Pre-school Teacher Killed in Motorcycle Crash

Jul 11, 2010 @ 07:36 PM

BRAINTREE — A pre-school teacher was killed after being flung from the back of her boyfriend’s motorcycle in Somerville on Friday night.

Sinead M. Lovett, 29, of Braintree, was a passenger on a 2003 Harley Davidson motorcycle that Richard Migliacci, 37, of Somerville, crashed into a curb on Route 28 south, said State Police Lt. David Wilson. State Police arrived at the scene at 9:10 p.m.

Lovett and Migliacci were rushed to Massachusetts General Hospital where she was pronounced dead, said Wilson.

Migliacci remains at the hospital in “fair” condition, according to Stacy Neale, Media Relations Officer for Massachusetts General Hospital.

The cause of the crash is under investigation, said Wilson.

“Physically he’s doing better, but emotionally he’s suffering,” said Diana Moore, Migliacci’s mother.

“He had to be sedated when he found out she died,” she said.

Migliacci told his mother that he struggled to maneuver around cars and hit a road island.

The couple had been together for about a year and Friday’s drive was the first motorcycle trip the couple had in a while. Both were wearing helmets, said Moore.

“People should be more alert of motorcycles,” Moore said.

Moore described Lovett, a pre-school teacher, as “kind-hearted” and “funny.”

“It’s so devastating for him. He wanted to marry her. He loved her so much and of course he feels like it’s his fault,” she said.

Migliacci underwent surgery the night of the accident, said Moore. He suffered brain damage, kidney and bladder failure, a fractured hip and his stomach was torn open, but he is expected to make a full recovery, said Moore.

“But it’s his mind. He’ll never be the same,” she 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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