Personal Injury and Social Security Disability Blog

Planning the Perfect Superbowl Party

We're less than a week away from the Super Bowl now, and many people are firming up their plans for viewing parties. This article that I stole from the good people at MADD has some good tips for your own Super Bowl party — how to have fun and stay safe. At the MADD site you can learn more about the organization, and can make a donation to the group.

There’s a reason it’s called throwing a party – a host has to be ready for the occasional trick play and juggle the unexpected when it comes to staging an event that’s fun, entertaining and safe for everyone. Responsible hosts know that part of showing guests a great time is making sure they get home safely. Dealing with safe driving is an important hosting duty so we’ve compiled some quick tips to help you throw a completion this season:

Plan activities. Planned activities like party games, door prize drawings or amateur fortune-telling engage people, make for less active consumption of alcohol and ensure that your friends remember the great event long after the last touchdown was thrown.

Avoid mixers. Mixers won’t help dilute alcohol. Carbonated mixers like club soda or tonic water cause alcohol to be absorbed into a person’s system more quickly. Fruit juice and other sweet mixers mask the taste of alcohol and may cause people to drink more.

Designate sober drivers. As guests RSVP, confirm that at least one person in each group is prepared to be the non-drinking designated driver.

Provide plenty of food. Food helps prevent guests from drinking on an empty stomach, which causes guests to get intoxicated faster.

Avoid too many salty snacks. They tend to make people thirsty and drink more.

Offer non-alcoholic beverages. Give beverage options that don’t involve alcohol to designated drivers and others who prefer not to drink alcohol.

Respect 21. Never serve alcohol to someone under the legal drinking age, and never ask children to serve alcohol at parties.

Be ready to step in. Despite your efforts, if some of your guests have had too much to drink, drive them home, arrange for a ride with another guest who is sober, call a taxi or invite them to stay over.

Don’t commit a party foul! Use these tips to help throw a party that sails into the end zone.

 

Breast Implants Linked to Lymphomatous Cancer, per FDA

ABC World News reported, "An important health warning tonight from the FDA about a possible link between breast implants and a rare form of cancer." ABC (Stark) added, "The government says they may be linked to a rare form of lymphoma. ... There are 60 cases worldwide, in as many 10-million women with implants."

The Washington Post reports that the FDA on Wednesday announced it had "detected a possible association between saline and silicone gel-filled breast implants and anaplastic large cell lymphoma (ALCL)" The agency said most women with implants "do not have to have them removed or take any other steps," but they should "immediately seek medical care" if they develop "unusual problems," such as "swelling or pain around the implant."

According to the AP, the FDA based its warning on a review of "scientific literature going back to 1997 along with information provided by international governments and manufacturers." Most of the cases were "reported after patients sought medical care" for problems "around the surgical site."

The Wall Street Journal reports the FDA has identified 60 ALCL cases in women who had breast implants, of which 34 cases have thus far been verified, according to a statement released by the agency.

HealthDay noted that 24 of the cases were "related to silicone implants, seven to saline implants and the type of implant in the remaining three cases are not known," according to the FDA. The agency also said that "19 of the implants were inserted for cosmetic reasons and 11 were used in reconstructive procedures. The reasons for the other four procedures are not known."

The New York Times reports in some cases, simply "removing the implant and scar tissue gets rid of the disease, but some women might need chemotherapy and radiation," said Center for Devices and Radiological Health Deputy Director Dr. William Maisel. He noted that although 60 cases is "a tiny number compared" with the number of women who have implants, it is an excess when "compared with the usual incidence." ALCL in the breast is "normally found in only three in 100-million women who do not have implants."

Bloomberg News says, "Allergan Inc. and Johnson & Johnson" breast implants were linked to ALCL by US investigators. Allergan, the "maker of Natrelle gel and saline breast implants," and J&J's "Mentor division each control about half the market for breast implants." Dr. Maisel told Bloomberg News that the agency is "working with manufacturers to revise their product labeling and plans to release an analysis of company-sponsored studies 'later this spring.'"

According to MedPage Today, Allergan released a statement, saying "company officials support the FDA recommendations" and advising all physicians to "remain diligent in their monitoring" for ALCL symptoms. A statement from the J&J Mentor division says the "company concurs with the FDA's position that the body of evidence supports the safety and efficacy of approved implants when used as labeled."

From the American Association for Justice news release.

