FDA TO REMOVE UNAPPROVED DRUGS

I thought the Food and Drug Administration’s (FDA) job was to make sure prescription medications were safe and effective! If so, why it is such big news that the FDA says it plans to step up efforts to remove unapproved drugs from the market? An accelerated removal of unapproved drugs will apparently take place this year. The FDA’s action apparently came about as a result of an USA Today story which pointed out that many doctors and pharmacists are unaware that nearly 2% of the prescription drugs on the market have never been scrutinized by the agency.

Why doesn’t the FDA just ban all unapproved drugs?

For more stories on the FDA and its efforts:

· Questions and Answers About Unapproved Drugs

· FDA Continues to Tackle Unapproved Drugs

· FDA Advances Effort Against Marketed Unapproved Drugs

· Unapproved Drugs Called “Threat”

INTEGRITY WANTED

I received some sad news today. A friend from college was recently indicted and plead guilty to conspiracy charges relating to one of the DC corruption cases - you know the one, citizen bribes public official, and all on the ship go down too... Well, it reminded me that professionals, more than any other skill or gift, need to serve with integrity.

NURSES - don't write something in the records you didn't do. I know it may be a crazy day, but did you really assess that patient for pain or examine the wound before you wrote, "no pain" "no change in wound?"

DOCTORS - please take a few extra minutes, when prescribing medication, to review the chart - make sure there is not a known allergy. Did a different medication work well before? Please explain why a new one is being prescribed, and go the extra step and speak to the patient yourself.

ADMINISTRATION (HEALTH CARE) - non profit or not, I know you have budgets, and botom lines, and maybe even a Bd. to report to, but please do the right thing. Hire more nurses, pay them better - make good health care your priority, not making money.

FAMILY MEMBERS - be present with your sick loved one. Be diligent about their care, take notes, remember who you spoke with about their care - write it down if necessary.

ATTORNEYS (couldn't leave them out today) - return phone calls, don't take cases you know little about, and always be compassionate, after all, you are "counselors" at law too.

My hope is that if we all act and serve with integrity, less medical errors will occur, more providers hired to do the work - and yup, wouldn't it be nice if there were no malpractice cases, because there were no errors.

10 THINGS YOUR HOSPITAL WON’T TELL YOU!

Treatment errors are common, finding someone in charge can seem impossible, patients sometimes wind up sicker than when they arrived, and bacterial infections are everywhere! And here's a tip: Try to avoid hospitals late at night, in July, and on holidays. Read a great article on these issues in SmartMoney.com

Getting ready to be hospitalized? Here are some must reads:

· Dr. David Sherer's Hospital Survival Guide: 100+ Ways to Make Your Hospital Stay Safe and Comfortable

· Protect Yourself in the Hospital: Insider Tips for Avoiding Hospital Mistakes for Yourself or Someone You Love

· How to Survive Your Hospital Stay: The Complete Guide to Getting the Care You Need--And Avoiding Problems You Don't

ABUSE OF ELDERLY IS NEWSWORTHY!

The Philadelphia Inquirer is running a series of articles on the abuses which befall residents in assisted living facilities and nursing homes. These same problems exist in our fair state of Virginia.

Read the first installment of the article here.

THE RELATIONSHIP BETWEEN DELIRIUM AND DEMENTIA

Dementia, including Alzheimer’s disease, is one of the most devastating conditions of older age. Currently affecting nearly 7 million individuals in the United States and 24 million worldwide, dementia leads to total loss of memory and the inability to function independently—making it one of people’s greatest fears of aging.

Delirium is an acute state of confusion, a common and serious complication in older individuals that often follows surgery or serious illness. Sometimes accompanied by disorientation, paranoia, and hallucinations, delirium develops in 14% to 56% of all hospitalized seniors, complicating hospital stays for more than 2.5 million older individuals in the United States each year.

For the most part, dementia and delirium have been viewed as separate and distinct conditions. But a special section of January’s The Journal of Gerontology: Medical Sciences looks at their interface, asking: Can delirium itself lead to the development of a cognitive disorder? Do delirium and dementia represent opposite ends of the same spectrum of disease rather than two separate conditions?

In a 1999 study in The New England Journal of Medicine reported that delirium could be decreased by 40% by implementing a number of interventions while patients are hospitalized. These include making sure that patients are oriented and hydrated, up and walking, using their hearing aids and vision aids, and avoiding the use of sleep medications.

RESIDENT FREEZES TO DEATH OUTSIDE NURSING HOME

Talk about an unnecessary tragedy! A 76 year old Alzheimer’s patient wandered away from an Indiana nursing home and was found last week …frozen to death. The nursing home, Bradner Village Health Care, is located near Marion, Indiana. The primary cause of the resident’s death was hypothermia. Read the fully story here.

