September 29, 2011

An intoxicated driver who was responsible for causing an accident that killed a man in Forsyth County last winter was sentenced Wednesday after pleading guilty to a felony charge for death by motor vehicle and a misdemeanor charge for driving while impaired. According to the Winston-Salem Journal, the drunken driver was given 20 to 33 months in state prison.

The accident happened on December 2, 2010 just after 9:00 p.m. on Baux Mountain Road. The 26-year-old Kernersville man was driving his Jeep along the road when he came to the red light at the intersection with NC 66. Rather than wait, he decided to cut through a gas station parking lot to avoid the light. He whipped the Jeep right onto 66 and cut an immediate left through the intersection back onto Baux Mountain Road. That’s when the accident happened. The 55-year-old victim was approaching on his motorcycle and did not have time to stop before colliding with the Jeep that had just cut him off. The driver of the Jeep had a blood alcohol level of .12, four points over the legal limit.

The ironic part of the story is that the victim had dedicated his life to helping others overcome drinking problems, as he had in his younger days. He was an active member of Alcoholics Anonymous and was helping an Iraq war veteran recover at the time of the crash.

The North Carolina Motorcycle Accident Attorneys with HensonFuerst would like to remind drivers to always look twice for a motorcycle.

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[photo from Victoria Advocate

According to a Texas-based news source, VictoriaAdvocate.com, by the time 7-year-old Michael got proper medical care, he was screaming “My brain hurts…I’m going to throw up.” After a CT scan, he was diagnosed with a skull fracture and contusion.

Michael’s mom, Michelle Robinson, who also has three other children reported that she had had previous difficulty communicating with the school nurse about her kids’ medical problems. According to VictoriaAdvocate.com:

“I personally went to the office and told her, ‘I don’t care if it’s something as little as a cut on his knee, I want to know,’” Robinson said. “At that time, she pulled all my kids’ emergency medical cards and wrote on there in red pen, ‘Call mom for anything.’ She led me to believe that communication was going to be better.”

Robinson did not receive a phone call about her son’s afternoon head bump.

The issues raised involved the nurse’s qualifications (the school said that the nurse was certified as a “licensed vocational nurse” who was in her first year with the school); the nurse’s treatment of Michael (the nurse’s clinic notes indicate he was treated for about a minute, and the child was sent back to class with just an ice pack); and protocol for head injury (standard protocol involves monitoring a student for 20 minutes to watch for symptoms of slurred speech, blurred vision, headache, etc.).

“What if it happens again? What if it happens to another child, and it’s worse next time? I will be more than happy to use my son as an example and do something to reprimand this nurse, or it can happen again,” Robinson said.

It is frightening to think how easily a slip can change from a “bump” to a skull fracture.

While there is no way to prevent all accidents, there are some tips provided by Dr. Jeffrey Lehman, Director of the Huff & Puff Allergy and Asthma program at St. John’s Children’s Hospital (on FoxIllinois.com) about how to ensure that your child receives the best care possible in school:

• If your child needs specialized treatment, make sure the school’s staff knows how to administer medications and other treatments;
• For chronic medical problems, provide the school with a personalized management plan to take the place of the school’s standard plan;
• Give the school a recent photo of your child to include in the child’s medical file, as well as up-to-the minute contact information for you and any other emergency contacts.
• Ask about the school’s protocol for dealing with common injuries, including falls and head bumps. Make sure you understand exactly what will happen if your child is injured.
• And even though it didn’t work for Michael’s mom, ask to have the school contact you anytime your child visits the school nurse.

To read the full story on VictoriaAdvocate.com, click here:   7-year-old Suffers Skull Fracture

A commentary in the latest issue of the New England Journal of Medicine (NEJM) talks about the common problem facing nursing home residents:  Unnecessary hospitalizations due to untrained nurses or substandard medical protocol when an elderly resident becomes ill.

According to the articles authors, Dr. Joseph G. Ouslander and Dr. Robert A. Berenson:

More than 1.6 million Americans live in nursing homes. Hospitalizations are common in this population; in 2006, 23.5% of the people admitted to a post-acute-care skilled-nursing facility were rehospitalized within 30 days. Several studies suggest that many of these hospitalizations are inappropriate, avoidable, or related to conditions that could be treated outside the hospital setting — and they cost more than $4 billion per year. Avoidable hospitalizations are also common among long-stay residents of nursing homes.

