MY WISH FOR 2008: IMPROVED NURSING HOMES

Nursing home residents are among society’s most vulnerable citizens. Regrettably, the U.S. Centers for Medicare and Medicaid Services, which regulates nursing homes, reports that the number of citations for putting patients in “immediate jeopardy” increased 22 percent from 2000 to 2006. Those citations include the physical or sexual abuse of patients and leaving them without medications.

Year’s end is the time when we look back and look forward. A time to learn from our mistakes and make things better! My wish for 2008 is that America’s nursing home industry takes a hard look at the substandard care it provides and move to make substantial improvements.

BAD NEWS FOR DIABETICS - AGAIN!

Bayer recalls Contour test strips for diabetes - AP Reports Wed Dec 26, 2007

WASHINGTON (Reuters) - A unit of Bayer AG recalled diabetes test strips used with its Contour TS Blood Glucose Meter because they may result in 5 to 17 percent higher blood glucose readings, the U.S. Food and Drug Administration said on Wednesday.
The test strips are used by diabetic patients to monitor their daily blood sugar levels.
Bayer Diabetes Care said the recalled test strips were produced on new manufacturing equipment and that it has fixed the problem.
Some 53 production lots were affected by the recall, totaling 230,000 bottles of strips, a Bayer spokeswoman said. Each bottle typically contains 25 to 50 strips.

Details about the recalled test strips' product code and lot numbers were posted on the FDA Web site: www.fda.gov/oc/po/firmrecalls/bayer12_07.html
(Reporting by Julie Vorman; Editing by Toni Reinhold)

Well I am glad that the FDA actually discovered the problem - but I can imagine how bad that could be for someone who regulates insulin intake based on the daily blood sugar readings - sure hope it hasn't caused any permanent damage!

RECENT ROANOKE JURY AWARD

Dan blogged this week on a local jury verdict of $340,000 in a medical malpractice case. We know the case and the attorneys well. It is actually the 4th time the lawyers tried the case - that means they started trial 3 times earlier and something occurred along the way to prevent the trial from continuing.

What I imagine, is the expense for both sides of having to pay experts, court reporters and lawyers to appear in trial and prepare three different times. Probably $100,000 for the doctor's insurance carrier, and $50,000 for the family for expert costs. It is not that these numbers scare us from trying cases - I simply think it is a sad state when "justice" requires over $150,000 be spent - to even get a case to final conclusion. Most families can't afford that, and I reminded weekly that good, valid cases, languish because "justice" comes at a price far to high for the average Virginian.

So what else can families do, other than file a lawsuit? They can call the Virginia Department of Health on a nursing home, nurse, doctor - and file a formal complaint. Call 1-800-955-1819 to reach the Department of Health. At least it won't cost $100,000!

CASE REPORT: GILES COUNTY FAMILY WINS MEDICAL MALPRACTICE CLAIM

A Roanoke jury awarded a verdict of more than $340,000 to the relatives of a Giles County woman who died in 2001 as a result of a botched lung removal surgery. The jurors found Dr. Bradley Nicholson negligent in the death of 62-year-old Frances Cumbee. Their judgment determined that Nicholson should pay more than $66,000 in compensation for medical and funeral expenses and an additional $40,000 to each of Cumbee's seven children.

Dr. Nicholson worked as a general surgeon for Carilion Giles Memorial Hospital until September 2001, when the hospital suspended his privileges to operate there. That same year, the Virginia Board of Medicine reprimanded him for unprofessional conduct that endangered his patients' health, citing Cumbee's case as one of the more egregious examples.

The lawsuit alleged that Nicholson didn't have the proper training to perform the surgery and that the Giles hospital did not have the proper equipment for the procedure.

My only surprise is that a jury found that the life of a 62 year old mother was only “worth” $340,000!

NO FREE LUNCH

I was reading the St. Petersburg Times, a Florida Newspaper this morning - and they featured the only local doctor that was a member of http://nofreelunch.org/. The group is dedicated to the practice of medicine without influence of pharm reps. You know, let your doctor prescribe the right medication, and hope he/she is not influenced by the free exam table they received from the Merck Product's rep.

I was curious - which doctors in Roanoke are members? THE ANSWER. None. Now, hopefully the word is not out yet and so local physicians don't know about this grass roots effort. Hopefully, this new year will bring many transformations in health care.