Nursing homes must have working alarms on all exits – there is no excuse!
Nursing homes must have enough trained staff to respond immediately to a door alarm!
Nursing homes must have nightly procedures for accounting for all residents!

Is your mother or father in a safe nursing home? Better ask these questions.

BUSH BUDGET WILL REDUCE CARE PROVIDED BY NURSING HOMES

The Bush Administration is proposing cuts to programs that benefit or protect long term care beneficiaries, including almost $25 billion from Medicaid over the next five years and $1 million from the long term care ombudsman program. The Administration’s FY 2008 budget proposal also asks Congress to cut Medicare rate increases for skilled nursing facilities by $10 billion over five years! These cuts will result in further reductions of already inadequate levels of staffing and limit state supervision.

State ombudsman programs would lose $1 million under the proposal. The programs’ caseload grew by 32 percent between 2000 and 2005, while their capacity to investigate complaints decreased. Ombudsmen currently are handling about 300,000 complaints a year, and their caseload is expanding with the rapid growth of assisted living.

State survey and certification programs are already having difficulty hiring and retaining qualified surveyors because of noncompetitive salaries and heavy workloads. The President’s budget proposal would reduce federal matching funds for administration of survey and certification from 75 percent to 50 percent, costing states almost a billion dollars a year. With the cuts, states would have even less ability to hire surveyors with the clinical skills and regulatory knowledge necessary to conduct inspections and investigate complaints.

State Medicaid fraud control units, which prosecute nursing home neglect and abuse, would also have their federal matching funds for administration cut from 75 percent to 50 percent. Legal services offices, which often are on the front lines providing free legal representation for long term care residents, would lose almost 5 percent of their overall funding.

The new Democratic majority in Congress is not likely to embrace the President’s budget with open arms. However, the risk is real and it is important that concerned citizens call their Senators and Representatives' offices (202/224-3121) and ask them to oppose the President's budget proposal. The budget cuts will only hurt nursing home residents!

The Center on Budget and Policy Priorities has an excellent analysis of the proposed Medicaid cuts on its website.

VIRGINIA LEGISLATORS DISAPPOINT

Every few days while the Virginia General Assembly is in Session, I check up on my elected officials to see what exciting new laws have been passed. Generally, I am not in favor of greater governmental control that often comes as a result of the "purse strings"... but there are a few exceptions. I don't know who Vivian Watts is, but I commend the Delegate for her HB 2607 which would have required nursing homes to establish staffing standards, and record the hours of direct care provided by nursing home staff. The bill can be found on the Gen. Assembly's website:
http://leg1.state.va.us/cgi-bin/legp504.exe?071+sum+HB2607. In her impact statement, the Delegate writes the law is necessary because "DMAS calculates that approximately 85% of nursing homes will have to add a total of 6.8 million nursing hours by 2012, a 23% increase over the total nursing hours currently provided nursing home residents statewide, to meet the staffing standards. Since Medicaid pays for approximately 65% of nursing home days, Medicaid would incur costs related to approximately 4.7 million additional nursing hours. The average cost in 2005 for each additional nursing hour worked was $17.70. The staffing cost was adjusted 5% annually for inflation. Based on these assumptions, this legislation will result in $126,176,664 million in additional costs for nursing facilities in FY 2013, a 12% increase in total nursing facility expenditures. Medicaid expenditures would increase as facilities attempt to increase their staffing." http://leg1.state.va.us/cgi-bin/legp504.exe?071+oth+HB2607F122+PDF

I have some other ideas of why the law is a great idea:
1. Requirement to hire more. (No longer can the excuse be, it was a weekend and everyone was off).
2. Accountability. (Don't hire - don't provide required care, you don't get paid and lose your license).
3. Standards. We have clients ask all the time, "they have to have 1 nurse for every few residents, don't they?" But for the need to have one RN on grounds at all times, the answer is basically no.
4. Helps the nursing staff. (Ask someone who provides care in a nursing home if the home is understaffed - I am quite confident they will say yes.)
So what happened to this great bill that Delegate Watts proposed?

Tabled, which is a nice word for ignored - and not sent to the Senate.

So what now? If the "tabling" of this law bothers you, do something about it. Contact one of the members of the Health, Welfare & Institutions Commitee, and express your disappointment. Need some help - well here is a link to all the Committee members. http://leg1.state.va.us/cgi-bin/legp504.exe?071+com+H12. Let me know what happens, I am waiting!

HEALTH LITERACY

http://www.washingtonpost.com/wp-dyn/content/article/2007/02/16/AR2007021602260.html This article will upset you. Woman wakes up after surgey to realize part of her uterus has been removed. Did she know she was going in for a hysteroctomy? YES... but didn't have the reading ability to read the papers she signed regarding the surgery.

If you are reading this blog, then I am guessing literacy is not a daily struggle in your life... but maybe you know someone who cannot fully understand the details of a medical procedure - or its ramifications. What do you do?

