Brain or Spinal Cord Injury

Unredacted Reports of Nursing Home Inspections Now Available!

From good buddy-nurse-paralegal Janabeth Taylor….’Feds Release Nursing Home Inspections, Free of Censor’s Marks’ – the government has released unredacted write-ups of problems found during nursing home inspections around the country. ProPublica is making them available today for anyone who wants to download the complete versions. http://www.propublica.org/article/feds-release-nursing-home-inspectionsWATCH “The Silent Epidemic – Nursing Home Care Abuse ”

Cars and trucks that are too quiet? In fact, it appears that some vehicles are so quiet that they may be dangerous! The National Highway Transportation Safety Agency has proposed a new safety standard, as required by the Pedestrian Safety Enhancement Act (PSEA) of 2010, which proposes to establish a Federal motor vehicle safety standard (FMVSS) setting minimum sound requirements for hybrid and electric vehicles. This new standard would require hybrid and electric passenger cars, light trucks and vans (LTVs), medium and heavy duty, trucks, and buses, low speed vehicles (LSVs), and motorcycles to produce sounds meeting the requirements of this standard. This proposed standard applies to electric vehicles (EVs) and to those hybrid vehicles (HVs) which are capable of propulsion in any forward or reverse gear without the vehicle’s internal combustion engine (ICE) operating. This standard would ensure that blind, visually-impaired, and other pedestrians are able to detect and recognize nearby hybrid and electric vehicles, as required by the PSEA, by requiring that hybrid and electric vehicles emit sound that pedestrians would be able to hear in a range of ambient environments and contain acoustic signal content that pedestrians will recognize as being emitted from a vehicle.

The site contains real stories about real people who have been harmed by “tort reform.” And it demonstrates how site visitors could easily find themselves victims themselves. It engages people with a full-time social media commitment and blogs from outside organizations dedicated to civil justice. And it provides all the tools to motivate people to take action right from the site, from contacting their members of Congress to signing petitions.

Researchers have found that as many as 28% of adult patients in intensive care units die each year with a misdiagnosis,
and up to 8% die with a potentially fatal “major missed diagnosis,” such as pulmonary embolism or myocardial infarction.

These findings come from a meta-analysis of 31 autopsy-based studies (BMJ Qual Saf 2012; doi:10.1136/bmjqs-2012-000803), and might even understate the rate of missed diagnoses, said Bradford Winters, MD, PhD, associate professor of anesthesiology and critical care medicine at Johns Hopkins University School of Medicine, in Baltimore, who led the research.

“Since we did not include non-autopsy-based studies in our analysis, we did not evaluate misdiagnoses that did not result in death, but that are likely associated with increased morbidity health care costs,” Dr. Winters told General Surgery News.

The 31 studies–which were observational, mostly retrospective studies and largely based in the United States–included information from 5,863 autopsied adults who had died in an intensive care unit (ICU). The papers were published between 1966 and 2011. The analysis excluded publications that examined the rate of disease-specific misdiagnoses and studies
that did not include original data. A median of 43% of ICU deaths that occurred during the study period were autopsied.

The investigators turned to the Goldman Classification, widely used for autopsy findings, to group the misdiagnoses they identified. The criteria define class I errors as “missed major misdiagnoses with potential adverse impact on survival and that would have changed management”; class II errors as missed major diagnoses that would not have affected survival or altered the course of care; and class III and class IV errors as misdiagnoses related to the terminal disease but not related to death or unrelated to both disease and death, respectively.

The rate of misdiagnoses detected during autopsy ranged from 5.5% to 100%, with a 28% overall rate (1,632 of 5,863), the researchers found. Class I and class II errors accounted for 8% and 15% of misdiagnoses, respectively; class III and class IV errors accounted for 15% and 21%, respectively. Dr. Winters noted that some studies reported only the total number
of misdiagnoses and class I or class II errors, leaving the specific misdiagnoses of the remaining 41% unclear.

The most common class I and class II misdiagnoses reported in the studies were vascular events and infections.

The 8% rate of major and potentially lethal ICU misdiagnoses is higher than the 5% rate of lethal misdiagnoses documented in the general hospital population in a previous study (JAMA 2003;289:2849-2856). The difference, Dr. Winters explained, can be attributed to ICU-specific factors such as the inability of patients to communicate their medical history during the workup process and limited staff resources leading to “competition for care.” Factors not specific to the ICU, including an overload of information and cognitive errors that lead to a biased interpretation of patient data, also may play a role.

Richard Dutton, MD, executive director of the Anesthesia Quality Institute, in Park Ridge, Ill., who specializes in trauma, said several limitations may undermine the generalizability of the findings. “Most autopsied patients have some level of diagnostic uncertainty to begin with, which makes the population in this meta-analysis not completely representative of the general ICU population,” said Dr. Dutton, who was not involved in the research.

