Kids in cars.

Many fatalities and injuries could be avoided if manufacturers directed their attention to appropriate child restraints.

For almost 30 years, concerned parents have tried to protect their children as passengers by restraining them in child car seats or vehicle restraint systems. With the proliferation of state mandatory use laws, restraint use by the general public rose from about 17 percent in the mid-1980s to almost 70 percent in 1996.(1)

Many issues associated with the proper restraint of adults have been addressed. Children, however, are not being protected as well as their adult counterparts. Motor vehicle crashes still remain the leading cause of death and acquired disability in children.(2)

Child car seats have suffered from poor design and construction starting with the early "hook over the seat" models. Difficult installation and poorly worded instructions have plagued parents. Although U.S. car seat manufacturers have made some improvements, child seat inadequacies are well documented.(3) In the short term, recent developments in Federal Motor Vehicle Safety Standard (FMVSS) 213 will cause even more confusion associated with these seats.

Similarly, auto manufacturers have directed little attention to proper child restraints, leaving this important subject to juvenile-product manufacturers. Deadly lap belts still exist in center front and center rear seats, and many children do not fit properly in lap shoulder belts designed to optimize performance for the 50th percentile male.

This article focuses on the inadequacies of child restraints. Lawyers who represent a family whose child has been seriously injured or killed in an auto collision should consider all the possible defects of restraints that pose harm to children.

Car seats

Child car seats suffer from common problems, many of which surface in every child car seat case. To achieve proper protection for a child, the seat must have all its important parts, it must be installed properly, and the child must be harnessed properly in the seat.

The parts necessary for proper seat function and protection of the child are a shoulder harness clip, a locking clip, and a top tether strap. The shoulder harness clip, adjusted at about armpit level or above, ensures that the harness will remain on the child's shoulders while the child is sitting in the seat and during the dynamic phase of a collision. The locking clip is used to secure the seat belt in vehicles where an automatic locking retractor is not in use (pre-1996 model year vehicles). The top tether is not currently supplied with many forward-facing car seats, nor is the vehicle-attaching hardware, but its use helps to reduce excursion and maintain the car seat in place and upright. This substantially reduces the effects of misuse.(4)

Proper installation is complicated by poorly worded and illustrated instructions. Compounding that problem is the fact that there are over 70 models of child seats now on the market, all with different methods of attachment. Incompatibility between the child seat and the vehicle seat and seat belt further frustrate parents' efforts to properly install child seats. Clinics that determine customer awareness of proper child seat installation report 90 percent misuse in installation.(5)

Effective restraint of the child also depends on securely harnessing the child in the car seat. This requires the proper placement of all belts associated with the restraint.

If a child restrained in a child seat has sustained catastrophic injuries or died, the attorney should carefully examine the performance of the seat to determine whether the client has a cause of action against the car seat manufacturer. During the dynamic event, and under reasonable accident conditions, protective parts of the shell should not break, nor should any of its lifesaving parts.

The outer shell should resist deformation, and the inner shell or padding should absorb energy and cushion. The seat should not slide or tip forward or sideways to an unreasonable extent. The harnessing system should not allow for excessive ejection of the child, nor should it play a role in substantially deforming or breaking free from the seat.

Instructions and warnings should be understandable and illustrated. They should fully advise parents of the real consequences of failure and instruct them to follow directions exactly or use the right equipment. Key warnings and instructions and key component parts should be attached to the seat. All parts should be operational for the real life of the car seat.

Restraints for infants. Children 1 year old and younger who weigh 20 pounds or less should be placed in rear-facing infant seats, optimally in the vehicle's center rear seat. Problems arise because the natural inclination is to place a child that age in the front seat or in the back seat facing forward, so that the child's behavior can be monitored. Instructions hospitals give about installing seats sometimes recommend placing the child in the front seat.

Front seat placement in newer vehicles exposes the child to the airbag. Forward-facing placement in the rear seat exposes the child to paralyzing neck injuries.

An effective warning, located where it will be seen, can persuade parents to resist this instinct. Changes to airbag deployment speed or on-off switches would allow parents faced with a maximum passenger load to place an older child in the front seat, freeing the back seat for the infant.

