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Posted on March 9, 2010 by Jonathan Rosenfeld

'Significant Medication Errors' Discovered In Nursing Home Following Investigation Related To Patient Injury & Death

Following a medication-error related death and other medication-related problems that resulted in patient injuries, Minnesota Department of Heath investigators concluded that Fair Oaks Lodge in Wadena, MN was guilty of neglect and other federally mandated nursing home standards.

The 'major medication errors' occurred within 16 days of one another. According to the State's investigative report:

A medication aide mistakenly gave an Alzheimer's patient drugs for her central nervous system, the heart and anti-psychotic medication all of which resulted in an immediate drop of her blood pressure. Despite being rushed to the emergency room, the elderly woman died three days later.
A patient was hospitalized after receiving two does of Tylenol within two hours and an improper medication related to hypertension
A third nursing home patient was hospitalized after a nurse administered medications a medication aide had intended for another patient.

Despite the serious medication-related problems at Fair Oaks, state investigators still found a medication error rate of 18% 2 1/2 months later. Read more about these medication errors in a nursing home here.

Medication Errors

In the nursing home setting, some of the more common medication errors include:

Administering The Incorrect Prescription

Medication errors can result when there is a mis-communication or misunderstanding of drug orders. These errors may be due to: poor handwriting, confusion between drugs with similar names, misuse of zeroes and decimal points, confusion of metric and other dosing units, and inappropriate abbreviations. Doctors must take reasonable care in correctly and accurately writing prescriptions and staff must similarly confirm medication types and dosages when in doubt.

Medication errors can also occur when doctors take an incomplete medical history from a patient. For example, the doctor might not know about the patient’s allergies, any other medications the patient is taking, previous diagnoses, and lab results. Nursing homes should help treating physicians by ensuring that they provide the physician with accurate medical charts.

Failure to Consider Adverse Side Effects of Drugs

Many prescription (and over-the-counter) 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. Similarly, the staff in a nursing home, should monitor patients to help detect adverse reactions as quickly as feasible.

Incorrect Medication Dosage

Prescription medications have more serious dangers associated with them than over the counter (OTC) drugs. Therefore, it is important that nursing home staff issue the correct drug (the one the doctor prescribed) at the correct dose. At many nursing homes and medical facilities, medications are administered via a ‘medication cart’ where many similar-looking pills are stored. Consequently, staff in nursing homes must check and re-check before administering medication to assure the patient receives the proper dosage.

Medical complications may arise when patients are administered too much or too little of a drug. Many prescription medications require must be taken at a specific time, staff must be aware of these administration parameters and dispense the medication accordingly.

Adverse Drug Interactions

Many 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.

Nursing Home Liability for Medication Errors

Medication error cases can frequently be some of the more complex cases due to the fact that a variety of parties may be responsible for the error(s). In some cases, liability may be imposed on the physician, nursing home and pharmacy involved in the incident. Consequently, in order to fully investigate each parties culpability, it is important to speak with a lawyer experienced in handling cases involving medication errors as soon as feasible after the event.

Related Nursing Homes Abuse Blog Entries:

Medication Aides In Nursing Homes: A Push To Save Money Or Improve Patient Care?

Study Shows Errors In Timing Of Administration Of Medication In Assisted Living Facilities

Study Reveals Nursing Home Patients Chronic Pain Is Not Adequately Controlled

Improper Drug Dosage, Wrong Medication, Interactions With Other Drugs.... May Be The Result Of Pharmaceutical Malpractice

Tags: Medication Errors, administering the wrong prescription, adverse drug reaction, death, fair oaks lodge, incorrect medication dosage, medication overdose, minnesota nursing home, patient injury

Posted on March 4, 2010 by Jonathan Rosenfeld

Even The Most Mundane Parts Of A Nursing Home Can Turn Deadly Without Proper Staff Supervision

Despite the glimpse of warmer temperatures that are (hopefully) around the corner, many nursing homes and long-term care facilities have their heating systems working at full force. Unfortunately, many of these facilities were constructed at a time when radiant heating systems were state of the art.

The danger radiators and portable heating units pose to disabled nursing home patients may seem like somewhat of an alarmist attitude, but the reality is that anything can pose a danger to people who may be unable to appreciate danger to themselves or others.

A radiator in a Minnesota nursing home patient's room turned deadly when the man 'wedged' his foot between his bed and the radiator. The man suffered second and third degree burns to his legs. Four weeks later, the man died from complications related to the burns.

An investigation in the incident, which occurred at Redeemer Health and Rehab, determined the facility was negligent in its care of this dementia patient because the facility knew that this man was prone to do this. In fact, the nursing home had noted that the man had a similar episode of wedging his feet between the radiator shortly before this incident occurred.

As a lawyer who has represented burn victims, I can personally attest to the horrific pain these victims experience while undergoing burn treatments. Many burn patients require skin grafts and other painful surgeries to heal the wound and reduce the risk of infection. In this respect, it always aggravates me when I hear of a person who needlessly suffered a burn injury because the toll the injury takes on the individual.

Read more about this burn to a nursing home patient here.

Related Nursing Homes Abuse Blog Entries:

Resident Who Smoked & Used Oxygen Suspected Of Causing Fire At Assisted Living Facility

Nursing Home Patient Sustains Serious Burns After Smoking In His Bed

Cigarette Lighter Mishap Results In Severe Burns To Nursing Home Patient

Tags: Dementia / Alzheimer's Patients, death, heating unit, minnesota nursing home, radiator, redeemer health and rehab, second degree burn, skin grafts, third degree burn

Posted on March 3, 2010 by Jonathan Rosenfeld

'Poor Judgment' To Blame For CNA's Failure To Implement Fall Precautions In Minnesota Nusing Home Death

“When planning for a year, plant corn. When planning for a decade, plant trees. When planning for life, train and educate people.” - Chinese Proverb

At employee at St. Anthony Health Care Center in St. Paul, MN failed to follow these words of wisdom when she failed to follow the fall precautions set for in a patients care plan. An investigation into the matter, revealed that the nursing home employee's errors contributed to the patient's death.

A Department of Health investigation into the matter cited the employee for neglect when she made the following errors:

Failing to activate a fall alarm
Failing to lower the patient's bed to a lower height
Failing to put a mat beside the patient's bed to provide padding in cases of falls

The patient fell out of her bed and hit her forehead and sustained a subdural hematoma. The patient died four days after the incident.

When questioned by Department of Health investigators, the CNA 'admitted she used poor judgment'. Incidentally, the investigation revealed the facility itself was not at fault.

I certainly appreciate this CNA's honesty when it comes to the careless errors she made. However, I am always frustrated when Heath Department investigators fail to impute responsibility on the part of the facility itself. I find it hard to believe no other employees witnessed this situation. Further, it only would have taken another co-worker a few seconds to implement some of the fall precautions had they chosen to check on this patient.

Read more about this case involving neglect in a Minnesota Nursing Home here.

New Technology Promises To Reduce Falls In The Elderly Population

Poor Training & Under-Staffing Blamed For The Death Of A Nursing Home Patient Who Died From Injuries Sustained After She Was Dropped By A CNA In A Minnesota Facility

Even Common Falls Put Elderly At Risk For Developing Subdural Hematomas

Tags: Nursing Home Falls, death, fall alarm, fall precautions, hematoma', minnesota nursing home, st. anthony health center, subdural

Posted on February 25, 2010 by Jonathan Rosenfeld

At Fraud Trial Involving A Home Health Agency, The Real Losers Are The Patients Who Miss Out On Care

A fraud trial pending in Federal Court in Philadelphia is providing glimpse into the sad world of fraud amongst home health care agencies. The trial involved four employees of MultiEthnic Behavior Services, Inc., a now defunct home health care agency, who were billing for home nursing services that they never provided.

The fraud was discovered following the death of 14-year-old Danieal Kelly, a girl suffering from cerebral palsy, that MultiEthnic was responsible for caring for. An investigation into her death revealed that Danieal's case worker-- a MultiEthnic employee-- failed to provide medical care to her that they were charging for.

According to Cindy Christian, co-director at Children's Hospital in Philadelphia, the home health agencies failure to provide care resulted in medical conditions that contributed to Danieal's death. Shortly before her death, Daniel suffered from extreme malnourishment and advanced bed sores. In describing the bed sores at the fraud trial, Christian described the bed sores, 'they were the multiple and severe, the most severe they could be."

Testimony at the fraud trial further revealed that had the home health care workers chosen to visit Daniel's home, they would have been able to smell her bed sores because they wounds were so severe that the smell of rotting flesh was pronounced.

Sadly, Daniel is probably one of many people who suffered because this home health care agency failed to do their job. According to her caseworker, he fabricated 60% of his progress reports during his four years with the agency. Further, he had no experience when he was hired and received no training from agency supervisors.

Read more about this trial involving a home health company here.

Related Nursing Homes abuse Blog Entries:

"Home Care Nursing" Doesn't Mean "No Care Nursing"

Home Care Nurse Gets Probation For Ignoring Bedsores On Child

Home Care Nurse Has License Suspended In Connection To Death Of Disabled Boy

Tags: Home Health Agency, advanced bed sores, cerebral palsy, death, fraud, home health agency, home medical care, liability of home health agency, malnourishment

Posted on February 24, 2010 by Jonathan Rosenfeld

Failure To Follow Doctor's Orders Results In The Choking Death Of Hospital Patient

I think most people would be amazed if they became aware of how many injuries and deaths were cased by an employee's failure to follow basic orders. This time, a hospital employee's failure to follow basic instructions related to a patient's dietary needs has cost another patient their life.

Ignoring doctors orders, an employee at Mayers Memorial Hospital gave a meat and cheese sandwhich to an Alzheimer's patient who was unable to eat solid food. Left unattended with the sandwhich, the patient literally 'inhaled' the sandwhich. Five days later, the patient died from pneumonia caused by inhaling food.

According to California Department of Public Health Director, Dr. Mark Horton, "The facility failed to protect the heath of a patient when the prescribed diet ordered by the phyisician and in the patient's care plan was not followed. As a result, the patient died."

The California Department of Public Health issued a AA citation and a $50,000 fine to the hospital following its investigation.

Read more about this choking incident here.

Pneumonia from inhaling food?

Yes. Many nursing home and hospital patients develop 'aspiration pneumonia' when food or foreign materials enter the bronchial tree (lungs). Aspiration pneumonia may result after oral or gastric contents (including food, saliva, or nasal secretions) are inhaled. Depending on the acidity of the materials inhaled, a chemical pneumonitis can develop, and bacteria may add to the inflammation.

Tags: Choking, aspiration pneumonia, california hospital, choking death, choking on food, death, failing to follow physician orders, inhaling food, mayers memorial hospital

Posted on February 14, 2010 by Jonathan Rosenfeld

Fire In An Assisted Living Facility Claims The Lives Of Two Residents

Two residents at a Georgia assisted living facility were killed when a fire broke out at the facility where they lived. Two other residents were taken to a hospital for further treatment. Investigators are still trying to determine the cause of the fire.

Unlike nursing homes, assisted living facilities and group homes are not subject to the same federal laws the require the use of smoke alarms and fire sprinkler systems. Clearly, as incidents such as this indicate, there is a need for more regulation at these type of facilities.

Ohio Nursing Home Fire Sparks Interest In Resident Safety

Nursing Home Patient Sustains Serious Burns After Smoking In His Bed

Unsupervised Nursing Home Resident Dies From Burns

Tags: Fires In Nursing Homes, assisted living facility, death, georgia, group home

Posted on February 9, 2010 by Jonathan Rosenfeld

Nursing Home Spotlight: Ballard Nursing Center, Des Plaines, Illinois

Ballard Nursing Center is yet another large nursing home facility located in Des Plaines, Illinois. Ballard can accomedate 231 Medicare / Medicaid patients. Ballard scored three out of five stars according to the Medicare Nursing Home Compare website, which is an average rating. Ballard had only five health deficiencies in the past year, which is three less than the average in Illinois and in the United States.

Despite the relatively low number of health deficiencies, some residents failed to receive the necessary care and services to attain or maintain the highest practicable physical, mental, and psychosocial well-being.

During a recertification survey on August 14, 2009, inspectors found that one resident was in severe pain for over twenty hours because the facility failed to reassess and relieve her pain within a reasonable timeframe. The resident was a 70 year-old female who had recently had surgery on her left thigh and was admitted to the facility with a non-healing surgical wound. She complained to nurses that she was experiencing severe knee pain and was given Tylenol and a Lidocaine patch. However, the severe pain persisted with no relief from the prescribed treatment. The facility did not order any additional pain medications until the surveyor intervened on her behalf. As a result, this resident suffered excruciating knee pain for over twenty hours.

Another resident, a 48 year-old female who is in a vegetative state and cannot communicate because of a traumatic brain injury, was observed in her room moaning and crying out. A review of her clinical chart revealed that she had no current pain assessment. When the surveyor asked staff why the resident was crying out, they responded that they didn’t know and that she cried out on occasion. In addition, because the resident cannot communicate, the staff must anticipate potential for pain. The facility failed to do so when removing hand splints, which may have caused the resident pain.

The facility also failed to ensure that food was stored and distributed under sanitary conditions, which exposed all residents in the facility to potential harm. Older adults are particularly susceptible to food poisoning because of weakened immune systems, and many older adults already have weakened immune systems because of age, illness, or disease and their bodies cannot handle the added onslaught of food poisoning illness. The surveyor found cups of juice and milk in the refrigerator without labels indicating the date they were opened. Also, food debris was observed on dishes after being “washed” in the dishwasher.

During a complaint investigation concerning the death of a 61 year-old male resident, it was found that the facility failed to ensure that the resident was free from neglect and also failed to thoroughly investigate the improperly placed tracheostomy tube. The facility’s failures resulted in the hospitalization and eventual death of the male resident because he did not receive enough oxygen during a respiratory arrest which led to respiratory failure.

Although the facility was supposed to check on the resident every four hours because he had a tracheostomy, documentation revealed that the Respiratory Therapist failed to check on the resident every four hours. A Certified Nurse Aide (CAN) found the resident with his trach tube out and reinserted it. The CNA called the Respiratory Therapist when the resident was unresponsive. While attempting to revive the resident, the resident passed out and coded. At this point, the facility called an ambulance, and the resident was rushed to the Emergency Room in “Full Arrest with Cardiac Pulmonary Resuscitate (CPR) in progress by the paramedics. In the ER, doctors removed the tracheostomy and inserted a new tube into the trachea to ventilate. However, by that time, the resident had gone at least half an hour without ventilation. The resident died as a result of fatal respiratory arrest.

The facility then failed to thoroughly investigate this occurrence that led to the resident’s death. In addition, the facility did not notify the state reporting agency of the occurrence. The facility fired the Respiratory Therapist for “unsatisfactory work performance” nine days after the incident. However, no evidence of an investigation was found even though the Respiratory Therapist’s actions led to the resident’s death. In response to these serious deficiencies, the facility checked all 37 residents with trach tubes and reviewed the policy on trach and vent checks with respiratory staff. Hopefully the facility response will prevent any future preventable deaths.

Although Ballard Nursing Center received an average rating from Medicare, the facility has suffered from problems, which even led to the death of one male resident. In a large nursing home such as this, sometimes not all residents receive adequate and appropriate care which can lead to serious health complications.

Furthermore, this recent survey demonstrates that seemingly quality nursing homes, such as Ballard, still have episodes where poor care result in patient injury or death. Families of patients at all nursing homes-- regardless of their reputation-- should visit regularly and speak up if dangerous conditions are seen. Your observations may prevent unfortunate situations from occurring.

Thank you to Heather Keil, J.D. for her assistance with this Nursing Homes Abuse Blog Entry

Resources:

IDPH: Ballard Nursing Center

Medicare: Ballard Nursing Center

Staff Must Be Diligent In Order To Avoid Clogged Breathing Tubes Amongst Nursing Home Patients

Elderly Nursing Home Patients Are Particularly Susceptible To Illness Related To Contaminated Food

Study Reveals Nursing Home Patients Chronic Pain Is Not Adequately Controlled

Tags: Food Poisoning, Illinois Nursing Homes, ballard nursing center, controlling pain, death, respiratory arrest, respiratory failure, surgical wound, tracheostomy tube, traumatic brain injury

Posted on February 7, 2010 by Jonathan Rosenfeld

Professor Devotes New Book To 'Oscar The Cat'-- The Feline With The Ability To Predict Death

Talk about worthless news stories, here's a news-clip about a Brown University professor who will be releasing a new book devoted to.... a cat. Not just any alley cat, 'Oscar' allegedly has the ability to predict the impending death of nursing home patients. Oscar has apparently successfully predicted the impending death of more than 50 patients in a Rhode Island nursing home. Apparently, when Oscar cuddles up with you, your day may be numbered.

Tags: National Nursing Home Issues, death, oscar the cat, rhode island nursing home

Posted on February 2, 2010 by Jonathan Rosenfeld

Elderly Woman Wanders From Her Convalescent Home To Her Death

I'll never get accustomed to the fact that many elderly will suffer an injury or die due to the carelessness of people who are intended to care for them. It seems that every few weeks we hear about an elderly person who mysteriously goes missing from a facility and wanders to his or her death. Despite the frequency, it still outrages me when I hear about such completely preventable situations.

Most recently, I was saddened to hear about the death of 63-year-old Rosemary Nelson who was found dead along the shoulder of the road after wandering from a California convalescent home. Ms. Nelson's body was discovered three days after she was reported missing from the facility that was responsible for her care. A medical examiner concluded Ms. Nelson's death was due to 'exposure'

According to a report from Ms. Nelson's family, Ms. Nelson had a history of wandering from facilities and had gone missing from other board-and-care facilities in the past.

Of course its easy to come up with excuses why this elderly woman managed to wander from this skilled nursing facility, yet the reality most certainly remains that someone at the facility was not doing their job when this lady managed to leave undetected. As a society we must begin to demand that nursing homes begin to look after our elders the same way we expect nursery schools to look after out toddlers. Until we demand full accountability, we will likely continue to hear about elderly who wandered into a world they are ill equipped to handle.

Read more about this wandering episode involving a California Nursing Home here.

Related Nursing Homes Abuse Blog Entries:

Assisted Living Facility Lets Resident Walk Out The Door & Into Semi

Woman Dies From Hypothermia After Wandering From Assisted Living Facility

Chicago Nursing Home Lawyer, Jonathan Rosenfeld, Interviewed Regarding Preventing Patients From Wandering

What Can Nursing Homes Learn From Jails?

Tags: Elopement / Wandering, board and care facilities, california nursing home, convalescent home, death, elderly, skilled nursing facility

Posted on January 31, 2010 by Jonathan Rosenfeld

60 Nursing Home Patients Sickened By Norovirus

More than 60 patients at the Good Shepherd Nursing Home in Ohio have become ill after contracting norovirus. According to the Ohio Department of Health the norovirus outbreak occurred sometime around January 15th.

It is unclear what triggered this norovirus outbreak, but norovirus is highly contagious and can be spread through feces, vomit or food poisoning. In order to reduce episodes of norovirus, it is important to regularly wash hand and follow common sense sanitation guidelines.

Most people with norovirus initially have a bad stomach ache followed by nausea, vomiting or diarrhea. Norovirus in the elderly can be particularly problematic because many of the symptoms result in dehydration. By some accounts, norovirus claims the lives of more than 500 people each year.

Read more about this norovirus outbreak in an Ohio Nursing Home here.

Related Nursing Homes Abuse Blog Entries:

MRSA In Nursing Homes On The Rise Amongst Residents & Staff

Food Safety

Elderly Nursing Home Patients Are Particularly Susceptible To Illness Related To Contaminated Food

Tags: Food Poisoning, death, elderly, good shepherd nursing home, norovirus in nursing home, ohio nursing home, virus

Posted on January 27, 2010 by Jonathan Rosenfeld

Diabetic Ketoacidosis Is An Under-Appreciated Danger Facing Many Nursing Home Patients

Diabetes is a serious illness affecting many nursing home residents. Diabetics face an increased risk for a variety of health problems and complications, including ketoacidosis. Diabetic ketoacidosis is a dangerous complication of diabetes that occurs when you don’t have enough insulin in your body. This serious complication is more common in people who have type 1 diabetes, rather than type 2 diabetes.

Diabetic ketoacidosis develops when you have too little insulin in your body, raising your blood sugar level. This causes your body to break down fat for energy, creating toxic acids known as ketones. If left untreated, this can cause you to lose consciousness and even result in death. Symptoms develop quickly and include:

Excessive thirst
Frequent urination
Nausea and vomiting
Abdominal pain
Loss of appetite
Weakness or fatigue
Shortness of breath
Fruity-scented breath
Confusion.

Doctors can test for high blood sugar level and high ketone level in your urine in order to confirm ketoacidosis.

Ketoacidosis is commonly triggered by an illness or a problem with insulin therapy. Elderly diabetic nursing home residents are more susceptible to infection and other illnesses, which in turn puts them at greater risk for developing ketoacidosis. However, the risk of ketoacidosis is highest if you are age 19 or younger and suffering from type 1 diabetes. Other possible triggers include: stress, physical or emotional trauma, high fever, surgery, heart attack, stroke, and alcohol or drug abuse.

Treatment of ketoacidosis is done with fluid replacement, electrolyte replacement, and insulin therapy. These very treatments that are used to correct ketoacidosis are also the source of most ketoacidosis complications. These complications include: low blood sugar (hypoglycemia), low potassium (hypokalemia), and swelling of the brain (cerebral edema).

The best way to prevent ketoacidosis is to properly manage your diabetes with healthy eating and physical activity as well as monitoring your blood sugar level to ensure that it remains within your target range.

Many nursing home residents rely on nursing home staff to properly monitor their blood sugar level and adjust insulin dosage as needed as well as provide healthy and well-balanced meals. Therefore, it is important that nursing homes develop care plans to provide adequate care and services to manage diabetic residents. Most diabetic complications develop faster in elderly diabetics with poor glycemic control.

Diabetes in the Elderly

Diabetes is a serious disease that can cause many complications for elderly diabetics. Ketoacidosis and other diabetic complications require that nursing home staff take special precautions to properly monitor diabetic residents and ensure that they receive necessary care and services to attain and maintain the highest quality of life possible.

If you worry that a nursing home facility is not providing adequate care to manage your diabetes, it is important that you take immediate action to get your diabetes under control and prevent medical problems and complications.

Resources:

Medicine Net: Ketoacidosis

Diabetes Disease: Ketoacidosis

Journal of Geriatric and Gerontology: Diabetes in the Elderly

Resident Grand Rounds: Diagnosis and Management of Diabetic Ketoacidosis in Adults

Nursing Homes Abuse Blog:

Nursing Homes Must Be Prepared To Handle Diabetic Patients

Never Event #3: Poorly Controlled Blood Sugar, Hyperglycemia & Hypoglycemia

Tags: Diabetic Ketoacidosis, National Nursing Home Issues, blood sugar, death, diabetes, injury, type 1 diabetes, type 2 diabetes

Posted on January 6, 2010 by Jonathan Rosenfeld

Seems Like Common Sense, Yet Many Medical Facilities Continue To Ignore Patients Daily Hydration Needs

By the looks of many nursing home patients' physical appearance, you'd think they were living in the desert. Rather than a weakened appearance due to trekking through the Sahara, most of these patients suffer the effects of dehydration due to improper care and general neglect.

Dehydration occurs when the amount of water leaving the body is greater than the amount of water taken in. Water is routinely lost when a person breathes, sweats, urinates or has a bowel movement and as humidified air leaves the body.

Dehydration is caused by too much water being lost, not enough water being taken in, or a combination of the two. Inadequate water consumption can be caused by an inability to drink fluids, which can be caused by a lack of strength to drink adequate amounts. The following can account for fluid loss:

Diarrhea
Vomiting
Sweat
Diabetes (elevated blood sugar levels cause sugar to spill into the urine with water following, causing frequent urination, which in turn can cause significant dehydration)
Drainage from wounds and pressure sores

Common signs of dehydration are thirst (to increase water intake) and more concentrated urine (more yellow in color). The following symptoms might also occur:

Dry mouth
Fatigue
Decreased urine output
Few or no tears
Body stops sweating
Muscle weakness
Electrolyte imbalances
Muscle cramps
Nausea and vomiting
Heart palpitations
Light-headedness

Severe dehydration can cause confusion and weakness, and if left untreated, even coma and organ failure.

The main treatment for dehydration is fluid replacement. This can be accomplished by replacing fluids by mouth or intravenous fluid (IV). As treatment occurs, urine output increases.

Complications of dehydration may occur either because of the dehydration or because of underlying disease or situations. Dehydration can cause kidney failure; although, if treated early, it is often reversible.

Electrolyte abnormalities may occur as important chemicals (sodium and potassium) are lost through sweat, vomiting, or diarrhea. Seizures can occur when the electrical discharges in the brain become disorganized.

Hypotension (drop in blood pressure) can also occur, causing a patient to go into hypovolemic shock (insufficient blood flow through the body resulting in inadequate oxygen reaching tissues). A decreased blood supply to the brain can also cause coma, and if enough organs malfunction, death can occur.

Older adults, people with chronic illnesses, and young children are most at risk for dehydration. As people age, the body’s ability to conserve water is reduced, the thirst sense becomes less acute, and persons become less able to respond to changes in temperature. Also, thirst is not a reliable gauge of the body’s need for water, especially for elderly persons.

In older adults, the region of the brain that predicts how much water a person needs (the mid cingulated cortex) can malfunction, which helps explain why the elderly are more at risk for dehydration. In Chicago’s 1995 heat wave, more than 600 people died in their homes due to heat exposure. It is important that elderly persons be checked on during periods of high heat to ensure proper hydration.

Dehydration can be easily prevented through proper hydration. However, some nursing home patients might be unable to drink adequate amounts of fluid because of forgetfulness, or illness. In addition, many nursing home residents suffer from diabetes, which is an increased risk factor for dehydration. Therefore, it is important that nursing home staff monitor residents to ensure proper hydration and urine output (dark yellow urine usually signals dehydration) in order to prevent serious complications caused by dehydration.

Proper nutrition and proper hydration are essential elements of maintaining the highest possible health and well-being of nursing home residents. As discussed above, elderly nursing home residents are particularly susceptible to dehydration. The danger of pressure sores adds a further complication for nursing home residents at risk for dehydration.

Dehydration is a risk factor for the actual development of pressure ulcers because dehydration can reduce blood volume, thus interrupting circulation and blood supply to the extremities. Maintaining tissue health is an important feature in pressure sore prevention; this includes proper nutrition and hydration, pressure relief and management, incontinence management, and wound care. In addition, the pressure sores can also be a major source of fluid loss as the sores drain, causing further dehydration.

Therefore, nutritional intervention is an important element of pressure sore prevention and treatment. Nursing home staff must properly assess the resident’s nutritional needs, monitor the resident’s food and fluid intake, and make changes to the nutrition plan as changes in the resident’s health occur. Early intervention is important when a resident is not eating or drinking enough in order to prevent further health complications such as malnutrition, dehydration, and pressure sores.

Resources:

Science Daily – Brain Malfunction Explains Dehydration in Elderly

Pressure Ulcer Management: The Importance of Nutrition

Dehydration Death Costs Nursing Home $6.5M

Autopsies May Help Families Determine If Their Loved One Was A Victim Of Nursing Home Neglect Or Abuse

Tags: Dehydration, coma, death, dehydration in the elderly, hypovolemic shock, organ failure, pressure sores

Posted on January 5, 2010 by Jonathan Rosenfeld

The Failure To Treat Pain In Paralyzed Patients With Decubitus Ulcers Can Result In Autonomic Dysreflexia

Autonomic dysreflexia (or hyperreflexia) is a dangerous condition that can occur with bed sore patients or patients with spinal cord injuries above the middle of the chest (usually above T-5). Autonomic dysreflexia occurs when an irritation or pain below the level of the spinal cord injury sends a signal that fails to reach the brain.

Over time, the bodies a delayed pain response results in changes to the sympathetic portion of the autonomic Nervous System (helps people adapt to changes in the environment and is associated with the “flight-or-fight” response), resulting in muscle spasms and a narrowing of the blood vessels. This in turn can cause blood pressure to rise and heart rate to drop, which can lead to stroke, seizure, or even death.

Signs autonomic dysreflexia may include:

Pounding headache
Goose bumps
Red blotches on the skin, above the level of the spinal cord injury
Sweating, above the level of injury
Cold, clammy skin, below the injury
Nasal congestion
Slow pulse (< 60 beats/minute)
Restlessness
Hypertension (blood pressure greater than 200/100)
Nausea

Autonomic dysreflexia can be prevented. Specific precautions include:

Frequent pressure relief in bed / chair (turning the patient to change positions)
Avoidance of sunburn and scalding from hot water
Maintain a regular bowel program
Proper nutrition and fluid intake
Compliance with medications
Proper maintenance of indwelling catheter (keep tube free of kinks, keep drainage bags empty, check catheter daily for deposits)
Perform routine skin assessments

Treatment of autonomic dysreflexia can be as easy as changing positions or removing the cause of irritation. However, treatment must be initiated quickly in order to prevent further complications. Many stimuli can cause autonomic dysreflexia including anything that would have been painful, uncomfortable, or physically irritating before the injury.

