Archive for the ‘Baltimore’ Category

Simulation Labs: Helping Teach Nurses in Baltimore

Tuesday, September 27th, 2011

From nursing.jhu.edu

Any one who has ever had a hospital stay or knows a loved one or friend who has been in the hospital knows that the nurses play a vital role in caring for patients. Nurses do many of the day-to-day activities of caring for patients in hospitals and clinics. They are also often the first ones at the bedside if a problem arises – so -isn’t it essential that nurses be well trained in all forms of emergency procedures? Even when doctors are present, nurses often play vital roles in assisting the doctors in providing life-saving care to patients.

Law and Medicine Intersect Once Again

I have recently been working on a case in which both doctors and nurses were present during an in-hospital delivery that ended with a significant injury to the child. During the delivery, a problem was encountered that has a low incidence rate during deliveries.  In considering this problem, I wondered just how frequently doctors and nurses are able to practice the skills they would need to successfully and calmly deliver a baby in a situation like this.  Faced with this “emergency” situation, how many of the doctors and nurses in the room had not experienced this problem before? For those who had –  just how much “experience” did they bring to the problem they were facing?

Simulations Rooms and Simulation Patients Provide Training Opportunities

Thankfully, technology is making it more feasible for training healthcare providers to practice handling a myriad of clinical situations during their education process that they might otherwise not experience frequently enough for their skills to develop in real world settings. In Baltimore, the Johns Hopkins University School of Nursing (JHUSON) has simulation rooms in which nursing students are able to practice a variety of procedures and techniques using simulation patients in rooms that are designed to replicate the real patient areas of the hospital. There is also a whole family of simulators to help. This “sim fam” is not like the lifeless plastic dummies you might be imagining. They are a variety of different types of “…life-like practice manikins, including Sim Man, Vital Sim Man, Noelle with newborn, and Sim Baby [that] give nursing students the hands-on experience without the anxiety of working with actual human beings.”

Harvey the Cardiac Sim, SimNewB and Sim Man 3G  - All New Additions to the “Sim Fam”

From nursing.jhu.edu

Just this year, in March, JHUSON added Harvey to its collection of simulators.  While Harvey is new to JHUSON, he is not exactly new technology:

For almost 40 years Harvey, developed in cooperation between Laerdal Medical Corporation and Miami University Miller School of Medicine, has been a proven simulation system teaching bedside cardiac assessment skills that transfer to real patients, and remains the longest continuous university-based simulation project in medical education.

Harvey’s job is to be able to simulate “nearly any cardiac disease at the touch of a button: varying blood pressure, pulses, heart sounds, and murmurs. The software installed in the simulator allows users to track history, bedside findings, lab data, medical and surgical treatment.”  He joins a collection of other sim patients that enable healthcare providers to learn and practice critical life-saving measures such as CPR, defibrillation, intubation and yes – even the proper checking of vital signs. JHSON has adult, child and baby versions of these simulators. Some of them can even “talk” to the practicing nurses. (I wonder if they are programmed to be cooperative and informative or hostile and combative – hmmm.)

New Family Members Arrived this Past August

Even newer, in August, JHUSON added SimNewB and Sim Man 3G to the family. The SimNewB is:

…a 7 pound, 21 inch female baby, with realistic newborn traits. Students will be able to simulate a wide variety of patient conditions with her, including life-threatening ones. The department’s current Sim baby is the size of a 6 month old and is not as conducive to delivery room procedures.

She is also interactive, though she is not wireless like the Sim Man 3G. Some of the new Sim Man’s traits include “…breath sounds both anteriorly and posteriorly, … pupil reactions, [and] skin temperature changes.”

What about Obstetrics Cases?

So, what about the case I was mentioning that involved obstetrical care? Well, JHUSON also has a pregnant simulator, which is can be used to practice a whole host of obstetrically related procedures. These include “Leopold maneuvers, normal vaginal and instrumented delivery, breech delivery, C-section, and postpartum hemorrhaging, among other functions.” The JHUSON sim family also has the new Sim newborn – SimNewB.

The “Jury” Is Still “Out”

Can there be any doubt that additional hands-on practice opportunities with simulators is a good idea for situations that may not come up very often in everyday practice? Won’t it help healthcare practitioners gain skills and keep those skills up-to-date? Any opinion I might have on these issues is not based on evidence….yet. Luckily, JHSON is “…among 10 nursing schools nationwide collaborating on a landmark study to find out just how well patient simulators—high-tech manikins that respond to a nurse’s care—help prepare the nurses of tomorrow.”  I – for one – will certainly be interested in the outcome of that study.

