Archive for the ‘Announcements’ Category

West Nile Virus is Back in D.C. -Things You Should Do to Stop the Spread

Wednesday, October 12th, 2011

Last week, the D.C. Department of Health confirmed this year’s first case of West Nile Virus (WNV). WNV is a bird disease. However, infected mosquitoes can transmit the virus to humans. Otherwise, this disease cannot be transmitted directly from a human or a bird.  Persons infected with the West Nile Virus may experience severe headaches, fever, nausea, vomiting, muscle aches, pain, and stiffness.

While the risk of a WNV infection is low, individuals who are immunocompromised should be particularly careful and seek medical attention if symptoms are present. Individuals with weak or suppressed immune systems include the elderly, young children and those prone to infections (e.g., HIV/AIDS patients).  The key is to implement measures to reduce exposure to mosquitoes. Individuals at risk should wear long-sleeved shirts and pants. Mosquito repellent should be used as well.

Every year, the Department of Health conducts WNV testing throughout the District, particularly in areas where infections have been reported. If you live in an affected area, you might receive additional information from the Department. Larvicide may be sprayed in your neighborhood. Should you require additional information about WNV, feel free to contact the D.C. Department of Health.

In the meantime, while mosquitoes are still flying around, here are a few things you could do stop the spread of the WNV:

1.  Dispose of cans, bottles and open containers properly.  Store items for recycling in covered containers.
2.  Remove discarded tires. Drill drainage holes in tires used on playground equipment.
3. Clean roof gutters and downspouts regularly.  Eliminate standing water from flat roofs.
4. Turn over plastic wading pools, wheelbarrows, and canoes when not in use.
5. Cover waste containers with tight-fitting lids; never allow lids or cans to accumulate water.
6. Flush bird baths and potted plant trays twice each week.
7. Adjust tarps over grills, firewood piles, boats or swimming pools to eliminate small pockets of water from standing   several days.
8. Re-grade low areas where water stands; clean debris in ditches to eliminate standing water in low spots.
9. Maintain swimming pools, clean and chlorinate them as needed, aerate garden ponds and treat with “mosquito dunks” found at hardware stores.
10. Fix dripping water faucets outside and eliminate puddles from air conditioners.
11. Store pet food and water bowls inside when not in use.

Please share this information with your friends and neighbors.

Attention Ward 7 & 8 Residents! Your Input is Needed!

Monday, September 12th, 2011

Are you living in Southeast and wondering how your money is being budgeted and spent?  Concerned about the direction of the United Medical Center?  Now is the time to act!

Let’s start with a little bit of background for anyone that is not living in Southeast or familiar with United Medical Center (formerly known as Greater Southeast Community Hospital.)  For years United Medical Center has struggled to pay its bills. In 2006 and 2007, the hospital was in danger of closing, requiring the city to step in to save it.   The Not-for-Profit Hospital Corporation, commonly known as United Medical Center, was established on July 9, 2010 through special legislation. Since then, the new leadership team, its medical staff, and nurses, clinical and support staff claim to be making major improvements in their quality of care, customer service, patient safety and campus security. The facility, which serves many of the city’s poorest residents, also received a new roof and generators, major improvements to the emergency department and replacement of nearly all radiology equipment.  Putting the hospital’s claims aside, have you noticed a difference?

The hospital has replaced most patient care diagnostic, monitoring and therapeutic equipment and upgraded most hospital physical plant systems. Over 75 physicians have joined the medical staff.  With changes being made everyday, now is the time to give your input and share your experience with the City Council.

On Thursday, September 29, 2011, at 10:00 a.m., Room 500, 1350 Pennsylvania Avenue, NW, Washington DC 20004, a public hearing will be held on issues related to the financial management of the hospital.  This hearing will be open to the public; however, only invited witnesses will be permitted to provide oral statements.  Members of the public may submit written testimony which will be made part of the official record.  Copies of written statements should be submitted to the Committee on Health no later than Thursday October 6, 2011.

Sufficiently concerned?  Make certain that you attend the hearing or, at a minimum, submit your written statements to the committee.

 

We’re Launching a New Facebook Page for Washington, D.C.

Saturday, September 3rd, 2011

Washington, D.C. - D.C. Court of Appeals Building

By: Brian Nash, Editor 

We are very pleased to announce the launching of our new Facebook page, DC Eye Opener. For the many thousands of readers who have read our posts in Eye Opener over the past twenty or so months, we want to let you know that we will be continuing to post there as well.