The most common causes are:

Overfill bladder – this can be due to a blockage in urinary drainage device, bladder infection, inadequate bladder emptying, bladder spasms, or bladder stones
Bowel full of stool or gas – due to constipation, hemorrhoids or anal fissures, or infection and irritation
Skin irritations – due to wounds below the injury, pressure sores, ingrown toenails, burns, or tight/restrictive clothing
Broken bones

If the trigger cannot be identified and removed or if problems persist, medications can be used to treat the autonomic dysreflexia.

People suffering from spinal cord injuries are particularly susceptible to pressure sores because of sitting or lying in the same position for an extended period of time. In addition, spinal cord injuries can reduce or eliminate sensations, making it more difficult for the person to know when a pressure sore is developing. These pressure sores can cause a dangerous condition known as autonomic dysreflexia in patients with spinal cord injuries.

Autonomic dysreflexia is a potentially life threatening condition resulting from over activity in the Autonomic Nervous System, which can cause high blood pressure leading to seizures, stroke, and even death.

Therefore, it is important that nursing home staff pay special attention to residents suffering from spinal cord injuries. This includes frequently turning the resident to relieve pressure, regulating bladder and bowel output, properly maintaining catheters, and regularly checking for skin irritations. Prevention of pressure sores is key to maintaining the physical health of residents with spinal cord injuries.

Are bed sore patients at risk for amyloidosis?

Can bed sores cause osteomyelitis?

Is necrotizing fasciitis related to bed sores?

If bed sores are not timely treated, can gangrene develop?

Tags: Bed Sores, Pressure Sores, Decubitus Ulcers & Pressure Ulcers, autonomic dysreflexia, bed sore complications, death, hyperreflexia, paralysis, seizure, stroke

Posted on December 31, 2009 by Jonathan Rosenfeld

Golden Moments Senior Care Center Continues To Accumulate Fines Related To Providing Poor Care To Its Patients

It never ceases to amaze me how some nursing home operators would rather incur fines for continually providing inadequate care rather than make necessary changes. However, when the cost of the fines is not sufficient to improve patient care, I guess that some business manager is making a conscious business decision that it's easier (and cheaper) to continue with the game plan and pay the consequences--- when-- and if they get caught.

Case in point, Golden Moments Senior Care Center.

The Jacksonville, IL nursing home has agreed to pay $6,500 in fines to the state in relation to complaints connected to mistreatment of the elderly. For Golden Moments, this most recent fine is just the latest hiccup along the way to providing quality care. Among recent fines:

May, 2009- The facility was fined $20,000 after an investigation revealed that Golden Moments failed to intervene in incidents where patients were verbally, mentally and physically abused.
October, 2009- The Illinois Department of Health imposed $3,050 per day fine for an 11 day period where the facility failed to make corrective changes related to patient care. Specifically, the facility failed to follow its own policy with respect to patients who require assistance while eating.
November, 2009- As of November 23rd, Golden Moments received approximately $40,000 in fines for failing to comply with federal regulations.

Sure, $40,000 is a lot of money. But my guess is that the cost of paying the fines is relatively cheap compared with making the necessary changes that would be necessary if the facility actually chose to improve patient care. Until states begin to impose more substantial fines, I predict nursing home patients will continue to receive much of the same poor care that leads to severe injury and death.

Read more about these fines against Golden Moments Senior Care Center here.

Aide identified in alleged nursing home abuse, The State-Journal Register, August 28, 2009

Illinois Nursing Home That Turned 'Blind Eye' To Sexual Assaults Now Faces Fines

Choking Death Just Latest Problem At California Nursing Home

Hefty Fine Imposed On A Kindred Nursing Home For Failing To Report Potential Abuse To Authorities

Judge Limits Fines For Poor Nursing Home Care

Tags: Illinois Nursing Homes, care centers, death, fines, golden moments senior care center, injury, mental abuse, physical abuse, verbal abuse

Posted on December 30, 2009 by Jonathan Rosenfeld

Falls In Nursing Homes Are A Serious Threat To The Safety Of Many Patients

Given the frequency (approximately 80+% of all nursing nursing home patients will experience a fall this coming year) with which nursing home falls occur, facilities must be on the lookout when it comes to implementing fall prevention techniques in order to improve patient safety. Too often, the prevention comes too late-- if at all.

Here are our most popular fall-related entries over the past year:

How Many Falls Is Enough To Impose Responsibility On Nursing Home?

Falls are a common problem facing elderly people in and out of nursing homes. By some accounts, every elderly person in America will fall at least one time over the course of the next year. Many of these falls will cause injury and some will even cause death.

In the case of falls occurring in the nursing home setting, many clients and their families focus their attention on tying a specific number of falls to a facilities responsibility. Truth be told, there really is no magic number when it comes to identifying a specific number of falls after which a nursing home or hospital becomes responsible....

Never Event #1: Hospital Falls & Trauma

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:...

Nursing Home Cited For Mistreatment Of Resident Following Investigation Of Resident's Fractured Neck

The Minnesota Department of Health released an investigative report concluding a resident of Presbyterian Homes of Arden Hills Nursing Home sustained a broken neck due to a fall or other trauma at the facility. The investigation follows the death of 91-year-old Gladys Gall, a resident at the facility. Despite the fact no federal or state nursing home violations were identified, investigators still determined there was ample circumstantial evidence to conclude the nursing home was at fault in the injury and subsequent death of Gall. On April 18, 2008 Gall was admitted to an emergency room after complaining of head and neck pain. A CT scan confirmed Gall's pain was related to a cervical fracture. On April 28th, Gall died from complications related to the cervical fracture....

What Is Hypostatic Blood Pressure & Why Is There An Associated 'Fall Risk'?

Hypotension (low blood pressure) is a problem for many nursing home residents, causing dizziness and fainting. Blood pressure readings measure the pressure in arteries - systolic pressure (the top number in a reading) measures the pressure the heart generates when pumping blood out to the rest of the body and diastolic pressure (the bottom number in a reading) measures the amount of pressure between heartbeats. A systolic blood pressure of 90 millimeters of mercury or less or a diastolic blood pressure of 60 millimeters of mercury or less is considered low....

Nursing Home Staff Must Take Precautions While Moving & Transferring Disabled Patients To Minimize Risk Of Dropping

The most dangerous part of the day for many nursing home patients may be getting out of bed in the morning. When staff fail to supervise or provide proper assistance to nursing home patients during transfers, patients are at risk for falls or being dropped by staff.

Disabled nursing home patients and those with physical limitations must be carefully monitored to avoid injuries while being transferred from one device to another. Some of the commonly encountered situations where patients are injured include:...

Even Common Falls Put Elderly At Risk For Developing Subdural Hematomas

Frequently undiagnosed and under-appreciated, falls amongst the elderly can frequently result in brain bleeds or technically termed 'subdural hamatoas'. Because elderly are predisposed to developing subdural hamatomas, staff in nursing homes and hospitals need to be tuned into the symptoms and when to seek additional medical care....

Bone Fractures In The Elderly Require Special Attention To Improve Recovery & Prevent Complications

A fracture is a broken bone that requires medical attention. Fifty percent of women over age fifty and twenty-five percent of men over age fifty will suffer from an age-related bone fracture sometime in their lifetime.

Elderly people are particularly susceptible to broken bones because as bones age, they lose the ability to resist the formation and growth of cracks that can lead to bone breaks because they cannot withstand as much pressure as younger bones. Unfortunately, as we age, our bodies ability to heal fractures is compromised....

Blood Thinning Medications, Such As Coumadin, Pose Substantial Danger To Nursing Home Patients Involved In Falls

Coumadin (generic name - Warfarin), is an anticoagulant (blood thinning medication) that is commonly used to help treat and prevent blood clots that could cause a heart attack, stroke, or pulmonary embolism. This prescription medication works by blocking the creation of certain clotting mechanisms, which prevents blood clots from forming. The goal of warfarin therapy is to decrease the clotting tendency of blood but not to prevent clotting altogether....

If your loved one suffered an injury related to a fall at a hospital or nursing home, the facility may be responsible for their injuries. You can always call our office to discuss the potential matter, free of charge. Toll-free across the country (888) 424-5757

Tags: Dropped Patients, Nursing Home Falls, Subdural Hematoma, brain bleed, coumadin, death, dropping patients, fractures, hospital falls, multiple falls, transferring patients

Posted on December 29, 2009 by Jonathan Rosenfeld

New York Jury Punishes Nursing Home Where Man Develops More Than 20 Bed Sores

It never fails to amaze me. Frequently, when I tell people about some of the cases I work on involving bed sores, I only to get a 'so what?' reaction from them. Are the people who surround me heartless? Maybe some of them (just joking, honey)? Nonetheless, the reality is that most people have no idea what a bed sore truly is or the catastrophic consequences that my arise after a person develops them.

When people actually see the gruesome photos of rotting flesh on a person's backside hear about the ongoing medical procedures that are necessary to heal the wound, they begin to understand the real impact of this medical condition.

Along these lines, an obviously compassionate jury in New York awarded the family of a man who succumbed to infection following the development of bed sores almost $19 million. The New York Post reported that the Brooklyn jury's award was comprised of $3.75 for the man's pain and suffering and a hefty $15 million in punitive damages.

According to the man's daughter's Margaret Whitehurst, the man rapidly declined during his nine month admission to Brooklyn Queens Nursing Home. "He walked in on two legs and a cane. He was 237 pounds. When we got him back, he was 148 pounds and had holes all over his body."

In addition to hearing testimony regarding severe bed sores (also called: decubitus ulcers, pressure ulcers or pressure sores), the jury also heard from an expert witness who testified about how the nursing home altered the man's medical records to make it appear as though he entered the facility with bed sores.

Not having any firsthand knowledge of whether the nursing home made any offer to settle the case prior to trial, I can only assume the offer was insignificant. I'll bet this facility is now re-thinking its decision to avoid responsibility for the death of this patient.

Read more about this nursing home lawsuit here.

Lawsuit Claims That Nursing Home's Negligence Resulted In Patient's Decubitus Ulcers

Lawsuit Alleges: One Week In The Nursing Home Results In Significant Deterioration Of Pressure Sores & Sepsis

Nursing Home Negligence Lawsuit Claims New York Facility Allowed Advanced Bed Sore To Develop In Rehab Patient

Big Verdicts Against Nursing Homes

What should I do if my family member develops bed sores during an admission to a nursing home?

Resource:

Nursing Home Injury Laws

Tags: Bed Sore Lawsuit, Litigation, brooklyn queens nursing home, death, infection, new york nursing home, nursing home injury, nursing home lawsuit, punitive damages

Posted on December 9, 2009 by Jonathan Rosenfeld

Lawsuit Alleges: One Week In The Nursing Home Results In Significant Deterioration Of Pressure Sores & Sepsis

After a one week stay at Caseyville Nursing and Rehabilitation, Theresa Mary Steiner's pressure sores significantly deteriorated to the point that she had become 'septic' according to a recently filed lawsuit. The lawsuit claims that on December 12, 2008 Ms. Steiner was admitted to the facility with stage II pressure sores on her buttocks and early stage pressure sores on her heels. Five days later, when Ms. Steiner was discharged, the pressure sores had advanced to stage IV and Ms. Steiner had become known as septic. As a result of the sepsis, Ms. Steiner died.

The lawsuit further alleges that Caseyville Nursing and Rehabilitation was negligent in the following ways:

Failing to screen Ms. Steiner on admission to the facility
Failed to have adequate staff to treat Ms. Steiner's wounds
Never developed a care plan for Ms. Steiner
Never notifying Ms. Steiner's physician as to her condition

My take:

With the obvious disclaimer (I don't know anything about the case other from what is in the newspaper), it would appear as though the Ms. Steiner's family may have a difficult time winning their case.

As the plaintiff in this matter, Ms. Steiner's family has the burden to prove their case. Given the fact that Ms. Steiner enter the nursing homes with clearly form pressure sores and the wounds worsened in such a brief period of time, perhaps the damages was done by the time she had entered the facility?

Sepsis and Pressure Sores

With open wounds from pressure sores, bacteria can easily enter the bloodstream and cause and infection in the body. When the infection progresses, it may cause sepsis. In order to make a diagnosis of sepsis, at least two of the following must occur: a heart rate above 90 beats per minute, hyperventilation (more than 20 breaths per minute) and white blood cell count below below 4000 cells/mm.

Symptoms of sepsis include:

Fever
Low body temperature (hypothermia)
Loss of ability to appreciate surroundings
Cool hands and feet
Anxiety
Shaking
Organ dysfunction

In order to provide patients with the best chance of recovery, facilities should identify and treat patients as quickly as feasible. If not treated properly, many patients with sepsis die shortly after the condition develops.

Resources:

Nursing home blamed for resident's sepsis St. Clair Record, December 7, 2009

Sepsis Nursing Homes Abuse Blog August 7, 2008

Nursing Home Injury Laws

Tags: Bed Sore Lawsuit, Bed Sores, Pressure Sores, Decubitus Ulcers & Pressure Ulcers, Sepsis, caseyville nursing and rehabilitation center, death, nursing home lawsuit, nursing home negligence, stage iv pressure sore

Posted on November 8, 2009 by Jonathan Rosenfeld

Legionnaires Outbreak Claims The Lives of At Least Two Residents Of Popular Chicagoland Retirement Community --The Park At Vernon Hills

Health offiicials believe the deaths of two residents of The Park of Vernon Hills are related to an outbreak of Legionnaires' disease. A third resident of The Park also was disagnosed with the bacterial disease and remains hospitalized.

According to Leslie Piotrowski, a spokeswoman for the Lake County Health Department, "At this point in time, it looks like this illness is contained. It's not contagious. But we have notified primary care providers throughout Lake County to be looking for people with pneumonia, just as a precaution."

About 260 people live at The Park of Vernon Hills, 145 N. Milwaukee Ave., Vernon Hills, IL. The Park of Vernon Hills is part of Horizon Bay Reitrement Living, a company that operates retirement communities throughout the country.

The source of this Legionnaires outbreak is under investigation. However, Legionnaires may occur in long-term care facilities due to contaminated water or heating equipment. Authorities suspect Legionnaires is contracted by inhaling airborne water droplets containing legionellae.

Legionnaires disease is particularly dangerous for the elderly because they are significantly more susceptible to complications from pneumonia and fever compared to the general population. Fatality rates attributed to legionnaires are believed to be between 5 and 50%.

If you or a family member live at The Park of Vernon Hills and have questions about you legal rights, we would honor the opportunity to speak with you. For more than 30 years Strellis & Field has championed the right of the elderly. (888) 424-5757

7 Cases Of Legionnaires Disease Attributed To Assisted Living Facility

Tags: Illinois Nursing Homes, chicago, death, horizon bay retirement living, legionnaires, legionnaires outbreak, retirement community, the park at vernon hills

Posted on November 5, 2009 by Jonathan Rosenfeld

Medications Such As: Visocol, OsmoPrep, or Fleet Phoso-Soda May Cause Kidney Failure Or Death In The Elderly

We've all gone through the unpleasant task of preparing for a colonoscopy. Drinking an unpleasant liquid or popping pills for the purpose of giving the doctor a better view of our colon's contents is.... anything but pleasant. Now, news has surfaced that, depending on the product you used to prepare for the procedure, the experience may not have been merely unpleasant-- but downright dangerous.

On December 11, 2008, the FDA ordered the makers of Visicol and OsmoPrep to put a black box warning on their products alerting consumers to the fact that the drugs can cause kidney damage or death. The warning came after the FDA confirmed more than 20 reports of a severe kidney injury called acute phosphate nephropathy after people consumed the products. Acute phosphate nephropathy may progress resulting in: kidney failure, long-term dialysis, the need for a kidney transplant or death.

On the heels of the FDA warnings regarding Visicol and OsmoPrep, C.B. Fleet Company, the manufacturer of Fleet Phoso-Soda and Fleet Phoso Soda EZ Prep Bowel Cleansing System, stopped selling the products over-the-counter without a prescription.

Visicol, OsmoPrep, and the Fleet Phoso-Soda products all contain high doses of sodium phosphate that works to clean out peoples bowels before medical procedures such as colonoscopies.

According to Dr. Joyce Korvick, deputy director of the FDA's Division of Gastroenterology Products at the Center for Drug Evaluation and Research, "Of the reported cases, three were biopsy-proven cases of acute phosphate nephropathy. The onset of the kidney injury in these cases varied, occurring n some within several hours of the use of the products and in other cases up to 21 days after use."

The FDA's warnings applicable to Visicol, OsmoPrep and Fleet Phoso-Soda products are particularly relevant to elderly people, because studies have repeatedly shown medical complications in the following demographics after they take oral sodium phosphate tablets:

People over 55-years-old
People suffering from dehydration
People suffering from kidney disease
People taking medications to control blood pressure (angiotensin converting enzyme inhibitors- to lower blood pressure or angiotensin receptor blockers- used to treat high blood pressure)
People taking anti-inflammatory medications (including many arthritis medications or ibuprofen)

Symptoms of Acute Phosphate Nephropathy:

People with acute phosphate nephropathy may or may not have physical symptoms of their illness. In the case of those with no physical symptoms, blood tests that measure kidney function can be used to confirm the diagnosis.

The majority of people with acute phosphate nephropathy have some physical manifestation of the disease including one or more of the following symptoms:

Reduced urine output
Rapid energy loss
Swelling in the legs and ankles

If you have a loved one who suffered acute phosphate nephropathy, kidney failure, the need for a kidney transplant, the need for long-term dialysis or died after taking a Fleet product, Visicol or OsmoPrep, you may have legal rights for damages against the manufacturer of the product. Additionally, if your family member was administered the drug at medical facility such as a nursing home or hospital, a cause of action may also exist against that facility.

At Strellis & Field, we pride ourselves on a hands-on approach when evaluating every case. We believe our rigorous case analysis with some of the leading medical professionals, helps secure the best results for our clients. As we have done for more than 30 years, we will evaluate your potential case at no expense for you. (888) 424-5757

Resource:

Oral Sodium Phosphate (OSP) Products for Bowel Cleansing (marketed as Visicol and OsmoPrep, and oral sodium phosphate products available without a prescription), FDA 12/11/2008

Tags: Dangerous Drugs, acute phosphate nephropathy, death, fleet lawsuit, fleet phoso soda, fleet phoso soda ez prep bowel cleansing system, kidney failure, osmoprep, sodium phosphate, visiscol

Posted on November 4, 2009 by Jonathan Rosenfeld

Bed Sore Problems Compounded: Amyloidosis

One of the nursing home negligence cases my office is currently investigating involves the death of a man related to complications related to amyloidosis. Turns out, the man was suffering from an advanced bed sore on his coccyx (also called pressure ulcers, pressure sores or decubitus ulcers) that had progressed so far that the bone in the area had become infected (osteomyelitis).

Elderly nursing home residents, especially those suffering from other diseases such as bed sores, have a higher risk of developing amyloidosis, a disease which can damage various tissues and organs. This can cause dangerous complications in residents who are already weak from advanced age or underlying disease.

Amyloidosis is a group of diseases caused by abnormal deposits of amyloid protein (usually produced by cells in bone marrow) in the body’s tissues and organs. The disease frequently affects the heart, kidneys, liver, spleen, nervous system, and gastrointestinal tract. The amyloid protein can deposit in a localized area (localized amyloidosis) or affect tissues throughout the body (systemic amyloidosis). Amyloidosis is diagnosed for testing for the amyloid protein in a biopsy of involved tissue.

Systemic amyloidosis is classified into three major types:

Primary (AL) amyloidosis
Secondary (AA) amyloidosis
Hereditary or Familial (ATTR) amyloidosis

Primary amyloidosis, the most common form of amyloidosis, occurs when a plasma cell in the bone marrow spontaneously overproduces a particular protein portion of an antibody. AL can affect many areas (heart, kidneys, liver, spleen, nerves, intestines, skin, tongue, blood vessels) and can occur with bone marrow cancer (bone marrow cancer), but is a disease entity of its own.

Secondary amyloidosis occurs as a result of another illness (multiple myeloma, chronic infections including tuberculosis and osteomyelitis, or chronic inflammatory diseases including rheumatoid arthritis and ankylosing spondylitis). It usually affects the kidneys, spleen, liver, and lymph nodes. Treatment for AA is usually treating the underlying illness.

Familial amyloidosis is a rare form of inherited amyloidosis that is an inherited autosomal dominant disease (meaning that the offspring of a person with the condition has a 50% chance of inheriting it). ATTR usually affects the liver, nerves, heart, and kidneys.

The signs and symptoms of amyloidosis depend on the tissues or organs affected. The symptoms result from abnormal functioning of the organs and tissues involved. They may include:

Swelling of ankles and legs
Numbness or tingling in hands or feet
Severe fatigue
Weakness
Significant weight loss
Loss of appetite
Shortness of breath
Irregular heartbeat
Diarrhea or constipation
Protein in urine
Feeling full quickly
Enlarged tongue
Difficulty swallowing
Swelling
Skin changes (thickening or easy bruising)
Purplish patches around the eyes

Risk factors for amyloidosis including:

Age – older than 65
Other diseases – having chronic infections or inflammatory disease or osteomyelitis
Family history – history of amyloidosis
Kidney dialysis – large, abnormal proteins can build up in the blood

The severity of the disease depends on which organs and tissues are affected. The disease can result in dangerous complications including kidney damage, heart damage, and nervous system damage. Kidney damage can result when amyloidosis affects the kidneys. Kidney problems frequently translate to damage with the bodied blood filtering system, allowing protein to leak from the blood into the urine. This may result in kidney failure.

Heart damage can also occur when amyloidosis affects the heart. This reduces the heart’s ability to fill with blood between heartbeats, meaning less blood is pumped with each beat. Nervous system damage can also occur when amyloid protein deposits affect the nerves. This can result in numbness, tingling, or difficulty controlling blood pressure.

There is no cure for amyloidosis, but treatment may help manage the signs and symptoms of the disease, limit further production of amyloid protein, and treat any underlying disease. Several treatments of primary amyloidosis are being studied including medicine and peripheral blood stem cell transplantation.

Nursing home residents suffering from painful pressure sores are at an increased risk for amyloidosis. Should a pressure sore patient develop amyloidosis, they run the risk of organ tissue damage and increased risk of amyloid protein deposits. Also, paraplegic patients suffering from sepsis as a result of pressure sores also face complications stemming from amyloidosis.

Sources:

Mayo Clinic: Amyloidosis

Boston University: Amyloid Treatment and Research Program

Amyloidosis Foundation

Pressure sores: aetiology, treatment and prevention (Colin Torrance)

Bed Sore FAQ

Bedsores: Are You At Risk?

In For Rehab. Out With Bedsores.

"The Nursing Home Says My Dad's Bedsores Were Unpreventable..."

Tags: Bed Sores, Pressure Sores, Decubitus Ulcers & Pressure Ulcers, Sepsis, amyloidosis, bedsores, death, infection, nursing home negligence, osteomyelitis

Posted on November 3, 2009 by Jonathan Rosenfeld

7 Cases Of Legionnaires Disease Attributed To Assisted Living Facility

Seven cases of Legionnaires' Disease have been reported at an assisted living facility in Waverly, Maryland. According to the Baltimore City Health Department, all the people were living at Stadium Place Apartments before they were diagnosed with the disease. So far, the disease has claimed the life of one of the residents.

What is Legionnaires Disease?

Legionnaires disease is an infectious disease caused by the Legionella bacteria. There are two types of Legionnaires disease: Legion fever (where people generally develop pneumonia) and Pontiac Fever (symptoms similar to the flu).

Legionnaires disease got its name when a group from the American Legion conference all developed pneumonia. When scientists analyzed the group, they noticed that they all had the same bacterium called Legionella.

Although Legionnaires' disease not contagious, outbreaks may occur in long-term care facilities due to contaminated water or heating equipment. Most authorities believe Legionnaires is contracted by inhaling airborne water droplets containing legionellae. Some authorities also believe that Legionnaires may be acquired by drinking contaminated water or using contaminated water to clean wounds.

Resource:

Legionnaires' Disease in Long-Term Care Facilities: Overview and Proposed Solutions, Meena H. Seenivasan, Victor L. Yu, Robert R. Muder (Journal of American Geriatrics Society, 53:875-880, 2005.

Tags: National Nursing Home Issues, assisted living facility, death, elderly, fatality rates, legion fever, legionnaires disease, maryland, pneumonia, pontiac fever

Posted on October 26, 2009 by Jonathan Rosenfeld

Ambulance Accident Claims The Life Of A Nursing Home Patient After Dialysis Treatment

I was recently emailed a news story involving a 78-year-old patient at Lakeshore Nursing Home in Nashville, TN who died when the ambulance in which she was a passenger, collided with a truck parked on the shoulder of the road. The victim identified as Sue Bly, was being transported back to her nursing home in the back of a Rural / Metro ambulance from dialysis treatment.

In addition to the death of Ms. Bly, the ambulance driver also died in the accident. Apparently, the ambulance driver drove into a Tennessee Department of Transportation (TDOT) truck that was parked on the should of the road.

As a personal injury lawyer, it would certainly appear that Ms. Bly's family is entitled to bring a wrongful death lawsuit against the ambulance company and/or the TDOT due to keeping an improper lookout or negligently parking the truck. If evidence proves that both parties were at fault, a jury could apportion damages based on the degree of culpability.

Ambulance Responsibility

Due to the fact that many nursing home patients suffer physical impairments, they are frequently reliant upon ambulance services to transport them to and from appointments outside of their facilities. These patients should expect that these services with provide them with safe transportation.

Many nursing homes have contracts with private ambulance services that may not adequately train their staff to assist with medical complications encountered by the elderly. In addition to inadequate training, some private ambulance services use off-duty public fire-fighters or paramedics. Many times these people are simply over-worked to safely do their jobs.

In addition to driving safely and avoiding accidents, ambulance companies my also be responsible for the following situations commonly involving nursing home patients:

Dropping patients
Improperly securing patients in beds and wheelchairs
Providing wrong medications
Sex / physical abuse
Failing to provide assistance during transfers to and from bed
Failing to monitor patients' vital signs
Failing to follow physician orders

If you believe that a family member or friend died or suffered an injury due to negligent care of an ambulance driver or attendant, we would be honored to discuss the matter with you. All attorney consultations are free kept in the strictest confidence. (888) 424-5757

Ambulance Stolen From Chicago Nursing Home Results In Multiple Injuries

Transportation In & Out Of Nursing Homes: Ambulance Responsibility.

HEALTH FACILITIES
(210 ILCS 50/) Emergency Medical Services (EMS) Systems Act.
(210 ILCS 50/1) (from Ch. 111 1/2, par. 5501)
Sec. 1. Short title.) This Act shall be known and may be cited as the "Emergency Medical Services (EMS) Systems Act".
(Source: P.A. 81‑1518; 88‑1.)

(210 ILCS 50/2) (from Ch. 111 1/2, par. 5502)
Sec. 2. The Legislature finds and declares that it is the intent of this legislation to provide the State with systems for emergency medical services by establishing within the State Department of Public Health a central authority responsible for the coordination and integration of all activities within the State concerning pre‑hospital and inter‑hospital emergency medical services, as well as non‑emergency medical transports, and the overall planning, evaluation, and regulation of pre‑hospital emergency medical services systems.
The provisions of this Act shall not be construed to deny emergency medical services to persons outside the boundaries of this State nor to limit, restrict, or prevent any cooperative agreement for the provision of emergency medical services between this State, or any of its political subdivisions, and any other State or its political subdivisions or a federal agency.
The provisions of this Act shall not be construed to regulate the emergency transportation of persons by friends or family members, in personal vehicles that are not ambulances, specialized emergency medical service vehicles, first response vehicles or medical carriers.
This legislation is intended to provide minimum standards for the statewide delivery of EMS services. It is recognized, however, that diversities exist between different areas of the State, based on geography, location of health care facilities, availability of personnel, and financial resources. The Legislature therefore intends that the implementation and enforcement of this Act by the Illinois Department of Public Health accommodate those varying needs and interests to the greatest extent possible without jeopardizing appropriate standards of medical care, through the Department's exercise of the waiver provision of this Act and its adoption of rules pursuant to this Act.
(Source: P.A. 88‑1; 89‑177, eff. 7‑19‑95.)

(210 ILCS 50/3) (from Ch. 111 1/2, par. 5503)
Sec. 3. Applicability.) This Act is not a limitation on the powers of home rule units.
(Source: P.A. 81‑1518; 88‑1.)

(210 ILCS 50/3.5)
Sec. 3.5. Definitions. As used in this Act:
"Department" means the Illinois Department of Public Health.
"Director" means the Director of the Illinois Department of Public Health.
"Emergency" means a medical condition of recent onset and severity that would lead a prudent layperson, possessing an average knowledge of medicine and health, to believe that urgent or unscheduled medical care is required.
"Health Care Facility" means a hospital, nursing home, physician's office or other fixed location at which medical and health care services are performed. It does not include "pre‑hospital emergency care settings" which utilize EMTs to render pre‑hospital emergency care prior to the arrival of a transport vehicle, as defined in this Act.
"Hospital" has the meaning ascribed to that term in the Hospital Licensing Act.
"Trauma" means any significant injury which involves single or multiple organ systems.
(Source: P.A. 89‑177, eff. 7‑19‑95.)