What about you? Do you think that it makes sense for nurses in training to make use of simulation rooms and simulated patients? Would it be better for them to spend more time in real world situations doing real patient care under the supervision of experienced practitioners? What about techniques that might not come up very often?

If any of the readers of this post have used these sim patients in your training and can give us firsthand information as to how, if at all, it carried-over to make you more “experienced and skilled” when facing similar clinical situations with real patients, your comments would be most welcomed as well.

FES Equipment Coming to Baltimore’s Mount Washington Pediatric Hospital

Thursday, September 8th, 2011

Author - Sarah Keogh

Back in February, Jon Stefanuca wrote about a study in the Journal of Neurorehabilitation and Neural Repair about Functional Electrical Stimulation (FES) and the benefits it can provide to those individuals who have suffered spinal cord injuries. He explained how FES is able to provide electrical impulses to stimulate paralyzed muscles. The study’s authors found improvements based on using FES that led them to recommend using stimulation therapy in conjunction with occupational therapy for patients with incomplete spinal cord injuries. This technology is now also being used to help people with a wide range of injuries and illnesses including, stroke, multiple sclerosis, traumatic brain injury, and cerebral palsy, in addition to spinal cord injuries. According to the Christopher and Dana Reeves Foundation website, FES works by applying “small electrical pulses to paralyzed muscles to restore or improve their function”. The benefits can be extensive:

FES is commonly used for exercise, but also to assist with breathing, grasping, transferring, standing and walking. FES can help some to improve bladder and bowel function. There’s evidence that FES helps reduce the frequency of pressure sores. From: Christopher and Dana Reeves Foundation website

Improved Technology To Be Locally Available

Since FES was originally developed, the technology improved from being something that was typically integrated into large expensive equipment, such as exercise bikes and wheelchair based equipment, into smaller more portable devices. The good news for individuals with neuro-motor injuries in Baltimore City and the surrounding areas is that this type of FES treatment is about to become more available locally. At the end of August, Mount Washington Pediatric Hospital announced that they have received a “Quality of Life” grant from the Christopher and Dana Reeve Foundation. The article explains:

The money will help Mt. Washington Pediatric Hospital purchase Bioness® equipment for its Adaptive Equipment Rehabilitation Clinic (the clinic). The clinic works with patients with neuro-motor disorders to maximize their movement as much as possible given their physical limitations.

From Bioness.com

The Bioness website explains that they produce a variety of “medical devices designed to benefit people with Stroke, Multiple Sclerosis, Traumatic Brain Injury, Cerebral Palsy, and Spinal Cord Injury. These products use electrical stimulation to help people regain mobility and independence, to improve quality of life and productivity.” While I do not know what particular equipment will be available at the Mount Washington Pediatric Hospital, Bioness makes equipment to assist patients with hand paralysis, foot drop and thigh weakness among other conditions.

MWPH Uses Interdisciplinary Approach Combining FES and Therapy

The article about the grant explains some of the many wonderful things available for patients at the Mount Washington Pediatric Hospital (MWPH):

  • …[an] interdisciplinary approach to the assessment and management of adolescents and children with neuromuscular impairments, paralysis and/or movement disorders
  • … [a] team of 21 experienced specialists in physiatry, occupational therapy, and physical therapy.

The new equipment at MWPH will be used along with the other occupational and physical therapy options available to patients. A study described in US Neurology looked at stroke victims and found the combination of FES and traditional therapies that include repeated motion provide the best results:

Stroke patients with limited voluntary movement could now benefit from technologies such as functional electrical stimulation (fes) combined with necessary repetition of functional tasks (use-dependent plasticity) to enhance the neural repair process and improve outcomes, thus enabling them to begin to overcome their previous limitations and to improve their physical capabilities.

From Bioness.com

The goal at MWPH for children and adolescents is based on a similar idea:

Patients whose muscles can be retrained will require several months of therapy to gain normal range of motion and strength. For those patients with more severe conditions where muscles cannot be retrained, the Bioness® equipment will be used to augment their range of motion. Using these two therapy modalities, patients will acquire greater functionality, range of motion, muscle strength, and the ability to move independently.

This multi-disciplinary approach should allow these children and teens to have the best chances of improved motor use and the most independence in their future lives.

Related Articles:

Coming Soon? Restored Breathing for Spinal Cord Injury Patients

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

Dog Days of Summer Bring Pool Parties and Cookouts but Increase Your Risk for Heat-Related Injury

Monday, July 11th, 2011

The dog days of summer are upon us and with that heat and humidity comes an increased risk for injury.

