Trooper struck on highway

Monday, July 5, 2010

State police recovered a shorn-off sideview mirror and scraped flecks of car paint off the utility belt of a trooper they say narrowly missed being killed yesterday morning by a hit-and-run driver.

A manhunt was on last night to locate the coward, and state police – who last month buried a sergeant struck and killed by an allegedly drunken driver – were imploring the public to be vigilant in auto-body shops and to even check their neighbors’ driveways for a damaged silver or gray sedan.

“There will be damage on the passenger side,” department spokesman David Procopio said. “We were fortunate this morning this wasn’t more serious. There but for the grace of God.

“It’s a safe estimate that at least once a month a trooper is struck in the roadway,” he said. “The severity of the injuries ranges from very, very minor to the worst imaginable and everything in between.”

Trooper Sean McGarry, 32, a newly married, five-year veteran of the Massachusetts State Police assigned to the Danvers barracks, was protecting a fellow officer questioning a motorist who’d been pulled over on Route 128 south in Peabody about 2 a.m. when he was sideswiped in the breakdown lane by a second car that then veered onto Route 1 and vanished.

McGarry was treated for a leg injury at Union Hospital in Lynn and released.

The driver is facing charges that include leaving the scene of an accident causing personal injury, failure to obey the move-over law and negligent driving, Procopio said.

McGarry was hit while providing backup to trooper Joseph Keefe, who had stopped a 2004 Infiniti G35 driven by Frank J. Imbruglia, 25, of East Boston for swerving into the breakdown lane.

Imbruglia is being held without bail pending his arraignment on the North Shore tomorrow on charges of driving with a suspended license, providing a false name to police, committing a marked-lanes violation and having three outstanding warrants for his arrest.

State police Sgt. Douglas Weddleton, 52, died last month at a construction detail on Interstate 95 in Attleboro when he was knocked down and crushed under a car he had pulled over, which was rear-ended by a second vehicle.

Last Monday, a Framingham man with a history of mental illness, Alejandro Serra, 29, led troopers on a high-speed chase on the Massachusetts Turnpike, during which he was accused of ramming cruisers and nearly running down a trooper at a Framingham rest stop.

Anyone with information about the Peabody crash or the missing sedan is asked to call the state police barracks in Danvers at 978-538-6161.


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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