 

Friday Fun

Are you a procrastinator? Can you draw? If so, you may recognize yourself in this video. Thank goodness I have zero artistic ability, or this would be me too. Procrastination from ism studios on Vimeo

Trial Lawyers Unhappy With Tort Reform Concessions in State of the Union Speech

The Hill reports in its "Healthwatch" blog, "President Obama's State of the Union speech" was "already causing consternation among trial lawyers, half an hour before he even" delivered it. "According to his remarks as prepared for delivery, Obama" planned to "throw a bone to Republicans by vowing to take up medical malpractice reform," which "usually means a $250,000 cap on non-economic damages and other restrictions." The Hill notes, "The remarks outraged Center for Justice & Democracy Executive Director Joanne Doroshow, who testified last week before the House Judiciary Committee that lawmakers should not try to 'reduce health care costs on the backs of injured patients.'"

House members ask Obama to support overhaul of medical malpractice laws. CQ HealthBeat reported, "Two House Republicans and a Democrat on Monday urged President Obama to back an overhaul of medical malpractice laws in his State of the Union address, following their introduction of legislation to reduce the number of claims filed against doctors." CQ says "the measure, proposed by Judiciary Committee Chairman Lamar Smith, R-Texas, Phil Gingrey, R-Ga., and David Scott, D-Ga., is dubbed the HEALTH Act and resembles legislation proposed by Gingrey in years past that failed to make it further than the House floor." Notably, the proposed law "would cap non-economic damages in lawsuits at $250,000, similar to a state law in California, and establish a three-year time limit following the date of injury by which most claims would have to be filed."

From the American Association for Justice news release.

 

Dementia Patients Hospitalized Too Often

A disturbing study about the care of dementia patients has been summarized in the New York Times. The bottom line is that many people with dementia are hospitalized unnecessarily. Here are excerpts from the article:

Perhaps no group of nursing home residents is more vulnerable than those with advanced dementia: unable to speak for themselves, suffering the physical as well as the cognitive effects of their terminal disease, prone to confusion or fear when subjected to blood tests or trips in screaming ambulances.

Yet dementia patients are often subjected to aggressive treatments and transfers even though studies show little benefit, as researchers at Hebrew Senior Life Institute for Aging Research in Boston keep pointing out.

This time, Dr. Susan Mitchell and her colleagues looked at Medicare spending for more than 300 patients with advanced dementia in Boston-area nursing homes over a period of 18 months. One of the largest expenditures, about 30 percent of the total, was for hospitalizations; skilled nursing care after those hospital stays accounted for another 10 percent. (Hospice was a big factor as well, though only 22 percent of the patients with advanced dementia were receiving hospice care, a dispiriting number in itself.)

So what’s wrong with this picture? “I’d estimate 75 percent of those hospitalizations are avoidable,” Dr. Mitchell told me in an interview. “By and large, research shows they can be treated with equal effectiveness in the nursing home. And it’s less traumatic for a nursing home resident with dementia to remain in place.”

Most of those hospital trips occurred when patients developed respiratory infections, particularly pneumonia, a common and recurring problem when dementia progresses to its final stages.

Ideally, patients’ relatives would be discussing, among one another and with doctors, whether to use aggressive treatments like intravenous antibiotics at this stage of the disease. These elderly patients, most in their 80s, could no longer recognize family members, speak more than a few words, leave their beds or feed themselves. The question of quality of life versus quantity comes into play.

But even when families decide to pursue every possible treatment, or when their ailing relatives have specified that course in advance directives, rushing demented old people to hospitals is unnecessary, Dr. Mitchell cautioned. “Being in an emergency room where people are taking blood and putting in IVs in this crazy, noisy setting — it’s been described as an ‘assault,’ and I concur,” she said. Intravenous antibiotics, if that’s the treatment agreed on, can be administered in nursing homes.

Part of the motive for hospitalization, Dr. Mitchell added, might be “cost-shifting” by nursing homes. Patients returning after a hospital stint will be covered for up to 100 days by Medicare, at higher rates than the Medicaid payments that may have covered them before. The billions of dollars saved by reducing repeated hospitalizations, she suggested, might better be spent improving nursing home care.

But families have a role to play, too. If they understand that dementia is a terminal disease, that treating recurring infections may prolong life but won’t restore health or bring comfort, that such treatments, if desired, can be usually administered in nursing homes themselves — they may be less willing to have the staff dial 911.