Check out the site - it is interesting~

Interesting story on the AP before Christnas, about West Virginia nurses:

"LEXINGTON, Ky. (AP) -- Hundreds of striking nurses from eastern Kentucky and West Virginia voted Saturday night to ratify a new contract with the region's largest health care provider.
More than 600 of the Appalachian Regional Healthcare hospital system's 750 registered nurses walked off the job on Oct. 1 and about 500 remained on strike before an agreement was reached this week.
Negotiators for the nurses had criticized back-to-work conditions proposed by the hospital system that included recognizing replacement workers as permanent employees. The hospital has hired about 150 replacements.
"We know that our nurses and our communities are as glad as management that this strike is over," Appalachian Regional's President and CEO, Jerry W. Haynes said in a statement Saturday night.
A statement from the nurses said most workers will be called back to work by the end of January and that the company has agreed to try to return at least 80 percent of striking workers back to where they were before the stoppage."

Sad state of affairs when we don't pay our nurses enough. What do the hospital CEO's make? What about shareholders of healthcare companies - in a good year, they get dividends... too bad the nurses don't get dividends!

CASE REPORT: WOMAN MISDIAGNOSED WITH HIV GETS $2.5 MILLION

Most of the time we discuss cases where the doctor failed to diagnose or properly treat a medical problem and, as a result, the patient died or was seriously injured. Well, here is a report of a verdict in a medial malpractice case, which is equally bad, but a little different!

A jury awarded $2.5 million in damages Wednesday to a Massachusetts woman who received HIV treatments for almost nine years before discovering she never actually had the virus that causes AIDS. In her lawsuit against a doctor who treated her, Audrey Serrano said the powerful combination of drugs she took triggered a string of ailments, including depression, chronic fatigue, loss of weight and appetite and inflammation of the intestine. Serrano, 45, said she cried after hearing the verdict in Worcester Superior Court and was gratified that the jury believed her."

ADDICTED DOCTORS ARE ALLOWED TO PRACTICE

Nearly all states have confidential rehabilitation programs that let doctors continue practicing as long as they stick with the treatment regimen. Nationwide, as many as 8,000 doctors may be in such programs. Most addiction specialists favor allowing doctors to continue practicing while in confidential treatment, as does the American Medical Association.

Between 10 percent and 15 percent of physicians nationwide will have a substance abuse problem at some point in their lives, a rate similar to that of the general population, according to widespread estimates. An estimated 7,500 to 8,000 practicing doctors are probably in confidential treatment, or about 1 percent of all physicians practicing in the U.S., said Dr. Greg Skipper, head of Alabama's program and a leader of an upcoming study on the issue.

Some doctors have been accused of harming patients while they were in treatment.
In Montana, a patient accused a doctor enrolled in the state's treatment program of not following up on her abnormal test results, delaying her cancer diagnosis by more than a year. Montana revoked Dr. Robert Schure's license last year after he flunked out of treatment six times since 1994, according to board documents. The patient's suit was settled for an undisclosed sum.

A North Carolina surgeon enrolled in the state's program for alcoholism charged patients for one type of gastric bypass and then performed a shortcut procedure that led to serious complications, including stomach ulcers and vomiting, according to patients and a medical board investigation.

I don’t know the answer to this issue but our readers, as consumers of health care in America, should be aware of the potential problem. Do you think impaired physicians should be allowed to continue their medical practice while in treatment for drug or alcohol addiction?

NURSING HOMES: MAXIMIZING PROFIT AND MINIMIZING CARE

The nursing home industry in America is run by smart, very smart business people. They know that if they pay minimum salaries they can keep their costs down and profits up. They know that if they ask 3 nurses to do what 5 nurses are needed to do…they can keep their costs down and their profits up. They know that if Mrs. Smith is agitated and demanding as a result of her advanced Alzheimer’s disease, they can give her antipsychotics and sedatives which will make her less demanding and less in need of constant nursing care and attention….again fewer nurses, lower costs, higher profits!

A new and worrisome trend in health care in the last few years has been the swift pace at which private investment firms have been buying up nursing homes. The latest example of this trend has been the $6.6 billion purchase by the Carlyle Group of a group of nursing homes in 30 states. Private equity firms are not interested in making average profits from investments in stocks, bonds, or mutual funds which would be acceptable to you and me. They are looking for unique opportunities, offering high returns that will enable them to attract big money and at the same time handsomely reward their managers.

If you didn’t think nursing homes could get worse…just wait!

CASE REPORT: LEAD PAINT POISONING CASE FILED IN ROANOKE, VIRGINIA

Although today's blog is not directly related to typical issues of Legal Medicine....we felt this was important news to share with the public! Today’s edition of the Roanoke Times reported on a lead paint poisoning case this firm recently filed in the Roanoke City Circuit Court. The lawsuit was filed on behalf on a 7 year old girl and claims her landlord did nothing to remove the threat of lead paint poisoning in the rental property occupied by the girl’s family in 2002.

