California Injury Attorney Blog

Many nursing homes are so understaffed they may be endangering the welfare of their patients, according to a new report by federal health officials.

The report, which will be presented to Congress later this month, recommends stricter guidelines that would require thousands of nursing homes to hire more nurses and nurses' aides, The New York Times reported today.

After eight years of research, health officials concluded that understaffing has contributed to increased incidences of severe bedsores, malnutrition, and abnormal weight loss among nursing home patients.

Problems Could Be Prevented?

A high number of those patients end up developing life-threatening infections, dehydration and other problems that could have been prevented had the homes been staffed adequately, the study said.

The U.S. Department of Health and Human Services recommends new federal standards to guarantee that patients receive a minimum of two hours of care each day from nurses aides, among other things. The study says that 54 percent of nursing homes currently fall below the proposed minimum standard.

The report also recommends that patients receive at least 12 minutes a day of care from registered nurses. Currently, 31 percent of nursing homes do not meet that standard.

Continue reading "Understaffing Compromises the Welfare of Patients In Skilled Nursing Facilities" »

Skilled nursing facilities whose patients are too frequently admitted to the hospital would face stiff new penalties according to the deficit reduction plan proposed by President Obama on Sept. 20, 2011. These admissions are often caused by Bed Sores, Pressure Sores also known as Decubitus Ulcers, falls, infections, or poor medication management.

Overall, as part of a broad deficit reduction plan, Obama would cut more than $300 billion from projected Medicare and Medicaid spending. Some would come from cuts in general payments to nursing homes, home health agencies, other providers, and drug companies. Some would result in higher out-of-pocket costs for seniors themselves. But one little-noticed provision is aimed squarely at facilities with high hospital admission rates.

An estimated 40 percent of nursing facility residents are admitted to the hospital in a typical year, and one-quarter of these may be preventable, according to the Kaiser Family Foundation. A congressional review panel estimates that about 14 percent of patients discharged directly from hospitals to skilled nursing facilities are sent back to the hospital for conditions that could have been avoided.

I've seen hospital emergency rooms filled with very frail seniors on Friday afternoons. Why? Because nursing homes know they won't have enough weekend staff to care for their sickest residents, so they simply send them back to the hospital. The new rules could stop those practices.

And the penalty for violations would be steep: Nursing facilities would lose up to 3 percent of their Medicare payment. For institutions whose margins are often razor-thin, three percent could be the difference between success and failure.

Because this is a Medicare penalty, it would only apply to those patients who are receiving rehabilitation or recovering from a hospital stay. It would not apply to long-stay residents receiving Medicaid. However, these changes could easily be expanded to Medicaid as well.

This readmission rule is similar to one soon to be imposed on hospitals under the 2010 health law. And while those hospital penalties have not yet kicked-in, they have already fundamentally changed the way those institutions think about their patients. Today, because Medicare pays for admissions no matter what the cause, the current system perversely encourages round trips to the hospital, especially in poor performing facilities with lots of empty beds. After all, a readmitted patient generates revenue. The hospital readmission rule radically changes those incentives.

If Congress approves Obama's idea, nursing homes also may have to rethink the way they do business. They'll have to more carefully care for patients even as other provisions of the health law encourage them to treat more complicated cases. To make the challenge even more difficult for nursing homes, Obama has also proposed reducing overall payments for post-hospital nursing home care by $32 billion over 10 years.

Skilled nursing facilities are also feeling pressure from hospitals themselves to reduce readmissions. Now, by hammering nursing homes directly, Obama would only reinforce the message.

Continue reading "Frequent Transfer of Elders and Dependant Adults From Skilled Nursing Facilities Could Cause Them to Incur Stiffer penalties" »

The general consensus indicates that nutrition is an important aspect of a comprehensive care plan for prevention and treatment of pressure ulcers, and it is essential to address nutrition in every individual with pressure ulcers. Adequate calories, protein, fluids, vitamins and minerals are required by the body for maintaining tissue integrity and preventing tissue breakdown.

Pressure ulcer incidence may be higher with increased age, frailty or severity of illness, pressure ulcer history or significant weight loss and eating difficulties . Compromised nutritional status such as unintentional weight loss, undernutrition, protein energy malnutrition (PEM), and dehydration deficits are known risk factors for pressure ulcer
development . Other nutrition-related risk factors associated with increased risk of
pressure ulcers include low body mass index (BMI), reduced food intake, and impaired ability to eat independently.

Continue reading "Poor Nutrition Effects The Development of Bed Sores, Pressure Sores and Decubitus Ulcers" »

Estimates indicate that 1 to 3 million people inthe US develop pressure ulcers each year .According to the Joint Commission, more than 2.5 million patients in United States (US) acute care facilities suffer from pressure ulcers, and 60,000 die from pressure ulcer complications each year .

