Cruiser struck; trooper injured

PALMER – A Massachusetts state police trooper received serious injuries when his cruiser was struck from behind by another driver on the Massachusetts Turnpike.

Two other people were also taken to Baystate Medical Center for treatment after the 7:15 a.m. accident Sunday.

Trooper Steven Larocco, 39, who is assigned to the Northampton barracks, had stopped to assist the driver of a Jeep Liberty. He had stopped in the eastbound side of the highway between the median and the left lane near Exit 8, said Sgt. Michael Popovics, spokesman for the state police.

Larocco was sitting in his cruiser when Robert Murangi, 40, of Federal Way, Washington, who was driving a Dodge Avenger, struck the cruiser from behind, crumbling the rear end of the car, and pushing him forward into the Jeep.

Murangi was not injured but two of his passengers, were taken to the Baystate Medical Center by ambulance. Juliana Muthee, 21, was treated for serious injuries and Christopher Munyiri, 26 was taken for evaluation. Both are from Brockton, Popovics said.

Murangi was cited for having an open container of alcohol in the car and for failure to take care in stopping, Popovics said.

The driver of the Jeep, Martin Prendergast, 23, of Weymouth, suffered minor injuries.

“It is not known why he was stopped. That is still under investigation,” Popovics said.

Both eastbound lanes were closed for three hours after the accident, Popovics said.

This is the most recent in a number of accidents where drivers have hit state troopers in recent month across the state and the region.

Four months ago a Connecticut officer was killed on Interstate 91 after making a routine traffic stop near the Longmeadow border.

On Sept. 2, Connecticut State Trooper Kenneth R. Hall, 57, was struck on Interstate 91 in Enfield after he had pulled a motorist over for a minor traffic violation.

Hall was sitting in his cruiser between Exit 48 and 49 near the Longmeadow border when a another driver crossed two lanes of traffic and rear-ended Hall’s cruiser with his pickup truck.

Michael Pajak, 32, of 8 Cranberry Hollow, Enfield, faces a variety of charges in the accident including manslaughter in the first and the second degree with a motor vehicle, driving under the influence of drugs or alcohol, assault in the second degree with a motor vehicle and misconduct with a motor vehicle.


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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