 

FDA Scales Back Changes to Medical Device-Approval System

The AP reports, "The Food and Drug Administration is laying out plans to update the 35-year-old system used to approve most medical devices." Notably, the "agency announced a series of changes it plans to make this year, including streamlining the review process for some low-risk devices," although "regulators said they will delay a decision on the most drastic proposals, which would give the government new power to police device makers."

Bloomberg News reports, "While companies say the 30-year-old review program is out-dated and inconsistent, lawmakers have criticized the FDA for not requiring substantial testing of new devices that developers claim are similar to existing products." The agency "plans to clarify when clinical studies are required and create a council of top FDA experts to guarantee timely and predictable decision-making." Notably, "about 3,000 new devices are cleared each year through the 510(k) program by demonstrating they are at least as safe and effective as legally marketed products for the same use. These applications rarely require tests in people, and they make up 90 percent of device approvals, according to a Government Accountability Office report in 2009."

The Hill reports in its "Healthwatch" blog that the "FDA launched a review of the so-called 510(K) process 16 months ago following growing criticism that it is failing both the industry and consumers." Jeffrey Shuren, director of the Center for Devices and Radiological Health at the FDA said, "We have been hearing major concerns about the program from industry, consumers, healthcare professionals and others." Therefore, "these actions are intended to foster medical device innovation and support the safety and effectiveness of medical technologies in the United States."

Reuters also quotes Shuren as saying that these changes will result in "a smarter medical device program that supports innovation, keeps jobs here at home, and brings important, safe, and effective technologies to patients quickly."

The Wall Street Journal says that this move by the FDA is considered a victory for device makers, but the agency is denying that its decision was influenced by pressure from industry and some lawmakers. Shuren said, "We are implementing 47 [changes], and that's a lot. ... We went out with truly bold proposals" last year.

The Minneapolis Star Tribune reports, "The new rules drew a collective sigh of relief from the $350 billion medical technology industry, which has a considerable stronghold in Minnesota. But the activist group Public Citizen fired back that the agency cowed to industry pressKraft

From the American Association for Justice news release.

 

Follow-Up on Move to Reduce Auto Insurance Limits in Wisconsin

I wrote last week about the bill to reduce automobile liability insurance limits in Wisconsin, and I said that was bizarre in these days of rapidly escalating medical costs. An article in the Green Bay Press Gazette has a little more information about the proposal. Here are excerpts:

Door County lawmakers are among the sponsors of companion bills in the Wisconsin Legislature that would roll back increases in auto insurance rates that were approved last year.

Senate Bill 7 and Assembly Bill 4 are scheduled for public hearing before the state Senate Committee on Insurance and Housing and the Assembly Insurance Committee today in Madison. State Sen. Frank Lasee, R-Bellevue, introduced the bill in the Senate and Rep. Garey Bies, R-Sister Bay, is a co-sponsor.

The Democratic-controlled Legislature in 2009 passed budget provisions requiring all Wisconsin drivers to carry insurance and also doubled the minimum allowable coverage to $50,000 for the injury or death of a person, $100,000 for the injury or death of more than one person and $15,000 for property damage.

The new bill would roll the minimum allowable coverages to the previous levels of $25,000, $50,000 and $10,000 respectively. Republicans, who won control of the Senate and Assembly in the November election, argue that the new limits raised premium rates for consumers who can only afford the minimum insurance required by law.

The Wisconsin Association for Justice, formerly the Wisconsin Academy of Trial Lawyers, objected to the rapid scheduling of a hearing on bills that alter what the previous Legislature had dubbed the "Truth in Auto Insurance Law."

"This means that if a drunk driver crashes into you or a loved one, the drunk driver won't have as much insurance to pay for your injuries or damages to your car," said Mike End, president of the association, in a news release. "Responsible drivers will be left holding the bag and not be paid for medical bills and lost wages."

Friday Fun

Do NOT try this at home. I promise you won't be able to do it. In my wildest imaginings as a reckless kid I would never have thought of even trying this stuff.

Mature Driver Advice Helps Aging Drivers Match Vehicles to Physical Changes

AAA Texas has a good article on their site about choosing a vehicle for an elderly person to drive. The research for the article was done by AAA in conjunction with the University of Florida's National Older Driver Research and Training Center (NODRTC).

This is assuming of course that the person is capable of driving safely. That's a different topic, and a delicate one. Here are excerpts from the article:

AAA's “Smart Features for Mature Drivers” identifies vehicle components that can assist drivers with visual, physical and mental changes that are frequently encountered as they age. The AAA information pointed out conditions often faced by senior adults, including diminished vision, arthritic hands, hip and leg pain and limited upper-body range of motion, highlights features that best address each condition, and provides examples of vehicles exemplifying those features.

