AUSTIN-- New Year's Eve is a night of celebration and hope for a happier, healthier future, but if your celebration doesn't include having a sober ride home, your new year could begin on a much different note.
In their efforts to reduce drinking and driving, the Texas Department of Transportation is reminding Texans that having a sober ride home may be the most important part of their New Year's celebrations. TxDOT's Holiday P.A.S.S. (Person Appointed to Stay Sober) campaign has spent the month of December encouraging Texans to always take a sober ride home.
"New Year's Eve is a festive occasion, but no one wants to begin their new year with a DWI. Instead, we are encouraging Texans to plan ahead for a sober ride home before attending New Year's Eve parties," said John Barton, TxDOT deputy executive director.
During last year's holiday season (Dec. 1, 2011, through Jan. 1, 2012) there were 2,462 alcohol-related traffic crashes in Texas, resulting in 842 serious injuries and 78 fatalities (TxDOT, 2012). This holiday season, law enforcement officers throughout the state will work thousands of additional hours to crack down on drunk driving. Many cities and towns in Texas will implement "no refusal" programs over the New Year holiday period.
During the month of December, the Texas Hospitality Association has assisted TxDOT in spreading the important message about having your Holiday P.A.S.S. The association distributed customizable sober driver "gift certificates" and other materials in stores across the state where alcohol is sold. Additionally, award-winning mixologist, Rob Pate, owner of restaurants Peche and Cherry Street in Austin, created four signature non-alcoholic drinks that will be perfect for New Year's Eve parties.
For tips on planning for sober rides home after New Year's Eve celebrations, visit the Holiday P.A.S.S. Facebook page or the Pinterest page . You will also find recipes for our original non-alcoholic drinks there.
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Source: Herald Online (TxDOT, 12/27)
Friday, December 28, 2012
Wednesday, December 26, 2012
5 Key Steps To Staying Safe In Winter Driving
1. Make sure you and your car are properly equipped before you leave.
Do a quick check of your vehicle before you hit the road. Make sure that your car has ample antifreeze, the windshield is clean and you have plenty of windshield washer fluid, the headlights are clean and in working order and the tires have tread and are properly inflated. Also, make sure to have your battery tested, to avoid being stranded in the cold with a car that won't start.
In addition to your vehicle's mechanical equipment, it's important to keep some extra items in the trunk or glove box in case of emergency. Equip your car with a flashlight and extra batteries, a first aid kit, warm clothes, and a blanket. Remember to have sunglasses in the car as well. Its amazing how many people drive in the winter without them. The glare of the sun off of snow and ice can be more intense in the winter than it is in the summer.
One last thing to remember, perhaps the most important of all: Your cell phone.
2. Slow down and drive smoothly.
This may seem like a no-brainer, but even if you're driving an SUV or a four-wheel-drive truck, you cannot safely do 80 mph during a snowstorm. Four-wheel-drive may help your vehicle get going in the slushy stuff, but it's of no use when you're trying to steer or safely stop on a slippery road surface.
It is also important to avoid abrupt acceleration, braking and turns. Doing so can cause your vehicle to lose traction and can launch you into an uncontrollable skid, leading to a collision.
Driving too quickly is the main cause of accidents in winter conditions. Just be patient and accept the fact that it is going to take longer to arrive at your destination.
3. Do not tailgate.
It is important to remember that it takes a much longer distance to stop your vehicle in the snow or ice due to the greatly reduced traction, even with just a light covering on the road. You may think that the driver in front of you doing 35 mph on the freeway is going too slow and needs a reminder in the form of you riding their bumper, but doing so is dangerous. Be patient and stay back until it's safe to pass.
Tailgating often leads to accidents, especially if you are driving in stop-and-go traffic. If the car in front of you stops abruptly and you are following too closely, you can reflexively slam on the brakes and end up sliding into it. The resulting accident may be no more than a fender-bender, but having to deal with it on a busy road in the snow is certainly something that you want to avoid, especially if other cars are sliding around as well. Many serious accident injuries come from a second impact from another car after a seemingly trivial collision.
4. Do not use cruise control.
For some, driving with cruise control has become almost second nature. Sure, it prevents you from getting leg fatigue, keeps you from unwittingly speeding and is great on long trips, but driving with it on in winter conditions can be unsafe. Thus, if cruise control has become a staple of your driving habits, make a conscious effort to ensure that you are not using it in winter weather.
Using cruise control in the snow, ice or even rain is dangerous because if your car hydroplanes or skids, it will accelerate and rapidly spin the wheels since it will be trying to maintain a constant speed. If this happens, it will be more likely that you lose control of your vehicle.
5. Pull over or stay home.
If at any point during your trip -- or before you even leave -- you feel that the weather is too bad to continue driving, simply stay put. If you're out on the road, find a safe spot to pull over and wait until the weather passes or calms to the point where you feel comfortable driving again. If you haven't left yet, stay home and off the roads.
Remember, there is no shame in making the logical decision to stay in when the conditions are bad. You may be late arriving to your destination, but arriving late in one piece is much better than the alternative. Your boss or significant other will understand.
_____________________________________
Source: Aol Autos (Zak, 12/21)
Do a quick check of your vehicle before you hit the road. Make sure that your car has ample antifreeze, the windshield is clean and you have plenty of windshield washer fluid, the headlights are clean and in working order and the tires have tread and are properly inflated. Also, make sure to have your battery tested, to avoid being stranded in the cold with a car that won't start.
In addition to your vehicle's mechanical equipment, it's important to keep some extra items in the trunk or glove box in case of emergency. Equip your car with a flashlight and extra batteries, a first aid kit, warm clothes, and a blanket. Remember to have sunglasses in the car as well. Its amazing how many people drive in the winter without them. The glare of the sun off of snow and ice can be more intense in the winter than it is in the summer.
