Case Study: Pedestrian Struck by Vehicle — Multiple Fractures and 14-Month Recovery

James Wong — Founder & Pharmacist, LienScripts | August 20, 2025 | 6 min read

A 55-year-old woman struck in a marked crosswalk in San Diego sustained an open femur fracture, pelvic fracture, three rib fractures, and a mild TBI requiring two surgeries. Her 14-month pharmacy record — spanning acute surgical pain management through PTSD treatment — told the full story of what the accident had taken from her.

Case Study: Pedestrian Struck by Vehicle — Multiple Fractures and 14-Month Recovery

Details have been modified to protect patient privacy. This is a composite account based on real scenarios encountered in our practice.

Pedestrian-versus-vehicle accidents are among the most catastrophic in personal injury law. The physics are unambiguous: a person on foot, struck by a vehicle traveling at even moderate speed, has no protection. The injuries that result — multiple fractures, traumatic brain injury, internal damage — are often life-altering, and the recovery is measured not in weeks but in many months. Documenting that recovery completely, from the day of the accident through the last physician encounter, is essential to presenting the full scope of damages.

This case involved a 14-month pharmacy record that documented exactly that.

[!KEY] Linda, 55, was struck in a crosswalk sustaining an open femur fracture, pelvic fracture, rib fractures, and a TBI — her 14-month pharmacy record spanned acute opioid management through PTSD treatment, documenting a multi-chapter injury that settled favorably after the insurer could not dispute the sustained medication burden.

Patient Background

Linda was 55 years old, a retired school administrator who had taken up part-time work as a bookkeeper for a small nonprofit. She was crossing in a marked crosswalk with the pedestrian signal in San Diego when a vehicle ran the red light and struck her at estimated highway on-ramp speed. The driver's distraction was documented by a traffic camera.

Linda's injuries were extensive:

• Open femur fracture (left) — the femoral shaft fractured with bone breaking through the skin, creating an immediate risk of life-threatening hemorrhage and infection
• Pelvic fracture — a fracture of the acetabulum (the hip socket) requiring stabilization
• Three rib fractures (left, ribs 4, 5, and 6) — causing significant pain and respiratory compromise
• Mild traumatic brain injury — Glasgow Coma Scale of 14 at the scene, with subsequent headaches, cognitive difficulty, and emotional lability consistent with mild TBI

She was transported by ambulance to a Level I trauma center. She required two surgeries: open reduction internal fixation (ORIF) of the femur and pelvic stabilization.

Her health insurance had covered the initial hospitalization, but following her discharge, the insurer notified her that her post-acute outpatient medical benefits had been exhausted — she had reached an annual policy limit she had not known existed. She had no supplemental coverage and limited savings.

Phase 1: Acute Surgical Pain Management (Months 1–3)

Linda's post-surgical medication regimen reflected the severity and complexity of her injuries. Multiple fractures, two surgical sites, and a concurrent TBI created a pain management challenge that required a staged, multi-agent approach.

Opioid analgesics — tapering sequence:

• Morphine IR — used for the first four weeks post-operatively, when pain was at its most severe
• Hydrocodone/acetaminophen — transitioned from morphine as acute post-surgical pain began to subside, easier to manage on an outpatient basis
• Tramadol — introduced in month three as the hydrocodone was tapered, bridging between stronger opioids and eventual non-opioid management

This tapering sequence — morphine to hydrocodone to tramadol — was clinically deliberate and documented in the pharmacy record with exact dates of transition. It told the story of a patient whose pain was severe enough to require morphine for a month, then persistent enough to require a stepped approach over three months before reaching a lower-risk maintenance phase.

Musculoskeletal agents:

• Baclofen — for spasm during femur healing, particularly in the weeks before the surgical hardware had fully stabilized the fracture site
• Naproxen and cyclobenzaprine — used during physical therapy flares as rehabilitation progressed and the musculoskeletal system was stressed by the demands of recovery

Phase 2: Nerve and Head Injury Medications (Months 2–6)

Linda's TBI and the nerve involvement from the femur fracture created a secondary layer of symptoms that required their own medications.

Nerve pain:

• Gabapentin — introduced in week six when neuropathic pain from the femur fracture became apparent, distinct from the surgical site pain

TBI sequelae:

• Topiramate — prescribed by her neurologist for post-traumatic headaches, which had evolved into a pattern consistent with post-traumatic migraine by month two

Sleep:

• Trazodone — for sleep disruption, which was severe in the early months due to a combination of pain, TBI-related sleep architecture disruption, and the anxiety of her situation

[!KEY] A morphine-to-hydrocodone-to-tramadol tapering sequence spanning three months is not a liability — it is documented clinical evidence of severe initial pain progressively managed and reduced, and it directly counters any defense argument that opioid use was inappropriate or excessive.

Phase 3: Psychological Medications (Months 3–14)

The psychological impact of Linda's accident was documented and treated. She had been struck while crossing legally, in a crosswalk with the signal, by a distracted driver who had not slowed at all. The accident was sudden and violent, and she had been fully conscious throughout.

Her treating psychiatrist diagnosed PTSD and major depressive disorder at her three-month evaluation. Both were directly attributable to the accident.