Many infant seats employ a fixed base that remains in the vehicle when the infant seat is removed. Customer complaints to the National Highway Traffic Safety Administration (NHTSA) and crash tests reveal that under crash conditions the seats can come loose from the base and project the child and the seat.(6)

Infants have narrow shoulders that require adherence to proper instructions for placement of the shoulder harness clip. Broken clips, sliding clips, and improper clip placement allow the child to ramp up the seat and become partially or fully ejected. Warnings fail to explain that failure to properly locate the clip means an infant's narrow shoulders will escape the restraint and the child may receive severe head or neck injuries. Shoulder harnesses that require constant readjustment of the clip almost guarantee that improper placement will occur.

Restraints for children ages 1 to 4. Children between 1 and 4 should be restrained in a child seat. Aftermarket products available are convertible child seats and toddler seats.

The convertible seat is used for both the rear-facing infant weighing 20 to 30 pounds and the forward-facing child older than 1 weighing 20 to 40 pounds. The toddler seat is used forward facing only for children in this age group weighing up to 40 pounds.

The convertible seat tries to do too much. Parents, who are generally not warned of the consequence of their action, switch children to forward facing before they are anatomically or behaviorally ready. Because the seat is designed to accommodate a wide range of child sizes, there are multiple shoulder harness slot adjustments and multiple seat adjustments, including angle adjustments of the seat shell. The harness slot placement in relation to the child's shoulder is critically different for an infant versus a child older than 1 year.

Manufacturers do not dynamically test the seats with all the possible child sizes, child weights, and car seat adjustment combinations. The instruction manuals are not clearly written. Extremely high misuse rates involving these seats expose the failures in design, warnings, and instruction.(7)

Child seats used in foreign countries have been shown to protect children. The poor performance of child seats made in the United States leads one to question whether U.S. manufacturers are motivated and equipped to produce good designs that address safety issues.(8)

A solution is a well-designed integrated child seat. Integrated seats do not have any of the installation or missing-parts problems the aftermarket seats exhibit. These seats are much easier to use, and because the restraint design should be uniform across vehicle lines, the difficulty parents experience in correctly using the shoulder harness is reduced.

Automakers have crash and sled test facilities and engineering staffs far superior to car seat makers. While the vehicle manufacturers may claim that it is not necessary or cost-effective to install integrated child seats in every vehicle, the argument can be made that these seats are necessary in vehicles marketed to families to support claims that the vehicles are especially safe for families.

Lap shoulder belts

Restraints for children ages 5 to 12. The child in the 5 to 12 age group has been labeled "the forgotten child" by auto safety advocates. Many of these children have outgrown car seats but do not fit properly into the seat belt designed for adults.

The shoulder harness cuts across the child's face or neck and, as a consequence, the harness is often placed under the child's arm or behind his or her back. Sometimes the belt is not worn at all.(9) Fatal injuries have resulted from seat belts positioned under the arm, and "lap belt syndrome" injuries have been documented in the medical literature for 40 years.(10)

Responsibility rests with the automakers to provide adequate restraint for all foreseeable vehicle occupants. That means belts that fit the range of people that might occupy any seat.

Integrated seat belts or belts-to-seat and adjustable shoulder harness anchors have been feasible for well over 20 years, and automakers have been free to use them to protect young passengers.(11) Only recently has NHTSA required their use. In 1994, FMVSS 208 was amended to require that seat belts installed for adjustable seats be integrated with the seat or equipped with a means of adjustability.

NHTSA declined to include in the regulation fixed rear seats, which the agency acknowledged are commonly occupied by children. NHTSA advised that booster seats should be used to provide comfortable belt fit for children.

Most aftermarket available booster seats are deadly "low shield" seats. The problems with these seats are well documented.(12) The child is placed in the seat with only the "safety" shield providing upper torso protection. During a collision, the child's buttocks leave the seat and the child's upper torso flexes up and over the shield, placing the head, neck, and torso in near horizontal alignment. This allows the spinal cord to stretch, which, coupled with head contact, results in high cervical distraction injuries.(13)

Once the child reaches 40 pounds, parents are instructed by the booster seat manufacturer to remove the shield and use the vehicle's lap and shoulder belt. This provides enhanced protection for the child, but the shoulder harness may still not sit properly on the clavicle.

Belt-positioning booster seats provide better protection by eliminating the shield and positioning the shoulder harness in a sliding adjuster. Since these seats are relatively new to the market, it is not known how they will perform.

