And those most affected are African Americans, poor, uninsured and rural residents.

Researchers from the University of California, San Francisco examined changes in driving time to trauma centers, which have increasingly been shuttered in recent years. They found that by 2007, 69 million Americans — nearly one in four — had to travel farther to the nearest trauma center than they traveled in 2001.

“Trauma centers aren’t just for ‘certain’ people — if you sustain a serious injury from a car accident or fall off your roof, you need a trauma center,’’ said lead author Dr. Renee Y. Hsia, an assistant professor of emergency medicine at UCSF. She is also an attending physician in the emergency department at San Francisco General Hospital & Trauma Center and a Robert Wood Johnson Foundation Physician Faculty Scholar.

“We found evidence that vulnerable communities have less geographic access to trauma care, adding to their health disparities,’’ Hsia said in a news release. “This study will help us better understand how trauma center closures are affecting people.’’

Hsia’s research centers on illustrating inequalities in accessing trauma care as well as the decline of emergency care in the United States. She has documented that tens of millions of Americans do not have ready access to a certified trauma center, and that nearly a third of urban and suburban emergency rooms have closed in the last two decades.

Trauma services are not, as commonly believed, available in all hospitals. They are hospitals with emergency departments that provide specialty care for injured patients, regardless of ability to pay. As a result, trauma centers face greater financial jeopardy depending on the surrounding patient population.

For their new study, the researchers analyzed 31,475 ZIP codes in the United States, covering some 283 million people, nearly the entire nation.

Overall, nearly three-quarters of the U.S. lives within 10 miles of a trauma center. Of the remainder, 14 percent live more than 30 miles from a trauma center.

Communities with a higher number of residents under the federal poverty level, black residents, uninsured residents and rural residents faced longer drives compared to communities with a low share of these vulnerable populations.

For nearly 16 million people, the extra driving time amounts to about 30 minutes — a critical period for people facing life-threatening injuries such as stroke and gunshot wounds.

In 1990 there were 1,125 trauma centers in the United States; by 2005, about 30 percent of them had closed primarily because of the high costs and fewer patients able to pay the bills. The majority of closures took place in urban areas but rural communities have also been affected.

The authors recommend policy makers should subsidize trauma centers that treat a large number of African American, uninsured or poor people. In rural areas, they recommend that hospitals establish agreements with nearby trauma centers to ease transfers of seriously injured patients.

For more on medical safety issues, see the library of articles by Daytona Beach medical malpractice attorney.

“Although the prevalence of high blood lead levels has decreased, the health effects from lead exposure are well characterized,’ according to an agency release from  the Center for Disease Control and Prevention.  “Workers in the manufacturing, construction, and mining industries account for the highest proportions of workers with elevated levels.”

Lead exposure can result in acute or chronic adverse effects in multiple organ systems, ranging from subclinical changes in function to symptomatic, life-threatening toxicity.

Despite improvements in public health policies and substantial reductions in blood lead levels in adults, lead exposure remains an important health problem worldwide, the agency says.

To update rate trends and identify industry subsectors and nonoccupational activities with high lead exposures, CDC collected and analyzed 2008–2009 data from 40 states. Industry subsectors with the highest numbers of lead-exposed workers were battery manufacturing, secondary smelting and refining of nonferrous metals, and painting and paper hanging.

The most common nonoccupational exposures to lead were shooting firearms; remodeling, renovating, or painting; retained bullets (gunshot wounds); and lead casting.

The number of states with high prevalence of elevated levels decreased from six of 17 states in 1994 to three of 40 states in 2009.  State resident prevalence of elevated levels  for 2008 ranged from 0.5 per 100,000 employed adults in Hawaii to 37.6 in Pennsylvania;  and for 2009, from 0.3 in Hawaii to  32.0 in Pennsylvania.

To calculate annual state prevalences, the numbers of adults with elevated blood lead levels  from each of the 40 states reporting were divided by the state’s annual employed population and expressed as a rate per 100,000 employed adults. The combined state numerators and denominators for each year were then used to calculate national (40-state) prevalence rates for 2008-2009.

