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On November 23, 2013 Kelly Douglass suffered severe electrical shock injuries while cleaning electrical switch gear at the Hitachi plant in San Jose. Kelly was working for Applied Power Systems under a contract issued by CH2M Hill Engineers, which was responsible for the maintenance and operations at the Hitachi facility.

CH2M Hill’s Robert Merlot reported to Kelly’s foreman that the switch gear was “cold” and safe to clean. Merlot was later fired for failing to follow detailed procedures to assure that 12,000-volt electrical equipment was de-energized and grounded before cabinets were opened for cleaning.

The burn wounds and scars to Kelly’s hands and head healed well, but the neuropsychological damage left him unable to work. In the lawsuit filed in Santa Clara County Superior Court CH2M Hill attempted to avoid liability for Kelly’s psychological injuries.

Facing the medical evidence that we amassed for Kelly’s trial, CH2M Hill eventually conceded that Kelly had suffered lifetime electrical shock injuries.

Electrocution injuries [EI] are common in the US and are associated with significant morbidity and mortality. Approximately 5000 injuries were associated with electricity in a twelve-year period as reported by NIOSH in 1998 in the national Traumatic Occupational Fatalities surveillance system Program. Three percent of these injuries resulted in death. (NIOSH 1998)

It has been reported that, when comparing outcomes between low-voltage (<1000 V) and high-voltage injuries (>1000 V), high-voltage injuries lead to a greater degree of morbidity and mortality; however, many studies do not analyze the complications of low- vs high-voltage injuries (Shih et al, 2017). Canadian researchers at the University of Montreal, however, have reported that electrical shocks between 120 to 52,000 volts can cause neurological and neuropsychological symptoms (Bailey et al, 2008).

In high-voltage injuries, many of the same psychological/neuropsychological sequelae are noted. A review of records from patients with electrical and lightning (ELI) injuries, 12 were noted to have experienced high-voltage and 2 suffered from lightning strikes. Thirteen underwent neuropsychological testing, and it was found that 92% (12 of 13) showed cognitive impairments (e.g., memory, attention, anxiety, depression, irritability, poor tolerance for frustration). Furthermore, 62% (5 of 12) suffered from multiple physically aggressive outburst, noted as not being present before their electrical injury (Janus and Barrash 1996).

Recently, a paper by Andrews and Reisner (2017) examined the neurological and neuropsychological consequences of electrical and lightning injuries (ELI). Their review of the literature noted in a 2006 study that 71% of those suffering from ELI had documented problems with memory, 63% had problems with concentration, and 50% had loss of mental powers. They also note that depression, anxiety, irritability, fatigue, and PTSD are common complaints of suffers from ELI.

In trying to understand the causation of these neuropsychiatric outcomes, Andrews and Reisner quote Pliskin and colleagues, “We hypothesize that neuropsychiatric changes in EI [electrical injury] relate to electrochemical alterations in brain systems” (Pliskin et al, 2006). Andrews and Reisner concluded that “A theory of causation of ELI has been advanced, and this theory suggests that circulating neurohormones explain enigmas like the delay in the onset of symptoms, and the appearance of symptoms attributable to body systems distant from the passage of electric current” (Andrew and Reisner, 2017)

It is known that hands and head are the most common sites of electrocution injury as reported by many sources. (Duff and McCaffery 2001) Blood and nerve tissues have low resistance to electrical current and travel through these tissues is common making them most susceptible to injury. Cell membrane and vascular endothelial breakdown are common causes of cell damage found in electrocution injury.

Brain imaging studies including MRI and CT scan have revealed brain atrophy and cerebral edema in various parts of the cerebral cortex including the cerebellum following EI. Brain pathological assessment also has revealed hemorrhage and demyelination in white matter. (Grube 1990) This author also reported behavioral changes in patients subjected to electrocution injuries and noted a patient with violent behavior and others with increased anxiety, stress and reported their similarity to patients with post traumatic stress and mild traumatic head injury. Some also presented with limb pain and the authors reported their similarity to those with causalgia. Many of these patients had their complaints resolve but many authors have reported that both peripheral and central nervous system and neuropsychological problems did not improve. (Grube 1990 and Duff and McCaffery 2005)

Delayed neurological symptoms are noted to be one of four types of neurological problem associated with electrocution injury. (Cherington 2005) These include I, temporary and benign; II, prolonged and permanent, including neurobehavioral complaints; III delayed and progressive neurological consequences and IV, secondary associated traumatic complaints, for example, from falls. Delayed and progressive consequences of EI may present days or weeks, months or years after the incident injury. (Chauhan 2015).

These peer reviewed papers, in combination with Kelly’s medical records and neurological examination, as well as the MRI of the brain, were remarkably consistent with the literature on EI. As a result, facing trial CH2M Hill finally agreed the electrocution injury of November 23, 2013 was responsible for Kelly’s emotional lability and depression, anxiety, insomnia, chronic left upper and lower extremity limb pain, neck and back pain and the cognitive electrocution aftermath confirmed by a neuropsychological testing.