Pressure ulcers can reduce overall quality of life due to pain, treatments, and increased length of institutional stay, and may also contribute to premature mortality in some patients .Therefore, any intervention that may help to prevent pressure ulcers or to treat them once they occur is important to reduce the cost of pressure ulcer care and improve quality of life for affected individuals.

The burden of having a pressure ulcer is high, in physical, emotional and financial terms. Data from 2009 indicates that the cost of treating pressure ulcers may range from $9.3 to 16.0 billion annually. AHRQ reported that pressure ulcer-related
hospitalizations ranged from 13 to 14 days and cost $16, 755 to $20,430 compared to the average stay of 5 days and costs approximately $10,000. The Centers for Medicare/Medicaid Services (CMS) reports the cost of treating a pressure ulcer in acute care (as a secondary diagnosis) is $43,180.00 per hospital stay. Contributing cost factors include increased length of stay due to pressure ulcer complications such as pain, infection, high tech support surfaces, and decreased functional ability. In addition to the financial cost of pressure ulcers, mortality rates are disturbing. A recent
AHRQ document reports 503,300 pressure ulcer-related hospitalizations in 2006 which
included 45,500 hospital admissions in which patients had pressure ulcers as the primary diagnosis. Of these admissions, one in 25 admissions ended in death. Another 457,800 pressure ulcer-related hospital admissions noted pressure ulcer as the secondary diagnosis. Of these admissions, the death rate was one in eight.

Continue reading "Over 60,000 People Die Each Year From the Complications of Bed Sores, Pressure Sores and Decubitus Ulcers" »

Bed sores are commonly called as pressure ulcers which are caused primarily by unrelieved pressure. It may affect any part of the body like knees, elbows and sacrum, which is kept under constant pressure. When individuals are bed ridden for several months there will be no movement of various parts of body causing continuous pressure inside. It is difficult to treat bed sores in elderly patients and patients who are terminally ill. Many cases of bed sore patients have died even though they are in constant medical care.

Symptoms by stages:

Patients who stay in bed for continuous hours without any physical movement are prone to bed sores, irrespective of age. It is necessary to change the position of the patients for every 2-3 hours to remove the pressure. In the first stage the disease is only superficial which is seen as red coloration in the skin. Even if the patient is shifted on turns, for relieving the pressure, the redness of the skin does not disappear. This type of pressure ulcers (bed sores) can be identified easily in fair complexioned people. In stage two, the pressure ulcer will destroy the epidermis layer of the skin and may extend till dermis. In stage three, the skin become very thick and ulcer may enter the subcutaneous layer. In final stages, the ulcer may affect and damage the muscles and even bones and is mostly fatal.

The patients will develop deep purple or maroon colored skin with blisters on account of damage caused to the thin layer of cells. It becomes difficult to detect bed sores in dark skin persons. Depending on the stages of development the time of healing may extend.

Continue reading "Bed Sores, Pressure Sores and Decubitus Ulcers Will Cause Pain and Death" »

Tips for preventing pressure ulceration
Risk Assessment:

Risk assessment tools, such as the Waterlow and Braden scales act as a prompt enabling clinicians to recognize any risk of pressure ulcer development. They encompass a range of factors known to influence the development of pressure ulcers, such as those mentioned above.

All patients should have a pressure ulcer risk assessment undertaken within six hours of admission into an acute area, such as a skilled nursing facility or a long term care hospital and this should be regularly reviewed throughout their stay. This will aid identification of individuals with an increased risk of pressure ulceration at the earliest stage.

It is vital that structured and clearly documented risk assessment is undertaken to ensure that risk factors are recognized and acted upon in an appropriate and timely fashion.

Continue reading "Risk Assessment A Proper Tool To Recognize Bed Sores. Pressure Sores and Decubitus Ulcer Development" »

What do twelve California hospitals have in common? All have been fined for preventable medical errors that injured or killed patients.

