FINDINGS OF FACT AND CONCLUSIONS OF LAW
I. INTRODUCTION
This case involves a 1998 collision (“the accident”) between a bus owned and operated by defendant United States and an automobile operated by plaintiff Enrique Calva-Cerqueira. As a result of the accident, the plaintiff suffers from paralysis, decreased sensation in the left side of his body and is wheelchair bound. The plaintiff, who was 18-years-old at the time of the accident, brings this case pursuant to the Federal Tort Claims Act (“FTCA”), 28 U.S.C. § 2671 et seq. On May 3, 2001, the court determined that the defendant was liable for the accident. Having presided over an eight-day trial on the plaintiffs actual damages and likely future damages, the court now determines that substantial evidence supports an award of the following compensatory damages: $5,000,000 for pain and suffering, $899,325 for past medical expenses, $2,562,906 for future lost wages, and $15,435,836 for future medical and related expenses. The court reduces the award to a total of $20,000,000 because the plaintiffs original claim for damages requests that amount. Finally, resolving two miscellaneous issues, the court declines to adopt the defendant’s request for a reversionary medical trust and determines that the defendant shall pay the fees of the guardian ad litem.
II. FINDINGS OF FACT
A. Procedural History
1. On August 3, 2000 the court granted the defendant’s motion to bifurcate the liability and damages portions of this action. On May 3, 2001, after a three-day bench trial on the issue of liability, the court determined that the defendant was liable for the accident and resultant injuries to the plaintiff. Findings of Fact and Conclusions of Law dated May 3, 2001 (“FFCL”) at 16. Beginning on December 9, 2002, the court presided over an eight-day bench trial on the issue of the plaintiffs damages. On February 25, 2003, the parties filed proposed findings of fact and conclusions of law.
B. Summary of the Plaintiffs Life Before the Accident
2. The plaintiff was born on November 16, 1979, the second son of Maria Teresa Cerqueira and Ro *283 berto Calva. Pl.’s Ex. 146. His older brother Daniel was born in 1977. Id.
3. The plaintiff spent his early years in Mexico City. Id.; Pl.’s Ex. 121. His parents separated in 1984 and divorced two years later. Pl.’s Ex. 146. After completing first and second grade in Mexico City, the plaintiff moved with his mother and brother to Ithaca, New York. Pl.’s Exs. 121, 146. The plaintiffs elementary school grades ranged from average to above average. Pl.’s Ex. 121. The plaintiff and his brother spent the summer of 1991 with their father in Mexico, and then elected to remain in Mexico with their father. Pl.’s Ex. 146. The plaintiffs school grades from 1991 through 1994 ranged from average to good. Pl.’s Ex. 121.
4. On December 25, 1994, the Calva-Cerqueira family was on a vacation in Italy when they were involved in a motor vehicle accident (“1994 accident”). Tr. 2/81-83, 2/104. 1 Roberto Calva, the plaintiffs father and a pediatrician, testified that he attended immediately to his son and observed no loss of consciousness. Id. Although the other occupants of the vehicle were not injured, the plaintiff suffered a fracture of the maxillary sinus, the thin bone which serves as the orbital floor and the upper boundary of the maxillary sinus. Tr. 2/36, 2/82-83.
5. The defendant presented evidence attempting to prove that this 1994 accident caused the plaintiff a mild brain injury, and the plaintiff presented evidence to the contrary. E.g., Tr. at 1/38, 2/36, 3/46-48, 3/75, 5/62-64, 6/127-28, 8/106-07, 8/127-28; Def.’s Exs. 21A, 23A, 53; Pl.’s Exs. 23, 111A-B. No such brain injury is documented in the plaintiffs medical records. Id. In addition, the defendant’s evidence of the plaintiffs alleged mild brain injury is not compelling and would require this court to speculate. Id.
6. While living with his father in Mexico, the plaintiff suffered an emotional breakdown and was hospitalized for six weeks for detoxification from cocaine, inhalants, alcohol and other illegal drugs. Tr. 3/112-13, 3/117, 3/122-23; Pl.’s Ex. 35. Upon discharge from the detoxification program, the plaintiff was diagnosed as having a depressive disorder. Pl.’s Ex. 32.
7. In January 1997, the plaintiff moved to the United States to live with his mother in Fairfax, Virginia. Pl.’s Ex. 146. He participated in a second substance abuse treatment program and saw a psychiatrist, Dr. Eliot Sorel, from January through November 1997, but continued to abuse drugs during that period. Tr. 1/90-91, 5/64-65, 5/109-11, 7/5-22; Pl.’s Exs. 6, 27, 49.
8. In November of 1997, Dr. Sorel recommended that the plaintiff consent to urine screening. Pl.’s Ex. 49. Despite his family’s encouragement, plaintiff chose to discontinue seeing his psychiatrist and continued to abuse illegal drugs and alcohol. Id.; Tr. 5/114-15, 7/49. Dr. Sorel’s records indicate that the plaintiff was using marijuana three *284 times a week in late 1997. FFCL at 7. The plaintiff continued this frequency of usage up to the time of the accident. Id.
9.At the plaintiffs post-accident urine drug screening, which was administered at 11:15 on the morning of the accident at George Washington University Hospital, he tested positive for cannabis. Id. The laboratory report indicated that the test was a “presumptive screen only,” and could be positive up to two weeks after marijuana use. Id.
