What is a DICOM?

DICOM Images

What is DICOM? 

In a clinical environment dealing with any medical imaging, DICOM, short for Digital Imaging and Communications in Medicine, has become essential. The broad application of DICOM is not difficult to understand, given the need and usefulness of medical imaging in healthcare. It allows the storage, viewing, and sharing of medical images and related data on devices within and across medical facilities.  
  

The standard communications protocol used to capture, store, and transmit medical images and related information is DICOM. In medical imaging, DICOM acts as a blueprint for the information structures and procedures in medical imaging systems that control the input and output of data. Both the protocol itself and its corresponding file format are referred to by the term. All data acquired in the medical imaging process is stored in this format. Without it, it would be considerably more difficult to exchange information between various imaging devices.  

Differences between DICOM and PACS, RIS, and CIS 

In addition to DICOM, words such as PACS, RIS, and CIS are often discussed , especially when talking about the benefits that have been brought to healthcare by modern software technologies, standards, and protocols. With regard to what differentiates them, this may lead to some confusion, particularly when it comes to the difference between PACS and DICOM.  

Medical IT systems focused on networks of different devices are the former. DICOM is the common protocol and file format that defines the communication between these devices and allows many different systems to communicate equally.  

Now that that’s clear, here’s an overview of the most popular medical IT systems:  

  • PACS (Picture Archiving and Communication Systems) are medical imaging systems that provide multi-modality storage and access to images. Its key application is as a superior storage option that removes the need to store and retrieve data manually. 
  • RIS (Radiology Information System) – Another type of information system for storing and handling medical imaging data widely used in radiological practices is RIS (Radiology Information System). Radiologists typically use it for, among other purposes, scheduling patients, monitoring and interpreting exams, and billing. 
  • As they are applied to the same area and sometimes used in combination, the distinction between RIS and PACS can be a little vague. These are both systems for enabling the handling of patient information, but while PACS provides storage and a long-term patient data management solution, RIS streamlines procedures and enhances workflow by allowing real-time patient monitoring and providing medical records for patients from one central source.  
  • EHR (Electronic Health Record) – EHRs are digital versions of patients’ paper charts. They are digital archives of the entire medical care history of patients. It encompasses medical pictures. EHRs can work in combination with other medical information systems, much like the previously described patient data systems. They can come with a DICOM production, send, or customer, and can be integrated with PACS or RIS as well. 
  • CIS (Clinical Information System) is an information system that documents, stores and manipulates the clinical information of patients. How does this vary, you might ask, from EHRs? EHRs include a patient’s entire medical history and are therefore much more generalized. CIS manages very precise data, obtained directly from inputs from equipment and medical staff. 

In addition to offering countless advantages, such as enhancing workflow and performance, reducing costs and space requirements, these medical information systems allow practices to concentrate more on patient care efforts. In modern medical services, this has made them indispensable.  

To respond to the diverse demands of medical imaging systems, medical technology is continually evolving and diversifying. New kinds of DICOM-compliant applications are constantly being developed, and cloud-based DICOM image viewers have been one of the most important innovations to emerge from this.  

R&G Medical Legal Solutions, is excited to announce that we have developed our very own proprietary online DICOM viewer that is a part of our database management system and will make this service available in the very near future. This will allow our clients to view any records including radiology, 24-7. Please give us a call at 1-623-566-3333 or email us at marketing@rngmedical.com today for a demonstration.  

R&G Medical Legal Solutions, LLC is a highly regarded litigation support services firm.  R&G is a second-generation company headed by Brian Oldham, a retired, service disabled veteran of The United States Air Force.  

Historical Perspective for a Successful Legal Nurse Consulting Firm

R&G Staff 
January 2021 

R&G Medical Consultants, now R&G Medical Legal Solutions, was founded in February 1992 by Rosie Oldham, BS, RN, LNCC. Her background in nursing administration, risk management and quality improvement were extremely valuable in the startup of the firm. 

