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Luis Mayorga Chap3_pe4_invoice_solution Feb 19th 2010

Invoice
TO: FROM:
Jack Hendrix Technologies John Q. Student
4999 Garland Street 9444 Elton Lane
Fayetteville, AR 72703 Tulsa, OK 74147

Description Amount
Consulting Fee for June $5640.00
Supplies 200.00
Travel Expenses 550.00

TOTAL $6390.00
Luis Mayorga Chap3_mid1_resume_solution Feb 19th 2010

Luis Mayorga
1700 S. State Street 6285 W Salto Sierra Wy.
Salt Lake City, UT West Valley City, UT 84128
Luismayorga@slcc.edu (801)860-7716
Objective To expand my knowledge and work with other trained professionals in
the hospital. To take care of people when they are in little or great
need.
Education Judge Memorial Catholic High School
High School
Salt Lake City Community College
Bachelors in Science of Nursing
Honors Deans List
Rotary Club
3rd pick in Argentina National U21 Futbol Team.
Keys to Success all 4 years of highschool.
Professional September 2005- Present
Accomplishments Olympia Furniture
Warehouse/Delivery Manager

Refrences Jose Mayorga- Father


Diana Pugh- Teacher
Luis Mayorga Chap3_mid3_stationery_solution Feb. 19th, 2010
Luis Mayorga
6285 W. Salto Sierra Way
West Valley City, UT 84128
Luis Mayorga Chap3_mid3_stationery_solution Feb. 19th, 2010

Luis Mayorga
6285 W. Salto Sierra Way
West Valley City, UT 84128
Luisangel1019@gmail.com
(801) 860-7716
Luis Mayorga chap3_mid4_fireworks_solution

City of Stockton

9:30 am Parade
12:00 pm Food Court in North Field
1:00 pm Children’s Contest
1:00 pm Adult Golf Tournament
1-4 pm Arts and Crafts Show
6:00 pm Free BBQ and Live Entertainment
Dark Free Firework Show!

Best Small-Town Celebration in the State


Luis ayorga Chap3_pe1_flyer_solution Feb. 19th, 2010

Annual Book Sale


March 1

Hourly Drawing For FREE Books!


Discounts of 50% Only at our North
or More Glenstone Location
Cancer Information
[Type the document subtitle]

Luis Mayorga
2/19/2010
Luis Mayorga Chap4_cap_cancer_solutions Feb. 19th 2010

Table of Figures
Table 1 Cancer-realted Deaths from 1990-1998_______________________________________________ 8
Figure 2 Rate of Prostate Cancer Deaths, 1990-1998___________________________________________ 9
Figure 3 Rate of Female Breast Cancer deaths 1990-1998 _____________________________________ 10
Luis Mayorga Chap4_cap_cancer_solutions Feb. 19th 2010

Table

Cancer Overview
Cancer is one of the scariest words in the English language. When you hear the word as
part of a diagnosis, it’s natural to feel many emotions, especially fear.

A cancer diagnosis can cause you and your family a great deal of stress, but you have
many resources to help you. You owe it to yourself to learn as much as possible about
your diagnosis and how it can be treated. Knowledge is power, and it can help you deal
with this disease.

What is cancer?
Cancer is a disease that occurs when cells in the body begin to divide at a faster rate than
the body requires. These rapidly dividing cells grow into a lump that is known as a tumor.
The tumor can be benign (non-cancerous) or malignant (cancerous).

What are the causes of cancer?


Many factors can cause the development of cancer in the body. Some of these factors,
such as heredity (family members who have the disease) cannot be avoided. Others, such
as lifestyle, can be controlled.

For instance, the use of tobacco is one of the main causes of cancer, especially lung
cancer. Tobacco use, whether in the form of smoking, chewing, or exposure to second-
hand smoke (smoking by others), can also cause cancer of the mouth and larynx,
esophagus, throat, and many other parts of the body.