Recently I ran a 7 miler race through the streets of downtown Baltimore on a hot and humid morning.  During that race, I saw at least one person suffering from what appeared to be heat exhaustion.  Luckily for that runner there was race support nearby and EMS on its way.  Had there not been race support there to cool the runner down with bottles of water he may not have survived.  Running is not the only outdoor summer activity that can result in heat exhaustion or heat stroke.  Any outdoor event in this heat can lead to an emergency situation.  It is important to know how to prevent such heat-related injury from happening but it’s also imperative to know what to do should someone suffer from heat exhaustion or heat stroke because if not properly treated death can occur.

What is Heat Exhaustion?

Heat Exhaustion usually develops after several days of exposure to high temperatures and inadequate intake of fluids. The elderly and people with high blood pressure are prone to heat exhaustion as well as people working or exercising in the heat. Heat exhaustion symptoms include heavy sweating, paleness, muscle cramps, tiredness, weakness, dizziness, headache, nausea, vomiting, and/or fainting. With heat exhaustion, a person’s skin may feel cool and moist.  Cooling off is the main treatment for heat exhaustion. Drinking cool, non-alcoholic liquids may help as well as taking a cool shower, bath, or sponge bath. Getting into an air-conditioned environment will also help. If the conditions worsen or have not subsided within an hour, seek medical attention. If heat exhaustion is not treated, it may lead to heatstroke which needs immediate emergency medical attention. Call 9-1-1.

What is Heat Stroke?

Heat Stroke is the most severe of the heat-related problems. Like heat exhaustion, it often results from exercise or heavy work in hot environments combined with inadequate fluid intake. Children, older adults, obese people, and people who do not sweat properly are at high risk of heatstroke. Other factors that increase the risk of heat stroke include dehydration, alcohol use, cardiovascular disease and certain medications. Heatstroke is life threatening because the body loses its ability to deal with heat stress. It can’t sweat or control the body’s temperature. Symptoms of heatstroke include rapid heartbeat, rapid and shallow breathing, elevated or lowered blood pressure, lack of sweating, irritability, confusion or unconsciousness, feeling dizzy or lightheaded, headache, nausea, and/or fainting.  If you suspect heatstroke, call 9-1-1 immediately. Then try to move the person out of the sun and into a shady or air-conditioned space. Cool the person down by spraying them with cool water or wrapping them in cool damp sheets. Fan the person, and if possible, get the person to drink cool water.

Tips for Prevention

An article on the Active.com website highlights 10 tips to prevent a heat-related injuries:

1.  Acclimatize – It takes your body time to adjust hot and humid weather.  Just because you can run a 10-miler at an 8-minute pace, doesn’t mean you can do the same when the dog days of summer approach.  The same goes for any outdoor exercise! The American Running and Fitness Association recommends that on your first run in the heat, you should cut your intensity by 65 to 75 percent. Then over the next 10 days, slowly build back to your previous level.

2.  Check the Index – Before you leave the comfort of your air conditioner, check the heat index and air quality index.  The Air Quality Index (AQI) is an index for reporting daily air quality. It tells you how clean or polluted your air is, and what associated health effects might be a concern for you. The Heat Index tells you what the temperature feels like when combining the air temperature and the relative humidity.  Both indexes should be checked before heading outdoors.  Your health depends on it!

3.  Hydrate! Hydrate! Hydrate! – Always remember to rehydrate after outdoor exercise! But it’s even more important to be well-hydrated BEFORE you exercise or spend time outdoors.  Hydration during your run depends on the temperature and the length of your run.  Don’t wait until you feel thirsty to drink. If you’re thirsty, that means you’re already low on fluids. Also, as you age, your thirst mechanism isn’t as efficient and your body may in the early stages of dehydration and you may not even feel thirsty. After 60 minutes of outdoor exercise, you will need to start using a sports drink or supplementing with a sports gel or a salty food such as pretzels. After 60 minutes, you begin to deplete vital electrolytes (i.e., sodium, potassium, etc.). Sodium is needed in order for your body to absorb the fluids you are ingesting and depleted potassium levels can increase your chances of experiencing muscle cramps.  Also, packing an extra bottle of water during outdoor exercise to pour over your head can help increase the evaporation-cooling effect.  Lastly, when you finished exercising, you need to replace the water you’ve lost.

