Nursing Homes Abuse Blog - By Jonathan Rosenfeld

When it comes to the effective prosecution of nursing home negligence cases or medical malplractice cases, medical records are a crucial piece of the puzzle in determining the essentials: who, what, where-- and sometimes why. 

Pursuant to the following federal regulations, nursing homes must create, maintain and release medical information to patients or their authorized representatives:

• F-514 §483.75(l)(1)&(5) – Maintaining/Content of Clinical Records
• F-515 §483.75(l)(2) – Retention of Clinical Records
• F-516 §483.20(f)(5); §483.75(l)(3) – Release of Resident Identifiable Information / Safeguarding Clinical Record Information

Obtaining copies of medical records from nursing nursing homes can become quite complicated in situations where a patient becomes disabled or dies.  A maze of privacy laws and probate laws, can rapidly make a (seemingly) straightforward process difficult. 

A prime example of the difficulty some families experience when attempting to obtain nursing home records for their loved one caught my attention out of Texas.  After unsuccessfully requesting the medical chart directly from the facility, the family of the deceased nursing home patient was forced to seek court involvement to get the facility to turnover the their mother's records.

In addition to ordering the nursing home to provide the family with access to the records, the court similarly granted a temporary restraining order (referred to as a TRO) that requires the facility to "produce all healthcare and medical records, correspondence, memos, incident reports, photographs, investigative documents, witness statements and other documentation" related to the deceased patient.

I surely can sympathize with this families frustration stemming from their difficulty getting copies of their loved ones medical records.  While I understand that facilities need to comply with privacy laws, I find many facilities use delay and deny tactics when it comes to providing medical charts when the requests are made by people with authority to do so and utilizing HIPPA compliant forms.

Particularly in circumstances where a family may suspect that the facility was negligent in the care of their loved one, I always encourage families to request copies of the medical chart as soon as feasible.  Disturbingly, I have worked on a number of nursing home abuse lawsuits where, the records provided to the family (and assumingly never reviewed by a lawyer defending the facility) differ significantly from the copies of records provided to me in the course of litigation. 

Mysteriously, entries seem to have a way of either getting omitted to added to the chart that I receive in a way to make the care provided seemingly much better than it actually was.  While most facilities know better than to alter a legal document, in circumstances where this does occur, I do my best demonstrate the descrepancies to staff during their depositions.  When the 'inconsistencies' come to light, many facilities recognize the probable fallout from their acts and may request our presence at a settlement conference.

Related Nursing Homes Abuse Blog Entries:

How Accurate Are Medical Records From Nursing Homes?

Nursing Home Settles Lawsuit After Fraudulent Records Discovered

How do I get a copy of medical records from a nursing home?

Putting aside the human toll medical errors impose on individuals, the financial impact of medical errors can be downright daunting.  According to a study commissioned by the Society of Actuaries, our country (and economy) is hobbled by a daunting $80 billion in medical errors every year!  An estimated 25% of those expenses, $19.5 billion, were determined to be avoidable.

In reconciling these figures, the actuaries determined that an estimated 1.5 million measurable and preventable medical errors in 2008 resulted in significant increases in disability, death, lost productivity and increased medical costs. 

Though preventable medical errors can occur in a number of hospital and situations, 55% errors were due to:

• Pressure ulcers
• Postoperative infections
• Mechanical complications of devices or implants
• Post-laminectomy syndrome
• Hemorrhages complicating a procedure

The actuaries arrived at their calculations based upon an insurance claims database. However, as acknowledged by the authors of the study, the actual cost of preventable medical errors may be substantially higher  as a notable number of errors go unreported.

From a dollars-and-sense analysis of cases involving medical errors, it is undeniable that these situations need to be addressed by medical facilities both in order to improve patient care and to help improve their own financial well being.

Read more about this study on preventable medical errors here.

Related:

Hospital Acquired Pressure Sores Are Devastating Source Of Patient Injury & Death

States Move To More Transparency Regarding Medical Malpractice & Hospital Errors

Medical Facilities Can Reduce The Incidence Of Infection By Taking Some Basic Precautionary Steps

Hospital Errors: Study Finds Preventable Errors Continue To Harm Patients At Alarming Rate

Disgusted by the high rates of unnecessary medical complications patients were experiencing during admissions to many hospitals, Maryland has implemented a new system to penalize these poorly performing facilities.

Under the new plan to improve the quality of care, Maryland Hospitals with medical complication rates higher than the state's average would be penalized by having lower rates of reimbursement provided by the state.  

