In these circumstances, it is especially important to know about the infection rates in hospitals or nursing homes you are considering for healthcare for you or a loved one. Fortunately Florida state government agrees that this information is vital and has gone to a great deal of time and expense to make it available to the Florida public. Representatives of the Florida Department of Health inspect hospitals and nursing homes and collect data on a wide variety of issues.

You can now compare infection rates from one hospital to another by a simple and quick internet search. The Florida Health Finder allows you to search by health condition, hospital or ambulatory surgical center. You can identify the health-care provider by county or name. You can compare length of stay and charges, mortality rates, complications and infection rates, and facility profiles.

A search to compare infection rates in Volusia County revealed that as of the date of this writing Halifax Health in Daytona Beach and Florida Hospital Ormond Memorial were listed as having an infection rate “higher-than-expected.”  This rating was for “infections due to medical care.” The Agency explained that this means the facility had, “More complications/infections than expected given how sick patients were.” “The results shown [on the site] are posted as reported and certified by health care facilities to the Agency for Health Care Administration (AHCA), Florida Center for Health Information and Policy Analysis. Th[e] data is effective as of  February 25, 2009.”

In order to avoid medical malpractice and death from serious infections in a hospital in Volusia County, Daytona Beach, Deltona and Ormond Beach it is critical to compare complication and infection rates before elective surgery.

During our over 20 years of representing clients in nursing home abuse and malpractice litigation in Daytona Beach and Deltona we have noticed that the course of nursing home lawsuits is strikingly similar from one case to the next. Nursing homes often repeat the same mistakes such as failing to turn and reposition a patient who cannot move in bed and thereby causing a bedsore.

The defenses nursing homes raise in many lawsuits are frequently similar. They try to blame somebody else rather than assume responsibility. Here are three things we see nursing homes say throughout the course of a lawsuit:

1. The nursing home resident was very sick.  At almost all mediations of nursing home lawsuits the defense lawyer starts the nursing home’s statement by pointing out that the resident was very sick when admitted.  The lawyer typically recites a long list of diagnoses that doctors have written into the medical records.  This includes diagnoses for a long time before admission to the nursing home. To look for as many diagnoses as possible, the defense lawyers get copies of the resident medical records, read them for references to other medical records and get copies of those.

The point the lawyer is trying to make is that whatever injury the residents sustained in the nursing home was caused by the resident being very sick rather than by nursing home negligence. Of course, this approach entirely misses the point that residents are in nursing homes because they are very sick and that, therefore, they need good care to avoid further injury and deterioration of their condition.

2. It was the doctor’s fault.  In an effort to shift blame, nursing homes frequently claim the resident’s doctor was negligent. For instance if our client fell and broke her hip at the nursing home, the defense sometimes claims that it was the doctor’s responsibility to order other interventions such as bedside rails and the doctor did not do so.  Or, if our client developed a bedsore in part caused by the nursing home using the wrong type of pressure relief mattress, the defense could claim that the   nurses were simply following the doctor’s orders.

This defense misses the point that the nurses spend much more time with the resident and are responsible for informing the doctor about the resident’s condition and suggesting appropriate nursing interventions.

3. It was the family’s fault. Nursing homes frequently claim that the care they provide must have been good because the family did not move the resident to another nursing home. They also claim that the nursing home is a good one because the family chose it in the first place.

This defense misses various points.  Family members often cannot make the choice of the nursing home.  An insurance company or a hospital discharge planner frequently makes the choice. Further, family members are not medical experts and   do not have the knowledge to know whether or not the care provided by a nursing home is up to standard.

Amazingly, sometimes doctors or physicians assistants in Daytona Beach, Ormond Beach, Deltona and other Volusia County cities misdiagnose your health condition because they do not recognize classic symptoms of heart attacks. Some symptoms of heart attacks are also symptoms of the flu, such as nausea, coughing, difficulty getting a deep breath and weakness. Many people having a heart attack do not have the classic symptom of severe chest pain. However because heart attacks are so life-threatening doctors’ procedures require that they check your complete condition to rule out the most dangerous conditions. If they do not they may be guilty of medical malpractice and you may be dead.

Doing a good job checking to see if you are having a heart attack includes, among other things, doing a complete clinical, physical examination, an electrocardiogram and blood testing. Blood testing is important because cardiac enzymes in the blood are a key part of diagnosing a heart attack.

Some doctors or other healthcare providers may not be thorough enough when you present with conditions that might also be symptoms of flu. Take responsibility and insist that the healthcare provider explain why they are not checking for a heart attack.

To make things worse, a New York Times article has reported that, “A recent New York state survey, for example, revealed that most cardiologists said that they sometimes did not operate on patients who might benefit from surgery because of their concerns about hurting their rankings on state-mandated physician scorecards.”

For more information about heart attack symptoms see the article in the Mayo Clinic website linked here.

