LOCAL RADIOLOGISTS?

Been to the emergency room lately? Had an X-ray or CT ordered? Chances are pretty good you didn't meet the radiologist who read them. Chances are also pretty good that person has never stepped foot into the hospital.

More and more, radiologists are reviewing films from their desks - receiving the images from computer technology.

Today we received an article By: Jean DerGurahian/ HITS staff writer, about the trend and teleradiology industry, nicknamed "nighthawking" after one of the industry favorites, NightHawk Radiology.

According to the article:
""Nighthawking services" have grown in the past decade into a $3 billion to $5 billion industry, as technology improves and makes reading images from remote locations easier and more efficient. About half of all U.S. hospitals use teleradiologists, who are trained and credentialed in this country before moving to overseas offices, from which they e-mail, fax or phone results. Hospitals pay the outsourced radiologists directly, typically between $50 and $70 for each read; in-house staff bill patients and insurers according to coded rates.
Radiologists are alarmed at how smoothly nighthawks have been able to grab hospitals' attention.
Although basic economic principles drive consumers to seek out the best quality for the lowest costs,
nighthawks are a contentious issue among radiologists who insist that teleradiology is a threat to patients.
Besides competitive pricing, teleradiologists offer something else: the ability for radiologists to sleep through the night without being called in after-hours to read emergency scans.
This doesn't sit well with some who believe that the bottom line, and not patient safety or quality, drive teleradiology. Nighthawking businesses were not started for the patients, Modic said. "We did it so we can sleep."

WOW - I admire and respect that need... but in our local hospital, recently scans at 5:15 pm, have been sent across the country to be read - that wasn't because of the time... rather cost I imagine.. and nothing beats having the opportunity to speak to the treating physician about the patient, reviewing old records, scans etc - and that personal review of films...

Too bad the health care industry is getting away from direct care.. isn't it?

$4 MILLION TO FAMILY

The family of Connecticut man who choked to death while being treated at a nursing home will receive $4 million in damages, a jury has ruled. According to the lawsuit, a replacement worker at County Manor Health Care Center wrongly fed the man meat and potatoes despite doctors’ instructions not to feed the man solid foods. Defendants in the case are expected to appeal the verdict. AP, Stamford Advocate 11/30/2007
Read Article: Stamford Advocate

FULL PAGE AD

In today's Wallstreet Journal, there is a full page ad for LIPITOR. Wow, I thought to myself - that is some pretty pricey ad placement. Do physicians read the Wallstreet Journal?
And while many physicians may read the Journal, it was clear the ad was not to attract physician support, but rather consumer interest.

Lets say 65 year old retired man, who golfs but participates in no other cardio activity, 20-30 lbs over weight, finds out his cholesterol is high. Goes to his PCP, doctor says eat your oatmeal and I am going to put you on medication to help reduce your cholesterol. Doctor prescribes Baycol. The man thinks, Baycol - never heard of that Doc, sort of scares me. Then the doctor says, "well - we can try Lipitor or Zocor" - man agrees, "Yes Dr. That sounds like a good idea. I have heard of those."
Is it better just because you know the name? Do you know it because of TV, the Journal, or because it has worked for a close friend? Doesn't matter - companies are now trying to get name recognition such that patients, and not doctors are selecting the medication... and frankly, I think this stinks.

So please, just because you saw the ad, or have heard the name - doesn't mean the medication is right for you.

THE WORST NURSING HOME IN VIRGINIA, IS?

Drum roll please.....

According to Medicare, the worst (or rather those facilities requiring special focus and more frequent checkups) nursing home in Virginia is RUXTON HEALTH OF WOODBRIDGE!
I would congratulate you on this, but its hardly an honor! I did 30 seconds of digging - and it seems it is privately owned, and for profit. Not a surprise. Check out the complete list of "special focus" nursing homes here.

MEDICAL RECORDS ONLINE

I am a faithful NPR listener, and this morning I was amazed by a discussion on medical records being available online. YES. Private medical records could be accessed (with the right code or password information) to physicians etc... Now it is one thing to allow physicians and staff of a hospital system to gain access through computer database, but another to have medical records on the internet.

Safety issue? I would say so. My credit card was stolen from a reputable travel website a few years ago, so I have no faith in internet security. Think about how this could be used. Employers seek health history information before hiring. Identity's are stolen and crooks even acess your medical identity. Is privacy giving way to convenience?

We request records on behalf of clients all the time, but if it means having to send letters, releases, and make many follow up calls - we will gladly make the effort to protect our clients.
Hear the report on NPR about future of Medical Records online, here. So far, I am not sold.