• Sertraline — first-line pharmacotherapy for PTSD and depression, maintained throughout the litigation period
• Trazodone (maintained) — continued for sleep as the TBI-related sleep disruption evolved into PTSD-related insomnia

The psychiatric medications were prescribed continuously from month three through the end of the case — 11 months of documented ongoing psychological treatment.

The Insurance Gap and the Pharmacy Lien

When Linda's health insurer notified her that she had hit her annual out-of-pocket limit, her situation was potentially serious. She was three weeks post-discharge, still in the acute phase of recovery, still requiring morphine for pain control. Losing access to her medications at that point would have had immediate clinical consequences.

Her attorney enrolled her in a LienScripts pharmacy lien within 48 hours of the insurance notification. From that point forward, every medication prescribed for her injury — across all three phases of her recovery — was covered at zero upfront cost through the lien.

The enrollment included all active prescriptions and was extended to cover new prescriptions as they were added — the psychiatric medications when they were initiated in month three, the topiramate for post-traumatic headaches, and the physical therapy support medications as rehabilitation progressed.

The 14-Month Pharmacy Record

The case against the at-fault driver's insurer proceeded over 14 months. During that period, Linda's pharmacy record accumulated a precise, timestamped documentation of her complete recovery arc.

For Linda's attorney, the pharmacy record served multiple functions:

Documenting the opioid tapering sequence. The morphine-to-hydrocodone-to-tramadol progression was not a liability — it was a documented clinical story of severe pain managed responsibly and progressively reduced over three months. Defense counsel could not argue that the pain medications were excessive when the record showed a deliberate de-escalation strategy.

Establishing the TBI as more than minor. Post-traumatic headaches severe enough to warrant topiramate, combined with PTSD, sertraline, and trazodone — all prescribed by treating specialists and documented continuously — supported the argument that Linda's mild TBI classification at the scene understated the sustained neurological consequences.

Quantifying the psychological injury. Eleven months of continuous sertraline and trazodone, prescribed by a treating psychiatrist who documented the PTSD diagnosis as causally linked to the accident, provided documentary support for psychological damages that went beyond the accident itself and reflected a sustained and medically treated injury.

Showing the sustained duration. A 14-month medication record spanning from acute surgical pain management to ongoing PTSD treatment showed, month by month, that Linda's injuries had not resolved — that she was still in active treatment from the day the driver ran the red light through the day the case settled.

"A pharmacy record that spans acute surgery, nerve injury, TBI, and PTSD tells a multi-chapter story of injury that no single medical record can replicate — the breadth of medications documents the breadth of injury."

Outcome

The case settled favorably with the driver's insurer. Linda's attorney cited the pharmacy record as among the most useful evidentiary tools in the case — both for establishing the intensity of the acute injury and for documenting the sustained and multi-domain nature of her recovery.

The pharmacy lien was resolved at settlement. Linda continued sertraline and topiramate through her treating providers after the case closed.

Key Takeaways for Attorneys

1. Policy limits can cut off access mid-recovery — enroll immediately when this happens. Annual benefit limits and lifetime maximums are real and often unknown to clients. When a health insurer notifies your client that benefits are exhausted, a pharmacy lien can provide seamless continuation of care the same day.

[!TIP] When a health insurer sends an annual benefit exhaustion notice mid-treatment, enroll your client in a pharmacy lien the same day — a gap at that stage, when they may still be on post-surgical pain medications, causes both clinical and evidentiary harm.

2. Opioid tapering sequences are evidence, not liability. A documented transition from morphine to hydrocodone to tramadol is a responsible pain management strategy that reflects injury severity. Present it as such — as clinical documentation of severe initial pain progressively managed over a three-month period.

[!KEY] Eleven months of continuous sertraline and trazodone prescribed by a treating psychiatrist for documented PTSD provides economic damage support that goes far beyond the accident itself — psychological injury documented by prescription is harder to minimize than psychological injury documented only by narrative alone.

3. Multi-domain medication records are among the most powerful damages documents. A pharmacy record that spans acute surgery, nerve injury, TBI, and PTSD tells a multi-chapter story of injury that no single medical record can replicate. The breadth of medications documents the breadth of injury.

Key Takeaways for Patients

1. Annual insurance limits can hit at the worst time. Many patients are unaware of annual benefit caps in their policies until they receive an exhaustion notice mid-treatment. If this happens, ask your attorney about a pharmacy lien immediately — do not allow a gap in your medication access.

2. Your PTSD is part of your injury. A traumatic accident can cause lasting psychological injury. If you are experiencing anxiety, depression, sleep disruption, or intrusive memories in the weeks or months following an accident, tell your doctor. A diagnosis and treatment plan creates a documented record that supports your damages claim.

3. The full recovery arc matters, not just the acute injury. Your most severe moments may be in the first days after the accident, but the damages calculation should reflect the full duration of your recovery — including the months of physical therapy, the ongoing nerve pain medication, and the continued psychiatric treatment. Your pharmacy record documents every chapter.

Related Resources

• Pedestrian Accident Medications and Pharmacy Liens
• Morphine ER for Severe Post-Surgical Pain
• Topiramate for Post-Traumatic Headaches
• Sertraline After a Traumatic Accident
• For Attorneys: How LienScripts Works
• Pharmacy Services for Personal Injury Clients: How It Works