For example nursing home residents who have had strokes or some other extremely debilitating medical condition sometimes cannot swallow. The resident and family must then decide whether to use a feeding tube. The feeding tube provides nutrition and hydration and extends life for people who cannot take in their own nutrition and hydration by swallowing.

Feeding tubes, however, are not without difficulties. The most common type of feeding tube utilized long-term is the percutaneous endoscopic gastrostomy tube or PEG tube. The Peg tube is surgically inserted through the abdomen into the stomach. The surgeon uses a camera inserted through the mouth down into the stomach to perform the surgery. The feeding tube rests in the stomach and exits through the skin. The nurses must carefully clean the surgical site for the remainder of the resident’s life in order to avoid infection.

The tube, of course, interferes with a resident’s mobility. While it provides sufficient nutrition and hydration for the resident to stay alive, it also has side effects and does not do as good a job providing nutrition as normal chewing and swallowing. Side effects include bloating and diarrhea. People on PEG tubes are at risk for poor nutrition and digestive problems. Because of the potential for poor nutrition and decreased mobility, they are also a risk for bedsores. For more information about this feeding tube, see the entry in Wikipedia through this link. http://en.wikipedia.org/wiki/Feeding_tube.

Any decisions about health care in a nursing home or hospital require balancing the goal of extending life with the goal of living a quality life. We recommend that family members talk about end-of-life planning in a very frank and nonjudgmental way well before decisions must be made in a nursing home or hospital. The best way to do this is to consider a thorough living will and designation of health care surrogate as allowed by Florida law.

Any business must make a profit in order to continue its existence. The danger for nursing home residents is that the most probable way nursing homes will have to adjust to reduced income and reimbursement is to decrease the number of staff to take care of their patients.

Our clients already report incidents which make it clear that nursing homes are frequently understaffed. For example one of our clients who needed help to go to the restroom had to call out for help to anyone passing by in the hallway because his call bell was not being answered. He was ignored and eventually tried to go to the bathroom by himself, fell and broke his hip. The fall could just as easily have resulted in a blow to his head, brain damage and death.

Understaffed nursing homes are unlikely to be able to provide sufficient care to prevent bedsores. A bedsore prevention program requires that the nurses turn and reposition their patients every two hours. If there are not enough people in the nursing home staff, it will be difficult for the nurses simply to remember to turn and reposition each patient much less to actually do it. Bedsores can become infected since intact skin is the body’s best defense to infection. Especially in light of some of the new “superbugs,” these infections can cause death.

When legislatures and the federal government are considering reduction in the reimbursement for nursing home care, they should also consider the likelihood of a substantially increased death rate for nursing home patients. At Zimmet & Quarles we urge you to contact your legislators, especially the Florida Legislature,  to ask them to consider the real dangers of reducing nursing home reimbursement.

A particularly dangerous form of infection for nursing home patients is often a result of taking antibiotics. Clostridium difficile, usually abbreviated as c. diff., has become more widespread and deadly for nursing home and hospital patients.

Many hospital and nursing home patients have to take antibiotics for some type of infection. For example, very sick nursing home patients sometimes have to use a catheter because of a urinary tract disorder. This raises the risk of a urinary tract infection which requires an antibiotic to resolve.

Unfortunately the use of the antibiotic can cause the death of both the bad bacteria causing the infection and good bacteria in the digestive tract. This creates an opportunity for the c. diff. organism to grow. Public health officials have recently estimated that the disease is now killing from 15,000 to 20,000 people per year.

One of the ways the disease causes death is through severe dehydration. C. diff. causes extended and serious diarrhea which in turn can result in dehydration. Therefore at any time a nursing home resident has had a course of antibiotics followed by diarrhea it is especially important for the resident’s family to be on the lookout for signs or symptoms of dehydration.

We have seen a growing number of cases in which the nursing home staff in Daytona Beach, Volusia County, Deltona and Ormond Beach do not recognize the symptoms of severe dehydration soon enough. For information about these nursing homes see the Florida Nursing Home Guide. A nursing home resident should be transferred to the hospital emergency room for treatment of severe dehydration as soon as possible. Therefore, if you start to see symptoms of even mild dehydration insist that a physician evaluate your family member.

Symptoms of dehydration include thirst, muscle weakness, headache, dizziness, lightheadedness, dry mouth, lack of sweating, shriveled skin that does not bounce back when pinched into a fold, low blood pressure, rapid heartbeat, delirium, altered mental status, and fever. For more information on c. diff. see a recent article in the New York Times by Tara Parker-Pope, Stomach Bug Crystallizes an Antibiotic Threat, and for more information on dehydration see an article on the Mayo Clinic website.

