THREE TESTS TO PREVENT STROKES AND ANEURYSMS

The Society for Vascular Surgery, representing the nation’s 2,400 vascular surgeons, is now recommending 3 separate screening tests for patients 55 years of age or older who have cardiovascular risk factors. The risk factors include high blood pressure, diabetes, smoking, high cholesterol, known cardio-vascular disease, or family history of abdominal aortic aneurysms.

The first screening test is a carotid ultrasound to detect fatty plaque in the neck arteries which could lead to a stroke. The second is an “ankle-brachial” test to detect fatty deposits in the arteries in the legs and throughout the body. The third screening test is an abdominal ultrasound to see if the body’s main artery, the aorta, has a dangerous bulge called an aneurysm.

The cost of these 3 screening tests could approach $1,000. However some hospitals and clinics provide the screenings for free. Also, check out this web site for vascular medical groups which provide the screenings at no cost.

NEW STUDY: PSA LEVEL A POOR PREDICTOR OF PROSTATE CANCER OUTCOME

A new study shows that while prostate-specific antigen (PSA) measurement remains an important monitoring tool, it performs poorly in distinguishing those who will develop lethal prostate cancer from those at low or no risk of disease progression. The results are reported in the April 4 issue of the Journal of the National Cancer Institute, where the authors call for better decision-making tools for active monitoring of patients with early disease.

In the study, part of the Scandinavian Prostate Cancer Group research, physicians analyzed the rate of change of PSA levels in 267 men from Sweden, Finland, and Iceland who were diagnosed with early localized prostate cancer. The researchers recorded the PSA levels for the first 2 years after diagnosis to capture the patients' early PSA patterns. The men in the study received no curative treatment for the first 2 years but were closely watched for signs of progression.

At the end of follow-up, 34 (13%) patients died from prostate cancer and 18 (7%) developed metastatic prostate cancer. Although initial PSA values and the rate of change were associated with later development of lethal prostate cancer, they were not accurate enough to predict lethal cancer.

Read the study here.

STAFF SHORTAGES RESULT IN POOR CARE

We have said it here before but the main problem with nursing homes is that the owners refuse to hire enough staff to provide good care for the residents. The corporations which own America’s nursing homes put profits ahead of people.

This recent article about a state owned nursing home in Arizona documents more of the same. States should impose mandatory minimum staffing levels at all long term care facilities.

Read what NCCNHR has to say about staffing.

EVER ASK YOUR PHYSICIAN, "WHY THAT MEDICATION?"

There I go again - reading the Washington Post... and what did I find? An article about a topic I am very interested in. Drug Companies and their relationships with physicians. Read here:
http://www.washingtonpost.com/wp-dyn/content/article/2007/04/28/AR2007042800896.html
The author, Christopher Lee, writes about a recently published study in the New England Journal of Medicine, which reflects 94 percent of doctors have some type of relationship with the drug industry, which "most commonly" means they are "accepting free food or drug samples, which about 80 percent of physicians did." The study and Mr. Lee's article reflect that more than "one-third of the 1,662 physicians who responded to a survey conducted from November 2003 to June 2004 reported being reimbursed by the drug industry for costs of going to professional meetings or continuing medical education, and 28 percent said they had been paid for consulting, giving lectures or signing up patients for clinical trials."

Well, I don't mind the samples or FREE pens - IF the physicians are able to make independent decisions about medications and individual patients. But if you have just had lunch with the Avonex folks, will you think that maybe Rebif is better for your MS Patient? Thats my only concern.

WOMAN ALLEGES SURGEON LEFT MATERIALS IN HER BODY

A Baltimore woman has filed a medical malpractice lawsuit against an Owings Mills gynecologist and Sinai Hospital, saying that the surgical team left sponges, gauze, fabric and plastic inside her abdomen during an operation six years ago. We have handled a number of these suits and it happens more frequently than it should.

The lawsuit, filed Tuesday in Baltimore County Circuit Court, accuses Dr. Sheo P. Sharma and the Sinai staff of negligence during the January 2001 surgery to remove a benign tumor on the patient's uterus. LaShawn McClary, 40, is seeking $5 million for the medical errors, which damaged her bowels, ovaries and fallopian tubes, according to the lawsuit.

Read the newspaper report here.

HOSPITALS PUSH TO MAKE MONEY PUTS PATIENTS AT RISK

Is your local hospital constantly reducing its staff to make more money? My local hospital, Carilion Roanoke Memorial Hospital, is the largest hospital in western Virginia and is constantly trying to reduce it costs and increase its profits.

Overcrowded hospitals that are pushing too hard to streamline and cut costs are putting their patients at risk for medication errors, nerve injuries, infections and other preventable mistakes, according to a study by two Boston hospitals. The study, published yesterday in the May issue of the journal Medical Care, found that the top hospital goals - cutting costs and improving patient safety - are ‘working against each other,’ said senior author Dr. David Bates, chief of the Division of General Medicine and Primary Care at Brigham and Women’s Hospital.”

