Ivanka Trump: Power Player In The Making


Link: http://www.vegaslegalmagazine.com/ivanka-trump/


The Firm, P.C. is a boutique Las Vegas law firm founded by Preston Rezaee, Esq. Preston Rezaee is also the founder and Editor in Chief of Vegas Legal Magazine.

Try to picture this: It’s the year 2028, and there’s another “President Trump” elected, but this is one is named Ivanka.

Okay, 2028 is a very long way off, and this scenario is pure speculation right now. But, then again, so was similar talk about Ivanka’s father – Donald Trump – some 30 years ago, and, after all, Ivanka is already a familiar face in American living rooms, much like her father.

The blinding glare of public scrutiny is all over the first family of President Donald Trump. But, that spotlight is nothing new for his oldest daughter, Ivanka. Now part of a “power couple” with husband Jared Kushner, some observers wonder if this young lady– who is so familiar to America — could become the most powerful woman in politics.

“You’re fired!” That famous catch phrase sprung up in 2004, uttered by a then-billionaire real estate baron Donald Trump, in his first season of NBC’s reality television series, The Apprentice. While most of the focus was on “The Donald,” a young woman executive on that show was sometimes as tough on contestants as Donald Trump himself. That stunning then-twentysomething blonde was Donald Trump’s oldest daughter, Ivanka. Now more than 13 years after the debut of the long-running show, The Apprentice, Ivanka is in a position perhaps few could have imagined back when she was critiquing the way various contestants fulfilled their assigned challenges: She is the first daughter and senior advisor to the president of the United States of America.

Ivanka Trump, now 35 and the married mother of three children, is still the stunning young woman that caught the nation’s eye on The Apprentice. But that tough, no-nonsense image she cultivated on television has softened some with time, and even more so after becoming a wife and mother.

Part of the intrigue with Ivanka may also stem from the fact that it has been about a quarter century since America has had a president in office with some full-grown, well-established adult children — namely Ivanka, Donald, Jr., and Eric Trump. That’s the theory of local historian Michael Green. (Donald Trump’s youngest son, Barron, is now 11. Meanwhile, his youngest daughter Tiffany is also grown, but she just graduated college last year).

“This is the first time, since the elder (President) George (H.W.) Bush, that the president’s children included adults,” explained Green, who is also a history professor at the University of Nevada, Las Vegas. “Chelsea Clinton, and the (former President Barack) Obama daughters, were much too young for speculation on their political futures. George W. Bush’s daughters were in their teens, or something.”

The Kids Are Alright 

There’s been a long string of presidents with only school-aged children since the elder Bush was in the White House from January 1989 to January 1993. He was followed by President Bill Clinton, who was in office from January 1993 to January 2001. The school-aged Chelsea Clinton lived in the White House with her parents, Bill Clinton and Hillary Clinton.

Bill Clinton’s presidency gave way to the two terms of the George H.W. Bush’s son, George W. Bush, in January 2001. The younger Bush moved into the White House with his own two twin daughters – Jenna and Barbara Bush. But the twins were both busy with high school and college during his presidency. After George W. Bush left office in January 2009, President Barack Obama took office, bringing with him his own two (even younger) daughters – Sasha and Malia Obama.

“Ivanka is not the first (adult child of a sitting president), but she is the first in a long time,” Green points out. “She has also been the one (child) most involved in her father’s political ambitions.

Besides, Ivanka is the most public of President Trump’s children, only adding to the curiosity about her future plans, the UNLV professor adds. “There’s difficulty in the adjustment. Barron stayed in New York to finish the school year before moving to Washington, D.C. While (younger) daughter, Tiffany, seems to avoid the limelight.”

Ivanka Trump recently spoke publicly about first coming to the Washington. D.C., to work with her father.

“It’s incredible. It takes time to acclimate to the intensity of the experience,” she told Us Magazine. “But it’s truly remarkable, and I feel so blessed to be able to come to work at the White House.

“I truly get goosebumps just walking through the door, and I think I will always feel that way. I hope I’ll always feel that way,” Ivanka Trump continued.

Meanwhile, President Trump’s grown sons, Donald Jr. and Eric, have had some difficulties with being the focus of worldwide attention. The two brothers are hunters and photos of the brothers with animals they killed had brought on outcries from some animal rights proponents, along with then-presidential candidate Hillary Clinton, Green recalls.

“Eric and Donald, Jr., have their own set of issues. You would have never seen Chelsea Clinton go big-game hunting,” he says. These are part of the pitfalls of being the adult children of a president, or presidential candidate.

Longtime Democratic political consultant Dan Hart is a little more critical of Donald, Jr., saying President Donald Trump’s namesake is “far from understanding politics.” But Hart believes Ivanka might have a future in politics, if she decides she wants one. “I think people have a lot of tolerance of her,” Hart says of Ivanka. “People have opinions of her, but not a well-formed opinion of her.”

All of then-candidate Donald Trump’s grown children – including Tiffany Trump – spoke at the 2016 Republican National Convention in Cleveland, on behalf of their father. Ivanka, Donald, Jr. and Eric, also gave many television and radio interviews during the campaign, to “stump” for their dad.

In the battleground state of Nevada, the three oldest Trump “kids” all guested on Las Vegas’ KXNT CBS radio with talk show host, and political commentator, Alan Stock. A Trump backer himself, Stock also gives high praise to Donald Trump’s three older children, calling them “well mannered” and “good humored.”

Stock has a high regard for Ivanka, but doesn’t think she wants to run for office herself, citing both her young children and the desire of most first families to get out of politics altogether once they leave the White House.

“Let’s just face it, she is poised, she speaks well, she is attractive, she doesn’t come across like a crazy of any kind,” he says of Ivanka. “I don’t think she was a Republican, as a matter-of-fact. I think she was independent, nonpartisan, especially.”

The Loyal Trump Supporter 

Not long after her father’s upset win over the former secretary of state and former first lady, Hillary Rodham Clinton in November 2016, Ivanka Trump and Jared Kushner were appointed as senior advisors to the president-elect. Donald Trump left his company to run by his two adult sons – Donald, Jr. and Eric – while Ivanka and Jared prepared to move to Washington, D.C. In tow with the young couple were their three children Arabella, 6, Joseph, 4, and Theodore, 18 months.

Ivanka was regnant with Theodore during Donald Trump’s 2015-2016 presidential run. The loyal daughter made appearances on the campaign trail with – and for — her father almost right up until the time she gave birth. Donald Trump even once joked about the then-very-pregnant Ivanka possibly giving birth during one of his famous – and often raucous – campaign rallies. (Fortunately, the baby was born in a hospital, instead).

With her father’s struggle to get the woman’s vote away from a woman (Hillary Clinton) who would have been the first female president, Ivanka was able to do something that her brothers Don, Jr. and Eric could not: She is a living example of a woman that was helped and nurtured by Donald Trump.

“She helped her father with the fence-leaning voters,” especially after the now-infamous Donald Trump-Billy Bush Access Hollywood tape was released in October 2016, Stock says.

Ivanka also takes a lot of heat from detractors, notes Las Vegas-based national radio host Wayne Allyn Root. The WAR Now: The Wayne Allyn Root Radio Show host says that Ivanka and her husband, Jared Kushner, will never be able to do anything right in the eyes of some critics.

“Liberals hate Jared and Ivanka reflexively … just because they are President Trump’s children and son in law,” answers Root. “No one knows exactly what they stand for. I’ll reserve judgement, except for one issue: Jared loves Israel. I love Israel. So, he starts off on the right foot with me!”