In a huge number of the medical “emergencies,” the condition could be treated effectively and safety in the nursing home, without having to admit the resident to a hospital. Can you guess why hospitalizations are so high? According to the commentary, the answer boils down to the money:

One fundamental problem is not clinical but financial, stemming from a misalignment of Medicare and Medicaid: state Medicaid programs do not benefit from savings that Medicare accrues from prevented hospitalizations of nursing home residents, even though the nursing home incurs expenses when managing changes in condition without hospital transfer. In addition, nursing homes have a financial incentive to hospitalize residents who have Medicaid coverage, because after a 3-day inpatient stay, the resident may qualify for Medicare Part A payment for post-acute care in the nursing home at three to four times the daily rate paid by Medicaid.

As with all things motivated by money, the recommended fixes are complex. First, the Medicare/Medicaid financing models will need to be rearranged, perhaps in a way that makes facilities accountable for costs. Incentives should be given for saving money. Nursing home infrastructures should be changed to pay for more trained registered nurses and nurse practitioners, the higher-lever professionals that can help treat residents in non-emergency situations.

We can improve care and reduce unnecessary complications and expenditures on preventable hospitalizations of nursing home residents. But it will require a multifaceted approach; commitment of energy and resources; teamwork among health care funders, regulators, health care professionals, nursing homes, and hospitals; and a true focus on resident-centered care.

Wouldn’t that be great? Fortunately, the NEJM is a prestigious, highly respected, widely read publication. Maybe these ideas will gain traction in the right circles…the kinds of circles that can make good things happen.

To read the full commentary in the New England Journal of Medicine, click here:  Reducing Unnecessary Hospitalizations of Nursing Home Residents

Results of a study just published in the Journal of the American Medical Association (JAMA) suggest guidelines for patients that could help keep them safer after carotid stenting. In fact, this advice might even save lives.

A stent is a tiny tube that acts to keep an artery open, allowing blood to flow properly. Stents are most commonly used to treat blocked arteries around the heart to prevent heart attack, but a newer procedure — carotid stenting — uses stents in the internal carotid artery (which rises to the brain through the neck) to prevent strokes.  This is significant because approximately 10% to 15% of ischemic strokes are due to atherosclerosis of the internal carotid artery. Since 2004 when the first carotid stent was placed, the use of this medical procedure has more than doubled in Medicare beneficiaries.

Unfortunately, carotid stenting is quite a demanding procedure that requires a great deal of technical skill on the part of the surgeon. Researchers from the University of Michigan and numerous other medical institutions examined whether a surgeon’s experience performing carotid stenting had any effect on outcomes for patients. Data came from nearly 25,000 patients and about 2300 operators who performed the surgeries between January 1, 2005, and December 31, 2007.

The results show that experience makes a big difference. I’ll even go out on a non-scientific limb and say:  Experience makes a ginormous difference… and it is news you can actually use.

Study Results

The researchers categorized operators into 4 groups:

• Very low experience:  performing fewer than 6 carotid stent procedures per year;
• Low experience:  performing 6 to 11 procedures per year;
• Medium experience:  performing 12 to 23 procedures per year;
• High experience:  performing 24 or more procedures per year.

They found that patients treated by operators with “Very Low” experience were nearly twice as likely to die within 30 days as those treated by operators with “High” experience. In addition–not surprisingly–patients who were treated by operators who were just beginning their experience faired worse than those who had more overall experience. For example, patients receiving one of an operator’s first 10 surgeries were about 70% more likely to die within 30 days than patients who received an operator’s 12th or or higher surgery.

It’s important to note that the overall 30-day death rate was only about 2%. So the differences we’re talking about here in raw numbers is small. Still, most people would like the option of reducing their risk of death after a procedure. In this case, the “fix” is simple:  When you talk with a potential surgeon before a carotid stenting, ask how many procedures he or she has performed in total… and how many procedures he or she performs each year.  Look for an operator who has performed more than 12 procedures overall, and—if possible—performs at least 24 procedures annually.

If you have an option, remember that “more is better,” and choose the most experienced operator possible.

RESOURCES

Article citation:

Nallamothu BK, Gurm HS, et al. Operator Experience and Carotid Stenting Outcomes in Medicare Beneficiaries. JAMA. 2011; 306(12):1338-1343.

To read a summary of of the JAMA article, click here:  JAMA abstract

Earlier this year, California Congresswoman Lucille Roybal-Allard introduced legislation known as H.R. 2552: “Nursing Home Patient Protection & Standards Act.”  (The “H.R.” stands for House of Representatives, signifying that the bill started in that body of Congress.)

H.R. 2522 was introduced to ensure consistent standards in nursing homes across the nation. It provides training and whistleblower protections for the surveyors who oversee the quality of care provided by nursing home facilities.

