PREEMPTION: WHAT DOES IT MEAN?

I am a proud member of a group of lawyers throughout the United States who represents individuals as opposed to corporate interests. The name of this group is "InjuryBoard" and we collectively maintain a web site which has tons of helpful information on topics from medical malpractice, to dangerous toys, lead poisoning, identity theft, and more.

Now...back to the title of this post. What is preemption and how can it affect me? Take 20 minutes out of your day to watch this video on InjuryBoard which describes a personal tragedy and how federal preemption affects your rights. The video is located near the bottom right side of the page.

TOP 10 REASONS TO STAY OUT OF THE HOSPITAL IN 2009

The Ecri Institute, which conducts patient safety research, issued a report last week listing the top 10 technology hazards for hospital patients. Without further adieu...here you go:

1. Alarm Hazards

2. Injuries from needle sticks and other sharp objects

3. Air embolism from contrast media injectors

4. Retained devices (like surgical sponges)

5. Surgical fires

6. Anesthesia hazards due to inadequate pre-use inspection

7. Misleading displays

8. CT radiation dosing

9. MR imaging burns

10. Fiberoptic light-source burns

My Question: What steps are being taken by the following hospitals in Western Virginia to prevent injuries from these technological hazards?

Carilion Roanoke Memorial Hospital, Lewis-Gale Hospital, Memorial Hospital of Martinsville and Henry County, Danville Regional Medical Center, Stonewall Jackson Hospital, Carilion New River Valley Hospital, Montgomery Regional Hospital, Wellmont Bristol Regional Hospital, Carilion Giles Memorial Hospital, Alleghany Regional Hospital, Carilion Franklin Memorial Hospital, and Tazewell Community Hospital

VIRGINIA'S NURSING HOMES RANKS NEAR BOTTOM FOR STAFFING

The best indicator of whether a nursing home can provide good care to your family member is whether the facility has enough well-trained staff to get the job done. You see...most nursing homes cut costs and increase profits by working with the fewest possible number of nurses and nursing aides. And patient care suffers whenever that happens.

Well, where do the nursing homes in Virginia rank in staffing? Try one of the 10 worst in the U.S. Don't believe me...check out this article in U.S. News & World Report.

My Take: Find out the ratio of staff to residents BEFORE selecting a nursing home.

NURSING HOME FLU OUTBREAK

I am not a reactionary, but the idea of a flu outbreak at a Roanoke Nursing Home does cause some alarm.

I ran across a blog this week that is local to our hometown, Roanoke Virginia. The author discusses some of the scary issues surrounding the eldely and flu outbreaks.

How is it that the flu is spreading like wildfire - don't most nursing home residents get flu vaccines every year? Well even if they did, does that prevent the flu if a different strain is going around? No.

I ran across this older article in the New Scientist that discusses flu vaccines in eldery.


The article cites a 2007 study that "has revealed elderly people are still dying of flu, but far fewer than 30 years ago - and those who are dying are older."
The article cites Lone Simonsen of the National Institute for Allergy and Infectious Disease in Bethesda, Maryland, who reported that there has been no obvious drop in wintertime deaths linked to flu in the US and Italy since widespread vaccination took off in 1980.

"People over 80 still die of flu, probably because they respond least well to vaccination. And there are four times as many people in their 80s now than 20 years ago, says Reichert. So the rise in deaths among the over 80s helped mask the overall drop in flu deaths until he looked closely at the numbers. He thinks the fact that there are fewer flu deaths overall explains why the impact of vaccination on populations as a whole has not been obvious."

Moral of the story - elderly friends and family, if physician recommends, should get the vaccines. Health care workers and family members need to remember the very basic ways to prevent infections from spreading - WASH HANDS, Don't share food, and if you are sick - might want to skip the visit to the nursing home this week.

If your loved one does have the flu at a local nursing home, I might try to find them a hospital bed. Chances are the staff is overwhelmed and one on one care may be needed.

DANVILLE VA NURSING HOMES

Yesterday Dan wrote about the nursing homes in Roanoke and Wytheville Virginia. This week Medicare.gov began a five star rating system for area nursing homes. Like the classic AAA restaurant or hotel rating system, the more stars, the better.

So which nursing homes 25 miles from Southside got a 5 star rating?

NONE OF THEM

How many received four stars? AGAIN - NOT A ONE! This means my friends in the Danville area, have very limited choices. Do they select a 3 star, 2 or 1 (the worst) for their loved one's care?

Not much of a choice at all if you ask me. So who were the "best of the worst?"

Three Stars?
Brian Center Health & Rehab in Yanceyville (owned by a large chain)

Stratford Rehab (who not so long ago was on the government's list of needing improvement on pressure ulcers and restraint issues)

And who were the worst with only 1 or 2 stars?
Morehead Nursing CenterRoman Eagle in Danville
Piney Forest in Danville
Riverside Health & Rehab (owned by same company as Piney Forest)

Danville, I am very sorry about your options!

WHAT ARE THE BEST NURSING HOMES WITHIN 50 MILES OF WYTHEVILLE, VIRGINIA?