(210 ILCS 50/3.10)
Sec. 3.10. Scope of Services.
(a) "Advanced Life Support (ALS) Services" means an advanced level of pre‑hospital and inter‑hospital emergency care and non‑emergency medical services that includes basic life support care, cardiac monitoring, cardiac defibrillation, electrocardiography, intravenous therapy, administration of medications, drugs and solutions, use of adjunctive medical devices, trauma care, and other authorized techniques and procedures, as outlined in the Advanced Life Support national curriculum of the United States Department of Transportation and any modifications to that curriculum specified in rules adopted by the Department pursuant to this Act.
That care shall be initiated as authorized by the EMS Medical Director in a Department approved advanced life support EMS System, under the written or verbal direction of a physician licensed to practice medicine in all of its branches or under the verbal direction of an Emergency Communications Registered Nurse.
(b) "Intermediate Life Support (ILS) Services" means an intermediate level of pre‑hospital and inter‑hospital emergency care and non‑emergency medical services that includes basic life support care plus intravenous cannulation and fluid therapy, invasive airway management, trauma care, and other authorized techniques and procedures, as outlined in the Intermediate Life Support national curriculum of the United States Department of Transportation and any modifications to that curriculum specified in rules adopted by the Department pursuant to this Act.
That care shall be initiated as authorized by the EMS Medical Director in a Department approved intermediate or advanced life support EMS System, under the written or verbal direction of a physician licensed to practice medicine in all of its branches or under the verbal direction of an Emergency Communications Registered Nurse.
(c) "Basic Life Support (BLS) Services" means a basic level of pre‑hospital and inter‑hospital emergency care and non‑emergency medical services that includes airway management, cardiopulmonary resuscitation (CPR), control of shock and bleeding and splinting of fractures, as outlined in the Basic Life Support national curriculum of the United States Department of Transportation and any modifications to that curriculum specified in rules adopted by the Department pursuant to this Act.
That care shall be initiated, where authorized by the EMS Medical Director in a Department approved EMS System, under the written or verbal direction of a physician licensed to practice medicine in all of its branches or under the verbal direction of an Emergency Communications Registered Nurse.
(d) "First Response Services" means a preliminary level of pre‑hospital emergency care that includes cardiopulmonary resuscitation (CPR), monitoring vital signs and control of bleeding, as outlined in the First Responder curriculum of the United States Department of Transportation and any modifications to that curriculum specified in rules adopted by the Department pursuant to this Act.
(e) "Pre‑hospital care" means those emergency medical services rendered to emergency patients for analytic, resuscitative, stabilizing, or preventive purposes, precedent to and during transportation of such patients to hospitals.
(f) "Inter‑hospital care" means those emergency medical services rendered to emergency patients for analytic, resuscitative, stabilizing, or preventive purposes, during transportation of such patients from one hospital to another hospital.
(g) "Non‑emergency medical services" means medical care or monitoring rendered to patients whose conditions do not meet this Act's definition of emergency, before or during transportation of such patients to or from health care facilities visited for the purpose of obtaining medical or health care services which are not emergency in nature, using a vehicle regulated by this Act.
(h) The provisions of this Act shall not apply to the use of an ambulance or SEMSV, unless and until emergency or non‑emergency medical services are needed during the use of the ambulance or SEMSV.
(Source: P.A. 94‑568, eff. 1‑1‑06.)

(210 ILCS 50/3.15)
Sec. 3.15. Emergency Medical Services (EMS) Regions. Beginning September 1, 1995, the Department shall designate Emergency Medical Services (EMS) Regions within the State, consisting of specific geographic areas encompassing EMS Systems and trauma centers, in which emergency medical services, trauma services, and non‑emergency medical services are coordinated under an EMS Region Plan.
In designating EMS Regions, the Department shall take into consideration, but not be limited to, the location of existing EMS Systems, Trauma Regions and trauma centers, existing patterns of inter‑System transports, population locations and density, transportation modalities, and geographical distance from available trauma and emergency department care.
Use of the term Trauma Region to identify a specific geographic area shall be discontinued upon designation of areas as EMS Regions.
(Source: P.A. 89‑177, eff. 7‑19‑95.)

(210 ILCS 50/3.20)
Sec. 3.20. Emergency Medical Services (EMS) Systems.
(a) "Emergency Medical Services (EMS) System" means an organization of hospitals, vehicle service providers and personnel approved by the Department in a specific geographic area, which coordinates and provides pre‑hospital and inter‑hospital emergency care and non‑emergency medical transports at a BLS, ILS and/or ALS level pursuant to a System program plan submitted to and approved by the Department, and pursuant to the EMS Region Plan adopted for the EMS Region in which the System is located.
(b) One hospital in each System program plan must be designated as the Resource Hospital. All other hospitals which are located within the geographic boundaries of a System and which have standby, basic or comprehensive level emergency departments must function in that EMS System as either an Associate Hospital or Participating Hospital and follow all System policies specified in the System Program Plan, including but not limited to the replacement of drugs and equipment used by providers who have delivered patients to their emergency departments. All hospitals and vehicle service providers participating in an EMS System must specify their level of participation in the System Program Plan.
(c) The Department shall have the authority and responsibility to:
(1) Approve BLS, ILS and ALS level EMS Systems which

meet minimum standards and criteria established in rules adopted by the Department pursuant to this Act, including the submission of a Program Plan for Department approval. Beginning September 1, 1997, the Department shall approve the development of a new EMS System only when a local or regional need for establishing such System has been identified. This shall not be construed as a needs assessment for health planning or other purposes outside of this Act. Following Department approval, EMS Systems must be fully operational within one year from the date of approval.
(2) Monitor EMS Systems, based on minimum standards

for continuing operation as prescribed in rules adopted by the Department pursuant to this Act, which shall include requirements for submitting Program Plan amendments to the Department for approval.
(3) Renew EMS System approvals every 4 years, after

an inspection, based on compliance with the standards for continuing operation prescribed in rules adopted by the Department pursuant to this Act.
(4) Suspend, revoke, or refuse to renew approval of

any EMS System, after providing an opportunity for a hearing, when findings show that it does not meet the minimum standards for continuing operation as prescribed by the Department, or is found to be in violation of its previously approved Program Plan.
(5) Require each EMS System to adopt written

protocols for the bypassing of or diversion to any hospital, trauma center or regional trauma center, which provide that a person shall not be transported to a facility other than the nearest hospital, regional trauma center or trauma center unless the medical benefits to the patient reasonably expected from the provision of appropriate medical treatment at a more distant facility outweigh the increased risks to the patient from transport to the more distant facility, or the transport is in accordance with the System's protocols for patient choice or refusal.
(6) Require that the EMS Medical Director of an ILS

or ALS level EMS System be a physician licensed to practice medicine in all of its branches in Illinois, and certified by the American Board of Emergency Medicine or the American Board of Osteopathic Emergency Medicine, and that the EMS Medical Director of a BLS level EMS System be a physician licensed to practice medicine in all of its branches in Illinois, with regular and frequent involvement in pre‑hospital emergency medical services. In addition, all EMS Medical Directors shall:
(A) Have experience on an EMS vehicle at the

highest level available within the System, or make provision to gain such experience within 12 months prior to the date responsibility for the System is assumed or within 90 days after assuming the position;
(B) Be thoroughly knowledgeable of all skills

included in the scope of practices of all levels of EMS personnel within the System;
(C) Have or make provision to gain experience

instructing students at a level similar to that of the levels of EMS personnel within the System; and
(D) For ILS and ALS EMS Medical Directors,

successfully complete a Department‑approved EMS Medical Director's Course.
(7) Prescribe statewide EMS data elements to be

collected and documented by providers in all EMS Systems for all emergency and non‑emergency medical services, with a one‑year phase‑in for commencing collection of such data elements.
(8) Define, through rules adopted pursuant to this

Act, the terms "Resource Hospital", "Associate Hospital", "Participating Hospital", "Basic Emergency Department", "Standby Emergency Department", "Comprehensive Emergency Department", "EMS Medical Director", "EMS Administrative Director", and "EMS System Coordinator".
(A) Upon the effective date of this amendatory

Act of 1995, all existing Project Medical Directors shall be considered EMS Medical Directors, and all persons serving in such capacities on the effective date of this amendatory Act of 1995 shall be exempt from the requirements of paragraph (7) of this subsection;
(B) Upon the effective date of this amendatory

Act of 1995, all existing EMS System Project Directors shall be considered EMS Administrative Directors.
(9) Investigate the circumstances that caused a

hospital in an EMS system to go on bypass status to determine whether that hospital's decision to go on bypass status was reasonable. The Department may impose sanctions, as set forth in Section 3.140 of the Act, upon a Department determination that the hospital unreasonably went on bypass status in violation of the Act.
(10) Evaluate the capacity and performance of any

freestanding emergency center established under Section 32.5 of this Act in meeting emergency medical service needs of the public, including compliance with applicable emergency medical standards and assurance of the availability of and immediate access to the highest quality of medical care possible.
(Source: P.A. 95‑584, eff. 8‑31‑07.)

(210 ILCS 50/3.21)
Sec. 3.21. Hospital first responders. The General Assembly finds that in the event of terrorist acts, especially those involving the release of biological agents, bacteria, viruses, or other agents intended to cause illness or injury, hospitals serve as first responders in diagnosing and treating the victims of those acts. As first responders, hospitals are on the front lines of the State's emergency management efforts. Given the increased demands for equipment, materials, and training associated with their responsibility as first responders in the event of terrorist acts, hospitals would benefit from additional resources to enable them to be better prepared to protect and aid the residents of the State. In awarding funds to support disaster preparedness by first responders, the Department and any other State agencies shall take into account the role of hospitals in being prepared to respond to emergencies or disasters.
(Source: P.A. 93‑249, eff. 7‑22‑03.)

(210 ILCS 50/3.25)
Sec. 3.25. EMS Region Plan; Development.
(a) Within 6 months after designation of an EMS Region, an EMS Region Plan addressing at least the information prescribed in Section 3.30 shall be submitted to the Department for approval. The Plan shall be developed by the Region's EMS Medical Directors Committee with advice from the Regional EMS Advisory Committee; portions of the plan concerning trauma shall be developed jointly with the Region's Trauma Center Medical Directors or Trauma Center Medical Directors Committee, whichever is applicable, with advice from the Regional Trauma Advisory Committee, if such Advisory Committee has been established in the Region. Portions of the Plan concerning stroke shall be developed jointly with the Regional Stroke Advisory Subcommittee.
(1) A Region's EMS Medical Directors Committee shall

be comprised of the Region's EMS Medical Directors, along with the medical advisor to a fire department vehicle service provider. For regions which include a municipal fire department serving a population of over 2,000,000 people, that fire department's medical advisor shall serve on the Committee. For other regions, the fire department vehicle service providers shall select which medical advisor to serve on the Committee on an annual basis.
(2) A Region's Trauma Center Medical Directors

Committee shall be comprised of the Region's Trauma Center Medical Directors.
(b) A Region's Trauma Center Medical Directors may choose to participate in the development of the EMS Region Plan through membership on the Regional EMS Advisory Committee, rather than through a separate Trauma Center Medical Directors Committee. If that option is selected, the Region's Trauma Center Medical Director shall also determine whether a separate Regional Trauma Advisory Committee is necessary for the Region.
(c) In the event of disputes over content of the Plan between the Region's EMS Medical Directors Committee and the Region's Trauma Center Medical Directors or Trauma Center Medical Directors Committee, whichever is applicable, the Director of the Illinois Department of Public Health shall intervene through a mechanism established by the Department through rules adopted pursuant to this Act.
(d) "Regional EMS Advisory Committee" means a committee formed within an Emergency Medical Services (EMS) Region to advise the Region's EMS Medical Directors Committee and to select the Region's representative to the State Emergency Medical Services Advisory Council, consisting of at least the members of the Region's EMS Medical Directors Committee, the Chair of the Regional Trauma Committee, the EMS System Coordinators from each Resource Hospital within the Region, one administrative representative from an Associate Hospital within the Region, one administrative representative from a Participating Hospital within the Region, one administrative representative from the vehicle service provider which responds to the highest number of calls for emergency service within the Region, one administrative representative of a vehicle service provider from each System within the Region, one Emergency Medical Technician (EMT)/Pre‑Hospital RN from each level of EMT/Pre‑Hospital RN practicing within the Region, and one registered professional nurse currently practicing in an emergency department within the Region. Of the 2 administrative representatives of vehicle service providers, at least one shall be an administrative representative of a private vehicle service provider. The Department's Regional EMS Coordinator for each Region shall serve as a non‑voting member of that Region's EMS Advisory Committee.
Every 2 years, the members of the Region's EMS Medical Directors Committee shall rotate serving as Committee Chair, and select the Associate Hospital, Participating Hospital and vehicle service providers which shall send representatives to the Advisory Committee, and the EMTs/Pre‑Hospital RN and nurse who shall serve on the Advisory Committee.
(e) "Regional Trauma Advisory Committee" means a committee formed within an Emergency Medical Services (EMS) Region, to advise the Region's Trauma Center Medical Directors Committee, consisting of at least the Trauma Center Medical Directors and Trauma Coordinators from each Trauma Center within the Region, one EMS Medical Director from a resource hospital within the Region, one EMS System Coordinator from another resource hospital within the Region, one representative each from a public and private vehicle service provider which transports trauma patients within the Region, an administrative representative from each trauma center within the Region, one EMT representing the highest level of EMT practicing within the Region, one emergency physician and one Trauma Nurse Specialist (TNS) currently practicing in a trauma center. The Department's Regional EMS Coordinator for each Region shall serve as a non‑voting member of that Region's Trauma Advisory Committee.
Every 2 years, the members of the Trauma Center Medical Directors Committee shall rotate serving as Committee Chair, and select the vehicle service providers, EMT, emergency physician, EMS System Coordinator and TNS who shall serve on the Advisory Committee.
(Source: P.A. 96‑514, eff. 1‑1‑10.)

(210 ILCS 50/3.30)
Sec. 3.30. EMS Region Plan; Content.
(a) The EMS Medical Directors Committee shall address at least the following:
(1) Protocols for inter‑System/inter‑Region patient

transports, including identifying the conditions of emergency patients which may not be transported to the different levels of emergency department, based on their Department classifications and relevant Regional considerations (e.g. transport times and distances);
(2) Regional standing medical orders;
(3) Patient transfer patterns, including criteria

for determining whether a patient needs the specialized services of a trauma center, along with protocols for the bypassing of or diversion to any hospital, trauma center or regional trauma center which are consistent with individual System bypass or diversion protocols and protocols for patient choice or refusal;
(4) Protocols for resolving Regional or Inter‑System

conflict;
(5) An EMS disaster preparedness plan which includes

the actions and responsibilities of all EMS participants within the Region. Within 90 days of the effective date of this amendatory Act of 1996, an EMS System shall submit to the Department for review an internal disaster plan. At a minimum, the plan shall include contingency plans for the transfer of patients to other facilities if an evacuation of the hospital becomes necessary due to a catastrophe, including but not limited to, a power failure;
(6) Regional standardization of continuing education

requirements;
(7) Regional standardization of Do Not Resuscitate

(DNR) policies, and protocols for power of attorney for health care;
(8) Protocols for disbursement of Department grants;

and
(9) Protocols for the triage, treatment, and

transport of possible acute stroke patients.
(b) The Trauma Center Medical Directors or Trauma Center Medical Directors Committee shall address at least the following:
(1) The identification of Regional Trauma Centers;
(2) Protocols for inter‑System and inter‑Region

trauma patient transports, including identifying the conditions of emergency patients which may not be transported to the different levels of emergency department, based on their Department classifications and relevant Regional considerations (e.g. transport times and distances);
(3) Regional trauma standing medical orders;
(4) Trauma patient transfer patterns, including

criteria for determining whether a patient needs the specialized services of a trauma center, along with protocols for the bypassing of or diversion to any hospital, trauma center or regional trauma center which are consistent with individual System bypass or diversion protocols and protocols for patient choice or refusal;
(5) The identification of which types of patients

can be cared for by Level I and Level II Trauma Centers;
(6) Criteria for inter‑hospital transfer of trauma

patients;
(7) The treatment of trauma patients in each trauma

center within the Region;
(8) A program for conducting a quarterly conference

which shall include at a minimum a discussion of morbidity and mortality between all professional staff involved in the care of trauma patients;
(9) The establishment of a Regional trauma quality

assurance and improvement subcommittee, consisting of trauma surgeons, which shall perform periodic medical audits of each trauma center's trauma services, and forward tabulated data from such reviews to the Department; and
(10) The establishment, within 90 days of the

effective date of this amendatory Act of 1996, of an internal disaster plan, which shall include, at a minimum, contingency plans for the transfer of patients to other facilities if an evacuation of the hospital becomes necessary due to a catastrophe, including but not limited to, a power failure.
(c) The Region's EMS Medical Directors and Trauma Center Medical Directors Committees shall appoint any subcommittees which they deem necessary to address specific issues concerning Region activities.
(Source: P.A. 96‑514, eff. 1‑1‑10.)

(210 ILCS 50/3.35)
Sec. 3.35. Emergency Medical Services (EMS) Resource Hospital; Functions. The Resource Hospital of an EMS System shall:
(a) Prepare a Program Plan in accordance with the provisions of this Act and minimum standards and criteria established in rules adopted by the Department pursuant to this Act, and submit such Program Plan to the Department for approval.
(b) Appoint an EMS Medical Director, who will continually monitor and supervise the System and who will have the responsibility and authority for total management of the System as delegated by the EMS Resource Hospital.
The Program Plan shall require the EMS Medical Director to appoint an alternate EMS Medical Director and establish a written protocol addressing the functions to be carried out in his or her absence.
(c) Appoint an EMS System Coordinator and EMS Administrative Director in consultation with the EMS Medical Director and in accordance with rules adopted by the Department pursuant to this Act.
(d) Identify potential EMS System participants and obtain commitments from them for the provision of services.
(e) Educate or coordinate the education of EMT personnel in accordance with the requirements of this Act, rules adopted by the Department pursuant to this Act, and the EMS System Program Plan.
(f) Notify the Department of EMT provider personnel who have successfully completed requirements for licensure testing and relicensure by the Department, except that an ILS or ALS level System may require its EMT‑B personnel to apply directly to the Department for determination of successful completion of relicensure requirements.
(g) Educate or coordinate the education of Emergency Medical Dispatcher candidates, in accordance with the requirements of this Act, rules adopted by the Department pursuant to this Act, and the EMS System Program Plan.
(h) Establish or approve protocols for prearrival medical instructions to callers by System Emergency Medical Dispatchers who provide such instructions.
(i) Educate or coordinate the education of Pre‑Hospital RN and ECRN candidates, in accordance with the requirements of this Act, rules adopted by the Department pursuant to this Act, and the EMS System Program Plan.
(j) Approve Pre‑Hospital RN and ECRN candidates to practice within the System, and reapprove Pre‑Hospital RNs and ECRNs every 4 years in accordance with the requirements of the Department and the System Program Plan.
(k) Establish protocols for the use of Pre‑Hospital RNs within the System.
(l) Establish protocols for utilizing ECRNs and physicians licensed to practice medicine in all of its branches to monitor telecommunications from, and give voice orders to, EMS personnel, under the authority of the EMS Medical Director.
(m) Monitor emergency and non‑emergency medical transports within the System, in accordance with rules adopted by the Department pursuant to this Act.
(n) Utilize levels of personnel required by the Department to provide emergency care to the sick and injured at the scene of an emergency, during transport to a hospital or during inter‑hospital transport and within the hospital emergency department until the responsibility for the care of the patient is assumed by the medical personnel of a hospital emergency department or other facility within the hospital to which the patient is first delivered by System personnel.
(o) Utilize levels of personnel required by the Department to provide non‑emergency medical services during transport to a health care facility and within the health care facility until the responsibility for the care of the patient is assumed by the medical personnel of the health care facility to which the patient is delivered by System personnel.
(p) Establish and implement a program for System participant information and education, in accordance with rules adopted by the Department pursuant to this Act.
(q) Establish and implement a program for public information and education, in accordance with rules adopted by the Department pursuant to this Act.
(r) Operate in compliance with the EMS Region Plan.
(Source: P.A. 89‑177, eff. 7‑19‑95.)

(210 ILCS 50/3.40)
Sec. 3.40. EMS System Participation Suspensions and Due Process.
(a) An EMS Medical Director may suspend from participation within the System any individual, individual provider or other participant considered not to be meeting the requirements of the Program Plan of that approved EMS System.
(b) Prior to suspending an EMT or other provider, an EMS Medical Director shall provide the EMT or provider with the opportunity for a hearing before the local System review board in accordance with subsection (f) and the rules promulgated by the Department.
(1) If the local System review board affirms or

modifies the EMS Medical Director's suspension order, the EMT or provider shall have the opportunity for a review of the local board's decision by the State EMS Disciplinary Review Board, pursuant to Section 3.45 of this Act.
(2) If the local System review board reverses or

modifies the EMS Medical Director's suspension order, the EMS Medical Director shall have the opportunity for a review of the local board's decision by the State EMS Disciplinary Review Board, pursuant to Section 3.45 of this Act.
(3) The suspension shall commence only upon the

occurrence of one of the following:
(A) the EMT or provider has waived the

opportunity for a hearing before the local System review board; or
(B) the suspension order has been affirmed or

modified by the local board and the EMT or provider has waived the opportunity for review by the State Board; or
(C) the suspension order has been affirmed or

modified by the local board, and the local board's decision has been affirmed or modified by the State Board.
(c) An EMS Medical Director may immediately suspend an EMT or other provider if he or she finds that the information in his or her possession indicates that the continuation in practice by an EMT or other provider would constitute an imminent danger to the public. The suspended EMT or other provider shall be issued an immediate verbal notification followed by a written suspension order to the EMT or other provider by the EMS Medical Director which states the length, terms and basis for the suspension.
(1) Within 24 hours following the commencement of

the suspension, the EMS Medical Director shall deliver to the Department, by messenger or telefax, a copy of the suspension order and copies of any written materials which relate to the EMS Medical Director's decision to suspend the EMT or provider.
(2) Within 24 hours following the commencement of

the suspension, the suspended EMT or provider may deliver to the Department, by messenger or telefax, a written response to the suspension order and copies of any written materials which the EMT or provider feels relate to that response.
(3) Within 24 hours following receipt of the EMS

Medical Director's suspension order or the EMT or provider's written response, whichever is later, the Director or the Director's designee shall determine whether the suspension should be stayed pending the EMT's or provider's opportunity for hearing or review in accordance with this Act, or whether the suspension should continue during the course of that hearing or review. The Director or the Director's designee shall issue this determination to the EMS Medical Director, who shall immediately notify the suspended EMT or provider. The suspension shall remain in effect during this period of review by the Director or the Director's designee.
(d) Upon issuance of a suspension order for reasons directly related to medical care, the EMS Medical Director shall also provide the EMT or provider with the opportunity for a hearing before the local System review board, in accordance with subsection (f) and the rules promulgated by the Department.
(1) If the local System review board affirms or

modifies the EMS Medical Director's suspension order, the EMT or provider shall have the opportunity for a review of the local board's decision by the State EMS Disciplinary Review Board, pursuant to Section 3.45 of this Act.
(2) If the local System review board reverses or

modifies the EMS Medical Director's suspension order, the EMS Medical Director shall have the opportunity for a review of the local board's decision by the State EMS Disciplinary Review Board, pursuant to Section 3.45 of this Act.
(3) The EMT or provider may elect to bypass the

local System review board and seek direct review of the EMS Medical Director's suspension order by the State EMS Disciplinary Review Board.
(e) The Resource Hospital shall designate a local System review board in accordance with the rules of the Department, for the purpose of providing a hearing to any individual or individual provider participating within the System who is suspended from participation by the EMS Medical Director. The EMS Medical Director shall arrange for a certified shorthand reporter to make a stenographic record of that hearing and thereafter prepare a transcript of the proceedings. The transcript, all documents or materials received as evidence during the hearing and the local System review board's written decision shall be retained in the custody of the EMS system. The System shall implement a decision of the local System review board unless that decision has been appealed to the State Emergency Medical Services Disciplinary Review Board in accordance with this Act and the rules of the Department.
(f) The Resource Hospital shall implement a decision of the State Emergency Medical Services Disciplinary Review Board which has been rendered in accordance with this Act and the rules of the Department.
(Source: P.A. 89‑177, eff. 7‑19‑95.)

(210 ILCS 50/3.45)
Sec. 3.45. State Emergency Medical Services Disciplinary Review Board.
(a) The Governor shall appoint a State Emergency Medical Services Disciplinary Review Board, composed of an EMS Medical Director, an EMS System Coordinator, an Emergency Medical Technician‑Paramedic (EMT‑P), an Emergency Medical Technician‑Basic (EMT‑B), and the following members, who shall only review cases in which a party is from the same professional category: a Pre‑Hospital RN, an ECRN, a Trauma Nurse Specialist, an Emergency Medical Technician‑Intermediate (EMT‑I), a representative from a private vehicle service provider, a representative from a public vehicle service provider, and an emergency physician who monitors telecommunications from and gives voice orders to EMS personnel. The Governor shall also appoint one alternate for each member of the Board, from the same professional category as the member of the Board.
(b) Of the members first appointed, 2 members shall be appointed for a term of one year, 2 members shall be appointed for a term of 2 years and the remaining members shall be appointed for a term of 3 years. The terms of subsequent appointments shall be 3 years. All appointees shall serve until their successors are appointed. The alternate members shall be appointed and serve in the same fashion as the members of the Board. If a member resigns his or her appointment, the corresponding alternate shall serve the remainder of that member's term until a subsequent member is appointed by the Governor.
(c) The function of the Board is to review and affirm, reverse or modify orders to suspend an EMT or other individual provider from participating within an EMS System.
(d) An individual, individual provider or other participant who received an immediate suspension from an EMS Medical Director may request the Board to reverse or modify the suspension order. If the suspension had been affirmed or modified by a local System review board, the suspended participant may request the Board to reverse or modify the local board's decision.
(e) An individual, individual provider or other participant who received a non‑immediate suspension order from an EMS Medical Director which was affirmed or modified by a local System review board may request the Board to reverse or modify the local board's decision.
(f) An EMS Medical Director whose suspension order was reversed or modified by a local System review board may request the Board to reverse or modify the local board's decision.
(g) The Board shall regularly meet on the first Tuesday of every month, unless no requests for review have been submitted. Additional meetings of the Board shall be scheduled as necessary to insure that a request for direct review of an immediate suspension order is scheduled within 14 days after the Department receives the request for review or as soon thereafter as a quorum is available. The Board shall meet in Springfield or Chicago, whichever location is closer to the majority of the members or alternates attending the meeting. The Department shall reimburse the members and alternates of the Board for reasonable travel expenses incurred in attending meetings of the Board.
(h) A request for review shall be submitted in writing to the Chief of the Department's Division of Emergency Medical Services and Highway Safety, within 10 days after receiving the local board's decision or the EMS Medical Director's suspension order, whichever is applicable, a copy of which shall be enclosed.
(i) At its regularly scheduled meetings, the Board shall review requests which have been received by the Department at least 10 working days prior to the Board's meeting date. Requests for review which are received less than 10 working days prior to a scheduled meeting shall be considered at the Board's next scheduled meeting, except that requests for direct review of an immediate suspension order may be scheduled up to 3 working days prior to the Board's meeting date.
(j) A quorum shall be required for the Board to meet, which shall consist of 3 members or alternates, including the EMS Medical Director or alternate and the member or alternate from the same professional category as the subject of the suspension order. At each meeting of the Board, the members or alternates present shall select a Chairperson to conduct the meeting.
(k) Deliberations for decisions of the State EMS Disciplinary Review Board shall be conducted in closed session. Department staff may attend for the purpose of providing clerical assistance, but no other persons may be in attendance except for the parties to the dispute being reviewed by the Board and their attorneys, unless by request of the Board.
(l) The Board shall review the transcript, evidence and written decision of the local review board or the written decision and supporting documentation of the EMS Medical Director, whichever is applicable, along with any additional written or verbal testimony or argument offered by the parties to the dispute.
(m) At the conclusion of its review, the Board shall issue its decision and the basis for its decision on a form provided by the Department, and shall submit to the Department its written decision together with the record of the local System review board. The Department shall promptly issue a copy of the Board's decision to all affected parties. The Board's decision shall be binding on all parties.
(Source: P.A. 89‑177, eff. 7‑19‑95; 90‑144, eff. 7‑23‑97.)