Other primary causes of cancer include:


Diet/nutrition — The proper diet is always important, but a poor diet might also
increase your risk of cancer. For instance, eating large amounts of high-fat foods can
contribute to cancer of the colon and prostate. Exercise is also key. Excess weight might
be a contributing factor for various types of cancer, including breast, uterus, ovary,
prostate, and colon.
Environment — Cancer can develop if the person is exposed over a period of time to
various chemicals in the environment, including pesticides, asbestos, and radon.
Exposure to radiation — Too much exposure to the sun (ultraviolet radiation) can
cause skin cancer. In addition, over-exposure to X-rays or to radiation therapy (as part of
cancer treatment) might be a risk factor for cancer.
Hormone therapy — Women who are going through menopause might receive a
prescription for hormone replacement therapy, either estrogen alone or in combination
with progesterone. The use of both of these hormones together has been shown to
increase the risk of breast cancer. A woman who still has her uterus and is taking
estrogen alone (without progesterone) has a greater risk of endometrial cancer.
Luis Mayorga Chap4_cap_cancer_solutions Feb. 19th 2010

What are the symptoms of cancer?


The most prominent symptoms of cancer include the following:

A sore that doesn’t heal


A wart or mole that changes
An unusual lump anywhere in the body
A persistent cough/hoarseness
Indigestion or problems swallowing
Changes in bowel movement or urination habits
Unusual weight loss
Unusual bleeding or discharge from various parts of the body
Please note that these symptoms do not mean that you definitely have cancer. However, if
any of these symptoms appear, you should see your doctor right away.

How is cancer diagnosed?


If your doctor thinks you might have cancer, he or she will examine you and might order
certain tests, including:

Blood and urine tests


Imaging tests that allow the doctor to see the inside your body to see if cancer is present
(Imaging tests include X-rays, computed tomography (CT) scans, magnetic resonance
imaging (MRI), radionuclide scanning, and ultrasonography.)
Biopsy (A procedure in which the doctor takes a small sample of the tumor and analyzes
it under a microscope.)

What is staging?
One of the biggest concerns about a cancer diagnosis is whether the cancer has spread
(metastasized) beyond its original location. To determine this, the doctor assigns a
number (I through IV) to your diagnosis. The higher the number, the more the cancer has
spread throughout your body. This is called "staging." The doctor needs this information
in order to plan your treatment.

What are the treatments for cancer?


In order to treat your cancer, your doctor needs to know the location of the tumor, the
stage (whether it has spread), and whether you are strong enough to handle the treatment.

Cancer treatment can take the following forms:

Chemotherapy — This treatment uses powerful drugs that destroy the cancer cells.
Chemotherapy is delivered orally (pills) or through an intravenous (IV) line.
Radiation — This is a treatment that kills cancerous cells with radiation (high-energy
rays). Radiation therapy can either be internal (placed within the body) or external
(delivered by a machine outside the body).
Luis Mayorga Chap4_cap_cancer_solutions Feb. 19th 2010

NOTE: In some cases, radiation therapy and chemotherapy are given to a patient at the
same time.

Surgery — A surgeon removes the tumor, along with the surrounding area (in some
cases).
Hormone therapy — Hormones (substances produced by the glands to regulate organ
functions) might be given to the patient to block other hormones that might cause cancer.
For example, men with prostate cancer might be given hormones to keep testosterone
(which contributes to prostate cancer) at bay.
Biological response modifier therapy — Biological response modifier therapy uses
natural or artificial (created in a laboratory) materials to reconstruct the body's natural
defenses against disease. Biological therapy includes monoclonal antibody therapy and
vaccines. (Monoclonal antibodies are created in a laboratory to work like natural
antibodies, which are produced by the body’s immune system to fight disease.)
Stem cell transplantation — Stem cells (immature cells from which all blood cells
develop) are removed from the patient's circulating blood or bone marrow and then
returned after chemotherapy treatment.

What are the side effects of cancer treatments?

Chemotherapy — Side effects include hair loss, fatigue, nausea, vomiting.


Radiation — Side effects include fatigue, hair loss, skin problems (darkening, dryness,
itchiness).
Surgery — Pain and weakness are possible side effects of surgery.
Hormone therapy — This therapy can result in fatigue, water retention (bloating), hot
flashes, impotence, and blood clots.
Biological response modifier therapy — This can result in symptoms that resemble
the flu (fever, chills, muscle ache, etc.), skin rash, swelling, and increased tendency to
bruise or bleed.
Stem cell transplantation — Side effects include nausea, vomiting, flu-like
symptoms, and greater risk of infection.

