Developing Countries As Air Pollution’s Major Victims

1 August 2014 by , No Comments

The problem of air pollution has been so rampant and is only escalating since the last few decades. The earth’s atmosphere has indeed seen better days before the start of the Industrial Revolution. This has inevitably led to an increase in respiratory illnesses like asthma and lung cancer. In fact, according to the World Health Organization, ambient outdoor air pollution caused 3.7 million premature deaths worldwide in 2012 alone. This is a very alarming rate.

But what is more alarming is the report that says 88% of these premature deaths happened in low- and middle-income countries, with the greatest number in the Western Pacific and Southeast Asian regions. Underdeveloped and developing countries, therefore, receive the worst effects of air pollution. But why is it this way? The answer is globalization. [...]

Medical Marijuana – Your Questions Answered

29 July 2014 by , No Comments

medical marijuana picture - locateadocTo date, 23 US States have legalized the use of marijuana for medical purposes. The debate on whether this should be allowed or not is one that will rage on for many years to come with opinion firmly divided. Some say that, as a Class A drug it should not be allowed while others are all for the legalization.  The most commonly asked question is, what is medical marijuana used for?

Uses of Medical Marijuana

The most common use for medical marijuana is for pain management in conditions such as Chrohns disease and MS. Doctors will also prescribe it for: [...]

The Pros and Cons of Marijuana Use

14 August 2014 by , No Comments

Until now, several states have not yet made a decision on whether to legalize marijuana or not. There are those who argue that marijuana is not a harmful substance relative to alcohol. Thus, they question the legal production and consumption of alcohol whereas marijuana is not. On the other hand, there are those who believe that the legalization of marijuana will only cause rippling negative effects. Thus, it should not be legalized at all.

Why Marijuana is Good

There are a lot of studies that show how marijuana can treat certain diseases. These researches have proofs and were backed up lots of facts. Therefore, it is hard to argue on the idea that marijuana may be of great help to patients. There are patients who have seizures and were temporarily relieved because of marijuana. There were also those who have started showing signs of dementia and Alzheimer’s disease, but were somehow healed. Thus, in terms of medicinal use, marijuana is somehow of great help.

The Down Sides of Marijuana

The main reason why a lot of states still don’t legalize marijuana use is because it is an addictive substance that may alter how one’s mind works. Thus, if we already confront lots of problems due to intoxication and drug abuse, this might increase if we include those who are under the influence of marijuana should it be made legal. Those who smoke pot may do things that are beyond their control. Worse, if they can smoke pot any time, this could pose a huge threat on their health. Marijuana may weaken the immune system. It could also lead to lung diseases and other problems. In fact, studies have shown that cannabis contains more than 3 times the usual carcinogenic materials found in tobacco.

Using Vaporizers

For those who wish to use marijuana minus the nicotine and tar, then using vaporizers could be a great alternative. It allows people to inhale instead of smoke cannabis. The effects are also the same. The only difference is that the harmful substances are being screened out. You may even assemble vapor accessories by yourself. Go here if you need more information.

In the end, the decision lies ultimately on us. Do we want to enjoy marijuana for temporry happiness it brings or do we want to stay away from its negative effects?

Issues that May be Faced by Pot Dispensary Owners

14 August 2014 by , No Comments

There are lots of risks involved in opening up a pot dispensary. This is true even for states in which pot possession and selling for recreational use is legal. In fact, even if Colorado is among the first states to legalize marijuana use for recreational purposes, a lot of business owners still find it a hard to sell marijuana and let their business soar.

Angry Neighbors

To begin with, even if a particular state legalizes marijuana, not all cities within that state allow pot dispensaries to operate. In California, this is true. Thus, it is the first hurdle to those who plan to put up a pot dispensary. Another issue is the idea that neighboring business establishments might be against a pot dispensary located next to them. Of course, nobody wants to locate their business next to a place where people may get stoned.