“I Don’t Know If She Is A Liberal Or A Conservative” 

The oldest first daughter was an independent prior to her father winning the presidency. “Ivanka remains an enigma,” says Green. “I don’t know if she is a liberal or a conservative,” the historian adds.

Furthermore, opinions she may have expressed as a celebrity aren’t “policy statements,” but just that – opinions, according to Green. Will she seek office? Root won’t hazard a guess on that one. “That’s up to Ivanka,’ says the author and avid Donald Trump backer. “I don’t know yet where she stands on issues. She is a blank slate. I don’t vote for anyone based on celebrity and brand recognition. Let’s see her agenda, then I’ll tell you if I support her.”

Democratic political consultant Dan Hart says Ivanka could start a potential political career by running for either congress or, perhaps, even governor of her home state of New York.  “New York is a fertile ground for celebrities and well-known people to move in and run for office,” he points out. “She could certainly be effective as a governor or as a U.S. senator. But a governor’s position would be harder for her, as it is a service-delivery job, while a U.S. senator (position) involves policy-making.”

Under The Influence? 

Critics complain that Ivanka Trump – and husband Jared Kushner – have too much influence on the president, and as family, shouldn’t be working in the White House. But Stock says it is not unheard of for presidents to install relatives in high posts.

Stock points to the early 1960s, and then- Democratic President John F. Kennedy appointing his brother Robert F. Kennedy as attorney general. Of course, JFK was assassinated in 1963, before his term expired. RFK ran for president in 1968, but was himself assassinated during the primary season. (Republican Richard Nixon would ultimately win the presidency that year).

“In terms of her being an influence on her father, I think without a doubt she’s been an influence,” Stock says of Ivanka. “She had to be an influence. They moved her into the White House. I mean, she has an office that she occupies in the White House. So, you know he thinks very highly of his own daughter to have her there.” Stock thinks Ivanka has had an influence on her father when talks about the budget, and her signature cause: the issue of day care and paid-family leave. “That would have never had happened, had she not brought that up,” Stock says.

Ivanka Trump discussed her goals, for working in her father’s administration, in a recent Us Magazineinterview. The senior advisor said those goals included “providing opportunities, like encouraging female and minority entrepreneurship in this country.” She added that: “Skills training needs to start with our youngest students and include our oldest workers, who have been displaced by technology. (I will also be) advocating for today’s dual-income families and for paid family leave.”

Root assesses Ivanka Trump’s influence this way: “Trust me, President Trump always listens to Ivanka, but makes his own decisions.”

Valerie Miller is an award-winning freelance writer. She can be reached at (702) 683-3986 or valeriemusicmagic@yahoo.com.


The Firm, P.C. is a boutique Las Vegas law firm founded by Preston Rezaee, Esq. Preston Rezaee is also the founder and Editor in Chief of Vegas Legal Magazine.




Court of Public Opinion


Link: http://www.vegaslegalmagazine.com/court-public-opinion-6/


The Firm, P.C. is a boutique Las Vegas law firm founded by Preston Rezaee, Esq. Preston Rezaee is also the founder and Editor in Chief of Vegas Legal Magazine.

-By Mark Fierro

It’s a case that has become known as the “Smoke Shop Shooting.” Many of us first heard about the case involving a young man who was clerking at a Las Vegas store when three young men burst into the shop with their faces covered and rushed the counter to steal items in a brazen robbery attempt. The event, which garnered international attention, was captured on video and aired on every local television station. (Link: http://www. lasvegasnow.com/news/man-accused-of-killing-teen-at-smoke-shop-will-stand-trial/683966864)

The video clearly shows the store clerk firing his pistol and shooting one of the would-be robbers dead. It’s the kind of storyline that Nevadans can get behind: A law-abiding citizen stands his ground against street criminals intent on robbery.

The police appeared to be comfortable enough with the initial facts. They removed handcuffs from the shooter, who soon volunteered a statement. But within days, public sentiment would dramatically shift. The store clerk, Raad Sunna, would be charged with one count of open murder with the use of a deadly weapon and soon be bound over for trial.

What could change so quickly? As the media weighed in and dug deeper into the story, the age of the deceased emerged as a prominent factor — he was just 13 years old at the time of the robbery. Secondly, the seven shots that hit him were all in the back. The court of public opinion had shifted against Sunna with lightning speed.

Attorneys for Sunna, Dominic Gentile and Paola Armeni of the law firm Gentile Cristalli Miller Armeni Savarese, say a closer look at the details of the shooting will lead to an acquittal. Armeni stated: “Age is a very big motivating factor but nobody knew his age when the perpetrator ran into the store.”

According to Armeni there was no way for Sunna to know that one of the attackers, Fabriccio Patti, was anything but a full-grown assailant. Patti stood 5-foot-9 and was wearing bulky winter clothes with his face covered by a T-shirt fashioned into a shemagh face mask, which is sometimes used by Middle Eastern terrorists.

“He (Patti) still made a choice. He made a very adult choice,” Armeni said. “He chose to run into the store with his face covered and made a criminal choice to run into that store and to do whatever he was planning on doing. At that point, whether he’s 13 or 40 should be irrelevant.”

Sunna, a churchgoing 24-year-old (he gave his statement to police accompanied by his pastor rather than an attorney) who had never had a scrape with the law, literally had a split second to react to the three-person crew that stormed into the store that late afternoon. Armeni says it was a decision made under the worst kind of duress, which was created by the robbers. “Raad was petrified,” says Armeni. “He was completely petrified. If Raad could change that day and make it all go away, of course he would. Even if there’s an acquittal, he still has to live with the trauma for the rest of his life. Was it justified? Absolutely. But he still has to live with it.

“In his voluntary statement, Raad said he thought he was going to die. He was thinking, ‘OK, I’m going to see you, Grandpa.’ This was all happening so quick. But he thought he was done. He thought he was about to go meet his maker.”

When questioned by police immediately after the shooting, Sunna said he thought the robbery was about to turn into an armed robbery. When asked by Las Vegas Metro Police Detective D. Boucher, “…what did you think was about to happen,” Sunna replied, “I thought maybe as he ran closer he would draw on me, I didn’t know. I don’t recall if he had a gun or not, any weapons, like, I don’t even know how to explain it, ’cause I’m still in shock and I’m still really shooken (sic) up by this. … I was afraid of dying tonight.”

At the March 31 preliminary hearing on the case, the defense called an expert, Robert Irwin, who has taught countless police academies and concealed weapons classes on “shoot/don’t shoot” situations. Irwin says that Sunna’s reaction was a textbook case of nanosecond response time:

Dominic Gentile: “Do you train your students … to wait before they shoot so that they see a weapon before they shoot?”

Irwin: “No. … These events generally take place in a half-second to one second to one and a half seconds, the actual part of this that the confrontation is. … Clearly if police or security or civilians wait until they see the gun coming or the knife coming toward their chest to fire their gun, they’re going to die.”

There are no winners, there is no prevailing party in this case. A young man, Raad Sunna, went to work that December morning just trying to make it through another day. The three robbers had very different goals. Patti is dead. The two surviving members of his crew face charges of attempted robbery. Sunna’s life as a somewhat cloistered young man living at home with his parents has changed forever. He has only one explanation for his actions on that December afternoon: “I was just petrified and afraid for my life.”

The father of the deceased, Martin Patti, is the one person who has not jumped to any conclusions, telling the Las Vegas Review-Journal, “God is helping me to go through this and I wish him the same.” As Sunna was bound over for trial by Justice Karen Bennett Haron, Gentile and Armeni informed the court of their intent to demand a speedy trial, which is now slated for July 31.