One last thing to remember, perhaps the most important of all: Your cell phone.
2. Slow down and drive smoothly.
This may seem like a no-brainer, but even if you're driving an SUV or a four-wheel-drive truck, you cannot safely do 80 mph during a snowstorm. Four-wheel-drive may help your vehicle get going in the slushy stuff, but it's of no use when you're trying to steer or safely stop on a slippery road surface.
It is also important to avoid abrupt acceleration, braking and turns. Doing so can cause your vehicle to lose traction and can launch you into an uncontrollable skid, leading to a collision.
Driving too quickly is the main cause of accidents in winter conditions. Just be patient and accept the fact that it is going to take longer to arrive at your destination.
3. Do not tailgate.
It is important to remember that it takes a much longer distance to stop your vehicle in the snow or ice due to the greatly reduced traction, even with just a light covering on the road. You may think that the driver in front of you doing 35 mph on the freeway is going too slow and needs a reminder in the form of you riding their bumper, but doing so is dangerous. Be patient and stay back until it's safe to pass.
Tailgating often leads to accidents, especially if you are driving in stop-and-go traffic. If the car in front of you stops abruptly and you are following too closely, you can reflexively slam on the brakes and end up sliding into it. The resulting accident may be no more than a fender-bender, but having to deal with it on a busy road in the snow is certainly something that you want to avoid, especially if other cars are sliding around as well. Many serious accident injuries come from a second impact from another car after a seemingly trivial collision.
4. Do not use cruise control.
For some, driving with cruise control has become almost second nature. Sure, it prevents you from getting leg fatigue, keeps you from unwittingly speeding and is great on long trips, but driving with it on in winter conditions can be unsafe. Thus, if cruise control has become a staple of your driving habits, make a conscious effort to ensure that you are not using it in winter weather.
Using cruise control in the snow, ice or even rain is dangerous because if your car hydroplanes or skids, it will accelerate and rapidly spin the wheels since it will be trying to maintain a constant speed. If this happens, it will be more likely that you lose control of your vehicle.
5. Pull over or stay home.
If at any point during your trip -- or before you even leave -- you feel that the weather is too bad to continue driving, simply stay put. If you're out on the road, find a safe spot to pull over and wait until the weather passes or calms to the point where you feel comfortable driving again. If you haven't left yet, stay home and off the roads.
Remember, there is no shame in making the logical decision to stay in when the conditions are bad. You may be late arriving to your destination, but arriving late in one piece is much better than the alternative. Your boss or significant other will understand.
_____________________________________
Source: Aol Autos (Zak, 12/21)
Wednesday, December 19, 2012
Safety Agency Widens Inquiry on Ford Floor Mats
The National Highway Traffic Safety Administration has intensified an investigation into whether 480,000 Ford, Lincoln and Mercury vehicles have floors designed so that floor mats – if not properly secured – are nudged forward to snag the gas pedal and possibly cause unintended acceleration.
In a report posted on the agency’s Web site over the weekend, the agency says its investigation covers 2008-10 Ford Fusions, Mercury Milans and Lincoln MKZ models.
The agency says it is aware of 52 complaints from drivers who said floor mats prevented the accelerator pedal from returning to idle. But no accidents were reported.
Consumers who complained to the agency often said the unintended acceleration typically occurred after the driver pushed hard on the accelerator, as when merging onto a highway. But when the driver eased off the gas, the engine speed didn’t decrease. Drivers solved the problem by shifting into neutral or turning the engine off.
It seems possible, the agency report said, that the design of the floor pan can lift an unsecured floor mat so that it reaches the gas pedal.
The report noted mechanics who checked vehicles after owners complained of the problem blamed unsecured floor mats.
Ford changed the design of the pedals early in the 2010 model year, government investigators found. And, the “elevated rates of pedal entrapment” were found in the 2008 -10 model years before that change was made.
The agency began investigating the issue in May 2010 after receiving three complaints.
In a letter to the agency dated Sept. 9, 2011, Ford’s global director of automotive safety, Steven M. Kenner, wrote that problems with the gas pedal could occur only if the floor mat was not properly secured.
It is not a serious issue because the driver can move the floor mat with a foot or by tapping the accelerator pedal, Mr. Kenner wrote. Consequently, he said, Ford does not see a safety defect or “unreasonable risk” to safety.
More than two years is an unusually long time for the agency to go from a “preliminary evaluation” to the engineering analysis now under way. A spokeswoman for the safety agency could not immediately be reached for comment.
______________________
Source: The New York Times (Jensen, 12/17)
In a report posted on the agency’s Web site over the weekend, the agency says its investigation covers 2008-10 Ford Fusions, Mercury Milans and Lincoln MKZ models.
The agency says it is aware of 52 complaints from drivers who said floor mats prevented the accelerator pedal from returning to idle. But no accidents were reported.
Consumers who complained to the agency often said the unintended acceleration typically occurred after the driver pushed hard on the accelerator, as when merging onto a highway. But when the driver eased off the gas, the engine speed didn’t decrease. Drivers solved the problem by shifting into neutral or turning the engine off.
It seems possible, the agency report said, that the design of the floor pan can lift an unsecured floor mat so that it reaches the gas pedal.
The report noted mechanics who checked vehicles after owners complained of the problem blamed unsecured floor mats.
Ford changed the design of the pedals early in the 2010 model year, government investigators found. And, the “elevated rates of pedal entrapment” were found in the 2008 -10 model years before that change was made.
The agency began investigating the issue in May 2010 after receiving three complaints.
