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The Nevada Supreme Court issued a decision last week in Vredenburg v. Sedgwick CMS allowing surviving family members to recover workers' compensation death benefits under certain circumstances when an injured employee commits suicide.
NRS 616C.230(1) provides for workers' compensation benefits for accidental employee deaths but precludes surviving family members from recovering when a the employee's death was caused by his "willful intention to injure himself."
The Supreme Court ruled that a suicide is not "willful" for the purpose of denying workers' compensation death benefits if a sufficient causal chain links an employee's work related injury to the employee's suicide. The precedent setting standard requires a surviving family member to show the following:
(1) the employee suffered an industrial injury,
(2) the industrial injury caused some psychological condition severe enough to override the employee's rational judgment, and
(3) the psychological condition caused the employee to commit suicide.
Vredenburg v. Sedgwick CMS, 124 Nev. Adv. Op. No. 53 (July 24, 2008)
The full opinion can be found here
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From IndoxConsulting.com:
Using enoxaparin or heparin to bridge long-term anticoagulation therapy with warfarin for secondary stroke prevention has been associated with a high risk for serious bleeding in patients with cardioembolic stroke (CES). A retrospective study of 204 CES patients showed that only those who received bridging with enoxaparin went on to have symptomatic intracranial bleeding. Similarly, all CES cases with systemic bleeding were treated with intravenous heparin.
"Our study suggests doctors should think twice before using enoxaparin, or intravenous heparin for that matter, to bridge anticoagulation therapy with warfarin in patients with cardioembolic stroke," principal investigator Hen Hallevi, MD, from the University of Texas Health Science Center at Houston, told Medscape Neurology & Neurosurgery.
Clinical Dilemma
While it is widely acknowledged that CES patients require long-term anticoagulation, the issue of when and how to initiate it remains a clinical dilemma, said Dr. Hallevi.
Routinely bridging CES patients in the acute phase with enoxaparin or heparin until warfarin therapy begins to work is a widespread practice, but one that is not supported by the literature or current guidelines, he said.
He added that the current study was initiated based on anecdotal observations that CES patients tend to have more intracranial and systemic bleeding, also described as hemorrhagic transformation, than other types of stroke patients.
To examine possible explanations for this phenomenon, the researchers looked at the type of treatment administered to CES patients who were admitted to a single stroke center between April 1, 2004 and June 30, 2006 and who were not treated with tissue plasminogen activator.
Patients were categorized into one of 5 possible treatment groups. These included no treatment, aspirin only, aspirin followed by warfarin, intravenous heparin in the acute phase followed by warfarin, and full-dose enoxaparin combined with warfarin.
The study's primary outcomes included serious bleeding (defined as a parenchymal hematoma, grade 2, or systemic bleeding) and stroke recurrence during hospital stay.
Secondary end points included discharge with a favorable outcome (modified Rankin Scale score of 0 to 3), stroke progression, and in-hospital mortality.
All Intracranial Hemorrhage Occurred in a Single Group
Of the total study group, 8 subjects received no anticoagulation, 88 received aspirin alone, 35 were treated with aspirin followed by warfarin, 44 received intravenous heparin followed by warfarin, and 29 received full-dose enoxaparin combined with warfarin.
Hemorrhagic transformation occurred in 23 (11%) patients. Of these cases, 3 were symptomatic. Systemic bleeding occurred in 2 patients, who were both taking heparin.
"We found that all of the hemorrhage cases were in 1 group - those who were bridged with enoxaparin," said Dr. Hallevi. "When you think about it, this is really not surprising, because the good thing, as well as the bad thing, about this drug is that it does exactly what it is supposed to do, it fully anticoagulates," he said.
"We believe the infarct damages the small and medium-sized vessels, which are later reperfused and tend to leak blood. But the difference between this patient group and patients with other types of stroke is that those with cardioembolic stroke get anticoagulated really quickly, which promotes bleeding," he added.
Stroke progression occurred in 11 (5%) of patients and was significantly associated with poor outcome. All except 1 of these cases occurred in the aspirin-only group. In fact, the analysis revealed that patients receiving aspirin alone were 12.5 times more likely to experience progressive stroke compared with individuals on other types of anticoagulation. This finding, said Dr. Hallevi, suggests aspirin may not be as potent as other forms of anticoagulation therapies.
Despite these findings, Dr. Hallevi, cautioned that the retrospective nature of the study cannot prove causality. Nevertheless, he added, clinicians treating CES patients may want to consider these findings before opting for anticoagulation with enoxaparin or heparin.
