Methuen man killed in Lawrence car crash

LAWRENCE – A Methuen man was killed early yesterday after the Acura Integra he was driving smashed into a telephone pole.

Arnoldo Vargas, 20, of 67 Ford St., was pronounced dead after the 2:45 a.m. crash at Saratoga and Park streets. Two young women riding in his car were also hurt, but are expected to survive, police said.

Police seized a pickup truck that may have played a role in the deadly accident.

When police arrived at the accident scene, the yellow Integra Vargas was driving was smashed against a telephone pole. Vargas “appeared deceased” and two women, Elsa Soto, 20, of 322 High St., Lawrence, and Karimar Amare, 19, of Lowell, were in the passenger side and back seats, police said.

Officer Nelson Potter said he spoke with witnesses that said “the yellow Acura was traveling at an extremely high rate of speed down Park Street. The Acura either struck or swerved in an attempt to avoid a pickup truck at the intersection of Saratoga and Park streets.”

One witness told Potter she saw a pickup driver get out of his truck, inspect the outside of his truck, then get back in and drive away.

Potter collected numerous pieces of debris at the intersection and placed them into evidence, according to his report.

Later yesterday morning, Detective Thomas Cuddy went to 2 Railroad St. to inspect a blue 1998 Chevrolet pickup registered to Blas Martinez, 56. Cuddy said the pickup had minimal damage to the rear bumper but there was a “transfer of yellow paint on the passenger’s side rear bumper as well as two more small chips of yellow paint on the rear bumper directly in front of the license plate,” Cuddy wrote.

Martinez, after he was read his Miranda rights, told police he’d been working on a food truck on Lawrence Street and arrived home 10 minutes earlier. He said he drove down Saratoga to Myrtle Street to get home “but did not believe that he was involved in an accident.”

Cuddy wrote Martinez appeared sober and “was very cooperative.”

The pickup was towed to Coady’s on Marston Street and stored inside until police can process it for possible evidence.


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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