Business owners especially for those who cater to children or are family-oriented, will most likely file an immediate complaint. Their business will be affected as their target clients will be scared to patronize them. When there is a pot dispensary nearby, it is also possible to find someone who is high in marijuana sitting somewhere in the vicinity. Though marijuana has positive effects to people who have diseases, it is still a drug. It may alter one’s way of thinking. Therefore, it puts everyone at risk. Imagine if there are dozens of people who are high in marijuana sitting in the vicinity of the business establishment.

Control of Users

Though pot dispensary owners are not directly in control of those who buy from them and what they do with marijuana, they will still feel liable should these people commit something wrong. Dispensary owners are the sources of the drug. Thus, they are more or less the reasons why the person committed something wrong. If some users become addicted to the drug or has eventually suffered from health problems, then it could also make one feel extremely guilty.

Well, if you are still interested in opening up a dispensary, you may visit Portland Dispensary here and learn from them.

The Use of Marijuana for Medical Purposes

12 August 2014 by , No Comments

The use and possession of marijuana is still considered a criminal offense by the federal government. However, there are currently 23 states in the US that allow the use of marijuana for medical purposes. Marijuana or cannabis has been used for medication way back. However, because of its addictive nature and the negative effects that it may cause the user for excessive use, it was forbidden for recreational use. One of the states that allow medical marijuana is Oregon, which largest city is Portland.

Marijuana is used to reduce vomiting and nausea for AIDS patients and those undergoing chemotherapy. Other conditions that may benefit from it are arthritis, anxiety, sleep disorders, epilepsy, chronic pain, kidney failure, irritable bower syndrome and brain injury. Patients could purchase medical marijuana from reputable dispensaries. A trusted Portland dispensary carries concentrated, edibles, topical and flowers that you can use for treating ailments. You need to have a medical marijuana ID card in order to legally purchase cannabis for medication.

How to Get a Medical Marijuana ID

If your doctor recommends the use of medical marijuana for treating your condition or its symptoms, secure a medical marijuana ID as you would need this when purchasing medical cannabis. The requirements vary from one state to another. Visit your state’s office or go to its website to determine if you’re qualified, as well as check the requirements that you need to have.

Moreover, even though the medical use of marijuana is accepted on the said states, there are still limitations on the amount that you can grow and possess. So make sure to get the right information to avoid problems with the law. Proof of identification and residency are usually needed, as well as a letter from your doctor stating that your condition requires the use of medical cannabis.

There are corresponding payments, which again may vary from different states. However, this typically ranges from $100 to $250. While you may send your application and paperwork to the health department of your state, most of these states offer online application and processing, which is convenient as you can do everything on the site. If you don’t qualify to get this card for some reason, but your doctor recommends the use of medical marijuana, you may send a letter to the health department to request for an exemption.

Marijuana in the Workplace: Setting Expectations

1 August 2014 by , No Comments

Cannabis_male_flowersThe Canadian government has just released the implementing rules and guidelines for the use of marijuana in the workplace. It simply means the employee should be allowed to take his marijuana prescription without being penalized in the workplace. In addition, it also states that the employee’s rights to medical marijuana starts by notifying the employer.

The rules are a clarification for medical marijuana, and employers. It ensures that the user’s rights are upheld. At the same time, it also makes sure that the business operations are not in any way disrupted. Some of the rights of a medical marijuana user is to be afforded accommodation. That is, he should be able to take his dose at the prescribed time without any bother from others. This might mean that the company has to provide a room or a designated space where marijuana could be used in peace.

On the other hand, the employer is expected to do due diligence when it comes to the employees. They can ask the employee to fill up a questionnaire or a survey, to determine the extent of use and the condition of the patient. This will serve as a baseline for the company. It will also determine the seriousness of the usage. It is important for the employer to understand the condition of the user. This will also include any study on the employee’s condition to determine if his job can be offloaded to other employees. In addition, the employer can also determine if the employee can continue with his job. As an example, a Bobcat driver under the influence of marijuana is not supposed to handle heavy equipment.