Arch Neurol. Published online July 14, 2008. Abstract
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Keeping up with the hepatitis cases against the Endoscopy Center of Southern Nevada, the Reno Gazette Journal reports today that patients from the center who were not physically injured may still be able to recover damages from the Center. Clark County District Court Judge Allan Earl dismissed the Center's argument that emotional distress claims unrelated to actual injuries should not be allowed to recover.
While allowing emotional distress claims to survive, Judge Earl dismissed products liability and warranty claims against the Center, saying that the Center did not sell supplies to its patients.
The RGJ reports that the Center currently faces 121 lawsuits.
Meanwhile, according to Fox News Las Vegas, the Southern Nevada Health District confirmed a ninth case of hepatitis C contracted from exposure at the Endoscopy Center.
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The rapid rise of the number of deaths by methadone overdose is receiving attention all over the country.
Maurreen Skowran of The News & Observer reported on the increase of methadone deaths in North Carolina as the drug is used more commonly as a painkiller. In her article, found here, Skowan reports on the deadly effects of the drug, even when used as directed.
"Even legal prescriptions can turn fatal when doses accumulate over time into overdoses.
That phenomenon may have contributed to the death of a Winston-Salem woman. Jewel Imperial, 25, a student and musician, overdosed in September 2007. Her father, Bobby Imperial, said she died five days after being prescribed up to 80 milligrams per day for back pain. He declined to identify her doctor because the family is pursuing legal action. Imperial's dosage was more than double the recommended maximum for patients new to opioids, the family of drugs that includes methadone. Her parents didn't know she had been prescribed methadone then. But a few days after she started the prescription, her mother, Nancy Imperial, took her back to the same doctor. Her symptoms were disorientation, aches, sweats, cough and, sometimes, a spacey feeling, her father wrote. She died the next day."
Spike Hurst of Altoonamirror.com reported on methadone's effects in Pennsylvania and the surrounding region in his "Killer or Cure," found in its entirety here. According to the article, methadone could be the region's number one killer.
"It's killing people at therapeutic levels," said Marti Hottenstein, vice president of Helping America Reduce Methadone Deaths, a grass-roots group battling to tighten regulations on the drug. "It's killing more than illicit drugs - drugs it's supposed to help people from."
Hurst's article emphasizes the critical need for education about methadone, quoting Dr. Westley Clark, of the Substance Abuse Treatment Center director for the U.S. Department of Health's SAMHSA agency, the Substance Abuse and Mental Health Services Administration.
Inside state-regulated clinics, education and counseling are part of methadone maintenance programs, Clark said.
Those added measures - combined with "lock boxes" for take-home doses - something SAMHSA recommends - all work to curb the likelihood of overdosing, as well as opportunity for thefts, he said.
But with practitioners, "there has to be a greater emphasis placed on educating them about the dangers of opiates like methadone," said Clark, who believes that, in many cases, there may be better alternatives for pain treatment. He says SAMHSA is working on drug policy and with the federal Drug Enforcement Administration on strategies to "encourage" practitioners to learn more about methadone.
Because things could get worse, Clark said."We need to reach out to patients, the public and the media because we need to be aware that we have a boomer population that will be running into more pain problems associated with getting older. There's going to be that demand [for pain medication]."
His message to physicians: Know the drug. "Know the drug and know your patient," Clark said, because it might be the best option available for those who cannot afford high-priced anesthetics.
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Issued back in 2006, this Health Advisory from the FDA warns against the dangers of methadone and includes important prescribing information for its safe use.
FDA Public Health Advisory: Methadone Use for Pain Control May Result in Death and Life-Threatening Changes in Breathing and Heart Beat
FDA has received reports of death and life-threatening side effects in patients taking methadone. These deaths and life-threatening side effects have occurred in patients newly starting methadone for pain control and in patients who have switched to methadone after being treated for pain with other strong narcotic pain relievers. Methadone can cause slow or shallow breathing and dangerous changes in heart beat that may not be felt by the patient.
Prescribing methadone is complex. Methadone should only be prescribed for patients with moderate to severe pain when their pain is not improved with other non-narcotic pain relievers. Pain relief from a dose of methadone lasts about 4 to 8 hours. However methadone stays in the body much longer--from 8 to 59 hours after it is taken. As a result, patients may feel the need for more pain relief before methadone is gone from the body. Methadone may build up in the body to a toxic level if it is taken too often, if the amount taken is too high, or if it is taken with certain other medicines or supplements.