Grandmother have dementia? Think she understands the medications she is on, or surgeries that have been proposed? What about a family member or friend where English is a second language. If our health care providers don't take the time to explain procedures, their ramifications, etc (AND MANY, NO MOST OF THEM DO!) then we need be advocates and investigators for our friends and family. You know, my Mother's doctor recently got mad at me - because I had done so much research on a medication, I scared my Mother into stopping the med... WELL, that was not my intent, but at least now her decision is one based on research, knowing both sides, and weighing her options.

MORE THINKING ABOUT SCREENING COLONOSCOPIES

Colonoscopy is the preferred and most effective strategy for colorectal cancer screening. However, the benefit of any procedure must be weighed against the potential risks. This is particularly important as it relates to screening exams, which for the most part are done in otherwise healthy individuals.

A retrospective study was conducted via a review of electronic records involving approximately 36,000 colonoscopies performed at Kaiser Permanente, an integrated healthcare delivery system. Of the 16,318 eligible colonoscopies, the incidence of serious complications was 5/1000 procedures. The 82 cases of serious complications that occurred involved 15 perforations, 53 cases of bleeding requiring hospitalization, 38 cases of bleeding requiring inpatient observation, 6 cases of diverticulitis. There were 10 deaths (0.6/1000) within 30 days of the procedure, but only 1 of these was directly related to colonoscopy.

A significant discovery from this study is the importance of recognizing the consequences of removing small lesions that otherwise might not have needed removal. It is recognized by experts that the prime risk in removal of many of these smaller lesions actually derives from the use of cautery. Therefore, many experts have switched to a "cold snare" guillotine-type removal approach for these smaller lesions.

Read the entire article here.

THIS REALLY HAPPENED!

Lauren posted an article a couple of days ago (2-16-07) entitled, “Don’t Assume Anything.” I want to put some more flesh on the bones of her article and tell you what we heard in depositions last week in one of our medical malpractice cases. Our client had gone to the same primary care doctor for years. The doctor’s records noted his patient/our client was allergic to a certain type of antibiotic medication. Our client sees the doctor and is diagnosed with a urinary tract infection (UTI) and you guessed it … the doctor called in a prescription for the very antibiotic to which our client was allergic!

Some of our readers will say … well, surely the pharmacy where our client had been getting her prescriptions filled for a many years would catch the problem and not fill the prescription. You would be wrong! The pharmacist denies he has any responsibility for catching these problems.

Other readers will ask …why didn’t your client recognize the name of the drug on the pill bottle or the appearance of the pills and know she should not take the medication. Good question – but the name on the prescription vial was the generic name of the drug which she had never seen before and the pills in the bottle did not look like the pills she knew she was allergic to!

What happened to our client? After taking the medication for several days and getting weaker and sicker, she was admitted to the hospital Intensive Care Unit where she ultimately suffered a stroke which caused partial, but permanent, paralysis. The client used to live on her own and was fully independent. She now resides in a nursing home with a greatly reduced quality of life.

10 TIPS ON FINDING A NURSING HOME

1. Know your rights. If a hospital tells you your loved one must be discharged within 24 hours, you have appeal rights under Medicare that can extend your relative's stay by two days and give you time to research nursing homes. Ask the hospital for a copy of "An Important Message from Medicare," or call toll-free 1-800-633-4227.

2. Use the Eldercare Locator. It will connect you with your local agency on aging, which can give you names and locations of nursing homes. Go to the Eldercare Locator on the Internet or call toll-free 1-800-677-1116

3. Do lots of clicking. Consumer Reports recently completed an investigation of nursing homes. Click here and select your state and you will be provided with a list of facilities to consider or avoid.

4. Tap into other resources. You can check less complete surveys of nursing homes through the Nursing Home Compare database on the Web site of the Center for Medicare and Medicaid Services (CMS).

5. Check state survey reports. When you visit a nursing home, ask for a copy of the state inspection survey. It will reveal the results of unannounced visits by state surveyors who spoke with residents and checked on conditions and care issues.

6. Contact the state's Long-Term Care Ombudsman Program. Call toll-free 1-888-831-0404 or visit the site on the Internet.

7. Make unannounced visits more than once. Visit nursing homes at different times of day. Are many residents still in bed at 10 a.m.? Do many eat dinner in their rooms rather than in the dining room? These all can be signs of an understaffed facility that isn't giving its residents enough stimulation.

8. Stay alert for other details. Are toilet needs being met right away? Are there safety precautions to prevent accidents? Are exercise and rehabilitation sessions scheduled regularly? How does the staff interact with its residents?

9. Sit down with the administrator. Ask about his or her views on long-term care and find out if the home has seen a lot of high-level turnover in recent years, which could be a sign of instability.

10. Inquire about Medicaid. If your relative lives in a nursing home for a long time, his or her financial resources most likely will be exhausted and he or she will then be eligible for Medicaid. Get in writing the nursing home’s payment policy once private money or Medicare reimbursements run out.