The answer is provided by a new "5 star" rating system provided by Medicare. When using the Medicare site...select "Find and Compare Nursing Homes"....then select "Find Nursing Homes within certain distance" of a zip code or identified city.

The nursing homes receiving the highest ratings include:

Westwood Center (Bluefield, VA)

Highland Ridge Rehabilitation Center (Dublin, VA)

Glenwood Park (Princeton, WV)

Radford Nursing and Rehabilitation (Radford, VA)

Heritage Hall - Laurel Meadows (Laurel Fork, VA)

The nursing homes receiving some of the worst ratings include:

Carrington Place at Wytheville - Birdmont Center

Bland County Nursing and Rehabilitation (Bastion, VA)

Golden Living Center - Blue Ridge (Galax, VA)

Maples Nursing Home (Bluefield, WV)

Grayson Nursing and Rehabilitation Center (Independence, VA)

Francis Marion Manor (Marion, VA)

Heritage Hall - Tazewell

My Take: Be an informed consumer of health care and do your loved one a favor....check out the nursing home BEFORE you decide what is best for a family member.

WHAT ARE THE BEST NURSING HOMES WITHIN 25 MILES OF ROANOKE, VIRGINIA?

The answer is provided by a new "5 star" rating system provided by Medicare. When using the Medicare site...select "Find and Compare Nursing Homes"....then select "Find Nursing Homes within certain distance" of a zip code or identified city.

The nursing homes receiving the highest ratings include:

South Roanoke Nursing Home (Roanoke, VA)

Brandon Oaks Nursing and Rehabilitation Center (Roanoke, VA)

Snyder Nursing Home (Salem, VA)

The nursing homes receiving the worst ratings include:

Avante at Roanoke

Raleigh Court Health Care Center (Roanoke, VA)

Berkshire Health and Rehabilitation Center (Roanoke, VA)

Friendship Health and Rehabilitation Center (Roanoke, VA)

Pheasant Ridge Nursing and Rehabilitation Center (Roanoke, VA)

Virginia Veterans Care Center (Salem, VA)

Salem Health and Rehabilitation Center (Salem, VA)

Brian Center Health and Rehabilition, (Fincastle, VA)

My Question: Why do we have almost three times as many bad nursing homes as good nursing homes?

FAILURE TO DIAGNOSE

Did you doctor think your Lyme disease was cellulitis?

Was multiple sclerosis mis-diagnosed as vision problem?

Did the lab tell you your path report came back clean and you learned 6 months later it was dysplastic, pre-melanoma?

These mistakes happen all the time. Sometimes, patients are harmed by the misdiagnosis. Sometimes, the mistake causes emotional pain, but not physical damage, and does not prevent necessary treatment.

Each case is different - just because there has been a misdiagnosis, or failure to diagnose, does not mean you have a case. We are happy to help determine if your case does have merit.

FLU OR SEPSIS?

I just read about a lawsuit in Minn where a man and wife both presented to the emergency room with flu like symptoms. Days later, the man came back, complaining of pain, decreased appetite, etc. Blood work was done and revealed the man had sepsis. Sepsis is often referred to as a blood stream infection. It is caused by the presence of bacteria (bacteremia) or other infectious organisms or their toxins in the blood (septicemia) or in other tissue of the body.

So how or why would someone confuse the FLU and sepsis? Sepsis may be associated with clinical symptoms of systemic (bodywide) illness, such as fever, chills, malaise (generally feeling "rotten"), low blood pressure, and mental status changes.

Some of these are similar to the Flu, but the two are not similar. Labs should tell you what is the Flu, and what is more serious. Sadly, it seems the Minn. doctor ordered the right tests, but didn't respond when nurses asked for further direction and care.

WIDESPREAD NURSING HOME VIOLATIONS REPORTED

It doesn't matter where you live or what nursing home you are talking about...most nursing homes provide substandard care. Don't want to believe me...would you believe the Inspector General for the federal Department of Health and Human Services (HHS)?

A memo from the Inspector General for HHS to the Centers for Medicare and Medicaid Services revealed the following bothersome news:

1. In each of the past 3 years, more than 91 percent of nursing homes have been found to be deficient in quality of care, with problems such as abuse, neglect, inadequate staffing, and other medical errors.

2. For-profit nursing homes are more likely to suffer deficiencies than non-profit nursing homes.

My Take: I would give America's nursing home industry an "F" for patient care.

ELDER ABUSE SHOCKS MINN TOWN

I wish I had not read this article this morning in the AP. I wish two young teenage employees of a Minnesota Nursing Home had not spat on a resident with dementia. I wish they didn't think it was acceptable to cover the mouths of Alzheimer's patients that were vocal, or poke residents when they screamed or hit.

According to the Associated Press, these young women (yup - you read that right) thought their actions were just a "joke."

Ironically, the name of the facility is the Good Samaritan Society, and the young girls (ages 18 and 19) are now facing criminal charges.

I wish I didn't read the article, but know that this type of monstorous abuse will continue to happen.