Read the article from the Boston Herald.

WAS THE FDA MISLEAD ABOUT THE ANTIPSYCHOTIC DRUG ZYPREXA?

The Food and Drug Administration (FDA) is examining whether Eli Lilly & Company provided it with accurate data about the side effects of the antipsychotic drug Zyprexa, a potent medicine that has been linked to weight gain and diabetes. The FDA has questions about a Lilly document from February 2000 in which the company found that patients taking Zyprexa in clinical trials were three and a half times as likely to develop high blood sugar as those who did not take the drug. That document was not submitted to the agency. But a few months later, Lilly provided data to the FDA that showed almost no difference in blood sugar between patients who took Zyprexa and those who did not. The FDA confirmed its inquiry in response to questions from The New York Times. The agency said it had not yet decided whether to take any action against Lilly.

Imagine that! A pharmaceutical company may have withheld information from the FDA! Read the New York Times article here.

ALZHEIMER'S DISEASE - SCARY STUFF

A new report from the Alzheimer's Association says there are more than 5 million people in the United States are living with Alzheimer's disease today. That is a substantial increase, from the estimated 4.5 million people with Alzheimers in 2002. (see http://www.medicalnewstoday.com/healthnews.php?newsid=65701).
Researchers estimate that number will climb to 14 million people by 2050, unless a cure or preventive measure can be found. http://www.usnews.com/usnews/health/brain/alzheimers/alz.about.htm

As age is the greatest risk factor for Alzheimer’s disease, the United States will see a surge in those needing Alzheimer care from the baby boomers generation. The first baby-boomers, now in their 60’s, are nearing the age of greatest risk.

Recent studies show African-Americans may be at greater risk for the disease, and by the year 2030, the number of African-Americans 65 or older is expected to more than double to 6.9 million.
(see http://www.alz.org/living_with_alzheimers_african_americans.asp)

So what can be done? While there isn’t a cure, or medication that can prevent disease progression, recent studies show certain preventative measures may be effective. Three minutes on the internet and I read articles that state the following may help prevent Alzheimer’s disease:
Drink Fruit Juice
Eat Blackcurrants
Do mental exercises (cross-word puzzles, etc)
Cardio-vascular activities
Eat Fish
Take Cholesterol Medication
Take Vitamin D
Eat foods high in folic acids

Please note, I have no idea if these work, but I for once, am paying attention.

SEXUAL ASSAULTS ON ELDERLY

I know, not a topic you want to research, hear about or blog about... but it happens, and more than you think. Sadly, with elderly patients there is a very low level of reporting and subsequently, few criminal charges filed. Why is that, you may ask? If the individual has Alzheimers or Dementia, they may not have the cognotive ability to understand the attack and therefore make report. But even absent confessions and reports, there are ways to determine if someone has been a victim of assault:
1. Change in appetite
2. Sudden onset of depression
3. Sudden aggressive behavior
4. Physical symptoms such as bruises, scars, etc.

What can you do if assault is possible? Take them to the Emergency Room and request a "rape kit" and or examination (including lab work) to search for signs of assault. If it is happening, studies show it is likely by another resident or employee - and repeat attacks are possible.

BREAST CANCER: GOOD NEWS FOR WOMEN

There is some new technology on the horizon for women. For many years the gold standard for breast screening has been the mammogram. However, while many doctors believe the mammogram has saved lives the biggest problem has been the discomfort which results from the required compression of breast tissue.

A new technology called digital breast tomosynthesis (DBT) may do a better job of detecting breast cancer but without the discomfort. With DBT, an x-ray tube moves in an arc around the breast taking several pictures and different angles in about 5 seconds. The result is a 3 dimensional image of the breast.

The only bad news is that the FDA has yet to review and approve this new technology. However, we may not have to wait long as the FDA may approve the technology this year and women may begin to see the availability of the DBT as early as 2008.

Read more about this new technology:

A New Tool for Detecting Breast Cancer

BreastCancer.org

DBT Adds Another Dimension

BEWARE OTHER RESIDENTS

Today I read about an Oklahoma Nursing Home who received a new resident from the state penal system when he was found incompetent to stand trial. Not a joke, a younger man charged with 4 homicides is now living on the Alzheimer's unit of a nursing home facility with someone's grandmother. http://www.kten.com/Global/story.asp?S=6416844. Are you shocked?
I wish I was surprised at the news, but sadly, we have seen this before. We have seen it in Virginia, younger adults put into Nursing Homes as an alternative to prison, or another care facility.