Utilizing a list of 49 types of medical complications (including common problems such as: bed sores, falls, urinary tract infections and accidental nicks and cuttings during medical procedures), Maryland's Health Services Cost Review Commission would then look to see if indeed the condition developed during a hospitalization or if it was indeed related to an existing illness.

According to Dianne Deeney, Associate Director of Quality Initiatives of the Commission; 

We don't believe all these complications are absolutely preventable.  But we believe... there is great room for improvement in these complication rates.

As a lawyer who works on medical malpractice cases, I am frequently downright repulsed by the fact that many people who go into hospitals for medical care, come away far sicker-- or with completely unrelated complications like pressure ulcers during their admission.  I feel as if the time has come for hospitals and other medical facilities to implement well-known preventative measures such as: specialized staff training, emergency reviews and utilization of electronic medical records.

Hopefully this program will serve as a kick-in-the-rear for under-performing hospitals to clean up their act-- or face real economic consequences.  The time has come.

Related:

Nursing Home Injury Laws: Maryland

Md. hospitals fined for high infection rates, The Examiner

A recent study conducted by researchers at Johns Hopkins School of Medicine in conjunction with the University of Maryland School of Nursing confirms what many people have long suspected-- tired nurses are more likely to make mistakes when it comes to patient care.

In researching this conclusion, 633 hospital nurses were evaluated in North Carolina and Illinois.  Though 12-hour shifts may be popular amongst nurses and hospitals alike, the longer shifts resulted in an increased death rate for patients related to pneumonia and acute myocardial infarctions (heart attacks).

What makes this study different from similar studies in the past is that, there now is conclusive evidence establishing the adverse patient outcomes with the longer shifts.

As a personal injury lawyer, who see patients needlessly harmed in nursing homes and hospitals due to basic errors, my hope is that medical facilities will implement changes in staffing schedules to improve nurses alertness.

Read more about this study related to nurse staffing here.

Unknown to many, there are people in nursing homes that require skilled nursing care for reasons aside from old-age and de-conditioning.  A substantial number of nursing home patients require short-term and long-term care due to various types of personal injuries and conditions related to negligence of others. 

In some circumstances, we have successfully prosecuted many ancillary cases despite the fact that we may have been initially contacted to investigate a situation involving nursing home abuse or neglect. Below is a sampling of the personal injury matters we have prosecuted on behalf of nursing home patients.

Medical Malpractice:

Errors made by physicians and hospital staff can permanently cripple and similarly cause complications that require ongoing care.  In addition to general negligence on behalf of a physician, medical malpractice may encompass: surgical errors, pharmacy errors, hospital mistakes and nursing negligence.

Automobile / Trucking Accidents:

Despite strides in automobile design safety, automobile accidents continue to be a major source of serious personal injury-- particularly amongst the younger population.  Drivers, passengers and pedestrians involved in automobile accidents remain susceptible to orthopedic and neurological injuries. 

Industrial Accidents:

Hard working men and woman are injured on the job everyday. A sizable contingent of working people may suffer a significant injury due to a fall, electrical shock or due to the negligence of another worker on the job site.  Some of these situations result in serious injuries such as: brain injuries, burn injuries and paralysis.  Industrial accidents may give rise to a lawsuit under a theory of general negligence or may be maintained under a law specific to the industry such as: FELA, workers compensation, Jones Act or Federal Tort Claims Act. 

Asbestos Exposure:

Some nursing home patients require specialized breathing treatments due to a condition called Mesothelioma. Mesothelioma is a unique type of cancer in the lining of the lungs that is almost exclusively found in people who have been exposed to asbestos.  Many cases of Mesothelioma are not diagnosed for decades after the exposure period.  Many laborers in the following industries are frequently diagnosed with Mesothelioma: automobile industry, steelworkers, ship builders and insulation to name a few.

Products Liability:

Unsafe products continue to make their way into our homes and workplace.  In some circumstances the manufacturer is aware of how they can improve the safety of the product, yet they are hesitant to due to because of the increased cost.  In some cases where a manufacturer is negligent in the design, manufacture or in providing warnings related to product usage and a person is seriously injured all medical expenses-- including nursing home case can be recovered as part of the claim.

Do you have a viable case against another party?

