Friday, March 30, 2007
ARTICLE ABOUT CONFIDENTIALITY OF SETTLEMENT AGREEMENTS
On the same note as my prior post, Massachusetts attorney, Eric Parker, has written an article about the decision on confidentiality for settlement agreements. You can read his article here.
PLAINTIFF'S COUNSEL CANNOT BE COMPELLED TO KEEP SETTLEMENT CONFIDENTIAL
In a post today the DC Medical Malpractice Blog writes about a new decision by the District of Columbia Bar Counsel. This decision states that defendants in a medical malpractice lawsuit can no longer require that the settlement details be kept confidential. A settlement agreement “may not compel counsel to keep confidential . . . public information about the case, such as the name of the opponent, the allegations set forth in the complaint on file, or the fact that the case has settled.”
See the full decision here.
See the full decision here.
BAD WEEK FOR NORTH CAROLINA NURSING HOMES
This week’s news contains two bad reports on nursing home care in our neighboring state of North Carolina. First, the Charlotte Observer reported that the conditions at Carolina Medical Center – Union Smith Nursing Center in Monroe, NC constituted “immediate jeopardy to resident health and safety.” State officials conducted an investigation of the facility after a 90 year old resident died after slipping between her bed mattress and bed rail. This blog has previously discussed the dangers of bed rails.
The second bit of bad news comes from the Wilmington Star newspaper. The paper reported that a veterans hospital in western North Carolina (Asheville) was told to stop admitting nursing home patients in 2004 after federal investigators found serious care problems, including a patient who died after an untrained worker removed fluid from his abdomen.
Read the story from the Charlotte Observer.
Read the story from the Wilmington Star.
The second bit of bad news comes from the Wilmington Star newspaper. The paper reported that a veterans hospital in western North Carolina (Asheville) was told to stop admitting nursing home patients in 2004 after federal investigators found serious care problems, including a patient who died after an untrained worker removed fluid from his abdomen.
Read the story from the Charlotte Observer.
Read the story from the Wilmington Star.
Thursday, March 29, 2007
A QUICK X-RAY COULD PREVENT SURGICAL ERROR
The gallbladder is a small sac under the liver that stores and concentrates bile, a fluid that helps the body digest fats. After a meal, the gallbladder contracts and releases bile through the common bile duct into the small intestine. A common but major problem with the gallbladder occurs when a gallstone becomes stuck in the cystic duct (the tube that carries bile from the gallbladder) and blocks fluid from passing out of the gallbladder resulting in an irritated and swollen gallbladder. This condition is called cholecystitis. When this occurs your doctor may recommend the surgical removal of your gallbladder.
Surgery to remove the gallbladder (called a cholecystectomy) occurs about 750,000 times per year in the United States. More and more of these surgeries are conducted laparoscopically – using a laparoscope through several small incisions in the abdomen. It is a “blind” surgical procedure since the surgeon only visualizes the gallbladder and accompanying structures via the scope.
Unfortunately, way too many complications occur with this procedure when the surgeon mis-identifies the patient’s anatomy and cuts the wrong structures. Recently, a number of prominent surgeons, including a review in the current Journal of the American College of Surgeons, have called for greater use of a special type of x-ray called a cholangiogram. This special x-ray helps surgeons correctly identify the gallbladder and all adjacent structures and organs thereby reducing the likelihood of surgical errors. A special group of surgeons who perform gallbladder surgeries, The Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) has also recommended these x-rays as a way to reduce the risk of surgical error.
Read more from the Journal of the American College of Surgeons.
Read the position statement by SAGES.
Does your surgeon use cholangiograms? Better ask?
Surgery to remove the gallbladder (called a cholecystectomy) occurs about 750,000 times per year in the United States. More and more of these surgeries are conducted laparoscopically – using a laparoscope through several small incisions in the abdomen. It is a “blind” surgical procedure since the surgeon only visualizes the gallbladder and accompanying structures via the scope.
Unfortunately, way too many complications occur with this procedure when the surgeon mis-identifies the patient’s anatomy and cuts the wrong structures. Recently, a number of prominent surgeons, including a review in the current Journal of the American College of Surgeons, have called for greater use of a special type of x-ray called a cholangiogram. This special x-ray helps surgeons correctly identify the gallbladder and all adjacent structures and organs thereby reducing the likelihood of surgical errors. A special group of surgeons who perform gallbladder surgeries, The Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) has also recommended these x-rays as a way to reduce the risk of surgical error.
Read more from the Journal of the American College of Surgeons.
Read the position statement by SAGES.
Does your surgeon use cholangiograms? Better ask?
Wednesday, March 28, 2007
NURSING HOME INDUSTRY GIVES GENEROUSLY TO POLITICIANS
Ever wonder why states don’t enact tougher laws to protect the infirm and elderly in nursing homes? Like minimum staffing ratios which require a sufficient number of nurses and aides to take care of the residents. One reason may be that politicians don’t want to pass laws that might “bite the hand that feeds them.”
Last month, The Plain Dealer in Cleveland, Ohio, published a story about how “piles of political money - sometimes brazenly solicited by favor-wielding officials…have contaminated the making of public policy.” Ohio is home to one of the most powerful nursing-home industries in the nation, according to officials who have confronted it.
With the aid of increasingly generous campaign contributions, the industry was able to dictate its own payment rates for Medicaid services in Ohio for most of the last three decades, while remaining Ohio's recipient of first resort for billions in Medicaid long-term-care dollars. The industry was particularly generous in the Ohio House of Representatives, where it contributed more than $377,000 just to the last two House speakers. Read the full article here.
The largest corporate, for-profit, nursing home chain in the state of Virginia, Medical Facilities of America (MFA), is located here in Roanoke, Virginia. MFA owns and/or operates 31 nursing homes throughout the state (click here for a list of facilities). This corporate giant, its officers and employees gave Virginia’s elected officials hundreds of thousands of dollars since 1996!
Check out what MFA, its officers and directors have given to the politicians who make the laws for the Commonwealth of Virginia:
MFA Political Action Committee
MFA (since 1996)
MFA Corporate Officers and Employees (since 1996)
NEW GUIDELINES FOR BREAST CANCER
Everyone is talking about - national and local news, radio, tv.... The American Cancer Society has published new guidelines that require a select group of women, to get mammorgrams and MRIs for early breast cancer detection. http://www.washingtonpost.com/wp-dyn/content/article/2007/03/27/AR2007032702326.html.
