Archive for the ‘Accidents’ Category

Coming Soon? Restored Breathing for Spinal Cord Injury Patients

Wednesday, July 20th, 2011

image from msstrength.com

The online version of the journal Nature publishes an article today about a potential breakthrough in the treatment of spinal cord patients. While I do not have access to the full article, medicalnewstoday.com provides an overview of the research work. The highlight is that the researchers from Case Western Reserve University School of Medicine were able to restore breathing in rodents with spinal cord injuries.

This research provides optimism for similar success in humans (clinical trials with humans are hopefully forthcoming). In the recently released studies, the scientists combined “…an old technology a peripheral nerve graft, and a new technology an enzyme” to be able to restore 80-100% of breathing function in the rodents.

Using a graft from the sciatic nerve, surgeons have been able to restore function to damaged peripheral nerves in the arms or legs for 100 years. But, they’ve had little or no success in using a graft on the spinal cord. Nearly 20 years ago, [Jerry Silver, professor of neurosciences at Case Western Reserve and senior author,] found that after a spinal injury, a structural component of cartilage, called chondroitin sulfate proteoglycans, was present and involved in the scarring that prevents axons from regenerating and reconnecting. Silver knew that the bacteria Proteus vulgaris produced an enzyme called Chondroitinase ABC, which could break down such structures. In previous testing, he found that the enzyme clips the inhibitory sugary branches of proteoglycans, essentially opening routes for nerves to grow through.

In this study, the researchers used a section of peripheral nerve to bridge a spinal cord injury at the second cervical level, which had paralyzed one-half of the diaphragm. They then injected Chondroitinase ABC. The enzyme opens passageways through scar tissue formed at the insertion site and promotes neuron growth and plasticity. Within the graft, Schwann cells, which provide structural support and protection to peripheral nerves, guide and support the long-distance regeneration of the severed spinal nerves. Nearly 3,000 severed nerves entered the bridge and 400 to 500 nerves grew out the other side, near disconnected motor neurons that control the diaphragm. There, Chondroitinase ABC prevented scarring from blocking continued growth and reinnervation.

“All the nerves hook up with interneurons and somehow unwanted activities are filtered out but signals for breathing come through,” Silver said. “The spinal cord is smart.”

Three months after the procedure, tests recording nerve and muscle activity showed that 80 to more than 100 percent of breathing function was restored. Breathing function was maintained at the same levels six months after treatment”

From medicalnewstoday.com

This could be life-changing for those spinal cord injury patients who currently need ventilators to survive. If human studies prove the efficacy of such treatment, patients would have the hope of being able to breath on their own again. Not only would this dramatically improve these patients’ quality of life, but it would also provide a dramatically improved outcome for these patients. Currently, “[r]estoration of breathing is the top desire of people with upper spinal cord injuries. Respiratory infections, which attack through the ventilators they rely on, are their top killer.”

The BBC is reporting that “[r]esearchers hope to begin trials in humans. They are also investigating whether bladder function can be restored, which can be lost when the lower spine is damaged.”

The CDC’s most recent statistics, which are a few years old, suggest that there are currently about 200,000 people in the United States who are living with spinal cord injuries. This number increases by approximately 12,000-20,000 new patients annually. If some portion of these individuals could be provided hope for breathing on their own and or regaining bladder function, their lives could be dramatically improved.

Related Articles:

Spinal Cord Injury Updates: More Reasons for Optimism?

New Treatment Holds Promise for Patients With Spinal Cord Injuries

New Microchip Promises to Make Life Much Easier for Paraplegic Patients

How Much is Your Marriage Worth?

Friday, June 10th, 2011

When you’re injured as a result of someone else’s negligence, it’s easy to see why you have a legal claim. You are entitled to recover for the injuries that you suffered, including economic damages (lost wages, medical bills, etc.) and non-economic damages (pain and suffering). However, if you’re married, there is another category of damages that you may be able to recover – damage to your marriage. It’s called Loss of Consortium and is an important element of damages in the right circumstances. It is a legal recognition that the marital relationship itself – separate and apart from the injury to the individual – is a protected interest that is deserving of compensation if it has been harmed by the negligence of another person.

Loss of consortium has an interesting history. Under Common Law (which roughly translates to “the olden days” in this circumstance) a woman had no right to sue for loss of consortium. It was only the man who had the right. That was because the woman was essentially seen as the man’s property. If she was injured and unable to provide her usual domestic or bedroom duties as a result of someone else’s negligence, the man could recover for the loss of such services. He had basically lost some of the value of his property so he was entitled to compensation. Eventually, the courts (most courts, at least) recognized the unfairness of such a one-sided system and ruled that women could also make such a claim if their husband suffered an injury. However, there are still some states (Virginia, for example) that do not recognize loss of consortium at all, no matter who tries to bring it.

