Hospital Acquired Infections. Super Bugs Get More…Um, Super.
Sources: NPR (National Public Radio); US Centers for Disease Control and Prevention (CDC)
WE’VE blogged about MRSA (methicillin-resistant Staphylococcus aureus), VRE (cancomycin Resistant Enterococcus) and C-Diff (Clostridium difficile). Get ready to add another nasty super bug to the list -CRE (carbapenem-resistant Enterobacteriaceae).
Federal officials warn that the newest kid on the block has become a significant health problem in hospitals throughout the United States. These germs, known as carbapenem-resistant Enterobacteriaceae, or CRE, have become much more common in the last decade, according to the Centers for Disease Control and Prevention. And the risk they pose to health is becoming evident. “What’s called CRE are nightmare bacteria,” says Dr. Thomas Frieden, director of the CDC, “They’re basically a triple threat.” First of all, they are resistant to virtually all antibiotics, including the ones doctors use as a last-ditch option. Second, these bugs can transfer their invincibility to other bacteria. “The mechanism of resistance to antibiotics not only works for one bacteria, but can be spread to others,” Frieden says. Third, the bacteria can be deadly. Infection with the bacteria “have a fatality rate as high as 50 percent,” Frieden says.
While resistant bacteria potentially pose a risk to anyone, people whose immune systems are weaker, such as elderly people, children and people who have other health problems, tend to be most susceptible to infection.
CDC data show the proportion of bacteria that have this resistance to many drugs has quadrupled in the last decade or so. CRE cases were reported by 4 percent of hospitals in 2012, up from about 1 percent from about a decade earlier, according to the report. In long-term care hospitals the situation is even worse — about 18 percent have reported cases, the CDC says. In addition, the proportion of Enterobacteriaceae bacteria that were resistant increased from 1.2 percent in 2001 to 4.2 percent in 2011, the CDC reported.
The big fear is that they’ll start to move out of hospitals and into the communities around them. “If CRE spreads out of hospitals and into communities, that’s when the ship is totally underwater and we all drown,” Infectious disease specialist Dr. Brad Spellberg, of the Los Angeles Biomedical Research Institute at the Harbor-UCLA Medical Center, says. To prevent that from happening, the CDC and others are calling on hospitals to contain CRE. The first thing hospitals need to do is test patients to see if they have these bugs. That includes common-sense things like keeping them away from other patients and sterilizing everything they come into contact with. And doctors have to use antibiotics more carefully to prevent more germs from developing into more dangerous superbugs.
The Lewis Law Firm represents patients and their families who are victims of hospital and physician malpractice in Philadelphia and New Jersey resulting in serious injury and death. If you or a loved one were the victim of hospital or physician malpractice, contact the Lewis Law Firm for a FREE consultation and case review today.
Novel Approach, Say You’re Sorry.
Sources: sorry works! coalition; Healthcare Providers Insurance Exchange; National Institutes of Health; National Institute of Medicine
It seems obvious to most of us but the importance of making an early an honest disclosure to a patient could mean the difference between no litigation at all or an expedient an amicable settlement. Contrast that with the lack of empathy, avoidance or flat out denial and obfuscation so typical of our health care system and you have all but guaranteed protracted and acrimonious litigation. We try to make all of our clients understand that we can’t make them or their loved ones whole again, or undo the physical and emotional suffering endured, that it isn’t personal -except it often is.
Groups such as the Sorry Works! Coalition have been advising hospitals, physicians and risk managers of the value of early and honest disclosures regarding medical errors for several years. It seems that the medical malpractice insurance industry is finally catching on as well. We’ve long recognized the value of this as among the most frequent complaints we hear from clients is that the doctor, nurse or hospital “didn’t acknowledge” that they had done something wrong, “didn’t seem to care” about the outcome and “didn’t even say they were sorry” that things went unexpectedly wrong.
Instead doctors find themselves in an antagonistic relationship with their own patients. The medical malpractice insurance industry would have you believe it’s all because of “frivilous lawsuits” and the “fear of litigation” brought about by Plaintiff trial attorneys. The reality is that apologies can cost insurance companies money in the form of settlements. This runs contrary to their traditional model of dragging out litigation for as long as possible, making it an expensive proposition for the patient and their attorneys to discourage otherwise valid lawsuits. This further allows medical malpractice insurance companies to keep their money in the bank longer, knowing that they will raise the premiums of their insured at the conslusion of litigation to offset any loss in profit.
