Take, for example, the common nursing procedure of placing a feeding tube in a patient’s stomach. If a patient cannot eat, the doctor will often write an order in the hospital chart telling the nursing staff that the patientis to receive nutrition by a tube that goes in through the nose, down the back of the throat and into the stomach.

Placing the tube is a nursing function that takes place on a routine basis. Sometimes the tube goes in easily, other times it can be difficult to pass the tube into the stomach easily due to the patient’s condition or because the tube gives the patient the feeling of gagging during the insertion and causes the patient to thrash. It is important for all Mainers to know that even if placing a tube is “challenging”, there is not a hospital in Maine that is allowed to deviate from the standard of care in nursing as it relates to insertion of a feeding or “enteral” feeding tube. In fact, if placing a tube is especially difficult in a particular case, it is all the more reason for the nurse to be especially careful.

The most serious potential misadventure of a feeding catheter or nasogastric tube is placement in the lung. If not recognized in time, lung collapse and death may result from placement of a feeding tube in the lung.

This x ray shows a feeding tube in the lung of a 64 year old woman recovering from spinal surgery. ( There is also a nasogastric tube properly positioned in the stomach.) This case illustrates the importance of looking at the lung bases where a feeding catheter is seen passing through the bronchial tree of the right lower lobe and extending well into the right pleural space.

There are simple devices that allow nurses to be 100% sure that the tube is in the stomach and not the lungs. One article describes some modern methods of checking for placement as follows:

Enteral feedings are an integral part of care for many hospitalized patients. Accessing the gastrointestinal (GI) tract safely and in a timely manner can be challenging. Various techniques and devices to enhance the safety of bedside feeding tube placement are available for clinicians. Three specific devices are highlighted, including the colorimetric CO(2) detector (CCD), a magnetically guided feeding tube (MGFT), and the electromagnetic tube placement device (ETPD).

The CO(2) detector is applied to detect the presence or absence of CO(2), thus assisting in correct placement of the feeding tube tip into the GI tract vs the lung. The MGFT uses a magnetic device to manipulate the feeding tube through the GI tract into the small intestine.

The ETPD provides real-time visualization of the feeding tube as it progresses into the small intestine. Training and repetition are essential for safe and successful feeding tube placement, and the highlighted devices can contribute to both of these goals.

As a Registered Nurse as well as a medical negligence lawyer, it is especially disheartening to hear when such a basic nursing procedures is carelessly handled.

Briggs & Counsel has successfully litigated numerous cases of medical and nursing malpractice on behalf of patients. Maine has very specialized laws and procedures for handling medical malpractice cases and few Maine law firms handle medical malpractice on a routine basis as we do.

If you or someone close to you has suffered from the careless actions of nurses at a Maine hospital, attorneys from our firm would be willing to meet with family members individually, or as a family group, to begin the process of sorting out what needs to be done to fix what can be fixed, and make up for the problems that can’t be fixed.

Copyright 2009 Briggs & Counsel

A Bedsore is A Wound

You visit your parent and overhear a nurse’s aide tell your mother/father that “the nurse will come in after your visitor leaves and change your dressing”  What dressing!!! 

This may be your first inkling that anything has gone wrong with you parent or grandparent.  You ask questions and learn the truth—your family member has been allowed to develop a bedsore! 

Step Two:  Take Action, and Involve The Doctor

No one who comes to a Maine nursing home should develop a bedsore.  Developing a bedsore in a Maine nursing home is supposed to be a “never event”.  It doesn’t matter whether you live in Augusta or Aroostook, Bangor, Portland or Rockland.  A bedsore wound should happen so rarely that the federal government has instructed Medicare and Medicaid not to pay for bedsore treatment. Maine Nursing homes are required to follow these federal laws just like every other state.