NURSING HOMES HIDE FROM LEGAL ACCOUNTABILITY

I have written here before about the dangers of signing an arbitration agreement when you admit your family member to a nursing home. The effect of this legal document is that the home can sue the resident for non-payment of fees, etc. but the resident (or resident’s family if they died as a result of poor care) cannot sue the nursing home for its negligence. Doesn’t seem fair does it?

Now the big corporations which own (and profit from) nursing homes have devised yet another way to avoid accountability. The corporate owners of nursing homes are now setting up “shell corporations” to operate the facility. These shell corporations have no assets and no insurance. The owner of the building and the property on which it is built “skims off” the profit by charging excessively high rents from the corporate operator of the nursing home….thereby making the operator penniless and uninsured. The result is the true owner of the nursing home makes its profits in the way of exorbitant rent but has no exposure to claims for poor care! Like taking candy from a baby!

Don’t believe me? Read what Consumer Reports has to say about this scheme!

DOES VIRGINIA CHECK UP ON ITS BAD DOCTORS?

According to the Richmond Times Dispatch newspaper, when state officials learned a Hampton Roads physician was convicted of felony child-pornography charges, the Board of Medicine suspended the doctor's medical license right away. The doctor, Lawrence Brielman Ryan, was in the U.S. Naval Reserve medical corps when he was court-martialed in 2004 for possessing and distributing child pornography. Virginia-licensed doctors have lost their licenses for drug diversion, income-tax evasion, mail fraud, unlawful prescribing, drunken-driving-related manslaughter and other felonies.

How is Virginia doing in its obligation to protect the public from bad doctors? It depends on how you look at the numbers.

Public Citizen, a national, nonprofit consumer advocacy organization founded in 1971 to represent consumer interests has published a report which sheds some light on this question. The report says doctors with criminal convictions are often getting by with a slap on the wrist from state regulators.

Virginia’s rate of 2.65 disciplinary actions per 1,000 doctors put the state in 34th place.
Public Citizen says that nearly two-thirds of the states have a higher rate of imposing serious disciplinary actions against physicians. This fact could mean a number of things:

• That Virginia is doing a poorer job than most other states of disciplining physicians.

• That Virginia is blessed with better qualified and more conscientious physicians than are most other states, resulting in less need for disciplinary action.

Read the report for yourself. How good of a job do you think Virginia is doing in protecting its citizens from incompetent doctors?

DON'T ASSUME ANYTHING

This week has been very enlightening, and not in a good way. I have learned a great deal about some aspects of the healthcare profession. Now, I preface my comments with the following statement: I know that not all health care providers operate this way, and that many, go to great lengths to make sure the care their patient is receiving, is the best care available. Now, having said that, let me make another comment - Just because you have told your physician, nurse, or pharmacist that you have an allergy, or that your body doesn't react well to a certain medication - DO NOT ASSUME THAT THIS IS WRITTEN DOWN, IN YOUR PERMANENT RECORD, or EVEN THAT THEY WILL REMEMBER.

Now maybe it is necessary to remind us all, that our physicians and pharmacists are busy, and that we are not their only patient.... But, just because you told them you were allergic to a medication on your last visit, don't assume they remembered. Also, anytime you pick up a medication, tell your pharmacists "I am allergic to ___ drug. This isn't that medication is it? Will this one interact with what I am taking."

You would be surprised, no, maybe amazed to learn that busy physicians don't always look back at your file when writing a prescription. That their nurses' may not have time to check records. That the clinic, or office, may not have kept your old records when they went to electronic records. Don't assume anything - ASK QUESTIONS, BE PROACTIVE, Tell your friends and family the name of medications /foods to which you have a known allergy. In fact, write it down and tell every healthcare provider you meet.

Do you know the generic name as well? You should. You may know you are allergic to Bactrim, but what is the generic form? Also, it might be a good idea to know what the pills should look like. Look them up on the internet - just to double check you were given the correct medication.

Lastly, if a certain medication works for you - tell your physician. There is no sense trying something new for an infection, or something routine, if the other one has worked well with few side effects. Your physician may have forgotten that Drug A works great for you... REMIND THEM. We would hate to have you harmed by a mistake, simply because you assumed your physician or phramacist, wrote down what you told them.

As a last word, be diligent about informing your providers about an allergy. Never assume they know, or that they wrote it down when you told them the first time.

CRIMINAL CHARGES AND NURSING HOME ADMINISTRATORS

We posted an article several months ago that bad nursing home administrators should go to jail! Not surprisingly, we received a private email from a nursing home administrator who believed our comments were outrageous. Well… maybe not as it seems that nursing home administrators are continuing to find themselves facing criminal charges for their outrageous conduct.

