By having an up-to-date comprehensive New Jersey estate plan, you can ensure continued care for loved ones and lasting gifts for family members and charity. Writing a will, making health care decisions and transferring financial powers to others are not easy decisions.
An estate plan should reflect a person's wishes and desires regarding property and possessions upon their death. However, documents executed many years ago may no longer reflect current circumstances or viewpoints. For example, an individual's children grow up and get married. Maybe the spouse should be included in a gift or a trust might be created to benefit grandchildren. Also, bank accounts and assets may change. This is why a yearly review is important.
]]> All comprehensive plans should include a checklist that details the following:Personal representatives often come to an attorney with no indication of where to start the process of distributing the estate. Without guidance a personal representative who is responsible for ensuring that bills are paid and assets are distributed properly may have difficulty locating assets.
A review of your estate plan will make sure that it still appropriately states your wishes. If you have not yet completed a comprehensive estate plan, Financial Literacy Month is a good reminder that while difficult to think about the estate planning process is meant to protect and provide for loved ones in your absence.
Source: The White House Office of Press Secretary, "National Financial Capability Month, 2012," Apr. 2, 2012.
]]>After a New Jersey man was told he had a virus and sent home, he became concerned about his health and hastily created and signed a will that same night. In the morning, shortly after his girlfriend called 911, the man died of a pulmonary embolism - a blockage in his lung's main artery.
The friend he had named as the executor of his estate sued the doctor, claiming negligence. The jury awarded the estate more than $1 million after hearing the allegations that the doctor's failure to diagnose the patient and sending him home led to his death.
]]> Failure to Diagnose Can Lead to Wrongful DeathFailure to diagnose and misdiagnosis are medical mistakes that can have serious consequences. When a doctor or other health care provider misses signs and symptoms that should have been detected, or misinterprets the symptoms, it may be medical negligence.
If the patient dies, the estate of that person may sue the medical care provider for wrongful death and medical malpractice. The estate may seek damages for the pain and suffering the patient experienced. The executor or administrator of the estate also may sue on behalf of family members the patient left behind, seeking compensation for lost wages, medical and funeral expenses, and the loss of support and companionship.
A situation like the misdiagnosis of a pulmonary embolism is a tragedy that unfortunately was not avoided in this case. The law allows a measure of compensation; although the man's loved ones certainly will continue to grieve.
Source: New Jersey On-line, "Vineland man's estate awarded $1.065 M in malpractice case," Jason Laday, Jan. 31, 2012.
]]>Doctors and pharmacists, therefore, play a large part in protecting the health and well-being of New Jersey nursing home residents. A recent study from another state pointed out this reality when it found serious errors in the management of nursing home prescriptions.
]]> Pharmacists, Doctors Must Protect Patient SafetyIn more than half of the cases the state investigated, pharmacists did not red-flag instances of potential prescription errors. The errors included:
New Jersey nursing home patients face the possibility of prescription errors as well. Whether the mistakes occur because of inattention, inaccurate recordkeeping, profit seeking or lack of concern, the result is the same.
Prescription errors can be devastating. The wrong prescription, combination of prescriptions or level of medication can cause seizures, arrhythmia, blindness, liver damage, psychotic behavior, brain damage or other medical problems. In some cases, prescription errors cause death.
Whether a nursing home prescription error occurs because of the profit-driven nature of the nursing home, a conflict of interest or medical negligence, residents can suffer greatly. In New Jersey nursing homes and beyond, residents deserve appropriate prescriptions that will foster their health.
Source: New York Times, "Nursing Home Investigation Finds Errors by Druggists," Laurie Udesky, Jan. 27, 2012
]]>With so many ideal locations for vacation homes in New York, New Jersey and beyond, many area residents have second homes they would like to keep in the family. Important considerations, however, come into play when a home is transferred to children or other family members.
]]> The Structure of SharingThe owner of the vacation home will want to consider whether some of the intended recipients of the home will want to sell their shares - and whether the recipients will be able to share with each other. If one recipient wishes to sell her share, for instance, other assets from the estate could be used to pay for it.
In many cases, setting up a structure that will help the transferees pay for maintenance is beneficial. Repairs and maintenance can be costly. The structure should also address how the home is to be shared, because certain holiday weekends may be coveted by all.
A trust can be set up with a trustee who manages the property, including making decisions about repairs and maintenance. The trust may be funded with life insurance. Depending on what type of trust it is, it can provide benefits surrounding the gift-tax exemption and ensure that the property stays in the family for years to come.
The property can be held by a limited liability company (LLC) that is in turn owned by the trust. The LLC could protect members from state estate taxes, and it can be useful in setting out the rules and establishing the maintenance funds for the property.
