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In the March edition of Consumer Reports, two Central New York hospitals will share the spotlight for having no central line bloodstream infections. A central line is a large diameter tube or catheter, usually inserted into a vein in the neck, chest or groin. Once in place, a central line can be used to deliver intravenous drugs and nutrition to patients. Without proper placement and maintenance, central lines are prone to infections. Central line bloodstream infections can lead to sepsis and death. As many at 15% of all hospital infections concern a central line.

Consumer Reports surveyed more than 100 hospitals nationwide. Of the hospitals surveyed, there were no reports of central line infections at Community General Hospital in Syracuse, New York. Likewise, there were no reports of central line infections at Cayuga Medical Center in Ithaca, New York.

In order to avoid hospital infections, both Community General Hospital and Cayuga Medical Center have developed protocols to decrease the possibility of contamination by, e.g., instructing staff to wear gowns, gloves and masks, draping the patient, and limiting the number of times that the central line is handled. Further, both hospitals attempt to limit how long a central line is in place because the longer a line is in place, the greater the risk for infection.

In addition to hospitals without infections, the report also highlighted New York hospitals with higher-than-average infection rates. One Syracuse hospital with a higher-than-average surgery infection rate was Upstate University Hospital. Crouse Hospital was noted to have below average colon-surgery site infections.
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Testing of a new therapy is underway at Nationwide Children’s Hospital in Columbus, Ohio, which may revolutionize the way that Syracuse babies diagnosed with cerebral palsy exercise to strengthen their muscles.

The system incorporates a harness into the use of a treadmill. The harness supports the child’s weight while he or she walks, which should make it easier for cerebral palsy patients to walk without the risk of falling. As children using the system learn how to walk and grow stronger, the amount of weight carried by the harness can be decreased — essentially returning the child’s body weight to their legs.

Previously, children with cerebral palsy received physical therapy only once a week. With the treadmill program, they can receive therapy several times a week. More therapy means more practice walking, and shorter periods of complete disability. More than 90% of recent participants showed improvement in walking over the course of eight weeks. Two children made remarkable advances, with one moving completely out of braces and the other moving to less supportive bracing.

Every day, at least one child in the United States is diagnosed with cerebral palsy. All too often, cerebral palsy is the result of a doctor’s mistake, such as when an OBGYN fails to perform a cesarean section despite fetal distress, when a medical resident ignores ominous fetal heart rate monitor tracings, or when a labor and delivery nurse negligently increases Pitocin despite pregnancy complications.
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According to the American College of Obstetricians and Gynecologists, all Central New York OBGYNs should closely review the nature of their practice and consider whether their patient load, hours worked and other time commitments are causing fatigue-related birth injuries.

A recent study suggests that most OBGYNs practicing in Upstate New York hospitals do not sleep enough. The most sleep deprived include residents and specialists on call, such as neonatologists. Without at least five hours of sleep, a doctor’s speech, numerical skills, memory and concentration decline. Missing faculties can leading to medical mistakes. Doctors awake more than 19 hours performed worse on tests than individuals with a blood alcohol content of 0.05. The legal limit for drunk driving in most U.S. states is 0.08.

During a labor and delivery, minutes and even seconds matter to a baby that may not be receiving appropriate blood flow and, in turn, may be suffering from brain damage due to a lack of oxygen. After just a few minutes of low oxygen levels, a fetus may develop cerebral palsy. Because delay caused by doctor fatigue and sleep deprivation could result in permanent injury to a baby, ACOG recommends that OBGYNS follow good sleep habits, sleep immediately after long shifts, make arrangements for a backup, nap, and avoid working between 2 a.m. and 9 a.m.
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According to the American College of Gynecologists (“ACOG”), with members including Binghamton New York obstetricians and Binghamton New York gynecologists, women should not deliver at home because a labor and delivery complication during a Central New York home birth could result in birth injury or death.

ACOG explains that labor and delivery complications can arise without warning, even in low-risk patients. Appropriate treatment for a complication, such as a shoulder dystocia or an umbilical cord wrapped around a baby’s neck, must come from an OBGYN or skilled birth center capable of determining whether a cesarean section is necessary to prevent Erb’s palsy, cerebral palsy or other birth injury. In high risk cases, such as vaginal birth after cesarean (“VBAC”) deliveries, a complication such as a uterine rupture could also lead to the death of a pregnant mother if hemorrhaging is not treated. ACOG reports that “the safest setting for labor, delivery, and the immediate postpartum period is in the hospital, or a birthing center within a hospital complex.”

ACOG also advocates against deliveries managed by midwives who are not certified by the American College of Nurse-Midwives or American Midwifery Certification Board.
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A few weeks ago, Syracuse’s Crouse Hospital launched a “Shhhhh” campaign. Around the hospital, visitors are staff are being reminded by posters to keep quiet. Recent studies show that a quiet environment helps to lower a patient’s heart rate and blood pressure, and may speed the healing process.

Crouse Hospital is not the first New York State hospital to adopt a quiet environment. In 2007, Montefiore Hospital in the Brox implemented a Silent Hospitals Help Healing, or SHHH, program. Crouse Hospital, like Montefiore, plans to reduce noise by silencing beeping monitors, eliminating squeaky cart wheels, reducing intercom pages, automating doors to prevent slamming, and encouraging late-night “whispering” between hospital staff, patients and visitors. Other ideas include installation of noise-reducing ceiling tile, curtains, turning beepers to vibrate, wearing soft-soled shoes, and headsets for patients to listen to television programming or music.

