with a knife after a verbal and physical altercation with another male. The medical records documented his injuries as a superficial flap-type laceration to the chest measuring about 3mm (0.12 inches) and lacerations to his left index, fourth and pinky fingers. There was an abrasion and contusion documented to his right hand; and there was also an abrasion to the right lower abdomen that could be seen in photographs but was not documented in the medical records..

On January 29th, Mr. Smith was seen in the emergency department for suture removal. There is no documentation as to the status of the hand or chest/abdominal wounds at that time, only that the suture removal was uneventful.

Mr. Smith visited his primary doctor on March 16th; at that time he was placed on Ventolin for pneumonia and given a referral to physical therapy for a complaint of decreased muscle strength in his left pinky finger. He also complained of a left shoulder strain. 

Summary of Opinions:

Chest and Abdominal Injuries

The chest wound is not consistent with a sharp object such as a knife grazing the area as described: Upon observation of the photographs, the wound edges are noted to be irregular and the wound is in direct line with the lower abdomen abrasion (not documented by emergency staff). Irregular edges are consistent with blunt force trauma, indicating the possibility of the chest wound being from the skin tearing from pressure, as opposed to a laceration with defined edges which would be consistent with sharp force trauma as with a knife. Abrasions are also from blunt force. The linear appearance of the two wounds correlates them visually and the opinion is that they are from the same injury. It is also of opinion that the wounds are most consistent with blunt force trauma and not a knife wound.

Hand and Shoulder Injuries

On the 3/16/11 visit, Mr. Smith complained of weakness to his left pinky finger. In my opinion, this is a fabricated complaint, as the location of the injury is on the fingertip of the left pinky. The musculature in that area is not likely to affect the entire pinky but this is a problem for the defense because the side effects of Neurontin are not likely to be the causal agent. The problem for the defense is that there is documentation in the medical records stating that the hand injury was full thickness; which indicates that the musculature was involved. The muscles and tendons together contribute to strength or weakness of a body part. 

The opinion is that the shoulder strain noted on 3/16 is unrelated to the assault in January; however, one would expect the prosecution to raise it as a delayed onset pain in order to argue GBI. There was no complaint in the emergency department records on 1/22 or on 1/29 regarding shoulder pain. It would not be unusual for the pain to present at a later time, but one would expect it to have presented by 1/29. If the prosecution raises the left shoulder or the left pinky weakness as related to the accident, we suggest you point this out and then correlate the left pinky weakness to the left shoulder injury. The most likely cause of the weakness in the pinky is the unrelated shoulder injury.

Effects of Medications

The medications of Ultram and Neurontin have serious side effects such as impaired coordination, dizziness, and hostility: Ultram in particular is persistent in its side effects. While most medications have decreased side effects the longer the patient is on them, this is not true of Ultram, or it takes much longer for the side effects to weaken. It should also be noted that the use of Ultram and Neurontin in combination increase the risk of CNS depression and motor impairment. It is our opinion that the potential for altered mental status, sensation and/or perception while on these medications is high.

It is likely that the prosecution will assert that Mr. Smith had not taken the Ultram that day or within the prior 24 hours. One thing to note is that the manufacturer recommends a lower dose for patients with liver disease and for patients over 65 years of age, indicating that these patients might be more sensitive to the medications as it is metabolized through the liver. 

Works Cited

A Parke-Davis. (2009). Patent No. LAB 0106-9.1. New York, NY.

Ortho-McNeil Pharmaceutical Company. (2003). Patent No. 5336691. Raritan, New Jersey.