R&G’s first cases were personal injury and in December 1992, the firm began working on product liability cases (resulting in completion of over 750 cases). This led to staff expansion and rapid company growth. During this project R&G   implemented total quality management procedures. Peer review of work products led to a successful 100% deficiency free submission of claims. From 1994 to 1996, R&G processed over 450 toxic tort cases (water contamination) for the defendants.  In 1997, R&G began focusing on complex medical malpractice and personal injury cases.  

Fast forward to 2021. Use of and incorporation of technology is the foundation of R&G’s continued success to managing large scale projects.  Incorporation of nurse project directors and non-nurse project managers free clients from the administrative burden of coordinating many logistical areas of mass tort. Record retrieval combined with customizable nurse work products allow for one stop shopping for clients.  

Foundational services such as nurse work products that range from in-depth, pertinent verbatim to summaries of care remain a staple.  Hybrid products, such as a combination of pertinent verbatim of key events, combined with summaries of general that capture events in an efficient, cost effective manner are now offered.    

A new service related to radiology films, will be launched in the near future.  Clients will be able to view, manage, and share radiology data online in lieu of tracking and managing CDs.  Key features of the service include cinematographic (CINE) views, digital measuring tools and panning.  

All services at R&G are customizable to fit the needs of each client.  No project is too big or small.  If interested in R&G services please call Catherine Beasley, MS, BSN, LNCC at 623-566-3333 or email cbeasley@rngmedical.com .   

How Veteran Nurses Help Distinguish R&G

Service Disabled Veteran Owned Small Business

January 2021 

Beth Ann Lumpkin, Lt. Col., USAF, NC (Ret.)

Thousands of registered nurses served as active duty, guard or reserve member in the Army, Air Force and Navy Nurse Corps, even the Public Health Service. Individual service duration varied anywhere between three to twenty years.  

The skills acquired in the military are extremely valuable for the civilian job market. Leading teams, critical thinking, cultural sensitivity, organization, adaptability, attention to detail, varied work hours, and solid work ethic are just a few of the traits Veteran nurses gained while on military duty. These traits make military nurses well suited for legal nurse consulting work.  

Nurses with a military background are highly educated. The structure of the military provided professional military education with each level of rank and nursing specialty. Veteran nurses have a variety of specialties translatable to nurse consulting. For example, specialties include operating room, infection control, quality assurance, midwifery, mental health, aeromedical evacuation, critical care and medical surgical are just a few of the areas for which military nurses have provided care. Military nurses provide care in both the inpatient and outpatient settings, and military nurses are trained in managing acute trauma under battlefield conditions. Military nurses must complete continuing education on an annual basis unlike some requirements from states for civilian nurses.  

R & G is a veteran owned and established business that works with a variety of clients. Highly experience nurse consultants, to include some military nurses, are part of the equation that allows R&G to provide outstanding service.  

Please give us a call today to see how legal nurse consulting at R&G can solve problems for you and/or your firm.  Dial 1-623-566-3333 today.  

Legal Nurse Consultants… Put them into action

A legal nurse consultant (LNC) is a subject matter authority on nursing and healthcare matters much like how an attorney is an expert in legal matters. They are state licensed, detail-oriented healthcare professionals, working on behalf of the litigation team.  

Legal nurse consultants apply their knowledge, education, and clinical training to medical legal cases. Supreme is their ability to interpret medical records. Using their nursing knowledge, LNCs can quickly evaluate medical records and distill them into comprehensive summaries, or chronologies. Their attorney clients can then quickly read, understand, and put them into action. 

The primary role of LNCs involves the identifying, analyzing, and evaluating medical records while providing their professional opinions regarding health issues in medical legal cases. This field of study is composed of evaluating the standards of care, causality, and other medically related issues through the examination of medical records, healthcare literature, and legal documents. Their expertise extends to multiple topics, including: long-term care, medical malpractice, personal injury, worker’s compensation, and mass-tort litigation.  

