Shoemaker Faces Life of Permanent Paralysis : Accident: The former jockey probably will never regain use of his arms and legs, doctors say.

Bill Shoemaker faces the prospect of permanent paralysis from the chest down as well as complications with his breathing, according to a medical statement released Wednesday by Dr. Robert G. Watkins of the Kerlan-Jobe Orthopaedic Clinic.

Shoemaker, horse racing’s all-time winningest jockey who retired last year, suffered a severe fracture dislocation of the cervical spine and a spinal cord injury after a single-car crash April 8 in San Dimas.

He had a blood-alcohol level of 0.13% at the time of the accident on the Foothill Freeway, California Highway Patrol officers said. It is illegal to drive in California with a concentration of 0.08% or greater.

Richard Jenkins, acting head deputy for the Los Angeles County District Attorney’s office in Pomona, said this week that he wanted an accurate prognosis of Shoemaker’s condition before considering the case. His decision on whether to file misdemeanor charges of driving under the influence could be made today.

Shoemaker, 59, is in critical condition at the Centinela Hospital Medical Center in Inglewood. He will be transferred Monday to the Neurotrauma Unit at Craig Rehabilitation Hospital in Englewood, Colo., where he will begin preparing for life without use of his arms and legs.

“He is very alert and familiar with his condition,” said Watkins, a back specialist. “He has no motion or sensation below his upper chest and shoulders. He has had a tracheostomy and his breathing is by means of a ventilator; his spinal cord injury is a complete C4 level.”

A tracheostomy is a procedure by which doctors cut a hole in the windpipe to insert a tube from a respirator. Such surgery usually is performed with the idea that a respirator is needed for a prolonged period, said Dr. John Frazee, an associate clinical professor of neurosurgery at UCLA.

Although it is difficult to say with certainty, neurological experts not associated with Shoemaker’s case said an injury to the fourth cervical vertebra involves a high risk of permanent respiratory damage. The centers for respiratory function are localized in the third, fourth and fifth cervical spinal cord area.

Shoemaker, who had been working as a horse trainer since his retirement from riding, faces two major problems, doctors said.

He has cervical spine instability, which could require traction or corrective surgery. Watkins said in the statement that Shoemaker might need a cervical fusion at some point.

The other problem is the injury to the spinal cord, which is difficult to treat. Frazee said patients with Shoemaker’s injury usually lose function of the arms, legs, bowels and bladder.

Frazee said Shoemaker’s condition was probably caused when one bone in the fracture forced one of the vertebrae out of position. Shoemaker suffered a blow to the head when his car flipped while rolling down a 50-foot embankment off the freeway.

“It is as though two blocks of bone sitting on top of each other get dislodged so that one goes forward and one goes backward,” Frazee said. “As the one goes backward, it strikes the spinal cord and may cut it in two or severely crush it so there is no function.”

Watkins said the Shoemaker family chose Craig Hospital because of its reputation. Located near Denver, the hospital specializes in spinal cord and head injuries. It is one of the few facilities in the country with respirator/ventilator programs.

“The goal is to help patients attain the most function possible,” said Marlene Casini, a hospital spokeswoman. “In the initial part, we give them the options of what they can do. We try to re-empower people so they can have control over their lives.”

Casini said 91% of Craig’s patients have returned home instead of requiring special housing.

Frazee said it is difficult to rehabilitate patients with injuries to the extent of Shoemaker’s because of a lack of muscles to work with.

“He will be alert, awake, totally normal, but he can’t do anything for himself,” Frazee said. “He will always be dependent on someone to move him from place to place.”

Still, depending on his breathing ability, Shoemaker will have many options, experts said. Frazee said patients can develop some independence by using computer technology. He said once in a wheel chair, patients can use their head and mouth to drive themselves.

“In spite of a severe injury, there are still other ways to be semi-independent,” Frazee said. “It would require getting out of bed and being put into a wheelchair, but you can get around, you can talk and use your eyes. You could be functional. It would be slower and more difficult, but you could do it.”