Back to the present day. A loss of consortium claim arises when one spouse suffers a serious injury that impairs the marital relationship. An easy example is if a husband suffers a traumatic brain injury as a result of a doctor’s negligence. In that circumstance, the man would be able to file a claim for his own damages, of course, but he and his wife could also allege loss of consortium because the brain injury impacts the marriage. The couple will now find it more difficult to do the things they use to do together as man and wife – going out together, caring for their children, taking vacations, intimacy, and the day-to-day marital difficulties that arise because the husband now has a brain injury. In Maryland, a jury can award monetary damages for the couples’ loss of companionship, affection, assistance and yes, sexual relations. It is notoriously difficult to put a dollar figure on such injuries, but the law recognizes the right of a husband and wife to recover financially if their marriage has been damaged. How much money to award for such injury is for the jury to decide. Like other damages, it is always the plaintiffs’ burden to prove that the marriage has been injured, which is usually done through the testimony of the husband and wife.

Speaking of intimacy, some pundits say that loss of consortium is just a code-word for damage to the couples’ sex life. This is not entirely true as the marital relationship entails far more than just sex, but these pundits have a point. A loss of consortium claim usually does include an allegation that the couples’ sex life has been impacted. If you are bringing a lawsuit, you have to understand that when you allege loss of consortium, you are opening up the door on the most intimate parts of your life. Defense attorneys will often ask highly personal questions – how often did you have sex before the injury, how often do you have sex now, how exactly does the injury make sex more difficult, have either of you ever strayed from the marriage, etc. Some couples are understandably reluctant to discuss such things. Thankfully, most defense attorneys are just as uncomfortable asking these questions as the plaintiffs are answering them, so the questions tend to be over with relatively quickly. Be aware, though, that if you do file a loss of consortium claim, your sex life may become an issue in open court.

In the District of Columbia, a loss of consortium claim is for similar damages, but with a slight difference. While in Maryland the claim belongs to both the husband and the wife and is brought by them jointly, in the District of Columbia the claim belongs solely to the non-injured spouse. Any money awarded by the jury for loss of consortium goes to the non-injured spouse rather than to the couple jointly.

Lastly, Maryland’s cap on non-economic damages applies to claims for loss of consortium. There is no separate cap for this claim. In other words, there is a single cap that applies to all allegations of injuries, whether it’s an injury to the individual or an injury to the marriage.  The Maryland Legislature does not allow a couple to receive more money for injury to the marriage above and beyond the cap, even if a jury decides that that money should be given. Just another example of how Maryland’s cap punishes plaintiffs.

Have you ever suffered an injury that impacted your marriage? Did you file a loss of consortium claim? What was the result?

Related Nash and Associates Links

Maryland’s alleged healthcare “crisis”

Insurance and Traumatic Brain Injury

Acquired Brain Injuries

 

 

Legal Boot Camp (First Class): The Story of Pam – Maryland’s Law on Earning Capacity

Thursday, May 26th, 2011

Image from cnbc.com

Wondering what “Legal Boot Camp” is all about? Check out our announcement, find out, come along, have some fun and learn some “law stuff” while you’re at it.   Please see our disclaimer at the end of this blog for a better understanding of the limitations of this series and our mission statement.

Class is now in session….

A 41-year-old woman, Pam, who was laid off from her job as a swimming instructor and swim coach in December of 2009, has been struggling to find a new position for the last few years. Even though Pam had been working as a swimming instructor full-time for the past 18 years, she felt that she needed to jump into a new career while waiting to find a new position as a swimming instructor and coach. Starting in October of 2010, her father died leaving her a rundown home that he had recently purchased with the intent of renovating it. Pam felt that she could put her physical fitness and knowledge of home aesthetics to work, not to mention the ideas she picked up watching renovations shows while unemployed, by renovating the home her father left and selling it for a profit. Since Pam thought that this could be her new vocation along with being a swim instructor, she formed a company for her new real estate and renovation business. She also bought a few additional run-down properties at auction. She started the renovations on the first house and completed a stunning new kitchen and had begun the demolition for a new bath by January of 2011. While still unemployed as a swimming instructor and before making any profit on her real estate business, Pam underwent a routine medical procedure at a local area hospital. Unfortunately, while still in the hospital following the procedure, she was severely injured and has been left paraplegic.

Now, Pam is considering filing a lawsuit as a result of the negligent care she received while hospitalized. Given the extent of her injuries, she will not be able to return to her job as a swimming instructor and she will have to hire workers if she is going to complete any additional renovations in the homes that she purchased. She may be able to work again, but not without significant assistance and not in either of her prior capacities. The question for today is what damages might she be able to claim in terms of a lost wages claim or a diminished earning capacity claim in Maryland.

Unemployment Not a Bar to Recovery for Loss of Earnings

In personal injury actions in Maryland, unemployment or self-employment without earning a profit at the time of injury are not a bar to recovery for loss of earning or loss of earning capability. In Ihrie v. Anthony, to Use of Gov’t Emp. Ins. Co., 205 Md. 296,107 A.2d 104 (1954), a woman was injured in a car accident while unemployed. She had previously worked in several jobs, both office positions and real estate work. Ihrie, 205 Md. at 303-304,107 A.2d at 107. After her injury, she was unable to continue to work in these types of positions, though there is some dispute about that. Id. at 304, 107 A.2d at 107. What is important to consider for Pam is that in the Ihrie case, the injured woman was allowed to recover. Id. at 309, 107 A.2d at 110.

