SMG alum killed in T accident

A 22-year-old Boston University graduate was struck and killed by a Green Line trolley traveling eastbound on the D Line early Sunday morning.

School of Management graduate Joshua Stimson of Brighton was found in the gauge of the track between the Longwood and Fenway stops at 12:19 a.m., according to the Massachusetts Bay Transit Authority.

The track where Stimson was hit is fenced in on both sides.

Brookline Police and Fire Department responded to the scene, where EMS personnel determined that Stimson was dead, according to an MBTA statement.

MBTA spokesman Joe Pesaturo said the exact circumstances of Stimson’s death were still unknown.

“Investigators have ruled out any problems with the train or the signals. It remains unclear why he was inside the fence-enclosed Green Line right-of-way. The investigation is ongoing,” Pesaturo said in an email.

“Investigators have interviewed people who were with Mr. Stimson prior to this incident. It’s believed that alcohol may have been a factor.”

People traveling on the T said that they didn’t feel the impact of the accident, but as soon as the train struck Stimson, the driver stopped the trolley and ran out of the vehicle.

The train was carrying about 55 passengers, including several BU students and two staff members of The Daily Free Press.

Upon seeing that the train ran over Stimson, the driver immediately re-boarded the car, announced that the person lying on the tracks could be dead and asked if there were any doctors on board.

While there were no paramedics, one person who said they had a Ph.D volunteered to go with the driver.

T passengers were held for about 30 minutes as an MBTA representative questioned witnesses.

Most passengers were in shock and some were crying.

Kay Loftus, a sophomore in the College of Communication who was on the train at the time of the death, said it was an upsetting experience.

“Suddenly we stopped and the driver ran off the T,” Loftus said. “When he came back on everyone was just shocked, no one knew what to do.”

Loftus said that the passengers weren’t allowed to leave until police had assessed the situation. Police interviewed passengers, particularly those near the front of the car, she said.

“We kind of just sat there,” she said. “Everyone was just pretty quiet.”

Rachel Blumberg, a sophomore in COM, was also on the T at the time of the accident.

“I was sitting towards the front and we were going along and then all of a sudden we came to a stop, it didn’t even feel like emergency breaks or anything,” Blumberg said. “People started getting worried. . .[the driver] was pretty panicked, I’ve never seen anyone so. . . I can’t even describe it.”

Finally, passengers on the T were informed that a man had died.

“Looking at people’s faces everyone was pretty shocked. I was in a state of shock,” Blumberg said. “People had looks of horror on their faces.”

Blumberg said that the passengers were escorted in a single file line down the tracks to the Fenway stop.

Colin Riley, BU spokesman, said that the situation is “incredibly sad.”

“We were notified that a BU recent graduate had been killed by a trolley. . . they notified us because they had some identification,” Riley said. “It’s terrible to get these calls. . . he had so much life ahead of him.”


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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