(210 ILCS 50/3.50)
Sec. 3.50. Emergency Medical Technician (EMT) Licensure.
(a) "Emergency Medical Technician‑Basic" or "EMT‑B" means a person who has successfully completed a course of instruction in basic life support as prescribed by the Department, is currently licensed by the Department in accordance with standards prescribed by this Act and rules adopted by the Department pursuant to this Act, and practices within an EMS System.
(b) "Emergency Medical Technician‑Intermediate" or "EMT‑I" means a person who has successfully completed a course of instruction in intermediate life support as prescribed by the Department, is currently licensed by the Department in accordance with standards prescribed by this Act and rules adopted by the Department pursuant to this Act, and practices within an Intermediate or Advanced Life Support EMS System.
(c) "Emergency Medical Technician‑Paramedic" or "EMT‑P" means a person who has successfully completed a course of instruction in advanced life support care as prescribed by the Department, is licensed by the Department in accordance with standards prescribed by this Act and rules adopted by the Department pursuant to this Act, and practices within an Advanced Life Support EMS System.
(d) The Department shall have the authority and responsibility to:
(1) Prescribe education and training requirements,

which includes training in the use of epinephrine, for all levels of EMT, based on the respective national curricula of the United States Department of Transportation and any modifications to such curricula specified by the Department through rules adopted pursuant to this Act.
(2) Prescribe licensure testing requirements for all

levels of EMT, which shall include a requirement that all phases of instruction, training, and field experience be completed before taking the EMT licensure examination. Candidates may elect to take the National Registry of Emergency Medical Technicians examination in lieu of the Department's examination, but are responsible for making their own arrangements for taking the National Registry examination.
(2.5) Review applications for EMT licensure from

honorably discharged members of the armed forces of the United States with military emergency medical training. Applications shall be filed with the Department within one year after military discharge and shall contain: (i) proof of successful completion of military emergency medical training; (ii) a detailed description of the emergency medical curriculum completed; and (iii) a detailed description of the applicant's clinical experience. The Department may request additional and clarifying information. The Department shall evaluate the application, including the applicant's training and experience, consistent with the standards set forth under subsections (a), (b), (c), and (d) of Section 3.10. If the application clearly demonstrates that the training and experience meets such standards, the Department shall offer the applicant the opportunity to successfully complete a Department‑approved EMT examination for which the applicant is qualified. Upon passage of an examination, the Department shall issue a license, which shall be subject to all provisions of this Act that are otherwise applicable to the class of EMT license issued.
(3) License individuals as an EMT‑B, EMT‑I, or EMT‑P

who have met the Department's education, training and testing requirements.
(4) Prescribe annual continuing education and

relicensure requirements for all levels of EMT.
(5) Relicense individuals as an EMT‑B, EMT‑I, or

EMT‑P every 4 years, based on their compliance with continuing education and relicensure requirements.
(6) Grant inactive status to any EMT who qualifies,

based on standards and procedures established by the Department in rules adopted pursuant to this Act.
(7) Charge each candidate for EMT a fee to be

submitted with an application for a licensure examination.
(8) Suspend, revoke, or refuse to renew the license

of an EMT, after an opportunity for a hearing, when findings show one or more of the following:
(A) The EMT has not met continuing education or

relicensure requirements as prescribed by the Department;
(B) The EMT has failed to maintain proficiency

in the level of skills for which he or she is licensed;
(C) The EMT, during the provision of medical

services, engaged in dishonorable, unethical or unprofessional conduct of a character likely to deceive, defraud or harm the public;
(D) The EMT has failed to maintain or has

violated standards of performance and conduct as prescribed by the Department in rules adopted pursuant to this Act or his or her EMS System's Program Plan;
(E) The EMT is physically impaired to the extent

that he or she cannot physically perform the skills and functions for which he or she is licensed, as verified by a physician, unless the person is on inactive status pursuant to Department regulations;
(F) The EMT is mentally impaired to the extent

that he or she cannot exercise the appropriate judgment, skill and safety for performing the functions for which he or she is licensed, as verified by a physician, unless the person is on inactive status pursuant to Department regulations; or
(G) The EMT has violated this Act or any rule

adopted by the Department pursuant to this Act.
The education requirements prescribed by the Department

under this subsection must allow for the suspension of those requirements in the case of a member of the armed services or reserve forces of the United States or a member of the Illinois National Guard who is on active duty pursuant to an executive order of the President of the United States, an act of the Congress of the United States, or an order of the Governor at the time that the member would otherwise be required to fulfill a particular education requirement. Such a person must fulfill the education requirement within 6 months after his or her release from active duty.
(e) In the event that any rule of the Department or an EMS Medical Director that requires testing for drug use as a condition for EMT licensure conflicts with or duplicates a provision of a collective bargaining agreement that requires testing for drug use, that rule shall not apply to any person covered by the collective bargaining agreement.
(Source: P.A. 96‑540, eff. 8‑17‑09.)

(210 ILCS 50/3.55)
Sec. 3.55. Scope of practice.
(a) Any person currently licensed as an EMT‑B, EMT‑I, or EMT‑P may perform emergency and non‑emergency medical services as defined in this Act, in accordance with his or her level of education, training and licensure, the standards of performance and conduct prescribed by the Department in rules adopted pursuant to this Act, and the requirements of the EMS System in which he or she practices, as contained in the approved Program Plan for that System.
(a‑5) A person currently approved as a First Responder or licensed as an EMT‑B, EMT‑I, or EMT‑P who has successfully completed a Department approved course in automated defibrillator operation and who is functioning within a Department approved EMS System may utilize such automated defibrillator according to the standards of performance and conduct prescribed by the Department in rules adopted pursuant to this Act and the requirements of the EMS System in which he or she practices, as contained in the approved Program Plan for that System.
(a‑7) A person currently licensed as an EMT‑B, EMT‑I, or EMT‑P who has successfully completed a Department approved course in the administration of epinephrine, shall be required to carry epinephrine with him or her as part of the EMT medical supplies whenever he or she is performing the duties of an emergency medical technician.
(b) A person currently licensed as an EMT‑B, EMT‑I, or EMT‑P may only practice as an EMT or utilize his or her EMT license in pre‑hospital or inter‑hospital emergency care settings or non‑emergency medical transport situations, under the written or verbal direction of the EMS Medical Director. For purposes of this Section, a "pre‑hospital emergency care setting" may include a location, that is not a health care facility, which utilizes EMTs to render pre‑hospital emergency care prior to the arrival of a transport vehicle. The location shall include communication equipment and all of the portable equipment and drugs appropriate for the EMT's level of care, as required by this Act, rules adopted by the Department pursuant to this Act, and the protocols of the EMS Systems, and shall operate only with the approval and under the direction of the EMS Medical Director.
This Section shall not prohibit an EMT‑B, EMT‑I, or EMT‑P from practicing within an emergency department or other health care setting for the purpose of receiving continuing education or training approved by the EMS Medical Director. This Section shall also not prohibit an EMT‑B, EMT‑I, or EMT‑P from seeking credentials other than his or her EMT license and utilizing such credentials to work in emergency departments or other health care settings under the jurisdiction of that employer.
(c) A person currently licensed as an EMT‑B, EMT‑I, or EMT‑P may honor Do Not Resuscitate (DNR) orders and powers of attorney for health care only in accordance with rules adopted by the Department pursuant to this Act and protocols of the EMS System in which he or she practices.
(d) A student enrolled in a Department approved emergency medical technician program, while fulfilling the clinical training and in‑field supervised experience requirements mandated for licensure or approval by the System and the Department, may perform prescribed procedures under the direct supervision of a physician licensed to practice medicine in all of its branches, a qualified registered professional nurse or a qualified EMT, only when authorized by the EMS Medical Director.
(Source: P.A. 92‑376, eff. 8‑15‑01.)

(210 ILCS 50/3.57)
Sec. 3.57. Physician do‑not‑resuscitate orders. The Department of Public Health Uniform DNR Advance Directive or a copy of that Advance Directive shall be honored under this Act.
(Source: P.A. 94‑865, eff. 6‑16‑06.)

(210 ILCS 50/3.60)
Sec. 3.60. First Responder.
(a) "First Responder" means a person who has successfully completed a course of instruction in emergency first response as prescribed by the Department, who provides first response services prior to the arrival of an ambulance or specialized emergency medical services vehicle, in accordance with the level of care established in the emergency first response course. A First Responder who provides such services as part of an EMS System response plan which utilizes First Responders as the personnel dispatched to the scene of an emergency to provide initial emergency medical care shall comply with the applicable sections of the Program Plan of that EMS System.
Persons who have already completed a course of instruction in emergency first response based on or equivalent to the national curriculum of the United States Department of Transportation, or as otherwise previously recognized by the Department, shall be considered First Responders on the effective date of this amendatory Act of 1995.
(b) The Department shall have the authority and responsibility to:
(1) Prescribe education requirements for the First

Responder, which meet or exceed the national curriculum of the United States Department of Transportation, through rules adopted pursuant to this Act.
(2) Prescribe a standard set of equipment for use

during first response services. An individual First Responder shall not be required to maintain his or her own set of such equipment, provided he or she has access to such equipment during a first response call.
(3) Require the First Responder to notify the

Department of any EMS System in which he or she participates as dispatched personnel as described in subsection (a).
(4) Require the First Responder to comply with the

applicable sections of the Program Plans for those Systems.
(5) Require the First Responder to keep the

Department currently informed as to who employs him or her and who supervises his or her activities as a First Responder.
(6) Establish a mechanism for phasing in the First

Responder requirements over a 5‑year period.
(Source: P.A. 89‑177, eff. 7‑19‑95.)

(210 ILCS 50/3.65)
Sec. 3.65. EMS Lead Instructor.
(a) "EMS Lead Instructor" means a person who has successfully completed a course of education as prescribed by the Department, and who is currently approved by the Department to coordinate or teach education, training and continuing education courses, in accordance with standards prescribed by this Act and rules adopted by the Department pursuant to this Act.
(b) The Department shall have the authority and responsibility to:
(1) Prescribe education requirements for EMS Lead

Instructor candidates through rules adopted pursuant to this Act.
(2) Prescribe testing requirements for EMS Lead

Instructor candidates through rules adopted pursuant to this Act.
(3) Charge each candidate for EMS Lead Instructor a

fee to be submitted with an application for an examination.
(4) Approve individuals as EMS Lead Instructors who

have met the Department's education and testing requirements.
(5) Require that all education, training and

continuing education courses for EMT‑B, EMT‑I, EMT‑P, Pre‑Hospital RN, ECRN, First Responder and Emergency Medical Dispatcher be coordinated by at least one approved EMS Lead Instructor. A program which includes education, training or continuing education for more than one type of personnel may use one EMS Lead Instructor to coordinate the program, and a single EMS Lead Instructor may simultaneously coordinate more than one program or course.
(6) Provide standards and procedures for awarding

EMS Lead Instructor approval to persons previously approved by the Department to coordinate such courses, based on qualifications prescribed by the Department through rules adopted pursuant to this Act.
(7) Suspend or revoke the approval of an EMS Lead

Instructor, after an opportunity for a hearing, when findings show one or more of the following:
(A) The EMS Lead Instructor has failed to

conduct a course in accordance with the curriculum prescribed by this Act and rules adopted by the Department pursuant to this Act; or
(B) The EMS Lead Instructor has failed to comply

with protocols prescribed by the Department through rules adopted pursuant to this Act.
(Source: P.A. 89‑177, eff. 7‑19‑95.)

(210 ILCS 50/3.70)
Sec. 3.70. Emergency Medical Dispatcher.
(a) "Emergency Medical Dispatcher" means a person who has successfully completed a training course in emergency medical dispatching meeting or exceeding the national curriculum of the United States Department of Transportation in accordance with rules adopted by the Department pursuant to this Act, who accepts calls from the public for emergency medical services and dispatches designated emergency medical services personnel and vehicles. The Emergency Medical Dispatcher must use the Department‑approved emergency medical dispatch priority reference system (EMDPRS) protocol selected for use by its agency and approved by its EMS medical director. This protocol must be used by an emergency medical dispatcher in an emergency medical dispatch agency to dispatch aid to medical emergencies which includes systematized caller interrogation questions; systematized prearrival support instructions; and systematized coding protocols that match the dispatcher's evaluation of the injury or illness severity with the vehicle response mode and vehicle response configuration and includes an appropriate training curriculum and testing process consistent with the specific EMDPRS protocol used by the emergency medical dispatch agency. Prearrival support instructions shall be provided in a non‑discriminatory manner and shall be provided in accordance with the EMDPRS established by the EMS medical director of the EMS system in which the EMD operates. If the dispatcher operates under the authority of an Emergency Telephone System Board established under the Emergency Telephone System Act, the protocols shall be established by such Board in consultation with the EMS Medical Director. Persons who have already completed a course of instruction in emergency medical dispatch based on, equivalent to or exceeding the national curriculum of the United States Department of Transportation, or as otherwise approved by the Department, shall be considered Emergency Medical Dispatchers on the effective date of this amendatory Act.
(b) The Department shall have the authority and responsibility to:
(1) Require certification and recertification of a

person who meets the training and other requirements as an emergency medical dispatcher pursuant to this Act.
(2) Require certification and recertification of a

person, organization, or government agency that operates an emergency medical dispatch agency that meets the minimum standards prescribed by the Department for an emergency medical dispatch agency pursuant to this Act.
(3) Prescribe minimum education and continuing

education requirements for the Emergency Medical Dispatcher, which meet the national curriculum of the United States Department of Transportation, through rules adopted pursuant to this Act.
(4) Require each EMS Medical Director to report to

the Department whenever an action has taken place that may require the revocation or suspension of a certificate issued by the Department.
(5) Require each EMD to provide prearrival

instructions in compliance with protocols selected and approved by the system's EMS medical director and approved by the Department.

(6) Require the Emergency Medical Dispatcher to keep

the Department currently informed as to the entity or agency that employs or supervises his activities as an Emergency Medical Dispatcher.
(7) Establish an annual recertification requirement

that requires at least 12 hours of medical dispatch‑specific continuing education each year.
(8) Approve all EMDPRS protocols used by emergency

medical dispatch agencies to assure compliance with national standards.
(9) Require that Department‑approved emergency

medical dispatch training programs are conducted in accordance with national standards.
(10) Require that the emergency medical dispatch

agency be operated in accordance with national standards, including, but not limited to, (i) the use on every request for medical assistance of an emergency medical dispatch priority reference system (EMDPRS) in accordance with Department‑approved policies and procedures and (ii) under the approval and supervision of the EMS medical director, the establishment of a continuous quality improvement program.
(11) Require that a person may not represent himself

or herself, nor may an agency or business represent an agent or employee of that agency or business, as an emergency medical dispatcher unless certified by the Department as an emergency medical dispatcher.
(12) Require that a person, organization, or

government agency not represent itself as an emergency medical dispatch agency unless the person, organization, or government agency is certified by the Department as an emergency medical dispatch agency.
(13) Require that a person, organization, or

government agency may not offer or conduct a training course that is represented as a course for an emergency medical dispatcher unless the person, organization, or agency is approved by the Department to offer or conduct that course.
(14) Require that Department‑approved emergency

medical dispatcher training programs are conducted by instructors licensed by the Department who:
(i) are, at a minimum, certified as emergency

medical dispatchers;
(ii) have completed a Department‑approved course

on methods of instruction;
(iii) have previous experience in a medical

dispatch agency; and
(iv) have demonstrated experience as an EMS

instructor.
(15) Establish criteria for modifying or waiving

Emergency Medical Dispatcher requirements based on (i) the scope and frequency of dispatch activities and the dispatcher's access to training or (ii) whether the previously‑attended dispatcher training program merits automatic recertification for the dispatcher.
(Source: P.A. 92‑506, eff. 1‑1‑02.)

(210 ILCS 50/3.75)
Sec. 3.75. Trauma Nurse Specialist (TNS) Certification.
(a) "Trauma Nurse Specialist" or "TNS" means a registered professional nurse who has successfully completed education and testing requirements as prescribed by the Department, and is certified by the Department in accordance with rules adopted by the Department pursuant to this Act.
(b) The Department shall have the authority and responsibility to:
(1) Establish criteria for TNS training sites,

through rules adopted pursuant to this Act;
(2) Prescribe education and testing requirements for

TNS candidates, which shall include an opportunity for certification based on examination only, through rules adopted pursuant to this Act;
(3) Charge each candidate for TNS certification a

fee to be submitted with an application for a certification examination;
(4) Certify an individual as a TNS who has met the

Department's education and testing requirements;
(5) Prescribe recertification requirements through

rules adopted to this Act;
(6) Recertify an individual as a TNS every 4 years,

based on compliance with recertification requirements;
(7) Grant inactive status to any TNS who qualifies,

based on standards and procedures established by the Department in rules adopted pursuant to this Act; and
(8) Suspend, revoke or deny renewal of the

certification of a TNS, after an opportunity for hearing by the Department, if findings show that the TNS has failed to maintain proficiency in the level of skills for which the TNS is certified or has failed to comply with recertification requirements.
(Source: P.A. 89‑177, eff. 7‑19‑95.)

(210 ILCS 50/3.80)
Sec. 3.80. Pre‑Hospital RN and Emergency Communications Registered Nurse.
(a) Emergency Communications Registered Nurse or "ECRN" means a registered professional nurse licensed under the Nurse Practice Act who has successfully completed supplemental education in accordance with rules adopted by the Department, and who is approved by an EMS Medical Director to monitor telecommunications from and give voice orders to EMS System personnel, under the authority of the EMS Medical Director and in accordance with System protocols.
Upon the effective date of this amendatory Act of 1995, all existing Registered Professional Nurse/MICNs shall be considered ECRNs.
(b) "Pre‑Hospital Registered Nurse" or "Pre‑Hospital RN" means a registered professional nurse licensed under the Nurse Practice Act who has successfully completed supplemental education in accordance with rules adopted by the Department pursuant to this Act, and who is approved by an EMS Medical Director to practice within an EMS System as emergency medical services personnel for pre‑hospital and inter‑hospital emergency care and non‑emergency medical transports.
Upon the effective date of this amendatory Act of 1995, all existing Registered Professional Nurse/Field RNs shall be considered Pre‑Hospital RNs.
(c) The Department shall have the authority and responsibility to:
(1) Prescribe education and continuing education

requirements for Pre‑Hospital RN and ECRN candidates through rules adopted pursuant to this Act:
(A) Education for Pre‑Hospital RN shall include

extrication, telecommunications, and pre‑hospital cardiac and trauma care;
(B) Education for ECRN shall include

telecommunications, System standing medical orders and the procedures and protocols established by the EMS Medical Director;
(C) A Pre‑Hospital RN candidate who is

fulfilling clinical training and in‑field supervised experience requirements may perform prescribed procedures under the direct supervision of a physician licensed to practice medicine in all of its branches, a qualified registered professional nurse or a qualified EMT, only when authorized by the EMS Medical Director;
(D) An EMS Medical Director may impose in‑field

supervised field experience requirements on System ECRNs as part of their training or continuing education, in which they perform prescribed procedures under the direct supervision of a physician licensed to practice medicine in all of its branches, a qualified registered professional nurse or qualified EMT, only when authorized by the EMS Medical Director;
(2) Require EMS Medical Directors to reapprove

Pre‑Hospital RNs and ECRNs every 4 years, based on compliance with continuing education requirements prescribed by the Department through rules adopted pursuant to this Act;
(3) Allow EMS Medical Directors to grant inactive

status to any Pre‑Hospital RN or ECRN who qualifies, based on standards and procedures established by the Department in rules adopted pursuant to this Act;
(4) Require a Pre‑Hospital RN to honor Do Not

Resuscitate (DNR) orders and powers of attorney for health care only in accordance with rules adopted by the Department pursuant to this Act and protocols of the EMS System in which he or she practices.
(Source: P.A. 95‑639, eff. 10‑5‑07.)

(210 ILCS 50/3.85)
Sec. 3.85. Vehicle Service Providers.
(a) "Vehicle Service Provider" means an entity licensed by the Department to provide emergency or non‑emergency medical services in compliance with this Act, the rules promulgated by the Department pursuant to this Act, and an operational plan approved by its EMS System(s), utilizing at least ambulances or specialized emergency medical service vehicles (SEMSV).
(1) "Ambulance" means any publicly or privately

owned on‑road vehicle that is specifically designed, constructed or modified and equipped, and is intended to be used for, and is maintained or operated for the emergency transportation of persons who are sick, injured, wounded or otherwise incapacitated or helpless, or the non‑emergency medical transportation of persons who require the presence of medical personnel to monitor the individual's condition or medical apparatus being used on such individuals.
(2) "Specialized Emergency Medical Services Vehicle"

or "SEMSV" means a vehicle or conveyance, other than those owned or operated by the federal government, that is primarily intended for use in transporting the sick or injured by means of air, water, or ground transportation, that is not an ambulance as defined in this Act. The term includes watercraft, aircraft and special purpose ground transport vehicles or conveyances not intended for use on public roads.
(3) An ambulance or SEMSV may also be designated as

a Limited Operation Vehicle or Special‑Use Vehicle:
(A) "Limited Operation Vehicle" means a vehicle

which is licensed by the Department to provide basic, intermediate or advanced life support emergency or non‑emergency medical services that are exclusively limited to specific events or locales.
(B) "Special‑Use Vehicle" means any publicly or

privately owned vehicle that is specifically designed, constructed or modified and equipped, and is intended to be used for, and is maintained or operated solely for the emergency or non‑emergency transportation of a specific medical class or category of persons who are sick, injured, wounded or otherwise incapacitated or helpless (e.g. high‑risk obstetrical patients, neonatal patients).
(b) The Department shall have the authority and responsibility to:
(1) Require all Vehicle Service Providers, both

publicly and privately owned, to function within an EMS System;
(2) Require a Vehicle Service Provider utilizing

ambulances to have a primary affiliation with an EMS System within the EMS Region in which its Primary Service Area is located, which is the geographic areas in which the provider renders the majority of its emergency responses. This requirement shall not apply to Vehicle Service Providers which exclusively utilize Limited Operation Vehicles;
(3) Establish licensing standards and requirements

for Vehicle Service Providers, through rules adopted pursuant to this Act, including but not limited to:
(A) Vehicle design, specification, operation and

maintenance standards;
(B) Equipment requirements;
(C) Staffing requirements; and
(D) Annual license renewal.
(4) License all Vehicle Service Providers that have

met the Department's requirements for licensure, unless such Provider is owned or licensed by the federal government. All Provider licenses issued by the Department shall specify the level and type of each vehicle covered by the license (BLS, ILS, ALS, ambulance, SEMSV, limited operation vehicle, special use vehicle);
(5) Annually inspect all licensed Vehicle Service

Providers, and relicense such Providers that have met the Department's requirements for license renewal;
(6) Suspend, revoke, refuse to issue or refuse to

renew the license of any Vehicle Service Provider, or that portion of a license pertaining to a specific vehicle operated by the Provider, after an opportunity for a hearing, when findings show that the Provider or one or more of its vehicles has failed to comply with the standards and requirements of this Act or rules adopted by the Department pursuant to this Act;
(7) Issue an Emergency Suspension Order for any

Provider or vehicle licensed under this Act, when the Director or his designee has determined that an immediate and serious danger to the public health, safety and welfare exists. Suspension or revocation proceedings which offer an opportunity for hearing shall be promptly initiated after the Emergency Suspension Order has been issued;
(8) Exempt any licensed vehicle from subsequent

vehicle design standards or specifications required by the Department, as long as said vehicle is continuously in compliance with the vehicle design standards and specifications originally applicable to that vehicle, or until said vehicle's title of ownership is transferred;
(9) Exempt any vehicle (except an SEMSV) which was

being used as an ambulance on or before December 15, 1980, from vehicle design standards and specifications required by the Department, until said vehicle's title of ownership is transferred. Such vehicles shall not be exempt from all other licensing standards and requirements prescribed by the Department;
(10) Prohibit any Vehicle Service Provider from

advertising, identifying its vehicles, or disseminating information in a false or misleading manner concerning the Provider's type and level of vehicles, location, primary service area, response times, level of personnel, licensure status or System participation; and
(11) Charge each Vehicle Service Provider a fee, to

be submitted with each application for licensure and license renewal, which shall not exceed $25.00 per vehicle, up to $500.00 per Provider.
(Source: P.A. 89‑177, eff. 7‑19‑95.)

(210 ILCS 50/3.86)
Sec. 3.86. Stretcher van providers.
(a) In this Section, "stretcher van provider" means an entity licensed by the Department to provide non‑emergency transportation of passengers on a stretcher in compliance with this Act or the rules adopted by the Department pursuant to this Act, utilizing stretcher vans.
(b) The Department has the authority and responsibility to do the following:
(1) Require all stretcher van providers, both

publicly and privately owned, to be licensed by the Department.
(2) Establish licensing and safety standards and

requirements for stretcher van providers, through rules adopted pursuant to this Act, including but not limited to:
(A) Vehicle design, specification, operation, and

maintenance standards.
(B) Safety equipment requirements and standards.
(C) Staffing requirements.
(D) Annual license renewal.
(3) License all stretcher van providers that have met

the Department's requirements for licensure.
(4) Annually inspect all licensed stretcher van

providers, and relicense providers that have met the Department's requirements for license renewal.
(5) Suspend, revoke, refuse to issue, or refuse to

renew the license of any stretcher van provider, or that portion of a license pertaining to a specific vehicle operated by a provider, after an opportunity for a hearing, when findings show that the provider or one or more of its vehicles has failed to comply with the standards and requirements of this Act or the rules adopted by the Department pursuant to this Act.
(6) Issue an emergency suspension order for any

provider or vehicle licensed under this Act when the Director or his or her designee has determined that an immediate or serious danger to the public health, safety, and welfare exists. Suspension or revocation proceedings that offer an opportunity for a hearing shall be promptly initiated after the emergency suspension order has been issued.
(7) Prohibit any stretcher van provider from

advertising, identifying its vehicles, or disseminating information in a false or misleading manner concerning the provider's type and level of vehicles, location, response times, level of personnel, licensure status, or EMS System participation.
(8) Charge each stretcher van provider a fee, to be

submitted with each application for licensure and license renewal, which shall not exceed $25 per vehicle, up to $500 per provider.
(c) A stretcher van provider may provide transport of a passenger on a stretcher, provided the passenger meets all of the following requirements:
(1) He or she needs no medical equipment, except

self‑administered medications.
(2) He or she needs no medical monitoring or medical

observation.
(3) He or she needs routine transportation to or from

a medical appointment or service if the passenger is convalescent or otherwise bed‑confined and does not require medical monitoring, aid, care, or treatment during transport.
(d) A stretcher van provider may not transport a passenger who meets any of the following conditions:
(1) He or she is currently admitted to a hospital or

is being transported to a hospital for admission or emergency treatment.
(2) He or she is acutely ill, wounded, or medically

unstable as determined by a licensed physician.
(3) He or she is experiencing an emergency medical

condition, an acute medical condition, an exacerbation of a chronic medical condition, or a sudden illness or injury.
(4) He or she was administered a medication that

might prevent the passenger from caring for himself or herself.
(5) He or she was moved from one environment where

24‑hour medical monitoring or medical observation will take place by certified or licensed nursing personnel to another such environment. Such environments shall include, but not be limited to, hospitals licensed under the Hospital Licensing Act or operated under the University of Illinois Hospital Act, and nursing facilities licensed under the Nursing Home Care Act.
(e) The Stretcher Van Licensure Fund is created as a

special fund within the State treasury. All fees received by the Department in connection with the licensure of stretcher van providers under this Section shall be deposited into the fund. Moneys in the fund shall be subject to appropriation to the Department for use in implementing this Section.
(Source: P.A. 96‑702, eff. 8‑25‑09.)