While not every accident-related matter may be compensable, it is important to contact a personal injury lawyer as soon after an incident as feasible.  Many cases must be filed within a specific statute of limitations that varies according to jurisdiction.  However, in the cases of a disabled person, the statute of limitations can be extended beyond the 'normal' statuary period to allow a lawsuit even after the time for filing a case has expired.

The other day, we discussed the popularity of physical therapy amongst nursing home patients.  The increasing use of physical therapy amongst the elderly-- and particularly nursing home patients-- has resulted in increases in the number of incidences of patient injury or death.

Obviously, the intent of physical therapy is to help improve a nursing home resident’s physical well-being. In skilled nursing facilities injuries may occur during physical therapy session that for a variety of reasons including the physical therapists unfamiliarity with the patients, inadequate supervision or broken equipment.

When an injury of a nursing home patients does occur during a physical therapy session, a cause of action for medical malpractice or negligence may be brought for the resulting injury or death.In a negligence case, you can sue your physical therapist for negligence regarding the care you received or failed to receive. 

A physical therapist (PT) owes each patient the duty to fully evaluate their signs and symptoms in order to diagnose and treat the patient so they benefit from physical therapy. A court of law can hold a physical therapist responsible/liable for an error, omission, or negligent act that results in harm. 

A successful negligence case against a physical therapist requires you to prove the following elements:

1. You were owed a duty from the physical therapist
2. The physical therapist breached the standard of care
3. This breach caused harm to you, and
4. There was actual harm or “damages” to you

Many states, such as Illinois, regulate physical therapists.  The Illinois Physical Therapy Act requires that physical therapists have licenses to practice. The Department of Financial and Professional Regulation, Division of Professional Regulation is responsible for licensing physical therapists. Physical Therapists can also pay to participate in malpractice insurance or Professional Liability Insurance (PLI) to shield their personal assets and ensure that there are adequate funds to make amends for wrong-doing. A PLI policy covers errors, omissions, or negligent acts. 

A study on PT malpractice revealed that treatment-related events and events related to improper technique were the most common reasons for a malpractice report. Civil litigation and professional discipline are two tools that can help reduce medical error by holding professionals responsible for their actions. 

If you or a family member is a nursing home resident receiving physical therapy, it is important to understand the medical necessity of physical therapy and its associated risks. Also, be aware that your physical therapist must be licensed by the state to ensure that the person is qualified to perform physical therapy. Injuries can easily occur when your physical therapist is negligent. 

For elderly nursing home residents, these injuries can be even more dangerous because of their weak bones and underlying medical conditions. If you or a family member suffered an injury at the hands of a physical therapist, you could be entitled to compensation for your injuries.

Common examples of physical therapist malpractice include:

• Dropping patients
• Leaving patients unattended on equipment
• Failure to supervise
• Using broken equipment
• Sexual assault
• Over-extending joints
• Failing to inform patients of risks

If you suffered an injury during a physical therapy session, you may have legal rights.  We would honor the opportunity to discuss your situation.  As always, you can speak to a lawyer for no initial charge to you.  (888) 424-5757

Related:

Advance for Occupational Therapy Practitioners: IL Court Overturns Malpractice Statute

Physical Therapy For The Elderly: A Necessity Or Just A Waste Of Time?

Physical Therapy For Nursing Home Patients

In times of need, locating necessary information regarding the legal rights and resources for nursing home patients can be difficult and imposing.  In this respect, we are proud to introduce a new resource for patients, families and practitioners looking for a concise compilation of information regarding nursing home laws.  Nursing Home Injury Laws, provides every states':

• Nursing Home Laws
• Medical Malpractice Laws
• State Resources
• Applicable State Code
• Common Nursing Home Injuries
• Glossary
• Recognized Books & Journals
• Nursing Home FAQ

Additionally, we will be posting regular updates regarding important developments relevant to nursing home care within each state.  Here is a link to Nursing Home Injury Laws.

Prescription drugs are invaluable tools in the practice of medicine, used to treat numerous illnesses and diseases. However, prescription errors can result in serious injury and death. In the United States, about 1.5 million preventable adverse drug events occur every year.

Pharmaceutical malpractice can occur when a doctor prescribes the wrong medication or incorrect dose or when a pharmacist fills the wrong medication or dosage. The National Coordinating Council for Medication Error Reporting and Prevention (NCC MERP) defines a medication error as:

"A medication error is any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the health care professional, patient, or consumer. Such events may be related to professional practice, health care products, procedures, and systems, including prescribing; order communication; product labeling, packaging, and nomenclature; compounding; dispensing; distribution; administration; education; monitoring; and use."

