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Assisted Living Regulations Available for all 50 States

Billy Cunningham — Sat, 11 Apr 2009 09:05:18 GMT

The National Center for Assisted Living (NCAL) recently compiled a summary of the assisted living regulations in all 50 states. The Assisted Living State Regulatory Review can be found at this web page: http://www.ncal.org/about/2009_reg_review.pdf

The Review noted that about one million Americans are now resident in assisted living facilities. Of those about 115,000 received assistance from Medicaid programs in the various states. Until recently, there was little or no oversight for these homes. While there are some federal laws that impact assisted living facilities the primary responsibility is in the hands of state governments. Regulations throughout the US vary. The Assisted Living State Regulatory Review is a source consumers can go to and learn about the regulations in your state.

The Review provides us not only with a summary of the regulations but also with the contact information for the state agencies which provide the oversight. You can find for every state the agency/phone number, the website for the agency, and the direct contact person with that agency who can answer questions and give you information on how to obtain a complete copy of that state’s regulations.

Eighteen states made changes in 2008 and ten states on working on changes this year. Last year some of the changes observed by the NCAL included updates of emergency/disaster preparedness and fire safety standards. Five state’s regulations increased staff training requirements. Four states reported changes to their medication requirements- like Maryland’s new regulation that requires a licensed pharmacist to review physician prescriptions, orders, and resident records every six months for residents who have nine or more medications. Other trends seen in regulation changes include additional disclosure requirements and changes to background check requirements.

The summary of these regulations can assist consumers trying to decide if a facility is proper for a loved one, in determining whether a facility is complying with the state’s requirement, will give the facility operators with contact information so they can be compliant with the regulations, and provide a resource of information for lawyers who represent victims of abuse in these facilities .

Originally posted at InjuryBoard by Billy Cunningham

Tips to Prevent Medical Errors

Jan Boswell — Wed, 11 Nov 2009 09:22:02 GMT

This blog is written in response to the blog, 98,000 Reasons to Care about Patient Safety, by Jane Ayre at InjuryBoard.com. This is the number of Americans who die from medical errors each year. As a nurse, I know that patient safety is a concept that is foremost in the minds of healthcare providers, administration, and regulatory agencies. How can you, the consumer, help prevent medical errors ? In this blog, I will outline tips to help the consumer prevent other medical errors.

1. Be an active part of your healthcare team. Ask questions not just in the hospital but anywhere you receive healthcare. If you don’t understand something, ask for clarification.
2. If you have a choice, choose a hospital at which many patients have had the procedure and surgery you need and have had good results.
3. When choosing a specialist, ask your own physician for a personal recommendation. I have been known to ask my primary doctor: “If this were your wife, who would you send her to for this condition?”
4. Ask all healthcare workers who have direct contact with you whether they have washed their hands. Adequate hand washing is a primary way to prevent infection.
5. Before you leave the doctor’s office or hospital, make sure you understand the treatment plan. This includes understanding about your medications, follow-up care, and when to contact the doctor.
6. Before you leave the hospital, make sure you understand when you can resume regular activities. Make sure your doctor understands your regular activity level. You should know when you can shower, take a tub bath, lift 5 lbs, return to work, etc.
7. If you are having surgery, make sure that you, your doctor, and your surgeon all agree on what exactly will be done. For example, if you are having surgery on your right arm, make sure all involved knows it is the right arm. Make sure the site is marked before surgery.
8. Make sure someone is in charge of your care. This could be your personal physician. You need a point person to direct your care.
9. Make sure that all health care professionals involve in your care has your important health information. I love patients who come in with a written history. It is important that healthcare professional know your allergies, past surgeries, past and current medical conditions, etc.
10. Have a family member or friend designated as your advocate. Ask that person today. Make sure they know your medical history and your preferences in regards to medical care.
11. Before a test or treatment, ask why it is needed and how it can help you. Be informed before you consent.
12. If you have a test, follow-up and get the results.
13. Learn about your condition and treatments. If you use the Internet, use reliable sources. Treatment recommendations based on the latest scientific evidence are available from the National Guidelines Clearinghouse at http://www.guideline.gov. One of my favorites is www.mayoclinic.com.
You can visit my previous blogs on detail ways to prevent medication errors. I have outlined below the top 6 tips:
1. Make sure all healthcare professionals involved in your care know everything you are taking. This includes over-the counter medications, vitamins, herbs, and dietary supplements. Review these with your doctors once a year.
2. Make sure all healthcare professionals involved in your care know about any allergies and adverse reactions you have had to any medications.
3. When you get a new prescription from your doctor, make sure you can read it.
4. Understand your medications. What is it for? How is it to be taken and for how long? What are the side effects? Can I take it with other medications? What should I avoid while taking this medication?
5. Ask the pharmacist if you have any questions about the directions on your medication labels.
6. Ask for written information about the side effects.

