Sale of Cheboygan Hospital Back On

Story first appeared in The Record Eagle.

Federal bankruptcy hearings scheduled for today could lead to the reopening of Cheboygan Memorial Hospital, which unexpectedly idled 400 people four weeks ago after federal regulatory issues halted its sale.

The hearings before a Judge in Bay City are expected to clear the way for Flint-based McLaren Health Care Corp. to buy the hospital, which is located in sparsely populated northern lower Michigan.

The hospital announced March 1 that it was filing for Chapter 11 bankruptcy protection after losing more than $7 million last year. It closed unexpectedly April 3 after a $5 million sale to McLaren fell through over licensing issues for Medicare and Medicaid services.

A community coalition organized a rally outside the hospital last Monday that drew about 2,500 residents, business leaders, nurses and other employees to support the reopening of the hospital, which served the area for seven decades and was Cheboygan County's largest employer.

Those at the rally cheered when a McLaren executive told them McLaren had just reached a deal with U.S. officials and hoped to complete the purchase soon. No reopening date has been set, but those involved in the process say they are hopeful it will happen within days or weeks.

An attorney for McLaren said that she thought it would take seven to 10 days, optimistically. The facility has been closed for approximately 30 days and there's obviously a lot of things that need to be done.

A lawyer for the Michigan Nurses Association, said she thinks it will take about two weeks, adding that what needs to be done takes time. It's also unclear how many people would get their jobs back. McLaren already has rehired about 50 people to work at clinics at the hospital's sites in Cheboygan, Pellston and Petoskey, the Cheboygan Daily Tribune reported.

While the emergency room and clinics are expected to reopen, no plan is in place to fully restore other inpatient care.


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Unnecessary Prescriptions in Nursing Homes

Story first appeared in USA Today.

Many nursing homes are typically using anti-psychotic drugs in residents who display agitation and combative behavior, but who should not be administered the powerful sedatives, a Boston Globe report based on government data has found.

The Globe based an investigation on data received 19 months after it filed a Freedom of Information Act request with the U.S. government.

At one nursing home, the Ledgewood Rehabilitation and Skilled Nursing Center in Beverly, Mass., the Globe found that 19% of residents who did not have a diagnosis for which the drugs are recommended were receiving them. The danger is that such patients are exposed to powerful side effects, the Globe reports. The drugs can leave people in a stupor, according to the Globe.

The Food and Drug Administration says that anti-psychotic drugs can cause dizziness, sudden drop in blood pressure, abnormal heart rhythm, blurred vision and urinary problems in people with dementia, the Globe reports.

At more than one in five U.S. nursing homes, anti-psychotic drugs are administered to people who do not have a condition that warrants their use.  San Diego Medical Malpractice Lawyers caution that the professional implications that misdiagnosis and unnecessary prescriptions will have on the employees and institution could be severe.

The news organization found that in 2010, about 185,000 nursing home residents in the United States received such drugs, although the administration of the drugs went against recommendations of federal nursing home regulators, the Globe reports. Many of the patients were suffering from Alzheimer's or some other ailment related to dementia. The drugs are normally intended for people suffering from schizophrenia, according to the Globe.

One medical school professor told the Globe that the use of the drugs raises questions. There is an inordinate amount of prescriptions written for a population that is already frail, and we know these drugs increase the risk for side effects, including death.

Members of the nursing home industry, however, told the Globe the drugs are sometimes necessary to keep people from hurting themselves and/or others.

The vice president of pharmacy services at Genesis Health Care, owner of more than 200 nursing homes, told the news organization that sometimes patients are given lower doses than someone with a psychosis and the data do not reflect that. There are things out there the industry can do better, there is no question about that, but there are good things in the industry that are not seen because of these issues with the statistical data.


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Patient Safety Advocates Band Together

Story first appeared in The Wall Street Journal.

Searching for ways to reduce medical errors and keep patients safe?

Look up.

That’s the idea of some patient-safety experts, who will discuss the formation of an independent patient-safety agency modeled on the National Transportation Safety Board, and other strategies to reduce errors at a summit in Washington.  Baltimore Medical Malpractice Lawyers are following the progress of this new agency.

Many of the safety and error-prevention strategies used in aviation are applicable to health care, such as investigating the root causes of accidents and developing programs to reduce fatalities, experts say. One pilot who will share lessons from aviation’s best practices at the summit: is the retired US Airways pilot who coolly brought down stricken Flight 1549 into the Hudson River with no loss of life.

“Surfing the Healthcare Tsunami,” a new patient-safety documentary looking at solutions such as safety protocols for hospitals, will also premier at the summit. The Discovery Channel will show the film on April 28, with repeats over subsequent weeks.  It will feature a prominent actor and patient-safety advocate, whose 12-day old twins received an overdose of heparin, a blood thinner, in a Los Angeles hospital that put them at serious risk, as the Health Blog discussed in 2008.

The concept of an NTSB for health care first surfaced in a report by the Institute of Medicine and has been taken up by patient-safety advocates led by Dr. Charles Denham. He’s chairman of the Texas Medical Institute of Technology, or TMIT, a nonprofit research group that supports development and dissemination of patient-safety practices.