These pharmaceutical errors can result in serious health complications including allergic reactions, organ damage caused by an overdose, infection, stroke, heart failure, and even death. Doctors and pharmacists must follow strict regulations in order to prevent mistakes. In Illinois, the Pharmacy Practice Act (225 ILCS 85) regulates the practice of pharmacy in Illinois. 

Types of Pharmaceutical Errors

• Adverse Drug Side Effects
• Incorrectly Filling A Prescription
• Incorrect Labeling
• Incorrect Dosage
• Drug Interactions
• Incorrect instructions regarding usage

Drug Side Effects

Many prescription medications have serious side effects that should be considered before taking them. Some serious and common side effects include: allergic reactions, heart problems, liver and kidney failure, weight gain/loss, and psychological effects. The doctor prescribing your medication should consider the pros and cons of prescribing the medication as opposed to leaving the condition untreated or prescribing a different medication. 

When considering whether to prescribe a drug with serious side effects, the doctor should consider your full medical history and information to determine whether you can handle the side effects. Also, when filling a prescription order, pharmacists have a duty to advise you about any side effects that might accompany the use of the prescription medication. 

Incorrect Prescription

Medication errors can result when there is a miscommunication of drug orders. This can involve poor handwriting, confusion between drugs with similar names, misuse of zeroes and decimal points, confusion of metric and other dosing units, and inappropriate abbreviations. As many people know, doctor’s handwriting is often times little more than a scrawl or scribble. 

Doctors must take reasonable care in correctly and accurately writing prescriptions. One way to reduce the chance of prescription errors is to use electronic prescriptions, removing the risk of errors associated with poor handwriting. However, mistakes can still occur when a doctor types in the wrong prescription order. Therefore, doctors should take extra care when prescribing medications to ensure that no transcribing errors have occurred. 

Medication errors can also occur when doctors take incomplete patient information. For example, the doctor might not know about the patient’s allergies, any other medications the patient is taking, previous diagnoses, and lab results. Doctors perform best when fully informed about the patient’s history and information. Doctors should ensure that they have a patient’s complete and up to date information before prescribing medication, in order to cut down on medication errors. 

Incorrect Labeling

Pharmacists must ensure that medications have correct labels before selling them to patients. Prescription medication labels should include the name of the drug it contains, the amount to be taken, the time of day to take the medication, and any warnings while taking the drug. When prescription medications are labeled incorrectly, you may end up taking the wrong drug, the wrong dose, the wrong time, or be unaware of warnings about what foods, beverages, or activities to avoid while taking the drug. 

These mistakes can result in serious complications including liver or kidney damage or death or not receiving the full benefit of the drug’s intended purpose. Even when pharmacists include the correct information on the label, they should go over the recommended dosage, procedures, and warnings to ensure that you understand how to safely and correctly take the medication. This is especially important with older adults who may be unable to read the label.  

Incorrect Dosage

Prescription medications have more serious dangers associated with them than over the counter (OTC) drugs. Therefore, it is important that pharmacists issue the correct drug (the one the doctor prescribed) at the correct dose. Errors in filling prescriptions can result from similar-looking pills, difficult to read physician handwriting, and rushed work at pharmacies. Pharmacists must exercise reasonable care when filling each and every prescription order to ensure that you receive the highest standard of care and avoid injury. 

In Illinois, registered pharmacy technicians may, under the supervision of a pharmacist, assist in the dispensing process, offer counseling, and receive new verbal prescription orders (225 ILCS 85/9 – Registration as pharmacy technician). Depending on the pace of business at the pharmacy, these pharmacy technicians might not receive proper supervision to ensure the highest standard of care. 

These mistakes can also cause serious medical complications, either because you take too much or too little of a drug or even taking the wrong drug. Many prescription medications treat serious illness and disease, and besides the risks associated with taking the wrong drug or the wrong dose, are the risks associated with not treating the illness or disease that prompted your doctor to give you a prescription in the first place. 

Adverse Drug Interactions

Many people, especially older adults, take multiple prescription medications, which are commonly prescribed my multiple doctors. However, problems can occur because the doctors prescribing these medications might not know about the other drugs you are taking. 

This can lead to serious complications stemming from drug interactions. Drug-drug interactions are not the only type of potentially dangerous drug interactions; there can also be drug interactions with foods, beverages, and dietary supplements. 