In October, the owner of the property, Frank Roupas, agreed to pay a $4,000 penalty to the U.S. Environmental Protection Agency for his failure to disclose lead paint hazards to his tenants, including those who lived in the home occupied by the 7 year old girl.

Children are exposed to lead when they ingest chips of lead-based paint or swallow or breathe lead contaminated dust. HUD (U.S. Department of Housing and Urban Development) conducted a study that determined that about 74% of privately owned housing units in the United States built before 1980 contain lead-based paint. Congress passed laws during 1978 outlawing the use of lead in paint. However, the law only banned the use of lead in paint sold after that time period.

Layers and layers of old lead-based paint remain on houses and apartments constructed before the ban went into effect. Old and poorly kept or maintained housing poses a great risk, because the lead paint flakes, chips and dust can shed and can come in contact with small children. Many cases of lead poisoning also result when homes containing lead-based paint are remodeled or renovated without precautions being taken.

MAKE HOSPITALS PAY!

Great article in NY TIMES - Making Hospitals Pay for Their Mistakes
"In most businesses, customers don’t pay for a vendor’s mistakes. But when hospitals make errors, they charge patients additional money to fix the problem.
The perverse economics of hospital charges were outlined yesterday in a fascinating article in the Journal of the American Medical Association. The story focused on one common but largely preventable medical error: urinary tract infections associated with the use of a catheter. It showed how in some ways, the medical system has built-in financial incentives for bad care.
Hospitals use urinary catheters more than almost any other medical device, and they account for 40 percent of all hospital-acquired infections — about one million annually. A urinary tract infection can add a day to a hospital stay; sometimes it can lead to a more serious infection, even death.
At one Colorado hospital, the article noted, Medicare would pay $5,436.66 for the care of a heart attack patient who recovered without complications. But if the patient developed a urinary tract infection related to use of a catheter, the hospital would receive $6,721.44. If the patient developed a more serious infection after a catheter was used, the hospital collected $8,905.43. That means the hospital would earn 63 percent more by providing inferior care.
Hospital-acquired urinary tract infections cost the health care system more than $400 million every year. But they are largely preventable, occurring most often because a catheter is left in too long. The risk of infection rises dramatically 48 hours after insertion. Most patients don’t need a catheter for nearly that long, but when nurses and other hospital staff are overstretched, or when record-keeping is lax, catheters may not be removed quickly enough.
The reimbursement system “tolerates and even financially rewards poor performance by hospitals that fail to prevent hospital-acquired complications,'’ write the report’s authors, Dr. Heidi Wald and Dr. Andrew Kramer, health care policy researchers at the University of Colorado at Denver.
In an effort to hold hospitals accountable for the costs associated with eight largely preventable injuries, Medicare changed its rules this fall. Now, the agency will not pay additional amounts to hospitals when doctors leave an object in a patient during surgery, use incompatible blood or introduce an air embolism while treating a patient.
Medicare also will no longer reimburse hospitals for infections that develop due to the use of vascular catheters, or for pressure ulcers, surgical site infections after coronary bypass surgery and other hospital-acquired injuries, such as fractures or burns that occur due to lax care. Some private insurers are considering adopting similar rules.
Some of the administrative changes relating to the new rules take effect in January, and they won’t apply to patient discharges until October. Patients may worry that hospitals will not have as much financial incentive to provide decent care, but hospitals are required by law to provide adequate care to patients. And because the rules are administrative in nature, many doctors making treatment decisions for patients in the hospital won’t necessarily know whether the care is to be reimbursed by the agency. The goal of the new rules is to force hospitals to adopt strict guidelines that will prevent the mistakes from happening altogether.
“All too often, clinicians, hospitals, and payers conclude that some harms are part of the price of doing business. But in many cases they are not,'’ write Dr. Wald and Dr. Kramer. “When properly designed, financial incentives should provide rewards for desired clinical outcomes, not hospital-acquired harms.'’

NEW MIRACLE DRUG: PROGENITORIVOX

I typically use this space to write about all that is wrong with healthcare in America….picking on doctors, hospitals, nursing homes, and the pharmaceutical industry! Well…we are approaching the Holidays and I thought we should share this positive and exciting news about a new medication. Progenitorivox is the last medication you will ever need!

Want to learn more about Progenitorivox? Click here to see the YouTube video.

NURSING HOMES NEED TO STOP ABUSING RESIDENTS WITH ANITPSYCHOTICS!