4. Know the Warning Signs – Dehydration occurs when your body loses too much fluid. This can happen when you stop drinking water or lose large amounts of fluid through diarrhea, vomiting, sweating, or exercise. Not drinking enough fluids can cause muscle cramps. When you’re dehydrated, you may feel faint, experience nausea and/or vomiting, have heart palpitations, and/or experience lightheadedness. Runners also need to be aware of the signs of severe dehydration such as heat exhaustion and heatstroke, not only for yourself, but so you’ll be able to identify the symptoms if a fellow runner is experiencing heat-related problems.

5.  Buddy-Up – In the severe heat, be sure to work-out with a buddy. That way you can keep tabs on each other. Sometimes it’s hard to tell if you’re starting to suffer the effects of the heat, but a buddy may be able to spot the signs before its too late.  Plus, working out is always more fun with someone else!

6.  Work-Out Early – If at all possible, get your work outs done in the early morning.  The hottest part of the day is typically around 5p.m.  So, if you can’t work-out until after work, wait until later in the evening.

7.  Go Technical – Wearing light-colored tops and shorts made of technical fabrics will keep you cool and allow moisture to evaporate more quickly.  Staying dry will also help prevent chafing.  Clothing made of Lycra, Nylon, CoolMax and Dry-Fit are some examples of technical fabrics. Be sure to hang dry your technical fabric clothes.  The fabric softener in dryer sheets can actually block up the fabric decreasing its moisture0wicking abilities.

8.  Change Your Route – If your normal running route or work-out spot is treeless, find one that provides more shade.  If this isn’t possible and you have access to a treadmill or gym, head indoors on really hot days.

9.  Lather It On – Be sure to wear sunscreen!! Use a sports sunscreen that is waterproof with an SPF of 15 or higher.  Also, be sure to wear a hat or visor.  This will help keep the sun out of your eyes as well as the sweat out of your eyes.

10.  Have a Plan – Let your family and friends know your running route or work-out location.  If you’re gone too long, they will know where to look for you.  If you are in a rural area or doing a trail work-out, you may even want to pack your cell phone.  Don’t change your plans at the last minute without letting someone know.  It’s better to be safe then sorry!

For additional information on heat related injury and illness, see the National Weather Services heat advisory information page – Heat Kills

Week in Review: (July 2 – July 9, 2011) Eye Opener Health, Law and Medicine Blog

Saturday, July 9th, 2011

Eye Opener’s Week in Review

From the guest editor:         Good morning! I was hoping that you would take a break from making your “to do” list to stop by and check in with us. As usual, we have been busy blogging. And practicing law. And getting ready for trial. And in trial! Needless to say, we have been pushing it to the limits. In truth, we wouldn’t have it any other way. Before we get back to trial preparation, lets take a step back and look at the past week.

–Jason Penn, guest editor

Litigating for the Sake of Litigating: A Temptation to Be Resisted

By Jon Stefanuca

What do you do when your opposing counsel forgets that the practice of law is a profession and not a blood sport? What do you do when the phase “zealous representation” gets confused with “obnoxious obstructionist behavior?” When faced with similar frustrations, Jon Stefanuca broke out his keyboard and explained what we litigators deal with on a day to day basis. Being a lawyer is a very rewarding profession, but like any other, it has its share of frustrations. Don’t take my word for it, read more

Can Copper Surfaces and Duct Tape Reduce Hospital Infections and Deaths?

By Sara Keogh

Germs are in your kitchen.  They are in your bathroom and your bedroom.  They are on your fingertips and even on your tongue.  And everyone knows that there are going to be germs in hospitals. Even the best hospitals have to work to keep the patients, rooms and visitors clean and safe.  Sara Keogh reported on news that may make keeping hospitals and other health care environments less germy in the future. Two simple solutions, copper and duct tape, might have a major impact on infection control.  Read more

Sneak Peak of the Week Ahead:

The Eye Opener and its writers are excited about the week ahead too!  Here’s a sneak peak of what’s in store for you:

  • Service dogs for children:  more than just a pet
  • Legal Boot Camp is back in session and Part IV of our Cerebral Palsy tutorial.
  • And more!

Images courtesy of:

www.lifehack.org

www.mountainpulse.blogspot.org

 

Nash & Associates in the Community: Wendy Kopp and Teach for America

Thursday, June 23rd, 2011

Tai Dixon of Baltimore Teach for America and IThe Eye Opener serves many purposes.  Not only do we serve as patient advocates, but we do our best to provide information to the community on a variety of topics.  There is little else that is more important to the health of a community than its educational system.  Committed to the health of our community, I recently attended an event sponsored by the Enoch Pratt Free Library:  An intimate discussion with Wendy Kopp, author of A Chance to Make History.