(210 ILCS 50/3.90)
Sec. 3.90. Trauma Center Designations.
(a) "Trauma Center" means a hospital which: (1) within designated capabilities provides optimal care to trauma patients; (2) participates in an approved EMS System; and (3) is duly designated pursuant to the provisions of this Act. Level I Trauma Centers shall provide all essential services in‑house, 24 hours per day, in accordance with rules adopted by the Department pursuant to this Act. Level II Trauma Centers shall have some essential services available in‑house, 24 hours per day, and other essential services readily available, 24 hours per day, in accordance with rules adopted by the Department pursuant to this Act.
(b) The Department shall have the authority and responsibility to:
(1) Establish minimum standards for designation as a

Level I or Level II Trauma Center, consistent with Sections 22 and 23 of this Act, through rules adopted pursuant to this Act;
(2) Require hospitals applying for trauma center

designation to submit a plan for designation in a manner and form prescribed by the Department through rules adopted pursuant to this Act;
(3) Upon receipt of a completed plan for

designation, conduct a site visit to inspect the hospital for compliance with the Department's minimum standards. Such visit shall be conducted by specially qualified personnel with experience in the delivery of emergency medical and/or trauma care. A report of the inspection shall be provided to the Director within 30 days of the completion of the site visit. The report shall note compliance or lack of compliance with the individual standards for designation, but shall not offer a recommendation on granting or denying designation;
(4) Designate applicant hospitals as Level I or

Level II Trauma Centers which meet the minimum standards established by this Act and the Department. Beginning September 1, 1997 the Department shall designate a new trauma center only when a local or regional need for such trauma center has been identified. The Department shall request an assessment of local or regional need from the applicable EMS Region's Trauma Center Medical Directors Committee, with advice from the Regional Trauma Advisory Committee. This shall not be construed as a needs assessment for health planning or other purposes outside of this Act;
(5) Attempt to designate trauma centers in all areas

of the State. There shall be at least one Level I Trauma Center serving each EMS Region, unless waived by the Department. This subsection shall not be construed to require a Level I Trauma Center to be located in each EMS Region. Level I Trauma Centers shall serve as resources for the Level II Trauma Centers in the EMS Regions. The extent of such relationships shall be defined in the EMS Region Plan;
(6) Inspect designated trauma centers to assure

compliance with the provisions of this Act and the rules adopted pursuant to this Act. Information received by the Department through filed reports, inspection, or as otherwise authorized under this Act shall not be disclosed publicly in such a manner as to identify individuals or hospitals, except in proceedings involving the denial, suspension or revocation of a trauma center designation or imposition of a fine on a trauma center;
(7) Renew trauma center designations every 2 years,

after an on‑site inspection, based on compliance with renewal requirements and standards for continuing operation, as prescribed by the Department through rules adopted pursuant to this Act;
(8) Refuse to issue or renew a trauma center

designation, after providing an opportunity for a hearing, when findings show that it does not meet the standards and criteria prescribed by the Department;
(9) Review and determine whether a trauma center's

annual morbidity and mortality rates for trauma patients significantly exceed the State average for such rates, using a uniform recording methodology based on nationally recognized standards. Such determination shall be considered as a factor in any decision by the Department to renew or refuse to renew a trauma center designation under this Act, but shall not constitute the sole basis for refusing to renew a trauma center designation;
(10) Take the following action, as appropriate,

after determining that a trauma center is in violation of this Act or any rule adopted pursuant to this Act:
(A) If the Director determines that the

violation presents a substantial probability that death or serious physical harm will result and if the trauma center fails to eliminate the violation immediately or within a fixed period of time, not exceeding 10 days, as determined by the Director, the Director may immediately revoke the trauma center designation. The trauma center may appeal the revocation within 15 days after receiving the Director's revocation order, by requesting a hearing as provided by Section 29 of this Act. The Director shall notify the chair of the Region's Trauma Center Medical Directors Committee and EMS Medical Directors for appropriate EMS Systems of such trauma center designation revocation;
(B) If the Director determines that the

violation does not present a substantial probability that death or serious physical harm will result, the Director shall issue a notice of violation and request a plan of correction which shall be subject to the Department's approval. The trauma center shall have 10 days after receipt of the notice of violation in which to submit a plan of correction. The Department may extend this period for up to 30 days. The plan shall include a fixed time period not in excess of 90 days within which violations are to be corrected. The plan of correction and the status of its implementation by the trauma center shall be provided, as appropriate, to the EMS Medical Directors for appropriate EMS Systems. If the Department rejects a plan of correction, it shall send notice of the rejection and the reason for the rejection to the trauma center. The trauma center shall have 10 days after receipt of the notice of rejection in which to submit a modified plan. If the modified plan is not timely submitted, or if the modified plan is rejected, the trauma center shall follow an approved plan of correction imposed by the Department. If, after notice and opportunity for hearing, the Director determines that a trauma center has failed to comply with an approved plan of correction, the Director may revoke the trauma center designation. The trauma center shall have 15 days after receiving the Director's notice in which to request a hearing. Such hearing shall conform to the provisions of Section 30 of this Act;
(11) The Department may delegate authority to local

health departments in jurisdictions which include a substantial number of trauma centers. The delegated authority to those local health departments shall include, but is not limited to, the authority to designate trauma centers with final approval by the Department, maintain a regional data base with concomitant reporting of trauma registry data, and monitor, inspect and investigate trauma centers within their jurisdiction, in accordance with the requirements of this Act and the rules promulgated by the Department;
(A) The Department shall monitor the performance

of local health departments with authority delegated pursuant to this Section, based upon performance criteria established in rules promulgated by the Department;
(B) Delegated authority may be revoked for

substantial non‑compliance with the Department's rules. Notice of an intent to revoke shall be served upon the local health department by certified mail, stating the reasons for revocation and offering an opportunity for an administrative hearing to contest the proposed revocation. The request for a hearing must be received by the Department within 10 working days of the local health department's receipt of notification;
(C) The director of a local health department

may relinquish its delegated authority upon 60 days written notification to the Director of Public Health.
(Source: P.A. 89‑177, eff. 7‑19‑95.)

(210 ILCS 50/3.95)
Sec. 3.95. Level I Trauma Center Minimum Standards. The Department shall establish, through rules adopted pursuant to this Act, standards for Level I Trauma Centers which shall include, but need not be limited to:
(a) The designation by the trauma center of a Trauma Center Medical Director and specification of his qualifications;
(b) The types of surgical services the trauma center must have available for trauma patients, including but not limited to a twenty‑four hour in‑house surgeon with operating privileges and ancillary staff necessary for immediate surgical intervention;
(c) The types of nonsurgical services the trauma center must have available for trauma patients;
(d) The numbers and qualifications of emergency medical personnel;
(e) The types of equipment that must be available to trauma patients;
(f) Requiring the trauma center to be affiliated with an EMS System;
(g) Requiring the trauma center to have a communications system that is fully integrated with all Level II Trauma Centers and EMS Systems with which it is affiliated;
(h) The types of data the trauma center must collect and submit to the Department relating to the trauma services it provides. Such data may include information on post‑trauma care directly related to the initial traumatic injury provided to trauma patients until their discharge from the facility and information on discharge plans;
(i) Requiring the trauma center to have helicopter landing capabilities approved by appropriate State and federal authorities, if the trauma center is located within a municipality having a population of less than two million people; and
(j) Requiring written agreements with Level II Trauma Centers in the EMS Regions it serves, executed within a reasonable time designated by the Department.
(Source: P.A. 89‑177, eff. 7‑19‑95.)

(210 ILCS 50/3.100)
Sec. 3.100. Level II Trauma Center Minimum Standards. The Department shall establish, through rules adopted pursuant to this Act, standards for Level II Trauma Centers which shall include, but need not be limited to:
(a) The designation by the trauma center of a Trauma Center Medical Director and specification of his qualifications;
(b) The types of surgical services the trauma center must have available for trauma patients. The Department shall not require the availability of all surgical services required of Level I Trauma Centers;
(c) The types of nonsurgical services the trauma center must have available for trauma patients;
(d) The numbers and qualifications of emergency medical personnel, taking into consideration the more limited trauma services available in a Level II Trauma Center;
(e) The types of equipment that must be available for trauma patients;
(f) Requiring the trauma center to have a written agreement with a Level I Trauma Center serving the EMS Region outlining their respective responsibilities in providing trauma services, executed within a reasonable time designated by the Department, unless the requirement for a Level I Trauma Center to serve that EMS Region has been waived by the Department;
(g) Requiring the trauma center to be affiliated with an EMS System;
(h) Requiring the trauma center to have a communications system that is fully integrated with the Level I Trauma Centers and the EMS Systems with which it is affiliated;
(i) The types of data the trauma center must collect and submit to the Department relating to the trauma services it provides. Such data may include information on post‑trauma care directly related to the initial traumatic injury provided to trauma patients until their discharge from the facility and information on discharge plans;
(j) Requiring the trauma center to have helicopter landing capabilities approved by appropriate State and federal authorities, if the trauma center is located within a municipality having a population of less than two million people.
(Source: P.A. 89‑177, eff. 7‑19‑95.)

(210 ILCS 50/3.105)
Sec. 3.105. Trauma Center Misrepresentation. After the effective date of this amendatory Act of 1995, no facility shall use the phrase "trauma center" or words of similar meaning in relation to itself or hold itself out as a trauma center without first obtaining designation pursuant to this Act.
(Source: P.A. 89‑177, eff. 7‑19‑95.)

(210 ILCS 50/3.110)
Sec. 3.110. EMS system and trauma center confidentiality and immunity.
(a) All information contained in or relating to any medical audit performed of a trauma center's trauma services pursuant to this Act or by an EMS Medical Director or his designee of medical care rendered by System personnel, shall be afforded the same status as is provided information concerning medical studies in Article VIII, Part 21 of the Code of Civil Procedure. Disclosure of such information to the Department pursuant to this Act shall not be considered a violation of Article VIII, Part 21 of the Code of Civil Procedure.
(b) Hospitals, trauma centers and individuals that perform or participate in medical audits pursuant to this Act shall be immune from civil liability to the same extent as provided in Section 10.2 of the Hospital Licensing Act.
(c) All information relating to the State Emergency Medical Services Disciplinary Review Board or a local review board, except final decisions, shall be afforded the same status as is provided information concerning medical studies in Article VIII, Part 21 of the Code of Civil Procedure. Disclosure of such information to the Department pursuant to this Act shall not be considered a violation of Article VIII, Part 21 of the Code of Civil Procedure.
(Source: P.A. 92‑651, eff. 7‑11‑02.)

(210 ILCS 50/3.115)
Sec. 3.115. Pediatric Trauma. Upon the availability of federal funds for pediatric care demonstration projects, the Department shall:
(a) Convene a work group which will be charged with conducting a needs assessment of pediatric trauma care and with developing strategies to correct areas of need;
(b) Contract with the University of Illinois School of Public Health to develop a secondary prevention program for parents;
(c) Contract with an Illinois medical school to develop training and continuing medical education programs for physicians and nurses in treatment of pediatric trauma;
(d) Contract with an Illinois medical school to develop and test triage and field scoring for pediatric trauma if the needs assessment by the work group indicates that current scoring is inadequate;
(e) Support existing pediatric trauma programs and assist in establishing new pediatric trauma programs throughout the State;
(f) Provide grants to EMS systems for special pediatric equipment for prehospital care based on needs identified by the work group; and
(g) Provide grants to EMS systems and trauma centers for specialized training in pediatric trauma based on needs identified by the work group.
(Source: P.A. 89‑177, eff. 7‑19‑95.)

(210 ILCS 50/3.116)
Sec. 3.116. Hospital Stroke Care; definitions. As used in Sections 3.116 through 3.119, 3.130, 3.200, and 3.226 of this Act:
"Certification" or "certified" means certification, using evidence‑based standards, from a nationally‑recognized certifying body approved by the Department.
"Designation" or "designated" means the Department's recognition of a hospital as a Primary Stroke Center or Emergent Stroke Ready Hospital.
"Emergent stroke care" is emergency medical care that includes diagnosis and emergency medical treatment of acute stroke patients.
"Emergent Stroke Ready Hospital" means a hospital that has been designated by the Department as meeting the criteria for providing emergent stroke care.
"Primary Stroke Center" means a hospital that has been certified by a Department‑approved, nationally‑recognized certifying body and designated as such by the Department.
"Regional Stroke Advisory Subcommittee" means a subcommittee formed within each Regional EMS Advisory Committee to advise the Director and the Region's EMS Medical Directors Committee on the triage, treatment, and transport of possible acute stroke patients and to select the Region's representative to the State Stroke Advisory Subcommittee. The Regional Stroke Advisory Subcommittee shall consist of one representative from the EMS Medical Directors Committee; equal numbers of administrative representatives, or their designees, from Primary Stroke Centers within the Region, if any, and from hospitals that are capable of providing emergent stroke care that are not Primary Stroke Centers within the Region; one neurologist from a Primary Stroke Center in the Region, if any; one nurse practicing in a Primary Stroke Center and one nurse from a hospital capable of providing emergent stroke care that is not a Primary Stroke Center; one representative from both a public and a private vehicle service provider which transports possible acute stroke patients within the Region; the State designated regional EMS Coordinator; and in regions that serve a population of over 2,000,000, a fire chief, or designee, from the EMS Region.
"State Stroke Advisory Subcommittee" means a standing advisory body within the State Emergency Medical Services Advisory Council.
(Source: P.A. 96‑514, eff. 1‑1‑10.)

(210 ILCS 50/3.117)
Sec. 3.117. Hospital Designations.
(a) The Department shall attempt to designate Primary Stroke Centers in all areas of the State.
(1) The Department shall designate as many certified

Primary Stroke Centers as apply for that designation provided they are certified by a nationally‑recognized certifying body, approved by the Department, and certification criteria are consistent with the most current nationally‑recognized, evidence‑based stroke guidelines related to reducing the occurrence, disabilities, and death associated with stroke.
(2) A hospital certified as a Primary Stroke Center

by a nationally‑recognized certifying body approved by the Department, shall send a copy of the Certificate to the Department and shall be deemed, within 30 days of its receipt by the Department, to be a State‑designated Primary Stroke Center.
(3) With respect to a hospital that is a designated

Primary Stroke Center, the Department shall have the authority and responsibility to do the following:
(A) Suspend or revoke a hospital's Primary Stroke

Center designation upon receiving notice that the hospital's Primary Stroke Center certification has lapsed or has been revoked by the State recognized certifying body.
(B) Suspend a hospital's Primary Stroke Center

designation, in extreme circumstances where patients may be at risk for immediate harm or death, until such time as the certifying body investigates and makes a final determination regarding certification.
(C) Restore any previously suspended or revoked

Department designation upon notice to the Department that the certifying body has confirmed or restored the Primary Stroke Center certification of that previously designated hospital.
(D) Suspend a hospital's Primary Stroke Center

designation at the request of a hospital seeking to suspend its own Department designation.
(4) Primary Stroke Center designation shall remain

valid at all times while the hospital maintains its certification as a Primary Stroke Center, in good standing, with the certifying body. The duration of a Primary Stroke Center designation shall coincide with the duration of its Primary Stroke Center certification. Each designated Primary Stroke Center shall have its designation automatically renewed upon the Department's receipt of a copy of the accrediting body's certification renewal.
(5) A hospital that no longer meets

nationally‑recognized, evidence‑based standards for Primary Stroke Centers, or loses its Primary Stroke Center certification, shall immediately notify the Department and the Regional EMS Advisory Committee.
(b) The Department shall attempt to designate hospitals

as Emergent Stroke Ready Hospitals capable of providing emergent stroke care in all areas of the State.
(1) The Department shall designate as many

Emergent Stroke Ready Hospitals as apply for that designation as long as they meet the criteria in this Act.
(2) Hospitals may apply for, and receive, Emergent

Stroke Ready Hospital designation from the Department, provided that the hospital attests, on a form developed by the Department in consultation with the State Stroke Advisory Subcommittee, that it meets, and will continue to meet, the criteria for Emergent Stroke Ready Hospital designation.
(3) Hospitals seeking Emergent Stroke Ready Hospital

designation shall develop policies and procedures that consider nationally‑recognized, evidence‑based protocols for the provision of emergent stroke care. Hospital policies relating to emergent stroke care and stroke patient outcomes shall be reviewed at least annually, or more often as needed, by a hospital committee that oversees quality improvement. Adjustments shall be made as necessary to advance the quality of stroke care delivered. Criteria for Emergent Stroke Ready Hospital designation of hospitals shall be limited to the ability of a hospital to:
(A) create written acute care protocols related

to emergent stroke care;
(B) maintain a written transfer agreement with

one or more hospitals that have neurosurgical expertise;
(C) designate a director of stroke care, which

may be a clinical member of the hospital staff or the designee of the hospital administrator, to oversee the hospital's stroke care policies and procedures;
(D) administer thrombolytic therapy, or

subsequently developed medical therapies that meet nationally‑recognized, evidence‑based stroke guidelines;
(E) conduct brain image tests at all times;
(F) conduct blood coagulation studies at all

times; and
(G) maintain a log of stroke patients, which

shall be available for review upon request by the Department or any hospital that has a written transfer agreement with the Emergent Stroke Ready Hospital.
(4) With respect to Emergent Stroke Ready Hospital

designation, the Department shall have the authority and responsibility to do the following:
(A) Require hospitals applying for Emergent

Stroke Ready Hospital designation to attest, on a form developed by the Department in consultation with the State Stroke Advisory Subcommittee, that the hospital meets, and will continue to meet, the criteria for a Emergent Stroke Ready Hospital.
(B) Designate a hospital as an Emergent Stroke

Ready Hospital no more than 20 business days after receipt of an attestation that meets the requirements for attestation.
(C) Require annual written attestation, on a form

developed by the Department in consultation with the State Stroke Advisory Subcommittee, by Emergent Stroke Ready Hospitals to indicate compliance with Emergent Stroke Ready Hospital criteria, as described in this Section, and automatically renew Emergent Stroke Ready Hospital designation of the hospital.
(D) Issue an Emergency Suspension of Emergent

Stroke Ready Hospital designation when the Director, or his or her designee, has determined that the hospital no longer meets the Emergent Stroke Ready Hospital criteria and an immediate and serious danger to the public health, safety, and welfare exists. If the Emergent Stroke Ready Hospital fails to eliminate the violation immediately or within a fixed period of time, not exceeding 10 days, as determined by the Director, the Director may immediately revoke the Emergent Stroke Ready Hospital designation. The Emergent Stroke Ready Hospital may appeal the revocation within 15 days after receiving the Director's revocation order, by requesting an administrative hearing.
(E) After notice and an opportunity for an

administrative hearing, suspend, revoke, or refuse to renew an Emergent Stroke Ready Hospital designation, when the Department finds the hospital is not in substantial compliance with current Emergent Stroke Ready Hospital criteria.
(c) The Department shall consult with the State Stroke

Advisory Subcommittee for developing the designation and de‑designation processes for Primary Stroke Centers and Emergent Stroke Ready Hospitals.
(Source: P.A. 96‑514, eff. 1‑1‑10.)

(210 ILCS 50/3.117.5)
Sec. 3.117.5. Hospital Stroke Care; grants.
(a) In order to encourage the establishment and retention of Primary Stroke Centers and Emergent Stroke Ready Hospitals throughout the State, the Director may award, subject to appropriation, matching grants to hospitals to be used for the acquisition and maintenance of necessary infrastructure, including personnel, equipment, and pharmaceuticals for the diagnosis and treatment of acute stroke patients. Grants may be used to pay the fee for certifications by Department approved nationally‑recognized certifying bodies or to provide additional training for directors of stroke care or for hospital staff.
(b) The Director may award grant moneys to Primary Stroke Centers and Emergent Stroke Ready Hospitals for developing or enlarging stroke networks, for stroke education, and to enhance the ability of the EMS System to respond to possible acute stroke patients.
(c) A Primary Stroke Center, Emergent Stroke Ready Hospital, or hospital seeking certification as a Primary Stroke Center or designation as an Emergent Stroke Ready Hospital may apply to the Director for a matching grant in a manner and form specified by the Director and shall provide information as the Director deems necessary to determine whether the hospital is eligible for the grant.
(d) Matching grant awards shall be made to Primary Stroke Centers, Emergent Stroke Ready Hospitals, or hospitals seeking certification or designation as a Primary Stroke Center or designation as an Emergent Stroke Ready Hospital. The Department may consider prioritizing grant awards to hospitals in areas with the highest incidence of stroke, taking into account geographic diversity, where possible.
(Source: P.A. 96‑514, eff. 1‑1‑10.)

(210 ILCS 50/3.118)
Sec. 3.118. Reporting.
(a) The Director shall, not later than July 1, 2012, prepare and submit to the Governor and the General Assembly a report indicating the total number of hospitals that have applied for grants, the project for which the application was submitted, the number of those applicants that have been found eligible for the grants, the total number of grants awarded, the name and address of each grantee, and the amount of the award issued to each grantee.
(b) By July 1, 2010, the Director shall send the list of designated Primary Stroke Centers and designated Emergent Stroke Ready Hospitals to all Resource Hospital EMS Medical Directors in this State and shall post a list of designated Primary Stroke Centers and Emergent Stroke Ready Hospitals on the Department's website, which shall be continuously updated.
(c) The Department shall add the names of designated Primary Stroke Centers and Emergent Stroke Ready Hospitals to the website listing immediately upon designation and shall immediately remove the name when a hospital loses its designation after notice and a hearing.
(d) Stroke data collection systems and all stroke‑related data collected from hospitals shall comply with the following requirements:
(1) The confidentiality of patient records shall be

maintained in accordance with State and federal laws.
(2) Hospital proprietary information and the names of

any hospital administrator, health care professional, or employee shall not be subject to disclosure.
(3) Information submitted to the Department shall be

privileged and strictly confidential and shall be used only for the evaluation and improvement of hospital stroke care. Stroke data collected by the Department shall not be directly available to the public and shall not be subject to civil subpoena, nor discoverable or admissible in any civil, criminal, or administrative proceeding against a health care facility or health care professional.
(e) The Department may administer a data collection

system to collect data that is already reported by designated Primary Stroke Centers to their certifying body, to fulfill Primary Stroke Center certification requirements. Primary Stroke Centers may provide complete copies of the same reports that are submitted to their certifying body, to satisfy any Department reporting requirements. In the event the Department establishes reporting requirements for designated Primary Stroke Centers, the Department shall permit each designated Primary Stroke Center to capture information using existing electronic reporting tools used for certification purposes. Nothing in this Section shall be construed to empower the Department to specify the form of internal recordkeeping. Three years from the effective date of this amendatory Act of the 96th General Assembly, the Department may post stroke data submitted by Primary Stroke Centers on its website, subject to the following:
(1) Data collection and analytical methodologies

shall be used that meet accepted standards of validity and reliability before any information is made available to the public.
(2) The limitations of the data sources and analytic

methodologies used to develop comparative hospital information shall be clearly identified and acknowledged, including, but not limited to, the appropriate and inappropriate uses of the data.
(3) To the greatest extent possible, comparative

hospital information initiatives shall use standard‑based norms derived from widely accepted provider‑developed practice guidelines.
(4) Comparative hospital information and other

information that the Department has compiled regarding hospitals shall be shared with the hospitals under review prior to public dissemination of the information. Hospitals have 30 days to make corrections and to add helpful explanatory comments about the information before the publication.
(5) Comparisons among hospitals shall adjust for

patient case mix and other relevant risk factors and control for provider peer groups, when appropriate.
(6) Effective safeguards to protect against the

unauthorized use or disclosure of hospital information shall be developed and implemented.
(7) Effective safeguards to protect against the

dissemination of inconsistent, incomplete, invalid, inaccurate, or subjective hospital data shall be developed and implemented.
(8) The quality and accuracy of hospital information

reported under this Act and its data collection, analysis, and dissemination methodologies shall be evaluated regularly.
(9) None of the information the Department discloses

to the public under this Act may be used to establish a standard of care in a private civil action.
(10) The Department shall disclose information under

this Section in accordance with provisions for inspection and copying of public records required by the Freedom of Information Act, provided that the information satisfies the provisions of this Section.
(11) Notwithstanding any other provision of law,

under no circumstances shall the Department disclose information obtained from a hospital that is confidential under Part 21 of Article VIII of the Code of Civil Procedure.
(12) No hospital report or Department disclosure may

contain information identifying a patient, employee, or licensed professional.
(Source: P.A. 96‑514, eff. 1‑1‑10.)

(210 ILCS 50/3.118.5)
Sec. 3.118.5. State Stroke Advisory Subcommittee; triage and transport of possible acute stroke patients.
(a) There shall be established within the State Emergency Medical Services Advisory Council, or other statewide body responsible for emergency health care, a standing State Stroke Advisory Subcommittee, which shall serve as an advisory body to the Council and the Department on matters related to the triage, treatment, and transport of possible acute stroke patients. Membership on the Committee shall be as geographically diverse as possible and include one representative from each Regional Stroke Advisory Subcommittee, to be chosen by each Regional Stroke Advisory Subcommittee. The Director shall appoint additional members, as needed, to ensure there is adequate representation from the following:
(1) an EMS Medical Director;
(2) a hospital administrator, or designee, from a

Primary Stroke Center;
(3) a hospital administrator, or designee, from a

hospital capable of providing emergent stroke care that is not a Primary Stroke Center;
(4) a registered nurse from a Primary Stroke Center;
(5) a registered nurse from a hospital capable of

providing emergent stroke care that is not a Primary Stroke Center;
(6) a neurologist from a Primary Stroke Center;
(7) an emergency department physician from a

hospital, capable of providing emergent stroke care, that is not a Primary Stroke Center;
(8) an EMS Coordinator;
(9) an acute stroke patient advocate;
(10) a fire chief, or designee, from an EMS Region

that serves a population of over 2,000,000 people;
(11) a fire chief, or designee, from a rural EMS

Region;
(12) a representative from a private ambulance

provider; and
(13) a representative from the State Emergency

Medical Services Advisory Council.
(b) Of the members first appointed, 7 members shall be

appointed for a term of one year, 7 members shall be appointed for a term of 2 years, and the remaining members shall be appointed for a term of 3 years. The terms of subsequent appointees shall be 3 years.
(c) The State Stroke Advisory Subcommittee shall be

provided a 90‑day period in which to review and comment upon all rules proposed by the Department pursuant to this Act concerning stroke care, except for emergency rules adopted pursuant to Section 5‑45 of the Illinois Administrative Procedure Act. The 90‑day review and comment period shall commence prior to publication of the proposed rules and upon the Department's submission of the proposed rules to the individual Committee members, if the Committee is not meeting at the time the proposed rules are ready for Committee review.
(d) The State Stroke Advisory Subcommittee shall

develop and submit an evidence‑based statewide stroke assessment tool to clinically evaluate potential stroke patients to the Department for final approval. Upon approval, the Department shall disseminate the tool to all EMS Systems for adoption. The Director shall post the Department‑approved stroke assessment tool on the Department's website. The State Stroke Advisory Subcommittee shall review the Department‑approved stroke assessment tool at least annually to ensure its clinical relevancy and to make changes when clinically warranted.
(e) Nothing in this Section shall preclude the State

Stroke Advisory Subcommittee from reviewing and commenting on proposed rules which fall under the purview of the State Emergency Medical Services Advisory Council. Nothing in this Section shall preclude the Emergency Medical Services Advisory Council from reviewing and commenting on proposed rules which fall under the purview of the State Stroke Advisory Subcommittee.
(f) The Director shall coordinate with and assist the EMS

System Medical Directors and Regional Stroke Advisory Subcommittee within each EMS Region to establish protocols related to the assessment, treatment, and transport of possible acute stroke patients by licensed emergency medical services providers. These protocols shall include regional transport plans for the triage and transport of possible acute stroke patients to the most appropriate Primary Stroke Center or Emergent Stroke Ready Hospital, unless circumstances warrant otherwise.
(Source: P.A. 96‑514, eff. 1‑1‑10.)

(210 ILCS 50/3.119)
Sec. 3.119. Stroke Care; restricted practices. Sections in this Act pertaining to Primary Stroke Centers and Emergent Stroke Ready Hospitals are not medical practice guidelines and shall not be used to restrict the authority of a hospital to provide services for which it has received a license under State law.
(Source: P.A. 96‑514, eff. 1‑1‑10.)

(210 ILCS 50/3.120)
Sec. 3.120. Helicopter Plan. The Department shall cooperate with the Illinois Department of Transportation to develop a statewide use plan for helicopters operated by the Illinois Department of Transportation.
(Source: P.A. 89‑177, eff. 7‑19‑95.)

(210 ILCS 50/3.125)
Sec. 3.125. Complaint Investigations.
(a) The Department shall promptly investigate complaints which it receives concerning any person or entity which the Department licenses, certifies, approves, permits or designates pursuant to this Act.
(b) The Department shall notify an EMS Medical Director of any complaints it receives involving System personnel or participants.
(c) The Department shall conduct any inspections, interviews and reviews of records which it deems necessary in order to investigate complaints.
(d) All persons and entities which are licensed, certified, approved, permitted or designated pursuant to this Act shall fully cooperate with any Department complaint investigation, including providing patient medical records requested by the Department. Any patient medical record received or reviewed by the Department shall not be disclosed publicly in such a manner as to identify individual patients, without the consent of such patient or his or her legally authorized representative. Patient medical records may be disclosed to a party in administrative proceedings brought by the Department pursuant to this Act, but such patient's identity shall be masked before disclosure of such record during any public hearing unless otherwise authorized by the patient or his or her legally authorized representative.
(Source: P.A. 89‑177, eff. 7‑19‑95.)

(210 ILCS 50/3.130)
Sec. 3.130. Violations; Plans of Correction. Except for emergency suspension orders, or actions initiated pursuant to Sections 3.117(a), 3.117(b), and 3.90(b)(10) of this Act, prior to initiating an action for suspension, revocation, denial, nonrenewal, or imposition of a fine pursuant to this Act, the Department shall:
(a) Issue a Notice of Violation which specifies the Department's allegations of noncompliance and requests a plan of correction to be submitted within 10 days after receipt of the Notice of Violation;
(b) Review and approve or reject the plan of correction. If the Department rejects the plan of correction, it shall send notice of the rejection and the reason for the rejection. The party shall have 10 days after receipt of the notice of rejection in which to submit a modified plan;
(c) Impose a plan of correction if a modified plan is not submitted in a timely manner or if the modified plan is rejected by the Department;
(d) Issue a Notice of Intent to fine, suspend, revoke, nonrenew or deny if the party has failed to comply with the imposed plan of correction, and provide the party with an opportunity to request an administrative hearing. The Notice of Intent shall be effected by certified mail or by personal service, shall set forth the particular reasons for the proposed action, and shall provide the party with 15 days in which to request a hearing.
(Source: P.A. 96‑514, eff. 1‑1‑10.)

(210 ILCS 50/3.133)
Sec. 3.133. Suspension of license for failure to pay restitution. The Department, without further process or hearing, shall suspend the license or other authorization to practice of any person issued under this Act who has been certified by court order as not having paid restitution to a person under Section 8A‑3.5 of the Illinois Public Aid Code or under Section 46‑1 of the Criminal Code of 1961. A person whose license or other authorization to practice is suspended under this Section is prohibited from practicing until the restitution is made in full.
(Source: P.A. 94‑577, eff. 1‑1‑06.)

(210 ILCS 50/3.135)
Sec. 3.135. Administrative Hearings.
(a) Administrative hearings shall be conducted by the Director or by an individual designated by the Director as Administrative Law Judge to conduct the hearing. On the basis of any such hearing, or upon default of the Respondent, the Director shall issue a Final Order specifying his findings, conclusions and decision. A copy of the Final Order shall be sent to the Respondent by certified mail or served personally upon the Respondent.
(b) The procedure governing hearings authorized by this Act shall be in accordance with the Department's rules governing administrative hearings.
(Source: P.A. 89‑177, eff. 7‑19‑95.)