Alameda Hospital in Alameda. In 2009, seven patients were given fentanyl patches for pain without being properly evaluated for their medical necessity or dosage. This was a first citation.
Brotman Medical Center in Culver City. An unattended patient fell trying to get out of his wheelchair. He suffered bleeding in his skull and subsequently died. This was Brotman's second penalty.
California Men's Colony in San Luis Obispo. A patient died after being given the wrong dosage of methadone. This was a first citation.
Dominican Hospital in Santa Cruz. A patient suffered kidney failure and hearing loss after receiving an overdose of chemotherapy for testicular cancer. This was a third penalty.
Emanuel Medical Center in Turlock. A guidewire (a thin wire inserted into an artery to guide a catheter) was left inside a patient during surgery and subsequently traveled into the heart before a second surgery was performed to remove it. This was a second citation.
Kaiser Foundation Hospital & Rehabilitation Center in Vallejo. A patient was implanted with a different patient's lens during cataract surgery. This was a second citation.
Los Angeles County + University of Southern California Medical Center in Los Angeles. A burn patient undergoing skin graft surgery suffered severe brain damage when anesthesia was administered without an anesthesiologist present. This was a fourth penalty.
Riverside Community Hospital in Riverside. A large metal clamp was left inside a patient during surgery. This was a first citation.
Stanislaus Surgical Hospital in Modesto. Surgery was initiated on the wrong ankle. This was a first citation.
Sutter Delta Medical Center in Antioch. A patient with a potentially fatal, abnormal heart beat went into cardiac arrest and later died after not being attached to a cardiac monitor for 40 minutes. This was a first citation.
Torrance Memorial Medical Center in Torrance. A bottle of solution used during a kidney surgery was left inside the patient. The bottle wasn't discovered until the patient returned to the medical center for another operation
OC San Francisco Medical Center in San Francisco. A sponge was left inside a patient during surgery. This was a fifth penalty for the hospital.
Although considerable attention has been given lately to methods of eliminating medical errors and enhancing patient safety, the number of avoidable errors remain staggeringly high. In fact, in 1999 the Institute of Medicine reported that up to 98,000 patients die, each year, as a result of such events. This began a patient safety movement that is obviously still a long way from where it should be. It has not helped that the US Chamber of Commerce and the insurance industry have led a "blame the lawyers, blame the victims" crusade, known to some, as 'tort reform' or "lawsuit abuse". We are all less safe when tort reform measures are successful.

Continue reading "Hospitals Are Fined for Preventable Medical Errors" »

Pressure against the skin reduces blood supply to that area, and the affected tissue dies. This may happen when you stay in one position for too long without shifting your weight. You might get a pressure ulcer if you use a wheelchair or are confined to a bed, even for a short period of time (for example, after surgery or an injury).
The following factors increase the risk for pressure ulcers:

•Being bedridden or in a wheelchair
•Being older
•Being unable to move certain parts of your body without help, such as after a spine or brain injury or if you have a disease like multiple sclerosis
•Having a chronic condition, such as diabetes or vascular disease, that prevents areas of the body from receiving proper blood flow
•Having a mental disability from conditions such as Alzheimer's disease
•Having fragile skin
•Having urinary incontinence or bowel incontinence
•Not getting enough nourishment (malnourishment)

Continue reading "A Pressure Ulcer / Bed Sore is an Area of Skin That Breaks Down When Constant Pressure is Placed Against the Skin" »

Signs of MRSA

Signs of MRSA include respiratory issues, infections around open wounds, and urinary tract issues. To discover if a resident has this bacterium a swab of the nostrils and a microscope examination for the bacterium is needed. It does not take long for MRSA to worsen. Usually the initial symptoms appear in 24 to 48 hours, and after 72 hours it is resistant to treatment. MRSA can be prevented with proper cleaning and care of patients. Treatment is through vancomycin or teicoplanin and if used early enough can stop the infection before death can occur.

Signs of VRSA

VRSA is vancomycin-resistant Staphylococcus aureus. VRSA can result from treatment of MRSA with vancomycin and teicoplanin. The patient may become resistant to the original infection, as well as the drug being used to stop the infection from spreading. This particular bacterium is rarer than MRSA, but it does occur with increasing regularity. The bacteria will thicken the cell walls depleting the amount of vancomycin that enters the blood stream and kills the bacteria. Patients with this infection must be isolated to avoid spreading it throughout the rest of the SNF. They may also have to be placed on a pump to clean out their system of the vancomycin before trying another drug. The bacterium has to be isolated in the body to help eradicate it.

Looking for Risk Factors

VRSA and MRSA are just two inflectional bacterium found in SNFs that you should look for before placing a loved one. To keep residents at SNFs free of this inflectional bacterium the staff must provide proper housekeeping, hygiene, and keep to federal and state regulations regarding care facilities.

Continue reading "MRSA and VRSA signs of Nursing Home Abuse and Neglect" »

The NTSB's proposal to regulate cellphones while driving goes farther than any prior attempt made by the agency to regulate cellphone use by commercial drivers. It came in the wake of a hearing in Washington after ruling that a truck driver using his cellphone caused a crash that killed 11 people on a Kentucky interstate in 2010. Kenneth Laymon, 45, of Jasper had just made a call that lasted one second at the time of the March 26, 2010, accident on Interstate 65 near Munfordville, Ky., investigators said.