 If you parent or grandparent develops a bedsore while a nursing home resident, send a fax to the nursing home and your loved one’s doctor along these lines:

 Dear “X” Nursing Home Administrator and Dr. “Y”:

 When my parent came to you he (she) did not have a bedsore.  I made a special point to ask that you take care that my parent not develop a bedsore.  Under Federal Law (42 CFR Sec. 483.25 you were supposed to make sure that my parent (grandparent) did not develop a pressure sore.  Please explain to me in writing why this happened. Also, please write to me and tell me what you are going to do to provide necessary treatment and services to promote healing, prevalent infections and prevent new sores from developing.

 Thank you for giving this matter your attention.

 Very truly yours,

 Make sure you save the fax transmission record and then call for an appointment with the nursing home director and the doctor to discuss what they plan to do.  When you meet, emphasize that you want them to write back to you, and that a conversation won’t cut the mustard.  Tell the doctor that you want him to personally inspect the wound.  Tell the doctor that you want a written report that tells you:

·        The size of the wound

·        The stage of the wound

·        The treatment he intends to use to heal the wound

·        How he intends to hold the nurses responsible for following his orders.

·        When he intends to inspect the wound next.

·        What pain medication he is going to give to your loved one.

These actions, writing and having a meeting, are important steps you can take to make sure that your loved one doesn’t linger, or even die, from a bedsore wound.

Tomorrow–

Step Three: What To Do Make Up For What Can’t Be Fixed About a Bedsore

Copyright 2009 Briggs & Counsel

Alison Wholey Mynick, R.N., Esq.

A Bedsore Is A Wound

There is no need for someone to suffer this fate.

When nursing home staff allow a patient to develop this wound it feels the same to the patient as if they had a deliberately inflicted wound.

Step One: Speak Up, And Leave A Record

What can we do to help our loved one’s nursing home and physician get it right? What can we do to prevent our parents and grandparents from suffering like this?

Let’s start with knowing what this problem is.

Bedsores, Pressure Sores, Ulceration, Skin Wound.  These are all words that are used to mean the same thing.

When your parent or grandparent goes into a nursing home consider doing the following:

Make sure there is a record that your loved one doesn’t have a bedsore.  (If your loved has a bedsore, make sure there is a record of where it is, how wide it is, what it looks like, how long it has been present, and what is being done to treat it.)

What do I mean about making a record?  I don’t mean telling the nice people who take down all the information about you parent or grandparent at the time of admission that you are concerned about the issue. Certainly, do that.  However, I mean something different.  I mean finding out the fax number of the nursing home and your parent’s doctor and faxing both of them a note along these lines:

Dear “X”,

My (mother/father/grandparent) is being admitted to your facility today.  This is to let you know that my (mother/father/grandparent) does not have any decubitus ulcer/pressure sore at this time.  Please take every measure to maintain the good condition/integrity of my (parent/grandparent)’s skin, including careful checking and documentation.  If my (parent/grandparent) should develop a pressure ulcer please notify me in writing of that fact, including the location, size, stage and steps you are taking to care for the wound, including repositioning, wound care and nutrition.  Please make this note a permanent part of my (mother/father/grandparent)’s chart.  Thank you.

Then, fax that letter and save the facsimile transmission record. 

This first step protects your family member by letting nursing home health care providers know that you are interested in being informed and that you expect them to be accountable for preventing this problem.

Tomorrow– Step Two: Take Action, And Ask The Doctor To Help

Copyright 2009 Briggs & Counsel

Alison Wholey Mynick, R.N., Esq.

You feel terrible.  You feel beyond terrible. You just found out that your parent or grandparent has been neglected, injured, abused, killed in a Maine nursing home.  It happens.  You can take action, right?  Not so fast.  The outgoing adminstration of George Bush quietly inserted language into federal law that pretends that all those nice Maine people who regulate Maine nursing homes are (even though they are not) federal employees who can’t be forced to tell the truth about what they find out about Maine nursing home safety.  Keith Olbermann blasted the law at the end of a recent MSN “Countdown”  piece.   Think it’s outrageous to silence Maine nursing regulators?  So do we. But it isn’t going to stop Briggs & Counsel from prosecuting cases of nursing home negligence.    If your loved one was injured or died from negligent care at a Maine nursing home, call an attorney who specializes in nursing home litigation.  And write to your U.S. Senator (Olympia Snowe or Susan Collins)  to allow State of Maine employees to tell the truth about what they find at Maine nursing homes.

