Texting in crosswalks while walking in New Jersey is about to get much more expensive. Cherry Hill Assemblywoman Pamela Lampitt has proposed legislation that would require a $50 fine and the possibility of imprisonment for texting while walking in a crosswalk. The penalties for texting while walking would be similar to jaywalking.
The bill is designed to “heighten the awareness of what’s going on around you,” said Lampitt, a Democrat.” Even if you have permission to walk sign to walk, you should not be distracted, you should be aware of what’s going on around you, especially in the street.” Drafting the bill came out of a personal experience, Lampitt said. She works at the University of Pennsylvania and knew a student who was killed after being hit by a bus when he was crossing the street. The student was using his phone when he was struck.
How Dangerous is Texting While Walking?
A research study out of William Patterson University found that distracted walkers have a much higher incidence of injury. Dr. Cory Bach studied more than 21,000 pedestrians at five intersections and discovered that nearly half crossed on a “Don’t Walk” signal, and nearly one-third of pedestrians who crossed on a “Walk” signal were wearing headphones, talking on a mobile phone, and/or looking down at an electronic device.” In 2010, more than 4,000 pedestrians were killed and another 70,000 were injured in traffic crashes in the United States, according to the study.
According to the National Highway Traffic Safety Administration, more than 32,000 people were killed in motor vehicle crashes on U.S. roadways in 2014. In the same year, 2.3 million people were injured in crashes. A large percentage of these crashes were caused by alcohol impairment, speeding, distracted driving, and drowsy drivers. There’s a lot we can do to prevent crashes and reduce the number of deaths and injuries on roads. Here are a few ideas to consider before you start the engine.
Take a moment to consider whether driving is a good idea – you may not be fit to operate a vehicle. If you have been drinking or if you are taking any medication that can impair your judgment, coordination, attention, vision, or reaction time, do not drive the vehicle. Ask a friend for a ride, catch a cab, or take a bus.
Consider your state of mind. Make sure you are well-rested. If you start to feel drowsy once you’ve started driving, park your vehicle somewhere safe (not on the shoulder of the road) and take a break until you feel more alert. If you are angry or upset, don’t get behind the wheel of any vehicle. Your emotions can distract you and lead to an accident.
Plan the trip and make sure your vehicle is ready. Try to avoid driving at night and in severe weather whenever possible. If your arrival time is critical, check online for road closures and heavy traffic. Leave a little bit early, just in case. Clean the lights and windows, and make sure your windshield wipers are working properly. Make sure you have enough fuel. Check your tires. Adjust the steering wheel, seat, control and mirrors before you take off.
Once you’re on the road drive safely:
- Avoid distractions like drinking, eating, talking on the phone, texting, adjusting the radio or other controls, and talking to a passenger. Driving requires your full attention.
- Make sure you and your passengers wear a seat belt at all times.
- Stay alert. Changing situations on the road require immediate reaction.
- Always travel at a safe speed. Consider factors like the weather, road conditions, traffic, construction work, and whether kids, cyclists, or pedestrians are, or might be, nearly.
- If you’re driving long distances, stop at least every two hours for a break. Get out of the vehicle, stretch, and walk around a little.
- Watch out for pedestrians, bikes, and motorcycles.
- Ignore horns and rude gestures directed at you. Don’t make hand or facial gestures at other drivers. Give angry drivers plenty of room.
It’s not just drivers and their passengers who are at risk. Each year, thousands of pedestrians and hundreds of cyclists are killed in motor vehicle accidents.
It has long been argued that when there are not enough nurses on staff, patient safety suffers. That theory has just been confirmed by a new study published in the British Medical Journal. According to lead researcher Jane Ball of Southampton University, when nurses are responsible for 10 or more patients at once, there is a 20% greater chance that a patient will die. That risk is greatly reduced when the nurse is responsible for 6 patients or fewer. The research team further found increasing the number of available healthcare assistants rather than nurses had no effect on the mortality rate.
The results, Ball told the Telegraph, demonstrate why hospital leaders should prioritize patient safety over their bottom lines. “When determining the safety of nurse staffing on hospital wards, the level of registered nurse staffing is crucial; hospitals with higher levels of healthcare support workers have higher mortality rates,” she said. “Patients should not be asked to pay the price of receiving care from a less skilled and less educated member of staff, just to make up for the failure of the system to ensure enough registered nurses.”