There was a point where there was concern over medical marijuana implementation. The implementing guidelines makes every stakeholder aware of their responsibilities. For instance, an employee may decide not to inform his employer. However, when he does that, he cannot give the marijuana use as an excuse for poor performance. The company is also aware beforehand of possible issues with performance and can make adjustments in terms of work flow, work load and responsibilities.

This is an important milestone in allowing medical marijuana. It could be said that this is the point where it all comes together. The main objection of employers is the possibility that users would not be able to perform their jobs due to the medications. In the same manner, users are concerned that they would not be able to either take their medication in the workplace, or that they would be let go because of their medication. By addressing these questions, the patient’s rights are protected, as well as those of the employer’s.

Currently there are around 40,000 Canadians with prescriptions for medical marijuana. The Canadian health authority, Health Canada estimates that this would increase to half a million Canadians would have prescriptions for medical marijuana in the next 10 years.
This is a serious matter, even though a lot of people would think otherwise. The medicinal uses of marijuana has been widely researched and there should be no point that a person who uses it for medical purposes should be made fun of. For a lot of people, marijuana works in alleviating pain, migraines and for recovery from cancer.

Millview’s key flaws – non-fluent nurses, nurse technicians administering medication, and doctor’s neglecting to treat patients promptly

9 October 2012 by , No Comments

Mill View Nursing Center had room for 300 patients. It was, by DPH definition, a skilled nursing facility: basically, a long-term home in which some patients require daily care from registered nurses. The second floor, where Donna Sonnenberg lived, reportedly housed patients who needed such care.

Most of Mill View’s nurses and nurses’ aides were from Korea, the Philippines, or Poland. Some worked under temporary permits as registered nurses. Illinois allows an immigrant nurse with a foreign license to work under a permit for six months. If she has not passed the Illinois nursing examination by then, she loses the permit. Except for the director of nursing and her assistant (Patricia Peterson and Arlene Cohen), all of the nurses we’ll be discussing were foreign born and had worked as RNs in their native countries. Two of these seven nurses held Illinois RN licenses. Of the other five, one had failed her exam, two were waiting to hear their exam results (which turned out to be failure), and two had yet to take the exam. This is significant for several reasons.

First, these nurses had difficulty with English, which may have been part of why they failed the nursing exam. Fluency is important in nursing. The Nursing Home Care Reform Act requires even those who have not passed a nursing examination nurses’ aides, technicians, etc.–to speak and understand English. In the Mill View nursing notes are numerous examples of the nurses’ language problem.

At a recent DRE hearing, at which some of these nurses appeared as respondents and witnesses, members of our staff noted that the nurses had a good deal of trouble making themselves understood. It is possible that this affected the nurses’ care of Mill View patients. They would have had a hard time describing to a supervisor or a physician a particular patient’s health problems.

The temporary permit issue is important for a second reason. The nurse who had failed her exam was then re-titled a “nurse technician.” Without a permit or license, a nurse technician is by law not allowed to give medications, take physician’s phone orders, or change sterile dressings. As we will see, this nurse technician and others at Mill View did all of these things.

Walsh interviewed (or tried to interview) the following nurses: Sang Hee Suh, RN (licensed since 1975); she often was regarded unofficially as a supervisor on the 11 pm to 7 am shift (Mill View reportedly had a hard time getting nurses to agree to supervisory duties; there was no extra pay to go with the title); Theresa Choi, RN (licensed since 1971); she worked part-time on the 3 to 11 pm shift, also unofficially regarded as a supervisor; Virginia Cruz, who worked as an RN under a temporary permit in January 1981; she subsequently failed her nursing exam in April; she worked the 7 am to 3 pm shift on the second floor; Elizabeth San Juan, who worked as an RN under a temporary permit in January 1981; she also subsequently failed her exam in April; she worked the 3 to 11 pm shift on the second floor; Zenaida Meriales, who worked as an RN under a temporary permit during January 1981; she was a “floater,” working when and where she was needed; Juliana Tiangha, who worked as an RN under a temporary permit in January 1981, during which time she worked the 11 pm to 7 am shift on the second floor; and Elenita Ciriaco, nurse technician; she also was a floater, usually working the 3 to 11 pm shift on the second floor.

