Posts Tagged ‘birth injuries’

Service dogs in school — a fresh look

Friday, July 22nd, 2011
Service Dog and Boy

service dogs

A while back I wrote a piece on the topic of service dogs for kids and mentioned the use of service dogs in schools. A regular reader of our blog then wrote in with a number of comments and questions about the propriety of dogs in schools. To help answer her questions, I recently spoke with Nancy Fierer, who is the Director at Susquehanna Service Dogs in Harrisburg, Pennsylvania, which is an organization that trains and places service dogs. Susquehanna is the organization that placed two of the dogs mentioned in this NPR story.

The ADA and dogs in school

I also did a little more research on the Americans with Disabilities Act (“ADA”) and its impact on the issue. The ADA requires that all public facilities allow a disabled person and his or her service dog (not pets) to enter the premises just the same as a non-disabled person. So is a school considered a public facility? It’s an interesting question. On the one hand it is accessible to the public in the sense that parents and students can freely enter a school. However, if you’re not the parent of a child at the school, can you just walk into a school and roam the halls like you might roam around a mall? I think if you tried that, you would get stopped pretty quickly and asked to leave if you had no valid business there. However, the law appears to be settled that schools are considered public facilities at least for those areas that are open to the public such as administrative offices, gymnasiums during sporting events, and auditoriums during public events. Therefore, schools must be accessible to service dogs in these public areas. For class rooms, however, it’s not so clear. While the law appears to favor allowing service dogs in class rooms, it is being decided on a case-by-case basis because there are other considerations as well – the age of the child, the disability at issue, the ability to control the dog, etc.

How much school assistance is necessary?

I have to admit that when I first wrote on this topic, I had envisioned that the dog and child were a self-contained unit that required little in the way of adult assistance. Ms. Fierer indicated that that is usually not the case. Depending on the age of the child and the level of disability, the child may be able to care for the dog independently. However, in most instances an adult (teacher’s aide or nurse perhaps) is required to pitch in with help giving the dog water and taking it out for bathroom breaks. Ms. Fierer indicated that the dog does need water breaks during the day (feeding can be done at home before and after school). This is usually accomplished by keeping a water bowl in a nearby room – perhaps a nurse’s office or a counselor’s office. Several times a day, either the child (if he/she is old enough) or an adult can take the dog for a drink. The same is true for bathroom breaks (pee only; No. 2 is usually taken care of at home). Again, service dogs do require assistance from the school but from what Ms. Fierer told me, the disruption is fairly minimal and can be worked out with proper planning.

Controlling a service dog

A larger issue is the child’s ability to control the dog. Even though service dogs are highly trained, the owner (in this case a child) must still be able to control the dog before being permitted to take a dog into school. These include such basic commands as making the dog sit, stay, come, leave it, and walk on loose leash. These are some of the common commands that all service dogs must know. In addition, a service dog also receives additional training in a particular disability and learns specific commands unique to that disability, e.g., retrieving specific items, pulling a wheelchair, responding to seizures, search and rescue. These commands must be mastered as well. For example, if an autistic child is in need of the dog to put its head in the child’s lap to help calm him/her down, the child (or a trained adult) has to be able to give the dog that command. If the child cannot give that command to the dog, then it undermines the usefulness of the dog in school.

Because of the demands that service dogs place on the child, very young children usually do not take dogs to school unescorted. Ms. Fierer said she would be surprised to see a six-year-old, for example, taking a dog to school alone. Older children can, with proper training, be permitted to take a dog to school alone. To ensure that the child is capable of caring for the dog, Susquehanna utilizes the Assistance Dogs International Public Access Test. This test requires the owner and the dog to perform multiple tests in a variety of settings to ensure that the dog is well-trained and that the owner can properly control the dog. For children, Ms. Fierer indicated that the testing is usually administered with the parent and child because she uses the team approach – the parent, child and dog are a team. For a child taking the dog to school, however, the parent is usually not there so the child must be able to control the dog independently. Only when a child is adept at controlling the dog should the child be permitted to take the dog to school. Even then, parents have to work closely with the child’s teacher and other school staff to coordinate the details of how the dog will be cared for.