“The findings underscore the need for government agencies, employers, public health professionals, health-care providers, and worker-affiliated organizations to increase interventions to prevent workplace lead exposure, and the importance of conducting lead exposure surveillance to assess the effectiveness of these interventions,” the agency said.

Measures to improve and expand preventive interventions focused in the manufacturing, construction, and mining industries should be implemented by government agencies, employers, and worker-affiliated organizations, says the CDC. It is also important to conduct and improve lead exposure surveillance to assess the effectiveness of these interventions.

For more on medical safety issues, see the library of articles by Daytona Beach personal injury attorney.

Average hospital stays after total hip arthroplasty (replacement) has gone from 9 days in 1991 to 3.5 days in 2008, according to analysis of data from Medicare beneficiaries who underwent hip replacement or subsequent follow-up corrective surgery between 1991 and 2008.

That’s both good and bad news for hip replacement patients.

“The good news is you don’t have to stay in the hospital to recover,” said Dr. Peter Cram,  of the University of Iowa’s Roy J. and Lucille A. Carver College of Medicine and lead researcher on the study, in a press release. “The bad news is that you’re not in the hospital while you’re recovering.”

Total hip arthroplasty is a safe and effective therapy for patients with advanced degenerative joint disease. In recent years, there has been a dramatic increase in performance of this procedure both in the United States and abroad.

There is a general assumption that increasing experience with total hip arthroplasty has resulted in improvements in patient outcomes, as has been observed in other procedures, but rigorous empirical data documenting such improvement are limited. This lack of data are striking given that an estimated 280,000 total hip arthroplasty procedures are performed annually at a cost of more than $12 billion, according to background information in the article.

Cram and Yue Li, associate professor of internal medicine at the UI Carver College of Medicine, evaluated the long-term trends in the outcomes of Medicare beneficiaries undergoing primary hip replacement and follow-up corrective surgery and to explore whether reductions in hospital length of stay (LOS) might be associated with increased discharge of patients to postacute care settings, increased readmission rates, or a combination of both outcomes.

The study included data from between 1991 and 2008 on 1,453,493 Medicare Part A beneficiaries who underwent primary total hip arthroplasty and 348,596 who underwent revision total hip arthroplasty.

“In an analysis of 1991-2008 Medicare administrative data, 3 trends were identified. First, we found that despite increasing patient complexity, both unadjusted and adjusted mortality for primary total hip arthroplasty showed substantial improvement over time,” the authors note in the study. “Conversely, our second finding was that for revision total hip arthroplasty, unadjusted mortality appeared to increase modestly but this increase was largely explained by increasing patient complexity. Third and most importantly, marked declines in hospital LOS for both primary and revision total hip arthroplasty seemed to correspond with an increase in the proportion of patients who were discharged to postacute care and an increase in patient readmissions.”

For primary total hip arthroplasty, average hospital LOS decreased from 9.1 days to 3.7 days. After adjustment for patient characteristics, risk-adjusted 30-day mortality over the study period decreased from 0.7 percent to 0.3 percent and 90-day mortality decreased from 1.3 percent to 0.7 percent.

“What we found is that patients are staying in the hospital a much shorter amount of time, patient mortality is increasingly low, but an increasing number of patients are requiring readmission 30 to 90 days after their initial surgery,” Cram said.

The researchers also found that the proportion of primary total hip arthroplasty patients discharged to home decreased from 68 percent in 1991-1992 to 48.2 percent in 2007-2008, while the proportion of patients discharged to skilled or intermediate care increased from 17.8 percent to 34.3 percent. The 30-day all-cause readmission rate decreased from 5.9 percent in 1991-1992 to 4.6 percent in 2001-2002, before increasing to 8.5 percent in 2007-2008. Results were similar for 90-day readmission rates.

“For revision total hip arthroplasty, similar trends were observed in hospital LOS, in-hospital mortality, discharge disposition, and hospital readmission rates,” the authors write.