Our blawgers have been posting articles and commentaries on issues relating to health, law and medicine for almost two years now. We have had over 150,000 visitors to our site since our inception. We thank each and every one of you who have stopped by and read our posts – particular thanks to our many subscribers.

So Why Washington, D.C.?

Well, the answer is quite simple – it’s one of the primary places where we practice law.

I moved from New Jersey to Washington, D.C. in 1965 and attended The Catholic University of America in Northeast D.C. While in college, I worked at the Safeway on 12th Street (sadly no longer there) as a grocery clerk and produce man, just up the road from Turkey Thicket and Providence Hospital. After I graduated from CUA, I taught for two years at Bullis Prep in Potomac, Maryland. I attended law school at the Columbus School of Law (Catholic University Law School) and obtained my Juris Doctor in 1974. I was admitted to the D.C. bar in 1976, two years after being admitted to the Maryland bar. I have been trying cases in the District of Columbia ever since. Frankly, I’ve lost track of the number of cases I’ve handled in D.C. over the years. There have been so many trials in the local and federal courtrooms of Washington, D.C. that some suggested I give up my office space and simply take up residence in the hallways of the Superior Court or in the federal district court across the street.

A number of the lawyers I began practicing with have now become judges on the Superior Court and the United States District Court for the District of Columbia. A few of my former law partners have donned the black robe and have made quite a career for themselves in the Superior Court. I am proud and pleased to call them my colleagues and my friends.

During the early part of my career, I represented numerous D.C. individuals, corporations and healthcare providers as a defense lawyer. As you can no doubt tell from our website, we are now representing people injured through the wrongdoing of others. It has been a wonderful journey, which continues on. Our lawyers at Nash & Associates, Marian, Mike, Jon and Jason, are all admitted to the District of Columbia bar as well as the Maryland bar. (Sarah Keogh is presently admitted to the Maryland bar only – we’re working on her to add D.C. to her impeccable credentials.) Simply put – the District of Columbia is our turf. One of our offices is located on Connecticut Avenue, N.W., just a half a block from the Red Line’s Farragut North Station on Connecticut and K Streets, N.W.

So Why the New Facebook Page for D.C.?

What we have seen and learned in our social media activities of blogging, Facebook, Twitter and LinkedIn is that our message can become diluted through worldwide distribution. We decided we needed to narrow our audience. Put another way, so many times we wanted to post information about what’s happening in law, medicine and health in the District of Columbia, but when your readers are from around the globe, there’s not much interest in the message and information if it’s just about Washington, D.C. Now we want to share our message and get to know you, who live and work in the District of Columbia. Frankly, our readers throughout the United States – “outside the Beltway“ as they say – don’t really care much about what’s happening in D.C.  Well we do and we know you do too!

Our Mission

Simply put, we’re going to bring you information that we hope will keep you informed about topics such as your health, trends in medicine, the laws that may affect you, what’s happening on the legal front in the areas of our expertise (negligence, medical malpractice and the like) and some postings about what’s happening around the city from our legal eye perspective. Our goal is to interact with you, have some fun, provide some useful information – all the things that social media is designed to do and has been doing so well for years now.

For those in the Twitterverse, we’ll soon be launching our new Twitter name/location. Collectively, our tweeps at Nash & Associates have over 5,000 followers. We should have our DC Twitter page up and running this week – we’ll post that new location here. In the meantime, if you want to connect on Twitter, we’re waiting to make your acquaintance at NashLawFirm.

Let’s connect! We’ve met so many great people and businesses on Twitter, Facebook and LinkedIn. We hope to soon count you among our friends and followers.

So, HELLO and WELCOME, D.C. – glad we finally get to share, meet and connect with you!

 

 

 

 

 

 

For close to two years now, our blawgers have been bringing

 

Photo from loringengineers.com

 

Autism and Wandering – a constant struggle

Wednesday, August 3rd, 2011

I have written before in this space about special needs children, including children with autism. This week I want to turn my attention to one aspect of autism – wandering – and some of the ways parents and schools are trying to keep kids safe. Wandering is something I really had not heard of before, but I’ve since learned that it is a serious danger to children with autism or other cognitive deficits. It is also a major source of stress to parents who are constantly worried about their child wandering off.

All children have a tendency to wander away from their parents at times. When my daughter was two, I lost her at Sports Authority. I thought she was standing right next to me while I was looking at something, then I looked down and she was gone. After a few frantic minutes – and with the quick help of the store employees – we found her all the way on the opposite side of the store looking at balls. She was perfectly fine, but it was terrifying for me.