What women should fall into this select group? Women at high risk because of a family history of disease, the breast cancer gene (a genetic predisposition). The ACS anticipates this will include as many as 1.6 million women in the United States that fall into this high-risk category.
So my first thought was, "great, guidelines are good" but "will insurance pay for the extra testing?" I know of family friends that have not gotten tested to see whether they have the family gene for fear that a positive will prevent them from having future insurance coverage - so will the companies pay for the MRIs? I sure hope so. Guess only time will tell... and what about women with No insurance - that is a pricey test for someone having to pay cash.
What women should fall into this select group? Women at high risk because of a family history of disease, the breast cancer gene (a genetic predisposition). The ACS anticipates this will include as many as 1.6 million women in the United States that fall into this high-risk category.
So my first thought was, "great, guidelines are good" but "will insurance pay for the extra testing?" I know of family friends that have not gotten tested to see whether they have the family gene for fear that a positive will prevent them from having future insurance coverage - so will the companies pay for the MRIs? I sure hope so. Guess only time will tell... and what about women with No insurance - that is a pricey test for someone having to pay cash.
Tuesday, March 27, 2007
NEW FLASH TODAY -
SAN FRANCISCO- Laguna Honda Hospital and Rehabilitation Center has received the state's most severe citation and fine after the California Department of Health Services determined that the poor care of an 82-year-old resident led to her death.
State Public Health Officer Dr. Mark Horton announced Monday that the skilled nursing facility in San Francisco received the ominous "AA" citation and a $100,000 fine after the investigation into the Oct. 30 death of a resident with dementia.
The woman, who had a history of falling and wandering out of the facility, was found unresponsive on the ground in a small garden, where she was pronounced dead by a physician. The coroner's report did not specify the cause of the fall.
The Department of Health Services said Monday that facility managers failed to review, evaluate, update and implement a care plan for the resident. The facility also failed to control the resident's history of wandering outside, the department reported.
Are you surprised that a resident could get out? Make it all the way outside with no one noticing? Don't be - there was a Va. case this fall - where a resident actually fell down a huge hill after eloping - 1.4 million verdict. We get calls frequently from families re: their loved ones - found outside, in the parking lot, fallen down stairwells - its a real problem. Dan this week blogged about "wandering" risks or elopement risks. If your loved one wanders (especially a risk for dementia) - TELL THE FACILITY TO KEEP AN EYE OUT!
SAN FRANCISCO- Laguna Honda Hospital and Rehabilitation Center has received the state's most severe citation and fine after the California Department of Health Services determined that the poor care of an 82-year-old resident led to her death.
State Public Health Officer Dr. Mark Horton announced Monday that the skilled nursing facility in San Francisco received the ominous "AA" citation and a $100,000 fine after the investigation into the Oct. 30 death of a resident with dementia.
The woman, who had a history of falling and wandering out of the facility, was found unresponsive on the ground in a small garden, where she was pronounced dead by a physician. The coroner's report did not specify the cause of the fall.
The Department of Health Services said Monday that facility managers failed to review, evaluate, update and implement a care plan for the resident. The facility also failed to control the resident's history of wandering outside, the department reported.
Are you surprised that a resident could get out? Make it all the way outside with no one noticing? Don't be - there was a Va. case this fall - where a resident actually fell down a huge hill after eloping - 1.4 million verdict. We get calls frequently from families re: their loved ones - found outside, in the parking lot, fallen down stairwells - its a real problem. Dan this week blogged about "wandering" risks or elopement risks. If your loved one wanders (especially a risk for dementia) - TELL THE FACILITY TO KEEP AN EYE OUT!
SERIOUS PROBLEMS AT DANVILLE REGIONAL MEDICAL CENTER
Danville Regional Medical Center (DRMC) in Danville, Virginia serves the cities of Martinsville and Danville, along with most of Southside Virginia. This once proud and accomplished hospital has a total of 350 staffed beds and gross revenue in excess of $375 Million Dollars. A couple of years ago the hospital was purchased by LifePoint Hospitals, Inc. and that is when the problems started.
DRMC, once a community based hospital is now run by a multi-state corporate medical empire (50 hospitals in 19 states) based in Tennessee. LifePoint, most likely run by MBA’s and accountants, quickly reduced the staff to increase profit and patient care suffered as a result. Last week, the hospital announced that it had received a “preliminary denial of accreditation” from the Joint Commission, a national health care accreditation organization. Sounds like trouble to me!
Read the comments published in this interesting blog.
DRMC, once a community based hospital is now run by a multi-state corporate medical empire (50 hospitals in 19 states) based in Tennessee. LifePoint, most likely run by MBA’s and accountants, quickly reduced the staff to increase profit and patient care suffered as a result. Last week, the hospital announced that it had received a “preliminary denial of accreditation” from the Joint Commission, a national health care accreditation organization. Sounds like trouble to me!
Read the comments published in this interesting blog.
Monday, March 26, 2007
THROMBOEMBOLISMS: WHO NEEDS THEM?
What is a thromboembolism? Just a fancy medical term for “blood clots” and they can be life threatening if they make their way to your lungs or brain. There are basically two types: DVT’s and PE’s.
A DVT is a deep venous thrombosis and is a blood clot embedded in one of the major veins in the legs. The more common risk factors their development include prolonged sitting or bed rest, recent surgery (particularly orthopedic, gynecologic, or heart surgery), recent trauma to the lower body, obesity, heart attack or heart failure.
A PE is a pulmonary embolism or a blood clot in the lungs. The presence of a PE is the third most common cause of death in the US, with at least 650,000 cases occurring annually. It is the first or second most common cause of unexpected death in most age groups. The highest incidence of recognized PE occurs in hospitalized patients. Autopsy results show that as many as 60% of patients dying in the hospital have had a PE, but the diagnosis has been missed in about 70% of the cases.
A DVT is a deep venous thrombosis and is a blood clot embedded in one of the major veins in the legs. The more common risk factors their development include prolonged sitting or bed rest, recent surgery (particularly orthopedic, gynecologic, or heart surgery), recent trauma to the lower body, obesity, heart attack or heart failure.
A PE is a pulmonary embolism or a blood clot in the lungs. The presence of a PE is the third most common cause of death in the US, with at least 650,000 cases occurring annually. It is the first or second most common cause of unexpected death in most age groups. The highest incidence of recognized PE occurs in hospitalized patients. Autopsy results show that as many as 60% of patients dying in the hospital have had a PE, but the diagnosis has been missed in about 70% of the cases.