These results back up similar research conducted in the U.S., including a 2013 study that found nursing staff ratios directly affect readmissions at pediatric hospitals. Nurses in several states, including New Jersey, Minnesota and Oregon, have lobbied extensively to impose mandatory nurse-to-patient ratios, while opponents of such measures have argued hospitals can achieve similar improvements at lower cost.
Over the course of years, we have observed that while doctors are ultimately responsible for various oversights, nurses are often the first to catch (or miss) mistakes. Various medical malpractice cases in Middlesex County, NJ have involved nurses as well as doctors. Once can only hope that medical providers learn from mistakes and adequately staff nurses so that patients receive adequate attention and care.
In the past seven years, healthcare miscommunication has cost over $1.7 billion in additional medical expenses, and over 1,700 lives. According to research from research/analysis firm CRICO Strategies, communication problems were a contributing factor in 7,149 cases (30 percent) of 23,000 medical malpractice claims filed between 2009 and 2013. Obviously, the statistics are only a fraction of the total number of medical malpractice incidents that did not lead to lawsuits.
Common breakdowns in communication include miscommunication about a patient’s condition, inadequate informed consent, poor documentation and an unsympathetic response to a patient’s complaint. Patient safety advocates have pushed for improved healthcare communication for decades, spurred by the 1994 death of a Boston Globe reporter from a chemotherapy overdose. The numbers in the CRICO report indicate disappointingly little progress on the issue in the intervening years, according to Frank Federico, vice president for patient safety at the Institute for Healthcare Improvement. “We’ve been working on this for a long time, and it still continues to be a big problem,” Federico told STAT.
The report includes several examples, including a situation in which one man died after a nurse noticed, but failed to alert the surgeon that the patient was experiencing signs of internal bleeding. Another case involved a diabetic patient who collapsed and died after staff at a medical practice failed to give the primary care provider telephone messages from the patient. In a third case, a woman asked to have her tubes tied after delivering a baby through a C-section, but her instructions were not shared with the obstetrician on duty. The patient filed a malpractice claim when she got pregnant again.
The report cites many challenges to healthcare providers, such as heavy workload, hierarchical workplace culture, cumbersome electronic health records, and constant interruptions. And it highlights solutions, including a program called I-PASS born at Boston Children’s Hospital.
The report also had disturbing findings with electronic medical records (which we have written about previously). While EMRs have emerged partly to improve incidents of healthcare miscommunication, in some cases they have the opposite effect. For instance, one woman’s cancer diagnosis was delayed for an entire year because her lab result was plugged into the electronic health record but was not flagged to her primary care provider.
In another case, a primary care provider referred a patient to a lung doctor but didn’t mention lab results signaling possible early congestive heart failure, assuming that doctor would see the results in the electronic medical record. About nine days later, the patient was rushed to the emergency room and died after his lungs filled with fluid.
On December 31, a New Jersey appeals court ruled that a chatty juror and a momentary conversation with a medical expert following testimony was not enough for a mistrial, or to disturb the Plaintiff’s $425,000 verdict. Jim Martin of Martin Kane Kuper was Plaintiff’s attorney in this case.
“Despite interaction between juror and witness, a new trial is not necessary in every instance where it appears that an individual juror has been exposed to an outside influence,” said the Appellate Division in Lukenda v. Grunberg. The appellate panel also affirmed the trial judge’s rejection of an intoxication defense in the case, which flowed from a boozy encounter between two friends.
On Christmas night, 2010, Defendant Michelle Grunberg sent Plaintiff Richard Lukenda a text message inviting him to her parents’ home. Upon his arrival, Defendant drank a glass of wine while Plaintiff had Scotch. When Plaintiff attempted to leave, Defendant and her parents stopped him, alleging that he was too intoxicated to drive. At this point, an altercation ensued in which Plaintiff alleged that Defendant performed a kind of martial arts kick to his right knee, sustaining tears to his ACL and lateral meniscus, requiring three corrective surgeries. Defendant alleged that Plaintiff sustained the injury while playing Nintendo Wii bowling.
At trial, Plaintiff’s expert, Dr. Wendell Scott, testified that the knee injuries resulted from lateral force, and noted that Plaintiff suffered permanent damage that could lead to arthritis.