There are three main types of drug interactions:

• Drugs with food and beverages
• Drugs with dietary supplements
• Drugs with other drugs

Drug interactions can reduce the effectiveness of drugs, cause unexpected side effects, or increase the action of a particular drug. Drug interactions with food and beverages might result in delayed, decreased, or enhanced absorption of a medication. Dietary supplements can also cause a variety of drug interactions, and with fifty percent of American adults using dietary supplements (vitamins, minerals, amino acids, herbs or botanicals) on a regular basis, the risk of negative drug interactions is high. 

For example, St. John’s Wort can reduce the concentration of medications in the blood; Vitamin E can increase anti-clotting activity and cause increased risk of bleeding when taken with blood-thinning medication; Ginseng can enhance the bleeding effects of aspirin and ibuprofen; and Ginkgo Biloba can decrease the effectiveness of anticonvulsant therapy. Drug-drug interactions can cause adverse drug reactions. 

The rate of adverse drug reactions increases significantly when a patient is on four or more medications. This is especially worrisome because almost 40% of Americans receive prescriptions for four or more medications. 

Because pharmacists fill prescriptions issued by multiple doctors, they are in the best position to catch potentially harmful drug interactions. However, some people use more than one pharmacy for their drug needs. Therefore, in order to avoid problems with drug interactions, you should use one pharmacy for all of your medications and keep a record of all prescription drugs, over the counter (OTC) drugs, and dietary supplements that you take. 

Nursing home staff must take extra precautions when distributing new prescription medications to nursing home residents. Many nursing home residents are on multiple medications for a variety of physical and mental conditions that are best treated with prescription drugs. These residents might be under the supervision of multiple doctors, and it is the nursing home’s responsibility to ensure that the doctors are aware of all the resident’s medications and changes in condition in order to avoid serious medical complications. 

Physician & Pharmacists Duty To Use Reasonable Care

Pharmacists and doctors have a duty to exercise reasonable care in prescribing and filling prescription drugs. When this duty is breached, serious injuries and even death can occur. Elderly adults are particularly susceptible to injuries stemming from pharmaceutical medication errors because many older adults take multiple medications. Furthermore, many older adults see multiple doctors for specialized care to treat specific injuries or illnesses. 

The increased number of prescription drugs and multiple drug providers can increase the likelihood for a pharmaceutical error. Older adults are also less able to prevent pharmaceutical errors because they might be less able to read the labels and warnings, be less able to understand the medication labels, and might be unable to provide doctors with a complete list of medications or medical information. Many older adults, especially those in nursing homes, rely on other people to fulfill their prescription needs. Therefore, additional care and caution must be taken when prescribing medications to older adults, especially those who rely on nursing home staff for medications and activities of daily living. 

If you or a member of your family has suffered injury because of a pharmaceutical error, you can bring a pharmaceutical malpractice or negligence action. In addition, if the worst occurs and the pharmaceutical malpractice results in the death of a loved one, you may also be entitled to bring a wrongful death action. 

Speak to our experienced pharmaceutical error lawyers about your case for free today.  Nationwide service.  (888) 424-5757

Resources:

FDA: Avoiding Drug Interactions

National Coordinating Council for Medication Error Reporting and Prevention

Adverse Drug Event Reporting: The Roles of Consumers and Health-Care Professionals

Illinois General Assembly – 225 ILCS 85/9 Registration as pharmacy technician

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Some politicians have thrown 'tort reform' into the mix of President Obama's new health care plan under the guise of saving money.  Several states already have full-fledged tort reform measures in place where the state legislature has set caps on the amount of money an injured person can recover.  

Years after many of these damage caps have been put into place, neither physician malpractice premiums nor individual health insurance rates have declined.

Nonetheless, rather than debate the philosophical aspects of imposing limits on recovery, here are some facts regarding tort reform:

• Medical malpractice has no place in the healthcare debate. Healthcare reform is about making sure that every American has access to quality, low-cost healthcare, not about limiting the legal rights of innocent patients harmed by medical negligence.
      
• Tort reform does not improve the quality of our healthcare system or produce cost savings. Forty-eight states have already enacted at least one medical malpractice tort reform measure. Yet, these legal restrictions have done nothing to improve our health care system—forty seven million Americans still have no health care, costs are still escalating and 98,000 Americans still die each year from preventable medical errors. Limiting the legal rights of injured patients will do nothing to fix these problems.
   