What other resources are available?


If you are diagnosed with cancer, it’s important to realize that you are not alone. You
have your family and friends, and there are support groups for nearly every type of
cancer. Ask your doctor for information about these groups. You can also contact your
local chapter of the American Cancer Society for more information.

In addition, your doctor can refer you to a social worker or a mental health professional,
both of whom can help you deal with the emotional aspects of your diagnosis. The social
worker can also help you with the practical and financial issues related to the disease.

The most consistent finding, over decades of research, is the strong association between
tobacco use and cancers of many sites. Hundreds of epidemiologic studies have
Luis Mayorga Chap4_cap_cancer_solutions Feb. 19th 2010

confirmed this association. Further support comes from the fact that lung cancer death
rates in the United States have mirrored smoking patterns, with increases in smoking
followed by dramatic increases in lung cancer death rates and, more recently, decreases
in smoking followed by decreases in lung cancer death rates in men.

Additional examples of modifiable cancer risk factors include alcohol consumption


(associated with increased risk of oral, esophageal, breast, and other cancers), physical
inactivity (associated (www) with increased risk of colon, breast, and possibly other
cancers), and obesity (associated with colon, breast, endometrial, and possibly other
cancers). Observational evidence shows associations between amount of alcohol
consumption, physical inactivity, and obesity and increased incidence of certain cancers.
More research is needed to determine whether these associations are causal and thus
whether avoiding these behaviors would actually reduce cancer incidence. Other lifestyle
and environmental factors known to affect cancer risk (either beneficially or
detrimentally) include certain sexual and reproductive practices, the use of exogenous
estrogens, exposure to ionizing radiation and ultraviolet radiation, certain occupational
and chemical exposures, and infectious agents.

Food and nutrient intake have been examined in relation to many types of cancer. Case-
control epidemiological studies have suggested an association between high fruit and
vegetable consumption and reduced risk of various cancers. The quality of this evidence,
however, has been questioned, and prospective cohort studies exploring this question
have shown inadequate evidence to conclude that such an association truly exists.
Contrary to expectation, randomized trials found no benefit of beta-carotene
supplementation in reducing lung cancer incidence and mortality; risk of lung cancer was
statistically significantly increased in smokers in the beta-carotene arms of 2 of the trials.
Similarly, randomized controlled trials have found no reduction in risk of subsequent
adenomatous polyps of the colon in individuals who have had polyps previously resected
taking dietary fiber supplements compared with those receiving much lower amounts of
supplemental wheat bran fiber. Ecologic, cohort, and case-control studies have found that
increased consumption of fat and red meat is associated with increased risk of colon
cancer. A randomized controlled trial of dietary modification to lower fat consumption in
postmenopausal women, however, showed no reduction in colon cancer. Likewise, there
was no benefit of the low-fat diet on all cancer mortality, overall mortality, or
cardiovascular disease. A large randomized trial is currently underway to investigate
whether men taking daily selenium or vitamin E or both experience a reduced incidence
of prostate cancer in comparison with men taking placebo pills.

Diagnosis

The rates of newly diagnosed cancer cases (incidence) are one way to measure progress
against cancer. The lower the rates, the better.

Another important measure is the proportion of cancers diagnosed at a late stage. The
stage of a cancer shows how far the disease has progressed. The earlier the stage at
diagnosis, the better the chances for cure. Downward trends in the proportion of late
Luis Mayorga Chap4_cap_cancer_solutions Feb. 19th 2010

cancer diagnoses are a sign that screening is working for the cancers for which early
detection methods are available.

This section of the Cancer Trends Progress Report - 2005 Update provides data on the
rates of new cancers, based on the NCI Surveillance, Epidemiology, and End-Results
(SEER) Program, by cancer site and by racial and ethnic group. Also included are data on
the proportion of cancers diagnosed at a late stage for five of the major cancer sites where
cancer screening has been shown or has been evaluated to make a difference in outcomes.
Cancer sites include: female breast, colon, rectum, cervix, and prostate.
Source: www.cancer.gov (www)1

Cancer: Choosing a Treatment Program


What are the different kinds of cancer treatment?
The three most common types of cancer treatment are surgery, radiotherapy and
chemotherapy. Treatment is aimed at removing the cancer cells or destroying them in the
body with medicines or other agents.