For reasons that are not well understood, children with Autism Spectrum Disorder (ASD) tend to wander more than non-autistic children. As reported by the Child Mind Institute and others, a recent study by the Interactive Autism Network has finally tried to quantify what has traditionally been more anecdotal evidence about wandering.

According to the responses from more than 800 parents, roughly 50 percent of children between the ages of 4 and 10 with an ASD wander at some point, four times more than their unaffected siblings. The behavior peaks at 4, almost four times higher than their unaffected siblings, but almost 30 percent of kids with an ASD between the ages of 7 and 10 are still eloping, eight times more than their unaffected brothers and sisters.

Autistic children seem to wander for two basic reasons. One is to find something they like, such as their favorite pond or playground; and one is to get away from something they don’t like such as a stressful school environment. It’s not really running away, at least as that term is usually used to describe a child who decides to leave home because of some real or perceived injustice at home. A majority of parents in the study described their child as happy and focused when they wandered off. It is usually a matter of the child being drawn to something that he or she likes. One child referenced in the Child Mind story had a fascination with exit signs. One day at school, the boy wandered off through the woods toward the highway to find his favorite exit sign. Thankfully, a good Samaritan picked-up the boy and returned him to where he belonged.

The danger for children is very real. While concrete statistics are difficult to come by, drowning seems to be the biggest danger (there are some who believe that autistic children are drawn to water). Children can also wander into traffic. Of course, when any small child wanders alone there is the risk of getting lost or being abducted. To further complicate matters, thirty-five percent of families in the study reported that their child is never or rarely able to communicate basic identifying information such as name, address and phone number. This obviously makes it harder for a wandering child to get back home. Even older or more high-functioning children may – due to their social anxiety – be reluctant to seek out help or cooperate with someone who is trying to intervene.

Wandering represents a challenge to schools because it can be very difficult to monitor a child all day long, especially during class changes and recess. The problem, however, also occurs at home. Wandering occurs not just during the day; night-time wandering is an especially big fear for parents of autistic children. Some children have been known to get up in the middle of the night, undo the deadbolt on the front door, and walk-off into the night. The terror of finding your child gone in the middle of the night is unimaginable. Some parents have installed deadbolts higher up on the doors, some have installed alarms that go off if the door is opened. Some parents have gone so far as to have their children wear tracking devices that send out a signal that can be pin-pointed. While all of these techniques can help, there are no sure-fire methods of preventing wandering. It is a constant worry for parents.

The autism community has taken action by getting the Center for Disease Control’s safety subcommittee to assign a specific medical code for wandering, which will be in conjunction with the diagnosis of ASD. By doing this, it is hoped that doctors will more readily recognize wandering as a legitimate diagnosis that they can address with the parents or other caregivers (the new code applies to adults with ASD as well). The American Academy of Pediatrics is also preparing a fact sheet to educate doctors on the topic so that they can better work with parents to try to reduce the incidence of wandering. The new code may also make it easier for parents to seek reimbursement from their insurance companies for alarms and tracking devices, and it may make it easier for parents to argue to their schools that a one-on-one monitor is needed as part of the child’s Individualized Education Plan (IEP). The new code takes effect in October 2011.

Lori McIlwain, Chairwoman of the National Autism Association, recently discussed how to deal with wandering:

The best overall strategy is a multi-tiered approach, which includes educating the child about safety and dangers using whatever means of communication works, including social stories, language and/or visual prompts. It’s also important that caregivers—and schools—work to understand what is causing, or contributing to, the wandering or bolting behaviors so that any triggers may be addressed or eliminated.

Have any of our readers had any experience with wandering? I’d like to hear your stories as to how you deal with it and how it affects your life.

Related Nash and Associates Links:

Dogs a Huge Help to Special Needs Kids

The Daily Struggle of Raising a Disabled Child

Many Parents Still Believe Vaccines Cause Autism

 

 

Photo courtesy of: Issueswithautism.com

Asthma News: Parents Underestimate Children’s Symptoms, Placebos Effective in Improving Patient’s Subjective Improvement but Not Objective Health

Monday, July 25th, 2011

image from consumerreports.org

A couple of months ago, one of my colleagues, Jon Stefanuca, wrote a post for Eye Opener entitled Four Tips For Getting the Medical Care You Need When You Are Having An Asthma Problem. In that article, he explained the importance of patients proactively knowing and explaining their asthma symptoms to healthcare providers. He focused on some of the key features of asthma and the unique symptoms that each individual may experience. If you have not already read that article, I highly recommend it as a great way to become a better advocate for yourself or someone in your life that suffers from asthma.