(210 ILCS 50/3.140)
Sec. 3.140. Violations; Fines.
(a) The Department shall have the authority to impose fines on any licensed vehicle service provider, designated trauma center, resource hospital, associate hospital, or participating hospital.
(b) The Department shall adopt rules pursuant to this Act which establish a system of fines related to the type and level of violation or repeat violation, including but not limited to:
(1) A fine not exceeding $10,000 for a violation

which created a condition or occurrence presenting a substantial probability that death or serious harm to an individual will or did result therefrom; and
(2) A fine not exceeding $5,000 for a violation

which creates or created a condition or occurrence which threatens the health, safety or welfare of an individual.
(c) A Notice of Intent to Impose Fine may be issued in conjunction with or in lieu of a Notice of Intent to Suspend, Revoke, Nonrenew or Deny, and shall conform to the requirements specified in Section 3.130(d) of this Act. All Hearings conducted pursuant to a Notice of Intent to Impose Fine shall conform to the requirements specified in Section 3.135 of this Act.
(d) All fines collected pursuant to this Section shall be deposited into the EMS Assistance Fund.
(Source: P.A. 89‑177, eff. 7‑19‑95.)

(210 ILCS 50/3.145)
Sec. 3.145. Administrative Review Law. All final administrative decisions of the Department hereunder shall be subject to judicial review pursuant to the provisions of the Administrative Review Law and the rules adopted pursuant thereto. The term "administrative decision" is defined as in Section 3‑101 of the Code of Civil Procedure.
Decisions of the State EMS Disciplinary Review Board are not final administrative decisions of the Department, and are not subject to judicial review under the Administrative Review Law.
(Source: P.A. 89‑177, eff. 7‑19‑95.)

(210 ILCS 50/3.150)
Sec. 3.150. Immunity from civil liability.
(a) Any person, agency or governmental body certified, licensed or authorized pursuant to this Act or rules thereunder, who in good faith provides emergency or non‑emergency medical services during a Department approved training course, in the normal course of conducting their duties, or in an emergency, shall not be civilly liable as a result of their acts or omissions in providing such services unless such acts or omissions, including the bypassing of nearby hospitals or medical facilities in accordance with the protocols developed pursuant to this Act, constitute willful and wanton misconduct.
(b) No person, including any private or governmental organization or institution that administers, sponsors, authorizes, supports, finances, educates or supervises the functions of emergency medical services personnel certified, licensed or authorized pursuant to this Act, including persons participating in a Department approved training program, shall be liable for any civil damages for any act or omission in connection with administration, sponsorship, authorization, support, finance, education or supervision of such emergency medical services personnel, where the act or omission occurs in connection with activities within the scope of this Act, unless the act or omission was the result of willful and wanton misconduct.
(c) Exemption from civil liability for emergency care is as provided in the Good Samaritan Act.
(d) No local agency, entity of State or local government, or other public or private organization, nor any officer, director, trustee, employee, consultant or agent of any such entity, which sponsors, authorizes, supports, finances, or supervises the training of persons in the use of cardiopulmonary resuscitation, automated external defibrillators, or first aid in a course which complies with generally recognized standards shall be liable for damages in any civil action based on the training of such persons unless an act or omission during the course of instruction constitutes willful and wanton misconduct.
(e) No person who is certified to teach the use of cardiopulmonary resuscitation, automated external defibrillators, or first aid and who teaches a course of instruction which complies with generally recognized standards for the use of cardiopulmonary resuscitation, automated external defibrillators, or first aid shall be liable for damages in any civil action based on the acts or omissions of a person who received such instruction, unless an act or omission during the course of such instruction constitutes willful and wanton misconduct.
(f) No member or alternate of the State Emergency Medical Services Disciplinary Review Board or a local System review board who in good faith exercises his responsibilities under this Act shall be liable for damages in any civil action based on such activities unless an act or omission during the course of such activities constitutes willful and wanton misconduct.
(g) No EMS Medical Director who in good faith exercises his responsibilities under this Act shall be liable for damages in any civil action based on such activities unless an act or omission during the course of such activities constitutes willful and wanton misconduct.
(h) Nothing in this Act shall be construed to create a cause of action or any civil liabilities.
(Source: P.A. 95‑447, eff. 8‑27‑07.)

(210 ILCS 50/3.155)
Sec. 3.155. General Provisions.
(a) Authority and responsibility for the EMS System shall be vested in the EMS Resource Hospital, through the EMS Medical Director or his designee.
(b) For an inter‑hospital emergency or non‑emergency medical transport, in which the physician from the sending hospital provides the EMS personnel with written medical orders, such written medical orders cannot exceed the scope of care which the EMS personnel are authorized to render pursuant to this Act.
(c) For an inter‑hospital emergency or non‑emergency medical transport of a patient who requires medical care beyond the scope of care which the EMS personnel are authorized to render pursuant to this Act, a qualified physician, nurse, perfusionist, or respiratory therapist familiar with the scope of care needed must accompany the patient and the transferring hospital and physician shall assume medical responsibility for that portion of the medical care.
(d) No emergency medical services vehicles or personnel from another State or nation may be utilized on a regular basis to pick up and transport patients within this State without first complying with this Act and all rules adopted by the Department pursuant to this Act.
(e) This Act shall not prevent emergency medical services vehicles or personnel from another State or nation from rendering requested assistance in this State in a disaster situation, or operating from a location outside the State and occasionally transporting patients into this State for needed medical care. Except as provided in Section 31 of this Act, this Act shall not provide immunity from liability for such activities.
(f) Except as provided in subsection (e) of this Section, no person or entity shall transport emergency or non‑emergency patients by ambulance, SEMSV, or medical carrier without first complying with the provisions of this Act and all rules adopted pursuant to this Act.
(g) Nothing in this Act or the rules adopted by the Department under this Act shall be construed to authorize any medical treatment to or transportation of any person who objects on religious grounds.
(h) Patients, individuals who accompany a patient, and emergency medical services personnel may not smoke while inside an ambulance or SEMSV. The Department of Public Health may impose a civil penalty on an individual who violates this subsection in the amount of $100.
(Source: P.A. 92‑376, eff. 8‑15‑01.)

(210 ILCS 50/3.160)
Sec. 3.160. Employer Responsibility.
(a) No employer shall employ or permit any employee to perform any services for which a license, certificate or other authorization is required by this Act, or by rules adopted pursuant to this Act, unless and until the person so employed possesses all licenses, certificates or authorizations that are so required.
(b) Any person or entity that employs or supervises a person's activities as a First Responder or Emergency Medical Dispatcher shall cooperate with the Department's efforts to monitor and enforce compliance by those individuals with the requirements of this Act.
(Source: P.A. 89‑177, eff. 7‑19‑95.)

(210 ILCS 50/3.165)
Sec. 3.165. Misrepresentation.
(a) No person shall hold himself or herself out to be or engage in the practice of an EMS Medical Director, EMS Administrative Director, EMS System Coordinator, EMT, Trauma Nurse Specialist, Pre‑Hospital RN, Emergency Communications Registered Nurse, EMS Lead Instructor, Emergency Medical Dispatcher or First Responder without being licensed, certified, approved or otherwise authorized pursuant to this Act.
(b) A hospital or other entity which employs or utilizes an EMT in a manner which is outside the scope of his or her EMT license shall not use the words "emergency medical technician", "EMT" or "paramedic" in that person's job description or title, or in any other manner hold that person out to be an emergency medical technician.
(c) No provider or participant within an EMS System shall hold itself out as providing a type or level of service that has not been approved by that System's EMS Medical Director.
(Source: P.A. 89‑177, eff. 7‑19‑95.)

(210 ILCS 50/3.170)
Sec. 3.170. Falsification of Documents. No person shall knowingly enter any false information on any application form, run sheet, record or other document required to be completed or submitted pursuant to this Act or any rule adopted pursuant to this Act, or knowingly submit any application form, run sheet, record or other document which contains false information.
(Source: P.A. 89‑177, eff. 7‑19‑95.)

(210 ILCS 50/3.175)
Sec. 3.175. Criminal Penalties. Any person who violates Sections 3.155(d) or (f), 3.160, 3.165 or 3.170 of this Act or any rule promulgated thereto, is guilty of a Class C misdemeanor.
(Source: P.A. 89‑177, eff. 7‑19‑95.)

(210 ILCS 50/3.180)
Sec. 3.180. Injunctions. Notwithstanding the existence or pursuit of any other remedy, the Director may, through the Attorney General, seek an injunction:
(a) To restrain or prevent any person or entity from functioning, practicing or operating without a license, certification, classification, approval, permit, designation or authorization required by this Act;
(b) To restrain or prevent any person, institution or governmental unit from representing itself to be a trauma center after the effective date of this amendatory Act of 1995 without designation as such pursuant to this Act;
(c) To restrain or prevent any hospital or other entity which employs or utilizes an EMT in a manner which is outside the scope of his EMT license from representing that person to be an EMT.
(Source: P.A. 89‑177, eff. 7‑19‑95.)

(210 ILCS 50/3.185)
Sec. 3.185. Waiver of Standards. In accordance with protocols and procedures which it established by rules adopted pursuant to this Act, the Department may grant a waiver to any provision of this Act or rule adopted pursuant to this Act for a specified period of time determined appropriate by the Department.
Any entity may apply in writing to the Department for a waiver to specific requirements or standards for which it considers compliance to be a hardship. The Department may grant a waiver on such applications when it can be demonstrated that there will be no reduction in standards of medical care as determined by the EMS Medical Director or the Department.
The Department shall establish a specific mechanism for granting hardship waivers to the Act's licensure fee requirements.
(Source: P.A. 89‑177, eff. 7‑19‑95.)

(210 ILCS 50/3.190)
Sec. 3.190. Emergency Department Classifications. The Department shall have the authority and responsibility to:
(a) Establish criteria for classifying the emergency departments of all hospitals within the State as Comprehensive, Basic, or Standby. In establishing such criteria, the Department may consult with the Illinois Hospital Licensing Board and incorporate by reference all or part of existing standards adopted as rules pursuant to the Hospital Licensing Act or Emergency Medical Treatment Act;
(b) Classify the emergency departments of all hospitals within the State in accordance with this Section;
(c) Annually publish, and distribute to all EMS Systems, a list reflecting the classification of all emergency departments.
(Source: P.A. 89‑177, eff. 7‑19‑95.)

(210 ILCS 50/3.195)
Sec. 3.195. Data Collection and Evaluation.
(a) The Department shall develop and administer an emergency medical services data collection system. Nothing in this Section shall be construed to empower the Department to specify the form of internal recordkeeping.
(b) The confidentiality of patient records shall be maintained in accordance with State and federal regulations on confidentiality of records.
(c) The Department shall develop parameters by which the availability and quality of emergency medical care can be evaluated to assure a reasonable standard of performance by individuals and organizations providing such services.
(d) EMS Medical Directors shall have the authority to require System participants to provide data to the System in addition to that required by the Department. Participants shall not be required to submit financial information that is proprietary in nature and unrelated to the scope or purposes of this Act.
(Source: P.A. 89‑177, eff. 7‑19‑95.)

(210 ILCS 50/3.200)
Sec. 3.200. State Emergency Medical Services Advisory Council.
(a) There shall be established within the Department of Public Health a State Emergency Medical Services Advisory Council, which shall serve as an advisory body to the Department on matters related to this Act.
(b) Membership of the Council shall include one representative from each EMS Region, to be appointed by each region's EMS Regional Advisory Committee. The Governor shall appoint additional members to the Council as necessary to insure that the Council includes one representative from each of the following categories:
(1) EMS Medical Director,
(2) Trauma Center Medical Director,
(3) Licensed, practicing physician with regular and

frequent involvement in the provision of emergency care,
(4) Licensed, practicing physician with special

expertise in the surgical care of the trauma patient,
(5) EMS System Coordinator,
(6) TNS,
(7) EMT‑P,
(8) EMT‑I,
(9) EMT‑B,
(10) Private vehicle service provider,
(11) Law enforcement officer,
(12) Chief of a public vehicle service provider,
(13) Statewide firefighters' union member affiliated

with a vehicle service provider,
(14) Administrative representative from a fire

department vehicle service provider in a municipality with a population of over 2 million people;
(15) Administrative representative from a Resource

Hospital or EMS System Administrative Director.
(c) Of the members first appointed, 5 members shall be appointed for a term of one year, 5 members shall be appointed for a term of 2 years, and the remaining members shall be appointed for a term of 3 years. The terms of subsequent appointees shall be 3 years. All appointees shall serve until their successors are appointed and qualified.
(d) The Council shall be provided a 90‑day period in which to review and comment, in consultation with the subcommittee to which the rules are relevant, upon all rules proposed by the Department pursuant to this Act, except for rules adopted pursuant to Section 3.190(a) of this Act, rules submitted to the State Trauma Advisory Council and emergency rules adopted pursuant to Section 5‑45 of the Illinois Administrative Procedure Act. The 90‑day review and comment period may commence upon the Department's submission of the proposed rules to the individual Council members, if the Council is not meeting at the time the proposed rules are ready for Council review. Any non‑emergency rules adopted prior to the Council's 90‑day review and comment period shall be null and void. If the Council fails to advise the Department within its 90‑day review and comment period, the rule shall be considered acted upon.
(e) Council members shall be reimbursed for reasonable travel expenses incurred during the performance of their duties under this Section.
(f) The Department shall provide administrative support to the Council for the preparation of the agenda and minutes for Council meetings and distribution of proposed rules to Council members.
(g) The Council shall act pursuant to bylaws which it adopts, which shall include the annual election of a Chair and Vice‑Chair.
(h) The Director or his designee shall be present at all Council meetings.
(i) Nothing in this Section shall preclude the Council from reviewing and commenting on proposed rules which fall under the purview of the State Trauma Advisory Council.
(Source: P.A. 96‑514, eff. 1‑1‑10.)

(210 ILCS 50/3.205)
Sec. 3.205. State Trauma Advisory Council.
(a) There shall be established within the Department of Public Health a State Trauma Advisory Council, which shall serve as an advisory body to the Department on matters related to trauma care and trauma centers.
(b) Membership of the Council shall include one representative from each Regional Trauma Advisory Committee, to be appointed by each Committee. The Governor shall appoint the following additional members:
(1) An EMS Medical Director,
(2) A trauma center medical director,
(3) A trauma surgeon,
(4) A trauma nurse coordinator,
(5) A representative from a private vehicle service

provider,
(6) A representative from a public vehicle service

provider,
(7) A member of the State EMS Advisory Council, and
(8) A neurosurgeon.
(c) Of the members first appointed, 5 members shall be appointed for a term of one year, 5 members shall be appointed for a term of 2 years, and the remaining members shall be appointed for a term of 3 years. The terms of subsequent appointees shall be 3 years. All appointees shall serve until their successors are appointed and qualified.
(d) The Council shall be provided a 90‑day period in which to review and comment upon all rules proposed by the Department pursuant to this Act concerning trauma care, except for emergency rules adopted pursuant to Section 5‑45 of the Illinois Administrative Procedure Act. The 90‑day review and comment period may commence upon the Department's submission of the proposed rules to the individual Council members, if the Council is not meeting at the time the proposed rules are ready for Council review. Any non‑emergency rules adopted prior to the Council's 90‑day review and comment period shall be null and void. If the Council fails to advise the Department within its 90‑day review and comment period, the rule shall be considered acted upon;
(e) Council members shall be reimbursed for reasonable travel expenses incurred during the performance of their duties under this Section.
(f) The Department shall provide administrative support to the Council for the preparation of the agenda and minutes for Council meetings and distribution of proposed rules to Council members.
(g) The Council shall act pursuant to bylaws which it adopts, which shall include the annual election of a Chair and Vice‑Chair.
(h) The Director or his designee shall be present at all Council meetings.
(i) Nothing in this Section shall preclude the Council from reviewing and commenting on proposed rules which fall under the purview of the State EMS Advisory Council.
(Source: P.A. 90‑655, eff. 7‑30‑98; 91‑743, eff. 6‑2‑00.)

(210 ILCS 50/3.210)
Sec. 3.210. EMS Medical Consultant. If the Chief of the Department's Division of Emergency Medical Services and Highway Safety is not a physician licensed to practice medicine in all of its branches, with extensive emergency medical services experience, and certified by the American Board of Emergency Medicine or the American Board of Osteopathic Emergency Medicine, then the Director shall appoint such a physician to serve as EMS Medical Consultant to the Division Chief.
(Source: P.A. 89‑177, eff. 7‑19‑95.)

(210 ILCS 50/3.215)
Sec. 3.215. Grants. The Department has the power to make grants to EMS Regions, for disbursement in accordance with protocols established in the EMS Region Plans, from moneys deposited into the EMS Assistance Fund and funds appropriated or otherwise made available to the Department, other than funds appropriated to the Illinois Department of Transportation for implementation of the Highway Safety Program.
(Source: P.A. 89‑177, eff. 7‑19‑95.)

(210 ILCS 50/3.220)
Sec. 3.220. EMS Assistance Fund.
(a) There is hereby created an "EMS Assistance Fund" within the State treasury, for the purpose of receiving fines and fees collected by the Illinois Department of Health pursuant to this Act.
(b) EMT licensure examination fees collected shall be distributed by the Department to the Resource Hospital of the EMS System in which the EMT candidate was educated, to be used for educational and related expenses incurred by the System's hospitals, as identified in the EMS System Program Plan.
(c) All other moneys within this fund shall be distributed by the Department to the EMS Regions for disbursement in accordance with protocols established in the EMS Region Plans, for the purposes of organization, development and improvement of Emergency Medical Services Systems, including but not limited to training of personnel and acquisition, modification and maintenance of necessary supplies, equipment and vehicles.
(d) All fees and fines collected pursuant to this Act shall be deposited into the EMS Assistance Fund, except that all fees collected under Section 3.86 in connection with the licensure of stretcher van providers shall be deposited into the Stretcher Van Licensure Fund.
(Source: P.A. 96‑702, eff. 8‑25‑09.)

(210 ILCS 50/3.225)
Sec. 3.225. Trauma Center Fund.
(a) The Department shall distribute 97.5% of 50% of the moneys deposited into the Trauma Center Fund, a special fund in the State Treasury, to Illinois hospitals that are designated as trauma centers. The payments to those hospitals shall be in addition to any other payments paid and shall be in an amount calculated under paragraph (b) of this Section.
(b) Trauma payment calculation.
(1) The Department shall implement an accounting

system to ensure that the moneys in the fund are distributed.
(2) The moneys in the fund shall be allocated

proportionately to each EMS region so that the EMS region receives the moneys collected from within its region for violations of laws or ordinances regulating the movement of traffic.
(3) The formula for distribution to individual

hospitals shall be based on factors identified in rules adopted by the Department pursuant to this Act. No moneys may be distributed to a trauma center located outside of the State.
(c) The Department may retain 2.5% of 50% of the moneys in the Trauma Center Fund to defray the cost of administering the distributions.
(Source: P.A. 89‑177, eff. 7‑19‑95.)

(210 ILCS 50/3.226)
Sec. 3.226. Hospital Stroke Care Fund.
(a) The Hospital Stroke Care Fund is created as a special fund in the State treasury for the purpose of receiving appropriations, donations, and grants collected by the Illinois Department of Public Health pursuant to Department designation of Primary Stroke Centers and Emergent Stroke Ready Hospitals. All moneys collected by the Department pursuant to its authority to designate Primary Stroke Centers and Emergent Stroke Ready Hospitals shall be deposited into the Fund, to be used for the purposes in subsection (b).
(b) The purpose of the Fund is to allow the Director of the Department to award matching grants to hospitals that have been certified Primary Stroke Centers, that seek certification or designation or both as Primary Stroke Centers, that have been designated Emergent Stroke Ready Hospitals, that seek designation as Emergent Stroke Ready Hospitals, and for the development of stroke networks. Hospitals may use grant funds to work with the EMS System to improve outcomes of possible acute stroke patients.
(c) Moneys deposited in the Hospital Stroke Care Fund shall be allocated according to the hospital needs within each EMS region and used solely for the purposes described in this Act.
(d) Interfund transfers from the Hospital Stroke Care Fund shall be prohibited.
(Source: P.A. 96‑514, eff. 1‑1‑10.)

(210 ILCS 50/3.230)
Sec. 3.230. Abuse and Neglect Reporting; Domestic Violence Referrals.
(a) All persons licensed, certified or approved under this Act shall report suspected cases of child abuse or neglect in accordance with the requirements of the Abused and Neglected Child Reporting Act.
(b) All persons licensed, certified or approved under this Act shall offer to a person suspected to be a victim of abuse immediate and adequate information regarding services available to victims of abuse, in accordance with Section 401 of the Illinois Domestic Violence Act of 1986.
(Source: P.A. 89‑177, eff. 7‑19‑95.)

(210 ILCS 50/3.235)
Sec. 3.235. Choke‑Saving Methods Act; Effect. Nothing in this Act shall impair or diminish any right, privilege or duty established in the Choke‑Saving Methods Act.
(Source: P.A. 89‑177, eff. 7‑19‑95.)

(210 ILCS 50/3.240)
Sec. 3.240. Coal Mine Medical Emergencies Act; Conflicts. In the event of conflict between this Act and the Coal Mine Medical Emergencies Act, the provisions of the Coal Mine Medical Emergencies Act shall govern.
(Source: P.A. 89‑177, eff. 7‑19‑95.)

(210 ILCS 50/3.245)
Sec. 3.245. Adoption of Rules by the Department. The Department shall adopt rules to implement the provisions of this Act, in accordance with the Illinois Administrative Procedure Act.
With the exception of emergency rules adopted pursuant to the Illinois Administrative Procedure Act or Section 3.190 of this Act, the Department shall submit all proposed rules to the State Emergency Medical Services Council or State Trauma Advisory Council for a 90‑day review and comment period prior to adoption, as specified in this Act.
(Source: P.A. 91‑357, eff. 7‑29‑99.)

(210 ILCS 50/3.250)
Sec. 3.250. Application of Administrative Procedure Act. The provisions of the Illinois Administrative Procedure Act are hereby expressly adopted and shall apply to all administrative rules and procedures of the Department of Public Health under this Act, except that in case of conflict between the Illinois Administrative Procedure Act and this Act the provisions of this Act shall control, and except that Section 5‑35 of the Illinois Administrative Procedure Act relating to procedures for rule‑making does not apply to the adoption of any rule required by federal law in connection with which the Department is precluded by law from exercising any discretion.
(Source: P.A. 92‑651, eff. 7‑11‑02.)

(210 ILCS 50/3.255)
Sec. 3.255. Emergency Medical Disaster Plan. The Department shall develop and implement an Emergency Medical Disaster Plan to assist emergency medical services personnel and health care facilities in working together in a collaborative way and to provide support in situations where local medical resources are overwhelmed, including but not limited to public health emergencies, as that term is defined in Section 4 of the Illinois Emergency Management Agency Act. As part of the plan, the Department may designate lead hospitals in each Emergency Medical Services region established under this Act and may foster the creation and coordination of volunteer medical response teams that can be deployed to assist when a locality's capacity is overwhelmed. In developing an Emergency Medical Disaster Plan, the Department shall collaborate with the entities listed in Sections 2310‑50.5 and 2310‑620 of the Department of Public Health Powers and Duties Law of the Civil Administrative Code of Illinois.
(Source: P.A. 93‑829, eff. 7‑28‑04.)

Tags: Medi-car & Ambulance Accidents, ambulance accident, automobile accident, death, dialysis, handicapped transportation, lakeshore nursing home, medical transport, personal injury lawyer, senior transportation, tennessee

Posted on October 24, 2009 by Jonathan Rosenfeld

Chicago Nursing Home Lawyer, Jonathan Rosenfeld, Interviewed Regarding Preventing Patients From Wandering

Nursing home lawyer, Jonathan Rosenfeld, was recently interviewed for an article on preventing patient wandering. The article 'Prevent Wandering Patient Tragedies' appeared in the on-line edition of Healthcare Technologies Online, can be viewed here.

Wandering Nursing Home Patients

Many nursing home patients with dementia and Alzheimer's are prone to wander from the facility. Once out of the safety of the nursing home, these vulnerable people are particularly susceptible to injury.

Simple preventative measures implemented by a facility could literally be the difference between life and death for nursing home patients. There is no excuse for a nursing home's failure to keep residents who are prone to wandering from leaving the premises of the facility.

Nursing homes that care for patients who are prone to wander or elope should have the following safeguards in place:

Door alarms
Window locks
Door locks
Bracelets that track each resident's location
Hire adequate staff to look after residents
Have contingent plan in case a resident does wander from the facility

Alzheimer's Patient Wanders From Texas Nursing Home To Her Death

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Family Sues Florida Nursing Home For Death Of Wandering Resident

Tags: Elopement / Wandering, chicago, death, jonathan rosenfeld, nursing home lawyer, nursing home patient

Posted on October 22, 2009 by Jonathan Rosenfeld

Left Untreated, Stomach Aches Can Be Deadly For Elderly Nursing Home Patients

Clostridium difficile (also called C. difficile or C. diff) associated disease (“CDAD”) is a bacterial infection that can cause diarrhea and serious intestinal conditions (such as colitis - inflammation of the colon). CDAD is responsible for about three million cases of diarrhea and colitis annually in the United States.

C. difficile is naturally found in the environment and even in a small number (fewer than 3%) of healthy people’s large intestine. Most people in good health do not usually get sick from C. difficile because of the millions of intestinal bacteria that help protect the body from infection.

When people-- particularly the elderly-- take antibiotics to treat infections (such as floroquinolones, cephalosporins, clindamycin, and penicillins), the antibiotics can kill some of the healthy bacteria along with the bacteria causing the infection. This allows C. difficile to grow out of control leading to a C. difficile infection.

After a C. difficile infection sets in, it can produce toxins that attack the lining of the intestine, killing cells and causing patches or plaques of inflammatory cells. The toxins can also decay cellular debris inside the colon.

A more recent strain of C. difficile is even more aggressive, producing much more of the harmful toxins than previous strains. This new strain is also more resistant to medications and has even affected people who have not spent time in the hospital or taken antibiotics.

Signs and symptoms of mild to moderate CDAD cases:

Watery diarrhea three or more times a day for two or more days
Mild abdominal cramping and tenderness
Low-grade fever

More severe cases of CDAD can cause the colon to become inflamed (colitis) or form patches of raw tissue that can bleed or pus (pseudomembranous colitis). Signs and symptoms of more severe C. difficile cases:

Watery diarrhea ten to fifteen times a day
Severe abdominal pain and tenderness
High fever
Blood or pus in stool
Nausea
Dehydration
Loss of appetite
Weight loss

CDAD incidence has doubled in recent years and is responsible for about three million cases of diarrhea and colitis annually in the United States. A much higher percentage of people carry the bacteria in nursing homes, hospitals and other healthcare facilities.

The bacteria are passed through the feces of an infected person and can spread to food, surfaces, and objects when infected people do not wash their hands thoroughly. The bacteria creates spores (nonactive form of the bacteria) can live in a room for weeks or even months; when ingested, they transform into the active, infectious form of the bacteria.

Most cases occur in healthcare settings because germs are spread easily, there is increased use of antibiotics, and there are people more vulnerable to infection. CDAD commonly affects the elderly, with persons 65 years of age or older being ten times more likely to become infected with C. difficile than younger people. Infections are also more common after antibiotic use.

There are several risk factors for C. difficile infections:

Currently taking or having recently taken antibiotics (C. difficile accounts for 15-20% of antibiotic-related diarrhea and most cases of pseudomembranous colitis)
Advanced age (65 years of age and older)
Recent hospitalization, especially for an extended period of time (10% of hospital patients will develop an infection after a stay of only two days)
Living in a nursing home or long-term care facility
Serious underlying illness or weakened immune system
Abdominal surgery or gastrointestinal procedure
Colon disease (IBS or colorectal cancer)
Previous C. difficile infections

Dangerous complications can occur with C. difficile infections. These include:

Dehydration and electrolyte deficiencies
Kidney failure
Bowel perforation (hole in the large intestine)
Toxic megacolon (colon becomes very distended and can even rupture)
Death (mortality rate is 1 to 2.5 percent and is higher in older adults)

There are several tests that can be performed to determine if a person has a C. difficile infection:

Stool tests (enzyme immunoassay, PCR, tissue culture assay)
Colon examination (flexible sigmoidscopy)
Imaging tests (CT scan)

While mild illness caused by CDAD may improve after stopping antibiotics (requiring only correction of dehydration and electrolyte deficiencies), more severe symptoms might require treatment with a different antibiotic (metronidazole for mild to moderate illness and vancomycin for more severe symptoms). Probiotics (organisms such as bacteria and yeast) can be used to help prevent recurrent C. difficile infections.

In severe cases, surgery might be necessary to remove diseased portions of the colon. Recurrent C. difficile infections occur in about twenty-five percent of people with C. difficile infections. Treatment for recurrent infection includes: antibiotics, Probiotics, and stool transplants to help restore healthy intestinal bacteria. A doctor should be consulted if a person has symptoms lasting more than three days, a fever, severe pain or cramping, blood in the stool, or more than three bowel movements a day.

C. difficile is considered the most common cause of diarrhea in nursing homes. Because many elderly nursing home patients are more susceptible to C. difficile infections and its accompanying complications, nursing home staff must closely monitor the bowel movements of residents in order to quickly diagnose a possible C. difficile infection.