Mark Fierro began his career as a reporter/anchor at KLAS-TV, the CBS television station in Las Vegas. He worked at the U.S. House of Representatives in Washington, D.C. He served as communications consultant on IPO road shows on Wall Street. He provided litigation support for the Michael Jackson death trial. Heis president of Fierro Communications, Inc., and author of several books including “Road Rage: The Senseless Murder of Tammy Meyers.”He has made numerous appearances on national TV news programs.

The Firm, P.C. is a boutique Las Vegas law firm founded by Preston Rezaee, Esq. Preston Rezaee is also the founder and Editor in Chief of Vegas Legal Magazine.



Why Can’t They Be Here Legally?

Link: http://www.vegaslegalmagazine.com/cant-just-come-legally/


The Firm, P.C. is a boutique Las Vegas law firm founded by Preston Rezaee, Esq. Preston Rezaee is also the founder and Editor in Chief of Vegas Legal Magazine.

-By Eva Garcia-Mendoza, Esq. & Tyler Morgan, Esq.

Donald Trump brought the subject of “illegal” immigration front and

center during his campaign and it has remained there since he took office. Trump repeatedly stated that a wall will be built on the United States’ southern border and Mexico will pay for it. In the current national dialogue, it’s often heard, “My ancestors came here legally, they [the current immigrants] should do the same.” However, in most cases this statement is entirely inaccurate for the reasons set forth below.

U.S. Immigration History

From the inception of our nation until the late 1800s, the United States had an open door to immigrants with some regulations imposed only by individual states. In other words, people were able to enter and remain here without filing any formal paperwork. It wasn’t until the gold rush of the mid 1800s, and the influx of Asian immigrants, that Americans developed negative sentiment towards immigrants. This negative sentiment continued through history and arguably still remains strong today. The U.S. has a long history of tightening immigration laws and a brief summary of the many immigration acts imposed by the government only shows the historical significance of this anti-immigration sentiment on our federal government.

By 1882, The Chinese Exclusion Act was enacted providing for the exclusion of persons from China. It should be noted, only thirteen years prior to this act, the nation’s first Transcontinental Railway was completed with enormous contributions from then Asian worker-immigrants now facing exclusion. This exclusion of Chinese people continued through further acts by the federal government until Dec 17, 1943, when Congress repealed all exclusion acts leaving a quota system in its place.

Following the Chinese Exclusion act came another measure on immigration in the same year– The Immigration Act of 1882. This was the first general federal immigration law and included a head tax of $0.50 and forbid convicts, lunatics, idiots and persons unable to care for themselves without becoming a public charge from entering the United States.

When Congress felt it necessary to pass responsibility onto the federal government to enforce immigration policy, the Immigration Act of 1891 was passed and established the Bureau of Immigration. This act further restricted immigration and provided for medical and general inspection, and excluded people who had contagious diseases from entering the United States. Also excluded were persons who had previously committed crimes involving moral turpitude, and who were either paupers or polygamists. By 1903, in response to President William McKinley’s assassination, federal law was changed to exclude from the United States epileptics, insane persons, professional beggars, and anarchists. Shortly thereafter, in 1907, the federal government established additional grounds of exclusion including: feeble-minded persons, unaccompanied children, persons with tuberculosis, and persons with a physical or mental defect that might affect their ability to earn a living. Also added was a deportation ground for persons who engaged in prostitution within four years of entering the United States.

Following WWI, a Quota Act was enacted in 1921 in response to post war fears that southern and eastern Europeans would inundate the United States. The federal government sharply reduced immigration to 350,000 admissions per year and immigration from southern and eastern Europe was especially hard hit, as the law intended. The annual quota for these regions was 155,000 admissions, far below the previous annual average of 783,000.

The quota tightened in 1924 by further reducing the number of southern and eastern European immigrants allowed to enter the United States annually to below 25,000. Through these quotas set forth in the early 1920s, “restrictionists” had effectively won their battle to close America’s gates.

Fast forward to 1952, Nevada’s U.S. Senator Pat McCarran co-sponsored the McCarran – Walter Act which established the basic structure of current U.S. immigration law. Opponents of this Act expressed concern that the restrictive quota system heavily favored immigration from Northern and Western Europe and therefore created resentment against the United States in other parts of the world. Opponents also felt the law created the sense that Americans thought people from Eastern Europe were less desirable and those from Asia were just plainly inferior to those of European descent. However, the group led by Senator McCarran expressed concerns that the United States could face communist infiltration through immigration and that unassimilated aliens could threaten the foundations of American life. Those in Senator McCarran’s camp argued that limited and selective immigration was the best way to ensure the preservation of national security and national interests. Economic factors were secondary to America’s Cold War concerns in the debate over immigration. The Act gave 85% of the 154,277 visas available annually to persons of Northern and Western European lineage. Before the passage of this law, residents of only three countries–Ireland, Germany and England were entitled to nearly 70% of the visas available to enter the United States.

Countries in the Western Hemisphere were not included in the quota system. Thus, persons from North, Central, and South America were exempt from the quotas and were allowed to enter unimpeded unless they were disqualified due to health, economic or criminal grounds. These quotas were eventually adjusted by the Immigration and Nationality Act of 1965, but by 1978, Congress eliminated the hemispheric quotas system and established a worldwide quota of 270,000 visas per year.

Between 1965 and 2000, 4.3 million immigrants to the United States came from Mexico. Today, immigration to the United States is dominated by people born in Asia and Latin America with immigrants from all of Europe accounting for only 10% of recent arrivals.

The Reality of “Get In Line and Enter Legally”

If it were only so simple. You often hear people say something in line with, “my ancestors came here legally and became citizens so why can’t the ones today do the same?” Or, you may hear the famous, “get in the back of the line if you want to enter.” Well, simply put, there is no line. In fact, with the quotas now in place for immigrants trying to enter the country, most have to remain undocumented for years, even decades, before they can officially become legally documented citizens. Point is, when our ancestors were arrived, they were neither legal nor illegal immigrants– they were just immigrants. They came in the same way and for the same reason current immigrants do: by crossing a border and seeking a better life for themselves and their family.

The references to “illegal” or “undocumented” solely refer to that fact that the immigrants do not have federal identification for their status in the country. That does not necessarily mean the federal government does not know they have entered the border. In fact, states and the federal government have been collecting taxes on them for years. According to the Institute on Taxation & Economic Policy, “illegal” immigrants contribute billions of dollars in state and local taxes each year. And as far as social security is concerned, illegal immigrants and their employers contribute to roughly $12 billion in social security taxes each year based on estimates from the Social Security Administration. Most important to note is that when many of these immigrants pay for social security, they do so knowing they may never get the benefit of drawing from the system because of their status.

So, when it comes to immigration and building walls to keep everyone out, just consider what is being shut out–hard working families, like those who built our railroads and agriculture industry, who often pay taxes (billions) and come to this great country in search of a better and peaceful life.

Eva Garcia Mendoza began her legal work in 1975 as the first official court interpreter in the State of Nevada.  She graduated from the University of San Diego and has practiced law for more than 35 years.  She founded the Nevada Chapter of the American Immigration Lawyers Association (AILA) in the late 1980s and has served as its Chapter Chair on two occasions.  She also practices in the field of general litigation and personal injury law.

The Firm, P.C. is a boutique Las Vegas law firm founded by Preston Rezaee, Esq. Preston Rezaee is also the founder and Editor in Chief of Vegas Legal Magazine.



