Monday, April 11, 2011


**************************************************************** A ProMED-mail post ProMED-mail is a program of the International Society for Infectious Diseases [1] Date: Thu 7 Apr 2011 Source: Fox 6 News, WBRC [edited] Bacteria that affected 19 Alabama hospital patients and possibly led to the death of 9, initiated on a faucet [tap] at the Homewood-based Meds IV pharmacy, according to the Alabama Department of Public Health. Samples of the bacteria, _Serratia marcescens_, were identified on a sink faucet in the pharmacy. Water from that tap was used along with soap to clean out a container used to create an amino-acid compound used to create TPN [total parenteral nutrition], the intravenous food supply given to the affected patients. The bacterium was also found on an impeller, a large stirring instrument used to mix up the amino-acid compound. Finding _Serratia_ bacterium on a faucet is not uncommon, according to State Health Officer Dr Don Williams. What's troubling, he said, is that the filter used to sterilize the product failed and this is where the real problem lies. Williams said in a press conference Thursday [7 Apr 2011] it was his department's 1st experience dealing with an outbreak of this kind and is working with the FDA to determine if washing containers with unsterile water is within federal guidelines. Williams confirmed that there is no risk to any other patients going forward and the problem is absolutely limited to the TPN obtained by Meds IV. He said the Centers for Disease Control and Prevention [CDC] polled other states to see if anyone else was seeing similar problems with the bacteria and TPN. The CDC found the problem was limited to Alabama, and only to the patients who received TPN from Meds IV. "There is nothing to suggest that any of the infections were associated with any pharmacy other than Meds IV," Williams said. "Based on everything that we know, it is clearly linked to the compounding of TPN in that pharmacy." The ADPH has identified the weak point in the chain of infection, but is still investigating what went wrong with the sterilization process. Last Friday afternoon [31 Mar 2011], a Fox 6 News crew saw several federal agents moving boxes out of the Meds IV pharmacy on West Oxmoor Road. A Shelby County judge granted a temporary restraining order preventing Meds IV from destroying any evidence which could be used in a lawsuit. Shelby Baptist Medical Center, one hospital where an infected patient died after using TPN sold by the pharmacy, sued Meds IV. Judge Hewitt Conwill will hear a motion Friday [8 Apr 2011] from Meds IV employees who wish to lift the restraining order so they may retrieve other materials from the location. [Byline: Tiffany Glick] -- Communicated by: ProMED-mail ****** [2] Date: Fri 8 Apr 2011 Source: The Birmingham News [edited] A failure in the sterilization process at a Birmingham pharmacy appears to have caused the infection that sickened 19 people in Alabama hospitals, 9 of whom died, the state health department said Thursday [7 Apr 2011]. Investigators found exact matches of the bacteria on a water faucet [tap], a container, and a device used to mix intravenous nutritious supplements at Meds IV, state health officer Don Williamson said. But there are still questions about how the contamination occurred. "We've identified the weak point in the chain where infection occurred," Williamson said. "We're now trying to figure out exactly what happened." The Alabama Department of Public Health and the federal Centers for Disease Control and Prevention have been investigating the outbreak of _Serratia marcescens_ in 5 hospitals around Birmingham and one in Prattville. It is linked to bags of TPN, total parenteral nutrition -- a supplement given intravenously to patients too sick to eat -- mixed by Meds IV and sent to those hospitals in January, February, and March [2011]. Williamson said Thursday [7 Apr 2011] that samples of the bacteria were taken from Meds IV's compounding room, grown out and run through a genetic fingerprinting process. The same strain found in the TPN and in 12 patients turned up on the water tap and mixing equipment. Samples weren't available from 6 patients and one is still in process, the health department said. _S. marcescens_ also grew from samples taken from a bag of amino-acids used to make the TPN, but that culture hasn't been fingerprinted yet; investigators suspect it will match and was tainted at the pharmacy. Williamson said Meds IV staff used tap water to wash the mixing vessel before rinsing it with sterile water. Then the amino acid solution, which was mixed from a powder and sterile water, was also contaminated by touching the equipment. That amino-acid mixture is supposed to be run through a filter small enough to catch the bacteria, Williamson said. But for some reason, that didn't work. "The thing that's really troubling is that the 0.2 micron filter that's used to sterilize the product failed to do that," he said. At this point, he said, it's not clear what went wrong, and whether the problem lies in the process itself, a flaw in the filtering equipment or in human error. Williamson said health investigators are working with the Alabama Board of Pharmacy and federal Food and Drug Administration (FDA) to find out more about what went wrong. Jim Ward, a lawyer representing the pharmacy board, said the board's head inspector is trying to interview everyone who worked in the pharmacy to get a picture of what happened. In addition, they're waiting to review records that were seized by the FDA. "Obviously, we weren't there when the sterilization and the mixture process was going on," Ward said. "Until we have a chance to talk to everybody and find out what's going on, we aren't going to know everything that people want us to know." Williamson said investigators plan to look at patients who received TPN in those 6 hospitals but did not show signs of infection and is working with the FDA to get samples of other recalled products made by Meds IV. For now, he said, they're not aware of any additional contamination. "As we go forward, there are several things we still have to investigate," Williamson said, adding that it could take weeks to get more answers. "We are not done." [Byline: Hannah Wolfson] -- Communicated by: ProMED-mail [A total of 19 people in 6 Alabama hospitals developed _Serratia marcescens_ bacteremia after receiving TPN (total parenteral nutrition) produced by a single pharmacy; 9 of the patients died. The _S. marcescens_ isolated from 12 of the 19 individuals have the same genetic fingerprint as the organisms isolated from a container and stirrer used to mix the powdered amino-acids, from the tap water faucet used for rinsing the container, and from the TPN. Genetic fingerprint results are pending for a bag of compounded amino-acids used in the production of TPN that has also grown _S. marcescens_. _S. marcescens_ is a common environmental contaminant. This investigation illustrates the ability of DNA genotyping to confirm the epidemiologic linkages in the attempt to identify the source of this outbreak. Preparation of TPN is complex, requires use of sterile techniques to avoid microbial contamination, and well-trained personnel. We await results of further investigations to find the cause of the problem. The state of Alabama can be located on the Gulf coast of the USA on the HealthMap/ ProMED-mail interactive map at . - Mod.ML] [Symptoms of _S. marcescens_ infection include urinary and respiratory tract infections, endocarditis, osteomyelitis, septicemia, wound infections, eye infections, meningitis, treatable with cephalosporins, gentamicin, amikacin. But most strains are resistant to several antibiotics because of the presence of R-factors on plasmids. Picture of a lab culture of _S. marcescens_ (natural red pigment) at - Mod.JW] [see also: Serratia marcescens, contaminated solution - USA: (AL), alert 20110330.0987 2008 ---- Serratia marcescens, pre-filled syringes - USA: recall 20080122.0267 Undiagnosed reactions, fatal, heparin - USA: (FL), alert, recall 20080119.0242 2007 ---- Serratia marcescens, heparin syringe - USA (02): (FL) 20071222.4112 Serratia marcescens, heparin syringe - USA: (IL, TX), alert 20071220.4090 Serratia marcescens, hospital, neonatal - Honduras (S. Pedro Sula) 20070316.0931 2005 ---- Serratia marcescens, contaminated solution - USA (NJ): alert 20050320.0808] *##########################################################* ************************************************************ ProMED-mail makes every effort to verify the reports that are posted, but the accuracy and completeness of the information, and of any statements or opinions based thereon, are not guaranteed. The reader assumes all risks in using information posted or archived by ProMED-mail. ISID and its associated service providers shall not be held responsible for errors or omissions or held liable for any damages incurred as a result of use or reliance upon posted or archived material. ************************************************************ Donate to ProMED-mail. Details available at: ************************************************************ Visit ProMED-mail's web site at . Send all items for posting to: (NOT to an individual moderator). If you do not give your full name name and affiliation, it may not be posted. You may unsub- scribe at . For assistance from a human being, send mail to: . ############################################################ ############################################################

Wednesday, January 12, 2011

Carless Nurse Contaminates Patient w/ Hep C

A ProMED-mail post

ProMED-mail is a program of the
International Society for Infectious Diseases

Date: Tue 11 Jan 2011
Source: [edited]

Health clinic patients possibly exposed to hepatitis, HIV
A contaminated IV [intravenous] line is being blamed for a patient
contracting hepatitis C [virus] at a health clinic in San Pedro,
California. Officials are urging patients of the Advanced Pain Treatment
and Medical Center who were treated between 16 Jan 2006 and 18 Aug 2010 to
get tested for hepatitis B [virus], hepatitis C [virus], and HIV [human
immunodeficiency virus] infection.