By most objective standards, many of our nation’s schools are failing.  The national conversation about education has been ongoing and has resulted in a series of changes to the way we educate our children.  The people driving those changes often go unrecognized by the greater public.  Their efforts are profound, but unless you are in some way connected to the educational movement, their names are not easily recognized.  Let me introduce Wendy Kopp and Teach for America.

“Wendy Kopp is the chief executive officer and founder of Teach For America, whose mission is to build the movement to eliminate educational inequity by enlisting the nation’s most promising future leaders in the effort. She is also chief executive officer and co-founder of Teach For All, which is working to accelerate and increase the impact of this model around the world.

Wendy proposed the creation of Teach For America in her undergraduate senior thesis in 1989. Today more than 8,000 Teach For America corps members are in the midst of two year teaching commitments in 39 regions across the country, reaching over 500,000 students, and 20,000 alumni are working inside and outside the field of education to continue the effort to ensure educational excellence and equity.

Since 2007, Wendy has led the development of Teach For All to be responsive to requests for support from social entrepreneurs around the world who are passionate about adapting the model to their contexts. Teach For All is a growing global network of independent organizations pursuing this mission in 18 countries, from India and China to Brazil and Lebanon. ”

Recently, Wendy was in town to discuss the education of America’s children.  The same questions remain:  “How do we ensure that every child is provided with a top-notch education, regardless of their socio-economic status?”  “How can we empower teachers to change the lives of their students?”  “How do we ensure that education is funded at appropriate levels?”  At an event moderated by Freeman Hrabowski, president of my alma mater UMBC, Wendy provided insightful answers to these questions.  The progress made in Baltimore and Washington D.C. schools is remarkable and is in no small part as a result of the efforts of Teach for America.

The reality, however, is that Wendy Kopp, Teach for America and its supporters cannot do it alone.  Improving education should be a community goal shared by all.  So I issue the challenge to you:  what can you contribute to ensure that our children receive an excellent education?  Can you give your time?  Your wealth?  Please feel free to leave your comments below…

Credit:  www.teachforamerica.org

Related Links:      Charity begins at home:  OriolesREACH program hits a grand slam with us!

Pictured above:  Tai Dixon of Baltimore Teach for America and I.

Don’t underestimate jurors. They really do get it – most of the time!

Tuesday, June 21st, 2011

I just finished a two week trial that was probably one of the most complex medical cases of my 37 year career. Since the “resolution” of the case is the subject of a confidentiality agreement, I’m not at liberty to discuss the details of the case or its “resolution.” Nevertheless, what I am free to tell you is that having tried hundreds of jury trials over my career, it amazes me just how often jurors “get it” when it comes to doing their very best to understand the evidence thrown at them and to do “the right thing.”

The case involved about 8,000 pages of medical records. Jurors heard from 8 medical witnesses ranging from surgery, to infectious disease, to radiology to pathology. This was not a case involving “Anatomy 101″; it was an advanced course in the biomechanics of the spine, neural element compression, biofilms on hardware, pulmonary hypertension, deep vein thrombosis – well, you get the picture.

After nine grueling, long days of evidence, sitting in hard, non-cushioned chairs and having to endure seemingly endless bench conferences dealing with evidentiary issues and objections that the jury was not allowed to follow, our panel patiently waited for over two hours on their final day of service while the parties to the lawsuit worked out “a resolution” of the case. The trial was to end the next day (today). They, the jurors, would finally get to speak to us, rather than having us speak to them for over two weeks.

Once the details of the “resolution” were hammered out, the judge had the courtroom clerk bring the jury into the courtroom to take their “luxurious” wooden seats. The Court announced that the parties had “resolved” the case and that the jurors’ service was now completed. Nine plus days and countless hours of sitting and listening – and now – no chance to deliberate and tell the parties who they – the jurors - thought was right in this legal battle. The judge then advised them that they had served a most important function because many times (this being one of them) the parties could not reach agreement – uh “resolution” – without them. It was further announced by the Court that if they cared to do so, they were now free to speak with the lawyers.

Rather than gather up their belongings and hustle out the door, each and every one of them remained in the courtroom to share their thoughts and observations of the trial. Once again, as has happened so many times in my career, I was pleasantly surprised  and amazed by what they had to say. Peppered with questions by the lawyers to see if they “got it,” our jurors shared their observations about key issues in the case. The told us about their “take” on the evidence involving T1 versus T2 weighted MRI’s. They accurately recounted the evidence regarding the issues of “sub-clinical infection.” They shared their individual thoughts and reflections on what role the decedent’s underlying, complicated co-morbidities played in their analysis of causation.