Choosing The Right Expert Witness


One of the best experts I’ve ever selected happens to be one of my mentors. More on that in a moment.

First, it’s imperative to say that not all cases require experts. In fact, sometimes they are a detriment. Quite often the facts of a case are simple and easy to understand and an expert’s opinion is not needed or justified.  Retaining an expert is practically a part of all young insurance defense attorneys’ “how to” manual or outline. Experts are retained to consult and educate counsel and offer opinions that lay witnesses couldn’t otherwise give. I learned early on that many jurors do not embrace experts. To the contrary, many jurors feel that experts are paid guns used as leverage or ammunition by a financially stronger litigant. Jurors have become more aware that in an auto accident trial, the defendant is being defended by an attorney retained by an insurance company. Many jurors feel that the insurance company can afford the expert and the expert will say whatever the insurance company pays him or her to say. Consequently, many jurors are not persuaded by an expert who wasn’t at the scene of the accident and therefore has no personal knowledge of the facts giving rise to the collision and/or alleged injuries.

In non-auto related cases, jurors are equally skeptical of experts. An expert should only be retained after considerable thought is given to the advantages and disadvantages of such retention. Will the expert assist the trier of fact as required by NRS 50.245? If the expert will assist the trier of fact, the next step focuses on selecting the right expert. I have had very qualified experts do well and not so well. Each case is different. You must consider the particular facts of the case when choosing the expert.

In a non-auto case tried over several months, I had the pleasure of working with an outstanding first or second time expert. This gentleman was professional in demeanor and enthusiastic about the science. He was inexperienced in handling cross examination but his undeniable honesty made up for it. In fact, years after the case was resolved, the trial judge commented on how well my expert performed. The trial judge, a former accomplished trial lawyer, was not only impressed with the expert’s credentials but also with his understanding of the case and connection with the jurors. I wouldn’t mention the Judge’s comments if I didn’t value highly the opinions of Judge Williams as a Judge and former trial lawyer.

While the above experience was good, it isn’t the focus of this article. I helped educate and train the expert in the case just referenced. The next expert I would like to discuss not only assisted the trier of fact but also me. I retained J. Mitchell (“Mitch”) Cobeaga, Esq., as my expert in a bad faith insurance case. Mitch was one of my mentors at Beckley Singleton. He trained many of the better trial lawyers practicing in Southern Nevada. He defended insurance companies and their insureds for over 35 years. I knew that he would not only be knowledgeable with regards to coverage but I also knew that he could explain coverage to a jury.

The particulars of insurance coverage is exciting only to a few people. Empaneling a jury

interested enough to listen and smart enough to understand would be challenging. I didn’t need a professional type. I needed an expert who would make listening and understanding insurance coverage, policies and claims language interesting or at least tolerable. I knew Mitch was perfect for my case.

Opposing counsel tried to preclude Mitch. When unsuccessful, opposing counsel tried to limit Mitch’s testimony. Because of his credentials and with his understanding of the case, Mitch was qualified to testify. Mitch with his easy-going approach entertained the jury. Between and among anecdotes and stories, the jurors learned the case and insurance coverage. In fact, when some of my questions seemed to esoteric, he rephrased the questions in his response. He assisted me and the jury simultaneously. The result was better than my client ever expected. Mitch’s contribution to the case was invaluable. I only take credit for selecting him as the expert.

Again, not every case requires an expert. When you have decided that the law and/or facts require an expert (i.e. medical malpractice case) be thoughtful in selecting the appropriate expert. If your theory can’t be articulated through the personal knowledge of lay witnesses, then an expert’s assistance is likely necessary. After you have determined the type of expert needed and have chosen the level of credentials suited for the case, then you must next consider the personality of the experts. Your expert’s ability to relate your theme of the case to the jury is extremely important in convincing a jury that your expert’s telling the truth and not what he/she was paid to say.

Theodore “Teddy” Parker is a founding partner of Parker & Nelson Assoc. in Las Vegas, Nev., where he specializes in administrative law, banking law, business litigation, corporate law and structuring, construction contract and defect, employment and labor law, insurance defense, municipal law, medical malpractice, personal injury, premises liability, products liability, real estate law, and regulatory compliance. Learn more about him and his practice’s work at http://www.pnalaw. net.

The Firm, P.C. is a boutique Las Vegas law firm founded by Preston Rezaee, Esq. Preston Rezaee is also the founder and Editor in Chief of Vegas Legal Magazine.

Partially Disabling Injuries

-By Stan V. Smith, PhD with Kyle Lauterhahn

The Firm, P.C. is a boutique Las Vegas law firm founded by Preston Rezaee, Esq. Preston Rezaee is also the founder and Editor in Chief of Vegas Legal Magazine.

Assessing the partial loss when an injured plaintiff can still continue to work in the future in “some reduced capacity” presents a complex challenge to plaintiff attorneys and to juries, a challenge that is often not well addressed in a litigation setting.  However, there are high-quality statistics produced by the United States Census Bureau that few expert economists, and even fewer lawyers, are aware of that can greatly aid in the analysis of lost earnings capacity. These government statistics allow an economist to provide an opinion to a jury regarding the partial loss of earnings capacity due to disability to a reasonable degree of economic certainty, obviating the need in many instances for a formal vocational analysis.

When an injured person returns to work, the rate of pay and the hours worked can be very misleading as they are frequently not indicative of the long-run impacts. Even if an injured person is back to work at the same job and the same rate of pay, with a disability, there are definite wage losses due to disability in the long-term future that are not readily evident and that should not be ignored. Fortunately, these Census Bureau statistics address and remedy the problem.

The partial loss of earning capacity can arise not only from physical injuries, it can also arise in a myriad of situations such as defamation that has a future career impact. The loss may arise if someone’s career in medical school, for example, is prematurely terminated by wrongful dismissal. An economist can measure such loss. This article focuses on ways to help juries understand the long-term impact on earning capacity loss due to a physical or mental impairment, such as difficulty standing, or difficulty concentrating, where government statistics provide a high-quality measure of the impact, both on employment probabilities and pay rates.  This long-term impact is typically not evident shortly after the injury.


After an injury, an individual may have already returned to work full-time, but he or she may be earning less than prior to their injury due to impairment. For example, a realtor who has difficulty walking or has back pain may work full-time after the injury but accomplish less per hour.

They may show fewer homes in a given afternoon due to difficulty walking, driving, and going up and down stairs, and thus earn less in commissions.  In addition, they may also work fewer hours per week due to the disability, and earn even less per year than if they worked full-time.  Furthermore, the degenerative impact of the injury on hours and earnings may increase over time.

A construction worker may continue to work full-time with some pain. Even if the worker earns the same union wage per hour, he or she may work less overtime in the long run, and may be able to work only to age 53 for example, rather than perhaps age 62 or 65, or even later.  The work life capacity prior to the disabling injury is forever impacted.  Less overtime and fewer years of work in the future reduce the injured person’s earnings capacity.

An accountant may be forced to retire early, giving up the business that took decades to build. A call center worker may choose to work less overtime due to fatigue, and he or she may take frequent personal leave as a body pain may flare up from time to time. Pain can be very debilitating. A truck driver may find that upon their return to work, pain associated with long-haul driving may force them to also accept shorter, lower-paying routes, leading to a double penalty of reduction in earnings and time worked.