For more on medical safety issues, see the library of articles by Daytona Beach medical malpractice attorney.

Carefully listening to your doctor and asking questions about a diagnosis or test results are very important. But just when you should be paying close attention to what your doctor is saying, you may be shocked by the news.

That’s when having a health or patient advocate can help, according to Dr. Carolyn Clancy, director of the U.S. Agency for Healthcare Research and Quality, AHRQ.

A health advocate can be a family member, friend, trusted coworker, or a hired professional who accompanies you to your appointments and asks questions, writes down information, and speaks up for you so you can better understand your illness and get the care you need.

Research shows that quality health care requires taking an active role in decisions about your care. If you’re facing a difficult medical decision, it’s a good idea to bring someone with you who can help focus on your care when you’re not fully up to it.

In a survey of more than 12,000 Medicare beneficiaries, all age 65 or older, researchers found that more than a third of those surveyed reported that they were usually accompanied on visits to their doctors, most often by spouses or adult children, but frequently by other relatives, friends or neighbors.

A notable finding of the study was that the older people who regularly had companions with them stated they liked their doctors more and were more satisfied with the care they received than those who went alone. The companions’ usefulness was most beneficial for people who were especially vulnerable—those who were older, sicker or less educated than the others.

A health advocate can:

• Ask your doctor questions for you.
• Compile or update your medicine list.
• Help you follow your medication regimen and treatment instructions, including asking questions about follow-up care.
• Help arrange transportation.
• Research treatment options, procedures, doctors, and hospitals.
• File paperwork or assist with insurance matters.

Who makes a good health advocate?
A health advocate should be a person who is calm, pays attention to details, and can ask questions and state information clearly. If possible, choose someone who knows you well. Be clear about what kind of help you need and what worries you.

Some professional advocates specialize in researching the best available treatments and can assist you at home or in the hospital. Check to see if your health insurance covers these services.

You can also ask your local hospital staff to recommend a patient advocate. In fact, some hospitals and nursing homes employ advocates who work on patients’ behalf at no charge.

For more on patient safety issues, see the library or articles by Daytona Beach personal injury lawyer.

These black box warnings, as they are known, should be rendered uniform for all medications within a single class of drugs, according to a team of researchers from Greece and the United States. The team also advised that supplemental warnings (for example, following a drug withdrawal) should be added in a reasonable timeframe.

The work by Orestis Panagiotou and John Ioannidis and colleagues from the University of Ioannina School of Medicine in Greece and Stanford University School of Medicine in the USA is published in Springer’s journal Journal of General Internal Medicine.

The purpose of the black box warnings is to highlight major drug-related risks. Because serious drug-related adverse events tend to be down to the pharmacological class of drug rather than to the individual drug, most black box warnings are typically applied to all members of a given class of drugs.

Researchers looked at how consistent black box warning labelling is across same-class drugs in order to assess whether some drugs fail to carry a warning when black box warnings exist for other drugs in the category, as well as whether there are differences in the time it takes to add a warning to drugs in the same class. They studied the
labels of 20 drug classes (176 drugs in total) selected from the USA’s ‘Top 200 Drugs for 2008 by Sales’.

Of these 20 categories, 10 had at least one black box warning while the other 10 had none.The authors identified differences in 9 of the 20 classes, with 15 black box warnings not present on all the labels of drugs in the same class. For 10 of these 15 different warnings, the information was included elsewhere on the labels as simple warnings or
text. For the remaining 5, the black box context was not found anywhere else on the drugs’ labels.

Significantly, withdrawn drugs tended not to have a black box warning before their withdrawal and the reason for their withdrawal rarely became a black box warning for the other drugs in the same category. In addition, among the 10 drug classes with at least one warning, there was a considerable time-lag in black box warning acquisition in 8 categories, ranging from 2 months to 14 years in some cases.

The authors argue that labels should mention and justify why a major recognized risk is not an issue for a particular agent in the same class, where other members have demonstrated major toxicity. In their view, unjustified omission of a black box warning may leave patients largely unaware of potential risks.