Other concerns

Our reader also asked questions about whether service dogs are a distraction in school and whether they can pose a danger to other children. After talking to Ms. Fierer, it’s my opinion that these are not major concerns. As for being a distraction, Ms. Fierer said that is usually not the case. Service dogs are generally introduced into the school gradually, starting with maybe a half-hour per day and building from there. The children get accustomed to the dog and the novelty soon wears off. Also, the other children need to be educated that this is a service dog and not a pet to be played with. Children can easily learn this lesson. As for being a danger to other children, Ms. Fierer said she has never heard of a dangerous incident happening at school such as a dog biting a child. These dogs are amazingly well-trained and the trainers allow zero tolerance for aggressive behavior. If a dog shows any aggression, that dog does not make the cut for being a service dog. Therefore, I don’t believe this concern is a valid reason for denying a child a service dog.

Training a service dog

In terms of the actual training given to the dogs, Ms. Fierer said that when a puppy is eight weeks old, it starts living with a dedicated puppy handler who is responsible for teaching the dog basic manners.  This time includes classes at Susquehanna twice per month.  This arrangement goes on till the dog is 18 months old, at which time the dog receives about six months of intense training.  About 50-60 percent of training is the same for all service dogs. The rest is devoted to the unique needs of each disability. Before a dog is placed, Susquehanna spends about 2 and ½ weeks training the family that is receiving the dog. Even after placement, Susquehanna continues to do follow-up training – at first on a weekly basis and then gradually declining over the next six months. It even does annual re-testing.

I hope this follow-up addresses our readers’ concerns. Ms. Fierer emphasized that service dogs are not the solution for every child. Susquehanna actually does therapy sessions with families before even agreeing to place a dog to ensure that the dog and the family are a good fit. She indicated that it is a big responsibility to own a service dog and it is not a decision that is made lightly by the dog trainers. However, for the right child and the right family, a service dog can be an amazing asset.

Related Nash and Associates Links:

Service Dogs for Kids

 

photo from servicedogtraining.wordpress.com

 

 

 

 

 

 

 

 

 

 

 

The death of a baby – the economic realities

Monday, June 6th, 2011

I recently wrote a blog about the grief that parents suffer when they lose an unborn child. At the risk of sounding crass, I want to now discuss the economics of lawsuits involving the death of an unborn child. For those contemplating taking legal action for the loss of their child, I hope this provides some useful information for you to consider.

Maryland courts have carved out specific rules for when an unborn child is considered a person capable of recovering damages in the event of death. The primary rule is that if a baby is actually born alive, no matter at what gestational age, that baby is considered a person with legal rights. So, if a 20-week baby is born alive and then dies one minute later, that baby is considered a “person,” and a lawsuit can be filed on behalf of the estate for that baby’s pain and suffering, otherwise known as a Survival Action.

(This leads to an interesting question – does a fetus feel pain? See Related Links below). The parents of the unborn child can also file what is known as a Wrongful Death action for their own economic and non-economic damages resulting from the death of their baby, primarily their grief and emotional loss over the death of their child. Survival actions and Wrongful Death actions are two separate claims, although they are usually pursued in the same lawsuit.

When a baby dies before birth, however, another question has to be asked: was the baby viable or not? Viability means that a baby is able to live outside the womb, even though he or she may require serious medical intervention. The current thinking is that babies are viable at around 22 weeks. The courts have made the rule that if an unborn child dies before the age of viability, that baby is not yet a “person” and has no legal rights. There can be no Survival Action and there can be no Wrongful Death action. If, however, the baby has reached the age of viability, then the baby is considered “a person” with legal rights, even if the baby was never born alive. Confusing? Yes it is.

The Maryland Courts were following the ruling in Roe v. Wade that a mother had a constitutional right to abort a non-viable baby. Therefore, a non-viable baby was not legally considered a person. If the baby was not a person, then no lawsuit could be filed on behalf of the estate of that baby, nor could the parents file a wrongful death action. So in order for a Survival Action or a Wrongful Death action to lie for an unborn baby, that baby has to have reached at least 22 weeks of gestation.