During a break, one of the jurors had a brief exchange with Scott. The juror apparently said something like “you are a great teacher” and smiled. After the defense moved for a mistrial, the judge questioned the juror, and found no improper influence as a result of the exchange. The recent ruling affirms the trial judge’s decision, and leaves the verdict for our client intact.
One of the most common ways to evaluate a healthcare provider is to examine their post-op infection rates. That data, however, is incomplete. There is much more that goes into safety than infection rates, and even those may not be current or tell the whole story.
As reported recently in the Orange County Register, some infections don’t get reported unless providers are required to turn over information. Details of conditions inside Mission Hospital [in Orange County, CA] – which temporarily closed its 14 operating rooms last fall because of a small outbreak of infections associated with orthopedic surgeries – were hidden by the federal government for six months. The final report was only presented after an Open Public Records Act request in the spring.
“These kinds of inspections are the checks and balances to make sure the hospital is doing what it’s supposed to be doing, but there’s a lack of awareness on the part of the public,” said Lisa McGiffert, director of Consumers Union’s Safe Patient Project. “Part of that is because this type of information is kept secret.”
While the hospital was required to report infection rates, it was not required to report the specific infection that caused closure of the operating rooms, nor was it required to disclose the full government report detailing the closures. A Register review of inspection reports for five major Orange County hospitals found issues such as lack of hand-hygiene compliance, rusty procedure tables and improper sterilization of surgical tools. These common issues would not be found in required hospital infection data.
A hospital might have an infection rate comparable to or better than state and national averages, but still might get cited for a number of deficiencies.
“Unfortunately, tens of thousands of patients die each year from medical errors. By bringing these reports into public view, we can encourage the kinds of improvement that will save lives,” said Len Bruzzese, with the Association of Health Care Journalists, which publishes details from inspection reports since 2011 online.
Recently, a writer on the Huffington Post described his experience with a friend undergoing treatment for slow-progressing lung cancer. The author describes multiple sets of mistakes by his friend’s “elite” medical team, and repeats the phrase that the doctors might kill him before the cancer does. There are a few excerpts below.
“The result is dangerous medical chaos. Doctors love pictures and get paid a lot for ordering and reading them. Over the years my friend has been subjected to countless and mostly unnecessary imaging studies with contrast dyes that have compromised his kidneys. It seems likely that renal insufficiency will kill him before his lung cancer does. He is also no longer eligible for additional lung-cancer treatments because his kidneys flunk protocol requirements. And along the way he has been prescribed several unnecessary medications that also hurt his kidneys. Everyone focused on the lung cancer; no one noticed the harm they were doing to the kidneys.
There have also been several close calls because he was prescribed multiple medicines by multiple doctors without coordination and due consideration of the drugs’ interactions and synergistic harms.
The mistakes were all easily preventable if anyone were minding the store and paying attention to the patient, not the lab tests. In any common-sense world doctors would care about risks and harms and wouldn’t always be rushing to order stupid and dangerous tests and treatments.”
Unfortunately, these experiences are not unique. According to recent statistics, medical mistakes cause about 440,000 deaths each year. Many of these deaths are preventable, and a significant number of these patients could be saved with basic communication and oversight.
With the healthcare model revolving around billing for the number of tests and procedures performed (and drugs prescribed), doctors have little financial incentive for minimizing tests and procedures. With the increase of specialization in the medical field, rarely is there a single doctor looking out for the patient’s global health. Even with the best of intentions, doctors frequently over-test, over-prescribe, and spend too little time with patients to get to know the full story.
Electronic Medical Records (“EMRs”) are supposed to be a great step forward for patient safety. They are supposed to (among other things) automatically cross check medication orders with patient allergies, ensure that two medications don’t have harmful interactions, and allow multiple medical providers to quickly and easily have access to important health information about the patient.
Unfortunately, due to their clunky design, cumbersome requirements, and time consuming processes, they can distract doctors and nurses from the primary focus of tending to a patient, which endangers safety much more so than any old record system. EMRs are now a constant presence in patient rooms, requiring more time and attention than traditional paper records ever did. The result is less time and focus the doctor or nurse can devote to the patient.