“Our findings imply that the process of black box warning acquisition requires transparent and systematic rules, as well as clear justification for the presence of, or lack of evidence for, specific major risks for individual drugs,” the authors noted in a press release.

For more on medical safety issues, see the medical malpractice library of articles by Daytona Beach medical malpractice lawyer.

Previous research has shown that targeted quality improvement programs can reduce healthcare-associated infections, but this study is the first to link these programs to reduced death rates.

Researchers led by Allison Lipitz-Snyderman, Ph.D., of The Johns Hopkins Bloomberg School of Public Health, analyzed Medicare data for ICU patients in Michigan hospitals and 364 hospitals in 11 other
Midwestern states. They looked at data before the improvement project was initiated, while it was being phased in, and up to 22 months after implementation.

The researchers found that overall a person’s chance of dying decreased by about 24 percent in Michigan after the program was implemented compared to only 16 percent in surrounding Midwestern
states where the program was not implemented.

“We knew that when we applied safety science principles to the delivery of health care, we would dramatically reduce infections in intensive care units, and now we know we are also saving lives,” said
Dr. Peter J. Pronovost, a professor of anesthesiology and critical care medicine at The Johns Hopkins University School of Medicine, in a press release.

Dr. Pronovost led development of the Keystone Intensive Care Unit Project , sponsored by the Agency for Healthcare Research and Quality, and implemented it in Michigan hospitals with the help of the Michigan Health and Hospital Association.

The Keystone Project uses a comprehensive approach that includes promoting a culture of patient safety, improving communication among ICU staff teams, and implementing practices based on guidelines by the Centers for Disease Control and Prevention (CDC). These practices
include checklists and hand washing, to reduce rates of catheter-related bloodstream infections and ventilator-associated pneumonia.

According to the CDC, healthcare associated infections are one of the most common complications of hospital care, accounting for an estimated 1.7 million infections, and 99,000 associated deaths in
2002. These infections are responsible for $28 billion to $34 billion in preventable health care expenses every year. Infectious agents, such as bacteria, found in health care settings can cause patients to develop infections when they have surgery or require central lines or
urinary tract catheters.

“This study gives us assurance that investing in large-scale, evidence-based quality improvement programs can save lives — the most important outcome for patients and doctors,” said AHRQ Director Dr. Carolyn M. Clancy. “AHRQ and others have already initiated work to expand this project nationwide to other ICUs across the country.”

The study was published in the Jan. 31st British Medical Journal.

For more on medical quality issues, see the medical malpractice library of articles by Ormond Beach personal injury attorney.

In a rear end car accident, Florida law imposes a presumption that the rear driver is at fault. This presumption can be overcome with sufficient evidence. If the rear driver can show that the lead driver stopped or changed lanes abruptly or arbitrarily in a place that a reasonable person would not expect them to, then Florida law no longer presumes the rear driver to be negligent.

If the lead driver’s vehicle is stopped illegally, then Florida law no longer presumes the rear driver to be negligent.

Lastly, if the rear driver in the wreck can show that his or her car suffered from a mechanical failure like sudden brake failure (and the mechanical failure is not the fault of the rear driver) then Florida law no longer presumes the rear driver to be negligent.

These exceptions to the rear driver negligence presumption played an important role in a recent Florida wrongful death lawsuit involving a highway wreck. The case almost got thrown out of court until a judge ruled that the plaintiff (who represented the rear driver) presented enough evidence of the first exception.

Without evidence that the lead driver of a tractor trailer abruptly changed lanes and decelerated, the rear driver would have been presumed to be the negligent party and the case would likely have been thrown out of court.

At the wrongful death trial, the plaintiffs argued that Shands was negligent in hiring and supervising O’Quinn. A competent background check would have revealed his history of stealing drugs. In addition, Shands was informed by its employees that O’Quinn was stealing drugs and did not immediately dismiss him. Shands accepted his two weeks’ notice but did not restrict his access to the drugs.