The court held that “[t]he fact that the plaintiff was unemployed at the time of the accident and for several years prior thereto is not fatal to her right to recover.” Id. at 305, 107 A.2d at 107. In that case, like the one we are considering today, the woman who was injured had worked in the past and had a history of employment and wages to consider. The judges took the woman’s injuries and her past earning history into account in making their decision:

We are of the opinion that there was sufficient evidence of the permanence of the plaintiff’s injuries and of their impairing her earning power to warrant the submission of those issues to the jury and that there was sufficient evidence to serve the jury as a guide in measuring the extent of her loss of earnings.

Id. at 306-307, 107 A.2d 104, 108. Pam’s injuries and her past history of employment as a swim instructor should be presented at trial in her claim for loss of earnings. The past year and a half of unemployment should not bar her recovery since she has an eighteen-year history of employment to measure her loss of earnings for the future.

Can She Recover for Her Business?

What about Pam’s fledgling real estate business? She was working herself on the houses, which she will not be able to do moving forward. In order to complete the renovations and sell the homes, she will have to hire renovators at a significant expense. Since her business did not yet have a profit, she does not have the same sort of earnings history as she does for her past job as a swim instructor. However, she may still be able to recover for a loss of earning capacity.

In Anderson v. Litzenberg, 115 Md. App. 549, 694 A.2d 150 (1997), the court found that if someone is self-employed in a not yet profitable business at the time of their injury, they may still be able to recover for their loss of earning capacity. The case examined the situation of a man who was injured in an accident while he was partially self-employed in a real estate business that was not making a profit. Id. The court examined the question of loss of earning capacity. Id. The court defined impairment of earning capacity as the “lost capacity to earn, rather than what a plaintiff would have earned.” Id. at 572, 694 A.2d at 161 (internal citations omitted). The court explains that:

It is generally recognized that impairment of earning capacity seeks to compensate the plaintiff for a reduction in his ability to earn through his personal services. Once the fact of impaired earning capacity is established, the plaintiff must submit evidence so that the extent of the impairment can reasonably be determined. The prevailing proper measure of lost earning capacity is the difference between the amount that the plaintiff was capable of earning before his injury and that which he is capable of earning thereafter. Essentially, the plaintiff must establish the disparity between the market value of his services before and after the injury.

The objective is to place [the victim] in the same economic position as would have been … had the injury not occurred. We seek to accomplish this goal by a formula which … consists of determining what [plaintiff's] annual earning power would have been but for the injury, deducting what it will be thereafter, multiplying the result by [plaintiff's] expectancy, and discounting the product to present value.”

Id. at 572-73, 694 A.2d at 161-62 (internal citations omitted). This would be the formula that would need to be considered in Pam’s case. The necessary proof would need to be provided of Pam’s former earning capacity before her injury and whatever earning capacity she has with her injury. However, Anderson makes clear that the specificity of earning capacity need not be as great as that of lost earnings – as it would be nearly impossible to know for certain what sort of profit Pam might make in the future. See id.

There are many factors to consider when deciding whether to file a personal injury action for medical malpractice. One of the considerations is certainly whether the potential damages award makes it worthwhile to undertake the costs of litigating for the wrong inflicted upon the injured party. Have you ever been involved in a case involving lost earnings or loss of earning capacity in a personal injury case? Was there unemployment involved? This seems likely to be a more frequent question with the current economic realities in our country.

Related Posts:

Every bad outcome or injury does NOT a malpractice case make! Some practical advice.

Should you sue a healthcare provider? Some guidelines to help you decide.

 

Disclaimer: As is the case with all of our blogs and the writings posted on our website, we are not offering legal advice to our readers. This information in our series,Legal Boot Camp, is being presented in the hope that we can provide some education about the law in Maryland and the District of Columbia. The law in the field of personal injury (and particularly in our sub-specialty of medical malpractice) can be complex and confusing at times. Even in these two jurisdictions where we are licensed to practice, the laws and their interpretation by the courts can vary significantly. It is simply our hope that by presenting this series – Legal Boot Camp - that we can provide a better understanding of some legal principles that can come into play when bringing a civil claim or lawsuit for damages as a result of the wrongdoing of others.

For those who do not live in either Maryland or the Washington, D.C., we hope that we can at least raise some issues for you to consider when you speak with an attorney licensed to practice in the state in which you live. Many times the basic concepts of law are similar. We hope that by raising some of these issues applicable to Maryland and the District of Columbia, you will at least have a basic understanding of some terms and principles that may apply to your situation. Don’t be afraid to raise these issues with your attorney. Education – be it in law or medicine – is our main goal.

