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Date:	03.12.2008 01:33
Hits:	3403
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Rating:	4.50 (2 Vote(s))
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Tensions over race and patient rights are common across the country
INDIANAPOLIS — Certified nursing assistant Brenda Chaney was on duty in an Indiana nursing home one day when she discovered a patient lying on the floor, unable to stand.
But Chaney couldn't help the woman up. She had to search for a white aide because the woman had left instructions that she did not want any black caregivers. And the nursing home insisted it was legally bound to honor the request.
The episode, which led to a recent federal court ruling that Chaney's civil rights had been violated, has brought to light a little　<a href="http://www.ymcmotor.com.cn">伺服电机</a> known consequence of the patients' rights movement that swept the nation's health care system over the last two decades.
Elderly patients, who won more legal control over their quality of life in nursing homes, sometimes want to dictate the race of those who care for them. And some nursing homes enforce those preferences in their staff policies.
"When people write laws, they don't think about these types of things very much," said Dennis Frick, an attorney with Indiana Legal Services' Senior Law Project.
At nursing homes, tension over patient rights and race "comes up occasionally in virtually every state in the United States," said Steve Maag, director of assisted living and continuing care at the American Association of Homes and Services for the Aging.
Maag said he has gotten several questions a year from nursing home officials about reassigning workers to suit residents' racial preferences. Another case in Indiana last year resulted in a damage settlement for a caregiver. A state agency in Montana has also handled a formal bias complaint.
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expect to notify all nursing homes of the court ruling, and Frick said it could be cited as precedent throughout the nation.
In 1987, Congress enacted the Nursing Home Reform Law to address evidence of widespread abuse of nursing home patients. The states followed suit with "a strong set of regulations that would guarantee that residents were free from abuse and had quality of care, and really had quality of life," said Robyn Grant, a national senior care advocate who was involved in drafting Indiana's rules in 1990.
But the emphasis on patient rights led some nursing homes to think they outweighed everything else.
"We were taught that residents' rights were paramount," said Janet McSharar, who specializes in long-term care issues and represented the nursing home where Chaney worked in Plainfield, an Indianapolis suburb of 23,000.
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Other states' laws are similarly broad. Grant said the Indiana law was intended to cover providers such as pharmacies, not caregivers.
Documents in Chaney's lawsuit, filed in 2008, say her daily assignment sheet at Plainfield Healthcare Center always included the reminder that one patient in her unit "Prefers No Black CNAs."
Chaney, a 49-year-old single mother who at the time was helping to put her only son through college, initially went along with the policy despite her misgivings because she needed the money.
"I always felt like it was wrong," said Chaney, who has worked in nursing homes since she earned certification in 2006. "I just had to go with the flow."
The nursing home said it was just following a long-standing interpretation of the patients' rights law. "The rules say this is their home and everyone else is just a visitor there, including staff," said McSharar.
Nursing homes can be hotbeds of racial friction, said David Smith, a Drexel University professor who has studied racial integration in hospitals and long-term care centers. In urban areas, staffs are often predominantly African-American while most patients are white. Some elderly people revert in dementia to the prejudices they grew up with.
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Courts have held that patients can refuse to be treated by a caregiver of the opposite sex, citing privacy issues. But the 7th U.S. Circuit Court of Appeals, ruling in Chaney's case last month, said applying that accommodation to race goes too far.
"The privacy interest that is offended when one undresses in front of a doctor or nurse of the opposite sex does not apply to race," the ruling said.
State and national officials say they aren't sure how often a patient has rejected a caregiver based on race. A similar case involving an Indianapolis nursing home resulted in an $84,000 settlement last year, but officials with the Indiana Equal Employment Opportunity Commission would not comment on whether other complaints had been filed because they are not public record.
In a case in 2000, the Montana Department of <a href="http://www.motooo.com">网店代理</a>　Labor and Industry said a nursing home acted inappropriately when it reassigned a black caregiver to avoid confrontations with biased patients.
Copyright 2010 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

25.08.2010 05:26

leewee
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Time, heat could take toll on trapped miners