Over the last few months, I have been thinking about Jon’s advice in relation to some work I have been doing. It makes good sense and hopefully will help people receive better care when they are having exacerbations of their asthma. However, I was disheartened to read a recent article from Reuters about how frequently parents underestimate their children’s asthma symptoms.

Parents Underestimate Their Children’s Asthma Symptoms

I am always a little leery of studies that are drugmaker-funded, particularly when the study suggests that perhaps more medications are needed to combat a problem. However, taken at face value, this is a pretty frightening idea given how many children now suffer from asthma and how serious a condition it can be for those children and families. The article points to a disconnect between the parents’ description of their child’s asthma and whether the asthma was actually being adequately treated:

While more than seven out of every 10 parents interviewed described their child’s asthma as “mild” or “intermittent,” the disease was adequately treated in only six in 10 kids.

A doctor who was not involved in the study explained it this way:

“Parents are only aware of asthma when the child is more severely ill,” Dr. Gordon Bloomberg…

“Physicians cannot just ask the parent ‘how is your child doing?’ The physician will get a global answer that doesn’t reflect the child’s quality of life,” said Bloomberg, of Washington University in St. Louis.

Poor treatment may influence asthmatic children’s quality of life, as well as that of their families.

In the survey, more than four in 10 parents reported missing work because of their child’s asthma, and similar numbers of parents regularly lost sleep for the same reason.

Children are Better Reporters Than Their Parents of Symptoms

Interestingly, “[t]he study also found children tended to be better than their parents at determining how well their asthma was being treated.” So, clearly, doctors must take the time to discuss the asthma symptoms and treatments not only with parents but also in a sensitive and appropriate way with the children patients themselves in order to receive a better indication of the disease status. The doctors interviewed for the Reuter’s article had different opinions on what this means for asthma treatment:

According to a new report, this suggests parents need more education about asthma medications.

But one expert said more medication is not the be-all and end-all for children.

“The idea of total control…is not where we should be putting our energy,” Dr. Barbara Yawn from Olmstead Medical Center in Rochester, Minnesota, told Reuters Health in an email.

Instead of just giving children with stubborn breathing problems more medication, she said better communication is needed to determine how children’s lives are affected, and what it will take to prevent their symptoms.

New Study Shows Receiving Treatment, Even with Placebo, Important for Asthma Patients – But Does not Improve Objective Health

image from 123rf.com

In another recent study, reported in the New England Journal of Medicine, researchers looked at how asthma patients responded to a medication (bronchodilator), two different types of placebos (fake inhaler or fake acupuncture), or no intervention at all. An objective measure was taken of the patient’s ability to exhale after each intervention (or lack of intervention) and the patient’s own rating of improvement was noted. What was so interesting about this study were the different outcomes between the objective (spirometry) and subjective (patient’s self-reporting) measurements of improvement.

The bronchodilator provided markedly better objective treatment over the placebos or no treatment – a 20% improvement rather than 7% for the placebos or no treatment. However, the subjective measure of improvement found that patients were almost the same, 45-50% improvement, whether the patients received the actual bronchodilator (50%), the placebo inhaler (45%) or the sham acupuncture (46%).  All of which were higher than the 21% improvement reported by those who did not receive intervention.

An article about the study in medicalnewstoday.com explains the outcome this way:

Now a study of asthma patients examining the impact of two different placebo treatments versus standard medical treatment with an albuterol bronchodilator has reached two important conclusions: while placebos had no effect on lung function (one of the key objective measures that physicians depend on in treating asthma patients) when it came to patient-reported outcomes, placebos were equally as effective as albuterol in helping to relieve patients’ discomfort and their self-described asthma symptoms.

The study’s senior author, Ted Kaptchuk, Director of the Program in Placebo Studies at Beth Israel Deaconess Medical Center and Associate Professor of Medicine at Harvard Medical School explained it this way in the article:

“It’s clear that for the patient, the ritual of treatment can be very powerful…This study suggests that in addition to active therapies for fixing diseases, the idea of receiving care is a critical component of what patients value in health care. In a climate of patient dissatisfaction, this may be an important lesson.”

However, I wonder if it cannot also be understood another way – which is that patients are likely to feel like their symptoms have been improved after a visit to a doctor, even if objectively their airway is still compromised.

How Should this Impact Asthma Treatment?