• Medical malpractice is about real people, with real injuries. The Institute of Medicine estimates that 98,000 people die each year in the US from preventable medical errors.  And, this number does not even include the countless other people who are injured by medical errors. Rather than reforming the legal system that provides protections to these injured patients, we must focus on reforming the medical system in this country to prevent these errors from ever happening in the first place.
   
• There is no medical malpractice crisis. In 2008, medical malpractice payments accounted to 0.2 percent of all health costs – the lowest level on record. Furthermore, researchers at the Harvard University School of Public Health have found that nearly all medical negligence claims are meritorious, with 97 percent of claims involving medical injury and 80 percent involving physical injuries resulting in major disability or death.
   
• Americans should not have to give up rights, in order to gain the right to healthcare. President Obama has repeatedly stated that in America, healthcare is a right.  Likewise, Americans should not have to relinquish their constitutionally protected 7th Amendment rights in order to gain access to quality healthcare.  
   
• Lawmakers should focus on the key issues. Achieving consensus on the health reform is an extremely delicate balance. Lawmakers must not unnecessarily insert extraneous, controversial issues such as tort reform into an already complicated issue. 
     
• Health courts would be an expensive, bureaucratic nightmare. They would exchange a patient’s constitutional right to a jury trial for a schedule of pre-determined outcomes that would be handed out by judges more interested in appeasing special interests than rendering justice to the injured patients standing before them. And health courts would not protect patients from wrongdoers, but instead, would shield doctors and hospitals from accountability for their careless, harmful acts. Health courts truly are an unfair proposition for patients.  

For more information, go to www.peopleoverprofits.org

Related Nursing Homes Abuse Blog Entry

Who Benefits From Damage Caps In Nursing Home Lawsuits?

Following an appeal by a nursing home operator based on an excessive verdict, an Appellate Court has ordered a re-trial of the punitive damage aspect of a nursing home negligence case.  The case was originally tried in Warren County Circuit court and a jury awarded $4.1 M in compensatory damages and $29.8 M in punitive damages.  

The nursing home negligence lawsuit was brought by the daughters of Cheatum Myers, an 88-year-old man who allegedly died prematurely while he was a resident at a nursing home owned by National Healthcare Corporation, a Murfreesboro-based nursing home operator.  The family's lawsuit involved separate counts for negligence, medical malpractice and wrongful death.  

National Healthcare Corporation has 60 days from the entry of the Appellate Court's decision to file a motion to reconsider with the Tennessee Supreme Court.  National Healthcare Corporation is the 11th largest nursing home operator in the United States and currently houses over 9,000 elderly residents.  Read more about this nursing home negligence lawsuit here.

Punitive Damages

Punitive damages are damages not awarded in order to compensate the plaintiff, but in order to punish or deter the defendant and similar persons from similar behavior that harmed the plaintiff (injured party).  In most jurisdictions, plaintiffs must get permission from the court to pursue a claim for punitive damages.  There is no set limit or absolutely impermissible ratio of punitive damages to compensatory damages, though punitive damages with outrageously high ratios have been reversed by appellate courts.

Related Nursing Homes Abuse Blog Posts

Juries Sending A Message To Nursing Homes

Big Verdicts Against Nursing Homes

According to the the Institute for Healthcare Improvement, 2.6% of the the 30 million operations performed each year are accompanied by a postoperative infection.  Certain procedures account for a higher number of infections---some procedures have infection rates of up to 11%.  

There are essentially two types of incisional infections.  Superficial infections involved infection on the skin surface and the subcutaneous tissue.  Deep incisional infections affect the deep tissue muscle and fascia.  Deep incisional infections are the most serious and have a higher death rate than an infection on the skin's surface.  Nonetheless, infections on the skin's surface must be timely treated to avoid the infection from spreading.

Surgical site infections result from endogenous (from the patient's own body) and exogenous sources (dirty surgical materials).  Infections that derive from the patient's body are more common. The three most common infection causing microorganisms that reside on the patient's body are: Staphylococcus aureus, Coagulase negative staphylococcus and enterococcus. 

Why are surgical site infections on the 'never list'?

Surgical site infections are on the 'never list' for several reasons.  There are multiple preoperative and intraoperative preventative measures that can significantly reduce if not eliminate surgical site infections.  Many of these preventative measures involve scientific principals proven over the last 50 years, yet some hospitals and physicians continually fail to implement them on a regular basis.