Use of a new generation of antipsychotic drugs to control the behavior of dementia patients has surged in recent years, despite the Food and Drug Administration's "black box" warning labels that these drugs can increase the risk of death for elderly dementia sufferers. About 30% of nursing-home residents are on antipsychotic drugs, according to the Centers for Medicare & Medicaid Services, most of them on newer ones called atypical antipsychotics.

Medicaid in 2005 spent $5.4 billion on atypical antipsychotic medicines -- more than it spent on any other class of drugs, including antibiotics, AIDS drugs or medicines to treat high blood pressure. Atypical antipsychotics are approved for schizophrenia and bipolar disorder. But in what is known as "off label" use, doctors often prescribe the drugs to elderly people with dementia.

Why do the nursing homes use these drugs? Because a “doped up” resident doesn’t need as much attention and care! They just lie in their beds or sit in their chairs! Less attention and care means fewer staff is needed…which means reduced cost of doing business….which means greater profits for the corporate owners!

TWO VIRGINIA NURSING AIDS GUILITY OF ABUSING RESIDENTS

I usually defend the front line workers in nursing homes as they are often poorly paid and overworked! I also realize that working as a nurse or nurse aid in a nursing home is a stressful and often thankless job. However, when a nurse aid abuses a resident it gets me angry! In Virginia two nurse aids recently had their licenses revoked by the Board of Nursing for incidences of abuse against patients….and they go what they deserved!

Sarah Green was both verbally and physically abusive to residents at The Woodview, Halifax Regional Health System in South Boston, Virginia. Green allegedly grabbed the arms of several residents and threw a wet wash cloth at another. Green also was charged with similar conduct while employed at the Chase City Nursing and Rehabilitation Center in Chase City, Virginia. She denied all instances of abuse but her license was pulled by the Board in October.

Brandy Fiddemon was also aggressive with patients while employed at the Arcadia Nursing and Rehabilitation Center in Nelsonia, Virginia. The Board of Nursing found she spit in another patient’s glass of water and tried to put wet linens back on the bed of other residents. She was fired from one job after a resident was found in their room, soaked in urine. Fiddemon denied all allegations but still had her license revoked by the board on October. 1

There is no excuse for Nurse Green and Fiddemon’s conduct!

MEDIATION v. ARBITRATION

Many health care provider contracts now contain language that states if a dispute arises between the health care provider, and the patient, all parties agree to arbitration.
Well, that doesn't sound so bad, does it? In my opinion, it is bad. Here is a brief summary of the differences between arbitration / mediation and trial.

Arbitration - is a system of dispute resolution, without a judge or jury. One person, often a lawyer, will hear evidence, and decide the fate of your case. Often it will not be held locally, and you will have no choice as to who serves as the arbitrator. It can be as expensive as trial, you are not entitled to an appeal; cannot have a jury of your peers; and will not have your day in Court. Rather, it will be in a conference room somewhere - and you will not be entitled to subpoena records from third parties, as you could in Court. The awards can be lower than what a typical jury would give, but I hear attorneys on the other side lament often that the awards can also be high. It is binding - if such an agreement exists, you can't take it back and decide you now want to exercise your rights to a jury trial. Also, you have to pay the Arbitrator (where you don't pay for the judge or jury's time).

Mediation - is a unique form of dispute resolution where parties agree to meet and attempt to negotiate settlement. No one decides the cases for you - it is formal or informal process of settlement talks. Most often, a retired judge or lawyer will serve as the mediator, an intermediary - going back between the parties making recommendations, and communicating offers and demands. Mediation is non-binding which means you are free to leave at any time, do not have to resolve the case, and will maintain your right to a jury trial. It is inexpensive as you will not be putting on evidence or witnesses. The only costs are the lawyers and mediators. We recommend it to many clients, as it provides a formal way to resolve the case, provide resolution, but allow for some involvement in the process.

Jury Trial - think law and order, smaller court room, no orange jump suits. Then think $$$ because hiring experts and getting witnesses to attend is expensive. You have your right to appeal. Sadly, jury can't always make a decision and sometimes you have to do it again.

We always want to give our clients access to a jury trial - although about 50% of our cases will go to mediation. Of those, about 75% will settle during mediation. About 90% of our cases settle before trial.... And arbitration, well, we try to avoid that as much as possible!

MORE AND MORE NURSING HOMES CITED FOR SERIOUS VIOLATIONS!