So what can be done with this new information? I think that Jon’s advice about patient’s knowing their own symptoms and expressing them clearly to their doctors is critical. I also agree completely with his advice that patients should ask for an objective measure of their respiratory improvement before leaving a health care facility. These two steps seem key to making sure that patients objective health is being improved – not just their subjective opinion of improvement. Finally, I think that it is critical that parents act as the best advocates possible for their children – which may include making sure that the children are heard on their own symptoms since parents are not the most reliable reporters.

What do you think? Are there other tips for asthma patients and their parents out there? How do respond to these new studies?

Related Videos:

Videos about Asthma

Related Articles:

Four Tips For Getting the Medical Care You Need When You Are Having An Asthma Problem

Asthma – How to Protect Your Child When the Steroid Inhaler Fails

Use Of Acetaminophen In Pregnancy Associated With Increased Asthma Symptoms In Children

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 Do I Choose A Lawyer? A Helpful Guide

Monday, June 20th, 2011

One of the most important things you can do if you are considering a lawsuit is to spend time doing a proper search for the lawyer, who will be handling your case.

Just because a law firm or a lawyer has a fancy webpage or an eye-catching ad in your local phone directory or even a professional looking TV commercial does not mean that this lawyer has a clue what he/she is doing in the specialized areas of medical malpractice or catastrophic personal injury.

We invite you to read and consider the issues and questions raised in our White Paper – “How to Choose a Lawyer.”

If you have other ideas or questions that you believe would be helpful to our readers in their search for a lawyer, post your reply on this topic so others may benefit by your insights.

 

Image courtesy of www.quadtechint.com

 

July 1 – New Residents, New Rules……Again!

Monday, June 13th, 2011

Last year, I wrote a blog on “The July Effect”, a long-observed phenomenon of increased hospital deaths during the month of July that was substantiated by medical data and statistics just last year. These data seemed to specifically relate these deaths to the influx of new medical school graduates into teaching hospitals as first-year residents of those institutions. The conclusions of the study seemed well-substantiated. I further elaborated on some of the potential causes of errors being made that could result in harm to patients; what I didn’t elaborate upon was the rigorous and demanding schedule that residents assume.

In 2003, the Accreditation Council for Graduate Medical Education (ACGME) instituted new policies regarding the time limitations of ALL residents, but specifically focused on the first year resident. These limitations were placed on the number of hours that residents could and should work in any given week or rotation in an effort to safeguard the health of the resident but more so to ensure the safety and well-being of patients being treated by these residents.

It is now 2011, and the ACGME is instituting even stricter limitations affecting both first year and mid-level residents; Nixon Peabody does a great job of delineating the changes in the guidelines. Much information has been published in the last year regarding the continued occurrence of medical errors despite protocols and safety mechanisms in place to protect patients (click on related blogs below). It seems that the ACGME is attempting to address some of these errors by addressing the fatigue factor of medical and surgical residents in training. The overall maximum hours per week will not change; it remains at 80 hours.  Yes, twice that of “normal” jobs. One big change is the limit on the maximum continuous duty period for first year residents; this will be decreased from 24 to 16 hours.  It will remain 24 hours for residents after their first year, but recommendations include “strategic napping.” Another change is the additional duty time, previously allotted as 6 extra hours to perform clinic duty, transfer of care, didactic training, etc.; for first year residents, these duties are to be included in the overall 80-hour work week, but after the first year, the residents will be allowed 4 additional hours. A third big change is the minimum time off between duty periods. Previously, it was noted that all residents “should have” 10 hours between shifts; year 1′s are still recommended to have 10  hours off, but they MUST HAVE AT LEAST 8! Intermediate-level residents should also have 10 hours off, but they also must have at least 8 hours off with a mandatory 14 hours off if they just completed a 24-hour shift. Final year residents are recommended to receive 8 hours off, but this is still being reviewed.  One thing that has not changed is the mandatory 1 day off in 7, averaged over 4 weeks.

Many of us watch the medical TV shows, but none of these shows really paint the true picture of medical residency training. As a Physician Assistant student, I trained alongside medical residents and medical students, alike. My training mirrored theirs in the hospital setting, and it happened well before the 2003 ACGME recommendations. There were times during my surgery rotation in a trauma center during which I worked 36 hours straight, followed by 10 hours off, then back to 10- and 12-hour days. The working hours entailed clinic time, managing daily in-patient care, many hours in the operating room, admitting patients during the overnight hours from the emergency room and emergency surgery for trauma victims, hours and hours at a time, in the overnight hours and during the day.  By the end of 36 hours, the exhaustion was indescribable. It is easy to understand how and why mistakes happen. After these crazy shifts, no one ever looked so glamorous as those who are depicted on television shows…..TRUST ME!

