Are you or a family member receiving dialysis? ProPublica has done a series of articles in the past month spotlighting the lack of proper oversight of dialysis clinics (Led by California, Inspection Backlogs Weaken Dialysis Oversight) that you should read. They report that in California alone, for example, regulators responsible for ensuring that dialysis facilities meet health and safety standards have not conducted full inspections of at least half of the state's 500 dialysis centers for five years or more.

ProPublica has also posted a database that will let you check the trackrecord of your dialysis clinic and those in your area. ProPublica used the Freedom of Information Act to obtain reports to Medicare by dialysis clinics across the country, going back to 2002. This is data and information that the public should have but which the government has not shared with us. ProPublica analyzed the data and the result is a web database that allows consumers to search for a dialysis clinic by name or location. Using the database, you can see how a dialysis clinic is rated and compares on 15 key quality of service measures, ranging from mortality rate, complications, and hospitalization to transplant rates and infection control. The database will help you make informed choices about where to receive dialysis.

Studies show that when this type of data is made publicly available, in report card type form, the mere fact of getting the data out in the open motivates the health care providers who are reviewed to improve their care, because they don't want to lose out on business that might go to better rated competitors.

I looked at the data for dialysis clinics in Oakland, for example, and there's a big difference in mortality rates among different clinics. Medicare will pay for you to have dialysis at any licensed clinic, so use the data base to make an informed choice about where to go.

The url for the ProPublica database is: http://projects.propublica.org/dialysis ... 2&w=10

To go the the dialysis website, click here.

To read about the faulty federal oversight of dialysis clinics, click here

Felicia Curran
www.ElderAdvocacyBlog.com
www.ElderAdvocacyLaw.com

If a senior in your family is taking narcotic pain medications such as OxyContin, Roxicodone, Oxycodone, Narco, or Vicodin, chances are your doctor thought it was the safest alternative compared to either TYLENOL (which can causes liver damage), or NSAIDs such as Ibuprofen, Advil or Aleve. Because "NSAIDs" (nonsteroidal anti-inflammatory drugs) have been reported to cause bleeding ulcers, stroke, and other cardiovascular problems, doctors often recommend narcotic pain killers instead of NSAIDs. So it may be a shock to find out that narcotic pain medicines have more deadly effects than NSAIDs, as reported by the New York Times, in “Narcotic Painkillers May Pose Danger to Elderly Patients, Study Says.” The Brigham and Womens Hospital study compared elderly patients taking narcotics, NSAIDs, and cox-2 inhibitors during 1999 to 2005. It found that, “patients in the narcotic group were four times more likely to experience a compound bone fracture, apparently as a result of a fall, and they were twice as likely to have a heart attack, [compared to patients taking NSAIDs such as Motrin]. The cardiovascular risks posed by narcotics were the same as for drugs like Celebrex and Vioxx, which have come under scrutiny for that hazard. ...The review also found that the rate of gastrointestinal bleeding among patients taking narcotics was about the same as those taking drugs like Advil and Aleve. A principal reason that medical experts have advocated narcotics in older patients is the belief that they reduce such problems.”

Because of the sedative effect that narcotics have, it makes perfect sense that they would increase the risk of falls in the elderly, but it is a shock to read that they make a person 4 times more likely to break a bone due to a fall. The finding that such drugs can double the death rate due to heart attack is also very surprising and disturbing.

But perhaps the most disturbing aspect of this study is that we are not learning about deadly effects of these drugs from the Food and Drug Administration (the governmental agency who is supposed to regulate these drugs and warn us about the dangers) or from the companies that make and sell us these drugs. Why is that these drugs have been on the markets for years but this is the first time these kind of deadly effects on the elderly are being made known? Have the drug companies known about the risks for the elderly and not told us? They certainly make enough money from selling these drugs to be able to do this kind of study. What kind of follow-up is the FDA going to do on this issue? Are they going to require the drug manufacturers to warn doctors and patients about these risks? If not, why not?