FOUR GREAT SOURCES FOR MEDICAL INFORMATION

Each of us, as consumers of medical care, should investigate our medical problems, treatment option, and doctors! Here are four excellent sources of information:

1. eMedicine is the original open access, comprehensive medical textbook for all clinical fields. It is very easy to search and is filled with detailed information on standard of care, known issues/complications, etc. 10,000 articles and 6,500 contributors make this an invaluable resource for medical information.

2. Healthgrades is a one stop shop for quality ratings of hospitals and reported actions on physicians. Offers a wealth of background information on individual doctors, hospitals, nursing homes and patient opinions.

3. Fierce Healthcare contains daily news for healthcare executives and is a great digest of what's happening in the field of healthcare. Whether its drug recalls, regulatory action or class action verdicts, Fierce Healthcare delivers a daily dose of what's going on in the field of healthcare.

4. Mdjdphd consists of a panel of three highly knowledgeable physicians and a physical therapist who provide their impressions of attorney submitted hypotheticals for free. The site is searchable by injury/issue and the information incredibly useful in evaluating potential cases, existing cases, deposition questions, novel theories and obtaining second opinions.

PATIENTS NOT TOLD ABOUT POTENTIAL DANGER FROM SYRINGES

628 patients in and around New York were notified this week they should be tested for hepatitis and H.I.V. infection because they were treated years ago by an anesthesiologist in Nassau County who used improper procedures for preventing the spread of blood-borne diseases. The anesthesiologist, Dr. Harvey Finkelstein, first became the focus of a state health investigation in 2005 after two of his patients contracted hepatitis C.

In 2005, investigators found that, in violation of widely accepted practices recommended by the Centers for Disease Control (CDC), Dr. Finkelstein, 52, who specializes in pain management, was reusing syringes when drawing doses of medicine from vials that hold more than one dose.

He would use a new syringe for each patient. But when giving one patient more than one type of drug by injection, his practice of using the same syringe to draw medicine from more than one vial led to the potential contamination of the vials. The blood of a patient who was infected with hepatitis C could, by backing up through the syringe and entering the vials, infect another patient when the same vial of medicine was used again. Health officials confirmed that this happened in at least one case.

The patients of Dr. Finkelstein who were at risk of contracting hepatitis and H.I.V. were not notified for approximately 34 months! Outrageous!! And guess what, under most states’ laws the statute of limitations has expired thereby preventing the victims of this gross medical negligence from holding their healthcare providers responsible.

OHIO MAN ARRESTED IN NURSING HOME SEXUAL ASSAULT CASE

We place our family members in nursing homes in order they may be protected and cared for. Well…then how did this example of gross abuse and neglect happen?

Ben W. Detweiler (81) has been charged with rape and two counts of gross sexual imposition and was arrested last week. The prosecutor said the charges stem from an investigation by the Ohio Department of Health. The agency concluded that a frail female resident was molested by a visitor at The Woodlands at Robinson nursing home and administrators failed to protect her from the assaults.

It would suit me just fine that if the defendant is found guilty of the crime the nursing home administrator and director of nursing should lose their jobs as they obviously don’t have the best interests of the residents as a priority! Allowing abuse and neglect is never acceptable!

BREAST CANCER DRUG

Pennsylvania Jury awards $3,000,000 to family, alleging that Prempro, hormone replacement therapy, caused plaintiff to develop breast cancer. WOW. I believe the lady lived, and the jury found that the drug company failed to properly warn of the risks.

That is great news - forcing disclosure of drug companies. Its about time if you ask me - they should put real warnings on these drugs, not just fluffy ones their marketing team has re-worded.

CASE REPORT: FAILURE TO DIAGNOSE AND TREAT COMPARTMENT SYNDROME

This case comes to us from Illinois. The patient, 37 years old, collapsed while running. He was admitted to a hospital for several days and treated by an internist. He experienced severe pain, swelling, and tenderness in his lower legs while in the hospital.

One week after the collapse the patient was seen by another internist who immediately diagnosed the patient to be suffering from compartment syndrome in both legs and referred him to an orthopedic surgeon. The orthopedic surgeon performed an emergency fasciotomy on both legs. However, due to the delay in diagnosing the patient’s condition and receiving appropriate surgical care (the fasciotomy), the patient suffered nerve and muscle damage resulting in permanent bilateral foot drop.

Compartment syndrome is a painful condition that develops when swelling takes place within an enclosed area (compartment), in which muscles, nerves, blood vessels, and bones in the compartment have no room to expand. Pressure on arteries, veins, and nerves causes extreme pain, slows circulation to the muscles and nerves, and can cause permanent damage to these tissues.