July 1, 2011, marks the date when over 100,000 medical residents across the USA from ACGME-accredited training programs start their training in teaching hospitals/institutions across this great nation. We should applaud the ACGME for looking at the data, analyzing studies regarding sleep deprivation, and putting forth these guidelines, not only to aid in patient safety but also to protect the health and well-being of these doctors in training. The pressures of residency are incredible. It is interesting that there was and still is opposition to the duty-hour limitations, citing oppositional rationale such as the residents do not learn enough in 16 hours, and small institutions do not have the support staff to treat all of the patients without the addition of medical resident hours.

So, who is going to fill those gaps created by the resident-hour restrictions placed by the ACGME come July 1st? Each institution will have to look at its own hospital model and decide according to current standards. In 2003, many of these gaps were filled by Physician Assistants and Nurse Practitioners; I suspect this will again be the case.  These mid-level practitioners are quite capable of providing many of the services necessary in hospital settings; they are a growing and well-respected addition to the healthcare team, and I suspect that their usefulness and potential will be more fully appreciated with the institution of healthcare reform!

For more information and Frequently Asked Questions (FAQs) regarding the ACGME guidelines, please go to the website and click on the links!

And, no matter who is caring for you or your loved one, never be afraid to ask questions about therapies and medications being ordered. Be informed!

Related Posts:

“The July Effect”: Where To Seek Medical Care When The Heat Is On

Medical Malpractice – Serious Medical Errors: Failure of the System or Just Plain Ignorance

Study Finds Regional Hospitals Often Are Better At Preventing Medical Errors Than Academic Centers – Kaiser Health News

Tort Reform or Just Plain Medical Care Reform: the debate continues as thousands are injured annually in US hospitals

 

 

 

 

 

 

Legal Boot Camp (Class Three): Sean and Kristy’s Story – Wrongful Death and Survival Actions

Wednesday, June 8th, 2011

From the Editor – Please see ourdisclaimer at the end of this blog for a better understanding of the limitations of this series and our mission statement.

Last month, Sean turned 24.  He and Kristy are married. Their daughter, Kira, is 2-years old.  Sean just entered medical school. Kristy’s parents support them, while Sean is in school.  Sean has never held a job.  Kristy is a stay at home mom. A month ago, Sean was driving home when a drunk driver pushed him off the road. In the accident, Sean broke his sternum. He also sustained a number of vascular injuries, which caused internal bleeding. He was rushed to the nearest hospital. Soon after his arrival, Sean underwent surgery to stop the bleeding.

Sean was recovering beautifully. Unfortunately, on his third day in the hospital, he developed rapid breathing, shortness of breath, and his chest pain got worse. A CT scan of the chest revealed that Sean had a pulmonary embolism. He was immediately ordered anticoagulation medication. The physician ordered 100 mg of anticoagulation medication to be split into two doses a day. The nurse misread the order and mistakenly administered 1000mg all at once. The overdose caused Sean to have extensive bleeding. Sean was scheduled for discharge within the next 3 days. Instead, he died within a few hours.

Now, think about this: Sean died prematurely at the young age of 24. Kira, lost her father. Kristy lost her husband. She now has a child to support all by herself. She has no income of her own, and she can’t rely on her parents indefinitely. After careful consideration, Kristy decided to sue the nurse (and her employer, the hospital) who overdosed her husband.

In Maryland, what will she be able to recover against the nurse in a medical malpractice suit if the jury finds the nurse (and/or her employer the hospital) negligent?

Recovery in a Maryland Survival Action

The answer to that question depends on the type of action brought against the nurse and/or hospital . Kristy, as the Personal Representative of Sean’s Estate, can sue the nurse  (i.e. a survival action). In a survival action, Kristy is essentially bringing a claim on behalf of her deceased husband for damages that he would have been entitled to claim against the nurse had he lived (i.e. had he survived – thus the name “survival action”).  In such an action, the monetary award would go to Sean’s Estate, and it would be distributed according to his will or, if he died without a will, according to Maryland’s Intestate Statute. In a survival action, Kristy can recover the medical expenses incurred by Sean as a result of the nurse’s negligence. This amount would be insignificant because Sean died within a couple of hours from the time the medication was administered.

