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1 dead after car hits bull in Leominster

LEOMINSTER — One person died after a car hit a bull in Leominster late Wednesday.

According to investigators, Steven Hamilton, 22, probably never saw the jet black bull weighing several thousand pounds before he hit it while driving home from work.

“He never had a chance,” said James Hamilton, the victim’s father. “From what I understand, there’s no brake marks on the highway or anything. He just ran right into him.”

State police said that the bull, along with three cows, wandered away from the nearby Manny’s Dairy Farm onto Interstate 190 near Route 117, where Steven’s car drove into the bull, tossing it to the side of the road, killing both Steven and the bull.

The animals somehow got through an electrified fence, and then the fence owned by National Grid, that may already have been knocked down.

The farm owner’s daughter, Susan Chavez, said she doesn’t know how it happened.

“Obviously this is an awful accident, and I wouldn’t wish this on anyone. I really feel beyond awful for the loss of that family. That’s just an awful thing to have to go through, and I don’t know what else to say,” said Chavez.

Investigators said that farm animals have wandered away from that area before. State police said that they rounded up three runaway cows just last month, and they were possibly from that same farm.

“As far as going down the road if it is criminal negligence, negligent homicide, any of those things that it could possibly fall under, we’re not even close to that yet,” said Lt. James Canty, of the Massachusetts State Police.

Steven Hamilton’s parents said that it is ridiculous that more wasn’t done to keep the bull from the highway.

“It’s a freak accident that could have been avoided,” said Carol Hamilton, the victim’s mother.

“Somebody has animals like that they are supposed to be fenced in, and because of carelessness, my son paid the ultimate price. He’s dead, and that’s ridiculous,” said Hamilton.

According to some of the workers at the farm, there may have been a power failure that would have disabled the electric fence that what supposed to keep the animals on the farm.

State police are looking into that possibility as part of their investigation.

Source:  http://www1.whdh.com/news/articles/local/12002777199626/1-dead-after-car-hits-bull-in-leominster/


Nursing Home Negligence

Falls in Nursing Homes

Litigators who work with cases involving long term care know how significant the issue of falls can be. Falls are the leading cause of injury and death by injury in adults over 65. Approximately half of the 1.6 million nursing home residents in the U.S. fall each year, and a report by the Office of the Inspector General found that about 10% of Medicare skilled nursing residents experience a fall resulting in significant injury; and, more than 1/3 of hospital falls result in injury. In the rehab setting, rates are often higher – for example, fall rates among stroke patients have been shown to be very high. Immobility and falls can lead to poor outcomes.

Fear of falling is defined as a geriatric syndrome. It not only occurs in older adults who have fallen, but in those with impaired mobility and is associated with decreased physical ability and depression. Care of older adults requires that clinicians be aware of the myriad of issues related to falls including knowledge of this syndrome, increased risk and interventions needed to prevent injury related to falls.

Just about every resident in a long term care setting, including assisted living and sub-acute rehab, is at risk for falling. Between medications, functional and medical issues and advancing age, older adults in most settings are prone to falling.

There are well established standards of care related to fall prevention; but, as I continue to review records related to issues like falls, I am amazed at how often these basic standards are not being practiced. The basics of a fall prevention program include assessment and ongoing reassessment of risk, ensuring a safe environment, medication review, providing therapy as needed, individualized interventions, and staff education.

Basic nursing practice includes assessment, planning (Care plan), putting interventions in place and then evaluating outcomes to determine if those interventions are appropriate and effective. Assessment includes completing fall risk assessments on admission and then as needed. Very often, the fall risk assessments completed by nurses in LTC are inaccurate. The tools utilized in long term care typically include these risk factors: history of falling, use of ambulatory aids, gait/balance issues, medications, secondary diagnoses (i.e. diabetes) and mental status. Care planning is the next step in nursing care - it is the standard of care that as the resident’s status changes, assessments and care plans must be updated, and often, are not. For example, with each fall, there should be updates, or if there is a new diagnosis, i.e. stroke, or worsening dementia, updated interventions should be put into place, with ongoing evaluation of effectiveness.

Care planning and interventions very often are generic and not individualized. For example, a toileting schedule that includes only after meals and before bedtime may not be appropriate. If a resident has issues with constipation or incontinence, this may lead to the need for more frequent toileting to prevent falls. The “make certain call bell is within reach” for residents with dementia is an example of a generic intervention. Older adults with dementia may not recognize a call bell or remember to use it. The debate about use of bed and chair alarms go on – they are a part of an individualized care plan, not a solution to preventing falls. Often, I see delays in putting interventions in place, i.e. with the resident who is incontinent NOT being put on a toileting plan immediately. The other common issue I see when reviewing records is the lack of updating care plans as the resident’s status changes – with every fall, with worsening dementia, physical decline, or new medical diagnosis (i.e. Parkinsonism).

Nurses reviewing records need to pay attention to the MDS, risk assessments, care plans and Interdisciplinary notes with attention to where the standard of care is not being met.
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