We’re not talking about a panel of medical experts here. We’re talking about everyday folks, who brought their common sense and varying levels of education and life-experiences to the litigation table. They “got it”!

None of the parties will ever know what the jury’s eventual verdict would have been. Nevertheless, because of the uncertainty of that verdict, the opposing sides in this lawsuit worked their way through a morass of emotion, righteousness, principles – you name it – to get the case “resolved.”

I hear so often from “professionals” that the jury system is broken. They rant endlessly that we need “professional” finders of fact to arrive at just results. Oh really! If that’s the case, then why is it that each side can have highly qualified experts, who can’t agree on the interpretation of medical evidence? Maybe – just maybe – it takes people of plain common sense, goodwill and a sense of justice to get it right.

Have jurors arrived at verdicts in my career that make you want to retire from the practice of law? They have – but on very rare occasions. When you put aside the self-righteousness of bias and advocacy and reflect on verdicts, many lawyers – I for one – appreciate that juries really do “get it” and really try to do “the right thing.”

To all the cynics out there, don’t be so unwilling to appreciate what these citizens do to advance our system of justice. Is the system perfect? Far from it, but not as far from it as many would have you believe.

Let me end by simply saying – THANKS to our citizens who made-up our jury. Your patience, attentiveness, endurance and willingness to serve is very much appreciated. You could easily have dreamed-up a way to avoid service on the jury during the selection (voir dire) process (as so many do in so many pathetic ways), but you didn’t do that. Kudos to each and every one of you. You did advance the cause of justice. You made the parties to this lawsuit take note of the fact that maybe, just maybe, their view of the case was about to be tested in the crucible of the jury room. That knowledge and the reality of an impending verdict made them step back, take a deep breath and come to a “resolution” of their dispute. Well done, Citizens! I for one applaud you.

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

 

Legal Boot Camp Class Four. Sean and Kristy’s Story: How a Jury Award is Conformed to the Cap.

Wednesday, June 15th, 2011

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

Last week, we published a blog about Sean and Kristy. You will recall that Sean died from excessive bleeding when the nurse overdosed him with anticoagulation medication after a major surgery. You will also recall that after careful consideration Kristy decided to file a medical malpractice claim against the nurse and her employer, the hospital.

Now, let’s skip forward.  Kristy’s Complaint stated two causes of action: survival and wrongful death. Under the survival claim, Kristy was the only named Plaintiff because she was named Personal Representative of Sean’s Estate. Only a personal representative can bring a survival action on behalf of a decedent. Kristy and Kira (Sean’ daughter) were both named Plaintiffs under the wrongful death count. Generally speaking, only a parent, spouse, or child (with some exceptions) can bring claims for wrongful death.

At the conclusion of the trial, the jury returned a verdict of 2.5 million with 1 million awarded in the survival action and 1.5 million awarded in the wrongful death action. Furthermore, in the wrongful death action, the jury awarded Kristy 1 million dollars and Kira 500,000 dollars.  All of these damages were for pain and suffering.  You will recall that Maryland has a cap on non-economic damages. The cap imposes a limitation of about 812,000 dollars when the jury’s award is for wrongful death and survival (this is regardless of the number of claims or claimants).

How will the Court reduce the verdict so that it conforms to the statutory cap? The answer is mandated by statute: the Court must make proportionate reductions in order to reduce the jury award to the statutory cap.  Here is how it works:  The total recovery in this case is 2.5 million (1 million under the survival action, 1.5 million under the wrongful death action). 1.5 million represents 60% of the total recovery of 2.5 million.  1 million represents 40% of the total recovery.

Now, 40% of the 812,000 cap is 320,800 dollars. 60% of the 812,000 cap is 487,200 dollars. Therefore, the monetary award under the survival action will be reduced by the Court to 324,800 dollars. The overall award under the wrongful death action will be reduced by the Court proportionately to 487,200 dollars.

Furthermore, proportionate reductions are necessary to conform the wrongful death award to the cap.  An overall amount of 1.5 million was awarded in the wrongful death action.  From that award, the jury gave Kira 500,000 dollars and Kristy 1 million dollars.  One million represents about 67% of the total recovery in the wrongful death action. Kira’s award of 500,000 dollars represent 33.3%. Applying these percentages to the capped wrongful death recovery of 487,200 dollars, Kira’s award will be reduced from 500,000 dollars to 160,776 (33% of 487,200) dollars. Kristy’s award of 1 million dollars will be reduced to 326,424 dollars (67% of 487,200). This is all Maryland law will permit them to recover. Justice or injustice, what do you think?

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.