Congresswoman Roybal-Allard, who has served in Congress since 1992, is one of the most powerful members of the House of Representatives. She is a member of the distinguished House Appropriations Committee, which controls the purse strings of the federal government. She also serves on two influential subcommittees — the Subcommittee on Homeland Security and the Subcommittee on Labor, Health and Human Services, and Education.According to the Congresswoman:

“According to a November 2009 GAO Report, nursing home inspectors known as surveyors are being improperly pressured to ‘under-report’ the problems with care of nursing home residents. These problems persist and my bill would prevent these surveyors from facing inappropriate pressure that can compromise the entire nursing home inspection process,” said Rep. Roybal-Allard. “Congress must act.”

“My bill targets inspection tampering by extending federal whistleblower protections to surveyors of nursing home facilities. It is critically important to have real accountability in the nursing home industry. This legislation doesn’t add one penny to federal spending while providing important protections to seniors.”  [Emphasis added by blogger]

In the United States there are more than 15,000 skilled nursing facilities that treat nearly 1.5 million people who are dealing with and recovering from serious health issues.  H.R. 2522 will improve training for surveyors, improve staffing for survey teams, and establish an advisory committee comprised of nursing home stakeholders to work together to ensure that the quality of care improves.

This bill is in the early stages of the process. Introduced bills and resolutions first go to committees that deliberate, investigate, and revise them before they go to general debate. The majority of bills and resolutions never make it out of committee, but we believe this one deserves our support. It will add nothing to federal spending, but will help to make sure that nursing homes provide the kind of care each of our senior citizens deserves. As the watchdog website ForceChange.com says:

The process of checking into a nursing care facility does not include relinquishing one’s rights to dignity and proper care. In fact, these rights are included in many existing federal and state statutes.  Some of these rights include treatment with respect, consideration and personal dignity which is adequate and appropriate, given the resident’s condition, and freedom from mental and physical abuse.  However, existing statutes do not go far enough and do not include sufficient punitive measures for caregivers, administrators, and facility owners to assure that proper conditions exist.  Sadly, the elderly and infirm in American society are viewed as a nuisance.  This lack of respect, coupled with the greed in the nursing home industry, leads to cutting corners, inappropriate staffing and resident neglect.

The Nursing Home lawyers of HensonFuerst support this bill’s efforts to strengthen accountability of nursing homes across the nation.  According to one of our experienced attorneys, Carma Henson:

In today’s economic climate of tight budgets, this is one law that won’t cost taxpayers anything, and yet will give heightened protections to state nursing home surveyors who a charged with investigating problems in facilities.  We urge supporters to contact their representatives to support this bill.

How to Contact Your Representative

To find the names and contact information for members of the House of Representatives by state, click here:  Directory of U.S. Representatives

Sample Letter to Congress

ForceChange.com is circulating an Internet petition to urge Congress to pass H.R. 2522. You can sign that petition here: Stop the Abuse and Neglect of Nursing Home Residents. You can also write your own letter, or select bits and pieces from this sample letter (from the ForceChange.com website):

Dear Members of Congress,

Elderly and ill Americans should be cared for and revered;  sadly, those that reside in U.S. nursing homes are often abused and neglected.  These forgotten members of our society deserve better and must be protected by legislative intervention.

We can not tolerate insufficient care and humiliating treatment at the expense of nursing home profits.  Cutting corners by limiting needed medical care,  reducing  staffing levels and providing insufficient nutrition is unconscionable and unacceptable.  Those that perpetrate this type of treatment, particularly for individuals who are incapable of advocating for themselves, must be held accountable and appropriate punitive measures must be taken.  With the aging of the Baby Boomer generation, our country will face increased residency in nursing care facilities and we will all be at risk for abusive, inadequate and neglectful care in our so-called Golden Years.

Please pass The Nursing Home Patient Protection and Standards Act of 2011 and assure that proper care is the standard in all U.S. nursing care facilities.

Sincerely,

[Your Name Goes Here]

We’ll keep you informed of how this bill fares as it moves through the process.

RESOURCES

To read the text of H.R. 2522, click here:  Nursing Home Patient Protection and Standards Act of 2011

Today, September 21, 2011, is World Alzheimer’s Day. Every year on September 21st, Alzheimer associations across the globe unite to recognize World Alzheimer’s Day, and this year is no exception.

World Alzheimer’s Day is a day that unites opinion leaders, people with dementia, their carers and family, medical professionals, researchers and the media from all around the world.

