August 2012 Granuflo Recall News

The manufacturer of GranuFlo, Fresenius Medical Care North America, treats about one-third of all Americans receiving dialysis.  It also supplies dialysis products and machines to many clinics in addition to their own.  Incorrect prescription of this product has the potential for high serum bicarbonate levels in patients undergoing hemodialysis.  This could lead to metabolic alkalosis, a risk associated with low blood pressure, hypoxemia, hypercapnia, hypokalemia and cardiac arrhythmia.  If these issues are not treated promptly and appropriately, cardiopulmonary arrest, or even death, could result.

Serum Bicarbonate: A measure of the bicarbonate level in the blood based on a venipuncture specimen. The serum carbon dioxide is one of the normally reported values in the electrolytes profile. Lower levels of carbon dioxide indicate an acidosis. The normal level is 20 to 29 mEq/L. Lower than normal levels can indicate diabetic ketoacidosis, lactic acidosis, alcoholic ketoacidosis, kidney disease, renal failure, diarrhoea, Addison's disease, ethylene glycol poisoning or methanol poisoning.

Read more: http://wiki.answers.com/Q/What_is_the_normal_serum_bicarbonate_level#ixzz24rJ3xPwP 

What is metabloic alkalosis? 

Metabolic alkalosis is a metabolic condition in which the pH of tissue is elevated beyond the normal range which is considered  7.35-7.45.

On November 4, 2011, an internal memo from Fresenius Medical Care was sent out to their Medical Directors and Attending Physicians regarding data suggesting GranuFlo could be associated with elevated bicarbonate levels along with an increased risk of cardiopulmonary arrest and sudden cardiac death.  

At the time of this internal memo, these results were only sent to company-owned dialysis treatment centers, not other clinics that operate independently.   In March 2012, Fresenius then communicated the warnings to dialysis clinics not owned or operated by the company.  Because of the information listed above, along with the GranuFlo Recall, dialysis centers are now checking bicarbonate levels and adjusting doses if found necessary.

We are investigating any link between this recall and any possible injuries, call us 404 451 7781. 

Sanofi recalls 9 lots of Genzyme transplant drug

Genzyme is pulling 9 lots of its kidney transplant drug Thymoglobulin after one lot failed a stability test



Read more: Sanofi recalls 9 lots of Genzyme transplant drug - FiercePharma http://www.fiercepharma.com/story/sanofi-recalls-9-lots-genzyme-transplant-drug/2012-08-28#ixzz24rHZRz55  Subscribe: http://www.fiercepharma.com/signup?sourceform=Viral-Tynt-FiercePharma-FiercePharma

China tells the FDA to Get Lost

The FDA is grossly underfunded and without adequate resources to keep Americans safe. I've written about it many times, and a recent report highlights how the global economy has impacted people and pets eat. China refused to allow tests to be independently conducted.

Chinese government officials overseeing plants that make chicken jerky pet treats blamed for thousands of illnesses and deaths among American dogs have refused to allow U.S. inspectors to collect samples for independent analysis, newly released records show.

Investigators with the federal Food and Drug Administration came away empty-handed after conducting April inspections at four jerky treat manufacturing sites in Liaocheng and Jinan, China, according to the records.

The plants make pet treats sold by the St. Louis-based Nestle Purina PetCare Co., including the popular Waggin’ Train jerky brands.Chinese officials stipulated that FDA officials could collect samples only if they agreed to specific conditions, including a requirement that the samples be tested in Chinese-run laboratories.

As a result, “no samples were collected during this inspection,” wrote Dennis L. Doupnik, an FDA investigator who visited the sites.

FDA Investigates Codeine Safety After Children’s Deaths

An article worth reading when it comes to prescribing any medication with codeine to kids after surgery. 

The U.S. Food and Drug Administration announced Wednesday that it was investigating the safety of codeine for post-operative pain relief in children  following reports of three deaths and one life-threatening emergency related to its use after tonsil surgery.

The children were between the ages of 2 and 5. All had received standard doses of codeine, but doctors believe each had a genetic trait that caused them to develop toxic levels of drug in their bodies.

