The Gary Galiher Law Hour — Episode 18: Stopping Elder Abuse w/ Anthony Carr

Elderly people are the targets of many forms of abuse. While it will sometimes be obvious, it goes undiscovered far too often. The elderly are frequently unable—too afraid or too frail—to report abuse themselves. Thus, different types of abuse, neglect and exploitation may only be discovered by somebody who knows what to look for, or what questions to ask.

“Being a civil litigation firm, primarily, the cases we’re able to take on and represent are usually pretty catastrophic: wrongful death and really tragic cases,” says Attorney Anthony Carr. “But there are many other issues touching upon elder care and elder abuse that unfortunately we’re not always able to take on in litigation, but we’re certainly invested in.”

These problems become widespread in part through gaps in the regulation of care facilities. Different sets of regulations apply to different types of facilities.

For example, a smaller type of facility known as a community care foster home (CCFH) is basically a mini-nursing home limited to three residents, that provides a “nursing level of care.” At a larger type of home, there would have to be a licensed medical doctor, there would be registered nurses. To operate a CCFH, however, only requires a registered certified nursing assistant. No nurse or medical doctor are required on staff.

While the nursing assistant qualification has its merits, not having more qualified medical professionals on staff subjects the residents to a lower standard of care. This problem goes on unabated in part because very few people are aware of it or problems like it.

When something gives cause for concern at a care home, Anthony has some advice: “It’s a two-part process, because a lot of the people involved in an individual’s care probably knows this person pretty well, maybe knows the immediate family. You’ll know when something out of the ordinary happens.” That’s the first part. Then, “when you notice that, investigate it, ask them questions, satisfy your curiosity.”

Placing an elderly loved one in an assisted living facility often happens in a hurry due to a medical emergencies suddenly increasing their need for care. This often limits their family’s choice because it forces a quick decision on where they will go.

Facilities are well aware of this common dilemma, and they are known to take advantage of it by focusing on the surface-level appearance of their homes, working up slick sales pitches and making big promises instead of delivering the best possible care for their residents.

Knowing the right questions to ask at the beginning can give vital information to a family going through the stressful process of finding a good, safe place for kūpuna. Our article on the 10 Questions to Ask Any Senior Care Home is helpful there.

We’ve scratched the surface, but there’s so much more to learn in this episode. Tune in!

Nursing Homes Now Forbidden From Forcing Residents Into Arbitration

After a decade of intense advocacy by the American Association for Justice, the Centers for Medicare & Medicaid Services issued a final rule prohibiting all federally funded nursing homes from using forced arbitration agreements against their residents. Because of the new rule, many senior citizens in Hawaiʻi and across the US will no longer be robbed of their constitutional right to go to court.

AAJ mounted an extensive lobbying, coalition building and communications campaign last year when the rule was first proposed. As a direct result of this campaign the rule was dramatically improved from its original version, which would have made legal outcomes worse for many nursing home residents by allowing nursing homes to continue to use pre-dispute arbitration agreements under certain conditions.

Nursing homes have been burying forced arbitration clauses in the fine print of their resident agreements. These clauses force residents to sign away their right to go to court, even when they become victims of abuse, neglect, or wrongful death. Instead of presenting their cases in court, victims of elder abuse who sign such agreements have to resolve their disputes in secretive, private dispute systems that favor the corporate interests.

While we would like to see the changes taken further to protect people in all care facilities from forced arbitration agreements, we are happy to see this big step in the right direction. Elderly people now have another line of legal defense in an industry rife with abuse and negligence.

The Gary Galiher Law Hour: Episode 16 w/ Coach Vince Goo! (part 2)

This is part two of a program about sports and concussions featuring Vince Goo, former head coach of the University of Hawai‘i Wahine basketball team.

When the news broke about the discovery of chronic traumatic encephalopathy—the degenerative brain disease that haunts NFL players—our founding partner, Gary Galiher, realized very soon that this is a much bigger issue than just the NFL’s. Gary’s background in psychology and special education led him to deduce that children’s developing brains could be affected to degrees varying with the amount of contact in their sport. Since then, the science of concussions has developed and that insight has been validated.

A concussion is pretty hard to ignore when a kid gets knocked out, but there are all kinds of things that happen in-between. We’re talking not just about the National Football League, here, but about kids who play in grade school, taking damage they carry with them for the rest of their lives.