A young man, with brain damage from a failed suicide attempt was living in a Nursing Home in Virginia. He may have sustained brain damage, but his physical capabilities were the same - and he assaulted numerous residents. What will this gentleman in Oklahoma be capable of? Who knows - it is however, a scary proposition and I would ask around any facility before you move in or allow a loved one to move in - Is there anyone in the facility not here for elder care - if so, why... and when they assure you safety is not an issue, keep looking!

HOW TO FIND A GOOD DOCTOR

Let’s state the obvious, like all other professions and occupations there are good doctors and not so good doctors! The problem is how do you know which is which?

Here are some sources of information to help you answer the question:

1. Virginia Department of Health Professions. This web site is free and will provide you with background information on the doctor’s education and licensure, together with “self-reported” experiences with prior negligence lawsuits.

2. Federation of State Medical Boards. This web site is free and allows you to search every state’s licensing and disciplinary databases.

3. DocInfo. This web site costs $10 per search and allows you to search all U. S. jurisdictions at once for license and disciplinary status.

4. HealthGrades. This web site costs approximately $18 and allows you to search for not only licensing and disciplinary actions but also medical training and some limited medical malpractice details.

5. Consumers’ Checkbook. For $25 per year this web site allows you to find doctors recommended by other doctors in 50 metropolitan areas plus patient satisfaction ratings in 7 of those areas.

NURSING HOMES RARELY PUNISHED BY REGULATORS

The Government Accountability Office (GAO) reported in 1998 that nursing homes repeatedly harm residents without facing sanctions. Unfortunately, a new report due out next week reaches the same conclusion. The Bush administration rarely uses its authority to deny payment to homes with a history of compliance problems and typically imposes fines far less than the maximum of $10,000 a day, the report said. Further, the Department of Health and Human Services “fails to hold homes with a long history of harming residents accountable for the poor care provided,” the investigators said.

Medicaid and Medicare payments accounted for 60 percent of the $122 billion spent on nursing home care in 2005, the most recent year for which figures are available. About 1.5 million people live in the nation’s 16,400 nursing homes on any given day. More than 3 million people receive nursing-home care at some point in the year. Medicaid and Medicare pay for more than two-thirds of patients.

Critics of America’s civil justice system argue for more personal responsibility. I agree! Isn’t it time to hold nursing homes accountable for providing substandard care? Why shouldn’t substantial fines and closures be the result of continued bad care by the same long term care facilities? As taxpayers, why do we continue to pay for bad care?

Read the New York Times take on this issue.

RESTRAINTS IN NURSING HOMES

What is a restraint? Well, I am certainly not going to try to define what a restraint is as facilities and health care providers may disagree on a clinical definition - but, I can tell you the purpose of a restraint in a skilled care setting like a Nursing Home or Hospital. A restraint is any physical device used to prohibit or discourage a certain kind of movement. Example - a Bed Rail (or set of bed rails) is considered a restraint as they are designed to prevent residents from getting out of bed alone. A Meri-walker, or walker that goes 360 degrees around a resident, and includes a chair, strap etc - is also considered a restraint as it prohibits certain activities, such as ambulating through doors, stairs etc.

Many families with loved ones in a nursing home, may have to consider whether certain "restraints" should be used for their loved one - and many are in fact, appropriate (when their use is properly supervised).... so, as that family member, what should you be thinking about regarding the restraint?
1. Why is it being recommended? (To remedy past falls, or mistakes or incidents?)
2. Who is recommending? (Physician or Nurse)
3. Are they used throughout the facility?
4. Does the restraint restrict movement or simply change it?
5. Does your loved one have the cognitive ability to understand the dangers of the restraint?
6. Who is the maker - manufacturer? Any recalls?
7. Is staff trained on how to monitor or handle the use of the restraint?
When called about an incident or fall involving your resident - ask if the restraint was involved? Is there a restraint commitee that discusses the device and your loved one? Ask to attend their discussions.

These are important issues to discuss because many times injuries will occur during the use or mis-use of the restraint, and the facility may say "but the family agreed we could use it" - and yes, that might be the case, but if you didn't fully understand the restraint, its uses, etc, then your agreeing to its use, isn't worth much at all!

TIPS FOR SENIORS TO AVOID FALLS

According to an article in USA Today, one in three adults over 65 fall each year and half of people over 80 fall each year. These falls typically occur when the person is doing an everyday activity. They may trip over a loose rug, take a misstep on the stairs, or slip on an icy sidewalk.

According to the article, bone fragility, muscle weakness, use of multiple medications and vision problems make seniors more likely to fall. With strength and balance training, 25% to 30% of these falls can be prevented.

Here are some tips to help you avoid falls at any age:

- Exercise regularly. It will increase your strength and coordination and therefore reduce your chance of falling. Tai Chi has been recommended for people of any age to boost strength and improve balance


- Review your medication. Sometimes a bad combination of medications can cause dizziness or a loss of equilibrium. Talk to your doctor and pharmacist to determine what is best for you.