 

Acquired Brain Injuries: Causes and Impact

Tuesday, May 17th, 2011

On the heels of Jason Penn’s blog regarding calling “911″ for signs of a possible stroke, I decided to introduce a variety of acquired brain injuries for further discussion in future blogs since damage to the brain results in some of the most catastrophic injuries possibly sustained by the human body with significant “collateral damage” for all of the friends and family involved in the individual’s life.

What is an “acquired brain injury”?

Wikipedia defines acquired brain injury as damage to the brain occurring after birth but not including neurodegenerative diseases, such as Parkinson’s or Alzheimer’s, that occur later in life.  These injuries can further be divided into traumatic and non-traumatic acquired brain injuries.

Traumatic brain injuries are a result of some kind of trauma to the cranium/brain, but the actual causes can vary significantly. Trauma, in general, is the leading cause of death in the young-adult age group. An obvious example of a significant head trauma is the gunshot wound to the head sustained by Arizona Representative Gabrielle Giffords earlier this year. Other examples are assaults with blows to the head, falls with blows to the head, car or bicycle accidents with head injuries, sports-related head injuries/concussion, childhood playground head injuries, and even damage sustained during brain surgery. The degree of damage and permanent sequellae obviously varies as well, ranging from fully recoverable within a few days to catastrophic permanent deficits and even death. Interestingly, the amount of external damage (or lack thereof) does not necessarily reflect the damage inside the cranial vault.

Non-traumatic acquired brain injuries, on the other hand, have a wide range of etiologies not related to head trauma that have just as wide of a range of catastrophic effects and recovery times. One of these causes is a stroke, as described by Jason Penn; however, strokes can be either ischemic (blockage of blood flow to the brain by, for example, a blood clot) or hemorrhagic (when a blood vessel in the brain ruptures), and each is treated very differently!  Other possible causes are infections, brain tumors, failure of other body organs (liver, kidney), loss of oxygen delivery to the brain (heart attack, blood clot in lungs), other chemical or drug ingestions with toxic effects, aneurysm rupture, and build-up of carbon dioxide in the blood stream from other lung pathology, including smoking!

A Virtual Tour of the Brain

Described as the most complex organ in the human body, the brain has been the subject of numerous educational videos, which attempt to give the layman a better understanding of the parts and functions of the human brain. YouTube has numerous “brain anatomy” videos for you to peruse. Here’s one from the University of Bristol that does a good job of providing the basics of this incredible organ.

httpv://www.youtube.com/watch?v=9UukcdU258A

Effects of Brain Damage

The brain is the body’s 3-pound computer that controls every conscious and unconscious function of the body. Different areas of the brain control different cognitive, behavioral and emotional functions as well as the everyday metabolic functions of the body. Damage to specific areas of the brain result in specific functional losses, which is why someone with a “stroke” might experience numbness and weakness of one side of the body or no weakness but loss of balance or loss of vision. Larger injuries result in more brain tissue damage and more functional deficits. The object of “the game” is to rapidly diagnose the problem and rapidly treat the problem in order to minimize the amount of brain damage, and thus, minimize the functional deficits. Many acquired brain injuries progressively worsen due to different “normal” pathophysiologic mechanisms. It is imperative to intervene sooner whenever possible.

A Personal Story

My uncle had a stroke 1 month ago while working in the yard.  ”911″ was called immediately, and he was transported to the closest hospital.  He apparently had an undiagnosed abnormal heart rhythm (atrial fibrillation) that caused a large blood clot to form in the heart. This clot ultimately got pumped out into the carotid artery and lodged itself at the beginning of the middle cerebral artery on right side of his brain.  He was initially unconscious, but he later “came to”, only to deteriorate into unconsciousness again as the brain swelled from the blocked artery and infarcted brain tissue. He was transferred to another hospital that was capable of performing brain surgery, and he had back-to-back brain surgeries on 4/10 and 4/11 to try to minimize the damage. They actually had to remove a large part of his skull to allow for the brain swelling to occur without the brain’s tissue being compressed against the skull so as to prevent herniation of the brain.

He was in a coma for several days, but he is slowly making some recovery. In the meantime, he needed a tracheostomy and feeding tube in his stomach, both of which he still has. His entire left side remains completely paralyzed. It is difficult for him to stay awake, although he does seem to know who is around at any given time. My aunt, God bless her, has spent the last month at the hospital, 8 hours or more every day, and she is just exhausted. It is unclear when he will be going home or even if he will be going home. We are hoping and praying for the best recovery possible, but the future remains uncertain.

Collateral Damage

In addition to the person affected by acquired brain injury being functionally limited, whether temporarily or permanently, there is often collateral damage to himself/herself as well as to friends and family members. Emotional issues often arise, whether through mood disorders like depression and anxiety, or with actual personality changes. Those affected can become more belligerent or difficult, angry, withdrawn, and a host of other characteristics, making it very difficult on the person caring for the affected individual. The physical demands alone can overwhelm the care-provider (like bathing, toileting, feeding, transporting to appointments, etc.) and lead to care-provider stress and mood disorders.  Financially, these injuries are often devastating. Marriages end; relationships among family members suffer; sometimes, physical abuse and neglect can even occur when frustrations become overwhelming.