Be involved in your care. Ask questions until you understand. Never consent to a test, surgery, or procedure until you are informed. Do not feel like a nuisance, you are standing up for your right to safe medicine that is appropriate for you and your condition. Your diligence could save your life. Share this with your family and friends.

Adapted from Agency for Healthcare Research and Quality

Originally posted at InjuryBoard by Jan Boswell

How does the Wound Ostomy and Continent Nurses Society Position Paper on Avoidable versus Unavoidable Pressure Ulcers impact pressure ulcer malpractice cases?

Jan Boswell — Tue, 11 Aug 2009 12:33:09 GMT

A recent position paper by the Wound Ostomy and Continence Nurses Society discussed avoidable versus unavoidable pressure ulcers. The paper concluded that there are clinical circumstances in which a pressure ulcer is unavoidable. The rationale behind this statement was that pressure ulcer formation is a complex process that may not be halted, even with excellent multidisciplinary care. Further, the skin is the largest organ in the body and its integrity is dependent upon the function of all other organs systems for nutrition, circulation, and immune function. Often the disease process can overwhelm the skin and interrupt nutrition, circulation, and immune functions to the skin. The statement of position states that it is the responsibility of the healthcare facility to adopt best practices aimed at pressure ulcer prevention. The rationale for this is that there are increasing reports of success in reducing the prevalence and incidence of pressure ulcers by implementing evidence-based clinical practice guidelines.

The following are the definition of avoidable and unavoidable pressure ulcers from the Centers of Medicare and Medicaid:

· Avoidable Pressure Ulcer: Avoidable means that the resident developed a pressure ulcer and that the facility did not do one or the more of the following: evaluate the resident’s clinical condition and pressure ulcer risk factors; define and implement interventions that are consistent with residents needs, resident goals, and recognized standards of practice; monitor and evaluate the impact of the intervention; or revise the intervention as appropriate. (483.25c/TagF314).
· Unavoidable Pressure Ulcer : Unavoidable means that the resident developed a pressure ulcer even though the facility had evaluated the resident’s clinical condition and pressure ulcer risk factors; defined and implemented interventions that are consistent with resident needs, goals, and recognized standards of practice; monitor and evaluated the impact of the interventions; and revised the approaches as appropriate. (483.25c/TageF314)

So how does this position paper impact pressure ulcer malpractice cases?

· One of the recommendations of the position statement is accurate documentation of preventive measures targeted at the reduction of risk. Also, the clinical reasons why prevention interventions are not appropriate or feasible should be documented. If the pressure ulcer is determined to be unavoidable, the rationale must be evident.
· So in screening your pressure ulcer cases pay close attention to the documentation. A risk assessment tool should be done upon admission. Many hospitals have in their policies that skin assessment along with a risk assessment should be done daily. Most nursing homes do weekly skin audits. The skin should be consistently assess and the results of this assessment should be well documented.

· If the patient’s score on the skin risk assessment puts them at risk for pressure ulcer, a pressure ulcer prevent protocol should be started. This should be documented on the chart.

· In screening your case, see if these protocols were followed. Was the patient turned every 2 hours? Were pressure relieving devices used? Was nutrition consulted? Was preventive skin care initiated?
· If a pressure ulcer did develop, was it adequately treated and monitored? Pressure ulcers should be re-assessed weekly to assess if treatment is working effectively. If not, was a new skin care regimen ordered?
· Was the pressure ulcer assessed weekly as to size, characteristics, odor, etc.?
· Were lab values related to nutrition and infection being monitored? If these lab values were outside of normal limits, were the appropriate medical professionals notified? Was the problem adequately addressed?
· If the pressure ulcer was malodorous or had an exudate, was the wound cultured?
· If the pressure ulcer developed past a Stage I, was a wound care nurse consulted?

In the end, these cases come down to assessment and documentation. The position paper cannot be used as an excuse for pressure ulcers to develop. Most pressure ulcers can be prevented with good, effective, and early interventions.

Originally posted at InjuryBoard by Jan Boswell

Hospital Errors - Is I'm Sorry Enough?

Jon Lewis — Mon, 27 Jul 2009 21:32:53 GMT

For years, we have received calls about potential medical malpractice claims. Many times, the potential client is only complaining about poor bedside manner. Had the doctor or nurse simply said, "I'm sorry" to the patient or to the patient's family, we would have never received a call. Of course, these individuals never have a claim anyway because of the intricacies of medical malpractice claims in Alabama.