The booster seat shoulder harness adjustment can change the vehicle's shoulder harness geometry to add slack. When the government tested aftermarket shoulder harness repositioning devices, the added slack resulted in poor performance.(14)

Properly designed integrated seat belts or integrated belt-positioning booster seats installed by the automaker provide the best protection. Integrated seat belts are now found in convertibles and in high-end vehicles like the Cadillac Seville. BMW introduced integrated seat belts in the 1990 850i.

Not until the early 1990s when Volvo and Chrysler provided belt-positioning booster seats did automakers direct time and attention to the proper restraint of this age group. Currently, seven manufacturers offer integrated child restraints in 31 vehicle models. Unfortunately, citing poor sales, some manufacturers, including Chrysler, are retreating from the integrated child seats.(15) Trial advocates are urged to consider these alternative designs when faced with a case involving serious injury to a child in this age group.

Lap belts

Lap belts pose a risk of paralyzing spinal and disabling abdominal injury to all occupants but especially to children who have underdeveloped pelvic structures.(16) Although rear seat outboard shoulder harnesses have been required in all vehicles since the 1991 model year, there are still many older vehicles on the road with rear seat outboard lap belts. Automakers installed rear seat outboard shoulder harnesses in vehicles sold in Australia and Europe 20 years before they did so in vehicles sold here.

Manufacturer-run crash tests from the 1970s with lap-shoulder-belted dummies in all seated positions exist because NHTSA originally proposed that all seated positions be equipped with lap shoulder belts. Lap belt injuries to children reported in the literature include severe abdominal injuries, lumbar fractures, and high cervical distraction injuries.(17)

Lap belts still exist in center front and center rear seats in many vehicles and can occupy numerous positions in sport utility vehicles, minivans, and station wagons. Parents are faced with the difficult choice of which child to place in the vehicle lap belt when transporting a full passenger load.

Parents are instructed to place children in the center rear seat because its location is considered the safest. Owner's manuals often instruct those whose children do not fit well in shoulder belts to place them in lap belts.

The center front seat is most often occupied by children, given the average hip room of about 11 inches between ends of the lap belt. This, coupled with the fact that the seat is often formed by the mating of the two front "bucket" seats, results in no anti-submarining pan and a seat back made out of armrests, which renders the position very dangerous.

Injuries to children in center front lap belts include high-paralyzing cervical shear neck injuries and fatal head injuries.(18) Injuries to children in center rear bench seats are similar. Often, people wearing lap shoulder belts situated on either side of the center seated child are not injured.(19)

Automakers have installed integrated center front seat lap shoulder belts in vehicles sold in Europe and center rear shoulder harnesses in vehicles sold in the United States but designed in Europe. For example, Volvo, BMW, and Mercedes E Class include center rear shoulder harnesses in their automobiles sold in the United States.

The Lexus LX 470 incorporates a shoulder harness in the center seat of the middle bench seat, and Volvo has a shoulder harness in the center rear seat in its station wagons. In 1986, the National Transportation Safety Board recommended installing shoulder harnesses in all seat positions.(20)

Airbags

The NHTSA Special Crash Investigation database contains 12 cases involving child fatalities in rear-facing child seats caused by deploying airbags. Based on a review of these cases, in which NHTSA completed its investigation and released results, the predominant injury in the car seat cases was skull fracture and fatal brain injury.

In one case, the child received the blow directly from bag contact, suggesting the head had extended over the top of the back of the car seat. Usually the accident's delta V, the speed change the vehicle experienced as a result of the accident, was 12 mph or less. In four cases, the back supports of the infant restraints were badly fractured.(21)

Twelve surviving children ages 12 years and younger who experienced front passenger seat airbag deployments were studied. Four of the 6 children in child car seats and 1 of the 6 restrained by a lap shoulder belt sustained significant brain injuries.(22)

NHTSA now recommends that children under the age of 12 be placed in rear seats. But there are, of course, instances where this advice cannot be followed. Families with more than three children who own vehicles with limited rear-seating capacity or who participate in car pools often face the dilemma of deciding which child to place in front of the passenger airbag.

Vehicle and car seat manufacturers should have addressed this problem before incorporating airbags into vehicles. Early on, automakers suspected that airbags could injure or kill small children. Based on instructions from hospitals and others, car seat makers were certainly aware that parents would place rear-facing infant seats in front seats.