There are support groups available many of which can be accessed through local hospitals, associations or your health department.

Locally, you may want to visit the Brain Injury Association of Maryland and the Brain Injury Association of Washington, D.C.

Stay posted for more details on some of these causes of acquired brain injury specifically. In the meantime, do you have a story to tell?

 

Image from neuroskills.com

Shaken Baby Syndrome – What We All Should Know To Prevent Child Abuse

Wednesday, April 6th, 2011

Shaken-Baby Syndrome - image: mydochub

Some people should think twice before becoming a parent.  According to the Medical Examiner’s Office in Hampton, Virginia, Natalynn Hamrick died on February 3, 2011 from a brain injury after being shaken by her mother. Natalynn was only eleven months old. Her mother, who is now the subject of a criminal investigation, reportedly told the police that she shook Natalynn while trying to put her in the car seat.

Believe it or not, there is an actual syndrome that describes what happened to Natalynn. It’s called Shaken Baby Syndrome (SBS, also referred to as “Abusive Head Trauma” ) – “a form of physical child abuse that occurs when an abuser violently shakes an infant or small child, creating a whiplash-type motion that causes acceleration-deceleration injuries.”

The injury usually ensues as a result of very violent shaking, which then produces an accelerated rotational movement of the head.  This type of movement may cause the brain to move/rotate within the skull cavity, resulting in trauma to brain tissue.  There may be associated bleeding around the brain caused by torn blood vessels. The bleeding usually leads to pulling within the skull (i.e., subdural hematoma), which in turn can cause additional brain injury by exerting pressure on the brain and causing it to move or herniate.

Diagnosing less severe cases of SBS can be difficult because the child may not initially manifest any signs or symptoms. Radiographic studies may be used to diagnose bone fractures or brain bleeds. An important external manifestation could be bleeding in one or both eyes. The pupils may be blown and/or unresponsive. The following are some additional signs and symptoms:

  • Lethargy / decreased muscle tone
  • Extreme irritability
  • Decreased appetite, poor feeding or vomiting for no apparent reason
  • Grab-type bruises on arms or chest are rare
  • No smiling or vocalization
  • Poor sucking or swallowing
  • Rigidity or posturing
  • Difficulty breathing
  • Seizures
  • Head or forehead appears larger than usual or soft-spot on head appears to be bulging
  • Inability to lift head
  • Inability of eyes to focus or track movement or unequal size of pupils

Some of the long-term consequences of SBS include:

  • Learning disabilities
  • Physical disabilities
  • Visual disabilities or blindness
  • Hearing impairment
  • Speech disabilities
  • Cerebral Palsy
  • Seizures
  • Behavior disorders
  • Cognitive impairment
  • Death

Babies are more prone to develop SBS symptoms because their heads are relatively large when compared with the size of an adult head (i.e., on average a baby’s head represents about 25%of his/her total body weight).  Additionally, babies have relatively weak neck muscles that we not fully capable of supporting the head. Also, a baby’s brain is not fully developed, making it more susceptible to traumatic injury.

The following  prevention measures can easily be implemented to reduce the possibility of SBS injuries:

  • NEVER shake a baby or child in play or in anger. Even gentle shaking can become violent shaking when you are angry.
  • Do not hold your baby during an argument.
  • If you find yourself becoming annoyed or angry with your baby, put him in the crib and leave the room. Try to calm down. Call someone for support.
  • Call a friend or relative to come and stay with the child if you feel out of control.
  • Contact a local crisis hotline or child abuse hotline for help and guidance.
  • Seek the help of a counselor and attend parenting classes.
  • Do not ignore the signs if you suspect child abuse in your home or in the home of someone you know.

April is the National Child Abuse Prevention Month. If you suspect that a child is being abused, be proactive and take steps to allow for timely intervention.  Share your knowledge about SBS with your friends and family because no child should ever have Natalynn’s fate.

4 Tips for Car Seat Safety

Wednesday, March 30th, 2011

Image from www.baby-safety-concerns.com

Most parents now know that car seats are essential for young children riding in cars. In today’s post, I am going to provide some updated information and lesser-known tips that might help keep your kids safer in their car seats. Does all of this matter? I think so. A recent article on healthychildren.org says that deaths in motor vehicle crashes are still the leading cause of death for young children:

While the rate of deaths in motor vehicle crashes in children under age 16 has decreased substantially – dropping 45 percent between 1997 and 2009 – it is still the leading cause of death for children ages 4 and older. Counting children and teens up to age 21, there are more than 5,000 deaths each year. Fatalities are just the tip of the iceberg; for every fatality, roughly 18 children are hospitalized and more than 400 are injured seriously enough to require medical treatment.

So how can you keep your children safer?

1. Keep Children Rear-Facing As Long As Possible

Parents often switch their toddlers into forward facing seats on or around their first birthdays. For many years, the AAP and others have recommended that children remain rear facing until they were at least 1 year old and 22 pounds. Many parents and caregivers thought that this meant that this was the appropriate age and weight to turn children around. I know plenty of parents who were elated to turn their children’s car seats around so that their kids could “see something” or so that their legs would not be cramped. Unfortunately, this is just not safe.