WANDERING IS HEALTH RISK FOR 1 IN 5 IMPAIRED NURSING HOME RESIDENTS
This statement should not surprise anyone but does serve as confirmation for what we all know. In a study involving over 15,000 cognitively impaired nursing home patients, researchers from the International Research Consortium on Wandering found that one in five were prone to aimless wandering through nursing home facilities, putting themselves at increased health risk.
Adverse outcomes associated with wandering include an increased incidence of weight loss, fatigue, sleep disturbance, getting lost, injuries as a result of falling and untimely death. This study confirms the need for close supervision of residents suffering from dementia or Alzheimer’s disease in order to prevent elopement, falls, and other risks.
Read a more detailed article on this report from Medical New Today.
Read more articles like this one by visiting the American Geriatrics Society.
Adverse outcomes associated with wandering include an increased incidence of weight loss, fatigue, sleep disturbance, getting lost, injuries as a result of falling and untimely death. This study confirms the need for close supervision of residents suffering from dementia or Alzheimer’s disease in order to prevent elopement, falls, and other risks.
Read a more detailed article on this report from Medical New Today.
Read more articles like this one by visiting the American Geriatrics Society.
Friday, March 23, 2007
LIBBY EDWARDS AND BREAST CANCER
As most of you already know, Presidential hopeful John Edwards’ wife, Libby, announced yesterday that her breast cancer (invasive ductal) had returned and was now incurable. Mrs. Edwards’ breast cancer first surfaced several years ago but has returned and apparently metastasized into her bones. Our thoughts and prayers are with Mrs. Edwards and her family.
The tragic story got me to thinking about breast cancer in general and the frequency of which this terrible disease goes undetected or mis-diagnosed. My firm has represented woman who breast cancer should have been detected and treated but it didn’t happen. The failures typically occurred as a result of negligently handled biopsies, poor pathology lab work, or dropped communications between medical specialists or between physician and patient.
Read what the Chairman of one of the country’s largest medical malpractice insurers, The Doctors’ Company, has to say on lawsuits for failure to diagnose and treat breast cancer.
Frequently Asked Questions about Breast Cancer
Blog Posts about Libby Edwards Breast Cancer
The tragic story got me to thinking about breast cancer in general and the frequency of which this terrible disease goes undetected or mis-diagnosed. My firm has represented woman who breast cancer should have been detected and treated but it didn’t happen. The failures typically occurred as a result of negligently handled biopsies, poor pathology lab work, or dropped communications between medical specialists or between physician and patient.
Read what the Chairman of one of the country’s largest medical malpractice insurers, The Doctors’ Company, has to say on lawsuits for failure to diagnose and treat breast cancer.
Frequently Asked Questions about Breast Cancer
Blog Posts about Libby Edwards Breast Cancer
DOCTORS EXAMINE THEMSELVES
Physician-writers have only recently detailed the deficiencies of medicine to the public. For most of the 20th century, doctors urged one another to conceal medical errors, largely because they feared lawsuits. But as a result of a series of research scandals in the 1970s, charges of paternalism and spiraling health care costs, medicine could no longer remain insular. Greater scrutiny of what doctors do came from journalists, bioethicists, insurers and economists -- and, eventually, from doctors themselves.
The Washington Post has published an article reviewing two recent books, written by doctors about doctors. The first book, “How Doctors Think” by Jerome Groopman was mentioned in this blog just days ago. The second book, “Better: A Surgeon's Notes on Performance” by Atul Gawande, a general surgeon at Harvard Medical School.
Read the Washington Post article here.
The Washington Post has published an article reviewing two recent books, written by doctors about doctors. The first book, “How Doctors Think” by Jerome Groopman was mentioned in this blog just days ago. The second book, “Better: A Surgeon's Notes on Performance” by Atul Gawande, a general surgeon at Harvard Medical School.
Read the Washington Post article here.
DOCTORS’ TIES TO DRUG MAKERS QUESTIONED
Doctors receive money in return for delivering lectures about drugs to other doctors. Some of the doctors receiving the most money sit on committees that prepare guidelines instructing doctors nationwide about when to use medicines. Dr. Allan Collins may be the most influential kidney specialist in the country.
In 2004, the year he was chosen as president-elect of the kidney foundation, the pharmaceutical company Amgen, which makes the most expensive drugs used in the treatment of kidney disease, underwrote more than $1.9 million worth of research and education programs led by Dr. Collins, according to records examined by The New York Times. In 2005, Amgen paid Dr. Collins at least $25,800, mostly in consulting and speaking fees, the records show
Most doctors say these types of payments have no effect on their care of patients. Do you believe it?
Read the New York Times article on this topic.
In 2004, the year he was chosen as president-elect of the kidney foundation, the pharmaceutical company Amgen, which makes the most expensive drugs used in the treatment of kidney disease, underwrote more than $1.9 million worth of research and education programs led by Dr. Collins, according to records examined by The New York Times. In 2005, Amgen paid Dr. Collins at least $25,800, mostly in consulting and speaking fees, the records show
Most doctors say these types of payments have no effect on their care of patients. Do you believe it?
Read the New York Times article on this topic.
Thursday, March 22, 2007
STATE LAWS AND NURSING HOMES
Each state regulates nursing homes differently. For example, some require minimum staffing ratios and some do not (unfortunately most do not, including my state of Virginia). How well does your state regulate nursing homes?
Check all 50 states laws governing the operation and licensure of nursing homes.
Check all 50 states laws governing the operation and licensure of nursing homes.
NURSING HOME CARE IS VERY EXPENSIVE
The average price paid per bed for skilled nursing facilities hit a record $47,400 in 2006, according to the latest edition of The Senior Care Acquisition Report. The figure marks a nearly 10% increase over the 2005 average sale price and 50% premium over the 2003 mark.
Why so expensive? The increasing number of elderly and infirm combined with the substantial profit made from running a nursing home. “We have been seeing a changed attitude over the past year or two about the skilled nursing facility industry, and with double-digit yields still available, investors have been taking a second look at the sector,” said Stephen M. Monroe, editor of The Senior Care Acquisition Report, which is produced by Irving Levin Associates, Norwalk, CT. “Even though there are still a lot of older nursing facilities in the market, the better quality facilities with a strong Medicare census are driving the market right now.”