Legal nurse consultants will also be able to establish a chronology or summary of medical records, and prepare evidence for trial. Additionally, they act as a liaison between the attorney, the healthcare provider, and medical experts. In brief, legal nurse consultation is a valuable asset to the litigation team. 

R&G Medical Legal Solutions has an extensive team of certified legal nurse consultants, that are available around-the-clock, 24-7, to assist you with anything you need. We are agile, in that we can scale up or scale down the project workload to adapt to your needs as they change. Please give us a call today to see how legal nurse consulting at R&G can solve problems for you, dial 1-623-566-3333 or send us an email: rngrfp@rngmedical.com

Retrieving Medical Records

For the most part, retrieval of medical records is a relatively straightforward process.  Armed with the appropriate HIPAA-compliant release of information, retrieving records for clients is often a matter of determining the appropriate custodian’s contact information and submitting the request.

Sometimes, it is not as simple as submitting a request and receiving the records in a timely manner.  Often provider staff members are very busy–sometimes delays or seeming unresponsiveness are merely a natural byproduct of human beings with hectic workloads.  In these cases, we at R&G have found conducting thorough research at the beginning of the process can improve turn-around time by ensuring that the request submitted meets the custodian’s internal requirements and reaches the correct individual at the organization–the individual who can fulfill the request.  Furthermore, building professional relationships with record custodians, and conducting appropriate follow-up on the status of the request often removes barriers caused by failures in communication or human error.

Still, there are times when conventional methods do not appear to work.  When this occurs, it becomes important to understand the rules and regulations which govern the custody of and availability of medical records.  What happens when records do not arrive in a reasonable amount of time?  What is a reasonable amount of time?  What if the provider appears unresponsive to the request?

The specific answers to these questions are found at the state level, and vary from state to state in terms of the specificity which is clearly defined in the statues or codes.  A state-by-state breakdown is beyond the scope of this post, but we can take a look at the State of Arizona as an example:

What is a reasonable amount of time?

In Arizona, many of the rules pertaining to medical records may be found in the Arizona Revised Statutes, under Title 12, in Chapter 14, Article 7.1, the section on Medical Records.  Although this code provides answers such as whether a custodian may charge a fee to third parties (yes, a reasonable charge is permitted), and the period after the last visit during which the custodian must maintain the patient’s record (six years), it does not define how long the custodian may take to produce the records.  Arizona Statute does, however, touch on this subject in Title 32, which governs Professions and Occupations.  In Article 1   In Article 1, “unprofessional conduct” is defined to include “Failing to make patient medical records in the physician’s possession promptly available…”.   Still, though, one must determine the meaning of “promptly” in this instance.

For further clarification, one might visit the Official Website of the Arizona Medical Board.  In the FAQ there, the board attempts to answer this question for its members, stating that “Three weeks is a reasonable amount of time unless there are extenuating circumstances.”

Keep in mind that this three week period is not part of the statute;  however, knowing that this is the time frame suggested by the Arizona Medical Board may be helpful when communicating with record custodians.  If the response to the request has been delayed, mentioning this interpretation by the Arizona Medical Board may help avoid the necessity for a costly subpoena.

 

No Legal Advice Intended:  This article is for informational purposes only, and is not intended, and should not be taken, as legal advice.  Contact an attorney for advice on specific legal issues.

Sources:

http://www.azleg.gov/ArizonaRevisedStatutes.asp

https://www.azmd.gov/FAQ/MedRecsPhysician.aspx

R&G Certified as Veteran-Owned Business

After completing a comprehensive vetting process conducted by the Center for Verification and Evaluation at the Department of Veterans Affairs, R&G is pleased to announce its certification as a Veteran-Owned Small Business.

Receipt of this designation enhances R&G’s ability to secure government contracts.  In addition, companies seeking to support Veterans through use of services provided by Veteran-owned businesses may be assured that R&G meets stringent government standards of Veteran ownership and management.