The new AAP recommendations, released last week, are grounded in safety research and the advice that many car seat advocates have emphasized for years. These recommendations call for children to remain rear facing as long as possible – at least until they are two years old and often beyond. A recent New York Times article explains that a 2007 study from the University of Virginia found “…that children under 2 are 75 percent less likely to suffer severe or fatal injuries in a crash if they are facing the rear.” That is a pretty compelling statistic.

I am excited about this new recommendation because I hope that it will encourage parents to consider keeping their children rear facing for much longer. I have kept both of my children rear facing far beyond their first birthdays.  In fact, my two year old is still happily rear facing. We have a car seat that allows rear facing until 45 pounds and my daughter is only about 23 pounds now. I doubt that she will stay rear facing until she is 45 pounds, but she will certainly stay that way for as long as possible.

My decisions were based on both safety and selfish reasons. First, the selfish reason: my first child was a kid who would sometimes fall asleep in the car on long trips. I realized that once we faced him forward his head would hang uncomfortably if he fell asleep and he would be much less likely to rest comfortably then rear facing when he was reclined enough to slumber with full support to his head and neck. Second, the safety reason is that we have relied on the assistance and expertise of Debbi Baer when installing our car seats for several years. Ms. Baer, “a labor and delivery nurse in Baltimore who has been a car safety advocate for children for more than 30 years,” is quoted extensively in the New York Times article (http://www.nytimes.com/2011/03/22/health/policy/22carseat.html), along with her daughter “Dr. Alisa Baer, a pediatrician at Morgan Stanley Children’s Hospital in New York.” Dr. Baer told the Times “she felt so strongly that if a parent wants to install a forward-facing seat for a child younger than 2, “I tell them, ‘If you really want to make a stupid decision for your child, you can do it, but I’m not going to help you.’ ”” Her mother’s attitude seems from our experience to be the same!

2. Don’t Rush Any of the Transitions – Car Seat to Booster to Seatbelt

In the The New York Times article , the AAP policy’s lead author says

“Our recommendations are meant to help parents move away from gospel-held notions that are based on a child’s age,” Dr. Durbin said. “We want them to recognize that with each transition they make, from rear-facing to forward-facing, to booster seats, there is a decline in the safety of their child. That’s why we are urging parents to delay these transitions for as long as possible.”

Therefore the same prudence should apply in making the transition from car seat to booster and ultimately to a regular seat.

The National Highway Traffic Safety Administration has created a nice flyer about the new recommendations.

The advice seems to boil down to a few key elements.

  • Keep kids rear facing as long as allowed by the seat.
  • Forward facing children should be in a 5-point harness as long as the seat allows
  • Only transition to a belt-positioning booster when children have outgrown the car seat with a harness
  • Keep kids in a belt-positioning booster until they are at least 4 feet 9 inches tall and 8-12 years old

3. Skip the Coats – Cover Kids Instead

Winter weather creates another potential danger about which many parents are unaware.  One of the keys to car seat safety is having straps that fit snuggly on the child. If kids are dressed in bulky winter clothing – particularly puffy type coats – those clothes can compress in an accident and leave the straps too loose for kids to be safety secured. To counter this dangerous possibility, most car seat experts recommend that parents always remove winter coats before strapping their children into a car seat. Instead, they recommend placing a coat or a blanket on top of the child after the child is safely and snuggly secured in the car seat. This way, the child stays warm without having any risk of the straps being too loose. If this seems to be a hassle, there is a whole group of both small and commercial companies and individuals out there who make poncho type coats that can be pulled up for the child to be strapped in safely. It is also a good idea to be in the habit of checking the snugness of the straps every time you strap your child.  For more details about winter coats in cars, check out this article.

4. Check the Installation!

All of the suggestions above are critical for safety, but none more so than making sure that your car seat is installed properly in the first place. If the car seat is not installed safely, having the child in the correct seat and having the child buckled properly will not be of nearly as much help. It is a commonly quoted statistic that 70% or more of children are not properly restrained. The good news is that help is available. At seatcheck.org you can find a listing of places near to you where you can get free or low cost assistance in properly installing your car seat. These experts can also check to make sure that the seats you have already installed are installed properly.

You may also want to watch this video from Dr. Alisa Baer, “the Car Seat Lady” -

httpv://www.youtube.com/watch?v=ULJ8Vx79Vv4&feature=player_embedded

Do you have other safety tips for car seats?  If so, share them with the rest of us!

Many doctors don’t blow whistle on colleagues

Friday, July 16th, 2010

Picture this scenario:  You are a doctor, and one of your very closest friends is also a physician.  You know for a fact that he/she has a terrible substance abuse problem and/or it has become readily apparent to you that they are incompetent within the practice of medicine.  You see it day in and day out.  There have been a few “close calls” where your friend’s impairment could have caused catastrophic results to one or more of their patients.  Your friend conceals their problems well.  What would you do?

