Schoolbus seatbelt bills falter again

Marblehead — As the state’s new texting-while-driving ban took effect Thursday, a handful of state lawmakers continued to press for a public-safety-related change in the way students travel to school. They want them strapped in seatbelts.

While seatbelt use is required in cars in Massachusetts, a group of legislators have for several years have tried unsuccessfully to make it mandatory for school buses to be equipped with seatbelts.

This year, their efforts appear to have failed again, with bills winning the endorsement of the Joint Committee on Public Safety and Homeland Security, but idling in another committee with little likelihood of votes in the House and Senate during informal sessions scheduled for the rest of 2010.

Lawmakers say seatbelt laws in Massachusetts send a mixed message.

“We are responsible for wearing a seatbelt in a car. We are responsible for putting kids in car seats and booster seats until they are 8 years old. When kids get on a bus, all those requirements go out the window,” said Sen. Thomas McGee, D-Lynn, who has filed legislation during the past two legislative sessions.

McGee’s bill (S 957) would require all school buses in the state to provide seatbelts within two years, but it would not mandate students wear them. And it limits the liability of the bus drivers and school districts should an accident occur and some students are not wearing belts.

“You can’t have 40 kids on a bus and expect every kid is wearing their seatbelt. It is the responsibility of everyone,” McGee said. “The reality is you want to have the seatbelt there; it is safer for kids, and we want them to get in the habit of wearing it. But we don’t want to create something that is going to create all these lawsuits.”

Rep. Garrett Bradley, D-Hingham, has worked on a similar bill on the House side. Now, the two lawmakers are working together to get it passed. Bradley said he disagrees with some of the arguments against seatbelts, one of which is that seatbelts are a “safety concern, especially in a rollover situation.”

“I never went by the theory that the big green seat in front of you will protect you,” Bradley said. “I just don’t buy that”.

He added, “The issue is cost concerns.” He tried to alleviate those concerns by making the legislation only require seatbelts on new buses and not requiring older buses to be retrofitted.

“Hopefully, I can get some agreement on the cost issue,” he said.

Bradley’s bill (H 2199) rests in the Committee on Steering and Policy.

“As the year goes on, the air goes out of the balloon,” he said. “But we are still trying to get it done, trying to get it over to the Senate.”

Rep. Ronald Mariano, D-Quincy, a former schoolteacher, has also filed a bill for the past several years that would mandate seatbelts on buses for preschool and kindergarten children only. His bill has never made it out of committee. The change runs up against opposition from school bus companies, and even school districts, he said. The school districts raise concerns about how it will change school-bus drivers’ jobs if they are required to strap children in seatbelts, according to lawmakers familiar with the issue.

“I think it should always be discussed,” he said. “Is there a system we can put into place that can guarantee the safety of young children?”

A handful of Massachusetts communities do require their buses to be seatbelt-equipped, and several others have local regulations in the works.

Marblehead school buses have had seatbelts for more than 10 years, and Newton started requiring belts after a 2001 accident in which four middle school students were killed while on a band field trip to Nova Scotia.

In Waltham this month, the school district plans to send out requests for bids for buses equipped with seatbelts. School officials hope Waltham students will be strapped in when school starts next September.

A group of parents and educators worked for three years, campaigning for the change on Waltham school buses. Costs could be a roadblock, school officials said.

“I hope we don’t get price-gauged out of having seatbelts,” said Lisa Limonciello, a member of the Waltham School Committee. “I think the bus companies have to move forward into the 21st century.”

Waltham officials estimate it could cost an additional $11 per student, over a three- to five-year contract.

“For 30 years, we have had buses with no seatbelts. It is time we change that,” said Limonciello, a mother of two elementary school children. “I don’t know how you can put a price tag on the safety of children. If we can provide that, I think we should.”

However, students riding Waltham school buses would not be forced to wear the seatbelts. It would be too difficult for school officials and bus drivers to monitor, school officials said. Bus drivers will not be responsible for fastening students in. The seatbelts on all the buses give students “an option to be safe they would have to choose to use,” said Limonciello.

“It becomes a matter of personal choice,” she said. “When you have middle school, high school students, compliance becomes an issue. You can’t make them wear them.”

Waltham parents would be required to sign a waiver, relieving the school system of any liability in the event of an accident. If their child chooses not to wear a seatbelt, the school system’s legal department wants to make sure the school cannot be held liable for the child not wearing it.

“That was one of the big obstacles we had to overcome in looking at this,” Limonciello said. “If we had seatbelts on buses, and half wore them and the other half did not, and there was an accident, could those students (who didn’t wear them) sue us?”

Six states have school bus seatbelt laws: New York, New Jersey, California, Texas, Florida and Louisiana. In Massachusetts, only a handful of school districts have seatbelts on the larger buses. The federal government mandates seatbelts on any smaller buses, those weighing less than 10,000 pounds. However, the National Highway Traffic Safety Administration said the newer large buses with high-back seats protect students in a crash, and the federal agency does not see a need for seatbelts on large school buses, according to a spokesman.

“Large school buses already provide excellent crash protection,” said Jose Ucles, a spokesman for NHTSA. “This concept of compartmentalization really does work.” If a bus is involved in a collision, the design of larger buses provides a “protective envelope” of closely spaced seats, with energy-absorbing seatbacks, he said. And seldom do large buses rollover, he said.

Ucles said an average of 19 school children nationwide die each year in school-bus-related incidents, and only a fraction of those actually occur on the bus.

The number of deaths in Massachusetts during the past five years was small, with one in 2008, and none from 2004 through 2007, according to NHTSA complied statistics.

“Any death is one too many,” Ucles said. “But when lawmakers are looking at this, they look at the numbers. The numbers speak to legislators.”

Proponents of school-bus seatbelts dispute those statistics as too low. McGee said he has read estimates there are 144 school-bus accidents across the country every day, which averages to 26,000 per year.

The American Academy of Pediatrics estimates 51,000 school bus-related injuries every year. Last month in Missouri, two children were killed and several injured in a school bus accident.

“This is something that is going on every day. It is interesting we don’t recognize we should make this a priority to put seatbelts on school buses,” McGee said.


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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