 

Week in Review: (June 6 – June 10, 2011) Eye Opener Health, Law and Medicine Blog

Saturday, June 11th, 2011

 

A Word of Special Thanks…

From the Editor:

I am so grateful to my bloggers and friends at the firm for all their hard work this week. I started a  multi-week trial this past Tuesday, but in my absence, the Eye Opener kept rolling right along thanks to them. Special thanks to Jason Penn, who took over the task of making sure the schedule was kept and the blogs got posted.

Brian Nash

 

From Jason Penn -

It is time to take a look back at the week that was.  With the temperatures soaring in the Baltimore-Washington area, the Eye Opener did its best to keep pace with the thermometer.  Five posts, five days.  All while the lawyers prepared for upcoming trials.  Not too shabby, if you ask me.  Without further ado, lets take a look at retrospective look:

The Death of a Baby – Economic Realities

By: Michael Sanders

The loss of a child, particularly an infant, is one of the most difficult and painful horrors anyone could every have to deal with.  Writing about it isn’t much easier.  Nonetheless, on Monday, blawger Michael Sanders’ post provided insight into the economics of lawsuits involving the death of an unborn child.  It is truly a “must read” for anyone that is contemplating taking legal action for the loss of their child.  The interplay between gestation, age of death and so-called “survival actions” is particularly tricky.  Mike lays out Maryland’s law on the topic and gives helpful primer for parent and practitioner alike.  Read more

Can A Simple Image Guide Nutrition?

By: Sarah Keogh

Obesity in America, particularly among our youth is a serious problem.  The problem itself certainly isn’t new but the approaches to promote healthy eating certainly have been. On Tuesday, Sara Keough pulled up to the table and reviewed the new MyPlate image and its impact on America’s unhealthy eating habits.  As I am sure you know, there have been a variety of methods to improve our nation’s eating habits. In most recent memory is the ostracized food pyramid and the First Lady’s “Let’s Move Campaign” (and associated dance moves). Sara provided her perspective on the new eating tool as both an individual and a parent.  I personally am curious: for the parents out there, will this change the way you handle your children’s nutrition?  Read more

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

By: Jon Stefanuca

On Wednesday, Jon Stefanuca provided the third installment of our Legal Boot Camp. With class in session, Jon presented the following scenario:  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. The physician ordered 100 mg of anticoagulation medication.  The nurse misread the order and made a mistake in its administration. 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.

What legal action could Kristy take?  Read more

Dealing with Cerebral Palsy: A Resource for Parents and Family (Part II)

By: Jason Penn

On Thursday, Jason Penn provided us with Part II of his series “Dealing with Cerebral Palsy:  A Resource for Parents and Family.”  Part II of the series takes a look at educating children with cerebral palsy.  Children that have special needs that impact his/her ability to learn at school often qualify for an Individual Education Plan.

An IEP is a legal document created to ensure your child’s teacher, staff and administration understands his learning and other limitations and utilizes the best practices to ensure that he gets the education that he/she deserves.  Curious about an IEP?  Read more

How Much Is Your Marriage Worth?

By: Michael Sanders

To finish up the week, Michael Sanders returned, and asked the question: What is Your Marriage Worth?  If you’re married, there is 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.  Read more…

Sneak Peak of the Week Ahead:

With the weather taking a turn for the better (hopefully), and the local sports teams showing renewed vigor, we are going to keep up the pace. As you finish up this week, and turn to the next, you can look forward to the following:

  • Service dogs for children:  more than just a pet
  • Subdural Hemorrhages – “Man, is my head aching…”
  • HIV Patients:  Increased risk for developing cancer
  • Crib bumpers & safety
  • Legal Boot Camp is back in session and Part III of our Cerebral Palsy tutorial.

Have a safe weekend, Everyone!

Week in Review: (May 22 – 28, 2011) The Eye Opener Health, Law and Medicine Blog

Saturday, May 28th, 2011

From the Editor – Brian Nash

Last week’s posts by our blawgers were packed with information about a variety of topics ranging from the medicine you need to know about concussions, living with cancer, cerebral palsy resources and the potential risks of overdosing your child with medications.

On the legal front, we began a series I’m personally excited about. We call it Legal Boot Camp. It will be a series for those in our practice jurisdictions of Maryland and Washington, D.C. Our teacher’s face is on – lesson plans in place. We hope you learn some things about the laws that can affect your lives in the areas of personal injury – particularly medical malpractice law.  Our first class took place with a piece by Sarah Keogh that examines the law in Maryland on the right to claim loss/diminished earning capacity. If you’re wondering if you can have such a claim even if you weren’t working when you were injured, Sarah has some information for you. Check it out. Turn in your class card and have some fun.