The first example arises from a bad situation in Pittsburgh. Martha Bell, the former administrator for the Ronald Reagan Atrium Nursing and Rehab Center was convicted of involuntary manslaughter and sentenced this month for the death of an 88 year old resident with Alzheimer’s disease. The resident wandered outside of the facility in 40 degree weather and died from exposure. Mrs. Bell attempted to cover up the event (by ordering nursing aides to place the resident’s body back in her bed and tell the family she died in her sleep) and will now spend almost 4 years in prison. Read the story here.

The second example is even worse. Donna M. Cameron, the administrator for the St. James Retirement and Rehab Center in Chester, Pennsylvania has been charged with criminal neglect, perjury, and record tampering. According to prosecutors, Mrs. Cameron neglected a deep head wound suffered by a 72 year old resident for so long that the wound filled with maggots and later tried to conceal the poor care by altering the records. Read the full story here.

I hope that some of the nursing home administrators who regularly read this blog will post their reaction to these outrageous events and tell us all why these people should escape criminal prosecution! I’m waiting……

THE LEAPFROG GROUP

You may know more about the TV or DVD player you want to buy than the hospital where you are about to be admitted for surgery. That just doesn’t seem right to me!

A relatively new advocacy group is out to change the situation. The Leapfrog Group is a voluntary program aimed at mobilizing employer purchasing power to alert America’s health industry that big leaps in health care safety, quality and customer value will be recognized and rewarded. Among other initiatives, Leapfrog works with its employer members to encourage transparency and easy access to health care information as well as rewards for hospitals that have a proven record of high quality care.

The Leapfrog Mission statement is clear: Their goal is to trigger giant leaps forward in the safety, quality and affordability of health care by:

· Supporting informed healthcare decisions by those who use and pay for health care; and,
· Promoting high-value health care through incentives and rewards.


Check out your hospital’s Leapfrog’s quality rating here.

DOCTORS OFTEN FAIL TO TELL PATIENTS DANGERS OF NEW DRUGS

Has your doctor changed your medications recently? What about prescribing a new drug altogether? If so, did your doctor tell you all you need to know about that drug? Probably not according to a new study published in the Archives of Internal Medicine.

An observational study conducted by Dr. Derjung Tarn from the School of Medicine at the University of California at Los Angeles (UCLA) finds that physicians often fail to communicate critical information about new prescription medication to patients. The missing critical information included a disclosure of side-effects and proper dosing. The lesson to be learned by the informed patient - ask you doctor about proper dosing, side-effects, interactions with other medications you are taking, what to do about missed doses, etc.

Read an abstract of the study here.

FOOD DOES IT AGAIN

This blog is a medical malpractice blog.... dedicated to discussing issues surrounding health care in the United States. Today, I digress, just a little. Its about our food supply, so yes, today, its about corporate negligence. I read in the Washington Post this morning (link below) that a recent batch of Peter Pan peanut butter is being linked to salmonella poisoning. "Hmm," I thought to myself... That is what I had for breakfast yesterday (needed the protein). So - I walked back to our office kitchen, and sure enough, the same batch number. And people wonder why I (along with Millions of other Americans) buy organic foods over non-organic, or why I pay extra for beef and chicken that has never seen a hormone or antibiotic injection. SO my closing word is, HEALTHCARE is as broad term. Take care of yourself, do the research on what you eat, the doctors you see and the medication you take. If we don't require corporate accountability, its up to the consumer to do be proactive. http://www.washingtonpost.com/wp-dyn/content/article/2007/02/14/AR2007021401486.html Enjoy!

ALL MEDICATIONS / VACCINES HAVE SIDE EFFECTS

http://www.washingtonpost.com/wp-dyn/content/article/2007/02/13/AR2007021301132.html

More bad news from the FDA... a vaccine, 3.5 million in production, may harm infants and children. Check out this article.

HOW TO PREVENT PRESSURE SORES AND DECUBITUS ULCERS

If bedridden or immobile with diabetes, circulation problems, incontinence, or mental disabilities, you should be checked for pressure sores every day. Look for reddened areas that, when pressed, do not turn white. Also look for blisters, sores, or craters. The following steps are crucial in preventing the development of decubitus ulcers:

· Change position at least every two hours to relieve pressure.
· Use items that can help reduce pressure -- pillows, sheepskin, foam padding, and powders from medical supply stores.
· Eat healthy, well-balanced meals and drink plenty of fluids.
· Exercise daily, including range-of-motion exercises for immobile patients.
· Keep skin clean and dry - incontinent people need to take extra steps to limit moisture.

Changing position every two hours is critical to the prevention of pressure sores. All nurses working in the long term care industry know that changing a resident’s position every two hours is a must. The only problem is that most nursing homes are so understaffed that there are not enough nurses and nursing aides to do the job!

For more information read the National Pressure Ulcer Advisory Panel’s recommendations.