The number of citations for putting patients in "immediate jeopardy" increased 22% from 2000 through 2006, according to the records from the U.S. Centers for Medicare and Medicaid Services, which regulates nursing homes. Those citations are the most serious reprimand inspectors can issue and often follow cases in which patients were physically or sexually abused or left without medications. The Medicare and Medicaid services' records for 2007, still incomplete, already show more than 1,300 "immediate jeopardy" citations!

I don’t know if this increase in the number of violations means that nursing homes are getting worse or if it means the investigators are doing a better job of policing these facilities. Either way…keep a close watch on the care provided to your loved one!

HEPARIN FILLED SYRINGES CAUSING INFECTIONS!

Beware! Federal health officials are investigating dozens of blood infections in at least two states linked to medical syringes contaminated with bacteria. No deaths have been reported but 40 people in Illinois and Texas have been sickened.

The syringes at issue are filled with heparin, a blood thinner, and are used by cancer patients at home to clear out catheters and intravenous lines. The infections were caused by a bacterium called Serratia marcescens. The company who manufacturers the syringes, Sierra PreFilled, is located in Angier, North Carolina.

TENNESSEE NURSING HOMES ARE REALLY BAD PLACES!

More outrageous depressing reports from our sister state of Tennessee. How about nursing homes where drug pushers sell to nursing home workers and residents? How about nursing homes where residents lie in their own feces for over 3 hours despite pushing the call bell for help? Well…in Tennessee it happens!

Drug dealers frequented The Cornelia House nursing home to sell crack to employees and residents. At Mitchell Manor, patients went without their pain medication for nearly a week because the facility was out. And at McKendree Village, staffing shortages caused multiple problems, such as one patient lying in his own feces for 3½ hours, despite pushing the call light five times.

According to state inspection reports, these are some of the conditions Tennessee's elderly residents endured that led to the three Middle Tennessee facilities being stripped of their funding from the Centers for Medicare and Medicaid Services (CMS) this year.

State officials need to stop this outrageous, I would even say criminal, neglect of the residents in Tennessee nursing homes!

ARBITRATION AGREEMENTS HELP THE LITTLE GUY?

You remember Atticus Finch in To Kill a Mockingbird, don't you? Access to the justice system is a right we hold dear in the United States. What if you have a dispute with a landlord, credit card company, hospital or nursing home? You go to your local court house to file a claim. Well millions of Americans are now learning the hard way, they can't go to the local court house and have a jury of their peers help - they have given away that right in small type print when they bought the product or signed the contract. Most people never even know they have agreed to binding arbitration and waived their right to a jury, until they want to exercise those rights in Court. Thankfully, many are trying to change the current system.

LA Times reports "The fight has escalated as the legislation has gained momentum. The measure, attached to a House bill that deals with the sub-prime loan crisis, would make arbitration voluntary instead of mandatory in residential mortgage contracts. Another, approved by the Senate Judiciary Committee and attached to the farm bill, would prohibit binding arbitration between livestock and poultry producers and packers, unless the parties agree. The broadest and most controversial measure, introduced by Feingold in the Senate and Rep. Hank Johnson (D-Ga.) in the House, would make arbitration voluntary in consumer, employment, franchise and medical contracts.

Johnson, a lawyer, said parties in disputes should be free to turn to the courts, arguing that mandatory arbitration amounts to a "private judicial system" that "benefits the commercial interests at the expense of consumers and employees."

We agree - we warn citizens not to sign them, but in the medical context, they can be denied health care for refusing to sign. What do you do about it then? Give in to the pressure, sign, and find that limited access to courts is now, almost the price of doing business.

NURSING HOME FINED $100,000

Pacific Coast Manor, in Santa Cruz, has been issued the most severe citation allowed by California law and fined $100,000 after a state investigation concluded inadequate care led to the death of a female resident at the nursing home. The California Department of Public Health concluded the nursing home failed to adequately monitor the woman for adverse consequences from combination of narcotic medications, leading to her death.

The state citation detailed the care of a 71-year-old woman suffering from breast cancer, which had spread to her spine. The resident made it clear she wanted to keep fighting the cancer and would be interested in taking medications. Her cancer specialist noted "she could have years to live” even with her cancer.

Three days after being admitted, a doctor ordered a fentanyl patch, haldol, a morphine sulfate injection for pain, and methadone. On the morning of Sept. 15, the fentanyl patch was placed on the woman, and when she awoke that afternoon, she yelled to the nurses, "I'm dying." The next day, she was comatose and responsive only to pain. She died the afternoon of Sept. 16, approximately 24 hours after the fentanyl patch was applied.

Pacific Coast Manor is a 99-bed skilled nursing facility. It is owned by Covenant Care of Aliso Viejo, which employs more than 5,000 people who care for more than 4,000 patients at 42 facilities.