10. Due to academic difficulties at W.T. Woodson High School caused by his mid-semester enrollment, the plaintiff failed three classes, received a “B” in a math class, and then withdrew from the school. Tr. 4/82-83, 5/66; Pl.’s Ex. 121. He subsequently enrolled at the Fairfax County Adult Education program, which afforded him an opportunity to earn the equivalent of a high school diploma. Id. His English teacher stated that he loved learning, was very bright and motivated, and had clear goals. Tr. 4/74-75. She added that he had an excellent attendance record and “was definitely college material.” Tr. 4/82.
11. The plaintiff held several part-time jobs during the 1997-98 school year. Pl.’s Ex. 146. He worked at Kentucky Fried Chicken (“KFC”) from April 29,1998 until the date of his injury, June 14, 1998. Id. The plaintiffs supervisor at KFC at the time of the accident, Maria Rivera, testified that he was enthusiastic, smart, intelligent, very motivated, and had perfect attendance. She said that she promoted him twice and that she would hire him back. Tr. 4/6-9. The plaintiff also played soccer with the Fairfax Police Youth Club League during the 1997-98 school year. Tr. 5/67. Jason Velasco, the plaintiffs soccer coach, testified to the plaintiffs perfect attendance over three seasons, interest in college, excellent physical condition, aptitude, and the absence of any hint of neurological problems. Tr. 3/130-33.
12. The plaintiffs rehabilitation psychiatrist, Dr. Sorel, testified that the plaintiff had demonstrated improvement. Tr. 7/55. Although the plaintiff did not enroll in urinalysis drug testing as Dr. Sorel had hoped, ambivalence is usual and customary for late adolescent patients. Tr. 7/61-62. Thus, the plaintiff was, more likely than not, on the road to full recovery immediately prior to the fateful accident.
13. Considering the plaintiffs pre-acci-dent circumstances, the court finds that the plaintiffs prospects improved when he returned to the United States to live with his mother, largely due to her close supervision of him. Tr. 5/70-75, 5/105-20. The plaintiffs academic and social performance showed improvement: by spring 1998 the plaintiff was better adapted socially, holding down a job, and looking forward to college following graduation from high school. Tr. 5/118-20. He had exhibited interest in taking the SAT, secured checking and savings accounts in his own name, and paid many of his own expenses. Tr. 1/67-70, 2/85-100, 5/105-18. The plaintiffs mother testified that he had taken steps toward college and, like her other son Daniel, he would *285 attend the northern Virginia community college (“NOVA”) and then continue on to a four-year college. Tr. 5/118-20. Similar to the plaintiffs work at a fast food restaurant while attending school, Daniel worked at a bagel store while he attended NOVA. Tr. 5/120. The plaintiff had discussed attending NOVA with his brother, psychiatrist, soccer coach, and a family friend. Tr. 1/70, 1/75, 3/182, 4/96; PL’s Ex. 23A. The plaintiffs brother’s path — working at a restaurant during school, attending NOVA while living at home, then enrolling at Georgetown and medical school — served as a road map for the plaintiff. Tr. 1/62-63, 5/120.
14. The plaintiff was a bright young man with good cognitive functions. His standardized testing scores showed above average intelligence, and he frequently scored his best grades in subjects such as mathematics, science, and English that indicate his potential for higher cognitive functioning. Tr. 4/75, 4/96. Further, the plaintiff has a highly educated family: his mother has a doctorate degree in nutrition, his father is a medical doctor and practicing pediatrician and gastroenterologist, his brother is attending medical school, and an uncle and a cousin are practicing veterinarians. Tr. 2/81-85, 5/61— 62.
15. The plaintiffs vocational rehabilitation expert, Dr. Estelle Davis, testified that the plaintiff would likely have finished college and at least two years in a graduate program. Tr. 4/34-37. She based her opinion on her interviews of the plaintiffs mother, teacher and tutor; her review of the plaintiffs academic, intelligence testing, medical and drug treatment records; and the educational level of the plaintiffs family. Id.
16. The defendant’s vocational rehabilitation expert, Mr. Steven Shedlin, considered similar information, but while he did not focus on the educational achievements of the plaintiffs family, he did focus on the plaintiffs alleged pre-accident brain injury. Tr. 7/197-98. Mr. Shedlin stated that the plaintiffs drug abuse was a serious concern, because drug abusers generally cannot maintain employment. Tr. 7/197. Ultimately, Mr. Shedlin opined that the plaintiff would not complete college. Tr. 7/197-98.
17. The testimony of the plaintiffs expert, Dr. Davis, is more credible than that of Mr. Shedlin because it addressed the facts of this case more thoroughly and more realistically. For example, the plaintiffs two promotions at Kentucky Fried Chicken belie Mr. Shedlin’s suggestion that the plaintiff could not work because he was abusing drugs — demonstrating that his drug problem was not as severe as Mr. Shedlin believed. Tr. 4/6-9, 7/197.
18. Based on the plaintiffs family history and substantial progress toward full recovery by early June 1998, the court finds, by a reasonable certainty, that the plaintiff likely would have finished college and two years in a graduate program. Tr. 2/154-55, 3/94, 4/46-47; 7/62-63.