Copyright 2009 Briggs & Counsel

Alison Wholey Mynick, RN, Esq.

In a recent federal study by the Centers for Disease Control and Prevention, it was found that over 60,000 people have been exposed to hepatitis, with at least 400 having been infected by it.

Hepatitis is defined as a viral infection of the liver. The most common form, hepatitis C, afflicts more than three million Americans and is potentially life threatening. It can cause permanent liver damage and may cause no initial symptoms, with the potential of remaining undetected for years.

Hygiene lapses, such as improper handwashing, have received more attention but according to Joe Perz of the CDC, reusing syringes “is something that is obviously wrong”.

“It really represents a breakdown in very basic patient safety. There really is a sense of outrage among many providers and others working in this area when they hear about some of these outbreaks and some of the practices,” Perz said. He blamed the problem on ignorance and lack of oversight.

At times, doctors or nurses injected several patients from single-use medicine vials - to “cut corners,” Perz said, or, some authorities believe, to save money, according to the CDC.

Advocates and the CDC are trying to raise awareness about the problem. The coalition includes infection control specialists and nurse anesthetists.

The campaign is designed to alert doctors, nurses and other medical workers that syringes must only be used once. Patients should be watching for safety precautions and speaking up if they see or suspect a violation.

Copyright 2009 Briggs & Counsel, by Eliza Stoll

Sometimes a picture, or in this case a video, truly is worth a thousand words. With our abundance of lakes and ponds,  as well as our access to the ocean, every Maine parent should think about this:

http://www.childdrowningprevention.com/index.html

Alison Wholey Mynick, RN, Esq.

Briggs & Counsel

815 Commercial Street

Rockport ME 04856

207.596.1099

297.596.7401 fax

amynick@dbriggslaw.com

www.maine-personal-injury-lawyers.com

After much laboratory testing and analysis, the Food and Drug Administration (FDA) and CDC confirmed that the sources of the outbreak were peanut butter and peanut paste produced by the Peanut Corporation of America (PCA) at its Blakely, Georgia, processing plant.

Peanut paste is a concentrated product consisting of ground, roasted peanuts that are distributed to food manufacturers to be used as an ingredient in many commercially produced products including cakes, cookies, crackers, candies, cereal and ice cream.

As a result of this finding, a number of foods containing peanut butter and peanut paste produced by PCA from July 1, 2008 until now were recalled on January 13, 2009. On January 28, 2009, PCA expanded its recall to include all peanut products produced on or after January 1, 2007.

Some of the recalls involve foods sold directly to consumers, such as peanut butter crackers, peanut butter cookies, and ice cream made with peanut butter, and others involve foods sold directly to institutions, restaurants, the food service industry, and private label food companies.

 copyright 2009 Briggs & Counsel by Elizabeth Stoll

Families need to know that that their elderly mother, father, aunt, uncle or dear, older friend is safe and well cared for.  How do Mainers scratch the surface of a nursing home that appears clean and pleasant on an introductory tour?  One starting point is to look at a nursing home’s “star rating”. 

The federal government has a five-star rating system. A Maine http://www.medicare.gov/NHCompare/Include/DataSection/Questions/HomeSelect.asp nursing home can obtain up to five stars (much above average) in each of five areas: Health Inspections, Nursing Home Staffing, Quality Measures, Fire/Safety. The lowest ranking possible is one star (much below average).

In Maine, the good news is that 26% of our long term care facilities received the government’s best nursing home score.  However, more than 7% of our nursing homes received the lowest “one star” ranking.