To prevent serious complications from methadone, health care professionals who prescribe methadone should read and carefully follow the methadone (Dolophine) prescribing information
FDA is issuing this public health advisory to alert patients and their caregivers and health care professionals to the following important safety information:
- Patients should take methadone exactly as prescribed. Taking more methadone than prescribed can cause breathing to slow or stop and can cause death. A patient who does not experience good pain relief with the prescribed dose of methadone, should talk to his or her doctor.
- Patients taking methadone should not start or stop taking other medicines or dietary supplements without talking to their health care provider. Taking other medicines or dietary supplements may cause less pain relief. They may also cause a toxic buildup of methadone in the body leading to dangerous changes in breathing or heart beat that may cause death.
- Health care professionals and patients should be aware of the signs of methadone overdose. Signs of methadone overdose include trouble breathing or shallow breathing; extreme tiredness or sleepiness; blurred vision; inability to think, talk or walk normally; and feeling faint, dizzy or confused. If these signs occur, patients should get medical attention right away.
FDA recently approved new prescribing information for methadone products approved for pain control. The information in the new prescribing information is based on a review of the scientific literature completed by FDA. A Medication Guide for patients is planned.
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Prescription painkiller overdose is becoming a common killer in Nevada, and nationally.
According to the National Center for Health Statistics, overdoses caused by prescription painkillers are increasing, and Methadone abuse is escalating more rapidly than any other drug. In fact, methadone overdoses have increased over 500% between 1999 and 2005.
Methadone is given to heroin users in liquid form to treat addiction, and doctors have progressively been prescribing methadone in pill form to treat chronic pain. As reported by Kathleen Fackelmann of USA Today, most methadone overdoses are caused by the abuse of the prescription painkiller pills.
Methadone is difficult to prescribe safely, according to Fackelmann, because it remains in the user's bloodstream long after the few hours of pain relief it provides. Too much methadone in the system will cause a user to go into a coma and stop breathing.
Another difficulty posed by methadone as a painkiller, reported by Holly Ramer of the Associated Press, is that methadone is metabolized slowly. Because a user may not feels its effects immediately, he or she might continue to take them, until the level of methadone becomes deadly.
Check back soon for more entries about the dangers of methadone.
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KCTV.com posted an interesting article discussing dangerous automobiles.
While the greater likelihood of rollovers make SUVs, vans, and pickups more hazardous in single vehicle crashes, smaller cars have a disadvantage in multi-car accidents.
Keep reading for the full text of the article, entitled "20 Most Dangerous Autos Named: SUVs, Small Autos Increase Risk for Drivers."
Want to stay safe as you navigate the open --or congested -- road? You may want to avoid certain vehicles.
Some cars are considered unsafe because of a lack of safety features, others because young, risky drivers seem to gravitate toward them.
One example of a vehicle that gets a bad rap is the Nissan 350z, because it has a death rate that is nearly double the rate for other sports cars. The reason for this isn't a lack of safety; it's that young, inexperienced and risky drivers are frequently behind the wheel when these cars are involved in fatal crashes.
"When they're in crashes, they're particularly serious ones," said Russ Rader, communications director for the Insurance Institute for Highway Safety.
Experts look at side-impact protection, stability control and rollover risk when assessing vehicles in order to predict safety. The 20 most dangerous vehicles compiled here were assessed in this way by Forbes.com.
The vehicle that tops the list could make Tiger Woods blush. The Buick Rendezvous -- Woods is a spokesman for the vehicle -- is ranked as the least safe vehicle available in the U.S. Its followed by other SUVs including Ford Escape, Mercury Mariner, Jeep Liberty and Nissan Xterra.
"What makes a vehicle unsafe today is a lack of side-impact protection," said Radar. "Whiplash is not a life-threatening injury, but head injuries -- from side impact -- are commonly life-threatening."
Because of this danger, side-curtain bags are mandatory for all 2009 autos. The National Highway Traffic Safety Administration suggests that these will help reduce fatal head injuries caused by side-impact crashes by 45 percent. This safety measure could potentially save 1,000 lives anually.
Autos need more than just head-protecting airbags. A well-built side structure that can handle an impact from vehicles of different heights is essential for safety. This brings up an important side note: larger vehicles are at an advantage in a crash, especially when the crash involves small, light vehicles like a Toyota Yaris or Chevrolet Cobalt. Other light autos at risk include Suzuki Forenza, Pontiac G5, Toyota Scion tC, Ford Focus, Suzuki Reno, Chevrolet Aveo, Kia Rio, Toyota Matrix and Hyundai Accent.
However, those small cars may be at an advantage in another area. Their handling and maneuverability can help avoid an accident if the driver is alert.