C. The Accident
19. On Sunday, June 14, 1998, the plaintiff was involved in a tragic *286 motor vehicle accident. FFCL at 2. On that morning, the plaintiff, then 18 years old, was driving his car eastbound on Eye Street, S.W. at its intersection with South Capitol Street in Washington, D.C. Id. The other vehicle involved in the accident was a Smithsonian Institution bus, which was proceeding southbound on South Capitol Street when it collided with the plaintiffs car. Id. The plaintiffs car weighed an estimated 3,880 pounds (including occupants), while the Smithsonian bus weighed an estimated 25,-950 pounds (including occupants). Id. The bus driver was driving in excess of the applicable 25 mph speed limit when she drove through a red light and into the intersection where she hit the plaintiffs car. Id. at 13-14.
D. The Plaintiff’s Post-Accident Medical Treatment
20. The plaintiff arrived by ambulance at the George Washington University Hospital Emergency Department at 9:25 a.m. on June 14, 1998. Pl.’s Ex. 1 at 5, 9-10; Tr. 1/6-7. He had sustained multiple traumas including injuries to the brain, skull and chest and was in a deep coma. Id.
21. After three weeks of treatment at George Washington University Hospital, the plaintiff was transferred in a comatose state to the National Rehabilitation Hospital (“NRH”). Pl.’s Exs. 2, 4; Tr. 4/110-18. He remained at NRH until December 24, 1998, and began to communicate verbally in August 1998. Id. His mother sat with him everyday. Tr. 5/68.
22. On January 4, 1998, the plaintiff moved to the Learning Services Corporation where he received 24-hour supervision from skilled trainers specializing in the care of brain-injured adults. Pl.’s Ex. 5 at 16-19. Following the plaintiffs departure in March 1999 from the Learning Services Corporation, he began outpatient rehabilitation training in an adult day program at NRH. Pl.’s Ex. 7; Tr. 1/79-80. He is currently receiving physical therapy three times per week at Fair-fax Rehabilitation, Incorporated. Id.
23. The plaintiff continues to reside with his mother in Fairfax, Virginia. He has someone with him at all times. Tr. 5/77-82.
24. The plaintiff has incurred medical bills totaling $899,325.46 as a result of the accident. Pl.’s Ex. 158. According to his mother, her insurance company has a medical lien in the amount of $400,000-$500,000. Tr. 5/92-93. The court finds that the record includes no proof that the plaintiffs health care providers did not require full payment from the plaintiff and no proof of the exact amount of the insurance company’s lien.
E. The Plaintiffs Injuries Caused By the Accident
25. The plaintiff suffered severe and permanent injuries, physical and mental disabilities, pain, emotional distress, disfigurement, deformity, and inconvenience as a result of the defendant’s negligence. Tr. l/34r-40, 2/47-50, 2/53-54.
26. Dr. Thomas P. Naidich, a professor of neuroradiology at Mt. Sinai Medical Center and the author of *287 innumerable articles and books on brain imaging, summarized the plaintiffs brain imaging studies. Tr. 2/46. Dr. Naidich explained that the plaintiffs imaging studies unequivocally demonstrate that the accident caused by the defendant inflicted extensive brain tissue damage that permanently altered the configuration of the plaintiffs brain, including the cortex, brain stem, and cerebellum. Tr. 2/47-50, 2/53-54. Specifically, the MRI and CT films show skull base fractures on the right and left sides, the absence of the right frontal lobe, and hemorrhagic damage and scarring in the basal ganglia affecting the putamen, globus pallidus, caudate and the internal and external capsules. Tr. 2/46^18. In addition, there has been partial loss and damage to the crossing fibers of the commissure or corpus collosum, the lenticular nucleus, the mid-brain, the fibers connecting the brain and spinal cord, the cerebral peduncles, and the thalamus, as well as fractures of the bones in the left ear. Tr. 2/48-58. A comparison of the MRI films of February 28, 1997 with the MRI films of December 16, 1999 shows that the accident caused substantial scarring and atrophic volume loss of the right superior frontal gyrus, middle frontal gyrus, precentral gyrus and to some extent the right postcentral gyrus. Tr. 2/56. In the wake of the trauma to the brain, multiple hemorrhages resulted in diffuse bleeding in various areas of the brain and when those areas liquified as part of the necrotic process they left behind multiple cavities. Tr. 2/53-54. P.E.T. scanning performed on February 16, 2000 confirmed the absence of functional brain activity in many of these areas. Pl.’s Ex. 10.
27. Dr. Anthony, J. Caputy, a neurosurgeon, Dr. Naidich, Dr. Richard N. Edelson, a neurologist, and Dr. Paul Fedio, a neuropsychologist, explained the functional significance of the loss of these neuroana-tomical regions of the plaintiffs brain. Tr. 1/34-36, 1/46, 1/51-52, 2/16, 2/21-23, 2/27-32, 2/53, 2/145, 3/45. The extensive damage to the plaintiffs brain has resulted in serious impairment of higher cortical functions, neurocognitive deficits, and multiple neuromuscular disabilities with paralysis, paresis, and contractures of the musculoskeletal system in the torso, head, and four extremities. Id. The brain injury has rendered the plaintiff quadri-paretic and resulted in a complete loss of mobility such that he now requires wheel-chair transportation plus assistance in making all transfers between wheelchair, bed, and bathing facilities. Tr. 2/23-29, 2/45, 3/45-46. The damage also has resulted in the inability of the plaintiffs brain to process and retain information, as well as a loss of ability to integrate information received from sensory and motor experience. Id. The absence of the plaintiffs right frontal cerebral area has caused him to encounter great difficulty in cognition, thinking and control of impulses. Id.; Tr. 2/147-49. According to Dr. Naidich, the body has much less ability to compensate when a person has suffered bilateral or multi-focal injuries, making it more likely to have permanent, irreparable *288 damage as the plaintiff exhibits. Tr. 2/76.