In a letter to the agency dated Sept. 9, 2011, Ford’s global director of automotive safety, Steven M. Kenner, wrote that problems with the gas pedal could occur only if the floor mat was not properly secured.
It is not a serious issue because the driver can move the floor mat with a foot or by tapping the accelerator pedal, Mr. Kenner wrote. Consequently, he said, Ford does not see a safety defect or “unreasonable risk” to safety.
More than two years is an unusually long time for the agency to go from a “preliminary evaluation” to the engineering analysis now under way. A spokeswoman for the safety agency could not immediately be reached for comment.
______________________
Source: The New York Times (Jensen, 12/17)
Friday, December 14, 2012
Bad to the bone: A medical horror story
FORTUNE -- On Nov. 16, 2011, Georgia Baddley, a 70-year-old woman living near Salt Lake City, received a shocking call from a special agent at the U.S. Department of Health and Human Services. The agent told her that the government had come across new information about her mother's death.
Baddley was speechless. Eight years before, her 83-year-old mother, Barbara Marcelino, had unexpectedly died during spine surgery. At the time, Baddley didn't question what had happened; surgery was always risky for a woman of that age. She was horrified when the agent told her that the surgeon had injected bone cement into her mother's spine and that the product -- which was not approved for that use -- may have played a role in her death.
The agent explained that the government had filed criminal charges against the maker of the cement, a company called Synthes, and four of its executives. After hanging up the phone, Baddley sat in stunned silence. "I was taken aback," she says. "I had no idea that anything like that had happened."
Most people have never heard of Synthes, a medical device maker headquartered in West Chester, Pa. But the company became part of one of the most recognizable names in health care in June when Johnson & Johnson (JNJ) completed the purchase of it for nearly $20 billion -- the largest acquisition in J&J's history. Market watchers cheered the deal, which will expand the company's stable of high-margin orthopedic products. J&J, which has endured a series of reputation-sullying recalls and lawsuits in recent years, specifically cited Synthes's "culture" and "values" as evidence of its appeal, even as former Synthes executives awaited sentencing on charges of grievous conduct.
In 2009 the U.S. attorney in Philadelphia accused the company of running illegal clinical trials -- essentially, experimenting on humans. Between 2002 and 2004, Synthes had tested a product called Norian XR, a cement that has a unique capacity to turn into bone when injected into the human skeleton. The Food and Drug Administration explicitly told Synthes not to promote Norian for certain spine surgeries, but the company pushed forward anyway. At least five patients who had Norian injected into their spines died on the operating-room table. One was Barbara Marcelino.
The indictment of Synthes and its executives shook the health care industry. What occurred is a classic example of corporate malfeasance, but set inside an insular corporation run by a reclusive and autocratic Swiss multibillionaire, the provider of the largest individual gift in the history of Harvard University. The case offers a rare, sometimes disturbing, glimpse inside the shrouded world of medical devices, where surgeons occasionally turn for advice during operations to twenty something sales representatives.
Most of all, this is a story about a company that repeatedly ignored evidence of potential lethal consequences. Interviews with more than 20 former employees and surgeons involved in the Norian project, hundreds of pages of court transcripts, and company documents submitted in the case reveal that Synthes not only disregarded multiple warnings that it was flouting the rules, but also brushed off scientists' cautions that the cement could cause fatal blood clots.VV The Department of Justice targeted four high-ranking executives, all of whom pleaded guilty to a misdemeanor under an unusual provision of health care law called the Responsible Corporate Officer Doctrine. They accepted responsibility for the company's crime of running unauthorized clinical trials and for engaging in off-label marketing, or promoting products for unapproved uses, without conceding that they were involved in the crime. At the time, no executive had ever gone to prison for such a charge.
(Lawyers for the four executives declined to make their clients available for interviews or to comment on the facts of the case.)
Off-label marketing is so common among drug and device makers that it's often dismissed as the equivalent of driving slightly over the speed limit. During the past decade, pharmaceutical behemoths such as Merck (MRK), Pfizer (PFE), Abbott Labs (ABT), and GlaxoSmithKline (GSK) have paid billions in fines to settle charges that they engaged in off-label drug promotion. Yet cases continue to happen, in part because the potential profits often exceed the fines.
But this wasn't the typical off-label marketing case. Nor was it typical of trials for medical devices or drugs. Patients sometimes die during such clinical trials -- but only after being advised of the risks and then granting their consent. In hiding the unapproved status of the cement, prosecutors argued, Synthes denied patients the right to choose whether they wanted to be test subjects.
For the Justice Department, the Synthes case posed an unprecedented opportunity. It could finally hold individual businessmen accountable for their actions. Mary Crawley, the assistant U.S. attorney who led the prosecution, urged the court to send the executives to jail for their "venal crime." The "callous disregard of patient safety," she argued, "warrants the highest sentence the law will allow."
Read the entire story at CNN’s website.
Baddley was speechless. Eight years before, her 83-year-old mother, Barbara Marcelino, had unexpectedly died during spine surgery. At the time, Baddley didn't question what had happened; surgery was always risky for a woman of that age. She was horrified when the agent told her that the surgeon had injected bone cement into her mother's spine and that the product -- which was not approved for that use -- may have played a role in her death.
The agent explained that the government had filed criminal charges against the maker of the cement, a company called Synthes, and four of its executives. After hanging up the phone, Baddley sat in stunned silence. "I was taken aback," she says. "I had no idea that anything like that had happened."