More at the link: http://abcnews.go.com/blogs/health/2012/08/15/fda-investigates-codeine-safety-after-childrens-deaths/

FDA Issues Warning about Tattoos

The U.S. Food and Drug Administration is warnings hospital and physician providers to be  on the alert for hard-to-treat raised skin rashes resulting from contaminated tattoo inks after a nineteen person outbreak in New York.

News the outbreak was published in the  New England Journal of Medicine. Public health officials in Rochester, New York reported the problem first. Officials found that nearly twenty people who went to a tattoo parlor were infected with Mycobacterium chelonae infections after receiving tattoos from a single shop in that city last fall. Mycobacterium chelonae is a species of the phylum actinobacteria (Gram-positive bacteria with high guanine and cytosine content, one of the dominant phyla of all bacteria), belonging to the genus mycobacterium. Mycobacterium chelonae is a rapidly growing mycobacterium, that is found all throughout the environment including sewage and tap water. It can occasionally cause opportunistic infections of humans.

Public health officials were alerted to the problem by a local dermatologist who said one of his patients had first sought care for the rash on his arm through another physician, who treated him unsuccessfully with a corticosteroid, and then referred him. The dermatologist did a skin biopsy to determine the infection.

http://www.healthleadersmedia.com/content/QUA-283689/Infections-From-Tattoos-Spark-FDA-Warnings

FDA asks that DePuy Orthopedics Recall Unused Custom Implants,

Following an FDA request,  DePuy Orthopaedics launched a recall of all unused units of its customer orthopedic implants, a product line the company shut down in January.

DePuy in January announced it would discontinue its custom orthopedics division after in response to an FDA warning following an inspection of the Warsaw, Ind.-based company's facilities.

Here is the link to the source:  https://www.massdevice.com/news/fda-asks-jjs-depuy-recall-unused-custom-implants

In the News: Blood-thinner Pradaxa target of mass-claims suit

Interesting read from USA Today. From time to time you will find a story that suggests - with insider type terms - what the 'next big mass tort' will be. It's actually offensive to me when I read lawyers and internet marketers serving as  nothing more than horsetrack touts about a product that may or may not hurt people.

In the USA Today article, the reporter notes that lawsuits involving Pradaxa are part of a "high-dollar stream of product liability lawsuits, a burgeoning world of mass claims in which specialty law firms cast a wide net for injured consumers who represent the pitfalls of marketing risky products."

Our law firm gets calls from people who believe that a product may be to blame for any number of maladies. On this site for nearly six years we have typically posted articles, news, information on recalls, and links to news on pharmaceutical products. I like to think that for the most part it's just reference to news, without a flat out pitch for cases.

So take a read of the USA Today article and tell me what you think (ageorgialawyer(at)yahoo.com):

   pearheading the Pradaxa litigation is the San Antonio-based law firm of attorney Mikal Watts, a prominent product liability attorney and deep-pocketed Democratic fundraiser.

Watts, who recently hosted President Barack Obama at his home for a private fundraiser, filed tens of thousands of claims for redress after a $20 billion fund was set up to handle claims from the 2010 Gulf oil spill. He was responsible for an $800 million settlement after winning a case against Ford and Firestone alleging defective tires and vehicle parts, one of the country's largest product liability payouts.

Pradaxa, Watts wagers, could be the country's next blockbuster civil settlement.

Emily Baier, a spokeswoman for Pradaxa's company, Boehringer Ingelheim, declined to comment on the lawsuit, though she said safety is the company's chief priority.

The drug has been under attack by physicians groups and patient advocates since 3,781 adverse effects and 542 deaths associated with Pradaxa were reported last year to the Food and Drug Administration. Its adverse reports and deaths surpassed all other monitored drugs. The FDA is now conducting a safety review of the drug, which millions of people around the country take twice a day.

Yet some legal observers say the case exposes the seams of mass litigation: Clients like Jackson are treated as no more than a claim number. And the fairest outcome for Jackson and numerous others, experts say, will not result from a collective suit in which cherry-picked examples stand-in for hundreds of individual stories.

