Series of Dog Attacks Rattles Cleveland

vicious-dog

Many of us have gotten nervous when a strange dog approaches us aggressively. But maybe the dogs we should actually be concerned about are the ones in our own homes. Three Northeast Ohio animal attacks in July illustrate the danger even loved ones can face from out-of-control pets.

Three dog attacks

On July 13, 2015, a woman died after being mauled by a pit bull at a Shaker Heights home. She was the 71-year-old grandmother of the dog’s owner. When the dog attacked, neighbors rushed in to help. One shot and wounded the dog, stopping the attack, but it was too late. The woman’s injuries were too severe and she died at the hospital. Police later shot and killed the dog.

In Willowick, a pair of large dogs broke loose from their owner’s house and bit two people before police subdued then with a stun gun. And in Chardon, a 7-month-old baby suffered life-threatening injuries when she got caught in the middle of a fight between a bulldog and a pit bull. Both dogs belonged to members of the infant’s family.

Can we blame the breed?

Two of these three violent attacks involved pit bulls. They add to the breed’s longstanding reputation for danger. So should Cleveland-area lawmakers ban breeds like pit bulls, Rottweilers, and Dobermans? It’s a national debate with passionate supporters on both sides. But currently, the trend is moving away from breed-specific legislation.

Many studies have concluded that breed-specific legislation doesn’t have a measurable effect on stopping dog attacks. In 2006, the National Canine Research Council identified the most common factors found in fatal dog attacks:

  • 97 percent of the dogs involved were not spayed or neutered.
  • 84 percent of the attacks involved owners who had abused or neglected their dogs, failed to contain their dogs, or failed to properly chain their dogs.
  • 78 percent of the dogs were not kept as pets but as guard, breeding, or yard dogs.

Organizations including the ASPCA and the American Bar Association currently advocate for breed-neutral laws that target troublesome pet owners:

  • Enhance enforcement of dog licensing and leash/dog–at–large laws.
  • Focus on dogs’ individual behavior, with mandated sterilization and microchipping of dogs deemed dangerous.
  • Hold dog owners financially, civilly, and criminally accountable for violations.
  • Mandate the sterilization of shelter animals and make low–cost sterilization services widely available.

Were these attacks preventable?

Although police are still investigating each case to determine whether to file charges, these don’t seem to be stories of random aggression. All of the victims were neighbors or family members of the dogs’ owners.

These three dog attacks underscore the importance of responsible pet ownership. In fact, the state of Ohio’s dog bite law holds dog owners and caretakers legally responsible for their dogs’ behavior. During May’s National Dog Bite Prevention Week I shared tips on preventing dog bites. Reviewing these tips with your family is about more than being a good neighbor—it could save lives.

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Coumadin: Nursing home residents beware necessary but dangerous drug

warfarin_bottles_nigms

Would it surprise you to know that nearly one in six nursing home residents takes the most dangerous drug in America?

That drug is Coumadin, generically known as Warfarin. It affects the clotting time of blood, thinning the blood to prevent blood clots that could cause strokes by heart attacks or pulmonary embolism.

This statistic sure got my attention! If it’s such a common prescription, why is this drug such a danger to nursing home residents? It all comes down to a tiny margin for error. The drug must be carefully monitored: If dosage is too high, the blood will not clot and excessive bleeding occurs. But a too-low dose can allow blood clots to form, potentially causing strokes, heart attacks, and death.

A person on Coumadin must have frequent blood tests to determine the correct balance. Different members of the care team must work together to routinely order blood tests, perform them in a timely manner, communicate results to the physician, make adjustments to the dose, and then communicate those changes back to the nurses and pharmacists.

If you’re thinking that’s a lot of people who have to be “on their game” with no mistakes or break in the chain of communication, you are right.

Dr. Jerry Gurwitz is chief of geriatric medicine at University of Massachusetts Medical School. He’s been warning about this problem for the past 20 years. Dr. Gurwitz regretfully reports that not much has changed. The administration of Coumadin in nursing homes requires coordination among so many healthcare professionals that nursing homes are “a perfect setup for bad things happening” (source: Washington Post).

So what can you do to help prevent your family member from being another prescription death statistic? Ask the nurses when and how often they draw and test your loved one’s blood. Also make sure to ask whether they notified the doctor and whether they made any dosage changes. If you see unexplained bruises — which could be a sign of incorrect dose — ask the nurse.