- Check your vision with an eye doctor at least once a year.


- Improve the lighting in your home. Install extra lamps on staircases and in rooms where you spend a good deal of time.


- Throw away old, floppy throw rugs and floor clutter that can be tripped over or use double sided tape to adhere throw rugs to the floor.


- Wear well fitting shoes both inside and outside the house. Avoid floppy slippers and going barefoot. Well fitting shoes give your feet the support they need and in turn, will help with your balance and wearing shoes will increase traction, resulting in fewer slips.


For more information on fall prevention:

- Fact sheets on fall prevention by the National Center for Injury Prevention and Control

- The Fall Prevention Center of Excellence in California

NURSING HOME EXECS MAKE BIG MONEY!

The corporate owners of America’s nursing homes complain loudly that they are losing money! The CEOs say that the Medicaid payments, which pay for about two-thirds of their residents, are not enough to cover operating costs.

Is this claim true or false? I don’t have the answer but do find it curious that these corporations pay their executives a handsome salary! How can the corporations pay these kinds of salaries and benefits if they are losing money?

Last year, for example, Edward Kuntz, Kindred's CEO, was paid $4.9 million in salary and other compensation as well as restricted stock and options valued at $7.9 million, a company filing shows.

Paul Ormond, who runs Manor Care Inc., took home $2.5 million in salary and other compensation as well as stock options valued at $5.6 million.

Beverly's CEO, William Floyd, got $1.3 million plus stock options worth $2.3 million more.

Source: St. Louis Today

ANTIBIOTIC PROPHYLAXIS AND HIP SURGERY

We all worry about the rampant infections in hospitals. The concern is heightened when surgery is involved. A common surgery with today’s aging population is the elective total hip arthroplasty – or hip replacement surgery. Should patients undergoing elective hip surgery be given antibiotics before surgery? A recent study indicates the answer is “no.”

According to the current study, surgical site infection following total hip arthroplasty can lead to prolonged hospitalization with high rate of complications and death, and deep implant surgical site infection often is diagnosed after hospital discharge. Although the use of prophylactic antibiotics before surgery has been shown to improve the rate of surgical site infection, according to the current study's authors, prior studies have included both emergent (trauma) and elective total hip surgeries. This study is the first to examine the effect of antibiotic prophylaxis timing and duration for elective total hip arthroplasty alone.

The conclusion: For patients undergoing elective total hip arthroplasty, the use of antibiotics before incision does not affect the incidence of surgical site infection. Only longer duration of surgery above the 75th percentile is independently associated with increased incidence of surgical site infection after elective total hip arthroplasty.

Read the study.

FORMER NURSING HOME EXEC GOING TO PRISON

A former St. Louis nursing home executive will spend two months in prison and two months in a halfway house for his part in a Medicaid and Medicare fraud scheme. Charles B. Kaiser III, former president of American Healthcare Management, pleaded guilty in January to a misdemeanor charge of making false statements. He was recently sentenced and ordered to pay $15,000 in fines.

As I have said before, there is plenty of corruption in the nursing home industry!

Read the article.

NURSING HOME AIDE RAPED 90 YEAR OLD RESIDENT

Sadly…you read it correctly! A former aide at the Rome Memorial Hospital Residential Health Care Facility, who was convicted last month of raping and sexually assaulting a 90-year-old resident of the nursing home, has been sentenced to over 30 years in prison. The aide was an employee at Rome Memorial Hospital in Rome, New York for several months before being transferred to the hospital’s affiliated 80-bed nursing home. The crime was committed about two weeks after the transfer.

Rome Memorial Hospital Residential Health Care Facility intended to perform a criminal background check on the aide but it was not completed before he raped the elderly resident. The background check would have revealed the aide was previously convicted for one felony drug offense in 1992 and several misdemeanors in the 1990s. His last conviction was for a misdemeanor drug offense in 1999.

No punishment could be too much for this guy. But what about the facility? Background checks are a must and should be performed on every worker BEFORE they work their first hour!

Read the story.

BEDSORES KILL OVER 100,000 PEOPLE EACH YEAR

We have previously written about bedsores or decubitus ulcers or pressure sores – different terms referring to the same medical condition. Decubitus ulcers arise when a person is in a sitting or lying position for an extended period of time without shifting his or her weight. The continuous pressure against the skin causes a decreased blood supply to that part of the body. Without a normal blood supply, that part of the body cannot survive and the affected tissue dies.

A study in the April 2007 issue of American Journal of Nursing examines the incidence and high cost of pressure ulcers and presents the results of an implemented protocol to reduce the occurrence of this widespread problem. The study notes that of more than 27 million deaths reported in the United States, pressure ulcers were listed as a cause of in 114,380 of those deaths. That is equivalent over 300 deaths occurring each day in the United States where a bedsore is considered one of the causes. Read what Healthsentinel.com has to say about this study.