RICHMOND, VIRGINIA NURSING HOME MAY BE CLOSED

Seven Hills Health Care Center, a Richmond-owned nursing home, has lost eligibility for Medicaid and Medicare funding and may have to close, forcing residents to find new homes. The not-for-profit nursing home is operated by the Hospital Authority of Richmond, with its board of commissioners appointed by the mayor of Richmond.

It doesn’t take long to figure out why Medicare and Medicaid have decided to stop paying for care at this facility. Medicare's Nursing Home Compare Web site reveals that between Aug. 1, 2006, and Oct. 31, 2007, investigations turned up 32 health deficiencies. The Web site notes that the average number of health deficiencies at nursing homes in the state is eight.

Bad nursing homes should be closed…goodbye Seven Hills Health Care Center!

THE SAMMELWEIS SOCIETY INTERNATIONAL: A HOME FOR BAD DOCTORS!

I acknowledge my biases…my law firm represents the victims of medical negligence. But I just couldn’t believe my eyes when I heard about the Sammelweis Society International!

First, let me explain a little about the operation of hospitals in America. Before a doctor may admit and treat patients at the local hospital, he/she must make application for staff privileges and submit proof of education, training, and experience in a chosen area of medicine – surgery, internal medicine, infectious diseases, etc. If granted staff privileges, the doctor may admit and treat patients in that hospital. However, the hospital has a Quality Assurance Committee and a Peer Review Committee. Both of these committees are charged with investigating “medical misadventures” or bad outcomes to determine if appropriate medical care has been provided to the patient. If these oversight committees, composed of other trained and experienced doctors, determine that the bad outcome was the result of substandard care then they may chose to reprimand the doctor involved or require that doctor to attend additional medical training in their chosen field in order to avoid future patient injury or death.

This is where the Sammelweis Society International comes into play. This organization, again composed of physicians, believes that Peer Review is a bad thing! That’s right… this group wants hospitals to stop reviewing those negative patient outcomes in the hospital’s quest to determine if there are problems with the involved physician.

If this were not so outrageous it would be funny!

BLOG WATCH

Lauren and I have a lot of fun writing articles for Legal Medicine. We know that not all of our readers agree with our view of the intersection of law and medicine…but that’s okay…we’ve got thick skin!

We read blogs constantly and thought we would share several we think are worthy of your time:

AmbulanceDriverFiles.blogspot.com – This blog is written by a critical care paramedic based in southern Louisiana and provides a realistic look into emergency medical services. The author has seen a lot over the years and reports his experiences in an open and thought provoking manner.

RandomReality.blogware.com – The author of this blog is an EMT who works for the London Ambulance Service. He is a great storyteller! In one story he recalls the time a freak accident occurred and blood from a patient with the AIDS virus enters his mouth!

NeeNaw.co.uk – Mark Myers, a pseudonym, is a dispatcher for the London Ambulance Service. He blogs to tell the public about how, when, and why to call for an ambulance.

InjuryBoard.com – a web site and blog authored by attorneys, media professionals, and safety industry experts making a difference by helping families stay safe and avoid injury, and helping those who are injured get the assistance they need.

SENATOR GRASSLEY INVESTIGATES ANTIPSYCHOTIC MARKETING TO NURSING HOMES

I have written here before that many nursing homes “over-medicate” their residents with antipsychotic drugs. This practice of over medication results in a sedated resident population which doesn’t place staffing demands on the facility. The corporate owners of nursing homes know that if they can keep their staffing costs down they can realize greater financial profits! Well…the party may be over!

Senate Finance Committee Ranking Member Chuck Grassley (R-Iowa) is asking four drug companies how they market antipsychotic drugs to nursing home residents as part of a review on how the drugs are used in the facilities. The antipsychotics include AstraZeneca’s Seroquel, Eli Lilly’s Zyprexa and Johnson & Johnson’s Risperdal and all contain a black box warning on their labeling saying the drugs are associated with an increased risk of death in elderly patients with dementia.

Go get ‘em Senator Grassley!

STAFFING PROBLEMS

Most states require nursing homes and assisted living facilities to do background checks on staff. But what about temporary staff, or those supplied by temp agencies? You call at noon, say we need three CNA's for the 7a to 7 p shift, think you will have time to do a background check? Doubt it. What about license check? No way they have time for that.
Clearly this is a problem.... Read more about it here. Any suggestions?

PROBLEMS WITH TENNESSEE NURSING HOMES BACK IN THE NEWS!