]]> http://www.daytonanursinghomeandmedicalmalpracticelawyer.com/death-by-antibiotics-in-a-nursing-home/feed 0 http://www.daytonanursinghomeandmedicalmalpracticelawyer.com/should-we-tie-a-patient-down-in-bed-to-prevent-a-fall http://www.daytonanursinghomeandmedicalmalpracticelawyer.com/should-we-tie-a-patient-down-in-bed-to-prevent-a-fall#comments Fri, 13 Mar 2009 13:48:38 +0000 Daytona Nursing Home and Medical Malpractice Lawyer http://floridainjuryattorney.wordpress.com/?p=6 Many of our clients have told us that when their elderly loved ones are in a hospital, nurses used wrist restraints and bedside rails to keep them from falling out of bed. Then after the hospital at a nursing home, the nurses claim that side rails cannot be used because they are “restraint’ and they are against the law. Since we hear this from our clients it is usually because the side rails were not used and the patient fell out of bed and broke a bone.

The fact that bedside rails are considered a restraint is normally a surprise to our clients. In fact anything that interferes with a patient’s freedom of movement is a restraint and is subject to legal regulation. This is morally correct because as a culture we have decided we want to respect other’s independence even if they are elderly and in a nursing home. Our federal government and state legislatures have passed laws giving nursing home patients rights to be free and Independent. However, many of the people in nursing homes suffer from dementia or have some other mental difficulty which keeps them from understanding their situation.

In these circumstances, a spouse or child often ends up having to make decisions about how to best provide quality care to ensure a patient’s safety. The problem with medical care is that every medical intervention has risks associated with it. For instance if we decide to use a seatbelt to keep an elderly patient from getting out of a wheelchair because the patient is very unsteady on her feet and we are afraid she will fall and break a hip, we limit the patient’s independence and may interfere with her chances of recovering the ability to walk with a steady gait. On the other hand if we do not use the seatbelt and the patient gets out of the wheelchair, falls and breaks a hip, the patient may experience excruciating pain, will likely have to undergo an operation to repair the hip and the risks of other medical complications and an earlier death go up.

Even bedside rails have some risks. Patients have been injured being caught between the mattress and the bedside rails. And the bedside rails interfere with the patient’s freedom of movement in a way that is mentally distressing to the patient. For example what if the patient wants to get up to go to the bathroom, a nurse is not readily available to respond to a call bell and the patient cannot get out of bed because of the side rails?

Although there are no easy answers to these kinds of questions which arise all the time in hospitals and nursing homes we are most likely to get to the best result if family members, the doctor, nurses and other health care providers involved all work together to make the best decision. Federal regulations are in place to protect the patient and also to be sure that health care providers carefully think through decisions about restraint use.

Despite what anyone may tell you to the contrary, restraints are, in fact, allowed under the law applicable to nursing homes and they may have a place for a particular patient. The challenge, however, is to carefully think through the decision about restraint use or non-use for each individual resident to get to the best decision.

The federal regulation for nursing homes provides that, “the resident has the right to be free from any physical or chemical restraints imposed for purposes of discipline or convenience, and not required to treat the resident’s medical symptoms.” Therefore, restraints are allowed when required to treat the resident’s medical symptoms and are not for the purpose of discipline or convenience.

The State Operations Manual which provides guidance to nursing homes also makes it clear that restraints are allowed under appropriate circumstances. “Medical symptom” is defined as an indication or characteristic of a physical or psychological condition. The manual explains that, “the resident’s medical symptoms should not be viewed in isolation, rather the symptoms should be viewed in the context of the resident’s condition, circumstances, and environment.” The manual also explains that a physician’s order alone is not sufficient to warrant the use of a restraint and that there should be some type of process for gradual reduction of the use of restraint if appropriate. A legal surrogate or representative cannot give permission to use restraints for discipline or convenience and the facility may not use restraints in violation of the regulation solely based on a surrogate’s request or approval.

The Operations Manual contains a checklist of questions that are helpful in describing the type of thorough thought process that should be completed when deciding on restraint use or non-use. Paraphrased, they are as follows:

1) What are the medical symptoms that lead to the consideration of the use of restraints?

2) Are the symptoms caused by failure to meet the resident’s needs, provide rehabilitation / restorative care, provide meaningful activities, or manipulate the resident’s environment?

3) Can the medical symptoms be eliminated or reduced?

4) Have alternatives to restraints been attempted?

5) Does the facility use the least restrictive restraint for the least amount of time while adequately monitoring restraint use for the resident?

6) Did the resident or legal surrogate give informed consent after explanation of risks, benefits and alternatives?

7) Does the facility use the physical restraints protocol to evaluate the appropriateness of restraint use and has the facility re-evaluated the need for restraints?

Family members with loved ones in Volusia County, Daytona Beach, Ormond Beach and Florida nursing homes serve the interests of their loved ones if they have this information and insist that the nurses and doctors carefully think through these questions before making any decisions about the use of restraints. Restraints do have a place in the list of medical care options, but they should be carefully considered before being used.