28. The damage to the plaintiffs cerebellum has hindered the plaintiffs spatial orientation and equilibrium. Tr. 1/24, 1/35, 5/74-75. Damage to the plaintiffs thalamus and hypothalamus has resulted in the loss or impairment of body sensation, long and short term memory function, learning, information retrieval and use, visual spatial orientation, and appetite. Pl.’s Ex. 156; Tr. 1/133, 2/45, 4/113.
29. Dr. Fedio evaluated the cognitive and personality functions of the plaintiff over five formal sessions and a home visit in May 2002 to assess the plaintiffs home environment. Pl.’s Exs. 202B, 202C; Tr. 1/142-44. Based on his own extensive testing and review of the plaintiffs school and medical records, Dr. Fedio concluded that the 1998 accident caused a tremendous amount of brain injury that has left the plaintiff severely impaired. Tr. 1/145. He noted that the primary loss is the massive hole in the plaintiff’s right frontal lobe but that there is extensive injury all over the plaintiffs brain. Id.
30. Wechsler Adult Intelligence Scale testing showed that the plaintiffs language skills (left brain) are still relatively good, but that his visuos-patial skills (right brain) are severely impaired. Pl.’s Exs. 161A-B, 202B at 6-7, 202C at 4-5. The accident also impaired the plaintiffs memory, perceptual organization, processing speed, and ability to understand information quickly. Tr. 2/163-65; Pl.’s Exs. 202B at 8-9, 202C at 5-6. Since the accident, the plaintiff has exhibited a very limited capacity for learning. Tr. 2/148. The plaintiff also has exhibited severe attention and concentration deficits since the accident, and has a severe memory and learning disability. Pl.’s Exs. 202B at 8, 202C at 5-6.
31. Dr. Edelson explained that there are “islands” of preserved function, such as verbal skills, but the plaintiff has lost other cognitive processes that are essential to overall cognitive performance. Tr. 3/52.
32. The plaintiff also has an executive function disorder which manifests itself in a severe disability in practical reasoning and problem solving. He lacks the ability to plan and to foresee the consequences of his behavior. Tr. 2/146. The plaintiff has lost the area of the frontal lobe that controls judgment, decision-making and social decorum. Tr. 1/115, 4/43.
33. The evidence demonstrates that the plaintiff is permanently disabled from gainful employment, even in a protected environment, and most likely will not finish college. Pl.’s Ex. 202C at 8; Tr. 4/44.
34. Dr. Ross Silverstein, a board-certified psychiatrist and clinical professor at Georgetown University, has been treating the plaintiff since October 2000 and has been seeing the plaintiff about once a month since March 2001. Tr. 3/82. Dr. Silver-stein testified to his psychiatric diagnosis of dementia secondary to head trauma, and explained that the plaintiffs emotional, mental, and cognitive functioning is principally determined by the massive brain injury suffered as a result of the 1998 accident. Tr. 3/82-83. Dr. Silverstein described the plain *289 tiff as a vulnerable individual with multiple emotional, cognitive, and behavioral problems who requires ongoing psychiatric treatment. Id. The plaintiff is completely out of touch with the reality of his life and has an unrealistic sense of his abilities and goals. Id. at 83. Dr. Sil-verstein testified that the plaintiff could become depressed as the reality of his deficits becomes more apparent to him. Tr. 3/86-87. Dr. Silverstein explained that the plaintiff will require psychiatric assistance for the remainder of his life, on an average of one session per month. Tr. 3/92. Dr. Silverstein was particularly concerned that the plaintiff would suffer acute deterioration if he were taken away from his family and put back into a group home or institutional setting. Tr. 3/93. He was specifically concerned that the plaintiff would “see the world as having given up on him” and “might experience that as punishment.” Id.
35.Experts for the plaintiff and the defendant agreed that the plaintiff is dependent upon some level of assistance 24 hours a day, seven days a week. Tr. 1/148, 3/49-50, 4/141-42, 4/149, 5/175, 6/91, 6/99, 6/147-48. Even at night the plaintiff frequently requires assistance. His mother testified that he wakes up at night to go to the bathroom or to seek comfort. Tr. 5/99. He has fallen out of bed at least six times within the last year. Tr. 5/100. Leaving the plaintiff alone would not be safe because he could fall, have a seizure, leave the stove on, or attempt a dangerous maneuver in his wheelchair. Tr. 3/50, 4/14-15, 4/178, 5/79-80, 6/91.
36. The court observed the plaintiff and watched a short videotape of his home functioning. Through these observations, the court finds that the plaintiff is a severely impaired individual who is wheel-chair bound, unable to ambulate, unable to transfer or move unassisted from chair to bed, and dependent on the assistance of others. Tr. 3/160, 5/64-75. In contrast, prior to June 14, 1998, the plaintiff had excellent motor functions and was able to walk, hike, jog, run, swim, play soccer, lift heavy objects, and otherwise function as a fully normal 18-year-old male. Tr. 3/130-33, 4/70-71. He was a gifted soccer player, described by his former coach as having “an incredible left foot” and by his mother as “dynamite on the soccer field.” Tr. 3/131, 5/67.