The idea isn’t to create another layer of health-care bureaucracy, or a new federal agency, but a public/private partnership that could be run at minimal cost to taxpayers — perhaps 10 to 25 cents a year per citizen. Consumers are absolutely shocked that that there is no safety entity for hospitals and health care.


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Move Over Stem Cells, Here Come MicroRNA

Story first appeared on Fox News.

When a person suffers a heart attack, scar tissue forms over the damaged areas of the heart, reducing the organ’s function.  However, in a recent study, scientists successfully turned this scar tissue into working heart muscle without the use of stem cells, say Livonia Cardiologists.

Duke University researchers used molecules called microRNAs to convert scar tissue (called fibroblasts) into heart muscle cells in a living mouse, improving the heart’s ability to pump blood.  According to the scientists, this process is much simpler than stem cell transplants and has none of the ethical concerns, making it a potential turning point in the science of tissue regeneration.

Right now, there’s no good evidence stem cells can do the job.

Scientists believe embryonic stem cells are the best to use for tissue regeneration because they are pluripotent—meaning they can become any type of cell in the body.  However, there have not been enough experiments done to prove how functional the stem cells are in regenerating tissues and whether or not they may form deadly tumors. Additionally, there are ethical concerns about using cells derived from a human embryo.

Meanwhile, adult stem cells avoid the controversy surrounding embryonic stem cells but have a limited capacity to form other types of cells.  The results of using these adult stem cells for tissue regeneration are not as satisfying as one would like.

Rather than stem cells, the new method uses microRNA molecules—which typically control gene activity—and delivers them into the scar tissue that develops after a heart attack.  The microRNAs are able to reprogram, or trick, the scar tissue into becoming heart muscle again instead.  Testing is still in its early stages, but so far, the method appears to be relatively easy, and the data looks very promising, according to the researchers.

It’s a much more simplified, feasible way of causing regeneration; very easy to use as therapy. With stem cells, you have to take them from the embryo or tissue in the body, grow them in culture, and re-inject them—and then there can be technical and biological problems. With microRNA, after a heart attack you can simply convert some of the fibroblasts and tell them to become the right cell type and regenerate.

According to Hamtramck Heart Doctors, this new method also has the potential to treat stroke, spinal cord injuries, chronic conditions such as heart disease—and even the normal damage that can come with aging.  It can feasibly be used for any type of organ in the body, though the process of converting the cells may be different for each organ.

The method must still be tested in then larger animals, and if successful there, it can move onto human clinical trials.  But one could think about all these things of possibilities.  Specialists with Garden City Stroke Care centers are excited about these possibilities. Could you use it to treat the disease of aging and losing brain cells?  Can you convert other cells in the brain to working brain cells?


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Airlifted Trauma Victims More Likely to Survive

Story first appeared on Futurity.org.

Patients with traumatic injuries, such as traumatic brain injury fare better when airlifted by helicopter compared to patients transported by ambulance.

According to a new study, airlifted patients by comparison are 16 percent more likely to survive. Helicopter trips are costly and carry some risks, but this research shows they do save lives.

It is important that professionals sharpen the ability to identify trauma patients who need the helicopter most to ensure that they deploy the helicopter for people who really will benefit from its use.

Big cost, big reward

Medical evacuation helicopters—iconic symbols of rapid, lifesaving medical transport in the United States—operate at a price, in terms of both the financial cost and the risk of rare but potentially tragic crashes, according to the study.

A medical helicopter trip costs thousands of dollars, charged, in most states, to insurance companies and consumers.

But trauma is the leading cause of death and disability among young people around the world; in the United States, more than 50 million people are injured annually. Some 169,000 die of injury each year, and the most seriously injured, whether victims of car crashes or other causes of injury, are regularly transported to trauma centers near and far by helicopter.

Sophisticated analysis techniques were used to examine records from more than 223,000 patients aged 16 and older from the 2007-2009 National Trauma Data Bank. All patients sustained at least moderately severe injuries and were taken to trauma centers. The researchers compared the more than 161,500 patients sent by ambulance to the nearly 62,000 transported by helicopter.

When they adjusted for such factors as injury severity, type of injury, and age of patient, they determined that airlifted patients were 16 percent more likely to survive than similarly injured patients transported by ground.

‘Who flies?’

Among their conclusions was that one in 65 significantly injured patients brought to a Level I trauma center by helicopter would have died if ground transportation had been the only option.

Because no one can yet predict with precision which patients might survive only with a flight, transporting anyone with serious injuries might seem warranted.

But using Maryland’s average cost $5,000 per helicopter transport, $325,000 would have to be spent to transport 65 more patients and save one more life. And Maryland’s cost are much lower than average because it has the only state-run helicopter system in the country.

Paramedics and emergency responders on the scene must make split-second decisions about whether to call a helicopter in. Sometimes, they make the wrong call, and a patient’s injuries turn out to be less severe than originally believed.

But there is good reason for overuse of the helicopter: The possibility of making the mistake of not calling for a helicopter and watching a patient who might have survived die instead.