"A more nimble, better-handling vehicle is likely going to be easier to control in an emergency and help the driver avoid the dangerous situation," said John Linkov, managing editor of Consumer Reports.
Before you rush out to buy the biggest SUV you can find, it's important to know that SUVs and pickups are at a noticeable disadvantage when involved in single-vehicle accidents -- when the driver swerves to miss an object or animal, or falls asleep behind the wheel. The danger is that these vehicles have an increased -- more than double - chance of rolling over.
In this type of accident, SUVs and pickups have more than double the chance of rolling over, according to NHTSA data. This risk relates closely to overall federal fatality data, showing that SUVs and pickups generally have a higher fatality rate than cars of a similar weight.
Technological advances have been made to help counteract these dangers. Electronic stability control systems, which apply brake pressure where it is most needed to prevent loss of vehicle control, have become more common among non-luxury vehicles. The NHTSA calls this advance "the most significant since the seat belt," and the federal government is requiring that all new cars have the feature, starting in 2012. This mandate is estimated to be able to prevent over 9,000 auto fatalities each year.
"Electronic stability control is one of those rare safety features that's having a dramatic effect on saving lives," said Rader. "Stability control alone can reduce the risk of fatal single-vehicle crashes by 56 percent. And it can reduce fatal single-vehicle rollovers by 80 percent for SUVs, 77 percent for passenger cars."
SUVs and small autos aren't the only vehicles to be wary of.
"Pickups have a rollover problem," said Radar. "They have a high center of gravity and a high propensity to roll over." And making matters worse, "They're the laggards in electronic-stability control," he said. Pickups ranked as most dangerous include Ford Ranger, Nissan Frontier and Dodge Dakota.
Any vehicle, even the safest autos on the road, can be dangerous if it's not used as it was intended. Poorly trained drivers can increase the risk.
Information on this report is based on available data by the IIHS, covering 2001 to 2004 models. Some manufacturers have made significant changes and/or redesigns of vehicles.
http://www.kctv5.com/automotive/15856467/detail.html
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A quick look at www.safercar.gov sheds lights on the significant dangers of "rollover" automobile accidents, information particularly relevant for Nevada drivers, especially those who do a lot of driving in the mountains or on rural roads.
Rollovers are not the most common type of automobile accident, but they often cause the most serious injuries. While rollovers account for only 3% of accidents, nearly 33% of fatalities in passenger vehicle accidents are caused by rollovers.
In 2002, over 10,000 people died in rollovers. Of those 10,000, 72% were not wearing seatbelts.
What Causes Rollovers?
SUVs have a reputation for causing rollover accidents, and with reason. The taller and narrower a vehicle, the more likely it is to rollover. SUVs, pickup trucks, and vans fit this description.
However, vehicle type is not the only factor leading to rollover accidents. All vehicles can rollover, and driving behavior plays the largest factor. 85% of rollover fatalities were single vehicle accidents.
Speeding: 40% of fatal rollovers involved excessive speeding, and almost 75% of fatal rollovers occurred in speed zones of 55 mph or greater.
Alcohol: Nearly 50% of fatal rollovers involve alcohol.
Rural roads: Rollovers are more common on rural roads, especially those with a speed limit of 55 mph or greater.
Minimizing Your Risk
The site lists some tips to minimize the risk of rollover and minimizing injury:
MAINTAIN YOUR TIRES
Improperly inflated and worn tires can be especially dangerous because they inhibit your ability to maintain vehicle control, the most important factor in reducing the chance of rollover. Worn tires may cause the vehicle to slide sideways on wet or slippery pavement, sliding the vehicle off the road and increasing its risk of rolling over. Improper inflation can accelerate tire wear, and can even lead to tire failure. It is important to maintain your tires properly, and replace them when necessary.
LOAD VEHICLES PROPERLY
Consult your vehicle's owner's manual to determine the maximum safe load for your vehicle, as well as proper load distribution. If you're using a roof rack, pay special attention to the manufacturer's instructions and weight limits. Any load placed on the roof will be above the vehicle's center of gravity, and will increase the vehicle's likelihood of rolling over.
AVOID PANIC-LIKE STEERING
Many rollovers occur when drivers overcorrect their steering as a panic reaction to an emergency--or even to a wheel going off the pavement's edge. At highway speeds, overcorrecting or excessive steering can cause the driver to lose control, which can force the vehicle to slide sideways and roll over.