37. The plaintiff appreciates many of his deficits. Tr. 6/31. He suffers mental anguish when he hears that he will never walk again and is self conscious about his surgical scars. Tr. 1/83, 4/17, 5/72. He is frustrated and anxious over questions of sexuality. Tr. 1/84. He feels hurt and frustrated when he upsets others by his inability to learn and understand. Tr. 3/140. He feels disheartened when reminded of the long list of courses he must complete to graduate from NOVA. Tr. 5/76.
38. In summary, as a result of the plaintiffs severe head and brain injuries, he suffers the loss of many bodily and mental functions and a great deal of pain, suffering, and mental anguish. The plaintiff has paralysis and decreased sensation in the left side of his body. Tr. 4/182. He has lost physical *290 strength, is wheelchair bound, and has to wear braces. Tr. 3/165; 2/23-29, 2/45; 3/45, 5/80. His braces pinch and cause pain. Tr. 3/165, 5/84-85. His exercises also cause pain. Tr. 4/170, 5/78-79. He suffers incontinence. Tr. 5/126. Aging will afflict him more severely, so that at age 40 he will more closely resemble a 60 or 70 year-old person. Tr. 3/54. He gets depressed at times and will likely develop depression in the future. Tr. 3/89, 3/99.
F. Future Medical Care and Related Needs
39. The parties each presented life care plans demonstrating that the plaintiff requires chronic care for the remainder of his life expectancy including full-time attendant care either at home or in a group residential setting. Pl.’s Ex. 151; Def.’s Ex. 19. The plaintiffs expert, Ellen Barker, R.N., and the defendant’s expert, Linda Ko-pishke, R.N., both prepared life care plans for the plaintiff. Id. Both life care plans account for the fact that the plaintiff is wheelchair bound and contemplate extensive services based on a life expectancy of 70 years. Id. The first major difference between the plans is whether this care should be provided in the plaintiffs family setting or in a group setting. Id. The second is the hourly wage of attendants. Id. The third major area of dispute concerns the frequency of medical and related services. Tr. 1/125-34, 4/130-31, 5/176-77; Pl.’s Ex. 151.
40. Addressing the first factual issue, the court considers that the plaintiffs mother, father and brother are committed to keeping the plaintiff in his home environment and outside the confines of a group home or institutional setting. Tr. 1/78, 5/86, 5/123, 8/24. The plaintiffs physiatrist, Dr. Stephen Wills, testified that the plaintiff is not suited for an adult daycare program or group home due to the extent of his injuries. Tr. 4/130. For these reasons, the plaintiffs well-being would be better served by living with or close to his family and not receiving care at a group home.
41. Considering the second factual issue, the provisions for attendant care, the court recognizes that the Barker life care plan provides for a day-time skilled-care attendant charging $50 per hour and a different evening and night-time attendant charging $8-10 per hour. Pl.’s Ex. 151 at 18. The defendant’s experts, Ms. Kopishke and Dr. Alan Frankel (the defendant’s economist), testified that no skilled-care attendants charging $50 per hour exist — rather, the hourly rate is lower. Tr. at 6/96, 8/82-83. In contrast, Ms. Barker testified that this is a reasonable fee for a nurse or medical student working through an employment agency, and she had confirmed this belief several years ago when she spoke to an employment agency in the Fairfax area. Tr. at 1/171-72. Judging the testimony and relevant facts, the court finds Ms. Barker’s testimony more credible than that of Ms. Kopishke or Dr. Frankel on this wage issue.
42. Turning to the third major factual issue regarding the life care plans, the court finds that Dr. Richard *291 Zorowitz, a professor of rehabilitation medicine who testified for the defendant, agreed with the plaintiffs experts that the Kopishke plan was deficient in not providing for care by specialists in neurology, orthopedics, urology, pulmonology, ear-nose-and-throat, plastic surgery, and nutrition. Tr. 5/176-77; Pl.’s Ex. 153. The Barker plan expressly covers these services, and Dr. Wills testified that these services are necessary for the plaintiffs care. Tr. 4/130-35; Pl.’s Ex. 151.
43. After listening to the extensive testimony regarding the two life care plans, and reviewing the testimony and the plans themselves, the court finds that the plaintiffs life care plan addresses the plaintiffs future medical care and related needs far better than the defendant’s plan. Pl.’s Ex. 151; Def.’s Ex. 19. The court also finds that the plaintiffs experts — Nurse Barker, who created the plan, Dr. Wills, the plaintiffs physiatrist, and Dr. Edelson, the plaintiffs neurologist — have reasonably recommended the items in the plan as necessary for the plaintiffs future care. E.g., Pl.’s Ex. 151; Tr. 1/120, 4/130-35.
G. Present Value Calculations
44. The plaintiffs expert economist, Dr. Richard Lurito, utilized a methodology which calculates the likely escalation of the plaintiffs future medical and related expenses and future lost wages, and then discounts those future damages figures to their present value using an after-tax discount rate. Tr. 4/203-06; see also Pl.’s Exs. 203F, 203G (Dr. Lurito’s reports). This approach recognizes that some categories of costs and wages generally increase faster than inflation. Pl.’s Ex. 153.
45. On the other hand, the defendant presented two experts each with different approaches to estimating the current value of future economic costs. Tr. 8/30-131. First, Dr. Alan Frankel utilized a “real” or net interest rate approach. Tr. 8/35-36; see also Def.’s Exs. 27A-D (Dr. Frankel’s reports). The “real” interest rate represents the difference between the overall rate of return on investments and the overall rate of inflation. Id. This method, which uses this “real” interest rate as the net discount rate, assumes that the growth in medical and related care costs and in the wages of college graduates will be same as the growth in the consumer price index generally. Tr. 8/63— 64, 8/138-40. Second, Mr. Thomas Walsh proposed a “market present value” approach, which uses the cost of an annuity to determine the cost of a future stream of payments. Tr. 8/112; see also Def.’s Exs. 20A-E (Mr. Walsh’s reports).