Clinical nurse specialists (CNS) instituted a Pressure Ulcer Prevention Protocol Interventions, or PUPPI, at the Ohio State University Medical Center in Columbus Ohio. The protocol is a nursing initiative that involves assessing risk and nutritional status, providing skin care, documenting, and giving referrals as needed.

Read about the PUPPI.

300 DIE A DAY FROM PRESSURE ULCERS

Pressure ulcer / bed sore / decubitus ulcer - all names for the same painful and life threatening "injury." Why do I hesitate to call them injuries, because their cause is so unique. When pressure is placed on the skin, in a non active person for long enough, the lack of circulation will cause the tissue around the area to die. The results can be amazing, and so terrible. Today I learned that recent studies have found that on average, 300 people die a day from pressure ulcers. If one of these individuals is in a nursing home, that 1 is too many - wound records, skin checks, turning schedules, hydration should prevent these - and if one starts, you have many days to prevents it forming into a Stage III or Stage IV. Read this article - http://www.healthsentinel.com, and then, next time you are in an acute care setting with a loved one and are told they have a pressure ulcer - raise a stink, demand to see it and learn about its progress or healing. The last thing you want is to learn about it in the Emergency Room, and find out its too late to help.

NURSING HOME RESIDENTS AT RISK FOR SUPERBUGS!

A Johns Hopkins University study of adult patients admitted to its hospital showed that patients who resided in nursing homes at any time within the last six months were far more likely than other adult patients to carry or be infected with a drug-resistant superbug. The study, conducted over a four-month period in 2006, was intended to grasp the extent of one of the lesser known hospital superbugs, multi drug-resistant Acinetobacter (MDR-ACIN), and control its spread among the hospital’s most vulnerable adult patients.

More than 1,600 were screened within 24 hours of admission to any one of five intensive care units where previous infections had been recorded. Results showed that patients who had been in nursing homes were 12 times more likely than other patients to be carriers of the bacterium. Rates were even higher, 22 times, among those patients who were wheelchair or bed-bound because their legs were paralyzed.

Read the complete story.

THE SENSELESS SHOOTINGS AT VIRGINIA TECH

Please allow me to post this short article on a topic outside of our norm. I am a graduate of Virginia Tech, grew up in Blacksburg, and have parents living about 1 mile from the campus. One of my brothers graduated from the university as did my father. My great-grandfather graduated from the university before the beginning of the 20th century. My ties are long and deep.

I do not feel anger or hatred toward the shooter. He was obviously a sick and demented individual. I do have sympathy for the victims, their families and friends. I do not know how they will overcome this tragedy. I don’t know if I could overcome such unspeakable tragedy if we lost one of our two sons in such a meaningless and vile manner. I am profoundly sad!

There will be better days for Virginia Tech, its students, faculty, staff, and alums…but it will take time to heal. I want to share with you what a friend sent me today which is reported to have been written by Homer Hickam, author of "Rocket Boys" and a Virginia Tech graduate, and sent to Virginia Tech President Charles Steger. The letter read in part as follows:

"Today, there is pain everywhere in our community, and our hearts are troubled. Yet, I am certain our university will persevere. The spirit of Virginia Tech cannot allow otherwise. We who once walked its halls and studied in its classrooms were trained to represent all that is good and right in the world, and we will prevail. Evil can never succeed, not while there are yet men and women like the people of Virginia Tech who reach every day for success, and endeavor for the improvement of the human condition across the planet."

I hope he is right!

WHO MAKES DECISIONS IN A LAWSUIT - NOT THE LAWYERS

I am by definition, a "trial lawyer."... but I really should be called a "settlement lawyer" or "mediation lawyer." The reason being, very few clients want to take their case to trial. And I can't blame them - stress, nervousness, it can be overwhelming. Well, today I read about a client who agreed to settle, and then decided against it (read below). Bottom line is, clients, and not their lawyers should make the decisions on whether to settle and if so, how much. We work the case up and then hand it right back to our clients, and say, "ok - now you decide." So, the moral of this tale, is that if you go into the case, not wanting to make any decisions, you may need to re-evaluate, but, if you are ready to make tough choices - you will be ready to go!
___________

SANTA ANA – A state appeals court on Monday reinstated a former transplant patient's medical negligence lawsuit against a University of California hospital.
Advertisement Irvine, who was diagnosed with a deadly kidney and liver disease, waited four years for organ transplants at the hospital before she went to another hospital and got the desperately needed procedures within two months.
She filed the malpractice suit and settled with the hospital for $50,000. But she later tried to get the settlement overturned after she suspected her lawyer, Lawrence Eisenberg, mishandled her case and pressured her into accepting the settlement.
The appeals panel ruled that Irvine's argument “demonstrated good cause to restore the case.”
http://www.signonsandiego.com/news/state/20070416-2245-ca-transplantlawsuit.html

Totally off subject

It would be a lie for me to write that I am thinking about legal medical issues right now - my thoughts, and prayers, as well as the thoughts and prayers of my entire office, are in Blacksburg. God bless you Hokies, wherever you are!