Most people have never heard of Synthes, a medical device maker headquartered in West Chester, Pa. But the company became part of one of the most recognizable names in health care in June when Johnson & Johnson (JNJ) completed the purchase of it for nearly $20 billion -- the largest acquisition in J&J's history. Market watchers cheered the deal, which will expand the company's stable of high-margin orthopedic products. J&J, which has endured a series of reputation-sullying recalls and lawsuits in recent years, specifically cited Synthes's "culture" and "values" as evidence of its appeal, even as former Synthes executives awaited sentencing on charges of grievous conduct.
In 2009 the U.S. attorney in Philadelphia accused the company of running illegal clinical trials -- essentially, experimenting on humans. Between 2002 and 2004, Synthes had tested a product called Norian XR, a cement that has a unique capacity to turn into bone when injected into the human skeleton. The Food and Drug Administration explicitly told Synthes not to promote Norian for certain spine surgeries, but the company pushed forward anyway. At least five patients who had Norian injected into their spines died on the operating-room table. One was Barbara Marcelino.
The indictment of Synthes and its executives shook the health care industry. What occurred is a classic example of corporate malfeasance, but set inside an insular corporation run by a reclusive and autocratic Swiss multibillionaire, the provider of the largest individual gift in the history of Harvard University. The case offers a rare, sometimes disturbing, glimpse inside the shrouded world of medical devices, where surgeons occasionally turn for advice during operations to twenty something sales representatives.
Most of all, this is a story about a company that repeatedly ignored evidence of potential lethal consequences. Interviews with more than 20 former employees and surgeons involved in the Norian project, hundreds of pages of court transcripts, and company documents submitted in the case reveal that Synthes not only disregarded multiple warnings that it was flouting the rules, but also brushed off scientists' cautions that the cement could cause fatal blood clots.VV The Department of Justice targeted four high-ranking executives, all of whom pleaded guilty to a misdemeanor under an unusual provision of health care law called the Responsible Corporate Officer Doctrine. They accepted responsibility for the company's crime of running unauthorized clinical trials and for engaging in off-label marketing, or promoting products for unapproved uses, without conceding that they were involved in the crime. At the time, no executive had ever gone to prison for such a charge.
(Lawyers for the four executives declined to make their clients available for interviews or to comment on the facts of the case.)
Off-label marketing is so common among drug and device makers that it's often dismissed as the equivalent of driving slightly over the speed limit. During the past decade, pharmaceutical behemoths such as Merck (MRK), Pfizer (PFE), Abbott Labs (ABT), and GlaxoSmithKline (GSK) have paid billions in fines to settle charges that they engaged in off-label drug promotion. Yet cases continue to happen, in part because the potential profits often exceed the fines.
But this wasn't the typical off-label marketing case. Nor was it typical of trials for medical devices or drugs. Patients sometimes die during such clinical trials -- but only after being advised of the risks and then granting their consent. In hiding the unapproved status of the cement, prosecutors argued, Synthes denied patients the right to choose whether they wanted to be test subjects.
For the Justice Department, the Synthes case posed an unprecedented opportunity. It could finally hold individual businessmen accountable for their actions. Mary Crawley, the assistant U.S. attorney who led the prosecution, urged the court to send the executives to jail for their "venal crime." The "callous disregard of patient safety," she argued, "warrants the highest sentence the law will allow."
Read the entire story at CNN’s website.
Tuesday, December 4, 2012
One Dead, One Injured In Head-On Crash On Central Texas Highway
PRAIRIE HILL--A Riesel man was killed and a Mexia man was injured Tuesday night in a head-on crash just west of Prairie Hill on U.S. Highway 84.
A Texas Department of Public Safety trooper who investigated the accident said Barton Smith, 42, died just after 6:10 p.m. Tuesday after the 2000 Oldsmobile Alero he was driving collided with a 2007 Chevrolet Sliverado pickup truck.
Cesar Riojas, 37, of Mexia, was taken to Hillcrest Baptist Medical Center, in Waco where Wednesday he was listed in stable condition.
Trooper James Willis said Smith was westbound in the eastbound lane of U.S. 84 near Prairie Hill when his car and the eastbound pick up truck collided.
Willis did not mention any other victims.
Smith's body was taken to Blair-Stubbs Funeral Home, in Mexia, where arrangements were pending Wednesday.
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Source: KWTX (Gately, 11/28)
A Texas Department of Public Safety trooper who investigated the accident said Barton Smith, 42, died just after 6:10 p.m. Tuesday after the 2000 Oldsmobile Alero he was driving collided with a 2007 Chevrolet Sliverado pickup truck.
Cesar Riojas, 37, of Mexia, was taken to Hillcrest Baptist Medical Center, in Waco where Wednesday he was listed in stable condition.
Trooper James Willis said Smith was westbound in the eastbound lane of U.S. 84 near Prairie Hill when his car and the eastbound pick up truck collided.
Willis did not mention any other victims.
Smith's body was taken to Blair-Stubbs Funeral Home, in Mexia, where arrangements were pending Wednesday.
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Source: KWTX (Gately, 11/28)
Monday, December 3, 2012
Federal investigation says state hospital failed in care of patient who died
When Brandy Bell was committed to Rusk State Hospital on May 14, there was little doubt she was a complicated patient with a long history of psychiatric problems. But one of her current struggles was painfully obvious.
“She was starving herself,” said Bell’s mother, Rita. “She wanted to die.”
During the Conroe woman’s 16 days at the state hospital, Bell virtually stopped eating. She lost 9 pounds in nine days, according to her medical records, grew dehydrated and lost strength. She began using a wheelchair.
On May 30, she died. She was 33.
Officially, Bell’s autopsy said she died from blood clots in her lungs. But a subsequent examination of her case by a federal Medicare investigator also concluded the hospital made crucial mistakes by neglecting Bell’s self-starvation and providing substandard nursing care.