Veteran-Owned Small Business Certification
Veteran-Owned Small Business Certification

The Future of TELEHEALTH is NOW!

Doctor with stethoscope Reaches out of computer screen.

The idea that a health care provider could diagnose and treat a patient via teleconferencing technology was a concept more at home in the Star Trek™ realm than what is now an increasingly commonplace event.

Patient consultations currently take place via video conference, e-health including patient portals, remote monitoring of vital signs, sleep studies at home and cardiac monitoring during the patients’ work day are common.  While there are many other applications,  (ATA, 2015) “all are considered part of telemedicine and telehealth”.

There are a great many questions regarding reimbursement, regulations, infrastructure and access as well as provider and patient adoption and whether these will fall into a viable alternative to face-to-face health care.  There are a great number of barriers that need to be overcome for telehealth to enjoy parity with inpatient visits.

With the shortage of health care providers, particularly in primary care, congressional and media attention over the past year has increased dramatically.  According to a Georgia Public Policy Foundation study, without telehealth, patient access might be delayed, denied or otherwise not available.  (Bachman 2015) reflects patient savings in time and money and reduction of stress from delayed or denied face-to-face medical care.

Patient and Doctor Consult via TabletThe Affordable Care Act has brought millions of people into the healthcare system, and currently 44 states have telehealth legislation pending.  Bills are being debated in committees for eventual introduction in Congress. There is also greater media attention highlighted on network TV and radio news shows to include blogs within the online community of health care providers and patients.

There are concerns regarding whether or not patients will readily accept telehealth alternatives, but these are essentially unfounded.  Most of the population has grown along with online technology, which includes user friendly programs that assist with reliable practice.

Elderly senior citizens may face some challenges using digital tools, a Pew Research Study (Smith, 2013) found that, “Six in ten seniors – 59%- report using the Internet.”  This percentage has been increasing by 6% over a similar point annually.  In fact, the rate of adoption of social media among those age 60 and over is the fastest growing segment of the marketplace.

Concerns about reliability of data to inform the provider is mitigated by ongoing advances in the industry making telehealth technology the cutting edge of innovation.   Higher video and image resolution, efficient use of bandwidth has made connectivity more reliable with electronic health record systems facilitating the increased data exchange (iHealthBeat, 2013).  Real time IT-enabled transfer of patient monitoring has evolved sufficiently to support telemedicine platforms. (Darves, 2014)

Scientific studies in the area of telemedicine and quality of care “indicate that the use of telemedicine for such applications as monitoring of chronic care patients or allowing specialists to provide care to patients over a large region have resulted in significantly improved care.  For most telemedicine applications, studies have shown that there is no difference in the ability of the provider to obtain clinical information, make an accurate diagnosis, and develop a treatment plan that produces the same desired clinical outcomes as compared to in-person care when used appropriately”.  (2013 American Telemedicine Report, Telemedicine’s Impact on Healthcare Cost and Quality)

Doctor Consults Specialist and Discuss Readiology Image via ComputerThe same report found that the vast majority of the peer-reviewed research studies about the cost effectiveness of telemedicine (based on large sample sizes and following sound scientific rigor) are relatively new but are consistently concluding that telemedicine saves the patients, providers and payers money when compared with more traditional approaches to providing care.  An August 2014 study by global professional services company Towers Watson estimated telemedicine could potentially deliver more than $6 billion a year in health care savings to U. S. companies (Towers Watson, 2014).

Reimbursement has been a thorny issue in telehealth.  There is a wide discrepancy between how to pay in comparison to traditional in-office visits.  (U.S. Department of Health and Human Services Health Information Technology, 2014).

Health care provider regulatory bodies are just getting started in the process of interstate practice, NCSBN’s Nurse Licensure Compact (LNC) has been ahead of the curve since implementation in 2000.  The NLC allows RNs and LPNs/LVNs to have multistate licenses with ability to practice in their home state and other NLC states.  Currently there are 24 states in the NLC.  BONs (Boards of Nursing) have been actively involved in revising the NLC to ensure it reflects best practices and provides public protection and continued high standards.  Several organizations are actively involved in compiling state by state telehealth nursing licensure requirements similar to what is available for physician requirements.