MEDICATIONS…DRUGS….PHARMACEUTICALS….ARE ALWAYS IN THE NEWS

Drugs are always in the news! There is Vioxx, and Celebrex, and the hormone-replacement drug Prempro, and the birth-control patch Ortho Evra and on and on and on. In the last few days the following articles have appeared in the media:

o FDA's Position on New Drugs May Hurt Merck's Arcoxia Bid

o Big Pharma's Achilles' Heel

o Amgen's Star Fades Amid Safety Questions

o Doctors: Arthritis Drug Arcoxia Risky Too

o FDA Says Bladder Drug Needs Child Warnings

o FDA Is Asked to Halt Celebrex Ad

o FDA Targets Unapproved Nausea Drugs

o Experts: New Merck Drug Won't Get OK

SECOND OPINIONS CAN PREVENT UNNECESSARY TREATMENT

In this article on MSNBC, a Canadian woman is suing her doctor, who told her she had cancer and administered six months of chemo therapy before she discovered from another doctor that she did not have cancer at all!

The woman lost her hair, shed 60 pounds, and became anemic as well as contracting a dangerous bacterial infection before another doctor told her she did not have cancer. Her tip to everyone else is “Never accept your first medical diagnosis.”

MEDICARE’S TWO YEAR WAITING PERIOD

In 1972, Medicare expanded its benefits to include disabled individuals. Unfortunately, while expanding their services, Medicare instituted a waiting period designed to limit costs and make certain that only people with severe and long lasting disabilities would qualify. Many groups have worked to eliminate the unfair waiting period, without success. The only two exceptions are for those patients with end-stage kidney disease or Lou Gehrig’s disease, who are now allowed quicker access.

The Medicare Rights Center released a report recently entitled “Too Sick to Work, Too Soon for Medicare: The Human Cost of the Two-Year Medicare Waiting Period for Americans with Disabilities”. This report discusses the stories of about 21 people who have been affected by this waiting period and was funded by the center and the Commonwealth Fund. The report comes along with renewed interest among members of Congress and the states to reduce the number of uninsured people.

See the full article from USA Today.

CASE REPORT: FAMILY SUES AFTER MAN GETS WIDE-AWAKE SURGERY

In this article, a West Virginia family has filed a lawsuit after their father had exploratory surgery for abdominal pain. The man was given drugs to paralyze his muscles, but was not given general anesthesia until 16 minutes after the first cut into his abdomen. The man committed suicide two weeks after the surgery, two weeks in which he did not want to be left alone, suffered nightmares and was convinced people were trying to bury him alive.

According to the Anesthesia Awareness website, anesthesia awareness is the phenomenon of being mentally alert (and terrified) while supposedly under full general anesthesia. The patient is paralyzed, unable to speak, and totally helpless to communicate his/her awareness. Actual cutting pain may or may not be present.

While it is not common, the Joint Commission on Accreditation of Healthcare Organizations says that anesthesia awareness happens in 0.1 percent or 0.2 percent of operations involving general anesthesia in this country. Half of those patients report mental distress and even post traumatic stress disorder after the surgery.

In 2005 the American Society of Anesthesiologists adopted guidelines to prevent this occurrence, including a checklist to make sure that anesthesia is delivered properly and that these cases no longer happen. West Virginia University School of Medicine uses brain monitors as well as blood pressure monitors and other equipment to measure things such as body temperature. The chances of anesthesia awareness are slim when appropriate monitoring equipment is used.

If you are going to have surgery, maybe you should ask your anesthesiologist and surgeon how you will be monitored during the surgery. Make sure that they will be checking and that you will not be added to those patient who have suffered anesthesia awareness.

SON FORCED TO ARBITRATE CLAIM AGAINST NURSING HOME

Many nursing homes do not want to be held accountable for acts of negligence which kill or injure their residents. How do they escape legal responsibility? Well, did the admission agreement your dad signed (or you signed for your mother) when first admitted to the facility contain a mandatory arbitration clause? If so, you may be in trouble!

Mandatory arbitration clauses, upheld by many courts in many states, provide that neither the resident nor their family may file a civil lawsuit against the nursing home. Instead, you may only file a claim with an arbitrator, often chosen by the nursing home, and the damages which may be awarded by the arbitrator (assuming you get one) could be limited by artificially low dollar amounts. And, by the way, many of these admission agreements specifically provide the nursing home may take you or your parents to court if you fail to pay for services…you just cannot sue them when they are at fault!