“Driving is a key to social interaction and healthy living and independence,” said Steve Mazor of the Automobile Club of Southern California's Automotive Research Center in Diamond Bar, CA. "This is important information for this growing segment of the driving population. We encourage older drivers and their families to use the “Smart Features for Mature Drivers” research as a guide when selecting their next vehicle or evaluating their current one because specific vehicle features can help improve driver safety and comfort."

Persons over age 65 represent the fastest growing population segment in the United States. According to the National Highway Traffic Safety Administration, there were more than 37 million people age 65 and older in the United States in 2006 and 29 million were licensed drivers in 2005. It is estimated that by 2020 there will be more than 40 million licensed drivers age 65 and older.

As a person ages, physiological changes can affect driving ability. Muscle strength, reaction times, range of motion and visual acuity tend to diminish as part of the natural aging process. Also, the increased prevalence of health issues such as arthritis, hip and knee joint pain or osteoporosis can reduce the ability to safely execute the complex task of driving.

In a recent survey, AAA found that 43 percent of motorists over the age of 55 suffered from at least one of nine driving related difficulties commonly caused by aging, and nearly one out of four motorists over 55 plan to purchase a vehicle in the next two years.

Because everyone ages differently, AAA recommends mature drivers look for vehicles with features that address their specific needs and health issues. Some of the recommendations included in “Smart Features for Mature Drivers” include:

• Drivers suffering from hip or leg pain, decreased leg strength or limited knee range of motion should look for vehicles with six-way adjustable power seats and seat heights that come between the driver's mid-thigh and lower buttocks. Both of these features can make it easier for drivers to enter and exit a vehicle.

• Drivers with arthritic hands, painful or stiff fingers or diminished fine motor skills would benefit from four-door models, thick steering wheels, keyless entry and ignition, power mirrors and seats and larger dashboard controls with buttons.

• Drivers with diminished vision or problems with low contrast sensitivity will find helpful vehicles with extendable sun visors, large audio and climate controls and displays with contrasting text.

AAA's “Smart Features for Mature Drivers” also includes vehicle features recommended for all seniors, regardless of their health issues, such as:

• Proven crashworthiness, crash test and rollover ratings from theNational Highway Traffic Safety Administration and the Insurance Institute for Highway Safety

• Side and dual-stage/threshold airbags that adjust the deployment force based on the severity of the crash

• Adjustable head restraints and extra padding

• Antilock brakes

• Dynamic stability control

 

Surgical Checklists Could Cut Malpractice Claims

Our law firm has used checklists for more than 30 years. I can't imagine doctors and hospitals not using checklists for important procedures and surgeries, but that does happen — all too frequently. Much has been written about this problem. One good article, based on a study in the Netherlands, was on Yahoo News. Here are excerpts:

Surgical checklists not only save lives by preventing medical errors, they could also make a big dent in medical malpractice claims, according to a study in the Netherlands.

Using data from the country's largest medical liability insurer, a team led by Eefje de Vries of the Academic Medical Center in Amsterdam found that nearly a third of the malpractice claims arose from mistakes that likely would have been caught by a checklist.

For the study, published in the Annals of Surgery, the team identified the main reasons for errors in 294 successful insurance claims related to surgeries from 2004 to 2005. They then compared those to the items on a comprehensive surgical checklist called SURPASS, which is now used in several hospitals in the Netherlands.

The checklist includes things such as making sure the operating schedule is correct, checking that all equipment is available, and marking on which side of the patient the surgery is going to happen.

They found that 29 percent of the reasons for lawsuits could be linked to a step on the checklist, such as marking the patient or communication between hospital staff.

Putting a price tag on the medical liability system is difficult, but one 2010 study estimated it costs the United States more than $55 billion annually, or 2.4 percent of the country's healthcare spending.

In addition, experts say tens of thousands of Americans die each year due to medical errors.

Earlier studies have shown that when healthcare providers follow a checklist, they reduce those deaths dramatically and could save money by preventing complications that require further treatment.

"This kind of evidence indicates that surgeons who do not use one of these checklists are endangering patients," said Atul Gawande at the Harvard School of Public Health, a surgeon who has written extensively on the topic.

Yet only about a fourth of U.S. hospitals use one of the three checklists that have been proven to work, he added.