For more information, check out www.safercar.gov
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The Reno Gazette Journal reports that after 84 hepatitis C cases were linked to the Endoscopy Center of Southern Nevada and more than 50,000 patients were notified they might be at risk, the Nevada Board of Medical Examiners received a bit of negative attention. As a result, the Board of Medical Examiners' website will be posting more information about Nevada doctors' malpractice history.
Currently, the site lists the names of doctors who've been disciplined and the infraction for which they've been disciplined.
Added to the site will be a database of all doctors involved in malpractice cases ending in settlement, award, or judgment.
According to the RGJ, the details of the site are unclear: "The board discussed including only cases that involved $5,000 or more, but did not come to a clear decision. It also did not state a firm launch date for the new site."
The board also discussed the possible adoption of a policy on the use of single and multiuse medication vials, but decided against implementing such a policy for fear of compelling doctors to use medication only according to the manufacturer's label, which is inconsistent with current practice of often using medications "off-label."
For the full article
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The Las Vegas Sun reported a disquieting article analyzing Nevadans consumption of prescription painkillers. The article reported that in Nevada, residents consume roughly twice the national average of numerous painkillers.
The article including several alarming statistics:
-- More people in Clark County die of prescription narcotics overdoses than of overdoses of illicit drugs or from vehicle accidents.
-- In 2006, Nevadans were the No. 1 users per capita of hydrocodone -- better-known as Vicodin or Lortab.
-- Nevadans consumed enough of the drug to equal 48 Vicodin pills for every man, woman and child in the state for a year.
What's behind the heavy use? That depends on whom you ask. "Law enforcement complains about the illegal activity, addiction specialists decry that more people are becoming hooked on drugs, and pain management specialists talk about the benefits of narcotics."
In response to the discovery that some patients were "doctor shopping," or illegally visiting and receiving drugs from multiple providers, the Nevada Pharmacy Board developed a database listing every prescription written in Nevada for certain medications. The listing included the provider and the patient, and was designed to prevent "doctor shopping." According to the Sun, the database was used 65,372 times in 2007.
In addition to the database, there are other precautions available to prevent abuse: "Among the precautions pain specialists can take to guard against abuse are requiring contracts with patients that discourage doctor shopping, urine tests to verify drug use and monthly visits to track prescriptions and lessen the number of pills a patient has at a given time."
In addition to prescription painkillers, Nevadans are turning towards narcotic painkillers as well. According to the Sun's analysis, Nevadans rank fourth nationally for methadone, morphine and oxycodone use per person.
Check out the article here
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The Nevada Supreme Court clarified a few sections of Nevada's Uniform Act on Rights of the Terminally Ill last week in Estate of Maxey v. Darden, 124 Nev. Adv. Op. No. 43 (July 2008). The Act authorizes three procedures for terminally ill patients or their families to withhold life-sustaining treatment. First, under certain circumstances, an individual may direct an attending physician to withhold life-sustaining treatment by executing a declaration. Second, an individual can execute a declaration designating another person to make decisions regarding withholding treatment. Finally, if neither declaration is present, a terminally ill patient's attending physician can withhold life-sustaining treatment if he or she receives surrogate consent from certain family members. In Estate of Maxey, involving the third situation, the Supreme Court addressed the meanings of "attending physician," valid "surrogate consent," and "terminally ill" under the Act.
Attending Physician
Evaluating the term "attending physician" de novo, the Court concluded that "in light of the Act's purpose and the Nevada Legislature's decision not to define "attending physician" with any particular limitations, we determine that the Legislature intended the attending physician to be the physician who has primary responsibility for the patient's treatment and care at the time when administering life-sustaining treatment becomes an issue."
Surrogate Consent
The Act requires that an attending physician act on the surrogate's written consent, attested by two witnesses. The Court determined that "an attesting witness must have personal knowledge that the surrogate gave written consent to withholding or withdrawing the terminally ill patient's life-sustaining treatment. If an attesting witness is present at the time when the surrogate provides written consent, personal knowledge of the surrogate's intent is presumed. Because, however, NRS 449.626(1) does not require an attesting witness to subscribe his or her name to the consent form, but instead only requires attestation, proof of the attesting witness's personal knowledge is not necessarily limited to the witness's signature on the consenting document."
Terminally Ill
The Court concluded that an attending physician's determination that a patient is terminally ill is subject to judicial review because the Act imposes a duty to act in accord with reasonable medical standards when determining the patient's status. Thus, "only if the physician acts in accord with such standards is he or she entitled to immunity from civil liability. A physician's conformity to the standard, when taking any action under the Act, is therefore subject to judicial review."
You can take a look at the entire opinion here: http://www.leg.state.nv.us/SCD/124NevAdvOpNo43.pdf
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