Coumadin can be a lifesaver, but only with vigilant monitoring and responsive care.

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Nursing Home Procedures You Should Question

question-mark-1026526_960_720Faced with that difficult decision whether to place a family member in a nursing home, we rely on a good deal of trust: trust that the doctors and nurses will make the best treatment decisions. But when should we question these professionals’ treatment decisions? Finally some nursing care guidelines come from the Society for Post-Acute and Long-Term Care Medicine (AMDA).

AMDA has joined an initiative called “Choosing Wisely.” Their goal is to initiate and promote conversations between clinicians and families to choose care that:

  • is supported by evidence
  • is not duplicative of previous tests or procedures
  • causes no harm
  • is necessary

AMDA partnered with “Choose Wisely” to design a set of guidelines for long-term care patients [PDF]. These guidelines set forth ten specific tests or procedures that you should discuss with the doctor before giving consent.

One procedure you should question is placement of an indwelling urinary catheter. Some circumstances do require a catheter, such as urinary retention, outlet obstruction, or to help in the healing of serious sacral or perineal wounds when there is incontinence. To manage general cases of urinary incontinence, however, nursing homes should not use catheters. That’s because they are the most common source of bacteremia, which can lead to several life-threatening conditions. But many facilities don’t have enough nursing staff to adequately toilet patients, so they resort to placing catheters to ease demands on the staff.

A second nursing care guideline concerns the placement of feeding tubes. The medical literature shows that nutrition delivered by a percutaneous feeding tube (through the skin into the stomach) does not prolong life or add to the quality of life in patients with advanced dementia. When a patient’s health declines to the point where caregivers consider artificial nutrition, it is often a sign of significant and irreversible decline. It may seem contrary to common sense, but tube feedings do not improve patients’ comfort or reduce their suffering. In fact, these feedings may cause fluid overload, diarrhea, and abdominal pain. They may also increase the risk of aspiration, which introduces harmful matter to the lungs. The best intervention with a patient who is not eating is to offer assistance with eating.

These “Choose Wisely” guidelines are a welcome list of topics to begin a conversation with your healthcare provider to help ensure that your family member is receiving the best and most effective care.

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Cleveland Letter Carriers Suffer the Most Dog Attacks in Ohio

14946491-mailmanMost of us would consider the family dog a friend, not an occupational hazard. But for postal workers around the country, the “dog bites mailman” trope is truly a big safety threat. Nationwide, dogs attacked 5,767 postal employees last year.

The United States Post Office has released its worst 30 cities for dog attacks — and Cleveland is one of them. In fact, with 37 dog attacks on mail carriers in 2014 alone, Cleveland ranks eighth worst in the country.

USPS 2014 Dog Attack Rankings by City

Ranking City, State 2014 Dog Attacks
1 Los Angeles, CA 74
2 Houston, TX 62
3 San Diego, CA 47
4 Chicago, IL 45
5 Dallas, TX 43
6 Denver, CO
Louisville, KY
40
7 St Louis, MO 38
8 Cleveland, OH 37
9 Phoenix, AZ 35
10 Minneapolis, MN
Philadelphia, PA
33

Cleveland isn’t the only Ohio city on the top 30 list. Columbus, Cincinnati, Dayton, Akron, and Toledo also made the ranks. The problem is widespread and getting worse.

How Can You Help?

The USPS announcement kicked off National Dog Bite Prevention Week, which I mentioned last month along with tips for preventing dog attacks. To add to that list, here are some specific ways you can protect your postal worker:

  • If a letter carrier delivers mail or packages to your front door, place your dog in a separate room and close that door before opening the front door. Dogs sometimes burst through screen doors or plate-glass windows to get at strangers.
  • Dog owners should remind their children about the need to keep the family dog secured. Parents should remind their children not to take mail directly from letter carriers in the presence of the family pet as the dog may view the letter carrier handing mail to a child as a threatening gesture.
  • The Postal Service places the safety of its employees as a top priority. If a letter carrier feels threatened by a vicious dog or if a dog is running loose, the postal service may ask the owner to pick up the mail at the Post Office until the carrier is sure the pet has been restrained. If the dog is roaming the neighborhood, the postal service may ask the pet owner’s neighbors to pick up their mail at the Post Office as well.

Take Action

These safety tips don’t apply only to letter carriers. How about when you or your child knock on a neighbor’s door to drop something off or for a play date? Or if your son or daughter is collecting or selling for a scouts troop or baseball team? When traveling around the neighborhood or answering your door for any reason, keep these tips in mind.

