JULI’S STORY
A real case demonstrating
the unfairness of damage caps.
Juli’s Story
Eleven-year-old Juli was a good student and very physically active, with dreams of becoming a gym teacher
or a veterinarian. All that changed, when the car in which she was riding was struck head-on by a driver
who had fallen asleep at the wheel. Juli suffered tremendous injuries and horrific pain as a result.
Juli was an active 11-year-old, a tomboy in her mother’s eyes, who loved to climb trees, play basketball
with the guys, ride bikes and horses, play football, skateboard, and run. She was a good student, earning mainly A’s, and she enjoyed school. A natural athlete, Juli couldn’t wait until she could play on all of the sports
teams in her local school district in Honesdale. She certainly did not know what she wanted to do in life yet,
but she knew that her future plans would include being very physically active. She was thinking of being a
gym teacher or a veterinarian.
Juli’s life changed suddenly in mid-January, as she was driving down the road in her mother’s car, the
front seat passenger. A large pick-up truck traveling in the opposite direction crossed the centerline of the dry
roadway with no warning whatsoever, slamming into the front of Juli’s mom’s car. The collision was horrific.
Despite wearing her seatbelt, Juli was propelled forward. Her head smashed the windshield, and her legs hit
the dashboard with such force that they cracked it into pieces. The damage to the vehicle was so severe that
Juli, her mom, and younger brother, who was in the back seat, had to be cut from the wreckage. Juli, whose
legs were mangled, screamed the entire time that the paramedics were extracting her from the car.
At the emergency department, the trauma doctors found that Juli had suffered a large
abrasion/hematoma of the front of her head, post-traumatic amnesia, abrasions and contusions of her right
lower leg, and obvious deformities of both upper legs, including a puncture wound with blood oozing in the
middle of the left thigh. Juli needed emergency surgery on her legs, during which the doctors found that both
of Juli’s thighbones were horribly shattered, with pieces of the left thighbone protruding through her muscle
and skin. Her bones were too shattered and displaced to use screws and plates to hold the pieces together.
Instead, her doctors placed femoral skeletal traction pins into both legs. These pins are the size of pencils, and
they were placed in holes drilled into her thighbones above the growth plate. These were for traction.
Juli spent the next three weeks in the hospital, bedridden, with both legs elevated and held in place with
ropes and weights—Buck’s traction. During this time she was catheterized and had to use a bedpan. She had
to be rotated so that she would not develop bedsores, and she was required to have frequent x-rays to monitor
her healing, all of which caused severe pain. Even involuntary muscle spasms caused extreme pain, since the
spasms made the fractures move. She was given painkillers and muscle relaxants every day while in traction.
Juli also had to undergo daily pin care of the traction pins that had been surgically placed right above both of
her knees, and which stuck out of her legs. The pin cleaning was excruciating for Juli, who was unable to have
her mother with her due to her mother’s own severe injuries.
To make matters worse, Juli’s treatment was complicated by blood-loss anemia because of the long
bone fractures. She required transfer to the intensive care unit and blood transfusions to correct the problem.
She also had episodes of “inappropriate” behavior, which her physicians thought was the result of head trauma.
Juli was diagnosed with a traumatic brain injury, and she was monitored closely for signs of a worsening or
deteriorating mental condition.
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Unfortunately, Juli’s left femur fracture did not heal well. Because of the severe shattering of the
bones, the bone fragments were very difficult to keep in place. After three weeks in traction, the bones were
still misaligned. Juli’s doctors decided to place her in a bilateral spica cast. This was a full body cast that
extended from Juli’s armpits to her toes. Her legs were bent into an almost knee-to-chin position. This cast
was applied during a four-hour procedure in the operating room, where the femoral pins were also removed.
