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Driver accused in four collisions

Quincy man allegedly was driving drunk

A Quincy man was arraigned on several charges yesterday, including driving under the influence, after he allegedly struck four vehicles on highways between Attleboro and Milton.

A not guilty plea was entered on behalf of Rony S. Santos-Cruz, 24, in Quincy District Court on charges including driving with a revoked license and leaving the scene of an accident causing property damage. He posted $1,000 cash bail and is due back in court Dec. 27.

Assistant District Attorney Erin McFarland said during the arraignment that Santos-Cruz struck four vehicles shortly after 5 a.m. and was found in a travel lane on I-93 in Milton near two of the vehicles.

McFarland said that Santos-Cruz admitted to driving the blue Buick involved in the accidents and that the vehicle he was driving had substantial damage, including a blown tire and several dents and scratches. She said he responded “home’’ when asked by a state trooper where he was coming from and where he was going.

She said Santos-Cruz failed multiple field sobriety tests and had a blood alcohol level of 0.23, above the legal limit of 0.08.

According to the State Police arrest report, Santos-Cruz had three revoked Massachusetts licenses in the system at booking. Police also reported finding four beer bottle caps on the driver’s seat of the car. State Police said the licenses had the same date of birth and picture, with slight variations of his name.

When asked about the licenses, he told State Police, “We all have to start somewhere,’’ according to the report.

Santos-Cruz’s court appointed lawyer, Paul Stanton of Medfield, said his client does not remember everything that happened yesterday morning. Stanton said it was “not necessarily proven’’ that two of the four vehicles were involved in an accident with Santos-Cruz.

He said his client was traveling from his legal address in Quincy, where he lives with his mother, to a room he has been renting in Dorchester. He said Santos-Cruz has no criminal record, is employed, is a graduate of Quincy High School, and has taken classes at Bunker Hill Community College.

Santos-Cruz, dressed in a blue windbreaker and green slacks, did not speak during the arraignment except to answer “yes’’ when asked whether he understood the charges and “yes, sir’’ when asked whether he would be willing to pay a fee for his lawyer.

Santos-Cruz and his girlfriend, whom authorities said he identified as the owner of the Buick, did not speak to reporters as they left court.

A spokesman for the state Department of Transportation said Santos-Cruz was issued one license this year and had three other applications rejected, in 2004 and 2005. The spokesman, Richard Nangle, said the department is trying to determine why the other applications were rejected. He said Santos-Cruz’s driving record was not immediately available yesterday.

Source:  Boston.com


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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6 days ago  ·  

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