We wrapped up the week with a piece by yours truly on a wonderful community outreach program by our local baseball heroes, the Baltimore Orioles. Aptly named – OriolesREACH, this initiative has a number of wonderful events, charities and missions that are worth knowing about. One in particular, Shannon’s Fund, is a great program to help those in need while dealing with the financial burdens while dealing with cancer. It is run by the University of Maryland Medical Center. Read about our challenge to our brethren before the bar in the Greater Baltimore Area.

Without further ado, here are the blogs we posted this past week …. and a sneak peak of the week ahead.

Concussions: The Message of Brian Roberts’ Injury Should Not Go Unheeded

Posted by Brian Nash

Anyone who follows sports is well aware that finally the old school mentality of “gut it out and get back in there” following blows to the head are coming (not too soon) to an end. Committees have been formed, articles written and the national spotlight of the media have finally focused on this issue. Those recommendations, debates and guidelines are beyond the scope of this post. Nevertheless, those involved in sports…Read more >

Children’s Medications: Coming Changes and Tips to Avoid Overdose

Posted by Sarah Keogh

My children are both young; the youngest is now a little past her second birthday. In the last few years, we have had both infant and children medication in the house, liquid and tablets, and I have been very careful to make sure to double-check myself if I ever have to medicate either child to make sure that I am reading the correct dosing matrix for the correct concentration and for the correct child. More often than not, I have found that children need medication when their parents are tired. As parents know – children frequently…Read more >

 

Living With Cancer: What to Expect After the Diagnosis

Posted by Jon Stefanuca

About a million and a half people will be diagnosed with cancer in the U.S. this year. The devastating truth about cancer is that about one-third of these people will die from cancer at some point. For most, the diagnosis is unexpected and completely overwhelming.The cancer does not just affect how one feels, it undermines all sense of security and stability. It changes lifestyles and redefines relationships. So often the emotional trauma is equally shared among family members and loved ones. Read more >

New Blog Series: Legal Boot Camp

Posted by Brian Nash

I’m really pleased to announce a new series we’re starting today. If you’re a reader of our blog, you know that we post numerous times a week on health, safety, medicine and related law topics. That’s what we do in our firm – we represent people who are injured by the negligence of health care providers and those who suffer catastrophic injuries in non-medical settings as well. So, sharing what we believe is some good information about medical, health and safety issues is our mission. We strongly believe that our social networking should be about giving good information, engaging in dialogue about relevant issues – just plain good, old sharing. Read more >

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

Posted by Sarah Keogh

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… Read more >

Dealing with Cerebral Palsy: A Resource for Parents and Family

Posted by Jason Penn

Today’s society has become increasingly dependent on aggregators. We use a variety of methods to assemble and sort information so that we can easily consume it.  Mint.com and Quicken help with our finances and Google Reader helps to manage our online content. A quick search of the internet suggests that the parents of children withcerebral palsy do not yet have an objective aggregator of information to turn to.  Let’s consider this our attempt to provide parents in the Baltimore and Washington D.C. areas with a place to turn. Read more >

Charity Begins at Home: OriolesREACH Program Hits a Grand Slam with Us!

Posted by Brian Nash

I recently wrote a post about our local area charities and civic organizations who do so much for so many in our community. With that in mind, as I was happily reading the sports page in the warm glow of the Orioles’ 12th inning victory yesterday (5 in a row – Go O’s), I came across a piece about a new initiative for our military personnel by the Birds. While looking at the details of this worthy program, I noticed (ashamedly for the first time, I admit) a host of community programs being run by the Orioles. The team uses the name OriolesREACH for the community programs they sponsor, promote or fund. Read more >

Sneak Peak of the Week Ahead

Here’s a sampling of what’s coming next week on The Eye Opener: Views and Opinions from the Nash Community:

  • As families prepare for the upcoming holidays and summer vacation, Theresa Neumann has some important medical advice about what else needs to be included in your travel plans.
  • Legal Boot Camp: Prepare for our second class – get those pencils, pens, iPads and whatever else you need out and ready – there could be a pop quiz on next week’s primary on law.
  • What rights do babies-before-birth (fetal rights) have in our legal system? Do parents who lose a child just before birth have any rights of recovery? You’ll find out next week.
  • Home births are on the rise. Is that a good or a bad thing? Sarah Keogh weighs in on that issue in the coming edition of The Eye Opener

And….maybe even more to come…you can never tell….

Have a wonderful and safe Memorial Day Weekend. Best to All of You and Your Families and Friends from All of Us at Nash & Associates