We have written several blogs about all of the problems with nursing homes in Tennessee…and the problems are too numerous to repeat here but suffice it to report the state suspended admissions to 21 nursing homes this year, up from 10 in 2006 and six in 2005. But now the story has taken an unusual twist!

Tennessee Governor Phil Bredesen wants Health Department officials to better explain a recent spike in enforcement measures against nursing homes. The state is responsible for making annual inspections and for investigating complaints at nursing homes. The results are passed through to the U.S. Centers for Medicare and Medicaid Services, which makes its own determinations about any punishments.

Sounds to me like someone should look into whether the nursing home industry has been making financial contributions to Governor Bredesen! What other explanation is there for the Governor taking sides with the industry?

WHO PAYS?

We have family members ask all the time "If I am Mom's POA, would I have to pay for her nursing home bill if she can't anymore?" Many of the agreements signed in the admission process, contain language that imposes the duty to make payments on responsible parties, or legal representatives should the resident be unable to make payment. We have even seen local nursing homes go after family members for payment.

I would encourage you as a family member, NOT to sign anything that says you agree to be bound for the payment. If there is a contract between you and the facility, stating you will pay - the facility would have a good breach of contract argument. Thankfully, most courts are finding the duty is to make payment from resident's resources as the representative, not make payment with your own money. That being said, it's scary - be careful!

INSTEAD OF A NURSING HOME

I got this hilarious email yesterday - about a woman that decided to take cruises, indefinitely, rather than go to a nursing home... cruise was cheaper, more fun, better food - anyone been on a cruise lately that could tell me the cost? Most nursing homes run about $3000-$8000 a month. I would love to compare the math!

ACTOR SUES MANUFACTURER OF HEPARIN

Actor Dennis Quaid and his wife have sued the makers of heparin after their newborn twins were inadvertently given massive doses of the blood thinner at a hospital. The product liability lawsuit, filed in Chicago, seeks more than $50,000 in damages.

The suit claims that Baxter Healthcare Corp., the manufacturer of the drug, was negligent in packaging different doses of the product in similar vials with blue backgrounds. The lawsuit also says the company should have recalled the large-dosage vials after overdoses killed three children at an Indianapolis hospital last year. The Quaids' two children, and a third patient, were at Cedars-Sinai Medical Center in Los Angeles when they were mistakenly given vials of heparin that were 1,000 times stronger than the usual dosage.

I think the nurse or doctor who administered the heparin as well as Baxter share the blame with this one!

FALL FROM MECHANICAL LIFT KILLS RESIDENT

Most nursing homes have mechanical lifts to assist patients in transfers from bed to chair or chair to bath. There are several manufacturers of these mechanical lifts including Hoyer, Stella, Ergostand, and Voyager. When residents get dropped or hurt during the use of one of these mechanical lifts, it is usually the result of inadequate training of the nurse or aid using the lift to assist and move a patient. The results can be horrible!

As an example, a Pennsylvania Medical Examiner recently determined a woman died of injuries she suffered after being dropped by a mechanical lift at a county-run nursing home. Judith Bilger was dropped Aug. 9 and died three days later at the Laurel Crest Rehabilitation & Special Care Center in Ebensburg. Bilger died from internal injuries caused in the fall -among other things, she broke ribs and developed pneumonia from a lung contusion.

Be wary of staff using a mechanical lift to transfer your loved one! Make sure they have been trained to use this beneficial medical equipment ….and avoid unnecessary injury or death!

FALLS - BE CAREFUL!

We had some freezing rain in Roanoke today, and I slipped in our office parking lot on the way into work. I am grateful I only fell a short distance (short legs help) and have pretty strong bones - but it occurred to me, that we need to be very vigilent in preventing falls of elderly as the weather turns cold and sidewalks ice.

According to American Family Physicians, falls are the top cause of accidents in people over the age of 65. Falls are also the main cause of serious injuries and accidental deaths in older people.

What causes falls? Well according to the article,

• The normal changes of aging
• Illnesses and physical conditions can affect your strength and balance
• Poor lighting or throw rugs
• The side effects of some medicines can upset your balance and make you fall.

What can I do to prevent falls?

• Wear shoes with nonskid soles
• Be sure your home is well lit
• so that you can see things you might trip over
• Have grab bars put in your bathtub, shower and toilet area
• Have handrails put on both sides of stairway
• Don't wax your floors at all, or use a non-skid wax
• Have sidewalks and walkways repaired so that surfaces are smooth and even

Please be safe - and if your loved one is in a nursing home, the risk is still there - in fact, a new environment may increase that risk. Please tell the staff if they have fallen in the last year and if it happens frequently, consider removing them from the facility,

CASE REPORT: PHARMACY MALPRACTICE

You may not think about it but your local pharmacist is a medical professional who must comply with high standards of professional conduct. Pharmacists, like doctors and nurses, are “healthcare providers” and in Virginia are regulated by the Virginia Board of Pharmacy. Dispensing the wrong medication or the wrong dosage can cause serious injury and death.