Surgery can be very successful in treating some kinds of cancer, but it isn't an option for
all people. If the cancer is in the form of a malignant tumor and the tumor is in one place
(localized), it may be possible to safely "cut out" the tumor and any surrounding affected
tissue. Surgery may not be possible if the cancer has spread to other areas of the body or
if the tumor cannot be removed without damaging vital organs, such as the liver or brain.

Radiotherapy uses radiation — in the form of a special kind of x-ray, gamma rays or
electrons — to damage cancer cells so that they can't multiply. There is usually no pain
during therapy. Radiotherapy may sometimes be the only treatment needed, or it may be
used with other therapies, such as surgery. A combination of surgery and radiotherapy
may be used for tumors that grow in one place.

Chemotherapy uses medicines to attack the cancer cells. Just the word "chemotherapy"
can cause a lot of fear because the side effects can be severe. However, not all people
experience severe side effects. The side effects of chemotherapy can often be reduced
with other medicines.

Chemotherapy is usually used when the cancer has spread to other areas in the body.
Chemotherapy can also be used in combination with surgery and radiation. Sometimes
the tumor is surgically removed and then chemotherapy is used to make sure all the
cancer cells are killed.

Another kind of treatment is biological therapy. This treatment uses proteins to trigger the
body's immune system to produce more white blood cells (or lymphocytes). Two
lymphocytes that can attack and kill cancer cells are the T-cell and the B-cell. The
proteins boost the ability of the T-cell and B-cell lymphocytes to kill cancer. Biological
therapy can also be used in combination with surgery, radiation therapy or chemotherapy.

1
Cancer.gov
Luis Mayorga Chap4_cap_cancer_solutions Feb. 19th 2010

Hormone therapy is sometimes used to treat breast or prostate cancer. The hormone
estrogen can make breast cancer tumors grow faster. Similarly, the hormone testosterone
can make cancerous tumors in the prostate grow faster. Drugs that contain other
hormones may be used to block the effects of estrogen and testosterone. In other cases,
surgery to remove the ovaries or the testicles may be used. Removing these organs
reduces the amount of estrogen or testosterone in the body.

Hormone therapy is often used in addition to chemotherapy or radiotherapy.

Other specialized treatments may be available. Your doctor may talk to you about these
treatments if they are an option.
Source: http://familydoctor.org (fam)2

Statistics

Table 1 Cancer-realted Deaths from 1990-1998

2
Familydoctor.com
Luis Mayorga Chap4_cap_cancer_solutions Feb. 19th 2010

Figure 2 Rate of Prostate Cancer Deaths, 1990-1998


Luis Mayorga Chap4_cap_cancer_solutions Feb. 19th 2010

Figure 3 Rate of Female Breast Cancer deaths 1990-1998

Tobacco and Cancer


Smoking damages nearly every organ in the human body, is linked to at least 10
different cancers, and accounts for some 30% of all cancer deaths. And it costs billions of
dollars each year. Yet one in four Americans still light up. If you or someone you love
uses tobacco, here's what you need to know about how tobacco kills, and how to get the
help you need to quit.
Luis Mayorga Chap4_cap_cancer_solutions Feb. 19th 2010

Sun Safety

A sunburn will fade, but damage to deeper layers of skin remains and can eventually
cause cancer. That's why sun-safe habits should begin in childhood and last a lifetime.

Food and Fitness

Eating right, being active, and maintaining a healthy weight are important ways to reduce
your risk of cancer—as well as heart disease and diabetes. Learn the American Cancer
Society's guidelines for diet and activity and find tips for a healthy lifestyle and
community.

Early Detection

If you can't prevent cancer, the next best thing you can do to protect your health is to
detect it early. Recognizing symptoms, getting regular check-ups, and performing self-
exams are just a few ways you can do this.