An unidentified nurse is believed to have contaminated the IV line that was
improperly administered. The nurse, who is no longer administering IVs, is
still working at the clinic. A 2nd case, involving a patient contracting
hepatitis B [virus], has also been linked to the clinic.

communicated by:
ProMED-mail rapporteur Brent Barrett

[Bloodborne infections as a result of medical malpractice are fortunately
rare. This news report does not reveal the nature of risk associated with
IV treatment at the Advanced Pain Treatment and Medical Center, which
appears to have spanned a period in excess of 3 years. Nor is revealed how
many, if any, patients became infected by hepatitis B virus, hepatitis C
virus, and/or HIV.

San Pedro is located in Los Angeles County, California (see map at
. The
HealthMap/ProMED-mail interactive map of the USA is available at
. - Mod.CP]

[see also:
Hepatitis B & C, HIV, nosocomial - USA: (FL) alert 20091007.3473
Hepatitis B & C, HIV, colonoscopy - USA: (TN,FL,GA) alert 20090328.1205
Hepatitis B & C, HIV, nosocomial (05): USA (NV) 20081210.3882
Hepatitis B & C, HIV, nosocomial (04): USA (NV) 20080928.3073
Hepatitis B & C, HIV, nosocomial (03): USA (NV) 20080302.0854
Hepatitis B & C, HIV, nosocomial (02): USA (NV) 20080228.0809
Hepatitis B & C, HIV, nosocomial - USA: (NV), alert, RFI 20080228.0802]


ProMED-mail makes every effort to verify the reports that
are posted, but the accuracy and completeness of the
information, and of any statements or opinions based
thereon, are not guaranteed. The reader assumes all risks in
using information posted or archived by ProMED-mail. ISID
and its associated service providers shall not be held
responsible for errors or omissions or held liable for any
damages incurred as a result of use or reliance upon posted
or archived material.
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Friday, October 22, 2010

Un-Break My Heart: Dealing with the Death of a Parent

If we live long enough, we all go through it. One thing I have learned since I have lost both of mine,...there are really only TWO stages of a persons life: With them and With-Out Them, and how to deal with their loss;

Tuesday, July 20, 2010

EMT Who Refused to Help Dying Pregnant Woman Gets Shot in Face, Killed

Medic Who Stood by While Pregnant Woman Died in Bakery Shot Outside NYC Nightclub, but Police Say Events Are Unrelated

(AP) Authorities say an emergency medical technician accused of refusing to help a dying pregnant woman during his coffee break was fatally shot near a New York City nightclub.

Police believe those accusations and the shooting were unrelated.

Police say Jason Green was shot in the face near the Greenhouse club Sunday morning. There have been no arrests.

Green and fellow EMT Melisa Jackson had been under criminal investigation for their handling of a distressed woman at a Brooklyn bakery Dec. 9. They were in line at the bakery when 25-year-old Eutisha Rennix collapsed.

Witnesses say the EMTs told workers to call 911 and left without helping the woman, whose prematurely born baby also died.

The EMTs denied wrongdoing.

Tuesday, July 13, 2010

Physician Negligence

A ProMED-mail post

ProMED-mail is a program of the
International Society for Infectious Diseases

Date: Fri 9 Jul 2010
Source: ModernMedicine, HealthDaily News [edited]

Improper Anesthesia Practice Causes Hepatitis Outbreak
An anesthesiologist who reused a contaminated single-use propofol
vial on multiple endoscopy patients caused an outbreak of hepatitis
infection affecting 13 patients at 2 clinics, according to a report
published in the July 2010 issue of Gastroenterology. [Propofol is a
drug used to induce or maintain anesthesia during certain surgeries,
tests, or procedures. - Mod.CP]

Bruce Gutelius, M.D., of the U.S. Centers for Disease Control and
Prevention (CDC) in Atlanta, and colleagues [reference below]
investigated outbreaks of hepatitis B virus (HBV) and hepatitis C
virus (HCV) infections among patients at the 2 clinics who had
received anesthesia from the same anesthesiologist. The investigators
reviewed medical charts, conducted patient interviews and site
visits, and performed infection control assessments. The
investigators also did molecular sequencing of available patient isolates.

At one clinic, the researchers identified 6 cases of HCV infection
and 6 cases of HBV infection, and at the other clinic, one case of
HCV infection; all the cases were associated with the outbreak. HCV
quasispecies sequences from the patients were found to be nearly
identical (96.9 to 100 percent) to those from the patients considered
to be the infection source. The investigators write that the
anesthesiologist used a single-use vial of propofol on multiple
patients, and conclude that the likely cause of the viral
transmission was the reuse of syringes to re-dose patients, which
contaminated the vials for later patients.

"Gastroenterologists are urged to review carefully the injection,
medication handling, and other infection control practices of all
staff under their supervision, including providers of anesthesia
services," the authors write.

Communicated by:

[Nosocomial transmission of hepatitis B and hepatitis C virus
infections have occurred frequently in the United States and
elsewhere as a result of medical negligence, most frequently in
association with haemodialysis. The incident described above involves
anesthesia and multiple use of a single-use vial during endoscopy. It
is presumed to refer to events 1st described in the ProMED-mail post
titled: "Hepatitis C, physician-associated cluster - USA (NY)
20070616.1965," and subsequently.

The reference for the Gastroenterology paper on which the above
report is based is the following: "Multiple Clusters of Hepatitis
Virus Infections Associated With Anesthesia for Outpatient Endoscopy
Procedures. B. Gutelius and others, Gastroenterology Volume 139,
Issue 1, Pages 163-170, July 2010
(registration, purchase required). - Mod.CP]

[see also:
Hepatitis C, physician-related cluster - Australia (04): New
Zealand 20100603.1840
Hepatitis C, physician-related cluster - Australia (03): (VI) 20100531.1807
Hepatitis C, nosocomial - China (02): (IMAR) 20100519.1657
Hepatitis C, physician-related cluster - Australia (02): (VI) 20100420.1278
Hepatitis C, physician-related cluster - Australia: (VI) 20100408.1134
Hepatitis C, dialysis-related - Spain: (TG), RFI 20100209.0447
Hepatitis C, nosocomial - China (AH), RFI 20100107.0070
Hepatitis C, transfusion related - Kazakhstan: (AA) 20091214.4243
Hepatitis C, nurse-associated - USA (02): (CO) clarification 20090708.2453
Hepatitis C, nurse-associated - USA: (CO) 20090707.2441
Hepatitis C, dialysis-related - USA: (NY) 20080917.2917
Hepatitis C, American Indians - USA: (MT) 20080325.1115
Hepatitis C, fibrinogen-transmitted - Japan: RFI 20071217.4063
Hepatitis C, physician-associated cluster - USA (NY) (04) 20071211.3988
Hepatitis C, hemodialysis unit - Spain (Barcelona) 20071209.3969
Hepatitis C, physician-associated cluster - USA (NY) (03) 20071207.3951
Hepatitis C, physician-associated cluster - USA (NY) (02) 20070628.2080
Hepatitis C, physician-associated cluster - USA (NY) 20070616.1965]

ProMED-mail makes every effort to verify the reports that
are posted, but the accuracy and completeness of the
information, and of any statements or opinions based
thereon, are not guaranteed. The reader assumes all risks in
using information posted or archived by ProMED-mail. ISID
and its associated service providers shall not be held
responsible for errors or omissions or held liable for any
damages incurred as a result of use or reliance upon posted
or archived material.
Donate to ProMED-mail. Details available at:

Visit ProMED-mail's web site at .
Send all items for posting to: (NOT to
an individual moderator). If you do not give your full name
name and affiliation, it may not be posted. You may unsub-
scribe at .
For assistance from a human being, send mail to:

Tuesday, June 15, 2010

World Elder-Abuse Awareness Day

June 15, 2010

Did you already know that June 15 is World Elder Abuse Awareness Day? Probably not, because elder abuse is not something one wants to think about or talk about. But it does happen and it happens in Sheboygan County.

Elder abuse happens to both men and women and isn't always something you can see. Elder abuse can be physical, emotional, sexual, financial, neglect and self-neglect. If you are a victim of elder abuse, please be aware that there is help and support for you. Reach out. You do not have to go through this alone.

If you think you know someone who is being abused, be supportive and talk to him or her. Whatever the circumstances there is help and support available by calling Safe Harbor at (920) 452-7640 any time of day or night. You can also call the Sheboygan County Aging and Disability Resource Center at (920) 467-4100. All calls are confidential.

Everyone should take one minute out of your busy life on today and reflect on the reality that at that particular moment an elder, somewhere in the world or in Sheboygan County, could be being abused.