We are currently handling a case against a local pharmacist who dispensed a generic form of a medication to which the patient had a known and documented allergy. The patient did not recognize the name of the medication or the appearance of the pills because it was the generic form of the medication, having a different name with a different shape and color of pill. The patient ended up in the hospital with multiple organ failure after taking the medication for several days. She suffered a stroke due to her reaction to the medication and will reside in a nursing home for the rest of her life!

How common are these types of pharmacy malpractice? In 2005 a jury in Arizona returned a $6 Million verdict in favor of a family of a high school wrestling coach who died of a toxic drug interaction. The defendant was a Walgreens Drug Store. In Missouri, a wrongful death suit was filed against Walgreens Drug Store alleging the pharmacist dispensed a potent chemotherapy drug to a pregnant woman who was supposed to receive prenatal vitamins! It was alleged that the woman’s fetus died as a result of the mother taking this drug over a period of time.

DIARY OF A NURSING HOME SURVIVOR

I recently read a story written by an electrician who was severely injured on the job and, at age 35, found himself in a nursing home. The nursing home was located in Tennessee but could have been located anywhere in America.

The writer “survived several life-threatening mistakes by poorly trained staff, years of conflict with unequipped and unsympathetic caregivers and countless unanswered calls for help.” The story is one of poor care and overworked staff – overworked because owners do not want to hire sufficient numbers of nurses to provide needed care. The owners’ main goal is to increase profits and hiring more staff just reduces those profits! And what about those unannounced surprise inspections from the state…just read the article.

Please tell us your stories about your experience with the nursing home industry. Let’s shine some light on this American embarrassment!

WALL STREET JOURNAL REPORT: NURSING HOMES PUSH ANTIPSYCHOTIC DRUGS

The Wall Street Journal reported today that Medicaid has spent more money on antipsychotic drugs for Americans than on any other class of pharmaceuticals -- including antibiotics, AIDS drugs or medicine to treat high-blood pressure. In a practice known as "off label" use of prescription drugs, patients can get these powerful medicines whether they are psychotic or not. The Centers for Medicare and Medicaid Services (CMS) says nearly 21% of nursing-home patients who don't have a psychosis diagnosis are on antipsychotic drugs.

Why do nursing homes push antipsychotics on residents who are not psychotic? The answer starts with the fact that almost all nursing homes are under-staffed. This reality is because staffing is the largest cost item in their budget and if costs stay low profits stay high! So what do you do with an elderly resident who has dementia or Alzheimer's disease and wanders around the facility requiring more staff supervision? You give them Seroquel or Risperdal or Haldol which will "depress" the resident to the extent that they don't wander around the facility and just sit lifelessly in their wheel chair requiring no attention. You think I am kidding? Well, just take a trip to your local nursing home and walk the halls...bet you see multiple residents slumped over in their wheel chairs.

The pharmaceutical industry makes money selling the drugs! The nursing home industry keeps their profits high by keeping their labor cost low! It's a "win - win" for everyone......except the resident!

FAILURE TO DIAGNOSE

PT Scan says - "no cancer" and so your oncologist is not worried about the large lump found on your head. Get a second opinion.

Family history of breast cancer and doctor does not biopsy mass found in ultrasound, because he doubts it could be cancer... Get a second opinion.

Failure to order MRI, would have shown slow growing brain tumor.

Every day, busy physicians make assumptions, that can cost their patients a great deal. If technology does not show them what they are expecting, they rule out certain diagnosis - but they are often wrong. And yes, while it is not the patient's job to diagnosis and treat, a second opinion certainly never hurt anyone. In the above cases, a second opinion could have meant an early diagnosis and maybe, caught early enough, effective treatment could have been possible.

TUBERCULOSIS DISCOVERED IN NURSING HOME

Here is a scary story! A resident in an Arizona nursing home was battling an active case of tuberculosis (TB) and passed the disease to several others before dying this fall, according to local health department officials. The health department was notified on Nov. 5 and began an investigation, which turned up a number of people who had been infected.

Most states require testing for TB before admission to a nursing home. The symptoms of active TB include weight loss, fever, weakness and night sweats.

Nursing homes need to do a better job screening for, detecting, and treating infectious diseases!