These long-term, future impacts of impairments are all but impossible to assess after the injury without the high-quality statistics that are available to measure them.  Even if an individual has not yet returned to work, but is making medical progress and return to work is feasible, a jury will want to understand what the person can do in the future, and how their capacity may be reduced in the long run.

As shown in the examples above, the average person who has a disability due to injury also has a significantly reduced probability of employment, and perhaps a significantly reduced pay rate. This reduction in employment can mean fewer years worked in one’s career (i.e. retiring early) or fewer hours worked in each year (i.e. shorter work week, more time off, etc.). The reduction in pay rate can result from reduced hourly earnings, reduced overtime, or reduced opportunities for promotion and advancement, all of which lead to significant losses for an injured person.  The reduction in employment and the reduction in pay rate can operate independently of one another.

We know that these losses exist anecdotally, such as in the examples above, but there are also reliable statistical databases for these work and pay reductions due to disabling injuries.  The United States Census Bureau collects employment and pay data on Americans with disabilities as part of its regular surveys.  Persons with disabling injuries may be compared to the total population in order to get a statistical comparison of the reduction in probability of employment or the median earnings of a disabled person, as compared to the average person in the workforce. This data indicates that people who have disabilities, unsurprisingly, have reduced likelihood of employment and reduced earnings (if they are employed) compared to the average American.

The Census Bureau has a breakdown of impact by disabling condition, which can be related to injured individuals to show what degree of future earning reduction is statistically expected. Independent measures of loss can be found for many types of disabilities including: difficulty seeing, hearing, concentrating, getting along with others, speaking, walking, lifting, grasping, standing, sitting, crouching, reaching, moving heavy objects, or coping with stress.  Disability is also indicated by the use of wheelchair or a walker, and by limitations in the basic activities of daily living, such as homemaking, dressing or bathing, or by limitations of the more complex or instrumental activities of daily living such as managing finances and planning meals.


For someone with difficulty sitting due to a spine injury, according to the Census Bureau statistics, the probability of employment is approximately 58.25 percent less than that of the total population. An assumed 58.25 percent reduction in future work can be applied to the expected normal future earnings of the person. If a long haul truck driver earning $70,000 per year would have worked for another 21.5 years but for their injury, their near 60 percent reduction in expected future years worked can mean 12.5 years of lost earnings, a loss of over a million dollars including benefits. This large loss is not otherwise evident to the jury if the driver has returned to work currently driving the same route and hours and at the same pay.  But government statistics can allow an economist to opine as to this future loss with a reasonable degree of economic certainty.

For persons who are employed subsequent to an injury that results in a disability, the data from the Census Bureau shows that the rate of pay or earnings per hour work is also likely to be reduced. In the instance of the realtor discussed above, the average earnings for someone who works despite difficulty walking are 66 percent of the earnings of an average American.  So if we assume that a realtor earning was capable of earning $60,000 per year prior to their injury, their long term post-injury earnings capacity may be expected to be only $40,000.  At an annual reduction of $20,000 in earnings, a young realtor may lose over half a million dollars in the future over their career.

In the instance of a child injury this data is particularly useful. While a child would not have yet established any career path, the impact of disability on an injured child can be also shown based on statistical reductions. If a child has been injured resulting in a mild traumatic brain injury and has difficulty concentrating, that child may yet graduate college, with very significant effort.  But difficulty concentrating will impair career prospects and earnings; such disabled people earn only 43 percent of the average, non-injured population. This 57 percent impact can be applied to future earnings of the injured child.  While the present value of a healthy child’s future earnings (assuming they graduate college) including benefits could approach $4 million, the child who has difficulty concentrating can expect a reduction in earnings that well exceeds $2 million.

In addition to the income capacity of a child being reduced, the prospective level of educational attainment of a child is likely to be reduced as well with a disability. We frequently assume several pre-injury educational outcomes, such as some college and college graduation. It may be that someone we thought had a great likelihood of completing college may now likely only complete some college, or may not even go to college at all. The jury can be shown all the possible combinations of equal and or lesser education due to the injury, with the post-injury wages and employment reduced by the Census Bureau employment statistics. So we can, for example, assume some college prior to injury and only high school after the injury. The post-injury high school earnings would be reduced based on the Census Bureau statistics.

Sometimes there is a vocational assessment of the reduced wages or employment.  But these assessments are not based on, nor supported by, the U.S. Census Bureau statistics. An economist, however, can provide a strong statistical basis for the employment and pay impact on earnings capacity and career, and show the jury an evidence-based reduction in loss of future earnings and capacity.


Assessing the partial loss of earnings capacity due to a disability presents a complex court challenge for plaintiff attorneys and for the juries.  Statistics produced by the Census Bureau can establish a solid and credible foundation for estimating those losses.  An economist, can provide opinions regarding the partial disability to a reasonable degree of economic certainty.  Without such testimony, there is a likelihood of a jury “guessing” which can lead to “unpredictable” jury verdicts, either much higher or much lower than might result through a better-informed jury.  This high variability can undermine the jury system which the Seventh Amendment established.  With credible economic testimony based on Census Bureau statistics, the jury system is better supported.  There may be more predictable jury verdicts (and, hence more settlements.)  We are all well-served by these real number results.

Stan V. Smith, Ph.D., is VLM’s Quarterly Economics Columnist and president of Smith Economics Group, Ltd., headquartered in Chicago.  Trained at the University of Chicago (one of the world’s pre-eminent institutions for the study of economics and the home of the law and economics movement), Smith has also taught at the university and co-authored the first textbook on the subject of economic damages.  A nationally-renowned expert in economics who has testified nationwide in personal injury, wrongful death and commercial damages cases, Smith has assisted thousands of law firms in successful results for both plaintiffs and defendants, including the U.S. Department of Justice. To that end, Smith also developed the first course in forensic economics at DePaul University, and pioneered the concept of “hedonic damages,” testifying about the topic in landmark cases.  His work has been featured in the ABA Journal, National Law Journal, and on the front page of The Wall Street Journal.  Kyle Lauterhahn is a Senior Economic Analyst at Smith Economics Group in Chicago. Smith Economics Group, Ltd., is located at 1165 N. Clark Street, Suite 600, Chicago, IL, 60610. Dr. Smith may be reached at 312-943-1551, and at Stan@SmithEconomics.com.

The Firm, P.C. is a boutique Las Vegas law firm founded by Preston Rezaee, Esq. Preston Rezaee is also the founder and Editor in Chief of Vegas Legal Magazine.


Looking For A Trifecta

The Firm, P.C. is a boutique Las Vegas law firm founded by Preston Rezaee, Esq. Preston Rezaee is also the founder and Editor in Chief of Vegas Legal Magazine.

On a recent morning, Las Vegas Mayor Carolyn Goodman sits behind her desk on the top floor of Las Vegas City Hall, with a picturesque view of downtown’s revitalization behind her. Greeting a reporter, the mayor takes pride in the development outside her windows. “I wanted to continue Oscar’s vision,” she says about her immediate predecessor — and husband – former Las Vegas Mayor Oscar Goodman.

Carolyn Goodman has certainly accomplished that, and much more. Now six years after taking office, and halfway through her second term, Mayor Carolyn Goodman tells Vegas Legal Magazine that she is “without question” running for a third term as mayor in 2019.

The mayor is especially proud of what is happening in downtown Las Vegas, which was always a central focus of her husband’s during his 12 years in office. The mayor turns to look out her office windows, and points to the development that started out as “Oscar’s vision,” but has now become their shared vision, as well.