Karen Lemkuil

Elder Abuse Specialist,
Safe Harbor of Sheboygan County

Saturday, April 10, 2010

Docs Fail to Diagnose Rabies: Man Dies

A ProMED-mail post

ProMED-mail is a program of the
International Society for Infectious Diseases

Date: Fri 9 Apr 2010
Source: MMWR Weekly, 59(13);393-396 [abbr. and edited]

Human Rabies -- Kentucky/Indiana, 2009
On 19 Oct 2009, clinicians from Kentucky contacted the CDC [Centers
for Disease Control and Prevention] regarding a suspected case of
rabies in a man from Indiana aged 43 years. This report summarizes
the patient's clinical presentation and course, the subsequent
epidemiologic investigation, and, for the 1st time, provides
infection control recommendations for personnel performing autopsies
on decedents with confirmed or suspected rabies infection.

Before the patient's death on 20 Oct 2009, a diagnosis of rabies was
suspected based on the history of acute, progressive encephalitis
with unknown etiology [recorded in the ProMED-mail post archived as:
"Rabies, bat, human - USA: (IN) 20091028.3733". - Mod.CP].
Preliminary serology results on antemortem serum samples detected
rabies virus-specific antibodies. Because local pathologists were
concerned about the biosafety risk posed by infectious aerosols at
autopsy and potential contamination of autopsy facilities, the
Kentucky Department for Public Health (KDPH) asked CDC staff members
to travel to Kentucky and perform an autopsy to confirm the diagnosis
and assist with the epidemiologic investigation.

Testing of autopsy samples was conducted at the CDC and detected
rabies virus antigens in brainstem and cerebellum. Rabies viral RNA
was isolated and typed as a variant common to the tricolored bat
(_Perimyotis subflavus_). Although rabies virus transmission from
organ or tissue transplant has been documented rarely (1,2),
transmission of rabies virus to persons performing autopsies has not
been reported. Autopsies can be performed safely on decedents with
confirmed or suspected rabies using careful dissection techniques,
personal protective equipment, and other recommended precautions.

Case Report
On 5 Oct 2009, a previously healthy man from Indiana aged 43 years
visited an employee health clinic with fever and cough. His vital
signs and physical examination were unremarkable except for coarse
rales on lung auscultation. The clinician made a diagnosis of
bronchitis, prescribed antibiotics, and asked the patient to return
the following day. At this follow-up appointment, the patient
reported worsening fever and chills, as well as new chest pain and
left arm numbness; he also exhibited decreased grip strength of the
left hand. An electrocardiogram showed no evidence of cardiac
ischemia. Later that day, an evaluation at a local emergency
department (ED) was similarly unrevealing, and the patient was given
narcotics and muscle relaxants for presumed musculoskeletal pain and
discharged home.

On 7 Oct 2009, the patient returned to the same ED, where he was
noted to have akathisia and motor restlessness thought to be side
effects from the muscle relaxant. The ED physician advised admission
to the hospital, but the patient returned home. Upon follow-up the
next day with a primary-care physician, the patient had prominent
muscle fasciculations, fever, tachycardia, and hypotension. Given
these signs, the physician was concerned about the possibility of
sepsis and admitted him to the hospital.

After admission, the patient's mental status deteriorated rapidly,
and he underwent endotracheal intubation for airway protection. On 9
Oct 2009, he was transferred to a referral hospital in the
neighboring state of Kentucky. A lumbar puncture yielded
cerebrospinal fluid (CSF) with glucose of 72 mg/dL (normal: 40--70
mg/dL), protein 140 mg/dL (normal: 15--45 mg/dL), 3 red blood
cells/mm3 (normal: 0--2 cells/ mm3), and 38 white blood cells /mm3
(normal: 0--5 cells/mm3); differential showed 99 percent lymphocytes
and 1 percent monocytes. During 9-19 Oct 2010, no etiology for the
patient's disease was identified, and his hospital course became
complicated by bradycardia, hypotension, rhabdomyolysis, and renal
failure requiring hemodialysis. Results of a magnetic resonance image
of the brain and a brain perfusion study were normal. Bacterial and
fungal cultures of CSF, in addition to laboratory tests for West Nile
virus, herpes simplex virus, influenza, and human immunodeficiency
virus, were negative.

On 19 Oct 2009, diagnostic testing for rabies was requested, and
samples of the patient's serum, saliva, and a nuchal skin biopsy were
sent to CDC for analysis. However, on 20 Oct 2009, while these tests
were pending, the patient's physical examination,
electroencephalogram, and apnea testing all indicated brain death.
Ventilatory support was withdrawn, and the patient died on 20 Oct 2010.

Postmortem Findings
On 22 Oct 2009, testing at the CDC indicated rabies specific
immunoglobulin G (1:2,048) and immunoglobulin M (1:512) antibodies in
serum by the indirect fluorescent-antibody (IFA) assay. Subsequent
testing detected rabies virus neutralizing antibodies (0.44 IU/mL) in
serum by rapid fluorescent focus inhibition test (RFFIT). The
formalin-fixed nuchal skin biopsy specimen tested negative for viral
antigens by immunohistochemistry (IHC). On 27 Oct 2009, a CSF sample
collected on 11 Oct 2009 and located postmortem was sent to the CDC
and also tested negative for rabies antibodies by IFA and RFFIT. The
family requested an autopsy, but pathologists at the referral
hospital were concerned about the biosafety risk posed by infectious
aerosols at autopsy and potential contamination of autopsy
facilities. In response to a request for assistance from KDPH, CDC
staff members traveled to Kentucky and performed an autopsy limited
to the head to collect tissue specimens for diagnostic evaluation.

At autopsy, the brain weighed 1610 g (normal: 1300--1400 g) and
showed markedly congested and hemorrhagic leptomeninges.
Histopathologic examination revealed encephalomyelitis and abundant
neuronal cytoplasmic inclusions (Negri bodies). Rabies virus antigens
were detected in multiple samples of fresh central nervous system
(CNS) tissue by direct fluorescent antibody (DFA) testing and in
formalin-fixed CNS tissues by IHC. Viral RNA was detected in the
patient's saliva collected antemortem and CNS tissues collected at
autopsy by reverse transcription--polymerase chain reaction and was
typed as a variant common to the tricolored bat (_Perimyotis subflavus_).

Public Health Investigation [abbreviated]
An investigation identified no specific source of rabies virus
exposure. However, the patient, who worked as a mechanic and lived in
a farming community in southern Indiana, had mentioned to his friends
that he had seen a bat in late July after removing a tarpaulin from a
tractor adjacent to his residence. He had not mentioned a bite or a
non-bite exposure associated with this or any other incident.

MMWR Editorial Note
The case described in this report represents the 1st rabies death in
an Indiana resident since 2006 and only the 2nd such death since
1959. Including this case, a total of 31 cases of human rabies have
been reported in the United States since 2000. Of these, 14 (45
percent) were diagnosed postmortem, reinforcing the need to consider
rabies in all cases of acute progressive encephalitis of unknown
etiology. Human rabies cases in the United States might be
underreported because of lack of recognition and lack of
confirmation by diagnostic testing. When rabies is suspected,
antemortem diagnosis requires testing of serum, saliva, CSF, and a
nuchal skin biopsy.

The postmortem diagnosis of rabies is made by examination of tissue
from the brain (e.g., medulla, cerebellum, and hippocampus).
Autopsies fulfill an important function by diagnosing cases of rabies
and furthering understanding of the disease. By providing a diagnosis
for deceased patients with suspected but unconfirmed rabies, or for
patients in whom the disease was never suspected clinically,
autopsies can 1) aid the public health investigation; 2) help raise
public awareness of rabies associated with specific exposures; 3)
emphasize the importance of seeking medical evaluation after such an
exposure occurs; and 4) add to knowledge about current human rabies
incidence. In patients with confirmed rabies, autopsies provide
information about pathogenesis that might be relevant to
investigations of treatment.

Although contact with decedents with confirmed or suspected rabies
can cause anxiety, no confirmed case of rabies has ever been reported
among persons performing postmortem examinations of humans or
animals. Even from living patients with rabies, human-to-human
transmission has been documented only rarely, in cases of organ or
tissue transplantation (1,2). Aerosol transmission of rabies virus
has never been well documented outside of a research laboratory
setting (5). Both the CDC and the World Health Organization (WHO)
have stated that the infection risk to health-care personnel from
human rabies patients is no greater than from patients with other
viral or bacterial infections. In addition, rabies post-exposure
prophylaxis (PEP) is available for exposed personnel. Nevertheless,
because of the nearly universal fatal outcome from rabies, both the
CDC and the WHO recommend that all personnel working with rabies
patients or decedents adhere to recommended precautions (3,6).