The patient sued the first internist who saw him open his admission to the hospital, alleging the doctor failed to timely diagnose his compartment syndrome and refer him to the appropriate medical specialist for treatment. The jury awarded the patient $2 million and the case was settled later on appeal for approximately the same amount.

PEOPLE FEAR NURSING HOMES MORE THAN DEATH!

Great article - AGING IN PLACE IN AMERICA...

Here is what it says:

"Senior citizens fear moving into a nursing home and losing their independence more than they fear death, according to a study, “Aging in Place in America,” commissioned by Clarity and The EAR Foundation, which also found that the Baby Boomer children of seniors also fear for their parents.
Boomers express particular concern about their parents’ emotional and physical wellbeing should they have to enter a nursing home, finds the study, which examines the attitudes and anxieties of the nation’s elderly population (via MediaPost).
When asked what they fear most, seniors rated loss of independence (26%) and moving out of home into a nursing home (13%) as their greatest fears. Death was cited as the greatest fear for just 3% of seniors.

Some key findings of the study:
89% of seniors want to age in place - or grow older without having to move from their homes - and more than half (53%) are concerned about their ability to do so.
82% of Baby Boomers fear their parents will be mistreated in a nursing home and 89% fear their parents will be saddened by the loss of their independence.
79% say they are worried that their parents would not like living in a nursing home, and 70% are concerned their parents will be scared to move out of their homes."

Wow - what does that say about our level of care?

MRSA FOUND IN VIRGINIA NURSING HOME

The Hampton Virginia Health Department confirmed a case of MRSA at a local nursing home. A resident at the Coliseum Park Nursing Home on Marcella Road contracted the infection and is being treated at the facility. The facility has also identified another case of MRSA according to the Hampton Health Department, but the second patient reportedly has no symptoms and is not being put on any antibiotics.

All nursing home should be on “High Alert” for MRSA in their residents and, if symptoms of the illness are present, immediately advise the resident’s family and attending physician in order that prompt medical attention can be provided. Prompt medical care is especially important in residents with open wounds.

ROANOKE PROPERTY OWNERS FAIL TO REMOVE LEAD

We all are now aware of the dangers of lead poisoning and the devastating effect lead can have on the neurological development of children. I was greatly saddened to read my local newspaper today, The Roanoke Times, and learn that a federally funded program (Lead Safe) to assist property owners in the removal of lead will expire January 1, 2008. Roanoke City officials are uncertain whether to reapply for the federal grant! Why?

It appears that Roanoke may not reapply because the Virginia Department of Health reported only 16 local children under the age of 6 had elevated lead levels in their blood in 2006. There were only 11 confirmed cases through September of this year. The Lead Safe program run by neighbors in Lynchburg, Virginia is not doing any better!

I have two responses/observations: First, 1 case of a child with dangerous levels of lead is enough to fill out the application for federal assistance in removing lead! The impact on children is devastating as the symptoms include reduced IQ’s and inability to succeed in school. Second, I seriously doubt that there were only 16 children poisoned by lead in 2006! The VDH estimates that there are at least 1,390 homes at risk for lead paint contamination…and you expect me to believe that only 27 children have lived in those 1,390 homes over the last 30 years! Doubtful….very doubtful!

LEAD POISONING IN CHILDREN - SCARY STUFF

Almost every day, we learn that another toy has been recalled because of high lead levels. Well, its not just toys that should cause parents concern - pipes, dirt and lead paint are often consumed by children and can cause lead poisoning.

According to our local paper, The Roanoke Times estimated 1,390 homes with lead paint will house children by year's end in our area.

According to the CDC, for infants and young children, lead levels of 10 micrograms or more in a deciliter of blood can damage ability to learn. At higher blood lead levels (that is levels equal to or greater than 25 micrograms per deciliter), lead can damage people's kidneys, blood, and nervous system. At very high levels, lead poisoning can cause mental retardation, coma, convulsions, or death.

One of the difficulties with lead poisoning, is that high lead levels will appear in children when they are young, but the damage of the poisoning may not be fully realized until they are adults.

So there is a moral to this story - for homeowners, tenants, land lords etc - make sure there is no chipping paint or dust from lead paint. Call your local health department to have your home tested, and ask your child's doctor to test for lead levels. At least in Roanoke, until Jan. 1, 2008 -the City can help mitigate the problems!

ALWAYS ASK QUESTIONS

Ask your surgeon "will you be the one doing the surgery?" Ask if a nurse or physician will be administering anesthesia. Ask the nurse if your wound looks normal. Ask what medication you are on. Ask why you are on it.

Yes, even medical providers get into the "routines" of work - and it may be, when asked to explain why or who or how something went, you both will be better prepared to fight the problem together.