"It's going to be one of the larger mass torts in the history of the United States," said Ryan L. Thompson, attorney with Watts Guerra Craft, who is working on scores of cases including Jackson's, with a team of 70 employees dedicated to the Pradaxa suit.

   http://www.usatoday.com/news/health/story/2012-08-19/pradaxa-blood-thinner-lawsuit/57134628/1?csp=34news 

Mirena IUD Injury Lawsuits

According to the FDA, Mirena has been associated with a number of serious side effects, including:    •  Perforation of the uterine wall or cervix    •  Embedment of the device in the uterine wall    •  Ectopic pregnancy    •  Intrauterine pregnancy (a pregnancy with Mirena in place)    •  Group A streptococcal sepsis    •  Pelvic inflammatory disease

Lawsuits were filed in NJ. All of the lawsuits allege the Mirena IUD caused users to suffer severe and permanent physical injuries and substantial pain and suffering. The complaints further allege that Bayer and other Defendants have a history of overstating the benefits of the Mirena IUD, and understating its potential complications

Child Safety Seat News

This is a disheartening post from Time, but it highlights what I see everyday on the roads in GA.   

Car crashes are one of the main causes of death and injury in children age 3 and older. The problem is that moms, dads, aunts, uncles and grandparents don’t use car seats properly, or have little to no idea about don’t know what the guidelines are for car safety restraints, says a study that was published in the  American Journal of Preventive Medicine.

In 2011, the American Academy of Pediatrics (AAP) updated its child passenger safety guidelines that include:  

• Rear-facing car seats for kids until at least age 2, or when the child exceeds the maximum height and weight recommended by the car seat manufacturer
• Forward-facing car seats with a five-point harness for kids over 2, until the child reaches the seat’s maximum weight and height
• Booster seats until an adult seat belt fits properly, typically when the child reaches 57 inches in height (4 ft., 9 in.), between 8 and 12 years of age
• Back seat riding with seat belt until age 13

Read more: http://healthland.time.com/2012/08/08/many-parents-still-cant-get-car-seat-safety-right/#ixzz24HrnKGfy

August 2012 Pradaxa News

News from a recent study regarding Pradaxa:  

Patients taking the new anti-clotting drug Pradaxa have a 33% higher risk of heart attack or severe symptoms ofheart disease than do patients taking warfarin.

The finding, from Cleveland Clinic researchers Ken Uchino, MD, and Adrian V. Hernandez, MD, PhD, is based on data from seven clinical trials that enrolled 30,514 patients.

"The risk of [heart attack] or acute coronary syndrome is increased with [Pradaxa] compared with various control treatments, which include adjusted-dose warfarin, [Lovenox], or placebo," Uchino and Hernandez conclude.

Acute coronary syndrome -- acute symptoms of seriousheart disease -- is usually caused by the rupture of a plaque in a heart artery.

http://www.cbsnews.com/8301-500368_162-57356568/study-higher-heart-attack-risk-from-pradaxa/

Here is an abstract from the JAMA Archives of Internal Medicine: 

Background  The original RE-LY (Randomized Evaluation of Long-term Anticoagulant Therapy) trial suggested a small increased risk of myocardial infarction (MI) with the use of dabigatran etexilate vs warfarin in patients with atrial fibrillation. We systematically evaluated the risk of MI or acute coronary syndrome (ACS) with the use of dabigatran.

Methods  We searched PubMed, Scopus, and the Web of Science for randomized controlled trials of dabigatran that reported on MI or ACS as secondary outcomes. The fixed-effects Mantel-Haenszel (M-H) test was used to evaluate the effect of dabigatran on MI or ACS. We expressed the associations as odds ratios (ORs) and their 95% CIs.