46. The field of economies is not an exact science and provides multiple methods for reaching the same goal: the estimate of future losses. One significant difference between Dr. Lurito’s calculations and Dr. Frankel’s calculations is that Dr. Frankel did not use an after-tax discount rate for most of his calculations, while Dr. Lurito did. Compare Tr. 8/49-50, 8/86 with Tr. 4/207-08 and Pl.’s Ex. 163; PL’s Ex. 203G at 10. The choice of an after-tax versus before-tax discount rate significantly affects the calculation of the net discount rate by *292 which future sums are being reduced to present value. See Pl.’s Ex. 163. Overall, of the three experts, the court finds the plaintiffs expert, Dr. Lurito, most clear and compelling.
47. The court also finds that the bulk of the plaintiffs future economic damages consists of health care and attendant care costs. Pl.’s Ex. 153. If the rate of growth in these items is understated, or if future costs are discounted at an excessive rate, the consequences to the plaintiff could be devastating — he might not be able to pay for medical care needed because of the defendant’s negligence. Compare Def.’s Ex. 27D at Ex. 20 (Dr. Frankel’s chart, showing that the present value of the plaintiffs life care plan when calculated with a 3.0 percent discount rate is $7,001,712) with Tr. 4/213 and Pl.’s Ex. 153 (Dr. Luri-to’s chart, showing that the present value of the plaintiffs life care plan when calculated with a -0.5 percent discount rate is $14,237,416 to $15,534,956).
48. Dr. Lurito projected that the cost of the items in Ms. Barker’s life care plan will rise at a rate faster than the overall rate of inflation. Tr. 4/209-11, 5/17. He assumed that the overall rate of inflation will be 3.0 percent per year and that the cost of items in Ms. Barker’s life care plan will rise at an average rate of 5.0 percent per year. Tr. 4/205-06, 4/209-12; Pl.’s Ex. 153. He based this assumption on (a) a current annual growth rate in medical care services costs of 5.35 percent; (b) a likely future growth as described in the 2002 Economic Report of the President; 2 and (c) a growth in the costs of medical care services over the 1986-2001 period of 5.67 percent per year. Tr. 4/210-12; Pl.’s Exs. 164 at 149, 203G.
49.In an economy where the overall demand for personal and home care aides is projected to increase by 67 percent by the year 2010, it is likely that the prices charged by home care agencies will generally grow faster than consumer prices. Tr. 5/52-53; Pl.’s Ex. 172 at 188. Thus, it is more probable than not that, as in the past 20 years, average earnings for health care providers and average prices for medical-related goods and services will continue to rise at approximately 1.5 times the overall inflation rate. Pl.’s Exs. 152A-B, 203G; Tr. 5/52-54, 8/139-40. Accordingly, Dr. Lurito’s calculation of the likely fu *293 ture growth in medical and related expenses is reasonably certain.
50. Turning to the future lost wages estimate, Dr. Lurito calculated the likely escalation in the wages that the plaintiff would have enjoyed absent his injuries caused by the accident. Tr. 5/16-24. Dr. Lurito supports his use of a 4.5 percent escalation rate for the plaintiffs future earnings absent injury with the 2002 Economic Report of the President, which shows that the earnings of college and post-college educated males in the United States have historically increased by a yearly amount well in excess of the inflation rate. Tr. 5/23-24; Pl.’s Ex. 171.
51. As with future medical and related expenses, the failure to take longstanding economic reality into account — that is, making the assumption that the earnings of college graduates will increase at the rate of overall inflation — would result in a significant understatement of the plaintiffs probable future earnings loss. Tr. 5/17-24. Thus, the court is persuaded that the plaintiffs future earnings, absent injury, would have been at the level of a person with two years of graduate study, and that such earnings would likely have grown at an average of 4.5 percent per year as calculated by Dr. Lurito. Tr. 5/23-24; Pl.’s Exs. 171, 203G.
52. Reducing the plaintiffs future lost earnings and medical and related expenses to present value, Dr. Lur-ito applied a 4.5 percent after-tax discount rate. Tr. 4/205-08, 5/46; Pl.’s Ex. 163. Dr. Lurito based his choice of discount rate on the rate of return on conservative bond and money market investments. Pl.’s Ex. 152E. The actual before-tax yield on this portfolio is 5.2 percent and the after-tax yield is 3.9 percent. Pl.’s Ex. 152E.
53. Dr. Lurito calculated the present value of plaintiffs future medical and related expenses based on an after-tax discount rate of 4.5 percent and an overall growth rate of 5.0 percent, producing a net discount rate of negative 0.5 percent. Tr. 4/213. Dr. Lurito calculated the present value of the plaintiffs future lost earnings based on an after-tax discount rate of 4.5 percent and growth rate of 4.5 percent, producing a net discount rate of zero percent. Tr. 5/21.
54. Having observed and reviewed the testimony of the expert economists, the court is satisfied that Dr. Luri-to’s methods and calculations are based on substantial evidence and provide a reasonably certain estimate of the plaintiffs future lost wages and medical and related expenses.