Telehealth is a concept waiting for all of the factors influencing its acceptance as part of the health care delivery system to align.

References

American Telemedicine Association.  “What is Telemedicine?”

American Telemedicine Association. (2013) “Telemedicine’s impact on healthcare cost and quality.”

Bachman, R.E. (2015).  Telehealth & Patient-Centered Care. Georgia Puclic Policy Foundaiton, Atlanta

Darves, B. (2014). “Technology advances boosting Telehealth, but changes to widespread use remain.”

iHealthBeat (2013). “Health care providers leveraging advances in Telehealth technology.”

Smith, A. (2013). “Older adults and technology use: Attitudes, impacts, and barriers to adoption.”

Towers Watson. (2-14). “Current Telemedicine Technology Could Mean Big Savings. [News Release]

U.S. Department of Health and Human Services Health Information Technology. “What are the reimbursement issues for telehealth?”

Arizona State Board of Nursing Regulatory Journal, (2015), In Focus, Spring.

National CPR and AED Awareness Week

The Beat Goes On!

In December of 2007, Congress declared the first week of June each year as National CPR/AED Awareness Week in an effort to increase the number of people certified in cardiopulmonary resuscitation (CPR) and trained to use an Automatic External Defibrillator (AED). In today’s advanced technological world, the American Heart Association (AHA) has determined that in order to increase the survival rates for victims of sudden cardiac arrest, we need to go back to the basics of  CPR. This is not limited to healthcare workers but includes lay people as well. According to the AHA there is a 95 percent mortality rate for over 300,000 Americans who are victims of sudden cardiac arrest each year. It is also estimated that on average it takes 8 to 10 minutes for 9-1-1 to reach a victim. Survival rates for individuals with ventricular fibrillation treated by AEDs have been reported between 0% and 31%. Comparatively, the survival rates for performing CPR alone are reported between 0% and 6%.  More lives could be saved if members of the general public have training in the use of AEDs and CPR. .

Why is this important?

The reason that this is so important is after four minutes without oxygen going to the brain it will begin to die. After eight minutes it becomes the point of no return, irreversible brain death begins to occur. So even if the heart is restarted, the damage after eight minutes can never come back. This is why we need people to do CPR. In cases where CPR is performed immediately, this risk is cut in half. Victims’ chances of survival decrease by 7 to 10 percent each minute that they go untreated after their heart stops, so bystanders’ knowledge of CPR is a matter of life or death.

Why did they change CPR?

New CPR Rules: Pump First, and Save the Breaths for Later If you have ever been trained in CPR, we were all trained  A-B-C,  for “airway, breathing, compressions”. But the American Heart Association (AHA) recommends a different approach. The new mnemonic is C-A-B; we’re now supposed to start chest compressions right after calling 911; adjust the airway and leave the rescue breaths for last. The AHA wants to encourage people to be willing to administer CPR; so making the mouth-to-mouth breathing a less prominent part may make the procedure more palatable.  In recent years, the results of study after study have supported the fact that the victims who receive compressions alone from bystanders survive as well as those who received traditional CPR.  The guidelines apply to adults, children, and infants but exclude newborns.

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  • Establish responsiveness, if victim is not responsive, roll the person onto their back. Check for a pulse for no more than 10 seconds.
  • Call 911 or ask someone else to do so.
  • Start chest compressions. Place the heel of your hand on the center of the victim’s chest. Put your other hand on top of the first with your fingers interlaced.
  • Press down so you compress the chest at least 2 inches in adults and children and 1.5 inches in infants. “One hundred times a minute or even a little faster is optimal,” Sayre says. (That’s about the same rhythm as the beat of the Bee Gee’s song “Stayin’ Alive.”) Allow for a complete recoil of the chest after each compression. Give at least 30 compressions before you proceed to rescue breathing.
  • If you’re been trained in CPR, you can now open the airway with a head tilt and chin lift.
  • Pinch closed the nose of the victim. Take a normal breath, cover the victim’s mouth with yours to create an airtight seal, and then give two, one-second breaths as you watch for the chest to rise.
  • Continue compressions and breaths – 30 compressions, two breaths – until help arrives.