The Importance of Solid Planning
For New Jersey and New York owners of vacation properties, planning early is vital for passing the second home to the second generation. Doing so will allow the new owners to enjoy the sunset, rather than arguing about whose turn it is to replace the light bulb on the porch.
Source: The Wall Street Journal, "Who Gets the Vacation Home?" Kelly Greene, Jan. 7, 2012
]]>Distracted medical professionals cannot provide the same quality of patient care. Even the minimal distraction caused by these devices may result in serious hospital errors. Further, personal use can be difficult to monitor during work hours.
]]> Abuse of Mobile Devices During Work Hours Can Cause Patient InjuryPersonal use of mobile devices during work hours has serious impacts on overall patient care. Several documented occurrences include:
A survey conducted by the Perfusion Journal found that 55% of the 439 medical technicians surveyed admitted to cellphone use when responsible for patient monitoring during surgery.
Mobile devices offer quick access to medical records, patient information and medical reference materials and are responsible for significant improvements in patient care. However, patient care can be compromised when medical professionals are distracted while multi-tasking or using mobile devices for personal use. Safeguards must be put in place to curb abuse and to ensure quality patient care.
Source: New York Times, "As Doctors Use More Devices Potential for Distraction Grows," Matt Richtel, Dec. 14, 2011
]]>To be sure, failing to test often enough remains a problem. After all, failure to diagnose cancer is a common form of medical malpractice. Everyone knows that if cancer isn't diagnosed in time, the chances of treating it effectively dwindle rapidly - and sometimes disappear entirely.
In recent years, however, several studies have shown that, in some cases, it is also possible to test too frequently. That is because of problems that include false positives, intrusive testing procedures, and harmful side effects from treatment.
Recent polling results suggest that people's perceptions of the role of cancer screening tests are evolving along with the medical literature. Nearly one of every three Americans (31 percent) believes that cancer screening tests do not occur frequently enough. But 7 percent believe that testing is done too often.
]]> It isn't difficult to understand the divergence of opinion. The U.S. Preventive Services Task Force has changed its recommendations substantially in the last year or two on the use of mammograms check for breast cancer and PSA tests for prostate cancer. The task force's revised guidelines, calling for fewer tests, have generated considerable controversy among medical practitioners and the general public.It isn't reasonable to expect everyone to agree. What's needed are doctors and nurses who are committed to continuing education and able to respond intelligently to national guidelines as they continue to evolve.
Source: "Americans Comfortable With Cancer Screening Frequency," Gallup, 11-30-2011
]]>But more still needs to be done to avoid medication errors that can occur when a doctor prescribes drugs.
In one case that was reported in the Philadelphia Inquirer and other news outlets, a pregnant woman named Mareena Silva who needed an antibiotic to fight an infection was instead given a cell-fighting drug that was intended for a cancer patient. It is unclear from news reports how seriously this may have affected the fetus. But clearly giving anti-cell growth medication is a recipe for trouble when given to a pregnant woman because it can lead to birth defects and increase the risk of a miscarriage.
The cell-fighting drug was intended for a woman with a similar name, Maria Silva.
]]> A case like this shows that pharmacists and others who fulfill prescriptions need to do a better job of verifying the identity of people who are picking up prescribed medication. Basic information like address and date of birth should be used as a precaution. This step should apply both to people who pick up their own prescriptions and to those who do it on others' behalf.If there is any confusion or doubt on the part of the pharmacist, additional information can be used. This could include telephone numbers or driver's license numbers. Even if the prescription is being dispensed at a drive-thru, it's important to spend enough time to get it right.
Source: "How to prevent yourself from accidentally getting someone else's prescription at the pharmacy," Philly.com, 10-3-11
]]>Doctors' and nurses' hands aren't the only sources of possible infection, by any means. University of Iowa researchers recently presented data showing that hospital privacy curtains area a common source of bacteria that causes disease. The research team examined 43 curtains in 30 hospital rooms over a three-week period by taking twice-weekly swab cultures.
Fully 95 percent of the curtains tested in the study were contaminated. Even completely new curtains got that way within a week of being installed.
Dr. Michael Ohl presented the findings at a conference last week. "There is a growing recognition that the hospital environment plays an important role in the transmission of infections in the health care setting and it's clear that these (privacy curtains) are potentially important sites of contamination because they are frequently touched by patients and providers," he said.
]]> Some of the bacteria detected in the study included species that are known to be resistant to antibiotics. These included the dangerous bacteria known as MRSA, for methicillin-resistant S. aureus.The findings raise questions about how well hospitals are doing in preventing patients from getting infectious diseases while in the hospital. Hospitals need to take proactive steps to encourage medical staff to follow better sanitary protocols. After pulling the privacy curtain, workers should wash their hands before interacting with the patient.