Read one family’s story here.

WE ARE PULLIING FOR THE DOCTORS ON THIS ISSUE!

Most of our articles on this blog highlight problems with health care providers and health care system. Well, this time we are rooting for the doctors!

A new policy announced by mega-health insurer, UnitedHealth Group, Inc., threatens to fine doctors who refer patients to out-of-network laboratories for medical tests. Most current health plans require members to pay more when they go to an out-of-network doctor or take nonpreferred medications. The current policy is obviously not enough to satisfy some health insurance companies and their drive to increase profits. UnitedHealth now wants to enforce a financial penalty upon doctors who send their patients to out-of-network laboratories. The policy change appears to stem from a 10 year deal which UnitedHealth struck with Laboratory Corp. of America to become its national in-network laboratory.

The American Medical Association has demanded UnitedHealth rescind the policy. Read the AMA’s position here.

Is the fox now guarding the hen house?

SOME HOSPITALS CALL 911 TO SAVE THEIR PATIENTS

Yes…you read that correctly…hospital staff calling 911 on the telephone to save their patients! Sound too bad to be true? Unfortunately not!

The New York Times reported that this actually happened recently in Texas, where a 44-year-old man named Steve Spivey developed breathing problems after spine surgery. No physician was working there when the staff first recognized he was in trouble. They phoned 911, and he was taken to a nearby full-service hospital, where he was pronounced dead a short time later.

Don’t hospitals have an obligation to the public to be sufficiently staffed to handle these types of emergencies? I think they do and bet you do too!

Read the article here.

SOMETIMES LONG-TERM CARE INSURANCE DOESN’T PAY

A recent article in the New York Times examines the extensive problems that many elderly policyholders are having with long-term-care insurance providers who are not delivering on their promises. Policyholders who made their payments in good faith now find themselves facing claims denials and lengthy runarounds that delay processing of claims to the point that policyholders either give up or die.

Mary Beth Senkewicz, a recently resigned senior executive at the National Association of Insurance Commissioners, stated that “The bottom line is that insurance companies make money when they don’t pay claims. They’ll do anything to avoid paying, because if they wait long enough, they know the policyholders will die.” The three insurers receiving the largest number of complaints are Conseco, Bankers Life (an affiliate of Conseco) and Penn Treaty. Statements in depositions and interviews by former employees of Conseco, Bankers Life and Penn Treaty illustrate business practices that denied or delayed claims for reasons that seemed trivial.

Read the New York Times article.

FLORIDA NURSING HOME FAILS TO HONOR LIVING WILL

In Florida a jury found that a West Palm Beach nursing home failed to honor the living will and advance directives of a 92 year-old resident with Alzheimer’s disease who had stipulated that she did not want to be kept alive by artificial means. The jurors ruled that the home should pay $150,000 in damages. However, the jury did not find the doctor, against whom suit had also been brought, negligent for his role.

The 12-year lawsuit goes back to 1995, when the resident became unconscious, and nursing facility staff called 911. The nursing home claimed calling emergency workers was the right thing to do because the doctor was not in the facility. The resident was taken to the hospital where she was hooked up to various life-sustaining equipment, including a breathing tube, but she died six days later.

The resident’s granddaughter sued the nursing home for prolonging her grandmother’s life unnecessarily. After the verdict, she said that she wanted to let those caring for the elderly know that “they need to pay attention to patients’ end-of-life directives and wishes.” The jurors said that they ruled against the facility because it did not have its procedures in place to make sure the resident’s living will was carried out, but felt the doctor was compassionate and caring and should not be held responsible. The verdict has been lauded by bioethicists. Dr. Kenneth Goodman, director of the University of Miami’s bioethics program and the Florida Bioethics Network, said, “This is a big deal. It’s a reaffirmation that no means no. There are a lot of institutions and a lot of health-care professionals who have acquired the belief that you reduce liability over treating patients. This case shows that’s a bad strategy. The whole point is that advance directives survive your inability to utter them.”

Read the article here.

COST OF NURSING HOME CARE NEARS $100,000 A YEAR!

A one year stay in a New Jersey nursing home costs approximately $98,178, or $268.98 a day. Nationwide the average cost of a single year in a private nursing home is $74,806, which is about 15% more than what nursing home care cost in 2004.

The source of this information is a study conducted by Richmond, Virginia based Genworth Financial. Read the study here.

PATIENT MIXUPS AND MISCOMMUNICATION

We have previously written about cases in which our law firm was involved where the wrong patient received another’s patient’s physician ordered blood transfusion. We have also talked about physicians’ ordering medication for a patient with a known allergy to the medication simply because the doctor either failed to check the patient’s chart for documented medication allergies or where the chart failed to contain previously known drug allergies. These mistakes can kill you!