JURY AWARDS $1MILLION OVER NURSING HOME NEGLECT

When will the corporate owners of America’s nursing homes get it? When will they learn not to put “profits over people” and provide the type of care and attention needed by the elderly? Well…this jury verdict should get their attention!

The family of an 84-year-old Louisiana man who died while in the care of a nursing home has been awarded $1 million in damages stemming from a nursing home neglect and medical malpractice lawsuit. Shortly after entering Olive Branch Senior Care, Leon Nelms had to be taken to a hospital because of infected pressure sores, weight loss, malnutrition and dehydration. He died six days later from the infected pressure sores, one of which was so advanced it went to the bone and was infected with his own feces!

The nursing facility is owned by Brown Development Inc. and D. Brown Enterprises Inc.

ERISA LIENS: ANOTHER SAD STORY!

In many of our firm’s medical malpractice cases the patient’s medical bills were paid by health insurance provided by the patient’s (our client’s) employer. The insurance coverage is provided as part of an Employee Retirement Income Security Act (ERISA) benefit package. ERISA is a federal law enacted by Congress in 1974.

The problem with health insurance benefits provided through ERISA is that the insurance carrier often has a lien for every dollar in medical care it has paid on behalf of the employee. What does this mean? Well, after paying thousand of dollars for expert witnesses and dealing with the emotional stress involved in the prosecution of a medical malpractice case and winning the case….the health insurer sticks out its greedy hand and requires that it be reimbursed for the medical bills it paid! Is this what medical insurance was designed to accomplish – I don’t think so.

ERISA liens are unfair and can really work an injustice to successful medical malpractice plaintiffs. Watch this video for a case in point.

NURSING HOME DISASTERS IN NORTH CAROLINA AND TENNESSEE

We place our loved family members in nursing homes because they need extra care and attention – they don’t need what these two nursing homes were providing!

The Tennessee Department of Health has suspended new admissions to the Hillcrest North nursing home. The 271-bed nursing home was ordered not to admit new residents after an investigation revealed conditions the state says could be harmful to residents. The nursing home has a history of problems dating back more than a decade. Hillcrest North’s suspension was put in place yesterday and included a state fine of $1,500 and a federal fine of $3,550 which must be paid everyday until the violations are corrected.

Not to be outdone, a Raleigh, North Carolina nursing home may have taken abuse of the elderly to a new low as police believe employees at the facility may be part of a drug network! Police arrested five people at Tara Plantation, including the home's Administrator and the Assisted Living Coordinator. Police say they found evidence the head administrator and four other employees were selling marijuana and patient medications from the facility. The 80-bed facility houses mostly Alzheimer’s patients.

NURSING HOME RESIDENTS HAVE RIGHTS!!

Nursing home residents have the right to be treated with dignity and respect as well as the right to privacy among others. But, what happens when those rights aren't respected? And, how do we ensure residents maintain their rights, but keep them safe at the same time?

As required by federal law those rights include:

o The right to access all records within 24 hours.

o The right to be fully informed of his/her health status and medical condition.

o The right to refuse treatment.

o The right to execute an Advanced Medical Directive.

o The right to be informed if they qualify for Medicaid benefits.

o The right to be informed of all available services and their costs.

o The right to be informed of the identity of the facility’s Medical Director and how to contact him/her.

o The right for the resident’s family to be notified of accidents and changes in the resident’s medical condition.

ROANOKE CITY SCHOOLS - BYRD HIGHSCHOOL

This is certainly a local issue - but one worth talking about.

Roanoke City Schools have had reports (since September) of strange symptoms affecting teachers and students at an area high school- William Byrd. The symptoms seem neurological - headache; dizziness; tremors - so what on earth could cause this?

The local Health Department assured family members last night the school was safe. Forgive my skepticism, but how do they know that? If you don't know what is causing the problem, how can you opine there is no problem?

Has the local health department called CDC? Asked for state Health Department assistance? Asked for environmental tests? Done lab work on teachers and students? I understand the desire to prevent public outrage - but making conclusions and public safety statements this soon, helps no one.

To the families of William Byrd staff and students - I am thinking of you. I know it must be scary situation.

ELECTION DAY

"Tort Reform." That is a very popular phrase to throw around election day. And in the spirit of election day - I wanted to share a few stories.

Senator, Rick Santorum, champion for tort reform, sued (with his wife) their chiropractor for malpractice. Rumor has it the case ended in a six-figure resolution.