Results  Seven trials were selected (N = 30 514), including 2 studies of stroke prophylaxis in atrial fibrillation, 1 in acute venous thromboembolism, 1 in ACS, and 3 of short-term prophylaxis of deep venous thrombosis. Control arms included warfarin, enoxaparin, or placebo administration. Dabigatran was significantly associated with a higher risk of MI or ACS than that seen with agents used in the control group (dabigatran, 237 of 20 000 [1.19%] vs control, 83 of 10 514 [0.79%]; OR_M-H, 1.33; 95% CI, 1.03-1.71; P = .03). The risk of MI or ACS was similar when using revised RE-LY trial results (OR_M-H, 1.27; 95% CI, 1.00-1.61; P = .05) or after exclusion of short-term trials (OR_M-H, 1.33; 95% CI, 1.03-1.72; P = .03). Risks were not heterogeneous for all analyses (I² = 0%; P ≥ .30) and were consistent using different methods and measures of association.

Conclusions  Dabigatran is associated with an increased risk of MI or ACS in a broad spectrum of patients when tested against different controls. Clinicians should consider the potential of these serious harmful cardiovascular effects with use of dabigatran.

DePuy Hip Replacement Deadline Approaching (August, 2012)

Many patients receiving the DePuy metal-on-metal hip replacements have serious and life-threatening complications. There is an allegedly high failure rate in these implants.  Projections are as high as approximately 80% failure at just 8 years after surgery. The complications of a metal-on-metal hip replacement can be extremely severe.  Problems after surgery range from pain, swelling, limited mobility, trouble walking, and dislocation, to a very serious disease called metallosis.  The grinding that occurs between parts of the hip replacement can release metal debris into the body and bloodstream, allegedly causing the blood levels of chromium and cobalt to become dangerously high.  This metal poisoning in the blood may cause cardiovascular, neurological, thyroid and renal issues in the body as well as destroying muscle, tissue, and bone.  There have  been thousands of lawsuits filed concerning the DePuy metal-on-metal hip implant.

DePuy, a Johnson & Johnson company, issued a recall on these products in August of 2010.  Due to  Georgia's  2 year statute of limitations law, clients may no longer be able to file lawsuits against DePuy metal-on-metal hip replacements after August 23, 2012.  A statute of limitations deadline is intended to put a specific length of time on certain lawsuits, so that future filings cannot be extended indefinitely.

If you or a loved one has been adversely affected by a DePuy metal-on-metal hip replacement, you should act quickly to protect your legal rights and avoid the upcoming deadline. We believe every patient should be entitled to proper care and certainly proper medical device implants.  If you fail to file a lawsuit by the August 23 deadline, your claim could be lost forever.

404-451-7781

Granuflo Recall News for August

According to the FDA, Class I recalls are the most serious type of recall and involve situations in which there is a reasonable probability that use of a product will cause serious adverse health consequences or death.

GranuFlo and NaturaLyte are alkaline substance administered to dialysis patients to neutralize the acid that builds up in the blood. The products are administered in conjunction with bicarbonate, and contain acetate, an ingredient that the body converts to bicarbonate. However, GranuFlo and NaturaLyte contain far more acetate than rival products, and thus result in more bicarbonate in the body.

What are GranuFlo and NaturaLyte?

GranuFlo® is the most-widely prescribed dry acid product used in dialysis treatment.  Clinics that use GranuFlo are required to mix their own concentrations of the solution.  NaturaLyte, also known as NaturaLyte Liquid Acid Concentrate, is a pre-mixed liquid solution. 

Who manufactures GranuFlo and NaturaLyte? 

Both products are manufactured and sold by the German company, Fresenius Medical Care (FMC). 

What injuries are caused by GranuFlo and NaturaLyte?

In a memo published by the products’ manufacturer, Fresenius Medical Care, it was noted that 941 patients had suffered cardiac arrest in 667 FMC facilities in 2010 alone.   (This does not include the number of patients that may have been injured or died in clinics not owned or operated by FMC.)

Talk to us if you are concerned that you or a loved one were hurt.   

Motion in Limine We Use

(From last year) 

I file a Motion in Limine on general issues early so that I can set the tone for depositions and other discovery issues that crop up during a case. Almost always, I file an extensive MIL within sixty days of service of an Answer. The MIL is lengthy, but I have won every single point, or had defense counsel agree to them in advance.