Walsh also interviewed the director of nursing, Patricia Peterson, RN, and tried to interview the assistant director of nursing, Arlene Cohen, RN; Cohen refused to talk to Walsh, as did Sang Hee Suh. The three shifts at Mill View were morning or daytime (7 am to 3 pm), evening (3 to 11 pm), and night (11 pm to 7 am) . Tiangha, Meriales, San Juan, Ciriaco, and Cruz wrote most of the nursing notes, and decubitus report and logbook entries, that we will discuss. A few other nurse technicians also made notations; Walsh didn’t interview them. We have expanded abbreviations. The nursing notes, logbook, and decubitus report tell the following story.

Donna Sonnenberg was admitted October 21, 1980. The first entry in the nursing notes gives her admission diagnosis, also noting her bedsore. She was “alert and coherent,” ate her first meal “with little assistance and good appetite,” could maneuver her wheelchair, and smoked “with care.” The entry records her vital signs blood pressure, pulse and respiration rates, and temperature and notes that Dr. Aren was to see her the next morning. The nurse thought Aren would be there October 22 because that was a Wednesday, and Aren almost always visted on Wednesdays. However, Aren did not give Sonnenberg a physical examination until the following Wednesday, October 29.

DPH requires nursing homes to have new patients examined by an MD within three days after admission. DRE investigator Walsh asked Mill View Director of Nursing Peterson about Aren’s tardiness in examining Donna. Peterson explained that doctors are aware of the requirement but that nurses often have to call the doctors many times to get them to examine new patients. Often the physicians don’t get to the home within 72 hours; but, Peterson said, the nurses couldn’t physically carry the doctors in. Nurse Virginia Cruz observed Aren’s examination of Sonnenberg. She described it as “adequate,” recalling that he had examined Sonnenberg’s bedsore. When Helen Thomas asked him about this examination in late January 1981, Aren could not recall looking at the ulcer. However, when he spoke with Janet Walsh in August, he said he had seen the sore. His orders simply continued Dixon Developmental Center’s: cleanse the wound with Betadine and apply Debrisan powder and a dressing.

The Complaint Committee Evaluates the case against Mill View Nursing Home

9 October 2012 by , No Comments

On April 20, 1981, when the department received DPH’s April 16 letter asking for an investigation of Marvin Aren, DRE had already assigned investigator Janet Walsh (now Janet Peters). The department had been reviewing the case before DPH wrote.
Two weeks earlier, on March 30, Mrs. Sonnenberg had called DRE to lodge a complaint against Donna’s physician, Marvin Aren. DRE employee Peggy Gorman summarized Mrs. Sonnenberg’s concerns:
Complainant alleges neglect of respondent [Aren] in care of her daughter which resulted in hospitalization for a severely infected decubiti, followed by death. Department of Public Health investigated the matter and made recommendations for improvement in the nursing regimen. However, complainant wishes to pursue the allegation of negligence against the respondent which resulted in the death of her daughter, as evidenced by the initial investigation by the Evanston North Shore Health Department.

On April 15, the Complaint Committee met to evaluate the case, taking into consideration medical records and other documents the Sonnenbergs had dropped off the night before. The committee recommended that DRE obtain Dixon records, attempt to interview Mill View nurses about their communications with Aren, obtain the regulations for a doctor seeing a nursing home patient, and get Aren’s billing records from the Department of Public Aid. The next day, the day DPH Director William Kempiners mailed his letter to DRE, investigator Walsh was assigned. The Medical Investigation Walsh began by reviewing Donna Sonnenberg’s medical records from Mill View. She then spoke with Helen Thomas, the nurse-investigator from Evanston-North Shore Health Department who first investigated the Sonnenbergs’ complaint. Walsh went on to interview the nurses who worked on Donna Sonnenberg’s floor, who might have spoken with Aren about the patient’s bedsore; she also interviewed Aren himself. Walsh basically reconstructed the story we outlined in the previous chapter, the story Helen Thomas and the DPH investigators learned.