Even the minimal risk for rabies virus transmission at autopsy can be
reduced by using careful dissection techniques and appropriate
personal protective equipment, including an N95 or higher respirator,
full face shield, goggles, gloves, complete body coverage by
protective wear, and heavy or chain mail gloves to help prevent cuts
or sticks from sharp instruments or bone fragments. Aerosols should
be minimized by using a handsaw rather than an oscillating saw, and
by avoiding contact of the saw blade with brain tissue while removing
the calvarium. Ample use of a 10 percent solution of sodium
hypochlorite for disinfection is recommended both during and after
the procedure to ensure decontamination of all exposed surfaces and equipment.

Participation in the autopsy should be limited to persons directly
involved in the procedure and collection of specimens. Previous
vaccination against rabies is not required for persons performing
such autopsies. PEP of autopsy personnel is recommended only if
contamination of a wound or mucous membrane with patient saliva or
other potentially infectious material (e.g., neural tissue) occurs
during the procedure (3,7,8). The case described in this report
highlights the need to educate pathologists and other hospital
personnel about appropriate rabies infection control procedures so
that autopsies can be performed safely in cases of confirmed or
suspected human rabies.

(1) Helmick CG, Tauxe RV, Vernon AA. Is there a risk to contacts of
patients with rabies? Rev Infect Dis 1987;9:511--8.
(2) CDC. Investigation of rabies infections in organ donor and
transplant recipients---Alabama, Arkansas, Oklahoma, and Texas, 2004.
MMWR 2004;53:586--9.
(3) CDC. Human rabies prevention---United States, 2008:
recommendations of the Advisory Committee on Immunization Practices.
MMWR 2008;57(No. RR-3).
(4) CDC. Use of a reduced (4-dose) vaccine schedule for postexposure
prophylaxis to prevent human rabies: recommendations of the Advisory
Committee on Immunization Practices. MMWR 2010;59(No. RR-2).
(5) Gibbons RV. Cryptogenic rabies, bats, and the question of aerosol
transmission. Ann Emerg Med 2002;39:528--36.
(6) World Health Organization. WHO expert committee on rabies. World
Health Organ Tech Rep Ser 2005;931:1--121.
(7) CDC. Human rabies---California, 1987. MMWR 1988;37:305--8.
(8) CDC. Human rabies---Miami, 1994. MMWR 1994;43:773--5.

Communicated by:

[There is the need to consider rabies in all cases of acute
progressive encephalitis of unknown etiology. Human rabies cases in
the United States might be underreported because of lack of
recognition and lack of confirmation by diagnostic testing. For the
1st time, this document provides infection control recommendations
for personnel performing autopsies on decedents with confirmed or
suspected rabies infection.

Interested readers should access the original text to view images of
the decedent's brain at autopsy and the histopathology. - Mod.CP]

[see also:
Rabies, bat, human - USA: (IN) 20091028.3733]

ProMED-mail makes every effort to verify the reports that
are posted, but the accuracy and completeness of the
information, and of any statements or opinions based
thereon, are not guaranteed. The reader assumes all risks in
using information posted or archived by ProMED-mail. ISID
and its associated service providers shall not be held
responsible for errors or omissions or held liable for any
damages incurred as a result of use or reliance upon posted
or archived material.
Donate to ProMED-mail. Details available at:

Visit ProMED-mail's web site at .
Send all items for posting to:
(NOT to an individual moderator). If you do not give your
full name and affiliation, it may not be posted. Send
commands to subscribe/unsubscribe, get archives, help,
etc. to: For assistance from a
human being send mail to:

Monday, April 5, 2010

RIP Sgt. Thomas P. Jubic: / A Merrills Maurader

April 01, 2010

Tommy, it was a pleasure to know you. You were always a gentleman and a joy to be around. What a talented, wonderful, meticulous artist you were and with a golden singing voice too. I will miss you and I know you will be sorely missed by all who knew you. Heartfelt sympathies to family-members.
Thought you might like to know I have submitted your name to the Historian of the Merrills Marauders Association who will add your name to the memorial wall.
Thank you for your service to our country and for the sacrifices you and your family made for U.S.!
Mrs. George J. Jubic,
Johnsonville, New York
Contact Me

A Reply from Merrills Mauraders Historian

April 01, 2010

In regards to my previous guestbook entry where I said I would notify the Merrills Mauraders Association of Tommys passing, email I recieved in reply today from the founder;
Mrs. George Jubic,
Thank you so very much for your kind concern in notifying me of the passing of Sgt. Jubic.

In the Obit, it doesn't state that he also earned the Combat Infantry Badge(CIB) and the Bronze Star Medal (BSM). He may not have known about the BSM, for it was awarded after the war. Then again he was receiving our newsletter and should have known.
If someone decides to apply for his BSM, they would need the following:
Award of the CIB, Gen Order #3 475th Inf. effective 1 June 1944. Award of the BSM, by EO 9419, while serving in the Composite Unit 5307th Provisional.

Our next issue of our newsletter, will list Thomas P Jubic as having answered The Final Roll Call and will go to the, 427 2nd Street address, then unless otherwise requested will stop.

Robert E. Passanisi, Historian
Merrill's Marauders Association
Note: If you are related to, or a descendant of a Merrill's Marauder, a veteran of the 475th Inf., 124 Cavalry, or Mars Task Force, and would
like to join the Merrill's Marauders Proud Descendants. Contact Secretary, Lorrie Carpenter.
Click on title above to go to the Merrills Mauraders Award Winning website to learn more about them and to see their Memorial Wall

Saturday, April 3, 2010

Up-State NY Nursing Home Gets Failing Grade

In MY hometown, of all places. Think this stuff dosent happen "close to home?" Think again.

SCHAGHTICOKE — A state investigation resulted in charges against 14 former and current employees of a Rensselaer County health care facility this week, but state records show the facility has long been plagued with problems.

Documents show that from 2007-2009, the Northwoods Rehabilitation and Extended Care Facility in Schaghticoke had a complaint rate more than three times the state average.

There were 104 complaints about the Northwoods facility between January 2007 and December 2009, 41 percent of which were for facility-reported incidents, according to the state health department. That makes for a rate of 94.9 reports per 100 beds occupied, a rate the state determines based on daily occupancy rates to help with comparing a specific facility’s complaint experience with that of other nursing homes.

For the same time period, the statewide average rate of complaints received per 100 beds was 24.4.

The department of health investigates any allegations that a nursing home has violated federal or state regulations, or has provided inadequate care. With regards to the complaints against Northwoods between 2007 and 2009, state health officials conducted 48 on-site inspections that resulted in 30 citations, the bulk of which were in regards to quality of the care at the facility.

An updated inspection report from last month showed that Northwoods had a total of 57 deficiencies with regards to standard health and life safety code. That’s compared to the state average of 24, and of those 57, the state deemed 12 of them to be related to actual harm or immediate jeopardy.

Northwoods Health Systems, which also runs facilities in Cortland. Rensselaer and Niskayuna, was fined $6,000 last year for citations for quality of care, organization and administration, and quality assessment and assurance stemming from a Jan. 16, 2009 health department inspection of the Schaghticoke facility. That inspection found several instances of patient neglect, inadequate care and lack of proper documentation and monitoring in at least one resident’s case.

The facility was also fined $2,000 in 2008 for citations regarding quality of life and dignity stemming from a 2007 inspection. It was also fined $3,000 in 2004 for violations of residents’ rights on multiple dates, and it was fined $4,000 in 2002 for multiple violations of quality of care.

State health department records also show that between 2007 and 2009, the 120-bed facility exceeded the state and national averages for the number of patients suffering from bed sores.

Eighteen percent of high-risk patients suffered from bed sores, compared to the state average of 13 percent and the national average of 11 percent. As far as low-risk patients go, 3 percent of Northwoods residents suffered from bed sores, a slight rise above the state and national average of 2 percent.

Additionally, 27 percent of patients there for a short stay between October 2008 and September 2009 suffered bed sores, higher than the state’s 17 percent average.

The records also show that 11 percent of patients suffered from urinary tract infections from January to September 2009. The state average for this period was 8 percent, and the national average was 9 percent.

On Wednesday, 14 current and former employees at the facility were arraigned on multiple counts of neglect and falsifying business records. The charges followed a six-week video surveillance investigation by the state Attorney General’s Medicaid Fraud Control Unit conducted from the end of February to early April in 2009.

According to Attorney General Cuomo, a hidden camera used with an unnamed 50-year-old patient, discovered that staff “routinely failed to turn and position an immobile resident, failed to administer medications and failed to treat bed sores. The patient suffered from multiple illnesses — including multiple sclerosis, epilepsy and organ brain syndrome — and was completely reliant on staffers for all personal needs, according to the charges.

Nine of the staffers were immediately suspended pending the outcome of the investigation, which covered a six-week period from the end of February to early April in 2009, according to Northwoods administrators. The alleged abuse took place before the current administration took control of the facility in July, said spokeswoman Lisa Cupolo, and the new administrators say they’ve made significant improvements since taking over.