A new study recently published by the American Medical Association (AMA) addresses this and other similar scenarios.  How frequently this occurs and why more physicians don’t report their colleagues’ problems were highlighted in a recent article in the USA Today, that reviewed the AMA’s study:

A surprising 17% of the doctors surveyed had direct, personal knowledge of an impaired or incompetent physician in their workplaces, said the study’s lead author, Catherine DesRoches of Harvard Medical School.

One-third of those doctors had not reported the matter to authorities such as hospital officials or state medical boards. The findings, appearing in Wednesday’s Journal of theAmerican Medical Association, are based on a 2009 survey of 1,891 practicing U.S. doctors.

There are several reasons for not reporting colleagues to the proper agencies.  Most notably, the fear that their colleagues would lose their medical license and livelihood.  However, as the article details, doctors have an ethical obligation to report other practitioners’ substance abuse problems and lack of competency issues:

The American Medical Association and other professional groups say doctors have an ethical obligation to make such reports. And many states require doctors to tell authorities about colleagues who endanger patients because of alcoholism, drug abuse or mental illness.

“I don’t think there’s any excuse for less than 100% of physicians holding true to these ideals,” said Dr. Matthew Wynia, director of the AMA Institute for Ethics.

Despite these ethical protocols, the concern and problems with non-reporting continue. So again we ask, what would you do in this situation, and what do you want to see done to correct this apparent problem within the medical profession?

The Hidden Dangers of Button Batteries

Wednesday, July 14th, 2010

Sunday evening, immediately after putting our two year old to bed, my wife and I watched 60 Minutes and settled in to begin to enjoy what we thought would be a ‘relaxing’ evening.  Unfortunately, one of the lead stories that the program featured involved the dangers of ‘button batteries’.  These batteries are especially dangerous to small children, because, as I learned from the show, the electrical current of the battery, once stuck in the esophagus, literally burns through the tissue surrounding it, causing holes in the esophagus.  They are also, unfortunately, very easy to get stuck in a child’s throat.

My mind starting racing; “OK, what products do we have in the house that are powered by button batteries?”  My concern was well-justified, as the vast majority of these tragic incidents occur to children under the age of four.  Scouring the internet this morning, I found several articles warning the parents of small children about dangers they should heed.  Sadly, I also saw blogs from the parents, in which they recount how they lost their child because of such a tragedy.  These products are not the subject of recalls, mind you.  These are batteries found in everyday products that you may have in your home.  The damage can be permanent and may effect your child’s ability to eat and drink permanently.

I found a warning on-line from the Consumer Product Safety Commission (CPSC), going all the way back to March of 1983, almost 30 years ago:

Technologic advances in electronic miniaturization have increased the availability of miniature (button) batteries in homes..in watches, calculators, cameras, hearing aids, and games. Although the vast majority of these button batteries, when accidentally swallowed, will pass through the person without any problem, occasional severe complications and even fatalities have been reported. Batteries may become lodged in the esophagus or intestine, slowly leaking alkaline electrolytes and causing an internal chemical burn.

Battery ingestions are preventable. Important prevention and treatment information is available based on preliminary results of a National Button Battery Ingestion Study conducted by Dr. Toby Litovitz, director of the National Capital Poison Center, of 62 button battery ingestions reported to the National Capital Poison Center in the past 9 months, 59% involved batteries that were left out loose rather than properly discarded or stored; 39% of the batteries were in the product they were intended for, and removed from the product. Half of these batteries were in hearing aids.

Fast forward to the present, and the warnings are all over the place.  In a recent article from examiner.com out of Baltimore, the urgency of getting the button battery out of the child as soon as possible is emphasized, due to how quickly damage can occur to the child’s throat:

The research also found there is only a two hour window to get the batteries out when lodged in the esophagus, which is less time than previously reported. Delayed removal can result in serious injuries such as tissue tears, burning, and internal bleeding .

Where can these batteries be found, and what can we do to help safeguard our children? A recent Reuters article provides us with some guidance:

They warn parents to keep not only loose batteries out of children’s reach, but also the household products that contain the batteries. In about 62 percent of cases where a young child swallowed a button battery, the child fished the battery out of a household item.

For an additional barrier, the researchers advise parents to place strong tape over the battery compartment of all household products.

They urge extra caution with any 20-mm lithium cell batteries, which can be recognized by their imprint codes — usually CR2032, CR2025 or CR2016.

On a final note, another danger is that doctors sometimes misdiagnose the injury, as the symptoms can be non-specific at times:

The current study found that in the majority of fatal or severe injuries, no one had seen the child swallow the battery. And because the symptoms of poisoning are non-specific — such as fever, vomiting, poor appetite and lethargy — doctors often initially misdiagnosed the problem.

Of course, the key is not to let your child get a hold of these ‘button batteries’ to begin with.  We strongly urge you to check your homes for these products and to take the appropriate steps to safeguard your family.  We are also again providing the link for the CPSC, as we have previously done so many times in our website‘s blog, for additional follow-up information.