The recommendation builds on previous proposals and a push by federal authorities stop commercial drivers from using hand-held cellphones and texting while operating large trucks and buses. The NTSB has previously recommended prohibiting bus drivers from talking on the phone and texting while driving. The U.S. Department of Transportation also has a rule in place barring the use of hand-held phones by commercial truck drivers and similar regulations are in place for pilots, train engineers and boat operators.

Continue reading "Cellphone Use By Truck Drivers Can Be the Cause of Serious and Catastrophic Injury" »

A 55-year-old man presents with a 2-day history of nausea and vomiting. Laboratory analysis reveals a normochromic normocytic anemia and hyponatremia. A cranial MRI is obtained.

An apathetic appearance coupled with a history of unexplained hypoglycemic episodes, weakness, nausea, vomiting, and fine peri-oral skin wrinkling.

Vehicle accidents, slip and fall, spinal cord, brain injuries and nursing home abuse and neglect often result in serious, life altering injuries. The Peck Law Group has the resources and experience to pursue compensation for expenses and damages sustained as a result of a catastrophic accidents and neglect leading to serious personal injury,We have lawyers and office locations throughout the State of California, and our legal team is ready to assist you in handling the complicated legal aspects of all accident lawsuits. We are familiar with the laws on personal injury and can work to ensure that you receive the justice you deserve

The PECK LAW GROUP a major Plaintiffs' Nursing Home Abuse and Neglect and Serious Personal Injury Law firm located in Los Angeles, California hereby announces the formation of PLG Marketing Group an attorneys marketing concern to help educate potential clients and attorneys to understand the factual and legal complexities and issues involving the matters of Elder Abuse, Nursing Home Abuse and Neglect and Serious Personal Injury.

Continue reading "PLG MARKETING GROUP ANNOUNCES ITS FORMATION IN THE AREAS OF ELDER ABUSE, NURSING HOME ABUSE & NEGLECT and SERIOUS PERSONAL INJURY" »

Septic shock occurs most often in the very old and the very young. It also occurs in people who have other illnesses.

Any type of bacteria can cause septic shock. Fungi and (rarely) viruses may also cause the condition. Toxins released by the bacteria or fungi may cause tissue damage, and may lead to low blood pressure and poor organ function. Some researchers think that blood clots in small arteries cause the lack of blood flow and poor organ function.

The body also produces a strong inflammatory response to the toxins. This inflammation may contribute to organ damage.

Risk factors for septic shock include:

Diabetes

Diseases of the genitourinary system, biliary system, or intestinal system

Diseases that weaken the immune system such as AIDS

Indwelling catheters (those that remain in place for extended periods, especially intravenous lines and urinary catheters and plastic and metal stents used for drainage)

Leukemia

Long-term use of antibiotics

Lymphoma

Recent infection

Recent surgery or medical procedure

Recent use of steroid medications

Symptoms

Septic shock can affect any part of the body, including the heart, brain, kidneys, liver, and intestines. Symptoms may include:

Cool, pale extremities

High or very low temperature, chills

Lightheadedness

Low blood pressure, especially when standing

Low or absent urine output

Palpitations

Rapid heart rate

Restlessness, agitation, lethargy, or confusion

Shortness of breath

Skin rash or discoloration

Signs and tests

Blood tests may be done to check for infection, low blood oxygen level, disturbances in the body's acid-base balance, or poor organ function or organ failure.

A chest x-ray may show pneumonia or fluid in the lungs (pulmonary edema).

A urine sample may show infection.

Additional studies, such as blood cultures, may not become positive for several days after the blood has been taken, or for several days after the shock has developed.
Treatment

Septic shock is a medical emergency. Patients are usually admitted to the intensive care unit of the hospital.

Treatment may include:

Breathing machine (mechanical ventilation)

Drugs to treat low blood pressure, infection, or blood clotting

Fluids given directly into a vein (intravenously)

Oxygen

Surgery

There are new drugs that act against the extreme inflammatory response seen in septic shock. These may help limit organ damage.

Hemodynamic monitoring -- the evaluation of the pressures in the heart and lungs -- may be required. This can only be done with special equipment and intensive care nursing.
Expectations (prognosis)

Septic shock has a high death rate. The death rate depends on the patient's age and overall health, the cause of the infection, how many organs have failed, and how quickly and aggressively medical therapy is started.
Complications

Respiratory failure, cardiac failure, or any other organ failure can occur. Gangrene may occur, possibly leading to amputation.

Continue reading "Septic Shock is a Serious Condition That Happens Too Much In Nursing Homes and Long Term Care Facilities" »