If demand is up and profit is up…why are many nursing homes understaffed with the explanation that there is just not enough money in the budget to hire a sufficient number of nurses and aids?
Read McKnight’s Long-Term Care News article here:
Why so expensive? The increasing number of elderly and infirm combined with the substantial profit made from running a nursing home. “We have been seeing a changed attitude over the past year or two about the skilled nursing facility industry, and with double-digit yields still available, investors have been taking a second look at the sector,” said Stephen M. Monroe, editor of The Senior Care Acquisition Report, which is produced by Irving Levin Associates, Norwalk, CT. “Even though there are still a lot of older nursing facilities in the market, the better quality facilities with a strong Medicare census are driving the market right now.”
If demand is up and profit is up…why are many nursing homes understaffed with the explanation that there is just not enough money in the budget to hire a sufficient number of nurses and aids?
Read McKnight’s Long-Term Care News article here:
MONTGOMERY COUNTY JURY AWARDS DAMAGES IN MEDICAL MALPRACTICE CASE
The Roanoke Times reported today on the results of a medical malpractice case concluded on March 20. The jury awarded $1.3 million to the adult children of a Giles county woman who died after complications from surgery to remove an ovarian cyst.
Read the complete story here.
Read the complete story here.
Wednesday, March 21, 2007
DOCTOR'S BLOGS
Have you seen you tube? Are you worried you will end up on it someday? Well here is a new one, you may end up on your physician's blog. YES, you read it right, many physicians acrosss the country have started blogging about patients, situations, etc. http://www.washingtonpost.com/wp-dyn/content/article/2007/03/16/AR2007031602097.html What kind of things are they talking about? Well, look for yourself:http://www.neonataldoc.blogspot.com/ This doctor speaks about stories, regrets, mistakes, hopes. The few posts I read were honest, refreshing, and real. But at what cost? Share too much about a patient and you have violated the age-old doctor patient privilege, or, HIPAA.. Even worse, share too much and maybe admit liability?
I don't have a side in this dog-fight. Part of me is delighted to see a physician share his or her experiences, honestly and openly - reminding us that physicians are human.... but I sure wouldn't want to see my physician blogging about my appointment, or information shared!
I don't have a side in this dog-fight. Part of me is delighted to see a physician share his or her experiences, honestly and openly - reminding us that physicians are human.... but I sure wouldn't want to see my physician blogging about my appointment, or information shared!
Tuesday, March 20, 2007
MORE NURSING HOME EXECUTIVES MAY BE GOING TO JAIL
Those of you who have followed our blogs on Legal Medicine know that we have previously published articles on some of the more corrupt executives who own and run nursing homes in America.
Well here we go again! Three former nursing home executives, one a lawyer, were charged on March 15 in a federal indictment with various offenses related to their operation of nursing homes located in Texas and elsewhere. These individuals have been charged with conspiracy to defraud the IRS, tax evasion, and filing false statements relating to health care matters. Two of those indicted concealed their control and management of nursing homes in Texas, Oklahoma, Kansas, Iowa, and Virginia. It is estimated that the defendants defrauded the Department of Health and Human Services (HHS) and the IRS out of approximately $34 million. If proven guilty of these charges…I hope they spend a long time in the federal penitentiary!
Read the article for yourself.
Well here we go again! Three former nursing home executives, one a lawyer, were charged on March 15 in a federal indictment with various offenses related to their operation of nursing homes located in Texas and elsewhere. These individuals have been charged with conspiracy to defraud the IRS, tax evasion, and filing false statements relating to health care matters. Two of those indicted concealed their control and management of nursing homes in Texas, Oklahoma, Kansas, Iowa, and Virginia. It is estimated that the defendants defrauded the Department of Health and Human Services (HHS) and the IRS out of approximately $34 million. If proven guilty of these charges…I hope they spend a long time in the federal penitentiary!
Read the article for yourself.
ALZHEIMER'S DISEASE ON THE RISE
A new report out on Alzheimer's Disease, estimates that at least 5 million Americans are living with the disease. Well, if that calculation is correct - then there are likely 20 million Americans battling Alzheimer's disease. What do I mean? Well for each patient, there is a family, a group of providers, fighting to keep their loved one in the present, focused, aware. We have discussed how to help your family prepare should you be diagnosed with dementia or Alzheimer's in an early blog. The advice, was to help make plans while you can - including wills, long term care - and even funeral plans. But what if you have missed that window to help, and now your family must make these plans with out you?
As the number of those suffering with the disease increases, so do the number of resources. State Medicaid, local aging agencies, local doctors, hospitals - advocacy groups - all great resources to learn more about treatment, and other options.
There is no doubt it is a most devestating disease... and it looks like, more and more of us will be faced with either a diagnosis, or caring for a loved one with Alzheimers. http://www.washingtonpost.com/wp-dyn/content/article/2007/03/20/AR2007032000103.html
As the number of those suffering with the disease increases, so do the number of resources. State Medicaid, local aging agencies, local doctors, hospitals - advocacy groups - all great resources to learn more about treatment, and other options.
There is no doubt it is a most devestating disease... and it looks like, more and more of us will be faced with either a diagnosis, or caring for a loved one with Alzheimers. http://www.washingtonpost.com/wp-dyn/content/article/2007/03/20/AR2007032000103.html
CASE REPORT: FAILURE TO TIMELY DIAGNOSE PROSTATE CANCER
A 65 year old man went to his family practitioner who ordered a prostate specific antigen (PSA) test. The test showed highly elevated PSA levels – indicative of prostate cancer. Two weeks later the patient returned to his family doctor who again ordered a PSA test. The second test, performed at a local hospital, revealed an even higher PSA, but the family doctor did not obtain those results or refer the patient to an urologist for further treatment. Approximately 10 months later, the patient underwent a biopsy which revealed advanced prostate cancer requiring hormone therapy and radiation treatment. The patient now has a high likelihood of cancer recurrence and metastasis.
The patient sued his family doctor alleging that he failed to timely diagnose the cancer based upon the elevated PSA studies. The doctor denied any negligence and, unbelievably, argued that it was the patient’s responsibility to ensure the results from the second PSA test performed at the hospital were forwarded to the family doctor.
The judge ruled that it was the doctor’s responsibility to obtain the results of the PSA test he ordered. Thereafter, the parties settled the case in mediation for a confidential amount.
Read more about the Prostate Specific Antigen (PSA) test.