If you’ve been bitten by a dog, whether on the job or not, please give me a call for a free legal consultation.

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Department of Justice Investigating ManorCare Nursing Home Chain

mother_and_son_holding_handsCan you imagine a nursing home putting its frail, dying residents through medically unnecessary rehab therapy? And doing it just so that the nursing home could bill Medicare in an effort to increase its profits? It’s hard to believe that kind of callousness and nursing home fraud goes on in places that we trust to care for our loved ones. But this type of overbilling is just one of the serious charges against Toledo-based nursing home chain ManorCare. The chain operates facilities around the country under the Heartland and Arden Courts brands.

A former employee, an occupational therapist, brought the lawsuit that catalyzed the government’s involvement. The lawsuit cites an example where ManorCare prescribed hospice care for an 85-year-old, “medically fragile” resident. Yet the patient received only 100 days of therapy — which is exactly the number of therapy days that Medicare reimburses.

The DOJ accuses this national nursing home company of regularly pushing its residents into the higher tier of rehabilitation services regardless of their needs. Its sharp increase in reimbursement rates is suspicious. In 2006 ManorCare billed 39% of residents at Medicare’s top reimbursement rate. But in just three years that number doubled to 80%.

The Department of Justice has just joined and taken control of this nursing home fraud lawsuit. Let’s hope that this litigation provides some answers and maybe some accountability for nursing homes, both here in Ohio and around the nation.

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Preventing Dog Bites

AVMA_DogBite_2016_FBCvr_851x315_ANext week (May 17–23, 2015) is National Dog Bite Prevention Week. It may seem dramatic to dedicate an entire week to this issue. But the Insurance Information Institute estimates that in 2013, insurers across the country paid over $483 million in dog bite claims. And according to the Centers for Disease Control, dog bites are among the top ten leading causes of nonfatal childhood injuries.

With numbers like that, it’s important to turn an eye to prevention. Educating yourself and your children about how to approach dogs and how to train your own pets is the best way to keep everyone safer.

Why do dogs bite?

Any dog can bite if provoked. But the provocation doesn’t have to come from an intentionally aggressive source: children, elderly, and postal carriers are the most frequent victims of dog bites. In fact, The American Veterinary Medical Association (AVMA) points out that most dog bites affecting kids occur during everyday activities and while interacting with familiar dogs.

Why would a dog turn on its friends? Regardless of size, age, or cuteness, any dog can bite if it feels startled, scared, or sick. A dog might bite if rough play like wrestling or tug-of-war gets out of control. Dogs don’t always understand how their strength and nips can harm their human playmates, so it’s important to teach them firm boundaries and to avoid situations that might tempt them into excessive excitement and aggression.

Avoiding risky situations with dogs

The American Kennel Club and the Humane Society of the United States offer advice to avoid being bitten by dogs. Teach children to always ask for permission to pet a dog. Make sure never to pet a dog before allowing it to see and sniff you first. Never approach a dog you don’t know if its owner isn’t present, especially if the dog is tied up or kept behind a fence. And never disturb a dog that is eating, sleeping, chewing on a toy, or caring for puppies.

If an aggressive dog approaches, don’t scream and run. Running triggers a dog’s instinct to chase you. Instead, stay still, keep your hands at your sides or on your shoulders, and avoid eye contact. Toss any object you have away from you and the dog, so it will go there to investigate. Slowly back away. If a dog knocks you down, curl into a ball and cover your ears. Remain silent and motionless.

Responsible dog ownership

The state of Ohio holds dog owners and caretakers legally responsible for their dogs’ behavior. So how can you make sure your dog is a trustworthy companion to your family and neighbors?

It starts with training and socializing your dog as a young puppy. Teach basic commands to show your dog (and other people) that you’re in control. Bring your dog into many public situations to make sure it feels at ease around other people and dogs. When your dog is comfortable, and doesn’t feel threatened or teased, it won’t feel the need to protect itself with aggression.

You can help your dog stay calm and friendly by taking regular walks and playing games together. Visit the vet regularly for vaccines and parasite control. It’s also best to neuter or spay your dog. A healthy, happy, well-exercised dog is less likely to store pent-up energy that can turn into aggression.