FIRST MOTION IN LIMINE

Plaintiff files this Motion in Limine and moves this Court for an Order prohibiting counsel for the Defense from making any comment, directly or indirectly, in any manner whatsoever, concerning any of the matters set forth:

1.APPROACH THE BENCH: Plaintiff requests that Defense counsel first approach the Bench and obtain a ruling of the Court outside the presence and hearing of all prospective jurors, or jurors ultimately selected in this case, in regard to any alleged theory of such matters contained herein, at trial and mentioned to jury at Voir Dire.

2. INFORM WITNESSES: Plaintiff moves the Court for an Order directing counsel to inform any and all defense witnesses of the Court order regarding these matters, and to instruct any and all such witnesses to refrain from mentioning any such matters in the presence and hearing of all prospective jurors or jurors ultimately selected in this case until defense counsel has obtained a ruling in compliance with this order that such matters would be admissible as evidence in this case.

3.COLLATERAL SOURCE PAYMENTS/BENEFITS: Any reference or suggestion that Plaintiff has received, has been entitled to receive, will receive, or will become entitled to receive, benefits of any kind or character from a collateral source, including, but not limited to, the following: (A) Benefits from collateral insurance coverage; (B) Services furnished without charge; (C) Compensation for time not actually worked; (D) Social Security or pensions; (E) Workers' compensation benefits; (F) Medicaid or Medicare. See Denton v. Conway Express, Inc., 261 Ga. 41 (1991); Georgia Power Co. v. Flagan, 261 Ga. 41 (1991); Bennett v. Haley, 132 Ga. App. 512, 525 (1974). See also Warren v. Ballard, 266 Ga. 408 (2), 467 S.E.2d 891 (1996); Worthy v. Kendall, 222 Ga. App. 324, 474 S.E.2d 627 (1996).

4.OTHER COMPENSATION. That the plaintiff, by reason of age, infirmity, or otherwise, is now or may be entitled in the future to receive any compensation or benefits by reason of the Social Security Law of the United States or from any governmental agency such as the veterans' Administration, Medicare, or sources of this nature.

5. ATTACKS ON PLAINTIFF'S TRIAL COUNSEL BY DEFENSE ATTORNEYS. Any reference or suggestion as a personal attack and uncivil comments about plaintiff's trial counsel by the defendant or their attorneys. Personal attacks on adversarial counsel has no place with the truth-seeking context of litigation.

6. ADVERTISEMENT BY PLAINTIFF'S ATTORNEY. Any reference or suggestion to the advertisement or the fact that plaintiff's attorney advertises. This includes slogans, jingles, or reference to the yellow pages, television or any media. The issue of how attorneys obtain business should not become an issue in the case. The fact that plaintiff's counsel advertises to obtain clients is no more relevant that the practice by defense attorneys to join exclusive organizations in which to wine and dine insurance adjusters and corporate clients for business, in order to obtain business.

7.FINANCIAL STATUS OF ATTORNEY OR MEDICAL PROVIDER. Any reference or suggestion to the income or financial status of the plaintiff’s attorney or the treating physicians. The issue of the wealth or income of the attorneys or treating physicians should not become an issue in the case. On at least one occasion, defense counsel has argued in other cases that plaintiff's attorneys advertised and stated to jury "how do you think these attorneys and these doctors can afford such expensive advertisement and have nice offices".

8.AMERICAN TORT SYSTEM OR PLAINTIFF'S LAWYERS IN GENERAL. Any reference or suggestion or the introduction of any evidence by the defense counsel directly or indirectly attacking the American Court System or plaintiffs attorneys or recent tort reform campaigns.
Neither the American tort system or plaintiffs attorneys in general are on trial in this case. The trial of this case should not be an opportunity for defense counsel to voice opinion regarding tort reform. The injuries sustained by the plaintiff are a result of the defendant’s negligence and the defense should not be permitted to ignore the issues in this case and attack the tort system in general.