Florida papers report this week - Florida State representative Stephen Wise has repeatedly voted for medical malpractice and nursing home reform. In 2004 he issued this quote: "The Legislature must not allow nursing homes to be put out of business because of lack of insurance and the possibility of law actions that have no merit.” Last week his wife filed a lawsuit against a Jacksonville nursing home on behalf of her deceased 89-year old father.

The moral of the story on election day - is don't judge the merits of "malpractice" lawsuits from afar. Some day, you and your family may be in the awful position of having to consider one yourself. And for my friends running for local and state office today - be reminded that people remember what you say.

JURY FINDS NURSING HOME LIABLE FOR RESIDENT’S DEATH

A Missouri jury has ordered the owner-operator of two nursing facilities to pay more than $3 million to the estate of a former patient who died in 2004. The verdict stems from a lawsuit alleging that the nursing staff at Barry Manor and White Oak Manor nursing homes was negligent and failed to properly care for the resident.

The jury ruled that the nursing homes failed to provide adequate staffing, didn't attend to the resident’s bedsores or turn and reposition him to prevent the problem. They also found the staff didn't properly treat the resident’s wounds and no one monitored his condition or alerted a physician when his condition worsened.

The jury awarded the estate $500,000 in compensatory damages and more than $2.5 million in punitive damages. Bravo!!

PRIVATE AND SEMI-PRIVATE NURSING HOME ROOM RATES INCREASE IN CREASE IN 2007 WHILE ASSISTED LIVING RATES REMAIN STEADY

Nursing home costs increased 3% on average across the country in the last year, according to newly released data from the MetLife Mature Market Institute. Assisted living costs remained virtually unchanged at $2,969 per month or $35,628 yearly. The average cost of a private room in a nursing home was $213 per day or $77,745 annually, compared to $206 in 2006.

Closer to home, the per day average cost for a private room in the Alexandria, Virginia area was $260 while the average per month charge for assisted living facilities in the same area was $3,923. For Richmond, Virginia the average per day charge for a private room was $185 while the average per month charge for assisted living facilities in Richmond was $3,396.

My only comment is that for these charges the level of care should be much better!

HEY CONGRESS – PASS THE NURSING HOME ABUSE BILL

A nursing home abuse bill, the Elder Justice Act, has been under consideration in Congress for the past five years but has received scant attention and has yet to be passed. Although nursing home and elder abuse are serious and growing problems in this country, the nursing home abuse bill has never even been voted on. Why?

Congressional critics say that the Elder Justice Act has not been passed for a number of reasons that have little to nothing to do with the bill itself. For one thing, Congress has been distracted by the war in Iraq and partisan bickering. But for the most part, they say the Elder Justice Act has been allowed to collect dust because the issue of nursing home abuse has not garnered the kind of media attention it deserves.

Write your representative in Congress and tell them to pass this important legislation!

HEALTHY BRAINS HAVE PROBLEMS TOO!

A newly released study reveals that 13% of healthy adults have abnormalities in their brains without even knowing it, according to research published in the New England Journal of Medicine. The study analyzed the MRI scans of 2,000 healthy individuals with an average age of 63 with no signs of brain problems. It found that more than 7 percent showed evidence of a brain clot, but the clots were too small to produce symptoms and seemed to be more common with age.

Nearly 2 percent had a brain aneurysm, which is a bulge in a blood vessel that can burst if it becomes too big, causing a stroke. But 32 of the 35 aneurysms were so small the researchers did not suggest follow-up medical treatment.

What do the results tell us? Well, to start off with, just because a head CT or MRI shows an abnormality there needs to be a clinical assessment before you let your favorite neurosurgeon drill a hole in your skull in order to cut on your brain!

As we have said before, "Be an Informed Consumer of Health Care."

PROTECTION TO APOLOGIZE

In my family, when you make a mistake, tell a lie, hurt someone, you apologize for it.
In Massachusetts, the legislature is trying to create a law that allows doctors to do the same thing, without fear the apology will end up before a jury as an admission.

We have similar legislation in Virginia - but sadly, defense attorneys instruct their clients NOT to say they are sorry... and honestly, this causes more lawsuits.

We have numerous clients that say to us "if only the doctor / nursing home had apologized for their mistake, we wouldn't be here." There is something to be said for feeling someone is taking responsibility for their actions and mistakes. Something else to feel as if the wrongdoer is regretful, and will not soon forget the pain they caused. Basically, we want all professionals to take responsibility for their actions. That is why so many file lawsuits - to force some acceptance of responsibility.

So I say - pass that law Mass! Allow doctors and medical professionals to say they are sorry, and I believe you will see fewer lawsuits. Clients often feel like their physicians do not care - doctors, nurses everywhere - please prove them wrong. You will put me out of a job, but maybe that is a good thing.