Bell’s case is one of three cases involving state hospital patients with eating disorders being investigated by Disability Rights Texas, a federally funded protection and advocacy group. The other two patients — one is in Austin State Hospital, the other in Big Spring — are still alive.
For clinicians, eating disorders can further complicate treatment of patients who already have serious psychiatric problems. Experts say the circumstances surrounding Bell’s death while in state care pose a host of medical and legal questions on how best to monitor and treat patients who endanger themselves by refusing to eat — and when to force-feed them, if necessary.
“The question is whether or not the patient was engaging in behavior that was posing a significant risk to his life,” said Floyd Jennings, a clinical psychologist and attorney who advises the Harris County Public Defender’s Office. He stressed that while he had no direct knowledge of Bell’s case, “clinicians have a duty to begin intervening before it becomes a matter of life and death.”
The are currently 85 patients with diagnosed eating disorders at the state psychiatric hospitals, said Carrie Williams, spokeswoman for the Department of State Health Services, which oversees the facilities. That doesn’t include people without such diagnoses who temporarily refuse food for other reasons, such as paranoia.
The state psychiatric hospitals have no set protocol for treating patients with eating problems, Williams said. People whose primary illness is an eating disorder generally aren’t admitted to state psychiatric hospitals. But when they are, she said, treatment is determined on a case-by-case basis and might include extra attention to a patient’s physical condition, food intake and hydration.
According to medical records obtained by the Statesman, that never happened with Bell — even though Rusk State Hospital staffers knew from the start that she had struggled with eating problems.
Bell “was a known patient at Rusk with an identified eating disorder,” said Robin Thorner, a Disability Rights attorney. “Her death raises many questions about how the state hospitals identify and treat patients with eating disorders. It remains to be seen whether staff have sufficient expertise to provide quality care to patients with a co-occurring eating disorder.”
Williams said quality treatment is a priority at all the hospitals.
“The goal is to meet the needs of every single one of our patients and provide good, quality care,” she said. “We’re constantly evaluating how we’re doing. There is always room for improvement, and we learn from our experiences.”
Rusk State Hospital has figured in previous reporting by the Statesman this year. In February, a psychiatrist who had been sanctioned for having sexual relationships with his patients resigned after the hospital began disciplinary action against him because he appeared to be under the influence of drugs or alcohol at work. He was one of two psychiatrists at Rusk with a history of sexual misconduct, the Statesman reported. And in April the state opened an investigation into the case of a patient at Rusk who overdosed on illicit drugs at the facility. Records showed the patient claimed he obtained the drugs from a hospital employee.
‘She was sick’
According to her mother, Bell had struggled in the weeks before her admission to Rusk State Hospital. Embroiled in a Child Protective Services case involving her three young children, she refused to take her psychiatric medicine. At one point, she tried to jump out of a moving vehicle.
Already diagnosed with schizophrenia, bipolar and borderline personality disorders, Bell had been admitted to Rusk State Hospital two other times, Rita Bell said. By May, Brandy Bell was living at her parents’ home, refusing to eat and lying on the couch all day.
“She couldn’t help it,” Rita Bell said. “She was sick.” After several days in a local mental health center, Brandy Bell was committed by a court to Rusk State Hospital, a 335-bed inpatient facility about 130 miles southeast of Dallas.
Texas’s 10 state-run psychiatric hospitals provide medication and treatment programs for people with profound mental illnesses. About 2,500 patients reside in those hospitals at any day, and 14,400 people are admitted each year. The facilities provide routine medical care, such as basic physicals and monitoring of stable patients with disorders such as high blood pressure or diabetes, Williams said.
She added that, for those with serious eating issues, doctors might order diagnostic tests, consultations with dietitians and regular assessments of nutritional status by registered nurses. Patients may be placed on special precautions, with increased monitoring of weight, food and fluid intake.
A May 15 chart entry observed that Bell hadn’t been eating much in the three weeks preceding her admission and that she had once been diagnosed with bulimia. A nutritional assessment two days later noted that she had an “eating disorder” but offered no specific diagnosis, such as bulimia or anorexia.
Complicating Bell’s food history was that at 5’4” and 151 pounds, she was borderline obese, Rusk records said. A nutritional assessment in her chart noted that she had been counseled on “the importance of a healthy diet, limiting sugar and making healthy food choices.” She was also encouraged to exercise regularly.
In the early days of her admission, Bell was monitored closely to ensure she didn’t hurt herself, the documents show. After she showed no signs of obvious self-abuse, she was placed on routine supervision. When Bell continued to reject medication, staffers got a court order requiring her to take the drugs.
Food was another matter. More than a dozen entries in Bell’s records document her self-starvation, noting that she “has not eaten in days,” was “refusing most meals,” and “refused to eat lunch.”
It is not uncommon for psychiatric patients to refuse food in the hospital — and not easy to decide when to intervene, said Dr. Susan Stone, a Bastrop County psychiatrist and lawyer. Some medications are appetite suppressants. Rejecting food can also be related to paranoia or other conditions. Whether seeking legal permission to force nutrition or medication on a patient, the grounds are similar, Jennings said: “It is subjective, but would be tested by reasonableness and evidence. For example, even if a person hadn’t been eating for a while, had he been drinking? Do blood tests show an electrolyte imbalance that puts his health at risk?”
If so, the treating physician can ask a judge to order feeding, which at Rusk would require transfer to another medical facility for tube feeding.
But her medical records indicate that was never done, even as Bell kept refusing to eat, and her condition continued to deteriorate. One chart entry states that she appeared depressed, wouldn’t participate in activities and often refused to speak. “She is spending most of her time on the ward just sitting and staring with little to no interaction with her peers,” her social worker wrote.