Source: www.cancer.org (www)3

3
www.cancer.org
Luis Mayorga Chap4_cap_cancer_solutions Feb. 19th 2010

Bibliography
http://familydoctor.org. (n.d.). Retrieved from http://familydoctor.org
http://www.cancer.gov. (n.d.). Retrieved from http://www.cancer.gov
http://www.cancer.org. (n.d.). Retrieved from http://www.cancer.org
http://www.clevelandclinic.org. (n.d.). Retrieved from
http://www.clevelandclinic.org/health/health-
info/docs/3700/3778.asp?index=12194
Sidewalk Café
Where trendy-conscious people dine!
Sidewalk Café is an avant-that has recently opened on Main Street in Carmel. Sidewalk
Café offers a diverse and eclectic menu that will appeal to a diverse and eclectic clientele.
Following is a list of lunch items available on a daily basis:
 Turkey Club
 Hamburger
 Cheeseburger
 Fish and Chips
 Soup of the Day
 Pasta of the Day
The décor in the Sidewalk Café is homey and inviting, yet surprisingly sophisticated.
Original artwork is displayed on every wall, adding a charming feeling to the already warm
environment. A large fireplace takes up the back wall, while the front windows provide a frame
for the activity on the street outside.
The owner, Sue McCrory, is a newcomer to the restaurant scene. Previously, she operated a
folk-art gallery. Ms. McCrory has vowed to maintain the integrity of the Sidewalk Café vision.
She makes herself available to her customers, and she can usually be found table-hopping
through the dining room.
The chef, Ken McCrory, is the owner's brother. His love of food, and his willingness to
experiment are evident in the interesting specials he prepares daily. Mr. McCrory's talents are
numerous: in addition to the daily specials, he is responsible for the fresh baked breads and
pastries that grace the tables.
The Sidewalk Café is open from 11:30 a.m. to 10:00 p.m. Tuesday through Saturday. On
Sundays, the hours are 9:30 a.m. to 10:00 p.m. The Sunday brunch is charming, and not to be
missed.
The Sidewalk Café also has a private room that can be reserved for parties and functions.
The room has a fireplace, and accommodates up to 25 people.
Stop by and find out why the Sidewalk Café is where those in the know come to dine!
[Type text] [Type text] [Type text]

Table Of Authorities

Cases
Cornelius v. Gipe, 625 S.W.2d 880, 882 (Mo. App. 1981)........................................................ .2
Florida Physician's Ins. Reciprocal v. Stanley, 452 So.2d 514, 515-16 (Fla. 1984) ...................4
Florida Physician's Insurance Reciprocal v. Stanley ..................................................................4
Washington v. Barnes Hosp., 897 S.W.2d 611, 619-21 (Mo. banc 1995) ..............................2, 4
Washington v. Barnes Hosp., 897 S.W.2d 611, 620 (Mo. banc 1995) .......................................2
Washington v. Barnes Hosp., 897 S.W.2d at 621 .......................................................................6
IN THE CIRCUIT COURT OF GREENE COUNTY, MISSOURI

BRADFORD )
)
)
Plaintiff, )
)
vs. ) Case No. 104CC0091
)
HILLCREST, )
)
Defendant. )

Medical Malpractice

In point 3 of his first motion in limine, plaintiff seeks to preclude evidence of collateral

source payments. Plaintiff attempts to categorize the evidence into two groups:

Group 1: Medicaid

Group 2: Goods and services provided by the public schools.

Plaintiff claims that evidence of Medicaid is subject to the rule, while the Missouri Supreme

Court in Washington v. Barnes Hosp., 897 S.W.2d 611, 619-21 (Mo. banc 1995) has held that

evidence of programs and therapies available through the public schools are not subject to the

collateral source rule.


While defendant does not agree that any Missouri appellate court has directly held that

Medicaid is subject to the collateral source rule, defendant does not plan to introduce evidence

that Medicaid has paid for certain medical expenses in this case.1

1
The only case cited by plaintiff concerning Medicaid payments is Cornelius v. Gipe, 625
S.W.2d 880, 882 (Mo. App. 1981). In that case, the court expressly said: "Even assuming
without deciding that the argument [that mentioned the availability of Social Security,
Medicare, and Medicaid] violated the collateral source rule, the argument clearly bore on
damages, and by reason of the defendant's verdict, Cornelius was not prejudiced." In
Washington v. Barnes Hosp., 897 S.W.2d 611, 620 (Mo. banc 1995) the court specifically noted
this was dicta.