A secondary benefit of a quiet hospital is a calm working environment, which should operate to decrease hospital mistakes and medical malpractice caused by distractions due to stress, commotion and noise.
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On January 4, 2010, a Fort Drum woman went into labor in her home. By the time that emergency responders arrived, the woman was in labor and the baby was crowning. The baby was delivered in a bathtub and was taken to Samaritan Medical Center in Watertown, New York, for care including difficulty breathing.

Precipitate delivery, which is any labor and delivery lasting less than 2 hours, can be dangerous for the mother and fetus. Generally, a precipitate delivery involves almost constant contractions that may be very intense. The rapid contractions make it difficult for a laboring mother to find a rhythm, and subject the fetus to constant pressure which can lead to umbilical cord compression and inadequate blood flow. Compromised blood flow may lead to low fetal oxygen levels and acidosis. Acidosis can lead to fetal brain damage and lifelong disabilities such as cerebral palsy.

Rapidly born babies also have insufficient time to adjust to life outside the womb and may require assistance with breathing. Many precipitate delivery babies are born with broken blood vessels, which may appear as red spots on the skin or burst blood vessels in the whites of the eyes. Precipitate delivery may also be associated with vaginal and perineum tears, as well as birth trauma, such as delivery of a baby onto the ground or other hard surface leading to lacerations and fractures. A tumble to the ground may also lead to umbilical cord snapping and delayed delivery of the placenta. A torn umbilical cord or late placental delivery can lead to maternal hemorrhaging.

The failure to anticipate a precipitate labor may be due to medical malpractice or hospital negligence. While precipitate labor is difficult to anticipate, their are warnings signs or risk factors, including: a multipara mother with relaxed pelvic or perineal floor muscles and/or a multipara mother with a history of strong contractions.
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Last month, Bottar Law, PLLC partners Edward S. Leone, Esq., and Anthony S. Bottar, Esq., secured $3,250,000.00 in compensation from a group of Syracuse medical defendants. The Syracuse birth injury lawsuit sounded in Syracuse OBGYN malpractice and Syracuse hospital negligence, and alleged that the defendants collectively failed to identify signs of fetal distress, failed to respond to labor and delivery complications, and failed to perform a cesarean section before the unborn baby’s brain was permanently damaged by prolonged hypoxia. Shortly after birth, the infant plaintiff was diagnosed with spastic quadriplegic cerebral palsy, further complicated by seizures, as well as hearing and vision loss.

Plaintiff’s claims included allegations that the defendants: failed to appreciate a lack of beat-to-beat variability, failed to note the absence of accelerations, failed to respond to a hypertonic contraction pattern, failed to respond to minimal variability, failed to appreciate and respond to thick meconium after rupture of membranes, prescribed Pitocin in the face of a non-reassuring fetal heat rate and uteroplacental insufficiency, and wholly failed to continuously monitor for and respond to prolonged decelerations.

Plaintiff’s settlement proceeds will be used to fund a trust (for future medical care), with a lifetime value of nearly $10,000,000.00.

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As many as 200,000 people die every year due to mistakes made in U.S. hospitals. Central New York hospitals are no exception.

In 1992, a 64 year old woman presented to Crouse Hospital in Syracuse, New York, for cancer therapy. She was supposed to receive an injection of carboplantin, but due to a medication mistake made by a hospital pharmacist, the woman received cisplantin. Cisplantin is far more powerful than carboplantin. Because of the Crouse Hospital prescription medication error, the woman died.

Probably because the woman was the wife of New York State Court of Appeals Judge Richard D. Simoons, Crouse administrators accepted responsibility for undeniable Central New York hospital negligence, stating that it was an “unmistakable human error.” The hospital also stated that “it would not surprise us if we settled this without going to a lawsuit.” Whether a lawsuit was necessary to secure compensation for the woman’s pain and suffering is unknown.
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Meridia (sibutramine) is a weight loss drug marketed by Abbott Laboratories. It acts on chemicals in the body that are associated with weight maintenance. In most people, consumption of the drug, which can be taken with or without food, results in a 4 pound weight loss over the course of 4 weeks (when joined with a low calorie diet).

The Food and Drug Administration recently announced that it will require that Meridia bottles be labeled with a warning that the drug may increase the risk of a heart attack or stroke, especially in patients with a history of heart problems. The new label will further emphasize how Meridia can cause a heart attack or stroke in people suffering from hypertension, irregular heart beats, or heart failure. If you have had a heart attack while taking Meridia, or if you have had a stroke while taking Meridia, your doctor may have made a medical mistake by prescribing you a drug that was not safe given your history.

If you take Meridia, you should see you doctor on a regular basis so that he or she can monitor your blood pressure and pulse. The drug should not be taken for longer than 2 years.
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ndian River Central School District, located in Jefferson County, New York just minutes from Fort Drum, recently received a $125,000 grant to combat teenage pregnancy. School administrators plan to use the funds to create programs that will create respect and responsibility when it comes to sexual activity.

Fort Drum (89.2 per 1,000), Evans Mills (78.7 per 1000) and Calcium (93.1 per 1,000) consistently have teenage pregnancy rates that are higher than the New York State average (58.4 per 1,000). According to the North Country Prenatal/Perinatal Council, one reason for higher teenage pregnancy rates in Fort Drum is the age of many Fort Drum couples. Statistics show that many Fort Drum soldiers marry young, often at age 18 or 19, and quickly have children. When those children reach age 18 or 19, they too marry and have children, leading to generations of young families.

There are many health risks associated with teenage pregnancy, including labor and delivery complications such as premature delivery and low birth weight babies. Premature delivery can cause cerebral palsy, respiratory and cardiovascular deficits, and disabilities from persistent pulmonary hypertension of the newborn. Other risks include mental retardation and difficulty controlling body temperature or blood sugar levels.
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