Addressing dangerous dogs

If a dog has acted aggressively toward you or your kids—even if it hasn’t bitten anyone yet—it’s time to take action. Your actions could prevent future attacks and future victims. Depending on the severity of the problem and who owns the dog, your actions could range from putting the dog in formal behavioral training to removing the dog from the home, or even reporting the dog to the appropriate authorities (here’s how to report dangerous dogs in Cleveland).

Find out more about Dog Bite Prevention Week from AVMA at avma.org/dogbiteprevention. For legal advice about dog bite claims and cases, please give me a call for a free consultation.

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Home Health Care Keeping Healthy

health-care-at-home

When our family members need everyday assistance due to aging or disabilities, why wouldn’t we want them to be cared for in their own homes? Home has all the comforts and familiarity gathered over a lifetime, not to mention closeness to family and friends. That makes it hard for anyone to choose to live in a nursing home, with its institutional furniture and smells, surrounded by strangers.

This growing preference has resulted in an “explosion” of new companies specializing in home-based care. That should be good, right? Unfortunately the industry’s quick growth has gone unchecked, resulting in rampant fraud: charging for care that has not been given.

In this fraud, Ohio has been a leader and Columbus a national leader: Franklin County has three times as many Medicare-certified home health agencies per person as Cuyahoga County and nearly four times as many as Hamilton County (source: The Columbus Dispatch). And Franklin County takes the lead in home-care fraud cases that have resulted in criminal convictions.

Though home health care accounts for only about 5 percent of Ohio’s Medicaid spending, it has consumed more than 50 percent of payments to providers in the last three years. Analysis of billing records by The Columbus Dispatch showed that short 15-minute visits are skyrocketing in number. This data seems to suggest that providers are exploiting the billing policy of paying for a full hour of care after only 15 minutes. The government may need to revise Medicaid’s payment policy of paying for a full hour of care even when less time is spent.

Requiring licenses is the first step toward improving care, but Ohio is currently one of only eight states that do not require home health care agencies to be licensed. These home health care fraud and payment issues — and hopefully a concern for our state’s most vulnerable citizens — are prompting Ohio lawmakers to consider legislation that would require the licensing of home health agencies. The legislation aligns with the National Association for Home Care & Hospice, one of whose officers stated that licensing “is a best practice and a no-brainer” (Source: The Columbus Dispatch).

I am quite certain that we all agree that home care is the preferred option for our family members. But we need to make sure that the care we’re billed for is the care we’ve been provided. Licensing these agencies will help create an expectation of quality care. It’s time for Ohio to take this step and require licensing of home health care agencies.

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How To Report Nursing Home Abuse

nursing-home-abuse-or-neglect-man-left-alone-in-wheelchairResidents of nursing homes face many challenges to their well-being, ranging from falls and fractures to bedsores and infection. How can we keep nursing homes accountable for the care they provide? We can hold them responsible by reporting nursing home abuse or neglect to government officials.

The Ohio Department of Health handles complaints involving regulated health care facilities statewide, including ones certified by Medicare or Medicaid. Each Ohio county offers adult protective services as well.

Who to call

The fastest way to report abuse is to call a hotline:

You should be able to find your county’s hotline by searching for “_______ County Ohio Adult Protective Services.”

What to say

The more specific you make your complaint, the better these agencies can help. Try to gather the following information:

  • Your full name, address, and phone number (they accept anonymous complaints, but can’t follow up with questions or results)
  • The nursing home’s name, address, and phone number
  • The names and contact information of everyone involved: victim, witnesses, and relevant staff
  • A detailed narrative of your complaint, including date, time, and frequency
  • Whether you believe this is an isolated event or a systemic problem
  • Why you think the incident occurred
  • Whether and how the facility has tried to address the situation
  • Whether you have tried filing previous complaints or contacting other agencies

What to expect

When you file a complaint with the Ohio Department of Health, you’ll receive an acknowledgement letter with a tracking number. Unannounced surveyors will investigate your complaint on site—they won’t divulge your identity or the victim’s except in very limited instances as required by law. Within one to three months, ODH will send you a second letter to notify you of the outcome of the investigation. Sometimes the state investigators cannot substantiate a complaint, which doesn’t mean it didn’t happen.

Most Ohio counties will send investigators or social workers to investigate allegations of neglect or abuse. They should review care records, interview staff, and review the nursing homes policies and procedures. They’ll immediately help to reduce or eliminate the danger. Once a case is substantiated, they can provide case management, including referrals to community services, such as home support, temporary shelter, meals, medical care, and financial counseling. Social workers will recommend legal action only after all other appropriate solutions have been explored.