III. CONCLUSIONS OF LAW
A. Legal Standard for Compensatory Damages
In cases arising under the FTCA, the law of the state where the misconduct occurred governs substantive tort liability, including the nature and measure of damages to be awarded.
Richards v. United States,
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Courts must base compensatory damages awards on substantial evidence and not on mere speculation.
Wood v. Day,
Regarding damages for the future consequences of a tort, an item is recoverable if the plaintiff proves by a reasonable certainty that the future consequence would have occurred or will occur.
Wood,
Using this framework, the court considers the individual types of compensatory damages that the plaintiff requests: pain and suffering, past medical expenses, future lost wages, and future medical and related expenses.
B. Pain and Suffering
The plaintiff requests an award of $8,000,000 for his past and future pain and suffering as caused by the accident. Pl.’s 2d Am. Prop. FFCL at 93. The defendant argues that an award of $750,000 would be reasonable. Def.’s Prop. FFCL at 31.
The plaintiff in the instant action has presented substantial evidence to prove that he suffers from severe and permanent injuries, physical and mental disabilities, pain, emotional distress, disfigurement, deformity and inconvenience as a result of the defendant’s negligence.
Wood,
In
Athridge v. Iglesias,
the court considered brain injuries similar to those of the
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instant plaintiff.
Athridge v. Iglesias,
Considering the pain and suffering that the plaintiff has already suffered and will continue to suffer throughout his life because of his injuries, and considering the $4,000,000 damage award in
Athridge
for a plaintiff with similar but slightly less severe injuries, the court awards the plaintiff $5,000,000 in pain and suffering damages.
Wood,
C. Past Medical Care Expenses
The plaintiff requests an award of $899,325 for the medical care expenses that he incurred because of the accident. Pl.’s 2d Am. Prop. FFCL at 73-75. The defendant does not contest this amount, but asks the court to subtract from this award the amounts that his health care providers forgave or “wrote-off.” Def.’s Reasonable Value Br. at 2. The defendant explains that the amount that the plaintiff actually paid — as opposed to the amount paid plus the written-off amounts — represents the reasonable value of the care. Id. The plaintiff objects to this request, arguing that pursuant to the collateral source rule, any written-off amounts are irrelevant and the award for past medical expenses should be $899,325, the amount billed. Pl.’s Reply at 9.
Plaintiffs are entitled to recover for past medical care expenses as well as the cost of reasonable diagnostic examinations.
Friends For All Children, Inc. v. Lockheed Aircraft Corp.,
The collateral source rule explicitly permits compensatory damages to include written-off amounts.
Hardi,
The collateral source rule applies in this case because the source of the benefit, the plaintiffs medical care providers’ alleged writing-off of costs, is independent of the tortfeasor.
Hardi,
D. Discounting to Present Value Awards for Future Damages
Before addressing the substance of the damages awards for future lost wages and medical and related expenses, the court discusses the methodology of calculating the present value of an award for future losses. For this purpose, the plaintiff advocates using the market interest rate method, while the defendant favors the real interest rate methodology and offers testimony of the use of an annuity as relevant to the present value calculation. Pl.’s 2d Am. Prop. FFCL at 78; Def.’s Prop. FFCL at 24, 29.
Courts must discount to present value lump-sum damages awards intended to compensate for future medical costs or future lost wages.
Jones & Laughlin Steel Corp. v. Pfeifer,
Regardless of the method of calculation, the court must rely on competent evidence in determining the discount rate.
Colleen v. United States,
The first case in this jurisdiction that dealt with the effects of inflation in arriving at an award for loss of future income was
Barriteau,
In an FTCA case, the Ninth Circuit held a military hospital liable for causing severe disability to a newborn child.
Trevino,
As in
Barriteau,
Dr. Lurito utilized the market interest rate method in the instant case. Dr. Lurito calculated the likely escalation of future wages and future care costs and then discounted those future damages figures to present value using an after-tax discount rate.
Barriteau,
In this case, Dr. Lurito used a 4.5 percent after-tax discount rate to reduce to present value the plaintiffs future lost earnings and medical and related expenses. His choice of this rate is in line with the basic economic principles discussed in
Pfeifer,
The appropriate net discount rate depends on the economic facts that the parties have proven.
Culver v. Slater Boat Co.,
Considering the defendant’s annuity evidence, the court notes that evidence regarding the cost of an annuity is not a fair measure of the present value of the plaintiffs future damages.
Wood,
E. The Plaintiff’s Award for Future Lost Wages
The court now turns to the plaintiffs claims for future lost wages. The plaintiff seeks an award of $2,562,906, and the defendant asserts that the award should be $546,663. Pl.’s 2d Am. Prop. FFCL at 93; Def.’s Prop. FFCL at 12.
Considering the plaintiffs request for future lost wages, the court must evaluate whether he has proven the future consequences of the accident by a reasonable certainty.
Wood,
Accordingly, the court considers that before the accident the plaintiff had several problems, including (1) the past abuse of alcohol, marijuana, cocaine, inhalants, and intravenous drugs, (2) the present abuse of marijuana and (3) a diagnosis of depres
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sion. The plaintiffs prospects improved, however, in January 1997 when he returned to the United States to live with his mother, largely due to her close supervision of him. At the time of the accident, the plaintiff was in school, was excelling in his position at Kentucky Fried Chicken, was a devoted and reliable member of a soccer team, and was planning to attend NOVA.
McDavitt,
After determining the amount of future earnings that the plaintiff would have earned but for the tort, the court must discount the amount to its present value.