Juli left the hospital almost a month after she first arrived. The cast itself made it impossible to transport Juli by automobile. An ambulance took her home, where she found that she could not sleep in her own
bed or sit in any of the chairs owned by her family. She had to have a hospital bed and a special chair brought
in for her. Any time that Juli wanted to move from her bed to her chair or back, someone had to pick her up
and carry her. Her mother was unable to do so because of her own injuries, and the family had to rely on
friends who were willing to be accessible both day and night. Juli had to be transported to and from her follow-up orthopedic visits by ambulance. She had to have special clothes bought for her to put over the cast.
Her eating was restricted so that her stomach would not enlarge and inhibit her breathing. Juli also had to be
constantly watched for constipation and choking, both of which were risks because she was not able to be in
an upright position. Juli also had to be monitored for circulation problems that can develop as a result of such
an extensive casting. Throughout her time in the cast, she was also required to use a bedpan, which she found
to be embarrassing and “gross”.
In addition to this being a horrific physical experience for a young girl of eleven to go through, it was
emotionally upsetting as well. Juli had terrible nightmares while in the hospital, requiring someone to stay at
the hospital with her all night. Once she got home in her full body cast, her fears changed. She became very
afraid to be moved, both because of the pain and the fear that someone would drop her. At night, she hardly
slept for fear that something catastrophic would happen, like the house catching fire, and she would not be
able to escape because of the body cast. She would call out to her mother several times during the night, and
she would also keep waking up her little brother to keep her company during the night and to reassure her
about every little sound that she heard in the house. As the day came closer to having her cast removed, Juli
became very afraid of having the cast cut off. She thought that she would be cut in half.
Juli was in the cast for four and a half agonizing weeks. It took over three hours for the cast to be cut
off of her. Juli was terrified during the ordeal, crying and squeezing her mother’s hand so tight that it turned
white. After weeks of being in the cast, her leg muscles were atrophied, and her joints were stiffly bent in the
same position as they had been in the cast. Her skin was scaly and peeling. Juli’s ordeal was nowhere near
over with the removal of the body cast. She still had a long road of physical therapy ahead of her. It took her
months of grueling, daily physical therapy before she could eliminate her walker and crutches and finally
walk, albeit with heavy, pronounced limping, on her own. She missed months of school and required home
tutoring. It was well into the summer before her gait began to improve and her stiffness lessen.
Juli still has not regained normal range of motion. She still can’t run or fully extend her legs. She has
a large scar over her left thigh, where the bone came through the skin. She has pinholes on both sides of her
legs, above both knees, from the traction pins. She refuses to wear shorts, and she will not allow her picture to
be taken because of her embarrassment over the scars.
Juli’s serious injuries have resulted in other long-term problems as well. She has suffered at least a
two-centimeter shortening of both femurs. This means that she will now be at least one inch shorter in height
than she otherwise would have been if she had not been in this accident. It is expected that, as she grows, she
will develop legs that are unequal in length, which will subject her to another surgery in order to try to “even
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out” the bone lengths, which could also affect her overall height. Additionally, Juli suffered meniscal tears in
her right knee in this accident, which will require arthroscopic surgery eventually. She is expected to develop
chondromalacia in her knee, and arthritis as she gets older. She has come a long way since the accident, but
there is still a long and difficult road ahead for Juli.
Juli did not suffer these injuries or go through this ordeal because of anything that she did. Why
should she be punished by being denied the ability to exercise her constitutional right to full and fair compensation for all of the damages that she has suffered? Juli’s damages are all non-economic. She was too young
to work. She was not responsible for the payment of her medical bills. Does that mean that her ordeal, her
physical pain, and mental suffering are somehow not as important as that of an adult? Does denying her the
right to recover from the driver who fell asleep at the wheel somehow help doctors in Pennsylvania pay lower
medical malpractice premiums?
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Juli spent three painful weeks hospitalized in Buck’s Traction. When some of her
fractures did not heal well, Juli had to be
placed in a full body cast for four weeks.
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The Spica casts shown above are only
examples. Juli is so embarrassed over
her injuries, she will not allow her
photo to be taken. Juli suffered severe
mental anguish during the time she
was in the cast, fearing she would die
in a fire because she couldn’t move on
her own.
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