New National ‘Pool Safely’ Campaign Initiated to Save Children’s Lives

Tuesday, July 6th, 2010

Approximately a month ago, we featured a blog on our website that dealt with child safety; specifically, safety in and around a pool.  Now, with record high temperatures hitting most of our local areas, we thought it worthwhile to further detail these safety issues and concerns, as more and more of us and our children head for comfort in the area local pools.  The Consumer Product Safety Commission (CPSC) has actually done that for us, through a national campaign that they have recently started, entitled ‘Pool Safely’:

The U.S. Consumer Product Safety Commission (CPSC) today kicks-off the Pool Safely campaign (www.poolsafely.gov), a first-of-its-kind national public education effort to reduce child drownings and non-fatal submersions, and entrapments in swimming pools and spas. At a press conference at the Fort Lauderdale Aquatic Complex today, Olympic swimmers Jason Lezak and Janet Evans joined Inez Tenenbaum, Chairman of the CPSC; U.S. Rep. Debbie Wasserman Schultz (D-FL); and Nancy Baker, mother of Virginia Graeme Baker, to officially launch Pool Safely and release the CPSC’s annual submersion and entrapment reports.

Please note that the campaign is NOT just about pool drownings and submersions; it also focuses on “entrapments”.  Entrapments should not be overlooked because sadly and tragically entrapments occur more frequently than one may think.  An entrapment occurs when a child is literally stuck to the pool floor at or near a drain site, where the suction force is so great, that the child is unable to break free from the suction, thereby causing the child to drown.  The statistics speak for themselves within this year’s memorandum drafted by the CPSC.

The campaign also details preventative measures for parents to take note of and remember, in addition to providing the tragic statistics regarding accidental child drownings:

The Pool Safely campaign will deliver an important and simple message: just adding an extra safety step in and around the water can make all the difference. Your greatest water safety assurance comes from adopting and practicing as many water safety measures as possible, including: barriers that completely surround the pool with self-closing, self-latching gates; staying close, being alert, and watching children at the pool; learning and practicing water safety skills (knowing how to swim and perform CPR); and having the appropriate equipment (compliant drain covers, alarms, barriers and sensors).

We encourage our readers to review all of the links within this article. We sincerely want you to be better aware and prepared as we go through a summer of intense heat.  It looks as if the heat is here to stay for awhile, and pools can be a great source of fun relief, if the proper safety precautions are followed.

Deaths of Infants in Cars Increasing with Summer Heat; Important Safety Reminders!

Monday, June 28th, 2010

The Associated Press (AP) has just posted a troubling article, one that should grab the attention of every parent who has a child that uses a car seat.

Unfortunately, with the summer comes the heat.  Already this season, we are seeing high temperatures that are matching or breaking records in the Mid-Atlantic Region.  It is with this in mind that we share excerpts from the AP article that we want you to remember, especially when transporting the ‘precious cargo’ that sometimes falls asleep in the back seat of a car:

Safety groups such as Kids and Cars and Safe Kids USA urge parents to check the back seat every time they exit the vehicle and to create a reminder system for themselves.

Some parents leave their cell phone or purse on the floor near the car seat to ensure they retrieve it along with the child. Others remind themselves by placing a stuffed animal in the car seat when the child isn’t using the seat and putting the toy in the front seat when the child is tucked in the car seat.

Unfortunately, not all parents are using these and other simple measures, to remember to never leave a child unattended in a vehicle.  Accidents happen, yes; unfortunately, these accidents can turn deadly when a child is trapped in a car in the intense heat.  As the following tragic scenario illustrates, the temperature in the car in this devastating loss was not survivable:

In Portageville, Mo., 2-year-old twins Allannah and Alliya Larry were found dead in their grandmother’s car on June 16 as temperatures pushed into the mid-90s. New Madrid County Sheriff Terry Stevens said the children apparently got into the unlocked car on their own and were locked inside the vehicle for two hours.

When investigators arrived, he said, the temperatures inside the car had surpassed 140 degrees.

The number of heat-related deaths of children in cars is dramatically increasing, so much so that “the government’s highway safety agency issued a consumer advisory this week that included a warning for parents not to leave children unattended in or near a vehicle.”

We leave you with these sobering statistics, including research done by Jan Null, an adjunct professor of meteorology at San Francisco State University:

The spate of deaths in June has caught the attention of safety advocates because July tends to be the most deadly month for children trapped in hot cars. With a week left in June, the number of deaths has already surpassed the previous record of 17 fatalities from January to June 2009, according to Null’s data.

In 2005, when Null counted a record 47 child hyperthermia fatalities, only 12 of the deaths occurred through the end of June.

Since 1998, Null has documented 463 child deaths involving heat exhaustion inside cars and trucks. Safety advocates said the deaths have been more prevalent since the mid-1990s when parent-drivers were required to put their children in the back seat, where they are safer in transit but more likely to be forgotten.

Please take precautions to make sure that you do not leave any child in your vehicle unattended for any length of time.