The debate surrounding tort reform is irrelevant to this case and would serve only to inflame and prejudice the jury. These references would poison this case with anti-lawsuit and anti-lawyer bias, which has been highlighted in recent corporate, media campaign and emotional propaganda. The only thing to be gained in allowing defense counsel to discuss these issues would be a concealment of the truth. This subject applies to Trial only and not Voir Dire.

9.UNRELATED CLAIMS. Any reference or suggestion that Plaintiff has had unrelated, prior or subsequent claims, suits or settlements or the amounts thereof. See O.C.G.A. §24-2-1 and §24-2-2; Goforth v. Wigley, 178 Ga. App. 558, 559-60 (1986). Further, no mention should be made concerning any injuries to the defendant(s), that they did not bring a claim or suit for.

10. UNRELATED ACCIDENTS AND INJURIES. Any reference or suggestion that Plaintiff has any other unrelated injuries, diseases, conditions, or illness, or the effects thereof, which are wholly disassociated from and do not relate to or serve as a "sole cause" defense to his/her present claims, and which Defendant cannot medically associate and relate to plaintiff's injuries for which compensatory damages are claimed in this case. See O.C.G.A. §24-2-1 and §24-2-2; Goforth v. Wigley, 1788 Ga. App. 558, 559-60 (1986); United Motor Freight Terminal Company Inc. v. Hixon, 76 Ga. App. 653, 655 (1948); Barnes v. Cornett, 134 Ga. App. 120, 122 (1975). Further, No mention should be made about the plaintiffs having previously filed claims or lawsuits.

11.FINANCIAL CONSEQUENCES OF JUDGMENT AGAINST DEFENDANT. Any reference or suggestion that Defendant is uninsured as to Plaintiff's claims, including, but not limited to, any reference as to Defendant as a little person, or small or struggling, or any other such reference which would tend to convey to the jury the impression that Defendant is a party of modest means who cannot afford to pay a substantial judgment. See O.C.G.A. §24-2-1; Adams v. Camp Harmony Association, 190 Ga. App. 506, 508, (1989); Denton v. Conway Express, Inc., 261 Ga. 41 (1991); Georgia Power Company v. Flagan, 261 Ga. 41 (1991); Northwestern University v. Crisp, 211 Ga. 636, 641 (1955); Brunswick & Western Railroad Co. v. Wiggins, 113 Ga. 842, 850 (1901); Higgins v. The Cherokee Railroad, 73 Ga., 149 (3) (1984); Bennett v. Haley, 132 Ga. App. 512, 525 (1974); See also Georgia State Bar Rules, DR 7-102(A)(3), (4) and (5); DR 7-106(C) (1); Rule 4-102(d) Standard 45 and O.C.G.A. § 9-10-185.

12.PAYMENT OF JUDGMENT. Any indication of any kind that Defendant driver personally will have to pay any judgment that may be entered in this case, especially since Defendant is insured against liability. See O.C.G.A. §24-2-1; Adams v. Camp Harmony Association, 190 Ga. App. 506, 508 (1989); Denton v. Conway Express, Inc., 261 Ga. 41 (1991); Northwestern University v. Crisp, 211 Ga. 636, 641 (1955); Brunswick & Western Railroad Co. v. Wiggins, 113 Ga. 149 (3) (1884); Bennett v. Haley, 132 Ga. App. 512, 525 (1974). See also Georgia State Bar Rules, DR 7-102(A)(3), (4) and (5); DR 7-106(C) (1); Rule 4-102(d) Standard 45 and O.C.G.A. §9-10-185.

13.PLAINTIFF'S USE OF AWARD. Any reference or suggestion as to what Plaintiff will or might do with any award of damages Plaintiff might receive. See O.C.G.A. §24-2-1 and §24-2-2; Gusky v. Candler General Hospital, 192 Ga. App. 521 (3) (1989). See also Hall v. Chicago & Northwestern Railway Co., 125 N.E.2d 77, 86 (Ill.1955); and Law note at 28 ATLA Law Reporter 101 (April 1985).