EMERGENCY ROOMS GET POOR GRADES

America's emergency rooms are disasters. Don't take my word for it...take the word of the American College of Emergency Physicians (ACEP). The annual report card by the ACEP gave the nation a D- grade for Americans’ access to emergency care, saying the emergency care system was “fraught with significant challenges and under more stress than ever before.”

The problem is that demand is many times greater than capacity. Demand is growing because many Americans have no other way to receive medical care. Capacity is not growing to keep pace with demand because hospitals can't make the enough of a profit providing emergency room care...they concentrate on the profitable lines of care like surgery, cancer treatment, etc.

How about you? Did you receive prompt and competent care in the emergency departments of the following hospitals? Carilion Roanoke Memorial Hospital, Lewis-Gale Hospital, Memorial Hospital of Martinsville and Henry County, Danville Regional Medical Center, Stonewall Jackson Hospital, Carilion New River Valley Hospital, Montgomery Regional Hospital, Wellmont Bristol Regional Hospital, Carilion Giles Memorial Hospital, Alleghany Regional Hospital, Carilion Franklin Memorial Hospital, and Tazewell Community Hospital

TOO MANY DECUBITUS ULCERS!

I remember the first time I saw a picture of a decubitus ulcer...also called a pressure ucler or bed sore. The picture was horrible! A huge hole in a patient's hip with black (dead) tissue surrounding it. Deep enough to put your fist into the wound!

There is no excuse for patients having pressure uclers. If they are provided with appropriate nutrition, hydration, and repositioned every 2 hours pressure ulcers almost never occur.

Now, McKnights, the nursing home industry's magazine recently published an article about the dramatic increase in decubitus uclers. Hospital admissions for which pressure ulcers were either a primary or secondary diagnosis rose 80% between 1993 and 2006. Pressure ulcer hospitalizations also typically lasted more than twice as long and cost between $6,000 and $10,000 more per visit than most other hospitalizations, according to the report. This is bad news indeed.

My Take: Nursing homes are doing a lousy job taking care of patients.

EXCITEMENT FOR NEW CHATHAM NURSING HOME

I read with interest an article in a recent issue of the Star-Tribune newspaper. The article hailed plans for the construction of a new 85 bed nursing home for Chatham, Virginia. The Roanoke, Virginia firm of Smith/Packett is developing and building the new facility, which will be called the Chatham Health and Rehabilitation Center.

So far...so good.

The part of the story which concerns me is the newspaper's report that Third Street Management from Hickory, North Carolina will manage the nursing home after it is constructed. It is almost always raises a "red flag" with me when one company builds the facility and another company runs and manages it.

A little research on Third Street Management reveals that it may be associated with Charles Trefzger Jr. and David Jones. All it takes is a little research in the News and Observer from Raleigh, NC and you find articles which state, "Rest homes run by...Trefzger and...Jones have had numerous violations and other problems cited by inspectors." The article cites problems at numerous facilities in North Carolina including Hunter Hill Senior Village in Rocky Mount, Oak Haven Senior Village in Greenville, Country Club Prime Time in Raleigh, Countrytime Inn in Gaston County, Taylorsville House in Alexander County, and Kings Bridge House in Transylvania County.

My Take: I am happy for the residents of Chatham and the surrounding area but you better proceed with caution.

FDA WARNINGS - YOUR PHARMACIST'S DUTY?

So if the FDA comes out with a warning on a medication, or the medication has been withdrawn, who is supposed to tell you - the consumer?

Well, some would argue that as an involved consumer, you should be proactive in your healthcare and investigate whether your medications are still on the market, etc.

The FDA posts warnings on their website at where you can look up each medication by name.

But not everyone has internet - and the press doesn't always over FDA actions.

Well, the Utah Supreme Court recently ruled that your pharmacist had a duty to warn patients that drugs have been withdrawn. In fact, the court held the pharmacist may even be liable for damages that resulted from a failure to warn. Not suprisingly, an Alabama state court ruled exactly the opposite.

So while I would hope (1) your doctor and (2) your phramacist would know that a drug has been removed from the market by the FDA - I wouldn't count on it. Nor would I count holding them responsible as states disagree as to their level of duty and responsibility.

ER DOCTOR POINTS FINGER AT NURSING HOME

An unidentified emergency room doctor in Washington, D.C. has informed ABC 7/News Channel 8 reporter Stephen Tschida he routinely sees patients from the Grant Park Care Center nursing home facility on the verge of death because of neglect.

As a result, the local ABC affiliate obtained inspection reports from the D.C. Department of Health that were done in February and May of 2008. The reports detail an abundance of deficiencies at the care facility such as, "nurse failed to notify physician of resident dehydration, resident with weight changes and of anemia. As a result, D.C. Long Term Care Ombudsman Jerry Kasunic says his staff "has actually filed over 100 complaints with the Department of Health," calling Grant Park one, if not, the worst he's seen.

My Take: Bad care just doesn't happen overnight! It builds and gets worse over time. Where were the Health Department investigators? Where were the investigators from the Centers for Medicare and Medicaid? Where were the police? In my opinion, they all share responsibility for the abuse suffered by the residents of this facility.