The patient sued his family doctor alleging that he failed to timely diagnose the cancer based upon the elevated PSA studies. The doctor denied any negligence and, unbelievably, argued that it was the patient’s responsibility to ensure the results from the second PSA test performed at the hospital were forwarded to the family doctor.
The judge ruled that it was the doctor’s responsibility to obtain the results of the PSA test he ordered. Thereafter, the parties settled the case in mediation for a confidential amount.
Read more about the Prostate Specific Antigen (PSA) test.
Monday, March 19, 2007
CLASS ACTION NURSING HOME SUIT
We have heard about class action litigation in a variety of areas - from big tobacco, to breast implants and telephone lines - as long as a certain number of people have the same or similar complaint or injury, and the damages are a certain amount - you can seek Class Action Status (here is my legal disclaimer - every state differs, and federal courts have more specific qualifications). Past residents from a chain of California nursing homes have sought and been given class action status against the nursing home owners: http://www.contracostatimes.com/mld/cctimes/news/politics/16929683.htm
I haven't seen the Complaint - but most nursing home cases are that of simple negligence, causing injury or wrongful death. The basis of the suit - the facility had a duty to care for my loved one, they failed, they breached that duty, that breach was negligence, and my loved one was damaged.
More and more cases however, claim additional wrongs. Fraud for example. The basis of a fraud suit is that the party made affirmative statements they knew to be untrue, to gain your business. In addition, people will raise claims for violating certain Consumer Protection laws - laws enacted to promote honesty and fair dealing in commercial transactions. For example, if the Nursing Homes tells you - "everyone here is an RN, not just a Nursing Aid" and "we have 20 full time RNs" - that is an affirmative statement regarding the services you should expect. Find out it is not true, and that the statement was made only so you would send your deposit - you have sufficient evidence to claim fraud.
So, why is this important to note - because if you are selecting a facility for a loved one, and certain statements (warranties, guarantees) are made - they mean something. So pay attention - I think fraud is the basis or at least an element in the California Class Action.
I haven't seen the Complaint - but most nursing home cases are that of simple negligence, causing injury or wrongful death. The basis of the suit - the facility had a duty to care for my loved one, they failed, they breached that duty, that breach was negligence, and my loved one was damaged.
More and more cases however, claim additional wrongs. Fraud for example. The basis of a fraud suit is that the party made affirmative statements they knew to be untrue, to gain your business. In addition, people will raise claims for violating certain Consumer Protection laws - laws enacted to promote honesty and fair dealing in commercial transactions. For example, if the Nursing Homes tells you - "everyone here is an RN, not just a Nursing Aid" and "we have 20 full time RNs" - that is an affirmative statement regarding the services you should expect. Find out it is not true, and that the statement was made only so you would send your deposit - you have sufficient evidence to claim fraud.
So, why is this important to note - because if you are selecting a facility for a loved one, and certain statements (warranties, guarantees) are made - they mean something. So pay attention - I think fraud is the basis or at least an element in the California Class Action.
HOW DOCTORS THINK
What kind of doctor do you want? A confident professional, little small talk, and a quick decider? Or how about a caring communicator who acknowledges uncertainty? Many patients might be inclined to select the former…and they would probably be wrong!
Jerome Groopman, MD has recently published a book entitled, “How Doctors Think” and it is must read…if you are interested in protecting your health. Dr. Groopman holds a chair in medicine at Harvard and a clinical practice at Beth Israel in Boston, and does a great job demystifying medicine. He begins by discussing the process of diagnosis – a combination of science and communication skills – and it is the communication skills which many doctors lack. Dr. Groopman believes that most doctors reach a diagnosis of their patient’s problems within seconds of coming face-to-face by gauging skin tone, posture, breathing, energy level and a quick glance of the patient’s chart.
The problem with this reality is that doctors often fail to hear what the patient is telling them about their symptoms. Simply put, many doctors either don’t care or don’t have the time to listen to what the patient has to say. The book is filled with real-life examples of doctors who fail to listen.
Check out “How Doctors Think” for yourself.
Jerome Groopman, MD has recently published a book entitled, “How Doctors Think” and it is must read…if you are interested in protecting your health. Dr. Groopman holds a chair in medicine at Harvard and a clinical practice at Beth Israel in Boston, and does a great job demystifying medicine. He begins by discussing the process of diagnosis – a combination of science and communication skills – and it is the communication skills which many doctors lack. Dr. Groopman believes that most doctors reach a diagnosis of their patient’s problems within seconds of coming face-to-face by gauging skin tone, posture, breathing, energy level and a quick glance of the patient’s chart.
The problem with this reality is that doctors often fail to hear what the patient is telling them about their symptoms. Simply put, many doctors either don’t care or don’t have the time to listen to what the patient has to say. The book is filled with real-life examples of doctors who fail to listen.
Check out “How Doctors Think” for yourself.
Sunday, March 18, 2007
FLU OUTBREAKS IN NURSING HOMES
The news this winter has followed a familiar path regarding the frequency and effects of flu outbreaks in nursing homes. I previously blogged on this topic.
Norovirus, flu, group a strep, whatever the infectious process… don’t we owe our elderly and infirm a safe environment in which to live? In 2007, more and more nursing homes and assisted living facilities in the U.S. reported widespread outbreaks of preventable diseases. My law firm has been involved in 3 lawsuits in my community alone where the results of an infectious outbreak lead to death (two residents) and loss of a leg (one resident). Why do so many frail and elderly have to die from something that can be prevented?
This problem is not hard to stop and maybe the nursing home industry is starting to take note. The American Medical Directors Association is the professional association of medical directors and physicians practicing in the long term care industry. This organization recently published the results of a study which found that flu outbreaks in nursing homes are almost 60 percent less likely to occur when at least 55 percent of staff and 89 percent of residents are vaccinated for the flu. Just imagine what those numbers might be with 100% vaccination for both residents and staff! All nursing homes and assisted living facilities should be required to vaccinate their residents and staff.
Read the article for yourself.
Norovirus, flu, group a strep, whatever the infectious process… don’t we owe our elderly and infirm a safe environment in which to live? In 2007, more and more nursing homes and assisted living facilities in the U.S. reported widespread outbreaks of preventable diseases. My law firm has been involved in 3 lawsuits in my community alone where the results of an infectious outbreak lead to death (two residents) and loss of a leg (one resident). Why do so many frail and elderly have to die from something that can be prevented?