14.MONEY WILL NOT UNDO DAMAGE. Any reference or suggestion to the effect that "money won't undo the injury and damage the plaintiff may have sustained", because such a suggestion is an improper appeal for jury sympathy toward Defendant. and invites the jury to disregard it's duty to apply the legal measure of damages which the evidence shows have been caused by Defendant's misconduct and instead to base a verdict on improper considerations. See O.C.G.A. §24-2-1; Gielow v. Strickland, 185 Ga. App. 85, 86 (1987) (jury cannot be urged to use some other measure of damages than that prescribed by law); Central of Georgia Railway v. Swindle, 260 Ga. 685, 687 (1990) (trial should not be invaded by improper considerations); Adams v. Camp Harmony Association, 190 Ga. App. 506, 508 (1989) (effect of verdict an improper consideration).

15.DEFENDANT IS “SORRY” OR “APOLOGIZES.” Any reference or suggestion that Defendant is sorry or regrets the occurrence in question, because such a suggestion is an improper appeal for jury sympathy toward Defendant, and invites the jury to disregard it's duty to apply the legal measure of damages by awarding such damages as the evidence shows have been caused by such defendant's misconduct and base a verdict on improper considerations. O.C.G.A. §24-2-1; Adams v. Camp Harmony Association, 190 Ga. App. 506, 508 (1989); Gielow v. Strickland, 185 Ga. App. 85, 86 (1987) (jury cannot be urged to use some other measure of damages than that prescribed by law); Central of Georgia Railway v. Swindle, 260 Ga. 685, 687 (1990) (trial should not be invaded by improper considerations).


16.TAXATION OF RECOVERY. Any reference or suggestion that any recovery by Plaintiff either would or would not be subject to federal or state income tax or any other form of taxation. See O.C.G.A. §24-2-1. Also, that any recovery by Plaintiff would not be subject to federal income taxation or any other form of taxation. Atlantic Coast Line R. Co. v. Brown, 93 GA. App. 805, 807 (1956).

17.EMPLOYMENT OF COUNSEL/FEES. Any reference or suggestion regarding the time or circumstances under which Plaintiff employed any of her attorneys. O.C.G.A. §24-9-21(2). Any reference or suggestion regarding the existence of a contingent fee arrangement between Plaintiff and her counsel. See O.C.G.A. §24-2-1; Stoner v. Eden, 199 Ga. App. 135 (1991).

18.FAILURE TO CALL EQUALLY AVAILABLE WITNESSES. Any reference or suggestion that Plaintiff has not called to testify any witness equally available to both parties in this case. See O.C.G.A. § 24-4-22; Bank of Emmanuel v. Smith, 32 Ga. App. 606 (1924); Bradford v. Parrish, 111 Ga. App. 167 (1965).

19.VOUCHING FOR DEFENSE WITNESSES. Any reference or suggestion as to whether or not Plaintiff or any of Plaintiff's witnesses believe that any of the defense witnesses are honorable or otherwise worthy of belief. O.C.G.A. §24-2-1.

20.PERSONAL BELIEF OF COUNSEL. Any reference or suggestion by defense counsel as to his or her personal belief concerning the credibility of any witnesses, or as to the merits of Plaintiff's claims, injuries, or damages. Manning v. State, 123 Ga. App. 844, 845-6 (6) (1971); Georgia State Bar Rules, DR 7-106 (C) (4); EC 7-24.

21.FUTURE INCOME, ETC. OF PLAINTIFF. Any reference or suggestion as to the future income or employment benefits of Plaintiff.

22.UNDISCLOSED PHOTOGRAPHS. Any reference or suggestion as to the existence or contents of any document, photograph, motion picture film or videotape which has not previously been disclosed in the pretrial order until the same has been tendered to the Court and Plaintiff's counsel, outside the presence of the jury, and shown or exhibited to determine its relevance and suitability for introduction into evidence. See O.C.G.A. §24-2-

23.EFFECT OF CLAIMS ON INSURANCE RATES. Any reference or suggestion regarding the effect or results of a claim, suit of judgment upon insurance rates, premiums, or charges, either generally or as particularly applied to Defendant in this case as a result of this or any other lawsuit or claim. See O.C.G.A. §24-2-1 and §24-2-2.