Many nursing home residents are already weak or suffer from other illnesses; therefore, it is important that nursing home staff provide proper treatment for diarrhea (fluids and good nutrition) in order to maintain resident health.

In addition, nursing homes should take extra precautions to prevent the spread of C. difficile through: thorough hand washing, contact precautions (keeping residents with infections separate from healthy residents), thorough cleaning of all surfaces and equipment, and avoiding unnecessary use of antibiotics.

We have successfully prosecuted cases involving individuals who died due to untreated or undiagnosed C. difficile. We always welcome the opportunity to speak with you regarding a potential cause of action against a nursing home or hospital. Our services are always free if there is no recovery for you. (888) 424-5757

Special thanks to Heather Keil, J.D. for her diligent work researching this important topic.

Sources:

Mayo Clinic: C. difficile

CDC: Clostridium difficile

Geriatric Nursing: Clostridium difficile: An emerging epidemic in nursing homes

Tags: Clostridium Difficile, Dehydration, c diff, c difficile, clostridium difficile, death, diarrhea, infection, stomach problems

Posted on October 18, 2009 by Jonathan Rosenfeld

Home Nurse Who Failed To Get Medical Attention For Patient With Severe Bed Sore Now Faces Criminal Charges

A home-care nurse has been charged with criminal mistreatment after she failed to seek medical attention for an elderly woman with severe bed sores that ultimately claimed her life. Prosecutors filed the charges against, Virginia Munger after an investigation revealed that although Munger was aware of advanced bed sores (also referred to as: decubitus ulcers, pressure ulcers or pressure sores) for six months, she took no medical intervention. Munger was employed as a CNA by Homewell Senior Care, a home-care nursing company.

Read more about this case of senior neglect here.

Home Care Services

Many seniors are turning to home-care services as a way of living independently for longer. Many of these companies offer senior a variety of medical and non-medical services and provide staffing on as 'as needed' basis. Unlike nursing homes, home-care services are loosely regulated by federal and state officials.

Officials at home care service companies should conduct an assessment to determine what the patient's needs are and determine if the company can indeed provide those services. Once the needs are assessed and services are provided, the company should provide supervision of its employees to make sure those services are properly provided and the patient's needs are continually met.

In the case above, the elderly woman's family may have a cause of action against the home service company-- not necessarily for the criminal conduct of its CNA, but for failing to provide adequate supervision. Additionally, if the company was made aware of the woman's bed sores-- yet failed to take any action they may similarly be liable for her treatment and death.

Related Nursing Homes Abuse Blog Entries

Home Care Nurse Gets Probation For Ignoring Bedsores On Child

Home Care Nurse Has License Suspended In Connection To Death Of Disabled Boy

Tags: Bed Sores, Pressure Sores, Decubitus Ulcers & Pressure Ulcers, death, home care services, home nurse, homewell senior care, senior services

Posted on October 13, 2009 by Jonathan Rosenfeld

California Nursing Home Issued Most Severe Citation After Patient Fall And Death

The California Department of Health has issued a "AA" citation and a $90,000 fine to Fallbrook Hospital District Skilled Nursing Facility after a patient fell and subsequently died at the San Diego, CA nursing home. According to director of public health director, Dr. Mark Horton, a state investigation determined that the facility failed to implement a plan of care to prevent the patient's injury.

The California Department of Heath has the statutory authority to impose fines against nursing facilities it licenses as part of enforcement remedies for poor care. State citations that require a civil monetary penalty be imposed are categorized as Class B, A or AA. The associated fines range from $100 to $1,000 for Class B, $2,000 to $20,000 for Class A and $25,000 to $100,000 for Class AA. The citation class and amount of the fine depend upon the significance and severity of the substantiated violation, as prescribed and defined in California law.

Nursing Home Falls

More than 1,800 people die each year in nursing home falls. All health care professionals in the nursing home setting must work together to help encourage nursing home safety. Nursing homes are required to conduct a fall-risk assessment for every resident to determine who may be at risk for falls. This puts the staff on notice as to who may need special attention and sets forth what accommodations should be in place for each resident.

Additionally, staff should always be on the lookout for residents who may require assistance getting about. If residents have a history of falls, the facility should consider using alarms on chairs or beds to notify the staff when the person attempts to walk on their own.

Falls in nursing homes occur for a variety of reasons. Some of the more common causes for falls are:

Muscle weakness and walking or gait problems
Hazards in the nursing home- wet floors, poor lighting, improper be heights, improperly maintained wheelchairs, equipment left out of place
Medications- Drugs that effect the central nervous system, such as sedatives and anti-anxiety drugs (psychoactive drugs)
Improperly fitting shoes or incorrect walking aids
Frequent use of restraints
Inadequate staffing levels that fail to provide sufficient assistance to residents

Here is is the California Department of Health survey regarding this fall-related incident

Tags: Nursing Home Falls, california nursing home, death, fallbrook hospital district skilled nursing facility, san diego

Posted on October 2, 2009 by Jonathan Rosenfeld

Nursing Home Staff Must Take Precautions While Moving & Transferring Disabled Patients To Minimize Risk Of Dropping

Bathing: facilities failing to provide assistance or provide specialized bathing equipment including chairs, stands and grips
Transfer into and out of bed
Failing to take extra-precautions with patients who may have uncontrolled muscle movement: many times these patients require special restraints during transfers
Failing to take patient medications into the equation: some commonly prescribed medications can make patients dizzy or cause blood pressure spike or drops when patients are moved
Failing to engage locks on wheelchairs
Allowing patients to wear socks or improper footwear during transfers
Failing to monitor patients with walkers

Although facilities like to claim that these incidents are isolated events, a dropped patient is usually indicative of poor staff training and chronic under-staffing. Most of these transfer-related incidents occur due to:

Poorly trained staff: Some facilities do not properly train staff in how to use equipment
Under-staffing: Facilities sometimes to not have enough man power to safely perform transfers as they were intended
Wrong equipment: facilities must have the proper equipment for the job
Faulty equipment: facilities must keep equipment in proper repair. This includes getting replacement parts from the manufacturer
Failing to provide timely assistance to patients who request it

Cases involving injury or death during transfer are particularly important to investigate as quickly as feasible after the incident in order to preserve the condition of equipment and to obtain statements from witnesses others who may have knowledge of the event.

If your loved one suffered an injury or died as a result of a fall or being 'dropped' by staff, we would honor the opportunity to speak with you. Our nursing home litigation team is always available for consultation. (888) 424-5757

Related Nursing Homes Abuse Blog Entries:

Nursing Home Waits 19 Hours To Provide Medical Treatment To Resident Who Fractured Her Hip During Sabina Lift Transfer

Nursing Home Cited For Mistreatment Of Resident Following Investigation Of Resident's Fractured Neck

Faulty Handicapped Lift Blamed For Nursing Home Death

Improper Transfer Leads To Fall & Ultimately Death Of Rehab Patient

Tags: Broken Bones, Dropped Patients, Nursing Home Falls, bathing injury, death, disabled nursing home patients, dropping patients, faulty equipment, injury, nursing home injury, restraint, transfer, wheelchair

Posted on September 23, 2009 by Jonathan Rosenfeld

Failure To Monitor Bowel Movements In Nursing Home Patients Can Lead To Impacted Bowels

In addition to monitoring food and liquid intake of nursing home patients, staff need to pay attention to the elimination of the wastes. When urine and feces are not produced on a regular basis, nursing home staff must bring these problems to the attention of physicians.

One of the more obvious cases of nursing home neglect my office is working on involves a patient who went at least 10 days without a bowel movement. Shift after shift of nursing home staff tended to our client-- yet no one cared enough to look at his medical chart to see when the last bowel movement occurred. It was not until the man was taken to a local hospital, was it determined that the man's bowel had become impacted with feces. Within 24-hours of his admission to the hospital, the man died from complications related to sepsis.

What is an impacted bowel?

An impacted bowel is the condition where feces are trapped in the lower part of the large intestine, causing a waste obstruction. The stool collects in the bowel and becomes hardened. This hard stool can irritate the rectum, resulting in the production of mucus and fluid which can leak, causing fecal incontinence.

One of the most common symptoms is lack of appetite, caused by pressure on the abdomen. Hemorrhoids (a mass of dilated veins in swollen tissue around the anus) are a common sign of impacted bowels because it is more difficult to rid your body of fecal matter. Other symptoms include: a constant feeling of fullness; diarrhea; hardened feces; cramping and pain; vomiting; constipation; bad breathe; and bloating. If left untreated, the waste obstruction can cause a rectal infection that can lead to sepsis or death.

The most common cause of impacted bowel symptoms is Crohn’s disease. In a nursing home setting, causes of impacted bowel include: not drinking enough water; not eating a diet with adequate fiber; lack of activity; certain prescription medications and generally unhealthy diet with high fat and processed foods.

When timely identified, impacted bowels can be treated with a higher fiber diet, increased hydration, exercise, laxatives, enemas, suppositories, or manually removing the hardened feces.

Unfortunately, many nursing home patients are highly susceptible to impacted bowels due to a combination of inattentive staff and an unhealthy lifestyle. In order to minimize the chances of impacted bowels among patients, nursing homes should:

Provide the residents with proper nutrition (sufficient fiber, water, and healthy foods), the residents can suffer from painful constipation.
Provide as much physical activity as feasible for patients.
Monitor each patients bowel movements (time, quantity, consistency)
Pay special attention to patients complaining of stomach pain or cramping

Resources:

Article Click - Fecal Impaction vs. Constipation

The association of fecal impaction and urinary retention in elderly nursing home patients

Annals of Internal Medicine – Incontinence in the Nursing Home

Tags: Impacted Bowel, Sepsis, Wrongful Death, death, fecal impaction, obstructed bowel, rectal infection

Posted on September 6, 2009 by Jonathan Rosenfeld

Nursing Home Staff Must Pay Special Attention To Avoid Complications When Caring For Patients Dependent On Feeding Tubes

Many nursing home residents require feeding tubes because of illness or weakness. In order to maintain a resident’s strength and health, a feeding tube can be used to either supplement eating by the mouth or completely replace a resident’s meals.

Good nutritional habits are especially important for residents who are already suffering from illness, trauma, or weakness. Eating a well-balanced diet gives residents strength and may help them fight infection.

When a nursing home resident’s dietary needs cannot be met by eating a well-balanced diet, the resident might be placed on alternative means of nutritional support such as a feeding tube.

One of the most common reasons for a feeding tube is cancer, especially of the head, neck, stomach, and esophagus. Other conditions such as Crohn’s disease, ALS, stroke, surgical bowl removal might also require a feeding tube.

A feeding tube might be needed if a resident has:

Severe nutritional problems
Severe dehydration
Aspiration pneumonia on several occasions
Great fear of suffocation from choking or aspiration

A feeding tube can be either a short-term or long-term solution for a resident’s nutritional needs. If the nursing home staff is concerned about a resident’s nutritional health and well-being, a doctor and nutritionist will determine where the feeding tube will be placed (through the nose or directly into the stomach) and the feeding formula. Usually, a feeding tube is not employed unless all attempts at feeding by mouth have been tested.

A doctor will decide the best plan for feeding based on the resident’s gastrointestinal function, physical capability, and degree of cooperation. The feeding formula can range from blended food products to commercial formulas. There are several types of feeding tubes: G-Tube, PEG (percutaneous esophago-gastronomy, placed directly into stomach), J-Tube (Jejunostomy Tube, placed directly into small bowel and stomach), NG-Tube (Nasogastric Tube, placed through nose).

The G-Tube is surgically placed into the abdominal wall, below the rib cage and goes directly into the stomach. It is a convenient delivery route for long-term feeding and can be easily replaced. The J-Tube is surgically placed into the upper section of the small intestine (jejunum). This tube bypasses the stomach and feeds directly into the intestinal tract. The NG-Tube is placed in a nostril, down the pharynx, through the esophagus, and into the stomach. It is usually used for short-term feeding. The placement of the tube must be checked before each feeding.

There are also several methods for formula delivery: bolus/syringe method, gravity drip method, and pump feeding. The bolus/syringe method uses a syringe attached to the feeding tube. The formula is poured into the syringe and flows into the tube. The gravity drip method uses a gravity feeding bag. The flow rate (determined by a doctor) can be controlled, and the bags must be changed every 24 hours to prevent bacteria growth. The pump feeding method is controlled by a battery or electrical operated device set to control the rate of infusion.

Complications with feeding tubes can occur, so nursing home staff must closely monitor residents’ feeding tubes. The feeding tube can become loose, and aspiration can still occur with a feeding tube in place. Therefore, it is important that the head remain above the level of the tube. In addition, care must be taken to prevent the growth of bacteria in feeding tube formula. Some bags have an ice pouch on the outside to keep the formula fresh, and bags must usually be changed every 24 hours.

Nursing home staff must also take extra precautions to prevent infection of the feeding tube and cause the resident further health problems. For feeding tubes that are surgically placed, greater care is required during the first week the tube is in place to prevent infection and prevent the tube from pulling away from the abdominal wall. For tubes placed directly into the stomach, care must be taken to keep the skin surrounding the tube clean and dry, and in some instances, covered with gauze. Furthermore, gastric leakage can occur with the stomach feeding tubes. This is problematic because the gastric juices are acidic and can cause skin irritation.

Most commercial feeding formulas are not very thick and do not leave a reside so that they do not clog the tube. The nursing home staff must still take precautions to prevent clogging including flushing the tube with water before and after feeding.

Many nursing home residents are at risk for illness and injury, so it is important to keep their strength up. Therefore, feeding tubes are an important method to help maintain residents’ health and well-being. It is important to know that additional complications can occur with feeding tubes. If your family member is a victim of feeding tube complications, I would honor the opportunity to discuss your situation. As always, our legal services are completely free if there is no recovery for you. Speak to our experienced nursing home lawyers today. (888)424-5757.

Sources:

Huntington’s Disease: What is a feeding tube?

Mayo Clinic: Tube Feedings

Mayo Clinic – Pneumonia (aspiration pneumonia)

Related Nursing Homes Abuse Blog Entries

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Tags: Feeding Tube Complications, Malnutrition, aspiration, death, feeding tube, g tube, peg tube, starvation

Posted on August 11, 2009 by Jonathan Rosenfeld

Assisted Living Employee Pleads Guilty To Manslaughter Charges After Resident Dies From Burn Injury

Alvador Thompson, a nurses aide who poured scalding oatmeal into the mouth of a disabled patient has pleaded guilty in response to the involuntary manslaughter charges filed against her by the Montgomery County District Attorney.

This incident at an assisted living facility caught national attention not only due to the fact that an aide failed to check the temperature of the food she was serving to a disabled resident, but also due to the fact that despite the severe burns on the man's lips, tongue, mouth and throat, the facility waited almost half a day to get medical attention for the injured man. Also, Cambridge Brightfield, the Pennsylvania assisted living facility, failed to notify state officials of the resident's injury.

The elderly man received hospital treatment for his injuries, but was discharged back to Cambridge Brightfield where he died two weeks later.

In several months, Ms. Thompson will return to court for her sentencing. Pennsylvania categorizes involuntary manslaughter as a misdemeanor which carries a maximum penalty of 2 1/2 to 5 years in prison and a $10,000 fines.

Cambridge Brightfield's provisional license was revoked by the Department of Public Welfare after authorities learned of this burn injury and two other incidents where residents were found unresponsive and required hospitalization.

As far as I can tell, no fine or corrective changes were ordered by Pennsylvania officials. The fact that no severe penalties were ordered leaves me wondering, what real incentive is there for assisted living facilities to clean up their act? It is always easy to blame the individual involved in a particular incident, yet the reality is that the management and owners of this assisted living facility are the ones to blame as they typically fail to train many staff members to look out for situations such as this. As long as our society gives a mere 'slap on the wrist' to facilities that allow this type of treatment to exist we can expect more unfortunate situations such as this to continue.

Read more about this tragedy at a Pennsylvania assisted living facility here.

Related Nursing Homes Abuse Blog Entries:

Can Assisted Living Facilities Adequately Care For Alzheimer's Patients?

Criminal Charges Filed Against Assisted Living Employee In Relation To Resident Suffering Burns While Eating

Man Chokes To Death While Left Unattended At Nursing Home

Tags: Assisted Living Facilities, assisted living facility, cambridge brightfield, death, disabled patient, nursing home, pennsylvania

Posted on August 7, 2009 by Jonathan Rosenfeld

Choking Death Just Latest Problem At California Nursing Home

Tustin Care Center, located in Orange County, California, was fined $50,000 by the California Department of Public Health for the choking death of one resident in March 2009. The California Department of Public Health concluded that the facility’s failure to assess the resident’s ability to eat was a direct cause of his death.

According to the government’s Medicare website, the Tustin Care Center received four out of five stars, which is an above average rating. In the past year, the nursing home had nine health deficiencies, which is three less than the average health deficiencies in California, and one more than the average number of health deficiencies in the United States.

The inspection report noted that one resident choked to death after eating lunch provided by the nursing home facility. In this case, the facility failed to conduct continuing assessments of the resident. Nursing homes are required to identify problems and develop an individual care plan for all residents based on initial and continuing assessments of resident needs. This requirement is in place to provide the best and most complete care and treatment to maintain the health and well-being of residents.

The resident was admitted to the facility on October 27, 2008 with hypertension, a lung mass, heart disease, and high cholesterol. The nurse’s assessment showed that the resident had both upper and lower dentures and was alert and able to feel himself. An individualized care plan was established, part of which was to monitor the patient’s diet tolerance.

Over the course of the resident’s stay at the facility, the nursing home staff noted that the resident was getting weaker and having difficulty moving around. However, there was no mention of an assessment by dietary or by the Interdisciplinary Team (IDT) of the resident’s swallowing ability or ability to tolerate a regular diet. The IDT notes from March 2, 2009 show that the resident had a change in condition caused by a decline in activities of daily living and a decline in mobility due to a five pound weight gain within a month. Still, the nursing home staff allowed the resident to eat regular meals on his own.

On March 14, 2009, the resident was served lunch in the dining room at noon. The resident ate twenty-percent of his lunch (Korean soup with rice). At 12:30 pm, the resident had difficulty breathing, and a licensed nurse performed the Heimlich maneuver but was unable to dislodge the food. The resident was then placed on the floor and given CPR before being transferred to the hospital. The resident did not have a pulse and did not regain consciousness. The hospital report indicated that the resident arrived at the emergency room in full arrest – he was flaccid and pale with a partially obstructed airway and no heartbeat. The hospital was unable to resuscitate the resident. The autopsy confirmed that the cause of death was asphyxia due to choking on food.

This unfortunate death could have been prevented had the facility taken better care to provide ongoing assessments of the resident’s ability to eat on his own.

Read more about this choking death in a California nursing home here.

Sources:

Mercury News - Tustin Nursing Home Fined $50,000 by State

Medicare – Tustin Care Center

California Department of Health: Nursing Home Citations – Tustin Care Center

Tags: Choking, california nursing home, death, nursing home, nursing home fine, tustin care center

Posted on July 23, 2009 by Jonathan Rosenfeld

Alzheimer's Patient Wanders From Texas Nursing Home To Her Death

Authorities are now looking into how 85-year-old, Edna May Sides, managed to wander from Hillside Plaza Nursing Home without the knowledge of nursing home staff. On July 15th, Sides dead body was found a short distance from the facility.

Initially, the nursing home told the family that Sides passed from 'natural causes'. However, when the family learned that Sides wandered from the facility, they notified the Cherokee County Sheriff and the Wells Police Department. "The family thought it was a little strange, so they went to the Justice of the Peace in Alto and then called the Sheriff's Office and our department." said Wells Police Chief Barry Starnes

Despite the fact that law enforcement officials are involved in an investigation, Chief Starnes doesn't believe foul play is involved, "I believe there was possible negligence, but I don't believe someone purposely did this. We're trying to get to the bottom of how this person got outside when she wasn't supposed to be," he said.

Read more about the wandering of a Texas nursing home patient here.

Wandering Nursing Home Patients

Once again, simple preventative measures implemented by a facility could literally be the difference between life and death for nursing home patients. There is no excuse for a nursing home's failure to keep residents who are prone to wandering from leaving the premises of the facility. Nursing homes that care for patients who are prone to wander or elope should have the following safeguards in place:

* Door alarms

* Window locks

* Door locks

* Bracelets that track each resident's location

* Hire adequate staff to look after residents

* Have contingent plans to locate residents who may wander from the facility

If you have loved one who may be prone to wandering from the facility, ask the administrator if the above safety measures are in place at the facility. My guess is that facilities that implement these safety measures have significantly lower rates of wandering.

Tags: Dementia / Alzheimer's Patients, Elopement / Wandering, death, hillside plaza nursing home, texas nursing home

Posted on June 25, 2009 by Jonathan Rosenfeld

Two Falls Within 24-Hours At California Nursing Home Cost Patient His Life

Two falls within a 24-hour period resulted in the death of a California nursing home patient. The incident involved a patient was was recently admitted to the facility for rehabilitation following hip surgery. The falls took place on May 9th and 10th at Aviara Healthcare Center in Encinitas, CA.

After the first fall (that did not cause any injury), the staff put a bed alarm on the patients bed to alert the staff if he got out of the bed. Despite the bed alarm, staff at the nursing home failed take notice when the man got out of his bed and entered the nearby hallway. In an effort to stabilize himself, the man grabbed on to a lift that was parked in the hallway and it fell on top of him resulting in multiple trauma. Three days later, the man died from his injuries.

An investigation into the matter revealed that the facility should have never allowed the lift machine to remain in the hallway it posed a risk to residents due to its propensity to fall. Investigators also determined that the facility failed to have proper guardrails that may have further contributed to the man's death.

The facility was fines $100,000 for this incident. Read more about the fines related to this California nursing home here.

The importance of investigations by state agencies

One of the things that jumped in my head after learning abut this fall incident was how valuable inspections by state agencies are. Inspectors have access to facilities where they can do a physical inspection of the equipment involved in an alleged incident-- but perhaps most importantly is that they have access to nursing home employees and administrators who have knowledge of an incident-- these people have no choice but to speak with these investigators.

In nursing home litigation cases, these inspections frequently provide the necessary information to successfully prosecute a case. In most situations, by the time a nursing home negligence lawsuit is filed, the employees involved in an event have long since left the facility and it is difficult-- if not downright impossible to find them. In the case of a disabled to deceased plaintiff, the testimony is essential to prove the case.

All this is to reinforce the importance of notifying the state department of health immediately upon learning of an event where a loved one was injured or killed. A timely investigation by state authorities can mean the difference between a successful prosecution of a matter and an 'unfortunate tragedy'.

Related Nursing Homes Abuse Blog Entries

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Tags: Nursing Home Falls, aviara healthcare center, bed alarm, california nursing home, death, preventable fall

Posted on May 21, 2009 by Jonathan Rosenfeld

Three Employees At Assisted Living Facity Disciplined For Their Failure To Report Missing Nursing Home Resident

An investigation into the death of a 93-year-old man at a New York assisted living facility revealed that three employees at the facility acted improperly when they failed to document that the man was missing from his room. Turns out-- the man had either jumped or fallen to his death from his second floor room. The incident occurred on February 17th at Dosberg Manor, part of the the Weinberg Campus. The man's dead body was discovered the following day on the ground outside his room.

An investigation into the death by the New York Health Department determined employees at the facility acted improperly in the hours following the man's death. The following omissions were noted in the department's report:

At 9:40 that evening an employee was called into the man's room by his roommate to shut an open window. Despite the fact that the employee noticed the man's glasses and a walker parked adjacent to the open window, the employee failed to look further into the man's whereabouts and lied to investigators about seeing the man in his room.
At 11:00 p.m. another employee at Dosberg failed to investigate the fact that the man was missing from his room, choosing to assume that man was in a hospital.
A third employee who made midnight rounds noticed that the man was missing-- yet failed to notify authorities.
Medical records indicate that staff helped the man take his medication at 6:30 a.m. on February 18th although by that time the man's dead body had been outside for over 11 hours.

As a result of the Department's findings, a new policy has been implemented by Dosberg Manor to ensure the whereabouts of all residents and the employees who were involved in the errors cited above will be disciplined.

Read more about the investigation of this missing nursing home resident here.

Nursing Homes Abuse Blog Posts On Missing Nursing Home Residents

Nursing Home Negligence Lawsuit Claims Sunrise Senior Living Failed To Supervise Resident During Field Trip

What Can Nursing Homes Learn From Jails?

Police Dog Finds Resident Who Went Missing From Chicago Nursing Home

Tags: Assisted Living Facilities, Elopement / Wandering, assisted living facility, death, dosberg manor, missing nursing home resident, new york

Posted on May 6, 2009 by Jonathan Rosenfeld

Man Falls From Fourth Floor Window To His Death At Alden Nursing Home

The Chicago Sun Times reported on the death of 84-year-old, Benny Saxon. Saxon was a resident at Alden Wentworth Rehabilitation and Health Care Center in Chicago, Illinois when he either jumped or fell to his death from the fourth floor. The Cook County Medical Examiner's office pronounced Saxon dead shortly after the incident.

Chicago Police are investigating the incident, but early reports indicate that the man suffered from dementia and showed signs of being agitated shortly before his death. Currently, the death is being evaluated a suicide.

A dementia unit on the fourth floor?

If the reports of this man being housed on the fourth floor prove to be true, this facility should not only be ashamed of exposing dementia resident to such harm, but the facility may also expose themselves in a liability context. Nursing home residents suffering from dementia or Alzheimer's should always be housed on a ground floor to minimize the risk of residents harming themselves.

About Alden

Alden has been involved in the nursing home industry since the 1970's. There are 38 Alden facilities in the Chicagoland area, Rockford and Wisconsin. The facilities are intended to care for individuals who require varying degrees of assistance. Alden nursing facilities include:

21 rehabilitation and health care centers
7 independent senior living facilities
5 special needs facilities
3 assisted living facilities
2 Alzheimer's residential centers

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Tags: 'alden, Illinois, Illinois Nursing Homes, alden nursing home, chicago, cook county, death, dementia, fall from window, wentworth'

Posted on April 9, 2009 by Jonathan Rosenfeld

Alzheimer's Resident Dies Hours After Escaping From Illinois Nursing Home

The Chicago Tribune reported that an 81-year-old resident at the Maryville Manor Nursing Home 'shimmied' through a window to escape the facility and wander from the grounds. Hours later, the man was found dead along a nearby road.

Authorities at Maryville Manor confirmed that the man suffered from Alzheimer's and had been living at the facility for two weeks. Madison County, Illinois authorities are conducting an investigation into this wandering incident.

An open window?

Nursing homes that house Alzheimer's residents should have necessary safeguards in place to ensure the safety of residents. One of the biggest threats to Alzheimer's residents is self-inflicted injury due to wandering from the safety of a facility. In addition to basic precautions such as locking windows and doors, nursing homes should also:

Use bracelets that track each resident's location
Assess each resident for their propensity to wander from the facility
Hire adequate staff to look after residents
Have contingent plans to locate residents who may wander from the facility

There is no obligation on the part of nursing homes to house every person who seeks out the facility's services. However, when the nursing home agrees to house a resident who is disoriented or has dementia, the nursing home is implicitly agreeing they are able to properly care for the individual and is responsible for providing proper care.

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Tags: Illinois, Illinois Nursing Homes, alheimers, death, madison county, maryville manor nursing home

Posted on April 5, 2009 by Jonathan Rosenfeld

Illinois Elder Abuse Trial To Help Define Standard Of Care

The pending criminal trial of Jill and Julie Barry will have an important impact on Illinois seniors as it will help define what constitutes 'reasonable care' when it comes to the home-care of elders. Currently, prosecutors in Illinois have few parameters when it comes to the definition of 'elder abuse' because Illinois courts have not formally ruled on the issue before. Consequently, the decision as to how to define 'reasonable care' in a criminal neglect context will fall squarely on jurors.

In 2008, Kane County State's Attorney, John Barsanti filed criminal neglect charges against the Barry sisters related to their responsibility to provide care to their elderly mother. Kane County jurors will soon make a determination if the care the sisters provided was 'reasonable'-- or criminal- for their 84-year-old mother.

The criminal charges follow a 2007 Kane County Coroner-ordered investigation. The coroner ruled Mary Virgina Barry's death was a homicide due to the physical sings of neglect encountered during an autopsy.

An investigation revealed that prior to her death, Ms. Barry weighed just 70 pounds, had extensive bed sores, and had not seen a doctor for nine months. According to a paramedic report, Ms. Barry was lying in soiled bed sheets and had ants crawling on her when authorities were called to her home. Barry was immediately taken to a local hospital where she died several days later.

Web Resource:

Elder abuse: Trial to shed light on horrors in home and help home Illinois law, chicagotribune.com, April 2, 2009

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Tags: Illinois, Illinois Nursing Homes, Neglect, bed sores, criminal neglect, death, elder abuse, home care, illinois laws, kane county, malnutrition

Posted on April 4, 2009 by Jonathan Rosenfeld

A Reminder Of What Constitutes Nursing Home Neglect

Occasionally I receive emails and comments from blog readers asking what 'really' constitutes neglect. Its easy to point to definitions, but the best explanations usually come by way of example.

Yesterday, I was reviewing the chart of a 70-year-old lady who resident who died in a Chicago nursing home. The lady who died from complications following a severe burn on her leg due to contact with a wall-mounted radiator.