Preoperative Causes Of Infection

• Inappropriate administration of antibiotics
• Inadequate sterilization of skin
• Infection in remote area not treated prior to surgery
• Shaving vs. clipping hair

Introperative Causes Of Infection

• Long duration of surgery
• Improper surgical team hand preparation
• Dirty surgical environment- equipment, ventilation, surgical tools
• Improper surgical technique: hemostatis, foreign bodies

If you have experienced extended illness or injury that is related to a surgical site infection, you may be entitled to compensation for your medical bills, disability, pain and suffering and lost wages. Contact an experienced medical malpractice attorney to learn your rights.

Resource: Center For Disease Control- Preventing Surgical Site Infections: A Surgeon's Perspective

On September 24th, Amber Joy Milbrodt injured her leg while playing volleyball.  Needing medical treatment, Milbrodt went to the emergency room at Parkland Hospital in Dallas, Texas.  After a three and a half hour wait the a nurse provided an initial assessment of Ms. Milbrodt and sent her back to the waiting area.  Fifteen hours later and still sitting in the waiting area, Ms. Milbrodt had enough and went home.  Ms. Milbrodt later visited a chiropractic school where they confirmed that she had a broken leg. Ms. Milbrodt received a bill for the emergency room assessment several days later.

What makes this incident particularly disturbing is that it comes just five days after a man died after waiting 19 hours for relief of his chest pain.  On September 20th, 59-year-old, Mike Herrera, died from cardiac arrest in an examination room in the emergency room.  Mr. Herrera checked himself into the emergency room at a computer kiosk before he began his wait.

Parkland officials acknowledge the problem with patient wait times in the emergency room.  "There's nothing you can say except just apologize for this happening," Parkland's president, Ron Anderson, told reporters after the September 20 death.

 

Mr. Herrera's death follows years of warnings about excessive wait times in the emergency department of Dallas County's charity hospital, which serves the indigent and others without health insurance.  A 2004 study on the hospital – which noted two previous consultant reports – said wait times in Parkland's ER were so excessive that more than one in 10 patients left the hospital before seeing a doctor.

 

Since then, that ratio has increased to one in five. Officials say the hospital simply has too few beds for the crush of people needing care. The emergency department, where 81 percent of the hospital's patients are admitted, is a perpetual logjam.  Last year, patients admitted to the hospital through the ER waited an average of 12 hours and 42 minutes for an inpatient bed. This year, the hospital has shaved an hour from that time.

 

Obviously this facility is in the business of providing inadequate patient care.  Even if the facility is overwhelmed with patients, a person from the hospital must be present to prioritize patient needs. Not tending to cardiac or orthopedic patients in a timely manner is malpractice and the facility should be held fully responsible for the injuries.

 

Read more about the September 20 this incident involving emergency room malpractice here.

Catheter related urinary tract infections are the most frequently encountered infection amongst people in nursing homes.  Generally, the longer a catheter is in place, the more likely an infection will develop.  According to the Centers for Disease Control and Prevention (CDC), infection rates range from 1% to 5% after a single brief catheterization to virtually 100% rate of infection for long-term catheter uses. 

The urinary tract is composed of the kidneys and urethra.  As a rule, the 'higher up' the infection, the more serious it is.  A lower urinary tract infection affects the urethra and bladder and can usually be treated easily with antibiotics.  An infection in the upper urinary tract is more severe and affects the kidneys (pyelonephritis) and requires extensive medical treatment.  Once a urinary tract infection reaches the kidneys, it must be closely monitored or it may spread to other areas of the body. An advanced urinary tract infection may result in kidney failure and death.

What are the symptoms of a catheter associated urinary tract infection?

• Painful urination
• Tenderness above the pubic bone
• Decreased appetite
• Inbalance, frequent falls
• Increased heartbeat

If there is such a high rate of infection, why is a catheter associated urinary tract infection on the 'never list'?

Most urinary tract infections are preventable with the implementation of basic sanitation.  Further, upper urinary tract infections are preventable with early detection and treatment.  Below are safeguards recommended by the CDC:

• Provide education to hospital and nursing home staff on proper catheter insertion technique
• Only catheterize when necessary
• Wash hands
• Use sterile equipment
• Use closed drainage bags
• Take regular urine samples
• Observe the color, clarity, and smell of draining urine
• Keep residents with urinary tract infections separate from other non-infected residents

As you can see, most of the prevention guidelines are extremely basic,  There is no excuse for facilities that fail to implement of urinary tract infection prevention techniques.  