‘Unresponsive’
One week before Bell’s death, a psychiatrist wrote in her medical chart that she had lost 9 pounds in nine days. The doctor suggested giving her liquids with electrolytes, such as Pedialyte or Gatorade.
“Otherwise, the role of non-psychiatric health care intervention is very limited at this time,” he wrote. “Ms. Bell’s refusal to eat, like her refusal to speak, appears to be psychogenic in origin, exactly why she was admitted to (Rusk State Hospital) in the first place.”
Bell had become paranoid, suspicious and depressed, records state. One day, she pulled off all her clothes and sat on a dayroom couch. On May 26, after nine days without a shower, staffers convinced her to bathe.
“Staff reported that she was in tears the whole time she showered and would not tell her what was wrong or talk to her,” medical document note.
By May 29, Bell was very pale and had thrown up twice that morning, her medical records show. That day, a nurse wrote in Bell’s medical records “Med clinic referral put in for c/o sore throat and not eating for days.”
“The night before she died, they tried to give her two cans of Ensure,” recalled Lea Miller, a fellow patient in Bell’s unit who has since been discharged. “She took one can and gave it away. The other can, she drank about half of it and poured the rest down the drain.”
Shortly after 6 a.m. on May 30, a nurse found Bell asleep on a dayroom couch and told her that she needed to have some blood drawn. Bell walked to the lab room, but was unsteady on her feet, records state.
“She sat in the chair and I turned to get the supplies,” the nurse wrote. “When I turned back to Brandy, she was slumped over forward and I thought she was doing something with her shoe. I asked her to sit up for me and she did not move. I touched her to help her sit up and realized she was unresponsive.”
Bell was revived and taken to East Texas Medical Center, where she was diagnosed with dehydration, low potassium and low blood pressure. “While at the emergency room, the decedent requested to use the restroom and during transfer to the restroom she became acutely unresponsive,” states the autopsy report by Forensic Medical Management Services of Texas.
Bell was declared dead at 10:52 a.m. A Rusk staffer called Rita Bell to give her the news.
“I just started slamming my hand on the table and screaming,” Rita Bell said.
The official cause of death was bilateral pulmonary emboli — blood clots — which can be caused by prolonged immobilization or bed rest. But the autopsy also found that Brandy Bell had starvation ketosis, a condition in which the body burns fat instead of carbohydrates and can lead to coma, seizures or death.
In August, an investigator with the Centers for Medicare and Medicaid Services — which funds treatment for some state hospital patients — made an unannounced visit to Rusk in response to a complaint about the circumstances surrounding Bell’s death. While the investigator didn’t single out any one staffer, she determined that that Rusk had given Bell substandard nursing care by failing to document everything she ate and drank, failing to regularly monitor her weight and failing to assess her care needs and medical status.
Rusk’s quality director, whose job is to improve patient care, responded by saying that the hospital’s “focus was on the psychiatric issues and not the possibility of medical issues,” according the report. She told the investigator that “the patient’s weight was slightly over the weight range for her age and height and that there were no visible signs that the patient was not eating or drinking.”
The federal inspector didn’t fine or penalize the hospital for its failings. In response to the report, Rusk State Hospital said it would make sure registered nurses “evaluate patient care needs, patient health status and patient response to interventions.” It also agreed to develop patient documentation requirements for its nurses, train nurses on how to deal with changes in patients’ eating habits and regularly sample its medical records to ensure proper documentation.
That’s small consolation to Rita Bell, whose grandchildren are now living with relatives. “She should have been in the hospital, and she should have been treated with IVs,” she said.
The family wanted to bury Brandy Bell in a nice coffin, but they couldn’t afford it, Rita Bell said. So they had her cremated, wrapped the plastic box in black velvet, decorated it with a silver bow and buried it.
Now her family is trying to make sense of why she died. “We don’t know what happened,” Rita Bell said. “She went there for help.”
________________________________
Source: The Statesman (Ball/Dexheimer, 12/01)
“She was starving herself,” said Bell’s mother, Rita. “She wanted to die.”
During the Conroe woman’s 16 days at the state hospital, Bell virtually stopped eating. She lost 9 pounds in nine days, according to her medical records, grew dehydrated and lost strength. She began using a wheelchair.
On May 30, she died. She was 33.
Officially, Bell’s autopsy said she died from blood clots in her lungs. But a subsequent examination of her case by a federal Medicare investigator also concluded the hospital made crucial mistakes by neglecting Bell’s self-starvation and providing substandard nursing care.
Bell’s case is one of three cases involving state hospital patients with eating disorders being investigated by Disability Rights Texas, a federally funded protection and advocacy group. The other two patients — one is in Austin State Hospital, the other in Big Spring — are still alive.
For clinicians, eating disorders can further complicate treatment of patients who already have serious psychiatric problems. Experts say the circumstances surrounding Bell’s death while in state care pose a host of medical and legal questions on how best to monitor and treat patients who endanger themselves by refusing to eat — and when to force-feed them, if necessary.
“The question is whether or not the patient was engaging in behavior that was posing a significant risk to his life,” said Floyd Jennings, a clinical psychologist and attorney who advises the Harris County Public Defender’s Office. He stressed that while he had no direct knowledge of Bell’s case, “clinicians have a duty to begin intervening before it becomes a matter of life and death.”
The are currently 85 patients with diagnosed eating disorders at the state psychiatric hospitals, said Carrie Williams, spokeswoman for the Department of State Health Services, which oversees the facilities. That doesn’t include people without such diagnoses who temporarily refuse food for other reasons, such as paranoia.