This problem is not hard to stop and maybe the nursing home industry is starting to take note. The American Medical Directors Association is the professional association of medical directors and physicians practicing in the long term care industry. This organization recently published the results of a study which found that flu outbreaks in nursing homes are almost 60 percent less likely to occur when at least 55 percent of staff and 89 percent of residents are vaccinated for the flu. Just imagine what those numbers might be with 100% vaccination for both residents and staff! All nursing homes and assisted living facilities should be required to vaccinate their residents and staff.
Read the article for yourself.
WHY PEDIATRICIANS GET SUED
An examination of child-related medical negligence settlements and judgments finds that failure to diagnose is the most common reason for payments. The study, published in Pediatrics, the official journal of the American Academy of Pediatrics, pulled statistics from the National Practitioner Data Bank, a mandatory electronic depository which documents such payments. My conclusion – pediatricians need to spend more time examining their patients and listening to what parents are telling them about their children’s symptoms.
Read an abstract of the study here.
Read an abstract of the study here.
Saturday, March 17, 2007
CASE REPORT: RADIOLOGIST FAILS TO TIMELY DIAGNOSE BREAST CANCER
This case comes from Oregon but could be from anywhere. The patient, a 54 year old woman, underwent a routine mammogram at a health clinic. The radiologist who interpreted the study reported it as normal. However, two years later the patient was diagnosed with Stage IV breast cancer which had metastasized to her bones and seven lymph nodes. She submitted to radiation, a lumpectomy, and chemotherapy but her condition is terminal.
The patient filed a medical negligence claim against the radiologist. The evidence revealed the radiologist missed a one to two centimeter mass on the original mammogram. The patient, and her experts, alleged the radiologist was negligent in missing the mass and failing to refer the patient for treatment which would have saved her life. An Oregon jury awarded the patient $5, 750,000.
The patient filed a medical negligence claim against the radiologist. The evidence revealed the radiologist missed a one to two centimeter mass on the original mammogram. The patient, and her experts, alleged the radiologist was negligent in missing the mass and failing to refer the patient for treatment which would have saved her life. An Oregon jury awarded the patient $5, 750,000.
Friday, March 16, 2007
DON’T HAVE A HEART ATTACK ON THE WEEKEND!
For that matter don’t get sick on the weekends or at other dangerous times! What are we talking about? Well, a recently published study found that heart-attack patients admitted to a hospital on Saturday or Sunday are at a greater risk of dying than those same patients when admitted between Monday and Friday. The report, which reviewed the outcomes of more than 230,000 patients hospitalized over a 16 year period, found those admitted on the weekend were also less likely to be treated with the invasive cardiac procedure known as angioplasty, a procedure often recommended by heart specialists. Read the report published in the New England Journal of Medicine here.
To say the results of this study are important would be an understatement! Most cardiac specialists believe early intervention is critical to the survival of heart-attack victims. The American Heart Association reports that 865,000 adult patients suffered a heart-attack in 2004. 157,550 of those heart-attacks proved to be fatal.
Other dangerous times in hospitals include shift changes and holidays. Remember, most hospital nursing staffs work 7AM – 3PM, 3PM – 11PM, or 11PM – 7AM. Each arriving shift is supposed to take “report” from the departing shift and learn about the status of the patients they will be taking care of during their shift. We have seen many preventable tragedies, including deaths, occur as a result of poor or missed communications between shifts. On holidays, many hospitals are short-staffed or working with temporary nurses.
Be vigilant of the hospital process…your life may depend on it!
To say the results of this study are important would be an understatement! Most cardiac specialists believe early intervention is critical to the survival of heart-attack victims. The American Heart Association reports that 865,000 adult patients suffered a heart-attack in 2004. 157,550 of those heart-attacks proved to be fatal.
Other dangerous times in hospitals include shift changes and holidays. Remember, most hospital nursing staffs work 7AM – 3PM, 3PM – 11PM, or 11PM – 7AM. Each arriving shift is supposed to take “report” from the departing shift and learn about the status of the patients they will be taking care of during their shift. We have seen many preventable tragedies, including deaths, occur as a result of poor or missed communications between shifts. On holidays, many hospitals are short-staffed or working with temporary nurses.
Be vigilant of the hospital process…your life may depend on it!
Thursday, March 15, 2007
IS YOUR NURSING HOME SAFE FROM FIRES?
Let’s face it – most residents in assisted living facilities and nursing homes are incapable of moving quickly. They may be confined to a bed…a wheel chair…or a meri-walker. This reality can have devastating results when a fire breaks out!
Virginia law requires fire suppression and alarm systems in its nursing homes. Although it is the law, I have been in facilities in the past few years which were without fire suppression and alarm systems. A fire in a nursing home can have horrible results as reported in these stories:
· Mocksville, NC
· Hartford, CN – as reported by CBS News
· Louisville, KY
· National Citizens Coalition for Nursing Home Reform – press release
Read what the federal General Accounting Office has to say about the risk.
Read this article from the USA Today newspaper.
Virginia law requires fire suppression and alarm systems in its nursing homes. Although it is the law, I have been in facilities in the past few years which were without fire suppression and alarm systems. A fire in a nursing home can have horrible results as reported in these stories:
· Mocksville, NC
· Hartford, CN – as reported by CBS News
· Louisville, KY
· National Citizens Coalition for Nursing Home Reform – press release
Read what the federal General Accounting Office has to say about the risk.
Read this article from the USA Today newspaper.
Wednesday, March 14, 2007
SHOULD SMOKERS GET LUNG SCANS?
This blog often discusses situations where health care providers do something wrong or fail to do something which should have been done. The issue of whether smokers should get regular lung scans may not fall in either of the situations mentioned in my first sentence.
The Journal of the American Medical Association (JAMA) has concluded that lung-cancer screening with CT scans does not save lives. Last fall, a major study published in the New England Journal of Medicine concluded just the opposite. The American Cancer Society simply advises patients to discuss the pros and cons of scanning with their doctor.
What should you do? The answer will vary with each patient and depend on facts too varied to discuss in this short post. It is clear from the medical literature that CT scans do help in finding early cancer. However, the problem lies in the fact that it is unclear whether early detection prolongs patients’ lives or merely subjects them to unnecessary procedures and risks.
Read the studies for yourself:
· JAMA article
· NEJM article (summary)
· American Cancer Society’s position
The Journal of the American Medical Association (JAMA) has concluded that lung-cancer screening with CT scans does not save lives. Last fall, a major study published in the New England Journal of Medicine concluded just the opposite. The American Cancer Society simply advises patients to discuss the pros and cons of scanning with their doctor.