Coach Goo has coached a variety of sports at many different levels. While he was not allowed to play full-contact football as a boy, as a father he did allow his sons to play. At the time, the revelations about brain injuries in football had not yet come to light, so the risks were unknown. Today, he sees things differently. “Knowing what I know now, I probably would’ve been in the same thought process as my dad, not letting my sons play,” he said. “My grandsons, I hope they never play the game.”

The coach agrees with Mike that “there haven’t been enough precautions, enough checks and balances so that you can take a kid out [of play] when he gets hurt.” We’re getting there education-wise, and trainers are putting the priority on the health and welfare of the student-athletes, said the coach.

Tune in to hear about plans to make sports safer, and how we can get leadership involved to make the right decisions for Hawai‘i.

Promising New Methods of Mesothelioma Diagnosis

Scientists are researching new methods of treating mesothelioma, as well as looking for improvements to existing treatments such as chemotherapy and surgery. Their innovations are advancing care practices not only of mesothelioma, but of cancer in all its forms.

Diagnosis is a relevant area of research that still has room to grow. Mesothelioma is typically diagnosed at an advanced stage, which makes it more difficult to treat. Breakthroughs in this area will give those afflicted a better chance to fight their illness.

Researchers are currently experimenting with a few new techniques to identify this deadly disease in its earlier stages. While the science has not yet produced final tests, several experiments have shown promising results that bring us that much closer to breaking through.

Mesothelioma Breath Test

One of these methods under development uses a fairly simple breath test. A Belgian research team has published a paper in the Journal of Breath Research that demonstrated an 87% rate of accuracy in detecting malignant pleural mesothelioma—the most common type of asbestos-related cancer, which comprises roughly 80% of mesothelioma cases.

The researchers were able to distinguish between asbestos workers who had no sign of any disease from workers who had already developed mesothelioma. This test is known as multicapillary column/ion mobility spectrometry (MCC/IMS), and is frequently employed in the detection of other dangerous matter inhaled in a variety of occupations.

The MCC/IMS test has a distance to go before it will be ready as a method of mesothelioma diagnosis, but as the research paper concludes it “holds promise for further investigation as a screening tool for former asbestos-exposed persons at risk of developing MPM.”

Mesothelioma Detection Using Exosomes

Minuscule substances known as exosomes are naturally occurring in the bloodstream, created during the formation of new cells. Exosomes contain materials from the cells that create them, which includes proteins and RNA. Thus, exosomes can be used in the detection of various forms of cancer. Because they pass through the kidney into urine, a urine test could be used to detect these cancers.

Dr. David W. Greening published a study in Scientific Reports to determine whether exosomes could be reliably used to detect mesothelioma. With proven methods of detecting ovarian and prostate cancers as a basis, Dr. Greening led a team study of mesothelioma cells to model and analyze what types of exosomes the cells produce.

This study did not conclusively demonstrate that exosomes could be used to detect mesothelioma, but the researchers are optimistic about further study. Comprehensive analysis of exosomes “could represent potential specific diagnostic targets for factors of MM origin.”

HMGB1

Finally, and probably the most promising of all, is the recent discovery that the high-mobility group box 1 (HMGB1) protein is a biomarker of cancer. As such, it can be measured (through a blood test) to detect the presence of cancer.

HMGB1 gives much more accurate and sensitive results than other currently existing techniques,  which makes it an exciting prospect for researchers who want to apply it to mesothelioma diagnosis. Because asbestos-damaged cells produce HMGB1, it is present in higher amounts in people who have developed mesothelioma. Not only that, but the researchers’ tests also identified patients who had been exposed to asbestos but had yet to develop mesothelioma.

This is big news for people who have been exposed to asbestos, as tests like this can be identified and monitored for the progression of asbestos-related illnesses, helping them and their medical team in potential health battles to come.

Early Diagnosis Still on the Horizon

Early mesothelioma diagnosis is still an area of active research, and these new techniques are still under development. If any of them are successfully developed, it will take years more of research and trials before they are put into clinical use.

Nevertheless, a reliable way to detect mesothelioma early on will improve patients’ chances to stop the disease before it can spread, and so the research must go on. Mesothelioma is very often caught in late stages, which is a major part of why it is so lethal. The prospect of early detection makes us hopeful that those diagnosed will go on to live much longer and healthier lives.