Unfortunately, in that time, O’Quinn murdered Herndon with drugs stolen from Shands. O’Quinn had become infatuated with Herndon and injected her with the deadly drugs when she told him she was engaged to be married.

On appeal, the court ruled that a legal duty did exist because (1) Shands knew or should have know that the unsupervised release of hazardous, controlled drugs was dangerous; (2) a reasonable hospital would recognize that not implementing controls to keep dangerous drugs secure and supervised would expose the public to unreasonable risk of harm; and (3) Mischelle Herndon’s death was a foreseeable result of Shands negligent hiring and supervising of O’Quinn.

Though Shands did not know O’Quinn to have a violent history, the court ruled that his history of stealing drugs was enough to make harm to the public foreseeable to Shands in light of the hospital’s failure to secure its dangerous drugs.

The court explained that a legal duty exists where a general threat of harm to others exists. The threat of harm does not need to be specific to create a legal duty to protect.

“A common law duty is recognized, regardless of intervening criminal conduct, when a person’s actions ‘create “a foreseeable zone of risk” posing a general threat of harm to others.’… Moreover… the essence of the zone of risk is not the foreseeability of the specific injury that occurred, but whether the zone of risk poses a general threat of harm to others.’ See Hewitt v. Avis Rent-a-Car, 912 So.2d 682 (Fla. 1st DCA 2005)”

Art Zimmet is an injury lawyer who will tell you something most lawyers won’t. If you’ve been injured by the negligence of another, you might not need a lawyer. But before you sign any forms, speak with an insurance company or hire a lawyer, get the free books and information available at my Florida medical malpractice lawyer website. Also visit my Florida child injury lawyer blog  for Florida child injury legal resources. Both sites are full of valuable information and you won’t be disappointed.

That question raises several interesting topics about the burden of proof in civil jury trials. First of all, there is no such requirement anywhere in the legal world that requires a plaintiff or prosecutor to prove the case beyond a shadow of a doubt. That phrase is a fictional creation. The most difficult burden of proof is “beyond a reasonable doubt” and is used only in criminal proceedings. So unless the person who injured you is also charged criminally, that person will not face the “reasonable doubt standard.”

If your Florida injury case reaches trial, regardless of whether it is in Orlando, Jacksonville or Daytona Beach, we will only be required to prove your case by a “preponderance of the evidence.” That is the burden of proof in civil jury trials. We will be successful in proving the case if the jury decides that it is “more probable than not” that your injury was caused by a liable defendant.

The preponderance of evidence standard is the only burden of proof that is widely accepted as being quantifiable. The standard is satisfied if there is a greater than 50 percent chance that the proposition is true.

The last of the three standards for conviction is “clear and convincing evidence.” This standard is a more difficult burden to prove than a “preponderance of the evidence.” It is also much less commonly used – for example in habeas corpus and capital punishment cases.

To prevail, a jury must be convinced that it is substantially more likely than not that the thing is true. See how that’s different than the preponderance of the evidence burden? One is more likely than not while the other is substantially more likely than not. That means it’s substantially more difficult to prove that burden than the preponderance of the evidence burden (and even more difficult to prove a case beyond a reasonable doubt).

These are standards for conviction. Other legal standards exist as well such as probable cause, but that deals with search and seizure law and is inapplicable to civil injury trials.

So in summary, if you’ve been injured anywhere in Florida, be it Orange City, Deltona, Port Orange or Ponte Vedra, and you file a civil claim, we’ll have to prove your case by a preponderance of the evidence.

James Harvey Tipler had earlier pled guilty to solicitation to prostitution in his criminal case. Tipler agreed to let his client, an 18-year-old woman,  reduce her $2,300 fee for her assault case.

Every time he had sex with her, Tipler would reduce his fee $200. Every time she arranged for another girl to have sex with him, Tipler would reduce her fee by $400.

Tipler also altered evidence in the case against him and persuaded a witness to falsify testimony.

As if our reputation wasn’t already bad enough.