In an opinion article written in the Wall Street Journal online, John Sotos recounts how his friend suffered in a large, well-respected university hospital as a result of distracted nurses. His friend, called Alex in the piece, was in the hospital for a fairly routine surgical procedure, but she was not permitted to eat or drink during her stay. I.V. fluids were supposed to replenish her body’s nourishment during her stay. He explained that three separate nurses, on three consecutive days, failed to correctly provide Alex with proper I.V. fluids – they provided no fluids on day 1, three times the required amount of fluids on day 2, and again no fluids on day 3.
While these oversights can be seen as unfortunately coincidences, he assigns blame to the EMR. In the old days of paper records, nurses would have opened the chart at the foot of Alex’s bed, looked at her fluid requirements and past orders, looked at the pole next to her bed, and acted accordingly.
“Today, nurses at Alex’s hospital are, almost literally, chained to a computer station with wheels that runs the EMR and goes with them from patient-room to patient-room,” he writes. “A basic nursing task, such as documenting a patient’s urination, requires the nurse to walk to the computer, sign on to the EMR (itself a chore), grasp the mouse, select the patient, click a “urination” tab (eventually), move hands to keyboard, type the volume of urine, then click “save.” Any new data, alerts or orders on the screen will distract the nurse from thinking about the significance of the urine volume just produced.”
Detecting Alex’s fluid mismanagement required only a glance at her, a glance at the I.V. pole next to her, and a modicum of thought. Obviously, the glances and thought didn’t happen… three times. That was likely because the nurses were distracted by having to spend that time entering information into a computer.
Thankfully, but for some temporary discomfort and having to page a doctor at 1 am to change a bandage (the excess day 2 fluids, combined with blood thinners, caused an inordinate amount of bleeding), Alex was ok. This is but one example how, with their attention spread more thin as a result of EMRs, doctors and nurses are prone to make more mistakes or become more easily distracted.
A medical journal published an anonymous essay last month by a physician recounting other doctors’ crude and sexual comments and behavior with patients during obstetric and gynecologic surgeries.
From rude and disparaging remarks about a nurse’s special needs son, to joking about a patient screaming in pain because the doctor did not use enough anesthetic, political correctness has clearly not penetrated into the operating room. Whether it’s angry outbursts, lewd remarks or passive aggressiveness, bad conduct by those in the medical community is called “disruptive behavior.” It’s considered such a risk to patient safety that hospitals must have a system for addressing it in order to meet accreditation standards.
Disruptive behavior leads to increased medication errors, more infections and other bad patient outcomes — partly because staff members are often afraid to speak up in the face of bullying by a physician. Since the majority of medical mistakes can be traced to poor communication, any barriers to communication (including operating room disruptions) represent significant health risks to patients.
Most experts estimate that up to 5% of physicians exhibit disruptive behavior, although fear of retaliation and other factors make it difficult to determine the extent of the problem. A 2008 survey of nurses and doctors at more than 100 hospitals showed that 77% of respondents said they witnessed physicians engaging in disruptive behavior, which often meant the verbal abuse of another staff member. Sixty-five percent said they saw nurses exhibit such behavior.
At Vanderbilt University Medical Center, 90% of team members don’t get any complaints, 6-8% get occasional complaints and 2-3% account for more than 40% of complaints. said Gerald Hickson, a doctor and senior vice president for quality, safety and risk prevention. Of that 2-3%, more than three-quarters turn their behavior around and don’t have recurrences. Only a couple medical professionals out of about 1,600 lose their staff privileges each year, meaning they are no longer able to see patients, for this sort of behavior, he says.
For more, read the USA Today.

Changes to the NJ Car Seat Law
Changes to the New Jersey car seat law go into effect on September 1, 2015. Here are the important facts to know:
- Small children must stay in rear-facing car seats with five-point harnesses until they’re 2 years-old and weigh 30 pounds.
- Once toddlers are turned around, they need to be in front-facing car seats with five-point harnesses until they’re 4 years-old or weigh 40 pounds. They can then be moved to boosters.
- Older children must stay in five-point harness car seats or booster seats until they’re 8 years-old and 57 inches tall.
Previously, the New Jersey car seat law only required rear-facing seats until the child was one year-old, and they could be moved to standard booster seats earlier. The new law is in accordance with the recommendations of the American Academy of Pediatrics, which notes that the new requirements keep children much safer in the event of an accident.
So, even if the new New Jersey Car Seat Law law contradicts the recommendations on your car seat, the law takes precedence. Violators can face $50-$75 fines for each violation.
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