Interviewing the nurses, Walsh filled in many details; we will give the complete story below. Her investigation did not, though, lead to the Medical Disciplinary Board taking any action against Aren. More than a year after Donna died, the board found that there wasn’t enough evidence of neglect to discipline Aren. We take our account of Sonnenberg’s stay at Mill View from the nursing notes and decubitus report, which Walsh studied, and from Walsh’s interviews. The decubitus report is a special report describing a patient’s bedsore problems and treatment. In the nursing notes, also part of the individual patient’s record, the nurses write observations about the patient’s overall condition, including any bedsore problems. Another nursing home document that Walsh tried to get was the nurses’ logbook. Each floor at Mill View had a logbook; in it different shifts communicated with each other about any problems on the floor. Mill View administrators couldn’t find the logbook for Walsh. Long after her investigation was over, the logbook turned up. Though we have supplemented what follows with the logbook’s entries, our account doesn’t differ from Walsh’s.

How the Complaint Committee Investigates a Case

9 October 2012 by , No Comments

The Complaint Committee consists of the medical coordinator, the chief of medical investigations, and two board members; it meets at least twice a month. Examining each complaint, the committee decides if the case involves possible violations of the Medical Practice Act, then recommends that the case be either opened or not opened.

When opening a case, the committee may specify what it wants done in the investigation. Here the chief of medical investigations takes over. He oversees investigations in DRE’s two offices, in Springfield and Chicago. The appropriate unit’s supervisor assigns the case to an investigator and together they draw up an outline of the investigation. The investigator then gathers and examines records and other documents, interviews respondents and witnesses, and does whatever else is needed. If, during his investigation, the investigator has a medical question, he asks the medical coordinator.

At the end of his study, the investigator summarizes the material he has gathered for the medical coordinator. The medical coordinator in turn reviews the file summary and writes his recommendations to the Complaint Committee. Any of several things can happen to the case at this point.
The Complaint Committee may close the case for insufficient evidence (the full Medical Disciplinary Board must concur); ask for futher investigation; give the case to the chief regulatory officer (the department’s prosecuting attorney) for possible disciplinary or legal action; refer the case to an outside professional agency, such as the Chicago Medical Society; ask the Attorney General’s Office to prosecute; or decide with the prosecutor to call the doctor in for an informal conference.
At the informal conference, the doctor and his attorney meet with DRE’s attorney and one board member who is also on the Complaint Committee. DRE reviews the doctor’s compliance with department directives, gathers additional information, and discusses the issues with the doctor, who can submit documents and make an oral statement. The conference can result in any of four recommendations to the board: close the case, investigate further, enter into a consent order with the doctor, or refer the matter for a formal hearing or for prosecution. Formal hearings are held before the full Medical Disciplinary Board; a department-appointed hearing officer presides. Both the accused person and the complainant can present evidence. If the director of DRE feels the doctor’s continued practice might endanger others, he can temporarily suspend the doctor’s license, pending the hearing results.
The board writes to the doctor with its findings and conclusions. He can ask for a rehearing within 20 days. If he doesn’t, the DRE director can act on the board’s recommendations. The director cannot take any disciplinary action unless the board directs him to. If he is dissatisfied with the board’s decision for example, if he thinks the doctor’s license should be suspended to protect the public when the board has recommended no suspension the director can order a rehearing by the board or other examiners (II 4449) . This is a basic outline of how DRE handles complaints against physicians; it is basically how the department handled the Sonnenberg case.

The Medical Investigation on the Nursing Home that killed Donna Sonnenber

9 October 2012 by , No Comments

The Department of Public Health (DPH) investigated the actions of the nursing home as a whole; that is where its jurisdiction lies. Another department has jurisdiction over the professionals who work in nursing homes: the Department of Registration and Education (DRE). DRE licenses a wide array of professionals in the state, including doctors, nurses, and nursing home administrators. When DPH officials thought the professionals involved in Donna Sonnenberg’s care should be investigated, they asked the appropriate department to investigate: DRE. DRE’s general mandate is to protect the public health, safety, and welfare through licensing the appropriate professional and occupational groups; 32 such groups in all, with 81 licensing categories (according to a 1981 auditor general’s report).