An investigation by state nursing home investigators verified that the woman's bed was jammed so close to the radiator that it had repeatedly come in contact with the bed, mattress and the woman's body (there were several burns noted on her right side). Despite the facilities own documentation of problems due to keeping the bed too close to the radiator, the bed was kept in place for months before the woman sustained a severe burn.

Four months after the 'radiator problems' had been initially noted, this woman sustained a third-degree burn to a large portion of her lower leg. Conservative burn treatment was unsuccessful in healing the large leg burn and ultimately the woman required a skin graft.

The woman underwent several weeks of successful burn treatment in a hospital. However, the woman was ultimately moved back to the original nursing home where she was injured and quickly contracted an infection. Within two weeks of moving back to the nursing home, the woman died.

In this case, the nursing home resident was a victim of neglect on so many occasions, it is literally difficult to keep track. Nonetheless, the point is not how many times the facility failed to properly care and assess the patient, but rather how easily preventable the injury and subsequent death were.

Related Nursing Homes Abuse Blog Posts On Nursing Home Burns

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Web Resources For Burn Victims

American Burn Association

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Tags: Neglect, burn, chicago nursing home, death, nursing home negligence, skin graft, third-degree burn

Posted on April 2, 2009 by Jonathan Rosenfeld

Nursing Home Negligence Lawsuit Filed Against Extendicare

Ricky Hamilton, the husband of Kimberly Hamilton, has filed a nursing home negligence lawsuit against Kenwood Nursing Home and the facilities parent company, Extendicare in Madison Circuit Court. The lawsuit alleges the nursing home deviated from acceptable standards of care and failed to maintain a safe environment. The lawsuit made a 'jury demand' and seeks an award of medical expenses, attorney fees and punitive damages.

Kenwood Nursing Home is part of the Richmond Health and Rehabilitation Complex in Richmond, Kentucky. The facility has has several smalling nursing homes on the property including Kenwood and Madison Manor.

Madison Manor has a well-documented history of problems. In 2008, the facility received a Type-A citation from the Cabinet for Health and Family Services after officials obtained a copy of a video documenting abuse of a resident. Following disclosure of the video, 9 staff members were fired and a new training program was implemented for the staff.

Nursing home ombudsman Kathy Gannoe, said her agency received 26 complaints regarding 14 Madison Manor residents in 2008. After investigating each claim, Gannoe determined 80% of the charges were verified.

Amazingly, the Kentucky nursing home had even more complaints in 2007. In 2007, nursing home ombudsmen investigated 56 complaints relating to 26 residents. According to Gannoe, 96.5% of the complaints were verified and one-quarter of the complaints were referred to law enforcement. Read more about this nursing home negligence lawsuit here.

About Extendicare

Extendicare Homes Inc. is headquartered in Milwaukee, WI. The company was recently named in a class action lawsuit for violating consumer-protection laws by advertising "quality standards above government regulations" that they failed to deliver. Extendicare is one of the largest nursing-home chains in North America. The company runs 268 facilities for up to 30,000 residents. Nearly all of Extendicare's nursing facilities have higher-than-average scores for health deficiencies and safety violations.

Nursing Home Abuse Blog Entries On Extendicare

Videotape Reveals Abuse In Kentucky Nursing Home

Poor Nursing Home Care Subject Of Class Action Lawsuit Against National Nursing Home Chain, Extendicare

Failure To Clean Trach Tube Leads To Lawsuit

Web Resource

Department Of Health & Human Services, Civil Remedies Division, decision involving Richmond Health & Rehabilitation Complex

Tags: Litigation, death, extendicare, kentucky, kenwood nursing home, nursing home negligence, punitive damages, richmond health and rehabilitation complex

Posted on March 23, 2009 by Jonathan Rosenfeld

Failure to Follow Orders Results In Death Of Patient & Hefty Fine

A nursing home cook and nursing assistant have been fired following the death of a 54-year-old schizophrenic patient at a California nursing home. The incident took place at the Raintree Convalescent Hospital. Despite the fact that Raintree documented the patient's swallowing problems and ordered all food to be sliced or pureed to accommodate his swallowing problems, the man was served whole meatballs.

According to a an investigation by the California Department of Public Health, the man stumbled out of his room, pale and unable to speak after he was served whole meatballs. A nurses attempt to do the Heimlich maneuver on the man was unsuccessful and he was pronounced dead a short time later at an area hospital.

This is a case where the facility admits that its staff failed to follow standing orders with this patient. According to Antonio Sandoval, assistant administrator at Raintree Convalescent Center, the cook and the nursing assistant ignored the residents care plan when they served whole meatballs to the man for lunch. "Neither of them did their job." he said.

This incident resulted in an $80,000 fine against the facility. Further, this reinforces Raintree's poor Medicare rating. Raintree received just one out of five stars according the Federal nursing home rating system.

Related Nursing Homes Abuse Blog Posts

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Tags: Choking, Dementia / Alzheimer's Patients, california nursing home, choking incident, death, raintree convalescent hospital, schizophrenia

Posted on March 11, 2009 by Jonathan Rosenfeld

Broken Door Alarm Cited In Investigation Of Nursing Home Residents Death

On February 2nd, Carrie 'Christine' Evans wandered from Primrose Villa Nursing Home just a few hundred yards to her death. Officials from the North Carolina Medical Examiner's office concluded that Ms. Evans' death was due to a closed head injury after a fall. The incident occurred less than 1/5 of a mile from the North Carolina nursing home. There were similar episodes where Ms. Evans' wandered from the facility prior to this incident.

The investigation into Evans' death also confirmed the following:

Primrose Villa had been visited by state inspectors 28 times in the past two years despite the fact that state law only requires quarterly inspections
The facility failed to assume referral and follow-up to meet the health care needs of residents
On the day of Evans' wandering from the facility, the door alarm was disengaged because a supervisor was not trained on how to operate it
The staff failed to document falls and other injuries despite the fact that residents received medical treatment for the injuries

As a result of the Ms. Evans' death and the subsequent investigation, Primrose Villa faces two Type A penalties and potentially two Type B penalties. A Type A violation is when a nursing home resident suffers serious physical harm and carries a potential fine of $20,000 per violation. A Type B violation is given for an incident that impacts the residents quality of care but has not been corrected despite request from the state to do so. Read more about this case of the death a North Carolina nursing home resident here.

Nursing home fines aside, I imagine a wrongful death lawsuit is in this nursing home's future. If proven accurate, the fact that this facility was aware of Ms. Evans' propensity to wander from the facility yet failed to implement preventive measures is appalling. This type of hap-hazard care needs to be prosecuted by public officials and private attorneys.

Nursing Homes Abuse Blog Entries On Wandering Nursing Home Residents

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Man Wanders 20 Ft. From Chicago Nursing Home To His Death

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Tags: Nursing Home Staff, closed head injury, death, fall, missing nursing home resident, north carolina nursing home, villa primrose

Posted on February 12, 2009 by Jonathan Rosenfeld

Woman Dies From Hypothermia After Wandering From Assisted Living Facility

An 87-year-old woman froze to death after walking out of the secured Alzheimer's unit at an Ohio nursing home. Dortha Gifford was a resident at the Heartland of Woodridge assisted living facility for the last five years. Gifford lived in the locked unit of the facility because of her propensity to wander. According to Gifford's family, she had gotten out of the assisted living facility on other occasions.

Why do these tragic themes of missing nursing home residents continue to emerge across the country? Unfortunately, the answer is not singular. Nursing homes consistently break the trust families place in them when they fail to:

Install technology updates (such as automatic locks and alarms) to their facilities that to help contain residents with a propensity to wander.
Train staff to identify residents who are likely to wander from the facility and how to search for missing residents.
Provide adequate staffing levels to look after residents. Many of the wandering incidents occur during 'off' hours when the facility is minimally staffed.

If your loved one has escaped from a nursing home or assisted living facility, the facility is likely responsible. We have helped many families recover civil damages for the death or injury of their loved one. More importantly, many of the nursing home cases Strellis & Field prosecute have led to safety improvements at many facilities and help ensure the safety of new residents.

Related Nursing Homes Abuse Blog Posts On Resident Wandering:

Fall Leaves Dementia Patient With Broken Neck At Assisted Living Facility

Nursing Homes For Alzheimer's Patients. What To Look For?

Family Sues Florida Nursing Home For Death Of Resident Who Wandered From Facilityy

How Much Freedom Should Assisted Living Facilities Give The Mentally Disabled?

Tags: Elopement / Wandering, death, heartland of woodridge, hypothermia, missing nursing home resident, ohio nursing home

Posted on January 25, 2009 by Jonathan Rosenfeld

Nursing Home Patients Stricken With Salmonella

More than 460 people have been diagnosed with salmonella that can be traced to peanut butter used in institutions. It is estimated that the salmonella outbreak has caused more than 100 of the people to seek hospital treatment. Salmonella can be especially serious in elderly people with weakened immune systems. If not quickly identified and treated, salmonella may cause death.

If you are concerned about potentially having peanut butter that may be contaminated with salmonella, check out the FDA website.

Tags: Food Poisoning, death, food poisoning death, food sickness, salmonella, virus

Posted on January 22, 2009 by Jonathan Rosenfeld

Nursing Home Fined For Negligent Care Of Resident On Ventilator

The California Department of Pubic Health has imposed the maximum fine permitted under the law against Casa Bonita Convalescent Hospital in connection with the death of a ventilator dependent resident. State regulators issued three citations against the facility for the 2007 death of the 90-year-old resident. An investigation in the incident by state authorities determined poor care led to the woman's death when staff at the facility intentionally disconnected the woman from a ventilator and shut-off a remote alarm to notify staff of problems with the machine. Read more abut this California nursing home here.

Tags: Ventilator Patients, california nursing home, casa bonita convalescent hospital, death, fine, negligence, ventilator

Posted on January 17, 2009 by Jonathan Rosenfeld

South Carolina Nursing Home Settles Claims Of Injury, Illness & Death

The C.M. Tucker, Jr. Nursing Care Center has agreed to settle allegations of poor care levied on it by the Justice Department following an eight month investigation into the state-run facility. The South Carolina facility houses 360 resident including 70 veterans and residents with long-term psychiatric illnesses.

The Justice Department conducted the report conducted the unannounced investigation under the powers granted it under the Civil Rights of Institutionalized Persons Act. In May, the investigative report was released to the public. Among the conditions cited to in the 36- page report include:

Staff failing to identify residents with swallowing problems
Failure to identify infection
Swallowing problems
Malnutrition
Failing to regularly turn residents at high risk for developing pressure ulcers
Not providing adequate pain medication
Not doing enough to prevent falls that cause injury
Inadequately investigating accusations of abuse
Unsanitary conditions

According to Grace Chung Becker, acting attorney general for the Civil Rights Division of the U.S. Justice Department, "[t]his agreement establishes systems to ensure that nursing home residents receive adequate services to meet their needs." Additionally under the terms set forth between the government and the state; the facility must keep the government informed as to staff training, reporting and evaluation. The settlement further requires staff to pay special attention to residents weight, food intake, pressure sores, pain management and report all deaths at the facility to the federal agency.

Read more about this settlement of nursing home investigation here.

Tags: National Nursing Home Issues, cm tucker nursing care center, death, illness, injury, nursing home settlement, pressure sores, south carolina nursing home, veterans nurisng home

Posted on December 29, 2008 by Jonathan Rosenfeld

It's Cold Out. Do You Know Where Your Nursing Home Resident Is?

Another completely preventable nursing home death recently made the headlines as reported in STLtoday. Employees at the Northgate Park Nursing Home left 95-year-old Fannie Mae Rooks in her wheelchair in an outdoor smoking area at the facility last week. Rooks reportedly died from exposure to the elements as she sat unattended in the cold weather. Local police investigators are trying to determine how Ms. Rooks made her way into the smoking area and how nursing home employees failed to keep track of her whereabouts.

Once again, I am amazed how nursing homes continually fail to provide even the most basic level of care to their residents. In this case, it is likely several nursing home employees were in a position where they should have seen this elderly lady sitting outside and brought her safety. Until nursing home owners are held responsible for the preventable injuries and deaths of their residents, situations involving nursing home neglect will continue to be an ongoing problem facing nursing home residents.

Tags: Neglect, death, missouri nursing home, northgate park nursing home, police investigation, smoking area

Posted on December 17, 2008 by Jonathan Rosenfeld

Recent Deaths Lead Officials To Shut Down Assisted Living Facility With Questionable Past

With two seemingly preventable patient deaths in recent weeks, officials have ordered Willow Crest Manor to be immediately shut down. An investigation of the deaths revealed multiple safety violations at the facility. "The department has determined that the conditions and the care provided here constitute an immediate danger to the residents," said Matt Jones of the Pennsylvania Department of Public Welfare.

The recent deaths include: a 49-year-old resident who died from complications related to pressure sores on her legs and the unexplainable death of a 24-year old man with cerebral palsy patient who was found dead in his room by a roommate. Pennsylvania officials doing a preliminary investigation of the matters determined that the facility had multiple violations relating to patient care in each incident.

These suspicious deaths come after the owner of Willow Crest Manor, David Mittal, has been in the headlines for allegedly choking a resident with Parkinson's for 'banging on the door'. While Mr. Mittal awaits trial for criminal charges related to his 'choking incident', a judge banned him from Willow Crest Manor and the other assisted living facilities he owns.

Why are people like put in positions where they are caring for handicapped and elderly?

Read more about the two recent deaths at Willow Crest Manor here.

Read more about the alleged choking of a Parkinson's patient here.

Tags: National Nursing Home Issues, assisted living facility, cerebal palsy, death, parkinsons, pennsylvania nursing home, willow crest manor

Posted on October 15, 2008 by Jonathan Rosenfeld

Nursing Home Workers Charged In Connection To Withholding Oxygen To Resident

Two nursing home workers in Arkansas are facing criminal charges, manslaughter and elder neglect, following the 2007 death of a resident. The charges stem from failing to plug an oxygen line into the wall spigot for an oxygen-dependent patient. By the time the workers came back to check-in on the patient her hands were blue and cold.

Upon learning of the resident's condition, the workers told the nursing director, but failed to alert the resident's family or physician that her condition was related to a lack of oxygen. Authorities believe that withholding the circumstances surrounding the lack of oxygen to the resident's physician contributed to resident's death. Read more about this incident involving nursing home neglect here.

My take is that of course mistakes--no matter how serious--happen and will continue. The real problem in this situation is that the staff failed to catch this mistake before the resident's injury became irreversible. Had a simple observation plan been in place, this situation could have been avoided.

Tags: Neglect, arkansas nursing home, criminal charges, death, elder neglect, oxygen

Posted on October 13, 2008 by Jonathan Rosenfeld

Never Event #3: Poorly Controlled Blood Sugar, Hyperglycemia & Hypoglycemia

Medicare has determined that complications associated with poorly controlled blood sugar should be included on the 'never list' as they are so easily avoidable that the costs of the treatment should not be permitted to be submitted to CMS for reimbursement. In 2007, there were 14,929 reported cases of poorly controlled blood sugar amongst diabetics in hospitals.

Hyperglycemia

Hyperglycemia develops when there is too much sugar in the blood (glucose > 180mg/dl). Hyperglycemia may be caused by skipping insulin does, infection or illness. Prolonged hyperglycemia can result in infection, slow-healing cuts and sores, vision problems, nerve damage in arms and legs, chronic constipation and death.

Hypoglycemia

Hypoglycemia develops when blood sugar levels fall (glucose < 70mg/dl). Like hyperglycemia, hypoglycemia may develop when insulin is not timely administered or if the dosage is too high. Hypoglycemia may lead to serious medical complications such as coma or death.

Importance of Monitoring Diabetic Patients

Residents of hospitals and nursing homes with diabetes must be monitored on a regular basis. Proper monitoring of diabetics should consist of not only monitoring their blood sugar levels and diet, but the medical staff must also keep track of how the residents look and behave. Special attention should be paid to residents who experience: frequent urination, weight loss, fatigue, unusual aches or vision problems.

If you or a loved one experienced an episode of hyperglycemia or hypoglycemia during a stay at a hospital or nursing home contact an experienced nursing home lawyer to learn your rights.

Tags: Medical Malpractice, death, diabetes, hyperglycemia, hypoglycemia, ketoacidosis

Posted on September 8, 2008 by Jonathan Rosenfeld

Resident Who Smoked & Used Oxygen Suspected Of Causing Fire At Assisted Living Facility

A woman was killed in a fire at the Lebanon Manner Village assisted living complex in Indiana when a fire broke out in her apartment. The other buildings in the complex were evacuated. It took firefighters more than an hour to put out the flames according to Lebanon firefighter Wheat. Thirteen apartments were damaged by flames and almost the entire building sustained some kind of damage, Wheat said. Most of the residents at the assisted living facility will remain out of their apartments due to smoke and water damage. Officials did not release a cause of the fire, but friends said the victim smoked and was on oxygen.

If the operators of this facility knew that this woman had a tendency to smoke and use oxygen they should be ashamed of themselves. Not only did they literally set this woman up to die they also put all of the other residents at this facility in jeopardy. Nursing homes and assisted-living facilities must ensure their residents' safety during fires, this includes: conducting drills, having a fire safety plane in effect and in my humble opinion not permitting people to smoke around oxygen tanks.

Read more about this assisted living facility fire here.

Tags: Burns, burn, death, fire, indiana, indiana assisted living facility, injury, lebanon manner village, oxygen tanks, smoking

Posted on September 2, 2008 by Jonathan Rosenfeld

Insulin Overdose Kills Nursing Home Resident

A nursing home resident in England died after receiving 5 times the normal dosage by a nurse at the nursing home where she resided. The woman who had Parkinson's was unable to communicate her physical needs or her insulin dosage to the nursing home employees.

An insulin overdose results in low blood sugar levels, or hypoglycemia. Symptoms of hypoglycemia include:

Anxiety
Confusion
Extreme hunger
Fatigue
Irritability
Sweating or clammy skin
Trembling hands

If sugar levels continue to fall during an insulin overdose, serious medical complications and even death. Low blood sugar is defined as less than 70 mg/dL. Hypoglycemia is defined as a low blood sugar which leads to symptoms.

Nursing homes must properly monitor diabetics blood sugar levels. Moreover, nursing homes must dispense medication in their proper dosage and at the proper times. If a nursing home makes errors with respect to medication dosage they are guilty of nursing home neglect.

Read more about this incident involving medication errors here.

Tags: Medication Errors, death, diabetics, hypoglycemia, insulin overdose

Posted on September 1, 2008 by Jonathan Rosenfeld

Heparin May Put Nursing Home Residents At Risk

Heparin is a commonly used blood thinner that has come under scrutiny for possible contamination. The FDA has recommended restricting the use of high doses of Heparin, or generally known as Bolus dosing in an attempt to limit the severity of adverse reactions to the drug. Bolus dosing is used to quickly thin blood in some patients.

The following people should be particularly aware of the Heparin contamination: hemodialysis patients, cardiovascular patients who have had surgery, photopheresis patients, plasapheresis patients and people who have had blood clots in their arteries.

There have been more than 350 complaints of adverse reactions to Heparin. The adverse reactions have been reported with the Heparin Sodium Injection multiple dose vials, 10 ml and 30 ml vials, 5000 units/ml, 10 ml vials and 10,000 units/ml, 4 ml vials. The following reactions have been reported shortly following the administration of Heparin:

Severe allergic reactions
Death
Severe nausea
Vomiting
Disphoresis
Difficulty breathing
Low blood pressure

If you were administered Heparin and experienced any of the above conditions, contact an attorney to learn your rights both individually and as part of a class action lawsuit today.

See the FDA recall of Heparin here.

Tags: Dangerous Drugs, blood clot, class action, death, dialysis, hemodialysis, heparin, phereses, photopheresis, plasmapheresis, recall lawsuit

Posted on August 31, 2008 by Jonathan Rosenfeld

Hip Fractures And Some Unsettling Statistics

Hip fractures are a frequent result of falls in nursing homes. In fact, an elderly person living in a nursing home is more likely to sustain a hip fracture while at the facility than they would living independently. Most hip fractures require surgery. The type of surgery required depends on where the break is and how bad it is. Your doctor may put metal screws, a metal plate, or a rod in your hip to fix the break. Or you may need to have all or part of your hip replaced.

The outcome for nursing home residents who sustain a hip fracture are disappointing:

17% to 33% mortality rate for the year following the fall
25% to 33% of residents are unable to walk following surgery and physical therapy
Up to 15% of hip fracture patients suffer from pressure sores

Nursing homes must take the risk of falls and hip fractures seriously. The best prevention of a hip fracture is for a nursing home to identify residents who may be at risk of falling and to have adequate staff in the facility to provide assistance to residents.

If you or a loved one has suffered a fall in a nursing home and sustained a hip fracture, the facility is responsible for damages from the initial fall, all subsequent medical care and decay in physical conditions.

Tags: Hip Fracture, Nursing Home Falls, death, hip replacement, lawsuit, pressure sore, surgery

Posted on August 26, 2008 by Jonathan Rosenfeld

Failure To Provide Medication Is A Common Error In Nursing Homes

Failure to provide medication is a common problem facing nursing home residents. Many situations involving failure to provide medication result from problems with the transition of a resident's medical charts from a hospital or facility where they were prior to their admission to the nursing home. Nonetheless, nursing homes have a responsibility to provide quality care to their residents. This includes conducting an assessment upon admission to assure all medical needs are met.

Yesterday's blog entry on the untimeliness of administration of medicatio n reminded me of a case my office is working on. In our case, a Chicago-area nursing home failed to provide insulin to our diabetic client for several months. As a result of this nursing home neglect, our client went into Diabetic Ketoacidosis. Diabetic Ketoacidosis, is a life-threatening condition that develops when diabetics do not get enough sugar into their cells. The lack of sugar results in the development of fatty acids which cause chemical imbalance.

Diabetic Ketoacidosis can be detected by monitoring the level of sugar in the blood and urinalysis. Diabetic Ketoacidosis may also be accompanied by:

Flushed, hot, dry skin
Blurred vision
Lack of interest in usual activities
Drowsiness
Rapid breathing
Breath smelling of vinegar or alcohol
Loss of appetite
Confusion

If the Diabetic Ketoacidosis is left untreated, the condition may cause brain damage or death. Unlike other situations involving medication errors, injuries due to failure to administer medication are completely preventable and result from nursing home staff neglect.

Tags: Medication Errors, brain damage, death, diabetes, diabetic ketoacidosis, failure to provide medication, insulin

Posted on August 17, 2008 by Jonathan Rosenfeld

Woman Dies From Brain Bleed Following Unsupervised Fall

Everyday nursing home residents fall. Much like a toddler learning to walk, some falls are unpreventable. Nursing home residents remain the highest risk for falling and getting injured compared with any other demographic. The most fall prone must be identified identified by the nursing home staff. Identification of individuals who are at 'high risk' for falling is only part of the solution.

After reading this newspaper article of a Montana woman who fell four times during a 35 day stay at a nursing home, I was reminded of how important is is for nursing homes to have adequate fall protection in place. Despite the fact that this resident had a medical history which put her at high-risk for falls, the facility did not take precautions. Moreover, the facility had three opportunities to put fall prevention measures into effect before the last episode when the resident fell and suffered a cerebral hemorrhage.

The Montana woman's husband and family have filed a lawsuit against the nursing home, drawing attention to the underlying cause of the woman's death- poor staffing. The lawsuit claims the facility did not have an adequate number of staff and did not properly train them.

For high-risk residents, nursing homes must have adequate fall prevention measures in place. The best fall prevention is to provide adequate number of nursing home staff to supervise residents. While federal and state laws may specify minimum staffing ratios, the fact remains that may nursing home residents who are at high risk for falling need significantly more attention than the bare-bones staffing requirement. Nursing home residents with dementia, Alzheimer's and low-blood pressure are particularly susceptible to falls.

According to Charlene Harrington, a University of San Francisco California professor, who has studied nursing home staffing, 'only 5 percent of nursing homes around the U.S. have adequate staffing." What will happen to the 95% of nursing home residents, who are exposed to chronic under-staffing, poor employee training and high staff turnover?

Tags: Nursing Home Falls, Subdural Hematoma, brain bleed, cerebral hemorrhage, death, fall prevention, inadequate staffing, lawsuit, montana nursing home, nursing home fall, staff turnover

Posted on August 14, 2008 by Jonathan Rosenfeld

World's Tallest Woman Dies In Nursing Home

7-foot-7, Sandy Allen, the world tallest woman died yesterday in an Indiana nursing home. Sandy Allen was 53-years old. Ms. Allen received care at Shelbyville Nursing Home for medical conditions related to her extreme height. Poor circulation in her legs caused Ms. Allen to rely on a wheelchair for getting about. Although Sandy Allen weighed just 6.5 pounds at birth, she developed quickly. By the age of 10, she was 6 feet 3 inches. By the time Ms. Allen was 16, she was 7 feet 1 inch. Read more about the world's tallest woman here.

Tags: National Nursing Home Issues, death, indiana nursing home, poor circulation, shelbyville nursing home, wheelchair

Posted on July 8, 2008 by Jonathan Rosenfeld

Do-Not-Resuscitate Order / DNR

End of life decisions are a difficult and often awkward decision for people to make. However, an open discussion on the subject will provide immediate family members with the ability to make informed decisions when they need to.

A DNR order does not give a nursing home the right to withhold medical treatment. Similarly, if no DNR order is on file, a nursing home must provide CPR to a resident in cardiac arrest. With or without a DNR order in place, nursing home residents have a right to proper treatment that meets their daily living needs.

A 'Do-Not-Resuscitate Order' (most commonly referred to as a 'DNR' order) is a medical treatment order stating that cardiopulmonary resuscitation (CPR) will not be attempted if your heart and/or breathing stops.

Before a DNR order may be entered into your medical record, either you or another person (your legal guardian, health care power of attorney or surrogate decision maker) must consent to the DNR order. This consent must be witnessed by two people who are 18 years or older. If a DNR order is entered into your medical record, appropriate medical treatment other than CPR will be given to you.

In addition to properly executing the legal document, it is also important to let your family, physicians, and your attorney aware of your decision to make one or more advance directives or a DNR order. If your family is aware of your advance directives / DNR orders, it will be easier for them to follow your wishes at a time when you may be unable to communicate them. If you cancel or change an advance directive or a DNR order in the future, remember to tell these same people about the change or cancellation.

All hospitals, long-term care facilities and nursing homes must follow your advance directive decisions. It is entirely your decision. If a health-care facility, health-care professional or insurer objects to following your advance directive or DNR order then they must tell you or the individual responsible for making your health-care decisions. They must continue to provide care until you or your decision maker can transfer you to another health-care provider who will follow your advance directive or DNR order.

A form DNR order is here.

Tags: Common Terms, advance directives, death, dnr order

Posted on June 29, 2008 by Jonathan Rosenfeld

Murder At All Faith Pavillion

Chicago Police charged Solomon Owasanoye, a 50-year-old West Cermak resident, with first degree murder of an All Faith Pavilion Nursing Home resident. The victim, Ivory Jackson, a 77-year old resident at All Faith Pavilion died following an assault. Mr. Jackson was struck in the head and developed an infection. All Faith Pavilion has a long history of fines for violating Illinois laws.

Residents of nursing homes and other long-term care facilities have a right to be safe and free from violence. Further, nursing homes must conduct a criminal background search to make sure no violent offenders come in contact with the nursing home population.

Read the full article here.

Tags: All Faith Pavilion, Illinois, Illinois Nursing Homes, chicago, criminal, death, murder, nursing home assault

Posted on June 22, 2008 by Jonathan Rosenfeld

Preventing Medication Errors: The List

Recently, I discussed medication errors in nursing homes. Every nursing home resident I have seen is on some type of medication or vitamin supplement. The likelihood of suffering an injury due to a medication error is higher than almost any type of treatment rendered in a nursing home. How can you prevent the medication errors from occurring?

Jeffery Levine, M.D., author of, Medical-Legal Aspects of Long Term Care, has put together a list for preventing medication errors and adverse drug reactions. Dr. Levine provides the necessary information for a family member to evaluate potential errors in the administration of medication. I highly recommend this book. Inspired by Dr. Levine, here is a listing of recommendations applicable to every nursing home and hospital patient.

Review each medication to determine its necessity

Make sure the list of medications is complete
Identify the condition for which each medication is prescribed
Determine the potential for any drug vs. drug interactions
Determine potential for any drug vs. disease interactions
Can the drug regimen be simplified?
Are there any new, safer drugs available to substitute with current medication?
Is it possible to discontinue any medication?

New medication tips

Is the diagnosis correct?
Can the condition be treated without medication?
Can a lower dosage be used?
Could the symptoms be related to another medication?
Can one drug be used to treat multiple conditions?

Inappropriate medication use

Don't try to treat every condition. It is impossible to treat every physical condition
Don't try to treat the side effects of medications
Try to have one physician prescribe all medications
Make sure each all physicians involved in a patients treatment are aware of each other

Clearly, the most important preventative measure is to take an active role in the care of your loved one. Making regular, unscheduled visits is suggested. Do not be afraid to ask questions from those who have a role in the dispensing of medications. A clarification may prevent an episode of injury down the road.

Tags: Medication Errors, adverse reaction to drugs, death, medication, medication error injury, medication error lawyer, prevention of medication errors

Jonathan Rosenfeld's Nursing Homes Abuse Blog
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