24.EFFECT OF CLAIMS ON INDUSTRY. Any reference or suggestion that damage awards may drive up the price of products, put manufacturers out of business, or cause jobs to be lost. See O.C.G.A. §24-2-1 and 24-2-2.

25.REQUESTS FOR PLAINTIFF'S FILE MATERIALS. Any demands or requests by defense counsel before the jury for matters found or contained in Plaintiff's or her counsel's files, which would include statements, pleadings, photographs, and other documents directed to the Plaintiff or Plaintiff's counsel during the course of the trial and in the presence of the jury.

26.REQUEST FOR INDEPENDENT OR COMPULSORY MEDICAL EXAMINATION DURING THE COURSE OF TRIAL. During the course of the trial, any demands or requests by Defendant or defense counsel for additional medical examination, physical demonstrations, or other similar requests directed to the Plaintiff or Plaintiff's counsel and in the presence of the jury. See O.C.G.A. § 24-2-1.

27.REQUESTS FOR PHYSICAL DEMONSTRATIONS. Any requests for Plaintiff or any of Plaintiff's witnesses to participate in or assist defense counsel with any physical or other demonstration. See O.C.G.A. §24-2-1.

28.SUPERSEDED PLEADINGS. Any reference or suggestion as to the contents of any pleadings which have been superseded by the current pleadings or the pretrial order on file in this case.

29.EX PARTE STATEMENTS. Any reference or suggestion as to the contents of, or tender of any ex parte statement or report of any person not then and there present in the Court to testify and to be cross-examined by counsel for Plaintiff.

30.TESTIMONY OF UNAVAILABLE WITNESS. Any reference or suggestion as to the probable testimony of a witness available to Defendant who is not called to testify in this case.

31.NOTICE TO DEFENDANT OF SUIT. Any reference or suggestion that no notice of the claim was given to Defendant(s) until the suit was filed in this case, since none is required to be given.

32.SPECIAL EFFORTS REQUIRED BY JURY. Any reference or suggestion that the jury must extend special efforts to be fair and impartial to the defendant.

33.SEAT BELTS. Any reference or suggestion that Plaintiff may not have been wearing a seat belt at the time of the collision made the basis of this suit. O.C.G.A. §40-8-76.2.

34.PRIOR TRAFFIC RECORD. Any reference or suggestion as to any prior moving traffic violations or any prior automobile collisions that Plaintiff may have had in the past. See O.C.G.A. §24-2-1 and 24-2-2; Myers v. Barnard, 180 Ga. App. 192 (1986); Underwood v. Butler, 166 Ga. App 527, 529 (1983). See also Green, Georgia Law of Evidence, 3rd Ed., §§68, 70 and 71 (Harrison Co., 1991 Supp.).

35.CRIMES INVOLVING FIRST OFFENDER STATUS. Any reference or suggestion as to any crimes involving first offender status. O.C.G.A. § 42-8-65(a) obligates the clerk to ensure that such information is disclosed only to those persons authorized to receive it. Witcher v. Pender, 260 Ga. 248 June 8, 1990, held that the first offender record of an adverse witness in a civil case is not admissible for the purpose of impeaching the witness for a crime of moral turpitude. In Georgia, the rule is that a witness may be impeached by proof of a conviction of a crime involving moral turpitude. Hall v. Hall, 261 Ga. 181 (402 S.E. 2d 726)(1991).

The use of the term moral turpitude has been "restricted to the gravest offenses consisting of felonies, infamous crimes and those that are malum in se and disclose a depraved mind", Lewis v. State, 243 Ga. 443, 444 (254 S.E. 2d 830)(1979). Under that definition it is apparent that a misdemeanor conviction for possession of less than an ounce of marijuana, a conviction equivalent to a misdemeanor conviction for DUI. See Hall v. Hall supra, it is not a crime of moral turpitude. It does not suggest an "insensibility to the obligation of an oath". Lewis supra, at 446.