The department, along with its boards and committees, sets standards, tests, licenses, investigates, inspects, and disciplines these groups. About 455,000 people and agencies hold DRE licenses, including architects, private detectives, funeral directors, physicians, real estate brokers, embalmers, public accountants, barbers, collection agencies, horseshoers, psychologists, and dentists. The department’s duties vary from profession to profession. Statutes governing some occupations detail the qualifications for getting a professional license but stop there, without saying what acts by the licensed professionals DRE is to monitor. At theother extreme, some statutes set up virtually no minimum qualifications for licensure but focus on specific actions that DRE must regulate. Most professions fall between these poles, with detailed licensing qualifications and some (though not much) attention to actions by licensees.

The auditor general’s report (1981) criticized this lack of uniformity, pointing out that itmakes DRE’s job all the harder. The auditor general’s report also criticized the variability and poor definition of the responsibilities of the department’s boards and committees. In 28 of the 32 professional areas DRE handles, a board or committee develops standards for licensure and acts as a hearing board in *DRE’s enabling statute is Ill. Rev. Stat. ch. 127, IT IT 60-62. Chapter Ill contains most of the relevant statutes concerning professionals.

The director of DRE appoints the members of all but two boards; the governor appoints the members of the Medical Disciplinary Board and the Board for Opinions on Professional Nursing, with senate approval. Most boards are made up of professionals in the appropriate area; the Medical Disciplinary Board and the Nursing Home Administrators Licensing Board are two of the only three boards with members from outside the profession. Most boards have considerable authority in DRE matters. For example, in medical investigations the director of DRE may not take disciplinary measures “except upon the action and report in writing of the Board” (Ill. Rev. Stat. ch. 111, ft 4449).

In some of DRE’s other licensing areas, the department can exercise none of its duties or functions without board approval. The auditor general’s report criticized the general lack of clear separation of powers and responsibilities. The statutes governing the professions, the boards and committees, and the Department, as now written, cannot be efficiently administered nor consistently complied with. A system of checks and balances between the boards and committees and the Department has not been achieved. Most enforcement control authority is vested in boards and committees; most responsibility is placed with the Department. The Department cannot act without board/committee approval, and the boards/committees cannot unilaterally enforce the acts. A more reasonable division of authority and responsibility needs to be achieved, and statutory conflicts and inconsistencies need to be addressed. We merely report this criticism here.

The reader might bear it in mind in discussions of the Medical Disciplinary Board’s involvement in the Sonnenberg case. Medical Investigations The Medical Disciplinary Board, which handles complaints against physicians, is made up of five physicians, one chiropractor, one doctor of osteopathy, and two members who have nothing to do with medicine. The non-medical members, added to the board a year and a half ago (by Public Act 82-1036), have no vote in the board’s decisions. Acting as the chief enforcement officer for the board is the medical coordinator, a doctor. He reviews all complaints that come into the office and decides if there’s enough information to bring the complaint before the Complaint Committee. If he needs moreinformation, he may ask for a preliminary investigation.

DRE Investigation: Determining the nature of the nursing home violation and the amount to be fined.

9 October 2012 by , No Comments

Litwiller wrote that Donna Sonnenberg’s care at Mill View was unfortunately not too unusual, in this case pointing to Aren’s absence from the home until the bedsore had gotten very bad:

“While this is not an acceptable standard of care, it is typical of physician involvement in most nursing homes.”

He concludes his memo: It was a good experience for me to have had a conversation with Mr. and Mrs. Sonnenberg at their home. Through someone’s fault their daughter is dead. At this point I would believe that Mill View is a principal contributor. With this perspective, we should consider a Class “A” violation against the nursing home. I would recommend that Mr. Uhlig and our legal section review all of the available documentation in considering their final determination. Two weeks later, on April 16, DPH officials did four things.