“In fact, the only reason why I ran for office was because 17 people filed to become mayor,” she recalls, as she admires the view of new development. “And, my family came to me and said, ‘Mom, you have to continue on with Dad’s dreams and visions.’ At that time, everything you are seeing here in the mayor’s office — outside the windows — they weren’t here.”

Downtown Las Vegas revitalization has become a passion of both Oscar and Carolyn Goodman. Carolyn takes a lot of pride in downtown’s new growth during her tenure. “We have seen a huge surge of improvement and growth in the hotel industry downtown, with the Boyd (Gaming) group putting $30 (million) to $40 million into renovation for the California (hotel-casino). The Plaza (hotel-casino) is coming online.  The D (hotel-casino) is (now opened) there and, of course, (D owner Derek Stevens) just bought the Las Vegas Club,” she points out. “We have these high rises, and we are getting a lot of marketing on those, where people are coming into live.”

Oscar Goodman’s plans for downtown slowed during his last term as mayor, when the recession hit, starting in late 2007, his wife of 55 years explains. A few projects managed to stay on track during the economic downturn: Downtown’s Smith Center for the Performing Arts, and the Cleveland Clinic  Lou Ruvo Center  for Brain Health, both opened in Symphony Park shortly before Oscar Goodman left office.

“There’s still more to accomplish for the city,” she says. Carolyn Goodman sees her five decades in the community as an asset, in that she has seen just how far Las Vegas has come. “I love this town … So many people come in to buy land, or think about opening a business,” the mayor says. “Or (they may be) coming here to look (for a place) to live, or book a convention, and they need to know a little history. I have been here, goodness, 50-plus years. It is going to be 53 years come August. We have seen the town grow from 100,000 to 2.2 million (people). “

Mayor Carolyn Goodman has seen the small-town Vegas of old bloom into “an entertainment and gaming mecca,” complete with an internationally recognized Las Vegas Convention Center. She points to the some 43 million tourists coming in a year. Those visitors need to know who they can call in a strange city, she explains. And Mayor Carolyn Goodman wants to remain that point person for the next six years.

“If you travel internationally, and you don’t know who to contact, you always call up the mayor of the city,” she says.

“She’s Her Own Person”

Carolyn Goodman, however, didn’t initially want to fill the mayoral big shoes of her husband Oscar. The first Mayor Goodman was a great showman and hugely popular. Oscar Goodman is praised as a “one-man PR machine for Las Vegas” by Alan Stock, who is a local radio talk show host and political analyst. But Stock sees Carolyn Goodman as “more of a traditional mayor, and more low-key,” he adds.

Stocks contends that a lot of people thought they would see the fourth term of Oscar Goodman when his wife was elected mayor, but she has governed with her own style. “It wasn’t ‘Oscar four,’” Stock opines. “It was ‘Carolyn one,’ and then ‘Carolyn two.’ And if she’s elected to a third term, it will be “Carolyn three.’”

Carolyn Goodman, like her husband Oscar, is now non-partisan. She says it’s preferable for mayors while in office. Stock gives credit to Carolyn Goodman for not being a “political mayor,” ala the controversial New York mayor, Democrat Bill de Blasio.  “She doesn’t do controversial things,” Stock notes.

Carolyn Goodman has continued Oscar Goodman’s vision for Las Vegas, but she has also remained her “own person,” according to Michael Green, a University of Nevada, Las Vegas history professor.

“She is not Oscar Goodman, and nor should she be,” says Green, who happens to sit on the board of the Mob Museum with Oscar. Before being elected mayor, Oscar Goodman had worked as a well-known defense attorney for clients accused of being involved in organized crime. As mayor, Oscar Goodman had long hoped to open the museum. But the Mob Museum became a reality under the tenure of Carolyn Goodman.

“People forget now that, in 1999, when Oscar Goodman first announced he was running for mayor, a lot of people said ‘the wrong Goodman is running for mayor.’ They actually thought Carolyn should have run,” Green recalls.

Of course in retrospect, most Las Vegans now view Oscar Goodman’s 12 years as mayor as a success. And in 2011, while Carolyn Goodman started out as a very reluctant candidate for mayor, she did throw herself all into her campaign. Carolyn Goodman’s initial reservations were partially based on her already-full schedule.

“I had no intention of running. I had been involved in education here for over 26 years and founded the Meadows School. That took me 24-7 all the time, plus my family, and I was a happy cat.”

Carolyn Goodman decided to run for the office when she saw the list of candidates hoping to take over for her term-limited husband Oscar. “I didn’t need to rock the boat. And then it became very clear that while they were all well intentioned — the people that wanted to become mayor — they would have a vision that was theirs. They didn’t want to carry on the vision of Oscar Goodman.”

At the pleading of her family, Carolyn Goodman threw her hat into the ring to be the next mayor of Las Vegas in 2011. And, as was generally expected, she won. In 2015, Carolyn Goodman won re-election to a second term.

While Las Vegas mayor, Carolyn Goodman would still like to bring a major league, professional sports team to the actual city of Las Vegas. That was also a dream of her husband while he was in office.

Now, of course, the National Hockey League (NHL) has expanded into the Greater Las Vegas area with the Las Vegas Golden Knights team. Meanwhile, the National Football League’s Oakland Raiders’ owner Mark Davis has since inked a deal to move to the Las Vegas metro area – once a new $1.9 billion stadium is completed in a few years.

“I will continue to pursue Major League Soccer, the MLS, and I am sure we will get an NBA team here within the next decade because I have a very good relationship with Adam Silver, who is the (NBA) Commissioner,” she explains. “I also have a very good relationship with the MLS Commissioner (Don Garber).” Mayor Carolyn Goodman also sees great locations for professional basketball or soccer, within Las Vegas’ city limits.

“I am looking to develop Cashman Complex. It is a 5-acre parcel. We see a huge potential there for sports. So, that will happen,” she promises. “My only hope is that I live to see it all happen, because I am going into my seventh year next year.“

Looking to the future, the mayor is hoping for re-election to a third term. Those four more years could give her enough time to fulfill those big-league sports dreams, Carolyn anticipates. “So, I only have one more year, or so, on this term. Then I get a chance at one more term after that. “So, I have like five to six years to get it all done.”

Vegas Legal Magazine:  What can you share about new projects, and plans, in the works for Las Vegas?

Carolyn Goodman: A new project that the City is  piloting  is a much-needed one. As mayor, I have been advocating for it well over a year:  a free circulating bus shuttle which will move people around easily and comfortably, on a fixed route, in the four-square-mile  downtown core. Its purpose is to afford the tourists, residents, and employees, convenient and regular  connectivity  to businesses, downtown hotels and apartment buildings, (along with) restaurants, shops, galleries, museums, and entertainment venues.

As we work to build a more pedestrian-and-bike-friendly city, the “Downtown LOOP” portends to make a huge difference in achieving this goal.  Other cities around the country provide similar free shuttle services in their inner cores, and our hopes are that our businesses will enjoy the increase in visitations that they have seen occur. In its initial plan, the LOOP will operate seven days a week, nine hours a day. (It will) have stops at Bonneville Transit Center, the Arts District, the Las Vegas Premium Outlets, the Plaza Hotel and the Fremont Street Experience (both its west and east entrances). [It will also stops at] the Mob Museum, the Fremont East Entertainment District, and the Pawn Plaza (home of the Pawn Stars). We will be monitoring ridership and the popularity of the shuttle with an eye to the future.

