New York Law Blog

New York is now in line with 48 other states which allow pharmacists to administer influenza and pneumococcal immunizations after Governor David Patterson signed a bill into law allowing them to do so. With pharmacies so accessible to the population, the ability for those even without medical insurance (and even those who do have it but just want to take advantage of the convenience of a pharmacy) to be able to receive simple immunizations to keep them healthy through the winter months when the flu and pneumonia run rampant could go a long way to keeping the majority of communities healthy. The American Lung Association of New York put out a press release lauding the signing of the bill by Governor Patterson, which was sponsored by Senator Charles J. Fuschillo and Assemblywoman Amy Paulin.

Allowing pharmacists to immunize is quickly becoming the standard of care in this country.   New York now joins the other forty eight states nationwide that allow pharmacists to administer vaccinations.  
 
Across the nation, states that allow pharmacists to vaccinate have witnessed higher influenza vaccination rates. In fact, 18- to 64-year-olds are 27 percent more likely to be vaccinated, and those over 65 are 22 percent more likely to be vaccinated. Moreover, influenza vaccination rates among those over age 65 grew at triple the rate in states that allow pharmacists to provide vaccinations (10.7 percent increase) compared with states that did not (3.5 percent increase).

In New York and throughout the U.S., virtually all vaccine-preventable deaths occur in adults. The Centers for Disease Control and Prevention report that 36,000 people in the United States die annually from influenza and an additional 200,000 are hospitalized every year. Most of those deaths occur among people age 65 and older. People over 65 who are immunized against flu experience 20 percent fewer cardiac- and stroke-related hospitalizations, 30 percent fewer hospitalizations for pneumonia or other influenza complications, and 50 percent lower risk of death from all causes during flu season. Thus, the majority of these deaths are preventable and unnecessary.

Many veterans of the Iraq war are finding themselves being misdiagnosed with a variety of ailments instead of the one they really have: some form of Traumatic Brain Injury. Also known as varying level of concussions, soldiers are being told they have varying forms of Post Traumatic Stress Disorder instead of being diagnosed with the debilitating brain injury they more than likely have. Along with the misdiagnosis comes the incorrect disability payment leaving some of these soldiers out in the cold when in fact they need help for the brain injuries they have suffered.

Mr. [Kevin, injured in a roadside bomb attack] Owsley is part of a growing tide of combat veterans who come home from Iraq and Afghanistan with mild traumatic brain injuries, or concussions, caused by powerful explosions. As many as 300,000, or 20 percent, of combat veterans who regularly worked outside the wire, away from bases, have suffered at least one concussion, according to the latest Pentagon estimates. About half the soldiers get better within hours, days or several months and require little if any medical assistance. But tens of thousands of others have longer-term problems that can include, to varying degrees, persistent memory loss, headaches, mood swings, dizziness, hearing problems and light sensitivity.

These symptoms, which may be subtle and may not surface for weeks or months after their return, are often debilitating enough to hobble lives and livelihoods.

To this day, some veterans — it is impossible to know how many — remain unscreened, their symptoms undiagnosed. Mild brain injury was widely overlooked by the military and the veterans health system until recently.

Mr. Owsley’s request for a Purple Heart, given to troops wounded or killed in action, was denied by the military, a devastating blow. Others say that their mild brain injury entitled them only to low disability payments, or, if the diagnosis was inconclusive, to none at all.

Army scientists are working on understanding brain injuries better so that they may diagnose any issues more easily, but it may be too little too late for soldiers who have suffered severe personal injury at the hands of bomb blasts in Iraq. Misdiagnosis is also leaving many veterans unable to work, pay their bills, and provide for their families. Veterans Affairs has now stepped in for better screening procedures for those going overseas as well as those coming home.

It was not until 2006, three years into the Iraq war, that the Departments of Defense and Veterans Affairs began to pay close attention to mild traumatic brain injuries. The Pentagon last year opened the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury, a clearinghouse for treatment, training, prevention, research and education. This year it is spending a record $300 million on research for traumatic brain injury and post-traumatic stress disorder.

“We are more attuned to brain injuries now,” said Lt. Col. Michael Jaffee, the director of the Defense and Veterans Brain Injury Center. “There has not been as aggressive an effort before.”

That effort begins with screening. As of May, service members who deploy longer than 30 days will undergo neurocognitive testing before leaving, to establish a baseline for changes that may occur later, and again upon returning. At the same time, soldiers in battle who lose consciousness or feel dazed after a blast or other event must be screened by a medical provider and are either approved for duty in the field, told to rest for several days on base or sent to Landstuhl for further evaluation.

And what to do if the military is neglecting some of these soldiers? Some are considering going to federal court over the issue.

Following up last week’s post on “never events” in regards to medical malpractice, here is the list of “28 errors that should never happen” from the National Quality Forum. The NPQ is a nonprofit health care safety agency, and this list represents “never events”, or avoidable errors.

1. Surgery on the wrong body part.
2. Surgery on the wrong patient.
3. Wrong surgical procedure performed on a patient.
4. Object left in patient after surgery.
5. Death of patient who had been generally healthy during or immediately after surgery for a localized problem.
6. Patient death or serious disability associated with the use of contaminated drugs, devices or biologics.
7. Patient death or serious disability associated with the misuse or malfunction of a device.
8. Patient death or serious disability associated with intravascular air embolism.
9. Infant discharged to wrong person.
10. Patient death or serious disability associated with patient disappearing for more than four hours.
11. Patient suicide or attempted suicide resulting in serious disability.
12. Patient death or serious disability associated with a medication error.
13. Patient death or serious disability associated with transfusion of blood or blood product of the wrong type.
14. Maternal death or serious disability associated with labor or delivery in a low-risk pregnancy.
15. Patient death or serious disability associated with the onset of hypoglycemia, a drop in blood sugar.
16. Death or serious disability associated with failure to identify and treat hyperbilirubinemia, a blood abnormality, in newborns.
17. Severe pressure ulcers acquired in the hospital.
18. Patient death or serious disability due to spinal manipulative therapy.
19. Patient death or serious disability associated with an electric shock.
20. Any incident in which a line designated for oxygen or other gas to be delivered to a patient contains the wrong gas or is contaminated by toxic substances.
21. Patient death or serious disability associated with a burn in the hospital.
22. Patient death associated with a fall suffered in the hospital.
23. Patient death or serious disability associated with the use of restraints or bedrails.
24. Any instance of care ordered by or provided by someone impersonating a physician, nurse, pharmacist or other licensed healthcare provider.
25. Abduction of a patient.
26. Sexual assault on a patient.
27. Death or significant injury of a patient or staff member resulting from a physical assault in the hospital.
28. Artificial insemination with the wrong donor sperm or donor egg.