The state psychiatric hospitals have no set protocol for treating patients with eating problems, Williams said. People whose primary illness is an eating disorder generally aren’t admitted to state psychiatric hospitals. But when they are, she said, treatment is determined on a case-by-case basis and might include extra attention to a patient’s physical condition, food intake and hydration.
According to medical records obtained by the Statesman, that never happened with Bell — even though Rusk State Hospital staffers knew from the start that she had struggled with eating problems.
Bell “was a known patient at Rusk with an identified eating disorder,” said Robin Thorner, a Disability Rights attorney. “Her death raises many questions about how the state hospitals identify and treat patients with eating disorders. It remains to be seen whether staff have sufficient expertise to provide quality care to patients with a co-occurring eating disorder.”
Williams said quality treatment is a priority at all the hospitals.
“The goal is to meet the needs of every single one of our patients and provide good, quality care,” she said. “We’re constantly evaluating how we’re doing. There is always room for improvement, and we learn from our experiences.”
Rusk State Hospital has figured in previous reporting by the Statesman this year. In February, a psychiatrist who had been sanctioned for having sexual relationships with his patients resigned after the hospital began disciplinary action against him because he appeared to be under the influence of drugs or alcohol at work. He was one of two psychiatrists at Rusk with a history of sexual misconduct, the Statesman reported. And in April the state opened an investigation into the case of a patient at Rusk who overdosed on illicit drugs at the facility. Records showed the patient claimed he obtained the drugs from a hospital employee.
‘She was sick’
According to her mother, Bell had struggled in the weeks before her admission to Rusk State Hospital. Embroiled in a Child Protective Services case involving her three young children, she refused to take her psychiatric medicine. At one point, she tried to jump out of a moving vehicle.
Already diagnosed with schizophrenia, bipolar and borderline personality disorders, Bell had been admitted to Rusk State Hospital two other times, Rita Bell said. By May, Brandy Bell was living at her parents’ home, refusing to eat and lying on the couch all day.
“She couldn’t help it,” Rita Bell said. “She was sick.” After several days in a local mental health center, Brandy Bell was committed by a court to Rusk State Hospital, a 335-bed inpatient facility about 130 miles southeast of Dallas.
Texas’s 10 state-run psychiatric hospitals provide medication and treatment programs for people with profound mental illnesses. About 2,500 patients reside in those hospitals at any day, and 14,400 people are admitted each year. The facilities provide routine medical care, such as basic physicals and monitoring of stable patients with disorders such as high blood pressure or diabetes, Williams said.
She added that, for those with serious eating issues, doctors might order diagnostic tests, consultations with dietitians and regular assessments of nutritional status by registered nurses. Patients may be placed on special precautions, with increased monitoring of weight, food and fluid intake.
A May 15 chart entry observed that Bell hadn’t been eating much in the three weeks preceding her admission and that she had once been diagnosed with bulimia. A nutritional assessment two days later noted that she had an “eating disorder” but offered no specific diagnosis, such as bulimia or anorexia.
Complicating Bell’s food history was that at 5’4” and 151 pounds, she was borderline obese, Rusk records said. A nutritional assessment in her chart noted that she had been counseled on “the importance of a healthy diet, limiting sugar and making healthy food choices.” She was also encouraged to exercise regularly.
In the early days of her admission, Bell was monitored closely to ensure she didn’t hurt herself, the documents show. After she showed no signs of obvious self-abuse, she was placed on routine supervision. When Bell continued to reject medication, staffers got a court order requiring her to take the drugs.
Food was another matter. More than a dozen entries in Bell’s records document her self-starvation, noting that she “has not eaten in days,” was “refusing most meals,” and “refused to eat lunch.”
It is not uncommon for psychiatric patients to refuse food in the hospital — and not easy to decide when to intervene, said Dr. Susan Stone, a Bastrop County psychiatrist and lawyer. Some medications are appetite suppressants. Rejecting food can also be related to paranoia or other conditions. Whether seeking legal permission to force nutrition or medication on a patient, the grounds are similar, Jennings said: “It is subjective, but would be tested by reasonableness and evidence. For example, even if a person hadn’t been eating for a while, had he been drinking? Do blood tests show an electrolyte imbalance that puts his health at risk?”
If so, the treating physician can ask a judge to order feeding, which at Rusk would require transfer to another medical facility for tube feeding.
But her medical records indicate that was never done, even as Bell kept refusing to eat, and her condition continued to deteriorate. One chart entry states that she appeared depressed, wouldn’t participate in activities and often refused to speak. “She is spending most of her time on the ward just sitting and staring with little to no interaction with her peers,” her social worker wrote.
‘Unresponsive’
One week before Bell’s death, a psychiatrist wrote in her medical chart that she had lost 9 pounds in nine days. The doctor suggested giving her liquids with electrolytes, such as Pedialyte or Gatorade.
“Otherwise, the role of non-psychiatric health care intervention is very limited at this time,” he wrote. “Ms. Bell’s refusal to eat, like her refusal to speak, appears to be psychogenic in origin, exactly why she was admitted to (Rusk State Hospital) in the first place.”
Bell had become paranoid, suspicious and depressed, records state. One day, she pulled off all her clothes and sat on a dayroom couch. On May 26, after nine days without a shower, staffers convinced her to bathe.
“Staff reported that she was in tears the whole time she showered and would not tell her what was wrong or talk to her,” medical document note.
By May 29, Bell was very pale and had thrown up twice that morning, her medical records show. That day, a nurse wrote in Bell’s medical records “Med clinic referral put in for c/o sore throat and not eating for days.”
“The night before she died, they tried to give her two cans of Ensure,” recalled Lea Miller, a fellow patient in Bell’s unit who has since been discharged. “She took one can and gave it away. The other can, she drank about half of it and poured the rest down the drain.”