So why not simply let the doctors and hospitals and Joint Commissions and Physician Boards take care of their own? Because they don’t do a very good job of it. The National Institute of Medicine estimates that 120 patients die every day in US hospitals as a direct result of medical errors. We may have one of the best healthcare systems in the world, but it still isn’t good enough for the 120 patients on any given day. Preventable occurrences such as wrong site surgeries (operating on wrong part of body) continue to be one of the largest categories of error. Patient falls and medication errors are a close second and third. Add to this the shortage of staffing from doctors to nurses to technicians and it’s clear to see that another approach may be needed.
What’s wrong with letting patients and their families know that something went wrong? (hint: they already know that) Better still, let them know how the error likely happened, what the doctor and hospital plan to do for the family now that it has occurred and what they plan to do in the future to ensure that it is not likely to happen again. Contrary to what the medical malpractice insurance industry spends a great deal of money advertising, “tort reform” doesn’t address the issues. Preventing preventable medical errors before they occur, and being open and honest with patients and their families when they do occur, is the real answer to the problem.
If you or a loved one were the victim of a preventable medical error and the doctor and hospital have not given you answers, much less an apology, contact the Lewis Law Firm for a free consultation.
Posted by: Gayle R. Lewis, Esquire
Medicaid Cuts to Impact Nursing Home Care in NJ?
Source: The Record
This Summer, New Jersey officials voted to move to a reimbursement system that would allow homes that care for the patients with greater medical needs to be paid at a higher daily Medicaid reimbursement rate. However the negative impact upon revenues for homes which care for healthy patients prompted a slow adoption process. During the course of this wrangling, Governor Christie’s budget for the state called for some $75 million in Medicaid spending reductions. The Christie plan was for a 3% cut across homes but was applied disporportionally.
The result? One nursing home in Wyckoff, which three years ago opened a 68-bed, post-acute care unit to accommodate sicker patients, saw its daily per-Medicaid-patient reimbursement rate drop from $198 to $187, although the new rate system had previously promised to raise that figure to $225. The state notified nursing homes of the revised Medicaid rates in early October, more than three months into the current fiscal year, meaning some facilities would have to pay back a portion of reimbursements already received.
Since then, nursing home advocates have been lobbying the Christie administration and lawmakers for some relief from cuts they say could in time force them to cut staff or services. Advocates say county-operated nursing homes also could be among the most hurt by the rate changes as they tend to serve patients who are predominantly on Medicaid. State Sen. Loretta Weinberg, D-Teaneck, outgoing chairwoman of the Health, Human Services and Senior Citizens committee, said she is discussing potential solutions with other legislative leaders but doubts anything could be done in the current fiscal year to roll back cuts, as some nursing home operators are hoping.
“I think these cuts are harmful, and they are harmful to the most vulnerable of populations,” Weinberg said. “We need to hear from the people who are affected. We need their voices on this.”
”There is a lot of uncertainty,” said Larry Lane, vice president for government relations at Nursing Home Giant -Genesis Health Care, a national chain that operates 30 nursing homes and three assisted living centers in New Jersey alone, which together will lose between $6 and $7 million in Medicaid cuts. On the labor side, Service Employees International Union Local 1199, which represents 7,000 long-term care workers in New Jersey, is already concerned that some homes are not staffed adequately, nor trained well enough, to care for these sicker patients, said Milly Silva, executive vice president. “No one wants to see a tragedy where somebody ends up injured because of a lack of staff,” Silva said. No indeed.
Posted by: Gayle R. Lewis, Esquire
Nursing Homes Over Medicating Patients?
Source: NY Daily News; Eli Lilly & Co.
According to Audits conducted on Nursing Home Facilities in the United States, elderly patients with dementia are too often prescribed anti-psychotic drugs to calm disruptive behavior. The Senate Committe on Aging is apparently having hearings on this issue. Health and Human Services Inspector General, Daniel Levinson has stated that recent government audits raise concerns about the use of antipsychotics by elderly people with dementia in nursing homes, raising their risk of death and wasting money for the US healthcare system.
More than half of such prescriptions were wrongly paid for in 2007 by government Medicare because the patients did not exhibit symptoms of schizophrenia or bipolar disorder, amounting to about 230 million dollars in waste. One audit showed 14 percent of nursing home residents had Medicare claims for antipsychotic drugs, Levinson said.
Toby Edelman, Senior policy attorney in the office of the Center for Medicare Advocacy, Tobt Edelman, said that the estimate was low because it only included some kinds of anti-psychotics. “Nursing facilities’ self-reported data indicate that in the third quarter of 2010, 26.2 percent of residents had received antipsychotic drugs in the previous seven days. That is approximately 350,000 individuals,” she said. “Facilities reported they gave antipsychotic drugs to many residents who did not have a psychosis, including 40 percent of patients at high risk because of behavior issues.”
