Whale watch crash in Boston Harbor under investigation

Jul 05, 2010 @ 08:20 PM

The Coast Guard is investigating why a whale watch boat veered from a well-marked channel outside Boston Harbor Saturday and ran aground on a rocky shoal off Deer Island, forcing an emergency evacuation of 168 tourists on board.

The shallow area where the wreck occurred is a known hazard and is well-marked on navigational maps, several Coast Guard officials said on Sunday. All of the buoys and markers in the channel were properly positioned and working, a statement from the Coast Guard noted.

The crew of the M/V Massachusetts, an 87-foot vessel owned by Massachusetts Bay Lines and often used for commuter-boat service from Hingham, was tested for drugs and alcohol as part of the investigation into the grounding, the Coast Guard said. Results of those tests will not be released until the investigation has concluded.

William Spence, president of Massachusetts Bay Lines Inc. said in a statement that the captain immediately radioed a distress call when the ship crashed and took on water about a mile-and-a-half from shore, at about 10 a.m. Saturday. The company offered no further comment.

Passengers had boarded the boat a half-hour earlier at Rowes Wharf in Boston and was headed out to Stellwagen Bank when it crashed into the rocky area known as Devil’s Bank Ledge. The boat had traveled about 100 feet outside the nearest buoy marking the borders of the South Channel, which runs through the outer harbor.

Two Coast Guard officers reached Sunday said they had never before witnessed an accident in that location, one that most experienced boaters steer clear of.

“Somebody who is responsible for a boat with that many people on board really should be aware,” said Coast Guard Petty Officer 2nd Class Michael Cella. “The channels are maybe a little confusing out there, but they’re well marked off to the experienced eye.”

According to published reports, several passengers said the boat veered out of the channel when a barge approached.

Boatswain’s Mate 1st Class Adriano Agostinio said when he arrived on the scene the Massachusetts was grounded and listing to the port side. The boat was down on the bow and the main deck was taking on water. He said it took about a half hour to evacuate passengers, all of whom were given life jackets.

“The passengers were fairly calm. I didn’t see any panic,” he said.

The Coast Guard coordinated the response with the help of State Police, local harbormasters, the state Environmental Police and several civilian boats. Agostinio said the last time he participated in such a large-scale rescue was when MassPort held an evacuation exercise concerning the staged-sinking of an airplane in Boston Harbor.

The tourists on the Massachusetts, who had come from across the country to experience Boston’s Fourth of July festivities, were brought to Point Allerton in Hull, about three miles away. From there, they boarded buses and The Freedom, another Mass Bay Line boat, to head back to Boston.

Mass Bay Lines is a subcontractor to Boston Harbor Cruises, which is the MBTA’s Hingham ferry service provider. There will be no impact on commuter boat service this week because the company has another vessel to ensure all scheduled trips are covered, MBTA spokesman Joe Pesaturo said.

The Massachusetts is now moored in a Chelsea shipyard awaiting repairs, after being towed from the scene on Saturday.

Material from the Associated Press was used in this report.


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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