Shortly after 6 a.m. on May 30, a nurse found Bell asleep on a dayroom couch and told her that she needed to have some blood drawn. Bell walked to the lab room, but was unsteady on her feet, records state.
“She sat in the chair and I turned to get the supplies,” the nurse wrote. “When I turned back to Brandy, she was slumped over forward and I thought she was doing something with her shoe. I asked her to sit up for me and she did not move. I touched her to help her sit up and realized she was unresponsive.”
Bell was revived and taken to East Texas Medical Center, where she was diagnosed with dehydration, low potassium and low blood pressure. “While at the emergency room, the decedent requested to use the restroom and during transfer to the restroom she became acutely unresponsive,” states the autopsy report by Forensic Medical Management Services of Texas.
Bell was declared dead at 10:52 a.m. A Rusk staffer called Rita Bell to give her the news.
“I just started slamming my hand on the table and screaming,” Rita Bell said.
The official cause of death was bilateral pulmonary emboli — blood clots — which can be caused by prolonged immobilization or bed rest. But the autopsy also found that Brandy Bell had starvation ketosis, a condition in which the body burns fat instead of carbohydrates and can lead to coma, seizures or death.
In August, an investigator with the Centers for Medicare and Medicaid Services — which funds treatment for some state hospital patients — made an unannounced visit to Rusk in response to a complaint about the circumstances surrounding Bell’s death. While the investigator didn’t single out any one staffer, she determined that that Rusk had given Bell substandard nursing care by failing to document everything she ate and drank, failing to regularly monitor her weight and failing to assess her care needs and medical status.
Rusk’s quality director, whose job is to improve patient care, responded by saying that the hospital’s “focus was on the psychiatric issues and not the possibility of medical issues,” according the report. She told the investigator that “the patient’s weight was slightly over the weight range for her age and height and that there were no visible signs that the patient was not eating or drinking.”
The federal inspector didn’t fine or penalize the hospital for its failings. In response to the report, Rusk State Hospital said it would make sure registered nurses “evaluate patient care needs, patient health status and patient response to interventions.” It also agreed to develop patient documentation requirements for its nurses, train nurses on how to deal with changes in patients’ eating habits and regularly sample its medical records to ensure proper documentation.
That’s small consolation to Rita Bell, whose grandchildren are now living with relatives. “She should have been in the hospital, and she should have been treated with IVs,” she said.
The family wanted to bury Brandy Bell in a nice coffin, but they couldn’t afford it, Rita Bell said. So they had her cremated, wrapped the plastic box in black velvet, decorated it with a silver bow and buried it.
Now her family is trying to make sense of why she died. “We don’t know what happened,” Rita Bell said. “She went there for help.”
________________________________
Source: The Statesman (Ball/Dexheimer, 12/01)
1 person killed in shuttle bus accident
HOUSTON -
One person was pinned to a pole and killed and 11 others were taken to the hospital after a bus accident in the Texas Medical Center.
It happened shortly before 6 p.m. at the intersection of South Braeswood and Holcombe.
Somehow the driver of the bus lost control moments before the crash happened. Investigators told KPRC Local 2 a passenger on the bus ran from the back to the front and tried to take hold of the wheel but the bus crashed.
"It is very possible the driver had a medical condition," said Deputy Chief Fernando Herrera with the Houston Fire Department." But that is not definitive yet."
"Somebody inside the shuttle told me she thought the driver may have passed out," said Alexis Perez. She saw the whole thing happen and was one of the first on the scene.
"I ran over there and there was about 10 of us trying to push the shuttle off the lady," Perez said. "I think she died on impact. I know somebody checked for a pulse and she didn't have one."
Deputy Chief Herrera said there were 17 people on the bus and 11 of them were taken to area hospitals to be treated for their injuries.
The most serious ,he said, was some abdominal bleeding on the driver and one patient was going in and out of consciousness.
"Almost everybody inside the shuttle was injured," said Perez. "Everyone was disoriented and we had one guy with a broken arm and gashes on his forehead. People were throwing up and one lady passed out completely."
The woman who was hit and killed in the crash hasn't been identified yet. The shuttle bus is used by Medical Center employees to get around the large campus. The crash remains under investigation.
__________________________
Source: Click2Houston (Bauer, 11/28)
It happened shortly before 6 p.m. at the intersection of South Braeswood and Holcombe.
Somehow the driver of the bus lost control moments before the crash happened. Investigators told KPRC Local 2 a passenger on the bus ran from the back to the front and tried to take hold of the wheel but the bus crashed.
"It is very possible the driver had a medical condition," said Deputy Chief Fernando Herrera with the Houston Fire Department." But that is not definitive yet."
"Somebody inside the shuttle told me she thought the driver may have passed out," said Alexis Perez. She saw the whole thing happen and was one of the first on the scene.
"I ran over there and there was about 10 of us trying to push the shuttle off the lady," Perez said. "I think she died on impact. I know somebody checked for a pulse and she didn't have one."
Deputy Chief Herrera said there were 17 people on the bus and 11 of them were taken to area hospitals to be treated for their injuries.
The most serious ,he said, was some abdominal bleeding on the driver and one patient was going in and out of consciousness.
"Almost everybody inside the shuttle was injured," said Perez. "Everyone was disoriented and we had one guy with a broken arm and gashes on his forehead. People were throwing up and one lady passed out completely."
The woman who was hit and killed in the crash hasn't been identified yet. The shuttle bus is used by Medical Center employees to get around the large campus. The crash remains under investigation.
__________________________
Source: Click2Houston (Bauer, 11/28)
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