On-off switches, smart airbags that detect the presence of infants or children, and seat sensors use technology that could have been incorporated before 1990. Manufacturers should have investigated the role of the child car seat and vehicle seat belt (in conjunction with pre-impact braking) in placing a child in the zone of airbag deployment.

Recent developments

The hazards of early designs of child car seats and the large number of deaths of children in auto accidents led NHTSA in 1970 to promulgate FMVSS 213. It establishes a minimum standard for child car seat performance.(23)

All too often, the presence of minimal federal standards results in minimally performing products, and child car seats are no exception. Instead of designing up to human tolerance levels, manufacturers design down to the federal standard. FMVSS 213 falls short of more stringent European child restraint regulations.(24)

NHTSA will soon announce an amendment to Rule 213 requiring new child car seats and new motor vehicles to incorporate universal attaching hardware. The purpose of the regulation is to avoid problems of incompatibility and to enhance the correct installation of child seats.

Rejecting the rigidly mounted ISOFIX method advocated by safety experts in European countries, NHTSA will probably adopt uniform child restraint anchorage (UCRA), a cheaper, less effective method proposed by GM.(25)

The final rule will most likely contain a reduction in the amount of head excursion permitted during dynamic testing of child car seats. NHTSA believes this requirement will have the effect of requiring child car seats to be equipped with an upper tether strap. Motor vehicles will be required to incorporate into two rear vehicle seating positions the specialized anchoring system and tether attachments.(26)

There are about 70 models of child car seats on the market. Over 400 different models have been sold over the years. Think of matching old seats with new cars, old cars with new seats, and the doubling of already lengthy instruction booklets.

Defenses

Many common defense issues are present in these cases whether the defendant is a vehicle or a car seat manufacturer. The most important issues to address before the case is filed are causation, contributory negligence, and federal preemption. In addition, lawyers need to be familiar with the current state of tort "reform" on the state and federal level. Federal regulations concerning the car seat and motor vehicle as it relates to child occupant protection should be checked because the restraint of children is currently under scrutiny.

Causation issues relate to how, in particular, a client was injured consistent with the defects alleged. Typically, the manufacturer will make one or more of the following arguments:

* The child was "out of position" so if the alternative designs the plaintiff claims should have been adopted were adopted, they would not have made any difference to the outcome.

* The interaction with other objects or people in the vehicle caused the child's injury; product defects were not involved.

* The accident was too severe to be survivable. The manufacturer may point to the deaths of other occupants.

Comparative fault issues, or contributory negligence, depending on the state of the law, may be alleged for any mistakes the parents may have made in restraining the child. Given the well-documented notice to manufacturers of common misuse, this defense can usually be addressed through pointing out failures in design or faulty warnings and instructions.

Manufacturers are turning to the doctrine of federal preemption in an effort to use the minimum motor vehicle safety standards as a bar to an injured child's rights. The argument is made that the state common law tort claims are preempted by the Supremacy Clause operating through FMVSS 213 and [sections] 1392(d) of the National Highway and Motor Vehicle Safety Act.

A good discussion of the inapplicability of the doctrine to child car seat cases is found in Welsh v. Century Products.(27)

Preemption has been raised in restraint cases involving vehicle manufacturers as well. If this will become an issue, lawyers should contact Trial Lawyers for Public Justice, located in Washington, D.C., an organization that has litigated this issue extensively. Federal preemption must be considered at the stage of theory development, not once the case is in suit.

There are many complex legal and technical issues in these cases, and there are many sources to help in their preparation.

The Crash Injury Research and Engineering Network (CIREN) is a government-funded effort to gather data concerning accidents involving children. The database could be important to trial lawyers to support claims of defective designs that injure restrained children.(28)

The Partnership for Child Passenger Safety is creating a database similar to CIREN. This is a cooperative effort between insurance companies and academia to study accidents involving children reported by claims agents. If the underlying data becomes public, the database could be invaluable in allowing child safety experts to help trial lawyers understand the mechanism of injury in these incidents.(29)

Among the most important sources is the Attorneys Information Exchange Group (AIEG). Located in Birmingham, Alabama, the group maintains briefs, technical papers, and case materials available to member attorneys representing injured persons in auto litigation. Information regarding car seats is available from NHTSA at its Web site at http://www.nhtsa.dot.gov.