Other projects underway — but not yet out of the Development and Planning Departments — are in Symphony Park, in the Cashman Complex, the Medical District, and in the booming northwest. Building proper infrastructure support, and streetscapes, are integral to every one of these projects we are undertaking. Having sufficient garage space and accessible roadway connectivity are other critical facets of preparation to building wisely, safely, well, and successfully.

VLM: What do you see as the biggest challenges facing the City of Las Vegas, now and into the near future?

CG: The challenges of addressing a growing homeless population have been evident for far too long in our community though we are not alone in facing this movement.  Cities around the country, and in particular in the more moderate climate areas such as ours, are each facing the impact of homelessness and the residual effects of their residency.

The recent recession with the enormity of the foreclosures in Southern Nevada, of course, added to our homeless population. But fortunately, as we are seeing an economic rebound, many of those who lost jobs and homes are back on the road to recovery and housing.  In the general homeless population, we see persons who have lost jobs and/or are abandoned by families, a population of veterans, individuals who are mentally challenged and ill, addicted individuals, and even human-trafficked persons.  Each group and each individual has special needs and problems. So, the challenge is ongoing and, of course, costly to assist with — and provide for — all of the wrap-around necessities that each requires.

While the impact the homeless population has on local businesses, homeowners, roadway traffic, our hospitals and care centers (just to mention a few areas) is mindboggling, fortunately, Las Vegas is supported by incredible social service providers and unique charitable organizations. [These services and organizations] donate to help address the multitude of issues this population demands.  These not-for-profits have bonded together to provide housing/beds, medical care, sanitation, meals, counseling, job training and placement —just to mention a few services they offer. And, many of these services are afforded in the City’s Corridor of Hope in Ward 5. The struggle and planning have been going on 24/7 for years, and we will not quit until we have found success for each human being, and addressed his/her need. But the enormity of the undertaking is exhausting.  Yet plans are afoot … [and] visits to other cities with successful programs continue, Best Practices are sought out, evaluated and implemented where appropriate, and solutions come slowly.

Addressing mental health issues, and providing funding, for fixes are not just Las Vegas problems. [These] are national problems that federal and state health care must provide. Our [Nevada] Legislature and Governor [Brian Sandoval] can and must help. And, readers need to know we each need to do our own part.

Another challenge that has been with us for so long is the specter of Yucca Mountain, and the nuclear waste being transported through our city. The infrastructure in this country is beyond in dangerous disrepair often rated a “D-“ in national civil-engineering studies. To consider transporting nuclear and radioactive waste along roads, over bridges, into tunnels, or on rail anywhere, and at this time, is appalling. That these highly dangerous materials will be rolling throughout the nation at times unknown, on routes undisclosed and passing through and past population centers challenge even the least caring. It is time to repurpose, deactivate and research new ways for disposing of this radioactive and nuclear waste. A waste site at Yucca Mountain is more than a Nevada issue, it is of huge national safety concern. Yucca Mountain has always been a flawed proposal for many reasons. As mayor of Las Vegas, like everyone else, safety is my number one priority. This is not a risk I am willing to take for my city or for our country.

VLM:  Looking at the wrap up of the current 2017 Nevada legislative session, which (potential) new laws do you think will have the most impact (if any) on the future of Las Vegas?

CG: It is hard to say, but three specific areas are legislatively critical: First, the overhaul and reorganization of the Clark County School District is singularly one of the most important issues that new legislation must address. Those reasons [include] developing a responsively qualified and well-educated workforce; and preparing all CCSD children for productive and meaningful lives, for college entrance, and/or for vocational readiness.

Second, another critical legislative area that must be addressed is that of matching Medicaid reimbursement rates to those of neighboring states.  These rates directly affect private insurance reimbursement rates, and without an adjustment to a competitive standard, Nevada will never be able to retain and/or attract the finest physicians to our State. Third, [another issue is] property tax adjustments to [put] both a cap and bottom level [limit].

VLM:  There has been much news coverage of the battle between some U.S. cities and the Trump Administration over the crack down on “sanctuary cities.” Clark County received a letter from the administration recently, as well. Can you talk about your efforts to make sure that the City of Las Vegas does not get caught up in this fight?

CG: It is really not a fight for the city, as we have been consistent from the previous administration to the new administration in Washington. The City of Las Vegas has no ‘sanctuary’ ordinances in place. We are in compliance with ICE regulations and continue to work with federal authorities as required.  While Las Vegas is not a Sanctuary City, it is a sensitive and compassionate city. I’m passionate about finding a pathway to citizenship for the multitudes of undocumented individuals who live and work in Las Vegas, and are valued law-abiding, caring, participatory, and good people. That is, it. We comply with federal regulations in the city jail, and we want our representatives to iron out a pathway to citizenship.

VLM: You have said that you plan to run for another term as major. What is still left on your list of things to accomplish while in office?

CG: You haven’t enough space for me to respond!!!! I want this city to reach its potential of being WORLD CLASS!  For starters:  First [on the list is] expanding security and safety measures to a point of citizenry full comfort. Second, building out and FULLY staffing the [University of Nevada, Las Vegas] Medical School with appropriate, and complementary, adjunct growth. [That includes] the development of research and newly specialized medical care. Third, expanding the Cleveland Clinic-Lou Ruvo Institute for Brain Health. Fourth, fix the quality of pre-K – 12 educating for all segments of the population. Fifth, enhancing the cultural arts. [That includes a new art museum for Symphony Park]. And sixth, bringing in a [Major League Soccer] franchise and the NBA.

VLM: Your previous career was in education, founding the Meadows school. Can you give your opinion on the state of public, and private, education in Southern Nevada? What do you think could be done to improve the school system?

CG: It’s all about the quality of teachers, about the mission/purpose of the program, the academic/curricular programming, providing for extracurricular activities, and having more than adequate funding available to meet all of these goals. When we talk about educational funding, now, more than ever, we have to ensure that we are putting every dollar into the per-pupil student allocation. There is no way that $5,500 currently allocated per pupil is near adequate to attain goals of high-quality education. At a minimum that number needs to be at $10,000, because buildings don’t teach, teachers teach.

Attracting, and retaining, the finest means per-pupil allocation must be raised to meet that mark. Back in the 1990s, when our population was growing so fast we couldn’t keep up, we needed capital projects and new school facilities. What was forgotten was the quality of the education, and providing appropriate per-pupil expenditures. Today we see the results of that poor planning.

Changes are coming to the Clark County School District, but that is a process, and it will take time. While the city is not responsible for, nor empowered to be integrated into CCSD, it is moving forward to fill in the gaps in our children’s educations. [That is done through] before-and-after-school programming. This is being led by our Department of Youth Development and Social Innovation, which is providing supplemental and support programming like Safekey, Batteries Included and Strong Start, to name a few.

We are Reinventing schools in our urban core, creating hubs that serve as centers for not only a student’s education, but also as a point where a family can access services and programs. Our Downtown Achieves, and Las Vegas My Brother’s Keeper, programs now operate under the Re-Invent Schools umbrella.

By giving children a strong start and getting them reading before kindergarten, we have the chance to improve our high school graduation rates, and revitalize our communities.

We are also teaching students and their families how to be healthy through our Healthy School Healthy Life Program. This has been a model program which the U.S. Conference of Mayors recently recognized with an award for its childhood obesity prevention efforts. The city was awarded a $150,000 grant to expand this program to additional schools and continue to improve the health of our residents.

Valerie Miller is an award-winning journalist based in Las Vegas. She can be reached at valeriemusicmagic@yahoo.com.

The Firm, P.C. is a boutique Las Vegas law firm founded by Preston Rezaee, Esq. Preston Rezaee is also the founder and Editor in Chief of Vegas Legal Magazine.