Kristy may also recover any of Sean’s lost earnings from the time of his injury to the time of his death. Well, there are no such damages here because Sean was unemployed. Kristy could recover Sean’s funeral expenses up to five thousand dollars. She could also recover non-economic damages associated with Sean’s pain and suffering from the time of his injury to the time of his death.  In Maryland, however, these damages are limited in Maryland to about  $650,000.  Therefore, the most Kristy could recover in a survival action would be limited to about $655,000.

Recovery in a Wrongful Death Action

Kristy could also bring an action for wrongful death. In this action, Kristy could recover economic damages that she personally sustained as a result of Sean’s death. She is also entitled to recover economic damages equal to the financial support that she would have had from Sean had he lived.  In this case, it is difficult, if not impossible, to make such a determination. Sean was unemployed at the time of his death. He had no employment history.  Sean was not supporting his family financially. Kristy’s parents supported both of them.

So, how does one calculate the financial support that Kristy’s could reasonably have expected to receive from Sean in the future had he lived? One could argue, pursuant to a number of Maryland cases, that Kristy is not entitled to recover any of Sean’s future lost wages because he never worked and because he never supported Kristy financially.

Theoretically, Kristy could make a claim for loss of household services (cooking, cleaning, babysitting, etc.). In this case, however, Sean was a busy medical student, and Kristy was in charge of the household.  Therefore, it is unlikely that she would recover any such damages.

Wrongful Death – Solatium (non-economic damages)

Since her case would be in Maryland, Kristy could claim damages for her mental anguish, emotional pain and suffering, loss of society, loss of companionship, comfort, protection, marital care, attention, advice and counsel associated with Sean’s death. Here again, these damages are limited to about $650,000 notwithstanding the severity of Kristy’s pain and suffering.

Total Recovery in a Survival and a Wrongful Death Action

If Kristy were to bring a survival action and a wrongful death action in Maryland, her damages for pain and suffering under both actions would be overall capped somewhere between $812,000 and $868,000 (the “cap” on such damages is determined by the year the “cause of action accrues). It is possible that this is all she would be able to reocover against the nurse if she brought claims for wrongful death and survival.

Sean’s daughter, Kira, has a wrongful death claim against the nurse as well.  She would be entitled to recover the value of the support, which Sean would have provided to her had he survived.  Again, because Sean never actually supported Kira financially and because he never worked, that may be something very difficult to prove.  Kira, just like her mother, will be able to claim damages for her pain and suffering resulting from her father’s death. However this recovery would also  be limited to about $650,000. This cap is imposed on both Kira and Kristy’s recovery. That is, if a jury were to award Kristy $650,000 for pain and suffering and another  amount  of $650,000  to Kristy for pain and suffering, both Kira and Kristy would recover an overall amount of $650,000 (not $1,300,000).

Keep in mind, these “possible recoveries” are reduced by the costs and fees associated with litigation.

Justice or Injustice?

Now, think about this for a second… Sean’s normal life expectancy was going to be approximately another 50 years. All things being equal, he would have had a normal working life expectancy. Kristy’s life expectancy is about the same. Kira has another 16 years before she reaches the age of 18. The average cost of living in Maryland is about $3400/month, and in some places it is a lot more. Generally speaking,  college tuitions can be anywhere between $8,000/year and 35,000/year. The average cost for family health insurance is about $13,300/year.

So, you do the math: How long is Kristy’s recovery going to last?  How are Kristy and Kira’s lives going to be affected by the Sean’s death? Is Kristy’s recovery sufficient compensation for her loss?  The principle of compensatory damages is to put a litigant in the same position that she/he would have been in had the loss not occurred. I, for one, think that this is hardly achieved in this case.

If in a survival action the Estate can bring an action that Sean himself could have brought had he survived, why should his Estate not recover all of his lost future income as a doctor? After all, Sean was expected to earn income as a physician for many years. Why should Kristy be precluded from recovering some of Sean’s future lost wages under the wrongful death action simply because Sean was not employed or contributing financially to his family at the time of his death? Surely, it is reasonable to assume that Sean would have contributed some or most of his income to his family. Finally, why should the State dictate what the value of Sean and Kristy’s pain and suffering is? Shouldn’t this be decided by a jury of their peers? What are your thoughts?

Related Posts:

Malpractice Wrongful Death Lawsuit by Couple Falsely Accused of Abusing Their Child Filed Against Children’s Hospital

Maryland’s Cap and a Message from the former MAJ President re the Goings-On in Annapolis

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

“Wrongful Death and Survival Actions”

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.
Finally, please see our introductory blog for Legal Boot Camp for a better understanding of our mission in presenting this series.


 

 

Can a Simple Image Guide Good Nutrition?