2
Defendant also agrees that goods and services provided by the public schools is not subject to the rule.

However, to the extent plaintiff is attempting to recast Washington v. Barnes Hospital as holding that

the availability of free public school programs is the only exception to the collateral source rule,

defendant disagrees. There are other free public programs and therapies that are available outside the

public school programs that will be available to Marcel that should also not be considered collateral

sources. Programs that will likely be at issue in this case are those provided through the Missouri

Department of Mental Health, Division of Mental Retardation and Developmental Disabilities

("MRDD") after Marcel turns 18.

The State of Missouri has an extensive system of care and treatment options for individuals with

developmental disabilities. The only criteria for eligibility is they have a developmental disability

which is defined as attributable to:


1. A. Mental retardation, cerebral palsy, epilepsy, head injury, autism or a learning
disability related to a brain dysfunction;
2. Is manifested before the person attains age twenty-two (22);
3. Is likely to continue indefinitely;
4. Results in substantial functional limitations in two (2) or more of the following six (6)
areas of major life activities: self care, receptive and expressive language development
and use, learning, self-direction, capacity for independent living or economic self
sufficiency and mobility; and
5. Reflects the person's need for a combination and sequence of special, interdisciplinary or
generic care, habilitation and sequence of special, interdisciplinary or generic care,
habilitation or other services which may be of lifelong or extended duration and are
individually planned and coordinated.

9 CSR 45-2.010(2)(F). Eligibility is not conditioned on indigence.2

In this case, Marcel will meet this criteria. He has already been documented as having cerebral

palsy prior to the age of twenty-two. Plaintiff's own experts state this is likely to continue indefinitely,

and results in substantial functional limitations in more than two of the six areas of major life.

Evidence that these public programs are available as an alternative to Dr. Elam's private one-on-one

attendant care projections in his life care plan are relevant and admissible.
2
If the recipient has annual adjusted gross income exceeding one hundred thousand dollars ($100,000)
he shall be assessed a charge for case management services, and the charge shall be the lesser of actual
cost or one-fourth (1/4) their monthly ability to pay. 9 CSR 10-31.011(3). This has no application in
this case as plaintiff's experts state Chavon will be permanently unemployable.

3
In Washington v. Barnes Hosp., 897 S.W.2d 611, 619-21 (Mo. banc 1995), the Missouri

Supreme Court extensively re-examined the collateral source rule. The court began its analysis with

the statement that "the collateral source rule is not a single rule but rather, a combination of rationales

applied to a number of different circumstances to determine whether evidence of mitigation of damages

should be precluded from admission." Id. In analyzing the rationales that supported the rules

application, the court reviewed decisions from other states. In reaching its decision that public school

benefits where not subject to the collateral source rule, the court rejected contrary views from other

states, and adopted the reasoning of the Florida Supreme Court in Florida Physician's Ins. Reciprocal

v. Stanley, 452 So.2d 514, 515-16 (Fla. 1984), emphasizing:


The policy behind the collateral source rule simply is not applicable if the plaintiff has incurred
no expense, obligation, or liability in obtaining the services for which he seeks compensation.
This is further made apparent upon comparison of the present case with a situation in which the
collateral source rule is frequently applied, that of the defendant who seeks a reduction in
damages because the plaintiff has received insurance benefits. It is a well-settled rule of
damages that the amount recoverable for tortious personal injuries is not wholly or partially
indemnified for the loss by proceeds from accident insurance where the tortfeasor did not
contribute to the payment of the premiums of such insurance. This rule is usually justified on
the basis that the wrongdoer should not benefit from the expenditures made by the injured party
in procuring the insurance coverage. In a situation in which the injured party incurs no
expense, obligation, or liability, we see no justification for applying the Collateral Source
rule. We refuse to join those courts which, without consideration of the facts of each case,
blindly adhere to the collateral source rule, permitting the plaintiff to exceed compensatory
limits in the interest of insuring an impact upon the defendant.