First, DPH Director William Kempiners ordered Irvine to review the department’s findings to see if it would be possible to cite Mill View with a type A violation.

Second, Kempiners ordered that DPH scrutinize Weiss Hospital’s involvement. Third, he asked the Department of Registration and Education (DRE) to examine Aren’s treatment of Donna. And finally, DPH Legal Advisor William Radkey sent the Sonnenbergs a summary of DPH’s position in the case.

He wrote that DPH had notified Mill View of B and C violations on February 23; that the facility had submitted a plan of correction for the violations; that DPH “is currently reviewing its initial findings to determine whether any other violation” had been committed; that the department had asked DRE to evaluate Aren’s conduct; and that the Sonnenbergs had the right to a hearing “to review or contest the department’s determinations regarding the complaint investigation.” A week after that, on April 24, DPH nurse investigator Carole Hinich reviewed Sonnenberg’s medical records; she was unaware of the first investigation, so her bosses could use this impartial review to assess the initial report’s adequacy. Also on that date, Fred Uhlig ordered William Irvine to investigate the department’s handling of the entire case. Irvine assigned Judy T. Weber and Frank Moore of the central and southern offices.

They reported on May 13, basically outlining what we have described in the last few paragraphs. They also reported that the regional administration had in their opinion failed to comply with the Nursing Home Care Reform Act of 1979 and had “failed to respond to the immediate needs of the Evanston-North Shore Health Department; the resident, Donna Sonnenberg and her family; and the Department of Public Health.”

The complaint had not been reduced to writing or logged in with time and date; a notice of violation had not been given to the facility; and Elaine Washington’s report of January 28 hadn’t been transferred to the appropriate DPH form, so that no plan of correction was received from Mill View (this was her first investigation; her supervisor hadn’t told her to fill in the right forms). Also, in cases of alleged type A violations (as Evanston-North Shore had recommended), supervisors (i.e., Helen Byrd) are to determine the immediate course of action. She didn’t. Though both internal investigations cast a bad light on Byrd’s handling of the case, neither apparently showed any fault with Kristopaitis’s and Schaffer’s investigation. In their summary, Moore and Weber mention visiting the Sonnenbergs.

“During our visit . . . it became apparent that they had spoken with many commentators and many of the explanations were contradictory. The conflicting statements left them with the opinion that they were getting the ‘run-around,’ or that the Department was concealing some activity. Taking into consideration the emotional state of the parents, there does seem to be some validity to their statements, and most of this deals with the classification of the deficiency as Type ‘A’ or Type ‘B’.” This sets the tone for the Sonnenbergs’ subsequent dealings with DRE and explains their feeling that state agencies are at best incompetent, at worst crooked. Whatever the internal problems in its investigation, the Department of Public Health corrected its initial error relatively quickly and decisively. Its communications with the Sonnenbergs were informative and honest. As we will see, the Sonnenbergs had a different experience with DRE.

Mill View’s neglect of Sonnenberg was deemed a type A violation after all. For this DPH fined Mill View $1,598.40 The department also pursued the other type B and C violations that Kristopaitis had cited in her February 23 report, for the same activities but against other residents–unlicensed nurse technicians administering medications, taking physicians phone orders, giving treatment. The DPH system of notification, plan of correction, and inspection then followed. On March 4, Mill View submitted a plan of correction to be adhered to no later than March 15. On April 30, DPH workers found that the promised changes had not occurred, found an additional type B violation, and notified Mill View.