Other bacteria-fighting tactics could be used as well. Privacy curtains could be disinfected more often and changed more often. But the most immediate sanitary protocol should still be hand washing.
Source: "Hospital Privacy Curtains Laden With Germs," FoxNews, 9-23-11
]]>In a recent case in California, Art Tenner, a 79-year-old man with a terminal illness, sank over $100,000 in savings into annuities sold by an unscrupulous insurance agent. The agent played on Art's fears that there wouldn't be enough money in his estate to pay for nursing home care for his wife. His wife didn't need this care yet, but she had Parkinson's disease and probably would one day.
The decision to buy the annuities turned out to be a costly one for Art. The transaction ended up costing him $11,000 in fees and penalties when he sought to withdraw the money early. As a result, he had to turn to his children to cover his daily living expenses.
]]> Art's son Jim, 52, was candid in his assessment of what happened to his father. "He lost huge on this thing. Instead of enjoying what turned out to be the last nine months of his life, he didn't have $100 to spare."Art Tenner's case is not an isolated one. The considerations are no different in New Jersey than in California or anywhere else in the country.
According to a study done in 2010 by the Investor Protection Trust, 1 of every 5 older Americans has faced a similar scenario. The dubious transactions include unwise investments, excessive fees for financial services, and outright fraud. One estimate of the collective losses from these transactions put the figure at $2.9 billion last year.
Seniors, and the adult children who interact with them, need to be more wary.
Source: "Protecting your parents: Keep the sharks at bay," CNN Money, 8-10-11
]]>The data comes from a respected healthcare reform group, the Joint Commission Center for Transforming Healthcare. Healthcare professionalism themselves know they need to do better to prevent surgical errors and other common medical mistakes.
The CEO of one professional organization, Linda Groah of the Association of periOperative Registered Nurses (AORN), recently discussed several ways that healthcare providers can try to reduce wrong-site surgery.
Not surprisingly, one of the main recommendations was to implement a checklist. "The use of a checklist actually identifies everything that needs to be done for the patient pre-operatively, including marking the side and site of the surgery," Groah said.
]]> The use of checklists has been proven to be effective in reducing errors. Its advocates include such leading figures in the medical profession as Peter Pronovost of Johns Hopkins and Atul Gawande of Harvard Medical School.In discussing checklists, Linda Groah noted that one of the challenges to implementing the requirement can be the noise and bustle of the operating room. To make sure the checklist is most effective as a communication tool, some hospitals have it enlarged to poster form and attach it to a wall. The enhanced size and display makes it more visible, and this in turn makes it easier for the surgical team to follow it.
Source: "6 Steps to Prevent Wrong-Site Surgery," ASC Review, 7-15-11
]]>Explaining the Law
An estate-planning lawyer can explain to parents how the law affects their guardianship decision. In New Jersey, a judge does not have to appoint or approve of a nominated guardian. Instead, the parents' wills control who is appointed as the guardian of any minor children should both parents pass away.
Highlighting Factors to Consider
An attorney with experience in estate planning knows that different characteristics of potential guardians are important to different parents. But an attorney can also remind parents of other significant factors that they may not have considered, including:
• The child's age and preferences
• The willingness and ability of the potential guardian to raise the child
• The potential guardian's values, religion and child-raising philosophy
• The potential guardian's family circumstances
]]> Discussing Economic ImplicationsA lawyer can guide parents in discussing the relevant issues. These can include the costs of raising a child, whether the potential guardian has the financial ability to do so, and how money would be distributed from the child's trust to provide for the child.
Creating Valid Estate-Planning Documents
An estate plan loses its value if it is found unenforceable or against the laws of New Jersey. An estate-planning attorney can help parents create estate and guardianship plans that clearly and validly communicate their wishes.
Source: Appointing a Guardian for a Minor Child, Forbes, 4-18-11
]]>Whatever one calls it, the effects are serious and potentially life-changing. To call it "mid" is often misnomer. Whether the head injury occurred in an accident, due to a fall, or from some other cause, it can lead to distinct cognitive challenges, memory problems, and recurring pain. It also can result in unpredictable emotional and personality changes.
When an injury like this occurs, the effects on the injured person's family, particularly the spouse, can be profound as well. One such spouse, Lorraine Devon Wilke, recently shared her story in The Huffington Post.
Three years ago, Wilke's husband, Pete, an attorney, was stopped in his car at a crosswalk when a distracted driver rear-ended him. The impact of the collision caused extensive damage to the right frontal lobe of Pete's brain, resulting in a closed head injury.