Barriteau,
F. The Plaintiffs Award for Future Medical and Related Expenses
Considering the issue of future medical and related expenses, the court notes that the plaintiff asks for $15,435,836 for these future costs. Pl.’s 2d Am. Prop. FFCL at 93. The defendant argues that this award should be $3,805,000. Def.’s Prop. FFCL at 20. In estimating the cost of the plaintiffs future medical and related expenses, the court recognizes the significant discrepancy between the parties’ estimates.
The plaintiff is entitled to an award for future medical and related expenses that are reasonable and necessary.
Muenstermann,
After listening to and reviewing the extensive testimony regarding the plaintiffs life care plan, the court concludes that the plaintiffs experts recommend all of the items in the plaintiffs life care plan as reasonable and necessary for the future treatment of his injuries as caused by the accident.
Muenstermann,
Dr. Lurito, the plaintiffs expert economist, relied on Nurse Barker’s life care plan to calculate the plaintiffs future medical and related expenses as necessitated by the accident. As stated previously, an expert economist may rely on the opinions of other experts.
Groobert,
G. Reversionary Medical Trust
The defendant argues that the court should permit the defendant to provide the plaintiffs damages award for future medical costs in a reversionary trust. Def.’s Prop. FFCL at 20-23. The plaintiff and the court-appointed guardian ad litem object to this proposal. Pl.’s Reversionary Trust Br. at 4; GAL Reversionary Trust Br. at 2.
In determining whether a reversionary trust is appropriate, the court gives significant weight to whether the plaintiff or his guardian
ad litem
consent to the use of a reversionary trust.
Hull I,
H. Guardian ad Litem Costs
The plaintiff asks the court to tax the guardian ad litem fees against the United States as costs. Pl.’s 2d Am. Prop. FFCL at 91. The defendant objects to this request. Def.’s GAL Fees Br. at 1. The plaintiff, however, has not submitted any evidence detailing the relevant guardian ad litem costs.
In FTCA actions, courts have interpreted Federal Rule of Civil Procedure 54(d) to allow taxation of guardian
ad litem
expenses as costs against the United States.
Hull I,
To the extent the guardian
ad litem
was performing his guardian role — acting as an officer of the court and looking after the interests of the plaintiff — the defendant should pay his costs. Thus, the court grants the plaintiffs request for taxation of the guardian
ad litem
expenses as costs against the defendant.
Hull I,
I. FTCA Cap on the Damages Award
On September 8, 1998, pursuant to the FTCA, the plaintiffs counsel filed with the defendant an administrative tort claim seeking $20,000,000 for “personal injury.” Compl. Ex. C (Form 95 dated Sept. 8, 1998). The plaintiff now asks the court for a damages award of $26,898,067. Pl.’s Prop. FFCL at 93. The defendant argues that the FTCA limits the plaintiffs recov *302 ery to the amount in the administrative claim, $20,000,000. Def.’s Resp. at 16. The plaintiff has presented no evidence on this issue and has not addressed this issue.
Considering the relevant law, the court notes that the FTCA explicitly states that a plaintiffs damages under the FTCA are limited to the amount requested in the administrative claim unless the plaintiff can satisfy a stringent “newly discovered evidence” or “intervening facts” standard. 28 U.S.C. § 2675(b);
Pullen v. United States,
In this action, the plaintiff has not argued that any evidence could qualify as “newly discovered evidence” or “intervening facts.” Indeed, as the defendant points out, the plaintiffs condition has improved since he filed his administrative claim. Def.’s Resp. at 16. Having reviewed the evidence of the plaintiffs condition, the court concludes that no “newly discovered evidence” or “intervening facts” exist that could justify an increased amount for the plaintiffs personal injury claim.
Dickerson,
IV. CONCLUSION
For all these reasons, the court grants the plaintiff the following compensatory damages: $5,000,000 for pain and suffering, $899,325 for past medical expenses, $2,562,906 for future lost wages and $15,435,836 for his future medical and related expenses. The court reduces the total award to $20,000,000 to account for the fact that the plaintiffs administrative claim for damages requests that amount. The court also declines to adopt the defendant’s request for a reversionary medical trust and determines that the defendant shall pay any fees of the guardian ad litem for services rendered in the guardian ad litem role. An order directing the parties in a manner consistent with this Memorandum Opinion is separately and contemporaneously issued this-day of September, 2003.
Notes
. References to the official trial transcript are to the day and page. In other words, "Tr. 1/6-7” denotes the trial transcript for day 1 of the trial at pages 6-7.
. The 2002 Economic Report of the President states:
Health care spending grew rapidly during the past decade, from $916.5 billion in 1990 to $1,311.1 billion in 2000, or more than 3.6 percent a year on average (2.6 percent a year in per capita terms; Chart 4-1). Home health care expenses and drugs were the fastest growing categories of this expenditure (Chart 4-2). The real, constant-dollar cost of private health insurance increased by 4.9 percent a year between 1984 and 1999.... Growth in health care costs is projected to accelerate, with total expenditure predicted to account for 16 percent of GDP by 2010. Over the longer term, forecasts predict that health care spending will become even more predominant in the economy, continuing a 60-year economic trend and reaching as much as 38 percent of GDP under conservative assumptions.
2002 Econ. Report of the Pres, at 149 <http://w3.access.gpo.gov/usbudgeiyfy2003/ pdf/2002_erp.pdf> (emphasis added).