Now for some promising news. The Wall Street Journal reported today, in an article written by Laura Landro, that some hospitals in Pennsylvania have started to issue standard colored patient wrist bands which easily and quickly identify patients who are a “fall risk,” or have a documented drug allergy, or those whose charts contain a “Do Not Resuscitate” order by their physician. Bravo! Seems like a pretty simply solution to a potentially deadly problem!

You may read the Pennsylvania state safety group’s materials here.

WHO HAS THE LAST CALL - YOU or YOUR DOCTOR?

There is a wonderful essay in today's New York Times, about the balance between a patient's request, and doctor's policy. What if the two are in conflict - who wins?
http://www.nytimes.com/2007/04/03/health/03essa.html?_r=1&adxnnl=1&oref=slogin&adxnnlx=1175629105-k+zaPwO4G3Y1M1sUNwOAWg
We see it often in Nursing Homes. Families will request a test, or treatment, the physician says is not necessary. On the flip side, we have seen physicians request a consulation with a physician the family thinks is unnecessary. It is the right of the individual and or his medical power of attorney, to make all health care decisions, based upon the advice of physicians. Sadly, that does not always occur. And as a family member, or patient yourself - FIGHT.

A neurologist refused to prescribe my mother a new and unique treatment for her MS because he didn't know much about it (actually - he said something about the pharmaceutical companies not making it and he wouldn't prescribe without a rep). She said she wanted it - and would gladly sign a release, anything to try the treatment. He refused - so she took her literature elsewhere, and now has a wonderful neurologist who will monitor the new treatment, and learn about it with her. The good news, its a great treatment - and her fighting paid off.

DOCTORS WERE PRICE-GOUGED BY THE INSURANCE INDUSTRY

Americans for Insurance Reform (AIR) announced last week the release of
a study that examines current insurance industry data to determine what caused the most recent medical malpractice insurance crisis for doctors. The study by AIR, a coalition of over 100 consumer and public interest groups representing more than 50 million people, finds that the insurance crisis that hit doctors between 2001 and 2004 was not caused by claims, payouts or legal system excesses as the insurance industry claimed.

Lawyers who represent victims of medical negligence are not the cause of escalating malpractice premiums. Doctors and hospitals purchase insurance to provide a remedy for those patients who become seriously injured as the result of predictable negligence. Predictable because doctors are human and mistakes will always be made. The insurance industry is the BAD GUY…don’t blame the lawyers!


See the Press Release here.

NEW GUIDELINES FOR TREATING BREAST CANCER

The National Comprehensive Cancer Network has issued a new guideline for the treatment of breast cancer. The guideline, issued in December of 2006, was developed by a panel of 25 multidisciplinary breast cancer experts from NCCN member institutions.

The guideline has 3 parts: an algorithm that follows the step-by-step clinical decision-making process; a manuscript that discusses the data the recommendations are based on and the issues that were considered by the panel; and a bibliography. Each recommendation is categorized according to both the level of evidence supporting the recommendation and the degree of consensus among the member institutions that the recommendation is appropriate. Some of recommendations for treatment include:

1. When breast MRI is indicated, it should be performed and interpreted by
a expert breast imaging team working in concert with the
multidisciplinary treatment team.


2. The panel added raloxifene as an option for reducing the
risk of invasive breast cancer in postmenopausal women with lobular
carcinoma in situ.


Read the guideline in its entirety.

PHARMACY MALPRACTICE: IT HAPPENS MORE THAN YOU THINK!

We have previously written about medical negligence by pharmacists. It looks like these problems occur even more frequently than we anticipated. Be an informed patient!

Watch the ABC News report on 20/20 here.

BE CAREFUL DURING THE HOLIDAYS

Planning on a visit to the Nursing Home this EASTER or PASSOVER? Taking your grandparent out on Mother's Day in May or Father's Day in June? This is a great opportunity to pay attention to their progress / health concerns or needs. How are they feeling? Getting better, or worse? What do you notice? Its is vital to be attentive, and then, more important to communicate these observations to the staff. Think they failed to write it down - write it down for them - fax a letter to the doctor and the nursing home with your observations. We had a case where a family member noticed swelling and pain in their loved ones' foot on Christmas - told the staff, but there is NO record of the call, or the symptoms.

Its also important to realize facilities are usually shorter staffed during the holidays... the staff wants to be with their families too.... so being a care provider for your loved one may mean taking extra steps for them - either observing and learning about their progress, or communicating concerns to staff. Please don't let the holiday go by without taking the opportunity to learn how they are really doing. My grandfather's nursing home records would show he wasn't eating - but man, you took that guy to a Red Lobster and he wouldn't stop - the problem, no one encouraged him to eat his meal - they just put it next to him, and came back in an hour..... Families have a duty to pay attention too!