To make things even more confusing, the Maryland courts have carved out an exception to the above rules. Let’s consider the example of a non-viable baby (i.e., less than 22 weeks gestation) who dies before birth as a result of someone else’s negligence that injures the mother.

A common situation occurs when the mother (let’s say she’s 8 weeks pregnant) is injured in a car accident and suffers a miscarriage as a result. Looking at the above rules, one would think that no claim is allowed. However, the courts have said not so fast. In this circumstance, while the mother cannot recover for the grief of losing her child (because the child is non-viable and, therefore, not legally a person), she can recover for similar damages, including:

  • The depression, anguish, and grief caused by the termination of the pregnancy;
  • The manner in which the pregnancy was terminated;
  • Having to carry a baby which was killed by someone else’s tortious conduct; and
  • Having to witness the stillborn child or the fetal tissue that was to be her child.

I realize this itemization of damages sounds awfully close to the damages permitted in a Wrongful Death action – the very damages that are not allowed in the case of a non-viable baby. It is confusing, to say the least. The courts are trying to find a way to compensate a woman who is injured and loses her non-viable baby as a result of someone else’s negligence, while remaining true to prior precedent in this state that there is no Wrongful Death action allowed in the case of a non-viable baby.

Lastly, keep in mind that Maryland’s cap on non-economic damages applies to cases involving the death of an unborn baby. Economic damages (medical bills, lost wages) are usually very small in such cases. There are no lost wages because we’re talking about a baby, and the medical bills are usually small.

The value of these cases is in the emotional pain and suffering of the parents, and the physical pain and suffering of the baby (assuming a viable baby). Under Maryland law, the maximum allowable recovery for such a claim is $868,750 in a medical negligence action (assuming Mom and Dad both file a wrongful death action).

Under the hypothetical of the mother seeking recovery for the loss of a non-viable baby, the maximum allowable recovery is $695,000 if the allegation is medical negligence, and $755,000 if the allegation is non-medical negligence. (The Maryland Legislature has for some strange reason imposed different caps depending on whether the negligence is medical or non-medical, e.g., a car accident).

As for the question of whether an unborn child feels pain, please click on the link below for a blog by Brian Nash on this very issue.

Related Nash and Associates Links

Does a fetus feel pain

Hysteria over malpractice “crisis”

 

 

 

Week in Review (May 8 – 13, 2011) The Eye Opener Health, Law and Medicine Blog

Saturday, May 14th, 2011

From Brian Nash (Editor)

It was another busy week of blogging at Nash & Associates.

The topics of the week were wide-ranging: special needs kids and man’s best friend; Ovarian Cancer – tips for getting the best care; school’s responsibility for informing parents when a child is in danger from themselves or others; stroke – particularly in the African-American community; and the role of social media in general and in our firm for getting the word out about wonderful charitable and civic organizations.

This past week also saw the posting our a new White Paper by Marian Hogan on a very real problem in many of our nation’s hospitals – patient controlled analgesia (PCA). Marian’s piece explores the risks and benefits of this great form of pain relief for hospital patients. Unfortunately, many of the practices in hospitals raise serious concerns about the level of monitoring of PCA in terms of patient safety.

See what strikes your fancy and then click the blog’s title, photo orread more” to view the entire article. Enjoy – and – as always – thanks for stopping by!

PCA Patient Controlled Analgesia: Is it Safe in Today’s Hospitals?

Author: Marian Hogan

Patients who undergo a surgical procedure in a hospital are often placed on intravenous pain medications after the procedure. These medications, such as morphine or other opioid narcotics, are frequently delivered by a pump mechanism that can be regulated by the patient. This is termed a PCA or patient controlled analgesia pump.

Studies have found that there are roughly one half million or more in-hospital cardiopulmonary arrests (IHCA) in the U.S. every year and that approximately 80% of those patients who suffer an in-house cardiopulmonary arrest do not survive, or sustain permanent and severe brain injury if they do live. Read more>>

 

Dogs a huge help for special needs kids

By:  Mike Sanders

Dogs and kids just seem to go together. Whether it’s running around the yard and roughhousing or just sitting quietly watching TV together on the sofa, dogs seem to gravitate toward kids. For some special needs kids, however, dogs are more than just a friend and play buddy; they are actually a daily caregiver.