Numerous consumer and child safety organizations; the Center for Auto Safety, based in Washington, D.C.; and the Exchange, ATLA's computerized reference service, located at http://www.exchange. atla.org, are also helpful.

Notes

(1.) NATIONAL HIGHWAY TRAFFIC ADMIN., BUCKLE UP AMERICA: THE PRESIDENTIAL INITIATIVE FOR INCREASING SEAT BELT USE NATIONWIDE--FIRST REPORT TO CONGRESS (1997).

(2.) Society of Automotive Eng'rs (SAE), Automotive Safety TOPTEC: Focus on the Child, Phila. (Oct. 26-27,1998).

(3.) ASSOCIATION FOR THE ADVANCEMENT OF AUTOMOTIVE MEDICINE (AAAM), 42d ANN. PROC. (1998); Child Occupant Protection, 2d SYMPOSIUM PROC., SAE P-316 (1997); Child Occupant Protection, 1st SYMPOSIUM PROC., SAE SP-986 (1993); SAE, supra note 2.

(4.) Jocelyn Peddler et al., Usability Trials of Alternative Child Restraint Attachment Systems, Child Occupant Protection, 2d SYMPOSIUM PROC., P-316, SAE 973301 (1997).

(5.) Phyllis F. Agran et al., Restraint Use Among Children in Fatal Crashes, Child Occupant Protection, 2d SYMPOSIUM PROC., P-316, SAE 973300 (1997).

(6.) For complaints, results of crash tests, and more, visit the NHTSA Web site at http://www.nhtsa. dot.gov.

(7.) More than one-third of children age five or under killed in the United States in traffic accidents last year were restrained in child seats designed to protect them. Lisa Zagaroli, Misuse of Child Seats Kills, Hurts Hundreds, DET. NEWS, Dec. 6, 1998, at 1A.

(8.) Irene Isaksson-Hellman et al., Trends and Effects of Child Restraint Systems Based on Volvo's Swedish Accident Database, Child Occupant Protection, 2d SYMPOSIUM PROC., P-316, SAE 973299 (1997); Michael Henderson, Children in Adult Seat Belts and Child Harnesses: Crash Sled Comparisons of Dummy Responses, Child Occupant Protection, 2d SYMPOSIUM PROC., P-316, SAE 973308 (1997).

(9.) Elaine B. Weinstein et al., The Effect of Size Appropriate and Proper Restraint Use on Injury Severity of Children, Child Occupant Protection, 2d SYMPOSIUM PROC., P-316, SAE 973310 (1997).

(10.) John D. States et al., Fatal Injuries Caused by Underarm Use of Shoulder Belts, 27 J. TRAUMA 740 (1987).

(11.) Patent No. 3,524,677 (Aug. 26,1968) assigned to GM (belts to seat); Patent No. 4,039,224 (Aug. 2, 1977) assigned to Volkswagen (seat belt positioning apparatus).

(12.) EDWARD HILTNER, EVALUATION OF BOOSTER SEAT SUITABILITY FOR CHILDREN OF DIFFERENT AGES AND COMPARISON OF STANDARD AND MODIFIED SA 103C AND SA 106C CHILD DUMMIES, DOT HS 807844 (1990); Gary R. Whitman et al., Booster-with-Shield Child Restraint Case Studies, Child Occupant Protection, 2d SYMPOSIUM PROC., P-316, SAE 973307 (1997).

(13.) Donald H. Slavik, Cervical Distraction Injuries to Children, Child Occupant Protection, 2d SYMPOSIUM PROC., P-316, SAE 973306, case 3, at 139 (1997).

(14.) LISA K. SULLIVAN ET AL., EVALUATION OF DEVICES TO IMPROVE SHOULDER BELT FIT, DOT HS 808383 (1994).

(15.) Lisa Zagaroli, Built-in Child Seats Fall Out of Favor, DET. NEWS, Oct. 16, 1998, at A1.

(16.) A.P. Burdi et al., Infants and Children in the Adult World of Automobile Safety Design: Pediatric and Anatomical Consideration for Design of Child Restraints, 2 BIOMECHANICS 267 (1969).

(17.) Petr Braun & Yvan Dion, Intestinal Stenosis Following Seat Belt Injury, 8 J. PEDIATRIC SURG. 549 (1973); Ibrahim, Seat Belt Syndrome, Presentation to the 48th Annual Meeting of the American Academy of Orthopedic Surgeons, Las Vegas, Nev., reported in 1 ORTHOPEDICS TODAY 35 (1981); Slavik, supra note 13.