Some of the studies included in the meta-analysis were conducted before the introduction of more accurate and advanced imaging-based diagnostics, Dr. Dutton noted. And he questioned the effect that missed class I or class II diagnoses would have had on patient outcomes had they been identified. “If a patient is dying of septic shock, secondary events like myocardial infarction and pulmonary embolism, which are common during the immediate premortem period, may not have affected their survival.”

For YEARS, Plaintiffs who have successfully prosecuted their personal injury and medical malpractice cases have been forced to wait unreasonably long periods of time because of the poor response times of Medicare and its administrative agencies. The crime has not been limited to the injury victims, though. Because they have had to wait, our government has also had to wait with them, often causing delays of months and even years in the receipt of settlement and verdict awards to plaintiffs and reimbursement of public funds to government agencies and medical insurance carriers, and payment for services provided by medical providers. At long last, a bi-partisan law has been passed by Congress and signed by President Obama into law. The following is a statement from the American Association for Justice (AAJ) President Mary Alice McLarty in response to the President signing the Strengthening Medicare and Repaying Taxpayers (SMART) Act, which was introduced by Reps. Tim Murphy (R-PA) and Ron Kind (D-WI) in the House and Sens. Ron Wyden (D-OR), Rob Portman (R-OH), Ben Nelson (D-NE) and Richard Burr (R-NC) in the Senate:
“This bipartisan legislation is a practical solution that will streamline the Medicare Secondary Payer system to ensure that seniors and persons with disabilities get timely assistance and taxpayers are repaid millions of dollars every year.”
“This legislation is a big step forward and is the result of senior advocates, the legal community and the business community coming together to work out a common sense solution.”
“There is still work to be done. To ensure this legislation has the most impact, [the Centers for Medicare and Medicaid Services] CMS must eliminate confusion and uncertainty by providing clear, efficient and definitive information to seniors.”
Medicare Secondary Payer (MSP):
• The MSP process ensures Medicare is reimbursed for medical bills that are the responsibility of another party – such as an insurer or negligent party.
• A senior or person with disabilities who has been injured, and later obtains recourse through the legal system, often cannot access their settlement until Medicare is reimbursed for all medical costs.
• The current MSP system is inefficient and slow to return dollars to the Medicare Trust Fund, which is funded by tax payer money.
• It can take years for the Centers for Medicare and Medicaid Services (CMS) to report reimbursement amounts to beneficiaries and CMS can seek multiple reimbursement amounts over time, providing further delay and uncertainty.
The SMART Act will:
• Require CMS to maintain a secure web portal to access claims and reimbursement amounts in a timely fashion.
o CMS must upload care payments they disperse within 15 days with the required information about the payment.
• Streamline the process of obtaining reimbursement amounts.
o Medicare beneficiaries must notify CMS they are anticipating a settlement no more than 120 days beforehand.
o CMS then has 65 days to ensure the web portal is up-to-date, but may request an additional 30 days, if needed.
o Reimbursement amounts are reliable if downloaded from the web portal within three days of settlement.
• Provide a process and timeline for discrepancies and appeals.
o Medicare beneficiaries can provide documentation for discrepancies on the web portal to CMS.
o CMS has 11 days to respond to discrepancies.
o If CMS does not respond in 11 days, the amount calculated by the beneficiary is the correct amount.
o An additional appeal process must be established by CMS for reimbursements it attempts to collect from insurance plans.
• Create a threshold for collecting any payment amounts by CMS that are below the cost it incurs to collect an average claim.
• Readjust the penalty for reporting errors by insurers based on the violation.
• Ensure greater privacy for beneficiaries by no longer requiring use of full social security or health id claim numbers.
• Create a three year limit for CMS to seek any repayments beginning from when they were informed of an anticipated settlement.

On June 16, 2013, the Illinois appellate court for the fourth district held that the City of Springfield may be responsible and liable for ankle injuries sustained by a woman who slipped into a pothole while she was walking around her parked vehicle after placing an item in the passenger seat. The vehicle was lawfully parked near a curb on a city street. The court held that the injured woman was an “intended user” of the portion of the street where the injury occurred. Therefore, the city of Springfield was not immune from liability for allegations that it failed to maintain its streets in a reasonably safe condition.

Lane Brown, LLC has handled numerous cases against cities and other governmental entities for for their failure to maintain premises. We have been very successful in overcoming their various defenses including the immunity they often claim.

If you or a loved one has suffered injury as a result of the unsafe condition of public or private property, you may be able to take action. Please contact the attorneys of Lane Brown, LLC, or call us at 312-332-1400 to speak with us about your options. We can help. To learn more about Lane Brown, please visit our website at lanebrownlaw.com.