The conclusion of the study appears to be that if you're a senior on OxyContin, Roxicodone, Oxycodone, Vicodin, or other narcotics, you should talk to your doctor about getting off of them, and switching to NSAIDs instead. Bring a print out of the New York Times article or the Archives of Internal Medicine abstract to the doctor’s appointment.

To read the New York Times article, click here.

To read the abstract from the Archives of Internal Medicine, click here.

To contact the FDA, call 1-888-INFO-FDA 1-888-463-6332

Felicia Curran, Esq.
www.ElderAdvocacyBlog.com
www.ElderAdvocacyLaw.com

The San Francisco Chronicle is running a series of articles under the caption "Dead by Mistake" that is an extremely interesting look at the needless deaths and injuries caused by preventable medical errors. Yesterday's article, "Secrecy Shields Medical Mishaps From Public View" discusses how little progress has been made since a 1999 federal study called "To Err Is Human" outlined steps the medical profession can take to cut the number of deaths by medical errors in half. It shows how the secrecy surrounding hospitals, the lack of compulsory reporting of mistakes, and the financial incentives given to hospitals, all combine to perpetuate if not encourage medical errors.

The article states that "A national investigation by Hearst Newspapers, including The Chronicle, found that the hospital industry, the federal government and most states have failed to take the effective steps outlined in the report a decade ago. Consequently, over that period, as many as 2 million Americans have died needlessly of preventable medical mistakes." The idea is that hospitals can prevent medical errors by setting up protocols, systems, and procedures that provide safety checks and balances to keep patient's safe, much the way that years ago car manufacturers began to design cars with safety features (such as ignitions that won't start unless the car is in park) that can prevent accidents from happening.

Why wouldn't a hospital want to save lives and prevent accidents by minimizing the number of mistakes they make? According the the Chronicle's report, "Hospitals can actually lose money by providing safer care. For example, when Utah's Intermountain Healthcare hospital chain improved its system for prescribing heart patients the proper medications on discharge, rehospitalizations were reduced by 900 beds a year. As a result, the hospital lost $3.5 million in revenue. 'To my hospital administrators, there was actually a certain amount of whining about this,' said Intermountain executive Dr. Brent James, another "To Err Is Human" co-author."

Medicare has recently taken the approach of denying payment to hospitals for "Never Events" -- viz.,illnesses and injuries patients pick up in the hospital that are entirely preventable if proper procedures are followed. Included in the list of Never Events are pressures ulcers or bed sores, and post-surgical infections. The idea is that if hospitals know they will not be able to bill the patient's Medicare for illnesses caused by the hospital's negligence, the hospital will stop negligent practices that cause injury.

New reporting laws, such as a 2007 California law that require hospitals to report errors to the the California Department of Public Health, and which requires the Department to investigate the error within 48 hours, also can make a difference.


A companion article, Lost, Stolen, or Never Existed profiles patients who have been the victim of medical mistakes. By reading the stories of the victims of medical mistakes you can hopefully learn something that might might protect you or your family next time you are in the hospital.

To read the Chronicle's article, Click here.

The Chronicle has also set up a website that has lots of information on medical errors, www.deadbymistake.com.

Felicia Curran
www.ElderAdvocacyLaw.com

Government-run nursing homes can be held liable for neglect and abuse of their residents under a federal civil rights statute, Section 1983 of Title 42 of the United States Code, under a recent ruling by the 3rd Circuit Court of Appeal. In Grammer v. Hazel the federal appeals court for the Third Circuit (which covers Pennsylvannia, Delaware and New Jersey) held that the Federal Nursing Home Reform Act gives residents of state and county-run facilities the right to bring federal civil rights lawsuits over inadequate care.

In the Grammer v. Mercy case, the lawsuit was brought on behalf of Melviteen Daniels, a deceased resident of the John J. Kane Regional Center at Glen Hazel, in Pittsburgh. At the nursing home, Melviteen is alleged to have acquired pressure ulcers due to neglect; the pressure ulcers became infected, causing her death by septic infection.