The advantage of a helicopter flight over an ambulance ride can be both the speed at which the patient gets to the hospital as well as the quality of the emergency medical team aboard. Helicopters tend to carry the most experienced crews.

In some cases, helicopters don’t help, but just increase the risk because of the flight and add costs.


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Traumatic Brain Injury Linked to Stroke

Story first appeared in Science Daily.

If you suffer traumatic brain injury, your risk of having a stroke within three months may increase tenfold, according to a new study reported in Stroke: Journal of the American Heart Association.

It's reasonable to assume that cerebrovascular damage in the head caused by a traumatic brain injury can trigger either a hemorrhagic stroke [when a blood vessel bursts inside the brain] or an ischemic stroke [when an artery in the brain is blocked]. However, until now, no research had been done showing a correlation between traumatic brain injury and stroke.

It is the first study that pinpoints traumatic brain injury as a potential risk factor for subsequent stroke.

Traumatic brain injury occurs when an external force such as a bump, blow or jolt to the head disrupts the normal function of the brain. Causes include falls, vehicle accidents, and violence.

In the United States alone, approximately 1 in 53 individuals sustain a traumatic brain injury each year, according to 2004 statistics from the Centers for Disease Control and Prevention. Worldwide, traumatic brain injuries are a major cause of physical impairment, social disruption and death.

Using records from a nationwide Taiwanese database, researchers investigated the risk of stroke in traumatic brain injury patients during a five-year period. The records included 23,199 adult traumatic brain injury patients who received ambulatory or hospital care between 2001 and 2003. The comparison group comprised 69,597 non-traumatic brain injury patients. The average age of all patients was 42 and 54 percent were male.

During the three months after injury, 2.91 percent of traumatic brain injury patients suffered a stroke compared with only 0.30 percent of those with non-traumatic brain injury -- a tenfold difference.

Stroke risk in patients with traumatic brain injury decreased gradually over time, Melvindale Stroke Care researchers have said:
After one year, the risk was about 4.6 times greater for patients who suffered a traumatic brain injury than for those who had not.

After five years, the risk was 2.3 times greater for traumatic brain injury patients.

According to experts in Lincoln Park Stroke Care, the stroke risk among traumatic brain injury patients with skull bone fractures was more pronounced than in traumatic brain injury patients without fractures. During the first three months, those with skull bone fractures were 20 times more likely to have a stroke than patients without skull bone fractures. The risk decreased over time.

Furthermore, the risk of subarachnoid hemorrhage (bleeding in the area between the brain and the thin tissues that cover the brain) and intracerebral hemorrhage (bleeding in the brain caused by the rupture of a blood vessel) increased significantly in patients with traumatic brain injury versus non-traumatic brain injury patients.

After considering age and gender, patients with traumatic brain injury were more likely to have hypertension, diabetes, coronary heart disease, atrial fibrillation and heart failure than non-traumatic brain injury patients, say professionals experienced with Romulus Stroke Care.

Early neuroimaging examinations -- such as MRI -- and intensive medical monitoring, support and intervention should be required following a traumatic brain injury, especially during the first few months and years. Moreover, better health education initiatives could increase public awareness about the factors that cause strokes and the signs and symptoms of stroke in patients with traumatic brain injuries.

Stroke is the most serious and disabling neurological disorder worldwide, say experts with Wayne County Stroke Care centers.


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Virginia Treats TBI As Dismissable Injury

Story first appeared on WorkersCompensation.com.
Seems a bit hard to believe, but in Virginia if a worker suffers a brain injury that prevents them from remembering the accident, it is not a compensable injury under workers’ compensation insurance. Even after an attempt to correct this elephant sized loophole, the state recently ruled that a man who fell off a roof and suffered traumatic brain injury – an injury that has left him wheelchair bound and permanently disabled, is not eligible for benefits.

The reason? At a hearing he could remember his name and age, but not remember the incident.

A 2011 law sponsored by a Representative and a Senator was intended to close the loophole that disallowed benefits for anyone who could not testify as to the accident that injured them. It provides a presumption that the accident was work related if a worker is physically or mentally unable to testify because of his injuries.

However, when the man fell off the roof of a garage he was building, fractured his skull and developed a blood clot in his brain that nearly killed him, he was denied workers' compensation benefits. At a workers’ compensation hearing, it was the fact that he knew his name and his age that did him in. The Workers' Compensation Deputy Commissioner apparently ruled that the State legislators only intended that the new law apply to fatally injured workers or those in comas who are completely unable to testify.

It seems that:
In Virginia, if you have an accident on the job resulting in a severe brain injury, you had best be in a coma or dead, or the state will rule that it was not a compensable incident. The fact that you can sit in a chair and utter your name is enough to convince bureaucrats that you are good to go.

The decision was made because of the absence of case law he could use to figure out the legislature's intent when they enacted it. Does the state of Virginia really believe that the legislature merely intended to make benefits available for brain injured dead people? And that somehow an on the job brain injury isn’t an on the job brain injury? Unless it puts someone in a coma or a box?

The message in Virginia is clear. If you are going to fall off a roof, make sure it is from the third story or higher.


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