What should you do? The answer will vary with each patient and depend on facts too varied to discuss in this short post. It is clear from the medical literature that CT scans do help in finding early cancer. However, the problem lies in the fact that it is unclear whether early detection prolongs patients’ lives or merely subjects them to unnecessary procedures and risks.
Read the studies for yourself:
· JAMA article
· NEJM article (summary)
· American Cancer Society’s position
Tuesday, March 13, 2007
THE NATIONAL CENTER ON ELDER ABUSE
1. Do you want answers to these types of questions?
2. What is elder abuse?
3. What are the warning signs of elder abuse?
4. What is self-neglect and what are the signs?
5. What makes an older person vulnerable to abuse?
6. Who are the abusers of older people?
7. Are there criminal penalties for the abusers?
8. How many people are suffering from elder abuse in the US?
9. Who do I call if I suspect elder abuse?
10. What should I expect if I call someone for help?
11. How can elder abuse be prevented?
12. What is being done to stop elder abuse?
13. How can I help stop elder abuse?
If so, check out the National Center on Elder Abuse (NCEA). The NCEA is a national resource for elder rights, law enforcement and legal professionals, public policy leaders, researchers, and the public. The Center’s mission is to promote understanding, knowledge sharing, and action on elder abuse, neglect, and exploitation.
NURSING HOME ABUSE IS EVERYWHERE
A congressional report has found that 5,283 — over 30 percent — of the nursing homes in the U.S. were cited for an abuse violation that had to cause harm between January 1999 and January 2001. Over 2,500 of the violations were serious enough to cause actual harm or to place residents in immediate jeopardy of death or serious injury. Read the report in its entirety here.
Read a CBS New Report here.
Read a CBS New Report here.
Monday, March 12, 2007
1 IN 20 HOSPITALIZED PATIENTS CONTRACT INFECTION
Some 2 million patients get a hospital-acquired infection (it’s called a nosocomial infection) every year and 90,000 of those patients die. In Pennsylvania alone, more than 19,000 infection cases occurred in 2005 (up from 11,600 in 2004) out of 1.6 million admissions to 168 hospitals, according to a report issued in November by the state’s Health Care Cost Containment Council. Pennsylvania, the first state to provide infection data collected directly from its hospitals, reported that nearly 13 percent of patients who got infections died. Read the full story in the AARP Bulletin.
Does your hospital follow strict guidelines to reduce the risk of infection for its patients?
Does your hospital require the use of gloves and other protective equipment for its doctors and nurses?
Better find out!
Does your hospital follow strict guidelines to reduce the risk of infection for its patients?
Does your hospital require the use of gloves and other protective equipment for its doctors and nurses?
Better find out!
CHANGE IN START OF DAYLIGHT SAVINGS TIME COULD EFFECT MEDICAL DEVICES
The change in the beginning and end of daylight saving time (DST) may adversely affect medical equipment which use date and time information for diagnosis or treatment, according to the U.S. Food and Drug Administration (FDA). The new DST began 3 weeks earlier and will end one week later this year.
Medical equipment that uses, creates, or records time or date information about a patient's diagnosis or treatment may register the wrong dates for the start and end of DST when the changes are implemented, according to an alert sent Friday from MedWatch, the FDA's safety information and adverse event reporting program.
The FDA notes that most devices currently in use are likely to be affected, unless they were manufactured after the DST change was approved (Energy Policy Act of 2005) or have been updated by the manufacturer.
Read the FDA alert here.
Medical equipment that uses, creates, or records time or date information about a patient's diagnosis or treatment may register the wrong dates for the start and end of DST when the changes are implemented, according to an alert sent Friday from MedWatch, the FDA's safety information and adverse event reporting program.
The FDA notes that most devices currently in use are likely to be affected, unless they were manufactured after the DST change was approved (Energy Policy Act of 2005) or have been updated by the manufacturer.
Read the FDA alert here.
Wednesday, March 07, 2007
DOCTORS SUE THEIR LAWYERS
A record breaking $217 million dollar lawsuit last year against a group of Emergency Room Physicians for failing to diagnose a stroke. Over $100,000,000 of that was punitive, meaning, the jury meant to punish the physicians for their negligence. Imagine being the physician - and learning (or knowing) that the plaintiff had offerred to settle the case for $1 million dollars, and your attorney said no.
Its true - check out today's St. Petersburg Times - http://www.sptimes.com/2007/03/07/Hillsborough/Doctors_in_lawsuit_no.shtml
Did the attorneys tell their clients about the $1 million demand? They should have? Did they? The case exposes a very unique aspect of malpractice law. You sue a physician - the physician is insured, so his/her insurance company raises the defense, and hires the lawyers. So what if the physician wants to settle, and the insurance company doesn't? Who will pay those punitive damages? Likely not the insurance company, but the physicians themselves.
Its a tough balance, and I for one, am glad to see an insurance company (or their attorneys at least) take a little heat for not wanting to settle a case. You mess up - thats why you have insurance. If I were the physicians - I would be angry too.
Its true - check out today's St. Petersburg Times - http://www.sptimes.com/2007/03/07/Hillsborough/Doctors_in_lawsuit_no.shtml
Did the attorneys tell their clients about the $1 million demand? They should have? Did they? The case exposes a very unique aspect of malpractice law. You sue a physician - the physician is insured, so his/her insurance company raises the defense, and hires the lawyers. So what if the physician wants to settle, and the insurance company doesn't? Who will pay those punitive damages? Likely not the insurance company, but the physicians themselves.
Its a tough balance, and I for one, am glad to see an insurance company (or their attorneys at least) take a little heat for not wanting to settle a case. You mess up - thats why you have insurance. If I were the physicians - I would be angry too.
Saturday, March 03, 2007
GROUP A STREP OUTBREAK HAPPENS AGAIN IN ROANOKE
Well here we go again! Two years ago a Roanoke, Virginia assisted living facility had an outbreak of the group a strep bacterial infection. Several residents died and one lost a leg to a complication from the infection known as necrotizing fasciitis, also known as the “flesh-eating bacteria.” How do I know? My firm represented several of the families in claims against the facility.
Today’s Roanoke Times newspaper reports that a Roanoke area nursing home, Eastwood Assisted Living, owned by the same company which owned the assisted living facility where the GAS outbreak occurred two years ago (Friendship Manor), has suffered an outbreak of this life-threatening bacterial infection. One resident has died from the GAS infection, which is easily treated with antibiotics.