Thanks to the lawyers (D. Aaron Rihn and Bob Daley, Robert Peirce & Associates, Pittsburgh, Pennsylvania)who brought the case on behalf of Melviteen's family, for their creative advocacy for their clients.

The ruling is especially significant for nursing home residents who live in states that do not have laws allowing civil lawsuits for elder abuse or neglect, because such residents can rely on the Grammer v. Hazel ruling to bring elder abuse lawsuits, in federal court, or in state court under federal law. To read the 3rd Circuit's decision, click here.

One open question is to what extent this ruling can be made applicable to nursing homes that are not government-operated but which receive government funds, such as Medicare and Medicaid payments (which virtually all nursing homes do). The lawsuit in Grammer was brought against a county-operated nursing home, under Title 42 U.S.C. Section 1983, which authorizes lawsuits against state-entities for violation of federally guaranteed rights. It is an open question whether a nursing home resident can sue a privately-owned nursing home directly under the Federal Nursing Home Reform Act (FNHRA), but one which the law surely lends itself to.

Felicia Curran
www.ElderAdvocacyLaw.com

Thought that you'd never be paying $4.79 for a gallon of gas? What if you are an elderly or homebound individual? Think the high price of gas doesn't affect you? Think again: What if you depend on Meals on Wheels or other home health support services for your very survival in your home?

The sharp increase in the price of gas is having dire effects on the nation’s home health agencies, and in turn on the elderly and homebound individuals they help. According to the National Association for Home Care & Hospice (NAHCH), there are 12 million people nationwide who are so disabled that they cannot leave home without assistance, and who are able to live in their own homes, and avoid a nursing home because of the assistance they receive from home health agencies. Collectively, the NAHCH reports that home support agencies employees drive nearly 5 billion miles each year to care for homebound individuals.

Many home health agencies operate at break-even, and 44% of home care agencies reported that they LOST money during 2007, and the rising cost of gas was reportedly a big factor in their operating in the red.

The New York Times reports that employees of home health agencies, and volunteers of federal programs such as Meals On Wheels, who are expected to use their own cars and pay for their own gas, are also being affected. Katie Clark (pictured here), a single mother of two, drives 700 miles a week in rural Michigan to provide home care for Bill Harmon, 77, and his wife Evelyn, 85 (pictured here) who has Alzheimer’s and is unable to care for herself. Katie is paid $9 an hour, or $250 a week, to care for the Harmons, but has to pay for her own gas, which now totals a whopping $100 a week. Katie says that the Harmons “are just like family to me” but she may not be able to continue to care for them because of the high price of gas. “Some weeks I have to borrow money to get here” she is quoted as saying.

When Evelyn started to develop Alzheimer’s disease 8-10 years ago, her husband promised her "Don’t worry, I’ll take care of you as long as I can.” Now he says that without Katie’s help, he would have to put his wife in a nursing home, and “probably need to live in one himself.”

The National Association for Home Care & Hospice is lobbying congress to take the following steps to help home health agencies help the elderly stay in their own homes and out of nursing homes:

1. Preserve the annual inflation updates for home health and hospice as provided in Medicare law.

2.Reinstate the 5 percent rural add on for home health services delivered to patients in rural areas.

3.Exempt home health agencies, hospices and their nurses and therapists from paying Federal gasoline taxes.
4. Recognize home telehealth between trained nurses and patients as the equivalent of in-home visits.

5. Retract the Medicare regulatory cuts of nearly 12% facing home health care in 2008-2011.

6. Withdraw the Medicare regulatory proposal to eliminate the Budget Neutrality Factor in the hospice wage index.

7. Grant home health providers priority status to fuel and supplies through “first responder” status in cases of public health emergencies and disaster situations.

To learn more about the National Association for Home Care and Hospice proposals, click here.

You can do your part by contacting your Congressperson or Senator and demanding that they pass and support THe NAHCH proposals. Click here for contact information for Congress and the Senate.

The read the New York Times article, click here.


Felicia Curran
www.ElderAdvocacyLaw.com