]]> traumatic brain injury because the injured person can still walk and talk. But the impact of the injury on Pete Wilke's life has been the opposite of mild.The harsh fact is that Pete has not been the same since the injury. An active man who had hiked the Grand Canyon almost every year and hunted pheasants in the depths of Montana has had that life taken from him. In its place has been a seemingly endless succession of hospital visits, cognitive difficulties, and terribly excruciating pain.
The effect of all this on Lorraine and Pete's marriage, as described by Lorraine, will give anyone who reads her account pause to reflect on how vulnerable all of us are. And how much suffering there is that usually goes unspoken.
Source: "Love in the Age of Mild Traumatic Brain Injury," Huffington Post, 4-9-2011
]]>Senator Weinberg pointed out that the medical director position at the New Jersey Board of Medical Examiners has been vacant for two years, and four of the nine positions on the malpractice-claim review board are also vacant. Also, a review of the board's history "reveals a short-staffed agency which doesn't necessarily pursue every allegation," Weinberg stated.
Dr. Sidney Wolfe, Director of Citizen Action, a citizen advocacy group, testified at the hearing that the Board of Medical Examiners - the agency that licenses doctors in New Jersey - is to blame for not disciplining doctors, even when multiple malpractice payments have been made for a single doctor's repeated errors.
Dr. Wolfe said that, between 1990 and 2009, 320 doctors were suspended or removed from hospitals for committing medical malpractice. But, more than half of those doctors, 183, were not disciplined by the state licensing board.
]]> This lack of agency discipline against doctors who have committed medical malpractice allows them to continue practicing medicine, potentially putting more patients at risk of harm. In addition, if the Board of Medical Examiners takes no disciplinary action against a doctor, there may be no official record of the doctor's medical malpractice, even though a hospital or clinic determined that the doctor was temporarily or permanently unsafe or unable to treat patients.By seeking greater oversight of the state's doctors through increased staffing at the Board of Medical Examiners, the New Jersey legislature is taking a step in the right direction to improve patient safety.
Source: Weinberg: More Staff Needed for N.J. Board That Oversees Doctors
]]>But setting up a comprehensive plan through health care directives is a wise step to take. It will help ensure that your treatment wishes are carried out. It will also save family members and health care providers trouble down the line.
A recent report from the federal Centers for Disease Control tried to quantify how many people in long-term care settings really do have advance directives in place. The CDC report found that 28 percent of home health care patients had an advance directive. The percentage rose to 65 percent for nursing home patients.
An advance directive is a legal document that expresses your desires about some aspect of your health care or bodily integrity. Should you become unable to make your own decisions, an advance directive gives instructions to those responsible for your care.
]]> The term "advance directive" can actually include several different instruments. One component is a living will or health care directive, which details your end-of-life treatment preferences. For example, do you want to be kept alive with interventions like breathing machines or tube feeding?Another type of directive is a durable power of attorney or health care proxy. This is a tool that allows you to delegate the ability to choose your medical options to a trusted individual should you become incapacitated.
There are also a number of types of advance directives available regarding issues like autopsy requests or organ donation preferences.
Talk with us if you have questions about advance directives. We can explain to you how they can be drafted to achieve your goals.
Source: "How Many Nursing-Home Residents Have End-of-Life Care Plans?" The Wall Street Journal, 1-6-11
]]>At first glance, New Jersey's jump from 43rd in the nation based on patient care to tenth indicates an outstanding change in hospital conditions. But, upon closer evaluation, the data gives rise to a few key consumer questions, illustrating that there is still considerable room for improvement:
•· Why would an infection ever be expected? When discussing infection scores, the report notes that only five hospitals had infection rates "higher than expected." Reference points for evaluation are not easily understood; how often are patients suffering from infections related to their hospital visit?
•· What is happening during childbirth? Although New Jersey faired higher than the national average in nine of 12 safety measures, it was below the national average regarding birth injuries. The state did not score well on preventable injuries during vaginal births as well as potentially preventable injuries to newborns. Why is this area lagging behind?
•· What went wrong in 2010 that's not being discussed? The report was released in 2011, yet the data relied on is from 2009. Using stale data allows for hospitals to assert that issues have been fixed in the meantime, but what is there to indicate such?
]]> Improving patient care and patient safety is a central concern for hospitals throughout New Jersey. Any time there is a medical error, there is room for improvement. Even one mistake, when it affects your family, is one too many. An experienced medical malpractice attorney can help you understand your options when something goes wrong at the hospital.Source: "High marks for hospital report card," MyCentralJersey, 2-6-11
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