In a recent Associated Press article from David Goodman, the doctors at the University of Michigan Health System have adopted the policy of apologizing to patients for errors at the hospital. According to the article, these doctors are admitting mistakes upfront, and in many of the cases, they are paying compensation before being sued. What is the result? Malpractice claims fell from 121 in 2001 to 61 in 2006. Open claims fell from 262 in 2001 to 83 in 2007. They cut costs per claims in half, and they dropped their reserves by two-thirds.

Patients want honesty. They want sincerity. They want the truth. Isn't that what everyone wants? Patients go to doctors and hospitals to receive medical care. Patients know that medicine is not an exact science. They know that mistakes happen which is why many juries rule in favor of hospitals and physicians in Alabama, at least. That's why patients can accept apologies. They can accept mistakes. Even if it involves a loved one and a death, I believe patients can understand if the doctor, nurse, or hospital administrators sit down with the family and patient and explain what happened.

If I made a mistake as a doctor, I don't think I could live with myself if I hid that from the patient or their family. I would want the family to be compensated for the error. That's what malpractice insurance is for.

This is what the new internet and social media are all about. Transparency. Everyone wants to know the truth about everything. Do certain doctors make more mistakes than others? Hospitals? Now, with Twitter and Facebook and other social media outlets, you can begin to find this information. It's also immediate.

Everyone wants the truth. That's what the legal system is for. Searching for Justice. Searching for the truth.

Originally posted at InjuryBoard by Jon Lewis

Policy Limits Demand

Pete Burns — Tue, 07 Apr 2009 14:28:50 GMT

The policy limits demand is a powerful tool for the plaintiff and should be taken seriously by the insured defendant. The plaintiff is saying that she will settle her case for a specific sum or the amount of insurance the coverage available to the defendant. If the insurance company refuses to settle the case and the plaintiff wins more than the policy limits sometimes the insurance company can be required to pay the entire judgment. That may require that the defendant sue his insurer for a "bad faith" refusal to settle. If the plaintiff will settle for policy limits and the defendant's insurance company will not agree the smart defendant will hire a lawyer to evaluate the situation immediatley.

Originally posted at InjuryBoard by Pete Burns

$2 Million Awarded in Rhode Island Medical Malpractice

Shannon Weidemann — Tue, 10 Jun 2008 14:36:00 GMT

A medical malpractice lawsuit was filed against Rhode Island Hospital and Dr. William Feng. The plaintiff claimed that he suffered a brain injury during open heart surgery at the hospital in 1998. The jury agreed that the doctor and hospital were liable and awarded the man $2 Million.

His lawyer says Barrett's brain damage erased some memories of his children, affected his ability to form new memories and impaired his ability to communicate.

The plaintiff's attorney claimed that low amounts of oxygen caused the brain damage. The hospital is planning on appealing the verdict. Their only comment was that the patient received excellent care.

Originally posted at InjuryBoard by Shannon Weidemann

AHA Advocates substituting good ole boys for juries

Pete Burns — Wed, 21 Oct 2009 09:14:53 GMT

The American Hospital Association is advancing a bizarre version of malpractice “reform”. It advocates substituting a local panel of experts appointed by state authorities for juries. So the state medical association would appoint doctors in each community to sit in judgment of doctors in their communities. That would be an effective way to curb malpractice suits! Suppose we gave the same opportunity to contractors, business executives, and drug companies? Industry insiders could be counted upon to reduce the cost of litigation to their comrades by shifting the burden of malfeasance to the victim. Heaven help us if we replace our venerable jury system with the good ole boy network.

Originally posted at InjuryBoard by Pete Burns

Caps on Damages Make No Sense

Billy Cunningham — Sat, 07 Nov 2009 11:14:08 GMT

The Republican proposal on health care reform has provisions to limit compensation for non-economic injuries to persons injured or killed as the result of medical malpractice including residents of nursing home who are neglected or abused. Most of my practice over the past 23 years of my 35 year career has been representing nursing home residents. I began thinking of how I would tell clients and/or their families that nursing home neglect and abuse was included in the medical negligence bill proposed. How do I explain that injuries to the elderly, vulnerable members of our society are limited? Here are people who cannot protect themselves, who rely on nursing homes for their safety and well being, and to provide a quality of life that Congress knows what the limit of those injuries are? I thought of all the cases that I have handled involving injuries in nursing homes. The following are actual examples of victims of nursing home neglect and abuse that under the standard proposed by the Republicans would be limited in any award against the nursing home that caused the injuries or death the award.

Mr. A. who had a grapefruit sized vaginal malignant tumor that the nursing home never knew about- death case.