Several relatives of former Northwoods patients said they’ve complained to the state and facility administrators about the quality of care there before but have received little response. They’ve complained of bed sores, untreated urinary tract infections, and unanswered call buttons, among other problems.

Penny Marcy of Waterford said she put her 87-year-old mother in Northwoods in May when she suffered health problems of her own, and took her out in January after becoming disgusted with what she and family members saw as a gross lack of care.

“They wouldn’t let her walk,” said Marcy. “They filled her with pills she didn’t need so she was comatose when we got to her.”

Marcy also said her mother suffered from untreated bed sores, and that administrators lied to her about her mother having a stroke that caused the loss of the use of her left side.

“A neurologist told me she hadn’t had a stroke and it was caused by the pills they were giving to her,” said Marcy, who said her complaints to then facility officials fell on deaf ears.

Marcy’s mother is now staying with her sister in Halfmoon where she’s doing much better.

“The care that the administrators provide is a disgrace,” Marcy said. “Northwoods is the worse nursing home I’ve ever been in.”

Darcy Spencer of Troy and her sisters have obtained the services of the Martin, Harding and Mazzotti law firm in investigating their claims that Northwoods staff severely neglected their 66-year-old mother and ultimately caused her death in August.

The firm is also investigating at least four other similar cases.

Spencer and her sisters also accuse Northwoods of giving their mother, Mary Ann Poppielion, wrong medications, letting her call button go unanswered for long stretches of time and failing to properly treat a urinary tract infection that eventually led her to die of septic shock.

They said they’ve reported these and other complains to state officials and have also called the attorney general’s office.

In August, federal officials barred Northwoods from receiving Medicaid or Medicare payments for new residents following complaints that workers were ignoring the buzzer system used by patients needing assistance.

That restriction was lifted within a few weeks, according to Cupolo.

The facility suffered yet another blow in January when a former nurse’s aide pleaded guilty to sexually abusing a physically helpless 78-year-old woman in late 2007 and early 2008. Robert Gundersen, 52, of Middleburgh was sentenced to 10 years of probation as part of a plea deal.

The latest charges in Schaghticoke follow the 2007 conviction of Northwoods’ former owner, Highgate LTC Management LLC, for six misdemeanor criminal charges stemming from an undercover state investigation at its Cortland facility.

A few individual employees were convicted on neglect charges in the case as well, and Highgate was ultimately barred from the long-term care business.

Jessica M. Pasko can be reached at 270-1288 or by e-mail at

Monday, March 8, 2010

Nursing home antipsychotic use under fire

March 8, 2010 — 11:45am ET | By Tracy Staton

Massachusetts joins the cadre of states spending funds on antipsychotics for nursing home patients who probably shouldn't be given the drugs at all, the Boston Globe reports. According to data collected by the Centers for Medicare and Medicaid Services, 28 percent of the state's nursing home residents got antipsychotics last year. Of that group, 22 percent--2,483 patients--did not have a medical condition indicated for that treatment.

The state's nursing home trade group, the Massachusetts Senior Care Association, said that too many are using antipsychotics in their elderly residents. "We recognize the number is too high," SVP Scott Plumb told the Globe, "and we are working to try to bring it down."

Nursing homes across the country have come under fire for using powerful antipsychotic drugs such as Eli Lilly's Zyprexa, AstraZeneca's Seroquel, Johnson & Johnson's Rispderal, and similar meds. And you'll recall that FDA has issued warnings against using these drugs for patients with dementia because of serious safety risks. The federal government recently sued J&J for alleged involvement in a kickback scheme designed to boost use of Risperdal in dementia patients with behavioral problems.

Apparently, the difference lies in training: Well-trained nursing home staff can used behavior management to help quell dementia patients' agitation, and thus reduce the need for drugs. In homes where staff is untrained, up to 80 percent of residents are on antipsychotic meds, whereas in homes with well-trained staff, drug use is about 2 percent to 3 percent, an Alzheimer's Association representative told the Globe.

- see the story in the Globe

Related Articles:
Advocates want new rules for antipsychotic use
Wrong drugs used in dementia, experts say
U.S. accuses J&J of kickbacks to Omnicare
Will safety concerns curtail atypicals' growth?

Click on title above for article w/ working links;

Wednesday, March 3, 2010

To Missionaries and of their Messages

If I should die and leave you here awhile Be not like others, soon undone, who keep Long vigil by the silent dust and weep.... For my sake turn again to life and smile Nerving the heart and trembling hand to do Something to comfort weaker hearts than mine And I perchance may therein comfort you.

Thomas Gray

Thursday, February 25, 2010

Tuesday, February 23, 2010

Avandia Maker Hides Danger of Drug, w/ Help from FDA

This is a diabetic drug I believe my father was on, and may have been responsible for the heart problems he was experiencing, and was used for the reason to put him on hospice as indicative that his heart was failing (NOT).....unfortunately, he lingered for over 11 mo on hospice until finally he was (allowed) to die (unaware) of malnutrition. (Witholding of nutrients)

Click on title above for original article;

Monday, February 1, 2010

Letters: Assisted suicide

Death wish denied led to the happiest years of my life

Monday, 1 February 2010

Your report on Lynn Gilderdale (27 January) worried me greatly. This is because however a law allowing assisted suicide is framed, and however many "safeguards" it has, it would not have saved me when I wanted to die. In fact, I think few people can understand Lynn's desperate and ongoing wish to die better than I can. And yet still I say the law should not allow actions such as hers, regardless of how disabled or determined is the one requesting it, and how "loving and compassionate" is the person asked to assist.

I use a wheelchair full-time, having spina bifida, hydrocephalus, emphysema, osteoporosis and arthritis. Like Lynn, I desperately wanted a child, and had to come to terms with the knowledge that I never would. I have severe pain every day, and, as with Lynn, morphine doesn't always alleviate it. I also have crushed and fractured vertebra, caused by my osteoporotic bones, which means additional pain. Typing this causes even more pain, due to arthritis in my fingers, wrists and elbows. But writing this letter is important, despite the pain.

Twenty-five years ago, I, like Lynn, decided I wanted to die, a settled and entirely competent death wish that lasted for 10 years. During those years I attempted suicide more than once. On the occasion I best remember, I was treated against my will by doctors, who saved my life. Then, I was very angry with the doctors who saved my life, but now I'm extremely grateful. Yet because of the requirements of the Mental Capacity Act, and the Director of Public Prosecutions' new guidelines, if similar circumstances obtained now, I would be left to die.

Had someone taken the apparently "common sense, decent and humane" decision to end my life all those years ago, no doubt a jury would also have given my "helper" a conditional discharge, if that.

But I would actually have missed the best years of my life, notwithstanding pain that is worse now than it was when I wanted to die. No one would ever have known that the future held something better for me, not in terms of physical ability, but in terms of support and the love of friends who refused to accept my view that my life was "over".

It's very easy to give up on a body as "broken" as Lynn's or mine, and it can be tough to continue. But it is possible to come out the other side of a death wish, to use well the time that would otherwise have been lost, and to demonstrate that life is precious and worth living, despite many serious challenges.

Alison Davis

Blandford Forum, Dorset

Wednesday, July 1, 2009

Denture Cream a Killer?

My father used fixodent from a very early age as when he went into the Marines as a youngster of 17 (he lied about his age to get in) he had some cavaties but at that time the military "didnt do" fillings, just extractions, so they yanked every tooth out of his head and gave him a full set of dentures. He never forgave them for that.
He was about 60-65 yrs old when he began to lose the feeling in his feet. He went to the Dr.s and they blamed it on bad circulation.

Fixodent and Zinc Poisoning Lawsuits
June 25, 2009. By Gordon Gibb

Miami, FL: A number of lawsuits pertaining to Fixodent denture cream due to the alleged effects of zinc toxicity and Fixodent zinc poisoning have--as expected--been consolidated after so many Fixodent denture cream customers complained of problems, or had been taken ill.

According to a June 15th update from Proctor & Gamble (P&G), the manufacturer of Fixodent, has been named in two lawsuits. The manufacturer of another denture cream has been named in 10. However, it appears as if there will be many more lawsuits coming out of the woodwork, prompting the transfer order earlier this month.

The Judicial Panel on Multidistrict Litigation (JPMDL) has been consolidating similar lawsuits that involve high numbers of plaintiffs since 1968. According to one law firm was in the process of evaluating about 3000 alleged zinc poisoning cases pertaining to the use of denture cream. A collection of three law firms has about 75 new lawsuits ready to slip into the pipeline, a fact likely not lost on the JPMDL.

On May 28th the Judicial Panel held hearings in Louisville, Kentucky with regard to the potential consolidation of lawsuits against P&G and GlaxoSmithKline, the manufacturer of Poligrip, into a single jurisdiction.