BED SORES = PRESSURE ULCERS = DECUBITUS ULCERS = PRESSURE SORES

We have all heard these terms discussed by nurses, family members and in the media. Is there a difference? The answer is no. All of these terms refer to the same condition which occurs when pressure is exerted on the skin, soft tissue, muscle, and bone by the weight of an individual against a surface beneath. These pressures are often in excess of capillary filling pressure, (the pressure it takes to fill small blood veins). In patients with normal sensitivity, mobility, and mental faculty, pressure sores do not occur. Feedback, both conscious and unconscious, from the areas of compression leads individuals to change body position or move.

Many factors contribute to the development of pressure sores, but pressure leading to ischemia (or lack of oxygen) is the common cause. Tissues are capable of withstanding enormous pressures when brief in duration, but prolonged exposure to pressures slightly above capillary filling pressure initiates a downward spiral towards ulceration.

Impaired mobility is an important contributing factor. Patients who are neurologically impaired, heavily sedated, restrained, or demented are incapable of assuming the responsibility of altering their position to relieve pressure. Moreover, this paralysis leads to muscle and soft tissue atrophy, decreasing the bulk over which these bony prominences are supported.

Read a more detailed explanation in this article from WebMD.

My next post will discuss ways to avoid pressure sores or decubitus ulcers.

FRAUD AND CORRUPTION IN NURSING HOMES: TEXAS STYLE

Investigators have alleged that a web of companies that oversaw nursing homes was part of a plan to cheat the government out of millions. The list of allegations includes tax evasion, healthcare fraud, money laundering, and lying to the government. Critics say the industry is ripe for abuse because regulators are kept in the dark.

Complex corporate structures are being created for nursing homes across the country, and Texas and many other states can’t keep tabs on the owners. In Texas, nursing homes are required to meet minimum financial conditions to ensure that they can provide adequate care. Just what are those conditions? The state doesn’t say. Jim Hine, former commissioner of the Texas Department of Aging and Disability Services, said it makes no sense to wait for care at a home to deteriorate. Financial monitoring would give earlier warning signals. He wanted the agency to implement financial standards for operators. A year after his departure, it still has not done so. Does your state require nursing homes to be financially stable? To have liability insurance coverage?

If the charges are true, these individuals who owned over 50 nursing homes, cheated the federal government out of millions of dollars and it residents out of the good and proper care they deserved! Read part one and part two of the investigative series from the Forth Worth Star Telegram.

FDA MEDICAL DEVICE AND FOOD ALERTS

The Food and Drug Administration (FDA) regularly publishes safety alerts and recall information for drugs, medical devices, and foods. It is important information we all should know. For eample, the alert for February 12 is listed below:

Device Recall:

HoMedics heating pads (produced in 2001 and sold in drug, discount and department stores)
Reason for recall: poor connection could cause overheating
http://www.fda.gov/oc/po/firmrecalls/homedics02_07.html

Food Recalls:

Little Debbie Nutty Bars (recall confined to Georgia, North Carolina, Maryland and Virginia)
Reason for recall: an ingredient may contain small metal particles
http://www.fda.gov/oc/po/firmrecalls/mckee02_07.html

Fortune Star brand Dried Lily Bulb; 10 oz. size
Reason for recall: undeclared sulfites
http://www.fda.gov/oc/po/firmrecalls/ho02_07.html

For a list of recalls, market withdrawals, and safety alerts involving FDA-regulated
products from the past 60 days, go to http://www.fda.gov/opacom/7alerts.html.

To access the RSS feed of FDA recalls information, go to
http://www.fda.gov/oc/po/firmrecalls/rssRecalls.xml
[What is an RSS feed? See http://www.fda.gov/bbs/topics/news/newsfeeds.html.]
_____________________________________________

NO SUCH THING AS A FREE LUNCH

Well, at least as far as doctors and their offices go.... http://www.nytimes.com/2007/02/12/business/12drug.html?em&ex=1171429200&en=0cb0e27ca6026e39&ei=5087 Check out the article in the New York Times. This is not the first time we have spoken about the "influence" of pharmaceutical companies on treating physicians. Many of the Nation's top research hospitals (Michigan and U. Penn included) have forbidden physicians from accepting anything, including free lunches from the drug reps. I celebrate this new move. It's not that I don't think doctors are deserving of a good free meal every once in a while.... it's that I fear the gifts of the drug reps my consciously or unconsciously, alter the physicians prescribing habits. When my physician is making a decision on my behalf about which medication is the most effective, I prefer it be the research, and not the free bread sticks that help her make that decision.

CHECK OUT THE VIDEO OF YOUR SURGERY BEFORE IT HAPPENS

Are you scheduled for surgery? If so, I am certain you are a little anxious and concerned. For some people, seeing what actually will take place during the surgery (before it happens) will have a calming effect. If you are one of those people, take a look at the surgical videos made available by the National Library of Medicine and the National Institute of Health.