Tuesday, June 7th, 2011

Image from www.choosemyplate.gov

Last week, the USDA unveiled the new MyPlate image to replace the outdated food pyramid. When I first saw the new image, I felt a welcome relief at the simplicity of this concept. The plate seemed like the iPhone of the nutrition world. Simply and intuitively designed – replacing a complex chart of recommendations with something that even a busy person could use in their every day lives.

As an individual and as a parent, I have worked hard for the last 5 or more years to dramatically change the buying and eating habits in our household. We buy most of our food, at least during the months from May until November, at the farmer’s markets around town. We try to buy most of our meat, eggs and dairy products from local farms. For the food that we purchase from the supermarket or from restaurants, I make a conscious effort to buy mostly real foods that are not full of preservatives, additives or other unidentifiable ingredients. Despite these efforts, it can still be a challenge to make sure that my meals are nutritionally well rounded.

My favorite feature of the new design MyPlate is that it is accessible even to the youngest children. Most people in this country eat their meals off plates, or at least are familiar with them. The idea of how much food to put on the plate and in what proportions resonates with me. Perhaps this image will also have the secondary effect of acting as a wake-up call to any Americans who are currently eating their meals primarily on the go, in their cars, or as undefined snacks constantly throughout the day (“grazing” as my father used to call it in our house).

Secondary Benefit of the Plate Image? Perhaps People will Focus on Sitting Down to Meals

To me, the take home message in the new image is that the healthiest option is to eat real meals, sitting down, preferably with others. These meals should be loaded with vegetables and fruits, with the addition of grains and protein. I suspect that the new USDA plate does not look like the plates of most Americans today at the average meal. Many, myself included most of the time, eat meals with more grains or proteins covering the plate than vegetables or fruits most of the time. However, this seems like a very achievable change to make. As long as we can help people get access to vegetables and fruits (outside the scope of this post – but there have been plenty of things written about how much easier it is in this country to get cheap meats and carbs than fresh fruits and veggies), then it seems simple with this guide to adjust your plate to be half covered in vegetables and fruits each meal.

Easy Enough for Kids and Busy Parents

Image from Zazzle.com

The other reason I like this image, besides its simplicity, is that it is easy. A child could easily use this as a template to fill their plate. Moreover, there are already a ton of children’s plates on the market that are easily divided…perhaps there should be similar plates for adults – I suspect someone is marketing this as I type. In case you were worried, someone has already developed the “Bacon My Plate” items. But, the point is that if you are a harried parent in today’s busy world, you may be searching for easy healthy foods for your kids. Well, perhaps the answer is here, just make sure that you fill the plate according to the guidelines and voila – dinner is ready.

Entire USDA MyPlate Website Devoted to Tips and Tools

What is less obvious from the media coverage in the last few days about the USDA MyPlate announcement is that the recommendations are not just in the image. The USDA has created a complete website and brochure that detail the recommendations much more thoroughly.  It also includes a number of interactive tools that help you evaluate the food group, calories and other details about particular foods. There are tools to help you plan meals, specific recommendations for toddlers and pregnant/nursing moms, advice for weight loss and other tips. A few of the other tips from the USDA brochure that I found especially important:

  • Make half your plate fruits and vegetables
  • Eat red, orange, and dark-green vegetables
  • Eat fruit, vegetables or unsalted nuts as snacks – they are nature’s original fast foods.
  • Switch to skim or 1% milk.
  • Make at least half your grains whole.
  • Vary your protein food choices.
  • Twice a week, make seafood the protein on your plate.
  • Use a smaller plate, bowl, and glass.
  • Stop eating when you are satisfied, not full.
  • Keep physically active.

These are just a few of the recommendations that accompany the new MyPlate image. There are lots more details available online. One of the recommendations that I was given when my son was a baby, just learning to eat finger foods, was to provide him with a rainbow of foods. Again, I think that the image works! If you feed your children (and yourself) a variety of different colored foods (and I am talking natural colors – think cherries, oranges, yellow peppers, spinach, blueberries, eggplant – not artificial colors…not fruit loops) throughout the day and week, you will provide a natural array of different vitamins and minerals without having to worry about reading labels.

Thoughts?

What are your tips for healthy eating? Do you like this new image? Do you think that it will make any impact on the obesity crisis?

Related Posts:

Does Nutrition Info on Fast-Food Menus Really Make a “Choice” Difference?

Decreasing Obesity Risks in Children: Another Benefit of Breastfeeding

Can Religion Make You Fat?