The resulting transfer order will see all Poligrip and Fixodent lawsuits currently pending in federal court, together with new cases, flow to District Judge Cecilia M. Altonaga in the Southern District of Florida.

Fixodent, as well as other denture creams that contain zinc have been linked to neurological disorders that have recently been outlined in a study published last year in Neurology, a medical journal. The 2008 study determined that four neuropathy patients who had used what were described in as excessive amounts of denture cream were found to have extremely elevated levels of zinc in their blood.

Researchers at the University of Texas—where the study originated—noted that the use of denture cream was the only thing the four patients had in common beyond their neuropathy disorders. Thus, the study authors concluded that the use of denture cream remained the only "plausible explanation" for the patient's high zinc levels, together with their copper deficiencies.

Symptoms range from a numbness or tingling in the feet, legs, hands or arms, to a tendency to lose one's balance. Some have noted a reduction in strength, or the ability to move legs and feet, or arms and hands. Blood pressure and heart rate can be affected and even sexual dysfunction has occurred. Some patients have been made to suffer through constipation or bladder dysfunction and even a reduced capacity to perspire. This latter symptom could have a serious impact on the body's ability to cool itself in hot weather, or while engaged in strenuous activity such as a workout.

Seniors—the sector most likely to have dentures and use denture cream—are much more active than their predecessors.

Other symptoms include unexplained pain in the extremities, a tendency to stumble or fall down, instability and lack of balance and a change or decrease in walking stride.

For anyone with false teeth Fixodent denture adhesive is a hedge against the embarrassing slippage of one's teeth—especially in a public, or social setting. It is not known if the manufacturer of Fixodent denture cream publishes recommendations for safe levels on the product packaging. However, it is basic human nature to err on the side of caution and, when using a product that may speak to a person's vanity, use a bit extra to make sure the job is done. That person may not realize that he is setting himself up for alleged Fixodent zinc poisoning.

Fixodent Denture Cream Legal Help
If you have suffered losses in this case, please send your complaint to a lawyer who will review your possible [Fixodent Denture Cream Lawsuit] at no cost or obligation.

Click on title above for INTAKE form;

Monday, June 22, 2009

Fatal Hospital Malpractices and Neglect / NYC

New York City pays $2M to family of woman who died on floor of city psych ward

Kings County Hospital Center

It was a disgraceful incident that never should happen in a hospital--but it did. In June 2008, 49-year-old Esmin Elizabeth Green died on the floor of the psychiatric ward at Kings County Hospital Center, ignored by staff, after waiting more than 24 hours to be treated.

Now, the city of New York has agreed to pay $2 million to Green's family, with the city's Health and Hospitals Corporation accepting full responsibility for her death. The agreement follows a 2007 suit by the New York Civil Liberties Union, which alleged abuse and neglect of patients at the hospital.

HHC said that since Green's death, it has taken steps to reduce crowding at the unit and increased the size of its mental health staff. The hospital system has started construction of a new Behavioral Health Pavilion, added more than 200 doctors, nurses, psychologists, social workers and other mental health workers, and restructured operations to rely less on police to manage patients in crisis.

To learn more about the case:
- read this article from The New York Times

Related Articles:
NY woman dies on floor of public hospital
Daughter of woman who died in NY waiting room sues for $25M

Sunday, June 21, 2009

The New Sooners: Rush to Oregon to Die

I know I am a goin soon. I always did like Oregon. Perhaps I will stay there forever, after I am gone that is, you know, 6 feet under. Finally I will have my own piece of land!

The Right-to-Die Debate and the Tenth Anniversary of Oregon’s Death with Dignity Act

October 9, 2007

by David Masci, Senior Research Fellow, Pew Forum on Religion & Public Life

Ten years ago this month, Oregon enacted a law permitting physicians to prescribe a lethal dose of drugs to certain terminally ill patients, a practice often called physician-assisted suicide. The Death with Dignity Act, which took effect on Oct. 27, 1997, is the only law of its kind in the United States, making it an important and controversial milestone in the nation’s debate over end-of-life treatment.

A number of other countries, including the Netherlands and Belgium, allow physician-assisted suicide. In the U.S., several other states – including Vermont, Michigan and Washington – have considered measures to legalize physician-assisted suicide, but efforts to enact such laws have failed either in the state legislature or at the ballot box. The most recent attempt, in California, stalled in the state assembly earlier this year.

Oregon’s law applies only to patients who are terminally ill and likely to die within six months, a diagnosis that must be confirmed by two physicians. In addition, eligible patients must possess the mental capacity to give informed consent; cannot suffer from depression; and must sign a written declaration, in front of two witnesses, stating that they are mentally competent and acting voluntarily. Finally, while doctors may prescribe the lethal drugs, the dose must be administered by the patient. Between the time the statute was enacted in 1997 and the end of 2006, 292 terminally ill people had availed themselves of the right to end their lives, according to state records.

Related Materials

Question & Answer: A Progressive Argument Against the Legalization of Physician-Assisted Suicide

Event Transcript Oregon's 'Death with Dignity' Law: 10 Years Later

Legal Backgrounder: Supreme Court’s Decision in Gonzales v. Oregon

Forum resource page on end-of-life issues
Opponents of physician-assisted suicide – including some medical groups, such as the American Medical Association; some disability-rights advocates; and some more socially conservative religious groups, such as the Roman Catholic Church, Orthodox Jews and evangelical Protestant denominations – argue that suicide is a tragedy, not a personal choice. Furthermore, they say, the practice will inevitably lead to abuses, such as patients who might be pressured to take their own lives by family members and others who wish to save money or end the burden of caring for someone with a debilitating illness. In addition, opponents say, doctor-assisted suicide devalues human life by sending a message to the broader culture that some people’s lives are worth less than others. Finally, they contend, physician-assisted suicide is at the top of a very slippery slope that could eventually lead to involuntary euthanasia of people who are severely handicapped or infirm.

Supporters of the practice include some more socially liberal Christian and Jewish religious denominations, some civil rights groups and some organizations that advocate on behalf of the rights of patients, particularly the terminally ill. These groups and others argue that “physician aid in dying” – calling the practice “suicide” unfairly imbues it with negative connotations, they contend – is not about forcing or pressuring anyone but rather is about giving people with no hope of recovery the option to end their lives before their physical pain becomes unbearable or before they fully lose control of their mental faculties. In addition, supporters argue, giving people the option to end their suffering does not devalue human life. On the contrary, they say, physician aid in dying promotes human dignity by allowing those in the last stages of potentially painful and debilitating illnesses to end their lives on their own terms.

Public Opinion

Polls show that the country is divided on the issue of physician-assisted suicide, although the numbers differ somewhat based on how the survey questions are worded. For instance, a July 2005 poll conducted by the Pew Research Center for the People & the Press and the Pew Forum on Religion & Public Life asked half the participants about their views on the issue using one question and asked the other half a differently worded question. The survey found that 44 percent of respondents favored making it legal for doctors to “assist terminally ill patients in committing suicide” when the question was worded this way. But support for the practice rose slightly, to 51 percent, when people were asked if they favor making it legal for doctors to “give terminally ill patients the means to end their lives.”

The History of the Debate
The debate over the legal, ethical and political implications of death and dying is not new. But the modernization of health care in the 20th century dramatically changed the character of death and dying, and has cast this old debate in a different light. Beginning a little more than a century ago, people began to routinely die in hospitals rather than at home. More importantly, new technologies, such as the artificial respirator, allowed doctors to prolong life, often for substantial periods of time. At the same time, new drugs, such as morphine, allowed doctors to alleviate pain and to painlessly end patients’ lives.

By the 1950s, a small body of writers and thinkers in the United States and Europe began to argue in favor of allowing patients’ lives to be ended by the patients themselves, in the case of the terminally ill, or by their families and guardians, in the case of those on life support. These arguments gained wider acceptance in the 1960s as the civil rights movement, the sexual revolution and other social movements helped to expand notions of personal freedom.

In the 1970s the end-of-life debate vaulted onto the national stage thanks in large part to the highly publicized 1975 case of Karen Ann Quinlan, a 21-year-old New Jersey woman who had fallen into a coma and was judged to be in a “chronic persistent vegetative state,” unable to survive without the help of an artificial respirator. Efforts by Quinlan’s family to remove her life support were thwarted by her doctor, leading to a lawsuit and a ruling by the New Jersey Supreme Court that patients (and by extension their families) have a right to terminate life support.

In 1990, the right-to-die debate reached the U.S. Supreme Court in a case involving Nancy Cruzan, who had been in a persistent vegetative state for five years when her parents asked that her feeding tube be removed. In Cruzan v. Director, Missouri Department of Public Health, the court, in a 5-4 decision, implicitly recognized for the first time a constitutional right to refuse treatment in extraordinary circumstances.