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What is it like to be trapped underground for weeks, if not months? That's the prospect faced by 33 men discovered alive on Sunday, 17 days after the Chilean mine they were working in collapsed. Their initial shelter was just 530 square feet — the size of some studio apartments — but they have since spread out into a tunnel.
Due to the danger of drilling close to the miners, it could take up to four months to reach them — raising the question of how the trapped men will cope. Below are some perspectives from mine safety experts, two Australian miners who in 2006 survived being trapped for two weeks and one of the trapped Chilean miners who was able to get a note out to his wife.
What is it like to be trapped underground for weeks, if not months? That's the prospect faced by 33 men discovered alive on Sunday, 17 days after the Chilean mine they were working in collapsed. Their initial shelter was just 530 square feet — the size of some studio apartments — but they have since spread out into a tunnel.
Due to the danger of drilling close to the miners, it could take up to four months to reach them — raising the question of how the trapped men will cope. Below are some perspectives from mine safety experts, two Australian miners who in 2006 survived being trapped for two weeks and one of the trapped Chilean miners who was able to get a note out to his wife.
? Mental health
"We need to urgently establish what psychological situation" the miners are in, Chilean Health Minister Jaime Manalich said Monday in announcing the arrival of doctors and psychiatrists. They "need to understand what we know up here at the surface, that it will take many weeks for them to reach the light."
Key to their well-being will be to keep them busy and well-supported, Manalich said. "There has to be leadership established, and to support them and prepare them for what's coming, which is no small thing."
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"Over time, individuals are likely to feel crowded, sleep-deprived, irritable, bored, and restless," she says. "Other noxious stimuli include loss of privacy while toileting, odors ... as well as absence or presence of noise by any operating machinery or life support systems. Low levels or lack of lighting provides no normal cycling of light to trigger the body’s natural circadian rhythms."
"Common symptoms," she adds, "include anxiety, withdrawal, aggression, hostility, depression and irrational and impulsive behavior."
Australian Todd Russell has first-hand experience coping in such a situation. In 2006 he and a fellow miner survived two weeks trapped in a safety cage 3,000 feet below the surface. The two were feared dead until a thermal imaging camera spotted them five days after they were trapped. A third miner died.
Russell told London's The Guardian newspaper that he and fellow miner Brant Webb "hoped that what they did on the outside wouldn't kill us. We knew that the guys were working their way towards us. We could hear everything that was happening outside us and we could hear the underground machinery operating."
Thirty-three miners are trapped in this mine in Copiapo, Chile.
What is it like to be trapped underground for weeks, if not months? That's the prospect faced by 33 men discovered alive on Sunday, 17 days after the Chilean mine they were working in collapsed. Their initial shelter was just 530 square feet — the size of some studio apartments — but they have since spread out into a tunnel.
Due to the danger of drilling close to the miners, it could take up to four months to reach them — raising the question of how the trapped men will cope. Below are some perspectives from mine safety　experts, two Australian miners who in 2006 survived being trapped for two weeks and one of the trapped Chilean miners who was able to get a note out to his wife.
"Brant and I relied on each other's strengths," he added. "We made up stories and sang songs just to take our mind off things and tried to put our minds into a positive state."
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But health officials are worried about the heat below and loss of body weight among the men. A TV camera lowered down the bore-hole showed that some miners had removed their shirts because of the heat and lack of air.
In a radio communication with Chile's mining minister Monday, the miners said "they had eyes irritated by the dust, that they needed tooth brushes, and that one of them had a stomach ache."
Officials fear the miners might have already lost up to 20 pounds each, and Chile's Health Ministry is asking NASA, due to its experience with astronauts in remote and reduced quarters, for advice on what kind of nutrition to provide.
Russell told the BBC that "it's amazing what your body can do. ... We survived on hope and courage, and each other, (and) we were lucky enough to have a bit of underground mine water."
? Living conditions
The miners so far have used the batteries of two trucks to power lights and charge their helmet lamps. Those details came from miner Mario Gomez, who scrawled notes on paper and tied it to the drill probe after it broke through their chamber.
Gomez, 63, said the men also had used a backhoe to get underground water.
It was unclear whether their air supply was in danger of running out.
Russell, the Australian miner, described to The Guardian how he and his partner survived. "We were stuck ... in a small pocket of air. We couldn't stand up or even sit up. We had to lie down on our backs. If one of us was on our back, the other had to lie on his side for 14 days. We were tossing and turning on sharp rocks and being cut to pieces. We were really worried about the cuts getting infected.