BLOOD CLOTS IN THE LEGS CAN KILL YOU!

The American College of Physicians and American Academy of Family Physicians has announced clinical practice guidelines for the diagnosis and management of venous blood clots, complications from which claim more than 200,000 lives each year in the United States. A DVT (deep vein thrombosis) occurs when clots form in the legs, often causing swelling and pain. If pieces of these leg clots break off and travel to the lungs, a serious condition known as a pulmonary embolism or PE can occur. An undiagnosed and untreated PE can result in up to 25% mortality. Early diagnosis and treatment is crucial.

There is strong evidence supporting the use of ultrasound for diagnosing blood clots in patients; however, the success rate is much lower for asymptomatic patients with blood clots in the calf vein. Treatment includes anticoagulation therapy (via the use of low molecular weight heparin), and compression stockings. Anticoagulation therapy typically runs for 3 to 6 months, but may last for 12 months or more for recurring clots.

Make sure your doctor fully investigates complaints of leg pain and swelling. Read the entire article here.

PREVENT WALK-AWAY DEATHS IN NURSING HOMES

Each year, vulnerable adults die from exposure after walking-away from their homes, as well as their assisted living and nursing home residences. Long-term care residents and family members with Alzheimer's disease, dementia, those who are confused, or who tend to wander are especially vulnerable.

It is not enough to simply watch over them. Much like children - if you turn your back for a few minutes, they are gone. Think they are asleep or occupied in an activity, before you know it - they are gone! When vulnerable adults do walk-away they are usually not dressed appropriately for the weather conditions. They could be in jeopardy within hours, even minutes.

Caregivers can prevent walk-away deaths by taking these simple precautions:

In Your Homes:

Position locks high or low so they are difficult to reach by affected family members.

Place alarms on all exterior doors that will sound when opened - including garages, enclosed patios, and yards.

In Nursing Homes & Assisted Living Facilities:

Family and staff should locate alarms for all exterior doors including enclosed patios and yards.
Make sure each alarm works. Open the door, do the alarms sound? Do staff members respond to alarms?

Check for tampering. Has the staff disabled the alarm so they can exit the building to smoke, without setting off the alarm? Are doors propped open? Do the locks work?

Encourage bracelets - ask for special bracelets that set off alarms when exiting the building or designated area, if loved ones have Alzheimer's, dementia, or tend to wander.

Request clarification - ask assisted living and nursing home facility staff about search and notification policies, for missing residents.

For All Situations:

Recruit neighbors - ask neighbors in advance to keep an eye out for wandering loved ones and / or residents. If a loved one or resident is missing, recruit neighbors to form an organized search party.

WHY DON’T YOU START AN ADVOCACY GROUP FOR YOUR MOTHER’S NURSING HOME?

Family members often arrive in our offices to complain about the horrible resident care and conditions at the Sleepy Time Nursing Home! They tell me their mother has resided at the facility for several years and has suffered from malnutrition, dehydration, decubitus ulcers, and violent attacks from other residents. They tell me they have complained to the nurses, Director of Nursing, Administrator, and local Ombudsman. No one has made any changes and the care remains poor, at best!

What do you do? How about forming a Residents’ Rights Advocacy Group! This group can provide more “push” for positive changes than you can imagine. Follow the guidelines established by the National Citizens Coalition for Nursing Home Reform (NCCNHR). It’s a great start toward making a difference!

TRIAL BEGINS FOR PRACTICING MEDICINE WITHOUT A LICENSE

You have to read this article to believe it: http://www.chron.com/disp/story.mpl/metropolitan/4535270.html Physician charged with practicing medicine after his license was revoked. The article says he had been sued at least 60 time for malpractice. How could his patients have known he had been sued for malpractice? Well most states operate on-line data bases now where physicians display information, including whether they have ever been involved in a lawsuit. They are great resources, and could have prevented the incident in Texas from happening. In Virginia - go to: http://www.vahealthprovider.com/ Should only take a minute, and may provide some wonderful insight.

HOSPITAL PATIENTS WATCH OUT!

Hospitalized patients can expect to experience at least one medication error a day, says the Institute of Medicine, which advises Congress on health policy. This statistic is outrageous!

While some mistakes are harmless or quickly corrected, others can be deadly. Forty-four thousand to 98,000 Americans a year die from medical errors. Hospitals around the country are taking steps to reduce medical mistakes. But with so much at stake, many experts say patients and their families also need to take a larger role in ensuring their safety in the hospital. Read the USA Today article here.

I thought we went to the hospital to get better!

The Need for Greater Drug Safety

The Food and Drug Administration (FDA) is making encouraging moves to strengthen its regulation of drugs that are already on the market. But the changes fall far short of what's needed to protect millions of unsuspecting patients whose adverse effects may show up only after years of use. The agency has traditionally focused on the drug-approval process to determine if a drug is safe and effective. Unfortunately, by that time a drug has typically been tested in only a few hundred or a few thousand patients - too few for many kinds of adverse effects to become apparent. Once the drug is being used by millions, the agency has limited powers to halt sales that begin to look risky.