The idea of service dogs for disabled children is a little-known yet burgeoning niche in the world of special needs. Everyone knows about service dogs for the blind. I have to admit that until recently, I had never even considered service dogs for other disabilities, let alone children. Then a friend of mine whose son is autistic mentioned that she was thinking about getting an autism service dog for her son. I was puzzled. Her son suffers from sensory processing disorder so I didn’t understand what a dog would be able to do for… read more>>


 

Ovarian Cancer

 

Ovarian Cancer – five tips to make sure you get the medical care you need

By Jon Stefanuca

Did you know that more than 21,000 women are diagnosed with ovarian cancer in the U.S. each year? An astonishing 15,000 women die from ovarian cancer each year. Despite numerous advances in healthcare, the mortality rate for ovarian cancer has not improved in the last 30 years. Simply put, ovarian cancer is the deadliest of all gynecologic cancers. If the cancer is diagnosed in its early stages (i.e. before it spreads to other organs), the five-year survival rate is . . . read more >>

 

School’s Duty to Parents: Is Your Child at Risk?

By: Sarah Keogh

Recently, I have been thinking quite a bit about schools. My son is going to start kindergarten in the fall and my daughter just started preschool last week. While both of my kids are still little, over the years children end up spending many of their waking hours each week at school. The school becomes as much a part of their lives as home for most kids. As parents, we put trust in the school that they will be keeping our children safe and healthy while we are not around to supervise. But do the schools recognize that trust and live up to it?

I was recently made aware of a situation involving a teenager who was having some health concerns. Her parents had first noticed that their daughter… read more >>

 

Brother, will you help me? If you don’t this stroke might kill me

By: Jason Penn

Mother’s Day is in the rearview mirror.  This past Mother’s Day someone told me a story about how their grandmother fell ill.  It was the holiday season, and as she climbed the ladder to decorate the tree, things took a tragic turn. She stumbled, lost her balance and fell.  She seemed “off.” A few short hours later, at the hospital, it was revealed that she had suffered a stroke. Read more >>

 

Social Media and Spreading the Word about Those Who Do So Much Good for Those in Need

By: Brian Nash

Recently my wife and I attended an event held by a newly formed Baltimore organization known as Rebels with a Cause. Frankly, I have to admit, I hadn’t heard of this organization before. According to the event flyer published by the person we are sponsoring, this is a local group of bicycle riders who are joining the Ride for a Feast 140 mile bike ride from Ocean City to Baltimore, MD. (Whew! Glad I’m only a sponsor).

Saturday night came and we traveled to Gertrude’s, a restaurant at the Baltimore Museum of Art which provided the venue for a pre-event gathering of this group of dedicated, good-cause-driven riders. Read more >>

 


Sneak Peak of the Week Ahead

Some topics we’ll be covering next week….and then some…

  • the “debate” rages on about breast milk.” Jason Penn takes an interesting look at this issue in light of some recent, fascinating work done at Johns Hopkins.
  • a report of a new HIV study, but what are the possible implications for medical implications under controlled studies
  • acquired brain injury – what is it all about – what is its impact?
  • … and more….

Have a great weekend, Everyone!






Dogs a huge help for special needs kids

Monday, May 9th, 2011

Dogs and kids just seem to go together. Whether it’s running around the yard and roughhousing or just sitting quietly watching TV together on the sofa, dogs seem to gravitate toward kids. For some special needs kids, however, dogs are more than just a friend and play buddy; they are actually a daily caregiver.

The idea of service dogs for disabled children is a little-known yet burgeoning niche in the world of special needs. Everyone knows about service dogs for the blind. I have to admit that until recently, I had never even considered service dogs for other disabilities, let alone children. Then a friend of mine whose son is autistic mentioned that she was thinking about getting an autism service dog for her son. I was puzzled. Her son suffers from sensory processing disorder so I didn’t understand what a dog would be able to do for him. Kids with autism usually don’t have physical handicaps. But as I talked to her and started reading up on the topic, I found that well-trained dogs can be a huge help to autistic kids, as well as kids with other disabilities.