Id. at 620-21 (Emphasis added). The Missouri Supreme Court also stated: "[w]e reject the concept that

the collateral source rule should be utilized solely to punish the defendant. Id. at 621.

While the specific issue addressed in Washington v. Barnes Hospital was evidence relating to

the availability of public special education services, the issue in Florida Physician's Insurance

Reciprocal v. Stanley, the Florida case adopted by the Missouri Supreme Court, also included the

"availability and effectiveness of free or low-cost charitable and governmental programs available in

the community." 452 So.2d at 515. In the Florida case, the plaintiff "brought a medical malpractice

action against the [defendants] for the retardation and cerebral palsy [plaintiff] has suffered from birth."

Id. Defendant cross-examined plaintiff's damage experts on the availability of free or low cost services

from governmental and charitable organizations that were available to people that had mental

4
retardation and cerebral palsy as children. Id. These are the same benefits that are at issue in the

present case. The Florida court held:


[Defendants] claim that evidence of free or low cost services from governmental or charitable
agencies available to anyone with specific disabilities is admissible on the issue of future
damages. We agree.... Governmental or charitable benefits available to all citizens, regardless
of wealth or status, should be admissible for the jury to consider in determining the reasonable
cost of necessary future care. Keeping such evidence from the jury may provide an undeserved
and unnecessary windfall to the plaintiff.

Id. at 515. As the Missouri Supreme Court adopted the Florida court's reasoning in Washington v.

Barnes Hospital, it is apparent it would reach the same result with regard to the admissibility of

evidence of other public programs, in addition to the public school special education programs,

available to anyone with specific disabilities on the issue of future damages.

The public programs available through MRDD are, in effect, an extension of those available

through the public schools. They replace those provided by the public school after the child turns 18.

Just as in the case of public school benefits, the plaintiff did not purchase the benefits available through

MRDD, nor work for them as an employment benefit, nor contract for them. Hence, the "benefit of the

bargain" rationale does not apply. Just as in the case of public school benefits, the MRDD programs

are funded by tax dollars. As the Missouri Supreme Court stated in Washington v. Barnes Hospital,

"[w]hile to some extent public schools are funded by plaintiffs' tax dollars, they are also funded by

defendants' tax dollars and no windfall results to either." Id. at 621. The same is true for MRDD

benefits. As the court emphasized in Washington v. Barnes Hospital: "[a]s the injured party [Marcel]

incurs no expense, obligation, or liability, we see no justification for applying the Collateral Source

rule." Moreover, these free public programs are available to any child that has been documented to

have a developmental disability before age 22, and is not contingent on indigent status (as in Medicaid

benefits) or having been earned through military service (as for veteran's benefits), or through work

credits (as for social security or medicare benefits.)

Accordingly, these free public benefits available to people, like Marcel, after they turn eighteen

and have cerebral palsy can be considered by the jury as alternatives to Dr. Elam's private one-on-one

attendant care projections in his life care plan. Plaintiff's motion in limine to this extent should be

5
denied. "Plaintiffs, of course, may respond to this evidence with arguments of its inadequacy, the risk

of its continued availability, etc." Washington v. Barnes Hosp., 897 S.W.2d at 621.

Luis Mayorga , P.C.

6
Luis Mayorga chap4_pe1_review_solution. Feb 19th 2010

A revision mark (a vertical line outside the left or right margin) signifies a change has
been made in the document. Aline through existing text indicates that the text should be
deleted, whereas text that is underlined is to be added. The suggestions of
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indicating that the reviewer has added a descriptive note without making a specific
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deleted by right clicking on the highlighted text and selecting the appropriate command
from the shortcut menu.
The review process is straightforward. The initial document is sent for review to
one or more individuals, who enter their changes through tools on the Review tab or
through the Track Changes command in the Tracking group on the Review tab. The
author of the original document receives the corrected document, and then uses the
Accept and Reject Changes command to review the document and implement the
suggested changes. The changes can be selectively accepted, reviewing each change
before accepting it, or the author can choose to accept them all without reviewing them.
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Luis Mayorga chap4_pe2_tips_solution Feb 19 2010

Tips for Windows XP


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