In some ways, Cruzan presaged another high-profile case, that of Terri Schiavo, the severely brain-damaged woman whose husband and legal guardian fought against her parents to remove the feeding tube that was keeping her alive. Schiavo became a national media story from 2003 to 2005, as those favoring the “right to die” and those favoring the “right to life” battled over her fate in the courts, in the court of public opinion and even in Congress. But throughout the struggle, courts consistently ruled that Schiavo’s husband had the ultimate right to decide what his wife would have wanted, and with all appeals exhausted, she died on March 31, 2005, after her feeding tube was removed.

In the years between the Cruzan and Schiavo cases, a number of states held referenda on legalizing physician-assisted suicide for certain terminally ill patients. Voters rejected such measures in Washington state in 1991 and in California the following year. Although voters in Oregon first approved the Death with Dignity Act in 1994, it did not take effect until 1997, owing to court challenges and a second state referendum that unsuccessfully sought to nullify the act.

In the last decade, many of the high-profile battles over physician-assisted suicide have taken place in the courts. In 1997, the Supreme Court ruled in Washington v. Glucksberg that while the Constitution guarantees the right to refuse medical treatment, it does not give patients the right to assisted suicide. In 2006, the high court, in Gonzales v. Oregon, rejected an effort by the U.S. attorney general to use a federal drug law to prohibit doctors in Oregon from prescribing lethal doses of drugs to terminally ill patients under the Death with Dignity Act.

Supporters of physician-assisted suicide had hoped that the Gonzales v. Oregon decision would give their movement the momentum it needed to encourage other states to adopt laws similar to Oregon’s Death with Dignity Act. But, as the recent defeat of a doctor-assisted suicide bill in California shows, opposition to the practice remains strong, even in a state with a reputation for being at the forefront of new social trends.

Going forward, it is hard to know if and when another state or states will join Oregon. The only thing certain is that the debate over what is and is not an appropriate course of action when it comes to end-of-life decisions will continue for a long time to come.

Go to the Pew Forum's Resource Page on End-of-Life Issues

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Thinking of You on This 3rd. Fathers Day Since Your Gone

June 20, 2010

Happy Fathers Day Daddy,...but of course silly, I still think of you everyday! And to be honest, I would rather be with you where ever you are, than anyplace here on earth. I AM NOT a happy camper here, and if Id the guts Id join you, Id be there with you today. But not for that and my animals, its the only things keeping me alive. Wouldnt ma be suprized to see me if I did decide to join you after all? She would probably think I had entered voluntairily into the afterlife for the sole purpose of haunting her through eternity, ..... like she is doing me! I miss you both so very much.
Your Favorite Daughter,


Monday, June 15, 2009

Shining a Spotlight on America's Silent Crisis: Elder Abuse

THE HUB: An estimated 5 million seniors in the U.S. are victims of elder abuse each year. To address this crisis, WITNESS and the National Council on Aging are using video to help pass the Elder Justice Act (EJA), holistic legislation that will help ensure citizens age with personal security and dignity. Join us today, World Elder Abuse Awareness Day, to break the silence and pass the EJA.

Click on title above for article w/ videos & to go to The Hub website; - once the link opens, you may have to page way down to see the text.

Friday, May 29, 2009

The Cancer of Good Intentions

Brother, do I KNOW about that kind of cancer! Both my parents died from it.

posted by Eric Steinman May 27, 2009 3:00 pm

filed under: Family Life, Children, Parenting at the Crossroads, cancer, chemotherapy, daniel hauser, personal freedom, religious freedom

One indelible memory I have from the last days of my father’s life was rifling through his filing cabinet at 3 AM. This was not a scheming attempt to uncover some dark family secret, and shamelessly confront him with it on his deathbed. No, I was dispatched to run a reconnaissance mission back to my father’s home office looking for a “do not resuscitate” order (DNR), which essentially functions as an advanced directive in writing from a patient who does not wish to have “unnecessary” life sustaining treatment, and instead wishes to have a more natural death. I was moved to rush, as the attending physician at the hospital said he was about to put my father on life support unless he received legal notice not to do so. Knowing my father, and the specifics of his wishes, I knew the last thing he would want was to be brain dead, indefinitely hospitalized, and hooked up to a machine that went “beep-beep-beep.”

Long story short: I found the DNR with a few minutes to spare and my father ultimately got his parting wish.

I was reminded of this significant moment in my life recently by the trials and tribulations of Daniel Hauser, a 13-year-old Minnesota boy suffering from Hodgkin’s lymphoma, who just last week lost a court battle he and his family waged to refuse any further invasive treatments (chemo, radiation, etc) and instead (with the consent of his parents) explore a more holistic approach to wellness and health. Hauser’s doctors claim that Daniel has a 90 percent chance of survival with treatment and a 95 percent chance of not seeing the end of the year if he doesn’t receive treatment. Fairly grim statistics. However, Daniel and his parents are ardent believers in a more natural path of treatment (the practices of the native American Nemenhah religious organization) and have a tremendous amount of faith in following this discipline toward a cure. Daniels mother says, “we believe in traditional methods. To strip that away would be stripping his soul right out of his body.”

Since the court ruling in favor of continuing chemotherapy against the will of the family as well as young Daniel, he and his mother have gone missing (most likely fleeing the mandate of the court) and have ignited a firestorm about parents rights, religious freedom, child endangerment, and personal freedoms.

It is difficult to know how this particular case will be resolved, but judging from the emotional uproar around the Terri Schiavo case from a few years back, we are likely to hear a lot of moral grandstanding and admonishments before anyone is truly cared for.

This particular case with Daniel Hauser appears to be suitably complicated, with doubts and dispersions being cast upon the parents and the ailing child being made into a symbolic martyr for the cause (what cause it may be is still unclear). Regardless, the whole tumult brings up difficult and troubling questions about not only life and euthanasia, but also how family members and loved ones choose to administer (or not) the needed care.

So how does this all sit with you? Are the parents just kooks and unfit to take care of their ailing child? Is the court way out of line and infringing on both individual and religious freedoms along with civil rights? Should the protection of life be the be all and end all?

Friday, May 22, 2009

Wash. state has first death under new suicide law

Posted: May 22, 2009 12:43 PM EDT

Assisted suicide law takes effect, opinions clash
Washington voters pass initiative allowing medically assisted suicide

OLYMPIA, Wash. - A 66-year-old woman from Sequim is the first person to die under the state's new assisted suicide law.

Linda Fleming died Thursday night after taking drugs prescribed under the "Death with Dignity" law that took effect in March.

Compassion & Choices of Washington announced the death Friday morning.

The organization says Fleming was diagnosed last month with stage 4 pancreatic cancer.

The new law was approved in last November's election with a nearly 60 percent vote. It is based on Oregon's measure which passed in 1997. Since then, about 401 people have used the Oregon law to end their lives.

Under Washington' law, any patient requesting fatal medication must be at least 18 and mentally competent. Two doctors must certify that the patient has less than six months to live.

The state Department of Health says it has received six forms from pharmacists saying they have dispensed life-ending drugs.

The passage of the Washington State Initiative 1000, the "Death with Dignity Act," has required hospitals and healthcare providers to make decisions about whether they will participate under the Act. The Act is clear that no provider, including Deaconess, is required to assist a qualified patient in ending his or her own life and requires hospitals that do not allow participation to provide public notice.

"After thoughtful conversations with our medical staff, board of trustees and patients, Deaconess Medical Center has chosen to not participate in the ‘Washington State Death with Dignity Act,'" said Shelley Peterson, Deaconess' Chief Nursing Officer. "However, we do believe that the passage of this act by Washington voters is a call to improve end of life care. We also believe that whether or not to participate in Death with Dignity is a decision for providers and their patients. Therefore, we will not interfere with decisions made in private clinics on the Deaconess campus."

Deaconess says it will continue to provide compassionate, high quality care to all patients. Any patient wishing to receive life-ending medication while a patient at the hospital will be assisted in transfer to another facility of the patient's choice, assuring continuity of care.

"All providers at Deaconess will continue to respond to a patient's questions about life-ending medication with compassion and without judgment. Deaconess believes our providers have an obligation to openly discuss the patient's concerns, unmet needs, and feelings about dying and end-of-life care. Providers will continue to seek to learn the meaning behind the patient's questions and help the patient understand the range of available options, including but not limited to comfort care, hospice care and pain management. Ultimately, Deaconess' goal is to help patients make informed decisions about end-of-life care," said Peterson.

Valley Hospital and Medical center also chose not to participate in the act.

Previous Coverage
Two prescriptions filled for WA assisted suicide

APRIL 22, 2009

SEATTLE, Wash. - State health officials say two prescriptions have been filled for life-ending drugs under Washington's new assisted suicide law.