Acute Trauma: An Imaging Perspective

The Firm, P.C. is a boutique Las Vegas law firm founded by Preston Rezaee, Esq. Preston Rezaee is also the founder and Editor in Chief of Vegas Legal Magazine.

-By Travis Snyder, DO

Distinguishing acute trauma from pre-existing degenerative changes (changes of aging) and other pathologic processes during medical imaging is essential for patient care and management, yet this is often challenging for both the treating physician and the radiologist. Imaging terminology and options, such as MRI pulse sequences can be confusing for physicians and non-physicians alike. Understanding of these concepts is surely essential for attorneys managing medical legal cases.

Imaging Options

Understanding the utility of the various modalities available in diagnostic imaging is important. Fractures in the spine or extremities can occasionally be subtle or not visualized on plain film (x-ray) and if there is high clinical concern, MRI is recommended. Extremity x-rays for fractures should ideally include standard 3 views. Ligament and tendon injuries are most often not seen on x-ray, although indirect signs may be present. MRI is the exam of choice to asses these and other soft tissue injuries. CT is excellent for assessing bony pathology such as fractures, particularly rib fractures, but is more limited in assessing the soft tissues. Intravenous contrast may be administered in cross sectional studies (MRI or CT), but other than to assess for abdominal organ or vascular injury, contrast is of limited value in evaluating acute or subacute injuries and is generally reserved to characterize or diagnose nontraumatic conditions such as infection or neoplasm or postsurgical spinal evaluation. A MRI arthrogram is a procedure where MRI sensitive contrast and water are injected into the joint under fluoroscopic imaging guidance by a radiologist and then scanned using MRI. This exam is typically ordered to assess the labrum (an important stabilizing thin but sturdy circumferential soft tissue structure peripheral and superficial to the cartilage), in either in the shoulder or hip where intraarticular contrast (Arthrogram) offers increased detection rate for labral tears1. Ultrasound may be of benefit to assess for traumatic ventral abdominal or inguinal hernia.

Spine Pathology

In the spine, straightening, and particularly reversal, of the normal cervical and lumbar lordotic (posterior concave arching as seen on sagittal/lateral view) curvatures, can be associated with muscle spasm and pain in the proper clinical setting. Anterior subluxation (anterolisthesis) and posterior subluxation (retrolisthesis) of a vertebral body compared to the one below may indicate underlying ligamentous injury, particularly in younger patients. Translation (movement) of one vertebral body on another as seen on sagittal (lateral or side view) imaging during flexion and extension x-ray/MRI or dynamic flexion/extension video fluoroscopy is a concerning finding. Translation can be indicative of instability with underlying ligamentous injury and has prognostic value in determining disability2. Assessment of ligamentous injury is best seen on sagittal STIR imaging (a dedicated fluid sensitive MRI sequence). Subtle injuries may be better identified on the more advanced 3.0 Tesla magnet (rather than a 1.0 or 1.5 Tesla system).

Intervertebral discs are present in-between the vertebral bodies and best evaluated on MRI. Morphology of disc pathology is important; disc protrusions and extrusions are more likely to be acute than disc osteophyte complexes or broad disc bulges, although acute pathology can be superimposed on preexisting degenerative changes. Size of the disc herniation is also significant secondary to mass effect on nerves and resultant narrowing of neuroforamina or resultant spinal stenosis which should be documented regardless of morphology. Absence of findings such as degenerative disc signal or osteophytes can occasionally aid in assessing acuity. Annular tears/fissures of the intervertebral disc can be associated with trauma or degenerative change; additional descriptions such as size, whether the tear is peripheral, vertically orientated, bright on STIR imaging, or demonstrates a radial component (extends to the center) may assist in determining etiology and prognosis3-4.

Extremity Pathology

Regarding extremities, edema and surrounding fluid at the site of pathology on MRI are helpful findings that may suggest acuity. Unusual injuries in a symptomatic young patient following trauma such as a rotator cuff tear or large SLAP tear (superior labral tear) in the shoulder or a complex meniscal tear in the knee do not typically present a diagnostic dilemma as to traumatic causality. Alternatively, joint space narrowing, subchondral cystic changes and uniform cartilage loss are not acute posttraumatic findings.

Traumatic Brain Injury

Traumatic brain injury often occurs at the grey-white matter junction due to differing densities of the grey (cortical) and white (subcortical) matter. These shearing injuries (diffuse axonal injuries) may be hemorrhagic or non-hemorrhagic. The hemorrhagic injures are best seen on SWI (susceptibility weighted imaging), which is 4-6 times more sensitive than dedicated hemo-sensitive gradient echo images5. Sagittal FLAIR imaging provides added sensitivity for the non-hemorrhagic lesions. Cerebral contusions, subdural hematomas and characteristic ‘coup contrecoup’ patterns are assessed utilizing standard brain sequences.

Diffuse Tensor Imaging (DTI) measures water diffusion along the white matter axons (which can be thought of as “telephone lines” of the brain). Decreased DTI values following head trauma is well documented in the literature and correlates with clinical outcome6. NeuroQuant hippocampal volumetric software analysis adds objective quantification in assessing the

hippocampal volume loss associated with head trauma7.

In addition, advanced trauma brain protocol may include functional (fMRI)8, perfusion imaging9 performed with contrast or using arterial spin labeling (ASL), and MR spectroscopy10.

Of course, any imaging findings, regardless of modality, should be assessed in the proper clinical context and absence of supporting imaging findings does not exclude injury. Clinical corroboration is always advised.

Dr. Snyder is a 2009 Touro University of Nevada Osteopathic Medical School graduate and a current assistant adjunct professor of Radiology and Neuroradiology at Touro. He completed his Radiology residency at McLaren Macomb (Michigan State) in Michigan and his Neuroradiology fellowship at the University of Miami and returned to Las Vegas to practice at SimonMed Imaging in Las Vegas. He has special interest in teaching rotating medical students, lecturing, and research on advanced imaging techniques for traumatic brain injury and carbon monoxide poisoning.


1. 3-T MRI of the Shoulder: Is Arthrography Necessary? Magee, T. AJR Jan 2009 Volume 192, Issue 1

2. Guides to the Evaluation of Permanent Impairment, Sixth Edition 6. American Medical Association.

3. Annular Tears and Disc Degeneration in the Lumbar Spine. A post-mortem study of 135 discs Osti OL, Vernon-Roberts B et al. J Bone Joint Surg Br. 1992 Sep;74(5):678-82

. 4. Do Presence and Location of Annular Tear Influence Clinical outcome after Lumbar total Disc Arthroplasty? A prospective 1-year follow-up study James J. Yue, et al Int J Spine Surg. 2012; 6: 13–17.

5. Hemorrhagic Shearing Lesions in Children and Adolescents with Posttraumatic Diffuse Axonal Injury: Improved Detection and Initial Results. Tong et al. Radiology 2003; 227:332–339.

6. A Decade of DTI in Traumatic Brain Injury: 10 Years and 100 Articles Later M.B. Hulkower, et al. American Journal of Neuroradiology November 2013, 34 (11) 2064-2074.

7. Man Versus Machine Part 2: Comparison of Radiologists’ Interpretations and NeuroQuant Measures of Brain Asymmetry and Progressive Atrophy in Patients With Traumatic Brain Injury. Ros DE, et al J Neuropsychiatry Clin Neurosci. 2015;27(2):147-52. doi: 10.1176/appi. neuropsych.13040088.

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