These guidelines apply to children and adults alike, since AHA officials did not want separate and potentially confusing advise for different groups of people. The change in CPR is part of a larger revision of its emergency heart care recommendations.

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AEDs are user-friendly devices that untrained bystanders can use to save the life of someone in cardiac arrest.

  • Before using an AED, check for puddles or water near the person who is unconscious. Move him or her to a dry area, and stay away from wetness when delivering shocks (water conducts electricity).
  • Turn on the AED’s power. The device will give you step-by-step instructions. You’ll hear voice prompts and see prompts on a screen.
  • Expose the person’s chest. If the person’s chest is wet, dry it. AEDs have sticky pads with sensors called electrodes.
    • Apply the pads to the person’s chest as pictured on the AED’s instructions.
    • Place one pad on the right center of the person’s chest above the nipple.
    • Place the other pad slightly below the other nipple and to the left of the ribcage.
  • Make sure the sticky pads have good connection with the skin. If the connection isn’t good, the machine may repeat the phrase “check electrodes.”
  • If the person has a lot of chest hair, you may have to trim it. (AEDs usually come with a kit that includes scissors and/or a razor.) If the person is wearing a medication patch that’s in the way, remove it and clean the medicine from the skin before applying the sticky pads.
  • Remove metal necklaces and underwire bras. The metal may conduct electricity and cause burns. You can cut the center of the bra and pull it away from the skin.
  • Check the person for implanted medical devices, such as a pacemaker or implantable cardioverter defibrillator. (The outline of these devices is visible under the skin on the chest or abdomen, and the person may be wearing a medical alert bracelet.) Also check for body piercings.
  • Move the defibrillator pads at least 1 inch away from implanted devices or piercings so the electric current can flow freely between the pads.
  • Check that the wires from the electrodes are connected to the AED. Make sure no one is touching the person, and then press the AED’s “analyze” button. Stay clear while the machine checks the person’s heart rhythm.
  • If a shock is needed, the AED will let you know when to deliver it. Stand clear of the person and make sure others are clear before you push the AED’s “shock” button.
  • Start or resume CPR until emergency medical help arrives or until the person begins to move. Stay with the person until medical help arrives, and report all of the information you know about what has happened.
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AED
AED Setup and Use

 

RESOURCES: American Heart Association. 2010 Guidelines for CPR and Emergency Cardiovascular Care, October 2010
http://www.cardiacscience.com/marking-national-cpr-and-aed-awareness-week/
http://www.heart.org/HEARTORG/CPRAndECC/WhatisCPR/What-is-CPR_UCM_001120_SubHomePage.jsp
http://www.heart.org/HEARTORG/CPRAndECC/WhatisCPR/CPRFactsandStats/CPR-Statistics_UCM_307542_Article.jsp
http://www.heart.org/idc/groups/heart-public/@wcm/@ecc/documents/downloadable/ucm_317350.pdf
http://mycprcoach.com/hands-only-cpr/ Weisfeldt ML, Sitlani CM, Ornato JP, Rea T, Aufderheide TP, Davis D, et al. Survival after application of automatic external defibrillators before arrival of the emergency medical system: evaluation in the resuscitation outcomes consortium population of 21 million. J Am Coll Cardiol. Apr 20 2010;55(16):1713-20.
Automatic External Defibrillation Author: Joseph J Bocka, MD; Chief Editor: David FM Brown, MD http://emedicine.medscape.com/article/780533-overview
AED use: National Institute of Health – AED proceedures
Graphic and CPR Data: American Heart Association CPR Awareness Page