When will these facilities, which care for our elderly and infirm, start providing a professional level of care which will insure residents’ health and safety?
Read the Roanoke Times article here.
Read the WDBJ Television news report here.
Today’s Roanoke Times newspaper reports that a Roanoke area nursing home, Eastwood Assisted Living, owned by the same company which owned the assisted living facility where the GAS outbreak occurred two years ago (Friendship Manor), has suffered an outbreak of this life-threatening bacterial infection. One resident has died from the GAS infection, which is easily treated with antibiotics.
When will these facilities, which care for our elderly and infirm, start providing a professional level of care which will insure residents’ health and safety?
Read the Roanoke Times article here.
Read the WDBJ Television news report here.
Friday, March 02, 2007
PENNSYLVANIA HOSPITAL NOW REQUIRING WAIVERS FROM PATIENTS
Maybe you thought you had the right to bring a lawsuit to establish responsibility and accountability when you or a family member suffers debilitating injuries or death as a result of medical negligence while in the hospital. You get someone else’s medication or blood transfusion…or maybe someone in the operating room leaves a surgical needle or other instrument inside your abdomen during your gallbladder surgery. It would only seem right and fair that you could bring your own claim wouldn’t it? You know that same hospital will sue you in the blink of an eye if you don’t promptly pay their bill in full, regardless of your financial situation.
Nursing homes have been sneaking in arbitration/mediation provisions in their admission agreements for the last few years. These argeements prevent the patient from suing the healthcare provider for negligence. Now a hospital in Pennsylvania, Kindred Hospital of Wyoming Valley, is doing the same thing to its patients. Its wrong…its unconscionable….its an unfair advantage taken by corporate healthcare. Read about the hospital’s new requirement here.
Refuse to sign these agreements. Protect your rights and those of your family. Write letters to the editors of your local newspaper and your representatives about this unacceptable tactic to avoid responsibility. If you don’t …you may live to regret the consequences!
Nursing homes have been sneaking in arbitration/mediation provisions in their admission agreements for the last few years. These argeements prevent the patient from suing the healthcare provider for negligence. Now a hospital in Pennsylvania, Kindred Hospital of Wyoming Valley, is doing the same thing to its patients. Its wrong…its unconscionable….its an unfair advantage taken by corporate healthcare. Read about the hospital’s new requirement here.
Refuse to sign these agreements. Protect your rights and those of your family. Write letters to the editors of your local newspaper and your representatives about this unacceptable tactic to avoid responsibility. If you don’t …you may live to regret the consequences!
NURSING HOMES: BUSINESS AS USUAL
…and that is a bad thing! We have shared with you horror stories from all over the country about the poor care provided by nursing homes…some of those stories taken directly from the cases we handle for residents and their families here in Virginia, West Virginia, and Tennessee.
What is being done to improve this deplorable situation? What improvements have been implemented? What effect has resident advocacy groups, state investigations, Congressmen and woman saying the right things had on the care received by our loved ones in nursing homes? Not much!
Don’t believe me – read what a Consumer Reports investigation has to say.
What is being done to improve this deplorable situation? What improvements have been implemented? What effect has resident advocacy groups, state investigations, Congressmen and woman saying the right things had on the care received by our loved ones in nursing homes? Not much!
Don’t believe me – read what a Consumer Reports investigation has to say.
FLORIDA DOCTORS - "sign here please"
http://www.sptimes.com/2007/03/01/State/Last_insurance__fix__.shtml
Wow - Now I understand the concern that lawsuits cause increase insurance premiums for physicians. I believe the real reason insurance rates increase are because insurance companies want to keep their profit margins high, but that is irrelevant to a new trend in Florida. Doctors ask their patients to sign a release, prior to the care. No release, no doctor. No - I am serious. What will be next? Refusal to treat without a release? I have heard that some physicians refuse to treat attorneys that take plaintiff cases. It is interesting - at least something to think about - is healthcare really about to approach that path?
Wow - Now I understand the concern that lawsuits cause increase insurance premiums for physicians. I believe the real reason insurance rates increase are because insurance companies want to keep their profit margins high, but that is irrelevant to a new trend in Florida. Doctors ask their patients to sign a release, prior to the care. No release, no doctor. No - I am serious. What will be next? Refusal to treat without a release? I have heard that some physicians refuse to treat attorneys that take plaintiff cases. It is interesting - at least something to think about - is healthcare really about to approach that path?
Thursday, March 01, 2007
AT HOME CARE - SKILLED, or KIND?
The New York Times published an article today on the increasing popularity of programs where non health care providers are hired to provide care for declining loved ones. Sure, I could have helped my grandmother turn over in bed, take her medications, and made her meals and kept her company - but wouldn't it be better if I was trained to turn, or, had some experience with medications, wound care etc?
http://www.nytimes.com/2007/03/01/us/01aides.html?_r=1&ref=us&oref=slogin
Many families would argue the benefit of someone staying in their home, far outweighs the benefit of having an RN on staff at the nursing home. And you know what, I agree, to a point. If you loved one needs monitoring, encouragement, help getting to and from the restroom, a non-trained companion may be just fine. At least that person will be present to witness a fall, or skin tear. At least that person will provide the one on one care to notice change in attitude, condition, mental state - fever, etc. So if you can find a reliable person you and your loved one trust, I say go for it. But you run the risk of your care-taker companion, taking off mid-day, leaving, ignoring your loved one, or worse, abusing them. So its a balancing act, but one that millions of Americans are facing. For more information, investigate the agency - call your State Dept. of Health or Social Services.
http://www.nytimes.com/2007/03/01/us/01aides.html?_r=1&ref=us&oref=slogin
Many families would argue the benefit of someone staying in their home, far outweighs the benefit of having an RN on staff at the nursing home. And you know what, I agree, to a point. If you loved one needs monitoring, encouragement, help getting to and from the restroom, a non-trained companion may be just fine. At least that person will be present to witness a fall, or skin tear. At least that person will provide the one on one care to notice change in attitude, condition, mental state - fever, etc. So if you can find a reliable person you and your loved one trust, I say go for it. But you run the risk of your care-taker companion, taking off mid-day, leaving, ignoring your loved one, or worse, abusing them. So its a balancing act, but one that millions of Americans are facing. For more information, investigate the agency - call your State Dept. of Health or Social Services.
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