For autistic children, service dogs don’t offer specific physical assistance, but are highly trained in behavior disruption, which is a major component of autism. As any parent of an autistic child can tell you, behavior disruption is common. It can be different triggers for different children, but the common denominator is that something (usually something benign to most of us) sets off what we laypeople would call an emotional or physical meltdown. This can be a mild tantrum or can be a full-blown one complete with collapsing on the floor and shrieking. Trying to calm an autistic child in the throes of such a meltdown can be a major challenge. It turns out that a dog trained to recognize such behavior and engage the child is a highly calming influence on the child. The dog essentially soothes the child and comforts him or her, shortening the duration and severity of the meltdown, and also cutting down on the number of meltdowns. Rather than getting overly focused on whatever it is that is bothering him or her, the child seems to focus on the ever-present dog and can bypass what otherwise might trigger a reaction.

The dog also gives other support that is less tangible but equally important – giving the child something to focus on if distracted, providing companionship, and assisting with developing friendships with other children. Special needs children are sadly often excluded by so-called normal children which can add a tremendous feeling of isolation for such children. Having a service dog helps break the ice with new kids and provides a constant companion when other children are not around.

Physically, a service dog also helps protect the child and keep him or her safe. One major concern with autistic children is that they are easily distracted and may not think as logically as other children.  They are more prone to wandering off in public because they get distracted by something and follow it, even if it takes them into traffic or near a dangerous body of water.  They may decide to leave the house alone for no apparent reason, even in the middle of the night. Service dogs are trained to restrain the child and act as a second pair of eyes on the child, which is a huge asset to the parents.

Legal fight over service dogs in school

A great piece of news recently came out of Oregon involving an autistic boy named Scooter Givens and his service dog, Madison. For years, Scooter’s parents fought their son’s school for the right to have the dog attend school with him under the ADA (American with Disabilities Act). The school fought back. Finally, the school backed down and agreed to at least try to allow Scooter to bring Madison to school with him. They are starting with part-time hours and working up to full days. If Madison can keep Scooter from having meltdowns, it should be a win-win for both the school and the family.

Cost and Availability

Service dogs are not cheap, nor are they readily available. A well-trained dog can cost  upwards of $20,000, depending on the level of training that is required (which is why my friend is not heading out this weekend to buy one). While this may seem excessive, the cost is actually justified when you realize that it can take six months or more of intense work  to properly train a service dog. That is months of food, shelter and paying a trainer to spend  hundreds of hours training each dog, as well as the additional training time when the dog is matched with the family. It is a labor-intensive process. However, there are ways to meet the cost. Many training facilities seek outside funding to help defray the costs of training, which lowers the ultimate cost to the family. Some families will actually do fundraising themselves to try to pay their portion of the cost. Even with this approach, however, the sad fact is that service dogs are unfortunately out of reach for a large number of people, especially when you consider the other high costs of raising a special needs child.

Other disabilities:

In addition to autism, service dogs are trained to care for people with other disabilities – deafness, mobility issues, and one that I found absolutely fascinating – seizure disorder. Dogs are trained to assist people who suffer seizures by getting the telephone and medicines, and keeping the person physically safe during a seizure. Some dogs can even go so far as to anticipate an oncoming seizure and alert the person to lay down in a safe position before the seizure starts. How the dog knows this is anyone’s guess. So far, science has been unable to explain it. Some researchers theorize that during the earliest phase of a seizure, the person’s electrical brain activity subtly changes a person’s odor which the dog detects. Dogs have a sense of smell that is 300 times stronger than what we have. While this may be the explanation, no one knows for sure so it remains a fascinating mystery.

If you are interested in a special needs dog, there are a number of organizations out there for you to consider. Here are just a few:

4 Paws for Ability:  http://www.4pawsforability.org/

North Star Foundation:  http://www.northstardogs.com/autism.shtml

Dogs for the Deaf:   http://www.dogsforthedeaf.org/index.php

Have any of our readers had any experience with special needs dogs?  I would love to hear your stories.

 

Photo from staplenews.com