According to officials, the five star rating system is meant to be an accompanying tool for consumers to compare nursing homes, but should not take the place of visits and interviews at the actual facility.  Here’s why:

A Nursing Home may receive five stars for staffing, three stars for inspections, three stars for fire safety, but only one star for quality measures, and still have an overall score of three stars.  Even if a nursing home has an overall three star score, would you want your mother or father exposed to a higher risk of injury, including bedsores and urinary tract infections, than they would encounter at a different nursing home only a half mile away?  When a nursing home tells the federal government that it has great staffing, but also has a high percentage of bedsores, urinary tract infections and depressed residents, the facts speak for themselves.  Nursing homes are only as good as the care they deliver. 

Mainers may see the five-star  rating system as a way to challenge nursing homes to improve the care they provide in the 112 facilities across the state. Maine families considering nursing homes for loved ones should weigh many factors when choosing a long term care facility. The number of stars a nursing home is assigned is just the tip of the iceberg.

Copyright 2009 Briggs & Counsel

In a recent letter to President-Elect Obama, several FDA scientists allege that dishonesty is prevalent at the agency and that the “scientific review process for medical devices has been corrupted and distorted by current FDA managers, thereby placing the American people at risk.”

Among the charges: scientists and doctors have been threatened and told, on occasion, to ignore FDA regulations; devices have not been properly labeled; managers without appropriate experience have been given authority to make final decisions about device regulation and have done so while ignoring serious safety and effectiveness concerns; FDA experts have been excluded from product meetings because manufacturers felt that they were “biased”; and manufacturers have been allowed to market their products without FDA approval.

An internal investigation of the charges, according to the scientists, has resulted in absolutely nothing. “No one was held accountable, no appropriate or effective actions have been taken, and the same managers who engaged in the wrongdoing remain in place and have been rewarded and promoted.”

With the transition to President-Elect Obama’s administration will come changes to the leadership of both the Food and Drug Administration (FDA) and the Centers for Disease Control and Prevention (CDC).

According to a recent statement from the FDA, “We have been working very closely with members of the transition team and any concerns or questions they have on any issue, we will address directly with the team. Separately, the agency is actively engaged in a process to explore the staff members’ concerns and take appropriate action.”

By: Eliza Stoll for Briggs & Counsel

Copyright 2009 Briggs&Counsel

Maine residents who have been prescribed antipsychotic medications by their psychiatrist or physician should be aware that there is a low to moderate risk of sudden cardiac death when taking such medications

According to a recent study among patients taking high doses of antipsychotics, there are about 3.3 cases per 1,000 that result in sudden cardiac death. Patients who have been prescribed antipsychotics need to be fully aware of all potential side effects before beginning a medication regime. Doctors need to fully disclose all potential risks to patients.

New research published recently in the New England Journal of Medicine shows that antipsychotic drugs are not risk free, the authors of the study urging more caution in fact in their use. The drugs are associated with a risk of sudden cardiac death, especially at higher doses.

Doctors prescribe antipsychotic medications for a variety of reasons these days, although they were originally intended to treat schizophrenia. They are now being used to treat anything from conduct disorder in children to aggressive behaviors in Alzheimer’s patients. Three particular antipsychotics; olanzepine, risperidone, and quetiapine; are in fact among the top ten drugs sold worldwide.

Antipsychotics are broken down into two categories: typical and atypical. The typical antipsychotics are older medications that have been used for many years to treat schizophrenia. The risk of sudden cardiac death with the use of typical antipsychotics is about 1.99 times greater than in patients who are not using antipsychotic medications. Atypical antipsychotics are newer medications used to treat a variety of behavioral and mental health problems and are considered to have a lesser risk of side effects than typical antipsychotics. According to the article, the risk of sudden cardiac death in patients taking atypical antipsychotics is 2.26 times greater than in patients who are not using antipsychotic medications. olanzapine, risperidone, and quetiapine