"We had no food or water for the first six days. ... We had to urinate into our helmets so we could collect something to drink."
"It was also very hot and humid down there but, because of the flow-through of air from fans that were blowing through into the level we were on, we were also suffering from hypothermia (because of the cold air blowing on our sweat). We had to cuddle each other to keep our body cores warm."
What is it like to be trapped underground for weeks, if not months? That's the prospect faced by 33 men discovered alive on Sunday, 17 days after the Chilean mine they were working in collapsed. Their initial shelter was just 530 square feet — the size of some studio apartments — but they have since spread out into a tunnel.
Due to the danger of drilling close to the miners, it could take up to four months to reach them — raising the question of how the trapped men will cope. Below are some perspectives from mine safety　<a href="http://www.jx-solar.com">太阳能热水器招商</a>　experts, two Australian miners who in 2006 survived being trapped for two weeks and one of the trapped Chilean miners who was able to get a note out to his wife.
? Passing the time
Chilean officials expect the rescue to take up to four months. "Miners have been rescued after over three weeks ... but four months would be a record," said Dave Feickert, an internationally recognized consultant on mine safety issues. "The psychology of such a situation is therefore not well known, but this group appears to have good leadership and they seem physically well."
Two key factors are likely to be heat stress and how the miners organize themselves, he said. "They will need to stay active and organize each day to try to mimic their normal lives. Communication (including video links) with the rescue team and their families will be very important."
"Generally speaking, miners survive underground on a daily basis because they know how to work in teams and are trained and experienced," said Feickert. "If the conditions are tolerable, they could become a bit like the crew of a nuclear sub, living under the ocean for months."
Webb, the Australian miner, told the Sydney Morning Herald that contact with relatives was crucial. "The mental rollercoaster they are on is huge and without getting reassurance, without getting words from your loved ones, your mental and physical state goes downhill," he said.
McAteer urged officials to keep the miners busy — not just communicating with relatives but also providing videos and even computer games.
Gomez, the trapped miner, addressed part of his letter to his wife, saying that "even if we have to wait months to communicate ... I want to tell everyone that I'm good and we'll surely come out OK."
"Patience and faith," he wrote. "God is great and the help of my God is going to make it possible to leave this mine alive."
Gomez's wife told reporters she looked forward to exchanging letters with her husband.
? Advice to miners
"We were never confident that they were going to get us out alive. We just had to rely on each other and keep positive," Russell told The Guardian. "That's probably the best thing those miners in Chile can do to keep themselves alive. They should think of their families and loved ones and rely on their mates around them to get them through."
What about after a rescue? "I personally　<a href="http://www.jx-solar.com">太阳能热水器厂家</a> don't think the miners in Chile will recover from this," Russell said. "We will never recover from our experience either. ... You've always got the constant memory with you for the whole of your life. It's going to be very hard for those guys and also their families because the families don't know from day to day whether their loved ones are going to survive the four months or whether they're going to perish where they are."
Webb predicted the miners "will come out very united, they will have really good friendships forever and a day, but they are going to be different men.''
''To be trapped is a different world," he added. "When I got out of the hole I ran around trying to let all my mates' birds out, rabbits and guinea pigs. 'Don't trap them,' I said. 'These blokes will go through the same thing where they won't like seeing zoos, trapped animals, cages — you get a different perspective on the world.''
Kowalski Trakofler, the research psychologist, says a dramatic change is not unlikely. "For people who are directly exposed to a disaster, acute post-traumatic reactions are not unusual and would tend to emerge early on," she says. "These reactions can include hyper-vigilance, difficulty sleeping and nightmares, feelings of anxiety, event-specific fears, anger or rage, and vulnerability. In a review and study of behavior associated with underground coal mine fires, NIOSH researchers found similar response symptoms. Recovery can be rapid for most, slower for others or, for some, may not occur at all."
? Advice to rescuers
The strategy being used is to drill a tunnel through solid rock that's wide enough for the men to escape through.
"This rescue technique was used at the Quecreek mine accident in the U.S. in 2002, but there the men were rescued after a few days," Feickert notes. "The problems they will have in Chile include the depth of the chamber where the men are and the instability of ground. So the rescuers need to be careful in ensuring the integrity of the rescue shaft, through which a cylinder holding one man at a time must pass."
McAteer is hopeful that since the mine is hardrock it's less likely to rumble as the drill comes through. On the other hand, he says, "you don't want to create any more problems than already exist."

25.08.2010 05:31

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