(18.) See Bonita Brodt, Father, Son Share Each Other ... and the Pain, CHI. TRIB., Dec. 11,1988, at 61; Roger Clendening, Accident Takes Lives, ST. PETERSBURG TIMES., Dec. 24, 1995 (Hernando Times), at 3.

(19.) Clendening, supra note 18.

(20.) NATIONAL TRANSP. SAFETY BD., PERFORMANCE OF LAP BELTS IN 26 FRONTAL CRASHES, NTSB/SS-86/03 (1986).

(21.) Jeffrey S. Augenstein et al., Airbag Induced Injury Mechanisms for Infants in Rear Facing Child Restraints, Child Occupant Protection, 2d SYMPOSIUM PROC., P-316, SAE 973296 (1997).

(22.) Catherine S. Gotschall, Nonfatal Air Bag Deployments Involving Child Passengers, Child Occupant Protection, 2d SYMPOSIUM PROC., P-316, SAE 973297 (1997).

(23.) 35 Fed. Reg. 5120 (1970).

(24.) Thomas Turbell et al., ECE Regulation 44--An Update on the Current Revision, Child Occupant Protection, 1st SYMPOSIUM PROC., SP-986, SAE 933084 (1993).

(25.) Richard Lowne, A Comparison of the Performance of Dedicated Child Restraint Attachment Systems (ISOFIX), Child Occupant Protection, 2d SYMPOSIUM PROC., P-316, SAE 973302 (1997).

(26.) 62 Fed. Reg. 7858, 7858 (1997).

(27.) 745 F. Supp. 313 (D. Md. 1990).

(28.) http://www_nrd.nhtsa.dot.gov/bio_and_trauma/ciren_final.htm.

(29.) Catherine S. Gotschall et al., Traffic-Related Injuries to Children: Lessons from Real World Crashes, Child Restraint and Pediatric Injuries, AAAM, 42d ANNUAL PROC., 165, 169-70 (1998).

RELATED ARTICLE: Preparing the case

Prosecuting a child restraint case is similar to prosecuting any crashworthiness case, but the former does have a few twists. Creating an accurate set of biomedical measurements of the child client during the initial investigation becomes invaluable later when a biomechanical expert seeks to reconstruct the child's kinematics and injury causation. Remember, the young child will grow rapidly, making accurate measurement at a later time difficult.

If the family comes for legal help some time after the collision or the child is deceased, school health records, pediatrician records, or measurements taken to fit wheelchairs or other apparatus can provide close to the same information. This information is critical whether the child was in a seat belt or a car seat.

Preservation of the vehicle is important in every crashworthiness case. Do not change the position of any of the seats or try to dismantle the vehicle in any way. Record its condition and its contents as close to the time of the collision as possible. Evidence of occupant contact and seat belt loading can deteriorate, and this evidence should be documented early on.

If the child has suffered a paralyzing or other catastrophic injury, the last thing on the parents' minds is preserving the car seat. Most often the child is taken to the hospital in the seat. The hospital may store the seat with the child's effects or turn the seat over to a relative or friend. Trace this path immediately and, if possible, get the seat.

Also, obtain an exemplar child seat, including all its parts, manufactured around the same time as the actual seat, and a full set of instructions (along with the packaging). Child seat designs, labeling, and instructions change often, and an accurate understanding of the hardware and information originally available is important to many issues, including whether a case exists.

If the child seat is not a current model, you may be able to locate an old seat through garage sales, newspaper ads, volunteer groups that supply child seats, or other child seat organizations. The National Highway Traffic Safety Administration has compiled labeling and instructions that accompanied older model child restraints. Also, child seat manufacturers maintain the carton labeling in their archives.

Find the individuals--typically family members, passersby, and emergency medical personnel--who saw the child immediately before and after the accident. Ask them to describe how the child was positioned in the vehicle and the relationship of the child to the restraint he or she was using.

Remember, the person you are representing in the case is a child, who may be asked questions in this critical area on deposition.

--Susan Lister

Susan Lister practices with Goodman, Lister & Peters in Detroit. She would like to thank Salena Schmidtke for her assistance in preparing this article.