Mr. B. , an Alzheimer patient in a ‘special unit’ who despite no other physical diseases developed multiple state 4 pressure sores, contractures and severe weight loss – death case.

Mr. C., a smoker, who was strapped in a wheelchair and unwatched burned to death when a lighter caught his clothing on fire.

Mrs. D who was overdosed with psychotropic medications to keep her quiet and while trying to escape the torture fell in a bush and lost an eye. After this incident she was moved to a nursing home that properly cared for and weaned her off the psychotropic medications. She was discharged and the last I heard was playing the slot machines in Biloxi. Personal injury case.

Mr. E. who was beaten to death by another nursing home resident who had previously beaten other resident. No precaution was taken to protect any of these residents.

Mr. F. who was demented and known to have a desire to leave the facility and fell from an open window. death case

Mr. G. who went in a nursing home for a 21 days rehabilitation after hip surgery and developed a pressure sore so big on his leg that the leg had to be amputated- personal injury case.

When you look at the data which shows that medical malpractice is a very miniscule part of the cost of health care, you have to ask yourself whether proposed limits are fnecessary for health care reform or fair to the victims.

Originally posted at InjuryBoard by Billy Cunningham

Study Does Not Support Changing Med-Mal Tort System

Billy Cunningham — Fri, 18 Sep 2009 13:34:43 GMT

In December, 2008, the Congressional Budget Office (“CBO”) prepared a study paper entitled Key Issues in Analyzing Major Health Insurance Proposals. One of the issues addressed were proposals which seek to change medical practices by focusing on the ways in which patients and medical providers settle disputes about treatment. That is a fancy way of saying proposals to modify the laws about medical malpractice.

The study found that in 2003 approximately 181,000 severe medical injuries occurred in U.S. hospitals that were attributable to negligence. Only 17% of those patients chose to file a malpractice claim. Interestingly, the study reported that patients who did not file a claim may have been unaware that the negligence had occurred, or they may have been discouraged from filing a lawsuit because of the time, effort and expense involved.

In 2008, CBO estimated that healthcare providers are likely to spend more than $30 billion to defend against and pay medical malpractice claims. However, that money represents about 1.5% of national health expenditures and less than 3% of total payments to doctors and hospitals. The report goes on to discuss caps on award damages in medical malpractice cases and determined that savings resulting from such caps would reduce total healthcare spending by less than 0.2%. The bottom line of the study by CBO was that it had not found consistent evidence that changes in the medical malpractice environment would have a measurable impact on healthcare spending. With such a small percentage of the overall health care costs involved, you wonder why there is such a clamor for change? Could it be that insurance companies see another way to make even more money while denying the injured their day in court?

In summary, this study produced during Bush’s administration does not support a change in our medical malpractice system. The changes proposed all involve a federal type system. A federal system is contrary to what most tort reformers advocate out of the other side of their mouths-state’s rights. For example, in the two states where I practice, Mississippi has very restrictive punitive damages laws and Alabama has very restrictive standards of proof in medical malpractice cases. Why can’t the states control their own destiny over such a minute matter in the healthcare debate?

Originally posted at InjuryBoard by Billy Cunningham

Apology Laws

Gaines Drago — Tue, 19 Aug 2008 17:08:00 GMT

Surfing the internet a few weekends ago I came across this article from a Dallas based plaintiffs firm discussing new measures state legislatures are taking to curb medical malpractice payouts. The apology laws, as they are being touted, basically state the contention that most med. mal cases are brought out of anger due to the victim's belief that health care providers show little concern for their contribution to the plaintiff's injuries. The legislators feel as though if doctors and medical personnel are able to have open communication with victims, free from repercussion, fewer suits would be filed and lower amounts of punitive damages would be awarded, thereby lowering costs. The article states that nineteen states have adopted such laws which allegedly protect and encourage health care employees to apologize and speak candidly with victims. Several VA hospitals have tried to put this theory into practice and have found that payouts have been lowered by $80,000. While, I in no way discourage open communication between the health care provider and the patient, I feel that not every consideration for the plaintiff's future well-being is taken into account by such practices. The article states, and I agree, that one of the disadvantages is the lack consideration for the future financial support many of these victims face. Many times expediency of settlement would limit the ability of the victim to consider possible repercussions and expenses he/she will face in the future. The apology laws do not provide for the kind of screening and planning that the victim needs to consider before just accepting a quick financial settlement. My knowledge of this subject is limited, due to my inexperience, but it just appears, while the concept of more open lines of communication is no doubt beneficial, I wonder if the best interests of the victim are what these laws really protect.

Source: http://www.wiredprnews.com/2008/06/22/dallas-veterans-medical-malpractice_20080622358.html

Originally posted at InjuryBoard by Gaines Drago