The home again promised to eliminate the violations by May 6 and June 15; again, DPH found that the home hadn’t, in inspections on May 7 and July 1. An inspection on August 20 also showed that Mill View continued its practices. For these violations, DPH fined Mill View $39,704 on July 1, 1981. The fines were for violations beginning February 23 (plus the B violation found April 30) and continued to increase each day after July 1, so long as the violations went uncorrected. The department also revoked Mill View’s license on June 15. Mill View, under DPH rules, could contest the fines and the license revocation, and did so, asking for a hearing. DPH scheduled a hearing ultimately for September 21. The Criminal Case Failure to correct type A or B violations (not type C) is a class A misdemeanor, and DPH may ask the state’s attorney to prosecute. Because Mill View repeatedly failed to correct the type B violations that Kristopaitis originally found on February 23, Cook County Assistant State’s Attorney Stuart Sikes, of the Nursing Home Division, representing DPH, filed criminal charges on August 11.

Mill View, having the option, chose to defend against the criminal charges first, receiving a judicial stay against all administrative proceedings until the criminal case was resolved. (Meanwhile Mill View Associates, owners of the home, sold it; the new home was called Spring Meadows and began operating under a temporary license September 30, 1981.) Against the criminal charges, Mill View mounted a constitutional defense; the home alleged that the Illinois Nursing Home Care Reform Act of 1979 the basis for the misdemeanor complaints?as well as DPH regulations were unconstitutional. Mill View said that the act denied the equal protection clause to the Fourteenth Amendment of the U.S. Constitution by exempting state-run homes from DPH scrutiny; the nursing home also said that DPH rules and regulations were unconstitutionally vague in that the same rules could be the basis for both civil and criminal actions. Associate Judge Kenneth J. Cohen of the Circuit Court of Cook County found for Mill View, holding that the Nursing Home Care Reform Act was unconstitutional, on April 23, 1982.

DPH rules in People v. Gurell, 98 111. 2d 194 (1984). The court rejected the defendants’ argument that the act jeopardized their right to carry on their business: “No case has been called to our attention in which the right to economic gain . . . has been held to be a fundamental right guaranteed by the Constitution.” Also, the court found a rational basis for exempting state facilities from the act and found no violation of the equal protection clause. “In our case the legislature chose to deal with the problems it perceived in the nursing-home industry one step at a time by regulating private facilities. . . . State-operated facilities are under the direct control of the State and . . . most of these facilities are regulated by statutes other than the one in question.”

The court also rejected the defendants’ notion that the civil-criminal possibilities in DPH rules were vague. Only civil penalties may be imposed for initial violations; after that, the violator has a right to a hearing. No criminal penalties may be imposed unless the defendant intentionally fails to correct type A or B violations within the time specified in the notice or the plan of correction. All of this took place over two years, during which the activities described in the rest of this report took place. In the end, Myron Gurell pleaded guilty to the criminal charges on May 4, 1984 in Cook County Circuit Court. The state dropped its charges against the other Mill View owners. Gurell was sentenced to one year’s criminal probation. For five years he is barred from serving as administrator or licensee of any Illinois nursing home.

Our discussion to this point has centered on DPH involvement in the Sonnenberg case: after some unfortunate lapses, a responsive and timely involvement. The focus of our report the role of the Department of Registration and Education follows. We have already mentioned that DPH asked DRE to investigate Donna’s physician at Mill View. In one of its many letters to the Sonnenbergs, DPH wrote: “You will be interested to know that in response to Director Kempiners’ request the Illinois Department of Registration and Education has assigned a medical investigator named Ms. Janet Walsh to investigate the conduct of Dr. Aren on this matter.” In the next chapter we will examine Walsh’s investigation including DRE’s findings about Donna Sonnenberg’s care at Mill View and the department’s dealings with the Sonnenbergs.

Neglectful healthcare causes death in nursing home – two sides of a DRE investigation

9 October 2012 by , No Comments

questionA month later, after Donna had died, Mrs. Sonnenberg called Alan Litwiller, asking what DPH had learned. This was the first Litwiller had heard of the matter. He asked Helen Byrd where her report was; she said there had been no investigation but would not explain why. When Litwiller assigned a doctor-nurse team – Bernard J. Schaffer and Regina Kristopaitis – to conduct the neglected investigation, Byrd gave him a hand-written preliminary report of surveyor Washington’s January 28 visit.

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