Health Department spokesman Tim Church said Thursday he could not provide any details about the people considering suicide. The department has received two forms from pharmacists saying they have dispensed the drugs that people say they want to use to end their lives.

The department has not received any forms certifying that a person has committed suicide under the state law that took effect in early March.

Church says the people who filled a prescription for life-ending medication have as long as they want to take the medication or can change their minds and never take it.

Friday, May 8, 2009

Nursing Home Sexual Abuse Committed by One Nurse Aid at Two Facilities

May 6th, 2009

A New York nursing home worker, who was already facing criminal charges for sexually abusing residents last summer, now faces new charges related to alleged abuses that occurred at another nursing home where he worked months earlier.

The New York Attorney General’s office has filed new charges against Robert Gundersen for misdemeanor forcible touching, felony sex abuse and misdemeanor third-degree sex abuse involving a 78 year-old nursing home resident. The sexual abuse allegedly occurred between December 15, 2007 and January 7, 2008, while he was working as a nurse aide at the Northwoods Rehabilitation Center in Troy.

At the time the charges were filed, Gundersen was already facing nursing home sex abuse charges as a result of forcibly French-kissing a younger wheel-chair bound resident with multiple sclerosis. That abuse allegedly occurred between August 2008 and September 2008, while he was working at the Eddy Ford Nursing Home in Cohoes, New York.

Discovery of the nursing home sexual abuse stems from increased investigations by the New York Attorney General’s Office, including the use of hidden cameras at facilities throughout the States.

Since the crackdown on abuse at nursing homes has become a top priority for the AG, more than 70 nursing home employees have been arrested or convicted for rape, sexual assault, theft and forgery. At least one nursing home company, Highgate LTC Management, has also been temporarily suspended from doing business as a result of nursing home neglect caught on camera.

Nursing home residents are susceptible to sexual abuses and unwanted physical contact, due to their weak and disabled conditions. Younger nursing home residents who are unable to speak or move independently could be especially at risk.

To ensure the safety of their residents, nursing homes have an obligation to conduct thorough background checks on their employees and to ensure that employees are properly trained and supervised. When a facility negligently fails to protect residents, they can often be held accountable through a nursing home abuse lawsuit.

Discovering abuse in nursing homes can often be challenging given the physical and mental impairments of many residents. In addition, information is often withheld from family members, facility supervisors and law enforcement because the residents are afraid of punishment or ashamed about what has occurred.

Patient advocates urge family members to always be alert for signs of nursing home abuse, which could include unusual cuts and bruises, broken bones, unexplained hair loss or changes in behavior when certain staff members are around.

Tags: New York, Nursing Home, Nursing Home Abuse, Nursing Home Neglect

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Nursing Home Penalizes Relatives for no advance notice of death

WHITE HOUSE, Tenn., May 8 (UPI) -- Members of a Tennessee family said they were penalized by a nursing home for not giving at least 30 days notice before their mother died.

Randy Harrell said he received a security check refund from the Windlands Center nursing home in White House after his mother, Lucille Harrell, 81, died at the facility March 20, WSMV-TV, Nashville, reported.

"At that time, the check was $301 instead of $1,295, which was her original deposit," Harrell said.

He said nursing home bosses told him the money was deducted for not giving 30 days notice of his mother's departure from the home, despite the reason being death.

Windlands Center manager John McCrory said the contract states that notice of leaving must be given at least 30 days in advance, although the document does not mention the word "death."

"If they see they are having lots of problems, I even recommend them giving 30-day notice at that time," McCrory said. "That way, it'll cut off some of the costs."


Saturday, April 25, 2009

Elderly Citizens Being Medicated Through Needless Mass Medications

(NaturalNews) April 24, 2009

Healthy senior citizens are being needlessly exposed to potentially risky medications due to blind adherence to national health guidelines drafted for younger people, a prominent cardiologist has warned.

"Nowadays few elderly people are allowed to enjoy being healthy," writes Edinburgh University cardiology professor emeritus Michael Oliver online in the British Medical Journal.

"A bureaucratic demand for documentation can lead to overdiagnosis, overtreatment and unnecessary anxiety," he wrote.

Specifically addressing the situation in the United Kingdom, Oliver criticizes the National Health Service (NHS) for aggressively encouraging doctors to treat people of all ages with blood pressure or cholesterol drugs intended to prevent heart disease and other chronic conditions. Yet the case for these drugs is based on studies showing that they slightly reduced the lifelong risk of heart attack, stroke or death in much younger patients.

"Preventive action may be irrelevant and even harmful in elderly people," Oliver writes. "More than 30 years ago, in his book Medical Nemesisn b , Ivan Illich called this trend 'the medicalization of health.'"

In part, the NHS encourages doctors to prescribe blood pressure and cholesterol drugs by financially rewarding doctors who achieve the Quality and Outcomes Framework targets.

"Many older people, often retired, are summoned by their general practitioner for an annual health check," Oliver writes. "They may feel reasonably well, but the NHS does not always permit such euphoria. They may be told that they have hypertension or diabetes or high cholesterol concentrations; that they are obese; that they take too little exercise, eat unhealthily and drink too much."

Yet medicating the elderly may pose a greater risk of side effects than medicating the young, he warns, and for lesser benefit.

"Are those people who have now been turned into patients warned sufficiently about side effects?" he asks. "Are minor side effects, which can be debilitating in this age group, reported to health authorities? More importantly, are doctors willing to discontinue treatment and permit these patients to return to their previously unencumbered and reasonably fit lives?"

Sources for this story include:

Friday, April 17, 2009

Preparing your children for a grandparents death

By Connie Matthiessen, senior editor

People often conceal the reality of death from young children in an effort to protect them from painful and frightening “adult” matters. In earlier times, grandparents and other relatives often passed away at home, cared for by the family, and children understood that death was part of the natural order of things. Today, the dying are often in hospitals and nursing homes, and many children have no concept of what it means to die. But experts agree that not talking about death, or dressing it up in euphemisms or platitudes, can confuse and frighten a young child. If a grandparent is ill and nearing death, here are steps you can take to help prepare your child for the loss.

Talk openly about death in advance. It’s a good idea to introduce the subject of death to your young child well before a grandparent is ailing. The death of a pet offers an excellent opportunity for such a discussion. Or you can simply show your child a dead flower or insect. Explain that death is the end of life, and that every living thing will die one day. Keep your explanation simple and to the point. Consider this the first of many conversations, as it will take your child a while to absorb the information.

If a grandparent is very ill or has received a terminal diagnosis, gently tell your child that his grandparent is going to die. It’s better to inform your child in advance, because at the time of death you may be too grief-stricken yourself to explain. It’s fine to show your child that you’re sad about the loss, but it may scare him if you disclose the news of his grandparent’s passing at a time when you’re overcome with grief.

Answer your child’s questions, no matter how difficult. Try to respond to all your child’s questions about death without distress or displeasure — or dishonesty. Many of them are likely to be difficult to answer — for example, “Will Grandma be able to see me when she’s dead?” — and your response will depend on your personal beliefs. Avoid telling your child fairy tales. If you say that Grandma is sitting on a fluffy white cloud in the sky, looking down on your child and sending kisses, your child may feel comfort in the moment but is likely to be confused about death in the long run. It’s fine to simply say that you don’t know the answer to certain questions.

Let your child spend lots of time with grandparents, if appropriate. If your child’s grandparent is up to it, arrange for them to see each other regularly. Your child may find this scary at first if you’ve just told him that his grandparent is going to die, but short visits will help dispel your child’s fear, may lift his grandparent’s spirits, and will create pleasant memories for years to come.

Put together a legacy project. Consider creating a legacy project with your parent, and involve your child in the process. Even a very young child can help select photographs for a poster or photo album. An older child may enjoy listening to his grandmother relate her life story for an oral history project; the child could also draw pictures for the final bound volume. If possible, take some pictures of your child with his grandparent and add them to the oral history. Frame one of the photos and put it in your child’s room.

Find children’s books on death and dying. Many excellent books for children deal with the subject of death. Pick a selection up from the library and purchase a few you think your child will like, so they can continue to provide comfort in the months to come.

Encourage your child to draw or paint pictures. Children often have trouble talking about their feelings and may be able to express themselves more easily through drawing or painting.

Inform your child’s teacher and other adults. Talk to your child’s teacher, to babysitters, and to other significant adults in his life. Tell them that your child’s grandparent is dying, and explain how your child is dealing with the experience. This information will help adults know how to interpret his behavior and provide support, as needed.

If you detect problems, take your child to a counselor or a child psychologist. If your child is having a very strong reaction to his grandparent’s death — if he’s acting out, is very withdrawn, or exhibits other signs of distress — it’s a good idea to consult a child psychologist. An expert can help your child work through his fear and loss.