Read what the New York Times has to say.

THE RENU CONTACT SOLUTION LITIGATION

In April 2006, the Centers for Disease Control and Prevention (CDC), and the Food and Drug Administration (FDA) confirmed reports of an outbreak of Fusarium keratitis, a harmful eye infection. Research linked the source of these outbreaks to the use of Bausch & Lomb’s ReNu with MoistureLoc contact lens solution. Fusarium keratitis has led to such side effects as eye pain, infection and scarring, blurry vision, glaucoma and, in some cases, blindness.

Many consumers who were affected by their use of the ReNu solution have sought legal counsel. Lawsuits have been filed alleging deceptive marketing practices by Bausch & Lomb and failure to disclose an inherent defect in the company’s products. Civil lawsuits against Bausch & Lomb have been filed in New York, Florida, Texas, South Carolina and Michigan.

Read the FDA warning about the Renu contact solution problem here.

PHARMACEUTICAL COMPANIES ARE KEEPING AN EYE ON YOU!

Next time you take medicine, consider the surprisingly lucrative and circuitous path of that scrap of paper known as a drug prescription form. After the pharmacy fills your order, it sells information about your drug and doctor - though not necessarily about you - to a health-data company, such as IMS Health Inc., Verispan L.L.C. and Wolters Kluwer, all in the Philadelphia area.

The health-data company uses powerful computers to create a scorecard of physicians' drug preferences by combining your transaction with millions of others from doctors and pharmacies nationwide. The health-data companies resell this information to pharmaceutical companies, which employ thousands of sales representatives to pitch drugs to doctors. Many companies tailor their bonuses for reps and pitches - and sometimes rewards - for individual doctors based on these prescription tallies.

The great state of New Hampshire is trying to put a stop to this tactic by the “big brother” pharmaceutical companies and the pharmacies which sell the data. Last year the state passed a law which prohibits this selling back and forth of health data… and the companies making millions of dollars off the process are fighting back. Two health-data companies are suing the state to block the law as an unconstitutional violation of their commercial rights. New Hampshire's attorney general defends the law as a legal way to protect physician confidentiality and reduce health-care costs, blamed in part on sales reps' pushing ever-costlier drugs.

Read the Philadelphia Inquirer’s article on the issue and the litigation here.

Listen to what New Hampshire Public Radio has to say about the lawsuit here.

NURSING HOMES WITHOUT WALLS! A GREAT IDEA

There is a need for more long term care services with people living longer. The goal should be to help senior citizens be more comfortable and that means in their own home.

Many senior citizens are turning to a new type of “nursing home.” They are staying “at home” and letting the nursing and other services come to them! Read an interesting article (and view the video) on this recent development.

NEW FDA VIDEO ALERTS DELIVERED VIA THE INTERNET

The federal Food and Drug Administration (FDA) has started a monthly video news show for healthcare professionals called Patient Safety News (PSN). It covers significant new product approvals, recalls and safety alerts, and offers important tips on
protecting patients.

Read the complete stories and watch or download the video program at http://www.fda.gov/psn. While these PSN stories are directed to medical professionals, they contain important information of which all consumers of healthcare services should be aware.

NEW GUIDELINES URGE CAUTION IN ANESTHETIZING CHILDREN

New guidelines, published in December by the American Academy of Pediatrics and the American Academy of Pediatric Dentistry, urge caution in anesthetizing children. Doctors and dentists who sedate children should be specially trained and use age-appropriate equipment. The special equipment should include emergency “crash carts” stocked with drugs and devices designed for young patients.

The guidelines reflect the need to closely monitor pediatric patients and to be prepared to respond quickly if their breathing becomes suppressed or other problems arise. The new guidelines were intended to address one of the most profound long-term trends in health care: the movement of surgical and diagnostic procedures into doctors’ and dentists’ offices. As a result, more children are receiving sedation outside of hospitals where specialized anesthesiologists are available to deal with life-threatening complications.

NO MEANINGFUL REGULATION OF ASSISTED LIVING FACILITIES

An assisted living facility is not a nursing home. It doesn’t provide medical care and rarely has trained nurses on site. Assisted living facilities are not inspected by or supervised by the federal government. Typically, such facilities are monitored by a state agency – and they are doing a terrible job!

Not only are the states doing a poor job regulating these facilities, state laws and regulations are almost non-existent! For example, only 32 states require CPR and first aid certification for the staff. Just 24 require a nurse on staff and Alabama is the only state in which the medical director must be a doctor.

The Washington Post newspaper did an investigative series of stories on the poor care provided by assisted living facilities in Virginia. The article makes for interesting reading!

See what this CBS News article has to say about this crisis!