Trooper hurt in crash, Haverhill man cited

Rash of accidents plague commuters on Interstates 93 and 495

METHUEN — A state trooper crashed his state-issued SUV on Interstate 495 South yesterday after swerving to avoid being hit by a basketball hoop and backboard that fell from the back of a pickup truck.

The momentum carried Trooper John McGrath’s 2007 unmarked Ford Expedition through the breakdown lane into a soft grassy area, where it rolled over and came to rest along a tree line at the side of the road, according to State Police Spokesman David Procopio.

Trooper McGrath, who is assigned to the Commercial Vehicle Enforcement Section, received treatment for minor injures at Lawrence General Hospital and was later released. The SUV was towed from the scene. State Police cited Ernest Penachio, 61, of Haverhill, for not securing the load in the bed of the 1997 Ford pickup he was driving.

McGrath’s crash was one of a rash of morning accidents on the two major Merrimack Valley highways that had commuters scrambling for alternate routes to work, causing traffic congestion on back streets and side roads for several hours.

A preliminary investigation determined that moments before the 11:10 a.m. crash, Trooper McGrath noticed the pickup truck on I-495 traveling north of the ramp to Route 213, carrying numerous pieces of debris in its bed, including a portable basketball net and backboard. Believing the net and backboard was not properly secured, the trooper pulled behind the pickup truck to investigate further. Soon after, the net flipped over, causing the backboard to come out of the truck, nearly striking the trooper’s Expedition and causing him to lose control of his vehicle.

Seven state police cruisers responded to the scene of the crash, which backed up traffic into Haverhill as the highway was reduced to two lanes, with the right travel lane being blocked.

In another incident with a major impact on morning traffic, an 8 a.m. truck fire in the center lane of Interstate 495 in Andover between the I-93 and Route 133 exits forced State Police and MassHighway crews to shutdown the roadway for about 30 minutes as fire crews doused the flames and a tow truck hauled the vehicle from the scene.

The cab of a truck caught fire and the operator jumped out to avoid getting burned. He was not injured.

But the incident caused a massive backup on I-495 South, which was closed until about 8:30 a.m., and a curiosity delay on the northbound side of I-495. Also, the ramps from I-93 to to I-495 southbound were shut around the same time.

By 8:30 a.m., the left travel lane was opened, and the whole road was reopened by 9:05 a.m., state police said.

Closing the I-93 ramps created its own set of problems, as traffic quickly backed on up both sides of the highway and drivers sought alternate routes on River Road. Traffic quickly became clogged on River Road, Andover Road, Route 114 and Massachusetts Avenue.

In addition, the slowdown on I-93 North contributed to two crashes just after 9 a.m. in Andover near River Road.

In the first accident, a 1996 Nissan Quest minivan driven by Jack Dam, 50, of Chelmsford, collided with a 2009 GMC Savcut operated by Dawn Rodriguez-Viens, 40, of Bradford. There were no injuries but one vehicle was towed.

At 9:10 a.m., suspected rubber-necking caused a second accident at the same location, when a 2007 Dodge Caravan driven by Kleiny Rojas, 32, of Lawrence, collided with a 2008 Toyota RAV driven by Robert Genova, 44, of Mansfield.

No injuries were reported but the Caravan was towed from the scene.

At around noon, a Jeep Grand Cherokee reportedly drove up onto the guardrail at the Merrimack Street ramp to 495 in Lawrence. No injuries were reported.


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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5 days ago  ·  

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