 

 

 

 

 

Falls in trauma top the list of preventable medical conditions in hospitals, accounting for 193,566 incidents in 2007.  Falls in hospitals (and similarly in nursing homes) are deemed to be preventable by Medicare because with proper fall/risk assessments and staff assistance most falls in hospital could be avoided.  A number of factors should be addressed by a hospital to determine if a person is at risk for falls:

• Medication that may effect balance or coordination
• Does the person normally use an assistive device like a walker or cane?  If so, one should be provided by the facility at all times.
• Age.  Older residents have a far greater risk of falling than their younger counterparts
• Is the person able to use the bathroom themselves?  If not, regular assistance should be provided by the staff.

In a recent study by researchers at Washington University in St. Louis, patients were injured in 42% of falls occurring in the hospital.  Hospital patients were seriously injured in 8% of the falls with head trauma or fractures.  The study also determined that the people most likely to sustain a serious fall-related injury were those on their way to or in the bathroom.  

In addition to determining patients who are at high risk for falling, hospitals should take precautions to minimize the likelihood of falls due to sloppiness or inadequate staffing.  In order to assure resident falls are minimized hospitals should make sure the following in done:

• Remove clutter from floor.  
• Remove improperly fitting slippers and other clothing.
• Keep bed rails up when patients are sleeping.
• Provide adequate staff and equipment when transferring into and out of bed.
• Install handrails in areas where patients need stability.
• Keep call lights within reach of residents in bed at all times.  Residents can request assistance easily.
• Lock wheels on wheelchairs and beds when transferring patients.

If a fall occurred during a hospitalization, do not assume that the fall resulted from an unforeseeable condition.  There is a good likelihood that the hospital should of identified the patients likelihood of falling and taken precautions. 

A fall or an injury in a nursing home frequently means a referral for a magnetic resonance image (MRI) of the injured area.  An MRI uses powerful magnets and radio waves to produce very clear images of the body that are more accurate than x-rays.  

Not everyone is capable of undergoing an MRI.  Because of the strong magnetic fields and electrical interference people with the following medical conditions should alert their physician or technician before undergoing any MRI procedure:

• Heart pacemaker
• Cerebral aneurysm clip (metal clip on a blood vessel in the brain)
• Implanted insulin pump (for treatment of diabetes), narcotics pump (for pain medication), or implanted nerve stimulator
• TENS" device for back pain
• Metal in the eye or eye socket
• Cochlear (ear) implant for hearing impairment

Even if you are unable to communicate your medical history to the MRI technician or physician, the facility must conduct a thorough examination of you prior to undergoing an MRI.  Failure of the MRI facility to detect the presence of an electronic or metal implant is a deviation from medical standards and imposes responsibility on the facility or hospital.  

Exposure to magnetic fields may result serious medical complications for those reliant on technology for their well being.  For example if a person with a heart pacemaker undergoes an MRI without the close monitoring of a cardiologist, they may go into cardiac arrest or heat failure.

If you you believe that you have been injured due to an improperly  performed MRI, contact my office for a confidential consultation anytime.  (312) 201-0000

 

 

The New York Times recently reported on the potential dangers with receiving a blood transfusion with blood drawn and screened by the Red Cross.  The Red Cross supplies 43% of the nations blood and handles blood from the actual donor draw to the time the donated blood is used.  FDA reports have documented problems with the screening of donors for possible exposure to diseases, failure to properly swab the arms of donors, failure to test for syphilis and failure to discard deficient blood. 

There is no way to determine the full extent of the mistakes made by the Red Cross in the handling of blood.  According to the FDA there are situations where the Red Cross has repeatedly failed to investigate its mistakes.  Potential diseases transferred through blood transfusions are HIV and hepatitis.

Blood transfusions are very common. Each year, almost 5 million Americans need blood transfusions. This procedure is used for people of all ages.  The most common need for a blood transfusion is for people who have lost their own blood during surgery.  Some people who have serious injuries—such as from car wrecks, war, or natural disasters—need blood transfusions to replace blood lost during the injury. 

Seniors who had disease are likely to require a transfusion at some time.  Many elderly with severe infection or liver disease that stops your body from properly making blood or some parts of blood.  An illness that causes anemia, such as kidney disease or cancer. Medicines or radiation used to treat a medical condition also can cause anemia.

Staffing problems are the real cause of blood supply problems.  Low paid employees are expected to follow complicated processes to harvest and store the blood.  The low pay and complex nature of the job leads to high employee turnover.