Trends in Nursing Home Litigation

Nursing home lawsuits have become one of the fastest growing segments of health care litigation. There are nearly 17,000 nursing homes in the United States that currently care for 1.7 million residents, a figure that is expected to quadruple to 6.6 million residents by 2050.(1)  Over 90% of the nursing home residents are over the age of 65, and almost half are over the age of 85; the average age is more than 80.(2)   Issues of concern in care may include: adverse drug events, falls with injury, pressure ulcers, faulty medical equipment, problems with tube feeding, restraint usage, malnutrition, dehydration, residents rights violations, elopement, and abuse and neglect.

Federal definitions of elder abuse, neglect and exploitation appeared for the first time in the 1987 Amendments to the Older Americans Act. These definitions were provided in the law only as guidelines for identifying the problems and not for enforcement purposes. Currently, elder abuse is defined by state laws, and state definitions vary considerably from one jurisdiction to another in terms of what constitutes the abuse, neglect, or exploitation of the elderly. Broadly defined, elder abuse definitions may be categorized as follows: Physical abuse is defined as the use of physical force that may result in bodily injury, physical pain, or impairment. It may include, but is not limited to, such acts of violence as striking, hitting, beating, pushing, shoving, shaking, slapping, kicking, pinching, and burning. In addition, it may also include the inappropriate use of drugs and physical restraints, force-feeding, and physical punishment.

  • Sexual abuse is defined as non-consensual sexual contact of any kind with an elderly or disabled person or with any person incapable of giving consent. It includes, but is not limited to, unwanted touching and all types of sexual assault or battery such as rape, sodomy, coerced nudity, and sexually explicit photography.
  • Emotional or psychological abuse is defined as the infliction of anguish, pain or distress through verbal or nonverbal acts. Emotional/ psychological abuse includes, but is not limited to, verbal assaults, insults, threats, intimidation, humiliation, and harassment. In addition, treating an older person as an infant, isolating an elderly person from his family, friends or regular activities, giving an older person the “silent treatment”, and enforced social isolation are examples of emotional/ psychological abuse.
  • Neglect is defined as the refusal or failure to fulfill any part of person’s obligations or duties to an elder. Neglect may also include failure of a person who has fiduciary responsibilities to provide care for an elder (e.g., pay for necessary home care services) or the failure on the part of an in-home service provider to provide necessary care. Neglect typically means the refusal or failure to provide an elderly person with such life necessities as food, water, clothing, shelter, personal hygiene, medicine, comfort, personal safety, and other essentials included in an implied or agreed-upon responsibility to an elder.
  • Exploitation is defined as misusing the resources of an elderly or disabled person for personal or monetary benefit. This includes taking Social Security or SSI (Supplemental Security Income) checks, abusing a joint checking account, and taking property and other resources.(3)

Estimates of the frequency of elder abuse range from 2% to 10% based on various sampling, survey methods and case definitions.(4) In 2013, state long term care Ombudsman programs nationally investigated 135,620 overall complaints of abuse, gross neglect, and exploitation on behalf of nursing home and board and care residents. Among seven types of abuse categories, physical abuse was the most common type reported.(5)

As the incidence of elder abuse rises, more programs and techniques are being developed by facilities and federal and state organizations to protect our aging population. “Grammy Cams” are being utilized in some states (currently 7 states). This allows families or residents to install surveillance cameras in their room in the nursing care facility. Several states (e.g. California and Maine) are now utilizing Elder Death Review Teams (EDRT) to evaluate nursing home deaths that may be linked to abuse and neglect. Most states now require background checks for all paid caregivers and those with criminal backgrounds are prohibited from caring for elders in nursing homes. Nursing homes and assisted living facilities are providing more orientation and education to their staff on recognizing and reporting signs and symptoms of abuse.