Sadly, this issue is not new -the same Senate committee issued a report on the misuse of drugs in nursing homes back in 1975. Although it is against federal law the practice of medication control continues, because of serious understaffing in nursing facilities, high turnover of staff, and “aggressive off-label marketing of anti-psychotic drugs.” In particular, in 2009, Eli Lilly Company accepted a Misdemeanor Charge related to Zyprexa(R) (olanzapine).Promotion Between 1999 and 2001. Lilly promoted Zyprexa in elderly populations as treatment for dementia, including Alzheimer’s dementia, although Zyprexa is not approved for such uses. As part of this agreement regarding the criminal investigation, Lilly agreed to pay $615 million. Under terms for the resolution of the civil investigations, Lilly agreed to make payments totaling nearly $800 million.
Posted by: Gayle R. Lewis, Esquire
Nursing Home Update
Civil Suits Uncover Nursing Home Abuse
Civil suits help uncover abuses by nursing home and insurance companies. Where regulatory and legislative bodies have been unable to cope with this distressing rise of neglect and abuse of our elderly, the civil justice system has stepped into the breach. A report, “Standing Up for Seniors: How the Civil Justice System Protects Elderly Americans,” reveals that litigation is critically important to protect nursing home residents.
According to the report, the vast majority of the nursing facilities that house more than 1.5 million elderly Americans are owned by private corporate chains, making it difficult for consumers to hold them accountable for abuse. The report also asserts that insurance companies are more likely to take advantage of older patients with practices like miscalculating mortality rates, denying claims and cutting off benefits for needed treatments.
The report outlines how, through litigation, trial attorneys across the country have uncovered evidence of corporate programs aimed at terminating seniors’ benefits as well as evidence of nursing home abuse and neglect. The report warns that efforts to combat nursing home abuses through civil suits are hampered by the use of mandatory arbitration clauses in nursing home and insurance contracts.
Source: LawyersUSAOnline.com
Gayle R. Lewis, Esquire
Nursing Home Care and Pressure (bed) Sores
Source: U.S. Centers for Disease Control and Prevention
In 2004 a National Survey was conducted of Nursing homes in the U.S. Unfortunately this is the most recent comprehensive study of its type. Among the Data from the National Nursing Home Survey, 2004 was the following:
- In 2004, about 159,000 current U.S. nursing home residents (11%) had pressure ulcers. Stage 2 pressure ulcers were the most common.
- Residents aged 64 years and under were more likely than older residents to have pressure ulcers.
- Residents of nursing homes for a year or less were more likely to have pressure ulcers than those with longer stays.
- One in five nursing home residents with a recent weight loss had pressure ulcers.
- Thirty-five percent of nursing home residents with stage 2 or higher (more severe) pressure ulcers received special wound care services in 2004.
Pressure ulcers, also known as bed sores, pressure sores, or decubitus ulcers, are wounds caused by unrelieved pressure on the skin. They usually develop over bony prominences, such as the elbow, heel, hip, shoulder, back, and back of the head.
Pressure ulcers are serious medical conditions and one of the important measures of the quality of clinical care in nursing homes. From about 2% to 28% of nursing home residents have pressure ulcers. The most common system for staging pressure ulcers classifies them based on the depth of soft tissue damage, ranging from the least severe (stage 1) to the most severe (stage 4). There is persistent redness of skin in stage 1; a loss of partial thickness of skin appearing as an abrasion, blister, or shallow crater in stage 2; a loss of full thickness of skin, presented as a deep crater in stage 3; and a loss of full thickness of skin exposing muscle or bone in stage 4. Clinical practice guidelines for pressure ulcers have been developed and provide specific treatment recommendations for stage 2 or higher pressure ulcers, including proper wound care (5).
More than 1 in 10 nursing home residents had a pressure ulcer.
Of the 1.5 million current U.S. nursing home residents in 2004, about 159,000 (11%) had pressure ulcers of any stage. Stage 2 was the most common (5%), accounting for about 50% of all pressure ulcers. Stages 1, 3, and 4 made up about the other 50% of all ulcers.
Summary:
Overall, 11% of nursing home residents had pressure ulcers in 2004. Various demographic and clinical factors were related to having a pressure ulcer in a nursing home. Residents in a nursing home for a year or less since admission, who had a recent weight loss, or who had high immobility had the highest prevalence of pressure ulcers. Among residents with a pressure ulcer of stage 2 or higher, 35% received special wound care services.
This suggests that a minority of nursing home residents with stage 2 or higher pressure ulcers received wound care in accordance with the clinical practice guidelines. Pressure ulcers are serious and all too common medical conditions in U.S. nursing homes, and remain an important public health problem. Information from this Data Brief on pressure ulcer prevalence and service use among nursing home residents with pressure ulcers may provide a foundation for targeting public health efforts.
~Posted by D.M. Schwadron