Legal action

By reporting nursing home abuse, you aren’t just demanding accountability for wrongdoing. You may also save other people from similar experiences in the future. So if you suspect your loved one has suffered injury, abuse, or wrongful death while under care of an Ohio nursing home, please reach out to me for a free legal consultation.

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Maybe Those (Rating) Stars Will Really Shine?

service-starsI am talking about the CMS (Center for Medicare and Medicaid Services) rating stars that rate the nation’s nursing homes. Families rely on this system when they’re evaluating nursing homes and their quality of care.

Last month Medicare implemented changes to the rating system on its website Nursing Home Compare. The changes impacted two areas: staffing and quality measuring statistics. Both relied on unverified information provided by the nursing homes themselves. CMS now will look to verify staffing information with objective payroll data. They’ll also use data to verify self-reported quality indicators.

Even a huge bureaucracy like CMS could see that the previous way of doing things — not requiring any check of the information supplied by the homes — was a huge conflict of interest. Since the changes have taken effect the “stars” have realigned. Ratings declined for almost one third of the nursing homes across the country. This certainly seems to provide support that the homes supplied inflated and inaccurate information. Before the change about 80% of all nursing homes received a 4- or 5-star rating (out of 5). But after the change only 50% did (source: New York Times).

These changes are great news for families, who can now be more confident in the information CMS supplies. This increased level of oversight will hopefully motivate the industry to provide better care. As an advocate for the elderly, I am grateful for the realignment of the “Stars” and for better and more reliable information for families.

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Cleveland’s Vicious Dog Laws

SD#23 Dog PolicyAfter a long, cruel winter, spring is finally approaching! I actually saw crocuses blooming in the yard last weekend. And as the sun thaws the snow, all of us have started venturing outside—including our children and pets. As a dog bite attorney, this feels like a good time to review your local rights in the event of an encounter with a dangerous dog.

Every Ohio city has the power to add its own legislation to the state’s dog laws, and Cleveland is no exception. The current version of the city’s ordinance took effect in 2011. Cleveland’s law, which had previously targeted pit bulls, now categorizes dangerous dogs by behavior rather than breed. This stance aligns with the American Bar Association, which supports laws that hold owners accountable by strengthening leash and licensing laws as well as imposing higher fines.

Levels of threat

You don’t have to suffer an actual dog bite before you can report a dangerous animal to the authorities. With sufficient proof, Cleveland officials (Municipal Court, Animal Control Services, or Police) can categorize a dog as a threat.

Cleveland considers a dangerous dog a level-one threat dog if it has:

  • chased or approached a person in a menacing fashion without provocation
  • repeatedly exhibited a tendency to attack or threaten the safety of humans or their pets
  • been impounded by an animal control officer on three separate occasions within a 12-month period for being unrestrained or uncontrolled off its owner’s property

Cleveland deems a vicious dog a level-two threat if it has killed or caused serious injury (puncture wounds that require immediate medical assistance) to any person or domestic animal.

The law requires owners of dogs classified as level-one or level-two threats to:

  • spay or neuter the offending dog
  • post signs indicating “Level I Threat dog” or “Level II Threat dog”
  • obtain liability insurance of at least $100,000

Reporting a dangerous dog

If a dog threatens or bites you or your child, make sure to report the incident to Animal Control Services within twenty-four hours by calling 216-664-3069. Cleveland Animal Control Officers are on duty twenty-four hours a day, seven days a week. The city requires an owner to quarantine a dog that bit someone for at least ten days afterward; it can’t be released until a veterinarian and an animal control officer approve.

Please be careful with your health after a dog bite. My experience as a nurse taught me that dog bites (even minor ones) can cause dangerous or even life-threatening infections. That’s why I urge you to err on the side of caution when treating any dog bite wound. Unless the bite is a superficial scrape and you’re in excellent health, you should seek immediate treatment from your family doctor or the nearest hospital.

What’s next?

Not all dog bites warrant legal action—for example, your child may have roughhoused too vigorously with a friend’s puppy and received a nip on the arm in response. But if a dangerous or vicious dog has attacked you or your child, it’s important to contact a dog bite attorney before the dog harms anyone else. The dog’s owner or keeper is liable for damages unless you were trespassing, committing a crime, or tormenting the dog at the time of the attack. If you’re seeking legal aid for your dog bite case, please reach out to me for a free consultation.

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