(6) Long term care organizations and associations are pairing with government agencies to promote public awareness of elder abuse and reporting mechanisms. State and federal survey agencies are focusing on abuse in nursing homes and have initiated procedures for timely investigation of complaints of abuse and neglect. Even one incident of abuse is unacceptable and we, as health care providers and litigators have an obligation to protect and defend our elders.

The National Center on Elder Abuse — www.elderabusecenter.org
State Long Term Care Ombudsman Programs — www.ltcombudsman.org
National Committee for the Prevention of Elder Abuse (NCPEA) — www.preventelderabuse.org
National Association of Adult Protective Services Administrators (NAAPSA) — www.naapsa.org
US Department of Justice, Office of Victims of Crime — www.ojp.usdoj.gov
US Administration on Aging — www.aoa.gov
American Society of Adult Abuse Professionals and Survivors — www.ASAAPS.org

References:
1 U. S. House of Representatives, Committee on Government Reform, Minority Office
2 Centers for Medicare and Medicaid Services, Department of Health and Human Services, Health Care Industry Market Update: Nursing Facilities. CMS, 2002:43.
3 National Association of Adult Protective Services Administrators; National Center on Elder Abuse; Elder Abuse Awareness Kit; April 2001, pg. 4.
4 Lachs, Mark S. and Karl Pillemar, Oct. 2004, “Elder Abuse,” The Lancet, Vol. 364: 1192-1263.
5 National Ombudsman Reporting System Data Tables, 2013 – 2014. Washington DC: US Administration on Aging.
6 Long-Term Care Services in the United States: 2013 Overview

Use of Technology Distinguishes R&G

Historical Perspective for a Successful Legal Nurse Consulting Firm

R&G Medical Consultants was founded in February of 1992 by Rosie Oldham, BS, RN, LNCC. Her background in Nursing Administration, Risk Management and Quality Improvement was extremely valuable in the startup of this legal nurse consulting firm.

R&G’s first cases were personal injury and in December of 1992, the firm began working on product liability cases (resulting in completion of over 750 cases). This led to staff expansion and the use of 32 nursing contractors. During this project R&G   implemented total quality management procedures. Peer review of work products led to a successful 100% deficiency free submission of claims. From 1994 to 1996, R&G processed over 450 toxic tort cases (water contamination) for the defendants. This successful project required our nurses to input medical information into a statistical data base for our clients. In 1997, R&G began focusing on complex Medical Malpractice and Personal Injury cases. Rosie Oldham,  CEO, also self-published the Medical Legal Internet Directory which contained over 3000 web sites for medical legal research. This directory was published in 2nd and 3rd (on CD) edition by Lawyers and Judges and contains over 5000 web sites. The MLID has been heralded as a great research tool for medical and legal case issues and is sold internationally.

In 1998, one of R&G’s goals was to solidify our position as “the technical leading” legal nurse consulting firm in the United States. At that time, our client base extended across 23 states and into Canada and Israel. The service areas of the firm were expanded to include graphics and illustrations  in our work products that were ultimately used as demonstrative evidence. Merit Screens were streamlined and are now offered for a flat fee. In addition, new software was added to our information systems to track cases, provide conflict checks and expert witness data management. In 1999, we to acquired equipment (laptops/projectors), software, and trained our “technical nurse consultants” adding a new service of technical trial support and settlement consulting services. Utilizing computerized demonstrative evidence, videos and synchronized depositions, we have successfully settled many cases in AZ, NM and NV. The integration of legal nurse consultants providing technical support culminated in our November, 2001, 18 million dollar verdict for a personal injury case in Nevada.

Since January, 2002, R&G began providing services on   large product liability mass tort and has over 140 RNs working on this defense pharmaceutical project. The successful thirteen year growth and expansion for R & G is a direct outcome of our team approach  in 43 states with great attorney clients. The caliber of our staff is educationally beyond the norm (MS, NP, PhD, JD, and MD’s) and directly contributes to our continuing success. Our clients love our “can do” attitude!