Having a globally coordinated awareness day sends a strong message to governments and policy makers alerting them to the fact that dementia is a serious health issue that will have serious implications for services and health systems around the world as the world’s population grows older. In addition, by focusing on a different message each year, the day can be used to educate and challenge people’s misconceptions about dementia.

Plus, having a special day  provides an opportunity for Alzheimer associations around the world to gain recognition and credibility for the work they do, placing themselves in a stronger position to influence opinion leaders and governments.

The theme of World Alzheimer’s Day for 2011 is “Faces of Dementia.” People with Alzheimer’s disease don’t look “crazy” or “out of their minds.” They look like your next door neighbor…your grandmother…or someone at the grocery store.

Today is a day to pay tribute to those who represent the “Faces of Dementia” in all parts of the world.

For a larger version of the “Faces of Dementia” poster, click here: World Alzheimer’s Day 2011

This feels like a win for everyone in North Carolina, and for everyone who loves an individual with traumatic brain injury (TBI):

Kevin Guskiewicz, Ph.D., works at the University of North Carolina, Chapel Hill in the UNC Injury Prevention Research Center. Through is research, he has made strides in the diagnosis, treatment and prevention of sports-related concussions. According to an article in the News & Observer, Dr. Guskiewicz, 45, said he wants to use some of the grant money to develop rehabilitation plans for athletes and soldiers who suffer concussions. The foundation noted Guskiewicz’s combination of laboratory and in-the-field investigations to further his research.

Based on the idea that balance and posture can help to evaluate concussions objectively, his diagnosis and rehabilitation system uses a symptom checklist as well as an inexpensive device made of foam and a stopwatch. According to an article in The New York Times:

Acknowledging that his work has the potential to save lives, Mr. Guskiewicz said he was still “floored, surprised and honored, all at the same time,” by the MacArthur grant.

Congratulations, Dr. Guskiewicz!
To read the full article in The New York Times, click here:  MacArthur Foundation Selects 22 ‘Geniuses’

To read the full article in the News & Observer, click here:  http://www.newsobserver.com/2011/09/20/1503230/macarthur-foundation-reveals-2011.html#ixzz1YVMuEd1h

This is one of those good news stories we don’t get to write about often enough. First, a little background:

Most people with Alzheimer’s disease and other forms of dementia eventually develop agitation as asymptom of their disease. While “agitation” sounds benign, akin to being “cranky,” it is, in fact, a serious concern for dementia patients and the people who care for them. Agitation is defined as inappropriate verbal or motor activity. To an observer, it could look like uncontrolled verbal abuse or screaming, physical aggression, or self-harm.

Because agitation can be dangerous to dementia patients and the people around them, it is important to control this symptom. Typically, agitation is controlled by antipsychotic medication…and those medications can have some dangerous side effects.

So imagine how thrilling it is for physicians, nursing home workers, and family members to hear the results of new research showing that humor therapy is as effective as antipsychotic drugs in managing agitation in patients with dementia…all while avoiding serious drug side effects.

According to an article on News-Medical.net, both short-term and persistent agitation were decreased among people with dementia:

The SMILE study across 36 Australian residential aged care facilities involved the recruitment and training of a staff member to act as a “LaughterBoss” who worked with a humour practitioner with comedic and improvisation skills – not unlike “Clown Doctors” used in hospitals to aid recovery and lift mood in children.

The SMILE study found a 20 percent reduction in agitation using humour therapy, an improvement comparable to the common use of antipsychotic drugs….Agitation decreased not only during the 12 week humour therapy program, but remained lower at 26 week follow up.

This program was not just a once-a-week treatment. All members of the staff were trained to incorporate humor into their daily routines to maintain a cheery atmosphere.

According to an article in The Sydney Morning Herald:

“There’s evidence to show that people with dementia still experience humour and to the same amount of enjoyment as people without dementia but they find different things funny,” [lead researcher Dr. Lee-Fay Low] said.

“I think in some facilities they are very task focused and think, ‘we have to do baths, showers, food and cleaning’ and because they are so busy looking after the clinical and physical needs of the residents they sometimes forget to look after the emotional needs so the lightheartedness (in the study) is part of that.”

Now consider this:  One in four people over the age of 85 have dementia. If we have a choice of medicating our loved ones into semi-consciousness or treating them with humor, humor is the safer, less expensive, and overall more pleasant option. This study was conducted in Australia. Let’s hope nursing homes in the United States hear about this study soon.

To read the full article on News-Medical.net, click here:  Humour as Effective as Medication

To read the full article in The Sydney Morning Herald, click here: Dose of Laughter Good for Dementia